TY - JOUR AU - Glynn, Lisa AU - Moloney, Eddie AU - Lane, Stephen AU - McNally, Emma AU - Buckley, Carol AU - McCann, Margaret AU - McCabe, Catherine PY - 2025/4/23 TI - A Smartphone App Self-Management Program for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial of Clinical Outcomes JO - JMIR Mhealth Uhealth SP - e56318 VL - 13 KW - COPD KW - self-management KW - smartphone application KW - clinical health outcomes KW - chronic obstructive pulmonary disease KW - clinical health KW - patient KW - patients KW - randomised controlled trial KW - RCT KW - smartphone KW - app KW - apps KW - application KW - applications KW - mhealth KW - mobile health KW - effectiveness KW - intervention KW - interventions KW - hospital setting KW - quality of life KW - self-efficacy KW - hospital KW - hospitals KW - mobile phone N2 - Background: Chronic obstructive pulmonary disease (COPD) negatively impacts clinical health outcomes, resulting in frequent exacerbations, increased hospitalizations, reduced physical activity, deteriorated quality of life, and diminished self-efficacy. Previous studies demonstrated that a self-management program tailored for adults with COPD improves self-management decisions, resulting in a positive effect on clinical health outcomes. Limitations of these studies include issues regarding heterogeneity among interventions used, patient population characteristics, outcome measures, and longitudinal studies. Limited studies focused on the use of a comprehensive self-management program using a smartphone app for adults with COPD over 12 months. Objective: This study aimed to explore the effectiveness of a smartphone app self-management program and monthly phone calls compared with standard respiratory outpatient care on clinical health outcomes in adults with COPD. Methods: This was a 3-arm parallel pilot randomized controlled trial (RCT) that included 92 participants. Participants were randomized into intervention arm 1, which included a self-management smartphone app and monthly phone calls (n=31); intervention arm 2, which included a self-management smartphone app (n=31); and arm 3, which was standard respiratory outpatient care (n=30). All arms received standard respiratory outpatient care. The primary outcome was a binary indicator equal to 1 if participants reported attendance to a general practitioner (GP) and or a hospital setting as a result of an exacerbation and 0 otherwise. This indicator was recorded at 6 months and 12 months from the baseline. Secondary outcomes included engagement, breathlessness, physical activity, health-related quality of life, and self-efficacy. Results: There was a statistically significant difference (P=.03), indicating fewer exacerbations in the intervention arm 2 compared with the control arm at 6 months in the hospital setting. The intervention arms had a statistically significant difference indicating a lower risk of developing an exacerbation at 6 months in both the GP (P=.01) and hospital setting (P=.006) compared to the control arm. Furthermore, intervention arm 1 demonstrated a statistically significant difference in exercise capacity at 6 and 12 months (P=.02 and P=.03). The intervention arm 2 illustrated a statistically significant difference in step count (P=.009) compared to the control arm. The majority of participants (60%, 33/55) used the app over the 12-month period. Conclusions: This study demonstrated that a smartphone app self-management program had a positive effect on clinical health outcomes for participants with COPD in comparison to standard respiratory outpatient care. This study illustrated benefits such as reduced exacerbations resulting in fewer hospitalizations, improved exercise capacity, and physical activity among the intervention arms. This was a single-center study, which was limited in power to demonstrate significant effects on all measured outcomes but paves the way for a larger, fully powered multicenter trial exploring the effect of a smartphone app self-management program on clinical health outcomes in adults with COPD. Trial Registration: ClinicalTrials.gov NCT05061810; https://clinicaltrials.gov/study/NCT05061810 UR - https://mhealth.jmir.org/2025/1/e56318 UR - http://dx.doi.org/10.2196/56318 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56318 ER - TY - JOUR AU - Staehelin, Dario AU - Schmid, Damaris AU - Gerber, Felix AU - Dolata, Mateusz AU - Schwabe, Gerhard PY - 2025/4/23 TI - Empowering Community Health Workers With Scripted Medicine: Design Science Research Study JO - JMIR Hum Factors SP - e57545 VL - 12 KW - community-based health care KW - community health workers KW - collaboration engineering KW - algorithmic management KW - Scripted Medicine KW - task shifting KW - empowerment KW - mobile health KW - mHealth KW - digital health N2 - Background: The World Health Organization anticipates a shortage of 14 million health workers by 2030, particularly affecting the Global South. Community health workers (CHWs) may mitigate the shortages of professional health care workers. Recent studies have explored the feasibility and effectiveness of shifting noncommunicable disease (NCD) services to CHWs. Challenges, such as high attrition rates and variable performance, persist due to inadequate organizational support and could hamper such efforts. Research on employee empowerment highlights how organizational structures affect employees? perception of empowerment and retention. Objective: This study aims to develop Scripted Medicine to empower CHWs to accept broader responsibilities in NCD care. It aims to convey relevant medical and counseling knowledge through medical algorithms and ThinkLets (ie, social scripts). Collaboration engineering research offers insights that could help address the structural issues in community-based health care and facilitate task shifting. Methods: This study followed a design science research approach to implement a mobile health?supported, community-based intervention in 2 districts of Lesotho. We first developed the medical algorithms and ThinkLets based on insights from collaboration engineering and algorithmic management literature. We then evaluated the designed approach in a field study in the ComBaCaL (Community Based Chronic Disease Care Lesotho) project. The field study included 10 newly recruited CHWs and spanned over 2 weeks of training and 12 weeks of field experience. Following an abductive approach, we analyzed surveys, interviews, and observations to study how Scripted Medicine empowers CHWs to accept broader responsibilities in NCD care. Results: Scripted Medicine successfully conveyed the required medical and counseling knowledge through medical algorithms and ThinkLets. We found that medical algorithms predominantly influenced CHWs? perception of structural empowerment, while ThinkLets affected their psychological empowerment. The different perceptions between the groups of CHWs from the 2 districts highlighted the importance of considering the cultural and economic context. Conclusions: We propose Scripted Medicine as a novel approach to CHW empowerment inspired by collaboration engineering and algorithmic management. Scripted Medicine broadens the perspective on mobile health?supported, community-based health care. It emphasizes the need to script not only essential medical knowledge but also script counseling expertise. These scripts allow CHWs to embed medical knowledge into the social interactions in community-based health care. Scripted Medicine empowers CHW to accept broader responsibilities to address the imminent shortage of medical professionals in the Global South. UR - https://humanfactors.jmir.org/2025/1/e57545 UR - http://dx.doi.org/10.2196/57545 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57545 ER - TY - JOUR AU - Seiterö, Anna AU - Henriksson, Pontus AU - Thomas, Kristin AU - Henriksson, Hanna AU - Löf, Marie AU - Bendtsen, Marcus AU - Müssener, Ulrika PY - 2025/4/22 TI - Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial JO - J Med Internet Res SP - e69425 VL - 27 KW - mHealth KW - multiple behavior KW - high school students KW - digital behavior change intervention KW - public health KW - telemedicine KW - randomized controlled trial N2 - Background: Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors. Objective: This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition. Methods: A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ?4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models. Results: In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI ?0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only. Conclusions: Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence. Trial Registration: ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623 UR - https://www.jmir.org/2025/1/e69425 UR - http://dx.doi.org/10.2196/69425 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69425 ER - TY - JOUR AU - Rudin, S. Robert AU - Santacroce, M. Leah AU - Ganguli, Ishani AU - Solomon, H. Daniel PY - 2025/4/21 TI - Tailoring Rheumatoid Arthritis Visit Timing Based on mHealth App Data: Mixed Methods Assessment of Implementation and Usability JO - JMIR Form Res SP - e60854 VL - 9 KW - mobile health KW - patient-reported outcomes KW - visit timing KW - visit frequency KW - rheumatoid arthritis KW - rheumatology N2 - Background: Visits to medical subspecialists are common, with follow-up timing often based on heuristics rather than evidence. Unnecessary visits contribute to long wait times for new patients. Specialists could enhance visit timing and reduce frequency by systematically monitoring patients? symptoms between visits, especially for symptom-driven conditions like rheumatoid arthritis (RA). We previously designed an intervention using a mobile health (mHealth) app to collect patient-reported outcomes (PRO). One of several aims of the app was to assist rheumatologists in determining visit timing for patients with RA. The intervention did not reduce visit frequency. Objective: To explore possible reasons for the lack of association between the intervention and visit frequency, we describe app usage, assess usability, and identify barriers and facilitators for using between-visit PRO data to reduce visits when patients? symptoms are stable. Methods: We analyzed patients? use of the app by reporting adherence (percent of PRO questionnaires completed during the 12-month study) and retention (use in the last month of the study). To examine rheumatologists? experiences, we summarized views of the electronic health record (EHR)?embedded PRO dashboard and EHR inbox messages suggesting early or deferred visits. We assessed app usability using the interactive mHealth App Usability Questionnaire for Ease of Use and Usefulness for patients and the System Usability Scale for rheumatologists. We assessed rheumatologist-level effects of intervention usage using Kruskal-Wallis rank sum and equality of proportion tests. We identified barriers and facilitators through interviews and surveys. Results: The analysis included 150 patients with RA and their 11 rheumatologists. Patients answered a median of 53.3% (IQR 34.1%-69.2%) of PRO questionnaires; this proportion varied by rheumatologist (range 40.7%?67%). Over half of the patients used the app during the final month of the study (56%, range 51%?65%, by rheumatologists); the median number of months of use was 12 (IQR 9-12). Rheumatologists viewed the dashboard 78 times (17.6% of 443 visits) with significant differences in viewing rates by rheumatologist (range 10%?66%; P<.01). There were 108 generated messages sent to rheumatologists suggesting a deferred visit (24.4% of 443 visits) with significant differences in message counts received per visit by rheumatologist (range 10.8%?22.6%; P=.03). Rheumatologists? reported barriers to offering visit deferrals included already scheduling as far out as they were comfortable and rescheduling complexities for staff. Based on 39 patient interviews and 44 surveys, patients reported 2 main barriers to app usage: questionnaire frequency not being tailored to them and reduced motivation after not discussing PRO data with their rheumatologist. A total of 5 interviewed patients received the option to defer their visits, of which 3 elected to defer the appointment and 2 chose to keep it. Conclusions: While an mHealth app for reporting RA PROs was used frequently by patients, using these data to reduce the frequency of unneeded visits was not straightforward. Better engagement of clinicians may improve the use of PRO data. UR - https://formative.jmir.org/2025/1/e60854 UR - http://dx.doi.org/10.2196/60854 ID - info:doi/10.2196/60854 ER - TY - JOUR AU - Pang, Yan AU - He, Honggu AU - Ng, Ruey-Pyng AU - Lee, Luan Nicole Kim AU - Htein, Win Me Me AU - Zhao, Xiao-Xin AU - Li, Ying-Hong AU - Chan, Jiahui Elizabeth AU - Zhu, Lixia AU - Liu, Yu Guang AU - Pikkarainen, Minna AU - Lim, Swee-Ho PY - 2025/4/21 TI - Effectiveness of an Innovative Mobile-Based Perioperative Care Program for Women Undergoing Breast Cancer Surgery (iCareBreast): Randomized Controlled Trial JO - J Med Internet Res SP - e71684 VL - 27 KW - breast cancer KW - digital health KW - mHealth KW - mobile health KW - psychosocial KW - randomized controlled trial KW - self-efficacy KW - mobile phone N2 - Background: Breast cancer is one of the most prevalent cancers among women and significantly impacts psychological well-being and health-related quality of life (HR-QoL) during the perioperative period. Mobile health interventions offer a promising approach to providing education and psychosocial support, yet their effectiveness in this context remains underexplored. Objective: This study aimed to develop and evaluate the effectiveness of an innovative, mobile-based, perioperative care program for women undergoing breast cancer surgery (iCareBreast). The assessment focused on perioperative self-efficacy, anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction. Methods: A two-group randomized control trial was conducted at a tertiary hospital in Singapore. The intervention group used the iCareBreast app, offering four main resources: perioperative care guidance, breast cancer and surgery education, psychological support, and social support. The control group received standard hospital care. Participants in the intervention group engaged with the fully automated app daily for 29 days (two weeks before surgery, on the day of surgery, and two weeks after surgery). Data were collected face-to-face or on the web at three time points: baseline, immediately after the intervention (T1; two weeks after surgery), and at a 2.5-month follow-up (T2; three months after surgery). The primary outcome was perioperative care self-efficacy, while secondary outcomes included anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction. Results: A total of 123 patients with early-stage breast cancer scheduled for breast surgery were enrolled in the study, with 62 patients assigned to the iCareBreast group and 61 patients to the control group. The results showed no significant differences between the groups in the primary outcome?perioperative self-efficacy?at any time point. Baseline scores were similar (P=.80), and while the iCareBreast group showed slightly lower scores at T1 (mean difference [MD] ?1.63, 95% CI ?3.43 to 0.18; P=.08) and T2 (MD ?1.90, 95% CI ?4.06 to 0.26; P=.09), the differences were not statistically significant. Similarly, secondary outcomes, including anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction, showed no significant changes between groups (all P>.05). However, the iCareBreast group reported higher perioperative care satisfaction during the postintervention assessment. Satisfaction scores were comparable at T1 (P=.68), while at T2, the iCareBreast group showed a slight increase compared to the control group (MD 0.35, 95% CI 0.04-0.73; P=.08), though the difference was not statistically significant. Conclusions: The mobile-based psychosocial intervention, although satisfied by users, did not demonstrate significant benefits compared to standard care. This highlights the need to refine the iCareBreast app in future iterations to enhance its effectiveness in addressing the targeted health outcomes. Future mobile health research should prioritize optimizing user engagement strategies and incorporating personalized approaches to better address the perioperative care needs of patients with breast cancer. Trial Registration: ClinicalTrials.gov NCT04172350; https://clinicaltrials.gov/study/NCT04172350 UR - https://www.jmir.org/2025/1/e71684 UR - http://dx.doi.org/10.2196/71684 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/71684 ER - TY - JOUR AU - Amon, Daria AU - Leisser, Christoph AU - Schlatter, Andreas AU - Ruiss, Manuel AU - Pilwachs, Caroline AU - Bayer, Natascha AU - Huemer, Josef AU - Findl, Oliver PY - 2025/4/17 TI - Quantification of Metamorphopsia Using a Smartphone-Based Hyperacuity Test in Patients With Idiopathic Epiretinal Membranes: Prospective Observational Study JO - JMIR Perioper Med SP - e60959 VL - 8 KW - mobile health KW - smartphone KW - telemedicine KW - Alleye KW - M-chart KW - metamorphopsia KW - epiretinal membrane KW - vitrectomy with membrane peeling KW - visual acuity KW - home monitoring KW - hyperacuity test KW - hyperacuity KW - surgical intervention KW - distorted vision KW - vision KW - ocular pathology KW - ocular KW - retinal KW - retina KW - surgery KW - macular degeneration KW - tomography KW - vitrectomy KW - ophthalmology N2 - Background: Quality of vision in patients with idiopathic epiretinal membranes (iERMs) is closely linked to distorted vision (metamorphopsia), which is often underestimated in clinical settings. Current surgical decision-making relies heavily on visual acuity and optical coherence tomography findings, which do not adequately reflect the patient?s functional vision or the severity of metamorphopsia. There is a clinical need for tools that can reliably quantify this symptom to improve patient outcomes and streamline care pathways. Objectives: This study is the first to assess the use of a novel smartphone-based hyperacuity test (SHT) in quantifying metamorphopsia before and after surgical intervention for iERMs, comparing it with a conventional printed chart. Methods: This prospective observational study included 27 patients with iERMs with symptomatic metamorphopsia detected on the Amsler grid scheduled for vitrectomy with membrane peeling. The SHT (Alleye, Oculocare Medical Inc) and the horizontal (MH) and vertical (MV) M-chart (Inami & Co, Ltd) tests were performed 3 times before and 3 months after surgery. Pre- and postoperative metamorphopsia scores, changes in distance-corrected visual acuity, optical coherence tomography biomarkers, and subjective perception of metamorphopsia were evaluated. Results: The mean SHT score significantly (r=0.686; P<.001) improved from 55.2 (SD 18.9) before surgery to 63.5 (SD 16.3) after surgery while the improvement of the M-chart scores were insignificant (MH r=0.37, P=.06; MV r=0.18, P=.36). Pre- and postoperative SHT scores showed very weak and insignificant correlations with the MH, MV, and MH+MV scores. Both metamorphopsia tests showed good reliability (intraclass correlation coefficients >0.75). Conclusions: The SHT showed a significant improvement in postoperative metamorphopsia scores, indicating that it could be a valuable tool for quantifying visual distortion in patients with iERMs. While discrepancies with M-chart results were observed, both tests demonstrated good reliability. Clinically, the SHT may offer a practical solution for monitoring metamorphopsia and guiding complex surgical decision-making, particularly in telemedicine settings. Its accessibility could improve patient management, potentially enhancing preoperative triaging and reducing unnecessary visits. Trial Registration: ClinicalTrials.gov NCT05138315; https://clinicaltrials.gov/study/NCT05138315 UR - https://periop.jmir.org/2025/1/e60959 UR - http://dx.doi.org/10.2196/60959 ID - info:doi/10.2196/60959 ER - TY - JOUR AU - Sonobe, Tatsuru AU - Matsumoto, Yoshihiro PY - 2025/4/17 TI - Locomotive Syndrome Digital Therapeutics Provided via a Smartphone App: Protocol for a Single-Group Trial JO - JMIR Res Protoc SP - e70163 VL - 14 KW - locomotive syndrome KW - locomotion training KW - digital therapeutic KW - TUG KW - 25-Geriatric Locomotive Function Scale KW - BREQ-3 KW - behavioral change KW - support application N2 - Background: Locomotive syndrome (LS) is a condition in which muscle weakness and reduced motor function due to musculoskeletal disorders cause reduced mobility and physical function. In Japan, musculoskeletal disorders are the most frequent reason for requiring home support or nursing care, and the prevention and amelioration of LS are thus being emphasized. However, it is difficult for older people to make a habit of exercise therapy, which is the mainstay of LS treatment. We investigated whether digital therapy could (1) lead to behavioral change in older people and (2) prevent or improve LS in older people. Objective: We sought to determine whether digital therapeutics (DTx) are useful for the prevention and amelioration of LS in older people, and we assessed the effects of DTx on the participants? exercise awareness and motor function. Methods: We conducted a multicenter, prospective, longitudinal, nonrandomized, single-group study of Japanese adults aged ?40 years who were eligible for LS checks. Each participant underwent an 8-week locomotion training (LT) intervention, and their subjective and objective motor abilities and motor awareness were objectively assessed at the following time points: baseline (before the start of the DTx), interim (4 weeks after the start of the DTx), and end (8 weeks after the start of the DTx). We evaluated the participants? objective motor function using the timed up and go (TUG) test, and we compare the results using a 3-way ANOVA with the TUG test at the 3 evaluation time points as the dependent variable. The results of the 25-question Geriatric Locomotive Function Scale, which is a subjective measure of motor function, and the results of the Behavioural Regulation in Exercise Questionnaire 3, which assesses motor awareness, were also evaluated using an ANOVA in the same way as the TUG test. The significance level was set at .05 / 3 = .0167 after Bonferroni correction. Results: As of April 2025, this study had enrolled 47 participants, and complete data had been gathered from 45 participants for the proposed analysis. Study participation was ongoing as of April 2025. Conclusions: The study cohort will be used as a basis for further observational and intervention studies. This research could lead to more efficient use of medical resources and a reduction in financial and medical burdens on individuals and the economy, and it could support the prevention and amelioration of LS and the establishment of exercise habits among older people. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000053922; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000061550 International Registered Report Identifier (IRRID): DERR1-10.2196/70163 UR - https://www.researchprotocols.org/2025/1/e70163 UR - http://dx.doi.org/10.2196/70163 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70163 ER - TY - JOUR AU - Chua, Xin Joelle Yan AU - Choolani, Mahesh AU - Chee, Ing Cornelia Yin AU - Yi, Huso AU - Lalor, Gabrielle Joan AU - Chong, Seng Yap AU - Shorey, Shefaly PY - 2025/4/17 TI - A Mobile App?Based Intervention (Parentbot?a Digital Healthcare Assistant) for Parents: Secondary Analysis of a Randomized Controlled Trial JO - J Med Internet Res SP - e64882 VL - 27 KW - perinatal KW - mobile app KW - app use KW - survey response KW - parents KW - randomized controlled trial KW - artificial intelligence KW - AI N2 - Background: Mobile app?based interventions are viable methods of delivering perinatal care support to parents. A mobile app?based intervention entitled Parentbot?a Digital Healthcare Assistant (PDA) was developed and evaluated via a randomized controlled trial. PDA aimed to provide informational, socioemotional, and psychological support to parents across the perinatal period. As developing such interventions is resource intensive, it is important to evaluate participants? use and the components that are appreciated by them. Objective: This study aims to examine the (1) relationship between participants? characteristics and PDA use, (2) relationship between PDA use and parenting outcomes, and (3) relationship between participants? characteristics and the time taken to respond to the surveys (survey response timing). Methods: This study is the secondary analysis of a randomized controlled trial. A convenient sample of 118 heterosexual couples (236 participants: n=118, 50% mothers and n=118, 50% fathers) from a public tertiary hospital in Singapore were recruited. Data were collected from November 2022 to August 2023. Descriptive statistics were used to summarize the parents? characteristics and study variables. Linear mixed models were used to examine the effect of (1) participants? sociodemographic characteristics on PDA use metrics, (2) use metrics on parenting outcomes, and (3) participants? sociodemographic characteristics on the survey response timing. The Pearson correlation was also used to examine the linear relationships between the PDA use metrics and parenting outcomes. Results: The following parental characteristics were found to be associated with PDA use: antenatal course attendance, gender, religion, ethnicity, and the number of children. After adjusting for baseline values and sociodemographic covariates, only the viewing of educational materials was statistically significantly associated with improvements in parents? anxiety (?=?0.48, 95% CI ?0.94 to ?0.009; P=.046), parent-child bonding (?=?0.10, 95% CI ?0.19 to ?0.01; P=.03), social support (?=0.31, 95% CI 0.08-0.54; P=.01), and parenting satisfaction (?=0.57, 95% CI 0.07-1.07; P=.03) at 1 month post partum. Moreover, parents? age, ethnicity, grouping, and number of children were found to be related to the survey response timing. Conclusions: As the viewing of PDA?s educational materials was linked to improvements in parents? perinatal well-being, the provision of educational resources should be prioritized in future app-based parenting interventions. Because the use of other PDA features, such as poster activities, forum posts, and reflection and gratitude exercises, had a limited effect in improving parents? well-being, future interventions could explore alternative activities to better engage parents. Future mobile app?based parenting interventions could conduct similar evaluations on app use and the effectiveness of specific features to validate the findings of this study. UR - https://www.jmir.org/2025/1/e64882 UR - http://dx.doi.org/10.2196/64882 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64882 ER - TY - JOUR AU - Musson, Samantha Lucy AU - Mitic, Nina AU - Leigh-Valero, Victoria AU - Onambele-Pearson, Gladys AU - Knox, Liam AU - Steyn, J. Frederik AU - Holdom, J. Cory AU - Dick, JM Taylor AU - van Eijk, PA Ruben AU - van Unnik, WJ Jordi AU - Botman, CM Lianne AU - Beswick, Emily AU - Murray, Deirdre AU - Griffiths, Alys AU - McDermott, Christopher AU - Hobson, Esther AU - Chaouch, Amina AU - Hodson-Tole, Emma PY - 2025/4/17 TI - The Use of Digital Devices to Monitor Physical Behavior in Motor Neuron Disease: Systematic Review JO - J Med Internet Res SP - e68479 VL - 27 KW - motor neuron disease KW - amyotrophic lateral sclerosis KW - physical behavior KW - digital devices KW - remote monitoring KW - wearable technology N2 - Background: Motor neuron disease (MND) is a progressive and incurable neurodegenerative disease. The Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) is the primary clinical tool for assessing disease severity and progression in MND. However, despite its widespread use, it does not adequately capture the extent of physical function decline. There is an urgent need for sensitive measures of disease progression that can be used to robustly evaluate new treatments. Measures of physical function derived from digital devices are beginning to be used to assess disease progression. There is value in establishing a consensus approach to standardizing the use of such devices. Objective: We aimed to explore how digital devices are being used to quantify free-living physical behavior in MND. We evaluated the feasibility and assessed the implications for monitoring physical behavior for future clinical trials and clinical practice. Methods: Systematic searches of 4 databases were performed in October 2023 and June 2024. Peer-reviewed English-language articles (including preprints) that examined how people living with MND used digital devices to assess their free-living physical behavior were included. Study reporting quality was assessed using a 22-item checklist (maximum possible score=44 points). Results: In total, 12 articles met the inclusion criteria for data extraction. All studies were longitudinal and observational in design, but data collection, analysis, and reporting protocols varied. Quality assessment scores ranged between 19 and 40 points. Sample sizes ranged between 10 and 376 people living with MND at baseline, declining over the course of the study. Most studies used an accelerometer device worn on the wrist, chest, hip, or ankle. Participants were typically asked to continuously wear devices for 1 to 8 days at 1- to 4-month intervals, with studies running for 12 weeks to 24 months. Some studies asked participants to wear the device continuously for the full duration. Studies derived traditional end points focusing on duration, intensity, and frequency of physical activity or nontraditional end points focusing on features of an individual?s movement patterns. The correlation coefficients (r) between physical behavior end points and ALSFRS-R ranged from 0.31 to 0.78. Greater monitoring frequencies and improved end point sensitivity were shown to provide smaller sample size requirements and shorter durations for hypothetical clinical trials. People living with MND found using devices acceptable and reported a low burden. Adherence assessed in 8 (67%) studies was good, ranging from approximately 86% to 96%, with differences evident between wear locations. The perspectives of other end users and implications on clinical practice were not explored. Conclusions: Remote monitoring of free-living physical behavior in MND is in its infancy but has the potential to quantify physical function. It is essential to develop a consensus statement, working toward agreed and standardized methods for data collection, analysis, and reporting. UR - https://www.jmir.org/2025/1/e68479 UR - http://dx.doi.org/10.2196/68479 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68479 ER - TY - JOUR AU - Mancuso, Noah AU - Michaels, Jenna AU - Browne, N. Erica AU - Maragh-Bass, C. Allysha AU - Stocks, B. Jacob AU - Soberano, R. Zachary AU - Bond, Lily C. AU - Yigit, Ibrahim AU - Comello, G. Maria Leonora AU - Larsen, Adams Margo AU - Muessig, E. Kathryn AU - Pettifor, Audrey AU - Hightow-Weidman, B. Lisa AU - Budhwani, Henna AU - Stoner, D. Marie C. PY - 2025/4/16 TI - Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial JO - JMIR Public Health Surveill SP - e67370 VL - 11 KW - COVID-19 KW - mHealth KW - African American and Black KW - young adults KW - vaccination KW - mobile health N2 - Background: Negative attitudes toward vaccines and suboptimal vaccination rates among African American and Black (Black) Americans have been well documented, due to a history of medical racism and human rights violations in the United States. However, digital health interventions (DHI) have been shown to address racial disparities in several health outcomes, such as cardiovascular disease, HIV, and maternal health. The Tough Talks COVID (TT-C) study was a randomized controlled trial of a DHI designed to empower Black young adults in the United States South to make informed, autonomous decisions about COVID-19 vaccine uptake by addressing structural barriers and misinformation about vaccines. Objective: Our objective was to identify subgroups of Black young adults with various vaccine attitudes at baseline and determine the subgroups for which the TT-C DHI was most impactful. Methods: Black young adults aged 18?29 years in Alabama, Georgia, and North Carolina who were unvaccinated or insufficiently vaccinated against COVID-19 completed three online surveys over three months (N=360). Latent profile analysis was used to identify subgroups based on general vaccine attitudes at baseline, including hesitancy, confidence, knowledge, conspiracy beliefs, and mistrust. Logistic regression was used to examine the associations between latent profiles and vaccine uptake, and linear regression was used to examine changes in vaccine attitudes at three months post-randomization. Modification of the TT-C DHI?s effects was assessed by latent profiles. Results: Three latent profiles emerged: vaccine-receptive (n=124), vaccine-neutral (n=155), and vaccine-resistant (n=81). Political affiliation, income, social support, and recent flu vaccination differed significantly between the three subgroups (P<.05). Vaccine uptake was not significantly different by subgroup, and the TTC-DHI did not have differing effects on uptake across subgroups. However, the DHI had the strongest effect?with statistically significant measures of association (P<.05) and interaction P values (P<.10)?among the baseline vaccine-resistant and vaccine-neutral subgroups compared to the vaccine-receptive subgroups at three months in improving vaccine hesitancy, confidence, and conspiracy beliefs at three months: vaccine-resistant difference: ?0.40 (?0.76 to ?0.37), 0.39 (0.02 to 0.75), and ?0.47 (?0.86 to ?0.09); vaccine neutral difference: ?0.36 (?0.52 to ?0.19), 0.35 (0.18 to 0.51), and ?0.24 (?0.44 to ?0.03). The DHI had no effects on these outcomes among the vaccine-receptive subgroup. Conclusions: Our findings revealed subgroups of Black young adults in the United States South with different vaccination attitudes, for which the TT-C intervention had differing effects. Black young adults who are vaccine-resistant or vaccine-neutral may experience larger gains from a digital vaccine intervention. Future work aimed at improving vaccination outcomes could target these populations to maximize resource efficiency and drive the greatest improvements in vaccine outcomes. Trial Registration: ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/study/NCT05490329 UR - https://publichealth.jmir.org/2025/1/e67370 UR - http://dx.doi.org/10.2196/67370 ID - info:doi/10.2196/67370 ER - TY - JOUR AU - Arader, Lindsay AU - Miller, Danielle AU - Perrin, Alexandra AU - Vicari, Frank AU - Friel, P. Ciaran AU - Vrany, A. Elizabeth AU - Goodwin, M. Ashley AU - Butler, Mark PY - 2025/4/16 TI - Digital, Personalized Clinical Trials Among Older Adults, Lessons Learned From the COVID-19 Pandemic, and Directions for the Future: Aggregated Feasibility Data From Three Trials Among Older Adults JO - J Med Internet Res SP - e54629 VL - 27 KW - older adults KW - personalized KW - digital KW - clinical trial KW - remote KW - physical activity KW - back pain KW - pain KW - COVID-19 KW - clinical trials KW - pandemic KW - chronic health KW - digital intervention KW - Fitbits KW - Fitbit KW - wearable KW - wearables KW - exercise KW - gerontology KW - geriatric KW - geriatrics KW - old KW - older KW - older people KW - aging KW - aged KW - mobile phone N2 - Background: The COVID-19 pandemic was extremely disruptive to clinical practice and research. Given older adults? increased likelihood of chronic health concerns, limited resources, and greater risk for adverse outcomes of COVID-19, access to research participation during this time was critical, particularly to interventions that may impact health conditions or behaviors. Fortunately, the implementation of personalized, digital research trials during the pandemic allowed for research and intervention delivery for older adults to continue remotely, resulting in feasibility findings that can benefit researchers, practitioners, and the broader older adult population. Objective: This study discusses 3 digital, remote, and personalized intervention trials implemented during the pandemic to increase physical activity (2 trials) or to reduce back pain (1 trial). Methods: We identified measures used for all 3 trials including Fitbit activity monitor use and self-reported participant satisfaction. Participant levels of Fitbit activity monitor use and satisfaction ratings of the digital trials were compared between younger (younger than 55 years) and older adults (older than 55 years). Differences between these cohorts were analyzed using chi-square tests for categorical outcomes and 2-tailed independent-sample t tests for continuous outcomes. Results: Across the 3 trials, the majority of participants reported high satisfaction with the usability of the trials? digital systems including SMS text message interventions and surveys (?62% satisfied) and the use of wearable devices such as Fitbits (?81% satisfied). In addition, the use of the Fitbit device was shown to be feasible, as older adults across all trials wore their Fitbits for the majority of the day (mean 20.3, SD 3.6 hours). Furthermore, consistent Fitbit wear was common; 100% of participants older than 55 years wore their Fitbit an average of 10 or more hours per day. These trials highlight that digital, remote intervention delivery may be successfully implemented among older adults by way of personalized trials. Across the 3 digital interventions, feasibility and acceptability were high among older adults, and comparable to younger adults. Conclusions: Given the success of the current trials amid pandemic restrictions, we argue that these trials serve as a useful framework to aid in designing personalized, digital, remote interventions in other areas of clinical care among older adults and in planning for future disruptions including new pandemics. UR - https://www.jmir.org/2025/1/e54629 UR - http://dx.doi.org/10.2196/54629 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54629 ER - TY - JOUR AU - Paneerselvam, Sritheran Ganesh AU - Lua, Lin Pei AU - Chooi, Han Wen AU - Rehman, Ur Inayat AU - Goh, Wen Khang AU - Ming, Chiau Long PY - 2025/4/16 TI - Effectiveness of Mobile Apps in Improving Medication Adherence Among Chronic Kidney Disease Patients: Systematic Review JO - J Med Internet Res SP - e53144 VL - 27 KW - mobile applications KW - medication adherence KW - chronic kidney disease KW - health outcomes KW - mobile health KW - mhealth KW - digital health KW - kidney disease KW - patient education KW - medication monitoring KW - e-medication KW - electronic medication N2 - Background: Chronic kidney disease (CKD) is a serious condition affecting millions of individuals worldwide. Adherence to medication regimens among patients with CKD is often suboptimal, leading to poor health outcomes. In recent years, mobile apps have gained popularity as a promising tool to improve medication adherence and self-management in various chronic diseases. Objective: This study aimed to evaluate the effectiveness of mobile apps to improve medication adherence among patients with CKD (including end-stage and renal replacement therapy). Methods: A systematic search was conducted using Scopus, Cochrane, PubMed, and EBSCOhost to include eligible articles that studied mobile apps to improve medication adherence among patients with CKD. The quality of the selected studies was evaluated using the Newcastle?Ottawa Scale and the Cochrane risk-of-bias tool. Results: Out of 231 relevant articles, only 9 studies were selected for this systematic review. Based on Newcastle?Ottawa Scale, 7 were deemed to be of high quality, while others were of fair quality. The Cochrane risk-of-bias tool indicated a low to moderate risk of bias across the included studies. Most of the included studies had a randomized controlled design. Of the 9 selected studies, 3 papers represented medication adherence by a coefficient of 10 variability of tacrolimus, 3 papers used adherence measurement scales to calculate the score for assessing medication adherence, 2 papers represented medication adherence by self-reporting, 2 papers represented medication adherence using electronic monitoring, and 1 represented medication adherence by pill count. The mobile apps were identified as Transplant Hero (Transplant Hero LLC), Perx (Perx Health), Smartphone Medication Adherence Saves Kidneys (developed by John McGillicuddy), Adhere4U (developed by Ahram Han), My Dialysis (developed by Benyamin Saadatifar), Kidney Love (developed by National Kidney foundation), and iCKD (developed by Dr Vivek Kumar). Of these apps, 3 focused on evaluating Transplant Hero, while the remaining investigated each of the other mentioned apps individually. The apps use various strategies to promote medication adherence, including reminders, gamification, patient education, and medication monitoring. A majority, 5 out of 9 mobile apps, had a statistically significant (P<.05) effect on medication adherence. There was strong evidence for a positive effect of interventions focusing on games and reminders combined with electronic medication tray monitoring and patient education. Conclusions: Mobile apps effectively improved medication adherence in patients with CKD, but low evidence and short intervention duration warrant caution. Future research should identify ideal features, provider costs, and user-friendly, secure apps. UR - https://www.jmir.org/2025/1/e53144 UR - http://dx.doi.org/10.2196/53144 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53144 ER - TY - JOUR AU - Rodberg, Danielle AU - Nawara, Roula AU - Taylor, Mischa AU - Struik, Laura PY - 2025/4/15 TI - User Perceptions of E-Cigarette Cessation Apps: Content Analysis of App Reviews JO - J Med Internet Res SP - e59997 VL - 27 KW - qualitative research KW - vaping KW - e-cigarette KW - mobile phone KW - mHealth KW - smartphone app KW - cessation KW - nicotine KW - consumer KW - perception KW - user KW - content analysis KW - Canada KW - experiences N2 - Background: Vaping rates in Canada are continuing to increase. In 2019, 4.7% of Canadians used an electronic cigarette (e-cigarette) in the past 30 days, which rose to 5.8% in 2022. In the same year, young adults aged 20-24 years demonstrated the highest use among Canadians, at 19.7%. Given this, existing interventions are not resulting in the desired outcomes, and smartphone apps have the potential to address this gap. Although limited, current evidence highlights that apps can be an effective cessation support; however, a gap persists in understanding the user experience of vaping cessation apps. Objective: The purpose of this study was to explore the user experience of vaping cessation apps through an analysis of app reviews. More specifically, this study aimed to identify positive and negative experiences of app users, as well as highlight recommendations from app users to improve the quality of these apps. Methods: Vaping cessation apps were identified through searches on the Canadian and US versions of Apple App Store and Android Google Play Store in August 2022. Searches revealed a total of 11 vaping cessation apps with app reviews, which resulted in a total of 310 reviews for analysis. Review material was analyzed using a deductive content analysis approach and divided into the following primary categories: content, functionality, aesthetic, cost, and other. These were further divided into 3 secondary categories (praise, criticism, and recommendations) and various tertiary categories. Results: The most discussed primary categories were content, functionality and cost. Comments regarding content tended to be positive (n=103, 33.2%), praising features, such as hypnosis audio sessions (n=29, 28.2%) and tracking features. In contrast, comments tended to criticize functionality (n=58, 18.7%), indicating issues with the functioning of an app that either made the whole app unusable (n=29, 50%) or a specific feature unusable (n=28, 48.3%). Reviews regarding cost were mixed, with 27 (8.7%) positive comments, the majority of these encompassing reviewers satisfied with their purchase (n=17, 63%), and 38 (12.3%) negative comments, including individuals both unsatisfied with their purchase (n=15, 39.5%) and unsatisfied with the free version (n=12, 31.6%). Conclusions: This study is the first of its kind to evaluate the user experience with vaping cessation apps via an analysis of app reviews. App developers may benefit from reading our findings to identify areas to focus on when developing and updating apps. Our study forms a basis for the development of future vaping interventions, as well as future studies. Future research should be conducted on vaping cessation interventions with an emphasis on the user experience because there is limited research available for comparison with the promising results from this study. UR - https://www.jmir.org/2025/1/e59997 UR - http://dx.doi.org/10.2196/59997 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59997 ER - TY - JOUR AU - Kamulegeya, Henry Louis AU - Kagolo, Ivan AU - Kabakaari, Brenda AU - Atuhaire, Joan AU - Nasamula, Racheal AU - Bwanika, M. J. PY - 2025/4/15 TI - Technology-Assisted Interventions in the Delivery of HIV Prevention, Care, and Treatment Services in Sub-Saharan Africa: Scoping Review JO - J Med Internet Res SP - e68352 VL - 27 KW - digital health KW - telehealth KW - HIV KW - Sub-Sahara Africa KW - chatbots KW - mobile application KW - mHealth N2 - Background: Sub-Saharan Africa (SSA) accounts for up to 67% of the global HIV burden yet grapples with health system challenges like distant health facilities, low doctor-to-patient ratio, and poor or non-functioning post-hospital follow-up mechanisms. The rising phone ownership and internet penetration in SSA (46% and 67%, respectively) offer an opportunity to leverage technology to address these gaps and drive toward achieving the UNAIDS (Joint United Nations Programme on HIV and AIDS) 95-95-95 targets. Objective: We undertook a scoping review to understand how digital technologies have been integrated into HIV prevention, care, and treatment services delivery in SSA. Methods: A scoping review involving 4 databases (PubMed, CINAHL, Cochrane, and Google Scholar) was carried out, encompassing studies related to technology use in the delivery of HIV prevention, care, and treatment published from January 1, 2019, to December 30, 2023. Search terms like ?telemedicine,? ?telehealth,? ?mobile health,? ?eHealth,? ?mHealth,? ?telecommunication,? ?mobile application,? and ?digital health,? among others, were used. Of the 310 papers identified, 11 were excluded due to duplicity, 299 were from outside SSA and the intervention was not well described, and 149 were due to the year of publication and study type being a literature review or study protocols, leaving 17 papers that were considered for the review. Results: From the 17 studies summarized, the technologies identified included social media (n=1), interactive voice response (n=1), hotlines (n=1), mobile apps (n=7), health information systems (n=2), chatbots (n=1), and SMS text messages (n=5). Adolescents (11-14 years) and youths (20-35 years) formed the majority of users. The use cases included reminders on facility events, teleconsultations, patient registration, and health information dissemination, among others. Different parameters of individual digital tools were tracked, including feasibility, usability, adoption, and impact on the desired outcome. Conclusions: The integration of digital technologies in health care can address the known challenges in the delivery of HIV prevention, care, and treatment services, facilitate customization of care to individual needs, and thus increase or diversify options available to patients. UR - https://www.jmir.org/2025/1/e68352 UR - http://dx.doi.org/10.2196/68352 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68352 ER - TY - JOUR AU - Pessoa, Cheila PY - 2025/4/14 TI - Enhancing Self-Management Support Apps for Spinal Cord Injury: The Missing Role of Caregivers JO - JMIR Mhealth Uhealth SP - e72037 VL - 13 KW - mobile phone KW - mHealth KW - eHealth KW - telemedicine KW - telehealth KW - spinal cord injury KW - self-management KW - internet-based intervention KW - World Wide Web KW - systematic review KW - caregiver UR - https://mhealth.jmir.org/2025/1/e72037 UR - http://dx.doi.org/10.2196/72037 ID - info:doi/10.2196/72037 ER - TY - JOUR AU - Cho, Minseo AU - Park, Doeun AU - Choo, Myounglee AU - Han, Hyun Doug AU - Kim, Jinwoo PY - 2025/4/9 TI - Adolescent Self-Reflection Process Through Self-Recording on Multiple Health Metrics: Qualitative Study JO - J Med Internet Res SP - e62962 VL - 27 KW - self-recording KW - self-tracking KW - self-regulation KW - personal informatics KW - digital health KW - qualitative study KW - grounded theory KW - adolescents KW - teenagers KW - adolescent health KW - self-reflection KW - health metrics KW - behavior change KW - self-awareness KW - decision-making KW - mental health KW - behavioral health KW - health management KW - semi-structured interview N2 - Background: Self-recording is an effective behavior change technology that has long been used in diverse health contexts. Recent technological advancements have broadened its applications. While previous studies have explored its role and benefits in enhancing self-awareness and informed decision-making, relatively little attention has been given to its potential to address the multidimensional nature of health with various health metrics. Objective: This study investigates the process of self-recording in adolescent health, recognizing the connections between lifestyle behaviors and mental health. Specifically, we aim to incorporate both behavioral and emotional health metrics into the self-recording process. Grounded in self-regulation theory, we explore how adolescents record lifestyle behaviors and emotions, and how they inform and implement health management strategies. Methods: We conducted a qualitative study using the grounded theory methodology. Data were collected through individual semistructured interviews with 17 adolescents, who recorded their emotions and behaviors over 4 weeks using a prototype application. Analysis followed iterative phases of coding, constant comparison, and theme saturation. This process revealed how adolescents engage in self-recording for behaviors and emotions, as well as their failures and potential system support strategies. We further examined the relevance of the identified themes to theoretical constructs in self-regulation theory. Results: Under self-regulation theory, we gained insights into how adolescents manage their health through self-recording. The findings suggested variability in the self-recording process, in relation to specific health metrics of lifestyle behaviors and emotions. Adolescents focused on evaluating behaviors for management purposes while exploring the causes underlying emotional experiences. Throughout the health management, which involved modifying behavior or distancing from triggering factors, they monitored progress and outcomes, demonstrating a self-experimental approach. Uncertainty emerged as a barrier throughout the self-regulation process, suggesting that self-recording systems for adolescents should prioritize strategies to address these uncertainties. In addition, the self-recording system demonstrated interventional effects in aiding future planning and fostering a sense of relatedness among users. Conclusions: This study offers a theoretical framework for adolescents? self-recording process on diverse health metrics. By integrating self-regulation theory, we suggest a stepwise process from recording lifestyle behaviors and emotions to health management behaviors. Through exploring potential features and health-supportive effects, our findings contribute to the development of digital self-recording systems that address various health metrics in adolescent health. UR - https://www.jmir.org/2025/1/e62962 UR - http://dx.doi.org/10.2196/62962 UR - http://www.ncbi.nlm.nih.gov/pubmed/40202781 ID - info:doi/10.2196/62962 ER - TY - JOUR AU - Ho, Minh Nhat AU - Johnson, Catherine AU - Chidester, Autumn AU - Viera Corral, Ruby AU - Ramos, Jacundo AU - Garcia, Miguel AU - Gonuguntla, Rishi AU - Cote, Cyrena AU - Chandramohan, Divya AU - Lin, Hueylie AU - Taranova, Anna AU - Nijhawan, E. Ank AU - Kools, Susan AU - Ingersoll, Karen AU - Dillingham, Rebecca AU - Taylor, S. Barbara PY - 2025/4/8 TI - Centering Youth Voice in the Adaptation of an mHealth Intervention for Young Adults With HIV in South Texas, United States: Human-Centered Design Approach JO - JMIR Form Res SP - e60531 VL - 9 KW - HIV KW - implementation science KW - youth KW - mHealth KW - adherence KW - young KW - mobile health KW - mobile health intervention KW - AIDS KW - US KW - adult KW - self-efficacy KW - willingness KW - health outcomes KW - mHealth intervention KW - interview KW - human-centered design KW - acceptability KW - usability KW - mobile phone N2 - Background: Young adults living with HIV are less likely to engage in care and achieve viral suppression, compared to other age groups. Young adults living with HIV also have a high degree of self-efficacy and willingness to adopt novel care modalities, including mobile health (mHealth) interventions. Interventions to increase care engagement could aid young adults living with HIV in overcoming structural and social barriers and leveraging youth assets to improve their health outcomes. Objective: The objective of the paper was to use an assets-based framework, positive youth development, and human-centered design principles to adapt an existing mHealth intervention, PositiveLinks (PL), to support care engagement for 18? to 29-year-olds with HIV. Methods: We conducted a formative evaluation including semistructured interviews with 14 young adults with HIV and focus groups with 26 stakeholders (providers, nurses, case managers, and clinic staff). Interviews covered barriers to care, provider communication, and concerns or suggestions about mHealth interventions. The research team used thematic analysis to review interview transcripts. In the second phase, human-centered design processes informed adaptation of the existing PL platform using data from real-time use suggestions of 3 young adults with HIV. Throughout the formative evaluation and adaptation, a Youth Advisory Board (YAB) provided input. Results: Young adults with HIV and stakeholders identified common elements of an mHealth intervention that would support care engagement including: the convenience of addressing needs through the app, online support groups to support interconnection, short videos or live chats with other young adults with HIV or providers, appointment and medication reminders, and medical information from a trustworthy source. Stakeholders also mentioned the need for youth empowerment. Concerns included worries about confidentiality, unintentional disclosures of status, urgent content in an unmoderated forum, and the impersonality of online platforms. Design suggestions from young adults with HIV included suggestions on appearance, new formatting for usability of the online support group, and prioritization of local content. Based on the feedback received, iterative changes were made to transform PL into Positive Links for Youth (PL4Y). Final votes on adaptations were made by the YAB. The overall appearance of the platform was changed, including logo, color, and font. The online support group was divided into 3 channels which support hashtags and content searches. The ?Resources? and ?Frequently Asked Questions? sections were condensed and revised to prioritize South Texas?specific content. Conclusions: Our assets-based framework supported young adults with HIV and stakeholder input in the transformation of an mHealth intervention to meet the needs of 18- to 29-year-olds in South Texas. The human-centered design approach allowed young adults with HIV to suggest specific changes to the intervention?s design to support usability and acceptability. This adapted version, PL4Y, is now ready for pilot testing in the final phase of this implementation science project. UR - https://formative.jmir.org/2025/1/e60531 UR - http://dx.doi.org/10.2196/60531 ID - info:doi/10.2196/60531 ER - TY - JOUR AU - Chauhan, Kumari Gauri AU - Vavken, Patrick AU - Jacob, Christine PY - 2025/4/4 TI - Mobile Apps and Wearable Devices for Cardiovascular Health: Narrative Review JO - JMIR Mhealth Uhealth SP - e65782 VL - 13 KW - eHealth KW - mobile health KW - mHealth KW - digital health KW - technology assessment KW - technology adoption KW - technology implementation KW - cardiovascular diseases KW - cardiovascular health KW - Germany KW - Austria KW - Switzerland KW - wearables KW - apps KW - smartphones KW - Swiss Apple App KW - Google Play Store KW - reviews KW - morbidity KW - mortality KW - well-being KW - care management KW - health technologies N2 - Background: Cardiovascular diseases (CVDs) continue to be the leading cause of global morbidity and mortality. Aiming to reduce the risk of CVD development and better manage them, an increasing number of individuals are adopting mobile health (mHealth) apps and wearable devices (wearables). These technologies provide critical insights into heart health and fitness, supporting users to monitor their lifestyle behaviors and adhere to preventative medication. Objective: In this review, we aimed to investigate the current state of mHealth apps and wearables designed for cardiovascular health, with a specific focus on the DACH region (Germany, Austria, and Switzerland). We assessed the benefits these technologies provide to clinicians and patients, particularly in addressing unmet needs like sex-specific symptoms, while also examining their potential integration into the broader health care ecosystem. Methods: To identify heart health apps, a keyword search was performed on both the Swiss Apple App Store and Google Play Stores. A separate search was performed on Google to identify heart health wearables. The identified apps and wearables were evaluated using the foundational and contextual criteria of the sociotechnical framework for assessing patient-facing eHealth tools. Results: After filtering out apps and wearables that did not meet our inclusion criteria, 20 apps and 22 wearables were included in the review. While all the apps were available in the DACH region, only 30% (6/20) were specifically designed for these countries. Only 25% (5/20) of the apps included sex-specific information; 40% (8/20) provided information from evidence-based research, 35% (7/20) provided general health information without academic and clinical references, and 25% (5/20) did not include any evidence-based or general health information. While 20% (4/20) of the included apps had clinical integration features such as clinician dashboards, only 10% (2/20) had the potential to effectively enhance clinician workflows. Privacy policies were present in 95% (19/20) of the apps, with 75% (15/20) adhering to General Data Protection Regulation (GDPR) regulations; 1 app had no data protection policy. Only 20% (4/20) of the apps were medically certified. For wearables, only 9% (2/22) were tailored to the DACH region, and 40% (9/22) addressed women?s health. While around 60% (13/22) offered features to support clinical integration, only 9% (2/22) had the potential to improve clinical workflows. More than half (12/22) of the wearables were medically certified, and 77% (17/22) referenced scientific or peer-reviewed research. All wearables included a privacy policy. Conclusions: While many mHealth tools for cardiovascular health are available, only a few provide meaningful value to both patients and clinicians or have the potential to integrate effectively into the health care system. Women?s sex-specific needs are often overlooked, and the benefits for clinicians are limited. In addition, mHealth apps largely lack robust evidence, whereas wearables showed comparatively stronger support through evidence-based and medical certification. UR - https://mhealth.jmir.org/2025/1/e65782 UR - http://dx.doi.org/10.2196/65782 ID - info:doi/10.2196/65782 ER - TY - JOUR AU - Wyatt, Bastien AU - Forstmann, Nicolas AU - Badier, Nolwenn AU - Hamy, Anne-Sophie AU - De Larochelambert, Quentin AU - Antero, Juliana AU - Danino, Arthur AU - Vercamer, Vincent AU - De Villele, Paul AU - Vittrant, Benjamin AU - Lanz, Thomas AU - Reyal, Fabien AU - Toussaint, Jean-François AU - Delrieu, Lidia PY - 2025/4/4 TI - Changes in Physical Activity, Heart Rate, and Sleep Measured by Activity Trackers During the COVID-19 Pandemic Across 34 Countries: Retrospective Analysis JO - J Med Internet Res SP - e68199 VL - 27 KW - Covid-19 KW - pandemic KW - physical activity KW - step KW - activity tracker KW - public health KW - Withings KW - heart rate KW - wearable sensors KW - sleep duration KW - sleep quality KW - pre-pandemic KW - sedentary behavior N2 - Background: The COVID-19 pandemic disrupted behavior within populations, affecting physical activity (PA), heart rate (HR), and sleep characteristics in particular. Activity trackers provide unique insights into these changes, enabling large-scale, real-time monitoring. Objective: This study aims to analyze the associations between the features of the COVID-19 pandemic worldwide and PA, HR, and sleep parameters, using data collected from activity trackers over a 3-year period. Methods: We performed a retrospective analysis using anonymized data collected from the 208,818 users of Withings Steel HR activity trackers, spanning 34 countries, over a 3-year period from January 2019 to March 2022. Key metrics analyzed included daily step counts, average heart rate, and sleep duration. The statistical methods used included descriptive analyses, time-trend analysis, and mixed models to evaluate the impact of restriction measures, controlling for potential confounders such as sex, age, and seasonal variations. Results: We detected a significant decrease in PA, with a 12.3% reduction in daily step count (from 5802 to 5082 steps/d) over the 3 years. The proportion of sedentary individuals increased from 38% (n=14,177) in 2019 to 52% (n=19,510) in 2020 and remained elevated at 51% (n=18,972) in 2022, while the proportion of active individuals dropped from 8% (n=2857) to 6% (n=2352) in 2020 before returning to 8% (n=2877) in 2022. In 2022, the global population had not returned to prepandemic PA levels, with a noticeable persistence of inactivity. During lockdowns, HR decreased by 1.5%, which was associated with lower activity levels. Sleep duration increased during restrictions, particularly in the countries with the most severe lockdowns (eg, an increase of 15 min in countries with stringent measures compared to 5 min in less restricted regions). Conclusions: The sustained decrease in PA and its physiological consequences highlight the need for public health strategies to mitigate the long-term effects of the measures taken during the pandemic. Despite the gradual lifting of restrictions, PA levels have not fully recovered, with lasting implications for global health. If similar circumstances arise in the future, priority should be given to measures for effectively increasing PA to counter the increase in sedentary behavior, mitigate health risks, and prevent the rise of chronic diseases. UR - https://www.jmir.org/2025/1/e68199 UR - http://dx.doi.org/10.2196/68199 UR - http://www.ncbi.nlm.nih.gov/pubmed/40184182 ID - info:doi/10.2196/68199 ER - TY - JOUR AU - Gustafson Sr, H. David AU - Mares, Marie-Louise AU - Johnston, C. Darcie AU - Curtin, J. John AU - Pe-Romashko, Klaren AU - Landucci, Gina PY - 2025/4/3 TI - Comparison of Smart Display Versus Laptop Platforms for an eHealth Intervention to Improve Functional Health for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Clinical Trial JO - JMIR Res Protoc SP - e64449 VL - 14 KW - eHealth KW - aged KW - geriatrics KW - functional health KW - multiple chronic conditions KW - smart display KW - smart speaker KW - primary care KW - quality of life N2 - Background: Maintaining functional health, or the ability to live independently, is a primary goal of individuals as they age, but most older adults develop chronic conditions that threaten this goal. Physical activity is a key aspect of self-care that can improve functional health, and digital interventions offering guidance on appropriate exercise can help. However, older adults with multiple morbidities may be unable to use a laptop or smartphone-based eHealth because poor vision, dexterity, mobility, or other physical challenges make typing or touch navigation difficult. A smart display platform?comprising a smart speaker plus a small visual screen?has the potential to remove these barriers because it is voice-activated. Objective: The study aims to compare usage patterns of an eHealth intervention for older adults when delivered via a voice-based smart display versus a typing-based laptop, and assess whether the smart display outperforms the laptop in improving functional health and its specific physical and mental aspects. Methods: A minimum of 356 adults aged 60 years and older with at least 5 chronic health conditions are to be recruited from primary care clinics and community organizations. Participants will be randomized 1:1 to 12 months of access to an evidence-based intervention, ElderTree, delivered on either a smart display or a touchscreen laptop, with a postintervention follow-up at 18 months. The primary outcome is differences between groups on a comprehensive measure of physical and mental functional health. Secondary outcomes are between-group differences in the subscales of functional health (eg, physical function and depression), as well as measures of health distress, loneliness, unscheduled health care, and falls. We will also examine mediators and moderators of the effects of ElderTree on both platforms. Participants will complete surveys at baseline, 6, 12, and 18 months, and ElderTree use data will be collected continuously during the intervention period in system logs. We will use linear mixed-effect models to evaluate outcomes over time, with treatment condition and time point as between-subjects factors. Separate analyses will be conducted for each outcome. Results: Recruitment began in July 2023 and was completed in May 2024, with 387 participants enrolled. The 12-month intervention period will end in May 2025; data collection will end in November 2025. Findings will be disseminated via peer-reviewed publications. Conclusions: Voice-activated digital health interventions have theoretical but untested advantages over typing-based technologies for older adults with physical limitations. As the population ages, and as multiple morbidities threaten the functional health of the majority of older adults, innovations in self-management are a matter of public health as well as individual quality of life. Trial Registration: ClinicalTrials.gov NCT05240534; https://clinicaltrials.gov/study/NCT05240534 International Registered Report Identifier (IRRID): DERR1-10.2196/64449 UR - https://www.researchprotocols.org/2025/1/e64449 UR - http://dx.doi.org/10.2196/64449 UR - http://www.ncbi.nlm.nih.gov/pubmed/40080672 ID - info:doi/10.2196/64449 ER - TY - JOUR AU - Kriara, Lito AU - Dondelinger, Frank AU - Capezzuto, Luca AU - Bernasconi, Corrado AU - Lipsmeier, Florian AU - Galati, Adriano AU - Lindemann, Michael PY - 2025/4/3 TI - Investigating Measurement Equivalence of Smartphone Sensor?Based Assessments: Remote, Digital, Bring-Your-Own-Device Study JO - J Med Internet Res SP - e63090 VL - 27 KW - Floodlight Open KW - multiple sclerosis KW - smartphone KW - sensors KW - mobile phone KW - wearable electronic devices KW - digital health KW - equivalence KW - device equivalence KW - cognition KW - gait KW - upper extremity function KW - hand motor function KW - balance KW - digital biomarker KW - variability KW - mHealth KW - mobile health KW - autoimmune disease KW - motor KW - digital assessment N2 - Background: Floodlight Open is a global, open-access, fully remote, digital-only study designed to understand the drivers and barriers in deployment and persistence of use of a smartphone app for measuring functional impairment in a naturalistic setting and broad study population. Objective: This study aims to assess measurement equivalence properties of the Floodlight Open app across operating system (OS) platforms, OS versions, and smartphone device models. Methods: Floodlight Open enrolled adult participants with and without self-declared multiple sclerosis (MS). The study used the Floodlight Open app, a ?bring-your-own-device? (BYOD) solution that remotely measured MS-related functional ability via smartphone sensor?based active tests. Measurement equivalence was assessed in all evaluable participants by comparing the performance on the 6 active tests (ie, tests requiring active input from the user) included in the app across OS platforms (iOS vs Android), OS versions (iOS versions 11-15 and separately Android versions 8-10; comparing each OS version with the other OS versions pooled together), and device models (comparing each device model with all remaining device models pooled together). The tests in scope were Information Processing Speed, Information Processing Speed Digit-Digit (measuring reaction speed), Pinching Test (PT), Static Balance Test, U-Turn Test, and 2-Minute Walk Test. Group differences were assessed by permutation test for the mean difference after adjusting for age, sex, and self-declared MS disease status. Results: Overall, 1976 participants using 206 different device models were included in the analysis. Differences in test performance between subgroups were very small or small, with percent differences generally being ?5% on the Information Processing Speed, Information Processing Speed Digit-Digit, U-Turn Test, and 2-Minute Walk Test; <20% on the PT; and <30% on the Static Balance Test. No statistically significant differences were observed between OS platforms other than on the PT (P<.001). Similarly, differences across iOS or Android versions were nonsignificant after correcting for multiple comparisons using false discovery rate correction (all adjusted P>.05). Comparing the different device models revealed a statistically significant difference only on the PT for 4 out of 17 models (adjusted P?.001-.03). Conclusions: Consistent with the hypothesis that smartphone sensor?based measurements obtained with different devices are equivalent, this study showed no evidence of a systematic lack of measurement equivalence across OS platforms, OS versions, and device models on 6 active tests included in the Floodlight Open app. These results are compatible with the use of smartphone-based tests in a bring-your-own-device setting, but more formal tests of equivalence would be needed. UR - https://www.jmir.org/2025/1/e63090 UR - http://dx.doi.org/10.2196/63090 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63090 ER - TY - JOUR AU - Tak, Won Yae AU - Kim, Junetae AU - Chung, Haekwon AU - Lee, Byul Sae AU - Park, Ja In AU - Lee, Won Sei AU - Jo, Min-Woo AU - Lee, Won Jong AU - Baek, Seunghee AU - Lee, Yura PY - 2025/4/1 TI - Analysis of Metabolic and Quality-of-Life Factors in Patients With Cancer for a New Approach to Classifying Walking Habits: Secondary Analysis of a Randomized Controlled Trial JO - J Med Internet Res SP - e52694 VL - 27 KW - telemedicine KW - mobile phone KW - physical activity KW - mobile apps KW - mobile health intervention KW - cancer KW - step count N2 - Background: As the number of people diagnosed with cancer continues to increase, self-management has become crucial for patients recovering from cancer surgery or undergoing chemotherapy. Technology has emerged as a key tool in supporting self-management, particularly through interventions that promote physical activity, which is important for improving health outcomes and quality of life for patients with cancer. Despite the growing availability of digital tools that facilitate physical activity tracking, high-level evidence of their long-term effectiveness remains limited. Objective: This study aimed to investigate the effect of long-term physical activity on patients with cancer by categorizing them into active and inactive groups based on step count time-series data using the mobile health intervention, the Walkon app (Swallaby Co, Ltd.). Methods: Patients with cancer who had previously used the Walkon app in a previous randomized controlled trial were chosen for this study. Walking step count data were acquired from the app users. Biometric measurements, including BMI, waist circumference, blood sugar levels, and body composition, along with quality of life (QOL) questionnaire responses (European Quality of Life 5 Dimensions 5 Level version and Health-related Quality of Life Instrument with 8 Items), were collected during both the baseline and 6-month follow-up at an outpatient clinic. To analyze step count patterns over time, the concept of sample entropy was used for patient clustering, distinguishing between the active walking group (AWG) and the inactive walking group (IWG). Statistical analysis was performed using the Shapiro-Wilk test for normality, with paired t tests for parametric data, Wilcoxon signed-rank tests for nonparametric data, and chi-square tests for categorical variables. Results: The proposed method effectively categorized the AWG (n=137) and IWG (n=75) based on step count trends, revealing significant differences in daily (4223 vs 5355), weekly (13,887 vs 40,247), and monthly (60,178 vs 174,405) step counts. Higher physical activity levels were observed in patients with breast cancer and younger individuals. In terms of biometric measurements, only waist circumference (P=.01) and visceral fat (P=.002) demonstrated a significant improvement exclusively within the AWG. Regarding QOL measurements, aspects such as energy (P=.01), work (P<.003), depression (P=.02), memory (P=.01), and happiness (P=.05) displayed significant improvements solely in the AWG. Conclusions: This study introduces a novel methodology for categorizing patients with cancer based on physical activity using step count data. Although significant improvements were noted in the AWG, particularly in QOL and specific physical metrics, differences in 6-month change between the AWG and IWG were statistically insignificant. These findings highlight the potential of digital interventions in improving outcomes for patients with cancer, contributing valuable insights into cancer care and self-management. Trial Registration: Clinical Research Information Service by Korea Centers for Diseases Control and Prevention, Republic of Korea KCT0005447; https://tinyurl.com/3zc7zvzz UR - https://www.jmir.org/2025/1/e52694 UR - http://dx.doi.org/10.2196/52694 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52694 ER - TY - JOUR AU - Spark, Jessica AU - Rowe, Elise AU - Alvarez-Jimenez, Mario AU - Bell, Imogen AU - Byrne, Linda AU - Dzafic, Ilvana AU - Ellinghaus, Carli AU - Lavoie, Suzie AU - Lum, Jarrad AU - McLean, Brooke AU - Thomas, Neil AU - Thompson, Andrew AU - Wadley, Greg AU - Whitford, Thomas AU - Wood, Stephen AU - Yuen, Pan Hok AU - Nelson, Barnaby PY - 2025/4/1 TI - Integrating Virtual Reality, Neurofeedback, and Cognitive Behavioral Therapy for Auditory Verbal Hallucinations (Hybrid): Protocol of a Pilot, Unblinded, Single-Arm Interventional Study JO - JMIR Res Protoc SP - e63405 VL - 14 KW - psychosis KW - first episode psychosis KW - schizophrenia KW - virtual reality KW - neurofeedback KW - EEG KW - auditory verbal hallucinations KW - voices KW - cognitive behavior therapy KW - youth mental health KW - pilot study KW - paracusias KW - paracusis KW - treatment KW - medication KW - psychotic disorder KW - efficacy KW - neuroscience KW - psychology KW - hybrid KW - adolescent KW - Australia N2 - Background: Current treatments for schizophrenia and other psychotic disorders have limited efficacy, with high rates of nonresponse to ?gold standard? treatments. New approaches are therefore urgently required. Objective: The aims of this pilot study are to investigate the feasibility, acceptability, safety, and usability of Hybrid treatment (primary aim); and to explore Hybrid?s treatment efficacy and engagement of treatment targets (secondary aim). The primary aim will be assessed via face-to-face user experience surveys on a (self-assessed) 5-point Likert scale (and qualitative open-ended questions) examining: (1) acceptability, (2) helpfulness, (3) engagement, and (4) perceived safety. We will also examine consent and completion rates, and the number of sessions attended. Our threshold for moving on to efficacy trials will be at least 70% of our participants to rate 3 and above (which corresponds to agree or strongly agree) that the intervention package was acceptable, feasible, and safe. The secondary aims will be assessed by observing whether individuals achieve self-directed modulation of high-? neurophysiological activity (neural target) and progression upwards through the VR-based exposure hierarchy (psychological target), and by assessing symptom change scores. This study developed a new treatment approach for auditory verbal hallucinations, a major symptom of psychotic disorders, that integrates advances in psychological therapy (cognitive behavioral therapy for psychosis), technology (virtual reality, VR), and neuroscience (electroencephalography-based neurofeedback). Methods: Hybrid takes a ?symptom capture? approach using individually tailored VR-based exposure exercises. Participants (N=10) will receive the intervention package weekly over 12 face-to-face sessions. Here, participants will be progressively exposed to symptom triggers and develop methods of downregulating neural activity associated with these symptoms (neurofeedback component) while concurrently receiving clinician-delivered cognitive behavioral therapy for psychosis. Results: As of February 2025, Hybrid has commenced (unblinded) recruitment activities from Orygen clinical services in Northwestern Melbourne, Australia. A total of 75 individuals have been approached and 64 individuals have been prescreened (41 individuals were deemed eligible, 15 individuals were ineligible, and 8 individuals declined or did not respond to contact attempts) and 5 individuals have been included in the study. Of the 5 individuals who have commenced the Hybrid treatment, 4 are actively engaged in the program and 1 individual has withdrawn. We expect recruitment to conclude in July 2025 and for the results to be published in 2026. Conclusions: The Hybrid study is piloting a novel approach that has the potential to address the shortcomings of current treatments for psychotic symptoms. If there is favorable evidence for the acceptability, feasibility, safety and usability of Hybrid, the study team will move on to efficacy trials. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12624000357550; https://tinyurl.com/24ey8hpy International Registered Report Identifier (IRRID): PRR1-10.2196/63405 UR - https://www.researchprotocols.org/2025/1/e63405 UR - http://dx.doi.org/10.2196/63405 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63405 ER - TY - JOUR AU - Allen, R. Rashell AU - Malik, A. Myrah AU - Aquin, Carley AU - Herceg, Lucijana AU - Brémault-Phillips, Suzette AU - Sevigny, R. Phillip PY - 2025/4/1 TI - Digital Health Resilience and Well-Being Interventions for Military Members, Veterans, and Public Safety Personnel: Environmental Scan and Quality Review JO - JMIR Mhealth Uhealth SP - e64098 VL - 13 KW - public safety personnel KW - veteran KW - military member KW - web-based program KW - resources KW - resilience KW - mobile app KW - quality review KW - well-being KW - military KW - environmental KW - review N2 - Background: Accessible mental health care, delivered via mobile apps or web-based services, may be essential for military members, public safety personnel (PSP), and veterans, as they report numerous barriers to seeking in-person care and are at an increased risk for a number of psychological disorders. Objective: We aimed to identify, describe, and evaluate apps, resource banks (RBs), and web-based programs (WBPs), referred to as digital mental health interventions (DMHIs), recommended for military members, PSP, and veterans. A multidimensional and multisystemic view of resilience and well-being were maintained throughout this environmental scan. Methods: Information was gathered from a comprehensive review of peer-reviewed literature, a Google search, and a targeted search of websites relevant to the study populations. DMHIs aimed at supporting resilience or well-being were included in the review, including those published in peer-reviewed articles, and those offered to these populations without research or literature backing their use. Results: In total, 69 DMHIs were identified in this study, including 42 apps, 19 RBs, and 8 WBPs, and were described based on 3 questions related to purpose, strategies, and evidence from the adapted Mobile App Rating Scale and the Mobile App Rating Scale. Each WBP and RB was then reviewed via the adapted Mobile App Rating Scale and each app via the Alberta Rating Index for Apps (ARIA). Overall, 24 (35%) of the DMHIs were recommended for military members, 20 (29%) for PSP, and 41 (59%) for veterans. The most common aim across apps, RBs, and WBPs was to increase happiness and well-being, and the most common strategies were advice, tips, and skills training. In total, 2 apps recommended for military members?PTSD Coach and Virtual Hope Box?received a high rating on the ARIA subscales and have also been trialed in pilot randomized control trial (RCT) and RCT evaluations, respectively, with positive initial results. Similarly, 2 apps recommended for PSP?PeerConnect and R2MR?have been trialed in non-RCT studies, with partially positive outcomes or little to no contradictory evidence and received a high rating on the ARIA. Finally, 2 apps recommended for veteran populations?PTSD Coach and VetChange?received high ratings on the ARIA and have been trialed via pilot-RCT and RCT studies, respectively, with positive outcomes. Conclusions: In conclusion, there is a need for efficacy and effectiveness trials for DMHIs for military members, PSP, and veterans to ensure that they are effectively meeting the population?s needs. While there appears to be many promising DMHIs, further research is needed before these interventions continue to be promoted as effective and widely distributed. UR - https://mhealth.jmir.org/2025/1/e64098 UR - http://dx.doi.org/10.2196/64098 UR - http://www.ncbi.nlm.nih.gov/pubmed/40168068 ID - info:doi/10.2196/64098 ER - TY - JOUR AU - Noh, Min Jung AU - Im, SongHyun AU - Park, JooYong AU - Kim, Myung Jae AU - Lee, Miyoung AU - Choi, Ji-Yeob PY - 2025/4/1 TI - Validation of Ecological Momentary Assessment With Reference to Accelerometer Data: Repeated-Measures Panel Study With Multilevel Modeling JO - J Med Internet Res SP - e59878 VL - 27 KW - telemedicine KW - wearable electronic devices KW - physical activity KW - mobile phone KW - wearables KW - smartphones KW - ecological momentary assessment KW - EMA KW - global physical activity questionnaire KW - GPAQ KW - Bouchard?s physical activity KW - multilevel modeling KW - females KW - women KW - males KW - men KW - sensors KW - evaluation KW - comparative KW - South Korea N2 - Background: There is growing interest in the real-time assessment of physical activity (PA) and physiological variables. Acceleration, particularly those collected through wearable sensors, has been increasingly adopted as an objective measure of physical activity. However, sensor-based measures often pose challenges for large-scale studies due to their associated costs, inability to capture contextual information, and restricted user populations. Smartphone-delivered ecological momentary assessment (EMA) offers an unobtrusive and undemanding means to measure PA to address these limitations. Objective: This study aimed to evaluate the usability of EMA by comparing its measurement outcomes with 2 self-report assessments of PA: Global Physical Activity Questionnaire (GPAQ) and a modified version of Bouchard Physical Activity Record (BAR). Methods: A total of 235 participants (137 female, 98 male, and 94 repeated) participated in one or more 7-day studies. Waist-worn sensors provided by ActiGraph captured accelerometer data while participants completed 3 self-report measures of PA. The multilevel modeling method was used with EMA, GPAQ, and BAR as separate measures, with 6 subdomains of physiological activity (overall PA, overall excluding occupational, transport, exercise, occupational, and sedentary) to model accelerometer data. In addition, EMA and GPAQ were further compared with 6 domains of PA from the BAR as outcome measures. Results: Among the 3 self-reporting instruments, EMA and BAR exhibited better overall performance in modeling the accelerometer data compared to GPAQ (eg EMA daily: ?=.387, P<.001; BAR daily: ?=.394, P<.001; GPAQ: ?=.281, P<.001, based on repeated-only participants with step counts from accelerometer as dependent variables). Conclusions: Multilevel modeling on 3 self-report assessments of PA indicates that smartphone-delivered EMA is a valid and efficient method for assessing PA. UR - https://www.jmir.org/2025/1/e59878 UR - http://dx.doi.org/10.2196/59878 UR - http://www.ncbi.nlm.nih.gov/pubmed/40168069 ID - info:doi/10.2196/59878 ER - TY - JOUR AU - Johnson, Hans AU - Huang, David AU - Liu, Vivian AU - Ammouri, Al Mahmoud AU - Jacobs, Christopher AU - El-Osta, Austen PY - 2025/3/31 TI - Impact of Digital Engagement on Weight Loss Outcomes in Obesity Management Among Individuals Using GLP-1 and Dual GLP-1/GIP Receptor Agonist Therapy: Retrospective Cohort Service Evaluation Study JO - J Med Internet Res SP - e69466 VL - 27 KW - obesity KW - weight loss KW - semaglutide KW - tirzepatide KW - digital health KW - engagement KW - behavior KW - coaching KW - retrospective study KW - service evaluation N2 - Background: Obesity is a global public health challenge. Pharmacological interventions, such as glucagon-like peptide-1 (GLP-1) receptor agonists (eg, semaglutide) and dual GLP-1/gastric inhibitory polypeptide receptor agonists (eg, tirzepatide), have led to significant weight loss among users. Digital health platforms offering behavioral support may enhance the effectiveness of these medications. Objective: This retrospective service evaluation investigated the impact of engagement with an app-based digital weight loss program on weight loss outcomes among individuals using GLP-1 receptor agonists (semaglutide) and dual GLP-1/gastric inhibitory polypeptide receptor agonists (tirzepatide) in the United Kingdom over 5 months. Methods: Data were collected from the Voy weight loss digital health platform between February 2023 and August 2024. Participants were adults aged 18-75 years with a BMI ?30 or ?27.5 kg/m2 with the presence of obesity-related comorbidities who initiated a weight management program involving semaglutide or tirzepatide. Engagement was defined based on attendance at coaching sessions, frequency of app use, and regular weight tracking. Participants were categorized as ?engaged? or ?nonengaged? accordingly. Weight loss outcomes were assessed over a period of up to 5 months. Statistical analyses included chi-square tests, independent t tests, Kaplan-Meier survival analysis, and calculations of Cohen d for effect sizes. Results: A total of 57,975 participants were included in the analysis, with 31,407 (54.2%) classified as engaged and 26,568 (45.8%) as nonengaged. Engaged participants achieved significantly greater weight loss at each time point. At month 3, engaged participants had a mean weight loss of 9% (95% CI 9% to 9.1%) compared with 5.9% (95% CI 5.9% to 6%) in nonengaged participants (P<.001), representing a mean difference of 3.1 percentage points (95% CI 3.1% to 3.1%). A Cohen d effect size of 0.89 indicated a large effect. At month 5, engaged participants had a mean weight loss of 11.53% (95% CI 11.5% to 11.6%) compared with 8% (95% CI 7.9% to 8%) in the nonengaged participants (P<.001). A Cohen d effect size of 0.56 indicated a moderate effect. Participants using tirzepatide achieved more significant weight loss than those using semaglutide at month 5 (13.9%, 95% CI 13.5% to 14.3% vs 9.5%, 95% CI 9.2% to 9.7%; P<.001). The proportion of engaged participants achieving ?5%, ?10%, and ?15% weight loss was significantly higher than the nonengaged group at corresponding time points from months 3 to 5 respectively (P<.001). Conclusions: Engagement with a digital weight management platform significantly enhances weight loss outcomes among individuals using GLP-1 receptor agonists. The combination of pharmacotherapy and digital behavioral support offers a promising strategy to promote the supported self-care journey of individuals seeking clinically effective obesity management interventions. UR - https://www.jmir.org/2025/1/e69466 UR - http://dx.doi.org/10.2196/69466 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69466 ER - TY - JOUR AU - Hestevik, Hillestad Christine AU - Varsi, Cecilie AU - Østerås, Nina AU - Tveter, Therese Anne AU - Skandsen, Jon AU - Eik, Hedda PY - 2025/3/28 TI - Perspectives on and Experiences With Remote Monitoring and Patient-Initiated Care Among Norwegian Patients With Axial Spondyloarthritis: Qualitative Study JO - J Med Internet Res SP - e63569 VL - 27 KW - remote monitoring KW - patient-initiated care KW - patient-reported outcome measures KW - chronic disease KW - rheumatology KW - axial spondyloarthritis KW - joint disease KW - spine KW - medication KW - therapy KW - rheumatic KW - patient care KW - randomized controlled trial KW - interventions KW - decision-making N2 - Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory joint disease affecting the spine and sacroiliac joints, requiring frequent, lifelong monitoring and treatment. This involves regular symptom monitoring, assessing medication tolerance and side effects, and prompt therapy adjustments. Typically, patients with axSpA attend prescheduled hospital visits, but once stable disease has been attained, these seldom align with periods of high disease activity. Remote monitoring and patient-initiated care offer flexible, need-based, follow-up options. However, knowledge about how patients with axSpA perceive and experience these approaches is limited. To effectively implement these strategies in clinical practice, understanding patient perspectives is crucial. Objective: This study aims to explore how patients with axSpA perceive and experience remote monitoring and patient-initiated care. Methods: Our qualitative study was embedded in a randomized controlled trial. Participants were allocated to either usual care, remote monitoring, or patient-initiated care. The 2 intervention groups had no prescheduled visits and used a remote monitoring app, but only the remote monitoring group received monitoring by health care professionals. Semistructured interviews were conducted with 18 participants from the intervention groups to explore their experiences. The interviews were audio recorded, transcribed, anonymized, and analyzed using thematic analysis. Participants provided informed consent. Results: Eighteen patients (11 men and 7 women, aged 26-65 years) participated, 10 from the remote monitoring group and 8 from the patient-initiated care group. Transcripts were analyzed into four key themes: (1) ?I don?t need to go to the hospital just to report I?m doing well.? When patients felt well, they perceived in-person consultations as less important. They acknowledged health care resource challenges and were willing to adapt but expressed concerns about rapid technological advancement, fearing it could exclude vulnerable groups. They emphasized the need for shared decision-making in determining follow-up strategies; (2) ?It feels safer to meet healthcare personnel in person? highlighted participants? preference for in-person interactions as a safety net for detecting changes or signs of disease. They felt more secure when communicating face-to-face with health care professionals; (3) Remote monitoring can promote a sense of freedom and self-efficacy. The app provided autonomy, enabling patients to monitor their health without disrupting daily routines and promoting their health competency; and (4) Practical challenges and limitations of technology affect sense of security. Concerns about app deactivation, digital privacy, and lack of personalized settings negatively affected confidence in technology and sense of security. Conclusions: Remote monitoring and patient-initiated care can adequately meet the needs of patients with axSpA with low disease activity, reducing unnecessary visits and enhancing self-efficacy. However, these approaches should not be one-size-fits-all. Care must adapt to evolving disease activity, circumstances, and preferences. Human interaction and support remain crucial, and future technological developments must address practical challenges to ensure user-friendly and reliable interfaces. UR - https://www.jmir.org/2025/1/e63569 UR - http://dx.doi.org/10.2196/63569 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63569 ER - TY - JOUR AU - Housni, Asmaa AU - Katz, Alexandra AU - Bergeron, Junior Lucien AU - Simard, Alain AU - Finkel, Ashley AU - Roy-Fleming, Amélie AU - Nakhla, Meranda AU - Brazeau, Anne-Sophie PY - 2025/3/28 TI - Bridging the Gap in Carbohydrate Counting With a Mobile App: Needs Assessment Survey JO - J Med Internet Res SP - e63278 VL - 27 KW - type 1 diabetes KW - carbohydrate counting KW - mobile apps KW - photo recognition KW - diabetes management KW - mHealth KW - mobile health KW - user-centered design KW - Canadian survey N2 - Background: Carbohydrate counting (CC) can be burdensome and difficulty with adherence has been reported. Automated CC through mobile apps offers innovative solutions to ease this burden. Objective: This cross-sectional web-based survey aims to identify (1) perceived barriers to CC by Canadians living with type 1 diabetes (T1D) and (2) app features that would help reduce these barriers. The secondary objective aims to compare apps used by participants with the suggested app features. Methods: People with T1D aged 14 years and older, living in Canada, were recruited through the BETTER Canadian registry, diabetes organizations, and social media. Participants completed a 39-question web-based survey (closed- and open-ended) to identify barriers in CC, preferred CC app features, and current app use. Respondents rated barriers and app features using a 5-point Likert scale. The features were cross-referenced in each app reported being used by participants. Descriptive statistics summarized barriers and app feature preferences, and statistical analyses identified differences by age, app use, and insulin modality. Mean scores (out of 5) were compared using 2-tailed t tests or nonparametric tests. Open-ended questions were analyzed using inductive thematic analysis. Results: Participants (N=196; woman: n=145, 74%; mean age 40 [SD 17] years; mean diabetes duration 22 (14) years; relied on CC to determine insulin doses at mealtimes: n=178, 90.8%) reported barriers related to carbohydrate identification, nutrient interaction, and insulin dose calculation, as well as psychosocial factors. Preferred app features included nutrient analysis (165/196, 84.2%), personalization (151/196, 77.1%), insulin bolus calculation (145/196, 74%), and health care professional support (135/196, 68.8%). Among the 16 apps used by participants, most (12/16, 75%) supported nutrient analysis but only one offered bolus calculations or health care professional support, and none offered personalization. Users on injections reported greater barriers to blood glucose monitoring for insulin adjustments compared to exclusive pump users (mean score of 3.87, SD 1.22 vs mean 3.30, SD 1.28; P=.001). They also expressed higher needs for meal logs in an electronic food journal (mean 4.06, SD 1.18 vs mean 3.69, SD 1.17; P=.01), bolus dose suggestions (mean 4.37, SD 0.98 vs mean 3.84, SD 1.26; P=.001), and app personalization (mean 4.47, SD 0.86 vs mean 3.93, SD 1.21; P<.001). No significant differences were observed based on age or app use. The thematic analysis revealed participants? perceptions of suggested barriers and features, as well as new barriers such as calculation errors from unreliable food data and nutrition labels, fear of eating disorders, limited app reliability, and insufficient health care support, with suggestions for technology-based solutions. Conclusions: CC mobile apps currently used do not meet the needs of people with T1D. A novel CC app with app features such as photo recognition, reliable nutrient values, and personalized bolus calculations could reduce the CC burden. UR - https://www.jmir.org/2025/1/e63278 UR - http://dx.doi.org/10.2196/63278 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63278 ER - TY - JOUR AU - Zhang, Xinyue PY - 2025/3/28 TI - Authors? Reply: The SCeiP Model for Remote Rehabilitation in Homebound Patients With Coronary Heart Disease JO - J Med Internet Res SP - e70247 VL - 27 KW - exercise rehabilitation KW - coronary heart disease KW - promotion strategy KW - home rehabilitation UR - https://www.jmir.org/2025/1/e70247 UR - http://dx.doi.org/10.2196/70247 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70247 ER - TY - JOUR AU - Zhang, Siqi AU - Chen, Tielong PY - 2025/3/28 TI - The SCeiP Model for Remote Rehabilitation in Homebound Patients With Coronary Heart Disease JO - J Med Internet Res SP - e69927 VL - 27 KW - remote exercise rehabilitation KW - SCeiP model KW - coronary heart disease KW - promotion strategy KW - home rehabilitation UR - https://www.jmir.org/2025/1/e69927 UR - http://dx.doi.org/10.2196/69927 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69927 ER - TY - JOUR AU - Kavanagh, E. Meaghan AU - Chiavaroli, Laura AU - Quibrantar, M. Selina AU - Viscardi, Gabrielle AU - Ramboanga, Kimberly AU - Amlin, Natalie AU - Paquette, Melanie AU - Sahye-Pudaruth, Sandhya AU - Patel, Darshna AU - Grant, M. Shannan AU - Glenn, J. Andrea AU - Ayoub-Charette, Sabrina AU - Zurbau, Andreea AU - Josse, G. Robert AU - Malik, S. Vasanti AU - Kendall, C. Cyril W. AU - Jenkins, A. David J. AU - Sievenpiper, L. John PY - 2025/3/28 TI - Acceptability of a Web-Based Health App (PortfolioDiet.app) to Translate a Nutrition Therapy for Cardiovascular Disease in High-Risk Adults: Mixed Methods Randomized Ancillary Pilot Study JO - JMIR Cardio SP - e58124 VL - 9 KW - diet KW - apps KW - dietary app KW - Portfolio Diet KW - dietary portfolio KW - cholesterol reduction KW - cardiovascular disease KW - eHealth KW - usability KW - acceptability N2 - Background: The Portfolio Diet is a dietary pattern for cardiovascular disease (CVD) risk reduction with 5 key categories including nuts and seeds; plant protein from specific food sources; viscous fiber sources; plant sterols; and plant-derived monounsaturated fatty acid sources. To enhance implementation of the Portfolio Diet, we developed the PortfolioDiet.app, an automated, web-based, multicomponent, patient-facing health app that was developed with psychological theory. Objective: We aimed to evaluate the effect of the PortfolioDiet.app on dietary adherence and its acceptability among adults with a high risk of CVD over 12 weeks. Methods: Potential participants with evidence of atherosclerosis and a minimum of one additional CVD risk factor in an ongoing trial were invited to participate in a remote web-based ancillary study by email. Eligible participants were randomized in a 1:1 ratio using a concealed computer-generated allocation sequence to the PortfolioDiet.app group or a control group for 12 weeks. Adherence to the Portfolio Diet was assessed by weighed 7-day diet records at baseline and 12 weeks using the clinical Portfolio Diet Score, ranging from 0 to 25. Acceptability of the app was evaluated using a multifaceted approach, including usability through the System Usability Scale ranging from 0 to 100, with a score >70 being considered acceptable, and a qualitative analysis of open-ended questions using NVivo 12. Results: In total, 41 participants were invited from the main trial to join the ancillary study by email, of which 15 agreed, and 14 were randomized (8 in the intervention group and 6 in the control group) and completed the ancillary study. At baseline, adherence to the Portfolio Diet was high in both groups with a mean clinical Portfolio Diet Score of 13.2 (SD 3.7; 13.2/25, 53%) and 13.7 (SD 5.8; 13.7/25, 55%) in the app and control groups, respectively. After the 12 weeks, there was a tendency for a mean increase in adherence to the Portfolio Diet by 1.25 (SD 2.8; 1.25/25, 5%) and 0.19 (SD 4.4; 0.19/25, 0.8%) points in the app and control group, respectively, with no difference between groups (P=.62). Participants used the app on average for 18 (SD 14) days per month and rated the app as usable (System Usability Scale of mean 80.9, SD 17.3). Qualitative analyses identified 4 main themes (user engagement, usability, external factors, and added components), which complemented the quantitative data obtained. Conclusions: Although adherence was higher for the PortfolioDiet.app group, no difference in adherence was found between the groups in this small ancillary study. However, this study demonstrates that the PortfolioDiet.app is considered usable by high-risk adults and may reinforce dietitian advice to follow the Portfolio Diet when it is a part of a trial for CVD management. Trial Registration: ClinicalTrials.gov NCT02481466; https://clinicaltrials.gov/study/NCT02481466 UR - https://cardio.jmir.org/2025/1/e58124 UR - http://dx.doi.org/10.2196/58124 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58124 ER - TY - JOUR AU - Hagiwara, Yuta AU - Adachi, Takuji AU - Kanai, Masashi AU - Shimizu, Kotoe AU - Ishida, Shinpei AU - Miki, Takahiro PY - 2025/3/27 TI - Interactive Effects of Weight Recording Frequency and the Volume of Chat Communication With Health Care Professionals on Weight Loss in mHealth Interventions for Noncommunicable Diseases: Retrospective Observational Study JO - Interact J Med Res SP - e65863 VL - 14 KW - weight change KW - behavior modification KW - health care communication KW - weight recording KW - chat communication KW - text communication KW - health care professionals KW - weight loss KW - mHealth KW - mobile health KW - app KW - digital health KW - smartphone KW - mobile health intervention KW - noncommunicable disease KW - NCD KW - weight loss outcome KW - obesity KW - overweight KW - retrospective study KW - observational study KW - cerebrovascular disease KW - cardiovascular disease KW - lifestyle modification KW - mobile phone N2 - Background: Mobile health (mHealth) apps are increasingly used for health promotion, particularly for managing noncommunicable diseases (NCDs) through behavior modification. Understanding the factors associated with successful weight loss in such interventions can improve program effectiveness. Objective: This study examined factors influencing weight change and the relationship between weight recording frequency and chat volume with health care professionals on weight loss in individuals with obesity and NCDs. Methods: The participants had obesity (BMI ?25 kg/m²) and were diagnosed with NCDs (eg, hypertension, diabetes, dyslipidemia). The program included 12 telephone consultations with health care professionals. Only participants who completed the full 6-month program, including all 12 telephone consultations, and provided an end-of-study weight were included in the analysis. The primary outcome was the rate of weight change, defined as the percentage change in weight from the initial period (first 14 days) to the final period (2 weeks before the last consultation), relative to the initial weight. The key independent variables were proportion of days with weight recording and chat communication volume (total messages exchanged). An interaction term between these variables was included to assess moderation effects in the regression analysis. The volume of communication was measured as the total number of messages exchanged, with each message, regardless of who sent it, being counted as 1 interaction. Health care staffs were instructed to send a single scheduled chat message per week following each biweekly phone consultation. These scheduled messages primarily included personalized feedback, reminders, and motivational support. In addition, providers responded to participant-initiated messages at any time during the program. Furthermore, 1 professional responded to each participant. Hierarchical multiple regression and simple slope analyses were conducted to identify relationships and interactions among these variables. Results: The final analysis of this study included 2423 participants. Significant negative associations were found between the rate of weight change and baseline BMI (?=?.10; P<.001), proportion of days with weight recording (?=?.017; P<.001), and communication volume (?=?.193; P<.001). The interaction between proportion of days with weight recording and chat frequency also showed a significantly negative effect on weight change (?=?.01; P<.001). Simple slope analysis showed that when the proportion of days with weight recording was +1 SD above the mean, frequent chats were associated with greater weight reduction (slope=?0.60; P<.001), whereas no significant effect was observed at ?1 SD (slope=?0.01; P=.94) Conclusions: The findings suggest that both the proportion of days with weight recording and communication volume independently and interactively influence weight change in individuals with obesity and NCDs. UR - https://www.i-jmr.org/2025/1/e65863 UR - http://dx.doi.org/10.2196/65863 ID - info:doi/10.2196/65863 ER - TY - JOUR AU - Young, P. Nathan AU - Stern, I. Jennifer AU - Steel, J. Stephanie AU - Ebbert, O. Jon PY - 2025/3/26 TI - Mobile App-Based Interactive Care Plan for Migraine: Survey Study of Usability and Improvement Opportunities JO - JMIR Form Res SP - e66763 VL - 9 KW - migraine KW - remote monitoring KW - mobile app KW - mHealth KW - patient-reported outcomes KW - care plan KW - digital health KW - app KW - smartphone KW - eHealth KW - technology KW - survey study KW - headache KW - electronic health record KW - remote assessment KW - older adult KW - adult KW - electronic survey KW - pain KW - mobile phone KW - telehealth KW - telemedicine N2 - Background: We implemented a novel mobile app-based Migraine Interactive Care Plan (MICP) integrated with our electronic health records (EHRs). The MICP facilitates remote assessment of adult patients with migraine, educational content delivery, and care team communication. Feasibility of the MICP was demonstrated in a pilot implementation study. Objective: We aimed to assess the preferences and satisfaction of patients with migraine users of a mobile app-based care plan integrated with the EHR. Methods: An electronic survey was administered to a single cohort of MICP users between December 6, 2021, and December 30, 2021. The survey assessed patient preferences for which data to track, frequency of tracking, and satisfaction with the MICP. Survey responses were compared between subsets determined by patient-reported headache frequency and treatment with and without botulinum toxin and calcitonin gene-related peptide (CGRP) antagonist therapy. The Wilcoxon rank-sum test was used for continuous variables and the ?2 test or Fisher exact test for categorical variables. Results: The total sample size was 184 and the survey response rate was 30.4% (56/184). No significant differences in age (P=.26) or sex (P=.19) between respondents and nonrespondents were observed. Respondent median age was 42 (range 20?72) years and 94.6% (53/56) were female. Headache frequency was (1) 0 to 8 days (26/56, 46.4%), (2) 9 to 14 days (12/56, 21.4%), and (3) 15 or more days (18/56, 32.1%). No difference was observed in any survey responses based on headache frequency or treatment. The majority of respondents preferred to track headache days weekly (30/56, 53.6%) or daily (15/56, 26.8%) and preferred to change the frequency of headache tracking reminders (42/56, 75%). Respondents were somewhat or very interested in daily tracking personal observations in free text (41/52, 78.8%), medication treatment (43/52, 82.7%) and treatment response (39/56, 69.6%), class of medication treatment (36/52, 69.2%), severity of functional impairment (39/56, 69.6%), type of functional impairment (35/53, 66%), headache day (40/54, 74.1%), and headache pain level on a scale of 1 to 10 (38/53, 71.7%). Respondents agreed or strongly agreed that the education content was useful (31/51, 60.8%) but lacked personalization (25/51, 49%). Most respondents agreed or strongly agreed that they were satisfied with the MICP (38/50, 76%) and that it helped them communicate with their care team (38/53, 71.7%). Conclusions: Most MICP users were motivated to track headache frequency, medication treatment with response, functional impairment, and pain intensity. Opportunities to improve the MICP include (1) allowing patients to change the frequency of assessments and notifications; (2) recording personal observations or comments through free text, which may include headache triggers; (3) assessment of headache severity using a 1 to 10 pain scale; and (4) tailoring headache education based on frequency and severity (episodic vs chronic migraine). These observations may be useful to improve the usability of the MICP and similar EHR-integrated migraine care platforms that others may develop. UR - https://formative.jmir.org/2025/1/e66763 UR - http://dx.doi.org/10.2196/66763 ID - info:doi/10.2196/66763 ER - TY - JOUR AU - Naef, C. Aileen AU - Duarte, Guichande AU - Neumann, Saskia AU - Shala, Migjen AU - Branscheidt, Meret AU - Easthope Awai, Chris PY - 2025/3/26 TI - Toward Unsupervised Capacity Assessments for Gait in Neurorehabilitation: Validation Study JO - J Med Internet Res SP - e66123 VL - 27 KW - gait analysis KW - gait rehabilitation KW - 10-meter walk test KW - stroke KW - unsupervised assessments KW - supervised assessments KW - sensors KW - motivation KW - capacity KW - monitoring KW - wearables KW - stroke survivors KW - quality of life N2 - Background: Gait impairments are common in stroke survivors, negatively impacting their overall quality of life. Therefore, gait rehabilitation is often targeted during in-clinic rehabilitation. While standardized assessments are available for inpatient evaluation, the literature often reports variable results when these assessments are conducted in a home environment. Several factors, such as the presence of an observer, the environment itself, or the technology used, may contribute to these differing results. Therefore, it is relevant to establish unsupervised capacity assessments for both in-clinic use and across the continuum of care. Objective: This study aimed to investigate the effect of supervision on the outcomes of a sensor-based 10-meter walk test conducted in a clinical setting, maintaining a controlled environment and setup. Methods: In total, 21 stroke survivors (10 female, 11 male; age: mean 63.9, SD 15.5 years) were assigned alternately to one of two data collection sequences and tested over 4 consecutive days, alternating between supervised test (ST) and unsupervised test (UST) assessments. For both assessments, participants were required to walk a set distance of 10 meters as fast as possible while data were collected using a single wearable sensor (Physilog 5) attached to each shoe. After each walking assessment, the participants completed the Intrinsic Motivation Inventory. Statistical analyses were conducted to examine the mean speed, stride length, and cadence, across repeated measurements and between assessment conditions. Results: The intraclass correlation coefficient indicated good to excellent reliability for speed (ST: ?=0.93, P<.001; UST: ?=0.93, P<.001), stride length (ST: ?=0.92, P<.001; UST: ?=0.88, P<.001), and cadence (ST: ?=0.91, P<.001; UST: ?=0.95, P<.001) across repeated measurements for both ST and UST assessments. There was no significant effect of testing order (ie, sequence A vs B). Comparing ST and UST, there were no significant differences in speed (t39=?0.735, P=.47, 95% CI 0.06-0.03), stride length (z=0.835, P=.80), or cadence (t39=?0.501, P=.62, 95% CI 3.38-2.04) between the 2 assessments. The overall motivation did not show any significant differences between the ST and UST conditions (P>.05). However, the self-reported perceived competence increased during the unsupervised assessment from the first to the second measurement. Conclusions: Unsupervised gait capacity assessments offer a reliable alternative to supervised assessments in a clinical environment, showing comparable results for gait speed, stride length, and cadence, with no differences in overall motivation between the two. Future work should build upon these findings to extend unsupervised assessment of both capacity and performance in home environments. Such assessments could allow improved and more specific tracking of rehabilitation progress across the continuum of care. UR - https://www.jmir.org/2025/1/e66123 UR - http://dx.doi.org/10.2196/66123 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66123 ER - TY - JOUR AU - Kukreti, Shikha AU - Lu, Meng-Ting AU - Yeh, Chun-Yin AU - Ko, Nai-Ying PY - 2025/3/26 TI - Physiological Sensors Equipped in Wearable Devices for Management of Long COVID Persisting Symptoms: Scoping Review JO - J Med Internet Res SP - e69506 VL - 27 KW - wearable devices KW - long COVID KW - physiological sensors KW - review KW - COVID KW - COVID-19 N2 - Background: Wearable technology has evolved in managing COVID-19, offering early monitoring of key physiological parameters. However, the role of wearables in tracking and managing long COVID is less understood and requires further exploration of their potential. Objective: This review assessed the application and effectiveness of wearable devices in managing long COVID symptoms, focusing on commonly used sensors and their potential for improving long-term patient care. Methods: A literature search was conducted across databases including PubMed, Embase, Web of Science, and Cochrane Central, adhering to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines. The search was updated regularly throughout 2024. Abstract and full-text screening and selection were facilitated using Rayyan software developed by Qatar Computing Research Institute. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) critical appraisal tool to ensure the methodological rigor of the included studies. Data were extracted on study characteristics, wearable devices, sensors used, and monitored physiological parameters, and the results were synthesized in a narrative format. Results: A total of 1186 articles were identified, and after duplicate removal and screening, 15 studies were initially included, with 11 studies meeting the criteria for final data synthesis. The included studies varied in design, ranging from observational to interventional trials, and involved sample sizes from 3 to 17,667 participants across different countries. In total, 10 different wearable devices were used to monitor long COVID symptoms, capturing key metrics such as heart rate variability, body temperature, sleep, and physical activity. Smartwatches were the most used wearable devices and fitness trackers with electrocardiography and photoplethysmography sensors were used to monitor heart rate, oxygen saturation, and respiratory rate. Of the 10 devices, 4 were Food and Drug Administration?approved, emphasizing the reliability and validation of the physiological data collected. Studies were primarily conducted in the United States and Europe, reflecting significant regional research interest in wearable technology for long COVID management. Conclusions: This review highlights the potential of wearable technology in providing continuous and personalized monitoring for long COVID patients. Although wearables show promise in tracking persistent symptoms, further research is needed to improve usability, validate long-term efficacy, and enhance patient engagement. UR - https://www.jmir.org/2025/1/e69506 UR - http://dx.doi.org/10.2196/69506 UR - http://www.ncbi.nlm.nih.gov/pubmed/40137051 ID - info:doi/10.2196/69506 ER - TY - JOUR AU - Liu, Chang AU - Chamberlain, Samuel AU - Ioannidis, Konstantinos AU - Tiego, Jeggan AU - Grant, Jon AU - Yücel, Murat AU - Hellyer, Peter AU - Lochner, Christine AU - Hampshire, Adam AU - Albertella, Lucy PY - 2025/3/26 TI - Transdiagnostic Compulsivity Traits in Problematic Use of the Internet Among UK Residents: Cross-Sectional Network Analysis Study JO - J Med Internet Res SP - e66191 VL - 27 KW - compulsivity KW - problematic use of the internet KW - network analysis KW - perfectionism KW - reward drive KW - cognitive rigidity KW - transdiagnostic KW - PUI KW - mental health KW - intrapersonal factor KW - cognitive KW - internet use KW - network N2 - Background: The societal and public health costs of problematic use of the internet (PUI) are increasingly recognized as a concern across all age groups, presenting a growing challenge for mental health research. International scientific initiatives have emphasized the need to explore the potential roles of personality features in PUI. Compulsivity is a key personality trait associated with PUI and has been recognized by experts as a critical factor that should be prioritized in PUI research. Given that compulsivity is a multidimensional construct and PUI encompasses diverse symptoms, different underlying mechanisms are likely involved. However, the specific relationships between compulsivity dimensions and PUI symptoms remain unclear, limiting our understanding of compulsivity?s role in PUI. Objective: This study aimed to clarify the unique relationships among different dimensions of compulsivity, namely, perfectionism, reward drive, cognitive rigidity, and symptoms of PUI using a symptom-based network approach. Methods: A regularized partial-correlation network was fitted using a large-scale sample from the United Kingdom. Bridge centrality analysis was conducted to identify bridge nodes within the network. Node predictability analysis was performed to assess the self-determination and controllability of the nodes within the network. Results: The sample comprised 122,345 individuals from the United Kingdom (51.4% female, age: mean 43.7, SD 16.5, range 9-86 years). The analysis identified several strong mechanistic relationships. The strongest positive intracluster edge was between reward drive and PUI4 (financial consequences due to internet use; weight=0.11). Meanwhile, the strongest negative intracluster edge was between perfectionism and PUI4 (financial consequences due to internet use; weight=0.04). Cognitive rigidity showed strong relationships with PUI2 (internet use for distress relief; weight=0.06) and PUI3 (internet use for loneliness or boredom; weight=0.07). Notably, reward drive (bridge expected influence=0.32) and cognitive rigidity (bridge expected influence=0.16) were identified as key bridge nodes, positively associated with PUI symptoms. Meanwhile, perfectionism exhibited a negative association with PUI symptoms (bridge expected influence=?0.05). The network?s overall mean predictability was 0.37, with PUI6 (compulsion, predictability=0.55) showing the highest predictability. Conclusions: The findings reveal distinct relationships between different dimensions of compulsivity and individual PUI symptoms, supporting the importance of choosing targeted interventions based on individual symptom profiles. In addition, the identified bridge nodes, reward drive, and cognitive rigidity may represent promising targets for PUI prevention and intervention and warrant further investigation. UR - https://www.jmir.org/2025/1/e66191 UR - http://dx.doi.org/10.2196/66191 UR - http://www.ncbi.nlm.nih.gov/pubmed/40137076 ID - info:doi/10.2196/66191 ER - TY - JOUR AU - Inderstrodt, Jill AU - Stumpff, C. Julia AU - Smollen, C. Rebecca AU - Sridhar, Shreya AU - El-Azab, A. Sarah AU - Ojo, Opeyemi AU - Bowns, Brendan AU - Haggstrom, A. David PY - 2025/3/25 TI - Informatics Interventions for Maternal Morbidity: Scoping Review JO - Interact J Med Res SP - e64826 VL - 14 KW - scoping review KW - maternal morbidity KW - medical informatics KW - clinical informatics KW - mother KW - pregnant KW - perinatal KW - GDM KW - preeclampsia KW - maternity KW - gestational diabetes mellitus N2 - Background: Women have been entering pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk women is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions. Objective: This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity. Methods: MEDLINE, Embase, and Cochrane Library were searched to identify relevant studies. The inclusion criteria were studies that tested a medical or clinical informatics intervention; enrolled adult women; and addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, Centers for Disease Control and Prevention?defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed. Results: A total of 80 studies were identified that met the inclusion criteria. Many of the studies tested for multiple conditions. Of these, 73% (60/82) of the technologies were tested for either GDM or perinatal mental health conditions, and 15% (12/82) were tested for preeclampsia. For technologies, 32% (28/87) of the technologies tested were smartphone or tablet applications, 26% (23/87) were telehealth interventions, and 14% (12/87) were remote monitoring technologies. Of the many outcomes measured by the studies, almost half (69/140, 49%) were patient physical or mental health outcomes. Conclusions: Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile apps. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may be opportunities to use informatics for lesser-targeted conditions and populations. UR - https://www.i-jmr.org/2025/1/e64826 UR - http://dx.doi.org/10.2196/64826 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64826 ER - TY - JOUR AU - Rookes, Alanna Tasmin AU - Batla, Amit AU - Armstrong, Megan AU - Ambler, Gareth AU - Walters, Kate AU - Schrag, Anette PY - 2025/3/25 TI - Patient Acceptability and Technical Reliability of Wearable Devices Used for Monitoring People With Parkinson Disease: Survey Study JO - JMIR Form Res SP - e63704 VL - 9 KW - Parkinson disease KW - feasibility KW - remote monitoring KW - Parkinson KW - acceptability KW - reliability KW - wearable devices KW - wearable KW - self-management KW - quantitative assessments KW - quantitative KW - qualitative KW - monitoring KW - patient N2 - Background: Parkinson disease is a progressive neurodegenerative disorder with complex motor and nonmotor symptoms. To assess these, clinical assessments are completed, providing a snapshot of a person?s experience. Monitoring Parkinson disease using wearable devices can provide continuous and objective data and capture information on movement patterns in daily life. Objective: The aim of the study is to assess patient acceptability and technical reliability of 2 wearable devices used in clinical trials (ActivInsights and Axivity AX3). Methods: Participants in a feasibility study testing a self-management toolkit (PD-Care) optionally wore a wearable device for 1 week, providing feedback through an open- and closed-question survey conducted over the telephone about the acceptability of wearing the device. The closed questions used a Likert scale from 1 to 5 (with 1=strongly agree and 5=strongly disagree) asking whether (1) the device was comfortable to wear, (2) the device was easy to put on, (3) the device was easy to wear, (4) the device was embarrassing to wear, and (5) if they were happy to wear the device for longer than 7 days. Differences in acceptability between devices were analyzed using Mann-Whitney U tests and Wilcoxon matched pairs signed rank tests. These were followed by open-ended questions asking (1) How did you find wearing the device? (2) How did you find putting the device on? (3) Did you take it off and why? (4) What was your overall impression? (5) Did you prefer the wrist- or trunk-worn device and why (Axivity AX3 only)? Results: A total of 22 of 32 (69%) participants offered the device agreed to wear it. There were no significant differences in the demographic characteristics between those monitored and those who chose not to be. Acceptance with both devices was generally good. The ActivInsights device was more acceptable than the wrist- and trunk-worn Axivity AX3 devices, as more participants found it to be comfortable (n=15, 100% vs n=5, 71%; P=.02 and n=4, 57%; P=.004, respectively), easy to wear (n=15, 100% vs n=6, 86%; P=.048 and n=3, 43%; P=.004, respectively) and would wear for more than 7 days (n=13, 87% vs n=4, 57%; P=.02 and n=1, 14%; P<.001, respectively). The trunk-worn Axivity AX3 device had the lowest acceptance rates, but there were no statistical differences in acceptability between the wrist- and trunk-worn Axivity AX3 devices (all P>.05). There were issues with battery life and recording errors in 3 of 14 (21%) Axivity AX3 devices and upload failures in 3 of 15 (20%) ActivInsights devices. Conclusions: Acceptability of wearables for monitoring Parkinson was satisfactory, especially when wrist-worn, although a few participants experienced difficulties in correct use, and there were some errors with the data upload. Trial Registration: ISRCTN Registry ISRCTN92831552; https://www.isrctn.com/ISRCTN92831552 UR - https://formative.jmir.org/2025/1/e63704 UR - http://dx.doi.org/10.2196/63704 ID - info:doi/10.2196/63704 ER - TY - JOUR AU - Chen, Si AU - Ebrahimi, V. Omid AU - Cheng, Cecilia PY - 2025/3/25 TI - New Perspective on Digital Well-Being by Distinguishing Digital Competency From Dependency: Network Approach JO - J Med Internet Res SP - e70483 VL - 27 KW - digital wellness KW - affective well-being KW - emotional regulation KW - coping KW - digital competence KW - digital autonomy KW - artificial intelligence N2 - Background: In the digital age, there is an emerging area of research focusing on digital well-being (DWB), yet conceptual frameworks of this novel construct are lacking. The current conceptualization either approaches the concept as the absence of digital ill-being, running the risk of pathologizing individual digital use, or follows the general subjective well-being framework, failing to highlight the complex digital nature at play. Objective: This preregistered study aimed to address this gap by using a network analysis, which examined the strength of the relationships among affective (digital stress and web-based hedonic well-being), cognitive (online intrinsic needs satisfaction), and social (online social connectedness and state empathy) dimensions of DWB and their associations with some major DWB protective and risk factors (ie, emotional regulation, nomophobia, digital literacy, self-control, problematic internet use, coping styles, and online risk exposure). Methods: The participants were 578 adults (mean age 38.7, SD 13.14 y; 277/578, 47.9% women) recruited from the United Kingdom and the United States who completed an online survey. Two network models were estimated. The first one assessed the relationships among multiple dimensions of DWB, and the second examined the relationships between DWB dimensions and related protective and risk factors. Results: The 2 resulting network structures demonstrated high stability, with the correlation stability coefficients being 0.67 for the first and 0.75 for the second regularized Gaussian graphical network models. The first network indicated that all DWB variables were positively related, except for digital stress, which was negatively correlated with the most central node?online intrinsic needs satisfaction. The second network revealed 2 distinct communities: digital competency and digital dependency. Emotional regulation emerged as the most central node with the highest bridge expected influence, positively associated with emotion-focused coping in the digital competency cluster and negatively associated with avoidant coping in the digital dependency cluster. In addition, some demographic differences were observed. Women scored higher on nomophobia (?24=10.7; P=.03) and emotion-focused coping (?24=14.9; P=.01), while men scored higher on digital literacy (?24=15.2; P=.01). Compared with their older counterparts, younger individuals scored lower on both emotional regulation (Spearman ?=0.27; P<.001) and digital self-control (Spearman ?=0.35; P<.001) and higher on both digital stress (Spearman ?=?0.14; P<.001) and problematic internet use (Spearman ?=?0.25; P<.001). Conclusions: The network analysis revealed how different aspects of DWB were interconnected, with the cognitive component being the most influential. Emotional regulation and adaptive coping strategies were pivotal in distinguishing digital competency from dependency. UR - https://www.jmir.org/2025/1/e70483 UR - http://dx.doi.org/10.2196/70483 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70483 ER - TY - JOUR AU - Böttinger, Johanna Melissa AU - Mellone, Sabato AU - Klenk, Jochen AU - Jansen, Carl-Philipp AU - Stefanakis, Marios AU - Litz, Elena AU - Bredenbrock, Anastasia AU - Fischer, Jan-Philipp AU - Bauer, M. Jürgen AU - Becker, Clemens AU - Gordt-Oesterwind, Katharina PY - 2025/3/21 TI - A Smartphone-Based Timed Up and Go Test Self-Assessment for Older Adults: Validity and Reliability Study JO - JMIR Aging SP - e67322 VL - 8 KW - timed up and go test KW - self-assessment KW - instrumented assessment KW - technology-based assess-ment KW - physical capacity KW - mobility KW - aged KW - mobile applications KW - smartphone KW - diagnostic self evaluation N2 - Background: The Timed Up and Go test (TUG) is recommended as an evidence-based tool for measuring physical capacity. Instrumented TUG (iTUG) approaches expand classical supervised clinical applications offering the potential of self-assessment for older adults. Objective: This study aimed to evaluate the concurrent validity and test-retest reliability of a smartphone-based TUG self-assessment ?up&go app.? Methods: A total of 52 community-dwelling older adults (>67 years old) were recruited. A validated and medically certified system attached with a belt at the lower back was used as a reference system to validate the ?up&go app? algorithm. The participants repeated the TUG 5 times wearing, a smartphone with the ?up&go app? in their front trouser pocket and an inertial sensor to test the concurrent validity. A subsample of 37 participants repeated the ?up&go app? measurement 2 weeks later to examine the test-retest reliability. Results: The correlation between the ?up&go app? and the reference measurement was r=0.99 for the total test duration and r=0.97 for the 5 single repetitions. Agreement between the 5 repetitions was intraclass correlation coefficient (ICC)=0.9 (0.84?0.94). Leaving out the first repetition, the agreement was ICC=0.95 (0.92?0.97). Test-retest agreement had an ICC=0.79 (0.53?0.9). Conclusions: The duration of 5 repetitions of the TUG test, measured with the pocket-worn ?up&go app,? was very consistent with the results of a lower-back sensor system, indicating excellent concurrent validity. Participants walked slower in the first round than in the other 4 repetitions within a test run. Test-retest reliability was also excellent. The ?up&go app? provides a useful smartphone-based approach to measure 5 repetitions of the TUG. The app could be used by older adults as a self-screening and monitoring tool of physical capacity at home and thereby help to early identify functional limitations and take interventions when necessary. UR - https://aging.jmir.org/2025/1/e67322 UR - http://dx.doi.org/10.2196/67322 ID - info:doi/10.2196/67322 ER - TY - JOUR AU - Wei, Lan AU - Wu, Yongsheng AU - Chen, Lin AU - Cheng, Jinquan AU - Zhao, Jin PY - 2025/3/20 TI - Spatiotemporal and Behavioral Patterns of Men Who Have Sex With Men Using Geosocial Networking Apps in Shenzhen From Mobile Big Data Perspective: Longitudinal Observational Study JO - J Med Internet Res SP - e69569 VL - 27 KW - men who have sex with men KW - geosocial networking apps KW - distribution KW - heterogeneity KW - mobility KW - HIV testing KW - risk behavior KW - big data N2 - Background: The use of geosocial networking apps is linked to increased risky sexual behaviors among men who have sex with men, but their relationship with HIV and other sexually transmitted infections remains inconclusive. Since 2015, the prevalence of app use among men who have sex with men in Shenzhen has surged, highlighting the need for research on their spatiotemporal and behavioral patterns to inform targeted prevention and intervention strategies. Objective: This study aims to investigate the population size, spatiotemporal and behavioral patterns, and mobility of app-using men who have sex with men in Shenzhen using mobile big data. The goal is to inform enhanced and innovative intervention strategies and guide health resource allocation. Methods: By leveraging mobile big data application technology, we collected demographic and geographic location data from 3 target apps?Blued (Blued Inc), Jack'd (Online Buddies Inc), and Zank (Zank Group)?over continuous time periods. Spatial autocorrelation (Global Moran I) and hot spot analysis (Getis-Ord Gi) were used to identify the geographic clusters. The Geodetector tool (Chinese Academy of Sciences) was adopted to measure spatially stratified heterogeneity features. Results: From September 2017 to August 2018, a total of 158,387 males aged 15-69 years in Shenzhen used one of the 3 apps, with the majority (71,318, 45.03%) aged 25-34 years. The app user-to-male ratio was approximately 2.6% among all males aged 15-69 years. The estimated population of app-using men who have sex with men in Shenzhen during this period was 268,817. The geographic distribution of app-using men who have sex with men in Shenzhen was clustered, with hot spots primarily located in central and western Shenzhen, while the distribution of HIV testing and counseling was more concentrated in central-eastern Shenzhen. Approximately 60,202 (38%) app-using men who have sex with men left Shenzhen during the Spring Festival, and 37,756 (62.7%) of them returned after the holiday. The destination distribution showed a relatively centralized flow throughout the country, with the largest mobility within Guangdong province (67.7%), followed by lower mobility to Hunan province (7.9%) and other neighboring provinces (3%-5%), such as Jiangxi, Guangxi, and Hubei Provinces. Conclusions: Shenzhen has a large population of men who have sex with men. The variation and inconsistent spatiotemporal distribution of app use and HIV testing and counseling emphasize the need to adapt traditional venue-based prevention and intervention to identified hot spots and to launch outreach initiatives that extend beyond traditional healthcare settings. Given the relatively high internal and interprovincial mobility of app-using men who have sex with men, further smartphone-based behavioral monitoring could provide valuable insights for developing enhanced and innovative HIV prevention and intervention strategies. Moreover, our study demonstrates the potential of mobile big data to address critical research gaps often overlooked by traditional methods. UR - https://www.jmir.org/2025/1/e69569 UR - http://dx.doi.org/10.2196/69569 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69569 ER - TY - JOUR AU - Patchen, Loral AU - Tsuei, Jeannette AU - Sherard, Donna AU - Moriarty, Patricia AU - Mungai-Barris, Zoe AU - Ma, Tony AU - Bajracharya, Elina AU - Chang, Katie AU - Evans, Douglas William PY - 2025/3/19 TI - Designing a Digital Intervention to Increase Human Milk Feeding Among Black Mothers: Qualitative Study of Acceptability and Preferences JO - JMIR Form Res SP - e67284 VL - 9 KW - health equity KW - breastfeeding KW - qualitative KW - mobile health KW - black mothers KW - preferences KW - cultural tailoring KW - mobile phone N2 - Background: Breastfeeding rates among US mothers, particularly Black or African American mothers, fall short of recommended guidelines. Despite the benefits of human milk, only 24.9% of all infants receive human milk exclusively at 6 months. Objective: Our team previously explored the key content areas a mobile health intervention should address and the usability of an initial prototype of the Knowledge and Usage of Lactation using Education and Advice from Support Network (KULEA-NET), an evidence-based mobile breastfeeding app guided by preferences of Black or African American parents. This study aimed to identify the preferences and acceptability of additional features, content, and delivery methods for an expanded KULEA-NET app. Key social branding elements were defined to guide app development as a trusted adviser. The study also aimed to validate previous findings regarding approaches to supporting breastfeeding goals and cultural tailoring. Methods: We conducted a qualitative study using in-depth interviews and focus groups with potential KULEA-NET users. A health branding approach provided a theoretical framework. We recruited 24 participants across 12 interviews and 2 focus groups, each with 6 participants. The Data methods aligned with qualitative research principles and concluded once saturation was reached. Given the focus on cultural tailoring, team members who shared social identities with study participants completed data collection and coding. Two additional team members, 1 with expertise in social branding and 1 certified in lactation, participated in the thematic analysis. Results: All participants identified as Black or African American mothers, and most interview participants (7/12, 58%) engaged in exclusive breastfeeding. In total, 4 themes were recognized. First, participants identified desired content, specifying peer support, facilitated access to experts, geolocation to identify resources, and tracking functions. Second, delivery of content differentiated platforms and messaging modality. Third, functionality and features were identified as key factors, highlighting content diversity, ease of use, credibility, and interactivity. Finally, appealing aspects of messaging to shape a social brand highlighted support and affirmation, inclusivity and body positivity, maternal inspiration, maternal identity, social norms, and barriers to alignment with aspirational maternal behaviors as essential qualities. Crosscutting elements of themes included a desire to communicate with other mothers in web-based forums and internet-based or in-person support groups to help balance the ideal medical recommendations for infant feeding with the contextual realities and motivations of mothers. Participants assigned high value to personalization and emphasized a need to achieve both social and factual credibility. Conclusions: This formative research suggested additional elements for an expanded KULEA-NET app that would be beneficial and desired. The health branding approach to establish KULEA-NET as a trusted adviser is appealing and acceptable to users. Next steps include developing full app functionality that reflects these findings and then testing the updated KULEA-NET edition in a randomized controlled trial. UR - https://formative.jmir.org/2025/1/e67284 UR - http://dx.doi.org/10.2196/67284 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67284 ER - TY - JOUR AU - Vinci, Christine AU - Sutton, K. Steve AU - Yang, Min-Jeong AU - Jones, R. Sarah AU - Kumar, Santosh AU - Wetter, W. David PY - 2025/3/19 TI - Proximal Effects of a Just-in-Time Adaptive Intervention for Smoking Cessation With Wearable Sensors: Microrandomized Trial JO - JMIR Mhealth Uhealth SP - e55379 VL - 13 KW - smoking cessation KW - mindfulness KW - ecological momentary assessment KW - micro-randomized trial KW - Just-in-Time Adaptive Intervention KW - JITAI KW - EMA KW - ecological momentary KW - smoking KW - smokers KW - quitting KW - cessation KW - meditation KW - mind body KW - sensors KW - motivational KW - tobacco KW - nicotine KW - NRT KW - counseling KW - wearables KW - abstinence KW - stress KW - craving KW - adaptive intervention KW - mobile phone N2 - Background: Tobacco use remains the leading preventable cause of morbidity and mortality in the United States. Novel interventions are needed to improve smoking cessation rates. Mindfulness-based interventions (MBIs) for cessation address tobacco use by increasing awareness of the automatic nature of smoking and related behaviors (eg, reactivity to triggers for smoking) from a nonjudgmental stance. Delivering MBIs for smoking cessation via innovative technologies allows for flexibility in the timing of intervention delivery, which has the potential to improve the efficacy of cessation interventions. Research shows MBIs target key mechanisms in the smoking cessation process and can be used to minimize drivers of smoking lapse. Objective: This single-arm study investigated the impact of mindfulness-based strategies and motivational messages on proximal outcomes, collected via ecological momentary assessment (EMA), relevant to tobacco abstinence via a microrandomized trial. This approach allows for the evaluation of intervention content on proximal outcomes (eg, reduced negative affect) that are thought to impact positive distal outcomes (eg, smoking abstinence). Methods: All participants were motivated to quit smoking, and the intervention they received included nicotine replacement therapy, brief individual counseling, and a 2-week Just-in-Time Adaptive Intervention (JITAI) with wearable sensors. Throughout the JITAI period, a single strategy was randomly pushed (vs not) multiple times per day through the smartphone application. An EMA next assessed negative affect, positive affect, mindfulness, abstinence self-efficacy, motivation to quit, craving, and smoking motives. The primary analyses evaluated differences in EMA outcomes (proximal) for when a strategy was pushed versus not pushed. Additional analyses evaluated changes in similar outcomes collected from surveys at the baseline and end-of-treatment visits. Results: Participants (N=38) were 63% (24/38) female, 18% (7/38) Hispanic or Latino, and 29% (11/38) African American. They had an average age of 49 years and smoked an average of 15 (SD 7.9) cigarettes per day. Results indicated that receiving the JITAI significantly reduced proximal negative affect in the second (and final) week of the intervention. Self-reports provided at baseline and end of treatment showed significant decreases in perceived stress, automaticity of smoking and craving, and a significant increase in abstinence self-efficacy. Increases in abstinence self-efficacy significantly predicted abstinence. Conclusions: To our knowledge, this is the first study to test the proximal impact of a mindfulness-based JITAI on key variables associated with smoking cessation. Our primary finding was that negative affect was lower following the completion of a strategy (vs when no strategy was delivered) in the final week of the JITAI. Among a larger sample size, future research should extend the length of the intervention to further evaluate the impact of the JITAI, as well as include a comparison condition to further evaluate how each component of the intervention uniquely impacts outcomes. Trial Registration: ClinicalTrials.gov NCT03404596; https://clinicaltrials.gov/study/NCT03404596 UR - https://mhealth.jmir.org/2025/1/e55379 UR - http://dx.doi.org/10.2196/55379 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55379 ER - TY - JOUR AU - Vey, Trinity AU - Kinnicutt, Eleonora AU - Day, G. Andrew AU - West, Nicola AU - Sleeth, Jessica AU - Nchimbi, Bernard Kenneth AU - Yeates, Karen PY - 2025/3/19 TI - Targeted Behavior Change Communication Using a Mobile Health Platform to Increase Uptake of Long-Lasting Insecticidal Nets Among Pregnant Women in Tanzania: Hati Salama ?Secure Voucher? Study Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e51524 VL - 27 KW - malaria prevention KW - pregnant KW - mHealth KW - mobile health KW - short message service KW - behaviour change communication KW - long-lasting insecticidal nets KW - protozoan infections KW - parasitic diseases KW - vector borne diseases KW - randomized controlled trial KW - morbidity KW - mortality KW - intervention N2 - Background: Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention. Objective: This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania. Methods: This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data. Results: The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers. Conclusions: The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 UR - https://www.jmir.org/2025/1/e51524 UR - http://dx.doi.org/10.2196/51524 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51524 ER - TY - JOUR AU - Kang, Hyunjin AU - Yang, Tingting AU - Banu, Nazira AU - Ng, Ting Sheryl Wei AU - Lee, Kyu Jeong PY - 2025/3/19 TI - Exploring Smart Health Wearable Adoption Among Singaporean Older Adults Based on Self-Determination Theory: Web-Based Survey Study JO - JMIR Aging SP - e69008 VL - 8 KW - smart health wearables KW - self-determination theory KW - AI anxiety KW - perceived privacy risk KW - health consciousness N2 - Background: Smart health wearables offer significant benefits for older adults, enabling seamless health monitoring and personalized suggestions based on real-time data. Promoting adoption and sustained use among older adults is essential to empower autonomous health management, leading to better health outcomes, improved quality of life, and reduced strain on health care systems. Objective: This study investigates how autonomy-related contextual factors, including artificial intelligence (AI) anxiety, perceived privacy risks, and health consciousness, are related to older adults? psychological needs of competence, autonomy, and relatedness (RQ1). We then examined whether the fulfillment of these needs positively predicts older adults? intentions to adopt these devices (H1), and how they mediate the relationship between these factors and older adults? intentions to use smart health wearables (RQ2). Additionally, it compares experienced and nonexperienced older adult users regarding the influence of these psychological needs on use intentions (RQ3). Methods: A web-based survey was conducted with individuals aged 60 years and above in Singapore, using a Qualtrics survey panel. A total of 306 participants (177 male; mean age of 65.47 years, age range 60?85 years) completed the survey. A structural equation model was used to analyze associations among AI anxiety, perceived privacy risks, and health consciousness, and the mediating factors of competence, autonomy, and relatedness, as well as their relationship to smart health wearable use intention. Results: Health consciousness positively influenced all intrinsic motivation factors?competence, autonomy, and relatedness?while perceived privacy risks negatively affected all three. AI anxiety was negatively associated with competence only. Both privacy risk perceptions and health consciousness were indirectly linked to older adults? intentions to use smart health wearables through competence and relatedness. No significant differences were found in motivational structures between older adults with prior experience and those without. Conclusions: This study contributes to the application of self-determination theory in promoting the use of smart technology for health management among older adults. The results highlight the critical role of intrinsic motivation?particularly competence?in older adults? adoption of smart health wearables. While privacy concerns diminish motivation, health consciousness fosters it. The study results offer valuable implications for designing technologies that align with older adults? motivations, potentially benefiting aging populations in other technologically advanced societies. Developers should focus on intuitive design, transparent privacy practices, and social features to encourage adoption, empowering older adults to use smart wearables for proactive health management. UR - https://aging.jmir.org/2025/1/e69008 UR - http://dx.doi.org/10.2196/69008 ID - info:doi/10.2196/69008 ER - TY - JOUR AU - Bianchini, Edoardo AU - Rinaldi, Domiziana AU - De Carolis, Lanfranco AU - Galli, Silvia AU - Alborghetti, Marika AU - Hansen, Clint AU - Suppa, Antonio AU - Salvetti, Marco AU - Pontieri, Ernesto Francesco AU - Vuillerme, Nicolas PY - 2025/3/18 TI - Reliability of Average Daily Steps Measured Through a Consumer Smartwatch in Parkinson Disease Phenotypes, Stages, and Severities: Cross-Sectional Study JO - JMIR Form Res SP - e63153 VL - 9 KW - gait KW - Parkinson disease KW - phenotype KW - wearable sensors KW - smartwatch KW - step count KW - reliability KW - activity monitor KW - digital health technology KW - digital outcome measures KW - wearable KW - mHealth KW - motor KW - quality of life KW - fall KW - posture KW - mobile health N2 - Background: Average daily steps (avDS) could be a valuable indicator of real-world ambulation in people with Parkinson disease (PD), and previous studies have reported the validity and reliability of this measure. Nonetheless, no study has considered disease phenotype, stage, and severity when assessing the reliability of consumer wrist-worn devices to estimate daily step count in unsupervised, free-living conditions in PD. Objective: This study aims to assess and compare the reliability of a consumer wrist-worn smartwatch (Garmin Vivosmart 4) in counting avDS in people with PD in unsupervised, free-living conditions among disease phenotypes, stages, and severity groups. Methods: A total of 104 people with PD were monitored through Garmin Vivosmart 4 for 5 consecutive days. Total daily steps were recorded and avDS were calculated. Participants were dichotomized into tremor dominant (TD; n=39) or postural instability and gait disorder (PIGD; n=65), presence (n=57) or absence (n=47) of tremor, and mild (n=65) or moderate (n=39) disease severity. Based on the modified Hoehn and Yahr scale (mHY), participants were further dichotomized into earlier (mHY 1?2; n=68) or intermediate (mHY 2.5?3; n=36) disease stages. Intraclass correlation coefficient (ICC; 3,k), standard error of measurement (SEM), and minimal detectable change (MDC) were used to evaluate the reliability of avDS for each subgroup. The threshold for acceptability was set at an ICC ?0.8 with a lower bound of 95% CI ?0.75. The 2-tailed Student t tests for independent groups and analysis of 83.4% CI overlap were used to compare ICC between each group pair. Results: Reliability of avDS measured through Garmin Vivosmart 4 for 5 consecutive days in unsupervised, free-living conditions was acceptable in the overall population with an ICC of 0.89 (95% CI 0.85?0.92), SEM below 10%, and an MDC of 1580 steps per day (27% of criterion). In all investigated subgroups, the reliability of avDS was also acceptable (ICC range 0.84?0.94). However, ICCs were significantly lower in participants with tremor (P=.03), with mild severity (P=.04), and earlier stage (P=.003). Moreover, SEM was below 10% in participants with PIGD phenotype, without tremor, moderate disease severity, and intermediate disease stage, with an MDC ranging from 1148 to 1687 steps per day (18%?25% of criterion). Conversely, in participants with TD phenotype, tremor, mild disease severity, and earlier disease stage, SEM was >10% of the criterion and MDC values ranged from 1401 to 2263 steps per day (30%?33% of the criterion). Conclusions: In mild-to-moderate PD, avDS measured through a consumer smartwatch in unsupervised, free-living conditions for 5 consecutive days are reliable irrespective of disease phenotype, stage, and severity. However, in individuals with TD phenotype, tremor, mild disease severity, and earlier disease stages, reliability could be lower. These findings could facilitate a broader and informed implementation of avDS as an index of ambulatory activity in PD. UR - https://formative.jmir.org/2025/1/e63153 UR - http://dx.doi.org/10.2196/63153 ID - info:doi/10.2196/63153 ER - TY - JOUR AU - Alexander, D. Jordan AU - Duffy, A. Kelly AU - Freis, M. Samantha AU - Chow, Sy-Miin AU - Friedman, P. Naomi AU - Vrieze, I. Scott PY - 2025/3/17 TI - Investigating the Magnitude and Persistence of COVID-19?Related Impacts on Affect and GPS-Derived Daily Mobility Patterns in Adolescence and Emerging Adulthood: Insights From a Smartphone-Based Intensive Longitudinal Study of Colorado-Based Youths From June 2016 to April 2022 JO - J Med Internet Res SP - e64965 VL - 27 KW - adolescence KW - emerging adulthood KW - intensive longitudinal assessment KW - COVID-19 KW - affect KW - GPS KW - mobility patterns KW - smartphone data KW - respiratory KW - infectious KW - pulmonary KW - pandemic KW - adolescents KW - teens KW - teenagers KW - mobility KW - apps KW - smartphones KW - intensive longitudinal panel studies KW - emotional well-being KW - well-being KW - daily routines KW - affect survey N2 - Background: The onset of the COVID-19 pandemic in early 2020 introduced unprecedented disruptions impacting the emotional well-being and daily routines of US youths. However, the patterns and persistence of these impacts over the pandemic?s multiyear course remain less well understood. Objective: This study examined longitudinal changes in affect and daily mobility patterns observed in adolescence and young adulthood from June 2016 to April 2022. The study aimed to quantify changes in youths? mood and daily routines following the pandemic?s onset and in response to local COVID-19 case rates as well as the persistence of these effects over the pandemic?s multiyear course. Methods: Colorado-based adolescent and young adult twins (N=887; n=479, 54% female; meanage 19.2, SDage 1.5 years on January 01, 2020) participating in the CoTwins study between June 2016 and April 2022 were followed via a smartphone app, which recorded persistent GPS location data and, beginning in February 2019, administered an abbreviated Positive and Negative Affect Schedule every 2 weeks. Nonlinear trajectories in affect and daily mobility over time and in response to local COVID-19 counts were modeled via generalized additive mixed models, while the magnitude and persistence of pandemic-related changes were quantified via linear mixed effects regressions. Results: Between January and April 2020, participants experienced a 28.6% decline in daily locations visited (from 3.5 to 2.5; SD 0.9) and a 60% reduction in daily travel distance (from 20.0 to 8.0 km; SD 9.4). Mean positive affect similarly declined by 0.3 SD (from 3.0 to 2.79; SD 0.6), while, correspondingly, mean negative affect increased by 0.3 SD (from 1.85 to 2.10; SD 0.6). Though mobility levels partially recovered beginning in the summer of 2020, daily locations visited remained slightly below 2019 levels through the study?s conclusion in April 2022 (standardized ?=?0.10; P<.001). Average positive affect similarly remained slightly below (standardized ?=?0.20; P<.001) and negative affect slightly above (standardized ?=0.14; P=.04) 2019 levels through April 2022. Weekly county-level COVID-19 transmission rates were negatively associated with mobility and positive affect and positively with negative affect, though these effects were greatly weakened later in the pandemic (eg, early 2022) or when transmission rates were high (eg, >200 new cases per 100,000 people per week). Conclusions: Findings demonstrate large initial declines in daily mobility, a moderate decline in positive affect, and a moderate increase in negative affect following the pandemic?s onset in 2020. Though most effects attenuated over time, affect and mobility levels had not recovered to prepandemic levels by April 2022. Findings support theories of hedonic adaptation and resiliency while also identifying lingering emotional and behavioral consequences. The study highlights both youth?s resiliency in adapting to major stressors while also underscoring the need for continued support for youth mental health and psychosocial functioning in the pandemic?s aftermath. UR - https://www.jmir.org/2025/1/e64965 UR - http://dx.doi.org/10.2196/64965 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64965 ER - TY - JOUR AU - Du, ShanShan AU - Zhao, Yining PY - 2025/3/14 TI - Enhancing Digital Health Interventions for Medication Adherence: Considerations for Broader Applicability and Long-Term Impact JO - J Med Internet Res SP - e69204 VL - 27 KW - mobile apps KW - digital health KW - atrial fibrillation KW - anticoagulants KW - medication adherence KW - mobile phone UR - https://www.jmir.org/2025/1/e69204 UR - http://dx.doi.org/10.2196/69204 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69204 ER - TY - JOUR AU - Wang, Jianing AU - Tang, Nu AU - Jin, Congcong AU - Yang, Jianxue AU - Zheng, Xiangpeng AU - Jiang, Qiujing AU - Li, Shengping AU - Xiao, Nian AU - Zhou, Xiaojun PY - 2025/3/14 TI - Association of Digital Health Interventions With Maternal and Neonatal Outcomes: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e66580 VL - 27 KW - digital health KW - telemedicine KW - telehealth KW - mobile health KW - mHealth KW - mobile phone KW - intervention KW - meta-analysis KW - pregnant women KW - systematic review N2 - Background: Gestational weight gain (GWG) is crucial to maternal and neonatal health, yet many women fail to meet recommended guidelines, increasing the risk of complications. Digital health interventions offer promising solutions, but their effectiveness remains uncertain. This study evaluates the impact of such interventions on GWG and other maternal and neonatal outcomes. Objective: This study aimed to investigate the effect of digital health interventions among pregnant women and newborns. Methods: A total of 2 independent researchers performed electronic literature searches in the PubMed, Embase, Web of Science, and Cochrane Library databases to identify eligible studies published from their inception until February 2024; an updated search was conducted in August 2024. The studies included randomized controlled trials (RCTs) related to maternal and neonatal clinical outcomes. The Revised Cochrane risk-of-bias tool for randomized trials was used to examine the risk of publication bias. Stata (version 15.1; StataCorp) was used to analyze the data. Results: We incorporated 42 pertinent RCTs involving 148,866 participants. In comparison to the routine care group, GWG was markedly reduced in the intervention group (standardized mean difference?0.19, 95% CI ?0.25 to ?0.13; P<.001). A significant reduction was observed in the proportion of women with excessive weight gain (odds ratio [OR] 0.79, 95% CI 0.69-0.91; P=.001), along with an increase in the proportion of women with adequate weight gain (OR 1.33, 95% CI 1.10-1.64; P=.003). Although no significant difference was reported for the proportion of individuals below standardized weight gain, there is a significant reduction in the risk of miscarriage (OR 0.66, 95% CI 0.46-0.95; P=.03), preterm birth (OR 0.8, 95% CI 0.75-0.86; P<.001), as well as complex neonatal outcomes (OR 0.93, 95% CI 0.87-0.99; P=.02). Other maternal and fetal outcomes were not significantly different between the 2 groups (all P>.05). Conclusions: The findings corroborate our hypothesis that digitally facilitated health care can enhance certain facets of maternal and neonatal outcomes, particularly by mitigating excessive weight and maintaining individuals within a reasonable weight gain range. Therefore, encouraging women to join the digital health team sounds feasible and helpful. Trial Registration: PROSPERO CRD42024564331; https://tinyurl.com/5n6bshjt UR - https://www.jmir.org/2025/1/e66580 UR - http://dx.doi.org/10.2196/66580 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66580 ER - TY - JOUR AU - Spierings, Jelle AU - Willinge, Gijs AU - Kokke, Marike AU - Repping, Sjoerd AU - de Lange, Wendela AU - Geerdink, Thijs AU - van Veen, Ruben AU - van der Velde, Detlef AU - Goslings, Carel AU - Twigt, Bas AU - PY - 2025/3/14 TI - Patient Experiences With a Mobile Self-Care Solution for Low-Complex Orthopedic Injuries: Mixed Methods Study JO - JMIR Hum Factors SP - e53074 VL - 12 KW - self-care application KW - mHealth KW - experience KW - traumasurgery KW - orthopedic surgery KW - virtual fracture clinic KW - patient perspective KW - direct discharge KW - musculoskeletal injury KW - mobile self-care KW - method study KW - health care system KW - hospital KW - mobile health KW - app KW - smartphone KW - satisfactory KW - effectiveness KW - treatment KW - virtual clinic KW - virtual care KW - digital health N2 - Background: The Dutch acute health care system faces challenges with limited resources and increasing patient numbers. To reduce outpatient follow-up, direct discharge (DD) has been implemented in over 30 out of 80 Dutch hospitals. With DD, no routine follow-up appointments are scheduled after the emergency department (ED) visit for low-complex, isolated, and stable musculoskeletal injuries. This policy is supported by information leaflets, a smartphone app, and a telephone helpline with human support. Growing evidence shows that DD is satisfactory, safe, and effective in reducing secondary health care use, but thorough patient experiences are lacking. Objective: The aim of this study was to explore the experiences of patients with DD to ensure durable adoption and to improve the treatment protocol. Methods: A mixed method study was conducted parallel to the implementation of DD in 3 hospitals. Data were collected through a survey directly after the ED visit, a survey 3 months post injury, and semistructured interviews. Quantitative data were reported descriptively, and qualitative data used thematic analysis. Outcomes included the Bowen feasibility parameters: implementation, acceptance, preliminary efficacy, and demand. All patients who consented to the study face-to-face with one of the 12 low-complex musculoskeletal injuries were included in the study during the implementation period. Results: Of the 429 patients who started the primary survey, 138 patients completed both surveys. A total of 18 semistructured interviews were conducted and analyzed. Patients reported a median treatment satisfaction score of 7.8 (IQR 6.6-8.8) on a 10-point scale of DD at the ED. Information quality was experienced as good (106/138, 77%), and most preferred DD over face-to-face follow-up (79/138, 59%). Patient information demands and app use varied among patients, with a median frequency of use of 4 times (ranging from 1 to 30). Conclusions: This study shows that patients consider DD a feasible and safe alternative to traditional treatment, with a favorable perception of its acceptability, efficacy, applicability, and demand. Nevertheless, response rates were relatively low, and personal nuances and preferences must be considered when implementing DD. Clinicians and policy makers can use the insights to improve DD and work towards the integration of DD into clinical practice and future guidelines. UR - https://humanfactors.jmir.org/2025/1/e53074 UR - http://dx.doi.org/10.2196/53074 ID - info:doi/10.2196/53074 ER - TY - JOUR AU - Doerr, J. Adam AU - Orwig, A. Taylor AU - McNulty, Matthew AU - Sison, M. Stephanie Denise AU - Paquette, R. David AU - Leung, Robert AU - Ding, Huitong AU - Erban, B. Stephen AU - Weinstein, R. Bruce AU - Guilarte-Walker, Yurima AU - Zai, H. Adrian AU - Walkey, J. Allan AU - Soni, Apurv AU - McManus, D. David AU - Lin, Honghuang PY - 2025/3/12 TI - Digital Assessment of Cognitive Health in Outpatient Primary Care: Usability Study JO - JMIR Form Res SP - e66695 VL - 9 KW - cognitive assessment KW - primary care KW - digital KW - cognitive impairment KW - digital assessment KW - assessment KW - cognitive health KW - cognition KW - cognitive evaluation KW - Core Cognitive Evaluation KW - CCE KW - cohort KW - impairment KW - cognitive KW - outpatient N2 - Background: Screening for cognitive impairment in primary care is important, yet primary care physicians (PCPs) report conducting routine cognitive assessments for less than half of patients older than 60 years of age. Linus Health?s Core Cognitive Evaluation (CCE), a tablet-based digital cognitive assessment, has been used for the detection of cognitive impairment, but its application in primary care is not yet studied. Objective: This study aimed to explore the integration of CCE implementation in a primary care setting. Methods: A cohort of participants was recruited from the upcoming schedules of participating PCPs at UMass Memorial Medical Center. Eligibility criteria included individuals aged ?65 years; ability to read, write, and speak in English or Spanish; no previous diagnosis of cognitive impairment; and no known untreated hearing or vision impairment. Research coordinators collected consent from participants and facilitated the screening process. PCPs reviewed reports in real time, immediately before the scheduled visits, and shared results at their discretion. A report was uploaded to each participant?s REDCap (Research Electronic Data Capture; Vanderbilt University) record and linked to the encounter in the electronic health record. Feedback from patients and their caregivers (if applicable) was collected by a tablet-based survey in the clinic before and after screening. Participating PCPs were interviewed following the completion of the study. Results: The screened cohort included 150 patients with a mean age of 74 (SD 7) years, of whom 65% (97/150) were female. The CCE identified 40 patients as borderline and 7 as positive for cognitive impairment. A total of 84 orders were placed for select laboratory tests or referrals to neurology and neuropsychology within 20 days of CCE administration. Before the assessment, 95% (143/150) of patients and all 15 caregivers expressed a desire to know if their or their loved one?s brain health was declining. All except one patient also completed the postassessment survey. Among them, 96% (143/149) of patients reported finding the CCE easy to complete, and 70% (105/149) felt that the experience was beneficial. In addition, 87% (130/149) of patients agreed or strongly agreed that they wanted to know their CCE results. Among the 7 participating PCPs, 6 stated that the CCE results influenced their patient care management, and all 7 indicated they would continue using the CCE if it were made available after the study. Conclusions: We explored the integration of the CCE into primary care visits, which showed minimal disruption to the practice workflow. Future studies will be warranted to further validate the implementation of digital cognitive impairment screening tools within primary care settings in the real world. UR - https://formative.jmir.org/2025/1/e66695 UR - http://dx.doi.org/10.2196/66695 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66695 ER - TY - JOUR AU - Gulec, Hayriye AU - Muzik, Michal AU - Smahel, David AU - Dedkova, Lenka PY - 2025/3/11 TI - Longitudinal Associations Between Adolescents? mHealth App Use, Body Dissatisfaction, and Physical Self-Worth: Random Intercept Cross-Lagged Panel Study JO - JMIR Ment Health SP - e60844 VL - 12 KW - mHealth app KW - body dissatisfaction KW - physical self-worth KW - random intercept cross-lagged panel model KW - RI-CLPM KW - longitudinal study KW - adolescent N2 - Background: Longitudinal investigation of the association between mobile health (mHealth) app use and attitudes toward one?s body during adolescence is scarce. mHealth apps might shape adolescents? body image perceptions by influencing their attitudes toward their bodies. Adolescents might also use mHealth apps based on how they feel and think about their bodies. Objective: This prospective study examined the longitudinal within-person associations between mHealth app use, body dissatisfaction, and physical self-worth during adolescence. Methods: The data were gathered from a nationally representative sample of Czech adolescents aged between 11 and 16 years (N=2500; n=1250, 50% girls; mean age 13.43, SD 1.69 years) in 3 waves with 6-month intervals. Participants completed online questionnaires assessing their mHealth app use, physical self-worth, and body dissatisfaction at each wave. The mHealth app use was determined by the frequency of using sports, weight management, and nutritional intake apps. Physical self-worth was assessed using the physical self-worth subscale of the Physical Self Inventory-Short Form. Body dissatisfaction was measured with the items from the body dissatisfaction subscale of the Eating Disorder Inventory-3. The random intercept cross-lagged panel model examined longitudinal within-person associations between the variables. A multigroup design was used to compare genders. Due to the missing values, the final analyses used data from 2232 adolescents (n=1089, 48.8% girls; mean age 13.43, SD 1.69 years). Results: The results revealed a positive within-person effect of mHealth app use on the physical self-worth of girls: increased mHealth app use predicted higher physical self-worth 6 months later (?=.199, P=.04). However, this effect was not consistent from the 6th to the 12th month: a within-person increase in using apps in the 6th month did not predict changes in girls? physical self-worth in the 12th month (?=.161, P=.07). Regardless of gender, the within-person changes in the frequency of using apps did not influence adolescents? body dissatisfaction. In addition, neither body dissatisfaction nor physical self-worth predicted app use frequency at the within-person level. Conclusions: This study highlighted that within-person changes in using mHealth apps were differentially associated with adolescents? body-related attitudes. While increased use of mHealth apps did not influence body dissatisfaction across genders, it significantly predicted higher physical self-worth in adolescent girls 6 months later. A similar association was not observed among boys after 6 months. These findings indicate that using mHealth apps is unlikely to have a detrimental impact on adolescents? body dissatisfaction and physical self-worth; instead, they may have a positive influence, particularly in boosting the physical self-worth of adolescent girls. UR - https://mental.jmir.org/2025/1/e60844 UR - http://dx.doi.org/10.2196/60844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60844 ER - TY - JOUR AU - Buawangpong, Nida AU - Siviroj, Penprapa AU - Pinyopornpanish, Kanokporn AU - Sirikul, Wachiranun PY - 2025/3/11 TI - Transcultural Adaptation, Validation, Psychometric Analysis, and Interpretation of the 22-Item Thai Senior Technology Acceptance Model for Mobile Health Apps: Cross-Sectional Study JO - JMIR Aging SP - e60156 VL - 8 KW - STAM KW - senior technology acceptance model KW - validity KW - reliability KW - mHealth KW - older adult KW - technology acceptance KW - mobile health KW - app KW - transcultural adaptation KW - psychometric analysis KW - geriatrics KW - cross-sectional study KW - Thai KW - theory analysis KW - Cronbach ? KW - McDonald ? KW - quality of life KW - well-being KW - social media KW - telehealth KW - health informatics KW - eHealth KW - mobile phone N2 - Background: The rapid advancement of technology has made mobile health (mHealth) a promising tool to mitigate health problems, particularly among older adults. Despite the numerous benefits of mHealth, assessing individual acceptance is required to address the specific needs of older people and promote their intention to use mHealth. Objective: This study aims to adapt and validate the senior technology acceptance model (STAM) questionnaire for assessing mHealth acceptance in the Thai context. Methods: In this cross-sectional study, we adapted the original, 38-item, English version of the STAM using a 10-point Likert scale for mHealth acceptability among the Thai population. We translated the mHealth STAM into Thai using forward and backward translation. A total of 15 older adults and experts completed the pilot questionnaire and were interviewed to assess its validity. The pilot items of the Thai mHealth STAM were then reworded and revised for better comprehension and cross-cultural compatibility. The construct validity of the Thai mHealth STAM was evaluated by a multidimensional approach, including exploratory and confirmatory factor analysis and nonparametric item response theory analysis. Discriminative indices consisting of sensitivity, specificity, and area under the receiver operating characteristic (AUROC) were used to determine appropriate banding and discriminant validity for the intention to use mHealth. Internal consistency was assessed using Cronbach ? and McDonald ? coefficients. Results: Out of the 1100 participants with a mean age of 62.3 (SD 8.8) years, 360 (32.7%) were adults aged 45-59 years, and 740 (67.3%) were older adults aged 60 years and older. Of the 40-item pilot questionnaire, exploratory factor analysis identified 22 items with factor loadings >0.4 across 7 principal components, explaining 91.45% of the variance. Confirmatory factor analysis confirmed that 9-dimensional sets of 22 items had satisfactory fit indices (comparative fit index=0.976, Tucker-Lewis index=0.968, root mean square error of approximation=0.043, standardized root mean squared residual=0.044, and R2 for each item>0.30). The score banding D (low?151, moderate 152-180, and high?181) was preferred as the optimal 22-item Thai mHealth STAM cutoff score based on the highest sensitivity of 89% (95% CI 86.1%-91.5%) and AUROC of 72.4% (95% CI 70%-74.8%) for predicting the intention to use mHealth. The final Thai mHealth STAM, consisting of 22 items, exhibited remarkable internal consistency, as evidenced by a Cronbach ? of 0.88 (95% CI 0.87-0.89) and a McDonald ? of 0.85 (95% CI 0.83-0.87). For all 22 items, the corrected item-total correlations ranged between 0.26 and 0.71. Conclusions: The 22-item Thai mHealth STAM demonstrated satisfactory psychometric properties in both validity and reliability. The questionnaire has the potential to serve as a practical questionnaire in assessing the acceptance and intention to use mHealth among pre-older and older adults. UR - https://aging.jmir.org/2025/1/e60156 UR - http://dx.doi.org/10.2196/60156 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60156 ER - TY - JOUR AU - Groninger, Hunter AU - Arem, Hannah AU - Ayangma, Lylian AU - Gong, Lisa AU - Zhou, Eric AU - Greenberg, Daniel PY - 2025/3/10 TI - Development of a Voice-Activated Virtual Assistant to Improve Insomnia Among Young Adult Cancer Survivors: Mixed Methods Feasibility and Acceptability Study JO - JMIR Form Res SP - e64869 VL - 9 KW - cancer KW - survivor KW - insomnia KW - cognitive behavioral therapy KW - technology KW - app KW - oncology KW - mobile health KW - artificial intelligence KW - young adults KW - sleep KW - mHealth KW - CBT KW - voice-activated virtual assistant KW - virtual assistants KW - focus group KW - qualitative research N2 - Background: Up to 75% of young adult cancer survivors (YACS) experience chronic insomnia, negatively affecting physical and emotional health and overall quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is a gold-standard intervention to address insomnia. To improve CBT-I access and treatment adherence, screen-based digital CBT-I platforms have been developed. However, even with these digital products, widespread uptake of CBT-I remains limited, and new strategies for CBT-I delivery are warranted. Objective: The objective of this study is to understand how YACS experience insomnia and how they might incorporate technology-delivered CBT-I into a daily routine and test the feasibility and acceptability of a novel screen-free voice-activated virtual assistant?delivered CBT-I prototype. Methods: Eligible participants?ages 18-39, living with a history of cancer (any type, any stage), self-reporting on average less sleep than National Sleep Foundation recommendations, and English-speaking?were recruited from a major urban cancer center, 2 regional oncology clinics, and 2 cancer survivorship support groups. We conducted 4 focus groups to understand the YACS experience of insomnia, their routine use of technology at home, particularly voice-activated virtual assistants such as Amazon Alexa, and input on how CBT-I might be delivered at home through a smart speaker system. We developed a prototype device to deliver key elements of CBT-I at home along with circadian lighting and monitoring of post-bedtime device use, collected YACS user perspectives on this prototype, and then conducted a single-arm feasibility and acceptability study. Results: In total, 26 YACS (6-7 participants per group) experiencing insomnia participated in focus groups to share experiences of insomnia during cancer survivorship and to provide input regarding a CBT-I prototype. Common triggers of insomnia included worry about disease management and progression, disease-related pain and other symptoms, choices regarding personal device use, and worry about the impact of poor sleep on daily functioning. In total, 12 participants completed device prototype testing, engaging with the prototype 94% of the assigned times (twice daily for 14 days; meeting predetermined feasibility cutoff of engagement ?70% of assigned times) and rating the prototype with an overall mean score of 5.43 on the Satisfaction subscale of the Usability, Satisfaction, and Ease of Use scale (range 4.42-7; exceeding the predetermined cutoff score for acceptability of 5.0). All participants completing the study reported they would be interested in using the prototype again and would recommend it to someone else with insomnia. Conclusions: YACS were highly engaged with our voice-activated virtual assistant?delivered CBT-I prototype and found it acceptable to use. Following final device development, future studies should evaluate the efficacy of this intervention among YACS. Trial Registration: ClinicalTrials.gov NCT05875129; https://clinicaltrials.gov/study/NCT05875129 UR - https://formative.jmir.org/2025/1/e64869 UR - http://dx.doi.org/10.2196/64869 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64869 ER - TY - JOUR AU - May, Susann AU - Muehlensiepen, Felix AU - Wengemuth, Eileen AU - Seifert, Frances AU - Heinze, Martin AU - Bruch, Dunja AU - Spethmann, Sebastian PY - 2025/3/10 TI - Benefits and Barriers to mHealth in Hypertension Care: Qualitative Study With German Health Care Professionals JO - JMIR Hum Factors SP - e52544 VL - 12 KW - hypertension KW - mHealth apps KW - digital health KW - physicians KW - nurses KW - HCP KW - qualitative interviews KW - health care professional KW - cardiologists KW - mHealth KW - Germany KW - general practitioners KW - blood pressure monitoring KW - qualitative study KW - qualitative content analysis N2 - Background: Digital health technologies, particularly mobile health (mHealth) apps and wearable devices, have emerged as crucial assets in the battle against hypertension. By enabling lifestyle modifications, facilitating home blood pressure monitoring, and promoting treatment adherence, these technologies have significantly enhanced hypertension treatment. Objective: This study aims to explore the perspectives of health care professionals (HCPs) regarding the perceived benefits and barriers associated with the integration of mHealth apps into routine hypertension care. Additionally, strategies for overcoming these barriers will be identified. Methods: Through qualitative analysis via semistructured interviews, general practitioners (n=10), cardiologists (n=14), and nurses (n=3) were purposefully selected between October 2022 and March 2023. Verbatim transcripts were analyzed using qualitative content analysis. Results: The results unveiled 3 overarching themes highlighting the benefits of mHealth apps in hypertension care from the perspective of HCPs. First, these technologies possess the potential to enhance patient safety by facilitating continuous monitoring and early detection of abnormalities. Second, they can empower patients, fostering autonomy in managing their health conditions, thereby promoting active participation in their care. Lastly, mHealth apps may provide valuable support to medical care by offering real-time data that aids in decision-making and treatment adjustments. Despite these benefits, the study identified several barriers hindering the seamless integration of mHealth apps into hypertension care. Challenges predominantly revolved around data management, communication contexts, daily routines, and system handling. HCPs underscored the necessity for structural and procedural modifications in their daily practices to effectively address these challenges. Conclusions: In conclusion, the effective usage of digital tools such as mHealth apps necessitates overcoming various obstacles. This entails meeting the information needs of both HCPs and patients, tackling interoperability issues to ensure seamless data exchange between different systems, clarifying uncertainties surrounding reimbursement policies, and establishing the specific clinical benefits of these technologies. Active engagement of users throughout the design and implementation phases is crucial for ensuring the usability and acceptance of mHealth apps. Moreover, enhancing knowledge accessibility through the provision of easily understandable information about mHealth apps is essential for eliminating barriers and fostering their widespread adoption in hypertension care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 UR - https://humanfactors.jmir.org/2025/1/e52544 UR - http://dx.doi.org/10.2196/52544 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52544 ER - TY - JOUR AU - Almalki, Manal PY - 2025/3/10 TI - Predictors of the Intention to Stop Using Smart Devices at Bedtime Among University Students in Saudi Arabia: Cross-Sectional Survey JO - JMIR Form Res SP - e67223 VL - 9 KW - smart devices KW - smartphone KW - digital health KW - digital technology KW - sleep quality KW - university student KW - bedtime habits KW - Saudi Arabia KW - path analysis KW - sleep disturbances KW - well-being KW - usage KW - intention KW - behavior KW - mobile phone N2 - Background: The widespread use of smart devices, particularly among university students, has raised concerns about their impact on sleep quality. Bedtime usage of smart devices is associated with sleep disruptions and poor sleep quality. Objective: This study aimed to explore the behavioral and perceptual factors influencing university students? intention to stop using smart devices at bedtime in Saudi Arabia. Methods: A cross-sectional survey was conducted in June 2024 and distributed via social media platforms to university students (aged ?18 years). The questionnaire collected data on demographics, smart device usage habits, perceived negative effects on sleep, and physical sleep disturbances. The Pittsburgh Sleep Quality Index was used to assess sleep quality. Path analysis was performed to evaluate relationships between the outcome variables, intended to stop using smart device usage, and 3 latent variables: sleep quality smartphone usage, sleep quality perceived negative effects, and sleep quality during the past month. Model fit was assessed using chi-square, comparative fit index, and root mean square error of approximation. Results: Of the 774 participants, 90.43% (700/774) reported using their smart devices every night and 72.48% (561/774) believed bedtime device use negatively affected them the next morning. The most frequently reported next-morning symptoms were fatigue or drowsiness (480/774, 62.01%). Common purposes for bedtime device use were staying in touch with friends or family (432/774, 55.81%), entertainment (355/774, 45.86%), and filling up spare time (345/774, 44.57%). Overall, 58.26% (451/774) expressed an intention to stop bedtime device use within the next 3 months. Path analysis demonstrated that frequent nightly use (path coefficient=0.36) and after-lights-off usage (0.49) were positively associated with the intention to stop, whereas spending ?3 hours on devices (?0.35) and engaging in multiple activities (?0.18) had negative associations. The strongest predictors of the intention to stop were perceived negative effects on next-morning well-being (0.71) and difficulty breathing comfortably during sleep (0.64). Model fit was excellent (comparative fit index=0.845 and root mean square error of approximation=0.039). Conclusions: Perceived negative effects on sleep quality and physical sleep disturbances are strong predictors of the intention to stop using smart devices at bedtime among university students in Saudi Arabia. Interventions aimed at improving sleep hygiene should focus on raising awareness about the impact of smart device use on well-being and addressing behaviors such as late-night usage and heavy screen time. Public health strategies should target both psychological and physiological aspects of bedtime smart device use to improve sleep quality in this population. UR - https://formative.jmir.org/2025/1/e67223 UR - http://dx.doi.org/10.2196/67223 UR - http://www.ncbi.nlm.nih.gov/pubmed/40063070 ID - info:doi/10.2196/67223 ER - TY - JOUR AU - Janowski, Roselinde AU - Cluver, D. Lucie AU - Shenderovich, Yulia AU - Wamoyi, Joyce AU - Wambura, Mwita AU - Stern, David AU - Clements, Lily AU - Melendez-Torres, J. G. AU - Baerecke, Lauren AU - Ornellas, Abigail AU - Chetty, Nicole Angelique AU - Klapwijk, Jonathan AU - Christine, Laetitia AU - Mukabana, Ateamate AU - Te Winkel, Esmee AU - Booij, Anna AU - Mbosoli, Gervas AU - Lachman, M. Jamie PY - 2025/3/10 TI - Optimizing Engagement With a Smartphone App to Prevent Violence Against Adolescents: Results From a Cluster Randomized Factorial Trial in Tanzania JO - J Med Internet Res SP - e60102 VL - 27 KW - digital health KW - engagement KW - parenting KW - adolescents KW - low- and middle-income country KW - violence against children KW - Multiphase Optimization Strategy KW - randomized factorial experiment KW - mobile phone N2 - Background: Violence and abuse exert extensive health, social, and economic burdens on adolescents in low- and middle-income countries. Digital parenting interventions are promising for mitigating risks at scale. However, their potential for public health impact hinges on meaningful engagement with the digital platform. Objective: The objective of this study was to evaluate the impact of 3 intervention design and implementation factors aimed at increasing engagement with a noncommercialized, offline-first smartphone app for caregivers of adolescents in Tanzania, in partnership with the United Nations Children?s Fund, the World Health Organization, and the Tanzanian national government. Methods: Following Multiphase Optimization Strategy (MOST) principles, we conducted a 2×2×2 cluster randomized factorial trial involving caregivers of adolescents aged 10 to 17 years. Caregivers were recruited by community representatives from 16 urban and periurban communities (ie, clusters) in the Mwanza region of Tanzania. Each cluster was randomized to 1 of 2 levels of each factor: guidance (self-guided or guided via facilitator-moderated WhatsApp groups), app design (structured or unstructured), and preprogram digital support (basic or enhanced). Primary outcomes were automatically tracked measures of engagement (app launches, modules completed, and home practice activities reviewed), with secondary outcomes including modules started, time spent in the app, and positive behaviors logged. Generalized linear mixed-effects models assessed the impact of experimental factors on engagement. Results: Automatically tracked engagement data from 614 caregivers were analyzed, of which 205 (33.4%) were men. Compared to self-guided participants, receiving guidance alongside the app led to significantly more app launches (mean ratio [MR] 2.93, 95% CI 1.84-4.68; P<.001), modules completed (MR 1.29, 95% CI 1.05-1.58; P=.02), modules started (MR 1.20, 95% CI 1.02-1.42; P=.03), time spent in the app (MR 1.45, 95% CI 1.39-1.51; P<.001), and positive behavior logs (MR 2.73, 95% CI 2.07-3.60; P<.001). Compared to the structured design, unstructured design use resulted in significantly more modules completed (MR 1.49, 95% CI 1.26-1.76; P<.001), home practice activity reviews (MR 7.49, 95% CI 5.19-10.82; P<.001), modules started (MR 1.27, 95% CI 1.06-1.52; P=.01), time spent in the app (MR 1.84, 95% CI 1.70-1.99; P<.001), and positive behavior logs (MR 55.68, 95% CI 16.48-188.14; P<.001). While analyses did not detect an effect of enhanced digital support on directly observed engagement, the combination of enhanced digital support and guidance positively influenced engagement across a range of outcomes. Conclusions: This study is the first to systematically optimize engagement with a digital parenting intervention in a low- and middle-income country. Our findings offer important learnings for developing evidence-based, scalable digital interventions in resource-constrained settings. Trial Registration: Pan-African Clinical Trial Registry PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-023-15989-x UR - https://www.jmir.org/2025/1/e60102 UR - http://dx.doi.org/10.2196/60102 UR - http://www.ncbi.nlm.nih.gov/pubmed/40063069 ID - info:doi/10.2196/60102 ER - TY - JOUR AU - Dubbala, Keerthi AU - Prizak, Roshan AU - Metzler, Ingrid AU - Rubeis, Giovanni PY - 2025/3/10 TI - Exploring Heart Disease?Related mHealth Apps in India: Systematic Search in App Stores and Metadata Analysis JO - J Med Internet Res SP - e53823 VL - 27 KW - mobile health apps KW - mHealth apps KW - heart disease KW - data collection methods KW - natural language processing KW - metadata analysis KW - Apple App Store KW - Google Play Store KW - mobile phone N2 - Background: Smartphone mobile health (mHealth) apps have the potential to enhance access to health care services and address health care disparities, especially in low-resource settings. However, when developed without attention to equity and inclusivity, mHealth apps can also exacerbate health disparities. Understanding and creating solutions for the disparities caused by mHealth apps is crucial for achieving health equity. There is a noticeable gap in research that comprehensively assesses the entire spectrum of existing health apps and extensively explores apps for specific health priorities from a health care and public health perspective. In this context, with its vast and diverse population, India presents a unique context for studying the landscape of mHealth apps. Objective: This study aimed to create a comprehensive dataset of mHealth apps available in India with an initial focus on heart disease (HD)?related apps. Methods: We collected individual app data from apps in the ?medical? and ?health and fitness? categories from the Google Play Store and the Apple App Store in December 2022 and July 2023, respectively. Using natural language processing techniques, we selected HD apps, performed statistical analysis, and applied latent Dirichlet allocation for clustering and topic modeling to categorize the resulting HD apps. Results: We collected 118,555 health apps from the Apple App Store and 108,945 health apps from the Google Play Store. Within these datasets, we found that approximately 1.7% (1990/118,555) of apps on the Apple App Store and 0.5% (548/108,945) on the Google Play Store included support for Indian languages. Using monograms and bigrams related to HD, we identified 1681 HD apps from the Apple App Store and 588 HD apps from the Google Play Store. HD apps make up only a small fraction of the total number of health apps available in India. About 90% (1496/1681 on Apple App Store and 548/588 on Google Play Store) of the HD apps were free of cost. However, more than 70% (1329/1681, 79.1% on Apple App Store and 423/588, 71.9% on Google Play Store) of HD apps had no reviews and rating-scores, indicating low overall use. Conclusions: Our study proposed a robust method for collecting and analyzing metadata from a wide array of mHealth apps available in India through the Apple App Store and Google Play Store. We revealed the limited representation of India?s linguistic diversity within the health and medical app landscape, evident from the negligible presence of Indian-language apps. We observed a scarcity of mHealth apps dedicated to HD, along with a lower level of user engagement, as indicated by reviews and app ratings. While most HD apps are financially accessible, uptake remains a challenge. Further research should focus on app quality assessment and factors influencing user adoption. UR - https://www.jmir.org/2025/1/e53823 UR - http://dx.doi.org/10.2196/53823 UR - http://www.ncbi.nlm.nih.gov/pubmed/40063078 ID - info:doi/10.2196/53823 ER - TY - JOUR AU - Lee, Yura AU - Park, Ye-Eun PY - 2025/3/7 TI - Authors? Reply: Advancing Digital Health Integration in Oncology JO - J Med Internet Res SP - e72477 VL - 27 KW - mHealth KW - user experience KW - cancer KW - technology acceptance model KW - structural equation modeling KW - health care app KW - mixed-method study KW - medical care KW - digital health care KW - cancer survivors KW - disparities KW - health status KW - behavioral intervention KW - clinician UR - https://www.jmir.org/2025/1/e72477 UR - http://dx.doi.org/10.2196/72477 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053760 ID - info:doi/10.2196/72477 ER - TY - JOUR AU - Khan, Umar Rai Muhammad AU - Tariq, Hassan PY - 2025/3/7 TI - Advancing Digital Health Integration in Oncology JO - J Med Internet Res SP - e70316 VL - 27 KW - mHealth KW - user experience KW - cancer KW - technology acceptance model KW - structural equation modeling KW - health care app KW - mixed-method study KW - medical care KW - digital health care KW - cancer survivors KW - disparities KW - health status KW - behavioral intervention KW - clinician UR - https://www.jmir.org/2025/1/e70316 UR - http://dx.doi.org/10.2196/70316 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053796 ID - info:doi/10.2196/70316 ER - TY - JOUR AU - Midao, Luis AU - Duarte, Mafalda AU - Sampaio, Rute AU - Almada, Marta AU - Dias, Camila Cláudia AU - Paúl, Constança AU - Costa, Elísio PY - 2025/3/7 TI - FRAILSURVEY?an mHealth App for Self-Assessment of Frailty Based on the Portuguese Version of the Groningen Frailty Indicator: Validation and Reliability Study JO - JMIR Form Res SP - e51975 VL - 9 KW - frailty KW - mHealth KW - assessment KW - validation KW - GFI KW - reliability KW - self-assessment KW - Groningen Frailty Indicator KW - FRAILSURVEY KW - mobile phone N2 - Background: Portugal is facing the challenge of population ageing, with a notable increase in the proportion of older individuals. This has positioned the country among those in Europe with a high prevalence of frailty. Frailty, a geriatric syndrome characterized by diminished physiological reserve and heightened vulnerability to stressors, imposes a substantial burden on public health. Objective: This study seeks to address two primary objectives: (1) translation and psychometric evaluation of the European Portuguese version of the Groningen Frailty Indicator (GFI); and (2) development and evaluation of the FRAILSURVEY app, a novel assessment tool for frailty based on the GFI. By achieving these objectives, the study aims to enhance the accuracy and reliability of frailty assessment in the Portuguese context, ultimately contributing to improved health care outcomes for older individuals in the region. Methods: To accomplish the objectives of the study, a comprehensive research methodology was used. The study comprised 2 major phases: the initial translation and validation of the GFI into European Portuguese and the development of the FRAILSURVEY app. Following this, an extensive examination of the app?s validity and reliability was conducted compared with the conventional paper version of the GFI. A randomized repeated crossover design was used to ensure rigorous evaluation of both assessment methods, using both the paper form of the GFI and the smartphone-based app FRAILSURVEY. Results: The findings of the study revealed promising outcomes in line with the research objectives. The meticulous translation process yielded a final version of the GFI with robust psychometric properties, ensuring clarity and comprehensibility for participants. The study included 522 participants, predominantly women (367/522, 70.3%), with a mean age of 73.7 (SD 6.7) years. Psychometric evaluation of the European Portuguese GFI in paper form demonstrates good reliability (internal consistency: Cronbach a value of 0.759; temporal stability: intraclass correlation coefficient=0.974) and construct validity (revealing a 4D structure explaining 56% of variance). Evaluation of the app-based European Portuguese GFI indicates good reliability (interinstrument reliability: Cohen k=0.790; temporal stability: intraclass correlation coefficient=0.800) and concurrent validity (r=0.694; P<.001). Conclusions: Both the smartphone-based app and the paper version of the GFI were feasible and acceptable for use. The findings supported that FRAILSURVEY exhibited comparable validity and reliability to its paper counterpart. FRAILSURVEY uses a standardized and validated assessment tool, offering objective and consistent measurements while eliminating subjective biases, enhancing accuracy, and ensuring reliability. This app holds promising potential for aiding health care professionals in identifying frailty in older individuals, enabling early intervention, and improving the management of adverse health outcomes associated with this syndrome. Its integration with electronic health records and other data may lead to personalized interventions, improving frailty management and health outcomes for at-risk individuals. UR - https://formative.jmir.org/2025/1/e51975 UR - http://dx.doi.org/10.2196/51975 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053720 ID - info:doi/10.2196/51975 ER - TY - JOUR AU - Karila, Laurent AU - Scher, Nathaniel AU - Draghi, Clement AU - Lichte, Delphine AU - Darmon, Ilan AU - Boudabous, Hanene AU - Lamallem, Hanah AU - Bauduceau, Olivier AU - Bollet, Marc AU - Toledano, Alain PY - 2025/3/6 TI - Understanding Problematic Smartphone and Social Media Use Among Adults in France: Cross-Sectional Survey Study JO - JMIR Ment Health SP - e63431 VL - 12 KW - problematic smartphone use KW - digital mental health KW - compulsive behavior KW - social network addiction KW - nomophobia KW - phubbing KW - screen time effects KW - public health interventions KW - cross-sectional KW - French KW - smartphone use KW - social media KW - France KW - mobile phone N2 - Background: The Evaluation of Digital Addiction (EVADD) study investigates problematic smartphone use in the digital age, as global smartphone users reached 55.88 million in France in 2023. With increased screen time from digital devices, especially smartphones, the study highlights adult use issues and associated risks. Objective: The aim of the study is to assess the prevalence of compulsive smartphone use among French adults and identify patterns of problematic behaviors, including their impact on daily activities, sleep, and safety. Methods: The EVADD study used a cross-sectional, nonprobability sample design, conducted from May 3 to June 5, 2023. Participants were recruited through the French mutual insurance company PRO-BTP. Data were collected anonymously via a digital questionnaire, including the Smartphone Compulsive Use Test, capturing information on social network engagement, device ownership, and daily screen use. Results: A total of 21,244 adults (average age 53, SD 15 years; 9844 female participants) participated. Among 21,244 participants, 8025 of 12,034 (66.7%) respondents exhibited compulsive smartphone use (P<.001). Additionally, 7,020 (36.7%) participants scored ?8 on the Smartphone Compulsion Test, indicating addiction. Younger participants (18?39 years) were significantly more likely to show signs of addiction (2504/4394, 57%; odds ratio 2.5, 95% CI 1.9?3.2) compared to participants aged ?60 years. Problematic behaviors included unsafe smartphone use while driving (5736/12,953, 44.3%), frequent smartphone use before bedtime (9136/21,244, 43%), and using smartphones in the bathroom (7659/21,244, 36.1%). Sleep disturbances and risky behaviors correlated strongly with higher compulsion scores (P<.01). Conclusions: The EVADD study highlights the complex relationship between adults and smartphones, revealing the prevalence of compulsive behaviors and their impact on daily life, sleep, and safety. These findings emphasize the need for public awareness campaigns, preventive strategies, and therapeutic interventions to mitigate health risks associated with excessive smartphone use. Trial Registration: ClinicalTrials.gov NCT05860660; https://clinicaltrials.gov/ct2/show/NCT05860660 UR - https://mental.jmir.org/2025/1/e63431 UR - http://dx.doi.org/10.2196/63431 ID - info:doi/10.2196/63431 ER - TY - JOUR AU - Zadushlivy, Nina AU - Biviji, Rizwana AU - Williams, S. Karmen PY - 2025/3/5 TI - Exploration of Reproductive Health Apps? Data Privacy Policies and the Risks Posed to Users: Qualitative Content Analysis JO - J Med Internet Res SP - e51517 VL - 27 KW - data privacy policy KW - reproductive health apps KW - Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective KW - THESIS KW - THESIS evaluation KW - women?s health KW - menstrual health KW - mobile health KW - mHealth KW - menstruating persons? health KW - mobile phone N2 - Background: Mobile health apps often require the collection of identifiable information. Subsequently, this places users at significant risk of privacy breaches when the data are misused or not adequately stored and secured. These issues are especially concerning for users of reproductive health apps in the United States as protection of sensitive user information is affected by shifting governmental regulations such as the overruling of Roe v Wade and varying state-level abortion laws. Limited studies have analyzed the data privacy policies of these apps and considered the safety issues associated with a lack of user transparency and protection. Objective: This study aimed to evaluate popular reproductive health apps, assess their individual privacy policies, analyze federal and state data privacy laws governing these apps in the United States and the European Union (EU), and recommend best practices for users and app developers to ensure user data safety. Methods: In total, 4 popular reproductive health apps?Clue, Flo, Period Tracker by GP Apps, and Stardust?as identified from multiple web sources were selected through convenience sampling. This selection ensured equal representation of apps based in the United States and the EU, facilitating a comparative analysis of data safety practices under differing privacy laws. A qualitative content analysis of the apps and a review of the literature on data use policies, governmental data privacy regulations, and best practices for mobile app data privacy were conducted between January 2023 and July 2023. The apps were downloaded and systematically evaluated using the Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective (THESIS) evaluation tool to assess their privacy and security practices. Results: The overall privacy and security scores for the EU-based apps, Clue and Flo, were both 3.5 of 5. In contrast, the US-based apps, Period Tracker by GP Apps and Stardust, received scores of 2 and 4.5, respectively. Major concerns regarding privacy and data security primarily involved the apps? use of IP address tracking and the involvement of third parties for advertising and marketing purposes, as well as the potential misuse of data. Conclusions: Currently, user expectations for data privacy in reproductive health apps are not being met. Despite stricter privacy policies, particularly with state-specific adaptations, apps must be transparent about data storage and third-party sharing even if just for marketing or analytical purposes. Given the sensitivity of reproductive health data and recent state restrictions on abortion, apps should minimize data collection, exceed encryption and anonymization standards, and reduce IP address tracking to better protect users. UR - https://www.jmir.org/2025/1/e51517 UR - http://dx.doi.org/10.2196/51517 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053713 ID - info:doi/10.2196/51517 ER - TY - JOUR AU - Dewan, Ananya AU - Eifler, M. AU - Hood, Amelia AU - Sanchez, William AU - Gross, Marielle PY - 2025/3/5 TI - Building a Decentralized Biobanking App for Research Transparency and Patient Engagement: Participatory Design Study JO - JMIR Hum Factors SP - e59485 VL - 12 KW - mobile health KW - mHealth KW - application KW - smartphone KW - digital health KW - digital intervention KW - participatory design KW - biobanking KW - research transparency KW - donation KW - patient-derived biospecimens KW - plain language communications KW - patient education N2 - Background: Patient-derived biospecimens are invaluable tools in biomedical research. Currently, there are no mechanisms for patients to follow along and learn about the uses of their donated samples. Incorporating patients as stakeholders and meaningfully engaging them in biomedical research first requires transparency of research activities. Objective: In this paper, we describe the use of participatory design methods to build a decentralized biobanking ?de-bi? mobile app where patients could learn about biobanking, track their specimens, and engage with ongoing research via patient-friendly interfaces overlaying institutional biobank databases, initially developed for a breast cancer use case. Methods: This research occurred in 2 phases. In phase 1, we designed app screens from which patients could learn about ongoing research involving their samples. We embedded these screens in a survey (n=94) to gauge patients? interests regarding types of feedback and engagement opportunities; survey responses were probed during 6 comprehensive follow-up interviews. We then held an immersive participatory design workshop where participants (approximately 50) provided general feedback about our approach, with an embedded codesign workshop where a subset (n=15) provided targeted feedback on screen designs. For phase 2, we refined user interfaces and developed a functional app prototype in consultation with institutional stakeholders to ensure regulatory compliance, workflow compatibility, and composability with local data architectures. We presented the app at a second workshop, where participants (n=25, across 9 groups) shared thoughts on the app?s usability and design. In this phase, we conducted cognitive walkthroughs (n=13) to gain in-depth feedback on in-app task navigation. Results: Most of the survey participants (61/81, 75%) were interested in learning the outcomes of research on their specimens, and 49% (41/83) were interested in connecting with others with the same diagnosis. Participants (47/60, 78%) expressed strong interest in receiving patient-friendly summaries of scientific information from scientists using their biospecimens. The first design workshop identified confusion in terminology and data presentation (eg, 9/15, 60% of co-designers were unclear on the biospecimens ?in use?), though many appreciated the ability to view their personal biospecimens (7/15, 47%), and most were excited about connecting with others (12/15, 80%). In the second workshop, all groups found the app?s information valuable. Moreover, 44% (5/9) noted they did not like the onboarding process, which was echoed in cognitive walkthroughs. Walkthroughs further confirmed interest in biospecimen tracking, and 23% (3/13) had confusion about not finding any of their biospecimens in the app. These findings guided refinements in onboarding, design, and user experience. Conclusions: Designing a patient-facing app that displays information about biobanked specimens can facilitate greater transparency and engagement in biomedical research. Co-designing the app with patient stakeholders confirmed interest in learning about biospecimens and related research, improved presentation of data, and ensured usability of the app in preparation for a pilot study. UR - https://humanfactors.jmir.org/2025/1/e59485 UR - http://dx.doi.org/10.2196/59485 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053747 ID - info:doi/10.2196/59485 ER - TY - JOUR AU - Nonaka, Sayuri AU - Fujii, Susumu AU - Yamada, Chris Kosuke PY - 2025/3/5 TI - Purposes of Smartphone Health Care Apps and the Practicality of Their Functions in Disaster Situations: Qualitative Function Assessment Study JO - JMIR Form Res SP - e56862 VL - 9 KW - health care KW - disaster medicine KW - mobile app KW - survey KW - disaster situations KW - self-reliance KW - Japan KW - disaster response KW - mobile phone N2 - Background: Japan has experienced various natural disasters, including the Great East Japan Earthquake in 2011. It becomes crucial to focus on strengthening self-help measures through health care apps that are used in normal times to help people during disasters. However, little is known about what health care apps would be useful in times of disaster. Objective: This study aimed to investigate the prevalent functionalities and purposes of using health care apps during normalcy, explore their potential utility, and propose strategies for disaster response through their utilization. Methods: We focus on highly ranked health care apps (within the top 100 in the health care category for iPhones by Apple, Inc for a certain period) and reclassify their purpose of use, such as sleep, relaxation, and exercise, in detail. We also investigate the functions within each health care app (measurement, recording, advice, content provision, and guidance to actual services), based on which we determine their potential utilization during disasters and anticipate potential solutions to address disaster-related challenges. We also consider the ideal framework of health care apps in disaster response, exploring possibilities such as the necessity of new disaster-specific apps or the adaptation of existing health care apps for disaster scenarios. Results: Among the 70 free apps, the predominant functions included ?recording? (n=60 cases, 86%) and ?measurement? (n=47 cases, 67%), primarily encompassing the mechanical functions of wearable devices and smartphones. A similar trend was seen in the 77 paid apps, but ?content provision? (n=54 cases, 70%) was the most prevalent. Furthermore, the ?content provision? function was particularly common in the ?purposes of use? categories ?sleep? (?211=29; P<.001), ?relaxation? (?211=14.6; P<.001), and ?exercise? (?211=9.3; P=.002). This suggested the possibility of using the content provision function in existing health care apps to support mental and physical health even during a disaster. Conclusions: The widespread use of apps during normal times could minimize hesitation in adopting them during disasters. The findings emphasize the potential for augmenting disaster-specific content within existing apps rather than developing new ones. This approach aligns with the likelihood of preinstalled app use during emergencies, indicating a pragmatic strategy for enhancing disaster response content within prevalent apps. UR - https://formative.jmir.org/2025/1/e56862 UR - http://dx.doi.org/10.2196/56862 ID - info:doi/10.2196/56862 ER - TY - JOUR AU - Yan, Mengyao AU - Sun, Wendi AU - Tan, Cheng AU - Wu, Yibo AU - Liu, Yuanli PY - 2025/3/4 TI - Analysis of Factors Influencing the Willingness of Chinese Older Adults to Use mHealth Devices: Nationwide Cross-Sectional Survey Study JO - J Med Internet Res SP - e66804 VL - 27 KW - older adults KW - mobile health devices KW - health management KW - medical services KW - mobile phone N2 - Background: In addition to standard older adult care services, mobile medical devices have proved to be an effective tool for controlling the health of older adults. However, little is known about the variables driving the acceptance of these gadgets and the willingness of older adults in China to use them. Objective: This study aims to explore the factors that affect the use of mobile health (mHealth) devices by older adults in China, focusing on individual, social, and family influences. Methods: The Psychology and Behavior Investigation of Chinese Residents survey database provided the data for this study. The survey was conducted in 148 Chinese cities between June 20 and August 31, 2022. The parameters linked to older persons? desire to use mobile medical devices were determined by this study using a combination model of multiple stepwise linear regression and a classification and regression tree decision tree. Results: In total, 4085 older adults took part in the poll. On a scale of 0 to 100, the average score for willingness to adopt mHealth devices was 63.70 (SD 25.11). The results of the multiple stepwise linear regression showed that having a postgraduate degree and higher (?=.040; P=.007), being unemployed (?=.037; P=.02), having a high social status (?=.085; P<.001), possessing high health literacy (?=.089; P<.001), demonstrating high self-efficacy (?=.043; P=.02), not living with children (?=.0340; P=.02), having a household per capita monthly income of >Y4000 (US $550) (?=.048; P=.002), experiencing high perceived social support (?=.096; P<.001), reporting a high quality of life (?=.149; P<.001), having higher levels of family communication (?=?.071; P<.001), having an identity bubble (?=.085; P<.001), not having chronic diseases (?=.049; P=.001), and experiencing mild depression (?=?.035; P=.02) were associated with older adults? willingness to use mHealth devices. The classification and regression tree decision tree model?s findings demonstrated that the primary determinants of older adults? desire to use mHealth devices are quality of life, identity bubble, social status, health literacy, family health, and perceived social support. Conclusions: This study uses the Andersen Healthcare Utilization Model to investigate the effects of demand variables, enabling resources, and predisposing traits on older persons? propensity to use mHealth devices. These results offer reference data for the marketing and use of mHealth devices for older individuals in the future. The ultimate goal of this strategy is to create a balanced and harmonious integration of technology and humanistic care. UR - https://www.jmir.org/2025/1/e66804 UR - http://dx.doi.org/10.2196/66804 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053781 ID - info:doi/10.2196/66804 ER - TY - JOUR AU - Wu, Jia AU - Zeng, Youjia AU - Yang, Jun AU - Yao, Yutong AU - Xu, Xiuling AU - Song, Gaofeng AU - Yi, Wuyong AU - Wang, Taifen AU - Zheng, Yihou AU - Jia, Zhongwei AU - Yan, Xiangyu PY - 2025/3/3 TI - Daily Treatment Monitoring for Patients Receiving Home-Based Peritoneal Dialysis and Prediction of Heart Failure Risk: mHealth Tool Development and Modeling Study JO - JMIR Form Res SP - e56254 VL - 9 KW - peritoneal dialysis KW - mHealth KW - patient management KW - heart failure KW - prediction model N2 - Background: Peritoneal dialysis is one of the major renal replacement modalities for patients with end-stage renal disease. Heart failure is a common adverse event among patients who undergo peritoneal dialysis treatment, especially for those who undergo continuous ambulatory peritoneal dialysis at home, because of the lack of professional input-output volume monitoring and management during treatment. Objective: This study aims to develop novel mobile health (mHealth) tools to improve the quality of home-based continuous ambulatory peritoneal dialysis treatment and to build a prediction model of heart failure based on the system?s daily treatment monitoring data. Methods: The mHealth tools with a 4-layer system were designed and developed using Spring Boot, MyBatis Plus, MySQL, and Redis as backend technology stack, and Vue, Element User Interface, and WeChat Mini Program as front-end technology stack. Patients were recruited to use the tool during daily peritoneal dialysis treatment from January 1, 2017, to April 20, 2023. Logistic regression models based on real-time treatment monitoring data were used for heart failure prediction. The sensitivity, specificity, accuracy, and Youden index were calculated to evaluate the performance of the prediction model. In the sensitivity analysis, the ratio of patients with and without heart failure was set to 1:4 and 1:10, respectively, to better evaluate the stability of the prediction model. Results: A WeChat Mini Program named Futou Bao for patients and a patient data management platform for doctors was developed. Futou Bao included an intelligent data upload function module and an auxiliary function module. The doctor?s data management platform consisted of 4 function modules, that is, patient management, data visualization and marking, data statistics, and system management. During the study period, the records of 6635 patients who received peritoneal dialysis treatment were uploaded in Futou Bao, with 0.71% (47/6635) of them experiencing heart failure. The prediction model that included sex, age, and diastolic blood pressure was considered as the optimal model, wherein the sensitivity, specificity, accuracy, and Youden index were 0.75, 0.91, 0.89, and 0.66, respectively, with an area under the curve value of 0.879 (95% CI 0.772-0.986) using the validation dataset. The sensitivity analysis showed stable results. Conclusions: This study provides a new home-based peritoneal dialysis management paradigm that enables the daily monitoring and early warning of heart failure risk. This novel paradigm is of great value for improving the efficiency, security, and personalization of peritoneal dialysis. UR - https://formative.jmir.org/2025/1/e56254 UR - http://dx.doi.org/10.2196/56254 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053710 ID - info:doi/10.2196/56254 ER - TY - JOUR AU - Franke, Anna Mara AU - Neumann, Anne AU - Nordmann, Kim AU - Suleymanova, Daniela AU - Ravololohanitra, Gabrielle Onja AU - Emmrich, Valentin Julius AU - Knauss, Samuel PY - 2025/3/3 TI - Impact of a Mobile Money?Based Conditional Cash Transfer Intervention on Health Care Utilization in Southern Madagascar: Mixed-Methods Study JO - JMIR Mhealth Uhealth SP - e60811 VL - 13 KW - cash transfer intervention KW - Madagascar KW - Sub-Saharan Africa KW - health care utilization KW - humanitarian assistance KW - Africa KW - mobile KW - mixed methods study KW - money KW - quantitative KW - qualitative KW - thematic analysis KW - policy KW - service KW - delivery KW - health care system KW - cash KW - economic KW - financial KW - payment KW - time series N2 - Background: Mobile money?based cash transfer interventions are becoming increasingly utilized, especially in humanitarian settings. southern Madagascar faced a humanitarian emergency in 2021-2022, when the second wave of the COVID-19 pandemic and a severe famine affected the fragile region simultaneously. Objective: This mixed-methods study aims to analyze the impact and factors influencing the success of a mobile money?based conditional cash transfer intervention for health care utilization at 4 primary and 11 secondary facilities in Madagascar. Methods: We obtained quantitative data from 11 facility registers, detailing patient numbers per month, categorized into maternity care, surgical care, pediatric care, outpatient care, and inpatient care. An interrupted time series analysis, without a control group, was conducted using the end of the intervention in July 2022 as the cut off point. For qualitative data, 64 in-depth interviews were conducted with health care providers, NGO staff, policymakers, beneficiaries, and nonbeneficiaries of the intervention, and was interpreted by 4 independent researchers using reflexive thematic analysis to identify facilitators and barriers to implementation. Results: The interrupted time series analysis showed a significant negative impact on health care utilization, indicating a reduction in health care?seeking behavior after the end of the cash transfer intervention. The effect was stronger in the slope change of patient numbers per month (defined as P<.05), which significantly decreased in 39 of 55 (70%) models compared to the step change at the end of the intervention, which showed a significant but lower change (P <.05) in 40% (22/55) of models. The changes were most pronounced in surgical and pediatric care. The key factors that influenced the success of the implementation were grouped across three levels. At the community level, outreach conducted to inform potential beneficiaries about the project by community health workers and using the radio was a decisive factor for success. At participating facilities, high intrinsic staff motivation and strong digital literacy among facility staff positively influenced the intervention. Confusion regarding previous activities by the same implementing NGO and perceptions of unfair bonus payments for health care providers included in the project negatively affected the intervention. Finally, at the NGO-level, the staff present at each facility and the speed and efficiency of administrative processes during the intervention were decisive factors that influenced the intervention. Conclusions: The conditional cash transfer intervention was overarchingly successful in increasing health care utilization in southern Madagascar in a humanitarian setting. However, this success was conditional on key implementation factors at the community, facility, and NGO levels. In the future, similar interventions should proactively consider the key factors identified in this study to optimize the impact. UR - https://mhealth.jmir.org/2025/1/e60811 UR - http://dx.doi.org/10.2196/60811 ID - info:doi/10.2196/60811 ER - TY - JOUR AU - Miranda, Christina AU - Matheson, Brittany AU - Datta, Nandini AU - Whyte, Aileen AU - Yang, Hyun-Joon AU - Schmiedmayer, Paul AU - Ravi, Vishnu AU - Aalami, Oliver AU - Lock, James PY - 2025/2/28 TI - Enhancing Distress Tolerance Skills in Adolescents With Anorexia Nervosa Through the BALANCE Mobile App: Feasibility and Acceptability Study JO - JMIR Form Res SP - e70278 VL - 9 KW - mHealth KW - mobile health KW - mobile application KW - emotion regulation KW - eating disorders KW - family-based treatment KW - distress tolerance KW - mealtimes N2 - Background: Anorexia nervosa is a severe psychiatric disorder with high morbidity and mortality, particularly among adolescents. Family-based treatment (FBT) is the leading evidence-based intervention for adolescent anorexia nervosa, involving parents in renourishment and behavior interruption. Despite its effectiveness, challenges in distress tolerance and emotion regulation during high-stress situations, such as mealtimes, contribute to suboptimal treatment outcomes, with only 35% to 50% of adolescents achieving full recovery. Enhancing distress tolerance skills during FBT may improve treatment responses and recovery rates. The BALANCE mobile app was developed to address this need, offering real-time, dialectical behavior therapy (DBT)?based distress tolerance skills to support adolescents and families during mealtimes. Objective: Our aim was to explore the feasibility and acceptability of a mobile app designed to deliver distress tolerance skills to adolescents with and adolescents without anorexia nervosa. When fully programmed and optimized, we plan to use the mobile app to improve distress tolerance during mealtimes for adolescents with anorexia nervosa undergoing FBT. Methods: BALANCE was developed collaboratively with Stanford University?s Center for Biodesign, leveraging the expertise of clinical psychologists and using biodesign student input and the Stanford Spezi ecosystem. The app underwent an iterative development process, with feedback from adolescent users. The initial feasibility and acceptability of the app were assessed through self-reported questionnaires and structured interviews with 24 adolescents aged 12 to 18 years, including 4 diagnosed with anorexia nervosa and 20 healthy controls. Adolescents with anorexia nervosa specifically used the app during mealtimes, and healthy controls used it as needed. Participants assessed the app?s usability, perceived effectiveness, and its impact on their distress tolerance. Results: The app demonstrated high usability and acceptability. Of 24 participants, 83% (n=20) reported enjoying the app, 88% (n=21) would recommend it to peers, and 100% (n=24) found it user-friendly. Adolescents with anorexia nervosa reported that BALANCE helped them manage stressful mealtimes more effectively, highlighting features such as guided meditation, breathing exercises, and gamification elements as particularly effective. Healthy controls provided additional feedback, confirming the app?s broad appeal to the target audience and potential scalability. Preliminary findings suggest that BALANCE may enhance distress tolerance in adolescents with and adolescents without anorexia nervosa. Conclusions: BALANCE shows promise as an innovative mobile health intervention for enhancing distress tolerance in adolescents with anorexia nervosa. Its user-friendly design and tailored DBT-based skills make it a feasible tool for integration into FBT. Future research should explore its integration into clinical practice and its impact on treatment outcomes. As distress tolerance skills are relevant to a range of mental health conditions, future research may also expand BALANCE?s application to broader adolescent populations. UR - https://formative.jmir.org/2025/1/e70278 UR - http://dx.doi.org/10.2196/70278 ID - info:doi/10.2196/70278 ER - TY - JOUR AU - Samele, Chiara AU - Urquia, Norman AU - Edwards, Rachel AU - Donnell, Katie AU - Krause, Nihara PY - 2025/2/28 TI - Evaluation of the Clear Fear Smartphone App for Young People Experiencing Anxiety: Uncontrolled Pre? and Post?Follow-Up Study JO - JMIR Form Res SP - e55603 VL - 9 KW - mental health KW - anxiety KW - depression KW - emotional and behavioral difficulties KW - mobile phone app KW - cognitive behavioral therapy KW - digital tool KW - young people KW - mobile phone N2 - Background: Mobile health apps are proving to be an important tool for increasing access to psychological therapies early on, particularly with rising rates of anxiety and depression in young people. Objective: We aimed to assess the usability, acceptability, safety, and effectiveness of a new app, Clear Fear, developed to help young people manage symptoms of anxiety using the principles of cognitive behavioral therapy. Methods: The Clear Fear app was developed to provide cognitive behavioral strategies to suit anxiety disorders. An uncontrolled pre? and post?follow-up design over a 9-week period was used to assess the app and its effects. This study comprised 3 phases: baseline (stage 1), post?app familiarization phase (stage 2), and follow-up (stage 3). Eligible participants were aged between 16 and 25 years with mild to moderate anxiety but not currently receiving treatment or in contact with specialist mental health services or using other interventions or apps to help monitor or manage their mental health. A community sample was recruited via advertisements, relevant websites, and social media networks. Eligible participants completed standardized self-report tools and questionnaires at each study stage. These measured probable symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (Mood and Feelings Questionnaire); emotional and behavioral difficulties (Strengths and Difficulties Questionnaire); and feedback on the usability, accessibility, and safety of the app. Mean scores at baseline and follow-up were compared using paired 2-tailed t tests or Wilcoxon signed rank tests. Qualitative data derived from open-ended questions were coded and entered into NVivo (version 10) for analysis. Results: A total of 48 young people entered the study at baseline, with 37 (77%) completing all outcome measures at follow-up. The sample was mostly female (37/48, 77%). The mean age was 20.1 (SD 2.1) years. In total, 48% (23/48) of the participants reached the threshold for probable anxiety disorder, 56% (27/48) had positive scores for probable depression, and 75% (36/48) obtained a total score of ?very high? on the Strengths and Difficulties Questionnaire for emotional and behavioral difficulties. The app was well received, offering reassurance, practical and immediate help to manage symptoms, and encouragement to seek help, and was generally found easy to use. A small minority (3/48, 6%) found the app difficult to navigate. The Clear Fear app resulted in statistically significant reductions in probable symptoms of anxiety (t36=2.6, 95% CI 0.41-3.53; P=.01) and depression (z=2.3; P=.02) and behavioral and emotional difficulties (t47=4.5, 95% CI 3.67-9.65; P<.001), representing mostly medium to large standardized effect sizes. Conclusions: The Clear Fear app was found to be usable, acceptable, safe, and effective in helping manage symptoms of anxiety and depression and emotional and behavioral difficulties. UR - https://formative.jmir.org/2025/1/e55603 UR - http://dx.doi.org/10.2196/55603 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053764 ID - info:doi/10.2196/55603 ER - TY - JOUR AU - Pickard, Abigail AU - Edwards, Katie AU - Farrow, Claire AU - Haycraft, Emma AU - Blissett, Jacqueline PY - 2025/2/27 TI - Capturing Everyday Parental Feeding Practices and Eating Behaviors of 3- to 5-Year-Old Children With Avid Eating Behavior: Ecological Momentary Assessment Feasibility and Acceptability Study JO - JMIR Form Res SP - e66807 VL - 9 KW - pediatric KW - paediatric KW - child KW - child eating KW - parent feeding KW - parent KW - ecological momentary assessment KW - mHealth KW - mobile health KW - mobile app KW - application KW - smartphone KW - digital KW - digital health KW - digital technology KW - digital intervention N2 - Background: The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as ecological momentary assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents? feeding practices and feeding goals, particularly when feeding children with high food approaches. Objective: The main objectives of this study were to (1) assess parents/caregivers? compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children?s eating occasions and parents? feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. Methods: Parents in the United Kingdom with a child aged 3 to 5 years who exhibit avid eating behavior were invited to participate in a 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey. Results: Of those parents who completed the EMA study, 104 (87.4%) parents provided at least 7 ?full? days of data (2 signal surveys and 1 event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), 3 daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the 10 days. Over the EMA period, a total of 2524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD 0.18; min=1.7, max=2.3). The majority of parents felt that the surveys made them more aware of their feelings (105/118, 89%) and activities (93/118, 79%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r=0.483, P<.001). However, the number of daily food requests per day estimated at baseline (mean 4.5, SD 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean 3.7, SD 1.1), (t116=18.8, P<.001). Conclusions: This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents? involvement to ensure successful data collection. International Registered Report Identifier (IRRID): RR2-10.2196/55193 UR - https://formative.jmir.org/2025/1/e66807 UR - http://dx.doi.org/10.2196/66807 ID - info:doi/10.2196/66807 ER - TY - JOUR AU - Gjestvang, Christina AU - Kalhovde, Magne John AU - Mauseth Tangen, Elene AU - Clemm, Hege AU - Haakstad, Hagen Lene Annette PY - 2025/2/25 TI - Impact of In-Person and Mobile Exercise Coaching on Psychosocial Factors Affecting Exercise Adherence in Inactive Women With Obesity: 20-Week Randomized Controlled Trial JO - J Med Internet Res SP - e68462 VL - 27 KW - barriers KW - exercise behavior KW - exercise coaching KW - health-related quality of life KW - motivation KW - obesity KW - psychosocial factors KW - self-efficacy KW - social support N2 - Background: Regular exercise may counteract obesity-related health risks, but adherence is low among individuals with obesity. Personal trainers may positively influence exercise behavior by providing motivational support. Individuals who receive regular exercise coaching are more likely to adhere to their exercise routine, compared with those who exercise individually. However, investing in personalized exercise guidance, such as a personal trainer, can be expensive for the individual. Thus, integrating web-based coaching could be a more economically sustainable option, offering both flexibility and reduced costs compared with in-person coaching only. Yet, research is needed to assess the effect of hybrid models in improving psychosocial factors among women with obesity. Objective: This 20-week, pragmatic randomized controlled trial aimed to investigate the effect of weekly in-person coaching compared with 2 combinations of in-person and web-based coaching on 5 psychosocial factors in women with obesity (BMI ?30 kg/m2). Methods: Participants were invited through Facebook and Instagram advertisements posted by various fitness clubs across rural and urban locations in Norway (7 different counties and 12 different municipalities). Women with low activity (n=188; <150 minutes of moderate-intensity physical activity/week; 42.7, SD 10.5 years; mean BMI of 35.1, SD 6.9 kg/m2) were allocated into 3 groups of in-person coaching?weekly (n=47), twice weekly (n=47), and once monthly (n=47)?and as controls (n=47). Those with twice weekly and once monthly in-person coaching received web-based coaching of 15 minutes during weeks without in-person coaching. Data included background variables, motivation (Behavioral Regulation in Exercise Questionnaire-2), barriers, self-efficacy (The Self-Efficacy Survey), social support (Social Support Questionnaire), and health-related quality of life (36-Item Short Form Health Survey [SF-36]). Results: A total of 120 (64%) out of 188 participants completed baseline and postintervention assessments. A minor difference was observed in one item of the SF-36, where all intervention groups reported a greater ?change in health last year? than the control group (mean difference: 14.2-17.1, 95% CI 2.04-29.5; g=0.79-1.14; P?.01). No other effects were found on the selected psychosocial factors. It should be noted that controls reported higher intrinsic motivational regulation at baseline than intervention groups (mean difference: 0.43-0.93; P?.05). All intervention arms exercised more frequently than controls (mean difference: 1.1-1.5; P?.001), with no differences in weekly exercise frequency between the 3 intervention arms (P=.30). Conclusions: We found no effects on motivation, barriers, self-efficacy, perceived social support, or other health domains compared with controls. All intervention groups reported a slight improvement in self-perceived health in 1 of the 8 subscales of the SF-36. Combined in-person and web-based coaching may give a minor improvement in self-perceived health in women with obesity. However, the lack of impact on motivation, barriers, and self-efficacy warrants further research. Trial Registration: ClinicalTrials.gov NCT05792657; https://clinicaltrials.gov/study/NCT05792657 UR - https://www.jmir.org/2025/1/e68462 UR - http://dx.doi.org/10.2196/68462 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68462 ER - TY - JOUR AU - Davis-Wilson, Hope AU - Hegarty-Craver, Meghan AU - Gaur, Pooja AU - Boyce, Matthew AU - Holt, R. Jonathan AU - Preble, Edward AU - Eckhoff, Randall AU - Li, Lei AU - Walls, Howard AU - Dausch, David AU - Temple, Dorota PY - 2025/2/24 TI - Effects of Missing Data on Heart Rate Variability Measured From A Smartwatch: Exploratory Observational Study JO - JMIR Form Res SP - e53645 VL - 9 KW - plethysmography KW - electrocardiogram KW - missing data KW - smartwatch KW - wearable KW - ECG KW - photoplethysmography KW - PPG KW - mobile phone KW - heart rate KW - pilot study KW - detection KW - sensor KW - monitoring KW - health metric KW - measure KW - real-world settings KW - rest KW - physical activity KW - remote monitoring KW - medical setting KW - youth KW - adolescent KW - teen KW - teenager N2 - Background: Measuring heart rate variability (HRV) through wearable photoplethysmography sensors from smartwatches is gaining popularity for monitoring many health conditions. However, missing data caused by insufficient wear compliance or signal quality can degrade the performance of health metrics or algorithm calculations. Research is needed on how to best account for missing data and to assess the accuracy of metrics derived from photoplethysmography sensors. Objective: This study aimed to evaluate the influence of missing data on HRV metrics collected from smartwatches both at rest and during activity in real-world settings and to evaluate HRV agreement and consistency between wearable photoplethysmography and gold-standard wearable electrocardiogram (ECG) sensors in real-world settings. Methods: Healthy participants were outfitted with a smartwatch with a photoplethysmography sensor that collected high-resolution interbeat interval (IBI) data to wear continuously (day and night) for up to 6 months. New datasets were created with various amounts of missing data and then compared with the original (reference) datasets. 5-minute windows of each HRV metric (median IBI, SD of IBI values [STDRR], root-mean-square of the difference in successive IBI values [RMSDRR], low-frequency [LF] power, high-frequency [HF] power, and the ratio of LF to HF power [LF/HF]) were compared between the reference and the missing datasets (10%, 20%, 35%, and 60% missing data). HRV metrics calculated from the photoplethysmography sensor were compared with HRV metrics calculated from a chest-worn ECG sensor. Results: At rest, median IBI remained stable until at least 60% of data degradation (P=.24), STDRR remained stable until at least 35% of data degradation (P=.02), and RMSDRR remained stable until at least 35% data degradation (P=.001). During the activity, STDRR remained stable until 20% data degradation (P=.02) while median IBI (P=.01) and RMSDRR P<.001) were unstable at 10% data degradation. LF (rest: P<.001; activity: P<.001), HF (rest: P<.001, activity: P<.001), and LF/HF (rest: P<.001, activity: P<.001) were unstable at 10% data degradation during rest and activity. Median IBI values calculated from photoplethysmography sensors had a moderate agreement (intraclass correlation coefficient [ICC]=0.585) and consistency (ICC=0.589) and LF had moderate consistency (ICC=0.545) with ECG sensors. Other HRV metrics demonstrated poor agreement (ICC=0.071-0.472). Conclusions: This study describes a methodology for the extraction of HRV metrics from photoplethysmography sensor data that resulted in stable and valid metrics while using the least amount of available data. While smartwatches containing photoplethysmography sensors are valuable for remote monitoring of patients, future work is needed to identify best practices for using these sensors to evaluate HRV in medical settings. UR - https://formative.jmir.org/2025/1/e53645 UR - http://dx.doi.org/10.2196/53645 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53645 ER - TY - JOUR AU - Prochnow, Tyler AU - Dunton, F. Genevieve AU - de la Haye, Kayla AU - Pollack Porter, M. Keshia AU - Lee, Chanam PY - 2025/2/21 TI - Combining Ecological Momentary Assessment and Social Network Analysis to Study Youth Physical Activity and Environmental Influences: Protocol for a Mixed Methods Feasibility Study JO - JMIR Res Protoc SP - e68667 VL - 14 KW - physical activity KW - youth KW - social environment KW - built environment KW - ecological momentary assessment KW - social network analysis KW - phenotypes KW - accelerometry KW - GPS N2 - Background: Physical activity (PA) is crucial for youth health, but up to 74% of adolescents fail to meet recommended levels, especially during summer when structured supports associated with school are not available. The social and built environments significantly influence youth PA; yet, their complex interactions remain poorly understood. This study aims to evaluate the feasibility of combining ecological momentary assessment (EMA) and social network analysis to examine bidirectional influences among youth PA, built environments, and social networks during summer. Objective: The objectives are to (1) evaluate the feasibility and acceptability of the combined EMA and Social Network Analysis protocol, and (2) identify phenotypes using person-level, microtemporal, and dynamic overlap between social and built environments. Methods: This mixed methods feasibility study with an exploratory observational component will recruit 120 youth aged 12 years to 15 years from an urban school district in Central Texas, US. Participants will first complete a baseline survey to report their general social network patterns and environmental perceptions. Then participants will wear an ActiGraph LEAP accelerometer and respond to EMA prompts via smartphone for 7 days. EMA will assess real-time perceptions of social networks and surrounding built environments, which will be time-matched with accelerometer-assessed PA data. GPS coordinates will be collected with each EMA prompt to assess features of the built environment. Follow-up semistructured interviews will assess protocol acceptability. Results: This study has been funded by the National Heart, Lung, and Blood Institute. Data collection is expected in the summers of 2025, 2026, and 2027. Conclusions: This innovative approach combines EMA, SNA, accelerometry, and GPS data to provide unprecedented insights into the dynamic interplay between social networks, built environments, and youth PA during summer. Findings will inform the development of more targeted, effective interventions to promote PA among youth. While limitations include potential participant burden and generalizability, the study?s strengths in capturing real-time, contextualized data make it a valuable contribution to understanding youth PA determinants. International Registered Report Identifier (IRRID): PRR1-10.2196/68667 UR - https://www.researchprotocols.org/2025/1/e68667 UR - http://dx.doi.org/10.2196/68667 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68667 ER - TY - JOUR AU - Yin, Ruoyu AU - Rajappan, Dakshayani AU - Martinengo, Laura AU - Chan, F. Frederick H. AU - Smith, Helen AU - Griva, Konstadina AU - Subramaniam, Mythily AU - Tudor Car, Lorainne PY - 2025/2/21 TI - Depression Self-Care Apps? Characteristics and Applicability to Older Adults: Systematic Assessment JO - J Med Internet Res SP - e56418 VL - 27 KW - older adults KW - elder KW - elderly KW - mental health KW - mental illness KW - mental disorders KW - mHealth KW - mobile health KW - mobile application KW - app KW - application KW - smartphone KW - depression KW - self-care KW - mobile apps KW - systematic assessment KW - assessment KW - effectiveness KW - Android app KW - mental health apps KW - mobile interventions KW - behaviour KW - therapy KW - mood monitoring KW - adaptations KW - online communities KW - impairments N2 - Background: Depression affects 32% of older adults. Loneliness and social isolation are common risk factors for depression in older adults. Mobile apps can connect users and are also effective in depression management in the general population. However, older adults have specific needs in terms of the content of depression self-care interventions and their accessibility. It remains unknown whether existing apps for depression self-care are applicable to older adults. Objective: The initial aim of this assessment was to systematically identify interactive depression self-care apps specifically designed for older adults. As we did not find any, we assessed the applicability of existing depression self-care apps to the needs of older adult users. Methods: Using an established app assessment methodology, we searched for Android and iOS interactive mental health apps providing self-care for depression in English and Chinese in the 42Matters database, Chinese Android app stores, and the first 10 pages of Google and Baidu. We developed an assessment rubric based on extensive revision of the literature. The rubric consisted of the following sections: general characteristics of the apps (eg, developer, platform, and category), app content (eg, epidemiology and risk factors of depression in older adults, techniques to improve mood and well-being), and technical aspects (eg, accessibility, privacy and confidentiality, and engagement). Results: We identified 23 apps (n=19, 82.6%, English and n=4, 17.4%, Chinese apps), with 5 (21.7%) iOS-only apps, 3 (13%) Android-only apps, and 15 (65.2%) apps on both platforms. None specifically targeted older adults with depression. All apps were designed by commercial companies and were free to download. Most of the apps incorporated cognitive behavior therapy, mood monitoring, or journaling. All but 3 (13%) apps had a privacy and confidentiality policy. In addition, 14 (60.9%) apps covered depression risk factors in older adults, and 3 (13%) apps delivered information about depression epidemiology in older adults via a chatbot. Furthermore, 17 (73.9%) apps mentioned other topics relevant to older adults, such as pain management, grief, loneliness, and social isolation. Around 30% (n=7) of the apps were supported by an online forum. Common accessibility issues included a lack of adaptations for users with visual or hearing impairments and incompatibility with larger font sizes in the phone settings. Conclusions: There are no depression apps developed specifically for older adults. Available mobile apps have limited applicability to older adults in terms of their clinical and technical features. Depression self-care apps should aim to incorporate content relevant to older adults, such as grief and loss; include online communities; and improve accessibility to adapt to potential health impairments in older adults. UR - https://www.jmir.org/2025/1/e56418 UR - http://dx.doi.org/10.2196/56418 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56418 ER - TY - JOUR AU - Gaynor, Mathew AU - Hesketh, Kylie AU - Gebremariam, Kidane AU - Wynter, Karen AU - Laws, Rachel PY - 2025/2/21 TI - Practicality of the My Baby Now App for Fathers by Fathers: Qualitative Case Study JO - JMIR Pediatr Parent SP - e64171 VL - 8 KW - fathers KW - parenting resources KW - health promotion KW - My Baby Now KW - MBN KW - app KW - mobile phone N2 - Background: Evolving societal trends are resulting in fathers having an increasing influence on the health-related behaviors that children develop. Research shows that most fathers are committed to their role and when equipped with knowledge, can have a positive impact on their child?s health. However, parenting resources typically target mothers, with fathers being excluded. While evolving mobile phone technology provides an efficient means for delivering parenting resources, many fathers find that mobile health (mHealth) technology does not provide material they can engage with. Objective: This study aimed to explore how to make parenting apps more engaging and useful for fathers using an existing parenting mHealth resource, the My Baby Now app, as a case study. Methods: A total of 14 purposefully selected, Australian fathers of 7 months to 5-year-old children took part in a qualitative study, comprising either focus groups or interviews. Recorded focus groups and interviews were transcribed verbatim, then coded using a combination of deductive and inductive methods. Reflexive thematic analysis was undertaken to identify patterns and themes. Results: Current parenting apps provide parenting information that can be unappealing for fathers. To improve paternal engagement with mHealth resources, fathers highlighted the need for father specific information, with an increase in positive imagery and positive descriptions of fathers in their parenting role. There should be father-exclusive domains such as forums, and also push notifications to provide positive reinforcement and encouragement for fathers. Conclusions: mHealth has the capacity to deliver information to fathers when needed. This reduces the risk of paternal frustration and disengagement from parenting. Further benefit will be gained by research to understand possible differences in mHealth app usage by fathers of differing socioeconomic position, cultural backgrounds, and family status, such as single fathers and same-sex couples. UR - https://pediatrics.jmir.org/2025/1/e64171 UR - http://dx.doi.org/10.2196/64171 UR - http://www.ncbi.nlm.nih.gov/pubmed/39982774 ID - info:doi/10.2196/64171 ER - TY - JOUR AU - Zhang, Tianyi AU - Camargo, Andres AU - Schmaal, Lianne AU - Kostakos, Vassilis AU - D'Alfonso, Simon PY - 2025/2/19 TI - Nomophobia, Psychopathology, and Smartphone-Inferred Behaviors in Youth With Depression: Longitudinal Study JO - JMIR Form Res SP - e57512 VL - 9 KW - mobile sensing KW - nomophobia KW - digital phenotyping KW - depression KW - mental health KW - smartphone use KW - personal sensing KW - behavior analysis KW - machine learning KW - mobile health KW - mobile phone N2 - Background: Smartphones have become an indispensable part of people?s lives, and the fear of being without them, what has been termed ?no mobile phone phobia? (nomophobia), is a growing phenomenon. The rise of problematic smartphone use highlights the urgent need to explore the intricate relationship between smartphones and human behavior. However, the connections between nomophobia, mental health indicators, smartphone use patterns, and daily activities remain largely underexplored. Objective: This study aimed to explore the relationship between young adults with depression and smartphones and investigate nomophobia by analyzing data obtained from a pilot study of depression in a youth cohort. Exploring nomophobia can enhance our understanding of the dynamics between young adults and smartphone use, potentially empowering them to manage and regulate their smartphone use more effectively. Methods: During an 8-week period, data collected via smartphone sensors, such as locations and screen status, were gathered from a cohort of 41 individuals diagnosed with major depressive disorder. In addition to passive-sensing smartphone data, the study collected ecological momentary assessments and psychometric measures, including the Nomophobia Questionnaire, which formed the basis of our investigation. We explored statistical associations among smartphone-derived behavioral features, psychometric indicators, and nomophobia. In addition, we used behavioral and psychometric data to develop regression models demonstrating the prediction of nomophobia levels. Results: Our findings revealed that the level of nomophobia was positively associated with depression and negative affect, lower geolocation movements, and higher comfort with smartphone sensing. The exploratory predictive linear regression models demonstrated the feasibility of predicting an individual?s Nomophobia Questionnaire score based on their smartphone sensing data. These models effectively used input features derived from both a combination of smartphone sensing data and psychometric measures and from smartphone sensing data alone. Conclusions: Our work is the first to explore the relationship between nomophobia and smartphone sensor data. It provides valuable insights into the predictors of nomophobia level, contributing to the understanding of the relationship between smartphones and human behavior and paving the way for future studies. UR - https://formative.jmir.org/2025/1/e57512 UR - http://dx.doi.org/10.2196/57512 UR - http://www.ncbi.nlm.nih.gov/pubmed/39969982 ID - info:doi/10.2196/57512 ER - TY - JOUR AU - Walter, Uso AU - Pennig, Stefan AU - Bleckmann, Lothar AU - Röschmann-Doose, Kristina AU - Wittig, Thomas AU - Thomsen, Jörn AU - Schlee, Winfried PY - 2025/2/18 TI - Continuous Improvement of Chronic Tinnitus Through a 9-Month Smartphone-Based Cognitive Behavioral Therapy: Randomized Controlled Trial JO - J Med Internet Res SP - e59575 VL - 27 KW - tinnitus KW - chronic tinnitus KW - mobile health app KW - mHealth KW - mobile app KW - application KW - smartphone KW - digital health KW - digital technology KW - digital intervention KW - cognitive behavioral therapy KW - randomized controlled trial KW - statistical analysis N2 - Background: Tinnitus is the perception of sound without an external auditive stimulus and can be a severe burden for affected patients. Medical guidelines recommend cognitive behavioral therapy (CBT) for tinnitus treatment, which effectively improves tinnitus-related distress and anxiety. Objective: This study investigates the outcome of a 9-month smartphone-based CBT for patients with tinnitus. Methods: The randomized controlled clinical trial in this study investigates the efficacy of a smartphone-based CBT for 187 patients with chronic tinnitus over a 9-month treatment period. In the initial 3 months, a waiting list design was applied, and in the subsequent study phase, the data of both treatment groups were collectively analyzed. The scores on the Tinnitus Questionnaire (TQ); 9-item Patient Health Questionnaire (PHQ-9); 9-item Self-Efficacy, Optimism, Pessimism (SWOP-K9) questionnaire; and 20-item Perceived Stress Questionnaire (PSQ-20) were assessed as endpoints after 3 and 9 months of treatment. Results: We observed a statistically significant reduction in the tinnitus burden in patients who received the smartphone-based CBT intervention. Although no changes were observed initially in the TQ sum scores in the waiting control group (baseline mean, 37.8, SD 4.7; 3 months mean 37.5, SD 4.8; analysis of covariance [ANCOVA] P=.52), the scores significantly decreased once the app-based CBT had commenced. Data pooled from both groups revealed significant reduction in the TQ sum score by 12.49 (SD 1.44) (ANCOVA, P<.001) and 18.48 (SD 1.85) (ANCOVA, P<.001) points after 3 and 9 months, respectively, which was also clinically important. The calculated Cohen d was 1.38. Similarly, the scores on PSQ-20 (?9.14 points; ANCOVA, P<.001), PHQ-9 (?2.47 points; ANCOVA, P<.001), and SWOP-K9 (0.17 points; ANCOVA, P<.001) were significantly improved at the end of the therapy, with corresponding intermediate effect sizes after 9 months. Conclusions: The data in our study provide evidence of statistically significant, clinically relevant, and continuous benefits of an app-based CBT intervention in patients with chronic tinnitus. Trial Registration: Deutsches Register Klinischer Studien DRKS00022973; https://drks.de/search/de/trial/DRKS00022973 UR - https://www.jmir.org/2025/1/e59575 UR - http://dx.doi.org/10.2196/59575 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59575 ER - TY - JOUR AU - Lee, Sol-Hee AU - Kim, Jiae AU - Kim, Han-Joon PY - 2025/2/13 TI - Smartphone Application?Based Voice and Speech Training Program for Parkinson Disease: Feasibility and Satisfaction Study With a Preliminary Rater-Blinded Single-Arm Pretest and Posttest Design JO - J Med Internet Res SP - e63166 VL - 27 KW - Parkinson disease KW - speech therapy KW - mHealth KW - home-based training KW - self-delivered KW - digital health care KW - app KW - feasibility KW - voice therapy KW - mobile phone KW - satisfaction KW - effectiveness KW - smartphone KW - apps KW - single-arm study KW - mobility KW - mobile health KW - acoustic analysis KW - self-training N2 - Background: Up to 75% of patients with Parkinson disease (PD) experience voice and speech impairments, such as breathy phonation and low speech volume, which worsen over time and negatively impact the quality of life. However, given their increasingly limited mobility, face-to-face speech therapy is often inaccessible. Mobile health (mHealth) apps offer accessible and cost-effective alternatives; yet, their application in PD-specific, self-delivered voice therapy remains underexplored. Objective: This study aimed to evaluate the feasibility, adherence, and satisfaction of a self-delivered smartphone app for voice therapy in patients with PD, designed to minimize speech-language pathologist involvement while promoting patient independence. In addition, it seeks to assess the preliminary therapeutic effectiveness of the app in addressing voice and speech problems in this population. Methods: A single-arm, rater-blinded, and pretest and posttest study was conducted between September to November 2023. Patients with PD with voice and speech problems who have no problem with using Android (Google) smartphones were recruited. Participants downloaded the researcher-developed mHealth app on their smartphone and participated in a patient-tailored 5-week home-based speech training program. Each session included 5 stages: breathing, oral motor exercises, loudness, prosody, and functional speaking. The training program consisted of 20 sessions, with participants completing 1 session per day, 4 days per week. Each session lasted approximately 20-30 minutes. Adherence was monitored through app logs, satisfaction was assessed through a phone survey, and therapeutic effectiveness was evaluated using acoustic analysis and auditory-perceptual assessments. Results: Out of 30 patients were initially recruited, but 2 of them withdrew. Out of 25 participants completed all the training sessions while 3 dropped out. The adherence was above 90% in 20 participants (80%, 20/25), 70% to 90% in 4 (16%, 4/25), and below 70% in 4 (16%, 4/25). Satisfaction was 75% (18/24) among the 24 people who participated in the survey. Significant improvements were observed in all acoustic measures: the maximum phonation time increased from 11.15 (SD 5.38) seconds to 14.01 (SD 5.64) seconds (P=.003), and vocal intensity increased from 71.59 (SD 4.39) dB to 73.81 (SD 3.48) dB (P<.001) across both sustained phonation and reading tasks. Voice quality scores on the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale improved significantly (all components P<.001). Furthermore, 58.3% (14/24) of participants reported subjective improvements in their voice. Conclusions: This study demonstrates that home-based, self-training speech therapy delivered through a mHealth app is a feasible solution for patients with PD, suggesting that mHealth apps can serve as a convenient and effective alternative to face-to-face therapy by enhancing accessibility and empowering patients to actively manage their condition. UR - https://www.jmir.org/2025/1/e63166 UR - http://dx.doi.org/10.2196/63166 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63166 ER - TY - JOUR AU - Jacob, Christine AU - Müller, Roman AU - Schüler, Sonja AU - Rey, Alix AU - Rey, Guillaume AU - Armenian, Berj AU - Vonlaufen, Alain AU - Drepper, Michael AU - Zimmerli, Marius PY - 2025/2/12 TI - Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study JO - JMIR Hum Factors SP - e67043 VL - 12 KW - eHealth KW - mobile health KW - mHealth KW - digital health KW - technology assessment KW - technology adoption KW - technology implementation KW - usability study KW - colonoscopy KW - app KW - application KW - examinations KW - smartphone KW - usability N2 - Background: Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective: This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app?s usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods: From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants? task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results: In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app?s usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions: The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial. UR - https://humanfactors.jmir.org/2025/1/e67043 UR - http://dx.doi.org/10.2196/67043 ID - info:doi/10.2196/67043 ER - TY - JOUR AU - Xiao, Jian AU - Li, Mengyao AU - Cai, Ruwen AU - Huang, Hangxing AU - Yu, Huimin AU - Huang, Ling AU - Li, Jingyang AU - Yu, Ting AU - Zhang, Jiani AU - Cheng, Shuqiao PY - 2025/2/11 TI - Smart Pharmaceutical Monitoring System With Personalized Medication Schedules and Self-Management Programs for Patients With Diabetes: Development and Evaluation Study JO - J Med Internet Res SP - e56737 VL - 27 KW - pharmaceutical services KW - diabetes KW - self-management KW - intelligent medication scheduling system KW - drug database KW - GPT-4 N2 - Background: With the climbing incidence of type 2 diabetes, the health care system is under pressure to manage patients with this condition properly. Particularly, pharmacological therapy constitutes the most fundamental means of controlling blood glucose levels and preventing the progression of complications. However, its effectiveness is often hindered by factors such as treatment complexity, polypharmacy, and poor patient adherence. As new technologies, artificial intelligence and digital technologies are covering all aspects of the medical and health care field, but their application and evaluation in the domain of diabetes research remain limited. Objective: This study aims to develop and establish a stand-alone diabetes management service system designed to enhance self-management support for patients, as well as to assess its performance with experienced health care professionals. Methods: Diabetes Universal Medication Schedule (DUMS) system is grounded in official medicine instructions and evidence-based data to establish medication constraints and drug-drug interaction profiles. Individualized medication schedules and self-management programs were generated based on patient-specific conditions and needs, using an app framework to build patient-side contact pathways. The system?s ability to provide medication guidance and health management was assessed by senior health care professionals using a 5-point Likert scale across 3 groups: outputs generated by the system (DUMS group), outputs refined by pharmacists (intervention group), and outputs generated by ChatGPT-4 (GPT-4 group). Results: We constructed a cloud-based drug information management system loaded with 475 diabetes treatment?related medications; 684 medication constraints; and 12,351 drug-drug interactions and theoretical supports. The generated personalized medication plan and self-management program included recommended dosing times, disease education, dietary considerations, and lifestyle recommendations to help patients with diabetes achieve correct medication use and active disease management. Reliability analysis demonstrated that the DUMS group outperformed the GPT-4 group in medication schedule accuracy and safety, as well as comprehensiveness and richness of the self-management program (P<.001). The intervention group outperformed the DUMS and GPT-4 groups on all indicator scores. Conclusions: DUMS?s treatment monitoring service can provide reliable self-management support for patients with diabetes. ChatGPT-4, powered by artificial intelligence, can act as a collaborative assistant to health care professionals in clinical contexts, although its performance still requires further training and optimization. UR - https://www.jmir.org/2025/1/e56737 UR - http://dx.doi.org/10.2196/56737 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56737 ER - TY - JOUR AU - Grieve, Natalie AU - Braaten, Kyra AU - MacPherson, Megan AU - Liu, Sam AU - Jung, E. Mary PY - 2025/2/11 TI - Involving End Users in the Development and Usability Testing of a Smartphone App Designed for Individuals With Prediabetes: Mixed-Methods Focus Group Study JO - JMIR Form Res SP - e59386 VL - 9 KW - usability evaluation KW - mHealth KW - usability testing KW - app KW - end-user KW - focus group KW - participant KW - survey KW - diabetes KW - user-centered KW - cognitive walkthrough KW - cognitive walkthroughs KW - questionnaire KW - mobile phone KW - digital health KW - prediabetes N2 - Background: Technology is more likely to be used when it is designed to meet the needs of end users. To supplement the Small Steps for Big Changes diabetes prevention program, a smartphone app was developed in partnership with past Small Steps for Big Changes clientele. Usability testing is critical for the ongoing use and adoption of mobile health apps by providing insight on where appropriate adjustments and improvements need to be made to ensure user satisfaction. Objective: A focus group with 7 participants was conducted to examine the app?s usability and collect feedback for future iterations. Methods: Past Small Steps for Big Changes clientele participated in a cognitive walkthrough of 8 novel tasks and completed the System Usability Scale survey. Participants were then given the option to use the app for 3 weeks before completing the User-Mobile Application Rating Scale. Results: Analysis of the cognitive walkthrough identified 26 usability problems; each was coded using a heuristic evaluation to describe usability errors. The most frequently coded errors included inappropriate progress feedback, information appearing in an illogical order, counterintuitive design, and issues with app aesthetics. A mean summary score of 66.8% (SD 18.91) was reported for the System Usability Scale, representing a marginal acceptability score and indicating that design issues needed to be resolved. A User-Mobile Application Rating Scale mean score of 3.59 (SD 0.33) was reported, implying an average acceptability rating. Conclusions: These findings identified necessary improvements in the app, ranging from minor aesthetic problems to major functionality problems. Involving end users allows the app to be tailored to the client?s preferences and increases the likelihood of usage. This app aligns with Small Steps for Big Changes? program components and behavior change techniques that can improve health outcomes for future clients and allow them to self-monitor their exercise, diet, and goals. UR - https://formative.jmir.org/2025/1/e59386 UR - http://dx.doi.org/10.2196/59386 ID - info:doi/10.2196/59386 ER - TY - JOUR AU - Henry, M. Lauren AU - Blay-Tofey, Morkeh AU - Haeffner, E. Clara AU - Raymond, N. Cassandra AU - Tandilashvili, Elizabeth AU - Terry, Nancy AU - Kiderman, Miryam AU - Metcalf, Olivia AU - Brotman, A. Melissa AU - Lopez-Guzman, Silvia PY - 2025/2/11 TI - Just-In-Time Adaptive Interventions to Promote Behavioral Health: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e58917 VL - 14 KW - just-in-time adaptive interventions KW - JITAI KW - behavioral health KW - systematic review KW - behavior change KW - health outcomes KW - accessibility KW - digital treatment delivery KW - mobile phone N2 - Background: The goal of just-in-time adaptive interventions (JITAIs) is to use mobile, digital tools to provide individuals with personalized interventions at the optimal time and in the optimal context. Accordingly, JITAIs are promising for advancing accessible, equitable, and evidence-based treatment for behavioral health. To guide future inquiry in this space, a review of the literature is needed to describe the state of research on JITAIs for behavioral health. Objective: This study aims to systematically review the literature to describe the landscape of existing JITAIs for behavioral health at any stage of intervention development. In addition, conditional upon a sufficiently homogeneous literature, we will conduct meta-analyses to investigate the effectiveness of JITAIs for promoting distal outcomes (here, aspects of behavioral health) and proximal outcomes (eg, emotion regulation). Methods: This systematic review is being conducted in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). We developed our search strategy and executed the literature search in collaboration with biomedical librarians; 5 databases (PubMed, Embase, Cochrane Library, Web of Science: Core Collection, and APA PsycINFO) were searched, and results were managed using EndNote 20 (Clarivate). We are screening (title, abstract, and full text) all records in duplicate in Covidence according to eligibility criteria. Data items will be extracted, and risk of bias will be assessed in duplicate from the included articles in Covidence. We will summarize JITAI characteristics in tables and text. We will conduct meta-analyses for the distal and proximal outcomes conditional upon sufficient homogeneity in subgroups. Moderation (conditional upon sufficient heterogeneity of outcomes) and mediation (ie, whether changes in proximal outcomes mediate the relation between JITAIs and distal outcomes) will be conducted as appropriate. We will investigate publication bias and use the Grading of Recommendations Assessment, Development and Evaluation to characterize the quality of evidence of our estimates. Results: The search strategy was developed between July 2023 and November 2023. The literature search was executed between November 2023 and December 2023. Title and abstract screening began in December 2023, and full-text screening began in May 2024. Data extraction and analyses have not begun. Conclusions: Here, we propose a systematic review to assess the state of the literature on JITAIs for behavioral health. The insights derived from this study will describe the literature on JITAIs in promoting behavioral health, reinforce JITAI definitions, clarify JITAI elements, and inform the next steps in JITAI research. International Registered Report Identifier (IRRID): PRR1-10.2196/58917 UR - https://www.researchprotocols.org/2025/1/e58917 UR - http://dx.doi.org/10.2196/58917 UR - http://www.ncbi.nlm.nih.gov/pubmed/39932763 ID - info:doi/10.2196/58917 ER - TY - JOUR AU - Ray, Katherine Mary AU - Fleming, Jorie AU - Aschenbrenner, Andrew AU - Hassenstab, Jason AU - Redwine, Brooke AU - Burns, Carissa AU - Arbelaez, Maria Ana AU - Vajravelu, Ellen Mary AU - Hershey, Tamara PY - 2025/2/11 TI - Assessing Dynamic Cognitive Function in the Daily Lives of Youths With and Without Type 1 Diabetes: Usability Study JO - JMIR Form Res SP - e60275 VL - 9 KW - ecological momentary assessment KW - EMA KW - ambulatory KW - smartphone KW - continuous glucose monitoring KW - CGM KW - assessment KW - daily lives KW - youth KW - type 1 diabetes KW - diabetes KW - feasibility study KW - pilot study KW - glycemic control KW - environmental factor KW - phone KW - acceptability KW - young KW - cognitive test KW - app KW - application KW - mobile phone N2 - Background: Studies have shown a relationship between worse glycemic control and lower cognitive scores in youths with type 1 diabetes (T1D). However, most studies assess long-term glucose control (eg, years-decades) and cognition at a single time point. Understanding this relationship at a higher temporal resolution (eg, minutes-hours) and in naturalistic settings has potential clinical implications. Newer technology (eg, continuous glucose monitoring [CGM] and ecological momentary assessment) provides a unique opportunity to explore the glucose dynamics that influence dynamic cognition; that is, cognitive functions that fluctuate short-term and are influenced by environmental factors. Objective: Before we can assess this relationship, we need to determine the feasibility of measuring cognition in youths in daily life and determine the plausibility of obtaining glucose variation with CGM to be integrated with real-time cognition measures. This study?s purpose was to assess the acceptability of measuring dynamic cognition using a smartphone app and adherence to cognitive testing in daily life in youths with and without T1D. Further, we assessed CGM-derived glucose measures at temporally related timeframes to cognitive testing in naturalistic settings. Methods: Data were obtained from 3 studies including one in-laboratory study and 2 remote studies. For all studies, youths were asked to complete cognitive tests on the Ambulatory Research in Cognition (ARC) smartphone app that measured processing speed, associative memory, and working memory. For the in-laboratory study, youths completed testing 4 times during 1 session. For the remote studies, youths were asked to complete cognitive tests 5 times per day for either 10 or 14 consecutive days in daily life. Youths were asked to rate their impressions of the app. Youths with T1D wore a CGM. Results: 74 youths (n=53 control; n=21 T1D) aged 4?16 years participated. Youths generally reported liking or understanding the ARC app tasks in a laboratory and remote setting. Youths had high testing adherence in daily life (2350/3080 to 721/900, 76.3%?80.2%) and none dropped out. The percentage of measurements within each glycemic range taken immediately before the app?s cognitive testing was 3% (28/942) low glucose, 51% (484/942) euglycemia, 23% (221/942) high glucose, and 22% (210/942) very high glucose. In the 2-hour window before each cognitive task, mean glucose was 182.5 (SD 76.2) mg/dL, SD in glucose was 27.1 mg/dL (SD 18.7), and the mean maximum difference between the highest and lowest glucose was 85.5 (SD 53.7) mg/dL. Conclusions: The results suggest that using the ARC smartphone app to assess dynamic cognitive functions in youths with and without T1D is feasible. Further, we showed CGM-derived glycemic variability at temporally associated timeframes of dynamic cognitive assessments. The next steps include using ecological momentary assessment in a fully powered study to determine the relationship between short-term glycemic control and cognition in youths with T1D. UR - https://formative.jmir.org/2025/1/e60275 UR - http://dx.doi.org/10.2196/60275 ID - info:doi/10.2196/60275 ER - TY - JOUR AU - Kim, Jaeyeon AU - Choi, Yiseul AU - Song, Yoolbin AU - Park, Wonse PY - 2025/2/10 TI - Smartphone-Based Telemonitoring for Better Oral Health With Toothbrushes: 6-Month Randomized Controlled Trial JO - J Med Internet Res SP - e65128 VL - 27 KW - clinical studies KW - clinical trials KW - oral hygiene KW - plaque KW - plaque biofilms KW - halitosis KW - microbiome N2 - Background: A toothbrush device that telemonitors toothbrushing is a technologically advanced solution providing personalized feedback on toothbrushing habits and oral hygiene. These devices integrate smartphone apps to enhance oral health compliance through dental professional feedback. Objective: This 6-month prospective randomized controlled trial aimed to compare the clinical effectiveness, defined as improved oral hygiene measured by plaque reduction and halitosis control, of an interactive telemonitoring toothbrush (ITT), an oscillating-rotating power toothbrush (ORT), and a manual toothbrush (MT). Methods: Participants were recruited offline from the Department of Advanced General Dentistry at Yonsei University Dental Hospital, South Korea. A total of 150 participants were randomly assigned to 3 groups (50 participants each): (1) an ITT connected to a smartphone app providing real-time feedback and weekly dental professional reviews, (2) an ORT with smartphone-based guidance requiring participants to send weekly brushing records via screenshots, and (3) an MT with a brushing diary for review. Data collection occurred in clinical settings. Primary outcomes included plaque reduction measured using the Simple Hygiene Score (SHS), while secondary outcomes included plaque reduction measured using the Turesky modification of the Quigley-Hein plaque index (QHI), reductions in halitosis, and changes in oral microbiota. All outcomes were assessed at baseline and 1 month, 3 months, and 6 months. Results: A total of 150 participants completed the study. Over 6 months, the SHS increased in the MT group (mean 3.16, SD 4.86 to mean 5.66, SD 5.20) but significantly decreased in the ITT group (mean 3.47, SD 5.50 to mean 2.27, SD 3.82; P=.004). Similarly, QHI decreased more in the ITT group (mean 1.79, SD 0.72 to mean 0.85, SD 0.63) than in the ORT (P<.001) and MT (P<.001) groups. Regarding microbiota, there were no significant differences in high-risk periodontal microbiota or the ratio of caries-risk to anticaries microbiota between the ITT and ORT groups. However, in the MT group, the ratio of caries-risk microbiota was significantly higher at the 3-month (P<.001) and 6-month (P=.005) recalls than at baseline and at the 3-month (P=.048) and 6-month (P=.03) recalls than at the 1-month recall. Poststudy questionnaires indicated that 45 of 50 ITT participants (92%) and 37 of 50 ORT participants (76%) reported improved brushing ability. The most effective feature in the ITT group was brushing training, while participants in the ORT group cited the brushing guide as most useful (P<.001). Satisfaction scores were higher in the ORT group (mean 7.90, SD 1.21) than in the ITT group (mean 7.15, SD 1.66; P=.004). The number of brushing events decreased significantly in the ORT group (P=.02), while brushing duration increased in the MT group (P=.01). Conclusions: ITTs enable better oral hygiene management than MTs through dental professional feedback. However, further studies are needed to optimize feedback intervals and improve long-term adherence. Trial Registration: Clinical Research Information Service (CRIS), Republic of Korea, KCT0009094; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26110&search_page=L UR - https://www.jmir.org/2025/1/e65128 UR - http://dx.doi.org/10.2196/65128 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65128 ER - TY - JOUR AU - Lee, Kyungmi AU - Azuero, Andres AU - Engler, Sally AU - Kumar, Sidharth AU - Puga, Frank AU - Wright, A. Alexi AU - Kamal, Arif AU - Ritchie, S. Christine AU - Demiris, George AU - Bakitas, A. Marie AU - Odom, Nicholas J. PY - 2025/2/7 TI - Exploring the Relationship Between Smartphone GPS Patterns and Quality of Life in Patients With Advanced Cancer and Their Family Caregivers: Longitudinal Study JO - JMIR Form Res SP - e59161 VL - 9 KW - cancer KW - digital phenotyping KW - global positioning system KW - quality of life KW - smartphone KW - mobile phone KW - family caregiver N2 - Background: Patients with advanced cancer and their family caregivers often experience poor quality of life (QOL). Self-report measures are commonly used to quantify QOL of family caregivers but may have limitations such as recall bias and social desirability bias. Variables derived from passively obtained smartphone GPS data are a novel approach to measuring QOL that may overcome these limitations and enable detection of early signs of mental and physical health (PH) deterioration. Objective: This study explored the feasibility of a digital phenotyping approach by assessing participant adherence and examining correlations between smartphone GPS data and QOL levels among family caregivers and patients with advanced cancer. Methods: This was a secondary analysis involving 7 family caregivers and 4 patients with advanced cancer that assessed correlations between GPS sensor data captured by a personally owned smartphone and QOL self-report measures over 12 weeks through linear correlation coefficients. QOL as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health 10 was collected at baseline, 6, and 12 weeks. Using a Beiwe smartphone app, GPS data were collected and processed into variables including total distance, time spent at home, transition time, and number of significant locations. Results: The study identified relevant temporal correlations between QOL and smartphone GPS data across specific time periods. For instance, in terms of PH, associations were observed with the total distance traveled (12 and 13 wk, with r ranging 0.37 to 0.38), time spent at home (?4 to ?2 wk, with r ranging from ?0.41 to ?0.49), and transition time (?4 to ?2 wk, with r ranging ?0.38 to ?0.47). Conclusions: This research offers insights into using passively obtained smartphone GPS data as a novel approach for assessing and monitoring QOL among family caregivers and patients with advanced cancer, presenting potential advantages over traditional self-report measures. The observed correlations underscore the potential of this method to detect early signs of deteriorating mental health and PH, providing opportunities for timely intervention and support. UR - https://formative.jmir.org/2025/1/e59161 UR - http://dx.doi.org/10.2196/59161 ID - info:doi/10.2196/59161 ER - TY - JOUR AU - Thiagarajan, Nishanth AU - Tan, Chang Hong AU - Rama Chandran, Suresh AU - Lee, Ching Phong AU - Chin, Ann Yun AU - Zeng, Wanling AU - Ho, Lin Emily Tse AU - Carmody, David AU - Goh, Su-Yen AU - Bee, Mong Yong PY - 2025/2/7 TI - Web-Based, Algorithm-Guided Insulin Titration in Insulin-Treated Type 2 Diabetes: Pre-Post Intervention Study JO - JMIR Form Res SP - e68914 VL - 9 KW - diabetes KW - insulin KW - monitoring KW - technology KW - mobile KW - app KW - intervention N2 - Background: Self-monitoring of blood glucose (SMBG) using web-based diabetes management platforms has demonstrated promise in managing type 2 diabetes (T2D). However, the effectiveness of such systems incorporating algorithm-guided insulin titration has not been extensively studied in Asian populations. Objective: This study evaluates the efficacy and safety of the ALRT telehealth solution?a US Food and Drug Administration?cleared, web-based platform that integrates SMBG with algorithm-driven insulin dose adjustments?in improving glycemia in insulin-treated T2D. Methods: This 24-week, pre-post intervention study enrolled 25 adults with T2D (mean age 58.9, SD 7.0 y; n=14, 56% male) on twice-daily premixed insulin. Inclusion criteria included a baseline hemoglobin A1c (HbA1c) level between 7.5% to 9.9% (58?86 mmol/mol), a BMI ?40 kg/m², and experience with SMBG. Participants uploaded twice-daily SMBG data weekly via a mobile app, which generated insulin titration recommendations based on a predefined algorithm. Physicians reviewed and approved the recommendations, which were then communicated back to participants via the app. The primary outcome was the change in HbA1c level from baseline to 24 weeks. Secondary outcomes included changes in fasting plasma glucose, insulin dose, hypoglycemia incidence, and SMBG adherence. Results: Participants achieved significant reductions in HbA1c level from 8.6% (70 mmol/mol) at baseline to 7.4% (57 mmol/mol) at 24 weeks (P<.001), with reductions of 0.8% and 0.4% in the first and second 12 weeks, respectively. Fasting plasma glucose decreased from 8.7 (SD 2.0) mmol/L to 7.1 (SD 1.4) mmol/L (P<.001). Mean total daily insulin dose increased modestly from 0.73 (SD 0.31) units/kg/day to 0.79 (SD 0.34) units/kg/day (P=.007). Participants demonstrated high adherence, completing 97.3% (327/336) of prescribed SMBG measurements. During the study, 48% (12/25) of participants experienced at least 1 hypoglycemia episode, predominantly mild hypoglycemia (85/96, 88.5%; glucose 3.0?3.9 mmol/L). Hypoglycemia episodes increased from 24 during weeks 0?12 to 72 during weeks 13?24. There were no episodes of severe hypoglycemia requiring external assistance. BMI increased slightly from 29.0 (SD 3.6) kg/m² to 29.5 (SD 3.6) kg/m² (P=.03), reflecting a modest weight gain associated with improved glycemia. Conclusions: In conclusion, patients with insulin-treated T2D initiated on a web-based glucose monitoring system with algorithm-guided dosing recommendations showed significant improvement in glycemic control compared to baseline. High adherence rates underscore the feasibility of integrating algorithm-guided insulin titration into routine care. While hypoglycemia incidence rose slightly, episodes were predominantly mild, and no severe events occurred. This intervention shows promise for broader adoption in T2D management, particularly in resource-constrained settings. UR - https://formative.jmir.org/2025/1/e68914 UR - http://dx.doi.org/10.2196/68914 ID - info:doi/10.2196/68914 ER - TY - JOUR AU - Sirohi, Diksha AU - Ng, HM Cecilia AU - Bidargaddi, Niranjan AU - Slater, Helen AU - Parker, Melissa AU - Hull, Louise M. AU - O'Hara, Rebecca PY - 2025/2/7 TI - Good-Quality mHealth Apps for Endometriosis Care: Systematic Search JO - J Med Internet Res SP - e49654 VL - 27 KW - adenomyosis KW - endometriosis KW - m-health apps KW - mobile apps KW - digital health KW - pelvic pain KW - self-learning KW - clinicians KW - mHealth KW - application KW - endometriomas KW - chocolate cysts KW - uterus KW - womb KW - pain management KW - women's health KW - mobile phone N2 - Background: Mobile health (mHealth) apps are increasingly being used by community members to track symptoms and manage endometriosis. In addition, clinicians use mHealth apps for continued medical education and clinical decision-making and recommend good-quality apps to patients. However, poor-quality apps can spread misinformation or provide recommendations that are not evidence-based. Therefore, a critical evaluation is needed to assess and recommend good-quality endometriosis mHealth apps. Objective: This study aimed to evaluate the quality and provide recommendations for good quality endometriosis mHealth apps for the community and clinicians. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines informed the search of mHealth apps on the Google Play Store and Apple App Store. The search terms included ?endometriosis,? ?adenomyosis,? and ?pelvic pain.? mHealth apps were eligible if they were (1) related to the search terms, (2) were in the English language, and (3) were available free of cost. Only the free content of the eligible mHealth apps was assessed. ENLIGHT, a validated evaluation tool for mobile and web-based interventions, was used to assess the quality across 7 domains such as usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. mHealth apps with a total score of ?3.5 were classified as ?good? according to the ENLIGHT scoring system and are recommended as good-quality mHealth apps for endometriosis care. Results: In total, 42 mHealth apps were screened, and 19 were included in the quality assessment. A total of 6 good-quality mHealth apps were identified (QENDO, Bearable, Luna for Health, Matilda Health, Branch Health: Pain Management, and CHARLI Health). These apps provided symptom-tracking functions and self-management support. A total of 17 apps were designed for community use, while 2 apps provided a digital endometriosis classification tool to clinicians. Most mHealth apps scored well (?3.5) in the domains of usability (16/19, 84.2%), visual design (14/19, 73.7%), user engagement (11/19, 57.9%), and content (15/19, 78.9%). Few eHealth websites scored well on therapeutic persuasiveness (6/19, 31.6%), therapeutic alliance (9/19, 47.4%), and general subjective evaluation (6/19, 31.6%). Conclusions: Although time and geographical location can influence the search results, we identified 6 ?good-quality? endometriosis mHealth apps that can be recommended to the endometriosis community. mHealth apps designed for community use should evaluate their effectiveness on user?s endometriosis knowledge, self-recommended management strategies, pain self-efficacy, user satisfaction, and user quality of life. Digital technology should be leveraged to develop mHealth apps for clinicians that contribute to continued medical education and assist clinical decision-making in endometriosis management. Factors that enhance usability, visual design, therapeutic persuasiveness, and therapeutic alliance should be incorporated to ensure successful and long-term uptake of mHealth apps. Trial Registration: PROSPERO CRD42020185475; https://tinyurl.com/384dkkmj UR - https://www.jmir.org/2025/1/e49654 UR - http://dx.doi.org/10.2196/49654 UR - http://www.ncbi.nlm.nih.gov/pubmed/39918848 ID - info:doi/10.2196/49654 ER - TY - JOUR AU - Kraft, A. Stephanie AU - Chopra, Shaan AU - Duran, C. Miriana AU - Rojina, A. Janet AU - Beretta, Abril AU - López, I. Katherine AU - Javan, Russell AU - Wilfond, S. Benjamin AU - Rosenfeld, Margaret AU - Fogarty, James AU - Ko, K. Linda PY - 2025/2/6 TI - Perspectives of Hispanic and Latinx Community Members on AI-Enabled mHealth Tools: Qualitative Focus Group Study JO - J Med Internet Res SP - e59817 VL - 27 KW - wearable electronic devices KW - qualitative research KW - mobile health KW - mHealth KW - digital health KW - privacy KW - data sharing KW - artificial intelligence KW - AI KW - community KW - chronic conditions KW - chronic disease N2 - Background: Mobile health (mHealth) tools have the potential to reduce the burden of chronic conditions that disproportionately affect Hispanic and Latinx communities; however, digital divides in the access to and use of health technology suggest that mHealth has the potential to exacerbate, rather than reduce, these disparities. Objective: A key step toward developing health technology that is accessible and usable is to understand community member perspectives and needs so that technology is culturally relevant and appropriately contextualized. In this study, we aimed to examine the perspectives of Hispanic and Latinx community members in Washington State about mHealth. Methods: We recruited English- and Spanish-speaking Hispanic or Latinx adults to participate in web-based focus groups through existing community-based networks across rural and urban regions of Washington State. Focus groups included a presentation of narrative slideshow materials developed by the research team depicting mHealth use case examples of asthma in children and fall risk in older adults. Focus group questions asked participants to respond to the case examples and to further explore mHealth use preferences, benefits, barriers, and concerns. Focus group recordings were professionally transcribed, and Spanish transcripts were translated into English. We developed a qualitative codebook using deductive and inductive methods and then coded deidentified transcripts using the constant comparison method. The analysis team proposed themes based on review of coded data, which were validated through member checking with a community advisory board serving Latino individuals in the region and finalized through discussion with the entire research team. Results: Between May and September 2023, we conducted 8 focus groups in English or Spanish with 48 participants. Focus groups were stratified by language and region and included the following: 3 (n=18, 38% participants) Spanish urban groups, 2 (n=14, 29% participants) Spanish rural groups, 1 (n=6, 13% participants) English urban group, and 2 (n=10, 21% participants) English rural groups. We identified the following seven themes: (1) mHealth is seen as beneficial for promoting health and peace of mind; (2) some are unaware of, unfamiliar with, or uncomfortable with technology and may benefit from individualized support; (3) financial barriers limit access to mHealth; (4) practical considerations create barriers to using mHealth in daily life; (5) mHealth raises concern for overreliance on technology; (6) automated mHealth features are perceived as valuable but fallible, requiring human input to ensure accuracy; and (7) data sharing is seen as valuable for limited uses but raises privacy concerns. These themes illustrate key barriers to the benefits of mHealth that communities may face, provide insights into the role of mHealth within families, and examine the appropriate balance of data sharing and privacy protections. Conclusions: These findings offer important insights that can help advance the development of mHealth that responds to community values and priorities. UR - https://www.jmir.org/2025/1/e59817 UR - http://dx.doi.org/10.2196/59817 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59817 ER - TY - JOUR AU - Ezeigwe, Juliet Ogochukwu AU - Nwosu, Samuel Kenechukwu Obumneme AU - Afolayan, Kunle Oladipo AU - Ojaruega, Amanda Akpevwe AU - Echere, Jovita AU - Desai, Manali AU - Onigbogi, Olajumoke Modupe AU - Oladoyin, Ope Olajumoke AU - Okoye, Chioma Nnenna AU - Fwelo, Pierre PY - 2025/2/5 TI - Technological-Based Interventions in Cancer and Factors Associated With the Use of Mobile Digital Wellness and Health Apps Among Cancer Information Seekers: Cross-Sectional Study JO - J Med Internet Res SP - e63403 VL - 27 KW - cancer intervention KW - digital health and wellness apps KW - cancer management KW - telehealth KW - mobile health KW - mhealth KW - decision-making KW - United States KW - cross-sectional study KW - adult KW - logistic regression KW - regression analysis KW - digital health KW - young adult KW - cancer screening KW - knowledge seeking KW - barrier KW - utilization KW - engagement KW - digital health engagement KW - diversity KW - cancer information KW - health seeking behavior KW - mobile phone N2 - Background: Mobile digital wellness and health apps play a significant role in optimizing health and aiding in cancer management and decision-making. Objective: This study aims to identify the factors influencing the use of mobile health and wellness apps among cancer information seekers in the United States. Methods: We conducted a cross-sectional study using data from the Health Information National Trends Survey. Our analysis focused on 4770 participants who sought cancer information. We performed weighted univariate and multivariable logistic regression to determine the association between the use of health and wellness apps and socioeconomic factors, medical history and conditions, and lifestyle and behavioral factors. Results: A total of 4770 participants who sought cancer information were included in the final analysis. Of these, 80.9% (n=2705) were health and wellness app users, while 19.1% (n=793) were nonusers. In the final adjusted model, participants with household incomes ?US $50,000 had 49% higher adjusted odds of using these apps than those with incomes 600 minutes/day. The mean (SD) number of steps was 8883 (3455) steps/day and the mean (SD) awake sedentary time was 564 (138) minutes/day. Male participants were more often engaged in very active (27 minutes/day) and moderately active physical activity (29 minutes/day) compared with female participants (15 and 17 minutes/day, respectively). Over 87% (588/677) of participants had sleep data available for 5 or more days, among whom the average nightly sleep duration was 7.9 (SD 0.9) hours. Conclusions: This study demonstrated the feasibility of using consumer wearable devices to measure physical activity and sleep in a cohort of US adolescents. The high compliance rates provide valuable insights into adolescent behavior patterns and their influence on chronic disease development and mental health outcomes. UR - https://pediatrics.jmir.org/2025/1/e59159 UR - http://dx.doi.org/10.2196/59159 ID - info:doi/10.2196/59159 ER - TY - JOUR AU - Nester, O. Caroline AU - De Vito, N. Alyssa AU - Prieto, Sarah AU - Kunicki, J. Zachary AU - Strenger, Jennifer AU - Harrington, D. Karra AU - Roque, Nelson AU - Sliwinski, J. Martin AU - Rabin, A. Laura AU - Thompson, I. Louisa PY - 2025/2/4 TI - Association of Subjective Cognitive Concerns With Performance on Mobile App?Based Cognitive Assessment in Cognitively Normal Older Adults: Observational Study JO - JMIR Aging SP - e64033 VL - 8 KW - subjective cognitive concerns KW - subjective cognitive decline KW - digital cognitive assessment KW - mobile app KW - app-based KW - preclinical Alzheimer disease KW - mild cognitive impairment KW - MCI KW - preclinical dementia KW - mobile monitoring of cognitive change KW - Cognitive Function Instrument KW - mHealth KW - mobile health KW - applications KW - cognition KW - assessment KW - remote KW - geriatrics KW - gerontology KW - aging KW - memory KW - older adult KW - elderly KW - digital health KW - mobile phone N2 - Background: Subjective cognitive concerns (SCCs) may be among the earliest clinical symptoms of dementia. There is growing interest in applying a mobile app?based cognitive assessment to remotely screen for cognitive status in preclinical dementia, but the relationship between SCC and relevant mobile assessment metrics is uncertain. Objective: This study aimed to characterize the relationship between SCC and adherence, satisfaction, and performance on mobile app assessments in cognitively unimpaired older adults. Methods: Participants (N=122; Meanage=68.85 [SD 4.93] years; Meaneducation=16.85 [SD 2.39] years; female: n=82, 66.7%; White:n=106, 86.2%) completed 8 assessment days using Mobile Monitoring of Cognitive Change (M2C2), an app-based testing platform, with brief daily sessions within morning, afternoon, and evening time windows (24 total testing sessions). M2C2 includes digital working memory, processing speed, and episodic memory tasks. Participants provided feedback about their satisfaction and motivation related to M2C2 upon study completion. SCC was assessed using the Cognitive Function Instrument. Regression analyses evaluated the association between SCC and adherence, satisfaction, and performance on M2C2, controlling for age, sex, depression, and loneliness. Linear-mixed effects models evaluated whether SCC predicted M2C2 subtest performance over the 8-day testing period, controlling for covariates. Results: SCC was not associated with app satisfaction or protocol motivation, but it was significantly associated with lower rates of protocol adherence (ß=?.20, P=.37, 95% CI ?.65 to ?.02). Higher SCC endorsement significantly predicted worse overall episodic memory performance (ß=?.20, P=.02, 95% CI ?.02 to ?.01), but not working memory or processing speed. There was a main effect of SCC on working memory performance at day 1 (estimate=?1.05, SE=0.47, P=.03) and a significant interaction between SCC and working memory over the 8-day period (estimate=0.05, SE=0.02, P=.03), such that SCC was associated with initially worse, then progressively better working memory performance. Conclusions: SCCs are associated with worse overall memory performance on mobile app assessments, patterns of cognitive inefficiency (variable working memory), and mildly diminished adherence across an 8-day assessment period. Findings suggest that mobile app assessments may be sensitive to subtle cognitive changes, with important implications for early detection and treatment for individuals at risk for dementia. UR - https://aging.jmir.org/2025/1/e64033 UR - http://dx.doi.org/10.2196/64033 ID - info:doi/10.2196/64033 ER - TY - JOUR AU - Thigpen, Nina AU - Patel, Shyamal AU - Zhang, Xi PY - 2025/1/31 TI - Oura Ring as a Tool for Ovulation Detection: Validation Analysis JO - J Med Internet Res SP - e60667 VL - 27 KW - ovulation KW - digital medicine KW - physiology KW - body temperature KW - menstrual cycles KW - wearable KW - fertility KW - nonhormonal contraception KW - reproductive health KW - women?s health KW - calendar method KW - mHealth KW - mobile health KW - detection N2 - Background: Oura Ring is a wearable device that estimates ovulation dates using physiology data recorded from the finger. Estimating the ovulation date can aid fertility management for conception or nonhormonal contraception and provides insights into follicular and luteal phase lengths. Across the reproductive lifespan, changes in these phase lengths can serve as a biomarker for reproductive health. Objective: We assessed the strengths, weaknesses, and limitations of using physiology from the Oura Ring to estimate the ovulation date. We compared performance across cycle length, cycle variability, and participant age. In each subgroup, we compared the algorithm?s performance with the traditional calendar method, which estimates the ovulation date based on an individual?s last period start date and average menstrual cycle length. Methods: The study sample contained 1155 ovulatory menstrual cycles from 964 participants recruited from the Oura Ring commercial database. Ovulation prediction kits served as a benchmark to evaluate the performance. The Fisher test was used to determine an odds ratio to assess if ovulation detection rate significantly differed between methods or subgroups. The Mann-Whitney U test was used to determine if the accuracy of the estimated ovulation date differed between the estimated and reference ovulation dates. Results: The physiology method detected 1113 (96.4%) of 1155 ovulations with an average error of 1.26 days, which was significantly lower (U=904942.0, P<.001) than the calendar method?s average error of 3.44 days. The physiology method had significantly better accuracy across all cycle lengths, cycle variability groups, and age groups compared with the calendar method (P<.001). The physiology method detected fewer ovulations in short cycles (odds ratio 3.56, 95% CI 1.65-8.06; P=.008) but did not differ between typical and long or abnormally long cycles. Abnormally long cycle lengths were associated with decreased accuracy (U=22,383, P=.03), with a mean absolute error of 1.7 (SEM .09) days compared with 1.18 (SEM .02) days. The physiology method was not associated with differences in accuracy across age or typical cycle variability, while the calendar method performed significantly worse in participants with irregular cycles (U=21,643, P<.001). Conclusions: The physiology method demonstrated superior accuracy over the calendar method, with approximately 3-fold improvement. Calendar-based fertility tracking could be used as a backup in cases of insufficient physiology data but should be used with caution, particularly for individuals with irregular menstrual cycles. Our analyses suggest the physiology method can reliably estimate ovulation dates for adults aged 18-52 years, across a variety of cycle lengths, and in users with regular or irregular cycles. This method may be used as a tool to improve fertile window estimation, which can aid in conceiving or preventing pregnancies. This method also offers a low-effort solution for follicular and luteal phase length tracking, which are key biomarkers for reproductive health. UR - https://www.jmir.org/2025/1/e60667 UR - http://dx.doi.org/10.2196/60667 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60667 ER - TY - JOUR AU - Seol, Jaehoon AU - Iwagami, Masao AU - Kayamare, Tawylum Megane Christiane AU - Yanagisawa, Masashi PY - 2025/1/30 TI - Relationship Among Macronutrients, Dietary Components, and Objective Sleep Variables Measured by Smartphone Apps: Real-World Cross-Sectional Study JO - J Med Internet Res SP - e64749 VL - 27 KW - sleep quality KW - dietary health KW - unsaturated fatty acids KW - dietary fiber intake KW - sodium-to-potassium ratio KW - compositional data analysis KW - sleep KW - smartphone KW - application N2 - Background: Few studies have explored the relationship between macronutrient intake and sleep outcomes using daily data from mobile apps. Objective: This cross-sectional study aimed to examine the associations between macronutrients, dietary components, and sleep parameters, considering their interdependencies. Methods: We analyzed data from 4825 users of the Pokémon Sleep and Asken smartphone apps, each used for at least 7 days to record objective sleep parameters and dietary components, respectively. Multivariable regression explored the associations between quartiles of macronutrients (protein; carbohydrate; and total fat, including saturated, monounsaturated, and polyunsaturated fats), dietary components (sodium, potassium, dietary fiber, and sodium-to-potassium ratio), and sleep variables (total sleep time [TST], sleep latency [SL], and percentage of wakefulness after sleep onset [%WASO]). The lowest intake group was the reference. Compositional data analysis accounted for macronutrient interdependencies. Models were adjusted for age, sex, and BMI. Results: Greater protein intake was associated with longer TST in the third (+0.17, 95% CI 0.09-0.26 h) and fourth (+0.18, 95% CI 0.09-0.27 h) quartiles. In contrast, greater fat intake was linked to shorter TST in the third (?0.11, 95% CI ?0.20 to ?0.27 h) and fourth (?0.16, 95% CI ?0.25 to ?0.07 h) quartiles. Greater carbohydrate intake was associated with shorter %WASO in the third (?0.82%, 95% CI ?1.37% to ?0.26%) and fourth (?0.57%, 95% CI ?1.13% to ?0.01%) quartiles, while greater fat intake was linked to longer %WASO in the fourth quartile (+0.62%, 95% CI 0.06%-1.18%). Dietary fiber intake correlated with longer TST and shorter SL. A greater sodium-to-potassium ratio was associated with shorter TST in the third (?0.11, 95% CI ?0.20 to ?0.02 h) and fourth (?0.19, 95% CI ?0.28 to ?0.10 h) quartiles; longer SL in the second (+1.03, 95% CI 0.08-1.98 min) and fourth (+1.50, 95% CI 0.53-2.47 min) quartiles; and longer %WASO in the fourth quartile (0.71%, 95% CI 0.15%-1.28%). Compositional data analysis, involving 6% changes in macronutrient proportions, showed that greater protein intake was associated with an elevated TST (+0.27, 95% CI 0.18-0.35 h), while greater monounsaturated fat intake was associated with a longer SL (+4.6, 95% CI 1.93-7.34 min) and a larger %WASO (+2.2%, 95% CI 0.63%-3.78%). In contrast, greater polyunsaturated fat intake was associated with a reduced TST (?0.22, 95% CI ?0.39 to ?0.05 h), a shorter SL (?4.7, 95% CI to 6.58 to ?2.86 min), and a shorter %WASO (+2.0%, 95% CI ?3.08% to ?0.92%). Conclusions: Greater protein and fiber intake were associated with longer TST, while greater fat intake and sodium-to-potassium ratios were linked to shorter TST and longer WASO. Increasing protein intake in place of other nutrients was associated with longer TST, while higher polyunsaturated fat intake improved SL and reduced WASO. UR - https://www.jmir.org/2025/1/e64749 UR - http://dx.doi.org/10.2196/64749 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64749 ER - TY - JOUR AU - MacIsaac, Angela AU - Neufeld, Teagan AU - Malik, Ishaq AU - Toombs, Elaine AU - Olthuis, V. Janine AU - Schmidt, Fred AU - Dunning, Crystal AU - Stasiuk, Kristine AU - Bobinski, Tina AU - Ohinmaa, Arto AU - Stewart, H. Sherry AU - Newton, S. Amanda AU - Mushquash, R. Aislin PY - 2025/1/30 TI - Increasing Access to Mental Health Supports for 18- to 25-Year-Old Indigenous Youth With the JoyPop Mobile Mental Health App: Study Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e64745 VL - 14 KW - mental health KW - youth KW - Indigenous KW - First Nations KW - eHealth KW - mHealth KW - JoyPop KW - protocol KW - mobile mental health app KW - mobile app KW - Canada KW - mobile health KW - emotion regulation N2 - Background: Transitional-aged youth have a high burden of mental health difficulties in Canada, with Indigenous youth, in particular, experiencing additional circumstances that challenge their well-being. Mobile health (mHealth) approaches hold promise for supporting individuals in areas with less access to services such as Northern Ontario. Objective: The primary objective of this study is to evaluate the effectiveness of the JoyPop app in increasing emotion regulation skills for Indigenous transitional-aged youth (aged 18-25 years) on a waitlist for mental health services when compared with usual practice (UP). The secondary objectives are to (1) evaluate the impact of the app on general mental health symptoms and treatment readiness and (2) evaluate whether using the app is associated with a reduction in the use (and therefore cost) of other services while one is waiting for mental health services. Methods: The study is a pragmatic, parallel-arm randomized controlled superiority trial design spanning a 4-week period. All participants will receive UP, which involves waitlist monitoring practices at the study site, which includes regular check-in phone calls to obtain any updates regarding functioning. Participants will be allocated to the intervention (JoyPop+UP) or control (UP) condition in a 1:1 ratio using stratified block randomization. Participants will complete self-report measures of emotion regulation (primary outcome), mental health, treatment readiness, and service use during 3 assessments (baseline, second [after 2 weeks], and third [after 4 weeks]). Descriptive statistics pertaining to baseline variables and app usage will be reported. Linear mixed modeling will be used to analyze change in outcomes over time as a function of condition assignment, while a cost-consequence analysis will be used to evaluate the association between app use and service use. Results: Recruitment began September 1, 2023, and is ongoing. In total, 2 participants have completed the study. Conclusions: This study will assess whether the JoyPop app is effective for Indigenous transitional-aged youth on a waitlist for mental health services. Positive findings may support the integration of the app into mental health services as a waitlist management tool. Trial Registration: ClinicalTrials.gov NCT05991154; https://clinicaltrials.gov/study/NCT05991154 International Registered Report Identifier (IRRID): DERR1-10.2196/64745 UR - https://www.researchprotocols.org/2025/1/e64745 UR - http://dx.doi.org/10.2196/64745 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64745 ER - TY - JOUR AU - Steyn, Sherrie AU - Slabbert, Meggan PY - 2025/1/30 TI - Self-Guided Smartphone App (Vimbo) for the Reduction of Symptoms of Depression and Anxiety in South African Adults: Pilot Quantitative Single-Arm Study JO - JMIR Form Res SP - e54216 VL - 9 KW - treatment gap KW - mental health KW - health KW - depression KW - anxiety KW - South Africa KW - CBT KW - cognitive behavioral therapy KW - app-based intervention KW - mobile health KW - mental health app KW - smartphone KW - mobile phone N2 - Background: Barriers to mental health assessment and intervention have been well documented within South Africa, in both urban and rural settings. Internationally, evidence has emerged for the effectiveness of technology and, specifically, app-based mental health tools and interventions to help overcome some of these barriers. However, research on digital interventions specific to the South African context and mental health is limited. Objective: This pilot study investigated the feasibility of using an app (Vimbo) to treat symptoms of anxiety and depression in South African adults recruited from a community sample. The Vimbo app is a self-guided, cognitive behavioral therapy?based digital intervention for common mental health difficulties developed for the South African context. Methods: This pilot study used a naturalistic, single-arm design testing the Vimbo app over 12 weeks, from October 2020 to February 2021. Participants were recruited through the South African Depression and Anxiety Group and social media advertisements online. A 2-week retention period was used to allow for a minimum of 2 datasets. App usage and engagement metrics were extracted directly from the back end of the app. Based on the model, researchers expected many users to discontinue usage when their symptom levels entered a healthy range. Pre-post review of symptom levels was used to reflect on clinical recovery status at discontinuation after the retention period. Results: A total of 218 applicants met study eligibility criteria and were invited to download the Vimbo app. Of these, 52% (114/218) of the participants registered with the app, who indicated multiple variances of depression and anxiety symptoms ranging in severity from mild to severe. Two participants users withdrew from the study. Moreover, 69% (77/112) of users were retained, including 8 who had technical issues with their treatment. When comparing broad uptake across all interested participants, chi-square analysis indicated significantly reduced uptake in participants identifying as ?unemployed but seeking employment? (?24=10.47; N=251; P=.03). When considering app usage for the entire cohort (n=69, excluding participants with technical issues), there was a mean of 72.87 (SD 71.425) total module pages read, a mean of 30% (SD 29.473%) of prescribed content completed, and a mean of 19.93 (SD 27.517) times engaging with tools and skills. Conclusions: Our findings support the case for continued exploration of app-based interventions for treating depression and anxiety in South Africa. Developing strategies to increase access and improve intervention uptake may prove essential to helping mobile health interventions make as significant an impact as possible. Future research should include a randomized controlled trial with a larger sample to further assess the efficacy of app-based interventions in treating mental health difficulties in South Africa. UR - https://formative.jmir.org/2025/1/e54216 UR - http://dx.doi.org/10.2196/54216 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54216 ER - TY - JOUR AU - Sankesara, Heet AU - Denyer, Hayley AU - Sun, Shaoxiong AU - Deng, Qigang AU - Ranjan, Yatharth AU - Conde, Pauline AU - Rashid, Zulqarnain AU - Asherson, Philip AU - Bilbow, Andrea AU - Groom, J. Madeleine AU - Hollis, Chris AU - Dobson, B. Richard J. AU - Folarin, Amos AU - Kuntsi, Jonna PY - 2025/1/29 TI - Identifying Digital Markers of Attention-Deficit/Hyperactivity Disorder (ADHD) in a Remote Monitoring Setting: Prospective Observational Study JO - JMIR Form Res SP - e54531 VL - 9 KW - ADHD KW - smartphones KW - wearable devices KW - mobile health KW - mHealth KW - remote monitoring KW - surveillance KW - digital markers KW - attention-deficit/hyperactivity disorder KW - behavioral data KW - real world KW - adult KW - adolescent KW - participants KW - digital signals KW - restlessness KW - severity KW - predicting outcomes N2 - Background: The symptoms and associated characteristics of attention-deficit/hyperactivity disorder (ADHD) are typically assessed in person at a clinic or in a research lab. Mobile health offers a new approach to obtaining additional passively and continuously measured real-world behavioral data. Using our new ADHD remote technology (ART) system, based on the Remote Assessment of Disease and Relapses (RADAR)?base platform, we explore novel digital markers for their potential to identify behavioral patterns associated with ADHD. The RADAR-base Passive App and wearable device collect sensor data in the background, while the Active App involves participants completing clinical symptom questionnaires. Objective: The main aim of this study was to investigate whether adults and adolescents with ADHD differ from individuals without ADHD on 10 digital signals that we hypothesize capture lapses in attention, restlessness, or impulsive behaviors. Methods: We collected data over 10 weeks from 20 individuals with ADHD and 20 comparison participants without ADHD between the ages of 16 and 39 years. We focus on features derived from (1) Active App (mean and SD of questionnaire notification response latency and of the time interval between questionnaires), (2) Passive App (daily mean and SD of response time to social and communication app notifications, the SD in ambient light during phone use, total phone use time, and total number of new apps added), and (3) a wearable device (Fitbit) (daily steps taken while active on the phone). Linear mixed models and t tests were employed to assess the group differences for repeatedly measured and time-aggregated variables, respectively. Effect sizes (d) convey the magnitude of differences. Results: Group differences were significant for 5 of the 10 variables. The participants with ADHD were (1) slower (P=.047, d=1.05) and more variable (P=.01, d=0.84) in their speed of responding to the notifications to complete the questionnaires, (2) had a higher SD in the time interval between questionnaires (P=.04, d=1.13), (3) had higher daily mean response time to social and communication app notifications (P=.03, d=0.7), and (4) had a greater change in ambient (background) light when they were actively using the smartphone (P=.008, d=0.86). Moderate to high effect sizes with nonsignificant P values were additionally observed for the mean of time intervals between questionnaires (P=.06, d=0.82), daily SD in responding to social and communication app notifications (P=.05, d=0.64), and steps taken while active on the phone (P=.09, d=0.61). The groups did not differ in the total phone use time (P=.11, d=0.54) and the number of new apps downloaded (P=.24, d=0.18). Conclusions: In a novel exploration of digital markers of ADHD, we identified candidate digital signals of restlessness, inconsistent attention, and difficulties completing tasks. Larger future studies are needed to replicate these findings and to assess the potential of such objective digital signals for tracking ADHD severity or predicting outcomes. UR - https://formative.jmir.org/2025/1/e54531 UR - http://dx.doi.org/10.2196/54531 ID - info:doi/10.2196/54531 ER - TY - JOUR AU - de Vries, Jaap Herman AU - Delahaij, Roos AU - van Zwieten, Marianne AU - Verhoef, Helen AU - Kamphuis, Wim PY - 2025/1/28 TI - The Effects of Self-Monitoring Using a Smartwatch and Smartphone App on Stress Awareness, Self-Efficacy, and Well-Being?Related Outcomes in Police Officers: Longitudinal Mixed Design Study JO - JMIR Mhealth Uhealth SP - e60708 VL - 13 KW - wearable electronic devices KW - ecological momentary assessment KW - psychological stress KW - psychological well-being KW - awareness KW - self-efficacy KW - occupational medicine KW - emergency responders KW - well-being KW - psychological KW - efficacy KW - stress KW - wearables KW - wearable device KW - smartwatch KW - smartphone app KW - app KW - sensor KW - sensor technology KW - police officers KW - questionnaire KW - stress awareness KW - stress management N2 - Background: Wearable sensor technologies, often referred to as ?wearables,? have seen a rapid rise in consumer interest in recent years. Initially often seen as ?activity trackers,? wearables have gradually expanded to also estimate sleep, stress, and physiological recovery. In occupational settings, there is a growing interest in applying this technology to promote health and well-being, especially in professions with highly demanding working conditions such as first responders. However, it is not clear to what extent self-monitoring with wearables can positively influence stress- and well-being?related outcomes in real-life conditions and how wearable-based interventions should be designed for high-risk professionals. Objective: The aim of this study was to investigate (1) whether offering a 5-week wearable-based intervention improves stress- and well-being?related outcomes in police officers and (2) whether extending a basic ?off-the-shelf? wearable-based intervention with ecological momentary assessment (EMA) questionnaires, weekly personalized feedback reports, and peer support groups improves its effectiveness. Methods: A total of 95 police officers from 5 offices participated in the study. The data of 79 participants were included for analysis. During the first 5 weeks, participants used no self-monitoring technology (control period). During the following 5 weeks (intervention period), 41 participants used a Garmin Forerunner 255 smartwatch with a custom-built app (comparable to that of the consumer-available wearable), whereas the other 38 participants used the same system, but complemented by daily EMA questionnaires, weekly personalized feedback reports, and access to peer support groups. At baseline (T0) and after the control (T1) and intervention (T2) periods, questionnaires were administered to measure 15 outcomes relating to stress awareness, stress management self-efficacy, and outcomes related to stress and general well-being. Linear mixed models that accounted for repeated measures within subjects, the control and intervention periods, and between-group differences were used to address both research questions. Results: The results of the first analysis showed that the intervention had a small (absolute Hedges g=0.25?0.46) but consistent effect on 8 of 15 of the stress- and well-being?related outcomes in comparison to the control group. The second analysis provided mixed results; the extended intervention was more effective than the basic intervention at improving recovery after work but less effective at improving self-efficacy in behavior change and sleep issues, and similarly effective in the remaining 12 outcomes. Conclusions: Offering a 5-week wearable-based intervention to police officers can positively contribute to optimizing their stress-related, self-efficacy, and well-being?related outcomes. Complementing the basic ?off-the-shelf? wearable-based intervention with additional EMA questionnaires, weekly personalized feedback reports, and peer support groups did not appear to improve the effectiveness of the intervention. Future work is needed to investigate how different aspects of these interventions can be tailored to specific characteristics and needs of employees to optimize these effects. UR - https://mhealth.jmir.org/2025/1/e60708 UR - http://dx.doi.org/10.2196/60708 ID - info:doi/10.2196/60708 ER - TY - JOUR AU - Sahandi Far, Mehran AU - Fischer, M. Jona AU - Senge, Svea AU - Rathmakers, Robin AU - Meissner, Thomas AU - Schneble, Dominik AU - Narava, Mamaka AU - Eickhoff, B. Simon AU - Dukart, Juergen PY - 2025/1/28 TI - Cross-Platform Ecological Momentary Assessment App (JTrack-EMA+): Development and Usability Study JO - J Med Internet Res SP - e51689 VL - 27 KW - digital biomarkers KW - mobile health KW - remote monitoring KW - smartphone KW - mobile phone KW - monitoring KW - biomarker KW - ecological momentary assessment KW - application KW - costly KW - user experience KW - data management KW - mobility N2 - Background: Traditional in-clinic methods of collecting self-reported information are costly, time-consuming, subjective, and often limited in the quality and quantity of observation. However, smartphone-based ecological momentary assessments (EMAs) provide complementary information to in-clinic visits by collecting real-time, frequent, and longitudinal data that are ecologically valid. While these methods are promising, they are often prone to various technical obstacles. However, despite the potential of smartphone-based EMAs, they face technical obstacles that impact adaptability, availability, and interoperability across devices and operating systems. Deficiencies in these areas can contribute to selection bias by excluding participants with unsupported devices or limited digital literacy, increase development and maintenance costs, and extend deployment timelines. Moreover, these limitations not only impede the configurability of existing solutions but also hinder their adoption for addressing diverse clinical challenges. Objective: The primary aim of this research was to develop a cross-platform EMA app that ensures a uniform user experience and core features across various operating systems. Emphasis was placed on maximizing the integration and adaptability to various study designs, all while maintaining strict adherence to security and privacy protocols. JTrack-EMA+ was designed and implemented per the FAIR (findable, accessible, interpretable, and reusable) principles in both its architecture and data management layers, thereby reducing the burden of integration for clinicians and researchers. Methods: JTrack-EMA+ was built using the Flutter framework, enabling it to run seamlessly across different platforms. This platform comprises two main components. JDash (Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour [INM-7]) is an online management tool created using Python (Python Software Foundation) with the Django (Django Software Foundation) framework. This online dashboard offers comprehensive study management tools, including assessment design, user administration, data quality control, and a reminder casting center. The JTrack-EMA+ app supports a wide range of question types, allowing flexibility in assessment design. It also has configurable assessment logic and the ability to include supplementary materials for a richer user experience. It strongly commits to security and privacy and complies with the General Data Protection Regulations to safeguard user data and ensure confidentiality. Results: We investigated our platform in a pilot study with 480 days of follow-up to assess participants? compliance. The 6-month average compliance was 49.3%, significantly declining (P=.004) from 66.7% in the first month to 42% in the sixth month. Conclusions: The JTrack-EMA+ platform prioritizes platform-independent architecture, providing an easy entry point for clinical researchers to deploy EMA in their respective clinical studies. Remote and home-based assessments of EMA using this platform can provide valuable insights into patients? daily lives, particularly in a population with limited mobility or inconsistent access to health care services. UR - https://www.jmir.org/2025/1/e51689 UR - http://dx.doi.org/10.2196/51689 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51689 ER - TY - JOUR AU - Kezbers, M. Krista AU - Robertson, C. Michael AU - Hébert, T. Emily AU - Montgomery, Audrey AU - Businelle, S. Michael PY - 2025/1/28 TI - Detecting Deception and Ensuring Data Integrity in a Nationwide mHealth Randomized Controlled Trial: Factorial Design Survey Study JO - J Med Internet Res SP - e66384 VL - 27 KW - ecological momentary assessment KW - enrollment KW - fraud KW - mHealth KW - randomized controlled trial KW - recruitment KW - deception KW - data integrity KW - behavior KW - social KW - RCT KW - factorial design KW - mobile phone N2 - Background: Social behavioral research studies have increasingly shifted to remote recruitment and enrollment procedures. This shifting landscape necessitates evolving best practices to help mitigate the negative impacts of deceptive attempts (eg, fake profiles and bots) at enrolling in behavioral research. Objective: This study aimed to develop and implement robust deception detection procedures during the enrollment period of a remotely conducted randomized controlled trial. Methods: A 32-group (2×2×2×2×2) factorial design study was conducted from November 2021 to September 2022 to identify mobile health (mHealth) survey design features associated with the highest completion rates of smartphone-based ecological momentary assessments (n=485). Participants were required to be at least 18 years old, live in the United States, and own an Android smartphone that was compatible with the Insight app that was used in the study. Recruitment was conducted remotely through Facebook advertisements, a 5-minute REDCap (Research Electronic Data Capture) prescreener, and a screening and enrollment phone call. The research team created and implemented a 12-step checklist (eg, address verification and texting a copy of picture identification) to identify and prevent potentially deceptive attempts to enroll in the study. Descriptive statistics were calculated to understand the prevalence of various types of deceptive attempts at study enrollment. Results: Facebook advertisements resulted in 5236 initiations of the REDCap prescreener. A digital deception detection procedure was implemented for those who were deemed pre-eligible (n=1928). This procedure resulted in 26% (501/1928) of prescreeners being flagged as potentially deceptive. Completing multiple prescreeners (301/501, 60.1%) and providing invalid addresses (156/501, 31.1%) were the most common reasons prescreeners were flagged. An additional 1% (18/1928) of prescreeners were flagged as potentially deceptive during the subsequent study screening and enrollment phone call. Reasons for exclusion at the screening and enrollment phone call level included having an invalid phone type (6/18, 33.3%), completing multiple prescreeners (6/18, 33.3%), and providing an invalid address (5/18, 27.7%). This resulted in 1409 individuals being eligible after all deception checks were completed. Postenrollment social security number checks revealed that 3 (0.6%) fully enrolled participants out of 485 provided erroneous social security numbers during the screening process. Conclusions: Implementation of a deception detection procedure in a remotely conducted randomized controlled trial resulted in a substantial proportion of cases being flagged as potentially engaging in deceptive attempts at study enrollment. The results of the deception detection procedures in this study confirmed the need for vigilance in conducting remote behavioral research in order to maintain data integrity. Implementing systematic deception detection procedures may support study administration, data quality, and participant safety in remotely conducted behavioral research. Trial Registration: ClinicalTrials.gov NCT05194228; https://clinicaltrials.gov/study/NCT05194228 UR - https://www.jmir.org/2025/1/e66384 UR - http://dx.doi.org/10.2196/66384 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66384 ER - TY - JOUR AU - Xiao, Yi AU - Zhang, Sirui AU - Ma, Yuanzheng AU - Wang, Shichan AU - Li, Chunyu AU - Liang, Yan AU - Shang, Huifang PY - 2025/1/28 TI - Long-Term Impact of Using Mobile Phones and Playing Computer Games on the Brain Structure and the Risk of Neurodegenerative Diseases: Large Population-Based Study JO - J Med Internet Res SP - e59663 VL - 27 KW - electronic device KW - parkinsonism KW - dementia KW - aging KW - brain MRI KW - magnetic resonance imaging N2 - Background: Despite the increasing popularity of electronic devices, the longitudinal effects of daily prolonged electronic device usage on brain health and the aging process remain unclear. Objective: The aim of this study was to investigate the impact of the daily use of mobile phones/computers on the brain structure and the risk of neurodegenerative diseases. Methods: We used data from the UK Biobank, a longitudinal population-based cohort study, to analyze the impact of mobile phone use duration, weekly usage time, and playing computer games on the future brain structure and the future risk of various neurodegenerative diseases, including all-cause dementia (ACD), Alzheimer disease (AD), vascular dementia (VD), all-cause parkinsonism (ACP), and Parkinson disease (PD). All the characteristics of using mobile phones and playing computer games were collected through face-to-face interviews at baseline, and outcomes were extracted from the algorithmic combinations of self-reported medical conditions, hospital admissions, and death registries. In addition, a group of participants underwent magnetic resonance imaging (MRI) at follow-up. Cox regression and linear regression were performed. Results: The study included over 270,000 participants for risk analysis, with a mean baseline age of approximately 55.85 (SD 8.07) years. The average follow-up duration was approximately 13.9 (SD 1.99) years. Lengthy mobile phone use was associated with a reduced risk of ACD (2-4 years: hazard ratio [HR] 0.815, 95% CI 0.729-0.912, P<.001; 5-8 years: HR 0.749, 95% CI 0.677-0.829, P<.001; >8 years: HR 0.830, 95% CI 0.751-0.918, P<.001), AD (5-8 years: HR 0.787, 95% CI 0.672-0.922, P=.003), and VD (2-4 years: HR 0.616, 95% CI 0.477-0.794, P<.001; 5-8 years: HR 0.729, 95% CI 0.589-0.902, P=.004; >8 years: HR 0.750, 95% CI 0.605-0.930, P=.009) compared to rarely using mobile phones. Additionally, lengthy mobile phone use was linked to a decreased risk of ACP (5-8 years: HR 0.747, 95% CI 0.637-0.875, P<.001; >8 years: HR 0.774, 95% CI 0.663-0.904, P=.001) and PD (5-8 years: HR 0.760, 95% CI 0.644-0.897, P=.001; >8 years: HR 0.777, 95% CI 0.660-0.913, P=.002) in participants older than 60 years. However, higher weekly usage time did not confer additional risk reduction compared to lower weekly usage of mobile phones. The neuroimaging analysis involved 35,643 participants, with an average duration of approximately 9.0 years between baseline and neuroimaging scans. Lengthy mobile phone use was related to a thicker cortex in different areas of the brain. Conclusions: Lengthy mobile phone use is associated with a reduced risk of neurodegenerative diseases and improved brain structure compared to minimal usage. Our research provides valuable background knowledge for future studies on the impact of modern electronic devices on brain health. UR - https://www.jmir.org/2025/1/e59663 UR - http://dx.doi.org/10.2196/59663 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59663 ER - TY - JOUR AU - Thompson, Lauren AU - Charitos, Sydney AU - Bird, Jon AU - Marshall, Paul AU - Brigden, Amberly PY - 2025/1/27 TI - Exploring the Use of Smartwatches and Activity Trackers for Health-Related Purposes for Children Aged 5 to 11 years: Systematic Review JO - J Med Internet Res SP - e62944 VL - 27 KW - children KW - systematic review KW - wearable activity trackers KW - smartwatches KW - feasibility KW - mobile phone N2 - Background:  Digital health interventions targeting behavior change are promising in adults and adolescents; however, less attention has been given to younger children. The proliferation of wearables, such as smartwatches and activity trackers, that support the collection of and reflection on personal health data highlights an opportunity to consider novel approaches to supporting health in young children (aged 5-11 y). Objective:  This review aims to investigate how smartwatches and activity trackers have been used across child health interventions (for children aged 5-11 y) for different health areas, specifically to identify the population characteristics of those being targeted, describe the characteristics of the devices being used, and report the feasibility and acceptability of these devices for health-related applications with children. Methods: We searched 10 databases (CINAHL, Embase, ACM Digital Library, IEEE Xplore, Cochrane Library, PsycINFO, Web of Science, PubMed, Scopus, and MEDLINE) to identify relevant literature in March 2023. The inclusion criteria for studies were as follows: (1) peer-reviewed, empirical studies; (2) published in English; (3) involved a child aged 5 to 11 years using a smartwatch for health-related purposes. Two researchers independently screened articles to assess eligibility. One researcher extracted data relating to the 3 aims and synthesized the results using narrative and thematic synthesis. Results:  The database searches identified 3312 articles, of which 15 (0.45%) were included in this review. Three (20%) articles referred to the same intervention. In 77% (10/13) of the studies, the devices were used to target improvements in physical activity. Other applications included using smartwatches to deliver interventions for emotional regulation and asthma management. In total, 9 commercial devices were identified, many of which delivered minimal data feedback on the smartwatch or activity tracker, instead relying on a partner app running on a linked parental smartphone with greater functionality. Of the 13 studies, 8 (62%) used devices designed for adults rather than children. User feedback was positive overall, demonstrating the acceptability and feasibility of using these devices with children. However, the studies often lacked a child-focused approach, with 3 (23%) studies gathering user feedback only from parents. Conclusions:  Interventions involving smartwatches and activity trackers for children aged 5 to 11 years remain limited, primarily focusing on enhancing physical activity, with few studies investigating other health applications. These devices often provide limited data feedback and functionality to support children?s independent engagement with the data, relying on paired smartphone apps managed by caregivers, who control access and facilitate children?s interaction with the data. Future research should adopt child-centered methods in the design and evaluation of these technologies, integrating children?s perspectives alongside their caregivers, to ensure that they are not only feasible and acceptable but also meaningful and effective for young children. Trial Registration: PROSPERO CRD42022373813, https://tinyurl.com/4kxu8zss UR - https://www.jmir.org/2025/1/e62944 UR - http://dx.doi.org/10.2196/62944 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62944 ER - TY - JOUR AU - Snipes, Cassandra AU - Dorner?Ciossek, Cornelia AU - Hare, D. Brendan AU - Besedina, Olya AU - Campellone, Tim AU - Petrova, Mariya AU - Lakhan, E. Shaheen AU - Pratap, Abhishek PY - 2025/1/27 TI - Establishment and Maintenance of a Digital Therapeutic Alliance in People Living With Negative Symptoms of Schizophrenia: Two Exploratory Single-Arm Studies JO - JMIR Ment Health SP - e64959 VL - 12 KW - therapeutic alliance KW - digital working alliance KW - experiential negative symptoms KW - schizophrenia KW - digital therapeutics KW - digital literacy N2 - Background: Evidence-based digital therapeutics represent a new treatment modality in mental health, potentially providing cost-efficient, accessible means of augmenting existing treatments for chronic mental illnesses. CT-155/BI 3972080 is a prescription digital therapeutic under development as an adjunct to standard of care treatments for patients 18 years of age and older with experiential negative symptoms (ENS) of schizophrenia. Individual components of CT-155/BI 3972080 are designed based on the underlying principles of face-to-face treatment. A positive therapeutic alliance between patients and health care providers is linked with improved clinical outcomes in mental health. Likewise, establishing a similar therapeutic alliance with a digital therapeutic (ie, digital working alliance [DWA]) may be important for engagement and treatment effectiveness of this modality. Objective: This study aimed to investigate the establishment and maintenance of a DWA between a beta version of CT-155/BI 3972080 (CT-155 beta) and adults with ENS of schizophrenia. Methods: Two multicenter, exploratory, single-arm studies (study 1: CT-155-C-001 and study 2: CT-155-C-002) enrolled adults with schizophrenia and ENS receiving stable antipsychotic medication (?12 weeks). Participants had access to CT-155 beta and were presented with daily in-app activities during a 3-week orientation phase that included lessons designed to facilitate building of a DWA. In study 2, the 3-week orientation phase was followed by an abbreviated active 4-week phase. Digital literacy at baseline was evaluated using the Mobile Device Proficiency Questionnaire (MDPQ). The mobile Agnew Relationship Measure (mARM) was used to assess DWA establishment after 3 weeks in both studies, and after 7 weeks in study 2 to assess DWA maintenance. Participant safety, digital literacy, and correlations between negative symptom severity and DWA were assessed in both studies. Results: Of the enrolled participants, 94% (46/49) and 86% (43/50) completed studies 1 and 2, respectively. Most were male (study 1: 71%, 35/49; study 2: 80%, 40/50). The baseline digital literacy assessed through MDPQ score was comparable in both studies (study 1: mean 30.56, SD 8.06; study 2: mean 28.69, SD 8.31) indicating proficiency in mobile device use. After 3 weeks, mARM scores (study 1: mean 5.16, SD 0.8; study 2: mean 5.36, SD 1.06) indicated that a positive DWA was established in both studies. In study 2, the positive DWA established at week 3 was maintained at week 7 (mARM: mean 5.48, SD 0.97). There were no adverse events (AEs) in study 1, and 3 nonserious and nontreatment-related AEs in study 2. Conclusions: A positive DWA was established between participants and CT-155 beta within 3 weeks. The second 7-week study showed maintenance of the DWA to the end of the study. Results support the establishment and maintenance of a DWA between adults with ENS of schizophrenia and a beta version of CT-155/BI 3972080, a prescription digital therapeutic under development to target these symptoms. Trial Registration: Clinicaltrials.gov NCT05486312; https://clinicaltrials.gov/study/NCT05486312 UR - https://mental.jmir.org/2025/1/e64959 UR - http://dx.doi.org/10.2196/64959 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64959 ER - TY - JOUR AU - Antico, Lia AU - Brewer, Judson PY - 2025/1/24 TI - Digital Mindfulness Training for Burnout Reduction in Physicians: Clinician-Driven Approach JO - JMIR Form Res SP - e63197 VL - 9 KW - burnout KW - anxiety KW - empathy fatigue KW - physician KW - mindfulness KW - digital therapeutics KW - app KW - smartphone KW - podcast KW - compassion KW - health care provider KW - training KW - physician burnout KW - cynicism KW - efficacy KW - treatment KW - meditation KW - chronic KW - workplace stress KW - digital health KW - mHealth KW - mobile phone N2 - Background: Physician burnout is widespread in health care systems, with harmful consequences on physicians, patients, and health care organizations. Mindfulness training (MT) has proven effective in reducing burnout; however, its time-consuming requirements often pose challenges for physicians who are already struggling with their busy schedules. Objective: This study aimed to design a short and pragmatic digital MT program with input from clinicians specifically to address burnout and to test its efficacy in physicians. Methods: Two separate nonrandomized pilot studies were conducted. In the first study, 27 physicians received the digital MT in a podcast format, while in the second study, 29 physicians and nurse practitioners accessed the same training through a free app-based platform. The main outcome measure was cynicism, one dimension of burnout. The secondary outcome measures were emotional exhaustion (the second dimension of burnout), anxiety, depression, intolerance of uncertainty, empathy (personal distress, perspective taking, and empathic concern subscales), self-compassion, and mindfulness (nonreactivity and nonjudgment subscales). In the second study, worry, sleep disturbances, and difficulties in emotion regulation were also measured. Changes in outcomes were assessed using self-report questionnaires administered before and after the treatment and 1 month later as follow-up. Results: Both studies showed that MT decreased cynicism (posttreatment: 33% reduction; P?.04; r?0.41 and follow-up: 33% reduction; P?.04; r?0.45), while improvements in emotional exhaustion were observed solely in the first study (25% reduction, P=.02, r=.50 at posttreatment; 25% reduction, P=.008, r=.62 at follow-up). There were also significant reductions in anxiety (P?.01, r?0.49 at posttreatment; P?.01, r?0.54 at follow-up), intolerance of uncertainty (P?.03, r?.57 at posttreatment; P<.001, r?0.66 at follow-up), and personal distress (P=.03, r=0.43 at posttreatment; P=.03, r=0.46 at follow-up), while increases in self-compassion (P?.02, r?0.50 at posttreatment; P?.006, r?0.59 at follow-up) and mindfulness (nonreactivity: P?.001, r?0.69 at posttreatment; P?.004, r?0.58 at follow-up; nonjudgment: P?.009, r?0.50 at posttreatment; P?.03, r?0.60 at follow-up). In addition, the second study reported significant decreases in worry (P=.04, r=0.40 at posttreatment; P=.006, r=0.58 at follow-up), sleep disturbances (P=.04, r=0.42 at posttreatment; P=.01, r=0.53 at follow-up), and difficulties in emotion regulation (P=.005, r=0.54 at posttreatment; P<.001, r=0.70 at follow-up). However, no changes were observed over time for depression or perspective taking and empathic concern. Finally, both studies revealed significant positive correlations between burnout and anxiety (cynicism: r?0.38; P?.04; emotional exhaustion: r?0.58; P?.001). Conclusions: To our knowledge, this research is the first where clinicians were involved in designing an intervention targeting burnout. These findings suggest that this digital MT serves as a viable and effective tool for alleviating burnout and anxiety among physicians. Trial Registration: ClinicalTrials.gov NCT06145425; https://clinicaltrials.gov/study/NCT06145425 UR - https://formative.jmir.org/2025/1/e63197 UR - http://dx.doi.org/10.2196/63197 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63197 ER - TY - JOUR AU - Kumar, Devender AU - Haag, David AU - Blechert, Jens AU - Niebauer, Josef AU - Smeddinck, David Jan PY - 2025/1/24 TI - Feature Selection for Physical Activity Prediction Using Ecological Momentary Assessments to Personalize Intervention Timing: Longitudinal Observational Study JO - JMIR Mhealth Uhealth SP - e57255 VL - 13 KW - digital health KW - behavior change KW - tailoring KW - personalization KW - adaptive systems KW - ecological momentary assessments KW - sensing KW - questionnaires KW - machine learning KW - feature selection KW - situated research KW - physical activity KW - implementation intentions KW - barriers KW - intention-behavior gap KW - artificial intelligence KW - AI KW - well-being KW - user assessment KW - survey KW - self-efficacy KW - stress KW - mood KW - emotions KW - mobile phone N2 - Background: There has been a surge in the development of apps that aim to improve health, physical activity (PA), and well-being through behavior change. These apps often focus on creating a long-term and sustainable impact on the user. Just-in-time adaptive interventions (JITAIs) that are based on passive sensing of the user?s current context (eg, via smartphones and wearables) have been devised to enhance the effectiveness of these apps and foster PA. JITAIs aim to provide personalized support and interventions such as encouraging messages in a context-aware manner. However, the limited range of passive sensing capabilities often make it challenging to determine the timing and context for delivering well-accepted and effective interventions. Ecological momentary assessment (EMA) can provide personal context by directly capturing user assessments (eg, moods and emotions). Thus, EMA might be a useful complement to passive sensing in determining when JITAIs are triggered. However, extensive EMA schedules need to be scrutinized, as they can increase user burden. Objective: The aim of the study was to use machine learning to balance the feature set size of EMA questions with the prediction accuracy regarding of enacting PA. Methods: A total of 43 healthy participants (aged 19?67 years) completed 4 EMA surveys daily over 3 weeks. These surveys prospectively assessed various states, including both motivational and volitional variables related to PA preparation (eg, intrinsic motivation, self-efficacy, and perceived barriers) alongside stress and mood or emotions. PA enactment was assessed retrospectively via EMA and served as the outcome variable. Results: The best-performing machine learning models predicted PA engagement with a mean area under the curve score of 0.87 (SD 0.02) in 5-fold cross-validation and 0.87 on the test set. Particularly strong predictors included self-efficacy, stress, planning, and perceived barriers, indicating that a small set of EMA predictors can yield accurate PA prediction for these participants. Conclusions: A small set of EMA-based features like self-efficacy, stress, planning, and perceived barriers can be enough to predict PA reasonably well and can thus be used to meaningfully tailor JITAIs such as sending well-timed and context-aware support messages. UR - https://mhealth.jmir.org/2025/1/e57255 UR - http://dx.doi.org/10.2196/57255 ID - info:doi/10.2196/57255 ER - TY - JOUR AU - Grüneberg, Catharina AU - Bäuerle, Alexander AU - Karunakaran, Sophia AU - Darici, Dogus AU - Dörrie, Nora AU - Teufel, Martin AU - Benson, Sven AU - Robitzsch, Anita PY - 2025/1/24 TI - Medical Students? Acceptance of Tailored e?Mental Health Apps to Foster Their Mental Health: Cross-Sectional Study JO - JMIR Med Educ SP - e58183 VL - 11 KW - eHealth KW - medical education KW - medical students KW - tailored interventions KW - UTAUT KW - intention to use KW - e?mental health apps KW - app KW - foster KW - cross-sectional study KW - mental health problems KW - physician KW - well-being KW - mobile apps KW - acceptance KW - assessment KW - mental health apps N2 - Background: Despite the high prevalence of mental health problems among medical students and physicians, help-seeking remains low. Digital mental health approaches offer beneficial opportunities to increase well-being, for example, via mobile apps. Objective: This study aimed to assess the acceptance, and its underlying predictors, of tailored e?mental health apps among medical students by focusing on stress management and the promotion of personal skills. Methods: From November 2022 to July 2023, a cross-sectional study was conducted with 245 medical students at the University of Duisburg-Essen, Germany. Sociodemographic, mental health, and eHealth-related data were assessed. The Unified Theory of Acceptance and Use of Technology (UTAUT) was applied. Differences in acceptance were examined and a multiple hierarchical regression analysis was conducted. Results: The general acceptance of tailored e?mental health apps among medical students was high (mean 3.72, SD 0.92). Students with a job besides medical school reported higher acceptance (t107.3=?2.16; P=.03; Padj=.027; Cohen d=4.13) as well as students with higher loads of anxiety symptoms (t92.4=2.36; P=.02; Padj=.03; Cohen d=0.35). The t values were estimated using a 2-tailed t test. Regression analysis revealed that acceptance was significantly predicted by anxiety symptoms (?=.11; P=.045), depressive symptoms (?=?.11; P=.05), internet anxiety (?=?.12; P=.01), digital overload (?=.1; P=.03), and the 3 UTAUT core predictors?performance expectancy (?=.24; P<.001), effort expectancy (?=.26; P<.001), and social influence (?=.43; P<.001). Conclusions: The high acceptance of e?mental health apps among medical students and its predictors lay a valuable basis for the development and implementation of tailored e?mental health apps within medical education to foster their mental health. More research using validated measures is needed to replicate our findings and to further investigate medical students? specific needs and demands regarding the framework of tailored e?mental health apps. UR - https://mededu.jmir.org/2025/1/e58183 UR - http://dx.doi.org/10.2196/58183 ID - info:doi/10.2196/58183 ER - TY - JOUR AU - Huang, Qinyuan AU - Zhong, Qinyi AU - Zeng, Yanjing AU - Li, Yimeng AU - Wiley, James AU - Wang, Ping Man AU - Chen, Jyu-Lin AU - Guo, Jia PY - 2025/1/24 TI - mHealth-Based Diabetes Prevention Program for Chinese Mothers With Abdominal Obesity: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e47837 VL - 13 KW - type 2 diabetes KW - mHealth KW - obesity KW - prevention KW - mothers N2 - Background: Among people with abdominal obesity, women are more likely to develop diabetes than men. Mobile health (mHealth)?based technologies provide the flexibility and resource-saving opportunities to improve lifestyles in an individualized way. However, mHealth-based diabetes prevention programs tailored for busy mothers with abdominal obesity have not been reported yet. Objective: The aim of this study is to evaluate the feasibility and acceptability of an mHealth-based diabetes prevention program and its preliminary efficacy in reducing weight-related variables, behavioral variables, psychological variables, and diabetes risk among Chinese mothers with abdominal obesity over 6 months. Methods: A randomized controlled trial was conducted at health management centers in 2 tertiary hospitals in Changsha, China. The mHealth group (n=40) received 12 weekly web-based lifestyle modification modules for diabetes prevention, 6 biweekly individualized health education messages based on their goal settings, and a Fitbit tracker. The control group (n=40) received 12 weekly web-based general health education modules, 6 biweekly general health education messages, and a Fitbit tracker. Data were collected at baseline, 3 months, and 6 months on the feasibility and acceptability outcomes, weight-related variables (waist circumference and BMI), diabetes risk scores, glycemic levels, behavioral variables (daily step count, active minutes, fruit and vegetable intake, calorie consumption, and sleep duration), and psychological variables (self-efficacy and social support for physical activity and diet, perceived stress, and quality of life). Generalized estimating equations were used for data analysis. Results: Approximately 85% (68/80) of the participants completed 6 months of follow-up assessments. Regarding the feasibility and acceptance of the program in the mHealth group, the average number of modules reviewed was 7.9 out of 12, and the satisfaction score was 4.37 out of 5. Significant improvements at 6 months between the intervention and control groups were found in waist circumference (?=?2.24, 95% CI ?4.12 to ?0.36; P=.02), modifiable diabetes risk scores (?=?2.5, 95% CI ?4.57 to ?0.44; P=.02), daily steps (?=1.67, 95% CI 0.06-3.29; P=.04), self-efficacy for physical activity (?=1.93, 95% CI 0.44-3.43; P=.01), social support for physical activity (?=2.27, 95% CI 0.80-3.74; P=.002), and physical health satisfaction (?=0.82, 95% CI 0.08-1.55; P=.03). No differences were found in BMI, total diabetes risk score, daily active minutes, daily intake of fruits and vegetables, sleep duration, daily calorie consumption, self-efficacy, and social support for diet (P>.05). Conclusions: This study addresses the potential role of tailored lifestyle interventions based on mHealth technology by offering tailored web-based health modules and health information in managing diabetes risk among mothers with abdominal obesity. The mHealth diabetes prevention program provides a flexible, customized, and resource-saving model for busy mothers. Future research could further explore the efficacy improvement on dietary behaviors to better serve the health care needs of this population. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400090554; https://www.chictr.org.cn/showproj.html?proj=226411 UR - https://mhealth.jmir.org/2025/1/e47837 UR - http://dx.doi.org/10.2196/47837 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47837 ER - TY - JOUR AU - Metaxa, Marina Athina AU - Liverpool, Shaun AU - Eisenstadt, Mia AU - Pollard, John AU - Carlsson, Courtney PY - 2025/1/23 TI - Improving Mental Health and Well-Being Through the Paradym App: Quantitative Study of Real-World Data JO - JMIR Form Res SP - e68031 VL - 9 KW - well-being KW - awareness KW - mental health KW - formative KW - mobile phone KW - apps KW - quantitative evaluation KW - real-world data KW - emotional well-being KW - pre-post KW - single arm KW - quantitative data N2 - Background: With growing evidence suggesting that levels of emotional well-being have been decreasing globally over the past few years, demand for easily accessible, convenient, and affordable well-being and mental health support has increased. Although mental health apps designed to tackle this demand by targeting diagnosed conditions have been shown to be beneficial, less research has focused on apps aiming to improve emotional well-being. There is also a dearth of research on well-being apps structured around users? lived experiences and emotional patterns and a lack of integration of real-world evidence of app usage. Thus, the potential benefits of these apps need to be evaluated using robust real-world data. Objective: This study aimed to explore usage patterns and preliminary outcomes related to mental health and well-being among users of an app (Paradym; Paradym Ltd) designed to promote emotional well-being and positive mental health. Methods: This is a pre-post, single-arm evaluation of real-world data provided by users of the Paradym app. Data were provided as part of optional built-in self-assessments that users completed to test their levels of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), life satisfaction (Satisfaction With Life Scale), and overall well-being (World Health Organization-5 Well-Being Index) when they first started using the app and at regular intervals following initial usage. Usage patterns, including the number of assessments completed and the length of time between assessments, were recorded. Data were analyzed using within-subjects t tests, and Cohen d estimates were used to measure effect sizes. Results: A total of 3237 app users completed at least 1 self-assessment, and 787 users completed a follow-up assessment. The sample was diverse, with 2000 users (61.8%) being located outside of the United States. At baseline, many users reported experiencing strong feelings of burnout (677/1627, 41.6%), strong insecurities (73/211, 34.6%), and low levels of thriving (140/260, 53.8%). Users also experienced symptoms of depression (mean 9.85, SD 5.55) and anxiety (mean 14.27, SD 6.77) and reported low levels of life satisfaction (mean 12.14, SD 7.42) and general well-being (mean 9.88, SD 5.51). On average, users had been using the app for 74 days when they completed a follow-up assessment. Following app usage, small but significant improvements were reported across all outcomes of interest, with anxiety and depression scores improving by 1.20 and 1.26 points on average, respectively, and life satisfaction and well-being scores improving by 0.71 and 0.97 points, respectively. Conclusions: This real-world data analysis and evaluation provided positive preliminary evidence for the Paradym app?s effectiveness in improving mental health and well-being, supporting its use as a scalable intervention for emotional well-being, with potential applications across diverse populations and settings, and encourages the use of built-in assessments in mental health app research. UR - https://formative.jmir.org/2025/1/e68031 UR - http://dx.doi.org/10.2196/68031 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68031 ER - TY - JOUR AU - Qi, Yihan AU - Mohamad, Emma AU - Azlan, Anis Arina AU - Zhang, Chenglin AU - Ma, Yilian AU - Wu, Anqi PY - 2025/1/23 TI - Digital Health Solutions for Cardiovascular Disease Prevention: Systematic Review JO - J Med Internet Res SP - e64981 VL - 27 KW - cardiovascular disease prevention KW - cardiovascular outcomes KW - digital technologies KW - remote care KW - mobile phone N2 - Background: Cardiovascular disease (CVD) is a major global health issue, with approximately 70% of cases linked to modifiable risk factors. Digital health solutions offer potential for CVD prevention; yet, their effectiveness in covering the full range of prevention strategies is uncertain. Objective: This study aimed to synthesize current literature on digital solutions for CVD prevention, identify the key components of effective digital interventions, and highlight critical research gaps to inform the development of sustainable strategies for CVD prevention. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a comprehensive search in Web of Science, Scopus, and PubMed to identify original English-language studies published between January 2000 and May 2024 that examined primary or secondary CVD prevention through digital solutions. The exclusion criteria included: telephone-only interventions, abstract-only publications, methodology-focused studies without primary data, studies without participants or specific groups, and studies with no follow-up period. The literature search used the string with terms like ?digital health,? ?mHealth,? ?mobile health,? ?text message,? ?short message service,? ?SMS,? ?prevention,? ?prevent,? ?cardiovascular disease,? ?CVD,? etc. Study bias was assessed using the RoB 2 (Cochrane Collaboration) and the ROBINS-I tool (Cochrane Collaboration). Data on prevention components, prevention types, study design, population, intervention, follow-up duration, personnel, and delivery settings were extracted. Results: A total of 2871 studies were identified through the search. After excluding ineligible studies, 30 studies remained, including 24 randomized controlled trials. The reviewed digital solutions for CVD prevention focused on baseline assessment (29/30, 97%), physical activity counseling (18/30, 60%), tobacco cessation (14/30, 47%), blood pressure management (13/30, 43%), and medication adherence (10/30, 33%). The technologies used were categorized into 3 types, smartphones and wearables (16/30, 53%), email and SMS communications (12/30, 40%), and websites or web portals (3/30, 10%). The majority of the study outcomes addressed blood pressure (14/30, 47%), exercise capacity (12/30, 40%), weight (12/30, 40%), and lipid profile (11/30, 37%), while fewer focused on nicotine dependence (9/30, 30%), medication use (8/30, 27%), quality of life (7/30, 23%), dietary habits (5/30, 17%), intervention adherence (4/30, 13%), waist circumference (4/30, 13%), and blood glucose levels (2/30, 7%). Conclusions: Digital solutions can address challenges in traditional CVD prevention by improving preventive behaviors and monitoring health indicators. However, most evaluated interventions have focused on medication use, quality of life, dietary habits, adherence, and waist circumference. Further studies are needed to assess the long-term impact of more comprehensive interventions on key cardiovascular outcomes. UR - https://www.jmir.org/2025/1/e64981 UR - http://dx.doi.org/10.2196/64981 UR - http://www.ncbi.nlm.nih.gov/pubmed/39847411 ID - info:doi/10.2196/64981 ER - TY - JOUR AU - Charlton, Jaidyn AU - Malik, Ishaq AU - Ashley, M. Angela AU - Newton, Amanda AU - Toombs, Elaine AU - Schmidt, Fred AU - Olthuis, V. Janine AU - Stasiuk, Kristine AU - Bobinski, Tina AU - Mushquash, Aislin PY - 2025/1/23 TI - Identifying the Minimal Clinically Important Difference in Emotion Regulation Among Youth Using the JoyPop App: Survey Study JO - JMIR Form Res SP - e64483 VL - 9 KW - mHealth KW - mobile health KW - app KW - psychometrics KW - emotion regulation KW - Indigenous mental health KW - Indigenous youth KW - mental health interventions KW - resilience KW - clinical psychology KW - adolescent mental health KW - mental health KW - JoyPop KW - pediatrics KW - mobile phone N2 - Background: The minimal clinically important difference (MCID) is an important threshold to consider when evaluating the meaningfulness of improvement following an intervention. The JoyPop app is an evidence-based smartphone app designed to improve resilience and emotion regulation. Information is needed regarding the JoyPop app?s MCID among culturally diverse youth. Objective: This study aims to calculate the MCID for youth using the JoyPop app and to explore how the MCID may differ for a subset of Indigenous youth. Methods: Youth (N=36; aged 12-18 years) were recruited to use the JoyPop app for up to 4 weeks as part of a larger pilot evaluation. Results were based on measures completed after 2 weeks of app use. The MCID was calculated using emotion regulation change scores (Difficulties in Emotion Regulation?Short Form [DERS-SF]) and subjective ratings on the Global Rating of Change Scale (GRCS). This MCID calculation was completed for youth overall and separately for Indigenous youth only. Results: A significant correlation between GRCS scores and change scores on the DERS-SF supported face validity (r=?0.37; P=.04). The MCID in emotion regulation following the use of the JoyPop app for youth overall was 2.80 on the DERS-SF. The MCID for Indigenous youth was 4.29 on the DERS-SF. In addition, most youth reported improved emotion regulation after using the JoyPop app. Conclusions: These MCID findings provide a meaningful threshold for improvement in emotion regulation for the JoyPop app. They provide potential effect sizes and can aid in sample size estimations for future research with the JoyPop app or e-mental health technologies in general. The difference between overall youth and Indigenous youth MCID values also highlights the importance of patient-oriented ratings of symptom improvement as well as cultural considerations when conducting intervention research and monitoring new interventions in clinical practice. UR - https://formative.jmir.org/2025/1/e64483 UR - http://dx.doi.org/10.2196/64483 UR - http://www.ncbi.nlm.nih.gov/pubmed/39847426 ID - info:doi/10.2196/64483 ER - TY - JOUR AU - Pereira, Polin Amanda AU - Machado Neto, Jose Olibario AU - Elui, Carril Valeria Meirelles AU - Pimentel, Campos Maria da Graca PY - 2025/1/22 TI - Wearable Smartphone-Based Multisensory Feedback System for Torso Posture Correction: Iterative Design and Within-Subjects Study JO - JMIR Aging SP - e55455 VL - 8 KW - stroke rehabilitation KW - posture KW - postural balance KW - wearable technology KW - multisensory feedback KW - smartphone KW - stroke KW - mHealth KW - mobile health KW - digital health KW - digital technology KW - digital intervention KW - gerontology N2 - Background: The prevalence of stroke is high in both males and females, and it rises with age. Stroke often leads to sensor and motor issues, such as hemiparesis affecting one side of the body. Poststroke patients require torso stabilization exercises, but maintaining proper posture can be challenging due to their condition. Objective: Our goal was to develop the Postural SmartVest, an affordable wearable technology that leverages a smartphone's built-in accelerometer to monitor sagittal and frontal plane changes while providing visual, tactile, and auditory feedback to guide patients in achieving their best-at-the-time posture during rehabilitation. Methods: To design the Postural SmartVest, we conducted brainstorming sessions, therapist interviews, gathered requirements, and developed the first prototype. We used this initial prototype in a feasibility study with individuals without hemiparesis (n=40, average age 28.4). They used the prototype during 1-hour seated sessions. Their feedback led to a second prototype, which we used in a pilot study with a poststroke patient. After adjustments and a kinematic assessment using the Vicon Gait Plug-in system, the third version became the Postural SmartVest. We assessed the Postural SmartVest in a within-subject experiment with poststroke patients (n=40, average age 57.1) and therapists (n=20, average age 31.3) during rehabilitation sessions. Participants engaged in daily activities, including walking and upper limb exercises, without and with app feedback. Results: The Postural SmartVest comprises a modified off-the-shelf athletic lightweight compression tank top with a transparent pocket designed to hold a smartphone running a customizable Android app securely. This app continuously monitors sagittal and frontal plane changes using the built-in accelerometer sensor, providing multisensory feedback through audio, vibration, and color changes. Patients reported high ratings for weight, comfort, dimensions, effectiveness, ease of use, stability, durability, and ease of adjustment. Therapists noted a positive impact on rehabilitation sessions and expressed their willingness to recommend it. A 2-tailed t-test showed a significant difference (P<.001) between the number of the best-at-the-time posture positions patients could maintain in 2 stages, without feedback (mean 13.1, SD 7.12) and with feedback (mean 4.2, SD 3.97), demonstrating the effectiveness of the solution in improving posture awareness. Conclusions: The Postural SmartVest aids therapists during poststroke rehabilitation sessions and assists patients in improving their posture during these sessions. UR - https://aging.jmir.org/2025/1/e55455 UR - http://dx.doi.org/10.2196/55455 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55455 ER - TY - JOUR AU - Ruiz-Leon, Maria Ana AU - Casas, Rosa AU - Castro-Barquero, Sara AU - Alfaro-González, Sofia AU - Radeva, Petia AU - Sacanella, Emilio AU - Casanovas-Garriga, Francesc AU - Pérez-Gesalí, Ainhoa AU - Estruch, Ramon PY - 2025/1/22 TI - Efficacy of a Mobile Health?Based Behavioral Treatment for Lifestyle Modification in Type 2 Diabetes Self-Management: Greenhabit Randomized Controlled Trial JO - J Med Internet Res SP - e58319 VL - 27 KW - type 2 diabetes KW - cardiovascular health KW - lifestyle intervention KW - mHealth KW - artificial intelligence KW - mobile health KW - mobile application KW - diabetes KW - DM KW - self-management KW - randomized controlled trial KW - RCT KW - health care KW - self-care KW - Greenhabit KW - behavioral health KW - treatment KW - medication KW - analysis of covariance KW - intervention KW - work-life balance KW - cardiovascular KW - cardiovascular risk N2 - Background: Enhancing self-management in health care through digital tools is a promising strategy to empower patients with type 2 diabetes (T2D) to improve self-care. Objective: This study evaluates whether the Greenhabit (mobile health [mHealth]) behavioral treatment enhances T2D outcomes compared with standard care. Methods: A 12-week, parallel, single-blind randomized controlled trial was conducted with 123 participants (62/123, 50%, female; mean age 58.25 years, SD 9.46 years) recently diagnosed with T2D. Participants were recruited face-to-face from primary care centers in Barcelona, Spain, between July 2021 and March 2022. They were randomly assigned to 1 of 2 groups: (1) an intervention group (n=61) instructed to use the Greenhabit mobile app alongside standard care, or (2) a control group (n=62) who received advice on maintaining a healthy diet and followed standard care. The Greenhabit app incorporates serious gaming technology. Participants received daily messages and challenges focused on promoting a healthy lifestyle, including nutrition, exercise, relaxation, a positive mindset, and a supportive social environment. The app encouraged participants to set weekly goals and awarded points for completing challenges. Data on nutrition, anthropometrics, and blood and urine samples were collected at baseline, 6 weeks, and 12 weeks. Questionnaires assessing quality of life, work-life balance, and social environment were administered at baseline and during the final visit. The primary outcomes were HbA1c and fasting plasma glucose (FPG). Repeated-measures analysis of variance was used to compare changes over time (baseline to 6 weeks and baseline to 12 weeks) between the 2 intervention groups. Analysis of covariance was performed to evaluate changes at 6 and 12 weeks, adjusted for baseline levels of each variable. Multiple contrasts were corrected using a Bonferroni post hoc test. Results: Both groups showed significant reductions in HbA1c after 6 and 12 weeks (mean change in the intervention group [n=50] ?0.4%, P<.001 vs ?0.3% in the control group [n=53], P=.001) and in FPG after 6 weeks (mean change in the intervention group ?5.3 mg/dL, P=.01 vs control group ?5.8 mg/dL, P=.01). At 12 weeks, the intervention group also showed significant reductions in systolic and diastolic blood pressures (mean change ?4.5, P=.049 and ?2.4 mmHg, P=.03, respectively), body weight (mean change ?0.8 kg, P=.03), BMI (mean change ?0.3 kg/m2, P=.03), waist circumference (mean change ?1.0 cm, P=.046), and triglyceride concentration (mean change ?20.0 mg/dL, P=.03). There was also a significant increase in high-density lipoprotein-cholesterol concentrations (mean change 2 mg/dL, P=.049). Finally, improvements were noted in 3 out of the 5 elements of balance: positivity, social environment, and work-life balance. Conclusions: The 12-week intervention with the Greenhabit behavioral treatment mHealth app showed beneficial effects on T2D outcomes and reduced the burden of cardiovascular risk factors. Although larger studies are warranted, these results suggest that mHealth apps can be a promising tool for improving T2D self-management. Trial Registration: ISRCTN Registry ISRCTN13456652; http://www.isrctn.com/ISRCTN13456652 UR - https://www.jmir.org/2025/1/e58319 UR - http://dx.doi.org/10.2196/58319 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58319 ER - TY - JOUR AU - Inayama, Yoshihide AU - Yamaguchi, Ken AU - Mizuno, Kayoko AU - Tanaka-Mizuno, Sachiko AU - Koike, Ayami AU - Higashiyama, Nozomi AU - Taki, Mana AU - Yamanoi, Koji AU - Murakami, Ryusuke AU - Hamanishi, Junzo AU - Yoshida, Satomi AU - Mandai, Masaki AU - Kawakami, Koji PY - 2025/1/20 TI - Changes in Physical Activity Across Cancer Diagnosis and Treatment Based on Smartphone Step Count Data Linked to a Japanese Claims Database: Retrospective Cohort Study JO - JMIR Cancer SP - e58093 VL - 11 KW - cancer KW - lifelog data KW - physical activity KW - quality of life KW - step count KW - Japanese KW - database KW - smartphone KW - mobile app KW - exercise KW - mobile phone N2 - Background: Although physical activity (PA) is recommended for patients with cancer, changes in PA across cancer diagnosis and treatment have not been objectively evaluated. Objective: This study aimed to assess the impact of cancer diagnosis and treatment on PA levels. Methods: This was a retrospective cohort study using a Japanese claims database provided by DeSC Healthcare Inc, in which daily step count data, derived from smartphone pedometers, are linked to the claims data. In this study, we included patients newly diagnosed with cancer, along with those newly diagnosed with diabetes mellitus for reference. We collected data between April 2014 and September 2021 and analyzed them. The observation period spanned from 6 months before diagnosis to 12 months after diagnosis. We applied a generalized additive mixed model with a cubic spline to describe changes in step counts before and after diagnosis. Results: We analyzed the step count data of 326 patients with malignant solid tumors and 1388 patients with diabetes. Patients with cancer exhibited a 9.6% (95% CI 7.1%-12.1%; P<.001) reduction in step counts from baseline at the start of the diagnosis month, which further deepened to 12.4% (95% CI 9.5%-15.2%; P<.001) at 3 months and persisted at 7.1% (95% CI 4.2%-10.0%; P<.001) at 12 months, all relative to baseline. Conversely, in patients with diabetes, step counts remained relatively stable after diagnosis, with a slight upward trend, resulting in a change of +0.6% (95% CI ?0.6% to 1.9%; P=.31) from baseline at 3 months after diagnosis. At 12 months after diagnosis, step counts remained decreased in the nonendoscopic subdiaphragmatic surgery group, with an 18.0% (95% CI 9.1%-26.2%; P<.001) reduction, whereas step counts returned to baseline in the laparoscopic surgery group (+0.3%, 95% CI ?6.3% to 7.5%; P=.93). Conclusions: The analysis of objective pre- and postdiagnostic step count data provided fundamental information crucial for understanding changes in PA among patients with cancer. While cancer diagnosis and treatment reduced PA, the decline may have already started before diagnosis. The study findings may help tailor exercise recommendations based on lifelog data for patients with cancer in the future. UR - https://cancer.jmir.org/2025/1/e58093 UR - http://dx.doi.org/10.2196/58093 UR - http://www.ncbi.nlm.nih.gov/pubmed/39726139 ID - info:doi/10.2196/58093 ER - TY - JOUR AU - Denissen, Stijn AU - Van Laethem, Delphine AU - Baijot, Johan AU - Costers, Lars AU - Descamps, Annabel AU - Van Remoortel, Ann AU - Van Merhaegen-Wieleman, Annick AU - D?hooghe, Marie AU - D'Haeseleer, Miguel AU - Smeets, Dirk AU - Sima, M. Diana AU - Van Schependom, Jeroen AU - Nagels, Guy PY - 2025/1/20 TI - A New Smartphone-Based Cognitive Screening Battery for Multiple Sclerosis (icognition): Validation Study JO - J Med Internet Res SP - e53503 VL - 27 KW - multiple sclerosis KW - telemedicine KW - cognition KW - memory KW - information processing speed KW - mobile phone N2 - Background: Cognitive deterioration is common in multiple sclerosis (MS) and requires regular follow-up. Currently, cognitive status is measured in clinical practice using paper-and-pencil tests, which are both time-consuming and costly. Remote monitoring of cognitive status could offer a solution because previous studies on telemedicine tools have proved its feasibility and acceptance among people with MS. However, existing smartphone-based apps include designs that are prone to motor interference and focus primarily on information processing speed, although memory is also commonly affected. Objective: This study aims to validate a smartphone-based cognitive screening battery, icognition, to detect deterioration in both memory and information processing speed. Methods: The icognition screening battery consists of 3 tests: the Symbol Test for information processing speed, the Dot Test for visuospatial short-term memory and learning, and the visual Backward Digit Span (vBDS) for working memory. These tests are based on validated paper-and-pencil tests: the Symbol Digit Modalities Test, the 10/36 Spatial Recall Test, and the auditory Backward Digit Span, respectively. To establish the validity of icognition, 101 people with MS and 82 healthy participants completed all tests. Of the 82 healthy participants, 20 (24%) repeated testing 2 to 3 weeks later. For each icognition test, validity was established by the correlation with its paper-and-pencil equivalent (concurrent validity), the correlation and intraclass correlation coefficient (ICC) between baseline and follow-up testing (test-retest reliability), the difference between people with MS and healthy participants, and the correlation with other clinical parameters such as the Expanded Disability Status Scale. Results: All icognition tests correlated well with their paper-and-pencil equivalents (Symbol Test: r=0.67; P<.001; Dot Test: r=0.31; P=.002; vBDS: r=0.69; P<.001), negatively correlated with the Expanded Disability Status Scale (Symbol Test: ?=?0.34; P<.001; Dot Test: ?=?0.32; P=.003; vBDS: ?=?0.21; P=.04), and showed moderate test-retest reliability (Symbol Test: ICC=0.74; r=0.85; P<.001; Dot Test: ICC=0.71; r=0.74; P<.001; vBDS: ICC=0.72; r=0.83; P<.001). Test performance was comparable between people with MS and healthy participants for all cognitive tests, both in icognition (Symbol Test: U=4431; P=.42; Dot Test: U=3516; P=.32; vBDS: U=3708; P=.27) and the gold standard paper-and-pencil tests (Symbol Digit Modalities Test: U=4060.5, P=.82; 10/36 Spatial Recall Test: U=3934; P=.74; auditory Backward Digit Span: U=3824.5, P=.37). Conclusions: icognition is a valid tool to remotely screen cognitive performance in people with MS. It is planned to be included in a digital health platform that includes volumetric brain analysis and patient-reported outcome measures. Future research should establish the usability and psychometric properties of icognition in a remote setting. UR - https://www.jmir.org/2025/1/e53503 UR - http://dx.doi.org/10.2196/53503 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53503 ER - TY - JOUR AU - Yakubu, I. Titilola AU - Jhajj, Poonamdeep AU - Pawer, Samantha AU - West, C. Nicholas AU - Amed, Shazhan AU - Tang, S. Tricia AU - Görges, Matthias PY - 2025/1/20 TI - Exploring the Needs and Preferences of Users and Parents to Design a Mobile App to Deliver Mental Health Peer Support to Adolescents With Type 1 Diabetes: Qualitative Study JO - JMIR Diabetes SP - e64267 VL - 10 KW - peer support KW - type 1 diabetes KW - digital interventions KW - diabetes distress KW - depression KW - mental health KW - focus groups KW - disease management KW - adolescent KW - parent KW - mobile app KW - mHealth KW - type 1 KW - diabetes KW - qualitative study KW - physical health KW - psychological KW - emotional health KW - mental health support KW - thematic analysis KW - data collection KW - mobile health N2 - Background: Beyond physical health, managing type 1 diabetes (T1D) also encompasses a psychological component, including diabetes distress, that is, the worries, fears, and frustrations associated with meeting self-care demands over the lifetime. While digital health solutions have been increasingly used to address emotional health in diabetes, these technologies may not uniformly meet the unique concerns and technological savvy across all age groups. Objective: This study aimed to explore the mental health needs of adolescents with T1D, determine their preferred modalities for app-based mental health support, and identify desirable design features for peer-delivered mental health support modeled on an app designed for adults with T1D. Methods: A semistructured qualitative focus group study was conducted with adolescents with T1D and parents of adolescents with T1D. Data were collected through pre?focus group surveys, including sociodemographic background, diabetes status, health care experiences, and focus group sessions, including their opinions on peer support and technology. A thematic analysis following an inductive and iterative process was performed to develop themes and subthemes from the collected information. Results: Focus group participants included 10 adolescents (mean 16, SD 1 years; 8/10, 80% female; who had been living with diabetes for an average of 9, SD 5 years) and 10 parents (mean age 51, SD 7 years; 9/10, 90% female). Four core themes emerged: (1) experience: navigating adolescence with T1D, (2) empowerment: support systems that enabled better management of their T1D, (3) obstacles: societal barriers that affect adolescents? T1D management, and (4) innovation: adolescent-driven preferences for digital peer support platforms. Conclusions: App-based peer support offers a promising avenue for addressing the mental health needs of adolescents with T1D. Understanding the unique support needs of these adolescents and using this information to suggest design considerations for a mental health peer support app is an important step toward addressing their complex emotional and social challenges. UR - https://diabetes.jmir.org/2025/1/e64267 UR - http://dx.doi.org/10.2196/64267 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64267 ER - TY - JOUR AU - Park, Sehwan AU - Cho, Young Hee AU - Park, Young Jin AU - Chung, Kyungmi AU - Jhung, Kyungun PY - 2025/1/17 TI - Development and Evaluation of a Mindfulness-Based Mobile Intervention for Perinatal Mental Health: Randomized Controlled Trial JO - J Med Internet Res SP - e56601 VL - 27 KW - anxiety KW - perinatal mental health KW - depression KW - mobile health care KW - mindfulness KW - mobile phone N2 - Background: Perinatal mental health problems, such as anxiety, stress, and depression, warrant particularly close monitoring and intervention, but they are often unaddressed in both obstetric and psychiatric clinics, with limited accessibility and treatment resources. Mobile health interventions may provide an effective and more accessible solution for addressing perinatal mental health. Development and evaluation of a mobile mental health intervention specifically for pregnant women are warranted. Objective: This study aimed to evaluate the effectiveness of a 4-week, self-administered mobile mindfulness intervention in reducing anxiety, depression, and stress, and improving emotional well-being, maternal-fetal attachment, and mindfulness skills in a general population of pregnant women. Methods: Pregnant women were recruited and randomized to an intervention or a wait-list control group. The intervention group participated in a self-administered 4-week smartphone-based mindfulness program. Anxiety, depression, and stress were assessed as primary outcomes at baseline and postintervention. Secondary outcomes were mental health well-being, maternal-fetal attachment, and skills of mindfulness. The usability of the mobile intervention was also evaluated. Results: A total of 133 pregnant women were randomly assigned to the intervention (n=66) or the control group (n=67). The overall dropout rate was 30% (39/133). Anxiety scores of the intervention group significantly decreased from baseline to postintervention (P=.03, Wilcoxon Signed-Rank test), whereas no significant changes were observed in the control group. Depression and stress scores showed no significant changes. Emotional well-being significantly improved in the intervention group (P=.01). Improvements were observed in maternal-fetal attachment, particularly in attributing characteristics to the fetus (P=.003) and in differentiating the self from the fetus (P=.006). Mindfulness awareness also showed significant improvement (P=.008). Significant between-group effects were identified for mindfulness awareness (P=.006) and attributing characteristics to the fetus (P=.002). After applying the false discovery rate corrections, within-group improvements in emotional well-being, maternal-fetal attachment, and mindfulness awareness remained significant, while between-group differences for emotional well-being and differentiation were not significant. Conclusions: A mobile mindfulness program effectively reduced anxiety and improved emotional well-being, maternal-fetal attachment, and mindfulness awareness in the general population of pregnant women. Mobile interventions may offer a cost-effective and feasible method for promoting perinatal mental health. Trial Registration: Clinical Research Information Service KCT0007166; https://tinyurl.com/458vfc4r UR - https://www.jmir.org/2025/1/e56601 UR - http://dx.doi.org/10.2196/56601 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56601 ER - TY - JOUR AU - Tang, Dongmei AU - Peng, Yuzhu AU - Gu, Dantong AU - Wu, Yongzhen AU - Li, Huawei PY - 2025/1/17 TI - Digital Frequency Customized Relieving Sound for Chronic Subjective Tinnitus Management: Prospective Controlled Study JO - J Med Internet Res SP - e60150 VL - 27 KW - tinnitus KW - digital frequency customized relieving sound KW - unmodified music KW - sound therapy KW - prospective study KW - mobile phone N2 - Background: Tinnitus is a major health issue, but currently no tinnitus elimination treatments exist for chronic subjective tinnitus. Acoustic therapy, especially personalized acoustic therapy, plays an increasingly important role in tinnitus treatment. With the application of smartphones, personalized acoustic stimulation combined with smartphone apps will be more conducive to the individualized treatment and management of patients with tinnitus. Objective: The aim of this study was to evaluate the efficacy of a new personalized approach known as the digital frequency customized relieving sound (DFCRS) for tinnitus treatment and to explore the factors that may influence its therapeutic effect. Methods: Patients with subjective tinnitus were enrolled in this study from July 14, 2020, to May 24, 2021, in the tinnitus specialist clinic of Eye and ENT Hospital, Fudan University, Shanghai, China. In this nonrandomized concurrent controlled trial, a total of 107 participants were assigned to listen to personalized DFCRS through our developed app, while the other 77 participants who did not want to download and use the app were assigned to listen to unmodified music (UM). All the recruits were instructed to listen to DFCRS or UM for at least 2 hours a day and complete follow-up assessments at baseline, 1, 2, and 3 months. Multidimensional assessment scales, that is, Tinnitus Handicapped Inventory (THI), Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), Fear of Tinnitus Questionnaire (FTQ), and Tinnitus Catastrophizing Scale (TCS) were used to evaluate the severity of tinnitus and the quality of life. Linear mixed models were used to test for changes in the THI scores across 3 months of acoustic treatment between group (DFCRS or UM treatment) and time. A multiclass logistic model was built with a stepwise function to determine the influence of the different covariates on the effects of acoustic treatment. Results: The results of the multidimensional assessment scales after 3 months of treatment showed that DFCRS-treated patients had significant tinnitus relief compared to those in the UM group. Linear mixed models revealed a significant reduction in the THI scores over time (P<.001), with the DFCRS group showing significantly greater improvement than the UM group (P<.001). At 3 months, 92.5% (99/107) of the patients undergoing DFCRS reported tinnitus relief or disappearance, and longer daily treatment time was associated with better outcomes (P=.007). Multiclass logistic regression confirmed that longer treatment time (odds ratio [OR] 13.07-64.78; P<.001) and more severe tinnitus at baseline (OR 10.46-83.71; P<.001) predicted better treatment response. All secondary outcomes (HADS, AIS, FTQ, TCS) showed significant improvements over time (P<.001). Conclusions: Our study suggests that DFCRS is a new promising and noninvasive therapy for chronic tinnitus, and it can be delivered through a mobile app to bring more convenience to patients with tinnitus. UR - https://www.jmir.org/2025/1/e60150 UR - http://dx.doi.org/10.2196/60150 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60150 ER - TY - JOUR AU - Skoglund, Gyri AU - Hilde, Gunvor AU - Lunde, Pernille AU - Cruz Naceno, Vera Venessa AU - Fromholt Olsen, Cecilie AU - Blakstad Nilsson, Birgitta PY - 2025/1/15 TI - Mobile Phone App to Promote Lifestyle Change in People at Risk of Type 2 Diabetes: Feasibility 3-Arm Randomized Controlled Trial JO - JMIR Form Res SP - e63737 VL - 9 KW - prevention KW - risk of type 2 diabetes KW - lifestyle change KW - feasibility KW - app adherence KW - mobile health KW - mHealth KW - mobile phone N2 - Background: The use of mobile health interventions, such as apps, are proposed to meet the challenges faced by preventive health care services due to the increasing prevalence of type 2 diabetes (T2D). Thus, we developed and conducted initial feasibility testing of the Plunde app for promoting and monitoring individual goals related to lifestyle change for people at risk of T2D. Objective: The primary aim of this study was to assess the feasibility of an app for promoting lifestyle change in people at risk of T2D. The secondary aim was to assess recruitment rate, resource requirements, and change in potential outcomes for a full scale randomized controlled trial (RCT) study . Methods: A 3-arm feasibility RCT lasting 12 weeks was designed. Participants were recruited from 9 general practitioners in Norway. Eligible participants were randomized to either (1) app follow-up; (2) app follow-up and referral to care as usual in Healthy Life Centers; or (3) referral to care as usual in a Healthy Life Center, only. The primary outcome was feasibility and was measured by app adherence (actual usage of the app), the System Usability Scale, and app motivation score gained from a questionnaire designed for this study. Criteria for success were preset based on these measures. Secondary outcomes included recruitment rate, resource requirements, and potential primary outcomes of a full-scale RCT. This included change in body weight, waist circumference, and self-evaluated functional health status, assessed with the Dartmouth Primary Care Cooperative Research Network/World Organization of Family Doctors (COOP/WONCA) functional health assessment chart. Results: Within 8 months, 9 general practitioners recruited a total of 54 participants, of which 45 were eligble for participation in the study. Mean age was 61 (SD 13) years and 53% (n=24) were female. App adherence was 86%, the mean System Usability Scale score was 87.3 (SD 11.9), and the mean app motivation score was 74.8 (SD 30.3). Throughout the intervention period, health care professionals spent on average 3.0 (SD 1.0) minutes per participant per week providing follow-up. Statistically significant reduction in body weight and waist circumference was shown in group 1 and 3. Conclusions: Based on the preset criteria for success, the Plunde app is feasible in providing support for lifestyle change. The Plunde app had excellent user satisfaction. The amount of time spent on monitoring and promoting lifestyle change through the app was low; however, the recruitment was slow. Results from this study will guide the development of further research within this field. Trial Registration: ClinicalTrials.gov NCT06117098; https://clinicaltrials.gov/study/NCT06117098 UR - https://formative.jmir.org/2025/1/e63737 UR - http://dx.doi.org/10.2196/63737 ID - info:doi/10.2196/63737 ER - TY - JOUR AU - Simioni, Lisa AU - Tessitore, Elena AU - Hagberg, Hamdi AU - Schneider-Paccot, Aurélie AU - Blondon, Katherine AU - Gschwind, Liliane AU - Meyer, Philippe AU - Ehrler, Frederic PY - 2025/1/15 TI - Cardiomeds, an mHealth App for Self-Management to Support Swiss Patients With Heart Failure: 2-Stage Mixed Methods Usability Study JO - JMIR Form Res SP - e63941 VL - 9 KW - usability KW - medication KW - mobile health KW - mHealth KW - Cardiomeds KW - mobile app KW - patient empowerment KW - eHealth KW - smartphone KW - heart failure KW - HF KW - chronic disease KW - interactive KW - self-monitoring KW - usability test KW - mobile phone N2 - Background: Mobile health apps have shown promising results in improving self-management of several chronic diseases in patients. We have developed a mobile health app (Cardiomeds) dedicated to patients with heart failure (HF). This app includes an interactive medication list; daily self-monitoring of symptoms, weight, blood pressure, and heart rate; and educational information on HF delivered through various formats. Objective: This study aimed to perform a mixed methods usability study of Cardiomeds. Methods: Smartphone users with HF were recruited from the HF outpatient clinic at the University Hospital of Geneva. The usability test was conducted in 2 stages, with modifications made to the app after the first stage to address major usability issues. Each stage required 10 participants to perform 14 tasks, such as entering vital signs, entering a new medication and time of intake, or finding information about HF. Each task was timed, sessions were recorded, and all data were anonymized. After completing the tasks, patients completed the System Usability Scale 10-item questionnaire and answered 5 open questions about their perceptions of Cardiomeds. Results: Twenty patients with HF, 75% (15/20) of whom were men, with a mean age of 55 years, were included in this study. The average time to complete all 14 tasks was 18 (SD 5.7) minutes. Manual medication entry was the most time-consuming task, taking an average of 154.40 (SD 68.08) seconds in the first stage, 103.10 (SD 42.76) seconds in the second stage, and 128 (SD 63) seconds overall. The mean overall success rate was 77% (SD 0.23%) for the first stage and 94% (SD 0.07%) for the second stage. A total of 30% (3/10) of participants in the first stage completed all tasks without any help compared with 50% (5/10) of participants during the second stage. The average System Usability Scale score was 80% (SD 17%), showing a slight increase from 79% (SD 16%) in the first stage to 80% (SD 28%) in the second stage, which qualifies the app as ?good? in terms of usability. Between the 2 stages, part of the app interface was redesigned to address the key issues identified in the first stage. Despite these improvements, problems related to guidance were frequent and comprised 36% (8/22) of the problems in the first stage and 40% (6/15) in the second stage. In response to open questions, 85% (17/20) of the participants responded that they would like to use the app when it became available. Conclusions: The usability test indicated that Cardiomeds is a suitable and user-friendly app for patients with HF. The app will be further tested in a randomized clinical trial (2022-00731) after acute HF hospitalization to assess its impact on patients? knowledge about HF, self-care, and quality of life. UR - https://formative.jmir.org/2025/1/e63941 UR - http://dx.doi.org/10.2196/63941 UR - http://www.ncbi.nlm.nih.gov/pubmed/39813081 ID - info:doi/10.2196/63941 ER - TY - JOUR AU - Krishnamurti, Tamar AU - Moon, Rachel AU - Richichi, Rudolph AU - Berger, Rachel PY - 2025/1/14 TI - Integrating Infant Safe Sleep and Breastfeeding Education Into an App in a Novel Approach to Reaching High-Risk Populations: Prospective Observational Study JO - JMIR Pediatr Parent SP - e65247 VL - 8 KW - SIDS KW - infant death KW - sleep KW - sudden infant death KW - US KW - United States KW - infant KW - infancy KW - baby KW - prenatal KW - safe sleep KW - breastfeeding KW - infant care KW - pregnancy KW - app KW - randomized controlled study KW - TodaysBaby KW - mobile health KW - mHealth KW - smartphone N2 - Background: Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and nonrecommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth. Objective: This study aims to assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end user push notifications for engagement. Methods: This prospective observational study was conducted from September 23, 2019 to March, 22 2022; push notifications were removed on October 26, 2021. TodaysBaby (University of Virginia, Boston University, and Washington University), a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app (Naima Health LLC). Pregnant mothers who received prenatal care within the University of Pittsburgh Medical Center hospital system were randomized to receive either safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post partum. Pregnant persons were designated as high risk if they lived in the 5% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least 1 video either in response to a push notification or directly from the app?s learning center. Results: A total of 7572 pregnant persons were enrolled in the TodaysBaby Program?3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8% with push notifications and 3.0% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little postpartum engagement. There was no difference in engagement between pregnant persons who were low and high risk. The most viewed videos were ones addressing the use of pacifiers, concerns about infant choking, and the response of the body to the start of breastfeeding. Conclusions: Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID?a leading cause of infant death after 1 month of age?appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact. UR - https://pediatrics.jmir.org/2025/1/e65247 UR - http://dx.doi.org/10.2196/65247 ID - info:doi/10.2196/65247 ER - TY - JOUR AU - Li, Chenxi AU - Guo, Lixin AU - Shi, Lixin AU - Chen, Li AU - Chen, Liming AU - Xue, Yaoming AU - Li, Hong AU - Liang, Yuzhen AU - Yang, Jing AU - Wang, Weimin AU - Zhu, Dalong PY - 2025/1/13 TI - Effectiveness and Safety of the TRIO Optimal Health Management Program in Patients With Type 2 Diabetes Mellitus Initiating Basal Insulin Therapy: Prospective Observational Real-World Study JO - J Med Internet Res SP - e67554 VL - 27 KW - type 2 diabetes KW - TRIO optimal health management program KW - initiating basal insulin therapy KW - glycemic control KW - real-world study N2 - Background: Diabetes, a chronic disease necessitating long-term treatment and self-management, presents significant challenges for patients who spend most of their treatment time outside of hospitals. The potential of digital therapeutics for diabetes has garnered recognition from different organizations. Although some prior studies have demonstrated successful reductions in patients? blood glucose levels and body weight through digital diabetes programs, many studies were limited by including patients with prediabetes, including patients treated with mostly premixed insulin, or evaluating user engagement outcomes rather than clinical outcomes. Consequently, limited evidence remains regarding the effectiveness of health management mobile apps specifically designed for patients with type 2 diabetes mellitus (T2DM) initiating basal insulin (BI). Based on this, a data-based and artificial intelligence management system named ?TRIO? was developed to provide patients with more personalized intervention methods in stages, in groups, and around the clock. TRIO assists doctors and nurses in achieving better blood glucose controls, truly carries out standardized management around patients, and allows them to have a higher quality of life. TRIO represents the 3 essential pillars in comprehensive diabetes management: physician, nurse, and patient. Objective: This prospective observational study evaluated the effectiveness and safety of the TRIO optimal health management program for patients with T2DM initiating BI therapy in a real-world setting. Methods: Patients aged 18-85 years with inadequate glycemic control (baseline hemoglobin A1c [HbA1c] ?7%) starting BI therapy were enrolled in outpatient and inpatient settings. The study lasted 3 months, with health education and phone-based follow-up assessments. Data collected included patient characteristics, medical history, baseline diabetes conditions, treatment compliance, glycemic control, and safety indicators. Results: A total of 199,431 patients were included, and 118,134 patients completed the 3-month follow-up between December 1, 2019, and December 31, 2021, involving 574 hospitals in China. The mean baseline HbA1c was 9.2%, the mean duration of diabetes was 7.3 years, and 80.4% (1,59,930/1,98,969) of patients were using BI with oral antihyperglycemic drugs. After the intervention, mean HbA1c decreased by ?2.59% from baseline, with 55.6% (28,858/51,912) achieving the target HbA1c level of <7%. Patients who set lower fasting plasma glucose goals (<6.1 mmol/L) showed more significant HbA1c reductions (P<.001) and higher target achievement than those with fasting plasma glucose goals of ?6.1 mmol/L. Factors such as complications, diabetes duration, and baseline HbA1c levels influenced the magnitude of HbA1c reduction. The presence of complications, shorter diabetes duration, and higher baseline HbA1c were significantly associated with increased hypoglycemia incidence risk (all P<.05). Conclusions: The TRIO optimal health management program effectively improved glycemic control in patients with T2DM initiating BI therapy. Individualized treatment approaches considering patient characteristics and glycemic goals are vital for optimal outcomes. UR - https://www.jmir.org/2025/1/e67554 UR - http://dx.doi.org/10.2196/67554 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67554 ER - TY - JOUR AU - Fan, Lok Heidi Sze AU - Leung, Yan Emily Tsz AU - Lau, Wing Ka AU - Wong, Ha Janet Yuen AU - Choi, Hang Edmond Pui AU - Lam, Christine AU - Tarrant, Marie AU - Ngan, Sheung Hextan Yuen AU - Ip, Patrick AU - Lin, Chin Chia AU - Lok, Wan Kris Yuet PY - 2025/1/10 TI - A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study JO - JMIR Form Res SP - e64191 VL - 9 KW - Baby-Friendly Community Initiative KW - Baby-Friendly Hospital Initiative KW - breastfeeding KW - community KW - stakeholders KW - mobile app KW - friendly communities KW - baby-friendly KW - well-being KW - mother KW - infant KW - application KW - mHealth KW - qualitative KW - user-friendly KW - self-management N2 - Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called ?bfGPS? (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged?bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant?s growth, and provides suggestions for further development. Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app?s potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies. UR - https://formative.jmir.org/2025/1/e64191 UR - http://dx.doi.org/10.2196/64191 ID - info:doi/10.2196/64191 ER - TY - JOUR AU - Schnitzspahn, Katharina AU - Abdulla, Kahar AU - Arensman, Ella AU - Van Audenhove, Chantal AU - Mere, Rainer AU - Pérez Sola, Victor AU - Sisask, Merike AU - Székely, András AU - Toczyski, Piotr AU - Hegerl, Ulrich PY - 2025/1/10 TI - Community-Based 4-Level Intervention Targeting Depression and Suicidal Behavior in Europe: Protocol for an Implementation Project JO - JMIR Res Protoc SP - e64218 VL - 14 KW - depression KW - suicide KW - mental health KW - European Alliance Against Depression KW - EAAD KW - 4-level community-based intervention KW - iFightDepression KW - cognitive behavioral therapy KW - mHealth N2 - Background: The community-based, 4-level intervention of the European Alliance Against Depression (EAAD) is simultaneously addressing depression and suicidal behavior. Intervention activities target primary care health professionals (level 1), the general public (level 2), community facilitators (level 3), and patients and their relatives (level 4). Activities comprise the digital iFightDepression tool, a guided self-management tool based on cognitive behavioral therapy. Objective: This study aimed to present the European Union?cofunded EAAD-Best study protocol, aiming at the implementation, dissemination, and evaluation of the 4-level intervention and the iFightDepression tool in several countries across Europe. Methods: The 4-level intervention has been implemented for the first time in Bulgaria, Estonia, Greece, and Poland. In 3 countries that have already implemented the 4-level intervention (Hungary, Ireland, and Spain), activities have been extended to new regions. In addition, the nationwide uptake of the iFightDepression tool by patients with depression has been promoted in all mentioned countries and Italy. Results: To evaluate the implementation of the 4-level intervention and the iFightDepression tool, data related to the process, output, and outcome were collected between 2022 and 2024. Data processing and analyses started in 2023. Analyses are expected to be completed in 2024. Results are expected to be published in 2025. Conclusions: This paper informs researchers, practitioners, and stakeholders on how to implement best practices in mental health promotion and evaluate their effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/64218 UR - https://www.researchprotocols.org/2025/1/e64218 UR - http://dx.doi.org/10.2196/64218 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64218 ER - TY - JOUR AU - Ishaque, Sana AU - Ela, Ola AU - Rissel, Chris AU - Canuto, Karla AU - Hall, Kerry AU - Bidargaddi, Niranjan AU - Briley, Annette AU - Roberts, T. Claire AU - Perkes, Jane Sarah AU - Dowling, Anna AU - Bonevski, Billie PY - 2025/1/10 TI - Cultural Adaptation of an Aboriginal and Torres Strait Islanders Maternal and Child mHealth Intervention: Protocol for a Co-Design and Adaptation Research Study JO - JMIR Res Protoc SP - e53748 VL - 14 KW - Aboriginal KW - co-design KW - mHealth KW - maternal KW - child health KW - digital health KW - children KW - women KW - female KW - cultural adaptation KW - Torres Strait KW - research study KW - Indigenous KW - digital health intervention KW - diversity KW - South Australia KW - pregnant KW - health professional KW - adaption KW - focus group KW - pretesting KW - usability KW - app KW - health disparities KW - information KW - technology KW - mobile phone N2 - Background: There is limited evidence of high-quality, accessible, culturally safe, and effective digital health interventions for Indigenous mothers and babies. Like any other intervention, the feasibility and efficacy of digital health interventions depend on how well they are co-designed with Indigenous communities and their adaptability to intracultural diversity. Objective: This study aims to adapt an existing co-designed mobile health (mHealth) intervention app with health professionals and Aboriginal and/or Torres Strait Islander mothers living in South Australia. Methods: Potential participants include Aboriginal and/or Torres Strait Islander pregnant women and mothers of children aged 0-5 years, non-Aboriginal and/or Torres Strait Islander women who are mothers of Aboriginal and/or Torres Strait Islander babies, and health professionals who predominantly care for Aboriginal and/or Torres Strait Islander mothers and babies. Participants will be recruited from multiple Aboriginal and/or Torres Strait Islander?specific health services under the local health networks around metropolitan South Australia. In this study, data collection will be carried out via culturally safe, and family-friendly yarning circles, facilitated by Aboriginal research staff to collect feedback on the existing mHealth app from approximately 20 women and 10 health professionals, with the aim to achieve data saturation. This will inform the changes required to the mHealth app. All focus groups and interviews will be audio recorded and transcribed verbatim. Data will be inductively analyzed using realist epistemology via NVivo software (Lumivero). Themes about the mHealth app?s cultural acceptability, usability, and appropriateness will be used to inform the changes applied to the app. Results: With the feedback received from participating women and health professionals, changes in the smartphone app will be made to ensure the intervention is supportive and meets the needs of Aboriginal and/or Torres Strait Islander mothers and families in South Australia. Participation of community members will promote ownership, community engagement, and implementation. Conclusions: A co-designed, culturally sensitive, and effective digital health intervention is likely to support Indigenous mothers and their children facing health disparities due to the disruption of Indigenous culture by colaying a foundation for a potential clinical trial and wider implementation. International Registered Report Identifier (IRRID): PRR1-10.2196/53748 UR - https://www.researchprotocols.org/2025/1/e53748 UR - http://dx.doi.org/10.2196/53748 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53748 ER - TY - JOUR AU - Scheffrahn, Katherine AU - Hall, Claire AU - Muñiz, Vanessa AU - Elkins, Gary PY - 2025/1/9 TI - User Outcomes for an App-Delivered Hypnosis Intervention for Menopausal Hot Flashes: Retrospective Analysis JO - JMIR Form Res SP - e63948 VL - 9 KW - hypnosis KW - hypnotherapy KW - hot flash KW - menopause KW - women?s health KW - gynecology KW - smartphone app KW - applications KW - mobile health KW - mHealth KW - user KW - outcome KW - intervention KW - alternative KW - complementary KW - mind-body KW - mobile phone N2 - Background: Hypnotherapy has been shown to be a safe, nonhormonal intervention effective for treating menopausal hot flashes. However, women experiencing hot flashes may face accessibility barriers to in-person hypnotherapy. To solve this issue, a smartphone app has been created to deliver hypnotherapy. The Evia app delivers audio-recorded hypnotherapy and has the potential to help individuals experiencing hot flashes. Objective: This study aims to determine user outcomes in hot flash frequency and severity for users of the Evia app. Methods: This study is a retrospective analysis of a dataset of Evia app users. Participants were divided into 2 groups for analysis. The first group reported daytime hot flashes and night sweats, while the second group was asked to report only daytime hot flashes. The participants in the first group (daytime hot flashes and night sweats) were 139 women with ?3 daily hot flashes who downloaded the Evia app between November 6, 2021, and June 9, 2022, with a baseline mean of 8.330 (SD 3.977) daily hot flashes. The participants in the second group (daytime hot flashes) were 271 women with ?3 daily hot flashes who downloaded the Evia app between June 10, 2022, and February 5, 2024, with a baseline mean of 6.040 (SD 3.282) daily hot flashes. The Evia program included a 5-week program for all participants with daily tasks such as educational readings, hypnotic inductions, and daily hot-flash tracking. The app uses audio-recorded hypnosis and mental imagery for coolness, such as imagery for a cool breeze, snow, or calmness. Results: A clinically significant reduction, defined as a 50% reduction, in daily hot flashes was experienced by 76.3% (106/139) of the women with hot flashes and night sweats and 56.8% (154/271) of the women with daily hot flashes from baseline to their last logged Evia app survey. On average, the women with hot flashes and night sweats experienced a reduction of 61.4% (SD 33.185%) in their hot flashes experienced at day and night while using the Evia app, and the women with daily hot flashes experienced a reduction of 45.2% (SD 42.567%) in their daytime hot flashes. In both groups, there was a large, statistically significant difference in the average number of daily hot flashes from baseline to end point (women with hot flashes and night sweats: Cohen d=1.28; t138=15.055; P<.001; women with daily hot flashes: Cohen d=0.82; t270=13.555; P<.001). Conclusions: Hypnotherapy is an efficacious intervention for hot flashes, with the potential to improve women?s lives by reducing hot flashes without hormonal or pharmacological intervention. This study takes the first step in evaluating the efficacy of an app-delivered hypnosis intervention for menopausal hot flashes, demonstrating the Evia app provides a promising app delivery of hypnotherapy with potential to increase accessibility to hypnotherapy. UR - https://formative.jmir.org/2025/1/e63948 UR - http://dx.doi.org/10.2196/63948 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63948 ER - TY - JOUR AU - Martins, Isabel Ana AU - Ribeiro, Óscar AU - Santinha, Gonçalo AU - Silva, Telmo AU - Rocha, P. Nelson AU - Silva, G. Anabela PY - 2025/1/9 TI - Effectiveness of Integrated Digital Solutions to Empower Older Adults in Aspects Related to Their Health: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e54466 VL - 27 KW - empowerment KW - older adults KW - digital health KW - digital solutions KW - effectiveness KW - health related KW - outcomes KW - systematic review KW - meta-analysis KW - synthesize KW - evaluate KW - apps KW - mHealth KW - mobile health N2 - Background: Digital solutions, such as mobile apps or telemonitoring devices, are frequently considered facilitators in the process of empowering older adults, but they can also act as a source of digital exclusion or disempowerment if they are not adequate for older adults? needs and characteristics. Objective: This study aimed to synthesize and critically evaluate existing evidence on the effectiveness of integrated digital solutions that enable interaction for empowering older adults in aspects related to their health and to explore potential factors (eg, type of technology, participants? characteristics) impacting effectiveness. Methods: A systematic search was carried out in PubMed, ScienceDirect, SCOPUS, EBSCO, and SciELO using a combination of terms informed by previous reviews on empowerment. Screening of references was performed against predefined inclusion criteria. Data extraction and the methodological quality of included studies using the PEDro (Physiotherapy Evidence Database) scale were performed by 2 authors. The certainty of evidence was graded for the main comparisons and outcomes of the review using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. When at least 3 studies were available within the same domain of empowerment (knowledge, support by others, capacities, and behaviors) and comparison group, a meta-analysis was performed. Results: A total of 30 manuscripts were included in the review. Regarding knowledge, there was very low certainty of evidence of a medium effect size (ES) favoring the digital intervention group (k=5, ES=0.40, 95% CI 0.07-0.73, I2=79%). Regarding capacities, there was low certainty of evidence of no between-group differences (k=5, d=0.13, 95% CI ?0.02 to 0.29, I2=0%) when comparing digital solutions against no intervention, low certainty of evidence of a medium ES favoring the digital intervention group (k=13, d=0.29, 95% CI 0.07-0.52, I2=79%) when comparing digital solutions against usual care, and very low certainty of evidence of no between-group differences (k=4, d=0.97, 95% CI ?0.62 to 2.56, I2=97%) when comparing digital interventions to face-to-face interventions. Regarding social support and behaviors, no meta-analysis was possible, and existing evidence is conflicting. Conclusions: There is very-low-to-low certainty of evidence that using integrated digital solutions results in increased knowledge and increased capacities (mainly self-efficacy) when compared to usual care and impacts capacities to an extent similar to face-to-face interventions at postintervention. Interestingly, results also suggest, with low certainty of evidence, that there are no differences between using digital solutions and no intervention for improving capacities. Included studies and technologies were diverse, and meta-analysis showed high heterogeneity, which limits the confidence in the results and suggests that further research might affect the conclusions of this review. Trial Registration: PROSPERO CRD42022346823; https://tinyurl.com/39k29pzc UR - https://www.jmir.org/2025/1/e54466 UR - http://dx.doi.org/10.2196/54466 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54466 ER - TY - JOUR AU - Chen, Hui-Yu AU - Tu, Ming-Hsiang AU - Chen, Miao-Yen PY - 2025/1/8 TI - Using a Mobile Health App (ColonClean) to Enhance the Effectiveness of Bowel Preparation: Development and Usability Study JO - JMIR Hum Factors SP - e58479 VL - 12 KW - mobile health app KW - bowel preparation KW - nursing guidance KW - technology acceptance model KW - mHealth KW - mobile health N2 - Background: Colonoscopy is the standard diagnostic method for colorectal cancer. Patients usually receive written and verbal instructions for bowel preparation (BP) before the procedure. Failure to understand the importance of BP can lead to inadequate BP in 25%-30% of patients. The quality of BP impacts the success of colonoscopy in diagnostic yield and adenoma detection. We developed the ?ColonClean? mobile health (mHealth) app for Android devices. It incorporates visual representations of dietary guidelines, steps for using bowel cleansing agents, and observations of the last bowel movement. We used the Technology Acceptance Model to investigate whether the use of the ColonClean mHealth app can improve users? attitudes and behaviors toward BP. Objective: This study aims to validate the effectiveness of the ColonClean app in enhancing user behavior and improving BP, providing safe and cost-effective outpatient colonoscopy guidance. Methods: This study uses a structured questionnaire to assess perceived usefulness, perceived ease of use, and users? attitudes and behaviors toward BP regarding the ColonClean mHealth app. A total of 40 outpatients who were physically and mentally healthy and proficient in Chinese were randomly chosen for this study. The data were analyzed using SPSS 25.0, and we used Pearson product-moment correlation and simple regression analysis to predict the perception of ColonClean. Results: The results showed that 75% (30/40) of participants achieved an ?excellent? or ?good? level of BP according to the Aronchick Bowel Preparation Scale. Perceived usefulness and perceived ease of use of the ColonClean mHealth app were positively correlated with users? attitudes and behaviors (P<.05). Conclusions: The ColonClean mHealth app serves as an educational reference and enhances the effectiveness of BP. Users expressed their willingness to use the app again in the future and recommend it to family and friends, highlighting its effectiveness as an educational guide for BP. UR - https://humanfactors.jmir.org/2025/1/e58479 UR - http://dx.doi.org/10.2196/58479 ID - info:doi/10.2196/58479 ER - TY - JOUR AU - Blomqvist, Andreas AU - Bäck, Maria AU - Klompstra, Leonie AU - Strömberg, Anna AU - Jaarsma, Tiny PY - 2025/1/8 TI - Testing the Recruitment Frequency, Implementation Fidelity, and Feasibility of Outcomes of the Heart Failure Activity Coach Study (HEALTHY): Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e62910 VL - 9 KW - heart failure KW - disease management KW - physical activity KW - sedentary KW - older adults KW - aging KW - mobile health KW - mHealth KW - feasibility KW - quality of life KW - digital health KW - smartphone N2 - Background: Heart failure (HF) is a common and deadly disease, precipitated by physical inactivity and sedentary behavior. Although the 1-year survival rate after the first diagnosis is high, physical inactivity and sedentary behavior are associated with increased mortality and negatively impact the health-related quality of life (HR-QoL). Objective: We tested the recruitment frequency, implementation fidelity, and feasibility of outcomes of the Activity Coach app that was developed using an existing mobile health (mHealth) tool, Optilogg, to support older adults with HF to be more physically active and less sedentary. Methods: In this pilot clinical randomized controlled trial (RCT), patients with HF who were already using Optilogg to enhance self-care behavior were recruited from 5 primary care health centers in Sweden. Participants were randomized to either have their mHealth tool updated with the Activity Coach app (intervention group) or a sham version (control group). The intervention duration was 12 weeks, and in weeks 1 and 12, the participants wore an accelerometer daily to objectively measure their physical activity. The HR-QoL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and subjective goal attainment was assessed using goal attainment scaling. Baseline data were collected from the participants? electronic health records (EHRs). Results: We found 67 eligible people using the mHealth tool, of which 30 (45%) initially agreed to participate, with 20 (30%) successfully enrolled and randomized to the control and intervention groups in a ratio of 1:1. The participants? daily adherence to registering physical activity in the Activity Coach app was 69% (range 24%-97%), and their weekly adherence was 88% (range 58%-100%). The mean goal attainment score was ?1.0 (SD 1.1) for the control group versus 0.6 (SD 0.6) for the intervention group (P=.001). The mean change in the overall HR-QoL summary score was ?9 (SD 10) for the control group versus 3 (SD 13) in the intervention group (P=.027). There was a significant difference in the physical limitation scores between the control (mean 45, SD 27) and intervention (mean 71, SD 20) groups (P=.04). The average length of sedentary bouts increased by 27 minutes to 458 (SD 84) in the control group minutes and decreased by 0.70 minutes to 391 (SD 117) in the intervention group (P=.22). There was a nonsignificant increase in the mean light physical activity (LPA): 146 (SD 46) versus 207 (SD 80) minutes in the control and intervention groups, respectively (P=.07). Conclusions: The recruitment rate was lower than anticipated. An active recruitment process is advised if a future efficacy study is to be conducted. Adherence to the Activity Coach app was high, and it may be able to support older adults with HF in being physically active. Trial Registration: ClinicalTrials.gov NCT05235763; https://clinicaltrials.gov/study/NCT05235763 UR - https://formative.jmir.org/2025/1/e62910 UR - http://dx.doi.org/10.2196/62910 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62910 ER - TY - JOUR AU - Hartch, Christa AU - Dietrich, S. Mary AU - Lancaster, Jeanette B. AU - Mulvaney, A. Shelagh AU - Stolldorf, P. Deonni PY - 2025/1/7 TI - Satisfaction and Usability of a Commercially Available Medication Adherence App (Medisafe) Among Medically Underserved Patients With Chronic Illnesses: Survey Study JO - JMIR Hum Factors SP - e63653 VL - 12 KW - medication adherence KW - mHealth KW - mobile phone KW - app KW - medically underserved KW - chronic disease KW - satisfaction KW - usage KW - health disparities N2 - Background: Research supports the use of mobile phone apps to promote medication adherence, but the use of and satisfaction with these apps among medically underserved patients with chronic illnesses remain unclear. Objective: This study reports on the overall use of and satisfaction with a medication adherence app (Medisafe) in a medically underserved population. Methods: Medically underserved adults who received care for one or more chronic illnesses at a federally qualified health center (FQHC) were randomized to an intervention group in a larger randomized controlled trial and used the app for 1 month (n=30), after which they completed a web-based survey. Objective data on app usage were provided as secondary data by the app company. Results: The participants were very satisfied with the app, with all participants (30/30, 100%) somewhat or strongly agreeing that they would recommend the app to family and friends. Participants strongly agreed (28/30, 93%) that the reminders helped them remember to take their medications at the correct time each day, and they (28/30, 93%) found the app easy to use. Additional features accessed by some included educational features and the adherence report. Participants noted the helpfulness of having a medication list on their phones, and some used it during medication reconciliation at doctor visits. Use of the Medfriend feature, which alerts a social support person if a medication is missed, was low (n=2), but those who used it were very positive about the feature. Conclusions: A commercially available medication adherence app was found to be useful by participants, and they were satisfied with the app and the additional features provided. The use of medication adherence mobile phone apps has the potential to positively influence chronic disease management in a medically underserved population on a large scale. Trial Registration: ClinicalTrials.gov NCT05098743; https://clinicaltrials.gov/study/NCT05098743 UR - https://humanfactors.jmir.org/2025/1/e63653 UR - http://dx.doi.org/10.2196/63653 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63653 ER - TY - JOUR AU - Epperson, Neill C. AU - Davis, Rachel AU - Dempsey, Allison AU - Haller, C. Heinrich AU - Kupfer, J. David AU - Love, Tiffany AU - Villarreal, M. Pamela AU - Matthews, Mark AU - Moore, L. Susan AU - Muller, Kimberly AU - Schneck, D. Christopher AU - Scott, L. Jessica AU - Zane, D. Richard AU - Frank, Ellen PY - 2025/1/7 TI - The Trifecta of Industry, Academic, and Health System Partnership to Improve Mental Health Care Through Smartphone-Based Remote Patient Monitoring: Development and Usability Study JO - JMIR Form Res SP - e57624 VL - 9 KW - digital health KW - mobile intervention KW - telepsychiatry KW - artificial intelligence KW - psychiatry KW - mental health KW - depression KW - mood KW - bipolar KW - monitor KW - diagnostic tool KW - diagnosis KW - electronic health record KW - EHR KW - alert KW - notification KW - prediction KW - mHealth KW - mobile health KW - smartphone KW - passive KW - self-reported KW - patient generated N2 - Background: Mental health treatment is hindered by the limited number of mental health care providers and the infrequency of care. Digital mental health technology can help supplement treatment by remotely monitoring patient symptoms and predicting mental health crises in between clinical visits. However, the feasibility of digital mental health technologies has not yet been sufficiently explored. Rhythms, from the company Health Rhythms, is a smartphone platform that uses passively acquired smartphone data with artificial intelligence and predictive analytics to alert patients and providers to an emerging mental health crisis. Objective: The objective of this study was to test the feasibility and acceptability of Rhythms among patients attending an academic psychiatric outpatient clinic. Methods: Our group embedded Rhythms into the electronic health record of a large health system. Patients with a diagnosis of major depressive disorder, bipolar disorder, or other mood disorder were contacted online and enrolled for a 6-week trial of Rhythms. Participants provided data by completing electronic surveys as well as by active and passive use of Rhythms. Emergent and urgent alerts were monitored and managed according to passively collected data and patient self-ratings. A purposively sampled group of participants also participated in qualitative interviews about their experience with Rhythms at the end of the study. Results: Of the 104 participants, 89 (85.6%) completed 6 weeks of monitoring. The majority of the participants were women (72/104, 69.2%), White (84/104, 80.8%), and non-Hispanic (100/104, 96.2%) and had a diagnosis of major depressive disorder (71/104, 68.3%). Two emergent alerts and 19 urgent alerts were received and managed according to protocol over 16 weeks. More than two-thirds (63/87, 72%) of those participating continued to use Rhythms after study completion. Comments from participants indicated appreciation for greater self-awareness and provider connection, while providers reported that Rhythms provided a more nuanced understanding of patient experience between clinical visits. Conclusions: Rhythms is a user-friendly, electronic health record?adaptable, smartphone-based tool that provides patients and providers with a greater understanding of patient mental health status. Integration of Rhythms into health systems has the potential to facilitate mental health care and improve the experience of both patients and providers. UR - https://formative.jmir.org/2025/1/e57624 UR - http://dx.doi.org/10.2196/57624 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57624 ER - TY - JOUR AU - Naranjo-Rojas, Anisbed AU - Perula-de Torres, Ángel Luis AU - Cruz-Mosquera, Eccehomo Freiser AU - Molina-Recio, Guillermo PY - 2025/1/6 TI - Efficacy and Acceptability of a Mobile App for Monitoring the Clinical Status of Patients With Chronic Obstructive Pulmonary Disease Receiving Home Oxygen Therapy: Randomized Controlled Trial JO - J Med Internet Res SP - e65888 VL - 27 KW - m-Health KW - chronic obstructive pulmonary disease KW - quality of life KW - mobile health applications KW - home oxygen therapy KW - mobile phone N2 - Background: Chronic obstructive pulmonary disease (COPD) primarily originates from exposure to tobacco smoke, although factors, such as air pollution and exposure to chemicals, also play a role. One of the primary treatments for COPD is oxygen therapy, which helps manage dyspnea and improve survival rates. Mobile health (mHealth) technologies have demonstrated significant potential in monitoring patients with chronic diseases, offering new avenues for enhancing patient care and disease management. Objective: The purpose of this study was to evaluate the efficacy and acceptability of a mobile app designed for the clinical monitoring of patients with COPD and home oxygen (HO) therapy, compared with conventional monitoring in real-world community settings. Methods: A parallel-group, nonblinded, multicenter randomized controlled trial was conducted with 45 participants; the intervention group (IG), which used the mobile app in addition to conventional monitoring (n=23) and the control group, which received only conventional monitoring (n=22), administered by therapists over a duration of 3 months. The primary outcomes included the chronic obstructive pulmonary disease assessment test (CAT) score, the level of dyspnea measured by the Borg scale, and oxygen saturation percentage, assessed at both the beginning and end of the trial. Secondary outcomes included the frequency of app use, the number of hospitalizations, and survival rates. In addition, a satisfaction survey and an interview were conducted with the IG. Results: The median use of the mobile app was 21 (IQR 16-28) days. At the end of the follow-up, the Borg dyspnea scale was significantly lower in patients who used the mobile app for HO therapy monitoring (mean 0.6, SD 0.8 vs mean 4.1, SD 1.4; P=.001). Regarding the impact of COPD on quality of life, as measured by the CAT, no differences were found in the scores between baseline and end-of-follow-up within the control group. However, a significant decrease was observed in the IG (baseline median CAT 27, IQR 23-31 vs final median CAT 22, IQR 14-28; P<.001). In addition, the CAT score was significantly higher in patients receiving conventional monitoring compared with those monitored with the mobile app (median 30, IQR 23-32 vs median 22, IQR 14-28; P=.02). Conclusions: The use of the mobile app, AppO2 (SINCO), designed for the clinical monitoring of patients with COPD and HO therapy, is associated with improved quality of life. In addition, the app is highly accepted by users, promotes self-care, and fosters patient confidence in managing their own condition. Trial Registration: ClinicalTrials NCT04820790; https://clinicaltrials.gov/study/NCT04820790 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1186/s12875-021-01450-8 UR - https://www.jmir.org/2025/1/e65888 UR - http://dx.doi.org/10.2196/65888 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65888 ER - TY - JOUR AU - Waki, Mari AU - Nakada, Ryohei AU - Waki, Kayo AU - Ban, Yuki AU - Suzuki, Ryo AU - Yamauchi, Toshimasa AU - Nangaku, Masaomi AU - Ohe, Kazuhiko PY - 2025/1/6 TI - Validation of Sleep Measurements of an Actigraphy Watch: Instrument Validation Study JO - JMIR Form Res SP - e63529 VL - 9 KW - actigraphy KW - sleep KW - Motion Watch 8 KW - iAide2 KW - total sleep time N2 - Background: The iAide2 (Tokai) physical activity monitoring system includes diverse measurements and wireless features useful to researchers. The iAide2?s sleep measurement capabilities have not been compared to validated sleep measurement standards in any published work. Objective: We aimed to assess the iAide2?s sleep duration and total sleep time (TST) measurement performance and perform calibration if needed. Methods: We performed free-living sleep monitoring in 6 convenience-sampled participants without known sleep disorders recruited from within the Waki DTx Laboratory at the Graduate School of Medicine, University of Tokyo. To assess free-living sleep, we validated the iAide2 against a second actigraph that was previously validated against polysomnography, the MotionWatch 8 (MW8; CamNtech Ltd). The participants wore both devices on the nondominant arm, with the MW8 closest to the hand, all day except when bathing. The MW8 and iAide2 assessments both used the MW8 EVENT-marker button to record bedtime and risetime. For the MW8, MotionWare Software (version 1.4.20; CamNtech Ltd) provided TST, and we calculated sleep duration from the sleep onset and sleep offset provided by the software. We used a similar process with the iAide2, using iAide2 software (version 7.0). We analyzed 64 nights and evaluated the agreement between the iAide2 and the MW8 for sleep duration and TST based on intraclass correlation coefficients (ICCs). Results: The absolute ICCs (2-way mixed effects, absolute agreement, single measurement) for sleep duration (0.69, 95% CI ?0.07 to 0.91) and TST (0.56, 95% CI ?0.07 to 0.82) were moderate. The consistency ICC (2-way mixed effects, consistency, single measurement) was excellent for sleep duration (0.91, 95% CI 0.86-0.95) and moderate for TST (0.78, 95% CI 0.67-0.86). We determined a simple calibration approach. After calibration, the ICCs improved to 0.96 (95% CI 0.94-0.98) for sleep duration and 0.82 (95% CI 0.71-0.88) for TST. The results were not sensitive to the specific participants included, with an ICC range of 0.96-0.97 for sleep duration and 0.79-0.87 for TST when applying our calibration equation to data removing one participant at a time and 0.96-0.97 for sleep duration and 0.79-0.86 for TST when recalibrating while removing one participant at a time. Conclusions: The measurement errors of the uncalibrated iAide2 for both sleep duration and TST seem too large for them to be useful as absolute measurements, though they could be useful as relative measurements. The measurement errors after calibration are low, and the calibration approach is general and robust, validating the use of iAide2?s sleep measurement functions alongside its other features in physical activity research. UR - https://formative.jmir.org/2025/1/e63529 UR - http://dx.doi.org/10.2196/63529 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63529 ER - TY - JOUR AU - Bae, Won Sang AU - Chung, Tammy AU - Zhang, Tongze AU - Dey, K. Anind AU - Islam, Rahul PY - 2025/1/2 TI - Enhancing Interpretable, Transparent, and Unobtrusive Detection of Acute Marijuana Intoxication in Natural Environments: Harnessing Smart Devices and Explainable AI to Empower Just-In-Time Adaptive Interventions: Longitudinal Observational Study JO - JMIR AI SP - e52270 VL - 4 KW - digital phenotyping KW - smart devices KW - intoxication KW - smartphone-based sensors KW - wearables KW - mHealth KW - marijuana KW - cannabis KW - data collection KW - passive sensing KW - Fitbit KW - machine learning KW - eXtreme Gradient Boosting Machine classifier KW - XGBoost KW - algorithmic decision-making process KW - explainable artificial intelligence KW - XAI KW - artificial intelligence KW - JITAI KW - decision support KW - just-in-time adaptive interventions KW - experience sampling N2 - Background: Acute marijuana intoxication can impair motor skills and cognitive functions such as attention and information processing. However, traditional tests, like blood, urine, and saliva, fail to accurately detect acute marijuana intoxication in real time. Objective: This study aims to explore whether integrating smartphone-based sensors with readily accessible wearable activity trackers, like Fitbit, can enhance the detection of acute marijuana intoxication in naturalistic settings. No previous research has investigated the effectiveness of passive sensing technologies for enhancing algorithm accuracy or enhancing the interpretability of digital phenotyping through explainable artificial intelligence in real-life scenarios. This approach aims to provide insights into how individuals interact with digital devices during algorithmic decision-making, particularly for detecting moderate to intensive marijuana intoxication in real-world contexts. Methods: Sensor data from smartphones and Fitbits, along with self-reported marijuana use, were collected from 33 young adults over a 30-day period using the experience sampling method. Participants rated their level of intoxication on a scale from 1 to 10 within 15 minutes of consuming marijuana and during 3 daily semirandom prompts. The ratings were categorized as not intoxicated (0), low (1-3), and moderate to intense intoxication (4-10). The study analyzed the performance of models using mobile phone data only, Fitbit data only, and a combination of both (MobiFit) in detecting acute marijuana intoxication. Results: The eXtreme Gradient Boosting Machine classifier showed that the MobiFit model, which combines mobile phone and wearable device data, achieved 99% accuracy (area under the curve=0.99; F1-score=0.85) in detecting acute marijuana intoxication in natural environments. The F1-score indicated significant improvements in sensitivity and specificity for the combined MobiFit model compared to using mobile or Fitbit data alone. Explainable artificial intelligence revealed that moderate to intense self-reported marijuana intoxication was associated with specific smartphone and Fitbit metrics, including elevated minimum heart rate, reduced macromovement, and increased noise energy around participants. Conclusions: This study demonstrates the potential of using smartphone sensors and wearable devices for interpretable, transparent, and unobtrusive monitoring of acute marijuana intoxication in daily life. Advanced algorithmic decision-making provides valuable insight into behavioral, physiological, and environmental factors that could support timely interventions to reduce marijuana-related harm. Future real-world applications of these algorithms should be evaluated in collaboration with clinical experts to enhance their practicality and effectiveness. UR - https://ai.jmir.org/2025/1/e52270 UR - http://dx.doi.org/10.2196/52270 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52270 ER - TY - JOUR AU - Boulton, Ann Kelsie AU - Hilton, Makana AU - Sutton, Emilia AU - Guastella, John Adam PY - 2025/1/1 TI - Apps and Digital Resources for Child Neurodevelopment, Mental Health, and Well-Being: Review, Evaluation, and Reflection on Current Resources JO - J Med Internet Res SP - e58693 VL - 27 KW - digital tools KW - neurodevelopmental conditions KW - mental health KW - digital health KW - implementation KW - digital interventions KW - child neurodevelopment KW - digital technology KW - mobile phone N2 - Background: An increase in the prevalence of neurodevelopmental conditions worldwide, alongside resource constraints within clinical services, has led to increased interest in health information technologies, such as apps and digital resources. Digital tools are often viewed as a solution to bridge this divide and to increase supports for families. There is, however, a paucity of research that has evaluated digital health tools, their potential benefits for child neurodevelopment and associated concerns (eg, mental health, well-being), and their benefit for families. Objective: This study conducted the first review of existing mobile apps and digital resources targeted at supporting the needs of children with developmental concerns or neurodevelopmental conditions. Methods: We identified 3435 separate resources, of which 112 (43 apps and 69 digital resources) met the criteria. These resources were categorized according to their purpose or target and were then reviewed based on their engagement, information quality, and evidence base using the Adapted Mobile App Rating Scale. Results: The most common condition of concern targeted by apps and digital resources was autism (19/112, 17% resources), with retrieved resources focusing on supporting challenging behaviors, promoting speech, language, and social development, and providing options for alternative and assistive communication. Other common areas of concern targeted by apps and digital resources included language and communication (16/112, 14.3%) and attention-deficit/hyperactivity disorder (11/112, 9.8%). Results showed that reviewed resources were engaging, with high levels of accessibility and functionality. Resources had various functions, including developmental or behavioral tasks targeted at children, assistive communication support, scheduling support, journaling, and advice, activities, and strategies for parents. The information quality of resources, such as credibility of source and evidence base was, however, mostly low. Apps and digital resources with good credibility and an existing evidence base were largely developed in partnership with research, health, or government institutions, and were rated significantly higher on overall quality compared with apps and digital resources not developed in partnership with such institutions (apps; t41=?4.35, P<.001; digital resources; t67=?4.95, P<.001). Conclusions: The lack of evidence base across resources means that it is extremely difficult to provide recommendations to families with respect to apps or digital resources that may support their needs. Frameworks for the development of new tools are discussed, highlighting the novel approaches required to demonstrate the efficacy of tools for improving outcomes for children and families. Such a framework requires collaboration with multiple stakeholders (software developers, researchers, regulatory bodies, clinicians, children, and families) and engagement across multiple levels of expertise (app development, implementation, and dissemination within services, policy, and clinical regulations), to harness the potential of digital health for improving outcomes and promoting support in child neurodevelopment, which at this juncture remains largely underdeveloped. UR - https://www.jmir.org/2025/1/e58693 UR - http://dx.doi.org/10.2196/58693 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58693 ER - TY - JOUR AU - Hodgson, William AU - Kirk, Alison AU - Lennon, Marilyn AU - Janssen, Xanne PY - 2024/12/30 TI - Exploring the Use of Activity Trackers to Support Physical Activity and Reduce Sedentary Behavior in Adults Diagnosed With Type 2 Diabetes: Qualitative Interview Study Using the RE-AIM Framework JO - JMIR Diabetes SP - e60066 VL - 9 KW - type 2 diabetes KW - physical activity KW - sedentary behavior KW - Fitbit KW - activity tracker KW - My Diabetes My Way KW - RE-AIM framework KW - diabetes care KW - clinical care KW - thematic analysis KW - health promotion N2 - Background: The prevalence of type 2 diabetes in adults worldwide is increasing. Low levels of physical activity and sedentary behavior are major risk factors for developing the disease. Physical activity interventions incorporating activity trackers can reduce blood glucose levels in adults diagnosed with type 2 diabetes. The My Diabetes My Way website is a support and educational platform for people diagnosed with diabetes and health care professionals. Users of the My Diabetes My Way website can upload their Fitbit (Google Inc) activity data into the system but this is not presently being analyzed and used routinely within clinical care. Developers of the My Diabetes My Way system are planning to allow different makes of activity trackers to be integrated with the platform. Objective: This qualitative study aimed to explore (through the RE-AIM [reach, effectiveness, adoption, implementation, and maintenance] framework) views from adults diagnosed with type 2 diabetes and health care professionals on the integration of activity trackers into type 2 diabetes care. Methods: Overall, 12 adults diagnosed with type 2 diabetes and 9 health care professionals (4 general practitioners, 1 consultant, 2 diabetes nurses, 1 practice nurse, and 1 physical activity advisor) were recruited through social media and professional contacts. Semistructured one-to-one interviews were conducted. Abductive thematic analysis was undertaken, and main themes and subthemes were identified. The RE-AIM framework was used to evaluate the themes with respect to the wider use of activity trackers and the My Diabetes My Way platform within type 2 diabetes clinical care. Results: Overall, 6 main themes (awareness, access, cost, promotion, support, and technology and data) and 20 subthemes were identified. Evaluation using the 5 RE-AIM dimensions found that reach could be improved by raising awareness of the My Diabetes My Way platform and the ability to upload activity tracker data into the system. Effectiveness could be improved by implementing appropriate personalized measures of health benefits and providing appropriate support for patients and health care staff. Adoption could be improved by better promotion of the intervention among stakeholders and the development of joint procedures. Implementation could be improved through the development of an agreed protocol, staff training, and introducing measurements of costs. Maintenance could be improved by supporting all patients for long-term engagement and measuring improvements to patients? health. Conclusions: Through this study, we identified how the reach, effectiveness, adoption, implementation, and maintenance of integrating activity trackers into adult type 2 diabetes care could be improved. UR - https://diabetes.jmir.org/2024/1/e60066 UR - http://dx.doi.org/10.2196/60066 ID - info:doi/10.2196/60066 ER - TY - JOUR AU - Leijse, L. Merel M. AU - van Dam, Levi AU - Jambroes, Tijs AU - Timmerman, Amber AU - Popma, Arne PY - 2024/12/30 TI - Using Active and Passive Smartphone Data to Enhance Adolescents? Emotional Awareness in Forensic Outpatient Setting: A Qualitative Feasibility and Usability Study JO - JMIR Form Res SP - e53613 VL - 8 KW - emotion regulation KW - emotion awareness KW - smartphone data KW - forensic outpatient youth care KW - treatment motivation KW - treatment alliance KW - emotion KW - behavioral KW - interview KW - mHealth KW - app KW - forensic KW - usability KW - feasibility KW - delinquent KW - pediatrics KW - youth KW - adolescent KW - teenager KW - experience KW - attitude KW - opinion KW - perception KW - perspective KW - acceptance KW - emoji KW - behavioral data KW - mobile phone N2 - Background: Delinquent behavior in adolescence is a prevalent issue, often associated with difficulties across multiple life domains, which in turn perpetuates negative life outcomes. While current treatment programs show partial success in improving behavioral changes and reducing recidivism, comprehensive conclusions regarding the overall efficacy of these interventions have yet to be established. In forensic outpatient settings, the discrepancy between adolescents? limited emotional awareness and the predominant emphasis on cognitive reflection, combined with low treatment adherence, may be factors that undermine treatment efficacy. New technologies, such as smartphone apps, may offer a solution by integrating real-life data into treatment to improve emotional and behavioral patterns. The low-threshold use of smartphone data can be useful in addressing these treatment challenges. Objective: This study aimed to explore the feasibility and usability of Feelee (Garage2020), a smartphone app that integrates active emoji and passive behavioral data, as a potential addition to treatment for adolescents in a forensic outpatient setting. Methods: We conducted a prepilot study with adolescents (n=4) who used the Feelee app over a 2-week period. App usage included completing a brief emoji survey 3 times a day (active data) and allowing Feelee to track the call logs, Bluetooth devices in proximity, cell tower IDs, app usage, and phone status (passive data). During treatment sessions, both adolescents and clinicians reviewed and discussed the active and passive data. Semistructured interviews were conducted with adolescents and clinicians (n=7) to gather experiences and feedback on the feasibility and usability of incorporating smartphone data into treatment. Results: The study showed that adolescents (n=3) succeeded in using Feelee for the full 2 weeks, and data were available for discussion in at least 1 session per participant. Both adolescents and clinicians (n=7) stated that Feelee was valuable for viewing, discussing, and gaining insight into their emotions, which facilitated targeted actions based on the Feelee data. However, neither adolescents nor clinicians reported increased engagement in treatment as a result of using Feelee. Despite technical issues, overall feedback on the Feelee app, in addition to treatment, was positive (n=7). However, further improvements are needed to address the high battery consumption and the inaccuracies in the accelerometer. Conclusions: This qualitative study provides an in-depth understanding of the potential benefits of integrating active and passive smartphone data for adolescents in a forensic outpatient setting. Feelee appears to contribute to a better understanding of emotions and behaviors, suggesting its potential value in enhancing emotional awareness in treatment. Further research is needed to assess Feelee?s clinical effectiveness and explore how it enhances emotional awareness. Recommendations from adolescents and clinicians emphasize the need for prepilot studies to address user issues, guiding technical improvements and future research in forensic outpatient settings. UR - https://formative.jmir.org/2024/1/e53613 UR - http://dx.doi.org/10.2196/53613 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53613 ER - TY - JOUR AU - Abdelaal, Yasmin AU - Aupetit, Michaël AU - Baggag, Abdelkader AU - Al-Thani, Dena PY - 2024/12/24 TI - Exploring the Applications of Explainability in Wearable Data Analytics: Systematic Literature Review JO - J Med Internet Res SP - e53863 VL - 26 KW - explainable artificial intelligence KW - XAI KW - wearable KW - machine learning KW - deep learning KW - health informatics KW - wearable sensors KW - user experience KW - wearable data KW - analytics KW - interpretation N2 - Background: Wearable technologies have become increasingly prominent in health care. However, intricate machine learning and deep learning algorithms often lead to the development of ?black box? models, which lack transparency and comprehensibility for medical professionals and end users. In this context, the integration of explainable artificial intelligence (XAI) has emerged as a crucial solution. By providing insights into the inner workings of complex algorithms, XAI aims to foster trust and empower stakeholders to use wearable technologies responsibly. Objective: This paper aims to review the recent literature and explore the application of explainability in wearables. By examining how XAI can enhance the interpretability of generated data and models, this review sought to shed light on the possibilities that arise at the intersection of wearable technologies and XAI. Methods: We collected publications from ACM Digital Library, IEEE Xplore, PubMed, SpringerLink, JMIR, Nature, and Scopus. The eligible studies included technology-based research involving wearable devices, sensors, or mobile phones focused on explainability, machine learning, or deep learning and that used quantified self data in medical contexts. Only peer-reviewed articles, proceedings, or book chapters published in English between 2018 and 2022 were considered. We excluded duplicates, reviews, books, workshops, courses, tutorials, and talks. We analyzed 25 research papers to gain insights into the current state of explainability in wearables in the health care context. Results: Our findings revealed that wrist-worn wearables such as Fitbit and Empatica E4 are prevalent in health care applications. However, more emphasis must be placed on making the data generated by these devices explainable. Among various explainability methods, post hoc approaches stand out, with Shapley Additive Explanations as a prominent choice due to its adaptability. The outputs of explainability methods are commonly presented visually, often in the form of graphs or user-friendly reports. Nevertheless, our review highlights a limitation in user evaluation and underscores the importance of involving users in the development process. Conclusions: The integration of XAI into wearable health care technologies is crucial to address the issue of black box models. While wrist-worn wearables are widespread, there is a notable gap in making the data they generate explainable. Post hoc methods such as Shapley Additive Explanations have gained traction for their adaptability in explaining complex algorithms visually. However, user evaluation remains an area in which improvement is needed, and involving users in the development process can contribute to more transparent and reliable artificial intelligence models in health care applications. Further research in this area is essential to enhance the transparency and trustworthiness of artificial intelligence models used in wearable health care technology. UR - https://www.jmir.org/2024/1/e53863 UR - http://dx.doi.org/10.2196/53863 UR - http://www.ncbi.nlm.nih.gov/pubmed/39718820 ID - info:doi/10.2196/53863 ER - TY - JOUR AU - Ruggiano, Nicole AU - Brown, Leslie Ellen AU - Clarke, J. Peter AU - Hristidis, Vagelis AU - Roberts, Lisa AU - Framil Suarez, Victoria Carmen AU - Allala, Chaithra Sai AU - Hurley, Shannon AU - Kopcsik, Chrystine AU - Daquin, Jane AU - Chevez, Hamilton AU - Chang-Lau, Raymond AU - Agronin, Marc AU - Geldmacher, S. David PY - 2024/12/23 TI - An Evidence-Based IT Program With Chatbot to Support Caregiving and Clinical Care for People With Dementia: The CareHeroes Development and Usability Pilot JO - JMIR Aging SP - e57308 VL - 7 KW - Alzheimer disease KW - artificial intelligence KW - caregivers KW - chatbot KW - dementia KW - mobile applications KW - conversational agent KW - design KW - apps N2 - Background: There are numerous communication barriers between family caregivers and providers of people living with dementia, which can pose challenges to caregiving and clinical decision-making. To address these barriers, a new web and mobile-enabled app, called CareHeroes, was developed, which promotes the collection and secured sharing of clinical information between caregivers and providers. It also provides caregiver support and education. Objective: The primary study objective was to examine whether dementia caregivers would use CareHeroes as an adjunct to care and gather psychosocial data from those who used the app. Methods: This paper presents the implementation process used to integrate CareHeroes into clinical care at 2 memory clinics and preliminary outcome evaluation. Family caregivers receiving services at clinics were asked to use the app for a 12-month period to collect, track, and share clinical information with the care recipient?s provider. They also used it to assess their own mental health symptoms. Psychosocial outcomes were assessed through telephone interviews and user data were collected by the app. Results: A total of 21 caregivers enrolled in the pilot study across the 2 memory clinics. Usage data indicated that caregivers used many of the features in the CareHeroes app, though the chatbot was the most frequently used feature. Outcome data indicated that caregivers? depression was lower at 3-month follow-up (t11=2.03, P=.03). Conclusions: Recruitment and retention of the pilot study were impacted by COVID-19 restrictions, and therefore more testing is needed with a larger sample to determine the potential impact of CareHeroes on caregivers? mental health. Despite this limitation, the pilot study demonstrated that integrating a new supportive app for caregivers as an adjunct to clinical dementia care is feasible. Implications for future technology intervention development, implementation planning, and testing for caregivers of people living with dementia are discussed. UR - https://aging.jmir.org/2024/1/e57308 UR - http://dx.doi.org/10.2196/57308 ID - info:doi/10.2196/57308 ER - TY - JOUR AU - Benouis, Mohamed AU - Andre, Elisabeth AU - Can, Said Yekta PY - 2024/12/23 TI - Balancing Between Privacy and Utility for Affect Recognition Using Multitask Learning in Differential Privacy?Added Federated Learning Settings: Quantitative Study JO - JMIR Ment Health SP - e60003 VL - 11 KW - privacy preservation KW - multitask learning KW - federated learning KW - privacy KW - physiological signals KW - affective computing KW - wearable sensors KW - sensitive data KW - empathetic sensors KW - data privacy KW - digital mental health KW - wearables KW - ethics KW - emotional well-being N2 - Background: The rise of wearable sensors marks a significant development in the era of affective computing. Their popularity is continuously increasing, and they have the potential to improve our understanding of human stress. A fundamental aspect within this domain is the ability to recognize perceived stress through these unobtrusive devices. Objective: This study aims to enhance the performance of emotion recognition using multitask learning (MTL), a technique extensively explored across various machine learning tasks, including affective computing. By leveraging the shared information among related tasks, we seek to augment the accuracy of emotion recognition while confronting the privacy threats inherent in the physiological data captured by these sensors. Methods: To address the privacy concerns associated with the sensitive data collected by wearable sensors, we proposed a novel framework that integrates differential privacy and federated learning approaches with MTL. This framework was designed to efficiently identify mental stress while preserving private identity information. Through this approach, we aimed to enhance the performance of emotion recognition tasks while preserving user privacy. Results: Comprehensive evaluations of our framework were conducted using 2 prominent public datasets. The results demonstrate a significant improvement in emotion recognition accuracy, achieving a rate of 90%. Furthermore, our approach effectively mitigates privacy risks, as evidenced by limiting reidentification accuracies to 47%. Conclusions: This study presents a promising approach to advancing emotion recognition capabilities while addressing privacy concerns in the context of empathetic sensors. By integrating MTL with differential privacy and federated learning, we have demonstrated the potential to achieve high levels of accuracy in emotion recognition while ensuring the protection of user privacy. This research contributes to the ongoing efforts to use affective computing in a privacy-aware and ethical manner. UR - https://mental.jmir.org/2024/1/e60003 UR - http://dx.doi.org/10.2196/60003 ID - info:doi/10.2196/60003 ER - TY - JOUR AU - Loh, Yi Pei AU - Martinengo, Laura AU - Heaukulani, Creighton AU - Tan, Yang Xin AU - Hng, Moses AU - Cheah, Yin Yong AU - Morris, T. Robert J. AU - Tudor Car, Lorainne AU - Lee, Jimmy PY - 2024/12/23 TI - Characteristics and Outcomes of mHealth Interventions in Psychosis: Systematic Mapping Review JO - J Med Internet Res SP - e55924 VL - 26 KW - mHealth KW - digital health KW - mobile applications KW - psychosis KW - schizophrenia KW - schizophrenia spectrum KW - psychotic disorders KW - mapping review N2 - Background: Mobile health (mHealth) interventions have gained popularity in augmenting psychiatric care for adults with psychosis. Interest has grown in leveraging mHealth to empower individuals living with severe mental illness and extend continuity of care beyond the hospital to the community. However, reported outcomes have been mixed, likely attributed in part to the intervention and adopted outcomes, which affected between-study comparisons. Objective: This study aimed to critically review outcome measures used to evaluate mHealth interventions for adults with psychosis in relation to the characteristics of mHealth interventions. Methods: A systematic mapping review was conducted. We searched PubMed, CINAHL, Embase, PsycINFO, and Cochrane Libraries from 1973 to the present. Selection criteria included randomized controlled studies of mHealth interventions in adults diagnosed with schizophrenia spectrum disorders. Reviewers worked in pairs to screen and extract data from included studies independently using a standardized form; disagreements were resolved by consensus with an independent reviewer. We report our findings in line with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: A total of 1703 citations were screened; 29 publications reporting on 23 studies were included in this review. mHealth interventions for psychosis span a wide range, with psychological therapy being the most-deployed intervention (12/23, 52%), followed by psychoeducation (8/23, 35%) and active self-monitoring (8/23, 35%). Several mHealth interventions for psychosis targeted multiple pillars of biopsychosocial well-being (10/23, 43%); the bulk of interventions (16/23, 70%) incorporated features promoting users? self-management. The majority of mHealth interventions were delivered through applications (14/23, 61%) as the main medium and smartphones (17/23, 74%) as the main channel of delivery. Interventions were primarily administered in the outpatient and community settings (16/23, 70%); many were also blended with in-person sessions (11/23, 48%) or guided remotely (6/23, 26%) by persons, including health care providers or trained peer supporters. The severity of psychosis-related symptoms (21/23, 91%) was the most prevalent outcome, of which positive symptoms (13/23, 57%), mood and anxiety (10/23, 43%), and overall psychopathology severity (9/23, 39%) were most commonly measured. Patient-centric outcomes, including well-being (17/23, 74%)?particularly quality of life (10/23, 43%)?and user experience (15/23, 65%), including feasibility (7/23, 30%), acceptability (7/23, 30%), and engagement (7/23, 26%). Notably, outcome choices remained diverse despite stratification by type of mHealth intervention. Conclusions: mHealth interventions for psychosis encompass a wide range of modalities and use outcome measures that probe various social and behavioral determinants of health. These should be considered complex interventions, and a holistic evaluation approach combining clinical and patient-centric outcomes is recommended. UR - https://www.jmir.org/2024/1/e55924 UR - http://dx.doi.org/10.2196/55924 UR - http://www.ncbi.nlm.nih.gov/pubmed/39714907 ID - info:doi/10.2196/55924 ER - TY - JOUR AU - Karoulla, Eirini AU - Matsangidou, Maria AU - Frangoudes, Fotos AU - Paspalides, Panayiotis AU - Neokleous, Kleanthis AU - Pattichis, S. Constantinos PY - 2024/12/23 TI - Tracking Upper Limb Motion via Wearable Solutions: Systematic Review of Research From 2011 to 2023 JO - J Med Internet Res SP - e51994 VL - 26 KW - motion tracking KW - motion sensing KW - posture monitoring KW - wearable devices KW - upper limb rehabilitation KW - interactive feedback KW - real-time feedback KW - wearble technology KW - upper limb motion N2 - Background: The development of wearable solutions for tracking upper limb motion has gained research interest over the past decade. This paper provides a systematic review of related research on the type, feasibility, signal processing techniques, and feedback of wearable systems for tracking upper limb motion, mostly in rehabilitation applications, to understand and monitor human movement. Objective: The aim of this article is to investigate how wearables are used to capture upper limb functions, especially related to clinical and rehabilitation applications. Methods: A systematic literature search identified 27 relevant studies published in English from 2011 to 2023, across 4 databases: ACM Digital Library, IEEE Xplore, PubMed, and ScienceDirect. We included papers focusing on motion or posture tracking for the upper limbs, wearable devices, feedback given to end users, and systems having clinical or rehabilitation purposes. We excluded papers focusing on exoskeletons, robotics, prosthetics, orthoses, or activity recognition systems; reviews; and books. Results: The results from this research focus on wearable devices that are designed to monitor upper limb movement. More specifically, studies were divided into 2 distinct categories: clinical motion tracking (15/27, 56%) and rehabilitation (12/27, 44%), involving healthy individuals and patients, with a total of 439 participants. Among the 27 studies, the majority (19/27) used inertial measurement units to track upper limb movement or smart textiles embedded with sensors. These devices were attached to the body with straps (mostly Velcro), providing flexibility and stability. The developed wearable devices positively influenced user motivation through the provided feedback, with visual feedback being the most common owing to the high level of independence provided. Moreover, a variety of signal processing techniques, such as Kalman and Butterworth filters, were applied to ensure data accuracy. However, limitations persist and include sensor positioning, calibration, and battery life, as well as a lack of clinical data on the effectiveness of these systems. The sampling rate of the data collection ranged from 50 Hz to 2000 Hz, which notably affected data quality and battery life. In addition, several findings were inconclusive, and thus, further future research is needed to understand and improve upper limb posture to develop progressive wearable systems. Conclusions: This paper offers a comprehensive overview of wearable monitoring systems, with a focus on upper limb motion tracking and rehabilitation. It emphasizes the various types of available solutions; their efficacy, wearability, and feasibility; and proposed processing techniques. Finally, it presents robust findings regarding feedback accuracy derived from experiments and outlines potential future research directions. UR - https://www.jmir.org/2024/1/e51994 UR - http://dx.doi.org/10.2196/51994 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51994 ER - TY - JOUR AU - Mi, Z. Ranran AU - Yang, Fan Ellie AU - Tahk, Alexander AU - Tarfa, Adati AU - Cotter, M. Lynne AU - Lu, Linqi AU - Yang, Sijia AU - Gustafson Sr, H. David AU - Westergaard, Ryan AU - Shah, Dhavan PY - 2024/12/20 TI - mHealth Engagement for Antiretroviral Medication Adherence Among People With HIV and Substance Use Disorders: Observational Study JO - J Med Internet Res SP - e57774 VL - 26 KW - information and communication technologies KW - ICTs KW - mHealth KW - medication adherence KW - HIV care KW - antiretroviral therapy KW - substance use KW - social support KW - patient management KW - health disparities KW - information technology KW - communication technology KW - mobile health KW - app KW - clinic KW - United States KW - participants KW - mobile phone N2 - Background: Despite the increasing popularity of mobile health (mHealth) technologies, little is known about which types of mHealth system engagement might affect the maintenance of antiretroviral therapy among people with HIV and substance use disorders. Objective: This study aimed to use longitudinal and detailed system logs and weekly survey data to test a mediation model, where mHealth engagement indicators were treated as predictors, substance use and confidence in HIV management were treated as joint mediators, and antiretroviral therapy adherence was treated as the outcome. We further distinguished the initiation and intensity of system engagement by mode (expression vs reception) and by communication levels (intraindividual vs dyadic vs network). Methods: Tailored for people with HIV living with substance use disorders, the mHealth app was distributed among 208 participants aged >18 years from 2 US health clinics. Supervised by medical professionals, participants received weekly surveys through the app to report their health status and medication adherence data. System use was passively collected through the app, operationalized as transformed click-level data, aggregated weekly, and connected to survey responses with a 7-day lagged window. Using the weekly check-in record provided by participants as the unit of analysis (N=681), linear regression and structure equation models with cluster-robust SEs were used for analyses, controlling within-person autocorrelation and group-level error correlations. Racial groups were examined as moderators in the structure equation models. Results: We found that (1) intensity, not initiation, of system use; (2) dyadic message expression and reception; and (3) network expression positively predicted medication adherence through joint mediators (substance use and confidence in HIV management). However, intraindividual reception (ie, rereading saved entries for personal motivation) negatively predicts medication adherence through joint mediators. We also found Black participants have distinct usage patterns, suggesting the need to tailor mHealth interventions for this subgroup. Conclusions: These findings highlight the importance of considering the intensity of system engagement, rather than initiation alone, when designing mHealth interventions for people with HIV and tailoring these systems to Black communities. UR - https://www.jmir.org/2024/1/e57774 UR - http://dx.doi.org/10.2196/57774 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57774 ER - TY - JOUR AU - Normann, J. Amber AU - Mo, C. Clifton AU - Wilson, L. Rebekah AU - Perez, Michelle AU - Cutler, Corey AU - Uno, Hajime AU - Thompson, V. LaDora AU - Skinner, L. Tina AU - Richardson, G. Paul AU - Marinac, R. Catherine AU - Dieli-Conwright, M. Christina PY - 2024/12/19 TI - Prehabilitation Exercise Training to Target Improved Muscle Strength in Pretransplant Patients Diagnosed With Multiple Myeloma: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e64905 VL - 13 KW - multiple myeloma KW - stem cell transplantation KW - exercise training KW - aerobic exercise KW - resistance exercise KW - preoperative exercise KW - muscle strength KW - physical fitness N2 - Background: Muscle mass and strength are severely compromised in patients diagnosed with multiple myeloma, such that the risk of poor overall survival increases as the prevalence of low muscle mass, also known as sarcopenia, increases. Additionally, at the time of autologous stem cell transplant (ASCT), 51% of patients experience low muscle mass and strength, which can prolong hospitalization and lead to increased risk of obesity, insulin resistance, lowered physical function, and poor quality of life. Objective: The PROTECT (Prehabilitation Exercise Training in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation) trial will examine the preliminary effects of digitally supervised prehabilitative aerobic and resistance exercise on muscle strength in patients with multiple myeloma scheduled for ASCT. Methods: This prospective, 2-armed single-center randomized controlled trial will recruit 30 patients with multiple myeloma, aged 18 years and older, planning to receive ASCT. Individuals will be assigned to either the exercise or the waitlist control group. The 8-week exercise intervention is home-based and digitally supervised by a clinical exercise trainer. The frequency of the exercise intervention is 3 times per week consisting of aerobic exercise on a cycle ergometer and resistance exercises, which are individually tailored based on patient health status. The waitlist control group maintains normal daily activities of living and is offered the intervention within 6 months from ASCT. The primary outcome is lower limb muscle strength, measured using the 10-repetition maximum leg press or extensor strength. Additional outcomes include physical and cardiorespiratory function, patient-reported outcomes, cardiometabolic health outcomes, and clinical outcomes. Results: The trial was funded in the fall of 2022 and recruitment began in June 2023. As of August 2024, a total of 3 participants have consented and been randomized (n=1, exercise group; n=2, waitlist control group). Trial completion and start of data analysis is expected in July 2025 with expected results to be published in early winter of 2026. Conclusions: We expect exercise to improve lower limb muscle strength and overall health outcomes compared to the waitlist control group. Results will contribute foundational knowledge needed to conduct larger-phase clinical trials testing the clinical benefits of prehabilitation exercise in this patient population. This study will provide insight into a prehabilitative exercise intervention designed to support patient prognosis. Trial Registration: ClinicalTrials.gov NCT05706766; https://clinicaltrials.gov/study/NCT05706766 International Registered Report Identifier (IRRID): DERR1-10.2196/64905 UR - https://www.researchprotocols.org/2024/1/e64905 UR - http://dx.doi.org/10.2196/64905 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64905 ER - TY - JOUR AU - Lopez-Alcalde, Jesus AU - Wieland, Susan L. AU - Yan, Yuqian AU - Barth, Jürgen AU - Khami, Reza Mohammad AU - Shivalli, Siddharudha AU - Lokker, Cynthia AU - Rai, Kaur Harleen AU - Macharia, Paul AU - Yun, Sergi AU - Lang, Elvira AU - Bwanika Naggirinya, Agnes AU - Campos-Asensio, Concepción AU - Ahmadian, Leila AU - Witt, M. Claudia PY - 2024/12/19 TI - Methodological Challenges in Randomized Controlled Trials of mHealth Interventions: Cross-Sectional Survey Study and Consensus-Based Recommendations JO - J Med Internet Res SP - e53187 VL - 26 KW - digital health KW - eHealth KW - mobile health KW - mHealth KW - randomized controlled trial KW - survey KW - recommendations KW - intervention integrity KW - adherence KW - consensus KW - mobile phone N2 - Background: Mobile health (mHealth) refers to using mobile communication devices such as smartphones to support health, health care, and public health. mHealth interventions have their own nature and characteristics that distinguish them from traditional health care interventions, including drug interventions. Thus, randomized controlled trials (RCTs) of mHealth interventions present specific methodological challenges. Identifying and overcoming those challenges is essential to determine whether mHealth interventions improve health outcomes. Objective: We aimed to identify specific methodological challenges in RCTs testing mHealth interventions? effects and develop consensus-based recommendations to address selected challenges. Methods: A 2-phase participatory research project was conducted. First, we sent a web-based survey to authors of mHealth RCTs. Survey respondents rated on a 5-point scale how challenging they found 21 methodological aspects in mHealth RCTs compared to non-mHealth RCTs. Nonsystematic searches until June 2022 informed the selection of the methodological challenges listed in the survey. Second, a subset of survey respondents participated in an online workshop to discuss recommendations to address selected methodological aspects identified in the survey. Finally, consensus-based recommendations were developed based on the workshop discussion and email interaction. Results: We contacted 1535 authors of mHealth intervention RCTs, of whom 80 (5.21%) completed the survey. Most respondents (74/80, 92%) identified at least one methodological aspect as more or much more challenging in mHealth RCTs. The aspects most frequently reported as more or much more challenging were those related to mHealth intervention integrity, that is, the degree to which the study intervention was implemented as intended, in particular managing low adherence to the mHealth intervention (43/77, 56%), defining adherence (39/79, 49%), measuring adherence (33/78, 42%), and determining which mHealth intervention components are used or received by the participant (31/75, 41%). Other challenges were also frequent, such as analyzing passive data (eg, data collected from smartphone sensors; 24/58, 41%) and verifying the participants? identity during recruitment (28/68, 41%). In total, 11 survey respondents participated in the subsequent workshop (n=8, 73% had been involved in at least 2 mHealth RCTs). We developed 17 consensus-based recommendations related to the following four categories: (1) how to measure adherence to the mHealth intervention (7 recommendations), (2) defining adequate adherence (2 recommendations), (3) dealing with low adherence rates (3 recommendations), and (4) addressing mHealth intervention components (5 recommendations). Conclusions: RCTs of mHealth interventions have specific methodological challenges compared to those of non-mHealth interventions, particularly those related to intervention integrity. Following our recommendations for addressing these challenges can lead to more reliable assessments of the effects of mHealth interventions on health outcomes. UR - https://www.jmir.org/2024/1/e53187 UR - http://dx.doi.org/10.2196/53187 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53187 ER - TY - JOUR AU - Kidman, G. Patrick AU - Curtis, G. Rachel AU - Watson, Amanda AU - Maher, A. Carol PY - 2024/12/18 TI - When and Why Adults Abandon Lifestyle Behavior and Mental Health Mobile Apps: Scoping Review JO - J Med Internet Res SP - e56897 VL - 26 KW - mobile health apps KW - smartphone applications KW - app abandonment KW - app attrition KW - user engagement KW - health behavior KW - user retention KW - lifestyle management KW - quantitative analysis KW - qualitative analysis KW - mobile phone N2 - Background: With 1 in 3 adults globally living with chronic conditions and the rise in smartphone ownership, mobile health apps have become a prominent tool for managing lifestyle-related health behaviors and mental health. However, high rates of app abandonment pose challenges to their effectiveness. Objective: We explored the abandonment of apps used for managing physical activity, diet, alcohol, smoking, and mental health in free-living conditions, examining the duration of app use before abandonment and the underlying reasons. Methods: A scoping review was conducted based on the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines and eligibility criteria were designed according to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework. In total, 4 databases were searched (MEDLINE, Scopus, Embase, and PsycINFO) to identify quantitative and qualitative studies with outcome measures related to app abandonment in adults with free-living conditions, including reasons for abandonment and duration of use, for mobile apps related to WHO (World Health Organization) modifiable health behaviors and mental health. The included studies? risk of bias was appraised based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and COREQ (Consolidated Criteria for Reporting Qualitative Research) checklists. To enable data synthesis across different methodologies, app domains, demographic data, and outcome measures were categorized. Results are presented in 2 sections: quantitatively in a scatterplot to understand when users abandon apps and qualitatively through basic qualitative content analysis to identify the underlying reasons. Results: Eighteen eligible studies (525,824 participants) published between 2014 and 2022, predominantly from the United States, Canada, the United Kingdom, and Germany, were identified. Findings revealed a curvilinear pattern of app abandonment, with sharper abandonment soon after acquisition, followed by a slowing rate of abandonment over time. Taken together, a median of 70% of users discontinued use within the first 100 days. The abandonment rate appeared to vary by app domain, with apps focusing on alcohol and smoking exhibiting faster abandonment, and physical activity and mental health exhibiting longer usage durations. In total, 22 unique reasons for abandonment were organized into six categories: (1) technical and functional issues, (2) privacy concerns, (3) poor user experience, (4) content and features, (5) time and financial costs, and (6) evolving user needs and goals. Conclusions: This study highlights the complex nature of health app abandonment and the need for an improved understanding of user engagement over time, underscoring the importance of addressing various factors contributing to abandonment, from technical issues to evolving user needs. Our findings also emphasize the need for longitudinal studies and a consistent definition of app abandonment to better understand and mitigate this phenomenon, thereby enhancing the effectiveness of health apps in supporting public health initiatives. UR - https://www.jmir.org/2024/1/e56897 UR - http://dx.doi.org/10.2196/56897 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56897 ER - TY - JOUR AU - Park, Ye-Eun AU - Tak, Won Yae AU - Kim, Inhye AU - Lee, Jeong Hui AU - Lee, Bok Jung AU - Lee, Won Jong AU - Lee, Yura PY - 2024/12/18 TI - User Experience and Extended Technology Acceptance Model in Commercial Health Care App Usage Among Patients With Cancer: Mixed Methods Study JO - J Med Internet Res SP - e55176 VL - 26 KW - mHealth KW - user experience KW - cancer KW - technology acceptance model KW - structural equation modeling KW - health care app KW - mixed-method study KW - medical care KW - digital health care KW - cancer survivors KW - disparities KW - health status KW - behavioral intervention KW - clinician N2 - Background: The shift in medical care toward prediction and prevention has led to the emergence of digital health care as a valuable tool for managing health issues. Aiding long-term follow-up care for cancer survivors and contributing to improved survival rates. However, potential barriers to mobile health usage, including age-related disparities and challenges in user retention for commercial health apps, highlight the need to assess the impact of patients? abilities and health status on the adoption of these interventions. Objective: This study aims to investigate the app adherence and user experience of commercial health care apps among cancer survivors using an extended technology acceptance model (TAM). Methods: The study enrolled 264 cancer survivors. We collected survey results from May to August 2022 and app usage records from the app companies. The survey questions were created based on the TAM. Results: We categorized 264 participants into 3 clusters based on their app usage behavior: short use (n=77), medium use (n=101), and long use (n=86). The mean usage days were 9 (SD 11) days, 58 (SD 20) days, and 84 (SD 176) days, respectively. Analysis revealed significant differences in perceived usefulness (P=.01), interface satisfaction (P<.01), equity (P<.01), and utility (P=.01) among the clusters. Structural equation modeling indicated that perceived ease-of-use significantly influenced perceived usefulness (?=0.387, P<.01), and both perceived usefulness and attitude significantly affected behavioral intention and actual usage. Conclusions: This study showed the importance of positive user experience and clinician recommendations in facilitating the effective usage of digital health care tools among cancer survivors and contributing to the evolving landscape of medical care. UR - https://www.jmir.org/2024/1/e55176 UR - http://dx.doi.org/10.2196/55176 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55176 ER - TY - JOUR AU - Dobson, Rosie AU - Whittaker, Robyn AU - Abroms, C. Lorien AU - Bramley, Dale AU - Free, Caroline AU - McRobbie, Hayden AU - Stowell, Melanie AU - Rodgers, Anthony PY - 2024/12/17 TI - Don?t Forget the Humble Text Message: 25 Years of Text Messaging in Health JO - J Med Internet Res SP - e59888 VL - 26 KW - text messaging KW - messaging KW - SMS KW - texting KW - mHealth KW - mobile health UR - https://www.jmir.org/2024/1/e59888 UR - http://dx.doi.org/10.2196/59888 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59888 ER - TY - JOUR AU - Lee, Yeonsu AU - Keel, Stuart AU - Yoon, Sangchul PY - 2024/12/16 TI - Evaluating the Effectiveness and Scalability of the World Health Organization MyopiaEd Digital Intervention: Mixed Methods Study JO - JMIR Public Health Surveill SP - e66052 VL - 10 KW - World Health Organization KW - digital intervention KW - MyopiaEd KW - behavior change KW - risk factor KW - myopia KW - refractive error KW - mobile phone N2 - Background: The rapid rise of myopia worldwide, particularly in East and Southeast Asia, has implied environmental influences beyond genetics. To address this growing public health concern, the World Health Organization and International Telecommunication Union launched the MyopiaEd program. South Korea, with its high rates of myopia and smartphone use, presented a suitable context for implementing and evaluating the MyopiaEd program. Objective: This is the first study to date to evaluate the effectiveness and scalability of the MyopiaEd program in promoting eye health behavior change among parents of children in South Korea. Methods: Parents of children aged 7 and 8 years were recruited through an open-access website with a recruitment notice distributed to public elementary schools in Gwangju Metropolitan City. Beginning in September 2022, parents received 42 SMS text messages from the MyopiaEd program over 6 months. This digital trial used a mixed methods approach combining both quantitative and qualitative data collection. Pre- and postintervention surveys were used to assess changes in parental knowledge and behavior regarding myopia prevention. Additionally, semistructured interviews were conducted to explore participants? experiences in depth and receive feedback on program design. Prior to the intervention, the MyopiaEd program design and message libraries were adapted for the Korean context following World Health Organization and International Telecommunication Union guidelines. Results: A total of 133 parents participated in this study, including 60 parents whose children had myopia and 73 parents whose children did not. Both groups reported high engagement and satisfaction with the program. Significant increases in knowledge about myopia were observed in both groups (P<.001). While time spent on near-work activities did not change significantly, parents of children with myopia reported increased outdoor time for their children (P=.048). A substantial increase in eye checkups was observed, with 52 (86.7%) out of 60 children with myopia and 50 (68.5%) out of 73 children without myopia receiving eye examinations following the intervention. Qualitative analysis indicated a shift in parents? attitudes toward outdoor activities, as increased recognition of their benefits prompted positive changes in behavior. However, reducing near-work activities posed challenges due to children?s preference for smartphone use during leisure periods and the demands of after-school academies. The credibility of the institution delivering the program enhanced parental engagement and children?s adoption of healthy behaviors. Messages that corrected common misconceptions about eye health and provided specific behavioral guidance were regarded as impactful elements of the program. Conclusions: This study demonstrates the MyopiaEd program?s potential as a scalable and innovative digital intervention to reduce myopia risk in children. The program?s effectiveness provides support for broader adoption and offers valuable insights to inform future myopia prevention policies. UR - https://publichealth.jmir.org/2024/1/e66052 UR - http://dx.doi.org/10.2196/66052 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66052 ER - TY - JOUR AU - Chen, Jiaren AU - Park, Jong-Hwan AU - Lin, Chien-Yu AU - Lai, Ting-Fu AU - Kim, Du-Ri AU - Shin, Myung-Jun AU - Moon, Eunsoo AU - Kang, Mo Jung AU - Lee, Won Jong AU - Cho, Jae Yoon AU - Liao, Yung AU - Goh, Sik Tae AU - Lee, Sub Jung PY - 2024/12/16 TI - Whole-Body and Segmental Phase Angles and Cognitive Function in the Older Korean Population: Cross-Sectional Analysis JO - JMIR Public Health Surveill SP - e63457 VL - 10 KW - bioelectrical impedance analysis KW - oxidative stress KW - cellular health KW - cognitive function KW - older adults KW - BIA KW - phase angle KW - PhA N2 - Background: Recently, the phase angle (PhA) has emerged as an essential indicator of cellular health. Most studies have examined its association with physiological conditions, such as sarcopenia, frailty, and physical function, in older populations. Simultaneously, growing attention is being paid to the clinical relevance of segmental PhAs for future applications. However, few studies have explored the relationship between PhAs, especially segmental PhAs, and the psychological aspects of health, particularly cognitive function. Objective: We aimed to investigate the association between whole-body and segmental PhAs and cognitive function in older adults. Methods: Individuals aged 65 years and above were recruited from adult community groups residing in Busan, South Korea, through the 2022 Bus-based Screening and Assessment Network (BUSAN) study of Pusan National University Hospital. Participants? whole-body and segmental PhAs were measured using a bioelectrical impedance analyzer (BWA 2.0 Body Water Analyzer, InBody), and cognitive functions (overall and subdomains, including memory, orientation, attention and calculation, and language) were self-reported using the Korean version of the Mini-Mental State Examination. Multiple linear regression analyses were performed to examine these associations. Results: This study included 625 older adults aged 65?96 years (women: n=444, 71%; men: n=191, 29%). A positive association was observed between whole-body PhA and cognitive function (b=0.62, 95% CI 0.16?1.08; P<.01). We observed significant positive associations between the PhA of the lower limbs (b=0.72, 95% CI 0.38?1.06; P<.001) and cognitive function. Analysis of the Mini-Mental State Examination subdomains revealed that whole-body PhA was significantly related to memory (b=0.11, 95% CI 0.00?0.22; P=.04); the PhA of the upper limbs was significantly related to orientation (b=0.29, 95% CI 0.09?0.49; P=.01); and the PhA of the lower limbs was significantly related to orientation (b=0.24, 95% CI 0.10?0.38; P<.001), attention and calculation (b=0.21, 95% CI 0.06?0.37; P=.01), memory (b=0.14, 95% CI 0.05?0.22; P=.001), and language functions (b=0.07, 95% CI 0.01?0.12; P=.01). However, trunk PhA showed no significant association. Conclusions: Our findings bolster the emerging evidence of a significant positive correlation between whole-body PhA and cognitive function in our sample, with nuanced relationships observed across different segmental PhAs and cognitive subdomains. Therefore, this study revealed that PhAs could be a useful tool for screening or preventing cognitive decline in the general older population, offering substantial evidence for future interventional studies. Further research should delve into the mechanisms and assess targeted interventions that enhance regional physical function to support cognitive health in older adults. Further long-term investigation on these associations is warranted. UR - https://publichealth.jmir.org/2024/1/e63457 UR - http://dx.doi.org/10.2196/63457 ID - info:doi/10.2196/63457 ER - TY - JOUR AU - Fernandez, Diana Isabel AU - Yang, Yu-Ching AU - Chang, Wonkyung AU - Kautz, Amber AU - Farchaus Stein, Karen PY - 2024/12/13 TI - Developing Components of an Integrated mHealth Dietary Intervention for Mexican Immigrant Farmworkers: Feasibility Usability Study of a Food Photography Protocol for Dietary Assessment JO - JMIR Form Res SP - e54664 VL - 8 KW - Mexican immigrant farmworker KW - diet-related noncommunicable diseases KW - mHealth KW - dietary assessment KW - image-based KW - healthcare disparities KW - minority KW - feasibility study KW - food photography KW - rural health KW - health literacy KW - culutural adaptation KW - women KW - technology acceptance KW - mobile health N2 - Background: Rural-urban disparities in access to health services and the burden of diet-related noncommunicable diseases are exacerbated among Mexican immigrant farmworkers due to work demands, social and geographical isolation, literacy issues, and limited access to culturally and language-competent health services. Although mobile health (mHealth) tools have the potential to overcome structural barriers to health services access, efficacious mHealth interventions to promote healthy eating have not considered issues of low literacy and health literacy, and food preferences and norms in the Mexican immigrant farmworker population. To address this critical gap, we conducted a series of preliminary studies among Mexican immigrant farmworkers with the long-term goal of developing a culture- and literacy-specific smartphone app integrating dietary assessment through food photography, diet analyses, and a non?text-based dietary intervention. Objective: This study aimed to report adherence and reactivity to a 14-day food photography dietary assessment protocol, in which Mexican immigrant farmworker women were instructed to take photos of all foods and beverages consumed. Methods: We developed a secure mobile app with an intuitive graphical user interface to collect food images. Adult Mexican immigrant farmworker women were recruited and oriented to the photography protocol. Adherence and reactivity were examined by calculating the mean number of food photos per day over time, differences between the first and second week, and differences between weekdays and weekends. The type of foods and meals photographed were compared with reported intake in three 24-hour dietary recalls. Results: In total, 16 Mexican farmworker women took a total of 1475 photos in 14 days, with a mean of 6.6 (SD 2.3) photos per day per participant. On average, participants took 1 fewer photo per day in week 2 compared with week 1 (mean 7.1, SD 2.5 in week 1 vs mean 6.1, SD 2.6 in week 2; P=.03), and there was a decrease of 0.6 photos on weekdays versus weekends (mean 6.4, SD 2.5 on weekdays vs mean 7, SD 2.7 on weekends; P=.50). Of individual food items, 71% (352/495) of foods in the photos matched foods in the recalls. Of all missing food items (n=138) and meals (n=36) in the photos, beverages (74/138, 54%), tortillas (15/138, 11%), snacks 16/36, 44%), and dinners (10/36, 28%) were the most frequently missed. Most of the meals not photographed (27/36, 75%) were in the second week of the protocol. Conclusions: Dietary assessment through food photography is feasible among Mexican immigrant farmworker women. For future protocols, substantive adjustments will be introduced to reduce the frequency of missing foods and meals. Our preliminary studies are a step in the right direction to extend the benefits of mHealth technologies to a hard-to-reach group and contribute to the prevention and control of diet-related noncommunicable diseases. UR - https://formative.jmir.org/2024/1/e54664 UR - http://dx.doi.org/10.2196/54664 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54664 ER - TY - JOUR AU - Pong, Candelyn AU - Tseng, Wen Rachel Marjorie Wei AU - Tham, Chung Yih AU - Lum, Elaine PY - 2024/12/12 TI - Current Implementation of Digital Health in Chronic Disease Management: Scoping Review JO - J Med Internet Res SP - e53576 VL - 26 KW - digital health KW - telemedicine KW - chronic disease KW - noncommunicable disease KW - implementation science KW - evidence-based practice KW - mobile phone N2 - Background: Approximately 1 in 3 adults live with multiple chronic diseases. Digital health is being harnessed to improve continuity of care and management of chronic diseases. However, meaningful uptake of digital health for chronic disease management remains low. It is unclear how these innovations have been implemented and evaluated. Objective: This scoping review aims to identify how digital health innovations for chronic disease management have been implemented and evaluated: what implementation frameworks, methods, and strategies were used; how successful these strategies were; key barriers and enablers to implementation; and lessons learned and recommendations shared by study authors. Methods: We used the Joanna Briggs Institute methodology for scoping reviews. Five databases were searched for studies published between January 2015 and March 2023: PubMed, Scopus, CINAHL, PsycINFO, and IEEE Xplore. We included primary studies of any study design with any type of digital health innovations for chronic diseases that benefit patients, caregivers, or health care professionals. We extracted study characteristics; type of digital health innovation; implementation frameworks, strategies, and outcome measures used; barriers and enablers to implementation; lessons learned; and recommendations reported by study authors. We used established taxonomies to synthesize extracted data. Extracted barriers and enablers were grouped into categories for reporting. Descriptive statistics were used to consolidate extracted data. Results: A total of 252 studies were included, comprising mainly mobile health (107/252, 42.5%), eHealth (61/252, 24.2%), and telehealth (97/252, 38.5%), with some studies involving more than 1 innovation. Only 23 studies (23/252, 9.1%) reported using an implementation science theory, model, or framework; the most common were implementation theories, classic theories, and determinant frameworks, with 7 studies each. Of 252 studies, 144 (57.1%) used 2 to 5 implementation strategies. Frequently used strategies were ?obtain and use patient or consumer feedback? (196/252, 77.8%); ?audit and provide feedback? (106/252, 42.1%); and piloting before implementation or ?stage implementation scale-up? (85/252, 33.7%). Commonly measured implementation outcomes were acceptability, feasibility, and adoption of the digital innovation. Of 252 studies, 247 studies (98%) did not measure service outcomes, while patient health outcomes were measured in 89 studies (35.3%). The main method used to assess outcomes was surveys (173/252, 68.7%), followed by interviews (95/252, 37.7%). Key barriers impacting implementation were data privacy concerns and patient preference for in-person consultations. Key enablers were training for health care workers and personalization of digital health features to patient needs. Conclusions: This review generated a summary of how digital health in chronic disease management is currently implemented and evaluated and serves as a useful resource for clinicians, researchers, health system managers, and policy makers planning real-world implementation. Future studies should investigate whether using implementation science frameworks, including how well they are used, would yield better outcomes compared to not using them. UR - https://www.jmir.org/2024/1/e53576 UR - http://dx.doi.org/10.2196/53576 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53576 ER - TY - JOUR AU - Loro, Laís Fernanda AU - Martins, Riane AU - Ferreira, Barcellos Janaína AU - de Araujo, Pereira Cintia Laura AU - Prade, Rene Lucio AU - Both, Bonato Cristiano AU - Nobre, Nobre Jéferson Campos AU - Monteiro, Borba Mariane AU - Dal Lago, Pedro PY - 2024/12/11 TI - Validation of a Wearable Sensor Prototype for Measuring Heart Rate to Prescribe Physical Activity: Cross-Sectional Exploratory Study JO - JMIR Biomed Eng SP - e57373 VL - 9 KW - heart rate KW - wearable device KW - HR KW - biosensor KW - physiological monitor KW - wearable system KW - medical device KW - mobile phone N2 - Background: Wearable sensors are rapidly evolving, particularly in health care, due to their ability to facilitate continuous or on-demand physiological monitoring. Objective: This study aimed to design and validate a wearable sensor prototype incorporating photoplethysmography (PPG) and long-range wide area network technology for heart rate (HR) measurement during a functional test. Methods: We conducted a transversal exploratory study involving 20 healthy participants aged between 20 and 30 years without contraindications for physical exercise. Initially, our laboratory developed a pulse wearable sensor prototype for HR monitoring. Following this, the participants were instructed to perform the Incremental Shuttle Walk Test while wearing the Polar H10 HR chest strap sensor (the reference for HR measurement) and the wearable sensor. This test allowed for real-time comparison of HR responses between the 2 devices. Agreement between these measurements was determined using the intraclass correlation coefficient (ICC3.1) and Lin concordance correlation coefficient. The mean absolute percentage error was calculated to evaluate reliability or validity. Cohen d was used to calculate the agreement?s effect size. Results: The mean differences between the Polar H10 and the wearable sensor during the test were ?2.6 (95% CI ?3.5 to ?1.8) for rest HR, ?4.1 (95% CI ?5.3 to ?3) for maximum HR, ?2.4 (95% CI ?3.5 to ?1.4) for mean test HR, and ?2.5 (95% CI ?3.6 to ?1.5) for mean recovery HR. The mean absolute percentage errors were ?3% for rest HR, ?2.2% for maximum HR, ?1.8% for mean test HR, and ?1.6% for recovery HR. Excellent agreement was observed between the Polar H10 and the wearable sensor for rest HR (ICC3.1=0.96), mean test HR (ICC3.1=0.92), and mean recovery HR (ICC3.1=0.96). The agreement for maximum HR (ICC3.1=0.78) was considered good. By the Lin concordance correlation coefficient, the agreement was found to be substantial for rest HR (rc=0.96) and recovery HR (rc=0.96), moderate for mean test HR (rc=0.92), and poor for maximum HR (rc=0.78). The power of agreement between the Polar H10 and the wearable sensor prototype was large for baseline HR (Cohen d=0.97), maximum HR (Cohen d=1.18), and mean recovery HR (Cohen d=0.8) and medium for mean test HR (Cohen d= 0.76). Conclusions: The pulse-wearable sensor prototype tested in this study proves to be a valid tool for monitoring HR at rest, during functional tests, and during recovery compared with the Polar H10 reference device used in the laboratory setting. UR - https://biomedeng.jmir.org/2024/1/e57373 UR - http://dx.doi.org/10.2196/57373 UR - http://www.ncbi.nlm.nih.gov/pubmed/39661434 ID - info:doi/10.2196/57373 ER - TY - JOUR AU - Singh, Rujul AU - Tetrick, K. Macy AU - Fisher, L. James AU - Washington, Peter AU - Yu, Jane AU - Paskett, D. Electra AU - Penedo, J. Frank AU - Clinton, K. Steven AU - Benzo, M. Roberto PY - 2024/12/10 TI - Analysis of Physical Activity Using Wearable Health Technology in US Adults Enrolled in the All of Us Research Program: Multiyear Observational Study JO - J Med Internet Res SP - e65095 VL - 26 KW - Physical Activity Guidelines for Americans KW - accelerometry KW - All of Us Research Program KW - wearable activity monitors KW - health equity KW - multiyear activity tracking KW - activity intensity estimation KW - US adult population KW - sociodemographic determinants of physical activity KW - physical activity KW - wearables KW - United States KW - older adults KW - observational studies KW - longitudinal setting KW - sociodemographic determinants KW - physical activity data KW - Fitbit data KW - step-based method KW - adherence N2 - Background: To date, no studies have examined adherence to the 2018 Physical Activity Guidelines for Americans (PAGA) in real-world longitudinal settings using objectively measured activity monitoring data. This study addresses this gap by using commercial activity monitoring (Fitbit) data from the All of Us dataset. Objective: The primary objectives were to describe the prevalence of adherence to the 2018 PAGA and identify associated sociodemographic determinants. Additionally, we compared 3 distinct methods of processing physical activity (PA) data to estimate adherence to the 2008 PAGA. Methods: We used the National Institutes of Health?s All of Us dataset, which contains minute-level Fitbit data for 13,947 US adults over a 7-year time span (2015-2022), to estimate adherence to PAGA. A published step-based method was used to estimate metabolic equivalents and assess adherence to the 2018 PAGA (ie, ?150 minutes of moderate- to vigorous-intensity PA per week). We compared the step-based method, the heart rate?based method, and the proprietary Fitbit-developed algorithm to estimate adherence to the 2008 PAGA. Results: The average overall adherence to the 2018 PAGA was 21.6% (3006/13,947; SE 0.4%). Factors associated with lower adherence in multivariate logistic regression analysis included female sex (relative to male sex; adjusted odds ratio [AOR] 0.66, 95% CI 0.60-0.72; P<.001); BMI of 25.0-29.9 kg/m2 (AOR 0.53, 95% CI 0.46-0.60; P<.001), 30-34.9 kg/m2 (AOR 0.30, 95% CI 0.25-0.36; P<.001), or ?35 kg/m2 (AOR 0.13, 95% CI 0.10-0.16; P<.001; relative to a BMI of 18.5-24.9 kg/m2); being aged 30-39 years (AOR 0.66, 95% CI 0.56-0.77; P<.001), 40-49 years (AOR 0.79, 95% CI 0.68-0.93; P=.005), or ?70 years (AOR 0.74, 95% CI 0.62-0.87; P<.001; relative to being 18-29 years); and non-Hispanic Black race or ethnicity (AOR 0.63, 95% CI 0.50-0.79; P<.001; relative to non-Hispanic White race or ethnicity). The Fitbit algorithm estimated that a larger percentage of the sample (10,307/13,947, 73.9%; 95% CI 71.2-76.6) adhered to the 2008 PAGA compared to the heart rate method estimate (4740/13,947, 34%; 95% CI 32.8-35.2) and the step-based method (1401/13,947, 10%; 95% CI 9.4-10.6). Conclusions: Our results show significant sociodemographic differences in PAGA adherence and notably different estimates of adherence depending on the algorithm used. These findings warrant the need to account for these disparities when implementing PA interventions and the need to establish an accurate and reliable method of using commercial accelerometers to examine PA, particularly as health care systems begin integrating wearable device data into patient health records. UR - https://www.jmir.org/2024/1/e65095 UR - http://dx.doi.org/10.2196/65095 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65095 ER - TY - JOUR AU - Konishi, Naoki AU - Oba, Takeyuki AU - Takano, Keisuke AU - Katahira, Kentaro AU - Kimura, Kenta PY - 2024/12/10 TI - Functions of Smartphone Apps and Wearable Devices Promoting Physical Activity: Six-Month Longitudinal Study on Japanese-Speaking Adults JO - JMIR Mhealth Uhealth SP - e59708 VL - 12 KW - mHealth KW - mobile health KW - smartphone app KW - physical activity KW - wearable activity tracker KW - longitudinal design KW - wearable KW - Japan KW - health promotion N2 - Background: Smartphone apps and wearable activity trackers are increasingly recognized for their potential to promote physical activity (PA). While studies suggest that the use of commercial mobile health tools is associated with higher PA levels, most existing evidence is cross-sectional, leaving a gap in longitudinal data. Objective: This study aims to identify app-use patterns that are prospectively associated with increases in and maintenance of PA. The primary objective was to test whether continued app use is linked to adherence to the recommended PA levels (ie, 23 metabolic equivalent task [MET] hours per week for adults or 10 MET hours/week for individuals aged >65 years) during a follow-up assessment. The secondary objective was to explore which functions and features of PA apps predict changes in PA levels. Methods: A 2-wave longitudinal survey was conducted, with baseline and follow-up assessments separated by 6 months. A total of 20,573 Japanese-speaking online respondents participated in the baseline survey, and 16,286 (8289 women; mean age 54.7 years, SD 16.8 years) completed the follow-up. At both time points, participants reported their current PA levels and whether they were using any PA apps or wearables. Each participant was classified into 1 of the following 4 categories: continued users (those using apps at both the baseline and follow-up; n=2150, 13.20%), new users (those who started using apps before the follow-up; n=1462, 8.98%), discontinued users (those who had used apps at baseline but not at follow-up; n=1899, 11.66%), and continued nonusers (those who had never used apps; n=10,775, 66.16%). Results: The majority of continued users (1538/2150, 71.53%) either improved or maintained their PA at the recommended levels over 6 months. By contrast, discontinued users experienced the largest reduction in PA (?7.95 MET hours/week on average), with more than half failing to meet the recommended levels at the follow-up (n=968, 50.97%). Analyses of individual app functions revealed that both energy analysis (eg, app calculation of daily energy expenditure) and journaling (eg, users manually entering notes and maintaining an exercise diary) were significantly associated with increases in PA. Specifically, energy analysis was associated with an odds ratio (OR) of 1.67 (95% CI 1.05-2.64, P=.03), and journaling had an OR of 1.76 (95% CI 1.12-2.76, P=.01). By contrast, individuals who maintained the recommended PA levels at the follow-up were more likely to use the goal setting (OR 1.73, 95% CI 1.21-2.48, P=.003), sleep information (OR 1.66, 95% CI 1.03-2.68, P=.04), and blood pressure recording (OR 2.05, 95% CI 1.10-3.83, P=.02) functions. Conclusions: The results highlight the importance of continued app use in both increasing and maintaining PA levels. Different app functions may contribute to these outcomes, with features such as goal setting and journaling playing a key role in increasing PA, while functions related to overall health, such as sleep tracking and blood pressure monitoring, are more associated with maintaining high PA levels. UR - https://mhealth.jmir.org/2024/1/e59708 UR - http://dx.doi.org/10.2196/59708 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59708 ER - TY - JOUR AU - Prignitz, Maren AU - Guldner, Stella AU - Lehmler, Johann Stephan AU - Aggensteiner, Pascal-M AU - Nees, Frauke AU - PY - 2024/12/10 TI - An Ecological Momentary Assessment Approach of Environmental Triggers in the Role of Daily Affect, Rumination, and Movement Patterns in Early Alcohol Use Among Healthy Adolescents: Exploratory Study JO - JMIR Mhealth Uhealth SP - e53401 VL - 12 KW - alcohol use KW - adolescence KW - affect KW - rumination KW - ecological momentary assessment KW - geospatial measures N2 - Background: Adolescence is a period characterized by an increased susceptibility to developing risky alcohol consumption habits. This susceptibility can be influenced by social and situational factors encountered in daily life, which, in conjunction with emotions and thoughts, contribute to behavioral patterns related to alcohol use even in the early stages of alcohol experimentation, when initial experiences with alcohol are formed, and regular consumption is still evolving. Objective: This study aimed to examine the association between detailed behavioral and movement patterns, along with emotional and cognitive factors, and the early onset of alcohol use in the everyday lives of adolescents. Methods: A total of 65 healthy adolescents (33 male, twenty-nine 14-year-olds, and thirty-six 16-year-olds) underwent mobile-based ecological momentary assessments on alcohol (once a day at 9 AM, assessing alcohol use the day before), positive and negative affect, craving, rumination, and social context (6 prompts/day at 9 AM, 11 AM, 2 PM, 4 PM, 6 PM and 8 PM), type of day (weekdays or weekends, with weekend including Fridays, Saturdays, and Sundays), and using geospatial measures (specifically roaming entropy and number and type of trigger points for alcohol use met) over 14 days. After adjusting for a compliance rate of at least 50%, 52 participants (26 male and twenty-four 14-year-olds) were included in the analyses. Results: Generalized linear multilevel models revealed that higher positive affect (b=0.685, P=.007), higher rumination (b=0.586, P=.02), and a larger movement radius (roaming entropy) (b=8.126, P=.02) were positively associated with alcohol use on the same day. However, social context (b=?0.076, P=.90), negative affect (b=?0.077, P=.80), or potential trigger points (all P>.05) did not show significant associations. Alcohol use varied depending on the type of day, with more alcohol use on weekends (b=1.082, P<.001) and age (t50=?2.910, P=.005), with 16-year-olds (mean 1.61, SD 1.66) reporting more days of alcohol consumption than 14-year-olds (mean 0.548, SD 0.72). Conclusions: Our findings support previously identified factors as significant contributors to very early and low levels of alcohol consumption through fine-grained analysis of daily behaviors. These factors include positive affect, rumination, weekend days, and age. In addition, we emphasize that exploratory environmental movement behavior (roaming entropy) is also significantly associated with adolescent alcohol use, highlighting its importance as an additional factor. UR - https://mhealth.jmir.org/2024/1/e53401 UR - http://dx.doi.org/10.2196/53401 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53401 ER - TY - JOUR AU - Melamed, C. Osnat AU - Mehra, Kamna AU - Panda, Roshni AU - Minian, Nadia AU - Veldhuizen, Scott AU - Zawertailo, Laurie AU - Buckley, Leslie AU - Maslej, Marta AU - Greaves, Lorraine AU - Brabete, C. Andreea AU - Rose, Jonathan AU - Ratto, Matt AU - Selby, Peter PY - 2024/12/10 TI - A Gender-Informed Smoking Cessation App for Women: Protocol for an Acceptability and Feasibility Study JO - JMIR Res Protoc SP - e60677 VL - 13 KW - smoking cessation KW - mHealth KW - co-development KW - feasibility KW - smoking KW - mobile app KW - cigarette smoking KW - tobacco cessation KW - gender-informed design KW - app design KW - women's health KW - behavior change KW - health behavior change KW - mobile phone N2 - Background: Tobacco smoking remains the leading preventable cause of death and disease among women. Quitting smoking offers numerous health benefits; however, women tend to have less success than men when attempting to quit. This discrepancy is partly due to sex- and gender-related factors, including the lower effectiveness of smoking cessation medication and the presence of unique motives for smoking and barriers to quitting among women. Despite the gendered nature of smoking, most smoking cessation apps are gender-neutral and fail to address women?s specific needs. Objective: This study aims to test the acceptability and feasibility of a smartphone app that delivers gender-informed content to support women in quitting smoking. Methods: We co-developed a smoking cessation app specifically tailored for women, named My Change Plan-Women (MCP-W). This app builds upon our previous gender-neutral app, MCP, by retaining its content grounded in behavioral change techniques aimed at supporting tobacco reduction and cessation. This includes goal setting for quitting, identifying triggers to smoking, creating coping strategies, tracking cigarettes and cravings, and assessing financial savings from quitting smoking. The MCP-W app contains additional gender-informed content that acknowledges barriers to quitting, such as coping with stress, having smokers in one?s social circle, and managing unpleasant emotions. This content is delivered through testimonials and animated videos. This study is a prospective, single-group, mixed methods investigation in which 30 women smokers will trial the app for a period of 28 days. Once participants provide informed consent, they will complete a baseline survey and download the app on their smartphones. After 28 days, participants will complete follow-up surveys. Acceptability will be assessed using the Theoretical Framework of Acceptability, which evaluates whether participants perceive the app as helpful in changing their smoking. The app will be deemed acceptable if the majority of participants rate it as such, and feasible if the majority of the participants use it for at least 7 days. Furthermore, after the 28-day trial period, participants will complete a semistructured interview regarding their experience with the app and suggestions for improvement. Results: Development of the MCP-W app was completed in September 2023. Participant recruitment for testing of the app commenced in February 2024 and was completed in July 2024. We will analyze the data upon completion of data collection from all 30 participants. We expect to share the results of this acceptability trial in the middle of 2025. Conclusions: Offering smoking cessation support tailored specifically to address the unique needs of women through a smartphone app represents a novel approach. This study will test whether women who smoke perceive this approach to be acceptable and feasible in their journey toward smoking cessation. International Registered Report Identifier (IRRID): DERR1-10.2196/60677 UR - https://www.researchprotocols.org/2024/1/e60677 UR - http://dx.doi.org/10.2196/60677 UR - http://www.ncbi.nlm.nih.gov/pubmed/39433391 ID - info:doi/10.2196/60677 ER - TY - JOUR AU - Höfer, Klemens AU - Plescher, Felix AU - Schlierenkamp, Sarah AU - Solar, Stefanie AU - Neusser, Silke AU - Schneider, Udo AU - Best, Dieter AU - Wasem, Jürgen AU - Abels, Carina AU - Bußmann, Anna PY - 2024/12/10 TI - mHealth Apps in German Outpatient Mental Health Care: Protocol for a Mixed Methods Approach JO - JMIR Res Protoc SP - e56205 VL - 13 KW - mental health care KW - mHealth KW - digital health applications KW - Digitale Gesundheitsanwendungen KW - mental disorders KW - health care research KW - applications KW - app KW - mental health KW - outpatient KW - digital health KW - adults KW - Germany KW - mobile health apps KW - treatment N2 - Background: Mental disorders are complex diseases that affect 28% (about 17.8 million people) of the adult population in Germany annually. Since 2020, certain mobile health (mHealth) apps, so-called digital health applications (DiGA), are reimbursable in the German statutory health insurance system. A total of 27 of the 56 currently available DiGA are approved for the treatment of mental and behavioral diseases. An indicator of existing problems hindering the use of DiGA is the rather hesitant prescribing behavior. Objective: This project aims to develop health policy recommendations for the optimal integration of DiGA into outpatient psychotherapeutic care. The project is funded by the Innovation Fund of the Joint Federal Committee (grant 01VSF22029). The current status quo of the use of DiGA will be analyzed. Furthermore, concepts for the integration of mHealth apps, as well as their transfer into the care process will be investigated. In addition, barriers will be identified, and existing expectations of different perspectives captured. Methods: The project will be based on a mixed methods approach. A scoping review and a qualitative analysis of focus groups and expert interviews will be carried out. Additionally, an analysis of claims data of the statutory health insurance will be conducted. This will be followed by a written survey of insured persons and health care providers. Finally, health policy recommendations will be derived in cooperation with stakeholders. Results: The scoping reviews and qualitative analyses have been completed, and the quantitative surveys are currently being carried out. The target number of responses in the survey of insured persons has already been achieved. Furthermore, the analysis claims data of the statutory health insurance is currently being conducted. Conclusions: There is a need for research on how DiGA can be optimally integrated into the care process of patients with mental disorders as evidence regarding the topic is limited and prescribing behavior low. Although the potential of DiGA in mental health care has not yet fully unfolded, Germany serves as a model for other countries regarding reimbursable mHealth apps. This project aims to explore the potentials of DiGA and to describe the organizational, institutional, and procedural steps necessary for them to best support mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/56205 UR - https://www.researchprotocols.org/2024/1/e56205 UR - http://dx.doi.org/10.2196/56205 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56205 ER - TY - JOUR AU - McCarthy, Hannah AU - Potts, W. Henry W. AU - Fisher, Abigail PY - 2024/12/10 TI - Tracked Physical Activity Levels Before and After a Change in Incentive Strategy Among UK Adults Using a Rewards App: Retrospective Quasi-Experimental Study JO - JMIR Form Res SP - e50041 VL - 8 KW - mHealth KW - rewards KW - incentives KW - physical activity KW - smartphone KW - apps KW - mobile apps KW - app-based intervention KW - behavior change KW - exercise N2 - Background: Financial incentives delivered via apps appear to be effective in encouraging physical activity. However, the literature on different incentive strategies is limited, and the question remains whether financial incentives offer a cost-effective intervention that could be funded at the population level. Objective: This study aimed to explore patterns of tracked physical activity by users of an incentive-based app before and after a change in incentive strategy. A business decision to alter the incentives in a commercially available app offered a natural experiment to explore GPS-tracked data in a retrospective, quasi-experimental study. The purpose of this exploratory analysis was to inform the design of future controlled trials of incentives delivered via an app to optimize their usability and cost-effectiveness. Methods: Weekly minutes of tracked physical activity were explored among a sample of 1666 participants. A Friedman test was used to determine differences in physical activity before and after the change in incentive strategies. Post hoc Wilcoxon tests were used to assess minutes of physical activity in the 2 weeks before and after the change. A secondary analysis explored longitudinal patterns of physical activity by plotting the mean and median minutes of physical activity from 17 weeks before and 13 weeks after the change in incentive strategy. CIs were calculated using bias-corrected bootstraps. Demographics were also explored in this way. Results: There were significant differences in the weekly minutes of activity before and after the change in incentive strategy (Friedman ?22=42, P<.001). However, a longitudinal view of the data showed a more complex and marked variation in activity over time that undermined the conclusions of the before/after analysis. Conclusions: Short-term before-and-after observational studies of app-tracked physical activity may result in misleading conclusions about the effectiveness of incentive strategies. Longitudinal views of the data show that important fluctuations are occurring over time. Future studies of app-tracked physical activity should explore such variations by using longitudinal analyses and accounting for possible moderating variables to better understand what an effective incentive might be, for whom, and at what cost. UR - https://formative.jmir.org/2024/1/e50041 UR - http://dx.doi.org/10.2196/50041 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50041 ER - TY - JOUR AU - Lewkowitz, K. Adam AU - Guillen, Melissa AU - Ursino, Katrina AU - Baker, Rackeem AU - Lum, Liana AU - Battle, L. Cynthia AU - Ware, Crystal AU - Ayala, K. Nina AU - Clark, Melissa AU - Ranney, L. Megan AU - Miller, S. Emily AU - Guthrie, M. Kate PY - 2024/12/9 TI - Optimizing a Novel Smartphone App to Prevent Postpartum Depression Adapted From an Evidence-Based Cognitive Behavioral Therapy Program: Qualitative Study JO - JMIR Hum Factors SP - e63143 VL - 11 KW - cognitive behavioral therapy KW - mothers and babies program KW - digital health KW - postpartum depression KW - smartphone application KW - FRAME for intervention adaptation KW - Framework for Modification and Adaptation KW - behavioral therapy KW - mental health apps N2 - Background: Low-income pregnant patients are at high risk of postpartum depression (PPD). Mothers and Babies (MB) is a cognitive behavioral therapy?based program that prevents up to 50% of de novo PPD when provided in person to low-income Spanish- and English-speaking people who are pregnant without depression. MB is limited by the need for trained personnel to support it. Transforming MB into a smartphone app may mitigate this key barrier. Objective: We aimed to use qualitative data from target end users to create and optimize MBapp, a novel app centered on the MB program. Methods: Draft wireframes of MBapp were created in English and Spanish with cognitive behavioral therapy?based modules adapted from MB. These wireframes included several features shown previously to sustain app engagement: (1) push notifications delivered at participant-preferred times; (2) text-, graphic-, and video-based content; and (3) gamification with digital rewards for app engagement. English- or Spanish-speaking individuals with public health insurance who were between 32 weeks gestation and 6 months post partum and owned smartphones were eligible to consent for individual in-depth interviews. Individuals with prior or current depression were excluded. Interviews were recorded, transcribed, and analyzed using deductive and inductive codes to characterize opinions about MBapp and perceptions of challenges and facilitators of use of MBapp or other perinatal or mental health apps. End user feedback led to major modifications to the wireframes. Each of these changes was categorized according to the FRAME (Framework for Modification and Adaptation), an established method of systematically reporting adaptations and modifications to evidence-based interventions via end user feedback. Recruitment ceased with content saturation, defined as 3 successive participants providing only positive feedback on MBapp?s wireframe, without further suggestions for improvement. Results: A total of 25 interviews were completed. Participants were racially and ethnically diverse, generally representing our target end user population, and 48% (n=12) of interviews were conducted in Spanish. Participants? suggestions to improve MBapp were categorized within the FRAME as adaptations that improved either content or context to optimize reach, retention, engagement, and fit for end users. Specifically, the following features were added to MBapp secondary to end user feedback: (1) audio narration; (2) ?ask a clinician? nonurgent questions; (3) on-demand module summaries accessible upon module completion; and (4) choice to defer assessments and start the next module. Participants also provided insights into features of perinatal or mental health apps they found appealing or unappealing to understand preferences, challenges, and negotiables or nonnegotiables for MBapp. Conclusions: Adapting MBapp to incorporate end users? perspectives optimized our digital PPD prevention intervention, ideally increasing its appeal to future users. Our team?s next steps will confirm that MBapp is a feasible, acceptable intervention among English- and Spanish-speaking perinatal people at risk of PPD. UR - https://humanfactors.jmir.org/2024/1/e63143 UR - http://dx.doi.org/10.2196/63143 ID - info:doi/10.2196/63143 ER - TY - JOUR AU - Gagnon, Marie-Pierre AU - Ouellet, Steven AU - Attisso, Eugène AU - Supper, Wilfried AU - Amil, Samira AU - Rhéaume, Caroline AU - Paquette, Jean-Sébastien AU - Chabot, Christian AU - Laferrière, Marie-Claude AU - Sasseville, Maxime PY - 2024/12/9 TI - Wearable Devices for Supporting Chronic Disease Self-Management: Scoping Review JO - Interact J Med Res SP - e55925 VL - 13 KW - chronic diseases KW - self-care KW - self-management KW - empowerment KW - mobile health KW - mHealth KW - wearable KW - devices KW - scoping KW - review KW - mobile phone KW - PRISMA N2 - Background: People with chronic diseases can benefit from wearable devices in managing their health and encouraging healthy lifestyle habits. Wearables such as activity trackers or blood glucose monitoring devices can lead to positive health impacts, including improved physical activity adherence or better management of type 2 diabetes. Few literature reviews have focused on the intersection of various chronic diseases, the wearable devices used, and the outcomes evaluated in intervention studies, particularly in the context of primary health care. Objective: This study aims to identify and describe (1) the chronic diseases represented in intervention studies, (2) the types or combinations of wearables used, and (3) the health or health care outcomes assessed and measured. Methods: We conducted a scoping review following the Joanna Briggs Institute guidelines, searching the MEDLINE and Web of Science databases for studies published between 2012 and 2022. Pairs of reviewers independently screened titles and abstracts, applied the selection criteria, and performed full-text screening. We included interventions using wearables that automatically collected and transmitted data to adult populations with at least one chronic disease. We excluded studies with participants with only a predisposition to develop a chronic disease, hospitalized patients, patients with acute diseases, patients with active cancer, and cancer survivors. We included randomized controlled trials and cohort, pretest-posttest, observational, mixed methods, and qualitative studies. Results: After the removal of 1987 duplicates, we screened 4540 titles and abstracts. Of the remaining 304 articles after exclusions, we excluded 215 (70.7%) full texts and included 89 (29.3%). Of these 89 texts, 10 (11%) were related to the same interventions as those in the included studies, resulting in 79 studies being included. We structured the results according to chronic disease clusters: (1) diabetes, (2) heart failure, (3) other cardiovascular conditions, (4) hypertension, (5) multimorbidity and other combinations of chronic conditions, (6) chronic obstructive pulmonary disease, (7) chronic pain, (8) musculoskeletal conditions, and (9) asthma. Diabetes was the most frequent health condition (18/79, 23% of the studies), and wearable activity trackers were the most used (42/79, 53% of the studies). In the 79 included studies, 74 clinical, 73 behavioral, 36 patient technology experience, 28 health care system, and 25 holistic or biopsychosocial outcomes were reported. Conclusions: This scoping review provides an overview of the wearable devices used in chronic disease self-management intervention studies, revealing disparities in both the range of chronic diseases studied and the variety of wearable devices used. These findings offer researchers valuable insights to further explore health care outcomes, validate the impact of concomitant device use, and expand their use to other chronic diseases. Trial Registration: Open Science Framework Registries (OSF) s4wfm; https://osf.io/s4wfm UR - https://www.i-jmr.org/2024/1/e55925 UR - http://dx.doi.org/10.2196/55925 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55925 ER - TY - JOUR AU - Wetzel, Anna-Jasmin AU - Preiser, Christine AU - Müller, Regina AU - Joos, Stefanie AU - Koch, Roland AU - Henking, Tanja AU - Haumann, Hannah PY - 2024/12/9 TI - Unveiling Usage Patterns and Explaining Usage of Symptom Checker Apps: Explorative Longitudinal Mixed Methods Study JO - J Med Internet Res SP - e55161 VL - 26 KW - self-triage KW - eHealth KW - self-diagnosis KW - mHealth KW - mobile health KW - usage KW - patterns KW - predicts KW - prediction KW - symptoms checker KW - apps KW - applications KW - explorative longitudinal study KW - self care KW - self management KW - self-rated KW - mixed method KW - circumstances KW - General Linear Mixed Models KW - GLMM KW - qualitative data KW - content analysis KW - Kuckartz KW - survey KW - participants KW - users N2 - Background: Symptom checker apps (SCA) aim to enable individuals without medical training to classify perceived symptoms and receive guidance on appropriate actions, such as self-care or seeking professional medical attention. However, there is a lack of detailed understanding regarding the contexts in which individuals use SCA and their opinions on these tools. Objective: This mixed methods study aims to explore the circumstances under which medical laypeople use SCA and to identify which aspects users find noteworthy after using SCA. Methods: A total of 48 SCA users documented their medical symptoms, provided open-ended responses, and recorded their SCA use along with other variables over 6 weeks in a longitudinal study. Generalized linear mixed models with and those without regularization were applied to consider the hierarchical structure of the data, and the models? outcomes were evaluated for comparison. Qualitative data were analyzed through Kuckartz qualitative content analysis. Results: Significant predictors of SCA use included the initial occurrence of symptoms, day of measurement (odds ratio [OR] 0.97), self-rated health (OR 0.80, P<.001), and the following International Classification in Primary Care-2?classified symptoms, that are general and unspecified (OR 3.33, P<.001), eye (OR 5.56, P=.001), cardiovascular (OR 8.33, P<.001), musculoskeletal (OR 5.26, P<.001), and skin (OR 4.76, P<.001). The day of measurement and self-rated health showed minor importance due to their small effect sizes. Qualitative analysis highlighted four main themes: (1) reasons for using SCA, (2) diverse affective responses, (3) a broad spectrum of behavioral reactions, and (4) unmet needs including a lack of personalization. Conclusions: The emergence of new and unfamiliar symptoms was a strong determinant for SCA use. Specific International Classification in Primary Care?rated symptom clusters, particularly those related to cardiovascular, eye, skin, general, and unspecified symptoms, were also highly predictive of SCA use. The varied applications of SCA fit into the concept of health literacy as bricolage, where SCA is leveraged as flexible tools by patients based on individual and situational requirements, functioning alongside other health care resources. UR - https://www.jmir.org/2024/1/e55161 UR - http://dx.doi.org/10.2196/55161 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55161 ER - TY - JOUR AU - Lee, Ting-Yi AU - Chen, Ching-Hsuan AU - Chen, I-Ming AU - Chen, Hsi-Chung AU - Liu, Chih-Min AU - Wu, Shu-I AU - Hsiao, Kate Chuhsing AU - Kuo, Po-Hsiu PY - 2024/12/6 TI - Dynamic Bidirectional Associations Between Global Positioning System Mobility and Ecological Momentary Assessment of Mood Symptoms in Mood Disorders: Prospective Cohort Study JO - J Med Internet Res SP - e55635 VL - 26 KW - ecological momentary assessment KW - digital phenotyping KW - GPS mobility KW - bipolar disorder KW - major depressive disorder KW - GPS KW - global positioning system KW - mood disorders KW - assessment KW - depression KW - anxiety KW - digital phenotype KW - smartphone app KW - technology KW - behavioral changes KW - patient KW - monitoring N2 - Background: Although significant research has explored the digital phenotype in mood disorders, the time-lagged and bidirectional relationship between mood and global positioning system (GPS) mobility remains relatively unexplored. Leveraging the widespread use of smartphones, we examined correlations between mood and behavioral changes, which could inform future scalable interventions and personalized mental health monitoring. Objective: This study aims to investigate the bidirectional time lag relationships between passive GPS data and active ecological momentary assessment (EMA) data collected via smartphone app technology. Methods: Between March 2020 and May 2022, we recruited 45 participants (mean age 42.3 years, SD 12.1 years) who were followed up for 6 months: 35 individuals diagnosed with mood disorders referred by psychiatrists and 10 healthy control participants. This resulted in a total of 5248 person-days of data. Over 6 months, we collected 2 types of smartphone data: passive data on movement patterns with nearly 100,000 GPS data points per individual and active data through EMA capturing daily mood levels, including fatigue, irritability, depressed, and manic mood. Our study is limited to Android users due to operating system constraints. Results: Our findings revealed a significant negative correlation between normalized entropy (r=?0.353; P=.04) and weekly depressed mood as well as between location variance (r=?0.364; P=.03) and depressed mood. In participants with mood disorders, we observed bidirectional time-lagged associations. Specifically, changes in homestay were positively associated with fatigue (?=0.256; P=.03), depressed mood (?=0.235; P=.01), and irritability (?=0.149; P=.03). A decrease in location variance was significantly associated with higher depressed mood the following day (?=?0.015; P=.009). Conversely, an increase in depressed mood was significantly associated with reduced location variance the next day (?=?0.869; P<.001). These findings suggest a dynamic interplay between mood symptoms and mobility patterns. Conclusions: This study demonstrates the potential of utilizing active EMA data to assess mood levels and passive GPS data to analyze mobility behaviors, with implications for managing disease progression in patients. Monitoring location variance and homestay can provide valuable insights into this process. The daily use of smartphones has proven to be a convenient method for monitoring patients? conditions. Interventions should prioritize promoting physical movement while discouraging prolonged periods of staying at home. UR - https://www.jmir.org/2024/1/e55635 UR - http://dx.doi.org/10.2196/55635 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55635 ER - TY - JOUR AU - Alves, A. Sónia AU - Temme, Steffen AU - Motamedi, Seyedamirhosein AU - Kura, Marie AU - Weber, Sebastian AU - Zeichen, Johannes AU - Pommer, Wolfgang AU - Baumgart, André PY - 2024/12/4 TI - Evaluating the Prognostic and Clinical Validity of the Fall Risk Score Derived From an AI-Based mHealth App for Fall Prevention: Retrospective Real-World Data Analysis JO - JMIR Aging SP - e55681 VL - 7 KW - falls KW - older adults KW - mHealth KW - prognostic tool KW - clinical validity KW - AI KW - mobile health KW - artificial intelligence N2 - Background: Falls pose a significant public health concern, with increasing occurrence due to the aging population, and they are associated with high mortality rates and risks such as multimorbidity and frailty. Falls not only lead to physical injuries but also have detrimental psychological and social consequences, negatively impacting quality of life. Identifying individuals at high risk for falls is crucial, particularly for those aged ?60 years and living in residential care settings; current professional guidelines favor personalized, multifactorial fall risk assessment approaches for effective fall prevention. Objective: This study aimed to explore the prognostic validity of the Fall Risk Score (FRS), a multifactorial-based metric to assess fall risk (using longitudinal real-world data), and establish the clinical relevance of the FRS by identifying threshold values and the minimum clinically important differences. Methods: This retrospective cohort study involved 617 older adults (857 observations: 615 of women, 242 of men; mean age 83.3, SD 8.7 years; mean gait speed 0.49, SD 0.19 m/s; 622 using walking aids) residing in German residential care facilities and used the LINDERA mobile health app for fall risk assessment. The study focused on the association between FRS at the initial assessment (T1) and the normalized number of falls at follow-up (T2). A quadratic regression model and Spearman correlation analysis were utilized to analyze the data, supported by descriptive statistics and subgroup analyses. Results: The quadratic model exhibited the lowest root mean square error (0.015), and Spearman correlation analysis revealed that a higher FRS at T1 was linked to an increased number of falls at T2 (?=0.960, P<.001). Subgroups revealed significant strong correlations between FRS at T1 and falls at T2, particularly for older adults with slower gait speeds (?=0.954, P<.001) and those using walking aids (?=0.955, P<.001). Threshold values revealed that an FRS of 45%, 32%, and 24% corresponded to the expectation of a fall within 6, 12, and 24 months, respectively. Distribution-based minimum clinically important difference values were established, providing ranges for small, medium, and large effect sizes for FRS changes. Conclusions: The FRS exhibits good prognostic validity for predicting future falls, particularly in specific subgroups. The findings support a stratified fall risk assessment approach and emphasize the significance of early and personalized intervention. This study contributes to the knowledge base on fall risk, despite limitations such as demographic focus and potential assessment interval variability. UR - https://aging.jmir.org/2024/1/e55681 UR - http://dx.doi.org/10.2196/55681 ID - info:doi/10.2196/55681 ER - TY - JOUR AU - Ikäheimonen, Arsi AU - Luong, Nguyen AU - Baryshnikov, Ilya AU - Darst, Richard AU - Heikkilä, Roope AU - Holmen, Joel AU - Martikkala, Annasofia AU - Riihimäki, Kirsi AU - Saleva, Outi AU - Isometsä, Erkki AU - Aledavood, Talayeh PY - 2024/12/3 TI - Predicting and Monitoring Symptoms in Patients Diagnosed With Depression Using Smartphone Data: Observational Study JO - J Med Internet Res SP - e56874 VL - 26 KW - data analysis KW - digital phenotyping KW - digital behavioral data KW - depression symptoms KW - depression monitoring KW - mHealth KW - mobile health KW - smartphone KW - mobile phone N2 - Background: Clinical diagnostic assessments and the outcome monitoring of patients with depression rely predominantly on interviews by professionals and the use of self-report questionnaires. The ubiquity of smartphones and other personal consumer devices has prompted research into the potential of data collected via these devices to serve as digital behavioral markers for indicating the presence and monitoring of the outcome of depression. Objective: This paper explores the potential of using behavioral data collected with smartphones to detect and monitor depression symptoms in patients diagnosed with depression. Specifically, it investigates whether this data can accurately classify the presence of depression, as well as monitor the changes in depressive states over time. Methods: In a prospective cohort study, we collected smartphone behavioral data for up to 1 year. The study consists of observations from 164 participants, including healthy controls (n=31) and patients diagnosed with various depressive disorders: major depressive disorder (MDD; n=85), MDD with comorbid borderline personality disorder (n=27), and major depressive episodes with bipolar disorder (n=21). Data were labeled based on depression severity using 9-item Patient Health Questionnaire (PHQ-9) scores. We performed statistical analysis and used supervised machine learning on the data to classify the severity of depression and observe changes in the depression state over time. Results: Our correlation analysis revealed 32 behavioral markers associated with the changes in depressive state. Our analysis classified patients who are depressed with an accuracy of 82% (95% CI 80%-84%) and change in the presence of depression with an accuracy of 75% (95% CI 72%-76%). Notably, the most important smartphone features for classifying depression states were screen-off events, battery charge levels, communication patterns, app usage, and location data. Similarly, for predicting changes in depression state, the most important features were related to location, battery level, screen, and accelerometer data patterns. Conclusions: The use of smartphone digital behavioral markers to supplement clinical evaluations may aid in detecting the presence and changes in severity of symptoms of depression, particularly if combined with intermittent use of self-report of symptoms. UR - https://www.jmir.org/2024/1/e56874 UR - http://dx.doi.org/10.2196/56874 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56874 ER - TY - JOUR AU - Gnadlinger, Florian AU - Werminghaus, Maika AU - Selmanagi?, André AU - Filla, Tim AU - Richter, G. Jutta AU - Kriglstein, Simone AU - Klenzner, Thomas PY - 2024/12/3 TI - Incorporating an Intelligent Tutoring System Into a Game-Based Auditory Rehabilitation Training for Adult Cochlear Implant Recipients: Algorithm Development and Validation JO - JMIR Serious Games SP - e55231 VL - 12 KW - cochlear implant KW - eHealth KW - evidence-centered design KW - hearing rehabilitation KW - adaptive learning KW - intelligent tutoring system KW - game-based learning N2 - Background: Cochlear implants are implanted hearing devices; instead of amplifying sounds like common hearing aids, this technology delivers preprocessed sound information directly to the hearing (ie, auditory) nerves. After surgery and the first cochlear implant activation, patients must practice interpreting the new auditory sensations, especially for language comprehension. This rehabilitation process is accompanied by hearing therapy through face-to-face training with a therapist, self-directed training, and computer-based auditory training. Objective: In general, self-directed, computer-based auditory training tasks have already shown advantages. However, compliance of cochlear implant recipients is still a major factor, especially for self-directed training at home. Hence, we aimed to explore the combination of 2 techniques to enhance learner motivation in this context: adaptive learning (in the form of an intelligent tutoring system) and game-based learning (in the form of a serious game). Methods: Following the suggestions of the evidence-centered design framework, a domain analysis of hearing therapy was conducted, allowing us to partially describe human hearing skill as a probabilistic competence model (Bayesian network). We developed an algorithm that uses such a model to estimate the current competence level of a patient and create training recommendations. For training, our developed task system was based on 7 language comprehension task types that act as a blueprint for generating tasks of diverse difficulty automatically. To achieve this, 1053 audio assets with meta-information labels were created. We embedded the adaptive task system into a graphic novel?like mobile serious game. German-speaking cochlear implant recipients used the system during a feasibility study for 4 weeks. Results: The 23 adult participants (20 women; 3 men) fulfilled 2259 tasks. In total, 2004 (90.5%) tasks were solved correctly, and 255 (9.5%) tasks were solved incorrectly. A generalized additive model analysis of these tasks indicated that the system adapted to the estimated competency levels of the cochlear implant recipients more quickly in the beginning than at the end. Compared with a uniform distribution of all task types, the recommended task types differed (?²6=86.713; P<.001), indicating that the system selected specific task types for each patient. This is underlined by the identified categories for the error proportions of the task types. Conclusions: This contribution demonstrates the feasibility of combining an intelligent tutoring system with a serious game in cochlear implant rehabilitation therapies. The findings presented here could lead to further advances in cochlear implant care and aural rehabilitation in general. Trial Registration: German Clinical Trials Register (DRKS) DRKS00022860; https://drks.de/search/en/trial/DRKS00022860 UR - https://games.jmir.org/2024/1/e55231 UR - http://dx.doi.org/10.2196/55231 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55231 ER - TY - JOUR AU - Luo, Lingzi AU - Li, Gen AU - Tang, Weiming AU - Wu, Dan AU - Hall, Brian PY - 2024/12/2 TI - Intention to Seek Mental Health Services During the 2022 Shanghai COVID-19 City-Wide Lockdown: Web-Based Cross-Sectional Study JO - JMIR Form Res SP - e51470 VL - 8 KW - COVID-19 KW - mental health services KW - intention KW - mobile KW - digital KW - lockdowns KW - depression KW - anxiety KW - help-seeking KW - regression KW - applications KW - mHealth KW - WeChat KW - pandemic KW - social isolation KW - mental health KW - intent KW - outbreak KW - SARS-CoV-2 KW - survey KW - usage KW - service N2 - Background: The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population?s intention to use mental health services during this time. Objective: This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services. Methods: An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes?mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]). Results: The analytical sample comprised 3230 respondents, among whom 29.7% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3%, n=728). Only 10.9% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19?related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders. Conclusions: Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations. UR - https://formative.jmir.org/2024/1/e51470 UR - http://dx.doi.org/10.2196/51470 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51470 ER - TY - JOUR AU - Nong, Thu Trang Thi AU - Nguyen, Hoang Giang AU - Lepe, Alexander AU - Tran, Bich Thuy AU - Nguyen, Phuong Lan Thi AU - Koot, R. Jaap A. PY - 2024/12/2 TI - Challenges and Opportunities in Digital Screening for Hypertension and Diabetes Among Community Groups of Older Adults in Vietnam: Mixed Methods Study JO - J Med Internet Res SP - e54127 VL - 26 KW - NCD screening KW - DHIS2 tracker KW - District Health Information Software, version 2 tracker KW - digital application KW - ISHC health volunteers KW - non-communicable diseases KW - prevention KW - Vietnam KW - mobile phone N2 - Background: The project of scaling up noncommunicable disease (NCD) interventions in Southeast Asia aimed to strengthen the prevention and control of hypertension and diabetes, focusing on primary health care and community levels. In Vietnam, health volunteers who were members of the Intergenerational Self-Help Clubs (ISHCs) implemented community-based NCD screening and health promotion activities in communities. The ISHC health volunteers used an app based on District Health Information Software, version 2 (DHIS2) tracker (Society for Health Information Systems Programmes, India) to record details of participants during screening and other health activities. Objective: This study aimed to assess the strengths, barriers, and limitations of the NCD screening app used by the ISHC health volunteers on tablets and to provide recommendations for further scaling up. Methods: A mixed methods observational study with a convergent parallel design was performed. For the quantitative data analysis, 2 rounds of screening data collected from all 59 ISHCs were analyzed on completeness and quality. For the qualitative analysis, 2 rounds of evaluation of the screening app were completed. Focus group discussions with ISHC health volunteers and club management boards and in-depth interviews with members of the Association of the Elderly and Commune Health Station staff were performed. Results: In the quantitative analysis, data completeness of all 6704 screenings (n=3485 individuals) was very high. For anthropomorphic measurements, such as blood pressure, body weight, and abdominal circumference, less than 1% errors were found. The data on NCD risk factors were not adequately recorded in 1908 (29.5%) of the screenings. From the qualitative analysis, the NCD screening app was appreciated by ISHC health volunteers and supervisors, as an easier and more efficient way to report to higher levels, secure data, and strengthen relationships with relevant stakeholders, using tablets to connect to the internet and internet-based platforms to access information for self-learning and sharing to promote a healthy lifestyle as the strengths. The barriers and limitations reported by the respondents were a non?age-friendly app, incomplete translation of parts of the app into Vietnamese, some issues with the tablet?s display, lack of sharing of responsibilities among the health volunteers, and suboptimal involvement of the health sector; limited digital literacy among ISHC health volunteers. Recommendations are continuous capacity building, improving app issues, improving tablet issues, and involving relevant stakeholders or younger members in technology adoption to support older people. Conclusions: The implementation of the NCD screening app by ISHC volunteers can be an effective way to improve community-led NCD screening and increase the uptake of NCD prevention and management services at the primary health care level. However, our study has shown that some barriers need to be addressed to maximize the efficient use of the app by ISHC health volunteers to record, report, and manage the screening data. UR - https://www.jmir.org/2024/1/e54127 UR - http://dx.doi.org/10.2196/54127 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54127 ER - TY - JOUR AU - Oh, Taek Kyue AU - Ko, Jisu AU - ­Jin, Nayoung AU - Han, Sangbin AU - Yoon, Yul Chan AU - Shin, Jaemyung AU - Ko, Minsam PY - 2024/11/29 TI - Understanding Morning Emotions by Analyzing Daily Wake-Up Alarm Usage: Longitudinal Observational Study JO - JMIR Hum Factors SP - e50835 VL - 11 KW - morning emotion KW - wake-up alarm usage KW - morning context KW - emotion monitoring KW - longitudinal observational study N2 - Background: Morning emotions can significantly affect daily wellness. While many studies have analyzed daily survey responses to identify factors influencing morning emotions, these methods require additional time and effort from individuals for emotional monitoring. Objective: This study aims to identify daily alarm usage patterns related to morning emotions. Methods: We recruited 373 users of the Alarmy app (DelightRoom) in the United States and South Korea and surveyed their demographics and usual behaviors related to morning emotions. Participants described their morning emotions over a 2-week period, during which we collected daily alarm app logs. We used a generalized estimating equation (GEE) method to identify factors affecting morning emotions. Results: The findings indicate that varied alarm usage is related to morning emotions. Alarm set time was positively associated with feelings of peacefulness and refreshment in the morning, while task-based alarms were related to nervousness. The time taken to deactivate the alarm after it rang was negatively correlated with happiness. In addition, usual behaviors and demographic factors were found to be related to morning emotions, consistent with previous studies. Conclusions: The study reveals that daily alarm usage is related to morning emotions, suggesting that daily alarm logs can supplement survey methods to facilitate daily emotion monitoring. UR - https://humanfactors.jmir.org/2024/1/e50835 UR - http://dx.doi.org/10.2196/50835 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50835 ER - TY - JOUR AU - Nakagomi, Atsushi AU - Abe, Noriyuki AU - Chen, Yu-Ru AU - Ide, Kazushige AU - Kobayashi, Shuhei AU - Hanazato, Masamichi AU - Kondo, Katsunori PY - 2024/11/29 TI - Messenger App?Based Information Provision for Promoting Social Participation to Enhance Well-Being Among Community-Dwelling Adults: Randomized Controlled Trial JO - J Med Internet Res SP - e57205 VL - 26 KW - messenger app KW - event information KW - happiness KW - social participation KW - messenger KW - app KW - well-being KW - adults KW - aging KW - randomized controlled trial KW - RCT KW - information technology KW - social activity KW - Japan KW - urban community KW - health information KW - control group KW - multivariable regression KW - life satisfaction KW - digital intervention KW - community-dwelling N2 - Background: Engaging in social activities, interacting with peers, and participating in community events may promote health and well-being. Recently, interventions leveraging information and communications technology have emerged as potent tools for promoting social connections and well-being. Particularly, messenger apps have become an integral part of our daily lives, facilitating communication, information dissemination, and social interaction. However, there remains a gap in the literature regarding the utilization of widely adopted messenger apps for this purpose. Objective: This study aimed to evaluate the impact of messenger app?based information provision aimed at promoting social participation on the enhancement of subjective well-being among Japanese community-dwelling adults. Methods: A 2-arm, parallel-group randomized controlled trial was conducted from October 2022 to January 2023 in the Kashiwa-no-ha campus area, Japan?an urban community with active local events. A total of 358 community-dwelling adults who use messenger apps daily were recruited for the study. Of these, 235 (65.6%) participants completed the follow-up survey. Participants were randomly assigned to either the intervention group, receiving the health benefits of social participation and information about local events or spots via a messenger app, or the control group, receiving general health information. The primary outcome was subjective happiness after the intervention, measured on an 11-point scale ranging from 0 (Unhappy) to 10 (Happy). Secondary outcomes included life satisfaction, meaning of life, purpose in life, and participation in local events. The outcomes were analyzed with t tests (2-tailed) and multivariable regression based on the intention-to-treat method. Results: After the intervention, the intervention group reported a mean happiness score of 7.7 (SD 1.7), while the control group reported a score of 7.5 (SD 2.0), with no statistically significant difference (P=.40). Multivariable linear regression analysis adjusted for baseline outcome values and covariates showed that the coefficient of the intervention for life satisfaction was 0.30 (95% CI ?0.07 to 0.68; P=.12), while that for meaning of life was 0.33 (95% CI ?0.03 to 0.70; P=.07). There was no significant difference in event participation rates between the 2 groups during the study period (P=.22). However, 82.2% (102/124) of the intervention group acknowledged the utility of the event information provided. Conclusions: Messenger app?based information provision did not yield a significant increase in subjective happiness, while there was a positive but not significant trend in life satisfaction. The findings underscore the need for more intensive intervention in future studies to harness the potential of digital interventions. Trial Registration: UMIN Clinical Trials Registry UMIN000049047; https://tinyurl.com/2zzrrae8 UR - https://www.jmir.org/2024/1/e57205 UR - http://dx.doi.org/10.2196/57205 UR - http://www.ncbi.nlm.nih.gov/pubmed/39612209 ID - info:doi/10.2196/57205 ER - TY - JOUR AU - Brügger, Victoria AU - Kowatsch, Tobias AU - Jovanova, Mia PY - 2024/11/28 TI - Wearables and Smartphones for Tracking Modifiable Risk Factors in Metabolic Health: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e59539 VL - 13 KW - wearable KW - smartphone KW - mHealth KW - metabolic disease KW - lifestyle KW - physiological KW - risk factor KW - mobile phone N2 - Background: Metabolic diseases, such as cardiovascular diseases and diabetes, contribute significantly to global mortality and disability. Wearable devices and smartphones are increasingly used to track and manage modifiable risk factors associated with metabolic diseases. However, no established guidelines exist on how to derive meaningful signals from these devices, often hampering cross-study comparisons. Objective: This study aims to systematically overview the current empirical literature on how wearables and smartphones are used to track modifiable (physiological and lifestyle) risk factors associated with metabolic diseases. Methods: We will conduct a scoping review to overview how wearable and smartphone-based studies measure modifiable risk factors related to metabolic diseases. We will search 5 databases (Scopus, Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and SPORTDiscus) from 2019 to 2024, with search terms related to wearables, smartphones, and modifiable risk factors associated with metabolic diseases. Eligible studies will use smartphones or wearables (worn on the wrist, finger, arm, hip, and chest) to track physiological or lifestyle factors related to metabolic diseases. We will follow the reporting guideline standards from PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) guidance on scoping review methodology. Two reviewers will independently screen articles for inclusion and extract data using a standardized form. The findings will be synthesized and reported qualitatively and quantitatively. Results: Data collection is expected to begin in November 2024; data analysis in the first quarter of 2025; and submission to a peer-reviewed journal by the second quarter of 2025. We expect to identify the degree to which wearable and smartphone-based studies track modifiable risk factors collectively (versus in isolation), and the consistency and variation in how modifiable risk factors are measured across existing studies. Conclusions: Results are expected to inform more standardized guidelines on wearable and smartphone-based measurements, with the goal of aiding cross-study comparison. The final report is planned for submission to a peer-reviewed, indexed journal. This review is among the first to systematically overview the current landscape on how wearables and smartphones measure modifiable risk factors associated with metabolic diseases. International Registered Report Identifier (IRRID): PRR1-10.2196/59539 UR - https://www.researchprotocols.org/2024/1/e59539 UR - http://dx.doi.org/10.2196/59539 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59539 ER - TY - JOUR AU - Chiou, Piao-Yi AU - Tsao, Wei-Wen AU - Li, Chia-Lin AU - Yu, Jheng-Min AU - Su, Wen-Han AU - Liu, Zhi-Hua AU - He, Cheng-Ru AU - Chang, Yu-Chun AU - Tsai, Yi-Hsuan PY - 2024/11/28 TI - Recruitment for Voluntary Video and Mobile HIV Testing on Social Media Platforms During the COVID-19 Pandemic: Cross-Sectional Study JO - J Med Internet Res SP - e54420 VL - 26 KW - COVID-19 KW - HIV testing KW - mobile health KW - risk-taking behavior KW - social media KW - video KW - mobile phone N2 - Background: The COVID-19 pandemic prompted social distancing policies and caused misinformation that hindered in-person HIV screening for high-risk groups. Social media platforms provide additional options for voluntary counseling and testing (VCT) for HIV, overcoming these limitations. However, there is a lack of data on HIV testing recruitment through social media platforms and its outcomes during the pandemic. Objective: This study aimed to measure the rate of face-to-face mobile and video VCT conducted after recruitment through social media platforms and friend referrals during the pandemic and compare the geographic distribution, risk feature targeting, testing outcome, and cost between the 2 models. Methods: Data were collected from March 3 to December 31, 2021, during the COVID-19 outbreak in Taiwan. Participants engaging in unprotected sex were recruited. After one-on-one message discussions through the platforms, the well-trained research assistants provided mobile or video VCT based on the participants? availability. Primary outcomes were completion rate, testing results, and CD4 count. Secondary outcomes included demographic and HIV risk-taking and protective features from a questionnaire. Selection bias was controlled by adjusting for the testing site (Taipei vs non-Taipei) using univariable multinomial logistic regression. Results: This study gathered 5142 responses on the social media platforms, recruiting 1187 participants. Video VCT had a completion rate of 31.8% (207/651), higher than mobile VCT?s 21.8% (980/4491). Both rates were higher than those before the COVID-19 pandemic. Recruitment through friend referrals, instant messaging apps (eg, Line [LY Corporation]), and geosocial dating apps (eg, Hornet [Queer Networks Inc], Grindr [Grindr LLC], and Gsland [Tien-Hao Tsai]) resulted in higher acceptance and completion rates than social networks (eg, Facebook [Meta], X [formerly Twitter], and Instagram [Meta]). Mobile VCT had higher recruitment among urban residents and screening density, while video VCT reached a broader geographic area. The mobile group was more likely to have had more than 10 sexual partners (odds ratio [OR] 1.92, 95% CI 1.05-3.50; P=.03), history of sex work (OR 4.19, 95% CI 1.68-10.43; P=.002), and sexually transmitted diseases (OR 2.23, 95% CI 1.18-4.23; P=.01) within the past 3 months. The video group was more likely to meet sexual partners through social media. The HIV-positive rate in the mobile group was 0.7% (7/973) with an average CD4 count of 460/?L, while in the video group, it was 1% (2/205) with an average CD4 count of 347/?L, indicating a later diagnosis. Both positivity rates were higher than those before the COVID-19 pandemic, with no significant difference between the groups. The video group cost US $54.68 per participant, slightly higher than the US $50.36 for the mobile group. Conclusions: Recruiting through social media platforms that facilitate one-on-one message discussions can effectively target high-risk groups for mobile and video VCT. This approach should be integrated into the current screening model to enhance HIV case finding. UR - https://www.jmir.org/2024/1/e54420 UR - http://dx.doi.org/10.2196/54420 UR - http://www.ncbi.nlm.nih.gov/pubmed/39607762 ID - info:doi/10.2196/54420 ER - TY - JOUR AU - Wang, Ruijing AU - Rezaeian, Olya AU - Asan, Onur AU - Zhang, Linghan AU - Liao, Ting PY - 2024/11/27 TI - Relationship Between Heart Rate and Perceived Stress in Intensive Care Unit Residents: Exploratory Analysis Using Fitbit Data JO - JMIR Form Res SP - e60759 VL - 8 KW - stress KW - perceived stress KW - heart rate KW - Fitbit KW - wearable KW - provider KW - occupational health KW - resident KW - trainee KW - physician KW - health care worker KW - intensive care unit KW - secondary data analysis KW - mental health KW - self-reported N2 - Background: Intensive care unit (ICU) residents are exposed to high stress levels due to the intense nature of their work, which can impact their mental health and job performance. Heart rate measured through wearable devices has the potential to provide insights into residents? self-reported stress and aid in developing targeted interventions. Objective: This exploratory study aims to analyze continuous heart rate data and self-reported stress levels and stressors in ICU residents to examine correlations between physiological responses, stress levels, and daily stressors reported. Methods: A secondary data analysis was conducted on heart rate measurements and stress assessments collected from 57 ICU residents over a 3-week period using Fitbit Charge 3 devices. These devices captured continuous physiological data alongside daily surveys that assessed stress levels and identified stressors. The study used Spearman rank correlation, point-biserial correlation analysis, 2-tailed paired t tests, and mixed-effect models to analyze the relationship between heart rate features and stress indicators. Results: The findings reveal complex interactions between stress levels and heart rate patterns. The correlation analysis between stress levels and median heart rate values across different percentile ranges showed that lower percentile heart rates (bottom 5%, 10%, 25%, and 50%) had modest correlations with stress, whereas higher percentiles (top 50%, 25%, 10%, and 5%) did not correlate significantly (all P>.05). The 2-tailed paired t test indicated significant differences in stress levels reported in midday versus end-of-day surveys (P<.001), although these changes in stress levels were not consistently reflected in heart rate patterns. Additionally, we explored and found that stressors related to ?other health? issues had the highest positive correlation with stress level changes from midday to end-of-day surveys. However, the weak effect of these stressors on peak heart rate suggests that their impact on physiological measures like heart rate is not yet clear. According to our mixed-effects model, stress levels significantly influenced heart rate variations when hierarchical data were taken into account (P=.03), meaning that as the stress level increased, there was a significant increase in mean heart rate. Conclusions: This study highlights the complexity of using heart rate as an indicator of stress, particularly in high-stress environments like the ICU. Our findings suggest that while heart rate is found to correlate with self-reported stress in the mixed-effect model, its impact is modest, and it should be combined with other physiological and psychological measures to obtain a more accurate and comprehensive assessment of residents? stress levels. UR - https://formative.jmir.org/2024/1/e60759 UR - http://dx.doi.org/10.2196/60759 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60759 ER - TY - JOUR AU - Valentine, Lee AU - Arnold, Chelsea AU - Nicholas, Jennifer AU - Castagnini, Emily AU - Malouf, Jessi AU - Alvarez-Jimenez, Mario AU - Bell, H. Imogen PY - 2024/11/27 TI - A Personalized, Transdiagnostic Smartphone App (Mello) Targeting Repetitive Negative Thinking for Depression and Anxiety: Qualitative Analysis of Young People?s Experience JO - J Med Internet Res SP - e63732 VL - 26 KW - repetitive negative thinking KW - rumination KW - anxiety KW - depression KW - mobile app KW - just-in-time adaptive interventions KW - youth mental health KW - adolescent KW - mobile phone N2 - Background: The increasing rates of mental health challenges among young people highlight an urgent need for accessible and effective treatment. However, current mental health systems face unprecedented demand, leaving most young people globally with unmet mental health needs. Smartphones present a promising solution to this issue by offering in-the-moment support through innovative just-in-time adaptive interventions, which provide support based on real-time data. Objective: This study explores young people?s experiences with Mello, a just-in-time adaptive intervention that focuses on the transdiagnostic mechanism of repetitive negative thinking (RNT), a significant factor contributing to youth depression and anxiety. Methods: Semistructured qualitative interviews were conducted with 15 participants aged 16 to 25 years, all of whom had previously participated in a pilot randomized controlled trial of Mello. Of the 15 participants, 9 (60%) identified as women, 4 (27%) as men (including 1 transgender man), and 2 (13%) as nonbinary. Interviews focused on participants? experiences with the Mello app, factors influencing engagement, perceived benefits and limitations, and suggestions for future improvements. Thematic analysis was used to analyze the data. Results: The analysis identified three superordinate themes: Mello as a tool for intentional reflection; doing therapy your own way; and barriers to engagement during low mood, anxiety, and RNT. Theme 1 explored young people?s experiences of how the app facilitated active management of negative thoughts and supported the development of reflective habits, contrasting with their typical strategies of avoidance or resistance. Theme 2 highlighted the value of the app?s self-guided nature, with a particular focus on its flexibility and accessibility, particularly when compared to traditional face-to-face therapy. Finally, theme 3 addressed barriers to engagement, particularly during emotionally difficult times, with participants reporting feeling ?stuck? in their negative thoughts. To mitigate these challenges, participants suggested incorporating gamification elements, such as progress-tracking visuals, to enhance motivation and increase engagement with the app. Conclusions: Our findings underscored the value of Mello in promoting intentional engagement and reflection with RNT, consistent with prior research that emphasizes the effectiveness of tailored interventions. Although some users valued the self-guided nature of the application, others encountered difficulties with motivation. Future research should explore strategies to enhance engagement for young people with low mood and motivation, such as co-design methodologies, advanced personalization features, and gamification techniques. UR - https://www.jmir.org/2024/1/e63732 UR - http://dx.doi.org/10.2196/63732 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63732 ER - TY - JOUR AU - Matsumura, Koichiro AU - Nakagomi, Atsushi AU - Yagi, Eijiro AU - Yamada, Nobuhiro AU - Funauchi, Yohei AU - Kakehi, Kazuyoshi AU - Yoshida, Ayano AU - Kawamura, Takayuki AU - Ueno, Masafumi AU - Nakazawa, Gaku AU - Tabuchi, Takahiro PY - 2024/11/26 TI - Impact of an mHealth App (Kencom) on Patients With Untreated Hypertension Initiating Antihypertensive Medications: Real-World Cohort Study JO - JMIR Cardio SP - e52266 VL - 8 KW - untreated hypertension KW - mobile health app KW - antihypertensive medication KW - cardiovascular disease KW - mHealth N2 - Background: To prevent the further development of cardiovascular diseases, it is a growing global priority to detect untreated hypertension in patients and ensure adequate blood pressure control via drug therapy. However, few effective tools that facilitate the initiation of antihypertensive medications among such patients have been identified. Objective: We aimed to determine whether a mobile health (mHealth) app facilitates the initiation of antihypertensive medications among patients with untreated hypertension. Methods: We analyzed a large longitudinal integrated database mainly comprised of data from middle-aged, employed people and their families. The database contained data from health checkups, health insurance claims, and the mHealth app kencom. kencom is used to manage daily life logs (eg, weight, number of steps) and to provide health information tailored to customers. Patients with untreated hypertension were identified using the baseline health checkup data, and follow-up health checkups were conducted to identify the rate of initiation of antihypertensive medications between mHealth app users and nonusers. Antihypertensive medication status was confirmed via a questionnaire administered during the medical checkup as well as a review of the health insurance claims database. We conducted a modified Poisson regression analysis, weighted by inverse probability of treatment weighting, to examine the effect of mHealth app usage on the initiation of antihypertensive medications. Additionally, data from four lifestyle questionnaires from the baseline and follow-up health checkups were collected to evaluate lifestyle modifications that could be attributed to the mHealth app. Results: Data were collected from 50,803 eligible patients (mean age 49, SD 9 years; men n=39,412, 77.6%; women n=11,391, 22.4%) with a median follow-up period of 3.0 (IQR 2.3?3.1) years. The rate of initiation of antihypertensive medications was significantly higher in the mHealth app user group than in the nonuser group: 23.4% (3482/14,879) versus 18.5% (6646/35,924; P<.001), respectively. The risk ratio of mHealth app usage for initiated antihypertensive medications was 1.28 (95% CI 1.23?1.33). Among those who did not intend to improve their lifestyle habits such as exercise and diet at baseline, the rate of lifestyle improvement at follow-up was compared between mHealth app users and nonusers, using data from the questionnaires; mHealth app users demonstrated a significantly higher rate of lifestyle changes than nonusers. Conclusions: For patients with untreated hypertension, the use of the mHealth app kencom, which was not dedicated to hypertension treatment, was associated with a higher initiation of antihypertensive medications. UR - https://cardio.jmir.org/2024/1/e52266 UR - http://dx.doi.org/10.2196/52266 ID - info:doi/10.2196/52266 ER - TY - JOUR AU - Danielson, C. Elizabeth AU - Saturday, Mystie AU - Leonard, Sarah AU - Levit, Alexandra AU - Graham, K. Andrea AU - Marquez, Melissa AU - Alperin, Keith AU - Shankman, A. Stewart AU - Griffith, W. James PY - 2024/11/26 TI - Efficacy of a Mobile App?Based Behavioral Intervention (DRIVEN) to Help Individuals With Unemployment-Related Emotional Distress Return to Work: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e62715 VL - 13 KW - unemployment KW - wellness KW - depression KW - job stress KW - job distress KW - career coaching KW - coaching KW - mhealth KW - ehealth KW - job-seeking KW - mobile app KW - behavioral intervention KW - N2 - Background: Employment plays an important role in the maintenance of mental and physical health. Losing a job creates emotional distress, which can, in turn, interfere with effective job seeking. Thus, a program for job seekers that provides support for both the logistics of job seeking as well as emotional distress may help people find employment and improve emotional well-being. Objective: This study aims to test the efficacy of the 6-week intervention for job seekers in a randomized controlled trial. Methods: This is a parallel-assignment randomized control trial comparing a 6-week return-to-work intervention versus job seeking as usual for a stratified sample of job seekers (n=150). The intervention will be delivered through a mobile phone app and scheduled video counseling sessions with a job coach. Assessments will be taken weekly during the intervention as well as 8 and 16 weeks later. The intervention and control group procedures will be administered remotely, allowing the study to take place in several regions of the United States. Eligible participants will be adults aged 18 to 65 years, currently unemployed, and actively searching for work. Participants will be recruited from 7 major metropolitan areas in the United States using online advertisements on Craigslist. The primary outcome measure is the Job Search Behavior Scale, which has 2 subscales, preparatory job search behavior and active job search behavior. Employment status will also be assessed throughout the trial. A mixed-model regression analysis will be used to compare job searching behavior in the intervention group versus the control group. A time-to-event analysis (ie, survival analysis) will be used to compare employment status in the 2 experimental groups. Secondary outcomes will also be evaluated, including job search self-efficacy and mental health-related outcomes such as anxiety and depression. Results: This study started on August 7, 2023, and as of June 2024, we have enrolled 140 participants. Enrollment began in August 2023 and will conclude by October 2024. Half of the participants (75/150, 50%) will be assigned to the intervention arm while the other half (75/150, 50%) will be assigned to the control arm, job seeking as usual. Conclusions: The findings from this study will determine the efficacy of a mobile app?based intervention that uses both job training and psychological techniques on job seeking and employment outcomes. This first trial of Distress Return-to-Work Intervention (DRIVEN) will provide important information about blended support techniques for unemployed individuals, determine the usefulness of mobile apps to address large-scale mental health outcomes, and improve our understanding of the relationship between depression and unemployment status. Trial Registration: ClinicalTrials.gov NCT06026280; https://clinicaltrials.gov/study/NCT06026280 International Registered Report Identifier (IRRID): DERR1-10.2196/62715 UR - https://www.researchprotocols.org/2024/1/e62715 UR - http://dx.doi.org/10.2196/62715 UR - http://www.ncbi.nlm.nih.gov/pubmed/39589786 ID - info:doi/10.2196/62715 ER - TY - JOUR AU - Li, ZhiRu AU - Lu, FangYan AU - Wu, JingYun AU - Bao, RuiJie AU - Rao, YuXin AU - Yang, Yun AU - Wang, Huafen PY - 2024/11/26 TI - Usability and Effectiveness of eHealth and mHealth Interventions That Support Self-Management and Health Care Transition in Adolescents and Young Adults With Chronic Disease: Systematic Review JO - J Med Internet Res SP - e56556 VL - 26 KW - eHealth KW - mHealth KW - mobile health KW - chronic disease KW - healthcare transition KW - self-management KW - adolescents KW - young adults KW - chronic illness KW - systematic review KW - digital health KW - health education KW - social support KW - symptom tracking KW - monitoring KW - effectiveness N2 - Background: With advances in medical technologies, more children with chronic diseases are now living on into adulthood. The development of proficient self-management skills is essential for adolescents and young adults to transition from pediatric to adult health care services. An innovative way to improve the current care model and foster self-management skills could be through eHealth or mHealth (mobile health) interventions, in particular, when considering the rising ownership of digital technology by adolescents and young adults. Objective: This systematic review aimed to evaluate the features, acceptability, usability, engagement, and intervention efficacy of eHealth and mHealth interventions that support self-management and health care transition in adolescents and young adults with chronic disease. Methods: This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines (registration number CRD42023378355). We systematically searched the MEDLINE complete, Embase, Cochrane Library, CINAHL complete, and ProQuest Health & Medical complete. We considered only articles published in or since 2019, as we aimed to extend the data collected by 2 previous systematic reviews. Results: A total of 16,752 studies were screened. After removing duplicates, 14,507 studies were excluded based on the title and abstract. Ultimately, 22 studies were included. The interventions ranged from simple text messages to complex interventions involving web-based games and engagement of health care providers, which were summarized into 6 themes: medication monitoring and reminders, symptom tracking and monitoring, management goal setting, knowledge education and self-management skills training, incentives and reinforcement, and communication. Most adolescents and young adults felt the eHealth and mHealth interventions were feasible, as they were convenient, easy to use, and accessible in the context of helping manage their health. However, user engagement was variable and presented a gradual decline in youth engagement with these apps over time. Barriers that prevent user engagement are diverse, such as time-consuming video uploads, noncontinuous access to a phone, reading literacy levels, language, and false impressions. Moreover, adolescents and young adults had different preferred styles of message delivery and functions, especially the engaging elements, disease-specific information, and opportunities to communicate with peers, health care providers, and app teams. Conclusions: There remains limited data about the effectiveness of eHealth and mHealth interventions facilitating the self-management and health care transition of adolescents and young adults with chronic diseases. Based on the available evidence, they were receptive to and interested in receiving information and managing their health using mobile apps or websites. Considering adolescents and young adults had different preferred styles of message delivery and features, to improve user engagement and provide focused interventions, it would be better to involve them early in the design process to identify their specific needs, as well as collaborate with health care providers and app teams to obtain suggestions. UR - https://www.jmir.org/2024/1/e56556 UR - http://dx.doi.org/10.2196/56556 UR - http://www.ncbi.nlm.nih.gov/pubmed/39589770 ID - info:doi/10.2196/56556 ER - TY - JOUR AU - Paolillo, W. Emily AU - Bomyea, Jessica AU - Depp, A. Colin AU - Henneghan, M. Ashley AU - Raj, Anunay AU - Moore, C. Raeanne PY - 2024/11/25 TI - Characterizing Performance on a Suite of English-Language NeuroUX Mobile Cognitive Tests in a US Adult Sample: Ecological Momentary Cognitive Testing Study JO - J Med Internet Res SP - e51978 VL - 26 KW - digital health KW - cognition KW - cognitive aging KW - neuropsychology KW - mobile health KW - psychometrics KW - mobile phone KW - Ecological Momentary Assessment KW - EMA KW - NeuroUX N2 - Background: Mobile cognitive testing is growing in popularity, with numerous advantages over traditional cognitive testing; however, the field lacks studies that deeply examine mobile cognitive test data from general adult samples. Objective: This study characterized performance for a suite of 8 mobile cognitive tests from the NeuroUX platform in a sample of US adults across the adult lifespan. Methods: Overall, 393 participants completed 8 NeuroUX cognitive tests and a brief ecological momentary assessment survey once per day on their smartphones for 10 consecutive days; each test was administered 5 times over the testing period. The tests tapped the domains of executive function, processing speed, reaction time, recognition memory, and working memory. Participants also completed a poststudy usability feedback survey. We examined alternate form test-retest reliability; practice effects; and associations between scores (averages and intraindividual variability) and demographics as well as test-taking context (ie, smartphone type, being at home vs not at home, and being alone vs not alone). Results: Our final sample consisted of 393 English-speaking US residents (aged 20-79 y; female: n=198, 50.4%). Of the 367 participants who provided responses about their race and ethnicity, 258 (70.3%) were White. Of the 393 participants, 181 (46.1%) were iOS users, and 212 (53.9%) were Android users. Of 12 test scores derived from the 8 tests, 9 (75%) showed good to excellent test-retest reliability (intraclass correlation coefficients >0.76). Practice effects (ie, improvements in performance) were observed for 4 (33%) of the 12 scores. Older age was associated with worse performance on most of the test scores (9/12, 75%) and greater within-person variability for nearly all reaction time scores (3/4, 75%). Relationships with smartphone type showed better performance among iOS users and those with newer Android software versions compared to those with older software. Being at home (vs not at home) was associated with better performance on tests of processing speed. Being alone (vs not alone) was associated with better performance on tests of recognition and working memory. Poststudy feedback indicated that participants found NeuroUX easy to learn and use, an enjoyable experience, and an app that would be helpful in understanding their thinking skills. Only 4.2% (16/379) endorsed privacy concerns, and 77.3% (293/379) reported that they would be willing to share their results with their health care provider. Older age?but not other demographics?was associated with finding the tests more challenging. Conclusions: In a sample of adults across a wide age range, this study characterized features that are particularly important for the interpretation of remote, repeated mobile cognitive testing performance, including test-retest reliability, practice effects, smartphone type, and test-taking context. These data enhance the understanding and application of mobile cognitive testing, paving the way for improved clinical decision-making, personalized interventions, and advancements in cognitive research. UR - https://www.jmir.org/2024/1/e51978 UR - http://dx.doi.org/10.2196/51978 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51978 ER - TY - JOUR AU - Ma, Jianwei AU - Wang, Jiangyuan AU - Ying, Jiapei AU - Xie, Shasha AU - Su, Qin AU - Zhou, Tianmeng AU - Han, Fuman AU - Xu, Jiayan AU - Zhu, Siyi AU - Yuan, Chenyi AU - Huang, Ziyuan AU - Xu, Jingfang AU - Chen, Xuyong AU - Bian, Xueyan PY - 2024/11/25 TI - Long-Term Efficacy of an AI-Based Health Coaching Mobile App in Slowing the Progression of Nondialysis-Dependent Chronic Kidney Disease: Retrospective Cohort Study JO - J Med Internet Res SP - e54206 VL - 26 KW - artificial intelligence KW - chronic kidney disease KW - eHealth care KW - mobile app KW - self-management KW - kidney function KW - telemedicine KW - app KW - health coaching KW - CKD KW - mobile phone N2 - Background: Chronic kidney disease (CKD) is a significant public health concern. Therefore, practical strategies for slowing CKD progression and improving patient outcomes are imperative. There is limited evidence to substantiate the efficacy of mobile app?based nursing systems for decelerating CKD progression. Objective: This study aimed to evaluate the long-term efficacy of the KidneyOnline intelligent care system in slowing the progression of nondialysis-dependent CKD. Methods: In this retrospective study, the KidneyOnline app was used for patients with CKD in China who were registered between January 2017 and April 2023. Patients were divided into 2 groups: an intervention group using the app?s nurse-led, patient-oriented management system and a conventional care group that did not use the app. Patients? uploaded health data were processed via deep learning optical character recognition, and the artificial intelligence (AI) system provided personalized health care plans and interventions. Conversely, the conventional care group received suggestions from nephrologists during regular visits without AI. Monitoring extended for an average duration of 2.1 (SD 1.4) years. The study?s objective is to assess the app?s effectiveness in preserving kidney function. The primary outcome was the estimated glomerular filtration rate slope over the follow-up period, and secondary outcomes included changes in albumin-to-creatinine ratio (ACR) and mean arterial pressure. Results: A total of 12,297 eligible patients were enrolled for the analysis. Among them, 808 patients were successfully matched using 1:1 propensity score matching, resulting in 404 (50%) patients in the KidneyOnline care system group and another 404 (50%) patients in the conventional care group. The estimated glomerular filtration rate slope in the KidneyOnline care group was significantly lower than that in the conventional care group (odds ratio ?1.3, 95% CI ?2.4 to ?0.1 mL/min/1.73 m2 per year vs odds ratio ?2.8, 95% CI ?3.8 to ?1.9 mL/min/1.73 m2 per year; P=.009). Subgroup analysis revealed that the effect of the KidneyOnline care group was more significant in male patients, patients older than 45 years, and patients with worse baseline kidney function, higher blood pressure, and heavier proteinuria. After 3 and 6 months, the mean arterial pressure in the KidneyOnline care group decreased to 85.6 (SD 9.2) and 83.6 (SD 10.5) mm Hg, respectively, compared to 94.9 (SD 10.6) and 95.2 (SD 11.6) mm Hg in the conventional care group (P<.001). The ACR in the KidneyOnline care group showed a more significant reduction after 3 and 6 months (736 vs 980 mg/g and 572 vs 840 mg/g; P=.07 and P=.03); however, there was no significant difference in ACR between the two groups at the end of the follow-up period (618 vs 639 mg/g; P=.90). Conclusions: The utilization of KidneyOnline, an AI-based, nurse-led, patient-centered care system, may be beneficial in slowing the progression of nondialysis-dependent CKD. UR - https://www.jmir.org/2024/1/e54206 UR - http://dx.doi.org/10.2196/54206 UR - http://www.ncbi.nlm.nih.gov/pubmed/39402012 ID - info:doi/10.2196/54206 ER - TY - JOUR AU - Hackett, Katherine AU - Xu, Shiyun AU - McKniff, Moira AU - Paglia, Lido AU - Barnett, Ian AU - Giovannetti, Tania PY - 2024/11/22 TI - Mobility-Based Smartphone Digital Phenotypes for Unobtrusively Capturing Everyday Cognition, Mood, and Community Life-Space in Older Adults: Feasibility, Acceptability, and Preliminary Validity Study JO - JMIR Hum Factors SP - e59974 VL - 11 KW - digital phenotyping KW - digital biomarkers KW - monitoring KW - mHealth KW - cognition KW - mobility KW - life space KW - depression KW - location data KW - Alzheimer disease KW - aging KW - mobile phone N2 - Background: Current methods of monitoring cognition in older adults are insufficient to address the growing burden of Alzheimer disease and related dementias (AD/ADRD). New approaches that are sensitive, scalable, objective, and reflective of meaningful functional outcomes are direly needed. Mobility trajectories and geospatial life space patterns reflect many aspects of cognitive and functional integrity and may be useful proxies of age-related cognitive decline. Objective: We investigated the feasibility, acceptability, and preliminary validity of a 1-month smartphone digital phenotyping protocol to infer everyday cognition, function, and mood in older adults from passively obtained GPS data. We also sought to clarify intrinsic and extrinsic factors associated with mobility phenotypes for consideration in future studies. Methods: Overall, 37 adults aged between 63 and 85 years with healthy cognition (n=31, 84%), mild cognitive impairment (n=5, 13%), and mild dementia (n=1, 3%) used an open-source smartphone app (mindLAMP) to unobtrusively capture GPS trajectories for 4 weeks. GPS data were processed into interpretable features across categories of activity, inactivity, routine, and location diversity. Monthly average and day-to-day intraindividual variability (IIV) metrics were calculated for each feature to test a priori hypotheses from a neuropsychological framework. Validation measures collected at baseline were compared against monthly GPS features to examine construct validity. Feasibility and acceptability outcomes included retention, comprehension of study procedures, technical difficulties, and satisfaction ratings at debriefing. Results: All (37/37, 100%) participants completed the 4-week monitoring period without major technical adverse events, 100% (37/37) reported satisfaction with the explanation of study procedures, and 97% (36/37) reported no feelings of discomfort. Participants? scores on the comprehension of consent quiz were 97% on average and associated with education and race. Technical issues requiring troubleshooting were infrequent, though 41% (15/37) reported battery drain. Moderate to strong correlations (r?0.3) were identified between GPS features and validators. Specifically, individuals with greater activity and more location diversity demonstrated better cognition, less functional impairment, less depression, more community participation, and more geospatial life space on objective and subjective validation measures. Contrary to predictions, greater IIV and less routine in mobility habits were also associated with positive outcomes. Many demographic and technology-related factors were not associated with GPS features; however, income, being a native English speaker, season of study participation, and occupational status were related to GPS features. Conclusions: Theoretically informed digital phenotypes of mobility are feasibly captured from older adults? personal smartphones and relate to clinically meaningful measures including cognitive test performance, reported functional decline, mood, and community activity. Future studies should consider the impact of intrinsic and extrinsic factors when interpreting mobility phenotypes. Overall, smartphone digital phenotyping is a promising method to unobtrusively capture relevant risk and resilience factors in the context of aging and AD/ADRD and should continue to be investigated in large, diverse samples. UR - https://humanfactors.jmir.org/2024/1/e59974 UR - http://dx.doi.org/10.2196/59974 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59974 ER - TY - JOUR AU - Ahumada-Newhart, Veronica AU - Wood, Taffeta AU - Satake, Noriko AU - Marcin, P. James PY - 2024/11/21 TI - Health Perceptions and Practices of a Telewellness Fitness Program: Exploratory Case Study JO - JMIR Form Res SP - e50710 VL - 8 KW - telehealth KW - telewellness KW - online fitness KW - health equity KW - community health KW - group exercise KW - mobile phone KW - mobile device N2 - Background: During the COVID-19 pandemic, many people lacked access to group fitness opportunities due to elevated risk of infection, lockdown, and closure of exercise facilities. Additionally, many people experienced higher than average rates of mental health burden (eg, anxiety and stress). To help address these needs, an existing in-person community exercise class, taught by a faculty member from an academic medical center, transitioned to an online synchronous (OS) physical fitness class via the Zoom (Zoom Video Communications) videoconferencing platform. As such, the instructor advertised the OS fitness classes through an existing email list of community members and university faculty, staff, students, or alumni email listservs. This telewellness intervention sought to create a sense of community, build social support, and promote physical and mental wellness during the COVID-19 pandemic. Objective: Our aim was to determine the perceived mental and physical health benefits of attending an OS fitness class for community members, including health care workers. We also assessed the use and functionality of related technologies necessary for delivering and attending the fitness classes. Methods: An online survey questionnaire was created and tested to collect quantitative and qualitative data for an exploratory study. Data were collected to evaluate the fitness class, motivation, perceived health benefits, and related technologies. A convenience sample of people who had participated in the OS fitness classes was recruited for this study via an emailed recruitment flyer. Results: A total of 51 participants accessed and completed the survey questionnaire. Survey participants consisted of 28 of 51 (55%) with a university affiliation, 17 of 51 (33%) with no university affiliation, and 6 of 51 (12%) who declined to state. The largest group of participants reporting full-time employment (18/51, 35%) also reported university affiliation with the academic medical center. In this group, 13 of 51 (25%) participants reported full-time employment, university affiliation, and doctoral degrees. High overall exercise class satisfaction was observed in the survey responses (mean 4.0, SD 1). Data analyses revealed significant perceived value of both mental and physical health benefits as motivating factors for participating in the OS fitness class. Challenges were identified as not being able to receive individual feedback from the instructor and the inability of some participants to see if they were in sync with the rest of the class. Conclusions: Results provide preliminary support for the use of online videoconferencing fitness platforms to promote wellness and facilitate group exercise in the community during times of high infection risk. Future studies should continue to explore perceived benefits, mental and physical wellness, best practices, and the design of related technologies. UR - https://formative.jmir.org/2024/1/e50710 UR - http://dx.doi.org/10.2196/50710 ID - info:doi/10.2196/50710 ER - TY - JOUR AU - Zimmermann, Jannik AU - Morf, Harriet AU - Scharf, Florian AU - Knitza, Johannes AU - Moeller, Heidi AU - Muehlensiepen, Felix AU - Nathrath, Michaela AU - Orlemann, Till AU - Voelker, Thomas AU - Deckers, Merlin PY - 2024/11/21 TI - German Version of the Telehealth Usability Questionnaire and Derived Short Questionnaires for Usability and Perceived Usefulness in Health Care Assessment in Telehealth and Digital Therapeutics: Instrument Validation Study JO - JMIR Hum Factors SP - e57771 VL - 11 KW - mHealth KW - mobile health KW - telehealth KW - usability KW - questionnaire validation KW - technology acceptance model KW - validity KW - questionnaire translation KW - Net Promoter Scale KW - NPS KW - usefulness KW - autoimmune chronic diseases KW - questionnaire KW - German KW - digital therapeutics KW - therapeutics KW - feasibility N2 - Background: The exponential growth of telehealth is revolutionizing health care delivery, but its evaluation has not matched the pace of its uptake. Various forms of assessment, from single-item to more extensive questionnaires, have been used to assess telehealth and digital therapeutics and their usability. The most frequently used questionnaire is the ?Telehealth Usability Questionnaire? (TUQ). The use of the TUQ is limited by its restricted availability in languages other than English and its feasibility. Objective: The aims of this study were to create a translated German TUQ version and to derive a short questionnaire for patients??Telehealth Usability and Perceived Usefulness Short Questionnaire for patients? (TUUSQ). Methods: As a first step, the original 21-item TUQ was forward and back-translated twice. In the second step, 13 TUQ items were selected for their suitability for the general evaluation of telehealth on the basis of expert opinion. These 13 items were surveyed between July 2022 and September 2023 in 4 studies with patients and family members of palliative care, as well as patients with chronic autoimmune diseases, evaluating 13 health care apps, including digital therapeutics and a telehealth system (n1=128, n2=220, n3=30, and n4=12). Psychometric exploratory factor analysis was conducted. Results: The analysis revealed that a parsimonious factor structure with 2 factors (?perceived usefulness in health care? and ?usability?) is sufficient to describe the patient?s perception. Consequently, the questionnaire could be shortened to 6 items without compromising its informativeness. Conclusions: We provide a linguistically precise German version of the TUQ for assessing the usability and perceived usefulness of telehealth. Beyond that, we supply a highly feasible shortened version that is versatile for general use in telehealth, mobile health, and digital therapeutics, which distinguishes between the 2 factors ?perceived usefulness in health care? and ?usability? in patients. Trial Registration: German Clinical Trials Register DRKS00030546; https://drks.de/search/de/trial/DRKS00030546 UR - https://humanfactors.jmir.org/2024/1/e57771 UR - http://dx.doi.org/10.2196/57771 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57771 ER - TY - JOUR AU - Mace, A. Ryan AU - Law, E. Makenna AU - Cohen, E. Joshua AU - Ritchie, S. Christine AU - Okereke, I. Olivia AU - Hoeppner, B. Bettina AU - Brewer, A. Judson AU - Bartels, J. Stephen AU - Vranceanu, Ana-Maria AU - PY - 2024/11/21 TI - A Mindfulness-Based Lifestyle Intervention for Dementia Risk Reduction: Protocol for the My Healthy Brain Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e64149 VL - 13 KW - lifestyle KW - cognitive decline KW - brain health KW - mindfulness KW - mind-body therapies KW - telemedicine KW - digital health KW - randomized clinical trial N2 - Background: Lifestyle behavior change and mindfulness have direct and synergistic effects on cognitive functioning and may prevent Alzheimer disease and Alzheimer disease?related dementias (AD/ADRD). We are iteratively developing and testing My Healthy Brain (MHB), the first mindfulness-based lifestyle group program targeting AD/ADRD risk factors in older adults with subjective cognitive decline. Our pilot studies (National Institutes of Health [NIH] stage 1A) have shown that MHB is feasible, acceptable, and associated with improvement in lifestyle behavior and cognitive outcomes. Objective: We will compare the feasibility of MHB versus an education control (health enhancement program [HEP]) in 50 older adults (aged ?60 y) with subjective cognitive decline and AD/ADRD risk factors. In an NIH stage 1B randomized controlled trial (RCT), we will evaluate feasibility benchmarks, improvements in cognitive and lifestyle outcomes, and engagement of hypothesized mechanisms. Methods: We are recruiting through clinics, flyers, web-based research platforms, and community partnerships. Participants are randomized to MHB or the HEP, both delivered in telehealth groups over 8 weeks. MHB participants learn behavior modification and mindfulness skills to achieve individualized lifestyle goals. HEP participants receive lifestyle education and group support. Assessments are repeated after the intervention and at a 6-month follow-up. Our primary outcomes are feasibility, acceptability, appropriateness, credibility, satisfaction, and fidelity benchmarks. The secondary outcomes are cognitive function and lifestyle (physical activity, sleep, nutrition, alcohol and tobacco use, and mental and social activity) behaviors. Data analyses will include the proportion of MHB and HEP participants who meet each benchmark (primary outcome) and paired samples 2-tailed t tests, Cohen d effect sizes, and the minimal clinically important difference for each measure (secondary outcomes). Results: Recruitment began in January 2024. We received 225 inquiries. Of these 225 individuals, 40 (17.8%) were eligible. Of the 40 eligible participants, 21 (52.5%) were enrolled in 2 group cohorts, 17 (42.5%) were on hold for future group cohorts, and 2 (5%) withdrew before enrollment. All participants have completed before the intervention assessments. All cohort 1 participants (9/21, 43%) have completed either MHB or the HEP (?6 of 8 sessions) and after the intervention assessments. The intervention for cohort 2 (12/21, 57%) is ongoing. Adherence rates for the Garmin Vivosmart 5 (128/147, 87.1% weeks) and daily surveys (105/122, 86.1% weeks) are high. No enrolled participants have dropped out. Enrollment is projected to be completed by December 2024. Conclusions: The RCT will inform the development of a larger efficacy RCT (NIH stage 2) of MHB versus the HEP in a more diverse sample of older adults, testing mechanisms of improvements through theoretically driven mediators and moderators. The integration of mindfulness with lifestyle behavior change in MHB has the potential to be an effective and sustainable approach for increasing the uptake of AD/ADRD risk reduction strategies among older adults. Trial Registration: ClinicalTrials.gov NCT05934136; https://www.clinicaltrials.gov/study/NCT05934136 International Registered Report Identifier (IRRID): DERR1-10.2196/64149 UR - https://www.researchprotocols.org/2024/1/e64149 UR - http://dx.doi.org/10.2196/64149 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64149 ER - TY - JOUR AU - Yoon, Minjae AU - Lee, Hyun Ji AU - Kim, In-Cheol AU - Lee, Ju-Hee AU - Kim, Mi-Na AU - Kim, Hack-Lyoung AU - Lee, Sunki AU - Kim, Jai In AU - Choi, Seonghoon AU - Park, Sung-Ji AU - Hur, Taeho AU - Hussain, Musarrat AU - Lee, Sungyoung AU - Choi, Dong-Ju PY - 2024/11/21 TI - Smartphone App for Improving Self-Awareness of Adherence to Edoxaban Treatment in Patients With Atrial Fibrillation (ADHERE-App Trial): Randomized Controlled Trial JO - J Med Internet Res SP - e65010 VL - 26 KW - mobile apps KW - digital health KW - atrial fibrillation KW - anticoagulants KW - medication adherence KW - mobile phone N2 - Background: Adherence to oral anticoagulant therapy is essential to prevent ischemic stroke in patients with atrial fibrillation (AF). Objective: This study aimed to evaluate whether smartphone app?based interventions improve medication adherence in patients with AF. Methods: This open-label, multicenter randomized controlled trial (ADHERE-App [Self-Awareness of Drug Adherence to Edoxaban Using an Automatic App Feedback System] study) enrolled patients with AF treated with edoxaban for stroke prevention. They were randomly assigned to app-conditioned feedback (intervention; n=248) and conventional treatment (control; n=250) groups. The intervention group received daily alerts via a smartphone app to take edoxaban and measure blood pressure and heart rate at specific times. The control group received only standard, guideline-recommended care. The primary end point was edoxaban adherence, measured by pill count at 3 or 6 months. Medication adherence and the proportion of adequate medication adherence, which was defined as ?95% of continuous medication adherence, were evaluated. Results: Medication adherence at 3 or 6 months was not significantly different between the intervention and control groups (median 98%, IQR 95%-100% vs median 98%, IQR 91%-100% at 3 months, P=.06; median 98%, IQR 94.5%-100% vs median 97.5%, IQR 92.8%-100% at 6 months, P=.15). However, the proportion of adequate medication adherence (?95%) was significantly higher in the intervention group at both time points (76.8% vs 64.7% at 3 months, P=.01; 73.9% vs 61% at 6 months, P=.007). Among patients aged >65 years, the intervention group showed a higher medication adherence value and a higher proportion of adequate medication adherence (?95%) at 6 months. Conclusions: There was no difference in edoxaban adherence between the groups. However, the proportion of adequate medication adherence was higher in the intervention group, and the benefit of the smartphone app?based intervention on medication adherence was more pronounced among older patients than among younger patients. Given the low adherence to oral anticoagulants, especially among older adults, using a smartphone app may potentially improve medication adherence. Trial Registration: International Clinical Trials Registry Platform KCT0004754; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=28496&search_page=L International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-048777 UR - https://www.jmir.org/2024/1/e65010 UR - http://dx.doi.org/10.2196/65010 UR - http://www.ncbi.nlm.nih.gov/pubmed/39570659 ID - info:doi/10.2196/65010 ER - TY - JOUR AU - Stone, Chris AU - Essery, Rosie AU - Matthews, Joe AU - Naughton, Felix AU - Munafo, Marcus AU - Attwood, Angela AU - Skinner, Andy PY - 2024/11/21 TI - Presenting and Evaluating a Smartwatch-Based Intervention for Smoking Relapse (StopWatch): Feasibility and Acceptability Study JO - JMIR Form Res SP - e56999 VL - 8 KW - smoking KW - smoking cessation KW - passive detection KW - just-in-time intervention KW - JITAI KW - relapse prevention KW - relapse KW - smartwatch KW - wearable technology KW - wearable KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Despite the benefits of smoking cessation, maintaining abstinence during a quit attempt is difficult, and most attempts result in relapse. Innovative, evidence-based methods of preventing relapse are needed. We present a smartwatch-based relapse prevention system that uses passive detection of smoking to trigger just-in-time smoking cessation support. Objective: This study aims to evaluate the feasibility of hosting just-in-time smoking cessation support on a smartwatch and the acceptability of the ?StopWatch? intervention on this platform. Methods: The person-based approach for intervention development was used to design the StopWatch smoking relapse prevention intervention. Intervention delivery was triggered by an algorithm identifying hand movements characteristic of smoking from the smartwatch?s motion sensors, and the system-generated intervention messages (co-designed by smokers) were delivered on the smartwatch screen. A total of 18 smokers tested the intervention over a 2-week period, and at the end of this period, they provided qualitative feedback on the acceptability of both the intervention and the smartwatch platform. Results: Participants reported that the smartwatch intervention increased their awareness of smoking and motivated them to quit. System-generated intervention messages were generally felt to be relevant and timely. There were some challenges with battery life that had implications for intervention adherence, and the bulkiness of the device and the notification style reduced some participants? acceptability of the smartwatch platform. Conclusions: Our findings indicate our smoking relapse prevention intervention and the use of a smartwatch as a platform to host a just-in-time behavior change intervention are both feasible and acceptable to most (12/18, 66%) participants as a relapse prevention intervention, but we identify some concerns around the physical limitations of the smartwatch device. In particular, the bulkiness of the device and the battery capacity present risks to adherence to the intervention and the potential for missed detections. We recommend that a longer-term efficacy trial be carried out as the next step. UR - https://formative.jmir.org/2024/1/e56999 UR - http://dx.doi.org/10.2196/56999 UR - http://www.ncbi.nlm.nih.gov/pubmed/39570656 ID - info:doi/10.2196/56999 ER - TY - JOUR AU - Alnooh, Ghadah AU - AlTamimi, Z. Jozaa AU - Williams, A. Elizabeth AU - Hawley, S. Mark PY - 2024/11/19 TI - An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study JO - JMIR Form Res SP - e60037 VL - 8 KW - hypertension KW - blood pressure KW - Dietary Approaches to Stop Hypertension KW - DASH diet KW - self-efficacy KW - mobile health KW - mHealth KW - Saudi Arabia KW - mobile phone N2 - Background: The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals? and patients? preferences. Objective: This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. Methods: This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. Results: Most participants (8/13, 62%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app?s educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also suggested developing an Arabic version of the app and simplifying the method of food logging. The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). Conclusions: The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia. UR - https://formative.jmir.org/2024/1/e60037 UR - http://dx.doi.org/10.2196/60037 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60037 ER - TY - JOUR AU - Boege, Selina AU - Milne-Ives, Madison AU - Ananthakrishnan, Ananya AU - Cong, Cen AU - Sharma, Aditya AU - Anderson, David AU - Meinert, Edward PY - 2024/11/19 TI - Mental Health Monitoring for Young People Through Mood Apps: Protocol for a Scoping Review and Systematic Search in App Stores JO - JMIR Res Protoc SP - e56400 VL - 13 KW - digital health KW - mental health KW - mood apps KW - mobile apps KW - mobile phone N2 - Background: The researchers have used mobile phones to assist in monitoring, analyzing, and managing moods to acquire insight into mood patterns. There is a lack of evidence in their use as clinical tools and interventions, which necessitates a comprehensive review and quality assessment to understand barriers and facilitators for app implementation as an impactful clinical intervention. Objective: This review aims to (1) provide an overview of the recent evidence on mobile mood-monitoring apps that are intended for facilitating self-management and support of mental health in children, adolescents, and young people; and (2) investigate the quality of publicly available apps. Methods: The study will first involve a scoping review of the literature on mood-monitoring apps for children, adolescents, and young people followed by an evaluation of features of the apps available in the marketplace. The scoping review will follow the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and search 6 databases? Embase, CINAHL, PubMed, ACM Digital Library, Scopus, and Springer LNCS?for relevant studies and reviews published in the last 3 years. The author will then screen the references, extract data from the included studies, and analyze them to synthesize the evidence on mood apps. Next, the Apple App Store and Google Play Store will be searched for mood apps. A total of 2 independent reviewers will screen the apps based on eligibility criteria, and disagreements will be resolved through consensus. The features of the selected apps will then be evaluated using the Mobile Health Index and Navigation framework, and descriptive analysis will be used to synthesize the findings. Results: Literature search and screening began soon after submission of the protocol and is expected to be completed by September 2024. The app evaluation will be completed by October 2024. Conclusions: Combined, the scoping literature review and app evaluation will provide an in-depth overview of the most recent scientific evidence related to mood apps and the quality of apps actually available for use. International Registered Report Identifier (IRRID): PRR1-10.2196/56400 UR - https://www.researchprotocols.org/2024/1/e56400 UR - http://dx.doi.org/10.2196/56400 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56400 ER - TY - JOUR AU - Dwyer, Bridget AU - Flathers, Matthew AU - Burns, James AU - Mikkelson, Jane AU - Perlmutter, Elana AU - Chen, Kelly AU - Ram, Nanik AU - Torous, John PY - 2024/11/19 TI - Assessing Digital Phenotyping for App Recommendations and Sustained Engagement: Cohort Study JO - JMIR Form Res SP - e62725 VL - 8 KW - engagement KW - mental health KW - digital phenotype KW - pilot study KW - phenotyping KW - smartphone sensors KW - anxiety KW - sleep KW - fitness KW - depression KW - qualitative KW - app recommendation KW - app use KW - mobile phone N2 - Background: Low engagement with mental health apps continues to limit their impact. New approaches to help match patients to the right app may increase engagement by ensuring the app they are using is best suited to their mental health needs. Objective: This study aims to pilot how digital phenotyping, using data from smartphone sensors to infer symptom, behavioral, and functional outcomes, could be used to match people to mental health apps and potentially increase engagement Methods: After 1 week of collecting digital phenotyping data with the mindLAMP app (Beth Israel Deaconess Medical Center), participants were randomly assigned to the digital phenotyping arm, receiving feedback and recommendations based on those data to select 1 of 4 predetermined mental health apps (related to mood, anxiety, sleep, and fitness), or the control arm, selecting the same apps but without any feedback or recommendations. All participants used their selected app for 4 weeks with numerous metrics of engagement recorded, including objective screentime measures, self-reported engagement measures, and Digital Working Alliance Inventory scores. Results: A total of 82 participants enrolled in the study; 17 (21%) dropped out of the digital phenotyping arm and 18 (22%) dropped out from the control arm. Across both groups, few participants chose or were recommended the insomnia or fitness app. The majority (39/47, 83%) used a depression or anxiety app. Engagement as measured by objective screen time and Digital Working Alliance Inventory scores were higher in the digital phenotyping arm. There was no correlation between self-reported and objective metrics of app use. Qualitative results highlighted the importance of habit formation in sustained app use. Conclusions: The results suggest that digital phenotyping app recommendation is feasible and may increase engagement. This approach is generalizable to other apps beyond the 4 apps selected for use in this pilot, and practical for real-world use given that the study was conducted without any compensation or external incentives that may have biased results. Advances in digital phenotyping will likely make this method of app recommendation more personalized and thus of even greater interest. UR - https://formative.jmir.org/2024/1/e62725 UR - http://dx.doi.org/10.2196/62725 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62725 ER - TY - JOUR AU - Fahey, C. Margaret PY - 2024/11/18 TI - Author's Reply: Expanding the Scope: Reflections on Digital Smoking Cessation Strategies for Diverse Age Groups JO - J Med Internet Res SP - e67749 VL - 26 KW - digital smoking cessation KW - age group comparisons KW - behavioral health intervention KW - older adult KW - cigarette KW - tobacco KW - quitting KW - telehealth KW - behavioral health KW - public health UR - https://www.jmir.org/2024/1/e67749 UR - http://dx.doi.org/10.2196/67749 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67749 ER - TY - JOUR AU - Wei, Bin AU - Hu, Xin AU - Wu, XiaoRong PY - 2024/11/18 TI - Expanding the Scope: Reflections on Digital Smoking Cessation Strategies for Diverse Age Groups JO - J Med Internet Res SP - e65929 VL - 26 KW - digital smoking cessation KW - age group comparisons KW - behavioral health interventions KW - older adults KW - digital cessation treatment KW - cigarettes KW - tobacco KW - quit KW - telehealth KW - behavioral health KW - public health UR - https://www.jmir.org/2024/1/e65929 UR - http://dx.doi.org/10.2196/65929 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65929 ER - TY - JOUR AU - Ricci, Sofia Fabiana AU - Liguori, Lorenzo AU - Palermo, Eduardo AU - Rizzo, John-Ross AU - Porfiri, Maurizio PY - 2024/11/18 TI - Navigation Training for Persons With Visual Disability Through Multisensory Assistive Technology: Mixed Methods Experimental Study JO - JMIR Rehabil Assist Technol SP - e55776 VL - 11 KW - assistive technology KW - human-computer interaction KW - multisensory feedback KW - virtual reality KW - visual impairment KW - haptic N2 - Background: Visual disability is a growing problem for many middle-aged and older adults. Conventional mobility aids, such as white canes and guide dogs, have notable limitations that have led to increasing interest in electronic travel aids (ETAs). Despite remarkable progress, current ETAs lack empirical evidence and realistic testing environments and often focus on the substitution or augmentation of a single sense. Objective: This study aims to (1) establish a novel virtual reality (VR) environment to test the efficacy of ETAs in complex urban environments for a simulated visual impairment (VI) and (2) evaluate the impact of haptic and audio feedback, individually and combined, on navigation performance, movement behavior, and perception. Through this study, we aim to address gaps to advance the pragmatic development of assistive technologies (ATs) for persons with VI. Methods: The VR platform was designed to resemble a subway station environment with the most common challenges faced by persons with VI during navigation. This environment was used to test our multisensory, AT-integrated VR platform among 72 healthy participants performing an obstacle avoidance task while experiencing symptoms of VI. Each participant performed the task 4 times: once with haptic feedback, once with audio feedback, once with both feedback types, and once without any feedback. Data analysis encompassed metrics such as completion time, head and body orientation, and trajectory length and smoothness. To evaluate the effectiveness and interaction of the 2 feedback modalities, we conducted a 2-way repeated measures ANOVA on continuous metrics and a Scheirer-Ray-Hare test on discrete ones. We also conducted a descriptive statistical analysis of participants? answers to a questionnaire, assessing their experience and preference for feedback modalities. Results: Results from our study showed that haptic feedback significantly reduced collisions (P=.05) and the variability of the pitch angle of the head (P=.02). Audio feedback improved trajectory smoothness (P=.006) and mitigated the increase in the trajectory length from haptic feedback alone (P=.04). Participants reported a high level of engagement during the experiment (52/72, 72%) and found it interesting (42/72, 58%). However, when it came to feedback preferences, less than half of the participants (29/72, 40%) favored combined feedback modalities. This indicates that a majority preferred dedicated single modalities over combined ones. Conclusions: AT is crucial for individuals with VI; however, it often lacks user-centered design principles. Research should prioritize consumer-oriented methodologies, testing devices in a staged manner with progression toward more realistic, ecologically valid settings to ensure safety. Our multisensory, AT-integrated VR system takes a holistic approach, offering a first step toward enhancing users? spatial awareness, promoting safer mobility, and holds potential for applications in medical treatment, training, and rehabilitation. Technological advancements can further refine such devices, significantly improving independence and quality of life for those with VI. UR - https://rehab.jmir.org/2024/1/e55776 UR - http://dx.doi.org/10.2196/55776 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55776 ER - TY - JOUR AU - Wong, Ching Arkers Kwan AU - Bayuo, Jonathan AU - Su, Jing Jing AU - Wong, Yuet Frances Kam AU - Chow, Sum Karen Kit AU - Wong, Po Bonnie AU - Wong, Man Siu AU - Hui, Vivian PY - 2024/11/18 TI - Effectiveness of the Support From Community Health Workers and Health Care Professionals on the Sustained Use of Wearable Monitoring Devices Among Community-Dwelling Older Adults: Feasibility Randomized Controlled Trial JO - J Med Internet Res SP - e52435 VL - 26 KW - wearable monitoring device KW - lay worker KW - smartwatch KW - older adult KW - nurse KW - engagement KW - attrition KW - wearable KW - user experience N2 - Background: The wearable monitoring device (WMD) is emerging as a promising tool for community-dwelling older adults to monitor personal health, enhance awareness of their activities, and promote healthy behaviors. However, the sustained use of WMDs among this population remains a significant challenge. Objective: This study aims to implement an interventional program that promotes and motivates the continued use of WMDs among older adults through a peer and professional support approach. This program will facilitate the integration of WMDs into their daily lives. Methods: This feasibility trial examined the following: (1) the usability of the WMD from the users? perspectives; (2) the feasibility of the Live With Wearable Monitoring Device program; and (3) the effectiveness of the Live With Wearable Monitoring Device program among community-dwelling older adults. The intervention, based on Self-Determination Theory, involved using the Live With Wearable Monitoring Device program over a 3-month period, with ongoing professional and peer support provided by community health workers, aided by a nurse and social workers. This support included 1 home visit and biweekly communication via WhatsApp. Data were collected at baseline and at 1, 3, and 6 months. Results: A total of 39 participants were enrolled in the intervention group, while 37 participants were in the control group. The recruitment rate was high (76/89, 85%), and the attrition rate was low (8/76, 11%), indicating that the program is feasible for older adults. Participants in the intervention group exhibited higher self-efficacy, lower anxiety levels, and used the smartwatch more frequently, in terms of both days and hours, compared with the control group. A between-group difference was observed in self-efficacy between the intervention and control groups (?=3.31, 95% CI 0.36-6.25, P=.03), with statistically significant higher mean values recorded at all 4 time points. Conclusions: It is clear that merely providing a WMD to older adults does not guarantee its usage, particularly for those unfamiliar with how to utilize its health-related functions in their daily routines. This study implemented a theory-based program aimed at enhancing the ongoing use of WMDs among older adults, suggesting that continuous professional and peer support may significantly influence WMD usage. Trial Registration: ClinicalTrials.gov NCT05269303; https://clinicaltrials.gov/ct2/show/NCT05269303 UR - https://www.jmir.org/2024/1/e52435 UR - http://dx.doi.org/10.2196/52435 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52435 ER - TY - JOUR AU - Liu, Jianyi AU - Giannone, Alyssa AU - Wang, Hailing AU - Wetherall, Lucy AU - Juarascio, Adrienne PY - 2024/11/18 TI - Understanding Patients? Preferences for a Digital Intervention to Prevent Posttreatment Deterioration for Bulimia-Spectrum Eating Disorders: User-Centered Design Study JO - JMIR Form Res SP - e60865 VL - 8 KW - bulimia nervosa KW - binge eating KW - digital intervention KW - deterioration prevention KW - eating disorder KW - bulimia KW - digital health KW - deterioration KW - maintenance KW - mHealth KW - mobile health app KW - interviews KW - qualitative KW - user-centered design KW - psychotherapy KW - CBT KW - cognitive behavioral therapy KW - needs KW - preferences KW - mobile phone N2 - Background: Deterioration rates after enhanced cognitive behavioral therapy (CBT-E) for patients with bulimia-spectrum eating disorders (BN-EDs) remain high, and decreased posttreatment skill use might be a particularly relevant contributor. Digital interventions could be an ideal option to improve skill use after treatment ends but they have yet to be investigated for BN-EDs. Objective: This study used a user-centered design approach to explore patients? interest in a digital intervention to prevent deterioration after CBT-E and their desired features. Methods: A total of 12 participants who previously received CBT-E for BN-EDs and experienced at least a partial response to treatment completed a qualitative interview asking about their interests and needs for an app designed to prevent deterioration after treatment ended. Participants were also presented with features commonly used in digital interventions for EDs and were asked to provide feedback. Results: All 12 participants expressed interest in using an app to prevent deterioration after treatment ended. In total, 11 participants thought the proposed feature of setting a goal focusing on skill use weekly would help improve self-accountability for skill use, and 6 participants supported the idea of setting goals related to specific triggers because they would know what skills to use in high-risk situations. A total of 10 participants supported the self-monitoring ED behaviors feature because it could increase their awareness levels. Participants also reported wanting to track mood (n=6) and food intake (n=5) besides the proposed tracking feature. A total of 10 participants reported wanting knowledge-based content in the app, including instructions on skill practice (n=6), general mental health strategies outside of EDs (n=4), guided mindfulness exercises (n=3), and nutrition recommendations (n=3). Eight participants reported a desire for the app to send targeted push notifications, including reminders of skill use (n=7) and inspirational quotes for encouragement (n=3). Finally, 8 participants reported wanting a human connection in the app, 6 participants wishing to interact with other users to support and learn from each other, and 4 participants wanting to connect with professionals as needed. Overall, participants thought that having an app targeting skill use could provide continued support and improve self-accountability, thus lowering the risk of decreased skill use after treatment ended. Conclusions: Insights from participants highlighted the perceived importance of continued support for continued skill use after treatment ended. This study also provided valuable design implications regarding potential features focusing on facilitating posttreatment skill use to include in digital deterioration prevention programs. Future research should examine the optimal approaches to deliver the core features identified in this study that could lead to higher continued skill use and a lower risk of deterioration in the long term. UR - https://formative.jmir.org/2024/1/e60865 UR - http://dx.doi.org/10.2196/60865 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60865 ER - TY - JOUR AU - Slade, Christopher AU - Benzo, M. Roberto AU - Washington, Peter PY - 2024/11/18 TI - Design Guidelines for Improving Mobile Sensing Data Collection: Prospective Mixed Methods Study JO - J Med Internet Res SP - e55694 VL - 26 KW - mobile health sensing KW - mHealth KW - active data collection KW - passive data collection KW - ecological momentary assessment KW - mobile data KW - mobile phone KW - machine learning KW - real-world setting KW - mixed method KW - college KW - student KW - user data KW - data consistency N2 - Background: Machine learning models often use passively recorded sensor data streams as inputs to train machine learning models that predict outcomes captured through ecological momentary assessments (EMA). Despite the growth of mobile data collection, challenges in obtaining proper authorization to send notifications, receive background events, and perform background tasks persist. Objective: We investigated challenges faced by mobile sensing apps in real-world settings in order to develop design guidelines. For active data, we compared 2 prompting strategies: setup prompting, where the app requests authorization during its initial run, and contextual prompting, where authorization is requested when an event or notification occurs. Additionally, we evaluated 2 passive data collection paradigms: collection during scheduled background tasks and persistent reminders that trigger passive data collection. We investigated the following research questions (RQs): (RQ1) how do setup prompting and contextual prompting affect scheduled notification delivery and the response rate of notification-initiated EMA? (RQ2) Which authorization paradigm, setup or contextual prompting, is more successful in leading users to grant authorization to receive background events? and (RQ3) Which polling-based method, persistent reminders or scheduled background tasks, completes more background sessions? Methods: We developed mobile sensing apps for iOS and Android devices and tested them through a 30-day user study asking college students (n=145) about their stress levels. Participants responded to a daily EMA question to test active data collection. The sensing apps collected background location events, polled for passive data with persistent reminders, and scheduled background tasks to test passive data collection. Results: For RQ1, setup and contextual prompting yielded no significant difference (ANOVA F1,144=0.0227; P=.88) in EMA compliance, with an average of 23.4 (SD 7.36) out of 30 assessments completed. However, qualitative analysis revealed that contextual prompting on iOS devices resulted in inconsistent notification deliveries. For RQ2, contextual prompting for background events was 55.5% (?21=4.4; P=.04) more effective in gaining authorization. For RQ3, users demonstrated resistance to installing the persistent reminder, but when installed, the persistent reminder performed 226.5% more background sessions than traditional background tasks. Conclusions: We developed design guidelines for improving mobile sensing on consumer mobile devices based on our qualitative and quantitative results. Our qualitative results demonstrated that contextual prompts on iOS devices resulted in inconsistent notification deliveries, unlike setup prompting on Android devices. We therefore recommend using setup prompting for EMA when possible. We found that contextual prompting is more efficient for authorizing background events. We therefore recommend using contextual prompting for passive sensing. Finally, we conclude that developing a persistent reminder and requiring participants to install it provides an additional way to poll for sensor and user data and could improve data collection to support adaptive interventions powered by machine learning. UR - https://www.jmir.org/2024/1/e55694 UR - http://dx.doi.org/10.2196/55694 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55694 ER - TY - JOUR AU - Preiser, Christine AU - Radionova, Natalia AU - Ög, Eylem AU - Koch, Roland AU - Klemmt, Malte AU - Müller, Regina AU - Ranisch, Robert AU - Joos, Stefanie AU - Rieger, A. Monika PY - 2024/11/18 TI - The Doctors, Their Patients, and the Symptom Checker App: Qualitative Interview Study With General Practitioners in Germany JO - JMIR Hum Factors SP - e57360 VL - 11 KW - symptom checker app KW - qualitative interviews KW - general practice KW - perceived work-related psychosocial stress KW - job satisfaction KW - professional identity KW - medical diagnosis N2 - Background: Symptom checkers are designed for laypeople and promise to provide a preliminary diagnosis, a sense of urgency, and a suggested course of action. Objective: We used the international symptom checker app (SCA) Ada App as an example to answer the following question: How do general practitioners (GPs) experience the SCA in relation to the macro, meso, and micro level of their daily work, and how does this interact with work-related psychosocial resources and demands? Methods: We conducted 8 semistructured interviews with GPs in Germany between December 2020 and February 2022. We analyzed the data using the integrative basic method, an interpretative-reconstructive method, to identify core themes and modes of thematization. Results: Although most GPs in this study were open to digitization in health care and their practice, only one was familiar with the SCA. GPs considered the SCA as part of the ?unorganized stage? of patients? searching about their conditions. Some preferred it to popular search engines. They considered it relevant to their work as soon as the SCA would influence patients? decisions to see a doctor. Some wanted to see the results of the SCA in advance in order to decide on the patient?s next steps. GPs described the diagnostic process as guided by shared decision-making, with the GP taking the lead and the patient deciding. They saw diagnosis as an act of making sense of data, which the SCA would not be able to do, despite the huge amounts of data. Conclusions: GPs took a techno-pragmatic view of SCA. They operate in a health care system of increasing scarcity. They saw the SCA as a potential work-related resource if it helped them to reduce administrative tasks and unnecessary patient contacts. The SCA was seen as a potential work-related demand if it increased workload, for example, if it increased patients? anxiety, was too risk-averse, or made patients more insistent on their own opinions. UR - https://humanfactors.jmir.org/2024/1/e57360 UR - http://dx.doi.org/10.2196/57360 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57360 ER - TY - JOUR AU - Essop, Hafsa AU - Kekana, Mable Ramadimetja AU - Brosens, Jacques AU - Smuts, Hanlie PY - 2024/11/15 TI - A Reflective Thematic Analysis Into the Perceptions of Pregnant Radiographers Regarding the Usefulness of the PregiDose Mobile App to Enhance Fetal Dosimetry and Well-Being: Qualitative Exploration JO - JMIR Form Res SP - e58608 VL - 8 KW - mobile app KW - design science research KW - usefulness KW - pregnant radiographers KW - fetal dosimetry KW - occupational health and safety KW - mobile phone KW - maternal and child health KW - PregiDose N2 - Background: Pregnancy apps are widely used by pregnant women, who benefit from self-tracking features to support their health goals. Pregnant radiographers are considered a high-risk group of health workers practicing in ionizing radiation environments. Radiation exposure above threshold limits can cause harmful genetic effects on a fetus. Accordingly, pregnant radiographers are required to wear special fetal dosimeters, which provide real-time readings of radiation dose exposure to the fetus. Pregnant radiographers have the responsibility to self-track their fetal doses to ensure that the threshold limit of 1 mGy is not exceeded. The traditional method used to track doses includes a written log of doses in a notebook. Thus, PregiDose, a unique offering in the context of pregnancy apps, was developed to enhance fetal dose tracking and monitoring using technological methods. Objective: This study aims to describe the users? perceptions of the app?s usefulness using PregiDose in a natural setting. Methods: The overarching framework adopted for the study was a design science research (DSR) methodology encompassing five steps, namely (1) problem awareness, (2) suggestion, (3) development, (4) evaluation, and (5) conclusion. This paper presents the evaluation step of DSR. DSR step 4 included a qualitative approach to explore users? perceptions regarding the app. Data were collected using a semistructured interview guide. Open-ended questions were guided by the app?s core features, namely dose tracking, education, and wellness. In total, 17 pregnant radiographers in South Africa enrolled to use the app, 9 (53%) engaged with the app, and 4 (24%) agreed to participate in the feedback interviews. The data were collected from October 2023 to March 2024 and analyzed using a reflective thematic data analysis method. Results: Three overarching themes emerged from the data, namely (1) usefulness of PregiDose, (2) barriers to PregiDose adoption and use, and (3) recommendations for the advancement of PregiDose. Users labeled the app?s usefulness as positive and perceived it as a modern approach to traditional dose-tracking methods. They perceived the graph output of the dose-tracking feature to be useful for viewing their accumulative doses. They did not fully engage with the journaling feature, indicating that it was a personal preference and not a practice they would usually engage in. Physiological barriers, such as fatigue and ?pregnancy brain,? were contributors to decreased engagement. Finally, because of the demanding workload and fast-paced nature of the radiography department, users recommended the automation of fetal dosimetry through the Internet of Things. Conclusions: PregiDose is an occupational health and safety mobile app developed for pregnant radiographers through a DSR approach. The app offers a modern method of dose tracking consistent with technological advancements in the context of self-tracking. However, future implementation would require using Internet of Things to make fetal dose tracking more effective. UR - https://formative.jmir.org/2024/1/e58608 UR - http://dx.doi.org/10.2196/58608 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58608 ER - TY - JOUR AU - Tandon, Animesh AU - Cobb, Bryan AU - Centra, Jacob AU - Izmailova, Elena AU - Manyakov, V. Nikolay AU - McClenahan, Samantha AU - Patel, Smit AU - Sezgin, Emre AU - Vairavan, Srinivasan AU - Vrijens, Bernard AU - Bakker, P. Jessie AU - PY - 2024/11/15 TI - Human Factors, Human-Centered Design, and Usability of Sensor-Based Digital Health Technologies: Scoping Review JO - J Med Internet Res SP - e57628 VL - 26 KW - digital health KW - remote KW - decentralized KW - sensors KW - connected care KW - usability KW - ergonomics KW - human-centered design KW - user experience KW - systematic scoping review KW - human factors KW - screening KW - clinicians KW - wearable KW - mobile phone N2 - Background: Increasing adoption of sensor-based digital health technologies (sDHTs) in recent years has cast light on the many challenges in implementing these tools into clinical trials and patient care at scale across diverse patient populations; however, the methodological approaches taken toward sDHT usability evaluation have varied markedly. Objective: This review aims to explore the current landscape of studies reporting data related to sDHT human factors, human-centered design, and usability, to inform our concurrent work on developing an evaluation framework for sDHT usability. Methods: We conducted a scoping review of studies published between 2013 and 2023 and indexed in PubMed, in which data related to sDHT human factors, human-centered design, and usability were reported. Following a systematic screening process, we extracted the study design, participant sample, the sDHT or sDHTs used, the methods of data capture, and the types of usability-related data captured. Results: Our literature search returned 442 papers, of which 85 papers were found to be eligible and 83 papers were available for data extraction and not under embargo. In total, 164 sDHTs were evaluated; 141 (86%) sDHTs were wearable tools while the remaining 23 (14%) sDHTs were ambient tools. The majority of studies (55/83, 66%) reported summative evaluations of final-design sDHTs. Almost all studies (82/83, 99%) captured data from targeted end users, but only 18 (22%) out of 83 studies captured data from additional users such as care partners or clinicians. User satisfaction and ease of use were evaluated for 83% (136/164) and 91% (150/164) of sDHTs, respectively; however, learnability, efficiency, and memorability were reported for only 11 (7%), 4 (2%), and 2 (1%) out of 164 sDHTs, respectively. A total of 14 (9%) out of 164 sDHTs were evaluated according to the extent to which users were able to understand the clinical data or other information presented to them (understandability) or the actions or tasks they should complete in response (actionability). Notable gaps in reporting included the absence of a sample size rationale (reported for 21/83, 25% of all studies and 17/55, 31% of summative studies) and incomplete sociodemographic descriptive data (complete age, sex/gender, and race/ethnicity reported for 14/83, 17% of studies). Conclusions: Based on our findings, we suggest four actionable recommendations for future studies that will help to advance the implementation of sDHTs: (1) consider an in-depth assessment of technology usability beyond user satisfaction and ease of use, (2) expand recruitment to include important user groups such as clinicians and care partners, (3) report the rationale for key study design considerations including the sample size, and (4) provide rich descriptive statistics regarding the study sample to allow a complete understanding of generalizability to other patient populations and contexts of use. UR - https://www.jmir.org/2024/1/e57628 UR - http://dx.doi.org/10.2196/57628 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57628 ER - TY - JOUR AU - Kaczmarczyk, Robert AU - Wilhelm, Isabelle Theresa AU - Roos, Jonas AU - Martin, Ron PY - 2024/11/15 TI - Decoding the Digital Pulse: Bibliometric Analysis of 25 Years in Digital Health Research Through the Journal of Medical Internet Research JO - J Med Internet Res SP - e60057 VL - 26 KW - digital health KW - JMIR publication analysis KW - network analysis KW - artificial intelligence KW - AI KW - large language models KW - eHealth KW - Claude 3 Opus KW - digital KW - digital technology KW - digital intervention KW - machine learning KW - natural language processing KW - NLP KW - deep learning KW - algorithm KW - model KW - analytics KW - practical model KW - pandemic KW - postpandemic era KW - mobile phone N2 - Background: As the digital health landscape continues to evolve, analyzing the progress and direction of the field can yield valuable insights. The Journal of Medical Internet Research (JMIR) has been at the forefront of disseminating digital health research since 1999. A comprehensive network analysis of JMIR publications can help illuminate the evolution and trends in digital medicine over the past 25 years. Objective: This study aims to conduct a detailed network analysis of JMIR?s publications to uncover the growth patterns, dominant themes, and potential future trajectories in digital health research. Methods: We retrieved 8068 JMIR papers from PubMed using the Biopython library. Keyword metrics were assessed using accuracy, recall, and F1-scores to evaluate the effectiveness of keyword identification from Claude 3 Opus and Gemini 1.5 Pro in addition to 2 conventional natural language processing methods using key bidirectional encoder representations from transformers. Future trends for 2024-2026 were predicted using Claude 3 Opus, Google?s Time Series Foundation Model, autoregressive integrated moving average, exponential smoothing, and Prophet. Network visualization techniques were used to represent and analyze the complex relationships between collaborating countries, paper types, and keyword co-occurrence. Results: JMIR?s publication volume showed consistent growth, with a peak in 2020. The United States dominated country contributions, with China showing a notable increase in recent years. Keyword analysis from 1999 to 2023 showed significant thematic shifts, from an early internet and digital health focus to the dominance of COVID-19 and advanced technologies such as machine learning. Predictions for 2024-2026 suggest an increased focus on artificial intelligence, digital health, and mental health. Conclusions: Network analysis of JMIR publications provides a macroscopic view of the evolution of the digital health field. The journal?s trajectory reflects broader technological advances and shifting research priorities, including the impact of the COVID-19 pandemic. The predicted trends underscore the growing importance of computational technology in future health care research and practice. The findings from JMIR provide a glimpse into the future of digital medicine, suggesting a robust integration of artificial intelligence and continued emphasis on mental health in the postpandemic era. UR - https://www.jmir.org/2024/1/e60057 UR - http://dx.doi.org/10.2196/60057 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60057 ER - TY - JOUR AU - Jackson, Sarah AU - Kale, Dimitra AU - Beard, Emma AU - Perski, Olga AU - West, Robert AU - Brown, Jamie PY - 2024/11/15 TI - Effectiveness of the Offer of the Smoke Free Smartphone App Compared With No Intervention for Smoking Cessation: Pragmatic Randomized Controlled Trial JO - J Med Internet Res SP - e50963 VL - 26 KW - randomized controlled trial KW - smartphone app KW - smoking cessation KW - digital intervention KW - tobacco KW - mobile phone N2 - Background: Digital technologies offer the potential for low-cost, scalable delivery of interventions to promote smoking cessation. Objective: We aimed to evaluate the effectiveness of the offer of Smoke Free?an evidence-informed, widely used app?for smoking cessation versus no support. Methods: In this 2-arm randomized controlled trial, 3143 motivated adult smokers were recruited online between August 2020 and April 2021 and randomized to receive an offer of the Smoke Free app plus follow-up (intervention arm) versus follow-up only (comparator arm). Both groups were shown a brief message at the end of the baseline questionnaire encouraging them to make a quit attempt. The primary outcome was self-reported 6-month continuous abstinence assessed 7 months after randomization. Secondary outcomes included quit attempts in the first month post randomization, 3-month continuous abstinence assessed at 4 months, and 6-month continuous abstinence at 7 months among those who made a quit attempt. The primary analysis was performed on an intention-to-treat (ITT) analysis basis. Sensitivity analyses included (1) restricting the intervention group to those who took up the offer of the app, (2) using complete cases, and (3) using multiple imputation. Results: The effective follow-up rate for 7 months was 41.9%. The primary analysis showed no evidence of a benefit of the intervention on rates of 6-month continuous abstinence (intervention 6.8% vs comparator 7.0%; relative risk 0.97, 95% CI 0.75-1.26). Analyses of all secondary outcomes also showed no evidence of a benefit. Similar results were observed on complete cases and using multiple imputation. When the intervention group was restricted to those who took up the offer of the app (n=395, 25.3%), participants in the intervention group were 80% more likely to report 6-month continuous abstinence (12.7% vs 7.0%; relative risk 1.80, 95% CI 1.30-2.45). Equivalent subgroup analyses produced similar results on the secondary outcomes. These differences persisted after adjustment for key baseline characteristics. Conclusions: Among motivated smokers provided with very brief advice to quit, the offer of the Smoke Free app did not have a detectable benefit for cessation compared with follow-up only. However, the app increased quit rates when smokers randomized to receive the app downloaded it. Trial Registration: ISRCTN ISRCTN85785540; https://www.isrctn.com/ISRCTN85785540 International Registered Report Identifier (IRRID): RR2-https://onlinelibrary.wiley.com/doi/full/10.1111/add.14652 UR - https://www.jmir.org/2024/1/e50963 UR - http://dx.doi.org/10.2196/50963 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50963 ER - TY - JOUR AU - Bito, Seiji AU - Hayashi, Yachie AU - Fujita, Takanori AU - Takahashi, Ikuo AU - Arai, Hiromi AU - Yonemura, Shigeto PY - 2024/11/14 TI - Survey of Citizens? Preferences for Combined Contact Tracing App Features During a Pandemic: Conjoint Analysis JO - JMIR Public Health Surveill SP - e53340 VL - 10 KW - digital contact tracing apps KW - infectious disease KW - conjoint analysis KW - user attitudes KW - public preferences KW - citizen values KW - attitude to health KW - COVID-19 KW - contact tracing KW - privacy KW - questionnaires N2 - Background: During the COVID-19 pandemic, an increased need for novel solutions such as digital contact tracing apps to mitigate virus spread became apparent. These apps have the potential to enhance public health initiatives through timely contact tracing and infection rate reduction. However, public and academic scrutiny has emerged around the adoption and use of these apps due to privacy concerns. Objective: This study aims to investigate public attitudes and preferences for contact tracing apps, specifically in Japan, using conjoint analysis to examine what specifications the public values most in such apps. By offering a nuanced understanding of the values that citizens prioritize, this study can help balance public health benefits and data privacy standards when designing contact tracing apps and serve as reference data for discussions on legal development and social consensus formation in the future. Methods: A cross-sectional, web-based questionnaire survey was conducted to determine how various factors related to the development and integration of infectious disease apps affect the public?s intention to use such apps. Individuals were recruited anonymously by a survey company. All respondents were asked to indicate their preferences for a combination of basic attributes and infectious disease app features for conjoint analysis. The respondents were randomly divided into 2 groups: one responded to a scenario where the government was assumed to be the entity dealing with infectious disease apps (ie, the government cluster), and the other responded to a scenario where a commercial company was assumed to be this entity (ie, the business cluster). Samples of 500 respondents from each randomly selected group were used as target data. Results: For the government cluster, the most important attribute in scenario A was distributor rights (42.557), followed by public benefits (29.458), personal health benefits (22.725), and profit sharing (5.260). For the business cluster, the most important attribute was distributor rights (45.870), followed by public benefits (32.896), personal health benefits (13.994), and profit sharing (7.240). Hence, personal health benefits tend to be more important in encouraging active app use than personal financial benefits. However, the factor that increased motivation for app use the most was the public health benefits of cutting infections by half. Further, concern about the use of personal data collected by the app for any secondary purpose was a negative incentive, which was more significant toward app use compared to the other 3 factors. Conclusions: The findings suggest that potential app users are positively motivated not only by personal health benefits but also by contributing to public health. Thus, a combined approach can be taken to increase app use. UR - https://publichealth.jmir.org/2024/1/e53340 UR - http://dx.doi.org/10.2196/53340 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53340 ER - TY - JOUR AU - Song, Faying AU - Gong, Xue AU - Yang, Yuting AU - Guo, Rui PY - 2024/11/14 TI - Comparing the Quality of Direct-to-Consumer Telemedicine Dominated and Delivered by Public and Private Sector Platforms in China: Standardized Patient Study JO - J Med Internet Res SP - e55400 VL - 26 KW - telemedicine KW - direct-to-consumer telemedicine KW - standardized patient KW - China KW - public KW - private KW - platform KW - objective evaluation KW - quality of care KW - effectiveness KW - safety KW - timeliness KW - regression model KW - management N2 - Background: Telemedicine is expanding rapidly, with public direct-to-consumer (DTC) telemedicine representing 70% of the market. A key priority is establishing clear quality distinctions between the public and private sectors. No studies have directly compared the quality of DTC telemedicine in the public and private sectors using objective evaluation methods. Objective: Using a standardized patient (SP) approach, this study aimed to compare the quality of DTC telemedicine provided by China?s public and private sectors. Methods: We recruited 10 SPs presenting fixed cases (urticaria and childhood diarrhea), with 594 interactions between them and physicians. The SPs evaluated various aspects of the quality of care, effectiveness, safety, patient-centeredness (PCC), efficiency, and timeliness using the Institute of Medicine (IOM) quality framework. Ordinary least-squares (OLS) regression models with fixed effects were used for continuous variables, while logistic regression models with fixed effects were used for categorical variables. Results: Significant quality differences were observed between public and private DTC telemedicine. Physicians from private platforms were significantly more likely to adhere to clinical checklists (adjusted ? 15.22, P<.001); provide an accurate diagnosis (adjusted odds ratio [OR] 3.85, P<.001), an appropriate prescription (adjusted OR 3.87, P<.001), and lifestyle modification advice (adjusted OR 6.82, P<.001); ensure more PCC (adjusted ? 3.34, P<.001); and spend more time with SPs (adjusted ? 839.70, P<.001), with more responses (adjusted ? 1.33, P=.001) and more words (adjusted ? 50.93, P=.009). However, SPs on private platforms waited longer for the first response (adjusted ? 505.87, P=.001) and each response (adjusted ? 168.33, P=.04) and paid more for the average visit (adjusted ? 40.03, P<.001). Conclusions: There is significant quality inequality in different DTC telemedicine platforms. Private physicians might provide a higher quality of service regarding effectiveness and safety, PCC, and response times and words. However, private platforms have longer wait times for their first response, as well as higher costs. Refining online reviews, establishing standardized norms and pricing, enhancing the performance evaluation mechanism for public DTC telemedicine, and imposing stricter limitations on the first response time for private physicians should be considered practical approaches to optimizing the management of DTC telemedicine. UR - https://www.jmir.org/2024/1/e55400 UR - http://dx.doi.org/10.2196/55400 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55400 ER - TY - JOUR AU - Widianti, Dini AU - Mahardhika, Pribadi Zwasta AU - Modjo, Robiana PY - 2024/11/14 TI - Development of a Mobile App for Occupational Stress Screening Among Female Workers: Protocol for an Exploratory Sequential Design Study JO - JMIR Res Protoc SP - e55874 VL - 13 KW - mobile app KW - study protocol KW - occupational stress KW - female workers KW - stress KW - screening KW - worker KW - app KW - safety hazards KW - technological innovation KW - ergonomic KW - psychological hazards KW - mobile health KW - digital platform KW - algorithm N2 - Background: Occupational safety hazards include physical, chemical, ergonomic, biological, and psychological hazards. Technological innovation in screening for occupational stress, especially among female workers, is needed to improve their health and productivity. Objective: This research is being conducted to obtain a prediction model of work stress through a questionnaire instrument that includes stressors and symptoms based on the transactional model, as well as measurement of work stress through a mobile app that can be used anywhere. Methods: The research is conducted in 3 stages: qualitative research, quantitative research (cross-sectional), and mobile app development. Data were collected from companies located in Jakarta, Indonesia. The sample was chosen based on purposive sampling. For the quantitative research (n=430), logistic regression analysis was used. Results: We are developing a work stress screening instrument for female workers, which includes stressors and symptoms based on the transactional model, in the form of a digital platform so that female workers can undertake the examination anywhere without interfering with working hours or home duties. This research was funded in January 2024 and qualitative data collection began in February 2024. Quantitative data were obtained in March 2024; the number of respondents in the qualitative stage was 6, and in the quantitative stage it was 430. The work stress screening app is in the development stage and will be launched at the same time as the data collection is performed so we can examine the respondents? perspectives on the use of the app. Conclusions: This study analyzes the prediction of work stress to help female workers screen for work stress. Workers who are detected as experiencing work stress will be educated using an algorithm programmed in the app. International Registered Report Identifier (IRRID): PRR1-10.2196/55874 UR - https://www.researchprotocols.org/2024/1/e55874 UR - http://dx.doi.org/10.2196/55874 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55874 ER - TY - JOUR AU - Shojaei, Fereshtehossadat AU - Shojaei, Fatemehalsadat AU - Desai, P. Archita AU - Long, Emily AU - Mehta, Jade AU - Fowler, R. Nicole AU - Holden, J. Richard AU - Orman, S. Eric AU - Boustani, Malaz PY - 2024/11/13 TI - The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design JO - JMIR Form Res SP - e57390 VL - 8 KW - AgileNudge+ KW - agile KW - nudge strategy KW - nudging interventions KW - agile implementation KW - human behavior KW - software design KW - human-computer interaction KW - user experience design KW - usability testing N2 - Background: In today?s digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. ?AgileNudge+? (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions. Objective: This paper aimed to outline the design process, methodologies, and usefulness of ?AgileNudge+? for the development of evidence-based nudges. It used a mixed methods approach to evaluate the software?s interface usability and usefulness for creating and testing nudge interventions. Methods: AgileNudge+ was developed through iterative processes integrating principles from behavioral economics and user-centered design. The content of AgileNudge+ operationalizes an Agile science?based process to efficiently design, embed, and disseminate evidence-based nudges that encourage positive behavior change without limiting choice. Using a mixed methods approach, we tested AgileNudge+ software?s ability to organize and simplify the nudge intervention process, allowing a diverse range of scholars with limited knowledge of Agile science to use nudges. Usability testing assessed the tool?s usefulness and interface with a sample of 18 health care professionals, each asked to interact with the software and create a nudge intervention to solve a problem within their professional project?s sphere. Results: The study was funded in August 2022, with data collection occurring from June 2023 to July 2024. As of July 2024, we have enrolled 18 participants. Quantitative results found a mean usefulness rating of AgileNudge+ of 3.83 (95% CI 3.00-4.66). Qualitative results highlighted ways to modify the language used in AgileNudge+ to be more comprehensible to a diverse user base and promoted modifications to the software that facilitate real-time assistance and prioritize time efficiency in user interactions. Feedback further supported the positive impact of gamification on participant motivation when using the software. Conclusions: AgileNudge+ is an effective assistive tool for simplifying the positive behavior change process using nudge interventions, with tailored content and interactions to meet users? needs and demands. Building onto the current design, future iterations of AgileNudge+ will use artificial intelligence to process large volumes of data while reducing the time and mental energy required to scan for existing cognitive biases and nudge prototypes. The software is also being upgraded to build on current gamification efforts, encouraging more sustained motivation by increasing the temporal resolution of the digital interface. These modifications stay true to the agility and user-centered aspects of AgileNudge+, emphasizing the novelty of the constantly evolving software design process. UR - https://formative.jmir.org/2024/1/e57390 UR - http://dx.doi.org/10.2196/57390 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57390 ER - TY - JOUR AU - Reynolds, W. Christopher AU - Lee, HaEun AU - Sieka, Joseph AU - Perosky, Joseph AU - Lori, R. Jody PY - 2024/11/13 TI - Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia JO - JMIR Mhealth Uhealth SP - e58624 VL - 12 KW - mHealth KW - mobile triage KW - referral pathways KW - Liberia KW - LMIC KW - low- income country KW - obstetric triage KW - third delay KW - mobile health KW - mobile application KW - digital health KW - digital intervention KW - smartphone KW - middle-income country N2 - Background: Maternal mortality remains a persistent challenge in low- and middle-income countries, where evidence-based interventions of obstetric triage and prehospital communication remain sparse. There is limited implementation evidence for technology-based approaches to improve obstetric care in such contexts. Liberia struggles with maternal mortality, particularly in rural areas where deaths are attributable to delays from absent triage and interfacility communication. We implemented a Mobile Obstetric Referral Emergency System (MORES) in rural Bong County to improve prehospital transfer, health worker attentiveness, and patient care for critical obstetric patients. MORES consisted of triage training and a 2-way, templated WhatsApp communication system to reduce delays among patients transferred from rural health facilities (RHF) to hospitals. Objective: This study aimed to examine MORES implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, as well as additional impacts on the wider health system. Methods: A structured case study design interview was developed by Liberian and US experts in obstetric triage. Participants included 62 frontline obstetric health providers including midwives (38/62, 61%), nurses (20/62, 32%), physicians assistants (3/62, 5%), and physicians (1/62, 2%) from 19 RHFs and 2 district hospitals who had used MORES for 1 year. Individual interviews were conducted on MORES implementation outcomes, transcribed, and analyzed in NVivo (version 12; Lumivero) with a team-based coding methodology. Content analysis with a deductive approach examined implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, while an inductive approach categorized the unanticipated impacts of MORES on the wider health system. Results: Four domains were identified regarding MORES implementation: Usability and Fidelity, Effectiveness, Sustainability and Scalability, and Health System Impact. All participants perceived MORES to have high usability and fidelity, as the triage and messaging system was implemented as intended for critical obstetric patients (62/62, 100%). For effectiveness, MORES accomplished its intended aims by improving prehospital transfer (57/62, 92%), increasing health worker attentiveness (39/62, 63%), and contributing to improved patient care (34/62, 55%). MORES was perceived as sustainable and scalable (62/62, 100%), particularly if technological barriers (21/62, 34%) and staff training (19/62, 31%) were addressed. MORES impacted the wider health system in unanticipated ways including improved coordination and accountability (55/62, 89%), feedback mechanisms for hospitals and RHFs (48/62, 77%), interprofessional teamwork (21/62, 34%), longitudinal follow-up care (20/62, 32%), creating a record of care delays (17/62, 27%), and electronic health record infrastructure (13/62, 21%). Conclusions: MORES was perceived to have high usability, fidelity, effectiveness, sustainability, and scalability by frontline obstetric providers in rural Liberia. MORES accomplished the intended aims of improving prehospital transfer, increasing health worker attentiveness, and contributing to improved patient care. Additionally, MORES strengthened the health system through 6 domains which impacted individual and system levels. Future studies should quantitatively evaluate delay and morbidity reductions and strategies for scaling MORES. UR - https://mhealth.jmir.org/2024/1/e58624 UR - http://dx.doi.org/10.2196/58624 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58624 ER - TY - JOUR AU - Liao, Wenmin AU - He, Rong AU - He, Zhonglian AU - Shi, Nan AU - Li, Dan AU - Zhuang, Aihua AU - Gan, Feng AU - Sun, Ying AU - Li, Chaofeng PY - 2024/11/12 TI - Influence of Blood Sampling Service Process Reengineering on Medical Services Supply: Quasi-Experimental Study JO - J Med Internet Res SP - e51412 VL - 26 KW - process reengineering KW - blood sampling KW - hospital administration KW - medical informatics KW - digital health KW - patient experience N2 - Background: Tertiary hospitals in China are confronted with significant challenges due to limited spatial capacity and workforce constraints, leading to saturated allocation of medical resources and restricted growth in medical service provision. The incorporation of digital health into medical service process reengineering (MSPR) marks a pivotal transformation and restructuring of conventional health service delivery models. Specifically, the application of MSPR to blood sampling services processes reengineering (BSSPR) holds promise for substantially enhancing the efficiency and quality of medical services through streamlining and optimizing these procedures. However, the comprehensive impact of BSSPR has been infrequently quantified in existing research. Objective: This study aims to investigate the influence of BSSPR on the efficiency and quality of medical services and to elucidate the key informative technological support points underpinning BSSPR. Methods: Data were collected from both the new and old laboratory information systems from August 1, 2019, to December 31, 2021. A combination of statistical description, chi-square test, and t test was used to compare check-in time and waiting time of outpatients before and after the implementation of BSSPR. An interrupted time-series design was used to analyze the impact of BSSPR on medical service efficiency and quality, enabling the control of confounding variables, including changes in medical human resources and both long- and short-term temporal trends. Results: BSSPR had an impact on the efficiency and quality of medical services. Notably, there was a significant increase in the number of patients receiving blood sampling services, with a daily service volume increase of ~150 individuals (P=.04). The average waiting time for patients decreased substantially from 29 (SD 36) to 11 (SD 11) minutes, indicating a marked improvement in patient experience. During the peak period, the number of patients receiving blood sampling services per working hour statistically increased from 9.56 to 16.77 (P<.001). The interrupted time-series model results demonstrated a reduction in patients? waiting time by an average of 26.1 (SD 3.8; 95% CI ?33.64 to ?18.57) minutes. Although there was an initial decline in the number of outpatients admitted following BSSPR implementation, an upward trend was observed over time (?=1.13, 95% CI 0.91-1.36). Conclusions: BSSPR implementation for outpatients not only reduced waiting time and improved patients? experience but also augmented the hospital?s capacity to provide medical services. This study?s findings offer valuable insights into the potential advantages of BSSPR and underscore the significance of harnessing digital technologies to optimize medical service processes. This research serves as a foundational basis and provides scientific support for the promotion and application of BSSPR in other health care contexts. By continuing to explore and refine the integration of digital technologies in health care, we can further enhance patient outcomes and elevate the overall quality of medical services. UR - https://www.jmir.org/2024/1/e51412 UR - http://dx.doi.org/10.2196/51412 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51412 ER - TY - JOUR AU - Carter, Michela AU - Linton, C. Samuel AU - Zeineddin, Suhail AU - Pitt, Benjamin J. AU - De Boer, Christopher AU - Figueroa, Angie AU - Gosain, Ankush AU - Lanning, David AU - Lesher, Aaron AU - Islam, Saleem AU - Sathya, Chethan AU - Holl, L. Jane AU - Ghomrawi, MK Hassan AU - Abdullah, Fizan PY - 2024/11/12 TI - Impact of Consumer Wearables Data on Pediatric Surgery Clinicians? Management: Multi-Institutional Scenario-Based Usability Study JO - JMIR Perioper Med SP - e58663 VL - 7 KW - postoperative care KW - telehealth KW - consultation KW - remote KW - appendectomy KW - pediatric hospital KW - children KW - wearable device KW - minimally invasive surgery KW - pediatric surgery KW - remote simulation study N2 - Background: At present, parents lack objective methods to evaluate their child?s postoperative recovery following discharge from the hospital. As a result, clinicians are dependent upon a parent?s subjective assessment of the child?s health status and the child?s ability to communicate their symptoms. This subjective nature of home monitoring contributes to unnecessary emergency department (ED) use as well as delays in treatment. However, the integration of data remotely collected using a consumer wearable device has the potential to provide clinicians with objective metrics for postoperative patients to facilitate informed longitudinal, remote assessment. Objective: This multi-institutional study aimed to evaluate the impact of adding actual and simulated objective recovery data that were collected remotely using a consumer wearable device to simulated postoperative telephone encounters on clinicians? management. Methods: In total, 3 simulated telephone scenarios of patients after an appendectomy were presented to clinicians at 5 children?s hospitals. Each scenario was then supplemented with wearable data concerning or reassuring against a postoperative complication. Clinicians rated their likelihood of ED referral before and after the addition of wearable data to evaluate if it changed their recommendation. Clinicians reported confidence in their decision-making. Results: In total, 34 clinicians participated. Compared with the scenario alone, the addition of reassuring wearable data resulted in a decreased likelihood of ED referral for all 3 scenarios (P<.01). When presented with concerning wearable data, there was an increased likelihood of ED referral for 1 of 3 scenarios (P=.72, P=.17, and P<.001). At the institutional level, there was no difference between the 5 institutions in how the wearable data changed the likelihood of ED referral for all 3 scenarios. With the addition of wearable data, 76% (19/25) to 88% (21/24 and 22/25) of clinicians reported increased confidence in their recommendations. Conclusions: The addition of wearable data to simulated telephone scenarios for postdischarge patients who underwent pediatric surgery impacted clinicians? remote patient management at 5 pediatric institutions and increased clinician confidence. Wearable devices are capable of providing real-time measures of recovery, which can be used as a postoperative monitoring tool to reduce delays in care and avoidable health care use. UR - https://periop.jmir.org/2024/1/e58663 UR - http://dx.doi.org/10.2196/58663 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58663 ER - TY - JOUR AU - Oliveira, Ashleigh AU - Wolff, John AU - Alfouzan, Nouf AU - Yu, Jin AU - Yahya, Asma AU - Lammy, Kayla AU - Nakamura, T. Manabu PY - 2024/11/11 TI - A Novel Web App for Dietary Weight Management: Development, Implementation, and Usability Study JO - JMIR Form Res SP - e58363 VL - 8 KW - health application KW - weight loss KW - behavior change technique KW - BCT KW - online weight loss program KW - weight monitoring KW - meal planning KW - sustainable weight loss KW - dietary fiber KW - mHealth KW - mobile health N2 - Background: Online weight loss programs have ambiguous efficacy. There is a growing body of evidence that weight loss programs when combined with apps have better outcomes; however, many apps lack an evidence-based approach to dietary changes for weight loss and do not rely on a theoretical framework for behavior change. Objective: This study aimed to describe the development and the preliminary usability and acceptability testing of a web app that uses behavior change techniques (BCTs) to support users of a comprehensive online weight loss program. Methods: The weight loss program intervention components were nutrient and weight tracking charts that needed a remotely accessible and online format. The app was designed by nutrition researchers and developers in a collaborative effort. A review of BCTs in weight loss and web apps was performed as well as an assessment of user needs to inform the initial prototype. A preliminary app prototype, version 1.0, was provided to participants of a weight loss trial (N=30) to assess for feasibility of its use. A full app prototype, version 2.0, was feasibility and acceptability tested by trial participants (n=11) with formal feedback by Likert-scale survey and open-ended questions. In the final round of testing, a user group of scientists and developers (n=11) was selected to provide a structured 3-month review through which the group met weekly for collective feedback sessions. Results: The process resulted in a fully developed web app, MealPlot, by the Applied Research Institute, for meal planning and weight tracking that can be used by weight loss users and health professionals to track their patients. MealPlot includes a weight chart, a protein-fiber chart, and a chat feature. In addition, MealPlot has 2 distinct platforms, 1 for weight loss users and 1 for health professionals. Selected BCTs for incorporation into the app were goal setting, feedback, problem-solving, self-monitoring, and social support. Version 1.0 was used successfully to provide a functioning, online weight chart over the course of a 1-year trial. Version 2.0 provided a functional weight chart and meal planning page, but 8 out of 11 participants indicated MealPlot was difficult to use. Version 3.0 was developed based on feedback and strategies provided from user group testing. Conclusions: The web app, MealPlot, was developed to improve outcomes and functionality of an online weight loss program by providing a remote method of tracking weight, food intake, and connecting users to health professionals for consistent guidance that is not otherwise available in a traditional in-person health care setting. The final version 3.0 of the web app will be refined based on findings of a review study gathering feedback from health professionals and from actual weight loss users who are part of a clinical weight loss trial. UR - https://formative.jmir.org/2024/1/e58363 UR - http://dx.doi.org/10.2196/58363 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58363 ER - TY - JOUR AU - Yang, Yanrong AU - Tavares, Jorge AU - Oliveira, Tiago PY - 2024/11/11 TI - A New Research Model for Artificial Intelligence?Based Well-Being Chatbot Engagement: Survey Study JO - JMIR Hum Factors SP - e59908 VL - 11 KW - artificial intelligence?based chatbot KW - AI-based chatbot KW - mental well-being KW - intention to engage KW - engagement behavior KW - theoretical models KW - mobile phone N2 - Background: Artificial intelligence (AI)?based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being. Objective: This study aimed to identify the factors that impact individuals? intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness. Methods: We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach. Results: The model explained 62.8% (R2) of the variance in intention to engage and 74% (R2) of the variance in engagement behavior. Affect (?=.201; P=.002), social factors (?=.184; P=.007), and compatibility (?=.149; P=.03) were statistically significant for the intention to engage. Habit (?=.154; P=.01), trust (?=.253; P<.001), and intention to engage (?=.464; P<.001) were statistically significant for engagement behavior. Conclusions: The new extended model provides a theoretical basis for studying users? AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users. UR - https://humanfactors.jmir.org/2024/1/e59908 UR - http://dx.doi.org/10.2196/59908 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59908 ER - TY - JOUR AU - Liu, Yayuan AU - Jin, Haofeng AU - Yu, Zhuoyuan AU - Tong, Yu PY - 2024/11/11 TI - Impact of Internet Hospital Consultations on Outpatient Visits and Expenses: Quasi-Experimental Study JO - J Med Internet Res SP - e57609 VL - 26 KW - internet hospital KW - online consultation KW - telehealth KW - outpatient visits KW - outpatient expenses KW - urban-rural healthcare disparity N2 - Background: Internet hospital consultations are emerging in China as a new channel for patients to access health care services. Unlike third-party health care platforms such as Haodf, Teladoc Health, and MDLive, internet hospitals seamlessly integrate patients? offline medical records with online consultations, offering a cohesive online and offline health care experience. However, its impact on outpatient visits remains ambiguous. While it may encourage outpatient visits due to better continuity of care, it could also reduce face-to-face visits because of the convenience of online consultations. Given that patients in China have the autonomy to freely choose their health care providers, it is critical for hospitals to understand the effect of this telehealth technology on outpatient visits. Objective: This study aimed to analyze the impact of patients? adoption of internet hospital consultations on their outpatient frequency and expenses, and whether these impacts vary between urban and rural patients. Methods: The data used in this study were collected from a public tertiary hospital situated in a southeastern county of China, covering internet hospital consultations from January 2021 to October 2022, and offline outpatient records from January 2020 to October 2022. The dataset also includes patient demographic information. To estimate the causal effect, we used a quasi-experimental design, combining the difference-in-differences (DiD) analysis with the propensity score matching (PSM). After performing PSM, 2065 pairs of patients (4130 patients) were obtained for data analysis. Results: Our findings highlight 3 key results. First, patients? adoption of internet hospital consultations increases their frequency of outpatient visits by 2.4% per month (P<.001), and the associated expenses by 15.5% per month (P<.001). Second, such positive effects are more pronounced for patients residing in rural areas. Specifically, for every 1% increase in the distance between patients? residences and the county government (an urban center), the positive effect on monthly outpatient visits increases by 0.3% (P=.06), and the positive effect on monthly outpatient expenses increases by 2.4% (P=.03). Third, our post hoc analysis shows that rural patients living in areas with higher local health care quality experience a mitigated positive effect of internet hospital consultations, compared with those in areas with lower health care quality. Conclusions: This study extends the research scope of telehealth technologies by investigating internet hospitals, which are characterized by the integration of online and offline services. Our findings suggest that patients? adoption of internet hospital consultations is associated with an increase in both the frequency and expenses of outpatient visits. In addition, these effects vary based on patients? urban-rural status and local health care quality. These insights offer valuable guidance for policy makers and health care providers in promoting and optimizing the development and operation of internet hospitals. UR - https://www.jmir.org/2024/1/e57609 UR - http://dx.doi.org/10.2196/57609 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57609 ER - TY - JOUR AU - Perme, Natalie AU - Reid, Endia AU - Eluagu, Chinwenwa Macdonald AU - Thompson, John AU - Hebert, Courtney AU - Gabbe, Steven AU - Swoboda, Marie Christine PY - 2024/11/8 TI - Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study JO - JMIR Form Res SP - e53299 VL - 8 KW - health resources KW - pregnancy KW - patient engagement KW - mHealth KW - maternal KW - mobile health KW - app KW - focus group KW - landscape analysis KW - birth KW - preterm KW - premature KW - mortality KW - death KW - pediatric KW - infant KW - neonatal KW - design KW - development KW - obstetric KW - mobile phone N2 - Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app?s intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. UR - https://formative.jmir.org/2024/1/e53299 UR - http://dx.doi.org/10.2196/53299 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53299 ER - TY - JOUR AU - Han, Tao AU - Wei, Qinpeng AU - Wang, Ruike AU - Cai, Yijin AU - Zhu, Hongyi AU - Chen, Jiani AU - Zhang, Zhiruo AU - Li, Sisi PY - 2024/11/8 TI - Service Quality and Patient Satisfaction of Internet Hospitals in China: Cross-Sectional Evaluation With the Service Quality Questionnaire JO - J Med Internet Res SP - e55140 VL - 26 KW - service quality KW - SERVQUAL KW - Service Quality Questionnaire KW - internet hospital KW - e-hospital KW - digital medical care KW - health care professionals KW - Chinese digital health care N2 - Background: Internet hospitals, which refer to service platforms that integrate consultation, prescription, payment, and drug delivery based on hospital entities, have been developing at a rapid pace in China since 2014. However, assessments regarding their service quality and patient satisfaction have not been well developed. There is an urgent need to comprehensively evaluate and improve the service quality of internet hospitals. Objective: This study aims to investigate the current status of patients? use of internet hospitals, as well as familiarity and willingness to use internet hospitals, to evaluate patients? expected and perceived service qualities of internet hospitals using the Chinese version of the Service Quality Questionnaire (SERVQUAL-C) with a national representative sample, and to explore the association between service quality of internet hospitals and patients? overall satisfaction toward associated medical platforms. Methods: This cross-sectional survey was conducted through face-to-face or digital interviews from June to September 2022. A total of 1481 outpatient participants (635 men and 846 women; mean age 33.22, SD 13.22). Participants reported their use of internet hospitals, and then rated their expectations and perceptions of service quality toward internet hospitals via the SERVQUAL-C, along with their demographic information. Results: Among the surveyed participants, 51.2% (n=758) of participants had used internet hospital service or services. Use varied across age, education level, and annual income. Although the majority of them (n=826, 55.8%) did not know internet hospital services well, 68.1% (n=1009) of participants expressed the willingness to adopt this service. Service quality evaluation revealed that the perceived service quality did not match with the expectation, especially the responsiveness dimension. Important-performance analysis results further alerted that reliable diagnosis, prompt response, clear feedback pathway, and active feedback handling were typically the services awaiting substantial improvement. More importantly, multiple linear regressions revealed that familiarity and willingness to use internet hospital services were significant predictors of satisfaction, above and over tangibles, reliability, and empathy service perspectives, and demographic characteristics such as gender, age, education level, and annual income. Conclusions: In the future, internet hospitals should focus more on how to narrow the gaps between the expected and perceived service quality. Promotion of internet hospitals should also be facilitated to increase patients? familiarity with and willingness to use these services. UR - https://www.jmir.org/2024/1/e55140 UR - http://dx.doi.org/10.2196/55140 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55140 ER - TY - JOUR AU - Wang, Tzu AU - Huang, Yen-Ming AU - Chan, Hsun-Yu PY - 2024/11/8 TI - Exploration of Features of Mobile Applications for Medication Adherence in Asia: Narrative Review JO - J Med Internet Res SP - e60787 VL - 26 KW - Asia KW - adherence KW - application KW - feature KW - medication KW - mobile N2 - Background: Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge. Objective: We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies. Methods: We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included ?Asia,? ?chronic disease,? ?app,? ?application,? ?survey,? ?experiment,? ?questionnaire,? ?group,? ?medical adherence,? ?medication adherence,? ?case-control,? ?cohort study,? ?randomized controlled trial,? ?clinical trial,? ?observational study,? ?qualitative research,? ?mixed methods,? and ?analysis,? combined using logical operators ?OR? and ?AND.? The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use. Results: The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction. Conclusions: This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence. UR - https://www.jmir.org/2024/1/e60787 UR - http://dx.doi.org/10.2196/60787 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60787 ER - TY - JOUR AU - Marier-Tétrault, Emmanuel AU - Bebawi, Emmanuel AU - Béchard, Stéphanie AU - Brouillard, Philippe AU - Zuchinali, Priccila AU - Remillard, Emilie AU - Carrier, Zoé AU - Jean-Charles, Loyda AU - Nguyen, Kha John Nam AU - Lehoux, Pascale AU - Pomey, Marie-Pascale AU - Ribeiro, B. Paula A. AU - Tournoux, François PY - 2024/11/6 TI - Remote Patient Monitoring and Digital Therapeutics Enhancing the Continuum of Care in Heart Failure: Nonrandomized Pilot Study JO - JMIR Form Res SP - e53444 VL - 8 KW - heart failure KW - remote patient management KW - telemonitoring KW - digital therapeutics KW - digital health KW - heart KW - therapeutics KW - pilot study KW - patient care KW - medical therapy KW - vitals KW - weight KW - symptoms KW - quality of life KW - medication optimization KW - mobile phone N2 - Background: Heart failure (HF) is the primary cause of hospitalization among Canadian patients aged ?65 years. Care for HF requires regular clinical follow-ups to prevent readmissions and facilitate medical therapy optimization. Multiple barriers lead to therapeutic medical inertia including limited human resources and regional inequities. Remote patient monitoring (RPM) and digital therapeutics (DTx) solutions have been developed to improve HF management, but their adoption remains limited and underexplored. The Continuum project emerged as a collaborative initiative involving a health care center, a software start-up, and an industrial partner. Objective: We aimed to develop and test the feasibility of the Continuum intervention that seamlessly combined an RPM system with a DTx solution for HF within the same software. Methods: A 3-month pre-post pilot study was conducted from October 2020 to June 2021. Patients with HF who owned a smartphone or tablet (having remote patient monitoring [RPM+]), had (1) access to a self-care app where they could enter their vital signs, weight, and HF symptoms and view educational content; (2) daily monitoring of their data by a nurse; and (3) a DTx module with automated HF medication suggestions based on national guidelines, made available to their treating medical team. Bluetooth devices were offered to facilitate data recording. Nurses on RPM monitoring could call patients and arrange appointments with their medical team. Patients without a mobile device or unable to use the app were followed in another group (without remote patient monitoring [RPM?]). Results: In total, 52 patients were enrolled in this study (32 RPM+ and 20 RPM?). Among patients owning a mobile device, only 14% (5/37) could not use the app. In the RPM+ group, 47% (15/32) of the patients used the app for more than 80% (67 days) of the 12-week study period. The use of our digital solution was integrated into the regular nursing workday and only 34 calls had to be made by the nurse during the study period. Only 6% (2/32) of the patients in the RPM+ group experienced at least 1 all-cause hospitalization versus 35% (7/20) of the RPM? ones during the follow-up (6%, 2/32 vs 25%, 5/20 for HF hospitalization) and patients were more likely to have their HF therapy optimized if the DTx solution was available. Quality of life improved in patients compliant with the use of the mobile app (mean score variation +10.6, SD 14.7). Conclusions: This pilot study demonstrated the feasibility of implementing our digital solution, within the specific context of HF. The seamless integration of Continuum into nursing workflow, mobile app accessibility, and adoption by patients, were the 3 main key learning points of this study. Further investigation is required to assess the potential impacts on hospitalizations, drug optimization, and quality of life. Trial Registration: ClinicalTrials.gov NCT05377190; https://clinicaltrials.gov/study/NCT05377190 (pilot study #21.403) UR - https://formative.jmir.org/2024/1/e53444 UR - http://dx.doi.org/10.2196/53444 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53444 ER - TY - JOUR AU - Tagi, Masato AU - Hamada, Yasuhiro AU - Shan, Xiao AU - Ozaki, Kazumi AU - Kubota, Masanori AU - Amano, Sosuke AU - Sakaue, Hiroshi AU - Suzuki, Yoshiko AU - Konishi, Takeshi AU - Hirose, Jun PY - 2024/11/5 TI - A Food Intake Estimation System Using an Artificial Intelligence?Based Model for Estimating Leftover Hospital Liquid Food in Clinical Environments: Development and Validation Study JO - JMIR Form Res SP - e55218 VL - 8 KW - artificial intelligence KW - machine learning KW - system development KW - food intake KW - dietary intake KW - dietary assessment KW - food consumption KW - image visual estimation KW - AI estimation KW - direct visual estimation N2 - Background: Medical staff often conduct assessments, such as food intake and nutrient sufficiency ratios, to accurately evaluate patients? food consumption. However, visual estimations to measure food intake are difficult to perform with numerous patients. Hence, the clinical environment requires a simple and accurate method to measure dietary intake. Objective: This study aims to develop a food intake estimation system through an artificial intelligence (AI) model to estimate leftover food. The accuracy of the AI?s estimation was compared with that of visual estimation for liquid foods served to hospitalized patients. Methods: The estimations were evaluated by a dietitian who looked at the food photo (image visual estimation) and visual measurement evaluation was carried out by a nurse who looked directly at the food (direct visual estimation) based on actual measurements. In total, 300 dishes of liquid food (100 dishes of thin rice gruel, 100 of vegetable soup, 31 of fermented milk, and 18, 12, 13, and 26 of peach, grape, orange, and mixed juices, respectively) were used. The root-mean-square error (RMSE) and coefficient of determination (R2) were used as metrics to determine the accuracy of the evaluation process. Corresponding t tests and Spearman rank correlation coefficients were used to verify the accuracy of the measurements by each estimation method with the weighing method. Results: The RMSE obtained by the AI estimation approach was 8.12 for energy. This tended to be smaller and larger than that obtained by the image visual estimation approach (8.49) and direct visual estimation approach (4.34), respectively. In addition, the R2 value for the AI estimation tended to be larger and smaller than the image and direct visual estimations, respectively. There was no difference between the AI estimation (mean 71.7, SD 23.9 kcal, P=.82) and actual values with the weighing method. However, the mean nutrient intake from the image visual estimation (mean 75.5, SD 23.2 kcal, P<.001) and direct visual estimation (mean 73.1, SD 26.4 kcal, P=.007) were significantly different from the actual values. Spearman rank correlation coefficients were high for energy (?=0.89-0.97), protein (?=0.94-0.97), fat (?=0.91-0.94), and carbohydrate (?=0.89-0.97). Conclusions: The measurement from the food intake estimation system by an AI-based model to estimate leftover liquid food intake in patients showed a high correlation with the actual values with the weighing method. Furthermore, it also showed a higher accuracy than the image visual estimation. The errors of the AI estimation method were within the acceptable range of the weighing method, which indicated that the AI-based food intake estimation system could be applied in clinical environments. However, its lower accuracy than that of direct visual estimation was still an issue. UR - https://formative.jmir.org/2024/1/e55218 UR - http://dx.doi.org/10.2196/55218 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55218 ER - TY - JOUR AU - Xu, Dandan AU - Xu, Dongmei AU - Wei, Lan AU - Bao, Zhipeng AU - Liao, Shengen AU - Zhang, Xinyue PY - 2024/11/5 TI - The Effectiveness of Remote Exercise Rehabilitation Based on the ?SCeiP? Model in Homebound Patients With Coronary Heart Disease: Randomized Controlled Trial JO - J Med Internet Res SP - e56552 VL - 26 KW - coronary heart disease KW - exercise rehabilitation KW - promotion strategy KW - home rehabilitation N2 - Background: While exercise rehabilitation is recognized as safe and effective, medium- to long-term compliance among patients with coronary heart disease (CHD) remains low. Therefore, promoting long-term adherence to exercise rehabilitation for these patients warrants significant attention. Objective: This study aims to investigate the impact of remote exercise rehabilitation on time investment and related cognitive levels in homebound patients with CHD. This study utilizes the SCeiP (Self-Evaluation/Condition of Exercise-Effect Perception-Internal Drive-Persistence Behavior) model, alongside WeChat and exercise bracelets. Methods: A total of 147 patients who underwent percutaneous coronary intervention in the cardiovascular department of a grade III hospital in Jiangsu Province from June 2022 to March 2023 were selected as study participants through convenience sampling. The patients were randomly divided into an experimental group and a control group. The experimental group received an exercise rehabilitation promotion strategy based on the ?SCeiP? model through WeChat and exercise bracelets, while the control group followed rehabilitation training according to a standard exercise rehabilitation guide. The days and duration of exercise, levels of cardiac rehabilitation cognition, exercise planning, and exercise input were analyzed before the intervention and at 1 month and 3 months after the intervention. Results: A total of 81 men (55.1%) and 66 women (44.9%) were recruited for the study. The completion rate of exercise days was significantly higher in the experimental group compared with the control group at both 1 month (t145=5.429, P<.001) and 3 months (t145=9.113, P<.001) after the intervention. Similarly, the completion rate of exercise duration was significantly greater in the experimental group (t145=3.471, P=.001) than in the control group (t145=5.574, P<.001). The levels of autonomy, exercise planning, and exercise input in the experimental group were significantly higher than those in the control group at both 1 month and 3 months after the intervention (P<.001). Additionally, the experimental group exhibited a significant reduction in both process anxiety and outcome anxiety scores (P<.001). Repeated measures ANOVA revealed significant differences in the trends of cognitive function related to cardiac rehabilitation between the 2 patient groups over time: autonomy, F1,145(time×group)=9.055 (P<.001); process anxiety, F1,145(time×group)=30.790 (P<.001); and outcome anxiety, F1,145(time×group)=28.186 (P<.001). As expected, the scores for exercise planning (t145=2.490, P=.01 and t145=3.379, P<.001, respectively) and exercise input (t145=2.255, P=.03 and t145=3.817, P<.001, respectively) consistently demonstrated superiority in the experimental group compared with the control group at both 1 and 3 months after the intervention. Interestingly, we observed that the levels of exercise planning and exercise input in both groups initially increased and then slightly decreased over time, although both remained higher than the preintervention levels (P<.001). Conclusions: The remote health intervention based on the ?SCeiP? model effectively enhances exercise compliance, exercise planning, exercise input, and cognitive levels during cardiac rehabilitation in patients with CHD. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069463; https://www.chictr.org.cn/showproj.html?proj=192461 UR - https://www.jmir.org/2024/1/e56552 UR - http://dx.doi.org/10.2196/56552 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56552 ER - TY - JOUR AU - Vey, Trinity AU - Kinnicutt, Eleonora AU - West, Nicola AU - Sleeth, Jessica AU - Nchimbi, Bernard Kenneth AU - Yeates, Karen PY - 2024/11/5 TI - Implementation of a Mobile Health Approach to a Long-Lasting Insecticidal Net Uptake Intervention for Malaria Prevention Among Pregnant Women in Tanzania: Process Evaluation of the Hati Salama (HASA) Randomized Controlled Trial Study JO - J Med Internet Res SP - e51527 VL - 26 KW - mHealth KW - short message service KW - behavior change communication KW - pregnancy KW - long-lasting insecticidal nets KW - malaria KW - protozoan infections KW - parasitic diseases KW - vector borne diseases KW - insecticide KW - intervention KW - malaria prevention N2 - Background: Malaria infection is associated with many adverse outcomes for pregnant women and neonates, yet pregnant women in East and Southern Africa remain frequently exposed to malaria. Long-lasting insecticidal nets (LLINs) can help prevent malarial infections and the associated adverse events. The Hati Salama (HASA) study was a cluster-randomized controlled trial implemented in 100 antenatal health facilities in urban and rural settings of Tanzania that provided pregnant women in both intervention and control groups with e-vouchers to redeem for LLINs for malaria prevention. The intervention group received behavior change communication mobile messages across a 14-day period while the e-voucher was active, and no significant difference between the rates of e-voucher redemption was found across the two groups. Objective: This study was a process evaluation of the HASA randomized controlled trial to determine barriers and facilitators to e-voucher reception and LLIN acquisition for pregnant women enrolled in the trial, as well as challenges and lessons learned by nurses who worked at the antenatal health facilities supporting the trial. Methods: Following the e-voucher?s expiration at 14 days, voluntary phone follow-up surveys were conducted for nurses who supported the trial, as well as participants in both intervention and control groups of the trial who did not redeem their e-vouchers. Survey questions asked nurses about workflow, training sessions, network connectivity, proxy phone use, and more. Surveys asked participants about reasons for not redeeming e-vouchers. Both surveys provided lists of preset answers to questions, as well as the option to provide open-ended responses. Nurses and trial participants were contacted between January and June 2016 on up to three occasions. Results: While nurses who supported the HASA trial seemed to recognize the value of the program in their communities, some barriers identified by nurses included network connectivity, workload increase, inadequate training and on-the-ground support, and difficulty following the workflow. Several barriers identified by trial participants included personal obligations preventing them from redeeming the e-voucher on time, network connectivity issues, losing the e-voucher number, no stock of LLINs at retailers when attended, inadequate explanation of where or how to redeem the e-voucher, or not receiving an SMS text message with the e-voucher number promptly or at all. Conclusions: Large-scale e-voucher platforms for health-related commodity interventions, such as LLIN distribution in sub-Saharan Africa, are feasible, but challenges, including network connectivity, must be addressed. Nurses identified issues to be considered in a future scale-up, such that the number of nurses trained should be increased and the e-voucher issuance workflow should be simplified. To address some of the key barriers impacting e-voucher redemption for trial participants, the network of retailers could be expanded and the e-voucher expiration period should be extended. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 UR - https://www.jmir.org/2024/1/e51527 UR - http://dx.doi.org/10.2196/51527 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51527 ER - TY - JOUR AU - Raman, Raghu AU - Singhania, Monica AU - Nedungadi, Prema PY - 2024/11/4 TI - Advancing the United Nations Sustainable Development Goals Through Digital Health Research: 25 Years of Contributions From the Journal of Medical Internet Research JO - J Med Internet Res SP - e60025 VL - 26 KW - sustainable development goal KW - topic modeling KW - public health KW - surveillance KW - gender equality KW - non-communicable disease KW - social media KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - machine learning KW - artificial intelligence KW - AI KW - digital health UR - https://www.jmir.org/2024/1/e60025 UR - http://dx.doi.org/10.2196/60025 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60025 ER - TY - JOUR AU - Gustafson Sr, H. David AU - Gustafson Jr, H. David AU - Mares, Marie-Louise AU - Johnston, C. Darcie AU - Vjorn, J. Olivia AU - Curtin, J. John AU - Epstein, E. Elizabeth AU - Bailey, L. Genie PY - 2024/11/1 TI - Couple-Focused Smartphone Intervention to Reduce Problem Drinking: Pilot Randomized Control Trial JO - JMIR Form Res SP - e58622 VL - 8 KW - alcohol use disorder KW - AUD KW - mHealth KW - mobile health KW - mobile phone KW - smartphone KW - couple therapy KW - Comprehensive Health Enhancement Support System KW - A-CHESS KW - Alcohol Behavioral Couple Therapy KW - ABCT N2 - Background: Alcohol use disorder is among the most pervasive substance use disorders in the United States, with a lifetime prevalence of 30%. Recommended treatment options include evidence-based behavioral interventions; smartphone-based interventions confer a number of benefits such as portability, continuous access, and stigma avoidance; and research suggests that interventions involving couples may outperform those for patients only. In this context, a behavioral intervention delivered to couples through smartphones may serve as an effective adjunct to alcohol use disorder treatment. Objective: This pilot study aimed to (1) evaluate the feasibility of comparing a patient-only (Addiction version of the Comprehensive Health Enhancement Support System; A-CHESS) versus a couple-focused (Partner version of the Comprehensive Health Enhancement Support System; Partner-CHESS) eHealth app for alcohol misuse delivered by smartphone, (2) assess perceptions about and use of the 2 apps, and (3) examine initial indications of differences in primary clinical outcomes between patient groups using the 2 apps. Broadly, these aims serve to assess the feasibility of the study protocol for a larger randomized controlled trial. Methods: A total of 33 romantic couples were randomized to 6 months of A-CHESS app use (active treatment control) or Partner-CHESS app use (experimental). Couples comprised a patient with current alcohol use disorder (25/33, 76% male) and a romantic partner (26/33, 79% female). Patients and partners in both arms completed outcome measure surveys at 0, 2, 4, and 6 months. Primary outcomes were patients? percentage of days with heavy drinking and percentage of days with any drinking, measured by timeline follow back. Secondary outcomes included app use and perceptions, and multiple psychosocial variables. Results: At 6 months, 78% (14/18) of Partner-CHESS patients and 73% (11/15) of A-CHESS patients were still using the intervention. The apps were rated helpful on a 5-point scale (1=not at all helpful, 5=extremely helpful) by 89% (29/33) of both Partner-CHESS patients (mean 3.7, SD 1) and partners (mean 3.6, SD 0.9) and by 87% (13/15) of A-CHESS patients (mean 3.1, SD 0.9). At 6 months, Partner-CHESS patients had a nonsignificantly lower percentage of days with heavy drinking compared with A-CHESS patients (?=?17.4, 95% CI ?36.1 to 1.4; P=.07; Hedges g=?0.53), while the percentage of drinking days was relatively equal between patient groups (?=?2.1, 95% CI ?24.8 to 20.7; P=.85; Hedges g=?0.12). Conclusions: Initial results support the feasibility of evaluating patient-only and couple-focused, smartphone-based interventions for alcohol misuse. Results suggest that both interventions are perceived as helpful and indicate maintained engagement of most participants for 6 months. A future, fully powered trial is warranted to evaluate the relative effectiveness of both interventions. Trial Registration: ClinicalTrials.gov NCT04059549; https://clinicaltrials.gov/ct2/show/NCT04059549 UR - https://formative.jmir.org/2024/1/e58622 UR - http://dx.doi.org/10.2196/58622 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58622 ER - TY - JOUR AU - Ho, Mu-Hsing AU - Peng, Chi-Yuan AU - Liao, Yung AU - Yen, Hsin-Yen PY - 2024/11/1 TI - Efficacy of a Wearable Activity Tracker With Step-by-Step Goal-Setting on Older Adults? Physical Activity and Sarcopenia Indicators: Clustered Trial JO - J Med Internet Res SP - e60183 VL - 26 KW - behavioral change technique KW - chronic disease prevention KW - health promotion KW - mHealth KW - sedentary behavior KW - smartwatch N2 - Background: Smart wearable technology has potential benefits for promoting physical activity and preventing sarcopenia. Objective: The purpose of this study was to explore the efficacy of a wearable activity tracker with 2-stage goal-setting for daily steps on older adults? physical activity and sarcopenia indicators. Methods: The study used a clustered trial design and was conducted in March to June 2022. Participants were community-dwelling adults older than 60 years who were recruited from 4 community centers in Taipei City. The intervention was designed with 2-stage goals set to 5000 steps/day in the first 4 weeks and 7500 steps/day in the final 4 weeks while wearing a commercial wearable activity tracker. Data were collected by self-reported questionnaires, a body composition analyzer, a handle grip tester, and 5 sit-to-stand tests. Results: All 27 participants in the experimental group and 31 participants in the control group completed the 8-week intervention. Total and light-intensity physical activities, skeletal muscle index, and muscle strength increased, while sedentary time, BMI, and the waist circumference of participants decreased in the experimental group, with significant group-by-time interactions compared to the control group. Conclusions: A wearable activity tracker with gradual goal-setting is an efficient approach to improve older adults? physical activity and sarcopenia indicators. Smart wearable products with behavioral change techniques are recommended to prevent sarcopenia in older adult populations. UR - https://www.jmir.org/2024/1/e60183 UR - http://dx.doi.org/10.2196/60183 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60183 ER - TY - JOUR AU - Terhorst, Yannik AU - Knauer, Johannes AU - Philippi, Paula AU - Baumeister, Harald PY - 2024/11/1 TI - The Relation Between Passively Collected GPS Mobility Metrics and Depressive Symptoms: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e51875 VL - 26 KW - smart sensing KW - digital phenotyping KW - depression KW - GPS KW - global positioning system KW - meta-analysis KW - mobile phone KW - depressive symptoms KW - smartphone KW - systematic review KW - depressive disorders KW - treatment KW - mental disorder KW - mental health KW - wearable N2 - Background: The objective, unobtrusively collected GPS features (eg, homestay and distance) from everyday devices like smartphones may offer a promising augmentation to current assessment tools for depression. However, to date, there is no systematic and meta-analytical evidence on the associations between GPS features and depression. Objective: This study aimed to investigate the between-person and within-person correlations between GPS mobility and activity features and depressive symptoms, and to critically review the quality and potential publication bias in the field. Methods: We searched MEDLINE, PsycINFO, Embase, CENTRAL, ACM, IEEE Xplore, PubMed, and Web of Science to identify eligible articles focusing on the correlations between GPS features and depression from December 6, 2022, to March 24, 2023. Inclusion and exclusion criteria were applied in a 2-stage inclusion process conducted by 2 independent reviewers (YT and JK). To be eligible, studies needed to report correlations between wearable-based GPS variables (eg, total distance) and depression symptoms measured with a validated questionnaire. Studies with underage persons and other mental health disorders were excluded. Between- and within-person correlations were analyzed using random effects models. Study quality was determined by comparing studies against the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines. Publication bias was investigated using Egger test and funnel plots. Results: A total of k=19 studies involving N=2930 participants were included in the analysis. The mean age was 38.42 (SD 18.96) years with 59.64% (SD 22.99%) of participants being female. Significant between-person correlations between GPS features and depression were identified: distance (r=?0.25, 95% CI ?0.29 to ?0.21), normalized entropy (r?0.17, 95% CI ?0.29 to ?0.04), location variance (r?0.17, 95% CI ?0.26 to ?0.04), entropy (r=?0.13, 95% CI ?0.23 to ?0.04), number of clusters (r=?0.11, 95% CI ?0.18 to ?0.03), and homestay (r=0.10, 95% CI 0.00 to 0.19). Studies reporting within-correlations (k=3) were too heterogeneous to conduct meta-analysis. A deficiency in study quality and research standards was identified: all studies followed exploratory observational designs, but no study referenced or fully adhered to the international guidelines for reporting observational studies (STROBE). A total of 79% (k=15) of the studies were underpowered to detect a small correlation (r=.20). Results showed evidence for potential publication bias. Conclusions: Our results provide meta-analytical evidence for between-person correlations of GPS mobility and activity features and depression. Hence, depression diagnostics may benefit from adding GPS mobility and activity features as an integral part of future assessment and expert tools. However, confirmatory studies for between-person correlations and further research on within-person correlations are needed. In addition, the methodological quality of the evidence needs to improve. Trial Registration: OSF Registeries cwder; https://osf.io/cwder UR - https://www.jmir.org/2024/1/e51875 UR - http://dx.doi.org/10.2196/51875 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51875 ER - TY - JOUR AU - Jin, Xiaorong AU - Zhang, Yimei AU - Zhou, Min AU - Zhang, Xiong AU - Mei, Qian AU - Bai, Yangjuan AU - Wei, Wei AU - Ma, Fang PY - 2024/10/31 TI - Experiences With mHealth Use Among Patient-Caregiver Dyads With Chronic Heart Failure: Qualitative Study JO - J Med Internet Res SP - e57115 VL - 26 KW - chronic heart failure KW - informal caregiver KW - mHealth KW - experience KW - dyad N2 - Background: Chronic heart failure has become a serious threat to the health of the global population, and self-management is key to treating chronic heart failure. The emergence of mobile health (mHealth) provides new ideas for the self-management of chronic heart failure in which the informal caregiver plays an important role. Current research has mainly studied the experiences with using mHealth among patients with chronic heart failure from the perspective of individual patients, and there is a lack of research from the dichotomous perspective. Objective: The aim of this study was to explore the experiences with mHealth use among patients with chronic heart failure and their informal caregivers from a dichotomous perspective. Methods: This descriptive phenomenological study from a post-positivist perspective used a dyadic interview method, and face-to-face semistructured interviews were conducted with patients with chronic heart failure and their informal caregivers. Data were collected and managed using NVivo 12 software, and data analysis used thematic analysis to identify and interpret participants? experiences and perspectives. The thematic analysis included familiarizing ourselves with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. Results: A total of 14 dyads of patients with chronic heart failure and their informal caregivers (13 men and 15 women) participated in this study, including 3 couples and 11 parent-child pairs. We constructed 4 key themes and their subthemes related to the experiences with mHealth use: (1) opposing experiences with mHealth as human interaction or trauma (great experience with mHealth use; trauma), (2) supplement instead of replacement (it is useful but better as a reference; offline is unavoidable sometimes), (3) both agreement and disagreement over who should be the adopter of mHealth (achieving consensus regarding who should adopt mHealth; conflict occurs when considering patients as the adopter of mHealth), (4) for better mHealth (applying mHealth with caution; suggestions for improved mHealth). Conclusions: This study reported that the experiences with mHealth use among patients with chronic heart failure and their informal caregivers were mixed, and it highlighted the human touch of mHealth and the importance of network security. These results featured mHealth as a complement to offline hospitals rather than a replacement. In the context of modern or changing Chinese culture, we encourage patients to use mHealth by themselves and their informal caregivers to provide help when necessary. In addition, we need to use mHealth carefully, and future mHealth designs should focus more on ease of use and be oriented more toward older adults. UR - https://www.jmir.org/2024/1/e57115 UR - http://dx.doi.org/10.2196/57115 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57115 ER - TY - JOUR AU - Kallio, Johanna AU - Kinnula, Atte AU - Mäkelä, Satu-Marja AU - Järvinen, Sari AU - Räsänen, Pauli AU - Hosio, Simo AU - Bordallo López, Miguel PY - 2024/10/31 TI - Lessons From 3 Longitudinal Sensor-Based Human Behavior Assessment Field Studies and an Approach to Support Stakeholder Management: Content Analysis JO - J Med Internet Res SP - e50461 VL - 26 KW - field trial KW - behavioral research KW - sensor data KW - machine learning KW - pervasive technology KW - stakeholder engagement KW - qualitative coding KW - mobile phone N2 - Background: Pervasive technologies are used to investigate various phenomena outside the laboratory setting, providing valuable insights into real-world human behavior and interaction with the environment. However, conducting longitudinal field trials in natural settings remains challenging due to factors such as low recruitment success and high dropout rates due to participation burden or data quality issues with wireless sensing in changing environments. Objective: This study gathers insights and lessons from 3 real-world longitudinal field studies assessing human behavior and derives factors that impacted their research success. We aim to categorize challenges, observe how they were managed, and offer recommendations for designing and conducting studies involving human participants and pervasive technology in natural settings. Methods: We developed a qualitative coding framework to categorize and address the unique challenges encountered in real-life studies related to influential factor identification, stakeholder management, data harvesting and management, and analysis and interpretation. We applied inductive reasoning to identify issues and related mitigation actions in 3 separate field studies carried out between 2018 and 2022. These 3 field studies relied on gathering annotated sensor data. The topics involved stress and environmental assessment in an office and a school, collecting self-reports and wrist device and environmental sensor data from 27 participants for 3.5 to 7 months; work activity recognition at a construction site, collecting observations and wearable sensor data from 15 participants for 3 months; and stress recognition in location-independent knowledge work, collecting self-reports and computer use data from 57 participants for 2 to 5 months. Our key extension for the coding framework used a stakeholder identification method to identify the type and role of the involved stakeholder groups, evaluating the nature and degree of their involvement and influence on the field trial success. Results: Our analysis identifies 17 key lessons related to planning, implementing, and managing a longitudinal, sensor-based field study on human behavior. The findings highlight the importance of recognizing different stakeholder groups, including those not directly involved but whose areas of responsibility are impacted by the study and therefore have the power to influence it. In general, customizing communication strategies to engage stakeholders on their terms and addressing their concerns and expectations is essential, while planning for dropouts, offering incentives for participants, conducting field tests to identify problems, and using tools for quality assurance are relevant for successful outcomes. Conclusions: Our findings suggest that field trial implementation should include additional effort to clarify the expectations of stakeholders and to communicate with them throughout the process. Our framework provides a structured approach that can be adopted by other researchers in the field, facilitating robust and comparable studies across different contexts. Constantly managing the possible challenges will lead to better success in longitudinal field trials and developing future technology-based solutions. UR - https://www.jmir.org/2024/1/e50461 UR - http://dx.doi.org/10.2196/50461 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50461 ER - TY - JOUR AU - Liu, Xiaoxia AU - Ning, Lianzhen AU - Fan, Wenqi AU - Jia, Chanyi AU - Ge, Lina PY - 2024/10/31 TI - Electronic Health Interventions and Cervical Cancer Screening: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e58066 VL - 26 KW - cervical cancer KW - electronic health record KW - cancer screening KW - HPV KW - women's health KW - electronic health interventions N2 - Background: Cervical cancer is a significant cause of mortality in women. Although screening has reduced cervical cancer mortality, screening rates remain suboptimal. Electronic health interventions emerge as promising strategies to effectively tackle this issue. Objective: This systematic review and meta-analysis aimed to determine the effectiveness of electronic health interventions in cervical cancer screening. Methods: On December 29, 2023, we performed an extensive search for randomized controlled trials evaluating electronic health interventions to promote cervical cancer screening in adults. The search covered multiple databases, including MEDLINE, the Cochrane Central Registry of Controlled Trials, Embase, PsycINFO, PubMed, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature. These studies examined the effectiveness of electronic health interventions on cervical cancer screening. Studies published between 2013 and 2022 were included. Two independent reviewers evaluated the titles, abstracts, and full-text publications, also assessing the risk of bias using the Cochrane Risk of Bias 2 tool. Subgroup analysis was conducted based on subjects, intervention type, and economic level. The Mantel-Haenszel method was used within a random-effects model to pool the relative risk of participation in cervical cancer screening. Results: A screening of 713 records identified 14 articles (15 studies) with 23,102 participants, which were included in the final analysis. The intervention strategies used in these studies included short messaging services (4/14), multimode interventions (4/14), phone calls (2/14), web videos (3/14), and internet-based booking (1/14). The results indicated that electronic health interventions were more effective than control interventions for improving cervical cancer screening rates (relative risk [RR] 1.464, 95% CI 1.285-1.667; P<.001; I2=84%), cervical cancer screening (intention-to-treat) (RR 1.382, 95% CI 1.214-1.574; P<.001; I2=82%), and cervical cancer screening (per-protocol; RR 1.565, 95% CI 1.381-1.772; P<.001; I2=74%). Subgroup analysis revealed that phone calls (RR 1.82, 95% CI 1.40-2.38), multimode (RR 1.62, 95% CI 1.26-2.08), SMS (RR 1.41, 95% CI 1.14-1.73), and video- and internet-based booking (RR 1.25, 95% CI 1.03-1.51) interventions were superior to usual care. In addition, electronic health interventions did not show a statistically significant improvement in cervical cancer screening rates among women with HPV (RR 1.17, 95% CI 0.95-1.45). Electronic health interventions had a greater impact on improving cervical cancer screening rates among women in low- and middle-income areas (RR 1.51, 95% CI 1.27-1.79). There were no indications of small study effects or publication bias. Conclusions: Electronic health interventions are recommended in cervical cancer screening programs due to their potential to increase participation rates. However, significant heterogeneity remained in this meta-analysis. Researchers should conduct large-scale studies focusing on the cost-effectiveness of these interventions. Trial Registration: CRD42024502884; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=502884 UR - https://www.jmir.org/2024/1/e58066 UR - http://dx.doi.org/10.2196/58066 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58066 ER - TY - JOUR AU - Báez Gutiérrez, Nerea AU - Rodríguez Ramallo, Héctor AU - Mendoza-Zambrano, María Elva AU - Brown Arreola, Berenice AU - Santos Ramos, Bernardo AU - Abdel-kader Martín, Laila AU - Otero Candelera, Remedios PY - 2024/10/30 TI - Smartphone Apps for Pulmonary Hypertension: Systematic Search and Content Evaluation JO - JMIR Mhealth Uhealth SP - e57289 VL - 12 KW - pulmonary hypertension KW - mobile apps KW - smartphone KW - eHealth KW - mHealth KW - app KW - hypertension KW - chronic condition KW - mobile health app KW - monitoring KW - systematic search KW - app development KW - clinical validation KW - evaluation KW - pulmonary N2 - Background: Pulmonary hypertension (PH) is a chronic and complex condition, requiring consistent management and education. The widespread use of smartphones has opened possibilities for mobile health apps to support both patients and health care professionals in monitoring and managing PH more effectively. Objective: This study aimed to identify and assess the quality of free smartphone apps for PH targeted at either patients or health care professionals. Methods: A systematic search was conducted on freely available apps for patients with PH and health care professionals, accessed from a Spanish IP address, on Android (Google Play) and iOS (App Store) platforms. Searches were performed in October 2022 and 2023. Apps were independently analyzed by two reviewers, focusing on general characteristics. Quality assessment was based on the Mobile Application Rating Scale (MARS) framework, and Mann-Whitney U tests compared mean MARS scores against specific variables. Results: In the overall study, 21 apps were identified. In the 2022 search, 19 apps were listed (9 iOS, 7 Android, 3 available on both platforms). In the subsequent 2023 search, 16 apps were identified (6 Android, 7 iOS, 3 available on both platforms). Of those identified in 2022, 14 remained available in 2023, with only 7 updated since 2022. In addition, 12 apps targeted patients or the general population, while 9 targeted health care professionals; none involved patients in the development or design. Conversely, 13 apps involving health care professionals were identified. There were 10 apps that received pharmaceutical industry funding. The primary goal for 81% (17/21) of the apps was to disseminate general information about PH. The overall mean MARS quality was acceptable in 2022 and 2023, with mean ratings of 3.1 (SD 0.6) and 3.3 (SD 0.5), respectively. The functionality category achieved the highest scores in both years, indicating ease of use and intuitive navigation. In contrast, the subjective quality domain consistently received the lowest ratings in the MARS assessment across both years. None of the apps underwent clinical testing themselves; however, 2 incorporated tools or algorithms derived from trials. The overall quality of iOS apps statistically outperformed that of Android apps in both years (P<.05). Furthermore, the involvement of health care professionals in app development was associated with enhanced quality, a trend observed in both years (P=.003 for both years). Conclusions: This review of mobile health apps for PH reveals their emergent development stage, with generally acceptable quality but lacking refinement. It highlights the critical role of health care professionals in app development, as they contribute significantly to quality and reliability. Despite this, a notable stagnation in app quality and functionality improvement over 2 years points to a need for continuous innovation and clinical validation for effective clinical integration. This research advocates for future app developers to actively engage with health care professionals, integrate patient insights, and mandate rigorous clinical validation for PH management. UR - https://mhealth.jmir.org/2024/1/e57289 UR - http://dx.doi.org/10.2196/57289 ID - info:doi/10.2196/57289 ER - TY - JOUR AU - Park, Jin-Hyuck PY - 2024/10/30 TI - Discriminant Power of Smartphone-Derived Keystroke Dynamics for Mild Cognitive Impairment Compared to a Neuropsychological Screening Test: Cross-Sectional Study JO - J Med Internet Res SP - e59247 VL - 26 KW - digital biomarker KW - motor function KW - digital device KW - neuropsychological screening KW - screening tools KW - cognitive assessment KW - mild cognitive impairment KW - keystroke dynamics N2 - Background: Conventional neuropsychological screening tools for mild cognitive impairment (MCI) face challenges in terms of accuracy and practicality. Digital health solutions, such as unobtrusively capturing smartphone interaction data, offer a promising alternative. However, the potential of digital biomarkers as a surrogate for MCI screening remains unclear, with few comparisons between smartphone interactions and existing screening tools. Objective: This study aimed to investigate the effectiveness of smartphone-derived keystroke dynamics, captured via the Neurokeys keyboard app, in distinguishing patients with MCI from healthy controls (HCs). This study also compared the discriminant performance of these digital biomarkers against the Korean version of the Montreal Cognitive Assessment (MoCA-K), which is widely used for MCI detection in clinical settings. Methods: A total of 64 HCs and 47 patients with MCI were recruited. Over a 1-month period, participants generated 3530 typing sessions, with 2740 (77.6%) analyzed for this study. Keystroke metrics, including hold time and flight time, were extracted. Receiver operating characteristics analysis was used to assess the sensitivity and specificity of keystroke dynamics in discriminating between HCs and patients with MCI. This study also explored the correlation between keystroke dynamics and MoCA-K scores. Results: Patients with MCI had significantly higher keystroke latency than HCs (P<.001). In particular, latency between key presses resulted in the highest sensitivity (97.9%) and specificity (96.9%). In addition, keystroke dynamics were significantly correlated with the MoCA-K (hold time: r=?.468; P<.001; flight time: r=?.497; P<.001), further supporting the validity of these digital biomarkers. Conclusions: These findings highlight the potential of smartphone-derived keystroke dynamics as an effective and ecologically valid tool for screening MCI. With higher sensitivity and specificity than the MoCA-K, particularly in measuring flight time, keystroke dynamics can serve as a noninvasive, scalable, and continuous method for early cognitive impairment detection. This novel approach could revolutionize MCI screening, offering a practical alternative to traditional tools in everyday settings. Trial Registration: Thai Clinical Trials Registry TCTR20220415002; https://www.thaiclinicaltrials.org/show/TCTR20220415002 UR - https://www.jmir.org/2024/1/e59247 UR - http://dx.doi.org/10.2196/59247 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59247 ER - TY - JOUR AU - Zhu, Yan-Yan AU - Ye, Ze-Hao AU - Chu, Zhen-Xing AU - Liu, Yingjie AU - Wei, Jie AU - Jia, Le AU - Jiang, Yong-Jun AU - Shang, Hong AU - Hu, Qing-Hai PY - 2024/10/29 TI - Effects of HIV Self-Testing on Testing Promotion and Risk Behavior Reduction Among Transgender Women in China: Randomized Controlled Trial JO - J Med Internet Res SP - e58591 VL - 26 KW - HIV KW - HIV self-testing KW - testing behavior KW - sexual behaviours KW - transgender women KW - sexual health KW - mobile phone N2 - Background: To date, no randomized controlled trials have specifically addressed behavior changes after HIV self-testing (HIVST) among transgender women. Objective: This study aims to evaluate the effects of HIVST on changes in HIV testing behavior, frequency of condomless sex, and partner numbers among transgender women in China. Methods: Participants were recruited from 2 Chinese cities using both online and offline methods. Transgender women were randomly assigned to receive an HIVST intervention. Data from the previous 3 months were collected at baseline, 3 months, and 6 months. The primary outcome was the mean change in the number of HIV tests among transgender women during the 6-month follow-up. An intention-to-treat analysis was conducted. The statistical analysis used analysis of covariance and linear mixed-effects models. Results: From February to June 2021, and 255 transgender women were recruited, of which only 36.5% (93/255) had a steady job, and 27.1% (69/255) earned less than US $414.9 of income per month. They were randomly assigned to the intervention (n=127) and control (n=128) groups. At 6 months, the mean number of HIV tests was 2.14 (95% CI 1.80-2.48) in the intervention group and 1.19 (95% CI 0.99-1.40) in the control group (P<.001), with increases of 0.84 (95% CI 0.54-1.14) and 0.11 (95% CI ?0.19-0.41) over 6 months, respectively. The net increase was 0.73 (95% CI 0.31-1.15; P<.001), with a similar adjusted result. No significant differences in the frequency of condomless sex or partner numbers were observed between the 2 groups. Conclusions: HIVST is an effective strategy for enhancing regular HIV testing behavior among transgender women in China. This strategy should be combined with measures to address the financial vulnerability of the transgender women community to reduce subsequent risk behaviors, including condomless sex. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000039766; https://www.chictr.org.cn/showproj.html?proj=61402 UR - https://www.jmir.org/2024/1/e58591 UR - http://dx.doi.org/10.2196/58591 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58591 ER - TY - JOUR AU - Zhou, Shuo AU - Brunetta, Paul AU - Silvasstar, Joshva AU - Feldman, Greg AU - Oromi, Nicolas AU - Bull, Sheana PY - 2024/10/29 TI - Initial Evaluation of Acceptability, Engagement, and Effectiveness of the MO App to Provide Tailored and Comprehensive Support for Smoking Cessation: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e55239 VL - 12 KW - smoking cessation KW - tobacco KW - mobile phone app KW - mHealth KW - mobile health KW - iterative design KW - feasibility KW - acceptability KW - engagement KW - efficacy KW - mobile phone N2 - Background: Despite the growing availability of smoking cessation apps, low engagement and cessation rates have remained a significant challenge. To address this issue, we used a user-centered design to iteratively develop a mobile app (MO) to provide comprehensive, tailored, and evidence-based content to support smokers in their quitting journey. Objective: This study examined the acceptability, use, and preliminary efficacy of the MO app for smoking cessation. Specifically, we sought to understand smokers? preferred features, engagement, and satisfaction with MO; identify concerns in using the app and ways to improve the app; and evaluate its smoking cessation outcomes. Methods: Through 3 cohorts, we recruited 10, 12, and 85 adult smokers who attempted to quit smoking to pilot-test the MO app between December 2019 and July 2022. Participants were instructed to complete a baseline survey, interact with the app for 6 weeks, and fill in a postsurvey at week 6. Participants in cohort 3 completed an additional postsurvey at week 12. Participants? app use was tracked and analyzed. The primary outcome measures were participants? 7-day point prevalence abstinence at 6 and 12 weeks. Results: Participants reported high levels of satisfaction with the MO app across all 3 cohorts, rating it between 4.40 and 4.76 on a scale of 5 for acceptability. Users engaged with app activities for an average of 89 to 159 times over 35 days. The most liked features of the app included ?quit plan,? ?tracking,? ?reminders and notifications,? ?MOtalks,? and ?motivational quotes.? The 7-day point prevalence abstinence rate of the modified intention to treat population in cohort 3 was 58% at 6 weeks and 52% at 12 weeks. Those who interacted more frequently with app features and engaged with more diverse activities were more likely to maintain abstinence at weeks 6 and 12. For each additional time logged into the app, the odds of staying abstinent at week 12 increased by 5% (odds ratio [OR] 1.05, 95% CI 1.01-1.08). Participants who earned >5000 points during app use also had higher odds of quitting at both 6 weeks (OR 3.12, 95% CI 1.25-7.75) and 12 weeks (OR 4.65, 95% CI 1.83-11.76), compared with those who earned <5000 points. Conclusions: Our study demonstrated that MO is a feasible mobile phone app with high acceptability and usability and can effectively deliver smoking cessation support to individuals who want to quit. Implications for developing and evaluating mobile phone apps for smoking cessation are discussed. UR - https://mhealth.jmir.org/2024/1/e55239 UR - http://dx.doi.org/10.2196/55239 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55239 ER - TY - JOUR AU - Liu, Qimin AU - Ning, Emma AU - Ross, K. Mindy AU - Cladek, Andrea AU - Kabir, Sarah AU - Barve, Amruta AU - Kennelly, Ellyn AU - Hussain, Faraz AU - Duffecy, Jennifer AU - Langenecker, A. Scott AU - Nguyen, M. Theresa AU - Tulabandhula, Theja AU - Zulueta, John AU - Demos, P. Alexander AU - Leow, Alex AU - Ajilore, Olusola PY - 2024/10/29 TI - Digital Phenotypes of Mobile Keyboard Backspace Rates and Their Associations With Symptoms of Mood Disorder: Algorithm Development and Validation JO - J Med Internet Res SP - e51269 VL - 26 KW - keyboard typing KW - passive sensing KW - digital phenotyping KW - mood disorder KW - mixture model KW - phenotypes KW - mobile keyboard KW - smartphone KW - keyboard data KW - monitoring KW - clinical decision-making KW - depression KW - mania, mobile phone N2 - Background: Passive sensing through smartphone keyboard data can be used to identify and monitor symptoms of mood disorders with low participant burden. Behavioral phenotyping based on mobile keystroke data can aid in clinical decision-making and provide insights into the individual symptoms of mood disorders. Objective: This study aims to derive digital phenotypes based on smartphone keyboard backspace use among 128 community adults across 2948 observations using a Bayesian mixture model. Methods: Eligible study participants completed a virtual screening visit where all eligible participants were instructed to download the custom-built BiAffect smartphone keyboard (University of Illinois). The BiAffect keyboard unobtrusively captures keystroke dynamics. All eligible and consenting participants were instructed to use this keyboard exclusively for up to 4 weeks of the study in real life, and participants? compliance was checked at the 2 follow-up visits at week 2 and week 4. As part of the research protocol, every study participant underwent evaluations by a study psychiatrist during each visit. Results: We found that derived phenotypes were associated with not only the diagnoses and severity of depression and mania but also specific individual symptoms. Using a linear mixed-effects model with random intercepts accounting for the nested data structure from daily data, the backspace rates on the continuous scale did not differ between participants in the healthy control and in the mood disorders groups (P=.11). The 3-class model had mean backspace rates of 0.112, 0.180, and 0.268, respectively, with a SD of 0.048. In total, 3 classes, respectively, were estimated to comprise 37.5% (n=47), 54.4% (n=72), and 8.1% (n=9) of the sample. We grouped individuals into Low, Medium, and High backspace rate groups. Individuals with unipolar mood disorder were predominantly in the Medium group (n=54), with some in the Low group (n=27) and a few in the High group (n=6). The Medium group, compared with the Low group, had significantly higher ratings of depression (b=2.32, P=.008). The High group was not associated with ratings of depression with (P=.88) or without (P=.27) adjustment for medication and diagnoses. The High group, compared with the Low group, was associated with both nonzero ratings (b=1.91, P=.02) and higher ratings of mania (b=1.46, P<.001). The High group, compared with the Low group, showed significantly higher odds of elevated mood (P=.03), motor activity (P=.04), and irritability (P<.05). Conclusions: This study demonstrates the promise of mobile typing kinematics in mood disorder research and practice. Monitoring a single mobile typing kinematic feature, that is, backspace rates, through passive sensing imposes a low burden on the participants. Based on real-life keystroke data, our derived digital phenotypes from this single feature can be useful for researchers and practitioners to distinguish between individuals with and those without mood disorder symptoms. UR - https://www.jmir.org/2024/1/e51269 UR - http://dx.doi.org/10.2196/51269 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51269 ER - TY - JOUR AU - Tveter, Therese Anne AU - Varsi, Cecilie AU - Maarnes, Kristin Marit AU - Pedersen, Jarle Stein AU - Christensen, S. Barbara AU - Blanck, Beate Thale AU - Nyheim, B. Sissel AU - Pelle, Tim AU - Kjeken, Ingvild PY - 2024/10/29 TI - Development of the Happy Hands Self-Management App for People with Hand Osteoarthritis: Feasibility Study JO - JMIR Form Res SP - e59016 VL - 8 KW - Osteoarthritis KW - hand exercises KW - home exercise KW - first-line treatment KW - mHealth KW - eHealth KW - self-management KW - app development KW - design KW - usefulness KW - satisfaction KW - activity performance KW - social cognitive theory KW - behavior change N2 - Background: Patient education, hand exercises, and the use of assistive devices are recommended as first-line treatments for individuals with hand osteoarthritis (OA). However, the quality of care services for this patient group is suboptimal in primary care. Objective: The overarching goal was to develop and evaluate feasibility of an app-based self-management intervention for people with hand OA. This feasibility study aims to assess self-reported usability and satisfaction, change in outcomes and quality-of-care, exercise adherence and patients? experiences using the app. Methods: The development and feasibility testing followed the first 2 phases of the Medical Research Council framework for the development and evaluation of complex interventions and were conducted in close collaboration with patient research partners (PRPs). A 3-month pre-post mixed methods design was used to evaluate feasibility. Men and women over 40 years of age diagnosed with painful, symptomatic hand OA were recruited. Usability was assessed using the System Usability Scale (0-100), while satisfaction, usefulness, pain, and stiffness were evaluated using a numeric rating scale (NRS score from 0 to 10). The activity performance of the hand was measured using the Measure of Activity Performance of the Hand (MAP-Hand) (1-4), grip strength was assessed with a Jamar dynamometer (kg), and self-reported quality of care was evaluated using the Osteoarthritis Quality Indicator questionnaire (0-100). Participants were deemed adherent if they completed at least 2 exercise sessions per week for a minimum of 8 weeks. Focus groups were conducted to explore participants? experiences using the app. Changes were analyzed using a paired sample t test (mean change and 95% CI), with the significance level set at P<.05. Results: The first version of the Happy Hands app was developed based on the needs and requirements of the PRPs, evidence-based treatment recommendations, and the experiences of individuals living with hand OA. The app was designed to guide participants through a series of informational videos, exercise videos, questionnaires, quizzes, and customized feedback over a 3-month period. The feasibility study included 71 participants (mean age 64 years, SD 8; n=61, 86%, women), of whom 57 (80%) completed the assessment after 3 months. Usability (mean 91.5 points, SD 9.2 points), usefulness (median 8, IQR 7-10), and satisfaction (median 8, IQR 7-10) were high. Significant improvements were observed in self-reported quality of care (36.4 points, 95% CI 29.7-43.1, P<.001), grip strength (right: 2.9 kg, 95% CI 1.7-4.1; left: 3.2 kg, 95% CI 1.9-4.6, P<.001), activity performance (0.18 points, 95% CI 0.11-0.25, P<.001), pain (1.7 points, 95% CI 1.2-2.2, P<.001), and stiffness (1.9 points, 95% CI 1.3-2.4, P=.001) after 3 months. Of the 71 participants, 53 (75%) were adherent to the exercise program. The focus groups supported these results and led to the implementation of several enhancements in the second version of the app. Conclusions: The app-based self-management intervention was deemed highly usable and useful by patients. The results further indicated that the intervention may improve quality of care, grip strength, activity performance, pain, and stiffness. However, definitive conclusions need to be confirmed in a powered randomized controlled trial. Trial Registration: NCT05150171 UR - https://formative.jmir.org/2024/1/e59016 UR - http://dx.doi.org/10.2196/59016 UR - http://www.ncbi.nlm.nih.gov/pubmed/39470716 ID - info:doi/10.2196/59016 ER - TY - JOUR AU - Wang, Xi AU - Wang, Suyuan AU - Zhong, Lingyu AU - Zhang, Chenghui AU - Guo, Yanhong AU - Li, Mingxia AU - Zhao, Li AU - Ji, Shuming AU - Pan, Junjie AU - Wu, Yunhong PY - 2024/10/28 TI - Mobile-Based Platform With a Low-Calorie Dietary Intervention Involving Prepackaged Food for Weight Loss for People With Overweight and Obesity in China: Half-Year Follow-Up Results of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e47104 VL - 12 KW - weight loss KW - obesity KW - body fat KW - food replacement product KW - meal replacement KW - weight KW - obese KW - RCT KW - randomized KW - mHealth KW - mobile health KW - mobile app KW - mobile application KW - mobile phone N2 - Background: Obesity is a rapidly increasing health problem in China, causing massive economic and health losses annually. Many techniques have emerged to help people with obesity better adhere to intervention programs and achieve their weight loss goals, including food replacement and internet-delivered weight loss consultations. Most studies on weight loss interventions mainly focused on the change in body weight or BMI; however, body fat, especially visceral fat mass, is considered the main pathogenic factor in obesity. In China, more reliable evidence is required on this topic. Moreover, it is unclear whether an integrated weight loss program combining food replacement products, mobile app-based platforms, and daily body composition monitoring using a wireless scale is useful and practical in China. Objective: In this 2-arm, parallel-designed, randomized study, we explored the effectiveness and safety of the Metawell (Weijian Technologies Inc) weight loss program in China, which combines prepackaged biscuits, a wireless scale, and a mobile app. Methods: Participants in the intervention group were guided to use food replacement products and a scale for weight loss and monitoring, whereas participants in the control group received printed material with a sample diet and face-to-face education on weight loss at enrollment. The intervention lasted for 3 months, and follow-up visits were conducted at months 3 and 6 after enrollment. Dual-energy x-ray absorptiometry and quantitative computed tomography were used to assess body fat. A multilevel model for repeated measurements was used to compare differences between the 2 groups. Results: In total, 220 patients were randomly assigned to intervention (n=110) and control (n=110) groups. Participants in the intervention group had significantly greater decreases in BMI, total body fat, visceral adipose area, and subcutaneous adipose area (all P<.001) than those in the control group. However, the rate of change in lean mass was not significantly different between the 2 groups (P=.62). Further, 35 participants in the intervention group reported adverse events. Constipation was the most frequently reported adverse event (11/110), followed by dizziness (6/110), hypoglycemia (4/110), fatigue (3/110), and gastritis (3/35). Conclusions: The Metawell program was effective for weight loss. After the intervention, participants in the intervention group lost more body weight and body fat while retaining muscle mass than those in the control group. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900021630; https://www.chictr.org.cn/showproj.html?proj=36183 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-048106 UR - https://mhealth.jmir.org/2024/1/e47104 UR - http://dx.doi.org/10.2196/47104 ID - info:doi/10.2196/47104 ER - TY - JOUR AU - Lee, JooHyun AU - Lim, JaeHyun AU - Kang, Soyeon AU - Kim, Sujin AU - Jung, Yoon So AU - Hong, Soon-Beom AU - Park, Rang Yu PY - 2024/10/28 TI - Mobile App?Assisted Parent Training Intervention for Behavioral Problems in Children With Autism Spectrum Disorder: Pilot Randomized Controlled Trial JO - JMIR Hum Factors SP - e52295 VL - 11 KW - autism spectrum disorder KW - parent training program KW - parent education KW - behavioral problems KW - child behavior KW - mobile app KW - feasibility KW - mHealth KW - evidence-based parent training N2 - Background: In children with autism spectrum disorder (ASD), problem behaviors play a dysfunctional role, causing as much difficulty with daily living and adjustment as the core symptoms. If such behaviors are not effectively addressed, they can result in physical, economic, and psychological issues not only for the individual but also for family members. Objective: We aimed to develop and evaluate the feasibility of a mobile app?assisted parent training program for reducing problem behaviors in children with ASD. Methods: This open-label, single-center, randomized controlled trial was conducted among parents of children with ASD aged 36-84 months. Participants were recruited from the Department of Psychiatry at Seoul National University Hospital. Participants were randomly assigned (1:1) by a blinded researcher. Randomization was performed using a stratified block randomization (with a block size of 4). Parents in the intervention group completed the mobile app?assisted parent training program at home over a 12-week period. They continued to receive their usual nondrug treatment in addition to the mobile app?assisted parent training program. The control group continued to receive their usual nonpharmaceutical treatment for 12 weeks without receiving the parent training program intervention. The primary outcome measure was the median change in the Korean Child Behavior Checklist (K-CBCL) scores from before to after the intervention. Lower scores on the K-CBCL indicated a decrease in overall problem behavior. Results: Between November 9, 2022, and December 8, 2022, 64 participants were enrolled. Overall, 42 children (intervention group median age: 49, IQR 41-52.5 months; control group median age: 49, IQR 42-58 months) of the participants joined the program. The intervention group included 20 (48%) participants and the control group included 22 (52%) participants. In the intervention group, the K-CBCL total scores showed a decrease after the intervention, with a median difference of ?0.5 (95% CI ?4.5 to 3). Pervasive developmental disorder scores also showed a decrease, with a median difference of ?2.1 (95% CI ?8.5 to 2.5). However, there was no significant difference in Clinical Global Impression?Severity of Illness scores after the intervention for both the control and intervention groups. Scores on the Korean version of the Social Communication Questionnaire showed a further decrease after the intervention in the intervention group (median difference ?2, 95% CI ?4 to 1). Caregivers? stress evaluated using the Korean Parenting Stress Index Fourth Edition?Short Form did not show any significant differences between the control and intervention groups. There were no adverse events related to study participation. Conclusions: The findings demonstrated the feasibility of using mobile devices for evidence-based parent training to reduce problem behaviors in children with ASD. Mobile devices? accessibility and flexibility may provide a viable alternative for offering early intervention for problem behaviors in children with ASD. Trial Registration: CRIS KCT0007841; https://cris.nih.go.kr/cris/search/detailSearch.do?&seq=23112 UR - https://humanfactors.jmir.org/2024/1/e52295 UR - http://dx.doi.org/10.2196/52295 UR - http://www.ncbi.nlm.nih.gov/pubmed/39466295 ID - info:doi/10.2196/52295 ER - TY - JOUR AU - Köhler, Charlotte AU - Bartschke, Alexander AU - Fürstenau, Daniel AU - Schaaf, Thorsten AU - Salgado-Baez, Eduardo PY - 2024/10/25 TI - The Value of Smartwatches in the Health Care Sector for Monitoring, Nudging, and Predicting: Viewpoint on 25 Years of Research JO - J Med Internet Res SP - e58936 VL - 26 KW - consumer devices KW - smartwatches KW - value-based health care KW - monitoring KW - nudging KW - predicting KW - mobile phone UR - https://www.jmir.org/2024/1/e58936 UR - http://dx.doi.org/10.2196/58936 UR - http://www.ncbi.nlm.nih.gov/pubmed/39356287 ID - info:doi/10.2196/58936 ER - TY - JOUR AU - Ozaki, Itsuko AU - Nishijima, Mariko AU - Shibata, Eiji AU - Zako, Yuri AU - Chiang, Chifa PY - 2024/10/25 TI - Factors Related to mHealth App Use Among Japanese Workers: Cross-Sectional Survey JO - JMIR Hum Factors SP - e54673 VL - 11 KW - mHealth KW - mobile health KW - mobile health apps KW - prevalence KW - health promotion KW - health management KW - Japanese worker KW - Japan KW - cross-sectional survey KW - disease management KW - app users KW - physical activity N2 - Background: Health care providers can make health guidance more effective by using mobile health technologies such as health apps. Although health care providers need to know who uses health apps, existing studies have yielded inconsistent results. Objective: The aim of the study was (1) to clarify the prevalence and patterns of health app use to improve health behaviors for preventing lifestyle-related diseases among Japanese workers and (2) to identify the associations among demographic characteristics, health behavior, and internet use and health app use by gender. Methods: Data were collected from a cross-sectional internet survey in 2023. In total, 2200 participants were included, with an even distribution of men and women in each age group aged 20 to 60 years. The participants were workers with smartphones and reported their gender, age, residence area, marital status, education, employment status, occupation, work pattern, diseases under treatment, health checkups, health guidance, health behaviors, internet use duration, and number of devices used. We asked about current and previous health app use for 1 month. A multivariate logistic regression analysis was conducted by gender. Results: Of the participants, 472 (21.5%) and 189 (8.6%) were current and previous health app users, respectively. Most current and previous health app users used features that record and track their physical activity and other health behaviors. Health app users?both men and women?were more likely to have health checkups (odds ratio [OR] 1.53, 95% CI 1.12-2.11 and OR 1.51, 95% CI 1.10-2.07, respectively), receive health guidance (OR 2.01, 95% CI 1.47-2.74 and OR 1.86, 95% CI 1.32-2.62, respectively), engage in regular physical activity (OR 2.57, 95% CI 1.91-3.47 and OR 1.94, 95% CI 1.41-2.67, respectively), use the internet for 120-179 minutes per day (OR 1.76, 95% CI 1.13-2.75 and OR 1.70, 95% CI 1.12-2.57, respectively), and were less likely to be older (50-59 years: OR 0.54, 95% CI 0.33-0.88 and OR 0.40, 95% CI 0.25-0.6, respectively, and 60-69 years: OR 0.37, 95% CI 0.22-0.62 and OR 0.47, 95% CI 0.28-0.77, respectively). According to gender, male health app users were more likely to be married (OR 1.69, 95% CI 1.23-2.33) and less likely to work in the security, agriculture, forestry, fishing, manufacturing, or transportation industries (OR 0.62, 95% CI 0.41-0.95). Female health app users were more likely to have a university education or higher (OR 1.55, 95% CI 1.061-2.26), maintain an appropriate body weight (OR 1.52, 95% CI 1.10-2.11), and use 3 or more devices (OR 2.13, 95% CI 1.41-3.23). Conclusions: Physical activity and health guidance are strong predictors of app use. Health care providers should assess the target populations? preferences for app use based on their characteristics, support their app use, and enhance the effectiveness of health guidance. UR - https://humanfactors.jmir.org/2024/1/e54673 UR - http://dx.doi.org/10.2196/54673 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54673 ER - TY - JOUR AU - Brunner, Loïc AU - Siebert, N. Johan AU - Ehrler, Frédéric AU - Manzano, Sergio AU - Marti, Joachim PY - 2024/10/25 TI - Evaluating the Economic Impact of the PedAMINES App in Reducing Medication Errors in Pediatric Emergency Care: Cost-Effectiveness Analysis JO - J Med Internet Res SP - e52077 VL - 26 KW - adverse drug event KW - health information technology KW - pediatric care KW - emergency care KW - ambulance care KW - economic evaluation KW - cost-effectiveness KW - epinephrine KW - norepinephrine KW - midazolam KW - dopamine KW - evidence-based KW - medical app KW - medication error KW - pediatric KW - child KW - pediatric emergency care KW - PedAMINES KW - Pediatric Accurate Medication in Emergency Situations KW - Switzerland KW - child care KW - mobile phone N2 - Background: The administration of drugs in pediatric emergency care is a time-consuming process and is associated with a higher occurrence of medication errors compared with adult care. This is attributed to the intricacies of administration, which involve calculating doses based on the child?s weight or age. To mitigate the occurrence of adverse drug events (ADEs), the PedAMINES (Pediatric Accurate Medication in Emergency Situations; Geneva University Hospitals) mobile app has been developed. This app offers a step-by-step guide for preparing and administering pediatric drugs during emergency interventions by automating the dose calculation process. Although previous simulation-based randomized controlled trials conducted in emergency care have demonstrated the efficacy of the PedAMINES app in reducing drug administration errors, there is a lack of evidence regarding its economic implications. Objective: This study aims to evaluate the cost-effectiveness of implementing the PedAMINES app for 4 emergency drugs: epinephrine, norepinephrine, dopamine, and midazolam. Methods: The economic evaluation was conducted by combining hospital data from 2019, previous trial outcomes, information extracted from existing literature, and PedAMINES maintenance costs. The cost per avoided medication error was calculated, along with the number of administrations needed to achieve a positive return on investment. Subsequently, Monte Carlo simulations were used to identify the key parameters contributing to result uncertainty. Results: The study revealed the number of preventable errors per administration for the 4 examined drugs: 0.513 for epinephrine, 0.484 for norepinephrine, 0.500 for dopamine, and 0.671 for midazolam. The cost-effectiveness ratios per ADE prevented were computed as follows: US $4808 for epinephrine, US $9705 for norepinephrine, US $6957 for dopamine, and US $2074 for midazolam. Accounting for the economic impact of ADEs, the analysis estimated that 16 administrations of epinephrine, 17 of norepinephrine and dopamine, and 13 of midazolam would be required to attain a positive return on investment. This corresponds to roughly one-third of the annual administrations at a major university hospital in Switzerland. The primary factors influencing the uncertainty in the estimated cost per ADE include the cost of maintenance of the app, the likelihood of an ADE resulting from an administration error, and the frequency of underdosing in the trial?s control group. Conclusions: A dedicated mobile app presents an economically viable solution to alleviate the health and economic burden of drug administration errors in in-hospital pediatric emergency care. The widespread adoption of this app is advocated to pool costs and extend the benefits on a national scale in Switzerland. UR - https://www.jmir.org/2024/1/e52077 UR - http://dx.doi.org/10.2196/52077 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52077 ER - TY - JOUR AU - Saliasi, Ina AU - Lan, Romain AU - Rhanoui, Maryem AU - Fraticelli, Laurie AU - Viennot, Stéphane AU - Tardivo, Delphine AU - Clément, Céline AU - du Sartz de Vigneulles, Benjamin AU - Bernard, Sandie AU - Darlington-Bernard, Adeline AU - Dussart, Claude AU - Bourgeois, Denis AU - Carrouel, Florence PY - 2024/10/24 TI - French Version of the User Mobile Application Rating Scale: Adaptation and Validation Study JO - JMIR Mhealth Uhealth SP - e63776 VL - 12 KW - mHealth KW - mobile health KW - mobile health apps KW - eHealth KW - Mobile Application Rating Scale, user version KW - mobile apps KW - quality assessment tool KW - uMARS N2 - Background: Managing noncommunicable diseases effectively requires continuous coordination and monitoring, often facilitated by eHealth technologies like mobile health (mHealth) apps. The end-user version of the Mobile Application Rating Scale is a valuable tool for assessing the quality of mHealth apps from the user perspective. However, the absence of a French version restricts its use in French-speaking countries, where the evaluation and regulation of mHealth apps are still lacking, despite the increasing number of apps and their strong relevance in health care. Objective: This study aims to translate and culturally adapt a French version of the user Mobile Application Rating Scale (uMARS-F) and to test its overall and internal reliability. Methods: Cross-cultural adaptation and translation followed the universalist approach. The uMARS-F was evaluated as part through a cohort study using the French mHealth app ?MonSherpa? (Qare). Participants were French-speaking adults with Apple or Android phones, excluding those with difficulty understanding French, prior app use, or physical limitations. They assessed the app using the uMARS-F twice (T1 and T2) 1 week apart. Scores for each section and overall were assessed for normal distribution using the Shapiro-Wilk test and presented as mean (SD), and potential floor or ceiling effects were calculated accordingly. Overall reliability was evaluated using intraclass correlation coefficients and internal reliability using Cronbach ?. Concordance between the 3 subscales (objective quality, subjective quality, and perceived impact), 4 sections, and 26 items at T1 and T2 was evaluated using the paired t test (2-tailed) and Pearson correlation. Results: In total, 167 participants assessed the app at both T1 and T2 (100% compliance). Among them, 49.7% (n=83) were female, and 50.3% (n=84) were male, with a mean age of 43 (SD 16) years. The uMARS-F intraclass correlation coefficients were excellent for objective quality (0.959), excellent for subjective quality (0.993), and moderate for perceived impact (0.624). Cronbach ? was good for objective quality (0.881), acceptable for subjective quality (0.701), and excellent for perceived impact (0.936). The paired t tests (2-tailed) demonstrated similar scores between the 2 assessments (P>.05), and the Pearson correlation coefficient indicated high consistency in each subscale, section, and item (r>0.76 and P<.001). The reliability and validity of the measures were similar to those found in the original English version as well as in the Spanish, Japanese, Italian, Greek, and Turkish versions that have already been translated and validated. Conclusions: The uMARS-F is a valid tool for end users to assess the quality of mHealth apps in French-speaking countries. The uMARS-F used in combination with the French version of the Mobile Application Rating Scale could enable health care professionals and public health authorities to identify reliable, high-quality, and valid apps for patients and should be part of French health care education programs. UR - https://mhealth.jmir.org/2024/1/e63776 UR - http://dx.doi.org/10.2196/63776 ID - info:doi/10.2196/63776 ER - TY - JOUR AU - Pimenta, Cristina M. AU - Torres, Silva Thiago AU - Hoagland, Brenda AU - Cohen, Mirian AU - Mann, Gruber Claudio AU - Jalil, M. Cristina AU - Carvalheira, Eduardo AU - Freitas, Lucilene AU - Fernandes, Nilo AU - Castanheira, Debora AU - Benedetti, Marcos AU - Moreira, Julio AU - Simpson, Keila AU - Trefiglio, Roberta AU - O?Malley, Gabrielle AU - Veloso, G. Valdilea AU - Grinsztejn, Beatriz PY - 2024/10/24 TI - Preparing for the Implementation of Long-Acting Injectable Cabotegravir for HIV Pre-Exposure Prophylaxis Within the Brazilian Public Health System (ImPrEP CAB Brasil): Qualitative Study JO - JMIR Public Health Surveill SP - e60961 VL - 10 KW - pre-exposure prophylaxis KW - PrEP KW - implementation KW - public health system KW - cabotegravir KW - HIV prevention KW - Latin America KW - long-acting PrEP N2 - Background: Although long-acting, injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention in clinical trials, research is needed to guide effective implementation in real-world settings. Formative work with community members and health care providers (HCPs) is important to provide insight into the needs and contexts of specific populations and reveal potential barriers and facilitators for implementation projects. Objective: We aimed to describe the results from formative work to develop an implementation package for CAB-LA PrEP within the ImPrEP CAB Brasil study. Methods: ImPrEP CAB Brasil is an implementation study of same-day delivery of CAB-LA PrEP for young sexual and gender minority (SGM) groups (aged 18-30 years) in 6 existing oral PrEP public health clinics. We conducted formative research to prepare for the implementation of ImPrEP CAB Brasil through community mobilization, process mapping with HCPs with experience in CAB-LA, and focus group discussions (FGDs) with young SGM groups (n=92) and HCPs (n=20) to identify initial perceptions of facilitators and barriers for CAB-LA PrEP implementation, refine the mobile health (mHealth) educational tool, and evaluate the acceptability of using a text message appointment reminder intervention through WhatsApp. FGDs were recorded, transcribed, systematically coded, and analyzed with thematic categorization by trained researchers using a qualitative data analysis program ATLAS.ti (version 7). Results: A community mobilization team comprising 34 SGM community leaders collaborated in creating a prototype for an mHealth educational tool and contributed to the planning of peer education activities. We created 3 process maps for each site to describe the initial visit, follow-up visits, and laboratory flow. The main challenge identified for same-day CAB-LA PrEP delivery was the extended duration of clinic visits due to the numerous laboratory tests and HIV counseling steps required. Proposed solutions included having point-of-care HIV rapid tests instead of laboratory tests and additional counseling staff. Barriers for CAB-LA PrEP implementation identified through FGDs were the training of HCPs, support for adherence to injection appointments, and stigma or discrimination against SGM groups and persons using PrEP. The mHealth educational tool and WhatsApp reminders were highly acceptable by SGM groups and HCPs, indicating their potential to support PrEP choice and adherence. Content analysis on the cultural appropriateness of the language and overall clarity of the material contributed to the refinement of the mHealth tool. Conclusions: Structured formative work with SGM persons and HCPs generated important refinements to context-specific materials and plans to launch ImPrEP CAB Brasil in public health clinics. Ongoing implementation monitoring will use the process maps to identify additional barriers and potential solutions to same-day delivery of CAB-LA PrEP. Summative evaluations are needed to measure the effectiveness of the mHealth educational tool to support PrEP choice and the use of WhatsApp appointment reminders. UR - https://publichealth.jmir.org/2024/1/e60961 UR - http://dx.doi.org/10.2196/60961 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446416 ID - info:doi/10.2196/60961 ER - TY - JOUR AU - Zhu, Di AU - Al Mahmud, Abdullah AU - Liu, Wei AU - Wang, Dahua PY - 2024/10/24 TI - Digital Storytelling for People With Cognitive Impairment Using Available Mobile Apps: Systematic Search in App Stores and Content Analysis JO - JMIR Aging SP - e64525 VL - 7 KW - mobile apps KW - digital storytelling KW - older adults KW - mobile phone KW - cognitive impairment N2 - Background: Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality. Objective: This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users. Methods: A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps. Results: From an initial screening of 297 apps, only 9 (3%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy. Conclusions: The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in engagement and functionality, others need significant improvements in information quality and user interface design to better serve those with cognitive impairments. Future research is recommended to investigate regional limitations and features that would result in more inclusive and effective digital storytelling apps. UR - https://aging.jmir.org/2024/1/e64525 UR - http://dx.doi.org/10.2196/64525 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446478 ID - info:doi/10.2196/64525 ER - TY - JOUR AU - Stevely, K. Abigail AU - Garnett, Claire AU - Holmes, John AU - Jones, Andrew AU - Dinu, Larisa AU - Oldham, Melissa PY - 2024/10/24 TI - Optimizing the Measurement of Information on the Context of Alcohol Consumption Within the Drink Less App Among People Drinking at Increasing and Higher Risk Levels: Mixed-Methods Usability Study JO - JMIR Form Res SP - e50131 VL - 8 KW - alcohol use disorder KW - substance use disorder KW - alcohol consumption KW - mobile app KW - mHealth KW - mobile health KW - diary KW - health behavior change KW - usability KW - user engagement N2 - Background: There is a growing public health evidence base focused on understanding the links between drinking contexts and alcohol consumption. However, the potential value of developing context-based interventions to help people drinking at increasing and higher risk levels to cut down remains underexplored. Digital interventions, such as apps, offer significant potential for delivering context-based interventions as they can collect contextual information and flexibly deliver personalized interventions while addressing barriers associated with face-to-face interventions, such as time constraints. Objective: This early phase study aimed to identify the best method for collecting information on the contexts of alcohol consumption among users of an alcohol reduction app by comparing 2 alternative drinking diaries in terms of user engagement, data quality, usability, and acceptability. Methods: Participants were recruited using the online platform Prolific and were randomly assigned to use 1 of the 2 adapted versions of the Drink Less app for 14 days. Tags (n=31) included tags for location, motivation, and company that participants added to drink records. Occasion type (n=31) included a list of occasion types that participants selected from when adding drink records. We assessed engagement and data quality with app data, usability with a validated questionnaire, and acceptability with semistructured interviews. Results: Quantitative findings on engagement, data quality, and app usability were good overall, with participants using the app on most days (tags: mean 12.23, SD 2.46 days; occasion type: mean 12.39, SD 2.12 days). However, around 40% of drinking records in tags did not include company and motivation tags. Mean usability scores were similar across app versions (tags: mean 72.39, SD 8.10; occasion type: mean 74.23, SD 6.76). Qualitative analysis found that both versions were acceptable to users and were relevant to their drinking occasions, and participants reported increased awareness of their drinking contexts. Several participants reported that the diary helped them to reduce alcohol consumption in some contexts (eg, home or lone drinking) more than others (eg, social drinking) and suggested that they felt less negative affect recording social drinking contexts out of their home. Participants also suggested the inclusion of ?work drinks? in both versions and ?habit? as a motivation in the tags version. Conclusions: There was no clearly better method for collecting data on alcohol consumption as both methods had good user engagement, usability, acceptability, and data quality. Participants recorded sufficient data on their drinking contexts to suggest that an adapted version of Drink Less could be used as the basis for context-specific interventions. The occasion type version may be preferable owing to lower participant burden. A more general consideration is to ensure that context-specific interventions are designed to minimize the risk of unintended positive reinforcement of drinking occasions that are seen as sociable by users. UR - https://formative.jmir.org/2024/1/e50131 UR - http://dx.doi.org/10.2196/50131 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446464 ID - info:doi/10.2196/50131 ER - TY - JOUR AU - Rauzi, R. Michelle AU - Akay, B. Rachael AU - Balakrishnan, Swapna AU - Piper, Christi AU - Gobert, Denise AU - Flach, Alicia PY - 2024/10/24 TI - Current State of Connected Sensor Technologies Used During Rehabilitation Care: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e60496 VL - 13 KW - connected sensor technology KW - digital health KW - rehabilitation KW - rehabilitation care KW - remote monitoring KW - telehealth KW - mHealth KW - mobile health KW - wearables KW - wearable technology N2 - Background: Connected sensor technologies can capture raw data and analyze them using advanced statistical methods such as machine learning or artificial intelligence to generate interpretable behavioral or physiological outcomes. Previous research conducted on connected sensor technologies has focused on design, development, and validation. Published review studies have either summarized general technological solutions to address specific behaviors such as physical activity or focused on remote monitoring solutions in specific patient populations. Objective: This study aimed to map research that focused on using connected sensor technologies to augment rehabilitation services by informing care decisions. Methods: The Population, Concept, and Context framework will be used to define inclusion criteria. Relevant articles published between 2008 to the present will be included if (1) the study enrolled adults (population), (2) the intervention used at least one connected sensor technology and involved data transfer to a clinician so that the data could be used to inform the intervention (concept), and (3) the intervention was within the scope of rehabilitation (context). An initial search strategy will be built in Embase; peer reviewed; and then translated to Ovid MEDLINE ALL, Web of Science Core Collection, and CINAHL. Duplicates will be removed prior to screening articles for inclusion. Two independent reviewers will screen articles in 2 stages: title/abstract and full text. Discrepancies will be resolved through group discussion. Data from eligible articles relevant to population, concept, and context will be extracted. Descriptive statistics will be used to report findings, and relevant outcomes will include the type and frequency of connected sensor used and method of data sharing. Additional details will be narratively summarized and displayed in tables and figures. Key partners will review results to enhance interpretation and trustworthiness. Results: We conducted initial searches to refine the search strategy in February 2024. The results of this scoping review are expected in October 2024. Conclusions: Results from the scoping review will identify critical areas of inquiry to advance the field of technology-augmented rehabilitation. Results will also support the development of a longitudinal model to support long-term health outcomes. Trial Registration: Open Science Framework jys53; https://osf.io/jys53 International Registered Report Identifier (IRRID): DERR1-10.2196/60496 UR - https://www.researchprotocols.org/2024/1/e60496 UR - http://dx.doi.org/10.2196/60496 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446418 ID - info:doi/10.2196/60496 ER - TY - JOUR AU - Rashid, Zulqarnain AU - Folarin, A. Amos AU - Zhang, Yuezhou AU - Ranjan, Yatharth AU - Conde, Pauline AU - Sankesara, Heet AU - Sun, Shaoxiong AU - Stewart, Callum AU - Laiou, Petroula AU - Dobson, B. Richard J. PY - 2024/10/23 TI - Digital Phenotyping of Mental and Physical Conditions: Remote Monitoring of Patients Through RADAR-Base Platform JO - JMIR Ment Health SP - e51259 VL - 11 KW - digital biomarkers KW - mHealth KW - mobile apps KW - Internet of Things KW - remote data collection KW - wearables KW - real-time monitoring KW - platform KW - biomarkers KW - wearable KW - smartphone KW - data collection KW - open-source platform KW - RADAR-base KW - phenotyping KW - mobile phone KW - IoT N2 - Background: The use of digital biomarkers through remote patient monitoring offers valuable and timely insights into a patient?s condition, including aspects such as disease progression and treatment response. This serves as a complementary resource to traditional health care settings leveraging mobile technology to improve scale and lower latency, cost, and burden. Objective: Smartphones with embedded and connected sensors have immense potential for improving health care through various apps and mobile health (mHealth) platforms. This capability could enable the development of reliable digital biomarkers from long-term longitudinal data collected remotely from patients. Methods: We built an open-source platform, RADAR-base, to support large-scale data collection in remote monitoring studies. RADAR-base is a modern remote data collection platform built around Confluent?s Apache Kafka to support scalability, extensibility, security, privacy, and quality of data. It provides support for study design and setup and active (eg, patient-reported outcome measures) and passive (eg, phone sensors, wearable devices, and Internet of Things) remote data collection capabilities with feature generation (eg, behavioral, environmental, and physiological markers). The back end enables secure data transmission and scalable solutions for data storage, management, and data access. Results: The platform has been used to successfully collect longitudinal data for various cohorts in a number of disease areas including multiple sclerosis, depression, epilepsy, attention-deficit/hyperactivity disorder, Alzheimer disease, autism, and lung diseases. Digital biomarkers developed through collected data are providing useful insights into different diseases. Conclusions: RADAR-base offers a contemporary, open-source solution driven by the community for remotely monitoring, collecting data, and digitally characterizing both physical and mental health conditions. Clinicians have the ability to enhance their insight through the use of digital biomarkers, enabling improved prevention, personalization, and early intervention in the context of disease management. UR - https://mental.jmir.org/2024/1/e51259 UR - http://dx.doi.org/10.2196/51259 ID - info:doi/10.2196/51259 ER - TY - JOUR AU - Garvin, Lynn AU - Richardson, Eric AU - Heyworth, Leonie AU - McInnes, Keith D. PY - 2024/10/23 TI - Exploring Contactless Vital Signs Collection in Video Telehealth Visits Among Veterans Affairs Providers and Patients: Pilot Usability Study JO - JMIR Form Res SP - e60491 VL - 8 KW - veteran KW - provider KW - video-based care KW - vital statistics KW - telemonitoring KW - usability KW - mobile health app KW - telemedicine KW - health care access KW - vital sign KW - video KW - telehealth KW - patient KW - Veterans Affairs KW - telehealth platform KW - photoplethysmography KW - camera KW - web-based survey KW - electronic medical record KW - home-based biometric devices KW - mHealth N2 - Background: To expand veterans? access to health care, the Veterans Affairs (VA) Office of Connected Care explored a novel software feature called ?Vitals? on its VA Video Connect telehealth platform. Vitals uses contactless, video-based, remote photoplethysmography (rPPG) through the infrared camera on veterans? smartphones (and other devices) to automatically scan their faces to provide real-time vital statistics on screen to both the provider and patient. Objective: This study aimed to assess VA clinical provider and veteran patient attitudes regarding the usability of Vitals. Methods: We conducted a mixed methods evaluation of Vitals among VA providers and patients, collecting data in July and August 2023 at the VA Boston Healthcare System and VA San Diego Healthcare System. We conducted analyses in October 2023. In-person usability testing sessions consisted of a think-aloud procedure while using the software, a semistructured interview, and a 26-item web-based survey. Results: Usability test sessions with 20 VA providers and 13 patients demonstrated that both groups found Vitals ?useful? and ?easy to use,? and they rated its usability highly (86 and 82 points, respectively, on a 100-point scale). Regarding acceptability or willingness/intent to use, providers and patients generally expressed confidence and trust in Vitals readings, with high ratings of 90 and 85 points, respectively. Providers and patients rated Vitals highly for its feasibility and appropriateness for context (90 and 90 points, respectively). Finally, providers noted that Vitals? flexibility makes it appropriate and advantageous for implementation in a wide range of clinical contexts, particularly in specialty care. Providers believed that most clinical teams would readily integrate Vitals into their routine workflow because it saves time; delivers accurate, consistently collected vitals; and may reduce reporting errors. Providers and veterans suggested training and support materials that could improve Vitals adoption and implementation. Conclusions: While remote collection of vital readings has been described in the literature, this is one of the first accounts of testing a contactless vital signs measurement tool among providers and patients. If ongoing initiatives demonstrate accuracy in its readings, Vitals could enhance telemedicine by providing accurate and automatic reporting and recording of vitals; sending patients? vital readings (pending provider approval) directly to their electronic medical record; saving provider and patient time; and potentially reducing necessity of some home-based biometric devices. Understanding usability issues before US Food and Drug Administration approval of Vitals and its implementation could contribute to a seamless introduction of Vitals to VA providers and patients. UR - https://formative.jmir.org/2024/1/e60491 UR - http://dx.doi.org/10.2196/60491 UR - http://www.ncbi.nlm.nih.gov/pubmed/39441645 ID - info:doi/10.2196/60491 ER - TY - JOUR AU - Zhou, You AU - Li, Si-Jia AU - Huang, Ren-Qian AU - Ma, Hao-Ming AU - Wang, Ao-Qi AU - Tang, Xing-Yi AU - Pei, Run-Yuan AU - Piao, Mei-Hua PY - 2024/10/22 TI - Behavior Change Techniques Used in Self-Management Interventions Based on mHealth Apps for Adults With Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e54978 VL - 26 KW - hypertension KW - mHealth KW - app KW - behavior change technique KW - systematic review KW - meta-analysis KW - mobile phone N2 - Background: Hypertension has become an important global public health challenge. Mobile health (mHealth) intervention is a viable strategy to improve outcomes for patients with hypertension. However, evidence on the effect of mHealth app interventions on self-management in patients with hypertension is yet to be updated, and the active ingredients promoting behavior change in interventions remain unclear. Objective: We aimed to evaluate the effect of mHealth app self-management interventions on blood pressure (BP) management and investigate the use of behavior change techniques (BCTs) in mHealth app interventions. Methods: We conducted a literature search in 6 electronic databases from January 2009 to October 2023 for studies reporting the application of mHealth apps in self-management interventions. The Cochrane Risk of Bias (version 2) tool for randomized controlled trials was used to assess the quality of the studies. BCTs were coded according to the Taxonomy of BCTs (version 1). The extracted data were analyzed using RevMan5.4 software (Cochrane Collaboration). Results: We reviewed 20 studies, of which 16 were included in the meta-analysis. In total, 21 different BCTs (mean 8.7, SD 3.8 BCTs) from 12 BCT categories were reported in mHealth app interventions. The most common BCTs were self-monitoring of outcomes of behavior, feedback on outcomes of behavior, instruction on how to perform the behavior, and pharmacological support. The mHealth app interventions resulted in a ?5.78 mm Hg (95% CI ?7.97 mm Hg to ?3.59 mm Hg; P<.001) reduction in systolic BP and a ?3.28 mm Hg (95% CI ?4.39 mm Hg to ?2.17 mm Hg; P<.001) reduction in diastolic BP. The effect of interventions on BP reduction was associated with risk factors, such as hypertension, that were addressed by the mHealth app intervention (multiple risk factors vs a single risk factor: ?6.50 mm Hg, 95% CI ?9.00 mm Hg to ?3.99 mm Hg vs ?1.54 mm Hg, 95% CI ?4.15 mm Hg to 1.06 mm Hg; P=.007); the presence of a theoretical foundation (with vs without behavior change theory: ?10.06 mm Hg, 95% CI ?16.42 mm Hg to ?3.70 mm Hg vs ?4.13 mm Hg, 95% CI ?5.50 to ?2.75 mm Hg; P=.07); intervention duration (3 vs ?6 months: ?8.87 mm Hg, 95% CI ?10.90 mm Hg to ?6.83 mm Hg vs ?5.76 mm Hg, 95% CI ?8.74 mm Hg to ?2.77 mm Hg; P=.09); and the number of BCTs (?11 vs <11 BCTs: ?9.68 mm Hg, 95% CI ?13.49 mm Hg to ?5.87 mm Hg vs ?2.88 mm Hg, 95% CI ?3.90 mm Hg to ?1.86 mm Hg; P<.001). Conclusions: The self-management interventions based on mHealth apps were effective strategies for lowering BP in patients with hypertension. The effect of interventions was influenced by factors related to the study?s intervention design and BCT. UR - https://www.jmir.org/2024/1/e54978 UR - http://dx.doi.org/10.2196/54978 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54978 ER - TY - JOUR AU - Manning, B. Julia AU - Blandford, Ann AU - Edbrooke-Childs, Julian PY - 2024/10/22 TI - Facilitators of and Barriers to Teachers? Engagement With Consumer Technologies for Stress Management: Qualitative Study JO - J Med Internet Res SP - e50457 VL - 26 KW - teachers KW - stress KW - workplace KW - self-management KW - digital health KW - technology KW - qualitative KW - context KW - high schools KW - wearables KW - apps KW - human-computer interaction KW - HCI KW - personal informatics N2 - Background: Consumer technology is increasingly being adopted to support personal stress management, including by teachers. Multidisciplinary research has contributed some knowledge of design and features that can help detect and manage workplace stress. However, there is less understanding of what facilitates engagement with ubiquitous ?off the shelf? technologies, particularly in a specific occupational setting. An understanding of features that facilitate or inhibit technology use, and the influences of contexts on the manner of interaction, could improve teachers? stress-management opportunities. Objective: The aim of the study was to investigate the interaction features that facilitated or inhibited engagement with 4 consumer technologies chosen by teachers for stress management, as well as the influence of the educational contexts on their engagement. We also examined how use of well-being technology could be better supported in the school. Methods: The choice of consumer technologies was categorized in a taxonomy for English secondary school teachers according to stress-management strategies and digital features. Due to the COVID-19 pandemic, we adapted the study so that working from home in the summer could be contrasted with being back in school. Thus, a longitudinal study intended for 6 weeks in the summer term (in 2020) was extended into the autumn term, lasting up to 27 weeks. Teachers chose to use either a Withings smartwatch or Wysa, Daylio, or Teacher Tapp apps. Two semistructured interviews and web-based surveys were conducted with 8 teachers in England in the summer term, and 6 (75%) of them took part in a third interview in the autumn term. Interviews were analyzed using reflexive thematic analysis informed by interpretive phenomenological analysis. Results: Technology elements and characteristics such as passive data collation, brevity of interaction, discreet appearance, reminders, and data visualization were described by teachers as facilitators. Lack of instructions and information on features, connectivity, extended interaction requirements, and nondifferentiation of activity and exercise data were described as barriers. Mesocontextual barriers to engagement were also reported, particularly when teachers were back on school premises, including temporal constraints, social stigma, and lack of private space to de-stress. Teachers had ideas for feature improvements and how educational leadership normalizing teachers? stress management with consumer technologies could benefit the school culture. Conclusions: Having preselected their stress-management strategies, teachers were able to harness design features to support themselves over an extended period. There could be an important role for digital interventions as part of teachers? stress management, which the school leadership would need to leverage to maximize their potential. The findings add to the holistic understanding of situated self-care and should inform developers? considerations for occupational digital stress support. UR - https://www.jmir.org/2024/1/e50457 UR - http://dx.doi.org/10.2196/50457 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50457 ER - TY - JOUR AU - Zhou, Weijiao AU - Shang, Shaomei AU - Cho, Youmin PY - 2024/10/22 TI - Associations of Wearable Activity Tracker Use With Physical Activity and Health Outcomes in Patients With Cancer: Findings from a Population-Based Survey Study JO - J Med Internet Res SP - e51291 VL - 26 KW - physical activity KW - exercise KW - wearable tracker KW - wearable device KW - cancer KW - oncology KW - cancer survivorship KW - wearable KW - wearables KW - tracker KW - trackers KW - health outcome KW - health outcomes KW - HINTS KW - survey KW - surveys KW - national KW - bivariate KW - epidemiology KW - epidemiological KW - association KW - associations N2 - Background: Physical inactivity is a global issue for cancer survivors. Wearable activity trackers are promising to address physical inactivity by providing real-time feedback on physical activity and offering opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable activity trackers on improved physical inactivity and related health outcomes (eg, BMI, anxiety and depression, and self-rated health status). However, wearable activity trackers were often used as an adjunct to physical activity interventions, and the effectiveness of wearable activity trackers alone is unknown. Objective: This study aims to determine the association of wearable activity trackers with physical activity and health outcomes in patients with cancer. Methods: Data from 957 cancer survivors from the Health Information National Trends Survey?Surveillance, Epidemiology, and End Results (HINTS-SEER) were analyzed. The outcome variables examined were time spent in moderate to vigorous physical activity, weekly frequency of strength training, BMI, anxiety and depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable activity trackers within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations after controlling for sociodemographic, cancer-related, and health-related factors. All data analyses accounted for the complex survey design and sample weights. Results: Only 29% of cancer survivors reported wearable activity tracker use. Bivariate analyses showed that younger age (P<.001), higher education (P=.04), higher income (P<.001), and an employed status (P<.001) were significantly associated with wearable activity tracker use. Wearable activity tracker use was significantly associated with higher time spent in moderate to vigorous physical activity (adjusted =37.94, 95% CI 8.38-67.5; P=.01), more frequent strength training per week (adjusted odds ratio [OR] 1.50, 95% CI 1.09-2.06; P=.01), and better self-rated health status (adjusted OR 1.58, 95% CI 1.09-2.29; P=.01), but not with BMI or anxiety and depression. Conclusions: This study suggests that the uptake of wearable activity trackers is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable activity tracker use with physical activity and self-rated health, supporting using wearable activity trackers as a promising tool to facilitate physical activity promotion. UR - https://www.jmir.org/2024/1/e51291 UR - http://dx.doi.org/10.2196/51291 UR - http://www.ncbi.nlm.nih.gov/pubmed/39436693 ID - info:doi/10.2196/51291 ER - TY - JOUR AU - LeSeure, Peeranuch AU - Chin, Elizabeth AU - Zhang, Shelley PY - 2024/10/21 TI - A Culturally Sensitive Mobile App (DiaFriend) to Improve Self-Care in Patients With Type 2 Diabetes: Development Study JO - JMIR Diabetes SP - e63393 VL - 9 KW - cultural sensitivity KW - design thinking KW - mobile app KW - self-care KW - type 2 diabetes KW - mobile phone KW - app KW - design KW - diabetes KW - development KW - prototype KW - effectiveness KW - user engagement KW - blood glucose KW - glucose KW - weight KW - carbohydrate KW - exercise KW - Portuguese Americans KW - ethnic group N2 - Background: Mobile apps designed with cultural sensitivity have demonstrated higher user acceptability and greater effectiveness in enhancing self-care skills. However, a significant gap exists in developing such apps for specific populations, such as Portuguese Americans living in southern Massachusetts, home to the second-largest Portuguese community in the United States. This group possesses unique cultural traditions, particularly in dietary practices, including a tendency toward high carbohydrate intake. Tailoring diabetes self-care apps to address these specific cultural requirements could substantially improve diabetes management within this population. Objective: The aim of this app development project was to develop a prototype diabetes management app for Portuguese Americans with type 2 diabetes mellitus using the design thinking methodology, incorporating user-centered design principles and cultural sensitivity. This paper describes the phase-2 results, focusing on app design and development. Methods: Phase 2 of this app development project adhered to the design thinking methodology delineated by the Hasso Plattner Institute of Design at Stanford University, focusing on 2 critical steps: ideation and prototyping. This phase started in March 2022 and continued until April 2024. The project was driven by a multidisciplinary team consisting of 2 nurse educators; an app development specialist; and 2 graduate research assistants from the university?s Computer and Information Sciences Department, both well-versed in mobile app development. Data collected during phase 1, which will be published separately, informed the app design and development process. Results: The prototype of the DiaFriend app (version 1) was designed and developed. The app comprises five features: (1) blood glucose monitoring, (2) weight tracking, (3) carbohydrate tracking, (4) exercise log, and (5) medication reminder. The carbohydrate tracking feature was explicitly tailored to correspond to Portuguese food culture. This paper presents the front-end interface flowchart, demonstrating how the user navigates through each screen. It also discusses the challenges faced during the backend development, such as data not being able to be stored and retrieved. Conclusions: The DiaFriend app (version 1) distinguishes itself from conventional diabetes self-care apps through its emphasis on cultural sensitivity. The development of this app underscores the importance of cultural considerations in health informatics. It establishes a foundation for future research in developing and evaluating culturally sensitive mobile health apps. The adaptation of such technologies has the potential to enhance self-care practices among Portuguese Americans with type 2 diabetes mellitus, with improved glycated hemoglobin levels as a potential outcome. The last step of the design thinking methodology, testing the app, will be conducted in phase 3 and the results will be published elsewhere. UR - https://diabetes.jmir.org/2024/1/e63393 UR - http://dx.doi.org/10.2196/63393 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63393 ER - TY - JOUR AU - Fietta, Valentina AU - Rizzi, Silvia AU - De Luca, Chiara AU - Gios, Lorenzo AU - Pavesi, Chiara Maria AU - Gabrielli, Silvia AU - Monaro, Merylin AU - Forti, Stefano PY - 2024/10/18 TI - A Chatbot-Based Version of the World Health Organization?Validated Self-Help Plus Intervention for Stress Management: Co-Design and Usability Testing JO - JMIR Hum Factors SP - e64614 VL - 11 KW - acceptance and commitment therapy KW - ACT KW - well-being KW - pregnancy KW - breast cancer KW - eHealth KW - mobile health KW - mHealth KW - development KW - usability KW - user-centered design N2 - Background: Advancements in technology offer new opportunities to support vulnerable populations, such as pregnant women and women diagnosed with breast cancer, during physiologically and psychologically stressful periods. Objective: This study aims to adapt and co-design the World Health Organization?s Self-Help Plus intervention into a mobile health intervention for these target groups. Methods: On the basis of the Obesity-Related Behavioral Intervention Trials and Center for eHealth Research and Disease Management models, low-fidelity and high-fidelity prototypes were developed. Prototypes were evaluated by 13 domain experts from diverse sectors and 15 participants from the target groups to assess usability, attractiveness, and functionality through semantic differential scales, the User Version of the Mobile Application Rating Scale questionnaire, and semistructured interviews. Results: Feedback from participants indicated positive perceptions of the mobile health intervention, highlighting its ease of use, appropriate language, and attractive multimedia content. Areas identified for improvement included enhancing user engagement through reminders, monitoring features, and increased personalization. The quality of the content and adherence to initial protocols were positively evaluated. Conclusions: This research provides valuable insights for future studies aiming to enhance the usability, efficacy, and effectiveness of the app, suggesting the potential role of a chatbot-delivered Self-Help Plus intervention as a supportive tool for pregnant women and women with a breast cancer diagnosis. UR - https://humanfactors.jmir.org/2024/1/e64614 UR - http://dx.doi.org/10.2196/64614 UR - http://www.ncbi.nlm.nih.gov/pubmed/39355954 ID - info:doi/10.2196/64614 ER - TY - JOUR AU - Watson-Mackie, Kimberley AU - Arundell, Lauren AU - Lander, Natalie AU - McKay, H. Fiona AU - Jerebine, Alethea AU - Venetsanou, Fotini AU - Barnett, M. Lisa PY - 2024/10/18 TI - Technology-Supported Physical Activity and Its Potential as a Tool to Promote Young Women?s Physical Activity and Physical Literacy: Systematic Review JO - J Med Internet Res SP - e52302 VL - 26 KW - physical literacy KW - young women KW - girls KW - adolescents KW - technology KW - mobile KW - digital KW - fitness KW - exercise KW - physical activity KW - technology-supported KW - systematic review KW - digital health KW - eHealth KW - health informatics KW - mobile phone N2 - Background: Despite the known benefits of physical activity (PA), rates of engagement in PA remain low globally. Low engagement in PA among young women can impact their health. Technology-supported PA may increase PA and physical literacy (PL; skills that can support PA) among young women. Objective: This systematic review aims to investigate the (1) associations between technology-supported PA and PA levels, (2) associations between technology-supported PA and PL levels, and (3) types of technology-supported PA that are associated with higher levels of PA engagement among young women aged 13 to 24 years. This age range was chosen as it includes two transitional periods characterized by decreases in PA. Methods: We searched 6 databases: Applied Science and Technology Source, Education Source, Embase, MEDLINE Complete, Global Health, and SPORTDiscus. Eligible studies were original research published in English between January 1, 2010, and April 24, 2024; focused on young women; and involving either technology-supported PA interventions or research exploring the correlation between technology and PA and PL. The findings of the review were presented descriptively. Study quality was assessed using the JBI Critical Appraisal tools. There were no deviations from the registered protocol. Results: In total, 23 (0.1%) studies (10,233 participants) from 23,609 records were included: randomized controlled trials (n=9, 39%), nonrandomized or retrospective observational studies (n=9, 39%), and cross-sectional studies (n=5, 22%). Of the 23 studies, 12 (52%) focused on young adults (aged ?19 y), 9 (39%) involved adolescents (aged <19 y), and 2 (9%) focused on both groups. Nine studies (39%) were theory based. Common types of technology-supported PA were interactive websites or social media platforms (10/23, 43%), wearable fitness trackers (4/23, 17%), and mobile apps (4/23, 17%). PA or PL were predominantly self-reported (18/23, 78%). A total of 53 PA outcomes were measured: 36% (19/53) reported a positive impact on PA from mobile apps (9/15; 60% of analyses), interactive websites or social media platforms (8/27; 30% of analyses) and wearable fitness trackers (2/11; 18% of analyses). The impact on PL was weak (2/7; 29% of analyses). Eight studies (35%) were rated high, 7 (30%) medium, and 8 (35%) low in quality. Conclusions: There was limited evidence that technology-supported PA improved young women?s PA or PL. The evidence was limited by poor study quality and a lack of theoretical frameworks. In addition, little information was provided on the designs of the technology used. Future interventions seeking to improve young women?s PA and PL should focus on the development of mobile apps underpinned by behavior change theory and addressing whole domains of PL rather than specific elements. Given that technology continues to rapidly advance, further studies are needed to demonstrate the impact of technology-supported PA in improving PA and PL among young women. UR - https://www.jmir.org/2024/1/e52302 UR - http://dx.doi.org/10.2196/52302 UR - http://www.ncbi.nlm.nih.gov/pubmed/39423006 ID - info:doi/10.2196/52302 ER - TY - JOUR AU - Chiu, Yi-Hang AU - Lee, Yen-Fen AU - Lin, Huang-Li AU - Cheng, Li-Chen PY - 2024/10/18 TI - Exploring the Role of Mobile Apps for Insomnia in Depression: Systematic Review JO - J Med Internet Res SP - e51110 VL - 26 KW - depression KW - insomnia KW - chatbots KW - conversational agents KW - medical apps KW - systematic review KW - technical aspects KW - PRISMA N2 - Background: The COVID-19 pandemic has profoundly affected mental health, leading to an increased prevalence of depression and insomnia. Currently, artificial intelligence (AI) and deep learning have thoroughly transformed health care?related mobile apps, offered more effective mental health support, and alleviated the psychological stress that may have emerged during the pandemic. Early reviews outlined the use of mobile apps for dealing with depression and insomnia separately. However, there is now an urgent need for a systematic evaluation of mobile apps that address both depression and insomnia to reveal new applications and research gaps. Objective: This study aims to systematically review and evaluate mobile apps targeting depression and insomnia, highlighting their features, effectiveness, and gaps in the current research. Methods: We systematically searched PubMed, Scopus, and Web of Science for peer-reviewed journal articles published between 2017 and 2023. The inclusion criteria were studies that (1) focused on mobile apps addressing both depression and insomnia, (2) involved young people or adult participants, and (3) provided data on treatment efficacy. Data extraction was independently conducted by 2 reviewers. Title and abstract screening, as well as full-text screening, were completed in duplicate. Data were extracted by a single reviewer and verified by a second reviewer, and risk of bias assessments were completed accordingly. Results: Of the initial 383 studies we found, 365 were excluded after title, abstract screening, and removal of duplicates. Eventually, 18 full-text articles met our criteria and underwent full-text screening. The analysis revealed that mobile apps related to depression and insomnia were primarily utilized for early detection, assessment, and screening (n=5 studies); counseling and psychological support (n=3 studies); and cognitive behavioral therapy (CBT; n=10 studies). Among the 10 studies related to depression, our findings showed that chatbots demonstrated significant advantages in improving depression symptoms, a promising development in the field. Additionally, 2 studies evaluated the effectiveness of mobile apps as alternative interventions for depression and sleep, further expanding the potential applications of this technology. Conclusions: The integration of AI and deep learning into mobile apps, particularly chatbots, is a promising avenue for personalized mental health support. Through innovative features, such as early detection, assessment, counseling, and CBT, these apps significantly contribute toward improving sleep quality and addressing depression. The reviewed chatbots leveraged advanced technologies, including natural language processing, machine learning, and generative dialog, to provide intelligent and autonomous interactions. Compared with traditional face-to-face therapies, their feasibility, acceptability, and potential efficacy highlight their user-friendly, cost-effective, and accessible nature with the aim of enhancing sleep and mental health outcomes. UR - https://www.jmir.org/2024/1/e51110 UR - http://dx.doi.org/10.2196/51110 UR - http://www.ncbi.nlm.nih.gov/pubmed/39423009 ID - info:doi/10.2196/51110 ER - TY - JOUR AU - Song, Meishu AU - Yang, Zijiang AU - Triantafyllopoulos, Andreas AU - Zhang, Zixing AU - Nan, Zhe AU - Tang, Muxuan AU - Takeuchi, Hiroki AU - Nakamura, Toru AU - Kishi, Akifumi AU - Ishizawa, Tetsuro AU - Yoshiuchi, Kazuhiro AU - Schuller, Björn AU - Yamamoto, Yoshiharu PY - 2024/10/18 TI - Empowering Mental Health Monitoring Using a Macro-Micro Personalization Framework for Multimodal-Multitask Learning: Descriptive Study JO - JMIR Ment Health SP - e59512 VL - 11 KW - multimodal KW - multitask KW - daily mental health KW - mental health KW - monitoring KW - macro KW - micro KW - framework KW - personalization KW - strategies KW - prediction KW - emotional state KW - wristbands KW - smartphone KW - mobile phones KW - physiological KW - signals KW - speech data KW - N2 - Background: The field of mental health technology presently has significant gaps that need addressing, particularly in the domain of daily monitoring and personalized assessments. Current noninvasive devices such as wristbands and smartphones are capable of collecting a wide range of data, which has not yet been fully used for mental health monitoring. Objective: This study aims to introduce a novel dataset for personalized daily mental health monitoring and a new macro-micro framework. This framework is designed to use multimodal and multitask learning strategies for improved personalization and prediction of emotional states in individuals. Methods: Data were collected from 298 individuals using wristbands and smartphones, capturing physiological signals, speech data, and self-annotated emotional states. The proposed framework combines macro-level emotion transformer embeddings with micro-level personalization layers specific to each user. It also introduces a Dynamic Restrained Uncertainty Weighting method to effectively integrate various data types for a balanced representation of emotional states. Several fusion techniques, personalization strategies, and multitask learning approaches were explored. Results: The proposed framework was evaluated using the concordance correlation coefficient, resulting in a score of 0.503. This result demonstrates the framework?s efficacy in predicting emotional states. Conclusions: The study concludes that the proposed multimodal and multitask learning framework, which leverages transformer-based techniques and dynamic task weighting strategies, is superior for the personalized monitoring of mental health. The study indicates the potential of transforming daily mental health monitoring into a more personalized app, opening up new avenues for technology-based mental health interventions. UR - https://mental.jmir.org/2024/1/e59512 UR - http://dx.doi.org/10.2196/59512 UR - http://www.ncbi.nlm.nih.gov/pubmed/39422993 ID - info:doi/10.2196/59512 ER - TY - JOUR AU - Pojednic, Rachele AU - Welch, Amy AU - Thornton, Margaret AU - Garvey, Meghan AU - Grogan, Tara AU - Roberts, Walter AU - Ash, Garrett PY - 2024/10/18 TI - Intensive, Real-Time Data Collection of Psychological and Physiological Stress During a 96-Hour Field Training Exercise at a Senior Military College: Feasibility and Acceptability Cohort Study JO - JMIR Form Res SP - e60925 VL - 8 KW - biomarker KW - biometric KW - heart rate variability KW - saliva KW - feasibility KW - warfighter KW - field training KW - acceptability KW - wearable biosensors KW - real-time KW - data collection KW - physiological stress KW - training exercise KW - pilot study KW - sweat sensors N2 - Background: Poor physical fitness, stress, and fatigue are factors impacting military readiness, national security, and economic burden for the United States Department of Defense. Improved accuracy of wearable biosensors and remote field biologic sample collection strategies could make critical contributions to understanding how physical readiness and occupational stressors result in on-the-job and environment-related injury, sleep impairments, diagnosis of mental health disorders, and reductions in performance in war-fighters. Objective: This study aimed to evaluate the feasibility and acceptability of intensive biomarker and biometric data collection to understand physiological and psychological stress in Army Reserved Officer Training Corps cadets before, during, and after a 96-hour field training exercise (FTX). Methods: A prospective pilot study evaluated the feasibility and acceptability of multimodal field data collection using passive drool saliva sampling, sweat sensors, accelerometry, actigraphy, and photoplethysmography. In addition, physical fitness (Army Combat Fitness Test), self-reported injury, and psychological resilience (Brief Resilience Scale) were measured. Results: A total of 22 cadets were included. Two were lost to follow-up due to injury during FTX, for a retention rate of 91%. Assessments of performance and psychological resilience were completed for all remaining participants, resulting in 100% testing adherence. All participants provided saliva samples before the FTX, with 98% adherence at the second time point and 91% at the third. For sweat, data collection was not possible. Average daily wear time for photoplethysmography devices was good to excellent, meeting a 70% threshold with data collected for ?80% of person-days at all time points. Of the participants who completed the FTX and 12 completed a post-FTX acceptability survey for a response rate of 60%. Overall, participant acceptance was high (?80%) for all metrics and devices. Conclusions: This study demonstrates that wearable biosensors and remote field biologic sample collection strategies during a military FTX have the potential to be used in higher stakes tactical environments in the future for some, but not all, of the strategies. Overall, real-time biometric and biomarker sampling is feasible and acceptable during field-based training and provides insights and strategies for future interventions on military cadet and active-duty readiness, environmental stress, and recovery. UR - https://formative.jmir.org/2024/1/e60925 UR - http://dx.doi.org/10.2196/60925 UR - http://www.ncbi.nlm.nih.gov/pubmed/39422988 ID - info:doi/10.2196/60925 ER - TY - JOUR AU - Mueller, L. Emily AU - Cochrane, R. Anneli AU - Campbell, E. Madison AU - Nikkhah, Sarah AU - Holden, J. Richard AU - Miller, D. Andrew PY - 2024/10/17 TI - An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Beta Stage Usability Study JO - JMIR Cancer SP - e52128 VL - 10 KW - oncology KW - supportive care KW - mHealth KW - children KW - caregivers KW - mobile phones N2 - Background: Previous research demonstrated that caregivers of children with cancer desired a mobile health (mHealth) tool to aid them in the medical management of their child. Prototyping and alpha testing of the Cope 360 app (Commissioning Agents, Inc) resulted in improvements in the ability to track symptoms, manage medications, and prepare for urgent medical needs. Objective: This study aims to engage caregivers of children with cancer in beta testing of a smartphone app for the medical management of children with cancer, assess acceptance, identify caregivers? perceptions and areas for improvement, and validate the app?s design concepts and use cases. Methods: In this pilot, study caregivers of children with cancer used the Cope 360 mHealth app for 1 week, with the goal of daily logging. Demographics and a technology acceptance survey were obtained from each participant. Recorded semistructured interviews were transcribed and analyzed iteratively using NVivo (version 12, QSR International) and analyzed for information on usage, perceptions, and suggestions for improvement. Results: A total of 10 caregivers participated in beta testing, primarily women (n=8, 80%), married, with some college education, and non-Hispanic White (n=10, 100%). The majority of participants (n=7, 70%) had children with acute lymphocytic leukemia who were being treated with chemotherapy only (n=8, 80%). Overall, participants had a favorable opinion of Cope 360. Almost all participants (n=9, 90%) believed that using the app would improve their ability to manage their child?s medical needs at home. All participants reported that Cope 360 was easy to use, and most would use the app if given the opportunity (n=8, 80%). These values indicate that the app had a high perceived ease of use with well-perceived usefulness and behavioral intention to use. Key topics for improvement were identified including items that were within the scope of change and others that were added to a future wish list. Changes that were made based on caregiver feedback included tracking or editing all oral and subcutaneous medications and the ability to change the time of a symptom tracked or medication administered if unable to do so immediately. Wish list items included adding a notes section, monitoring skin changes, weight and nutrition tracking, and mental health tracking. Conclusions: The Cope 360 app was well received by caregivers of children with cancer. Our validation testing suggests that the Cope 360 app is ready for testing in a randomized controlled trial to assess outcome improvements. UR - https://cancer.jmir.org/2024/1/e52128 UR - http://dx.doi.org/10.2196/52128 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52128 ER - TY - JOUR AU - Brinson, K. Alison AU - Jahnke, R. Hannah AU - Henrich, Natalie AU - Moss, Christa AU - Shah, Neel PY - 2024/10/16 TI - Digital Health as a Mechanism to Reduce Neonatal Intensive Care Unit Admissions: Retrospective Cohort Study JO - JMIR Pediatr Parent SP - e56247 VL - 7 KW - digital health KW - education KW - gestational conditions KW - Maven Clinic KW - mental health management KW - neonatal KW - NICU admissions KW - neonatal intensive care unit KW - mobile phone N2 - Background: Admission to the neonatal intensive care unit (NICU) is costly and has been associated with financial and emotional stress among families. Digital health may be well equipped to impact modifiable health factors that contribute to NICU admission rates. Objective: The aim of the study is to investigate how the use of a comprehensive prenatal digital health platform is associated with gestational age at birth and mechanisms to reduce the risk of admission to the NICU. Methods: Data were extracted from 3326 users who enrolled in a comprehensive digital health platform between January 2020 and May 2022. Multivariable linear and logistic regression models were used to estimate the associations between hours of digital health use and (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission. Multivariable logistic regression models estimated the associations between (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission and the likelihood of a NICU admission. All analyses were stratified by the presence of any gestational conditions during pregnancy. Results: For users both with and without gestational conditions, hours of digital health use were positively associated with gestational age at birth (in weeks; with gestational conditions: ?=.01; 95% CI 0.0006-0.02; P=.04 and without gestational conditions: ?=.01; 95% CI 0.0006-0.02; P=.04) and mechanisms that have the potential to reduce risk of a NICU admission, including learning medically accurate information (with gestational conditions: adjusted odds ratio [AOR] 1.05, 95% CI 1.03-1.07; P<.001 and without gestational conditions: AOR 1.04, 95% CI 1.02-1.06; P<.001), mental health management (with gestational conditions: AOR 1.06, 95% CI 1.04-1.08; P<.001 and without gestational conditions: AOR 1.03, 95% CI 1.02-1.05; P<.001), and understanding warning signs during pregnancy (with gestational conditions: AOR 1.08, 95% CI 1.06-1.11; P<.001 and without gestational conditions: AOR 1.09, 95% CI 1.07-1.11; P<.001). For users with and without gestational conditions, an increase in gestational age at birth was associated with a decreased likelihood of NICU admission (with gestational conditions: AOR 0.62, 95% CI 0.55-0.69; P<.001 and without gestational conditions: AOR 0.59, 95% CI 0.53-0.65; P<.001). Among users who developed gestational conditions, those who reported that the platform helped them understand warning signs during pregnancy had lower odds of a NICU admission (AOR 0.63, 95% CI 0.45-0.89; P=.01). Conclusions: Digital health use may aid in extending gestational age at birth and reduce the risk of NICU admission. UR - https://pediatrics.jmir.org/2024/1/e56247 UR - http://dx.doi.org/10.2196/56247 ID - info:doi/10.2196/56247 ER - TY - JOUR AU - Fabens, Isabella AU - Makhele, Calsile AU - Igaba, Kibiribiri Nelson AU - Hlongwane, Sizwe AU - Phohole, Motshana AU - Waweru, Evelyn AU - Oni, Femi AU - Khwepeya, Madalitso AU - Sardini, Maria AU - Moyo, Khumbulani AU - Tweya, Hannock AU - Wafula, Barasa Mourice AU - Pienaar, Jacqueline AU - Ndebele, Felex AU - Setswe, Geoffrey AU - Dong, Qi Tracy AU - Feldacker, Caryl PY - 2024/10/16 TI - WhatsApp Versus SMS for 2-Way, Text-Based Follow-Up After Voluntary Medical Male Circumcision in South Africa: Exploration of Messaging Platform Choice JO - JMIR Form Res SP - e62762 VL - 8 KW - 2-way texting KW - text messages KW - WhatsApp KW - digital health innovations KW - male circumcision KW - South Africa KW - quality improvement N2 - Background: Telehealth is growing, especially in areas where access to health facilities is difficult. We previously used 2-way texting (2wT) via SMS to improve the quality of postoperative care after voluntary medical male circumcision in South Africa. In this study, we offered males aged 15 years and older WhatsApp or SMS as their message delivery and interaction platform to explore user preferences and behaviors. Objective: The objectives of this process evaluation embedded within a larger 2wT expansion trial were to (1) explore 2wT client preferences, including client satisfaction, with WhatsApp or SMS; (2) examine response rates (participation) by SMS and WhatsApp; and (3) gather feedback from the 2wT implementation team on the WhatsApp approach. Methods: Males aged 15 years and older undergoing voluntary medical male circumcision in program sites could choose their follow-up approach, selecting 2wT via SMS or WhatsApp or routine care (in-person postoperative visits). The 2wT system provided 1-way educational messages and an open 2-way communication channel between providers and clients. We analyzed quantitative data from the 2wT database on message delivery platforms (WhatsApp vs SMS), response rates, and user behaviors using chi-square tests, z tests, and t tests. The team conducted short phone calls with WhatsApp and SMS clients about their perceptions of this 2wT platform using a short, structured interview guide. We consider informal reflections from the technical team members on the use of WhatsApp. We applied an implementation science lens using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to focus results on practice and policy improvement. Results: Over a 2-month period?from August to October, 2023?337 males enrolled in 2wT and were offered WhatsApp or SMS and were included in the analysis. For 2wT reach, 177 (53%) participants chose WhatsApp as their platform (P=.38). Mean client age was 30 years, and 253 (75%) participants chose English for automated messages. From quality assurance calls, almost all respondents (87/89, 98%) were happy with the way they were followed up. For effectiveness, on average for the days on which responses were requested, 58 (33%) WhatsApp clients and 44 (28%) SMS clients responded (P=.50). All 2wT team members believed WhatsApp limited the automated message content, language choices, and inclusivity as compared with the SMS-based 2wT approach. Conclusions: When presented with a choice of 2wT communication platform, clients appear evenly split between SMS and WhatsApp. However, WhatsApp requires a smartphone and data plan, potentially reducing reach at scale. Clients using both platforms responded to 2wT interactive prompts, demonstrating similar effectiveness in engaging clients in follow-up. For telehealth interventions, digital health designers should maintain an SMS-based platform and carefully consider adding WhatsApp as an option for clients, using an implementation science approach to present evidence that guides the best implementation approach for their setting. UR - https://formative.jmir.org/2024/1/e62762 UR - http://dx.doi.org/10.2196/62762 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412842 ID - info:doi/10.2196/62762 ER - TY - JOUR AU - Martin-Key, A. Nayra AU - Funnell, L. Erin AU - Benacek, Jiri AU - Spadaro, Benedetta AU - Bahn, Sabine PY - 2024/10/16 TI - Intention to Use a Mental Health App for Menopause: Health Belief Model Approach JO - JMIR Form Res SP - e60434 VL - 8 KW - menopause KW - menopause transition KW - mental health KW - perimenopause KW - women?s health KW - psychological framework KW - symptom tracking KW - app usage KW - app KW - Health Belief Model N2 - Background: Menopause presents a period of heightened vulnerability for mental health issues. Despite this, mental health screening is not consistently integrated into menopausal health care, and access to psychological interventions is limited. Digital technologies, such as web and smartphone apps, may offer a way to facilitate and improve mental health care provision throughout menopause. However, little is known about potential users? intention to use such technologies during this critical phase of life. Objective: To examine the factors that impact the intention of potential users to use a mental health app during menopause, we used the Health Belief Model (HBM), a psychological framework widely used to understand and predict individuals? health-related behaviors. Methods: An online survey was generated. Convenience sampling was used, with participants recruited via social media and email, through relevant foundations and support groups, and by word of mouth. Structural equation modeling with maximum likelihood estimation was conducted to explore whether the factor structure of the HBM is a good fit for predicting the intention to use a mental health app for menopause. A Cronbach ? value of .05 was used for determining statistical significance. Results: A total of 1154 participants commenced the survey, of which 82.49% (n=952) completed at least 97% of the survey. Of these, 86.76% (n=826) expressed that their menopausal symptoms had negatively affected their mental health, and went on to answer questions regarding their experiences and interest in using a web or smartphone app for mental health symptoms related to menopause. Data from this subgroup (N=826) were analyzed. In total, 74.09% (n=612) of respondents sought online help for mental health symptoms related to menopause. The most common topics searched for were symptom characteristics (n=435, 52.66%) and treatment or therapy options (n=210, 25.42%). Psychoeducation (n=514, 62.23%) was the most desired mental health app feature, followed by symptom tracking (n=499, 60.41%) and self-help tips (n=469, 56.78%). In terms of the intention to use a mental health app, the Satorra-Bentler?scaled fit statistics indicated a good fit for the model (?2278=790.44, P<.001; comparative fit index=0.933, root mean square error of approximation=0.047, standardized root mean square residual=0.056), with cues to action emerging as the most significant predictor of intention (?=.48, P<.001). This was followed by perceived barriers (?=?.25, P<.001), perceived susceptibility (?=.15, P<.001), and perceived benefits (?=.13, P<.001). Perceived severity (?=.01, P=.869) and self-efficacy (?=.03, P=.286) were not significantly associated with behavioral intention. Conclusions: This study reveals important factors that influence the intention to use a mental health app during menopause. It emphasizes the need to address barriers to app usage, while highlighting the impact of credible endorsements and psychoeducation. Furthermore, the study underscores the significance of improving accessibility for users with lower digital literacy or limited resources. UR - https://formative.jmir.org/2024/1/e60434 UR - http://dx.doi.org/10.2196/60434 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412868 ID - info:doi/10.2196/60434 ER - TY - JOUR AU - Sabben, Gaëlle AU - Telfort, Courtney AU - Morales, Marissa AU - Zhang, Stella Wenjia AU - Espinoza, C. Juan AU - Pasquel, J. Francisco AU - Winskell, Kate PY - 2024/10/15 TI - Technology and Continuous Glucose Monitoring Access, Literacy, and Use Among Patients at the Diabetes Center of an Inner-City Safety-Net Hospital: Mixed Methods Study JO - JMIR Diabetes SP - e54223 VL - 9 KW - diabetes mellitus KW - type 1 KW - type 2 KW - digital health KW - continuous glucose monitoring KW - mobile phone N2 - Background: Despite the existence of an increasing array of digital technologies and tools for diabetes management, there are disparities in access to and uptake and use of continuous glucose monitoring (CGM) devices, particularly for those most at risk of poor diabetes outcomes. Objective: This study aims to assess communication technology and CGM access, literacy, and use among patients receiving treatment for diabetes at an inner-city safety-net hospital. Methods: A survey on digital technology ownership and use was self-administered by 75 adults with type 1 and type 2 diabetes at the diabetes clinic of Grady Memorial Hospital in Atlanta, Georgia. In-depth interviews were conducted with 16% (12/75) of these patient participants and 6 health care providers (HCPs) to obtain additional insights into the use of communication technology and CGM to support diabetes self-management. Results: Most participants were African American (66/75, 88%), over half (39/75, 52%) were unemployed or working part time, and 29% (22/75) had no health insurance coverage, while 61% (46/75) had federal coverage. Smartphone ownership and use were near universal; texting and email use were common (63/75, 84% in both cases). Ownership and use of tablets and computers and use and daily use of various forms of media were more prevalent among younger participants and those with type 1 diabetes, who also rated them as easier to use. Technology use specifically for diabetes and health management was low. Participants were supportive of a potential smartphone app for diabetes management, with a high interest in such an app helping them track blood sugar levels and communicate with their care teams. Younger participants showed higher levels of interest, perceived value, and self-efficacy for using an app with these capabilities. History of CGM use was reported by 56% (42/75) of the participants, although half (20/42, 48%) had discontinued use, above all due to the cost of the device and issues with its adhesive. Nonuse was primarily due to not being offered CGM by their HCP. Reasons given for continued use included convenience, improved blood glucose control, and better tracking of blood glucose. The in-depth interviews (n=18) revealed high levels of satisfaction with CGM by users and supported the survey findings regarding reasons for continued use. They also highlighted the value of CGM data to enhance communication between patients and HCPs. Conclusions: Smartphone ownership was near universal among patients receiving care at an inner-city hospital. Alongside the need to address barriers to CGM access and continued use, there is an opportunity to leverage increased access to communication technology in combination with CGM to improve diabetes outcomes among underresourced populations. UR - https://diabetes.jmir.org/2024/1/e54223 UR - http://dx.doi.org/10.2196/54223 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54223 ER - TY - JOUR AU - Karas, Marta AU - Huang, Debbie AU - Clement, Zachary AU - Millner, J. Alexander AU - Kleiman, M. Evan AU - Bentley, H. Kate AU - Zuromski, L. Kelly AU - Fortgang, G. Rebecca AU - DeMarco, Dylan AU - Haim, Adam AU - Donovan, Abigail AU - Buonopane, J. Ralph AU - Bird, A. Suzanne AU - Smoller, W. Jordan AU - Nock, K. Matthew AU - Onnela, Jukka-Pekka PY - 2024/10/11 TI - Smartphone Screen Time Characteristics in People With Suicidal Thoughts: Retrospective Observational Data Analysis Study JO - JMIR Mhealth Uhealth SP - e57439 VL - 12 KW - smartphone KW - mobile apps KW - mobile health KW - screen time KW - suicidal thoughts and behavior KW - suicidal KW - app KW - observational data KW - data analysis study KW - monitor KW - survey KW - psychiatric KW - screen KW - mental health KW - feasibility KW - suicidal ideation KW - mobile phone N2 - Background: Smartphone-based monitoring in natural settings provides opportunities to monitor mental health behaviors, including suicidal thoughts and behaviors. To date, most suicidal thoughts and behaviors research using smartphones has primarily relied on collecting so-called ?active? data, requiring participants to engage by completing surveys. Data collected passively from smartphone sensors and logs may offer an objectively measured representation of an individual?s behavior, including smartphone screen time. Objective: This study aims to present methods for identifying screen-on bouts and deriving screen time characteristics from passively collected smartphone state logs and to estimate daily smartphone screen time in people with suicidal thinking, providing a more reliable alternative to traditional self-report. Methods: Participants (N=126; median age 22, IQR 16-33 years) installed the Beiwe app (Harvard University) on their smartphones, which passively collected phone state logs for up to 6 months after discharge from an inpatient psychiatric unit (adolescents) or emergency department visit (adults). We derived daily screen time measures from these logs, including screen-on time, screen-on bout duration, screen-off bout duration, and screen-on bout count. We estimated the mean of these measures across age subgroups (adults and adolescents), phone operating systems (Android and iOS), and monitoring stages after the discharge (first 4 weeks vs subsequent weeks). We evaluated the sensitivity of daily screen time measures to changes in the parameters of the screen-on bout identification method. Additionally, we estimated the impact of a daylight time change on minute-level screen time using function-on-scalar generalized linear mixed-effects regression. Results: The median monitoring period was 169 (IQR 42?169) days. For adolescents and adults, mean daily screen-on time was 254.6 (95% CI 231.4-277.7) and 271.0 (95% CI 252.2-289.8) minutes, mean daily screen-on bout duration was 4.233 (95% CI 3.565-4.902) and 4.998 (95% CI 4.455-5.541) minutes, mean daily screen-off bout duration was 25.90 (95% CI 20.09-31.71) and 26.90 (95% CI 22.18-31.66) minutes, and mean daily screen-on bout count (natural logarithm transformed) was 4.192 (95% CI 4.041-4.343) and 4.090 (95% CI 3.968-4.213), respectively; there were no significant differences between smartphone operating systems (all P values were >.05). The daily measures were not significantly different for the first 4 weeks compared to the fifth week onward (all P values were >.05), except average screen-on bout in adults (P value = .018). Our sensitivity analysis indicated that in the screen-on bout identification method, the cap on an individual screen-on bout duration has a substantial effect on the resulting daily screen time measures. We observed time windows with a statistically significant effect of daylight time change on screen-on time (based on 95% joint confidence intervals bands), plausibly attributable to sleep time adjustments related to clock changes. Conclusions: Passively collected phone logs offer an alternative to self-report measures for studying smartphone screen time characteristics in people with suicidal thinking. Our work demonstrates the feasibility of this approach, opening doors for further research on the associations between daily screen time, mental health, and other factors. UR - https://mhealth.jmir.org/2024/1/e57439 UR - http://dx.doi.org/10.2196/57439 ID - info:doi/10.2196/57439 ER - TY - JOUR AU - Oh, Sung-Hee AU - Kang, Jae-Heon AU - Kwon, Jin-Won PY - 2024/10/11 TI - Information and Communications Technology?Based Monitoring Service for Tailored Chronic Disease Management in Primary Care: Cost-Effectiveness Analysis Based on ICT-CM Trial Results JO - J Med Internet Res SP - e51239 VL - 26 KW - mHealth KW - mobile health KW - smartphone application KW - cost-effectiveness analysis KW - hypertension KW - diabetes mellitus KW - primary care KW - artificial intelligence KW - applications digital health KW - mobile phone N2 - Background: Information and communications technology?based tailored management (TM) intervention is a novel automatic system in which a smartphone app for the management of patients with hypertension and diabetes, the provider web, and Bluetooth devices are linked. However, little evidence exists regarding the cost-effectiveness of the interventions using mobile apps. Objective: This study aimed to assess the cost-effectiveness of TM intervention for adult patients with hypertension or diabetes in primary care compared with usual care (UC). Methods: Cost-effectiveness analysis using a Markov model was conducted from the Korean health care system perspective. Based on 6-month outcome data from an information and communications technology?based tailored chronic disease management (ICT-CM) trial, effectiveness over a lifetime beyond the trial periods was extrapolated using a cardiovascular disease risk prediction model. Costs were estimated using ICT-CM trial data and national health insurance claims data. Health utility weights were obtained from the Korea National Health and Nutrition Examination Survey. Results: In the base-case analysis, compared with UC, TM was more costly (US $23,157 for TM vs US $22,391 for UC) and more effective (12.006 quality-adjusted life-years [QALYs] for TM vs 11.868 QALYs for UC). The incremental cost-effectiveness ratio was US $5556 per QALY gained. Probabilistic sensitivity analysis showed that the probability of TM being cost-effective compared with UC was approximately 97% at an incremental cost-effectiveness ratio threshold of US $26,515 (KRW 35 million) per QALY gained. Conclusions: Compared with UC, TM intervention is a cost-effective option for patients with hypertension or diabetes in primary care settings. The study results can assist policy makers in making evidence-based decisions when implementing accessible chronic disease management services. UR - https://www.jmir.org/2024/1/e51239 UR - http://dx.doi.org/10.2196/51239 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51239 ER - TY - JOUR AU - Yi, Li AU - Hart, E. Jaime AU - Straczkiewicz, Marcin AU - Karas, Marta AU - Wilt, E. Grete AU - Hu, R. Cindy AU - Librett, Rachel AU - Laden, Francine AU - Chavarro, E. Jorge AU - Onnela, Jukka-Pekka AU - James, Peter PY - 2024/10/11 TI - Measuring Environmental and Behavioral Drivers of Chronic Diseases Using Smartphone-Based Digital Phenotyping: Intensive Longitudinal Observational mHealth Substudy Embedded in 2 Prospective Cohorts of Adults JO - JMIR Public Health Surveill SP - e55170 VL - 10 KW - big data KW - daily mobility KW - digital phenotyping KW - ecological momentary assessment KW - epidemiological monitoring KW - health behavior KW - smartphone apps and sensors KW - mobile phone N2 - Background: Previous studies investigating environmental and behavioral drivers of chronic disease have often had limited temporal and spatial data coverage. Smartphone-based digital phenotyping mitigates the limitations of these studies by using intensive data collection schemes that take advantage of the widespread use of smartphones while allowing for less burdensome data collection and longer follow-up periods. In addition, smartphone apps can be programmed to conduct daily or intraday surveys on health behaviors and psychological well-being. Objective: The aim of this study was to investigate the feasibility and scalability of embedding smartphone-based digital phenotyping in large epidemiological cohorts by examining participant adherence to a smartphone-based data collection protocol in 2 ongoing nationwide prospective cohort studies. Methods: Participants (N=2394) of the Beiwe Substudy of the Nurses? Health Study 3 and Growing Up Today Study were followed over 1 year. During this time, they completed questionnaires every 10 days delivered via the Beiwe smartphone app covering topics such as emotions, stress and enjoyment, physical activity, access to green spaces, pets, diet (vegetables, meats, beverages, nuts and dairy, and fruits), sleep, and sitting. These questionnaires aimed to measure participants? key health behaviors to combine them with objectively assessed high-resolution GPS and accelerometer data provided by participants during the same period. Results: Between July 2021 and June 2023, we received 11.1 TB of GPS and accelerometer data from 2394 participants and 23,682 survey responses. The average follow-up time for each participant was 214 (SD 148) days. During this period, participants provided an average of 14.8 (SD 5.9) valid hours of GPS data and 13.2 (SD 4.8) valid hours of accelerometer data. Using a 10-hour cutoff, we found that 51.46% (1232/2394) and 53.23% (1274/2394) of participants had >50% of valid data collection days for GPS and accelerometer data, respectively. In addition, each participant submitted an average of 10 (SD 11) surveys during the same period, with a mean response rate of 36% across all surveys (SD 17%; median 41%). After initial processing of GPS and accelerometer data, we also found that participants spent an average of 14.6 (SD 7.5) hours per day at home and 1.6 (SD 1.6) hours per day on trips. We also recorded an average of 1046 (SD 1029) steps per day. Conclusions: In this study, smartphone-based digital phenotyping was used to collect intensive longitudinal data on lifestyle and behavioral factors in 2 well-established prospective cohorts. Our assessment of adherence to smartphone-based data collection protocols over 1 year suggests that adherence in our study was either higher or similar to most previous studies with shorter follow-up periods and smaller sample sizes. Our efforts resulted in a large dataset on health behaviors that can be linked to spatial datasets to examine environmental and behavioral drivers of chronic disease. UR - https://publichealth.jmir.org/2024/1/e55170 UR - http://dx.doi.org/10.2196/55170 UR - http://www.ncbi.nlm.nih.gov/pubmed/39392682 ID - info:doi/10.2196/55170 ER - TY - JOUR AU - Wakeman, Michael AU - Tesfaye, Lydia AU - Gregory, Tim AU - Leahy, Erin AU - Kendrick, Brandon AU - El-Toukhy, Sherine PY - 2024/10/11 TI - Perceptions of the Use of Mobile Technologies for Smoking Cessation: Focus Group Study With Individuals of Low Socioeconomic Status Who Smoke JO - JMIR Form Res SP - e58221 VL - 8 KW - smoking cessation KW - social determinants of health KW - mhealth KW - apps KW - qualitative research KW - young adults N2 - Background: The use of mobile technologies to deliver behavioral health interventions, including smoking cessation support, has grown. Users? perceptions are important determinants of the adoption and use of new technologies. However, little is known about users? perceptions of mobile technologies as smoking cessation aids, particularly among disadvantaged individuals who smoke. Objective: This study aimed to examine the acceptance of mobile technologies for smoking cessation among young adults with low socioeconomic status who smoke. Methods: In total, 38 current cigarette smokers, 18 to 29 years old, who wanted to quit and did not have a 4-year college degree nor were enrolled in a 4-year college, participated in 12 semistructured digital focus groups. The moderation guide was guided by the Unified Theory of Acceptance and Use of Technology. Discussions were audio recorded, transcribed verbatim, and coded for the Unified Theory of Acceptance and Use of Technology constructs (ie, effort expectancy, facilitating conditions, performance expectancy, and social influence), sentiment (ie, negative, neutral, and positive), and purpose of using mobile technologies (ie, lifestyle and health management and smoking cessation) following a deductive thematic analysis approach. Results: Participants had positive experiences using mobile technologies for lifestyle and health management, primarily for fitness and dietary purposes. Salient themes were facilitating conditions of use (44/80, 55%), with prior experiences and costs subthemes, followed by perceived usefulness of mobile technologies in helping users attain health goals (22/80, 27.50%), which were generally positive. Ease of use (11/80, 13.75%) and social influences (3/80, 3.75%) were minimally discussed. Conversely, participants had limited awareness of smoking cessation uses of mobile technologies, which was the primary barrier under facilitating conditions discussed (33/51, 64.70%). Participants expressed skepticism about the usefulness of mobile technologies in helping them quit smoking (14/51, 27.45%). Effort expectancy was not discussed, given participants? limited prior use. Social influences on mobile technology use for smoking cessation were minimally discussed (4/51, 7.84%). Conclusions: The use of mobile technologies for smoking cessation was unknown to young adults with low socioeconomic status who smoke. To reduce cigarette smoking and associated health disparities, increasing awareness and use of evidence-based mobile-based smoking cessation interventions are needed. Smoking cessation interventions should incorporate features perceived as useful and easy to use to capitalize on positive user experiences and the acceptability of mobile technologies for lifestyle and health management. UR - https://formative.jmir.org/2024/1/e58221 UR - http://dx.doi.org/10.2196/58221 UR - http://www.ncbi.nlm.nih.gov/pubmed/39392684 ID - info:doi/10.2196/58221 ER - TY - JOUR AU - Zych, Marek Maciej AU - Bond, Raymond AU - Mulvenna, Maurice AU - Martinez Carracedo, Jorge AU - Bai, Lu AU - Leigh, Simon PY - 2024/10/10 TI - Quality Assessment of Digital Health Apps: Umbrella Review JO - J Med Internet Res SP - e58616 VL - 26 KW - mHealth assessment KW - digital health KW - quality assessment KW - health apps quality KW - assessment criteria KW - evaluation criteria KW - health apps criteria KW - assessment KW - digital health app KW - app KW - umbrella review KW - risk KW - mobile phone KW - frameworks N2 - Background: With an increasing number of digital health apps available in app stores, it is important to assess these technologies reliably regarding their quality. This is done to mitigate the risks associated with their use. There are many different guidelines, methods, and metrics available to assess digital health apps with regard to their quality. Objective: This study aimed to give a holistic summary of the current methods and ?condition agnostic? frameworks that are broadly applicable for the quality assessment of all digital health apps. Methods: A systematic search of literature was conducted on 4 databases: Scopus, PubMed, ACM Digital Library, and IEEE Xplore. We followed the PICOS (Population, Patient, or Problem; Intervention; Comparison; Outcomes; and Study Design) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodologies when conducting this umbrella review. The search was conducted on January 26, 2024, for review articles published between 2018 and 2023. We identified 4781 candidate papers for inclusion; after title and abstract screening, 39 remained. After full-text analysis, we included 15 review articles in the full review. Results: Of the 15 review articles, scoping reviews were the most common (n=6, 40%), followed by systematic reviews (n=4, 27%), narrative reviews (n=4, 27%), and a rapid review (n=1, 7%). A total of 4 (27%) review articles proposed assessment criteria for digital health apps. ?Data privacy and/or security? was the most mentioned criterion (n=13, 87%) and ?Cost? was the least mentioned criterion (n=1, 7%) for the assessment of digital health apps. The Mobile App Rating Scale was the most frequently used framework for quality assessment of digital health apps. Conclusions: There is a lack of unity or consolidation across identified frameworks, as most do not meet all the identified criteria from the reviewed articles. Safety concerns associated with the use of digital health apps may be mitigated with the use of quality frameworks. UR - https://www.jmir.org/2024/1/e58616 UR - http://dx.doi.org/10.2196/58616 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58616 ER - TY - JOUR AU - Hong, Minji AU - Rajaguru, Vasuki AU - Kim, KyungYi AU - Jang, Suk-Yong AU - Lee, Gyu Sang PY - 2024/10/10 TI - Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study JO - J Med Internet Res SP - e53146 VL - 26 KW - menstruation KW - dysmenorrhea KW - period tracker app, menstrual cycle management, health care application, millennial KW - Gen Z KW - mobile phone N2 - Background: Menstruation is a physical symptom that occurs in women of reproductive age. It has a significant impact on the daily life and health of women when their academic and social activities are most active. Since many women experience difficulties in daily life because of premenstrual syndrome and dysmenorrhea, it is important to identify, prepare for, and manage the menstrual cycle in advance. Objective: This study aimed to investigate the relationship between menstruation-related experiences and the use of mobile-based period tracker apps by millennial and generation Z (gen Z) individuals. The objectives of this study are to investigate (1) menstrual cycle management, (2) factors affecting app usage (3) factors affecting cycle management, and (4) motivators and barriers to using period tracker apps, in millennial and gen Z women. Methods: A mixed methods design was used for this study. The participants were young women aged 20-39 years and recruited via the Ovey application. Data were collected through surveys and focus group interviews. The survey was conducted among 700 women, and 8 of them participated in the focus group interviews. Results: In total, 431 (62.3%) participants used period tracker apps primarily to predict their next menstrual cycle. Factors affecting app usage included childbirth experience (odds ratio [OR] 0.475, P<.05), number of dysmenorrhea symptoms (OR 1.136, P<.05), and cycle management level (OR 2.279, P<.001). Additionally, education level (OR 1.122, P<.05 [university level compared high school level]) and the number of dysmenorrhea symptoms (OR 1.024, P<.05) showed a positive association with the cycle management level. However, childbirth experience (OR 0.902, P<.05) and period irregularity (OR 0.929, P<.001) were negatively associated with the cycle management level. Conclusions: Period tracker apps are becoming the new normal among millennials and gen Z individuals for managing their menstrual cycles. The use of a period tracker app empowers women by helping them gain a better understanding of their bodies, ultimately enhancing their social, academic, and health-related lives. Improving the accuracy and literacy of the app is an ongoing task for period-tracking apps, and it is important to provide added value tailored to users? needs. Therefore, the findings of this study should be considered when designing or upgrading period tracker apps to facilitate the adoption of digital technology among young women, thereby promoting their overall well-being and reproductive health. UR - https://www.jmir.org/2024/1/e53146 UR - http://dx.doi.org/10.2196/53146 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53146 ER - TY - JOUR AU - Polivka, Barbara AU - Krueger, Kathryn AU - Bimbi, Olivia AU - Huntington-Moskos, Luz AU - Nyenhuis, Sharmilee AU - Cramer, Emily AU - Eldeirawi, Kamal PY - 2024/10/10 TI - Integrating Real-Time Air Quality Monitoring, Ecological Momentary Assessment, and Spirometry to Evaluate Asthma Symptoms: Usability Study JO - JMIR Form Res SP - e60147 VL - 8 KW - indoor air quality KW - asthma KW - real-time assessment KW - EMA KW - ecological momentary assessment KW - mobile phone KW - monitoring KW - air quality KW - real time KW - spirometry KW - acceptability KW - usability KW - residential toxins KW - volatile organic compounds KW - VOC KW - adult KW - female KW - women KW - college student N2 - Background: Individuals are exposed to a variety of indoor residential toxins including volatile organic compounds and particulates. In adults with asthma, such exposures are associated with asthma symptoms, asthma exacerbations, and decreased lung function. However, data on these exposures and asthma-related outcomes are generally collected at different times and not in real time. The integration of multiple platforms to collect real-time data on environmental exposure, asthma symptoms, and lung function has rarely been explored. Objective: This paper describes how adults with asthma perceive the acceptability and usability of three integrated devices: (1) residential indoor air quality monitor, (2) ecological momentary assessment (EMA) surveys delivered via a smartphone app, and (3) home spirometry, over 14 days. Methods: Participants (N=40) with uncontrolled asthma were mailed the Awair Omni indoor air quality monitor, ZEPHYRx home spirometer, and detailed instructions required for the in-home monitoring. The air quality monitor, spirometer, and EMA app were set up and tested during a videoconference or phone orientation with a research team member. Midway through the 14-day data collection period, participants completed an interview about the acceptability of the study devices or apps, instructional materials provided, and the setup process. At the end of the 14-day data collection period, participants completed a modified System Usability Scale. A random sample of 20 participants also completed a phone interview regarding the acceptability of the study and the impact of the study on their asthma. Results: Participants ranged in age from 26 to 77 (mean 45, SD 13.5) years and were primarily female (n=36, 90%), White (n=26, 67%), college graduates (n=25, 66%), and residing in a single-family home (n=30, 75%). Most indicated that the air quality monitor (n=23, 58%), the EMA (n=20, 50%), and the spirometer (n=17, 43%) were easy to set up and use. Challenges with the EMA included repetitive surveys, surveys arriving during the night, and technical issues. While the home spirometer was identified as a plausible means to evaluate lung function in real time, the interpretation of the readings was unclear, and several participants reported side effects from home spirometer use. Overall, the acceptability of the study and the System Usability Scale scores were high. Conclusions: The study devices were highly acceptable and usable. Participant feedback was instrumental in identifying technical challenges that should be addressed in future studies. UR - https://formative.jmir.org/2024/1/e60147 UR - http://dx.doi.org/10.2196/60147 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60147 ER - TY - JOUR AU - Oluokun, Oluwatosin Emmanuel AU - Adedoyin, Fatai Festus AU - Dogan, Huseyin AU - Jiang, Nan PY - 2024/10/9 TI - Digital Interventions for Managing Medication and Health Care Service Delivery in West Africa: Systematic Review JO - J Med Internet Res SP - e44294 VL - 26 KW - digital interventions KW - medications delivery KW - phone-based intervention KW - tele and e-based intervention KW - West Africa KW - management, technology KW - intervention KW - medication KW - tool KW - smartphone N2 - Background: As a result of the recent advancements in technology, the incorporation of digital interventions into the health care system has gained a lot of attention and adoption globally. However, these interventions have not been fully adopted, thereby limiting their impact on health care delivery in West Africa. Objective: This review primarily aims at evaluating the current digital interventions for medication and health care delivery in West Africa. Its secondary aim is to assess the impacts of digital interventions in managing medication and health care service delivery with the intent of providing vital recommendations that would contribute to an excellent adoption of digital intervention tools in the health care space in West Africa. Methods: In line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a comprehensive search through various databases yielded 529 results. After a rigorous screening, 29 articles that provided information on 3 broad digital health intervention tools were found eligible for this review. Results: Out of 29 studies, 16 (55%) studies examined phone-based interventions, 9 (31%) studies focused on tele- and e-based interventions, and 4 (14%) studies evaluated digital interventions. These interventions were used for diverse purposes, some of which are monitoring adverse drug reactions, general health, sexual and reproductive health, and training of health care practitioners. The phone-based intervention appears to be the most known and impactful of all the interventions, followed by tele- and e-based, while digital interventions were scarcely used. Conclusions: Digital interventions have had a considerable level of impact on medication and health care delivery across West Africa. However, the overall impact is limited. Therefore, strategies must be developed to address the challenges limiting the use of digital intervention tools so that these tools can be fully incorporated into the health care space in West Africa. UR - https://www.jmir.org/2024/1/e44294 UR - http://dx.doi.org/10.2196/44294 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/44294 ER - TY - JOUR AU - Bushey, Erica AU - Wu, Yin AU - Wright, Alexander AU - Pescatello, Linda PY - 2024/10/9 TI - The Influence of Physical Activity and Diet Mobile Apps on Cardiovascular Disease Risk Factors: Meta-Review JO - J Med Internet Res SP - e51321 VL - 26 KW - physical activity KW - diet KW - mobile applications KW - obesity KW - hypertension KW - dyslipidemia KW - diabetes KW - mobile phone N2 - Background: The literature on whether physical activity (PA) and PA and diet (PA+Diet) mobile apps improve cardiovascular disease (CVD) risk factors is promising. Objective: The aim of this meta-review is to provide an evidence synthesis of systematic reviews and meta-analyses examining the influence of PA and PA+Diet apps on the major CVD risk factors. Methods: We systematically searched 5 databases until January 12, 2022. Included systematic reviews and meta-analyses (1) reported the CVD risk factor outcomes of BMI, waist circumference, body weight, blood pressure (BP), hemoglobin A1c (HbA1c), fasting blood glucose, blood lipids, or PA; (2) enrolled healthy participants ?18 years who may or may not have the metabolic syndrome, diabetes mellitus, or preexisting CVD risk factors; (3) reviewed PA or PA+Diet app interventions integrating behavioral change techniques (BCT) to deliver their information; and (4) had a nonapp control. Results: In total, 17 reviews (9 systematic reviews and 8 meta-analyses) published between 2012 and 2021 qualified. Participants were middle-aged, mostly women ranging in number from 10 to 62,219. Interventions lasted from 1 to 24 months, with the most common behavioral strategies being personalized feedback (n=8), self-monitoring (n=7), and goal setting (n=5). Of the PA app systematic reviews (N=4), the following CVD risk factors improved: body weight and BMI (n=2, 50%), BP (n=1, 25%), HbA1c (n=1, 25%), and blood lipids (n=1, 25%) decreased, while PA (n=4, 100%) increased. Of the PA+Diet app systematic reviews (N=5), the following CVD risk factors improved: body weight and BMI (n=3, 60%), BP (n=1, 20%), and HbA1c (n=3, 60%) decreased, while PA (n=3, 60%) increased. Of the PA app meta-analyses (N=1), the following CVD risk factors improved: body weight decreased (?0.73 kg, 95% CI ?1.45 to ?0.01; P=.05) and PA increased by 25 minutes/week (95% CI 0.58-1.68; P<.001), while BMI (?0.09 kg/m2, 95% CI ?0.29 to 0.10; P=.35) and waist circumference (?1.92 cm, 95% CI ?3.94 to 0.09; P=.06) tended to decrease. Of the PA+Diet app meta-analyses (n=4), the following CVD risk factors improved: body weight (n=4, 100%; from ?1.79 kg 95% CI ?3.17 to ?0.41; P=.01 to ?2.80 kg 95% CI ?4.54 to ?1.06, P=.002), BMI (n=1, 25%; ?0.64 kg/m2, 95% CI ?1.09 to ?0.18; P=.01), waist circumference (n=1, 25%; ?2.46 cm, 95% CI ?4.56 to ?0.36; P=.02), systolic/diastolic BP (n=1, 25%; ?4.22/?2.87 mm Hg, 95% CI ?6.54 to ?1.91/ ?4.44 to ?1.29; P<.01), and HbA1c (n=1, 25%; ?0.43%, 95% CI ?0.68 to ?0.19; P<.001) decreased. Conclusions: PA and PA+Diet apps appear to be most consistent in improving PA and anthropometric measures with favorable but less consistent effects on other CVD risk factors. Future studies are needed that directly compare and better quantify the effects of PA and PA+Diet apps on CVD risk factors. Trial Registration: PROSPERO CRD42023392359; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392359 UR - https://www.jmir.org/2024/1/e51321 UR - http://dx.doi.org/10.2196/51321 UR - http://www.ncbi.nlm.nih.gov/pubmed/39382958 ID - info:doi/10.2196/51321 ER - TY - JOUR AU - Waranski, Melina AU - Garbsch, René AU - Kotewitsch, Mona AU - Teschler, Marc AU - Schmitz, Boris AU - Mooren, C. Frank PY - 2024/10/8 TI - A Behavioral Change?Based Mobile Intervention for Promoting Regular Physical Activity in Medical Rehabilitation Maintenance of Patients With Coronary Artery Disease: Controlled Trial JO - J Med Internet Res SP - e56480 VL - 26 KW - rehabilitation KW - eHealth KW - mobile health KW - mHealth KW - telemedicine KW - cardiovascular disease KW - behavioral change KW - mobile phone N2 - Background: Cardiac rehabilitation is known to reduce coronary artery disease (CAD) severity and symptoms, but adoption of a healthy postrehabilitation lifestyle remains challenging. Innovative eHealth solutions could help, but behavioral change?based eHealth maintenance programs for patients with CAD are scarce. RehaPlus+ aims to improve postrehabilitation outcomes with a personalized eHealth intervention built on behavioral change concepts emphasizing healthy lifestyle changes, especially regular physical activity (PA). Objective: This study aims to evaluate the effectiveness of the personalized eHealth program RehaPlus+ for promoting regular PA against usual care. Methods: A total of 169 patients with CAD who had undergone stent implantation or bypass surgery were recruited after completing center-based phase II rehabilitation. They were then divided, without blinding, into 2 groups using a quasi-experimental approach: a case manager?assisted 24-week eHealth program (RehaPlus+; n=84) and a conventional physician-assisted outpatient program (usual care; n=85). The study was designed as a noninferiority trial. RehaPlus+ participants received motivational messages twice weekly for 6 months, and the usual care group engaged in a 6-month outpatient program (twenty-four 90-minute strength and endurance training sessions). The primary outcomes, evaluated using the self-assessed Bewegungs- und Sportaktivität questionnaire, were regular PA (?150 min/wk) and weekly activities of daily living (ADLs) 6 months after rehabilitation. Secondary outcomes involved PA during work and floors climbed weekly (measured by Bewegungs- und Sportaktivität questionnaire), psychological well-being (assessed by the 5-item World Health Organization Well-Being Index), cardiac self-efficacy, health-related quality of life (measured by the 36-Item Short Form Survey), and work ability (using the Work Ability Index). Results: Data of 105 patients (RehaPlus+: n=44, 41.9%; usual care: n=61, 58.1%; male patients: n=80, 76.2%; female patients: n=25, 23.8%; mean age 56.0, SD 7.3 years) were available at the 6-month follow-up. At 6 months after discharge from phase II cardiac rehabilitation, the RehaPlus+ group exhibited 182 (SD 208) minutes per week of PA and the usual care group exhibited 119 (SD 175) minutes per week of PA (P=.15), with no interaction effect (P=.12). The RehaPlus+ group showed an ADL level of 443 (SD 538) minutes per week compared to the usual care group with 308 (SD 412) minutes per week at the 6-month follow-up, with no interaction effect (P=.84). The differences observed in PA and ADL levels between the RehaPlus+ and usual care groups were within the predefined 1-sided noninferiority margin, indicating that the RehaPlus+ intervention is not inferior to usual care based on these outcomes. There were no differences between the groups for all secondary outcomes (P>.05). Conclusions: RehaPlus+ is not inferior to the usual care program, as both groups improved PA and ADLs to a similar extent. These findings emphasize the potential of eHealth interventions to assist in maintaining healthy lifestyles after rehabilitation. Trial Registration: ClinicalTrials.gov NCT06162793; https://clinicaltrials.gov/study/NCT06162793 UR - https://www.jmir.org/2024/1/e56480 UR - http://dx.doi.org/10.2196/56480 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56480 ER - TY - JOUR AU - Aguilera, Adrian AU - Arévalo Avalos, Marvyn AU - Xu, Jing AU - Chakraborty, Bibhas AU - Figueroa, Caroline AU - Garcia, Faviola AU - Rosales, Karina AU - Hernandez-Ramos, Rosa AU - Karr, Chris AU - Williams, Joseph AU - Ochoa-Frongia, Lisa AU - Sarkar, Urmimala AU - Yom-Tov, Elad AU - Lyles, Courtney PY - 2024/10/8 TI - Effectiveness of a Digital Health Intervention Leveraging Reinforcement Learning: Results From the Diabetes and Mental Health Adaptive Notification Tracking and Evaluation (DIAMANTE) Randomized Clinical Trial JO - J Med Internet Res SP - e60834 VL - 26 KW - digital health KW - physical activity KW - mobile phone KW - text messages KW - SMS KW - steps KW - walking KW - diabetes KW - depression KW - reinforcement learning KW - exercise KW - machine learning N2 - Background: Digital and mobile health interventions using personalization via reinforcement learning algorithms have the potential to reach large number of people to support physical activity and help manage diabetes and depression in daily life. Objective: The Diabetes and Mental Health Adaptive Notification and Tracking Evaluation (DIAMANTE) study tested whether a digital physical activity intervention using personalized text messaging via reinforcement learning algorithms could increase step counts in a diverse, multilingual sample of people with diabetes and depression symptoms. Methods: From January 2020 to June 2022, participants were recruited from 4 San Francisco, California?based public primary care clinics and through web-based platforms to participate in the 24-week randomized controlled trial. Eligibility criteria included English or Spanish language preference and a documented diagnosis of diabetes and elevated depression symptoms. The trial had 3 arms: a Control group receiving a weekly mood monitoring message, a Random messaging group receiving randomly selected feedback and motivational text messages daily, and an Adaptive messaging group receiving text messages selected by a reinforcement learning algorithm daily. Randomization was performed with a 1:1:1 allocation. The primary outcome, changes in daily step counts, was passively collected via a mobile app. The primary analysis assessed changes in daily step count using a linear mixed-effects model. An a priori subanalysis compared the primary step count outcome within recruitment samples. Results: In total, 168 participants were analyzed, including those with 24% (40/168) Spanish language preference and 37.5% (63/168) from clinic-based recruitment. The results of the linear mixed-effects model indicated that participants in the Adaptive arm cumulatively gained an average of 3.6 steps each day (95% CI 2.45-4.78; P<.001) over the 24-week intervention (average of 608 total steps), whereas both the Control and Random arm participants had significantly decreased rates of change. Postintervention estimates suggest that participants in the Adaptive messaging arm showed a significant step count increase of 19% (606/3197; P<.001), in contrast to 1.6% (59/3698) and 3.9% (136/3480) step count increase in the Random and Control arms, respectively. Intervention effectiveness differences were observed between participants recruited from the San Francisco clinics and those recruited via web-based platforms, with the significant step count trend persisting across both samples for participants in the Adaptive group. Conclusions: Our study supports the use of reinforcement learning algorithms for personalizing text messaging interventions to increase physical activity in a diverse sample of people with diabetes and depression. It is the first to test this approach in a large, diverse, and multilingual sample. Trial Registration: ClinicalTrials.gov NCT03490253; https://clinicaltrials.gov/study/NCT03490253 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-034723 UR - https://www.jmir.org/2024/1/e60834 UR - http://dx.doi.org/10.2196/60834 UR - http://www.ncbi.nlm.nih.gov/pubmed/39378080 ID - info:doi/10.2196/60834 ER - TY - JOUR AU - Fernandez-Lazaro, I. Cesar AU - Santamaría, Gema AU - Fernandez Milano, Annika AU - Martin-Vergel, I. Maria AU - Fernandez-Lazaro, Diego PY - 2024/10/4 TI - Nutrition-Related Mobile Apps in the Spanish App Stores: Quality and Content Analysis JO - JMIR Mhealth Uhealth SP - e52424 VL - 12 KW - mobile apps KW - mHealth KW - mobile health KW - app KW - nutritional KW - nutrition KW - dietary KW - eating KW - diet KW - food KW - lifestyle KW - Spain KW - Spanish KW - chronic diseases KW - chronic KW - review KW - quality KW - MARS KW - Mobile App Rating Scale KW - uMARS KW - user version of the Mobile App Rating Scale KW - assessment KW - mobile phone N2 - Background: Mobile apps represent accessible and cost-effective tools to improve nutrition and prevent chronic diseases. However, most of these apps have been characterized as having limited functionality, raising concerns about their effectiveness, acceptability, and efficacy. Objective: The aims of the study were to assess the quality of popular nutrition-related app platforms in Spain and to describe their characteristics and functionalities. Methods: We screened apps providing information on dietary advice, food advice, and nutritional content in the Apple App Store and Google Play Store in Spain from March 2 to March 16, 2024. Apps with a star rating of ?4 (of 5 stars), those available in Spanish, those that were free of charge, those last updated after January 2022, those with >500 reviews, and those with >500,000 downloads were included. The quality of apps was assessed using the user version of the Mobile App Rating Scale (uMARS). General characteristics and nutritional, health, and market-related functionalities of the nutrition-related apps were described. Correlations among total and uMARS sections, star ratings, and number of reviews and downloads were evaluated. Results: Among the 1460 apps identified in the search, 42 apps met the criteria. The majority of these (n=20, 48%) aimed at recording and analyzing food intake, followed by those providing nutritional plans or diets (n=9, 21%), advising on healthy habits (n=7, 17%), and offering recipes (n=6, 14%). The most prevalent nutritional functionalities offered were recording and monitoring body measurements (n=30, 71%), food tracking (n=26, 62%), and dietary analysis (n=25, 60%), whereas nutrition education was less common (n=16, 38%). Among market-related functionalities, advertisements were the most common among the study apps (n=30, 71%), followed by the option of sharing on social media (n=29, 69%) and customizable reminders (n=26, 62%). Sharing the recorded information in the app with health professionals was infrequent (n=1, 2%). The mean (SD) total uMARS score (maximum 5 points) was 3.78 (0.35), while the mean (SD) uMARS scores for functionality, aesthetics, engagement, and information were 4.21 (0.38), 3.94 (0.54), 3.51 (0.46), and 3.48 (0.44), respectively. Lower mean scores were observed for the subjective quality (mean 2.65, SD 0.56) and perceived impact (mean 3.06, SD 0.67). Moderate to strong positive significant correlations were mostly observed between total uMARS and section-specific uMARS scores, while the correlations between the uMARS section scores were mostly moderate positive. Total uMARS scores were very weakly correlated with user rating, number of reviews, and number of downloads. Conclusions: The quality of popular nutrition-related app platforms in Spain was acceptable, with observed remarkable differences between sections. The majority of the apps were appealing due to their user-friendly interfaces. Only a few apps, however, provided dietary structure analysis or nutritional education. Further research is needed to assess the long-term impact of these apps on users. UR - https://mhealth.jmir.org/2024/1/e52424 UR - http://dx.doi.org/10.2196/52424 ID - info:doi/10.2196/52424 ER - TY - JOUR AU - Zhang, Chenchen AU - Guo, Xing AU - Zhu, Rui AU - Hou, Wenjie AU - Wang, Lingmeng AU - Wang, Fuzhi AU - Zhang, Li AU - Luo, Dan PY - 2024/10/3 TI - Mobile Apps for Vaccination Services: Content Analysis and Quality Assessment JO - Online J Public Health Inform SP - e50364 VL - 16 KW - vaccination service app KW - Mobile Application Rating Scale KW - MARS KW - quality evaluation KW - app KW - apps KW - application KW - applications KW - quality KW - evaluation KW - rating KW - mHealth KW - mobile health KW - service KW - services KW - service content KW - user evaluation KW - vaccine KW - vaccines KW - public health N2 - Background: Vaccination services are increasingly in demand by the public, and mobile apps are an effective tool to meet that demand. However, the characteristics and quality of these apps are unknown. Objective: Commonly used vaccination service apps on the market were surveyed with regard to quality, service content, and user experience to evaluate and guide users. Methods: The Qimai Data mobile app data analytics platform was used to search for common vaccination service apps by keyword, and the WeChat and Alipay platforms were searched for apps. The apps included in the study were independently evaluated by two reviewers using the Mobile Application Rating Scale, and the service content and user experience of the apps were analyzed. The intragroup correlation coefficient between raters was used to measure interrater reliability. Results: In the app stores of the four major Android platforms and the iOS app store, 1092 and 207 apps were found, respectively; 189 WeChat applets and 30 Alipay applets were also found. A total of 29 apps was ultimately included in this study according to the inclusion criteria, including 21 independent apps, 4 WeChat applets, and 4 Alipay applets. Significant differences were found between independent apps and applets in terms of the quality score (t449.57=?5.301; P<.001) and the subjective quality score (z=?4.753; P<.001). No significant differences were found between iOS and Android platforms in terms of the quality score (t1404=?2.55; P=.80) and the subjective quality score (z=?0.137; P=.89). There was good intragroup consistency among the raters. Conclusions: In this study, independent apps and nonindependent apps that rely on social and payment platforms for implementation were included in the vaccination services category. The overall quality of these apps was acceptable. Nonindependent running apps were found to have slightly lower scores and showed room for improvement, and scores for the participatory apps were found to be generally low overall. UR - https://ojphi.jmir.org/2024/1/e50364 UR - http://dx.doi.org/10.2196/50364 UR - http://www.ncbi.nlm.nih.gov/pubmed/39361418 ID - info:doi/10.2196/50364 ER - TY - JOUR AU - MacNeil, Nora AU - Price, Victoria AU - Pike, Meghan PY - 2024/10/3 TI - The WeThrive App and Its Impact on Adolescents Who Menstruate: Qualitative Study JO - JMIR Form Res SP - e57936 VL - 8 KW - heavy menstrual bleeding KW - adolescents KW - menorrhagia KW - quality of life KW - mobile applications KW - mobile health application KW - mobile phone N2 - Background: Heavy menstrual bleeding (HMB) affects up to 37% of adolescents. Without recognition, HMB can lead to other medical conditions resulting in diminished health-related quality of life. WeThrive, a new mobile health (mHealth) app, implements the pictorial bleeding assessment chart to identify HMB, and the adolescent Menstrual Bleeding Questionnaire to measure the effects of HMB on adolescents? health-related quality of life. If HMB is identified, WeThrive will connect users to local clinics for further assessment of their menstrual bleeding with a health care provider. Objective: This study aimed to describe adolescents? experiences using WeThrive app. Methods: This qualitative study was approved by the local Research Ethics Board in Halifax, Nova Scotia, and informed consent was provided by all participants. Individual semistructured interviews were held via videoconference with adolescents younger than 18 years, who had at least 1 menstrual period and had used WeThrive at least once. Interview transcripts were thematically analyzed by 2 investigators (MP and NMN) independently, and the ? statistic was calculated to determine the strength of correlation in themes. Results: Five adolescents (mean age 15.5, range 13-18 years), participated in the interviews. All participants stated that WeThrive helps them better understand their menstrual periods by predicting period onset, recognizing menstrual symptoms, and identifying HMB. Four themes were identified: (1) the importance of visual features and usability, (2) newly obtained knowledge using WeThrive, (3) feature use depends on menstrual health, and (4) trustworthiness. There was substantial agreement on the identified themes (?=0.73). Conclusions: WeThrive is visually appealing, and trustworthy, and helps users better understand their menstrual periods, including identifying HMB. By identifying HMB early, WeThrive has the potential to improve the recognition of bleeding disorders and iron deficiency in adolescents. WeThrive is a useful tool to help adolescents better understand their menstrual periods. UR - https://formative.jmir.org/2024/1/e57936 UR - http://dx.doi.org/10.2196/57936 UR - http://www.ncbi.nlm.nih.gov/pubmed/39361373 ID - info:doi/10.2196/57936 ER - TY - JOUR AU - Ong, E. Laura AU - Speicher, Sarah AU - Villasenor, Diana AU - Kim, Jamie AU - Jacobs, Adam AU - Macia, S. Kathryn AU - Cloitre, Marylene PY - 2024/10/2 TI - Brief Peer-Supported Web-Based Skills Training in Affective and Interpersonal Regulation (BPS webSTAIR) for Trauma-Exposed Veterans in the Community: Randomized Controlled Trial JO - J Med Internet Res SP - e52130 VL - 26 KW - posttraumatic stress disorder KW - PTSD KW - depression KW - depressive symptoms KW - veterans KW - veterans health KW - mHealth KW - mobile health KW - peer support KW - peer-to-peer KW - transdiagnostic KW - mental health KW - mental health services KW - community KW - emotion regulation KW - interpersonal regulation KW - mHealth program N2 - Background: Peer-supported mobile health (mHealth) programs hold the promise of providing a low-burden approach to increasing access to care and improving mental health. While peer support has been shown to improve engagement in care, there is limited investigation into the impact of peers on symptom outcomes. Trauma-exposed populations frequently endure co-occurring posttraumatic stress and depressive symptoms as well as difficulties in day-to-day functioning. This study evaluated the potential benefits of a peer-supported, transdiagnostic mHealth program on symptom outcomes and functioning. Objective: This randomized controlled trial tested the effectiveness of Brief Peer-Supported (BPS) web-based Skills Training in Affective and Interpersonal Regulation (webSTAIR), a 6-module transdiagnostic digital program derived from Skills Training in Affective and Interpersonal Regulation and compared to waitlist control in a community sample of veterans who screened positive for either posttraumatic stress disorder (PTSD) or depression. Methods: A total of 178 veterans were enrolled in this study using a 2:1 randomization scheme with 117 assigned to BPS webSTAIR and 61 assigned to waitlist control. PTSD and depressive symptoms as well as emotion regulation and psychosocial functioning were assessed at pretreatment, posttreatment, and 8-week follow-up time points. Mixed-effects models were used to assess change in outcome measures across time points. Exploratory analyses were conducted to determine whether the type and number of peer interactions influenced outcomes. Results: Significant interaction effects were observed for all outcomes such that participants randomized to BPS webSTAIR reported significantly greater improvement at the posttreatment time point compared to waitlist control with moderate effect sizes for PTSD (d=0.48), depression (d=0.64), emotion regulation (d=0.61), and functional impairment (d=0.61); gains were maintained at 8-week follow-up. An initial cohort of participants who were required to engage with a peer coach to progress through the modules interacted more frequently with peers but completed fewer modules compared to a later cohort for whom peer engagement was optional. Overall, those who completed more modules reported greater improvement in all outcomes. Conclusions: BPS webSTAIR was effective in improving PTSD and depression symptoms, emotion regulation, and psychosocial functioning in community veterans. Peer-supported, transdiagnostic mHealth programs may be a particularly efficient, effective, and low-burden approach to improving mental health among trauma-exposed populations. Investigation of peer-supported programs among other populations is necessary to evaluate the generalizability of the findings. Analyses comparing peer support that was required versus optional indicated that some veterans may not need or want peer support. Future research should evaluate how best to deliver peer support and for whom it is most beneficial. If successful, peer-supported tech programs may increase the Veteran Affairs workforce as well as improve veteran mental health services and outcomes. Trial Registration: ClinicalTrials.gov NCT04286165; https://clinicaltrials.gov/study/NCT04286165 UR - https://www.jmir.org/2024/1/e52130 UR - http://dx.doi.org/10.2196/52130 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012722 ID - info:doi/10.2196/52130 ER - TY - JOUR AU - Bustamante Perez, Adriana Luz AU - Romo, Lucia AU - Zerhouni, Oulmann PY - 2024/10/2 TI - Feasibility and Engagement of a Mobile App Preparation Program (Kwit) for Smoking Cessation in an Ecological Context: Quantitative Study JO - JMIR Mhealth Uhealth SP - e51025 VL - 12 KW - smoking cessation KW - digital intervention KW - behavior change techniques KW - attrition rate KW - mobile app KW - preparation program KW - motivation KW - quit smoking KW - ecological settings KW - mobile phone N2 - Background: Mobile health apps can facilitate access to effective treatment and therapeutic information services. However, the real-world effectiveness of mobile apps for smoking cessation and their potential impact in everyday settings remain unclear. Objective: In an ecological context, this study aimed to estimate the engagement rate of a mobile app?based smoking cessation preparation program and its potential impact on users? willingness, ability, and readiness to quit smoking. Methods: A total of 2331 ?organic users? (ie, users who discover and install a mobile app on their own, without any prompts) chose 1 of 2 program versions of the mobile app (Kwit): the basic version or the premium version. Both versions were identical in design, with 4 more evidence-based content items and strategies in the premium version. Outcomes were analyzed based on automated data registered in the app (engagement rate, motivation to quit, motivation type, motivation levels, and satisfaction level). Mann-Whitney and ?2 tests were used to compare the results of both groups. Results: As expected, in the ecological context, a high dropout rate was observed at different moments. A significant difference was observed between the 2 versions (n=2331; ?21=5.4; P=.02), with a proportionally higher engagement rate in the premium version (premium=4.7% vs basic=2%). Likewise, differences were also observed between the 2 groups in terms of reasons to quit (n=2331; ?24=19; P?.001; V=0.08), motivation type (n=2331; ?27=14.7; P=.04), and motivation level. Users of the app?s premium version more frequently reported ?well-being? (23.3% vs 17.9%) and ?planning a pregnancy? (7.4% vs 4.4%) as their primary reasons for quitting smoking compared to those with the basic version. Moreover, they reported being more likely to be driven in the smoking cessation process by intrinsic motivation (premium=28% vs basic=20.4%), as well as feeling significantly more willing (z score=156,055; P?.001; Cohen d=0.15), able (z score=172,905; P=.04; Cohen d=0.09), and ready (z score=166,390; P=.005; Cohen d=0.12) to stop smoking than users who had the basic version before completion of the preparation program. Among participants who finished each version of the program (premium: 9/189, 4.8%; basic: 47/2142, 2.19%), significant improvements in motivation levels were observed in both groups, although in different areas for each group (willingness levels for the premium group and ability for the basic group). Conclusions: These results suggest that even in ecological contexts where engagement rates are meager, the Kwit preparation program can address ambivalence by increasing willingness to change, self-confidence, and readiness to quit among its users, especially those who feel less able to do so. Further development and evaluations are needed to better understand determinants for regular mobile health apps. UR - https://mhealth.jmir.org/2024/1/e51025 UR - http://dx.doi.org/10.2196/51025 UR - http://www.ncbi.nlm.nih.gov/pubmed/39357053 ID - info:doi/10.2196/51025 ER - TY - JOUR AU - Wang, Qingling AU - Lee, Lai-Tong Regina AU - Hunter, Sharyn AU - Zhu, Aiyong AU - Chan, Wai-Chi Sally PY - 2024/10/1 TI - Patient Engagement in a Mobile App?Based Rehabilitation Program for Total Hip or Knee Arthroplasty: Secondary Data Analysis of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e57635 VL - 12 KW - total hip arthroplasty KW - total knee arthroplasty KW - rehabilitation KW - mobile health KW - social media application KW - patient engagement N2 - Background: Health care professionals use mobile apps to support patients? rehabilitation after total hip or knee arthroplasty. Understanding patient engagement in such mobile health interventions can help tailor these interventions to better support patients. Objective: This study aimed to investigate patient engagement in a mobile app?based arthroplasty rehabilitation program and to investigate the association between patient engagement and their characteristics. Methods: Data were extracted from a pool of 42 participants in the experimental arm of a randomized controlled trial that used a mobile app (WeChat [Tencent Holdings Limited])?based program to support patients? rehabilitation after total hip or knee arthroplasty. The primary outcomes were the number of days the participants accessed the program and completed recommended rehabilitation tasks. Secondary outcomes included data on the participants? posts on a discussion forum, messages sent by the participants, access to the program components, and reading and sharing the program content. Generalized linear models were used to analyze the association between patient engagement and personal characteristics. Results: The participants reported in a rehabilitation diary accessing the program on a mean of 5.2 (SD 2) days per week and completing recommended rehabilitation tasks on a mean of 6.5 (SD 0.8) days per week. The majority (31/42, 74%) posted on the discussion forum, with a mean of 18.1 (SD 21.2) posts. Most participants (37/42, 88%) sent messages to health care professionals, with a mean of 14 (SD 15.9) messages. The program components were visited for a total of 525 times. The program content was read 898 times and shared 82 times in total. Generalized linear models showed that both primary outcomes, the number of days the participants accessed the program (B=6.46, 95% CI 1.98-15.35; ?21=11.1, P=.001) and the number of days they completed rehabilitation tasks (B=2.65, 95% CI 0.45-5.48; ?21=5.7, P=.02), were positively associated with having a high school education or above. In addition, the number of posts on the discussion forum was positively associated with living with family, having a high school education or above, undergoing total knee arthroplasty, having comorbidities, and the score of self-efficacy but was negatively associated with age. The number of messages sent by the participants was positively associated with having a high school education or above, having comorbidities, and the score of self-efficacy. Conclusions: Patient engagement in mobile arthroplasty rehabilitation is associated with their education level, cohabitation status, age, type of surgery, presence of comorbidities, and sense of self-efficacy. Program developers can consider these characteristics and use strategies, such as family involvement, in the design of mobile arthroplasty rehabilitation programs to enhance patient engagement in such interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000867897; https://tinyurl.com/mtdw25fp UR - https://mhealth.jmir.org/2024/1/e57635 UR - http://dx.doi.org/10.2196/57635 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57635 ER - TY - JOUR AU - Marelli, Ariane AU - Rozenblum, Ronen AU - Bolster-Foucault, Clara AU - Via-Dufresne Ley, Alicia AU - Maynard, Noemie AU - Amaria, Khush AU - Galuppi, Barb AU - Strohm, Sonya AU - Nguyen, Linda AU - Dawe-McCord, Claire AU - Putterman, Connie AU - Kovacs, H. Adrienne AU - Gorter, Willem Jan PY - 2024/10/1 TI - Development of MyREADY Transition BBD Mobile App, a Health Intervention Technology Platform, to Improve Care Transition for Youth With Brain-Based Disabilities: User-Centered Design Approach JO - JMIR Pediatr Parent SP - e51606 VL - 7 KW - patient-centered care KW - patient engagement KW - mobile app KW - health IT KW - health care transition KW - mobile phone N2 - Background: Transition from pediatric to adult health care varies and is resource intensive. Patient-centered health information technology (HIT) interventions are increasingly being developed in partnership with patients. Objective: This study aims to develop an internet-based mobile app intervention for patients with brain-based disabilities to improve transition in care readiness. Methods: The app was designed for patients aged 15 to 17 years with brain-based disabilities having the ability to use a mobile app. A multidisciplinary team, an industry partner, and a patient and family advisory council was assembled. We hypothesized that existing tools could be migrated into the app to address education, empowerment, and navigation. We used cognitive learning theory to support chapters targeting transition in care skill sets. We used the agile iterative methodology to engage stakeholders. Results: We developed a novel MyREADY Transition HIT platform. An electronic mentor supported cognitive learning with messaging, quizzes, rewards, and videos. We used gaming to guide navigation through a fictitious health care city. Adapting existing tools was achieved by the patient and family advisory council requesting personalization. Our iterative design required time-consuming back-end technology management. Developing the platform took 24 months instead of our grant-approved 12 months, impacting the onset of the planned trial within the allotted budget. Conclusions: A novel patient-centered HIT platform to improve health care transition was successfully developed in partnership with patients and industry. Careful resource management was needed to achieve timely delivery of the end product, flagging the cautious planning required to deliver HIT tools in time for the much-needed trials informing their clinical application. Trial Registration: ClinicalTrials.gov NCT03852550; https://clinicaltrials.gov/study/NCT03852550 UR - https://pediatrics.jmir.org/2024/1/e51606 UR - http://dx.doi.org/10.2196/51606 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51606 ER - TY - JOUR AU - Maaß, Laura AU - Hrynyschyn, Robert AU - Lange, Martin AU - Löwe, Alexandra AU - Burdenski, Kathrin AU - Butten, Kaley AU - Vorberg, Sebastian AU - Hachem, Mariam AU - Gorga, Aldo AU - Grieco, Vittorio AU - Restivo, Vincenzo AU - Vella, Giuseppe AU - Varnfield, Marlien AU - Holl, Felix PY - 2024/9/30 TI - Challenges and Alternatives to Evaluation Methods and Regulation Approaches for Medical Apps as Mobile Medical Devices: International and Multidisciplinary Focus Group Discussion JO - J Med Internet Res SP - e54814 VL - 26 KW - medical apps KW - mobile medical devices KW - evaluation methods KW - mobile medical device regulation KW - focus group study KW - alternative approaches KW - logic model KW - mobile phone N2 - Background: The rapid proliferation of medical apps has transformed the health care landscape by giving patients and health care providers unprecedented access to personalized health information and services. However, concerns regarding the effectiveness and safety of medical apps have raised questions regarding the efficacy of randomized controlled trials (RCTs) in the evaluation of such apps and as a requirement for their regulation as mobile medical devices. Objective: This study aims to address this issue by investigating alternative methods, apart from RCTs, for evaluating and regulating medical apps. Methods: Using a qualitative approach, a focus group study with 46 international and multidisciplinary public health experts was conducted at the 17th World Congress on Public Health in May 2023 in Rome, Italy. The group was split into 3 subgroups to gather in-depth insights into alternative approaches for evaluating and regulating medical apps. We conducted a policy analysis on the current regulation of medical apps as mobile medical devices for the 4 most represented countries in the workshop: Italy, Germany, Canada, and Australia. We developed a logic model that combines the evaluation and regulation domains on the basis of these findings. Results: The focus group discussions explored the strengths and limitations of the current evaluation and regulation methods and identified potential alternatives that could enhance the quality and safety of medical apps. Although RCTs were only explicitly mentioned in the German regulatory system as one of many options, an analysis of chosen evaluation methods for German apps on prescription pointed toward a ?scientific reflex? where RCTs are always the chosen evaluation method. However, this method has substantial limitations when used to evaluate digital interventions such as medical apps. Comparable results were observed during the focus group discussions, where participants expressed similar experiences with their own evaluation approaches. In addition, the participants highlighted numerous alternatives to RCTs. These alternatives can be used at different points during the life cycle of a digital intervention to assess its efficacy and potential harm to users. Conclusions: It is crucial to recognize that unlike analog tools, digital interventions constantly evolve, posing challenges to inflexible evaluation methods such as RCTs. Potential risks include high dropout rates, decreased adherence, and nonsignificant results. However, existing regulations do not explicitly advocate for other evaluation methodologies. Our research highlighted the necessity of overcoming the gap between regulatory demands to demonstrate safety and efficacy of medical apps and evolving scientific practices, ensuring that digital health innovation is evaluated and regulated in a way that considers the unique characteristics of mobile medical devices. UR - https://www.jmir.org/2024/1/e54814 UR - http://dx.doi.org/10.2196/54814 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54814 ER - TY - JOUR AU - Horvath, J. Keith AU - Lammert, Sara AU - Erickson, Darin AU - Amico, Rivet K. AU - Talan, J. Ali AU - Shalhav, Ore AU - Sun, J. Christina AU - Rendina, Jonathon H. PY - 2024/9/30 TI - A Web-Based Antiretroviral Therapy Adherence Intervention (Thrive With Me) in a Community-Recruited Sample of Sexual Minority Men Living With HIV: Results of a Randomized Controlled Study JO - J Med Internet Res SP - e53819 VL - 26 KW - HIV KW - antiretroviral therapy KW - ART KW - mobile health KW - mHealth KW - intervention KW - men who have sex with men N2 - Background: Most new HIV infections are attributed to male-to-male sexual contact in the United States. However, only two-thirds of sexual minority men living with HIV achieve an undetectable viral load (UVL). We tested a web-based antiretroviral therapy adherence intervention called Thrive with Me (TWM) with core features that included medication self-monitoring and feedback, HIV and antiretroviral therapy information, and a peer-to-peer exchange. Objective: We assessed the efficacy of TWM on HIV UVL among adult (aged ?18 years) sexual minority men. Moreover, we assessed the impact of overall engagement and engagement with specific intervention features on HIV UVL. Methods: In total, 401 sexual minority men (mean age 39.1, SD 10.8 y; 230/384, 59.9% African American) in New York City were recruited between October 2016 and December 2019 and randomized to receive TWM (intervention) or a weekly email newsletter (control) for 5 months. Computerized assessments occurred at baseline and months 5, 11, and 17. The primary outcome was a dichotomous measure of HIV UVL (?20 copies/?L). Generalized estimating equations with robust SEs were used to assess the effect of the TWM intervention on HIV UVL over the follow-up period in an unadjusted model and a model adjusted for baseline differences and then stratified by baseline recent drug use urinalysis. In secondary analyses, generalized linear models were used to estimate risk differences in the association of overall engagement with TWM (the sum of the number of days participants accessed ?1 screen of the TWM intervention out of a possible 150 days) and engagement with specific TWM components on HIV UVL throughout the 17-month intervention period. Results: Participant retention was 88.5% (355/401; month 5), 81.8% (328/401; month 11), and 80.3% (322/401; month 17). No consistent differences in HIV UVL were found between those randomized to receive TWM or the control at the 5- (difference-in-differences [DD]=?7.8, 95% CI ?21.1 to 5.5), 11- (DD=?13.9, 95% CI ?27.7 to 0.04), or 17-month (DD=?8.2, 95% CI ?22.0 to 5.7) time points, or when stratified by baseline recent drug use. However, those TWM-assigned participants with high overall levels of engagement (in the upper 25th percentile) were more likely to have an HIV UVL at the end of the 5-month active intervention period compared to those with low engagement (below the 75th percentile; risk difference=17.8, 95% CI 2.5-33.0) or no engagement (risk difference=19.4, 95% CI 3.3-35.5) in the intervention. Moreover, high engagement with the peer-to-peer exchange was associated with HIV UVL over time in unadjusted models. Conclusions: TWM did not have overall impacts on HIV UVL; however, it may assist some sexual minority men who are highly engaged with this web-based intervention in achieving HIV viral suppression. Trial Registration: ClinicalTrials.gov NCT02704208; https://clinicaltrials.gov/study/NCT02704208 UR - https://www.jmir.org/2024/1/e53819 UR - http://dx.doi.org/10.2196/53819 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53819 ER - TY - JOUR AU - Podda, Jessica AU - Grange, Erica AU - Susini, Alessia AU - Tacchino, Andrea AU - Di Antonio, Federica AU - Pedullà, Ludovico AU - Brichetto, Giampaolo AU - Ponzio, Michela PY - 2024/9/30 TI - Italian Version of the mHealth App Usability Questionnaire (Ita-MAUQ): Translation and Validation Study in People With Multiple Sclerosis JO - JMIR Hum Factors SP - e58079 VL - 11 KW - mHealth KW - multiple sclerosis KW - cognitive assessment KW - questionnaire validation KW - usability KW - mHealth app KW - mHealth application KW - validation study KW - MAUQ KW - app usability KW - telemedicine KW - disability KW - usability questionnaire KW - mobile health N2 - Background: Telemedicine and mobile health (mHealth) apps have emerged as powerful tools in health care, offering convenient access to services and empowering participants in managing their health. Among populations with chronic and progressive disease such as multiple sclerosis (MS), mHealth apps hold promise for enhancing self-management and care. To be used in clinical practice, the validity and usability of mHealth tools should be tested. The most commonly used method for assessing the usability of electronic technologies are questionnaires. Objective: This study aimed to translate and validate the English version of the mHealth App Usability Questionnaire into Italian (ita-MAUQ) in a sample of people with MS. Methods: The 18-item mHealth App Usability Questionnaire was forward- and back-translated from English into Italian by an expert panel, following scientific guidelines for translation and cross-cultural adaptation. The ita-MAUQ (patient version for stand-alone apps) comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. After interacting with DIGICOG-MS (Digital Assessment of Cognitive Impairment in Multiple Sclerosis), a novel mHealth app for cognitive self-assessment in MS, people completed the ita-MAUQ and the System Usability Scale, included to test construct validity of the translated questionnaire. Confirmatory factor analysis, internal consistency, test-retest reliability, and construct validity were assessed. Known-groups validity was examined based on disability levels as indicated by the Expanded Disability Status Scale (EDSS) score and gender. Results: In total, 116 people with MS (female n=74; mean age 47.2, SD 14 years; mean EDSS 3.32, SD 1.72) were enrolled. The ita-MAUQ demonstrated acceptable model fit, good internal consistency (Cronbach ?=0.92), and moderate test-retest reliability (intraclass coefficient correlation 0.84). Spearman coefficients revealed significant correlations between the ita-MAUQ total score; the ease of use (5 items), interface and satisfaction (7 items), and usefulness subscales; and the System Usability Scale (all P values <.05). Known-group analysis found no difference between people with MS with mild and moderate EDSS (all P values >.05), suggesting that ambulation ability, mainly detected by the EDSS, did not affect the ita-MAUQ scores. Interestingly, a statistical difference between female and male participants concerning the ease of use ita-MAUQ subscale was found (P=.02). Conclusions: The ita-MAUQ demonstrated high reliability and validity and it might be used to evaluate the usability, utility, and acceptability of mHealth apps in people with MS. UR - https://humanfactors.jmir.org/2024/1/e58079 UR - http://dx.doi.org/10.2196/58079 ID - info:doi/10.2196/58079 ER - TY - JOUR AU - Zigdon, Avi AU - Zwilling, Moti AU - Zigdon, Ofek AU - Reges, Orna PY - 2024/9/30 TI - Health Maintenance Organization?mHealth Versus Face-to-Face Interaction for Health Care in Israel: Cross-Sectional Web-Based Survey Study JO - J Med Internet Res SP - e55350 VL - 26 KW - HMO-mHealth KW - mHealth KW - face-to-face KW - digital health KW - digital health apps KW - eHealth KW - HMO-mHealth adoption KW - health care KW - mHealth adoption KW - mobile phone KW - HMO KW - health maintenance organization N2 - Background: Health maintenance organization?mobile health (HMO-mHealth) services have a direct impact on patients? daily lives, and HMOs regularly expand their range of mHealth services. HMO-mHealth apps are saving HMOs time and money, as services are becoming more accessible to patients. However, the willingness to use mHealth apps depends on user perception. Although mHealth apps can change the relationship dynamic between HMOs and patients, patients prefer to use them to facilitate face-to-face interactions rather than replace them. Objective: This study aims to examine the extent to which Israeli adults prefer adopting health care services using HMO-mHealth as a replacement for face-to-face interaction. Methods: Israeli adults aged ?18 years completed an electronic questionnaire. Data were collected from December 2020 to February 2021. All services in the main HMO-mHealth apps of the 4 Israeli HMOs were mapped. The 29 health care services used in this study were identical in all 4 HMO-mHealth apps in Israel. The association between sociodemographic characteristics and health condition with preference for HMO-mHealth or face-to-face interaction was analyzed separately for each health service by using a logistic model. Results: A total of 6321 respondents completed the questionnaire (female: 4296/6321, 68%; male: 2025/6321, 32%). Approximately 80.9% (5115/6321) to 88.2% (5578/6321) of the respondents preferred using HMO-mHealth apps for administrative matters. However, 55.3% (3498/6321), 52.2% (3301/6321), and 46.9% (2969/6321) preferred face-to-face meetings for the initial medical diagnosis, medical treatment, and medical diagnosis results, respectively. Seven main variables were found to be associated with HMO-mHealth adoption, including gender, age, education, marital status, religious affiliation, and subjective health condition. Female respondents were more likely than male respondents to prefer HMO-mHealth apps for administrative matters and face-to-face interaction for personal medical diagnosis and treatment (odds ratio [OR] 0.74, 95% CI 0.67-0.83; P<.001 and OR 0.82, 95% CI 0.74-0.92; P<.001, respectively). Married individuals preferred using HMO-mHealth apps over face-to-face meetings for a new medical diagnosis (OR 1.31, 95% CI 1.15-1.49; P<.001) or treatment (OR 1.34, 95% CI 1.18-1.52; P<.001). Improved health perception was associated with higher preference for HMO-mHealth apps across all health care services in this study (OR 1.11, 95% CI 1.02-1.22; P<.02 to OR 1.38, 95% CI 1.25-1.53; P<.001). No significant association was found between the presence of a chronic disease and the preferred mode of interaction for most services. Conclusions: HMO-mHealth is proving to be a robust and efficient tool for health care service delivery. However, there are barriers that affect vulnerable populations when adopting HMO-mHealth. Therefore, it is important to tailor HMO-mHealth apps for older adults, the chronically ill, and minorities in society, as these groups have a greater need for these services. Future studies should focus on identifying the barriers that affect the utilization of HMO-mHealth in these groups. UR - https://www.jmir.org/2024/1/e55350 UR - http://dx.doi.org/10.2196/55350 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55350 ER - TY - JOUR AU - D'Arcey, Jessica AU - Torous, John AU - Asuncion, Toni-Rose AU - Tackaberry-Giddens, Leah AU - Zahid, Aqsa AU - Ishak, Mira AU - Foussias, George AU - Kidd, Sean PY - 2024/9/30 TI - Leveraging Personal Technologies in the Treatment of Schizophrenia Spectrum Disorders: Scoping Review JO - JMIR Ment Health SP - e57150 VL - 11 KW - schizophrenia KW - digital mental health KW - personal technology KW - access to specialized resources KW - mental health KW - scoping review KW - mental health care KW - feasibility KW - efficacy KW - clinical integration KW - support KW - specialized care KW - care KW - database KW - schizophrenia spectrum disorder KW - text messaging KW - text KW - user feedback KW - usability KW - acceptability KW - satisfaction KW - engagement KW - digital health KW - technology KW - health technology KW - mood disorder KW - mood disorders KW - neurodevelopment KW - eHealth KW - mobile phone N2 - Background: Digital mental health is a rapidly growing field with an increasing evidence base due to its potential scalability and impacts on access to mental health care. Further, within underfunded service systems, leveraging personal technologies to deliver or support specialized service delivery has garnered attention as a feasible and cost-effective means of improving access. Digital health relevance has also improved as technology ownership in individuals with schizophrenia has improved and is comparable to that of the general population. However, less digital health research has been conducted in groups with schizophrenia spectrum disorders compared to other mental health conditions, and overall feasibility, efficacy, and clinical integration remain largely unknown. Objective: This review aims to describe the available literature investigating the use of personal technologies (ie, phone, computer, tablet, and wearables) to deliver or support specialized care for schizophrenia and examine opportunities and barriers to integrating this technology into care. Methods: Given the size of this review, we used scoping review methods. We searched 3 major databases with search teams related to schizophrenia spectrum disorders, various personal technologies, and intervention outcomes related to recovery. We included studies from the full spectrum of methodologies, from development papers to implementation trials. Methods and reporting follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: This search resulted in 999 studies, which, through review by at least 2 reviewers, included 92 publications. Included studies were published from 2010 to 2023. Most studies examined multitechnology interventions (40/92, 43%) or smartphone apps (25/92, 27%), followed by SMS text messaging (16/92, 17%) and internet-based interventions (11/92, 12%). No studies used wearable technology on its own to deliver an intervention. Regarding the stage of research in the field, the largest number of publications were pilot studies (32/92, 35%), followed by randomized control trials (RCTs; 20/92, 22%), secondary analyses (16/92, 17%), RCT protocols (16/92, 17%), development papers (5/92, 5%), and nonrandomized or quasi-experimental trials (3/92, 3%). Most studies did not report on safety indices (55/92, 60%) or privacy precautions (64/92, 70%). Included studies tend to report consistent positive user feedback regarding the usability, acceptability, and satisfaction with technology; however, engagement metrics are highly variable and report mixed outcomes. Furthermore, efficacy at both the pilot and RCT levels report mixed findings on primary outcomes. Conclusions: Overall, the findings of this review highlight the discrepancy between the high levels of acceptability and usability of these digital interventions, mixed efficacy results, and difficulties with sustained engagement. The discussion highlights common patterns that may underscore this observation in the field; however, as this was a scoping review, a more in-depth systematic review or meta-analysis may be required to better understand the trends outlined in this review. UR - https://mental.jmir.org/2024/1/e57150 UR - http://dx.doi.org/10.2196/57150 UR - http://www.ncbi.nlm.nih.gov/pubmed/39348196 ID - info:doi/10.2196/57150 ER - TY - JOUR AU - Mutale, Jacob AU - Sikombe, Kombatende AU - Mwale, Boroma AU - Lumpa, Mwansa AU - Simbeza, Sandra AU - Bukankala, Chama AU - Mukamba, Njekwa AU - Mody, Aaloke AU - Beres, K. Laura AU - Holmes, B. Charles AU - Bolton Moore, Carolyn AU - Geng, H. Elvin AU - Sikazwe, Izukanji AU - Pry, M. Jake PY - 2024/9/30 TI - Assessing the Response Results of an mHealth-Based Patient Experience Survey Among People Receiving HIV Care in Lusaka, Zambia: Cohort Study JO - J Med Internet Res SP - e54304 VL - 26 KW - mHealth KW - mobile health KW - survey KW - incentives KW - HIV KW - Zambia KW - airtime KW - USSD KW - unstructured supplementary service data KW - HIV care KW - pilot study KW - mobile phone KW - public health service KW - urban KW - rural KW - regression model KW - longitudinal KW - mobile KW - patient feedback N2 - Background: This pilot study evaluates the effectiveness of mobile talk-time incentives in maintaining participation in a longitudinal mobile health (mHealth) data collection program among people living with HIV in Lusaka, Zambia. While mHealth tools, such as mobile phone surveys, provide vital health feedback, optimal incentive strategies to ensure long-term engagement remain limited. This study explores how different incentive levels affect response rates in multiple survey rounds, providing insights into effective methods for encouraging ongoing participation, especially in the context of Zambia?s prepaid mobile system and multi-SIM usage, a common practice in sub-Saharan Africa. Objective: This study aimed to assess the response rate success across multiple invitations to participate in a care experience survey using a mobile phone short codes and unstructured supplementary service data (USSD) model among individuals in an HIV care setting in the Lusaka, Zambia. Methods: Participants were recruited from 2 study clinics?1 in a periurban setting and 1 in an urban setting. A total of 2 rounds of survey invitations were sent to study participants on a 3-month interval between November 1, 2018, and September 23, 2019. Overall, 3 incentive levels were randomly assigned by participant and survey round: (1) no incentive, (2) 2 Zambian Kwacha (ZMW; US $0.16), and (3) 5 ZMW (US $0.42). Survey response rates were analyzed using mixed-effects Poisson regression, adjusting for individual- and facility-level factors. Probability plots for survey completion were generated based on language, incentive level, and survey round. We projected the cost per additional response for different incentive levels. Results: A total of 1006 participants were enrolled, with 72.3% (727/1006) from the urban HIV care facility and 62.4% (628/1006) requesting the survey in English. We sent a total of 1992 survey invitations for both rounds. Overall, survey completion across both surveys was 32.1% (637/1992), with significantly different survey completion between the first (40.5%, 95% CI 37.4-43.6%) and second (23.7%, 95% CI 21.1-26.4) invitations. Implementing a 5 ZMW (US $0.42) incentive significantly increased the adjusted prevalence ratio (aPR) for survey completion compared with those that received no incentive (aPR 1.35, 95% CI 1.11-1.63). The cost per additional response was highest at 5 ZMW, equivalent to US $0.42 (72.8 ZMW [US $5.82] per 1% increase in response). Conclusions: We observed a sharp decline of almost 50% in survey completion success from the initial invitation to follow-up survey administered 3 months later. This substantial decrease suggests that longitudinal data collection potential for a care experience survey may be limited without additional sensitization and, potentially, added survey reminders. Implementing a moderate incentive increased response rates to our health care experience survey. Tailoring survey strategies to accommodate language preferences and providing moderate incentives can optimize response rates in Zambia. Trial Registration: Pan African Clinical Trial Registry PACTR202101847907585; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14613 UR - https://www.jmir.org/2024/1/e54304 UR - http://dx.doi.org/10.2196/54304 UR - http://www.ncbi.nlm.nih.gov/pubmed/39348170 ID - info:doi/10.2196/54304 ER - TY - JOUR AU - Kawaguchi, Kenjiro AU - Nakagomi, Atsushi AU - Ide, Kazushige AU - Kondo, Katsunori PY - 2024/9/30 TI - Effects of a Mobile App to Promote Social Participation on Older Adults: Randomized Controlled Trial JO - J Med Internet Res SP - e64196 VL - 26 KW - gerontology KW - geriatrics KW - older adults KW - elderly KW - older people KW - community dwelling older adult KW - aging KW - social participation KW - walking KW - mHealth KW - apps KW - smartphone KW - digital health KW - digital technology KW - digital interventions KW - physical activity KW - exercise N2 - Background: Social participation is crucial for healthy aging, improving physical and mental health, cognitive function, and quality of life among older adults. However, social participation tends to decline with age due to factors like loss of social networks and health issues. Mobile health apps show promise in promoting healthy behaviors among older adults, but their effectiveness in increasing social participation remains understudied. Objective: This randomized controlled trial aimed to evaluate the efficacy of a mobile app called Encouragement of Social Participation (ESP, ?Shakai Sanka no Susume;? Hitachi) in promoting social participation and physical activity among community-dwelling older adults. Methods: The study recruited 181 community-dwelling adults aged 60 years or older from 2 municipalities in Japan and through a web-based research panel. Participants were randomly assigned to either the intervention group (n=87), which used the ESP app for 12 weeks, or the control group (n=94), which used only Google Fit. The ESP app incorporated features such as self-monitoring of social participation, personalized feedback, gamification elements, and educational content. Primary outcomes were changes in social participation frequency over the previous 2 months and changes in step counts, measured at baseline and week 12. Secondary outcomes included changes in specific types of social activities and subjective well-being. Data were analyzed using analysis of covariance and linear mixed-effects models. Results: The intervention group showed a significantly greater increase in social participation frequency compared with the control group (adjusted difference 3.03; 95% CI 0.17-5.90; P=.04). Specifically, the intervention group demonstrated higher frequencies of participation in hobbies (adjusted difference: 0.82; 95% CI 0.01-1.63) and cultural clubs (adjusted difference 0.65; 95% CI 0.07-1.23) compared with the control group. However, there were no significant differences in weekly step counts between the groups. Subgroup analyses suggested potentially larger effects among participants who were older than 70 years, female, had lower educational attainment, and were recruited from community settings, although only females and the lower educational attainment subgroups demonstrated 95% CIs that did not encompass zero. Conclusions: The ESP mobile app effectively promoted social participation among community-dwelling older adults, particularly in hobbies and cultural club activities. However, it did not significantly impact physical activity levels as measured by step counts. These findings suggest that mobile apps can be valuable tools for encouraging social engagement in older populations, potentially contributing to healthy aging. Future research should focus on optimizing app features to maintain long-term engagement and exploring strategies to enhance physical activity alongside social participation. Trial Registration: University Medical Information Network Clinical Trial Registry UMIN000049045; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055781 UR - https://www.jmir.org/2024/1/e64196 UR - http://dx.doi.org/10.2196/64196 UR - http://www.ncbi.nlm.nih.gov/pubmed/39348180 ID - info:doi/10.2196/64196 ER - TY - JOUR AU - Iacoella, Francesco AU - Tirivayi, Nyasha PY - 2024/9/27 TI - Mobile Phones and HIV Testing: Multicountry Instrumental Variable Analysis From Sub-Saharan Africa JO - J Med Internet Res SP - e48794 VL - 26 KW - information and knowledge KW - communication KW - health and economic development KW - public health KW - technological change KW - choices and consequences KW - mobile phone KW - connectivity KW - access KW - HIV KW - testing KW - Sub-Saharan Africa KW - women?s health N2 - Background: Sub-Saharan Africa has been a technological hothouse when it comes to mobile phone technology adoption. However, evidence on the role played by mobile technology on infectious disease prevention has been mostly limited to experimental studies. Objective: This observational study investigates the role of mobile phone connectivity on HIV testing in sub-Saharan Africa. Methods: We make use of the novel and comprehensive OpenCelliD cell tower database and Demographic and Health Survey geocoded information for over 400,000 women in 29 sub-Saharan African countries. We examine, through ordinary least square and instrumental variable regressions, whether women?s community distance from the closest cell tower influences knowledge about HIV testing facilities and the likelihood of ever being tested for HIV. Results: After finding a negative and significant impact of distance to the nearest cell tower on knowledge of HIV testing facility (?0.7 percentage points per unit increase in distance) and HIV testing (?0.5 percentage points per unit increase), we investigate the mechanisms through which such effects might occur. Our analysis shows that distance to a cell tower reduces HIV-related knowledge (?0.4 percentage points per unit increase) as well as reproductive health knowledge (?0.4 percentage points per unit increase). Similar results are observed when the analysis is performed at community level. Conclusions: Results suggest that the effect of mobile phone connectivity is channeled through increased knowledge of HIV, sexually transmittable infections, and modern contraceptive methods. Further analysis shows that cell phone ownership has an even larger impact on HIV testing and knowledge. This paper adds to the recent literature on the impact of mobile-based HIV prevention schemes by showing through large-scale analysis that better mobile network access is a powerful tool to spread reproductive health knowledge and increase HIV awareness. UR - https://www.jmir.org/2024/1/e48794 UR - http://dx.doi.org/10.2196/48794 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48794 ER - TY - JOUR AU - Muehlensiepen, Felix AU - Bruch, Dunja AU - Seifert, Frances AU - Wengemuth, Eileen AU - Heinze, Martin AU - Spethmann, Sebastian AU - May, Susann PY - 2024/9/27 TI - mHealth Apps for Hypertension Self-Management: Interview Study Among Patient-Users JO - JMIR Form Res SP - e56162 VL - 8 KW - hypertension KW - mobile health KW - mHealth apps KW - digital health KW - patient perspective KW - qualitative study KW - cardiology N2 - Background: Hypertension is a major risk factor for cardiovascular disease, affecting over a billion people worldwide. Mobile health (mHealth) apps have emerged as effective tools for managing hypertension, offering capabilities for monitoring blood pressure, fostering lifestyle changes, and improving treatment adherence. Objective: This study aimed to explore patient-users? perspectives on the hypertension care mHealth app Hypertension.APP, focusing on its accessibility, expected benefits, potential risks, and role in hypertension management in Germany. Methods: A qualitative study was conducted involving semistructured interviews with 20 patient-users of a hypertension care mHealth app, Hypertension.APP. Participants were recruited between January and June 2023 using purposive sampling. Verbatim transcripts were analyzed using qualitative content analysis. Results: Participants primarily discovered the app independently, driven by recent hypertension diagnoses and insufficient information from health care professionals regarding effective self-management strategies for their blood pressure. They valued the app for its continuous monitoring and feedback capabilities, aiding in understanding their condition and making lifestyle adjustments. Risks were perceived as minimal, mainly concerning data privacy and potential overreliance on the app. The app became integral to patient-users? hypertension management by offering consistent information and support. The integration into formal health care was limited, as patient-users felt that health care professionals did not accept the use of the technology or might have even felt intimidated to use it. Conclusions: Among the sample studied, mHealth apps like Hypertension.APP were valued for their continuous monitoring and educational content, aiding in hypertension management. The findings suggest potential benefits of mHealth apps for effective hypertension care among patients who are health- and digitally literate as well as self-effective. There is a critical need for better integration of these apps into routine health care practices, as perceived by the app users. Given the small and specific sample of this qualitative study, further quantitative research with a broader and more varied participant group is necessary to validate these findings. Trial Registration: Deutsches Register Klinischer Studien DRKS00029761; https://tinyurl.com/r33ru22s UR - https://formative.jmir.org/2024/1/e56162 UR - http://dx.doi.org/10.2196/56162 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56162 ER - TY - JOUR AU - Portz, Jennifer AU - Moore, Susan AU - Bull, Sheana PY - 2024/9/27 TI - Evolutionary Trends in the Adoption, Adaptation, and Abandonment of Mobile Health Technologies: Viewpoint Based on 25 Years of Research JO - J Med Internet Res SP - e62790 VL - 26 KW - technology adoption KW - mobile health KW - SMS text messaging KW - mobile apps KW - wearables KW - social media UR - https://www.jmir.org/2024/1/e62790 UR - http://dx.doi.org/10.2196/62790 UR - http://www.ncbi.nlm.nih.gov/pubmed/39331463 ID - info:doi/10.2196/62790 ER - TY - JOUR AU - Donawa, Alyssa AU - Powell, Christian AU - Wang, Rong AU - Chih, Ming-Yuan AU - Patel, Reema AU - Zinner, Ralph AU - Aronoff-Spencer, Eliah AU - Baker, E. Corey PY - 2024/9/26 TI - Designing Survey-Based Mobile Interfaces for Rural Patients With Cancer Using Apple?s ResearchKit and CareKit: Usability Study JO - JMIR Form Res SP - e57801 VL - 8 KW - usability KW - usability testing KW - digital literacy KW - ehealth literacy KW - digital divide KW - mobile health KW - mHealth KW - patients with cancer KW - rural health KW - distress KW - apps KW - ehealth adoption KW - HealthKit KW - CareKit N2 - Background: Despite the increased accessibility and availability of technology in recent years, equality and access to health-related technology remain limited to some demographics. In particular, patients who are older or from rural communities represent a large segment of people who are currently underusing mobile health (mHealth) solutions. System usability continues to hinder mHealth adoption among users with nontraditional digital literacy. Objective: This study aims to investigate if state-of-the-art mobile app interfaces from open-source libraries provide sufficient usability for rural patients with cancer, with minimal design changes and forgoing the co-design process. Methods: We developed Assuage (Network Reconnaissance Lab) as a research platform for any mHealth study. We conducted a pilot study using Assuage to assess the usability of 4 mobile user interfaces (UIs) based on open-source libraries from Apple?s ResearchKit and CareKit. These UIs varied in complexity for reporting distress symptoms. Patients with cancer were recruited at the Markey Cancer Center, and all research procedures were conducted in person. Participants completed the distress assessment using a randomly selected UI in Assuage with little to no assistance. Data were collected on participant age, location, mobile app use, and familiarity with mHealth apps. Participants rated usability with the System Usability Scale (SUS), and usability issues were documented and compared. A one-way ANOVA was used to compare the effect of the UIs on the SUS scores. Results: We recruited 30 current or postsurgery patients with cancer for this pilot study. Most participants were aged >50 years (24/30, 80%), from rural areas (25/30, 83%), had up to a high school education (19/30, 63%), and were unfamiliar with mHealth apps (21/30, 70%). General mobile app use was split, with 43% (14/30) of the patients not regularly using mobile apps. The mean SUS score across the UIs was 75.8 (SD 22.2), with UI 3 and UI 4 achieving an SUS score ?80, meeting the industry standard for good usability of 80. Critical usability issues were related to data input and navigation with touch devices, such as scale-format questions, vertical scrolling, and traversing multiple screens. Conclusions: The findings from this study show that most patients with cancer (20/30, 67%) who participated in this study rated the different interfaces of Assuage as above-average usability (SUS score >68). This suggests that Apple?s ResearchKit and CareKit libraries can provide usable UIs for older and rural users with minimal interface alterations. When resources are limited, the design stage can be simplified by omitting the co-design process while preserving suitable usability for users with nontraditional technical proficiency. Usability comparable to industry standards can be achieved by considering heuristics for interface and electronic survey design, specifically how to segment and navigate surveys, present important interface elements, and signal gestural interactions. UR - https://formative.jmir.org/2024/1/e57801 UR - http://dx.doi.org/10.2196/57801 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57801 ER - TY - JOUR AU - Sosanya, Eloho Mercy AU - Samuel, Olukemi Folake AU - Bashir, Sadia AU - Omoera, Osariemen Victoria AU - Freeland-Graves, H. Jeanne PY - 2024/9/26 TI - A Mobile Gaming App to Train Teenage Mothers on Appropriate Child Feeding Practices: Development and Validation Study JO - J Med Internet Res SP - e53560 VL - 26 KW - mobile health KW - mHealth KW - mobile gaming app KW - validation KW - infant and young child feeding KW - teenage mother KW - Nigeria KW - mobile phone N2 - Background: Undernutrition is an underlying factor in nearly 50% of 1 million estimated annual deaths among Nigerian children aged <5 years. Inappropriate maternal infant and young child feeding (IYCF) practices are basic contributors to child undernutrition. Teenage motherhood exacerbates the problem of inadequate child feeding. One possible intervention method to improve IYCF knowledge and practices of teenage mothers is the use of mobile gaming technologies. Despite extreme poverty in low- and middle-income countries, a ubiquity of mobile phone networks exists. Objective: This study aims to develop and validate a mobile gaming app, called BabyThrive, to train Nigerian teenage mothers on appropriate IYCF practices. Methods: To identify gaps in current IYCF practices in northern Nigeria, we conducted an extensive search of the literature and held 2 focus group interviews with 16 teenage mothers with low-income status. An initial app content design was then created, and content validity was established by 10 nutrition experts. Next, we developed an app prototype, which was assessed for quality by 7 nutrition and mobile gaming experts and evaluated for usability by 90 teenage mothers from rural areas in Abuja, the country?s capital. The final app, BabyThrive, is a 2D mobile game that is fully functional offline and available in English as well as Hausa, which is commonly spoken in northern Nigeria. The efficacy of the BabyThrive app was assessed using IYCF knowledge scores obtained from the administration of the validated Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. Construct validity was established via crossover design by comparing the total IYCF knowledge scores of the teenage mothers obtained after a verbal training program and BabyThrive app use. Results: Large proportions of the study participants were married (53/90, 59%) and had no personal income (63/90, 70%). The mean quality rating for the BabyThrive app was 4.3 (SD 0.39) out of 5.0. High levels (>80%) of usability and user satisfaction were documented. Knowledge of exclusive breastfeeding (P<.001) and total knowledge scores (P=.002) were significantly higher in the BabyThrive group than in the verbal training group. The IYCF knowledge scores obtained from both groups showed coherence, with a statistically significant Spearman correlation coefficient of 0.50 (P<.001). Conclusions: This research developed and validated a novel, offline mobile gaming app. It will be an easy, effective, and acceptable method to disseminate critical knowledge on IYCF practices to teenage mothers in rural Nigeria. UR - https://www.jmir.org/2024/1/e53560 UR - http://dx.doi.org/10.2196/53560 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53560 ER - TY - JOUR AU - Spijker, A. Jeroen J. AU - Barl?n, Hande AU - Grad, Alecsandra Diana AU - Gu, Yang AU - Klavina, Aija AU - Korkmaz Yaylagul, Nilufer AU - Kulla, Gunilla AU - Orhun, Eda AU - ?ev?íková, Anna AU - Unim, Brigid AU - Tofan, Maria Cristina PY - 2024/9/26 TI - The Impact of Digital Technology on the Physical Health of Older Workers: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e59900 VL - 13 KW - digital tools KW - digital technology KW - digitalization KW - physical health KW - mobility KW - vision loss KW - musculoskeletal disorders KW - migraine KW - older workers KW - older population KW - aging KW - scoping review KW - mobile phone N2 - Background: Digital technologies have penetrated most workplaces. However, it is unclear how such digital technologies affect the physical health of older workers. Objective: This scoping review aims to examine and summarize the evidence from scientific literature concerning the impact of digital technology on the physical health of older workers. Methods: This scoping review will be conducted following recommendations outlined by Levac et al and will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines for reporting. Peer-reviewed papers written in English will be searched in the following databases: MEDLINE, Cochrane, ProQuest, Web of Science, Scopus, APA PsycInfo, and ERIH PLUS. The web-based systematic review platform Covidence will be used to create a data extraction template. It will cover the following items: study and participant characteristics, health measures, digital tool characteristics and usage, and research findings. Following the Population, Concept, and Context (PCC) framework, our review will focus on studies involving older workers aged 50 years or older, any form of digital technology (including teleworking and the use of digital tools at work), and how digital technologies affect physical health (such as vision loss, musculoskeletal disorders, and migraines). Studies that focus only on mental health will be excluded. Study selection based on title and abstract screening (first stage), full-text review (second stage), and data extraction (third stage) will be performed by a group of researchers, whereby each paper will be reviewed by at least 2 people. Any conflict regarding the inclusion or exclusion of a study and the data extraction will be resolved by discussion between the researchers who evaluated the papers; a third researcher will be involved if consensus is not reached. Results: A preliminary search of MEDLINE, Epistemonikos, Cochrane, PROSPERO, and JBI Evidence Synthesis was conducted, and no current or ongoing systematic reviews or scoping reviews on the topic were identified. The results of the study are expected in April 2025. Conclusions: Our scoping review will seek to provide an overview of the available evidence and identify research gaps regarding the effect of digital technology and the use of digital tools in the work environment on the physical health of older workers. International Registered Report Identifier (IRRID): PRR1-10.2196/59900 UR - https://www.researchprotocols.org/2024/1/e59900 UR - http://dx.doi.org/10.2196/59900 UR - http://www.ncbi.nlm.nih.gov/pubmed/39325529 ID - info:doi/10.2196/59900 ER - TY - JOUR AU - Okamoto, Masumi AU - Saito, Yoshinobu AU - Nakamura, Sho AU - Nagasawa, Makoto AU - Shibuya, Megumi AU - Nagasaka, Go AU - Narimatsu, Hiroto PY - 2024/9/24 TI - Smartphone-Based Digital Peer Support for a Walking Intervention Among Public Officers in Kanagawa Prefecture: Single-Arm Pre- and Postintervention Evaluation JO - JMIR Form Res SP - e53759 VL - 8 KW - digital health KW - mhealth KW - ehealth KW - smartphone app KW - smartphone application KW - peer support KW - digital peer support KW - social support KW - group intervention KW - physical activity KW - health promotion KW - behavior change KW - apps KW - step counting KW - workplace health N2 - Background: Digital peer support, defined as peer support delivered through technology such as smartphone apps, may be promising to promote activity in the form of step counts. Interactions among users have a positive impact on retention rates, and apps with social elements show significant improvements in daily step count. However, the feasibility of digital peer support in promoting physical activity (PA) is unknown; therefore, its effectiveness on step count and the clinical implications remain unconfirmed. Objective: This study aimed to assess the feasibility of digital peer support over a 3-month intervention period using the retention rate as the outcome. Moreover, changes in daily step count and physical measurements were compared between pre- and postintervention. Methods: The study design was a 3-month 1-arm intervention with participants from local government offices in Kanagawa, Japan. We used an available smartphone app, Minchalle, as the tool for the group intervention. Participants were required to report their daily step count to a maximum of 5 members composed exclusively of study participants. The primary outcome was the retention rate. Secondary outcomes included daily step count, the rate of achieving daily step goals, physical measurements, and lifestyle characteristics. Descriptive statistics and the Pearson coefficient were used to examine the relationship between goal achievement and step count, as well as changes in step count and various variables including physical measurements. Results: Of the 63 participants, 62 completed the intervention. The retention rate was 98% (62/63). The average daily step count during the intervention was 6993 (SD 2328) steps, an 1182-step increase compared with the count observed 1 week before the intervention began. The rate of achieving the daily step count during the intervention was 53.5% (SD 26.2%). There was a significant correlation (r=0.27, P=.05) between achieving daily step goals and increasing daily step count. Comparative analyses showed that changes in weight (68.56, SD 16.97 kg vs 67.30, SD 16.86 kg; P<.001), BMI (24.82, SD 4.80 kg/m2 vs 24.35, SD 4.73 kg/m2; P<.001), somatic fat rate (28.50%, SD 7.44% vs 26.58%, SD 7.90%; P=.005), systolic blood pressure (130.42, SD 17.92 mm Hg vs 122.00, SD 15.06 mm Hg; P<.001), and diastolic blood pressure (83.24, SD 13.27 mm Hg vs 77.92, SD 11.71 mm Hg; P=.002) were significantly different before and after the intervention. Similarly, the daily amount of PA significantly improved from 5.77 (SD 3.81) metabolic equivalent (MET)?hours per day to 9.85 (SD 7.84) MET-hours per day (P<.001). Conclusions: This study demonstrated that digital peer support is feasible for maintaining a high retention rate and can, therefore, effectively promote PA. It can be a promising tool to improve daily step count, subjective PA, and clinical outcomes, such as weight and somatic fat rate. Trial Registration: UMIN Clinical Trials Registry UMIN000042520; https://tinyurl.com/46c4nm8z UR - https://formative.jmir.org/2024/1/e53759 UR - http://dx.doi.org/10.2196/53759 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53759 ER - TY - JOUR AU - Mackworth-Young, Sina Constance Ruth AU - Charashika, Privillage AU - AU - Larsson, Leyla AU - Wilding-Davies, Jane Olivia AU - Simpson, Nikita AU - Kydd, Sorrel Anna AU - Chinyanga, Tinashe Theonevus AU - Ferrand, Abbas Rashida AU - Mangombe, Aveneni AU - Webb, Karen AU - Doyle, Margaret Aoife PY - 2024/9/24 TI - Digital Intervention to Improve Health Services for Young People in Zimbabwe: Process Evaluation of ?Zvatinoda!? (What We Want) Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework JO - JMIR Form Res SP - e53034 VL - 8 KW - adolescents KW - young people KW - digital health KW - mobile intervention KW - HIV KW - sexual and reproductive health KW - Zimbabwe N2 - Background: Youth in Southern Africa face a high burden of HIV and sexually transmitted infections, yet they exhibit low uptake of health care services. Objective: The Zvatinoda! intervention, co-designed with youth, aims to increase the demand for and utilization of health services among 18-24-year-olds in Chitungwiza, Zimbabwe. Methods: The intervention utilized mobile phone?based discussion groups, complemented by ?ask the expert? sessions. Peer facilitators, supported by an ?Auntie,? led youth in anonymous online chats on health topics prioritized by the participants. Feedback on youth needs was compiled and shared with health care providers. The intervention was tested in a 12-week feasibility study involving 4 groups of 7 youth each, totaling 28 participants (n=14, 50%, female participants), to evaluate feasibility and acceptability. Mixed methods process evaluation data included pre- and postintervention questionnaires (n=28), in-depth interviews with participants (n=15) and peer facilitators (n=4), content from discussion group chats and expert guest sessions (n=24), facilitators? debrief meetings (n=12), and a log of technical challenges. Descriptive quantitative analysis and thematic qualitative analysis were conducted. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was adapted to analyze and present findings on (1) reach, (2) potential efficacy, (3) adoption, (4) implementation, and (5) maintenance. Results: Mobile delivery facilitated engagement with diverse groups, even during COVID-19 lockdowns (reach). Health knowledge scores improved from pre- to postintervention across 9 measures. Preintervention scores varied from 14% (4/28) for contraception to 86% (24/28) for HIV knowledge. After the intervention, all knowledge scores reached 100% (28/28). Improvements were observed across 10 sexual and reproductive health (SRH) self-efficacy measures. The most notable changes were in the ability to start a conversation about SRH with older adults in the family, which increased from 50% (14/28) preintervention to 86% (24/28) postintervention. Similarly, the ability to use SRH services even if a partner does not agree rose from 57% (16/28) preintervention to 89% (25/28) postintervention. Self-reported attendance at a health center in the past 3 months improved from 32% (9/28) preintervention to 86% (24/28) postintervention (potential efficacy). Chat participation varied, largely due to network challenges and school/work commitments. The key factors facilitating peer learning were interaction with other youth, the support of an older, knowledgeable ?Auntie,? and the anonymity of the platform. As a result of COVID-19 restrictions, regular feedback to providers was not feasible. Instead, youth conveyed their needs to stakeholders through summaries of key themes from chat groups and a music video presented at a final in-person workshop (adoption and implementation). Participation in discussions decreased over time. To maintain engagement, introducing an in-person element was suggested (maintenance). Conclusions: The Zvatinoda! intervention proved both acceptable and feasible, showing promise for enhancing young people?s knowledge and health-seeking behavior. Potential improvements include introducing in-person discussions once the virtual group has established rapport and enhancing feedback and dialog with service providers. UR - https://formative.jmir.org/2024/1/e53034 UR - http://dx.doi.org/10.2196/53034 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53034 ER - TY - JOUR AU - Griffin, C. Ashley AU - Mentch, Lucas AU - Lin, Feng-Chang AU - Chung, E. Arlene PY - 2024/9/24 TI - mHealth Physical Activity and Patient-Reported Outcomes in Patients With Inflammatory Bowel Diseases: Cluster Analysis JO - J Med Internet Res SP - e48020 VL - 26 KW - inflammatory bowel diseases KW - patient-reported outcome measures KW - cluster analysis KW - wearable electronic devices KW - medical informatics KW - mHealth KW - mobile health KW - physical activity KW - bowel disease KW - psychosocial KW - smartphone KW - wearables KW - mobile phone N2 - Background: Regular physical activity is associated with improved quality of life in patients with inflammatory bowel diseases (IBDs), although much of the existing research is based on self-reported data. Wearable devices provide objective data on many rich physical activity dimensions including steps, duration, distance, and intensity. Little is known about how patients with IBDs engage in these varying dimensions of exercise and how it may influence their symptom and disease-specific patient-reported outcomes (PROs). Objective: This study aims to (1) cluster physical activity patterns from consumer-grade wearable devices and (2) assess the relationship between the clusters and PROs in patients with IBDs. Methods: We conducted a cross-sectional and longitudinal cohort study among adults with IBDs in the Crohn?s and Colitis Foundation IBD Partners cohort. Participants contribute physical activity data through smartphone apps or wearable devices in a bring-your-own-device model. Participants also complete biannual PRO questionnaires from the Patient-Reported Outcomes Measurement Information System short forms and IBD-specific questionnaires. K-means cluster analysis was used to generate physical activity clusters based on 3 key features: number of steps, duration of moderate to vigorous activity (minutes), and distance of activity (miles). Based on the clusters, we conducted a cross-sectional analysis to examine differences in mean questionnaire scores and participant characteristics using one-way ANOVA and chi-square tests. We also conducted a longitudinal analysis to examine individual cluster transitions among participants who completed multiple questionnaires, and mean differences in questionnaire scores were compared using 2-tailed paired sample t tests across 6-month periods. Results: Among 430 participants comprising 1255 six-week physical activity periods, we identified clusters of low (33.7%, n=423), moderate (46%, n=577), and high (20.3%, n=255) physical activity. Scores varied across clusters for depression (P=.004), pain interference (P<.001), fatigue (P<.001), sleep disturbance (P<.001), social satisfaction (P<.001), and short Crohn Disease Activity Index (P<.001), with those in the low activity cluster having the worst scores. Sociodemographic characteristics also differed, and those with low physical activity were older (P=.002), had higher BMIs (P<.001), and had longer disease durations (P=.02) compared to other clusters. Among 246 participants who completed at least 2 consecutive questionnaires consisting of 726 questionnaire periods, 67.8% (n=492) remained in the same cluster, and only 1.2% (n=9) moved to or from the furthest clusters of low and high activity across 6-month periods. Conclusions: For patients with IBDs, there were positive associations between physical activity and PROs related to disease activity and psychosocial domains. Physical activity patterns mostly did not fluctuate over time, suggesting little variation in exercise levels in the absence of an intervention. The use of real-world data to identify subgroups with similar lifestyle behaviors could be leveraged to develop targeted interventions that provide support for psychosocial symptoms and physical activity for personalized IBD care. UR - https://www.jmir.org/2024/1/e48020 UR - http://dx.doi.org/10.2196/48020 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48020 ER - TY - JOUR AU - Daneshvar, Hadi AU - Carver, Hannah AU - Strachan, Graeme AU - Greenhalgh, Jessica AU - Matheson, Catriona PY - 2024/9/24 TI - From Digital Inclusion to Digital Transformation in the Prevention of Drug-Related Deaths in Scotland: Qualitative Study JO - J Med Internet Res SP - e52345 VL - 26 KW - digital inclusion KW - digital transformation KW - digital health KW - drug-related death KW - digitalization KW - drug overdose KW - drug overdose death KW - harm reduction KW - mobile phone KW - digital divide N2 - Background: Globally, drug-related deaths (DRDs) are increasing, posing a significant challenge. Scotland has the highest DRD rate in Europe and one of the highest globally. The Scottish Government launched the Digital Lifelines Scotland (DLS) program to increase the provision of digital technology in harm reduction services and other support services. Digital technology responses to DRDs can include education through digital platforms, improved access to treatment and support via telehealth and mobile apps, analysis of data to identify risk factors, and the use of digital tools for naloxone distribution. However, digital technology should be integrated into a comprehensive approach that increases access to services and addresses underlying causes. Digital transformation could enhance harm reduction service and support, but challenges must be addressed for successful implementation. The DLS program aims to enhance digital inclusion and improve health outcomes for people who use or are affected by drug use to reduce the risk of DRDs. Objective: This study aims to explore the role of digital technology as an enabler and supporter in enhancing existing services and innovating new solutions, rather than being a stand-alone solution. Specifically focusing on individuals who use drugs, the research investigates the potential of digital inclusion and technology provision for preventing DRDs within the context of the DLS program. Methods: Semistructured interviews were conducted with 47 people: 21 (45%) service users, 14 (30%) service providers, and 12 (26%) program staff who were all involved in DLS. Interviews were audio recorded, transcribed, and then coded. Analysis was done in three phases: (1) thematic analysis of interview data to identify the benefits of digital technologies in this sector; (2) identification of the challenges and enablers of using digital technologies using the Technology, People, Organizations, and Macroenvironment conceptual framework; and (3) mapping digital technology provision to services offered to understand the extent of digital transformation of the field. Results: Participants identified increased connectivity, enhanced access to services, and improved well-being as key benefits. Digital devices facilitated social connections, alleviated loneliness, and fostered a sense of community. Devices enabled engagement with services and support workers, providing better access to resources. In addition, digital technology was perceived as a preventive measure to reduce harmful drug use. Lack of technical knowledge, organizational constraints, and usability challenges, including device preferences and security issues, were identified. Conclusions: The study found that digital inclusion through the provision of devices and connections has the potential to enhance support in the harm reduction sector. However, it highlighted the limitations of existing digital inclusion programs in achieving comprehensive digital transformation. To progress, there is a need for sustained engagement, cultural change, and economic considerations to overcome barriers. UR - https://www.jmir.org/2024/1/e52345 UR - http://dx.doi.org/10.2196/52345 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52345 ER - TY - JOUR AU - Sahan, Fatma AU - Guthardt, Lisa AU - Panitz, Karin AU - Siegel-Kianer, Anna AU - Eichhof, Isabel AU - Schmitt, D. Björn AU - Apolinario-Hagen, Jennifer PY - 2024/9/20 TI - Enhancing Digital Health Awareness and mHealth Competencies in Medical Education: Proof-of-Concept Study and Summative Process Evaluation of a Quality Improvement Project JO - JMIR Med Educ SP - e59454 VL - 10 KW - medical students KW - digital health KW - design thinking KW - digital health literacy KW - medical education KW - digital health competencies KW - mobile phone N2 - Background: Currently, there is a need to optimize knowledge on digital transformation in mental health care, including digital therapeutics (eg, prescription apps), in medical education. However, in Germany, digital health has not yet been systematically integrated into medical curricula and is taught in a relatively small number of electives. Challenges for lecturers include the dynamic field as well as lacking guidance on how to efficiently apply innovative teaching formats for these new digital competencies. Quality improvement projects provide options to pilot-test novel educational offerings, as little is known about the acceptability of participatory approaches in conventional medical education. Objective: This quality improvement project addressed the gap in medical school electives on digital health literacy by introducing and evaluating an elective scoping study on the systematic development of different health app concepts designed by students to cultivate essential skills for future health care professionals (ie, mobile health [mHealth] competencies). Methods: This proof-of-concept study describes the development, optimization, implementation, and evaluation of a web-based elective on digital (mental) health competencies in medical education. Implemented as part of a quality improvement project, the elective aimed to guide medical students in developing app concepts applying a design thinking approach at a German medical school from January 2021 to January 2024. Topics included defining digital (mental) health, quality criteria for health apps, user perspective, persuasive design, and critical reflection on digitization in medical practice. The elective was offered 6 times within 36 months, with continuous evaluation and iterative optimization using both process and outcome measures, such as web-based questionnaires. We present examples of app concepts designed by students and summarize the quantitative and qualitative evaluation results. Results: In total, 60 students completed the elective and developed 25 health app concepts, most commonly targeting stress management and depression. In addition, disease management and prevention apps were designed for various somatic conditions such as diabetes and chronic pain. The results indicated high overall satisfaction across the 6 courses according to the evaluation questionnaire, with lower scores indicating higher satisfaction on a scale ranging from 1 to 6 (mean 1.70, SD 0.68). Students particularly valued the content, flexibility, support, and structure. While improvements in group work, submissions, and information transfer were suggested, the results underscore the usefulness of the web-based elective. Conclusions: This quality improvement project provides insights into relevant features for the successful user-centered and creative integration of mHealth competencies into medical education. Key factors for the satisfaction of students involved the participatory mindset, focus on competencies, discussions with app providers, and flexibility. Future efforts should define important learning objectives for digital health literacy and provide recommendations for integration rather than debating the need for digital health integration. UR - https://mededu.jmir.org/2024/1/e59454 UR - http://dx.doi.org/10.2196/59454 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59454 ER - TY - JOUR AU - Grube, Lara AU - Petit, Pascal AU - Vuillerme, Nicolas AU - Nitschke, Marlies AU - Nwosu, Bertrand Obioma AU - Knitza, Johannes AU - Krusche, Martin AU - Seifer, Ann-Kristin AU - Eskofier, M. Bjoern AU - Schett, Georg AU - Morf, Harriet PY - 2024/9/19 TI - Complementary App-Based Yoga Home Exercise Therapy for Patients With Axial Spondyloarthritis: Usability Study JO - JMIR Form Res SP - e57185 VL - 8 KW - DTx KW - DHA KW - usability KW - Yoga KW - YogiTherapy KW - ankylosing spondylitis KW - axial spondylarthritis KW - digital health application KW - eHealth KW - self-assessment KW - physical exercise KW - patient acceptance KW - therapy KW - home exercise KW - exercise KW - patients KW - patient KW - spondyloarthritis KW - usability study KW - app KW - apps KW - rheumatic disease KW - chronic KW - spine KW - adjacent joints KW - joints KW - joint KW - correlation analysis KW - digital therapeutics N2 - Background: Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy. Objective: This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS. Methods: Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics. Results: A total of 65 patients with AS (33, 51% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43% (26/65 nonpromoters, 42% (25/65) indifferent, and 15% (9/65) promoters. A total of 7% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is ?26%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=?0.21, P<.001). Conclusions: The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy. UR - https://formative.jmir.org/2024/1/e57185 UR - http://dx.doi.org/10.2196/57185 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57185 ER - TY - JOUR AU - Miller, M. Janis AU - Wyman, F. Jean AU - An, Lawrence AU - Chu, Haitao AU - Fok, S. Cynthia AU - Lavender, Missy AU - Lewis, Elizabeth Cora AU - Markland, D. Alayne AU - Rickey, M. Leslie AU - Sheng, Ying AU - Sutcliffe, Siobhan AU - Low, Kane Lisa AU - Mueller, R. Elizabeth AU - PY - 2024/9/18 TI - Design of a Tool Capable of Assessing Environmental Sociocultural Physical Factors Influencing Women?s Decisions on When and Where to Toilet Within Real-World Settings: Protocol for the Build and Usability Testing of a Mobile App for Use by Community-Dwelling Women JO - JMIR Res Protoc SP - e54046 VL - 13 KW - mobile app KW - urinary bladder KW - woman?s health KW - toileting KW - ecological momentary assessment KW - time factors KW - population studies KW - real-world environment KW - mobile phone N2 - Background: Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool. Objective: The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women?s decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when ?thinking about my bladder? and shortly before ?I just peed,? (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere. Methods: The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ?74, was 40 women completing the study. Results: Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022. Conclusions: WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health. International Registered Report Identifier (IRRID): RR1-10.2196/54046 UR - https://www.researchprotocols.org/2024/1/e54046 UR - http://dx.doi.org/10.2196/54046 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54046 ER - TY - JOUR AU - Shin, Daun AU - Kim, Hyoseung AU - Lee, Seunghwan AU - Cho, Younhee AU - Jung, Whanbo PY - 2024/9/18 TI - Using Large Language Models to Detect Depression From User-Generated Diary Text Data as a Novel Approach in Digital Mental Health Screening: Instrument Validation Study JO - J Med Internet Res SP - e54617 VL - 26 KW - depression KW - screening KW - artificial intelligence KW - digital health technology KW - text data N2 - Background: Depressive disorders have substantial global implications, leading to various social consequences, including decreased occupational productivity and a high disability burden. Early detection and intervention for clinically significant depression have gained attention; however, the existing depression screening tools, such as the Center for Epidemiologic Studies Depression Scale, have limitations in objectivity and accuracy. Therefore, researchers are identifying objective indicators of depression, including image analysis, blood biomarkers, and ecological momentary assessments (EMAs). Among EMAs, user-generated text data, particularly from diary writing, have emerged as a clinically significant and analyzable source for detecting or diagnosing depression, leveraging advancements in large language models such as ChatGPT. Objective: We aimed to detect depression based on user-generated diary text through an emotional diary writing app using a large language model (LLM). We aimed to validate the value of the semistructured diary text data as an EMA data source. Methods: Participants were assessed for depression using the Patient Health Questionnaire and suicide risk was evaluated using the Beck Scale for Suicide Ideation before starting and after completing the 2-week diary writing period. The text data from the daily diaries were also used in the analysis. The performance of leading LLMs, such as ChatGPT with GPT-3.5 and GPT-4, was assessed with and without GPT-3.5 fine-tuning on the training data set. The model performance comparison involved the use of chain-of-thought and zero-shot prompting to analyze the text structure and content. Results: We used 428 diaries from 91 participants; GPT-3.5 fine-tuning demonstrated superior performance in depression detection, achieving an accuracy of 0.902 and a specificity of 0.955. However, the balanced accuracy was the highest (0.844) for GPT-3.5 without fine-tuning and prompt techniques; it displayed a recall of 0.929. Conclusions: Both GPT-3.5 and GPT-4.0 demonstrated relatively reasonable performance in recognizing the risk of depression based on diaries. Our findings highlight the potential clinical usefulness of user-generated text data for detecting depression. In addition to measurable indicators, such as step count and physical activity, future research should increasingly emphasize qualitative digital expression. UR - https://www.jmir.org/2024/1/e54617 UR - http://dx.doi.org/10.2196/54617 UR - http://www.ncbi.nlm.nih.gov/pubmed/39292502 ID - info:doi/10.2196/54617 ER - TY - JOUR AU - Butler, Sonia AU - Sculley, Dean AU - Santos, Derek AU - Gironès, Xavier AU - Singh-Grewal, Davinder AU - Coda, Andrea PY - 2024/9/17 TI - Development and Delivery of an Integrated Digital Health Care Approach for Children With Juvenile Idiopathic Arthritis: Usability Study JO - JMIR Pediatr Parent SP - e56816 VL - 7 KW - phone app KW - smart watch KW - juvenile idiopathic arthritis KW - pain KW - medication adherence KW - physical activity KW - integrated care KW - medication KW - development KW - usability study KW - chronic inflammatory disorder KW - children KW - child KW - usability KW - survey KW - thematic analysis KW - gamification KW - modules KW - web-based platform KW - support N2 - Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disorder with no cure. Most children are prescribed several medications aimed at controlling disease activity, managing symptoms, and reducing pain. Physical activity is also encouraged to retain musculoskeletal function. The primary determinants of treatment success are maintaining long-term adherence, ongoing monitoring by a pediatric rheumatologist, and involvement of an interdisciplinary team. To support these goals, a new digital intervention was developed, InteractiveClinics, which aimed to prompt children to take their medications, report pain levels, and increase their physical activity. Objective: This study aims to evaluate the usability of InteractiveClinics among children with JIA. Methods: As part of this pediatric cross-sectional study, 12 children were asked to wear a smartwatch for 2 weeks, which was synchronized to the InteractiveClinics phone app and web-based platform. Personalized notifications were sent daily to the watch and phone, to prompt and record medication adherence and pain level assessment. Physical activity was automatically recorded by the watch. At the end of the study, all children and parents completed a postintervention survey. Written comments were also encouraged to gain further feedback. Descriptive statistics were used to summarize the survey results, and all qualitative data underwent thematic analysis. Results: Twelve children aged 10 to 18 years (mean 14.2, SD 3.1 years; female: n=8, 66.7%) and 1 parent for each child (n=12; female: n=8, 66.7%) were enrolled in the study. Based on the highest and lowest agreement areas of the survey, most children and parents liked the smartwatch and web-based platform; they found it easy to learn and simple to use. They were also satisfied with the pain and physical activity module. However, usability and acceptability barriers that hindered uptake were identified in the phone app and medication module. Children required a unique in-app experience, and their suggestive improvements included more personalization within the app; simplification by removing all links not relevant to antirheumatic medications; flexibility in response times; improved conferment through gamification; additional comment fields for the input of more data, such as medication side effects or pain-related symptoms; more detailed graphical illustrations of the physical activity module, including a breakdown of metrics; and importantly, interconnections between modules, because medication adherence, pain levels, and physical activity can each influence the other. They were, overall, improving usefulness for children and parents. Conclusions: The usability of InteractiveClinics was positive. Children and parents liked the watch and web-based platform and were satisfied with the pain and physical activity module. However, children wanted a unique in-app experience through more personalization, simplification, flexibility, conferment, comment fields, graphical illustrations, a breakdown of metrics, and interconnections. Certainly, inclusions are needed to promote user adoption and advancement of new validated digital health interventions in pediatric rheumatology, to support the delivery of integrated care. Trial Registration: ANZCTR ACTRN12616000665437; https://tinyurl.com/mwwfje8r UR - https://pediatrics.jmir.org/2024/1/e56816 UR - http://dx.doi.org/10.2196/56816 ID - info:doi/10.2196/56816 ER - TY - JOUR AU - Mirabootalebi, Narjes AU - Meidani, Zahra AU - Akbari, Hossein AU - Rangraz Jeddi, Fatemeh AU - Tagharrobi, Zahra AU - Swoboda, Walter AU - Holl, Felix PY - 2024/9/17 TI - Design and Psychometric Evaluation of Nurses? Mobile Health Device Acceptance Scale (NMHDA-Scale): Application of the Expectation-Confirmation Theory JO - JMIR Hum Factors SP - e55324 VL - 11 KW - mobile health KW - acceptance KW - psychometric evaluation KW - nursing KW - Expectation-Confirmation Theory KW - smartphone N2 - Background: The use of mobile tools in nursing care is indispensable. Given the importance of nurses? acceptance of these tools in delivering effective care, this issue requires greater attention. Objective: This study aims to design the Mobile Health Tool Acceptance Scale for Nurses based on the Expectation-Confirmation Theory and to evaluate it psychometrically. Methods: Using a Waltz-based approach grounded in existing tools and the constructs of the Expectation-Confirmation Theory, the initial version of the scale was designed and evaluated for face and content validity. Construct validity was examined through exploratory factor analysis, concurrent validity, and known-group comparison. Reliability was assessed using measures of internal consistency and stability. Results: The initial version of the scale consisted of 33 items. During the qualitative and quantitative content validity stage, 1 item was added and 1 item was removed. Exploratory factor analysis, retaining 33 items, identified 5 factors that explained 70.53% of the variance. A significant positive correlation was found between the scores of the designed tool and nurses? attitudes toward using mobile-based apps in nursing care (r=0.655, P<.001). The intraclass correlation coefficient, Cronbach ?, and ? coefficient were 0.938, 0.953, and 0.907, respectively. Conclusions: The 33-item scale developed is a valid and reliable instrument for measuring nurses? acceptance of mobile health tools. UR - https://humanfactors.jmir.org/2024/1/e55324 UR - http://dx.doi.org/10.2196/55324 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55324 ER - TY - JOUR AU - Fu, Yan AU - Zhang, Yuxin AU - Ye, Bing AU - Babineau, Jessica AU - Zhao, Yan AU - Gao, Zhengke AU - Mihailidis, Alex PY - 2024/9/16 TI - Smartphone-Based Hand Function Assessment: Systematic Review JO - J Med Internet Res SP - e51564 VL - 26 KW - hand function assessment KW - smartphone-based sensing KW - rehabilitation KW - digital health KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Hand function assessment heavily relies on specific task scenarios, making it challenging to ensure validity and reliability. In addition, the wide range of assessment tools, limited and expensive data recording, and analysis systems further aggravate the issue. However, smartphones provide a promising opportunity to address these challenges. Thus, the built-in, high-efficiency sensors in smartphones can be used as effective tools for hand function assessment. Objective: This review aims to evaluate existing studies on hand function evaluation using smartphones. Methods: An information specialist searched 8 databases on June 8, 2023. The search criteria included two major concepts: (1) smartphone or mobile phone or mHealth and (2) hand function or function assessment. Searches were limited to human studies in the English language and excluded conference proceedings and trial register records. Two reviewers independently screened all studies, with a third reviewer involved in resolving discrepancies. The included studies were rated according to the Mixed Methods Appraisal Tool. One reviewer extracted data on publication, demographics, hand function types, sensors used for hand function assessment, and statistical or machine learning (ML) methods. Accuracy was checked by another reviewer. The data were synthesized and tabulated based on each of the research questions. Results: In total, 46 studies were included. Overall, 11 types of hand dysfunction?related problems were identified, such as Parkinson disease, wrist injury, stroke, and hand injury, and 6 types of hand dysfunctions were found, namely an abnormal range of motion, tremors, bradykinesia, the decline of fine motor skills, hypokinesia, and nonspecific dysfunction related to hand arthritis. Among all built-in smartphone sensors, the accelerometer was the most used, followed by the smartphone camera. Most studies used statistical methods for data processing, whereas ML algorithms were applied for disease detection, disease severity evaluation, disease prediction, and feature aggregation. Conclusions: This systematic review highlights the potential of smartphone-based hand function assessment. The review suggests that a smartphone is a promising tool for hand function evaluation. ML is a conducive method to classify levels of hand dysfunction. Future research could (1) explore a gold standard for smartphone-based hand function assessment and (2) take advantage of smartphones? multiple built-in sensors to assess hand function comprehensively, focus on developing ML methods for processing collected smartphone data, and focus on real-time assessment during rehabilitation training. The limitations of the research are 2-fold. First, the nascent nature of smartphone-based hand function assessment led to limited relevant literature, affecting the evidence?s completeness and comprehensiveness. This can hinder supporting viewpoints and drawing conclusions. Second, literature quality varies due to the exploratory nature of the topic, with potential inconsistencies and a lack of high-quality reference studies and meta-analyses. UR - https://www.jmir.org/2024/1/e51564 UR - http://dx.doi.org/10.2196/51564 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51564 ER - TY - JOUR AU - Debeij, M. Suzanne AU - Aardoom, J. Jiska AU - Haaksma, L. Miriam AU - Stoop, M. Wieteke A. AU - van Dam van Isselt, F. Eléonore AU - Kasteleyn, J. Marise PY - 2024/9/13 TI - The Potential Use and Value of a Wearable Monitoring Bracelet for Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study Investigating the Patient and Health Care Professional Perspectives JO - JMIR Form Res SP - e57108 VL - 8 KW - eHealth KW - Chronic Obstructive Pulmonary Disease KW - COPD KW - wearable KW - exacerbation KW - self-management KW - monitoring bracelet KW - remote monitoring KW - mobile phone N2 - Background: The occurrence of exacerbations has major effects on the health of people with chronic obstructive pulmonary disease (COPD). Monitoring devices that measure (vital) parameters hold promise for timely identification and treatment of exacerbations. Stakeholders? perspectives on the use of monitoring devices are of importance for the successful development and implementation of a device. Objective: This study aimed to explore the potential use and value of a wearable monitoring bracelet (MB) for patients with COPD at high risk for exacerbation. The perspectives of health care professionals as well as patients were examined, both immediately after hospitalization and over a longer period. Furthermore, potential facilitators and barriers to the use and implementation of an MB were explored. Methods: Data for this qualitative study were collected from January to April 2023. A total of 11 participants (eg, n=6 health care professionals [HCPs], 2 patients, and 3 additional patients) participated. In total, 2 semistructured focus groups were conducted via video calls; 1 with HCPs of various professional backgrounds and 1 with patients. In addition, 3 semistructured individual interviews were held with patients. The interviews and focus groups addressed attitudes, wishes, needs, as well as factors that could either support or impede the potential MB use. Data from interviews and focus groups were coded and analyzed according to the principles of the framework method. Results: HCPs and patients both predominantly emphasized the importance of an MB in terms of promptly identifying exacerbations by detecting deviations from normal (vital) parameters, and subsequently alerting users. According to HCPs, this is how an MB should support the self-management of patients. Most participants did not anticipate major differences in value and use of an MB between the short-term and the long-term periods after hospitalization. Facilitators of the potential use and implementation of an MB that participants highlighted were ease of use and some form of support for patients in using an MB and interpreting the data. HCPs as well as patients expressed concerns about potential costs as a barrier to use and implementation. Another barrier that HCPs mentioned, was the prerequisite of digital literacy for patients to be able to interpret and react to the data from an MB. Conclusions: HCPs and patients both recognize that an MB could be beneficial and valuable to patients with COPD at high risk for exacerbation, in the short as well as the long term. In particular, they perceived value in supporting self-management of patients with COPD. Stakeholders would be able to use the obtained insights in support of the effective implementation of MBs in COPD patient care, which can potentially improve health care and the overall well-being of patients with COPD. UR - https://formative.jmir.org/2024/1/e57108 UR - http://dx.doi.org/10.2196/57108 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57108 ER - TY - JOUR AU - Swain, Alexander T. AU - McNarry, A. Melitta AU - Mackintosh, A. Kelly PY - 2024/9/13 TI - Assessing and Enhancing Movement Quality Using Wearables and Consumer Technologies: Thematic Analysis of Expert Perspectives JO - JMIR Form Res SP - e56784 VL - 8 KW - physical activity KW - exercise KW - wellness KW - qualitative KW - sensors KW - motor skill KW - motor learning KW - movement skills KW - skill development KW - movement assessment N2 - Background: Improvements in movement quality (ie, how well an individual moves) facilitate increases in movement quantity, subsequently improving general health and quality of life. Wearable technology offers a convenient, affordable means of measuring and assessing movement quality for the general population, while technology more broadly can provide constructive feedback through various modalities. Considering the perspectives of professionals involved in the development and implementation of technology helps translate user needs into effective strategies for the optimal application of consumer technologies to enhance movement quality. Objective: This study aimed to obtain the opinions of wearable technology experts regarding the use of wearable devices to measure movement quality and provide feedback. A secondary objective was to determine potential strategies for integrating preferred assessment and feedback characteristics into a technology-based movement quality intervention for the general, recreationally active population. Methods: Semistructured interviews were conducted with 12 participants (age: mean 42, SD 9 years; 5 males) between August and September 2022 using a predetermined interview schedule. Participants were categorized based on their professional roles: commercial (n=4) and research and development (R&D; n=8). All participants had experience in the development or application of wearable technology for sports, exercise, and wellness. The verbatim interview transcripts were analyzed using reflexive thematic analysis in QSR NVivo (release 1.7), resulting in the identification of overarching themes and subthemes. Results: Three main themes were generated as follows: (1) ?Grab and Go,? (2) ?Adjust and Adapt,? and (3) ?Visualize and Feedback.? Participants emphasized the importance of convenience to enhance user engagement when using wearables to collect movement data. However, it was suggested that users would tolerate minor inconveniences if the benefits were perceived as valuable. Simple, easily interpretable feedback was recommended to accommodate diverse audiences and aid understanding of their movement quality, while avoiding excessive detail was advised to prevent overload, which could deter users. Adaptability was endorsed to accommodate progressions in user movement quality, and customizable systems were advocated to offer variety, thereby increasing user interest and engagement. The findings indicate that visual feedback representative of the user (ie, an avatar) should be used, supplemented with concise text or audible instructions to form a comprehensive, multimodal feedback system. Conclusions: The study provides insights from wearable technology experts on the use of consumer technologies for enhancing movement quality. The findings recommend the prioritization of user convenience and simplistic, multimodal feedback centered around visualizations, and an adaptable system suitable for a diverse audience. Emphasizing individualized feedback and user-centric design, this study provides valuable findings around the use of wearables and other consumer technologies to enhance movement quality among the general population. These findings, in conjunction with those of future research into user perspectives, should be applied in practical settings to evaluate their effectiveness in enhancing movement quality. UR - https://formative.jmir.org/2024/1/e56784 UR - http://dx.doi.org/10.2196/56784 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56784 ER - TY - JOUR AU - Sun, Hui AU - Wu, Yanping AU - Sun, Jia AU - Zhou, Wu AU - Xu, Qian AU - Hu, Dandan PY - 2024/9/12 TI - Nutrition Management Miniprograms in WeChat: Evaluation of Functionality and Quality JO - JMIR Hum Factors SP - e56486 VL - 11 KW - nutrition management KW - WeChat mini-program KW - User Version of the Mobile Application Rating Scale KW - uMARS KW - function and quality evaluation N2 - Background: With the rise in people?s living standards and aging populations, a heightened emphasis has been placed in the field of medical and health care. In recent years, there has been a drastic increase in nutrition management in domestic research circles. The mobile nutritional health management platform based on WeChat miniprograms has been widely used to promote health and self-management and to monitor individual nutritional health status in China. Nevertheless, there has been a lack of comprehensive scientific evaluation regarding the functionality and quality of the diverse range of nutritional miniprograms that have surfaced in the market. Objective: This study aimed to evaluate the functionality and quality of China?s WeChat nutrition management miniprogram by using the User Version of the Mobile Application Rating Scale (uMARS). Methods: This observational study involves quantitative methods. A keyword search for ?nutrition,? ?diet,? ?food,? and ?meal? in Chinese or English was conducted on WeChat, and all miniprograms pertaining to these keywords were thoroughly analyzed. Then, basic information including name, registration date, update date, service type, user scores, and functional scores was extracted from January 2017 to November 2023. Rating scores were provided by users based on their experience and satisfaction with the use of the WeChat miniprogram, and functional scores were integrated and summarized for the primary functions of each miniprogram. Moreover, the quality of nutrition management applets was evaluated by 3 researchers independently using the uMARS. Results: Initially, 27 of 891 miniprograms identified were relevant to nutrition management. Among them, 85.2% (23/27) of them offered features for diet management, facilitating recording of daily dietary intake to evaluate nutritional status; 70.4% (19/27) provided resources for nutrition education and classroom instruction; 59.3% (16/27) included functionalities for exercise management, allowing users to record daily physical activity; and only 44.4% (12/27) featured components for weight management. The total quality score on the uMARS ranged 2.85-3.88 (median 3.38, IQR 3.14-3.57). Engagement scores on the uMARS varied from 2.00 to 4.33 (median 3.00, IQR 2.67-3.67). Functional dimension scores ranged from 3.00 to 4.00 (median 3.33, IQR 3.33-3.67), with a lower score of 2.67 and a higher score of 4.33 outside the reference range. Aesthetic dimension scores ranged from 2.33 to 4.67 (median 3.67, IQR 3.33-4.00). Informational dimension scores ranged from 2.33 to 4.67 (median 3.33, IQR 2.67-3.67). Conclusions: Our findings from the uMARS highlight a predominant emphasis on health aspects over nutritional specifications in the app supporting WeChat miniprograms related to nutrition management. The quality of these miniprograms is currently at an average level, with considerable room for functional improvements in the future. UR - https://humanfactors.jmir.org/2024/1/e56486 UR - http://dx.doi.org/10.2196/56486 ID - info:doi/10.2196/56486 ER - TY - JOUR AU - Egan, Kieren AU - Macdonald, Bradley AU - Hodgson, William AU - Kirk, Alison AU - Fawcett, Barbara AU - Dunlop, D. Mark AU - Maguire, Roma AU - Flynn, Greg AU - Stott, Joshua AU - Windle, Gill PY - 2024/9/12 TI - Physical Activity Mobile App (CareFit) for Informal Carers of People With Dementia: Protocol for a Feasibility and Adaptation Study JO - JMIR Res Protoc SP - e53727 VL - 13 KW - carers KW - dementia KW - physical activity KW - sedentary KW - cross platform app KW - caregivers KW - mobile phone N2 - Background: Physical activity is a critical component of both well-being and preventative health, reducing the risk of both chronic mental and physical conditions and early death. Yet, there are numerous groups in society who are not able to undertake as much physical activity as they would like to. This includes informal (unpaid) carers, with the United Kingdom national survey data suggesting that 81% would like to do more physical activity on a regular basis. There is a clear need to develop innovations, including digital interventions that hold implementation potential to support regular physical activity in groups such as carers. Objective: This study aims to expand and personalize a cross-platform digital health app designed to support regular physical activity in carers of people with dementia for a period of 8 weeks and evaluate the potential for implementation. Methods: The CareFit for dementia carers study was a mixed methods co-design, development, and evaluation of a novel motivational smartphone app to support home-based regular physical activity for unpaid dementia carers. The study was planned to take place across 16 months in total (September 1, 2022, to December 31, 2023). The first phase included iterative design sprints to redesign an initial prototype for widespread use, supported through a bespoke content management system. The second phase included the release of the ?CareFit? app across Scotland through invitations on the Apple and Google stores where we aimed to recruit 50 carers and up to 20 professionals to support the delivery in total. Partnerships for the work included a range of stakeholders across charities, health and social care partnerships, physical activity groups, and carers? organizations. We explored the implementation of CareFit, guided by both Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and the Complex Intervention Frameworks. Results: Project processes and outcomes were evaluated using mixed methods. The barriers and enablers for professional staff to signpost and use CareFit with clients were assessed through interviews or focus groups and round stakeholder meetings. The usability of CareFit was explored through qualitative interviews with carers and a system usability scale. We examined how CareFit could add value to carers by examining ?in-app? data, pre-post questionnaire responses, and qualitative work, including interviews and focus groups. We also explored how CareFit could add value to the landscape of other online resources for dementia carers. Conclusions: Results from this study will contribute new knowledge including identifying (1) suitable pathways to identify and support carers through digital innovations; (2) future design of definitive studies in carer populations; and (3) an improved understanding of the Reach, Effectiveness, Adoption, Implementation, and Maintenance across a range of key stakeholders. International Registered Report Identifier (IRRID): DERR1-10.2196/53727 UR - https://www.researchprotocols.org/2024/1/e53727 UR - http://dx.doi.org/10.2196/53727 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53727 ER - TY - JOUR AU - Velmovitsky, Elkind Pedro AU - Kirolos, Merna AU - Alencar, Paulo AU - Leatherdale, Scott AU - Cowan, Donald AU - Morita, Pelegrini Plinio PY - 2024/9/12 TI - Leveraging mHealth Technologies for Public Health JO - JMIR Public Health Surveill SP - e49719 VL - 10 KW - mobile health KW - mHealth KW - smart technology KW - wearables KW - public health KW - population health KW - apps KW - surveys KW - self-report KW - surveillance KW - digital public health KW - mobile phone UR - https://publichealth.jmir.org/2024/1/e49719 UR - http://dx.doi.org/10.2196/49719 UR - http://www.ncbi.nlm.nih.gov/pubmed/39265164 ID - info:doi/10.2196/49719 ER - TY - JOUR AU - Ferguson, M. Jacqueline AU - Van Campen, James AU - Slightam, Cindie AU - Greene, Liberty AU - Heyworth, Leonie AU - Zulman, M. Donna PY - 2024/9/9 TI - Evaluation of the Veterans Health Administration?s Digital Divide Consult for Tablet Distribution and Telehealth Adoption: Cohort Study JO - J Med Internet Res SP - e59089 VL - 26 KW - veterans KW - health care access KW - video-based care KW - telehealth KW - barriers to care KW - telemedicine N2 - Background: Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health care access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource. Objective: We sought to evaluate the reach and impact of VHA?s Connected Device Program, leveraging Digital Divide Consult data to determine whether resources are supporting veterans with health care needs and access barriers. Methods: We examined the reach of VHA?s Connected Device Program using national secondary data from VHA?s electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,219 veterans from the general VHA population. We assessed changes in tablet recipients? demographic and clinical characteristics before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of tablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet recipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based services by tablet referral reason. Results: Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9%), distance from a VHA facility >30 miles (17,228/79,230, 21.7%), and social isolation (16,161/79,230, 20.4%). Moreover, 63.0% (49,925/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first 6 months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8% [830/1100] with video use), living >30 miles from a VHA facility (68.3% [10,557/17,228] with video use), and having a mental health diagnosis (68.1% [34,301/50,367] with video use). Tablet recipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95% CI 2.91-2.99) before consult implementation and 2.73 (95% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of nonuse. Conclusions: This evaluation of VHA?s Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention. UR - https://www.jmir.org/2024/1/e59089 UR - http://dx.doi.org/10.2196/59089 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250183 ID - info:doi/10.2196/59089 ER - TY - JOUR AU - Tak, Won Yae AU - Lee, Won Jong AU - Kim, Junetae AU - Lee, Yura PY - 2024/9/9 TI - Predicting Long-Term Engagement in mHealth Apps: Comparative Study of Engagement Indices JO - J Med Internet Res SP - e59444 VL - 26 KW - treatment adherence and compliance KW - patient compliance KW - medication adherence KW - digital therapeutics KW - engagement index KW - mobile phone N2 - Background: Digital health care apps, including digital therapeutics, have the potential to increase accessibility and improve patient engagement by overcoming the limitations of traditional facility-based medical treatments. However, there are no established tools capable of quantitatively measuring long-term engagement at present. Objective: This study aimed to evaluate an existing engagement index (EI) in a commercial health management app for long-term use and compare it with a newly developed EI. Methods: Participants were recruited from cancer survivors enrolled in a randomized controlled trial that evaluated the impact of mobile health apps on recovery. Of these patients, 240 were included in the study and randomly assigned to the Noom app (Noom Inc). The newly developed EI was compared with the existing EI, and a long-term use analysis was conducted. Furthermore, the new EI was evaluated based on adapted measurements from the Web Matrix Visitor Index, focusing on click depth, recency, and loyalty indices. Results: The newly developed EI model outperformed the existing EI model in terms of predicting EI of a 6- to 9-month period based on the EI of a 3- to 6-month period. The existing model had a mean squared error of 0.096, a root mean squared error of 0.310, and an R2 of 0.053. Meanwhile, the newly developed EI models showed improved performance, with the best one achieving a mean squared error of 0.025, root mean squared error of 0.157, and R2 of 0.610. The existing EI exhibited significant associations: the click depth index (hazard ratio [HR] 0.49, 95% CI 0.29-0.84; P<.001) and loyalty index (HR 0.17, 95% CI 0.09-0.31; P<.001) were significantly associated with improved survival, whereas the recency index exhibited no significant association (HR 1.30, 95% CI 1.70-2.42; P=.41). Among the new EI models, the EI with a menu combination of menus available in the app?s free version yielded the most promising result. Furthermore, it exhibited significant associations with the loyalty index (HR 0.32, 95% CI 0.16-0.62; P<.001) and the recency index (HR 0.47, 95% CI 0.30-0.75; P<.001). Conclusions: The newly developed EI model outperformed the existing model in terms of the prediction of long-term user engagement and compliance in a mobile health app context. We emphasized the importance of log data and suggested avenues for future research to address the subjectivity of the EI and incorporate a broader range of indices for comprehensive evaluation. UR - https://www.jmir.org/2024/1/e59444 UR - http://dx.doi.org/10.2196/59444 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250192 ID - info:doi/10.2196/59444 ER - TY - JOUR AU - Dieter, Valerie AU - Janssen, Pia AU - Krauss, Inga PY - 2024/9/9 TI - Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e54356 VL - 12 KW - digital app KW - mobile health KW - mHealth KW - knee osteoarthritis KW - exercise KW - knee brace N2 - Background: Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply. Objective: This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis. Methods: This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately. Results: A total of 61 participants were included (IG: n=30, 49%; CG: n=31, 51%; male: n=31, 51%; female: n=30, 49%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5% (899/972) of all scheduled exercise sessions. Conclusions: Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls. Trial Registration: German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269 UR - https://mhealth.jmir.org/2024/1/e54356 UR - http://dx.doi.org/10.2196/54356 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250181 ID - info:doi/10.2196/54356 ER - TY - JOUR AU - Yanez Touzet, Alvaro AU - Houhou, Tatiana AU - Rahic, Zerina AU - Laufer, Ilya AU - Margetis, Konstantinos AU - Martin, R. Allan AU - Dea, Nicolas AU - Ghogawala, Zoher AU - Kapushesky, Misha AU - Kotter, N. Mark R. AU - Davies, M. Benjamin AU - PY - 2024/9/9 TI - Validity of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Preliminary Findings From a Longitudinal Observational Study JO - JMIR Neurotech SP - e52832 VL - 3 KW - validation study KW - patient outcome assessment KW - smartphone KW - neurology KW - psychometrics KW - validity KW - validation KW - outcomes KW - degenerative KW - myelopathy KW - neuroscience KW - spine KW - monitor KW - monitoring KW - neuromuscular KW - muscular KW - mHealth KW - apps KW - measure KW - measures KW - measurements N2 - Background: Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM research priority. Difficulties detecting DCM, and changes in DCM, cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. Objective: The study aims to assess the validity of MoveMed, a battery of performance outcome measures performed using a smartphone app, in the measurement of DCM. Methods: A prospective observational study in decentralized secondary care was performed in England, United Kingdom. Validity and risk of bias were assessed using criteria from the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) manual. Each MoveMed outcome was compared with 2 patient-reported comparators, with a priori hypotheses of convergence or divergence tested against consensus thresholds. The primary outcome was the correlation coefficient between the MoveMed outcome and the patient-reported comparators. The secondary outcome was the percentage of correlations that aligned with the a priori hypotheses. The comparators used were the patient-derived modified Japanese Orthopaedic Association score and the World Health Organization Quality of Life Brief Version questionnaire. Thresholds for convergence or divergence were set at ?0.3 for convergence, <0.3 for divergence, and >0/<0 for directionality. Results: A total of 27 adults aged 60 (SD 11) years who live with DCM and possess an approved smartphone were included in a preliminary analysis. As expected, MoveMed tests of neuromuscular function correlated most with questionnaires of neuromuscular function (?0.3) and least with questionnaires of quality of life (<0.3). Furthermore, directly related constructs correlated positively to each other (>0), while inversely related constructs correlated negatively (<0). Overall, 74% (67/90) and 47% (8/17) of correlations (unidimensional and multidimensional, respectively) were in accordance with hypotheses. No risk-of-bias factors from the COSMIN Risk of Bias checklist were recorded. Overall, this was equivalent to ?very good? quality evidence of sufficient construct validity in DCM. Conclusions: MoveMed outcomes and patient-reported questionnaires converge and diverge in accordance with expectations. These findings support the validity of the MoveMed tests in an adult population living with DCM. Criteria from COSMIN provide ?very good? quality evidence to support this. UR - https://neuro.jmir.org/2024/1/e52832 UR - http://dx.doi.org/10.2196/52832 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52832 ER - TY - JOUR AU - Adu, K. Medard AU - Eboreime, Oghenekome AU - Shalaby, Reham AU - Eboreime, Ejemai AU - Agyapong, Belinda AU - da Luz Dias, Raquel AU - Sapara, O. Adegboyega AU - Agyapong, O. Vincent I. PY - 2024/9/9 TI - Comparing Email Versus Text Messaging as Delivery Platforms for Supporting Patients With Major Depressive Disorder: Noninferiority Randomized Controlled Trial JO - JMIR Form Res SP - e59003 VL - 8 KW - major depressive disorder KW - Text4Support KW - SMS text messaging KW - email messaging KW - digital health KW - mental health KW - mobile phone KW - depressive disorder KW - health communication KW - global health KW - treatments KW - patient KW - text messaging-based KW - cognitive behavioral therapy KW - communication KW - effectiveness KW - mental health support KW - digital intervention KW - digital interventions KW - mental health care KW - well-being KW - depression symptoms N2 - Background: The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging?based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain. Objective: This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care. Methods: A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5). Results: Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded ?No? to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: ?1.90, 95% CI ?6.53 to 2.74; 5.78, 95% CI ?1.94 to 13.50; and 11.85, 95% CI ?3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life. Conclusions: The study?s findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings. Trial Registration: ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/ UR - https://formative.jmir.org/2024/1/e59003 UR - http://dx.doi.org/10.2196/59003 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250182 ID - info:doi/10.2196/59003 ER - TY - JOUR AU - Shi, Weihong AU - Zhang, Yuhang AU - Bian, Yanyan AU - Chen, Lixia AU - Yuan, Wangshu AU - Zhang, Houqiang AU - Feng, Qiyang AU - Zhang, Huiling AU - Liu, Diana AU - Lin, Ye PY - 2024/9/6 TI - The Physical and Psychological Effects of Telerehabilitation-Based Exercise for Patients With Nonspecific Low Back Pain: Prospective Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e56580 VL - 12 KW - nonspecific low back pain KW - telerehabilitation KW - physical therapy KW - low back pain KW - back pain KW - psychological KW - exercise KW - randomized controlled trial KW - efficacy KW - medical infrastructure KW - pain intensity KW - quality of life KW - health survey KW - therapeutic KW - mobile phone N2 - Background: Physical therapy has demonstrated efficacy in managing nonspecific low back pain (NLBP) among patients. Nevertheless, the prevalence of NLBP poses a challenge, as the existing medical infrastructure may be insufficient to care for the large patient population, particularly in geographically remote regions. Telerehabilitation emerges as a promising method to address this concern by offering a method to deliver superior medical care to a greater number of patients with NLBP. Objective: The purpose of this study is to demonstrate the physical and psychological effectiveness of a user-centered telerehabilitation program, consisting of a smartphone app and integrated sensors, for patients with NLBP. Methods: This was a single-center, prospective, randomized controlled trial for individuals with NLBP for a duration exceeding 3 months. All participants were assigned randomly to either the telerehabilitation-based exercise group (TBEG) or the outpatient-based exercise group (OBEG). All participants completed a 30-minute regimen of strength and stretching exercises 3 times per week, for a total of 8 weeks, and were required to complete assessment questionnaires at 0, 2, 4, and 8 weeks. The TBEG completed home-based exercises and questionnaires using a telerehabilitation program, while the OBEG completed them in outpatient rehabilitation. The Oswestry Disability Index (ODI) served as the primary outcome measure, assessing physical disability. Secondary outcomes included the Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire, and 36-item Short-Form Health Survey. Results: In total, 54 of 129 eligible patients were enrolled and randomly assigned to the study. The completion of all the interventions and assessments in the TBEG and OBEG was 89% (24/27) and 81% (22/27). The findings indicate that no statistical significance was found in the difference of ODI scores between the TBEG and the OBEG at 2 weeks (mean difference ?0.91; odds ratio [OR] 0.78, 95% CI ?5.96 to 4.14; P=.72), 4 weeks (mean difference ?3.80; OR 1.33, 95% CI ?9.86 to ?2.25; P=.21), and 8 weeks (mean difference ?3.24; OR 0.92, 95% CI ?8.65 to 2.17; P=.24). The improvement of the ODI in the TBEG (mean ?16.42, SD 7.30) and OBEG (mean ?13.18, SD 8.48) was higher than 10 after an 8-week intervention. No statistically significant differences were observed between the 2 groups at the 8-week mark regarding the Fear-Avoidance Beliefs Questionnaire (mean difference 8.88; OR 1.04, 95% CI ?2.29 to 20.06; P=.12) and Numeric Pain Rating Scale (mean difference ?0.39; OR 0.44, 95% CI ?2.10 to 1.31; P=.64). In the subgroup analysis, there was no statistically significant difference in outcomes between the 2 groups. Conclusions: Telerehabilitation interventions demonstrate comparable therapeutic efficacy for individuals with NLBP when compared to conventional outpatient-based physical therapy, yielding comparable outcomes in pain reduction and improvement in functional limitations. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300068984; https://www.chictr.org.cn/showproj.html?proj=189852 UR - https://mhealth.jmir.org/2024/1/e56580 UR - http://dx.doi.org/10.2196/56580 ID - info:doi/10.2196/56580 ER - TY - JOUR AU - Hodson, Nathan AU - Woods, Peter AU - Solano, Luque Juan AU - Talbot, Charlotte AU - Giacco, Domenico PY - 2024/9/5 TI - Evaluating a Mobile App Supporting Evidence-Based Parenting Skills: Thematic Analysis of Parent Experience JO - JMIR Pediatr Parent SP - e53907 VL - 7 KW - digital microintervention KW - parenting app KW - product management KW - parent KW - parents KW - parenting KW - app KW - apps KW - usability KW - acceptability KW - family KW - families KW - interview KW - interviews KW - pediatric KW - pediatrics KW - child KW - children KW - youths KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - behavior KW - behaviors KW - disruptive behavior KW - thematic analysis N2 - Background: Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. Objective: The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents? values. Methods: We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Results: Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family?s experience. Conclusions: Parents? use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app. UR - https://pediatrics.jmir.org/2024/1/e53907 UR - http://dx.doi.org/10.2196/53907 ID - info:doi/10.2196/53907 ER - TY - JOUR AU - Chung, H. Kaitlin AU - Youngblood, M. Shari AU - Clingan, L. Carin AU - Deighton, C. Dana AU - Jump, A. Virginia AU - Manuweera, Thushini AU - McGeorge, M. Nicolette AU - Renn, L. Cynthia AU - Rosenblatt, Y. Paula AU - Winder, T. Aaron AU - Zhu, Shijun AU - Kleckner, R. Ian AU - Kleckner, S. Amber PY - 2024/9/5 TI - Digitizing Survivorship Care Plans Through the POST-Treatment Health Outcomes of Cancer Survivors (POSTHOC) Mobile App: Protocol for a Phase II Randomized Controlled Trial JO - JMIR Res Protoc SP - e59222 VL - 13 KW - mobile health KW - mHealth KW - symptoms KW - clinical trial KW - posttreatment KW - oncology KW - mobile phone N2 - Background: Survivorship care plans (SCPs) are provided at the completion of cancer treatment to aid in the transition from active treatment to long-term survivorship. They describe the details of a patient?s diagnosis and treatment and offer recommendations for follow-up appointments, referrals, and healthy behaviors. The plans are currently paper-based and become outdated as soon as a patient?s health status changes. There is a need to digitize these plans to improve their accessibility, modifiability, and longevity. With current technology, SCPs can be linked to mobile devices and activity trackers so that patients can track health behaviors and compare them to their clinical goals, taking charge of their own health. Objective: A mobile app, POSTHOC (POST-Treatment Health Outcomes of Cancer Survivors), that digitizes the SCP was developed, with goals of integrating it with wearable technologies and electronic medical records. Herein, we are conducting a randomized controlled trial that evaluates the POSTHOC app versus the traditional SCP on total symptom burden in the early posttreatment period. Methods: We will recruit 54 patients who have recently completed curative therapy for cancer (any type) in person and remotely. They will be randomized 2:1, POSTHOC:usual care (unblinded). Those randomized to the POSTHOC group will receive their SCP via the app and will choose to focus on nutrition or exercise for the duration of the study based on their individual plan and personal preferences. Those randomized to the control group will get a paper-based plan. At baseline, 6 weeks, and 12 weeks, we will evaluate patient-reported outcomes, including total symptom burden (web-based questionnaire), diet (24-hour Automated Self-Administered [ASA24]), and physical activity (Fitbit Charge 6 [Google LLC]). We will also collect quantitative and qualitative feedback on the usability of the app from those in the POSTHOC arm to improve the app for future implementation studies, with a specific focus on patient-provider communication. For feasibility, we will calculate the percentage of patients who used the POSTHOC app at least 3 times per week. We will use linear mixed models to evaluate the effects of the POSTHOC app versus those of usual care on other outcomes at weeks 6 and 12. Results: This trial is open to accrual in the University of Maryland Medical System as of March 2024, and as of July 3, 2024, a total of 20 participants have consented. Conclusions: This study is among the first to digitize the SCP in a mobile app and test the effects of a mobile health?delivered behavioral health intervention on symptom burden in cancer survivors. Our results will provide evidence about the effects of health self-management on symptoms. This knowledge will be integral to larger randomized controlled studies, integration with the electronic medical record, and nationwide implementation. Trial Registration: ClinicalTrials.gov NCT05499663; https://clinicaltrials.gov/ct2/show/NCT05499663 International Registered Report Identifier (IRRID): DERR1-10.2196/59222 UR - https://www.researchprotocols.org/2024/1/e59222 UR - http://dx.doi.org/10.2196/59222 UR - http://www.ncbi.nlm.nih.gov/pubmed/39235855 ID - info:doi/10.2196/59222 ER - TY - JOUR AU - Ho, Ngan Dang Khanh AU - Chiu, Wan-Chun AU - Kao, Jing-Wen AU - Tseng, Hsiang-Tung AU - Lin, Cheng-Yu AU - Huang, Pin-Hsiang AU - Fang, Yu-Ren AU - Chen, Kuei-Hung AU - Su, Ting-Ying AU - Yang, Chia-Hui AU - Yao, Chih-Yuan AU - Su, Hsiu-Yueh AU - Wei, Pin-Hui AU - Chang, Jung-Su PY - 2024/9/4 TI - Reliability Issues of Mobile Nutrition Apps for Cardiovascular Disease Prevention: Comparative Study JO - JMIR Mhealth Uhealth SP - e54509 VL - 12 KW - mobile apps KW - mHealth KW - dietary assessment KW - validity KW - cardiovascular disease prevention KW - app KW - apps KW - applications KW - application KW - nutrition KW - cardiovascular KW - nutrients KW - fitness KW - diet KW - mobile health N2 - Background: Controlling saturated fat and cholesterol intake is important for the prevention of cardiovascular diseases. Although the use of mobile diet-tracking apps has been increasing, the reliability of nutrition apps in tracking saturated fats and cholesterol across different nations remains underexplored. Objective: This study aimed to examine the reliability and consistency of nutrition apps focusing on saturated fat and cholesterol intake across different national contexts. The study focused on 3 key concerns: data omission, inconsistency (variability) of saturated fat and cholesterol values within an app, and the reliability of commercial apps across different national contexts. Methods: Nutrient data from 4 consumer-grade apps (COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!) and an academic app (Formosa FoodApp) were compared against 2 national reference databases (US Department of Agriculture [USDA]?Food and Nutrient Database for Dietary Studies [FNDDS] and Taiwan Food Composition Database [FCD]). Percentages of missing nutrients were recorded, and coefficients of variation were used to compute data inconsistencies. One-way ANOVAs were used to examine differences among apps, and paired 2-tailed t tests were used to compare the apps to national reference data. The reliability across different national contexts was investigated by comparing the Chinese and English versions of MyFitnessPal with the USDA-FNDDS and Taiwan FCD. Results: Across the 5 apps, 836 food codes from 42 items were analyzed. Four apps, including COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, significantly underestimated saturated fats, with errors ranging from ?13.8% to ?40.3% (all P<.05). All apps underestimated cholesterol, with errors ranging from ?26.3% to ?60.3% (all P<.05). COFIT omitted 47% of saturated fat data, and MyFitnessPal-Chinese missed 62% of cholesterol data. The coefficients of variation of beef, chicken, and seafood ranged from 78% to 145%, from 74% to 112%, and from 97% to 124% across MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, respectively, indicating a high variability in saturated fats across different food groups. Similarly, cholesterol variability was consistently high in dairy (71%-118%) and prepackaged foods (84%-118%) across all selected apps. When examining the reliability of MyFitnessPal across different national contexts, errors in MyFitnessPal were consistent across different national FCDs (USDA-FNDSS and Taiwan FCD). Regardless of the FCDs used as a reference, these errors persisted to be statistically significant, indicating that the app?s core database is the source of the problems rather than just mismatches or variances in external FCDs. Conclusions: The findings reveal substantial inaccuracies and inconsistencies in diet-tracking apps? reporting of saturated fats and cholesterol. These issues raise concerns for the effectiveness of using consumer-grade nutrition apps in cardiovascular disease prevention across different national contexts and within the apps themselves. UR - https://mhealth.jmir.org/2024/1/e54509 UR - http://dx.doi.org/10.2196/54509 ID - info:doi/10.2196/54509 ER - TY - JOUR AU - He, Yunfan AU - Chen, Han AU - Xiang, Peng AU - Zhao, Min AU - Li, Yingjun AU - Liu, Yongcheng AU - Wang, Tong AU - Liang, Jun AU - Lei, Jianbo PY - 2024/9/3 TI - Establishing an Evaluation Indicator System for User Satisfaction With Hypertension Management Apps: Combining User-Generated Content and Analytic Hierarchy Process JO - J Med Internet Res SP - e60773 VL - 26 KW - hypertension management KW - mobile health KW - user satisfaction KW - evaluation indicator system KW - analytic hierarchy process N2 - Background: Hypertension management apps (HMAs) can be effective in controlling blood pressure, but their actual impact is often suboptimal. Establishing a user satisfaction evaluation indicator system for HMAs can assist app developers in enhancing app design and functionality, while also helping users identify apps that best meet their needs. This approach aims to improve the overall effectiveness of app usage. Objective: This study aims to systematically collect data on HMAs and their user reviews in the United States and China. It analyzes app usage patterns and functional characteristics, identifies factors influencing user satisfaction from existing research, and develops a satisfaction evaluation indicator system to provide more accurate recommendations for improving user satisfaction. Methods: We conducted a descriptive statistical analysis to assess the development status of HMAs in both countries and applied the task-technology fit model to evaluate whether the app functionalities align with business needs. We separately summarized the factors influencing user satisfaction in both countries from previous research, utilized the analytic hierarchy process to develop an evaluation indicator system for HMA user satisfaction, and calculated satisfaction levels. Based on these findings, we propose improvements to enhance app functionality and user satisfaction. Results: In terms of current development status, there were fewer HMAs and user reviews in China compared with the United States. Regarding app functional availability, fewer than 5% (4/91) of the apps achieved a demand fulfillment rate exceeding 80% (8/10). Overall, user satisfaction in both countries was low. Conclusions: In the United States, user satisfaction was lowest for advertising distribution, data synchronization, and reliability. By contrast, Chinese apps need improvements in cost efficiency and compatibility. UR - https://www.jmir.org/2024/1/e60773 UR - http://dx.doi.org/10.2196/60773 UR - http://www.ncbi.nlm.nih.gov/pubmed/39226103 ID - info:doi/10.2196/60773 ER - TY - JOUR AU - Banire, Bilikis AU - Orr, Matt AU - Burns, Hailey AU - McGowan, Youna AU - Orji, Rita AU - Meier, Sandra PY - 2024/9/2 TI - Smartphone-Delivered Attentional Bias Modification Training for Mental Health: Systematic Review and Meta-Analysis JO - JMIR Ment Health SP - e56326 VL - 11 KW - attentional bias KW - mental health problem KW - anxiety KW - depression KW - systematic review KW - meta-analysis KW - smartphone KW - mobile phone N2 - Background: Smartphone-delivered attentional bias modification training (ABMT) intervention has gained popularity as a remote solution for alleviating symptoms of mental health problems. However, the existing literature presents mixed results indicating both significant and insignificant effects of smartphone-delivered interventions. Objective: This systematic review and meta-analysis aims to assess the impact of smartphone-delivered ABMT on attentional bias and symptoms of mental health problems. Specifically, we examined different design approaches and methods of administration, focusing on common mental health issues, such as anxiety and depression, and design elements, including gamification and stimulus types. Methods: Our search spanned from 2014 to 2023 and encompassed 4 major databases: MEDLINE, PsycINFO, PubMed, and Scopus. Study selection, data extraction, and critical appraisal were performed independently by 3 authors using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. When necessary, we pooled the standardized mean difference with a 95% CI. In addition, we conducted sensitivity, subgroup, and meta-regression analyses to explore moderator variables of active and placebo ABMT interventions on reducing symptoms of mental health problems and attentional bias. Results: Our review included 12 papers, involving a total of 24,503 participants, and we were able to conduct a meta-analysis on 20 different study samples from 11 papers. Active ABMT exhibited an effect size (Hedges g) of ?0.18 (P=.03) in reducing symptoms of mental health problems, while the overall effect remained significant. Similarly, placebo ABMT showed an effect size of ?0.38 (P=.008) in reducing symptoms of mental health problems. In addition, active ABMT (Hedges g ?0.17; P=.004) had significant effects on reducing attentional bias, while placebo ABMT did not significantly alter attentional bias (Hedges g ?0.04; P=.66). Conclusions: Our understanding of smartphone-delivered ABMT?s potential highlights the value of both active and placebo interventions in mental health care. The insights from the moderator analysis also showed that tailoring smartphone-delivered ABMT interventions to specific threat stimuli and considering exposure duration are crucial for optimizing their efficacy. This research underscores the need for personalized approaches in ABMT to effectively reduce attentional bias and symptoms of mental health problems. Trial Registration: PROSPERO CRD42023460749; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=460749 UR - https://mental.jmir.org/2024/1/e56326 UR - http://dx.doi.org/10.2196/56326 UR - http://www.ncbi.nlm.nih.gov/pubmed/39222349 ID - info:doi/10.2196/56326 ER - TY - JOUR AU - Mogk, Jessica AU - Idu, E. Abisola AU - Bobb, F. Jennifer AU - Key, Dustin AU - Wong, S. Edwin AU - Palazzo, Lorella AU - Stefanik-Guizlo, Kelsey AU - King, Deborah AU - Beatty, Tara AU - Dorsey, N. Caitlin AU - Caldeiro, M. Ryan AU - Garza McWethy, Angela AU - Glass, E. Joseph PY - 2024/9/2 TI - Prescription Digital Therapeutics for Substance Use Disorder in Primary Care: Mixed Methods Evaluation of a Pilot Implementation Study JO - JMIR Form Res SP - e59088 VL - 8 KW - implementation KW - digital therapeutics KW - substance use disorder KW - practice facilitation KW - health coaching KW - primary care KW - mobile phone N2 - Background: Delivering prescription digital therapeutics (ie, evidence-based interventions designed to treat, manage, or prevent disorders via websites or smartphone apps) in primary care could increase patient access to substance use disorder (SUD) treatments. However, the optimal approach to implementing prescription digital therapeutics in primary care remains unknown. Objective: This pilot study is a precursor to a larger trial designed to test whether implementation strategies (practice facilitation [PF] and health coaching [HC]) improve the delivery of prescription digital therapeutics for SUDs in primary care. This mixed methods study describes outcomes among patients in the 2 pilot clinics and presents qualitative findings on implementation. Methods: From February 10 to August 6, 2021, a total of 3 mental health specialists embedded in 2 primary care practices of the same integrated health system were tasked with offering app-based prescription digital therapeutics to patients with SUD. In the first half of the pilot, implementation activities included training and supportive tools. PF (at 1 clinic) and HC (at 2 clinics) were added in the second half. All study analyses relied on secondary data, including electronic health records and digital therapeutic vendor data. Primary outcomes were the proportion of patients reached by the prescription digital therapeutics and fidelity related to ideal use. We used qualitative methods to assess the adherence to planned activities and the barriers and facilitators to implementing prescription digital therapeutics. Results: Of all 18 patients prescribed the apps, 10 (56%) downloaded the app and activated their prescription, and 8 (44%) completed at least 1 module of content. Patients who activated the app completed 1 module per week on average. Ideal use (fidelity) was defined as completing 4 modules per week and having a monthly SUD-related visit; 1 (6%) patient met these criteria for 10 weeks (of the 12-week prescription period). A total of 5 (28%) patients had prescriptions while HC was available, 2 (11%) were successfully contacted, and both declined coaching. Clinicians reported competing clinical priorities, technical challenges, and logistically complex workflows in part because the apps required a prescription. Some pilot activities were impacted by staff turnover that coincided with the COVID-19 pandemic. The facilitators to implementation were high engagement and the perception that the apps could meet patient needs. Conclusions: The pilot study encountered the barriers to implementing prescription digital therapeutics in a real-world primary care setting, especially staffing shortages, turnover, and competing priorities for clinic teams. The larger randomized trial will clarify the extent to which PF and HC improve the implementation of digital therapeutics. Trial Registration: ClinicalTrials.gov NCT04907045; https://clinicaltrials.gov/study/NCT04907045 UR - https://formative.jmir.org/2024/1/e59088 UR - http://dx.doi.org/10.2196/59088 UR - http://www.ncbi.nlm.nih.gov/pubmed/39222348 ID - info:doi/10.2196/59088 ER - TY - JOUR AU - Singh, Ben AU - Chastin, Sebastien AU - Miatke, Aaron AU - Curtis, Rachel AU - Dumuid, Dorothea AU - Brinsley, Jacinta AU - Ferguson, Ty AU - Szeto, Kimberley AU - Simpson, Catherine AU - Eglitis, Emily AU - Willems, Iris AU - Maher, Carol PY - 2024/8/30 TI - Real-World Accuracy of Wearable Activity Trackers for Detecting Medical Conditions: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e56972 VL - 12 KW - wearable activity trackers KW - disease detection KW - atrial fibrillation KW - COVID-19 diagnosis KW - meta-analysis KW - wearables KW - wearable tracker KW - tracker KW - detection KW - monitoring KW - physiological KW - diagnostic tool KW - tool KW - tools KW - Fitbit KW - atrial KW - COVID-19 KW - wearable N2 - Background: Wearable activity trackers, including fitness bands and smartwatches, offer the potential for disease detection by monitoring physiological parameters. However, their accuracy as specific disease diagnostic tools remains uncertain. Objective: This systematic review and meta-analysis aims to evaluate whether wearable activity trackers can be used to detect disease and medical events. Methods: Ten electronic databases were searched for studies published from inception to April 1, 2023. Studies were eligible if they used a wearable activity tracker to diagnose or detect a medical condition or event (eg, falls) in free-living conditions in adults. Meta-analyses were performed to assess the overall area under the curve (%), accuracy (%), sensitivity (%), specificity (%), and positive predictive value (%). Subgroup analyses were performed to assess device type (Fitbit, Oura ring, and mixed). The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Diagnostic Test Accuracy Studies. Results: A total of 28 studies were included, involving a total of 1,226,801 participants (age range 28.6-78.3). In total, 16 (57%) studies used wearables for diagnosis of COVID-19, 5 (18%) studies for atrial fibrillation, 3 (11%) studies for arrhythmia or abnormal pulse, 3 (11%) studies for falls, and 1 (4%) study for viral symptoms. The devices used were Fitbit (n=6), Apple watch (n=6), Oura ring (n=3), a combination of devices (n=7), Empatica E4 (n=1), Dynaport MoveMonitor (n=2), Samsung Galaxy Watch (n=1), and other or not specified (n=2). For COVID-19 detection, meta-analyses showed a pooled area under the curve of 80.2% (95% CI 71.0%-89.3%), an accuracy of 87.5% (95% CI 81.6%-93.5%), a sensitivity of 79.5% (95% CI 67.7%-91.3%), and specificity of 76.8% (95% CI 69.4%-84.1%). For atrial fibrillation detection, pooled positive predictive value was 87.4% (95% CI 75.7%-99.1%), sensitivity was 94.2% (95% CI 88.7%-99.7%), and specificity was 95.3% (95% CI 91.8%-98.8%). For fall detection, pooled sensitivity was 81.9% (95% CI 75.1%-88.1%) and specificity was 62.5% (95% CI 14.4%-100%). Conclusions: Wearable activity trackers show promise in disease detection, with notable accuracy in identifying atrial fibrillation and COVID-19. While these findings are encouraging, further research and improvements are required to enhance their diagnostic precision and applicability. Trial Registration: Prospero CRD42023407867; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=407867 UR - https://mhealth.jmir.org/2024/1/e56972 UR - http://dx.doi.org/10.2196/56972 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56972 ER - TY - JOUR AU - Santopetro, Nicholas AU - Jones, Danielle AU - Garron, Andrew AU - Meyer, Alexandria AU - Joyner, Keanan AU - Hajcak, Greg PY - 2024/8/30 TI - Examining a Fully Automated Mobile-Based Behavioral Activation Intervention in Depression: Randomized Controlled Trial JO - JMIR Ment Health SP - e54252 VL - 11 KW - digital intervention KW - digital health KW - digital application KW - digital applications KW - mobile health KW - mHealth KW - automation KW - automate KW - automated KW - behavioral activation KW - BA KW - BA intervention KW - depression KW - depressed KW - depressive KW - depressive symptoms KW - anhedonia KW - anhedonia symptoms KW - anxiety KW - anxious KW - anxiety symptoms KW - adults KW - adult KW - psychiatry KW - psych KW - psychology KW - major depressive disorder KW - MDD N2 - Background: Despite significant progress in our understanding of depression, prevalence rates have substantially increased in recent years. Thus, there is an imperative need for more cost-effective and scalable mental health treatment options, including digital interventions that minimize therapist burden. Objective: This study focuses on a fully automated digital implementation of behavioral activation (BA)?a core behavioral component of cognitive behavioral therapy for depression. We examine the efficacy of a 1-month fully automated SMS text message?based BA intervention for reducing depressive symptoms and anhedonia. Methods: To this end, adults reporting at least moderate current depressive symptoms (8-item Patient Health Questionnaire score ?10) were recruited online across the United States and randomized to one of three conditions: enjoyable activities (ie, BA), healthy activities (ie, an active control condition), and passive control (ie, no contact). Participants randomized to enjoyable and healthy activities received daily SMS text messages prompting them to complete 2 activities per day; participants also provided a daily report on the number and enjoyment of activities completed the prior day. Results: A total of 126 adults (mean age 32.46, SD 7.41 years) with current moderate depressive symptoms (mean score 16.53, SD 3.90) were recruited. Participants in the enjoyable activities condition (BA; n=39) experienced significantly greater reductions in depressive symptoms compared to participants in the passive condition (n=46). Participants in both active conditions?enjoyable activities and healthy activities (n=41)?reported reduced symptoms of anxiety compared to those in the control condition. Conclusions: These findings provide preliminary evidence regarding the efficacy of a fully automated digital BA intervention for depression and anxiety symptoms. Moreover, reminders to complete healthy activities may be a promising intervention for reducing anxiety symptoms. Trial Registration: ClincalTrials.gov NCT06492824; https://clinicaltrials.gov/study/NCT06492824 UR - https://mental.jmir.org/2024/1/e54252 UR - http://dx.doi.org/10.2196/54252 ID - info:doi/10.2196/54252 ER - TY - JOUR AU - Catania, Julianna AU - Beaver, Steph AU - Kamath, S. Rakshitha AU - Worthington, Emma AU - Lu, Minyi AU - Gandhi, Hema AU - Waters, C. Heidi AU - Malone, C. Daniel PY - 2024/8/30 TI - Evaluation of Digital Mental Health Technologies in the United States: Systematic Literature Review and Framework Synthesis JO - JMIR Ment Health SP - e57401 VL - 11 KW - mental health KW - mobile health KW - mHealth KW - digital health KW - digital therapeutics KW - systematic review KW - framework synthesis KW - mixed methods N2 - Background: Digital mental health technologies (DMHTs) have the potential to enhance mental health care delivery. However, there is little information on how DMHTs are evaluated and what factors influence their use. Objective: A systematic literature review was conducted to understand how DMHTs are valued in the United States from user, payer, and employer perspectives. Methods: Articles published after 2017 were identified from MEDLINE, Embase, PsycINFO, Cochrane Library, the Health Technology Assessment Database, and digital and mental health congresses. Each article was evaluated by 2 independent reviewers to identify US studies reporting on factors considered in the evaluation of DMHTs targeting mental health, Alzheimer disease, epilepsy, autism spectrum disorder, or attention-deficit/hyperactivity disorder. Study quality was assessed using the Critical Appraisal Skills Program Qualitative and Cohort Studies Checklists. Studies were coded and indexed using the American Psychiatric Association?s Mental Health App Evaluation Framework to extract and synthesize relevant information, and novel themes were added iteratively as identified. Results: Of the 4353 articles screened, data from 26 unique studies from patient, caregiver, and health care provider perspectives were included. Engagement style was the most reported theme (23/26, 88%), with users valuing DMHT usability, particularly alignment with therapeutic goals through features including anxiety management tools. Key barriers to DMHT use included limited internet access, poor technical literacy, and privacy concerns. Novel findings included the discreetness of DMHTs to avoid stigma. Conclusions: Usability, cost, accessibility, technical considerations, and alignment with therapeutic goals are important to users, although DMHT valuation varies across individuals. DMHT apps should be developed and selected with specific user needs in mind. UR - https://mental.jmir.org/2024/1/e57401 UR - http://dx.doi.org/10.2196/57401 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57401 ER - TY - JOUR AU - Goeldner, Moritz AU - Gehder, Sara PY - 2024/8/29 TI - Digital Health Applications (DiGAs) on a Fast Track: Insights From a Data-Driven Analysis of Prescribable Digital Therapeutics in Germany From 2020 to Mid-2024 JO - J Med Internet Res SP - e59013 VL - 26 KW - digital health application KW - DiGA KW - data-driven analysis KW - clinical evidence KW - health economics KW - positive care effect KW - medical benefit KW - patient-relevant structural and procedural improvements KW - pSVV KW - digital health care act N2 - Background: This study aimed to analyze the rapidly evolving ecosystem of digital health applications (Digitale Gesundheitsanwendung; DiGAs) in Germany, spurred by the 2019 Digital Healthcare Act. With over 73 million people in Germany now having access to DiGAs, these prescribable digital health apps and web-based applications represent a substantial stride in health care modernization, supporting both patients and health care providers with digital solutions for disease management and care improvement. Objective: Through a data-driven approach, this research aimed to unpack the complexities of DiGA market dynamics, economic factors, and clinical evidence, offering insights into their impact over the past years. Methods: The analysis draws from a range of public data sources, including the DiGA directory, statutory health insurance reports, app store feedback, and clinical study results. Results: As of July 1, 2024, there are 56 DiGAs listed by the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte), divided into 35 permanently and 21 preliminarily listed applications. Our findings reveal that a majority of DiGAs extend beyond the intended 1-year period to achieve permanent listing, reflecting the extensive effort required to demonstrate clinical efficacy. Economic analysis uncovered a dynamic pricing landscape, with initial prices ranging from approximately ?200 to ?700 (?1=US $1.07), averaging at a median of ?514 for a 3-month DiGA prescription. Following negotiations or arbitration board decisions, prices typically see a 50% reduction, settling at a median of ?221. Prescription data offer valuable insights into DiGA acceptance, with total prescriptions jumping from around 41,000 in the first period to 209,000 in the latest reporting period. The analysis of the top 15 DiGAs, representing 82% of the total prescriptions, shows that these best-performing apps receive from a minimum of 8 to a maximum of 77 daily prescriptions, with native apps and early market entrants achieving higher rates. Clinical evidence from all 35 permanently listed DiGAs indicates a uniform preference for randomized controlled trials to validate primary end points, with no noteworthy use of alternative study designs encouraged in the Digital Healthcare Act and related regulations. Moreover, all evaluated DiGAs focused on medical benefits, with health status improvement as a key end point, suggesting an underuse of patient-relevant structural and procedural improvement in demonstrating health care impact. Conclusions: This study highlights the growth and challenges within the DiGA sector, suggesting areas for future research, such as the exploration of new study designs and the potential impact of patient-relevant structural and procedural improvements. For DiGA manufacturers, the strategic advantage of early market entry is emphasized. Overall, this paper underscores the evolving landscape of digital health, advocating for a nuanced understanding of digital health technology integration in Germany and beyond. UR - https://www.jmir.org/2024/1/e59013 UR - http://dx.doi.org/10.2196/59013 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59013 ER - TY - JOUR AU - Feng, Yuanyuan AU - Stenger, Brad AU - Zhang, Shikun PY - 2024/8/29 TI - Contextual Acceptance of COVID-19 Mitigation Mobile Apps in the United States: Mixed Methods Survey Study on Postpandemic Data Privacy JO - J Med Internet Res SP - e57309 VL - 26 KW - data privacy KW - health privacy KW - COVID-19 KW - mobile apps KW - contextual integrity KW - respiratory KW - infectious KW - pulmonary KW - pandemic KW - mobile app KW - app KW - apps KW - digital health KW - digital technology KW - digital intervention KW - digital interventions KW - smartphone KW - smartphones KW - mobile phone N2 - Background: The COVID-19 pandemic gave rise to countless user-facing mobile apps to help fight the pandemic (?COVID-19 mitigation apps?). These apps have been at the center of data privacy discussions because they collect, use, and even retain sensitive personal data from their users (eg, medical records and location data). The US government ended its COVID-19 emergency declaration in May 2023, marking a unique time to comprehensively investigate how data privacy impacted people?s acceptance of various COVID-19 mitigation apps deployed throughout the pandemic. Objective: This research aims to provide insights into health data privacy regarding COVID-19 mitigation apps and policy recommendations for future deployment of public health mobile apps through the lens of data privacy. This research explores people?s contextual acceptance of different types of COVID-19 mitigation apps by applying the privacy framework of contextual integrity. Specifically, this research seeks to identify the factors that impact people?s acceptance of data sharing and data retention practices in various social contexts. Methods: A mixed methods web-based survey study was conducted by recruiting a simple US representative sample (N=674) on Prolific in February 2023. The survey includes a total of 60 vignette scenarios representing realistic social contexts that COVID-19 mitigation apps could be used. Each survey respondent answered questions about their acceptance of 10 randomly selected scenarios. Three contextual integrity parameters (attribute, recipient, and transmission principle) and respondents? basic demographics are controlled as independent variables. Regression analysis was performed to determine the factors impacting people?s acceptance of initial data sharing and data retention practices via these apps. Qualitative data from the survey were analyzed to support the statistical results. Results: Many contextual integrity parameter values, pairwise combinations of contextual integrity parameter values, and some demographic features of respondents have a significant impact on their acceptance of using COVID-19 mitigation apps in various social contexts. Respondents? acceptance of data retention practices diverged from their acceptance of initial data sharing practices in some scenarios. Conclusions: This study showed that people?s acceptance of using various COVID-19 mitigation apps depends on specific social contexts, including the type of data (attribute), the recipients of the data (recipient), and the purpose of data use (transmission principle). Such acceptance may differ between the initial data sharing and data retention practices, even in the same context. Study findings generated rich implications for future pandemic mitigation apps and the broader public health mobile apps regarding data privacy and deployment considerations. UR - https://www.jmir.org/2024/1/e57309 UR - http://dx.doi.org/10.2196/57309 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57309 ER - TY - JOUR AU - Reece, Jeanette AU - Yu, Maggie AU - Bevens, William AU - Simpson-Yap, Steve AU - Davenport, Rebekah AU - Jelinek, George AU - Neate, Sandra PY - 2024/8/28 TI - Sociodemographic, Health, and Lifestyle-Related Characteristics Associated With the Commencement and Completion of a Web-Based Lifestyle Educational Program for People With Multiple Sclerosis: Randomized Controlled Trial JO - J Med Internet Res SP - e58253 VL - 26 KW - multiple sclerosis KW - web-based education KW - lifestyle KW - randomized controlled trial KW - engagement KW - completion N2 - Background: Digital health interventions increase access to multiple sclerosis (MS)?related knowledge for people living with MS; however, our understanding of factors associated with engagement in web-based learning is limited. Objective: This study aims to examine associations between participant sociodemographic, health, and lifestyle-related characteristics and the commencement and completion of the Multiple Sclerosis Online Course (MSOC) in a randomized controlled trial (RCT). Methods: An intervention course was developed based on the Overcoming MS Program?an evidence-based lifestyle modification program for MS, and a standard care course was developed based on international MS website information. An RCT was conducted to compare the effectiveness of the intervention course versus the standard care course in improving health outcomes in people living with MS. Participant data were collected from a baseline survey. Associations between baseline participant characteristics and MSOC commencement and completion, respectively, were assessed using multivariate log-binomial regression. Results: Overall, 1893 participants enrolled in the RCT, and 45.27% (n=857) completed the baseline survey: 23.5% (n=444) in the intervention course and 21.8% (n=413) in the standard care course. Of these 857 participants, 631 (73.6%) commenced the standard care course or intervention course, and 49.1% (218/444) and 54.2% (224/413) completed the intervention course and standard care course, respectively. University education, partnered relationship status, and higher mental and physical quality of life were associated with 19%, 12%, 20%, and 22% higher rates of course commencement, respectively. Clinically significant fatigue was associated with a 10% reduction in the likelihood of commencement. Strongest associations with intervention course completion included middle and older adulthood, male sex, fatigue, and preexisting adherence to a diet program, with 96%, 27%, 24%, and 19% higher rates of completion observed, respectively, whereas higher self-efficacy was associated with up to 35% lower intervention course completion. Associations with standard care course completion included practicing meditation (20% higher completion), whereas employment was associated with 22% lower completion. Conclusions: Sociodemographic and clinical factors, as well as lifestyle-related factors, were important factors in MSOC commencement and completion. These data may help guide the design and enhancement of digital health interventions tailored for people living with MS. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001605886; https://tinyurl.com/2vyve9p9 International Registered Report Identifier (IRRID): RR2-10.1186/s12883-023-03298-0 UR - https://www.jmir.org/2024/1/e58253 UR - http://dx.doi.org/10.2196/58253 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58253 ER - TY - JOUR AU - Rauwerdink, Anneloek AU - Spinazze, Pier AU - Gijsbers, Harm AU - Molendijk, Juul AU - Zwolsman, Sandra AU - Schijven, P. Marlies AU - Chavannes, H. Niels AU - Kasteleyn, J. Marise PY - 2024/8/28 TI - Approaches to Evaluating Digital Health Technologies: Scoping Review JO - J Med Internet Res SP - e50251 VL - 26 KW - ehealth KW - digital health KW - telemedicine KW - methods KW - evaluation KW - literature review KW - DHI KW - health technology KW - health technologies KW - telehealth KW - e-health KW - scoping review KW - digital health intervention N2 - Background: Profound scientific evaluation of novel digital health technologies (DHTs) is key to enhance successful development and implementation. As such, we previously developed the eHealth evaluation cycle. The eHealth evaluation cycle contains 5 consecutive study phases: conceptual, development, feasibility, effectiveness, and implementation. Objective: The aim of this study is to develop a better understanding of the daily practice of the eHealth evaluation cycle. Therefore, the objectives are to conduct a structured analysis of literature data to analyze the practice of the evaluation study phases and to determine which evaluation approaches are used in which study phase of the eHealth evaluation cycle. Methods: We conducted a systematic literature search in PubMed including the MeSH term ?telemedicine? in combination with a wide variety of evaluation approaches. Original peer-reviewed studies published in the year 2019 (pre-COVID-19 cohort) were included. Nonpatient-focused studies were excluded. Data on the following variables were extracted and systematically analyzed: journal, country, publication date, medical specialty, primary user, functionality, evaluation study phases, and evaluation approach. RStudio software was used to summarize the descriptive data and to perform statistical analyses. Results: We included 824 studies after 1583 titles and abstracts were screened. The majority of the evaluation studies focused on the effectiveness (impact; 304/824, 36.9%) study phase, whereas uptake (implementation; 70/824, 8.5%) received the least focus. Randomized controlled trials (RCTs; 170/899, 18.9%) were the most commonly used DHT evaluation method. Within the effectiveness (impact) study phase, RCTs were used in one-half of the studies. In the conceptual and planning phases, survey research (27/78, 35%) and interview studies (27/78, 35%) were most frequently used. The United States published the largest amount of DHT evaluation studies (304/824, 36.9%). Psychiatry and mental health (89/840, 10.6%) and cardiology (75/840, 8.9%) had the majority of studies published within the field. Conclusions: We composed the first comprehensive overview of the actual practice of implementing consecutive DHT evaluation study phases. We found that the study phases of the eHealth evaluation cycle are unequally studied and most attention is paid to the effectiveness study phase. In addition, the majority of the studies used an RCT design. However, in order to successfully develop and implement novel DHTs, stimulating equal evaluation of the sequential study phases of DHTs and selecting the right evaluation approach that fits the iterative nature of technology might be of the utmost importance. UR - https://www.jmir.org/2024/1/e50251 UR - http://dx.doi.org/10.2196/50251 UR - http://www.ncbi.nlm.nih.gov/pubmed/39196643 ID - info:doi/10.2196/50251 ER - TY - JOUR AU - Fahey, C. Margaret AU - Carpenter, J. Mathew AU - O'Neal, Riley AU - Pebley, Kinsey AU - Schick, R. Melissa AU - Ware, Emily AU - Toll, A. Benjamin AU - Dahne, Jennifer PY - 2024/8/28 TI - Expectations and Preferences for Digital Cessation Treatment: Multimethods Study Among Older Adults Who Smoke Cigarettes JO - J Med Internet Res SP - e52919 VL - 26 KW - older adults KW - digital health KW - digital cessation treatment KW - smoking cessation KW - digital cessation KW - treatment KW - smoke KW - cigarettes KW - cigarette KW - tobacco KW - adults KW - elderly KW - older person KW - older people KW - aging KW - smoking KW - quit KW - quitting KW - questionnaire KW - telehealth KW - treatments KW - behavioral health KW - public health KW - mobile phone N2 - Background: To address enduring age-related tobacco disparities, it is critical to promote cessation treatment among older adults (aged 65+ years). Digital health platforms offer opportunities for wide dissemination of evidence-based behavioral cessation support. However, existing digital cessation treatments are not tailored to unique aging-related needs and preferences, resulting in low uptake. Detailed information is needed about how to best adapt these treatments for this age group. Objective: We aimed to collect detailed, hypothesis-generating information about expectations and preferences for cessation digital treatment among older adults who smoke cigarettes. Methods: Semistructured interviews were conducted with adults aged 65+ years currently smoking or who had quit within the past month. Interviews included open-ended questions regarding prior experiences with digital health platforms and expectations and preferences for cessation treatment via various modalities (app-delivered, texting-based, or videoconferencing counseling). Interviews also elicited questions regarding digital modalities that integrated social components (app-delivered social forums and group videoconferencing counseling). Using an iterative, team-based approach, the thematic analysis identified meaningful themes. Interviews were supplemented with quantitative measures assessing sociodemographics, digital literacy, and physical health symptoms. Results: Participants (12/20, 60% men; 15/20, 75% White; 4/20, 20% Black or African American; 1/20, 5% Asian) were currently smoking (17/20, 85%) or had recently quit (3/20, 15%). Thematic analysis identified 3 meaningful themes across all digital modalities: convenience, accessibility, and personalization. Expected benefits of digital platforms included convenient treatment access, without reliance on transportation. Participants preferred treatments to be personalized and deliver content or strategies beyond standard education. Most (17/20, 85%) were unfamiliar with cessation apps but found them appealing given the potential for offering a novel quitting strategy. App ease of use (eg, easy navigation) was preferred. Half (10/20, 50%) would try a texting-based intervention, with many preferring texting with a counselor rather than automated messaging. Most (17/20, 85%) would use videoconferencing and expected this modality to deliver better quality counseling than via telephone. Expected videoconferencing challenges included looking presentable onscreen, technological difficulties, and privacy or security. Videoconferencing was regarded as the most personalized digital treatment, yet benefits unique to app-delivered and texting-based treatments included anonymity and access to treatment 24/7. Participants expected integrating social components into digital treatment to be useful for quit success and social connection, yet were concerned about possible interpersonal challenges. Conclusions: Because a long history of quit attempts and familiarity with standard quitting advice is common among older adults who smoke cigarettes, digital platforms might offer appealing and novel strategies for cessation that are accessible and convenient. Overall, this population was open to trying digital cessation treatments and would prefer that these platforms prioritize ease of use and personalized content. These findings challenge the bias that older adults are uninterested or unwilling to engage with digital treatments for behavioral health. UR - https://www.jmir.org/2024/1/e52919 UR - http://dx.doi.org/10.2196/52919 UR - http://www.ncbi.nlm.nih.gov/pubmed/39196628 ID - info:doi/10.2196/52919 ER - TY - JOUR AU - Suffoletto, Brian PY - 2024/8/27 TI - Deceptively Simple yet Profoundly Impactful: Text Messaging Interventions to Support Health JO - J Med Internet Res SP - e58726 VL - 26 KW - SMS intervention KW - behavior KW - intervention KW - review KW - text messaging KW - SMS KW - interventions KW - behaviors KW - behaviour KW - behaviours KW - effectiveness KW - development KW - impact KW - narrative review KW - physical activity KW - diet KW - weight loss KW - mental health KW - substance use KW - meta-analysis KW - chatbot KW - chatbots KW - large language model KW - LLM KW - large language models KW - mobile phone UR - https://www.jmir.org/2024/1/e58726 UR - http://dx.doi.org/10.2196/58726 UR - http://www.ncbi.nlm.nih.gov/pubmed/39190427 ID - info:doi/10.2196/58726 ER - TY - JOUR AU - Chambers, C. Laura AU - Malyuta, Yelena AU - Goedel, C. William AU - Chan, A. Philip AU - Sutten Coats, Cassandra AU - Allen, Ken AU - Nunn, S. Amy PY - 2024/8/23 TI - Identifying Effective Components of a Social Marketing Campaign to Improve Engagement With Express Sexual Health Services Among Gay, Bisexual, and Other Men Who Have Sex With Men: Case Study JO - JMIR Public Health Surveill SP - e50944 VL - 10 KW - social marketing KW - sexually transmitted infection KW - HIV KW - sexual and gender minorities KW - sexual health KW - gay KW - MSM KW - men who have sex with men KW - STI KW - testing KW - digital marketing KW - digital KW - campaign KW - promote KW - treatment KW - prevention KW - bisexual KW - advertisement KW - Google display KW - Grindr KW - Facebook N2 - Background: Little is known about how best to reach people with social marketing messages promoting use of clinical HIV and sexually transmitted infection (STI) services. Objective: We evaluated a multiplatform, digital social marketing campaign intended to increase use of HIV/STI testing, treatment, and prevention services among gay, bisexual, and other men who have sex with men (MSM) at an LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and/or questioning) community health center. Methods: We evaluated engagement with a social marketing campaign launched by Open Door Health, the only LGBTQ+ community health center in Rhode Island, during the first 8 months of implementation (April to November 2021). Three types of advertisements encouraging use of HIV/STI services were developed and implemented on Google Search, Google Display, Grindr, and Facebook. Platforms tracked the number of times that an advertisement was displayed to a user (impressions), that a user clicked through to a landing page that facilitated scheduling (clicks), and that a user requested a call to schedule an appointment from the landing page (conversions). We calculated the click-through rate (clicks per impression), conversion rate (conversions per click), and the dollar amount spent per 1000 impressions and per click and conversion. Results: Overall, Google Search yielded the highest click-through rate (7.1%) and conversion rate (7.0%) compared to Google Display, Grindr, and Facebook (click-through rates=0.4%?3.3%; conversion rates=0%?0.03%). Although the spend per 1000 impressions and per click was higher for Google Search compared to other platforms, the spend per conversion?which measures the number of people intending to attend the clinic for services?was substantially lower for Google Search (US $48.19 vs US $3120.42-US $3436.03). Conclusions: Campaigns using the Google Search platform may yield the greatest return on investment for engaging MSM in HIV/STI services at community health clinics. Future studies are needed to measure clinical outcomes among those who present to the clinic for services after viewing campaign advertisements and to compare the return on investment with use of social marketing campaigns relative to other approaches. UR - https://publichealth.jmir.org/2024/1/e50944 UR - http://dx.doi.org/10.2196/50944 ID - info:doi/10.2196/50944 ER - TY - JOUR AU - Burns, James AU - Chen, Kelly AU - Flathers, Matthew AU - Currey, Danielle AU - Macrynikola, Natalia AU - Vaidyam, Aditya AU - Langholm, Carsten AU - Barnett, Ian AU - Byun, Soo) Andrew (Jin AU - Lane, Erlend AU - Torous, John PY - 2024/8/23 TI - Transforming Digital Phenotyping Raw Data Into Actionable Biomarkers, Quality Metrics, and Data Visualizations Using Cortex Software Package: Tutorial JO - J Med Internet Res SP - e58502 VL - 26 KW - digital phenotyping KW - mental health KW - data visualization KW - data analysis KW - smartphones KW - smartphone KW - Cortex KW - open-source KW - data processing KW - mindLAMP KW - app KW - apps KW - data set KW - clinical KW - real world KW - methodology KW - mobile phone UR - https://www.jmir.org/2024/1/e58502 UR - http://dx.doi.org/10.2196/58502 UR - http://www.ncbi.nlm.nih.gov/pubmed/39178032 ID - info:doi/10.2196/58502 ER - TY - JOUR AU - Szeto, Kimberley AU - Arnold, John AU - Horsfall, Marie Erin AU - Sarro, Madeline AU - Hewitt, Anthony AU - Maher, Carol PY - 2024/8/23 TI - Establishing a Consensus-Based Framework for the Use of Wearable Activity Trackers in Health Care: Delphi Study JO - JMIR Mhealth Uhealth SP - e55254 VL - 12 KW - wearable activity tracker KW - health care KW - physical activity KW - sedentary behavior KW - wearable KW - wearables KW - wearable tracker KW - tracker KW - wearable technology KW - support KW - exercise KW - prevention KW - management KW - monitor KW - promote KW - survey KW - utility N2 - Background: Physical activity (PA) plays a crucial role in health care, providing benefits in the prevention and management of many noncommunicable diseases. Wearable activity trackers (WATs) provide an opportunity to monitor and promote PA in various health care settings. Objective: This study aimed to develop a consensus-based framework for the optimal use of WATs in health care. Methods: A 4-round Delphi survey was conducted, involving a panel (n=58) of health care professionals, health service managers, and researchers. Round 1 used open-response questions to identify overarching themes. Rounds 2 and 3 used 9-point Likert scales to refine participants? opinions and establish consensus on key factors related to WAT use in health care, including metrics, device characteristics, clinical populations and settings, and software considerations. Round 3 also explored barriers and mitigating strategies to WAT use in clinical settings. Insights from Rounds 1-3 informed a draft checklist designed to guide a systematic approach to WAT adoption in health care. In Round 4, participants evaluated the draft checklist?s clarity, utility, and appropriateness. Results: Participation rates for rounds 1 to 4 were 76% (n=44), 74% (n=43), 74% (n=43), and 66% (n=38), respectively. The study found a strong interest in using WATs across diverse clinical populations and settings. Key metrics (step count, minutes of PA, and sedentary time), device characteristics (eg, easy to charge, comfortable, waterproof, simple data access, and easy to navigate and interpret data), and software characteristics (eg, remote and wireless data access, access to multiple patients? data) were identified. Various barriers to WAT adoption were highlighted, including device-related, patient-related, clinician-related, and system-level issues. The findings culminated in a 12-item draft checklist for using WATs in health care, with all 12 items endorsed for their utility, clarity, and appropriateness in Round 4. Conclusions: This study underscores the potential of WATs in enhancing patient care across a broad spectrum of health care settings. While the benefits of WATs are evident, successful integration requires addressing several challenges, from technological developments to patient education and clinician training. Collaboration between WAT manufacturers, researchers, and health care professionals will be pivotal for implementing WATs in the health care sector. UR - https://mhealth.jmir.org/2024/1/e55254 UR - http://dx.doi.org/10.2196/55254 UR - http://www.ncbi.nlm.nih.gov/pubmed/39178034 ID - info:doi/10.2196/55254 ER - TY - JOUR AU - Silvera-Tawil, David AU - Cameron, Jan AU - Li, Jane AU - Varnfield, Marlien AU - Allan, P. Liam AU - Harris, Mitch AU - Lannin, A. Natasha AU - Redd, Christian AU - Cadilhac, A. Dominique PY - 2024/8/22 TI - Multicomponent Support Program for Secondary Prevention of Stroke Using Digital Health Technology: Co-Design Study With People Living With Stroke or Transient Ischemic Attack JO - J Med Internet Res SP - e54604 VL - 26 KW - mobile app KW - stroke KW - transient ischemic attack KW - health service delivery KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Few individuals (<2%) who experience a stroke or transient ischemic attack (TIA) participate in secondary prevention lifestyle programs. Novel approaches that leverage digital health technology may provide a viable alternative to traditional interventions that support secondary prevention in people living with stroke or TIA. To be successful, these strategies should focus on user needs and preferences and be acceptable to clinicians and people living with stroke or TIA. Objective: This study aims to co-design, with people with lived experience of stroke or TIA (referred to as consumers) and clinicians, a multicomponent digital technology support program for secondary prevention of stroke. Methods: A consumer user needs survey (108 items) was distributed through the Australian Stroke Clinical Registry and the Stroke Association of Victoria. An invitation to a user needs survey (135 items) for clinicians was circulated via web-based professional forums and national organizations (eg, the Stroke Telehealth Community of Practice Microsoft Teams Channel) and the authors? research networks using Twitter (subsequently rebranded X, X Corp) and LinkedIn (LinkedIn Corp). Following the surveys, 2 rounds of user experience workshops (design and usability testing workshops) were completed with representatives from each end user group (consumers and clinicians). Feedback gathered after each round informed the final design of the digital health program. Results: Overall, 112 consumers (male individuals: n=63, 56.3%) and 54 clinicians (female individuals: n=43, 80%) responded to the survey; all items were completed by 75.8% (n=85) of consumers and 78% (n=42) of clinicians. Most clinicians (46/49, 94%) indicated the importance of monitoring health and lifestyle measures more frequently than current practice, particularly physical activity, weight, and sleep. Most consumers (87/96, 90%) and clinicians (41/49, 84%) agreed that providing alerts about potential deterioration in an individual?s condition were important functions for a digital program. Intention to use a digital program for stroke prevention and discussing the data collected during face-to-face consultations was high (consumers: 79/99, 80%; clinicians 36/42, 86%). In addition, 7 consumers (male individuals: n=5, 71%) and 9 clinicians (female individuals: n=6, 67%) took part in the user experience workshops. Participants endorsed using a digital health program to help consumers manage stroke or TIA and discussed preferred functions and health measures in a digital solution for secondary prevention of stroke. They also noted the need for a mobile app that is easy to use. Clinician feedback highlighted the need for a customizable clinician portal that captures individual consumer goals. Conclusions: Following an iterative co-design process, supported by evidence from user needs surveys and user experience workshops, a consumer-facing app that integrates wearable activity trackers and a clinician web portal were designed and developed to support secondary prevention of stroke. Feasibility testing is currently in progress to assess acceptability and use. UR - https://www.jmir.org/2024/1/e54604 UR - http://dx.doi.org/10.2196/54604 UR - http://www.ncbi.nlm.nih.gov/pubmed/39172512 ID - info:doi/10.2196/54604 ER - TY - JOUR AU - Castillo-Valdez, Fernando Pedro AU - Rodriguez-Salvador, Marisela AU - Ho, Yuh-Shan PY - 2024/8/22 TI - Scientific Production Dynamics in mHealth for Diabetes: Scientometric Analysis JO - JMIR Diabetes SP - e52196 VL - 9 KW - competitive technology intelligence KW - diabetes KW - digital health care KW - mobile health KW - mHealth KW - scientometrics KW - mobile phone N2 - Background: The widespread use of mobile technologies in health care (mobile health; mHealth) has facilitated disease management, especially for chronic illnesses such as diabetes. mHealth for diabetes is an attractive alternative to reduce costs and overcome geographical and temporal barriers to improve patients? conditions. Objective: This study aims to reveal the dynamics of scientific publications on mHealth for diabetes to gain insights into who are the most prominent authors, countries, institutions, and journals and what are the most cited documents and current hot spots. Methods: A scientometric analysis based on a competitive technology intelligence methodology was conducted. An innovative 8-step methodology supported by experts was executed considering scientific documents published between 1998 and 2021 in the Science Citation Index Expanded database. Publication language, publication output characteristics, journals, countries and institutions, authors, and most cited and most impactful articles were identified. Results: The insights obtained show that a total of 1574 scientific articles were published by 7922 authors from 90 countries, with an average of 15 (SD 38) citations and 6.5 (SD 4.4) authors per article. These documents were published in 491 journals and 92 Web of Science categories. The most productive country was the United States, followed by the United Kingdom, China, Australia, and South Korea, and the top 3 most productive institutions came from the United States, whereas the top 3 most cited articles were published in 2016, 2009, and 2017 and the top 3 most impactful articles were published in 2016 and 2017. Conclusions: This approach provides a comprehensive knowledge panorama of research productivity in mHealth for diabetes, identifying new insights and opportunities for research and development and innovation, including collaboration with other entities, new areas of specialization, and human resource development. The findings obtained are useful for decision-making in policy planning, resource allocation, and identification of research opportunities, benefiting researchers, health professionals, and decision makers in their efforts to make significant contributions to the advancement of diabetes science. UR - https://diabetes.jmir.org/2024/1/e52196 UR - http://dx.doi.org/10.2196/52196 UR - http://www.ncbi.nlm.nih.gov/pubmed/39172508 ID - info:doi/10.2196/52196 ER - TY - JOUR AU - Moebus, Max AU - Hilty, Marc AU - Oldrati, Pietro AU - Barrios, Liliana AU - AU - Holz, Christian PY - 2024/8/21 TI - Assessing the Role of the Autonomic Nervous System as a Driver of Sleep Quality in Patients With Multiple Sclerosis: Observation Study JO - JMIR Neurotech SP - e48148 VL - 3 KW - sleep quality KW - multiple sclerosis KW - autonomic nervous system KW - wearable sensors KW - mobile phone N2 - Background: Low sleep quality is a common symptom of multiple sclerosis (MS) and substantially decreases patients? quality of life. The autonomic nervous system (ANS) is crucial to healthy sleep, and the transition from wake to sleep produces the largest shift in autonomic activity we experience every day. For patients with MS, the ANS is often impaired. The relationship between the ANS and perceived sleep quality in patients with MS remains elusive. Objective: In this study, we aim to quantify the impact of the ANS and MS on perceived sleep quality. Methods: We monitored 77 participants over 2 weeks using an arm-worn wearable sensor and a custom smartphone app. Besides recording daily perceived sleep quality, we continuously recorded participants? heart rate (HR) and HR variability on a per-second basis, as well as stress, activity, and the weather (20,700 hours of sensor data). Results: During sleep, we found that reduced HR variability and increased motion led to lower perceived sleep quality in patients with MS (n=53) as well as the age- and gender-matched control group (n=24). An activated stress response (high sympathetic activity and low parasympathetic activity) while asleep resulted in lower perceived sleep quality. For patients with MS, an activated stress response while asleep reduced perceived sleep quality more heavily than in the control group. Similarly, the effect of increased stress levels throughout the day is particularly severe for patients with MS. For patients with MS, we found that stress correlated negatively with minimal observed HR while asleep and might even affect their daily routine. We found that patients with MS with more severe impairments generally recorded lower perceived sleep quality than patients with MS with less severe disease progression. Conclusions: For patients with MS, stress throughout the day and an activated stress response while asleep play a crucial role in determining sleep quality, whereas this is less important for healthy individuals. Besides ensuring an adequate sleep duration, patients with MS might thus work to reduce stressors, which seem to have a particularly negative effect on sleep quality. Generally, however, sleep quality decreases with MS disease progression. UR - https://neuro.jmir.org/2024/1/e48148 UR - http://dx.doi.org/10.2196/48148 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48148 ER - TY - JOUR AU - Seretlo, James Raikane AU - Smuts, Hanlie AU - Mokgatle, Mpata Mathildah PY - 2024/8/21 TI - Development of an mHealth App by Experts for Queer Individuals? Sexual-Reproductive Health Care Services and Needs: Nominal Group Technique Study JO - JMIR Form Res SP - e59963 VL - 8 KW - experts KW - mobile health app KW - mHealth app KW - digital health care KW - telemedicine KW - digital innovation KW - sexual-reproductive health care services and needs KW - lesbian, gay, bisexual, transgender, queer, intersex, asexual individuals, and related identities KW - LBQTQIA+ KW - queer individuals KW - nominal group technique KW - mobile phone N2 - Background: Queer individuals continue to be marginalized in South Africa; they experience various health care challenges (eg, stigma, discrimination, prejudice, harassment, and humiliation), mental health issues (eg, suicide and depression), and an increased spread of HIV or AIDS and sexually transmitted illnesses (STIs; chlamydia, gonorrhea, and syphilis). Mobile health (mHealth) apps have the potential to resolve the health care deficits experienced by health care providers when managing queer individuals and by queer individuals when accessing sexual-reproductive health care services and needs, thus ensuring inclusivity and the promotion of health and well-being. Studies have proven that the nominal group technique (NGT) could be used to solve different social and health problems and develop innovative solutions. This technique ensures that different voices are represented during decision-making processes and leads to robust results. Objective: This study aims to identify important contents to include in the development of an mHealth app for addressing the sexual-reproductive health care services and needs of queer individuals. Methods: We invited a group of 13 experts from different fields, such as researchers, queer activists, sexual and reproductive health experts, private practicing health care providers, innovators, and private health care stakeholders, to take part in a face-to-face NGT. The NGT was conducted in the form of a workshop with 1 moderator, 2 research assistants, and 1 principal investigator. The workshop lasted approximately 2 hours 46 minutes and 55 seconds. We followed and applied 5 NGT steps in the workshop for experts to reach consensus. The main question that experts were expected to answer was as follows: Which content should be included in the mHealth app for addressing sexual-reproductive health care services and needs for queer individuals? This question was guided by user demographics and background, health education and information, privacy and security, accessibility and inclusivity, functionality and menu options, personalization and user engagement, service integration and partnerships, feedback and improvement, cultural sensitivity and ethical considerations, legal and regulatory compliance, and connectivity and data use. Results: Overall, experts voted and ranked the following main icons: menu options (66 points), privacy and security (39 points), user engagement (27 points), information hub (26 points), user demographics (20 points), connectivity (16 points), service integration and partnerships (10 points), functionalities (10 points), and accessibility and inclusivity (7 points). Conclusions: Conducting an NGT with experts from different fields, possessing vast skill sets, knowledge, and expertise, enabled us to obtain targeted data on the development of an mHealth app to address sexual-reproductive health care services and needs for queer individuals. This approach emphasized the usefulness of a multidisciplinary perspective to inform the development of our mHealth app and demonstrated the future need for continuity in using this approach for other digital health care innovations and interventions. UR - https://formative.jmir.org/2024/1/e59963 UR - http://dx.doi.org/10.2196/59963 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59963 ER - TY - JOUR AU - Klassen, A. Stephen AU - Jabbar, Jesica AU - Osborne, Jenna AU - Iannarelli, J. Nathaniel AU - Kirby, S. Emerson AU - O'Leary, D. Deborah AU - Locke, Sean PY - 2024/8/20 TI - Examining the Light Heart Mobile Device App for Assessing Human Pulse Interval and Heart Rate Variability: Validation Study JO - JMIR Form Res SP - e56921 VL - 8 KW - pulse interval KW - mobile app KW - validation KW - mHealth KW - mHealth app KW - app mobile device KW - mobile device app KW - pulse KW - heart KW - heart rate KW - validation study KW - biomarker KW - psychological KW - physiological KW - pulse rate KW - young adults KW - youth KW - linear correlation KW - heart rate variability KW - examining KW - examine KW - validity KW - psychological health KW - physiological health KW - interval data KW - mobile phone N2 - Background: Pulse interval is a biomarker of psychological and physiological health. Pulse interval can now be assessed using mobile phone apps, which expands researchers? ability to assess pulse interval in the real world. Prior to implementation, measurement accuracy should be established. Objective: This investigation evaluated the validity of the Light Heart mobile app to measure pulse interval and pulse rate variability in healthy young adults. Methods: Validity was assessed by comparing the pulse interval and SD of normal pulse intervals obtained by Light Heart to the gold standard, electrocardiogram (ECG), in 14 young healthy individuals (mean age 24, SD 5 years; n=9, 64% female) in a seated posture. Results: Mean pulse interval (Light Heart: 859, SD 113 ms; ECG: 857, SD 112 ms) demonstrated a strong positive linear correlation (r=0.99; P<.001) and strong agreement (intraclass correlation coefficient=1.00, 95% CI 0.99-1.00) between techniques. The Bland-Altman plot demonstrated good agreement for the mean pulse interval measured with Light Heart and ECG with evidence of fixed bias (?1.56, SD 1.86; 95% CI ?5.2 to 2.1 ms), suggesting that Light Heart overestimates pulse interval by a small margin. When Bland-Altman plots were constructed for each participant?s beat-by-beat pulse interval data, all participants demonstrated strong agreement between Light Heart and ECG with no evidence of fixed bias between measures. Heart rate variability, assessed by SD of normal pulse intervals, demonstrated strong agreement between techniques (Light Heart: mean 73, SD 23 ms; ECG: mean 73, SD 22 ms; r=0.99; P<.001; intraclass correlation coefficient=0.99, 95% CI 0.97-1.00). Conclusions: This study provides evidence to suggest that the Light Heart mobile app provides valid measures of pulse interval and heart rate variability in healthy young adults. UR - https://formative.jmir.org/2024/1/e56921 UR - http://dx.doi.org/10.2196/56921 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56921 ER - TY - JOUR AU - Lyles, Courtney AU - Berrean, Beth AU - Buenaventura, Ana AU - Milter, Svetlana AU - Hernandez, Daniel Dayana AU - Sarkar, Urmimala AU - Gutierrez, Christian AU - Palmer, Nynikka AU - Brown III, William PY - 2024/8/16 TI - Building a Client Resource and Communication Platform for Community-Based Organizations to Address Health and Social Needs: Co-Design Study JO - JMIR Hum Factors SP - e53939 VL - 11 KW - mHealth KW - mobile health KW - eHealth KW - electronic health KW - application KW - digital health KW - digital ecosystem KW - informatics KW - community-based KW - community KW - co-design KW - human-centered design KW - community health KW - population health KW - technology KW - innovation KW - operations KW - social needs KW - health resources KW - qualitative analysis N2 - Background: Connecting individuals to existing community resources is critical to addressing social needs and improving population health. While there is much ongoing informatics work embedding social needs screening and referrals into health care systems and their electronic health records, there has been less focus on the digital ecosystem and needs of community-based organizations (CBOs) providing or connecting individuals to these resources. Objective: We used human-centered design to develop a digital platform for CBOs, focused on identification of health and social resources and communication with their clients. Methods: Centered in the Develop phase of the design process, we conducted in-depth interviews in 2 phases with community-based organizational leadership and staff to create and iterate on the platform. We elicited and mapped participant feedback to theory-informed domains from the Technology Acceptance Model, such as Usefulness and Ease of Use, to build the final product and summarized all major design decisions as the platform development proceeded. Results: Overall, we completed 22 interviews with 18 community-based organizational leadership and staff in 2 consecutive Develop phases. After coding of the interview transcripts, there were 4 major themes related to usability, relevance, and external factors impacting use. Specifically, CBOs expressed an interest in a customer relationship management software to manage their client interactions and communications, and they needed specific additional features to address the scope of their everyday work, namely (1) digital and SMS text messaging communication with clients and (2) easy ways to identify relevant community resources based on diverse client needs and various program eligibility criteria. Finally, clear implementation needs emerged, such as digital training and support for staff using new platforms. The final platform, titled ?Mapping to Enhance the Vitality of Engaged Neighborhoods (MAVEN),? was completed in the Salesforce environment in 2022, and it included features and functions directly mapped to the design process. Conclusions: Engaging community organizations in user-centered design of a health and social resource platform was essential to tapping into their deep expertise in serving local communities and neighborhoods. Design methods informed by behavioral theory can be similarly employed in other informatics research. Moving forward, much more work will be necessary to support the implementation of platforms specific to CBOs? needs, especially given the resources, training, and customization needed in these settings. UR - https://humanfactors.jmir.org/2024/1/e53939 UR - http://dx.doi.org/10.2196/53939 ID - info:doi/10.2196/53939 ER - TY - JOUR AU - Dasari, Saisamhitha AU - Gopinath, Bhavya AU - Gaulke, James Carter AU - Patel, Mahendra Sunny AU - Merali, K. Khalil AU - Sunil Kumar, Aravind AU - Acharya, Soumyadipta PY - 2024/8/16 TI - A Handheld Tool for the Rapid Morphological Identification of Mosquito Species (VectorCam) for Community-Based Malaria Vector Surveillance: Summative Usability Study JO - JMIR Hum Factors SP - e56605 VL - 11 KW - malaria KW - vector surveillance KW - usability study testing KW - usability study KW - usability studies KW - usability KW - usable KW - usableness KW - usefulness KW - utility KW - convolution neural networks KW - artificial intelligence KW - AI KW - human factors design KW - human factors KW - mHealth KW - mobile health KW - app KW - apps KW - digital health KW - digital technology KW - digital intervention KW - digital interventions KW - smartphone KW - smartphones KW - mobile phone N2 - Background: Malaria impacts nearly 250 million individuals annually. Specifically, Uganda has one of the highest burdens, with 13 million cases and nearly 20,000 deaths. Controlling the spread of malaria relies on vector surveillance, a system where collected mosquitos are analyzed for vector species? density in rural areas to plan interventions accordingly. However, this relies on trained entomologists known as vector control officers (VCOs) who identify species via microscopy. The global shortage of entomologists and this time-intensive process cause significant reporting delays. VectorCam is a low-cost artificial intelligence?based tool that identifies a mosquito?s species, sex, and abdomen status with a picture and sends these results electronically from surveillance sites to decision makers, thereby deskilling the process to village health teams (VHTs). Objective: This study evaluates the usability of the VectorCam system among VHTs by assessing its efficiency, effectiveness, and satisfaction. Methods: The VectorCam system has imaging hardware and a phone app designed to identify mosquito species. Two users are needed: (1) an imager to capture images of mosquitos using the app and (2) a loader to load and unload mosquitos from the hardware. Critical success tasks for both roles were identified, which VCOs used to train and certify VHTs. In the first testing phase (phase 1), a VCO and a VHT were paired to assume the role of an imager or a loader. Afterward, they swapped. In phase 2, two VHTs were paired, mimicking real use. The time taken to image each mosquito, critical errors, and System Usability Scale (SUS) scores were recorded for each participant. Results: Overall, 14 male and 6 female VHT members aged 20 to 70 years were recruited, of which 12 (60%) participants had smartphone use experience. The average throughput values for phases 1 and 2 for the imager were 70 (SD 30.3) seconds and 56.1 (SD 22.9) seconds per mosquito, respectively, indicating a decrease in the length of time for imaging a tray of mosquitos. The loader?s average throughput values for phases 1 and 2 were 50.0 and 55.7 seconds per mosquito, respectively, indicating a slight increase in time. In terms of effectiveness, the imager had 8% (6/80) critical errors and the loader had 13% (10/80) critical errors in phase 1. In phase 2, the imager (for VHT pairs) had 14% (11/80) critical errors and the loader (for VHT pairs) had 12% (19/160) critical errors. The average SUS score of the system was 70.25, indicating positive usability. A Kruskal-Wallis analysis demonstrated no significant difference in SUS (H value) scores between genders or users with and without smartphone use experience. Conclusions: VectorCam is a usable system for deskilling the in-field identification of mosquito specimens in rural Uganda. Upcoming design updates will address the concerns of users and observers. UR - https://humanfactors.jmir.org/2024/1/e56605 UR - http://dx.doi.org/10.2196/56605 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56605 ER - TY - JOUR AU - Shi, Lin-Hong Jenny AU - Sit, Wing-Shan Regina PY - 2024/8/16 TI - Impact of 25 Years of Mobile Health Tools for Pain Management in Patients With Chronic Musculoskeletal Pain: Systematic Review JO - J Med Internet Res SP - e59358 VL - 26 KW - mHealth KW - mobile health KW - mobile app KW - chronic musculoskeletal pain KW - pain management KW - patient compliance KW - adherence KW - usability KW - feasibility KW - acceptability KW - PRISMA N2 - Background: Mobile technologies are increasingly being used in health care and public health practice for patient communication, monitoring, and education. Mobile health (mHealth) tools have also been used to facilitate adherence to chronic musculoskeletal pain (CMP) management, which is critical to achieving improved pain outcomes, quality of life, and cost-effective health care. Objective: The aim of this systematic review was to evaluate the 25-year trend of the literature on the adherence, usability, feasibility, and acceptability of mHealth interventions in CMP management among patients and health care providers. Methods: We searched the PubMed, Cochrane CENTRAL, MEDLINE, EMBASE, and Web of Science databases for studies assessing the role of mHealth in CMP management from January 1999 to December 2023. Outcomes of interest included the effect of mHealth interventions on patient adherence; pain-specific clinical outcomes after the intervention; and the usability, feasibility, and acceptability of mHealth tools and platforms in chronic pain management among target end users. Results: A total of 89 articles (26,429 participants) were included in the systematic review. Mobile apps were the most commonly used mHealth tools (78/89, 88%) among the included studies, followed by mobile app plus monitor (5/89, 6%), mobile app plus wearable sensor (4/89, 4%), and web-based mobile app plus monitor (1/89, 1%). Usability, feasibility, and acceptability or patient preferences for mHealth interventions were assessed in 26% (23/89) of the studies and observed to be generally high. Overall, 30% (27/89) of the studies used a randomized controlled trial (RCT), cohort, or pilot design to assess the impact of the mHealth intervention on patients? adherence, with significant improvements (all P<.05) observed in 93% (25/27) of these studies. Significant (judged at P<.05) between-group differences were reported in 27 of the 29 (93%) RCTs that measured the effect of mHealth on CMP-specific clinical outcomes. Conclusions: There is great potential for mHealth tools to better facilitate adherence to CMP management, and the current evidence supporting their effectiveness is generally high. Further research should focus on the cost-effectiveness of mHealth interventions for better incorporating these tools into health care practices. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42024524634; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=524634 UR - https://www.jmir.org/2024/1/e59358 UR - http://dx.doi.org/10.2196/59358 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59358 ER - TY - JOUR AU - El-Toukhy, Sherine AU - Hegeman, Phillip AU - Zuckerman, Gabrielle AU - Das, Roy Anirban AU - Moses, Nia AU - Troendle, James AU - Powell-Wiley, M. Tiffany PY - 2024/8/16 TI - Study of Postacute Sequelae of COVID-19 Using Digital Wearables: Protocol for a Prospective Longitudinal Observational Study JO - JMIR Res Protoc SP - e57382 VL - 13 KW - postacute sequelae of COVID-19 KW - wearable devices KW - physiological parameters KW - prospective observational study KW - mobile phone N2 - Background: Postacute sequelae of COVID-19 (PASC) remain understudied in nonhospitalized patients. Digital wearables allow for a continuous collection of physiological parameters such as respiratory rate and oxygen saturation that have been predictive of disease trajectories in hospitalized patients. Objective: This protocol outlines the design and procedures of a prospective, longitudinal, observational study of PASC that aims to identify wearables-collected physiological parameters that are associated with PASC in patients with a positive diagnosis. Methods: This is a single-arm, prospective, observational study of a cohort of 550 patients, aged 18 to 65 years, male or female, who own a smartphone or a tablet that meets predetermined Bluetooth version and operating system requirements, speak English, and provide documentation of a positive COVID-19 test issued by a health care professional within 5 days before enrollment. The primary end point is long COVID-19, defined as ?1 symptom at 3 weeks beyond the first symptom onset or positive diagnosis, whichever comes first. The secondary end point is chronic COVID-19, defined as ?1 symptom at 12 weeks beyond the first symptom onset or positive diagnosis. Participants must be willing and able to consent to participate in the study and adhere to study procedures for 6 months. Results: The first patient was enrolled in October 2021. The estimated year for publishing the study results is 2025. Conclusions: This is a fully decentralized study investigating PASC using wearable devices to collect physiological parameters and patient-reported outcomes. The study will shed light on the duration and symptom manifestation of PASC in nonhospitalized patient subgroups and is an exemplar of the use of wearables as population-level monitoring health tools for communicable diseases. Trial Registration: ClinicalTrials.gov NCT04927442; https://clinicaltrials.gov/study/NCT04927442 International Registered Report Identifier (IRRID): DERR1-10.2196/57382 UR - https://www.researchprotocols.org/2024/1/e57382 UR - http://dx.doi.org/10.2196/57382 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57382 ER - TY - JOUR AU - Kim, Hana AU - Schnall, Rebecca AU - Yoon, Nagyeom AU - Koh, Seong-Joon AU - Lee, Jisan AU - Cheon, Hee Jae PY - 2024/8/13 TI - Development and Validation of a Mobile-Centered Digital Health Readiness Scale (mDiHERS): Health Literacy and Equity Scale JO - J Med Internet Res SP - e58497 VL - 26 KW - digital health KW - health literacy KW - health equity KW - inflammatory bowel diseases KW - telemedicine KW - patient participation KW - validation KW - validate KW - IBD KW - bowel KW - inflammatory KW - inflammation KW - gastrointestinal KW - GI KW - internal medicine KW - gastroenterology KW - scale KW - readiness KW - adoption KW - measure KW - measures KW - measurement KW - measurements KW - assessment KW - assessments KW - scales KW - eHealth KW - e-health KW - literacy KW - mHealth KW - mobile health KW - chronic KW - mobile phone N2 - Background: There has been a rapid expansion of digital health care services, making the need for measuring and improving digital health readiness a priority. In response, our study team developed the Mobile-Centered Digital Health Readiness: Health Literacy and Equity Scale (mDiHERS) to measure digital health readiness. Objective: We aim to develop and validate a scale that assesses digital health readiness, encompassing literacy and equity, and to ensure the effective use of mobile-centered digital health services. Methods: This study was conducted from October 2021 to October 2022 to develop and validate the mDiHERS. Participants included patients with inflammatory bowel disease, which is a chronic condition requiring continuous management, and experts in medical and nursing informatics. The scale development involved a literature review, focus group interviews, and content validity evaluations. A total of 440 patients with inflammatory bowel disease were recruited for the validation phase, with 403 completing the survey. The scale?s validity and reliability were assessed through exploratory factor analysis and Cronbach ?. The scale was translated into English by translators and bilingual and native researchers, ensuring its applicability in diverse settings. Results: The mDiHERS consists of 36 items across 6 domains, with a 5-point Likert scale for responses. The validation process confirmed the scale?s construct validity, with 4 factors explaining 65.05% of the total variance. The scale?s reliability was established with Cronbach ? values ranging from 0.84 to 0.91. The scale?s development considered the technical proficiency necessary for engaging with health mobile apps and devices, reflecting the importance of subjective confidence and objective skills in digital health literacy. Conclusions: The mDiHERS is a validated tool for measuring patients? readiness and ability to use digital health services. The mDiHERS assesses user characteristics, digital accessibility, literacy, and equity to contribute to the effective use of digital health services and improve accessibility. The development and validation of the mDiHERS emphasize the importance of confidence and competence in managing health digitally. Continuous improvements are necessary to ensure that all patients can benefit from digital health care. UR - https://www.jmir.org/2024/1/e58497 UR - http://dx.doi.org/10.2196/58497 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58497 ER - TY - JOUR AU - Gautam, Kamal AU - Shrestha, Roman AU - Dlamini, Sihlelelwe AU - Razali, Belle AU - Paudel, Kiran AU - Azwa, Iskandar AU - Saifi, Rumana AU - Toh, YuHang AU - Justin Lim, Hazriq AU - Sutherland, Ryan AU - Restar, Arjee AU - Phanuphak, Nittaya AU - Wickersham, A. Jeffrey PY - 2024/8/13 TI - Adaptation of a Theory-Based Mobile App to Improve Access to HIV Prevention Services for Transgender Women in Malaysia: Focus Group Study JO - JMIR Form Res SP - e56250 VL - 8 KW - HIV KW - AIDS KW - pre-exposure prophylaxis KW - PrEP KW - mobile health KW - mHealth KW - transgender women KW - Malaysia KW - mobile phone N2 - Background: Globally, transgender women have been disproportionately affected by the HIV epidemic, including in Malaysia, where an estimated 11% of transgender women are living with HIV. Available interventions designed specifically to meet transgender women?s needs for HIV prevention are limited. Mobile health, particularly smartphone mobile apps, is an innovative and cost-effective strategy for reaching transgender women and delivering interventions to reduce HIV vulnerability. Objective: This study aims to adapt a theory-based mobile health HIV prevention smartphone app, HealthMindr, to meet the unique needs of transgender women in Malaysia. We conducted theater testing of the HealthMindr app with transgender women and key stakeholders and explored barriers to transgender women?s uptake of HIV pre-exposure prophylaxis (PrEP). Methods: From February to April 2022, a total of 6 focus group (FG) sessions were conducted with 29 participants: 4 FG sessions with transgender women (n=18, 62%) and 2 FG sessions with stakeholders (n=11, 38%) providing HIV prevention services to transgender women in Malaysia. Barriers to PrEP uptake and gender-affirming care services among transgender women in Malaysia were explored. Participants were then introduced to the HealthMindr app and provided a comprehensive tour of the app?s features and functions. Participants provided feedback on the app and on how existing features should be adapted to meet the needs of transgender women, as well as any features that should be removed or added. Each FG was digitally recorded and transcribed. Transcripts were coded inductively using Dedoose software (version 9.0.54; SocioCultural Research Consultants, LLC) and analyzed to identify and interpret emerging themes. Results: Six subthemes related to PrEP barriers were found: stigma and discrimination, limited PrEP knowledge, high PrEP cost, accessibility concerns, alternative prevention methods, and perceived adverse effects. Participants suggested several recommendations regarding the attributes and app features that would be the most useful for transgender women in Malaysia. Adaptation and refinement of the app were related to the attributes of the app (user interface, security, customizable colors, themes, and avatars), feedback, and requests for additional mobile app functional (appointment booking, e-consultation, e-pharmacy, medicine tracker, mood tracker, resources, and service site locator) and communication (peer support group, live chat, and discussion forum) features. Conclusions: The results reveal that multifaceted barriers hinder PrEP uptake and use among transgender women in Malaysia. The findings also provide detailed recommendations for successfully adapting the HealthMindr app to the context of Malaysian transgender women, with a potential solution for delivering tailored HIV prevention, including PrEP, and increasing accessibility to gender-affirming care services. UR - https://formative.jmir.org/2024/1/e56250 UR - http://dx.doi.org/10.2196/56250 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56250 ER - TY - JOUR AU - Palmer, Anna AU - Sharma, Shaishab AU - Nagpal, Jayesh AU - Kimani, Victor AU - Mai, Florence AU - Ahmed, Zara PY - 2024/8/12 TI - Identifying Barriers to the Adoption of Digital Contact Tracing Apps in England: Semistructured Interview Study With Professionals Involved in the Pandemic Response JO - JMIR Form Res SP - e56000 VL - 8 KW - COVID-19 KW - global health KW - public health KW - qualitative study KW - tracing KW - England KW - apps KW - effectiveness KW - contact tracing KW - barrier KW - digital health KW - thematic analysis KW - privacy KW - communication KW - social support KW - tracing app KW - digital illiteracy KW - technology KW - support N2 - Background: The NHS (National Health Service) COVID-19 app was a digital contact tracing app (DCTA) used in England in response to the COVID-19 pandemic. The aim of which was to limit the spread of COVID-19 by providing exposure alerts. At the time of the pandemic, questions were raised regarding the effectiveness and cost of the NHS COVID-19 app and whether DCTAs have a role in future pandemics. Objective: This study aims to explore key barriers to DCTAs in England during the COVID-19 pandemic. Methods: This is a qualitative study using semistructured video interviews conducted with professionals in public health, digital health, clinicians, health care law, and health executives who had an active role in the COVID-19 pandemic. These interviews aimed to explore the perspective of different experts involved in the pandemic response and gauge their opinions on the key barriers to DCTAs in England during the COVID-19 pandemic. The initial use of maximum variation sampling combined with a snowball sampling approach ensured diversity within the cohort of interviewees. Interview transcripts were then analyzed using Braun and Clarke's 6 steps for thematic analysis. Results: Key themes that acted as barriers to DCTAs were revealed by interviewees such as privacy concerns, poor communication, technological accessibility, digital literacy, and incorrect use of the NHS COVID-19 app. Interviewees believed that some of these issues stemmed from poor governmental communication and a lack of transparency regarding how the NHS COVID-19 app worked, resulting in decreased public trust. Moreover, interviewees highlighted that a lack of social support integration within the NHS COVID-19 app and delayed app notification period also contributed to the poor adoption rates. Conclusions: Qualitative findings from interviews highlighted barriers to the NHS COVID-19 app, which can be applied to DCTAs more widely and highlight some important implications for the future use of DCTAS. There was no consensus among interviewees as to whether the NHS COVID-19 app was a success; however, all interviewees provided recommendations for improvements in creating and implementing DCTAs in the future. UR - https://formative.jmir.org/2024/1/e56000 UR - http://dx.doi.org/10.2196/56000 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56000 ER - TY - JOUR AU - Businelle, S. Michael AU - Hébert, T. Emily AU - Shi, Dingjing AU - Benson, Lizbeth AU - Kezbers, M. Krista AU - Tonkin, Sarah AU - Piper, E. Megan AU - Qian, Tianchen PY - 2024/8/12 TI - Investigating Best Practices for Ecological Momentary Assessment: Nationwide Factorial Experiment JO - J Med Internet Res SP - e50275 VL - 26 KW - ecological momentary assessment KW - mobile health KW - smartphone KW - compliance KW - ambulatory assessment KW - adherence KW - experience sampling KW - mobile phone KW - mHealth KW - real-time data KW - behavior KW - dynamic behavioral processes KW - self-report KW - factorial design N2 - Background: Ecological momentary assessment (EMA) is a measurement methodology that involves the repeated collection of real-time data on participants? behavior and experience in their natural environment. While EMA allows researchers to gain valuable insights into dynamic behavioral processes, the need for frequent self-reporting can be burdensome and disruptive. Compliance with EMA protocols is important for accurate, unbiased sampling; yet, there is no ?gold standard? for EMA study design to promote compliance. Objective: The purpose of this study was to use a factorial design to identify optimal study design factors, or combinations of factors, for achieving the highest completion rates for smartphone-based EMAs. Methods: Participants recruited from across the United States were randomized to 1 of 2 levels on each of 5 design factors in a 2×2×2×2×2 design (32 conditions): factor 1?number of questions per EMA survey (15 vs 25); factor 2?number of EMAs per day (2 vs 4); factor 3?EMA prompting schedule (random vs fixed times); factor 4?payment type (US $1 paid per EMA vs payment based on the percentage of EMAs completed); and factor 5?EMA response scale type (ie, slider-type response scale vs Likert-type response scale; this is the only within-person factor; each participant was randomized to complete slider- or Likert-type questions for the first 14 days or second 14 days of the study period). All participants were asked to complete prompted EMAs for 28 days. The effect of each factor on EMA completion was examined, as well as the effects of factor interactions on EMA completion. Finally, relations between demographic and socioenvironmental factors and EMA completion were examined. Results: Participants (N=411) were aged 48.4 (SD 12.1) years; 75.7% (311/411) were female, 72.5% (298/411) were White, 18.0% (74/411) were Black or African American, 2.7% (11/411) were Asian, 1.5% (6/411) were American Indian or Alaska Native, 5.4% (22/411) belonged to more than one race, and 9.6% (38/396) were Hispanic/Latino. On average, participants completed 83.8% (28,948/34,552) of scheduled EMAs, and 96.6% (397/411) of participants completed the follow-up survey. Results indicated that there were no significant main effects of the design factors on compliance and no significant interactions. Analyses also indicated that older adults, those without a history of substance use problems, and those without current depression tended to complete more EMAs than their counterparts. No other demographic or socioenvironmental factors were related to EMA completion rates. Finally, the app was well liked (ie, system usability scale score=82.7), and there was a statistically significant positive association between liking the app and EMA compliance. Conclusions: Study results have broad implications for developing best practices guidelines for future studies that use EMA methodologies. Trial Registration: ClinicalTrials.gov number NCT05194228; https://clinicaltrials.gov/study/NCT05194228 UR - https://www.jmir.org/2024/1/e50275 UR - http://dx.doi.org/10.2196/50275 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50275 ER - TY - JOUR AU - Idalski Carcone, April AU - Holtz, E. Bree AU - Reardon, Madeleine AU - Vesey, Dariane AU - Ellis, A. Deborah AU - Parks, Michael PY - 2024/8/7 TI - Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study JO - JMIR Form Res SP - e55650 VL - 8 KW - emerging adults KW - type 1 diabetes KW - intervention KW - qualitative KW - mHealth KW - mobile phone KW - smartphone N2 - Background: Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D. Objective: This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management. Methods: EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs? experiences living in a rural community with T1D and discussed EAs? impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis. Results: In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities (?everyone knows?) and community members? lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging. Conclusions: mHealth interventions aligned with EAs? needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited. Trial Registration: N/A, not a clinical trial UR - https://formative.jmir.org/2024/1/e55650 UR - http://dx.doi.org/10.2196/55650 UR - http://www.ncbi.nlm.nih.gov/pubmed/39110496 ID - info:doi/10.2196/55650 ER - TY - JOUR AU - Keikhosrokiani, Pantea AU - Polus, Manria AU - Guardado Medina, Sharon AU - Isomursu, Minna PY - 2024/8/6 TI - The Effectiveness of Medical Adherence Mobile Health Solutions for Individuals With Epilepsy: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e55123 VL - 13 KW - digital care pathway KW - epilepsy KW - mHealth KW - mobile health KW - effectiveness KW - systematic review KW - management KW - medical adherence KW - patient outcomes KW - digital health KW - design KW - eHealth solutions KW - health care professionals N2 - Background: Epilepsy requires continuous management and treatment to optimize patient outcomes. The advancement of digital health has led to the development of various mobile health (mHealth) tools designed to enhance treatment adherence among individuals with epilepsy. These solutions offer crucial support through features such as reminders, educational resources, personalized feedback, assistance with managing costs, shared decision-making, and access to supportive communities. To design effective medication adherence mHealth solutions, it is essential to evaluate the effectiveness of existing mHealth tools, understand the unique circumstances of different patients, and identify the roles of health care professionals within the digital care pathway. Existing studies on epilepsy primarily focus on self-management, whereas the effectiveness and usability of medical adherence mHealth solutions often remain overlooked. Furthermore, the involvement of health care professionals in digital care pathways for epilepsy as well as the impact of adherence mHealth solutions on the patient experience have not been adequately explored. Objective: This study aims to assess the effectiveness of current mHealth solutions designed to improve medical adherence among patients with epilepsy. Furthermore, the study will examine the experiences of patients using mHealth solutions for maintaining medical adherence in epilepsy care. Finally, this review intends to determine the roles of health care professionals within mHealth systems aimed at supporting adherence to medication among patients with epilepsy. Methods: A systematic literature review has been selected as the appropriate method to address the research questions, adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion and exclusion criteria have been carefully selected, and both qualitative and quantitative analyses will be used to analyze the results. The expected results will mainly focus on the comparison, classification, and analysis of the effectiveness of current medical adherence mHealth tools. Moreover, the patient experiences using available medical adherence mHealth tools for epilepsy will be assessed. Finally, the role of health care professionals in the epilepsy digital care pathway will be explored, with emphasis on medical adherence. Results: The initial search, full-text screening, and data extraction have been carried out. Thirty-three papers were included in the final stage of the review. The study is expected to be completed by October 2024. Conclusions: To enhance the digital care pathway for epilepsy, a medical adherence mHealth solution should be personalized, manage medications, include an alarm system, track seizures, support consultations, and offer updated treatment plans. This study aims to understand how findings from the research questions can improve mHealth solutions for individuals with epilepsy. Insights from this research on the effectiveness of current mHealth adherence solutions will provide guidance for developing future mHealth systems, making them more efficient and effective in managing epilepsy. Trial Registration: PROSPERO CRD4202347400; https://tinyurl.com/48mfx22e International Registered Report Identifier (IRRID): DERR1-10.2196/55123 UR - https://www.researchprotocols.org/2024/1/e55123 UR - http://dx.doi.org/10.2196/55123 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55123 ER - TY - JOUR AU - Zhang, Jinxi AU - Li, Zhen AU - Liu, Yu AU - Li, Jian AU - Qiu, Hualong AU - Li, Mohan AU - Hou, Guohui AU - Zhou, Zhixiong PY - 2024/8/5 TI - An Effective Deep Learning Framework for Fall Detection: Model Development and Study Design JO - J Med Internet Res SP - e56750 VL - 26 KW - fall detection KW - deep learning KW - self-attention KW - accelerometer KW - gyroscope KW - human health KW - wearable sensors KW - Sisfall KW - MobiFall N2 - Background: Fall detection is of great significance in safeguarding human health. By monitoring the motion data, a fall detection system (FDS) can detect a fall accident. Recently, wearable sensors?based FDSs have become the mainstream of research, which can be categorized into threshold-based FDSs using experience, machine learning?based FDSs using manual feature extraction, and deep learning (DL)?based FDSs using automatic feature extraction. However, most FDSs focus on the global information of sensor data, neglecting the fact that different segments of the data contribute variably to fall detection. This shortcoming makes it challenging for FDSs to accurately distinguish between similar human motion patterns of actual falls and fall-like actions, leading to a decrease in detection accuracy. Objective: This study aims to develop and validate a DL framework to accurately detect falls using acceleration and gyroscope data from wearable sensors. We aim to explore the essential contributing features extracted from sensor data to distinguish falls from activities of daily life. The significance of this study lies in reforming the FDS by designing a weighted feature representation using DL methods to effectively differentiate between fall events and fall-like activities. Methods: Based on the 3-axis acceleration and gyroscope data, we proposed a new DL architecture, the dual-stream convolutional neural network self-attention (DSCS) model. Unlike previous studies, the used architecture can extract global feature information from acceleration and gyroscope data. Additionally, we incorporated a self-attention module to assign different weights to the original feature vector, enabling the model to learn the contribution effect of the sensor data and enhance classification accuracy. The proposed model was trained and tested on 2 public data sets: SisFall and MobiFall. In addition, 10 participants were recruited to carry out practical validation of the DSCS model. A total of 1700 trials were performed to test the generalization ability of the model. Results: The fall detection accuracy of the DSCS model was 99.32% (recall=99.15%; precision=98.58%) and 99.65% (recall=100%; precision=98.39%) on the test sets of SisFall and MobiFall, respectively. In the ablation experiment, we compared the DSCS model with state-of-the-art machine learning and DL models. On the SisFall data set, the DSCS model achieved the second-best accuracy; on the MobiFall data set, the DSCS model achieved the best accuracy, recall, and precision. In practical validation, the accuracy of the DSCS model was 96.41% (recall=95.12%; specificity=97.55%). Conclusions: This study demonstrates that the DSCS model can significantly improve the accuracy of fall detection on 2 publicly available data sets and performs robustly in practical validation. UR - https://www.jmir.org/2024/1/e56750 UR - http://dx.doi.org/10.2196/56750 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56750 ER - TY - JOUR AU - Kapoor, Melissa AU - Holman, Blair AU - Cohen, Carolyn PY - 2024/8/5 TI - Contactless and Calibration-Free Blood Pressure and Pulse Rate Monitor for Screening and Monitoring of Hypertension: Cross-Sectional Validation Study JO - JMIR Cardio SP - e57241 VL - 8 KW - remote photoplethysmography KW - vital signs KW - calibration-free blood pressure monitor KW - medical device KW - hypertension screening KW - home blood pressure monitoring KW - vital KW - vitals KW - device KW - devices KW - hypertension KW - hypertensive KW - cardiovascular KW - cardiology KW - heart KW - blood pressure KW - monitoring KW - monitor KW - mHealth KW - mobile health KW - validation N2 - Background: The key to reducing the immense morbidity and mortality burdens of cardiovascular diseases is to help people keep their blood pressure (BP) at safe levels. This requires that more people with hypertension be identified, diagnosed, and given tools to lower their BP. BP monitors are critical to hypertension diagnosis and management. However, there are characteristics of conventional BP monitors (oscillometric cuff sphygmomanometers) that hinder rapid and effective hypertension diagnosis and management. Calibration-free, software-only BP monitors that operate on ubiquitous mobile devices can enable on-demand BP monitoring, overcoming the hardware barriers of conventional BP monitors. Objective: This study aims to investigate the accuracy of a contactless BP monitor software app for classifying the full range of clinically relevant BPs as hypertensive or nonhypertensive and to evaluate its accuracy for measuring the pulse rate (PR) and BP of people with BPs relevant to stage-1 hypertension. Methods: The software app, known commercially as Lifelight, was investigated following the data collection and data analysis methodology outlined in International Organization for Standardization (ISO) 81060-2:2018/AMD 1:2020 ?Non-invasive Sphygmomanometers?Part 2: Clinical investigation of automated measurement type.? This validation study was conducted by the independent laboratory Element Materials Technology Boulder (formerly Clinimark). The study generated data from 85 people aged 18-85 years with a wide-ranging distribution of BPs specified in ISO 81060-2:2018/AMD 1:2020. At least 20% were required to have Fitzpatrick scale skin tones of 5 or 6 (ie, dark skin tones). The accuracy of the app?s BP measurements was assessed by comparing its BP measurements with measurements made by dual-observer manual auscultation using the same-arm sequential method specified in ISO 81060-2:2018/AMD 1:2020. The accuracy of the app?s PR measurements was assessed by comparing its measurements with concurrent electroencephalography-derived heart rate values. Results: The app measured PR with an accuracy root-mean-square of 1.3 beats per minute and mean absolute error of 1.1 (SD 0.8) beats per minute. The sensitivity and specificity with which it determined that BPs exceeded the in-clinic systolic threshold for hypertension diagnosis were 70.1% and 71.7%, respectively. These rates are consistent with those reported for conventional BP monitors in a literature review by The National Institute for Health and Care Excellence. The app?s mean error for measuring BP in the range of normotension and stage-1 hypertension (ie, 65/85, 76% of participants) was 6.5 (SD 12.9) mm Hg for systolic BP and 0.4 (SD 10.6) mm Hg for diastolic BP. Mean absolute error was 11.3 (SD 10.0) mm Hg and 8.6 (SD 6.8) mm Hg, respectively. Conclusions: A calibration-free, software-only medical device was independently tested against ISO 81060-2:2018/AMD 1:2020. The safety and performance demonstrated in this study suggest that this technique could be a potential solution for rapid and scalable screening and management of hypertension. UR - https://cardio.jmir.org/2024/1/e57241 UR - http://dx.doi.org/10.2196/57241 UR - http://www.ncbi.nlm.nih.gov/pubmed/39102277 ID - info:doi/10.2196/57241 ER - TY - JOUR AU - Wu, Pei-Chang AU - Chiang, Wei-Yu AU - Lo, Jung AU - Lee, Jong-Jer AU - Chen, Yung-Jen AU - Kuo, Hsi-Kung AU - Chiau, Jie-Shin AU - Hsu, Shu-Hui AU - Chen, Yi-Hao PY - 2024/8/2 TI - Using a Smartphone-Based Chatbot for Postoperative Care After Intravitreal Injection During the COVID-19 Pandemic: Retrospective Cohort Study JO - JMIR Form Res SP - e43022 VL - 8 KW - smartphone chatbot KW - postoperative care KW - intravitreal injection KW - age-related macular degeneration KW - self-report, endophthalmitis KW - COVID-19 N2 - Background: During the COVID-19 pandemic period, it was difficult to carry out regular and scheduled follow-up of patients in the outpatient department, especially during lockdown periods. However, early detection of initial infection or other serious conditions is vital for patients after ocular surgery, such as intravitreal injection (IVI) for age-related macular degeneration (AMD). Objective: We evaluated the use of a smartphone-based postoperative care chatbot system (PCCS) with an instant bidirectional feedback system for patients to self-report postoperative symptoms and signs. Methods: During the COVID-19 level 3 epidemic alert in July 2021 in Taiwan, the PCCS alerted the patients to report and grade 6 ocular symptoms and signs associated with ocular inflammation or retinal detachment. Patients used the PCCS for 7 days post surgery to assess their symptoms and signs each day after receiving an alert. Data were automatically collected using a cloud computer system, including symptom grades and messages sent to medical staff for further medical assistance. A user satisfaction questionnaire was administered to the patients on the seventh day post surgery. Results: In total, 185 patients participated in this study. There were 26 (3.03%) reports of symptom grade deterioration (including increased blurred vision, eye swelling, nausea, and floaters or flashes) from 12 (6.5%) patients. We found no difference in the gender of patients who received an early medical consultation. One case of endophthalmitis was reported, wherein an improvement was observed after prompt administration of IVI antibiotics twice. Overall, 87% (n=185) of patients were satisfied or very satisfied with communicating their symptoms instantly through the app; they were willing to use it again and believed that it could improve the quality of care. Seven of the 185 (3.8%) patients had an earlier medical consultation and 1 (0.5%) had endophthalmitis. Conclusions: The chatbot system, designed for self-reporting postoperative symptoms and providing instant bidirectional feedback on smartphones, could be beneficial for enhancing the quality of care in early medical consultations without gender differences among patients with AMD receiving IVI, and achieved satisfactory responses from patients. UR - https://formative.jmir.org/2024/1/e43022 UR - http://dx.doi.org/10.2196/43022 UR - http://www.ncbi.nlm.nih.gov/pubmed/38643063 ID - info:doi/10.2196/43022 ER - TY - JOUR AU - LaVine, Danielle AU - Greer, Zara AU - Kim, Jiyun AU - Kumar, Santosh AU - Belin, Thomas AU - Shetty, Vivek PY - 2024/8/2 TI - A Remote Oral Self-Care Behaviors Assessment System in Vulnerable Populations: Usability and Feasibility Study JO - JMIR Form Res SP - e54999 VL - 8 KW - dental disease KW - underserved populations KW - mHealth KW - usability testing KW - feasibility testing, mobile phone N2 - Background: Preventative self-care can reduce dental disease that disproportionately burdens vulnerable populations. Personalized digital oral self-care behavioral interventions offer a promising solution. However, the success of these digital interventions depends on toothbrushing data collection e-platforms attuned to the needs and preferences of vulnerable communities. Objective: The aim of this study is to assess the usability and feasibility of the Remote Oral Behaviors Assessment System (ROBAS), which has been adapted to address the unique requirements of socioeconomically disadvantaged minority individuals. Methods: A cohort of 53 community-clinic participants, including 31 (58%) Latino and 22 (42%) Black individuals with no prior experience using electric toothbrushes, were recruited to use ROBAS, with planned assessments at baseline, 2 months, and 4 months. Beyond evaluating ROBAS?s technical performance, extensive feedback was gathered to gauge users? experiences, viewpoints, and overall contentment. The System Usability Scale (SUS) served as a primary metric for assessing user satisfaction and acceptability. Results: ROBAS exhibited largely reliable and consistent data-gathering capabilities. SUS scores (mean 75.6, SD 14.5) reflected participant contentment within a range of values for other commonly used digital devices and technologies. Among participants who answered questions about willingness to pay for ROBAS, 97% (30/31) indicated that they were willing to pay for ROBAS either as a one-time payment or as a subscription-based service. Additionally, 87.5% of participants expressed that they would endorse it to acquaintances. Most participants expressed no reservations about privacy; among those who expressed privacy concerns (n=20, 50%), the concerns included exposure of information (n=18, 45%), monitoring of brushing habits (n=12, 30%), and collection of information (n=14, 35%), although these concerns did not significantly correlate with specific participant traits. In qualitative terms, users valued ROBAS's ability to monitor brushing habits but called for refinements, especially in Wi-Fi and application connectivity. Recommendations for system improvements encompassed enhanced app functionality, individualized coaching, more comprehensive brushing data, and the addition of flossing activity tracking. Conclusions: The research highlights ROBAS's promise as a digital platform for unobtrusively tracking daily oral self-care activities in marginalized communities. The system proved to be both feasible, as evidenced by its stable and accurate data capture of brushing behaviors, and user-friendly, as reflected by strong SUS scores and positive user feedback. Influential factors for its uptake included ease of learning and operation, and the feedback provided. UR - https://formative.jmir.org/2024/1/e54999 UR - http://dx.doi.org/10.2196/54999 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54999 ER - TY - JOUR AU - Guo, Ziqiu AU - Wu, Yongda AU - Wang, Ping Man PY - 2024/8/1 TI - Mobile Phone?Based Personalized and Interactive Augmented Reality Pictorial Health Warnings for Enhancing a Brief Advice Model for Smoking Cessation: Pilot Randomized Controlled Trial JO - JMIR XR Spatial Comput SP - e52893 VL - 1 KW - augmented reality KW - mobile-based KW - smoking cessation KW - brief advice KW - pictorial health warning KW - pilot randomized controlled trial N2 - Background: Augmented reality (AR) is a novel modality for promoting smoking cessation (SC). AR-visualized adverse consequences for education and smoking prevention have only been evaluated in nonsmokers in previous studies. Objective: To assess the feasibility and preliminary effectiveness for SC of AR pictorial health warnings (PHWs) on cigarette packs. Methods: We conducted a pilot randomized controlled trial in adult daily smokers in communities in Hong Kong. All participants received AWARD (ask, warn, advise, referral, do-it-again) model?guided SC advice, a warning leaflet, and referral to SC services at baseline. Interactive, chat-based SC support comprising regular messages and real-time support was provided to all participants via instant messaging apps (eg, WhatsApp) for 3 months after randomization. Participants in the intervention group additionally received 6 links to the AR PHWs showing the worsening health status of various organs caused by smoking. The level of the AR PHWs was adjustable to smoking behaviors (ie, smoking duration or daily cigarette consumption) to increase interaction. Participants could swipe, drag, or rotate the 3D PHWs to reinforce their impression of the health consequences of smoking. The primary outcome was self-reported past 7-day point-prevalence abstinence (PPA) at 3 months. The acceptability of the AR intervention was assessed by the proportion of participants who had viewed AR PHWs during the intervention. Participants who viewed AR PHWs further evaluated the perceived effect of the AR PHWs on a scale of 0 (not helpful at all) to 10 (very helpful). Intention to treat was used, and the risk ratio (RR) of the intervention effect was estimated by Poisson regression. Results: From April to November 2021, 80 participants were recruited and randomly assigned to intervention (n=40) and control (n=40) groups. Most participants were male (66/80, 83%) and planned to quit beyond 30 days or were undecided (65/80, 81%). The intervention group had a higher but nonsignificant 7-day PPA (7/40, 18% vs 5/40, 13%; RR 1.40, 95% CI 0.48-4.07) and quit attempts (15/40, 38% vs 11/40, 28%; RR 1.36, 95% CI 0.71-2.60) at 3 months than the control group. In the intervention group, 17 of 40 (43%) participants viewed the AR PHWs. The AR PHWs had modest effects on knowledge of the adverse consequences of smoking on personal health (mean score 3.94, SD 3.52), reducing the frequency of buying cigarettes (mean score 3.29, SD 3.08), increasing the perceived importance of quitting (mean score 3.88, SD 3.50), and making the PHWs more disgusting (mean score 3.41, SD 3.08) and horrible (mean score 3.38, SD 3.05). The 3-month self-reported 7-day PPA was higher in those who ever (vs never) viewed the AR PHWs (5/17, 29% vs 2/23, 9%). Conclusions: The mobile-based interactive AR PHWs were feasible, and the effectiveness on smoking abstinence warrants further testing. Trial Registration: ClinicalTrials.gov NCT04830072; https://clinicaltrials.gov/study/NCT04830072 UR - https://xr.jmir.org/2024/1/e52893 UR - http://dx.doi.org/10.2196/52893 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52893 ER - TY - JOUR AU - Haq, Ul Zaeem AU - Naeem, Ayesha AU - Zaeem, Durayya AU - Sohail, Mohina AU - Pervaiz, Ain Noor ul PY - 2024/7/31 TI - Development of a Digital Platform to Promote Mother and Child Health in Underserved Areas of a Lower-Middle-Income Country: Mixed Methods Formative Study JO - JMIRx Med SP - e48213 VL - 5 KW - primary health care KW - mother and child health KW - community health worker KW - slums KW - digital applications KW - health communication. N2 - Background: Primary health care (PHC) is the backbone of universal health coverage, with community health workers (CHWs) being one of its critical pillars in lower-middle-income countries. Most CHW functions require them to be an efficient communicator, but their program development has been deficient in this area. Can IT provide some solutions? Moreover, can some IT-based CHW-delivered innovations help mothers and children in areas not covered by PHC services? We explored these questions during the development and feasibility testing of a digital application designed to improve the communication capacity of CHWs in two underserved areas of Islamabad. Objective: This study aims to explore the perceptions, practices, and related gaps about mother and child health, and child development in an underserved area; develop and deploy a behavior change communication program to address the gaps; and assess the feasibility of the program. Methods: We carried out a mixed methods study with three steps. First, we conducted 13 in-depth interviews and two focus group discussions with stakeholders to explore the issues faced by mothers living in these underserved areas. To address these barriers, we developed Sehat Ghar, a video-based health education application to demonstrate practices mothers and families needed to adopt. Second, we trained 10 volunteer CHWs from the same community to deliver health education using the application and assessed their pre-post knowledge and skills. Third, these CHWs visited pregnant and lactating mothers in the community with random observation of their work by a supporting supervisor. Results: Initial exploration revealed a need for health-related knowledge among mothers and suboptimal utilization of public health care. Sehat Ghar used behavior change techniques, including knowledge transfer, enhancing mothers? self-efficacy, and improving family involvement in mother and child care. Volunteer CHWs were identified from the community, who after the training, showed a significant improvement in mean knowledge score (before: mean 8.00, SD 1.49; after: mean 11.40, SD 1.43; P<.001) about health. During supportive supervision, these CHWs were rated as excellent in their interaction with mothers and excellent or very good in using the application. The CHW and her community reported their satisfaction with the application and wanted its delivery regularly. Conclusions: Sehat Ghar is a simple, easy-to-use digital application for CHWs and is acceptable to the community. Mothers appreciate the content and presentation and are ready to incorporate its messages into their daily practices. The real-world effectiveness of the innovation tested on 250 mother-infant pairs will be important for its proof of effectiveness. With its usefulness and adaptability, and the rapidly spreading use of mobile phones and internet technology, this cost-effective innovation can help in delivering health communications at a large scale in a minimum amount of time. UR - https://xmed.jmir.org/2024/1/e48213 UR - http://dx.doi.org/10.2196/48213 ID - info:doi/10.2196/48213 ER - TY - JOUR AU - Caserman, Polona AU - Yum, Sungsoo AU - Göbel, Stefan AU - Reif, Andreas AU - Matura, Silke PY - 2024/7/31 TI - Assessing the Accuracy of Smartwatch-Based Estimation of Maximum Oxygen Uptake Using the Apple Watch Series 7: Validation Study JO - JMIR Biomed Eng SP - e59459 VL - 9 KW - maximal oxygen uptake KW - oxygen consumption KW - cardiorespiratory fitness KW - physical fitness KW - physical activity KW - fitness tracker KW - wearables KW - wearable KW - exercise KW - fitness KW - tracker KW - trackers KW - cardiorespiratory KW - wrist worn device KW - devices KW - validation study KW - VO2max KW - sport watch KW - fitness level KW - mobile phone N2 - Background: Determining maximum oxygen uptake (VO2max) is essential for evaluating cardiorespiratory fitness. While laboratory-based testing is considered the gold standard, sports watches or fitness trackers offer a convenient alternative. However, despite the high number of wrist-worn devices, there is a lack of scientific validation for VO2max estimation outside the laboratory setting. Objective: This study aims to compare the Apple Watch Series 7?s performance against the gold standard in VO2max estimation and Apple?s validation findings. Methods: A total of 19 participants (7 female and 12 male), aged 18 to 63 (mean 28.42, SD 11.43) years were included in the validation study. VO2max for all participants was determined in a controlled laboratory environment using a metabolic gas analyzer. Thereby, they completed a graded exercise test on a cycle ergometer until reaching subjective exhaustion. This value was then compared with the estimated VO2max value from the Apple Watch, which was calculated after wearing the watch for at least 2 consecutive days and measured directly after an outdoor running test. Results: The measured VO2max (mean 45.88, SD 9.42 mL/kg/minute) in the laboratory setting was significantly higher than the predicted VO2max (mean 41.37, SD 6.5 mL/kg/minute) from the Apple Watch (t18=2.51; P=.01) with a medium effect size (Hedges g=0.53). The Bland-Altman analysis revealed a good overall agreement between both measurements. However, the intraclass correlation coefficient ICC(2,1)=0.47 (95% CI 0.06-0.75) indicated poor reliability. The mean absolute percentage error between the predicted and the actual VO2max was 15.79%, while the root mean square error was 8.85 mL/kg/minute. The analysis further revealed higher accuracy when focusing on participants with good fitness levels (mean absolute percentage error=14.59%; root-mean-square error=7.22 ml/kg/minute; ICC(2,1)=0.60 95% CI 0.09-0.87). Conclusions: Similar to other smartwatches, the Apple Watch also overestimates or underestimates the VO2max in individuals with poor or excellent fitness levels, respectively. Assessing the accuracy and reliability of the Apple Watch?s VO2max estimation is crucial for determining its suitability as an alternative to laboratory testing. The findings of this study will apprise researchers, physical training professionals, and end users of wearable technology, thereby enhancing the knowledge base and practical application of such devices in assessing cardiorespiratory fitness parameters. UR - https://biomedeng.jmir.org/2024/1/e59459 UR - http://dx.doi.org/10.2196/59459 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59459 ER - TY - JOUR AU - Ferguson, IreLee AU - George, Grace AU - Narine, O. Kevin AU - Turner, Amari AU - McGhee, Zelda AU - Bajwa, Harris AU - Hart, G. Frances AU - Carter, Sierra AU - Beard, Courtney PY - 2024/7/31 TI - Acceptability and Engagement of a Smartphone-Delivered Interpretation Bias Intervention in a Sample of Black and Latinx Adults: Open Trial JO - JMIR Ment Health SP - e56758 VL - 11 KW - interpretation bias KW - anxiety KW - depression KW - Black KW - Latinx KW - smartphone KW - mobile phone N2 - Background: Access to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials? samples consisted of predominantly non-Hispanic, White individuals. Objective: This study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults. Methods: Black, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks. Results: Of the 31 participants that downloaded the app, 27 (87%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55). Conclusions: This study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention. UR - https://mental.jmir.org/2024/1/e56758 UR - http://dx.doi.org/10.2196/56758 UR - http://www.ncbi.nlm.nih.gov/pubmed/39083330 ID - info:doi/10.2196/56758 ER - TY - JOUR AU - Lau, Nancy AU - Palermo, M. Tonya AU - Zhou, Chuan AU - Badillo, Isabel AU - Hong, Shannon AU - Aalfs, Homer AU - Yi-Frazier, P. Joyce AU - McCauley, Elizabeth AU - Chow, J. Eric AU - Weiner, J. Bryan AU - Ben-Zeev, Dror AU - Rosenberg, R. Abby PY - 2024/7/30 TI - Mobile App Promoting Resilience in Stress Management for Adolescents and Young Adults With Cancer: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e57950 VL - 13 KW - adolescents KW - young adult KW - cancer KW - mHealth KW - psychosocial intervention KW - stress management KW - coping KW - resilience KW - health-related quality of life KW - randomized controlled trial KW - mobile phone N2 - Background: Adolescents and young adults (AYAs) with cancer are at risk of poor psychosocial outcomes. AYAs grew up with the internet and digital technology, and mobile Health (mHealth) psychosocial interventions have the potential to overcome care access barriers. Objective: This pilot randomized controlled trial (RCT) aimed to establish the feasibility, acceptability, and preliminary efficacy of a fully automated mobile app version of the Promoting Resilience in Stress Management intervention (mPRISM). Promoting Resilience in Stress Management is an evidence-based intervention developed in collaboration with AYAs, based on stress and coping theory, resilience theory, and evidence-based coping strategies. We hypothesized that mPRISM would be feasible, acceptable, and appropriate. Methods: This is a parallel, 2-arm, single-site pilot RCT with a waitlist control design. The study will recruit 80 AYAs with cancer from a clinic. Eligible AYAs are aged 12 to 25 years, within 12 months of a new cancer diagnosis, receiving chemotherapy or radiation therapy, speak, read, or write in English, and are cognitively able to participate in study procedures. Recruitment by clinical research coordinators will occur remotely by phone, video, or text. Participants will be randomized to psychosocial usual care (UC) alone or UC plus mPRISM for an 8-week intervention period, and will remain unblinded to study condition. Enrolled participants will complete surveys at baseline before randomization, 8 weeks, and 3-month follow-up. Using a waitlist design, the UC arm will receive mPRISM upon completion of 3-month follow-up surveys. Those in the UC arm will complete 2 additional measurement points at immediate posttreatment and 3 months later. The primary outcomes of interest are feasibility, defined as ?60% enrollment and ?70% retention (ie, percentage of participants who completed the study), and ?feasibility, acceptability, and appropriateness? as defined by cut-off scores ?4/5 on 3 brief validated implementation outcome measures (feasibility of implementation measure, acceptability of intervention measure [AIM], intervention appropriateness measure [IAM]). We will apply top-box scoring for the implementation measures. Exploratory outcomes of interest include patient-reported health-related quality of life, resilience, distress, anxiety, depression, pain, and sleep. We will conduct an intention-to-treat analysis to compare the outcomes of the mPRISM arm versus the control arm with covariate-adjusted regression models. We will summarize individual digital usage metrics using descriptive statistics. Results: Since September 2023, we have enrolled 20 participants and recruitment is ongoing. Conclusions: Although our previous work suggests AYAs with cancer are interested in mHealth psychosocial interventions, such interventions have not yet been sufficiently evaluated or implemented among AYA oncology patients. mPRISM may serve as a potential mHealth intervention to fill this gap. In this study, we will test the feasibility, acceptability, and preliminary efficacy of mPRISM. This work will inform future larger-scale RCTs powered for efficacy outcomes. Trial Registration: ClinicalTrials.gov NCT05842902; https://clinicaltrials.gov/study/NCT05842902 International Registered Report Identifier (IRRID): DERR1-10.2196/57950 UR - https://www.researchprotocols.org/2024/1/e57950 UR - http://dx.doi.org/10.2196/57950 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57950 ER - TY - JOUR AU - Tung, Heng-Hsin AU - Kuo, Chen-Yuan AU - Lee, Pei-Lin AU - Chang, Chih-Wen AU - Chou, Kun-Hsien AU - Lin, Ching-Po AU - Chen, Liang-Kung PY - 2024/7/30 TI - Efficacy of Digital Dance on Brain Imagery, Cognition, and Health: Randomized Controlled Trial JO - J Med Internet Res SP - e57694 VL - 26 KW - digital KW - somatosensory dance KW - somatosensory game KW - cognitive performance KW - physical function KW - resilience KW - demoralization KW - quality of life KW - dance KW - dancer KW - dancing KW - movement KW - sport KW - sports KW - cognitive KW - cognition KW - brain KW - neuroscience KW - image KW - imagery KW - imaging KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - somatosensory KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - aged KW - game KW - games KW - gaming N2 - Background: Multidomain interventions have demonstrable benefits for promoting healthy aging, but self-empowerment strategies to sustain long-term gains remain elusive. Objective: This study evaluated the effects of digital somatosensory dance game participation on brain imagery changes as primary outcomes and other physical and mental health measures as secondary outcomes related to healthy aging. Methods: Between August 31, 2020, and June 27, 2021, this randomized controlled trial recruited 60 eligible participants older than 55 years with no recent engagement in digital dance games. A computer-generated randomization sequence was used to allocate participants 1:1, without stratification, to an intervention group (n=30) who underwent digital somatosensory dance game training or a control group (n=30). An anonymized code masked the intervention allocations from the investigators, and individuals who assigned the interventions were not involved in analyzing the study data. The intervention entailed two 30-minute dance game sessions per week for 6 months, and the control group received healthy aging education. Primary outcomes were brain imagery changes. All variables were measured at baseline and the 6-month follow-up, and intervention effects were estimated using t tests with intention-to-treat analyses. Results: Compared with the control group, intervention participants had significantly different brain imagery in the gray matter volume (GMV) of the left putamen (estimate 0.016, 95% CI 0.008 to 0.024; P<.001), GMV of the left pallidum (estimate 0.02, 95% CI 0.006 to 0.034; P=.004), and fractional amplitude of low frequency fluctuations of the left pallidum (estimate 0.262, 95% CI 0.084 to 0.439; P=.004). Additionally, the intervention group had different imagery in the cerebellum VI GMV (estimate 0.011, 95% CI 0.003 to 0.02; P=.01). The intervention group also had improved total Montreal Cognitive Assessment scores (estimate 1.2, 95% CI 0.27 to ?2.13; P<.01), quality of life (estimate 7.08, 95% CI 2.35 to 11.82; P=.004), and time spent sitting on weekdays (estimate ?1.96, 95% CI ?3.33 to ?0.60; P=.005). Furthermore, dance performance was significantly associated with cognitive performance (P=.003), health status (P=.14), resilience (P=.007), and demoralization (P<.001). Conclusions: Digital somatosensory dance game participation for 6 months was associated with brain imagery changes in multiple regions involving somatosensory, motor, visual, and attention functions, which were consistent with phenotypic improvements associated with healthy aging. Trial Registration: ClinicalTrials.gov NCT05411042; https://clinicaltrials.gov/study/NCT05411042 UR - https://www.jmir.org/2024/1/e57694 UR - http://dx.doi.org/10.2196/57694 UR - http://www.ncbi.nlm.nih.gov/pubmed/39078687 ID - info:doi/10.2196/57694 ER - TY - JOUR AU - Bear, Alice Holly AU - Ayala Nunes, Lara AU - Ramos, Giovanni AU - Manchanda, Tanya AU - Fernandes, Blossom AU - Chabursky, Sophia AU - Walper, Sabine AU - Watkins, Edward AU - Fazel, Mina PY - 2024/7/30 TI - The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study JO - J Med Internet Res SP - e48964 VL - 26 KW - adolescent mental health KW - marginalized groups KW - smartphone apps KW - engagement KW - implementation science KW - mobile app KW - smartphone KW - mobile health KW - mHealth KW - mental health KW - challenges KW - acceptability KW - young KW - effectiveness KW - mobile phone N2 - Background: Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. Objective: This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. Methods: We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. Results: The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users? objective engagement. Conclusions: Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in ?real-world? settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. Trial Registration: PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241 UR - https://www.jmir.org/2024/1/e48964 UR - http://dx.doi.org/10.2196/48964 UR - http://www.ncbi.nlm.nih.gov/pubmed/39078699 ID - info:doi/10.2196/48964 ER - TY - JOUR AU - Chen, Wenfei AU - Chen, Jiana AU - Jiang, Shaojun AU - Wang, Chunhua AU - Zhang, Jinhua PY - 2024/7/29 TI - Web-Based Warfarin Management (Alfalfa App) Versus Traditional Warfarin Management: Multicenter Prospective Cohort Study JO - J Med Internet Res SP - e46319 VL - 26 KW - warfarin KW - telemedicine KW - smart phone application KW - anti-coagulation management KW - management KW - cohort study KW - application KW - chronic disease KW - support KW - effectiveness KW - online model KW - patient management N2 - Background: Poor anticoagulation management of warfarin may lead to patient admission, prolonged hospital stays, and even death due to anticoagulation-related adverse events. Traditional non?web-based outpatient clinics struggle to provide ideal anticoagulation management services for patients, and there is a need to explore a safer, more effective, and more convenient mode of warfarin management. Objective: This study aimed to compare differences in the quality of anticoagulation management and clinical adverse events between a web-based management model (via a smartphone app) and the conventional non?web-based outpatient management model. Methods: This study is a prospective cohort research that includes multiple national centers. Patients meeting the nadir criteria were split into a web-based management group using the Alfalfa app or a non?web-based management group with traditional outpatient management, and they were then monitored for a 6-month follow-up period to collect coagulation test results and clinical events. The effectiveness and safety of the 2 management models were assessed by the following indicators: time in therapeutic range (TTR), bleeding events, thromboembolic events, all-cause mortality events, cumulative event rates, and the distribution of the international normalized ratio (INR). Results: This national multicenter cohort study enrolled 522 patients between June 2019 and May 2021, with 519 (99%) patients reaching the follow-up end point, including 260 (50%) in the non?web-based management group and 259 (50%) in the web-based management group. There were no observable differences in baseline characteristics between the 2 patient groups. The web-based management group had a significantly higher TTR than the non?web-based management group (82.4% vs 71.6%, P<.001), and a higher proportion of patients received effective anticoagulation management (81.2% vs 63.5%, P<.001). The incidence of minor bleeding events in the non?web-based management group was significantly higher than that in the web-based management group (12.1% vs 6.6%, P=.048). Between the 2 groups, there was no statistically significant difference in the incidence of severe bleeding and thromboembolic and all-cause death events. In addition, compared with the non?web-based management group, the web-based management group had a lower proportion of INR in the extreme subtreatment range (17.6% vs 21.3%) and severe supertreatment range (0% vs 0.8%) and a higher proportion in the treatment range (50.4% vs 43.1%), with statistical significance. Conclusions: Compared with traditional non?web-based outpatient management, web-based management via the Alfalfa app may be more beneficial because it can enhance patient anticoagulation management quality, lower the frequency of small bleeding events, and improve INR distribution. UR - https://www.jmir.org/2024/1/e46319 UR - http://dx.doi.org/10.2196/46319 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073869 ID - info:doi/10.2196/46319 ER - TY - JOUR AU - Shin, Jiyoon AU - Kim, Sujin AU - Lee, Jooyoung AU - Gu, Hyerin AU - Ahn, Jihye AU - Park, Chowon AU - Seo, Mincheol AU - Jeon, Eun Jeong AU - Lee, Young Ha AU - Yeom, Won Ji AU - Kim, Sojeong AU - Yoon, Yeaseul AU - Lee, Heon-Jeong AU - Kim, Ju Seog AU - Lee, Jin Yu PY - 2024/7/26 TI - Efficacy of Mobile App?Based Cognitive Behavioral Therapy for Insomnia: Multicenter, Single-Blind Randomized Clinical Trial JO - J Med Internet Res SP - e50555 VL - 26 KW - digital therapeutics KW - mobile app?based cognitive behavioral therapy for insomnia KW - cognitive behavioral therapy KW - insomnia KW - mental health KW - mobile phone N2 - Background: Cognitive behavioral therapy for insomnia (CBTi) is the first-line therapy for chronic insomnia. Mobile app?based CBTi (MCBTi) can enhance the accessibility of CBTi treatment; however, few studies have evaluated the effectiveness of MCBTi using a multicenter, randomized controlled trial design. Objective: We aimed to assess the efficacy of Somzz, an MCBTi that provides real-time and tailored feedback to users, through comparison with an active comparator app. Methods: In our multicenter, single-blind randomized controlled trial study, participants were recruited from 3 university hospitals and randomized into a Somzz group and a sleep hygiene education (SHE) group at a 1:1 ratio. The intervention included 6 sessions for 6 weeks, with follow-up visits over a 4-month period. The Somzz group received audiovisual sleep education, guidance on relaxation therapy, and real-time feedback on sleep behavior. The primary outcome was the Insomnia Severity Index score, and secondary outcomes included sleep diary measures and mental health self-reports. We analyzed the outcomes based on the intention-to-treat principle. Results: A total of 98 participants were randomized into the Somzz (n=49, 50%) and SHE (n=49, 50%) groups. Insomnia Severity Index scores for the Somzz group were significantly lower at the postintervention time point (9.0 vs 12.8; t95=3.85; F2,95=22.76; ?p2=0.13; P<.001) and at the 3-month follow-up visit (11.3 vs 14.7; t68=2.61; F2,68=5.85; ?p2=0.03; P=.01) compared to those of the SHE group. The Somzz group maintained their treatment effect at the postintervention time point and follow-ups, with a moderate to large effect size (Cohen d=?0.62 to ?1.35; P<.01 in all cases). Furthermore, the Somzz group showed better sleep efficiency (t95=?3.32; F2,91=69.87; ?p2=0.41; P=.001), wake after sleep onset (t95=2.55; F2,91=51.81; ?p2=0.36; P=.01), satisfaction (t95=?2.05; F2,91=26.63; ?p2=0.20; P=.04) related to sleep, and mental health outcomes, including depression (t95=2.11; F2,94=29.64; ?p2=0.21; P=.04) and quality of life (t95=?3.13; F2,94=54.20; ?p2=0.33; P=.002), compared to the SHE group after the intervention. The attrition rate in the Somzz group was 12% (6/49). Conclusions: Somzz outperformed SHE in improving insomnia, mental health, and quality of life. The MCBTi can be a highly accessible, time-efficient, and effective treatment option for chronic insomnia, with high compliance. Trial Registration: Clinical Research Information Service (CRiS) KCT0007292; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=22214&search_page=L UR - https://www.jmir.org/2024/1/e50555 UR - http://dx.doi.org/10.2196/50555 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50555 ER - TY - JOUR AU - Cruz-Cobo, Celia AU - Bernal-Jiménez, Ángeles María AU - Calle, Germán AU - Gheorghe, Luciana Livia AU - Gutiérrez-Barrios, Alejandro AU - Cañadas, Dolores AU - Tur, A. Josep AU - Vázquez-García, Rafael AU - Santi-Cano, José María PY - 2024/7/25 TI - Efficacy of a Mobile Health App (eMOTIVA) Regarding Compliance With Cardiac Rehabilitation Guidelines in Patients With Coronary Artery Disease: Randomized Controlled Clinical Trial JO - JMIR Mhealth Uhealth SP - e55421 VL - 12 KW - coronary event KW - coronary heart disease KW - eHealth KW - lifestyle KW - mHealth KW - mobile health N2 - Background: Cardiac rehabilitation is fundamental among patients recovering from a coronary event, and mHealth technology may constitute a useful tool that provides guidelines based on scientific evidence in an entertaining, attractive, and user-friendly format. Objective: This study aimed to compare the efficacy of an mHealth intervention involving the eMOTIVA app and that of usual care regarding compliance with cardiac rehabilitation guidelines in terms of lifestyle, cardiovascular risk factors, and satisfaction among patients with acute coronary syndrome. Methods: A randomized controlled clinical trial with a parallel group design was conducted. It included 300 patients (mHealth group, 150; control group, 150) who underwent percutaneous coronary intervention for acute coronary syndrome. Both groups underwent evaluations initially (during hospitalization) and after 3 and 6 months (face-to-face consultations). The eMOTIVA app incorporates a virtual classroom providing audio and video information about a healthy lifestyle, a section for self-recording cardiovascular risk factors, and a section for feedback messages and gamification. The primary outcome variables were (1) adherence to the Mediterranean diet and the frequency of consumption of food; (2) physical activity level, sedentary time, and exercise capacity; (3) smoking cessation and nicotine dependence; (4) level of knowledge about cardiovascular risk factors; and (5) app satisfaction and usability. Results: The study analyzed 287 patients (mHealth group, 145; control group, 142). Most participants were male (207/300, 69.0%), and the mean age was 62.53 (SD 8.65) years. Significant improvements were observed in the mHealth group compared with the control group at 6 months in terms of (1) adherence to the Mediterranean diet (mean 11.92, SD 1.70 vs 8.92, SD 2.66 points; P<.001) and frequency of eating foods (red meat [?1/week]: 141/143, 97.9% vs 96/141, 68.1%; industrial pastries [<2/week]: 129/143, 89.6% vs 80/141, 56.8%; oily fish [?2/week]: 124/143, 86.1% vs 64/141, 41.4%; vegetables [?2/day]: 130/143, 90.3% vs 78/141, 55.3%; fruit [?2/day]: 128/143, 88.9% vs 85/141, 60.2%; all P<.001); (2) physical activity (mean 2112.66, SD 1196.67 vs 1372.60, SD 944.62 metabolic equivalents/week; P<.001) and sedentary time (mean 8.38, SD 1.88 vs 9.59, SD 2.09 hours; P<.001); (3) exercise capacity (distance: mean 473.49, SD 102.28 vs 447.25, SD 93.68 meters; P=.04); and (4) level of knowledge (mean 117.85, SD 3.83 vs 111.00, SD 7.11 points; P<.001). App satisfaction was high (mean 42.53, SD 6.38 points), and its usability was excellent (mean 95.60, SD 4.03 points). Conclusions: With the eMOTIVA app, favorable results were obtained in the intervention group in terms of adherence to the Mediterranean diet, frequency of eating certain foods, physical activity, sedentary time, exercise capacity, knowledge level, systolic blood pressure, heart rate, and blood sugar level. Furthermore, participants reported high app satisfaction and rated its usability as excellent. Thus, this innovative tool is very promising. Trial Registration: ClinicalTrials.gov NCT05247606; https://clinicaltrials.gov/study/NCT05247606 UR - https://mhealth.jmir.org/2024/1/e55421 UR - http://dx.doi.org/10.2196/55421 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55421 ER - TY - JOUR AU - Avanceña, V. Anton L. AU - Brody, Carinne AU - Chhoun, Pheak AU - Tuot, Sovannary AU - Yi, Siyan PY - 2024/7/25 TI - Connecting Female Entertainment Workers in Cambodia to Health Care Services Using mHealth: Economic Evaluation of Mobile Link JO - JMIR Form Res SP - e52734 VL - 8 KW - female entertainment workers KW - Cambodia KW - mHealth KW - mobile health KW - economic evaluation KW - stigmatized populations KW - women's health KW - sexual health KW - STI KW - sexually transmitted infection KW - STD KW - sexually transmitted disease KW - economic KW - cost KW - costs KW - affordable KW - affordability KW - budget KW - finance KW - financial N2 - Background: Mobile Link is a mobile phone?based intervention to increase access to, and use of, health care services among female entertainment workers in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected female entertainment workers with outreach workers for information and escorted referrals after 6 months but did not lead to statistically significant improvements in HIV and sexually transmitted infection testing, contraceptive use, and condom use. Objective: This study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability. Methods: We conducted cost, cost-effectiveness, and budget impact analyses of Mobile Link using cost and outcomes data from the Mobile Link trial and other sources. For the cost analysis, we estimated the total, per-person, and incremental costs of Mobile Link compared with usual care. Using probabilistic decision-analytic models, we estimated the 1-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting selected primary and secondary outcomes from the trial to disability-adjusted life years (DALYs) averted. Finally, we estimated the financial costs of scaling up Mobile Link?s messaging and outreach services to 70% of female entertainment workers in 5 years. Results: The incremental costs of Mobile Link were US $199 from a payer perspective and US $195 per person from a combined payer and patient perspective. With an average of 0.018 (95% predicted interval ?0.088 to 0.126) DALYs averted, Mobile Link?s cost-effectiveness was US $10,955 per DALY from a payer perspective (US $10,755 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 85%, or its effectiveness would have to be 5.56 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia (US $1671 per DALY averted). The 5-year cost of scaling Mobile Link to 34,790 female entertainment workers was estimated at US $1.64 million or US $46 per person per year. Conclusions: This study provided a comprehensive economic evaluation of Mobile Link. We found that Mobile Link is not likely to be cost-effective unless its costs decrease or its effectiveness increases. Scaling up Mobile Link to more female entertainment workers is estimated to cost less than the costs of the trial. Given the importance of linking female entertainment workers to essential services, future research should focus on enhancing the effectiveness of Mobile Link or developing new mobile health interventions for this population. Trial Registration: ClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT03117842 UR - https://formative.jmir.org/2024/1/e52734 UR - http://dx.doi.org/10.2196/52734 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52734 ER - TY - JOUR AU - Spartano, L. Nicole AU - Zhang, Yuankai AU - Liu, Chunyu AU - Chernofsky, Ariel AU - Lin, Honghuang AU - Trinquart, Ludovic AU - Borrelli, Belinda AU - Pathiravasan, H. Chathurangi AU - Kheterpal, Vik AU - Nowak, Christopher AU - Vasan, S. Ramachandran AU - Benjamin, J. Emelia AU - McManus, D. David AU - Murabito, M. Joanne PY - 2024/7/24 TI - Agreement Between Apple Watch and Actical Step Counts in a Community Setting: Cross-Sectional Investigation From the Framingham Heart Study JO - JMIR Biomed Eng SP - e54631 VL - 9 KW - accelerometer KW - mobile health KW - mHealth KW - wearable device KW - fitness tracker KW - physical activity KW - mobile phone KW - Apple Watch KW - step counts KW - Framingham Heart Study KW - Actical KW - digital health KW - tracker KW - wearable KW - wearables N2 - Background: Step counting is comparable among many research-grade and consumer-grade accelerometers in laboratory settings. Objective: The purpose of this study was to compare the agreement between Actical and Apple Watch step-counting in a community setting. Methods: Among Third Generation Framingham Heart Study participants (N=3486), we examined the agreement of step-counting between those who wore a consumer-grade accelerometer (Apple Watch Series 0) and a research-grade accelerometer (Actical) on the same days. Secondarily, we examined the agreement during each hour when both devices were worn to account for differences in wear time between devices. Results: We studied 523 participants (n=3223 person-days, mean age 51.7, SD 8.9 years; women: n=298, 57.0%). Between devices, we observed modest correlation (intraclass correlation [ICC] 0.56, 95% CI 0.54-0.59), poor continuous agreement (29.7%, n=957 of days having steps counts with ?15% difference), a mean difference of 499 steps per day higher count by Actical, and wide limits of agreement, roughly ±9000 steps per day. However, devices showed stronger agreement in identifying who meets various steps per day thresholds (eg, at 8000 steps per day, kappa coefficient=0.49), for which devices were concordant for 74.8% (n=391) of participants. In secondary analyses, in the hours during which both devices were worn (n=456 participants, n=18,760 person-hours), the correlation was much stronger (ICC 0.86, 95% CI 0.85-0.86), but continuous agreement remained poor (27.3%, n=5115 of hours having step counts with ?15% difference) between devices and was slightly worse for those with mobility limitations or obesity. Conclusions: Our investigation suggests poor overall agreement between steps counted by the Actical device and those counted by the Apple Watch device, with stronger agreement in discriminating who meets certain step thresholds. The impact of these challenges may be minimized if accelerometers are used by individuals to determine whether they are meeting physical activity guidelines or tracking step counts. It is also possible that some of the limitations of these older accelerometers may be improved in newer devices. UR - https://biomedeng.jmir.org/2024/1/e54631 UR - http://dx.doi.org/10.2196/54631 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54631 ER - TY - JOUR AU - Galvin, Karyn AU - Tomlin, Dani AU - Timmer, B. Barbra H. AU - McNeice, Zoe AU - Mount, Nicole AU - Gray, Kathleen AU - Short, E. Camille PY - 2024/7/23 TI - Consumer Perspectives for a Future Mobile App to Document Real-World Listening Difficulties: Qualitative Study JO - JMIR Form Res SP - e47578 VL - 8 KW - adults KW - hearing loss KW - listening difficulties KW - digital health KW - app KW - self-management KW - mobile health KW - smartphone KW - mobile phone N2 - Background: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. Objective: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. Methods: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. Results: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. Conclusions: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician. UR - https://formative.jmir.org/2024/1/e47578 UR - http://dx.doi.org/10.2196/47578 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47578 ER - TY - JOUR AU - Jiang, Nan AU - Zhao, Ariel AU - Rogers, S. Erin AU - Cupertino, Paula Ana AU - Zhao, Xiaoquan AU - Cartujano-Barrera, Francisco AU - Siu, Katherine AU - Sherman, E. Scott PY - 2024/7/22 TI - Feasibility and Preliminary Effects of a Social Media?Based Peer-Group Mobile Messaging Smoking Cessation Intervention Among Chinese Immigrants who Smoke: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e59496 VL - 12 KW - smoking cessation KW - tobacco KW - mHealth KW - social media KW - Chinese American KW - immigrant KW - smoking KW - smoker KW - mobile messaging KW - randomized controlled trial KW - tobacco use KW - feasibility KW - acceptability KW - nicotine replacement therapy N2 - Background: Chinese immigrants experience significant disparities in tobacco use. Culturally adapted tobacco treatments targeting this population are sparse and the use is low. The low use of these treatment programs is attributed to their exclusive focus on individuals who are ready to quit and the wide range of barriers that Chinese immigrants face to access these programs. To support Chinese immigrant smokers at all levels of readiness to quit and address their access barriers, we developed the WeChat Quit Coach, a culturally and linguistically appropriate WeChat (Tencent Holdings Limited)?based peer group mobile messaging smoking cessation intervention. Objective: This study aims to assess the feasibility, acceptability, and preliminary effects of WeChat Quit Coach. Methods: We enrolled a total of 60 Chinese immigrant smokers in 2022 in New York City for a pilot randomized controlled trial (RCT) and a single-arm pilot test. The first 40 participants were randomized to either the intervention arm (WeChat Quit Coach) or the control arm (self-help print material) using 1:1 block randomization stratified by sex. WeChat Quit Coach lasted 6 weeks, featuring small peer groups moderated by a coach, daily text messages with text questions, and chat-based instant messaging support from the coach in response to peer questions. The next 20 participants were enrolled in the single-arm pilot test to further assess intervention feasibility and acceptability. All 60 participants were offered a 4-week supply of complimentary nicotine replacement therapy. Surveys were administered at baseline and 6 weeks, with participants in the pilot RCT completing an additional survey at 6 months and biochemical verification of abstinence at both follow-ups. Results: Of 74 individuals screened, 68 (92%) were eligible and 60 (88%) were enrolled. The majority of participants, with a mean age of 42.5 (SD 13.8) years, were male (49/60, 82%) and not ready to quit, with 70% (42/60) in the precontemplation or contemplation stage at the time of enrollment. The pilot RCT had follow-up rates of 98% (39/40) at 6 weeks and 93% (37/40) at 6 months, while the single-arm test achieved 100% follow-up at 6 weeks. On average, participants responded to daily text questions for 25.1 days over the 42-day intervention period and 23% (9/40) used the chat-based instant messaging support. Most participants were satisfied with WeChat Quit Coach (36/39, 92%) and would recommend it to others (32/39, 82%). At 6 months, self-reported 7-day point prevalence abstinence rates were 25% (5/20) in the intervention arm and 15% (3/20) in the control arm, with biochemically verified abstinence rates of 25% (5/20) and 5% (1/20), respectively. Conclusions: WeChat Quit Coach was feasible and well-received by Chinese immigrants who smoke and produced promising effects on abstinence. Large trials are warranted to assess its efficacy in promoting abstinence in this underserved population. Trial Registration: ClinicalTrials.gov NCT05130788; https://clinicaltrials.gov/study/NCT05130788 UR - https://mhealth.jmir.org/2024/1/e59496 UR - http://dx.doi.org/10.2196/59496 UR - http://www.ncbi.nlm.nih.gov/pubmed/39037756 ID - info:doi/10.2196/59496 ER - TY - JOUR AU - Smith, M. Amy AU - Marin, Anna AU - DeCaro, E. Renee AU - Feinn, Richard AU - Wack, Audrey AU - Hughes, I. Gregory AU - Rivard, Nathaniel AU - Umashankar, Akshay AU - Turk, W. Katherine AU - Budson, E. Andrew PY - 2024/7/19 TI - Algorithmic Spaced Retrieval Enhances Long-Term Memory in Alzheimer Disease: Case-Control Pilot Study JO - JMIR Form Res SP - e51943 VL - 8 KW - Alzheimer disease KW - spaced retrieval KW - mobile app KW - assistive technology KW - episodic memory KW - semantic memory KW - mobile phone N2 - Background: Spaced retrieval is a learning technique that involves engaging in repeated memory testing after increasingly lengthy intervals of time. Spaced retrieval has been shown to improve long-term memory in Alzheimer disease (AD), but it has historically been difficult to implement in the everyday lives of individuals with AD. Objective: This research aims to determine, in people with mild cognitive impairment (MCI) due to AD, the efficacy and feasibility of a mobile app that combines spaced retrieval with a machine learning algorithm to enhance memory retention. Specifically, the app prompts users to answer questions during brief daily sessions, and a machine learning algorithm tracks each user?s rate of forgetting to determine the optimal spacing schedule to prevent anticipated forgetting. Methods: In this pilot study, 61 participants (young adults: n=21, 34%; healthy older adults: n=20, 33%; people with MCI due to AD: n=20, 33%) used the app for 4 weeks to learn new facts and relearn forgotten name-face associations. Participation during the 4-week period was characterized by using the app once per day to answer 15 questions about the facts and names. After the 4-week learning phase, participants completed 2 recognition memory tests approximately 1 week apart, which tested memory for information they had studied using the app as well as information they had not studied. Results: After using the mobile app for 1 month, every person with MCI due to AD demonstrated improvements in memory for new facts that they had studied via the app compared to baseline (P<.001). All but one person with MCI due to AD (19/20, 95%) showed improvements of more than 10 percentage points, comparable to the improvements shown by young adults and healthy older adults. Memory for name-face associations was similarly improved for all participant groups after using the app but to a lesser degree. Furthermore, for both new facts and name-face associations, we found no memory decay for any participant group after they took a break of approximately 1 week from using the app at the end of the study. Regarding usability, of the 20 people with MCI due to AD, 16 (80%) self-adhered to the app?s automated practice schedule, and half of them (n=10, 50%) expressed an interest in continuing to use it. Conclusions: These results demonstrate early evidence that spaced retrieval mobile apps are both feasible for people with early-stage AD to use in their everyday lives and effective for supporting memory retention of recently learned facts and name-face associations. UR - https://formative.jmir.org/2024/1/e51943 UR - http://dx.doi.org/10.2196/51943 UR - http://www.ncbi.nlm.nih.gov/pubmed/39028554 ID - info:doi/10.2196/51943 ER - TY - JOUR AU - Wu, Weizi AU - Graziano, Teresa AU - Salner, Andrew AU - Chen, Ming-Hui AU - Judge, P. Michelle AU - Cong, Xiaomei AU - Xu, Wanli PY - 2024/7/18 TI - Acceptability, Effectiveness, and Roles of mHealth Applications in Supporting Cancer Pain Self-Management: Integrative Review JO - JMIR Mhealth Uhealth SP - e53652 VL - 12 KW - cancer pain KW - self-management KW - mHealth applications KW - integrative review KW - cancer survivors N2 - Background:  Cancer pain remains highly prevalent and persistent throughout survivorship, and it is crucial to investigate the potential of leveraging the advanced features of mobile health (mHealth) apps to empower individuals to self-manage their pain. Objective:  This review aims to comprehensively understand the acceptability, users? experiences, and effectiveness of mHealth apps in supporting cancer pain self-management. Methods:  We conducted an integrative review following Souza and Whittemore and Knafl?s 6 review processes. Literature was searched in PubMed, Scopus, CINAHL Plus with Full Text, PsycINFO, and Embase, from 2013 to 2023. Keywords including ?cancer patients,? ?pain,? ?self-management,? ?mHealth applications,? and relevant synonyms were used in the search. The Johns Hopkins research evidence appraisal tool was used to evaluate the quality of eligible studies. A narrative synthesis was conducted to analyze the extracted data. Results:  A total of 20 studies were included, with the overall quality rated as high (n=15) to good (n=5). Using mHealth apps to monitor and manage pain was acceptable for most patients with cancer. The internal consistency of the mHealth in measuring pain was 0.96. The reported daily assessment or engagement rate ranged from 61.9% to 76.8%. All mHealth apps were designed for multimodal interventions. Participants generally had positive experiences using pain apps, rating them as enjoyable and user-friendly. In addition, 6 studies reported significant improvements in health outcomes, including enhancement in pain remission (severity and intensity), medication adherence, and a reduced frequency of breakthrough pain. The most frequently highlighted roles of mHealth apps included pain monitoring, tracking, reminders, education facilitation, and support coordination. Conclusions:  mHealth apps are effective and acceptable in supporting pain self-management. They offer a promising multi-model approach for patients to monitor, track, and manage their pain. These findings provide evidence-based insights for leveraging mHealth apps to support cancer pain self-management. More high-quality studies are needed to examine the effectiveness of digital technology?based interventions for cancer pain self-management and to identify the facilitators and barriers to their implementation in real-world practice. UR - https://mhealth.jmir.org/2024/1/e53652 UR - http://dx.doi.org/10.2196/53652 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53652 ER - TY - JOUR AU - Davis, Adrian C. AU - Miller, Madeleine AU - McLean, P. Carmen PY - 2024/7/18 TI - The Impact of User Engagement With Exposure Components on Posttraumatic Stress Symptoms in an mHealth Mobile App: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e49393 VL - 12 KW - posttraumatic stress disorder KW - PTSD KW - mHealth apps KW - user engagement KW - mHealth interventions KW - digital interventions KW - veterans N2 - Background: Mobile mental health apps are a cost-effective option for managing mental health problems, such as posttraumatic stress disorder (PTSD). The efficacy of mobile health (mHealth) apps depends on engagement with the app, but few studies have examined how users engage with different features of mHealth apps for PTSD. Objective: This study aims to examine the relationship between app engagement indices and PTSD symptom reduction using data from an unblinded pilot randomized controlled trial of ?Renew? (Vertical Design), an exposure-based app for PTSD with and without coaching support. Because exposure is an effective approach for treating PTSD, we expected that engagement with exposure activities would be positively related to symptom reduction, over and above overall app usage. Methods: Participants were veterans (N=69) with clinically significant PTSD symptoms who were recruited online using Facebook advertisements and invited to use the Renew app as often as they wanted over a 6-week period. Participants completed screening and assessments online but provided informed consent, toured the app, and completed feedback interviews via telephone. We assessed users? self-reported PTSD symptoms before and after a 6-week intervention period and collected app usage data using a research-instrumented dashboard. To examine overall app engagement, we used data on the total time spent in the app, the number of log-in days, and the number of points that the user gained in the app. To examine engagement with exposure components, we used data on total time spent completing exposure activities (both in vivo and imaginal), the number of in vivo exposure activities completed, and the number of characters written in response to imaginal exposure prompts. We used hierarchical regression analyses to test the effect of engagement indices on change in PTSD symptoms. Results: Usage varied widely. Participants spent an average of 166.09 (SD 156.52) minutes using Renew, over an average of 14.7 (SD 10.71) mean log-in days. Engagement with the exposure components of the app was positively associated with PTSD symptom reduction (F6,62=2.31; P=.04). Moreover, this relationship remained significant when controlling for overall engagement with the app (?F3,62=4.42; P=.007). The number of characters written during imaginal exposure (?=.37; P=.009) and the amount of time spent completing exposure activities (?=.36; P=.03) were significant contributors to the model. Conclusions: To our knowledge, this is the first study to show a relationship between symptom improvement and engagement with the active therapeutic components of an mHealth app (ie, exposure) for PTSD. This relationship held when controlling for overall app use, which suggests that it was engagement with exposure, specifically, that was associated with symptom change. Future work to identify ways of promoting greater engagement with self-guided exposure may help improve the effectiveness of mHealth apps for PTSD. Trial Registration: ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736 UR - https://mhealth.jmir.org/2024/1/e49393 UR - http://dx.doi.org/10.2196/49393 ID - info:doi/10.2196/49393 ER - TY - JOUR AU - Oldham, Melissa AU - Dina, Larisa-Maria AU - Loebenberg, Gemma AU - Perski, Olga AU - Brown, Jamie AU - Angus, Colin AU - Beard, Emma AU - Burton, Robyn AU - Field, Matt AU - Greaves, Felix AU - Hickman, Matthew AU - Kaner, Eileen AU - Michie, Susan AU - Munafò, R. Marcus AU - Pizzo, Elena AU - Garnett, Claire PY - 2024/7/18 TI - Evaluating the Acceptability of the Drink Less App and the National Health Service Alcohol Advice Web Page: Qualitative Interview Process Evaluation JO - J Med Internet Res SP - e42319 VL - 26 KW - alcohol reduction KW - digital intervention KW - acceptability KW - mobile health KW - mHealth KW - mobile phone N2 - Background: The extent to which interventions are perceived as acceptable to users impacts engagement and efficacy. Objective: In this study, we evaluated the acceptability of (1) the smartphone app Drink Less (intervention) and (2) the National Health Service (NHS) alcohol advice web page (usual digital care and comparator) among adult drinkers in the United Kingdom participating in a randomized controlled trial evaluating the effectiveness of the Drink Less app. Methods: A subsample of 26 increasing- and higher-risk drinkers (Alcohol Use Disorders Identification Test score?8) assigned to the intervention group (Drink Less; n=14, 54%; female: n=10, 71%; age: 22-72 years; White: n=9, 64%) or usual digital care group (NHS alcohol advice web page; n=12, 46%; female: n=5, 42%; age: 23-68 years: White: n=9, 75%) took part in semistructured interviews. The interview questions were mapped on to the 7 facets of acceptability according to the Theoretical Framework of Acceptability: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Alongside these constructs, we also included a question on perceived personal relevance, which previous research has linked to acceptability and engagement. Framework and thematic analysis of data was undertaken. Results: The Drink Less app was perceived as being ethical, easy, user-friendly, and effective for the period the app was used. Participants reported particularly liking the tracking and feedback sections of the app, which they reported increased personal relevance and which resulted in positive affect when achieving their goals. They reported no opportunity cost. Factors such as negative affect when not meeting goals and boredom led to disengagement in the longer term for some participants. The NHS alcohol advice web page was rated as being easy and user-friendly with no opportunity costs. However, the information presented was not perceived as being personally relevant or effective in changing drinking behavior. Most participants reported neutral or negative affect, most participants thought the alcohol advice web page was accessible, and some participants reported ethical concerns around the availability of suggested resources. Some participants reported that it had acted as a starting point or a signpost to other resources. Participants in both groups discussed motivation to change and contextual factors such as COVID-19 lockdowns, which influenced their perceived self-efficacy regardless of their assigned intervention. Conclusions: Drink Less appears to be an acceptable digital intervention among the recruited sample. The NHS alcohol advice web page was generally considered unacceptable as a stand-alone intervention among the recruited sample, although it may signpost and help people access other resources and interventions. UR - https://www.jmir.org/2024/1/e42319 UR - http://dx.doi.org/10.2196/42319 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/42319 ER - TY - JOUR AU - Gallinat, Christina AU - Moessner, Markus AU - Wilhelm, Maximilian AU - Keuthen, Nancy AU - Bauer, Stephanie PY - 2024/7/18 TI - Patterns of Skin Picking in Skin Picking Disorder: Ecological Momentary Assessment Study JO - Interact J Med Res SP - e53831 VL - 13 KW - skin picking disorder KW - ecological momentary assessment KW - EMA KW - body-focused repetitive behavior KW - obsessive-compulsive spectrum KW - skin KW - dermatology KW - mental health KW - assessment KW - mobile phone N2 - Background: Skin picking disorder (SPD) is an understudied mental illness that is classified as a body-focused repetitive behavior disorder. Literature suggests that pathological skin picking is strongly integrated into the daily lives of affected individuals and may involve a high degree of variability in terms of episode characteristics, frequency, and intensity. However, existing data on the phenomenology of SPD are limited and typically involve retrospective assessments, which may fail to accurately capture the behavior?s variability. Objective: This study aimed to investigate skin picking in the daily lives of individuals with SPD by using ecological momentary assessment (EMA). The first aim focused on the description of skin picking patterns (eg, characteristics, intensity, and distribution of episodes and urges), and the second aim explored differences in characteristics and patterns between automatic and focused skin picking. Methods: Participants were recruited online and underwent a web-based screening, a diagnostic telephone interview, and a comprehensive online self-report questionnaire before participating in an EMA protocol. The latter included 10 consecutive days with 7 pseudorandom, time-contingent assessments per day between 8 AM and 10 PM. The EMA questionnaire assessed the current skin picking urge, the occurrence of the behavior, and a detailed assessment of the episodes? characteristics (eg, length, intensity, and consciousness) if applicable. Results: The final sample consisted of 57 participants, who completed at least 70% of the scheduled assessments (n=54, 94.7% female: mean age 29.3, SD 6.77 years). They completed 3758 EMAs and reported 1467 skin picking episodes. Skin picking occurred frequently (mean 2.57, SD 1.12 episodes per day and person) in relatively short episodes (10-30 min; 10 min: nepisodes=642, 43.8%; 20 min: nepisodes=312, 21.3%; 30 min: nepisodes=217, 14.8%), and it was distributed quite evenly throughout the day and across different days of the week. Focused and automatic episodes were relatively balanced across all reported episodes (focused: nepisodes=806, 54.9%) and over the course of the day. The analyses showed statistically significant differences between self-reported triggers for the different styles. Visual or tactile cues and the desire to pick the skin were more important for the focused style (visual or tactile cues: mean focused style [Mf]=4.01, SD 0.69 vs mean automatic style [Ma]=3.47, SD 0.99; P<.001; SMD=0.64; desire to pick: Mf=2.61, SD 1.06 vs Ma=1.94, SD 1.03; P<.001; SMD=0.82), while boredom and concentration problems were more prominent in automatic skin picking (boredom: Mf=1.69, SD 0.89 vs Ma=1.84, SD 0.89; P=.03; SMD=?0.31; concentration problems: Mf=2.06, SD 0.87 vs Ma=2.31, SD 1.06; P=.006; SMD=?0.41). Conclusions: These results contribute to an enhanced understanding of the phenomenology of SPD using a more rigorous assessment methodology. Our findings underscore that picking can impact affected persons multiple times throughout their daily lives. Trial Registration: German Clinical Trials Register DRKS00025168; https://tinyurl.com/mr35pdwh UR - https://www.i-jmr.org/2024/1/e53831 UR - http://dx.doi.org/10.2196/53831 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53831 ER - TY - JOUR AU - Hernandez, Raymond AU - Hoogendoorn, Claire AU - Gonzalez, S. Jeffrey AU - Pyatak, A. Elizabeth AU - Crespo-Ramos, Gladys AU - Schneider, Stefan PY - 2024/7/18 TI - Reliability and Validity of Ecological Momentary Assessment Response Time?Based Measures of Emotional Clarity: Secondary Data Analysis JO - JMIR Ment Health SP - e58352 VL - 11 KW - digital mental health KW - drift-diffusion model KW - ecological momentary assessment KW - emotional clarity KW - emotional health KW - emotion regulation KW - response time KW - positive affect KW - negative affect KW - type 1 diabetes KW - mobile phone N2 - Background: Emotional clarity has often been assessed with self-report measures, but efforts have also been made to measure it passively, which has advantages such as avoiding potential inaccuracy in responses stemming from social desirability bias or poor insight into emotional clarity. Response times (RTs) to emotion items administered in ecological momentary assessments (EMAs) may be an indirect indicator of emotional clarity. Another proposed indicator is the drift rate parameter, which assumes that, aside from how fast a person responds to emotion items, the measurement of emotional clarity also requires the consideration of how careful participants were in providing responses. Objective: This paper aims to examine the reliability and validity of RTs and drift rate parameters from EMA emotion items as indicators of individual differences in emotional clarity. Methods: Secondary data analysis was conducted on data from 196 adults with type 1 diabetes who completed a 2-week EMA study involving the completion of 5 to 6 surveys daily. If lower RTs and higher drift rates (from EMA emotion items) were indicators of emotional clarity, we hypothesized that greater levels (ie, higher clarity) should be associated with greater life satisfaction; lower levels of neuroticism, depression, anxiety, and diabetes distress; and fewer difficulties with emotion regulation. Because prior literature suggested emotional clarity could be valence specific, EMA items for negative affect (NA) and positive affect were examined separately. Results: Reliability of the proposed indicators of emotional clarity was acceptable with a small number of EMA prompts (ie, 4 to 7 prompts in total or 1 to 2 days of EMA surveys). Consistent with expectations, the average drift rate of NA items across multiple EMAs had expected associations with other measures, such as correlations of r=?0.27 (P<.001) with depression symptoms, r=?0.27 (P=.001) with anxiety symptoms, r=?0.15 (P=.03) with emotion regulation difficulties, and r=0.63 (P<.001) with RTs to NA items. People with a higher NA drift rate responded faster to NA emotion items, had greater subjective well-being (eg, fewer depression symptoms), and had fewer difficulties with overall emotion regulation, which are all aligned with the expectation for an emotional clarity measure. Contrary to expectations, the validities of average RTs to NA items, the drift rate of positive affect items, and RTs to positive affect items were not strongly supported by our results. Conclusions: Study findings provided initial support for the validity of NA drift rate as an indicator of emotional clarity but not for that of other RT-based clarity measures. Evidence was preliminary because the sample size was not sufficient to detect small but potentially meaningful correlations, as the sample size of the diabetes EMA study was chosen for other more primary research questions. Further research on passive emotional clarity measures is needed. UR - https://mental.jmir.org/2024/1/e58352 UR - http://dx.doi.org/10.2196/58352 UR - http://www.ncbi.nlm.nih.gov/pubmed/39024004 ID - info:doi/10.2196/58352 ER - TY - JOUR AU - Esmaeilpour, Zeinab AU - Natarajan, Aravind AU - Su, Hao-Wei AU - Faranesh, Anthony AU - Friel, Ciaran AU - Zanos, P. Theodoros AU - D?Angelo, Stefani AU - Heneghan, Conor PY - 2024/7/17 TI - Detection of Common Respiratory Infections, Including COVID-19, Using Consumer Wearable Devices in Health Care Workers: Prospective Model Validation Study JO - JMIR Form Res SP - e53716 VL - 8 KW - COVID detection KW - wearable KW - respiratory virus detection KW - algorithm KW - respiratory infection KW - respiratory virus KW - COVID-19 KW - wearable device KW - well-being KW - health KW - physiology KW - health care worker KW - prediction KW - infection KW - physical stress KW - emotional stress N2 - Background: The early detection of respiratory infections could improve responses against outbreaks. Wearable devices can provide insights into health and well-being using longitudinal physiological signals. Objective: The purpose of this study was to prospectively evaluate the performance of a consumer wearable physiology-based respiratory infection detection algorithm in health care workers. Methods: In this study, we evaluated the performance of a previously developed system to predict the presence of COVID-19 or other upper respiratory infections. The system generates real-time alerts using physiological signals recorded from a smartwatch. Resting heart rate, respiratory rate, and heart rate variability measured during the sleeping period were used for prediction. After baseline recordings, when participants received a notification from the system, they were required to undergo testing at a Northwell Health System site. Participants were asked to self-report any positive tests during the study. The accuracy of model prediction was evaluated using respiratory infection results (laboratory results or self-reports), and postnotification surveys were used to evaluate potential confounding factors. Results: A total of 577 participants from Northwell Health in New York were enrolled in the study between January 6, 2022, and July 20, 2022. Of these, 470 successfully completed the study, 89 did not provide sufficient physiological data to receive any prediction from the model, and 18 dropped out. Out of the 470 participants who completed the study and wore the smartwatch as required for the 16-week study duration, the algorithm generated 665 positive alerts, of which 153 (23.0%) were not acted upon to undergo testing for respiratory viruses. Across the 512 instances of positive alerts that involved a respiratory viral panel test, 63 had confirmed respiratory infection results (ie, COVID-19 or other respiratory infections detected using a polymerase chain reaction or home test) and the remaining 449 had negative upper respiratory infection test results. Across all cases, the estimated false-positive rate based on predictions per day was 2%, and the positive-predictive value ranged from 4% to 10% in this specific population, with an observed incidence rate of 198 cases per week per 100,000. Detailed examination of questionnaires filled out after receiving a positive alert revealed that physical or emotional stress events, such as intense exercise, poor sleep, stress, and excessive alcohol consumption, could cause a false-positive result. Conclusions: The real-time alerting system provides advance warning on respiratory viral infections as well as other physical or emotional stress events that could lead to physiological signal changes. This study showed the potential of wearables with embedded alerting systems to provide information on wellness measures. UR - https://formative.jmir.org/2024/1/e53716 UR - http://dx.doi.org/10.2196/53716 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53716 ER - TY - JOUR AU - Chua, Hui Xin AU - Edney, Martine Sarah AU - Müller, Matthias Andre AU - Petrunoff, A. Nicholas AU - Whitton, Clare AU - Tay, Zoey AU - Goh, Lin Claire Marie Jie AU - Chen, Bozhi AU - Park, Hyun Su AU - Rebello, A. Salome AU - Low, Alicia AU - Chia, Janelle AU - Koek, Daphne AU - Cheong, Karen AU - van Dam, M. Rob AU - Müller-Riemenschneider, Falk PY - 2024/7/17 TI - Rationale, Design, and Baseline Characteristics of Participants in the Health@NUS mHealth Augmented Cohort Study Examining Student-to-Work Life Transition: Protocol for a Prospective Cohort Study JO - JMIR Res Protoc SP - e56749 VL - 13 KW - wearable KW - wearables KW - movement behaviors KW - university students KW - mHealth KW - cohort study KW - data collection KW - well-being KW - young adults KW - health behaviors KW - physical health KW - Singapore KW - biometric assessment KW - questionnaire KW - Fitbit KW - smartwatch KW - smartphone app KW - app KW - application KW - sleep KW - dietary data KW - diet KW - dietary KW - psychological distress KW - distress KW - mobile phone N2 - Background: Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals? health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults. Objective: This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition. Methods: University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points. Results: Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ?50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ?13; 109/776, 14.1%). Conclusions: The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults. Trial Registration: ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227 International Registered Report Identifier (IRRID): DERR1-10.2196/56749 UR - https://www.researchprotocols.org/2024/1/e56749 UR - http://dx.doi.org/10.2196/56749 UR - http://www.ncbi.nlm.nih.gov/pubmed/39018103 ID - info:doi/10.2196/56749 ER - TY - JOUR AU - Bai, Xinrui AU - Zhang, Hongyan AU - Jiao, Yanxia AU - Yuan, Chenlu AU - Ma, Yuxia AU - Han, Lin PY - 2024/7/16 TI - Digital Health Interventions for Chronic Wound Management: A Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e47904 VL - 26 KW - chronic wounds KW - digital health interventions KW - wound healing KW - meta-analysis KW - systematic review KW - digital technologies KW - mobile health KW - eHealth KW - telemedicine KW - telehealth N2 - Background: Digital health interventions (DHIs) have shown promising results for the management of chronic wounds. However, its effectiveness compared to usual care and whether variability in the type of intervention affects wound outcomes are unclear. Objective: The main objective was to determine the effectiveness of DHIs on wound healing outcomes in adult patients with chronic wounds. The secondary objectives were to assess if there was any variation in wound healing outcomes across the various types of DHIs. Methods: In total, 9 databases were searched for the literature up to August 1, 2023. Randomized controlled trials (RCTs), cohort studies, and quasi-experimental studies comparing the efficacy of DHIs with controls in improving wound outcomes in adult patients with chronic wounds were included. Study selection, data extraction, and risk of bias assessment were conducted independently by 2 reviewers. We assessed the quality of each RCT, cohort study, and quasi-experimental study separately using the Cochrane risk of bias tool, ROBINS-I, and the Joanna Briggs Institute Critical Appraisal tools checklists. Relative risks (RRs) and 95% CIs were pooled using the random effects model, and heterogeneity was assessed by the I2 statistic. Subgroup analysis and sensitivity analysis were also performed. Results: A total of 25 studies with 8125 patients were included in this systematic review, while only 20 studies with 6535 patients were included in the meta-analysis. Efficacy outcomes in RCTs showed no significant differences between the DHIs and control groups in terms of wound healing (RR 1.02, 95% CI 0.93-1.12; P=.67) and all-cause mortality around 1 year (RR 1.08, 95% CI 0.55-2.12; P=.83). Compared with the control group, the use of DHIs was associated with significant changes in adverse events (RR 0.44, 95% CI 0.22-0.89; P=.02). Subgroup analysis suggested a positive effect of the digital platforms in improving wound healing (RR 2.19, 95% CI 1.35-3.56; P=.002). Although meta-analysis was not possible in terms of wound size, cost analysis, patient satisfaction, and wound reporting rates, most studies still demonstrated that DHIs were not inferior to usual care in managing chronic wounds. Conclusions: The findings of our study demonstrate the viability of adopting DHIs to manage chronic wounds. However, more prominent, high-quality RCTs are needed to strengthen the evidence, and more detailed clinical efficacy research is required. Trial Registration: PROSPERO CRD42023392415; https://tinyurl.com/4ybz6bs9 UR - https://www.jmir.org/2024/1/e47904 UR - http://dx.doi.org/10.2196/47904 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012684 ID - info:doi/10.2196/47904 ER - TY - JOUR AU - Anisha, Azmin Sadia AU - Sen, Arkendu AU - Bain, Chris PY - 2024/7/16 TI - Evaluating the Potential and Pitfalls of AI-Powered Conversational Agents as Humanlike Virtual Health Carers in the Remote Management of Noncommunicable Diseases: Scoping Review JO - J Med Internet Res SP - e56114 VL - 26 KW - conversational agents KW - artificial intelligence KW - noncommunicable disease KW - self-management KW - remote monitoring KW - mobile phone N2 - Background: The rising prevalence of noncommunicable diseases (NCDs) worldwide and the high recent mortality rates (74.4%) associated with them, especially in low- and middle-income countries, is causing a substantial global burden of disease, necessitating innovative and sustainable long-term care solutions. Objective: This scoping review aims to investigate the impact of artificial intelligence (AI)?based conversational agents (CAs)?including chatbots, voicebots, and anthropomorphic digital avatars?as human-like health caregivers in the remote management of NCDs as well as identify critical areas for future research and provide insights into how these technologies might be used effectively in health care to personalize NCD management strategies. Methods: A broad literature search was conducted in July 2023 in 6 electronic databases?Ovid MEDLINE, Embase, PsycINFO, PubMed, CINAHL, and Web of Science?using the search terms ?conversational agents,? ?artificial intelligence,? and ?noncommunicable diseases,? including their associated synonyms. We also manually searched gray literature using sources such as ProQuest Central, ResearchGate, ACM Digital Library, and Google Scholar. We included empirical studies published in English from January 2010 to July 2023 focusing solely on health care?oriented applications of CAs used for remote management of NCDs. The narrative synthesis approach was used to collate and summarize the relevant information extracted from the included studies. Results: The literature search yielded a total of 43 studies that matched the inclusion criteria. Our review unveiled four significant findings: (1) higher user acceptance and compliance with anthropomorphic and avatar-based CAs for remote care; (2) an existing gap in the development of personalized, empathetic, and contextually aware CAs for effective emotional and social interaction with users, along with limited consideration of ethical concerns such as data privacy and patient safety; (3) inadequate evidence of the efficacy of CAs in NCD self-management despite a moderate to high level of optimism among health care professionals regarding CAs? potential in remote health care; and (4) CAs primarily being used for supporting nonpharmacological interventions such as behavioral or lifestyle modifications and patient education for the self-management of NCDs. Conclusions: This review makes a unique contribution to the field by not only providing a quantifiable impact analysis but also identifying the areas requiring imminent scholarly attention for the ethical, empathetic, and efficacious implementation of AI in NCD care. This serves as an academic cornerstone for future research in AI-assisted health care for NCD management. Trial Registration: Open Science Framework; https://doi.org/10.17605/OSF.IO/GU5PX UR - https://www.jmir.org/2024/1/e56114 UR - http://dx.doi.org/10.2196/56114 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012688 ID - info:doi/10.2196/56114 ER - TY - JOUR AU - Ng, Yi Mei AU - Frederick, A. Jennifer AU - Fisher, J. Aaron AU - Allen, B. Nicholas AU - Pettit, W. Jeremy AU - McMakin, L. Dana PY - 2024/7/16 TI - Identifying Person-Specific Drivers of Depression in Adolescents: Protocol for a Smartphone-Based Ecological Momentary Assessment and Passive Sensing Study JO - JMIR Res Protoc SP - e43931 VL - 13 KW - adolescents KW - depression KW - idiographic assessment KW - network modeling KW - treatment personalization KW - ecological momentary assessment KW - mobile sensing KW - digital phenotyping KW - actigraphy KW - smartphones N2 - Background: Adolescence is marked by an increasing risk of depression and is an optimal window for prevention and early intervention. Personalizing interventions may be one way to maximize therapeutic benefit, especially given the marked heterogeneity in depressive presentations. However, empirical evidence that can guide personalized intervention for youth is lacking. Identifying person-specific symptom drivers during adolescence could improve outcomes by accounting for both developmental and individual differences. Objective: This study leverages adolescents? everyday smartphone use to investigate person-specific drivers of depression and validate smartphone-based mobile sensing data against established ambulatory methods. We describe the methods of this study and provide an update on its status. After data collection is completed, we will address three specific aims: (1) identify idiographic drivers of dynamic variability in depressive symptoms, (2) test the validity of mobile sensing against ecological momentary assessment (EMA) and actigraphy for identifying these drivers, and (3) explore adolescent baseline characteristics as predictors of these drivers. Methods: A total of 50 adolescents with elevated symptoms of depression will participate in 28 days of (1) smartphone-based EMA assessing depressive symptoms, processes, affect, and sleep; (2) mobile sensing of mobility, physical activity, sleep, natural language use in typed interpersonal communication, screen-on time, and call frequency and duration using the Effortless Assessment of Risk States smartphone app; and (3) wrist actigraphy of physical activity and sleep. Adolescents and caregivers will complete developmental and clinical measures at baseline, as well as user feedback interviews at follow-up. Idiographic, within-subject networks of EMA symptoms will be modeled to identify each adolescent?s person-specific drivers of depression. Correlations among EMA, mobile sensor, and actigraph measures of sleep, physical, and social activity will be used to assess the validity of mobile sensing for identifying person-specific drivers. Data-driven analyses of mobile sensor variables predicting core depressive symptoms (self-reported mood and anhedonia) will also be used to assess the validity of mobile sensing for identifying drivers. Finally, between-subject baseline characteristics will be explored as predictors of person-specific drivers. Results: As of October 2023, 84 families were screened as eligible, of whom 70% (n=59) provided informed consent and 46% (n=39) met all inclusion criteria after completing baseline assessment. Of the 39 included families, 85% (n=33) completed the 28-day smartphone and actigraph data collection period and follow-up study visit. Conclusions: This study leverages depressed adolescents? everyday smartphone use to identify person-specific drivers of adolescent depression and to assess the validity of mobile sensing for identifying these drivers. The findings are expected to offer novel insights into the structure and dynamics of depressive symptomatology during a sensitive period of development and to inform future development of a scalable, low-burden smartphone-based tool that can guide personalized treatment decisions for depressed adolescents. International Registered Report Identifier (IRRID): DERR1-10.2196/43931 UR - https://www.researchprotocols.org/2024/1/e43931 UR - http://dx.doi.org/10.2196/43931 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012691 ID - info:doi/10.2196/43931 ER - TY - JOUR AU - Bachman, L. Shelby AU - Gomes, Emma AU - Aryal, Suvekshya AU - Cella, David AU - Clay, Ieuan AU - Lyden, Kate AU - Leach, J. Heather PY - 2024/7/15 TI - Do Measures of Real-World Physical Behavior Provide Insights Into the Well-Being and Physical Function of Cancer Survivors? Cross-Sectional Analysis JO - JMIR Cancer SP - e53180 VL - 10 KW - accelerometer KW - cancer survivorship KW - cancer survivors KW - digital health technology KW - health-related quality of life KW - physical behavior KW - physical function N2 - Background: As the number of cancer survivors increases, maintaining health-related quality of life in cancer survivorship is a priority. This necessitates accurate and reliable methods to assess how cancer survivors are feeling and functioning. Real-world digital measures derived from wearable sensors offer potential for monitoring well-being and physical function in cancer survivorship, but questions surrounding the clinical utility of these measures remain to be answered. Objective: In this secondary analysis, we used 2 existing data sets to examine how measures of real-world physical behavior, captured with a wearable accelerometer, were related to aerobic fitness and self-reported well-being and physical function in a sample of individuals who had completed cancer treatment. Methods: Overall, 86 disease-free cancer survivors aged 21-85 years completed self-report assessments of well-being and physical function, as well as a submaximal exercise test that was used to estimate their aerobic fitness, quantified as predicted submaximal oxygen uptake (VO2). A thigh-worn accelerometer was used to monitor participants? real-world physical behavior for 7 days. Accelerometry data were used to calculate average values of the following measures of physical behavior: sedentary time, step counts, time in light and moderate to vigorous physical activity, time and weighted median cadence in stepping bouts over 1 minute, and peak 30-second cadence. Results: Spearman correlation analyses indicated that 6 (86%) of the 7 accelerometry-derived measures of real-world physical behavior were not significantly correlated with Functional Assessment of Cancer Therapy-General total well-being or linked Patient-Reported Outcomes Measurement Information System-Physical Function scores (Ps?.08). In contrast, all but one of the physical behavior measures were significantly correlated with submaximal VO2 (Ps?.03). Comparing these associations using likelihood ratio tests, we found that step counts, time in stepping bouts over 1 minute, and time in moderate to vigorous activity were more strongly associated with submaximal VO2 than with self-reported well-being or physical function (Ps?.03). In contrast, cadence in stepping bouts over 1 minute and peak 30-second cadence were not more associated with submaximal VO2 than with the self-reported measures (Ps?.08). Conclusions: In a sample of disease-free cancer survivors, we found that several measures of real-world physical behavior were more associated with aerobic fitness than with self-reported well-being and physical function. These results highlight the possibility that in individuals who have completed cancer treatment, measures of real-world physical behavior may provide additional information compared with self-reported and performance measures. To advance the appropriate use of digital measures in oncology clinical research, further research evaluating the clinical utility of real-world physical behavior over time in large, representative samples of cancer survivors is warranted. Trial Registration: ClinicalTrials.gov NCT03781154; https://clinicaltrials.gov/ct2/show/NCT03781154 UR - https://cancer.jmir.org/2024/1/e53180 UR - http://dx.doi.org/10.2196/53180 UR - http://www.ncbi.nlm.nih.gov/pubmed/39008350 ID - info:doi/10.2196/53180 ER - TY - JOUR AU - Charifson, Mia AU - Wen, Timothy AU - Zell, Bonnie AU - Vaidya, Priyanka AU - Rios, I. Cynthia AU - Fagbohun, Funsho C. AU - Fulcher, Isabel PY - 2024/7/12 TI - Impact of Remote Blood Pressure Monitoring Device Connectivity on Engagement Among Pregnant Individuals Enrolled in the Delfina Care Platform: Observational Study JO - JMIR Mhealth Uhealth SP - e55617 VL - 12 KW - blood pressure KW - hypertension KW - remote patient monitoring KW - pregnancy KW - digital health KW - remote monitoring KW - user engagement KW - users KW - connected KW - unconnected KW - comparison KW - patient engagement KW - prospective pregnancy cohort KW - device KW - devices KW - female KW - females KW - women KW - logistic regression KW - Poisson UR - https://mhealth.jmir.org/2024/1/e55617 UR - http://dx.doi.org/10.2196/55617 ID - info:doi/10.2196/55617 ER - TY - JOUR AU - Takano, Keisuke AU - Oba, Takeyuki AU - Katahira, Kentaro AU - Kimura, Kenta PY - 2024/7/12 TI - Deconstructing Fitbit to Specify the Effective Features in Promoting Physical Activity Among Inactive Adults: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e51216 VL - 12 KW - wearable activity tracker KW - mHealth KW - mobile health KW - motivation KW - physical activity KW - lifestyle KW - smartwatch KW - wearables KW - Fitbit KW - exercise KW - fitness KW - BCT KW - behavior change technique KW - behavior change KW - adherence KW - engagement N2 - Background: Wearable activity trackers have become key players in mobile health practice as they offer various behavior change techniques (BCTs) to help improve physical activity (PA). Typically, multiple BCTs are implemented simultaneously in a device, making it difficult to identify which BCTs specifically improve PA. Objective: We investigated the effects of BCTs implemented on a smartwatch, the Fitbit, to determine how each technique promoted PA. Methods: This study was a single-blind, pilot randomized controlled trial, in which 70 adults (n=44, 63% women; mean age 40.5, SD 12.56 years; closed user group) were allocated to 1 of 3 BCT conditions: self-monitoring (feedback on participants? own steps), goal setting (providing daily step goals), and social comparison (displaying daily steps achieved by peers). Each intervention lasted for 4 weeks (fully automated), during which participants wore a Fitbit and responded to day-to-day questionnaires regarding motivation. At pre- and postintervention time points (in-person sessions), levels and readiness for PA as well as different aspects of motivation were assessed. Results: Participants showed excellent adherence (mean valid-wear time of Fitbit=26.43/28 days, 94%), and no dropout was recorded. No significant changes were found in self-reported total PA (dz<0.28, P=.40 for the self-monitoring group, P=.58 for the goal setting group, and P=.19 for the social comparison group). Fitbit-assessed step count during the intervention period was slightly higher in the goal setting and social comparison groups than in the self-monitoring group, although the effects did not reach statistical significance (P=.052 and P=.06). However, more than half (27/46, 59%) of the participants in the precontemplation stage reported progress to a higher stage across the 3 conditions. Additionally, significant increases were detected for several aspects of motivation (ie, integrated and external regulation), and significant group differences were identified for the day-to-day changes in external regulation; that is, the self-monitoring group showed a significantly larger increase in the sense of pressure and tension (as part of external regulation) than the goal setting group (P=.04). Conclusions: Fitbit-implemented BCTs promote readiness and motivation for PA, although their effects on PA levels are marginal. The BCT-specific effects were unclear, but preliminary evidence showed that self-monitoring alone may be perceived demanding. Combining self-monitoring with another BCT (or goal setting, at least) may be important for enhancing continuous engagement in PA. Trial Registration: Open Science Framework; https://osf.io/87qnb/?view_only=f7b72d48bb5044eca4b8ce729f6b403b UR - https://mhealth.jmir.org/2024/1/e51216 UR - http://dx.doi.org/10.2196/51216 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51216 ER - TY - JOUR AU - Zhang, Kun AU - Huang, Qiyuan AU - Wang, Qiaosong AU - Li, Chengyang AU - Zheng, Qirong AU - Li, Zhuoyue AU - Xu, Dan AU - Xie, Cuiling AU - Zhang, Mingqi AU - Lin, Rongjin PY - 2024/7/9 TI - Telemedicine in Improving Glycemic Control Among Children and Adolescents With Type 1 Diabetes Mellitus: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e51538 VL - 26 KW - telemedicine KW - digital health KW - web-based KW - type 1 diabetes mellitus KW - children KW - adolescents KW - glycemic control KW - chronic disease management KW - randomized controlled trials KW - meta-analysis KW - mobile phone N2 - Background: Type 1 diabetes mellitus (T1DM) is the most common chronic autoimmune disease among children and adolescents. Telemedicine has been widely used in the field of chronic disease management and can benefit patients with T1DM. However, existing studies lack high-level evidence related to the effectiveness of telemedicine for glycemic control in children and adolescents with T1DM. Objective: This study aims to systematically review the evidence on the effectiveness of telemedicine interventions compared with usual care on glycemic control among children and adolescents with T1DM. Methods: In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials (RCTs) that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. In total, 2 independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Our primary outcome was glycated hemoglobin (HbA1c) levels. Secondary outcomes were quality of life, self-monitoring of blood glucose, the incidence of hypoglycemia, and cost-effectiveness. A random-effects model was used for this meta-analysis. Results: Overall, 20 RCTs (1704 participants from 12 countries) were included in the meta-analysis. Only 5% (1/20) of the studies were at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA1c levels by 0.22 (95% CI ?0.33 to ?0.10; P<.001; I2=35%). There was an improvement in self-monitoring of blood glucose (mean difference [MD] 0.54, 95% CI ?0.72 to 1.80; P=.40; I2=67.8%) and the incidence of hypoglycemia (MD ?0.15, 95% CI ?0.57 to 0.27; P=.49; I2=70.7%), although this was not statistically significant. Moreover, telemedicine had no convincing effect on the Diabetes Quality of Life for Youth score (impact of diabetes: P=.59; worries about diabetes: P=.71; satisfaction with diabetes: P=.68), but there was a statistically significant improvement in non?youth-specific quality of life (MD ?0.24, 95% CI ?0.45 to ?0.02; P=.04; I2=0%). Subgroup analyses revealed that the effect of telemedicine on HbA1c levels appeared to be greater in studies involving children (MD ?0.41, 95% CI ?0.62 to ?0.20; P<.001), studies that lasted <6 months (MD ?0.32, 95% CI ?0.48 to ?0.17; P<.001), studies where providers used smartphone apps to communicate with patients (MD ?0.37, 95% CI ?0.53 to ?0.21; P<.001), and studies with medication dose adjustment (MD ?0.25, 95% CI ?0.37 to ?0.12; P<.001). Conclusions: Telemedicine can reduce HbA1c levels and improve quality of life in children and adolescents with T1DM. Telemedicine should be regarded as a useful supplement to usual care to control HbA1c levels and a potentially cost-effective mode. Meanwhile, researchers should develop higher-quality RCTs using large samples that focus on hard clinical outcomes, cost-effectiveness, and quality of life. UR - https://www.jmir.org/2024/1/e51538 UR - http://dx.doi.org/10.2196/51538 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51538 ER - TY - JOUR AU - Tong, Ly Huong AU - Rakic, Severin AU - Al-Hazzaa, M. Hazzaa AU - Alqahtani, A. Saleh PY - 2024/7/8 TI - Authors? Reply: The Power of Collaboration in Facilitating Mobile Technology Adoption in Health Care JO - J Med Internet Res SP - e62891 VL - 26 KW - mobile apps KW - fitness trackers KW - SMS KW - SMS text messaging KW - physical activity KW - exercise KW - sedentary behavior KW - Middle East KW - Africa, Northern KW - movement KW - physical inactivity KW - smartphone KW - mobile phone KW - mobile health KW - mHealth KW - digital health KW - behavior change KW - intervention UR - https://www.jmir.org/2024/1/e62891 UR - http://dx.doi.org/10.2196/62891 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62891 ER - TY - JOUR AU - Fan, Weijing AU - Liu, Guobin PY - 2024/7/8 TI - The Power of Collaboration in Facilitating Mobile Technology Adoption in Health Care JO - J Med Internet Res SP - e60350 VL - 26 KW - social workers KW - government KW - mobile technology KW - mobile apps KW - fitness trackers KW - SMS KW - SMS text messaging KW - physical activity KW - exercise KW - sedentary behavior KW - Middle East KW - Africa KW - movement KW - physical inactivity KW - smartphone KW - mobile phone KW - mobile health KW - mHealth KW - digital health KW - behavior change KW - intervention UR - https://www.jmir.org/2024/1/e60350 UR - http://dx.doi.org/10.2196/60350 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60350 ER - TY - JOUR AU - McClure, B. Jennifer AU - Heffner, L. Jaimee AU - Krakauer, Chloe AU - Mun, Sophia AU - Catz, L. Sheryl PY - 2024/7/8 TI - A Novel mHealth App for Smokers Living With HIV Who Are Ambivalent About Quitting Smoking: Formative Research and Randomized Feasibility Study JO - JMIR Form Res SP - e58063 VL - 8 KW - HIV KW - tobacco KW - nicotine KW - smoking cessation KW - mobile health KW - mHealth KW - motivation KW - ambivalence KW - app KW - mobile phone N2 - Background: More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV. Objective: This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development. Methods: In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants? willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19). Results: Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up. Conclusions: On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health?based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted. Trial Registration: ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659 UR - https://formative.jmir.org/2024/1/e58063 UR - http://dx.doi.org/10.2196/58063 UR - http://www.ncbi.nlm.nih.gov/pubmed/38976321 ID - info:doi/10.2196/58063 ER - TY - JOUR AU - Matzke, Ina AU - Huhn, Sophie AU - Koch, Mara AU - Maggioni, Anna Martina AU - Munga, Stephen AU - Muma, Okoth Julius AU - Odhiambo, Ochieng Collins AU - Kwaro, Daniel AU - Obor, David AU - Bärnighausen, Till AU - Dambach, Peter AU - Barteit, Sandra PY - 2024/7/4 TI - Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study JO - JMIR Mhealth Uhealth SP - e54669 VL - 12 KW - wearables KW - wearable KW - tracker KW - trackers KW - climate KW - Africa KW - environment KW - environmental KW - heat KW - weather KW - exposure KW - temperature KW - rural KW - fitness trackers KW - climate change KW - health KW - sub-Saharan Africa KW - Kenya KW - outcome KW - outcomes N2 - Background: Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time. Objective: The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures. Methods: We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes. Results: Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness. Conclusions: Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study?s application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change. UR - https://mhealth.jmir.org/2024/1/e54669 UR - http://dx.doi.org/10.2196/54669 UR - http://www.ncbi.nlm.nih.gov/pubmed/38963698 ID - info:doi/10.2196/54669 ER - TY - JOUR AU - Siefried, J. Krista AU - Bascombe, Florence AU - Clifford, Brendan AU - Liu, Zhixin AU - Middleton, Peter AU - Kay-Lambkin, Frances AU - Freestone, Jack AU - Herman, Daniel AU - Millard, Michael AU - Steele, Maureen AU - Acheson, Liam AU - Moller, Carl AU - Bath, Nicky AU - Ezard, Nadine PY - 2024/7/3 TI - Effect of a Smartphone App (S-Check) on Actual and Intended Help-Seeking and Motivation to Change Methamphetamine Use Among Adult Consumers of Methamphetamine in Australia: Randomized Waitlist-Controlled Trial JO - JMIR Mhealth Uhealth SP - e55663 VL - 12 KW - methamphetamine KW - smartphone app KW - behavior change KW - help-seeking KW - motivation to change KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - smartphone KW - smartphones KW - motivation KW - motivational KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - drug KW - drugs KW - substance use KW - engagement KW - substance abuse KW - mobile phone N2 - Background: Interventions are required that address delays in treatment-seeking and low treatment coverage among people consuming methamphetamine. Objective: We aim to determine whether a self-administered smartphone-based intervention, the ?S-Check app? can increase help-seeking and motivation to change methamphetamine use, and determine factors associated with app engagement. Methods: This study is a randomized, 28-day waitlist-controlled trial. Consenting adults residing in Australia who reported using methamphetamine at least once in the last month were eligible to download the app for free from Android or iOS app stores. Those randomized to the intervention group had immediate access to the S-Check app, the control group was wait-listed for 28 days before gaining access, and then all had access until day 56. Actual help-seeking and intention to seek help were assessed by the modified Actual Help Seeking Questionnaire (mAHSQ), modified General Help Seeking Questionnaire, and motivation to change methamphetamine use by the modified readiness ruler. ?2 comparisons of the proportion of positive responses to the mAHSQ, modified General Help Seeking Questionnaire, and modified readiness ruler were conducted between the 2 groups. Logistic regression models compared the odds of actual help-seeking, intention to seek help, and motivation to change at day 28 between the 2 groups. Secondary outcomes were the most commonly accessed features of the app, methamphetamine use, feasibility and acceptability of the app, and associations between S-Check app engagement and participant demographic and methamphetamine use characteristics. Results: In total, 560 participants downloaded the app; 259 (46.3%) completed eConsent and baseline; and 84 (32.4%) provided data on day 28. Participants in the immediate access group were more likely to seek professional help (mAHSQ) at day 28 than those in the control group (n=15, 45.5% vs n=12, 23.5%; ?21=4.42, P=.04). There was no significant difference in the odds of actual help-seeking, intention to seek help, or motivation to change methamphetamine use between the 2 groups on the primary logistic regression analyses, while in the ancillary analyses, the imputed data set showed a significant difference in the odds of seeking professional help between participants in the immediate access group compared to the waitlist control group (adjusted odds ratio 2.64, 95% CI 1.19-5.83, P=.02). For participants not seeking help at baseline, each minute in the app increased the likelihood of seeking professional help by day 28 by 8% (ratio 1.08, 95% CI 1.02-1.22, P=.04). Among the intervention group, a 10-minute increase in app engagement time was associated with a decrease in days of methamphetamine use by 0.4 days (regression coefficient [?] ?0.04, P=.02). Conclusions: The S-Check app is a feasible low-resource self-administered intervention for adults in Australia who consume methamphetamine. Study attrition was high and, while common in mobile health interventions, warrants larger studies of the S-Check app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000534189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377288&isReview=true UR - https://mhealth.jmir.org/2024/1/e55663 UR - http://dx.doi.org/10.2196/55663 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55663 ER - TY - JOUR AU - Chun, Minki AU - Yu, Ha-Jin AU - Jung, Hyunggu PY - 2024/7/3 TI - A Deep Learning?Based Rotten Food Recognition App for Older Adults: Development and Usability Study JO - JMIR Form Res SP - e55342 VL - 8 KW - digital health KW - mobile health KW - mHealth KW - app KW - apps KW - application KW - applications KW - smartphone KW - smartphones KW - classification KW - digital sensor KW - deep learning KW - artificial intelligence KW - machine learning KW - food KW - foods KW - fruit KW - fruits KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - opinions KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - adoption KW - usability KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - aged KW - camera KW - image KW - imaging KW - photo KW - photos KW - photograph KW - photographs KW - recognition KW - picture KW - pictures KW - sensor KW - sensors KW - develop KW - development KW - design N2 - Background: Older adults are at greater risk of eating rotten fruits and of getting food poisoning because cognitive function declines as they age, making it difficult to distinguish rotten fruits. To address this problem, researchers have developed and evaluated various tools to detect rotten food items in various ways. Nevertheless, little is known about how to create an app to detect rotten food items to support older adults at a risk of health problems from eating rotten food items. Objective: This study aimed to (1) create a smartphone app that enables older adults to take a picture of food items with a camera and classifies the fruit as rotten or not rotten for older adults and (2) evaluate the usability of the app and the perceptions of older adults about the app. Methods: We developed a smartphone app that supports older adults in determining whether the 3 fruits selected for this study (apple, banana, and orange) were fresh enough to eat. We used several residual deep networks to check whether the fruit photos collected were of fresh fruit. We recruited healthy older adults aged over 65 years (n=15, 57.7%, males and n=11, 42.3%, females) as participants. We evaluated the usability of the app and the participants? perceptions about the app through surveys and interviews. We analyzed the survey responses, including an after-scenario questionnaire, as evaluation indicators of the usability of the app and collected qualitative data from the interviewees for in-depth analysis of the survey responses. Results: The participants were satisfied with using an app to determine whether a fruit is fresh by taking a picture of the fruit but are reluctant to use the paid version of the app. The survey results revealed that the participants tended to use the app efficiently to take pictures of fruits and determine their freshness. The qualitative data analysis on app usability and participants? perceptions about the app revealed that they found the app simple and easy to use, they had no difficulty taking pictures, and they found the app interface visually satisfactory. Conclusions: This study suggests the possibility of developing an app that supports older adults in identifying rotten food items effectively and efficiently. Future work to make the app distinguish the freshness of various food items other than the 3 fruits selected still remains. UR - https://formative.jmir.org/2024/1/e55342 UR - http://dx.doi.org/10.2196/55342 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55342 ER - TY - JOUR AU - Ali, Suad AU - Alizai, Hira AU - Hagos, Jemal Delal AU - Rubio, Ramos Sindy AU - Calabia, Dale AU - Serrano Jimenez, Penelope AU - Senthil, Aarif Vinuu AU - Appel, Lora PY - 2024/7/3 TI - mHealth Apps for Dementia, Alzheimer Disease, and Other Neurocognitive Disorders: Systematic Search and Environmental Scan JO - JMIR Mhealth Uhealth SP - e50186 VL - 12 KW - dementia KW - Alzheimer disease KW - mHealth KW - mobile health KW - apps KW - lifestyle behaviors KW - mobile phone N2 - Background: Lifestyle behaviors including exercise, sleep, diet, stress, mental stimulation, and social interaction significantly impact the likelihood of developing dementia. Mobile health (mHealth) apps have been valuable tools in addressing these lifestyle behaviors for general health and well-being, and there is growing recognition of their potential use for brain health and dementia prevention. Effective apps must be evidence-based and safeguard user data, addressing gaps in the current state of dementia-related mHealth apps. Objective: This study aims to describe the scope of available apps for dementia prevention and risk factors, highlighting gaps and suggesting a path forward for future development. Methods: A systematic search of mobile app stores, peer-reviewed literature, dementia and Alzheimer association websites, and browser searches was conducted from October 19, 2022, to November 2, 2022. A total of 1044 mHealth apps were retrieved. After screening, 152 apps met the inclusion criteria and were coded by paired, independent reviewers using an extraction framework. The framework was adapted from the Silberg scale, other scoping reviews of mHealth apps for similar populations, and background research on modifiable dementia risk factors. Coded elements included evidence-based and expert credibility, app features, lifestyle elements of focus, and privacy and security. Results: Of the 152 apps that met the final selection criteria, 88 (57.9%) addressed modifiable lifestyle behaviors associated with reducing dementia risk. However, many of these apps (59/152, 38.8%) only addressed one lifestyle behavior, with mental stimulation being the most frequently addressed. More than half (84/152, 55.2%) scored 2 points out of 9 on the Silberg scale, with a mean score of 2.4 (SD 1.0) points. Most of the 152 apps did not disclose essential information: 120 (78.9%) did not disclose expert consultation, 125 (82.2%) did not disclose evidence-based information, 146 (96.1%) did not disclose author credentials, and 134 (88.2%) did not disclose their information sources. In addition, 105 (69.2%) apps did not disclose adherence to data privacy and security practices. Conclusions: There is an opportunity for mHealth apps to support individuals in engaging in behaviors linked to reducing dementia risk. While there is a market for these products, there is a lack of dementia-related apps focused on multiple lifestyle behaviors. Gaps in the rigor of app development regarding evidence base, credibility, and adherence to data privacy and security standards must be addressed. Following established and validated guidelines will be necessary for dementia-related apps to be effective and advance successfully. UR - https://mhealth.jmir.org/2024/1/e50186 UR - http://dx.doi.org/10.2196/50186 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50186 ER - TY - JOUR AU - Gabarron, Elia AU - Larbi, Dillys AU - Rivera-Romero, Octavio AU - Denecke, Kerstin PY - 2024/7/3 TI - Human Factors in AI-Driven Digital Solutions for Increasing Physical Activity: Scoping Review JO - JMIR Hum Factors SP - e55964 VL - 11 KW - machine learning KW - ML KW - artificial intelligence KW - AI KW - algorithm KW - algorithms KW - predictive model KW - predictive models KW - predictive analytics KW - predictive system KW - practical model KW - practical models KW - deep learning KW - human factors KW - physical activity KW - physical exercise KW - healthy living KW - active lifestyle KW - exercise KW - physically active KW - digital health KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - digital technology KW - digital intervention KW - digital interventions KW - smartphone KW - smartphones KW - PRISMA N2 - Background: Artificial intelligence (AI) has the potential to enhance physical activity (PA) interventions. However, human factors (HFs) play a pivotal role in the successful integration of AI into mobile health (mHealth) solutions for promoting PA. Understanding and optimizing the interaction between individuals and AI-driven mHealth apps is essential for achieving the desired outcomes. Objective: This study aims to review and describe the current evidence on the HFs in AI-driven digital solutions for increasing PA. Methods: We conducted a scoping review by searching for publications containing terms related to PA, HFs, and AI in the titles and abstracts across 3 databases?PubMed, Embase, and IEEE Xplore?and Google Scholar. Studies were included if they were primary studies describing an AI-based solution aimed at increasing PA, and results from testing the solution were reported. Studies that did not meet these criteria were excluded. Additionally, we searched the references in the included articles for relevant research. The following data were extracted from included studies and incorporated into a qualitative synthesis: bibliographic information, study characteristics, population, intervention, comparison, outcomes, and AI-related information. The certainty of the evidence in the included studies was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Results: A total of 15 studies published between 2015 and 2023 involving 899 participants aged approximately between 19 and 84 years, 60.7% (546/899) of whom were female participants, were included in this review. The interventions lasted between 2 and 26 weeks in the included studies. Recommender systems were the most commonly used AI technology in digital solutions for PA (10/15 studies), followed by conversational agents (4/15 studies). User acceptability and satisfaction were the HFs most frequently evaluated (5/15 studies each), followed by usability (4/15 studies). Regarding automated data collection for personalization and recommendation, most systems involved fitness trackers (5/15 studies). The certainty of the evidence analysis indicates moderate certainty of the effectiveness of AI-driven digital technologies in increasing PA (eg, number of steps, distance walked, or time spent on PA). Furthermore, AI-driven technology, particularly recommender systems, seems to positively influence changes in PA behavior, although with very low certainty evidence. Conclusions: Current research highlights the potential of AI-driven technologies to enhance PA, though the evidence remains limited. Longer-term studies are necessary to assess the sustained impact of AI-driven technologies on behavior change and habit formation. While AI-driven digital solutions for PA hold significant promise, further exploration into optimizing AI?s impact on PA and effectively integrating AI and HFs is crucial for broader benefits. Thus, the implications for innovation management involve conducting long-term studies, prioritizing diversity, ensuring research quality, focusing on user experience, and understanding the evolving role of AI in PA promotion. UR - https://humanfactors.jmir.org/2024/1/e55964 UR - http://dx.doi.org/10.2196/55964 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55964 ER - TY - JOUR AU - Buis, R. Lorraine AU - Kim, Junhan AU - Sen, Ananda AU - Chen, Dongru AU - Dawood, Katee AU - Kadri, Reema AU - Muladore, Rachelle AU - Plegue, Melissa AU - Richardson, R. Caroline AU - Djuric, Zora AU - McNaughton, Candace AU - Hutton, David AU - Robert, P. Lionel AU - Park, Young Sun AU - Levy, Phillip PY - 2024/6/28 TI - The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e57863 VL - 12 KW - blood pressure KW - hypertension KW - mobile health KW - mHealth KW - mobile phone KW - smartphone N2 - Background: Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease?related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. Objective: We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. Methods: We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). Results: We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mm Hg decrease in average systolic BP and P<.001; control group: 24.1 mm Hg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60%). Conclusions: Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. Trial Registration: ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537 International Registered Report Identifier (IRRID): RR2-10.2196/12601 UR - https://mhealth.jmir.org/2024/1/e57863 UR - http://dx.doi.org/10.2196/57863 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57863 ER - TY - JOUR AU - Zhang, Yuezhou AU - Folarin, A. Amos AU - Sun, Shaoxiong AU - Cummins, Nicholas AU - Ranjan, Yatharth AU - Rashid, Zulqarnain AU - Stewart, Callum AU - Conde, Pauline AU - Sankesara, Heet AU - Laiou, Petroula AU - Matcham, Faith AU - White, M. Katie AU - Oetzmann, Carolin AU - Lamers, Femke AU - Siddi, Sara AU - Simblett, Sara AU - Vairavan, Srinivasan AU - Myin-Germeys, Inez AU - Mohr, C. David AU - Wykes, Til AU - Haro, Maria Josep AU - Annas, Peter AU - Penninx, WJH Brenda AU - Narayan, A. Vaibhav AU - Hotopf, Matthew AU - Dobson, JB Richard AU - PY - 2024/6/28 TI - Longitudinal Assessment of Seasonal Impacts and Depression Associations on Circadian Rhythm Using Multimodal Wearable Sensing: Retrospective Analysis JO - J Med Internet Res SP - e55302 VL - 26 KW - circadian rhythm KW - biological rhythms KW - mental health KW - major depressive disorder KW - MDD KW - wearable KW - mHealth KW - mobile health KW - digital health KW - monitoring N2 - Background: Previous mobile health (mHealth) studies have revealed significant links between depression and circadian rhythm features measured via wearables. However, the comprehensive impact of seasonal variations was not fully considered in these studies, potentially biasing interpretations in real-world settings. Objective: This study aims to explore the associations between depression severity and wearable-measured circadian rhythms while accounting for seasonal impacts. Methods: Data were sourced from a large longitudinal mHealth study, wherein participants? depression severity was assessed biweekly using the 8-item Patient Health Questionnaire (PHQ-8), and participants? behaviors, including sleep, step count, and heart rate (HR), were tracked via Fitbit devices for up to 2 years. We extracted 12 circadian rhythm features from the 14-day Fitbit data preceding each PHQ-8 assessment, including cosinor variables, such as HR peak timing (HR acrophase), and nonparametric features, such as the onset of the most active continuous 10-hour period (M10 onset). To investigate the association between depression severity and circadian rhythms while also assessing the seasonal impacts, we used three nested linear mixed-effects models for each circadian rhythm feature: (1) incorporating the PHQ-8 score as an independent variable, (2) adding seasonality, and (3) adding an interaction term between season and the PHQ-8 score. Results: Analyzing 10,018 PHQ-8 records alongside Fitbit data from 543 participants (n=414, 76.2% female; median age 48, IQR 32-58 years), we found that after adjusting for seasonal effects, higher PHQ-8 scores were associated with reduced daily steps (?=?93.61, P<.001), increased sleep variability (?=0.96, P<.001), and delayed circadian rhythms (ie, sleep onset: ?=0.55, P=.001; sleep offset: ?=1.12, P<.001; M10 onset: ?=0.73, P=.003; HR acrophase: ?=0.71, P=.001). Notably, the negative association with daily steps was more pronounced in spring (? of PHQ-8 × spring = ?31.51, P=.002) and summer (? of PHQ-8 × summer = ?42.61, P<.001) compared with winter. Additionally, the significant correlation with delayed M10 onset was observed solely in summer (? of PHQ-8 × summer = 1.06, P=.008). Moreover, compared with winter, participants experienced a shorter sleep duration by 16.6 minutes, an increase in daily steps by 394.5, a delay in M10 onset by 20.5 minutes, and a delay in HR peak time by 67.9 minutes during summer. Conclusions: Our findings highlight significant seasonal influences on human circadian rhythms and their associations with depression, underscoring the importance of considering seasonal variations in mHealth research for real-world applications. This study also indicates the potential of wearable-measured circadian rhythms as digital biomarkers for depression. UR - https://www.jmir.org/2024/1/e55302 UR - http://dx.doi.org/10.2196/55302 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55302 ER - TY - JOUR AU - Gerald Dcruz, Julian AU - Yeh, Paichang PY - 2024/6/28 TI - The Accuracy of Pulse Oxygen Saturation, Heart Rate, Blood Pressure, and Respiratory Rate Raised by a Contactless Telehealth Portal: Validation Study JO - JMIR Form Res SP - e55361 VL - 8 KW - medical devices KW - mHealth KW - vital signs KW - measurements validity KW - validation KW - validity KW - device KW - devices KW - vital KW - vitals KW - accuracy KW - pulse KW - oxygen KW - saturation KW - heart rate KW - blood pressure KW - respiration KW - respiratory KW - telehealth KW - telemedicine KW - eHealth KW - e-health KW - self-check KW - self-checker KW - breathing KW - portal KW - portals KW - self-checking KW - self-monitor KW - self-monitoring N2 - Background: The traditional measurement of heart rate (HR), oxygen saturation (SpO2), blood pressure (BP), and respiratory rate (RR) via physical examination can be challenging, and the recent pandemic has accelerated trends toward telehealth and remote monitoring. Instead of going to the physician to check these vital signs, measuring them at home would be more convenient. Vital sign monitors, also known as physiological parameter monitors, are electronic devices that measure and display biological information about patients under constant monitoring. Objective: The purpose of this study was to validate the accuracy of the pulse SpO2, HR, BP, and RR raised by Docsun Telehealth Portal by comparing it with approved medical devices. Methods: This is a noninvasive, self-check, system-based study conducted to validate the detection of vital signs (SpO2, HR, BP, and RR) raised by Docsun Telehealth Portal. The input for software processing involves facial screening without any accessories on the face, scanning directly through the software application portal. The participant?s facial features are detected and screened for the extraction of necessary readings. Results: For the validation of HR, SpO2, BP, and RR measurements, the main outcomes were the mean of the absolute difference between the respective investigational devices and the reference values as well as the absolute percentage difference between the respective investigational devices and the reference values. If the HR was within ±10% of the reference standard or 5 beats per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 1.41 (SD 1.14) beats per minute. The mean absolute percentage difference was 1.69% (SD 1.37). Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for HR measurements. If the RR was within ±10% of the reference standard or 3 breaths per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 0.86 breaths per minute. The mean absolute percentage difference was 4.72%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for RR measurements. SpO2 levels were considered acceptable if the average absolute difference between the Docsun Telehealth Portal and the reference values was ±3%. The mean absolute percentage difference was 0.59%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for SpO2 measurements. The Docsun Telehealth Portal predicted systolic BP with an accuracy of 94.81% and diastolic BP with an accuracy of 95.71%. Conclusions: The results of the study show that the accuracy of the HR, BP, SpO2, and RR values raised by the Docsun Telehealth Portal, compared against the clinically approved medical devices, proved to be accurate by meeting predefined accuracy guidelines. UR - https://formative.jmir.org/2024/1/e55361 UR - http://dx.doi.org/10.2196/55361 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598698 ID - info:doi/10.2196/55361 ER - TY - JOUR AU - Hodson, Nathan AU - Woods, Peter AU - Sobolev, Michael AU - Giacco, Domenico PY - 2024/6/28 TI - A Digital Microintervention Supporting Evidence-Based Parenting Skills: Development Study Using the Agile Scrum Methodology JO - JMIR Form Res SP - e54892 VL - 8 KW - parenting KW - child behavior KW - mental health KW - app development KW - digital N2 - Background: Conduct disorder increases risks of educational dropout, future mental illness, and incarceration if untreated. First-line treatment of conduct disorder involves evidence-based parenting skills programs. Time-outs, a frequent tool in these programs, can be effective at improving behavior, and recent apps have been developed to aid this process. However, these apps promote the use of time-outs in inconsistent or developmentally inappropriate ways, potentially worsening behavior problems. Digital microinterventions like these apps could guide parents through high-quality time-outs in the moment, but current time-out apps lack features promoting adherence to the evidence-based best practice. Agile scrum is a respected approach in the software development industry. Objective: We aimed to explore the feasibility of using the agile scrum approach to build a digital microintervention to help parents deliver an evidence-based time-out. Methods: The agile scrum methodology was used. Four sprints were conducted. Figma software was used for app design and wireframing. Insights from 42 expert stakeholders were used during 3 sprint reviews. We consulted experts who were identified from councils around the Midlands region of the United Kingdom and charities through personal contacts and a snowballing approach. Results: Over 4 development sprints from August 2022 to March 2023, the app was iteratively designed and refined based on consultation with a diverse group of 42 experts who shared their knowledge about the content of common parenting programs and the challenges parents commonly face. Modifications made throughout the process resulted in significant app enhancements, including tailored timer algorithms and enhanced readability, as well as an onboarding zone, mindfulness module, and pictorial information to increase inclusivity. By the end of the fourth sprint, the app was deemed ready for home use by stakeholders, demonstrating the effectiveness of our agile scrum development approach. Conclusions: We developed an app to support parents to use the evidence-based time-out technique. We recommend the agile scrum approach to create mobile health apps. Our experience highlights the valuable role that frontline health and social care professionals, particularly those working with vulnerable families, can play as experts in scrum reviews. There is a need for research to both evaluate the impact of digital microinterventions on child behavioral change and also create digital microinterventions that cater to non?English speakers and individuals who participate in parenting programs in settings outside the United Kingdom. UR - https://formative.jmir.org/2024/1/e54892 UR - http://dx.doi.org/10.2196/54892 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54892 ER - TY - JOUR AU - Carey, L. Rachel AU - Le, Ha AU - Coffman, L. Donna AU - Nahum-Shani, Inbal AU - Thirumalai, Mohanraj AU - Hagen, Cole AU - Baehr, A. Laura AU - Schmidt-Read, Mary AU - Lamboy, R. Marlyn S. AU - Kolakowsky-Hayner, A. Stephanie AU - Marino, J. Ralph AU - Intille, S. Stephen AU - Hiremath, V. Shivayogi PY - 2024/6/28 TI - mHealth-Based Just-in-Time Adaptive Intervention to Improve the Physical Activity Levels of Individuals With Spinal Cord Injury: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e57699 VL - 13 KW - spinal cord injury KW - physical activity KW - just-in-time adaptive intervention KW - mobile health KW - randomized controlled trial KW - microrandomized trial KW - wearable sensors KW - ecological momentary assessment KW - community KW - mobile phone N2 - Background: The lack of regular physical activity (PA) in individuals with spinal cord injury (SCI) in the United States is an ongoing health crisis. Regular PA and exercise-based interventions have been linked with improved outcomes and healthier lifestyles among those with SCI. Providing people with an accurate estimate of their everyday PA level can promote PA. Furthermore, PA tracking can be combined with mobile health technology such as smartphones and smartwatches to provide a just-in-time adaptive intervention (JITAI) for individuals with SCI as they go about everyday life. A JITAI can prompt an individual to set a PA goal or provide feedback about their PA levels. Objective: The primary aim of this study is to investigate whether minutes of moderate-intensity PA among individuals with SCI can be increased by integrating a JITAI with a web-based PA intervention (WI) program. The WI program is a 14-week web-based PA program widely recommended for individuals with disabilities. A secondary aim is to investigate the benefit of a JITAI on proximal PA, defined as minutes of moderate-intensity PA within 120 minutes of a PA feedback prompt. Methods: Individuals with SCI (N=196) will be randomized to a WI arm or a WI+JITAI arm. Within the WI+JITAI arm, a microrandomized trial will be used to randomize participants several times a day to different tailored feedback and PA recommendations. Participants will take part in the 24-week study from their home environment in the community. The study has three phases: (1) baseline, (2) WI program with or without JITAI, and (3) PA sustainability. Participants will provide survey-based information at the initial meeting and at the end of weeks 2, 8, 16, and 24. Participants will be asked to wear a smartwatch every day for ?12 hours for the duration of the study. Results: Recruitment and enrollment began in May 2023. Data analysis is expected to be completed within 6 months of finishing participant data collection. Conclusions: The JITAI has the potential to achieve long-term PA performance by delivering tailored, just-in-time feedback based on the person?s actual PA behavior rather than a generic PA recommendation. New insights from this study may guide intervention designers to develop engaging PA interventions for individuals with disability. Trial Registration: ClinicalTrials.gov NCT05317832; https://clinicaltrials.gov/study/NCT05317832 International Registered Report Identifier (IRRID): DERR1-10.2196/57699 UR - https://www.researchprotocols.org/2024/1/e57699 UR - http://dx.doi.org/10.2196/57699 UR - http://www.ncbi.nlm.nih.gov/pubmed/38941145 ID - info:doi/10.2196/57699 ER - TY - JOUR AU - McCallum, Meaghan AU - Baldwin, Matthew AU - Thompson, Paige AU - Blessing, Kelly AU - Frisch, Maria AU - Ho, Annabell AU - Ainsworth, Cole Matthew AU - Mitchell, Siobhan Ellen AU - Michaelides, Andreas AU - May, N. Christine PY - 2024/6/27 TI - Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study JO - JMIR Mhealth Uhealth SP - e54634 VL - 12 KW - mHealth KW - psychological distress KW - Noom Mood KW - digital mental wellness programs KW - mobile phone N2 - Background: Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app?based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. Objective: Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. Methods: A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks? postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). Results: The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). Conclusions: This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations. UR - https://mhealth.jmir.org/2024/1/e54634 UR - http://dx.doi.org/10.2196/54634 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54634 ER - TY - JOUR AU - Hall, Evelyn AU - Keyser, Laura AU - McKinney, Jessica AU - Pulliam, Samantha AU - Weinstein, Milena PY - 2024/6/27 TI - Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design JO - JMIR Form Res SP - e58551 VL - 8 KW - urinary incontinence KW - digital health KW - pelvic floor muscle training KW - real-world KW - evidence KW - user-centered design KW - mobile phone N2 - Background: Urinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women?s access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. Objective: The primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. Methods: This retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ?18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. Results: Of 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P<.001). Improvement was reported by 74% (697/947) and was similar across age, BMI, and incontinence subtype. Mean adherence was 89% (mean 12.5, SD 2.1 of 14 possible weekly uses) over 12 weeks. Those who used the device ?10 times per week were more likely to achieve symptom improvement. In multivariate logistic regression analysis, baseline incontinence symptom severity and maximum angle change during pelvic floor muscle contraction were significantly associated with meeting the UDI-6 minimum clinically important difference. Age, BMI, and UI subtype were not associated. Conclusions: This study provides real-world evidence to support the effectiveness and safety of a prescribed digital health treatment program for female UI. A digital PFMT program completed with visual guidance from a motion-based device yields significant results when executed ?10 times per week over a period of 12 weeks. The program demonstrates high user engagement, with 92.9% (880/947) of users adhering to the prescribed training regimen. First-line incontinence treatment, when implemented using this digital program, leads to statistically and clinically substantial symptom improvements across age and BMI categories and incontinence subtypes. UR - https://formative.jmir.org/2024/1/e58551 UR - http://dx.doi.org/10.2196/58551 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58551 ER - TY - JOUR AU - Huecker, Martin AU - Schutzman, Craig AU - French, Joshua AU - El-Kersh, Karim AU - Ghafghazi, Shahab AU - Desai, Ravi AU - Frick, Daniel AU - Thomas, Jeremy Jarred PY - 2024/6/26 TI - Accurate Modeling of Ejection Fraction and Stroke Volume With Mobile Phone Auscultation: Prospective Case-Control Study JO - JMIR Cardio SP - e57111 VL - 8 KW - ejection fraction KW - stroke volume KW - auscultation KW - digital health KW - telehealth KW - acoustic recording KW - acoustic recordings KW - acoustic KW - mHealth KW - mobile health KW - mobile phone KW - mobile phones KW - heart failure KW - heart KW - cardiac KW - cardiology KW - health care costs KW - audio KW - echocardiographic KW - echocardiogram KW - ultrasonography KW - echocardiography KW - accuracy KW - monitoring KW - telemonitoring KW - recording KW - recordings KW - ejection KW - machine learning KW - algorithm KW - algorithms N2 - Background: Heart failure (HF) contributes greatly to morbidity, mortality, and health care costs worldwide. Hospital readmission rates are tracked closely and determine federal reimbursement dollars. No current modality or technology allows for accurate measurement of relevant HF parameters in ambulatory, rural, or underserved settings. This limits the use of telehealth to diagnose or monitor HF in ambulatory patients. Objective: This study describes a novel HF diagnostic technology using audio recordings from a standard mobile phone. Methods: This prospective study of acoustic microphone recordings enrolled convenience samples of patients from 2 different clinical sites in 2 separate areas of the United States. Recordings were obtained at the aortic (second intercostal) site with the patient sitting upright. The team used recordings to create predictive algorithms using physics-based (not neural networks) models. The analysis matched mobile phone acoustic data to ejection fraction (EF) and stroke volume (SV) as evaluated by echocardiograms. Using the physics-based approach to determine features eliminates the need for neural networks and overfitting strategies entirely, potentially offering advantages in data efficiency, model stability, regulatory visibility, and physical insightfulness. Results: Recordings were obtained from 113 participants. No recordings were excluded due to background noise or for any other reason. Participants had diverse racial backgrounds and body surface areas. Reliable echocardiogram data were available for EF from 113 patients and for SV from 65 patients. The mean age of the EF cohort was 66.3 (SD 13.3) years, with female patients comprising 38.3% (43/113) of the group. Using an EF cutoff of ?40% versus >40%, the model (using 4 features) had an area under the receiver operating curve (AUROC) of 0.955, sensitivity of 0.952, specificity of 0.958, and accuracy of 0.956. The mean age of the SV cohort was 65.5 (SD 12.7) years, with female patients comprising 34% (38/65) of the group. Using a clinically relevant SV cutoff of <50 mL versus >50 mL, the model (using 3 features) had an AUROC of 0.922, sensitivity of 1.000, specificity of 0.844, and accuracy of 0.923. Acoustics frequencies associated with SV were observed to be higher than those associated with EF and, therefore, were less likely to pass through the tissue without distortion. Conclusions: This work describes the use of mobile phone auscultation recordings obtained with unaltered cellular microphones. The analysis reproduced the estimates of EF and SV with impressive accuracy. This technology will be further developed into a mobile app that could bring screening and monitoring of HF to several clinical settings, such as home or telehealth, rural, remote, and underserved areas across the globe. This would bring high-quality diagnostic methods to patients with HF using equipment they already own and in situations where no other diagnostic and monitoring options exist. UR - https://cardio.jmir.org/2024/1/e57111 UR - http://dx.doi.org/10.2196/57111 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57111 ER - TY - JOUR AU - Paolillo, W. Emily AU - Casaletto, B. Kaitlin AU - Clark, L. Annie AU - Taylor, C. Jack AU - Heuer, W. Hilary AU - Wise, B. Amy AU - Dhanam, Sreya AU - Sanderson-Cimino, Mark AU - Saloner, Rowan AU - Kramer, H. Joel AU - Kornak, John AU - Kremers, Walter AU - Forsberg, Leah AU - Appleby, Brian AU - Bayram, Ece AU - Bozoki, Andrea AU - Brushaber, Danielle AU - Darby, Ryan R. AU - Day, S. Gregory AU - Dickerson, C. Bradford AU - Domoto-Reilly, Kimiko AU - Elahi, Fanny AU - Fields, A. Julie AU - Ghoshal, Nupur AU - Graff-Radford, Neill AU - G H Hall, Matthew AU - Honig, S. Lawrence AU - Huey, D. Edward AU - Lapid, I. Maria AU - Litvan, Irene AU - Mackenzie, R. Ian AU - Masdeu, C. Joseph AU - Mendez, F. Mario AU - Mester, Carly AU - Miyagawa, Toji AU - Naasan, Georges AU - Pascual, Belen AU - Pressman, Peter AU - Ramos, Marisa Eliana AU - Rankin, P. Katherine AU - Rexach, Jessica AU - Rojas, C. Julio AU - VandeVrede, Lawren AU - Wong, Bonnie AU - Wszolek, K. Zbigniew AU - Boeve, F. Bradley AU - Rosen, J. Howard AU - Boxer, L. Adam AU - Staffaroni, M. Adam AU - PY - 2024/6/26 TI - Examining Associations Between Smartphone Use and Clinical Severity in Frontotemporal Dementia: Proof-of-Concept Study JO - JMIR Aging SP - e52831 VL - 7 KW - digital KW - technology KW - remote KW - monitoring KW - cognition KW - neuropsychology KW - cognitive impairment KW - neurodegenerative KW - screening KW - clinical trials KW - mobile phone N2 - Background: Frontotemporal lobar degeneration (FTLD) is a leading cause of dementia in individuals aged <65 years. Several challenges to conducting in-person evaluations in FTLD illustrate an urgent need to develop remote, accessible, and low-burden assessment techniques. Studies of unobtrusive monitoring of at-home computer use in older adults with mild cognitive impairment show that declining function is reflected in reduced computer use; however, associations with smartphone use are unknown. Objective: This study aims to characterize daily trajectories in smartphone battery use, a proxy for smartphone use, and examine relationships with clinical indicators of severity in FTLD. Methods: Participants were 231 adults (mean age 52.5, SD 14.9 years; n=94, 40.7% men; n=223, 96.5% non-Hispanic White) enrolled in the Advancing Research and Treatment of Frontotemporal Lobar Degeneration (ARTFL study) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS study) Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) Mobile App study, including 49 (21.2%) with mild neurobehavioral changes and no functional impairment (ie, prodromal FTLD), 43 (18.6%) with neurobehavioral changes and functional impairment (ie, symptomatic FTLD), and 139 (60.2%) clinically normal adults, of whom 55 (39.6%) harbored heterozygous pathogenic or likely pathogenic variants in an autosomal dominant FTLD gene. Participants completed the Clinical Dementia Rating plus National Alzheimer?s Coordinating Center Frontotemporal Lobar Degeneration Behavior and Language Domains (CDR+NACC FTLD) scale, a neuropsychological battery; the Neuropsychiatric Inventory; and brain magnetic resonance imaging. The ALLFTD Mobile App was installed on participants? smartphones for remote, passive, and continuous monitoring of smartphone use. Battery percentage was collected every 15 minutes over an average of 28 (SD 4.2; range 14-30) days. To determine whether temporal patterns of battery percentage varied as a function of disease severity, linear mixed effects models examined linear, quadratic, and cubic effects of the time of day and their interactions with each measure of disease severity on battery percentage. Models covaried for age, sex, smartphone type, and estimated smartphone age. Results: The CDR+NACC FTLD global score interacted with time on battery percentage such that participants with prodromal or symptomatic FTLD demonstrated less change in battery percentage throughout the day (a proxy for less smartphone use) than clinically normal participants (P<.001 in both cases). Additional models showed that worse performance in all cognitive domains assessed (ie, executive functioning, memory, language, and visuospatial skills), more neuropsychiatric symptoms, and smaller brain volumes also associated with less battery use throughout the day (P<.001 in all cases). Conclusions: These findings support a proof of concept that passively collected data about smartphone use behaviors associate with clinical impairment in FTLD. This work underscores the need for future studies to develop and validate passive digital markers sensitive to longitudinal clinical decline across neurodegenerative diseases, with potential to enhance real-world monitoring of neurobehavioral change. UR - https://aging.jmir.org/2024/1/e52831 UR - http://dx.doi.org/10.2196/52831 UR - http://www.ncbi.nlm.nih.gov/pubmed/38922667 ID - info:doi/10.2196/52831 ER - TY - JOUR AU - Mtenga, Elias Alan AU - Maro, Anenmose Rehema AU - Dillip, Angel AU - Msoka, Perry AU - Emmanuel, Naomi AU - Ngowi, Kennedy AU - Sumari-de Boer, Marion PY - 2024/6/26 TI - Acceptability of a Digital Adherence Tool Among Patients With Tuberculosis and Tuberculosis Care Providers in Kilimanjaro Region, Tanzania: Mixed Methods Study JO - Online J Public Health Inform SP - e51662 VL - 16 KW - acceptability KW - digital adherence tool KW - medication reminder monitors KW - patients with tuberculosis KW - TB KW - adherence KW - TB care provider N2 - Background: The World Health Organization has recommended digital adherence tools (DATs) as a promising intervention to improve antituberculosis drug adherence. However, the acceptability of DATs in resource-limited settings is not adequately studied. Objective: We investigated the acceptability of a DAT among patients with tuberculosis (TB) and TB care providers in Kilimanjaro, Tanzania. Methods: We conducted a convergent parallel mixed methods study among patients with TB and TB care providers participating in our 2-arm cluster randomized trial (REMIND-TB). The trial aimed to investigate whether the evriMED pillbox with reminder cues and adherence feedback effectively improves adherence to anti-TB treatment among patients with TB in Kilimanjaro, Tanzania. We conducted exit and in-depth interviews among patients as well as in-depth interviews among TB care providers in the intervention arm. We conducted a descriptive analysis of the quantitative data from exit interviews. Translated transcripts and memos were organized using NVivo software. We employed inductive and deductive thematic framework analysis, guided by Sekhon?s theoretical framework of acceptability. Results: Out of the 245 patients who completed treatment, 100 (40.8%) were interviewed during exit interviews, and 18 patients and 15 TB care providers were interviewed in-depth. Our findings showed that the DAT was highly accepted: 83% (83/100) expressed satisfaction, 98% (98/100) reported positive experiences with DAT use, 78% (78/100) understood how the intervention works, and 92% (92/100) successfully used the pillbox. Good perceived effectiveness was reported by 84% (84/100) of the participants who noticed improved adherence, and many preferred continuing receiving reminders through SMS text messages, indicating high levels of self-efficacy. Ethical concerns were minimal, as 85 (85%) participants did not worry about remote monitoring. However, some participants felt burdened using DATs; 9 (9%) faced difficulties keeping the device at home, 12 (12%) were not pleased with receiving daily reminder SMS text messages, and 30 (30%) reported challenges related to mobile network connectivity issues. TB care providers accepted the intervention due to its perceived impact on treatment outcomes and behavior change in adherence counseling, and they demonstrated high level of intervention coherence. Conclusions: DATs are highly acceptable in Tanzania. However, some barriers such as TB-related stigma and mobile network connectivity issues may limit acceptance. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3483-4 UR - https://ojphi.jmir.org/2024/1/e51662 UR - http://dx.doi.org/10.2196/51662 UR - http://www.ncbi.nlm.nih.gov/pubmed/38922643 ID - info:doi/10.2196/51662 ER - TY - JOUR AU - Hooker, A. Stephanie AU - Crain, Lauren A. AU - Muegge, Jule AU - Rossom, C. Rebecca AU - Pronk, P. Nicolaas AU - Pasumarthi, Prasad Dhavan AU - Kunisetty, Gopikrishna AU - Masters, S. Kevin PY - 2024/6/25 TI - Applying Meaning and Self-Determination Theory to the Development of a Web-Based mHealth Physical Activity Intervention: Proof-of-Concept Pilot Study JO - JMIR Form Res SP - e55722 VL - 8 KW - physical activity KW - midlife KW - digital health KW - SMS text messaging KW - theory-based KW - meaning in life KW - mobile phone N2 - Background: Meaning in life is positively associated with health, well-being, and longevity, which may be partially explained by engagement in healthier behaviors, including physical activity (PA). However, promoting awareness of meaning is a behavior change strategy that has not been tested in previous PA interventions. Objective: This study aims to develop, refine, and pilot-test the Meaningful Activity Program (MAP; MAP to Health), a web-based mobile health PA intervention, theoretically grounded in meaning and self-determination theory, for insufficiently active middle-aged adults. Methods: Following an iterative user-testing and refinement phase, we used a single-arm double baseline proof-of-concept pilot trial design. Participants included 35 insufficiently active adults in midlife (aged 40-64 years) interested in increasing their PA. After a 4-week baseline period, participants engaged in MAP to Health for 8 weeks. MAP to Health used a web-based assessment and just-in-time SMS text messaging to individualize the intervention; promote meaning salience; support the basic psychological needs of autonomy, competence, and relatedness; and increase PA. Participants completed measures of the hypothesized mechanisms of behavior change, including meaning salience, needs satisfaction, and autonomous motivation at pretest (?4 weeks), baseline (0 weeks), midpoint (4 weeks), and posttest (8 weeks) time points, and wore accelerometers for the study duration. At the end of the intervention, participants completed a qualitative interview. Mixed models compared changes in behavioral mechanisms during the intervention to changes before the intervention. Framework matrix analyses were used to analyze qualitative data. Results: Participants were aged 50.8 (SD 8.2) years on average; predominantly female (27/35, 77%); and 20% (7/35) Asian, 9% (3/35) Black or African American, 66% (23/35) White, and 6% (2/35) other race. Most (32/35, 91%) used MAP to Health for ?5 of 8 weeks. Participants rated the intervention as easy to use (mean 4.3, SD 0.8 [out of 5.0]) and useful (mean 4.3, SD 0.6). None of the hypothesized mechanisms changed significantly during the preintervention phase (Cohen d values <0.15). However, autonomy (P<.001; Cohen d=0.76), competence (P<.001; Cohen d=0.65), relatedness (P=.004; Cohen d=0.46), autonomous motivation (P<.001; Cohen d=0.37), and meaning salience (P<.001; Cohen d=0.40) increased significantly during the intervention. Comparison of slopes before the intervention versus during the intervention revealed that increases during the intervention were significantly greater for autonomy (P=.002), competence (P<.001), and meaning salience (P=.001); however, slopes were not significantly different for relatedness (P=.10) and autonomous motivation (P=.17). Qualitative themes offered suggestions for improvement. Conclusions: MAP to Health was acceptable to participants, feasible to deliver, and associated with increases in the target mechanisms of behavior change. This is the first intervention to use meaning as a behavior change strategy in a PA intervention. Future research will test the efficacy of the intervention in increasing PA compared to a control condition. UR - https://formative.jmir.org/2024/1/e55722 UR - http://dx.doi.org/10.2196/55722 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55722 ER - TY - JOUR AU - Barac, Milica AU - Scaletty, Samantha AU - Hassett, C. Leslie AU - Stillwell, Ashley AU - Croarkin, E. Paul AU - Chauhan, Mohit AU - Chesak, Sherry AU - Bobo, V. William AU - Athreya, P. Arjun AU - Dyrbye, N. Liselotte PY - 2024/6/25 TI - Wearable Technologies for Detecting Burnout and Well-Being in Health Care Professionals: Scoping Review JO - J Med Internet Res SP - e50253 VL - 26 KW - wearable KW - healthcare professionals KW - burnout KW - digital health KW - mental health N2 - Background: The occupational burnout epidemic is a growing issue, and in the United States, up to 60% of medical students, residents, physicians, and registered nurses experience symptoms. Wearable technologies may provide an opportunity to predict the onset of burnout and other forms of distress using physiological markers. Objective: This study aims to identify physiological biomarkers of burnout, and establish what gaps are currently present in the use of wearable technologies for burnout prediction among health care professionals (HCPs). Methods: A comprehensive search of several databases was performed on June 7, 2022. No date limits were set for the search. The databases were Ovid: MEDLINE(R), Embase, Healthstar, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection via Clarivate Analytics, Scopus via Elsevier, EBSCOhost: Academic Search Premier, CINAHL with Full Text, and Business Source Premier. Studies observing anxiety, burnout, stress, and depression using a wearable device worn by an HCP were included, with HCP defined as medical students, residents, physicians, and nurses. Bias was assessed using the Newcastle Ottawa Quality Assessment Form for Cohort Studies. Results: The initial search yielded 505 papers, from which 10 (1.95%) studies were included in this review. The majority (n=9) used wrist-worn biosensors and described observational cohort studies (n=8), with a low risk of bias. While no physiological measures were reliably associated with burnout or anxiety, step count and time in bed were associated with depressive symptoms, and heart rate and heart rate variability were associated with acute stress. Studies were limited with long-term observations (eg, ?12 months) and large sample sizes, with limited integration of wearable data with system-level information (eg, acuity) to predict burnout. Reporting standards were also insufficient, particularly in device adherence and sampling frequency used for physiological measurements. Conclusions: With wearables offering promise for digital health assessments of human functioning, it is possible to see wearables as a frontier for predicting burnout. Future digital health studies exploring the utility of wearable technologies for burnout prediction should address the limitations of data standardization and strategies to improve adherence and inclusivity in study participation. UR - https://www.jmir.org/2024/1/e50253 UR - http://dx.doi.org/10.2196/50253 UR - http://www.ncbi.nlm.nih.gov/pubmed/38916948 ID - info:doi/10.2196/50253 ER - TY - JOUR AU - Schrills, Tim AU - Kojan, Lilian AU - Gruner, Marthe AU - Calero Valdez, André AU - Franke, Thomas PY - 2024/6/25 TI - Effects of User Experience in Automated Information Processing on Perceived Usefulness of Digital Contact-Tracing Apps: Cross-Sectional Survey Study JO - JMIR Hum Factors SP - e53940 VL - 11 KW - COVID-19 KW - contact tracing KW - user experience KW - trust KW - health information processing N2 - Background: In pandemic situations, digital contact tracing (DCT) can be an effective way to assess one?s risk of infection and inform others in case of infection. DCT apps can support the information gathering and analysis processes of users aiming to trace contacts. However, users? use intention and use of DCT information may depend on the perceived benefits of contact tracing. While existing research has examined acceptance in DCT, automation-related user experience factors have been overlooked. Objective: We pursued three goals: (1) to analyze how automation-related user experience (ie, perceived trustworthiness, traceability, and usefulness) relates to user behavior toward a DCT app, (2) to contextualize these effects with health behavior factors (ie, threat appraisal and moral obligation), and (3) to collect qualitative data on user demands for improved DCT communication. Methods: Survey data were collected from 317 users of a nationwide-distributed DCT app during the COVID-19 pandemic after it had been in app stores for >1 year using a web-based convenience sample. We assessed automation-related user experience. In addition, we assessed threat appraisal and moral obligation regarding DCT use to estimate a partial least squares structural equation model predicting use intention. To provide practical steps to improve the user experience, we surveyed users? needs for improved communication of information via the app and analyzed their responses using thematic analysis. Results: Data validity and perceived usefulness showed a significant correlation of r=0.38 (P<.001), goal congruity and perceived usefulness correlated at r=0.47 (P<.001), and result diagnosticity and perceived usefulness had a strong correlation of r=0.56 (P<.001). In addition, a correlation of r=0.35 (P<.001) was observed between Subjective Information Processing Awareness and perceived usefulness, suggesting that automation-related changes might influence the perceived utility of DCT. Finally, a moderate positive correlation of r=0.47 (P<.001) was found between perceived usefulness and use intention, highlighting the connection between user experience variables and use intention. Partial least squares structural equation modeling explained 55.6% of the variance in use intention, with the strongest direct predictor being perceived trustworthiness (?=.54; P<.001) followed by moral obligation (?=.22; P<.001). Based on the qualitative data, users mainly demanded more detailed information about contacts (eg, place and time of contact). They also wanted to share information (eg, whether they wore a mask) to improve the accuracy and diagnosticity of risk calculation. Conclusions: The perceived result diagnosticity of DCT apps is crucial for perceived trustworthiness and use intention. By designing for high diagnosticity for the user, DCT apps could improve their support in the action regulation of users, resulting in higher perceived trustworthiness and use in pandemic situations. In general, automation-related user experience has greater importance for use intention than general health behavior or experience. UR - https://humanfactors.jmir.org/2024/1/e53940 UR - http://dx.doi.org/10.2196/53940 UR - http://www.ncbi.nlm.nih.gov/pubmed/38916941 ID - info:doi/10.2196/53940 ER - TY - JOUR AU - Weichelt, P. Bryan AU - Burke, Rick AU - Kieke, Burney AU - Pilz, Matt AU - Shimpi, Neel PY - 2024/6/24 TI - Provider Adoption of mHealth in Rural Patient Care: Web-Based Survey Study JO - JMIR Hum Factors SP - e55443 VL - 11 KW - mHealth KW - clinician KW - physician KW - rural KW - patient KW - mobile KW - health care KW - adoption KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - mobile health KW - app KW - apps KW - provider KW - providers KW - physicians KW - survey KW - surveys KW - barrier KW - barriers KW - digital health N2 - Background: Physicians and patient-facing caregivers have increasingly used mobile health (mHealth) technologies in the past several years, accelerating during the COVID-19 pandemic. However, barriers and feedback surrounding adoption remain relatively understudied and varied across health systems, particularly in rural areas. Objective: This study aims to identify provider adoption, attitudes, and barriers toward mHealth in a large, multisite, rural US health care system. We investigated (1) mHealth apps that providers use for their own benefit and (2) mHealth apps that a provider uses in conjunction with a patient. Methods: We surveyed all patient-seeing providers within the Marshfield Clinic Health System with a brief, 16-item, web-based survey assessing attitudes toward mHealth, adoption of these technologies, and perceived barriers faced by providers, their peers, and the institution. Survey results were summarized via descriptive statistics, with log-binomial regression and accompanying pairwise analyses, using Kruskal-Wallis and Jonckheere-Terpstra tests for significance, respectively. Respondents were grouped by reported clinical role and specialty. Results: We received a 38% (n/N=916/2410) response rate, with 60.7% (n=556) of those sufficiently complete for analyses. Roughly 54.1% (n=301) of respondents reported mHealth use, primarily around decision-making and supplemental information, with use differing based on provider role and years of experience. Self-reported barriers to using mHealth included a lack of knowledge and time to study mHealth technologies. Providers also reported concerns about patients? internet access and the complexity of mHealth apps to adequately use mHealth technologies. Providers believed the health system?s barriers were largely privacy, confidentiality, and legal review concerns. Conclusions: These findings echo similar studies in other health systems, surrounding providers? lack of time and concerns over privacy and confidentiality of patient data. Providers emphasized concerns over the complexity of these technologies for their patients and concerns over patients? internet access to fully use mHealth in their delivery of care. UR - https://humanfactors.jmir.org/2024/1/e55443 UR - http://dx.doi.org/10.2196/55443 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55443 ER - TY - JOUR AU - Jiang, Jiayi AU - Zheng, Zexing PY - 2024/6/21 TI - Medical Information Protection in Internet Hospital Apps in China: Scale Development and Content Analysis JO - JMIR Mhealth Uhealth SP - e55061 VL - 12 KW - hospital apps KW - privacy policy KW - personal information protection KW - policy evaluation KW - content analysis N2 - Background: Hospital apps are increasingly being adopted in many countries, especially since the start of the COVID-19 pandemic. Web-based hospitals can provide valuable medical services and enhanced accessibility. However, increasing concerns about personal information (PI) and strict legal compliance requirements necessitate privacy assessments for these platforms. Guided by the theory of contextual integrity, this study investigates the regulatory compliance of privacy policies for internet hospital apps in the mainland of China. Objective: In this paper, we aim to evaluate the regulatory compliance of privacy policies of internet hospital apps in the mainland of China and offer recommendations for improvement. Methods: We obtained 59 internet hospital apps on November 7, 2023, and reviewed 52 privacy policies available between November 8 and 23, 2023. We developed a 3-level indicator scale based on the information processing activities, as stipulated in relevant regulations. The scale comprised 7 level-1 indicators, 26 level-2 indicators, and 70 level-3 indicators. Results: The mean compliance score of the 52 assessed apps was 73/100 (SD 22.4%), revealing a varied spectrum of compliance. Sensitive PI protection compliance (mean 73.9%, SD 24.2%) lagged behind general PI protection (mean 90.4%, SD 14.7%), with only 12 apps requiring separate consent for processing sensitive PI (mean 73.9%, SD 24.2%). Although most apps (n=41, 79%) committed to supervising subcontractors, only a quarter (n=13, 25%) required users? explicit consent for subcontracting activities. Concerning PI storage security (mean 71.2%, SD 29.3%) and incident management (mean 71.8%, SD 36.6%), half of the assessed apps (n=27, 52%) committed to bear corresponding legal responsibility, whereas fewer than half (n=24, 46%) specified the security level obtained. Most privacy policies stated the PI retention period (n=40, 77%) and instances of PI deletion or anonymization (n=41, 79%), but fewer (n=20, 38.5%) committed to prompt third-party PI deletion. Most apps delineated various individual rights, but only a fraction addressed the rights to obtain copies (n=22, 42%) or to refuse advertisement based on automated decision-making (n=13, 25%). Significant deficiencies remained in regular compliance audits (mean 11.5%, SD 37.8%), impact assessments (mean 13.5%, SD 15.2%), and PI officer disclosure (mean 48.1%, SD 49.3%). Conclusions: Our analysis revealed both strengths and significant shortcomings in the compliance of internet hospital apps? privacy policies with relevant regulations. As China continues to implement internet hospital apps, it should ensure the informed consent of users for PI processing activities, enhance compliance levels of relevant privacy policies, and fortify PI protection enforcement across the information processing stages. UR - https://mhealth.jmir.org/2024/1/e55061 UR - http://dx.doi.org/10.2196/55061 UR - http://www.ncbi.nlm.nih.gov/pubmed/38904994 ID - info:doi/10.2196/55061 ER - TY - JOUR AU - Kunchay, Sahiti AU - Linden-Carmichael, N. Ashley AU - Abdullah, Saeed PY - 2024/6/20 TI - Using a Smartwatch App to Understand Young Adult Substance Use: Mixed Methods Feasibility Study JO - JMIR Hum Factors SP - e50795 VL - 11 KW - smartwatches KW - substance use KW - ecological momentary assessment KW - mobile health KW - mHealth KW - human-centered design KW - feasibility studies KW - mobile phone N2 - Background: Young adults in the United States exhibit some of the highest rates of substance use compared to other age groups. Heavy and frequent substance use can be associated with a host of acute and chronic health and mental health concerns. Recent advances in ubiquitous technologies have prompted interest and innovation in using technology-based data collection instruments to understand substance use and associated harms. Existing methods for collecting granular, real-world data primarily rely on the use of smartphones to study and understand substance use in young adults. Wearable devices, such as smartwatches, show significant potential as platforms for data collection in this domain but remain underused. Objective: This study aims to describe the design and user evaluation of a smartwatch-based data collection app, which uses ecological momentary assessments to examine young adult substance use in daily life. Methods: This study used a 2-phase iterative design and acceptability evaluation process with young adults (aged 18-25 y) reporting recent alcohol or cannabis use. In phase 1, participants (8/15, 53%) used the data collection app for 14 days on their Apple Watches to report their substance use patterns, social contexts of substance use, and psychosocial risk factors (eg, affect). After this 14-day deployment, the participants completed a user experience survey and a semistructured interview to record their perspectives and experiences of using the app. Formative feedback from this phase informed feature modification and refinement of the app. In phase 2, an additional cohort (7/15, 47%) used the modified app for 14 days and provided feedback through surveys and interviews conducted after the app use period. Results: Analyses of overall app use patterns indicated high, consistent use of the app, with participants using the app for an average of 11.73 (SD 2.60) days out of 14 days of data collection. Participants reported 67 instances of substance use throughout the study, and our analysis indicates that participants were able to respond to ecological momentary assessment prompts in diverse temporal and situational contexts. Our findings from the user experience survey indicate that participants found the app usable and functional. Comparisons of app use metrics and user evaluation scores indicate that the iterative app design had a measurable and positive impact on users? experience. Qualitative data from the participant interviews highlighted the value of recording substance use patterns, low disruption to daily life, minimal overall burden, preference of platforms (smartphones vs smartwatches), and perspectives relating to privacy and app use in social contexts. Conclusions: This study demonstrated the acceptability of using a smartwatch-based app to collect intensive, longitudinal substance use data among young adults. The findings document the utility of smartwatches as a novel platform to understand sensitive and often-stigmatized behaviors such as substance use with minimal burden. UR - https://humanfactors.jmir.org/2024/1/e50795 UR - http://dx.doi.org/10.2196/50795 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50795 ER - TY - JOUR AU - Page, L. Lindsey AU - Fanning, Jason AU - Phipps, Connor AU - Berger, Ann AU - Reed, Elizabeth AU - Ehlers, Diane PY - 2024/6/20 TI - Heart Rate Monitoring Among Breast Cancer Survivors: Quantitative Study of Device Agreement in a Community-Based Exercise Program JO - JMIR Cancer SP - e51210 VL - 10 KW - wearable devices KW - exercise prescription KW - validity KW - photoplethysmography KW - monitoring KW - wearables KW - devices KW - exercise KW - heart rate KW - breast cancer KW - cancer KW - cancer survivor KW - community KW - chest monitor KW - Fitbit KW - recovery KW - safety N2 - Background: Exercise intensity (eg, target heart rate [HR]) is a fundamental component of exercise prescription to elicit health benefits in cancer survivors. Despite the validity of chest-worn monitors, their feasibility in community and unsupervised exercise settings may be challenging. As wearable technology continues to improve, consumer-based wearable sensors may represent an accessible alternative to traditional monitoring, offering additional advantages. Objective: The purpose of this study was to examine the agreement between the Polar H10 chest monitor and Fitbit Inspire HR for HR measurement in breast cancer survivors enrolled in the intervention arm of a randomized, pilot exercise trial. Methods: Participants included breast cancer survivors (N=14; aged 38-72 years) randomized to a 12-week aerobic exercise program. This program consisted of three 60-minute, moderate-intensity walking sessions per week, either in small groups or one-on-one, facilitated by a certified exercise physiologist and held at local community fitness centers. As originally designed, the exercise prescription included 36 supervised sessions at a fitness center. However, due to the COVID-19 pandemic, the number of supervised sessions varied depending on whether participants enrolled before or after March 2020. During each exercise session, HR (in beats per minute) was concurrently measured via a Polar H10 chest monitor and a wrist-worn Fitbit Inspire HR at 5 stages: pre-exercise rest; midpoint of warm-up; midpoint of exercise session; midpoint of cool-down; and postexercise recovery. The exercise physiologist recorded the participant?s HR from each device at the midpoint of each stage. HR agreement between the Polar H10 and Fitbit Inspire HR was assessed using Lin concordance correlation coefficient (rc) with a 95% CI. Lin rc ranges from 0 to 1.00, with 0 indicating no concordance and 1.00 indicating perfect concordance. Relative error rates were calculated to examine differences across exercise session stages. Results: Data were available for 200 supervised sessions across the sample (session per participant: mean 13.33, SD 13.7). By exercise session stage, agreement between the Polar H10 monitor and the Fitbit was highest during pre-exercise seated rest (rc=0.76, 95% CI 0.70-0.81) and postexercise seated recovery (rc=0.89, 95% CI 0.86-0.92), followed by the midpoint of exercise (rc=0.63, 95% CI 0.55-0.70) and cool-down (rc=0.68, 95% CI 0.60-0.74). The agreement was lowest during warm-up (rc=0.39, 95% CI 0.27-0.49). Relative error rates ranged from ?3.91% to 3.09% and were greatest during warm-up (relative error rate: mean ?3.91, SD 11.92%). Conclusions: The Fitbit overestimated HR during peak exercise intensity, posing risks for overexercising, which may not be safe for breast cancer survivors? fitness levels. While the Fitbit Inspire HR may be used to estimate exercise HR, precautions are needed when considering participant safety and data interpretation. Trial Registration: Clinicaltrials.gov NCT03980626; https://clinicaltrials.gov/study/NCT03980626?term=NCT03980626&rank=1 UR - https://cancer.jmir.org/2024/1/e51210 UR - http://dx.doi.org/10.2196/51210 UR - http://www.ncbi.nlm.nih.gov/pubmed/38900505 ID - info:doi/10.2196/51210 ER - TY - JOUR AU - Podda, Jessica AU - Tacchino, Andrea AU - Ponzio, Michela AU - Di Antonio, Federica AU - Susini, Alessia AU - Pedullà, Ludovico AU - Battaglia, Alberto Mario AU - Brichetto, Giampaolo PY - 2024/6/20 TI - Mobile Health App (DIGICOG-MS) for Self-Assessment of Cognitive Impairment in People With Multiple Sclerosis: Instrument Validation and Usability Study JO - JMIR Form Res SP - e56074 VL - 8 KW - cognitive assessment KW - cognitive impairment KW - digital health KW - mHealth app KW - multiple sclerosis KW - self-management KW - usability N2 - Background: Mobile health (mHealth) apps have proven useful for people with multiple sclerosis (MS). Thus, easy-to-use digital solutions are now strongly required to assess and monitor cognitive impairment, one of the most disturbing symptoms in MS that is experienced by almost 43% to 70% of people with MS. Therefore, we developed DIGICOG-MS (Digital assessment of Cognitive Impairment in Multiple Sclerosis), a smartphone- and tablet-based mHealth app to self-assess cognitive impairment in MS. Objective: This study aimed to test the validity and usability of the novel mHealth app with a sample of people with MS. Methods: DIGICOG-MS includes 4 digital tests assumed to evaluate the most affected cognitive domains in MS (visuospatial memory [VSM], verbal memory [VM], semantic fluency [SF], and information processing speed [IPS]) and inspired by traditional paper-based tests that assess the same cognitive functions (10/36 Spatial Recall Test, Rey Auditory Verbal Learning Test, Word List Generation, Symbol Digit Modalities Test). Participants were asked to complete both digital and traditional assessments in 2 separate sessions. Convergent validity was analyzed using the Pearson correlation coefficient to determine the strength of the associations between digital and traditional tests. To test the app?s reliability, the agreement between 2 repeated measurements was assessed using intraclass correlation coefficients (ICCs). Usability of DIGICOG-MS was evaluated using the System Usability Scale (SUS) and mHealth App Usability Questionnaire (MAUQ) administered at the conclusion of the digital session. Results: The final sample consisted of 92 people with MS (60 women) followed as outpatients at the Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Genoa (Italy). They had a mean age of 51.38 (SD 11.36) years, education duration of 13.07 (SD 2.74) years, disease duration of 12.91 (SD 9.51) years, and a disability level (Expanded Disability Status Scale) of 3.58 (SD 1.75). Relapsing-remitting MS was most common (68/92, 74%), followed by secondary progressive (15/92, 16%) and primary progressive (9/92, 10%) courses. Pearson correlation analyses indicated significantly strong correlations for VSM, VM, SF, and IPS (all P<.001), with r values ranging from 0.58 to 0.78 for all cognitive domains. Test-retest reliability of the mHealth app was excellent (ICCs>0.90) for VM and IPS and good for VSM and SF (ICCs>0.80). Moreover, the SUS score averaged 84.5 (SD 13.34), and the mean total MAUQ score was 104.02 (SD 17.69), suggesting that DIGICOG-MS was highly usable and well appreciated. Conclusions: The DIGICOG-MS tests were strongly correlated with traditional paper-based evaluations. Furthermore, people with MS positively evaluated DIGICOG-MS, finding it highly usable. Since cognitive impairment poses major limitations for people with MS, these findings open new paths to deploy digital cognitive tests for MS and further support the use of a novel mHealth app for cognitive self-assessment by people with MS in clinical practice. UR - https://formative.jmir.org/2024/1/e56074 UR - http://dx.doi.org/10.2196/56074 UR - http://www.ncbi.nlm.nih.gov/pubmed/38900535 ID - info:doi/10.2196/56074 ER - TY - JOUR AU - Denis, Fabrice AU - Le Goff, Florian AU - Desbois, Madhu AU - Gepner, Agnes AU - Feliciano, Guillaume AU - Silber, Denise AU - Zeitoun, Jean-David AU - Assuied, Peretz Guedalia PY - 2024/6/18 TI - Early Detection of 5 Neurodevelopmental Disorders of Children and Prevention of Postnatal Depression With a Mobile Health App: Observational Cross-Sectional Study JO - JMIR Public Health Surveill SP - e58565 VL - 10 KW - mobile phone KW - pediatric KW - infant KW - baby KW - neonate KW - newborn KW - toddler KW - child KW - early detection KW - app KW - application KW - screening KW - algorithm KW - NDD KW - neurodevelopmental disorder KW - autism KW - ASD KW - autism spectrum disorder KW - attention deficit/hyperactivity disorder KW - ADHD KW - attention deficit KW - PND KW - postnatal depression KW - mHealth KW - mobile health KW - real-world study KW - smartphone KW - dyspraxia KW - delayed KW - language KW - dyslexia KW - incidence KW - prevalence N2 - Background: Delay in the diagnosis of neurodevelopmental disorders (NDDs) in toddlers and postnatal depression (PND) is a major public health issue. In both cases, early intervention is crucial but too rarely implemented in practice. Objective: Our goal was to determine if a dedicated mobile app can improve screening of 5 NDDs (autism spectrum disorder [ASD], language delay, dyspraxia, dyslexia, and attention-deficit/hyperactivity disorder [ADHD]) and reduce PND incidence. Methods: We performed an observational, cross-sectional, data-based study in a population of young parents in France with at least 1 child aged <10 years at the time of inclusion and regularly using Malo, an ?all-in-one? multidomain digital health record electronic patient-reported outcome (PRO) app for smartphones. We included the first 50,000 users matching the criteria and agreeing to participate between May 1, 2022, and February 8, 2024. Parents received periodic questionnaires assessing skills in neurodevelopment domains via the app. Mothers accessed a support program to prevent PND and were requested to answer regular PND questionnaires. When any PROs matched predefined criteria, an in-app recommendation was sent to book an appointment with a family physician or pediatrician. The main outcomes were the median age of the infant at the time of notification for possible NDD and the incidence of PND detection after childbirth. One secondary outcome was the relevance of the NDD notification by consultation as assessed by health professionals. Results: Among 55,618 children median age 4 months (IQR 9), 439 (0.8%) had at least 1 disorder for which consultation was critically necessary. The median ages of notification for probable ASD, language delay, dyspraxia, dyslexia, and ADHD were 32.5 (IQR 12.8), 16 (IQR 13), 36 (IQR 22.5), 80 (IQR 5), and 61 (IQR 15.5) months, respectively. The rate of probable ADHD, ASD, dyslexia, language delay, and dyspraxia in the population of children of the age included between the detection limits of each alert was 1.48%, 0.21%, 1.52%, 0.91%, and 0.37%, respectively. Sensitivity of alert notifications for suspected NDDs as assessed by the physicians was 78.6% and specificity was 98.2%. Among 8243 mothers who completed a PND questionnaire, highly probable PND was detected in 938 (11.4%), corresponding to a reduction of ?31% versus our previous study without a support program. Suspected PND was detected a median 96 days (IQR 86) after childbirth. Among 130 users who filled in the satisfaction survey, 99.2% (129/130) found the app easy to use and 70% (91/130) reported that the app improved follow-up of their child. The app was rated 4.8/5 on Apple?s App Store. Conclusions: Algorithm-based early alerts suggesting NDDs were highly specific with good sensitivity as assessed by real-life practitioners. Early detection of 5 NDDs and PNDs was efficient and led to a possible 31% reduction in PND incidence. Trial Registration: ClinicalTrials.gov NCT06301087; https://www.clinicaltrials.gov/study/NCT06301087 UR - https://publichealth.jmir.org/2024/1/e58565 UR - http://dx.doi.org/10.2196/58565 UR - http://www.ncbi.nlm.nih.gov/pubmed/38888952 ID - info:doi/10.2196/58565 ER - TY - JOUR AU - Chen, Hung-Hsun AU - Lin, Chen AU - Chang, Hsiang-Chih AU - Chang, Jen-Ho AU - Chuang, Hai-Hua AU - Lin, Yu-Hsuan PY - 2024/6/17 TI - Developing Methods for Assessing Mental Activity Using Human-Smartphone Interactions: Comparative Analysis of Activity Levels and Phase Patterns in General Mental Activities, Working Mental Activities, and Physical Activities JO - J Med Internet Res SP - e56144 VL - 26 KW - digital phenotyping KW - human-smartphone interaction KW - labor or leisure KW - machine learning KW - mental activity KW - physical activity N2 - Background: Human biological rhythms are commonly assessed through physical activity (PA) measurement, but mental activity may offer a more substantial reflection of human biological rhythms. Objective: This study proposes a novel approach based on human-smartphone interaction to compute mental activity, encompassing general mental activity (GMA) and working mental activity (WMA). Methods: A total of 24 health care professionals participated, wearing wrist actigraphy devices and using the ?Staff Hours? app for more than 457 person-days, including 332 workdays and 125 nonworkdays. PA was measured using actigraphy, while GMA and WMA were assessed based on patterns of smartphone interactions. To model WMA, machine learning techniques such as extreme gradient boosting and convolutional neural networks were applied, using human-smartphone interaction patterns and GPS-defined work hours. The data were organized by date and divided into person-days, with an 80:20 split for training and testing data sets to minimize overfitting and maximize model robustness. The study also adopted the M10 metric to quantify daily activity levels by calculating the average acceleration during the 10-hour period of highest activity each day, which facilitated the assessment of the interrelations between PA, GMA, and WMA and sleep indicators. Phase differences, such as those between PA and GMA, were defined using a second-order Butterworth filter and Hilbert transform to extract and calculate circadian rhythms and instantaneous phases. This calculation involved subtracting the phase of the reference signal from that of the target signal and averaging these differences to provide a stable and clear measure of the phase relationship between the signals. Additionally, multilevel modeling explored associations between sleep indicators (total sleep time, midpoint of sleep) and next-day activity levels, accounting for the data?s nested structure. Results: Significant differences in activity levels were noted between workdays and nonworkdays, with WMA occurring approximately 1.08 hours earlier than PA during workdays (P<.001). Conversely, GMA was observed to commence about 1.22 hours later than PA (P<.001). Furthermore, a significant negative correlation was identified between the activity level of WMA and the previous night?s midpoint of sleep (?=?0.263, P<.001), indicating that later bedtimes and wake times were linked to reduced activity levels in WMA the following day. However, there was no significant correlation between WMA?s activity levels and total sleep time. Similarly, no significant correlations were found between the activity levels of PA and GMA and sleep indicators from the previous night. Conclusions: This study significantly advances the understanding of human biological rhythms by developing and highlighting GMA and WMA as key indicators, derived from human-smartphone interactions. These findings offer novel insights into how mental activities, alongside PA, are intricately linked to sleep patterns, emphasizing the potential of GMA and WMA in behavioral and health studies. UR - https://www.jmir.org/2024/1/e56144 UR - http://dx.doi.org/10.2196/56144 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885499 ID - info:doi/10.2196/56144 ER - TY - JOUR AU - Zhang, Yuankai AU - Wang, Xuzhi AU - Pathiravasan, H. Chathurangi AU - Spartano, L. Nicole AU - Lin, Honghuang AU - Borrelli, Belinda AU - Benjamin, J. Emelia AU - McManus, D. David AU - Larson, G. Martin AU - Vasan, S. Ramachandran AU - Shah, V. Ravi AU - Lewis, D. Gregory AU - Liu, Chunyu AU - Murabito, M. Joanne AU - Nayor, Matthew PY - 2024/6/13 TI - Association of Smartwatch-Based Heart Rate and Physical Activity With Cardiorespiratory Fitness Measures in the Community: Cohort Study JO - J Med Internet Res SP - e56676 VL - 26 KW - mobile health KW - smartwatch KW - heart rate KW - physical activity KW - cardiorespiratory fitness KW - cardiopulmonary exercise testing N2 - Background: Resting heart rate (HR) and routine physical activity are associated with cardiorespiratory fitness levels. Commercial smartwatches permit remote HR monitoring and step count recording in real-world settings over long periods of time, but the relationship between smartwatch-measured HR and daily steps to cardiorespiratory fitness remains incompletely characterized in the community. Objective: This study aimed to examine the association of nonactive HR and daily steps measured by a smartwatch with a multidimensional fitness assessment via cardiopulmonary exercise testing (CPET) among participants in the electronic Framingham Heart Study. Methods: Electronic Framingham Heart Study participants were enrolled in a research examination (2016-2019) and provided with a study smartwatch that collected longitudinal HR and physical activity data for up to 3 years. At the same examination, the participants underwent CPET on a cycle ergometer. Multivariable linear models were used to test the association of CPET indices with nonactive HR and daily steps from the smartwatch. Results: We included 662 participants (mean age 53, SD 9 years; n=391, 59% women, n=599, 91% White; mean nonactive HR 73, SD 6 beats per minute) with a median of 1836 (IQR 889-3559) HR records and a median of 128 (IQR 65-227) watch-wearing days for each individual. In multivariable-adjusted models, lower nonactive HR and higher daily steps were associated with higher peak oxygen uptake (VO2), % predicted peak VO2, and VO2 at the ventilatory anaerobic threshold, with false discovery rate (FDR)?adjusted P values <.001 for all. Reductions of 2.4 beats per minute in nonactive HR, or increases of nearly 1000 daily steps, corresponded to a 1.3 mL/kg/min higher peak VO2. In addition, ventilatory efficiency (VE/VCO2; FDR-adjusted P=.009), % predicted maximum HR (FDR-adjusted P<.001), and systolic blood pressure-to-workload slope (FDR-adjusted P=.01) were associated with nonactive HR but not associated with daily steps. Conclusions: Our findings suggest that smartwatch-based assessments are associated with a broad array of cardiorespiratory fitness responses in the community, including measures of global fitness (peak VO2), ventilatory efficiency, and blood pressure response to exercise. Metrics captured by wearable devices offer a valuable opportunity to use extensive data on health factors and behaviors to provide a window into individual cardiovascular fitness levels. UR - https://www.jmir.org/2024/1/e56676 UR - http://dx.doi.org/10.2196/56676 UR - http://www.ncbi.nlm.nih.gov/pubmed/38870519 ID - info:doi/10.2196/56676 ER - TY - JOUR AU - Maxin, J. Anthony AU - Lim, H. Do AU - Kush, Sophie AU - Carpenter, Jack AU - Shaibani, Rami AU - Gulek, G. Bernice AU - Harmon, G. Kimberly AU - Mariakakis, Alex AU - McGrath, B. Lynn AU - Levitt, R. Michael PY - 2024/6/13 TI - Smartphone Pupillometry and Machine Learning for Detection of Acute Mild Traumatic Brain Injury: Cohort Study JO - JMIR Neurotech SP - e58398 VL - 3 KW - smartphone pupillometry KW - pupillary light reflex KW - biomarkers KW - digital health KW - mild traumatic brain injury KW - concussion KW - machine learning KW - artificial intelligence KW - AI KW - pupillary KW - pilot study KW - brain KW - brain injury KW - injury KW - diagnostic KW - pupillometer KW - neuroimaging KW - diagnosis KW - artificial KW - mobile phone N2 - Background: Quantitative pupillometry is used in mild traumatic brain injury (mTBI) with changes in pupil reactivity noted after blast injury, chronic mTBI, and sports-related concussion. Objective: We evaluated the diagnostic capabilities of a smartphone-based digital pupillometer to differentiate patients with mTBI in the emergency department from controls. Methods: Adult patients diagnosed with acute mTBI with normal neuroimaging were evaluated in an emergency department within 36 hours of injury (control group: healthy adults). The PupilScreen smartphone pupillometer was used to measure the pupillary light reflex (PLR), and quantitative curve morphological parameters of the PLR were compared between mTBI and healthy controls. To address the class imbalance in our sample, a synthetic minority oversampling technique was applied. All possible combinations of PLR parameters produced by the smartphone pupillometer were then applied as features to 4 binary classification machine learning algorithms: random forest, k-nearest neighbors, support vector machine, and logistic regression. A 10-fold cross-validation technique stratified by cohort was used to produce accuracy, sensitivity, specificity, area under the curve, and F1-score metrics for the classification of mTBI versus healthy participants. Results: Of 12 patients with acute mTBI, 33% (4/12) were female (mean age 54.1, SD 22.2 years), and 58% (7/12) were White with a median Glasgow Coma Scale (GCS) of 15. Of the 132 healthy patients, 67% (88/132) were female, with a mean age of 36 (SD 10.2) years and 64% (84/132) were White with a median GCS of 15. Significant differences were observed in PLR recordings between healthy controls and patients with acute mTBI in the PLR parameters, that are (1) percent change (mean 34%, SD 8.3% vs mean 26%, SD 7.9%; P<.001), (2) minimum pupillary diameter (mean 34.8, SD 6.1 pixels vs mean 29.7, SD 6.1 pixels; P=.004), (3) maximum pupillary diameter (mean 53.6, SD 12.4 pixels vs mean 40.9, SD 11.9 pixels; P<.001), and (4) mean constriction velocity (mean 11.5, SD 5.0 pixels/second vs mean 6.8, SD 3.0 pixels/second; P<.001) between cohorts. After the synthetic minority oversampling technique, both cohorts had a sample size of 132 recordings. The best-performing binary classification model was a random forest model using the PLR parameters of latency, percent change, maximum diameter, minimum diameter, mean constriction velocity, and maximum constriction velocity as features. This model produced an overall accuracy of 93.5%, sensitivity of 96.2%, specificity of 90.9%, area under the curve of 0.936, and F1-score of 93.7% for differentiating between pupillary changes in mTBI and healthy participants. The absolute values are unable to be provided for the performance percentages reported here due to the mechanism of 10-fold cross validation that was used to obtain them. Conclusions: In this pilot study, quantitative smartphone pupillometry demonstrates the potential to be a useful tool in the future diagnosis of acute mTBI. UR - https://neuro.jmir.org/2024/1/e58398 UR - http://dx.doi.org/10.2196/58398 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58398 ER - TY - JOUR AU - Shen, Hongxia AU - van der Kleij, Rianne AU - van der Boog, M. Paul J. AU - Chavannes, H. Niels PY - 2024/6/13 TI - Developing a Tailored eHealth Self-Management Intervention for Patients With Chronic Kidney Disease in China: Intervention Mapping Approach JO - JMIR Form Res SP - e48605 VL - 8 KW - eHealth KW - self-management KW - intervention mapping KW - chronic kidney disease KW - intervention development KW - mobile phone N2 - Background: Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes, and control health care expenditures. Using eHealth to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China specifically, is still limited. Objective: This study aims to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) eHealth self-management intervention. Methods: We used an intervention mapping approach. In phase 1, a systematic review and 2 qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and health care professionals regarding CKD self-management and eHealth interventions. Afterward, key factors gathered from the aforementioned studies were categorized following the 5 domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, determinants, theory-based methods, and practical strategies. Knowledge obtained from previous results was combined to complement core components of the MD self-management intervention and adapt them for Chinese patients with CKD. Additionally, the CFIR?Expert Recommendations for Implementing Change Matching Tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions, and implementation strategies were discussed and finalized with the intervention monitoring group. Results: An overview of the CFIR domains showed the essential factors influencing the implementation of eHealth CKD self-management interventions in Chinese settings, including ?knowledge and beliefs? in the domain ?individual characteristics,? ?quality and advantage of eHealth intervention? in the domain ?intervention characteristics,? ?compatibility? in the domain ?inner setting,? and ?cultural context? in the domain ?outer setting.? To ensure the effectiveness of the Dutch MD?based self-management intervention, we did not change the core self-management intervention components of MD that underlie its effectiveness, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of the local population to enhance the intervention?s appeal, receptivity, and feasibility, such as providing video or voice call options to support interactions with health care professionals. Furthermore, the adapted modules such as Knowledge Center and My Self-Monitoring were developed in a mobile health app. Conclusions: Our study resulted in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China that has the potential to optimize patients? self-management skills and improve health status and quality of life. Moreover, our study?s research approach and results can inform future research on the tailoring and translation of evidence-based, eHealth self-management interventions to various contexts. Trial Registration: ClinicalTrials.gov NCT04212923; https://classic.clinicaltrials.gov/ct2/show/NCT04212923 UR - https://formative.jmir.org/2024/1/e48605 UR - http://dx.doi.org/10.2196/48605 UR - http://www.ncbi.nlm.nih.gov/pubmed/38869943 ID - info:doi/10.2196/48605 ER - TY - JOUR AU - Skolarus, E. Lesli AU - Lin, Chieh Chun AU - Mishra, Sonali AU - Meurer, William AU - Dinh, Mackenzie AU - Whitfield, Candace AU - Bi, Ran AU - Brown, Devin AU - Oteng, Rockefeller AU - Buis, R. Lorraine AU - Kidwell, Kelley PY - 2024/6/12 TI - Engagement in mHealth-Prompted Self-Measured Blood Pressure Monitoring Among Participants Recruited From a Safety-Net Emergency Department: Secondary Analysis of the Reach Out Trial JO - JMIR Mhealth Uhealth SP - e54946 VL - 12 KW - hypertension KW - self-measured blood pressure KW - mobile health KW - blood pressure KW - emergency KW - blood pressure monitoring KW - risk factor KW - cardiovascular KW - cardiovascular disease KW - utilization KW - feedback KW - care KW - systolic blood pressure KW - emergency department KW - mHealth KW - health disparities KW - engagement N2 - Background: Hypertension, a key modifiable risk factor for cardiovascular disease, is more prevalent among Black and low-income individuals. To address this health disparity, leveraging safety-net emergency departments for scalable mobile health (mHealth) interventions, specifically using text messaging for self-measured blood pressure (SMBP) monitoring, presents a promising strategy. This study investigates patterns of engagement, associated factors, and the impact of engagement on lowering blood pressure (BP) in an underserved population. Objective: We aimed to identify patterns of engagement with prompted SMBP monitoring with feedback, factors associated with engagement, and the association of engagement with lowered BP. Methods: This is a secondary analysis of data from Reach Out, an mHealth, factorial trial among 488 hypertensive patients recruited from a safety-net emergency department in Flint, Michigan. Reach Out participants were randomized to weekly or daily text message prompts to measure their BP and text in their responses. Engagement was defined as a BP response to the prompt. The k-means clustering algorithm and visualization were used to determine the pattern of SMBP engagement by SMBP prompt frequency?weekly or daily. BP was remotely measured at 12 months. For each prompt frequency group, logistic regression models were used to assess the univariate association of demographics, access to care, and comorbidities with high engagement. We then used linear mixed-effects models to explore the association between engagement and systolic BP at 12 months, estimated using average marginal effects. Results: For both SMBP prompt groups, the optimal number of engagement clusters was 2, which we defined as high and low engagement. Of the 241 weekly participants, 189 (78.4%) were low (response rate: mean 20%, SD 23.4) engagers, and 52 (21.6%) were high (response rate: mean 86%, SD 14.7) engagers. Of the 247 daily participants, 221 (89.5%) were low engagers (response rate: mean 9%, SD 12.2), and 26 (10.5%) were high (response rate: mean 67%, SD 8.7) engagers. Among weekly participants, those who were older (>65 years of age), attended some college (vs no college), married or lived with someone, had Medicare (vs Medicaid), were under the care of a primary care doctor, and took antihypertensive medication in the last 6 months had higher odds of high engagement. Participants who lacked transportation to appointments had lower odds of high engagement. In both prompt frequency groups, participants who were high engagers had a greater decline in BP compared to low engagers. Conclusions: Participants randomized to weekly SMBP monitoring prompts responded more frequently overall and were more likely to be classed as high engagers compared to participants who received daily prompts. High engagement was associated with a larger decrease in BP. New strategies to encourage engagement are needed for participants with lower access to care. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04340-z UR - https://mhealth.jmir.org/2024/1/e54946 UR - http://dx.doi.org/10.2196/54946 ID - info:doi/10.2196/54946 ER - TY - JOUR AU - Togo, Eiichi AU - Takami, Miki AU - Ishigaki, Kyoko PY - 2024/6/12 TI - Evaluation of Autonomic Nervous System Function During Sleep by Mindful Breathing Using a Tablet Device: Randomized Controlled Trial JO - JMIR Nursing SP - e56616 VL - 7 KW - mindfulness KW - sleep KW - cardiac potential KW - low frequency KW - high frequency KW - mobile phone N2 - Background: One issue to be considered in universities is the need for interventions to improve sleep quality and educational systems for university students. However, sleep problems remain unresolved. As a clinical practice technique, a mindfulness-based stress reduction method can help students develop mindfulness skills to cope with stress, self-healing skills, and sleep. Objective: We aim to verify the effectiveness of mindful breathing exercises using a tablet device. Methods: In total, 18 nursing students, aged 18-22 years, were randomly assigned and divided equally into mindfulness (Mi) and nonmindfulness (nMi) implementation groups using tablet devices. During the 9-day experimental period, cardiac potentials were measured on days 1, 5, and 9. In each sleep stage (sleep with sympathetic nerve dominance, shallow sleep with parasympathetic nerve dominance, and deep sleep with parasympathetic nerve dominance), low frequency (LF) value, high frequency (HF) value, and LF/HF ratios obtained from the cardiac potentials were evaluated. Results: On day 5, a significant correlation was observed between sleep duration and each sleep stage in both groups. In comparison to each experimental day, the LF and LF/HF ratios of the Mi group were significantly higher on day 1 than on days 5 and 10. LF and HF values in the nMi group were significantly higher on day 1 than on day 5. Conclusions: The correlation between sleep duration and each sleep stage on day 5 suggested that sleep homeostasis in both groups was activated on day 5, resulting in similar changes in sleep stages. During the experimental period, the cardiac potentials in the nMi group showed a wide range of fluctuations, whereas the LF values and LF/HF ratio in the Mi group showed a decreasing trend over time. This finding suggests that implementing mindful breathing exercises using a tablet device may suppress sympathetic activity during sleep. Trial Registration: UMIN-CTR Clinical Trials Registry UMIN000054639; https://tinyurl.com/mu2vdrks UR - https://nursing.jmir.org/2024/1/e56616 UR - http://dx.doi.org/10.2196/56616 UR - http://www.ncbi.nlm.nih.gov/pubmed/38865177 ID - info:doi/10.2196/56616 ER - TY - JOUR AU - Hou, Ling Qiao AU - Liu, Yang Le AU - Wu, Ying PY - 2024/6/11 TI - The Effects of mHealth Interventions on Quality of Life, Anxiety, and Depression in Patients With Coronary Heart Disease: Meta-Analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e52341 VL - 26 KW - mobile health KW - coronary heart disease KW - quality of life KW - anxiety KW - depression KW - meta-analysis KW - mobile phone N2 - Background: Coronary heart disease (CHD) is the leading cause of death globally. In addition, 20% to 40% of the patients with CHD have comorbid mental health issues such as anxiety or depression, affecting the prognosis and quality of life (QoL). Mobile health (mHealth) interventions have been developed and are widely used; however, the evidence for the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD is currently ambiguous. Objective: In this study, we aimed to assess the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD. Methods: We searched the Cochrane Library, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang databases from inception to August 12, 2023. Eligible studies were randomized controlled trials that involved patients with CHD who received mHealth interventions and that reported on QoL, anxiety, or depression outcomes. We used the Cochrane risk-of-bias tool for randomized trials to evaluate the risk of bias in the studies, ensuring a rigorous and methodologically sound analysis. Review Manager (desktop version 5.4; The Cochrane Collaboration) and Stata MP (version 17.0; StataCorp LLC) were used to conduct the meta-analysis. The effect size was calculated using the standardized mean difference (SMD) and its 95% CI. Results: The meta-analysis included 23 studies (5406 participants in total) and showed that mHealth interventions significantly improved QoL in patients with CHD (SMD 0.49, 95% CI 0.25-0.72; Z=4.07; P<.001) as well as relieved their anxiety (SMD ?0.46, 95% CI ?0.83 to ?0.08; Z=2.38; P=.02) and depression (SMD ?0.34, 95% CI ?0.56 to ?0.12; Z=3.00; P=.003) compared to usual care. The subgroup analyses indicated a significant effect favoring the mHealth intervention on reducing anxiety and depressive symptoms compared to usual care, especially when (1) the intervention duration was ?6 months (P=.04 and P=.001), (2) the mHealth intervention was a simple one (only 1 mHealth intervention was used) (P=.01 and P<.001), (3) it was implemented during the COVID-19 pandemic (P=.04 and P=.01), (4) it was implemented in low- or middle-income countries (P=.01 and P=.02), (5) the intervention focused on mental health (P=.01 and P=.007), and (6) adherence rates were high (?90%; P=.03 and P=.002). In addition, comparing mHealth interventions to usual care, there was an improvement in QoL when (1) the mHealth intervention was a simple one (P<.001), (2) it was implemented in low- or middle-income countries (P<.001), and (3) the intervention focused on mental health (P<.001). Conclusions: On the basis of the existing evidence, mHealth interventions might be effective in improving QoL and reducing anxiety and depression in patients with CHD. However, large sample, high-quality, and rigorously designed randomized controlled trials are needed to provide further evidence. Trial Registration: PROSPERO CRD42022383858; https://tinyurl.com/3ea2npxf UR - https://www.jmir.org/2024/1/e52341 UR - http://dx.doi.org/10.2196/52341 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861710 ID - info:doi/10.2196/52341 ER - TY - JOUR AU - Dangerfield II, T. Derek AU - Anderson, N. Janeane AU - Wylie, Charleen AU - Bluthenthal, Ricky AU - Beyrer, Chris AU - Farley, E. Jason PY - 2024/6/11 TI - A Multicomponent Intervention (POSSIBLE) to Improve Perceived Risk for HIV Among Black Sexual Minority Men: Feasibility and Preliminary Effectiveness Pilot Study JO - JMIR Hum Factors SP - e54739 VL - 11 KW - pre-exposure prophylaxis KW - PrEP KW - sexual health KW - peers KW - apps KW - community KW - mobile phone KW - HIV KW - sexual minority KW - minority communities KW - minority KW - Black KW - African American KW - patient education KW - self-monitoring KW - treatment adherence KW - treatment participation KW - community health KW - mobile health KW - digital health KW - digital technology KW - digital interventions KW - smartphones N2 - Background: Increased pre-exposure prophylaxis (PrEP) use is urgently needed to substantially decrease HIV incidence among Black sexual minority men. Low perceived risk for HIV (PRH) is a key unaddressed PrEP barrier for Black sexual minority men. Peers and smartphone apps are popular intervention tools to promote community health behaviors, but few studies have used these together in a multicomponent strategy. Therefore, we designed a multicomponent intervention called POSSIBLE that used an existing smartphone app called PrEPme (Emocha Mobile Health, Inc) and a peer change agent (PCA) to increase PRH as a gateway to PrEP. Objective: This paper aims to describe the feasibility and preliminary impact of POSSIBLE on PRH and willingness to accept a PrEP referral among Black sexual minority men. Methods: POSSIBLE was a theoretically guided, single-group, 2-session pilot study conducted among Black sexual minority men from Baltimore, Maryland between 2019 and 2021 (N=69). POSSIBLE integrated a PCA and the PrEPme app that allows users to self-monitor sexual risk behaviors and chat with the in-app community health worker to obtain PrEP service information. PRH was assessed using the 8-item PRH scale before and after baseline and follow-up study visits. At the end of each study visit, the PCA referred interested individuals to the community health worker to learn more about PrEP service options. Results: The average age of participants was 32.5 (SD 8.1, range 19-62) years. In total, 55 (80%) participants were retained for follow-up at month 1. After baseline sessions, 29 (42%) participants were willing to be referred to PrEP services, 20 (69%) of those confirmed scheduled appointments with PrEP care teams. There were no statistically significant differences in PRH between baseline and follow-up visits (t122=?1.36; P=.17). Conclusions: We observed no statistically significant improvement in PRH between baseline and month 1. However, given the high retention rate and acceptability, POSSIBLE may be feasible to implement. Future research should test a statistically powered peer-based approach on PrEP initiation among Black sexual minority men. Trial Registration: ClinicalTrials.gov NCT04533386; https://clinicaltrials.gov/study/NCT04533386 UR - https://humanfactors.jmir.org/2024/1/e54739 UR - http://dx.doi.org/10.2196/54739 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861707 ID - info:doi/10.2196/54739 ER - TY - JOUR AU - Takeuchi, Hiroki AU - Ishizawa, Tetsuro AU - Kishi, Akifumi AU - Nakamura, Toru AU - Yoshiuchi, Kazuhiro AU - Yamamoto, Yoshiharu PY - 2024/6/11 TI - Just-in-Time Adaptive Intervention for Stabilizing Sleep Hours of Japanese Workers: Microrandomized Trial JO - J Med Internet Res SP - e49669 VL - 26 KW - objective push-type sleep feedback KW - stability of habitual sleep behaviors KW - just-in-time adaptive intervention KW - microrandomized trial KW - mobile phone N2 - Background: Sleep disturbance is a major contributor to future health and occupational issues. Mobile health can provide interventions that address adverse health behaviors for individuals in a vulnerable health state in real-world settings (just-in-time adaptive intervention). Objective: This study aims to identify a subpopulation with vulnerable sleep state in daily life (study 1) and, immediately afterward, to test whether providing mobile health intervention improved habitual sleep behaviors and psychological wellness in real-world settings by conducting a microrandomized trial (study 2). Methods: Japanese workers (n=182) were instructed to collect data on their habitual sleep behaviors and momentary symptoms (including depressive mood, anxiety, and subjective sleep quality) using digital devices in a real-world setting. In study 1, we calculated intraindividual mean and variability of sleep hours, midpoint of sleep, and sleep efficiency to characterize their habitual sleep behaviors. In study 2, we designed and conducted a sleep just-in-time adaptive intervention, which delivered objective push-type sleep feedback messages to improve their sleep hours for a subset of participants in study 1 (n=81). The feedback messages were generated based on their sleep data measured on previous nights and were randomly sent to participants with a 50% chance for each day (microrandomization). Results: In study 1, we applied hierarchical clustering to dichotomize the population into 2 clusters (group A and group B) and found that group B was characterized by unstable habitual sleep behaviors (large intraindividual variabilities). In addition, linear mixed-effect models showed that the interindividual variability of sleep hours was significantly associated with depressive mood (?=3.83; P=.004), anxiety (?=5.70; P=.03), and subjective sleep quality (?=?3.37; P=.03). In study 2, we found that providing sleep feedback prolonged subsequent sleep hours (increasing up to 40 min; P=.01), and this effect lasted for up to 7 days. Overall, the stability of sleep hours in study 2 was significantly improved among participants in group B compared with the participants in study 1 (P=.001). Conclusions: This is the first study to demonstrate that providing sleep feedback can benefit the modification of habitual sleep behaviors in a microrandomized trial. The findings of this study encourage the use of digitalized health intervention that uses real-time health monitoring and personalized feedback. UR - https://www.jmir.org/2024/1/e49669 UR - http://dx.doi.org/10.2196/49669 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861313 ID - info:doi/10.2196/49669 ER - TY - JOUR AU - Chen, Dongjin AU - Han, Wenchao AU - Yang, Yili AU - Pan, Jay PY - 2024/6/10 TI - Doctors? Personal Preference and Adoption of Mobile Apps to Communicate with Patients in China: Qualitative Study JO - JMIR Mhealth Uhealth SP - e49040 VL - 12 KW - medical platforms KW - doctor-patient communication KW - social networking apps KW - thematic content analysis KW - China N2 - Background: Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients? mobile app adoption behavior; however, they offer limited insights into doctors? personal preferences among a variety of choices of mobile apps. Objective: This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps? Methods: We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals. Results: In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees? perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors? affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues. Conclusions: Our findings contribute to a nuanced understanding of doctors? adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns. UR - https://mhealth.jmir.org/2024/1/e49040 UR - http://dx.doi.org/10.2196/49040 UR - http://www.ncbi.nlm.nih.gov/pubmed/38857491 ID - info:doi/10.2196/49040 ER - TY - JOUR AU - Nguyen, Antony AU - Yu, Filmer AU - Park, G. Linda AU - Fukuoka, Yoshimi AU - Wong, Ching AU - Gildengorin, Ginny AU - Nguyen, T. Tung AU - Tsoh, Y. Janice AU - Jih, Jane PY - 2024/6/10 TI - An App-Based Physical Activity Intervention in Community-Dwelling Chinese-, Tagalog-, and Vietnamese-Speaking Americans: Single-Arm Intervention Study JO - JMIR Form Res SP - e56373 VL - 8 KW - physical activity KW - mHealth KW - mobile health KW - mobile app KW - Asian Americans KW - physical activity tracker KW - mobile phone KW - app KW - apps KW - application KW - applications KW - app-based KW - intervention KW - interventions KW - community-dwelling KW - tracker KW - trackers KW - pilot study KW - feasibility KW - acceptability KW - cultural KW - culturally KW - linguistic KW - linguistically KW - evidence-based KW - community-based KW - sociodemographic KW - lifestyle KW - Chinese KW - Vietnamese KW - Filipino KW - adult KW - adults KW - multicomponent KW - multilingual N2 - Background: Physical inactivity is associated with adverse health outcomes among Asian Americans, who exhibit the least adherence to physical activity guidelines compared with other racial and ethnic groups. Mobile app?based interventions are a promising approach to promote healthy behaviors. However, there is a lack of app-based interventions focused on improving physical activity among Asian Americans whose primary language is not English. Objective: This pilot study aimed to assess the feasibility and acceptability of a 5-week intervention using a culturally and linguistically adapted, evidence-based mobile phone app with an accelerometer program, to promote physical activity among Chinese-, Tagalog-, or Vietnamese-speaking Americans. Methods: Participants were recruited through collaborations with community-based organizations. The intervention was adapted from a 12-month physical activity randomized controlled trial involving the app and accelerometer for English-speaking adults. Sociodemographic characteristics, lifestyle factors, and physical measurements were collected at the baseline visit. A 7-day run-in period was conducted to screen for the participants who could wear a Fitbit One (Fitbit LLC) accelerometer and complete the app?s daily step diary. During the 4-week intervention period, participants wore the accelerometer and reported their daily steps in the app. Participants also received daily messages to reinforce key contents taught during an in-person educational session, remind them to input steps, and provide tailored feedback. Feasibility measures were the percentage of eligible participants completing the run-in period and the percentage of participants who used the app diary for at least 5 out of 7 days during the intervention period. We conducted poststudy participant interviews to explore overall intervention acceptability. Results: A total of 19 participants were enrolled at the beginning of the study with a mean age of 47 (SD 13.3; range 29-70) years, and 58% (n=11) of them were female. Of the participants, 26% (n=5) were Chinese, 32% (n=6) were Vietnamese, and 42% (n=8) were Filipino. All participants met the run-in criteria to proceed with the intervention. Adherence to the app diary ranged from 74% (n=14) in week 2 to 95% (n=18) in week 4. The daily average steps per week from accelerometers increased each week from 8451 (SD 3378) steps during the run-in period to 10,930 (SD 4213) steps in week 4. Participants reported positive experiences including an increased motivation to walk and the enjoyment of being able to monitor their physical activity. Conclusions: This is the first pilot study of a multicomponent intervention and evidence-based mobile phone app to promote physical activity among Asian Americans who use apps in traditional Chinese, Tagalog, or Vietnamese, which demonstrated high feasibility and acceptability. Future work focused on multilingual mobile apps to address disparities in physical inactivity among Asian Americans should be considered. UR - https://formative.jmir.org/2024/1/e56373 UR - http://dx.doi.org/10.2196/56373 UR - http://www.ncbi.nlm.nih.gov/pubmed/38857065 ID - info:doi/10.2196/56373 ER - TY - JOUR AU - Lyons, Katy AU - Hei Man, Hau Alison AU - Booth, David AU - Rena, Graham PY - 2024/6/10 TI - Defining Activity Thresholds Triggering a ?Stand Hour? for Apple Watch Users: Cross-Sectional Study JO - JMIR Form Res SP - e53806 VL - 8 KW - stand hour KW - Apple Watch KW - sedentary behavior KW - light physical activity KW - cardiovascular disease KW - type 2 diabetes KW - data collection KW - wearable KW - wearables KW - watch KW - smartwatch KW - stand KW - standing KW - sedentary KW - physical activity KW - exercise KW - movement KW - algorithm KW - algorithms KW - predict KW - predictive KW - predictor KW - predictors KW - prediction KW - machine learning N2 - Background: Sedentary behavior (SB) is one of the largest contributing factors increasing the risk of developing noncommunicable diseases, including cardiovascular disease and type 2 diabetes. Guidelines from the World Health Organization for physical activity suggest the substitution of SB with light physical activity. The Apple Watch contains a health metric known as the stand hour (SH). The SH is intended to record standing with movement for at least 1 minute per hour; however, the activity measured during the determination of the SH is unclear. Objective: In this cross-sectional study, we analyzed the algorithm used to determine time spent standing per hour. To do this, we investigated activity measurements also recorded on Apple Watches that influence the recording of an SH. We also aimed to estimate the values of any significant SH predictors in the recording of a SH. Methods: The cross-sectional study used anonymized data obtained in August 2022 from 20 healthy individuals gathered via convenience sampling. Apple Watch data were extracted from the Apple Health app through the use of a third-party app. Appropriate statistical models were fitted to analyze SH predictors. Results: Our findings show that active energy (AE) and step count (SC) measurements influence the recording of an SH. Comparing when an SH is recorded with when an SH is not recorded, we found a significant difference in the mean and median AE and SC. Above a threshold of 97.5 steps or 100 kJ of energy, it became much more likely that an SH would be recorded when each predictor was analyzed as a separate entity. Conclusions: The findings of this study reveal the pivotal role of AE and SC measurements in the algorithm underlying the SH recording; however, our findings also suggest that a recording of an SH is influenced by more than one factor. Irrespective of the internal validity of the SH metric, it is representative of light physical activity and might, therefore, have use in encouraging individuals through various means, for example, notifications, to reduce their levels of SB. UR - https://formative.jmir.org/2024/1/e53806 UR - http://dx.doi.org/10.2196/53806 UR - http://www.ncbi.nlm.nih.gov/pubmed/38857078 ID - info:doi/10.2196/53806 ER - TY - JOUR AU - Lehmann, Marco AU - Jones, Lucy AU - Schirmann, Felix PY - 2024/6/7 TI - App Engagement as a Predictor of Weight Loss in Blended-Care Interventions: Retrospective Observational Study Using Large-Scale Real-World Data JO - J Med Internet Res SP - e45469 VL - 26 KW - obesity KW - weight loss KW - blended-care KW - digital health KW - real-world data KW - app engagement KW - mHealth KW - mobile health KW - technology engagement KW - weight management KW - mobile phone N2 - Background: Early weight loss is an established predictor for treatment outcomes in weight management interventions for people with obesity. However, there is a paucity of additional, reliable, and clinically actionable early predictors in weight management interventions. Novel blended-care weight management interventions combine coach and app support and afford new means of structured, continuous data collection, informing research on treatment adherence and outcome prediction. Objective: Against this backdrop, this study analyzes app engagement as a predictor for weight loss in large-scale, real-world, blended-care interventions. We hypothesize that patients who engage more frequently in app usage in blended-care treatment (eg, higher logging activity) lose more weight than patients who engage comparably less frequently at 3 and 6 months of intervention. Methods: Real-world data from 19,211 patients in obesity treatment were analyzed retrospectively. Patients were treated with 3 different blended-care weight management interventions, offered in Switzerland, the United Kingdom, and Germany by a digital behavior change provider. The principal component analysis identified an overarching metric for app engagement based on app usage. A median split informed a distinction in higher and lower engagers among the patients. Both groups were matched through optimal propensity score matching for relevant characteristics (eg, gender, age, and start weight). A linear regression model, combining patient characteristics and app-derived data, was applied to identify predictors for weight loss outcomes. Results: For the entire sample (N=19,211), mean weight loss was ?3.24% (SD 4.58%) at 3 months and ?5.22% (SD 6.29%) at 6 months. Across countries, higher app engagement yielded more weight loss than lower engagement after 3 but not after 6 months of intervention (P3 months<.001 and P6 months=.59). Early app engagement within the first 3 months predicted percentage weight loss in Switzerland and Germany, but not in the United Kingdom (PSwitzerland<.001, PUnited Kingdom=.12, and PGermany=.005). Higher age was associated with stronger weight loss in the 3-month period (PSwitzerland=.001, PUnited Kingdom=.002, and PGermany<.001) and, for Germany, also in the 6-month period (PSwitzerland=.09, PUnited Kingdom=.46, and PGermany=.03). In Switzerland, higher numbers of patients? messages to coaches were associated with higher weight loss (P3 months<.001 and P6 months<.001). Messages from coaches were not significantly associated with weight loss (all P>.05). Conclusions: Early app engagement is a predictor of weight loss, with higher engagement yielding more weight loss than lower engagement in this analysis. This new predictor lends itself to automated monitoring and as a digital indicator for needed or adapted clinical action. Further research needs to establish the reliability of early app engagement as a predictor for treatment adherence and outcomes. In general, the obtained results testify to the potential of app-derived data to inform clinical monitoring practices and intervention design. UR - https://www.jmir.org/2024/1/e45469 UR - http://dx.doi.org/10.2196/45469 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848556 ID - info:doi/10.2196/45469 ER - TY - JOUR AU - Ulm, Clayton AU - Chen, Sixia AU - Fleshman, Brianna AU - Benson, Lizbeth AU - Kendzor, E. Darla AU - Frank-Pearce, Summer AU - Neil, M. Jordan AU - Vidrine, Damon AU - De La Torre, Irene AU - Businelle, S. Michael PY - 2024/6/7 TI - Smartphone-Based Survey and Message Compliance in Adults Initially Unready to Quit Smoking: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Form Res SP - e56003 VL - 8 KW - just-in-time adaptive intervention KW - tailored messaging KW - smoking cessation KW - mobile health KW - survey compliance KW - phase-based model KW - smoking KW - smoker KW - survey KW - smokers KW - messaging KW - smartphone KW - efficacy KW - pilot randomized controlled trial KW - adult smokers KW - linear regression KW - age KW - intervention engagement KW - engagement N2 - Background: Efficacy of smartphone-based interventions depends on intervention content quality and level of exposure to that content. Smartphone-based survey completion rates tend to decline over time; however, few studies have identified variables that predict this decline over longer-term interventions (eg, 26 weeks). Objective: This study aims to identify predictors of survey completion and message viewing over time within a 26-week smoking cessation trial. Methods: This study examined data from a 3-group pilot randomized controlled trial of adults who smoke (N=152) and were not ready to quit smoking within the next 30 days. For 182 days, two intervention groups received smartphone-based morning and evening messages based on current readiness to quit smoking. The control group received 2 daily messages unrelated to smoking. All participants were prompted to complete 26 weekly smartphone-based surveys that assessed smoking behavior, quit attempts, and readiness to quit. Compliance was operationalized as percentages of weekly surveys completed and daily messages viewed. Linear regression and mixed-effects models were used to identify predictors (eg, intervention group, age, and sex) of weekly survey completion and daily message viewing and decline in compliance over time. Results: The sample (mean age 50, SD 12.5, range 19-75 years; mean years of education 13.3, SD 1.6, range 10-20 years) was 67.8% (n=103) female, 74.3% (n=113) White, 77% (n=117) urban, and 52.6% (n=80) unemployed, and 61.2% (n=93) had mental health diagnoses. On average, participants completed 18.3 (71.8%) out of 25.5 prompted weekly surveys and viewed 207.3 (60.6%) out of 345.1 presented messages (31,503/52,460 total). Age was positively associated with overall weekly survey completion (P=.003) and daily message viewing (P=.02). Mixed-effects models indicated a decline in survey completion from 77% (114/148) in the first week of the intervention to 56% (84/150) in the last week of the intervention (P<.001), which was significantly moderated by age, sex, ethnicity, municipality (ie, rural/urban), and employment status. Similarly, message viewing declined from 72.3% (1533/2120) in the first week of the intervention to 44.6% (868/1946) in the last week of the intervention (P<.001). This decline in message viewing was significantly moderated by age, sex, municipality, employment status, and education. Conclusions: This study demonstrated the feasibility of a 26-week smartphone-based smoking cessation intervention. Study results identified subgroups that displayed accelerated rates in the decline of survey completion and message viewing. Future research should identify ways to maintain high levels of interaction with mobile health interventions that span long intervention periods, especially among subgroups that have demonstrated declining rates of intervention engagement over time. Trial Registration: ClinicalTrials.gov NCT03405129; https://clinicaltrials.gov/ct2/show/NCT03405129 UR - https://formative.jmir.org/2024/1/e56003 UR - http://dx.doi.org/10.2196/56003 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848557 ID - info:doi/10.2196/56003 ER - TY - JOUR AU - Tran, Dieu-My AU - Dingley, Catherine AU - Bonilla, Roger PY - 2024/6/7 TI - mHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study JO - JMIR Form Res SP - e48520 VL - 8 KW - blood pressure KW - mHealth KW - self-management KW - students KW - intervention KW - elevated blood pressure KW - college KW - hypertension KW - young adult KW - mobile app KW - smartphone KW - monitoring KW - text messaging KW - text mining N2 - Background: Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population. Objective: The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults. Methods: Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ?80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant?s BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention. Results: The participants? (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese. The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days. Conclusions: The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research. UR - https://formative.jmir.org/2024/1/e48520 UR - http://dx.doi.org/10.2196/48520 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848120 ID - info:doi/10.2196/48520 ER - TY - JOUR AU - Mastrototaro, J. John AU - Leabman, Michael AU - Shumate, Joe AU - Tompkins, L. Kim PY - 2024/6/5 TI - Performance of a Wearable Ring in Controlled Hypoxia: A Prospective Observational Study JO - JMIR Form Res SP - e54256 VL - 8 KW - pulse oximetry KW - SpO2 KW - pulse oximeter KW - hypoxia KW - hypoxemia KW - clinical trial KW - accuracy KW - digital health KW - wearable KW - smart ring KW - ISO 80601-2-61 KW - racial bias N2 - Background: Over recent years, technological advances in wearables have allowed for continuous home monitoring of heart rate and oxygen saturation. These devices have primarily been used for sports and general wellness and may not be suitable for medical decision-making, especially in saturations below 90% and in patients with dark skin color. Wearable clinical-grade saturation of peripheral oxygen (SpO2) monitoring can be of great value to patients with chronic diseases, enabling them and their clinicians to better manage their condition with reliable real-time and trend data. Objective: This study aimed to determine the SpO2 accuracy of a wearable ring pulse oximeter compared with arterial oxygen saturation (SaO2) in a controlled hypoxia study based on the International Organization for Standardization (ISO) 80601-2-61:2019 standard over the range of 70%-100% SaO2 in volunteers with a broad range of skin color (Fitzpatrick I to VI) during nonmotion conditions. In parallel, accuracy was compared with a calibrated clinical-grade reference pulse oximeter (Masimo Radical-7). Acceptable medical device accuracy was defined as a maximum of 4% root mean square error (RMSE) per the ISO 80601-2-61 standard and a maximum of 3.5% RMSE per the US Food and Drug Administration guidance. Methods: We performed a single-center, blinded hypoxia study of the test device in 11 healthy volunteers at the Hypoxia Research Laboratory, University of California at San Francisco, under the direction of Philip Bickler, MD, PhD, and John Feiner, MD. Each volunteer was connected to a breathing apparatus for the administration of a hypoxic gas mixture. To facilitate frequent blood gas sampling, a radial arterial cannula was placed on either wrist of each participant. One test device was placed on the index finger and another test device was placed on the fingertip. SaO2 analysis was performed using an ABL-90 multi-wavelength oximeter. Results: For the 11 participants included in the analysis, there were 236, 258, and 313 SaO2-SpO2 data pairs for the test device placed on the finger, the test device placed on the fingertip, and the reference device, respectively. The RMSE of the test device for all participants was 2.1% for either finger or fingertip placement, while the Masimo Radical-7 reference pulse oximeter RMSE was 2.8%, exceeding the standard (4% or less) and the Food and Drug Administration guidance (3.5% or less). Accuracy of SaO2-SpO2 paired data from the 4 participants with dark skin in the study was separately analyzed for both test device placements and the reference device. The test and reference devices exceeded the minimum accuracy requirements for a medical device with RMSE at 1.8% (finger) and 1.6% (fingertip) and for the reference device at 2.9%. Conclusions: The wearable ring meets an acceptable standard of accuracy for clinical-grade SpO2 under nonmotion conditions without regard to skin color. Trial Registration: ClinicalTrials.gov NCT05920278; https://clinicaltrials.gov/study/NCT05920278 UR - https://formative.jmir.org/2024/1/e54256 UR - http://dx.doi.org/10.2196/54256 UR - http://www.ncbi.nlm.nih.gov/pubmed/38838332 ID - info:doi/10.2196/54256 ER - TY - JOUR AU - Zawati, H. Ma'n AU - Lang, Michael PY - 2024/6/5 TI - Does an App a Day Keep the Doctor Away? AI Symptom Checker Applications, Entrenched Bias, and Professional Responsibility JO - J Med Internet Res SP - e50344 VL - 26 KW - artificial intelligence KW - applications KW - mobile health KW - mHealth KW - bias KW - biases KW - professional obligations KW - professional obligation KW - app KW - apps KW - application KW - symptom checker KW - symptom checkers KW - diagnose KW - diagnosis KW - self-diagnose KW - self-diagnosis KW - ethic KW - ethics KW - ethical KW - regulation KW - regulations KW - legal KW - law KW - laws KW - safety KW - mobile phone UR - https://www.jmir.org/2024/1/e50344 UR - http://dx.doi.org/10.2196/50344 UR - http://www.ncbi.nlm.nih.gov/pubmed/38838309 ID - info:doi/10.2196/50344 ER - TY - JOUR AU - Chuang, Hai-Hua AU - Lin, Chen AU - Lee, Li-Ang AU - Chang, Hsiang-Chih AU - She, Guan-Jie AU - Lin, Yu-Hsuan PY - 2024/6/5 TI - Comparing Human-Smartphone Interactions and Actigraphy Measurements for Circadian Rhythm Stability and Adiposity: Algorithm Development and Validation Study JO - J Med Internet Res SP - e50149 VL - 26 KW - actigraphy KW - body composition KW - circadian rhythm KW - human-smartphone interaction KW - interdaily stability KW - obesity N2 - Background: This study aimed to investigate the relationships between adiposity and circadian rhythm and compare the measurement of circadian rhythm using both actigraphy and a smartphone app that tracks human-smartphone interactions. Objective: We hypothesized that the app-based measurement may provide more comprehensive information, including light-sensitive melatonin secretion and social rhythm, and have stronger correlations with adiposity indicators. Methods: We enrolled a total of 78 participants (mean age 41.5, SD 9.9 years; 46/78, 59% women) from both an obesity outpatient clinic and a workplace health promotion program. All participants (n=29 with obesity, n=16 overweight, and n=33 controls) were required to wear a wrist actigraphy device and install the Rhythm app for a minimum of 4 weeks, contributing to a total of 2182 person-days of data collection. The Rhythm app estimates sleep and circadian rhythm indicators by tracking human-smartphone interactions, which correspond to actigraphy. We examined the correlations between adiposity indices and sleep and circadian rhythm indicators, including sleep time, chronotype, and regularity of circadian rhythm, while controlling for physical activity level, age, and gender. Results: Sleep onset and wake time measurements did not differ significantly between the app and actigraphy; however, wake after sleep onset was longer (13.5, SD 19.5 minutes) with the app, resulting in a longer actigraphy-measured total sleep time (TST) of 20.2 (SD 66.7) minutes. The obesity group had a significantly longer TST with both methods. App-measured circadian rhythm indicators were significantly lower than their actigraphy-measured counterparts. The obesity group had significantly lower interdaily stability (IS) than the control group with both methods. The multivariable-adjusted model revealed a negative correlation between BMI and app-measured IS (P=.007). Body fat percentage (BF%) and visceral adipose tissue area (VAT) showed significant correlations with both app-measured IS and actigraphy-measured IS. The app-measured midpoint of sleep showed a positive correlation with both BF% and VAT. Actigraphy-measured TST exhibited a positive correlation with BMI, VAT, and BF%, while no significant correlation was found between app-measured TST and either BMI, VAT, or BF%. Conclusions: Our findings suggest that IS is strongly correlated with various adiposity indicators. Further exploration of the role of circadian rhythm, particularly measured through human-smartphone interactions, in obesity prevention could be warranted. UR - https://www.jmir.org/2024/1/e50149 UR - http://dx.doi.org/10.2196/50149 UR - http://www.ncbi.nlm.nih.gov/pubmed/38838328 ID - info:doi/10.2196/50149 ER - TY - JOUR AU - Sawyer, Chelsea AU - Carney, Rebekah AU - Hassan, Lamiece AU - Bucci, Sandra AU - Sainsbury, John AU - Lovell, Karina AU - Torous, John AU - Firth, Joseph PY - 2024/6/5 TI - Digital Lifestyle Interventions for Young People With Mental Illness: A Qualitative Study Among Mental Health Care Professionals JO - JMIR Hum Factors SP - e53406 VL - 11 KW - digital health KW - behavior change KW - mental health care professionals KW - physical health KW - lifestyle intervention KW - qualitative KW - thematic analysis KW - service optimization KW - mobile phone N2 - Background: Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation. Objective: Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care. Methods: Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings. Results: Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients? readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described. Conclusions: The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks. UR - https://humanfactors.jmir.org/2024/1/e53406 UR - http://dx.doi.org/10.2196/53406 UR - http://www.ncbi.nlm.nih.gov/pubmed/38837191 ID - info:doi/10.2196/53406 ER - TY - JOUR AU - Faizah, Aaya AU - Hardian, Azzahra Alifah Fatimah AU - Nandini, Devina Rania AU - Handayani, Wuri Putu AU - Harahap, Cyldea Nabila PY - 2024/6/5 TI - The Influence of Incentive-Based Mobile Fitness Apps on Users? Continuance Intention With Gender Moderation Effects: Quantitative and Qualitative Study JO - JMIR Hum Factors SP - e50957 VL - 11 KW - incentive KW - fitness KW - mobile fitness apps KW - gender KW - continuance usage intention KW - Indonesia KW - mobile phone N2 - Background: A survey conducted by McKinsey & Company reported that, as of May 2022, as many as 26% of Indonesians had recently started to engage actively in physical activity, 32% undertook regular physical activity, and 9% exercised intensely. The Fourth Industrial Revolution has spurred the rapid development of mobile fitness apps (MFAs) used to track people?s sports activities. However, public interest in using these apps for any length of time is still relatively low. Objective: In this study, we aimed to determine the effect of incentives (eg, self-monitoring, social support, platform rewards, and external influence) on the use of MFAs and the moderating effect of gender on users? continuance usage intention. Methods: The study used a mixed methods approach. Quantitative data were collected through a web-based questionnaire and qualitative data from interviews with 30 respondents. The quantitative data, collected from 379 valid responses, were processed using covariance-based structural equation modeling. The qualitative data were processed using thematic analysis. The MFAs included in this research were those used as sports or physical activity trackers, such as Apple Fitness, Strava, Nike Run Club, and Fita. Results: The results of the data analysis show that 3 groups of incentives, namely, self-monitoring, platform rewards, and external influence (with the exception of social support), affect the perceived usefulness of these apps. Gender was also shown to moderate user behavior in relation to physical activity. The study showed that women were more likely to be motivated to exercise by social and external factors, while men paid greater attention to the tracking features of the app and to challenges and rewards. Conclusions: This research contributes to the field of health promotion by providing guidance for MFA developers. UR - https://humanfactors.jmir.org/2024/1/e50957 UR - http://dx.doi.org/10.2196/50957 UR - http://www.ncbi.nlm.nih.gov/pubmed/38837199 ID - info:doi/10.2196/50957 ER - TY - JOUR AU - Hurtado, Lidia AU - Gonzalez Concepcion, Melinda AU - Flix-Valle, Aida AU - Ruiz-Romeo, Marina AU - Gonzalez-Rodriguez, Sonia AU - Peña, Marta AU - Paviglianiti, Annalisa AU - Pera Jambrina, Angeles Maria AU - Sureda, Anna AU - Ochoa-Arnedo, Cristian AU - Mussetti, Alberto PY - 2024/6/4 TI - Telemedicine With Wearable Technologies in Patients Undergoing Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T-Cell Therapy (TEL-HEMATO Study): Prospective Noninterventional Single-Center Study JO - JMIR Form Res SP - e55918 VL - 8 KW - hematology KW - hematopoietic cell transplantation KW - telemedicine KW - wearables KW - chimeric antigen receptor T KW - CART KW - wearable KW - hematopoietic KW - transplantation KW - transplant KW - pilot study KW - hematological KW - HCT KW - telehealth KW - therapy KW - device KW - quality of life KW - digital health KW - smartphone KW - app KW - patient KW - teenager KW - youth KW - noninterventional N2 - Background: Patients with hematological malignancies receiving hematopoietic cell transplantation (HCT) or chimeric antigen receptor (CAR) T-cell therapy are at risk of developing serious clinical complications after discharge. Objective: The aim of the TEL-HEMATO study was to improve our telehealth platform for the follow-up of patients undergoing HCT or CAR T-cell therapy during the first 3 months after discharge with the addition of wearable devices. Methods: Eleven patients who received autologous (n=2) or allogeneic (n=5) HCT or CAR T-cell therapy (n=4) for hematological malignancies were screened from November 2022 to July 2023. Two patients discontinued the study after enrollment. The telehealth platform consisted of the daily collection of vital signs, physical symptoms, and quality of life assessment up to 3 months after hospital discharge. Each patient received a clinically validated smartwatch (ScanWatch) and a digital thermometer, and a dedicated smartphone app was used to collect these data. Daily revision of the data was performed through a web-based platform by a hematologist or a nurse specialized in HCT and CAR T-cell therapy. Results: Vital signs measured through ScanWatch were successfully collected with medium/high adherence: heart rate was recorded in 8/9 (89%) patients, oxygen saturation and daily steps were recorded in 9/9 (100%) patients, and sleeping hours were recorded in 7/9 (78%) patients. However, temperature recorded manually by the patients was associated with lower compliance, which was recorded in 5/9 (55%) patients. Overall, 5/9 (55%) patients reported clinical symptoms in the app. Quality of life assessment was completed by 8/9 (89%) patients at study enrollment, which decreased to 3/9 (33%) at the end of the third month. Usability was considered acceptable through ratings provided on the System Usability Scale. However, technological issues were reported by the patients. Conclusions: While the addition of wearable devices to a telehealth clinical platform could have potentially synergic benefits for HCT and CAR T-cell therapy patient monitoring, noncomplete automation of the platform and the absence of a dedicated telemedicine team still represent major limitations to be overcome. This is especially true in our real-life setting where the target population generally comprises patients of older age with a low digital education level. UR - https://formative.jmir.org/2024/1/e55918 UR - http://dx.doi.org/10.2196/55918 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833696 ID - info:doi/10.2196/55918 ER - TY - JOUR AU - Umibe, Akiko AU - Fushiki, Hiroaki AU - Tsunoda, Reiko AU - Kuroda, Tatsuaki AU - Kuroda, Kazuhiro AU - Tanaka, Yasuhiro PY - 2024/6/4 TI - Development of a Subjective Visual Vertical Test System Using a Smartphone With Virtual Reality Goggles for Screening of Otolithic Dysfunction: Observational Study JO - JMIR Form Res SP - e53642 VL - 8 KW - vestibular function tests KW - telemedicine KW - smartphone KW - virtual reality KW - otolith dysfunction screening tool KW - vestibular evoked myogenic potential KW - iPhone KW - mobile phone N2 - Background: The subjective visual vertical (SVV) test can evaluate otolith function and spatial awareness and is performed in dedicated vertigo centers using specialized equipment; however, it is not otherwise widely used because of the specific equipment and space requirements. An SVV test smartphone app was developed to easily perform assessments in outpatient facilities. Objective: This study aimed to verify whether the SVV test smartphone app with commercially available virtual reality goggles can be used in a clinical setting. Methods: The reference range was calculated for 15 healthy participants. We included 14 adult patients with unilateral vestibular neuritis, sudden sensorineural hearing loss with vertigo, and Meniere disease and investigated the correlation between the SVV test results and vestibular evoked myogenic potential (VEMP) results. Results: The SVV reference range of healthy participants for the sitting front-facing position was small, ranging from ?2.6º to 2.3º. Among the 14 patients, 6 (43%) exceeded the reference range for healthy participants. The SVV of patients with vestibular neuritis and sudden sensorineural hearing loss tended to deviate to the affected side. A total of 9 (64%) had abnormal cervical VEMP (cVEMP) values and 6 (43%) had abnormal ocular VEMP (oVEMP) values. No significant difference was found between the presence or absence of abnormal SVV values and the presence or absence of abnormal cVEMP and oVEMP values; however, the odds ratios (ORs) suggested a higher likelihood of abnormal SVV values among those with abnormal cVEMP and oVEMP responses (OR 2.40, 95% CI 0.18-32.88; P>.99; and OR 2, 95% CI 0.90-4.45; P=.46, respectively). Conclusions: The SVV app can be used anywhere and in a short period while reducing directional bias by using virtual reality goggles, thus making it highly versatile and useful as a practical otolith dysfunction screening tool. UR - https://formative.jmir.org/2024/1/e53642 UR - http://dx.doi.org/10.2196/53642 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833295 ID - info:doi/10.2196/53642 ER - TY - JOUR AU - Kumwichar, Ponlagrit AU - Prappre, Tagoon AU - Chongsuvivatwong, Virasakdi PY - 2024/6/3 TI - Tuberculosis Treatment Compliance Under Smartphone-Based Video-Observed Therapy Versus Community-Based Directly Observed Therapy: Cluster Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e53411 VL - 12 KW - video-enhanced therapy KW - tuberculosis KW - health care system KW - observed therapy KW - treatment compliance KW - lung disease KW - randomized trial KW - digital health KW - telehealth KW - telemedicine KW - mobile phone N2 - Background: There are no recent studies comparing the compliance rates of both patients and observers in tuberculosis treatment between the video-observed therapy (VOT) and directly observed therapy (DOT) programs. Objective: This study aims to compare the average number of days that patients with pulmonary tuberculosis and their observers were compliant under VOT and DOT. In addition, this study aims to compare the sputum conversion rate of patients under VOT with that of patients under DOT. Methods: Patient and observer compliance with tuberculosis treatment between the VOT and DOT programs were compared based on the average number of VOT and DOT compliance days and sputum conversion rates in a 60-day cluster randomized controlled trial with patients with pulmonary tuberculosis (VOT: n=63 and DOT: n=65) with positive sputum acid-fast bacilli smears and 38 observers equally randomized into the VOT and DOT groups (19 observers per group and n=1-5 patients per observer). The VOT group submitted videos to observers via smartphones; the DOT group followed standard procedures. An intention-to-treat analysis assessed the compliance of both the patients and the observers. Results: The VOT group had higher average compliance than the DOT group (patients: mean difference 15.2 days, 95% CI 4.8-25.6; P=.005 and observers: mean difference 21.2 days, 95% CI 13.5-28.9; P<.001). The sputum conversion rates in the VOT and DOT groups were 73% and 61.5%, respectively (P=.17). Conclusions: Smartphone-based VOT significantly outperformed community-based DOT in ensuring compliance with tuberculosis treatment among observers. However, the study was underpowered to confirm improved compliance among patients with pulmonary tuberculosis and to detect differences in sputum conversion rates. Trial Registration: Thai Clinical Trials Registry (TCTR) TCTR20210624002; https://tinyurl.com/3bc2ycrh International Registered Report Identifier (IRRID): RR2-10.2196/38796 UR - https://mhealth.jmir.org/2024/1/e53411 UR - http://dx.doi.org/10.2196/53411 UR - http://www.ncbi.nlm.nih.gov/pubmed/38830205 ID - info:doi/10.2196/53411 ER - TY - JOUR AU - Guardado, Sharon AU - Karampela, Maria AU - Isomursu, Minna AU - Grundstrom, Casandra PY - 2024/5/31 TI - Use of Patient-Generated Health Data From Consumer-Grade Devices by Health Care Professionals in the Clinic: Systematic Review JO - J Med Internet Res SP - e49320 VL - 26 KW - patient-generated health data KW - mHealth KW - health care professionals KW - mobile technologies KW - self-management N2 - Background: Mobile health (mHealth) uses mobile technologies to promote wellness and help disease management. Although mHealth solutions used in the clinical setting have typically been medical-grade devices, passive and active sensing capabilities of consumer-grade devices like smartphones and activity trackers have the potential to bridge information gaps regarding patients? behaviors, environment, lifestyle, and other ubiquitous data. Individuals are increasingly adopting mHealth solutions, which facilitate the collection of patient-generated health data (PGHD). Health care professionals (HCPs) could potentially use these data to support care of chronic conditions. However, there is limited research on real-life experiences of HPCs using PGHD from consumer-grade mHealth solutions in the clinical context. Objective: This systematic review aims to analyze existing literature to identify how HCPs have used PGHD from consumer-grade mobile devices in the clinical setting. The objectives are to determine the types of PGHD used by HCPs, in which health conditions they use them, and to understand the motivations behind their willingness to use them. Methods: A systematic literature review was the main research method to synthesize prior research. Eligible studies were identified through comprehensive searches in health, biomedicine, and computer science databases, and a complementary hand search was performed. The search strategy was constructed iteratively based on key topics related to PGHD, HCPs, and mobile technologies. The screening process involved 2 stages. Data extraction was performed using a predefined form. The extracted data were summarized using a combination of descriptive and narrative syntheses. Results: The review included 16 studies. The studies spanned from 2015 to 2021, with a majority published in 2019 or later. Studies showed that HCPs have been reviewing PGHD through various channels, including solutions portals and patients? devices. PGHD about patients? behavior seem particularly useful for HCPs. Our findings suggest that PGHD are more commonly used by HCPs to treat conditions related to lifestyle, such as diabetes and obesity. Physicians were the most frequently reported users of PGHD, participating in more than 80% of the studies. Conclusions: PGHD collection through mHealth solutions has proven beneficial for patients and can also support HCPs. PGHD have been particularly useful to treat conditions related to lifestyle, such as diabetes, cardiovascular diseases, and obesity, or in domains with high levels of uncertainty, such as infertility. Integrating PGHD into clinical care poses challenges related to privacy and accessibility. Some HCPs have identified that though PGHD from consumer devices might not be perfect or completely accurate, their perceived clinical value outweighs the alternative of having no data. Despite their perceived value, our findings reveal their use in clinical practice is still scarce. International Registered Report Identifier (IRRID): RR2-10.2196/39389 UR - https://www.jmir.org/2024/1/e49320 UR - http://dx.doi.org/10.2196/49320 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820580 ID - info:doi/10.2196/49320 ER - TY - JOUR AU - Meczner, András AU - Cohen, Nathan AU - Qureshi, Aleem AU - Reza, Maria AU - Sutaria, Shailen AU - Blount, Emily AU - Bagyura, Zsolt AU - Malak, Tamer PY - 2024/5/31 TI - Controlling Inputter Variability in Vignette Studies Assessing Web-Based Symptom Checkers: Evaluation of Current Practice and Recommendations for Isolated Accuracy Metrics JO - JMIR Form Res SP - e49907 VL - 8 KW - symptom checker KW - accuracy KW - vignette studies KW - variability KW - methods KW - triage KW - evaluation KW - vignette KW - performance KW - metrics KW - mobile phone N2 - Background: The rapid growth of web-based symptom checkers (SCs) is not matched by advances in quality assurance. Currently, there are no widely accepted criteria assessing SCs? performance. Vignette studies are widely used to evaluate SCs, measuring the accuracy of outcome. Accuracy behaves as a composite metric as it is affected by a number of individual SC- and tester-dependent factors. In contrast to clinical studies, vignette studies have a small number of testers. Hence, measuring accuracy alone in vignette studies may not provide a reliable assessment of performance due to tester variability. Objective: This study aims to investigate the impact of tester variability on the accuracy of outcome of SCs, using clinical vignettes. It further aims to investigate the feasibility of measuring isolated aspects of performance. Methods: Healthily?s SC was assessed using 114 vignettes by 3 groups of 3 testers who processed vignettes with different instructions: free interpretation of vignettes (free testers), specified chief complaints (partially free testers), and specified chief complaints with strict instruction for answering additional symptoms (restricted testers). ? statistics were calculated to assess agreement of top outcome condition and recommended triage. Crude and adjusted accuracy was measured against a gold standard. Adjusted accuracy was calculated using only results of consultations identical to the vignette, following a review and selection process. A feasibility study for assessing symptom comprehension of SCs was performed using different variations of 51 chief complaints across 3 SCs. Results: Intertester agreement of most likely condition and triage was, respectively, 0.49 and 0.51 for the free tester group, 0.66 and 0.66 for the partially free group, and 0.72 and 0.71 for the restricted group. For the restricted group, accuracy ranged from 43.9% to 57% for individual testers, averaging 50.6% (SD 5.35%). Adjusted accuracy was 56.1%. Assessing symptom comprehension was feasible for all 3 SCs. Comprehension scores ranged from 52.9% and 68%. Conclusions: We demonstrated that by improving standardization of the vignette testing process, there is a significant improvement in the agreement of outcome between testers. However, significant variability remained due to uncontrollable tester-dependent factors, reflected by varying outcome accuracy. Tester-dependent factors, combined with a small number of testers, limit the reliability and generalizability of outcome accuracy when used as a composite measure in vignette studies. Measuring and reporting different aspects of SC performance in isolation provides a more reliable assessment of SC performance. We developed an adjusted accuracy measure using a review and selection process to assess data algorithm quality. In addition, we demonstrated that symptom comprehension with different input methods can be feasibly compared. Future studies reporting accuracy need to apply vignette testing standardization and isolated metrics. UR - https://formative.jmir.org/2024/1/e49907 UR - http://dx.doi.org/10.2196/49907 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820578 ID - info:doi/10.2196/49907 ER - TY - JOUR AU - Alhammad, Nasser AU - Alajlani, Mohannad AU - Abd-alrazaq, Alaa AU - Epiphaniou, Gregory AU - Arvanitis, Theodoros PY - 2024/5/31 TI - Patients? Perspectives on the Data Confidentiality, Privacy, and Security of mHealth Apps: Systematic Review JO - J Med Internet Res SP - e50715 VL - 26 KW - mobile health apps KW - mHealth apps KW - mobile health KW - privacy KW - confidentiality KW - security KW - awareness KW - perspectives KW - mobile phone N2 - Background: Mobile health (mHealth) apps have the potential to enhance health care service delivery. However, concerns regarding patients? confidentiality, privacy, and security consistently affect the adoption of mHealth apps. Despite this, no review has comprehensively summarized the findings of studies on this subject matter. Objective: This systematic review aims to investigate patients? perspectives and awareness of the confidentiality, privacy, and security of the data collected through mHealth apps. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted in 3 electronic databases: PubMed, Ovid, and ScienceDirect. All the retrieved articles were screened according to specific inclusion criteria to select relevant articles published between 2014 and 2022. Results: A total of 33 articles exploring mHealth patients? perspectives and awareness of data privacy, security, and confidentiality issues and the associated factors were included in this systematic review. Thematic analyses of the retrieved data led to the synthesis of 4 themes: concerns about data privacy, confidentiality, and security; awareness; facilitators and enablers; and associated factors. Patients showed discordant and concordant perspectives regarding data privacy, security, and confidentiality, as well as suggesting approaches to improve the use of mHealth apps (facilitators), such as protection of personal data, ensuring that health status or medical conditions are not mentioned, brief training or education on data security, and assuring data confidentiality and privacy. Similarly, awareness of the subject matter differed across the studies, suggesting the need to improve patients? awareness of data security and privacy. Older patients, those with a history of experiencing data breaches, and those belonging to the higher-income class were more likely to raise concerns about the data security and privacy of mHealth apps. These concerns were not frequent among patients with higher satisfaction levels and those who perceived the data type to be less sensitive. Conclusions: Patients expressed diverse views on mHealth apps? privacy, security, and confidentiality, with some of the issues raised affecting technology use. These findings may assist mHealth app developers and other stakeholders in improving patients? awareness and adjusting current privacy and security features in mHealth apps to enhance their adoption and use. Trial Registration: PROSPERO CRD42023456658; https://tinyurl.com/ytnjtmca UR - https://www.jmir.org/2024/1/e50715 UR - http://dx.doi.org/10.2196/50715 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820572 ID - info:doi/10.2196/50715 ER - TY - JOUR AU - Berrigan, T. Margaret AU - Beaulieu-Jones, R. Brendin AU - Baines, Rachel AU - Berkowitz, Seth AU - Evans, Heather AU - Brat, A. Gabriel PY - 2024/5/31 TI - Barriers to Postdischarge Smartphone App Use Among Patients With Traumatic Rib Fractures JO - JMIR Form Res SP - e52726 VL - 8 KW - mobile health KW - smartphone app KW - electronic health record KW - postdischarge monitoring KW - implementation science KW - mHealth KW - app KW - apps KW - application KW - applications KW - digital health KW - smartphone KW - smartphones KW - mobile phone UR - https://formative.jmir.org/2024/1/e52726 UR - http://dx.doi.org/10.2196/52726 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820574 ID - info:doi/10.2196/52726 ER - TY - JOUR AU - Weirauch, Vera AU - Soehnchen, Clarissa AU - Burmann, Anja AU - Meister, Sven PY - 2024/5/31 TI - Methods, Indicators, and End-User Involvement in the Evaluation of Digital Health Interventions for the Public: Scoping Review JO - J Med Internet Res SP - e55714 VL - 26 KW - digital health KW - digital health intervention KW - public end user KW - evaluation methods KW - evaluation criteria KW - end-user involvement KW - scoping review N2 - Background: Digital health interventions (DHIs) have the potential to enable public end users, such as citizens and patients, to manage and improve their health. Although the number of available DHIs is increasing, examples of successfully established DHIs in public health systems are limited. To counteract the nonuse of DHIs, they should be comprehensively evaluated while integrating end users. Unfortunately, there is a wide variability and heterogeneity according to the approaches of evaluation, which creates a methodological challenge. Objective: This scoping review aims to provide an overview of the current established processes for evaluating DHIs, including methods, indicators, and end-user involvement. The review is not limited to a specific medical field or type of DHI but offers a holistic overview. Methods: This scoping review was conducted following the JBI methodology for scoping reviews based on the framework by Arksey & O?Malley and complies with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Three scientific databases (PubMed, Scopus, and Science Direct) were searched in April 2023. English and German studies between 2008 and 2023 were considered when evaluating DHIs that explicitly address public end users. The process of study selection was carried out by several researchers to avoid reviewer bias. Results: The search strategy identified 9618 publications, of which 160 were included. Among these included articles, 200 evaluations were derived and analyzed. The results showed that there is neither a consensus on the methods to evaluate DHIs nor a commonly agreed definition or usage of the evaluated indicators, which results in a broad variety of evaluation practices. This aligns with observations of the existing literature. It was found that there is a lack of references to existing frameworks for the evaluation of DHIs. The majority of the included studies referred to user-centered approaches and involved end users in the evaluation process. As assistance for people developing and evaluating DHIs and as a basis for thinking about appropriate ways to evaluate DHIs, a results matrix was created where the findings were combined per DHI cluster. Additionally, general recommendations for the evaluators of DHIs were formulated. Conclusions: The findings of this scoping review offer a holistic overview of the variety and heterogeneity according to the approaches of evaluation of DHIs for public end users. Evaluators of these DHIs should be encouraged to reference established frameworks or measurements for justification. This would ease the transferability of the results among similar evaluation studies within the digital health sector, thereby enhancing the coherence and comparability of research in this area. UR - https://www.jmir.org/2024/1/e55714 UR - http://dx.doi.org/10.2196/55714 UR - http://www.ncbi.nlm.nih.gov/pubmed/38819891 ID - info:doi/10.2196/55714 ER - TY - JOUR AU - Cormack, Francesca AU - McCue, Maggie AU - Skirrow, Caroline AU - Cashdollar, Nathan AU - Taptiklis, Nick AU - van Schaik, Tempest AU - Fehnert, Ben AU - King, James AU - Chrones, Lambros AU - Sarkey, Sara AU - Kroll, Jasmin AU - Barnett, H. Jennifer PY - 2024/5/31 TI - Characterizing Longitudinal Patterns in Cognition, Mood, And Activity in Depression With 6-Week High-Frequency Wearable Assessment: Observational Study JO - JMIR Ment Health SP - e46895 VL - 11 KW - cognition KW - depression KW - digital biomarkers KW - ecological momentary assessment KW - mobile health KW - remote testing N2 - Background: Cognitive symptoms are an underrecognized aspect of depression that are often untreated. High-frequency cognitive assessment holds promise for improving disease and treatment monitoring. Although we have previously found it feasible to remotely assess cognition and mood in this capacity, further work is needed to ascertain the optimal methodology to implement and synthesize these techniques. Objective: The objective of this study was to examine (1) longitudinal changes in mood, cognition, activity levels, and heart rate over 6 weeks; (2) diurnal and weekday-related changes; and (3) co-occurrence of fluctuations between mood, cognitive function, and activity. Methods: A total of 30 adults with current mild-moderate depression stabilized on antidepressant monotherapy responded to testing delivered through an Apple Watch (Apple Inc) for 6 weeks. Outcome measures included cognitive function, assessed with 3 brief n-back tasks daily; self-reported depressed mood, assessed once daily; daily total step count; and average heart rate. Change over a 6-week duration, diurnal and day-of-week variations, and covariation between outcome measures were examined using nonlinear and multilevel models. Results: Participants showed initial improvement in the Cognition Kit N-Back performance, followed by a learning plateau. Performance reached 90% of individual learning levels on average 10 days after study onset. N-back performance was typically better earlier and later in the day, and step counts were lower at the beginning and end of each week. Higher step counts overall were associated with faster n-back learning, and an increased daily step count was associated with better mood on the same (P<.001) and following day (P=.02). Daily n-back performance covaried with self-reported mood after participants reached their learning plateau (P=.01). Conclusions: The current results support the feasibility and sensitivity of high-frequency cognitive assessments for disease and treatment monitoring in patients with depression. Methods to model the individual plateau in task learning can be used as a sensitive approach to better characterize changes in behavior and improve the clinical relevance of cognitive data. Wearable technology allows assessment of activity levels, which may influence both cognition and mood. UR - https://mental.jmir.org/2024/1/e46895 UR - http://dx.doi.org/10.2196/46895 UR - http://www.ncbi.nlm.nih.gov/pubmed/38819909 ID - info:doi/10.2196/46895 ER - TY - JOUR AU - Musiimenta, Angella AU - Tumuhimbise, Wilson AU - Atukunda, Esther AU - Mugaba, Aaron AU - Linnemayr, Sebastian AU - Haberer, Jessica PY - 2024/5/31 TI - Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study JO - JMIR Hum Factors SP - e47996 VL - 11 KW - digital adherence technologies KW - real-time monitoring KW - SMS text message reminders KW - mobile money KW - financial incentives KW - tuberculosis KW - medication adherence KW - user-centered approach N2 - Background: Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear. Objective: This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting. Methods: We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ?18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients? experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data. Results: All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox?based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as ?being watched? while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82%) to reminders linked to missed doses (7/39, 18%), citing the fact that tuberculosis medication is taken daily. Conclusions: The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care. UR - https://humanfactors.jmir.org/2024/1/e47996 UR - http://dx.doi.org/10.2196/47996 UR - http://www.ncbi.nlm.nih.gov/pubmed/38819905 ID - info:doi/10.2196/47996 ER - TY - JOUR AU - Murabito, M. Joanne AU - Faro, M. Jamie AU - Zhang, Yuankai AU - DeMalia, Angelo AU - Hamel, Alexander AU - Agyapong, Nakesha AU - Liu, Hongshan AU - Schramm, Eric AU - McManus, D. David AU - Borrelli, Belinda PY - 2024/5/30 TI - Smartphone App Designed to Collect Health Information in Older Adults: Usability Study JO - JMIR Hum Factors SP - e56653 VL - 11 KW - mobile application surveys KW - mixed methods KW - electronic data collection KW - mHealth KW - mobile health KW - mobile application KW - mobile applications KW - app KW - apps KW - application KW - applications KW - digital health KW - digital technology KW - digital intervention KW - digital interventions KW - smartphone KW - smartphones KW - usability KW - usable KW - usableness KW - usefulness KW - utility KW - health information N2 - Background: Studies evaluating the usability of mobile-phone assessments in older adults are limited. Objective: This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. Methods: We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40% women; 15/15, 100% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47% women; 3/15, 20% Hispanic; and 8/15, 53% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). Results: In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. Conclusions: Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences. UR - https://humanfactors.jmir.org/2024/1/e56653 UR - http://dx.doi.org/10.2196/56653 UR - http://www.ncbi.nlm.nih.gov/pubmed/38815261 ID - info:doi/10.2196/56653 ER - TY - JOUR AU - Tabira, Kento AU - Oguma, Yuko AU - Yoshihara, Shota AU - Shibuya, Megumi AU - Nakamura, Manabu AU - Doihara, Natsue AU - Hirata, Akihiro AU - Manabe, Tomoki PY - 2024/5/30 TI - Digital Peer-Supported App Intervention to Promote Physical Activity Among Community-Dwelling Older Adults: Nonrandomized Controlled Trial JO - JMIR Aging SP - e56184 VL - 7 KW - physical activity KW - physical function KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - aged KW - digital peer support app KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - eHealth KW - peer support KW - exercise KW - mobile phone N2 - Background: The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support?based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. Objective: This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. Methods: We conducted a nonrandomized controlled trial of older adults aged ?65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. Results: The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. Conclusions: The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials. UR - https://aging.jmir.org/2024/1/e56184 UR - http://dx.doi.org/10.2196/56184 UR - http://www.ncbi.nlm.nih.gov/pubmed/38814686 ID - info:doi/10.2196/56184 ER - TY - JOUR AU - Adedoja, Dorcas AU - Kuhns, M. Lisa AU - Radix, Asa AU - Garofalo, Robert AU - Brin, Maeve AU - Schnall, Rebecca PY - 2024/5/30 TI - MyPEEPS Mobile App for HIV Prevention Among Transmasculine Youth: Adaptation Through Community-Based Feedback and Usability Evaluation JO - JMIR Form Res SP - e56561 VL - 8 KW - HIV KW - mobile app KW - transgender men KW - transmasculine N2 - Background: Transgender men and transmasculine youth are at high risk for acquiring HIV. Growing research on transgender men demonstrates increased HIV risk and burden compared with the general US population. Despite biomedical advancements in HIV prevention, there remains a dearth of evidence-based, sexual health HIV prevention interventions for young transgender men. MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) Mobile is a web-based app that builds on extensive formative community?informed work to develop an evidence-based HIV prevention intervention. Our study team developed and tested the MyPEEPS Mobile intervention for 13- to 18-year-old cisgender young men in a national randomized controlled trial, which demonstrated efficacy to reduce sexual risk in the short term?at 3-month follow-up. Trans men and transmasculine youth resonated with basic HIV educational information and sexual scenarios of the original MyPEEPS app for cisgender men, but recognized the app's lack of transmasculine specificity. Objective: The purpose of this study is to detail the user-centered design methods to adapt, improve the user interface, and enhance the usability of the MyPEEPS Mobile app for young transgender men and transmasculine youth. Methods: The MyPEEPS Mobile app for young transgender men was adapted through a user-centered design approach, which included an iterative review of the adapted prototype by expert advisors and a youth advisory board. The app was then evaluated through a rigorous usability evaluation. Results: MyPEEPS Mobile is among the first mobile health interventions developed to meet the specific needs of young transgender men and transmasculine youth to reduce HIV risk behaviors. While many of the activities in the original MyPEEPS Mobile were rigorously developed and tested, there was a need to adapt our intervention to meet the specific needs and risk factors among young transgender men and transmasculine youth. The findings from this study describe the adaptation of these activities through feedback from a youth advisory board and expert advisors. Following adaptation of the content, the app underwent a rigorous usability assessment through an evaluation with experts in human-computer interaction (n=5) and targeted end users (n=20). Conclusions: Usability and adaptation findings demonstrate that the MyPEEPS Mobile app is highly usable and perceived as potentially useful for targeting HIV risk behaviors in young transgender men and transmasculine youth. UR - https://formative.jmir.org/2024/1/e56561 UR - http://dx.doi.org/10.2196/56561 UR - http://www.ncbi.nlm.nih.gov/pubmed/38814701 ID - info:doi/10.2196/56561 ER - TY - JOUR AU - Ostermann, Jan AU - Njau, Bernard AU - van Zwetselaar, Marco AU - Yamanis, Thespina AU - McClimans, Leah AU - Mwangi, Rose AU - Beti, Melkiory AU - Hobbie, Amy AU - Gass, Salomé-Joelle AU - Mtuy, Tara AU - Thielman, Nathan PY - 2024/5/30 TI - Mobile Phone?Based Confidential Social Network Referrals for HIV Testing (CONSORT): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e55068 VL - 13 KW - confidential referrals KW - HIV counseling and testing KW - mHealth KW - mobile health KW - social networks KW - stigma KW - sub-Saharan Africa KW - Tanzania N2 - Background: Critical to efforts to end the HIV epidemic is the identification of persons living with HIV who have yet to be diagnosed and engaged in care. Expanded HIV testing outreach efforts need to be both efficient and ambitious, targeting the social networks of persons living with HIV and those at above-average risk of undiagnosed HIV infection. The ubiquity of mobile phones across many high HIV prevalence settings has created opportunities to leverage mobile health (mHealth) technologies to engage social networks for HIV testing outreach, prevention, and treatment. Objective: The purpose of this study is to evaluate the acceptability and efficacy of a novel mHealth intervention, ?Confidential Social Network Referrals for HIV Testing (CONSORT),? to nudge at-risk individuals to test for HIV using SMS text messages. Methods: We will conduct the CONSORT study in Moshi, Tanzania, the commercial center and administrative capital of the Kilimanjaro Region in northern Tanzania. After qualitative formative work and pilot testing, we will enroll 400 clients presenting for HIV counseling and testing and 200 persons living with HIV and receiving care at HIV care and treatment centers as ?inviters? into a randomized controlled trial. Eligible participants will be aged 18 years or older and live, work, or regularly receive care in Moshi. We will randomize inviters into 1 of 2 study arms. All inviters will be asked to complete a survey of their HIV testing and risk behaviors and to think of social network contacts who would benefit from HIV testing. They will then be asked to whom they would prefer to extend an HIV testing invitation in the form of a physical invitation card. Arm 1 participants will also be given the opportunity to extend CONSORT invitations in the form of automated confidential SMS text messages to any of their social network contacts or ?invitees.? Arm 2 participants will be offered physical invitation cards alone. The primary outcome will be counselor-documented uptake of HIV testing by invitees within 30 days of inviter enrollment. Secondary outcomes will include the acceptability of CONSORT among inviters, the number of new HIV diagnoses, and the HIV risk of invitees who present for testing. Results: Enrollment in the randomized controlled trial is expected to start in September 2024. The findings will be disseminated to stakeholders and published in peer-reviewed journals. Conclusions: If CONSORT is acceptable and effective for increasing the uptake of HIV testing, given the minimal costs of SMS text reminders and the potential for exponential but targeted growth using chain referrals, it may shift current practices for HIV testing programs in the area. Trial Registration: ClincalTrials.gov NCT05967208; https://clinicaltrials.gov/study/NCT05967208 International Registered Report Identifier (IRRID): PRR1-10.2196/55068 UR - https://www.researchprotocols.org/2024/1/e55068 UR - http://dx.doi.org/10.2196/55068 UR - http://www.ncbi.nlm.nih.gov/pubmed/38814692 ID - info:doi/10.2196/55068 ER - TY - JOUR AU - Ameyaw, Kwabena Edward AU - Amoah, Adusei Padmore AU - Ezezika, Obidimma PY - 2024/5/29 TI - Effectiveness of mHealth Apps for Maternal Health Care Delivery: Systematic Review of Systematic Reviews JO - J Med Internet Res SP - e49510 VL - 26 KW - mHealth KW - mobile health KW - maternal health KW - telemedicine KW - technology KW - health care KW - newborn KW - systematic review KW - database KW - mHealth impact KW - mHealth effectiveness KW - health care applications N2 - Background: Globally, the use of mobile health (mHealth) apps or interventions has increased. Robust synthesis of existing systematic reviews on mHealth apps may offer useful insights to guide maternal health clinicians and policy makers. Objective: This systematic review aims to assess the effectiveness or impact of mHealth apps on maternal health care delivery globally. Methods: We systematically searched Scopus, Web of Science (Core Collection), MEDLINE or PubMed, CINAHL, and Cochrane Database of Systematic Reviews using a predeveloped search strategy. The quality of the reviews was independently assessed by 3 reviewers, while study selection was done by 2 independent raters. We presented a narrative synthesis of the findings, highlighting the specific mHealth apps, where they are implemented, and their effectiveness or outcomes toward various maternal conditions. Results: A total of 2527 documents were retrieved, out of which 16 documents were included in the review. Most mHealth apps were implemented by sending SMS text messages with mobile phones. mHealth interventions were most effective in 5 areas: maternal anxiety and depression, diabetes in pregnancy, gestational weight management, maternal health care use, behavioral modification toward smoking cessation, and controlling substance use during pregnancy. We noted that mHealth interventions for maternal health care are skewed toward high-income countries (13/16, 81%). Conclusions: The effectiveness of mHealth apps for maternity health care has drawn attention in research and practice recently. The study showed that research on mHealth apps and their use dominate in high-income countries. As a result, it is imperative that low- and middle-income countries intensify their commitment to these apps for maternal health care, in terms of use and research. Trial Registration: PROSPERO CRD42022365179; https://tinyurl.com/e5yxyx77 UR - https://www.jmir.org/2024/1/e49510 UR - http://dx.doi.org/10.2196/49510 UR - http://www.ncbi.nlm.nih.gov/pubmed/38810250 ID - info:doi/10.2196/49510 ER - TY - JOUR AU - Mizuno, Emi AU - Ogasawara, Takayuki AU - Mukaino, Masahiko AU - Yamaguchi, Masumi AU - Tsukada, Shingo AU - Sonoda, Shigeru AU - Otaka, Yohei PY - 2024/5/29 TI - Highlighting Unseen Activity Through 48-Hour Continuous Measurement in Subacute Stroke Rehabilitation: Preliminary Cohort Study JO - JMIR Form Res SP - e51546 VL - 8 KW - activity monitoring KW - smart clothing system KW - stroke KW - unseen KW - monitoring KW - recovery KW - physical condition KW - deconditioning KW - muscle wasting KW - wearable technology KW - wearable KW - activity level KW - rehabilitation KW - physical therapy KW - heart rate KW - ADL KW - activities of daily living KW - training KW - older people KW - mobile phone N2 - Background: Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities. Objective: This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity. Methods: In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients? daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks. Results: A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission (?=0.86, P<.001) and 4 weeks post admission (?=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission (?=?0.41, P=.21) or 4 weeks post admission (?=?0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission (?=?0.82, P=.002) and 4 weeks post admission (?=?0.73, P=.01). Conclusions: Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings. UR - https://formative.jmir.org/2024/1/e51546 UR - http://dx.doi.org/10.2196/51546 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809596 ID - info:doi/10.2196/51546 ER - TY - JOUR AU - Shiyab, Wa'ed AU - Rolls, Kaye AU - Ferguson, Caleb AU - Halcomb, Elizabeth PY - 2024/5/29 TI - Nurses? Use of mHealth Apps for Chronic Conditions: Cross-Sectional Survey JO - JMIR Nursing SP - e57668 VL - 7 KW - mHealth apps KW - adoption KW - smartphone KW - chronic conditions KW - nursing KW - technology KW - chronic KW - nurse KW - nurses KW - mHealth KW - mobile health KW - app KW - apps KW - use KW - cross-sectional KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - mobile phone N2 - Background: Mobile health (mHealth) is increasingly used to support public health practice, as it has positive benefits such as enhancing self-efficacy and facilitating chronic disease management. Yet, relatively few studies have explored the use of mHealth apps among nurses, despite their important role in caring for patients with and at risk of chronic conditions. Objective: The aim of the study is to explore nurses? use of mHealth apps to support adults with or at risk of chronic conditions and understand the factors that influence technology adoption. Methods: A web-based cross-sectional survey was conducted between September 2022 and January 2023. The survey was shared via social media and professional nursing organizations to Australian nurses caring for adults with or at risk of chronic conditions. Results: A total of 158 responses were included in the analysis. More than two-thirds (n=108, 68.4%) of respondents reported that they personally used at least 1 mHealth app. Over half (n=83, 52.5% to n=108, 68.4%) reported they use mHealth apps at least a few times a month for clinical purposes. Logistic regression demonstrated that performance expectancy (P=.04), facilitating condition (P=.05), and personal use of mHealth apps (P=.05) were significantly associated with mHealth app recommendation. In contrast, effort expectancy (P=.09) and social influence (P=.46) did not have a significant influence on whether respondents recommended mHealth apps to patients. The inability to identify the quality of mHealth apps and the lack of access to mobile devices or internet were the most common barriers to mHealth app recommendation. Conclusions: While nurses use mHealth apps personally, there is potential to increase their clinical application. Given the challenges reported in appraising and assessing mHealth apps, app regulation and upskilling nurses will help to integrate mHealth apps into usual patient care. UR - https://nursing.jmir.org/2024/1/e57668 UR - http://dx.doi.org/10.2196/57668 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809593 ID - info:doi/10.2196/57668 ER - TY - JOUR AU - Willemsen, Fleur Romy AU - Chavannes, Henrik Niels AU - Aardoom, Joëlle Jiska PY - 2024/5/29 TI - Feasibility and Acceptability of a Health App Platform Providing Individuals With a Budget to Purchase Preselected Apps to Work on Their Health and Well-Being: Quantitative Evaluation Study JO - JMIR Form Res SP - e51408 VL - 8 KW - acceptability KW - accessible KW - adoption KW - application KW - design KW - ehealth KW - engagement KW - evaluation study KW - feasibility KW - health app platform KW - health apps KW - health empowerment KW - prevention KW - public health KW - uptake KW - user-friendly KW - users KW - wellbeing N2 - Background: The potential of health apps for health promotion and disease prevention is widely recognized. However, uptake is limited due to barriers individuals face in finding suitable and trustworthy apps, such as the overwhelming amount of available health apps. Therefore, the health app platform ?FitKnip? was developed, enabling individuals to purchase preselected, trustworthy health apps with a budget of 100 euros (a currency exchange rate of EUR ?1=US $1.0831 is applicable). The platform aimed to empower individuals to improve their health and vitality, ultimately supporting a more healthy society. Objective: The primary aim of this study was to evaluate the health app platform in terms of feasibility and acceptability. Potential effects on health empowerment and health outcomes were secondarily explored. Methods: This quantitative study was part of a mixed methods study with a prospective pre-post interventional design. We collected web-based user data, and self-reported web-based questionnaires were collected over 5 measurements over an 8-month period. Use statistics were tracked on the platform, including the number of purchased apps and euros spent per user registered within the health app platform. We measured the user-friendliness of the health app platform using the System Usability Scale (SUS) and satisfaction using the Client Satisfaction Questionnaire?8 (CSQ-8) and several 10-point Likert items. We asked participants to indicate, on a scale from 1 (not at all) to 10 (completely), how much the health app platform contributed to various areas related to health empowerment. We assessed health-related quality of life by the 12-item Short-Form Health Survey (SF-12) and one?s perceived level of stress by the 10-item Perceived Stress Scale (PSS-10). Results: A total of 1650 participants were included, of whom 42% (685/1650) bought at least 1 app. The majority of those purchased one app (244/685, 35.6%). The health app platform was rated as user-friendly (SUS mean 66.5, SD 20.7; range 66.5-70.0), and the acceptability of the health app platform was moderate (CSQ-8 mean 20.0, SD 1.5; range 19.6-20.0). Results furthermore showed that participants were generally satisfied to highly satisfied with the ease of the payment system to purchase apps on the platform (median 8, IQR 7-10), the look and feel of the platform (median 7, IQR 6-8), as well as the provided budget of 100 euros (median 9, IQR 7-10). Participants were less satisfied with the amount (median 6, IQR 4-7) and diversity (median 6, IQR 4-7) of apps offered on the platform. Conclusions: A health app platform is a promising initiative to enhance public health. Feasibility and acceptability are critical for success, as they ensure that such a platform is accessible, user-friendly, and meets end users? needs and preferences. This can help to increase uptake, engagement, and ultimately the platform?s adoption and effectiveness. UR - https://formative.jmir.org/2024/1/e51408 UR - http://dx.doi.org/10.2196/51408 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809585 ID - info:doi/10.2196/51408 ER - TY - JOUR AU - Leitner, Jared AU - Chiang, Po-Han AU - Agnihotri, Parag AU - Dey, Sujit PY - 2024/5/28 TI - The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial JO - JMIR Cardio SP - e51916 VL - 8 KW - blood pressure KW - hypertension KW - digital health KW - lifestyle change KW - lifestyle medicine KW - wearables KW - remote patient monitoring KW - artificial intelligence KW - AI KW - mobile phone N2 - Background: Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications. Objective: This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)?based lifestyle coaching program on achieving BP control among adults with hypertension. Methods: Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches. Results: In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95% CI ?7.1 to ?4.2; P<.001) and 3.8 mm Hg (95% CI ?4.7 to ?2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95% CI ?12.2 to ?6.9; P<.001) and 5.7 mm Hg (95% CI ?7.6 to ?3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95% CI ?10.1 to ?6.1; P<.001) and 5.1 mm Hg (95% CI ?6.2 to ?3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95% CI ?17.7 to ?10.7; P<.001) and 8.1 mm Hg (95% CI ?10.4 to ?5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2% (22/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25% (32/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92% (SD 3.9%), and only 5.9% (6/102) of the participants required manual outreach over 24 weeks. Conclusions: The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads. Trial Registration: ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734 UR - https://cardio.jmir.org/2024/1/e51916 UR - http://dx.doi.org/10.2196/51916 UR - http://www.ncbi.nlm.nih.gov/pubmed/38805253 ID - info:doi/10.2196/51916 ER - TY - JOUR AU - Dinh, Mackenzie AU - Lin, Chieh Chun AU - Whitfield, Candace AU - Farhan, Zahera AU - Meurer, J. William AU - Bailey, Sarah AU - Skolarus, E. Lesli PY - 2024/5/28 TI - Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial JO - JMIR Form Res SP - e54010 VL - 8 KW - hypertension KW - cognition KW - mobile health KW - Bluetooth KW - remote KW - monitoring KW - monitor KW - low income KW - mHealth KW - hypertensive KW - cardiology KW - cardiovascular KW - feasibility KW - acceptability KW - satisfaction KW - RCT KW - randomized controlled trial KW - assessment KW - blood pressure KW - neurological N2 - Background: Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease?related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. Objective: The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Methods: Reach Out was a randomized, controlled, mobile health?based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message?linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Results: Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Conclusions: Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 UR - https://formative.jmir.org/2024/1/e54010 UR - http://dx.doi.org/10.2196/54010 UR - http://www.ncbi.nlm.nih.gov/pubmed/38805251 ID - info:doi/10.2196/54010 ER - TY - JOUR AU - Zainal, Hani Nur AU - Newman, G. Michelle PY - 2024/5/24 TI - Examining the Effects of a Brief, Fully Self-Guided Mindfulness Ecological Momentary Intervention on Empathy and Theory-of-Mind for Generalized Anxiety Disorder: Randomized Controlled Trial JO - JMIR Ment Health SP - e54412 VL - 11 KW - empathy KW - theory-of-mind KW - mindfulness KW - ecological momentary intervention KW - generalized anxiety disorder KW - randomized controlled trial KW - mobile phone N2 - Background: The utility of brief mindfulness ecological momentary interventions (EMIs) to improve empathy and theory-of-mind has been underinvestigated, particularly in generalized anxiety disorder (GAD). Objective: In this randomized controlled trial, we aimed to examine the efficacy of a 14-day, fully self-guided, mindfulness EMI on the empathy and theory-of-mind domains for GAD. Methods: Adults (aged ?18 y) diagnosed with GAD were randomized to a mindfulness EMI (68/110, 61.8%) or self-monitoring app (42/110, 38.2%) arm. They completed the Interpersonal Reactivity Index self-report empathy measure and theory-of-mind test (Bell-Lysaker Emotion Recognition Task) at prerandomization, postintervention, and 1-month follow-up (1MFU) time points. Hierarchical linear modeling was conducted with the intent-to-treat principle to determine prerandomization to postintervention (pre-post intervention) and prerandomization to 1MFU (pre-1MFU) changes, comparing the mindfulness EMI to self-monitoring. Results: Observed effects were generally stronger from pre-1MFU than from pre-post intervention time points. From pre-post intervention time points, the mindfulness EMI was more efficacious than the self-monitoring app on fantasy (the ability to imagine being in others? shoes; between-intervention effect size: Cohen d=0.26, P=.007; within-intervention effect size: Cohen d=0.22, P=.02 for the mindfulness EMI and Cohen d=?0.16, P=.10 for the self-monitoring app). From pre-1MFU time points, the mindfulness EMI, but not the self-monitoring app, improved theory-of-mind (a window into others? thoughts and intentions through abstract, propositional knowledge about their mental states, encompassing the ability to decipher social cues) and the fantasy, personal distress (stress when witnessing others? negative experiences), and perspective-taking (understanding others? perspective) empathy domains. The effect sizes were small to moderate (Cohen d=0.15-0.36; P<.001 to P=.01) for significant between-intervention effects from pre-1MFU time points. Furthermore, the within-intervention effect sizes for these significant outcomes were stronger for the mindfulness EMI (Cohen d=0.30-0.43; P<.001 to P=.03) than the self-monitoring app (Cohen d=?0.12 to 0.21; P=.001 to P>.99) from pre-1MFU time points. No between-intervention and within-intervention effects on empathic concern (feeling affection, compassion, and care when observing others in distress, primarily attending to their emotional well-being) were observed from pre-post intervention and pre-1MFU time points. Conclusions: The brief mindfulness EMI improved specific domains of empathy (eg, fantasy, personal distress, and perspective-taking) and theory-of-mind with small to moderate effect sizes in persons with GAD. Higher-intensity, self-guided or coach-facilitated, multicomponent mindfulness EMIs targeting the optimization of social relationships are likely necessary to improve the empathic concern domain in this population. Trial Registration: ClinicalTrials.gov NCT04846777; https://clinicaltrials.gov/study/NCT04846777 UR - https://mental.jmir.org/2024/1/e54412 UR - http://dx.doi.org/10.2196/54412 UR - http://www.ncbi.nlm.nih.gov/pubmed/38787613 ID - info:doi/10.2196/54412 ER - TY - JOUR AU - Yanez Touzet, Alvaro AU - Houhou, Tatiana AU - Rahic, Zerina AU - Kolias, Angelos AU - Yordanov, Stefan AU - Anderson, B. David AU - Laufer, Ilya AU - Li, Maggie AU - Grahovac, Gordan AU - Kotter, RN Mark AU - Davies, M. Benjamin AU - PY - 2024/5/24 TI - Reliability of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Observational Study JO - JMIR Form Res SP - e56889 VL - 8 KW - reproducibility of results KW - patient outcome assessment KW - smartphone KW - neurology KW - psychometrics KW - spinal cord compression KW - mobile phone N2 - Background: Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM Research, an international and multi-stakeholder partnership, priority. Difficulties in detecting DCM and its changes cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. Objective: The aim of this study is to assess the reliability of the MoveMed battery of performance outcome measures. Methods: A prospective observational study in decentralized secondary care was performed in England, United Kingdom. The primary outcome was to determine the test-retest reliability of the MoveMed performance outcomes using the intraclass correlation (ICC) of agreement . The secondary outcome was to determine the measurement error of the MoveMed performance outcomes using both the SE of the mean (SEM) of agreement and the smallest detectable change (SDC) of agreement . Criteria from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) manual were used to determine adequate reliability (ie, ICC of agreement ?0.7) and risk of bias. Disease stability was controlled using 2 minimum clinically important difference (MCID) thresholds obtained from the literature on the patient-derived modified Japanese Orthopaedic Association (p-mJOA) score, namely, MCID ?1 point and MCID ?2 points. Results: In total, 7 adults aged 59.5 (SD 12.4) years who live with DCM and possess an approved smartphone participated in the study. All tests demonstrated moderate to excellent test-retest coefficients and low measurement errors. In the MCID ?1 group, ICC of agreement values were 0.84-0.94 in the fast tap test, 0.89-0.95 in the hold test, 0.95 in the typing test, and 0.98 in the stand and walk test. SEM of agreement values were ±1 tap, ±1%-3% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively. SDC of agreement values were ±3 taps, ±4%-7% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. In the MCID ?2 group, ICC of agreement values were 0.61-0.91, 0.75-0.77, 0.98, and 0.62, respectively; SEM of agreement values were ±1 tap, ±2%-4% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively; and SDC of agreement values were ±3-7 taps, ±7%-10% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. Furthermore, the fast tap, hold, and typing tests obtained sufficient ratings (ICC of agreement ?0.7) in both MCID ?1 and MCID ?2 groups. No risk of bias factors from the COSMIN Risk of Bias checklist were recorded. Conclusions: The criteria from COSMIN provide ?very good? quality evidence of the reliability of the MoveMed tests in an adult population living with DCM. UR - https://formative.jmir.org/2024/1/e56889 UR - http://dx.doi.org/10.2196/56889 UR - http://www.ncbi.nlm.nih.gov/pubmed/38787602 ID - info:doi/10.2196/56889 ER - TY - JOUR AU - Kelley, M. Marjorie AU - Powell, Tia AU - Camara, Djibril AU - Shah, Neha AU - Norton, M. Jenna AU - Deitelzweig, Chelsea AU - Vaidy, Nivedha AU - Hsiao, Chun-Ju AU - Wang, Jing AU - Bierman, S. Arlene PY - 2024/5/23 TI - Mobile Health Apps, Family Caregivers, and Care Planning: Scoping Review JO - J Med Internet Res SP - e46108 VL - 26 KW - caregivers KW - carers KW - informal caregivers KW - family caregivers KW - mHealth applications KW - telemedicine KW - mobile health KW - mHealth KW - eHealth KW - digital health KW - apps KW - chronic condition KW - caregiver KW - application KW - support KW - clinicians KW - development KW - electronic health record KW - implementation KW - mobile phone N2 - Background: People living with multiple chronic conditions (MCCs) face substantial challenges in planning and coordinating increasingly complex care. Family caregivers provide important assistance for people with MCCs but lack sufficient support. Caregiver apps have the potential to help by enhancing care coordination and planning among the health care team, including patients, caregivers, and clinicians. Objective: We aim to conduct a scoping review to assess the evidence on the development and use of caregiver apps that support care planning and coordination, as well as to identify key factors (ie, needs, barriers, and facilitators) related to their use and desired caregiver app functionalities. Methods: Papers intersecting 2 major domains, mobile health (mHealth) apps and caregivers, that were in English and published from 2015 to 2021 were included in the initial search from 6 databases and gray literature and ancestry searches. As per JBI (Joanna Briggs Institute) Scoping Review guidelines and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), 2 authors independently screened full texts with disagreements resolved by a third author. Working in pairs, the authors extracted data using a pilot-tested JBI extraction table and compared results for consensus. Results: We identified 34 papers representing 25 individual studies, including 18 (53%) pilot and feasibility studies, 13 (38%) qualitative studies, and 2 experimental or quasi-experimental studies. None of the identified studies assessed an intervention of a caregiver app for care planning and coordination for people with MCCs. We identified important caregiver needs in terms of information, support, and care coordination related to both caregiving and self-care. We compiled desired functionalities and features enabling apps to meet the care planning and care coordination needs of caregivers, in particular, the integration of caregiver roles into the electronic health record. Conclusions: Caregiver needs identified through this study can inform developers and researchers in the design and implementation of mHealth apps that integrate with the electronic health record to link caregivers, patients, and clinicians to support coordinated care for people with MCCs. In addition, this study highlights the need for more rigorous research on the use of mHealth apps to support caregivers in care planning and coordination. UR - https://www.jmir.org/2024/1/e46108 UR - http://dx.doi.org/10.2196/46108 UR - http://www.ncbi.nlm.nih.gov/pubmed/38781588 ID - info:doi/10.2196/46108 ER - TY - JOUR AU - Alhammad, Nasser AU - Alajlani, Mohannad AU - Abd-alrazaq, Alaa AU - Arvanitis, Theodoros AU - Epiphaniou, Gregory PY - 2024/5/22 TI - Patients and Stakeholders? Perspectives Regarding the Privacy, Security, and Confidentiality of Data Collected via Mobile Health Apps in Saudi Arabia: Protocol for a Mixed Method Study JO - JMIR Res Protoc SP - e54933 VL - 13 KW - awareness KW - data privacy KW - confidentiality KW - security KW - health care KW - patients KW - Saudi Arabia KW - mHealth KW - mobile apps N2 - Background: There is data paucity regarding users? awareness of privacy concerns and the resulting impact on the acceptance of mobile health (mHealth) apps, especially in the Saudi context. Such information is pertinent in addressing users? needs in the Kingdom of Saudi Arabia (KSA). Objective: This article presents a study protocol for a mixed method study to assess the perspectives of patients and stakeholders regarding the privacy, security, and confidentiality of data collected via mHealth apps in the KSA and the factors affecting the adoption of mHealth apps. Methods: A mixed method study design will be used. In the quantitative phase, patients and end users of mHealth apps will be randomly recruited from various provinces in Saudi Arabia with a high population of mHealth users. The research instrument will be developed based on the emerging themes and findings from the interview conducted among stakeholders, app developers, health care professionals, and users of mHealth apps (n=25). The survey will focus on (1) how to improve patients? awareness of data security, privacy, and confidentiality; (2) feedback on the current mHealth apps in terms of data security, privacy, and confidentiality; and (3) the features that might improve data security, privacy, and confidentiality of mHealth apps. Meanwhile, specific sections of the questionnaire will focus on patients? awareness, privacy concerns, confidentiality concerns, security concerns, perceived usefulness, perceived ease of use, and behavioral intention. Qualitative data will be analyzed thematically using NVivo version 12. Descriptive statistics, regression analysis, and structural equation modeling will be performed using SPSS and partial least squares structural equation modeling. Results: The ethical approval for this research has been obtained from the Biomedical and Scientific Research Ethics Committee, University of Warwick, and the Medical Research and Ethics Committee Ministry of Health in the KSA. The qualitative phase is ongoing and 15 participants have been interviewed. The interviews for the remaining 10 participants will be completed by November 25, 2023. Preliminary thematic analysis is still ongoing. Meanwhile, the quantitative phase will commence by December 10, 2023, with 150 participants providing signed and informed consent to participate in the study. Conclusions: The mixed methods study will elucidate the antecedents of patients? awareness and concerns regarding the privacy, security, and confidentiality of data collected via mHealth apps in the KSA. Furthermore, pertinent findings on the perspectives of stakeholders and health care professionals toward the aforementioned issues will be gleaned. The results will assist policy makers in developing strategies to improve Saudi users?/patients? adoption of mHealth apps and addressing the concerns raised to benefit significantly from these advanced health care modalities. International Registered Report Identifier (IRRID): DERR1-10.2196/54933 UR - https://www.researchprotocols.org/2024/1/e54933 UR - http://dx.doi.org/10.2196/54933 UR - http://www.ncbi.nlm.nih.gov/pubmed/38776540 ID - info:doi/10.2196/54933 ER - TY - JOUR AU - Scott, E. Suzanne AU - Thompson, J. Matthew PY - 2024/5/20 TI - ?Notification! You May Have Cancer.? Could Smartphones and Wearables Help Detect Cancer Early? JO - JMIR Cancer SP - e52577 VL - 10 KW - wearables KW - early diagnosis KW - cancer KW - challenges KW - diagnosis KW - wearable KW - detect KW - detection KW - smartphone KW - cancer diagnosis KW - symptoms KW - monitoring KW - monitor KW - implementation KW - anxiety KW - health care service KW - mobile phone UR - https://cancer.jmir.org/2024/1/e52577 UR - http://dx.doi.org/10.2196/52577 UR - http://www.ncbi.nlm.nih.gov/pubmed/38767941 ID - info:doi/10.2196/52577 ER - TY - JOUR AU - Soltero, G. Erica AU - Musaad, M. Salma AU - O?Connor, M. Teresia AU - Thompson, Debbe AU - Norris, Keith AU - Beech, M. Bettina PY - 2024/5/17 TI - Feasibility of Fit24, a Digital Diabetes Prevention Program for Hispanic Adolescents: Qualitative Evaluation Study JO - JMIR Form Res SP - e54595 VL - 8 KW - health disparities KW - diabetes prevention KW - Mexican youth KW - physical activity KW - sleep KW - digital health N2 - Background: Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population. Objective: This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity. Methods: After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes into dimensions based on participant perspectives using the Practical, Robust Implementation, and Sustainability Model (PRISM) framework. Results: Participants shared positive perceptions of wearing the Fitbit and receiving SMS text messages. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (eg, lack of resources and school schedules), that limited participation in activity suggestions. Additionally, sync issues with the Fitbit limited the transmission of data, leading to inaccurate feedback. Conclusions: Fit24 is a promising approach for engaging Hispanic youth in a diabetes prevention program. Strategies are needed to address technical issues with the Fitbit and environmental issues such as message timing. While integrating peer social support may be desired by some, peer support strategies should be mindful of youth?s desire to foster personal motivation for behavior change. Findings from this study will inform future diabetes prevention trials of Fit24 and other digital health interventions for high-risk pediatric populations. UR - https://formative.jmir.org/2024/1/e54595 UR - http://dx.doi.org/10.2196/54595 UR - http://www.ncbi.nlm.nih.gov/pubmed/38758584 ID - info:doi/10.2196/54595 ER - TY - JOUR AU - Lemos, Marta AU - Henriques, Rita Ana AU - Lopes, Gil David AU - Mendonça, Nuno AU - Victorino, André AU - Costa, Andreia AU - Arriaga, Miguel AU - Gregório, João Maria AU - de Sousa, Rute AU - Canhão, Helena AU - Rodrigues, M. Ana PY - 2024/5/17 TI - Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study JO - JMIR Form Res SP - e46151 VL - 8 KW - DigiAdherence KW - mHealth KW - mobile app KW - technology KW - utility KW - usability KW - ICT KW - application KW - patient-centered KW - tool KW - prevention KW - falls KW - treatment KW - nutrition KW - physical activity KW - pilot study KW - older adults KW - adherence KW - engagement KW - compliance N2 - Background: Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity. Objective: This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older. Methods: In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portimão, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed. Results: The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67%) and managing therapies and polypharmacy (16/26, 62%). Conclusions: The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge. International Registered Report Identifier (IRRID): RR2-10.2196/29675 UR - https://formative.jmir.org/2024/1/e46151 UR - http://dx.doi.org/10.2196/46151 UR - http://www.ncbi.nlm.nih.gov/pubmed/38758585 ID - info:doi/10.2196/46151 ER - TY - JOUR AU - Karim, Lynn Jalisa AU - Wan, Rachel AU - Tabet, S. Rhea AU - Chiu, S. Derek AU - Talhouk, Aline PY - 2024/5/16 TI - Person-Generated Health Data in Women?s Health: Scoping Review JO - J Med Internet Res SP - e53327 VL - 26 KW - digital health KW - women?s health KW - mobile health KW - health app KW - wearables KW - femtech KW - self-tracking KW - personalized health KW - person-generated health data KW - patient-generated health data KW - scoping review KW - mobile phone N2 - Background: The increased pervasiveness of digital health technology is producing large amounts of person-generated health data (PGHD). These data can empower people to monitor their health to promote prevention and management of disease. Women make up one of the largest groups of consumers of digital self-tracking technology. Objective: In this scoping review, we aimed to (1) identify the different areas of women?s health monitored using PGHD from connected health devices, (2) explore personal metrics collected through these technologies, and (3) synthesize facilitators of and barriers to women?s adoption and use of connected health devices. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, we searched 5 databases for articles published between January 1, 2015, and February 29, 2020. Papers were included if they targeted women or female individuals and incorporated digital health tools that collected PGHD outside a clinical setting. Results: We included a total of 406 papers in this review. Articles on the use of PGHD for women steadily increased from 2015 to 2020. The health areas that the articles focused on spanned several topics, with pregnancy and the postpartum period being the most prevalent followed by cancer. Types of digital health used to collect PGHD included mobile apps, wearables, websites, the Internet of Things or smart devices, 2-way messaging, interactive voice response, and implantable devices. A thematic analysis of 41.4% (168/406) of the papers revealed 6 themes regarding facilitators of and barriers to women?s use of digital health technology for collecting PGHD: (1) accessibility and connectivity, (2) design and functionality, (3) accuracy and credibility, (4) audience and adoption, (5) impact on community and health service, and (6) impact on health and behavior. Conclusions: Leading up to the COVID-19 pandemic, the adoption of digital health tools to address women?s health concerns was on a steady rise. The prominence of tools related to pregnancy and the postpartum period reflects the strong focus on reproductive health in women?s health research and highlights opportunities for digital technology development in other women?s health topics. Digital health technology was most acceptable when it was relevant to the target audience, was seen as user-friendly, and considered women?s personalization preferences while also ensuring accuracy of measurements and credibility of information. The integration of digital technologies into clinical care will continue to evolve, and factors such as liability and health care provider workload need to be considered. While acknowledging the diversity of individual needs, the use of PGHD can positively impact the self-care management of numerous women?s health journeys. The COVID-19 pandemic has ushered in increased adoption and acceptance of digital health technology. This study could serve as a baseline comparison for how this field has evolved as a result. International Registered Report Identifier (IRRID): RR2-10.2196/26110 UR - https://www.jmir.org/2024/1/e53327 UR - http://dx.doi.org/10.2196/53327 UR - http://www.ncbi.nlm.nih.gov/pubmed/38754098 ID - info:doi/10.2196/53327 ER - TY - JOUR AU - Maugeri, Andrea AU - Barchitta, Martina AU - Basile, Guido AU - Agodi, Antonella PY - 2024/5/16 TI - Public and Research Interest in Telemedicine From 2017 to 2022: Infodemiology Study of Google Trends Data and Bibliometric Analysis of Scientific Literature JO - J Med Internet Res SP - e50088 VL - 26 KW - telemedicine KW - eHealth KW - digital medicine KW - COVID-19 KW - Google Trends KW - bibliometric KW - Google KW - data spanning KW - accessibility KW - cost reduction KW - cost KW - noncommunicable disease KW - mobile health KW - awareness KW - policy decision N2 - Background: Telemedicine offers a multitude of potential advantages, such as enhanced health care accessibility, cost reduction, and improved patient outcomes. The significance of telemedicine has been underscored by the COVID-19 pandemic, as it plays a crucial role in maintaining uninterrupted care while minimizing the risk of viral exposure. However, the adoption and implementation of telemedicine have been relatively sluggish in certain areas. Assessing the level of interest in telemedicine can provide valuable insights into areas that require enhancement. Objective: The aim of this study is to provide a comprehensive analysis of the level of public and research interest in telemedicine from 2017 to 2022 and also consider any potential impact of the COVID-19 pandemic. Methods: Google Trends data were retrieved using the search topics ?telemedicine? or ?e-health? to assess public interest, geographic distribution, and trends through a joinpoint regression analysis. Bibliographic data from Scopus were used to chart publications referencing the terms ?telemedicine? or ?eHealth? (in the title, abstract, and keywords) in terms of scientific production, key countries, and prominent keywords, as well as collaboration and co-occurrence networks. Results: Worldwide, telemedicine generated higher mean public interest (relative search volume=26.3%) compared to eHealth (relative search volume=17.6%). Interest in telemedicine remained stable until January 2020, experienced a sudden surge (monthly percent change=95.7%) peaking in April 2020, followed by a decline (monthly percent change=?22.7%) until August 2020, and then returned to stability. A similar trend was noted in the public interest regarding eHealth. Chile, Australia, Canada, and the United States had the greatest public interest in telemedicine. In these countries, moderate to strong correlations were evident between Google Trends and COVID-19 data (ie, new cases, new deaths, and hospitalized patients). Examining 19,539 original medical articles in the Scopus database unveiled a substantial rise in telemedicine-related publications, showing a total increase of 201.5% from 2017 to 2022 and an average annual growth rate of 24.7%. The most significant surge occurred between 2019 and 2020. Notably, the majority of the publications originated from a single country, with 20.8% involving international coauthorships. As the most productive country, the United States led a cluster that included Canada and Australia as well. European, Asian, and Latin American countries made up the remaining 3 clusters. The co-occurrence network categorized prevalent keywords into 2 clusters, the first cluster primarily focused on applying eHealth, mobile health (mHealth), or digital health to noncommunicable or chronic diseases; the second cluster was centered around the application of telemedicine and telehealth within the context of the COVID-19 pandemic. Conclusions: Our analysis of search and bibliographic data over time and across regions allows us to gauge the interest in this topic, offer evidence regarding potential applications, and pinpoint areas for additional research and awareness-raising initiatives. UR - https://www.jmir.org/2024/1/e50088 UR - http://dx.doi.org/10.2196/50088 UR - http://www.ncbi.nlm.nih.gov/pubmed/38753427 ID - info:doi/10.2196/50088 ER - TY - JOUR AU - Nassehi, Damoun AU - Gripsrud, Haga Birgitta AU - Ramvi, Ellen PY - 2024/5/15 TI - Theoretical Perspectives Underpinning Research on the Physician-Patient Relationship in a Digital Health Practice: Scoping Review JO - Interact J Med Res SP - e47280 VL - 13 KW - digital health KW - mobile health KW - telemedicine KW - physician-patient relations KW - relational ethics KW - primary care KW - patient-provider KW - physician-patient KW - telehealth KW - relationship KW - eHealth KW - scoping review KW - review method KW - mobile phone N2 - Background: The advent of digital health technologies has transformed the landscape of health care, influencing the dynamics of the physician-patient relationship. Although these technologies offer potential benefits, they also introduce challenges and complexities that require ethical consideration. Objective: This scoping review aims to investigate the effects of digital health technologies, such as digital messaging, telemedicine, and electronic health records, on the physician-patient relationship. To understand the complex consequences of these tools within health care, it contrasts the findings of studies that use various theoretical frameworks and concepts with studies grounded in relational ethics. Methods: Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review. Data were retrieved through keyword searches on MEDLINE/PubMed, Embase, IEEE Xplore, and Cochrane. We screened 427 original peer-reviewed research papers published in English-language journals between 2010 and 2021. A total of 73 papers were assessed for eligibility, and 10 of these were included in the review. The data were summarized through a narrative synthesis of the findings. Results: Digital health technologies enhance communication, improve health care delivery efficiency, and empower patients, leading to shifts in power dynamics in the physician-patient relationship. They also potentially reinforce inequities in health care access due to variations in technology literacy among patients and lead to decreases in patient satisfaction due to the impersonal nature of digital interactions. Studies applying a relational ethics framework have revealed the nuanced impacts of digital health technologies on the physician-patient relationship, highlighting shifts toward more collaborative and reciprocal care. These studies have also explored transitions from traditional hierarchical relationships to mutual engagement, capturing the complexities of power dynamics and vulnerabilities. Other theoretical frameworks, such as patient-centered care, and concepts, such as patient empowerment, were also valuable for understanding these interactions in the context of digital health. Conclusions: The shift from hierarchical to collaborative models in the physician-patient relationship not only underscores the empowering potential of digital tools but also presents new challenges and reinforces existing ones. Along with applications for various theoretical frameworks and concepts, this review highlights the unique comprehensiveness of a relational ethics perspective, which could provide a more nuanced understanding of trust, empathy, and power dynamics in the context of digital health. The adoption of relational ethics in empirical research may offer richer insights into the real-life complexities of the physician-patient relationship, as mediated by digital technologies. UR - https://www.i-jmr.org/2024/1/e47280 UR - http://dx.doi.org/10.2196/47280 UR - http://www.ncbi.nlm.nih.gov/pubmed/38748465 ID - info:doi/10.2196/47280 ER - TY - JOUR AU - Szkodny, Dominika AU - Wróblewska-Czajka, Ewa AU - Stryja, Miko?aj AU - Gara, Filip AU - Wyl?ga?a, Edward PY - 2024/5/15 TI - Exploring the Potential of an Eye Tissue Donor Reporting App in Enhancing the Procurement of Corneal Donors: Mixed Methods Observational Study JO - JMIR Form Res SP - e50398 VL - 8 KW - eye donor KW - corneal transplant KW - donor shortage KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - application KW - tissue procurement KW - organ KW - procurement KW - donor KW - donors KW - donation KW - transplant KW - transplantation KW - transplants KW - usability KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - interview KW - interviews KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - reporting N2 - Background: The availability of donated eye tissue saves and enhances vision in transplant recipients; however, the current demand for tissue surpasses the available supply. Corneal donor shortages lead to increased wait times, delayed surgeries, prolonged visual impairment, and increased inconvenience to patients requiring eye tissue transplantation. A web-based application was previously developed to facilitate easy and intuitive submission of potential donor information. Objective: The primary objectives of this study were to assess health care professionals? attitudes toward the potential application and evaluate its effectiveness based on user feedback and donor registrations through the application. Methods: Researchers used a mixed methods approach, commencing with a literature review to identify challenges associated with donor procurement. Stakeholder interviews were conducted to gauge health care professionals? perspectives regarding the application. User feedback was collected through questionnaires, surveys, and interviews to assess the application?s usability and impact. An assessment of the reported potential donors and questionnaire responses were analyzed. Results: The final version of the application successfully reported 24 real cornea donors. Among 64 health care providers who used the application to communicate about potential donors, 32 of them submitted trial entries exclusively for testing purposes. The remaining 8 health care professionals reported potential donors; however, these individuals did not meet the donor qualification criteria. The majority of participants found the application user-friendly and expressed their readiness to use it in the future. Positive ratings were assigned to the layout, appearance, purpose, and specific features of the application. Respondents highlighted the automatic sending of notifications via SMS text messages and the integration of all necessary documents for donor qualification and tissue collection as the most valuable functions of the application. Conclusions: The study indicates that donor reporting applications offer promising solutions to enhance tissue donor procurement. This application streamlined the reporting process, reduced paperwork, facilitated communication, and collected valuable data for analysis. UR - https://formative.jmir.org/2024/1/e50398 UR - http://dx.doi.org/10.2196/50398 UR - http://www.ncbi.nlm.nih.gov/pubmed/38748474 ID - info:doi/10.2196/50398 ER - TY - JOUR AU - McDuff, Daniel AU - Barakat, Andrew AU - Winbush, Ari AU - Jiang, Allen AU - Cordeiro, Felicia AU - Crowley, Ryann AU - Kahn, E. Lauren AU - Hernandez, John AU - Allen, B. Nicholas PY - 2024/5/14 TI - The Google Health Digital Well-Being Study: Protocol for a Digital Device Use and Well-Being Study JO - JMIR Res Protoc SP - e49189 VL - 13 KW - digital KW - health KW - well-being KW - mobile KW - google health KW - digital health KW - mhealth KW - digital device KW - smartphone N2 - Background: The impact of digital device use on health and well-being is a pressing question. However, the scientific literature on this topic, to date, is marred by small and unrepresentative samples, poor measurement of core constructs, and a limited ability to address the psychological and behavioral mechanisms that may underlie the relationships between device use and well-being. Recent authoritative reviews have made urgent calls for future research projects to address these limitations. The critical role of research is to identify which patterns of use are associated with benefits versus risks and who is more vulnerable to harmful versus beneficial outcomes, so that we can pursue evidence-based product design, education, and regulation aimed at maximizing benefits and minimizing the risks of smartphones and other digital devices. Objective: The objective of this study is to provide normative data on objective patterns of smartphone use. We aim to (1) identify how patterns of smartphone use impact well-being and identify groups of individuals who show similar patterns of covariation between smartphone use and well-being measures across time; (2) examine sociodemographic and personality or mental health predictors and which patterns of smartphone use and well-being are associated with pre-post changes in mental health and functioning; (3) discover which nondevice behavior patterns mediate the association between device use and well-being; (4) identify and explore recruitment strategies to increase and improve the representation of traditionally underrepresented populations; and (5) provide a real-world baseline of observed stress, mood, insomnia, physical activity, and sleep across a representative population. Methods: This is a prospective, nonrandomized study to investigate the patterns and relationships among digital device use, sensor-based measures (including both behavioral and physiological signals), and self-reported measures of mental health and well-being. The study duration is 4 weeks per participant and includes passive sensing based on smartphone sensors, and optionally a wearable (Fitbit), for the complete study period. The smartphone device will provide activity, location, phone unlocks and app usage, and battery status information. Results: At the time of submission, the study infrastructure and app have been designed and built, the institutional review board of the University of Oregon has approved the study protocol, and data collection is underway. Data from 4182 enrolled and consented participants have been collected as of March 27, 2023. We have made many efforts to sample a study population that matches the general population, and the demographic breakdown we have been able to achieve, to date, is not a perfect match. Conclusions: The impact of digital devices on mental health and well-being raises important questions. The Digital Well-Being Study is designed to help answer questions about the association between patterns of smartphone use and well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/49189 UR - https://www.researchprotocols.org/2024/1/e49189 UR - http://dx.doi.org/10.2196/49189 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743938 ID - info:doi/10.2196/49189 ER - TY - JOUR AU - Tran, Steven AU - Smith, Lorraine AU - Carter, Stephen PY - 2024/5/14 TI - Understanding Patient Perspectives on the Use of Gamification and Incentives in mHealth Apps to Improve Medication Adherence: Qualitative Study JO - JMIR Mhealth Uhealth SP - e50851 VL - 12 KW - qualitative KW - patient KW - perspectives KW - gamification KW - incentives KW - mobile app KW - mobile health KW - mHealth KW - medication adherence KW - mobile phone N2 - Background: Medication nonadherence remains a significant health and economic burden in many high-income countries. Emerging smartphone interventions have started to use features such as gamification and financial incentives with varying degrees of effectiveness on medication adherence and health outcomes. A more consistent approach to applying these features, informed by patient perspectives, may result in more predictable and beneficial results from this type of intervention. Objective: This qualitative study aims to identify patient perspectives on the use of gamification and financial incentives in mobile health (mHealth) apps for medication adherence in Australian patients taking medication for chronic conditions. Methods: A total of 19 participants were included in iterative semistructured web-based focus groups conducted between May and December 2022. The facilitator used exploratory prompts relating to mHealth apps, gamification, and financial incentives, along with concepts raised from previous focus groups. Transcriptions were independently coded to develop a set of themes. Results: Three themes were identified: purpose-driven design, trust-based standards, and personal choice. All participants acknowledged gamification and financial incentives as potentially effective features in mHealth apps for medication adherence. However, they also indicated that the effectiveness heavily depended on implementation and execution. Major concerns relating to gamification and financial incentives were perceived trivialization and potential for medication abuse, respectively. Conclusions: The study?s findings provide a foundation for developers seeking to apply these novel features in an app intervention for a general cohort of patients. However, the study highlights the need for standards for mHealth apps for medication adherence, with particular attention to the use of gamification and financial incentives. Future research with patients and stakeholders across the mHealth app ecosystem should be explored to formalize and validate a set of standards or framework. UR - https://mhealth.jmir.org/2024/1/e50851 UR - http://dx.doi.org/10.2196/50851 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743461 ID - info:doi/10.2196/50851 ER - TY - JOUR AU - Papadopoulos, Petros AU - Soflano, Mario AU - Connolly, Thomas PY - 2024/5/14 TI - A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study JO - JMIR Hum Factors SP - e50430 VL - 11 KW - mobile health KW - mHealth KW - digital health intervention KW - total knee replacement KW - TKR KW - total hip replacement KW - THR KW - dynamic hip screw KW - DHS KW - rehabilitation KW - usability KW - mobile phone N2 - Background: Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement. Objective: The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge. Methods: Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app. Results: For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range ?3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire. Conclusions: The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw. UR - https://humanfactors.jmir.org/2024/1/e50430 UR - http://dx.doi.org/10.2196/50430 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743479 ID - info:doi/10.2196/50430 ER - TY - JOUR AU - Wu, Socrates Yongda AU - Cheung, Derek Yee Tak AU - Lee, Jae Jay Jung AU - Wong, Ho Carlos King AU - Ho, Yin Sai AU - Li, Cheung William Ho AU - Yao, Ying AU - Lam, Hing Tai AU - Wang, Ping Man PY - 2024/5/13 TI - Effect of Adding Personalized Instant Messaging Apps to a Brief Smoking Cessation Model in Community Smokers in Hong Kong: Pragmatic Randomized Clinical Trial JO - J Med Internet Res SP - e44973 VL - 26 KW - instant messaging KW - text messaging KW - chatting KW - smoking cessation KW - COVID-19 KW - community smoker N2 - Background: While text messaging has proven effective for smoking cessation (SC), engagement in the intervention remains suboptimal. Objective: This study aims to evaluate whether using more interactive and adaptive instant messaging (IM) apps on smartphones, which enable personalization and chatting with SC advisors, can enhance SC outcomes beyond the provision of brief SC advice and active referral (AR) to SC services. Methods: From December 2018 to November 2019, we proactively recruited 700 adult Chinese daily cigarette users in Hong Kong. Participants were randomized in a 1:1 ratio. At baseline, all participants received face-to-face brief advice on SC. Additionally, they were introduced to local SC services and assisted in selecting one. The intervention group received an additional 26 personalized regular messages and access to interactive chatting through IM apps for 3 months. The regular messages aimed to enhance self-efficacy, social support, and behavioral capacity for quitting, as well as to clarify outcome expectations related to cessation. We developed 3 sets of messages tailored to the planned quit date (within 30 days, 60 days, and undecided). Participants in the intervention group could initiate chatting with SC advisors on IM themselves or through prompts from regular messages or proactive inquiries from SC advisors. The control group received 26 SMS text messages focusing on general health. The primary outcomes were smoking abstinence validated by carbon monoxide levels of <4 parts per million at 6 and 12 months after the start of the intervention. Results: Of the participants, 505/700 (72.1%) were male, and 450/648 (69.4%) were aged 40 or above. Planning to quit within 30 days was reported by 500/648 (77.2%) participants, with fewer intervention group members (124/332, 37.3%) reporting previous quit attempts compared with the control group (152/335, 45.4%; P=.04). At the 6- and 12-month follow-ups (with retention rates of 456/700, 65.1%, and 446/700, 63.7%, respectively), validated abstinence rates were comparable between the intervention (14/350, 4.0%, and 19/350, 5.4%) and control (11/350, 3.1% and 21/350, 6.0%) groups. Compared with the control group, the intervention group reported greater utilization of SC services at 12 months (RR 1.26, 95% CI 1.01-1.56). Within the intervention group, engaging in chat sessions with SC advisors predicted better validated abstinence at 6 months (RR 3.29, 95% CI 1.13-9.63) and any use of SC services (RR 1.66, 95% CI 1.14-2.43 at 6 months; RR 1.67, 95% CI 1.26-2.23 at 12 months). Conclusions: An IM-based intervention, providing support and assistance alongside brief SC advice and AR, did not yield further increases in quitting rates but did encourage the utilization of SC services. Future research could explore whether enhanced SC service utilization leads to improved long-term SC outcomes. Trial Registration: ClinicalTrials.gov NCT03800719; https://clinicaltrials.gov/ct2/show/NCT03800719 UR - https://www.jmir.org/2024/1/e44973 UR - http://dx.doi.org/10.2196/44973 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739429 ID - info:doi/10.2196/44973 ER - TY - JOUR AU - Shashidhara, N. Y. AU - Raghavendra, G. AU - P Kundapur, Poornima AU - Binil, V. PY - 2024/5/13 TI - Effectiveness of Gerontechnology Empowerment Program on Awareness and Use of Mobile Apps Among Older Adults for Instrumental Activities of Daily Living: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e53587 VL - 13 KW - gerontechnology KW - older adults KW - awareness KW - older people KW - instrumental activities of daily living KW - iADLs KW - mobile apps KW - mobile phone KW - empowerment N2 - Background: Instrumental activities of daily living (iADLs) are crucial for older adults to live independently. Health care and technological advancements will increase the older adult population and life expectancy globally. Difficulties with iADLs impact older adults? quality of life. Mobile apps can assist older adults, but many require help due to limited awareness. Lack of awareness is a barrier to app use. Existing literature mainly covers health care and app design, needing more focus on iADL apps for older adults. Objective: The study objectives encompass 2 main aspects: first, to evaluate the awareness, use, and factors influencing the use of apps among older adults for iADLs; and second, to create and assess the effectiveness of a gerontechnology empowerment program (GEP) for older adults on the awareness and use of apps for iADLs. Methods: This research uses a quantitative approach divided into 2 distinct phases. In phase 1, we conduct a descriptive survey to assess the level of awareness and use of mobile apps for iADLs and identify the factors that influence the use of such apps among older adults. To ensure clarity and comprehension among participants, we provide them with a subject information sheet in both Kannada and English. The data collected during this phase enable us to gain insights into awareness levels, use patterns, and factors that shape older adults? use of apps for iADLs. The results serve as the foundation for designing the GEP. In phase 2, a cluster randomization method will be used to select older adults aged 60 to 75 years in Udupi district, Karnataka, India, who are active smartphone users. These participants will be divided into 2 groups: the experimental and the control groups. The experimental group will join the GEP. The sample size for phase 1 is 554, and phase 2 is 50. To assess the effectiveness of this program, we will measure the outcomes before and after its implementation using the same assessment tools used in phase 1. Results: This study is funded by the Indian Council of Medical Research (Adhoc/193/2022/SBHSR on November 18, 2022). Phase 1 data collection is expected to be completed by November 2023, and phase 2 is scheduled to commence in the upcoming months. Phase 1 and 2 findings will be analyzed and discussed in the main paper, which we intend to submit to a high-quality peer-reviewed journal for publication. The research protocol, informed consent forms, and associated documentation received approval from institutional ethics committees (214/2020). Conclusions: Upon the successful testing of the GEP, it can be recommended that welfare departments encourage older adults to use mobile apps for iADLs and establish training programs to provide support to older adults in using these apps. Trial Registration: Clinical Trials Registry - India CTRI/2020/09/027977; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDUxMzM=&Enc=&userName=027977 International Registered Report Identifier (IRRID): DERR1-10.2196/53587 UR - https://www.researchprotocols.org/2024/1/e53587 UR - http://dx.doi.org/10.2196/53587 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739442 ID - info:doi/10.2196/53587 ER - TY - JOUR AU - Almasri, Abdullah AU - El-Kour, Y. Tatyana AU - Silva, Liliana AU - Abdulfattah, Yousef PY - 2024/5/10 TI - Evaluating the Energy Efficiency of Popular US Smartphone Health Care Apps: Comparative Analysis Study Toward Sustainable Health and Nutrition Apps Practices JO - JMIR Hum Factors SP - e58311 VL - 11 KW - mobile health KW - energy consumption in health care smartphone apps KW - dietary tracking apps KW - optimization and sustainability in mobile health KW - user engagement and experience KW - Android apps performance KW - digital health technologies KW - app KW - apps KW - applications KW - digital health KW - energy KW - consumption KW - sustainable KW - sustainability KW - environment KW - environmental KW - use KW - smartphone KW - smartphones KW - electricity KW - electrical KW - mobile phone N2 - Background: The emergence of smartphones has sparked a transformation across multiple fields, with health care being one of the most notable due to the advent of mobile health (mHealth) apps. As mHealth apps have gained popularity, there is a need to understand their energy consumption patterns as an integral part of the evolving landscape of health care technologies. Objective: This study aims to identify the key contributors to elevated energy consumption in mHealth apps and suggest methods for their optimization, addressing a significant void in our comprehension of the energy dynamics at play within mHealth apps. Methods: Through quantitative comparative analysis of 10 prominent mHealth apps available on Android platforms within the United States, this study examined factors contributing to high energy consumption. The analysis included descriptive statistics, comparative analysis using ANOVA, and regression analysis to examine how certain factors impact energy use and consumption. Results: Observed energy use variances in mHealth apps stemmed from user interactions, features, and underlying technology. Descriptive analysis revealed variability in app energy consumption (150-310 milliwatt-hours), highlighting the influence of user interaction and app complexity. ANOVA verified these findings, indicating the critical role of engagement and functionality. Regression modeling (energy consumption = ?? + ?? × notification frequency + ?? × GPS use + ?? × app complexity + ?), with statistically significant P values (notification frequency with a P value of .01, GPS use with a P value of .05, and app complexity with a P value of .03), further quantified these bases? effects on energy use. Conclusions: The observed differences in the energy consumption of dietary apps reaffirm the need for a multidisciplinary approach to bring together app developers, end users, and health care experts to foster improved energy conservation practice while achieving a balance between sustainable practice and user experience. More research is needed to better understand how to scale-up consumer engagement to achieve sustainable development goal 12 on responsible consumption and production. UR - https://humanfactors.jmir.org/2024/1/e58311 UR - http://dx.doi.org/10.2196/58311 UR - http://www.ncbi.nlm.nih.gov/pubmed/38729624 ID - info:doi/10.2196/58311 ER - TY - JOUR AU - Higashi, T. Robin AU - Etingen, Bella AU - Richardson, Eric AU - Palmer, Jennifer AU - Zocchi, S. Mark AU - Bixler, R. Felicia AU - Smith, Bridget AU - McMahon, Nicholas AU - Frisbee, L. Kathleen AU - Fortney, C. John AU - Turvey, Carolyn AU - Evans, Jennifer AU - Hogan, P. Timothy PY - 2024/5/10 TI - Veteran Experiences With an mHealth App to Support Measurement-Based Mental Health Care: Results From a Mixed Methods Evaluation JO - JMIR Ment Health SP - e54007 VL - 11 KW - measurement-based care KW - mobile health app KW - mental health KW - veteran KW - mHealth KW - support KW - mixed-methods evaluation KW - digital health N2 - Background: Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. Objective: This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. Methods: Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ?3 versus <3 months using ?2 tests. We analyzed interview data using thematic analysis. Results: We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ?3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ?3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). Conclusions: Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA?s Collect-Share-Act model of MBC. UR - https://mental.jmir.org/2024/1/e54007 UR - http://dx.doi.org/10.2196/54007 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728684 ID - info:doi/10.2196/54007 ER - TY - JOUR AU - Bisconti, Nicholas AU - Odier, Mackenzie AU - Becker, Matthew AU - Bullock, Kim PY - 2024/5/10 TI - Feasibility and Acceptability of a Mobile App?Based TEAM-CBT (Testing Empathy Assessment Methods?Cognitive Behavioral Therapy) Intervention (Feeling Good) for Depression: Secondary Data Analysis JO - JMIR Ment Health SP - e52369 VL - 11 KW - depression KW - mobile health KW - mHealth KW - cognitive behavioral therapy KW - mobile phone N2 - Background: The Feeling Good App is an automated stand-alone digital mobile mental health tool currently undergoing beta testing with the goal of providing evidence-informed self-help lessons and exercises to help individuals reduce depressive symptoms without guidance from a mental health provider. Users work through intensive basic training (IBT) and ongoing training models that provide education regarding cognitive behavioral therapy principles from a smartphone. Objective: The key objective of this study was to perform a nonsponsored third-party academic assessment of an industry-generated data set; this data set focused on the safety, feasibility, and accessibility of a commercial automated digital mobile mental health app that was developed to reduce feelings associated with depression. Methods: The Feeling Good App development team created a waitlist cohort crossover design and measured symptoms of depression and anxiety using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and an app-specific measure of negative feelings called the 7 Dimension Emotion Slider (7-DES). The waitlist cohort crossover design divided the participants into 2 groups, where 48.6% (141/290) of the participants were given immediate access to the apps, while 51.4% (149/290) were placed on a 2-week waitlist before being given access to the app. Data collected by the Feeling Good App development team were deidentified and provided to the authors of this paper for analysis through a nonsponsored university data use agreement. All quantitative data were analyzed using SPSS Statistics (version 28.0; IBM Corp). Descriptive statistics were calculated for demographic variables. Feasibility and acceptability were descriptively assessed. All participants included in the quantitative data were given access to the Feeling Good App; this study did not include a control group. Results: In terms of safety, there was no statistically significant change in suicidality from preintervention to postintervention time points (t288=0.0; P>.99), and there was a statistically significant decrease in hopelessness from preintervention to postintervention time points (F289=30.16; P<.01). In terms of acceptability, 72.2% (166/230) of the users who started the initial 2-day IBT went on to complete it, while 34.8% (80/230) of the users who started IBT completed the entirety of the apps? 4-week protocol (150/230, 65.22% dropout rate over 4 weeks). Conclusions: This study is the first reported proof-of-concept evaluation of the Feeling Good App in terms of safety, feasibility, and statistical trends within the data set. It demonstrates a feasible and novel approach to industry and academic collaboration in the process of developing a digital mental health technology translated from an existing evidence-informed treatment. The results support the prototype app as safe for a select nonclinical population. The app had acceptable levels of engagement and dropouts throughout the intervention. Those who stay engaged showed reductions in symptom severity of depression warranting further investigation of the app?s efficacy. UR - https://mental.jmir.org/2024/1/e52369 UR - http://dx.doi.org/10.2196/52369 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728080 ID - info:doi/10.2196/52369 ER - TY - JOUR AU - Rizzi, Silvia AU - Poggianella, Stefania AU - Pavesi, Chiara Maria AU - Gios, Lorenzo AU - Bincoletto, Giorgia AU - Scolari, Isabella AU - Paoli, Claudia AU - Marroni, Debora AU - Tassinari, Irene AU - Baietti, Barbara AU - Gianatti, Anna AU - Albertini, Veronica AU - Burlon, Barbara AU - Chiodega, Vanda AU - Endrizzi, Barbara AU - Benini, Elena AU - Guella, Chiara AU - Gadotti, Erik AU - Forti, Stefano AU - Taddei, Fabrizio PY - 2024/5/10 TI - A Mindfulness-Based App Intervention for Pregnant Women: Protocol for a Pilot Feasibility Study JO - JMIR Res Protoc SP - e53890 VL - 13 KW - mindfulness KW - promoting well-being KW - pregnancy KW - eHealth KW - mobile health KW - mHealth KW - mobile apps KW - development KW - usability KW - user-centered design KW - mindfulness based KW - intervention KW - pregnant women KW - pregnant KW - feasibility study KW - well-being KW - women KW - quality of life KW - psychological symptoms KW - digital solution KW - virtual coach KW - smartphone KW - mobile phone N2 - Background: Pregnancy is a complex time characterized by major transformations in a woman, which impact her physical, mental, and social well-being. How a woman adapts to these changes can affect her quality of life and psychological well-being. The literature indicates that pregnant women commonly experience psychological symptoms, with anxiety, stress, and depression being among the most frequent. Hence, promoting a healthy lifestyle focused on women?s psychological well-being is crucial. Recently developed digital solutions have assumed a crucial role in supporting psychological well-being in physiologically pregnant women. Therefore, the need becomes evident for the development and implementation of digital solutions, such as a virtual coach implemented in a smartphone, as a support for the psychological well-being of pregnant women who do not present psychological and psychiatric disorders. Objective: This study aims to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. The primary objective is to explore the feasibility of using a virtual coach, Maia, developed within the TreC Mamma app to promote women?s psychological well-being during pregnancy through a psychoeducational module based on mindfulness. Finally, through the delivery of this module, the level of psychological well-being will be explored as a secondary objective. Methods: This is a proof-of-concept study in which a small sample (N=50) is sufficient to achieve the intended purposes. Recruitment will occur within the group of pregnant women belonging to the pregnancy care services of the Trento Azienda Provinciale per i Servizi Sanitari di Trento. The convenience sampling method will be used. Maia will interact with the participating women for 8 weeks, starting from weeks 24 and 26 of pregnancy. Specifically, there will be 2 sessions per week, which the woman can choose, to allow more flexibility toward her needs. Results: The psychoeducational pathway is expected to lead to significant results in terms of usability and engagement in women?s interactions with Maia. Furthermore, it is anticipated that there will be improvements in psychological well-being and overall quality of life. The analysis of the data collected in this study will be mainly descriptive, orientated toward assessing the achievement of the study objectives. Conclusions: Literature has shown that women preferred web-based support during the perinatal period, suggesting that implementing digital interventions can overcome barriers to social stigma and asking for help. Maia can be a valuable resource for regular psychoeducational support for women during pregnancy. International Registered Report Identifier (IRRID): RR1-10.2196/53890 UR - https://www.researchprotocols.org/2024/1/e53890 UR - http://dx.doi.org/10.2196/53890 UR - http://www.ncbi.nlm.nih.gov/pubmed/38567964 ID - info:doi/10.2196/53890 ER - TY - JOUR AU - Wolff, Christian AU - Steinheimer, Patrick AU - Warmerdam, Elke AU - Dahmen, Tim AU - Slusallek, Philipp AU - Schlinkmann, Christian AU - Chen, Fei AU - Orth, Marcel AU - Pohlemann, Tim AU - Ganse, Bergita PY - 2024/5/8 TI - Characteristic Changes of the Stance-Phase Plantar Pressure Curve When Walking Uphill and Downhill: Cross-Sectional Study JO - J Med Internet Res SP - e44948 VL - 26 KW - podiatry KW - podiatric medicine KW - movement analysis KW - ground reaction forces KW - wearables KW - slope KW - gait analysis KW - monitoring KW - gait KW - rehabilitation KW - treatment KW - sensor KW - injury KW - postoperative treatment KW - sensors KW - personalized medicine KW - movement KW - digital health KW - pedography KW - baropedography N2 - Background: Monitoring of gait patterns by insoles is popular to study behavior and activity in the daily life of people and throughout the rehabilitation process of patients. Live data analyses may improve personalized prevention and treatment regimens, as well as rehabilitation. The M-shaped plantar pressure curve during the stance phase is mainly defined by the loading and unloading slope, 2 maxima, 1 minimum, as well as the force during defined periods. When monitoring gait continuously, walking uphill or downhill could affect this curve in characteristic ways. Objective: For walking on a slope, typical changes in the stance phase curve measured by insoles were hypothesized. Methods: In total, 40 healthy participants of both sexes were fitted with individually calibrated insoles with 16 pressure sensors each and a recording frequency of 100 Hz. Participants walked on a treadmill at 4 km/h for 1 minute in each of the following slopes: ?20%, ?15%, ?10%, ?5%, 0%, 5%, 10%, 15%, and 20%. Raw data were exported for analyses. A custom-developed data platform was used for data processing and parameter calculation, including step detection, data transformation, and normalization for time by natural cubic spline interpolation and force (proportion of body weight). To identify the time-axis positions of the desired maxima and minimum among the available extremum candidates in each step, a Gaussian filter was applied (?=3, kernel size 7). Inconclusive extremum candidates were further processed by screening for time plausibility, maximum or minimum pool filtering, and monotony. Several parameters that describe the curve trajectory were computed for each step. The normal distribution of data was tested by the Kolmogorov-Smirnov and Shapiro-Wilk tests. Results: Data were normally distributed. An analysis of variance with the gait parameters as dependent and slope as independent variables revealed significant changes related to the slope for the following parameters of the stance phase curve: the mean force during loading and unloading, the 2 maxima and the minimum, as well as the loading and unloading slope (all P<.001). A simultaneous increase in the loading slope, the first maximum and the mean loading force combined with a decrease in the mean unloading force, the second maximum, and the unloading slope is characteristic for downhill walking. The opposite represents uphill walking. The minimum had its peak at horizontal walking and values dropped when walking uphill and downhill alike. It is therefore not a suitable parameter to distinguish between uphill and downhill walking. Conclusions: While patient-related factors, such as anthropometrics, injury, or disease shape the stance phase curve on a longer-term scale, walking on slopes leads to temporary and characteristic short-term changes in the curve trajectory. UR - https://www.jmir.org/2024/1/e44948 UR - http://dx.doi.org/10.2196/44948 UR - http://www.ncbi.nlm.nih.gov/pubmed/38718385 ID - info:doi/10.2196/44948 ER - TY - JOUR AU - Cruz, Stefany AU - Lu, Claire AU - Ulloa, Mara AU - Redding, Alexander AU - Hester, Josiah AU - Jacobs, Maia PY - 2024/5/8 TI - Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study JO - JMIR Mhealth Uhealth SP - e50826 VL - 12 KW - mHealth KW - mobile health KW - wearable KW - wearables KW - Health wearables KW - COVID-19 KW - digital divide KW - low-socioeconomic status KW - socioeconomic KW - adoption KW - underserved KW - poverty KW - low income KW - low resource KW - marginalized KW - equity KW - attitude KW - attitudes KW - opinion KW - opinions KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - Spanish KW - Hispanic KW - Latinx KW - Hispanics KW - interview KW - interviews N2 - Background: Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low?socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. Objective: This study?s aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. Methods: We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. Results: Through qualitative analysis, we identified 4 main themes. Participants? perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants? interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. Conclusions: The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices. UR - https://mhealth.jmir.org/2024/1/e50826 UR - http://dx.doi.org/10.2196/50826 UR - http://www.ncbi.nlm.nih.gov/pubmed/38717816 ID - info:doi/10.2196/50826 ER - TY - JOUR AU - Chew, Jocelyn Han Shi AU - Chew, WS Nicholas AU - Loong, Ern Shaun Seh AU - Lim, Lin Su AU - Tam, Wilson Wai San AU - Chin, Han Yip AU - Chao, M. Ariana AU - Dimitriadis, K. Georgios AU - Gao, Yujia AU - So, Yan Jimmy Bok AU - Shabbir, Asim AU - Ngiam, Yuan Kee PY - 2024/5/7 TI - Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation JO - J Med Internet Res SP - e46036 VL - 26 KW - artificial intelligence KW - chatbot KW - chatbots KW - weight KW - overweight KW - eating KW - food KW - weight loss KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - self-regulation KW - self-monitoring KW - anxiety KW - depression KW - consideration of future consequences KW - mental health KW - conversational agent KW - conversational agents KW - eating behavior KW - healthy eating KW - food consumption KW - obese KW - obesity KW - diet KW - dietary N2 - Background: A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one?s self-regulation over momentary eating impulses. Objective: This study aims to examine the feasibility and effectiveness of a novel artificial intelligence?assisted weight management app in improving eating behaviors in a Southeast Asian cohort. Methods: A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation. Results: The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean ?0.32, SD 1.16; P<.001), snacking habits (mean ?0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean ?0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251). Conclusions: eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity. Trial Registration: ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803 UR - https://www.jmir.org/2024/1/e46036 UR - http://dx.doi.org/10.2196/46036 UR - http://www.ncbi.nlm.nih.gov/pubmed/38713909 ID - info:doi/10.2196/46036 ER - TY - JOUR AU - Ren, Sicong AU - McDonald, C. Catherine AU - Corwin, J. Daniel AU - Wiebe, J. Douglas AU - Master, L. Christina AU - Arbogast, B. Kristy PY - 2024/5/6 TI - Response Rate Patterns in Adolescents With Concussion Using Mobile Health and Remote Patient Monitoring: Observational Study JO - JMIR Pediatr Parent SP - e53186 VL - 7 KW - concussion KW - mHealth KW - response rate KW - adolescents KW - reporting behavior KW - remote monitoring KW - engagement KW - monitoring KW - adolescent KW - teen KW - youth KW - remote patient monitoring KW - mobile health KW - injury KW - neurobiological KW - neurobiological development KW - quality of life KW - academic KW - academic performance KW - mHealth engagement KW - tertiary care N2 - Background: A concussion is a common adolescent injury that can result in a constellation of symptoms, negatively affecting academic performance, neurobiological development, and quality of life. Mobile health (mHealth) technologies, such as apps for patients to report symptoms or wearables to measure physiological metrics like heart rate, have been shown to be promising in health maintenance. However, there is limited evidence about mHealth engagement in adolescents with a concussion during their recovery course. Objective: This study aims to determine the response rate and response rate patterns in concussed adolescents reporting their daily symptoms through mHealth technology. It will also examine the effect of time-, demographic-, and injury-related characteristics on response rate patterns. Methods: Participants aged between 11-18 years (median days since injury at enrollment: 11 days) were recruited from the concussion program of a tertiary care academic medical center and a suburban school?s athletic teams. They were asked to report their daily symptoms using a mobile app. Participants were prompted to complete the Post-Concussion Symptom Inventory (PCSI) 3 times (ie, morning, afternoon, and evening) per day for 4 weeks following enrollment. The primary outcome was the response rate pattern over time (by day since initial app use and the day since injury). Time-, demographic-, and injury-related differences in reporting behaviors were compared using Mann Whitney U tests. Results: A total of 56 participants were enrolled (mean age 15.3, SD 1.9 years; n=32, 57% female). The median response rate across all days of app use in the evening was 37.0% (IQR 27.2%-46.4%), which was significantly higher than the morning (21.2%, IQR 15.6%-30.5%) or afternoon (26.4%, IQR 21.1%-31.5%; P<.001). The median daily response was significantly different by sex (female: 53.8%, IQR 46.2%-64.2% vs male: 42.0%, IQR 28.6%-51.1%; P=.003), days since injury to app use (participants starting to use the app >7 days since injury: 54.1%, IQR 47.4%-62.2% vs starting to use the app ?7 days since injury: 38.0%, IQR 26.0%-53.3%; P=.002), and concussion history (participants with a history of at least one prior concussion: 57.4%, IQR 44.5%-70.5% vs participants without concussion history: 42.3%, IQR 36.8%-53.5%; P=.03). There were no significant differences by age. Differences by injury mechanism (sports- and recreation-related injury: 39.6%, IQR 36.1%-50.4% vs non?sports- or recreation-related injury: 30.6%, IQR 20.0%-42.9%; P=.04) and initial symptom burden (PCSI scores greater than the median score of 47: 40.9%, IQR 35.2%-53.8% vs PCSI scores less than or equal to the median score: 31.9%, IQR 24.6%-40.6%; P=.04) were evident in the evening response rates; however, daily rates were not statistically different. Conclusions: Evening may be the optimal time to prompt for daily concussion symptom assessment among concussed adolescents compared with morning or afternoon. Multiple demographic- and injury-related characteristics were associated with higher daily response rates, including for female participants, those with more than 1 week from injury to beginning mHealth monitoring, and those with a history of at least one previous concussion. Future studies may consider incentive strategies or adaptive digital concussion assessments to increase response rates in populations with low engagement. UR - https://pediatrics.jmir.org/2024/1/e53186 UR - http://dx.doi.org/10.2196/53186 ID - info:doi/10.2196/53186 ER - TY - JOUR AU - Wei, Lai AU - Wang, Jia Stephen PY - 2024/5/6 TI - Motion Tracking of Daily Living and Physical Activities in Health Care: Systematic Review From Designers? Perspective JO - JMIR Mhealth Uhealth SP - e46282 VL - 12 KW - motion tracking KW - daily living KW - physical activity KW - health care application KW - design KW - public health KW - systematic review KW - mobile phone N2 - Background: Motion tracking technologies serve as crucial links between physical activities and health care insights, facilitating data acquisition essential for analyzing and intervening in physical activity. Yet, systematic methodologies for evaluating motion tracking data, especially concerning user activity recognition in health care applications, remain underreported. Objective: This study aims to systematically review motion tracking in daily living and physical activities, emphasizing the critical interaction among devices, users, and environments from a design perspective, and to analyze the process involved in health care application research. It intends to delineate the design and application intricacies in health care contexts, focusing on enhancing motion tracking data?s accuracy and applicability for health monitoring and intervention strategies. Methods: Using a systematic review, this research scrutinized motion tracking data and their application in health care and wellness, examining studies from Scopus, Web of Science, EBSCO, and PubMed databases. The review used actor network theory and data-enabled design to understand the complex interplay between humans, devices, and environments within these applications. Results: Out of 1501 initially identified studies, 54 (3.66%) were included for in-depth analysis. These articles predominantly used accelerometer and gyroscope sensors (n=43, 80%) to monitor and analyze motion, demonstrating a strong preference for these technologies in capturing both dynamic and static activities. While incorporating portable devices (n=11, 20%) and multisensor configurations (n=16, 30%), the application of sensors across the body (n=15, 28%) and within physical spaces (n=17, 31%) highlights the diverse applications of motion tracking technologies in health care research. This diversity reflects the application?s alignment with activity types ranging from daily movements to specialized scenarios. The results also reveal a diverse participant pool, including the general public, athletes, and specialized groups, with a focus on healthy individuals (n=31, 57%) and athletes (n=14, 26%). Despite this extensive application range, the focus primarily on laboratory-based studies (n=39, 72%) aimed at professional uses, such as precise activity identification and joint functionality assessment, emphasizes a significant challenge in translating findings from controlled environments to the dynamic conditions of everyday physical activities. Conclusions: This study?s comprehensive investigation of motion tracking technology in health care research reveals a significant gap between the methods used for data collection and their practical application in real-world scenarios. It proposes an innovative approach that includes designers in the research process, emphasizing the importance of incorporating data-enabled design framework. This ensures that motion data collection is aligned with the dynamic and varied nature of daily living and physical activities. Such integration is crucial for developing health applications that are accessible, intuitive, and tailored to meet diverse user needs. By leveraging a multidisciplinary approach that combines design, engineering, and health sciences, the research opens new pathways for enhancing the usability and effectiveness of health technologies. UR - https://mhealth.jmir.org/2024/1/e46282 UR - http://dx.doi.org/10.2196/46282 UR - http://www.ncbi.nlm.nih.gov/pubmed/38709547 ID - info:doi/10.2196/46282 ER - TY - JOUR AU - Goldgof, M. Gregory AU - Mishra, Shweta AU - Bajaj, Kriti PY - 2024/5/6 TI - Efficacy of the QuitSure App for Smoking Cessation in Adult Smokers: Cross-Sectional Web Survey JO - JMIR Hum Factors SP - e49519 VL - 11 KW - smoking KW - quit smoking KW - smoking cessation KW - smoking app KW - QuitSure KW - smoke free KW - quit vaping KW - vaping KW - smoker KW - smoke KW - cross-sectional study KW - smartphone app KW - tobacco consumption KW - tobacco KW - survey KW - nicotine KW - nicotine withdrawal KW - mobile phone N2 - Background: Cigarette smoking remains one of the leading causes of preventable death worldwide. A worldwide study by the World Health Organization concluded that more than 8 million people die every year from smoking, tobacco consumption, and secondhand smoke. The most effective tobacco cessation programs require personalized human intervention combined with costly pharmaceutical supplementation, making them unaffordable or inaccessible to most tobacco users. Thus, digital interventions offer a promising alternative to these traditional methods. However, the leading smartphone apps available in the market today have either not been studied in a clinical setting or are unable to match the smoking cessation success rates of their expensive offline counterparts. We would like to understand whether QuitSure, a novel smoking cessation app built by Rapidkart Online Private Limited, is able to bridge this efficacy gap and deliver affordable and effective smoking cessation at scale. Objective: Our objective was to do an initial exploration into the engagement, efficacy, and safety of QuitSure based on the self-reported experiences of its users. Outcomes measured were program completion, the effect of program completion on smoking behavior, including self-reported cessation outcomes, and negative health events from using the app. Methods: All QuitSure registered users who created their accounts on the QuitSure app between April 1, 2021, and February 28, 2022, were sent an anonymized web-based survey. The survey results were added to their engagement data on the app to evaluate the feasibility and efficacy of the app as a smoking cessation intervention. The data were analyzed using descriptive statistics (frequencies and percentages) and the ?2 test of independence. Results: In total, 1299 users who had completed the QuitSure program submitted the survey and satisfied the inclusion criteria of the study. Of these, 1286 participants had completed the program more than 30 days before filling out the survey, and 1040 (80.1%, 95% CI 79.1%-82.6%) of them had maintained prolonged abstinence for at least 30 days after program completion. A majority of participants (770/891, 86.4%) who were still maintaining abstinence at the time of submitting the survey did not experience any severe nicotine withdrawal symptoms, while 41.9% (373/891) experienced no mild withdrawal symptoms either. Smoking quantity prior to completing the program significantly affected quit rates (P<.001), with heavy smokers (>20 cigarettes per day) having a lower 30-day prolonged abstinence rate (relative risk=0.91; 95% CI 90.0%-96.2%) compared to lighter smokers. No additional adverse events outside of known nicotine withdrawal symptoms were reported. Conclusions: The nature of web-based surveys and cohort selection allows for extensive unknown biases. However, the efficacy rates of survey respondents who completed the program were high and provide a case for further investigation in the form of randomized controlled trials on the QuitSure tobacco cessation program. UR - https://humanfactors.jmir.org/2024/1/e49519 UR - http://dx.doi.org/10.2196/49519 UR - http://www.ncbi.nlm.nih.gov/pubmed/38709553 ID - info:doi/10.2196/49519 ER - TY - JOUR AU - Iqbal, Mujtaba Fahad AU - Aggarwal, Ravi AU - Joshi, Meera AU - King, Dominic AU - Martin, Guy AU - Khan, Sadia AU - Wright, Mike AU - Ashrafian, Hutan AU - Darzi, Ara PY - 2024/5/6 TI - Barriers to and Facilitators of Key Stakeholders Influencing Successful Digital Implementation of Remote Monitoring Solutions: Mixed Methods Analysis JO - JMIR Hum Factors SP - e49769 VL - 11 KW - implementation science KW - health plan implementation KW - mobile health KW - health care industry KW - stakeholder KW - COVID-19 KW - remote monitoring KW - digital tools KW - digital health KW - pandemic KW - virtual wards KW - virtual ward KW - health care delivery KW - telemedicine KW - telehealth KW - wearables KW - wearable KW - technology KW - United Kingdom KW - UK KW - digital services N2 - Background: Implementation of remote monitoring solutions and digital alerting tools in health care has historically been challenging, despite the impetus provided by the COVID-19 pandemic. To date, a health systems?based approach to systematically describe barriers and facilitators across multiple domains has not been undertaken. Objective: We aimed to undertake a comprehensive mixed methods analysis of barriers and facilitators for successful implementation of remote monitoring and digital alerting tools in complex health organizations. Methods: A mixed methods approach using a modified Technology Acceptance Model questionnaire and semistructured interviews mapped to the validated fit among humans, organizations, and technology (HOT-fit) framework was undertaken. Likert frequency responses and deductive thematic analyses were performed. Results: A total of 11 participants responded to the questionnaire and 18 participants to the interviews. Key barriers and facilitators could be mapped onto 6 dimensions, which incorporated aspects of digitization: system use (human), user satisfaction (human), environment (organization), structure (organization), information and service quality (technology), and system quality (technology). Conclusions: The recommendations proposed can enhance the potential for future remote sensing solutions to be more successfully integrated in health care practice, resulting in more successful use of ?virtual wards.? Trial Registration: ClinicalTrials.gov NCT05321004; https://www.clinicaltrials.gov/study/NCT05321004 UR - https://humanfactors.jmir.org/2024/1/e49769 UR - http://dx.doi.org/10.2196/49769 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338929 ID - info:doi/10.2196/49769 ER - TY - JOUR AU - Sharma, Kant Kamal AU - Somasundaram, Jeeva AU - Sachdeva, Ashish PY - 2024/5/6 TI - Self-Selected Versus Assigned Target to Reduce Smartphone Use and Improve Mental Health: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e53756 VL - 13 KW - screen time KW - monetary incentives KW - target selection KW - mental health KW - mobile phone N2 - Background: Smartphones have become integral to people?s lives, with a noticeable increase in the average screen time, both on a global scale and, notably, in India. Existing research links mobile consumption to sleep problems, poor physical and mental health, and lower subjective well-being. The comparative effectiveness of monetary incentives given for self-selected versus assigned targets on reducing screen time and thereby improving mental health remains unanswered. Objective: This study aims to assess the impact of monetary incentives and target selection on mobile screen time reduction and mental health. Methods: We designed a 3-armed randomized controlled trial conducted with employees and students at an educational institution in India. The study is conducted digitally over 12 weeks, including baseline (2 weeks), randomization (1 week), intervention (5 weeks), and postintervention (4 week) periods. We emailed the employees and students to inquire about their interest in participation. Those who expressed interest received detailed study information and consent forms. After securing consent, participants were asked to complete the initial survey and provide their mobile screen time during the baseline period. At the beginning of the intervention period, the participants were randomly allocated into 1 of 3 study groups in a 2:2:1 ratio (self-selected vs assigned vs control). Participants in the self-selected group were presented with 3 target options: 10%, 20%, and 30%, and they were asked to self-select a target to reduce their mobile screen time from their baseline average mobile screen time. Participants in the assigned group were given a target to reduce their mobile screen time from their baseline average mobile screen time. The assigned target was set as the average of the targets selected by participants in the self-selected group. During the intervention period, participants in the self-selected and assigned group were eligible to receive a monetary incentive of INR (Indian Rupee) 50 (US $0.61) per day for successfully attaining their target. Participants in the control group neither received nor selected a target for reducing their mobile screen time and did not receive any monetary incentives during the intervention period. All participants received information regarding the advantages of reducing mobile screen time. As an incentive, all participants would receive INR 500 (US $6.06) upon completion of the study and a chance to win 1 of 2 lotteries valued at INR 5000 (US $60.55) for consistently sharing their mobile screen time data. Results: Currently, the study intervention is being rolled out. Enrollment occurred between August 21, 2023, and September 2, 2023; data collection concluded in November 2023. We expect that results will be available by early 2024. Conclusions: The monetary incentives and self-selected versus assigned targets might be effective interventions in reducing mobile screen time among working professionals and students. Trial Registration: AsPredicted 142497; https://aspredicted.org/hr3nn.pdf International Registered Report Identifier (IRRID): DERR1-10.2196/53756 UR - https://www.researchprotocols.org/2024/1/e53756 UR - http://dx.doi.org/10.2196/53756 UR - http://www.ncbi.nlm.nih.gov/pubmed/38709546 ID - info:doi/10.2196/53756 ER - TY - JOUR AU - Ambrosio, Graca Maria Da AU - Lachman, M. Jamie AU - Zinzer, Paula AU - Gwebu, Hlengiwe AU - Vyas, Seema AU - Vallance, Inge AU - Calderon, Francisco AU - Gardner, Frances AU - Markle, Laurie AU - Stern, David AU - Facciola, Chiara AU - Schley, Anne AU - Danisa, Nompumelelo AU - Brukwe, Kanyisile AU - Melendez-Torres, GJ PY - 2024/5/3 TI - A Factorial Randomized Controlled Trial to Optimize User Engagement With a Chatbot-Led Parenting Intervention: Protocol for the ParentText Optimisation Trial JO - JMIR Res Protoc SP - e52145 VL - 13 KW - parenting intervention KW - chatbot-led public health intervention KW - engagement KW - implementation science KW - mobile phone N2 - Background: Violence against children (VAC) is a serious public health concern with long-lasting adverse effects. Evidence-based parenting programs are one effective means to prevent VAC; however, these interventions are not scalable in their typical in-person group format, especially in low- and middle-income countries where the need is greatest. While digital delivery, including via chatbots, offers a scalable and cost-effective means to scale up parenting programs within these settings, it is crucial to understand the key pillars of user engagement to ensure their effective implementation. Objective: This study aims to investigate the most effective and cost-effective combination of external components to optimize user engagement with ParentText, an open-source chatbot-led parenting intervention to prevent VAC in Mpumalanga, South Africa. Methods: This study will use a mixed methods design incorporating a 2 × 2 factorial cluster-randomized controlled trial and qualitative interviews. Parents of adolescent girls (32 clusters, 120 participants [60 parents and 60 girls aged 10 to 17 years] per cluster; N=3840 total participants) will be recruited from the Ehlanzeni and Nkangala districts of Mpumalanga. Clusters will be randomly assigned to receive 1 of the 4 engagement packages that include ParentText alone or combined with in-person sessions and a facilitated WhatsApp support group. Quantitative data collected will include pretest-posttest parent- and adolescent-reported surveys, facilitator-reported implementation data, and digitally tracked engagement data. Qualitative data will be collected from parents and facilitators through in-person or over-the-phone individual semistructured interviews and used to expand the interpretation and understanding of the quantitative findings. Results: Recruitment and data collection started in August 2023 and were finalized in November 2023. The total number of participants enrolled in the study is 1009, with 744 caregivers having completed onboarding to the chatbot-led intervention. Female participants represent 92.96% (938/1009) of the sample population, whereas male participants represent 7.03% (71/1009). The average participant age is 43 (SD 9) years. Conclusions: The ParentText Optimisation Trial is the first study to rigorously test engagement with a chatbot-led parenting intervention in a low- or middle-income country. The results of this study will inform the final selection of external delivery components to support engagement with ParentText in preparation for further evaluation in a randomized controlled trial in 2024. Trial Registration: Open Science Framework (OSF); https://doi.org/10.17605/OSF.IO/WFXNE International Registered Report Identifier (IRRID): DERR1-10.2196/52145 UR - https://www.researchprotocols.org/2024/1/e52145 UR - http://dx.doi.org/10.2196/52145 UR - http://www.ncbi.nlm.nih.gov/pubmed/38700935 ID - info:doi/10.2196/52145 ER - TY - JOUR AU - Willinger, Laura AU - Böhm, Birgit AU - Schweizer, Florian AU - Reimer, Marie Lara AU - Jonas, Stephan AU - Scheller, A. Daniel AU - Oberhoffer-Fritz, Renate AU - Müller, Jan PY - 2024/5/3 TI - KIJANI App to Promote Physical Activity in Children and Adolescents: Protocol for a Mixed Method Evaluation JO - JMIR Res Protoc SP - e55156 VL - 13 KW - physical activity KW - health promotion KW - digital health KW - gamification KW - childhood KW - adolescence KW - adolescents KW - adolescent KW - children KW - augmented reality KW - KIJANI intervention KW - KIJANI KW - intervention KW - user experience N2 - Background: The prevalence of physical inactivity among children and adolescents is alarmingly high despite the well-documented and comprehensive benefits of regular physical activity (PA). Therefore, PA promotion should start early in childhood and adolescence. Although reducing recreational screen time in children and adolescents is an urgent concern, digital approaches have the potential to make activity promotion attractive and age appropriate for the target group. KIJANI is a mobile app approach to promote PA in children and adolescents via gamification and augmented reality. Objective: This study protocol aims to describe the KIJANI intervention in detail, as well as the evaluation approach. Methods: KIJANI is based on the concept that virtual coins can be earned through PA, for example, in the form of a collected step count. With these coins, in turn, blocks can be bought, which can be used to create virtual buildings and integrate them into the player?s real-world environment via augmented reality. PA of users is detected via accelerometers integrated into the smartphones. KIJANI can be played at predefined play locations that were comprehensively identified as safe, child-friendly, and attractive for PA by the target group in a partner project. The evaluation process will be divided into 2 different stages. The phase-I evaluation will be a mixed methods approach with one-on-one semistructured interviews and questionnaires to evaluate the user experience and receive feedback from the target group. After the implementation of results and feedback from the target group, the phase-II evaluation will proceed in the form of a 2-arm randomized controlled trial, in which the effectiveness of KIJANI will be assessed via objectively measured PA as well as questionnaires. Results: The study received ethical approval from the ethical board of the Technical University of Munich. Participants for the phase-I evaluation are currently being recruited. Conclusions: The study will help to determine the efficacy, applicability, and user experience of a gamified activity promotion application in children and adolescents. Overall, digital health approaches provide easy and wide reachability at low cost and are age appropriate and attractive for the target group of adolescents. Strategies have to be developed to apply digital health approaches in the best possible way for activity promotion. International Registered Report Identifier (IRRID): DERR1-10.2196/55156 UR - https://www.researchprotocols.org/2024/1/e55156 UR - http://dx.doi.org/10.2196/55156 UR - http://www.ncbi.nlm.nih.gov/pubmed/38700911 ID - info:doi/10.2196/55156 ER - TY - JOUR AU - Cunningham, C. Adam AU - Prentice, Carley AU - Peven, Kimberly AU - Wickham, Aidan AU - Bamford, Ryan AU - Radovic, Tara AU - Klepchukova, Anna AU - Fomina, Maria AU - Cunningham, Katja AU - Hill, Sarah AU - Hantsoo, Liisa AU - Payne, Jennifer AU - Zhaunova, Liudmila AU - Ponzo, Sonia PY - 2024/5/2 TI - Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e54124 VL - 12 KW - digital health KW - health literacy KW - menstrual cycle KW - period tracking app KW - women?s health KW - PMS KW - PMDD KW - tracking KW - app KW - application KW - tracking app KW - tracking application KW - menstrual KW - women KW - efficacy KW - general health KW - wellbeing KW - randomized controlled trial KW - awareness KW - symptoms KW - manage KW - management KW - premenstrual KW - premenstrual syndrome KW - premenstrual dysphoric disorder KW - reproductive KW - reproductive health KW - health management KW - communication KW - pregnancy KW - quality of life KW - productivity KW - education KW - functionality N2 - Background: Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one?s own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. Objective: The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. Methods: We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). Results: The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D?=1.11; t311=5.73, P<.001; PMS or PMDD: D?=1.20; t115=3.76, P<.001) and menstrual health awareness (D?=3.97; t311=7.71, P<.001), health and well-being (D?=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D?=?7.08; t115=?5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D?=1.01; t311=5.08, P<.001), communication about health (D?=0.93; t311=2.41, P=.002), menstrual cycle stigma (D?=?0.61; t311=?2.73, P=.007), and fear of unplanned pregnancies (D?=?0.22; t311=?2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D?=?1.67; t144=?2.49, P=.01). Conclusions: These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. Trial Registration: OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq UR - https://mhealth.jmir.org/2024/1/e54124 UR - http://dx.doi.org/10.2196/54124 UR - http://www.ncbi.nlm.nih.gov/pubmed/38696773 ID - info:doi/10.2196/54124 ER - TY - JOUR AU - Kinoshita, Shotaro AU - Hanashiro, Sayaka AU - Tsutsumi, Shiori AU - Shiga, Kiko AU - Kitazawa, Momoko AU - Wada, Yasuyo AU - Inaishi, Jun AU - Kashiwagi, Kazuhiro AU - Fukami, Toshikazu AU - Mashimo, Yasumasa AU - Minato, Kazumichi AU - Kishimoto, Taishiro PY - 2024/5/2 TI - Assessment of Stress and Well-Being of Japanese Employees Using Wearable Devices for Sleep Monitoring Combined With Ecological Momentary Assessment: Pilot Observational Study JO - JMIR Form Res SP - e49396 VL - 8 KW - wearable device KW - sleep feedback KW - well-being KW - stress KW - ecological momentary assessment KW - feasibility study N2 - Background: Poor sleep quality can elevate stress levels and diminish overall well-being. Japanese individuals often experience sleep deprivation, and workers have high levels of stress. Nevertheless, research examining the connection between objective sleep assessments and stress levels, as well as overall well-being, among Japanese workers is lacking. Objective: This study aims to investigate the correlation between physiological data, including sleep duration and heart rate variability (HRV), objectively measured through wearable devices, and 3 states (sleepiness, mood, and energy) assessed through ecological momentary assessment (EMA) and use of rating scales for stress and well-being. Methods: A total of 40 office workers (female, 20/40, 50%; mean age 40.4 years, SD 11.8 years) participated in the study. Participants were asked to wear a wearable wristband device for 8 consecutive weeks. EMA regarding sleepiness, mood, and energy levels was conducted via email messages sent by participants 4 times daily, with each session spaced 3 hours apart. This assessment occurred on 8 designated days within the 8-week timeframe. Participants? stress levels and perception of well-being were assessed using respective self-rating questionnaires. Subsequently, participants were categorized into quartiles based on their stress and well-being scores, and the sleep patterns and HRV indices recorded by the Fitbit Inspire 2 were compared among these groups. The Mann-Whitney U test was used to assess differences between the quartiles, with adjustments made for multiple comparisons using the Bonferroni correction. Furthermore, EMA results and the sleep and HRV indices were subjected to multilevel analysis for a comprehensive evaluation. Results: The EMA achieved a total response rate of 87.3%, while the Fitbit Inspire 2 wear rate reached 88.0%. When participants were grouped based on quartiles of well-being and stress-related scores, significant differences emerged. Specifically, individuals in the lowest stress quartile or highest subjective satisfaction quartile retired to bed earlier (P<.001 and P=.01, respectively), whereas those in the highest stress quartile exhibited greater variation in the midpoint of sleep (P<.001). A multilevel analysis unveiled notable relationships: intraindividual variability analysis indicated that higher energy levels were associated with lower deviation of heart rate during sleep on the preceding day (?=?.12, P<.001), and decreased sleepiness was observed on days following longer sleep durations (?=?.10, P<.001). Furthermore, interindividual variability analysis revealed that individuals with earlier midpoints of sleep tended to exhibit higher energy levels (?=?.26, P=.04). Conclusions: Increased sleep variabilities, characterized by unstable bedtime or midpoint of sleep, were correlated with elevated stress levels and diminished well-being. Conversely, improved sleep indices (eg, lower heart rate during sleep and earlier average bedtime) were associated with heightened daytime energy levels. Further research with a larger sample size using these methodologies, particularly focusing on specific phenomena such as social jet lag, has the potential to yield valuable insights. Trial Registration: UMIN-CTR UMIN000046858; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053392 UR - https://formative.jmir.org/2024/1/e49396 UR - http://dx.doi.org/10.2196/49396 UR - http://www.ncbi.nlm.nih.gov/pubmed/38696237 ID - info:doi/10.2196/49396 ER - TY - JOUR AU - Kluge, Felix AU - Brand, E. Yonatan AU - Micó-Amigo, Encarna M. AU - Bertuletti, Stefano AU - D'Ascanio, Ilaria AU - Gazit, Eran AU - Bonci, Tecla AU - Kirk, Cameron AU - Küderle, Arne AU - Palmerini, Luca AU - Paraschiv-Ionescu, Anisoara AU - Salis, Francesca AU - Soltani, Abolfazl AU - Ullrich, Martin AU - Alcock, Lisa AU - Aminian, Kamiar AU - Becker, Clemens AU - Brown, Philip AU - Buekers, Joren AU - Carsin, Anne-Elie AU - Caruso, Marco AU - Caulfield, Brian AU - Cereatti, Andrea AU - Chiari, Lorenzo AU - Echevarria, Carlos AU - Eskofier, Bjoern AU - Evers, Jordi AU - Garcia-Aymerich, Judith AU - Hache, Tilo AU - Hansen, Clint AU - Hausdorff, M. Jeffrey AU - Hiden, Hugo AU - Hume, Emily AU - Keogh, Alison AU - Koch, Sarah AU - Maetzler, Walter AU - Megaritis, Dimitrios AU - Niessen, Martijn AU - Perlman, Or AU - Schwickert, Lars AU - Scott, Kirsty AU - Sharrack, Basil AU - Singleton, David AU - Vereijken, Beatrix AU - Vogiatzis, Ioannis AU - Yarnall, Alison AU - Rochester, Lynn AU - Mazzà, Claudia AU - Del Din, Silvia AU - Mueller, Arne PY - 2024/5/1 TI - Real-World Gait Detection Using a Wrist-Worn Inertial Sensor: Validation Study JO - JMIR Form Res SP - e50035 VL - 8 KW - digital mobility outcomes KW - validation KW - wearable sensor KW - walking KW - digital health KW - inertial measurement unit KW - accelerometer KW - Mobilise-D N2 - Background: Wrist-worn inertial sensors are used in digital health for evaluating mobility in real-world environments. Preceding the estimation of spatiotemporal gait parameters within long-term recordings, gait detection is an important step to identify regions of interest where gait occurs, which requires robust algorithms due to the complexity of arm movements. While algorithms exist for other sensor positions, a comparative validation of algorithms applied to the wrist position on real-world data sets across different disease populations is missing. Furthermore, gait detection performance differences between the wrist and lower back position have not yet been explored but could yield valuable information regarding sensor position choice in clinical studies. Objective: The aim of this study was to validate gait sequence (GS) detection algorithms developed for the wrist position against reference data acquired in a real-world context. In addition, this study aimed to compare the performance of algorithms applied to the wrist position to those applied to lower back?worn inertial sensors. Methods: Participants with Parkinson disease, multiple sclerosis, proximal femoral fracture (hip fracture recovery), chronic obstructive pulmonary disease, and congestive heart failure and healthy older adults (N=83) were monitored for 2.5 hours in the real-world using inertial sensors on the wrist, lower back, and feet including pressure insoles and infrared distance sensors as reference. In total, 10 algorithms for wrist-based gait detection were validated against a multisensor reference system and compared to gait detection performance using lower back?worn inertial sensors. Results: The best-performing GS detection algorithm for the wrist showed a mean (per disease group) sensitivity ranging between 0.55 (SD 0.29) and 0.81 (SD 0.09) and a mean (per disease group) specificity ranging between 0.95 (SD 0.06) and 0.98 (SD 0.02). The mean relative absolute error of estimated walking time ranged between 8.9% (SD 7.1%) and 32.7% (SD 19.2%) per disease group for this algorithm as compared to the reference system. Gait detection performance from the best algorithm applied to the wrist inertial sensors was lower than for the best algorithms applied to the lower back, which yielded mean sensitivity between 0.71 (SD 0.12) and 0.91 (SD 0.04), mean specificity between 0.96 (SD 0.03) and 0.99 (SD 0.01), and a mean relative absolute error of estimated walking time between 6.3% (SD 5.4%) and 23.5% (SD 13%). Performance was lower in disease groups with major gait impairments (eg, patients recovering from hip fracture) and for patients using bilateral walking aids. Conclusions: Algorithms applied to the wrist position can detect GSs with high performance in real-world environments. Those periods of interest in real-world recordings can facilitate gait parameter extraction and allow the quantification of gait duration distribution in everyday life. Our findings allow taking informed decisions on alternative positions for gait recording in clinical studies and public health. Trial Registration: ISRCTN Registry 12246987; https://www.isrctn.com/ISRCTN12246987 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-050785 UR - https://formative.jmir.org/2024/1/e50035 UR - http://dx.doi.org/10.2196/50035 UR - http://www.ncbi.nlm.nih.gov/pubmed/38691395 ID - info:doi/10.2196/50035 ER - TY - JOUR AU - Ausserhofer, Dietmar AU - Piccoliori, Giuliano AU - Engl, Adolf AU - Mahlknecht, Angelika AU - Plagg, Barbara AU - Barbieri, Verena AU - Colletti, Nicoletta AU - Lombardo, Stefano AU - Gärtner, Timon AU - Tappeiner, Waltraud AU - Wieser, Heike AU - Wiedermann, Josef Christian PY - 2024/4/30 TI - Community-Dwelling Older Adults? Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study JO - JMIR Form Res SP - e54120 VL - 8 KW - frail older adults KW - Italy KW - Italian KW - Europe KW - European KW - digital health KW - health technologies KW - health technology KW - telemedicine KW - telehealth KW - eHealth KW - e-health KW - adoption KW - readiness KW - usage KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - robotics KW - cross-sectional study KW - population-based survey KW - stratified probabilistic sampling KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging N2 - Background: Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored. Objective: This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults? readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics. Methods: This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults? readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data. Results: In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7% (n=571), telemedicine by 30.1% (n=510), smartphones and texting apps by 24.5% (n=416), and assistant robots by 13.7% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ?85 years (odds ratio [OR] 0.74, 95% CI 0.56-0.96), financial constraints (OR 0.68, 95% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95% CI 1.16-2.60), smartphones (OR 1.69, 95% CI 1.22-2.35), and the internet (OR 2.26, 95% CI 1.47-3.49) reported readiness for adoption. Conclusions: Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults. UR - https://formative.jmir.org/2024/1/e54120 UR - http://dx.doi.org/10.2196/54120 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687989 ID - info:doi/10.2196/54120 ER - TY - JOUR AU - Innominato, F. Pasquale AU - Macdonald, H. Jamie AU - Saxton, Wendy AU - Longshaw, Laura AU - Granger, Rachel AU - Naja, Iman AU - Allocca, Carlo AU - Edwards, Ruth AU - Rasheed, Solah AU - Folkvord, Frans AU - de Batlle, Jordi AU - Ail, Rohit AU - Motta, Enrico AU - Bale, Catherine AU - Fuller, Claire AU - Mullard, P. Anna AU - Subbe, P. Christian AU - Griffiths, Dawn AU - Wreglesworth, I. Nicholas AU - Pecchia, Leandro AU - Fico, Giuseppe AU - Antonini, Alessio PY - 2024/4/30 TI - Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study JO - JMIR Res Protoc SP - e52957 VL - 13 KW - cancer KW - survivorship KW - artificial intelligence KW - remote monitoring KW - mobile health KW - mHealth KW - digital health KW - circadian KW - actigraphy KW - mobile phone N2 - Background: Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. Objective: This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. Methods: This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). Results: This study is part of an array of pilots within a European Union funded project, entitled ?GATEKEEPER,? conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. Conclusions: In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. International Registered Report Identifier (IRRID): PRR1-10.2196/52957 UR - https://www.researchprotocols.org/2024/1/e52957 UR - http://dx.doi.org/10.2196/52957 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687985 ID - info:doi/10.2196/52957 ER - TY - JOUR AU - Zakiyah, Neily AU - Marulin, Dita AU - Alfaqeeh, Mohammed AU - Puspitasari, Melyani Irma AU - Lestari, Keri AU - Lim, Keat Ka AU - Fox-Rushby, Julia PY - 2024/4/30 TI - Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review JO - J Med Internet Res SP - e53500 VL - 26 KW - digital health KW - telemonitoring KW - telehealth KW - heart failure KW - cost-effectiveness KW - systematic review KW - mobile phone N2 - Background: Digital health interventions (DHIs) have shown promising results in enhancing the management of heart failure (HF). Although health care interventions are increasingly being delivered digitally, with growing evidence on the potential cost-effectiveness of adopting them, there has been little effort to collate and synthesize the findings. Objective: This study?s objective was to systematically review the economic evaluations that assess the adoption of DHIs in the management and treatment of HF. Methods: A systematic review was conducted using 3 electronic databases: PubMed, EBSCOhost, and Scopus. Articles reporting full economic evaluations of DHIs for patients with HF published up to July 2023 were eligible for inclusion. Study characteristics, design (both trial based and model based), input parameters, and main results were extracted from full-text articles. Data synthesis was conducted based on the technologies used for delivering DHIs in the management of patients with HF, and the findings were analyzed narratively. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. The reporting quality of the included studies was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Results: Overall, 27 economic evaluations were included in the review. The economic evaluations were based on models (13/27, 48%), trials (13/27, 48%), or a combination approach (1/27, 4%). The devices evaluated included noninvasive remote monitoring devices (eg, home telemonitoring using digital tablets or specific medical devices that enable transmission of physiological data), telephone support, mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems. Most of the studies (24/27, 89%) used cost-utility analysis. The majority of the studies (25/27, 93%) were conducted in high-income countries, particularly European countries (16/27, 59%) such as the United Kingdom and the Netherlands. Mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems yielded cost-effective results or even emerged as dominant strategies. However, conflicting results were observed, particularly in noninvasive remote monitoring devices and telephone support. In 15% (4/27) of the studies, these DHIs were found to be less costly and more effective than the comparators (ie, dominant), while 33% (9/27) reported them to be more costly but more effective with incremental cost-effectiveness ratios below the respective willingness-to-pay thresholds (ie, cost-effective). Furthermore, in 11% (3/27) of the studies, noninvasive remote monitoring devices and telephone support were either above the willingness-to-pay thresholds or more costly than, yet as effective as, the comparators (ie, not cost-effective). In terms of reporting quality, the studies were classified as good (20/27, 74%), moderate (6/27, 22%), or excellent (1/27, 4%). Conclusions: Despite the conflicting results, the main findings indicated that, overall, DHIs were more cost-effective than non-DHI alternatives. Trial Registration: PROSPERO CRD42023388241; https://tinyurl.com/2p9axpmc UR - https://www.jmir.org/2024/1/e53500 UR - http://dx.doi.org/10.2196/53500 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687991 ID - info:doi/10.2196/53500 ER - TY - JOUR AU - Fink, Franziska AU - Kalter, Ivonne AU - Steindorff, Jenny-Victoria AU - Helmbold, Konrad Hans AU - Paulicke, Denny AU - Jahn, Patrick PY - 2024/4/30 TI - Identifying Factors of User Acceptance of a Drone-Based Medication Delivery: User-Centered Design Approach JO - JMIR Hum Factors SP - e51587 VL - 11 KW - human-drone interaction KW - medical supplies KW - participative research KW - user-centered design KW - technology acceptance N2 - Background: The use of drones in the health care sector is increasingly being discussed against the background of the aging population and the growing shortage of skilled workers. In particular, the use of drones to provide medication in rural areas could bring advantages for the care of people with and without a need for care. However, there are hardly any data available that focus on the interaction between humans and drones. Objective: This study aims to disclose and analyze factors associated with user acceptance of drone-based medication delivery to derive practice-relevant guidance points for participatory technology development (for apps and drones). Methods: A controlled mixed methods study was conducted that supports the technical development process of an app design for drone-assisted drug delivery based on a participatory research design. For the quantitative analysis, established and standardized survey instruments to capture technology acceptance, such as the System Usability Scale; Technology Usage Inventory (TUI); and the Motivation, Engagement, and Thriving in User Experience model, were used. To avoid possible biasing effects from a continuous user development (eg, response shifts and learning effects), an ad hoc group was formed at each of the 3 iterative development steps and was subsequently compared with the consisting core group, which went through all 3 iterations. Results: The study found a positive correlation between the usability of a pharmacy drone app and participants? willingness to use it (r=0.833). Participants? perception of usefulness positively influenced their willingness to use the app (r=0.487; TUI). Skepticism had a negative impact on perceived usability and willingness to use it (r=?0.542; System Usability Scale and r=?0.446; TUI). The study found that usefulness, skepticism, and curiosity explained most of the intention to use the app (F3,17=21.12; P<.001; R2=0.788; adjusted R2=0.751). The core group showed higher ratings on the intention to use the pharmacy drone app than the ad hoc groups. Results of the 2-tailed t tests showed a higher rating on usability for the third iteration of the core group compared with the first iteration. Conclusions: With the help of the participatory design, important aspects of acceptance could be revealed by the people involved in relation to drone-assisted drug delivery. For example, the length of time spent using the technology is an important factor for the intention to use the app. Technology-specific factors such as user-friendliness or curiosity are directly related to the use acceptance of the drone app. Results of this study showed that the more participants perceived their own competence in handling the app, the more they were willing to use the technology and the more they rated the app as usable. UR - https://humanfactors.jmir.org/2024/1/e51587 UR - http://dx.doi.org/10.2196/51587 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687589 ID - info:doi/10.2196/51587 ER - TY - JOUR AU - Cano, Mireia AU - Ruiz-Postigo, A. José AU - Macharia, Paul AU - Ampem Amoako, Yaw AU - Odame Phillips, Richard AU - Kinyeru, Esther AU - Carrion, Carme PY - 2024/4/30 TI - Evaluating the World Health Organization?s SkinNTDs App as a Training Tool for Skin Neglected Tropical Diseases in Ghana and Kenya: Cross-Sectional Study JO - J Med Internet Res SP - e51628 VL - 26 KW - SkinNTDs app KW - mHealth KW - mobile health KW - neglected tropical diseases KW - NTDs KW - skin neglected tropical diseases KW - low- and middle-income countries KW - tropical disease KW - app KW - training tool KW - digital health KW - intervention KW - decision support tool KW - mobile phone N2 - Background: Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, primarily impoverished populations in low- and middle-income countries. Skin NTDs, a significant subgroup, manifest primarily as skin lesions and require extensive diagnosis and treatment resources, including trained personnel and financial backing. The World Health Organization has introduced the SkinNTDs app, a mobile health tool designed to train and be used as a decision support tool for frontline health care workers. As most digital health guidelines prioritize the thorough evaluation of mobile health interventions, it is essential to conduct a rigorous and validated assessment of this app. Objective: This study aims to assess the usability and user experience of World Health Organization SkinNTDs app (version 3) as a capacity-building tool and decision-support tool for frontline health care workers. Methods: A cross-sectional study was conducted in Ghana and Kenya. Frontline health care workers dealing with skin NTDs were recruited through snowball sampling. They used the SkinNTDs app for at least 5 days before completing a web-based survey containing demographic variables and the user version of the Mobile Application Rating Scale (uMARS), a validated scale for assessing health apps. A smaller group of participants took part in semistructured interviews and one focus group. Quantitative data were analyzed using SPSS with a 95% CI and P?.05 for statistical significance and qualitative data using ATLAS.ti to identify attributes, cluster themes, and code various dimensions that were explored. Results: Overall, 60 participants participated in the quantitative phase and 17 in the qualitative phase. The SkinNTDs app scored highly on the uMARS questionnaire, with an app quality mean score of 4.02 (SD 0.47) of 5, a subjective quality score of 3.82 (SD 0.61) of 5, and a perceived impact of 4.47 (SD 0.56) of 5. There was no significant association between the app quality mean score and any of the categorical variables examined, according to Pearson correlation analysis; app quality mean score vs age (P=.37), sex (P=.70), type of health worker (P=.35), country (P=.94), work context (P=.17), frequency of dealing with skin NTDs (P=.09), and dermatology experience (P=.63). Qualitative results echoed the quantitative outcomes, highlighting the ease of use, the offline functionality, and the potential utility for frontline health care workers in remote and resource-constrained settings. Areas for improvement were identified, such as enhancing the signs and symptoms section. Conclusions: The SkinNTDs app demonstrates notable usability and user-friendliness. The results indicate that the app could play a crucial role in improving capacity building of frontline health care workers dealing with skin NTDs. It could be improved in the future by including new features such as epidemiological context and direct contact with experts. The possibility of using the app as a diagnostic tool should be considered. International Registered Report Identifier (IRRID): RR2-10.2196/39393 UR - https://www.jmir.org/2024/1/e51628 UR - http://dx.doi.org/10.2196/51628 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687587 ID - info:doi/10.2196/51628 ER - TY - JOUR AU - Wang, Jun-Wei AU - Zhu, Zhicheng AU - Shuling, Zhang AU - Fan, Jia AU - Jin, Yu AU - Gao, Zhan-Le AU - Chen, Wan-Di AU - Li, Xue PY - 2024/4/30 TI - Effectiveness of mHealth App?Based Interventions for Increasing Physical Activity and Improving Physical Fitness in Children and Adolescents: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e51478 VL - 12 KW - mobile health KW - mHealth apps KW - children and adolescents KW - physical activity KW - physical fitness KW - systematic review KW - meta-analysis KW - mobile phone N2 - Background: The COVID-19 pandemic has significantly reduced physical activity (PA) levels and increased sedentary behavior (SB), which can lead to worsening physical fitness (PF). Children and adolescents may benefit from mobile health (mHealth) apps to increase PA and improve PF. However, the effectiveness of mHealth app?based interventions and potential moderators in this population are not yet fully understood. Objective: This study aims to review and analyze the effectiveness of mHealth app?based interventions in promoting PA and improving PF and identify potential moderators of the efficacy of mHealth app?based interventions in children and adolescents. Methods: We searched for randomized controlled trials (RCTs) published in the PubMed, Web of Science, EBSCO, and Cochrane Library databases until December 25, 2023, to conduct this meta-analysis. We included articles with intervention groups that investigated the effects of mHealth-based apps on PA and PF among children and adolescents. Due to high heterogeneity, a meta-analysis was conducted using a random effects model. The Cochrane Risk of Bias Assessment Tool was used to evaluate the risk of bias. Subgroup analysis and meta-regression analyses were performed to identify potential influences impacting effect sizes. Results: We included 28 RCTs with a total of 5643 participants. In general, the risk of bias of included studies was low. Our findings showed that mHealth app?based interventions significantly increased total PA (TPA; standardized mean difference [SMD] 0.29, 95% CI 0.13-0.45; P<.001), reduced SB (SMD ?0.97, 95% CI ?1.67 to ?0.28; P=.006) and BMI (weighted mean difference ?0.31 kg/m2, 95% CI ?0.60 to ?0.01 kg/m2; P=.12), and improved muscle strength (SMD 1.97, 95% CI 0.09-3.86; P=.04) and agility (SMD ?0.35, 95% CI ?0.61 to ?0.10; P=.006). However, mHealth app?based interventions insignificantly affected moderate to vigorous PA (MVPA; SMD 0.11, 95% CI ?0.04 to 0.25; P<.001), waist circumference (weighted mean difference 0.38 cm, 95% CI ?1.28 to 2.04 cm; P=.65), muscular power (SMD 0.01, 95% CI ?0.08 to 0.10; P=.81), cardiorespiratory fitness (SMD ?0.20, 95% CI ?0.45 to 0.05; P=.11), muscular endurance (SMD 0.47, 95% CI ?0.08 to 1.02; P=.10), and flexibility (SMD 0.09, 95% CI ?0.23 to 0.41; P=.58). Subgroup analyses and meta-regression showed that intervention duration was associated with TPA and MVPA, and age and types of intervention was associated with BMI. Conclusions: Our meta-analysis suggests that mHealth app?based interventions may yield small-to-large beneficial effects on TPA, SB, BMI, agility, and muscle strength in children and adolescents. Furthermore, age and intervention duration may correlate with the higher effectiveness of mHealth app?based interventions. However, due to the limited number and quality of included studies, the aforementioned conclusions require validation through additional high-quality research. Trial Registration: PROSPERO CRD42023426532; https://tinyurl.com/25jm4kmf UR - https://mhealth.jmir.org/2024/1/e51478 UR - http://dx.doi.org/10.2196/51478 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687568 ID - info:doi/10.2196/51478 ER - TY - JOUR AU - Olsen, Christine AU - Lungu, Adrian Daniel PY - 2024/4/30 TI - Effectiveness of a Smartphone App (Heia Meg) in Improving Decisions About Nutrition and Physical Activity: Prospective Longitudinal Study JO - JMIR Form Res SP - e48185 VL - 8 KW - app KW - BMI KW - diet KW - exercise KW - health KW - Heia Meg KW - lifestyle change KW - longitudinal KW - mHealth KW - mobile health KW - motivation KW - nutrition KW - obese KW - obesity KW - overweight KW - physical activity KW - smartphone apps KW - weight N2 - Background: Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of children with overweight or obesity aged 5-19 years growing from 4% to 18% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. Objective: This study aims to investigate the potential impact of the mobile app Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. Methods: A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. Participants were recruited through the Heia Meg app and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (preintervention) questionnaire, while 99 valid responses were obtained in the second (postintervention) questionnaire. Results: The majority (159/199, 79.9%) of participants were female, and their age ranged from 18 years to 70 years and older. The results show a reduction in BMI after the digital intervention. However, some variables influence the BMI reduction effect: sex, age, education, and smoking. The group that obtained the most benefit from the intervention consisted of those who were male, aged 30-39 years, highly educated, and nonsmokers. Although positive, some of the findings are slightly above the statistical significance threshold and therefore should be interpreted carefully. Conclusions: Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research in different populations with larger sample sizes is needed to confirm or disprove our findings. UR - https://formative.jmir.org/2024/1/e48185 UR - http://dx.doi.org/10.2196/48185 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687565 ID - info:doi/10.2196/48185 ER - TY - JOUR AU - Chen, Han Tzu AU - Lee, Shin-Da AU - Ma, Wei-Fen PY - 2024/4/29 TI - Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study JO - JMIR Form Res SP - e51076 VL - 8 KW - app quality KW - caregiver KW - dementia KW - geriatrics KW - aging KW - technology KW - digital health KW - mHealth KW - mobile health KW - seniors KW - mobile app KW - patient KW - adoption KW - development KW - management N2 - Background: The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps. Objective: The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers. Methods: We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads. Results: Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three? and bottom three?rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app?s perceived impact. Conclusions: The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app. UR - https://formative.jmir.org/2024/1/e51076 UR - http://dx.doi.org/10.2196/51076 UR - http://www.ncbi.nlm.nih.gov/pubmed/38684083 ID - info:doi/10.2196/51076 ER - TY - JOUR AU - Kandola, Aaron AU - Edwards, Kyra AU - Straatman, Joris AU - Dührkoop, Bettina AU - Hein, Bettina AU - Hayes, Joseph PY - 2024/4/29 TI - Digital Self-Management Platform for Adult Asthma: Randomized Attention-Placebo Controlled Trial JO - J Med Internet Res SP - e50855 VL - 26 KW - asthma KW - mobile health KW - self-management KW - randomized controlled trial KW - randomized KW - controlled trial KW - controlled trials KW - RCT KW - RCTs KW - respiratory KW - pulmonary KW - smartphone KW - platform KW - digital health KW - chronic KW - breathing KW - disease management KW - mHealth KW - app KW - apps KW - application KW - applications KW - mobile phone N2 - Background: Asthma is one of the most common chronic conditions worldwide, with a substantial individual and health care burden. Digital apps hold promise as a highly accessible, low-cost method of enhancing self-management in asthma, which is critical to effective asthma control. Objective: We conducted a fully remote randomized controlled trial (RCT) to assess the efficacy of juli, a commercially available smartphone self-management platform for asthma. Methods: We conducted a pragmatic single-blind, RCT of juli for asthma management. Our study included participants aged 18 years and older who self-identified as having asthma and had an Asthma Control Test (ACT) score of 19 or lower (indicating uncontrolled asthma) at the beginning of the trial. Participants were randomized (1:1 ratio) to receive juli for 8 weeks or a limited attention-placebo control version of the app. The primary outcome measure was the difference in ACT scores after 8 weeks. Secondary outcomes included remission (ACT score greater than 19), minimal clinically important difference (an improvement of 3 or more points on the ACT), worsening of asthma, and health-related quality of life. The primary analysis included participants using the app for 8 weeks (per-protocol analysis), and the secondary analysis used a modified intention-to-treat (ITT) analysis. Results: We randomized 411 participants between May 2021 and April 2023: a total of 152 (37%) participants engaged with the app for 8 weeks and were included in the per-protocol analysis, and 262 (63.7%) participants completed the week-2 outcome assessment and were included in the modified ITT analysis. Total attrition between baseline and week 8 was 259 (63%) individuals. In the per-protocol analysis, the intervention group had a higher mean ACT score (17.93, SD 4.72) than the control group (16.24, SD 5.78) by week 8 (baseline adjusted coefficient 1.91, 95% CI 0.31-3.51; P=.02). Participants using juli had greater odds of achieving or exceeding the minimal clinically important difference at 8 weeks (adjusted odds ratio 2.38, 95% CI 1.20-4.70; P=.01). There were no between group differences in the other secondary outcomes at 8 weeks. The results from the modified ITT analyses were similar. Conclusions: Users of juli had improved asthma symptom control over 8 weeks compared with users of a version of the app with limited functionality. These findings suggest that juli is an effective digital self-management platform that could augment existing care pathways for asthma. The retention of patients in RCTs and real-world use of digital health care apps is a major challenge. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN87679686; https://www.isrctn.com/ISRCTN87679686 UR - https://www.jmir.org/2024/1/e50855 UR - http://dx.doi.org/10.2196/50855 UR - http://www.ncbi.nlm.nih.gov/pubmed/38684084 ID - info:doi/10.2196/50855 ER - TY - JOUR AU - Yoon, Minjae AU - Lee, Seonhwa AU - Choi, Yeon Jah AU - Jung, Mi-Hyang AU - Youn, Jong-Chan AU - Shim, Young Chi AU - Choi, Jin-Oh AU - Kim, Ju Eung AU - Kim, Hyungseop AU - Yoo, Byung-Su AU - Son, Joo Yeon AU - Choi, Dong-Ju PY - 2024/4/29 TI - Effectiveness of a Smartphone App?Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial JO - J Med Internet Res SP - e52075 VL - 26 KW - heart failure KW - mobile applications KW - mobile health KW - self-care KW - vital sign monitoring KW - mobile phone N2 - Background: Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. Objective: We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app?based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. Methods: In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. Results: At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean ?1.3, SD 2.1 vs mean ?0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. Conclusions: The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app?based self-care strategies and feedback for patients with HF. Trial Registration: ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000 UR - https://www.jmir.org/2024/1/e52075 UR - http://dx.doi.org/10.2196/52075 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683665 ID - info:doi/10.2196/52075 ER - TY - JOUR AU - Cooper, Hal AU - Nadzri, Mohd Farah Zeehan AU - Vyas, Seema AU - Juhari, Rumaya AU - Ismail, Nellie AU - Arshat, Zarinah AU - Rajandiran, Durgesh AU - Markle, Laurie AU - Calderon, Francisco AU - Vallance, Inge AU - Melendez-Torres, J. G. AU - Facciolà, Chiara AU - Senesathith, Vanisa AU - Gardner, Frances AU - Lachman, M. Jamie PY - 2024/4/26 TI - A Hybrid Digital Parenting Program Delivered Within the Malaysian Preschool System: Protocol for a Feasibility Study of a Small-Scale Factorial Cluster Randomized Trial JO - JMIR Res Protoc SP - e55491 VL - 13 KW - parenting intervention KW - chatbot-led public health intervention KW - engagement KW - implementation science KW - feasibility KW - evidence-based program N2 - Background: The United Nations? Sustainable Development Goal 4, and particularly target 4.2, which seeks to ensure that, by 2030, all children have access to quality early childhood development, care, and preprimary education so that they are ready for primary education, is far from being achieved. The COVID-19 pandemic compromised progress by disrupting education, reducing access to well-being resources, and increasing family violence. Evidence from low- and middle-income countries suggests that in-person parenting interventions are effective at improving child learning and preventing family violence. However, scaling up these programs is challenging because of resource constraints. Integrating digital and human-delivered intervention components is a potential solution to these challenges. There is a need to understand the feasibility and effectiveness of such interventions in low-resource settings. Objective: This study aims to determine the feasibility and effectiveness of a digital parenting program (called Naungan Kasih in Bahasa Melayu [Protection through Love]) delivered in Malaysia, with varying combinations of 2 components included to encourage engagement. The study is framed around the following objectives: (1) to determine the recruitment, retention, and engagement rates in each intervention condition; (2) to document implementation fidelity; (3) to explore program acceptability among key stakeholders; (4) to estimate intervention costs; and (5) to provide indications of the effectiveness of the 2 components. Methods: This 10-week factorial cluster randomized trial compares ParentText, a chatbot that delivers parenting and family violence prevention content to caregivers of preschool-aged children in combination with 2 engagement components: (1) a WhatsApp support group and (2) either 1 or 2 in-person sessions. The trial aims to recruit 160 primary and 160 secondary caregivers of children aged 4-6 years from 8 schools split equally across 2 locations: Kuala Lumpur and Negeri Sembilan. The primary outcomes concern the feasibility and acceptability of the intervention and its components, including recruitment, retention, and engagement. The effectiveness outcomes include caregiver parenting practices, mental health and relationship quality, and child development. The evaluation involves mixed methods: quantitative caregiver surveys, digitally tracked engagement data of caregivers? use of the digital intervention components, direct assessments of children, and focus group discussions with caregivers and key stakeholders. Results: Overall, 208 parents were recruited at baseline December 2023: 151 (72.6%) primary caregivers and 57 (27.4%) secondary caregivers. In January 2024, of these 208 parents, 168 (80.8%) enrolled in the program, which was completed in February. Postintervention data collection was completed in March 2024. Findings will be reported in the second half of 2024. Conclusions: This is the first factorial cluster randomized trial to assess the feasibility of a hybrid human-digital playful parenting program in Southeast Asia. The results will inform a large-scale optimization trial to establish the most effective, cost-effective, and scalable version of the intervention. Trial Registration: OSF Registries; https://osf.io/f32ky International Registered Report Identifier (IRRID): DERR1-10.2196/55491 UR - https://www.researchprotocols.org/2024/1/e55491 UR - http://dx.doi.org/10.2196/55491 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669679 ID - info:doi/10.2196/55491 ER - TY - JOUR AU - Arring, Noel AU - Barton, L. Debra AU - Lafferty, Carolyn AU - Cox, Bryana AU - Conroy, A. Deirdre AU - An, Lawrence PY - 2024/4/26 TI - Mi Sleep Coach Mobile App to Address Insomnia Symptoms Among Cancer Survivors: Single-Arm Feasibility Study JO - JMIR Form Res SP - e55402 VL - 8 KW - cognitive behavioral therapy KW - insomnia KW - mobile health KW - breast cancer KW - prostate cancer KW - colon cancer KW - cancer survivor N2 - Background: Rates of sleep disturbance among survivors of cancer are more than 3 times higher than the general population. Causes of sleep disturbance among survivors are many and multifaceted, including anxiety and fear related to cancer diagnosis and treatments. Cognitive behavioral therapy for insomnia (CBT-I) is considered a first-line treatment for insomnia; However, a lack of access to trained professionals and limited insurance coverage for CBT-I services has limited patient access to these effective treatments. Evidence supports digital delivery of CBT-I (dCBT-I), but there is only limited evidence to support its use among survivors of cancer. Broad adoption of smartphone technology provides a new channel to deliver dCBT-I, but no prior studies have evaluated mobile dCBT-I interventions for survivors. To address the need for accessible and efficacious CBT-I for survivors of cancer, the Mi Sleep Coach program was developed to adapt CBT-I for delivery to survivors of cancer as a self-directed mobile health app. Objective: This single-arm feasibility study assessed the adherence, attrition, usefulness, and satisfaction of the Mi Sleep Coach app for insomnia. Methods: A 7-week, single-arm study was conducted, enrolling adult survivors of breast, prostate, or colon cancer reporting sleep disturbances. Results: In total, 30 participants were enrolled, with 100% completing the study and providing data through week 7. Further, 9 out of 10 app features were found to be useful by 80% (n=24) to 93% (n=28) of the 30 participants. Furthermore, 27 (90%) participants were satisfied with the Mi Sleep Coach app and 28 (93%) would recommend the use of the Mi Sleep Coach app for those with insomnia. The Insomnia Severity Index showed a decrease from baseline (18.5, SD 4.6) to week 7 (10.4, SD 4.2) of 8.1 (P<.001; Cohen d=1.5). At baseline, 25 (83%) participants scored in the moderate (n=19; 15-21) or severe (n=6; 22-28) insomnia range. At week 7, a total of 4 (13%) patients scored in the moderate (n=4) or severe (n=0) range. The number of patients taking prescription sleep medications decreased from 7 (23%) at baseline to 1 (3%; P<.001) at week 7. The number of patients taking over-the-counter sleep medications decreased from 14 (47%) at baseline to 9 (30%; P=.03) at week 7. Conclusions: The Mi Sleep Coach app demonstrated high levels of program adherence and user satisfaction and had large effects on the severity of insomnia among survivors of cancer. The Mi Sleep Coach app is a promising intervention for cancer-related insomnia, and further clinical trials are warranted. If proven to significantly decrease insomnia in survivors of cancer in future randomized controlled clinical trials, this intervention would provide more survivors of cancer with easy access to evidence-based CBT-I treatment. Trial Registration: ClinicalTrials.gov NCT04827459; https://clinicaltrials.gov/study/NCT04827459 UR - https://formative.jmir.org/2024/1/e55402 UR - http://dx.doi.org/10.2196/55402 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669678 ID - info:doi/10.2196/55402 ER - TY - JOUR AU - Benda, Natalie AU - Woode, Sydney AU - Niño de Rivera, Stephanie AU - Kalish, B. Robin AU - Riley, E. Laura AU - Hermann, Alison AU - Masterson Creber, Ruth AU - Costa Pimentel, Eric AU - Ancker, S. Jessica PY - 2024/4/26 TI - Understanding Symptom Self-Monitoring Needs Among Postpartum Black Patients: Qualitative Interview Study JO - J Med Internet Res SP - e47484 VL - 26 KW - maternal mortality KW - patient-reported outcomes KW - patient-reported outcome KW - health equity KW - qualitative research KW - mobile health KW - mHealth KW - qualitative KW - postpartum KW - postnatal KW - maternity KW - maternal KW - Black KW - women?s health KW - ethnic KW - design need KW - mortality KW - death KW - decision support KW - information need KW - informational need KW - obstetric KW - obstetrics KW - mental health KW - mobile phone N2 - Background: Pregnancy-related death is on the rise in the United States, and there are significant disparities in outcomes for Black patients. Most solutions that address pregnancy-related death are hospital based, which rely on patients recognizing symptoms and seeking care from a health system, an area where many Black patients have reported experiencing bias. There is a need for patient-centered solutions that support and encourage postpartum people to seek care for severe symptoms. Objective: We aimed to determine the design needs for a mobile health (mHealth) patient-reported outcomes and decision-support system to assist Black patients in assessing when to seek medical care for severe postpartum symptoms. These findings may also support different perinatal populations and minoritized groups in other clinical settings. Methods: We conducted semistructured interviews with 36 participants?15 (42%) obstetric health professionals, 10 (28%) mental health professionals, and 11 (31%) postpartum Black patients. The interview questions included the following: current practices for symptom monitoring, barriers to and facilitators of effective monitoring, and design requirements for an mHealth system that supports monitoring for severe symptoms. Interviews were audio recorded and transcribed. We analyzed transcripts using directed content analysis and the constant comparative process. We adopted a thematic analysis approach, eliciting themes deductively using conceptual frameworks from health behavior and human information processing, while also allowing new themes to inductively arise from the data. Our team involved multiple coders to promote reliability through a consensus process. Results: Our findings revealed considerations related to relevant symptom inputs for postpartum support, the drivers that may affect symptom processing, and the design needs for symptom self-monitoring and patient decision-support interventions. First, participants viewed both somatic and psychological symptom inputs as important to capture. Second, self-perception; previous experience; sociocultural, financial, environmental, and health systems?level factors were all perceived to impact how patients processed, made decisions about, and acted upon their symptoms. Third, participants provided recommendations for system design that involved allowing for user control and freedom. They also stressed the importance of careful wording of decision-support messages, such that messages that recommend them to seek care convey urgency but do not provoke anxiety. Alternatively, messages that recommend they may not need care should make the patient feel heard and reassured. Conclusions: Future solutions for postpartum symptom monitoring should include both somatic and psychological symptoms, which may require combining existing measures to elicit symptoms in a nuanced manner. Solutions should allow for varied, safe interactions to suit individual needs. While mHealth or other apps may not be able to address all the social or financial needs of a person, they may at least provide information, so that patients can easily access other supportive resources. UR - https://www.jmir.org/2024/1/e47484 UR - http://dx.doi.org/10.2196/47484 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669066 ID - info:doi/10.2196/47484 ER - TY - JOUR AU - Hu, Lu AU - Wyatt, C. Laura AU - Mohsin, Farhan AU - Lim, Sahnah AU - Zanowiak, Jennifer AU - Mammen, Shinu AU - Hussain, Sarah AU - Ali, H. Shahmir AU - Onakomaiya, Deborah AU - Belli, M. Hayley AU - Aifah, Angela AU - Islam, S. Nadia PY - 2024/4/26 TI - Characterizing Technology Use and Preferences for Health Communication in South Asian Immigrants With Prediabetes or Diabetes: Cross-Sectional Descriptive Study JO - JMIR Form Res SP - e52687 VL - 8 KW - South Asian immigrants KW - type 2 diabetes KW - technology access KW - technology use KW - prediabetes KW - health disparities KW - mHealth KW - health equity KW - immigrant health KW - mobile health KW - smartphone KW - diabetes KW - diabetic KW - DM KW - diabetes mellitus KW - immigrants KW - prevention KW - regression KW - regression model KW - logistic regression KW - mobile health interventions N2 - Background: Type 2 diabetes disproportionately affects South Asian subgroups. Lifestyle prevention programs help prevent and manage diabetes; however, there is a need to tailor these programs for mobile health (mHealth). Objective: This study examined technology access, current use, and preferences for health communication among South Asian immigrants diagnosed with or at risk for diabetes, overall and by sex. We examined factors associated with interest in receiving diabetes information by (1) text message, (2) online (videos, voice notes, online forums), and (3) none or skipped, adjusting for sociodemographic characteristics and technology access. Methods: We used baseline data collected in 2019-2021 from two clinical trials among South Asian immigrants in New York City (NYC), with one trial focused on diabetes prevention and the other focused on diabetes management. Descriptive statistics were used to examine overall and sex-stratified impacts of sociodemographics on technology use. Overall logistic regression was used to examine the preference for diabetes information by text message, online (videos, voice notes, or forums), and no interest/skipped response. Results: The overall sample (N=816) had a mean age of 51.8 years (SD 11.0), and was mostly female (462/816, 56.6%), married (756/816, 92.6%), with below high school education (476/816, 58.3%) and limited English proficiency (731/816, 89.6%). Most participants had a smartphone (611/816, 74.9%) and reported interest in receiving diabetes information via text message (609/816, 74.6%). Compared to male participants, female participants were significantly less likely to own smartphones (317/462, 68.6% vs 294/354, 83.1%) or use social media apps (Viber: 102/462, 22.1% vs 111/354, 31.4%; WhatsApp: 279/462, 60.4% vs 255/354, 72.0%; Facebook: Messenger 72/462, 15.6% vs 150/354, 42.4%). A preference for receiving diabetes information via text messaging was associated with male sex (adjusted odds ratio [AOR] 1.63, 95% CI 1.01-2.55; P=.04), current unemployment (AOR 1.62, 95% CI 1.03-2.53; P=.04), above high school education (AOR 2.17, 95% CI 1.41-3.32; P<.001), and owning a smart device (AOR 3.35, 95% CI 2.17-5.18; P<.001). A preference for videos, voice notes, or online forums was associated with male sex (AOR 2.38, 95% CI 1.59-3.57; P<.001) and ownership of a smart device (AOR 5.19, 95% CI 2.83-9.51; P<.001). No interest/skipping the question was associated with female sex (AOR 2.66, 95% CI 1.55-4.56; P<.001), high school education or below (AOR 2.02, 95% CI 1.22-3.36; P=.01), not being married (AOR 2.26, 95% CI 1.13-4.52; P=.02), current employment (AOR 1.96, 95% CI 1.18-3.29; P=.01), and not owning a smart device (AOR 2.06, 95% CI 2.06-5.44; P<.001). Conclusions: Technology access and social media usage were moderately high in primarily low-income South Asian immigrants in NYC with prediabetes or diabetes. Sex, education, marital status, and employment were associated with interest in mHealth interventions. Additional support to South Asian women may be required when designing and developing mHealth interventions. Trial Registration: ClinicalTrials.gov NCT03333044; https://classic.clinicaltrials.gov/ct2/show/NCT03333044, ClinicalTrials.gov NCT03188094; https://classic.clinicaltrials.gov/ct2/show/NCT03188094 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3711-y UR - https://formative.jmir.org/2024/1/e52687 UR - http://dx.doi.org/10.2196/52687 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669062 ID - info:doi/10.2196/52687 ER - TY - JOUR AU - Hirten, P. Robert AU - Danieletto, Matteo AU - Landell, Kyle AU - Zweig, Micol AU - Golden, Eddye AU - Pyzik, Renata AU - Kaur, Sparshdeep AU - Chang, Helena AU - Helmus, Drew AU - Sands, E. Bruce AU - Charney, Dennis AU - Nadkarni, Girish AU - Bagiella, Emilia AU - Keefer, Laurie AU - Fayad, A. Zahi PY - 2024/4/25 TI - Remote Short Sessions of Heart Rate Variability Biofeedback Monitored With Wearable Technology: Open-Label Prospective Feasibility Study JO - JMIR Ment Health SP - e55552 VL - 11 KW - biofeedback KW - digital health KW - digital technology KW - health care worker KW - HCW KW - heart rate variability KW - mHealth KW - mobile health KW - mobile phone KW - remote monitoring KW - smartphone KW - wearable devices N2 - Background: Heart rate variability (HRV) biofeedback is often performed with structured education, laboratory-based assessments, and practice sessions. It has been shown to improve psychological and physiological function across populations. However, a means to remotely use and monitor this approach would allow for wider use of this technique. Advancements in wearable and digital technology present an opportunity for the widespread application of this approach. Objective: The primary aim of the study was to determine the feasibility of fully remote, self-administered short sessions of HRV-directed biofeedback in a diverse population of health care workers (HCWs). The secondary aim was to determine whether a fully remote, HRV-directed biofeedback intervention significantly alters longitudinal HRV over the intervention period, as monitored by wearable devices. The tertiary aim was to estimate the impact of this intervention on metrics of psychological well-being. Methods: To determine whether remotely implemented short sessions of HRV biofeedback can improve autonomic metrics and psychological well-being, we enrolled HCWs across 7 hospitals in New York City in the United States. They downloaded our study app, watched brief educational videos about HRV biofeedback, and used a well-studied HRV biofeedback program remotely through their smartphone. HRV biofeedback sessions were used for 5 minutes per day for 5 weeks. HCWs were then followed for 12 weeks after the intervention period. Psychological measures were obtained over the study period, and they wore an Apple Watch for at least 7 weeks to monitor the circadian features of HRV. Results: In total, 127 HCWs were enrolled in the study. Overall, only 21 (16.5%) were at least 50% compliant with the HRV biofeedback intervention, representing a small portion of the total sample. This demonstrates that this study design does not feasibly result in adequate rates of compliance with the intervention. Numerical improvement in psychological metrics was observed over the 17-week study period, although it did not reach statistical significance (all P>.05). Using a mixed effect cosinor model, the mean midline-estimating statistic of rhythm (MESOR) of the circadian pattern of the SD of the interbeat interval of normal sinus beats (SDNN), an HRV metric, was observed to increase over the first 4 weeks of the biofeedback intervention in HCWs who were at least 50% compliant. Conclusions: In conclusion, we found that using brief remote HRV biofeedback sessions and monitoring its physiological effect using wearable devices, in the manner that the study was conducted, was not feasible. This is considering the low compliance rates with the study intervention. We found that remote short sessions of HRV biofeedback demonstrate potential promise in improving autonomic nervous function and warrant further study. Wearable devices can monitor the physiological effects of psychological interventions. UR - https://mental.jmir.org/2024/1/e55552 UR - http://dx.doi.org/10.2196/55552 UR - http://www.ncbi.nlm.nih.gov/pubmed/38663011 ID - info:doi/10.2196/55552 ER - TY - JOUR AU - Kim, Yuyoung AU - Kim, Minjung AU - Kim, Jinwoo AU - Song, Tae-Jin PY - 2024/4/25 TI - Smartphone-Based Speech Therapy for Poststroke Dysarthria: Pilot Randomized Controlled Trial Evaluating Efficacy and Feasibility JO - J Med Internet Res SP - e56417 VL - 26 KW - dysarthria KW - stroke KW - smartphone KW - speech therapy KW - app KW - acute and early subacute KW - feasibility KW - mobile phone N2 - Background: Dysarthria is a common poststroke speech disorder affecting communication and psychological well-being. Traditional speech therapy is effective but often poses challenges in terms of accessibility and patient adherence. Emerging smartphone-based therapies may offer promising alternatives for the treatment of poststroke dysarthria. Objective: This study aimed to assess the efficacy and feasibility of smartphone-based speech therapy for improving speech intelligibility in patients with acute and early subacute poststroke dysarthria. This study also explored the impact of the intervention on psychological well-being, user experience, and overall feasibility in a clinical setting. Methods: Participants were divided into 2 groups for this randomized, evaluator-blinded trial. The intervention group used a smartphone-based speech therapy app for 1 hour per day, 5 days per week, for 4 weeks, with guideline-based standard stroke care. The control group received standard guideline-based stroke care and rehabilitation. Speech intelligibility, psychological well-being, quality of life, and user acceptance were assessed using repeated measures ANOVA. Results: In this study, 40 patients with poststroke dysarthria were enrolled, 32 of whom completed the trial (16 in each group). The intervention group showed significant improvements in speech intelligibility compared with the control group. This was evidenced by improvements from baseline (F1,30=34.35; P<.001), between-group differences (F1,30=6.18; P=.02), and notable time-by-group interactions (F1,30=6.91; P=.01). Regarding secondary outcomes, the intervention led to improvements in the percentage of correct consonants over time (F1,30=5.57; P=.03). In addition, significant reductions were noted in the severity of dysarthria in the intervention group over time (F1,30=21.18; P<.001), with a pronounced group effect (F1,30=5.52; P=.03) and time-by-group interaction (F1,30=5.29; P=.03). Regarding quality of life, significant improvements were observed as measured by the EQ-5D-3L questionnaire (F1,30=13.25; P<.001) and EQ-VAS (F1,30=7.74; P=.009) over time. The adherence rate to the smartphone-based app was 64%, with over half of the participants completing all the sessions. The usability of the app was rated high (system usability score 80.78). In addition, the intervention group reported increased self-efficacy in using the app compared with the control group (F1,30=10.81; P=.003). Conclusions: The smartphone-based speech therapy app significantly improved speech intelligibility, articulation, and quality of life in patients with poststroke dysarthria. These findings indicate that smartphone-based speech therapy can be a useful assistant device in the management of poststroke dysarthria, particularly in the acute and early subacute stroke stages. Trial Registration: ClinicalTrials.gov NCT05146765; https://clinicaltrials.gov/ct2/show/NCT05146765 UR - https://www.jmir.org/2024/1/e56417 UR - http://dx.doi.org/10.2196/56417 UR - http://www.ncbi.nlm.nih.gov/pubmed/38509662 ID - info:doi/10.2196/56417 ER - TY - JOUR AU - Tremoulet, D. Patrice AU - Lobo, F. Andrea AU - Simmons, A. Christina AU - Baliga, Ganesh AU - Brady, Matthew PY - 2024/4/25 TI - Assessing the Usability and Feasibility of Digital Assistant Tools for Direct Support Professionals: Participatory Design and Pilot-Testing JO - JMIR Hum Factors SP - e51612 VL - 11 KW - technology prototype KW - data collection KW - documentation KW - direct support professionals KW - intellectual and developmental disabilities KW - pilot test KW - mobile phone N2 - Background: The United States is experiencing a direct support professional (DSP) crisis, with demand far exceeding supply. Although generating documentation is a critical responsibility, it is one of the most wearisome aspects of DSPs? jobs. Technology that enables DSPs to log informal time-stamped notes throughout their shift could help reduce the burden of end-of-shift documentation and increase job satisfaction, which in turn could improve the quality of life of the individuals with intellectual and developmental disabilities (IDDs) whom DSPs support. However, DSPs, with varied ages, levels of education, and comfort using technology, are not likely to adopt tools that detract from caregiving responsibilities or increase workload; therefore, technological tools for them must be relatively simple, extremely intuitive, and provide highly valued capabilities. Objective: This paper describes the development and pilot-testing of a digital assistant tool (DAT) that enables DSPs to create informal notes throughout their shifts and use these notes to facilitate end-of-shift documentation. The purpose of the pilot study was to assess the usability and feasibility of the DAT. Methods: The research team applied an established user-centered participatory design process to design, develop, and test the DAT prototypes between May 2020 and April 2023. Pilot-testing entailed having 14 DSPs who support adults with IDDs use the first full implementation of the DAT prototypes during 2 or 3 successive work shifts and fill out demographic and usability questionnaires. Results: Participants used the DAT prototypes to create notes and help generate end-of-shift reports. The System Usability Scale score of 81.79 indicates that they found the prototypes easy to use. Survey responses imply that using the DAT made it easier for participants to produce required documentation and suggest that they would adopt the DAT if this tool were available for daily use. Conclusions: Simple technologies such as the DAT prototypes, which enable DSPs to use mobile devices to log time-stamped notes throughout their shift with minimal effort and use the notes to help write reports, have the potential to both reduce the burden associated with producing documentation and enhance the quality (level of detail and accuracy) of this documentation. This could help to increase job satisfaction and reduce turnover in DSPs, both of which would help improve the quality of life of the individuals with IDDs whom they support. The pilot test results indicate that DSPs found the DAT easy to use. Next steps include (1) producing more robust versions of the DAT with additional capabilities, such as storing data locally on mobile devices when Wi-Fi is not available; and (2) eliciting input from agency directors, families, and others who use data about adults with IDDs to help care for them to ensure that data produced by DSPs are relevant and useful. UR - https://humanfactors.jmir.org/2024/1/e51612 UR - http://dx.doi.org/10.2196/51612 UR - http://www.ncbi.nlm.nih.gov/pubmed/38662420 ID - info:doi/10.2196/51612 ER - TY - JOUR AU - Lu, Yinn Si AU - Yoon, Sungwon AU - Yee, Qi Wan AU - Heng Wen Ngiam, Nerice AU - Ng, Yi Kennedy Yao AU - Low, Leng Lian PY - 2024/4/25 TI - Experiences of a Community-Based Digital Intervention Among Older People Living in a Low-Income Neighborhood: Qualitative Study JO - JMIR Aging SP - e52292 VL - 7 KW - digital divide KW - digital learning KW - smartphones KW - social gerontology KW - older adults KW - COVID-19 pandemic KW - technology adoption N2 - Background: Older adults worldwide experienced heightened risks of depression, anxiety, loneliness, and poor mental well-being during the COVID-19 pandemic. During this period, digital technology emerged as a means to mitigate social isolation and enhance social connectedness among older adults. However, older adults? behaviors and attitudes toward the adoption and use of digital technology are heterogeneous and shaped by factors such as age, income, and education. Few empirical studies have examined how older adults experiencing social and economic disadvantages perceive the learning of digital tools. Objective: This study aims to examine the motivations, experiences, and perceptions toward a community-based digital intervention among older adults residing in public rental flats in a low-income neighborhood. Specifically, we explored how their attitudes and behaviors toward learning the use of smartphones are shaped by their experiences related to age and socioeconomic challenges. Methods: This study adopted a qualitative methodology. Between December 2020 and March 2021, we conducted semistructured in-depth interviews with 19 participants aged ?60 years who had completed the community-based digital intervention. We asked participants questions about the challenges encountered amid the pandemic, their perceived benefits of and difficulties with smartphone use, and their experiences with participating in the intervention. All interviews were audio recorded and analyzed using a reflexive thematic approach. Results: Although older learners stated varying levels of motivation to learn, most expressed ambivalence about the perceived utility and relevance of the smartphone to their current needs and priorities. While participants valued the social interaction with volunteers and the personalized learning model of the digital intervention, they also articulated barriers such as age-related cognitive and physical limitations and language and illiteracy that hindered their sustained use of these digital devices. Most importantly, the internalization of ageist stereotypes of being less worthy learners and the perception of smartphone use as being in the realm of the privileged other further reduced self-efficacy and interest in learning. Conclusions: To improve learning and sustained use of smartphones for older adults with low income, it is essential to explore avenues that render digital tools pertinent to their daily lives, such as creating opportunities for social connections and relationship building. Future studies should investigate the relationships between older adults? social, economic, and health marginality and their ability to access digital technologies. We recommend that the design and implementation of digital interventions should prioritize catering to the needs and preferences of various segments of older adults, while working to bridge rather than perpetuate the digital divide. UR - https://aging.jmir.org/2024/1/e52292 UR - http://dx.doi.org/10.2196/52292 UR - http://www.ncbi.nlm.nih.gov/pubmed/38662423 ID - info:doi/10.2196/52292 ER - TY - JOUR AU - Nakajima, Yuki AU - Kitayama, Asami AU - Ohta, Yuji AU - Motooka, Nobuhisa AU - Kuno-Mizumura, Mayumi AU - Miyachi, Motohiko AU - Tanaka, Shigeho AU - Ishikawa-Takata, Kazuko AU - Tripette, Julien PY - 2024/4/25 TI - Objective Assessment of Physical Activity at Home Using a Novel Floor-Vibration Monitoring System: Validation and Comparison With Wearable Activity Trackers and Indirect Calorimetry Measurements JO - JMIR Form Res SP - e51874 VL - 8 KW - smart home system KW - physical behavior KW - physical activity KW - activity tracker KW - floor vibration KW - housework-related activity KW - home-based activity KW - mobile phone N2 - Background: The self-monitoring of physical activity is an effective strategy for promoting active lifestyles. However, accurately assessing physical activity remains challenging in certain situations. This study evaluates a novel floor-vibration monitoring system to quantify housework-related physical activity. Objective: This study aims to assess the validity of step-count and physical behavior intensity predictions of a novel floor-vibration monitoring system in comparison with the actual number of steps and indirect calorimetry measurements. The accuracy of the predictions is also compared with that of research-grade devices (ActiGraph GT9X). Methods: The Ocha-House, located in Tokyo, serves as an independent experimental facility equipped with high-sensitivity accelerometers installed on the floor to monitor vibrations. Dedicated data processing software was developed to analyze floor-vibration signals and calculate 3 quantitative indices: floor-vibration quantity, step count, and moving distance. In total, 10 participants performed 4 different housework-related activities, wearing ActiGraph GT9X monitors on both the waist and wrist for 6 minutes each. Concurrently, floor-vibration data were collected, and the energy expenditure was measured using the Douglas bag method to determine the actual intensity of activities. Results: Significant correlations (P<.001) were found between the quantity of floor vibrations, the estimated step count, the estimated moving distance, and the actual activity intensities. The step-count parameter extracted from the floor-vibration signal emerged as the most robust predictor (r2=0.82; P<.001). Multiple regression models incorporating several floor-vibration?extracted parameters showed a strong association with actual activity intensities (r2=0.88; P<.001). Both the step-count and intensity predictions made by the floor-vibration monitoring system exhibited greater accuracy than those of the ActiGraph monitor. Conclusions: Floor-vibration monitoring systems seem able to produce valid quantitative assessments of physical activity for selected housework-related activities. In the future, connected smart home systems that integrate this type of technology could be used to perform continuous and accurate evaluations of physical behaviors throughout the day. UR - https://formative.jmir.org/2024/1/e51874 UR - http://dx.doi.org/10.2196/51874 UR - http://www.ncbi.nlm.nih.gov/pubmed/38662415 ID - info:doi/10.2196/51874 ER - TY - JOUR AU - Ahmed, Sabbir Md AU - Hasan, Tanvir AU - Islam, Salekul AU - Ahmed, Nova PY - 2024/4/24 TI - Investigating Rhythmicity in App Usage to Predict Depressive Symptoms: Protocol for Personalized Framework Development and Validation Through a Countrywide Study JO - JMIR Res Protoc SP - e51540 VL - 13 KW - depressive symptoms KW - app usage rhythm KW - behavioral markers KW - personalization KW - multitask learning framework N2 - Background: Understanding a student?s depressive symptoms could facilitate significantly more precise diagnosis and treatment. However, few studies have focused on depressive symptom prediction through unobtrusive systems, and these studies are limited by small sample sizes, low performance, and the requirement for higher resources. In addition, research has not explored whether statistically significant rhythms based on different app usage behavioral markers (eg, app usage sessions) exist that could be useful in finding subtle differences to predict with higher accuracy like the models based on rhythms of physiological data. Objective: The main objective of this study is to explore whether there exist statistically significant rhythms in resource-insensitive app usage behavioral markers and predict depressive symptoms through these marker-based rhythmic features. Another objective of this study is to understand whether there is a potential link between rhythmic features and depressive symptoms. Methods: Through a countrywide study, we collected 2952 students? raw app usage behavioral data and responses to the 9 depressive symptoms in the 9-item Patient Health Questionnaire (PHQ-9). The behavioral data were retrieved through our developed app, which was previously used in our pilot studies in Bangladesh on different research problems. To explore whether there is a rhythm based on app usage data, we will conduct a zero-amplitude test. In addition, we will develop a cosinor model for each participant to extract rhythmic parameters (eg, acrophase). In addition, to obtain a comprehensive picture of the rhythms, we will explore nonparametric rhythmic features (eg, interdaily stability). Furthermore, we will conduct regression analysis to understand the association of rhythmic features with depressive symptoms. Finally, we will develop a personalized multitask learning (MTL) framework to predict symptoms through rhythmic features. Results: After applying inclusion criteria (eg, having app usage data of at least 2 days to explore rhythmicity), we kept the data of 2902 (98.31%) students for analysis, with 24.48 million app usage events, and 7 days? app usage of 2849 (98.17%) students. The students are from all 8 divisions of Bangladesh, both public and private universities (19 different universities and 52 different departments). We are analyzing the data and will publish the findings in a peer-reviewed publication. Conclusions: Having an in-depth understanding of app usage rhythms and their connection with depressive symptoms through a countrywide study can significantly help health care professionals and researchers better understand depressed students and may create possibilities for using app usage?based rhythms for intervention. In addition, the MTL framework based on app usage rhythmic features may more accurately predict depressive symptoms due to the rhythms? capability to find subtle differences. International Registered Report Identifier (IRRID): DERR1-10.2196/51540 UR - https://www.researchprotocols.org/2024/1/e51540 UR - http://dx.doi.org/10.2196/51540 UR - http://www.ncbi.nlm.nih.gov/pubmed/38657238 ID - info:doi/10.2196/51540 ER - TY - JOUR AU - Tate, D. Allan AU - Fertig, R. Angela AU - de Brito, N. Junia AU - Ellis, M. Émilie AU - Carr, Patrick Christopher AU - Trofholz, Amanda AU - Berge, M. Jerica PY - 2024/4/24 TI - Momentary Factors and Study Characteristics Associated With Participant Burden and Protocol Adherence: Ecological Momentary Assessment JO - JMIR Form Res SP - e49512 VL - 8 KW - adherence KW - burden KW - data quality KW - ecological momentary assessment KW - mental health KW - mHealth KW - mobile health KW - participant adherence KW - public health KW - stress KW - study design KW - survey burden KW - survey N2 - Background: Ecological momentary assessment (EMA) has become a popular mobile health study design to understand the lived experiences of dynamic environments. The numerous study design choices available to EMA researchers, however, may quickly increase participant burden and could affect overall adherence, which could limit the usability of the collected data. Objective: This study quantifies what study design, participant attributes, and momentary factors may affect self-reported burden and adherence. Methods: The EMA from the Phase 1 Family Matters Study (n=150 adult Black, Hmong, Latino or Latina, Native American, Somali, and White caregivers; n=1392 observation days) was examined to understand how participant self-reported survey burden was related to both design and momentary antecedents of adherence. The daily burden was measured by the question ?Overall, how difficult was it for you to fill out the surveys today?? on a 5-item Likert scale (0=not at all and 4=extremely). Daily protocol adherence was defined as completing at least 2 signal-contingent surveys, 1 event-contingent survey, and 1 end-of-day survey each. Stress and mood were measured earlier in the day, sociodemographic and psychosocial characteristics were reported using a comprehensive cross-sectional survey, and EMA timestamps for weekends and weekdays were used to parameterize time-series models to evaluate prospective correlates of end-of-day study burden. Results: The burden was low at 1.2 (SD 1.14) indicating ?a little? burden on average. Participants with elevated previous 30-day chronic stress levels (mean burden difference: 0.8; P=.04), 1 in 5 more immigrant households (P=.02), and the language primarily spoken in the home (P=.04; 3 in 20 more non-English?speaking households) were found to be population attributes of elevated moderate-high burden. Current and 1-day lagged nonadherence were correlated with elevated 0.39 and 0.36 burdens, respectively (P=.001), and the association decayed by the second day (?=0.08; P=.47). Unit increases in momentary antecedents, including daily depressed mood (P=.002) and across-day change in stress (P=.008), were positively associated with 0.15 and 0.07 higher end-of-day burdens after controlling for current-day adherence. Conclusions: The 8-day EMA implementation appeared to capture momentary sources of stress and depressed mood without substantial burden to a racially or ethnically diverse and immigrant or refugee sample of parents. Attention to sociodemographic attributes (eg, EMA in the primary language of the caregiver) was important for minimizing participant burden and improving data quality. Momentary stress and depressed mood were strong determinants of participant-experienced EMA burden and may affect adherence to mobile health study protocols. There were no strong indicators of EMA design attributes that created a persistent burden for caregivers. EMA stands to be an important observational design to address dynamic public health challenges related to human-environment interactions when the design is carefully tailored to the study population and to study research objectives. UR - https://formative.jmir.org/2024/1/e49512 UR - http://dx.doi.org/10.2196/49512 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656787 ID - info:doi/10.2196/49512 ER - TY - JOUR AU - Lam, T. Lawrence AU - Lam, P. Mary K. PY - 2024/4/23 TI - A Web-Based and Mobile Intervention Program Using a Spaced Education Approach for Workplace Mental Health Literacy: Cluster Randomized Controlled Trial JO - JMIR Ment Health SP - e51791 VL - 11 KW - mHealth KW - web-based intervention KW - mental health literacy KW - psychoeducation KW - randomized controlled trial KW - workplace KW - performance KW - worker KW - intervention KW - digital health KW - mental wellness KW - promote KW - well-being KW - mobile health KW - technology N2 - Background: Workplace mental health is an important global health concern. Objectives: This unblinded, phase-III, wait-listed cluster randomized controlled trial aimed to examine the effectiveness of a mobile health (mHealth) psychoeducation program using a spaced education approach on mental health literacy (MHL) in the workplace. The main interest of this paper was the immediate and 3-month medium-term effect of the program on the MHL of workers. The purposely built mHealth platform was also evaluated as a health-related app. Methods: The mHealth platform was designed using the principle of spaced education as a psychoeducation intervention program, with various modules of web-based and mobile materials presented to the participant in a progressive manner. Short quizzes at the end of each module ensured adequate learning, and successful completion qualified the learner to progress to the next level. The trial recruited 456 employees of specific industries with high levels of work-related stress. Participants who were nested in different offices or units were allocated into the intervention and wait-listed control groups using a block randomization process, with the office or unit as the cluster. A separate sample of 70 individual raters were used for the evaluation of the mHealth platform. The Australian National MHL and Stigma Survey and the Mobile Apps Rating Scale were completed through a web-based self-reported survey to assess MHL and evaluate the app. The trial and follow-up data were analyzed by a generalized linear latent and mixed model with adjustments for the clustering effect of work sites and repeated measures. Results: Of the 456 participants in the trial, 236 (51.8%) responded to the follow-up survey. Most MHL outcomes obtained significant results immediately after the intervention and across time. After adjusting for the clustering effect, the postintervention weighted mean scores were significantly higher in the intervention group than the control group for correct recognition of a mental health problem, help seeking, and stigmatization by 0.2 (SE 0.1; P=.003), 0.9 (SE 0.2; P<.001), and 1.8 (SE 0.4; P<.001), respectively. After adjusting for the clustering effect, significant differences across time were found in help-seeking intention (P=.01), stigmatization (P<.001), and social distancing (P<.001). The evaluation of the mHealth program resulted in average scores of the 4 major domains ranging from 3.8 to 4.2, with engagement having the lowest score. Conclusions: The mHealth psychoeducation intervention program using this platform had immediate and 3-month medium-term effects of retaining and improving MHL. The platform was evaluated to have satisfactory performance in terms of functionality, aesthetics, information content, and utility in enhancing MHL. It is anticipated that ongoing development in digital health will provide great benefits in improving the mental health of the global population. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000464167; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377176 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3748-y UR - https://mental.jmir.org/2024/1/e51791 UR - http://dx.doi.org/10.2196/51791 ID - info:doi/10.2196/51791 ER - TY - JOUR AU - Giebel, Denk Godwin AU - Abels, Carina AU - Plescher, Felix AU - Speckemeier, Christian AU - Schrader, Frederik Nils AU - Börchers, Kirstin AU - Wasem, Jürgen AU - Neusser, Silke AU - Blase, Nikola PY - 2024/4/23 TI - Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study JO - J Med Internet Res SP - e49982 VL - 26 KW - mobile health KW - mHealth KW - mHealth app KW - patient KW - problems KW - barriers KW - digital health applications KW - DiGA KW - app KW - barrier KW - mobile app KW - health care system KW - economic outcome KW - context KW - mobile phone N2 - Background: Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered. Objective: The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients. Methods: Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories (?validity,? ?usability,? ?technology,? ?use and adherence,? ?data privacy and security,? ?patient-physician relationship,? ?knowledge and skills,? ?individuality,? ?implementation,? and ?costs?) identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology. Results: A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention. Conclusions: There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients. UR - https://www.jmir.org/2024/1/e49982 UR - http://dx.doi.org/10.2196/49982 UR - http://www.ncbi.nlm.nih.gov/pubmed/38652508 ID - info:doi/10.2196/49982 ER - TY - JOUR AU - Polus, Manria AU - Keikhosrokiani, Pantea AU - Korhonen, Olli AU - Behutiye, Woubshet AU - Isomursu, Minna PY - 2024/4/23 TI - Impact of Digital Interventions on the Treatment Burden of Patients With Chronic Conditions: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e54833 VL - 13 KW - chronic illness KW - treatment burden KW - eHealth KW - mHealth KW - digital health KW - mobile health N2 - Background: There is great potential for delivering cost-effective, quality health care for patients with chronic conditions through digital interventions. Managing chronic conditions often includes a substantial workload required for adhering to the treatment regimen and negative consequences on the patient?s function and well-being. This treatment burden affects adherence to treatment and disease outcomes. Digital interventions can potentially exacerbate the burden but also alleviate it. Objective: The objective of this review is to identify, summarize, and synthesize the evidence of how digital interventions impact the treatment burden of people with chronic conditions. Methods: The search, selection, and data synthesis processes were designed according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015. A systematic search was conducted on October 16, 2023, from databases PubMed, Scopus, Web of Science, ACM, PubMed Central, and CINAHL. Results: Preliminary searches have been conducted, and screening has been started. The review is expected to be completed in October 2024. Conclusions: As the number of patients with chronic conditions is increasing, it is essential to design new digital interventions for managing chronic conditions in a way that supports patients with their treatment burden. To the best of our knowledge, the proposed systematic review will be the first review that investigates the impact of digital interventions on the treatment burden of patients. The results of this review will contribute to the field of health informatics regarding knowledge of the treatment burden associated with digital interventions and practical implications for developing better digital health care for patients with chronic conditions. Trial Registration: PROSPERO CRD42023477605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=477605 International Registered Report Identifier (IRRID): DERR1-10.2196/54833 UR - https://www.researchprotocols.org/2024/1/e54833 UR - http://dx.doi.org/10.2196/54833 UR - http://www.ncbi.nlm.nih.gov/pubmed/38652531 ID - info:doi/10.2196/54833 ER - TY - JOUR AU - Smith, M. Sharissa AU - Bais, Babette AU - Ismaili M'hamdi, Hafez AU - Schermer, HN Maartje AU - Steegers-Theunissen, PM Régine PY - 2024/4/22 TI - Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study JO - JMIR Hum Factors SP - e53614 VL - 11 KW - preconception care KW - mHealth KW - mobile health KW - pregnancy preparation KW - nudge KW - health inequality KW - socioeconomic status KW - lifestyle KW - women KW - pregnancy KW - pregnant women KW - pregnant KW - socioeconomic KW - pilot feasibility study KW - mHealth app KW - mHealth application KW - app KW - application KW - risk factor KW - nutrition KW - stress KW - chronic stress KW - health literacy KW - usability KW - user satisfaction KW - user KW - users N2 - Background: A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. Objective: This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. Methods: Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. Results: Due to limited inclusions, the inclusion criterion ?living in a deprived neighborhood? was dropped. This resulted in the inclusion of 47 women, of whom 39 (83%) completed the intervention. In total, 16 (41%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. Conclusions: Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. International Registered Report Identifier (IRRID): RR2-10.2196/45293 UR - https://humanfactors.jmir.org/2024/1/e53614 UR - http://dx.doi.org/10.2196/53614 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648092 ID - info:doi/10.2196/53614 ER - TY - JOUR AU - Foster, Marva AU - Fix, M. Gemmae AU - Hyde, Justeen AU - Dunlap, Shawn AU - Byrne, H. Thomas AU - Sugie, F. Naomi AU - Kuhn, Randall AU - Gabrielian, Sonya AU - Roncarati, S. Jill AU - Zhao, Shibei AU - McInnes, Keith D. PY - 2024/4/22 TI - Capturing the Dynamics of Homelessness Through Ethnography and Mobile Technology: Protocol for the Development and Testing of a Smartphone Technology?Supported Intervention JO - JMIR Res Protoc SP - e53022 VL - 13 KW - ethnography KW - homelessness KW - housing transitions KW - longitudinal data KW - military KW - mobile technology KW - smartphone KW - social support KW - veterans N2 - Background: US military veterans who have experienced homelessness often have high rates of housing transition. Disruptions caused by these transitions likely exacerbate this population?s health problems and interfere with access to care and treatment engagement. Individuals experiencing homelessness increasingly use smartphones, contributing to improved access to medical and social services. Few studies have used smartphones as a data collection tool to systematically collect information about the daily life events that precede and contribute to housing transitions, in-the-moment emotions, behaviors, geographic movements, and perceived social support. Objective: The study aims to develop and test a smartphone app to collect longitudinal data from veterans experiencing homelessness (VEH) and to evaluate the feasibility and acceptability of using the app in a population that is unstably housed or homeless. Methods: This study?s design had 3 phases. Phase 1 used ethnographic methods to capture detailed data on day-to-day lived experiences of up to 30 VEH on topics such as housing stability, health, and health behaviors. Phase 2 involved focus groups and usability testing to develop and refine mobile phone data collection methods. Phase 3 piloted the smartphone mobile data collection with 30 VEH. We included mobile ethnography, real-time surveys through an app, and the collection of GPS data in phase 3. Results: The project was launched in June 2020, and at this point, some data collection and analysis for phases 1 and 2 are complete. This project is currently in progress. Conclusions: This multiphase study will provide rich data on the context and immediate events leading to housing transitions among VEH. This study will ensure the development of a smartphone app that will match the actual needs of VEH by involving them in the design process from the beginning. Finally, this study will offer important insights into how best to develop a smartphone app that can help intervene among VEH to reduce housing transitions. International Registered Report Identifier (IRRID): DERR1-10.2196/53022 UR - https://www.researchprotocols.org/2024/1/e53022 UR - http://dx.doi.org/10.2196/53022 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648101 ID - info:doi/10.2196/53022 ER - TY - JOUR AU - Alvarez-Romero, Celia AU - Polo-Molina, Alejandro AU - Sánchez-Úbeda, Francisco Eugenio AU - Jimenez-De-Juan, Carlos AU - Cuadri-Benitez, Pastora Maria AU - Rivas-Gonzalez, Antonio Jose AU - Portela, Jose AU - Palacios, Rafael AU - Rodriguez-Morcillo, Carlos AU - Muñoz, Antonio AU - Parra-Calderon, Luis Carlos AU - Nieto-Martin, Dolores Maria AU - Ollero-Baturone, Manuel AU - Hernández-Quiles, Carlos PY - 2024/4/19 TI - Machine Learning?Based Prediction of Changes in the Clinical Condition of Patients With Complex Chronic Diseases: 2-Phase Pilot Prospective Single-Center Observational Study JO - JMIR Form Res SP - e52344 VL - 8 KW - patients with complex chronic diseases KW - functional impairment KW - Barthel Index KW - artificial intelligence KW - machine learning KW - prediction model KW - pilot study KW - chronic patients KW - chronic KW - development study KW - prognostic KW - diagnostic KW - therapeutic KW - wearable KW - wearables KW - wearable activity tracker KW - mobility device KW - device KW - physical activity KW - caregiver N2 - Background: Functional impairment is one of the most decisive prognostic factors in patients with complex chronic diseases. A more significant functional impairment indicates that the disease is progressing, which requires implementing diagnostic and therapeutic actions that stop the exacerbation of the disease. Objective: This study aimed to predict alterations in the clinical condition of patients with complex chronic diseases by predicting the Barthel Index (BI), to assess their clinical and functional status using an artificial intelligence model and data collected through an internet of things mobility device. Methods: A 2-phase pilot prospective single-center observational study was designed. During both phases, patients were recruited, and a wearable activity tracker was allocated to gather physical activity data. Patients were categorized into class A (BI?20; total dependence), class B (2060; moderate or mild dependence, or independent). Data preprocessing and machine learning techniques were used to analyze mobility data. A decision tree was used to achieve a robust and interpretable model. To assess the quality of the predictions, several metrics including the mean absolute error, median absolute error, and root mean squared error were considered. Statistical analysis was performed using SPSS and Python for the machine learning modeling. Results: Overall, 90 patients with complex chronic diseases were included: 50 during phase 1 (class A: n=10; class B: n=20; and class C: n=20) and 40 during phase 2 (class B: n=20 and class C: n=20). Most patients (n=85, 94%) had a caregiver. The mean value of the BI was 58.31 (SD 24.5). Concerning mobility aids, 60% (n=52) of patients required no aids, whereas the others required walkers (n=18, 20%), wheelchairs (n=15, 17%), canes (n=4, 7%), and crutches (n=1, 1%). Regarding clinical complexity, 85% (n=76) met patient with polypathology criteria with a mean of 2.7 (SD 1.25) categories, 69% (n=61) met the frailty criteria, and 21% (n=19) met the patients with complex chronic diseases criteria. The most characteristic symptoms were dyspnea (n=73, 82%), chronic pain (n=63, 70%), asthenia (n=62, 68%), and anxiety (n=41, 46%). Polypharmacy was presented in 87% (n=78) of patients. The most important variables for predicting the BI were identified as the maximum step count during evening and morning periods and the absence of a mobility device. The model exhibited consistency in the median prediction error with a median absolute error close to 5 in the training, validation, and production-like test sets. The model accuracy for identifying the BI class was 91%, 88%, and 90% in the training, validation, and test sets, respectively. Conclusions: Using commercially available mobility recording devices makes it possible to identify different mobility patterns and relate them to functional capacity in patients with polypathology according to the BI without using clinical parameters. UR - https://formative.jmir.org/2024/1/e52344 UR - http://dx.doi.org/10.2196/52344 UR - http://www.ncbi.nlm.nih.gov/pubmed/38640473 ID - info:doi/10.2196/52344 ER - TY - JOUR AU - Zainal, Hani Nur AU - Tan, Han Hui AU - Hong, Shiun Ryan Yee AU - Newman, Gayle Michelle PY - 2024/4/19 TI - Testing the Efficacy of a Brief, Self-Guided Mindfulness Ecological Momentary Intervention on Emotion Regulation and Self-Compassion in Social Anxiety Disorder: Randomized Controlled Trial JO - JMIR Ment Health SP - e53712 VL - 11 KW - social anxiety disorder KW - mindfulness KW - ecological momentary intervention KW - randomized controlled trial KW - emotion regulation KW - self-compassion KW - mechanisms of change KW - mobile phone KW - momentary interventions KW - self-monitoring app KW - regulations KW - participant N2 - Background: Theories propose that brief, mobile, self-guided mindfulness ecological momentary interventions (MEMIs) could enhance emotion regulation (ER) and self-compassion. Such changes are posited to be mechanisms of change. However, rigorous tests of these theories have not been conducted. Objective: In this assessor-blinded, parallel-group randomized controlled trial, we aimed to test these theories in social anxiety disorder (SAD). Methods: Participants with SAD (defined as having a prerandomization cut-off score ?20 on the Social Phobia Inventory self-report) were randomized to a 14-day fully self-guided MEMI (96/191, 50.3%) or self-monitoring app (95/191, 49.7%) arm. They completed web-based self-reports of 6 clinical outcome measures at prerandomization, 15-day postintervention (administered the day after the intervention ended), and 1-month follow-up time points. ER and self-compassion were assessed at preintervention and 7-day midintervention time points. Multilevel modeling determined the efficacy of MEMI on ER and self-compassion domains from pretrial to midintervention time points. Bootstrapped parallel multilevel mediation analysis examined the mediating role of pretrial to midintervention ER and self-compassion domains on the efficacy of MEMI on 6 clinical outcomes. Results: Participants demonstrated strong compliance, with 78% (149/191) engaging in at least 80% of the MEMI and self-monitoring prompts. MEMI was more efficacious than the self-monitoring app in decreasing ER goal?directed behavior difficulties (between-group Cohen d=?0.24) and lack of emotional clarity (Cohen d=0.16) and increasing self-compassion social connectedness (Cohen d=0.19), nonidentification with emotions (Cohen d=0.16), and self-kindness (Cohen d=0.19) from pretrial to midintervention time points. The within-group effect sizes from pretrial to midintervention were larger in the MEMI arm than in the self-monitoring app arm (ER goal?directed behavior difficulties: Cohen d=?0.73 vs ?0.29, lack of emotional clarity: Cohen d=?0.39 vs ?0.21, self-compassion domains of social connectedness: Cohen d=0.45 vs 0.19, nonidentification with emotions: Cohen d=0.63 vs 0.48, and self-kindness: Cohen d=0.36 vs 0.10). Self-monitoring, but not MEMI, alleviated ER emotional awareness issues (between-group Cohen d=0.11 and within-group: Cohen d=?0.29 vs ?0.13) and reduced self-compassion acknowledging shared human struggles (between-group Cohen d=0.26 and within-group: Cohen d=?0.23 vs 0.13). No ER and self-compassion domains were mediators of the effect of MEMI on SAD symptoms (P=.07-<.99), generalized anxiety symptoms (P=.16-.98), depression severity (P=.20-.94), repetitive negative thinking (P=.12-.96), and trait mindfulness (P=.18-.99) from pretrial to postintervention time points. Similar nonsignificant mediation effects emerged for all of these clinical outcomes from pretrial to 1-month follow-up time points (P=.11-.98). Conclusions: Brief, fully self-guided, mobile MEMIs efficaciously increased specific self-compassion domains and decreased ER difficulties associated with goal pursuit and clarity of emotions from pretrial to midintervention time points. Higher-intensity MEMIs may be required to pinpoint the specific change mechanisms in ER and self-compassion domains of SAD. Trial Registration: Open Science Framework (OSF) Registries; osf.io/m3kxz https://osf.io/m3kxz UR - https://mental.jmir.org/2024/1/e53712 UR - http://dx.doi.org/10.2196/53712 UR - http://www.ncbi.nlm.nih.gov/pubmed/38640015 ID - info:doi/10.2196/53712 ER - TY - JOUR AU - Slob, Joeri AU - van Houwelingen, Thijs AU - Kort, M. Helianthe S. PY - 2024/4/18 TI - Health Care Workers? Expectations of the Mercury Advance SMARTcare Solution to Prevent Pressure Injuries: Individual and Focus Group Interview Study JO - JMIR Nursing SP - e47992 VL - 7 KW - digital technology KW - pressure injury KW - health care professionals KW - mobile phone KW - health care workers N2 - Background: The transformation in global demography and the shortage of health care workers require innovation and efficiency in the field of health care. Digital technology can help improve the efficiency of health care. The Mercury Advance SMARTcare solution is an example of digital technology. The system is connected to a hybrid mattress and is able to detect patient movement, based on which the air pump either starts automatically or sends a notification to the app. Barriers to the adoption of the system are unknown, and it is unclear if the solution will be able to support health care workers in their work. Objective: This study aims to gain insight into health care workers? expectations of factors that could either hamper or support the adoption of the Mercury Advance SMARTcare unit connected to a Mercury Advance mattress to help prevent patients from developing pressure injuries in hospitals and long-term care facilities. Methods: We conducted a generic qualitative study from February to December 2022. Interviews were conducted, and a focus group was established using an interview guide of health care workers from both the United Kingdom and the Netherlands. Thematic analysis was performed by 2 independent researchers. Results: A total of 14 participants took part in the study: 6 (43%) participants joined the focus group, and 8 (57%) participants took part in the individual interviews. We identified 13 factors based on four themes: (1) factors specifically related to SMARTresponse, (2) vision on innovation, (3) match with health care activities, and (4) materials and resources involved. Signaling function, SMARTresponse as prevention, patient category, representatives, and implementation strategy were identified as facilitators. Perception of patient repositioning, accessibility to pressure injury aids, and connectivity were identified as barriers. Conclusions: Several conditions must be met to enhance the adoption of the Mercury Advance SMARTcare solution, including the engagement of representatives during training and a reliable wireless network. The identified factors can be used to facilitate the implementation process. UR - https://nursing.jmir.org/2024/1/e47992 UR - http://dx.doi.org/10.2196/47992 UR - http://www.ncbi.nlm.nih.gov/pubmed/38635323 ID - info:doi/10.2196/47992 ER - TY - JOUR AU - Ezeonu, Alexandra Nwamaka AU - Hertelendy, J. Attila AU - Adu, Kofi Medard AU - Kung, Y. Janice AU - Itanyi, Uchenna Ijeoma AU - Dias, Luz Raquel da AU - Agyapong, Belinda AU - Hertelendy, Petra AU - Ohanyido, Francis AU - Agyapong, Opoku Vincent Israel AU - Eboreime, Ejemai PY - 2024/4/17 TI - Mobile Apps to Support Mental Health Response in Natural Disasters: Scoping Review JO - J Med Internet Res SP - e49929 VL - 26 KW - mental health KW - disasters KW - mobile health KW - mHealth KW - application KW - applications KW - app KW - apps KW - smartphone KW - stress KW - psychological KW - traumatic KW - disaster KW - hazard KW - hazards KW - emergency KW - psychological trauma KW - mobile apps KW - trauma KW - scoping KW - review methods KW - review methodology KW - mobile phone N2 - Background: Disasters are becoming more frequent due to the impact of extreme weather events attributed to climate change, causing loss of lives, property, and psychological trauma. Mental health response to disasters emphasizes prevention and mitigation, and mobile health (mHealth) apps have been used for mental health promotion and treatment. However, little is known about their use in the mental health components of disaster management. Objective: This scoping review was conducted to explore the use of mobile phone apps for mental health responses to natural disasters and to identify gaps in the literature. Methods: We identified relevant keywords and subject headings and conducted comprehensive searches in 6 electronic databases. Studies in which participants were exposed to a man-made disaster were included if the sample also included some participants exposed to a natural hazard. Only full-text studies published in English were included. The initial titles and abstracts of the unique papers were screened by 2 independent review authors. Full texts of the selected papers that met the inclusion criteria were reviewed by the 2 independent reviewers. Data were extracted from each selected full-text paper and synthesized using a narrative approach based on the outcome measures, duration, frequency of use of the mobile phone apps, and the outcomes. This scoping review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Results: Of the 1398 papers retrieved, 5 were included in this review. A total of 3 studies were conducted on participants exposed to psychological stress following a disaster while 2 were for disaster relief workers. The mobile phone apps for the interventions included Training for Life Skills, Sonoma Rises, Headspace, Psychological First Aid, and Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioural Health Disaster Response Apps. The different studies assessed the effectiveness or efficacy of the mobile app, feasibility, acceptability, and characteristics of app use or predictors of use. Different measures were used to assess the effectiveness of the apps? use as either the primary or secondary outcome. Conclusions: A limited number of studies are exploring the use of mobile phone apps for mental health responses to disasters. The 5 studies included in this review showed promising results. Mobile apps have the potential to provide effective mental health support before, during, and after disasters. However, further research is needed to explore the potential of mobile phone apps in mental health responses to all hazards. UR - https://www.jmir.org/2024/1/e49929 UR - http://dx.doi.org/10.2196/49929 UR - http://www.ncbi.nlm.nih.gov/pubmed/38520699 ID - info:doi/10.2196/49929 ER - TY - JOUR AU - Qian, Weicheng AU - Cooke, Aranock AU - Stanley, Gordon Kevin AU - Osgood, David Nathaniel PY - 2024/4/17 TI - Comparing Contact Tracing Through Bluetooth and GPS Surveillance Data: Simulation-Driven Approach JO - J Med Internet Res SP - e38170 VL - 26 KW - smartphone-based sensing KW - proximity contact data KW - transmission models KW - agent-based simulation KW - health informatics KW - mobile phone N2 - Background: Accurate and responsive epidemiological simulations of epidemic outbreaks inform decision-making to mitigate the impact of pandemics. These simulations must be grounded in quantities derived from measurements, among which the parameters associated with contacts between individuals are notoriously difficult to estimate. Digital contact tracing data, such as those provided by Bluetooth beaconing or GPS colocating, can provide more precise measures of contact than traditional methods based on direct observation or self-reporting. Both measurement modalities have shortcomings and are prone to false positives or negatives, as unmeasured environmental influences bias the data. Objective: We aim to compare GPS colocated versus Bluetooth beacon?derived proximity contact data for their impacts on transmission models? results under community and types of diseases. Methods: We examined the contact patterns derived from 3 data sets collected in 2016, with participants comprising students and staff from the University of Saskatchewan in Canada. Each of these 3 data sets used both Bluetooth beaconing and GPS localization on smartphones running the Ethica Data (Avicenna Research) app to collect sensor data about every 5 minutes over a month. We compared the structure of contact networks inferred from proximity contact data collected with the modalities of GPS colocating and Bluetooth beaconing. We assessed the impact of sensing modalities on the simulation results of transmission models informed by proximate contacts derived from sensing data. Specifically, we compared the incidence number, attack rate, and individual infection risks across simulation results of agent-based susceptible-exposed-infectious-removed transmission models of 4 different contagious diseases. We have demonstrated their differences with violin plots, 2-tailed t tests, and Kullback-Leibler divergence. Results: Both network structure analyses show visually salient differences in proximity contact data collected between GPS colocating and Bluetooth beaconing, regardless of the underlying population. Significant differences were found for the estimated attack rate based on distance threshold, measurement modality, and simulated disease. This finding demonstrates that the sensor modality used to trace contact can have a significant impact on the expected propagation of a disease through a population. The violin plots of attack rate and Kullback-Leibler divergence of individual infection risks demonstrated discernible differences for different sensing modalities, regardless of the underlying population and diseases. The results of the t tests on attack rate between different sensing modalities were mostly significant (P<.001). Conclusions: We show that the contact networks generated from these 2 measurement modalities are different and generate significantly different attack rates across multiple data sets and pathogens. While both modalities offer higher-resolution portraits of contact behavior than is possible with most traditional contact measures, the differential impact of measurement modality on the simulation outcome cannot be ignored and must be addressed in studies only using a single measure of contact in the future. UR - https://www.jmir.org/2024/1/e38170 UR - http://dx.doi.org/10.2196/38170 UR - http://www.ncbi.nlm.nih.gov/pubmed/38422493 ID - info:doi/10.2196/38170 ER - TY - JOUR AU - Opper, A. Claudia AU - Browne, A. Felicia AU - Howard, N. Brittni AU - Zule, A. William AU - Wechsberg, M. Wendee PY - 2024/4/16 TI - Assessing Differences in mHealth Usability and App Experiences Among Young African American Women: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Hum Factors SP - e51518 VL - 11 KW - HIV KW - Black women KW - mobile apps KW - social determinants of health KW - prevention KW - substance use KW - usability N2 - Background: In North Carolina, HIV continues to disproportionately affect young African American women. Although mobile health (mHealth) technology appears to be a tool capable of making public health information more accessible for key populations, previous technology use and social determinants may impact users? mHealth experiences. Objective: The objective of this study was to evaluate mHealth usability, assessing differences based on previous technology use and social determinants among a sample of African American women in emerging adulthood. Methods: As part of a National Institute on Drug Abuse?funded randomized controlled trial with African American women (aged 18-25 years), counties were assigned to receive an evidence-based HIV risk reduction intervention through mHealth and participants were asked to complete usability surveys at 6- and 12-month follow-ups. Participants? first survey responses were analyzed through 2-tailed t tests and linear regression models to examine associations with previous technology use and social determinants (P<.05). Results: The mean System Usability Scale (SUS) score was 69.2 (SD 17.9; n=159), which was higher than the threshold of acceptability (68.0). Participants who had previously used a tablet indicated higher usability compared to participants without previous use (mean 72.9, SD 18.1 vs mean 57.6, SD 11.4; P<.001), and participants with previous smartphone use also reported higher usability compared to participants without previous use (mean 71.9, SD 18.3 vs mean 58.0, SD 10.7; P<.001). Differences in SUS scores were observed among those reporting homelessness (mean 58.3, SD 19.0 vs mean 70.8, SD 17.2; P=.01), unemployment (mean 65.9, SD 17.2 vs mean 71.6, SD 18.1; P=.04), or current school enrollment (mean 73.2, SD 18.5 vs mean 65.4, SD 16.5; P=.006). Statistically significant associations were not observed for food insecurity (mean 67.3, SD 18.6 vs mean 69.9, SD 17.7; P=.45). Conclusions: Although above-average usability was observed overall, these findings demonstrate differences in mHealth usability based on past and current life experiences. As mHealth interventions become more prevalent, these findings may have important implications for ensuring that mHealth apps improve the reach of evidence-based interventions. Trial Registration: ClinicalTrials.gov NCT02965014; https://clinicaltrials.gov/study/NCT02965014 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5796-8 UR - https://humanfactors.jmir.org/2024/1/e51518 UR - http://dx.doi.org/10.2196/51518 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625721 ID - info:doi/10.2196/51518 ER - TY - JOUR AU - Lee, Lachlan AU - Hall, Rosemary AU - Stanley, James AU - Krebs, Jeremy PY - 2024/4/15 TI - Tailored Prompting to Improve Adherence to Image-Based Dietary Assessment: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e52074 VL - 12 KW - dietary assessment KW - diet KW - dietary KW - nutrition KW - mobile phone apps KW - image-based dietary assessment KW - nutritional epidemiology KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - image KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - cross-over KW - images KW - photo KW - photographs KW - photos KW - photograph KW - assessment KW - prompt KW - prompts KW - nudge KW - nudges KW - food KW - meal KW - meals KW - consumption KW - behaviour change KW - behavior change N2 - Background: Accurately assessing an individual?s diet is vital in the management of personal nutrition and in the study of the effect of diet on health. Despite its importance, the tools available for dietary assessment remain either too imprecise, expensive, or burdensome for clinical or research use. Image-based methods offer a potential new tool to improve the reliability and accessibility of dietary assessment. Though promising, image-based methods are sensitive to adherence, as images cannot be captured from meals that have already been consumed. Adherence to image-based methods may be improved with appropriately timed prompting via text message. Objective: This study aimed to quantitatively examine the effect of prompt timing on adherence to an image-based dietary record and qualitatively explore the participant experience of dietary assessment in order to inform the design of a novel image-based dietary assessment tool. Methods: This study used a randomized crossover design to examine the intraindividual effect of 3 prompt settings on the number of images captured in an image-based dietary record. The prompt settings were control, where no prompts were sent; standard, where prompts were sent at 7:15 AM, 11:15 AM, and 5:15 PM for every participant; and tailored, where prompt timing was tailored to habitual meal times for each participant. Participants completed a text-based dietary record at baseline to determine the timing of tailored prompts. Participants were randomized to 1 of 6 study sequences, each with a unique order of the 3 prompt settings, with each 3-day image-based dietary record separated by a washout period of at least 7 days. The qualitative component comprised semistructured interviews and questionnaires exploring the experience of dietary assessment. Results: A total of 37 people were recruited, and 30 participants (11 male, 19 female; mean age 30, SD 10.8 years), completed all image-based dietary records. The image rate increased by 0.83 images per day in the standard setting compared to control (P=.23) and increased by 1.78 images per day in the tailored setting compared to control (P?.001). We found that 13/21 (62%) of participants preferred to use the image-based dietary record versus the text-based dietary record but reported method-specific challenges with each method, particularly the inability to record via an image after a meal had been consumed. Conclusions: Tailored prompting improves adherence to image-based dietary assessment. Future image-based dietary assessment tools should use tailored prompting and offer both image-based and written input options to improve record completeness. UR - https://mhealth.jmir.org/2024/1/e52074 UR - http://dx.doi.org/10.2196/52074 ID - info:doi/10.2196/52074 ER - TY - JOUR AU - Sobrinho, Silva Andressa Crystine da AU - Gomes, Oliveira Grace Angelica de AU - Bueno Júnior, Roberto Carlos PY - 2024/4/15 TI - Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach JO - JMIR Form Res SP - e54214 VL - 8 KW - information and communications technologies KW - ICTs KW - health care KW - digital inclusion KW - focus groups KW - health promotion KW - user KW - usability KW - health literacy KW - digital competencies KW - digital skills KW - mobile phone N2 - Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeirão Prêto, São Paulo, Brazil, and involved 20 older adults of both genders who were aged ?60 years and enrolled in the Physical Education Program for the Elderly at the University of São Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90% (18/20) of the participants owned smartphones. However, 20% (4/20) of the participants faced installation challenges and 30% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89% to 70.65%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. UR - https://formative.jmir.org/2024/1/e54214 UR - http://dx.doi.org/10.2196/54214 UR - http://www.ncbi.nlm.nih.gov/pubmed/38619865 ID - info:doi/10.2196/54214 ER - TY - JOUR AU - Kim, KunJung AU - Hwang, Hyunchan AU - Bae, Sujin AU - Kim, Mi Sun AU - Han, Hyun Doug PY - 2024/4/12 TI - The Effectiveness of a Digital App for Reduction of Clinical Symptoms in Individuals With Panic Disorder: Randomized Controlled Trial JO - J Med Internet Res SP - e51428 VL - 26 KW - digital app KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - functional near-infrared spectroscopy KW - hemodynamic KW - hemodynamics KW - panic disorder KW - anxiety KW - panic KW - mental KW - fear KW - spectroscopy KW - digital therapy KW - fNIRS KW - brain KW - imaging KW - neurology KW - neuroscience KW - cortex KW - cortices N2 - Background: Panic disorder is a common and important disease in clinical practice that decreases individual productivity and increases health care use. Treatments comprise medication and cognitive behavioral therapy. However, adverse medication effects and poor treatment compliance mean new therapeutic models are needed. Objective: We hypothesized that digital therapy for panic disorder may improve panic disorder symptoms and that treatment response would be associated with brain activity changes assessed with functional near-infrared spectroscopy (fNIRS). Methods: Individuals (n=50) with a history of panic attacks were recruited. Symptoms were assessed before and after the use of an app for panic disorder, which in this study was a smartphone-based app for treating the clinical symptoms of panic disorder, panic symptoms, depressive symptoms, and anxiety. The hemodynamics in the frontal cortex during the resting state were measured via fNIRS. The app had 4 parts: diary, education, quest, and serious games. The study trial was approved by the institutional review board of Chung-Ang University Hospital (1041078-202112-HR-349-01) and written informed consent was obtained from all participants. Results: The number of participants with improved panic symptoms in the app use group (20/25, 80%) was greater than that in the control group (6/21, 29%; ?21=12.3; P=.005). During treatment, the improvement in the Panic Disorder Severity Scale (PDSS) score in the app use group was greater than that in the control group (F1,44=7.03; P=.01). In the app use group, the total PDSS score declined by 42.5% (mean score 14.3, SD 6.5 at baseline and mean score 7.2, SD 3.6 after the intervention), whereas the PDSS score declined by 14.6% in the control group (mean score 12.4, SD 5.2 at baseline and mean score 9.8, SD 7.9 after the intervention). There were no significant differences in accumulated oxygenated hemoglobin (accHbO2) at baseline between the app use and control groups. During treatment, the reduction in accHbO2 in the right ventrolateral prefrontal cortex (VLPFC; F1,44=8.22; P=.006) and the right orbitofrontal cortex (OFC; F1,44=8.88; P=.005) was greater in the app use than the control group. Conclusions: Apps for panic disorder should effectively reduce symptoms and VLPFC and OFC brain activity in patients with panic disorder. The improvement of panic disorder symptoms was positively correlated with decreased VLPFC and OFC brain activity in the resting state. Trial Registration: Clinical Research Information Service KCT0007280; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=21448 UR - https://www.jmir.org/2024/1/e51428 UR - http://dx.doi.org/10.2196/51428 UR - http://www.ncbi.nlm.nih.gov/pubmed/38608270 ID - info:doi/10.2196/51428 ER - TY - JOUR AU - Dorronzoro-Zubiete, Enrique AU - Castro-Marrero, Jesús AU - Ropero, Jorge AU - Sevillano-Ramos, Luis José AU - Dolores Hernández, María AU - Sanmartin Sentañes, Ramon AU - Alegre-Martin, Jose AU - Launois-Obregón, Patricia AU - Martin-Garrido, Isabel AU - Luque Budia, Asuncion AU - Lacalle-Remigio, R. Juan AU - Béjar Prado, Luis AU - Rivera Romero, Octavio PY - 2024/4/12 TI - Personalized Management of Fatigue in Individuals With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID Using a Smart Digital mHealth Solution: Protocol for a Participatory Design Approach JO - JMIR Res Protoc SP - e50157 VL - 13 KW - acceptability KW - myalgic encephalomyelitis/chronic fatigue syndrome KW - long COVID KW - mHealth KW - fatigue KW - physical activity KW - lifestyle health KW - personalized self-management KW - user-centered design N2 - Background: Fatigue is the most common symptom in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID, impacting patients? quality of life; however, there is currently a lack of evidence-based context-aware tools for fatigue self-management in these populations. Objective: This study aimed to (1) address fatigue in ME/CFS and long COVID through the development of digital mobile health solutions for self-management, (2) predict perceived fatigue severity using real-time data, and (3) assess the feasibility and potential benefits of personalized digital mobile health solutions. Methods: The MyFatigue project adopts a patient-centered approach within the participatory health informatics domain. Patient representatives will be actively involved in decision-making processes. This study combines inductive and deductive research approaches, using qualitative studies to generate new knowledge and quantitative methods to test hypotheses regarding the relationship between factors like physical activity, sleep behaviors, and perceived fatigue in ME/CFS and long COVID. Co-design methods will be used to develop a personalized digital solution for fatigue self-management based on the generated knowledge. Finally, a pilot study will evaluate the feasibility, acceptance, and potential benefits of the digital health solution. Results: The MyFatigue project opened to enrollment in November 2023. Initial results are expected to be published by the end of 2024. Conclusions: This study protocol holds the potential to expand understanding, create personalized self-management approaches, engage stakeholders, and ultimately improve the well-being of individuals with ME/CFS and long COVID. International Registered Report Identifier (IRRID): PRR1-10.2196/50157 UR - https://www.researchprotocols.org/2024/1/e50157 UR - http://dx.doi.org/10.2196/50157 UR - http://www.ncbi.nlm.nih.gov/pubmed/38608263 ID - info:doi/10.2196/50157 ER - TY - JOUR AU - Sakamoto, Masahiko AU - Ishikawa, Hirono AU - Suzuki, Asuka PY - 2024/4/11 TI - Evaluation of Parents? Use of a Child Health Care Information App and Their Health Literacy: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e48478 VL - 7 KW - health literacy KW - European Health Literacy Survey Questionnaire KW - HLS-EU-Q47 KW - child KW - preschool KW - parent education KW - health care knowledge KW - apps KW - digital media KW - emergency room visit KW - mobile phone N2 - Background: Recently, digital media, including internet websites and smartphone apps, have become popular resources for parents in searching for child health care information. Higher health literacy among parents in obtaining adequate health care information and making proper decisions may lead to improved child health outcomes and a reduction in the burden on health care professionals. However, few studies have examined the association between the provision of child health care information apps and parents? health literacy. Objective: This study aims to evaluate whether parents? use of an app that provides child health care information is associated with their health care knowledge, their health literacy, and emergency room visits for their children. Methods: Participants were recruited during checkups for their 1.5-year-old children at health centers within Saku City in 2022. Parents who agreed to participate were included in this study; individuals were excluded if they were not the mother or father of the child or did not have a smartphone. Participants were asked if they had used the Oshiete-Doctor app, which was distributed by Saku City free of charge to improve the home nursing skills of parents and guardians. Sociodemographic data of parents and children, data on health care knowledge about children, data on the frequency of emergency room visits in the past 6 months, and health literacy scores (HLSs) of parents (measured with the HLS-EU-Q47 [European Health Literacy Survey Questionnaire]) were collected from participants in this cross-sectional survey. Univariable and multivariable analyses were conducted to examine the associations of app use with health care knowledge, health literacy, and emergency room visits. Results: In total, 251 respondents completed the survey (response rate: 251/267, 94%). Although the proportion of health care workers was significantly higher among app users than among non?app users (P=.005), no other participant attributes were significantly associated with the use of the app. The proportions of participants with higher health care knowledge and participants with higher total HLSs were significantly higher among app users than among non?app users (P=.001 and P=.003, respectively). After adjusting for potentially confounding covariates, these proportions were still significantly higher among app users than among non?app users (P=.02 and P=.007, respectively). Emergency room visits were significantly more frequent among app users than among non?app users (P=.007) in the univariable analysis, but the association was not significant (P=.07) after adjusting for sociodemographic variables. Conclusions: This study showed a significant association between parents? use of a child health care information app and higher child health care knowledge and health literacy. The use of the app may lead to more appropriate health decisions and behaviors in children?s health care. Future studies are needed to evaluate the association between app use and emergency room visits. UR - https://pediatrics.jmir.org/2024/1/e48478 UR - http://dx.doi.org/10.2196/48478 ID - info:doi/10.2196/48478 ER - TY - JOUR AU - Bene, Ayaka Benard AU - Ibeneme, Sunny AU - Fadahunsi, Philip Kayode AU - Harri, Isa Bala AU - Ukor, Nkiruka AU - Mastellos, Nikolaos AU - Majeed, Azeem AU - Car, Josip PY - 2024/4/11 TI - Regulatory Standards and Guidance for the Use of Health Apps for Self-Management in Sub-Saharan Africa: Scoping Review JO - J Med Internet Res SP - e49163 VL - 26 KW - regulation KW - standard KW - framework KW - guidance KW - guideline KW - health app KW - self-management KW - World Health Organization KW - WHO African Region KW - sub-Saharan Africa N2 - Background: Health apps are increasingly recognized as crucial tools for enhancing health care delivery. Many countries, particularly those in sub-Saharan Africa, can substantially benefit from using health apps to support self-management and thus help to achieve universal health coverage and the third sustainable development goal. However, most health apps published in app stores are of unknown or poor quality, which poses a risk to patient safety. Regulatory standards and guidance can help address this risk and promote patient safety. Objective: This review aims to assess the regulatory standards and guidance for health apps supporting evidence-based best practices in sub-Saharan Africa with a focus on self-management. Methods: A methodological framework for scoping reviews was applied. A search strategy was built and applied across the following databases, gray literature sources, and institutional websites: PubMed, Scopus, World Health Organization (WHO) African Index Medicus, OpenGrey, WHO Regional Office for Africa Library, ICTworks, WHO Directory of eHealth policies, HIS Strengthening Resource Center, International Telecommunication Union, Ministry of Health websites, and Google. The search covered the period between January 2005 and January 2024. The findings were analyzed using a deductive descriptive content analysis. The policy analysis framework was adapted and used to organize the findings. The Reporting Items for Stakeholder Analysis tool guided the identification and mapping of key stakeholders based on their roles in regulating health apps for self-management. Results: The study included 49 documents from 31 sub-Saharan African countries. While all the documents were relevant for stakeholder identification and mapping, only 3 regulatory standards and guidance contained relevant information on regulation of health apps. These standards and guidance primarily aimed to build mutual trust; promote integration, inclusion, and equitable access to services; and address implementation issues and poor coordination. They provided guidance on systems quality, software acquisition and maintenance, security measures, data exchange, interoperability and integration, involvement of relevant stakeholders, and equitable access to services. To enhance implementation, the standards highlight that legal authority, coordination of activities, building capacity, and monitoring and evaluation are required. A number of stakeholders, including governments, regulatory bodies, funders, intergovernmental and nongovernmental organizations, academia, and the health care community, were identified to play key roles in regulating health apps. Conclusions: Health apps have huge potential to support self-management in sub-Saharan Africa, but the lack of regulatory standards and guidance constitutes a major barrier. Hence, for these apps to be safely and effectively integrated into health care, more attention should be given to regulation. Learning from countries with effective regulations can help sub-Saharan Africa build a more robust and responsive regulatory system, ensuring the safe and beneficial use of health apps across the region. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025714 UR - https://www.jmir.org/2024/1/e49163 UR - http://dx.doi.org/10.2196/49163 UR - http://www.ncbi.nlm.nih.gov/pubmed/38602718 ID - info:doi/10.2196/49163 ER - TY - JOUR AU - Lyzwinski, Nathalie Lynnette AU - Elgendi, Mohamed AU - Menon, Carlo PY - 2024/4/11 TI - Users' Acceptability and Perceived Efficacy of mHealth for Opioid Use Disorder: Scoping Review JO - JMIR Mhealth Uhealth SP - e49751 VL - 12 KW - acceptability KW - addict KW - addiction KW - addictions KW - app KW - app-based KW - application KW - applications KW - apps KW - barrier KW - barriers KW - challenge KW - challenges KW - messaging KW - mHealth KW - mobile health KW - monitoring KW - opioid KW - opioids KW - overdose KW - overdosing KW - pharmacology KW - review methodology KW - review methods KW - scoping KW - sensor KW - sensors KW - SMS KW - substance abuse KW - substance use KW - text message KW - wearable technology KW - wearable KW - wearables N2 - Background: The opioid crisis continues to pose significant challenges to global public health, necessitating the development of novel interventions to support individuals in managing their substance use and preventing overdose-related deaths. Mobile health (mHealth), as a promising platform for addressing opioid use disorder, requires a comprehensive understanding of user perspectives to minimize barriers to care and optimize the benefits of mHealth interventions. Objective: This study aims to synthesize qualitative insights into opioid users? acceptability and perceived efficacy of mHealth and wearable technologies for opioid use disorder. Methods: A scoping review of PubMed (MEDLINE) and Google Scholar databases was conducted to identify research on opioid user perspectives concerning mHealth-assisted interventions, including wearable sensors, SMS text messaging, and app-based technology. Results: Overall, users demonstrate a high willingness to engage with mHealth interventions to prevent overdose-related deaths and manage opioid use. Users perceive mHealth as an opportunity to access care and desire the involvement of trusted health care professionals in these technologies. User comfort with wearing opioid sensors emerged as a significant factor. Personally tailored content, social support, and encouragement are preferred by users. Privacy concerns and limited access to technology pose barriers to care. Conclusions: To maximize benefits and minimize risks for users, it is crucial to implement robust privacy measures, provide comprehensive user training, integrate behavior change techniques, offer professional and peer support, deliver tailored messages, incorporate behavior change theories, assess readiness for change, design stigma-reducing apps, use visual elements, and conduct user-focused research for effective opioid management in mHealth interventions. mHealth demonstrates considerable potential as a tool for addressing opioid use disorder and preventing overdose-related deaths, given the high acceptability and perceived benefits reported by users. UR - https://mhealth.jmir.org/2024/1/e49751 UR - http://dx.doi.org/10.2196/49751 UR - http://www.ncbi.nlm.nih.gov/pubmed/38602751 ID - info:doi/10.2196/49751 ER - TY - JOUR AU - Lorenzo-Luaces, Lorenzo AU - Wasil, Akash AU - Kacmarek, N. Corinne AU - DeRubeis, Robert PY - 2024/4/11 TI - Race and Socioeconomic Status as Predictors of Willingness to Use Digital Mental Health Interventions or One-On-One Psychotherapy: National Survey Study JO - JMIR Form Res SP - e49780 VL - 8 KW - digital mental health KW - ethnicity KW - health disparities KW - internet-based CBT KW - cognitive behavioral therapy KW - intervention KW - mental health KW - mental health care KW - race KW - therapy N2 - Background: There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. A key factor in this debate involves the extent to which racial and ethnic minoritized individuals and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. Objective: This study examined racial and ethnic as well as socioeconomic differences in participants? willingness to pay for DMHIs versus one-on-one therapy (1:1 therapy). Methods: We conducted a national survey of people in the United States (N=423; women: n=204; mean age 45.15, SD 16.19 years; non-Hispanic White: n=293) through Prolific. After reading descriptions of DMHIs and 1:1 therapy, participants rated their willingness to use each treatment (1) for free, (2) for a small fee, (3) as a maximum dollar amount, and (4) as a percentage of their total monthly income. At the end of the study, there was a decision task to potentially receive more information about DMHIs and 1:1 therapy. Results: Race and ethnicity was associated with willingness to pay more of one?s income, as a percent or in dollar amounts, and was also associated with information-seeking for DMHIs in the behavioral task. For most outcomes, race and ethnicity was not associated with willingness to try 1:1 therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for 1:1 therapy. Income was inconsistently associated to willingness to try DMHIs or 1:1 therapy. Conclusions: If they are available for free or at very low costs, DMHIs may reduce inequities by expanding access to mental health care for racial and ethnic minoritized individuals and economically disadvantaged groups. UR - https://formative.jmir.org/2024/1/e49780 UR - http://dx.doi.org/10.2196/49780 UR - http://www.ncbi.nlm.nih.gov/pubmed/38602769 ID - info:doi/10.2196/49780 ER - TY - JOUR AU - Segur-Ferrer, Joan AU - Moltó-Puigmartí, Carolina AU - Pastells-Peiró, Roland AU - Vivanco-Hidalgo, Maria Rosa PY - 2024/4/10 TI - Methodological Frameworks and Dimensions to Be Considered in Digital Health Technology Assessment: Scoping Review and Thematic Analysis JO - J Med Internet Res SP - e48694 VL - 26 KW - digital health KW - eHealth KW - mHealth KW - mobile health KW - AI KW - artificial intelligence KW - framework KW - health technology assessment KW - scoping review KW - technology KW - health care system KW - methodological framework KW - thematic analysis N2 - Background: Digital health technologies (dHTs) offer a unique opportunity to address some of the major challenges facing health care systems worldwide. However, the implementation of dHTs raises some concerns, such as the limited understanding of their real impact on health systems and people?s well-being or the potential risks derived from their use. In this context, health technology assessment (HTA) is 1 of the main tools that health systems can use to appraise evidence and determine the value of a given dHT. Nevertheless, due to the nature of dHTs, experts highlight the need to reconsider the frameworks used in traditional HTA. Objective: This scoping review (ScR) aimed to identify the methodological frameworks used worldwide for digital health technology assessment (dHTA); determine what domains are being considered; and generate, through a thematic analysis, a proposal for a methodological framework based on the most frequently described domains in the literature. Methods: The ScR was performed in accordance with the guidelines established in the PRISMA-ScR guidelines. We searched 7 databases for peer reviews and gray literature published between January 2011 and December 2021. The retrieved studies were screened using Rayyan in a single-blind manner by 2 independent authors, and data were extracted using ATLAS.ti software. The same software was used for thematic analysis. Results: The systematic search retrieved 3061 studies (n=2238, 73.1%, unique), of which 26 (0.8%) studies were included. From these, we identified 102 methodological frameworks designed for dHTA. These frameworks revealed great heterogeneity between them due to their different structures, approaches, and items to be considered in dHTA. In addition, we identified different wording used to refer to similar concepts. Through thematic analysis, we reduced this heterogeneity. In the first phase of the analysis, 176 provisional codes related to different assessment items emerged. In the second phase, these codes were clustered into 86 descriptive themes, which, in turn, were grouped in the third phase into 61 analytical themes and organized through a vertical hierarchy of 3 levels: level 1 formed by 13 domains, level 2 formed by 38 dimensions, and level 3 formed by 11 subdimensions. From these 61 analytical themes, we developed a proposal for a methodological framework for dHTA. Conclusions: There is a need to adapt the existing frameworks used for dHTA or create new ones to more comprehensively assess different kinds of dHTs. Through this ScR, we identified 26 studies including 102 methodological frameworks and tools for dHTA. The thematic analysis of those 26 studies led to the definition of 12 domains, 38 dimensions, and 11 subdimensions that should be considered in dHTA. UR - https://www.jmir.org/2024/1/e48694 UR - http://dx.doi.org/10.2196/48694 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598288 ID - info:doi/10.2196/48694 ER - TY - JOUR AU - Choi, Soyoung PY - 2024/4/10 TI - Comparison of Self-Tracking Health Practices, eHealth Literacy, and Subjective Well-Being Between College Students With and Without Disabilities: Cross-Sectional Survey JO - JMIR Form Res SP - e48783 VL - 8 KW - college students KW - personal health data KW - self-tracking KW - eHealth literacy KW - well-being KW - tracking KW - students KW - disability KW - cross-sectional survey KW - pediatric care KW - adult care KW - smartphone health app KW - application KW - literacy N2 - Background: College students with disabilities need to transition from pediatric-centered care to adult care. However, they may become overwhelmed by multiple responsibilities, such as academic activities, peer relationships, career preparation, job seeking, independent living, as well as managing their health and promoting healthy behaviors. Objective: As the use of smartphones and wearable devices for collecting personal health data becomes popular, this study aimed to compare the characteristics of self-tracking health practices between college students with disabilities and their counterparts. In addition, this study examined the relationships between disability status, self-tracking health practices, eHealth literacy, and subjective well-being among college students. Methods: The web-based questionnaire was designed using Qualtrics for the cross-sectional online survey. The survey data were collected from February 2023 to April 2023 and included responses from 702 participants. Results: More than 80% (563/702, 80.2%) of the respondents participated voluntarily in self-tracking health practices. College students with disabilities (n=83) showed significantly lower levels of eHealth literacy and subjective well-being compared with college students without disabilities (n=619). The group with disabilities reported significantly lower satisfaction (t411=?5.97, P<.001) and perceived efficacy (t411=?4.85, P<.001) when using smartphone health apps and wearable devices. Finally, the study identified a significant correlation between subjective well-being in college students and disability status (?=3.81, P<.001), self-tracking health practices (?=2.22, P=.03), and eHealth literacy (?=24.29, P<.001). Conclusions: Given the significant relationships among disability status, self-tracking health practices, eHealth literacy, and subjective well-being in college students, it is recommended to examine their ability to leverage digital technology for self-care. Offering learning opportunities to enhance eHealth literacy and self-tracking health strategies within campus environments could be a strategic approach to improve the quality of life and well-being of college students. UR - https://formative.jmir.org/2024/1/e48783 UR - http://dx.doi.org/10.2196/48783 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598285 ID - info:doi/10.2196/48783 ER - TY - JOUR AU - Detsomboonrat, Palinee AU - Pisarnturakit, Pantuwadee Pagaporn PY - 2024/4/10 TI - Time Efficiency, Reliability, and User Satisfaction of the Tooth Memo App for Recording Oral Health Information: Cross-Sectional Questionnaire Study JO - JMIR Form Res SP - e56143 VL - 8 KW - capability KW - health survey KW - oral health KW - mobile apps KW - personal health information KW - PHI KW - satisfaction KW - tooth KW - teeth KW - oral KW - dental KW - dentist KW - dentistry KW - data entry KW - data collection KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - periodontal KW - survey KW - questionnaire KW - questionnaires N2 - Background: Digitalizing oral health data through an app can help manage the extensive data obtained through oral health surveys. The Tooth Memo app collects data from oral health surveys and personal health information. Objective: This study aims to evaluate the evaluate the time efficiency, reliability, and user satisfaction of the Tooth Memo app. Methods: There are 2 sections in the Tooth Memo app: oral health survey and personal oral health record. For the oral health survey section of the Tooth Memo app, different data entry methods were compared and user satisfaction was evaluated. Fifth-year dental students had access to the oral health survey section in the Tooth Memo app during their clinical work. The time required for data entry, analysis, and summary of oral health survey data by 3 methods, that is, pen-and-paper (manual), Tooth Memo app on iOS device, and Tooth Memo app on Android device were compared among 3 data recorders who entered patients? information on decayed, missing, and filled permanent teeth (DMFT) index and community periodontal index (CPI), which were read aloud from the database of 103 patients by another dental personnel. The interobserver reliability of the 3 different data-entering procedures was evaluated by percent disagreement and kappa statistic values. Laypeople had access to the personal oral health record section of this app, and their satisfaction was evaluated through a Likert scale questionnaire. The satisfaction assessments for both sections of the Tooth Memo app involved the same set of questions on the app design, usage, and overall satisfaction. Results: Of the 103 dental records on DMFT and CPI, 5.2% (177/3399) data points were missing in the manual data entries, but no data on tooth status were missing in the Android and iOS methods. Complete CPI information was provided by all 3 methods. Transferring data from paper to computer took an average of 55 seconds per case. The manual method required 182 minutes more than the iOS or Android methods to clean the missing data and transfer and analyze the tooth status data of 103 patients. The users, that is, 109 fifth-year dental students and 134 laypeople, expressed high satisfaction with using the Tooth Memo app. The overall satisfaction with the oral health survey ranged between 3 and 10, with an average (SD) of 7.86 (1.46). The overall satisfaction with the personal oral health record ranged between 4 and 10, with an average (SD) of 8.09 (1.28). Conclusions: The Tooth Memo app was more efficacious than manual data entry for collecting data of oral health surveys. Dental personnel as well as general users reported high satisfaction when using this app. UR - https://formative.jmir.org/2024/1/e56143 UR - http://dx.doi.org/10.2196/56143 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598287 ID - info:doi/10.2196/56143 ER - TY - JOUR AU - Lozada-Tequeanes, Lilia Ana AU - Théodore, L. Florence AU - Kim-Herrera, Edith AU - García-Guerra, Armando AU - Quezada-Sánchez, D. Amado AU - Alvarado-Casas, Rocio AU - Bonvecchio, Anabelle PY - 2024/4/9 TI - Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e55509 VL - 12 KW - effectiveness KW - feasibility KW - mHealth KW - SMS text message KW - mixed methods KW - infant obesity KW - physical activity KW - healthy feeding KW - children KW - COVID-19 KW - Mexico N2 - Background: Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. Objective: This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. Methods: NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children?s age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants? experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. Results: Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was ?good,? ?useful,? and ?helpful? for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. Conclusions: While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. Trial Registration: ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896 UR - https://mhealth.jmir.org/2024/1/e55509 UR - http://dx.doi.org/10.2196/55509 UR - http://www.ncbi.nlm.nih.gov/pubmed/38592753 ID - info:doi/10.2196/55509 ER - TY - JOUR AU - Wilhelm, Sabine AU - Bernstein, E. Emily AU - Bentley, H. Kate AU - Snorrason, Ivar AU - Hoeppner, S. Susanne AU - Klare, Dalton AU - Greenberg, L. Jennifer AU - Weingarden, Hilary AU - McCoy, H. Thomas AU - Harrison, Oliver PY - 2024/4/9 TI - Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone App?Led Cognitive Behavioral Therapy for Depression Under Therapist Supervision: Open Trial JO - JMIR Ment Health SP - e53998 VL - 11 KW - depressive disorder KW - depressive KW - depression KW - open trial KW - open trials KW - single arm KW - smartphone KW - cognitive behavioral therapy KW - cognitive behavioural therapy KW - CBT KW - psychotherapy KW - psychoeducation KW - digital health KW - mobile applications KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - psychiatry KW - psychiatric KW - feasibility KW - acceptability KW - usability KW - satisfaction KW - user experience KW - mental N2 - Background: Major depressive disorder affects approximately 1 in 5 adults during their lifetime and is the leading cause of disability worldwide. Yet, a minority receive adequate treatment due to person-level (eg, geographical distance to providers) and systems-level (eg, shortage of trained providers) barriers. Digital tools could improve this treatment gap by reducing the time and frequency of therapy sessions needed for effective treatment through the provision of flexible, automated support. Objective: This study aimed to examine the feasibility, acceptability, and preliminary clinical effect of Mindset for Depression, a deployment-ready 8-week smartphone-based cognitive behavioral therapy (CBT) supported by brief teletherapy appointments with a therapist. Methods: This 8-week, single-arm open trial tested the Mindset for Depression app when combined with 8 brief (16-25 minutes) video conferencing visits with a licensed doctoral-level CBT therapist (n=28 participants). The app offers flexible, accessible psychoeducation, CBT skills practice, and support to patients as well as clinician guidance to promote sustained engagement, monitor safety, and tailor treatment to individual patient needs. To increase accessibility and thus generalizability, all study procedures were conducted remotely. Feasibility and acceptability were assessed via attrition, patient expectations and feedback, and treatment utilization. The primary clinical outcome measure was the clinician-rated Hamilton Depression Rating Scale, administered at pretreatment, midpoint, and posttreatment. Secondary measures of functional impairment and quality of life as well as maintenance of gains (3-month follow-up) were also collected. Results: Treatment credibility (week 4), expectancy (week 4), and satisfaction (week 8) were moderate to high, and attrition was low (n=2, 7%). Participants self-reported using the app or practicing (either on or off the app) the CBT skills taught in the app for a median of 50 (IQR 30-60; week 4) or 60 (IQR 30-90; week 8) minutes per week; participants accessed the app on an average 36.8 (SD 10.0) days and completed a median of 7 of 8 (IQR 6-8) steps by the week 8 assessment. The app was rated positively across domains of engagement, functionality, aesthetics, and information. Participants? depression severity scores decreased from an average Hamilton Depression Rating Scale score indicating moderate depression (mean 19.1, SD 5.0) at baseline to a week 8 mean score indicating mild depression (mean 10.8, SD 6.1; d=1.47; P<.001). Improvement was also observed for functional impairment and quality of life. Gains were maintained at 3-month follow-up. Conclusions: The results show that Mindset for Depression is a feasible and acceptable treatment option for individuals with major depressive disorder. This smartphone-led treatment holds promise to be an efficacious, scalable, and cost-effective treatment option. The next steps include testing Mindset for Depression in a fully powered randomized controlled trial and real-world clinical settings. Trial Registration: ClinicalTrials.gov NCT05386329; https://clinicaltrials.gov/study/NCT05386329?term=NCT05386329 UR - https://mental.jmir.org/2024/1/e53998 UR - http://dx.doi.org/10.2196/53998 UR - http://www.ncbi.nlm.nih.gov/pubmed/38592771 ID - info:doi/10.2196/53998 ER - TY - JOUR AU - Mabetha, Khuthala AU - Soepnel, M. Larske AU - Mabena, Gugulethu AU - Motlhatlhedi, Molebogeng AU - Nyati, Lukhanyo AU - Norris, A. Shane AU - Draper, E. Catherine PY - 2024/4/8 TI - Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study JO - JMIR Form Res SP - e48144 VL - 8 KW - mobile technologies KW - health promotion KW - mixed methods KW - clinical practice KW - mobile phone N2 - Background: The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. Objective: This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. Methods: A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were ?contactability of the participants? and ?participants? mobile number changes,? and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ?12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). Results: Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ?2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. Conclusions: Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice. UR - https://formative.jmir.org/2024/1/e48144 UR - http://dx.doi.org/10.2196/48144 UR - http://www.ncbi.nlm.nih.gov/pubmed/38588527 ID - info:doi/10.2196/48144 ER - TY - JOUR AU - Gagnon, M. Michelle AU - Brilz, R. Alexandra AU - Alberts, M. Nicole AU - Gordon, L. Jennifer AU - Risling, L. Tracie AU - Stinson, N. Jennifer PY - 2024/4/8 TI - Understanding Adolescents? Experiences With Menstrual Pain to Inform the User-Centered Design of a Mindfulness-Based App: Mixed Methods Investigation Study JO - JMIR Pediatr Parent SP - e54658 VL - 7 KW - adolescent health KW - endometriosis KW - pain management, biopsychosocial KW - women?s health KW - dysmenorrhea KW - thematic analysis KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - interest KW - intent KW - intention KW - survey KW - surveys KW - focus group KW - focus groups KW - content analysis KW - mindfulness KW - meditation KW - menstrual KW - menstruation KW - experience KW - experiences KW - pain KW - youth KW - adolescent KW - adolescents KW - teen KW - teens KW - teenager KW - teenagers N2 - Background: Digital interventions are increasingly popular for the provision of nonpharmacological pain interventions, but few exist for adolescents with menstrual pain. User-centered design involves incorporating users across phases of digital health intervention design, development, and implementation and leads to improved user engagement and outcomes. A needs assessment is the first step of this approach. Objective: The goal of this study was to conduct a needs assessment to understand menstrual pain management needs and preferences and mindfulness experiences, preferences, and knowledge of adolescents with menstrual pain to inform the future development of an app for managing menstrual pain. Methods: We used an explanatory sequential mixed method design that included a survey followed by focus groups. Adolescents aged 13-17 years completed a survey (n=111) and participated in focus groups (n=16). Data were analyzed using descriptive statistics and thematic content analysis and synthesized to provide specific recommendations based on adolescent responses. Results: Adolescents (n=111) who completed the survey reported a moderate understanding of mindfulness and menstrual pain. Over three-quarters (n=87, 78%) of participants practiced some form of mindfulness and 87% (n=97) of survey participants used nonpharmacological pain management strategies. Teens had a moderate perception that mindfulness could help their menstrual pain (mean 4.51/10, SD 2.45, with higher scores suggesting more interest). Themes were generated related to mindfulness experiences, menstrual pain knowledge and experiences, and app functionality. These themes underscored adolescents? need for continued support and flexible access to mindfulness activities; their awareness of multiple influences to pain, with potential for further education in this area; and the need for menstrual pain?specific content, along with content relevant to typical day-to-day experiences of adolescents. Conclusions: Adolescents with menstrual pain have an interest in using a mindfulness app for pain but have unique needs that need to be addressed to ensure app engagement and relevance for this population. Concrete recommendations for future app development are provided. UR - https://pediatrics.jmir.org/2024/1/e54658 UR - http://dx.doi.org/10.2196/54658 UR - http://www.ncbi.nlm.nih.gov/pubmed/38587886 ID - info:doi/10.2196/54658 ER - TY - JOUR AU - Moorthy, Preetha AU - Weinert, Lina AU - Schüttler, Christina AU - Svensson, Laura AU - Sedlmayr, Brita AU - Müller, Julia AU - Nagel, Till PY - 2024/4/5 TI - Attributes, Methods, and Frameworks Used to Evaluate Wearables and Their Companion mHealth Apps: Scoping Review JO - JMIR Mhealth Uhealth SP - e52179 VL - 12 KW - wearables KW - mobile health KW - mHealth KW - mobile phone KW - usability methods KW - usability attributes KW - evaluation frameworks KW - health care N2 - Background: Wearable devices, mobile technologies, and their combination have been accepted into clinical use to better assess the physical fitness and quality of life of patients and as preventive measures. Usability is pivotal for overcoming constraints and gaining users? acceptance of technology such as wearables and their companion mobile health (mHealth) apps. However, owing to limitations in design and evaluation, interactive wearables and mHealth apps have often been restricted from their full potential. Objective: This study aims to identify studies that have incorporated wearable devices and determine their frequency of use in conjunction with mHealth apps or their combination. Specifically, this study aims to understand the attributes and evaluation techniques used to evaluate usability in the health care domain for these technologies and their combinations. Methods: We conducted an extensive search across 4 electronic databases, spanning the last 30 years up to December 2021. Studies including the keywords ?wearable devices,? ?mobile apps,? ?mHealth apps,? ?physiological data,? ?usability,? ?user experience,? and ?user evaluation? were considered for inclusion. A team of 5 reviewers screened the collected publications and charted the features based on the research questions. Subsequently, we categorized these characteristics following existing usability and wearable taxonomies. We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Results: A total of 382 reports were identified from the search strategy, and 68 articles were included. Most of the studies (57/68, 84%) involved the simultaneous use of wearables and connected mobile apps. Wrist-worn commercial consumer devices such as wristbands were the most prevalent, accounting for 66% (45/68) of the wearables identified in our review. Approximately half of the data from the medical domain (32/68, 47%) focused on studies involving participants with chronic illnesses or disorders. Overall, 29 usability attributes were identified, and 5 attributes were frequently used for evaluation: satisfaction (34/68, 50%), ease of use (27/68, 40%), user experience (16/68, 24%), perceived usefulness (18/68, 26%), and effectiveness (15/68, 22%). Only 10% (7/68) of the studies used a user- or human-centered design paradigm for usability evaluation. Conclusions: Our scoping review identified the types and categories of wearable devices and mHealth apps, their frequency of use in studies, and their implementation in the medical context. In addition, we examined the usability evaluation of these technologies: methods, attributes, and frameworks. Within the array of available wearables and mHealth apps, health care providers encounter the challenge of selecting devices and companion apps that are effective, user-friendly, and compatible with user interactions. The current gap in usability and user experience in health care research limits our understanding of the strengths and limitations of wearable technologies and their companion apps. Additional research is necessary to overcome these limitations. UR - https://mhealth.jmir.org/2024/1/e52179 UR - http://dx.doi.org/10.2196/52179 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578671 ID - info:doi/10.2196/52179 ER - TY - JOUR AU - Reading, Miki Jean AU - Crane, M. Melissa AU - Guan, Justin AU - Jackman, Ronston AU - Thomson, D. Maria AU - LaRose, Gokee Jessica PY - 2024/4/5 TI - Acceptability of a Self-Guided Lifestyle Intervention Among Young Men: Mixed Methods Analysis of Pilot Findings JO - JMIR Form Res SP - e53841 VL - 8 KW - digital health KW - gender KW - weight loss KW - health behaviors KW - low touch KW - obesity KW - obese KW - mixed methods analysis KW - lifestyle intervention KW - young men KW - men KW - effectiveness KW - digital tools KW - food intake KW - diet N2 - Background: Young men are vastly underrepresented in lifestyle interventions, suggesting a need to develop appealing yet effective interventions for this population. Objective: This study aimed to determine the acceptability of a self-guided lifestyle intervention designed specifically for young men (age: 18-35 years old). Methods: Semistructured interviews and surveys were completed by 14 men following completion of a remotely delivered, 12-week lifestyle intervention. The intervention included 1 virtual group session, digital tools, access to self-paced web- and mobile-based content, and 12 weekly health risk text messages. We quantitatively and qualitatively examined young men?s experiences with the intervention components of a remotely delivered, self-guided lifestyle intervention targeting weight loss. Data were integrated using convergent mixed methods analysis. Results: Men were a mean age of 29.9 (SD 4.9) years with a mean BMI of 31.0 (SD 4.5) kg/m2. The self-guided aspect was not acceptable, and a majority preferred more check-ins. Participants expressed a desire for a social aspect in future lifestyle interventions. All men found the focus on health risks appealing. A majority of men found the study-issued, Bluetooth-enabled scale acceptable. Conclusions: Acceptability of the self-guided lifestyle intervention was perceived as suboptimal by young men. The findings highlight the need to add intervention components that sustain motivation and provide additional social support for young men. Trial Registration: ClinicalTrials.gov NCT04267263; https://www.clinicaltrials.gov/study/NCT04267263 UR - https://formative.jmir.org/2024/1/e53841 UR - http://dx.doi.org/10.2196/53841 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578686 ID - info:doi/10.2196/53841 ER - TY - JOUR AU - Short, E. Camille AU - Rawstorn, C. Jonathan AU - Jones, L. Tamara AU - Edbrooke, Lara AU - Hayes, C. Sandra AU - Maddison, Ralph AU - Nightingale, Sophie AU - Ismail, Hilmy AU - De Boer, Richard AU - Hegi-Johnson, Fiona AU - Sverdlov, L. Aaron AU - Bell, Robyn AU - Halligan, Irene AU - Denehy, Linda PY - 2024/4/5 TI - Evaluating a Remotely Delivered Cardio-Oncology Rehabilitation Intervention for Patients With Breast Cancer (REMOTE-COR-B): Protocol for a Single-Arm Feasibility Trial JO - JMIR Res Protoc SP - e53301 VL - 13 KW - breast cancer survivor KW - breast cancer KW - cancer survivor KW - cancer KW - cardiac rehabilitation KW - cardiac KW - cardiotoxicity KW - cardiovascular disease KW - digital health KW - efficacy KW - exercise KW - feasibility KW - fitness KW - rehabilitation intervention KW - rehabilitation KW - safety N2 - Background: Exercise rehabilitation is a promising strategy for reducing cardiovascular disease risk among patients with breast cancer. However, the evidence is primarily derived from programs based at exercise centers with in-person supervised delivery. Conversely, most patients report a preference for home-based rehabilitation. As such, there is a clear need to explore strategies that can provide real-time supervision and coaching while addressing consumer preferences. Evidence from cardiac rehabilitation has demonstrated the noninferiority of a smartphone-based telerehabilitation approach (REMOTE-CR) to improve cardiorespiratory fitness in people with cardiovascular disease compared to a center-based program. Objective: This study aims to assess the feasibility, safety, and preliminary efficacy of the REMOTE-CR program adapted for patients with breast cancer at risk of cardiotoxicity (REMOTE-COR-B). We will also assess the satisfaction and usability of REMOTE-COR-B. Methods: We will conduct a single-arm feasibility study of the REMOTE-COR-B program among patients with stage I-III breast cancer who are at risk of cardiotoxicity (taking treatment type and dose, as well as other common cardiovascular disease risk factors into account) and who are within 24 months of completing primary definitive treatment. Participants (target sample size of 40) will receive an 8-week smartphone-based telerehabilitation exercise program involving remotely delivered real-time supervision and behavior change support. The platform comprises a smartphone and wearable heart rate monitor, as well as a custom-built smartphone app and web application. Participants will be able to attend remotely monitored exercise sessions during set operating hours each week, scheduled in both the morning and evening. Adherence is the primary outcome of the trial, assessed through the number of remotely monitored exercise sessions attended compared to the trial target (ie, 3 sessions per week). Secondary outcomes include additional trial feasibility indicators (eg, recruitment and retention), safety, satisfaction, and usability, and objective and patient-reported efficacy outcomes (cardiovascular fitness, quality of life, fatigue, self-reported exercise, self-efficacy, habit strength, and motivation). Adherence, feasibility, and safety outcomes will be assessed during the intervention period; intervention satisfaction and usability will be assessed post intervention; and objective and patient-reported efficacy outcomes will be assessed at baseline, post intervention (2-month postbaseline assessment), and at follow-up (5-month postbaseline assessment). Results: Recruitment for this trial commenced in March 2023, and 7 participants had been recruited as of the submission of the manuscript. The estimated completion date for the project is October 2024, with results expected to be published in mid-2025. Conclusions: The REMOTE-COR-B intervention is a novel and promising approach to providing exercise therapy to patients with breast cancer at risk of cardiotoxicity who have unique needs and heightened safety risks. This project will provide important information on the extent to which this approach is satisfactory to patients with breast cancer, safe, and potentially effective, which is necessary before larger-scale research or clinical projects. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001557820; www.anzctr.org.au/ACTRN12621001557820.aspx International Registered Report Identifier (IRRID): DERR1-10.2196/53301 UR - https://www.researchprotocols.org/2024/1/e53301 UR - http://dx.doi.org/10.2196/53301 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578682 ID - info:doi/10.2196/53301 ER - TY - JOUR AU - Barnett, P. Nancy AU - Sokolovsky, W. Alexander AU - Meisel, K. Matthew AU - Forkus, R. Shannon AU - Jackson, M. Kristina PY - 2024/4/5 TI - A Bluetooth-Based Smartphone App for Detecting Peer Proximity: Protocol for Evaluating Functionality and Validity JO - JMIR Res Protoc SP - e50241 VL - 13 KW - Bluetooth technology KW - passive sensing KW - proximity detection KW - ecological momentary assessment KW - social influence KW - alcohol use KW - mobile phone N2 - Background: While ecological momentary assessment (EMA) is commonly used to study social contexts and social influence in the real world, EMA almost exclusively relies on participant self-report of present circumstances, including the proximity to influential peers. There is the potential for developing a proximity sensing approach that uses small Bluetooth beacons and smartphone-based detection and data collection to collect information about interactions between individuals passively in real time. Objective: This paper aims to describe the methods for evaluating the functionality and validity of a Bluetooth-based beacon and a smartphone app to identify when ?2 individuals are physically proximal. Methods: We will recruit 20 participants aged 18 to 29 years with Android smartphones to complete a 3-week study during which beacon detection and self-report data will be collected using a smartphone app (MEI Research). Using an interviewer-administered social network interview, participants will identify up to 3 peers of the same age who are influential on health behavior (alcohol use in this study). These peers will be asked to carry a Bluetooth beacon (Kontakt asset tag) for the duration of the study; each beacon has a unique ID that, when detected, will be recorded by the app on the participant?s phone. Participants will be prompted to respond to EMA surveys (signal-contingent reports) when a peer beacon encounter meets our criteria and randomly 3 times daily (random reports) and every morning (morning reports) to collect information about the presence of peers. In all reports, the individualized list of peers will be presented to participants, followed by questions about peer and participant behavior, including alcohol use. Data from multiple app data sets, including beacon encounter specifications, notification, and app logs, participant EMA self-reports and postparticipation interviews, and peer surveys, will be used to evaluate project goals. We will examine the functionality of the technology, including the stability of the app (eg, app crashes and issues opening the app), beacon-to-app detection (ie, does the app detect proximal beacons?), and beacon encounter notification when encounter criteria are met. The validity of the technology will be defined as the concordance between passive detection of peers via beacon-to-app communication and the participant?s EMA report of peer presence. Disagreement between the beacon and self-report data (ie, false negatives and false positives) will be investigated in multiple ways (ie, to determine if the reason was technology-related or participant compliance-related) using encounter data and information collected from participants and peers. Results: Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025. Conclusions: This Bluetooth-based technology has important applications and clinical implications for various health behaviors, including the potential for just-in-time adaptive interventions that target high-risk behavior in real time. International Registered Report Identifier (IRRID): DERR1-10.2196/50241 UR - https://www.researchprotocols.org/2024/1/e50241 UR - http://dx.doi.org/10.2196/50241 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578672 ID - info:doi/10.2196/50241 ER - TY - JOUR AU - van den Berg, N. Liselot AU - Hallensleben, Cynthia AU - Vlug, AE Lisa AU - Chavannes, H. Niels AU - Versluis, Anke PY - 2024/4/4 TI - The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study JO - JMIR Hum Factors SP - e54386 VL - 11 KW - asthma KW - short-acting beta2-agonist KW - SABA overuse KW - app KW - eHealth KW - feasibility KW - usability KW - mobile phone N2 - Background: Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication?specifically, short-acting beta2-agonist (SABA) overuse?is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation. Objective: This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined. Methods: A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method. Results: The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; ?=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38%). Qualitative data (from a total of 4 participants; n=2, 50% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist. Conclusions: The initial findings regarding the app?s feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices. UR - https://humanfactors.jmir.org/2024/1/e54386 UR - http://dx.doi.org/10.2196/54386 UR - http://www.ncbi.nlm.nih.gov/pubmed/38574348 ID - info:doi/10.2196/54386 ER - TY - JOUR AU - Trojan, Andreas AU - Roth, Sven AU - Atassi, Ziad AU - Kiessling, Michael AU - Zenhaeusern, Reinhard AU - Kadvany, Yannick AU - Schumacher, Johannes AU - Kullak-Ublick, A. Gerd AU - Aapro, Matti AU - Eniu, Alexandru PY - 2024/4/4 TI - Comparison of the Real-World Reporting of Symptoms and Well-Being for the HER2-Directed Trastuzumab Biosimilar Ogivri With Registry Data for Herceptin in the Treatment of Breast Cancer: Prospective Observational Study (OGIPRO) of Electronic Patient-Reported Outcomes JO - JMIR Cancer SP - e54178 VL - 10 KW - breast cancer KW - biosimilar KW - trastuzumab KW - electronic patient-reported outcome KW - ePRO KW - medidux KW - app N2 - Background: Trastuzumab has had a major impact on the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). Anti-HER2 biosimilars such as Ogivri have demonstrated safety and clinical equivalence to trastuzumab (using Herceptin as the reference product) in clinical trials. To our knowledge, there has been no real-world report of the side effects and quality of life (QoL) in patients treated with biosimilars using electronic patient-reported outcomes (ePROs). Objective: The primary objective of this prospective observational study (OGIPRO study) was to compare the ePRO data related to treatment side effects collected with the medidux app in patients with HER2-positive BC treated with the trastuzumab biosimilar Ogivri (prospective cohort) to those obtained from historical cohorts treated with Herceptin alone or combined with pertuzumab and/or chemotherapy (ClinicalTrials.gov NCT02004496 and NCT03578731). Methods: Patients were treated with Ogivri alone or combined with pertuzumab and/or chemotherapy and hormone therapy in (neo)adjuvant and palliative settings. Patients used the medidux app to dynamically record symptoms (according to the Common Terminology Criteria for Adverse Events [CTCAE]), well-being (according to the Eastern Cooperative Oncology Group Performance Status scale), QoL (using the EQ-5D-5L questionnaire), cognitive capabilities, and vital parameters over 6 weeks. The primary endpoint was the mean CTCAE score. Key secondary endpoints included the mean well-being score. Data of this prospective cohort were compared with those of the historical cohorts (n=38 patients; median age 51, range 31-78 years). Results: Overall, 53 female patients with a median age of 54 years (range 31-87 years) were enrolled in the OGIPRO study. The mean CTCAE score was analyzed in 50 patients with available data on symptoms, while the mean well-being score was evaluated in 52 patients with available data. The most common symptoms reported in both cohorts included fatigue, taste disorder, nausea, diarrhea, dry mucosa, joint discomfort, tingling, sleep disorder, headache, and appetite loss. Most patients experienced minimal (grade 0) or mild (grade 1) toxicities in both cohorts. The mean CTCAE score was comparable between the prospective and historical cohorts (29.0 and 30.3, respectively; mean difference ?1.27, 95% CI ?7.24 to 4.70; P=.68). Similarly, no significant difference was found for the mean well-being score between the groups treated with the trastuzumab biosimilar Ogivri and Herceptin (74.3 and 69.8, respectively; mean difference 4.45, 95% CI ?3.53 to 12.44; P=.28). Conclusions: Treatment of patients with HER2-positive BC with the trastuzumab biosimilar Ogivri resulted in equivalent symptoms, adverse events, and well-being as found for patients treated with Herceptin as determined by ePRO data. Hence, integration of an ePRO system into research and clinical practice can provide reliable information when investigating the real-world tolerability and outcomes of similar therapeutic compounds. Trial Registration: ClinicalTrials.gov NCT05234021; https://clinicaltrials.gov/study/NCT05234021 UR - https://cancer.jmir.org/2024/1/e54178 UR - http://dx.doi.org/10.2196/54178 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573759 ID - info:doi/10.2196/54178 ER - TY - JOUR AU - Borrelli, Belinda AU - Bartlett, Kiera Y. AU - Fulford, Daniel AU - Frasco, Greg AU - Armitage, J. Christopher AU - Wearden, Alison PY - 2024/4/4 TI - Behavioral Activation Mobile App to Motivate Smokers to Quit: Feasibility and Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e54912 VL - 8 KW - smoking cessation KW - mobile app KW - motivation KW - depressed mood KW - depression KW - behavioral activation KW - negative affect KW - positive affect KW - quit smoking KW - health behavior change N2 - Background: Behavioral activation (BA) is an evidence-based treatment for depression that fosters engagement in values-based activities to increase access to positive reinforcement. Depressed mood has been shown to hinder smoking cessation. Objective: This study determined the feasibility and preliminary efficacy of a mobile app to motivate smokers to quit by using BA and integrating motivational messages to quit smoking. Methods: Adult smokers (N=56; mean age 34.5, SD 9.52 years) who were not ready to quit smoking within 30 days were recruited from advertisements and randomized to either 8 weeks of the BA app (set 2 values-based activities per week+motivational messages+feedback on changes in smoking, mood, and values-based activities) or the control group (no app; received resources for quitting smoking). All participants completed the baseline and end-of-treatment web-based questionnaires. Controls also completed weekly web-based assessments, and BA app participants completed assessments through the app. Results: There were no dropouts and only 2 participants in each condition did not complete the end-of-treatment questionnaire. The results demonstrated that it is feasible to recruit smokers who are unmotivated to quit into a smoking cessation induction trial: 86% (57/66) of eligible participants were randomized (BA app: n=27; control: n=29). Participants reported high levels of satisfaction: 80% (20/25) of participants said they would recommend the BA app, there were moderate-to-high scores on the Mobile App Rating Scale, and 88% (22/25) of participants rated the app 3 stars or higher (out of 5). There were high levels of BA app engagement: 96% (26/27) of participants planned activities, and 67% (18/27) of participants planned 7 or more activities. High engagement was found even among those who were at the highest risk for continued smoking (low motivation to quit, low confidence to quit, and high negative affect). The results provided support for the hypothesized relationships between BA constructs: greater pleasant activity completion was associated with greater positive affect (b=0.37, SE 0.21; 95% CI ?0.05 to 0.79; P=.08), and greater positive affect tended to predict fewer cigarettes smoked the next day (b=?0.19, SE 0.10; 95% CI ?0.39 to 0.01; P=.06). Additionally, a greater number of activities planned was associated with lower negative affect (b=?0.26, SE 0.15; 95% CI ?0.55 to 0.04; P=.09). Overall, 16% (4/25) of BA app participants set a quit date versus 4% (1/27) among controls, and there were promising (but not significant) trends for motivation and confidence to quit. Conclusions: The findings suggest that a mobile app intervention can be made appealing to smokers who are unmotivated to quit by focusing on aspects most important to them, such as mood management. This theory-based intervention has shown some initial support for the underlying theoretical constructs, and further efficacy testing is warranted in a fully powered trial. UR - https://formative.jmir.org/2024/1/e54912 UR - http://dx.doi.org/10.2196/54912 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573739 ID - info:doi/10.2196/54912 ER - TY - JOUR AU - Wang, Zheng AU - Kempen, John AU - Luo, Gang PY - 2024/4/4 TI - Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study JO - JMIR Form Res SP - e55270 VL - 8 KW - vision screening KW - refractive error KW - strabismus KW - smartphone KW - visual acuity KW - vision KW - visual KW - eye KW - eyes KW - screening KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - feasibility KW - optometry KW - ophthalmology N2 - Background: While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. Objective: We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. Methods: A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. Results: A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72?prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). Conclusions: The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas. UR - https://formative.jmir.org/2024/1/e55270 UR - http://dx.doi.org/10.2196/55270 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573757 ID - info:doi/10.2196/55270 ER - TY - JOUR AU - Correia de Barros, Ana AU - Bergmans, Mariëtte AU - Hasanaj, Kreshnik AU - Krasniqi, Drianë AU - Nóbrega, Catarina AU - Carvalho Carneiro, Bruna AU - Vasconcelos, A. Priscila AU - Quinta-Gomes, Luísa Ana AU - Nobre, J. Pedro AU - Couto da Silva, Joana AU - Mendes-Santos, Cristina PY - 2024/4/3 TI - Evaluating the User Experience of a Smartphone-Delivered Sexual Health Promotion Program for Older Adults in the Netherlands: Single-Arm Pilot Study JO - JMIR Hum Factors SP - e56206 VL - 11 KW - internet interventions KW - mobile health KW - mHealth KW - older adults KW - sexual health KW - smartphone KW - user experience KW - pilot study KW - mobile phone N2 - Background: Sexual health is an important component of quality of life in older adults. However, older adults often face barriers to attaining a fulfilling sexual life because of issues such as stigma, lack of information, or difficult access to adequate support. Objective: We aimed to evaluate the user experience of a self-guided, smartphone-delivered program to promote sexual health among older adults. Methods: The mobile app was made available to community-dwelling older adults in the Netherlands, who freely used the app for 8 weeks. User experience and its respective components were assessed using self-developed questionnaires, the System Usability Scale, and semistructured interviews. Quantitative and qualitative data were descriptively and thematically analyzed, respectively. Results: In total, 15 participants (mean age 71.7, SD 9.5 years) completed the trial. Participants showed a neutral to positive stance regarding the mobile app?s usefulness and ease of use. Usability was assessed as ?Ok/Fair.? The participants felt confident about using the mobile app. To increase user experience, participants offered suggestions to improve content and interaction, including access to specialized sexual health services. Conclusions: The sexual health promotion program delivered through a smartphone in a self-guided mode was usable. Participants? perception is that improvements to user experience, namely in content and interaction, as well as connection to external services, will likely improve usefulness and acceptance. UR - https://humanfactors.jmir.org/2024/1/e56206 UR - http://dx.doi.org/10.2196/56206 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568726 ID - info:doi/10.2196/56206 ER - TY - JOUR AU - Fundoiano-Hershcovitz, ?Yifat AU - Ritholz, D. Marilyn AU - Horwitz, L. David AU - Behar, Ephraim AU - Manejwala, Omar AU - Goldstein, Pavel PY - 2024/4/2 TI - The Impact of Digital Self-Monitoring of Weight on Improving Diabetes Clinical Outcomes: Quasi-Randomized Study JO - J Med Internet Res SP - e54940 VL - 26 KW - obesity KW - diabetes management KW - weight monitoring KW - digital health platform KW - self-monitoring KW - clinical outcome KW - type 2 diabetes KW - weight changes KW - blood glucose KW - patient empowerment N2 - Background: The management of type 2 diabetes (T2D) and obesity, particularly in the context of self-monitoring, remains a critical challenge in health care. As nearly 80% to 90% of patients with T2D have overweight or obesity, there is a compelling need for interventions that can effectively manage both conditions simultaneously. One of the goals in managing chronic conditions is to increase awareness and generate behavioral change to improve outcomes in diabetes and related comorbidities, such as overweight or obesity. There is a lack of real-life evidence to test the impact of self-monitoring of weight on glycemic outcomes and its underlying mechanisms. Objective: This study aims to assess the efficacy of digital self-monitoring of weight on blood glucose (BG) levels during diabetes management, investigating whether the weight changes may drive glucose fluctuations. Methods: In this retrospective, real-world quasi-randomized study, 50% of the individuals who regularly used the weight monitoring (WM) feature were propensity score matched with 50% of the users who did not use the weight monitoring feature (NWM) based on demographic and clinical characteristics. All the patients were diagnosed with T2D and tracked their BG levels. We analyzed monthly aggregated data 6 months before and after starting their weight monitoring. A piecewise mixed model was used for analyzing the time trajectories of BG and weight as well as exploring the disaggregation effect of between- and within-patient lagged effects of weight on BG. Results: The WM group exhibited a significant reduction in BG levels post intervention (P<.001), whereas the nonmonitoring group showed no significant changes (P=.59), and both groups showed no differences in BG pattern before the intervention (P=.59). Furthermore, the WM group achieved a meaningful decrease in BMI (P<.001). Finally, both within-patient (P<.001) and between-patient (P=.008) weight variability was positively associated with BG levels. However, 1-month lagged back BMI was not associated with BG levels (P=.36). Conclusions: This study highlights the substantial benefits of self-monitoring of weight in managing BG levels in patients with diabetes, facilitated by a digital health platform, and advocates for the integration of digital self-monitoring tools in chronic disease management. We also provide initial evidence of testing the underlying mechanisms associated with BG management, underscoring the potential role of patient empowerment. UR - https://www.jmir.org/2024/1/e54940 UR - http://dx.doi.org/10.2196/54940 UR - http://www.ncbi.nlm.nih.gov/pubmed/38564266 ID - info:doi/10.2196/54940 ER - TY - JOUR AU - Adler, F. Rachel AU - Baez, Kevin AU - Morales, Paulina AU - Sotelo, Jocelyn AU - Victorson, David AU - Magasi, Susan PY - 2024/4/2 TI - Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing JO - JMIR Hum Factors SP - e51522 VL - 11 KW - mobile health KW - mHealth KW - apps KW - usability KW - cancer survivors KW - accessibility KW - disabilities KW - cancer KW - oncology KW - heuristics KW - empowerment KW - advocacy KW - mindfulness KW - problem-solving N2 - Background: More than 18 million cancer survivors are living in the United States. The effects of cancer and its treatments can have cognitive, psychological, physical, and social consequences that many survivors find incredibly disabling. Posttreatment support is often unavailable or underused, especially for survivors living with disabilities. This leaves them to deal with new obstacles and struggles on their own, oftentimes feeling lost during this transition. Mobile health (mHealth) interventions have been shown to effectively aid cancer survivors in dealing with many of the aftereffects of cancer and its treatments; these interventions hold immense potential for survivors living with disabilities. We developed a prototype for WeCanManage, an mHealth-delivered self-management intervention to empower cancer survivors living with disabilities through problem-solving, mindfulness, and self-advocacy training. Objective: Our study conducted a heuristic evaluation of the WeCanManage high-fidelity prototype and assessed its usability among cancer survivors with known disabilities. Methods: We evaluated the prototype using Nielsen?s 10 principles of heuristic evaluation with 22 human-computer interaction university students. On the basis of the heuristic evaluation findings, we modified the prototype and conducted usability testing on 10 cancer survivors with a variety of known disabilities, examining effectiveness, efficiency, usability, and satisfaction, including a completion of the modified System Usability Scale (SUS). Results: The findings from the heuristic evaluation were mostly favorable, highlighting the need for a help guide, addressing accessibility concerns, and enhancing the navigation experience. After usability testing, the average SUS score was 81, indicating a good-excellent design. The participants in the usability testing sample expressed positive reactions toward the app?s design, educational content and videos, and the available means of connecting with others. They identified areas for improvement, such as improving accessibility, simplifying navigation within the community forums, and providing a more convenient method to access the help guide. Conclusions: Overall, usability testing showed positive results for the design of WeCanManage. The course content and features helped participants feel heard, understood, and less alone. UR - https://humanfactors.jmir.org/2024/1/e51522 UR - http://dx.doi.org/10.2196/51522 UR - http://www.ncbi.nlm.nih.gov/pubmed/38564261 ID - info:doi/10.2196/51522 ER - TY - JOUR AU - Yeshurun, Shlomo AU - Cramer, Tomer AU - Souroujon, Daniel AU - Mor, Merav PY - 2024/4/1 TI - The Association of Macronutrient Consumption and BMI to Exhaled Carbon Dioxide in Lumen Users: Retrospective Real-World Study JO - JMIR Mhealth Uhealth SP - e56083 VL - 12 KW - app KW - applications KW - association KW - BMI KW - body mass index KW - carbohydrate KW - carbon dioxide KW - consumption KW - correlate KW - correlation KW - diet KW - dietary KW - exhalation KW - exhale KW - food KW - Lumen KW - macronutrient KW - meal KW - metabolic flexibility KW - metabolic KW - metabolism KW - mHealth KW - mobile health KW - nutrient KW - nutrition KW - nutritional KW - obese KW - obesity KW - postprandial KW - prandial KW - retrospective KW - weight N2 - Background: Metabolic flexibility is the ability of the body to rapidly switch between fuel sources based on their accessibility and metabolic requirements. High metabolic flexibility is associated with improved health outcomes and a reduced risk of several metabolic disorders. Metabolic flexibility can be improved through lifestyle changes, such as increasing physical activity and eating a balanced macronutrient diet. Lumen is a small handheld device that measures metabolic fuel usage through exhaled carbon dioxide (CO2), which allows individuals to monitor their metabolic flexibility and make lifestyle changes to enhance it. Objective: This retrospective study aims to examine the postprandial CO2 response to meals logged by Lumen users and its relationship with macronutrient intake and BMI. Methods: We analyzed deidentified data from 2607 Lumen users who logged their meals and measured their exhaled CO2 before and after those meals between May 1, 2023, and October 18, 2023. A linear mixed model was fitted to test the association between macronutrient consumption, BMI, age, and gender to the postprandial CO2 response, followed by a 2-way ANOVA. Results: The model demonstrated significant associations (P<.001) between CO2 response after meals and both BMI and carbohydrate intake (BMI: ?=?0.112, 95% CI ?0.156 to ?0.069; carbohydrates: ?=0.046, 95% CI 0.034-0.058). In addition, a 2-way ANOVA revealed that higher carbohydrate intake resulted in a higher CO2 response compared to low carbohydrate intake (F2,2569=24.23; P<.001), and users with high BMI showed modest responses to meals compared with low BMI (F2,2569=5.88; P=.003). Conclusions: In this study, we show that Lumen?s CO2 response is influenced both by macronutrient consumption and BMI. The results of this study highlight a distinct pattern of reduced metabolic flexibility in users with obesity, indicating the value of Lumen for assessing postprandial metabolic flexibility. UR - https://mhealth.jmir.org/2024/1/e56083 UR - http://dx.doi.org/10.2196/56083 UR - http://www.ncbi.nlm.nih.gov/pubmed/38439744 ID - info:doi/10.2196/56083 ER - TY - JOUR AU - Bendtsen, Grønlund Magnus AU - Schönwandt, Thuesen Bodil Marie AU - Rubæk, Mette AU - Hitz, Friberg Mette PY - 2024/4/1 TI - Evaluation of an mHealth App on Self-Management of Osteoporosis: Prospective Survey Study JO - Interact J Med Res SP - e53995 VL - 13 KW - eHealth literacy KW - health literacy KW - mHealth KW - mobile health KW - eHealth KW - mobile health apps KW - self-management KW - osteoporosis KW - usability KW - acceptability N2 - Background: Mobile health (mHealth) technologies can be used for disease-specific self-management, and these technologies are experiencing rapid growth in the health care industry. They use mobile devices, specifically smartphone apps, to enhance and support medical and public health practices. In chronic disease management, the use of apps in the realm of mHealth holds the potential to improve health outcomes. This is also true for mHealth apps on osteoporosis, but the usage and patients? experiences with these apps are underexplored. Objective: This prospective survey study aimed to investigate the eHealth literacy of Danish patients with osteoporosis, as well as the usability and acceptability of the app ?My Bones.? Methods: Data on patient characteristics, disease knowledge, eHealth literacy, usability, and acceptability were collected using self-administered questionnaires at baseline, 2 months, and 6 months. The following validated questionnaires were used: eHealth Literacy Questionnaire, System Usability Scale, and Service User Technology Acceptability Questionnaire. Results: Mean scores for eHealth literacy ranged from 2.6 to 3.1, with SD ranging from 0.5 to 0.6 across the 7 domains. The mean (SD) System Usability Scale score was 74.7 (14.4), and the mean (SD) scores for domains 1, 2, and 6 of the Service User Technology Acceptability Questionnaire were 3.4 (1.2), 4.5 (1.1), 4.1 (1.2), respectively. Conclusions: Danish patients with osteoporosis are both motivated and capable of using digital health services. The app?s usability was acceptable, and it has the potential to reduce visits to general practitioner clinics, enhance health outcomes, and serve as a valuable addition to regular health or social care services. UR - https://www.i-jmr.org/2024/1/e53995 UR - http://dx.doi.org/10.2196/53995 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557362 ID - info:doi/10.2196/53995 ER - TY - JOUR AU - King Jr, Lewis Van AU - Siegel, Gregg AU - Priesmeyer, Richard Henry AU - Siegel, H. Leslie AU - Potter, S. Jennifer PY - 2024/4/1 TI - Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study JO - JMIR Form Res SP - e48068 VL - 8 KW - opioid use disorder KW - digital health KW - behavioral medicine KW - KIOS KW - mHealth KW - substance use disorder KW - substance use treatment KW - self-management KW - opioid misuse KW - substance use KW - social support KW - KIOS app KW - KIOS application KW - software KW - patient-centered KW - opioid N2 - Background: Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient?s recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers. Objective: This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs. Methods: We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual?s patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual?s changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes. Results: In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use. Conclusions: KIOS tracks key clinical variables and generates advice specifically relevant to the patient?s current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse?funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted. UR - https://formative.jmir.org/2024/1/e48068 UR - http://dx.doi.org/10.2196/48068 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557501 ID - info:doi/10.2196/48068 ER - TY - JOUR AU - Chaves, Antonio AU - Arnáez, Sandra AU - García-Soriano, Gemma PY - 2024/3/29 TI - The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive Disorder: Pilot Questionnaire Study JO - JMIR Mhealth Uhealth SP - e48027 VL - 12 KW - obsessive-compulsive disorder KW - OCD KW - mental health literacy KW - stigma KW - app KW - help-seeking intention KW - seek help KW - mobile phone N2 - Background: Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people?s lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a mental health mobile app, esTOCma, developed to improve knowledge about OCD and its treatment, increase help-seeking intention, and reduce stigmatizing attitudes and social distance associated with OCD. Methods: We used preintervention, postintervention, and 3-month follow-up assessments in this single-arm pilot intervention. Overall, 90 participants were recruited from the community using the snowball sampling method. We used esTOCma to defeat the ?stigma monster? over the course of 10 missions. The participants completed the sociodemographic information and Obsessive-Compulsive Inventory?Revised at preassessment and an acceptability questionnaire at postassessment. All other measures were completed at the preassessment, postassessment, and 3-month follow-up (ie, the Spanish Mental Illness Stigma Attribution Questionnaire?27, the General Help-Seeking Questionnaire, the Social Distance Scale, and the Mental Health Literacy Questionnaire). Results: Of the 90 participants from the community that were assessed for eligibility, 86% (n=78) were allocated to intervention. Of these 78 participants, 79% (n=62) completed the game and answered the postintervention assessment (completer group). Overall, 69% (43/62) of the participants also completed the 3-month follow-up assessment. The participants completing the study were older (P=.003) and had a higher baseline knowledge of OCD (P=.05). The participants took an average of 13.64 (SD 10.50) days to complete the intervention, including the pre- and postassessments. The participants spent an average of 4.56 (SD 3.33) days completing the 10 missions included in the app. Each mission took a mean of between 2 (SD 3.01) and 9.35 (SD 3.06) minutes. The app was rated as useful or very useful by the vast majority of participants 90% (56/62). Moreover, 90% (56/62) of the participants reported that they had learned or learned a lot, and 98% (61/62) of the participants reported that they would recommend the app to a friend. Repeated measures ANOVA (43/62, 69%) showed that after the intervention participants showed an increased knowledge of mental health and intention to seek help as well as fewer stigmatizing attitudes and less social distance. Conclusions: Preliminary data show that esTOCma is a feasible and acceptable app, and after completing its 10 missions, there is an increase in the understanding of OCD and help-seeking intention along with a decrease in the social stigma and social distance associated with OCD that lasts for at least 3 months. The results support the potential of technology-based interventions to increase the intention to seek help and reduce the stigma associated with OCD. A larger, community-controlled study is also recommended. UR - https://mhealth.jmir.org/2024/1/e48027 UR - http://dx.doi.org/10.2196/48027 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551629 ID - info:doi/10.2196/48027 ER - TY - JOUR AU - Gautam, Kamal AU - Aguilar, Camille AU - Paudel, Kiran AU - Dhakal, Manisha AU - Wickersham, A. Jeffrey AU - Acharya, Bibhav AU - Sapkota, Sabitri AU - Deuba, Keshab AU - Shrestha, Roman PY - 2024/3/29 TI - Preferences for mHealth Intervention to Address Mental Health Challenges Among Men Who Have Sex With Men in Nepal: Qualitative Study JO - JMIR Hum Factors SP - e56002 VL - 11 KW - mental health KW - MSM KW - mHealth KW - smartphone apps KW - digital health KW - Nepal KW - gay KW - homosexual KW - homosexuality KW - men who have sex with men KW - focus group KW - focus groups KW - qualitative KW - barrier KW - barriers KW - thematic KW - mobile health KW - app KW - apps KW - applications N2 - Background: Men who have sex with men (MSM) are disproportionately burdened by poor mental health. Despite the increasing burden, evidence-based interventions for MSM are largely nonexistent in Nepal. Objective: This study explored mental health concerns, contributing factors, barriers to mental health care and support, and preferred interventions to improve access to and use of mental health support services among MSM in Nepal. Methods: We conducted focus groups with MSM in Kathmandu, Nepal, in January 2023. In total, 28 participants took part in 5 focus group sessions. Participants discussed several topics related to the mental health issues they experienced, factors contributing to these issues, and their suggestions for potential interventions to address existing barriers. The discussions were recorded, transcribed, and analyzed using Dedoose (version 9.0.54; SocioCultural Research Consultants, LLC) software for thematic analysis. Results: Participants reported substantial mental health problems, including anxiety, depression, suicidal ideation, and behaviors. Contributing factors included family rejection, isolation, bullying, stigma, discrimination, and fear of HIV and other sexually transmitted infections. Barriers to accessing services included cost, lack of lesbian, gay, bisexual, transgender, intersex, queer, and asexual (LGBTIQA+)?friendly providers, and the stigma associated with mental health and sexuality. Participants suggested a smartphone app with features such as a mental health screening tool, digital consultation, helpline number, directory of LGBTIQA+-friendly providers, mental health resources, and a discussion forum for peer support as potential solutions. Participants emphasized the importance of privacy and confidentiality to ensure mobile apps are safe and accessible. Conclusions: The findings of this study have potential transferability to other low-resource settings facing similar challenges. Intervention developers can use these findings to design tailored mobile apps to facilitate mental health care delivery and support for MSM and other marginalized groups. UR - https://humanfactors.jmir.org/2024/1/e56002 UR - http://dx.doi.org/10.2196/56002 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551632 ID - info:doi/10.2196/56002 ER - TY - JOUR AU - Dietrich, Damien AU - Bornet dit Vorgeat, Helena AU - Perrin Franck, Caroline AU - Ligier, Quentin PY - 2024/3/28 TI - A Mobile App (Concerto) to Empower Hospitalized Patients in a Swiss University Hospital: Development, Design, and Implementation Report JO - JMIR Med Inform SP - e47914 VL - 12 KW - patient empowerment KW - mobile apps KW - digital health KW - mobile health KW - implementation science KW - health care system KW - hospital information system KW - health promotion N2 - Background: Patient empowerment can be associated with better health outcomes, especially in the management of chronic diseases. Digital health has the potential to promote patient empowerment. Objective: Concerto is a mobile app designed to promote patient empowerment in an in-patient setting. This implementation report focuses on the lessons learned during its implementation. Methods: The app was conceptualized and prototyped during a hackathon. Concerto uses hospital information system (HIS) data to offer the following key functionalities: a care schedule, targeted medical information, practical information, information about the on-duty care team, and a medical round preparation module. Funding was obtained following a feasibility study, and the app was developed and implemented in four pilot divisions of a Swiss University Hospital using institution-owned tablets. Implementation (Results): The project lasted for 2 years with effective implementation in the four pilot divisions and was maintained within budget. The induced workload on caregivers impaired project sustainability and warranted a change in our implementation strategy. The presence of a killer function would have facilitated the deployment. Furthermore, our experience is in line with the well-accepted need for both high-quality user training and a suitable selection of superusers. Finally, by presenting HIS data directly to the patient, Concerto highlighted the data that are not fit for purpose and triggered data curation and standardization initiatives. Conclusions: This implementation report presents a real-world example of designing, developing, and implementing a patient-empowering mobile app in a university hospital in-patient setting with a particular focus on the lessons learned. One limitation of the study is the lack of definition of a ?key success? indicator. UR - https://medinform.jmir.org/2024/1/e47914 UR - http://dx.doi.org/10.2196/47914 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546728 ID - info:doi/10.2196/47914 ER - TY - JOUR AU - Gryglewicz, Kim AU - Orr, L. Victoria AU - McNeil, J. Marissa AU - Taliaferro, A. Lindsay AU - Hines, Serenea AU - Duffy, L. Taylor AU - Wisniewski, J. Pamela PY - 2024/3/28 TI - Translating Suicide Safety Planning Components Into the Design of mHealth App Features: Systematic Review JO - JMIR Ment Health SP - e52763 VL - 11 KW - suicide prevention KW - suicide safety planning KW - mobile health KW - mHealth apps KW - eHealth KW - digital health KW - systematic review KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses KW - PRISMA N2 - Background: Suicide safety planning is an evidence-based approach used to help individuals identify strategies to keep themselves safe during a mental health crisis. This study systematically reviewed the literature focused on mobile health (mHealth) suicide safety planning apps. Objective: This study aims to evaluate the extent to which apps integrated components of the safety planning intervention (SPI), and if so, how these safety planning components were integrated into the design-based features of the apps. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically analyzed 14 peer-reviewed studies specific to mHealth apps for suicide safety planning. We conducted an analysis of the literature to evaluate how the apps incorporated SPI components and examined similarities and differences among the apps by conducting a comparative analysis of app features. An independent review of SPI components and app features was conducted by downloading the available apps. Results: Most of the mHealth apps (5/7, 71%) integrated SPI components and provided customizable features that expanded upon traditional paper-based safety planning processes. App design features were categorized into 5 themes, including interactive features, individualized user experiences, interface design, guidance and training, and privacy and sharing. All apps included access to community supports and revisable safety plans. Fewer mHealth apps (3/7, 43%) included interactive features, such as associating coping strategies with specific stressors. Most studies (10/14, 71%) examined the usability, feasibility, and acceptability of the safety planning mHealth apps. Usability findings were generally positive, as users often found these apps easy to use and visually appealing. In terms of feasibility, users preferred using mHealth apps during times of crisis, but the continuous use of the apps outside of crisis situations received less support. Few studies (4/14, 29%) examined the effectiveness of mHealth apps for suicide-related outcomes. Positive shifts in attitudes and desire to live, improved coping strategies, enhanced emotional stability, and a decrease in suicidal thoughts or self-harm behaviors were examined in these studies. Conclusions: Our study highlights the need for researchers, clinicians, and app designers to continue to work together to align evidence-based research on mHealth suicide safety planning apps with lessons learned for how to best deliver these technologies to end users. Our review brings to light mHealth suicide safety planning strategies needing further development and testing, such as lethal means guidance, collaborative safety planning, and the opportunity to embed more interactive features that leverage the advanced capabilities of technology to improve client outcomes as well as foster sustained user engagement beyond a crisis. Although preliminary evidence shows that these apps may help to mitigate suicide risk, clinical trials with larger sample sizes and more robust research designs are needed to validate their efficacy before the widespread adoption and use. UR - https://mental.jmir.org/2024/1/e52763 UR - http://dx.doi.org/10.2196/52763 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546711 ID - info:doi/10.2196/52763 ER - TY - JOUR AU - Vereschagin, Melissa AU - Wang, Y. Angel AU - Richardson, G. Chris AU - Xie, Hui AU - Munthali, J. Richard AU - Hudec, L. Kristen AU - Leung, Calista AU - Wojcik, D. Katharine AU - Munro, Lonna AU - Halli, Priyanka AU - Kessler, C. Ronald AU - Vigo, V. Daniel PY - 2024/3/27 TI - Effectiveness of the Minder Mobile Mental Health and Substance Use Intervention for University Students: Randomized Controlled Trial JO - J Med Internet Res SP - e54287 VL - 26 KW - mental health KW - substance use KW - college students KW - mobile interventions KW - digital interventions KW - randomized controlled trial KW - mobile phone N2 - Background: University attendance represents a transition period for students that often coincides with the emergence of mental health and substance use challenges. Digital interventions have been identified as a promising means of supporting students due to their scalability, adaptability, and acceptability. Minder is a mental health and substance use mobile app that was codeveloped with university students. Objective: This study aims to examine the effectiveness of the Minder mobile app in improving mental health and substance use outcomes in a general population of university students. Methods: A 2-arm, parallel-assignment, single-blinded, 30-day randomized controlled trial was used to evaluate Minder using intention-to-treat analysis. In total, 1489 participants were recruited and randomly assigned to the intervention (n=743, 49.9%) or waitlist control (n=746, 50.1%) condition. The Minder app delivers evidence-based content through an automated chatbot and connects participants with services and university social groups. Participants are also assigned a trained peer coach to support them. The primary outcomes were measured through in-app self-assessments and included changes in general anxiety symptomology, depressive symptomology, and alcohol consumption risk measured using the 7-item General Anxiety Disorder scale, 9-item Patient Health Questionnaire, and US Alcohol Use Disorders Identification Test?Consumption Scale, respectively, from baseline to 30-day follow-up. Secondary outcomes included measures related to changes in the frequency of substance use (cannabis, alcohol, opioids, and nonmedical stimulants) and mental well-being. Generalized linear mixed-effects models were used to examine each outcome. Results: In total, 79.3% (589/743) of participants in the intervention group and 83% (619/746) of participants in the control group completed the follow-up survey. The intervention group had significantly greater average reductions in anxiety symptoms measured using the 7-item General Anxiety Disorder scale (adjusted group mean difference=?0.85, 95% CI ?1.27 to ?0.42; P<.001; Cohen d=?0.17) and depressive symptoms measured using the 9-item Patient Health Questionnaire (adjusted group mean difference=?0.63, 95% CI ?1.08 to ?0.17; P=.007; Cohen d=?0.11). A reduction in the US Alcohol Use Disorders Identification Test?Consumption Scale score among intervention participants was also observed, but it was not significant (P=.23). Statistically significant differences in favor of the intervention group were found for mental well-being and reductions in the frequency of cannabis use and typical number of drinks consumed. A total of 77.1% (573/743) of participants in the intervention group accessed at least 1 app component during the study period. Conclusions: In a general population sample of university students, the Minder app was effective in reducing symptoms of anxiety and depression, with provisional support for increasing mental well-being and reducing the frequency of cannabis and alcohol use. These findings highlight the potential ability of e-tools focused on prevention and early intervention to be integrated into existing university systems to support students? needs. Trial Registration: ClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601 International Registered Report Identifier (IRRID): RR2-10.2196/49364 UR - https://www.jmir.org/2024/1/e54287 UR - http://dx.doi.org/10.2196/54287 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536225 ID - info:doi/10.2196/54287 ER - TY - JOUR AU - Narayan, Aditya AU - Weng, Kydo AU - Shah, Nirav PY - 2024/3/27 TI - Decentralizing Health Care: History and Opportunities of Web3 JO - JMIR Form Res SP - e52740 VL - 8 KW - Web3 KW - health care KW - patient-centric KW - data ownership KW - decentralization KW - interoperability KW - electronic health record (EHR) KW - privacy KW - blockchain KW - digital transformation KW - digital health care KW - digital health KW - patient KW - patients KW - technological framework KW - security and privacy KW - security UR - https://formative.jmir.org/2024/1/e52740 UR - http://dx.doi.org/10.2196/52740 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536235 ID - info:doi/10.2196/52740 ER - TY - JOUR AU - Liu, Y. Albert AU - Alleyne, Cat-Dancing AU - Doblecki-Lewis, Susanne AU - Koester, A. Kimberly AU - Gonzalez, Rafael AU - Vinson, Janie AU - Scott, Hyman AU - Buchbinder, Susan AU - Torres, S. Thiago PY - 2024/3/27 TI - Adapting mHealth Interventions (PrEPmate and DOT Diary) to Support PrEP Retention in Care and Adherence Among English and Spanish-Speaking Men Who Have Sex With Men and Transgender Women in the United States: Formative Work and Pilot Randomized Trial JO - JMIR Form Res SP - e54073 VL - 8 KW - preexposure prophylaxis KW - PrEP KW - Spanish-speaking KW - Latino KW - transgender KW - men who have sex with men KW - mobile health KW - mHealth KW - HIV prevention KW - HIV KW - technology KW - formative KW - development KW - mobile technology, mobile app KW - text-messaging KW - SMS KW - app KW - application KW - USA KW - United States KW - health equity KW - mHealth tool KW - tool KW - acceptability KW - self-management KW - pilot KW - support N2 - Background: A growing number of mobile health (mHealth) technologies are being developed to support HIV preexposure prophylaxis (PrEP) adherence and persistence; however, most tools have focused on men who have sex with men (MSM), and few are available in Spanish. To maximize the potential impact of these tools in reducing gender and racial/ethnic disparities and promoting health equity, mHealth tools tailored to Spanish-speaking people and transgender women are critically needed. Objective: The aim of this study is to adapt and tailor 2 mHealth technologies, PrEPmate and DOT Diary, to support daily PrEP adherence and persistence among Spanish-speaking MSM and English- and Spanish-speaking transgender women and to evaluate the feasibility and acceptability of these tools. Methods: PrEPmate, an interactive, bidirectional, text messaging intervention that promotes personalized communication between PrEP users and providers, and DOT Diary, a mobile app that promotes self-management of PrEP use and sexual health through an integrated electronic pill-taking and sexual activity diary, were previously developed for English-speaking MSM. We conducted 3 focus groups with 15 English- and Spanish-speaking transgender women and MSM in San Francisco and Miami to culturally tailor these tools for these priority populations. We then conducted a 1-month technical pilot among 21 participants to assess the usability and acceptability of the adapted interventions and optimize the functionality of these tools. Results: Participants in focus groups liked the ?human touch? of text messages in PrEPmate and thought it would be helpful for scheduling appointments and asking questions. They liked the daily reminder messages, especially the fun facts, gender affirmations, and transgender history topics. Participants recommended changes to tailor the language and messages for Spanish-speaking and transgender populations. For DOT Diary, participants liked the adherence tracking and protection level feedback and thought the calendar functions were easy to use. Based on participant recommendations, we tailored language within the app for Spanish-speaking MSM and transgender women, simplified the sexual diary, and added motivational badges. In the technical pilot of the refined tools, mean System Usability Scale scores were 81.2/100 for PrEPmate and 76.4/100 for DOT Diary (P=.48), falling in the ?good? to ?excellent? range, and mean Client Satisfaction Questionnaire scores were 28.6 and 28.3 for PrEPmate and DOT Diary, respectively (maximum possible score=32). Use of both tools was high over the 1-month pilot (average of 10.5 messages received from each participant for PrEPmate; average of 17.6 times accessing the DOT Diary app), indicating good feasibility for both tools. Conclusions: Using a user-centered design approach, we culturally tailored PrEPmate and DOT Diary to support daily PrEP use among Spanish-speaking MSM and English- and Spanish-speaking transgender women. Our positive findings in a technical pilot support further testing of these mHealth interventions in an upcoming comparative effectiveness trial. UR - https://formative.jmir.org/2024/1/e54073 UR - http://dx.doi.org/10.2196/54073 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536232 ID - info:doi/10.2196/54073 ER - TY - JOUR AU - Aboye, Tadese Genet AU - Simegn, Lamesgin Gizeaddis AU - Aerts, Jean-Marie PY - 2024/3/27 TI - Assessment of the Barriers and Enablers of the Use of mHealth Systems in Sub-Saharan Africa According to the Perceptions of Patients, Physicians, and Health Care Executives in Ethiopia: Qualitative Study JO - J Med Internet Res SP - e50337 VL - 26 KW - barriers KW - chronic disease KW - digital health KW - eHealth KW - enablers KW - health care KW - mHealth KW - mobile health KW - perspectives KW - Sub-Saharan Africa N2 - Background: Digital technologies are increasingly being used to deliver health care services and promote public health. Mobile wireless technologies or mobile health (mHealth) technologies are particularly relevant owing to their ease of use, broad reach, and wide acceptance. Unlike developed countries, Sub-Saharan Africa experiences more challenges and obstacles when it comes to deploying, using, and expanding mHealth systems. In addition to barriers, there are enabling factors that could be exploited for the design, implementation, and scaling up of mHealth systems. Sub-Saharan Africa may require tailored solutions that address the specific challenges facing the region. Objective: The overall aim of this study was to identify the barriers and enablers for using mHealth systems in Sub-Saharan Africa from the perspectives of patients, physicians, and health care executives. Methods: Multi-level and multi-actor in-depth semistructured interviews were employed to qualitatively explore the barriers and enablers of the use of mHealth systems. Data were collected from patients, physicians, and health care executives. The interviews were audio recorded, transcribed verbatim, translated, and coded. Thematic analysis methodology was adopted, and NVivo software was used for the data analysis. Results: Through this rigorous study, a total of 137 determinants were identified. Of these determinants, 68 were identified as barriers and 69 were identified as enablers. Perceived barriers in patients included lack of awareness about mHealth systems and language barriers. Perceived enablers in patients included need for automated tools for health monitoring and an increasing literacy level of the society. According to physicians, barriers included lack of available digital health systems in the local context and concern about patients? mHealth capabilities, while enablers included the perceived usefulness in reducing workload and improving health care service quality, as well as the availability of mobile devices and the internet. As perceived by health care executives, barriers included competing priorities alongside digitalization in the health sector and lack of interoperability and complete digitalization of implemented digital health systems, while enablers included the perceived usefulness of digitalization for the survival of the highly overloaded health care system and the abundance of educated manpower specializing in technology. Conclusions: mHealth systems in Sub-Saharan Africa are hindered and facilitated by various factors. Common barriers and enablers were identified by patients, physicians, and health care executives. To promote uptake, all relevant stakeholders must actively mitigate the barriers. This study identified a promising outlook for mHealth in Sub-Saharan Africa, despite the present barriers. Opportunities exist for successful integration into health care systems, and a user-centered design is crucial for maximum uptake. UR - https://www.jmir.org/2024/1/e50337 UR - http://dx.doi.org/10.2196/50337 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536231 ID - info:doi/10.2196/50337 ER - TY - JOUR AU - Paul, Lorna AU - Thomson, Katie AU - Asibey, Osei Shadrack AU - Brady, Marian AU - van Wijck, Frederike AU - Antwi, Derrick AU - Opoku, Nkansah Eric AU - Sarfo, Stephen Fred PY - 2024/3/27 TI - Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study JO - JMIR Mhealth Uhealth SP - e49501 VL - 12 KW - telerehabilitation KW - low- to middle-income country KW - LMIC KW - service user KW - health care professional KW - qualitative study KW - caregiver KW - neurorehabilitation KW - barriers KW - facilitators KW - eHealth KW - focus group KW - thematic analysis N2 - Background: Up to 50% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings, almost all are anecdotal. Furthermore, family or carers have a significant influence on the adoption and success of telerehabilitation, but their views have not been reported. Objective: This study aimed to investigate the views of service users, their family or carers, and health care professionals (HCPs) on telerehabilitation for people with neurological conditions in Ghana. Methods: Two focus groups were held at Komfo Anokye Hospital in Kumasi, Ghana: one in person for service users (n=11) and their family or carers (n=9), conducted in the Ghanaian language of Twi, and one hybrid for HCPs (n=18) conducted in English. The mean (SD) age of the service users was 59.8 (8.6) years; 5 users had a stroke and 6 had Parkinson disease. The HCP group consisted of 7 speech and language therapists, 3 physiotherapists, 3 occupational therapists, 3 medical staff, 1 nurse, and 1 industry representative. Focus groups were semi-structured and explored previous experiences of telerehabilitation, perceived benefits and challenges, and solutions to overcome these challenges. Focus groups were audio transcribed, and the service user transcript was translated into English. The resulting transcripts were analyzed using thematic analysis. Results: Overall, participants were positive about the role of telerehabilitation but recommended hybrid delivery, with in-person rehabilitation in the early stages and telerehabilitation in the later stages. In relation to telerehabilitation in Ghana, there were 3 main themes: benefits, challenges or barriers, and implementation. Benefits included the convenience and lower cost for service users, the higher dose of therapy possible, and increased access for people in remote areas. However, challenges included lack of a stable internet connection, cost of phones and data packages, and low levels of literacy. Implementation issues included cultural relevance, information governance, and the platform used to deliver telerehabilitation, with most participants being familiar with WhatsApp. Conclusions: Telerehabilitation has the potential to be a useful method of delivering rehabilitation to people with neurological conditions in Ghana, especially in a hybrid rehabilitation model with telerehabilitation augmenting in-person sessions. However, many people were unaware of telerehabilitation, and challenges such as a reliable internet connection, cultural relevance, and costs need to be addressed. Clinical trials of low-cost telerehabilitation interventions contextualized to the specific user group are required. UR - https://mhealth.jmir.org/2024/1/e49501 UR - http://dx.doi.org/10.2196/49501 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536218 ID - info:doi/10.2196/49501 ER - TY - JOUR AU - Ulfsdotter Gunnarsson, Katarina AU - Henriksson, Martin AU - Bendtsen, Marcus PY - 2024/3/27 TI - Digital Alcohol Interventions Could Be Part of the Societal Response to Harmful Consumption, but We Know Little About Their Long-Term Costs and Health Outcomes JO - J Med Internet Res SP - e44574 VL - 26 KW - alcohol KW - health economics KW - telemedicine KW - psychological harm KW - eHealth KW - digital intervention KW - decision-making UR - https://www.jmir.org/2024/1/e44574 UR - http://dx.doi.org/10.2196/44574 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536228 ID - info:doi/10.2196/44574 ER - TY - JOUR AU - Monachelli, Rebecca AU - Davis, Watkins Sharon AU - Barnard, Allison AU - Longmire, Michelle AU - Docherty, P. John AU - Oakley-Girvan, Ingrid PY - 2024/3/26 TI - Designing mHealth Apps to Incorporate Evidence-Based Techniques for Prolonging User Engagement JO - Interact J Med Res SP - e51974 VL - 13 KW - adherence KW - app design KW - attrition KW - mHealth KW - user engagement KW - user experience KW - proof-of-concept UR - https://www.i-jmr.org/2024/1/e51974 UR - http://dx.doi.org/10.2196/51974 UR - http://www.ncbi.nlm.nih.gov/pubmed/38416858 ID - info:doi/10.2196/51974 ER - TY - JOUR AU - Yoon, Sungwook AU - Lim, Hyungsoo AU - Park, Sungho PY - 2024/3/25 TI - The Impact of Wireless Emergency Alerts on a Floating Population in Seoul, South Korea: Panel Data Analysis JO - JMIR Public Health Surveill SP - e43554 VL - 10 KW - COVID-19 KW - empirical identification KW - floating population KW - social distancing KW - wireless emergency alert N2 - Background: Wireless emergency alerts (WEAs), which deliver disaster information directly to individuals? mobile phones, have been widely used to provide information related to COVID-19 and to encourage compliance with social distancing guidelines during the COVID-19 pandemic. The floating population refers to the number of people temporarily staying in a specific area, and this demographic data can be a useful indicator to understand the level of social distancing people are complying with during the COVID-19 pandemic. Objective: This study aimed to empirically analyze the impact of WEAs on the floating population where WEAs were transmitted in the early stages of the COVID-19 pandemic. As most WEA messages focus on compliance with the government?s social distancing guidelines, one of the goals of transmitting WEAs during the COVID-19 pandemic is to control the floating population at an appropriate level. Methods: We investigated the empirical impact of WEAs on the floating population across 25 districts in Seoul by estimating a panel regression model at the district-hour level with a series of fixed effects. The main independent variables were the number of instant WEAs, the daily cumulative number of WEAs, the total cumulative number of WEAs, and information extracted from WEAs by natural language processing at the district-hour level. The data set provided a highly informative empirical setting as WEAs were sent by different local governments with various identifiable district-hour?level data. Results: The estimates of the impact of WEAs on the floating population were significantly negative (?0.013, P=.02 to ?0.014, P=.01) across all specifications, implying that an additional WEA issuance reduced the floating population by 1.3% (=100(1?e?0.013)) to 1.4% (=100(1?e?0.014)). Although the coefficients of DCN (the daily cumulative number of WEAs) were also negative (?0.0034, P=.34 to ?0.0052, P=.15) across all models, they were not significant. The impact of WEAs on the floating population doubled (?0.025, P=.02 to ?0.033, P=.005) when the first 82 days of observations were used as subsamples to reduce the possibility of people blocking WEAs. Conclusions: Our results suggest that issuing WEAs and distributing information related to COVID-19 to a specific district was associated with a decrease in the floating population of that district. Furthermore, among the various types of information in the WEAs, location information was the only significant type of information that was related to a decrease in the floating population. This study makes important contributions. First, this study measured the impact of WEAs in a highly informative empirical setting. Second, this study adds to the existing literature on the mechanisms by which WEAs can affect public response. Lastly, this study has important implications for making optimal WEAs and suggests that location information should be included. UR - https://publichealth.jmir.org/2024/1/e43554 UR - http://dx.doi.org/10.2196/43554 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526536 ID - info:doi/10.2196/43554 ER - TY - JOUR AU - Kargarandehkordi, Ali AU - Slade, Christopher AU - Washington, Peter PY - 2024/3/25 TI - Personalized AI-Driven Real-Time Models to Predict Stress-Induced Blood Pressure Spikes Using Wearable Devices: Proposal for a Prospective Cohort Study JO - JMIR Res Protoc SP - e55615 VL - 13 KW - stress KW - hypertension KW - precision health KW - personalized artificial intelligence KW - wearables KW - ecological momentary assessments KW - passive sensing KW - mobile phone N2 - Background: Referred to as the ?silent killer,? elevated blood pressure (BP) often goes unnoticed due to the absence of apparent symptoms, resulting in cumulative harm over time. Chronic stress has been consistently linked to increased BP. Prior studies have found that elevated BP often arises due to a stressful lifestyle, although the effect of exact stressors varies drastically between individuals. The heterogeneous nature of both the stress and BP response to a multitude of lifestyle decisions can make it difficult if not impossible to pinpoint the most deleterious behaviors using the traditional mechanism of clinical interviews. Objective: The aim of this study is to leverage machine learning (ML) algorithms for real-time predictions of stress-induced BP spikes using consumer wearable devices such as Fitbit, providing actionable insights to both patients and clinicians to improve diagnostics and enable proactive health monitoring. This study also seeks to address the significant challenges in identifying specific deleterious behaviors associated with stress-induced hypertension through the development of personalized artificial intelligence models for individual patients, departing from the conventional approach of using generalized models. Methods: The study proposes the development of ML algorithms to analyze biosignals obtained from these wearable devices, aiming to make real-time predictions about BP spikes. Given the longitudinal nature of the data set comprising time-series data from wearables (eg, Fitbit) and corresponding time-stamped labels representing stress levels from Ecological Momentary Assessment reports, the adoption of self-supervised learning for pretraining the network and using transformer models for fine-tuning the model on a personalized prediction task is proposed. Transformer models, with their self-attention mechanisms, dynamically weigh the importance of different time steps, enabling the model to focus on relevant temporal features and dependencies, facilitating accurate prediction. Results: Supported as a pilot project from the Robert C Perry Fund of the Hawaii Community Foundation, the study team has developed the core study app, CardioMate. CardioMate not only reminds participants to initiate BP readings using an Omron HeartGuide wearable monitor but also prompts them multiple times a day to report stress levels. Additionally, it collects other useful information including medications, environmental conditions, and daily interactions. Through the app?s messaging system, efficient contact and interaction between users and study admins ensure smooth progress. Conclusions: Personalized ML when applied to biosignals offers the potential for real-time digital health interventions for chronic stress and its symptoms. The project?s clinical use for Hawaiians with stress-induced high BP combined with its methodological innovation of personalized artificial intelligence models highlights its significance in advancing health care interventions. Through iterative refinement and optimization, the aim is to develop a personalized deep-learning framework capable of accurately predicting stress-induced BP spikes, thereby promoting individual well-being and health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/55615 UR - https://www.researchprotocols.org/2024/1/e55615 UR - http://dx.doi.org/10.2196/55615 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526539 ID - info:doi/10.2196/55615 ER - TY - JOUR AU - O'Kane, K. Kiarah M. AU - Otamendi, Thalia AU - Silverberg, D. Noah AU - Choi, Esther AU - Sicard, Veronik AU - Zemek, Roger AU - Healey, Katherine AU - Brown, Olivier AU - Butterfield, Lauren AU - Smith, Andra AU - Goldfield, Gary AU - Kardish, Rachel AU - Saab, J. Bechara AU - Ledoux, Andrée-Anne AU - Cairncross, Molly PY - 2024/3/22 TI - Development of Therapeutic Alliance and Social Presence in a Digital Intervention for Pediatric Concussion: Qualitative Exploratory Study JO - JMIR Form Res SP - e49133 VL - 8 KW - adolescent KW - concussion KW - digital therapeutics KW - eHealth KW - mHealth KW - mindfulness KW - mobile health KW - social presence KW - working alliance N2 - Background: Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence?the extent to which digital encounters feel like they are occurring in person?may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored. Objective: This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents? development of therapeutic alliance and social presence with the intervention. Methods: Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention. Results: Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by ?developing a genuine connection? with their mindfulness guides and ?sensing real people.? Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides? ?personal backgrounds and voices,? such that participants felt more connected to the guides by knowing information about them and through the guides? calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants? average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would. Conclusions: Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents? development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment. UR - https://formative.jmir.org/2024/1/e49133 UR - http://dx.doi.org/10.2196/49133 UR - http://www.ncbi.nlm.nih.gov/pubmed/38517472 ID - info:doi/10.2196/49133 ER - TY - JOUR AU - Gabb, Grace Victoria AU - Blackman, Jonathan AU - Morrison, Duncan Hamish AU - Biswas, Bijetri AU - Li, Haoxuan AU - Turner, Nicholas AU - Russell, M. Georgina AU - Greenwood, Rosemary AU - Jolly, Amy AU - Trender, William AU - Hampshire, Adam AU - Whone, Alan AU - Coulthard, Elizabeth PY - 2024/3/22 TI - Remote Evaluation of Sleep and Circadian Rhythms in Older Adults With Mild Cognitive Impairment and Dementia: Protocol for a Feasibility and Acceptability Mixed Methods Study JO - JMIR Res Protoc SP - e52652 VL - 13 KW - feasibility KW - sleep KW - mild cognitive impairment KW - dementia KW - Lewy body disease KW - Alzheimer disease KW - Parkinson KW - wearable devices KW - research KW - mobile phone KW - electroencephalography KW - accelerometery KW - mobile applications KW - application KW - app KW - cognitive KW - cognitive impairment KW - sleeping KW - sleep disturbance KW - risk factor KW - Alzheimer KW - wearable KW - wearables KW - acceptability KW - smart device N2 - Background: Sleep disturbances are a potentially modifiable risk factor for neurodegenerative dementia secondary to Alzheimer disease (AD) and Lewy body disease (LBD). Therefore, we need to identify the best methods to study sleep in this population. Objective: This study will assess the feasibility and acceptability of various wearable devices, smart devices, and remote study tasks in sleep and cognition research for people with AD and LBD. Methods: We will deliver a feasibility and acceptability study alongside a prospective observational cohort study assessing sleep and cognition longitudinally in the home environment. Adults aged older than 50 years who were diagnosed with mild to moderate dementia or mild cognitive impairment (MCI) due to probable AD or LBD and age-matched controls will be eligible. Exclusion criteria include lack of capacity to consent to research, other causes of MCI or dementia, and clinically significant sleep disorders. Participants will complete a cognitive assessment and questionnaires with a researcher and receive training and instructions for at-home study tasks across 8 weeks. At-home study tasks include remote sleep assessments using wearable devices (electroencephalography headband and actigraphy watch), app-based sleep diaries, online cognitive assessments, and saliva samples for melatonin- and cortisol-derived circadian markers. Feasibility outcomes will be assessed relating to recruitment and retention, data completeness, data quality, and support required. Feedback on acceptability and usability will be collected throughout the study period and end-of-study interviews will be analyzed using thematic analysis. Results: Recruitment started in February 2022. Data collection is ongoing, with final data expected in February 2024 and data analysis and publication of findings scheduled for the summer of 2024. Conclusions: This study will allow us to assess if remote testing using smart devices and wearable technology is a viable alternative to traditional sleep measurements, such as polysomnography and questionnaires, in older adults with and without MCI or dementia due to AD or LBD. Understanding participant experience and the barriers and facilitators to technology use for research purposes and remote research in this population will assist with the development of, recruitment to, and retention within future research projects studying sleep and cognition outside of the clinic or laboratory. International Registered Report Identifier (IRRID): DERR1-10.2196/52652 UR - https://www.researchprotocols.org/2024/1/e52652 UR - http://dx.doi.org/10.2196/52652 UR - http://www.ncbi.nlm.nih.gov/pubmed/38517469 ID - info:doi/10.2196/52652 ER - TY - JOUR AU - Ahn, Hyo-Jeong AU - Choi, Eue-Keun AU - Lee, So-Ryoung AU - Kwon, Soonil AU - Song, Hee-Seok AU - Lee, Young-Shin AU - Oh, Seil PY - 2024/3/21 TI - Three-Day Monitoring of Adhesive Single-Lead Electrocardiogram Patch for Premature Ventricular Complex: Prospective Study for Diagnosis Validation and Evaluation of Burden Fluctuation JO - J Med Internet Res SP - e46098 VL - 26 KW - premature ventricular complex KW - single-lead electrocardiogram KW - wearable device KW - extended monitor KW - electrocardiogram KW - EKG KW - ECG KW - wearable KW - heart KW - cardiology KW - cardiovascular N2 - Background: Wearable electrocardiogram (ECG) monitoring devices are used worldwide. However, data on the diagnostic yield of an adhesive single-lead ECG patch (SEP) to detect premature ventricular complex (PVC) and the optimal duration of wearing an SEP for PVC burden assessment are limited. Objective: We aimed to validate the diagnostic yield of an SEP (mobiCARE MC-100, Seers Technology) for PVC detection and evaluate the PVC burden variation recorded by the SEP over a 3-day monitoring period. Methods: This is a prospective study of patients with documented PVC on a 12-lead ECG. Patients underwent simultaneous ECG monitoring with the 24-hour Holter monitor and SEP on the first day. On the subsequent second and third days, ECG monitoring was continued using only SEP, and a 3-day extended monitoring was completed. The diagnostic yield of SEP for PVC detection was evaluated by comparison with the results obtained on the first day of Holter monitoring. The PVC burden monitored by SEP for 3 days was used to assess the daily and 6-hour PVC burden variations. The number of patients additionally identified to reach PVC thresholds of 10%, 15%, and 20% during the 3-day extended monitoring by SEP and the clinical factors associated with the higher PVC burden variations were explored. Results: The recruited data of 134 monitored patients (mean age, 54.6 years; males, 45/134, 33.6%) were analyzed. The median daily PVC burden of these patients was 2.4% (IQR 0.2%-10.9%), as measured by the Holter monitor, and 3.3% (IQR 0.3%-11.7%), as measured in the 3-day monitoring by SEP. The daily PVC burden detected on the first day of SEP was in agreement with that of the Holter monitor: the mean difference was ?0.07%, with 95% limits of agreement of ?1.44% to 1.30%. A higher PVC burden on the first day was correlated with a higher daily (R2=0.34) and 6-hour burden variation (R2=0.48). Three-day monitoring by SEP identified 29% (12/42), 18% (10/56), and 7% (4/60) more patients reaching 10%, 15%, and 20% of daily PVC burden, respectively. Younger age was additionally associated with the identification of clinically significant PVC burden during the extended monitoring period (P=.02). Conclusions: We found that the mobiCARE MC-100 SEP accurately detects PVC with comparable diagnostic yield to the 24-hour Holter monitor. Performing 3-day PVC monitoring with SEP, especially among younger patients, may offer a pragmatic alternative for identifying more individuals exceeding the clinically significant PVC burden threshold. UR - https://www.jmir.org/2024/1/e46098 UR - http://dx.doi.org/10.2196/46098 UR - http://www.ncbi.nlm.nih.gov/pubmed/38512332 ID - info:doi/10.2196/46098 ER - TY - JOUR AU - Bonn, E. Stephanie AU - Hummel, Madeleine AU - Peveri, Giulia AU - Eke, Helén AU - Alexandrou, Christina AU - Bellocco, Rino AU - Löf, Marie AU - Trolle Lagerros, Ylva PY - 2024/3/21 TI - Effectiveness of a Smartphone App to Promote Physical Activity Among Persons With Type 2 Diabetes: Randomized Controlled Trial JO - Interact J Med Res SP - e53054 VL - 13 KW - behavior change KW - exercise KW - intervention KW - mHealth KW - smartphone app KW - self-monitoring N2 - Background: Physical activity is well known to have beneficial effects on glycemic control and to reduce risk factors for cardiovascular disease in persons with type 2 diabetes. Yet, successful implementation of lifestyle interventions targeting physical activity in primary care has shown to be difficult. Smartphone apps may provide useful tools to support physical activity. The DiaCert app was specifically designed for integration into primary care and is an automated mobile health (mHealth) solution promoting daily walking. Objective: This study aimed to investigate the effect of a 3-month-long intervention promoting physical activity through the use of the DiaCert app among persons with type 2 diabetes in Sweden. Our primary objective was to assess the effect on moderate to vigorous physical activity (MVPA) at 3 months of follow-up. Our secondary objective was to assess the effect on MVPA at 6 months of follow-up and on BMI, waist circumference, hemoglobin A1c, blood lipids, and blood pressure at 3 and 6 months of follow-up. Methods: We recruited men and women with type 2 diabetes from 5 primary health care centers and 1 specialized center. Participants were randomized 1:1 to the intervention or control group. The intervention group was administered standard care and access to the DiaCert app at baseline and 3 months onward. The control group received standard care only. Outcomes of objectively measured physical activity using accelerometers, BMI, waist circumference, biomarkers, and blood pressure were assessed at baseline and follow-ups. Linear mixed models were used to assess differences in outcomes between the groups. Results: A total of 181 study participants, 65.7% (119/181) men and 34.3% (62/181) women, were recruited into the study and randomized to the intervention (n=93) or control group (n=88). The participants? mean age and BMI were 60.0 (SD 11.4) years and 30.4 (SD 5.3) kg/m2, respectively. We found no significant effect of the intervention (group by time interaction) on MVPA at either the 3-month (?=1.51, 95% CI ?5.53 to 8.55) or the 6-month (?=?3.53, 95% CI ?10.97 to 3.92) follow-up. We found no effect on any of the secondary outcomes at follow-ups, except for a significant effect on BMI at 6 months (?=0.52, 95% CI 0.20 to 0.84). However, mean BMI did not differ between the groups at the 6-month follow-up. Conclusions: We found no evidence that persons with type 2 diabetes being randomized to use an app promoting daily walking increased their levels of MVPA at 3 or 6 months? follow-up compared with controls receiving standard care. The effect of the app on BMI was unclear, and we found nothing to support an effect on secondary outcomes. Further research is needed to determine what type of mHealth intervention could be effective to increase physical activity among persons with type 2 diabetes. Trial Registration: ClinicalTrials.gov NCT03053336; https://clinicaltrials.gov/study/NCT03053336 UR - https://www.i-jmr.org/2024/1/e53054 UR - http://dx.doi.org/10.2196/53054 UR - http://www.ncbi.nlm.nih.gov/pubmed/38512333 ID - info:doi/10.2196/53054 ER - TY - JOUR AU - Li, Shiyu AU - Du, Yan AU - Miao, Hongyu AU - Sharma, Kumar AU - Li, Chengdong AU - Yin, Zenong AU - Brimhall, Bradley AU - Wang, Jing PY - 2024/3/20 TI - Understanding Heterogeneity in Individual Responses to Digital Lifestyle Intervention Through Self-Monitoring Adherence Trajectories in Adults With Overweight or Obesity: Secondary Analysis of a 6-Month Randomized Controlled Trial JO - J Med Internet Res SP - e53294 VL - 26 KW - self-monitoring KW - adherence KW - weight loss KW - digital technology KW - behavior change KW - group-based trajectory modeling KW - precision health KW - mobile phone N2 - Background: Achieving clinically significant weight loss through lifestyle interventions for obesity management is challenging for most individuals. Improving intervention effectiveness involves early identification of intervention nonresponders and providing them with timely, tailored interventions. Early and frequent self-monitoring (SM) adherence predicts later weight loss success, making it a potential indicator for identifying nonresponders in the initial phase. Objective: This study aims to identify clinically meaningful participant subgroups based on longitudinal adherence to SM of diet, activity, and weight over 6 months as well as psychological predictors of participant subgroups from a self-determination theory (SDT) perspective. Methods: This was a secondary data analysis of a 6-month digital lifestyle intervention for adults with overweight or obesity. The participants were instructed to perform daily SM on 3 targets: diet, activity, and weight. Data from 50 participants (mean age: 53.0, SD 12.6 y) were analyzed. Group-based multitrajectory modeling was performed to identify subgroups with distinct trajectories of SM adherence across the 3 SM targets. Differences between subgroups were examined for changes in clinical outcomes (ie, body weight, hemoglobin A1c) and SDT constructs (ie, eating-related autonomous motivation and perceived competence for diet) over 6 months using linear mixed models. Results: Two distinct SM trajectory subgroups emerged: the Lower SM group (21/50, 42%), characterized by all-around low and rapidly declining SM, and the Higher SM group (29/50, 58%), characterized by moderate and declining diet and weight SM with high activity SM. Since week 2, participants in the Lower SM group exhibited significantly lower levels of diet (P=.003), activity (P=.002), and weight SM (P=.02) compared with the Higher SM group. In terms of clinical outcomes, the Higher SM group achieved a significant reduction in body weight (estimate: ?6.06, SD 0.87 kg; P<.001) and hemoglobin A1c (estimate: ?0.38, SD 0.11%; P=.02), whereas the Lower SM group exhibited no improvements. For SDT constructs, both groups maintained high levels of autonomous motivation for over 6 months. However, the Lower SM group experienced a significant decline in perceived competence (P=.005) compared with the Higher SM group, which maintained a high level of perceived competence throughout the intervention (P=.09). Conclusions: The presence of the Lower SM group highlights the value of using longitudinal SM adherence trajectories as an intervention response indicator. Future adaptive trials should identify nonresponders within the initial 2 weeks based on their SM adherence and integrate intervention strategies to enhance perceived competence in diet to benefit nonresponders. Trial Registration: ClinicalTrials.gov NCT05071287; https://clinicaltrials.gov/study/NCT05071287 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2022.106845 UR - https://www.jmir.org/2024/1/e53294 UR - http://dx.doi.org/10.2196/53294 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506903 ID - info:doi/10.2196/53294 ER - TY - JOUR AU - Sahu, Sundar Kirti AU - Dubin, A. Joel AU - Majowicz, E. Shannon AU - Liu, Sam AU - Morita, P. Plinio PY - 2024/3/20 TI - Revealing the Mysteries of Population Mobility Amid the COVID-19 Pandemic in Canada: Comparative Analysis With Internet of Things?Based Thermostat Data and Google Mobility Insights JO - JMIR Public Health Surveill SP - e46903 VL - 10 KW - population-level health indicators KW - internet of things KW - public health surveillance KW - mobility KW - risk factors KW - chronic diseases KW - chronic KW - risk KW - surveillance KW - movement KW - sensor KW - population N2 - Background: The COVID-19 pandemic necessitated public health policies to limit human mobility and curb infection spread. Human mobility, which is often underestimated, plays a pivotal role in health outcomes, impacting both infectious and chronic diseases. Collecting precise mobility data is vital for understanding human behavior and informing public health strategies. Google?s GPS-based location tracking, which is compiled in Google Mobility Reports, became the gold standard for monitoring outdoor mobility during the pandemic. However, indoor mobility remains underexplored. Objective: This study investigates in-home mobility data from ecobee?s smart thermostats in Canada (February 2020 to February 2021) and compares it directly with Google?s residential mobility data. By assessing the suitability of smart thermostat data, we aim to shed light on indoor mobility patterns, contributing valuable insights to public health research and strategies. Methods: Motion sensor data were acquired from the ecobee ?Donate Your Data? initiative via Google?s BigQuery cloud platform. Concurrently, residential mobility data were sourced from the Google Mobility Report. This study centered on 4 Canadian provinces?Ontario, Quebec, Alberta, and British Columbia?during the period from February 15, 2020, to February 14, 2021. Data processing, analysis, and visualization were conducted on the Microsoft Azure platform using Python (Python Software Foundation) and R programming languages (R Foundation for Statistical Computing). Our investigation involved assessing changes in mobility relative to the baseline in both data sets, with the strength of this relationship assessed using Pearson and Spearman correlation coefficients. We scrutinized daily, weekly, and monthly variations in mobility patterns across the data sets and performed anomaly detection for further insights. Results: The results revealed noteworthy week-to-week and month-to-month shifts in population mobility within the chosen provinces, aligning with pandemic-driven policy adjustments. Notably, the ecobee data exhibited a robust correlation with Google?s data set. Examination of Google?s daily patterns detected more pronounced mobility fluctuations during weekdays, a trend not mirrored in the ecobee data. Anomaly detection successfully identified substantial mobility deviations coinciding with policy modifications and cultural events. Conclusions: This study?s findings illustrate the substantial influence of the Canadian stay-at-home and work-from-home policies on population mobility. This impact was discernible through both Google?s out-of-house residential mobility data and ecobee?s in-house smart thermostat data. As such, we deduce that smart thermostats represent a valid tool for facilitating intelligent monitoring of population mobility in response to policy-driven shifts. UR - https://publichealth.jmir.org/2024/1/e46903 UR - http://dx.doi.org/10.2196/46903 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506901 ID - info:doi/10.2196/46903 ER - TY - JOUR AU - Jacobucci, Ross AU - Ammerman, Brooke AU - Ram, Nilam PY - 2024/3/20 TI - Examining Passively Collected Smartphone-Based Data in the Days Prior to Psychiatric Hospitalization for a Suicidal Crisis: Comparative Case Analysis JO - JMIR Form Res SP - e55999 VL - 8 KW - screenomics KW - digital phenotyping KW - passive assessment KW - intensive time sampling KW - suicide risk KW - suicidal behaviors KW - risk detection KW - Comparative Analysis KW - suicide KW - suicidal KW - risk KW - risks KW - behavior KW - behaviors KW - detection KW - prediction KW - Smartphone-Based KW - screenomic KW - case review KW - participant KW - participants KW - smartphone KW - smartphones KW - suicidal ideation N2 - Background: Digital phenotyping has seen a broad increase in application across clinical research; however, little research has implemented passive assessment approaches for suicide risk detection. There is a significant potential for a novel form of digital phenotyping, termed screenomics, which captures smartphone activity via screenshots. Objective: This paper focuses on a comprehensive case review of 2 participants who reported past 1-month active suicidal ideation, detailing their passive (ie, obtained via screenomics screenshot capture) and active (ie, obtained via ecological momentary assessment [EMA]) risk profiles that culminated in suicidal crises and subsequent psychiatric hospitalizations. Through this analysis, we shed light on the timescale of risk processes as they unfold before hospitalization, as well as introduce the novel application of screenomics within the field of suicide research. Methods: To underscore the potential benefits of screenomics in comprehending suicide risk, the analysis concentrates on a specific type of data gleaned from screenshots?text?captured prior to hospitalization, alongside self-reported EMA responses. Following a comprehensive baseline assessment, participants completed an intensive time sampling period. During this period, screenshots were collected every 5 seconds while one?s phone was in use for 35 days, and EMA data were collected 6 times a day for 28 days. In our analysis, we focus on the following: suicide-related content (obtained via screenshots and EMA), risk factors theoretically and empirically relevant to suicide risk (obtained via screenshots and EMA), and social content (obtained via screenshots). Results: Our analysis revealed several key findings. First, there was a notable decrease in EMA compliance during suicidal crises, with both participants completing fewer EMAs in the days prior to hospitalization. This contrasted with an overall increase in phone usage leading up to hospitalization, which was particularly marked by heightened social use. Screenomics also captured prominent precipitating factors in each instance of suicidal crisis that were not well detected via self-report, specifically physical pain and loneliness. Conclusions: Our preliminary findings underscore the potential of passively collected data in understanding and predicting suicidal crises. The vast number of screenshots from each participant offers a granular look into their daily digital interactions, shedding light on novel risks not captured via self-report alone. When combined with EMA assessments, screenomics provides a more comprehensive view of an individual?s psychological processes in the time leading up to a suicidal crisis. UR - https://formative.jmir.org/2024/1/e55999 UR - http://dx.doi.org/10.2196/55999 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506916 ID - info:doi/10.2196/55999 ER - TY - JOUR AU - van Alen, Marie Catharina AU - Brenner, Alexander AU - Warnecke, Tobias AU - Varghese, Julian PY - 2024/3/20 TI - Smartwatch Versus Routine Tremor Documentation: Descriptive Comparison JO - JMIR Form Res SP - e51249 VL - 8 KW - Parkinson disease KW - tremor KW - smart wearables KW - smartwatch KW - mobile apps KW - movement disorders KW - tremor documentation KW - tremor occurrence KW - tremor score UR - https://formative.jmir.org/2024/1/e51249 UR - http://dx.doi.org/10.2196/51249 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506919 ID - info:doi/10.2196/51249 ER - TY - JOUR AU - O'Driscoll, Ciarán AU - Singh, Aneesha AU - Chichua, Iya AU - Clodic, Joachim AU - Desai, Anjali AU - Nikolova, Dara AU - Yap, Jie Alex AU - Zhou, Irene AU - Pilling, Stephen PY - 2024/3/20 TI - An Ecological Mobile Momentary Intervention to Support Dynamic Goal Pursuit: Feasibility and Acceptability Study JO - JMIR Form Res SP - e49857 VL - 8 KW - goal pursuit KW - ecological momentary intervention KW - ecological momentary assessment KW - mood KW - dynamics KW - network analysis KW - MCII KW - COM-B KW - support KW - pilot study KW - training KW - feasibility KW - acceptability KW - self-monitoring KW - implementation KW - psychological KW - effectiveness N2 - Background: Individuals can experience difficulties pursuing their goals amid multiple competing priorities in their environment. Effective goal dynamics require flexible and generalizable pursuit skills. Supporting successful goal pursuit requires a perpetually adapting intervention responsive to internal states. Objective: The purpose of this study was to (1) develop a flexible intervention that can adapt to an individual?s changing short to medium-term goals and be applied to their daily life and (2) examine the feasibility and acceptability of the just-in-time adaptive intervention for goal pursuit. Methods: This study involved 3 iterations to test and systematically enhance all aspects of the intervention. During the pilot phase, 73 participants engaged in an ecological momentary assessment (EMA) over 1 month. After week 1, they attended an intervention training session and received just-in-time intervention prompts during the following 3 weeks. The training employed the Capability, Opportunity, Motivation, and Behavior (COM-B) framework for goal setting, along with mental contrasting with implementation intentions (MCII). Subsequent prompts, triggered by variability in goal pursuit, guided the participants to engage in MCII in relation to their current goal. We evaluated feasibility and acceptability, efficacy, and individual change processes by combining intensive (single-case experimental design) and extensive methods. Results: The results suggest that the digital intervention was feasible and acceptable to participants. Compliance with the intervention was high (n=63, 86%). The participants endorsed high acceptability ratings relating to both the study procedures and the intervention. All participants (N=73, 100%) demonstrated significant improvements in goal pursuit with an average difference of 0.495 units in the outcome (P<.001). The results of the dynamic network modeling suggest that self-monitoring behavior (EMA) and implementing the MCII strategy may aid in goal reprioritization, where goal pursuit itself is a driver of further goal pursuit. Conclusions: This pilot study demonstrated the feasibility and acceptability of a just-in-time adaptive intervention among a nonclinical adult sample. This intervention used self-monitoring of behavior, the COM-B framework, and MCII strategies to improve dynamic goal pursuit. It was delivered via an Ecological Momentary Intervention (EMI) procedure. Future research should consider the utility of this approach as an additional intervention element within psychological interventions to improve goal pursuit. Sustaining goal pursuit throughout interventions is central to their effectiveness and warrants further evaluation. UR - https://formative.jmir.org/2024/1/e49857 UR - http://dx.doi.org/10.2196/49857 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506904 ID - info:doi/10.2196/49857 ER - TY - JOUR AU - Tong, Ly Huong AU - Alnasser, Aroub AU - Alshahrani, Z. Najim AU - Bawaked, A. Rowaedh AU - AlAhmed, Reem AU - Alsukait, F. Reem AU - Rakic, Severin AU - Cetinkaya, Volkan AU - Al-Hazzaa, M. Hazzaa AU - Alqahtani, A. Saleh PY - 2024/3/19 TI - The Use of Mobile Technologies to Promote Physical Activity and Reduce Sedentary Behaviors in the Middle East and North Africa Region: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e53651 VL - 26 KW - mobile apps KW - fitness trackers KW - SMS KW - SMS text messaging KW - physical activity KW - exercise KW - sedentary behavior KW - Middle East KW - Africa, Northern KW - movement KW - physical inactivity KW - smartphone KW - mobile phone KW - mobile health KW - mHealth KW - digital health KW - behavior change KW - intervention N2 - Background: The Middle East and North Africa (MENA) region faces unique challenges in promoting physical activity and reducing sedentary behaviors, as the prevalence of insufficient physical activity is higher than the global average. Mobile technologies present a promising approach to delivering behavioral interventions; however, little is known about the effectiveness and user perspectives on these technologies in the MENA region. Objective: This study aims to evaluate the effectiveness of mobile interventions targeting physical activity and sedentary behaviors in the MENA region and explore users? perspectives on these interventions as well as any other outcomes that might influence users? adoption and use of mobile technologies (eg, appropriateness and cultural fit). Methods: A systematic search of 5 databases (MEDLINE, Embase, CINAHL, Scopus, and Global Index Medicus) was performed. Any primary studies (participants of all ages regardless of medical condition) conducted in the MENA region that investigated the use of mobile technologies and reported any measures of physical activity, sedentary behaviors, or user perceptions were included. We conducted a narrative synthesis of all studies and a meta-analysis of randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to assess the quality of the included RCTs; quality assessment of the rest of the included studies was completed using the relevant Joanna Briggs Institute critical appraisal tools. Results: In total, 27 articles describing 22 interventions (n=10, 37% RCTs) and 4 (15%) nonexperimental studies were included (n=6141, 46% women). Half (11/22, 50%) of the interventions included mobile apps, whereas the other half examined SMS. The main app functions were goal setting and self-monitoring of activity, whereas SMS interventions were primarily used to deliver educational content. Users in experimental studies described several benefits of the interventions (eg, gaining knowledge and receiving reminders to be active). Engagement with the interventions was poorly reported; few studies (8/27, 30%) examined users? perspectives on the appropriateness or cultural fit of the interventions. Nonexperimental studies examined users? perspectives on mobile apps and fitness trackers, reporting several barriers to their use, such as perceived lack of usefulness, loss of interest, and technical issues. The meta-analysis of RCTs showed a positive effect of mobile interventions on physical activity outcomes (standardized mean difference=0.45, 95% CI 0.17-0.73); several sensitivity analyses showed similar results. The trim-and-fill method showed possible publication bias. Only 20% (2/10) of the RCTs measured sedentary behaviors; both reported positive changes. Conclusions: The use of mobile interventions for physical activity and sedentary behaviors in the MENA region is in its early stages, with preliminary evidence of effectiveness. Policy makers and researchers should invest in high-quality studies to evaluate long-term effectiveness, intervention engagement, and implementation outcomes, which can inform the design of culturally and socially appropriate interventions for countries in the MENA region. Trial Registration: PROSPERO CRD42023392699; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392699 UR - https://www.jmir.org/2024/1/e53651 UR - http://dx.doi.org/10.2196/53651 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502160 ID - info:doi/10.2196/53651 ER - TY - JOUR AU - Breuer-Asher, Inbar AU - Ritholz, D. Marilyn AU - Horwitz, L. David AU - Manejwala, Omar AU - Behar, Ephraim AU - Fundoiano-Hershcovitz, Yifat PY - 2024/3/19 TI - Association of Digital Engagement With Relaxation Tools and Stress Level Reduction: Retrospective Cohort Study JO - JMIR Form Res SP - e50506 VL - 8 KW - mental health KW - perceived stress KW - stress reduction KW - digital health KW - video sessions KW - behavioral health KW - relaxation KW - breathing exercises KW - CBT KW - anxiety KW - cognitive behavioral therapy N2 - Background: Stress is an emotional response caused by external triggers and is a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions are effective for stress management. However, there is limited understanding of the association between relaxation components and stress levels when using a digital app. Objective: This study investigated the contribution of relaxation tools to stress levels over time. We hypothesized that participation in breathing exercises and cognitive behavioral therapy?based video sessions would be associated with a reduction in stress levels. We also hypothesized a significant reduction specifically in participants? perceived sense of burden and lack of productivity when engaged with breathing exercises and video sessions. Methods: Stress levels were evaluated in a real-world data cohort using a behavioral health app for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform?based treatment followed users (N=490) who started with moderate and above levels of stress and completed at least 2 stress assessments. The levels of stress were tracked throughout the first 10 weeks. A piecewise mixed effects model was applied to model the trajectories of weekly stress mean scores in 2 time segments (1-6 weeks and 6-10 weeks). Next, a simple slope analysis was used for interpreting interactions probing the moderators: breathing exercises and video sessions. Piecewise mixed-effects models were also used to model the trajectories of specific perceived stress item rates in the stress questionnaire in the 2 segments (1-6 weeks and 6-10 weeks) and whether they are moderated by the relaxation engagements. Simple slope analysis was also used here for the interpretation of the interactions. Results: Analysis revealed a significant decrease in stress symptoms (?=?.25; 95% CI ?0.32 to ?0.17; P<.001) during the period of 1-6 weeks of app use that was maintained during the period of 6-10 weeks. Breathing exercises significantly moderated the reduction in stress symptoms during the period of 1-6 weeks (?=?.07; 95% CI ?0.13 to ?0.01; P=.03), while engagement in digital video sessions did not moderate stress scores. Engagement in digital video sessions, as well as breathing exercises, significantly moderated the reduction in perceived sense of burden and lack of productivity during weeks 1-6 and remained stable during weeks 6-10 on both items. Conclusions: This study sheds light on the association between stress level reduction and specific components of engagement in a digital health app, breathing exercises, and cognitive behavioral therapy?based video sessions. Our findings provide a basis for further investigation of current and moderating factors that contribute to the personalization of digital intervention. In addition, results may aid in developing a more comprehensive understanding of how digital intervention tools work for mental health and for whom they are most effective. UR - https://formative.jmir.org/2024/1/e50506 UR - http://dx.doi.org/10.2196/50506 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502164 ID - info:doi/10.2196/50506 ER - TY - JOUR AU - Aycock, A. Chase AU - Mallawaarachchi, Indika AU - Wang, Xin-Qun AU - Cassidy, G. Daniel AU - Ellis, M. Jordan AU - Klesges, C. Robert AU - Talcott, Wayne G. AU - Wiseman, Kara PY - 2024/3/19 TI - Developing a Text Messaging Intervention to Prevent Binge and Heavy Drinking in a Military Population: Mixed Methods Development Study JO - JMIR Form Res SP - e55041 VL - 8 KW - text messaging KW - alcohol reduction KW - binge drinking KW - US KW - United States KW - US military KW - alcohol misuse KW - military KW - functioning KW - readiness KW - health KW - career KW - careers KW - text message KW - text messages KW - short message service KW - SMS KW - SMS intervention KW - drinking KW - Air Force KW - Airmen KW - mixed methods approach KW - message KW - messages KW - development study KW - qualitative coding KW - drinking alcohol KW - alcohol consumption KW - survey KW - descriptive statistics N2 - Background: Alcohol misuse is the fourth leading cause of death in the United States and a significant problem in the US military. Brief alcohol interventions can reduce negative alcohol outcomes in civilian and military populations, but additional scalable interventions are needed to reduce binge and heavy drinking. SMS text messaging interventions could address this need, but to date, no programs exist for military populations. Objective: We aimed to develop an SMS text messaging intervention to address binge and heavy drinking among Airmen in Technical Training in the US Air Force. Methods: We implemented a 2-phase, mixed methods study to develop the SMS text messaging intervention. In phase 1, a total of 149 respondents provided feedback about the persuasiveness of 49 expert-developed messages, preferences regarding message frequency, timing and days to receive messages, and suggested messages, which were qualitatively coded. In phase 2, a total of 283 respondents provided feedback about the persuasiveness of 77 new messages, including those developed through the refinement of messages from phase 1, which were coded and assessed based on the Behavior Change Technique Taxonomy (BCTT). For both phases, mean persuasiveness scores (range 1-5) were calculated and compared according to age (aged <21 or ?21 years) and gender. Top-ranking messages from phase 2 were considered for inclusion in the final message library. Results: In phase 1, top-rated message themes were about warnings about adverse outcomes (eg, impaired judgment and financial costs), recommendations to reduce drinking, and invoking values and goals. Through qualitative coding of suggested messages, we identified themes related to warnings about adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Respondents preferred to receive 1 to 3 messages per week (124/137, 90.5%) and to be sent messages on Friday, Saturday, and Sunday (65/142, 45.8%). In phase 2, mean scores for messages in the final message library ranged from 3.31 (SD 1.29) to 4.21 (SD 0.90). Of the top 5 highest-rated messages, 4 were categorized into 2 behavior change techniques (BCTs): valued self-identity and information about health consequences. The final message library includes 28 BCTT-informed messages across 13 BCTs, with messages having similar scores across genders. More than one-fourth (8/28, 29%) of the final messages were informed by the suggested messages from phase 1. As Airmen aged <21 years face harsher disciplinary action for alcohol consumption, the program is tailored based on the US legal drinking age. Conclusions: This study involved members from the target population throughout 2 formative stages of intervention development to design a BCTT-informed SMS text messaging intervention to reduce binge and heavy drinking, which is now being tested in an efficacy trial. The results will determine the impact of the intervention on binge drinking and alcohol consumption in the US Air Force. UR - https://formative.jmir.org/2024/1/e55041 UR - http://dx.doi.org/10.2196/55041 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502165 ID - info:doi/10.2196/55041 ER - TY - JOUR AU - Toïgo, Mickael AU - Marc, Julie AU - Hayot, Maurice AU - Moulis, Lionel AU - Carbonnel, Francois PY - 2024/3/18 TI - Quality Assessment of Smartphone Medication Management Apps in France: Systematic Search JO - JMIR Mhealth Uhealth SP - e54866 VL - 12 KW - medication adherence KW - mobile apps KW - telemedicine KW - reminder system KW - behavioral therapy KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - smartphone apps KW - medication KW - medications KW - adherence KW - search KW - searches KW - searching KW - systematic KW - App Store KW - Google Play KW - French KW - reminder KW - reminders KW - MARS KW - quality KW - Mobile App Rating Scale KW - mobile phone N2 - Background: Adherence to medication is estimated to be around 50% for chronically ill patients in high-income countries. Improving the effectiveness of adherence interventions could have a far greater impact on population health than any improvement in specific medical treatments. Mobile health (mHealth) is one of the most effective solutions for helping patients improve their medication intake, notably through the use of mobile apps with reminder systems. With more than 327,000 apps available in the mHealth field, it is difficult for health care professionals and patients alike to choose which apps to recommend and use. Objective: We aim to carry out a systematic search of medication management smartphone apps available in France that send reminders to patients and assess their quality using a validated scale. Methods: Mobile apps were identified in October and November 2022 after a systematic keyword search on the 2 main app download platforms: App Store (Apple Inc) and Google Play Store. Inclusion criteria were free availability, date of last update, and availability in French. Next, 2 health care professionals independently evaluated the included apps using the French version of the Mobile App Rating Scale (MARS-F), an objective scoring system validated for assessing the overall quality of apps in the mHealth field. An intraclass correlation coefficient was calculated to determine interrater reliability. Results: In total, 960 apps were identified and 49 were selected (25 from the App Store and 24 from the Google Play Store). Interrater reliability was excellent (intraclass correlation coefficient 0.92; 95% CI 0.87-0.95; P<.001). The average MARS-F score was 3.56 (SD 0.49) for apps on the App Store and 3.51 (SD 0.46) for those on the Google Play Store, with 10 apps scoring above 4 out of 5. Further, 2 apps were tested in at least one randomized controlled trial and showed positive results. The 2 apps with the highest ratings were Mediteo rappel de médicaments (Mediteo GmbH) and TOM rappel medicaments, pilule (Innovation6 GmbH), available on both platforms. Each app?s MARS-F score was weakly correlated with user ratings on the App Store and moderately correlated on the Google Play Store. Conclusions: To our knowledge, this is the first study that used a validated scoring system to evaluate medication management apps that send medication reminders. The quality of the apps was heterogeneous, with only 2 having been studied in a randomized controlled trial with positive results. The evaluation of apps in real-life conditions by patients is necessary to determine their acceptability and effectiveness. Certification of apps is also essential to help health care professionals and patients identify validated apps. UR - https://mhealth.jmir.org/2024/1/e54866 UR - http://dx.doi.org/10.2196/54866 UR - http://www.ncbi.nlm.nih.gov/pubmed/38498042 ID - info:doi/10.2196/54866 ER - TY - JOUR AU - Marziali, Alessandra Rachele AU - Franceschetti, Claudia AU - Dinculescu, Adrian AU - Nistorescu, Alexandru AU - Kristály, Mircea Dominic AU - Mo?oi, Alexandru Adrian AU - Broekx, Ronny AU - Marin, Mihaela AU - Vizitiu, Cristian AU - Moraru, Sorin-Aurel AU - Rossi, Lorena AU - Di Rosa, Mirko PY - 2024/3/18 TI - Reducing Loneliness and Social Isolation of Older Adults Through Voice Assistants: Literature Review and Bibliometric Analysis JO - J Med Internet Res SP - e50534 VL - 26 KW - voice assistant KW - loneliness KW - social isolation KW - older adults KW - literature review KW - bibliometric analysis KW - mobile phone N2 - Background: Loneliness and social isolation are major public health concerns for older adults, with severe mental and physical health consequences. New technologies may have a great impact in providing support to the daily lives of older adults and addressing the many challenges they face. In this scenario, technologies based on voice assistants (VAs) are of great interest and potential benefit in reducing loneliness and social isolation in this population, because they could overcome existing barriers with other digital technologies through easier and more natural human-computer interaction. Objective: This study aims to investigate the use of VAs to reduce loneliness and social isolation of older adults by performing a systematic literature review and a bibliometric cluster mapping analysis. Methods: We searched PubMed, Embase, and Scopus databases for articles that were published in the last 6 years, related to the following main topics: voice interface, VA, older adults, isolation, and loneliness. A total of 40 articles were found, of which 16 (40%) were included in this review. The included articles were then assessed through a qualitative scoring method and summarized. Finally, a bibliometric analysis was conducted using VOSviewer software (Leiden University?s Centre for Science and Technology Studies). Results: Of the 16 articles included in the review, only 2 (13%) were considered of poor methodological quality, whereas 9 (56%) were of medium quality and 5 (31%) were of high quality. Finally, through bibliometric analysis, 221 keywords were extracted, of which 36 (16%) were selected. The most important keywords, by number of occurrences and by total link strength; results of the analysis with the Association Strength normalization method; and default values were then presented. The final bibliometric network consisted of 36 selected keywords, which were grouped into 3 clusters related to 3 main topics (ie, VA use for social isolation among older adults, the significance of age in the context of loneliness, and the impact of sex factors on well-being). For most of the selected articles, the effect of VA on social isolation and loneliness of older adults was a minor theme. However, more investigations were done on user experience, obtaining preliminary positive results. Conclusions: Most articles on the use of VAs by older adults to reduce social isolation and loneliness focus on usability, acceptability, or user experience. Nevertheless, studies directly addressing the impact that using a VA has on the social isolation and loneliness of older adults find positive and promising results and provide important information for future research, interventions, and policy development in the field of geriatric care and technology. UR - https://www.jmir.org/2024/1/e50534 UR - http://dx.doi.org/10.2196/50534 UR - http://www.ncbi.nlm.nih.gov/pubmed/38498039 ID - info:doi/10.2196/50534 ER - TY - JOUR AU - Sieber, Chloé AU - Haag, Christina AU - Polhemus, Ashley AU - Haile, R. Sarah AU - Sylvester, Ramona AU - Kool, Jan AU - Gonzenbach, Roman AU - von Wyl, Viktor PY - 2024/3/18 TI - Exploring the Major Barriers to Physical Activity in Persons With Multiple Sclerosis: Observational Longitudinal Study JO - JMIR Rehabil Assist Technol SP - e52733 VL - 11 KW - physical activity KW - barriers to physical activity KW - Barriers to Health Promoting Activities for Disabled Persons scale KW - BHADP scale KW - multiple sclerosis KW - Fitbit KW - wearable N2 - Background: Physical activity (PA) represents a low-cost and readily available means of mitigating multiple sclerosis (MS) symptoms and alleviating the disease course. Nevertheless, persons with MS engage in lower levels of PA than the general population. Objective: This study aims to enhance the understanding of the barriers to PA engagement in persons with MS and to evaluate the applicability of the Barriers to Health Promoting Activities for Disabled Persons (BHADP) scale for assessing barriers to PA in persons with MS, by comparing the BHADP score with self-reported outcomes of fatigue, depression, self-efficacy, and health-related quality of life, as well as sensor-measured PA. Methods: Study participants (n=45; median age 46, IQR 40-51 years; median Expanded Disability Status Scale score 4.5, IQR 3.5-6) were recruited among persons with MS attending inpatient neurorehabilitation. They wore a Fitbit Inspire HR (Fitbit Inc) throughout their stay at the rehabilitation clinic (phase 1; 2-4 wk) and for the 4 following weeks at home (phase 2; 4 wk). Sensor-based step counts and cumulative minutes in moderate to vigorous PA were computed for the last 7 days at the clinic and at home. On the basis of PA during the last 7 end-of-study days, we grouped the study participants as active (?10,000 steps/d) and less active (<10,000 steps/d) to explore PA barriers compared with PA level. PA barriers were repeatedly assessed through the BHADP scale. We described the relevance of the 18 barriers of the BHADP scale assessed at the end of the study and quantified their correlations with the Spearman correlation test. We evaluated the associations of the BHADP score with end-of-study reported outcomes of fatigue, depression, self-efficacy, and health-related quality of life with multivariable regression models. We performed separate regression analyses to examine the association of the BHADP score with different sensor-measured outcomes of PA. Results: The less active group reported higher scores for the BHADP items Feeling what I do doesn?t help, No one to help me, and Lack of support from family/friends. The BHADP items Not interested in PA and Impairment were positively correlated. The BHADP score was positively associated with measures of fatigue and depression and negatively associated with self-efficacy and health-related quality of life. The BHADP score showed an inverse relationship with the level of PA measured but not when dichotomized according to the recommended PA level thresholds. Conclusions: The BHADP scale is a valid and well-adapted tool for persons with MS because it reflects common MS symptoms such as fatigue and depression, as well as self-efficacy and health-related quality of life. Moreover, decreases in PA levels are often related to increases in specific barriers in the lives of persons with MS and should hence be addressed jointly in health care management. UR - https://rehab.jmir.org/2024/1/e52733 UR - http://dx.doi.org/10.2196/52733 UR - http://www.ncbi.nlm.nih.gov/pubmed/38498024 ID - info:doi/10.2196/52733 ER - TY - JOUR AU - Chen, Shanshan AU - Tang, Jinsong AU - Wu, Congyang AU - Zhang, Ge AU - Zhang, Jing AU - Liao, Yanhui PY - 2024/3/18 TI - Preliminary Efficacy of a Cognitive Behavioral Therapy?Based Smartphone App for Smoking Cessation in China: Randomized Controlled Pilot Trial JO - JMIR Form Res SP - e48050 VL - 8 KW - China KW - cognitive behavioral therapy KW - program acceptability KW - randomized controlled trial KW - smartphone app KW - smoking cessation N2 - Background: The overall prevalence of cigarette smokers in China is very high, and China?s total cigarette consumption makes up more than 40% of the world?s consumption. In view of the lack of smoking cessation services and social support in China and the effectiveness of mobile phone apps for quitting smoking in other countries, we carried out a smartphone app?based smoking cessation trial in China. Objective: This study aimed to evaluate the efficacy of a cognitive behavioral therapy (CBT)?based smoking cessation smartphone app among smokers seeking treatment in China. Methods: We conducted a randomized controlled, web-based pilot clinical trial in China between February 23 and June 27, 2021. Eligible participants were randomly assigned to the smoking cessation app intervention group or the control group in a ratio of 1:1. The intervention group received the CBT smoking cessation intervention using a smartphone app, and the control group received a ?thank you? message. The intervention was 4 weeks long, and the patients were followed up for 4 weeks. The primary outcome was self-reported continuous smoking abstinence at week 4 after the quit date. The secondary outcomes included self-reported 7-day point prevalence of smoking abstinence; reduction of the number of cigarettes smoked per day at weeks 1, 2, 3, and 4; and program acceptability. Results: A total of 973 people were recruited to quit smoking, of whom 262 completed basic information, 56 were excluded, and 206 were randomized and included in the final analysis. There were 189 (91.7%) men and 17 (8.3%) women, with an average age of 34.46 (SD 7.53) years and an average daily smoking rate of 15.93 (SD 7.10) cigarettes/day. We found 30 (29.7%) of the 101 participants in the intervention group and 7 (6.7%) of the 105 participants in the control group reported continuous smoking cessation after the quit date at week 4 (odds ratio 5.92, 95% CI 3.78-9.26; P<.001). The 7-day point prevalence abstinence rate of the intervention group varied from 42.6% (43/101) to 46.5% (47/101) after 1, 2, 3, and 4 weeks, while the control group varied from 18.1% (19/105) to 26.7% (28/105). Compared to the control group, continued smokers consumed 1.5-3.0 fewer cigarettes per day in the intervention group. The overall program got positive user feedback with a high satisfaction rate (66/87, 76%) and an average Mobile Application Rating Scale user version score of 3.46. Conclusions: Our pilot study provided preliminary evidence that the CBT-based smoking cessation smartphone app led to improved smoking quit rates versus control in Chinese smokers. The study demonstrated the CBT-based smartphone app may be an effective and feasible digital treatment model to help smokers quit, which may improve smoking cessation service quality and accessibility in China. Trial Registration: ClinicalTrials.gov NCT04421170; https://clinicaltrials.gov/study/NCT04421170 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-041985 UR - https://formative.jmir.org/2024/1/e48050 UR - http://dx.doi.org/10.2196/48050 UR - http://www.ncbi.nlm.nih.gov/pubmed/38498030 ID - info:doi/10.2196/48050 ER - TY - JOUR AU - Cáceres Rivera, Isabel Diana AU - Rojas, Jaimes Luz Mileyde AU - Rojas, Z. Lyda AU - Gomez, Canon Diana AU - Castro Ruiz, Andrés David AU - López Romero, Alberto Luis PY - 2024/3/18 TI - Using Principles of Digital Development for a Smartphone App to Support Data Collection in Patients With Acute Myocardial Infarction and Physical Activity Intolerance: Case Study JO - JMIR Form Res SP - e33868 VL - 8 KW - app KW - applications of medical informatics KW - coronary disease KW - data collection KW - development KW - health care reform KW - health data KW - medical informatics KW - medical informatics apps KW - mobile app KW - mobile applications KW - nursing diagnosis KW - nursing research KW - research data KW - software KW - validation N2 - Background: Advances in health have highlighted the need to implement technologies as a fundamental part of the diagnosis, treatment, and recovery of patients at risk of or with health alterations. For this purpose, digital platforms have demonstrated their applicability in the identification of care needs. Nursing is a fundamental component in the care of patients with cardiovascular disorders and plays a crucial role in diagnosing human responses to these health conditions. Consequently, the validation of nursing diagnoses through ongoing research processes has become a necessity that can significantly impact both patients and health care professionals. Objective: We aimed to describe the process of developing a mobile app to validate the nursing diagnosis ?intolerance to physical activity? in patients with acute myocardial infarction. Methods: We describe the development and pilot-testing of a mobile system to support data collection for validating the nursing diagnosis of activity intolerance. This was a descriptive study conducted with 11 adults (aged ?18 years) who attended a health institution for highly complex needs with a suspected diagnosis of coronary syndrome between August and September 2019 in Floridablanca, Colombia. An app for the clinical validation of activity intolerance (North American Nursing Diagnosis Association [NANDA] code 00092) in patients with acute coronary syndrome was developed in two steps: (1) operationalization of the nursing diagnosis and (2) the app development process, which included an evaluation of the initial requirements, development and digitization of the forms, and a pilot test. The agreement level between the 2 evaluating nurses was evaluated with the ? index. Results: We developed a form that included sociodemographic data, hospital admission data, medical history, current pharmacological treatment, and thrombolysis in myocardial infarction risk score (TIMI-RS) and GRACE (Global Registry of Acute Coronary Events) scores. To identify the defining characteristics, we included official guidelines, physiological measurements, and scales such as the Piper fatigue scale and Borg scale. Participants in the pilot test (n=11) had an average age of 63.2 (SD 4.0) years and were 82% (9/11) men; 18% (2/11) had incomplete primary schooling. The agreement between the evaluators was approximately 80% for most of the defining characteristics. The most prevalent characteristics were exercise discomfort (10/11, 91%), weakness (7/11, 64%), dyspnea (3/11, 27%), abnormal heart rate in response to exercise (2/10, 20%), electrocardiogram abnormalities (1/10, 9%), and abnormal blood pressure in response to activity (1/10, 10%). Conclusions: We developed a mobile app for validating the diagnosis of ?activity intolerance.? Its use will guarantee not only optimal data collection, minimizing errors to perform validation, but will also allow the identification of individual care needs. UR - https://formative.jmir.org/2024/1/e33868 UR - http://dx.doi.org/10.2196/33868 UR - http://www.ncbi.nlm.nih.gov/pubmed/38498019 ID - info:doi/10.2196/33868 ER - TY - JOUR AU - Simmich, Joshua AU - Andrews, Emma Nicole AU - Claus, Andrew AU - Murdoch, Megan AU - Russell, Glen Trevor PY - 2024/3/18 TI - Assessing a GPS-Based 6-Minute Walk Test for People With Persistent Pain: Validation Study JO - JMIR Form Res SP - e46820 VL - 8 KW - GPS KW - mobile apps KW - exercise test KW - pain KW - chronic pain KW - mobile phone N2 - Background: The 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance. Objective: The primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods. Methods: People with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test. Results: The mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95% CI ?2.7 to 29.1) m higher than that assessed in the conventional manner. The 95% limits of agreement were 103.9 (95% CI 87.4-134.1) m and ?77.6 (95% CI ?107.7 to ?61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points. Conclusions: In individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment. UR - https://formative.jmir.org/2024/1/e46820 UR - http://dx.doi.org/10.2196/46820 UR - http://www.ncbi.nlm.nih.gov/pubmed/38498031 ID - info:doi/10.2196/46820 ER - TY - JOUR AU - Bernstein, E. Emily AU - Wolfe, C. Emma AU - Huguenel, M. Brynn AU - Wilhelm, Sabine PY - 2024/3/15 TI - Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review JO - JMIR Mhealth Uhealth SP - e45860 VL - 12 KW - smartphone KW - digital health KW - exercise KW - physical activity KW - mental health KW - depression KW - anxiety KW - mobile phone N2 - Background: Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness. Objective: This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns. Methods: In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on. Results: To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area. Conclusions: Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support. UR - https://mhealth.jmir.org/2024/1/e45860 UR - http://dx.doi.org/10.2196/45860 UR - http://www.ncbi.nlm.nih.gov/pubmed/38488834 ID - info:doi/10.2196/45860 ER - TY - JOUR AU - Veneman, Tim AU - Koopman, Sophia Fieke AU - Oorschot, Sander AU - Koomen, G. Pien AU - Nollet, Frans AU - Voorn, L. Eric PY - 2024/3/15 TI - A Mobile Health App to Support Home-Based Aerobic Exercise in Neuromuscular Diseases: Usability Study JO - JMIR Hum Factors SP - e49808 VL - 11 KW - neuromuscular disorders KW - endurance training KW - home-based exercise KW - eHealth KW - tele-rehabilitation KW - app KW - exercise KW - aerobic exercise KW - mhealth KW - mobile app KW - neuromuscular disease KW - usability N2 - Background: Home-based aerobic exercise in people with neuromuscular diseases (NMDs) has benefits compared to exercise in the hospital or a rehabilitation center because traveling is often cumbersome due to mobility limitations, and societal costs are lower. Barriers to home-based aerobic exercise include reduced possibilities for monitoring and lack of motivation. To overcome these and other barriers, we developed a mobile health app: Keep on training with ReVi (hereafter referred to as ReVi). Objective: We aimed to determine the usability of the ReVi app. Methods: Patients followed a 4-month, polarized, home-based aerobic exercise program on a cycle or rowing ergometer, with 2 low-intensity sessions and 1 high-intensity session per week supported by the ReVi app. The app collected training data, including heart rate and ratings of perceived exertion, provided real-time feedback on reaching target intensity zones, and enabled monitoring via an online dashboard. Physiotherapists instructed patients on how to use the ReVi app and supervised them during their training program. Patients and physiotherapists separately evaluated usability with self-developed questionnaires, including 9 questions on a 5-point Likert scale, covering the usability elements efficiency, effectiveness, and satisfaction. Results: Twenty-nine ambulatory adult patients (n=19 women; mean age 50.4, SD 14.2 years) with 11 different slowly progressive NMDs participated. Both patients and physiotherapists (n=10) reported that the app, in terms of its efficiency, was easy to use and had a rapid learning curve. Sixteen patients (55%) experienced 1 or more technical issue(s) during the course of the exercise program. In the context of effectiveness, 23 patients (81%) indicated that the app motivated them to complete the program and that it helped them to exercise within the target intensity zones. Most patients (n=19, 70%) and physiotherapists (n=6, 60%) were satisfied with the use of the app. The median attendance rate was 88% (IQR 63%-98%), with 76% (IQR 69%-82%) of time spent within the target intensity zones. Four adverse events were reported, 3 of which were resolved without discontinuation of the exercise program. Conclusions: The usability of the ReVi app was high, despite the technical issues that occurred. Further development of the app to resolve these issues is warranted before broader implementation into clinical practice. UR - https://humanfactors.jmir.org/2024/1/e49808 UR - http://dx.doi.org/10.2196/49808 UR - http://www.ncbi.nlm.nih.gov/pubmed/38488838 ID - info:doi/10.2196/49808 ER - TY - JOUR AU - Snyder, Morgan AU - Elkins, R. Gary PY - 2024/3/14 TI - Characteristics of Users of a Digital Hypnotherapy Intervention for Hot Flashes: Retrospective Study JO - JMIR Form Res SP - e53555 VL - 8 KW - hypnotherapy KW - hot flashes KW - smartphone app KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - hypnosis KW - menopause KW - menopausal KW - gynecology KW - usage KW - women's health KW - user KW - users KW - demographics KW - demographic KW - characteristic KW - characteristics KW - mental health KW - alternative KW - complementary KW - mind body KW - hypnotism N2 - Background: Hot flashes are associated with a lower quality of life and sleep disturbances. Given the many consequences of hot flashes, it is important to find treatments to reduce them. Hypnotherapy, the use of hypnosis for a medical disorder or concern, has been shown in clinical trials to be effective in reducing hot flashes, but it is not routinely used in clinical practice. One solution to close this implementation gap is to administer hypnotherapy for hot flashes via a smartphone app. Evia is a smartphone app that delivers hypnotherapy for hot flashes. Evia has made hypnotherapy more widely accessible for women who are experiencing hot flashes; however, the app has yet to undergo empirical testing. Additionally, research on user characteristics is lacking. Objective: This study aims to (1) determine the average age, stage of menopause, and length of menopause symptoms for users of the Evia app; (2) determine the characteristics of hot flashes and night sweats for users of the Evia app; (3) determine the self-reported sleep quality of users of the Evia app; (4) determine the self-reported mental health of users of the Evia app; and (5) determine the relationship between hot flash frequency and anxiety and depression for users of the Evia app. Methods: This study analyzed data collected from participants who have downloaded the Evia app. Data were collected at 1 time point from a self-report questionnaire that assessed the demographic and clinical characteristics of users. The questionnaire was given to users when they downloaded the Evia app. Users of the Evia app fill out a questionnaire upon enrolling in the program and prior to beginning the intervention. This included 9764 users. Results: Results showed that the mean age of users was 49.31 years. A total of 41.6% (1942/4665) of users reported experiencing 5 or more hot flashes per day, while 51.2% (1473/2877) of users reported having difficulty falling asleep each night and 47.7% (1253/2626) of users reported their sleep quality to be terrible. In addition, 38.4% (1104/2877) of users reported that they often feel anxious or depressed. There was a small, significant, and negative correlation between hot flash frequency and self-report frequency of anxiety and depression (r=?0.09). Conclusions: This study showed that the average age of app users is in line with the median age of natural menopause. A large percentage of users reported experiencing 5 or more hot flashes per day, reported difficulties with sleep, and reported experiencing depression and anxiety. These findings are in line with previous studies that assessed hot flash frequency and the consequences of hot flashes. This was the first study to report on the characteristics of users of the Evia app. Results will be used to optimize the hypnotherapy program delivered via the Evia app. UR - https://formative.jmir.org/2024/1/e53555 UR - http://dx.doi.org/10.2196/53555 UR - http://www.ncbi.nlm.nih.gov/pubmed/38483465 ID - info:doi/10.2196/53555 ER - TY - JOUR AU - Sánchez-Fernández, Sergio AU - Lasa, María Eva AU - Terrados, Soledad AU - Sola-Martínez, Javier Francisco AU - Martínez-Molina, Sara AU - López de Calle, Marta AU - Cabrera-Freitag, Paula AU - Goikoetxea, José María PY - 2024/3/13 TI - Mobile App/Web Platform for Monitoring Food Oral Immunotherapy in Children: Longitudinal Clinical Validation Study JO - JMIR Pediatr Parent SP - e54163 VL - 7 KW - adverse reactions KW - egg allergy KW - food oral immunotherapy KW - mHealth KW - milk allergy KW - monitoring N2 - Background: Milk and egg allergies significantly impact the quality of life, particularly in children. In this regard, food oral immunotherapy (OIT) has emerged as an effective treatment option; however, the occurrence of frequent adverse reactions poses a challenge, necessitating close monitoring during treatment. Objective: This study aims to evaluate the ability of a new mobile/web app called OITcontrol to monitor milk and egg OIT. Methods: Patients undergoing milk or egg OIT were recruited and divided into 2 groups: the active group used the OITcontrol app in conjunction with standard written monitoring methods, whereas the control group relied solely on written diaries. Investigators documented hospital doses, hospital reactions, and administered treatments on the website. Patients recorded their daily allergen home-dose intake, home reactions, and administered treatments using the app. The following variables were compared between both groups: number and severity of hospital and reported home reactions, patient?s adhesion to the OITcontrol app or written diary or both in terms of daily home-dose intake and home reactions recording, and treatment and dose adjustment compliance at home in case of reaction. Results: Sixteen patients were assigned to be monitored using the OITcontrol app along with additional written methods (active group), while 14 patients relied solely on a written paper diary (control group). A similar distribution was observed in terms of sex, age, basal characteristics, allergen treated in OIT, premedication, and sensitization profile. Active patients reported a comparable number of hospital and home reactions compared with the control group. In terms of recording system usage, 13/16 (81%) active patients used the OITcontrol app, while 10/14 (71%) control patients relied on the written diary. Among active patients, 6/16 (38%) used both methods, and 1 active patient used only written methods. However, control patients recorded home reactions more frequently than active patients (P=.009). Among active patients, the app was the preferred method for recording reactions (59/86, 69%), compared with the written diary (15/86, 17%) or both methods (12/86, 14%; P<.001). Treatment compliance in home-recorded reactions was similar between both groups (P=.15). However, treatment indications after an adverse reaction were more frequently followed (P=.04) in reactions recorded solely in the app (36/59, 61%) than in the written diary (29/71, 41%) or both systems (4/12, 33%). Moreover, compliance with dose adjustments after a moderate-severe reaction in home-recorded reactions was higher in the active group than in the control group (P<.001). Home reactions recorded only in the app (16/19, 84%) were more likely to follow dose adjustments (P<.001) than those recorded in the written diary (3/20, 15%) or using both methods (2/3, 67%). Conclusions: The OITcontrol app appears to be a valuable tool for monitoring OIT treatment in children with food allergies. It proves to be a suitable method for recording daily home dose intakes and reactions, and it seems to enhance adherence to treatment indications following an adverse reaction as well as compliance with dose adjustments in home reactions. However, additional studies are necessary to comprehensively grasp the benefits and limitations of using the OITcontrol app in the management of OIT. UR - https://pediatrics.jmir.org/2024/1/e54163 UR - http://dx.doi.org/10.2196/54163 UR - http://www.ncbi.nlm.nih.gov/pubmed/38477961 ID - info:doi/10.2196/54163 ER - TY - JOUR AU - Thibaudeau, Elisabeth AU - Peyroux, Elodie AU - Franck, Nicolas AU - Carling, Hannah AU - Lepage, Martin PY - 2024/3/13 TI - Navigating Social Cognitive Impairments in Schizophrenia Spectrum Disorders: Protocol for a Pilot Pre-Post Quasi-Experimental Study for Remote Avatar-Assisted Cognitive Remediation Therapy JO - JMIR Res Protoc SP - e54251 VL - 13 KW - social cognition KW - schizophrenia spectrum disorder KW - psychosis KW - cognitive remediation therapy KW - social cognitive training KW - digital relational simulation KW - cultural adaptation KW - feasibility KW - acceptability KW - mobile phone N2 - Background: Social cognitive impairments are prevalent in schizophrenia spectrum disorder (SSD) and have detrimental effects on functioning. Cognitive remediation (CR) has shown its efficacy in improving social cognitive impairments, although the transfer of these skills to daily life and the personalization of these interventions remain challenging. RC2S (Remédiation Cognitive de la Cognition Sociale dans la Schizophrénie; Cognitive remediation of social cognition in Schizophrenia) is a French CR that combines the learning of strategies and practice using paper-and-pencil exercises and digital relational simulations. This French program was designed as an in-person intervention. Objective: This project aims to culturally adapt the RC2S program, in French-Canadian and North American English and to assess the feasibility, acceptability, safety, and implementation of a remote version in people with SSD. An exploratory objective is to assess the preliminary effect of remote RC2S on goal attainment, social cognition, and psychosocial outcomes. Methods: We will use a pre-post quasi-experimental design. First, the translation and cultural adaptation in North American English and French-Canadian of RC2S is presented. Then, 20 participants aged ?18 years with a diagnosis of SSD, presenting with a subjective or an objective impairment in social cognition, will be included to receive RC2S. In addition, 5 therapists will be included as research participants to assess their perspective on RC2S. Participants with SSD will undergo a baseline remote assessment of their social cognition, clinical symptoms, and functioning. They will then start remote RC2S for 24 biweekly individual 1-hour sessions with a therapist. Following the case formulation and goal setting, participants will complete personalized paper-and-pencil exercises to develop strategies and integrative digital relational simulations, during which they will help an avatar navigate through a variety of social contexts and relationships. The last 2 sessions are dedicated to the transfer to daily life. All participants will complete in-session questionnaires assessing therapeutic alliance, motivation, acceptability, feasibility, and implementation. Following RC2S, the participants with SSD will repeat the same assessment as the baseline. Descriptive statistics will be used to summarize the data about acceptability, feasibility, safety, and implementation. To assess the preliminary effect of RC2S, an intention-to-treat approach will be used with linear mixed models for repeated measures with fixed effects of time. Results: So far, 45% (9/20) of participants with SSD (mean age 37.9, SD 9.3 years) have completed the project. They received a mean of 20.5 out of 24 (SD 3.5) sessions of RC2S. A total of 5 therapists also completed the project. Conclusions: Improving social cognitive impairments is an important target in SSD to promote functional recovery. Using digital technologies to address these impairments and deliver the intervention is a promising approach to increase the ecological validity of CR and access to the intervention. Trial Registration: ClinicalTrials.gov NCT05017532; https://classic.clinicaltrials.gov/ct2/show/NCT05017532 International Registered Report Identifier (IRRID): DERR1-10.2196/54251 UR - https://www.researchprotocols.org/2024/1/e54251 UR - http://dx.doi.org/10.2196/54251 UR - http://www.ncbi.nlm.nih.gov/pubmed/38477975 ID - info:doi/10.2196/54251 ER - TY - JOUR AU - Lang, Anna-Lena AU - Bruhn, Rosa-Lotta AU - Fehling, Maya AU - Heidenreich, Anouk AU - Reisdorf, Jonathan AU - Khanyaree, Ifrah AU - Henningsen, Maike AU - Remschmidt, Cornelius PY - 2024/3/12 TI - Feasibility Study on Menstrual Cycles With Fitbit Device (FEMFIT): Prospective Observational Cohort Study JO - JMIR Mhealth Uhealth SP - e50135 VL - 12 KW - women?s health KW - menstrual cycle KW - premenstrual syndrome KW - PMS KW - mobile app KW - wearable device KW - sensor data KW - digital health N2 - Background: Despite its importance to women?s reproductive health and its impact on women?s daily lives, the menstrual cycle, its regulation, and its impact on health remain poorly understood. As conventional clinical trials rely on infrequent in-person assessments, digital studies with wearable devices enable the collection of longitudinal subjective and objective measures. Objective: The study aims to explore the technical feasibility of collecting combined wearable and digital questionnaire data and its potential for gaining biological insights into the menstrual cycle. Methods: This prospective observational cohort study was conducted online over 12 weeks. A total of 42 cisgender women were recruited by their local gynecologist in Berlin, Germany, and given a Fitbit Inspire 2 device and access to a study app with digital questionnaires. Statistical analysis included descriptive statistics on user behavior and retention, as well as a comparative analysis of symptoms from the digital questionnaires with metrics from the sensor devices at different phases of the menstrual cycle. Results: The average time spent in the study was 63.3 (SD 33.0) days with 9 of the 42 individuals dropping out within 2 weeks of the start of the study. We collected partial data from 114 ovulatory cycles, encompassing 33 participants, and obtained complete data from a total of 50 cycles. Participants reported a total of 2468 symptoms in the daily questionnaires administered during the luteal phase and menses. Despite difficulties with data completeness, the combined questionnaire and sensor data collection was technically feasible and provided interesting biological insights. We observed an increased heart rate in the mid and end luteal phase compared with menses and participants with severe premenstrual syndrome walked substantially fewer steps (average daily steps 10,283, SD 6277) during the luteal phase and menses compared with participants with no or low premenstrual syndrome (mean 11,694, SD 6458). Conclusions: We demonstrate the feasibility of using an app-based approach to collect combined wearable device and questionnaire data on menstrual cycles. Dropouts in the early weeks of the study indicated that engagement efforts would need to be improved for larger studies. Despite the challenges of collecting wearable data on consecutive days, the data collected provided valuable biological insights, suggesting that the use of questionnaires in conjunction with wearable data may provide a more complete understanding of the menstrual cycle and its impact on daily life. The biological findings should motivate further research into understanding the relationship between the menstrual cycle and objective physiological measurements from sensor devices. UR - https://mhealth.jmir.org/2024/1/e50135 UR - http://dx.doi.org/10.2196/50135 UR - http://www.ncbi.nlm.nih.gov/pubmed/38470472 ID - info:doi/10.2196/50135 ER - TY - JOUR AU - Nkabane-Nkholongo, Elizabeth AU - Mpata-Mokgatle, Mathildah AU - Jack, W. Brian AU - Julce, Clevanne AU - Bickmore, Timothy PY - 2024/3/12 TI - Usability and Acceptability of a Conversational Agent Health Education App (Nthabi) for Young Women in Lesotho: Quantitative Study JO - JMIR Hum Factors SP - e52048 VL - 11 KW - preconception care KW - conversational agent technology KW - women?s health education KW - mHealth adaptation KW - health information technology KW - health education in Africa KW - education KW - women's health KW - women KW - woman KW - health information KW - young women KW - survey KW - usability KW - acceptability KW - application KW - applications KW - app KW - health promotion N2 - Background: Young women in Lesotho face myriad sexual and reproductive health problems. There is little time to provide health education to women in low-resource settings with critical shortages of human resources for health. Objective: This study aims to determine the acceptability and usability of a conversational agent system, the Nthabi health promotion app, which was culturally adapted for use in Lesotho. Methods: We conducted a descriptive quantitative study, using a 22-item Likert scale survey to assess the perceptions of the usability and acceptability of 172 young women aged 18-28 years in rural districts of Lesotho, who used the system on either smartphones or tablets for up to 6 weeks. Descriptive statistics were used to calculate the averages and frequencies of the variables. ?2 tests were used to determine any associations among variables. Results: A total of 138 participants were enrolled and completed the survey. The mean age was 22 years, most were unmarried, 56 (40.6%) participants had completed high school, 39 (28.3%) participants were unemployed, and 88 (63.8%) participants were students. Respondents believed the app was helpful, with 134 (97.1%) participants strongly agreeing or agreeing that the app was ?effective in helping them make decisions? and ?could quickly improve health education and counselling.? In addition, 136 (98.5%) participants strongly agreed or agreed that the app was ?simple to use,? 130 (94.2 %) participants reported that Nthabi could ?easily repeat words that were not well understood,? and 128 (92.7%) participants reported that the app ?could quickly load the information on the screen.? Respondents were generally satisfied with the app, with 132 (95.6%) participants strongly agreeing or agreeing that the health education content delivered by the app was ?well organised and delivered in a timely way,? while 133 (96.4%) participants ?enjoyed using the interface.? They were satisfied with the cultural adaptation, with 133 (96.4%) participants strongly agreeing or agreeing that the app was ?culturally appropriate and that it could be easily shared with a family or community members.? They also reported that Nthabi was worthwhile, with 127 (92%) participants reporting that they strongly agreed or agreed that they were ?satisfied with the application and intended to continue using it,? while 135 (97.8%) participants would ?encourage others to use it.? Participants aged 18-24 years (vs those aged 25-28 years) agreed that the ?Nthabi app was simple to use? (106/106, 100% vs 30/32, 98.8%; P=.01), and agreed that ?the educational content was well organised and delivered in a timely way? (104/106, 98.1% vs 28/32, 87.5%; P=.01). Conclusions: These results support further study of conversational agent systems as alternatives to traditional face-to-face provision of health education services in Lesotho, where there are critical shortages of human resources for health. Trial Registration: ClinicalTrials.gov NCT04354168; https://www.clinicaltrials.gov/study/NCT04354168 UR - https://humanfactors.jmir.org/2024/1/e52048 UR - http://dx.doi.org/10.2196/52048 UR - http://www.ncbi.nlm.nih.gov/pubmed/38470460 ID - info:doi/10.2196/52048 ER - TY - JOUR AU - Poudyal, Anubhuti AU - Lewis, Delta-Marie AU - Taha, Sarah AU - Martinez, J. Alyssa AU - Magoun, Lauren AU - Ho, Xian Y. AU - Carmio, Natali AU - Naslund, A. John AU - Sanchez, Katherine AU - Lesh, Neal AU - Patel, Vikram PY - 2024/3/11 TI - Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study JO - JMIR Form Res SP - e55205 VL - 8 KW - digital technology KW - mental health KW - depression KW - task sharing KW - nonspecialist providers KW - peer supervision KW - therapy quality N2 - Background: The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support. Objective: We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions. Methods: We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app?s overall usability. We also calculated the participants? likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains. Results: A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants? likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs? workloads. Conclusions: We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app?s use and efficacy in real-world settings to support task-shared mental health programs across the United States. UR - https://formative.jmir.org/2024/1/e55205 UR - http://dx.doi.org/10.2196/55205 UR - http://www.ncbi.nlm.nih.gov/pubmed/38466971 ID - info:doi/10.2196/55205 ER - TY - JOUR AU - Gao, Yu AU - Shi, Lu AU - Fu, Ning AU - Yang, Nan AU - Weeks-Gariepy, Tracy AU - Mao, Yuping PY - 2024/3/8 TI - Mobile-Delivered Mindfulness Intervention on Anxiety Level Among College Athletes: Randomized Controlled Trial JO - J Med Internet Res SP - e40406 VL - 26 KW - anxiety KW - athletes KW - body KW - calmness KW - cognition KW - college students KW - college KW - feasibility KW - feedback KW - intervention KW - meditation KW - mHealth KW - mindfulness KW - mobile KW - participant KW - positive KW - program KW - relaxation KW - sleep KW - students N2 - Background: College athletes are a group often affected by anxiety. Few interventional studies have been conducted to address the anxiety issues in this population. Objective: We conducted a mobile-delivered mindfulness intervention among college athletes to study its feasibility and efficacy in lowering their anxiety level and improving their mindfulness (measured by the Five Facet Mindfulness Questionnaire [FFMQ]). Methods: In April 2019, we recruited 290 college athletes from a public university in Shanghai, China, and 288 of them were randomized into an intervention group and a control group (closed trial), with the former (n=150) receiving a therapist-guided, smartphone-delivered mindfulness-based intervention and the latter receiving mental health promotion messages (n=138). We offered in-person instructions during the orientation session for the intervention group in a classroom, with the therapist interacting with the participants on the smartphone platform later during the intervention. We used generalized linear modeling and the intent-to-treat approach to compare the 2 groups' outcomes in dispositional anxiety, precompetition anxiety, and anxiety during competition, plus the 5 dimensions of mindfulness (measured by the FFMQ). Results: Our intent-to-treat analysis and generalized linear modeling found no significant difference in dispositional anxiety, precompetition anxiety, or anxiety during competition. Only the ?observation? facet of mindfulness measures had a notable difference between the changes experienced by the 2 groups, whereby the intervention group had a net gain of .214 yet fell short of reaching statistical significance (P=.09). Participants who specialized in group sports had a higher level of anxiety (?=.19; SE=.08), a lower level of ?nonjudgemental inner experience? in FFMQ (?=?.07; SE=.03), and a lower level of ?nonreactivity? (?=?.138; SE=.052) than those specializing in individual sports. Conclusions: No significant reduction in anxiety was detected in this study. Based on the participant feedback, the time availability for mindfulness practice and session attendance for these student athletes in an elite college could have compromised the intervention?s effectiveness. Future interventions among this population could explore a more student-friendly time schedule (eg, avoid final exam time) or attempt to improve cognitive and scholastic outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900024449; https://www.chictr.org.cn/showproj.html?proj=40865 UR - https://www.jmir.org/2024/1/e40406 UR - http://dx.doi.org/10.2196/40406 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457201 ID - info:doi/10.2196/40406 ER - TY - JOUR AU - Nabunya, Proscovia AU - Cavazos-Rehg, Patricia AU - Mugisha, James AU - Kasson, Erin AU - Namuyaba, Imelda Olive AU - Najjuuko, Claire AU - Nsubuga, Edward AU - Filiatreau, M. Lindsey AU - Mwebembezi, Abel AU - Ssewamala, M. Fred PY - 2024/3/8 TI - An mHealth Intervention to Address Depression and Improve Antiretroviral Therapy Adherence Among Youths Living With HIV in Uganda: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e54635 VL - 13 KW - depression KW - adherence KW - mHealth KW - cognitive behavioral therapy KW - antiretroviral therapy KW - youth living with HIV KW - Uganda N2 - Background: People living with HIV often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. There is growing evidence that depression treatment may improve ART adherence and result in improved HIV outcomes. Given that mental health services are severely underequipped in low-resource settings, including in Uganda, new solutions to increase access to mental health care and close the treatment gap are urgently needed. This protocol paper presents the Suubi-Mhealth study, which proposed to develop a mobile health (mHealth) intervention for use among Ugandan youths (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. Objective: The proposed study is guided by the following objectives: (1) to develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand the needs of youths living with HIV; (2) to explore the feasibility and acceptability of Suubi-Mhealth on a small scale to inform subsequent refinement; (3) to test the preliminary impact of Suubi-Mhealth versus a waitlist control group on youths? outcomes, including depression and treatment adherence; and (4) to examine barriers and facilitators for integrating Suubi-Mhealth into health care settings. Methods: Youths will be eligible to participate in the study if they are (1) 14-17 years of age, (2) HIV-positive and aware of their status, (3) receiving care and ART from one of the participating clinics, and (4) living within a family. The study will be conducted in 2 phases. In phase 1, we will conduct focus group discussions with youths and health care providers, for feedback on the proposed intervention content and methods, and explore the feasibility and acceptability of the intervention. In phase II, we will pilot-test the preliminary impact of the intervention on reducing depression and improving ART adherence. Assessments will be conducted at baseline, 1-, 2-, and 6-months post intervention completion. Results: Participant recruitment for phase 1 is completed. Youths and health care providers participated in focus group discussions to share their feedback on the proposed Suubi-Mhealth intervention content, methods, design, and format. Transcription and translation of focus group discussions have been completed. The team is currently developing Suubi-Mhealth content based on participants? feedback. Conclusions: This study will lay important groundwork for several initiatives at the intersection of digital therapeutics, HIV treatment, and mental health, especially among sub-Saharan African youths, as they transition through adolescence and into adult HIV care settings. Trial Registration: ClinicalTrials.gov NCT05965245; https://clinicaltrials.gov/study/NCT05965245 International Registered Report Identifier (IRRID): DERR1-10.2196/54635 UR - https://www.researchprotocols.org/2024/1/e54635 UR - http://dx.doi.org/10.2196/54635 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457202 ID - info:doi/10.2196/54635 ER - TY - JOUR AU - Rizvi, Fatima Rubina AU - Schoephoerster, Ann Jamee AU - Desphande, Satish Sagar AU - Usher, Michael AU - Oien, Elaine Andy AU - Peters, Marie Maya AU - Loth, Scott Matthew AU - Bahr, William Matthew AU - Ventz, Steffen AU - Koopmeiners, Stephen Joseph AU - Melton, B. Genevieve PY - 2024/3/8 TI - Decreasing Opioid Addiction and Diversion Using Behavioral Economics Applied Through a Digital Engagement Solution: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e52882 VL - 13 KW - opioid abuse KW - opioid naïve patients KW - opioid addiction KW - behavioral economics KW - nudges KW - MyChart KW - personal health record KW - post-operative care KW - opioid KW - opioid use KW - randomized controlled trial KW - RCT KW - digital engagement KW - health crisis KW - overdose KW - acute pain KW - pain KW - tool KW - tools KW - phone app KW - website KW - application N2 - Background: Despite strong and growing interest in ending the ongoing opioid health crisis, there has been limited success in reducing the prevalence of opioid addiction and the number of deaths associated with opioid overdoses. Further, 1 explanation for this is that existing interventions target those who are opiate-dependent but do not prevent opioid-naïve patients from becoming addicted. Objective: Leveraging behavioral economics at the patient level could help patients successfully use, discontinue, and dispose of their opioid medications in an acute pain setting. The primary goal of this project is to evaluate the effect of the 3 versions of the Opioid Management for You (OPY) tool on measures of opioid use relative to the standard of care by leveraging a pragmatic randomized controlled trial (RCT). Methods: A team of researchers from the Center for Learning Health System Sciences (CLHSS) at the University of Minnesota partnered with M Health Fairview to design, build, and test the 3 versions of the OPY tool: social influence, precommitment, and testimonial version. The tool is being built using the Epic Care Companion (Epic Inc) platform and interacts with the patient through their existing MyChart (Epic Systems Corporation) personal health record account, and Epic patient portal, accessed through a phone app or the MyChart website. We have demonstrated feasibility with pilot data of the social influence version of the OPY app by targeting our pilot to a specific cohort of patients undergoing upper-extremity procedures. This study will use a group sequential RCT design to test the impact of this important health system initiative. Patients who meet OPY inclusion criteria will be stratified into low, intermediate, and high risk of opiate use based on their type of surgery. Results: This study is being funded and supported by the CLHSS Rapid Prospective Evaluation and Digital Technology Innovation Programs, and M Health Fairview. Support and coordination provided by CLHSS include the structure of engagement, survey development, data collection, statistical analysis, and dissemination. The project was initially started in August 2022. The pilot was launched in February 2023 and is still running, with the data last counted in August 2023. The actual RCT is planned to start by early 2024. Conclusions: Through this RCT, we will test our hypothesis that patient opioid use and diverted prescription opioid availability can both be improved by information delivery applied through a behavioral economics lens via sending nudges directly to the opioid users through their personal health record. Trial Registration: ClinicalTrials.gov NCT06124079; https://clinicaltrials.gov/study/NCT06124079 International Registered Report Identifier (IRRID): PRR1-10.2196/52882 UR - https://www.researchprotocols.org/2024/1/e52882 UR - http://dx.doi.org/10.2196/52882 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457203 ID - info:doi/10.2196/52882 ER - TY - JOUR AU - Main, Ashleigh AU - McCartney, Haruno AU - Ibrar, Maryam AU - Rai, Kaur Harleen AU - Muirhead, Fiona AU - Mavroeidi, Alexandra AU - Maguire, Roma PY - 2024/3/7 TI - Patients? Experiences of Digital Health Interventions for the Self-Management of Chronic Pain: Protocol for a Systematic Review and Thematic Synthesis JO - JMIR Res Protoc SP - e52469 VL - 13 KW - chronic pain KW - digital health KW - digital tool KW - digital health intervention KW - mHealth KW - eHealth KW - pain-management KW - person-centered KW - experience KW - protocol KW - patients' experiences KW - patient experiences KW - self-management KW - systematic review KW - thematic synthesis KW - protocol. N2 - Background: Chronic pain is a highly prevalent condition that requires multidisciplinary treatment. However, in the United Kingdom, access to specialist pain clinics where patients can receive medical multidisciplinary treatment is limited, and provision varies between health boards. As such, self-management of chronic pain using digital tools has been gaining traction recently, but evidence of its effectiveness from clinical-based trials focuses mainly on quantitative outcomes. Objective: This systematic review aims to identify, appraise, and synthesize qualitative evidence on patients? experiences with digital health interventions (DHIs) for the management of chronic pain. Methods: This systematic review will consider qualitative and mixed methods studies that explore the experience of patients (aged 18 years and older) with chronic pain engaging in DHIs to manage their pain. MEDLINE Ovid, PubMed, Embase, CINAHL, PsycINFO, and Scopus databases will be searched for published studies. The systematic review will be conducted in accordance with the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. Following the 3-step thematic synthesis methodology of Thomas and Harden, titles and abstracts will be screened by 2 independent reviewers (AM and HM), and a third reviewer (MI or FM) will resolve any conflict that arises before the full-text screening. The Critical Appraisal Skills Programme checklist tool will be used to critically appraise the included studies. The extracted data will be imported to NVivo (QSR International), where thematic synthesis will be used to derive analytical themes from the included studies. Results: Themes that encapsulate the patient experience will be identified from qualitative evidence, and these themes will shed light on the perceived benefits and disadvantages, usability, acceptability, and the overall impact digital tools can have on the lives of those with chronic pain. Conclusions: This systematic review will identify, appraise, and synthesize the overall experience of patients engaging in DHI to manage a diverse range of chronic pain conditions. By elaborating the patient experience through qualitative analysis, the findings from this review will enhance our current understanding of the experiences of patients with chronic pain using digital tools for the self-management of their pain and highlight what person-centered elements are essential for future DHI development. Trial Registration: PROSPERO CRD42023445100; http://tinyurl.com/4z77khfs International Registered Report Identifier (IRRID): DERR1-10.2196/52469 UR - https://www.researchprotocols.org/2024/1/e52469 UR - http://dx.doi.org/10.2196/52469 UR - http://www.ncbi.nlm.nih.gov/pubmed/38451694 ID - info:doi/10.2196/52469 ER - TY - JOUR AU - Rodriguez, V. Danissa AU - Lawrence, Katharine AU - Gonzalez, Javier AU - Brandfield-Harvey, Beatrix AU - Xu, Lynn AU - Tasneem, Sumaiya AU - Levine, L. Defne AU - Mann, Devin PY - 2024/3/6 TI - Leveraging Generative AI Tools to Support the Development of Digital Solutions in Health Care Research: Case Study JO - JMIR Hum Factors SP - e52885 VL - 11 KW - digital health KW - GenAI KW - generative KW - artificial intelligence KW - ChatGPT KW - software engineering KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - diabetes KW - diabetic KW - diabetes prevention KW - digital prescription KW - software KW - engagement KW - behaviour change KW - behavior change KW - developer KW - developers KW - LLM KW - LLMs KW - language model KW - language models KW - NLP KW - natural language processing N2 - Background: Generative artificial intelligence has the potential to revolutionize health technology product development by improving coding quality, efficiency, documentation, quality assessment and review, and troubleshooting. Objective: This paper explores the application of a commercially available generative artificial intelligence tool (ChatGPT) to the development of a digital health behavior change intervention designed to support patient engagement in a commercial digital diabetes prevention program. Methods: We examined the capacity, advantages, and limitations of ChatGPT to support digital product idea conceptualization, intervention content development, and the software engineering process, including software requirement generation, software design, and code production. In total, 11 evaluators, each with at least 10 years of experience in fields of study ranging from medicine and implementation science to computer science, participated in the output review process (ChatGPT vs human-generated output). All had familiarity or prior exposure to the original personalized automatic messaging system intervention. The evaluators rated the ChatGPT-produced outputs in terms of understandability, usability, novelty, relevance, completeness, and efficiency. Results: Most metrics received positive scores. We identified that ChatGPT can (1) support developers to achieve high-quality products faster and (2) facilitate nontechnical communication and system understanding between technical and nontechnical team members around the development goal of rapid and easy-to-build computational solutions for medical technologies. Conclusions: ChatGPT can serve as a usable facilitator for researchers engaging in the software development life cycle, from product conceptualization to feature identification and user story development to code generation. Trial Registration: ClinicalTrials.gov NCT04049500; https://clinicaltrials.gov/ct2/show/NCT04049500 UR - https://humanfactors.jmir.org/2024/1/e52885 UR - http://dx.doi.org/10.2196/52885 UR - http://www.ncbi.nlm.nih.gov/pubmed/38446539 ID - info:doi/10.2196/52885 ER - TY - JOUR AU - Kong, Weitao AU - Li, Yuanyuan AU - Luo, Aijing AU - Xie, Wenzhao PY - 2024/3/6 TI - Status and Influencing Factors of Social Media Addiction in Chinese Workers: Cross-Sectional Survey Study JO - J Med Internet Res SP - e48026 VL - 26 KW - social media addiction KW - job burnout KW - mindfulness KW - mobile phone KW - technology addiction KW - cross-sectional survey N2 - Background: Social media addiction (SMA) caused by excessive dependence on social media is becoming a global problem. At present, most of the SMA studies recruit college students as research participants, with very few studies involving workers and other age groups, especially in China. Objective: This study aims to investigate the current status of SMA among Chinese workers and analyze its influencing factors. Methods: From November 1, 2022, to January 30, 2023, we conducted an anonymous web-based questionnaire survey in mainland China, and a total of 5176 participants completed the questionnaire. The questionnaire included the Social Networking Service Addiction Scale, Maslach Burnout Inventory?General Survey scale, Mindful Attention Awareness Scale, as well as questionnaires regarding participants? social media use habits and demographic information. Results: Through strict screening, 3468 valid questionnaires were included in this study. The main findings of this study revealed the following: the average SMA score of workers was higher (mean 53.19, SD 12.04), and some of them (393/3468, 11.33%) relied heavily on social media; there were statistically significant differences in SMA scores among workers in different industries (F14,3453=3.98; P<.001); single workers (t3106=8.6; P<.001) and workers in a relationship (t2749=5.67; P<.001) had higher SMA scores than married workers, but some married workers (214/3468, 6.17%) were highly dependent on social media; the level of SMA among female workers was higher than that of male workers (t3466=3.65; P<.001), and the SMA score of workers negatively correlated with age (r=?0.22; P<.001) and positively correlated with education level (r=0.12; P<.001); the frequency of using social media for entertainment during work (r=0.33; P<.001) and the frequency of staying up late using social media (r=0.14; P<.001) were positively correlated with the level of SMA in workers; and the level of SMA in workers was significantly positively correlated with their level of burnout (r=0.35; P<.001), whereas it was significantly negatively correlated with their level of mindfulness (r=?0.55; P<.001). Conclusions: The results of this study suggest that SMA among Chinese workers is relatively serious and that the SMA problem among workers requires more attention from society and academia. In particular, female workers, young workers, unmarried workers, highly educated workers, workers with bad social media habits, workers with high levels of job burnout, and workers with low levels of mindfulness were highly dependent on social media. In addition, occupation is an important influencing factor in SMA. Thus, the government should strengthen the supervision of social media companies. Medical institutions should provide health education on SMA and offer intervention programs for those addicted to social media. Workers should cultivate healthy habits while using social media. UR - https://www.jmir.org/2024/1/e48026 UR - http://dx.doi.org/10.2196/48026 UR - http://www.ncbi.nlm.nih.gov/pubmed/38446542 ID - info:doi/10.2196/48026 ER - TY - JOUR AU - Benthem de Grave, Remco AU - Bull, N. Christopher AU - Monjardino de Souza Monteiro, Diogo AU - Margariti, Eleni AU - McMurchy, Gareth AU - Hutchinson, William Joseph AU - Smeddinck, David Jan PY - 2024/3/6 TI - Smartphone Apps for Food Purchase Choices: Scoping Review of Designs, Opportunities, and Challenges JO - J Med Internet Res SP - e45904 VL - 26 KW - behavior change KW - mobile apps KW - food choices KW - grocery shopping KW - sustainability KW - healthy eating KW - digital health KW - mobile phone N2 - Background: Smartphone apps can aid consumers in making healthier and more sustainable food purchases. However, there is still a limited understanding of the different app design approaches and their impact on food purchase choices. An overview of existing food purchase choice apps and an understanding of common challenges can help speed up effective future developments. Objective: We examined the academic literature on food purchase choice apps and provided an overview of the design characteristics, opportunities, and challenges for effective implementation. Thus, we contribute to an understanding of how technologies can effectively improve food purchase choice behavior and provide recommendations for future design efforts. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we considered peer-reviewed literature on food purchase choice apps within IEEE Xplore, PubMed, Scopus, and ScienceDirect. We inductively coded and summarized design characteristics. Opportunities and challenges were addressed from both quantitative and qualitative perspectives. From the quantitative perspective, we coded and summarized outcomes of comparative evaluation trials. From the qualitative perspective, we performed a qualitative content analysis of commonly discussed opportunities and challenges. Results: We retrieved 55 articles, identified 46 unique apps, and grouped them into 5 distinct app types. Each app type supports a specific purchase choice stage and shares a common functional design. Most apps support the product selection stage (selection apps; 27/46, 59%), commonly by scanning the barcode and displaying a nutritional rating. In total, 73% (8/11) of the evaluation trials reported significant findings and indicated the potential of food purchase choice apps to support behavior change. However, relatively few evaluations covered the selection app type, and these studies showed mixed results. We found a common opportunity in apps contributing to learning (knowledge gain), whereas infrequent engagement presents a common challenge. The latter was associated with perceived burden of use, trust, and performance as well as with learning. In addition, there were technical challenges in establishing comprehensive product information databases or achieving performance accuracy with advanced identification methods such as image recognition. Conclusions: Our findings suggest that designs of food purchase choice apps do not encourage repeated use or long-term adoption, compromising the effectiveness of behavior change through nudging. However, we found that smartphone apps can enhance learning, which plays an important role in behavior change. Compared with nudging as a mechanism for behavior change, this mechanism is less dependent on continued use. We argue that designs that optimize for learning within each interaction have a better chance of achieving behavior change. This review concludes with design recommendations, suggesting that food purchase choice app designers anticipate the possibility of early abandonment as part of their design process and design apps that optimize the learning experience. UR - https://www.jmir.org/2024/1/e45904 UR - http://dx.doi.org/10.2196/45904 UR - http://www.ncbi.nlm.nih.gov/pubmed/38446500 ID - info:doi/10.2196/45904 ER - TY - JOUR AU - Khaleghi, Ali AU - Narimani, Abbas AU - Aghaei, Zahra AU - Khorrami Banaraki, Anahita AU - Hassani-Abharian, Peyman PY - 2024/3/6 TI - A Smartphone-Gamified Virtual Reality Exposure Therapy Augmented With Biofeedback for Ailurophobia: Development and Evaluation Study JO - JMIR Serious Games SP - e34535 VL - 12 KW - animal phobia KW - specific phobia KW - ailurophobia KW - cat phobia KW - biofeedback KW - smartphones KW - virtual reality KW - gamification KW - mobile phone N2 - Background: To the best of our knowledge, no specialized research has been conducted to address ailurophobia (fear of cats) in Iran or globally. This has driven our project, along with the prevalence of ailurophobia and the absence of a gamified virtual reality exposure therapy (VRET) that incorporates affordable and easily accessible biofeedback (BF) tools. We hypothesize that a gamified VRET augmented with BF will yield more positive effects than a similar device lacking BF. Objective: This study primarily focuses on the development and preliminary evaluation of a smartphone-gamified VRET integrated with BF, targeting animal phobia, with a specific case study on ailurophobia. The secondary objectives are using affordable and readily available BF found in devices such as smart bands and smartwatches and creating a mobile virtual reality gamified app to improve patients? adherence to treatments while simultaneously enhancing the app?s accessibility, scalability, and outreach. Methods: Evaluations encompassed 3 methods. First, we identified the tool?s potential positive effects on phobia interventions, exploring 4 effects: intrinsic motivation, simulation of fearful situations, management of stressful circumstances without therapists? presence and mitigation of catastrophic thoughts, and preliminary effects on ailurophobia treatment. Participants were divided into BF and non-BF groups. Second, we gathered user preferences and opinions about the treatment. Third, we conducted heuristic evaluations using 44 heuristics from existing system usability scales assessing user interfaces, virtual reality platforms, and video games? playability. To interpret the data, mean scores; ANOVA, single factor; and ANOVA, 2-factor with replication were used. A total of 29 individuals were identified, of which 10 met the eligibility criteria or were accessible. Results: The smartphone-gamified VRET augmented with BF exhibited better results on the identified effects compared with the non-BF version and contributed to normalizing encounters with cats. Moreover, 41 of the 44 heuristics achieved a percentage above 62%, indicating its potential as a therapeutic product and its ability to enhance patient adherence to treatments. Patient preferences on the treatment and its strengths and weaknesses were provided for further improvement. Conclusions: The tool has the potential to evolve into a comprehensive solution by incorporating various types of cats and their behaviors, simulating environments in which they are commonly found, and enhancing its appeal through an increased sense of adventure without inducing unrealistic fears. By adapting fear elements, the game can be tailored to treat various animal phobias. Phobia-focused games should avoid action and combat scenarios to prevent reinforcement of fear responses. After rigorous evaluation, further exploration is required to provide remote use beyond clinical settings. UR - https://games.jmir.org/2024/1/e34535 UR - http://dx.doi.org/10.2196/34535 UR - http://www.ncbi.nlm.nih.gov/pubmed/38446522 ID - info:doi/10.2196/34535 ER - TY - JOUR AU - Yoon, Sungwon AU - Tang, Haoming AU - Tan, Min Chao AU - Phang, Kie Jie AU - Kwan, Heng Yu AU - Low, Leng Lian PY - 2024/3/6 TI - Acceptability of Mobile App?Based Motivational Interviewing and Preferences for App Features to Support Self-Management in Patients With Type 2 Diabetes: Qualitative Study JO - JMIR Diabetes SP - e48310 VL - 9 KW - mobile health KW - motivational interviewing KW - diabetes KW - self-management KW - health coaching KW - acceptability KW - application KW - management KW - type 2 diabetes KW - communication KW - patient barrier KW - healthy behavior KW - feedback KW - visualization KW - hybrid model N2 - Background: Patients with type 2 diabetes mellitus (T2DM) experience multiple barriers to improving self-management. Evidence suggests that motivational interviewing (MI), a patient-centered communication method, can address patient barriers and promote healthy behavior. Despite the value of MI, existing MI studies predominantly used face-to-face or phone-based interventions. With the growing adoption of smartphones, automated MI techniques powered by artificial intelligence on mobile devices may offer effective motivational support to patients with T2DM. Objective: This study aimed to explore the perspectives of patients with T2DM on the acceptability of app-based MI in routine health care and collect their feedback on specific MI module features to inform our future intervention. Methods: We conducted semistructured interviews with patients with T2DM, recruited from public primary care clinics. All interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted using NVivo. Results: In total, 33 patients with T2DM participated in the study. Participants saw MI as a mental reminder to increase motivation and a complementary care model conducive to self-reflection and behavior change. Yet, there was a sense of reluctance, mainly stemming from potential compromise of autonomy in self-care by the introduction of MI. Some participants felt confident in their ability to manage conditions independently, while others reported already making changes and preferred self-management at their own pace. Compared with in-person MI, app-based MI was viewed as offering a more relaxed atmosphere for open sharing without being judged by health care providers. However, participants questioned the lack of human touch, which could potentially undermine a patient-provider therapeutic relationship. To sustain motivation, participants suggested more features of an ongoing supportive nature such as the visualization of milestones, gamified challenges and incremental rewards according to achievements, tailored multimedia resources based on goals, and conversational tools that are interactive and empathic. Conclusions: Our findings suggest the need for a hybrid model of intervention involving both app-based automated MI and human coaching. Patient feedback on specific app features will be incorporated into the module development and tested in a randomized controlled trial. UR - https://diabetes.jmir.org/2024/1/e48310 UR - http://dx.doi.org/10.2196/48310 UR - http://www.ncbi.nlm.nih.gov/pubmed/38446526 ID - info:doi/10.2196/48310 ER - TY - JOUR AU - Anders, Carolin AU - Moorthy, Preetha AU - Svensson, Laura AU - Müller, Julia AU - Heinze, Oliver AU - Knaup, Petra AU - Wallwiener, Markus AU - Deutsch, M. Thomas AU - Le, Thao-Vy AU - Weinert, Lina PY - 2024/3/5 TI - Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking JO - JMIR Hum Factors SP - e50926 VL - 11 KW - mobile health KW - mHealth KW - usability KW - breast cancer KW - eye tracking KW - user interface KW - mixed methods KW - mobile phone N2 - Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app?s content regularly, and self-administration. In contrast to the app?s current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients? feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy. UR - https://humanfactors.jmir.org/2024/1/e50926 UR - http://dx.doi.org/10.2196/50926 UR - http://www.ncbi.nlm.nih.gov/pubmed/38441959 ID - info:doi/10.2196/50926 ER - TY - JOUR AU - Merolli, Mark AU - Francis, J. Jill AU - Vallance, Patrick AU - Bennell, L. Kim AU - Malliaras, Peter AU - Hinman, S. Rana PY - 2024/3/4 TI - Evaluation of Patient-Facing Mobile Apps to Support Physiotherapy Care: Systematic Review JO - JMIR Mhealth Uhealth SP - e55003 VL - 12 KW - physiotherapy KW - physical therapy KW - digital health intervention KW - mobile app KW - behavior change technique KW - behavior change KW - exercise KW - systematic review KW - quality KW - rehabilitation KW - BCT KW - mHealth KW - mobile health KW - app KW - apps KW - physical activity KW - fitness KW - synthesis KW - syntheses KW - review methods KW - review methodology KW - search KW - searches KW - searching KW - systematic KW - mobile phone N2 - Background: Mobile health interventions delivered through mobile apps are increasingly used in physiotherapy care. This may be because of the potential of apps to facilitate changes in behavior, which is central to the aims of care delivered by physiotherapists. A benefit of using apps is their ability to incorporate behavior change techniques (BCTs) that can optimize the effectiveness of physiotherapeutic interventions. Research continues to suggest that despite their importance, behavior change strategies are often missing in patient management. Evaluating mobile apps that physiotherapists can use to drive behavior change may inform clinical practice and potentially improve patient outcomes. Examining the quality of apps and exploring their key features that can support behavior change and physiotherapy care are important aspects of such an evaluation. Objective: The primary aim of this study was to describe the range of mobile apps in app stores that are intended for use by patients to support physiotherapy care. The secondary aims were to assess app quality, BCTs, and their behavior change potential. Methods: A systematic review of mobile apps in app stores was undertaken. The Apple App Store and Google Play were searched using a 2-step search strategy, using terms relevant to the physiotherapy discipline. Strict inclusion and exclusion criteria were applied: apps had to be intended for use by patients and be self-contained (or stand-alone) without the requirement to be used in conjunction with a partner wearable device or another plugin. Included apps were coded for BCTs using the Behavior Change Technique Taxonomy version 1. App quality was assessed using the Mobile App Rating Scale, and the App Behavior Change Scale was used to assess the app?s potential to change behavior. Results: In total, 1240 apps were screened, and 35 were included. Of these 35 apps, 22 (63%) were available on both the Apple App Store and Google Play platforms. In total, 24 (69%) were general in their focus (eg, not condition-specific), with the remaining 11 (31%) being more specific (eg, knee rehabilitation and pelvic floor training). The mean app quality score (Mobile App Rating Scale) was 3.7 (SD 0.4) of 5 (range 2.8-4.5). The mean number of BCTs identified per app was 8.5 (SD 3.6). BCTs most frequently included in the apps were instruction on how to perform a behavior (n=32), action planning (n=30), and self-monitoring of behavior (n=28). The mean behavior change potential score (App Behavior Change Scale) was 8.5 (SD 3.1) of 21 (range 3-15). Conclusions: Mobile apps available to support patient care received from a physiotherapist are of variable quality. Although they contain some BCTs, the potential for behavior change varied widely across apps. International Registered Report Identifier (IRRID): RR2-10.2196/29047 UR - https://mhealth.jmir.org/2024/1/e55003 UR - http://dx.doi.org/10.2196/55003 UR - http://www.ncbi.nlm.nih.gov/pubmed/38437018 ID - info:doi/10.2196/55003 ER - TY - JOUR AU - Keogh, Alison AU - Brennan, Carol AU - Johnston, William AU - Dickson, Jane AU - Leslie, J. Stephen AU - Burke, David AU - Megyesi, Peter AU - Caulfield, Brian PY - 2024/3/1 TI - Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study JO - JMIR Form Res SP - e52442 VL - 8 KW - digital health KW - heart failure KW - cardiology KW - self-care KW - behavior change KW - eHealth KW - mHealth KW - mobile health KW - mobile app KW - mobile phone KW - elderly KW - self-management KW - digital tools KW - digital tool KW - human-centered design KW - app KW - apps KW - applications KW - wearables KW - wearable KW - Fitbit KW - usability KW - adherence KW - feasibility KW - congestive heart failure KW - cardiac failure KW - myocardial failure KW - heart decompensation N2 - Background: Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people?s acceptance of it in practice. Objective: This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. Methods: A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. Results: Participants wore their devices for an average of 86.2% of the days in the 6-month testing period ranging from 40.6% to 98%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. Conclusions: The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs. UR - https://formative.jmir.org/2024/1/e52442 UR - http://dx.doi.org/10.2196/52442 UR - http://www.ncbi.nlm.nih.gov/pubmed/38427410 ID - info:doi/10.2196/52442 ER - TY - JOUR AU - Zheng, Amy AU - Bergh, Marissa AU - Patel Murali, Komal AU - Sadarangani, Tina PY - 2024/3/1 TI - Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility JO - JMIR Form Res SP - e49492 VL - 8 KW - adult day services KW - primary health care KW - health communication KW - dementia KW - mobile health KW - mHealth KW - community-based KW - health care KW - older adults KW - older adult KW - chronic condition KW - health information KW - feasibility KW - acceptability KW - CareMOBI KW - mixed methods design KW - caregivers KW - caregiver KW - care workers KW - nurses KW - social workers N2 - Background: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users? health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. Objective: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. Methods: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. Results: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. Conclusions: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting. UR - https://formative.jmir.org/2024/1/e49492 UR - http://dx.doi.org/10.2196/49492 UR - http://www.ncbi.nlm.nih.gov/pubmed/38427418 ID - info:doi/10.2196/49492 ER - TY - JOUR AU - Demirel, Sevda AU - Roke, Yvette AU - Hoogendoorn, W. Adriaan AU - Hoefakker, Jamie AU - Hoeberichts, Kirsten AU - van Harten, N. Peter PY - 2024/2/29 TI - Assessing the Effectiveness of STAPP@Work, a Self-Management Mobile App, in Reducing Work Stress and Preventing Burnout: Single-Case Experimental Design Study JO - J Med Internet Res SP - e48883 VL - 26 KW - mental health KW - stress KW - coping KW - burnout KW - stress management KW - digital intervention KW - health promotion KW - mobile apps KW - mobile health KW - mHealth KW - mental health professionals N2 - Background: Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. Objective: This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. Methods: The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. Results: After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=?0.38, 95% CI ?0.67 to ?0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=?0.31, 95% CI ?0.51 to ?0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. Conclusions: The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism. UR - https://www.jmir.org/2024/1/e48883 UR - http://dx.doi.org/10.2196/48883 UR - http://www.ncbi.nlm.nih.gov/pubmed/38275128 ID - info:doi/10.2196/48883 ER - TY - JOUR AU - Ni, Chenxu AU - Wang, Yi-fu AU - Zhang, Yun-ting AU - Yuan, Min AU - Xu, Qing AU - Shen, Fu-ming AU - Li, Dong-Jie AU - Huang, Fang PY - 2024/2/29 TI - A Mobile Applet for Assessing Medication Adherence and Managing Adverse Drug Reactions Among Patients With Cancer: Usability and Utility Study JO - JMIR Form Res SP - e50528 VL - 8 KW - WeChat applet KW - usability testing KW - utility testing KW - cancer patients KW - patients KW - cancer KW - qualitative study N2 - Background: Medication adherence and the management of adverse drug reactions (ADRs) are crucial to the efficacy of antitumor drugs. A WeChat applet, also known as a ?Mini Program,? is similar to the app but has marked advantages. The development and use of a WeChat applet makes follow-up convenient for patients with cancer. Objective: This study aimed to assess the usability and utility of a newly developed WeChat applet, ?DolphinCare,? among patients with cancer in Shanghai. Methods: A qualitative methodology was used to obtain an in-depth understanding of the experiences of patients with cancer when using DolphinCare from the usability and utility aspects. The development phase consisted of 2 parts: alpha and beta testing. Alpha testing combined the theory of the Fogg Behavior Model and the usability model. Alpha testing also involved testing the design of DolphinCare using a conceptual framework, which included factors that could affect medication adherence and ADRs. Beta testing was conducted using in-depth interviews. In-depth interviews allowed us to assist the patients in using DolphinCare and understand whether they liked or disliked DolphinCare and found it useful. Results: We included participants who had an eHealth Literacy Scale (eHEALS) score of ?50%, and a total of 20 participants were interviewed consecutively. The key positive motivators described by interviewers were to be reminded to take their medications and to alleviate their ADRs. The majority of the patients were able to activate and use DolphinCare by themselves. Most patients indicated that their trigger to follow-up DolphinCare was the recommendation of their known and trusted health care professionals. All participants found that labels containing the generic names of their medication and the medication reminders were useful, including timed pop-up push notifications and text alerts. The applet presented the corresponding information collection forms of ADRs to the patient to fill out. The web-based consultation system enables patients to consult pharmacists or physicians in time when they have doubts about medications or have ADRs. The applet had usabilities and utilities that could improve medication adherence and the management of ADRs among patients with cancer. Conclusions: This study provides preliminary evidence regarding the usability and utility of this type of WeChat applet among patients with cancer, which is expected to be promoted for managing follow-up among other patients with other chronic disease. UR - https://formative.jmir.org/2024/1/e50528 UR - http://dx.doi.org/10.2196/50528 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421700 ID - info:doi/10.2196/50528 ER - TY - JOUR AU - Lee, Audrey AU - Dionicio, Patricia AU - Farcas, Emilia AU - Godino, Job AU - Patrick, Kevin AU - Wyckoff, Elijah AU - Loh, J. Kenneth AU - Gombatto, Sara PY - 2024/2/29 TI - Physical Therapists? Acceptance of a Wearable, Fabric-Based Sensor System (Motion Tape) for Use in Clinical Practice: Qualitative Focus Group Study JO - JMIR Hum Factors SP - e55246 VL - 11 KW - low back pain KW - physical therapy KW - physical therapist KW - wearable sensor KW - technology acceptance model KW - motion tape KW - kinesiology tape N2 - Background: Low back pain (LBP) is a costly global health condition that affects individuals of all ages and genders. Physical therapy (PT) is a commonly used and effective intervention for the management of LBP and incorporates movement assessment and therapeutic exercise. A newly developed wearable, fabric-based sensor system, Motion Tape, uses novel sensing and data modeling to measure lumbar spine movements unobtrusively and thus offers potential benefits when used in conjunction with PT. However, physical therapists? acceptance of Motion Tape remains unexplored. Objective: The primary aim of this research study was to evaluate physical therapists? acceptance of Motion Tape to be used for the management of LBP. The secondary aim was to explore physical therapists? recommendations for future device development. Methods: Licensed physical therapists from the American Physical Therapy Association Academy of Leadership Technology Special Interest Group participated in this study. Overall, 2 focus groups (FGs; N=8) were conducted, in which participants were presented with Motion Tape samples and examples of app data output on a poster. Informed by the Technology Acceptance Model, we conducted semistructured FGs and explored the wearability, usefulness, and ease of use of and suggestions for improvements in Motion Tape for PT management of LBP. FG data were transcribed and analyzed using rapid qualitative analysis. Results: Regarding wearability, participants perceived that Motion Tape would be able to adhere for several days, with some variability owing to external factors. Feedback was positive for the low-profile and universal fit, but discomfort owing to wires and potential friction with clothing was of concern. Other concerns included difficulty with self-application and potential skin sensitivity. Regarding usefulness, participants expressed that Motion Tape would enhance the efficiency and specificity of assessments and treatment. Regarding ease of use, participants stated that the app would be easy, but data management and challenges with interpretation were of concern. Physical therapists provided several recommendations for future design improvements including having a wireless system or removable wires, customizable sizes for the tape, and output including range of motion data and summary graphs and adding app features that consider patient input and context. Conclusions: Several themes related to Motion Tape?s wearability, usefulness, and ease of use were identified. Overall, physical therapists expressed acceptance of Motion Tape?s potential for assessing and monitoring low back posture and movement, both within and outside clinical settings. Participants expressed that Motion Tape would be a valuable tool for the personalized treatment of LBP but highlighted several future improvements needed for Motion Tape to be used in practice. UR - https://humanfactors.jmir.org/2024/1/e55246 UR - http://dx.doi.org/10.2196/55246 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421708 ID - info:doi/10.2196/55246 ER - TY - JOUR AU - Willms, Amanda AU - Liu, Sam PY - 2024/2/29 TI - Exploring the Feasibility of Using ChatGPT to Create Just-in-Time Adaptive Physical Activity mHealth Intervention Content: Case Study JO - JMIR Med Educ SP - e51426 VL - 10 KW - ChatGPT KW - digital health KW - mobile health KW - mHealth KW - physical activity KW - application KW - mobile app KW - mobile apps KW - content creation KW - behavior change KW - app design N2 - Background: Achieving physical activity (PA) guidelines? recommendation of 150 minutes of moderate-to-vigorous PA per week has been shown to reduce the risk of many chronic conditions. Despite the overwhelming evidence in this field, PA levels remain low globally. By creating engaging mobile health (mHealth) interventions through strategies such as just-in-time adaptive interventions (JITAIs) that are tailored to an individual?s dynamic state, there is potential to increase PA levels. However, generating personalized content can take a long time due to various versions of content required for the personalization algorithms. ChatGPT presents an incredible opportunity to rapidly produce tailored content; however, there is a lack of studies exploring its feasibility. Objective: This study aimed to (1) explore the feasibility of using ChatGPT to create content for a PA JITAI mobile app and (2) describe lessons learned and future recommendations for using ChatGPT in the development of mHealth JITAI content. Methods: During phase 1, we used Pathverse, a no-code app builder, and ChatGPT to develop a JITAI app to help parents support their child?s PA levels. The intervention was developed based on the Multi-Process Action Control (M-PAC) framework, and the necessary behavior change techniques targeting the M-PAC constructs were implemented in the app design to help parents support their child?s PA. The acceptability of using ChatGPT for this purpose was discussed to determine its feasibility. In phase 2, we summarized the lessons we learned during the JITAI content development process using ChatGPT and generated recommendations to inform future similar use cases. Results: In phase 1, by using specific prompts, we efficiently generated content for 13 lessons relating to increasing parental support for their child?s PA following the M-PAC framework. It was determined that using ChatGPT for this case study to develop PA content for a JITAI was acceptable. In phase 2, we summarized our recommendations into the following six steps when using ChatGPT to create content for mHealth behavior interventions: (1) determine target behavior, (2) ground the intervention in behavior change theory, (3) design the intervention structure, (4) input intervention structure and behavior change constructs into ChatGPT, (5) revise the ChatGPT response, and (6) customize the response to be used in the intervention. Conclusions: ChatGPT offers a remarkable opportunity for rapid content creation in the context of an mHealth JITAI. Although our case study demonstrated that ChatGPT was acceptable, it is essential to approach its use, along with other language models, with caution. Before delivering content to population groups, expert review is crucial to ensure accuracy and relevancy. Future research and application of these guidelines are imperative as we deepen our understanding of ChatGPT and its interactions with human input. UR - https://mededu.jmir.org/2024/1/e51426 UR - http://dx.doi.org/10.2196/51426 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421689 ID - info:doi/10.2196/51426 ER - TY - JOUR AU - Patel, Priya AU - Brown, Susan AU - Guo, Boliang AU - Holmes, A. Emily AU - Iyadurai, Lalitha AU - Kingslake, Jonathan AU - Highfield, Julie AU - Morriss, Richard PY - 2024/2/29 TI - Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences JO - JMIR Form Res SP - e47458 VL - 8 KW - intensive care KW - posttraumatic stress disorder KW - PTSD KW - qualitative research KW - intervention study KW - health care professionals KW - digital intervention KW - staff well-being KW - pandemic KW - intrusive memories KW - work-related trauma KW - mobile phone N2 - Background: Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers. Objective: This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention. Methods: The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach. Results: Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation. Conclusions: The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial. UR - https://formative.jmir.org/2024/1/e47458 UR - http://dx.doi.org/10.2196/47458 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421698 ID - info:doi/10.2196/47458 ER - TY - JOUR AU - Lightfoot, Marguerita AU - Campbell, Chadwick AU - Maragh-Bass, C. Allysha AU - Jackson-Morgan, Joi AU - Taylor, Kelly PY - 2024/2/28 TI - What Adolescents Say in Text Messages to Motivate Peer Networks to Access Health Care and Sexually Transmitted Infection Testing: Qualitative Thematic Analysis JO - J Med Internet Res SP - e44861 VL - 26 KW - adolescents KW - clinics KW - HIV/STI testing KW - intervention KW - mobile health KW - peer KW - screening KW - sexually active KW - STI KW - text messaging KW - young adult N2 - Background: While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths. Objective: This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic. Methods: We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youths (n=100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to 5 friends they believed were sexually active to encourage their friends to visit the clinic and receive STI or HIV screening. Thematic analysis was used to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding were used to ensure interrater reliability and significance of themes. Results: We identified four themes in the messages sent by participants: (1) calls to action to encourage peers to get tested, (2) personalized messages with sender-specific information, (3) clinic information such as location and hours, and (4) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youths were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40/100, 40%) received an immediate response to their message, and most participants reported receiving at least 1 positive response, while a few reported that they had received at least 1 negative response. There were some differences in responses depending on the type of message sent. Conclusions: Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youths are willing to text message their friends, and there are clear types of messages they develop and use. Future research should use these methods with a large, more diverse sample of youths and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV and STI among adolescents and young adults. UR - https://www.jmir.org/2024/1/e44861 UR - http://dx.doi.org/10.2196/44861 UR - http://www.ncbi.nlm.nih.gov/pubmed/38416541 ID - info:doi/10.2196/44861 ER - TY - JOUR AU - Siebelink, M. Nienke AU - van Dam, N. Kirstin AU - Lukkien, M. Dirk R. AU - Boon, Brigitte AU - Smits, Merlijn AU - van der Poel, Agnes PY - 2024/2/28 TI - Action Opportunities to Pursue Responsible Digital Care for People With Intellectual Disabilities: Qualitative Study JO - JMIR Ment Health SP - e48147 VL - 11 KW - ethics KW - value-based health care KW - digital technology KW - intellectual disability KW - digital care N2 - Background: Responsible digital care refers to any intentional systematic effort designed to increase the likelihood of a digital care technology developed through ethical decision-making, being socially responsible and aligned with the values and well-being of those impacted by it. Objective: We aimed to present examples of action opportunities for (1) designing ?technology?; (2) shaping the ?context? of use; and (3) adjusting the behavior of ?users? to guide responsible digital care for people with intellectual disabilities. Methods: Three cases were considered: (1) design of a web application to support the preparation of meals for groups of people with intellectual disabilities, (2) implementation of an app to help people with intellectual disabilities regulate their stress independently, and (3) implementation of a social robot to stimulate interaction and physical activity among people with intellectual disabilities. Overall, 26 stakeholders participated in 3 multistakeholder workshops (case 1: 10/26, 38%; case 2: 10/26, 38%; case 3: 6/26, 23%) based on the ?guidance ethics approach.? We identified stakeholders? values based on bottom-up exploration of experienced and expected effects of using the technology, and we formulated action opportunities for these values in the specific context of use. Qualitative data were analyzed thematically. Results: Overall, 232 effects, 33 values, and 156 action opportunities were collected. General and case-specific themes were identified. Important stakeholder values included quality of care, autonomy, efficiency, health, enjoyment, reliability, and privacy. Both positive and negative effects could underlie stakeholders? values and influence the development of action opportunities. Action opportunities comprised the following: (1) technology: development of the technology (eg, user experience and customization), technology input (eg, recipes for meals, intervention options for reducing stress, and activities), and technology output (eg, storage and use of data); (2) context: guidelines, training and support, policy or agreements, and adjusting the physical environment in which the technology is used; and (3) users: integrating the technology into daily care practice, by diminishing (eg, ?letting go? to increase the autonomy of people with intellectual disabilities), retaining (eg, face-to-face contact), and adding (eg, evaluation moments) certain behaviors of care professionals. Conclusions: This is the first study to provide insight into responsible digital care for people with intellectual disabilities by means of bottom-up exploration of action opportunities to take account of stakeholders? values in designing technology, shaping the context of use, and adjusting the behavior of users. Although part of the findings may be generalized, case-specific insights and a complementary top-down approach (eg, predefined ethical frameworks) are essential. The findings represent a part of an ethical discourse that requires follow-up to meet the dynamism of stakeholders? values and further develop and implement action opportunities to achieve socially desirable, ethically acceptable, and sustainable digital care that improves the lives of people with intellectual disabilities. UR - https://mental.jmir.org/2024/1/e48147 UR - http://dx.doi.org/10.2196/48147 UR - http://www.ncbi.nlm.nih.gov/pubmed/38416547 ID - info:doi/10.2196/48147 ER - TY - JOUR AU - Oehm, Benedict Johannes AU - Riepenhausen, Luise Sarah AU - Storck, Michael AU - Dugas, Martin AU - Pryss, Rüdiger AU - Varghese, Julian PY - 2024/2/27 TI - Integration of Patient-Reported Outcome Data Collected Via Web Applications and Mobile Apps Into a Nation-Wide COVID-19 Research Platform Using Fast Healthcare Interoperability Resources: Development Study JO - J Med Internet Res SP - e47846 VL - 26 KW - Fast Healthcare Interoperability Resources KW - FHIR KW - FHIR Questionnaire KW - patient-reported outcome KW - mobile health KW - mHealth KW - research compatibility KW - interoperability KW - Germany KW - harmonized data collection KW - findable, accessible, interoperable, and reusable KW - FAIR data KW - mobile phone N2 - Background: The Network University Medicine projects are an important part of the German COVID-19 research infrastructure. They comprise 2 subprojects: COVID-19 Data Exchange (CODEX) and Coordination on Mobile Pandemic Apps Best Practice and Solution Sharing (COMPASS). CODEX provides a centralized and secure data storage platform for research data, whereas in COMPASS, expert panels were gathered to develop a reference app framework for capturing patient-reported outcomes (PROs) that can be used by any researcher. Objective: Our study aims to integrate the data collected with the COMPASS reference app framework into the central CODEX platform, so that they can be used by secondary researchers. Although both projects used the Fast Healthcare Interoperability Resources (FHIR) standard, it was not used in a way that data could be shared directly. Given the short time frame and the parallel developments within the CODEX platform, a pragmatic and robust solution for an interface component was required. Methods: We have developed a means to facilitate and promote the use of the German Corona Consensus (GECCO) data set, a core data set for COVID-19 research in Germany. In this way, we ensured semantic interoperability for the app-collected PRO data with the COMPASS app. We also developed an interface component to sustain syntactic interoperability. Results: The use of different FHIR types by the COMPASS reference app framework (the general-purpose FHIR Questionnaire) and the CODEX platform (eg, Patient, Condition, and Observation) was found to be the most significant obstacle. Therefore, we developed an interface component that realigns the Questionnaire items with the corresponding items in the GECCO data set and provides the correct resources for the CODEX platform. We extended the existing COMPASS questionnaire editor with an import function for GECCO items, which also tags them for the interface component. This ensures syntactic interoperability and eases the reuse of the GECCO data set for researchers. Conclusions: This paper shows how PRO data, which are collected across various studies conducted by different researchers, can be captured in a research-compatible way. This means that the data can be shared with a central research infrastructure and be reused by other researchers to gain more insights about COVID-19 and its sequelae. UR - https://www.jmir.org/2024/1/e47846 UR - http://dx.doi.org/10.2196/47846 UR - http://www.ncbi.nlm.nih.gov/pubmed/38411999 ID - info:doi/10.2196/47846 ER - TY - JOUR AU - Waki, Kayo AU - Tsurutani, Yuya AU - Waki, Hironori AU - Enomoto, Syunpei AU - Kashiwabara, Kosuke AU - Fujiwara, Akira AU - Orime, Kazuki AU - Kinguchi, Sho AU - Yamauchi, Toshimasa AU - Hirawa, Nobuhito AU - Tamura, Kouichi AU - Terauchi, Yasuo AU - Nangaku, Masaomi AU - Ohe, Kazuhiko PY - 2024/2/23 TI - Efficacy of StepAdd, a Personalized mHealth Intervention Based on Social Cognitive Theory to Increase Physical Activity Among Patients With Type 2 Diabetes Mellitus: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e53514 VL - 13 KW - digital therapeutics KW - behavior change KW - social cognitive theory KW - exercise KW - type 2 diabetes mellitus KW - mobile app KW - randomized controlled trial KW - mobile phone N2 - Background: Increasing physical activity improves glycemic control in patients with type 2 diabetes (T2D). Mobile health (mHealth) interventions have been proven to increase exercise, but engagement often fades with time. As the use of health behavior theory in mHealth design can increase effectiveness, we developed StepAdd, an mHealth intervention based on the constructs of social cognitive theory (SCT). StepAdd improves exercise behavior self-efficacy and self-regulation through the use of goal-setting, barrier-identifying, and barrier-coping strategies, as well as automatic feedback functions. A single-arm pilot study of StepAdd among 33 patients with T2D showed a large increase in step count (mean change of 4714, SD 3638 daily steps or +86.7%), along with strong improvements in BMI (mean change of ?0.3 kg/m2) and hemoglobin A1c level (mean change of ?0.79 percentage points). Objective: In this study, we aim to investigate the efficacy and safety of StepAdd, an mHealth exercise support system for patients with T2D, via a large, long, and controlled follow-up to the pilot study. Methods: This is a randomized, open-label, multicenter study targeting 160 patients with T2D from 5 institutions in Japan with a 24-week intervention. The intervention group will record daily step counts, body weight, and blood pressure using the SCT-based mobile app, StepAdd, and receive feedback about these measurements. In addition, they will set weekly step count goals, identify personal barriers to walking, and define strategies to overcome these barriers. The control group will record daily step counts, body weight, and blood pressure using a non?SCT-based placebo app. Both groups will receive monthly consultations with a physician who will advise patients regarding lifestyle modifications and use of the app. The 24-week intervention period will be followed by a 12-week observational period to investigate the sustainability of the intervention?s effects. The primary outcome is between-group difference in the change in hemoglobin A1c values at 24 weeks. The secondary outcomes include other health measures, measurements of steps, measurements of other behavior changes, and assessments of app use. The trial began in January 2023 and is intended to be completed in December 2025. Results: As of September 5, 2023, we had recruited 44 patients. We expect the trial to be completed by October 8, 2025, with the follow-up observation period being completed by December 31, 2025. Conclusions: This trial will provide important evidence about the efficacy of an SCT-based mHealth intervention in improving physical activities and glycemic control in patients with T2D. If this study proves the intervention to be effective and safe, it could be a key step toward the integration of mHealth as part of the standard treatment received by patients with T2D in Japan. Trial Registration: Japan Registry of Clinical Trials (JRCT) jRCT2032220603; https://rctportal.niph.go.jp/en/detail?trial_id=jRCT2032220603 International Registered Report Identifier (IRRID): DERR1-10.2196/53514 UR - https://www.researchprotocols.org/2024/1/e53514 UR - http://dx.doi.org/10.2196/53514 UR - http://www.ncbi.nlm.nih.gov/pubmed/38393770 ID - info:doi/10.2196/53514 ER - TY - JOUR AU - Schmitz, Boris AU - Wirtz, Svenja AU - Sestayo-Fernández, Manuela AU - Schäfer, Hendrik AU - Douma, R. Emma AU - Alonso Vazquez, Marta AU - González-Salvado, Violeta AU - Habibovic, Mirela AU - Gatsios, Dimitris AU - Kop, Johan Willem AU - Peña-Gil, Carlos AU - Mooren, Frank PY - 2024/2/22 TI - Living Lab Data of Patient Needs and Expectations for eHealth-Based Cardiac Rehabilitation in Germany and Spain From the TIMELY Study: Cross-Sectional Analysis JO - J Med Internet Res SP - e53991 VL - 26 KW - eHealth KW - coronary artery disease KW - rehabilitation KW - mHealth KW - mobile health KW - mobile phone KW - app KW - apps KW - applications KW - personalized medicine KW - patient empowerment KW - living lab KW - coronary KW - cardiac KW - cardiology KW - heart KW - telehealth KW - telemedicine KW - monitoring KW - survey KW - surveys KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - technology use KW - usage N2 - Background: The use of eHealth technology in cardiac rehabilitation (CR) is a promising approach to enhance patient outcomes since adherence to healthy lifestyles and risk factor management during phase III CR maintenance is often poorly supported. However, patients? needs and expectations have not been extensively analyzed to inform the design of such eHealth solutions. Objective: The goal of this study was to provide a detailed patient perspective on the most important functionalities to include in an eHealth solution to assist them in phase III CR maintenance. Methods: A guided survey as part of a Living Lab approach was conducted in Germany (n=49) and Spain (n=30) involving women (16/79, 20%) and men (63/79, 80%) with coronary artery disease (mean age 57 years, SD 9 years) participating in a structured center-based CR program. The survey covered patients? perceived importance of different CR components in general, current usage of technology/technical devices, and helpfulness of the potential features of eHealth in CR. Questionnaires were used to identify personality traits (psychological flexibility, optimism/pessimism, positive/negative affect), potentially predisposing patients to acceptance of an app/monitoring devices. Results: All the patients in this study owned a smartphone, while 30%-40% used smartwatches and fitness trackers. Patients expressed the need for an eHealth platform that is user-friendly, personalized, and easily accessible, and 71% (56/79) of the patients believed that technology could help them to maintain health goals after CR. Among the offered components, support for regular physical exercise, including updated schedules and progress documentation, was rated the highest. In addition, patients rated the availability of information on diagnosis, current medication, test results, and risk scores as (very) useful. Of note, for each item, except smoking cessation, 35%-50% of the patients indicated a high need for support to achieve their long-term health goals, suggesting the need for individualized care. No major differences were detected between Spanish and German patients (all P>.05) and only younger age (P=.03) but not sex, education level, or personality traits (all P>.05) were associated with the acceptance of eHealth components. Conclusions: The patient perspectives collected in this study indicate high acceptance of personalized user-friendly eHealth platforms with remote monitoring to improve adherence to healthy lifestyles among patients with coronary artery disease during phase III CR maintenance. The identified patient needs comprise support in physical exercise, including regular updates on personalized training recommendations. Availability of diagnoses, laboratory results, and medications, as part of a mobile electronic health record were also rated as very useful. Trial Registration: ClinicalTrials.gov NCT05461729; https://clinicaltrials.gov/study/NCT05461729 UR - https://www.jmir.org/2024/1/e53991 UR - http://dx.doi.org/10.2196/53991 UR - http://www.ncbi.nlm.nih.gov/pubmed/38386376 ID - info:doi/10.2196/53991 ER - TY - JOUR AU - Gheisari, Mehdi AU - Ghaderzadeh, Mustafa AU - Li, Huxiong AU - Taami, Tania AU - Fernández-Campusano, Christian AU - Sadeghsalehi, Hamidreza AU - Afzaal Abbasi, Aaqif PY - 2024/2/22 TI - Mobile Apps for COVID-19 Detection and Diagnosis for Future Pandemic Control: Multidimensional Systematic Review JO - JMIR Mhealth Uhealth SP - e44406 VL - 12 KW - COVID-19 KW - detection KW - diagnosis KW - internet of things KW - cloud computing KW - mobile applications KW - mobile app KW - mobile apps KW - artificial intelligence: AI KW - mobile phone KW - smartphone N2 - Background: In the modern world, mobile apps are essential for human advancement, and pandemic control is no exception. The use of mobile apps and technology for the detection and diagnosis of COVID-19 has been the subject of numerous investigations, although no thorough analysis of COVID-19 pandemic prevention has been conducted using mobile apps, creating a gap. Objective: With the intention of helping software companies and clinical researchers, this study provides comprehensive information regarding the different fields in which mobile apps were used to diagnose COVID-19 during the pandemic. Methods: In this systematic review, 535 studies were found after searching 5 major research databases (ScienceDirect, Scopus, PubMed, Web of Science, and IEEE). Of these, only 42 (7.9%) studies concerned with diagnosing and detecting COVID-19 were chosen after applying inclusion and exclusion criteria using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. Results: Mobile apps were categorized into 6 areas based on the content of these 42 studies: contact tracing, data gathering, data visualization, artificial intelligence (AI)?based diagnosis, rule- and guideline-based diagnosis, and data transformation. Patients with COVID-19 were identified via mobile apps using a variety of clinical, geographic, demographic, radiological, serological, and laboratory data. Most studies concentrated on using AI methods to identify people who might have COVID-19. Additionally, symptoms, cough sounds, and radiological images were used more frequently compared to other data types. Deep learning techniques, such as convolutional neural networks, performed comparatively better in the processing of health care data than other types of AI techniques, which improved the diagnosis of COVID-19. Conclusions: Mobile apps could soon play a significant role as a powerful tool for data collection, epidemic health data analysis, and the early identification of suspected cases. These technologies can work with the internet of things, cloud storage, 5th-generation technology, and cloud computing. Processing pipelines can be moved to mobile device processing cores using new deep learning methods, such as lightweight neural networks. In the event of future pandemics, mobile apps will play a critical role in rapid diagnosis using various image data and clinical symptoms. Consequently, the rapid diagnosis of these diseases can improve the management of their effects and obtain excellent results in treating patients. UR - https://mhealth.jmir.org/2024/1/e44406 UR - http://dx.doi.org/10.2196/44406 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231538 ID - info:doi/10.2196/44406 ER - TY - JOUR AU - Haverinen, Jari AU - Harju, Terttu AU - Mikkonen, Hanna AU - Liljamo, Pia AU - Turpeinen, Miia AU - Reponen, Jarmo PY - 2024/2/22 TI - Digital Care Pathway for Patients With Sleep Apnea in Specialized Care: Mixed Methods Study JO - JMIR Hum Factors SP - e47809 VL - 11 KW - health services KW - telehealth KW - telemedicine KW - health personnel KW - sleep apnea syndromes KW - mobile phone N2 - Background: Sleep apnea is a significant public health disorder in Finland, with a prevalence of 3.7%. Continuous positive airway pressure (CPAP) therapy is the first-line treatment for moderate or severe sleep apnea. From November 18, 2019, all patients who started their CPAP therapy at Oulu University Hospital were attached to a sleep apnea digital care pathway (SA-DCP) and were instructed on its use. Some patients still did not use the SA-DCP although they had started their CPAP therapy. Objective: We aimed to study health care professionals? (HCPs?) perspectives on the SA-DCP and its usefulness for their work; whether the main targets of SA-DCP can be reached: shortening the initial guiding sessions of CPAP therapy, reducing patient calls and contact with HCPs, and improving patients? adherence to CPAP therapy; and patients? perspectives on the SA-DCP and its usefulness to them. Methods: Overall, 6 HCPs were interviewed in May and June 2021. The survey for SA-DCP users (58/91, 64%) and SA-DCP nonusers (33/91, 36%) was conducted in 2 phases: from May to August 2021 and January to June 2022. CPAP device remote monitoring data were collected from SA-DCP users (80/170, 47.1%) and SA-DCP nonusers (90/170, 52.9%) in May 2021. The registered phone call data were collected during 2019, 2020, and 2021. Feedback on the SA-DCP was collected from 446 patients between February and March 2022. Results: According to HCPs, introducing the SA-DCP had not yet significantly improved their workload and work practices, but it had brought more flexibility in some communication situations. A larger proportion of SA-DCP users familiarized themselves with prior information about CPAP therapy before the initial guiding session than nonusers (43/58, 74% vs 16/33, 49%; P=.02). Some patients still had not received prior information about CPAP therapy; therefore, most of the sessions were carried out according to their needs. According to the patient survey and remote monitoring data of CPAP devices, adherence to CPAP therapy was high for both SA-DCP users and nonusers. The number of patients? phone calls to HCPs did not decrease during the study. SA-DCP users perceived their abilities to use information and communications technology to be better than nonusers (mean 4.2, SD 0.8 vs mean 3.2, SD 1.2; P<.001). Conclusions: According to this study, not all the goals set for the introduction of the SA-DCP have been achieved. Despite using the SA-DCP, some patients still wanted to communicate with HCPs by phone. The most significant factors explaining the nonuse of the SA-DCP were lower digital literacy and older age of the patients. In the future, more attention should be paid to these user groups when designing and introducing upcoming digital care pathways. UR - https://humanfactors.jmir.org/2024/1/e47809 UR - http://dx.doi.org/10.2196/47809 UR - http://www.ncbi.nlm.nih.gov/pubmed/38386368 ID - info:doi/10.2196/47809 ER - TY - JOUR AU - Agarwal, K. Anish AU - Gonzales, Rachel AU - Scott, Kevin AU - Merchant, Raina PY - 2024/2/22 TI - Investigating the Feasibility of Using a Wearable Device to Measure Physiologic Health Data in Emergency Nurses and Residents: Observational Cohort Study JO - JMIR Form Res SP - e51569 VL - 8 KW - digital health KW - emergency medicine training KW - wearable devices KW - burnout KW - mobile health KW - feasibility KW - wearable device KW - wearable KW - physiologic health data KW - nurse KW - resident KW - emergency department KW - acceptability KW - well-being N2 - Background: Emergency departments play a pivotal role in the US health care system, with high use rates and inherent stress placed on patients, patient care, and clinicians. The impact of the emergency department environment on the health and well-being of emergency residents and nurses can be seen in worsening rates of burnout and cardiovascular health. Research on clinician health has historically been completed outside of clinical areas and not personalized to the individual. The expansion of digital technology, specifically wearable devices, may enhance the ability to understand how health care environments impact clinicians. Objective: The primary objective of this pilot study was to assess the feasibility and acceptability of using wearable devices to measure and record physiologic data from emergency nurses and resident physicians. Understanding strategies that are accepted and used by clinicians is critical prior to launching larger investigations aimed at improving outcomes. Methods: This was a longitudinal pilot study conducted at an academic, urban, level 1 trauma center. A total of 20 participants, including emergency medicine resident physicians and nurses, were equipped with a wearable device (WHOOP band) and access to a mobile health platform for 6 weeks. Baseline surveys assessed burnout, mental health, and expectations of the device and experience. Participants provided open-ended feedback on the device and platform, contributing to the assessment of acceptance, adoption, and use of the wearable device. Secondary measures explored early signs and variations in heart rate variability, sleep, recovery, burnout, and mental health assessments. Results: Of the 20 participants, 10 consistently used the wearable device. Feedback highlighted varying experiences with the device, with a preference for more common wearables like the Apple Watch or Fitbit. Resident physicians demonstrated higher engagement with the device and platform as compared with nurses. Baseline mental health assessments indicated mild anxiety and depressive symptoms among participants. The Professional Fulfillment Index revealed low professional fulfillment, moderate workplace exhaustion, and interpersonal disengagement. Conclusions: This pilot study underscores the potential of wearable devices in monitoring emergency clinicians? physiologic data but reveals challenges related to device preferences and engagement. The key takeaway is the necessity to optimize device and platform design for clinician use. Larger, randomized trials are recommended to further explore and refine strategies for leveraging wearable technology to support the well-being of the emergency workforce. UR - https://formative.jmir.org/2024/1/e51569 UR - http://dx.doi.org/10.2196/51569 UR - http://www.ncbi.nlm.nih.gov/pubmed/38386373 ID - info:doi/10.2196/51569 ER - TY - JOUR AU - Jiang, Shan AU - Ng, Y. Johan Y. AU - Chong, Hau Kar AU - Peng, Bo AU - Ha, S. Amy PY - 2024/2/21 TI - Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e52905 VL - 26 KW - preschooler KW - movement behaviors KW - eHealth KW - physical activity KW - sedentary behavior KW - sleep KW - mobile phone KW - review KW - systematic review N2 - Background: The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers. Objective: This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness. Methods: We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. Results: Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=?0.15, 95% CI ?0.27 to ?0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as ?moderate? for moderate to vigorous intensity PA and sedentary time outcomes and ?low? for sleep outcomes. Conclusions: eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions. Trial Registration: PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3 UR - https://www.jmir.org/2024/1/e52905 UR - http://dx.doi.org/10.2196/52905 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381514 ID - info:doi/10.2196/52905 ER - TY - JOUR AU - Chang, Jinghui AU - Mai, Yanshan AU - Zhang, Dayi AU - Yang, Xixi AU - Li, Anqi AU - Yan, Wende AU - Wu, Yibo AU - Chen, Jiangyun PY - 2024/2/19 TI - Media Use Behavior Mediates the Association Between Family Health and Intention to Use Mobile Health Devices Among Older Adults: Cross-Sectional Study JO - J Med Internet Res SP - e50012 VL - 26 KW - older adults KW - family health KW - media use KW - intention to use mobile health devices KW - China N2 - Background: With the advent of a new era for health and medical treatment, characterized by the integration of mobile technology, a significant digital divide has surfaced, particularly in the engagement of older individuals with mobile health (mHealth). The health of a family is intricately connected to the well-being of its members, and the use of media plays a crucial role in facilitating mHealth care. Therefore, it is important to examine the mediating role of media use behavior in the connection between the family health of older individuals and their inclination to use mHealth devices. Objective: This study aims to investigate the impact of family health and media use behavior on the intention of older individuals to use mHealth devices in China. The study aims to delve into the intricate dynamics to determine whether media use behavior serves as a mediator in the relationship between family health and the intention to use mHealth devices among older adults. The ultimate goal is to offer well-founded and practical recommendations to assist older individuals in overcoming the digital divide. Methods: The study used data from 3712 individuals aged 60 and above, sourced from the 2022 Psychology and Behavior Investigation of Chinese Residents study. Linear regression models were used to assess the relationships between family health, media use behavior, and the intention to use mHealth devices. To investigate the mediating role of media use behavior, we used the Sobel-Goodman Mediation Test. This analysis focused on the connection between 4 dimensions of family health and the intention to use mHealth devices. Results: A positive correlation was observed among family health, media use behavior, and the intention to use mHealth devices (r=0.077-0.178, P<.001). Notably, media use behavior was identified as a partial mediator in the relationship between the overall score of family health and the intention to use mHealth devices, as indicated by the Sobel test (z=5.451, P<.001). Subgroup analysis further indicated that a complete mediating effect was observed specifically between family health resources and the intention to use mHealth devices in older individuals with varying education levels. Conclusions: The study revealed the significance of family health and media use behavior in motivating older adults to adopt mHealth devices. Media use behavior was identified as a mediator in the connection between family health and the intention to use mHealth devices, with more intricate dynamics observed among older adults with lower education levels. Going forward, the critical role of home health resources must be maximized, such as initiatives to develop digital education tailored for older adults and the creation of media products specifically designed for them. These measures aim to alleviate technological challenges associated with using media devices among older adults, ultimately bolstering their inclination to adopt mHealth devices. UR - https://www.jmir.org/2024/1/e50012 UR - http://dx.doi.org/10.2196/50012 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373031 ID - info:doi/10.2196/50012 ER - TY - JOUR AU - Haack, M. Lauren AU - Armstrong, C. Courtney AU - Travis, Kate AU - Aguilera, Adrian AU - Darrow, M. Sabrina PY - 2024/2/19 TI - HealthySMS Text Messaging System Adjunct to Adolescent Group Cognitive Behavioral Therapy in the Context of COVID-19 (Let?s Text!): Pilot Feasibility and Acceptability Study JO - JMIR Ment Health SP - e49317 VL - 11 KW - depression KW - adolescents KW - evidence-based intervention KW - texting KW - SMS text message KW - cognitive behavioral therapy KW - CBT KW - group CBT KW - shelter-in-place KW - COVID-19 KW - mobile health KW - mHealth KW - therapy KW - cognitive KW - behavior KW - web-based therapy KW - e-therapy KW - youth KW - young adults KW - mobile phone N2 - Background: The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants? texts. Objective: This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system?s impact on adolescents? group CBT engagement and, ultimately, depression outcomes. Methods: Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system. Results: All (n=17, 100%) research participants invited agreed to receive HealthySMS messages, and 94% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement. Conclusions: Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants? qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research. UR - https://mental.jmir.org/2024/1/e49317 UR - http://dx.doi.org/10.2196/49317 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373030 ID - info:doi/10.2196/49317 ER - TY - JOUR AU - Toma, Marian-Vladut AU - Turcu, Elena Cristina AU - Turcu, Octavian Corneliu AU - Vlad, Sorin AU - Tiliute, Eugen Doru AU - Pascu, Paul PY - 2024/2/19 TI - Extended Reality?Based Mobile App Solutions for the Therapy of Children With Autism Spectrum Disorders: Systematic Literature Review JO - JMIR Serious Games SP - e49906 VL - 12 KW - autism KW - autistic KW - autism spectrum disorder KW - ASD KW - virtual reality KW - augmented reality KW - extended reality KW - mixed reality KW - mobile app KW - children KW - preschool KW - mobile phone N2 - Background: The increasing prevalence of autism spectrum disorder (ASD) has driven research interest on the therapy of individuals with autism, especially children, as early diagnosis and appropriate treatment can lead to improvement in the condition. With the widespread availability of virtual reality, augmented reality (AR), and mixed reality technologies to the public and the increasing popularity of mobile devices, the interest in the use of applications and technologies to provide support for the therapy of children with autism is growing. Objective: This study aims to describe the literature on the potential of virtual reality, AR, and mixed reality technologies in the context of therapy for children with ASD. We propose to investigate and analyze the temporal distribution of relevant papers, identify the target audience for studies related to extended reality apps in ASD therapy, examine the technologies used in the development of these apps, assess the skills targeted for improvement in primary studies, explore the purposes of the proposed solutions, and summarize the results obtained from their application. Methods: For the systematic literature review, 6 research questions were defined in the first phase, after which 5 international databases (Web of Science, Scopus, ScienceDirect, IEEE Xplore Digital Library, and ACM Digital Library) were searched using specific search strings. Results were centralized, filtered, and processed applying eligibility criteria and using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The results were refined using a technical and IT-oriented approach. The quality criteria assessed whether the research addressed ASDs, focused on children?s therapy, involved targeted technologies, deployed solutions on mobile devices, and produced results relevant to our study. Results: In the first step, 179 publications were identified in Zotero reference manager software (Corporation for Digital Scholarship). After excluding articles that did not meet the eligibility or quality assessment criteria, 28 publications were finalized. The analysis revealed an increase in publications related to apps for children with autism starting in 2015 and peaking in 2019. Most studies (22/28, 79%) focused on mobile AR solutions for Android devices, which were developed using the Unity 3D platform and the Vuforia engine. Although 68% (19/28) of these apps were tested with children, 32% (9/28) were tested exclusively by developers. More than half (15/28, 54%) of the studies used interviews as an evaluation method, yielding mostly favorable although preliminary results, indicating the need for more extensive testing. Conclusions: The findings reported in the studies highlight the fact that these technologies are appropriate for the therapy of children with ASD. Several studies showed a distinct trend toward the use of AR technology as an educational tool for people with ASD. This trend entails multidisciplinary cooperation and an integrated research approach, with an emphasis on comprehensive empirical evaluations and technology ethics. UR - https://games.jmir.org/2024/1/e49906 UR - http://dx.doi.org/10.2196/49906 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373032 ID - info:doi/10.2196/49906 ER - TY - JOUR AU - Li, Zhaoying AU - Lei, Yating AU - Bui, Quoc AU - DePaul, Olivia AU - Nicol, E. Ginger AU - Mohr, C. David AU - Lee, I. Sunghoon AU - Fong, M. Mandy W. AU - Metts, L. Christopher AU - Tomazin, E. Stephanie AU - Wong, K. Alex W. PY - 2024/2/19 TI - A Digital Intervention to Promote Self-Management Self-Efficacy Among Community-Dwelling Individuals With Stroke: Pilot Randomized Controlled Trial JO - JMIR Rehabil Assist Technol SP - e50863 VL - 11 KW - digital intervention KW - feasibility KW - mobile health KW - participation KW - rehabilitation KW - self-efficacy KW - self-management KW - stroke KW - technology KW - telehealth KW - telemedicine KW - text messaging N2 - Background: Digital interventions provided through smartphones or the internet that are guided by a coach have been proposed as promising solutions to support the self-management of chronic conditions. However, digital intervention for poststroke self-management is limited; we developed the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention to address this gap. Objective: This study aimed to examine the feasibility and initial effects of the iSMART intervention to improve self-management self-efficacy in people with stroke. Methods: A parallel, 2-arm, nonblinded, randomized controlled trial of 12-week duration was conducted. A total of 24 participants with mild-to-moderate chronic stroke were randomized to receive either the iSMART intervention or a manual of stroke rehabilitation (attention control). iSMART was a coach-guided, technology-supported self-management intervention designed to support people managing chronic conditions and maintaining active participation in daily life after stroke. Feasibility measures included retention and engagement rates in the iSMART group. For both the iSMART intervention and active control groups, we used the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure to assess the feasibility, acceptability, and appropriateness, respectively. Health measures included the Participation Strategies Self-Efficacy Scale and the Patient-Reported Outcomes Measurement Information System?s Self-Efficacy for Managing Chronic Conditions. Results: The retention rate was 82% (9/11), and the engagement (SMS text message response) rate was 78% for the iSMART group. Mean scores of the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure were 4.11 (SD 0.61), 4.44 (SD 0.73), and 4.36 (SD 0.70), respectively, which exceeded our benchmark (4 out of 5), suggesting high feasibility, acceptability, and appropriateness of iSMART. The iSMART group showed moderate-to-large effects in improving self-efficacy in managing emotions (r=0.494), symptoms (r=0.514), daily activities (r=0.593), and treatments and medications (r=0.870), but the control group showed negligible-to-small effects in decreasing self-efficacy in managing emotions (r=0.252), symptoms (r=0.262), daily activities (r=0.136), and treatments and medications (r=0.049). In addition, the iSMART group showed moderate-to-large effects of increasing the use of participation strategies for management in the home (r=0.554), work (r=0.633), community (r=0.673), and communication activities (r=0.476). In contrast, the control group showed small-to-large effects of decreasing the use of participation strategies for management in the home (r=0.567), work (r=0.342, community (r=0.215), and communication activities (r=0.379). Conclusions: Our findings support the idea that iSMART was feasible to improve poststroke self-management self-efficacy. Our results also support using a low-cost solution, such as SMS text messaging, to supplement traditional therapeutic patient education interventions. Further evaluation with a larger sample of participants is still needed. Trial Registration: ClinicalTrials.gov 202004137; https://clinicaltrials.gov/study/NCT04743037?id=202004137&rank=1 UR - https://rehab.jmir.org/2024/1/e50863 UR - http://dx.doi.org/10.2196/50863 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373029 ID - info:doi/10.2196/50863 ER - TY - JOUR AU - Hovadick, Andrade Ana Carolina de AU - Cardoso, Augusto Marly PY - 2024/2/19 TI - Family-Based WhatsApp Intervention to Promote Healthy Eating Behaviors Among Amazonian School Children: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e54446 VL - 13 KW - child health KW - Amazon KW - dietary intake KW - mHealth KW - mobile health KW - multimedia messaging service KW - WhatsApp N2 - Background: Stunting and micronutrient deficiencies have persistently affected children in the Brazilian Amazon for decades. However, in recent years, a notable increase in childhood overweight prevalence has been observed, particularly in the context of heightened food insecurity exacerbated by the COVID-19 pandemic. Despite the limited number of effective solutions proposed to tackle this problem, digital interventions have shown great promise worldwide in preventing obesity and promoting healthy diets. Objective: This study aims to describe the protocol of a family-based WhatsApp intervention, specifically designed to investigate the efficacy of multimedia messaging in preventing excessive weight gain and improving healthy eating practices among school-aged children in the Amazon region. Methods: This study protocol outlines a theory-driven randomized controlled trial based on the cognitive theory of multimedia learning and the social cognitive theory. A total of 240 parents or caregivers of children enrolled in the Maternal and Child Health and Nutrition Cohort Study in Acre (MINA-Brazil) will be recruited by phone and social media. The intervention group will receive persuasive multimedia messages through WhatsApp over 19 weeks, while the waitlist control group will remain in the usual care. The primary outcome is a change in children?s BMI in z score. Secondary outcomes are changes in dietary intake and biochemical indicators of the children. Outcome measures will be assessed at baseline and 5 months after randomization in comparison to usual care. The analysis will use an intent-to-treat approach and will be conducted using the statistical package Stata (version 18.0), with a significance level set at P<.05. Paired and unpaired 2-tailed t tests will be applied to compare mean changes in the outcomes. Results: Data collection started in June 2023, and final measurements are scheduled to be completed in December 2023. The results of the main analysis are expected to be available in 2024. Conclusions: This innovative multimedia message intervention holds significant potential for fostering behavioral changes among Amazonian children. Trial Registration: Brazilian Clinical Trials Registry RBR-5zdnw6t; https://ensaiosclinicos.gov.br/rg/RBR-5zdnw6t International Registered Report Identifier (IRRID): DERR1-10.2196/54446 UR - https://www.researchprotocols.org/2024/1/e54446 UR - http://dx.doi.org/10.2196/54446 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373039 ID - info:doi/10.2196/54446 ER - TY - JOUR AU - Nizio, Pamella AU - Clausen, Bryce AU - Businelle, S. Michael AU - Ponton, Natalia AU - Jones, A. Ava AU - Redmond, Y. Brooke AU - Buckner, D. Julia AU - Obasi, M. Ezemenari AU - Zvolensky, J. Michael AU - Garey, Lorra PY - 2024/2/19 TI - Mobile Intervention to Address Cannabis Use Disorder Among Black Adults: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e52776 VL - 13 KW - cannabis use KW - false safety behaviors KW - mobile health, just-in-time adaptive interventions KW - Black or African American KW - mobile phone KW - African American KW - Black KW - cannabis KW - adults KW - adult KW - Hispanic KW - Latin KW - adaptive intervention KW - cannabis reduction KW - cessation KW - ecological momentary assessments N2 - Background: African American or Black (hereafter referred to as Black) adults who use cannabis use it more frequently and are more likely to meet criteria for cannabis use disorder (CUD) than both White and Hispanic or Latin individuals. Black adults may be more apt to use cannabis to cope with distress, which constitutes a false safety behavior (FSB; a behavior designed to reduce psychological distress in the short term). Although FSB engagement can perpetuate the cycle of high rates of CUD among Black individuals, limited work has applied an FSB elimination treatment approach to Black adults with CUD, and no previous work has evaluated FSB reduction or elimination in the context of a culturally tailored and highly accessible treatment developed for Black individuals. Objective: This study aims to develop and pilot-test a culturally tailored adaptive intervention that integrates FSB reduction or elimination skills for cannabis reduction or cessation among Black adults with probable CUD (Culturally Tailored-Mobile Integrated Cannabis and Anxiety Reduction Treatment [CT-MICART]). Methods: Black adults with probable CUD (N=50) will complete a web-based screener, enrollment call, baseline assessment, 3 daily ecological momentary assessments (EMAs) for 6 weeks, and a follow-up self-report assessment and qualitative interview at 6 weeks after randomization. Participants will be randomized into 1 out of the 2 conditions after baseline assessment: (1) CT-MICART+EMAs for 6 weeks or (2) EMAs only for 6 weeks. Results: The enrollment started in June 2023 and ended in November 2023. Data analysis will be completed in March 2024. Conclusions: No culturally tailored, evidence-based treatment currently caters to the specific needs of Black individuals with CUD. This study will lay the foundation for a new approach to CUD treatment among Black adults that is easily accessible and has the potential to overcome barriers to treatment and reduce practitioner burden in order to support Black individuals who use cannabis with probable CUD. Trial Registration: ClinicalTrials.gov NCT05566730; https://clinicaltrials.gov/study/NCT05566730 International Registered Report Identifier (IRRID): DERR1-10.2196/52776 UR - https://www.researchprotocols.org/2024/1/e52776 UR - http://dx.doi.org/10.2196/52776 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373037 ID - info:doi/10.2196/52776 ER - TY - JOUR AU - Peterson, E. Neil AU - Thomas, Michael AU - Hunsaker, Stacie AU - Stewart, Tevin AU - Collett, J. Claire PY - 2024/2/16 TI - mHealth Gratitude Exercise Mindfulness App for Resiliency Among Neonatal Intensive Care Unit Staff: Three-Arm Pretest-Posttest Interventional Study JO - JMIR Nursing SP - e54561 VL - 7 KW - burnout KW - compassion fatigue KW - compassion satisfaction KW - secondary trauma KW - trauma KW - satisfaction KW - compassion KW - gratitude KW - resilience KW - quality of life KW - QoL KW - mindfulness KW - meditation KW - exercise KW - happiness KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - neonatal intensive care unit KW - NICU KW - intensive care unit KW - ICU KW - intensive care KW - nurse KW - nurses KW - nursing KW - health care worker KW - health care workers KW - provider KW - providers KW - phone app KW - physical activity KW - resiliency KW - mobile phone N2 - Background: Health care is highly complex and can be both emotionally and physically challenging. This can lead health care workers to develop compassion fatigue and burnout (BO), which can negatively affect their well-being and patient care. Higher levels of resilience can potentially prevent compassion fatigue and BO. Strategies that enhance resilience include gratitude, exercise, and mindfulness. Objective: The purpose of this study was to determine if a 3-week daily resiliency practice, prompted via a gratitude, exercise, and mindfulness smartphone app, impacted the professional quality of life, physical activity, and happiness level of health care workers in a newborn intensive care unit setting. Methods: In total, 65 participants from a level III newborn intensive care unit at a regional hospital in the western United States completed this study. The Professional Quality of Life Scale, Physical Activity Vital Sign, and Subjective Happiness Score instruments were used to evaluate the effects of the mobile health (mHealth) intervention. Further, 2-tailed dependent paired t tests were used to evaluate participant pre- and postintervention instrument scores. Multiple imputation was used to predict scores of participants who practiced an intervention but did not complete the 3 instruments post intervention. Results: Dependent t tests using the original data showed that participants, as a whole, significantly improved in BO (t35=2.30, P=.03), secondary trauma stress (STS; t35=2.11, P=.04), and happiness (t35=?3.72, P<.001) scores. Compassion satisfaction (CS; t35=?1.94, P=.06) and exercise (t35=?1.71, P=.10) were trending toward, but did not reach, significance. Using the original data, only the gratitude intervention group experienced significant improvements (CS, BO, and happiness), likely due to the higher number of participants in this group. Analysis using imputed data showed that participants, as a whole, had significant improvements in all areas: CS (t64=?4.08, P<.001), BO (t64=3.39, P=.001), STS (t64=4.08, P<.001), exercise (t64=?3.19, P=.002), and happiness (t64=?3.99, P<.001). Looking at the intervention groups separately using imputed data, the gratitude group had significant improvements in CS, BO, STS, and happiness; the exercise group had significant improvements in STS and exercise; and the mindfulness group had significant improvements in CS and happiness. Conclusions: Phone app delivery of resilience-enhancing interventions is a potentially effective intervention model for health care workers. Potential barriers to mHealth strategies are the technical issues that can occur with this type of intervention. Additional longitudinal and experimental studies with larger sample sizes need to be completed to better evaluate this modality. UR - https://nursing.jmir.org/2024/1/e54561 UR - http://dx.doi.org/10.2196/54561 UR - http://www.ncbi.nlm.nih.gov/pubmed/38363595 ID - info:doi/10.2196/54561 ER - TY - JOUR AU - Lyzwinski, Lynnette AU - Elgendi, Mohamed AU - Menon, Carlo PY - 2024/2/15 TI - Innovative Approaches to Menstruation and Fertility Tracking Using Wearable Reproductive Health Technology: Systematic Review JO - J Med Internet Res SP - e45139 VL - 26 KW - fertility cycle KW - fertility monitoring KW - ovulation KW - menstruation KW - wearable devices KW - mHealth KW - reproductive health KW - wearable KW - fertility KW - menstrual KW - women?s health KW - ovulate KW - sexual health KW - scoping KW - review method N2 - Background: Emerging digital health technology has moved into the reproductive health market for female individuals. In the past, mobile health apps have been used to monitor the menstrual cycle using manual entry. New technological trends involve the use of wearable devices to track fertility by assessing physiological changes such as temperature, heart rate, and respiratory rate. Objective: The primary aims of this study are to review the types of wearables that have been developed and evaluated for menstrual cycle tracking and to examine whether they may detect changes in the menstrual cycle in female individuals. Another aim is to review whether these devices are effective for tracking various stages in the menstrual cycle including ovulation and menstruation. Finally, the secondary aim is to assess whether the studies have validated their findings by reporting accuracy and sensitivity. Methods: A review of PubMed or MEDLINE was undertaken to evaluate wearable devices for their effectiveness in predicting fertility and differentiating between the different stages of the menstrual cycle. Results: Fertility cycle?tracking wearables include devices that can be worn on the wrists, on the fingers, intravaginally, and inside the ear. Wearable devices hold promise for predicting different stages of the menstrual cycle including the fertile window and may be used by female individuals as part of their reproductive health. Most devices had high accuracy for detecting fertility and were able to differentiate between the luteal phase (early and late), fertile window, and menstruation by assessing changes in heart rate, heart rate variability, temperature, and respiratory rate. Conclusions: More research is needed to evaluate consumer perspectives on reproductive technology for monitoring fertility, and ethical issues around the privacy of digital data need to be addressed. Additionally, there is also a need for more studies to validate and confirm this research, given its scarcity, especially in relation to changes in respiratory rate as a proxy for reproductive cycle staging. UR - https://www.jmir.org/2024/1/e45139 UR - http://dx.doi.org/10.2196/45139 UR - http://www.ncbi.nlm.nih.gov/pubmed/38358798 ID - info:doi/10.2196/45139 ER - TY - JOUR AU - Lund-Jacobsen, Trine AU - Schwarz, Peter AU - Martino, Gabriella AU - Pappot, Helle AU - Piil, Karin PY - 2024/2/15 TI - Development of an App for Symptom Management in Women With Breast Cancer Receiving Maintenance Aromatase Inhibitors: Protocol for a Mixed Methods Feasibility Study JO - JMIR Res Protoc SP - e49549 VL - 13 KW - acceptability KW - aromatase inhibitors KW - breast cancer KW - cancer KW - chemotherapy KW - disease KW - feasibility KW - inhibitor KW - management KW - mHealth KW - postmenopausal KW - psychosocial KW - QoL KW - quality of life KW - radiation therapy KW - symptom management KW - symptom KW - tool KW - treatment KW - usability KW - user-friendliness N2 - Background: Patients with postmenopausal nonmetastatic estrogen receptor?positive breast cancer often experience a reduced quality of life after primary treatment. The disease and treatment trajectory consists of surgery followed by chemotherapy or radiation therapy. Upon this, maintenance hormone therapy with an aromatase inhibitor can result in several physical and psychosocial symptoms. Optimal symptom control during maintenance therapy is central to maintaining the patient?s quality of life. Objective: This study aims to (1) develop an electronic symptom management tool for patients with postmenopausal early breast cancer receiving maintenance aromatase inhibitors with an endocrine aspect and (2) assess the feasibility, acceptability, and usability of the pilot version of the Bone@BC app. Furthermore, longitudinally, symptom prevalence and quality of life for patients with postmenopausal nonmetastatic estrogen receptor?positive breast cancer will be explored. Methods: This study follows a multistage research plan. In stage 1, a systematic literature review to establish an overview of aromatase inhibitor?related symptoms reported by postmenopausal women with nonmetastatic estrogen receptor?positive breast cancer will be completed. In stage 2, a comprehensive overview of symptoms related to aromatase inhibitors (letrozole, exemestane, and anastrozole) will be performed (eg, by reviewing medical leaflets and guidelines). In stage 3, an electronic app with a user-friendly Patient Concern Inventory list to comprise symptoms and concerns will be developed. Last, in stage 4, a convergent mixed methods feasibility study of the pilot version of the Bone@BC app will be conducted. A total of 45 patients with postmenopausal nonmetastatic estrogen receptor?positive breast cancer will use the app daily for symptom identification and respond to 6 serial patient-reported outcome measurements for 12 weeks. Finally, semistructured interviews will be performed. The primary outcome includes consent rate, attrition rate, retention rates, technical issues, and adherence, assessed using preestablished criteria on feasibility and a mixed methods approach for exploring acceptability. A patient advisory board consisting of 5 women with breast cancer is recruited to include their perspectives and experiences in the planning, organization, implementation, and dissemination of the research throughout the project. Results: At the time of submitting this paper (January 2024), a total of 23 patients have been included in the stage 2 medical audit over the recruitment period of 3 months (November 2022 to February 2023), and 19 patients have been enrolled in stage 2, the semistructured patient interviews. Conclusions: This protocol describes a study investigating the feasibility, acceptability, and usability of the symptom management tool Bone@BC developed for patients with breast cancer with an endocrine aspect. Trial Registration: ClinicalTrails.gov NCT05367830; https://clinicaltrials.gov/ct2/show/NCT05367830 International Registered Report Identifier (IRRID): DERR1-10.2196/49549 UR - https://www.researchprotocols.org/2024/1/e49549 UR - http://dx.doi.org/10.2196/49549 UR - http://www.ncbi.nlm.nih.gov/pubmed/38358787 ID - info:doi/10.2196/49549 ER - TY - JOUR AU - Yordanov, Stefan AU - Akhter, Kalsoom AU - Quan Teh, Jye AU - Naushahi, Jawad AU - Jalloh, Ibrahim PY - 2024/2/14 TI - Measurement of Head Circumference Using a Smartphone: Feasibility Cohort Study JO - JMIR Form Res SP - e54194 VL - 8 KW - head circumference KW - HC KW - hydrocephalus KW - neurosurgery KW - pediatric neurosurgery KW - paediatric neurosurgery KW - neurology KW - neuro KW - neurosurgeon KW - neurologist KW - mobile health KW - mHealth KW - app KW - apps KW - application KW - applications KW - digital health KW - smartphone KW - smartphones KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - infant KW - infants KW - infancy KW - baby KW - babies KW - neonate KW - neonates KW - neonatal KW - toddler KW - toddlers KW - child KW - children N2 - Background: Accurate head circumference (HC) measurement is essential when assessing neonates and infants. Tape measure HC measurements are prone to errors, particularly when performed by parents/guardians, due to individual differences in head shape, hair style and texture, subject cooperation, and examiner techniques, including tape measure placement and tautness. There is, therefore, the need for a more reliable method. Objective: The primary objective of this study was to evaluate the validity, reliability, and consistency of HC app measurement compared to the current standard of practice, serving as a proof-of-concept for use by health care professionals. Methods: We recruited infants attending the neurosurgery clinic, and parents/guardians were approached and consented to participate in the study. Along with the standard head circumference measurement, measurements were taken with the head circumference app (HC app) developed in-house, and we also collected baseline medical history and characteristics. For the statistical analysis, we used RStudio (version 4.1.1). In summary, we analyzed covariance and intraclass correlation coefficient (ICC) to compare the measurement's within-rater and interrater reliability. The F test was used to analyze the variance between measurements and the Bland-Altman agreement, t test, and correlation coefficients were used to compare the tape measurement to the measures taken by the HC app. We also used nonvalidated questionnaires to explore parental or guardians? experiences, assess their views on app utility, and collect feedback. Results: The total number of recruited patients was 37. Comparison between the app measurements and the measurements with a tape measure showed poor reliability (ICC=0.177) and wide within-app variations (ICC=0.341). The agreement between the measurements done by parents/guardians and the tape measurements done by the researcher was good (ICC=0.901). Parental/guardian feedback was overall very positive, with most of the parents/guardians reporting that the app was easy to use (n=31, 84%) and that they are happy to use the app in an unsupervised setting, provided that they are assured of the measurement quality. Conclusions: We developed this project as a proof-of-concept study, and as such, the app has shown great potential to be used both in a clinical setting and by parents/guardians in their own homes. UR - https://formative.jmir.org/2024/1/e54194 UR - http://dx.doi.org/10.2196/54194 UR - http://www.ncbi.nlm.nih.gov/pubmed/38354022 ID - info:doi/10.2196/54194 ER - TY - JOUR AU - Kormanis, Aryn AU - Quinones, Selina AU - Obermiller, Corey AU - Denizard-Thompson, Nancy AU - Palakshappa, Deepak PY - 2024/2/13 TI - Feasibility of Using Text Messaging to Identify and Assist Patients With Hypertension With Health-Related Social Needs: Cross-Sectional Study JO - JMIR Cardio SP - e54530 VL - 8 KW - social determinants of health KW - health-related social needs KW - mobile health KW - health information technology KW - feasibility KW - mobile phone KW - SMS text messaging KW - message KW - pilot study KW - patients KW - patient KW - hypertension KW - screening N2 - Background: Health-related social needs are associated with poor health outcomes, increased acute health care use, and impaired chronic disease management. Given these negative outcomes, an increasing number of national health care organizations have recommended that the health system screen and address unmet health-related social needs as a routine part of clinical care, but there are limited data on how to implement social needs screening in clinical settings to improve the management of chronic diseases such as hypertension. SMS text messaging could be an effective and efficient approach to screen patients; however, there are limited data on the feasibility of using it. Objective: We conducted a cross-sectional study of patients with hypertension to determine the feasibility of using SMS text messaging to screen patients for unmet health-related social needs. Methods: We randomly selected 200 patients (?18 years) from 1 academic health system. Patients were included if they were seen at one of 17 primary care clinics that were part of the academic health system and located in Forsyth County, North Carolina. We limited the sample to patients seen in one of these clinics to provide tailored information about local community-based resources. To ensure that the participants were still patients within the clinic, we only included those who had a visit in the previous 3 months. The SMS text message included a link to 6 questions regarding food, housing, and transportation. Patients who screened positive and were interested received a subsequent message with information about local resources. We assessed the proportion of patients who completed the questions. We also evaluated for the differences in the demographics between patients who completed the questions and those who did not using bivariate analyses. Results: Of the 200 patients, the majority were female (n=109, 54.5%), non-Hispanic White (n=114, 57.0%), and received commercial insurance (n=105, 52.5%). There were no significant differences in demographics between the 4446 patients who were eligible and the 200 randomly selected patients. Of the 200 patients included, the SMS text message was unable to be delivered to 9 (4.5%) patients and 17 (8.5%) completed the social needs questionnaire. We did not observe a significant difference in the demographic characteristics of patients who did versus did not complete the questionnaire. Of the 17, a total of 5 (29.4%) reported at least 1 unmet need, but only 2 chose to receive resource information. Conclusions: We found that only 8.5% (n=17) of patients completed a SMS text message?based health-related social needs questionnaire. SMS text messaging may not be feasible as a single modality to screen patients in this population. Future research should evaluate if SMS text message?based social needs screening is feasible in other populations or effective when paired with other screening modalities. UR - https://cardio.jmir.org/2024/1/e54530 UR - http://dx.doi.org/10.2196/54530 UR - http://www.ncbi.nlm.nih.gov/pubmed/38349714 ID - info:doi/10.2196/54530 ER - TY - JOUR AU - Gagnon, Julie AU - Probst, Sebastian AU - Chartrand, Julie AU - Lalonde, Michelle PY - 2024/2/13 TI - mHealth App Usability Questionnaire for Stand-Alone mHealth Apps Used by Health Care Providers: Canadian French Translation, Cross-Cultural Adaptation, and Validation (Part 1) JO - JMIR Form Res SP - e50839 VL - 8 KW - cross-cultural adaptation KW - French language KW - mHealth App Usability Questionnaire KW - MAUQ KW - mobile health KW - mHealth KW - mobile app KW - questionnaire translation KW - usability KW - validation KW - health care providers KW - French translation N2 - Background: An increasing number of health care professionals are using mobile apps. The mHealth App Usability Questionnaire (MAUQ) was designed to evaluate the usability of mobile health apps by patients and providers. However, this questionnaire is not available in French. Objective: This study aims to translate (from English to Canadian French), cross-culturally adapt, and initiate the validation of the original version of MAUQ for stand-alone mobile health apps used by French-speaking health care providers. Methods: A cross-cultural research study using a well-established method was conducted to translate MAUQ to Canadian French by certified translators and subsequently review it with a translation committee. It was then back translated to English. The back translations were compared with the original by the members of the committee to reach consensus regarding the prefinal version. A pilot test of the prefinal version was conducted with a sample of 49 potential users and 10 experts for content validation. Results: The statements are considered clear, with interrater agreement of 99.14% among potential users and 90% among experts. Of 21 statements, 5 (24%) did not exceed the 80% interrater agreement of the experts regarding clarity. Following the revisions, interrater agreement exceeded 80%. The content validity index of the items varied from 0.90 to 1, and the overall content validity index was 0.981. Individual Fleiss multirater ? of each item was between 0.89 and 1, showing excellent agreement and increasing confidence in the questionnaire?s content validity. Conclusions: This process of translation and cultural adaptation produced a new version of MAUQ that was validated for later use among the Canadian French?speaking population. An upcoming separate study will investigate the psychometric properties of the adapted questionnaire. UR - https://formative.jmir.org/2024/1/e50839 UR - http://dx.doi.org/10.2196/50839 UR - http://www.ncbi.nlm.nih.gov/pubmed/38349710 ID - info:doi/10.2196/50839 ER - TY - JOUR AU - Meherali, Salima AU - Bhaumik, Soumyadeep AU - Idrees, Sobia AU - Kennedy, Megan AU - Lassi, S. Zohra PY - 2024/2/13 TI - Digital Knowledge Translation Tools for Disseminating Sexual and Reproductive Health Information to Adolescents: Protocol for an Evidence Gap Map Review JO - JMIR Res Protoc SP - e55081 VL - 13 KW - adolescents KW - sexual and reproductive health KW - digital tools KW - knowledge translation KW - mobile phone N2 - Background: Digital or eHealth knowledge translation (KT) interventions have been identified as useful public health tools, particularly to advance sexual and reproductive health (SRH) among adolescents. Existing literature reviews on digital health interventions for adolescents? SRH demonstrate limitations, including shortcomings in reporting and comprehensiveness that limit the utility and trustworthiness of findings. However, there is a lack of evidence synthesis on the effectiveness of available digital or mobile health KT tools to promote SRH interventions for adolescents. Objective: We aim to identify, map, and describe existing empirical evidence on the digital KT tools developed to improve adolescent SRH outcomes globally. Methods: This study will be conducted using an evidence gap map (EGM) approach to address the objectives, including reviewing relevant literature and a landscape analysis of the outcomes of interest. The following electronic databases will be searched for retrieval of literature: MEDLINE (1946-present), Embase (1974-present), and Global Health (1910-present) via OVID; CINAHL (1936-present) via EBSCOhost; Scopus (1976-present); and Cochrane Library (1993-present) via Wiley. We will include only those studies that focused on adolescents aged 10-19 years and addressed SRH outcomes. We will include experimental studies (randomized or cluster randomized and nonrandomized controlled trials, including quasi-randomized, controlled before-after, and interruptive time series) and observational studies, that is, including prospective cohort and case-control studies. The experimental and observational studies will only be included in the presence of control or comparison arms. Studies with a historical control arm will be excluded. The systematic review software, Covidence (Ventas Health Innovation), will be used to screen and select the studies. Further, 2 independent reviewers will complete the first and second levels of screening of studies and any conflicts arising will be resolved by consensus between the 2 reviewers or by involving the third reviewer. We will conduct the quality assessment of all included studies using the Risk of Bias tool for randomized controlled trials and nonrandomized controlled trials, and AMSTAR2 for systematic reviews. Results: Papers screening, data extraction, and synthesis will be completed by March 2024. We will use EPPI-Mapper (The International Public Policy Observatory) software to generate an online evidence map and to produce the tables and figures for the descriptive report. This EGM review will identify areas with high-quality, evidence-based digital KT tools (for immediate scale and spread) and areas where few or no KT tools exist (for targeted KT tool development and research or policy prioritization). Conclusions: This protocol focused on mapping eHealth KT tools that have been used in the literature to address SRH among adolescents. This will be the first EGM exercise to map digital KT tools to promote adolescents? SRH and will incorporate a range of published sources. International Registered Report Identifier (IRRID): DERR1-10.2196/55081 UR - https://www.researchprotocols.org/2024/1/e55081 UR - http://dx.doi.org/10.2196/55081 UR - http://www.ncbi.nlm.nih.gov/pubmed/38349722 ID - info:doi/10.2196/55081 ER - TY - JOUR AU - Adam, Maya AU - Nguy?n, Kính V?n PY - 2024/2/12 TI - Authors' Reply: Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers JO - J Med Internet Res SP - e55930 VL - 26 KW - maternal child health KW - mHealth KW - mobile health KW - randomized controlled trial KW - short animated storytelling KW - South Africa KW - video health messaging UR - https://www.jmir.org/2024/1/e55930 UR - http://dx.doi.org/10.2196/55930 UR - http://www.ncbi.nlm.nih.gov/pubmed/38345840 ID - info:doi/10.2196/55930 ER - TY - JOUR AU - Lin, Yongjian PY - 2024/2/12 TI - Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers JO - J Med Internet Res SP - e53861 VL - 26 KW - letter KW - maternal child health KW - mHealth KW - mobile health KW - randomized controlled trial KW - short animated storytelling KW - South Africa KW - video health messaging UR - https://www.jmir.org/2024/1/e53861 UR - http://dx.doi.org/10.2196/53861 UR - http://www.ncbi.nlm.nih.gov/pubmed/38345847 ID - info:doi/10.2196/53861 ER - TY - JOUR AU - François, Julien AU - Audrain-Pontevia, Anne-Françoise AU - Boudhraâ, Sana AU - Vial, Stéphane PY - 2024/2/12 TI - Assessing the Influence of Patient Empowerment Gained Through Mental Health Apps on Patient Trust in the Health Care Provider and Patient Compliance With the Recommended Treatment: Cross-sectional Study JO - J Med Internet Res SP - e48182 VL - 26 KW - patient empowerment KW - patient compliance KW - patient trust KW - mental health app KW - mental health N2 - Background: In chronic mental illness, noncompliance with treatment significantly worsens the illness course and outcomes for patients. Considering that nearly 1 billion people worldwide experience mental health issues, including 1 of 5 Canadians in any given year, finding tools to lower noncompliance in these populations is critical for health care systems. A promising avenue is apps that make mental health services more accessible to patients. However, little is known regarding the impact of the empowerment gained from mental health apps on patient compliance with recommended treatment. Objective: This study aimed to investigate the impact of patient empowerment gained through mental health apps on patient trust in the health care provider and patient compliance with the recommended treatment. Methods: A cross-sectional web-based survey was conducted in Canada. Eligible participants were Canadian adults diagnosed with chronic mental health disorders who were using at least one of the following apps: Dialogue, MindBeacon, Deprexis, Ginger, Talkspace, BetterHelp, MindStrong, Mindshift, Bloom, Headspace, and Calm. A total of 347 valid questionnaires were collected and analyzed using partial least-squares structural equation modeling. Trust in the health care provider and patient compliance were measured with multiple-item scales adapted from existing scales. Patient empowerment was conceived and measured as a higher-order construct encompassing the following 2 dimensions: patient process and patient outcome. All the items contributing to the constructs in the model were measured with 7-point Likert scales. The reliability and validity of the measurement model were assessed, and the path coefficients of the structural model were estimated. Results: The results clearly show that patient empowerment gained through mental health apps positively influenced patient trust in the health care provider (?=.306; P<.001). Patient trust in the health care provider had a positive effect on patient compliance (?=.725; P<.001). The direct relationship between patient empowerment and patient compliance was not significant (?=.061, P=.23). Interestingly, the data highlight that the effect of patient empowerment on patient compliance was fully mediated by trust in the health care provider (?=.222; P<.001). The results show that patient empowerment gained through the mental health app involves 2 dimensions: a process and an outcome. Conclusions: This study shows that for individuals living with mental health disorders, empowerment gained through mental health apps enhances trust in the health care provider. It reveals that patient empowerment impacts patient compliance but only through the full mediating effect of patient trust in the health care provider, indicating that patient trust is a critical variable to enhance patient compliance. Hence, our results confirm that health care systems could encourage the use of mental health apps to favor a climate that facilitates patients? trust in health care provider recommendations, possibly leading to better compliance with the recommended treatment. UR - https://www.jmir.org/2024/1/e48182 UR - http://dx.doi.org/10.2196/48182 UR - http://www.ncbi.nlm.nih.gov/pubmed/38345851 ID - info:doi/10.2196/48182 ER - TY - JOUR AU - Ipsen, Ammundsen Jonas AU - Sandal, Fleng Louise AU - Chang, Siu Natalie Hong AU - Schiøttz-Christensen, Berit AU - Søgaard, Karen AU - Hansen, Anders PY - 2024/2/12 TI - Interest in mHealth Among Patients With Low Back Pain: Cross-Sectional Study JO - JMIR Hum Factors SP - e48729 VL - 11 KW - low back pain KW - mHealth solutions KW - mobile health KW - characteristics KW - patient interest KW - transferability KW - representativeness N2 - Background: Digitally supported self-management tailored to an individual?s need, in addition to usual care, may reduce pain-related disability compared to usual care alone, and patients with low back pain (LBP) using mobile health (mHealth) solutions express positive experiences. Hence, implementing mHealth solutions designed to support self-management is desirable from a clinical and patient perspective. Easily accessible mHealth solutions that can support the self-management of patients with LBP are available, but interest may be subgroup specific. Understanding the characteristics and preferences of patients with LBP labeled as interested may help to reach relevant LBP patient groups and inform the development and implementation of effective interventions with mHealth for patients with LBP. Objective: This study aims to explore the proportion of patients with LBP labeled as interested in testing an mHealth solution designed to support self-management in addition to usual care and to assess how these patients differ from those who were labeled as not interested. Methods: This exploratory cross-sectional study analyzed demographic and patient-reported outcomes from the SpineData registry, a Danish registry of patients with LBP in an outpatient setting. Between February and December 2019, the SpineData registry was used to assess the preliminary eligibility of patients for a clinical trial (selfBACK). Patients were labeled as interested or uninterested depending on if they responded to an invitation to be tested for eligibility for the trial Outcomes were selected from the International Classification of Functioning core set of LBP using a clinical approach. Associations were assessed in a backward selection process, and the proportion of variance explained was assessed with pseudo-R2 statistic. Results: This study included 843 patients, with 181 (21%) individuals labeled as interested in participating in the selfBACK trial. Notably, the cohort labeled as interested differed from their uninterested counterparts in two key aspects: age (36-65 years: 116/181, 64.1% vs 347/662, 52.4%; P=.003) and smoking status (smokers: 22/181, 12.5% vs 174/662, 26.6%; P<.001). Those aged 36-65 years had higher odds of being labeled as interested compared to individuals aged 18-35 years (odds ratio [OR] 0.43, 95% CI 0.26-0.71) and those 65 years or older (OR 0.77, 95% CI 0.53-1.15). Nevertheless, age accounted for only a modest proportion of variance (R2=0.014). Smokers demonstrated lower odds of being labeled as interested (OR 0.39, 95% CI 0.24-0.64), with smoking status explaining a similarly small proportion of variance (R2=0.019). Collectively, age and smoking status accounted for 3.3% of the variance. Conclusions: Our investigation revealed that 181 (21%) individuals with LBP invited to participate in the mHealth solution trial for self-management expressed interest. Generally, the characteristics of those labeled as interested and uninterested were comparable. Of note, patients aged 36-65 years had a higher frequency of being labeled as interested compared to their younger and older counterparts. UR - https://humanfactors.jmir.org/2024/1/e48729 UR - http://dx.doi.org/10.2196/48729 UR - http://www.ncbi.nlm.nih.gov/pubmed/38345837 ID - info:doi/10.2196/48729 ER - TY - JOUR AU - Ocké, Marga AU - Dinnissen, Simone Ceciel AU - van den Bogaard, Coline AU - Beukers, Marja AU - Drijvers, José AU - Sanderman-Nawijn, Eline AU - van Rossum, Caroline AU - Toxopeus, Ido PY - 2024/2/9 TI - A Smartphone Food Record App Developed for the Dutch National Food Consumption Survey: Relative Validity Study JO - JMIR Mhealth Uhealth SP - e50196 VL - 12 KW - relative validity KW - smartphone food record KW - 24-hour dietary recall KW - mobile app KW - national food consumption surveys KW - smartphone KW - food KW - food consumption KW - app KW - diet KW - dietary intake KW - nutrients KW - survey KW - mobile phone N2 - Background: In the Dutch National Food Consumption Survey, dietary intake has been assessed since 2003 through 24-hour dietary recalls using the GloboDiet software. A new self-administered smartphone food record app called DitEetIk! was developed for potential use in future surveys. Objective: This study aims to evaluate the data collected using the DitEetIk! app and its relative validity for food group, energy, and nutrient intake compared with the previous dietary assessment method (GloboDiet 24-hour dietary recalls). Methods: A total of 300 participants aged 18 to 79 years were recruited from a consumer panel. Participants were asked to keep a record of their consumption using the DitEetIk! app on 3 nonconsecutive days. Trained dietitians conducted a 24-hour dietary recall interview by telephone using the GloboDiet software (International Agency for Research on Cancer) regarding 1 of 3 DitEetIk! recording days. Nutrient intake was calculated using the NEVO database (version 2021/7.0). Relative validity was studied by comparing data from GloboDiet 24-hour dietary recalls and the DitEetIk app for the same day. Participants with implausible records, defined as days with energy intake of <0.6 or >3.0 basal metabolic rate, were excluded from the analyses. For 19 food groups and 29 nutrients, differences in median intake were assessed using the Wilcoxon signed rank test, and Spearman correlation coefficients were calculated. Bland-Altman plots with mean differences and 95% limits of agreement were created for energy intake and the contribution to energy intake from fat, carbohydrates, and protein. Results: A total of 227 participants completed a combination of a DitEetIk! app recording day and a 24-hour dietary recall interview for the same day. Of this group, 211 participants (n=104, 49.3% men and n=107, 50.7% women) had plausible recording days. Of all recorded food items, 12.8% (114/894) were entered via food barcode scanning, and 18.9% (169/894) were searched at the brand level. For 31% (5/16) of the food groups, the median intake assessed using the DitEetIk! app was >10% lower than that assessed using 24-hour dietary recalls; this was the case for fruit (P=.005), added fats (P=.001), milk and milk products (P=.02), cereal products (P=.01), and sauces (P<.001). This was also the case for 14% (4/29) of the nutrients (all P<.001). Regarding mean intake, differences were generally smaller. Regarding energy intake, the mean difference and 95% limits of agreement were 14 kcal (?1096 to 1124). Spearman correlation coefficients between intake assessed using the DitEetIk! app and 24-hour dietary recalls ranged from 0.48 to 0.88 (median 0.78) for food groups and from 0.58 to 0.90 (median 0.72) for nutrients. Conclusions: Compared with GloboDiet 24-hour dietary recalls, the DitEetIk! app assessed similar mean energy intake levels but somewhat lower median intake levels for several food groups and nutrients. UR - https://mhealth.jmir.org/2024/1/e50196 UR - http://dx.doi.org/10.2196/50196 UR - http://www.ncbi.nlm.nih.gov/pubmed/38335009 ID - info:doi/10.2196/50196 ER - TY - JOUR AU - Buss, Helen Vera AU - Barr, Margo AU - Parker, M. Sharon AU - Kabir, Alamgir AU - Lau, S. Annie Y. AU - Liaw, Siaw-Teng AU - Stocks, Nigel AU - Harris, F. Mark PY - 2024/2/9 TI - Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study JO - JMIR Mhealth Uhealth SP - e45942 VL - 12 KW - health literacy KW - primary health care KW - mobile application KW - overweight KW - vulnerable populations KW - health behavior KW - mHealth KW - obesity KW - weight loss KW - mysnapp app KW - mobile phone N2 - Background: The Health eLiteracy for Prevention in General Practice trial is a primary health care?based behavior change intervention for weight loss in Australians who are overweight and those with obesity from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp), and a referral to telephone coaching. Objective: This study aimed to assess mysnapp app use, its user profiles, the duration and frequency of use within the Health eLiteracy for Prevention in General Practice trial, its association with other intervention components, and its association with study outcomes (health literacy and diet) to determine whether they have significantly improved at 6 months. Methods: In 2018, a total of 22 general practices from 2 Australian states were recruited and randomized by cluster to the intervention or usual care. Patients who met the main eligibility criteria (ie, BMI>28 in the previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about this study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants? choice. Data were collected directly through the app and combined with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants? questionnaires at baseline and 6-month follow-up. The analyses comprised descriptive and inferential statistics. Results: Of the 120 participants who received the intervention, 62 (52%) chose to use the app. The app and nonapp user groups did not differ significantly in demographics or prior recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (2-sided Fisher exact test; P<.001) and participate in the telephone coaching (2-sided Fisher exact test; P=.007) than nonapp users. There was no association between app use and study outcomes shown to have significantly improved (health literacy and diet) at 6 months. Conclusions: Recruitment and engagement were difficult for this study in disadvantaged populations with low health literacy. However, app users were more likely to attend the 6-week health check and participate in telephone coaching, suggesting that participants who opted for several intervention components felt more committed to this study. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001508369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373505 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-023239 UR - https://mhealth.jmir.org/2024/1/e45942 UR - http://dx.doi.org/10.2196/45942 UR - http://www.ncbi.nlm.nih.gov/pubmed/38335014 ID - info:doi/10.2196/45942 ER - TY - JOUR AU - Lee, Hyerim AU - Choi, Ho Eung AU - Shin, U. Jung AU - Kim, Tae-Gyun AU - Oh, Jooyoung AU - Shin, Bokyoung AU - Sim, Yeon Jung AU - Shin, Jaeyong AU - Kim, Meelim PY - 2024/2/9 TI - The Impact of Intervention Design on User Engagement in Digital Therapeutics Research: Factorial Experiment With a Mixed Methods Study JO - JMIR Form Res SP - e51225 VL - 8 KW - atopic KW - dermatitis KW - experimental design KW - mobile health KW - patient engagement KW - research methodology N2 - Background: User engagement is crucial for digital therapeutics (DTx) effectiveness; due to variations in the conceptualization of engagement and intervention design, assessment and retention of engagement remain challenging. Objective: We investigated the influence of the perceived acceptability of experimental intervention components and satisfaction with core intervention components in DTx on user engagement, while also identifying potential barriers and facilitators to user engagement. Methods: We conducted a mixed methods study with a 2 × 2 factorial design, involving 12 outpatients with atopic dermatitis. Participants were randomized into 4 experimental groups based on push notification (?basic? or ?advanced?) and human coach (?on? or ?off?) experimental intervention components. All participants engaged in self-monitoring and learning courses as core intervention components within an app-based intervention over 8 weeks. Data were collected through in-app behavioral data, physician- and self-reported questionnaires, and semistructured interviews assessed at baseline, 4 weeks, and 8 weeks. Descriptive statistics and thematic analysis were used to evaluate user engagement, perceived acceptability of experimental intervention components (ie, push notification and human coach), satisfaction with core intervention components (ie, self-monitoring and learning courses), and intervention effectiveness through clinical outcomes. Results: The primary outcome indicated that group 4, provided with ?advanced-level push notifications? and a ?human coach,? showed higher completion rates for self-monitoring forms and learning courses compared to the predetermined threshold of clinical significance. Qualitative data analysis revealed three key themes: (1) perceived acceptability of the experimental intervention components, (2) satisfaction with the core intervention components, and (3) suggestions for improvement in the overall intervention program. Regarding clinical outcomes, the Perceived Stress Scale and Dermatology Life Quality Index scores presented the highest improvement in group 4. Conclusions: These findings will help refine the intervention and inform the design of a subsequent randomized trial to test its effectiveness. Furthermore, this design may serve as a model for broadly examining and optimizing overall engagement in DTx and for future investigation into the complex relationship between engagement and clinical outcomes. Trial Registration: Clinical Research Information Service KCT0007675; http://tinyurl.com/2m8rjrmv UR - https://formative.jmir.org/2024/1/e51225 UR - http://dx.doi.org/10.2196/51225 UR - http://www.ncbi.nlm.nih.gov/pubmed/38335015 ID - info:doi/10.2196/51225 ER - TY - JOUR AU - Pierz, A. Kerri AU - Locantore, Nicholas AU - McCreary, Gretchen AU - Calvey, J. Robert AU - Hackney, Nickole AU - Doshi, Pooja AU - Linnell, John AU - Sundaramoorthy, Abirammy AU - Reed, R. Carol AU - Yates, Julie PY - 2024/2/9 TI - Investigation of the Impact of Wellinks on the Quality of Life and Clinical Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Interventional Research Study JO - JMIR Form Res SP - e47555 VL - 8 KW - chronic obstructive pulmonary disease KW - COPD KW - health coaching KW - pulmonary rehabilitation KW - remote care KW - disease management KW - patient engagement KW - Wellinks KW - digital health KW - adult KW - mobile app KW - remote model of care KW - mobile phone N2 - Background: Wellinks is a remote disease management solution that provides novel chronic obstructive pulmonary disease (COPD) care delivery. Objective: This study evaluated the satisfaction, engagement, and clinical outcomes of Wellinks participants. This study also investigated the cadence of health coaching for patients with COPD. Methods: A 24-week interventional study was conducted by Wellinks and the COPD Foundation in 2022. Adults with COPD were recruited by the COPD Foundation in the United States and determined to be eligible if they had phone and internet access, owned a smartphone, and were not currently participating in pulmonary rehabilitation. All study participants provided written informed consent. The Wellinks solution included remote health coaching, pulmonary rehabilitation, and group education; participants were provided the Wellinks app and smart spirometry and pulse oximetry devices. Participants were offered 6 coaching sessions in the first 12 weeks. For the second 12-week period, participants either reduced frequency or discontinued coaching; all other components of the Wellinks solution remained unchanged. The COPD Self-Efficacy Scale, Modified Medical Research Council dyspnea scale, pulmonary function, pulse oximetry, and patient-reported healthcare resource utilization were the clinical outcome measures. Nonclinical outcomes included engagement and satisfaction with Wellinks and net promoter score. Results: In total, 141 adults consented and completed Wellinks onboarding; 84.4% (n=119) of whom remained engaged throughout the 24-week study. Participants had a mean age of 70 (SD 7.8; range 48-88) years, and 55.7% (n=78) were female. Most participants (n=119, 84.4%) completed all 6 coaching sessions during the first 12-week period. Compliance with spirometer and pulse oximeter use was 82.3% and 89.4%, respectively, at week 1 but waned over the study period to 8.5% and 9.2%, respectively, at the end of the study. Participants indicated a high degree of satisfaction with Wellinks, with 95.5% (n=85) and 91% (n=81) of participants indicating that they agreed or strongly agreed that the educational content and health coaching, respectively, were valuable. At the end of the study, the net promoter score was +64 and +55 in the coaching continuation and discontinuation arms, respectively. A significant improvement from baseline to end of the study was observed in the COPD Self-Efficacy Scale total score (P<.001) and domain scores (P<.001 for each domain). In total, 35.1% (n=27) of participants improved by at least 1 category of change on the 5-point Modified Medical Research Council dyspnea scale from baseline to week 24. Conclusions: This study confirmed the feasibility of using a remote model of care delivery to support people living with COPD. The insights gained in this study have allowed for further refinement and personalization of the Wellinks care model. Findings related to the combined use of technology and personal care delivery should be considered by others developing remote disease management tools. Trial Registration: ClinicalTrials.gov NCT05259280; https://clinicaltrials.gov/ct2/show/NCT05259280 UR - https://formative.jmir.org/2024/1/e47555 UR - http://dx.doi.org/10.2196/47555 UR - http://www.ncbi.nlm.nih.gov/pubmed/38335023 ID - info:doi/10.2196/47555 ER - TY - JOUR AU - McElwain, L. Nancy AU - Fisher, C. Meghan AU - Nebeker, Camille AU - Bodway, M. Jordan AU - Islam, Bashima AU - Hasegawa-Johnson, Mark PY - 2024/2/8 TI - Evaluating Users? Experiences of a Child Multimodal Wearable Device: Mixed Methods Approach JO - JMIR Hum Factors SP - e49316 VL - 11 KW - wearable devices KW - multimodal sensing KW - user experience KW - usability KW - privacy KW - children KW - mobile phone N2 - Background: Wearable devices permit the continuous, unobtrusive collection of data from children in their natural environments and can transform our understanding of child development. Although the use of wearable devices has begun to emerge in research involving children, few studies have considered families? experiences and perspectives of participating in research of this kind. Objective: Through a mixed methods approach, we assessed parents? and children?s experiences of using a new wearable device in the home environment. The wearable device was designed specifically for use with infants and young children, and it integrates audio, electrocardiogram, and motion sensors. Methods: In study 1, semistructured phone interviews were conducted with 42 parents of children aged 1 month to 9.5 years who completed 2 day-long recordings using the device, which the children wore on a specially designed shirt. In study 2, a total of 110 parents of children aged 2 months to 5.5 years responded to a questionnaire assessing their experience of completing 3 day-long device recordings in the home. Guided by the Digital Health Checklist, we assessed parental responses from both studies in relation to the following three key domains: (1) access and usability, (2) privacy, and (3) risks and benefits. Results: In study 1, most parents viewed the device as easy to use and safe and remote visits as convenient. Parents? views on privacy related to the audio recordings were more varied. The use of machine learning algorithms (vs human annotators) in the analysis of the audio data, the ability to stop recordings at any time, and the view that the recordings reflected ordinary family life were some reasons cited by parents who expressed minimal, if any, privacy concerns. Varied risks and benefits were also reported, including perceived child comfort or discomfort, the need to adjust routines to accommodate the study, the understanding gained from the study procedures, and the parent?s and child?s enjoyment of study participation. In study 2, parents? ratings on 5 close-ended items yielded a similar pattern of findings. Compared with a ?neutral? rating, parents were significantly more likely to agree that (1) device instructions were helpful and clear (t109=?45.98; P<.001), (2) they felt comfortable putting the device on their child (t109=?22.22; P<.001), and (3) they felt their child was safe while wearing the device (t109=?34.48; P<.001). They were also less likely to worry about the audio recordings gathered by the device (t108=6.14; P<.001), whereas parents? rating of the burden of the study procedures did not differ significantly from a ?neutral? rating (t109=?0.16; P=.87). Conclusions: On the basis of parents? feedback, several concrete changes can be implemented to improve this new wearable platform and, ultimately, parents? and children?s experiences of using child wearable devices in the home setting. UR - https://humanfactors.jmir.org/2024/1/e49316 UR - http://dx.doi.org/10.2196/49316 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329785 ID - info:doi/10.2196/49316 ER - TY - JOUR AU - Bhattacharjee, Ananya AU - Chen, Pan AU - Mandal, Abhijoy AU - Hsu, Anne AU - O'Leary, Katie AU - Mariakakis, Alex AU - Williams, Jay Joseph PY - 2024/2/8 TI - Exploring User Perspectives on Brief Reflective Questioning Activities for Stress Management: Mixed Methods Study JO - JMIR Form Res SP - e47360 VL - 8 KW - reflection KW - mental health KW - stress KW - reflective questioning activity KW - RQA KW - brief intervention KW - computer-mediated communication KW - email KW - SMS text messaging KW - mobile phone N2 - Background: Current online interventions dedicated to assisting individuals in managing stress and negative emotions often necessitate substantial time commitments. This can be burdensome for users, leading to high dropout rates and reducing the effectiveness of these interventions. This highlights an urgent need for concise digital activities that individuals can swiftly access during instances of negative emotions or stress in their daily lives. Objective: The primary aim of this study was to investigate the viability of using a brief digital exercise, specifically a reflective questioning activity (RQA), to help people reflect on their thoughts and emotions about a troubling situation. The RQA is designed to be quick, applicable to the general public, and scalable without requiring a significant support structure. Methods: We conducted 3 simultaneous studies. In the first study, we recruited 48 participants who completed the RQA and provided qualitative feedback on its design through surveys and semistructured interviews. In the second study, which involved 215 participants from Amazon Mechanical Turk, we used a between-participants design to compare the RQA with a single-question activity. Our hypotheses posited that the RQA would yield greater immediate stress relief and higher perceived utility, while not significantly altering the perception of time commitment. To assess these, we measured survey completion times and gathered multiple self-reported scores. In the third study, we assessed the RQA?s real-world impact as a periodic intervention, exploring engagement via platforms such as email and SMS text messaging, complemented by follow-up interviews with participants. Results: In our first study, participants appreciated the RQA for facilitating structured reflection, enabling expression through writing, and promoting problem-solving. However, some of the participants experienced confusion and frustration, particularly when they were unable to find solutions or alternative perspectives on their thoughts. In the second study, the RQA condition resulted in significantly higher ratings (P=.003) for the utility of the activity and a statistically significant decrease (P<.001) in perceived stress rating compared with the single-question activity. Although the RQA required significantly more time to be completed (P<.001), there was no statistically significant difference in participants? subjective perceived time commitment (P=.37). Deploying the RQA over 2 weeks in the third study identified some potential challenges to consider for such activities, such as the monotony of doing the same activity several times, the limited affordances of mobile phones, and the importance of having the prompts align with the occurrence of new troubling situations. Conclusions: This paper describes the design and evaluation of a brief online self-reflection activity based on cognitive behavioral therapy principles. Our findings can inform practitioners and researchers in the design and exploration of formats for brief interventions to help people with everyday struggles. UR - https://formative.jmir.org/2024/1/e47360 UR - http://dx.doi.org/10.2196/47360 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329800 ID - info:doi/10.2196/47360 ER - TY - JOUR AU - Ahn, Chan-Young AU - Lee, Jong-Sun PY - 2024/2/8 TI - Digital Phenotyping for Real-Time Monitoring of Nonsuicidal Self-Injury: Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e53597 VL - 13 KW - nonsuicidal self-injury KW - NSSI KW - digital phenotyping KW - digital phenotype KW - wearable device KW - wearable KW - wearables KW - wrist worn KW - mood KW - emotion KW - emotions KW - heart rate KW - step KW - sleep KW - machine learning KW - multilevel modeling KW - ecological momentary assessment KW - EMA KW - self-injury KW - self-harm KW - psychiatry KW - psychiatric KW - mental health KW - predict KW - prediction KW - predictions KW - predictor KW - predictors KW - predictive N2 - Background: Nonsuicidal self-injury (NSSI) is a major global health concern. The limitations of traditional clinical and laboratory-based methodologies are recognized, and there is a pressing need to use novel approaches for the early detection and prevention of NSSI. Unfortunately, there is still a lack of basic knowledge of a descriptive nature on NSSI, including when, how, and why self-injury occurs in everyday life. Digital phenotyping offers the potential to predict and prevent NSSI by assessing objective and ecological measurements at multiple points in time. Objective: This study aims to identify real-time predictors and explain an individual?s dynamic course of NSSI. Methods: This study will use a hybrid approach, combining elements of prospective observational research with non?face-to-face study methods. This study aims to recruit a cohort of 150 adults aged 20 to 29 years who have self-reported engaging in NSSI on 5 or more days within the past year. Participants will be enrolled in a longitudinal study conducted at 3-month intervals, spanning 3 long-term follow-up phases. The ecological momentary assessment (EMA) technique will be used via a smartphone app. Participants will be prompted to complete a self-injury and suicidality questionnaire and a mood appraisal questionnaire 3 times a day for a duration of 14 days. A wrist-worn wearable device will be used to collect heart rate, step count, and sleep patterns from participants. Dynamic structural equation modeling and machine learning approaches will be used. Results: Participant recruitment and data collection started in October 2023. Data collection and analysis are expected to be completed by December 2024. The results will be published in a peer-reviewed journal and presented at scientific conferences. Conclusions: The insights gained from this study will not only shed light on the underlying mechanisms of NSSI but also pave the way for the development of tailored and culturally sensitive treatment options that can effectively address this major mental health concern. International Registered Report Identifier (IRRID): DERR1-10.2196/53597 UR - https://www.researchprotocols.org/2024/1/e53597 UR - http://dx.doi.org/10.2196/53597 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329791 ID - info:doi/10.2196/53597 ER - TY - JOUR AU - Martínez-Gaitero, Carlos AU - Dennerlein, Maximilian Sebastian AU - Dobrowolska, Beata AU - Fessl, Angela AU - Moreno-Martínez, Daniel AU - Herbstreit, Stephanie AU - Peffer, Gilbert AU - Cabrera, Esther AU - PY - 2024/2/8 TI - Connecting Actors With the Introduction of Mobile Technology in Health Care Practice Placements (4D Project): Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e53284 VL - 13 KW - practice-based learning KW - practice placement KW - technology enhanced learning KW - mobile learning KW - co-design KW - cocreation KW - higher education KW - health professionals KW - health students. N2 - Background: The learning process in clinical placements for health care students is a multifaceted endeavor that engages numerous actors and stakeholders, including students, clinical tutors, link teachers, and academic assessors. Successfully navigating this complex process requires the implementation of tasks and mentorships that are synchronized with educational and clinical processes, seamlessly embedded within their respective contexts. Given the escalating number of students and the rising demand for health care services from the general population, it becomes imperative to develop additional tools that support the learning process. These tools aim to simplify day-to-day clinical practice, allowing a concentrated focus on value-based activities. This paper introduces a project funded by the European Commission that involves 5 European countries. The project?s objective is to comprehensively outline the entire process of development and ultimately implement mobile technology in practice placements. The project tackles the existing gap by constructing tailored mobile apps designed for students, teachers, tutors, and supervisors within each participating organization. This approach leverages practice-based learning, mobile technology, and technology adoption to enhance the overall educational experience. Objective: This study aims to introduce mobile technology in clinical practice placements with the goal of facilitating and enhancing practice-based learning. The objective is to improve the overall effectiveness of the process for all stakeholders involved. Methods: The ?4D in the Digitalization of Learning in Practice Placement? (4D Project) will use a mixed methods research design, encompassing 3 distinct study phases: phase 1 (preliminary research), which incorporates focus groups and a scoping review, to define the problem, identify necessities, and analyze contextual factors; phase 2 (collaborative app development), which involves researchers and prospective users working together to cocreate and co-design tailored apps; and phase 3, which involves feasibility testing of these mobile apps within practice settings. Results: The study?s potential impact will primarily focus on improving communication and interaction processes, fostering connections among stakeholders in practice placements, and enhancing the assessment of training needs. The literature review and focus groups will play a crucial role in identifying barriers, facilitators, and factors supporting the integration of mobile technology in clinical education. The cocreation process of mobile learning apps will reveal the core values and needs of various stakeholders, including students, teachers, and health care professionals. This process also involves adapting and using mobile apps to meet the specific requirements of practice placements. A pilot study aimed at validating the app will test and assess mobile technology in practice placements. The study will determine results related to usability and design, learning outcomes, student engagement, communication among stakeholders, user behavior, potential issues, and compliance with regulations. Conclusions: Health care education, encompassing disciplines such as medicine, nursing, midwifery, and others, confronts evolving challenges in clinical training. Essential to addressing these challenges is bridging the gap between health care institutions and academic settings. The introduction of a new digital tool holds promise for empowering health students and mentors in effectively navigating the intricacies of the learning process. International Registered Report Identifier (IRRID): DERR1-10.2196/53284 UR - https://www.researchprotocols.org/2024/1/e53284 UR - http://dx.doi.org/10.2196/53284 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329786 ID - info:doi/10.2196/53284 ER - TY - JOUR AU - Peake, Emily AU - Miller, Ian AU - Flannery, Jessica AU - Chen, Lang AU - Lake, Jessica AU - Padmanabhan, Aarthi PY - 2024/2/7 TI - Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial JO - J Med Internet Res SP - e48467 VL - 26 KW - adolescent KW - depression KW - randomized controlled trial KW - mobile phone KW - digital therapeutics KW - mobile app KW - cognitive behavioral therapy KW - behavioral activation KW - mobile health N2 - Background: Adolescent depression is a significant public health concern; however, access to effective mental health care is limited. Digital therapeutics (DTx) can improve access to evidence-based interventions; however, their efficacy in adolescents is sparsely documented. Objective: This study aims to examine the efficacy of a mobile app DTx versus an active control as an adjunct treatment for adolescent depression symptoms. Methods: An internet-based open-label randomized control trial was conducted nationwide with a partial crossover design, and 168 adolescents aged 13 to 21 years with symptoms of depression were recruited between November 2020 and September 2021. Participants were randomized (1:1) to the cognitive behavioral therapy?based treatment app (Spark) or to a psychoeducational control app (control), which they would use for a duration of 5 weeks. The primary outcome was a between-group (Spark vs control) difference in the change in depression symptoms from baseline to postintervention, as measured by the Patient Health Questionnaire-8 (PHQ-8) using a linear mixed-effects analysis. The PHQ-8 ranges from 0 to 24, with scores of 5 to 9 indicating mild depression symptoms, scores of 10 to 14 indicating moderate symptoms, scores of 15 to 19 indicating moderately severe symptoms, and scores of 20 to 24 indicating severe symptoms. A minimal clinically important difference (5-point reduction between baseline and postintervention) in the Spark arm and group differences in remission and treatment response rates based on the PHQ-8 at postintervention were also investigated. Results: A total of 160 participants were randomized, 80 in the Spark arm (mean age 16.89, SD 2.5 y) and 80 in the control arm (mean age 16.79, SD 2.59 y). Data from 121 participants (Spark: n=63; control: n=58) with moderate to severe (PHQ-8?10) symptoms at baseline were included in the primary analyses following a modified intention-to-treat principle. A linear mixed-effect analysis revealed a nonsignificant difference between the study arms in depression symptom change over the intervention period. The Spark arm met a minimal clinically important difference threshold (mean ?5.08, 95% CI ?6.72 to ?3.42). The remission rate in the Spark arm was significantly higher than that in the control arm (11/63, 17% vs 2/58, 3%; ?21=6.2; P=.01; false discovery rate?adjusted P=.03). The treatment response rates were not significantly different between the study arms (P=.07; false discovery rate?adjusted P=.16). Post hoc analyses including participants with mild to severe (PHQ-8 score ?5) symptoms at baseline revealed promising evidence that Spark is effective in those with mild to severe symptoms. Conclusions: There is initial evidence that a self-guided, cognitive behavioral therapy?based DTx intervention may effectively treat mild to severe depression symptoms in adolescents. DTx may improve access to mental health care for adolescents or serve as an important adjunct to the standard of care. Trial Registration: ClinicalTrials.gov NCT04524598; https://clinicaltrials.gov/study/NCT04524598 UR - https://www.jmir.org/2024/1/e48467 UR - http://dx.doi.org/10.2196/48467 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324367 ID - info:doi/10.2196/48467 ER - TY - JOUR AU - King, D. Zachary AU - Yu, Han AU - Vaessen, Thomas AU - Myin-Germeys, Inez AU - Sano, Akane PY - 2024/2/7 TI - Investigating Receptivity and Affect Using Machine Learning: Ecological Momentary Assessment and Wearable Sensing Study JO - JMIR Mhealth Uhealth SP - e46347 VL - 12 KW - mobile health KW - mHealth KW - affect inference KW - study design KW - ecological momentary assessment KW - EMA KW - just-in-time adaptive interventions KW - JITAIs KW - receptivity KW - mobile phone N2 - Background: As mobile health (mHealth) studies become increasingly productive owing to the advancements in wearable and mobile sensor technology, our ability to monitor and model human behavior will be constrained by participant receptivity. Many health constructs are dependent on subjective responses, and without such responses, researchers are left with little to no ground truth to accompany our ever-growing biobehavioral data. This issue can significantly impact the quality of a study, particularly for populations known to exhibit lower compliance rates. To address this challenge, researchers have proposed innovative approaches that use machine learning (ML) and sensor data to modify the timing and delivery of surveys. However, an overarching concern is the potential introduction of biases or unintended influences on participants? responses when implementing new survey delivery methods. Objective: This study aims to demonstrate the potential impact of an ML-based ecological momentary assessment (EMA) delivery system (using receptivity as the predictor variable) on the participants? reported emotional state. We examine the factors that affect participants? receptivity to EMAs in a 10-day wearable and EMA?based emotional state?sensing mHealth study. We study the physiological relationships indicative of receptivity and affect while also analyzing the interaction between the 2 constructs. Methods: We collected data from 45 healthy participants wearing 2 devices measuring electrodermal activity, accelerometer, electrocardiography, and skin temperature while answering 10 EMAs daily, containing questions about perceived mood. Owing to the nature of our constructs, we can only obtain ground truth measures for both affect and receptivity during responses. Therefore, we used unsupervised and supervised ML methods to infer affect when a participant did not respond. Our unsupervised method used k-means clustering to determine the relationship between physiology and receptivity and then inferred the emotional state during nonresponses. For the supervised learning method, we primarily used random forest and neural networks to predict the affect of unlabeled data points as well as receptivity. Results: Our findings showed that using a receptivity model to trigger EMAs decreased the reported negative affect by >3 points or 0.29 SDs in our self-reported affect measure, scored between 13 and 91. The findings also showed a bimodal distribution of our predicted affect during nonresponses. This indicates that this system initiates EMAs more commonly during states of higher positive emotions. Conclusions: Our results showed a clear relationship between affect and receptivity. This relationship can affect the efficacy of an mHealth study, particularly those that use an ML algorithm to trigger EMAs. Therefore, we propose that future work should focus on a smart trigger that promotes EMA receptivity without influencing affect during sampled time points. UR - https://mhealth.jmir.org/2024/1/e46347 UR - http://dx.doi.org/10.2196/46347 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324358 ID - info:doi/10.2196/46347 ER - TY - JOUR AU - Young, Ruth Stephanie AU - Dworak, McManus Elizabeth AU - Byrne, Joseph Greg AU - Jones, Madison Callie AU - Yao, Lihua AU - Yoshino Benavente, Noelani Julia AU - Diaz, Varela Maria AU - Curtis, Laura AU - Gershon, Richard AU - Wolf, Michael AU - Nowinski, J. Cindy PY - 2024/2/7 TI - Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App JO - JMIR Form Res SP - e54299 VL - 8 KW - cognitive screening KW - cognitive KW - cognition KW - psychometric KW - usability KW - feasibility KW - early detection KW - dementia KW - Alzheimer?s disease, Alzheimer's KW - Alzheimer?s disease and age-related dementia KW - mHealth, mobile health apps KW - detection KW - screening KW - mobile health KW - mobile phone KW - app KW - apps KW - applications KW - user experience KW - smartphone KW - smartphones KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - aged N2 - Background: Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians? ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics? time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile? Methods: A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items. Results: All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants? rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants? abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items. Conclusions: Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia. UR - https://formative.jmir.org/2024/1/e54299 UR - http://dx.doi.org/10.2196/54299 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324368 ID - info:doi/10.2196/54299 ER - TY - JOUR AU - Sun, Yinan AU - Kargarandehkordi, Ali AU - Slade, Christopher AU - Jaiswal, Aditi AU - Busch, Gerald AU - Guerrero, Anthony AU - Phillips, T. Kristina AU - Washington, Peter PY - 2024/2/7 TI - Personalized Deep Learning for Substance Use in Hawaii: Protocol for a Passive Sensing and Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e46493 VL - 13 KW - machine learning KW - precision health KW - Indigenous data sovereignty KW - substance use KW - personalized artificial intelligence KW - wearables KW - ecological momentary assessments KW - passive sensing KW - mobile phone N2 - Background: Artificial intelligence (AI)?powered digital therapies that detect methamphetamine cravings via consumer devices have the potential to reduce health care disparities by providing remote and accessible care solutions to communities with limited care solutions, such as Native Hawaiian, Filipino, and Pacific Islander communities. However, Native Hawaiian, Filipino, and Pacific Islander communities are understudied with respect to digital therapeutics and AI health sensing despite using technology at the same rates as other racial groups. Objective: In this study, we aimed to understand the feasibility of continuous remote digital monitoring and ecological momentary assessments in Native Hawaiian, Filipino, and Pacific Islander communities in Hawaii by curating a novel data set of longitudinal Fitbit (Fitbit Inc) biosignals with the corresponding craving and substance use labels. We also aimed to develop personalized AI models that predict methamphetamine craving events in real time using wearable sensor data. Methods: We will develop personalized AI and machine learning models for methamphetamine use and craving prediction in 40 individuals from Native Hawaiian, Filipino, and Pacific Islander communities by curating a novel data set of real-time Fitbit biosensor readings and the corresponding participant annotations (ie, raw self-reported substance use data) of their methamphetamine use and cravings. In the process of collecting this data set, we will gain insights into cultural and other human factors that can challenge the proper acquisition of precise annotations. With the resulting data set, we will use self-supervised learning AI approaches, which are a new family of machine learning methods that allows a neural network to be trained without labels by being optimized to make predictions about the data. The inputs to the proposed AI models are Fitbit biosensor readings, and the outputs are predictions of methamphetamine use or craving. This paradigm is gaining increased attention in AI for health care. Results: To date, more than 40 individuals have expressed interest in participating in the study, and we have successfully recruited our first 5 participants with minimal logistical challenges and proper compliance. Several logistical challenges that the research team has encountered so far and the related implications are discussed. Conclusions: We expect to develop models that significantly outperform traditional supervised methods by finetuning according to the data of a participant. Such methods will enable AI solutions that work with the limited data available from Native Hawaiian, Filipino, and Pacific Islander populations and that are inherently unbiased owing to their personalized nature. Such models can support future AI-powered digital therapeutics for substance abuse. International Registered Report Identifier (IRRID): DERR1-10.2196/46493 UR - https://www.researchprotocols.org/2024/1/e46493 UR - http://dx.doi.org/10.2196/46493 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324375 ID - info:doi/10.2196/46493 ER - TY - JOUR AU - Jones, Catherine AU - Chandarana, Shikha AU - Vyas, Amita AU - Napolitano, Melissa PY - 2024/2/6 TI - Attitudes, Barriers, and Motivators Toward Daily Walking and a Mobile App to Increase Walking Among Women: Web-Based Anonymous Survey JO - JMIR Form Res SP - e48668 VL - 8 KW - mHealth KW - mobile health KW - mobile app KW - walking KW - physical activity KW - step counts KW - women?s health KW - age KW - wearable activity tracker KW - chronic disease KW - mental health KW - mobile phone KW - COVID-19 N2 - Background: There are disparities in the prevalence of physical activity (PA) with women engaging in less PA than men, a gap which widens during midlife. Walking is a generally accepted form of PA among women and should be encouraged. Motivations, barriers, and attitudes to engaging in walking change with age, but the influencing factors are not well understood nor are the features of mobile apps that facilitate daily walking. Objective: This study explores the relationship between age and women?s self-reported motivations, barriers, attitudes, and beliefs toward daily walking. It further assesses attitudes toward features of a mobile app designed to sync with a wearable step tracker to increase and maintain levels of daily walking among women. Methods: A web-based anonymous survey was completed by 400 women, aged 21-75 years. The 31-item survey captured women?s perceived barriers and motivators toward daily walking and attitudes toward mobile apps to support and maintain daily walking. For analysis, responses to the survey were grouped into 2 categories of women: ages 21-49 years and ages 50-75 years. Bivariate analyses were conducted through SPSS (IBM Corp) for each of the survey questions using chi-square for dichotomous variables and 1-tailed t tests for scales and continuous variables to identify significant differences between the groups. One-tailed t tests were run for scaled variables to identify significant differences between the 10-year age increments. Results: Significant barriers to daily walking were observed in the 21-49?year group for personal and work responsibilities, motivational and psychosocial factors, and physical and environmental factors. Motivators to walk daily in the 21- 49?year group were significantly higher to reduce stress and anxiety, and motivators to walk daily in the 50-75?year group were significantly higher to help manage or lose weight and to reduce the risk of chronic illness. Women?s walking preferences, beliefs around their walking behaviors, and their perceived importance of the features of a future mobile app for walking designed specifically for women showed significant variation according to age. When asked about the importance of features for a mobile app, women aged 21-49 years indicated a significantly higher number of positive responses for the following features: digital community support, rewards or point system, and seeing a daily or weekly or monthly progress chart. Conclusions: Our findings indicate that barriers, motivators, and beliefs around daily walking and the importance of preferred features of a mobile app vary according to women?s ages. Messaging and app features should be tailored to different age groups of women. These study results can be viewed as a foundation for future research and development of mobile health interventions to effectively increase daily walking among women of all ages. UR - https://formative.jmir.org/2024/1/e48668 UR - http://dx.doi.org/10.2196/48668 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319695 ID - info:doi/10.2196/48668 ER - TY - JOUR AU - Laird, Breanne AU - Zuniga, Sabrina AU - Hook, N. Joshua AU - Van Tongeren, R. Daryl AU - Joeman, Lynda AU - Huberty, Jennifer PY - 2024/2/2 TI - Mental Health and Well-Being in Racial or Ethnic Minority Individuals After Using a Faith and Prayer Mobile App (Pray.com): Feasibility and Preliminary Efficacy Trial JO - JMIR Form Res SP - e52560 VL - 8 KW - religion KW - spirituality KW - mobile apps KW - mental health KW - well-being KW - app KW - ethnic KW - technology KW - engagement KW - stress KW - depression KW - anxiety KW - quality of life KW - spiritual well-being KW - racial KW - spiritual practices KW - spiritual practice KW - mobile phone KW - mobile health KW - mHealth N2 - Background: Research is needed on how faith and prayer apps fit within the values of racial and ethnic minority (REM) groups, as well as whether such apps are effective in promoting mental health and well-being. Objective: This study aims to determine the feasibility and preliminary effectiveness of using the mobile app Pray.com on mental health and well-being among REM participants. Methods: This study was a single-group (N=77), 4-week feasibility trial in REM groups (65/77, 84% Black or African American). Participants were asked to use the Pray.com app at no cost for at least 5 times per week for 5 minutes per day. Participants completed questionnaires at the baseline and postintervention time points. Feasibility questionnaires were only completed at the postintervention time point, including qualitative interviews (n=15). The feasibility questions included acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture), demand (ie, self-reported app use, expressed interest, and perceived demand), and practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness). Frequency and descriptive statistics were used to analyze feasibility outcomes. Changes in dependent variables were analyzed using paired-sample 2-tailed t tests. Partial correlations were conducted to explore the association between app use and outcomes, controlling for baseline scores. Results: Participants reported (54/72, 75% responded with ?very likely? or ?likely? to the feasibility questions) that they perceived the Pray.com app as acceptable. These findings were supported by qualitative interviews (n=15). Most participants (62/72, 86%) did not meet the app use prescription but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive (US $7.99). Participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) at postintervention despite relatively low average levels and high variability of app use (average total of 45.83, SD 111.90 min over the course of the study). Greater app use was significantly associated with improvements in mental health and spiritual well-being. However, app use and study methodology limitations suggest that the study results may not accurately capture the full impact of Pray.com use. Conclusions: This is the first study to assess the feasibility of a faith and prayer app for mental health and well-being in a sample of REM individuals. Our findings suggest that the use of a faith and prayer app (ie, Pray.com) could be feasible and significantly impactful for the improvement of mental health symptoms and well-being in REM individuals and their communities, especially Black and African American individuals with a Christian affiliation. Further research is warranted. UR - https://formative.jmir.org/2024/1/e52560 UR - http://dx.doi.org/10.2196/52560 UR - http://www.ncbi.nlm.nih.gov/pubmed/38306173 ID - info:doi/10.2196/52560 ER - TY - JOUR AU - Ronen, Keshet AU - Gewali, Anupa AU - Dachelet, Kristin AU - White, Erica AU - Jean-Baptiste, Marimirca AU - Evans, N. Yolanda AU - Unger, A. Jennifer AU - Tandon, Darius S. AU - Bhat, Amritha PY - 2024/2/2 TI - Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study JO - JMIR Form Res SP - e51066 VL - 8 KW - perinatal depression KW - youth KW - mHealth KW - digital health KW - acceptability KW - utility KW - depression KW - pilot study KW - pregnancy KW - postpartum KW - prevention KW - cognitive behavioral therapy KW - psychoeducation KW - mixed methods KW - manage KW - mood KW - mobile phone N2 - Background: Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. Objective: We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. Methods: IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ?80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. Results: Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. Conclusions: This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study?s small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation. UR - https://formative.jmir.org/2024/1/e51066 UR - http://dx.doi.org/10.2196/51066 UR - http://www.ncbi.nlm.nih.gov/pubmed/38306159 ID - info:doi/10.2196/51066 ER - TY - JOUR AU - Masiero, Marianna AU - Filipponi, Chiara AU - Fragale, Elisa AU - Pizzoli, Maria Silvia Francesca AU - Munzone, Elisabetta AU - Milani, Alessandra AU - Guido, Luca AU - Guardamagna, Vittorio AU - Marceglia, Sara AU - Prandin, Roberto AU - Prenassi, Marco AU - Caruso, Annamaria AU - Manzelli, Vania AU - Savino, Chiara AU - Conti, Costanza AU - Rizzi, Federica AU - Casalino, Alice AU - Candiani, Giulia AU - Memini, Francesca AU - Chiveri, Luca AU - Vitali, Luigi Andrea AU - Corbo, Massimo AU - Grasso, Roberto AU - Didier, Florence AU - Ferrucci, Roberta AU - Pravettoni, Gabriella PY - 2024/2/2 TI - Support for Chronic Pain Management for Breast Cancer Survivors Through Novel Digital Health Ecosystems: Pilot Usability Study of the PainRELife Mobile App JO - JMIR Form Res SP - e51021 VL - 8 KW - chronic pain KW - eHealth KW - cancer KW - decision-making KW - survivorship KW - self-efficacy KW - pain KW - oncology KW - health ecosystem KW - health ecosystems KW - breast KW - survivor KW - survivors KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - MARS N2 - Background: Chronic pain is one of the most common and critical long-term effects of breast cancer. Digital health technologies enhance the management of chronic pain by monitoring physical and psychological health status and supporting pain self-management and patient treatment decisions throughout the clinical pathway. Objective: This pilot study aims to evaluate patients? experiences, including usability, with a novel digital integrated health ecosystem for chronic pain named PainRELife. The sample included patients with breast cancer during survivorship. The PainRELife ecosystem comprises a cloud technology platform interconnected with electronic health records and patients' devices to gather integrated health care data. Methods: We enrolled 25 patients with breast cancer (mean age 47.12 years) experiencing pain. They were instructed to use the PainRELife mobile app for 3 months consecutively. The Mobile Application Rating Scale (MARS) was used to evaluate usability. Furthermore, pain self-efficacy and participation in treatment decisions were evaluated. The study received ethical approval (R1597/21-IEO 1701) from the Ethical Committee of the European Institute of Oncology. Results: The MARS subscale scores were medium to high (range: 3.31-4.18), and the total app quality score was 3.90. Patients with breast cancer reported reduced pain intensity at 3 months, from a mean of 5 at T0 to a mean of 3.72 at T2 (P=.04). The total number of times the app was accessed was positively correlated with pain intensity at 3 months (P=.03). The engagement (P=.03), information (P=.04), and subjective quality (P=.007) subscales were positively correlated with shared decision-making. Furthermore, participants with a lower pain self-efficacy at T2 (mean 40.83) used the mobile app more than participants with a higher pain self-efficacy (mean 48.46; P=.057). Conclusions: The data collected in this study highlight that digital health technologies, when developed using a patient-driven approach, might be valuable tools for increasing participation in clinical care by patients with breast cancer, permitting them to achieve a series of key clinical outcomes and improving quality of life. Digital integrated health ecosystems might be important tools for improving ongoing monitoring of physical status, psychological burden, and socioeconomic issues during the cancer survivorship trajectory. International Registered Report Identifier (IRRID): RR2-10.2196/41216 UR - https://formative.jmir.org/2024/1/e51021 UR - http://dx.doi.org/10.2196/51021 UR - http://www.ncbi.nlm.nih.gov/pubmed/38306176 ID - info:doi/10.2196/51021 ER - TY - JOUR AU - De Jesús-Romero, Robinson AU - Holder-Dixon, R. Amani AU - Buss, F. John AU - Lorenzo-Luaces, Lorenzo PY - 2024/2/1 TI - Race, Ethnicity, and Other Cultural Background Factors in Trials of Internet-Based Cognitive Behavioral Therapy for Depression: Systematic Review JO - J Med Internet Res SP - e50780 VL - 26 KW - diversity KW - cognitive behavioral therapy KW - internet-based KW - depression KW - race KW - racial KW - ethnicity KW - culture KW - depressive KW - diverse KW - inclusive KW - inclusivity KW - DEI KW - diversity, equity, and inclusion KW - internet-based cognitive behavioral therapy KW - mental health KW - ethnic KW - cultures KW - culturally KW - review methods KW - review methodology KW - systematic KW - clinical trial KW - clinical trials KW - randomized controlled trial KW - randomized controlled trials KW - controlled trial KW - controlled trials KW - reporting KW - immigrant KW - migrant KW - migrants KW - immigrants KW - psychotherapy KW - underrepresented KW - underrepresentation KW - representation KW - mobile phone N2 - Background: There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature. Objective: Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence. Methods: Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures. Results: A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27%) of the trials reported race, and only 12 (19%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88%) out of 17 of studies that reported race and 9 (75%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic review, the racial category reported the most was White (n=2716, 74.9%), followed by Asian (n=209, 5.8%) and Black (n=274, 7.6%). Furthermore, only 25 (54%) out of the 46 papers conducted outside of the United States reported other background demographics. Conclusions: It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions. UR - https://www.jmir.org/2024/1/e50780 UR - http://dx.doi.org/10.2196/50780 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300699 ID - info:doi/10.2196/50780 ER - TY - JOUR AU - Karimi, Nazgol AU - Opie, Rachelle AU - Crawford, David AU - O?Connell, Stella AU - Ball, Kylie PY - 2024/2/1 TI - Digitally Delivered Interventions to Improve Nutrition Behaviors Among Resource-Poor and Ethnic Minority Groups With Type 2 Diabetes: Systematic Review JO - J Med Internet Res SP - e42595 VL - 26 KW - digitally delivered KW - eHealth KW - type 2 diabetes KW - nutrition KW - socioeconomically disadvantaged KW - mobile phone N2 - Background: Resource-poor individuals, such as those with a low income, are disproportionately affected by diabetes and unhealthy eating patterns that contribute to poor disease self-management and prognosis. Digitally delivered interventions have the potential to address some of the barriers to healthy eating experienced by this group. However, little is known about their effectiveness in disadvantaged populations. Objective: This systematic review is conducted to assess the effectiveness of digitally delivered interventions in improving nutritional behaviors and nutrition?related health outcomes among disadvantaged people with type 2 diabetes (T2D). Methods: MEDLINE complete, Global Health, Embase, CINAHL complete, Informit Health, IEEE Xplore, and Applied Science and Technology Source databases were searched for studies published between 1990 and 2022 on digitally delivered nutrition interventions for disadvantaged people with T2D. Two reviewers independently assessed the studies for eligibility and determined the study quality using the Cochrane Risk-of-Bias Assessment Tool. The Behavioral Change Technique Taxonomy V1 was used to identify behavior change techniques used in the design of interventions. Results: Of the 2434 identified records, 10 (0.4%), comprising 947 participants, met the eligibility criteria and were included in the review. A total of 2 digital platforms, web and messaging services (eg, SMS text messaging interventions or multimedia messaging service), were used to deliver interventions. Substantial improvements in dietary behaviors were reported in 5 (50%) of the 10 studies, representing improvements in healthier food choices or increases in dietary knowledge and skills or self-efficacy. Of the 10 studies, 7 (70%) examined changes in blood glucose levels, of which 4 (57%) out of 7 achieved significant decreases in hemoglobin A1C levels ranging from 0.3% to 1.8%. The most frequently identified behavior change techniques across all studies were instruction on how to perform the behavior, information about health consequences, and social support. Conclusions: This review provided some support for the efficacy of digitally delivered interventions in improving healthy eating behaviors in disadvantaged people with T2D, an essential dietary prerequisite for changes in clinical metabolic parameters. Further research is needed into how disadvantaged people with T2D may benefit more from digital approaches and to identify the specific features of effective digital interventions for supporting healthy behaviors among disadvantaged populations. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020149844; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=149844 UR - https://www.jmir.org/2024/1/e42595 UR - http://dx.doi.org/10.2196/42595 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300694 ID - info:doi/10.2196/42595 ER - TY - JOUR AU - Zhou, Tianyu AU - Salman, David AU - McGregor, Alison PY - 2024/2/1 TI - mHealth Apps for the Self-Management of Low Back Pain: Systematic Search in App Stores and Content Analysis JO - JMIR Mhealth Uhealth SP - e53262 VL - 12 KW - smartphone KW - mHealth KW - mobile health KW - low back pain KW - self-management KW - treatment interventions KW - mobile phone N2 - Background: With the rapid development of mobile health (mHealth) technology, many health apps have been introduced to the commercial market for people with back pain conditions. However, little is known about their content, quality, approaches to care for low back pain (LBP), and associated risks of use. Objective: The aims of this research were to (1) identify apps for the self-management of LBP currently on the market and (2) assess their quality, intervention content, theoretical approaches, and risk-related approaches. Methods: The UK iTunes and Google Play stores were initially searched for apps related to the self-management of LBP in May 2022. A repeat search in June 2023 was conducted to ensure that any relevant new apps developed in the last year were incorporated into the review. A total of 3 keywords recommended by the Cochrane Back and Neck Group were used to search apps ?low back pain,? ?back pain,? and ?lumbago.? The quality of the apps was assessed by using the 5-point Mobile App Rating Scale (MARS). Results: A total of 69 apps (25 iOS and 44 Android) met the inclusion criteria. These LBP self-management apps mainly provide recommendations on muscle stretching (n=51, 73.9%), muscle strengthening (n=42, 60.9%), core stability exercises (n=32, 46.4%), yoga (n=19, 27.5%), and information about LBP mechanisms (n=17, 24.6%). Most interventions (n=14, 78%) are consistent with the recommendations in the National Institute for Health and Care Excellence (NICE) guidelines. The mean (SD) MARS overall score of included apps was 2.4 (0.44) out of a possible 5 points. The functionality dimension was associated with the highest score (3.0), whereas the engagement and information dimension resulted in the lowest score (2.1). Regarding theoretical and risk-related approaches, 18 (26.1%) of the 69 apps reported the rate of intervention progression, 11 (15.9%) reported safety checks, only 1 (1.4%) reported personalization of care, and none reported the theoretical care model or the age group targeted. Conclusions: mHealth apps are potentially promising alternatives to help people manage their LBP; however, most of the LBP self-management apps were of poor quality and did not report the theoretical approaches to care and their associated risks. Although nearly all apps reviewed included a component of care listed in the NICE guidelines, the model of care delivery or embracement of care principles such as the application of a biopsychosocial model was unclear. UR - https://mhealth.jmir.org/2024/1/e53262 UR - http://dx.doi.org/10.2196/53262 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300700 ID - info:doi/10.2196/53262 ER - TY - JOUR AU - Lee, Kyoungjin AU - Park, Jeongok AU - Oh, Geum Eui AU - Lee, JuHee AU - Park, Chang AU - Choi, Deuk Young PY - 2024/2/1 TI - Effectiveness of a Nurse-Led Mobile-Based Health Coaching Program for Patients With Prostate Cancer at High Risk of Metabolic Syndrome: Randomized Waitlist Controlled Trial JO - JMIR Mhealth Uhealth SP - e47102 VL - 12 KW - nurses KW - prostate neoplasms KW - healthy lifestyle KW - metabolic syndrome KW - exercise KW - diet KW - mobile phone N2 - Background: Androgen deprivation therapy (ADT), a standard treatment for prostate cancer (PC), causes many physical side effects. In particular, it causes metabolic changes such as fasting glucose abnormalities or accumulation of body fat, and its continuation can lead to metabolic syndrome (MetS), which is closely related to diabetes and cardiovascular disease. Therefore, it is important to maintain and practice a healthy lifestyle in patients with PC. Objective: This study aims to evaluate the effectiveness of a nurse-led mobile-based program that aims to promote a healthy lifestyle in patients with PC undergoing ADT with MetS risk factors. Methods: This was a single-blind, randomized, waitlist control interventional study. A total of 48 patients were randomly assigned to the experimental and waitlist control groups at the urology cancer clinic of a tertiary general hospital in South Korea. The inclusion criteria were patients who had undergone ADT for >6 months, had at least 1 of the 5 MetS components in the abnormal range, and could access a mobile-based education program. The experimental group attended a 4-week mobile-based program on exercise and diet that included counseling and encouragement to maintain a healthy lifestyle, whereas the control group was placed on a waitlist and received usual care during the follow-up period, followed by the intervention. The primary outcome was a change in the lifestyle score. The secondary outcomes were changes in 5 MetS components, body composition, and health-related quality of life. The outcomes were measured at 6 weeks and 12 weeks after the initiation of the intervention. Each participant was assigned to each group in a sequential order of enrollment in a 4×4 permuted block design randomization table generated in the SAS (SAS Institute) statistical program. A linear mixed model was used for statistical analysis. Results: A total of 24 participants were randomly assigned to each group; however, 2 participants in the experimental group dropped out for personal reasons before starting the intervention. Finally, 46 participants were included in the intention-to-treat analysis. The experimental group showed more positive changes in the healthy lifestyle score (?=29.23; P?.001), level of each MetS component (fasting blood sugar: ?=?12.0; P=.05 and abdominal circumference: ?=?2.49; P=.049), body composition (body weight: ?=?1.52; P<.001 and BMI: ?=?0.55; P<.001), and the urinary irritative and obstructive domain of health-related quality of life (?=14.63; P<.001) over time than the waitlist control group. Conclusions: Lifestyle changes through nurse-led education can improve level of each MetS components, body composition, and ADT side effects. Nurses can induce positive changes in patients? lifestyles and improve the self-management of patients starting ADT through this program. Trial Registration: Clinical Research Information Service KCT0006560; http://tinyurl.com/yhvj4vwh UR - https://mhealth.jmir.org/2024/1/e47102 UR - http://dx.doi.org/10.2196/47102 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300697 ID - info:doi/10.2196/47102 ER - TY - JOUR AU - van der Heijden, Zoë AU - de Gooijer, Femke AU - Camps, Guido AU - Lucassen, Desiree AU - Feskens, Edith AU - Lasschuijt, Marlou AU - Brouwer-Brolsma, Elske PY - 2024/2/1 TI - User Requirements in Developing a Novel Dietary Assessment Tool for Children: Mixed Methods Study JO - JMIR Form Res SP - e47850 VL - 8 KW - diet KW - children KW - dietary assessment KW - recall KW - technological innovation KW - mobile health KW - mHealth KW - mobile phone N2 - Background: The prevalence of childhood obesity and comorbidities is rising alarmingly, and diet is an important modifiable determinant. Numerous dietary interventions in children have been developed to reduce childhood obesity and overweight rates, but their long-term effects are unsatisfactory. Stakeholders call for more personalized approaches, which require detailed dietary intake data. In the case of primary school children, caregivers are key to providing such dietary information. However, as school-aged children are not under the full supervision of one specific caregiver anymore, data are likely to be biased. Recent technological advancements provide opportunities for the role of children themselves, which would serve the overall quality of the obtained dietary data. Objective: This study aims to conduct a child-centered exploratory sequential mixed methods study to identify user requirements for a dietary assessment tool for children aged 5 to 6 years. Methods: Formative, nonsystematic narrative literature research was undertaken to delineate initial user requirements and inform prototype ideation in an expert panel workshop (n=11). This yielded 3 prototype dietary assessment tools: FoodBear (tangible piggy bank), myBear (smartphone or tablet app), and FoodCam (physical camera). All 3 prototypes were tested for usability by means of a usability task (video analyses) and user experience (This or That method) among 14 Dutch children aged 5 to 6 years (n=8, 57% boys and n=6, 43% girls). Results: Most children were able to complete FoodBear?s (11/14, 79%), myBear?s (10/14, 71%), and FoodCam?s (9/14, 64%) usability tasks, but all children required assistance (14/14, 100%) and most of the children encountered usability problems (13/14, 93%). Usability issues were related to food group categorization and recognition, frustrations owing to unsatisfactory functioning of (parts) of the prototypes, recall of food products, and the distinction between eating moments. No short-term differences in product preference between the 3 prototypes were observed, but autonomy, challenge, gaming elements, being tablet based, appearance, social elements, and time frame were identified as determinants of liking the product. Conclusions: Our results suggest that children can play a complementary role in dietary data collection to enhance the data collected by their parents. Incorporation of a training program, auditory or visual prompts, reminders and feedback, a user-friendly and intuitive interaction design, child-friendly food groups or icons, and room for children?s autonomy were identified as requirements for the future development of a novel and usable dietary assessment tool for children aged 5 to 6 years. Our findings can serve as valuable guidance for ongoing innovations in the field of children?s dietary assessment and the provision of personalized dietary support. UR - https://formative.jmir.org/2024/1/e47850 UR - http://dx.doi.org/10.2196/47850 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300689 ID - info:doi/10.2196/47850 ER - TY - JOUR AU - Abd-alrazaq, Alaa AU - Alajlani, Mohannad AU - Ahmad, Reham AU - AlSaad, Rawan AU - Aziz, Sarah AU - Ahmed, Arfan AU - Alsahli, Mohammed AU - Damseh, Rafat AU - Sheikh, Javaid PY - 2024/1/31 TI - The Performance of Wearable AI in Detecting Stress Among Students: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e52622 VL - 26 KW - stress KW - artificial intelligence KW - wearable devices KW - machine learning KW - systematic review KW - students KW - mobile phone N2 - Background: Students usually encounter stress throughout their academic path. Ongoing stressors may lead to chronic stress, adversely affecting their physical and mental well-being. Thus, early detection and monitoring of stress among students are crucial. Wearable artificial intelligence (AI) has emerged as a valuable tool for this purpose. It offers an objective, noninvasive, nonobtrusive, automated approach to continuously monitor biomarkers in real time, thereby addressing the limitations of traditional approaches such as self-reported questionnaires. Objective: This systematic review and meta-analysis aim to assess the performance of wearable AI in detecting and predicting stress among students. Methods: Search sources in this review included 7 electronic databases (MEDLINE, Embase, PsycINFO, ACM Digital Library, Scopus, IEEE Xplore, and Google Scholar). We also checked the reference lists of the included studies and checked studies that cited the included studies. The search was conducted on June 12, 2023. This review included research articles centered on the creation or application of AI algorithms for the detection or prediction of stress among students using data from wearable devices. In total, 2 independent reviewers performed study selection, data extraction, and risk-of-bias assessment. The Quality Assessment of Diagnostic Accuracy Studies?Revised tool was adapted and used to examine the risk of bias in the included studies. Evidence synthesis was conducted using narrative and statistical techniques. Results: This review included 5.8% (19/327) of the studies retrieved from the search sources. A meta-analysis of 37 accuracy estimates derived from 32% (6/19) of the studies revealed a pooled mean accuracy of 0.856 (95% CI 0.70-0.93). Subgroup analyses demonstrated that the accuracy of wearable AI was moderated by the number of stress classes (P=.02), type of wearable device (P=.049), location of the wearable device (P=.02), data set size (P=.009), and ground truth (P=.001). The average estimates of sensitivity, specificity, and F1-score were 0.755 (SD 0.181), 0.744 (SD 0.147), and 0.759 (SD 0.139), respectively. Conclusions: Wearable AI shows promise in detecting student stress but currently has suboptimal performance. The results of the subgroup analyses should be carefully interpreted given that many of these findings may be due to other confounding factors rather than the underlying grouping characteristics. Thus, wearable AI should be used alongside other assessments (eg, clinical questionnaires) until further evidence is available. Future research should explore the ability of wearable AI to differentiate types of stress, distinguish stress from other mental health issues, predict future occurrences of stress, consider factors such as the placement of the wearable device and the methods used to assess the ground truth, and report detailed results to facilitate the conduct of meta-analyses. Trial Registration: PROSPERO CRD42023435051; http://tinyurl.com/3fzb5rnp UR - https://www.jmir.org/2024/1/e52622 UR - http://dx.doi.org/10.2196/52622 UR - http://www.ncbi.nlm.nih.gov/pubmed/38294846 ID - info:doi/10.2196/52622 ER - TY - JOUR AU - Rebus, David AU - Iskander, Andrew AU - Deonarine, Felicia AU - Almas, Asad AU - Rattigan, Darren AU - Henn, Patrick AU - Fadahunsi, Philip Kayode AU - O'Donoghue, John PY - 2024/1/31 TI - Compliance of Type 2 Diabetes Applications to International Guidelines: Protocol for a Quantitative App Assessment JO - JMIR Res Protoc SP - e48781 VL - 13 KW - diabetes KW - mobile apps KW - Mobile Apps Rating Scale KW - mHealth KW - mobile health KW - diabetes application KW - application KW - chronic condition KW - monitoring KW - accuracy KW - safety KW - tool KW - assistance KW - treatment KW - management KW - type 2 diabetes N2 - Background: Diabetes is among the most common chronic conditions people live with across the world. While it can be managed to a substantial degree, it can result in significant complications. As such, easy access to accurate tools to aid diabetes management is useful in minimizing these complications. Mobile apps are highly accessible and widely used, but there is a gap in the literature examining their compliance with medical guidelines. Objective: The aims of this study are to develop the Analysis of Diabetes Apps (ADA) checklist to evaluate apps? compliance to guidelines set by the International Diabetes Federation (IDF) on the treatment and management of type 2 diabetes; to assess type 2 diabetes apps in the Apple App Store and the Android Google Play Store, and their compliance with international guidelines using the ADA framework; and to compare the novel ADA checklist against both the Mobile App Rating Scale (MARS) tool kit and app ratings for each store. Methods: We will develop a checklist based on the ?IDF Clinical Practice Recommendations for Managing Type 2 Diabetes in Primary Care.? Type 2 diabetes apps will be scraped from 6 countries? app stores using web scraping tools. These countries include Australia, Brazil, India, Nigeria, the United States, and the United Kingdom, which were selected based on the largest population of English-speaking people in each continent. The apps will be searched on the web-based scraper using the search terms ?blood sugar,? ?diabetes,? ?glucose level,? ?insulin,? ?sugar level,? and ?type 2 diabetes.? Apps will be excluded if they are paid or are not in English. The apps will be assessed using the ADA checklist to evaluate their compliance to the international diabetes guidelines. Once scored, the results will be analyzed with descriptive statistics. The most popular apps will be further analyzed using the MARS tool kit. The ADA checklist scores will then be compared to both the MARS tool kit score and app ratings for each store. Results: The ADA checklist developed based on the IDF guidelines focuses on general information, risk factors, diagnosis, pharmacology, lifestyle modification, glycemic recommendations, and medications. The initial stress testing of the protocol resulted in 173 included apps. This will vary in the final search as the app stores are constantly changing. Conclusions: The protocol presents the development of a checklist to investigate the compliance of type 2 diabetes apps with international guidelines. The checklist will hopefully form the basis of a scoring system for future research on compliance of mobile apps with international guidelines. High standardization of the ADA checklist will make it a robust tool for people with diabetes and their health care providers alike in assessing type 2 diabetes apps in the future. International Registered Report Identifier (IRRID): PRR1-10.2196/48781 UR - https://www.researchprotocols.org/2024/1/e48781 UR - http://dx.doi.org/10.2196/48781 UR - http://www.ncbi.nlm.nih.gov/pubmed/38294861 ID - info:doi/10.2196/48781 ER - TY - JOUR AU - Al-yaseen, Waraf AU - Raggio, Procida Daniela AU - Araujo, Mariana AU - Innes, Nicola PY - 2024/1/30 TI - ?I Just Wanted a Dentist in My Phone??Designing Evidence-Based mHealth Prototype to Improve Preschool Children?s Oral and Dental Health: Multimethod Study of the Codevelopment of an App for Children?s Teeth JO - JMIR Form Res SP - e49561 VL - 8 KW - oral health promotion KW - mobile health KW - mHealth KW - children KW - oral health KW - behavior change KW - coproduction KW - mobile phone N2 - Background: Dental caries in preschool children is a global health concern. With increased access to technology and the disruption of health care during the pandemic, mobile health apps have been of interest as potential vehicles for individuals? health maintenance. However, little is known about caring for their child?s teeth and what their preferences would be regarding the content or design of an oral health app. Objective: This study aims to co-design the prototype of an app named App for Children?s Teeth with parents, providing a source of information for them about caring for their children?s teeth and promoting positive dental habits. Methods: This multimethod study conducted user involvement research with a purposive sample of parents or carers of children aged ?6 years to (1) understand their use of the internet through the eHealth Literacy Scale and interviews, (2) determine their opinions about content related to children?s oral health, and (3) collect feedback about the app?s acceptability using the Theoretical Framework of Acceptability. There were three stages: (1) interviews with parents to understand their needs, preferences, and abilities; (2) prototype design with app developers; and (3) parent feedback interviews using the think aloud method for data collection. Data were deductively analyzed using a codebook strategy, whereas data from the think aloud sessions were analyzed inductively using reflexive thematic analysis. Results: The prototype design stage involved 10 parents who reported using the internet for health information but found it to be scattered and contradictory. Parents generally welcomed the App for Children?s Teeth but expressed concerns about screen time and practicality. They suggested guidance regarding oral hygiene practices, teething symptoms, and pain relief. Parents appreciated features such as clear fonts, categorization according to their child?s age, and ?In a Nutshell? bullet points. Topics that resonated with parents included information about teething, finding a dentist, and breastfeeding. They believed that the app aligned with their goals and offered suggestions for future developments, such as outlining the process of finding a dentist and incorporating a forum for parents to communicate and exchange ideas. Conclusions: The coproduction design approach highlighted parents? need for solutions such as mobile health apps to access reliable information about oral health. Parents identified key design concepts for the app, including a simple and uncluttered interface, content categorization according to their child?s age, and practical guidance supported by visual aids. Despite potential challenges related to screen time restrictions, parents provided insights into how such an app could fit seamlessly into their lives. Trial Registration: Open Science Framework; https://osf.io/uj9az UR - https://formative.jmir.org/2024/1/e49561 UR - http://dx.doi.org/10.2196/49561 UR - http://www.ncbi.nlm.nih.gov/pubmed/38289667 ID - info:doi/10.2196/49561 ER - TY - JOUR AU - Liu, Peng AU - Wang, Lingmeng AU - Wang, Fuzhi PY - 2024/1/26 TI - Evaluation of Chinese HIV Mobile Apps by Researchers and Patients With HIV: Quality Evaluation Study JO - JMIR Mhealth Uhealth SP - e52573 VL - 12 KW - HIV KW - mobile app KW - evaluation KW - mobile phone N2 - Background: Against the backdrop of globalization, China remains one of the most heavily burdened countries in Asia with regard to AIDS. However, many high-risk groups and patients affected by AIDS may be less likely to actively seek care from medical institutions because of fear of experiencing shame or discrimination. Mobile apps provide a promising avenue for supporting the prevention, diagnosis, and treatment of AIDS. However, a comprehensive systematic evaluation of these mobile apps? functionality and quality has not been conducted yet. Objective: This study aims to identify the available mobile apps for AIDS in China, assess and discuss the functional features and quality of these Chinese AIDS mobile apps, and offer decision support for patients and clinical practitioners in accessing high-quality AIDS mobile apps. Furthermore, based on the evaluation results, recommendations for improvement will be provided. Methods: A systematic search was conducted on the Qimai app data platform, the Aladdin WeChat applet data platform, and WeChat to identify mobile apps related to AIDS. A snowball sampling method was used to supplement the potentially overlooked apps. The selected mobile apps underwent a rigorous screening process based on unified criteria. Subsequently, assessments were independently undertaken by 3 separate researchers and 2 patients with HIV, using both the Mobile App Rating Scale (MARS) and the User Mobile App Rating Scale (uMARS). Quantitative interpretations of the data were facilitated by the MedCalc statistical software (version 20.217, MedCalc Software). Results: A total of 2901 AIDS mobile apps were included in the study, with 2897 identified through information retrieval and an additional 4 added via snowball sampling. After a rigorous selection process, 21 apps were determined to be usable. Among them, the Hong Feng Wan app achieved the highest combined average score, calculated based on the MARS (3.96, SD 0.33) and uMARS (4.47, SD 0.26). Overall, there was no significant correlation between MARS and uMARS (rapp quality total score=0.41; P=.07; rsubjective quality=0.39; P=.08). A notable issue was the widespread lack of user privacy protection, with only 24% (5/21) of the apps offering this feature. Conclusions: The number of available Chinese AIDS mobile apps is limited, with WeChat applets dominating the market. Nonetheless, the performance of WeChat mini-apps is generally inferior to that of independent apps, and there may be significant discrepancies between assessments conducted by researchers and those provided by genuine end users, emphasizing the necessity of involving real users in the development and evaluation of HIV mobile apps. In addition, developers of these Chinese HIV mobile apps need to devote attention to improving privacy protection mechanisms, in addition to considering the evaluations of researchers and real users. This will help attract more users and increase user loyalty. UR - https://mhealth.jmir.org/2024/1/e52573 UR - http://dx.doi.org/10.2196/52573 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277215 ID - info:doi/10.2196/52573 ER - TY - JOUR AU - Phillips, Craig J. AU - Alfano, R. Alliete AU - Barfield, C. Latisha AU - Cain, Lisa AU - Sadjadi, Masoud AU - Morales, Eduardo AU - Phillips-Beck, Wanda AU - Galarza, Grisel M. AU - Torres, Maritza AU - Zindani, Sadaf AU - Rayani, Ahmad AU - Edwards, Khalee AU - Jones, Gracia Sande AU - Hannan, Jean PY - 2024/1/26 TI - Exploring Maternal and Infant Health App Development and Effectiveness Research: Scoping Review JO - JMIR Pediatr Parent SP - e46973 VL - 7 KW - maternal and child health KW - smartphone KW - mobile health KW - mHealth KW - eHealth KW - app development KW - app evaluation KW - app effectiveness KW - maternal and infant app KW - pregnancy, postpartum KW - mothers KW - mobile phone KW - artificial intelligence KW - AI N2 - Background: Globally, high rates of maternal and infant mortality call for interventions during the perinatal period to engage pregnant people as well as their loved ones in care. Mobile health technologies have become ubiquitous in our lives and in health care settings. However, there is a need to further explore their safety and effectiveness to support and improve health outcomes locally and globally. Objective: The aim of this study was to review and synthesize published literature that described the development process or effectiveness evaluations of maternal and infant apps. Methods: We applied a methodological framework for scoping reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines; in addition, the systematic review platform Covidence (Veritas Health Innovation Ltd) was used to facilitate the review of included studies. Search terms were developed collaboratively, and health sciences?associated databases were searched for studies conducted between January 1, 2000, and February 4, 2022. We excluded studies about apps that only gathered or tracked data or targeted care providers. Results: A total of 1027 articles were included for title and abstract screening, of which 87 (8.47%) were chosen for full-text screening. Of these 87 articles, 74 (85%) were excluded with reasons, and 19 (22%) were included. Four articles were added at data extraction from hand searching and 2 others were excluded. Thus, we reviewed and synthesized data from 11 unique studies reported in 21 articles published between 2017 and 2021. The included studies represented 8 different countries. Most of the apps (8/11, 73%) were in English, although apps were also developed in Arabic, Bahasa Indonesia, and Nepali. The articles reviewed revealed the early stage of development of the field of maternal and infant health apps, with modest evidence of app use and achievement of study outcomes. Only 1 (9%) of the 11 apps was endorsed by an independent health care provider society. App development and evaluation processes emerged, and specific app features were identified as vital for well-functioning apps. End-user engagement occurred in some, but not all, parts of app research and development. Conclusions: Apps to improve maternal and infant health are being developed and launched in enormous numbers, with many of them not developed with mothers? needs in mind. There are concerns about privacy, safety, and the standardization of current apps as well as a need for professional or institution-specific guidelines or best practices. Despite challenges inherent in currently available apps and their design processes, maternal and infant app technology holds promise for achieving health equity goals and improving maternal and child health outcomes. Finally, we propose recommendations for advancing the knowledge base for maternal and infant apps. UR - https://pediatrics.jmir.org/2024/1/e46973 UR - http://dx.doi.org/10.2196/46973 UR - http://www.ncbi.nlm.nih.gov/pubmed/38055330 ID - info:doi/10.2196/46973 ER - TY - JOUR AU - Walker, Tim AU - Buckingham, Ann Sarah AU - Poole, Ria AU - Elliott, Roland Lewis AU - Menneer, Tamaryn AU - Tu, Gengyang AU - Morrissey, Karyn PY - 2024/1/26 TI - Telephone-Based Training Intervention for Using Digital Communication Technologies for Social Housing Residents During the COVID-19 Pandemic: Mixed Methods Feasibility and Acceptability Evaluation JO - JMIR Form Res SP - e45506 VL - 8 KW - digital training KW - telephone-based KW - social housing KW - feasibility KW - acceptability KW - communication technologies KW - sociodigital inequalities KW - mobile phone N2 - Background: In an era in which digital communication technologies play a pivotal role in everyday life, social housing residents remain highly susceptible to digital exclusion. Objective: This study aims to evaluate the feasibility and acceptability of a telephone-based training intervention designed to empower people to confidently use digital communication technologies (ie, video calls and web-based messaging). Methods: Conducted in collaboration with a UK social housing association, the intervention was facilitated by a unitary authority?s Digital Inclusion Team during the COVID-19 pandemic. A mixed methods approach was used, encompassing quantitative and qualitative data collection on demand, reach, implementation, and potential outcomes. Demographic and qualitative data on the reasons for undertaking or not undertaking the training were collected via telephone interviews during the recruitment process. Digital competency and well-being data were collected via a self-reported survey before and after the intervention. Results: Among the 4485 residents who were offered training, 67 (1.49%) expressed interest, of whom 12 (18%) of the 67 completed the training. The findings indicate a demand for basic digital training among social housing residents. The key findings revolve around the substantial dropout rate among those who were interested in undertaking the training. Barriers were strongly influenced by socioeconomic and health circumstances, reflecting the sociodigital inequalities commonly found in this group. For the training participants, the intervention was acceptable and achieved its goals, demonstrating the potential of tailored, persistent training efforts in overcoming barriers. There were no changes in self-reported well-being or digital competency outcomes (but this was limited by the small sample size). Conclusions: Sociodigital inequalities impact the reach, implementation, and acceptability of telephone-based digital training for social housing residents. Barriers to reaching and training digitally excluded groups can be overcome through the use of trusted intermediaries, personalized recruitment approaches, the minimization of administrative barriers, and tailored and agile training programs. Recognizing the resource-intensive nature of such initiatives, this study calls for enhanced recognition of intermediary efforts in national digital inclusion policies. UR - https://formative.jmir.org/2024/1/e45506 UR - http://dx.doi.org/10.2196/45506 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277209 ID - info:doi/10.2196/45506 ER - TY - JOUR AU - Vanderkruik, C. Rachel AU - Ferguson, Craig AU - Kobylski, A. Lauren AU - Locascio, J. Joseph AU - Hamlett, E. Gabriella AU - Killenberg, C. Parker AU - Lewis, Robert AU - Jones, Noah AU - Rossa, T. Ella AU - Dineen, Hannah AU - Picard, Rosalind AU - Cohen, S. Lee PY - 2024/1/26 TI - Testing a Behavioral Activation Gaming App for Depression During Pregnancy: Multimethod Pilot Study JO - JMIR Form Res SP - e44029 VL - 8 KW - perinatal depression KW - pregnancy KW - behavioral activation KW - mobile app KW - digital intervention KW - mobile phone N2 - Background: Depression during pregnancy is increasingly recognized as a worldwide public health problem. If untreated, there can be detrimental outcomes for the mother and child. Anxiety is also often comorbid with depression. Although effective treatments exist, most women do not receive treatment. Technology is a mechanism to increase access to and engagement in mental health services. Objective: The Guardians is a mobile app, grounded in behavioral activation principles, which seeks to leverage mobile game mechanics and in-game rewards to encourage user engagement. This study seeks to assess app satisfaction and engagement and to explore changes in clinical symptoms of depression and anxiety among a sample of pregnant women with elevated depressive symptoms. Methods: This multimethod pilot test consisted of a single-arm, proof-of-concept trial to examine the feasibility and acceptability of The Guardians among a pregnant sample with depression (N=18). Participation included two web-based study visits: (1) a baseline assessment to collect demographic and obstetric information and to assess clinical symptoms and (2) an exit interview to administer follow-up measures and explore user experience. Participants completed biweekly questionnaires (ie, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7) during the trial to assess depression and anxiety symptom severity. App satisfaction was measured using 2 self-report scales (ie, Mobile Application Rating Scale and Player Experience of Needs Satisfaction scale). Engagement with The Guardians was captured using game interaction metric data. We used backward-eliminated mixed effects longitudinal models to examine the effects of app engagement and satisfaction and length of time in the study on symptoms of depression and anxiety. Content analysis was conducted on qualitative data from exit interviews. Results: The 15-day and 30-day overall app retention rates were 26.6% and 15.1%, respectively. Mixed effects models found significant negative main effects of week in study (?=?.35; t61=?3.05; P=.003), number of activities completed (?=?.12; t61=?2.05; P=.04), days played (?=?.12; t58=?2.9; P=.005), and satisfaction, according to the Mobile Application Rating Scale (?=?3.05; t45=?2.19; P=.03) on depressive symptoms. We have reported about similar analyses for anxiety. There is preliminary evidence suggesting harder activities are associated with greater mood improvement than easier activities. Qualitative content analysis resulted in feedback falling under the following themes: activities, app design, engagement, fit of the app with lifestyle, perceived impact of the app on mood, and suggestions for app modifications. Conclusions: Preliminary results from this multimethod study of The Guardians indicate feasibility and acceptability among pregnant women with depression. Retention and engagement levels were more than double those of previous public mental health apps, and use of the app was associated with significant decrease in depressive symptom scores over the 10-week trial. The Guardians shows promise as an effective and scalable digital intervention to support women experiencing depression. UR - https://formative.jmir.org/2024/1/e44029 UR - http://dx.doi.org/10.2196/44029 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277191 ID - info:doi/10.2196/44029 ER - TY - JOUR AU - Sienko, Anna AU - Thirunavukarasu, James Arun AU - Kuzmich, Tanya AU - Allen, Louise PY - 2024/1/25 TI - An Initial Validation of Community-Based Air-Conduction Audiometry in Adults With Simulated Hearing Impairment Using a New Web App, DigiBel: Validation Study JO - JMIR Form Res SP - e51770 VL - 8 KW - audiology KW - audiometry KW - hearing test KW - eHealth KW - mobile application KW - automated audiometry KW - hearing loss KW - hearing impairment KW - web-app KW - web-apps KW - web-application KW - digital health KW - hearing KW - adult KW - adults KW - mobile health KW - mhealth KW - community-based KW - home-based KW - assistive technology KW - screening KW - usability KW - ears KW - ear N2 - Background: Approximately 80% of primary school children in the United States and Europe experience glue ear, which may impair hearing at a critical time for speech acquisition and social development. A web-based app, DigiBel, has been developed primarily to identify individuals with conductive hearing impairment who may benefit from the temporary use of bone-conduction assistive technology in the community. Objective: This preliminary study aims to determine the screening accuracy and usability of DigiBel self-assessed air-conduction (AC) pure tone audiometry in adult volunteers with simulated hearing impairment prior to formal clinical validation. Methods: Healthy adults, each with 1 ear plugged, underwent automated AC pure tone audiometry (reference test) and DigiBel audiometry in quiet community settings. Threshold measurements were compared across 6 tone frequencies and DigiBel test-retest reliability was calculated. The accuracy of DigiBel for detecting more than 20 dB of hearing impairment was assessed. A total of 30 adults (30 unplugged ears and 30 plugged ears) completed both audiometry tests. Results: DigiBel had 100% sensitivity (95% CI 87.23-100) and 72.73% (95% CI 54.48-86.70) specificity in detecting hearing impairment. Threshold mean bias was insignificant except at 4000 and 8000 Hz where a small but significant overestimation of threshold measurement was identified. All 24 participants completing feedback rated the DigiBel test as good or excellent and 21 (88%) participants agreed or strongly agreed that they would be able to do the test at home without help. Conclusions: This study supports the potential use of DigiBel as a screening tool for hearing impairment. The findings will be used to improve the software further prior to undertaking a formal clinical trial of AC and bone-conduction audiometry in individuals with suspected conductive hearing impairment. UR - https://formative.jmir.org/2024/1/e51770 UR - http://dx.doi.org/10.2196/51770 UR - http://www.ncbi.nlm.nih.gov/pubmed/38271088 ID - info:doi/10.2196/51770 ER - TY - JOUR AU - El Barbari, Siad Jan AU - Fikuart, Maxim AU - Beisemann, Nils AU - Müller, Michael AU - Syrek, Hannah AU - Grützner, Alfred Paul AU - Franke, Jochen AU - Vetter, Yves Sven PY - 2024/1/25 TI - Improving Medical Photography in a Level 1 Trauma Center by Implementing a Specialized Smartphone-Based App in Comparison to the Usage of Digital Cameras: Prospective Panel Study JO - JMIR Form Res SP - e47572 VL - 8 KW - app KW - device usability KW - digital camera KW - medical photo KW - medical photography KW - mRay app KW - PACS KW - patient care KW - patient education KW - picture archiving and communication system KW - questionnaire KW - smartphone N2 - Background: Medical photography plays a pivotal role in modern health care, serving multiple purposes ranging from patient care to medical documentation and education. Specifically, it aids in wound management, surgical planning, and medical training. While digital cameras have traditionally been used, smartphones equipped with specialized apps present an intriguing alternative. Smartphones offer several advantages, including increased usability and efficiency and the capability to uphold medicolegal standards more effectively and consistently. Objective: This study aims to assess whether implementing a specialized smartphone app could lead to more frequent and efficient use of medical photography. Methods: We carried out this study as a comprehensive single-center panel investigation at a level 1 trauma center, encompassing various settings including the emergency department, operating theaters, and surgical wards, over a 6-month period from June to November 2020. Using weekly questionnaires, health care providers were asked about their experiences and preferences with using both digital cameras and smartphones equipped with a specialized medical photography app. Parameters such as the frequency of use, time taken for image upload, and general usability were assessed. Results: A total of 65 questionnaires were assessed for digital camera use and 68 for smartphone use. Usage increased significantly by 5.4 (SD 1.9) times per week (95% CI 1.7-9.2; P=.005) when the smartphone was used. The time it took to upload pictures to the clinical picture and archiving system was significantly shorter for the app (mean 1.8, SD 1.2 min) than for the camera (mean 14.9, SD 24.0 h; P<.001). Smartphone usage also outperformed the digital camera in terms of technical failure (4.4% vs 9.7%; P=.04) and for the technical process of archiving (P<.001) pictures to the picture archiving and communication system (PACS) and display images (P<.001) from it. No difference was found in regard to the photographer?s intent (P=.31) or reasoning (P=.94) behind the pictures. Additionally, the study highlighted that potential concerns regarding data security and patient confidentiality were also better addressed through the smartphone app, given its encryption capabilities and password protection. Conclusions: Specialized smartphone apps provide a secure, rapid, and user-friendly platform for medical photography, showing significant advantages over traditional digital cameras. This study supports the notion that these apps not only have the potential to improve patient care, particularly in the realm of wound management, but also offer substantial medicolegal and economic benefits. Future research should focus on additional aspects such as patient comfort and preference, image resolution, and the quality of photographs, as well as seek to corroborate these findings through a larger sample size. UR - https://formative.jmir.org/2024/1/e47572 UR - http://dx.doi.org/10.2196/47572 UR - http://www.ncbi.nlm.nih.gov/pubmed/38271087 ID - info:doi/10.2196/47572 ER - TY - JOUR AU - Kapoor, Alok AU - Patel, Parth AU - Chennupati, Soumya AU - Mbusa, Daniel AU - Sadiq, Hammad AU - Rampam, Sanjeev AU - Leung, Robert AU - Miller, Megan AU - Vargas, Rivera Kevin AU - Fry, Patrick AU - Lowe, Martin Mary AU - Catalano, Christina AU - Harrison, Charles AU - Catanzaro, Nicholas John AU - Crawford, Sybil AU - Smith, Marie Anne PY - 2024/1/24 TI - Comparing the Efficacy of Targeted and Blast Portal Messaging in Message Opening Rate and Anticoagulation Initiation in Patients With Atrial Fibrillation in the Preventing Preventable Strokes Study II: Prospective Cohort Study JO - JMIR Cardio SP - e49590 VL - 8 KW - anticoagulants KW - atrial fibrillation KW - humans KW - outpatients KW - patient education as topic KW - patient portals N2 - Background: The gap in anticoagulation use among patients with atrial fibrillation (AF) is a major public health threat. Inadequate patient education contributes to this gap. Patient portal?based messaging linked to educational materials may help bridge this gap, but the most effective messaging approach is unknown. Objective: This study aims to compare the responsiveness of patients with AF to an AF or anticoagulation educational message between 2 portal messaging approaches: sending messages targeted at patients with upcoming outpatient appointments 1 week before their scheduled appointment (targeted) versus sending messages to all eligible patients in 1 blast, regardless of appointment scheduling status (blast), at 2 different health systems: the University of Massachusetts Chan Medical School (UMass) and the University of Florida College of Medicine-Jacksonville (UFL). Methods: Using the 2 approaches, we sent patient portal messages to patients with AF and grouped patients by high-risk patients on anticoagulation (group 1), high-risk patients off anticoagulation (group 2), and low-risk patients who may become eligible for anticoagulation in the future (group 3). Risk was classified based on the congestive heart failure, hypertension, age ?75 years, diabetes mellitus, stroke, vascular disease, age between 65 and 74 years, and sex category (CHA2DS2-VASc) score. The messages contained a link to the Upbeat website of the Heart Rhythm Society, which displays print and video materials about AF and anticoagulation. We then tracked message opening, review of the website, anticoagulation use, and administered patient surveys across messaging approaches and sites using Epic Systems (Epic Systems Corporation) electronic health record data and Google website traffic analytics. We then conducted chi-square tests to compare potential differences in the proportion of patients opening messages and other evaluation metrics, adjusting for potential confounders. All statistical analyses were performed in SAS (version 9.4; SAS Institute). Results: We sent 1686 targeted messages and 1450 blast messages. Message opening was significantly higher with the targeted approach for patients on anticoagulation (723/1156, 62.5% vs 382/668, 57.2%; P=.005) and trended the same in patients off anticoagulation; subsequent website reviews did not differ by messaging approach. More patients off anticoagulation at baseline started anticoagulation with the targeted approach than the blast approach (adjusted percentage 9.3% vs 2.1%; P<.001). Conclusions: Patients were more responsive in terms of message opening and subsequent anticoagulation initiation with the targeted approach. UR - https://cardio.jmir.org/2024/1/e49590 UR - http://dx.doi.org/10.2196/49590 UR - http://www.ncbi.nlm.nih.gov/pubmed/38265849 ID - info:doi/10.2196/49590 ER - TY - JOUR AU - Nagel, Johanna AU - Wegener, Florian AU - Grim, Casper AU - Hoppe, Wilhelm Matthias PY - 2024/1/23 TI - Effects of Digital Physical Health Exercises on Musculoskeletal Diseases: Systematic Review With Best-Evidence Synthesis JO - JMIR Mhealth Uhealth SP - e50616 VL - 12 KW - mobile health KW - mHealth KW - electronic health KW - eHealth KW - digital health applications KW - DiGA KW - musculoskeletal KW - MSK KW - home-based KW - PROM KW - disorder KW - mobile phone N2 - Background: Musculoskeletal diseases affect 1.71 billion people worldwide, impose a high biopsychosocial burden on patients, and are associated with high economic costs. The use of digital health interventions is a promising cost-saving approach for the treatment of musculoskeletal diseases. As physical exercise is the best clinical practice in the treatment of musculoskeletal diseases, digital health interventions that provide physical exercises could have a highly positive impact on musculoskeletal diseases, but evidence is lacking. Objective: This systematic review aims to evaluate the impact of digital physical health exercises on patients with musculoskeletal diseases concerning the localization of the musculoskeletal disease, patient-reported outcomes, and medical treatment types. Methods: We performed systematic literature research using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted using the PubMed, BISp, Cochrane Library, and Web of Science databases. The Scottish Intercollegiate Guidelines Network checklist was used to assess the quality of the included original studies. To determine the evidence and direction of the impact of digital physical health exercises, a best-evidence synthesis was conducted, whereby only studies with at least acceptable methodological quality were included for validity purposes. Results: A total of 8988 studies were screened, of which 30 (0.33%) randomized controlled trials met the inclusion criteria. Of these, 16 studies (53%) were of acceptable or high quality; they included 1840 patients (1008/1643, 61.35% female; 3 studies including 197 patients did not report gender distribution) with various musculoskeletal diseases. A total of 3 different intervention types (app-based interventions, internet-based exercises, and telerehabilitation) were used to deliver digital physical health exercises. Strong evidence was found for the positive impact of digital physical health exercises on musculoskeletal diseases located in the back. Moderate evidence was found for diseases located in the shoulder and hip, whereas evidence for the entire body was limited. Conflicting evidence was found for diseases located in the knee and hand. For patient-reported outcomes, strong evidence was found for impairment and quality of life. Conflicting evidence was found for pain and function. Regarding the medical treatment type, conflicting evidence was found for operative and conservative therapies. Conclusions: Strong to moderate evidence was found for a positive impact on musculoskeletal diseases located in the back, shoulder, and hip and on the patient-reported outcomes of impairment and quality of life. Thus, digital physical health exercises could have a positive effect on a variety of symptoms of musculoskeletal diseases. UR - https://mhealth.jmir.org/2024/1/e50616 UR - http://dx.doi.org/10.2196/50616 UR - http://www.ncbi.nlm.nih.gov/pubmed/38261356 ID - info:doi/10.2196/50616 ER - TY - JOUR AU - Morsa, Maxime AU - Perrin, Amélie AU - David, Valérie AU - Rault, Gilles AU - Le Roux, Enora AU - Alberti, Corinne AU - Gagnayre, Rémi AU - Pougheon Bertrand, Dominique PY - 2024/1/23 TI - Experiences Among Patients With Cystic Fibrosis in the MucoExocet Study of Using Connected Devices for the Management of Pulmonary Exacerbations: Grounded Theory Qualitative Research JO - JMIR Form Res SP - e38064 VL - 8 KW - cystic fibrosis KW - mobile health KW - mHealth KW - patient education KW - chronic disease KW - empowerment KW - devices KW - patients KW - detection KW - treatment KW - respiratory KW - education KW - monitoring KW - care N2 - Background: Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis is important to quickly trigger treatment and reduce respiratory damage. An intervention was designed in the frame of the MucoExocet research study providing patients with cystic fibrosis with connected devices and educating them to detect and react to their early signs of PEx. Objective: This study aims to identify the contributions and conditions of home monitoring in relation to their care teams from the users? point of view to detect PEx early and treat it. This study focused on the patients? experiences as the first and main users of home monitoring. Methods: A qualitative study was conducted to explore patients? and professionals? experiences with the intervention. We interviewed patients who completed the 2-year study using semistructured guides and conducted focus groups with the care teams. All the interviews were recorded and transcribed verbatim. Their educational material was collected. A grounded analysis was conducted by 2 researchers. Results: A total of 20 patients completed the study. Three main categories emerged from the patients? verbatim transcripts and were also found in those of the professionals: (1) task technology fit, reflecting reliability, ease of use, accuracy of data, and support of the technology; (2) patient empowerment through technology, grouping patients? learnings, validation of their perception of exacerbation, assessment of treatment efficacy, awareness of healthy behaviors, and ability to react to PEx signs in relation to their care team; (3) use, reflecting a continuous or intermittent use, the perceived usefulness balanced with cumbersome measurements, routinization and personalization of the measurement process, and the way data are shared with the care team. Furthermore, 3 relationships were highlighted between the categories that reflect the necessary conditions for patient empowerment through the use of technology. Conclusions: We discuss a theorization of the process of patient empowerment through the use of connected devices and call for further research to verify or amend it in the context of other technologies, illnesses, and care organizations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028 UR - https://formative.jmir.org/2024/1/e38064 UR - http://dx.doi.org/10.2196/38064 UR - http://www.ncbi.nlm.nih.gov/pubmed/38261372 ID - info:doi/10.2196/38064 ER - TY - JOUR AU - Antoniou, Panagiotis AU - Dafli, Eleni AU - Giannakoulas, George AU - Igimbayeva, Gaukhar AU - Visternichan, Olga AU - Kyselov, Serhii AU - Lykhasenko, Ivetta AU - Lashkul, Dmytro AU - Nadareishvili, Ilia AU - Tabagari, Sergo AU - Bamidis, D. Panagiotis PY - 2024/1/23 TI - Education of Patients With Atrial Fibrillation and Evaluation of the Efficacy of a Mobile Virtual Patient Environment: Protocol for a Multicenter Pseudorandomized Controlled Trial JO - JMIR Res Protoc SP - e45946 VL - 13 KW - atrial fibrillation KW - virtual patient KW - scenario based learning KW - technology enhanced learning KW - mHealth KW - mobile health KW - patient engagement KW - patient education KW - cardiac arrhythmia KW - mortality KW - mobile application KW - mobile app KW - health education KW - randomized control trial KW - cardiology KW - cardiac KW - heart KW - Greece KW - Ukraine KW - Kazakhstan KW - clinical decision support systems KW - CDSS KW - virtual patient scenario KW - myocardial infarction KW - arrhythmia KW - stroke N2 - Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is a leading cause of mortality and morbidity. Patient knowledge about AF and its management is paramount but often limited. Patients need to be appropriately informed about treatment options, medicinal adherence, and potential consequences of nonadherence, while also understanding treatment goals and expectations from it. Mobile health apps have experienced an explosion both in their availability and acceptance as ?soft interventions? for patient engagement and education; however, the prolific nature of such solutions revealed a gap in the evidence base regarding their efficacy and impact. Virtual patients (VPs), interactive computer simulations, have been used as learning activities in modern health care education. VPs demonstrably improved cognitive and behavioral skills; hence, they have been effectively implemented across undergraduate and postgraduate curricula. However, their application in patient education has been rather limited so far. Objective: This work aims to implement and evaluate the efficacy of a mobile-deployed VP regimen for the education and engagement of patients with AF on crucial topics regarding their condition. A mobile VP app is being developed with the goal of each VP being a simple scenario with a set goal and very specific messages and will be subsequently attempted and evaluated. Methods: A mobile VP player app is being developed so as to be used for the design of 3 educational scenarios for AF management. A pseudorandomized controlled trial for the efficacy of VPs is planned to be executed at 3 sites in Greece, Ukraine, and Kazakhstan for patients with AF. The Welch t test will be used to demonstrate the performance of patients? evaluation of the VP experience. Results: Our study is at the development stage. A preliminary study regarding the system?s development and feasibility was initiated in December 2022. The results of our study are expected to be available in 2024 or when the needed sample size is achieved. Conclusions: This study aims to evaluate and demonstrate the first significant evidence for the value of VP resources in outreach and training endeavors for empowering and patients with AF and fostering healthy habits among them. International Registered Report Identifier (IRRID): PRR1-10.2196/45946 UR - https://www.researchprotocols.org/2024/1/e45946 UR - http://dx.doi.org/10.2196/45946 UR - http://www.ncbi.nlm.nih.gov/pubmed/38261376 ID - info:doi/10.2196/45946 ER - TY - JOUR AU - Jaiswal, Satish AU - Purpura, R. Suzanna AU - Manchanda, K. James AU - Nan, Jason AU - Azeez, Nihal AU - Ramanathan, Dhakshin AU - Mishra, Jyoti PY - 2024/1/22 TI - Design and Implementation of a Brief Digital Mindfulness and Compassion Training App for Health Care Professionals: Cluster Randomized Controlled Trial JO - JMIR Ment Health SP - e49467 VL - 11 KW - compassion KW - digital app KW - digital health KW - digital intervention KW - digital mental health KW - digital mindfulness KW - EEG KW - health workers KW - healthcare professionals KW - mindfulness KW - neuroplasticity KW - physicians KW - training N2 - Background: Several studies show that intense work schedules make health care professionals particularly vulnerable to emotional exhaustion and burnout. Objective: In this scenario, promoting self-compassion and mindfulness may be beneficial for well-being. Notably, scalable, digital app?based methods may have the potential to enhance self-compassion and mindfulness in health care professionals. Methods: In this study, we designed and implemented a scalable, digital app?based, brief mindfulness and compassion training program called ?WellMind? for health care professionals. A total of 22 adult participants completed up to 60 sessions of WellMind training, 5-10 minutes in duration each, over 3 months. Participants completed behavioral assessments measuring self-compassion and mindfulness at baseline (preintervention), 3 months (postintervention), and 6 months (follow-up). In order to control for practice effects on the repeat assessments and calculate effect sizes, we also studied a no-contact control group of 21 health care professionals who only completed the repeated assessments but were not provided any training. Additionally, we evaluated pre- and postintervention neural activity in core brain networks using electroencephalography source imaging as an objective neurophysiological training outcome. Results: Findings showed a post- versus preintervention increase in self-compassion (Cohen d=0.57; P=.007) and state-mindfulness (d=0.52; P=.02) only in the WellMind training group, with improvements in self-compassion sustained at follow-up (d=0.8; P=.01). Additionally, WellMind training durations correlated with the magnitude of improvement in self-compassion across human participants (?=0.52; P=.01). Training-related neurophysiological results revealed plasticity specific to the default mode network (DMN) that is implicated in mind-wandering and rumination, with DMN network suppression selectively observed at the postintervention time point in the WellMind group (d=?0.87; P=.03). We also found that improvement in self-compassion was directly related to the extent of DMN suppression (?=?0.368; P=.04). Conclusions: Overall, promising behavioral and neurophysiological findings from this first study demonstrate the benefits of brief digital mindfulness and compassion training for health care professionals and compel the scale-up of the digital intervention. Trial Registration: Trial Registration: International Standard Randomized Controlled Trial Number Registry ISRCTN94766568, https://www.isrctn.com/ISRCTN94766568 UR - https://mental.jmir.org/2024/1/e49467 UR - http://dx.doi.org/10.2196/49467 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252479 ID - info:doi/10.2196/49467 ER - TY - JOUR AU - Adams, B. Leslie AU - Watts, Thomasina AU - DeVinney, Aubrey AU - Haroz, E. Emily AU - Thrul, Johannes AU - Stephens, Brooks Jasmin AU - Campbell, N. Mia AU - Antoine, Denis AU - Lê Cook, Benjamin AU - Joe, Sean AU - Thorpe Jr, J. Roland PY - 2024/1/22 TI - Acceptability and Feasibility of a Smartphone-Based Real-Time Assessment of Suicide Among Black Men: Mixed Methods Pilot Study JO - JMIR Form Res SP - e48992 VL - 8 KW - Black men KW - suicide KW - ecological momentary assessment KW - feasibility KW - acceptability KW - mixed methods KW - smartphone KW - real-time assessment KW - suicide prevention KW - user experience KW - behavior KW - implementation KW - intervention KW - mobile phone N2 - Background: Suicide rates in the United States have increased recently among Black men. To address this public health crisis, smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men. Objective: This study aims to clarify the acceptability and feasibility of using smartphone-based EMA through a pilot study that assesses the user experience among Black men. Methods: We recruited Black men aged 18 years and older using the MyChart patient portal messaging (the patient-facing side of the Epic electronic medical record system) or outpatient provider referrals. Eligible participants self-identified as Black men with a previous history of STB and ownership of an Android or iOS smartphone. Eligible participants completed a 7-day smartphone-based EMA study. They received a prompt 4 times per day to complete a brief survey detailing their STB, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of everyday discrimination. Participants completed a semistructured exit interview of 60-90 minutes at the study?s conclusion. Results: In total, 10 participants completed 166 EMA surveys and 39 daily diary entries. A total of 4 of the 10 participants completed 75% (21/28) or more of the EMA surveys, while 9 (90%) out of 10 completed 25% (7/28) or more. The average completion rate of all surveys was 58% (20.3/35), with a minimum of 17% (6/35) and maximum of 100% (35/35). A total of 4 (40%) out of 10 participants completed daily diary entries for the full pilot study. No safety-related incidents were reported. On average, participants took 2.08 minutes to complete EMA prompts and 2.72 minutes for daily diary surveys. Our qualitative results generally affirm the acceptability and feasibility of the study procedures, but the participants noted difficulties with the technology and the redundancy of the survey questions. Emerging themes also addressed issues such as reduced EMA survey compliance and diminished mood related to deficit-framed questions related to suicide. Conclusions: Findings from this study will be used to clarify the suitability of EMA for Black men. Overall, our EMA pilot study demonstrated mixed feasibility and acceptability when delivered through smartphone-based apps to Black men. Specific recommendations are provided for managing safety within these study designs and for refinements in future intervention and implementation science research. International Registered Report Identifier (IRRID): RR2-10.2196/31241 UR - https://formative.jmir.org/2024/1/e48992 UR - http://dx.doi.org/10.2196/48992 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252475 ID - info:doi/10.2196/48992 ER - TY - JOUR AU - White, M. Katie AU - Carr, Ewan AU - Leightley, Daniel AU - Matcham, Faith AU - Conde, Pauline AU - Ranjan, Yatharth AU - Simblett, Sara AU - Dawe-Lane, Erin AU - Williams, Laura AU - Henderson, Claire AU - Hotopf, Matthew PY - 2024/1/19 TI - Engagement With a Remote Symptom-Tracking Platform Among Participants With Major Depressive Disorder: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e44214 VL - 12 KW - remote measurement KW - technology KW - engagement KW - app KW - depression KW - smartphones KW - wearable devices KW - symptom tracking KW - self-awareness KW - community KW - mobile phone N2 - Background: Multiparametric remote measurement technologies (RMTs), which comprise smartphones and wearable devices, have the potential to revolutionize understanding of the etiology and trajectory of major depressive disorder (MDD). Engagement with RMTs in MDD research is of the utmost importance for the validity of predictive analytical methods and long-term use and can be conceptualized as both objective engagement (data availability) and subjective engagement (system usability and experiential factors). Positioning the design of user interfaces within the theoretical framework of the Behavior Change Wheel can help maximize effectiveness. In-app components containing information from credible sources, visual feedback, and access to support provide an opportunity to promote engagement with RMTs while minimizing team resources. Randomized controlled trials are the gold standard in quantifying the effects of in-app components on engagement with RMTs in patients with MDD. Objective: This study aims to evaluate whether a multiparametric RMT system with theoretically informed notifications, visual progress tracking, and access to research team contact details could promote engagement with remote symptom tracking over and above the system as usual. We hypothesized that participants using the adapted app (intervention group) would have higher engagement in symptom monitoring, as measured by objective and subjective engagement. Methods: A 2-arm, parallel-group randomized controlled trial (participant-blinded) with 1:1 randomization was conducted with 100 participants with MDD over 12 weeks. Participants in both arms used the RADAR-base system, comprising a smartphone app for weekly symptom assessments and a wearable Fitbit device for continuous passive tracking. Participants in the intervention arm (n=50, 50%) also had access to additional in-app components. The primary outcome was objective engagement, measured as the percentage of weekly questionnaires completed during follow-up. The secondary outcomes measured subjective engagement (system engagement, system usability, and emotional self-awareness). Results: The levels of completion of the Patient Health Questionnaire-8 (PHQ-8) were similar between the control (67/97, 69%) and intervention (66/97, 68%) arms (P value for the difference between the arms=.83, 95% CI ?9.32 to 11.65). The intervention group participants reported slightly higher user engagement (1.93, 95% CI ?1.91 to 5.78), emotional self-awareness (1.13, 95% CI ?2.93 to 5.19), and system usability (2.29, 95% CI ?5.93 to 10.52) scores than the control group participants at follow-up; however, all CIs were wide and included 0. Process evaluation suggested that participants saw the in-app components as helpful in increasing task completion. Conclusions: The adapted system did not increase objective or subjective engagement in remote symptom tracking in our research cohort. This study provides an important foundation for understanding engagement with RMTs for research and the methodologies by which this work can be replicated in both community and clinical settings. Trial Registration: ClinicalTrials.gov NCT04972474; https://clinicaltrials.gov/ct2/show/NCT04972474 International Registered Report Identifier (IRRID): RR2-10.2196/32653 UR - https://mhealth.jmir.org/2024/1/e44214 UR - http://dx.doi.org/10.2196/44214 UR - http://www.ncbi.nlm.nih.gov/pubmed/38241070 ID - info:doi/10.2196/44214 ER - TY - JOUR AU - Handa, Tomoko AU - Onoue, Takeshi AU - Kobayashi, Tomoko AU - Maeda, Ryutaro AU - Mizutani, Keigo AU - Yamagami, Ayana AU - Kinoshita, Tamaki AU - Yasuda, Yoshinori AU - Iwama, Shintaro AU - Miyata, Takashi AU - Sugiyama, Mariko AU - Takagi, Hiroshi AU - Hagiwara, Daisuke AU - Suga, Hidetaka AU - Banno, Ryoichi AU - Azuma, Yoshinori AU - Kasai, Takatoshi AU - Yoshioka, Shuko AU - Kuwatsuka, Yachiyo AU - Arima, Hiroshi PY - 2024/1/19 TI - Effects of Digitization of Self-Monitoring of Blood Glucose Records Using a Mobile App and the Cloud System on Outpatient Management of Diabetes: Single-Armed Prospective Study JO - JMIR Diabetes SP - e48019 VL - 9 KW - app KW - diabetes care KW - diabetes KW - digital intervention KW - digital therapeutics KW - glycemic control KW - mobile app KW - mHealth N2 - Background: In recent years, technologies promoting the digitization of self-monitoring of blood glucose (SMBG) records including app-cloud cooperation systems have emerged. Studies combining these technological interventions with support from remote health care professionals have reported improvements in glycemic control. Objective: To assess the use of an app-cloud cooperation system linked with SMBG devices in clinical settings, we evaluated its effects on outpatient management of diabetes without remote health care professional support. Methods: In this multicenter, open-label, and single-armed prospective study, 48 patients with diabetes (including type 1 and type 2) at 3 hospitals in Japan treated with insulin or glucagon-like peptide 1 receptor agonists and performing SMBG used the app-cloud cooperation system for 24 weeks. The SMBG data were automatically uploaded to the cloud via the app. The patients could check their data, and their attending physicians reviewed the data through the cloud prior to the patients? regular visits. The primary outcome was changes in glycated hemoglobin (HbA1c) levels. Results: Although HbA1c levels did not significantly change in all patients, the frequency of daily SMBG following applying the system was significantly increased before induction at 12 (0.60 per day, 95% CI 0.19-1.00; P=.002) and 24 weeks (0.43 per day, 95% CI 0.02-0.84; P=.04). In the subset of 21 patients whose antidiabetic medication had not been adjusted during the intervention period, a decrease in HbA1c level was observed at 12 weeks (P=.02); however, this significant change disappeared at 24 weeks (P=.49). The Diabetes Treatment Satisfaction Questionnaire total score and ?Q4: convenience? and ?Q5: flexibility? scores significantly improved after using the system (all P<.05), and 72% (33/46) patients and 76% (35/46) physicians reported that the app-cloud cooperation system helped them adjust insulin doses. Conclusions: The digitization of SMBG records and sharing of the data by patients and attending physicians during face-to-face visits improved self-management in patients with diabetes. Trial Registration: Japan Registry of Clinical Trials (jRCT) jRCTs042190057; https://jrct.niph.go.jp/en-latest-detail/jRCTs042190057 UR - https://diabetes.jmir.org/2024/1/e48019 UR - http://dx.doi.org/10.2196/48019 UR - http://www.ncbi.nlm.nih.gov/pubmed/38241065 ID - info:doi/10.2196/48019 ER - TY - JOUR AU - Wadle, Lisa-Marie AU - Ebner-Priemer, W. Ulrich AU - Foo, C. Jerome AU - Yamamoto, Yoshiharu AU - Streit, Fabian AU - Witt, H. Stephanie AU - Frank, Josef AU - Zillich, Lea AU - Limberger, F. Matthias AU - Ablimit, Ayimnisagul AU - Schultz, Tanja AU - Gilles, Maria AU - Rietschel, Marcella AU - Sirignano, Lea PY - 2024/1/18 TI - Speech Features as Predictors of Momentary Depression Severity in Patients With Depressive Disorder Undergoing Sleep Deprivation Therapy: Ambulatory Assessment Pilot Study JO - JMIR Ment Health SP - e49222 VL - 11 KW - ambulatory assessment KW - experience sampling KW - ecological momentary assessment KW - speech features KW - speech pattern KW - depression KW - sleep deprivation therapy KW - mobile phone N2 - Background: The use of mobile devices to continuously monitor objectively extracted parameters of depressive symptomatology is seen as an important step in the understanding and prevention of upcoming depressive episodes. Speech features such as pitch variability, speech pauses, and speech rate are promising indicators, but empirical evidence is limited, given the variability of study designs. Objective: Previous research studies have found different speech patterns when comparing single speech recordings between patients and healthy controls, but only a few studies have used repeated assessments to compare depressive and nondepressive episodes within the same patient. To our knowledge, no study has used a series of measurements within patients with depression (eg, intensive longitudinal data) to model the dynamic ebb and flow of subjectively reported depression and concomitant speech samples. However, such data are indispensable for detecting and ultimately preventing upcoming episodes. Methods: In this study, we captured voice samples and momentary affect ratings over the course of 3 weeks in a sample of patients (N=30) with an acute depressive episode receiving stationary care. Patients underwent sleep deprivation therapy, a chronotherapeutic intervention that can rapidly improve depression symptomatology. We hypothesized that within-person variability in depressive and affective momentary states would be reflected in the following 3 speech features: pitch variability, speech pauses, and speech rate. We parametrized them using the extended Geneva Minimalistic Acoustic Parameter Set (eGeMAPS) from open-source Speech and Music Interpretation by Large-Space Extraction (openSMILE; audEERING GmbH) and extracted them from a transcript. We analyzed the speech features along with self-reported momentary affect ratings, using multilevel linear regression analysis. We analyzed an average of 32 (SD 19.83) assessments per patient. Results: Analyses revealed that pitch variability, speech pauses, and speech rate were associated with depression severity, positive affect, valence, and energetic arousal; furthermore, speech pauses and speech rate were associated with negative affect, and speech pauses were additionally associated with calmness. Specifically, pitch variability was negatively associated with improved momentary states (ie, lower pitch variability was linked to lower depression severity as well as higher positive affect, valence, and energetic arousal). Speech pauses were negatively associated with improved momentary states, whereas speech rate was positively associated with improved momentary states. Conclusions: Pitch variability, speech pauses, and speech rate are promising features for the development of clinical prediction technologies to improve patient care as well as timely diagnosis and monitoring of treatment response. Our research is a step forward on the path to developing an automated depression monitoring system, facilitating individually tailored treatments and increased patient empowerment. UR - https://mental.jmir.org/2024/1/e49222 UR - http://dx.doi.org/10.2196/49222 UR - http://www.ncbi.nlm.nih.gov/pubmed/38236637 ID - info:doi/10.2196/49222 ER - TY - JOUR AU - Danielson, Kmett Carla AU - Moreland, Angela AU - Hahn, Austin AU - Banks, Devin AU - Ruggiero, J. Kenneth PY - 2024/1/18 TI - Development and Usability Testing of an mHealth Tool for Trauma-Informed Prevention of Substance Use, HIV Acquisition, and Risky Sexual Behaviors Among Adolescents: Mixed Methods Study JO - JMIR Form Res SP - e52835 VL - 8 KW - traumatic stress KW - prevention KW - substance use KW - HIV KW - qualitative methods KW - adolescents KW - mobile phone N2 - Background: Youth who experience traumatic events are at a substantially higher risk of engaging in substance use and sexual risk behaviors and problems (eg, HIV acquisition) than their non?trauma-exposed counterparts. Evidence-based substance use and risky sexual behavior prevention may reduce the risk of these outcomes. Trauma-focused mental health treatment provides a window of opportunity for the implementation of such preventive work with these youth. However, overburdened clinicians face challenges in adding prevention content while implementing evidence-based treatments. Mobile health (mHealth) tools can help reduce this burden in delivering prevention curricula. Trauma-Informed Prevention for Substance Use and Risky Sexual Behavior (TIPS) is an mHealth app that was developed to aid trauma-focused cognitive behavioral therapy (TF-CBT) clinicians in the implementation of an evidence-based risk behavior prevention curriculum. Objective: The goal of this paper is to describe the rationale for and development of the TIPS app and present the results of a mixed methods approach for the initial evaluation of its usability. Methods: Participants included clinicians (n=11), adolescents (n=11), and caregivers (n=10) who completed qualitative interviews and an adapted version of the Website Analysis and Measurement Inventory. Results: In total, 4 overarching themes emerged from the participants? answers to the qualitative interview questions, demonstrating a generally positive response to the app. The themes were (1) strength of app content, (2) suggestions about app content, (3) esthetics and usability, and (4) benefits to the patient and session implementation. Clinicians, adolescents, and caregivers all agreed that the content was very relevant to adolescents and used examples and language that adolescents could relate to. All 3 groups also discussed that the content was comprehensive and addressed issues often faced by adolescents. All 3 groups of users made suggestions about the esthetics, which mostly comprised suggestions to change the font, color, or pictures within the app. Of all the groups, adolescents were most positive about the esthetics and usability of the app. Results from the Website Analysis and Measurement Inventory further illustrated the users? favorable reaction to the TIPS app, with 100% (11/11) of clinicians, 100% (10/10) of caregivers, and most adolescents (7/11, 64%) selecting strongly agree or somewhat agree to the following statement: ?This app has much that is of interest to me.? Adolescents generally found the app easier to use than did caregivers and clinicians. Conclusions: The TIPS app shows promise as an mHealth tool for TF-CBT clinicians to integrate evidence-based substance use, risky sexual behavior, and HIV prevention during treatment. Future research, including a randomized controlled trial comparing TF-CBT implementation with and without the inclusion of the app, is necessary to evaluate the feasibility and efficacy of the app in reducing the risk of substance use and risky sexual behavior among trauma-exposed adolescents. Trial Registration: ClinicalTrials.gov NCT03710720; https://clinicaltrials.gov/study/NCT03710720 UR - https://formative.jmir.org/2024/1/e52835 UR - http://dx.doi.org/10.2196/52835 UR - http://www.ncbi.nlm.nih.gov/pubmed/38236634 ID - info:doi/10.2196/52835 ER - TY - JOUR AU - Gordon, L. Jennifer AU - Poulter, L. Megan M. AU - Balsom, A. Ashley AU - Campbell, S. Tavis PY - 2024/1/18 TI - Testing an Evidence-Based Self-Help Program for Infertility-Related Distress: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e52662 VL - 13 KW - anxiety KW - cognitive-behavior therapy KW - depression KW - infertility KW - infertility-related distress KW - mHealth N2 - Background: Infertility?the inability to achieve pregnancy despite ?12 months of focused attempts to conceive?is experienced by 1 in 6 couples. Women typically carry a disproportionate share of the psychological burden associated with infertility, experiencing poor quality of life, and 30%-40% experiencing depressive mood or anxiety. Unfortunately, currently available psychological interventions targeting infertility-related distress are associated with modest effects. Objective: Our team, in collaboration with patient advisors, has designed a self-help intervention for infertility-related distress involving 7 weekly 10-minute videos addressing the cognitive, behavioral, and interpersonal challenges associated with infertility, delivered through a mobile app. A feasibility study suggests that it is well accepted and highly effective in reducing symptoms of anxiety and depressed mood among distressed individuals dealing with infertility. This study represents the next step in this line of research: a fully powered randomized controlled trial comparing the intervention to a waitlist control group. Methods: We will recruit 170 individuals struggling to become pregnant in Canada or the United States to be randomized to our 7-week self-help program or a treatment-as-usual condition. The primary outcome will be fertility quality of life, while secondary outcomes will include depressive symptoms, anxious symptoms, and relationship quality, assessed before and after the program as well as biweekly for 16 weeks following completion of the program. Self-reported health care use and the presence of diagnosed mood and anxiety disorders, assessed through a structured psychiatric interview, will also be assessed immediately following the intervention and at the 16-week follow-up assessment. Treatment adherence and retention will also be recorded throughout the intervention. Multilevel modeling will compare the intervention arm to the treatment-as-usual condition in terms of all continuous outcomes across the 9 measurement points. Logistic regression will be used to assess the occurrence of mood and anxiety disorders in the 2 treatment arms at the posttreatment assessment as well as at the 16-week follow-up. Sensitivity analyses will examine potential treatment moderators: membership in the LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) communities, baseline fertility quality of life, cultural background, disability status, and pursuit of conception through medical intervention. Results: We expect our intervention to be more effective than treatment-as-usual in improving all mental health parameters assessed and decreasing health care use related to both mental and reproductive health. Effects are expected to be larger with decreasing baseline quality of life and equally effective regardless of membership in the LGBTQIA+ communities, cultural background, or disability status. Conclusions: If our intervention is successful, this would suggest that it should be scaled up and made publicly available. The availability of this program would fill an important gap in light of the high rates of psychopathology among those experiencing infertility and considering the current lack of effective psychotherapy approaches for infertility. Trial Registration: Clinicaltrials.gov NCT06006936; https://classic.clinicaltrials.gov/ct2/show/NCT06006936 International Registered Report Identifier (IRRID): PRR1-10.2196/52662 UR - https://www.researchprotocols.org/2024/1/e52662 UR - http://dx.doi.org/10.2196/52662 UR - http://www.ncbi.nlm.nih.gov/pubmed/38236638 ID - info:doi/10.2196/52662 ER - TY - JOUR AU - Schroeder, Tanja AU - Haug, Maximilian AU - Georgiou, Andrew AU - Seaman, Karla AU - Gewald, Heiko PY - 2024/1/17 TI - Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study JO - JMIR Mhealth Uhealth SP - e48345 VL - 12 KW - mobile health apps KW - DiGA KW - adoption KW - prescription KW - mHealth KW - aging and individual differences N2 - Background: The enactment of the ?Act to Improve Healthcare Provision through Digitalisation and Innovation ? (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany?s medical landscape. Objective: This study aims to investigate physicians? responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps. Methods: Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021. Results: The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians? self-perceived digital competence and their evaluation of patients? digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps. Conclusions: Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians? and patients? sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice. UR - https://mhealth.jmir.org/2024/1/e48345 UR - http://dx.doi.org/10.2196/48345 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231550 ID - info:doi/10.2196/48345 ER - TY - JOUR AU - He, Yirong AU - Huang, Chuanya AU - He, Qiuyang AU - Liao, Shujuan AU - Luo, Biru PY - 2024/1/17 TI - Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e49373 VL - 12 KW - mobile health KW - mHealth KW - lifestyle intervention KW - gestational diabetes mellitus KW - meta-analysis KW - mobile phone N2 - Background: The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM. Objective: This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity. Methods: A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration). Results: A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I2=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I2=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I2=59%), and gestational weight gain (mean difference=?1.12 kg, 95% CI ?1.44 to ?0.80; P<.001; I2=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I2=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I2=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I2=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I2=69%) showed a statistically significant reduction in the risk of GDM. Conclusions: mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995 UR - https://mhealth.jmir.org/2024/1/e49373 UR - http://dx.doi.org/10.2196/49373 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231555 ID - info:doi/10.2196/49373 ER - TY - JOUR AU - Nordby, S. Emilie AU - Guribye, Frode AU - Schønning, Viktor AU - Andersen, Lindholm Sander AU - Kuntsi, Jonna AU - Lundervold, J. Astri PY - 2024/1/17 TI - A Blended Intervention Targeting Emotion Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder: Development and Feasibility Study JO - JMIR Form Res SP - e53931 VL - 8 KW - ADHD KW - adult KW - adults KW - app KW - applications KW - apps KW - attention deficit KW - blended intervention KW - blended KW - develop KW - development KW - digital KW - emotion regulation KW - emotion KW - emotional KW - emotions KW - feasibility KW - group session KW - group sessions KW - hybrid KW - hyperactivity KW - inattention KW - mental health KW - neurodevelopmental KW - psychotherapy KW - satisfaction KW - skill KW - training N2 - Background: Many adults with attention-deficit/hyperactivity disorder (ADHD) experience difficulties related to emotion regulation. Such difficulties are known to substantially impact quality of life and overall functioning. Yet, there is a lack of treatment interventions specifically designed to address these challenges. Objective: This study aimed to describe the development and assess the feasibility, along with the initial clinical outcomes, of a novel blended intervention for adults with ADHD. The blended intervention combines both face-to-face and digital components and is specifically designed to address emotion dysregulation in ADHD. Methods: This intervention was an 8-week blended intervention combining weekly face-to-face group sessions with a supplementary digital companion app. The intervention is based on elements from dialectic behavioral therapy skills training and positive psychology. To evaluate its feasibility, we performed a 10-week feasibility study with an uncontrolled pre-post study design, including 16 adults with ADHD and co-occurring emotion dysregulation. The feasibility measures encompassed adherence, satisfaction, and perceived credibility of the intervention. Clinical outcomes were evaluated by self-reported symptoms of emotion dysregulation, inattention, hyperactivity-impulsivity, executive function, depression, anxiety, and a measure of quality of life. Paired sample 2-tailed t tests were used to analyze clinical outcomes with a Bonferroni-corrected significance level. Results: Both treatment credibility and treatment satisfaction were rated favorably by the majority of the participants. In particular, the participants emphasized meeting others with ADHD as beneficial. In terms of adherence, 3 participants withdrew before initiating the intervention, while another 4 participants did not complete the intervention. On average, the participants who enrolled in the intervention attended 6.2 of the 8 group sessions and completed 6.7 of the 8 skills training modules in the companion app. In terms of clinical outcomes, there was a reduction in symptoms of emotion dysregulation from before to after the intervention (d=2.0). Significant improvements were also observed in measures of inattention (d=1.1) and hyperactivity-impulsivity (d=0.9). However, no significant improvements were found in the domains of depression, anxiety, quality of life, and executive functioning. Conclusions: The results are encouraging, both in terms of feasibility and the preliminary clinical results on emotion dysregulation. The blended format, combining digital and face-to-face elements, may also seem to offer some advantages: the group-based format was valued as it facilitated peer interaction, while a rather high completion of modules in the companion app highlights its potential to enhance skills training between the group sessions. Future randomized controlled trials are called for to further evaluate the clinical effectiveness of the intervention. Trial Registration: ClinicalTrials.gov NCT05644028; https://clinicaltrials.gov/study/NCT05644028 UR - https://formative.jmir.org/2024/1/e53931 UR - http://dx.doi.org/10.2196/53931 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231536 ID - info:doi/10.2196/53931 ER - TY - JOUR AU - Shanmugavel, Aarthi AU - Shakya, Raj Prabin AU - Shrestha, Archana AU - Nepal, Jyoti AU - Shrestha, Abha AU - Daneault, Jean-Francois AU - Rawal, Shristi PY - 2024/1/17 TI - Designing and Developing a Mobile App for Management and Treatment of Gestational Diabetes in Nepal: User-Centered Design Study JO - JMIR Form Res SP - e50823 VL - 8 KW - mHealth KW - mobile health KW - gestational diabetes KW - telehealth KW - usability testing KW - LMICs KW - low- and middle-income countries KW - user-centric design KW - social cognitive theory KW - South Asians KW - maternal health KW - diabetes KW - diabetes mellitus KW - daily glucose monitoring KW - hospital KW - medical institution KW - health center KW - clinical utility KW - Nepal KW - low income KW - clinical trial KW - focus group KW - interview KW - health care provider KW - medical practitioner KW - mobile app KW - application KW - digital health KW - app KW - apps KW - health education KW - web based KW - self-monitoring KW - glucose KW - physical activity KW - intervention N2 - Background: Mobile apps can aid with the management of gestational diabetes mellitus (GDM) by providing patient education, reinforcing regular blood glucose monitoring and diet/lifestyle modification, and facilitating clinical and social support. Objective: This study aimed to describe our process of designing and developing a culturally tailored app, Garbhakalin Diabetes athawa Madhumeha?Dhulikhel Hospital (GDM-DH), to support GDM management among Nepalese patients by applying a user-centered design approach. Methods: A multidisciplinary team of experts, as well as health care providers and patients in Dhulikhel Hospital (Dhulikhel, Nepal), contributed to the development of the GDM-DH app. After finalizing the app?s content and features, we created the app?s wireframe, which illustrated the app?s proposed interface, navigation sequences, and features and function. Feedback was solicited on the wireframe via key informant interviews with health care providers (n=5) and a focus group and in-depth interviews with patients with GDM (n=12). Incorporating their input, we built a minimum viable product, which was then user-tested with 18 patients with GDM and further refined to obtain the final version of the GDM-DH app. Results: Participants in the focus group and interviews unanimously concurred on the utility and relevance of the proposed mobile app for patients with GDM, offering additional insight into essential modifications and additions to the app?s features and content (eg, inclusion of example meal plans and exercise videos).The mean age of patients in the usability testing (n=18) was 28.8 (SD 3.3) years, with a mean gestational age of 27.2 (SD 3.0) weeks. The mean usability score across the 10 tasks was 3.50 (SD 0.55; maximum score=5 for ?very easy?); task completion rates ranged from 55.6% (n=10) to 94.4% (n=17). Findings from the usability testing were reviewed to further optimize the GDM-DH app (eg, improving data visualization). Consistent with social cognitive theory, the final version of the GDM-DH app supports GDM self-management by providing health education and allowing patients to record and self-monitor blood glucose, blood pressure, carbohydrate intake, physical activity, and gestational weight gain. The app uses innovative features to minimize the self-monitoring burden, as well as automatic feedback and data visualization. The app also includes a social network ?follow? feature to add friends and family and give them permission to view logged data and a progress summary. Health care providers can use the web-based admin portal of the GDM-DH app to enter/review glucose levels and other clinical measures, track patient progress, and guide treatment and counseling accordingly. Conclusions: To the best of our knowledge, this is the first mobile health platform for GDM developed for a low-income country and the first one containing a social support feature. A pilot clinical trial is currently underway to explore the clinical utility of the GDM-DH app. UR - https://formative.jmir.org/2024/1/e50823 UR - http://dx.doi.org/10.2196/50823 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231562 ID - info:doi/10.2196/50823 ER - TY - JOUR AU - Alhuwail, Dari AU - Alhouti, Aisha AU - Alsarhan, Latifah PY - 2024/1/16 TI - Assessing the Quality, Privacy, and Security of Breast Cancer Apps for Arabic Speakers: Systematic Search and Review of Smartphone Apps JO - JMIR Cancer SP - e48428 VL - 10 KW - apps KW - Arabic KW - awareness KW - breast cancer KW - consumer health informatics KW - education KW - mHealth KW - mobile health KW - privacy KW - quality KW - security KW - smartphone KW - women N2 - Background: Breast cancer is a widespread disease, and its incidence is rapidly increasing in the Middle East and North Africa region. With the increasing availability of smartphone apps for various health purposes, breast cancer apps have emerged as tools for raising awareness, providing support, and empowering women affected by this disease. These apps offer many features, including information on breast cancer risk factors, self-examination guides, appointment reminders, and community support groups or hotlines. Using apps raises the risk of privacy and security issues, and we hope that examining these features of the apps will contribute to the understanding of how technology can be used to improve these apps and provide insights for future development and improvement of breast cancer apps. Objective: This study aims to critically review the quality, privacy, and security of breast cancer apps available to Arabic speakers. Methods: Similar to several recent studies, we used a systematic search for apps available in Google Play and Apple App stores using both the web interface and the built-in native stores installed on smartphones. The search was conducted in mid-December 2022 in Arabic using the following keywords: ????? ????? ? ??? ????? ????? ? ???? ????? ????? ? ??? ????? ????? ? ????? ????? ????? ? ??? ????? (breast cancer, breast cancer treatment, breast cancer disease, breast cancer symptoms, breast cancer screening, and breast test). These preidentified search terms are based on earlier work concerning the top searched breast cancer topics by Arabic speakers through Google?s search engine. We excluded apps that did not have an Arabic interface, were developed for non-Arabic speakers, were paid, needed a subscription, or were directed toward health care workers. The Mobile App Rating Scale was used to evaluate the quality of the apps concerning their engagement, functionality, aesthetics, and information. A risk score was calculated for the apps to determine their security risk factors. Results: Only 9 apps were included, with most (6/9, 67%) being supported by advertisements and categorized as informational. Overall, the apps had low numbers of downloads (>10 to >1000). The majority of the included apps (8/9, 89%) requested dangerous access permissions, including access to storage, media files, and the camera. The average security score of the included apps was 3.22, while only 2 apps provided information about data security and privacy. The included apps achieved an overall average quality score of 3.27, with individual dimension scores of 4.75 for functionality, 3.04 for information, 3.00 for aesthetics, and 2.32 for engagement. Conclusions: The limited availability of breast cancer apps available to Arabic speakers should be a call to action and prompt health care organizations and developers to join forces and collaboratively develop information-rich, usable, functional, engaging, and secure apps. UR - https://cancer.jmir.org/2024/1/e48428 UR - http://dx.doi.org/10.2196/48428 UR - http://www.ncbi.nlm.nih.gov/pubmed/38227353 ID - info:doi/10.2196/48428 ER - TY - JOUR AU - Ribaut, Janette AU - DeVito Dabbs, Annette AU - Dobbels, Fabienne AU - Teynor, Alexandra AU - Mess, Veronica Elisabeth AU - Hoffmann, Theresa AU - De Geest, Sabina PY - 2024/1/15 TI - Developing a Comprehensive List of Criteria to Evaluate the Characteristics and Quality of eHealth Smartphone Apps: Systematic Review JO - JMIR Mhealth Uhealth SP - e48625 VL - 12 KW - telemedicine KW - smartphone KW - mobile apps KW - program evaluation KW - decision-making KW - systematic review KW - mobile phone N2 - Background: The field of eHealth is growing rapidly and chaotically. Health care professionals need guidance on reviewing and assessing health-related smartphone apps to propose appropriate ones to their patients. However, to date, no framework or evaluation tool fulfills this purpose. Objective: Before developing a tool to help health care professionals assess and recommend apps to their patients, we aimed to create an overview of published criteria to describe and evaluate health apps. Methods: We conducted a systematic review to identify existing criteria for eHealth smartphone app evaluation. Relevant databases and trial registers were queried for articles. Articles were included that (1) described tools, guidelines, dimensions, or criteria to evaluate apps, (2) were available in full text, and (3) were written in English, French, German, Italian, Portuguese, or Spanish. We proposed a conceptual framework for app evaluation based on the dimensions reported in the selected articles. This was revised iteratively in discussion rounds with international stakeholders. The conceptual framework was used to synthesize the reported evaluation criteria. The list of criteria was discussed and refined by the research team. Results: Screening of 1258 articles yielded 128 (10.17%) that met the inclusion criteria. Of these 128 articles, 30 (23.4%) reported the use of self-developed criteria and described their development processes incompletely. Although 43 evaluation instruments were used only once, 6 were used in multiple studies. Most articles (83/128, 64.8%) did not report following theoretical guidelines; those that did noted 37 theoretical frameworks. On the basis of the selected articles, we proposed a conceptual framework to explore 6 app evaluation dimensions: context, stakeholder involvement, features and requirements, development processes, implementation, and evaluation. After standardizing the definitions, we identified 205 distinct criteria. Through consensus, the research team relabeled 12 of these and added 11 more?mainly related to ethical, legal, and social aspects?resulting in 216 evaluation criteria. No criteria had to be moved between dimensions. Conclusions: This study provides a comprehensive overview of criteria currently used in clinical practice to describe and evaluate apps. This is necessary as no reviewed criteria sets were inclusive, and none included consistent definitions and terminology. Although the resulting overview is impractical for use in clinical practice in its current form, it confirms the need to craft it into a purpose-built, theory-driven tool. Therefore, in a subsequent step, based on our current criteria set, we plan to construct an app evaluation tool with 2 parts: a short section (including 1-3 questions/dimension) to quickly disqualify clearly unsuitable apps and a longer one to investigate more likely candidates in closer detail. We will use a Delphi consensus-building process and develop a user manual to prepare for this undertaking. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227064; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227064 UR - https://mhealth.jmir.org/2024/1/e48625 UR - http://dx.doi.org/10.2196/48625 UR - http://www.ncbi.nlm.nih.gov/pubmed/38224477 ID - info:doi/10.2196/48625 ER - TY - JOUR AU - Høgsdal, Helene AU - Kyrrestad, Henriette AU - Rye, Marte AU - Kaiser, Sabine PY - 2024/1/15 TI - Exploring Adolescents? Attitudes Toward Mental Health Apps: Concurrent Mixed Methods Study JO - JMIR Form Res SP - e50222 VL - 8 KW - mental health applications KW - mental health KW - adolescents KW - adolescent KW - youth KW - mobile health KW - app KW - apps KW - application KW - applications KW - opinion KW - opinions KW - cross sectional KW - survey KW - surveys KW - questionnaire N2 - Background: Adolescence is a critical time in which many psychological disorders develop. Mental health promotion is important, especially during this period. In recent years, an increasing number of mobile apps geared toward mental health promotion and preventing mental illness have been developed specifically for adolescents, with the goal of strengthening their mental health and well-being. Objective: This study aims to explore adolescents? attitudes toward mental health apps, as well as the perceived usefulness of mental health apps. Methods: In this mixed methods study, a total of 183 adolescents (mean age 15.62, SD 3.21 years) answered a cross-sectional questionnaire, with 10 questions (eg, ?What do you think about mental health apps in general??). To complement the quantitative findings, individual interviews were conducted with 9 adolescents, during which they could elaborate on their opinions about mental health apps. Results: A total of 30% (56/183) of the adolescents in the quantitative study had used a mental health app. Over half of the respondents (77/126, 61.1%) reported that they would use a mental health app if they had a mental health problem as well as that they thought mental health apps were somewhat or very useful (114/183, 62.3%). Availability was the most frequently reported advantage of mental health apps (107/183, 58.8%). Possible associated costs of mental health apps were the most frequently mentioned barrier to their use (87/183, 47.5%). Findings from the interviews also pointed to the importance of the availability of mental health apps as well as their credibility and potential to provide adolescents with autonomy when seeking mental health advice and help. Conclusions: Overall, the results indicate that adolescents have a positive attitude toward and an interest in mental health apps. However, adolescents are also more or less unaware of such apps, which might be one reason why they are often not used. The findings of this study have important implications for future research on mental health apps and for developers of mental health apps that target young people. The insights gained from this study can inform the development of more effective mental health apps that better meet the needs and preferences of adolescents. UR - https://formative.jmir.org/2024/1/e50222 UR - http://dx.doi.org/10.2196/50222 UR - http://www.ncbi.nlm.nih.gov/pubmed/38224474 ID - info:doi/10.2196/50222 ER - TY - JOUR AU - Nestor, A. Bridget AU - Chimoff, Justin AU - Koike, Camila AU - Weitzman, R. Elissa AU - Riley, L. Bobbie AU - Uhl, Kristen AU - Kossowsky, Joe PY - 2024/1/11 TI - Adolescent and Parent Perspectives on Digital Phenotyping in Youths With Chronic Pain: Cross-Sectional Mixed Methods Survey Study JO - J Med Internet Res SP - e47781 VL - 26 KW - acceptability KW - adolescent KW - chronic pain KW - digital phenotyping KW - mobile health KW - pediatric N2 - Background: Digital phenotyping is a promising methodology for capturing moment-to-moment data that can inform individually adapted and timely interventions for youths with chronic pain. Objective: This study aimed to investigate adolescent and parent endorsement, perceived utility, and concerns related to passive data stream collection through smartphones for digital phenotyping for clinical and research purposes in youths with chronic pain. Methods: Through multiple-choice and open-response survey questions, we assessed the perspectives of patient-parent dyads (103 adolescents receiving treatment for chronic pain at a pediatric hospital with an average age of 15.6, SD 1.6 years, and 99 parents with an average age of 47.8, SD 6.3 years) on passive data collection from the following 9 smartphone-embedded passive data streams: accelerometer, apps, Bluetooth, SMS text message and call logs, keyboard, microphone, light, screen, and GPS. Results: Quantitative and qualitative analyses indicated that adolescents and parent endorsement and perceived utility of digital phenotyping varied by stream, though participants generally endorsed the use of data collected by passive stream (35%-75.7% adolescent endorsement for clinical use and 37.9%-74.8% for research purposes; 53.5%-81.8% parent endorsement for clinical and 52.5%-82.8% for research purposes) if a certain level of utility could be provided. For adolescents and parents, adjusted logistic regression results indicated that the perceived utility of each stream significantly predicted the likelihood of endorsement of its use in both clinical practice and research (Ps<.05). Adolescents and parents alike identified accelerometer, light, screen, and GPS as the passive data streams with the highest utility (36.9%-47.5% identifying streams as useful). Similarly, adolescents and parents alike identified apps, Bluetooth, SMS text message and call logs, keyboard, and microphone as the passive data streams with the least utility (18.5%-34.3% identifying streams as useful). All participants reported primary concerns related to privacy, accuracy, and validity of the collected data. Passive data streams with the greatest number of total concerns were apps, Bluetooth, call and SMS text message logs, keyboard, and microphone. Conclusions: Findings support the tailored use of digital phenotyping for this population and can help refine this methodology toward an acceptable, feasible, and ethical implementation of real-time symptom monitoring for assessment and intervention in youths with chronic pain. UR - https://www.jmir.org/2024/1/e47781 UR - http://dx.doi.org/10.2196/47781 UR - http://www.ncbi.nlm.nih.gov/pubmed/38206665 ID - info:doi/10.2196/47781 ER - TY - JOUR AU - Piernas, Carmen AU - Lee, Charlotte AU - Hobson, Alice AU - Harmer, Georgina AU - Payne Riches, Sarah AU - Noreik, Michaela AU - Jebb, A. Susan PY - 2024/1/11 TI - A Behaviorally Informed Mobile App to Improve the Nutritional Quality of Grocery Shopping (SwapSHOP): Feasibility Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e45854 VL - 12 KW - swaps KW - mobile app KW - supermarket KW - food purchases KW - diet KW - randomized controlled trial KW - mobile phone N2 - Background: Interventions targeting the nutritional quality of grocery shopping have the potential to help improve diet and health outcomes. Objective: This study aims to assess the feasibility and acceptability of receiving advice on healthier food purchases through SwapSHOP, a behaviorally informed smartphone app that allows users to scan barcodes of grocery products from the United Kingdom, providing nutritional information and personalized swap suggestions to encourage healthier purchases. Methods: We randomized adult volunteers in a 6-arm parallel-group controlled feasibility trial. Participants used the SwapSHOP app to record their grocery shopping during a 2-week run-in period and were individually randomized in a 3:1 ratio to either intervention or control arms within 3 strata related to a nutrient of concern of their choice: saturated fat (SFA), sugar, or salt. Participants randomized to the intervention received the SwapSHOP app with a healthier swap function, goal setting, and personalized feedback. Participants in the control group were instructed to use a simpler version of the app to log all their food purchases without receiving any guidance or advice. The primary outcome was the feasibility of progression to a full trial, including app use and follow-up rates at 6 weeks. The secondary outcomes included other feasibility outcomes, process and qualitative measures, and exploratory effectiveness outcomes to assess changes in the nutrient content of the purchased foods. Results: A total of 112 participants were randomized into 3 groups: SFA (n=38 intervention and n=13 control), sugar (n=40 intervention and n=15 control), and salt (n=5 intervention and n=1 control, not analyzed). The 2 progression criteria were met for SFA and sugar: 81% (30/37) and 87% (34/39) of intervention participants in the SFA and sugar groups, respectively, used the app to obtain healthier swaps, and 89% (68/76) of intervention participants and 96% (23/24) of control participants completed follow-up by scanning all purchases over the follow-up period. The process and qualitative outcomes suggested that the intervention was acceptable and has the potential to influence shopping behaviors. There were reductions of ?0.56 g per 100 g (95% CI ?1.02 to ?0.19) in SFA and ?1 g per 100 g (95% CI ?1.97 to ?0.03) in total sugars across all food purchases in the intervention groups. Conclusions: People were willing to use the SwapSHOP app to help reduce sugar and SFA (but not salt) in their grocery shopping. Adherence and follow-up rates suggest that a full trial is feasible. Given the suggestive evidence indicating that the intervention resulted in reductions in sugars and SFA, a definitive trial is necessary to target improvements in health outcomes. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN13022312; https://doi.org/10.1186/ISRCTN13022312 UR - https://mhealth.jmir.org/2024/1/e45854 UR - http://dx.doi.org/10.2196/45854 UR - http://www.ncbi.nlm.nih.gov/pubmed/38206671 ID - info:doi/10.2196/45854 ER - TY - JOUR AU - Block, J. Valerie AU - Koshal, Kanishka AU - Wijangco, Jaeleene AU - Miller, Nicolette AU - Sara, Narender AU - Henderson, Kyra AU - Reihm, Jennifer AU - Gopal, Arpita AU - Mohan, D. Sonam AU - Gelfand, M. Jeffrey AU - Guo, Chu-Yueh AU - Oommen, Lauren AU - Nylander, Alyssa AU - Rowson, A. James AU - Brown, Ethan AU - Sanders, Stephen AU - Rankin, Katherine AU - Lyles, R. Courtney AU - Sim, Ida AU - Bove, Riley PY - 2024/1/11 TI - A Closed-Loop Falls Monitoring and Prevention App for Multiple Sclerosis Clinical Practice: Human-Centered Design of the Multiple Sclerosis Falls InsightTrack JO - JMIR Hum Factors SP - e49331 VL - 11 KW - digital health KW - mobile tools KW - falls KW - prevention KW - behavioral medicine KW - implementation science KW - closed-loop monitoring KW - multiple sclerosis KW - mobile phone N2 - Background: Falls are common in people with multiple sclerosis (MS), causing injuries, fear of falling, and loss of independence. Although targeted interventions (physical therapy) can help, patients underreport and clinicians undertreat this issue. Patient-generated data, combined with clinical data, can support the prediction of falls and lead to timely intervention (including referral to specialized physical therapy). To be actionable, such data must be efficiently delivered to clinicians, with care customized to the patient?s specific context. Objective: This study aims to describe the iterative process of the design and development of Multiple Sclerosis Falls InsightTrack (MS-FIT), identifying the clinical and technological features of this closed-loop app designed to support streamlined falls reporting, timely falls evaluation, and comprehensive and sustained falls prevention efforts. Methods: Stakeholders were engaged in a double diamond process of human-centered design to ensure that technological features aligned with users? needs. Patient and clinician interviews were designed to elicit insight around ability blockers and boosters using the capability, opportunity, motivation, and behavior (COM-B) framework to facilitate subsequent mapping to the Behavior Change Wheel. To support generalizability, patients and experts from other clinical conditions associated with falls (geriatrics, orthopedics, and Parkinson disease) were also engaged. Designs were iterated based on each round of feedback, and final mock-ups were tested during routine clinical visits. Results: A sample of 30 patients and 14 clinicians provided at least 1 round of feedback. To support falls reporting, patients favored a simple biweekly survey built using REDCap (Research Electronic Data Capture; Vanderbilt University) to support bring-your-own-device accessibility?with optional additional context (the severity and location of falls). To support the evaluation and prevention of falls, clinicians favored a clinical dashboard featuring several key visualization widgets: a longitudinal falls display coded by the time of data capture, severity, and context; a comprehensive, multidisciplinary, and evidence-based checklist of actions intended to evaluate and prevent falls; and MS resources local to a patient?s community. In-basket messaging alerts clinicians of severe falls. The tool scored highly for usability, likability, usefulness, and perceived effectiveness (based on the Health IT Usability Evaluation Model scoring). Conclusions: To our knowledge, this is the first falls app designed using human-centered design to prioritize behavior change and, while being accessible at home for patients, to deliver actionable data to clinicians at the point of care. MS-FIT streamlines data delivery to clinicians via an electronic health record?embedded window, aligning with the 5 rights approach. Leveraging MS-FIT for data processing and algorithms minimizes clinician load while boosting care quality. Our innovation seamlessly integrates real-world patient-generated data as well as clinical and community-level factors, empowering self-care and addressing the impact of falls in people with MS. Preliminary findings indicate wider relevance, extending to other neurological conditions associated with falls and their consequences. UR - https://humanfactors.jmir.org/2024/1/e49331 UR - http://dx.doi.org/10.2196/49331 UR - http://www.ncbi.nlm.nih.gov/pubmed/38206662 ID - info:doi/10.2196/49331 ER - TY - JOUR AU - Robinson, Billy AU - Proimos, Eleni AU - Zou, Daniel AU - Gong, Enying AU - Oldenburg, Brian AU - See, Katharine PY - 2024/1/10 TI - Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Structured Search and Evaluation JO - JMIR Mhealth Uhealth SP - e47295 VL - 12 KW - asthma KW - mobile health KW - mHealth KW - app KW - mobile KW - chronic disease KW - systematic review KW - smartphone KW - review methodology KW - respiratory KW - compliance KW - guideline KW - guidelines KW - review of apps KW - evaluation KW - quality KW - best practices KW - apps KW - mobile phone N2 - Background: Asthma is a chronic respiratory disorder requiring long-term pharmacotherapy and judicious patient self-management. Few studies have systematically evaluated asthma mobile health (mHealth) apps for quality and functionality; however, none have systematically assessed these apps for their content alignment with international best practice guidelines. Objective: This review aims to conduct a systematic search and evaluation of current mHealth apps in the Australian marketplace for their functionality, quality, and consistency with best practice guidelines. Methods: The most recent Global Initiative for Asthma (GINA) guidelines were reviewed to identify key recommendations that could be feasibly incorporated into an mHealth app. We developed a checklist based on these recommendations and a modified version of a previously developed framework. App stores were reviewed to identify potential mHealth apps based on predefined criteria. Evaluation of suitable apps included the assessment of technical information, an app quality assessment using the validated Mobile App Rating Scale (MARS) framework, and an app functionality assessment using the Intercontinental Medical Statistics Institute for Health Informatics (IMS) Functionality Scoring System. Finally, the mHealth apps were assessed for their content alignment with the GINA guidelines using the checklist we developed. Results: Of the 422 apps initially identified, 53 were suitable for further analysis based on inclusion and exclusion criteria. The mean number of behavioral change techniques for a single app was 3.26 (SD 2.27). The mean MARS score for all the reviewed apps was 3.05 (SD 0.54). Of 53 apps, 27 (51%) achieved a total MARS score of ?3. On average, the reviewed apps achieved 5.1 (SD 2.79) functionalities on the 11-point IMS functionality scale. The median number of functionalities identified was 5 (IQR 2-7). Overall, 10 (22%) of the 45 apps with reviewer consensus in this domain provided general knowledge regarding asthma. Of 53 apps, skill training in peak flow meters, inhaler devices, recognizing or responding to exacerbations, and nonpharmacological asthma management were identified in 8 (17%), 12 (25%), 11 (28%), and 14 (31%) apps, respectively; 19 (37%) apps could track or record ?asthma symptoms,? which was the most commonly recorded metric. The most frequently identified prompt was for taking preventive medications, available in 9 (20%) apps. Five (10%) apps provided an area for patients to store or enter their asthma action plan. Conclusions: This study used a unique checklist developed based on the GINA guidelines to evaluate the content alignment of asthma apps. Good-quality asthma apps aligned with international best practice asthma guidelines are lacking. Future app development should target the currently lacking key features identified in this study, including the use of asthma action plans and the deployment of behavioral change techniques to engage and re-engage with users. This study has implications for clinicians navigating the ever-expanding mHealth app market for chronic diseases. Trial Registration: PROSPERO CRD42021269894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269894 International Registered Report Identifier (IRRID): RR2-10.2196/33103 UR - https://mhealth.jmir.org/2024/1/e47295 UR - http://dx.doi.org/10.2196/47295 UR - http://www.ncbi.nlm.nih.gov/pubmed/38198204 ID - info:doi/10.2196/47295 ER - TY - JOUR AU - Shaw Jr, George AU - Castro, A. Bianca AU - Gunn, H. Laura AU - Norris, Keith AU - Thorpe Jr, J. Roland PY - 2024/1/10 TI - The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data JO - JMIR Mhealth Uhealth SP - e46656 VL - 12 KW - accessibility KW - eHealth literacy KW - mHealth KW - multivariable logistic regression KW - obesity KW - smartphones N2 - Background: Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. Objective: The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (?18 years of age) with obesity (BMI ?30 kg/m2). Methods: Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI. Results: A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor?s office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ?7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. Conclusions: This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps. UR - https://mhealth.jmir.org/2024/1/e46656 UR - http://dx.doi.org/10.2196/46656 UR - http://www.ncbi.nlm.nih.gov/pubmed/38198196 ID - info:doi/10.2196/46656 ER - TY - JOUR AU - Buawangpong, Nida AU - Pinyopornpanish, Kanokporn AU - Pliannuom, Suphawita AU - Nantsupawat, Nopakoon AU - Wiwatkunupakarn, Nutchar AU - Angkurawaranon, Chaisiri AU - Jiraporncharoen, Wichuda PY - 2024/1/10 TI - Designing Telemedicine for Older Adults With Multimorbidity: Content Analysis Study JO - JMIR Aging SP - e52031 VL - 7 KW - telemedicine KW - telehealth KW - chronic disease KW - multimorbidity KW - older adults KW - mobile phone N2 - Background: Telemedicine is a potential option for caring for older adults with multimorbidity. There is a need to explore the perceptions about telemedicine among older adults with multimorbidity to tailor it to the needs of older adults with multiple chronic conditions. Objective: This study aims to explore the perceptions about telemedicine among older patients with multimorbidity. Methods: A qualitative study was conducted using semistructured interviews. The interview questions examined older adults? perspectives about telemedicine, including their expectations regarding telemedicine services and the factors that affect its use. Thematic analysis was performed using NVivo (version 12; Lumivero). The study was reported using the Standards for Reporting Qualitative Research guidelines. Results: In total, 29 patients with multimorbidity?21 (72%) female patients and 8 (28%) male patients with a mean age of 69 (SD 10.39) years?were included. Overall, 4 themes and 7 subthemes emerged: theme 1?perceived benefit of telemedicine among older adults with multimorbidities, theme 2?appropriate use of telemedicine for multimorbid care, theme 3?telemedicine system catering to the needs of older patients, and theme 4?respect patients? decision to decline to use telemedicine. Conclusions: Telemedicine for older adults with multimorbidity should focus on those with stable conditions. This can help increase access to care for those requiring continuous condition monitoring. A structured telemedicine program and patient-centered services can help increase patient acceptance of telemedicine. However, health care providers must accept the limitations of older patients that may prevent them from receiving telemedicine services. UR - https://aging.jmir.org/2024/1/e52031 UR - http://dx.doi.org/10.2196/52031 UR - http://www.ncbi.nlm.nih.gov/pubmed/38198201 ID - info:doi/10.2196/52031 ER - TY - JOUR AU - Josefsson, Cecilia AU - Liljeroos, Thea AU - Hellgren, Margareta AU - Pöder, Ulrika AU - Hedström, Mariann AU - Olsson, G. Erik M. PY - 2024/1/10 TI - The Sukaribit Smartphone App for Better Self-Management of Type 2 Diabetes: Randomized Controlled Feasibility Study JO - JMIR Form Res SP - e46222 VL - 8 KW - diabetes mellitus KW - type 2 KW - health behavior KW - mobile health KW - mobile application KW - pilot study KW - mobile app KW - mHealth KW - diabetes KW - diabetic KW - RCT KW - randomized KW - glycemic KW - self care KW - self management KW - blood sugar KW - T2D KW - diabetes type 2 KW - home-testing KW - digital health N2 - Background: A new app, Sukaribit, was designed to enable contact between the caregiver and the patient with the intent to improve self-care and glycemic control (hemoglobin A1c [HbA1c]). Objective: This study investigated the feasibility of the study methodology and the intervention in preparation for a larger effectiveness study. Methods: Adults with type 2 diabetes were recruited in this randomized controlled feasibility study with a mixed methods design. The intervention group (n=28) tried Sukaribit for 2 months. They were encouraged to report blood glucose levels and medications, and they received feedback from a physician. The control group (n=31) received standard care. Both groups were evaluated with pre and postmeasurements of glycemic control (HbA1c), diabetes distress, physical activity, and self-care. Feasibility was evaluated against 5 progression criteria regarding recruitment, study methods, and active participation. Results: Of the 5 progression criteria, only 2 were met or partially met. The recruitment process exceeded expectations, and data collection worked well for self-reported data but not for HbA1c measured with a home testing kit. The participants were less active than anticipated, and the effect sizes were small. Only the number of blood glucose tests per day was positively affected by the intervention, with 0.6 more tests per day in the intervention group. Conclusions: Recruitment of participants to a future fully powered study may work with minor adjustments. The collection of HbA1c using home testing constituted a major problem, and an alternative strategy is warranted. Finally, the app was not used as intended. In order to proceed with a larger study, the app and study procedures need improvement. UR - https://formative.jmir.org/2024/1/e46222 UR - http://dx.doi.org/10.2196/46222 UR - http://www.ncbi.nlm.nih.gov/pubmed/38198200 ID - info:doi/10.2196/46222 ER - TY - JOUR AU - Bérubé, Caterina AU - Lehmann, Franziska Vera AU - Maritsch, Martin AU - Kraus, Mathias AU - Feuerriegel, Stefan AU - Wortmann, Felix AU - Züger, Thomas AU - Stettler, Christoph AU - Fleisch, Elgar AU - Kocaballi, Baki A. AU - Kowatsch, Tobias PY - 2024/1/9 TI - Effectiveness and User Perception of an In-Vehicle Voice Warning for Hypoglycemia: Development and Feasibility Trial JO - JMIR Hum Factors SP - e42823 VL - 11 KW - hypoglycemia KW - type-1 diabetes mellitus KW - in-vehicle voice assistant KW - voice interface KW - voice warning KW - digital health intervention KW - mobile phone N2 - Background: Hypoglycemia is a frequent and acute complication in type 1 diabetes mellitus (T1DM) and is associated with a higher risk of car mishaps. Currently, hypoglycemia can be detected and signaled through flash glucose monitoring or continuous glucose monitoring devices, which require manual and visual interaction, thereby removing the focus of attention from the driving task. Hypoglycemia causes a decrease in attention, thereby challenging the safety of using such devices behind the wheel. Here, we present an investigation of a hands-free technology?a voice warning that can potentially be delivered via an in-vehicle voice assistant. Objective: This study aims to investigate the feasibility of an in-vehicle voice warning for hypoglycemia, evaluating both its effectiveness and user perception. Methods: We designed a voice warning and evaluated it in 3 studies. In all studies, participants received a voice warning while driving. Study 0 (n=10) assessed the feasibility of using a voice warning with healthy participants driving in a simulator. Study 1 (n=18) assessed the voice warning in participants with T1DM. Study 2 (n=20) assessed the voice warning in participants with T1DM undergoing hypoglycemia while driving in a real car. We measured participants? self-reported perception of the voice warning (with a user experience scale in study 0 and with acceptance, alliance, and trust scales in studies 1 and 2) and compliance behavior (whether they stopped the car and reaction time). In addition, we assessed technology affinity and collected the participants? verbal feedback. Results: Technology affinity was similar across studies and approximately 70% of the maximal value. Perception measure of the voice warning was approximately 62% to 78% in the simulated driving and 34% to 56% in real-world driving. Perception correlated with technology affinity on specific constructs (eg, Affinity for Technology Interaction score and intention to use, optimism and performance expectancy, behavioral intention, Session Alliance Inventory score, innovativeness and hedonic motivation, and negative correlations between discomfort and behavioral intention and discomfort and competence trust; all P<.05). Compliance was 100% in all studies, whereas reaction time was higher in study 1 (mean 23, SD 5.2 seconds) than in study 0 (mean 12.6, SD 5.7 seconds) and study 2 (mean 14.6, SD 4.3 seconds). Finally, verbal feedback showed that the participants preferred the voice warning to be less verbose and interactive. Conclusions: This is the first study to investigate the feasibility of an in-vehicle voice warning for hypoglycemia. Drivers find such an implementation useful and effective in a simulated environment, but improvements are needed in the real-world driving context. This study is a kickoff for the use of in-vehicle voice assistants for digital health interventions. UR - https://humanfactors.jmir.org/2024/1/e42823 UR - http://dx.doi.org/10.2196/42823 UR - http://www.ncbi.nlm.nih.gov/pubmed/38194257 ID - info:doi/10.2196/42823 ER - TY - JOUR AU - Gill, Roopan AU - Ogilvie, Gina AU - Norman, V. Wendy AU - Fitzsimmons, Brian AU - Maher, Ciana AU - Renner, Regina PY - 2024/1/9 TI - Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care After Surgical Abortion (the FACTS Study Phase 3): Mixed Methods Prospective Pilot Study JO - JMIR Form Res SP - e46284 VL - 8 KW - mobile health KW - mHealth KW - digital health KW - abortion KW - human-centered design KW - sexual and reproductive health KW - qualitative research KW - mixed methods N2 - Background: In Canada, 1 in 3 women and people of gestational age undergo an abortion in their lifetime. Despite the liberal legal context, barriers continue to exist for women and people who can become pregnant to access this service. Objective: This study aims to (1) conduct a pilot study to demonstrate the feasibility and acceptability of myPostCare to support follow-up care after a procedural abortion; (2) use the findings to understand whether myPostCare has the potential to improve contraceptive behavior and knowledge, emotional well-being, and sexual health knowledge; and (3) develop a better understanding of how innovative mobile solutions can support integrative health programs in British Columbia with the goal of expanding to other sites across Canada. Methods: People of gestational age (aged 14-45 y) who underwent a procedural abortion were recruited from 2 urban abortion facilities in British Columbia. The participants completed a baseline quantitative survey and were provided access to myPostCare for up to 30 days. A follow-up quantitative survey was sent via email on day 30. Qualitative interviews were conducted to explore user satisfaction and usability of myPostCare. Responses to the survey questions were summarized using descriptive statistics, and the system usability scale (SUS) was scored according to the instructions. A secure analytics platform was implemented to obtain data on the overall use of the website by users. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the Women?s and Children?s Research Ethics Board. Results: Overall, 62 participants were recruited (average age 30 y); 40% (25/62) of the participants completed the exit surveys, and 24% (6/25) consented to participate in the semistructured interviews; 40 participants had undergone an immediate postabortion intrauterine device (IUD) insertion, and 22 did not have an IUD inserted. Participants were satisfied with myPostCare. The SUS average score was 81.5 (SD 9.7; median 82.5, IQR 77.5-87.5), indicating high usability of the tool. Overall, 88% (22/25) of the participants changed their contraceptive method to an IUD. Web-based analytics demonstrated that there were 61 unique visitors to the site, and the top pages visited were Postprocedure Care, Emotional Well-Being, and Contraception Explorer. The longest time spent on the website was 56 minutes. The overall email open rate was 80%, with a click rate of 36%. Conclusions: This study demonstrates that communities and individuals are important collaborators in developing a mobile innovation that facilitates access to high-quality patient-centered abortion care. Through the cocreation process, a digital platform such as myPostCare highlighted a gap in abortion care in Canada, particularly around follow-up support after a procedural abortion. UR - https://formative.jmir.org/2024/1/e46284 UR - http://dx.doi.org/10.2196/46284 UR - http://www.ncbi.nlm.nih.gov/pubmed/38194252 ID - info:doi/10.2196/46284 ER - TY - JOUR AU - Béjar, María Luis AU - Mesa-Rodríguez, Pedro AU - García-Perea, Dolores María PY - 2024/1/8 TI - Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial JO - JMIR Mhealth Uhealth SP - e49302 VL - 12 KW - primary care professionals KW - Mediterranean diet KW - smartphone applications KW - smartphone apps KW - health promotion KW - Mediterranean diet adherence KW - food group N2 - Background: The World Health Organization has called for addressing the growing burden of noncommunicable diseases (NCDs) by promoting healthy lifestyles among the population. Regarding patient health, primary care professionals (PCPs) are the first line of care who can positively influence patients? behavior and lifestyle habits. However, a significant percentage of PCPs do not lead a healthy lifestyle. Therefore, addressing their health behaviors may be the key to substantially increasing health promotion advice in general practice. The Mediterranean diet has been extensively studied, and there is strong evidence of it being a dietary pattern for the prevention of NCDs, in addition to its significant environmental, sociocultural, and local economics benefits. Objective: This study focused only on the dietary aspect of the PCPs? lifestyle. The primary objective was to evaluate the effect of using the Electronic 12-Hour Dietary Recall (e-12HR) smartphone app to improve diet, specifically to promote adherence to the Mediterranean diet (AMD), among PCPs. The secondary objectives were to establish the usability of the e-12HR app and to determine AMD among PCPs. Methods: An individual-level randomized, controlled, and single-blind clinical trial was conducted with 2 parallel groups: a control group (CG), using the nonfeedback version of the e-12HR app, and an intervention group (IG), using the feedback version of the e-12HR app. The level of human involvement was fully automated through the use of the app. There was a 28-day follow-up period. Participants were PCPs (medicine or nursing) recruited offline at one of the selected primary care centers (Andalusia, Spain, Southern Europe), of both sexes, over 18 years old, possessing a smartphone, and having smartphone literacy. Results: The study response rate was 73% (71 of 97 PCPs), with 27 (38%) women and 44 (62%) men: 40 (56%) PCPs in the CG and 31 (44%) in the IG. At baseline, AMD was medium (mean Mediterranean Diet Serving Score [MDSS] index 9.45, range 0-24), with 47 (66%) PCPs with a medium/high MDSS index. There were significant statistical improvements (CG vs IG, in favor of the IG) at week 4 (no significant statistical differences at baseline): +25.6% for the MDSS index (P=.002) and +213.1% for the percentage with a medium/high MDSS index (P=.001). In relation to specific food groups, there were significant statistical improvements for fruits (+33.8%, P=.02), vegetables (+352%, P=.001), nuts (+184%, P=.02), and legumes (+75.1%, P=.03). The responses to the usability rating questionnaire were satisfactory. Conclusions: The results support recommending the use of the e-12HR app as a tool to contribute to improving diet and preventing NCDs among PCPs, while positively influencing patient dietary behavior and preventing diet-related NCDs among patients. Trial Registration: ClinicalTrials.gov NCT05532137; https://clinicaltrials.gov/study/NCT05532137 UR - https://mhealth.jmir.org/2024/1/e49302 UR - http://dx.doi.org/10.2196/49302 UR - http://www.ncbi.nlm.nih.gov/pubmed/38190226 ID - info:doi/10.2196/49302 ER - TY - JOUR AU - Moungui, Claude Henri AU - Nana-Djeunga, Clotaire Hugues AU - Anyiang, Frankline Che AU - Cano, Mireia AU - Ruiz Postigo, Antonio Jose AU - Carrion, Carme PY - 2024/1/5 TI - Dissemination Strategies for mHealth Apps: Systematic Review JO - JMIR Mhealth Uhealth SP - e50293 VL - 12 KW - mobile health KW - mHealth KW - mobile health apps KW - mHealth apps KW - dissemination KW - marketing strategies KW - digital marketing KW - engagement KW - onboarding KW - systematic review KW - systematic KW - market KW - marketing KW - app KW - apps KW - adoption KW - consumer KW - mobile phone N2 - Background: Among the millions of mobile apps in existence, thousands fall under the category of mobile health (mHealth). Although the utility of mHealth apps has been demonstrated for disease diagnosis, treatment data management, and health promotion strategies, to be effective they must reach and be used by their target audience. An appropriate marketing strategy can ensure that apps reach potential users and potentially convert them to actual users. Such a strategy requires definitions of target end users, communication channels, and advertising content, as well as a timeline for effectively reaching and motivating end users to adopt and maintain engagement with the mHealth app. Objective: The aim of this study was to identify strategies and elements that ensure that end users adopt and remain engaged with mHealth apps. Methods: A systematic search of the PubMed, PsycINFO, Scopus, and CINAHL databases was conducted for suitable studies published between January 1, 2018, and September 30, 2022. Two researchers independently screened studies for inclusion, extracted data, and assessed the risk of bias. The main outcome was dissemination strategies for mHealth apps. Results: Of the 648 papers retrieved from the selected databases, only 10 (1.5%) met the inclusion criteria. The marketing strategies used in these studies to inform potential users of the existence of mHealth apps and motivate download included both paid and unpaid strategies and used various channels, including social media, emails, printed posters, and face-to-face communication. Most of the studies reported a combination of marketing concepts used to advertise their mHealth apps. Advertising messages included instructions on where and how to download and install the apps. In most of the studies (6/10, 60%), instructions were oriented toward how to use the apps and maintain engagement with a health intervention. The most frequently used paid marketing platform was Facebook Ads Manager (2/10, 20%). Advertising performance was influenced by many factors, including but not limited to advertising content. In 1 (10%) of the 10 studies, animated graphics generated the greatest number of clicks compared with other image types. The metrics used to assess marketing strategy effectiveness were number of downloads; nonuse rate; dropout rate; adherence rate; duration of app use; and app usability over days, weeks, or months. Additional indicators such as cost per click, cost per install, and clickthrough rate were mainly used to assess the cost-effectiveness of paid marketing campaigns. Conclusions: mHealth apps can be disseminated via paid and unpaid marketing strategies using various communication channels. The effects of these strategies are reflected in download numbers and user engagement with mHealth apps. Further research could provide guidance on a framework for disseminating mHealth apps and encouraging their routine use. UR - https://mhealth.jmir.org/2024/1/e50293 UR - http://dx.doi.org/10.2196/50293 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180796 ID - info:doi/10.2196/50293 ER - TY - JOUR AU - Cheung, Kin AU - Yip, Sum Chak PY - 2024/1/5 TI - Documentation Completeness and Nurses? Perceptions of a Novel Electronic App for Medical Resuscitation in the Emergency Room: Mixed Methods Approach JO - JMIR Mhealth Uhealth SP - e46744 VL - 12 KW - tablet computer KW - nursing documentation KW - paper resuscitation record KW - electronic resuscitation record KW - medical resuscitation KW - electronic medical record KW - documentation KW - resuscitation KW - electronic health record KW - nurses? perception KW - traditional paper record KW - nurse N2 - Background: Complete documentation of critical care events in the accident and emergency department (AED) is essential. Due to the fast-paced and complex nature of resuscitation cases, missing data is a common issue during emergency situations. Objective: This study aimed to evaluate the impact of a tablet-based resuscitation record on documentation completeness during medical resuscitations and nurses? perceptions of the use of the tablet app. Methods: A mixed methods approach was adopted. To collect quantitative data, randomized retrospective reviews of paper-based resuscitation records before implementation of the tablet (Pre-App Paper; n=176), paper-based resuscitation records after implementation of the tablet (Post-App Paper; n=176), and electronic tablet-based resuscitation records (Post-App Electronic; n=176) using a documentation completeness checklist were conducted. The checklist was validated by 4 experts in the emergency medicine field. The content validity index (CVI) was calculated using the scale CVI (S-CVI). The universal agreement S-CVI was 0.822, and the average S-CVI was 0.939. The checklist consisted of the following 5 domains: basic information, vital signs, procedures, investigations, and medications. To collect qualitative data, nurses? perceptions of the app for electronic resuscitation documentation were obtained using individual interviews. Reporting of the qualitative data was guided by Consolidated Criteria for Reporting Qualitative Studies (COREQ) to enhance rigor. Results: A significantly higher documentation rate in all 5 domains (ie, basic information, vital signs, procedures, investigations, and medications) was present with Post-App Electronic than with Post-App Paper, but there were no significant differences in the 5 domains between Pre-App Paper and Post-App Paper. The qualitative analysis resulted in main categories of ?advantages of tablet-based documentation of resuscitation records,? ?challenges with tablet-based documentation of resuscitation records,? and ?areas for improvement of tablet-based resuscitation records.? Conclusions: This study demonstrated that higher documentation completion rates are achieved with electronic tablet-based resuscitation records than with traditional paper records. During the transition period, the nurse documenters faced general problems with resuscitation documentation such as multitasking and unique challenges such as software updates and a need to familiarize themselves with the app?s layout. Automation should be considered during future app development to improve documentation and redistribute more time for patient care. Nurses should continue to provide feedback on the app?s usability and functionality during app refinement to ensure a successful transition and future development of electronic documentation records. UR - https://mhealth.jmir.org/2024/1/e46744 UR - http://dx.doi.org/10.2196/46744 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180801 ID - info:doi/10.2196/46744 ER - TY - JOUR AU - Luu, Phuoc An AU - Nguyen, Thanh Truong AU - Cao, Cam Van Thi AU - Ha, Diem Trinh Hoang AU - Chung, Thu Lien Thi AU - Truong, Ngoc Trung AU - Nguyen Le Nhu, Tung AU - Dao, Bach Khoa AU - Nguyen, Van Hao AU - Khanh, Quoc Phan Nguyen AU - Le, Thuy Khanh Thuy AU - Tran, Bao Luu Hoai AU - Nhat, Huy Phung Tran AU - Tran, Minh Duc AU - Lam, Minh Yen AU - Thwaites, Louise Catherine AU - Mcknight, Jacob AU - Vinh Chau, Van Nguyen AU - Van Nuil, Ilo Jennifer AU - PY - 2024/1/5 TI - Acceptance and User Experiences of a Wearable Device for the Management of Hospitalized Patients in COVID-19?Designated Wards in Ho Chi Minh City, Vietnam: Action Learning Project JO - JMIR Hum Factors SP - e44619 VL - 11 KW - vital signs KW - wearable devices KW - action learning KW - technology acceptance model KW - TAM KW - COVID-19 KW - user-centered design KW - wearables KW - remote monitoring KW - technology acceptance KW - oximeter N2 - Background: Wearable devices have been used extensively both inside and outside of the hospital setting. During the COVID-19 pandemic, in some contexts, there was an increased need to remotely monitor pulse and saturated oxygen for patients due to the lack of staff and bedside monitors. Objective: A prototype of a remote monitoring system using wearable pulse oximeter devices was implemented at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from August to December 2021. The aim of this work was to support the ongoing implementation of the remote monitoring system. Methods: We used an action learning approach with rapid pragmatic methods, including informal discussions and observations as well as a feedback survey form designed based on the technology acceptance model to assess the use and acceptability of the system. Based on these results, we facilitated a meeting using user-centered design principles to explore user needs and ideas about its development in more detail. Results: In total, 21 users filled in the feedback form. The mean technology acceptance model scores ranged from 3.5 (for perceived ease of use) to 4.4 (for attitude) with behavioral intention (3.8) and perceived usefulness (4.2) scoring in between. Those working as nurses scored higher on perceived usefulness, attitude, and behavioral intention than did physicians. Based on informal discussions, we realized there was a mismatch between how we (ie, the research team) and the ward teams perceived the use and wider purpose of the technology. Conclusions: Designing and implementing the devices to be more nurse-centric from their introduction could have helped to increase their efficiency and use during the complex pandemic period. UR - https://humanfactors.jmir.org/2024/1/e44619 UR - http://dx.doi.org/10.2196/44619 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180799 ID - info:doi/10.2196/44619 ER - TY - JOUR AU - Henry, M. Lauren AU - Hansen, Eleanor AU - Chimoff, Justin AU - Pokstis, Kimberly AU - Kiderman, Miryam AU - Naim, Reut AU - Kossowsky, Joe AU - Byrne, E. Meghan AU - Lopez-Guzman, Silvia AU - Kircanski, Katharina AU - Pine, S. Daniel AU - Brotman, A. Melissa PY - 2024/1/4 TI - Selecting an Ecological Momentary Assessment Platform: Tutorial for Researchers JO - J Med Internet Res SP - e51125 VL - 26 KW - ecological momentary assessment KW - methodology KW - psychology and psychiatry KW - child and adolescent KW - in vivo and real time N2 - Background: Although ecological momentary assessment (EMA) has been applied in psychological research for decades, delivery methods have evolved with the proliferation of digital technology. Technological advances have engendered opportunities for enhanced accessibility, convenience, measurement precision, and integration with wearable sensors. Notwithstanding, researchers must navigate novel complexities in EMA research design and implementation. Objective: In this paper, we aimed to provide guidance on platform selection for clinical scientists launching EMA studies. Methods: Our team includes diverse specialties in child and adolescent behavioral and mental health with varying expertise on EMA platforms (eg, users and developers). We (2 research sites) evaluated EMA platforms with the goal of identifying the platform or platforms with the best fit for our research. We created a list of extant EMA platforms; conducted a web-based review; considered institutional security, privacy, and data management requirements; met with developers; and evaluated each of the candidate EMA platforms for 1 week. Results: We selected 2 different EMA platforms, rather than a single platform, for use at our 2 research sites. Our results underscore the importance of platform selection driven by individualized and prioritized laboratory needs; there is no single, ideal platform for EMA researchers. In addition, our project generated 11 considerations for researchers in selecting an EMA platform: (1) location; (2) developer involvement; (3) sample characteristics; (4) onboarding; (5) survey design features; (6) sampling scheme and scheduling; (7) viewing results; (8) dashboards; (9) security, privacy, and data management; (10) pricing and cost structure; and (11) future directions. Furthermore, our project yielded a suggested timeline for the EMA platform selection process. Conclusions: This study will guide scientists initiating studies using EMA, an in vivo, real-time research tool with tremendous promise for facilitating advances in psychological assessment and intervention. UR - https://www.jmir.org/2024/1/e51125 UR - http://dx.doi.org/10.2196/51125 UR - http://www.ncbi.nlm.nih.gov/pubmed/38175682 ID - info:doi/10.2196/51125 ER - TY - JOUR AU - Chen, Yuling AU - Turkson-Ocran, Ruth-Alma AU - Koirala, Binu AU - Davidson, M. Patricia AU - Commodore-Mensah, Yvonne AU - Himmelfarb, Dennison Cheryl PY - 2024/1/4 TI - Association Between the Composite Cardiovascular Risk and mHealth Use Among Adults in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study JO - J Med Internet Res SP - e46277 VL - 26 KW - mobile health KW - usage KW - cardiovascular risk KW - association KW - mobile phone N2 - Background: Numerous studies have suggested that the relationship between cardiovascular disease (CVD) risk and the usage of mobile health (mHealth) technology may vary depending on the total number of CVD risk factors present. However, whether higher CVD risk is associated with a greater likelihood of engaging in specific mHealth use among US adults is currently unknown. Objective: We aim to assess the associations between the composite CVD risk and each component of mHealth use among US adults regardless of whether they have a history of CVD or not. Methods: This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey. The exposure was CVD risk (diabetes, hypertension, smoking, physical inactivity, and overweight or obesity). We defined low, moderate, and high CVD risk as having 0-1, 2-3, and 4-5 CVD risk factors, respectively. The outcome variables of interest were each component of mHealth use, including using mHealth to make health decisions, track health progress, share health information, and discuss health decisions with health providers. We used multivariable logistic regression models to examine the association between CVD risk and mHealth use adjusted for demographic factors. Results: We included 10,531 adults, with a mean age of 54 (SD 16.2) years. Among the included participants, 50.2% were men, 65.4% were non-Hispanic White, 41.9% used mHealth to make health decisions, 50.8% used mHealth to track health progress toward a health-related goal, 18.3% used mHealth to share health information with health providers, and 37.7% used mHealth to discuss health decisions with health providers (all are weighted percentages). Adults with moderate CVD risk were more likely to use mHealth to share health information with health providers (adjusted odds ratio 1.49, 95% CI 1.24-1.80) and discuss health decisions with health providers (1.22, 95% CI 1.04-1.44) compared to those with low CVD risk. Similarly, having high CVD risk was associated with higher odds of using mHealth to share health information with health providers (2.61, 95% CI 1.93-3.54) and discuss health decisions with health providers (1.56, 95% CI 1.17-2.10) compared to those with low CVD risk. Upon stratifying by age and gender, we observed age and gender disparities in the relationship between CVD risk and the usage of mHealth to discuss health decisions with health providers. Conclusions: Adults with a greater number of CVD risk factors were more likely to use mHealth to share health information with health providers and discuss health decisions with health providers. These findings suggest a promising avenue for enhancing health care communication and advancing both primary and secondary prevention efforts related to managing CVD risk factors through the effective usage of mHealth technology. UR - https://www.jmir.org/2024/1/e46277 UR - http://dx.doi.org/10.2196/46277 UR - http://www.ncbi.nlm.nih.gov/pubmed/38175685 ID - info:doi/10.2196/46277 ER - TY - JOUR AU - Bullock, Garrett AU - Stocks, Joanne AU - Feakins, Benjamin AU - Alizadeh, Zahra AU - Arundale, Amelia AU - Kluzek, Stefan PY - 2024/1/4 TI - Comparing Self-Reported Running Distance and Pace With a Commercial Fitness Watch Data: Reliability Study JO - JMIR Form Res SP - e39211 VL - 8 KW - GPS KW - Garmin KW - training load KW - running KW - exercise KW - fitness KW - wearables KW - running distance KW - pace KW - pace distance N2 - Background: There is substantial evidence exploring the reliability of running distance self-reporting and GPS wearable technology, but there are currently no studies investigating the reliability of participant self-reporting in comparison to GPS wearable technology. There is also a critical sports science and medical research gap due to a paucity of reliability studies assessing self-reported running pace. Objective: The purpose of this study was to assess the reliability of weekly self-reported running distance and pace compared to a commercial GPS fitness watch, stratified by sex and age. These data will give clinicians and sports researchers insights into the reliability of runners? self-reported pace, which may improve training designs and rehabilitation prescriptions. Methods: A prospective study of recreational runners was performed. Weekly running distance and average running pace were captured through self-report and a fitness watch. Baseline characteristics collected included age and sex. Intraclass correlational coefficients were calculated for weekly running distance and running pace for self-report and watch data. Bland-Altman plots assessed any systemic measurement error. Analyses were then stratified by sex and age. Results: Younger runners reported improved weekly distance reliability (median 0.93, IQR 0.92-0.94). All ages demonstrated similar running pace reliability. Results exhibited no discernable systematic bias. Conclusions: Weekly self-report demonstrated good reliability for running distance and moderate reliability for running pace in comparison to the watch data. Similar reliability was observed for male and female participants. Younger runners demonstrated improved running distance reliability, but all age groups exhibited similar pace reliability. Running pace potentially should be monitored through technological means to increase precision. UR - https://formative.jmir.org/2024/1/e39211 UR - http://dx.doi.org/10.2196/39211 UR - http://www.ncbi.nlm.nih.gov/pubmed/38175696 ID - info:doi/10.2196/39211 ER - TY - JOUR AU - Cooray, Nipuna AU - Ho, Catherine AU - Bestman, Amy AU - Adams, Susan AU - Nassar, Natasha AU - Keay, Lisa AU - Brown, Julie PY - 2024/1/3 TI - Exploring the Potential of a Behavior Theory?Informed Digital Intervention for Infant Fall Prevention: Mixed Methods Longitudinal Study JO - JMIR Pediatr Parent SP - e47361 VL - 7 KW - child injury KW - digital behavior change interventions KW - user experience KW - falls KW - infant fall KW - injury KW - mobile app KW - digital intervention KW - users KW - mixed methods longitudinal study KW - behavior KW - development KW - fall risk KW - fall prevention KW - acceptability KW - app KW - children KW - internet KW - parents KW - maternal, paternal KW - accidents KW - infancy KW - infant KW - accidental fall KW - accidental falls KW - infant behavior KW - longitudinal design KW - mixed methods KW - parent KW - mobile phone N2 - Background: Falls are the most common hospitalized injury mechanism in children aged ?1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. Objective: This study aims to evaluate a behavior theory?informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. Methods: Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention. Results: A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. Conclusions: This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app. UR - https://pediatrics.jmir.org/2024/1/e47361 UR - http://dx.doi.org/10.2196/47361 UR - http://www.ncbi.nlm.nih.gov/pubmed/38170580 ID - info:doi/10.2196/47361 ER - TY - JOUR AU - Fubini, Elias Pietro AU - Savoldelli, Louis Georges AU - Beckmann, Sara Tal AU - Samer, Flora Caroline AU - Suppan, Mélanie PY - 2024/1/3 TI - Impact of a Mobile App (LoAD Calc) on the Calculation of Maximum Safe Doses of Local Anesthetics: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e53679 VL - 13 KW - dose calculation KW - drug safety KW - information systems research KW - local anesthetic systemic toxicity KW - local anesthetics KW - mobile health app KW - study protocol KW - toxicity N2 - Background: Local anesthetics (LAs) are regularly used to alleviate pain during medical or surgical procedures. Their use is generally considered safe, but exceeding the maximum recommended doses can lead to LA systemic toxicity, a rare but potentially lethal complication. Determining maximum safe doses is therefore mandatory before performing local anesthesia, but rules are often unclear and the factors affecting dose calculation are numerous. Mobile health apps have been shown to help clinical decision-making, but most currently available apps present significant limitations. The Local Anesthetics Dose Calculator (LoAD Calc) app was designed to overcome these limitations by taking all relevant parameters into account. Before deploying this app in a clinical setting, it should be tested to determine its effectiveness and whether clinicians would be willing to use it. Objective: The primary objective will be to evaluate the effectiveness of the LoAD Calc app through written simulated cases. The secondary objective will be to determine whether physicians find this app easier, faster, and safer than the methods they generally use. Methods: We describe a parallel-group randomized controlled trial protocol. Anesthesiologists working at the Geneva University Hospitals will be invited to participate. Participants will be asked to compute the maximum dose of LA in 10 simulated clinical cases using 3 different LAs. The maximum safe dose will be determined manually using the same calculation rules that were used to develop LoAD Calc, without using the app itself. An overdose will be considered any dose higher than the correct dose, rounded to the superior integer, while an underdose will be defined as the optimal calculated dose minus 20%, rounded to the inferior integer. Randomization will be stratified according to current position (resident vs registrar). The participants allocated to the LoAD Calc (experimental) group will use the LoAD Calc app to compute the maximum safe LA doses. Those allocated to the control group will be asked to use the method they generally use. The primary outcome will be the overall overdose rate. Secondary outcomes will include the overdose rate according to ideal and actual body weight and to each specific LA, the overall underdose rate, and the time taken to complete these calculations. The app?s usability will also be assessed. Results: A sample size of 46 participants will be needed to detect a difference of 10% with a power of 90%. Thus, a target of 50 participants was set to allow for attrition and exclusion criteria. We expect recruitment to begin during the winter of 2023, data analysis in the spring of 2024, and results by the end of 2024. Conclusions: This study should determine whether LoAD Calc, a mobile health app designed to compute maximum safe LA doses, is safer and more efficient than traditional LA calculation methods. International Registered Report Identifier (IRRID): PRR1-10.2196/53679 UR - https://www.researchprotocols.org/2024/1/e53679 UR - http://dx.doi.org/10.2196/53679 UR - http://www.ncbi.nlm.nih.gov/pubmed/38170571 ID - info:doi/10.2196/53679 ER - TY - JOUR AU - Chen, Hung-Hsun AU - Lu, Horng-Shing Henry AU - Weng, Wei-Hung AU - Lin, Yu-Hsuan PY - 2023/12/29 TI - Developing a Machine Learning Algorithm to Predict the Probability of Medical Staff Work Mode Using Human-Smartphone Interaction Patterns: Algorithm Development and Validation Study JO - J Med Internet Res SP - e48834 VL - 25 KW - human-smartphone interaction KW - digital phenotyping KW - work hours KW - machine learning KW - deep learning KW - probability in work mode KW - one-dimensional convolutional neural network KW - extreme gradient-boosted trees N2 - Background: Traditional methods for investigating work hours rely on an employee?s physical presence at the worksite. However, accurately identifying break times at the worksite and distinguishing remote work outside the worksite poses challenges in work hour estimations. Machine learning has the potential to differentiate between human-smartphone interactions at work and off work. Objective: In this study, we aimed to develop a novel approach called ?probability in work mode,? which leverages human-smartphone interaction patterns and corresponding GPS location data to estimate work hours. Methods: To capture human-smartphone interactions and GPS locations, we used the ?Staff Hours? app, developed by our team, to passively and continuously record participants? screen events, including timestamps of notifications, screen on or off occurrences, and app usage patterns. Extreme gradient boosted trees were used to transform these interaction patterns into a probability, while 1-dimensional convolutional neural networks generated successive probabilities based on previous sequence probabilities. The resulting probability in work mode allowed us to discern periods of office work, off-work, breaks at the worksite, and remote work. Results: Our study included 121 participants, contributing to a total of 5503 person-days (person-days represent the cumulative number of days across all participants on which data were collected and analyzed). The developed machine learning model exhibited an average prediction performance, measured by the area under the receiver operating characteristic curve, of 0.915 (SD 0.064). Work hours estimated using the probability in work mode (higher than 0.5) were significantly longer (mean 11.2, SD 2.8 hours per day) than the GPS-defined counterparts (mean 10.2, SD 2.3 hours per day; P<.001). This discrepancy was attributed to the higher remote work time of 111.6 (SD 106.4) minutes compared to the break time of 54.7 (SD 74.5) minutes. Conclusions: Our novel approach, the probability in work mode, harnessed human-smartphone interaction patterns and machine learning models to enhance the precision and accuracy of work hour investigation. By integrating human-smartphone interactions and GPS data, our method provides valuable insights into work patterns, including remote work and breaks, offering potential applications in optimizing work productivity and well-being. UR - https://www.jmir.org/2023/1/e48834 UR - http://dx.doi.org/10.2196/48834 UR - http://www.ncbi.nlm.nih.gov/pubmed/38157232 ID - info:doi/10.2196/48834 ER - TY - JOUR AU - Breitinger, Scott AU - Gardea-Resendez, Manuel AU - Langholm, Carsten AU - Xiong, Ashley AU - Laivell, Joseph AU - Stoppel, Cynthia AU - Harper, Laura AU - Volety, Rama AU - Walker, Alex AU - D'Mello, Ryan AU - Byun, Soo Andrew Jin AU - Zandi, Peter AU - Goes, S. Fernando AU - Frye, Mark AU - Torous, John PY - 2023/12/29 TI - Digital Phenotyping for Mood Disorders: Methodology-Oriented Pilot Feasibility Study JO - J Med Internet Res SP - e47006 VL - 25 KW - mood disorders KW - depression KW - bipolar disorder KW - digital health KW - digital phenotyping KW - mobile apps KW - patient-generated health data KW - wearable devices N2 - Background: In the burgeoning area of clinical digital phenotyping research, there is a dearth of literature that details methodology, including the key challenges and dilemmas in developing and implementing a successful architecture for technological infrastructure, patient engagement, longitudinal study participation, and successful reporting and analysis of diverse passive and active digital data streams. Objective: This article provides a narrative rationale for our study design in the context of the current evidence base and best practices, with an emphasis on our initial lessons learned from the implementation challenges and successes of this digital phenotyping study. Methods: We describe the design and implementation approach for a digital phenotyping pilot feasibility study with attention to synthesizing key literature and the reasoning for pragmatic adaptations in implementing a multisite study encompassing distinct geographic and population settings. This methodology was used to recruit patients as study participants with a clinician-validated diagnostic history of unipolar depression, bipolar I disorder, or bipolar II disorder, or healthy controls in 2 geographically distinct health care systems for a longitudinal digital phenotyping study of mood disorders. Results: We describe the feasibility of a multisite digital phenotyping pilot study for patients with mood disorders in terms of passively and actively collected phenotyping data quality and enrollment of patients. Overall data quality (assessed as the amount of sensor data obtained vs expected) was high compared to that in related studies. Results were reported on the relevant demographic features of study participants, revealing recruitment properties of age (mean subgroup age ranged from 31 years in the healthy control subgroup to 38 years in the bipolar I disorder subgroup), sex (predominance of female participants, with 7/11, 64% females in the bipolar II disorder subgroup), and smartphone operating system (iOS vs Android; iOS ranged from 7/11, 64% in the bipolar II disorder subgroup to 29/32, 91% in the healthy control subgroup). We also described implementation considerations around digital phenotyping research for mood disorders and other psychiatric conditions. Conclusions: Digital phenotyping in affective disorders is feasible on both Android and iOS smartphones, and the resulting data quality using an open-source platform is higher than that in comparable studies. While the digital phenotyping data quality was independent of gender and race, the reported demographic features of study participants revealed important information on possible selection biases that may result from naturalistic research in this domain. We believe that the methodology described will be readily reproducible and generalizable to other study settings and patient populations given our data on deployment at 2 unique sites. UR - https://www.jmir.org/2023/1/e47006 UR - http://dx.doi.org/10.2196/47006 UR - http://www.ncbi.nlm.nih.gov/pubmed/38157233 ID - info:doi/10.2196/47006 ER - TY - JOUR AU - Pandya, Apurvakumar AU - K S, Mythri AU - Mishra, Shweta AU - Bajaj, Kriti PY - 2023/12/29 TI - Effectiveness of the QuitSure Smartphone App for Smoking Cessation: Findings of a Prospective Single Arm Trial JO - JMIR Form Res SP - e51658 VL - 7 KW - smoking KW - nicotine dependence KW - smoking cessation KW - QuitSure app KW - smartphone application KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - nicotine KW - smoke KW - smoker KW - quit KW - quitting KW - cessation KW - abstinence KW - mobile phone N2 - Background: Digital therapies, especially smartphone apps for active and continuous smoking cessation support, are strongly emerging as an alternative smoking cessation therapy. In the Indian context, there is a growing interest in the use of app-based smoking cessation programs; however, there is limited evidence regarding their effectiveness in achieving long-term continuous abstinence. Objective: This study aimed to evaluate the long-term abstinence effect (up to 30-d abstinence postprogram completion) of a smartphone app, QuitSure, for smoking cessation in active smokers from India. Methods: In this prospective single-arm study, participants who signed up for the QuitSure app were enrolled in this study. The primary end point was the prolonged abstinence (PA) rate from weeks 1 to 4 (day 7 to day 30). Furthermore, data for withdrawal symptoms, relapse reasons, and reasons for not continuing the program were also assessed. Results: The quit rate was calculated considering only the participants who followed up and completed the survey sent to them (per protocol) at day 7 and at day 30, respectively. The PA rate at day 7 was found to be 64.5% (111/172; 95% CI 56% to 72%), and the PA rate at day 30 was found to be 55.8% (72/129; 95% CI 45% to 65%). Within the 7-day abstinence period, 60.4% (67/111) of the participants did not have any withdrawal symptoms. The most common mild withdrawal symptoms were mild sleep disturbance (21/111, 18.9%), mild digestive changes (19/111, 17.1%), and coughing (17/111, 15.3%). Severe withdrawal symptoms were rare, with only 5.4% (6/111) experiencing them. For those achieving 30-day postprogram abstinence, 85% (61/72) had no mild withdrawal symptoms, and 99% (71/72) had no severe withdrawal symptoms. Among successful quitters at day 7, a total of 72.1% (80/111) reported minimal to no cravings, which increased to 88% (63/72) at day 30. Furthermore, 78% (56/72) of those with PA at day 30 reported no change in weight or reduced weight. Among participants experiencing relapse, 48% (28/58) cited intense cravings, 28% (16/58) mentioned facing a tragedy, and 26% (15/58) reported relapsing due to alcohol consumption. The PA rates as a result of the QuitSure program were found to be better than those reported in the results of other smoking-cessation app programs? studies. Conclusions: The QuitSure app yields high PA rates and ameliorates symptoms associated with smoking cessation. In order to obtain conclusive evidence regarding the effectiveness and efficacy of the QuitSure program, future research should include appropriate control measures. Nevertheless, the QuitSure program can serve as a valuable adjunct to a conventional smoking cessation treatment program to aid sustained abstinence. UR - https://formative.jmir.org/2023/1/e51658 UR - http://dx.doi.org/10.2196/51658 UR - http://www.ncbi.nlm.nih.gov/pubmed/38157243 ID - info:doi/10.2196/51658 ER - TY - JOUR AU - McDermott, Katherine AU - Levey, Nadine AU - Brewer, Julie AU - Ehmann, Madison AU - Hooker, E. Julia AU - Pasinski, Roger AU - Yousif, Neda AU - Raju, Vidya AU - Gholston, Milton AU - Greenberg, Jonathan AU - Ritchie, S. Christine AU - Vranceanu, Ana-Maria PY - 2023/12/29 TI - Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic JO - JMIR Res Protoc SP - e52117 VL - 12 KW - chronic pain KW - mind-body KW - underserved KW - musculoskeletal pain KW - pain KW - older adults KW - pain management KW - feasibility KW - intervention N2 - Background: Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). Objective: We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. Methods: We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ?55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (?75% of patients who are approached agree to participate), acceptability (?75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (?75% of session components are delivered as intended). Secondary outcomes include physical function?self-reported, performance based (6-minute walk test), and objective (step count)?and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). Results: We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. Conclusions: We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. Trial Registration: ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231 International Registered Report Identifier (IRRID): DERR1-10.2196/52117 UR - https://www.researchprotocols.org/2023/1/e52117 UR - http://dx.doi.org/10.2196/52117 UR - http://www.ncbi.nlm.nih.gov/pubmed/38157234 ID - info:doi/10.2196/52117 ER - TY - JOUR AU - Abdelhameed, Farah AU - Pearson, Eilish AU - Parsons, Nick AU - Barber, M. Thomas AU - Panesar, Arjun AU - Summers, Charlotte AU - de la Fosse, Michaela AU - Hanson, Petra PY - 2023/12/28 TI - Health Outcomes Following Engagement With a Digital Health Tool Among People With Prediabetes and Type 2 Diabetes: Prospective Evaluation Study JO - JMIR Diabetes SP - e47224 VL - 8 KW - application KW - diabetes KW - digital health tool KW - digital health KW - eHealth KW - mHealth KW - mobile app KW - mobile health KW - prediabetes KW - quality of life KW - type 2 diabetes N2 - Background: Diabetes is a worldwide chronic condition causing morbidity and mortality, with a growing economic burden on health care systems. Complications from poorly controlled diabetes are associated with increased socioeconomic costs and reduced quality of life. Smartphones have become an influential platform, providing feasible tools such as health apps to deliver tailored support to enhance the ability of patients with diabetes for self-management. Gro Health is a National Health Service division X?certified digital health tool used to deliver educational and monitoring support to facilitate the development of skills and practices for maintaining good health. Objective: This study aims to assess self-reported outcomes of the Gro Health app among users with diabetes and prediabetes and identify the factors that determine engagement with the digital health tool. Methods: This was a service evaluation of self-reported data collected prospectively by the developers of the Gro Health app. The EQ-5D questionnaire is a standardized tool used to measure health status for clinical and economic appraisal. Gro Health users completed the EQ-5D at baseline and 6 months after using the app. Users provided informed consent for the use of their anonymized data for research purposes. EQ-5D index scores and visual analogue scale (VAS) scores were calculated at baseline and 6 months for individuals with prediabetes and type 2 diabetes. Descriptive statistics and multiple-regression models were used to assess changes in the outcome measures and determine factors that affected engagement with the digital tool. Results: A total of 84% (1767/2114) of Gro Health participants completed EQ-5D at baseline and 6 months. EQ-5D index scores are average values that reflect people?s preferences about their health state (1=full health and 0=moribund). There was a significant and clinically meaningful increase in mean EQ-5D index scores among app users between baseline (0.746, SD 0.23) and follow-up (0.792, SD 0.22; P<.001). The greatest change was observed in the mean VAS score, with a percentage change of 18.3% improvement (61.7, SD 18.1 at baseline; 73.0, SD 18.8 at follow-up; P<.001). Baseline EQ-5D index scores, age, and completion of educational modules were associated with significant changes in the follow-up EQ-5D index scores, with baseline EQ-5D index scores, race and ethnicity, and completion of educational modules being significantly associated with app engagement (P<.001). Conclusions: This study provides evidence of a significant positive effect on self-reported quality of life among people living with type 2 diabetes engaging with a digital health intervention. The improvements, as demonstrated by the EQ-5D questionnaire, are facilitated through access to education and monitoring support tools within the app. This provides an opportunity for health care professionals to incorporate National Health Service?certified digital tools, such as Gro Health, as part of the holistic management of people living with diabetes. UR - https://diabetes.jmir.org/2023/1/e47224 UR - http://dx.doi.org/10.2196/47224 UR - http://www.ncbi.nlm.nih.gov/pubmed/38016426 ID - info:doi/10.2196/47224 ER - TY - JOUR AU - Park, Y. Susanna AU - Yourell, Jacqlyn AU - McAlister, L. Kelsey AU - Huberty, Jennifer PY - 2023/12/28 TI - Exploring Generation Z and Young Millennials? Perspectives of a Spiritual Self-Care App and Their Spiritual Identity (Skylight): Qualitative Semistructured Interview Study JO - JMIR Form Res SP - e54284 VL - 7 KW - Gen Z KW - Generation Z KW - millennial KW - GenZennials KW - millennials KW - young adult KW - young adults KW - spirituality KW - spiritual KW - self-care KW - mental health KW - sleep KW - mobile health KW - app KW - apps KW - digital health KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - interview KW - interviews KW - thematic analysis KW - mobile phone N2 - Background: Generation Z and young millennials (ages 18-35 years), collectively referred to as GenZennials, are connected to technology and the internet like no other generation before them. This has mental health implications, such as increased rates of anxiety and stress. Recent research has shown that app-based mental health interventions can be useful to address such mental health concerns. However, spirituality is an untapped resource, especially since GenZennials largely identify as spiritual and already integrate spiritual practices into their self-care. Objective: There were four objectives to this study: (1) comprehensively explore reasons why GenZennials use a spiritual self-care app (ie, Skylight; Radiant Foundation), (2) understand how GenZennials identify spiritually, (3) understand the app?s relevance to GenZennials, and (4) gather feedback and suggestions to improve the app. Methods: Semistructured interviews were conducted with 23 GenZennials (ages 18-35 years; mean 28.7, SD 5.0 years; n=20, 87% female) who used the Skylight app. Interviews were 30 to 60 minutes and conducted on Zoom. Thematic analysis was used to analyze interviews. Results: Five major categories emerged from the analysis, each encompassing one to several themes: (1) reasons for using the Skylight app, (2) content favorites, (3) defining spiritual identity, (4) relevance to GenZennials, and (5) overall improvement recommendations. Participants used the app for various reasons including to relax, escape, or ground themselves; improve mood; and enhance overall health and wellness. Participants also cited the app?s variety of content offerings and its free accessibility as their primary reasons for using it. Most participants identified themselves as solely spiritual (8/23/35%) among the options provided (ie, spiritual or religious or both), and they appreciated the app?s inclusive content. Participants felt that the app was relevant to their generation as it offered modern content (eg, spiritual self-care activities and short content). Participants recommended adding more personalization capabilities, content, and representation to the app. Conclusions: This is the first study to qualitatively explore GenZennials? perspectives and the use of a spiritual self-care app. Our findings should inform the future creation and improvement of spiritual self-care apps aimed at cultivating GenZennials? spiritual and mental well-being. Future research is warranted to examine the effects of using a spiritual self-care app on GenZennial mental health. UR - https://formative.jmir.org/2023/1/e54284 UR - http://dx.doi.org/10.2196/54284 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064199 ID - info:doi/10.2196/54284 ER - TY - JOUR AU - Richards, Rebecca AU - Wren, M. Gina AU - Campion, Peta AU - Whitman, Michael PY - 2023/12/28 TI - A Remotely Delivered, Semaglutide-Supported Specialist Weight Management Program: Preliminary Findings From a Retrospective Service Evaluation JO - JMIR Form Res SP - e53619 VL - 7 KW - digital health intervention KW - smartphone KW - obesity management KW - medication KW - mobile phone N2 - Background: Digital weight management interventions have the potential to increase access to novel pharmacotherapy for people living with obesity. At present, there is limited real-world evidence on the effectiveness, feasibility, and acceptability of this type of intervention. Objective: This retrospective service evaluation examines real-world data to evaluate the preliminary impact of Second Nature?s 24-month, remotely delivered, semaglutide-supported weight management intervention for adults living with obesity at 12 weeks. Methods: Retrospective data were extracted in October 2023 for participants who started the intervention between June 8, 2023, and July 22, 2023. The primary outcomes were weight change (kg) and percentage of weight change at 12 weeks. The secondary outcomes were the proportion of participants who achieved ?5% and ?10% weight loss and the feasibility and acceptability of this type of intervention. Descriptive statistics were used to evaluate the baseline characteristics, retention, engagement, prevalence of side effects, and weight change. A paired 2-tailed t test was used to determine the significance of weight change. Content analysis was used to analyze the free-text questionnaire responses. Results: A total of 113 participants with a mean baseline BMI of 38.4 kg/m2 (SD 7.3) were included in the analysis (n=102, 90.4% women, mean age 46.6, SD 11.1 years). Over 12 weeks, 23% (n=26) of participants withdrew from the intervention. A total of 70.8% (n=80) of participants provided weight data at 12 weeks. The average weight loss observed over this 12-week period was 6.5 (SD 4.4) kg (P<.001) or 6.4% (SD 4.2%) of their starting weight (P<.001). Of the 80 participants who recorded weight readings, 62.5% (n=50) achieved ?5% weight loss, and 11.3% (n=9) achieved ?10% weight loss. Engagement with the app-based program declined from a mean of 131 (SD 142.6) home screen views in week 0 to 35 (SD 57.1) in week 11. Common side effects reported over 12 weeks included feeling more tired than usual, constipation, and feeling sick. However, a significant proportion of participants reported no side effects. Most participants (n=106, 93.8%) did not experience any difficulties in medication administration. Qualitative data showed that most participants had a positive or neutral experience of the intervention, with some reporting perceived benefits as early as 4 weeks. Most participants did not feel that improvements in the intervention were needed; however, some participants faced issues with medication shipping or logistics. Conclusions: This retrospective preliminary service evaluation suggests that a remotely delivered semaglutide-supported weight management intervention has the potential to be effective, feasible, and acceptable for self-paying consumer adults with obesity in the United Kingdom. Areas for further improvement were highlighted, including user engagement in an app-based program. A full-service evaluation at the end of the 24-month intervention with a larger sample size is required to support these early findings. UR - https://formative.jmir.org/2023/1/e53619 UR - http://dx.doi.org/10.2196/53619 UR - http://www.ncbi.nlm.nih.gov/pubmed/38153780 ID - info:doi/10.2196/53619 ER - TY - JOUR AU - Reid, Denzil AU - Mehta, Jyotsna AU - Anis, Karim AU - Mehta, Shail PY - 2023/12/28 TI - Impact of Remote Patient Monitoring Platform on Patients With Moderate to Severe Persistent Asthma: Observational Study JO - JMIR Form Res SP - e51065 VL - 7 KW - asthma KW - remote patient monitoring KW - virtual care solution KW - respiratory care KW - chronic disease management KW - spirometry KW - telehealth KW - management KW - chronic disease KW - virtual care KW - patient monitoring KW - respiratory KW - respiratory illness KW - patient monitoring tool KW - tool KW - decision-making N2 - Background: Asthma is one of the most common respiratory diseases, with an ever-growing health care burden. Remote patient monitoring (RPM) has gained increasing importance in the respiratory care area with the outbreak of the COVID-19 pandemic. In this pilot study, we introduced a novel platform that remotely monitors patients with chronic respiratory illnesses using Centers for Disease Control and Prevention guidelines to reduce hospitalizations and emergency department visits. Objective: This study aimed to understand patient and physician engagement with a new virtual care solution (KevaTalk app and Keva365 platform) and the value, for both patients and providers, of using an RPM tool. We assessed real-world use of the platform from both physician and patient perspectives and the impact of devices on engagement and monitoring. Methods: Participants with a history of moderate to severe persistent asthma, seen by a pulmonologist at a hospital, were included in this study. The inclusion criteria involved being aged ?18 years and having access to an Android or iOS mobile device with internet. We provided patient questionnaires to assess the app?s usefulness and evaluate its features. We monitored remote spirometry and oximetry data, app check-ins, alerts, and escalations during this study?s time window. Data were reviewed daily and predetermined criteria were set to escalate for physician review based on the patient?s symptoms and objective data. Results: Overall, 25 patients were included in this pilot. The mean age was 57 (SD 10.7) years and a majority (n=23, 92%) were female. A baseline questionnaire, which was used to rate the app, indicated that the ease of check-in and ease of modification to the patient?s asthma plan were the 2 highest rated features. In total, 2066 check-ins (1550 green, 506 yellow, and 10 red check-ins) and 1155 spirometry sessions were recorded during this 3-month period. Further, 64% (14/22) and 91% (20/22) of patients were found to have peak flows in their red and yellow zones at least once, respectively. During the course of this study, 484 alerts were recorded and evaluated by the team, of which 37.2% (n=180) required an escalation to the physician; this included a transfer to a medical facility, change in respiratory medication, or further education. Conclusions: In this pilot study, we demonstrated the feasibility of implementing a novel RPM platform in patients with asthma. Our platform showed high patient engagement and satisfaction and provided physicians with real-time subjective data to evaluate patients remotely that aids in clinical decision-making. The escalations prevented patients from having an exacerbation or flare up, which led to the prevention of an emergency department visit. Continuous monitoring of chronic disease has benefits over episodic monitoring. It allows for improved quality of life, better outcomes, and huge health care savings. UR - https://formative.jmir.org/2023/1/e51065 UR - http://dx.doi.org/10.2196/51065 UR - http://www.ncbi.nlm.nih.gov/pubmed/38153783 ID - info:doi/10.2196/51065 ER - TY - JOUR AU - Arnaert, Antonia AU - Sumbly, Pia AU - da Costa, Daniel AU - Liu, Yuxin AU - Debe, Zoumanan AU - Charbonneau, Sylvain PY - 2023/12/26 TI - Acceptance of the Apple Watch Series 6 for Telemonitoring of Older Adults With Chronic Obstructive Pulmonary Disease: Qualitative Descriptive Study Part 1 JO - JMIR Aging SP - e41549 VL - 6 KW - Apple Watch KW - chronic obstructive pulmonary disease KW - digital health KW - older adults KW - qualitative descriptive KW - technology acceptance KW - telemonitoring N2 - Background: The Apple Watch is not a medical device per se; it is a smart wearable device that is increasingly being used for health monitoring. Evidence exists that the Apple Watch Series 6 can reliably measure blood oxygen saturation (SpO2) in patients with chronic obstructive pulmonary disease under controlled circumstances. Objective: This study aimed to better understand older adults? acceptance of the Watch as a part of telemonitoring, even with these advancements. Methods: This study conducted content analysis on data collected from 10 older adults with chronic obstructive pulmonary disease who consented to wear the Watch. Results: Using the Extended Unified Theory of Acceptance and Use of Technology model, results showed that participants experienced potential health benefits; however, the inability of the Watch to reliably measure SpO2 when in respiratory distress was concerning. Participants? level of tech savviness varied, which caused some fear and frustration at the start, yet all felt supported by family and would have explored more features if they owned the Watch. All agreed that the Watch is mainly a medical tool and not a gadget. Conclusions: To conclude, although the Watch may enhance their physical health and well-being, results indicated that participants are more likely to accept the Watch if it ultimately proves to be useful when experiencing respiratory distress. UR - https://aging.jmir.org/2023/1/e41549 UR - http://dx.doi.org/10.2196/41549 UR - http://www.ncbi.nlm.nih.gov/pubmed/38147371 ID - info:doi/10.2196/41549 ER - TY - JOUR AU - Balsam, Donna AU - Bounds, T. Dawn AU - Rahmani, M. Amir AU - Nyamathi, Adeline PY - 2023/12/25 TI - Evaluating the Impact of an App-Delivered Mindfulness Meditation Program to Reduce Stress and Anxiety During Pregnancy: Pilot Longitudinal Study JO - JMIR Pediatr Parent SP - e53933 VL - 6 KW - mindfulness app KW - pregnancy KW - pregnant KW - maternal KW - obstetric KW - obstetrics KW - stress KW - anxiety KW - heart rate variability KW - mindfulness KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - mental health KW - meditation KW - mind-body KW - complementary KW - alternative KW - heart rate KW - sleep KW - mobile phone N2 - Background: Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility. Objective: The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy. Methods: A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participant?s levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring. Results: Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P<.0001). Hierarchical linear modeling revealed a statistically significant reduction in the physiological data reflective of stress in 1 of 6 heart rate variability metrics, the low-frequency power band, which decreased by 13% (P=.006). A total of 65% of study participants (n=13) reported their sleep improved during the trial, and 95% (n=19) stated that learning mindfulness helped with other aspects of their lives. Participant retention was 100%, with 65% of participants (n=13) completing about two-thirds of the intervention, and 50% of participants (n=10) completing ?95%. Conclusions: This study found evidence to support the Headspace app as an effective intervention to aid in stress and anxiety reduction during pregnancy. UR - https://pediatrics.jmir.org/2023/1/e53933 UR - http://dx.doi.org/10.2196/53933 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145479 ID - info:doi/10.2196/53933 ER - TY - JOUR AU - Choi, Soyoung AU - Sajib, Zaman Md Refat Uz AU - Manzano, Jenna AU - Chlebek, Joseph Christian PY - 2023/12/25 TI - mHealth Technology Experiences of Middle-Aged and Older Individuals With Visual Impairments: Cross-Sectional Interview Study JO - JMIR Form Res SP - e52410 VL - 7 KW - aging KW - mobile health KW - older adults KW - technology KW - visual impairment KW - wearables KW - wearable KW - vision KW - visual KW - qualitative analysis KW - health behavior KW - mHealth KW - mHealth technology KW - digital technology KW - medical application KW - application KW - app KW - applications KW - usage KW - well-being KW - cross-section interview KW - interview KW - interviews KW - tracking KW - health data KW - symptom monitoring KW - monitor KW - monitoring KW - symptom KW - symptoms KW - physical activity KW - walking KW - routine KW - mobile phone N2 - Background: Current mobile health (mHealth) technology is predominantly designed with a visual orientation, often resulting in user interfaces that are inaccessible to visually impaired users. While mHealth technology offers potential for facilitating chronic illness management and enhancing health behaviors among visually impaired older populations, understanding its usage remains limited. Objective: This qualitative research aimed to explore the mHealth technology experiences of middle-aged and older individuals with visual impairments including the accessibility and usability issues they faced. Methods: The qualitative exploration was structured using the mHealth for Older Users framework. Cross-sectional interviews were conducted via Zoom between June 1 and July 31, 2023, using an interview protocol for data collection. A thematic analysis approach was employed to analyze the transcribed interview scripts. Results: Of the 7 participants who took part in the Zoom interviews, 3 were men and 4 were women, with ages ranging from 53 to 70 years. Most participants adopted mHealth apps and wearable devices for promoting health. They exhibited 3 distinct adoption patterns. Seven themes were emerged from the perceived challenges in using mHealth technologies: (1) a scarcity of accessible user manuals, (2) user interfaces that are not visually impaired-friendly, (3) health data visualizations that are not accessible, (4) unintuitive arrangement of app content, (5) health information that is challenging to comprehend, (6) cognitive overload caused by an excess of audible information, and (7) skepticism regarding the accuracy of health records. mHealth technologies seem to positively affect the health and health management of participants. Conclusions: Design considerations for mHealth technologies should consider individuals? disabilities and chronic conditions and should emphasize the importance of providing accessible manuals and training opportunities when introducing new mHealth solutions. UR - https://formative.jmir.org/2023/1/e52410 UR - http://dx.doi.org/10.2196/52410 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145472 ID - info:doi/10.2196/52410 ER - TY - JOUR AU - Folkvord, Frans AU - Bol, Nadine AU - Stazi, Giacomo AU - Peschke, Lutz AU - Lupiáñez-Villanueva, Francisco PY - 2023/12/25 TI - Preferences in the Willingness to Download an mHealth App: Discrete Choice Experimental Study in Spain, Germany, and the Netherlands JO - JMIR Form Res SP - e48335 VL - 7 KW - mHealth adoption KW - discrete choice task KW - mobile apps KW - self-monitoring KW - willingness KW - mobile health app KW - mobile app KW - mobile health KW - mHealth KW - adoption KW - mHealth tools KW - health care cost KW - effectiveness KW - mobile phone N2 - Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the adoption of mHealth is low, and only a limited number of studies have examined the intention to download mHealth apps. Objective: In this study, we investigated individuals? preferences in the adoption of a health app. Methods: We conducted a discrete choice experimental study in 3 countries (Spain: n=800, Germany: n=800, and the Netherlands: n=416) with 4 different attributes and levels (ie, price: ?1.99 vs ?4.99 [a currency exchange rate of ?1=US $1.09 is applicable] vs for free, data protection: data protection vs no information, recommendation: patients? association vs doctors, and manufacturer: medical association vs pharmaceutical company). Participants were randomly assigned. For the analyses, we used the conditional logistic model separately for each country. Results: The results showed that price and data protection were considered important factors that significantly increased the probability to download an mHealth app. In general, the source of the recommendation and the manufacturer affected the probability to download the mHealth app less. However, in Germany and the Netherlands, we found that if the app was manufactured by a pharmaceutical company, the probability to download the mHealth app decreased. Conclusions: mHealth tools are highly promising to reduce health care costs and increase the effectiveness of traditional health interventions and therapies. Improving data protection, reducing costs, and creating sound business models are the major driving forces to increase the adoption of mHealth apps in the future. It is thereby essential to create trustworthy standards for mobile apps, whereby prices, legislation concerning data protection, and health professionals can have a leading role to inform the potential consumers. UR - https://formative.jmir.org/2023/1/e48335 UR - http://dx.doi.org/10.2196/48335 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145470 ID - info:doi/10.2196/48335 ER - TY - JOUR AU - Harris, M. Kelly AU - Mayo Gamble, Tilicia AU - Yoo, G. Madelyn AU - Spell, A. Lindsay AU - Minor, N. Timira AU - Jones, Holly AU - Lynch, Donald PY - 2023/12/22 TI - Leveraging mHealth to Mitigate the Impact of COVID-19 in Black American Communities: Qualitative Analysis JO - JMIR Hum Factors SP - e47294 VL - 10 KW - COVID-19 KW - mobile health KW - mHealth KW - information-seeking behavior KW - Black communities KW - cardiovascular health KW - community KW - qualitative analysis KW - morbidity KW - mortality KW - develop KW - pilot KW - evaluate KW - mHealth intervention KW - cardiovascular KW - racism KW - health equity N2 - Background: COVID-19 remains an ongoing public health crisis. Black Americans remain underrepresented among those vaccinated and overrepresented in both COVID-19 morbidity and mortality. Medical misinformation, specifically related to COVID-19, has exacerbated the impact of the disease in Black American communities. Communication tools and strategies to build relationships and disseminate credible and trustworthy diagnostic and preventative health information are necessary to improve outcomes and equity for historically oppressed populations. Objective: As the initial phase of a larger mixed methods project to develop, pilot, and evaluate a mobile health (mHealth) intervention among a population at high risk for COVID-19 and cardiovascular comorbidities, this study sought to explore COVID-19 information behavior among Black Americans. Specifically, this study examined (1) preferences for COVID-19 education via mHealth, (2) barriers and facilitators to COVID-19 education and diagnostic testing and routine care for associated cardiovascular and respiratory comorbidities in the local community, and (3) key content for inclusion in a COVID-19 mHealth app. Methods: This qualitative study used principles of community-based participatory research and information systems research to conduct 7 focus groups across 3 sites. Focus groups were audio recorded and transcribed for thematic analysis using an abductive approach. Results: The study sample included 54 individuals across sites with a mean age of 50.24 (SD 11.76; range 20-71) years. Participants were primarily female (n=42, 78%) and Black (n=54, 100%) with varied education levels. Over half (n=29, 54%) of the participants were employed full-time, and nearly three-fourths (n=40, 74%) had household incomes .05). After 6 months, although both groups show a significant pre-post improvement (P<.001 each), the BP control rate (ie, the proportion of patients with a systolic BP of <140 mm Hg and diastolic BP of <90 mm Hg) in the intervention group was better than that in the control group (100/111, 90.1% vs 75/115, 65.2%; P<.001). The mean systolic and diastolic BP were significantly reduced by 25.83 (SD 8.99) and 14.28 (SD 3.74) mm Hg in the intervention group (P<.001) and by 21.83 (SD 6.86) and 8.87 (SD 4.22) mm Hg in the control group (P<.001), respectively. The differences in systolic and diastolic BP between the 2 groups were significant (P<.001 and P=.01, respectively). Hypertension knowledge significantly improved only in the intervention group in both pre-post and intergroup comparisons (both P<.001). However, only intragroup improvement was observed for lifestyle behaviors in the intervention group (P<.001), including medication adherence (P<.001), healthy diet (P=.02), low salt intake (P<.001), and physical exercises (P=.02), and no significant difference was observed in the control group or on intergroup comparisons. Conclusions: This research shows that the mHealth app?based intervention has the potential to improve patient health knowledge and support self-management among them toward a healthier lifestyle, including medication adherence, low-salt diets, and physical exercises, thereby achieving optimal BP control. Further research is still needed to verify the specific effects of these interventions. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026437; https://www.chictr.org.cn/showproj.html?proj=38801 UR - https://www.jmir.org/2023/1/e43809 UR - http://dx.doi.org/10.2196/43809 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113071 ID - info:doi/10.2196/43809 ER - TY - JOUR AU - Safiee, Ladan AU - Rough, Daniel AU - George, Priya AU - Mudenha, Roselyn PY - 2023/12/19 TI - Baseline Perceptions of Women With Gestational Diabetes Mellitus and Health Care Professionals About Digital Gestational Diabetes Mellitus Self-Management Health Care Technologies: Interview Study Among Patients and Health Care Professionals JO - JMIR Hum Factors SP - e51691 VL - 10 KW - gestational diabetes KW - self-management KW - mobile health KW - mHealth KW - qualitative study KW - mobile phone N2 - Background: Gestational diabetes mellitus (GDM) is a significant medical complication of pregnancy that requires close monitoring by a multidisciplinary health care team. The growing sophistication of mobile health (mHealth) technology could play a significant supporting role for women with GDM and health professionals (HPs) regarding GDM management. Objective: This study included 2 phases. The aim of phase 1 was to explore the perceptions of HPs and women with GDM regarding the use of mHealth for GDM self-management and to identify their needs from these technologies. The aim of phase 2 was to explore the perceptions of women with GDM about their experiences with a state-of-the-art app for managing GDM that was offered to them during the COVID-19 lockdown. This phase aimed to understand the impact that COVID-19 has had on women?s perceptions about using technology to manage their GDM. By combining both phases, the overall aim was to establish how perceptions about GDM self-management technology have changed owing to the pandemic restrictions and experience of using such technology. Methods: In total, 26 semistructured interviews were conducted in 2 phases. In phase 1, overall, 62% (16/26) of the participants, including 44% (7/16) of HPs, 50% (8/16) of women with GDM, and 6% (1/16) of women in the postpartum period with GDM history participated in the interviews. In phase 2, overall, 38% (10/26) of women with GDM participated in the interviews. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis. Results: Phase 1 identified 3 themes from the interviews with women with GDM: fitting with women?s lifestyle constraints, technology?s design not meeting women?s needs, and optimizing the technology?s design to meet women?s needs. Overall, 3 themes were derived from the interviews with HPs: optimizing the technology?s design to improve the quality of care, technology to support women?s independence, and limitations in the care system and facilities. Analysis of phase-2 interviews identified 2 further themes: enhancing the information and functionalities and optimizing the interface design. In both phases, participants emphasized a simple and user-friendly interface design as the predominant positive influence on their use of technology for GDM management. Conclusions: The combined findings underlined similar points. Poor usability, data visualization limitations, lack of personalization, limited information, and lack of communication facilities were the prime issues of current GDM self-management mHealth technology that need to be addressed. The analysis also revealed how women with GDM should play a vital role in gathering the requirements for GDM self-management technology; some needs were identified from in-depth discussion with women with GDM that would be missed without their involvement. UR - https://humanfactors.jmir.org/2023/1/e51691 UR - http://dx.doi.org/10.2196/51691 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113070 ID - info:doi/10.2196/51691 ER - TY - JOUR AU - Sriraam, Natarajan AU - Raghu, S. AU - Gommer, D. Erik AU - Hilkman, W. Danny M. AU - Temel, Yasin AU - Vasudeva Rao, Shyam AU - Hegde, Satyaranjandas Alangar AU - L Kubben, Pieter PY - 2023/12/19 TI - Application of a Low-Cost mHealth Solution for the Remote Monitoring of Patients With Epilepsy: Algorithm Development and Validation JO - JMIR Neurotech SP - e50660 VL - 2 KW - Android KW - epileptic seizures KW - mobile health KW - mHealth KW - mobile phone?based epilepsy monitoring KW - support vector machine KW - seizure KW - epileptic KW - epilepsy KW - monitoring KW - smartphone KW - smartphones KW - mobile phone KW - neurology KW - neuroscience KW - electroencephalography KW - EEG KW - brain KW - classification KW - detect KW - detection KW - neurological KW - electroencephalogram KW - diagnose KW - diagnosis KW - diagnostic KW - imaging N2 - Background: Implementing automated seizure detection in long-term electroencephalography (EEG) analysis enables the remote monitoring of patients with epilepsy, thereby improving their quality of life. Objective: The objective of this study was to explore an mHealth (mobile health) solution by investigating the feasibility of smartphones for processing large EEG recordings for the remote monitoring of patients with epilepsy. Methods: We developed a mobile app to automatically analyze and classify epileptic seizures using EEG. We used the cross-database model developed in our previous study, incorporating successive decomposition index and matrix determinant as features, adaptive median feature baseline correction for overcoming interdatabase feature variation, and postprocessing-based support vector machine for classification using 5 different EEG databases. The Sezect (Seizure Detect) Android app was built using the Chaquopy software development kit, which uses the Python language in Android Studio. Various durations of EEG signals were tested on different smartphones to check the feasibility of the Sezect app. Results: We observed a sensitivity of 93.5%, a specificity of 97.5%, and a false detection rate of 1.5 per hour for EEG recordings using the Sezect app. The various mobile phones did not differ substantially in processing time, which indicates a range of phone models can be used for implementation. The computational time required to process real-time EEG data via smartphones and the classification results suggests that our mHealth app could be a valuable asset for monitoring patients with epilepsy. Conclusions: Smartphones have multipurpose use in health care, offering tools that can improve the quality of patients? lives. UR - https://neuro.jmir.org/2023/1/e50660 UR - http://dx.doi.org/10.2196/50660 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50660 ER - TY - JOUR AU - Faisal, Sadaf AU - Samoth, Devine AU - Aslam, Yusra AU - Patel, Hawa AU - Park, SooMin AU - Baby, Bincy AU - Patel, Tejal PY - 2023/12/19 TI - Key Features of Smart Medication Adherence Products: Updated Scoping Review JO - JMIR Aging SP - e50990 VL - 6 KW - technology KW - medication KW - aging KW - adherence KW - smart medication KW - digital technology KW - self-management KW - older adult KW - mobile health KW - mHealth KW - apps KW - digital health KW - geriatrics KW - older adults KW - mHealth app KW - application KW - management KW - scoping review KW - medication adherence KW - consumer KW - use KW - mobile phone N2 - Background: Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging smart medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders and notifications. A 2021 review identified 51 SMAPs owing to the rapid influx of digital technology; an update to this review is required. Objective: This review aims to identify new products and summarize and compare the key features of SMAPs. Methods: Gray and published literature and videos were searched using Google, YouTube, PubMed, Embase, and Scopus. The first 10 pages of Google and the first 100 results of YouTube were screened using 4 and 5 keyword searches, respectively. SMAPs were included if they were able to store and allowed for the dispensation of medications, tracked real-time medication intake data, and could automatically analyze data. Products were excluded if they were stand-alone software applications, not marketed in English, not for in-home use, or only used in clinical trials. In total, 5 researchers independently screened and extracted the data. Results: This review identified 114 SMAPs, including 80 (70.2%) marketed and 34 (29.8%) prototypes, grouped into 15 types. Among the marketed products, 68% (54/80) were available for consumer purchase. Of these products, 26% (14/54) were available worldwide and 78% (42/54) were available in North America. There was variability in the hardware, software, data collection and management features, and cost of the products. Examples of hardware features include battery life, medication storage capacity, availability of types and number of alarms, locking features, and additional technology required for use of the product, whereas software features included reminder and notification capabilities and availability of manufacturer support. Data capture methods included the availability of sensors to record the use of the product and data-syncing capabilities with cloud storage with short-range communications. Data were accessible to users via mobile apps or web-based portals. Some SMAPs provided data security assurance with secure log-ins (use of personal identification numbers or facial recognition), whereas other SMAPs provided data through registered email addresses. Although some SMAPs were available at set prices or free of cost to end users, the cost of other products varied based on availability, shipping fees, and subscription fees. Conclusions: An expanding market for SMAPs with features specific to at-home patient use is emerging. Health care professionals can use these features to select and suggest products that meet their patients? unique requirements. UR - https://aging.jmir.org/2023/1/e50990 UR - http://dx.doi.org/10.2196/50990 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113067 ID - info:doi/10.2196/50990 ER - TY - JOUR AU - Montilva-Monsalve, Jonas AU - Dimantas, Bruna AU - Perski, Olga AU - Gutman, Morrison Leslie PY - 2023/12/19 TI - Barriers and Enablers to the Adoption of a Healthier Diet Using an App: Qualitative Interview Study With Patients With Type 2 Diabetes Mellitus JO - JMIR Diabetes SP - e49097 VL - 8 KW - behavior change techniques KW - diabetes KW - apps KW - smartphone KW - enablers KW - barriers KW - mobile phone N2 - Background: Adopting a healthy diet is one of the cornerstones of type 2 diabetes (T2D) management. Apps are increasingly used in diabetes self-management, but most studies to date have focused on assessing their impact in terms of weight loss or glycemic control, with limited evidence on the behavioral factors that influence app use to change dietary habits. Objective: The main objectives of this study were to assess the enablers and barriers to adopting a healthier diet using the Gro Health app in 2 patient groups with T2D (patients with recently diagnosed and long-standing T2D) and to identify behavior change techniques (BCTs) to enhance enablers and overcome barriers. Methods: Two semistructured qualitative interview studies were conducted; the first study took place between June and July 2021, with a sample of 8 patients with recently diagnosed (<12 mo) T2D, whereas the second study was conducted between May and June 2022 and included 15 patients with long-standing (>18 mo) T2D. In both studies, topic guides were informed by the Capability, Opportunity, Motivation, and Behavior model and the Theoretical Domains Framework. Transcripts were analyzed using a combined deductive framework and inductive thematic analysis approach. The Behavior Change Wheel framework was applied to identify appropriate BCTs that could be used in future iterations of apps for patients with diabetes. Themes were compared between the patient groups. Results: This study identified similarities and differences between patient groups in terms of enablers and barriers to adopting a healthier diet using the app. The main enablers for recently diagnosed patients included the acquired knowledge about T2D diets and skills to implement these, whereas the main barriers were the difficulty in deciding which app features to use and limited cooking skills. By contrast, for patients with long-standing T2D, the main enablers included knowledge validation provided by the app, along with app elements to help self-regulate food intake; the main barriers were the limited interest paid to the content provided or limited skills engaging with apps in general. Both groups reported more enablers than barriers to performing the target behavior when using the app. Consequently, BCTs were selected to address key barriers in both groups, such as simplifying the information hierarchy in the app interface, including tutorials demonstrating how to use the app features, and redesigning the landing page of the app to guide users toward these tutorials. Conclusions: Patients with recently diagnosed and long-standing T2D encountered similar enablers but slightly different barriers when using an app to adopting a healthier diet. Consequently, the development of app-based approaches to adopt a healthier diet should account for these similarities and differences within patient segments to reduce barriers to performing the target behavior. UR - https://diabetes.jmir.org/2023/1/e49097 UR - http://dx.doi.org/10.2196/49097 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113087 ID - info:doi/10.2196/49097 ER - TY - JOUR AU - Williamson, Grace AU - Carr, Ewan AU - Fear, T. Nicola AU - Dymond, Simon AU - King, Kate AU - Simms, Amos AU - Goodwin, Laura AU - Murphy, Dominic AU - Leightley, Daniel PY - 2023/12/19 TI - Digital Therapeutic Intervention for Women in the UK Armed Forces Who Consume Alcohol at a Hazardous or Harmful Level: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e51531 VL - 12 KW - mental health KW - digital health KW - DrinksRation KW - women KW - woman KW - United Kingdom KW - Armed Forces KW - alcohol KW - randomized controlled trial KW - RCT KW - controlled trials KW - study protocol KW - alcohol misuse KW - smartphone app KW - mobile app KW - mobile health KW - mHealth KW - veterans KW - women veterans KW - mobile phone KW - digital therapeutic N2 - Background: Alcohol misuse is common in the United Kingdom Armed Forces (UKAF), with prevalence significantly higher than in the general population. To date, digital health initiatives to support alcohol misuse have focused on male individuals, who represent approximately 89% of the UKAF. However, female veterans drink disproportionally more than female members of the public. Objective: This 2-arm participant-blinded (single-blinded) confirmatory randomized controlled trial (RCT) aims to assess the efficacy of a brief alcohol intervention (DrinksRation) in reducing weekly self-reported alcohol consumption between baseline and a 3-month follow-up (day 84) among women who have served in the UKAF. Methods: In this 2-arm single-blinded RCT, a smartphone app that includes interactive user-focused features tailored toward the needs of female veterans and designed to enhance participants? motivations to reduce the amount of alcohol they consume is compared with the UK Chief Medical Officer guidance on alcohol consumption. The trial will be conducted among women who have served at least 1 day of paid service in the UKAF. Recruitment, consent, and data collection will be carried out automatically through the DrinksRation app or the BeAlcoholSmart platform. The primary outcome is change in self-reported weekly alcohol consumption between baseline (day 0) and the 3-month follow-up (day 84) measured using the Timeline Follow Back for alcohol consumption. The secondary outcome is the change in the Alcohol Use Disorders Identification Test score measured at baseline and 3-month follow-up between the control and intervention groups. The process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. Results: RCT recruitment will begin in January 2024 and last for 5 months. We aim to complete all data collection, including interviews, by May 2024. Conclusions: This study will assess whether a smartphone app tailored to the needs of women who have served in the UKAF is efficacious in reducing self-reported alcohol consumption. If successful, the digital therapeutics platform could be used not only to support women who have served in the UKAF but also for other conditions and disorders. Trial Registration: ClinicalTrials.gov NCT05970484; https://www.clinicaltrials.gov/study/NCT05970484 International Registered Report Identifier (IRRID): PRR1-10.2196/51531 UR - https://www.researchprotocols.org/2023/1/e51531 UR - http://dx.doi.org/10.2196/51531 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113103 ID - info:doi/10.2196/51531 ER - TY - JOUR AU - Arcos, Daniela AU - Russo, N. Lyric AU - Kazmierski, M. Kelly F. AU - Zhou, Elayne AU - Montiel, Itzel Gloria AU - Bracho, America AU - Mejia, Nancy AU - Borelli, L. Jessica PY - 2023/12/19 TI - A Relationship-Based Resilience Program for Promotores: Protocol for a Randomized Controlled Waitlist Trial JO - JMIR Res Protoc SP - e51427 VL - 12 KW - psychosocial intervention KW - relational savoring KW - cardiometabolic health KW - community service providers KW - Hispanic or Latinx KW - CSP N2 - Background: Community service providers (CSPs) play an integral role in the health care of low-income Hispanic or Latinx (HL) communities. CSPs have high-stress frontline jobs and share the high-risk demographics of their communities. Relational savoring (RS) has been associated with lower cardiovascular reactivity and psychosocial benefits, with particular promise among HL participants. In this study, we aim to identify RS?s potential in promoting CSPs? cardiometabolic health and, in so doing, having broader impacts on the community they serve. Objective: This randomized controlled waitlist study aims to examine the effect of an RS intervention on (1) CSPs? cardiometabolic health (cardiometabolic risk factors and outcomes) and (2) CSPs? threats to leaving the workforce. Methods: We will recruit a sample of 80 CSPs from community health agencies serving low-income HL populations. Participating CSPs will be randomized into an experimental or a waitlist control. Participants will complete 1 or 2 baseline assessment batteries (before the intervention), depending on the assigned group, and then complete 2 more assessment batteries following the 4-week RS intervention (after the intervention and at a 3-mo follow-up). The RS intervention consists of guided reflections on positive moments of connection with others. Electrocardiogram data will be obtained from a wearable device (Polar Verity Sense or Movisens) to measure heart rate variability. The primary outcome is cardiometabolic health, consisting of cardiometabolic risk (obtained from heart rate variability) and cardiometabolic health behaviors. The secondary outcomes include CSPs? threats to leaving the workforce (assessed via psychological well-being), intervention acceptability, and CSPs? delivery of cardiometabolic health programming to the community (exploratory). Analyses of covariance will be used to examine the effects of RS on cardiometabolic health and on CSPs? threats to leaving the workforce, comparing outcomes at baseline, postintervention, and at follow-up across participants in the experimental versus waitlist group. Results: The study has been approved by the University of California, Irvine, Institutional Review Board and is currently in the data collection phase. By May 2023, 37 HL CSPs have been recruited: 34 have completed the baseline assessment, 28 have completed the 4 intervention sessions, 27 have completed the posttreatment assessment, and 10 have completed all assessments (including the 3-mo follow-up). Conclusions: This study will provide valuable information on the potential of RS to support cardiometabolic health in HL CSPs and, indirectly, in the communities they serve. Trial Registration: ClinicalTrials.gov NCT05560893; https://clinicaltrials.gov/study/NCT05560893 International Registered Report Identifier (IRRID): DERR1-10.2196/51427 UR - https://www.researchprotocols.org/2023/1/e51427 UR - http://dx.doi.org/10.2196/51427 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113093 ID - info:doi/10.2196/51427 ER - TY - JOUR AU - Kreniske, Philip AU - Namuyaba, Imelda Olive AU - Kasumba, Robert AU - Namatovu, Phionah AU - Ssewamala, Fred AU - Wingood, Gina AU - Wei, Ying AU - Ybarra, L. Michele AU - Oloya, Charlotte AU - Tindyebwa, Costella AU - Ntulo, Christina AU - Mujune, Vincent AU - Chang, W. Larry AU - Mellins, A. Claude AU - Santelli, S. John PY - 2023/12/19 TI - Mobile Phone Technology for Preventing HIV and Related Youth Health Problems, Sexual Health, Mental Health, and Substance Use Problems in Southwest Uganda (Youth Health SMS): Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e49352 VL - 12 KW - adolescence KW - PrEP KW - pre-exposure prophylaxis KW - HIV KW - mental health KW - substance use KW - sexual health KW - mobile phones KW - randomized controlled trial KW - adaptation KW - Uganda N2 - Background: East and Southern Africa have the highest HIV incidence and prevalence in the world, with adolescents and young adults being at the greatest risk. Despite effective combination prevention tools, including the recently available pre-exposure prophylaxis (PrEP), HIV incidence among adolescents and young adults in Uganda remains high, and PrEP use remains low. Mental health and substance use (behavioral health) play a role in sexual behavior and decision-making, contributing to an increase in the risk for acquiring HIV. Interventions that target multiple HIV risk factors, including sexual and mental health and problematic substance use, are crucial to ending the HIV epidemic. Yet few interventions addressing HIV related health disparities and comorbidities among adolescents and young adults in East and Southern Africa currently exist. Objective: This study aims to evaluate the acceptability and feasibility of Kirabo, an SMS text message intervention informed by the information, motivation, and behavior model and to be disseminated through secondary schools. The study will gather preliminary estimates of Kirabo?s effectiveness in increasing HIV testing and linking users to mental health counselors. Methods: We identified Mobile 4 Reproductive Health for adaptation using the assessment, decision, administration, production, topical experts, integration, training, testing (ADAPT-ITT) framework. Mobile 4 Reproductive Health is an evidence-based automated 2-way SMS text messaging and interactive voice response platform that offers sexual and reproductive health information and links users to HIV clinics in East Africa. Through ADAPT-ITT we refined our approach and created Kirabo, an SMS text message?based intervention for linking adolescents and young adults to health services, including HIV testing and mental health counseling. We will conduct a 2-arm randomized controlled trial in Masaka, Uganda. Adolescents (N=200) will be recruited from local schools. Baseline sociodemographic characteristics, HIV test history, and behavioral health symptoms will be assessed. We will evaluate acceptability and feasibility using surveys, interviews, and mobile phone data. The preliminary efficacy of Kirabo in increasing HIV testing and linking users to mental health counselors will be evaluated immediately after the intervention and at the 3-month follow-up. We will also assess the intervention?s impact on self-efficacy in testing for HIV, adopting PrEP, and contacting a mental health counselor. Results: Intervention adaptation began in 2019. A pretest was conducted in 2021. The randomized controlled trial, including usability and feasibility assessments and effectiveness measurements, commenced in August 2023. Conclusions: Kirabo is a tool that assists in the efforts to end the HIV epidemic by targeting the health disparities and comorbidities among adolescents in Uganda. The intervention includes local HIV clinic information, PrEP information, and behavioral health screening, with referrals as needed. Increasing access to prevention strategies and mitigating factors that make adolescents and young adults susceptible to HIV acquisition can contribute to global efforts to end the HIV epidemic. Trial Registration: ClinicalTrials.gov NCT05130151; https://clinicaltrials.gov/study/NCT05130151 International Registered Report Identifier (IRRID): DERR1-10.2196/49352 UR - https://www.researchprotocols.org/2023/1/e49352 UR - http://dx.doi.org/10.2196/49352 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113102 ID - info:doi/10.2196/49352 ER - TY - JOUR AU - He, Xin AU - Zheng, Xi AU - Ding, Huiyuan PY - 2023/12/18 TI - Existing Barriers Faced by and Future Design Recommendations for Direct-to-Consumer Health Care Artificial Intelligence Apps: Scoping Review JO - J Med Internet Res SP - e50342 VL - 25 KW - artificial intelligence KW - medical KW - health care KW - consumer KW - consumers KW - app KW - apps KW - application KW - applications KW - DTC KW - direct to consumer KW - barrier KW - barriers KW - implementation KW - design KW - scoping KW - review methods KW - review methodology N2 - Background: Direct-to-consumer (DTC) health care artificial intelligence (AI) apps hold the potential to bridge the spatial and temporal disparities in health care resources, but they also come with individual and societal risks due to AI errors. Furthermore, the manner in which consumers interact directly with health care AI is reshaping traditional physician-patient relationships. However, the academic community lacks a systematic comprehension of the research overview for such apps. Objective: This paper systematically delineated and analyzed the characteristics of included studies, identified existing barriers and design recommendations for DTC health care AI apps mentioned in the literature and also provided a reference for future design and development. Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines and was conducted according to Arksey and O?Malley?s 5-stage framework. Peer-reviewed papers on DTC health care AI apps published until March 27, 2023, in Web of Science, Scopus, the ACM Digital Library, IEEE Xplore, PubMed, and Google Scholar were included. The papers were analyzed using Braun and Clarke?s reflective thematic analysis approach. Results: Of the 2898 papers retrieved, 32 (1.1%) covering this emerging field were included. The included papers were recently published (2018-2023), and most (23/32, 72%) were from developed countries. The medical field was mostly general practice (8/32, 25%). In terms of users and functionalities, some apps were designed solely for single-consumer groups (24/32, 75%), offering disease diagnosis (14/32, 44%), health self-management (8/32, 25%), and health care information inquiry (4/32, 13%). Other apps connected to physicians (5/32, 16%), family members (1/32, 3%), nursing staff (1/32, 3%), and health care departments (2/32, 6%), generally to alert these groups to abnormal conditions of consumer users. In addition, 8 barriers and 6 design recommendations related to DTC health care AI apps were identified. Some more subtle obstacles that are particularly worth noting and corresponding design recommendations in consumer-facing health care AI systems, including enhancing human-centered explainability, establishing calibrated trust and addressing overtrust, demonstrating empathy in AI, improving the specialization of consumer-grade products, and expanding the diversity of the test population, were further discussed. Conclusions: The booming DTC health care AI apps present both risks and opportunities, which highlights the need to explore their current status. This paper systematically summarized and sorted the characteristics of the included studies, identified existing barriers faced by, and made future design recommendations for such apps. To the best of our knowledge, this is the first study to systematically summarize and categorize academic research on these apps. Future studies conducting the design and development of such systems could refer to the results of this study, which is crucial to improve the health care services provided by DTC health care AI apps. UR - https://www.jmir.org/2023/1/e50342 UR - http://dx.doi.org/10.2196/50342 UR - http://www.ncbi.nlm.nih.gov/pubmed/38109173 ID - info:doi/10.2196/50342 ER - TY - JOUR AU - Lin, Chen AU - Chen, I-Ming AU - Chuang, Hai-Hua AU - Wang, Zih-Wen AU - Lin, Hsiao-Han AU - Lin, Yu-Hsuan PY - 2023/12/15 TI - Examining Human-Smartphone Interaction as a Proxy for Circadian Rhythm in Patients With Insomnia: Cross-Sectional Study JO - J Med Internet Res SP - e48044 VL - 25 KW - actigraphy KW - circadian rhythm KW - digital biomarkers KW - human-smartphone interaction KW - insomnia KW - intradaily variability KW - mobile apps N2 - Background: The sleep and circadian rhythm patterns associated with smartphone use, which are influenced by mental activities, might be closely linked to sleep quality and depressive symptoms, similar to the conventional actigraphy-based assessments of physical activity. Objective: The primary objective of this study was to develop app-defined circadian rhythm and sleep indicators and compare them with actigraphy-derived measures. Additionally, we aimed to explore the clinical correlations of these indicators in individuals with insomnia and healthy controls. Methods: The mobile app ?Rhythm? was developed to record smartphone use time stamps and calculate circadian rhythms in 33 patients with insomnia and 33 age- and gender-matched healthy controls, totaling 2097 person-days. Simultaneously, we used standard actigraphy to quantify participants? sleep-wake cycles. Sleep indicators included sleep onset, wake time (WT), wake after sleep onset (WASO), and the number of awakenings (NAWK). Circadian rhythm metrics quantified the relative amplitude, interdaily stability, and intradaily variability based on either smartphone use or physical activity data. Results: Comparisons between app-defined and actigraphy-defined sleep onsets, WTs, total sleep times, and NAWK did not reveal any significant differences (all P>.05). Both app-defined and actigraphy-defined sleep indicators successfully captured clinical features of insomnia, indicating prolonged WASO, increased NAWK, and delayed sleep onset and WT in patients with insomnia compared with healthy controls. The Pittsburgh Sleep Quality Index scores were positively correlated with WASO and NAWK, regardless of whether they were measured by the app or actigraphy. Depressive symptom scores were positively correlated with app-defined intradaily variability (?=9.786, SD 3.756; P=.01) and negatively correlated with actigraphy-based relative amplitude (?=?21.693, SD 8.214; P=.01), indicating disrupted circadian rhythmicity in individuals with depression. However, depressive symptom scores were negatively correlated with actigraphy-based intradaily variability (?=?7.877, SD 3.110; P=.01) and not significantly correlated with app-defined relative amplitude (?=?3.859, SD 12.352; P=.76). Conclusions: This study highlights the potential of smartphone-derived sleep and circadian rhythms as digital biomarkers, complementing standard actigraphy indicators. Although significant correlations with clinical manifestations of insomnia were observed, limitations in the evidence and the need for further research on predictive utility should be considered. Nonetheless, smartphone data hold promise for enhancing sleep monitoring and mental health assessments in digital health research. UR - https://www.jmir.org/2023/1/e48044 UR - http://dx.doi.org/10.2196/48044 UR - http://www.ncbi.nlm.nih.gov/pubmed/38100195 ID - info:doi/10.2196/48044 ER - TY - JOUR AU - Chen, Hwa Huan AU - Hsu, Tien Hsin AU - Lin, Chao Pei AU - Chen, Chin-Yin AU - Hsieh, Fen Hsiu AU - Ko, Hung Chih PY - 2023/12/14 TI - Efficacy of a Smartphone App in Enhancing Medication Adherence and Accuracy in Individuals With Schizophrenia During the COVID-19 Pandemic: Randomized Controlled Trial JO - JMIR Ment Health SP - e50806 VL - 10 KW - cognitive functions KW - medication adherence KW - psychiatric symptoms KW - schizophrenia KW - smartphone app N2 - Background: Poor medication adherence or inaccuracy in taking prescribed medications plays an important role in the recurrence or worsening of psychiatric symptoms in patients with schizophrenia, and the COVID-19 pandemic impacted their medication adherence with exacerbated symptoms or relapse. The use of mobile health services increased during the COVID-19 pandemic, and their role in improving mental health is becoming clearer. Objective: This study aimed to explore the effectiveness of a smartphone app (MedAdhere) on medication adherence and accuracy among patients with schizophrenia and to measure their psychiatric symptoms and cognitive functions. Methods: In this 12-week experimental study, participants were provided interventions with the MedAdhere app, and data were collected between June 2021 and September 2022. A total of 105 participants were randomly assigned to either the experimental or control groups. We used the Positive and Negative Syndrome Scale and Mini-Mental State Examination to measure the participants? psychiatric symptoms and cognitive functions. Generalized estimating equations were used for data analysis. Results: A total of 94 participants met the inclusion criteria and completed the protocol, and the medication adherence rate of the experimental group was 94.72% (2785/2940) during the intervention. Psychotic symptoms (positive, negative, and general psychopathology symptoms) and cognitive functions (memory, language, and executive function) were significantly improved in the experimental group compared to the control group after the intervention. Conclusions: The MedAdhere app effectively and significantly improved medication adherence and, thereby, the psychiatric symptoms of patients with schizophrenia. This artificial intelligence assisted app could be extended to all patients who need to be reminded to take medication on schedule. Trial Registration: ClinicalTrials.gov NCT05892120; https://clinicaltrials.gov/study/NCT05892120 UR - https://mental.jmir.org/2023/1/e50806 UR - http://dx.doi.org/10.2196/50806 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096017 ID - info:doi/10.2196/50806 ER - TY - JOUR AU - Wang, Tse-Lun AU - Wu, Hao-Yi AU - Wang, Wei-Yun AU - Chen, Chao-Wen AU - Chien, Wu-Chien AU - Chu, Chi-Ming AU - Wu, Yi-Syuan PY - 2023/12/14 TI - Assessment of Heart Rate Monitoring During Exercise With Smart Wristbands and a Heart Rhythm Patch: Validation and Comparison Study JO - JMIR Form Res SP - e52519 VL - 7 KW - running KW - wearable device KW - photoplethysmography KW - heart rhythm patch, smart wristband N2 - Background: The integration of wearable devices into fitness routines, particularly in military settings, necessitates a rigorous assessment of their accuracy. This study evaluates the precision of heart rate measurements by locally manufactured wristbands, increasingly used in military academies, to inform future device selection for military training activities. Objective: This research aims to assess the reliability of heart rate monitoring in chest straps versus wearable wristbands. Methods: Data on heart rate and acceleration were collected using the Q-Band Q-69 smart wristband (Mobile Action Technology Inc) and compared against the Zephyr Bioharness standard measuring device. The Lin concordance correlation coefficient, Pearson product moment correlation coefficient, and intraclass correlation coefficient were used for reliability analysis. Results: Participants from a Northern Taiwanese medical school were enrolled (January 1-June 31, 2021). The Q-Band Q-69 demonstrated that the mean absolute percentage error (MAPE) of women was observed to be 13.35 (SD 13.47). Comparatively, men exhibited a lower MAPE of 8.54 (SD 10.49). The walking state MAPE was 7.79 for women and 10.65 for men. The wristband?s accuracy generally remained below 10% MAPE in other activities. Pearson product moment correlation coefficient analysis indicated gender-based performance differences, with overall coefficients of 0.625 for women and 0.808 for men, varying across walking, running, and cooldown phases. Conclusions: This study highlights significant gender and activity-dependent variations in the accuracy of the MobileAction Q-Band Q-69 smart wristband. Reduced accuracy was notably observed during running. Occasional extreme errors point to the necessity of caution in relying on such devices for exercise monitoring. The findings emphasize the limitations and potential inaccuracies of wearable technology, especially in high-intensity physical activities. UR - https://formative.jmir.org/2023/1/e52519 UR - http://dx.doi.org/10.2196/52519 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096010 ID - info:doi/10.2196/52519 ER - TY - JOUR AU - Peterson, E. Neil AU - Bate, A. Danielle AU - Macintosh, LB Janelle AU - Trujillo Tanner, Corinna PY - 2023/12/14 TI - Wearable Activity Trackers That Motivate Women to Increase Physical Activity: Mixed Methods Study JO - JMIR Form Res SP - e48704 VL - 7 KW - physical activity KW - women KW - motivation KW - wearable activity trackers KW - mobile health KW - mHealth KW - self-determination KW - mobile phone N2 - Background: Physical inactivity is a significant public health concern, particularly among women in the United States. Wearable activity trackers (WATs) have been proposed as a potential solution to increase awareness of and engagement in physical activity (PA). However, to be effective, WATs must include features and designs that encourage daily use. Objective: This study aims to explore the features and designs of WATs that appeal to women and determine whether devices with these attributes are effective motivators for women to be physically active. Methods: A mixed methods study guided by the self-determination theory was conducted among 15 women. Participants trialed 3 WATs with influence in their respective accessory domains: Apple Watch for the wrist; Oura Ring for the finger; and Bellabeat Leaf Urban for multiple sites (it can be worn as a bracelet, necklace, or clip). Participants documented their daily PA levels and rated their satisfaction with each device?s comfort, features, and motivational effect. Focus groups were also conducted to gather additional feedback and experiences within the a priori areas of comfort, features, and motivation. Results: Behavioral Regulation in Exercise Questionnaire?2 scores indicated that most participants (14/15, 93%) were motivated at baseline (amotivation score: mean 0.13, SD 0.45), but on average, participants did not meet the national minimum PA guidelines according to the self-reported Physical Activity Vital Sign questionnaire (moderate to vigorous PA score: mean 144, SD 97.5 min/wk). Mean WAT wear time was 16.9 (SD 4.4) hours, 19.4 (SD 5.3) hours, and 20.4 (SD 4.7) hours for Apple Watch, Bellabeat Leaf Urban, and Oura Ring, respectively. During focus groups, participants reinforced their quantitative ratings and rankings of the WATs based on personal experiences. Participants shared a variety of both activity-related and non?activity-related features that they look for in a motivating device. When considering what the ideal WAT would be for a woman, participants suggested features of (1) comfort, (2) extended battery life, (3) durability, (4) immediate PA feedback, (5) intuitive PA sensing, and (6) programmability. Conclusions: This study is the first to specifically address women?s experiences with and preferences for different types of WATs. Those who work with women should realize how they view WATs and the role they play in motivation to be active. UR - https://formative.jmir.org/2023/1/e48704 UR - http://dx.doi.org/10.2196/48704 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096000 ID - info:doi/10.2196/48704 ER - TY - JOUR AU - Kawai, Keita AU - Iwamoto, Kunihiro AU - Miyata, Seiko AU - Okada, Ippei AU - Fujishiro, Hiroshige AU - Noda, Akiko AU - Nakagome, Kazuyuki AU - Ozaki, Norio AU - Ikeda, Masashi PY - 2023/12/13 TI - Comparison of Polysomnography, Single-Channel Electroencephalogram, Fitbit, and Sleep Logs in Patients With Psychiatric Disorders: Cross-Sectional Study JO - J Med Internet Res SP - e51336 VL - 25 KW - consumer sleep-tracking device KW - polysomnography KW - portable sleep EEG monitor KW - electroencephalography KW - EEG KW - psychiatric disorders KW - sleep logs KW - sleep state misperception KW - sleep study KW - wearable KW - psychiatric disorder KW - sleep KW - disturbances KW - quality of sleep KW - Fitbit KW - mHealth KW - wearables KW - psychiatry KW - electroencephalogram N2 - Background: Sleep disturbances are core symptoms of psychiatric disorders. Although various sleep measures have been developed to assess sleep patterns and quality of sleep, the concordance of these measures in patients with psychiatric disorders remains relatively elusive. Objective: This study aims to examine the degree of agreement among 3 sleep recording methods and the consistency between subjective and objective sleep measures, with a specific focus on recently developed devices in a population of individuals with psychiatric disorders. Methods: We analyzed 62 participants for this cross-sectional study, all having data for polysomnography (PSG), Zmachine, Fitbit, and sleep logs. Participants completed questionnaires on their symptoms and estimated sleep duration the morning after the overnight sleep assessment. The interclass correlation coefficients (ICCs) were calculated to evaluate the consistency between sleep parameters obtained from each instrument. Additionally, Bland-Altman plots were used to visually show differences and limits of agreement for sleep parameters measured by PSG, Zmachine, Fitbit, and sleep logs. Results: The findings indicated a moderate agreement between PSG and Zmachine data for total sleep time (ICC=0.46; P<.001), wake after sleep onset (ICC=0.39; P=.002), and sleep efficiency (ICC=0.40; P=.006). In contrast, Fitbit demonstrated notable disagreement with PSG (total sleep time: ICC=0.08; wake after sleep onset: ICC=0.18; sleep efficiency: ICC=0.10) and exhibited particularly large discrepancies from the sleep logs (total sleep time: ICC=?0.01; wake after sleep onset: ICC=0.05; sleep efficiency: ICC=?0.02). Furthermore, subjective and objective concordance among PSG, Zmachine, and sleep logs appeared to be influenced by the severity of the depressive symptoms and obstructive sleep apnea, while these associations were not observed between the Fitbit and other sleep instruments. Conclusions: Our study results suggest that Fitbit accuracy is reduced in the presence of comorbid clinical symptoms. Although user-friendly, Fitbit has limitations that should be considered when assessing sleep in patients with psychiatric disorders. UR - https://www.jmir.org/2023/1/e51336 UR - http://dx.doi.org/10.2196/51336 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090797 ID - info:doi/10.2196/51336 ER - TY - JOUR AU - Bell, Imogen AU - Arnold, Chelsea AU - Gilbertson, Tamsyn AU - D?Alfonso, Simon AU - Castagnini, Emily AU - Chen, Nicola AU - Nicholas, Jennifer AU - O?Sullivan, Shaunagh AU - Valentine, Lee AU - Alvarez-Jimenez, Mario PY - 2023/12/13 TI - A Personalized, Transdiagnostic Smartphone Intervention (Mello) Targeting Repetitive Negative Thinking in Young People With Depression and Anxiety: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e47860 VL - 25 KW - repetitive negative thinking KW - rumination KW - anxiety KW - depression KW - mobile app KW - just-in-time adaptive interventions KW - youth mental health KW - adolescent KW - mobile phone N2 - Background: Repetitive negative thinking (RNT) is a key transdiagnostic mechanism underpinning depression and anxiety. Using ?just-in-time adaptive interventions? via smartphones may disrupt RNT in real time, providing targeted and personalized intervention. Objective: This pilot randomized controlled trial evaluates the feasibility, acceptability, and preliminary clinical outcomes and mechanisms of Mello?a fully automated, personalized, transdiagnostic, and mechanistic smartphone intervention targeting RNT in young people with depression and anxiety. Methods: Participants with heightened depression, anxiety, and RNT were recruited via social media and randomized to receive Mello or a nonactive control over a 6-week intervention period. Assessments were completed via Zoom sessions at baseline and at 3 and 6 weeks after baseline. Results: The findings supported feasibility and acceptability, with high rates of recruitment (N=55), uptake (55/64, 86% of eligible participants), and retention (52/55, 95% at 6 weeks). Engagement was high, with 90% (26/29) and 59% (17/29) of the participants in the Mello condition still using the app during the third and sixth weeks, respectively. Greater reductions in depression (Cohen d=0.50), anxiety (Cohen d=0.61), and RNT (Cohen d=0.87) were observed for Mello users versus controls. Mediation analyses suggested that changes in depression and anxiety were accounted for by changes in RNT. Conclusions: The results indicate that mechanistic, targeted, and real-time technology-based solutions may provide scalable and effective interventions that advance the treatment of youth mental ill health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001701819; http://tinyurl.com/4d3jfj9f UR - https://www.jmir.org/2023/1/e47860 UR - http://dx.doi.org/10.2196/47860 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090786 ID - info:doi/10.2196/47860 ER - TY - JOUR AU - Bufano, Pasquale AU - Laurino, Marco AU - Said, Sara AU - Tognetti, Alessandro AU - Menicucci, Danilo PY - 2023/12/13 TI - Digital Phenotyping for Monitoring Mental Disorders: Systematic Review JO - J Med Internet Res SP - e46778 VL - 25 KW - digital phenotyping KW - mobile KW - mental health KW - smartphone KW - mobile sensing KW - passive sensing KW - active sensing KW - digital phenotype KW - digital biomarker KW - mobile phone N2 - Background: The COVID-19 pandemic has increased the impact and spread of mental illness and made health services difficult to access; therefore, there is a need for remote, pervasive forms of mental health monitoring. Digital phenotyping is a new approach that uses measures extracted from spontaneous interactions with smartphones (eg, screen touches or movements) or other digital devices as markers of mental status. Objective: This review aimed to evaluate the feasibility of using digital phenotyping for predicting relapse or exacerbation of symptoms in patients with mental disorders through a systematic review of the scientific literature. Methods: Our research was carried out using 2 bibliographic databases (PubMed and Scopus) by searching articles published up to January 2023. By following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines, we started from an initial pool of 1150 scientific papers and screened and extracted a final sample of 29 papers, including studies concerning clinical populations in the field of mental health, which were aimed at predicting relapse or exacerbation of symptoms. The systematic review has been registered on the web registry Open Science Framework. Results: We divided the results into 4 groups according to mental disorder: schizophrenia (9/29, 31%), mood disorders (15/29, 52%), anxiety disorders (4/29, 14%), and substance use disorder (1/29, 3%). The results for the first 3 groups showed that several features (ie, mobility, location, phone use, call log, heart rate, sleep, head movements, facial and vocal characteristics, sociability, social rhythms, conversations, number of steps, screen on or screen off status, SMS text message logs, peripheral skin temperature, electrodermal activity, light exposure, and physical activity), extracted from data collected via the smartphone and wearable wristbands, can be used to create digital phenotypes that could support gold-standard assessment and could be used to predict relapse or symptom exacerbations. Conclusions: Thus, as the data were consistent for almost all the mental disorders considered (mood disorders, anxiety disorders, and schizophrenia), the feasibility of this approach was confirmed. In the future, a new model of health care management using digital devices should be integrated with the digital phenotyping approach and tailored mobile interventions (managing crises during relapse or exacerbation). UR - https://www.jmir.org/2023/1/e46778 UR - http://dx.doi.org/10.2196/46778 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090800 ID - info:doi/10.2196/46778 ER - TY - JOUR AU - Zvulunov, Alex AU - Lenevich, Stepan AU - Migacheva, Natalia PY - 2023/12/13 TI - A Mobile Health App for Facilitating Disease Management in Children With Atopic Dermatitis: Feasibility and Impact Study JO - JMIR Dermatol SP - e49278 VL - 6 KW - atopic dermatitis KW - eczema KW - Atopic App mobile health application KW - artificial intelligence KW - dermatitis KW - dermatology KW - skin KW - disease management KW - child KW - children KW - pediatric KW - pediatrics KW - feasibility KW - mHealth KW - mobile health KW - app KW - apps KW - applications N2 - Background: Inadequate control of atopic dermatitis (AD) increases the frequency of exacerbations and reduces the quality of life. Mobile health apps provide information and communication technology and may increase treatment adherence and facilitate disease management at home. The mobile health app, Atopic App, designed for patients and their caregivers, and the associated web-based patient education program, Atopic School, provide an opportunity for improving patients? and caregivers? engagement and adherence to the management of AD. Objective: This noninterventional, observational study aimed to explore the feasibility and potential impact on the management of AD in children by caregivers using the Atopic App mobile health app. Methods: The patient-oriented eczema measure (POEM) and numerical rating scale for the grading of pruritus were used as severity scores (scale range: 0-28). The artificial intelligence model of the app was used to assess the severity of AD based on the eczema area and severity index approach. The deidentified data enabled the analysis of the severity of AD, treatment plan history, potential triggers of flare-ups, usage of available features of the app, and the impact of patient education. Results: During a 12-month period, of the 1223 users who installed the app, 910 (74.4%) registered users were caregivers of children with AD. The web-based Atopic School course was accessed by 266 (29.2%) caregivers of children with AD, 134 (50.4%) of whom completed the course. Usage of the app was significantly more frequent among those who completed the Atopic School program than among those who did not access or did not complete the course (P<.001). Users who completed a second POEM 21 to 27 days apart exhibited a significant improvement of AD severity based on the POEM score (P<.001), with an average improvement of 3.86 (SD 6.85) points. The artificial intelligence severity score and itching score were highly correlated with the POEM score (r=0.35 and r=0.52, respectively). Conclusions: The Atopic App provides valuable real-world data on the epidemiology, severity dynamics, treatment patterns, and exacerbation-trigger correlations in patients with AD. The significant reduction in the POEM score among users of the Atopic App indicates a potential impact of this tool on health care engagement by caregivers of children with AD. UR - https://derma.jmir.org/2023/1/e49278 UR - http://dx.doi.org/10.2196/49278 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090787 ID - info:doi/10.2196/49278 ER - TY - JOUR AU - Gregory, E. Megan AU - Cao, Weidan AU - Rahurkar, Saurabh AU - Jonnalagadda, Pallavi AU - Stock, C. James AU - Ghazi, M. Sanam AU - Reid, Endia AU - Berk, L. Abigail AU - Hebert, Courtney AU - Li, Lang AU - Addison, Daniel PY - 2023/12/12 TI - Exploring the Incorporation of a Novel Cardiotoxicity Mobile Health App Into Care of Patients With Cancer: Qualitative Study of Patient and Provider Perspectives JO - JMIR Cancer SP - e46481 VL - 9 KW - cancer, cardiology, implementation science, mobile app, oncology KW - mobile phone KW - cancer patient KW - patient care KW - mobile health application KW - application KW - implementation KW - design KW - development KW - symptom tracking KW - cardiotoxicity KW - cancer therapy KW - symptom KW - primary care N2 - Background: Cardiotoxicity is a limitation of several cancer therapies and early recognition improves outcomes. Symptom-tracking mobile health (mHealth) apps are feasible and beneficial, but key elements for mHealth symptom-tracking to indicate early signs of cardiotoxicity are unknown. Objective: We explored considerations for the design of, and implementation into a large academic medical center, an mHealth symptom-tracking tool for early recognition of cardiotoxicity in patients with cancer after cancer therapy initiation. Methods: We conducted semistructured interviews of >50% of the providers (oncologists, cardio-oncologists, and radiation oncologists) who manage cancer treatment-related cardiotoxicity in the participating institution (n=11), and either interviews or co-design or both with 6 patients. Data were coded and analyzed using thematic analysis. Results: Providers indicated that there was no existing process to enable early recognition of cardiotoxicity and felt the app could reduce delays in diagnosis and lead to better patient outcomes. Signs and symptoms providers recommended for tracking included chest pain or tightness, shortness of breath, heart racing or palpitations, syncope, lightheadedness, edema, and excessive fatigue. Implementation barriers included determining who would receive symptom reports, ensuring all members of the patient?s care team (eg, oncologist, cardiologist, and primary care) were informed of the symptom reports and could collaborate on care plans, and how to best integrate the app data into the electronic health record. Patients (n=6, 100%) agreed that the app would be useful for enhanced symptom capture and education and indicated willingness to use it. Conclusions: Providers and patients agree that a patient-facing, cancer treatment-related cardiotoxicity symptom-tracking mHealth app would be beneficial. Additional studies evaluating the role of mHealth as a potential strategy for targeted early cardioprotective therapy initiation are needed. UR - https://cancer.jmir.org/2023/1/e46481 UR - http://dx.doi.org/10.2196/46481 UR - http://www.ncbi.nlm.nih.gov/pubmed/38085565 ID - info:doi/10.2196/46481 ER - TY - JOUR AU - Nitschke, Marlies AU - Nwosu, Bertrand Obioma AU - Grube, Lara AU - Knitza, Johannes AU - Seifer, Ann-Kristin AU - Eskofier, M. Bjoern AU - Schett, Georg AU - Morf, Harriet PY - 2023/12/12 TI - Refinement and Usability Analysis of an eHealth App for Ankylosing Spondylitis as a Complementary Treatment to Physical Therapy: Development and Usability Study JO - JMIR Form Res SP - e47426 VL - 7 KW - ankylosing spondylitis KW - axial spondylarthritis KW - DHA KW - digital health application KW - eHealth KW - self-assessment KW - Usability KW - Yoga KW - YogiTherapy N2 - Background: Mobile eHealth apps have been used as a complementary treatment to increase the quality of life of patients and provide new opportunities for the management of rheumatic diseases. Telemedicine, particularly in the areas of prevention, diagnostics, and therapy, has become an essential cornerstone in the care of patients with rheumatic diseases. Objective: This study aims to improve the design and technology of YogiTherapy and evaluate its usability and quality. Methods: We newly implemented the mobile eHealth app YogiTherapy with a modern design, the option to change language, and easy navigation to improve the app?s usability and quality for patients. After refinement, we evaluated the app by conducting a study with 16 patients with AS (4 female and 12 male; mean age 48.1, SD 16.8 y). We assessed the usability of YogiTherapy with a task performance test (TPT) with a think-aloud protocol and the quality with the German version of the Mobile App Rating Scale (MARS). Results: In the TPT, the participants had to solve 6 tasks that should be performed on the app. The overall task completion rate in the TPT was high (84/96, 88% completed tasks). Filtering for videos and navigating to perform an assessment test caused the largest issues during the TPT, while registering in the app and watching a yoga video were highly intuitive. Additionally, 12 (75%) of the 16 participants completed the German version of MARS. The quality of YogiTherapy was rated with an average MARS score of 3.79 (SD 0.51) from a maximum score of 5. Furthermore, results from the MARS questionnaire demonstrated a positive evaluation regarding functionality and aesthetics. Conclusions: The refined and tested YogiTherapy app showed promising results among most participants. In the future, the app could serve its function as a complementary treatment for patients with AS. For this purpose, surveys with a larger number of patients should still be conducted. As a substantial advancement, we made the app free and openly available on the iOS App and Google Play stores. UR - https://formative.jmir.org/2023/1/e47426 UR - http://dx.doi.org/10.2196/47426 UR - http://www.ncbi.nlm.nih.gov/pubmed/38085558 ID - info:doi/10.2196/47426 ER - TY - JOUR AU - Jan, Michael AU - Coppin-Renz, Antonia AU - West, Robin AU - Gallo, Le Christophe AU - Cochran, M. Jeffrey AU - Heumen, van Emiel AU - Fahmy, Michael AU - Reuteman-Fowler, Corey J. PY - 2023/12/12 TI - Safety Evaluation in Iterative Development of Wearable Patches for Aripiprazole Tablets With Sensor: Pooled Analysis of Clinical Trials JO - JMIR Form Res SP - e44768 VL - 7 KW - wearable sensor KW - adhesive patch KW - adverse events KW - skin irritation KW - product iteration KW - mobile phone KW - biocompatibility KW - Abilify MyCite KW - development KW - sensors KW - skin KW - monitoring KW - treatment KW - schizophrenia KW - bipolar disorder KW - depressive disorder KW - abrasions KW - blisters KW - dermatitis KW - pain KW - rash N2 - Background: Wearable sensors in digital health may pose a risk for skin irritation through the use of wearable patches. Little is known about how patient- and product-related factors impact the risk of skin irritation. Aripiprazole tablets with sensor (AS, Abilify MyCite; Otsuka America Pharmaceutical, Inc) is a digital medicine system indicated for the treatment of patients with schizophrenia, bipolar I disorder, and major depressive disorder. AS includes aripiprazole tablets with an embedded ingestible event marker, a wearable sensor attached to the skin through a wearable patch, a smartphone app, and a web-based portal. To continuously improve the final product, successive iterations of wearable patches were developed, including raisin patch version 4 (RP4), followed by disposable wearable sensor version 5 (DW5), and then reusable wearable sensor version 2 (RW2). Objective: This analysis pooled safety data from clinical studies in adult participants using the RP4, DW5, and RW2 wearable patches of AS and evaluated adverse events related to the use of wearable patches. Methods: Safety data from 12 studies in adults aged 18-65 years from May 2010 to August 2020 were analyzed. All studies evaluated safety, with studies less than 2 weeks also specifically examining human factors associated with the use of the components of AS. Healthy volunteers or patients with schizophrenia, bipolar I disorder, or major depressive disorder were enrolled; those who were exposed to at least 1 wearable patch were included in the safety analysis. Adverse events related to the use of a wearable patch were evaluated. Abrasions, blisters, dermatitis, discoloration, erythema, irritation, pain, pruritus, rash, and skin reactions were grouped as skin irritation events (SIEs). All statistical analyses were descriptive. Results: The analysis included 763 participants (mean [SD] age 42.6 [12.9] years; White: n=359, 47.1%; and male: n=420, 55%). Participants were healthy volunteers (n=269, 35.3%) or patients with schizophrenia (n=402, 52.7%), bipolar I disorder (n=57, 7.5%), or major depressive disorder (n=35, 4.6%). Overall, 13.6% (104/763) of the participants reported at least 1 SIE, all of which were localized to the wearable patch site. Incidence of ?1 patch-related SIEs was seen in 18.1% (28/155), 14.2% (55/387), and 9.2% (28/306) of participants who used RP4, DW5, and RW2, respectively. Incidence of SIE-related treatment discontinuation was low, which is reported by 1.9% (3/155), 3.1% (12/387), and 1.3% (4/306) of participants who used RP4, DW5, and RW2, respectively. Conclusions: The incidence rates of SIEs reported as the wearable patch versions evolved from RP4 through RW2 suggest that information derived from reported adverse events may have informed product design and development, which could have improved both tolerability and wearability of successive products. Trial Registration: Clinicaltrials.gov NCT02091882, https://clinicaltrials.gov/study/NCT02091882; Clinicaltrials.gov NCT02404532, https://clinicaltrials.gov/study/NCT02404532; Clinicaltrials.gov NCT02722967, https://clinicaltrials.gov/study/NCT02722967; Clinicaltrials.gov NCT02219009, https://clinicaltrials.gov/study/NCT02219009; Clinicaltrials.gov NCT03568500, https://clinicaltrials.gov/study/NCT03568500; Clinicaltrials.gov NCT03892889, https://clinicaltrials.gov/study/NCT03892889 UR - https://formative.jmir.org/2023/1/e44768 UR - http://dx.doi.org/10.2196/44768 UR - http://www.ncbi.nlm.nih.gov/pubmed/38085556 ID - info:doi/10.2196/44768 ER - TY - JOUR AU - Turesson, Christina AU - Liedberg, Gunilla AU - Björk, Mathilda PY - 2023/12/11 TI - Evaluating the Clinical Use and Utility of a Digital Support App for Employees With Chronic Pain Returning to Work (SWEPPE): Observational Study JO - JMIR Hum Factors SP - e52088 VL - 10 KW - chronic pain KW - digital support KW - eHealth KW - return-to-work KW - user data KW - mobile phone N2 - Background: The digital app SWEPPE (sustainable worker, a digital support for persons with chronic pain and their employers) was developed to improve the support of people with chronic pain in their return-to-work process after sick leave and includes functions such as the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. Objective: This study aims to describe the use of the smartphone app SWEPPE among people with chronic pain who have participated in an interdisciplinary pain rehabilitation program. Methods: This is a case study including 16 people participating in a feasibility study. The analyses were based on user data collected for 3 months. Quantitative data regarding used functions were analyzed with descriptive statistics, and qualitative data of identified needs of support from the employer were grouped into 8 categories. Results: Self-monitoring was used by all participants (median 26, IQR 8-87 daily registrations). A total of 11 (N=16, 69%) participants set a work-related goal and performed weekly evaluations of goal fulfillment and ratings of their work ability. In total, 9 (56%) participants shared information with their employer and 2 contacted the coach. A total of 15 (94%) participants identified a total of 51 support interventions from their employer. Support to adapt to work assignments and support to adapt to work posture were the 2 biggest categories. The most common type of support identified by 53% (8/15) of the participants was the opportunity to take breaks and short rests. Conclusions: Participants used multiple SWEPPE functions, such as daily self-registration, goal setting, self-monitoring, and employer support identification. This shows the flexible nature of SWEPPE, enabling individuals to select functions that align with their needs. Additional research is required to investigate the extended use of SWEPPE and how employers use shared employee information. UR - https://humanfactors.jmir.org/2023/1/e52088 UR - http://dx.doi.org/10.2196/52088 UR - http://www.ncbi.nlm.nih.gov/pubmed/38079212 ID - info:doi/10.2196/52088 ER - TY - JOUR AU - Mahmoodi Kahriz, Bahram AU - Snuggs, Sarah AU - Sah, Anumeha AU - Clot, Sophie AU - Lamport, Daniel AU - Forrest, Joseph AU - Helme-Guizon, Agnes AU - Wilhelm, Marie-Claire AU - Caldara, Cindy AU - Anin, Valentine Camille AU - Vogt, Julia PY - 2023/12/11 TI - Unveiling Consumer Preferences and Intentions for Cocreated Features of a Combined Diet and Physical Activity App: Cross-Sectional Study in 4 European Countries JO - JMIR Hum Factors SP - e44993 VL - 10 KW - mobile apps KW - healthy eating and physical activity KW - attitude KW - BMI and self-efficacy N2 - Background: Numerous mobile health apps are marketed globally, and these have specific features including physical activity tracking, motivational feedback, and recipe provision. It is important to understand which features individuals prefer and whether these preferences differ between consumer groups. Objective: In this study, we aimed to identify consumers? most preferred features and rewards for a mobile app that targets healthy eating and physical activity and to reduce the number of individual mobile health app features to a smaller number of key categories as perceived by consumers. In addition, we investigated the impact of differences in consumers? BMI and self-efficacy on their intention to use and willingness to pay for such an app. Finally, we identified the characteristics of different target groups of consumers and their responses toward app features via cluster analysis. Methods: A total of 212 participants from France, Italy, the United Kingdom, and Germany were recruited via the web to answer questions about app features, motivation, self-efficacy, demographics, and geographic factors. It is important to note that our study included an evenly distributed sample of people in the age range of 23 to 50 years (23-35 and 35-50 years). The app features in question were generated from a 14-day cocreation session by a group of consumers from the United Kingdom and the Republic of Ireland. Results: ?Home work out suggestions,? ?exercise tips,? and ?progress charts? were the most preferred app features, whereas ?gift vouchers? and ?shopping discounts? were the most preferred rewards. ?Connections with other communication apps? was the least preferred feature, and ?charitable giving? was the least preferred reward. Importantly, consumers? positive attitude toward the ?social support and connectedness and mindfulness? app feature predicted willingness to pay for such an app (?=.229; P=.004). Differences in consumers? health status, motivational factors, and basic demographics moderated these results and consumers? intention to use and willingness to pay for such an app. Notably, younger and more motivated consumers with more experience and knowledge about health apps indicated more positive attitudes and intentions to use and willingness to pay for this type of app. Conclusions: This study indicated that consumers tend to prefer app features that are activity based and demonstrate progress. It also suggested a potential role for monetary rewards in promoting healthy lifestyle behaviors. Moreover, the results highlighted the role of consumers? health status, motivational factors, and socioeconomic status in predicting their app use. These results provide up-to-date, practical, and pragmatic information for the future design and operation of mobile health apps. UR - https://humanfactors.jmir.org/2023/1/e44993 UR - http://dx.doi.org/10.2196/44993 UR - http://www.ncbi.nlm.nih.gov/pubmed/38079197 ID - info:doi/10.2196/44993 ER - TY - JOUR AU - Hartch, E. Christa AU - Dietrich, S. Mary AU - Stolldorf, P. Deonni PY - 2023/12/11 TI - Effect of a Medication Adherence Mobile Phone App on Medically Underserved Patients with Chronic Illness: Preliminary Efficacy Study JO - JMIR Form Res SP - e50579 VL - 7 KW - medication adherence KW - medication self-efficacy KW - mobile phone applications KW - medically underserved populations KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - underserved KW - adherence KW - survey KW - surveys KW - chronic illness N2 - Background: Medication adherence is vital in the treatment of patients with chronic illness who require long-term medication therapies to maintain optimal health. Medication adherence, a complex and widespread problem, has been difficult to solve. Additionally, lower-income, medically underserved communities have been found to have higher rates of inadequate adherence to oral medications. Even so, this population has been underrepresented in studies using mobile medication adherence app interventions. Federally qualified health centers provide care for medically underserved populations, defined as communities and populations where there is a demonstrable unmet need for health services. These centers have been reporting an increase in a more complex chronic disease population. Including medically underserved individuals in mobile health studies provides opportunities to support this disproportionately affected group, work toward reducing health disparities in access to health care, and understand barriers to mobile health uptake. Objective: The aim of this preliminary efficacy study was to evaluate the effects and feasibility of a commercially available medication adherence app, Medisafe, in a medically underserved adult population with various chronic illnesses seeking care in a federally qualified health center. Methods: Participants in this single-arm pre-post intervention preliminary efficacy study (N=10) completed a baseline survey, used the app for 2 weeks, and completed an end-of-study survey. The primary outcome measures were medication adherence and medication self-efficacy. Feedback on the use of the app was also gathered. Results: A statistically significant median increase of 8 points on the self-efficacy for adherence to medications scale was observed (P=.03, Cohen d=0.69). Though not significant, the adherence to refills and medications scale demonstrated a median change of 2.5 points in the direction of increased medication adherence (P=.21, Cohen d=0.41). Feedback about the app was positive. Conclusions: Use of the Medisafe app is a viable option to improve medication self-efficacy and medication adherence in medically underserved patients in an outpatient setting with a variety of chronic illnesses. UR - https://formative.jmir.org/2023/1/e50579 UR - http://dx.doi.org/10.2196/50579 UR - http://www.ncbi.nlm.nih.gov/pubmed/38079192 ID - info:doi/10.2196/50579 ER - TY - JOUR AU - Carpenter, M. Stephanie AU - Greer, M. Zara AU - Newman, Rebecca AU - Murphy, A. Susan AU - Shetty, Vivek AU - Nahum-Shani, Inbal PY - 2023/12/11 TI - Developing Message Strategies to Engage Racial and Ethnic Minority Groups in Digital Oral Self-Care Interventions: Participatory Co-Design Approach JO - JMIR Form Res SP - e49179 VL - 7 KW - engagement KW - oral health KW - mobile health intervention KW - mHealth intervention KW - formative KW - racial and ethnic minority group KW - digital health KW - mobile health KW - mHealth KW - message development KW - health equity KW - racial minority KW - ethnic minority KW - digital intervention KW - dental care KW - barrier KW - oral self-care KW - mobile phone N2 - Background: The prevention of oral health diseases is a key public health issue and a major challenge for racial and ethnic minority groups, who often face barriers in accessing dental care. Daily toothbrushing is an important self-care behavior necessary for sustaining good oral health, yet engagement in regular brushing remains a challenge. Identifying strategies to promote engagement in regular oral self-care behaviors among populations at risk of poor oral health is critical. Objective: The formative research described here focused on creating messages for a digital oral self-care intervention targeting a racially and ethnically diverse population. Theoretically grounded strategies (reciprocity, reciprocity-by-proxy, and curiosity) were used to promote engagement in 3 aspects: oral self-care behaviors, an oral care smartphone app, and digital messages. A web-based participatory co-design approach was used to develop messages that are resource efficient, appealing, and novel; this approach involved dental experts, individuals from the general population, and individuals from the target population?dental patients from predominantly low-income racial and ethnic minority groups. Given that many individuals from racially and ethnically diverse populations face anonymity and confidentiality concerns when participating in research, we used an approach to message development that aimed to mitigate these concerns. Methods: Messages were initially developed with feedback from dental experts and Amazon Mechanical Turk workers. Dental patients were then recruited for 2 facilitator-mediated group webinar sessions held over Zoom (Zoom Video Communications; session 1: n=13; session 2: n=7), in which they provided both quantitative ratings and qualitative feedback on the messages. Participants interacted with the facilitator through Zoom polls and a chat window that was anonymous to other participants. Participants did not directly interact with each other, and the facilitator mediated sessions by verbally asking for message feedback and sharing key suggestions with the group for additional feedback. This approach plausibly enhanced participant anonymity and confidentiality during the sessions. Results: Participants rated messages highly in terms of liking (overall rating: mean 2.63, SD 0.58; reciprocity: mean 2.65, SD 0.52; reciprocity-by-proxy: mean 2.58, SD 0.53; curiosity involving interactive oral health questions and answers: mean 2.45, SD 0.69; curiosity involving tailored brushing feedback: mean 2.77, SD 0.48) on a scale ranging from 1 (do not like it) to 3 (like it). Qualitative feedback indicated that the participants preferred messages that were straightforward, enthusiastic, conversational, relatable, and authentic. Conclusions: This formative research has the potential to guide the design of messages for future digital health behavioral interventions targeting individuals from diverse racial and ethnic populations. Insights emphasize the importance of identifying key stimuli and tasks that require engagement, gathering multiple perspectives during message development, and using new approaches for collecting both quantitative and qualitative data while mitigating anonymity and confidentiality concerns. UR - https://formative.jmir.org/2023/1/e49179 UR - http://dx.doi.org/10.2196/49179 UR - http://www.ncbi.nlm.nih.gov/pubmed/38079204 ID - info:doi/10.2196/49179 ER - TY - JOUR AU - Ruiz-Cárdenas, D. Juan AU - Montemurro, Alessio AU - Martínez-García, Mar María del AU - Rodríguez-Juan, J. Juan PY - 2023/12/8 TI - Sit-to-Stand Video Analysis?Based App for Diagnosing Sarcopenia and Its Relationship With Health-Related Risk Factors and Frailty in Community-Dwelling Older Adults: Diagnostic Accuracy Study JO - J Med Internet Res SP - e47873 VL - 25 KW - sarcopenia KW - power KW - calf circumference KW - diagnosis KW - screening KW - affordable KW - community dwelling KW - older adults KW - smartphone N2 - Background: Probable sarcopenia is determined by a reduction in muscle strength assessed with the handgrip strength test or 5 times sit-to-stand test, and it is confirmed with a reduction in muscle quantity determined by dual-energy X-ray absorptiometry or bioelectrical impedance analysis. However, these parameters are not implemented in clinical practice mainly due to a lack of equipment and time constraints. Nowadays, the technical innovations incorporated in most smartphone devices, such as high-speed video cameras, provide the opportunity to develop specific smartphone apps for measuring kinematic parameters related with sarcopenia during a simple sit-to-stand transition. Objective: We aimed to create and validate a sit-to-stand video analysis?based app for diagnosing sarcopenia in community-dwelling older adults and to analyze its construct validity with health-related risk factors and frailty. Methods: A total of 686 community-dwelling older adults (median age: 72 years; 59.2% [406/686] female) were recruited from elderly social centers. The index test was a sit-to-stand video analysis?based app using muscle power and calf circumference as proxies of muscle strength and muscle quantity, respectively. The reference standard was obtained by different combinations of muscle strength (handgrip strength or 5 times sit-to-stand test result) and muscle quantity (appendicular skeletal mass or skeletal muscle index) as recommended by the European Working Group on Sarcopenia in Older People-2 (EWGSOP2). Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) of the receiver operating characteristic curve were calculated to determine the diagnostic accuracy of the app. Construct validity was evaluated using logistic regression to identify the risks associated with health-related outcomes and frailty (Fried phenotype) among those individuals who were classified as having sarcopenia by the index test. Results: Sarcopenia prevalence varied from 2% to 11% according to the different combinations proposed by the EWGSOP2 guideline. Sensitivity, specificity, and AUC were 70%-83.3%, 77%-94.9%, and 80.5%-87.1%, respectively, depending on the diagnostic criteria used. Likewise, positive and negative predictive values were 10.6%-43.6% and 92.2%-99.4%, respectively. These results proved that the app was reliable to rule out the disease. Moreover, those individuals who were diagnosed with sarcopenia according to the index test showed more odds of having health-related adverse outcomes and frailty compared to their respective counterparts, regardless of the definition proposed by the EWGSOP2. Conclusions: The app showed good diagnostic performance for detecting sarcopenia in well-functioning Spanish community-dwelling older adults. Individuals with sarcopenia diagnosed by the app showed more odds of having health-related risk factors and frailty compared to their respective counterparts. These results highlight the potential use of this app in clinical settings. Trial Registration: ClinicalTrials.gov NCT05148351; https://clinicaltrials.gov/study/NCT05148351 International Registered Report Identifier (IRRID): RR2-10.3390/s22166010 UR - https://www.jmir.org/2023/1/e47873 UR - http://dx.doi.org/10.2196/47873 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064268 ID - info:doi/10.2196/47873 ER - TY - JOUR AU - Lu, Ziyuan AU - Signer, Tabea AU - Sylvester, Ramona AU - Gonzenbach, Roman AU - von Wyl, Viktor AU - Haag, Christina PY - 2023/12/8 TI - Implementation of Remote Activity Sensing to Support a Rehabilitation Aftercare Program: Observational Mixed Methods Study With Patients and Health Care Professionals JO - JMIR Mhealth Uhealth SP - e50729 VL - 11 KW - physical activity KW - activity sensor KW - normalization process theory KW - rehabilitation KW - chronic disease KW - chronic KW - aftercare KW - sensor KW - sensors KW - exercise KW - neurology KW - neuroscience KW - neurorehabilitation KW - adherence KW - need KW - needs KW - experience KW - experiences KW - questionnaire KW - questionnaires KW - mobile phone N2 - Background: Physical activity is central to maintaining the quality of life for patients with complex chronic conditions and is thus at the core of neurorehabilitation. However, maintaining activity improvements in daily life is challenging. The novel Stay With It program aims to promote physical activity after neurorehabilitation by cultivating self-monitoring skills and habits. Objective: We examined the implementation of the Stay With It program at the Valens Rehabilitation Centre in Switzerland using the normalization process theory framework, focusing on 3 research aims. We aimed to examine the challenges and facilitators of program implementation from the perspectives of patients and health care professionals. We aimed to evaluate the potential of activity sensors to support program implementation and patient acceptance. Finally, we aimed to evaluate patients? engagement in physical activity after rehabilitation, patients? self-reported achievement of home activity goals, and factors influencing physical activity. Methods: Patients were enrolled if they had a disease that was either chronic or at risk for chronicity and participated in the Stay With It program. Patients were assessed at baseline, the end of rehabilitation, and a 3-month follow-up. The health care professionals designated to deliver the program were surveyed before and after program implementation. We used a mixed methods approach combining standardized questionnaires, activity-sensing data (patients only), and free-text questions. Results: This study included 23 patients and 13 health care professionals. The diverse needs of patients and organizational hurdles were major challenges to program implementation. Patients? intrinsic motivation and health care professionals? commitment to refining the program emerged as key facilitators. Both groups recognized the value of activity sensors in supporting program implementation and sustainability. Although patients appreciated the sensor?s ability to monitor, motivate, and quantify activity, health care professionals saw the sensor as a motivational tool but expressed concerns about technical difficulties and potential inaccuracies. Physical activity levels after patients returned home varied considerably, both within and between individuals. The self-reported achievement of activity goals at home also varied, in part because of vague definitions. Common barriers to maintaining activity at home were declining health and fatigue often resulting from heat and pain. At the 3-month follow-up, 35% (8/23) of the patients withdrew from the study, with most citing deteriorating physical health as the reason and that monitoring and discussing their low activity would negatively affect their mental health. Conclusions: Integrating aftercare programs like Stay With It into routine care is vital for maintaining physical activity postrehabilitation. Although activity trackers show promise in promoting motivation through monitoring, they may lead to frustration during health declines. Their acceptability may also be influenced by an individual?s health status, habits, and technical skills. Our study highlights the importance of considering health care professionals? perspectives when integrating new interventions into routine care. UR - https://mhealth.jmir.org/2023/1/e50729 UR - http://dx.doi.org/10.2196/50729 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064263 ID - info:doi/10.2196/50729 ER - TY - JOUR AU - Starnecker, Fabian AU - Reimer, Marie Lara AU - Nissen, Leon AU - Jovanovi?, Marko AU - Kapsecker, Maximilian AU - Rospleszcz, Susanne AU - von Scheidt, Moritz AU - Krefting, Johannes AU - Krüger, Nils AU - Perl, Benedikt AU - Wiehler, Jens AU - Sun, Ruoyu AU - Jonas, Stephan AU - Schunkert, Heribert PY - 2023/12/8 TI - Guideline-Based Cardiovascular Risk Assessment Delivered by an mHealth App: Development Study JO - JMIR Cardio SP - e50813 VL - 7 KW - cardiovascular disease KW - cardiovascular risk assessment KW - HerzFit KW - mobile health app KW - mHealth app KW - public information campaigns KW - prevention KW - risk calculator KW - mobile phone N2 - Background: Identifying high-risk individuals is crucial for preventing cardiovascular diseases (CVDs). Currently, risk assessment is mostly performed by physicians. Mobile health apps could help decouple the determination of risk from medical resources by allowing unrestricted self-assessment. The respective test results need to be interpretable for laypersons. Objective: Together with a patient organization, we aimed to design a digital risk calculator that allows people to individually assess and optimize their CVD risk. The risk calculator was integrated into the mobile health app HerzFit, which provides the respective background information. Methods: To cover a broad spectrum of individuals for both primary and secondary prevention, we integrated the respective scores (Framingham 10-year CVD, Systematic Coronary Risk Evaluation 2, Systematic Coronary Risk Evaluation 2 in Older Persons, and Secondary Manifestations Of Arterial Disease) into a single risk calculator that was recalibrated for the German population. In primary prevention, an individual?s heart age is estimated, which gives the user an easy-to-understand metric for assessing cardiac health. For secondary prevention, the risk of recurrence was assessed. In addition, a comparison of expected to mean and optimal risk levels was determined. The risk calculator is available free of charge. Data safety is ensured by processing the data locally on the users? smartphones. Results: Offering a risk calculator to the general population requires the use of multiple instruments, as each provides only a limited spectrum in terms of age and risk distribution. The integration of 4 internationally recommended scores allows risk calculation in individuals aged 30 to 90 years with and without CVD. Such integration requires recalibration and harmonization to provide consistent and plausible estimates. In the first 14 months after the launch, the HerzFit calculator was downloaded more than 96,000 times, indicating great demand. Public information campaigns proved effective in publicizing the risk calculator and contributed significantly to download numbers. Conclusions: The HerzFit calculator provides CVD risk assessment for the general population. The public demonstrated great demand for such a risk calculator as it was downloaded up to 10,000 times per month, depending on campaigns creating awareness for the instrument. UR - https://cardio.jmir.org/2023/1/e50813 UR - http://dx.doi.org/10.2196/50813 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064248 ID - info:doi/10.2196/50813 ER - TY - JOUR AU - Colonna, Giulia AU - Hoye, Jocelyn AU - de Laat, Bart AU - Stanley, Gelsina AU - Ibrahimy, Alaaddin AU - Tinaz, Sule AU - Morris, D. Evan PY - 2023/12/8 TI - Measuring Heart Rate Accurately in Patients With Parkinson Disease During Intense Exercise: Usability Study of Fitbit Charge 4 JO - JMIR Biomed Eng SP - e51515 VL - 8 KW - Fitbit KW - heart rate measurements KW - Parkinson disease KW - exercise KW - accuracy KW - intensity KW - heart rate KW - wearable KW - neurodegenerative disease KW - aerobic exercise KW - physical exercise KW - program KW - device N2 - Background: Parkinson disease (PD) is the second most common neurodegenerative disease, affecting approximately 1% of the world?s population.Increasing evidence suggests that aerobic physical exercise can be beneficial in mitigating both motor and nonmotor symptoms of the disease.In a recent pilot study of the role of exercise on PD, we sought to confirm exercise intensity by monitoring heart rate (HR). For this purpose, we asked participants to wear a chest strap HR monitor (Polar Electro Oy) and the Fitbit Charge 4 (Fitbit Inc) wrist-worn HR monitor as a potential proxy due to its convenience.Polar H10 has been shown to provide highly accurate R-R interval measurements. Therefore, we treated it as the gold standard in this study. It has been shown that Fitbit Charge 4 has comparable accuracy to Polar H10 in healthy participants. It has yet to be determined if the Fitbit is as accurate as Polar H10 in patients with PD during rest and exercise. Objective: This study aimed to compare Fitbit Charge 4 to Polar H10 for monitoring HR in patients with PD at rest and during an intensive exercise program. Methods: A total of 596 exercise sessions from 11 (6 male and 5 female) participants were collected simultaneously with both devices. Patients with early-stage PD (Hoehn and Yahr ?2) were enrolled in a 6-month exercise program designed for patients with PD. They participated in 3 one-hour exercise sessions per week. They wore both Fitbit and Polar H10 during each session. Sessions included rest, warm-up, intense exercise, and cool-down periods.We calculated the bias in the HR of the Fitbit Charge 4 at rest (5 min) and during intense exercise (20 min) by comparing the mean HR during each of the periods to the respective means measured by Polar H10 (HRFitbit ? HRPolar). We also measured the sensitivity and specificity of Fitbit Charge 4 to detect average HRs that exceed the threshold for intensive exercise, defined as 70% of an individual?s theoretical maximum HR. Different types of correlations between the 2 devices were investigated. Results: The mean bias was 1.68 beats per minute (bpm) at rest and 6.29 bpm during high-intensity exercise, with an overestimation by Fitbit Charge 4 in both conditions. The mean bias of the Fitbit across both rest and intensive exercise periods was 3.98 bpm. The device?s sensitivity in identifying high-intensity exercise sessions was 97.14%. The correlation between the 2 devices was nonlinear, suggesting Fitbit?s tendency to saturate at high values of HR. Conclusions: The performance of Fitbit Charge 4 is comparable to Polar H10 for assessing exercise intensity in a cohort of patients with PD (mean bias 3.98 bpm). The device could be considered a reasonable surrogate for more cumbersome chest-worn devices in future studies of clinical cohorts. UR - https://biomedeng.jmir.org/2023/1/e51515 UR - http://dx.doi.org/10.2196/51515 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875680 ID - info:doi/10.2196/51515 ER - TY - JOUR AU - Turvey, Carolyn AU - Fuhrmeister, Lindsey AU - Klein, Dawn AU - McCoy, Kimberly AU - Moeckli, Jane AU - Stewart Steffensmeier, R. Kenda AU - Suiter, Natalie AU - Van Tiem, Jen PY - 2023/12/8 TI - Secure Messaging Intervention in Patients Starting New Antidepressant to Promote Adherence: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e51277 VL - 7 KW - depression KW - text messaging KW - medication adherence KW - medication KW - medications KW - adherence KW - antidepressant KW - antidepressants KW - depressive KW - text message KW - text messages KW - messaging KW - SMS KW - veteran KW - veterans KW - military KW - randomized controlled trial KW - RCT KW - controlled trials KW - mental health KW - psychiatry KW - mobile phone N2 - Background: There are a range of effective pharmacological and behavioral treatments for depression. However, approximately one-third of patients discontinue antidepressants within the first month of treatment and 44% discontinue them by the third month of treatment. The major reasons reported for discontinuation were side effect burden, patients experiencing that the medications were not working, and patients wanting to resolve their depression without using medication. Objective: This study tested the acceptability, feasibility, and preliminary effectiveness of an SMS messaging intervention designed to improve antidepressant adherence and depression outcomes in veterans. The intervention specifically targeted the key reasons for antidepressant discontinuation. For example, the secure message included reminders that it can take up to 6 weeks for an antidepressant to work, or prompts to call their provider should the side effect burden become significant. Methods: This pilot was a 3-armed randomized controlled trial of 53 veterans undergoing depression treatment at the Iowa City Veterans Affairs Health Care System. Veterans starting a new antidepressant were randomized to secure messaging only (SM-Only), secure messaging with coaching (SM+Coach), or attention control (AC) groups. The intervention lasted 12 weeks with follow-up assessments of key outcomes at 6 and 12-weeks. This included a measure of antidepressant adherence, depressive symptom severity, and side effect burden. Results: The 2 active interventions (SM-Only and SM+Coach) demonstrated small to moderate effect sizes (ESs) in improving antidepressant adherence and reducing side effect burden. They did not appear to reduce the depressive symptom burden any more than in the AC arm. Veteran participants in the SM arms demonstrated improved medication adherence from baseline to 12 weeks on the Medication Adherence Rating Scale compared with those in the AC arm, who had a decline in adherence (SM-Only: ES=0.09; P=.19; SM+Coach: ES=0.85; P=.002). Depression scores on the 9-Item Patient Health Questionnaire decreased for all 3 treatment arms, although the decline was slightly larger for the SM-Only (ES=0.32) and the SM+Coach (ES=0.24) arms when compared with the AC arm. The 2 intervention arms indicated a decrease in side effects on the Frequency, Intensity, and Burden of Side Effects Ratings, whereas the side effect burden for the AC arm increased. These differences indicated moderate ES (SM-Only vs AC: ES=0.40; P=.07; SM+Coach: ES=0.54; P=.07). Conclusions: A secure messaging program targeting specific reasons for antidepressant discontinuation had small-to-moderate ES in improving medication adherence. Consistent with prior research, the intervention that included brief synchronic meetings with a coach appeared to have a greater benefit than the SMS-alone intervention. Veterans consistently engaged with the SMS messaging in both treatment arms throughout the study period. They additionally provided feedback on which texts were most helpful, tending to prefer messages providing overall encouragement rather than specific wellness recommendations. Trial Registration: ClinicalTrials.gov NCT03930849; https://clinicaltrials.gov/study/NCT03930849 UR - https://formative.jmir.org/2023/1/e51277 UR - http://dx.doi.org/10.2196/51277 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064267 ID - info:doi/10.2196/51277 ER - TY - JOUR AU - Guo, Huey-Ming Sophie AU - Lin, Jiun-Lu AU - Hsing, Hung-Chun AU - Lee, Chun-Chuan AU - Chuang, Shih-Ming PY - 2023/12/6 TI - The Effect of Mobile eHealth Education to Improve Knowledge, Skills, Self-Care, and Mobile eHealth Literacies Among Patients With Diabetes: Development and Evaluation Study JO - J Med Internet Res SP - e42497 VL - 25 KW - mobile eHealth technology KW - mHealth literacy KW - eHealth literacy KW - diabetes KW - HbA1c KW - self-care behavior N2 - Background: The promotion of mobile health (mHealth) and eHealth technologies as tools for managing chronic diseases, particularly diabetes mellitus, is on the rise. Nevertheless, individuals with diabetes frequently face a literacy gap that hinders their ability to fully leverage the benefits offered by these resources. Enhancing technology literacy to facilitate the adoption of mobile eHealth services poses a significant challenge in numerous countries. Objective: This study aims to develop an educational mobile eHealth literacy (eHL) program for patients with diabetes and to evaluate its effect on patients? outcomes. Methods: This study designed a mobile eHL education program comprising 2 modules specifically tailored for individuals with type 2 diabetes (T2D). These modules focused on guiding participants through the process of effectively navigating reliable health websites and utilizing diabetes-related apps. Using a pre- and posttest experimental design, the study featured an intervention group and a control group. Participants were recruited from 3 outpatient departments in hospitals, and assessments were conducted both before and after the intervention, along with a follow-up measure at the 3-month mark. The evaluation encompassed sociodemographic characteristics, computer and internet proficiency, mobile app usage, mobile eHL, and patient outcomes such as self-care behaviors and glycated hemoglobin (HbA1c) levels. Results: The analysis included a total of 132 eligible participants. Significant differences were observed in the mean scores of knowledge (P<.001) and skills (P<.001) related to computers, the web, and mobile devices at the initiation of the study and after the intervention. During the 3-month follow-up, the findings indicated a significant improvement in mobile eHL (t114=3.391, P=.001) and mHealth literacy (mHL, a subconcept of mobile eHL; t114=3.801, P<.001) within the intervention group, whereas no such improvement was observed in the control group. The chi-square values from the McNemar test underscored that individuals with uncontrolled diabetes (HbA1c?7%) in the intervention group exhibited more improvement compared with the control group. The generalized estimating equations model unveiled a significant difference in the change of general mHL in the intervention group (?=1.91, P=.047) and self-care behavior in the control group from T0 to T2 (?=?8.21, P=.015). Despite being small, the effect sizes for mobile eHL (d=0.49) and HbA1c (d=0.33) in the intervention group were greater than those in the control group (d=0.14 and d=0.16, respectively). Conclusions: The implementation of a mobile eHL education intervention demonstrates a positive influence on the familiarity of patients with T2D regarding health technology, leading to favorable glycemic outcomes. While additional studies are warranted for a more comprehensive understanding, this program emerges as a promising solution for enhancing patients? uptake of digital health technology. UR - https://www.jmir.org/2023/1/e42497 UR - http://dx.doi.org/10.2196/42497 UR - http://www.ncbi.nlm.nih.gov/pubmed/38055321 ID - info:doi/10.2196/42497 ER - TY - JOUR AU - Saad, Fiby AU - Eisenstadt, Mia AU - Liverpool, Shaun AU - Carlsson, Courtney AU - Vainieri, Isabella PY - 2023/12/6 TI - Self-Guided Mental Health Apps Targeting Racial and Ethnic Minority Groups: Scoping Review JO - JMIR Ment Health SP - e48991 VL - 10 KW - mental health apps KW - racial and ethnic minority groups KW - self-guided KW - mental health KW - culturally appropriate technology N2 - Background: The use of mental health apps (MHAs) is increasing rapidly. However, little is known about the use of MHAs by racial and ethnic minority groups. Objective: In this review, we aimed to examine the acceptability and effectiveness of MHAs among racial and ethnic minority groups, describe the purposes of using MHAs, identify the barriers to MHA use in racial and ethnic minority groups, and identify the gaps in the literature. Methods: A systematic search was conducted on August 25, 2023, using Web of Science, Embase, PsycINFO, PsycArticles, PsycExtra, and MEDLINE. Articles were quality appraised using the Mixed Methods Appraisal Tool, and data were extracted and summarized to form a narrative synthesis. Results: A total of 15 studies met the inclusion criteria. Studies were primarily conducted in the United States, and the MHAs designed for racial and ethnic minority groups included ¡Aptívate!, iBobbly, AIMhi- Y, BRAVE, Build Your Own Theme Song, Mindful You, Sanadak, and 12 more MHAs used in 1 study. The MHAs were predominantly informed by cognitive behavioral therapy and focused on reducing depressive symptoms. MHAs were considered acceptable for racial and ethnic minority groups; however, engagement rates dropped over time. Only 2 studies quantitatively reported the effectiveness of MHAs among racial and ethnic minority groups. Barriers to use included the repetitiveness of the MHAs, stigma, lack of personalization, and technical issues. Conclusions: Considering the growing interest in MHAs, the available evidence for MHAs for racial and ethnic minority groups appears limited. Although the acceptability seems consistent, more research is needed to support the effectiveness of MHAs. Future research should also prioritize studies to explore the specific needs of racial and ethnic minority groups if MHAs are to be successfully adopted. UR - https://mental.jmir.org/2023/1/e48991 UR - http://dx.doi.org/10.2196/48991 UR - http://www.ncbi.nlm.nih.gov/pubmed/38055315 ID - info:doi/10.2196/48991 ER - TY - JOUR AU - Thompson, N. Alexandra AU - Dawson, R. Deirdre AU - Legasto-Mulvale, Michelle Jean AU - Chandran, Nivetha AU - Tanchip, Chelsea AU - Niemczyk, Veronika AU - Rashkovan, Jillian AU - Jeyakumar, Saisa AU - Wang, H. Rosalie AU - Cameron, I. Jill AU - Nalder, Emily PY - 2023/12/6 TI - Mobile Technology?Based Interventions for Stroke Self-Management Support: Scoping Review JO - JMIR Mhealth Uhealth SP - e46558 VL - 11 KW - stroke KW - chronic disease KW - self-management KW - rehabilitation KW - mobile health KW - mHealth KW - eHealth KW - telehealth KW - telemedicine KW - digital health KW - mobile phone N2 - Background: There is growing interest in enhancing stroke self-management support using mobile health (mHealth) technology (eg, smartphones and apps). Despite this growing interest, ?self-management support? is inconsistently defined and applied in the poststroke mHealth intervention literature, which limits efforts to synthesize and compare evidence. To address this gap in conceptual clarity, a scoping review was conducted. Objective: The objectives were to (1) identify and describe the types of poststroke mHealth interventions evaluated using a randomized controlled trial design, (2) determine whether (and how) such interventions align with well-accepted conceptualizations of self-management support (the theory by Lorig and Holman and the Practical Reviews in Self-Management Support [PRISMS] taxonomy by Pearce and colleagues), and (3) identify the mHealth functions that facilitate self-management. Methods: A scoping review was conducted according to the methodology by Arksey and O?Malley and Levac et al. In total, 7 databases were searched. Article screening and data extraction were performed by 2 reviewers. The data were analyzed using descriptive statistics and content analysis. Results: A total of 29 studies (26 interventions) were included. The interventions addressed 7 focal areas (physical exercise, risk factor management, linguistic exercise, activities of daily living training, medication adherence, stroke education, and weight management), 5 types of mobile devices (mobile phones or smartphones, tablets, wearable sensors, wireless monitoring devices, and laptops), and 7 mHealth functions (educating, communicating, goal setting, monitoring, providing feedback, reminding, and motivating). Collectively, the interventions aligned well with the concept of self-management support. However, on an individual basis (per intervention), the alignment was less strong. Conclusions: On the basis of the results, it is recommended that future research on poststroke mHealth interventions be more theoretically driven, more multidisciplinary, and larger in scale. UR - https://mhealth.jmir.org/2023/1/e46558 UR - http://dx.doi.org/10.2196/46558 UR - http://www.ncbi.nlm.nih.gov/pubmed/38055318 ID - info:doi/10.2196/46558 ER - TY - JOUR AU - Peven, Kimberly AU - Wickham, P. Aidan AU - Wilks, Octavia AU - Kaplan, C. Yusuf AU - Marhol, Andrei AU - Ahmed, Saddif AU - Bamford, Ryan AU - Cunningham, C. Adam AU - Prentice, Carley AU - Meczner, András AU - Fenech, Matthew AU - Gilbert, Stephen AU - Klepchukova, Anna AU - Ponzo, Sonia AU - Zhaunova, Liudmila PY - 2023/12/5 TI - Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study JO - JMIR Mhealth Uhealth SP - e46718 VL - 11 KW - women's health KW - symptom checkers KW - symptom checker KW - digital health KW - chatbot KW - accuracy KW - eHealth apps KW - mobile phone KW - mobile health KW - mHealth KW - mobile health app KW - polycystic ovary syndrome KW - gynecology KW - digital health tool KW - endometriosis KW - uterus KW - uterine KW - uterine fibroids KW - vignettes KW - clinical vignettes N2 - Background: Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. Objective: This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. Methods: Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. Results: A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. Conclusions: The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways. UR - https://mhealth.jmir.org/2023/1/e46718 UR - http://dx.doi.org/10.2196/46718 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051574 ID - info:doi/10.2196/46718 ER - TY - JOUR AU - Sadhu, Shehjar AU - Solanki, Dhaval AU - Brick, A. Leslie AU - Nugent, R. Nicole AU - Mankodiya, Kunal PY - 2023/12/5 TI - Designing a Clinician-Centered Wearable Data Dashboard (CarePortal): Participatory Design Study JO - JMIR Form Res SP - e46866 VL - 7 KW - digital health KW - wearables KW - smart watch KW - smartwatch KW - symptom monitoring KW - mobile health KW - mHealth KW - participatory design KW - stress management KW - monitoring KW - eHealth KW - wearable technology KW - remote monitoring KW - physical stress KW - psychological stress KW - stress KW - data interpretation KW - visualization KW - questionnaire KW - decision-making KW - mobile phone N2 - Background: The recent growth of eHealth is unprecedented, especially after the COVID-19 pandemic. Within eHealth, wearable technology is increasingly being adopted because it can offer the remote monitoring of chronic and acute conditions in daily life environments. Wearable technology may be used to monitor and track key indicators of physical and psychological stress in daily life settings, providing helpful information for clinicians. One of the key challenges is to present extensive wearable data to clinicians in an easily interpretable manner to make informed decisions. Objective: The purpose of this research was to design a wearable data dashboard, named CarePortal, to present analytic visualizations of wearable data that are meaningful to clinicians. The study was divided into 2 main research objectives: to understand the needs of clinicians regarding wearable data interpretation and visualization and to develop a system architecture for a web application to visualize wearable data and related analytics. Methods: We used a wearable data set collected from 116 adolescent participants who experienced trauma. For 2 weeks, participants wore a Microsoft Band that logged physiological sensor data such as heart rate (HR). A total of 834 days of HR data were collected. To design the CarePortal dashboard, we used a participatory design approach that interacted directly with clinicians (stakeholders) with backgrounds in clinical psychology and neuropsychology. A total of 8 clinicians were recruited from the Rhode Island Hospital and the University of Massachusetts Memorial Health. The study involved 5 stages of participatory workshops and began with an understanding of the needs of clinicians. A User Experience Questionnaire was used at the end of the study to quantitatively evaluate user experience. Physiological metrics such as daily and hourly maximum, minimum, average, and SD of HR and HR variability, along with HR-based activity levels, were identified. This study investigated various data visualization graphing methods for wearable data, including radar charts, stacked bar plots, scatter plots combined with line plots, simple bar plots, and box plots. Results: We created a CarePortal dashboard after understanding the clinicians? needs. Results from our workshops indicate that overall clinicians preferred aggregate information such as daily HR instead of continuous HR and want to see trends in wearable sensor data over a period (eg, days). In the User Experience Questionnaire, a score of 1.4 was received, which indicated that CarePortal was exciting to use (question 5), and a similar score was received, indicating that CarePortal was the leading edge (question 8). On average, clinicians reported that CarePortal was supportive and can be useful in making informed decisions. Conclusions: We concluded that the CarePortal dashboard integrated with wearable sensor data visualization techniques would be an acceptable tool for clinicians to use in the future. UR - https://formative.jmir.org/2023/1/e46866 UR - http://dx.doi.org/10.2196/46866 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051573 ID - info:doi/10.2196/46866 ER - TY - JOUR AU - König, Lars AU - Suhr, Ralf PY - 2023/12/4 TI - The Effectiveness of Publicly Available Web-Based Interventions in Promoting Health App Use, Digital Health Literacy, and Media Literacy: Pre-Post Evaluation Study JO - J Med Internet Res SP - e46336 VL - 25 KW - digital health literacy KW - e-learning KW - health apps KW - health education KW - health literacy KW - media literacy KW - mHealth KW - mobile health KW - serious games KW - user experience KW - web-based intervention N2 - Background: According to the World Health Organization, implementing mobile health (mHealth) technologies can increase access to quality health services worldwide. mHealth apps for smartphones, also known as health apps, are a central component of mHealth, and they are already used in diverse medical contexts. To benefit from health apps, potential users need specific skills that enable them to use such apps in a responsible and constructive manner. Objective: This study aimed to evaluate the effectiveness of the free and widely used web-based intervention, The APPocalypse?. Besides providing knowledge about health apps, the web-based intervention was designed to promote digital health and media literacy by teaching skills that enable users to distinguish between trustworthy and less trustworthy health apps. It was hypothesized that after completing the web-based intervention, participants? knowledge in the domain of health apps, their digital health literacy, and their media literacy would be higher than it was before completing the web-based intervention. Methods: The study was divided into 3 parts. During part 1, participants (n=365; 181 female, 181 male, and 3 diverse; mean age 17.74, SD 1.391 years) provided demographic information and answered the pre- and postmeasurements. The measurements included questionnaires about participants? knowledge in the domain of health apps, digital health literacy, and media literacy. During part 2, participants had 1 week to complete the web-based intervention. During part 3, participants answered the pre- and postmeasurements again. Furthermore, they answered educational quality and user experience questionnaires. Bayesian paired samples 2-tailed t tests were conducted to test the hypotheses. Results: Overall, the results support the hypotheses. After completing the web-based intervention, participants demonstrated more elaborate knowledge in the domain of health apps. Specifically, they displayed higher competencies in the domains of subjective (Bayes factor10 [BF10]=1.475×1079; effect size ?=?1.327) and objective health app knowledge (BF10=8.162×1080; effect size ?=?1.350). Furthermore, participants demonstrated higher digital health literacy. Specifically, they displayed higher competencies in the domains of information appraisal (BF10=3.413×1043; effect size ?=?0.870), information searching (BF10=3.324×1023; effect size ?=?0.604), evaluating reliability (BF10=3.081×1035; effect size ?=?0.766), and determining relevance (BF10=3.451×1024; effect size ?=?0.618). Regarding media literacy, the results were mixed. Participants displayed higher competencies in the domain of technology literacy beliefs (BF10=1.533×1021; effect size ?=?0.570). In the domain of technology control beliefs, their competencies did not seem to improve (BF10=0.109; effect size ?=?0.058). In comparison to relevant benchmarks, the web-based intervention offers exceptional educational quality and a superior user experience. Conclusions: The free web-based intervention The APPocalypse? might promote the constructive use of health apps, digital health literacy, and media literacy. Therefore, it may contribute to achieving the health-related United Nations Sustainable Development Goals. UR - https://www.jmir.org/2023/1/e46336 UR - http://dx.doi.org/10.2196/46336 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048146 ID - info:doi/10.2196/46336 ER - TY - JOUR AU - Masel, Joanna AU - Petrie, Mackie James Ian AU - Bay, Jason AU - Ebbers, Wolfgang AU - Sharan, Aalekh AU - Leibrand, Michael Scott AU - Gebhard, Andreas AU - Zimmerman, Samuel PY - 2023/12/4 TI - Combatting SARS-CoV-2 With Digital Contact Tracing and Notification: Navigating Six Points of Failure JO - JMIR Public Health Surveill SP - e49560 VL - 9 KW - COVID-19 KW - SARS-CoV-2 KW - pandemic preparedness KW - decentralized protocols KW - smartphone KW - mobile phone KW - contact tracing UR - https://publichealth.jmir.org/2023/1/e49560 UR - http://dx.doi.org/10.2196/49560 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048155 ID - info:doi/10.2196/49560 ER - TY - JOUR AU - Bentsen, Line AU - Hanghøj, Signe AU - Hjerming, Maiken AU - Bergmann, Buur Mette AU - Thycosen, Marianne AU - Borup, Anette AU - Larsen, Camilla AU - Pappot, Helle PY - 2023/12/4 TI - Development of Quality of Life in Adolescents and Young Adults With Cancer Using a Patient Support Smartphone App: Prepost Interventional Study JO - JMIR Cancer SP - e49735 VL - 9 KW - adolescent KW - young adult KW - cancer KW - quality of life KW - eHealth KW - smartphone application KW - application KW - development KW - interventional study KW - youth KW - grief KW - symptom tracker KW - social community KW - Denmark KW - physical functioning KW - treatment KW - mobile phone N2 - Background: Adolescents and young adults often experience existential concerns in addition to side effects during a cancer trajectory, which they often carry alone. Thus, cohesion with other adolescents and young adults with cancer is essential but difficult due to the relatively small, widely dispersed nationwide population. In cocreation, a smartphone app has been developed and includes an information bank, a symptom tracker, and a social community platform, aiming to improve the quality of life (QoL) in this patient group. Objective: This nationwide, multicenter study aimed to investigate the QoL in adolescents and young adults undergoing a cancer trajectory as they used the app for 6 weeks. Methods: Via youth support initiatives, participants were recruited from hospitals in all regions of Denmark. Inclusion criteria were patients with cancer aged 15-29 years who either initiated any cancer treatment or started follow-up after cancer treatment within 30 days. Participants used the adolescents and young adults cancer app for 6 weeks. Before and after the 6 weeks of app use, they completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The participants were divided into a treatment and a follow-up group for analysis. A high score for a functional scale or the global health or overall QoL represents a high or healthy level of functioning or high QoL, respectively; however, a high score for a symptom scale or item represents a high level of symptomatology. Results: Overall, 81 participants were recruited. However, 4 participants did not answer the questionnaire and 6 participants did not use the app. In the treatment group (n=36), significant improvement was found in 2 domains: ?Role functioning? (baseline median 33.33, IQR 16.67-83.33 vs 6 weeks median 66.67, IQR 33.33-83.33; P=.04) and ?Pain? (baseline median 33.33, IQR 16.67-50.00 vs 6 weeks median 16.67, IQR 0.00-33.33; P=.04). The ?Global health/Overall QoL? scale remained stable (baseline median 58.33, IQR 45.83-77.08 vs 6 weeks median 62.50, IQR 41.67-75.00; P=.25). In the follow-up group (n=35), significant improvement was found in 3 domains: ?Physical functioning? (baseline median 79.23, IQR 73.33-93.33 vs 6 weeks median 82.86, IQR 73.33-100.00; P=.03), ?Cognitive functioning? (baseline median 62.38, IQR 50.00-83.33 vs 6 weeks median 69.52, IQR 50.00-100.00; P=.02), and ?Social functioning? (baseline median 76.19, IQR 50.00-100.00 vs 6 weeks median 85.71, IQR 83.33-100.00; P=.05), as well as in the ?Global health/Overall QoL? scale (baseline median 57.14, IQR 83.33-100.00 vs 6 weeks median 75.0, IQR 62.91-85.73; P<.001). Conclusions: In this study, we found an improvement in specific QoL scales for both participants in treatment and follow-up when using the app for 6 weeks. The global health or overall QoL score improved significantly in the follow-up group. In the treatment group, it remained stable. International Registered Report Identifier (IRRID): RR2-10.2196/10098 UR - https://cancer.jmir.org/2023/1/e49735 UR - http://dx.doi.org/10.2196/49735 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048144 ID - info:doi/10.2196/49735 ER - TY - JOUR AU - Mokaya, Moses AU - Kyallo, Florence AU - Yiga, Peter AU - Koole, Lena Janna AU - Boedt, Tessy AU - Vangoitsenhoven, Roman AU - Matthys, Christophe PY - 2023/12/4 TI - Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study JO - JMIR Res Protoc SP - e48271 VL - 12 KW - behavior change techniques KW - Behavior Change Wheel KW - type 2 diabetes KW - low-income populations KW - mHealth KW - mobile health KW - glycemic control KW - adults KW - diabetes KW - Africa KW - mobile phone KW - support care KW - care KW - support KW - behavior N2 - Background: The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care. Objective: This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya. Methods: The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention. Results: In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs. Conclusions: This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D. International Registered Report Identifier (IRRID): RR1-10.2196/48271 UR - https://www.researchprotocols.org/2023/1/e48271 UR - http://dx.doi.org/10.2196/48271 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048150 ID - info:doi/10.2196/48271 ER - TY - JOUR AU - Shea, A. Amanda AU - Thornburg, Jonathan AU - Vitzthum, J. Virginia PY - 2023/12/1 TI - Assessment of App-Based Versus Conventional Survey Modalities for Reproductive Health Research in India, South Africa, and the United States: Comparative Cross-Sectional Study JO - JMIR Form Res SP - e44705 VL - 7 KW - mobile health KW - mHealth KW - femtech KW - reproductive health KW - menstrual health KW - sexual health KW - survey modalities KW - menstrual tracking app KW - India KW - South Africa KW - United States KW - mobile phone N2 - Background: There is a widely acknowledged global need for more research on reproductive health (including contraception, menstrual health, sexuality, and maternal morbidities) and its impact on overall well-being. However, several factors?notably, high costs, considerable effort, and the sensitivity of these topics?impede the collection of the necessary data, especially in less accessible and lower-income populations. The burgeoning ownership of smartphones and growing use of menstrual tracking apps (MTAs) may present an opportunity to conduct reproductive health research with fewer impediments than those associated with conventional survey methods. Objective: The main objective was to ascertain the feasibility, potential usefulness, and limitations of conducting reproductive health research using a mainstream MTA. Methods: In each of the 3 countries, we evaluated questionnaire responses from (1) current users of an MTA (Clue) and (2) participants surveyed using conventional survey modalities (in-person interviews, SMS text messaging, and web-based questionnaires). We compared these responses with published data collected from large nationally representative benchmark samples (the United States Census and the Demographic and Health Surveys for South Africa and India). Results: Given a sufficiently large user base, app-distributed surveys were able to quickly capture large samples on par with other methods and at low cost, with the additional advantage of being able to deploy remotely and simultaneously across countries. In each country, neither the app nor the conventional modality sample emerged as a consistently closer match to the distributions of the demographic attributes and the patterns of contraceptive use reported for the respective benchmark sample. Despite efforts to obtain representative samples, the conventional modality samples sometimes over- and other times underrepresented some subgroups (eg, underrepresentation of married persons in the United States and overrepresentation of rural residents in India). In all 3 countries, app users were younger, more educated, more likely to be urban residents, and more likely to use nonhormonal rather than hormonal contraceptive methods compared with the respective national benchmark. App users, compared with the conventional modality samples, consistently reported being more comfortable discussing their menstrual periods with other persons (eg, family, friends, and health care providers), suggesting that MTA users may be more likely to respond truthfully to questions on sensitive or taboo health topics. The app samples? consistency across countries regarding users? demographic profiles, contraceptive choices, and personal attitudes toward menstruation supports the validity of making cross-country comparisons of survey findings for a given app?s users. Conclusions: MTAs such as Clue can provide a quick, scalable, and cost-effective method for collecting health data, including on sensitive topics, across a wide variety of settings and countries. With expanding global access to technology and the increasing use of these tools, consumer MTAs can be a viable survey modality to strengthen reproductive health research. UR - https://formative.jmir.org/2023/1/e44705 UR - http://dx.doi.org/10.2196/44705 UR - http://www.ncbi.nlm.nih.gov/pubmed/38039064 ID - info:doi/10.2196/44705 ER - TY - JOUR AU - Buck, Benjamin AU - Wingerson, Mary AU - Whiting, Erica AU - Snyder, Jaime AU - Monroe-DeVita, Maria AU - Ben-Zeev, Dror PY - 2023/11/30 TI - User-Centered Development of Bolster, an mHealth Intervention for Early Psychosis Caregivers: Needs Assessment, Prototyping, and Field Trial JO - JMIR Ment Health SP - e50522 VL - 10 KW - caregiving KW - psychosis KW - mobile health KW - mHealth KW - user-centered design KW - mobile phone KW - artificial intelligence KW - AI N2 - Background: Caregivers play a critical role in the treatment and recovery of youth and young adults at risk for psychosis. Caregivers often report feeling isolated, overwhelmed, and lacking in resources. Mobile health (mHealth) has the potential to provide scalable, accessible, and in-the-moment support to caregivers. To date, few if any mHealth resources have been developed specifically for this population. Objective: The aim of this study was to conduct user-centered design and testing of an mHealth intervention to support early psychosis caregivers. Methods: We conducted a multiphase user-centered development process to develop the Bolster mobile app. In phase 1, a total of 21 caregivers were recruited to participate in a qualitative needs assessment and respond to an initial prototype of the Bolster platform. Content analysis was used to identify key needs and design objectives, which guided the development of the Bolster mobile app. In phase 2, a total of 11 caregivers were recruited to participate in a 1-week field trial wherein they provided qualitative and quantitative feedback regarding the usability and acceptability of Bolster; in addition, they provided baseline and posttest assessments of the measures of distress, illness appraisals, and family communication. Results: In phase 1, participants identified psychoeducation, communication coaching, a guide to seeking services, and support for coping as areas to address. Live prototype interaction sessions led to multiple design objectives, including ensuring that messages from the platform were actionable and tailored to the caregiver experience, delivering messages in multiple modalities (eg, video and text), and eliminating a messaging-style interface. These conclusions were used to develop the final version of Bolster tested in the field trial. In phase 2, of the 11 caregivers, 10 (91%) reported that they would use Bolster if they had access to it and would recommend it to another caregiver. They also reported marked changes in their appraisals of illness (Cohen d=0.55-0.68), distress (Cohen d=1.77), and expressed emotion (Cohen d=0.52). Conclusions: To our knowledge, this study is the first to design an mHealth intervention specifically for early psychosis caregivers. Preliminary data suggest that Bolster is usable, acceptable, and promising to improve key targets and outcomes. A future fully powered clinical trial will help determine whether mHealth can reduce caregiver burdens and increase engagement in services among individuals affected by psychosis. UR - https://mental.jmir.org/2023/1/e50522 UR - http://dx.doi.org/10.2196/50522 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032692 ID - info:doi/10.2196/50522 ER - TY - JOUR AU - Harper, C. Rosie AU - Sheppard, Sally AU - Stewart, Carly AU - Clark, J. Carol PY - 2023/11/30 TI - Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review JO - JMIR Mhealth Uhealth SP - e45947 VL - 11 KW - adherence KW - behavior change KW - mHealth KW - mobile apps KW - pelvic floor muscle training KW - women N2 - Background: Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women. Objective: We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core ?capability, opportunity, and motivation? (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care. Methods: We conducted a scoping review of the literature. Published quantitative literature that compared the use of a PFMT mobile app to a control group was included to address the objectives of the study. The electronic bibliographic databases searched included MEDLINE, CINAHL, Scopus, Web of Science, and PEDro, along with CENTRAL. Studies were also identified from reference searching of systematic reviews. Original articles written in English from 2006 onward were included. Nonexperimental quantitative studies, qualitative studies, studies that use male participants, case studies, web-based interventions, and interventions that use vaginal probes were excluded. Narrative synthesis was conducted on eligible articles based on the aims of the study. Results: Of the 114 records retrieved from the search, a total of 6 articles met the eligibility and inclusion criteria. The total number of participants in the studies was 471. All PFMT mobile apps used the BCT ?prompts and cues.? Opportunity was the core COM behavior targeted by the PFMT mobile apps. Higher levels of adherence to PFMT were observed among women using PFMT mobile apps. Conclusions: Digital ?prompts and cues? are a BCT commonly used in PFMT mobile apps, and further research is required to practically assess whether a future randomized controlled trial that investigates the effectiveness of digital ?prompts and cues? on PFMT adherence in women can be conducted. UR - https://mhealth.jmir.org/2023/1/e45947 UR - http://dx.doi.org/10.2196/45947 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032694 ID - info:doi/10.2196/45947 ER - TY - JOUR AU - Shaker, Abbas Ali AU - Austin, F. Stephen AU - Jørgensen, Sedoc Mie AU - Sørensen, Aasted John AU - Bechmann, Henrik AU - Kinnerup, E. Henriette AU - Petersen, Juul Charlotte AU - Olsen, Klein Ragnar AU - Simonsen, Erik PY - 2023/11/30 TI - Facilitating In-House Mobile App Development Within Psychiatric Outpatient Services for Patients Diagnosed With Borderline Personality Disorder: Rapid Application Development Approach JO - JMIR Hum Factors SP - e46928 VL - 10 KW - software models KW - in-house development KW - psychiatric services KW - borderline personality disorder KW - mobile application KW - development KW - mental health KW - user design KW - design KW - psychiatric KW - implementation KW - innovation N2 - Background: Mobile app development within mental health is often time- and resource-consuming, challenging the development of mobile apps for psychiatry. There is a continuum of software development methods ranging from linear (waterfall model) to continuous adaption (Scrum). Rapid application development (RAD) is a model that so far has not been applied to psychiatric settings and may have some advantages over other models. Objective: This study aims to explore the utility of the RAD model in developing a mobile app for patients with borderline personality disorder (BPD) in a psychiatric outpatient setting. Methods: The 4 phases of the RAD model: (1) requirements planning, (2) user design, (3) construction, and (4) cutover, were applied to develop a mobile app within psychiatric outpatient services for patients diagnosed with BPD. Results: For the requirements planning phase, a short time frame was selected to minimize the time between product conceptualization and access within a clinical setting. Evidenced-based interactive content already developed was provided by current staff to enhance usability and trustworthiness. For the user design phase, activity with video themes and a discrete number of functions were used to improve the app functionality and graphical user interface. For the construction phase, close collaboration between clinicians, researchers, and software developers yielded a fully functional, in-house?developed app ready to be tested in clinical practice. For the cutover phase, the mobile app was tested successfully with a small number (n=5) of patients with a BPD. Conclusions: The RAD model could be meaningfully applied in a psychiatric setting to develop an app for BPD within a relatively short time period from conceptualization to implementation in the clinic. Short time frames and identifying a limited number of stakeholders with relevant skills in-house facilitated the use of this model. Despite some limitations, RAD could be a useful model in the development of apps for clinical populations to enable development and access to evidence-based technology. UR - https://humanfactors.jmir.org/2023/1/e46928 UR - http://dx.doi.org/10.2196/46928 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032709 ID - info:doi/10.2196/46928 ER - TY - JOUR AU - Pozuelo, R. Julia AU - Moffett, D. Bianca AU - Davis, Meghan AU - Stein, Alan AU - Cohen, Halley AU - Craske, G. Michelle AU - Maritze, Meriam AU - Makhubela, Princess AU - Nabulumba, Christine AU - Sikoti, Doreen AU - Kahn, Kathleen AU - Sodi, Tholene AU - AU - van Heerden, Alastair AU - O?Mahen, A. Heather PY - 2023/11/30 TI - User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study JO - JMIR Form Res SP - e51423 VL - 7 KW - depression KW - adolescents KW - mental health app KW - behavioral activation KW - user-centered design KW - low- and middle-income countries KW - mobile phone N2 - Background: There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. Objective: This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. Methods: An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. Results: A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (?episodes?) played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. Conclusions: The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention?s feasibility, acceptability, and efficacy in reducing depressive symptoms. UR - https://formative.jmir.org/2023/1/e51423 UR - http://dx.doi.org/10.2196/51423 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032691 ID - info:doi/10.2196/51423 ER - TY - JOUR AU - Rupp, Helene Lydia AU - Keinert, Marie AU - Böhme, Stephanie AU - Schindler-Gmelch, Lena AU - Eskofier, Bjoern AU - Schuller, Björn AU - Berking, Matthias PY - 2023/11/30 TI - Sadness-Based Approach-Avoidance Modification Training for Subjective Stress in Adults: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e50324 VL - 7 KW - stress KW - emotion KW - eHealth KW - approach-avoidance KW - mental health KW - somatic health KW - chronic stress KW - intervention KW - stress-related illness KW - app-based KW - stress management KW - belief KW - training KW - mobile phone N2 - Background: A key vulnerability factor in mental health problems is chronic stress. There is a need for easy-to-disseminate and effective interventions to advance the prevention of stress-related illnesses. App-based stress management trainings can fulfill this need. As subjectively experienced stress may be influenced by dysfunctional beliefs, modifying their evaluations might reduce subjective stress. Approach-avoidance modification trainings (AAMT) can be used to modify stimulus evaluations and are promising candidates for a mobile stress intervention. As the standard training reactions of the AAMT (swiping and joystick motion) have little valence, emotions could be incorporated as approach and avoidance reactions to enhance the effectiveness of AAMTs. Objective: We aimed to evaluate the feasibility of a mobile emotion-enhanced AAMT that engages users to display sadness to move stress-enhancing beliefs away and display positive emotions to move stress-reducing beliefs toward themselves (emotion-based AAMT using sadness and positive emotions [eAAMT-SP]). We explored the clinical efficacy of this novel intervention. Methods: We allocated 30 adult individuals with elevated stress randomly to 1 of 3 conditions (eAAMT-SP, a swipe control condition, and an inactive control condition). We evaluated the feasibility of the intervention (technical problems, adherence, usability, and acceptability). To explore the clinical efficacy of the intervention, we compared pretest-posttest differences in perceived stress (primary clinical outcome) and 3 secondary clinical outcomes (agreement with and perceived helpfulness of dysfunctional beliefs, emotion regulation, and depressive symptoms) among the conditions. Results: The predetermined benchmarks of 50% for intervention completion and 75% for feasibility of the study design (completion of the study design) were met, whereas the cutoff for technical feasibility of the study design (95% of trials without technical errors) was not met. Effect sizes for usability and acceptability were in favor of the eAAMT-SP condition (compared with the swipe control condition; intelligibility of the instructions: g=?0.86, distancing from dysfunctional beliefs: g=0.22, and approaching functional beliefs: g=0.55). Regarding clinical efficacy, the pretest-posttest effect sizes for changes in perceived stress were g=0.80 for the comparison between the eAAMT-SP and inactive control conditions and g=0.76 for the comparison between the eAAMT-SP and swipe control conditions. Effect sizes for the secondary clinical outcomes indicated greater pretest-posttest changes in the eAAMT-SP condition than in the inactive control condition and comparable changes in the swipe control condition. Conclusions: The findings regarding the feasibility of the intervention were satisfactory except for the technical feasibility of the intervention, which should be improved. The effect sizes for the clinical outcomes provide preliminary evidence for the therapeutic potential of the intervention. The findings suggest that extending the AAMT paradigm through the use of emotions may increase its efficacy. Future research should evaluate the eAAMT-SP in sufficiently powered randomized controlled trials. Trial Registration: German Clinical Trials Registry DRKS00023007; https://drks.de/search/en/trial/DRKS00023007 UR - https://formative.jmir.org/2023/1/e50324 UR - http://dx.doi.org/10.2196/50324 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032725 ID - info:doi/10.2196/50324 ER - TY - JOUR AU - Schwab, Josephine AU - Wachinger, Jonas AU - Munana, Richard AU - Nabiryo, Maxencia AU - Sekitoleko, Isaac AU - Cazier, Juliette AU - Ingenhoff, Rebecca AU - Favaretti, Caterina AU - Subramonia Pillai, Vasanthi AU - Weswa, Ivan AU - Wafula, John AU - Emmrich, Valentin Julius AU - Bärnighausen, Till AU - Knauf, Felix AU - Knauss, Samuel AU - Nalwadda, K. Christine AU - Sudharsanan, Nikkil AU - Kalyesubula, Robert AU - McMahon, A. Shannon PY - 2023/11/30 TI - Design Research to Embed mHealth into a Community-Led Blood Pressure Management System in Uganda: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e46614 VL - 12 KW - Uganda KW - hypertension KW - mobile health KW - mHealth KW - mobile money KW - pooled financing KW - medication availability KW - human-centered design KW - mixed methods KW - mobile phone N2 - Background: Uncontrolled hypertension is a leading risk factor for cardiovascular diseases. In Uganda, such diseases account for approximately 10% of all deaths, with 1 in 5 adults having hypertension (>90% of the hypertensive cases are uncontrolled). Although basic health care in the country is available free of cost at government facilities, regularly accessing medication to control hypertension is difficult because supply chain challenges impede availability. Clients therefore frequently suspend treatment or buy medication individually at private facilities or pharmacies (incurring significant costs). In recent years, mobile health (mHealth) interventions have shown increasing potential in addressing health system challenges in sub-Saharan Africa, but the acceptability, feasibility, and uptake conditions of mobile money approaches to chronic disease management remain understudied. Objective: This study aims to design and pilot-test a mobile money?based intervention to increase the availability of antihypertensive medication and lower clients? out-of-pocket payments. We will build on existing local approaches and assess the acceptability, feasibility, and uptake of the designed intervention. Furthermore, rather than entering the study setting with a ready-made intervention, this research will place emphasis on gathering applied ethnographic insights early, which can then inform the parameters of the intervention prototype and concurrent trial. Methods: We will conduct a mixed methods study following a human-centered design approach. We will begin by conducting extensive qualitative research with a range of stakeholders (clients; health care providers; religious, cultural, and community leaders; academics; and policy makers at district and national levels) on their perceptions of hypertension management, money-saving systems, and mobile money in the context of health care. Our results will inform the design, iterative adaptation, and implementation of an mHealth-facilitated pooled financing intervention prototype. At study conclusion, the finalized prototype will be evaluated quantitatively via a randomized controlled trial. Results: As of August 2023, qualitative data collection, which started in November 2022, is ongoing, with data analysis of the first qualitative interviews underway to inform platform and implementation design. Recruitment for the quantitative part of this study began in August 2023. Conclusions: Our results aim to inform the ongoing discourse on novel and sustainable pathways to facilitate access to medication for the management of hypertension in resource-constrained settings. Trial Registration: German registry of clinical trials DRKS00030922; https://drks.de/search/en/trial/DRKS00030922 International Registered Report Identifier (IRRID): DERR1-10.2196/46614 UR - https://www.researchprotocols.org/2023/1/e46614 UR - http://dx.doi.org/10.2196/46614 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032702 ID - info:doi/10.2196/46614 ER - TY - JOUR AU - Chen, Dandan AU - Zhang, Hui AU - Wu, Jingjie AU - Xue, Erxu AU - Guo, Pingping AU - Tang, Leiwen AU - Shao, Jing AU - Cui, Nianqi AU - Wang, Xiyi AU - Chen, Liying AU - Ye, Zhihong PY - 2023/11/29 TI - Effects of an Individualized mHealth-Based Intervention on Health Behavior Change and Cardiovascular Risk Among People With Metabolic Syndrome Based on the Behavior Change Wheel: Quasi-Experimental Study JO - J Med Internet Res SP - e49257 VL - 25 KW - metabolic syndrome KW - health behavior KW - cardiovascular risk KW - mobile health KW - behavior change wheel N2 - Background: Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)?based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China. Objective: We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS. Methods: We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney U test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp). Results: Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (P=.04, P=.001, P=.04, P=.04, P=.001, P=.04, P=.04, and P<.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (P<.001, P=.03, P<.001, P=.04, P<.001, P<.001, and P<.001). The intervention also led to enhanced health management services and quality. Conclusions: The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs. UR - https://www.jmir.org/2023/1/e49257 UR - http://dx.doi.org/10.2196/49257 UR - http://www.ncbi.nlm.nih.gov/pubmed/38019579 ID - info:doi/10.2196/49257 ER - TY - JOUR AU - Jia, Si Si AU - Allman-Farinelli, Margaret AU - Roy, Rajshri AU - Phongsavan, Philayrath AU - Hyun, Karice AU - Gibson, Anne Alice AU - Partridge, Ruth Stephanie PY - 2023/11/29 TI - Using Mobile Ecological Momentary Assessment to Understand Consumption and Context Around Online Food Delivery Use: Pilot Feasibility and Acceptability Study JO - JMIR Mhealth Uhealth SP - e49135 VL - 11 KW - ecological momentary assessment KW - mobile applications KW - mobile apps KW - feasibility studies KW - online food delivery KW - smartphone KW - young adult KW - adolescent KW - food environment KW - consumer behavior KW - mobile phone N2 - Background: Mobile ecological momentary assessment (EMA) is a powerful tool for collecting real-time and contextual data from individuals. As our reliance on online technologies to increase convenience accelerates, the way we access food is changing. Online food delivery (OFD) services may further encourage unhealthy food consumption habits, given the high availability of energy-dense, nutrient-poor foods. We used EMA to understand the real-time effects of OFD on individuals? food choices and consumption behaviors. Objective: The primary aims of this pilot study were to assess the feasibility and acceptability of using EMA in young users of OFD and compare 2 different EMA sampling methods. The secondary aims were to gather data on OFD events and their context and examine any correlations between demographics, lifestyle chronic disease risk factors, and OFD use. Methods: This study used EMA methods via a mobile app (mEMASense, ilumivu Inc). Existing users of OFD services aged 16 to 35 years in Australia who had access to a smartphone were recruited. Participants were randomly assigned to 1 of 2 groups: signal-contingent or event-contingent. The signal-contingent group was monitored over 3 days between 7 AM and 10 PM. They received 5 prompts each day to complete EMA surveys via the smartphone app. In contrast, the event-contingent group was monitored over 7 days and was asked to self-report any instance of OFD. Results: A total of 102 participants were analyzed, with 53 participants in the signal-contingent group and 49 participants in the event-contingent group. Compliance rates, indicating the feasibility of signal-contingent and event-contingent protocols, were similar at 72.5% (574/792) and 73.2% (251/343), respectively. Feedback from the participants suggested that the EMA app was not easy to use, which affected their acceptability of the study. Participants in the event-contingent group were 3.53 (95% CI 1.52-8.17) times more likely to have had an OFD event captured during the study. Pizza (23/124, 18.5%) and fried chicken (18/124, 14.5%) comprised a bulk of the 124 OFD orders captured. Most orders were placed at home (98/124, 79%) for 1 person (68/124, 54.8%). Age (incidence rate ratio 0.95, 95% CI 0.91-0.99; P=.03) and dependents (incidence rate ratio 2.01, 95% CI 1.16-3.49; P=.01) were significantly associated with the number of OFD events in a week after adjusting for gender, socioeconomic status, diet quality score, and perceived stress levels. Conclusions: This pilot study showed that EMA using an event-contingent sampling approach may be a better method to capture OFD events and context than signal-contingent sampling. The compliance rates showed that both sampling methods were feasible and acceptable. Although the findings from this study have gathered some insight on the consumption and context of OFD in young people, further studies are required to develop targeted interventions. UR - https://mhealth.jmir.org/2023/1/e49135 UR - http://dx.doi.org/10.2196/49135 UR - http://www.ncbi.nlm.nih.gov/pubmed/38019563 ID - info:doi/10.2196/49135 ER - TY - JOUR AU - Bibi, Igor AU - Schaffert, Daniel AU - Blauth, Mara AU - Lull, Christian AU - von Ahnen, Alwin Jan AU - Gross, Georg AU - Weigandt, Alexander Wanja AU - Knitza, Johannes AU - Kuhn, Sebastian AU - Benecke, Johannes AU - Leipe, Jan AU - Schmieder, Astrid AU - Olsavszky, Victor PY - 2023/11/28 TI - Automated Machine Learning Analysis of Patients With Chronic Skin Disease Using a Medical Smartphone App: Retrospective Study JO - J Med Internet Res SP - e50886 VL - 25 KW - automated machine learning KW - psoriasis KW - hand and foot eczema KW - medical smartphone app KW - application KW - smartphone KW - machine learning KW - digitalization KW - skin KW - skin disease KW - use KW - hand KW - foot KW - mobile phone N2 - Background: Rapid digitalization in health care has led to the adoption of digital technologies; however, limited trust in internet-based health decisions and the need for technical personnel hinder the use of smartphones and machine learning applications. To address this, automated machine learning (AutoML) is a promising tool that can empower health care professionals to enhance the effectiveness of mobile health apps. Objective: We used AutoML to analyze data from clinical studies involving patients with chronic hand and/or foot eczema or psoriasis vulgaris who used a smartphone monitoring app. The analysis focused on itching, pain, Dermatology Life Quality Index (DLQI) development, and app use. Methods: After extensive data set preparation, which consisted of combining 3 primary data sets by extracting common features and by computing new features, a new pseudonymized secondary data set with a total of 368 patients was created. Next, multiple machine learning classification models were built during AutoML processing, with the most accurate models ultimately selected for further data set analysis. Results: Itching development for 6 months was accurately modeled using the light gradient boosted trees classifier model (log loss: 0.9302 for validation, 1.0193 for cross-validation, and 0.9167 for holdout). Pain development for 6 months was assessed using the random forest classifier model (log loss: 1.1799 for validation, 1.1561 for cross-validation, and 1.0976 for holdout). Then, the random forest classifier model (log loss: 1.3670 for validation, 1.4354 for cross-validation, and 1.3974 for holdout) was used again to estimate the DLQI development for 6 months. Finally, app use was analyzed using an elastic net blender model (area under the curve: 0.6567 for validation, 0.6207 for cross-validation, and 0.7232 for holdout). Influential feature correlations were identified, including BMI, age, disease activity, DLQI, and Hospital Anxiety and Depression Scale-Anxiety scores at follow-up. App use increased with BMI >35, was less common in patients aged >47 years and those aged 23 to 31 years, and was more common in those with higher disease activity. A Hospital Anxiety and Depression Scale-Anxiety score >8 had a slightly positive effect on app use. Conclusions: This study provides valuable insights into the relationship between data characteristics and targeted outcomes in patients with chronic eczema or psoriasis, highlighting the potential of smartphone and AutoML techniques in improving chronic disease management and patient care. UR - https://www.jmir.org/2023/1/e50886 UR - http://dx.doi.org/10.2196/50886 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015608 ID - info:doi/10.2196/50886 ER - TY - JOUR AU - Khalemsky, Michael AU - Khalemsky, Anna AU - Lankenau, Stephen AU - Ataiants, Janna AU - Roth, Alexis AU - Marcu, Gabriela AU - Schwartz, G. David PY - 2023/11/28 TI - Predictive Dispatch of Volunteer First Responders: Algorithm Development and Validation JO - JMIR Mhealth Uhealth SP - e41551 VL - 11 KW - volunteer KW - emergency KW - dispatch KW - responder KW - smartphone KW - emergency response KW - smartphone-based apps KW - mobile phone apps KW - first responders KW - medical emergency KW - dispatch algorithms KW - dispatch decisions KW - dispatch prediction KW - smartphone app KW - decision-making KW - algorithm KW - mobile health KW - mHealth intervention KW - mobile phone N2 - Background: Smartphone-based emergency response apps are increasingly being used to identify and dispatch volunteer first responders (VFRs) to medical emergencies to provide faster first aid, which is associated with better prognoses. Volunteers? availability and willingness to respond are uncertain, leading in recent studies to response rates of 17% to 47%. Dispatch algorithms that select volunteers based on their estimated time of arrival (ETA) without considering the likelihood of response may be suboptimal due to a large percentage of alerts wasted on VFRs with shorter ETA but a low likelihood of response, resulting in delays until a volunteer who will actually respond can be dispatched. Objective: This study aims to improve the decision-making process of human emergency medical services dispatchers and autonomous dispatch algorithms by presenting a novel approach for predicting whether a VFR will respond to or ignore a given alert. Methods: We developed and compared 4 analytical models to predict VFRs? response behaviors based on emergency event characteristics, volunteers? demographic data and previous experience, and condition-specific parameters. We tested these 4 models using 4 different algorithms applied on actual demographic and response data from a 12-month study of 112 VFRs who received 993 alerts to respond to 188 opioid overdose emergencies. Model 4 used an additional dynamically updated synthetic dichotomous variable, frequent responder, which reflects the responder?s previous behavior. Results: The highest accuracy (260/329, 79.1%) of prediction that a VFR will ignore an alert was achieved by 2 models that used events data, VFRs? demographic data, and their previous response experience, with slightly better overall accuracy (248/329, 75.4%) for model 4, which used the frequent responder indicator. Another model that used events data and VFRs? previous experience but did not use demographic data provided a high-accuracy prediction (277/329, 84.2%) of ignored alerts but a low-accuracy prediction (153/329, 46.5%) of responded alerts. The accuracy of the model that used events data only was unacceptably low. The J48 decision tree algorithm provided the best accuracy. Conclusions: VFR dispatch has evolved in the last decades, thanks to technological advances and a better understanding of VFR management. The dispatch of substitute responders is a common approach in VFR systems. Predicting the response behavior of candidate responders in advance of dispatch can allow any VFR system to choose the best possible response candidates based not only on ETA but also on the probability of actual response. The integration of the probability to respond into the dispatch algorithm constitutes a new generation of individual dispatch, making this one of the first studies to harness the power of predictive analytics for VFR dispatch. Our findings can help VFR network administrators in their continual efforts to improve the response times of their networks and to save lives. UR - https://mhealth.jmir.org/2023/1/e41551 UR - http://dx.doi.org/10.2196/41551 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015602 ID - info:doi/10.2196/41551 ER - TY - JOUR AU - Edbrooke, Lara AU - Jones, L. Tamara PY - 2023/11/28 TI - Behavior Change Techniques for the Maintenance of Physical Activity in Cancer JO - JMIR Cancer SP - e53602 VL - 9 KW - cancer KW - physical activity KW - behavior change UR - https://cancer.jmir.org/2023/1/e53602 UR - http://dx.doi.org/10.2196/53602 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015601 ID - info:doi/10.2196/53602 ER - TY - JOUR AU - Mallafré-Larrosa, Meritxell AU - Papi, Ginevra AU - Trilla, Antoni AU - Ritchie, David PY - 2023/11/28 TI - Development and Promotion of an mHealth App for Adolescents Based on the European Code Against Cancer: Retrospective Cohort Study JO - JMIR Cancer SP - e48040 VL - 9 KW - adolescent health KW - cancer prevention KW - digital health KW - ECAC KW - European Code Against Cancer KW - health promotion KW - mHealth KW - mobile app KW - mobile health KW - NCD KW - noncommunicable disease KW - primary prevention N2 - Background: Mobile health technologies, underpinned by scientific evidence and ethical standards, exhibit considerable promise and potential in actively engaging consumers and patients while also assisting health care providers in delivering cancer prevention and care services. The WASABY mobile app was conceived as an innovative, evidence-based mobile health tool aimed at disseminating age-appropriate messages from the European Code Against Cancer (ECAC) to adolescents across Europe. Objective: This study aims to assess the outcomes of the design, development, and promotion of the WASABY app through a 3-pronged evaluation framework that encompasses data on social media promotion, app store traffic, and user engagement. Methods: The WASABY app?s content, cocreated with cancer-focused civil society organizations across 6 European countries, drew upon scientific evidence from the ECAC. The app?s 10 modules were designed using the health belief model and a gamification conceptual framework characterized by spaced repetition learning techniques, refined through 2 rounds of testing. To evaluate the effectiveness of the app, we conducted a retrospective cohort study using the WASABY app?s user database registered from February 4 to June 30, 2021, using a 3-pronged assessment framework: social media promotion, app store traffic, and user engagement. Descriptive statistics and association analyses explored the relationship between sociodemographic variables and user performance analytics. Results: After extensive promotion on various social media platforms and subsequent traffic to the Apple App and Google Play stores, a sample of 748 users aged between 14 and 19 years was included in the study cohort. The selected sample exhibited a mean age of 16.08 (SD 1.28) years and was characterized by a predominant representation of female users (499/748, 66.7%). Most app users identified themselves as nonsmokers (689/748, 92.1%), reported either no or infrequent alcohol consumption (432/748, 57.8% and 250/748, 33.4%, respectively), and indicated being physically active for 1 to 5 hours per week (505/748, 67.5%). In aggregate, the app?s content garnered substantial interest, as evidenced by 40.8% (305/748) of users visiting each of the 10 individual modules. Notably, sex and smoking habits emerged as predictors of app completion rates; specifically, male and smoking users demonstrated a decreased likelihood of successfully completing the app?s content (odds ratio 0.878, 95% CI 0.809-0.954 and odds ratio 0.835, 95% CI 0.735-0.949, respectively). Conclusions: The development and promotion of the WASABY app presents a valuable case study, illustrating the effective dissemination of evidence-based recommendations on cancer prevention within the ECAC through an innovative mobile app aimed at European adolescents. The data derived from this study provide insightful findings for the implementation of Europe?s Beating Cancer Plan, particularly the creation of the EU Mobile App for Cancer Prevention. UR - https://cancer.jmir.org/2023/1/e48040 UR - http://dx.doi.org/10.2196/48040 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015612 ID - info:doi/10.2196/48040 ER - TY - JOUR AU - Ding, Y. Eric AU - Tran, Khanh-Van AU - Lessard, Darleen AU - Wang, Ziyue AU - Han, Dong AU - Mohagheghian, Fahimeh AU - Mensah Otabil, Edith AU - Noorishirazi, Kamran AU - Mehawej, Jordy AU - Filippaios, Andreas AU - Naeem, Syed AU - Gottbrecht, F. Matthew AU - Fitzgibbons, P. Timothy AU - Saczynski, S. Jane AU - Barton, Bruce AU - Chon, Ki AU - McManus, D. David PY - 2023/11/28 TI - Accuracy, Usability, and Adherence of Smartwatches for Atrial Fibrillation Detection in Older Adults After Stroke: Randomized Controlled Trial JO - JMIR Cardio SP - e45137 VL - 7 KW - accuracy KW - atrial fibrillation KW - cardiac arrhythmia KW - design KW - detection KW - diagnosis KW - electrocardiography KW - monitoring KW - older adults KW - photoplethysmography KW - prevention KW - remote monitoring KW - smartwatch KW - stroke KW - usability N2 - Background: Atrial fibrillation (AF) is a common cause of stroke, and timely diagnosis is critical for secondary prevention. Little is known about smartwatches for AF detection among stroke survivors. We aimed to examine accuracy, usability, and adherence to a smartwatch-based AF monitoring system designed by older stroke survivors and their caregivers. Objective: This study aims to examine the feasibility of smartwatches for AF detection in older stroke survivors. Methods: Pulsewatch is a randomized controlled trial (RCT) in which stroke survivors received either a smartwatch-smartphone dyad for AF detection (Pulsewatch system) plus an electrocardiogram patch or the patch alone for 14 days to assess the accuracy and usability of the system (phase 1). Participants were subsequently rerandomized to potentially 30 additional days of system use to examine adherence to watch wear (phase 2). Participants were aged 50 years or older, had survived an ischemic stroke, and had no major contraindications to oral anticoagulants. The accuracy for AF detection was determined by comparing it to cardiologist-overread electrocardiogram patch, and the usability was assessed with the System Usability Scale (SUS). Adherence was operationalized as daily watch wear time over the 30-day monitoring period. Results: A total of 120 participants were enrolled (mean age 65 years; 50/120, 41% female; 106/120, 88% White). The Pulsewatch system demonstrated 92.9% (95% CI 85.3%-97.4%) accuracy for AF detection. Mean usability score was 65 out of 100, and on average, participants wore the watch for 21.2 (SD 8.3) of the 30 days. Conclusions: Our findings demonstrate that a smartwatch system designed by and for stroke survivors is a viable option for long-term arrhythmia detection among older adults at risk for AF, though it may benefit from strategies to enhance adherence to watch wear. Trial Registration: ClinicalTrials.gov NCT03761394; https://clinicaltrials.gov/study/NCT03761394 International Registered Report Identifier (IRRID): RR2-10.1016/j.cvdhj.2021.07.002 UR - https://cardio.jmir.org/2023/1/e45137 UR - http://dx.doi.org/10.2196/45137 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015598 ID - info:doi/10.2196/45137 ER - TY - JOUR AU - Noronha, Angelitta Judith AU - Lewis, S. Mitchelle AU - Phagdol, Tenzin AU - Nayak, S. Baby AU - D, Anupama AU - Shetty, Jyothi AU - N, Ravishankar AU - Nair, Sreekumaran PY - 2023/11/28 TI - Efficacy of mHealth Interventions for Improving Maternal and Neonatal Outcomes Among Pregnant Women With Hypertensive Disorders: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e51792 VL - 12 KW - digital health KW - gestational hypertension KW - hypertension KW - hypertensive KW - knowledge synthesis KW - maternal health outcomes KW - maternal KW - mHealth KW - mobile health application KW - mobile health KW - neonatal health outcomes KW - neonatal KW - neonates KW - preeclampsia KW - pregnancy KW - pregnant KW - review methodology KW - review methods KW - SMS KW - systematic KW - telemedicine KW - text messaging KW - sustainable development goal N2 - Background: Hypertension is one of the most prevalent medical conditions that arise during pregnancy, resulting in maternal and neonatal complications. Mobile health (mHealth) has emerged as an innovative intervention for delivering maternal and child health care services. The evidence on the effectiveness of mHealth interventions in improving the health outcomes of pregnant women with hypertensive disorders is lacking. Therefore, there is a need for evidence synthesis using systematic review methods to address this evidence gap. Objective: This review aims to determine the efficacy of mHealth interventions in improving maternal and neonatal outcomes among pregnant women with hypertensive disorders. The review will answer the following research questions: (1) What are the types of mHealth interventions used in pregnant women with hypertensive disorders? (2) Are the various mHealth interventions effective in improving maternal and neonatal health outcomes, health behaviors, and their knowledge of the disease? and (3) Are mHealth interventions effective in supporting health care providers to make health care decisions for pregnant women with hypertensive disorders? Methods: This review will include randomized controlled trials, nonrandomized controlled trials, and cohort studies focusing on mHealth interventions for pregnant women with hypertensive disorders. Studies reporting health care providers use of mHealth interventions in caring for pregnant women with hypertensive disorders will be included. The search strategy will be tailored to each database using database-specific search terms. The search will be conducted in PubMed-MEDLINE, ProQuest, CINAHL, Scopus, Web of Science, and CENTRAL. Other literature sources, such as trial registries and bibliographies of relevant studies, will be additionally searched. Studies published in English from January 2000 to January 2023 will be included. A total of 2 review authors will independently perform the data extraction and the quality appraisal. For quality appraisal of randomized controlled trials, the Cochrane Risk of Bias 2 tool will be used. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-1) tool will be used for nonrandomized controlled trials, and the Critical Appraisal Skills Programme checklist for cohort studies will be used. Any disagreements between the 2 reviewers will be resolved through discussion and a third reviewer if required. A meta-analysis will be performed based on the availability of the data. Results: As per the protocol, the study methodology was followed, and 2 independent reviewers conducted the search in 6 databases and clinical registries. Currently, the review is in the full-text screening stage. The review will publish the results in the first quarter of 2024. Conclusions: The evidence synthesized from this systematic review will help guide future research, support health care decisions, and inform policy makers on the effectiveness of mHealth interventions in improving the maternal and neonatal outcomes of pregnant women with hypertensive disorders. International Registered Report Identifier (IRRID): PRR1-10.2196/51792 UR - https://www.researchprotocols.org/2023/1/e51792 UR - http://dx.doi.org/10.2196/51792 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015596 ID - info:doi/10.2196/51792 ER - TY - JOUR AU - Taramasco, Carla AU - Rimassa, Carla AU - Noël, René AU - Bravo Storm, Loreto María AU - Sánchez, César PY - 2023/11/27 TI - Co-design of a Mobile App for Engaging Breast Cancer Patients in Reporting Health Experiences: Qualitative Case Study JO - J Med Internet Res SP - e45968 VL - 25 KW - cancer KW - registration systems KW - patient-reported outcome measures KW - patient-reported experience measures KW - software analysis and design KW - cancer patient report KW - adverse event reporting KW - quality of life KW - eHealth KW - mHealth KW - mobile health N2 - Background: The World Health Organization recommends incorporating patient-reported experience measures and patient-reported outcome measures to ensure care processes. New technologies, such as mobile apps, could help report and monitor patients? adverse effects and doubts during treatment. However, engaging patients in the daily use of mobile apps is a challenge that must be addressed in accordance with the needs of people. Objective: We present a qualitative case study documenting the process of identifying the information needs of breast cancer patients and health care professionals during the treatment process in a Chilean cancer institution. The study aims to identify patients? information requirements for integration into a mobile app that accompanies patients throughout their treatment while also providing features for reporting adverse symptoms. Methods: We conducted focus groups with breast cancer patients who were undergoing chemotherapy (n=3) or who completed chemotherapy between 3 months and 1 year (n=1). We also surveyed health care professionals (n=9) who were involved in patient care and who belonged to the oncology committee of the cancer center where the study took place. Content analysis was applied to the responses to categorize the information needs and the means to satisfy them. A user interface was designed according to the findings of the focus groups and was assessed by 3 trained information system and user interaction design experts from 2 countries, using heuristic evaluation guidelines for mobile apps. Results: Patients? information needs were classified into 4 areas: an overview of the disease, information on treatment and day-to-day affairs, assistance on the normality and abnormality of symptoms during treatment, and symptoms relevant to report. Health care professionals required patients to be provided with information on the administrative and financial process. We noted that the active involvement of the following 4 main actors is required to satisfy the information needs: patients, caregivers, social network moderators, and health professionals. Seven usability guidelines were extracted from the heuristic evaluation recommendations. Conclusions: A mobile app that seeks to accompany breast cancer patients to report symptoms requires the involvement of multiple participants to handle the reports and day-to-day information needs. User interfaces must be designed with consideration of the patient?s social conventions and the emotional load of the disease information. UR - https://www.jmir.org/2023/1/e45968 UR - http://dx.doi.org/10.2196/45968 UR - http://www.ncbi.nlm.nih.gov/pubmed/38010791 ID - info:doi/10.2196/45968 ER - TY - JOUR AU - Koppenaal, Tjarco AU - van Dongen, M. Johanna AU - Kloek, JJ Corelien AU - Arensman, M. Remco AU - Veenhof, Cindy AU - Pisters, F. Martijn AU - Ostelo, WJG Raymond PY - 2023/11/24 TI - Effectiveness and Cost-Effectiveness of a Stratified Blended Physiotherapy Intervention Compared With Face-to-Face Physiotherapy in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e43034 VL - 25 KW - economic evaluation KW - eHealth KW - nonspecific low back pain KW - physiotherapy KW - blended care KW - mobile phone N2 - Background: Nonspecific low back pain (LBP) is a leading contributor to disability worldwide, and its socioeconomic burden is substantial. Self-management support is an important recommendation in clinical guidelines for the physiotherapy treatment of patients with LBP and may support cost-effective management. However, providing adequate individually tailored self-management support is difficult. The integration of web-based applications into face-to-face care (ie, blended care) seems promising to optimize tailored treatment and enhance patients? self-management and, consequently, may reduce LBP-related costs. Objective: We aimed to evaluate the long-term effectiveness and cost-effectiveness of stratified blended physiotherapy (e-Exercise LBP) compared with face-to-face physiotherapy in patients with nonspecific LBP. Methods: An economic evaluation was conducted alongside a prospective, multicenter, cluster randomized controlled trial in primary care physiotherapy. Patients with nonspecific LBP were treated with either stratified blended physiotherapy (e-Exercise LBP) (n=104) or face-to-face physiotherapy (n=104). The content of both interventions was based on the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients? risk of developing persistent LBP using the STarT Back Screening Tool. The primary clinical outcome was physical functioning (Oswestry Disability Index version 2.1a). For the economic evaluation, quality-adjusted life years (QALYs; EQ-5D-5L) and physical functioning were the primary outcomes. Secondary clinical outcomes included fear avoidance beliefs and self-reported adherence. Costs were measured from societal and health care perspectives using self-report questionnaires. Effectiveness was estimated using linear mixed models. Seemingly unrelated regression analyses were conducted to estimate total cost and effect differences for the economic evaluation. Results: Neither clinically relevant nor statistically substantial differences were found between stratified blended physiotherapy and face-to-face physiotherapy regarding physical functioning (mean difference [MD] ?1.1, 95% CI ?3.9 to 1.7) and QALYs (MD 0.026, 95% CI ?0.020 to 0.072) over 12 months. Regarding the secondary outcomes, fear avoidance beliefs showed a statistically significant improvement in favor of stratified blended physiotherapy (MD ?4.3, 95% CI ?7.3 to ?1.3). Societal and health care costs were higher for stratified blended physiotherapy than for face-to-face physiotherapy, but the differences were not statistically significant (societal: ?972 [US $1027], 95% CI ??1090 to ?3264 [US ?$1151 to $3448]; health care: ?73 [US $77], 95% CI ??59 to ?225 [US ?$62 to $238]). Among the disaggregated cost categories, only unpaid productivity costs were significantly higher for stratified blended physiotherapy. From both perspectives, a considerable amount of money must be paid per additional QALY or 1-point improvement in physical functioning to reach a relatively low to moderate probability (ie, 0.23-0.81) of stratified blended physiotherapy being cost-effective compared with face-to-face physiotherapy. Conclusions: The stratified blended physiotherapy intervention e-Exercise LBP is neither more effective for improving physical functioning nor more cost-effective from societal or health care perspectives compared with face-to-face physiotherapy for patients with nonspecific LBP. Trial Registration: ISRCTN 94074203; https://www.isrctn.com/ISRCTN94074203 International Registered Report Identifier (IRRID): RR2-10.1186/s12891-020-3174-z UR - https://www.jmir.org/2023/1/e43034 UR - http://dx.doi.org/10.2196/43034 UR - http://www.ncbi.nlm.nih.gov/pubmed/37999947 ID - info:doi/10.2196/43034 ER - TY - JOUR AU - Geng, Lan AU - Jiang, Genyan AU - Yu, Lingling AU - Xu, Yueming AU - Huang, Wei AU - Chen, Zhiqi AU - Qi, Xiaoyan AU - Zhang, Ting AU - Zhao, Mei PY - 2023/11/24 TI - The Most Popular Commercial Weight Management Apps in the Chinese App Store: Analysis of Quality, Features, and Behavior Change Techniques JO - JMIR Mhealth Uhealth SP - e50226 VL - 11 KW - quality KW - mobile health KW - mobile apps KW - weight loss KW - weight management KW - apps KW - MARS KW - China N2 - Background: Many smartphone apps designed to assist individuals in managing their weight are accessible, but the assessment of app quality and features has predominantly taken place in Western countries. Nevertheless, there is a scarcity of research evaluating weight management apps in China, which highlights the need for further investigation in this area. Objective: This study aims to conduct a comprehensive search for the most popular commercial Chinese smartphone apps focused on weight management and assess their quality, behavior change techniques (BCTs), and content-related features using appropriate evaluation scales. Additionally, the study sought to investigate the associations between the quality of various domains within weight management apps and the number of incorporated BCTs and app features. Methods: In April 2023, data on weight management apps from the iOS and Android app stores were downloaded from the Qimai Data platform. Subsequently, a total of 35 weight management apps were subjected to screening and analysis by 2 researchers. The features and quality of the apps were independently assessed by 6 professionals specializing in nutrition management and health behavioral change using the Mobile Application Rating Scale (MARS). Two registered dietitians, who had experience in app development and coding BCTs, applied the established 26-item BCT taxonomy to verify the presence of BCTs. Mean (SD) scores and their distributions were calculated for each section and item. Spearman correlations were used to assess the relationship between an app?s quality and its technical features, as well as the number of incorporated BCTs. Results: The data set included a total of 35 apps, with 8 available in the Android Store, 10 in the Apple Store, and 17 in both. The overall quality, with a mean MARS score of 3.44 (SD 0.44), showed that functionality was the highest scoring domain (mean 4.18, SD 0.37), followed by aesthetics (mean 3.43, SD 0.42), engagement (mean 3.26, SD 0.64), and information (mean 2.91, SD 0.52), which had the lowest score. The mean number of BCTs in the analyzed apps was 9.17 (range 2-18 BCTs/app). The most common BCTs were ?prompt review of behavioral goals? and ?provide instruction,? present in 31 apps (89%). This was followed by ?prompt self-monitoring of behavior? in 30 apps (86%), ?prompt specific goal setting? in 29 apps (83%), and ?provide feedback on performance? in 27 apps (77%). The most prevalent features in the analyzed apps were the need for web access (35/35, 100%), monitoring/tracking (30/35, 86%), goal setting (29/35, 83%), and sending alerts (28/35, 80%). The study also revealed strong positive correlations among the number of BCTs incorporated, app quality, and app features. This suggests that apps with a higher number of BCTs tend to have better overall quality and more features. Conclusions: The study found that the overall quality of weight management apps in China is moderate, with a particular weakness in the quality of information provided. The most prevalent BCTs in these apps were reviewing behavioral goals, providing guidance, self-monitoring of behavior, goal setting, and offering performance feedback. The most common features were the need for web access, monitoring and tracking, goal setting, and sending alerts. Notably, higher-quality weight management apps in China tended to incorporate more BCTs and features. These findings can be valuable for developers looking to improve weight management apps and enhance their potential to drive behavioral change in weight management. UR - https://mhealth.jmir.org/2023/1/e50226 UR - http://dx.doi.org/10.2196/50226 UR - http://www.ncbi.nlm.nih.gov/pubmed/37999950 ID - info:doi/10.2196/50226 ER - TY - JOUR AU - Althobiani, A. Malik AU - Ranjan, Yatharth AU - Jacob, Joseph AU - Orini, Michele AU - Dobson, Butler Richard James AU - Porter, C. Joanna AU - Hurst, R. John AU - Folarin, A. Amos PY - 2023/11/24 TI - Evaluating a Remote Monitoring Program for Respiratory Diseases: Prospective Observational Study JO - JMIR Form Res SP - e51507 VL - 7 KW - remote monitoring KW - home health care KW - mHealth KW - mobile health KW - apps KW - applications KW - wearables KW - passive data collection KW - data collection KW - retention KW - engagement KW - attrition KW - dropout KW - spirometry KW - oximetry KW - home based KW - machine learning KW - artificial intelligence KW - chronic obstructive pulmonary disease KW - COPD KW - pulmonary KW - lungs KW - respiratory KW - interstitial lung disease KW - ILD KW - COVID-19 KW - respiratory diseases KW - lung KW - chronic KW - SARS-CoV-2 KW - monitoring KW - observational KW - cohort KW - feasibility KW - usability KW - acceptability KW - community based KW - self-management N2 - Background: Patients with chronic respiratory diseases and those in the postdischarge period following hospitalization because of COVID-19 are particularly vulnerable, and little is known about the changes in their symptoms and physiological parameters. Continuous remote monitoring of physiological parameters and symptom changes offers the potential for timely intervention, improved patient outcomes, and reduced health care costs. Objective: This study investigated whether a real-time multimodal program using commercially available wearable technology, home-based Bluetooth-enabled spirometers, finger pulse oximeters, and smartphone apps is feasible and acceptable for patients with chronic respiratory diseases, as well as the value of low-burden, long-term passive data collection. Methods: In a 3-arm prospective observational cohort feasibility study, we recruited 60 patients from the Royal Free Hospital and University College Hospital. These patients had been diagnosed with interstitial lung disease, chronic obstructive pulmonary disease, or post?COVID-19 condition (n=20 per group) and were followed for 180 days. This study used a comprehensive remote monitoring system designed to provide real-time and relevant data for both patients and clinicians. Data were collected using REDCap (Research Electronic Data Capture; Vanderbilt University) periodic surveys, Remote Assessment of Disease and Relapses?base active app questionnaires, wearables, finger pulse oximeters, smartphone apps, and Bluetooth home-based spirometry. The feasibility of remote monitoring was measured through adherence to the protocol, engagement during the follow-up period, retention rate, acceptability, and data integrity. Results: Lowest-burden passive data collection methods, via wearables, demonstrated superior adherence, engagement, and retention compared with active data collection methods, with an average wearable use of 18.66 (SD 4.69) hours daily (77.8% of the day), 123.91 (SD 33.73) hours weekly (72.6% of the week), and 463.82 (SD 156.70) hours monthly (64.4% of the month). Highest-burden spirometry tasks and high-burden active app tasks had the lowest adherence, engagement, and retention, followed by low-burden questionnaires. Spirometry and active questionnaires had the lowest retention at 0.5 survival probability, indicating that they were the most burdensome. Adherence to and quality of home spirometry were analyzed; of the 7200 sessions requested, 4248 (59%) were performed. Of these, 90.3% (3836/4248) were of acceptable quality according to American Thoracic Society grading. Inclusion of protocol holidays improved retention measures. The technologies used were generally well received. Conclusions: Our findings provide evidence supporting the feasibility and acceptability of remote monitoring for capturing both subjective and objective data from various sources for respiratory diseases. The high engagement level observed with passively collected data suggests the potential of wearables for long-term, user-friendly remote monitoring in respiratory disease management. The unique piloting of certain features such as protocol holidays, alert notifications for missing data, and flexible support from the study team provides a reference for future studies in this field. International Registered Report Identifier (IRRID): RR2-10.2196/28873 UR - https://formative.jmir.org/2023/1/e51507 UR - http://dx.doi.org/10.2196/51507 UR - http://www.ncbi.nlm.nih.gov/pubmed/37999935 ID - info:doi/10.2196/51507 ER - TY - JOUR AU - Klier, Kristina AU - Koch, Lucas AU - Graf, Lisa AU - Schinköthe, Timo AU - Schmidt, Annette PY - 2023/11/23 TI - Diagnostic Accuracy of Single-Lead Electrocardiograms Using the Kardia Mobile App and the Apple Watch 4: Validation Study JO - JMIR Cardio SP - e50701 VL - 7 KW - accuracy KW - electrocardiography KW - eHealth KW - mHealth KW - mobile health KW - app KW - applications KW - mobile monitoring KW - electrocardiogram KW - ECG KW - telemedicine KW - diagnostic KW - diagnosis KW - monitoring KW - heart KW - cardiology KW - mobile phone N2 - Background: To date, the 12-lead electrocardiogram (ECG) is the gold standard for cardiological diagnosis in clinical settings. With the advancements in technology, a growing number of smartphone apps and gadgets for recording, visualizing, and evaluating physical performance as well as health data is available. Although this new smart technology is innovative and time- and cost-efficient, less is known about its diagnostic accuracy and reliability. Objective: This study aimed to examine the agreement between the mobile single-lead ECG measurements of the Kardia Mobile App and the Apple Watch 4 compared to the 12-lead gold standard ECG in healthy adults under laboratory conditions. Furthermore, it assessed whether the measurement error of the devices increases with an increasing heart rate. Methods: This study was designed as a prospective quasi-experimental 1-sample measurement, in which no randomization of the sampling was carried out. In total, ECGs at rest from 81 participants (average age 24.89, SD 8.58 years; n=58, 72% male) were recorded and statistically analyzed. Bland-Altman plots were created to graphically illustrate measurement differences. To analyze the agreement between the single-lead ECGs and the 12-lead ECG, Pearson correlation coefficient (r) and Lin concordance correlation coefficient (CCCLin) were calculated. Results: The results showed a higher agreement for the Apple Watch (mean deviation QT: 6.85%; QT interval corrected for heart rate using Fridericia formula [QTcF]: 7.43%) than Kardia Mobile (mean deviation QT: 9.53%; QTcF: 9.78%) even if both tend to underestimate QT and QTcF intervals. For Kardia Mobile, the QT and QTcF intervals correlated significantly with the gold standard (rQT=0.857 and rQTcF=0.727; P<.001). CCCLin corresponded to an almost complete heuristic agreement for the QT interval (0.835), whereas the QTcF interval was in the range of strong agreement (0.682). Further, for the Apple Watch, Pearson correlations were highly significant and in the range of a large effect (rQT=0.793 and rQTcF=0.649; P<.001). CCCLin corresponded to a strong heuristic agreement for both the QT (0.779) and QTcF (0.615) intervals. A small negative correlation between the measurement error and increasing heart rate could be found of each the devices and the reference. Conclusions: Smart technology seems to be a promising and reliable approach for nonclinical health monitoring. Further research is needed to broaden the evidence regarding its validity and usability in different target groups. UR - https://cardio.jmir.org/2023/1/e50701 UR - http://dx.doi.org/10.2196/50701 UR - http://www.ncbi.nlm.nih.gov/pubmed/37995111 ID - info:doi/10.2196/50701 ER - TY - JOUR AU - Maes, Iris AU - Mertens, Lieze AU - Poppe, Louise AU - Vetrovsky, Tomas AU - Crombez, Geert AU - De Backere, Femke AU - Brondeel, Ruben AU - Van Dyck, Delfien PY - 2023/11/23 TI - Within-Person Associations of Accelerometer-Assessed Physical Activity With Time-Varying Determinants in Older Adults: Time-Based Ecological Momentary Assessment Study JO - JMIR Aging SP - e44425 VL - 6 KW - ecological momentary assessment KW - EMA KW - associations KW - emotions KW - physical concerns KW - intention KW - self-efficacy KW - older adult KW - mobile phone N2 - Background: Despite the availability of physical activity (PA) interventions, many older adults are still not active enough. This might be partially explained by the often-limited effects of PA interventions. In general, health behavior change interventions often do not focus on contextual and time-varying determinants, which may limit their effectiveness. However, before the dynamic tailoring of interventions can be developed, one should know which time-dependent determinants are associated with PA and how strong these associations are. Objective: The aim of this study was to examine within-person associations between multiple determinants of the capability, opportunity, motivation, and behavior framework assessed using Ecological Momentary Assessment (EMA) and accelerometer-assessed light PA, moderate to vigorous PA, and total PA performed at 15, 30, 60, and 120 minutes after the EMA trigger. Methods: Observational data were collected from 64 healthy older adults (36/64, 56% men; mean age 72.1, SD 5.6 y). Participants were asked to answer a time-based EMA questionnaire 6 times per day that assessed emotions (ie, relaxation, satisfaction, irritation, and feeling down), the physical complaint fatigue, intention, intention, and self-efficacy. An Axivity AX3 was wrist worn to capture the participants? PA. Multilevel regression analyses in R were performed to examine these within-person associations. Results: Irritation, feeling down, intention, and self-efficacy were positively associated with subsequent light PA or moderate to vigorous PA at 15, 30, 60, or 120 minutes after the trigger, whereas relaxation, satisfaction, and fatigue were negatively associated. Conclusions: Multiple associations were observed in this study. This knowledge in combination with the time dependency of the determinants is valuable information for future interventions so that suggestions to be active can be provided when the older adult is most receptive. UR - https://aging.jmir.org/2023/1/e44425 UR - http://dx.doi.org/10.2196/44425 UR - http://www.ncbi.nlm.nih.gov/pubmed/37995131 ID - info:doi/10.2196/44425 ER - TY - JOUR AU - Nurmi, Johanna AU - Knittle, Keegan AU - Naughton, Felix AU - Sutton, Stephen AU - Ginchev, Todor AU - Khattak, Fida AU - Castellano-Tejedor, Carmina AU - Lusilla-Palacios, Pilar AU - Ravaja, Niklas AU - Haukkala, Ari PY - 2023/11/23 TI - Biofeedback and Digitalized Motivational Interviewing to Increase Daily Physical Activity: Series of Factorial N-of-1 Randomized Controlled Trials Piloting the Precious App JO - JMIR Form Res SP - e34232 VL - 7 KW - smartphone KW - daily steps KW - activity tracker KW - activity bracelet KW - motivational interviewing KW - self-efficacy KW - self-regulation KW - biofeedback KW - N-of-1 KW - automated KW - digitalized KW - behavior change KW - intervention KW - ecological momentary assessment KW - within-person design KW - intensive longitudinal multilevel modeling KW - mobile phone N2 - Background: Insufficient physical activity is a public health concern. New technologies may improve physical activity levels and enable the identification of its predictors with high accuracy. The Precious smartphone app was developed to investigate the effect of specific modular intervention elements on physical activity and examine theory-based predictors within individuals. Objective: This study pilot-tested a fully automated factorial N-of-1 randomized controlled trial (RCT) with the Precious app and examined whether digitalized motivational interviewing (dMI) and heart rate variability?based biofeedback features increased objectively recorded steps. The secondary aim was to assess whether daily self-efficacy and motivation predicted within-person variability in daily steps. Methods: In total, 15 adults recruited from newspaper advertisements participated in a 40-day factorial N-of-1 RCT. They installed 2 study apps on their phones: one to receive intervention elements and one to collect ecological momentary assessment (EMA) data on self-efficacy, motivation, perceived barriers, pain, and illness. Steps were tracked using Xiaomi Mi Band activity bracelets. The factorial design included seven 2-day biofeedback interventions with a Firstbeat Bodyguard 2 (Firstbeat Technologies Ltd) heart rate variability sensor, seven 2-day dMI interventions, a wash-out day after each intervention, and 11 control days. EMA questions were sent twice per day. The effects of self-efficacy, motivation, and the interventions on subsequent steps were analyzed using within-person dynamic regression models and aggregated data using longitudinal multilevel modeling (level 1: daily observations; level 2: participants). The analyses were adjusted for covariates (ie, within- and between-person perceived barriers, pain or illness, time trends, and recurring events). Results: All participants completed the study, and adherence to activity bracelets and EMA measurements was high. The implementation of the factorial design was successful, with the dMI features used, on average, 5.1 (SD 1.0) times of the 7 available interventions. Biofeedback interventions were used, on average, 5.7 (SD 1.4) times out of 7, although 3 participants used this feature a day later than suggested and 1 did not use it at all. Neither within- nor between-person analyses revealed significant intervention effects on step counts. Self-efficacy predicted steps in 27% (4/15) of the participants. Motivation predicted steps in 20% (3/15) of the participants. Aggregated data showed significant group-level effects of day-level self-efficacy (B=0.462; P<.001), motivation (B=0.390; P<.001), and pain or illness (B=?1524; P<.001) on daily steps. Conclusions: The automated factorial N-of-1 trial with the Precious app was mostly feasible and acceptable, especially the automated delivery of the dMI components, whereas self-conducted biofeedback measurements were more difficult to time correctly. The findings suggest that changes in self-efficacy and motivation may have same-day effects on physical activity, but the effects vary across individuals. This study provides recommendations based on the lessons learned on the implementation of factorial N-of-1 RCTs. UR - https://formative.jmir.org/2023/1/e34232 UR - http://dx.doi.org/10.2196/34232 UR - http://www.ncbi.nlm.nih.gov/pubmed/37995122 ID - info:doi/10.2196/34232 ER - TY - JOUR AU - Frey, Anna-Lena AU - Baines, Rebecca AU - Hunt, Sophie AU - Kent, Rachael AU - Andrews, Tim AU - Leigh, Simon PY - 2023/11/22 TI - Association Between the Characteristics of mHealth Apps and User Input During Development and Testing: Secondary Analysis of App Assessment Data JO - JMIR Mhealth Uhealth SP - e46937 VL - 11 KW - patient and public involvement KW - user involvement KW - mobile apps KW - digital health KW - mobile health KW - quality assessment N2 - Background: User involvement is increasingly acknowledged as a central part of health care innovation. However, meaningful user involvement during the development and testing of mobile health apps is often not fully realized. Objective: This study aims to examine in which areas user input is most prevalent and whether there is an association between user inclusion and compliance with best practices for mobile health apps. Methods: A secondary analysis was conducted on an assessment data set of 1595 health apps. The data set contained information on whether the apps had been developed or tested with user input and whether they followed best practices across several domains. Background information was also available regarding the apps? country of origin, targeted condition areas, subjective user ratings, download numbers, and risk (as per the National Institute for Health and Care Excellence Evidence Standards Framework [ESF]). Descriptive statistics, Mann-Whitney U tests, and Pearson chi-square analyses were applied to the data. Results: User involvement was reported by 8.71% (139/1595) of apps for only the development phase, by 33.67% (537/1595) of apps for only the testing phase, by 21.88% (349/1595) of apps for both phases, and by 35.74% (570/1595) of apps for neither phase. The highest percentage of health apps with reported user input during development was observed in Denmark (19/24, 79%); in the condition areas of diabetes (38/79, 48%), cardiology (15/32, 47%), pain management (20/43, 47%), and oncology (25/54, 46%); and for high app risk (ESF tier 3a; 105/263, 39.9%). The highest percentage of health apps with reported user input during testing was observed in Belgium (10/11, 91%), Sweden (29/34, 85%), and France (13/16, 81%); in the condition areas of neurodiversity (42/52, 81%), respiratory health (58/76, 76%), cardiology (23/32, 72%), and diabetes (56/79, 71%); and for high app risk (ESF tier 3a; 176/263, 66.9%). Notably, apps that reported seeking user input during testing demonstrated significantly more downloads than those that did not (P=.008), and user inclusion was associated with better compliance with best practices in clinical assurance, data privacy, risk management, and user experience. Conclusions: The countries and condition areas in which the highest percentage of health apps with user involvement were observed tended to be those with higher digital maturity in health care and more funding availability, respectively. This suggests that there may be a trade-off between developers? willingness or ability to involve users and the need to meet challenges arising from infrastructure limitations and financial constraints. Moreover, the finding of a positive association between user inclusion and compliance with best practices indicates that, where no other guidance is available, users may benefit from prioritizing health apps developed with user input as the latter may be a proxy for broader app quality. UR - https://mhealth.jmir.org/2023/1/e46937 UR - http://dx.doi.org/10.2196/46937 UR - http://www.ncbi.nlm.nih.gov/pubmed/37991822 ID - info:doi/10.2196/46937 ER - TY - JOUR AU - Alluhaidan, Saleh Ala AU - Chatterjee, Samir AU - Drew, E. David AU - Ractham, Peter AU - Kaewkitipong, Laddawan PY - 2023/11/22 TI - Empowerment Enabled by Information and Communications Technology and Intention to Sustain a Healthy Behavior: Survey of General Users JO - JMIR Hum Factors SP - e47103 VL - 10 KW - empowerment KW - behavior change KW - information and communications technology KW - ICT KW - sustaining health behavior KW - long-term health behavior KW - mobile phone N2 - Background: Most people with chronic conditions fail to adhere to self-management behavioral guidelines. In the last 2 decades, several mobile health apps and IT-based systems have been designed and developed to help patients change and sustain their healthy behaviors. However, these systems often lead to short-term behavior change or adherence while the goal is to engage the population toward long-term behavior change. Objective: This study aims to contribute to the development of long-term health behavior changes or to help people sustain their healthy behavior. For this purpose, we built and tested a theoretical model that includes enablers of empowerment and an intention to sustain a healthy behavior when patients are assisted by information and communications technology. Methods: Structural equation modeling was used to analyze 427 survey returns collected from a diverse population of participants and patients. Notably, the model testing was performed for physical activity as a generally desirable healthy goal. Results: Message aligned with personal goals, familiarity with technology tools, high self-efficacy, social connection, and community support played a significant role (P<.001) in empowering individuals to maintain a healthy behavior. The feeling of being empowered exhibited a strong influence, with a path coefficient of 0.681 on an intention to sustain healthy behavior. Conclusions: The uniqueness of this model is its recognition of needs (ie, social connection, community support, and self-efficacy) to sustain a healthy behavior. Individuals are empowered when they are assisted by family and community, specifically when they possess the knowledge, skills, and self-awareness to ascertain and achieve their goals. This nascent theory explains what might lead to more sustainable behavior change and is meant to help designers build better apps that enable people to conduct self-care routines and sustain their behavior. UR - https://humanfactors.jmir.org/2023/1/e47103 UR - http://dx.doi.org/10.2196/47103 UR - http://www.ncbi.nlm.nih.gov/pubmed/37991814 ID - info:doi/10.2196/47103 ER - TY - JOUR AU - Miller, Ian AU - Peake, Emily AU - Strauss, Gabriel AU - Vierra, Elise AU - Koepsell, Xin AU - Shalchi, Brandon AU - Padmanabhan, Aarthi AU - Lake, Jessica PY - 2023/11/22 TI - Self-Guided Digital Intervention for Depression in Adolescents: Feasibility and Preliminary Efficacy Study JO - JMIR Form Res SP - e43260 VL - 7 KW - depression KW - adolescents KW - young adults KW - cognitive behavioral therapy KW - behavioral activation KW - digital health KW - mobile interventions KW - mobile phone N2 - Background: Depression in adolescents is a large and growing problem; however, access to effective mental health care continues to be a challenge. Digitally based interventions may serve to bridge this access gap for adolescents in need of care. Digital interventions that deliver components of cognitive behavioral therapy (CBT) have been shown to reduce symptoms of depression, and virtual reality (VR) may be a promising adjunctive component. However, research on these types of treatments in adolescents and young adults is limited. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary efficacy of Spark (v1.0), a 5-week, self-guided, CBT-based digital program using a mobile app and VR experiences to target symptoms of depression in adolescents. Methods: A single-arm, open-label study of the Spark program was conducted with a community sample of 30 adolescents and young adults aged 12 to 21 years with self-reported moderate to severe depression symptoms. Participants completed a weekly depression assessment (Patient Health Questionnaire-8) in the app during the 5-week intervention period as well as web-based baseline, postintervention, and 1-month follow-up self-report assessments. The participants also completed a qualitative postintervention interview. For participants aged <18 years, caregivers completed assessments at baseline and postintervention time points. Feasibility outcomes included recruitment rate (the proportion of participants who enrolled in the study divided by the total number of participants screened for eligibility) and retention rate (the proportion of participants who completed postintervention assessments divided by the total number of participants who received the intervention). Acceptability outcomes included engagement with the program and quantitative and qualitative feedback about the program. Preliminary efficacy was evaluated based on the Patient Health Questionnaire-8. Results: The study recruitment (31/66, 47%) and retention (29/30, 97%) rates were high. Participants provided higher ratings for the ease of use of the Spark program (8.76 out of 10) and their enjoyment of both the mobile app (7.00 out of 10) and VR components (7.48 out of 10) of the program, whereas they provided lower ratings for the program?s ability to improve mood (4.38 out of 10) or fit into their daily routines (5.69 out of 10). We observed a clinically and statistically significant reduction in depression scores at postintervention (mean difference 5.36; P<.001) and 1-month follow-up (mean difference 6.44; P<.001) time points. Conclusions: The Spark program was found to be a feasible and acceptable way to deliver a self-guided CBT-focused intervention to adolescents and young adults with symptoms of depression. Preliminary data also indicated that the Spark program reduced the symptoms of depression in adolescents and young adults. Future studies should evaluate the efficacy of this intervention in an adequately powered randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04165681; https://classic.clinicaltrials.gov/ct2/show/NCT04165681 UR - https://formative.jmir.org/2023/1/e43260 UR - http://dx.doi.org/10.2196/43260 UR - http://www.ncbi.nlm.nih.gov/pubmed/37991839 ID - info:doi/10.2196/43260 ER - TY - JOUR AU - Dobson, Rosie AU - Stowell, Melanie AU - Warren, Jim AU - Tane, Taria AU - Ni, Lin AU - Gu, Yulong AU - McCool, Judith AU - Whittaker, Robyn PY - 2023/11/21 TI - Use of Consumer Wearables in Health Research: Issues and Considerations JO - J Med Internet Res SP - e52444 VL - 25 KW - wearable device KW - wearable KW - wearables KW - inclusion KW - inclusive KW - inclusivity KW - data quality KW - consumer wearables KW - sensors KW - digital health KW - mental health KW - ethics KW - ethic KW - ethical KW - privacy KW - security KW - viewpoint KW - digital divide KW - data privacy KW - health information management KW - data science KW - data collection UR - https://www.jmir.org/2023/1/e52444 UR - http://dx.doi.org/10.2196/52444 UR - http://www.ncbi.nlm.nih.gov/pubmed/37988147 ID - info:doi/10.2196/52444 ER - TY - JOUR AU - Liew, Huiling AU - Pienkowska, Anita AU - Ang, Chin-Siang AU - Mahadzir, Azlan Muhammad Daniel AU - Goh, Ing Kelley Fann AU - Lodh, Nandika AU - Bojic, Iva AU - Lawate, Ashwini AU - Ong, Chwen Qi AU - Venkataraman, Kavita AU - Car, Josip AU - Ho, Yan Andy Hau PY - 2023/11/21 TI - Empowering Foot Care Literacy Among People Living With Diabetes and Their Carers With an mHealth App: Protocol for a Feasibility Study JO - JMIR Res Protoc SP - e52036 VL - 12 KW - digital therapeutics KW - mHealth KW - diabetes mellitus KW - diabetes foot ulcer KW - feasibility study KW - mobile phone N2 - Background: Diabetic foot ulcers (DFUs) cause significant morbidity affecting 19% to 34% of people living with diabetes mellitus. DFUs not only impair quality of life but may also result in limb loss and mortality. Patient education has been advocated to raise awareness of proper foot self-care and the necessity of seeking assistance when a foot wound occurs. Modern technologies, including mobile health (mHealth) interventions such as health apps, bring the potential for more cost-effective and scalable interventions. Objective: This study aims to examine the feasibility and usability of a newly developed mHealth app called Well Feet, which is a diabetes and foot care education app for individuals at risk of developing DFU. Methods: Well Feet was developed using an evidence-based and expert panel cocreation approach to deliver educational content available in 3 languages (ie, English, Chinese, and Malay) via animation videos and a range of additional features, including adaptive learning. A nonrandomized, single-arm feasibility study using a mixed methods approach with a series of validated questionnaires and focus group discussions will be conducted. In total, 40 patients and carers will be recruited from a tertiary hospital diabetes clinic to receive a 1-month mHealth intervention. The primary outcomes are the usability of the app and a qualitative perspective on user experience. Secondary outcomes include changes in foot care knowledge, self-management behaviors, and quality of life. Results: Patient recruitment began in July 2023, and the intervention and data collection will be completed by the end of September 2023. This study has been approved by National Healthcare Group Domain Specific Review Board (2022/00614) on February 10, 2023. The expected results will be published in spring 2024. Conclusions: Through this feasibility study, the Well Feet DFU education app will undergo a comprehensive quantitative and qualitative evaluation of its usability and acceptance for future improvement in its design. With local contextualization, cultural adaptation, and its multilingual functionality, the app addresses a critical aspect of DFU health education and self-management in a multiethnic population. Findings from this study will refine and enhance the features of the app based on user feedback and shape the procedural framework for a subsequent randomized controlled trial to assess the effectiveness of Well Feet. Trial Registration: ClinicalTrials.gov NCT05564728; https://clinicaltrials.gov/study/NCT05564728 International Registered Report Identifier (IRRID): DERR1-10.2196/52036 UR - https://www.researchprotocols.org/2023/1/e52036 UR - http://dx.doi.org/10.2196/52036 UR - http://www.ncbi.nlm.nih.gov/pubmed/37988150 ID - info:doi/10.2196/52036 ER - TY - JOUR AU - Rheinberger, Demee AU - Baffsky, Rachel AU - McGillivray, Lauren AU - Zbukvic, Isabel AU - Dadich, Ann AU - Larsen, Erik Mark AU - Lin, Ping-I AU - Gan, Q. Daniel Z. AU - Kaplun, Catherine AU - Wilcox, C. Holly AU - Eapen, Valsamma AU - Middleton, M. Paul AU - Torok, Michelle PY - 2023/11/16 TI - Examining the Feasibility of Implementing Digital Mental Health Innovations Into Hospitals to Support Youth in Suicide Crisis: Interview Study With Young People and Health Professionals JO - JMIR Form Res SP - e51398 VL - 7 KW - mobile health KW - mHealth KW - digital health KW - mental health KW - suicide prevention KW - self-harm KW - young people KW - hospitals KW - mobile phone N2 - Background: Hospitals are insufficiently resourced to appropriately support young people who present with suicidal crises. Digital mental health innovations have the potential to provide cost-effective models of care to address this service gap and improve care experiences for young people. However, little is currently known about whether digital innovations are feasible to integrate into complex hospital settings or how they should be introduced for sustainability. Objective: This qualitative study explored the potential benefits, barriers, and collective action required for integrating digital therapeutics for the management of suicidal distress in youth into routine hospital practice. Addressing these knowledge gaps is a critical first step in designing digital innovations and implementation strategies that enable uptake and integration. Methods: We conducted a series of semistructured interviews with young people who had presented to an Australian hospital for a suicide crisis in the previous 12 months and hospital staff who interacted with these young people. Participants were recruited from the community nationally via social media advertisements on the web. Interviews were conducted individually, and participants were reimbursed for their time. Using the Normalization Process Theory framework, we developed an interview guide to clarify the processes and conditions that influence whether and how an innovation becomes part of routine practice in complex health systems. Results: Analysis of 29 interviews (n=17, 59% young people and n=12, 41% hospital staff) yielded 4 themes that were mapped onto 3 Normalization Process Theory constructs related to coherence building, cognitive participation, and collective action. Overall, digital innovations were seen as a beneficial complement to but not a substitute for in-person clinical services. The timing of delivery was important, with the agreement that digital therapeutics could be provided to patients while they were waiting to be assessed or shortly before discharge. Staff training to increase digital literacy was considered key to implementation, but there were mixed views on the level of staff assistance needed to support young people in engaging with digital innovations. Improving access to technological devices and internet connectivity, increasing staff motivation to facilitate the use of the digital therapeutic, and allowing patients autonomy over the use of the digital therapeutic were identified as other factors critical to integration. Conclusions: Integrating digital innovations into current models of patient care for young people presenting to hospital in acute suicide crises is challenging because of several existing resource, logistical, and technical barriers. Scoping the appropriateness of new innovations with relevant key stakeholders as early as possible in the development process should be prioritized as the best opportunity to preemptively identify and address barriers to implementation. UR - https://formative.jmir.org/2023/1/e51398 UR - http://dx.doi.org/10.2196/51398 UR - http://www.ncbi.nlm.nih.gov/pubmed/37971790 ID - info:doi/10.2196/51398 ER - TY - JOUR AU - Wickwire, M. Emerson AU - Collen, Jacob AU - Capaldi, F. Vincent AU - Williams, G. Scott AU - Assefa, Z. Samson AU - Adornetti, P. Julianna AU - Huang, Kathleen AU - Venezia, M. Janet AU - Jones, L. Rachell AU - Johnston, W. Christine AU - Thomas, Connie AU - Thomas, Ann Mary AU - Mounts, Charles AU - Drake, L. Christopher AU - Businelle, S. Michael AU - Grandner, A. Michael AU - Manber, Rachel AU - Albrecht, S. Jennifer PY - 2023/11/16 TI - Patient Engagement and Provider Effectiveness of a Novel Sleep Telehealth Platform and Remote Monitoring Assessment in the US Military: Pilot Study Providing Evidence-Based Sleep Treatment Recommendations JO - JMIR Form Res SP - e47356 VL - 7 KW - sleep KW - sleep disorders KW - insomnia KW - obstructive sleep apnea KW - telehealth KW - remote monitoring KW - monitoring KW - patient engagement KW - effectiveness KW - effective care KW - behavioral KW - care KW - application KW - wearables N2 - Background: Sleep problems are common and costly in the US military. Yet, within the military health system, there is a gross shortage of trained specialist providers to address sleep problems. As a result, demand for sleep medicine care far exceeds the available supply. Telehealth including telemedicine, mobile health, and wearables represents promising approaches to increase access to high-quality and cost-effective care. Objective: The purpose of this study was to evaluate patient engagement and provider perceived effectiveness of a novel sleep telehealth platform and remote monitoring assessment in the US military. The platform includes a desktop web portal, native mobile app, and integrated wearable sensors (ie, a commercial off-the-shelf sleep tracker [Fitbit]). The goal of the remote monitoring assessment was to provide evidence-based sleep treatment recommendations to patients and providers. Methods: Patients with sleep problems were recruited from the Internal Medicine clinic at Walter Reed National Military Medical Center. Patients completed intensive remote monitoring assessments over 10 days (including a baseline intake questionnaire, daily sleep diaries, and 2 daily symptom surveys), and wore a Fitbit sleep tracker. Following the remote monitoring period, patients received assessment results and personalized sleep education in the mobile app. In parallel, providers received a provisional patient assessment report in an editable electronic document format. Patient engagement was assessed via behavioral adherence metrics that were determined a priori. Patients also completed a brief survey regarding ease of completion. Provider effectiveness was assessed via an anonymous survey. Results: In total, 35 patients with sleep problems participated in the study. There were no dropouts. Results indicated a high level of engagement with the sleep telehealth platform, with all participants having completed the baseline remote assessment, reviewed their personalized sleep assessment report, and completed the satisfaction survey. Patients completed 95.1% of sleep diaries and 95.3% of symptom surveys over 10 days. Patients reported high levels of satisfaction with most aspects of the remote monitoring assessment. In total, 24 primary care providers also participated and completed the anonymous survey. The results indicate high levels of perceived effectiveness and identified important potential benefits from adopting a sleep telehealth approach throughout the US military health care system. Conclusions: Military patients with sleep problems and military primary care providers demonstrated high levels of engagement and satisfaction with a novel sleep telehealth platform and remote monitoring assessment. Sleep telehealth approaches represent a potential pathway to increase access to evidence-based sleep medicine care in the US military. Further evaluation is warranted. UR - https://formative.jmir.org/2023/1/e47356 UR - http://dx.doi.org/10.2196/47356 UR - http://www.ncbi.nlm.nih.gov/pubmed/37971788 ID - info:doi/10.2196/47356 ER - TY - JOUR AU - Brown, Carter AU - Roucoux, Guillaume AU - Rousset-Torrente, Olivia AU - Ali, Saleh AU - Yombo-Kokule, Lisa AU - Chaplin, John AU - Chassany, Olivier AU - Duracinsky, Martin PY - 2023/11/16 TI - Fostering Patient-Clinician Communication to Promote Rapid HIV, Hepatitis B Virus, and Hepatitis C Virus Diagnostic Testing: Conceptual Development of a Multilingual App JO - JMIR Form Res SP - e49251 VL - 7 KW - app development KW - agile development KW - mobile health KW - mHealth KW - user-centered design KW - communication barriers KW - migrants KW - HIV KW - AIDS KW - hepatitis KW - rapid diagnostic testing KW - public health N2 - Background: Migrants are disproportionately affected by HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV). Clinicians, at times, fail to offer rapid diagnostic testing (RDT) for these viruses when a language barrier exists in the patient-clinician relationship, therefore creating missed testing opportunities. Although their effectiveness has been demonstrated elsewhere, conventional, in-person interpreters are costly and underused in practice. Furthermore, clinicians often call upon ad hoc interpreters, which introduces complexities in the clinical relationship. Digital solutions exist to diminish the burden of language barriers; however, the challenges of developing a multilingual and multicultural app have yet to be documented with respect to RDT in the nonfrancophone migrant population in France. Objective: Our goal was to design a multilingual app to overcome language barriers, health literacy barriers, and fears related to being tested to promote RDT of HIV, HBV, and HCV in the nonfrancophone migrant population in France. Methods: A combination of qualitative methods, agile development, and user-centered design was used. We conducted 2 focus groups (FGs) with 12 participants, including physicians, nurses, and social workers conducting RDT, as well as 1 modified Delphi survey with 68 participants including physicians and nurses. FGs explored the content (risk factors and medical history), functions (cultural adaptation and instant translation), and interface ergonomics (graphics and font) needed in the app. The Delphi presented 95 content items that the researchers sought to include in the app. Results: Using FGs to inform the Delphi survey, we scientifically determined the app?s content consisting of 95 items using expert consensus, developed a mock-up, and conducted initial user testing. We created an app that contains both migrant and clinician interfaces and includes a sociodemographic, risk assessment, health literacy, and testing barrier questionnaires available in 11 languages. Educational content is related to HIV, HBV, and HCV, along with the ability to understand whether the migrant agrees to be tested. Conclusions: This study allowed us to conceptualize a multilingual app that aims to increase the acceptance of RDT for HIV, HBV, and HCV. The specific features of the Assistant intelligent au dépistage des allophones app were designed to overcome the testing barriers in the nonfrancophone migrant population. The next phase will be an implementation study, as we intend to validate our app. UR - https://formative.jmir.org/2023/1/e49251 UR - http://dx.doi.org/10.2196/49251 UR - http://www.ncbi.nlm.nih.gov/pubmed/37971810 ID - info:doi/10.2196/49251 ER - TY - JOUR AU - Hirten, P. Robert AU - Danieletto, Matteo AU - Landell, Kyle AU - Zweig, Micol AU - Golden, Eddye AU - Orlov, Georgy AU - Rodrigues, Jovita AU - Alleva, Eugenia AU - Ensari, Ipek AU - Bottinger, Erwin AU - Nadkarni, N. Girish AU - Fuchs, J. Thomas AU - Fayad, A. Zahi PY - 2023/11/16 TI - Development of the ehive Digital Health App: Protocol for a Centralized Research Platform JO - JMIR Res Protoc SP - e49204 VL - 12 KW - digital health KW - wearable devices KW - research platform KW - eHive KW - smartphone KW - wearables KW - digital technologies KW - digital study KW - multimodal data collection KW - framework KW - development KW - centralized digital research platform KW - ehive app KW - mobile phone N2 - Background: The increasing use of smartphones, wearables, and connected devices has enabled the increasing application of digital technologies for research. Remote digital study platforms comprise a patient-interfacing digital application that enables multimodal data collection from a mobile app and connected sources. They offer an opportunity to recruit at scale, acquire data longitudinally at a high frequency, and engage study participants at any time of the day in any place. Few published descriptions of centralized digital research platforms provide a framework for their development. Objective: This study aims to serve as a road map for those seeking to develop a centralized digital research platform. We describe the technical and functional aspects of the ehive app, the centralized digital research platform of the Hasso Plattner Institute for Digital Health at Mount Sinai Hospital, New York, New York. We then provide information about ongoing studies hosted on ehive, including usership statistics and data infrastructure. Finally, we discuss our experience with ehive in the broader context of the current landscape of digital health research platforms. Methods: The ehive app is a multifaceted and patient-facing central digital research platform that permits the collection of e-consent for digital health studies. An overview of its development, its e-consent process, and the tools it uses for participant recruitment and retention are provided. Data integration with the platform and the infrastructure supporting its operations are discussed; furthermore, a description of its participant- and researcher-facing dashboard interfaces and the e-consent architecture is provided. Results: The ehive platform was launched in 2020 and has successfully hosted 8 studies, namely 6 observational studies and 2 clinical trials. Approximately 1484 participants downloaded the app across 36 states in the United States. The use of recruitment methods such as bulk messaging through the EPIC electronic health records and standard email portals enables broad recruitment. Light-touch engagement methods, used in an automated fashion through the platform, maintain high degrees of engagement and retention. The ehive platform demonstrates the successful deployment of a central digital research platform that can be modified across study designs. Conclusions: Centralized digital research platforms such as ehive provide a novel tool that allows investigators to expand their research beyond their institution, engage in large-scale longitudinal studies, and combine multimodal data streams. The ehive platform serves as a model for groups seeking to develop similar digital health research programs. International Registered Report Identifier (IRRID): DERR1-10.2196/49204 UR - https://www.researchprotocols.org/2023/1/e49204 UR - http://dx.doi.org/10.2196/49204 UR - http://www.ncbi.nlm.nih.gov/pubmed/37971801 ID - info:doi/10.2196/49204 ER - TY - JOUR AU - Straczkiewicz, Marcin AU - Keating, L. Nancy AU - Thompson, Embree AU - Matulonis, A. Ursula AU - Campos, M. Susana AU - Wright, A. Alexi AU - Onnela, Jukka-Pekka PY - 2023/11/15 TI - Open-Source, Step-Counting Algorithm for Smartphone Data Collected in Clinical and Nonclinical Settings: Algorithm Development and Validation Study JO - JMIR Cancer SP - e47646 VL - 9 KW - accelerometer KW - cancer KW - open-source KW - smartphone KW - step count KW - validation KW - wearable N2 - Background: Step counts are increasingly used in public health and clinical research to assess well-being, lifestyle, and health status. However, estimating step counts using commercial activity trackers has several limitations, including a lack of reproducibility, generalizability, and scalability. Smartphones are a potentially promising alternative, but their step-counting algorithms require robust validation that accounts for temporal sensor body location, individual gait characteristics, and heterogeneous health states. Objective: Our goal was to evaluate an open-source, step-counting method for smartphones under various measurement conditions against step counts estimated from data collected simultaneously from different body locations (?cross-body? validation), manually ascertained ground truth (?visually assessed? validation), and step counts from a commercial activity tracker (Fitbit Charge 2) in patients with advanced cancer (?commercial wearable? validation). Methods: We used 8 independent data sets collected in controlled, semicontrolled, and free-living environments with different devices (primarily Android smartphones and wearable accelerometers) carried at typical body locations. A total of 5 data sets (n=103) were used for cross-body validation, 2 data sets (n=107) for visually assessed validation, and 1 data set (n=45) was used for commercial wearable validation. In each scenario, step counts were estimated using a previously published step-counting method for smartphones that uses raw subsecond-level accelerometer data. We calculated the mean bias and limits of agreement (LoA) between step count estimates and validation criteria using Bland-Altman analysis. Results: In the cross-body validation data sets, participants performed 751.7 (SD 581.2) steps, and the mean bias was ?7.2 (LoA ?47.6, 33.3) steps, or ?0.5%. In the visually assessed validation data sets, the ground truth step count was 367.4 (SD 359.4) steps, while the mean bias was ?0.4 (LoA ?75.2, 74.3) steps, or 0.1%. In the commercial wearable validation data set, Fitbit devices indicated mean step counts of 1931.2 (SD 2338.4), while the calculated bias was equal to ?67.1 (LoA ?603.8, 469.7) steps, or a difference of 3.4%. Conclusions: This study demonstrates that our open-source, step-counting method for smartphone data provides reliable step counts across sensor locations, measurement scenarios, and populations, including healthy adults and patients with cancer. UR - https://cancer.jmir.org/2023/1/e47646 UR - http://dx.doi.org/10.2196/47646 UR - http://www.ncbi.nlm.nih.gov/pubmed/37966891 ID - info:doi/10.2196/47646 ER - TY - JOUR AU - Lunde, Pernille AU - Skoglund, Gyri AU - Olsen, Fromholt Cecilie AU - Hilde, Gunvor AU - Bong, Kiat Way AU - Nilsson, Blakstad Birgitta PY - 2023/11/15 TI - Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study JO - JMIR Hum Factors SP - e48950 VL - 10 KW - mHealth KW - mobile phone app KW - smartphone KW - lifestyle KW - usability KW - diabetes KW - diabetic KW - mobile health KW - app KW - apps KW - application KW - applications KW - think-aloud KW - think aloud KW - user experience KW - mobile phone N2 - Background: Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted. Objective: The aim of this study was to assess the usability of an app among people at risk of DM2. Methods: A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis. Results: In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app. Conclusions: Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial. UR - https://humanfactors.jmir.org/2023/1/e48950 UR - http://dx.doi.org/10.2196/48950 UR - http://www.ncbi.nlm.nih.gov/pubmed/37966894 ID - info:doi/10.2196/48950 ER - TY - JOUR AU - Ciolfi Felice, Marianela AU - Søndergaard, Juul Marie Louise AU - Balaam, Madeline PY - 2023/11/14 TI - Analyzing User Reviews of the First Digital Contraceptive: Mixed Methods Study JO - J Med Internet Res SP - e47131 VL - 25 KW - digital contraception KW - reproductive health KW - digital health KW - women?s health KW - intimate health KW - computational methods KW - natural language processing KW - NLP KW - user experience KW - health informatics N2 - Background: People in Western countries are increasingly rejecting hormone-based birth control and expressing a preference for hormone-free methods. Digital contraceptives have emerged as nonhormonal medical devices that make use of self-tracked data and algorithms to find a user?s fertile window. However, there is little knowledge about how people experience this seemingly new form of contraception, whose failure may result in unwanted pregnancies, high health risks, and life-changing consequences. As digital contraception becomes more widely adopted, examining its user experience is crucial to inform the design of technologies that not only are medically effective but also meet users? preferences and needs. Objective: We examined the user experience offered by Natural Cycles?the first digital contraceptive?through an analysis of app reviews written by its users worldwide. Methods: We conducted a mixed methods analysis of 3265 publicly available reviews written in English by users of Natural Cycles on the Google Play Store. We combined computational and human techniques, namely, topic modeling and reflexive thematic analysis. Results: For some users of digital contraception, the hormone-free aspect of the experience can be more salient than its digital aspect. Cultivating self-knowledge through the use of the technology can, in turn, feel empowering. Users also pointed to an algorithmic component that allows for increased accuracy over time as long as user diligence is applied. The interactivity of the digital contraceptive supports mutual learning and is experienced as agential and rewarding. Finally, a digital contraceptive can facilitate sharing the burden of contraceptive practices or highlight single-sided responsibilities while creating points of friction in the required daily routines. Conclusions: Digital contraception is experienced by users as a tamed natural approach?a natural method contained and regulated by science and technology. This means that users can experience a method based on a digital product as ?natural,? which positions digital contraceptives as a suitable option for people looking for evidence-based nonhormonal contraceptive methods. We point to interactivity as core to the user experience and highlight that a digital contraceptive might allow for collaboration between partners around contraceptive practices and responsibilities. We note that the user diligence required for the digital contraceptive to provide accurate and frequent data is sometimes not enough. Future research could look at designing (and redesigning) digital contraceptives with primary users and intimate partners, enhancing the experience of tamed naturalness; exploring how trust fluctuates among involved actors and in interactions with the technology; and, ultimately, designing more inclusive approaches to digital contraception. UR - https://www.jmir.org/2023/1/e47131 UR - http://dx.doi.org/10.2196/47131 UR - http://www.ncbi.nlm.nih.gov/pubmed/37962925 ID - info:doi/10.2196/47131 ER - TY - JOUR AU - Sanches, Alberto Carlos AU - Silva, Alves Graziella AU - Librantz, Henriques Andre Felipe AU - Sampaio, Malosa Luciana Maria AU - Belan, Adriano Peterson PY - 2023/11/14 TI - Wearable Devices to Diagnose and Monitor the Progression of COVID-19 Through Heart Rate Variability Measurement: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e47112 VL - 25 KW - heart rate variability KW - HRV KW - wearable device KW - COVID-19 KW - SARS-CoV-2 KW - wearable KW - diagnosis KW - mobile phone N2 - Background: Recent studies have linked low heart rate variability (HRV) with COVID-19, indicating that this parameter can be a marker of the onset of the disease and its severity and a predictor of mortality in infected people. Given the large number of wearable devices that capture physiological signals of the human body easily and noninvasively, several studies have used this equipment to measure the HRV of individuals and related these measures to COVID-19. Objective: The objective of this study was to assess the utility of HRV measurements obtained from wearable devices as predictive indicators of COVID-19, as well as the onset and worsening of symptoms in affected individuals. Methods: A systematic review was conducted searching the following databases up to the end of January 2023: Embase, PubMed, Web of Science, Scopus, and IEEE Xplore. Studies had to include (1) measures of HRV in patients with COVID-19 and (2) measurements involving the use of wearable devices. We also conducted a meta-analysis of these measures to reduce possible biases and increase the statistical power of the primary research. Results: The main finding was the association between low HRV and the onset and worsening of COVID-19 symptoms. In some cases, it was possible to predict the onset of COVID-19 before a positive clinical test. The meta-analysis of studies reported that a reduction in HRV parameters is associated with COVID-19. Individuals with COVID-19 presented a reduction in the SD of the normal-to-normal interbeat intervals and root mean square of the successive differences compared with healthy individuals. The decrease in the SD of the normal-to-normal interbeat intervals was 3.25 ms (95% CI ?5.34 to ?1.16 ms), and the decrease in the root mean square of the successive differences was 1.24 ms (95% CI ?3.71 to 1.23 ms). Conclusions: Wearable devices that measure changes in HRV, such as smartwatches, rings, and bracelets, provide information that allows for the identification of COVID-19 during the presymptomatic period as well as its worsening through an indirect and noninvasive self-diagnosis. UR - https://www.jmir.org/2023/1/e47112 UR - http://dx.doi.org/10.2196/47112 UR - http://www.ncbi.nlm.nih.gov/pubmed/37820372 ID - info:doi/10.2196/47112 ER - TY - JOUR AU - Lin, Huicong AU - Ye, Mingzhu AU - Lin, Yanjuan AU - Chen, Fuhong AU - Chan, Sally AU - Cai, Hongxia AU - Zhu, Jiemin PY - 2023/11/13 TI - Mobile App for Gynecologic Cancer Support for Patients With Gynecologic Cancer Receiving Chemotherapy in China: Multicenter Randomized Controlled Trial JO - J Med Internet Res SP - e49939 VL - 25 KW - mobile app KW - gynecologic cancer KW - uncertainty in illness KW - quality of life KW - symptom distress KW - social support KW - cancer care KW - gynecologic KW - application KW - chemotherapy KW - support KW - women KW - well-being KW - emotional well-being KW - cancer KW - mobile phone N2 - Background: Patients with gynecologic cancer receiving chemotherapy often report unmet supportive care needs. Compared with traditional face-to-face clinical interventions, mobile health can increase access to supportive care and may address patients? needs. Although app-based support programs have been developed to support patients with gynecologic cancer, their efficacy has not been adequately tested. Objective: The aim of this study was to examine the efficacy of a mobile app for gynecologic cancer support (MGCS) for patients with gynecologic cancer receiving chemotherapy in China. Methods: A multicenter randomized controlled trial was conducted in 2 university-affiliated hospitals in China. A total of 168 Chinese patients with gynecologic cancer were recruited and randomized to receive routine care or MGCS program plus routine care for 24 weeks. The Mishel uncertainty in illness theory guided the development of MGCS program, which has 4 modules: weekly topics, emotional care, discussion center, and health consultation. The primary outcome of this program was the assessment of the uncertainty in illness. The secondary outcomes were quality of life, symptom distress, and social support. All health outcomes were evaluated at baseline (T0), 12 weeks (T1), and 24 weeks (T2). Repeated measures analysis of covariance was used to assess the efficacy of the MGCS program. Results: In this trial, 67 patients in the control group and 69 patients in the intervention group completed 2 follow-up assessments (response rate, 136/168, 81%). At 12 weeks, no significant differences were observed in any of the health outcomes between the 2 groups. At 24 weeks, compared to patients in the control group, those in the intervention group reported significant decreased uncertainty in illness (P<.001; d=?0.60; adjusted mean difference ?7.69, 95% CI ?11.31 to ?4.07) and improved quality of life (P=.04; d=0.30; adjusted mean difference 4.77, 95% CI 0.12-9.41). Conclusions: The MGCS program demonstrated efficacy in supporting patients with gynecologic cancer receiving chemotherapy. This trial illustrates that an app-based program can be incorporated into routine care to support patients with cancer and suggests that allocation of more resources (grants, manpower, etc) to mobile health in clinics is warranted. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000033678; https://www.chictr.org.cn/showproj.html?proj=54807 UR - https://www.jmir.org/2023/1/e49939 UR - http://dx.doi.org/10.2196/49939 UR - http://www.ncbi.nlm.nih.gov/pubmed/37955943 ID - info:doi/10.2196/49939 ER - TY - JOUR AU - Hodgson, William AU - Kirk, Alison AU - Lennon, Marilyn AU - Janssen, Xanne AU - Russell, Eilidh AU - Wani, Carolina AU - Eskandarani, Dina PY - 2023/11/13 TI - RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Evaluation of the Use of Activity Trackers in the Clinical Care of Adults Diagnosed With a Chronic Disease: Integrative Systematic Review JO - J Med Internet Res SP - e44919 VL - 25 KW - activity trackers KW - clinical care KW - physical activity KW - sedentary behavior KW - adults KW - chronic diseases KW - Reach, Effectiveness, Adoption, Implementation, and Maintenance KW - RE-AIM KW - mortality KW - sedentary lifestyle KW - intervention KW - mobile phone N2 - Background: Chronic diseases are a leading cause of adult mortality, accounting for 41 million deaths globally each year. Low levels of physical activity and sedentary behavior are major risk factors for adults to develop a chronic disease. Physical activity interventions can help support patients in clinical care to be more active. Commercial activity trackers that can measure daily steps, physical activity intensity, sedentary behavior, and distance moved are being more frequently used within health-related interventions. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a planning and evaluation approach to explore the reach, effectiveness, adoption, implementation, and maintenance of interventions. Objective: The objective of this study is to conduct an integrative systematic review and report the 5 main RE-AIM dimensions in interventions that used activity trackers in clinical care to improve physical activity or reduce sedentary behavior in adults diagnosed with chronic diseases. Methods: A search strategy and study protocol were developed and registered on the PROSPERO platform. Inclusion criteria included adults (18 years and older) diagnosed with a chronic disease and have used an activity tracker within their clinical care. Searches of 10 databases and gray literature were conducted, and qualitative, quantitative, and mixed methods studies were included. Screening was undertaken by more than 1 researcher to reduce the risk of bias. After screening, the final studies were analyzed using a RE-AIM framework data extraction evaluation tool. This tool assisted in identifying the 28 RE-AIM indicators within the studies and linked them to the 5 main RE-AIM dimensions. Results: The initial search identified 4585 potential studies. After a title and abstract review followed by full-text screening, 15 studies were identified for data extraction. The analysis of the extracted data found that the RE-AIM dimensions of adoption (n=1, 7% of studies) and maintenance (n=2, 13% of studies) were underreported. The use of qualitative thematic analysis to understand the individual RE-AIM dimensions was also underreported and only used in 3 of the studies. Two studies used qualitative analysis to explore the effectiveness of the project, while 1 study used thematic analysis to understand the implementation of an intervention. Conclusions: Further research is required in the use of activity trackers to support patients to lead a more active lifestyle. Such studies should consider using the RE-AIM framework at the planning stage with a greater focus on the dimensions of adoption and maintenance and using qualitative methods to understand the main RE-AIM dimensions within their design. These results should form the basis for establishing long-term interventions in clinical care. Trial Registration: PROSPERO CRD42022319635; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319635 UR - https://www.jmir.org/2023/1/e44919 UR - http://dx.doi.org/10.2196/44919 UR - http://www.ncbi.nlm.nih.gov/pubmed/37955960 ID - info:doi/10.2196/44919 ER - TY - JOUR AU - Mora, Nallely AU - Arvanitakis, Zoe AU - Thomas, Merly AU - Kramer, Holly AU - Morrato, H. Elaine AU - Markossian, W. Talar PY - 2023/11/13 TI - Applying Customer Discovery Method to a Chronic Disease Self-Management Mobile App: Qualitative Study JO - JMIR Form Res SP - e50334 VL - 7 KW - mobile app KW - disease management KW - customer discovery KW - customer segment KW - value proposition KW - chronic disease management KW - self-management KW - chronic disease KW - digital health KW - ehealth KW - mobile application KW - mhealth KW - customer delivery N2 - Background: A significant health challenge is evident in the United States, with 6 in 10 adults having a chronic disease and 4 in 10 adults having 2 or more. Chronic disease self-management aims to prevent or delay disease progression and disability and reduce mortality risk. The evidence to support the use of information technology tools, including mobile apps, web-based portals, and web-based educational interventions, that support disease self-management and improve clinical outcomes is growing. Customer discovery and value proposition design methodology is a form of stakeholder engagement and is based on marketing and lean start-up business methods. As applied in health care, customer discovery and value proposition methodology can be used to understand the clinical problem and articulate the product?s hypothesized unique value proposition relative to alternative options that are available to end users. Objective: This study aims to describe the experience and findings of academic researchers applying the customer discovery and value proposition methodology to identify stakeholders, needs, adaptability, and sustainability of a chronic disease self-management mobile app (CDapp). The motivation of the work is to make mobile health app interventions accessible and acceptable for all segments of patients? chronic diseases. Methods: Data were obtained through key informant interviews and analyzed using rapid qualitative analysis techniques. The value proposition framework was used to build the interview guide. The aim was to identify the needs, challenges (pains), and potential benefits (gains) of the CDapp for our stakeholders. Results: Our results showed that the primary consumers (end users) of a CDapp were the patients. The app adopters (decision makers) can be medical center leaders including population health department managers or insurance providers, while the consumer adoption influencers (influencers or saboteurs) are clinicians and patient caregivers. We developed an ecosystem map to visualize the clinical practice workflow and how an app for chronic disease management might integrate within an academic health care center or system. A value proposition for the identified customer segments was generated. Each stakeholder segment was working within a different framework to improve patient self-management. Patients needed help to adhere to self-care activities and they needed tailored health education. Health care leaders aim to improve the quality of care while reducing costs and workload. Clinicians wanted to improve patient education and care while reducing the time burden. Our results also showed that within academic medical centers, there were variations regarding patients? self-reported abilities to manage their diseases. Conclusions: Customer discovery is a useful form of stakeholder engagement when designing studies that seek to implement, adapt, and sustain an intervention. The customer discovery and value proposition methodology can be used as an alternative or complementary approach to formative research to generate valuable information in a brief period. UR - https://formative.jmir.org/2023/1/e50334 UR - http://dx.doi.org/10.2196/50334 UR - http://www.ncbi.nlm.nih.gov/pubmed/37955947 ID - info:doi/10.2196/50334 ER - TY - JOUR AU - Hendawi, Rasha AU - Li, Juan AU - Roy, Souradip PY - 2023/11/13 TI - A Mobile App That Addresses Interpretability Challenges in Machine Learning?Based Diabetes Predictions: Survey-Based User Study JO - JMIR Form Res SP - e50328 VL - 7 KW - disease prediction KW - explainable AI KW - artificial intelligence KW - knowledge graph KW - machine learning KW - ontology KW - diabetes N2 - Background: Machine learning approaches, including deep learning, have demonstrated remarkable effectiveness in the diagnosis and prediction of diabetes. However, these approaches often operate as opaque black boxes, leaving health care providers in the dark about the reasoning behind predictions. This opacity poses a barrier to the widespread adoption of machine learning in diabetes and health care, leading to confusion and eroding trust. Objective: This study aimed to address this critical issue by developing and evaluating an explainable artificial intelligence (AI) platform, XAI4Diabetes, designed to empower health care professionals with a clear understanding of AI-generated predictions and recommendations for diabetes care. XAI4Diabetes not only delivers diabetes risk predictions but also furnishes easily interpretable explanations for complex machine learning models and their outcomes. Methods: XAI4Diabetes features a versatile multimodule explanation framework that leverages machine learning, knowledge graphs, and ontologies. The platform comprises the following four essential modules: (1) knowledge base, (2) knowledge matching, (3) prediction, and (4) interpretation. By harnessing AI techniques, XAI4Diabetes forecasts diabetes risk and provides valuable insights into the prediction process and outcomes. A structured, survey-based user study assessed the app?s usability and influence on participants? comprehension of machine learning predictions in real-world patient scenarios. Results: A prototype mobile app was meticulously developed and subjected to thorough usability studies and satisfaction surveys. The evaluation study findings underscore the substantial improvement in medical professionals? comprehension of key aspects, including the (1) diabetes prediction process, (2) data sets used for model training, (3) data features used, and (4) relative significance of different features in prediction outcomes. Most participants reported heightened understanding of and trust in AI predictions following their use of XAI4Diabetes. The satisfaction survey results further revealed a high level of overall user satisfaction with the tool. Conclusions: This study introduces XAI4Diabetes, a versatile multi-model explainable prediction platform tailored to diabetes care. By enabling transparent diabetes risk predictions and delivering interpretable insights, XAI4Diabetes empowers health care professionals to comprehend the AI-driven decision-making process, thereby fostering transparency and trust. These advancements hold the potential to mitigate biases and facilitate the broader integration of AI in diabetes care. UR - https://formative.jmir.org/2023/1/e50328 UR - http://dx.doi.org/10.2196/50328 UR - http://www.ncbi.nlm.nih.gov/pubmed/37955948 ID - info:doi/10.2196/50328 ER - TY - JOUR AU - Raab, Roxana AU - Geyer, Kristina AU - Zagar, Sophia AU - Hauner, Hans PY - 2023/11/10 TI - App-Supported Lifestyle Interventions in Pregnancy to Manage Gestational Weight Gain and Prevent Gestational Diabetes: Scoping Review JO - J Med Internet Res SP - e48853 VL - 25 KW - mobile health KW - mHealth KW - eHealth KW - mobile app KW - lifestyle intervention KW - pregnancy KW - gestational weight gain KW - gestational diabetes KW - prevention KW - overweight KW - obesity KW - mobile phone N2 - Background: Excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) are common pregnancy complications that have been shown to be preventable through the use of lifestyle interventions. However, a significant gap exists between research on pregnancy lifestyle interventions and translation into clinical practice. App-supported interventions might aid in overcoming previous implementation barriers. The current status in this emerging research area is unknown. Objective: This scoping review aims to provide a comprehensive overview of planned, ongoing, and completed studies on eHealth and mobile health (mHealth) app?supported lifestyle interventions in pregnancy to manage GWG and prevent GDM. The review assesses the scope of the literature in the field; describes the population, intervention, control, outcomes, and study design (PICOS) characteristics of included studies as well as the findings on GWG and GDM outcomes; and examines app functionalities. Methods: The scoping review was conducted according to a preregistered protocol and followed established frameworks. Four electronic databases and 2 clinical trial registers were systematically searched. All randomized and quasi-randomized controlled trials (RCTs) of app-supported lifestyle interventions in pregnancy and related qualitative and quantitative research across the different study phases were considered for inclusion. Eligible studies and reports of studies were included until June 2022. Extracted data were compiled in descriptive analyses and reported in narrative, tabular, and graphical formats. Results: This review included 97 reports from 43 lifestyle intervention studies. The number of published reports has steadily increased in recent years; of the 97 included reports, 38 (39%) were trial register entries. Of the 39 identified RCTs, 10 efficacy or effectiveness trials and 8 pilot trials had published results on GWG (18/39, 46%); of these 18 trials, 7 (39%) trials observed significant intervention effects on GWG outcomes. Of all 39 RCTs, 5 (13%) efficacy or effectiveness trials reported GDM results, but none observed significant intervention effects on GDM. The RCTs included in the review were heterogeneous in terms of their PICOS characteristics. Most of the RCTs were conducted in high-income countries, included women with overweight or obesity and from all BMI categories, delivered multicomponent interventions, delivered interventions during pregnancy only, and focused on diet and physical activity. The apps used in the studies were mostly mHealth apps that included features for self-monitoring, feedback, goal setting, prompts, and educational content. Self-monitoring was often supported by wearable activity monitors and Bluetooth-connected weight scales. Conclusions: Research in this field is nascent, and the effectiveness and implementability of app-supported interventions have yet to be determined. The complexity and heterogeneity of intervention approaches pose challenges in identifying the most beneficial app features and intervention components and call for consistent and comprehensive intervention and outcome reporting. UR - https://www.jmir.org/2023/1/e48853 UR - http://dx.doi.org/10.2196/48853 UR - http://www.ncbi.nlm.nih.gov/pubmed/37948111 ID - info:doi/10.2196/48853 ER - TY - JOUR AU - Htet, Ko Kyaw Ko AU - Phyu, Nyein Aye AU - Zayar, Nyi Nyi AU - Chongsuvivatwong, Virasakdi PY - 2023/11/10 TI - Active Tuberculosis Screening via a Mobile Health App in Myanmar: Incremental Cost-Effectiveness Evaluation JO - JMIR Form Res SP - e51998 VL - 7 KW - mobile app KW - tuberculosis screening KW - TB screening KW - cost effectiveness KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - cost KW - costs KW - economic KW - economics KW - TB KW - tuberculosis KW - screening KW - communicable KW - x-ray KW - imaging KW - radiography KW - decision tree KW - detect KW - detection KW - detecting N2 - Background: A mobile app that calculates a tuberculosis (TB) risk score based on individual social and pathological characteristics has been shown to be a better predictor of the risk of contracting TB than conventionally used TB signs and symptoms (TBSS) in Myanmar, where the TB burden is high. Its cost-effectiveness, however, has not yet been assessed. Objective: This study aimed to determine the incremental costs of this mobile app and of chest x-rays (CXRs) in averting disability-adjusted life years (DALYs) among missed cases of active TB in the population being screened. Methods: Elements of incremental costs and effectiveness of 3 initial TB screening strategies were examined, including TBSS followed by CXR, the mobile app followed by CXR, and universal CXR. The incremental cost-effectiveness ratio (ICER; ie, the additional cost for each additional DALY averted) was compared to TBSS screening. Based on the latest 2020 gross domestic product (GDP) per capita of Myanmar (US $1477.50), the ICER was compared to willingness-to-pay (WTP) thresholds of 1, 2, and 3 times the GDP per capita. Probabilistic sensitivity analysis was conducted with a Monte Carlo simulation to compute the levels of probability that the ICER for each strategy was below each WTP threshold. Results: For each 100,000 population, the incremental cost compared to TBSS of active TB screening was US $345,942 for the mobile app and US $1,810,712 for universal CXR. The incremental effectiveness was 325 DALYs averted for the mobile app and 576 DALYs averted for universal CXR. For the mobile app, the estimated ICER was US $1064 (72% of GDP per capita) per 1 DALY averted. Furthermore, 100% of the simulated values were below an additional cost of 1 times the GDP per capita for 1 additional DALY averted. The universal CXR strategy has an estimated ICER of US $3143 (2.1 times the GDP per capita) per 1 DALY averted and an additional 77.2% DALYs averted compared to the app (ie, 576 ? 325 / 325 DALYs); however, 0.5% of the simulated values were higher than an additional expenditure of 3 times the GDP per capita. Conclusions: Based on the status of the economy in 2020, the mobile app strategy is affordable for Myanmar. The universal CXR strategy, although it could prevent an additional 77% of DALYs, is probably unaffordable. Compared to the TBSS strategy, the mobile app system based on social and pathological characteristics of TB has potential as a TB screening tool to identify missing TB cases and to reduce TB morbidity and mortality, thereby helping to achieve the global goal of ?End TB? in resource-limited settings with a high TB burden. UR - https://formative.jmir.org/2023/1/e51998 UR - http://dx.doi.org/10.2196/51998 UR - http://www.ncbi.nlm.nih.gov/pubmed/37948119 ID - info:doi/10.2196/51998 ER - TY - JOUR AU - Feldacker, Caryl AU - Mugwanya, Raymond AU - Irongo, Daniel AU - Kathumba, Daneck AU - Chiwoko, Jane AU - Kitsao, Emmanuel AU - Sippell, Kenn AU - Wasunna, Beatrice AU - Jonas, Kingsley AU - Samala, Bernadette AU - Mwakanema, Daniel AU - Oni, Femi AU - Jafa, Krishna AU - Tweya, Hannock PY - 2023/11/10 TI - A Community-Based, Mobile Electronic Medical Record System App for High-Quality, Integrated Antiretroviral Therapy in Lilongwe, Malawi: Design Process and Pilot Implementation JO - JMIR Form Res SP - e48671 VL - 7 KW - antiretroviral therapy KW - differentiated service delivery KW - digital innovations KW - Malawi KW - mobile electronic medical record systems KW - monitoring and evaluation N2 - Background: Differentiated service delivery (DSD) increases antiretroviral therapy (ART) access in sub-Saharan Africa by moving clients out of congested ART clinics to communities for care. However, DSD settings challenge provider adherence to complex, chronic care treatment guidelines and have burdensome systems for client monitoring and evaluation (M&E), reducing data for decision-making. Electronic medical record systems (EMRS) improve client outcomes and reduce M&E workload. Traditional EMRS cannot operate in most DSD settings with unreliable power and poor connectivity. Objective: This study aims to detail the human-centered design (HCD) process of developing a mobile EMRS for community-based DSD services in Lilongwe, Malawi. Methods: Lighthouse Trust (LT) operates 2 Ministry of Health (MoH) clinics in Lilongwe, Malawi, with a combined total of >35,000 ART clients. LT?s real-time, point-of-care EMRS collects complex client M&E data and provides decision-making support, ensuring adherence to integrated HIV and tuberculosis guidelines that optimize client and program outcomes. LT?s EMRS scaled to all large MoH ART clinics. LT also implements a nurse-led community-based ART program (NCAP), a DSD model to provide ART and rapid assessment for 2400 stable LT clients in the community. LT, alongside collaborators, from the University of Washington?s International Training and Education Center for Health and technology partner, Medic, used the open-source Community Health Toolkit (CHT) and HCD to develop an open-source, offline-first, mobile EMRS-like app, ?community-based ART retention and suppression? (CARES). CARES aims to bring EMRS-like provider benefits to NCAP?s DSD clients. Results: CARES design took approximately 12 months and used an iterative process of highly participatory feedback sessions with provider, data manager, and M&E team inputs to ensure CARES optimization for the NCAP and LT settings. The CARES mobile EMRS prototype supports NCAP providers with embedded prompts and alerts to ensure adherence to integrated MoH ART guidelines, aiming to improve the quality of client care. CARES facilitates improved data quality and flow for NCAP M&E, aiming to reduce data gaps between community and clinic settings. The CARES pilot demonstrates the potential of a mobile, point-of-care EMRS-like app that could benefit NCAP clients, providers, and program teams with integrated client care and complete M&E data for decision-making. CARES challenges include app speed, search features to align longitudinal records, and CARES to EMRS integration that supports timely care alerts. Conclusions: Leveraging the CHT and HCD processes facilitated the design of a locally specified and optimized mobile app with the promise to bring EMRS-like benefits to DSD settings. Moving from the CARES prototype to routine NCAP implementation should result in improved client care and strengthened M&E while reducing workload. Our transparent and descriptive process shares the progress and pitfalls of the CARES design and development, helping others in this digital innovation area to learn from our experiences at this stage. UR - https://formative.jmir.org/2023/1/e48671 UR - http://dx.doi.org/10.2196/48671 UR - http://www.ncbi.nlm.nih.gov/pubmed/37948102 ID - info:doi/10.2196/48671 ER - TY - JOUR AU - Sun, Haonan AU - Zhang, Kai AU - Lan, Wei AU - Gu, Qiufeng AU - Jiang, Guangxiang AU - Yang, Xue AU - Qin, Wanli AU - Han, Dongran PY - 2023/11/9 TI - An AI Dietitian for Type 2 Diabetes Mellitus Management Based on Large Language and Image Recognition Models: Preclinical Concept Validation Study JO - J Med Internet Res SP - e51300 VL - 25 KW - ChatGPT KW - artificial intelligence KW - AI KW - diabetes KW - diabetic KW - nutrition KW - nutritional KW - diet KW - dietary KW - dietician KW - medical nutrition therapy KW - ingredient recognition KW - digital health KW - language model KW - image recognition KW - machine learning KW - deep learning KW - NLP KW - natural language processing KW - meal KW - recommendation KW - meals KW - food KW - GPT 4.0 N2 - Background: Nutritional management for patients with diabetes in China is a significant challenge due to the low supply of registered clinical dietitians. To address this, an artificial intelligence (AI)?based nutritionist program that uses advanced language and image recognition models was created. This program can identify ingredients from images of a patient?s meal and offer nutritional guidance and dietary recommendations. Objective: The primary objective of this study is to evaluate the competence of the models that support this program. Methods: The potential of an AI nutritionist program for patients with type 2 diabetes mellitus (T2DM) was evaluated through a multistep process. First, a survey was conducted among patients with T2DM and endocrinologists to identify knowledge gaps in dietary practices. ChatGPT and GPT 4.0 were then tested through the Chinese Registered Dietitian Examination to assess their proficiency in providing evidence-based dietary advice. ChatGPT?s responses to common questions about medical nutrition therapy were compared with expert responses by professional dietitians to evaluate its proficiency. The model?s food recommendations were scrutinized for consistency with expert advice. A deep learning?based image recognition model was developed for food identification at the ingredient level, and its performance was compared with existing models. Finally, a user-friendly app was developed, integrating the capabilities of language and image recognition models to potentially improve care for patients with T2DM. Results: Most patients (182/206, 88.4%) demanded more immediate and comprehensive nutritional management and education. Both ChatGPT and GPT 4.0 passed the Chinese Registered Dietitian examination. ChatGPT?s food recommendations were mainly in line with best practices, except for certain foods like root vegetables and dry beans. Professional dietitians? reviews of ChatGPT?s responses to common questions were largely positive, with 162 out of 168 providing favorable reviews. The multilabel image recognition model evaluation showed that the Dino V2 model achieved an average F1 score of 0.825, indicating high accuracy in recognizing ingredients. Conclusions: The model evaluations were promising. The AI-based nutritionist program is now ready for a supervised pilot study. UR - https://www.jmir.org/2023/1/e51300 UR - http://dx.doi.org/10.2196/51300 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943581 ID - info:doi/10.2196/51300 ER - TY - JOUR AU - Santiago-Torres, Margarita AU - Mull, E. Kristin AU - Sullivan, M. Brianna AU - Bricker, B. Jonathan PY - 2023/11/9 TI - Use of e-Cigarettes in Cigarette Smoking Cessation: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e48896 VL - 11 KW - acceptance and commitment therapy KW - cigarette smoking KW - digital behavioral interventions KW - e-cigarettes KW - smoking cessation KW - smartphone apps KW - vaping KW - mobile phone N2 - Background: Many adults use e-cigarettes to help them quit cigarette smoking. However, the impact of self-selected use of e-cigarettes on cigarette smoking cessation, particularly when concurrently receiving app-based behavioral interventions, remains unexplored. Objective: This study used data from a randomized trial of 2 smartphone apps to compare 12-month cigarette smoking cessation rates between participants who used e-cigarettes on their own (ie, adopters: n=465) versus those who did not (ie, nonadopters: n=1097). Methods: The study population included all participants who did not use e-cigarettes at baseline. ?Adopters? were those who self-reported the use of e-cigarettes at either 3- or 6-month follow-ups. ?Nonadopters? were those who self-reported no use of e-cigarettes at either follow-up time point. The primary cessation outcome was self-reported, complete-case, 30-day point prevalence abstinence from cigarette smoking at 12 months. Secondary outcomes were missing-as-smoking and multiple imputation analyses of the primary outcome, prolonged abstinence, and cessation of all nicotine and tobacco products at 12 months. In logistic regression models, we first examined the potential interaction between e-cigarette use and treatment arm (iCanQuit vs QuitGuide) on the primary cessation outcome. Subsequently, we compared 12-month cigarette smoking cessation rates between adopters and nonadopters separately for each app. Results: There was suggestive evidence for an interaction between e-cigarette use and treatment arm on cessation (P=.05). In the iCanQuit arm, 12-month cigarette smoking cessation rates were significantly lower among e-cigarette adopters compared with nonadopters (41/193, 21.2% vs 184/527, 34.9%; P=.003; odds ratio 0.55, 95% CI 0.37-0.81). In contrast, in the QuitGuide arm, 12-month cigarette smoking cessation rates did not differ between adopters and nonadopters (46/246, 18.7% vs 104/522, 19.9%; P=.64; odds ratio 0.91, 95% CI 0.62-1.35). Conclusions: The use of e-cigarettes while concurrently receiving an app-based smoking cessation intervention was associated with either a lower or an unimproved likelihood of quitting cigarette smoking compared to no use. Future behavioral treatments for cigarette smoking cessation should consider including information on the potential consequences of e-cigarette use. Trial Registration: ClinicalTrials.gov NCT02724462; https://clinicaltrials.gov/study/NCT02724462 UR - https://mhealth.jmir.org/2023/1/e48896 UR - http://dx.doi.org/10.2196/48896 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943594 ID - info:doi/10.2196/48896 ER - TY - JOUR AU - Abd-alrazaq, Alaa AU - AlSaad, Rawan AU - Harfouche, Manale AU - Aziz, Sarah AU - Ahmed, Arfan AU - Damseh, Rafat AU - Sheikh, Javaid PY - 2023/11/8 TI - Wearable Artificial Intelligence for Detecting Anxiety: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e48754 VL - 25 KW - anxiety KW - artificial intelligence KW - wearable devices KW - machine learning KW - systematic review KW - mobile phone N2 - Background: Anxiety disorders rank among the most prevalent mental disorders worldwide. Anxiety symptoms are typically evaluated using self-assessment surveys or interview-based assessment methods conducted by clinicians, which can be subjective, time-consuming, and challenging to repeat. Therefore, there is an increasing demand for using technologies capable of providing objective and early detection of anxiety. Wearable artificial intelligence (AI), the combination of AI technology and wearable devices, has been widely used to detect and predict anxiety disorders automatically, objectively, and more efficiently. Objective: This systematic review and meta-analysis aims to assess the performance of wearable AI in detecting and predicting anxiety. Methods: Relevant studies were retrieved by searching 8 electronic databases and backward and forward reference list checking. In total, 2 reviewers independently carried out study selection, data extraction, and risk-of-bias assessment. The included studies were assessed for risk of bias using a modified version of the Quality Assessment of Diagnostic Accuracy Studies?Revised. Evidence was synthesized using a narrative (ie, text and tables) and statistical (ie, meta-analysis) approach as appropriate. Results: Of the 918 records identified, 21 (2.3%) were included in this review. A meta-analysis of results from 81% (17/21) of the studies revealed a pooled mean accuracy of 0.82 (95% CI 0.71-0.89). Meta-analyses of results from 48% (10/21) of the studies showed a pooled mean sensitivity of 0.79 (95% CI 0.57-0.91) and a pooled mean specificity of 0.92 (95% CI 0.68-0.98). Subgroup analyses demonstrated that the performance of wearable AI was not moderated by algorithms, aims of AI, wearable devices used, status of wearable devices, data types, data sources, reference standards, and validation methods. Conclusions: Although wearable AI has the potential to detect anxiety, it is not yet advanced enough for clinical use. Until further evidence shows an ideal performance of wearable AI, it should be used along with other clinical assessments. Wearable device companies need to develop devices that can promptly detect anxiety and identify specific time points during the day when anxiety levels are high. Further research is needed to differentiate types of anxiety, compare the performance of different wearable devices, and investigate the impact of the combination of wearable device data and neuroimaging data on the performance of wearable AI. Trial Registration: PROSPERO CRD42023387560; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387560 UR - https://www.jmir.org/2023/1/e48754 UR - http://dx.doi.org/10.2196/48754 UR - http://www.ncbi.nlm.nih.gov/pubmed/37938883 ID - info:doi/10.2196/48754 ER - TY - JOUR AU - Eguchi, Akifumi AU - Kawamura, Yumi AU - Kawashima, Takayuki AU - Ghaznavi, Cyrus AU - Ishimura, Keiko AU - Kohsaka, Shun AU - Matsuo, Satoru AU - Mizuno, Shinichiro AU - Sasaki, Yuki AU - Takahashi, Arata AU - Tanoue, Yuta AU - Yoneoka, Daisuke AU - Miyata, Hiroaki AU - Nomura, Shuhei PY - 2023/11/8 TI - The Efficacy of an mHealth App in Facilitating Weight Loss Among Japanese Fitness Center Members: Regression Analysis Study JO - JMIR Form Res SP - e48435 VL - 7 KW - digital health KW - gym attendance KW - Japan KW - real-world data KW - smartphone application KW - weight loss N2 - Background: Self-tracking smartphone apps have emerged as promising tools to encourage healthy behaviors. In this longitudinal study, we used gym use data from members of a major fitness club that operates gyms throughout Japan from January 2014 to December 2019. Objective: Our objective was to assess the extent to which a health and fitness self-tracking mobile app introduced to gym members on January 1, 2018, contributed to their weight loss. The app allows users to input information regarding diet, sleep, weight, and gym exercise so that they can receive personalized feedback from an artificial intelligence chatbot to improve their health behaviors. Methods: We used linear regression to quantify the association between app use and weight loss. The primary outcome of the study was the weight loss achieved by each gym user, which was calculated as the difference between their initial and final weights in kilograms, as recorded in the app. Individuals who did not attend the gym or failed to use the mobile app at least twice during the study period were excluded from the analysis. The model accounted for age, gender, distance between the gym and the member?s residence, average weekly number of times a member used the gym, user?s gym membership length in weeks, average weekly number of times a member input information into the app, and the number of weeks that the app was used at least once. Results: Data from 26,589 participants were analyzed. Statistically significant associations were detected between weight loss and 2 metrics related to app use: the average weekly frequency of use and the total number of weeks in which the app was used at least once. One input per week was found to be associated with a loss of 62.1 (95% CI 53.8-70.5) g, and 1 week of app use was associated with 21.7 (95% CI 20.5-22.9) g of weight loss from the day of the first input to that of the final input to the app. Furthermore, the average number of times that a member used the gym weekly was also shown to be statistically significantly associated with weight loss: 1 use per week was associated with 255.5 (95% CI 228.5-282.6) g of weight loss. Conclusions: This empirical study demonstrated a significant association between weight loss among gym members and not only the frequency of weekly gym use but also the use of a health and fitness self-tracking app. However, further work is needed to examine the mechanisms through which mobile apps affect health behaviors and to identify the specific app features that are most effective in promoting weight loss. UR - https://formative.jmir.org/2023/1/e48435 UR - http://dx.doi.org/10.2196/48435 UR - http://www.ncbi.nlm.nih.gov/pubmed/37938885 ID - info:doi/10.2196/48435 ER - TY - JOUR AU - Nowell, B. William AU - Curtis, R. Jeffrey AU - Zhao, Hong AU - Xie, Fenglong AU - Stradford, Laura AU - Curtis, David AU - Gavigan, Kelly AU - Boles, Jessica AU - Clinton, Cassie AU - Lipkovich, Ilya AU - Venkatachalam, Shilpa AU - Calvin, Amy AU - Hayes, S. Virginia PY - 2023/11/7 TI - Participant Engagement and Adherence to Providing Smartwatch and Patient-Reported Outcome Data: Digital Tracking of Rheumatoid Arthritis Longitudinally (DIGITAL) Real-World Study JO - JMIR Hum Factors SP - e44034 VL - 10 KW - real-world evidence KW - real-world data KW - patients KW - rheumatoid arthritis KW - patient-reported outcomes KW - patient-generated health data KW - mobile technology KW - wearable digital technology KW - mobile phone N2 - Background: Digital health studies using electronic patient-reported outcomes (ePROs) and wearables bring new challenges, including the need for participants to consistently provide trial data. Objective: This study aims to characterize the engagement, protocol adherence, and data completeness among participants with rheumatoid arthritis enrolled in the Digital Tracking of Arthritis Longitudinally (DIGITAL) study. Methods: Participants were invited to participate in this app-based study, which included a 14-day run-in and an 84-day main study. In the run-in period, data were collected via the ArthritisPower mobile app to increase app familiarity and identify the individuals who were motivated to participate. Successful completers of the run-in period were mailed a wearable smartwatch, and automated and manual prompts were sent to participants, reminding them to complete app input or regularly wear and synchronize devices, respectively, during the main study. Study coordinators monitored participant data and contacted participants via email, SMS text messaging, and phone to resolve adherence issues per a priori rules, in which consecutive spans of missing data triggered participant contact. Adherence to data collection during the main study period was defined as providing requested data for >70% of 84 days (daily ePRO, ?80% daily smartwatch data) or at least 9 of 12 weeks (weekly ePRO). Results: Of the 470 participants expressing initial interest, 278 (59.1%) completed the run-in period and qualified for the main study. Over the 12-week main study period, 87.4% (243/278) of participants met the definition of adherence to protocol-specified data collection for weekly ePRO, and 57.2% (159/278) did so for daily ePRO. For smartwatch data, 81.7% (227/278) of the participants adhered to the protocol-specified data collection. In total, 52.9% (147/278) of the participants met composite adherence. Conclusions: Compared with other digital health rheumatoid arthritis studies, a short run-in period appears useful for identifying participants likely to engage in a study that collects data via a mobile app and wearables and gives participants time to acclimate to study requirements. Automated or manual prompts (ie, ?It?s time to sync your smartwatch?) may be necessary to optimize adherence. Adherence varies by data collection type (eg, ePRO vs smartwatch data). International Registered Report Identifier (IRRID): RR2-10.2196/14665 UR - https://humanfactors.jmir.org/2023/1/e44034 UR - http://dx.doi.org/10.2196/44034 UR - http://www.ncbi.nlm.nih.gov/pubmed/37934559 ID - info:doi/10.2196/44034 ER - TY - JOUR AU - Zaki, Sasha PY - 2023/11/6 TI - Tailoring Educational Materials to Cultural Context Matters JO - J Med Internet Res SP - e42604 VL - 25 KW - Bangladesh KW - health education KW - health knowledge KW - quality of life KW - motivation KW - randomized controlled trial KW - RCT KW - campaign KW - chronic kidney disease KW - knowledge KW - mobile health KW - mHealth KW - kidney KW - chronic disease KW - chronic condition KW - patient education KW - patient knowledge KW - low- and middle-income countries KW - LMIC UR - https://www.jmir.org/2023/1/e42604 UR - http://dx.doi.org/10.2196/42604 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930771 ID - info:doi/10.2196/42604 ER - TY - JOUR AU - Kerber, André AU - Beintner, Ina AU - Burchert, Sebastian AU - Knaevelsrud, Christine PY - 2023/11/6 TI - Effects of a Self-Guided Transdiagnostic Smartphone App on Patient Empowerment and Mental Health: Randomized Controlled Trial JO - JMIR Ment Health SP - e45068 VL - 10 KW - patient empowerment KW - mental health?related self-management skills KW - help-seeking attitude KW - mental health literacy KW - internet-based interventions KW - unguided KW - self-guided KW - transdiagnostic mental health app N2 - Background: Mental disorders impact both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in chronification. Besides limited health care resources, within-person barriers such as the lack of trust in professionals, the fear of stigmatization, or the desire to cope with problems without professional help contribute to the treatment gap. Self-guided mental health apps may support treatment seeking by reducing within-person barriers and facilitating mental health literacy. Digital mental health interventions may also improve mental health related self-management skills and contribute to symptom reduction and the improvement of quality of life. Objective: This study aims to investigate the effects of a self-guided transdiagnostic app for mental health on help seeking, reduced stigma, mental health literacy, self-management skills, mental health symptoms, and quality of life using a randomized controlled design. Methods: Overall, 1045 participants (recruited via open, blinded, and web-based recruitment) with mild to moderate depression or anxiety-, sleep-, eating-, or somatization-related psychopathology were randomized to receive either access to a self-guided transdiagnostic mental health app (MindDoc) in addition to care as usual or care as usual only. The core features of the app were regular self-monitoring, automated feedback, and psychological courses and exercises. The coprimary outcomes were mental health literacy, mental health?related patient empowerment and self-management skills (MHPSS), attitudes toward help seeking, and actual mental health service use. The secondary outcomes were psychopathological symptom burden and quality of life. Data were collected at baseline and 8 weeks and 6 months after randomization. Treatment effects were investigated using analyses of covariance, including baseline variables as predictors and applying multiple imputation. Results: We found small but robust between-group effects for MHPSS (Cohen d=0.29), symptoms burden (Cohen d=0.28), and quality of life (Cohen d=0.19) 8 weeks after randomization. The effects on MHPSS were maintained at follow-up. Follow-up assessments also showed robust effects on mental health literacy and preliminary evidence for the improvement of help seeking. Predictors of attrition were lower age and higher personality dysfunction. Among the non-attritors, predictors for deterioration were less outpatient treatment and higher initial symptom severity. Conclusions: A self-guided transdiagnostic mental health app can contribute to lasting improvements in patient empowerment. Symptoms of common mental disorders and quality of life improved faster in the intervention group than in the control group. Therefore, such interventions may support individuals with symptoms of 1 or more internalizing disorders, develop health-centered coping skills, prevent chronification, and accelerate symptom improvement. Although the effects for individual users are small and predictors of attrition and deterioration need to be investigated further, the potential public health impact of a self-guided intervention can be large, given its high scalability. Trial Registration: German Clinical Trials Register DRKS00022531; https://drks.de/search/de/trial/DRKS00022531 UR - https://mental.jmir.org/2023/1/e45068 UR - http://dx.doi.org/10.2196/45068 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930749 ID - info:doi/10.2196/45068 ER - TY - JOUR AU - Berry, Michael AU - Taylor, Lauren AU - Huang, Zhuoran AU - Chwyl, Christina AU - Kerrigan, Stephanie AU - Forman, Evan PY - 2023/11/6 TI - Automated Messaging Delivered Alongside Behavioral Treatment for Weight Loss: Qualitative Study JO - JMIR Form Res SP - e50872 VL - 7 KW - mobile health technology KW - weight loss KW - tailored messaging KW - lifestyle modification KW - mobile health KW - mHealth KW - messaging KW - intervention KW - overweight KW - obesity KW - qualitative KW - thematic analysis N2 - Background: Mobile health interventions for weight loss frequently use automated messaging. However, this intervention modality appears to have limited weight loss efficacy. Furthermore, data on users? subjective experiences while receiving automated messaging?based interventions for weight loss are scarce, especially for more advanced messaging systems providing users with individually tailored, data-informed feedback. Objective: The purpose of this study was to characterize the experiences of individuals with overweight or obesity who received automated messages for 6-12 months as part of a behavioral weight loss trial. Methods: Participants (n=40) provided Likert-scale ratings of messaging acceptability and completed a structured qualitative interview (n=39) focused on their experiences with the messaging system and generating suggestions for improvement. Interview data were analyzed using thematic analysis. Results: Participants found the messages most useful for summarizing goal progress and least useful for suggesting new behavioral strategies. Overall message acceptability was moderate (2.67 out of 5). From the interviews, 2 meta-themes emerged. Participants indicated that although the messages provided useful reminders of intervention goals and skills, they did not adequately capture their lived experiences while losing weight. Conclusions: Many participants found the automated messages insufficiently tailored to their personal weight loss experiences. Future studies should explore alternative methods for message tailoring (eg, allowing for a higher degree of participant input and interactivity) that may boost treatment engagement and efficacy. Trial Registration: ClinicalTrials.gov NCT05231824; https://clinicaltrials.gov/study/NCT05231824 UR - https://formative.jmir.org/2023/1/e50872 UR - http://dx.doi.org/10.2196/50872 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930786 ID - info:doi/10.2196/50872 ER - TY - JOUR AU - Foley, Gillian AU - Ricciardelli, Rosemary PY - 2023/11/6 TI - Views on the Functionality and Use of the PeerConnect App Among Public Safety Personnel: Qualitative Analysis JO - JMIR Form Res SP - e46968 VL - 7 KW - peer support KW - apps KW - mobile health technology KW - mobile health KW - mHealth KW - public safety personnel KW - correctional workers KW - police officers KW - emergency workers KW - first responders KW - mental health KW - Canada KW - digital health KW - intervention KW - peers KW - mobile app KW - peer support apps KW - web-based KW - web-based communities N2 - Background: Research supports that public safety personnel (PSP) are regularly exposed to potentially psychologically traumatic events and occupational stress, which can compromise their well-being. To help address PSP well-being and mental health, peer support is increasingly being adopted (and developed) in PSP organizations. Peer support apps have been developed to connect the peer and peer supporter anonymously and confidentially, but little is known about their effectiveness, utility, and uptake. Objective: We designed this study to evaluate the functionality and use of the PeerConnect app, which is a vehicle for receiving and administering peer support. The app connects peers but also provides information (eg, mental health screening tools, newsfeed) to users; thus, we wanted to understand why PSP adopted or did not adopt the app and the app?s perceived utility. Our intention was to determine if the app served the purpose of connectivity for PSP organizations implementing peer support. Methods: A sample of PSP (N=23) participated in an interview about why they used or did not use the app. We first surveyed participants across PSP organizations in Ontario, Canada, and at the end of the survey invited participants to participate in a follow-up interview. Of the 23 PSP interviewed, 16 were PeerConnect users and 7 were nonusers. After transcribing all audio recordings of the interviews, we used an emergent theme approach to analyze themes within and across responses. Results: PSP largely viewed PeerConnect positively, with the Connect feature being most popular (this feature facilitated peer support), followed by the Newsfeed and Resources. App users appreciated the convenience of the app and felt the app helped reduce the stigma around peer support use and pressure on peer supporters while raising awareness of wellness. PSP who did not use the app attributed their nonuse to disinterest or uncertainty about the need for a peer support app and the web-based nature of the app. To increase app adoption, participants recommended increased communication and promotion of the app by the services and continued efforts to combat mental health stigma. Conclusions: We provide contextual information about a peer support app?s functionality and use. Our findings demonstrate that PSP are open to the use of mental health and peer support apps, but more education is required to reduce mental health stigma. Future research should continue to evaluate peer support apps for PSP to inform their design and ensure they are fulfilling their purpose. UR - https://formative.jmir.org/2023/1/e46968 UR - http://dx.doi.org/10.2196/46968 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930765 ID - info:doi/10.2196/46968 ER - TY - JOUR AU - Simonson, K. Julie AU - Anderson, Misty AU - Polacek, Cate AU - Klump, Erika AU - Haque, N. Saira PY - 2023/11/3 TI - Characterizing Real-World Implementation of Consumer Wearables for the Detection of Undiagnosed Atrial Fibrillation in Clinical Practice: Targeted Literature Review JO - JMIR Cardio SP - e47292 VL - 7 KW - arrhythmias KW - atrial fibrillation KW - clinical workflow KW - consumer wearable devices KW - smartwatches KW - wearables KW - remote patient monitoring KW - virtual care KW - mobile phone N2 - Background: Atrial fibrillation (AF), the most common cardiac arrhythmia, is often undiagnosed because of lack of awareness and frequent asymptomatic presentation. As AF is associated with increased risk of stroke, early detection is clinically relevant. Several consumer wearable devices (CWDs) have been cleared by the US Food and Drug Administration for irregular heart rhythm detection suggestive of AF. However, recommendations for the use of CWDs for AF detection in clinical practice, especially with regard to pathways for workflows and clinical decisions, remain lacking. Objective: We conducted a targeted literature review to identify articles on CWDs characterizing the current state of wearable technology for AF detection, identifying approaches to implementing CWDs into the clinical workflow, and characterizing provider and patient perspectives on CWDs for patients at risk of AF. Methods: PubMed, ClinicalTrials.gov, UpToDate Clinical Reference, and DynaMed were searched for articles in English published between January 2016 and July 2023. The searches used predefined Medical Subject Headings (MeSH) terms, keywords, and search strings. Articles of interest were specifically on CWDs; articles on ambulatory monitoring tools, tools available by prescription, or handheld devices were excluded. Search results were reviewed for relevancy and discussed among the authors for inclusion. A qualitative analysis was conducted and themes relevant to our study objectives were identified. Results: A total of 31 articles met inclusion criteria: 7 (23%) medical society reports or guidelines, 4 (13%) general reviews, 5 (16%) systematic reviews, 5 (16%) health care provider surveys, 7 (23%) consumer or patient surveys or interviews, and 3 (10%) analytical reports. Despite recognition of CWDs by medical societies, detailed guidelines regarding CWDs for AF detection were limited, as was the availability of clinical tools. A main theme was the lack of pragmatic studies assessing real-world implementation of CWDs for AF detection. Clinicians expressed concerns about data overload; potential for false positives; reimbursement issues; and the need for clinical tools such as care pathways and guidelines, preferably developed or endorsed by professional organizations. Patient-facing challenges included device costs and variability in digital literacy or technology acceptance. Conclusions: This targeted literature review highlights the lack of a comprehensive body of literature guiding real-world implementation of CWDs for AF detection and provides insights for informing additional research and developing appropriate tools and resources for incorporating these devices into clinical practice. The results should also provide an impetus for the active involvement of medical societies and other health care stakeholders in developing appropriate tools and resources for guiding the real-world use of CWDs for AF detection. These resources should target clinicians, patients, and health care systems with the goal of facilitating clinician or patient engagement and using an evidence-based approach for establishing guidelines or frameworks for administrative workflows and patient care pathways. UR - https://cardio.jmir.org/2023/1/e47292 UR - http://dx.doi.org/10.2196/47292 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921865 ID - info:doi/10.2196/47292 ER - TY - JOUR AU - Soehnchen, Clarissa AU - Rietz, Annika AU - Weirauch, Vera AU - Meister, Sven AU - Henningsen, Maike PY - 2023/11/3 TI - Creating an Intercultural User-Centric Design for a Digital Sexual Health Education App for Young Women in Resource-Poor Regions of Kenya: Qualitative Self-Extended Double Diamond Model for Requirements Engineering Analysis JO - JMIR Form Res SP - e50304 VL - 7 KW - sexual health information KW - sexual health education KW - sub-Saharan Africa KW - women KW - semistructured interviews KW - requirements engineering analysis KW - user-centered design KW - youth, slum KW - health education KW - sexual health KW - digital health KW - stigmatization KW - reproductive health services N2 - Background: The stigmatization around sexual health due to culture, religious traditions, and norms leads to myths and a lack of available information and resources related to universal access to sexual and reproductive health services. Additional sexual health education not being part of the Kenya school curriculum leads to insufficient access to knowledge about safe contraception, menstruation, and female genital mutilation. A digital app could support and provide education and information for universal equal access, addressing United Nations Sustainable Development Goals 3, 4, and 5. Objective: The study targeted the requirements for establishing a reusable framework to develop a successful accessible web-based sexual health education app and the behavioral intention to use it to obtain sexual health information by mainly young women in Kenya. Methods: The double diamond model, with a problem room including the discover and define phases, enriched with cultural aspects and modeled to a self-expanded intercultural research model was used in a user-centered design thinking approach to develop a framework for requirements engineering analysis. For problem identification, semistructured pilot phase interviews based on Consolidated Criteria for Reporting Qualitative Research guidelines were conducted, followed by expert interviews for qualitative content analysis. A sample size of 12 pilot phase interviews and 5 expert interviews was determined using data saturation. The responses were coded and analyzed according to the affinity mapping method. Results: The requirements engineering analysis showed potential enablers of and barriers to the use of a digital sexual health education app. Through this qualitative study, a conservative cultural background, classic text communication, and the influence of social affiliation within society were identified as barriers, which should be enhanced through visual and auditory channels as well as a fictional character in the app. Conclusions: The developed intercultural research model provides an impetus to providing digital sexual health education, integrating culture-specific aspects in the design process, while focusing on cultural and religious stigmata. The reusable framework enables identifying and overcoming hurdles in providing information about taboo and intimate topics. The overall use of online education tools focusing on intimate topics is correlated with accessibility and understanding specific cultural needs while delivering content on a basic and comprehensive level. It helps the target user from a social conservative background and in resource-poor circumstances to benefit from a digital educational solution. UR - https://formative.jmir.org/2023/1/e50304 UR - http://dx.doi.org/10.2196/50304 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921860 ID - info:doi/10.2196/50304 ER - TY - JOUR AU - Lee, Taeyoung AU - Cho, Younghoon AU - Cha, Su Kwang AU - Jung, Jinhwan AU - Cho, Jungim AU - Kim, Hyunggug AU - Kim, Daewoo AU - Hong, Joonki AU - Lee, Dongheon AU - Keum, Moonsik AU - Kushida, A. Clete AU - Yoon, In-Young AU - Kim, Jeong-Whun PY - 2023/11/2 TI - Accuracy of 11 Wearable, Nearable, and Airable Consumer Sleep Trackers: Prospective Multicenter Validation Study JO - JMIR Mhealth Uhealth SP - e50983 VL - 11 KW - consumer sleep trackers KW - wearables KW - nearables KW - airables KW - sleep monitoring KW - sleep stage KW - comparative study KW - polysomnography KW - multicenter study KW - deep learning KW - artificial intelligence KW - Fitbit Sense 2, Amazon Halo Rise, SleepRoutine N2 - Background: Consumer sleep trackers (CSTs) have gained significant popularity because they enable individuals to conveniently monitor and analyze their sleep. However, limited studies have comprehensively validated the performance of widely used CSTs. Our study therefore investigated popular CSTs based on various biosignals and algorithms by assessing the agreement with polysomnography. Objective: This study aimed to validate the accuracy of various types of CSTs through a comparison with in-lab polysomnography. Additionally, by including widely used CSTs and conducting a multicenter study with a large sample size, this study seeks to provide comprehensive insights into the performance and applicability of these CSTs for sleep monitoring in a hospital environment. Methods: The study analyzed 11 commercially available CSTs, including 5 wearables (Google Pixel Watch, Galaxy Watch 5, Fitbit Sense 2, Apple Watch 8, and Oura Ring 3), 3 nearables (Withings Sleep Tracking Mat, Google Nest Hub 2, and Amazon Halo Rise), and 3 airables (SleepRoutine, SleepScore, and Pillow). The 11 CSTs were divided into 2 groups, ensuring maximum inclusion while avoiding interference between the CSTs within each group. Each group (comprising 8 CSTs) was also compared via polysomnography. Results: The study enrolled 75 participants from a tertiary hospital and a primary sleep-specialized clinic in Korea. Across the 2 centers, we collected a total of 3890 hours of sleep sessions based on 11 CSTs, along with 543 hours of polysomnography recordings. Each CST sleep recording covered an average of 353 hours. We analyzed a total of 349,114 epochs from the 11 CSTs compared with polysomnography, where epoch-by-epoch agreement in sleep stage classification showed substantial performance variation. More specifically, the highest macro F1 score was 0.69, while the lowest macro F1 score was 0.26. Various sleep trackers exhibited diverse performances across sleep stages, with SleepRoutine excelling in the wake and rapid eye movement stages, and wearables like Google Pixel Watch and Fitbit Sense 2 showing superiority in the deep stage. There was a distinct trend in sleep measure estimation according to the type of device. Wearables showed high proportional bias in sleep efficiency, while nearables exhibited high proportional bias in sleep latency. Subgroup analyses of sleep trackers revealed variations in macro F1 scores based on factors, such as BMI, sleep efficiency, and apnea-hypopnea index, while the differences between male and female subgroups were minimal. Conclusions: Our study showed that among the 11 CSTs examined, specific CSTs showed substantial agreement with polysomnography, indicating their potential application in sleep monitoring, while other CSTs were partially consistent with polysomnography. This study offers insights into the strengths of CSTs within the 3 different classes for individuals interested in wellness who wish to understand and proactively manage their own sleep. UR - https://mhealth.jmir.org/2023/1/e50983 UR - http://dx.doi.org/10.2196/50983 UR - http://www.ncbi.nlm.nih.gov/pubmed/37917155 ID - info:doi/10.2196/50983 ER - TY - JOUR AU - Martinengo, Laura AU - Lin, Xiaowen AU - Jabir, Ishqi Ahmad AU - Kowatsch, Tobias AU - Atun, Rifat AU - Car, Josip AU - Tudor Car, Lorainne PY - 2023/11/1 TI - Conversational Agents in Health Care: Expert Interviews to Inform the Definition, Classification, and Conceptual Framework JO - J Med Internet Res SP - e50767 VL - 25 KW - conceptual framework KW - conversational agent KW - chatbot KW - mobile health KW - mHealth KW - digital health KW - expert interview KW - mobile phone N2 - Background: Conversational agents (CAs), or chatbots, are computer programs that simulate conversations with humans. The use of CAs in health care settings is recent and rapidly increasing, which often translates to poor reporting of the CA development and evaluation processes and unreliable research findings. We developed and published a conceptual framework, designing, developing, evaluating, and implementing a smartphone-delivered, rule-based conversational agent (DISCOVER), consisting of 3 iterative stages of CA design, development, and evaluation and implementation, complemented by 2 cross-cutting themes (user-centered design and data privacy and security). Objective: This study aims to perform in-depth, semistructured interviews with multidisciplinary experts in health care CAs to share their views on the definition and classification of health care CAs and evaluate and validate the DISCOVER conceptual framework. Methods: We conducted one-on-one semistructured interviews via Zoom (Zoom Video Communications) with 12 multidisciplinary CA experts using an interview guide based on our framework. The interviews were audio recorded, transcribed by the research team, and analyzed using thematic analysis. Results: Following participants? input, we defined CAs as digital interfaces that use natural language to engage in a synchronous dialogue using ?1 communication modality, such as text, voice, images, or video. CAs were classified by 13 categories: response generation method, input and output modalities, CA purpose, deployment platform, CA development modality, appearance, length of interaction, type of CA-user interaction, dialogue initiation, communication style, CA personality, human support, and type of health care intervention. Experts considered that the conceptual framework could be adapted for artificial intelligence?based CAs. However, despite recent advances in artificial intelligence, including large language models, the technology is not able to ensure safety and reliability in health care settings. Finally, aligned with participants? feedback, we present an updated iteration of the conceptual framework for health care conversational agents (CHAT) with key considerations for CA design, development, and evaluation and implementation, complemented by 3 cross-cutting themes: ethics, user involvement, and data privacy and security. Conclusions: We present an expanded, validated CHAT and aim at guiding researchers from a variety of backgrounds and with different levels of expertise in the design, development, and evaluation and implementation of rule-based CAs in health care settings. UR - https://www.jmir.org/2023/1/e50767 UR - http://dx.doi.org/10.2196/50767 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910153 ID - info:doi/10.2196/50767 ER - TY - JOUR AU - Dahne, Jennifer AU - Wahlquist, E. Amy AU - Kustanowitz, Jacob AU - Natale, Noelle AU - Fahey, Margaret AU - Graboyes, M. Evan AU - Diaz, A. Vanessa AU - Carpenter, J. Matthew PY - 2023/11/1 TI - Behavioral Activation?Based Digital Smoking Cessation Intervention for Individuals With Depressive Symptoms: Randomized Clinical Trial JO - J Med Internet Res SP - e49809 VL - 25 KW - smoking cessation KW - depression KW - digital health KW - decentralized trial KW - mental health KW - depressive KW - RCT KW - randomized KW - controlled trial KW - smoking KW - smoke KW - smoker KW - quit KW - quitting KW - cessation KW - eHealth KW - e-health KW - NRT KW - nicotine KW - mobile health KW - mHealth KW - app KW - apps KW - application KW - applications N2 - Background: Depression is common among adults who smoke cigarettes. Existing depression-specific cessation interventions have limited reach and are unlikely to improve smoking prevalence rates among this large subgroup of smokers. Objective: This study aimed to determine whether a mobile app?based intervention tailored for depression paired with a mailed sample of nicotine replacement therapy (NRT) is efficacious for treating depression and promoting smoking cessation. Methods: A 2-arm nationwide remote randomized clinical trial was conducted in the United States. Adults (N=150) with elevated depressive symptoms (Patient Health Questionnaire-8?10) who smoked were enrolled. The mobile app (?Goal2Quit?) provided behavioral strategies for treating depression and quitting smoking based on Behavioral Activation Treatment for Depression. Goal2Quit participants also received a 2-week sample of combination NRT. Treatment as usual participants received a self-help booklet for quitting smoking that was not tailored for depression. Primary end points included Goal2Quit usability, change in depression (Beck Depression Inventory-II) across 12 weeks, and smoking cessation including reduction in cigarettes per day, incidence of 24-hour quit attempts, floating abstinence, and 7-day point prevalence abstinence (PPA). Results: In total, 150 participants were enrolled between June 25, 2020, and February 23, 2022, of which 80 were female (53.3%) and the mean age was 38.4 (SD 10.3) years. At baseline, participants on average reported moderate depressive symptoms and smoked a mean of 14.7 (SD 7.5) cigarettes per day. Goal2Quit usability was strong with a mean usability rating on the System Usability Scale of 78.5 (SD 16.9), with 70% scoring above the ?68 cutoff for above-average usability. Retention data for app use were generally strong immediately following trial enrollment and declined in subsequent weeks. Those who received Goal2Quit and the NRT sample reported lower mean depressive symptoms over the trial duration as compared to treatment as usual (difference of mean 3.72, SE 1.37 points less; P=.01). Across time points, all cessation outcomes favored Goal2Quit. Regarding abstinence, Goal2Quit participants reported significantly higher rates of 7-day PPA at weeks 4 (11% vs 0%; P=.02), 8 (7-day PPA: 12% vs 0%; P=.02), and 12 (16% vs 2%; P=.02). Conclusions: A mobile app intervention tailored for depression paired with a sample of NRT was effective for depression treatment and smoking cessation. Findings support the utility of this intervention approach for addressing the currently unmet public health treatment need for tailored, scalable depression-specific cessation treatments. Trial Registration: ClinicalTrials.gov NCT03837379; https://clinicaltrials.gov/ct2/show/NCT03837379 UR - https://www.jmir.org/2023/1/e49809 UR - http://dx.doi.org/10.2196/49809 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910157 ID - info:doi/10.2196/49809 ER - TY - JOUR AU - Moorthy, Preetha AU - Weinert, Lina AU - Harms, Christian Bendix AU - Anders, Carolin AU - Siegel, Fabian PY - 2023/11/1 TI - German Version of the mHealth App Usability Questionnaire in a Cohort of Patients With Cancer: Translation and Validation Study JO - JMIR Hum Factors SP - e51090 VL - 10 KW - usability KW - mobile health KW - mHealth app KW - questionnaire validation KW - questionnaire translation KW - mHealth App Usability Questionnaire KW - MAUQ KW - mobile phone N2 - Background: Good usability is important for the adoption and continued use of mobile health (mHealth) apps. In particular, high usability can support intuitive use by patients, which improves compliance and increases the app?s effectiveness. However, many usability studies do not use adequate tools to measure perceived usability. The mHealth App Usability Questionnaire (MAUQ) was developed specifically for end users in a medical context. MAUQ is a relatively new but increasingly used questionnaire to evaluate mHealth apps, but it is not yet available in German. Objective: This study aims to translate MAUQ into German and determine its internal consistency, reliability, and construct validity. Methods: This validation study was conducted as part of a usability evaluation project for an mHealth app used as a therapy support tool during breast cancer chemotherapy. MAUQ was translated into German through a rigorous forward-backward translation process, ensuring semantic and conceptual equivalence. Patient responses to MAUQ and System Usability Scale (SUS) were analyzed for validation. Descriptive analysis was performed for the MAUQ subscales and SUS standard scores. Significance tests and correlation coefficients assessed the relationship between the SUS and MAUQ results, confirming construct validity. Internal consistency was assessed for item reliability and consistency in measuring the target construct. Free-text questions assessed translation comprehensibility, with responses analyzed descriptively and qualitatively using content analysis. Results: In this study, 133 participants responded to the questionnaire, and the validation analysis showed substantially positive correlations between the overall MAUQ score and its subscales: ease of use (r=0.56), interface and satisfaction (r=0.75), and usefulness (r=0.83). These findings support the construct validity of MAUQ and emphasize the importance of these subscales in assessing the usability of the Enable app. The correlation coefficients ranging from 0.39 to 0.68 for the items further validate the questionnaire by aligning with the overall score and capturing the intended concept. The high internal consistency reliability of MAUQ (Cronbach ?=.81) and its subscales further enhances the instrument?s robustness in accurately evaluating the usability of mHealth apps. Conclusions: We successfully validated the German translation of the MAUQ for stand-alone apps using a standardized approach in a cohort of patients with breast cancer. In our validation study, MAUQ exhibited strong internal consistency reliability (Cronbach ?=.81) across its subscales, indicating reliable and consistent measurement. Furthermore, a significant positive correlation (P<.001) was found between the subscales and the overall score, supporting their consistent measurement of the intended construct. Therefore, MAUQ can be considered a reliable instrument for assessing the usability of mHealth apps among German-speaking adults. The availability of the German version of MAUQ will help other researchers in conducting usability studies of mHealth apps in German-speaking cohorts and allow for international comparability of their results. UR - https://humanfactors.jmir.org/2023/1/e51090 UR - http://dx.doi.org/10.2196/51090 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910144 ID - info:doi/10.2196/51090 ER - TY - JOUR AU - Yamada, Kazunosuke AU - Enokida, Yasuaki AU - Kato, Ryuji AU - Imaizumi, Jun AU - Takada, Takahiro AU - Ojima, Hitoshi PY - 2023/11/1 TI - The Feasibility and Reliability of Upper Arm?Worn Apple Watch Heart Rate Monitoring for Surgeons During Surgery: Observational Study JO - JMIR Hum Factors SP - e50891 VL - 10 KW - Apple Watch KW - heart rate KW - surgery KW - robot N2 - Background: Health care professionals, particularly those in surgical settings, face high stress levels, impacting their well-being. Traditional monitoring methods, like using Holter electrocardiogram monitors, are impractical in the operating room, limiting the assessment of physicians? health. Wrist-worn heart rate monitors, like the Apple Watch, offer promise but are restricted in surgeries due to sterility issues. Objective: This study aims to assess the feasibility and accuracy of using an upper arm?worn Apple Watch for heart rate monitoring during robotic-assisted surgeries, comparing its performance with that of a wrist-worn device to establish a reliable alternative monitoring site. Methods: This study used 2 identical Apple Watch Series 8 devices to monitor the heart rate of surgeons during robotic-assisted surgery. Heart rate data were collected from the wrist-worn and the upper arm?worn devices. Statistical analyses included calculating the mean difference and SD of difference between the 2 devices, constructing Bland-Altman plots, assessing accuracy based on mean absolute error and mean absolute percentage error, and calculating the intraclass correlation coefficient. Results: The mean absolute errors for the whole group and for participants A, B, C, and D were 3.63, 3.58, 2.70, 3.93, and 4.28, respectively, and the mean absolute percentage errors were 3.58%, 3.34%, 2.42%, 4.58%, and 4.00%, respectively. Bland-Altman plots and scatter plots showed no systematic error when comparing the heart rate measurements obtained from the upper arm?worn and the wrist-worn Apple Watches. The intraclass correlation coefficients for participants A, B, C, and D were 0.559, 0.651, 0.508, and 0.563, respectively, with a significance level of P<.001, indicating moderate reliability. Conclusions: The findings of this study suggest that the upper arm is a viable alternative site for monitoring heart rate during surgery using an Apple Watch. The agreement and reliability between the measurements obtained from the upper arm?worn and the wrist-worn devices were good, with no systematic error and a high level of accuracy. These findings have important implications for improving data collection and management of the physical and mental demands of operating room staff during surgery, where wearing a watch on the wrist may not be feasible. UR - https://humanfactors.jmir.org/2023/1/e50891 UR - http://dx.doi.org/10.2196/50891 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910162 ID - info:doi/10.2196/50891 ER - TY - JOUR AU - Seyedi, Salman AU - Griner, Emily AU - Corbin, Lisette AU - Jiang, Zifan AU - Roberts, Kailey AU - Iacobelli, Luca AU - Milloy, Aaron AU - Boazak, Mina AU - Bahrami Rad, Ali AU - Abbasi, Ahmed AU - Cotes, O. Robert AU - Clifford, D. Gari PY - 2023/10/31 TI - Using HIPAA (Health Insurance Portability and Accountability Act)?Compliant Transcription Services for Virtual Psychiatric Interviews: Pilot Comparison Study JO - JMIR Ment Health SP - e48517 VL - 10 KW - ASR KW - automatic speech recognition KW - Health Insurance Portability and Accountability Act KW - HIPAA KW - Linguistic Inquiry and Word Count KW - LIWC KW - mental health KW - psychiatric interview KW - speech to text KW - WER KW - word error rate N2 - Background: Automatic speech recognition (ASR) technology is increasingly being used for transcription in clinical contexts. Although there are numerous transcription services using ASR, few studies have compared the word error rate (WER) between different transcription services among different diagnostic groups in a mental health setting. There has also been little research into the types of words ASR transcriptions mistakenly generate or omit. Objective: This study compared the WER of 3 ASR transcription services (Amazon Transcribe [Amazon.com, Inc], Zoom-Otter AI [Zoom Video Communications, Inc], and Whisper [OpenAI Inc]) in interviews across 2 different clinical categories (controls and participants experiencing a variety of mental health conditions). These ASR transcription services were also compared with a commercial human transcription service, Rev (Rev.Com, Inc). Words that were either included or excluded by the error in the transcripts were systematically analyzed by their Linguistic Inquiry and Word Count categories. Methods: Participants completed a 1-time research psychiatric interview, which was recorded on a secure server. Transcriptions created by the research team were used as the gold standard from which WER was calculated. The interviewees were categorized into either the control group (n=18) or the mental health condition group (n=47) using the Mini-International Neuropsychiatric Interview. The total sample included 65 participants. Brunner-Munzel tests were used for comparing independent sets, such as the diagnostic groupings, and Wilcoxon signed rank tests were used for correlated samples when comparing the total sample between different transcription services. Results: There were significant differences between each ASR transcription service?s WER (P<.001). Amazon Transcribe?s output exhibited significantly lower WERs compared with the Zoom-Otter AI?s and Whisper?s ASR. ASR performances did not significantly differ across the 2 different clinical categories within each service (P>.05). A comparison between the human transcription service output from Rev and the best-performing ASR (Amazon Transcribe) demonstrated a significant difference (P<.001), with Rev having a slightly lower median WER (7.6%, IQR 5.4%-11.35 vs 8.9%, IQR 6.9%-11.6%). Heat maps and spider plots were used to visualize the most common errors in Linguistic Inquiry and Word Count categories, which were found to be within 3 overarching categories: Conversation, Cognition, and Function. Conclusions: Overall, consistent with previous literature, our results suggest that the WER between manual and automated transcription services may be narrowing as ASR services advance. These advances, coupled with decreased cost and time in receiving transcriptions, may make ASR transcriptions a more viable option within health care settings. However, more research is required to determine if errors in specific types of words impact the analysis and usability of these transcriptions, particularly for specific applications and in a variety of populations in terms of clinical diagnosis, literacy level, accent, and cultural origin. UR - https://mental.jmir.org/2023/1/e48517 UR - http://dx.doi.org/10.2196/48517 UR - http://www.ncbi.nlm.nih.gov/pubmed/37906217 ID - info:doi/10.2196/48517 ER - TY - JOUR AU - Kytö, Mikko AU - Koivusalo, Saila AU - Tuomonen, Heli AU - Strömberg, Lisbeth AU - Ruonala, Antti AU - Marttinen, Pekka AU - Heinonen, Seppo AU - Jacucci, Giulio PY - 2023/10/31 TI - Supporting the Management of Gestational Diabetes Mellitus With Comprehensive Self-Tracking: Mixed Methods Study of Wearable Sensors JO - JMIR Diabetes SP - e43979 VL - 8 KW - gestational diabetes KW - self-management KW - self-tracking KW - wearable sensor KW - mobile application KW - self-discovery KW - behavior change KW - user experience N2 - Background: Gestational diabetes mellitus (GDM) is an increasing health risk for pregnant women as well as their children. Telehealth interventions targeted at the management of GDM have been shown to be effective, but they still require health care professionals for providing guidance and feedback. Feedback from wearable sensors has been suggested to support the self-management of GDM, but it is unknown how self-tracking should be designed in clinical care. Objective: This study aimed to investigate how to support the self-management of GDM with self-tracking of continuous blood glucose and lifestyle factors without help from health care personnel. We examined comprehensive self-tracking from self-discovery (ie, learning associations between glucose levels and lifestyle) and user experience perspectives. Methods: We conducted a mixed methods study where women with GDM (N=10) used a continuous glucose monitor (CGM; Medtronic Guardian) and 3 physical activity sensors: activity bracelet (Garmin Vivosmart 3), hip-worn sensor (UKK Exsed), and electrocardiography sensor (Firstbeat 2) for a week. We collected data from the sensors, and after use, participants took part in semistructured interviews about the wearable sensors. Acceptability of the wearable sensors was evaluated with the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Moreover, maternal nutrition data were collected with a 3-day food diary, and self-reported physical activity data were collected with a logbook. Results: We found that the CGM was the most useful sensor for the self-discovery process, especially when learning associations between glucose and nutrition intake. We identified new challenges for using data from the CGM and physical activity sensors in supporting self-discovery in GDM. These challenges included (1) dispersion of glucose and physical activity data in separate applications, (2) absence of important trackable features like amount of light physical activity and physical activities other than walking, (3) discrepancy in the data between different wearable physical activity sensors and between CGMs and capillary glucose meters, and (4) discrepancy in perceived and measured quantification of physical activity. We found the body placement of sensors to be a key factor in measurement quality and preference, and ultimately a challenge for collecting data. For example, a wrist-worn sensor was used for longer compared with a hip-worn sensor. In general, there was a high acceptance for wearable sensors. Conclusions: A mobile app that combines glucose, nutrition, and physical activity data in a single view is needed to support self-discovery. The design should support tracking features that are important for women with GDM (such as light physical activity), and data for each feature should originate from a single sensor to avoid discrepancy and redundancy. Future work with a larger sample should involve evaluation of the effects of such a mobile app on clinical outcomes. Trial Registration: Clinicaltrials.gov NCT03941652; https://clinicaltrials.gov/study/NCT03941652 UR - https://diabetes.jmir.org/2023/1/e43979 UR - http://dx.doi.org/10.2196/43979 UR - http://www.ncbi.nlm.nih.gov/pubmed/37906216 ID - info:doi/10.2196/43979 ER - TY - JOUR AU - Keogh, Alison AU - Mc Ardle, Ríona AU - Diaconu, Gabriela Mara AU - Ammour, Nadir AU - Arnera, Valdo AU - Balzani, Federica AU - Brittain, Gavin AU - Buckley, Ellen AU - Buttery, Sara AU - Cantu, Alma AU - Corriol-Rohou, Solange AU - Delgado-Ortiz, Laura AU - Duysens, Jacques AU - Forman-Hardy, Tom AU - Gur-Arieh, Tova AU - Hamerlijnck, Dominique AU - Linnell, John AU - Leocani, Letizia AU - McQuillan, Tom AU - Neatrour, Isabel AU - Polhemus, Ashley AU - Remmele, Werner AU - Saraiva, Isabel AU - Scott, Kirsty AU - Sutton, Norman AU - van den Brande, Koen AU - Vereijken, Beatrix AU - Wohlrab, Martin AU - Rochester, Lynn AU - PY - 2023/10/27 TI - Mobilizing Patient and Public Involvement in the Development of Real-World Digital Technology Solutions: Tutorial JO - J Med Internet Res SP - e44206 VL - 25 KW - patient involvement KW - patient engagement KW - public-private partnership KW - research consortium KW - digital mobility outcomes KW - real-world mobility KW - digital mobility measures UR - https://www.jmir.org/2023/1/e44206 UR - http://dx.doi.org/10.2196/44206 UR - http://www.ncbi.nlm.nih.gov/pubmed/37889531 ID - info:doi/10.2196/44206 ER - TY - JOUR AU - Adnan, Tatheer AU - Li, Huichu AU - Peer, Komal AU - Peebles, Elizabeth AU - James, Kaitlyn AU - Mahalingaiah, Shruthi PY - 2023/10/27 TI - Evaluation of Menstrual Cycle Tracking Behaviors in the Ovulation and Menstruation Health Pilot Study: Cross-Sectional Study JO - J Med Internet Res SP - e42164 VL - 25 KW - reproductive informatics KW - menstrual health tracking apps KW - digital epidemiology KW - women's health KW - mobile health KW - mHealth KW - gynecology KW - health application KW - tracking health app KW - menstrual health KW - reproductive health N2 - Background: Menstrual cycle tracking apps (MCTAs) have potential in epidemiological studies of women?s health, facilitating real-time tracking of bleeding days and menstrual-associated signs and symptoms. However, information regarding the characteristics of MCTA users versus cycle nontrackers is limited, which may inform generalizability. Objective: We compared characteristics among individuals using MCTAs (app users), individuals who do not track their cycles (nontrackers), and those who used other forms of menstrual tracking (other trackers). Methods: The Ovulation and Menstruation Health Pilot Study tested the feasibility of a digitally enabled evaluation of menstrual health. Recruitment occurred between September 2017 and March 2018. Menstrual cycle tracking behavior, demographic, and general and reproductive health history data were collected from eligible individuals (females aged 18-45 years, comfortable communicating in English). Menstrual cycle tracking behavior was categorized in 3 ways: menstrual cycle tracking via app usage, that via other methods, and nontracking. Demographic factors, health conditions, and menstrual cycle characteristics were compared across the menstrual tracking method (app users vs nontrackers, app users vs other trackers, and other trackers vs nontrackers) were assessed using chi-square or Fisher exact tests. Results: In total, 263 participants met the eligibility criteria and completed the digital survey. Most of the cohort (n=191, 72.6%) was 18-29 years old, predominantly White (n=170, 64.6%), had attained 4 years of college education or higher (n= 209, 79.5%), and had a household income below US $50,000 (n=123, 46.8%). Among all participants, 103 (39%) were MCTA users (app users), 97 (37%) did not engage in any tracking (nontrackers), and 63 (24%) used other forms of tracking (other trackers). Across all groups, no meaningful differences existed in race and ethnicity, household income, and education level. The proportion of ever-use of hormonal contraceptives was lower (n=74, 71.8% vs n=87, 90%, P=.001), lifetime smoking status was lower (n=6, 6% vs n=15, 17%, P=.04), and diagnosis rate of gastrointestinal reflux disease (GERD) was higher (n=25, 24.3% vs n=12, 12.4%, P=.04) in app users than in nontrackers. The proportions of hormonal contraceptives ever used and lifetime smoking status were both lower (n=74, 71.8% vs n=56, 88.9%, P=.01; n=6, 6% vs n=11, 17.5%, P=.02) in app users than in other trackers. Other trackers had lower proportions of ever-use of hormonal contraceptives (n=130, 78.3% vs n=87, 89.7%, P=.02) and higher diagnostic rates of heartburn or GERD (n=39, 23.5% vs n=12, 12.4%, P.03) and anxiety or panic disorder (n=64, 38.6% vs n=25, 25.8%, P=.04) than nontrackers. Menstrual cycle characteristics did not differ across all groups. Conclusions: Our results suggest that app users, other trackers, and nontrackers are largely comparable in demographic and menstrual cycle characteristics. Future studies should determine reasons for tracking and tracking-related behaviors to further understand whether individuals who use MCTAs are comparable to nontrackers. UR - https://www.jmir.org/2023/1/e42164 UR - http://dx.doi.org/10.2196/42164 UR - http://www.ncbi.nlm.nih.gov/pubmed/37889545 ID - info:doi/10.2196/42164 ER - TY - JOUR AU - del Carmen, Carmen María del AU - Cagigas-Muñiz, Daniel AU - García-Robles, Rocío AU - Oprescu, Madalina Andreea PY - 2023/10/27 TI - Reducing Dental Anxiety in Children Using a Mobile Health App: Usability and User Experience Study JO - JMIR Form Res SP - e30443 VL - 7 KW - dentistry KW - dental anxiety KW - children KW - mobile KW - app KW - usability KW - user experience KW - human-centered design KW - mobile health KW - mHealth KW - digital health KW - mobile application KW - application development N2 - Background: Dentistry interventions cause common anxiety and fear problems in children (6-11 years), and according to scientific evidence, this causes a decrease in their quality of life. Therapies mediated by IT-based tools have been shown to positively influence children?s mood based on distraction as well as relaxing activities, but there is no evidence of their use to reduce dental anxiety in children. Objective: The aim of this study was to answer the following research question: Does our new children-centered codesign methodology contribute to achieving a usable mobile-based product with a highly scored user experience? Methods: A mobile health app was developed to reduce dental anxiety in children using rapid application development following the usage-centered design methodology. Structured interviews were conducted to test the usability and user experience of the app prototype among 40 children (n=20, 50%, boys and n=20, 50%, girls; age 6-11 years) using a children-adapted questionnaire and the 7-point Single Ease Question rating scale. The Smiley Faces Program?Revised questionnaire was used to assess the level of dental anxiety in participants. Results: There were no significant differences between girls and boys. The task completion rate was 95% (n=19) for children aged 6-8 years (group 1) and 100% (n=20) for children aged 9-11 years (group 2). Group 1 found watching the relaxing video (task C) to be the easiest, followed by playing a video minigame (task B) and watching the narrative (task A). Group 2 found task C to be the easiest, followed by task A and then task B. The average time spent on the different types of tasks was similar in both age groups. Most of the children in both age groups were happy with the app and found it funny. All children thought that having the app in the waiting room during a dental visit would be useful. Conclusions: The findings confirmed that the app is usable and provides an excellent user experience. Our children-adapted methodology contributes to achieving usable mobile-based products for children with a highly scored user experience. UR - https://formative.jmir.org/2023/1/e30443 UR - http://dx.doi.org/10.2196/30443 UR - http://www.ncbi.nlm.nih.gov/pubmed/37889521 ID - info:doi/10.2196/30443 ER - TY - JOUR AU - Laure, Tajda AU - Engels, E. Rutger C. M. AU - Remmerswaal, Danielle AU - Spruijt-Metz, Donna AU - Konigorski, Stefan AU - Boffo, Marilisa PY - 2023/10/27 TI - Optimization of a Transdiagnostic Mobile Emotion Regulation Intervention for University Students: Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e46603 VL - 12 KW - transdiagnostic KW - mobile intervention KW - microrandomized trial KW - mental health KW - emotion regulation KW - university students KW - mobile app KW - mobile phone N2 - Background: Many university students experience mental health problems such as anxiety and depression. To support their mental health, a transdiagnostic mobile app intervention has been developed. The intervention provides short exercises rooted in various approaches (eg, positive psychology, mindfulness, self-compassion, and acceptance and commitment therapy) that aim to facilitate adaptive emotion regulation (ER) to help students cope with the various stressors they encounter during their time at university. Objective: The goals of this study are to investigate whether the intervention and its components function as intended and how participants engage with them. In addition, this study aims to monitor changes in distress symptoms and ER skills and identify relevant contextual factors that may moderate the intervention?s impact. Methods: A sequential explanatory mixed methods design combining a microrandomized trial and semistructured interviews will be used. During the microrandomized trial, students (N=200) will be prompted via the mobile app twice a day for 3 weeks to evaluate their emotional states and complete a randomly assigned intervention (ie, an exercise supporting ER) or a control intervention (ie, a health information snippet). A subsample of participants (21/200, 10.5%) will participate in interviews exploring their user experience with the app and the completed exercises. The primary outcomes will be changes in emotional states and engagement with the intervention (ie, objective and subjective engagement). Objective engagement will be evaluated through log data (eg, exercise completion time). Subjective engagement will be evaluated through exercise likability and helpfulness ratings as well as user experience interviews. The secondary outcomes will include the distal outcomes of the intervention (ie, ER skills and distress symptoms). Finally, the contextual moderators of intervention effectiveness will be explored (eg, the time of day and momentary emotional states). Results: The study commenced on February 9, 2023, and the data collection was concluded on June 13, 2023. Of the 172 eligible participants, 161 (93.6%) decided to participate. Of these 161 participants, 137 (85.1%) completed the first phase of the study. A subsample of participants (18/172, 10.5%) participated in the user experience interviews. Currently, the data processing and analyses are being conducted. Conclusions: This study will provide insight into the functioning of the intervention and identify areas for improvement. Furthermore, the findings will shed light on potential changes in the distal outcomes of the intervention (ie, ER skills and distress symptoms), which will be considered when designing a follow-up randomized controlled trial evaluating the full-scale effectiveness of this intervention. Finally, the results and data gathered will be used to design and train a recommendation algorithm that will be integrated into the app linking students to relevant content. Trial Registration: ClinicalTrials.gov NCT05576883; https://www.clinicaltrials.gov/study/NCT05576883 International Registered Report Identifier (IRRID): DERR1-10.2196/46603 UR - https://www.researchprotocols.org/2023/1/e46603 UR - http://dx.doi.org/10.2196/46603 UR - http://www.ncbi.nlm.nih.gov/pubmed/37889525 ID - info:doi/10.2196/46603 ER - TY - JOUR AU - Bos, Ernst AU - Preller, H. Katrin AU - Kaur, Gavneet AU - Malhotra, Pooja AU - Kharawala, Saifuddin AU - Motti, Dario PY - 2023/10/24 TI - Challenges With the Use of Digital Sham: Systematic Review and Recommendations JO - J Med Internet Res SP - e44764 VL - 25 KW - cognitive behavioral therapy KW - digital intervention KW - sham KW - neurosciences KW - neurodegenerative diseases KW - placebo KW - psychiatric disorders KW - systematic review KW - mobile phone N2 - Background: Digital therapeutics (DTx) are software-based products that prevent, manage, or treat a medical condition and are delivered through a smartphone app, web application, or wearable device. Clinical trials assessing DTx pose challenges, foremost among which is designing appropriate digital shams (or digital placebos), which should ideally mimic DTx (in terms of design, components, and duration of treatment) while omitting the active principle or component. Objective: The objective of our review was to understand how digital shams are being used in clinical research on DTx in neuroscience, which is the most common therapy area for DTx. Methods: We conducted a systematic literature review of DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) with a focus on controlled clinical trials involving digital shams. Studies were identified from trial registries (ClinicalTrials.gov, the European Union Clinical Trials Register, and Trial Trove) and through structured searches in MEDLINE and Embase (both via the Embase website) and were limited to articles in English published from 2010 onward. These were supplemented by keyword-based searches in PubMed, Google, and Google Scholar and bibliographic searches. Studies assessing DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) were included. Details related to the publication, DTx, comparator, patient population, and outcomes were extracted and analyzed. Results: Our search criteria identified 461 neuroscience studies involving 213 unique DTx. Most DTx were extended reality based (86/213, 40.4%) or mobile device based (56/213, 26.3%); 313 were comparative, of which 68 (21.7%) used shams. The most common therapeutic areas assessed in these studies were stroke (42/213, 19.7%), depression (32/213, 15%), and anxiety (24/213, 11.3%). The most common treatments were cognitive behavioral therapy or behavioral therapy (67/213, 32.4%), physical rehabilitation (60/213, 28.2%), and cognitive training (41/213, 19.2%). We identified the following important issues related to the use of digital shams in neuroscience: shams were not validated before use in studies, they varied widely in design (from being nearly identical to the DTx to using different software programs altogether), and the level of patient engagement or satisfaction with the sham and the impact of the sham on study outcomes were infrequently reported. Conclusions: Digital shams are critical for the clinical development of DTx in neuroscience. Given the importance of sham controls in evaluating DTx efficacy, we provide recommendations on the key information that should be reported in a well-designed DTx trial and propose an algorithm to allow the correct interpretation of DTx study results. Sham-controlled studies should be routinely used in DTx trials?in early-phase studies?to help identify DTx active components and?in late-phase studies?to confirm the efficacy of DTx. The use of shams early in development will ensure that the appropriate sham control is used in later confirmatory trials. UR - https://www.jmir.org/2023/1/e44764 UR - http://dx.doi.org/10.2196/44764 UR - http://www.ncbi.nlm.nih.gov/pubmed/37874638 ID - info:doi/10.2196/44764 ER - TY - JOUR AU - Medich, Melissa AU - Cannedy, L. Shay AU - Hoffmann, C. Lauren AU - Chinchilla, Y. Melissa AU - Pila, M. Jose AU - Chassman, A. Stephanie AU - Calderon, A. Ronald AU - Young, S. Alexander PY - 2023/10/24 TI - Clinician and Patient Perspectives on the Use of Passive Mobile Monitoring and Self-Tracking for Patients With Serious Mental Illness: User-Centered Approach JO - JMIR Hum Factors SP - e46909 VL - 10 KW - serious mental illness KW - mobile health KW - mental health KW - passive sensing KW - health informatics KW - behavior KW - self-tracking KW - monitoring KW - mental illness KW - prevention KW - acceptability KW - usability KW - usefulness KW - application KW - tool KW - management KW - mobile phone N2 - Background: Early intervention in mental health crises can prevent negative outcomes. A promising new direction is remote mental health monitoring using smartphone technology to passively collect data from individuals to rapidly detect the worsening of serious mental illness (SMI). This technology may benefit patients with SMI, but little is known about health IT acceptability among this population or their mental health clinicians. Objective: We used the Health Information Technology Acceptability Model to analyze the acceptability and usability of passive mobile monitoring and self-tracking among patients with serious mental illness and their mental health clinicians. Methods: Data collection took place between December 2020 and June 2021 in 1 Veterans Administration health care system. Interviews with mental health clinicians (n=16) assessed the acceptability of mobile sensing, its usefulness as a tool to improve clinical assessment and care, and recommendations for program refinements. Focus groups with patients with SMI (n=3 groups) and individual usability tests (n=8) elucidated patient attitudes about engaging in health IT and perceptions of its usefulness as a tool for self-tracking and improving mental health assessments. Results: Clinicians discussed the utility of web-based data dashboards to monitor patients with SMI health behaviors and receiving alerts about their worsening health. Potential benefits included improving clinical care, capturing behaviors patients do not self-report, watching trends, and receiving alerts. Clinicians? concerns included increased workloads tied to dashboard data review, lack of experience using health IT in clinical care, and how SMI patients? associated paranoia and financial instability would impact patient uptake. Despite concerns, all mental health clinicians stated that they would recommend it. Almost all patients with SMI were receptive to using smartphone dashboards for self-monitoring and having behavioral change alerts sent to their mental health clinicians. They found the mobile app easy to navigate and dashboards easy to find and understand. Patient concerns centered on privacy and ?government tracking,? and their phone?s battery life and data plans. Despite concerns, most reported that they would use it. Conclusions: Many people with SMI would like to have mobile informatics tools that can support their illness and recovery. Similar to other populations (eg, older adults, people experiencing homelessness) this population presents challenges to adoption and implementation. Health care organizations will need to provide resources to address these and support successful illness management. Clinicians are supportive of technological approaches, with adapting informatics data into their workflow as the primary challenge. Despite clear challenges, technological developments are increasingly designed to be acceptable to patients. The research development?clinical deployment gap must be addressed by health care systems, similar to computerized cognitive training. It will ensure clinicians operate at the top of their skill set and are not overwhelmed by administrative tasks, data summarization, or reviewing data that do not indicate a need for intervention. International Registered Report Identifier (IRRID): RR2-10.2196/39010 UR - https://humanfactors.jmir.org/2023/1/e46909 UR - http://dx.doi.org/10.2196/46909 UR - http://www.ncbi.nlm.nih.gov/pubmed/37874639 ID - info:doi/10.2196/46909 ER - TY - JOUR AU - Yan, Xinghui AU - Newman, W. Mark AU - Park, Young Sun AU - Sander, Angelle AU - Choi, Won Sung AU - Miner, Jennifer AU - Wu, Zhenke AU - Carlozzi, Noelle PY - 2023/10/24 TI - Identifying Design Opportunities for Adaptive mHealth Interventions That Target General Well-Being: Interview Study With Informal Care Partners JO - JMIR Form Res SP - e47813 VL - 7 KW - mHealth intervention KW - mobile health KW - behavior change KW - qualitative study KW - user adherence KW - behavioral messages KW - general well-being N2 - Background: Mobile health (mHealth) interventions can deliver personalized behavioral support to users in daily contexts. These interventions have been increasingly adopted to support individuals who require low-cost and low-burden support. Prior research has demonstrated the feasibility and acceptability of an mHealth intervention app (CareQOL) designed for use with informal care partners. To further optimize the intervention delivery, we need to investigate how care partners, many of whom lack the time for self-care, react and act in response to different behavioral messages. Objective: The goal of this study was to understand the factors that impact care partners? decision-making and actions in response to different behavioral messages. Insights from this study will help optimize future tailored and personalized behavioral interventions. Methods: We conducted semistructured interviews with participants who had recently completed a 3-month randomized controlled feasibility trial of the CareQOL mHealth intervention app. Of the 36 participants from the treatment group of the randomized controlled trial, 23 (64%) participated in these interviews. To prepare for each interview, the team first selected representative behavioral messages (eg, targeting different health dimensions) and presented them to participants during the interview to probe their influence on participants? thoughts and actions. The time of delivery, self-reported perceptions of the day, and user ratings of a message were presented to the participants during the interviews to assist with recall. Results: The interview data showed that after receiving a message, participants took various actions in response to different messages. Participants performed suggested behaviors or adjusted them either immediately or in a delayed manner (eg, sometimes up to a month later). We identified 4 factors that shape the variations in user actions in response to different behavioral messages: uncertainties about the workload required to perform suggested behaviors, concerns about one?s ability to routinize suggested behaviors, in-the-moment willingness and ability to plan for suggested behaviors, and overall capability to engage with the intervention. Conclusions: Our study showed that care partners use mHealth behavioral messages differently regarding the immediacy of actions and the adaptation to suggested behaviors. Multiple factors influence people?s perceptions and decisions regarding when and how to take actions. Future systems should consider these factors to tailor behavioral support for individuals and design system features to support the delay or adaptation of the suggested behaviors. The findings also suggest extending the assessment of user adherence by considering the variations in user actions on behavioral support (ie, performing suggested or adjusted behaviors immediately or in a delayed manner). International Registered Report Identifier (IRRID): RR2-10.2196/32842 UR - https://formative.jmir.org/2023/1/e47813 UR - http://dx.doi.org/10.2196/47813 UR - http://www.ncbi.nlm.nih.gov/pubmed/37874621 ID - info:doi/10.2196/47813 ER - TY - JOUR AU - Skeen, J. Simone AU - Tokarz, Stephanie AU - Gasik, E. Rayna AU - Solano, McGettigan Chelsea AU - Smith, A. Ethan AU - Sagoe, Binaifer Momi AU - Hudson, V. Lauryn AU - Steele, Kara AU - Theall, P. Katherine AU - Clum, A. Gretchen PY - 2023/10/24 TI - A Trauma-Informed, Geospatially Aware, Just-in-Time Adaptive mHealth Intervention to Support Effective Coping Skills Among People Living With HIV in New Orleans: Development and Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e47151 VL - 12 KW - mobile health KW - mHealth KW - HIV KW - traumatic stress KW - posttraumatic growth KW - coping KW - geospatial KW - just-in-time adaptive intervention KW - JITAI KW - just-in-time KW - posttraumatic KW - medication adherence KW - mental well-being KW - viral suppression KW - development KW - design KW - acceptability KW - feasibility KW - mobile phone N2 - Background: In 2020, Greater New Orleans, Louisiana, was home to 7048 people living with HIV?1083 per 100,000 residents, 2.85 times the US national rate. With Louisiana routinely ranked last in indexes of health equity, violent crime rates in Orleans Parish quintupling national averages, and in-care New Orleans people living with HIV surviving twice the US average of adverse childhood experiences, accessible, trauma-focused, evidence-based interventions (EBIs) for violence-affected people living with HIV are urgently needed. Objective: To meet this need, we adapted Living in the Face of Trauma, a well-established EBI tailored for people living with HIV, into NOLA GEM, a just-in-time adaptive mobile health (mHealth) intervention. This study aimed to culturally tailor and refine the NOLA GEM app and assess its acceptability; feasibility; and preliminary efficacy on care engagement, medication adherence, viral suppression, and mental well-being among in-care people living with HIV in Greater New Orleans. Methods: The development of NOLA GEM entailed identifying real-time tailoring variables via a geographic ecological momentary assessment (GEMA) study (n=49; aim 1) and place-based and user-centered tailoring, responsive to the unique cultural contexts of HIV survivorship in New Orleans, via formative interviews (n=12; aim 2). The iOS- and Android-enabled NOLA GEM app leverages twice-daily GEMA prompts to offer just-in-time, in-app recommendations for effective coping skills practice and app-delivered Living in the Face of Trauma session content. For aim 3, the pilot trial will enroll an analytic sample of 60 New Orleans people living with HIV individually randomized to parallel NOLA GEM (intervention) or GEMA-alone (control) arms at a 1:1 allocation for a 21-day period. Acceptability and feasibility will be assessed via enrollment, attrition, active daily use through paradata metrics, and prevalidated usability measures. At the postassessment time point, primary end points will be assessed via a range of well-validated, domain-specific scales. Care engagement and viral suppression will be assessed via past missed appointments and self-reported viral load at 30 and 90 days, respectively, and through well-demonstrated adherence self-efficacy measures. Results: Aims 1 and 2 have been achieved, NOLA GEM is in Beta, and all aim-3 methods have been reviewed and approved by the institutional review board of Tulane University. Recruitment was launched in July 2023, with a target date for follow-up assessment completion in December 2023. Conclusions: By leveraging user-centered development and embracing principles that elevate the lived expertise of New Orleans people living with HIV, mHealth-adapted EBIs can reflect community wisdom on posttraumatic resilience. Sustainable adoption of the NOLA GEM app and a promising early efficacy profile will support the feasibility of a future fully powered clinical trial and potential translation to new underserved settings in service of holistic survivorship and well-being of people living with HIV. Trial Registration: ClinicalTrials.gov NCT05784714; https://clinicaltrials.gov/ct2/show/NCT05784714 International Registered Report Identifier (IRRID): PRR1-10.2196/47151 UR - https://www.researchprotocols.org/2023/1/e47151 UR - http://dx.doi.org/10.2196/47151 UR - http://www.ncbi.nlm.nih.gov/pubmed/37874637 ID - info:doi/10.2196/47151 ER - TY - JOUR AU - Li, Yufei AU - Chen, Weihong AU - Liang, Yanjing AU - Yang, Ling AU - Hou, Lili PY - 2023/10/23 TI - Evaluation of Mobile Health Technology Interventions for the Postdischarge Management of Patients With Head and Neck Cancer: Scoping Review JO - JMIR Mhealth Uhealth SP - e49051 VL - 11 KW - head and neck cancer KW - mobile health technology KW - postdischarge KW - self-management KW - rehabilitation N2 - Background: Patients with head and neck cancer (HNC) often experience various types and degrees of complications and functional impairment following surgery or radiotherapy. Consequently, these patients require extensive postdischarge rehabilitation, either at home or in the community. Numerous studies have shown the advantages of mobile Health (mHealth) technology in assisting patients with cancer with self-management and rehabilitation during the postdischarge period. However, few reviews have focused on the intervention, management, and evaluation of mHealth technology in postdischarge patients with HNC. Objective: This study aimed to conduct a scoping review of mHealth technology apps and interventions currently available to patients discharged from hospitals after receiving treatment for HNC. This study sought to identify and summarize the types and effectiveness of existing mHealth interventions as well as the differences in their outcome assessments. Methods: The PubMed, Embase, Web of Science, and CINAHL databases were used to identify studies with no publication time limits. The keywords ?mobile health technology? and ?head and neck cancer? were combined to address the main concepts of the research questions. Results: Of the 1625 papers identified, 13 (0.8%) met the inclusion and exclusion criteria. Most studies (n=8, 61.5%) were randomized controlled trials (RCTs) and cohort studies. These studies were conducted in 6 countries. The main aims of the mHealth interventions in these studies are as follows: (1) symptom monitoring and assessment, (2) rehabilitation training, (3) access to medical health information, (4) telehealth advisers, (5) peer communication and support, and (6) follow-up/review reminders. The outcome evaluations of the 13 included studies were grouped into 4 categories: (1) technology usability and patient satisfaction, (2) self-management of symptoms and patient-reported outcome?related indicators, (3) adherence, and (4) health-related quality of life. Conclusions: A limited number of studies have investigated the use of mHealth technology in the postdischarge self-management of patients with HNC. The existing literature suggests that mHealth technology can effectively assist patients with HNC in self-management and postdischarge interventions. It plays an important role in addressing patients? health information needs, reducing both their somatic and psychological burdens, and improving their overall quality of life. Future research should prioritize conducting additional high-quality RCTs to evaluate the usability and analyze the cost-effectiveness of mHealth technology. UR - https://mhealth.jmir.org/2023/1/e49051 UR - http://dx.doi.org/10.2196/49051 UR - http://www.ncbi.nlm.nih.gov/pubmed/37870887 ID - info:doi/10.2196/49051 ER - TY - JOUR AU - Sze, Thing Wei AU - Kow, Guan Suk PY - 2023/10/23 TI - Perspectives and Needs of Malaysian Patients With Diabetes for a Mobile Health App Support on Self-Management of Diabetes: Qualitative Study JO - JMIR Diabetes SP - e40968 VL - 8 KW - mHealth KW - self-management KW - diabetes KW - remote monitoring KW - telehealth KW - telemedicine N2 - Background: Effective self-management of diabetes is crucial for improving clinical outcomes by maintaining glucose levels and preventing the exacerbation of the condition. Mobile health (mHealth) has demonstrated its significance in enhancing self-management practices. However, only 20% of Malaysians are familiar with mHealth technologies and use them for health management. Objective: This study aims to explore the perceived benefits and challenges, needs and preferences, and willingness of patients with diabetes to use mHealth apps for self-management of diabetes. Methods: The study involved one-on-one semistructured online interviews with a total of 15 participants, all of whom were aged 18 years or older and had been diagnosed with diabetes for more than 6 months. An interview guide was developed based on the constructs of the Technology Acceptance Model (TAM), the Health Information Technology Acceptance Model (HITAM), and the aesthetics factor derived from the Mobile Application Rating Scale. All interviews were recorded in audio format and transcribed verbatim. The interview content was then organized and coded using ATLAS.ti version 8. Thematic analysis was conducted in accordance with the recommended guidelines for analyzing the data. Results: From the interviews with participants, 3 key themes emerged regarding the perceived benefits of using mHealth app support in diabetes self-management. These themes were the ability to track and monitor diabetes control, assistance in making lifestyle modifications, and the facilitation of more informed treatment decision-making for health care professionals. The interviews with participants revealed 4 prominent themes regarding the perceived barriers to using mHealth app support for diabetes self-management. These themes were a lack of awareness about the availability of mHealth support, insufficient support in using mHealth apps, the perception that current mHealth apps do not align with users? specific needs, and limited digital literacy among users. The interviews with participants unveiled 4 key themes related to their needs and preferences concerning mHealth app support for diabetes self-management. These themes were the desire for educational information, user-friendly design features, carbohydrate-counting functionality, and the ability to engage socially with both peers and health care professionals. The majority of participants expressed their willingness to use mHealth apps if they received recommendations and guidance from health care professionals. Conclusions: Patients generally perceive mHealth app support as beneficial for diabetes self-management and are willing to use these apps, particularly if recommended by health care professionals. However, several barriers may hinder the utilization of mHealth apps, including a lack of awareness and recommendations regarding these apps from health care professionals. To ensure the effective development of mHealth app support systems for diabetes self-management, it is crucial to implement user-centered design processes that consider the specific needs and preferences of patients. This approach will help create apps that are tailored to the requirements of individuals managing diabetes. UR - https://diabetes.jmir.org/2023/1/e40968 UR - http://dx.doi.org/10.2196/40968 UR - http://www.ncbi.nlm.nih.gov/pubmed/37870903 ID - info:doi/10.2196/40968 ER - TY - JOUR AU - Kgasi, Mmamolefe AU - Chimbo, Bester AU - Motsi, Lovemore PY - 2023/10/23 TI - mHealth Self-Monitoring Model for Medicine Adherence of Patients With Diabetes in Resource-Limited Countries: Structural Equation Modeling Approach JO - JMIR Form Res SP - e49407 VL - 7 KW - diabetes KW - mobile health KW - mHealth KW - self-monitoring KW - self-management KW - chronic diseases KW - health care provision N2 - Background: The COVID-19 pandemic has led to serious challenges and emphasized the importance of using technology for health care operational transformation. Consequently, the need for technological innovations has increased, thus empowering patients with chronic conditions to tighten their adherence to medical prescriptions. Objective: This study aimed to develop a model for a mobile health (mHealth) self-monitoring system for patients with diabetes in rural communities within resource-limited countries. The developed model could be based on the implementation of a system for the self-monitoring of patients with diabetes to increase medical adherence. Methods: This study followed a quantitative approach, in which data were collected from health care providers using a questionnaire with close-ended questions. Data were collected from district hospitals in 3 South African provinces that were selected based on the prevalence rates of diabetes and the number of patients with diabetes treated. The collected data were analyzed using smart partial least squares to validate the model and test the suggested hypotheses. Results: Using variance-based structural equation modeling that leverages smart partial least squares, the analysis indicated that environmental factors significantly influence all the independent constructs that inform patients? change of behavior toward the use of mHealth for self-monitoring of medication adherence. Technology characteristics such as effort expectancy, self-efficacy, and performance expectancy were equally significant; hence, their hypotheses were accepted. In contrast, the contributions of culture and social aspects were found to be insignificant, and their hypotheses were rejected. In addition, an analysis was conducted to determine the interaction effects of the moderating variables on the independent constructs. The results indicated that with the exception of cultural and social influences, there were significant interacting effects on other independent constructs influencing mHealth use for self-monitoring. Conclusions: On the basis of the findings of this study, we conclude that behavioral changes are essential for the self-monitoring of chronic diseases. Therefore, it is important to enhance those effects that stimulate the behavior to change toward the use of mHealth for self-monitoring. Motivational aspects were also found to be highly significant as they triggered changes in behavior. The developed model can be used to extend the research on the self-monitoring of patients with chronic conditions. Moreover, the model will be used as a basic architecture for the implementation of fully fledged systems for self-monitoring of patients with diabetes. UR - https://formative.jmir.org/2023/1/e49407 UR - http://dx.doi.org/10.2196/49407 UR - http://www.ncbi.nlm.nih.gov/pubmed/37870902 ID - info:doi/10.2196/49407 ER - TY - JOUR AU - Chen, Bi-Lian AU - Lien, Han-Chung AU - Yang, Shyh-Sheng AU - Wu, Shiao-Chi AU - Chiang, Hsien-Hsien AU - Lin, Li-Chan PY - 2023/10/20 TI - Impact of Mobile Apps in Conjunction With Percutaneous Endoscopic Gastrostomy on Patients' Complications, Quality of Life, and Health-Related Self-Care Behaviors: Randomized Clinical Trial JO - JMIR Mhealth Uhealth SP - e48970 VL - 11 KW - percutaneous endoscopic gastrostomy KW - mobile applications tracking system KW - self-care KW - complications KW - quality of life KW - mobile application KW - mHealth app KW - mHealth intervention KW - health promotion KW - health education KW - endoscopy KW - application KW - education KW - gastrostomy KW - care KW - prevention KW - behavior KW - tracking KW - utilization N2 - Background: Percutaneous endoscopic gastrostomy (PEG) is commonly chosen for long-term enteral nutrition support. However, common complications of PEG include wound infection, leakage, obstruction, bleeding, dislodgement, pneumonia, peritonitis, and more. The anticipation of these complications by both patients and their family caregivers underscores the essential requirement of ongoing technical guidance for the daily care of PEG and the adoption of preventative strategies. Objective: This study aimed to establish and compare a health education program utilizing a tracking system for PEG using a mobile app (PEG app) and instant messaging software versus a paper-based health education program with instant messaging software. Their effectiveness to prevent complications, avoid hospital readmissions, improve self-care practices, and enhance quality of life outcomes was assessed. Methods: A randomized controlled trial design was used, and the study sample consisted of patients from a medical center in central Taiwan who underwent thoracic surgery or gastroenterology procedures. Inclusion criteria were being a new case undergoing his or her first gastric tube insertion and having the ability to operate a smartphone. Exclusion criteria were cases requiring tube replacement or nasogastric tubes. A total of 74 participants were enrolled, with 37 participants in the experimental group and 37 participants in the control group. Data collection took place from hospitalization until 1 month after discharge. The experimental group received care utilizing the gastric tube tracking system (PEG app) and the Line app that included phone, text, and photo capture capabilities, while the control group received routine nursing care and used the Line app. Results: The experimental group demonstrated a significant reduction in the occurrence of complications compared with the control group (?21=12.087, P=.001). Specifically, the occurrence of leakage events was significantly lower in the experimental group than in the control group (?21=12.906, P=.001). However, the experimental group exhibited superior self-care ability compared with the control group (t72=2.203, P=.03). There was no significant difference in overall quality of life scores between the experimental and control groups (t72=1.603, P=.11). However, the experimental group showed better social aspects of quality of life than the control group (t72=2.164, P=.03). Conclusions: Integration of the PEG app with instant messaging can enhance self-care ability, improve social aspects of quality of life, and reduce complications. The study results suggest that the PEG app could be used as an adjunct tool to promote patients? self-directed management of their gastric tube at home, particularly for patients who have undergone their first PEG placement and are being discharged from the hospital. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300071271; https://tinyurl.com/4vvy584e UR - https://mhealth.jmir.org/2023/1/e48970/ UR - http://dx.doi.org/10.2196/48970 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48970 ER - TY - JOUR AU - Zaidi, Maryum AU - Gazarian, Priscilla AU - Mattie, Heather AU - Sheldon, Kennedy Lisa AU - Gakumo, Ann C. PY - 2023/10/20 TI - Examining the Impact of Selected Sociodemographic Factors and Cancer-Related Fatalistic Beliefs on Patient Engagement via Health Information Technology Among Older Adults: Cross-Sectional Analysis JO - JMIR Aging SP - e44777 VL - 6 KW - health information technology KW - patient portals KW - older adults KW - digital health KW - self-management KW - mobile phone N2 - Background: Despite the role of health information technology (HIT) in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults with a high burden of chronic diseases such as cancer. This study examines the role of selected sociodemographic factors and cancer-related fatalistic beliefs on patient engagement expressed through HIT use for patient engagement in adults aged ?65 years. We controlled for cancer diagnosis to account for its potential influence on patient engagement. Objective: This study has 2 aims: to investigate the role of sociodemographic factors such as race, education, poverty index, and psychosocial factors of cancer fatalistic beliefs in accessing and using HIT in older adults and to examine the association between access and use of HIT in the self-management domain of patient activation that serves as a precursor to patient engagement. Methods: This is a secondary data analysis of a subset of the Health Information National Trend Survey (Health Information National Trend Survey 4, cycle 3). The subset included individuals aged ?65 years with and without a cancer diagnosis. The relationships between access to and use of HIT to several sociodemographic variables and psychosocial factors of fatalistic beliefs were analyzed. Logistic and linear regression models were fit to study these associations. Results: This study included 180 individuals aged ?65 years with a cancer diagnosis and 398 without a diagnosis. This analysis indicated that having less than a college education level (P=<.001), being an individual from an ethnic and minority group (P=<.001), and living in poverty (P=.001) were significantly associated with decreased access to HIT. Reduced HIT use was associated with less than a college education (P=.001) and poverty(P=.02). This analysis also indicated that fatalistic beliefs about cancer were significantly associated with lower HIT use (P=.03). Specifically, a 1-point increase in the cancer fatalistic belief score was associated with a 36% decrease in HIT use. We found that controlling for cancer diagnosis did not affect the outcomes for sociodemographic variables or fatalistic beliefs about cancer. However, patients with access to HIT had a self-management domain of patient activation (SMD) score of 0.21 points higher (P=.003) compared with patients who did not have access. SMD score was higher by 0.28 points (P=.002) for individuals who used HIT and 0.14 points higher (P=.04) who had a prior diagnosis of cancer. Conclusions: Sociodemographic factors (education, race, poverty, and cancer fatalistic beliefs) impact HIT access and use in older adults, regardless of prior cancer diagnosis. Among older adults, HIT users report higher self-management, which is essential for patient activation and engagement. UR - https://aging.jmir.org/2023/1/e44777 UR - http://dx.doi.org/10.2196/44777 UR - http://www.ncbi.nlm.nih.gov/pubmed/37655786 ID - info:doi/10.2196/44777 ER - TY - JOUR AU - Kaburi, Benduri Basil AU - Wyss, Kaspar AU - Kenu, Ernest AU - Asiedu-Bekoe, Franklin AU - Hauri, M. Anja AU - Laryea, Odai Dennis AU - Klett-Tammen, J. Carolina AU - Leone, Frédéric AU - Walter, Christin AU - Krause, Gérard PY - 2023/10/20 TI - Facilitators and Barriers in the Implementation of a Digital Surveillance and Outbreak Response System in Ghana Before and During the COVID-19 Pandemic: Qualitative Analysis of Stakeholder Interviews JO - JMIR Form Res SP - e45715 VL - 7 KW - implementation KW - Surveillance Outbreak Response Management and Analysis System KW - SORMAS KW - barriers KW - facilitators KW - digital disease surveillance KW - outbreak response KW - COVID-19 KW - pandemic KW - Ghana KW - mobile phone N2 - Background: In the past 2 decades, many countries have recognized the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low- and middle-income countries, the adoption of these electronic systems remains a priority and has attracted the support of global health players. However, the successful implementation and institutionalization of electronic systems in low- and middle-income countries have been challenged by the local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes toward innovation, and organizational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis System (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response. Objective: This study aims to identify the facilitators of and barriers to the sustainable implementation and operation of SORMAS in Ghana. Methods: Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed consistent with the model of diffusion of innovations in health service organizations. We transcribed the interviews verbatim and performed independent validation of transcripts and pseudonymization. We performed deductive coding using 7 a priori categories: innovation, adopting health system, adoption and assimilation, diffusion and dissemination, outer context, institutionalization, and linkages among the aspects of implementation. We used MAXQDA Analytics Pro for transcription, coding, and analysis. Results: The facilitators of SORMAS implementation included its coherent design consistent with the Integrated Disease Surveillance and Response system, adaptability to evolving local needs, relative advantages for task performance (eg, real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone-savvy workforce. Other facilitators were its alignment with health system goals, dedicated national leadership, political endorsement, availability of in-country IT capacities, and financial and technical support from inventors and international development partners. The main barriers were unstable technical interoperability between SORMAS and existing health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable national power supply, inadequate numbers and poor quality of data collection devices, and substantial dependence on external funding. Conclusions: The facilitators of and barriers to SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political stewardship, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to implementation and progress to country ownership. Some barriers are external, relate to the overall national infrastructural development, and are not amenable even to unlimited project funding. UR - https://formative.jmir.org/2023/1/e45715 UR - http://dx.doi.org/10.2196/45715 UR - http://www.ncbi.nlm.nih.gov/pubmed/37862105 ID - info:doi/10.2196/45715 ER - TY - JOUR AU - Toh, Yang Sean Han AU - Lee, Chi Sze AU - Sündermann, Oliver PY - 2023/10/20 TI - Mobile Behavioral Health Coaching as a Preventive Intervention for Occupational Public Health: Retrospective Longitudinal Study JO - JMIR Form Res SP - e45678 VL - 7 KW - mobile health apps KW - mHealth apps KW - behavioral health coaching KW - behavioral coaching KW - app-based coaching KW - self-help KW - employees KW - well-being KW - mood KW - stress KW - public health KW - preventive interventions KW - positive psychology N2 - Background: Researchers have recently proposed that behavioral health coaching (BHC) is effective in promoting proactive care among employees. However, to qualify as a preventive workplace intervention, more research is needed to evaluate whether BHC can further elevate well-being among moderately mentally healthy employees. Objective: Using real-world data, this study evaluates the preliminary effectiveness of app-based BHC against a nonrandomized control group with open access to self-help tools in improving well-being (ie, mood levels and perceived stress). The study also explores the active ingredients of BHC and dose-response associations between the number of BHC sessions and well-being improvements. Methods: Employees residing across Asia-Pacific countries (N=1025; mean age 30.85, SD 6.97 y) who reported moderately positive mood and medium levels of perceived stress in their first week of using the mental health app Intellect were included in this study. Users who were given access by their organizations to Intellect?s BHC services were assigned to the ?Coaching? condition (512/1025, 49.95%; mean age 31.09, SD 6.87 y), whereas other employees remained as ?Control? participants (513/1025, 50.05%; mean age 30.61, SD 7.06 y). To evaluate effectiveness, monthly scores from the validated mood and stress sliders were aggregated into a composite well-being score and further examined using repeated-measure conditional growth models. Postcoaching items on ?Perceived Usefulness of the BHC session? and ?Working Alliance with my Coach? were examined as active ingredients of BHC using 1-1-1 multilevel mediation models. Finally, 2-way repeated-measure mixed ANOVA models were conducted to examine dose-response effects on well-being improvements between groups (coaching and control) across time. Results: Growth curve analyses revealed significant time by group interaction effects for composite well-being, where ?Coaching? users reported significantly greater improvements in well-being than ?Control? participants across time (composite well-being: F1,391=6.12; ?p2=0.02; P=.01). Among ?Coaching? participants, dependent-sample 2-tailed t tests revealed significant improvements in composite well-being from baseline to 11 months (t512=1.98; Cohen d=0.17; P=.049). Improvements in ?Usefulness of the BHC session? (?=.078, 95% Cl .043-.118; P<.001) and ?Working Alliance? (?=.070, 95% Cl .037-.107; P<.001) fully mediated within-level well-being enhancements over time. Comparing against baseline or first month scores, significant time by group interactions were observed between the second and sixth months, with the largest effect size observed at the fifth month mark (first month vs fifth month: F1,282=15.0; P<.001; ?p2=0.051). Conclusions: We found preliminary evidence that BHC is an effective preventive workplace intervention. Mobile-based coaching may be a convenient, cost-effective, and scalable means for organizations and governments to boost public mental health. UR - https://formative.jmir.org/2023/1/e45678 UR - http://dx.doi.org/10.2196/45678 UR - http://www.ncbi.nlm.nih.gov/pubmed/37862086 ID - info:doi/10.2196/45678 ER - TY - JOUR AU - Sprave, Tanja AU - Pfaffenlehner, Michelle AU - Stoian, Raluca AU - Christofi, Eleni AU - Rühle, Alexander AU - Zöller, Daniela AU - Fabian, Alexander AU - Fahrner, Harald AU - Binder, Harald AU - Schäfer, Henning AU - Gkika, Eleni AU - Grosu, Anca-Ligia AU - Heinemann, Felix AU - Nicolay, Henrik Nils PY - 2023/10/19 TI - App-Controlled Treatment Monitoring and Support for Patients With Head and Neck Cancer Undergoing Radiotherapy: Results From a Prospective Randomized Controlled Trial JO - J Med Internet Res SP - e46189 VL - 25 KW - mHealth KW - head and neck cancer KW - head and neck squamous cell carcinoma KW - HNSCC KW - radiotherapy KW - mobile app KW - quality of life KW - patient-reported outcome measure KW - PROM KW - mobile health KW - head KW - neck KW - cancer KW - oncology KW - radiation KW - randomized controlled trial KW - RCT KW - satisfaction KW - treatment surveillance KW - patient surveillance KW - feasibility KW - patient reported KW - outcome measure KW - app-based N2 - Background: Head and neck cancers (HNCs) are very common malignancies, and treatment often requires multimodal approaches, including radiotherapy and chemotherapy. Patients with HNC often display a high symptom burden, both due to the disease itself and the adverse effects of the multimodal therapy. Close telemonitoring of symptoms and quality of life during the course of treatment may help to identify those patients requiring early medical support. Objective: The App-Controlled Treatment Monitoring and Support for Patients With Head and Neck Cancer (APCOT) trial aimed to investigate the feasibility of integrating electronic patient-reported outcomes (ePROs) in the treatment surveillance pathway of patients with HNC during the course of their radiotherapy. Additionally, the influence of app-based ePRO monitoring on global and disease-specific quality of life and patient satisfaction with treatment was assessed. Methods: Patients undergoing radiotherapy for histologically proven HNCs at the Department of Radiation Oncology, University Medical Center Freiburg, Germany, were enrolled in this trial and monitored by weekly physician appointments. Patients were randomized between additional ePRO monitoring on each treatment day or standard-of-care monitoring. Feasibility of ePRO monitoring was defined as ?80% of enrolled patients answering ?80% of their daily app-based questions. Quality of life and patient satisfaction were assessed by the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30), the head and neck cancer module (H&N35), and the validated Patient Satisfaction Questionnaire Short Form (PSQ-18) at the completion of treatment and compared between trial arms. Results: A total of 100 patients were enrolled in this trial, and 93 patients were evaluable. All patients (100%) in the experimental arm answered ?80% of the ePRO questions during treatment, reaching the predefined threshold for the feasibility of ePRO monitoring (P<.001 in the binomial test). No clinical or patient-specific factor was found to influence feasibility. Global health and most domains of the general quality of life were comparable between trial arms, but an increased HNC-specific symptom burden was reported by patients undergoing ePRO surveillance. ePRO monitoring resulted in improved patient satisfaction regarding interpersonal manners (P=.01), financial aspects (P=.01), and time spent with a doctor (P=.01). Conclusions: This trial demonstrated the feasibility of incorporating daily app-based ePRO surveillance for patients with HNC undergoing radiotherapy. Our data, for the first time, demonstrate that telemonitoring in this setting led to increased reporting of HNC-specific symptom burden and significantly improved several domains of patient satisfaction. Further analyses are needed to assess whether our findings hold true outside the context of a clinical trial. Trial Registration: German Clinical Trials Register DRKS00020491; https://drks.de/search/en/trial/DRKS00020491 UR - https://www.jmir.org/2023/1/e46189 UR - http://dx.doi.org/10.2196/46189 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856185 ID - info:doi/10.2196/46189 ER - TY - JOUR AU - Tutunji, Rayyan AU - Kogias, Nikos AU - Kapteijns, Bob AU - Krentz, Martin AU - Krause, Florian AU - Vassena, Eliana AU - Hermans, J. Erno PY - 2023/10/19 TI - Detecting Prolonged Stress in Real Life Using Wearable Biosensors and Ecological Momentary Assessments: Naturalistic Experimental Study JO - J Med Internet Res SP - e39995 VL - 25 KW - biosensor KW - devices KW - ecological momentary assessments KW - experience sampling KW - machine learning KW - mental disorder KW - mental health KW - monitoring KW - physiological KW - prevention KW - psychological KW - smartwatches KW - stress KW - wearables N2 - Background: Increasing efforts toward the prevention of stress-related mental disorders have created a need for unobtrusive real-life monitoring of stress-related symptoms. Wearable devices have emerged as a possible solution to aid in this process, but their use in real-life stress detection has not been systematically investigated. Objective: We aimed to determine the utility of ecological momentary assessments (EMA) and physiological arousal measured through wearable devices in detecting ecologically relevant stress states. Methods: Using EMA combined with wearable biosensors for ecological physiological assessments (EPA), we investigated the impact of an ecological stressor (ie, a high-stakes examination week) on physiological arousal and affect compared to a control week without examinations in first-year medical and biomedical science students (51/83, 61.4% female). We first used generalized linear mixed-effects models with maximal fitting approaches to investigate the impact of examination periods on subjective stress exposure, mood, and physiological arousal. We then used machine learning models to investigate whether we could use EMA, wearable biosensors, or the combination of both to classify momentary data (ie, beeps) as belonging to examination or control weeks. We tested both individualized models using a leave-one-beep-out approach and group-based models using a leave-one-subject-out approach. Results: During stressful high-stakes examination (versus control) weeks, participants reported increased negative affect and decreased positive affect. Intriguingly, physiological arousal decreased on average during the examination week. Time-resolved analyses revealed peaks in physiological arousal associated with both momentary self-reported stress exposure and self-reported positive affect. Mediation models revealed that the decreased physiological arousal in the examination week was mediated by lower positive affect during the same period. We then used machine learning to show that while individualized EMA outperformed EPA in its ability to classify beeps as originating from examinations or from control weeks (1603/4793, 33.45% and 1648/4565, 36.11% error rates, respectively), a combination of EMA and EPA yields optimal classification (1363/4565, 29.87% error rate). Finally, when comparing individualized models to group-based models, we found that the individualized models significantly outperformed the group-based models across all 3 inputs (EMA, EPA, and the combination). Conclusions: This study underscores the potential of wearable biosensors for stress-related mental health monitoring. However, it emphasizes the necessity of psychological context in interpreting physiological arousal captured by these devices, as arousal can be related to both positive and negative contexts. Moreover, our findings support a personalized approach in which momentary stress is optimally detected when referenced against an individual?s own data. UR - https://www.jmir.org/2023/1/e39995 UR - http://dx.doi.org/10.2196/39995 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856180 ID - info:doi/10.2196/39995 ER - TY - JOUR AU - Hægermark, Aale Emil AU - Kongshaug, Nina AU - Raj, Xavier Sunil AU - Hofsli, Eva AU - Faxvaag, Arild PY - 2023/10/19 TI - Design, Development, and Evaluation of an mHealth App for Reporting of Side Effects During Cytostatic Treatment: Usability Test and Interview Study JO - JMIR Form Res SP - e47374 VL - 7 KW - mobile health KW - mHealth KW - user-centered design KW - usability testing KW - cancer KW - side effects KW - cytostatic treatment KW - intervention KW - mobile app KW - usability KW - user interface KW - user KW - smartphone KW - mobile phone N2 - Background: Using mobile health (mHealth) interventions such as smartphone apps to deliver health services is an opportunity to engage patients more actively in their own treatment. Usability tests allow for the evaluation of a service by testing it out on the relevant users before implementation in clinical practice. Objective: The objective of this study was to design, develop, and evaluate the user interface of an app that would aid patients with cancer in reporting a more comprehensive summary of their side effects. Methods: The usability test was conducted by exposing patients with cancer to a prototype of an mHealth app that allowed for reporting of side effects from a chemotherapy regimen. After solving a set of 13 tasks, the test participants completed a system usability scale questionnaire and were interviewed using a semistructured interview guide. The interviews were later transcribed and analyzed. Results: The 10 test participants had a mean age of 56.5 (SD 7.11) years. The mean total task completion time for the task-solving session was 240.15 (SD 166.78) seconds. The calculated system usability scale score was 92.5. Most participants solved most of the tasks without any major issues. A minority reported having difficulties using apps on smartphones in general. One patient never achieved a meaningful interaction with our app prototype. Most of those who engaged with the app approved of features that calmed them down, made them more empowered, and put them in control. They preferred to report on side effects in a detailed and concise manner. App features that provided specific advice could provoke both fear and rational action. Conclusions: The user tests uncovered design flaws that allowed for subsequent refining of an app that has the potential to enhance the safety of patients undergoing home-based chemotherapy. However, a refined version of the app is unlikely to be of value to all patients. Some might not be able to use apps on smartphones in general, or their ability to use apps is impaired because of their disease. This finding should have implications for health care providers? overall design of their follow-up service as the service must allow for all the patients to receive safe treatment whether they can use an mHealth app or not. UR - https://formative.jmir.org/2023/1/e47374 UR - http://dx.doi.org/10.2196/47374 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856183 ID - info:doi/10.2196/47374 ER - TY - JOUR AU - Brin, Maeve AU - Trujillo, Paul AU - Jia, Haomiao AU - Cioe, Patricia AU - Huang, Ming-Chun AU - Chen, Huan AU - Qian, Xiaoye AU - Xu, Wenyao AU - Schnall, Rebecca PY - 2023/10/19 TI - Pilot Testing of an mHealth App for Tobacco Cessation in People Living With HIV: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e49558 VL - 12 KW - addict KW - addiction KW - app KW - application KW - applications KW - apps KW - cessation KW - cigar KW - cigarette KW - cigarettes KW - HIV KW - mHealth KW - mobile health KW - quit KW - quitting KW - randomized controlled trial KW - RCT KW - smartwatch KW - smoker KW - smoking cessation KW - smoking KW - tobacco N2 - Background: An estimated 40% of people living with HIV smoke cigarettes. Although smoking rates in the United States have been declining in recent years, people living with HIV continue to smoke cigarettes at twice the rate of the general population. Mobile health (mHealth) technology is an effective tool for people living with a chronic illness, such as HIV, as currently 84% of households in the United States report that they have a smartphone. Although many studies have used mHealth interventions for smoking cessation, few studies have recruited people living with HIV who smoke. Objective: The objective of the pilot randomized controlled trial (RCT) is to examine the feasibility, acceptability, and preliminary efficacy of the Sense2Quit App as a tool for people living with HIV who are motivated to quit smoking. Methods: The Sense2Quit study is a 2-arm RCT for people living with HIV who smoke cigarettes (n=60). Participants are randomized to either the active intervention condition, which consists of an 8-week supply of nicotine replacement therapy, standard smoking cessation counseling, and access to the Sense2Quit mobile app and smartwatch, or the control condition, which consists of standard smoking cessation counseling and a referral to the New York State Smokers? Quitline. The Sense2Quit app is a mobile app connected through Bluetooth to a smartwatch that tracks smoking gestures and distinguishes them from other everyday hand movements. In the Sense2Quit app, participants can view their smoking trends, which are recorded through their use of the smartwatch, including how often or how much they smoke and the amount of money that they are spending on cigarettes, watch videos with quitting tips, information, and distractions, play games, set reminders, and communicate with a study team member. Results: Enrollment of study participants began in March 2023 and is expected to end in October 2023. All data collection is expected to be completed by the end of January 2024. This RCT will test the difference in outcomes between the control and intervention arms. The primary outcome will be the percentage of participants with biochemically verified 7-day point prevalence smoking or tobacco abstinence at their 12-week follow-up. Results from this pilot study will be disseminated to the research community following the completion of all data collection. Conclusions: The Sense2Quit study leverages mHealth so that it can help smokers improve their efforts at smoking cessation. Our research has the potential to not only increase quitting rates among people living with HIV who may need a prolonged, tailored intervention but also inform further development of mHealth for people living with HIV. This mHealth study will contribute significant findings to the greater mHealth research community, providing evidence as to how mHealth should be developed and tested among the target population. Trial Registration: ClinicalTrials.gov NCT05609032; https://clinicaltrials.gov/study/NCT05609032 International Registered Report Identifier (IRRID): DERR1-10.2196/49558 UR - https://www.researchprotocols.org/2023/1/e49558 UR - http://dx.doi.org/10.2196/49558 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856173 ID - info:doi/10.2196/49558 ER - TY - JOUR AU - Ryan, T. Arthur AU - Stearns-Yoder, A. Kelly AU - Brenner, A. Lisa PY - 2023/10/18 TI - Real-World User Demographics of Three Web-Based Digital Mental Health Interventions Provided by the US Department of Veterans Affairs: Observational Study Using Web Analytics Data JO - JMIR Form Res SP - e48365 VL - 7 KW - digital intervention KW - unguided KW - web-based KW - internet-delivered KW - mental health KW - veterans KW - Google Analytics KW - insomnia KW - anger KW - depression KW - mobile phone N2 - Background: Unguided digital mental health interventions (UDMHIs) have the potential to provide low-cost and effective mental health care at scale. Controlled trials have demonstrated the efficacy of UDMHIs to address mental health symptoms and conditions. However, few previous publications have described the demographics of real-world users of UDMHIs that are freely available to the public. The US Department of Veterans Affairs has created and hosts several UDMHIs on its Veteran Training Portal website. These web-based, free-to-use, and publicly available UDMHIs include Path to Better Sleep, Anger and Irritability Management Skills, and Moving Forward, which focus on insomnia, problematic anger, and depression symptoms, respectively. Objective: This study aimed to examine the user demographics of these 3 UDMHIs in the year 2021. In addition, it aimed to compare the age and gender distribution of the users of those 3 UDMHIs with one another and with the age and gender distribution of the total US veteran population. Methods: Google Analytics was used to collect user data for each of the 3 UDMHIs. The age and gender distribution of the users of each UDMHI was compared with that of the other UDMHIs as well as with that of the overall US veteran population using chi-square tests. Information on the total number of users, the country they were in, and the devices they used to access the UDMHIs was also collected and reported. Results: In 2021, the 3 UDMHIs together recorded 29,306 unique users. The estimated age range and gender were available for 24.12% (7068/29,306) of those users. Each UDMHI?s age and gender distribution significantly differed from that of the other UDMHIs and from that of the overall US veteran population (P<.001 on all chi-square tests). Women and younger age groups were overrepresented among UDMHI users compared with the overall US veteran population. The majority of devices used to access the UDMHIs were desktop or laptop devices, although a substantial proportion of devices used were mobile devices (10,199/29,752, 34.28%). Most users (27,789/29,748, 93.41%) were located in the United States, with users from Canada, the United Kingdom, and Australia accounting for another 2.61% (775/29,748) of total users. Conclusions: Our use of Google Analytics data provided useful information about the users of 3 free and publicly available UDMHIs provided by the US Department of Veterans Affairs. Although our findings should be considered in light of the limitations of autonomously collected web analytics data, they still offer useful information for health care policy makers, administrators, and UDMHI developers. UR - https://formative.jmir.org/2023/1/e48365 UR - http://dx.doi.org/10.2196/48365 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851501 ID - info:doi/10.2196/48365 ER - TY - JOUR AU - Bakker, J. Caitlin AU - Wyatt, H. Tami AU - Breth, CS Melissa AU - Gao, Grace AU - Janeway, M. Lisa AU - Lee, A. Mikyoung AU - Martin, L. Christie AU - Tiase, L. Victoria PY - 2023/10/17 TI - Nurses? Roles in mHealth App Development: Scoping Review JO - JMIR Nursing SP - e46058 VL - 6 KW - mobile health KW - mHealth KW - mobile app KW - product development KW - software design KW - scoping KW - search strategy KW - nursing KW - health app KW - nurse KW - allied health KW - development KW - design KW - software KW - scoping literature review KW - scoping review KW - app KW - sensor KW - wearable KW - software development KW - mobile phone N2 - Background: Although mobile health (mHealth) apps for both health consumers and health care providers are increasingly common, their implementation is frequently unsuccessful when there is a misalignment between the needs of the user and the app?s functionality. Nurses are well positioned to help address this challenge. However, nurses? engagement in mHealth app development remains unclear. Objective: This scoping review aims to determine the extent of the evidence of the role of nurses in app development, delineate developmental phases in which nurses are involved, and to characterize the type of mHealth apps nurses are involved in developing. Methods: We conducted a scoping review following the 6-stage methodology. We searched 14 databases to identify publications on the role of nurses in mHealth app development and hand searched the reference lists of relevant publications. Two independent researchers performed all screening and data extraction, and a third reviewer resolved any discrepancies. Data were synthesized and grouped by the Software Development Life Cycle phase, and the app functionality was described using the IMS Institute for Healthcare Informatics functionality scoring system. Results: The screening process resulted in 157 publications being included in our analysis. Nurses were involved in mHealth app development across all stages of the Software Development Life Cycle but most frequently participated in design and prototyping, requirements gathering, and testing. Nurses most often played the role of evaluators, followed by subject matter experts. Nurses infrequently participated in software development or planning, and participation as patient advocates, research experts, or nurse informaticists was rare. Conclusions: Although nurses were represented throughout the preimplementation development process, nurses? involvement was concentrated in specific phases and roles. UR - https://nursing.jmir.org/2023/1/e46058 UR - http://dx.doi.org/10.2196/46058 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847533 ID - info:doi/10.2196/46058 ER - TY - JOUR AU - Nakrys, Marius AU - Valinskas, Sarunas AU - Aleknavicius, Kasparas AU - Jonusas, Justinas PY - 2023/10/17 TI - Pilot Investigation of Blood Pressure Control Using a Mobile App (Cardi.Health): Retrospective Chart Review Study JO - JMIR Cardio SP - e48454 VL - 7 KW - mobile app KW - Cardi.Health KW - blood pressure KW - engagement KW - app KW - pilot study KW - hypertension KW - effective KW - blood pressure control KW - self-monitoring KW - medication KW - management KW - users KW - use N2 - Background: The high prevalence of hypertension necessitates effective, scalable interventions for blood pressure (BP) control. Self-monitoring has shown improved adherence to medication and better BP management. Mobile apps offer a promising approach with their increasing popularity and potential for large-scale implementation. Studies have demonstrated associations between mobile app interventions and lowered BP, yet real-world data on app effectiveness and engagement remain limited. Objective: In this study, we analyzed real-world user data from the Cardi.Health mobile app, which is aimed at helping its users monitor and control their BP. Our goal was to find out whether there is an association between the use of the mobile app and a decrease in BP. Additionally, the study explored how engagement with the app may influence this outcome. Methods: This was a retrospective chart review study. The initial study population comprised 4407 Cardi.Health users who began using the app between January 2022 and April 2022. After applying inclusion criteria, the final study cohort comprised 339 users with elevated BP at the baseline. The sample consisted of 108 (31.9%) men and 231 (68.1%) women (P=.04). This retrospective chart review study obtained permission from the Biomedical Research Alliance of New York Institutional Review Board (June 2022, registration ID 22-08-503-939). Results: The study?s main findings were that there is a possible relationship between use of the Cardi.Health mobile app and a decrease in systolic BP. Additionally, there was a significant association between active use of the app and systolic BP decrease (?21=5.311; P=.02). Finally, active users had an almost 2 times greater chance of reducing systolic BP by 5 mm Hg or more over 4 weeks (odds ratio 1.932, 95% CI 1.074-3.528; P=.03). Conclusions: This study shows a possible relationship between Cardi.Health mobile app use and decreased BP. Additionally, engagement with the app may be related to better results?active use was associated with an almost 2-fold increase in the odds of reducing BP by 5 or more mm Hg. UR - https://cardio.jmir.org/2023/1/e48454 UR - http://dx.doi.org/10.2196/48454 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847544 ID - info:doi/10.2196/48454 ER - TY - JOUR AU - Zapata, Pablo Juan AU - Hirshfield, Sabina AU - Nelson, Kimberly AU - Horvath, Keith AU - John, A. Steven PY - 2023/10/16 TI - Preferred Characteristics for mHealth Interventions Among Young Sexual Minoritized Men to Support HIV Testing and PrEP Decision-Making: Focus Group Study JO - JMIR Form Res SP - e51103 VL - 7 KW - mobile health KW - eHealth KW - minority health KW - male adolescents KW - HIV prevention KW - sexual health KW - support KW - HIV testing KW - prevention KW - decision-making KW - men KW - sexual minority men KW - youth KW - adolescent KW - mobile simulation KW - virtual simulation KW - user-friendly KW - design KW - implementation KW - mobile phone N2 - Background: Epidemiological trends in the United States have shown an increase in HIV cases among young sexual minoritized men. Using mobile health (mHealth), which refers to health services and information delivered or enhanced through the internet and related technologies, is a crucial strategy to address HIV disparities. However, despite its potential, the practical implementation of mHealth remains limited. Additionally, it is important to consider that young individuals may become accustomed to, distracted from, or lose interest in these apps, highlighting the need for regular updates and monitoring of relevant content. Objective: In this study, we sought to highlight the voices of young sexual minoritized men aged 17-24 years and explored preferred mHealth intervention characteristics and willingness to adopt these technologies among a diverse, nationwide sample of young sexual minoritized men. Methods: From April to September 2020, we recruited participants through web-based platforms such as social media and geosocial networking apps for men. These individuals were invited to participate in synchronous web-based focus group discussions centered around topics pertaining to HIV testing and prevention and their preferences for mHealth technologies. Results: A total of 41 young sexual minoritized men, aged between 17 and 24 years, participated in 9 focus group discussions spanning April to September 2020, with 3-7 participants in each group. The findings shed light on three key insights regarding young sexual minoritized men?s preferences: (1) the need for personalized and representative content, (2) a preference for mobile and web-based simulation of prevention scenarios, and (3) a preference for digital software with individually tailored content. As expected, preference for mHealth apps was high, which supports the potential and need to develop or adapt interventions that use smartphones as a platform for engaging young sexual minoritized men in HIV prevention. This study expands on previous research in multiple meaningful ways, delving into the use and perceptions of mHealth information amid the COVID-19 pandemic. This study also highlighted the importance of streamlined access to health care providers, especially in light of the barriers faced by young people during the COVID-19 pandemic. In terms of presentation and navigation, participants favored a user-friendly design that was easy to use and appropriate for their age, which was effectively addressed through the implementation of web-based simulations. Conclusions: Ultimately, this study provides valuable insight into the preferences of young sexual minoritized men when it comes to mHealth interventions and highlights the need for further research in order to develop effective and tailored HIV prevention tools. A future direction for researchers is to evaluate how best to address participants? desire for personalized content within mHealth apps. Additionally, as technology rapidly evolves, there is a need to re-assess the effectiveness of web-based simulations, particularly those that are used in HIV prevention. UR - https://formative.jmir.org/2023/1/e51103 UR - http://dx.doi.org/10.2196/51103 UR - http://www.ncbi.nlm.nih.gov/pubmed/37713640 ID - info:doi/10.2196/51103 ER - TY - JOUR AU - Ross, Edgar AU - Al Ozairi, Ebaa AU - Al qabandi, Naeema AU - Jamison, Robert PY - 2023/10/16 TI - Optimizing an mHealth Program to Promote Type 2 Diabetes Prevention in High-Risk Individuals: Cross-Sectional Questionnaire Study JO - JMIR Form Res SP - e45977 VL - 7 KW - SMS KW - short text message interventions: mHealth KW - smartphone KW - type 2 diabetes prevention KW - social media KW - friends and family KW - percolation theory KW - diabetes KW - prevention KW - risk KW - development KW - pilot study KW - social network KW - theory modeling KW - disease control KW - initiative N2 - Background: We evaluated the outcomes of a pilot SMS text messaging?based public health campaign that identified social networking nodes and variations of response rates to develop a list of variables that could be used to analyze and develop an outreach strategy that would maximize the impact of future public health campaigns planned for Kuwait. Computational analysis of connections has been used to analyze the spread of infectious diseases, dissemination of new thoughts and ideas, efficiency of logistics networks, and even public health care campaigns. Percolation theory network analysis provides a mathematical alternative to more established heuristic approaches that have been used to optimize network development. We report on a pilot study designed to identify and treat subjects at high risk of developing type 2 diabetes mellitus in Kuwait. Objective: The aim of this study was to identify ways to optimize efficient deployment of resources and improve response rates in a public health campaign by using variables identified in this secondary analysis of our previously published data (Alqabandi et al, 2020). This analysis identified key variables that could be used in a computational analysis to plan for future public health campaigns. Methods: SMS text message screening posts were sent inviting recipients to answer 6 questions to determine their risk of developing type 2 diabetes mellitus. If subjects agreed to participate, a link to the Centers for Disease Control and Prevention prediabetes screening test was automatically transmitted to their mobile devices. The phone numbers used in this campaign were recorded and compared to the responses received through SMS text messaging and social media forwarding. Results: A total of 180,000 SMS text messages through 5 different campaigns were sent to 6% of the adult population in Kuwait. A total of 260 individuals agreed to participate, of which 153 (58.8%) completed the screening. Remarkably, 367 additional surveys were received from individuals who were not invited by the original circulated SMS text messages. These individuals were invited through forwarded surveys from the original recipients after authentication with the study center. The original SMS text messages were found to successfully identify influencers in existing social networks to improve the efficacy of the public health campaign. Conclusions: SMS text messaging?based health care screening campaigns were found to have limited effectiveness alone; however, the increased reach through shared second-party forwarding suggests the potential of exponentially expanding the reach of the study and identifying a higher percentage of eligible candidates through the use of percolation theory. Future research should be directed toward designing SMS text messaging campaigns that support a combination of SMS text message invitations and social networks along with identification of influential nodes and key variables, which are likely unique to the environment and cultural background of the population, using percolation theory modeling and chatbots. UR - https://formative.jmir.org/2023/1/e45977 UR - http://dx.doi.org/10.2196/45977 UR - http://www.ncbi.nlm.nih.gov/pubmed/37843911 ID - info:doi/10.2196/45977 ER - TY - JOUR AU - Adam, Maya AU - Kwinda, Zwannda AU - Dronavalli, Mithilesh AU - Leonard, Elizabeth AU - Nguy?n, Kính V?n AU - Tshivhase, Vusani AU - Bärnighausen, Till AU - Pillay, Yogan PY - 2023/10/13 TI - Effect of Short, Animated Video Storytelling on Maternal Knowledge and Satisfaction in the Perinatal Period in South Africa: Randomized Controlled Trial JO - J Med Internet Res SP - e47266 VL - 25 KW - maternal child health KW - mHealth KW - mobile health KW - randomized controlled trial KW - short animated storytelling KW - South Africa KW - video health messaging N2 - Background: Innovative mobile health (mHealth) interventions can improve maternal knowledge, thereby supporting national efforts to reduce preventable maternal and child mortality in South Africa. Studies have documented a potential role for mobile video content to support perinatal health messaging, enhance maternal satisfaction, and overcome literacy barriers. Short, animated storytelling (SAS) is an innovative, emerging approach to mHealth messaging. Objective: We aimed to measure the effect of SAS videos on maternal knowledge and user satisfaction for mothers enrolled in antenatal care programs at 2 public health facilities in the Tshwane District of South Africa. Methods: We used a randomized controlled trial with a nested evaluation of user satisfaction. Participants were randomized 1:1 into Standard-of-Care (SOC) Control, and SAS Intervention groups. The intervention videos were delivered through WhatsApp, and 1 month later, participants responded to telephone surveys assessing their knowledge. The intervention group then participated in a nested evaluation of user satisfaction. Results: We surveyed 204 participants. Of them, 49.5% (101/204) were aged between 25 and 34 years. Almost all participants self-identified as Black, with the majority (190/204, 93.2%) having completed secondary school. The mean overall knowledge score was 21.92/28. We observed a slight increase of 0.28 (95% uncertainty interval [UI] ?0.58 to 1.16) in the overall knowledge score in the intervention arm. We found that those with secondary education or above scored higher than those with only primary education by 2.24 (95% UI 0.76-4.01). Participants aged 35 years or older also scored higher than the youngest age group (18-24 years) by 1.83 (95% CI 0.39-3.33). Finally, the nested user satisfaction evaluation revealed high maternal satisfaction (4.71/5) with the SAS video series. Conclusions: While the SAS videos resulted in high user satisfaction, measured knowledge gains were small within a participant population that was already receiving perinatal health messages through antenatal clinics. The higher knowledge scores observed in older participants with higher education levels suggest that boosting maternal knowledge in younger mothers with lower education levels should continue to be a public health priority in South Africa. Given the high maternal satisfaction among the SAS video-users in this study, policy makers should consider integrating similar approaches into existing, broad-reaching perinatal health programs, such as MomConnect, to boost satisfaction and potentially enhance maternal engagement. While previous studies have shown the promise of animated video health education, most of this research has been conducted in high-income countries. More research in underresourced settings is urgently needed, especially as access to mobile technology increases in the Global South. Future studies should explore the effect of SAS videos on maternal knowledge in hard-to-reach populations with limited access to antenatal care, although real-world logistical challenges persist when implementing studies in underresourced South African populations. Trial Registration: Pan African Clinical Trials Registry PACTR202203673222680; https://tinyurl.com/362cpuny UR - https://www.jmir.org/2023/1/e47266 UR - http://dx.doi.org/10.2196/47266 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831505 ID - info:doi/10.2196/47266 ER - TY - JOUR AU - Hoffman, Valerie AU - Flom, Megan AU - Mariano, Y. Timothy AU - Chiauzzi, Emil AU - Williams, Andre AU - Kirvin-Quamme, Andrew AU - Pajarito, Sarah AU - Durden, Emily AU - Perski, Olga PY - 2023/10/13 TI - User Engagement Clusters of an 8-Week Digital Mental Health Intervention Guided by a Relational Agent (Woebot): Exploratory Study JO - J Med Internet Res SP - e47198 VL - 25 KW - anxiety KW - clustering KW - depression KW - digital health KW - digital mental health intervention KW - mental health KW - relational agents KW - user engagement N2 - Background: With the proliferation of digital mental health interventions (DMHIs) guided by relational agents, little is known about the behavioral, cognitive, and affective engagement components associated with symptom improvement over time. Obtaining a better understanding could lend clues about recommended use for particular subgroups of the population, the potency of different intervention components, and the mechanisms underlying the intervention?s success. Objective: This exploratory study applied clustering techniques to a range of engagement indicators, which were mapped to the intervention?s active components and the connect, attend, participate, and enact (CAPE) model, to examine the prevalence and characterization of each identified cluster among users of a relational agent-guided DMHI. Methods: We invited adults aged 18 years or older who were interested in using digital support to help with mood management or stress reduction through social media to participate in an 8-week DMHI guided by a natural language processing?supported relational agent, Woebot. Users completed assessments of affective and cognitive engagement, working alliance as measured by goal and task working alliance subscale scores, and enactment (ie, application of therapeutic recommendations in real-world settings). The app passively collected data on behavioral engagement (ie, utilization). We applied agglomerative hierarchical clustering analysis to the engagement indicators to identify the number of clusters that provided the best fit to the data collected, characterized the clusters, and then examined associations with baseline demographic and clinical characteristics as well as mental health outcomes at week 8. Results: Exploratory analyses (n=202) supported 3 clusters: (1) ?typical utilizers? (n=81, 40%), who had intermediate levels of behavioral engagement; (2) ?early utilizers? (n=58, 29%), who had the nominally highest levels of behavioral engagement in week 1; and (3) ?efficient engagers? (n=63, 31%), who had significantly higher levels of affective and cognitive engagement but the lowest level of behavioral engagement. With respect to mental health baseline and outcome measures, efficient engagers had significantly higher levels of baseline resilience (P<.001) and greater declines in depressive symptoms (P=.01) and stress (P=.01) from baseline to week 8 compared to typical utilizers. Significant differences across clusters were found by age, gender identity, race and ethnicity, sexual orientation, education, and insurance coverage. The main analytic findings remained robust in sensitivity analyses. Conclusions: There were 3 distinct engagement clusters found, each with distinct baseline demographic and clinical traits and mental health outcomes. Additional research is needed to inform fine-grained recommendations regarding optimal engagement and to determine the best sequence of particular intervention components with known potency. The findings represent an important first step in disentangling the complex interplay between different affective, cognitive, and behavioral engagement indicators and outcomes associated with use of a DMHI incorporating a natural language processing?supported relational agent. Trial Registration: ClinicalTrials.gov NCT05672745; https://classic.clinicaltrials.gov/ct2/show/NCT05672745 UR - https://www.jmir.org/2023/1/e47198 UR - http://dx.doi.org/10.2196/47198 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831490 ID - info:doi/10.2196/47198 ER - TY - JOUR AU - Weber, Joy Summer AU - Mulvaney, A. Shelagh AU - Faiola, Anthony AU - Brown, Madeline AU - Koyama, Tatsuki AU - Sun, Lili AU - Goggans, Lynn Susanna AU - Hull, Carmen Pamela PY - 2023/10/13 TI - Commercially Available Mobile Apps With Family Behavioral Goal Setting and Tracking for Parents: Review and Quality Evaluation JO - JMIR Pediatr Parent SP - e41779 VL - 6 KW - goal setting KW - goal tracking KW - nutrition KW - health behavior KW - parents KW - children KW - mobile apps N2 - Background: Goal setting and tracking are well established behavior change techniques. Little is known about the extent to which commercially available mobile apps are designed to guide parents in using these strategies, their evidence base, and their quality. Objective: This study aims to review commercially available apps that target parents in relation to setting and tracking behavioral goals for their children. The objectives were to classify the apps? general characteristics, features, evidence base, and target behaviors and assess app quality overall and separately for apps that target health-related behaviors (HRBs) and apps without a health-related behavior (WHRB). Methods: Apps were identified using keyword searches in the Apple App Store and Google Play in the United States. Apps were included if their primary purpose was to assist with setting goals, tracking goals, tracking behaviors, or giving feedback pertaining to goals for children by parents. App characteristics and common features were documented and summarized. Two reviewers assessed app quality using the Mobile App Rating Scale (MARS). Descriptive statistics summarized the MARS total score, 4 quality subscales, and 6 app-specific items that reflect the perceived impact of the app on goal setting and tracking, overall and with subgroup analysis for HRB and WHRB apps. Results: Of the 21 apps identified, 16 (76%) met the review criteria. Overall, 9 apps defined and targeted the following HRBs: nutrition and mealtime (6/16, 38%), physical activity and screen time (5/16, 31%), sleep (7/16, 44%), and personal hygiene (6/16, 38%). Three apps targeted specific age groups (2 apps were for children aged 6-13 years and 1 app was for children aged ?4 years). None of the apps provided tailored assessments or guidance for goal setting. None of the apps indicated that they were intended for the involvement of a health professional or had been tested for efficacy. The MARS total score indicated moderate app quality overall (mean 3.42, SD 0.49) and ranged from 2.5 to 4.2 out of 5 points. The Habitz app ranked highest on the MARS total score among HRB apps (score=4.2), whereas Thumsters ranked highest (score=3.9) among the WHRB apps. Subgroup analysis revealed a pattern of higher quality ratings in the HRB group than the WHRB group, including the mean MARS total score (mean 3.67, SD 0.34 vs mean 3.09, SD 0.46; P=.02); the engagement and information subscales; and the app-specific items about perceived impact on knowledge, attitudes, and behavior change. Conclusions: Several high-quality commercially available apps target parents to facilitate goal setting and tracking for child behavior change related to both health and nonhealth behaviors. However, the apps lack evidence of efficacy. Future research should address this gap, particularly targeting parents of young children, and consider individually tailored guided goal setting and involvement of health professionals. UR - https://pediatrics.jmir.org/2023/1/e41779 UR - http://dx.doi.org/10.2196/41779 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831486 ID - info:doi/10.2196/41779 ER - TY - JOUR AU - Wang, Liying AU - Yuwen, Weichao AU - Hua, Wenzhe AU - Chen, Lingxiao AU - Forsythe Cox, Vibh AU - Zheng, Huang AU - Ning, Zhen AU - Zhao, Zhuojun AU - Liu, Zhaoyu AU - Jiang, Yunzhang AU - Li, Xinran AU - Guo, Yawen AU - Simoni, M. Jane PY - 2023/10/13 TI - Enhancing Mental Health and Medication Adherence Among Men Who Have Sex With Men Recently Diagnosed With HIV With a Dialectical Behavior Therapy?Informed Intervention Incorporating mHealth, Online Skills Training, and Phone Coaching: Development Study Using Human-Centered Design Approach JO - JMIR Form Res SP - e47903 VL - 7 KW - intervention mapping KW - participatory approach KW - cultural adaptation KW - dialectical behavior therapy KW - DBT KW - men who have sex with men KW - MSM KW - coping skill training N2 - Background: Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. Objective: This study aims to systematically describe the development of a mobile health?based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. Methods: We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. Results: The dialectical behavior therapy (DBT)?informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user?s mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. Conclusions: This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes. UR - https://formative.jmir.org/2023/1/e47903 UR - http://dx.doi.org/10.2196/47903 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831497 ID - info:doi/10.2196/47903 ER - TY - JOUR AU - Woodworth, C. Emily AU - Briskin, A. Ellie AU - Plys, Evan AU - Macklin, Eric AU - Tatar, G. Raquel AU - Huberty, Jennifer AU - Vranceanu, Ana-Maria PY - 2023/10/13 TI - Mindfulness-Based App to Reduce Stress in Caregivers of Persons With Alzheimer Disease and Related Dementias: Protocol for a Single-Blind Feasibility Proof-of-Concept Randomized Controlled Trial JO - JMIR Res Protoc SP - e50108 VL - 12 KW - caregiver KW - dementia KW - mindfulness KW - mobile app KW - protocol KW - randomized controlled trial N2 - Background: Informal caregivers (ie, individuals who provide assistance to a known person with health or functional needs, often unpaid) experience high levels of stress. Caregiver stress is associated with negative outcomes for both caregivers and care recipients. Mindfulness-based interventions (MBIs) show promise for improving stress, emotional distress, and sleep disturbance in caregivers of persons with Alzheimer disease and related dementias (ADRD). Commercially available mobile mindfulness apps can deliver MBIs to caregivers of persons with ADRD in a feasible and cost-effective manner. Objective: We are conducting a single-blind feasibility proof-of-concept randomized controlled trial (RCT; National Institutes of Health [NIH] stage 1B) comparing 2 free mobile apps: the active intervention Healthy Minds Program (HMP) with within-app text tailored for addressing stress among caregivers of persons with ADRD, versus Wellness App (WA), a time- and dose-matched educational control also tailored for caregivers of persons with ADRD. Methods: We aim to recruit 80 geographically diverse and stressed caregivers of persons with ADRD. Interested caregivers use a link or QR code on a recruitment flyer to complete a web-based eligibility screener. Research assistants conduct enrollment phone calls, during which participants provide informed consent digitally. After participants complete baseline surveys, we randomize them to the mindfulness-based intervention (HMP) or educational control podcast app (WA) and instruct them to listen to prescribed content for 10 minutes per day (70 minutes per week) for 12 weeks. Caregivers are blinded to intervention versus control. The study team checks adherence weekly and contacts participants to promote adherence as needed. Participants complete web-based self-report measures at baseline, posttest, and follow-up; weekly process measures are also completed. Primary outcomes are a priori set feasibility benchmarks. Secondary outcomes are stress, emotional distress, sleep disturbance, caregiver burden, mindfulness, awareness, connection, insight, and purpose. We will calculate 1-sided 95% CI to assess feasibility benchmarks. Effect sizes of change in outcomes will be used to examine the proof of concept. Results: Recruitment started on February 20, 2023. We have enrolled 27 caregivers (HMP: n=14; WA: n=13) as of June 2023. Funding began in August 2022, and we plan to finish enrollment by December 2023. Data analysis is expected to begin in May 2024 when all follow-ups are complete; publication of findings will follow. Conclusions: Through this trial, we aim to establish feasibility benchmarks for HMP and WA, as well as establish a proof of concept that HMP improves stress (primary quantitative outcome), emotional distress, sleep, and mindfulness more than WA. Results will inform a future efficacy trial (NIH stage II). HMP has the potential to be a cost-effective solution to reduce stress in caregivers of persons with ADRD, benefiting caregiver health and quality of care as well as patient care. Trial Registration: ClinicalTrials.gov NCT05732038; https://clinicaltrials.gov/study/NCT05732038 International Registered Report Identifier (IRRID): DERR1-10.2196/50108 UR - https://www.researchprotocols.org/2023/1/e50108 UR - http://dx.doi.org/10.2196/50108 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831492 ID - info:doi/10.2196/50108 ER - TY - JOUR AU - King, Kate AU - Leightley, Daniel AU - Greenberg, Neil AU - Fear, Nicola PY - 2023/10/13 TI - The DrinksRation Smartphone App for Modifying Alcohol Use Behaviors in UK Military Service Personnel at Risk of Alcohol-Related Harm: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e49918 VL - 12 KW - alcohol drinking KW - alcohol brief intervention KW - digital intervention KW - military N2 - Background: Consumption of alcohol is synonymous with military populations, and studies have shown that serving personnel drink more than age- and sex-matched civilian populations. While ingrained in the military culture, excessive alcohol use is associated with increased rates of disciplinary issues, sickness absence, and loss of productivity, as well as contributing to a burden of acute and chronic health problems. Alcohol brief interventions can reduce alcohol use in civilian populations, but there is a paucity of evidence relating to the effectiveness of similar interventions in military populations. The DrinksRation smartphone app was designed to have a basis in behavior change technique theory and focuses on providing interactive behavioral prompts tailored to a military population. It has previously been shown to be effective in a help-seeking veteran population. Objective: The primary aim of the Military DrinksRation randomized controlled trial study is to determine whether it is similarly effective in a serving military population. Methods: We compare the effectiveness of the DrinksRation smartphone app with treatment as usual for personnel identified at risk of alcohol-related harm using the Military DrinksRation study that is a 2-arm, single-blind, 1:1 randomized controlled trial of the UK Armed Forces population. It is hypothesized that the DrinksRation app will be more efficacious at reducing alcohol consumption compared to treatment as usual. Recruitment will be predominantly from routine, periodic dental inspections all service personnel regularly undertake, supplemented by recruitment from military-targeted media messaging. The primary outcome is the change in alcohol units consumed per week between baseline and day 84, measured using the timeline follow-back method. Secondary outcome measures are a change in the Alcohol Use Disorders Identification Test score, a change in the quality of life assessment, and a change in drinking motivations and app usability (intervention arm only) between baseline and day 84. A final data collection at 168 days will assess the persistence of any changes over a longer duration. Results: The study is expected to open in August 2023 and aims to enroll 728 participants to allow for a study sample size requirement of 218 per arm and a 40% attrition rate. It is expected to take up to 12 months to complete. The results will be published in 2024. Conclusions: The Military DrinksRation study will assess the efficacy of the smartphone app on changing alcohol use behaviors in service personnel. If a positive effect is shown, the UK Defence Medical Services would have an effective, evidence-based tool to use as part of an alcohol management clinical pathway, thereby providing better support for military personnel at risk of harm from alcohol drinking. Trial Registration: ISRCTN Registry 42646;. https://doi.org/10.1186/ISRCTN14977034 International Registered Report Identifier (IRRID): PRR1-10.2196/49918 UR - https://www.researchprotocols.org/2023/1/e49918 UR - http://dx.doi.org/10.2196/49918 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831507 ID - info:doi/10.2196/49918 ER - TY - JOUR AU - Ye, Bing AU - Chu, H. Charlene AU - Bayat, Sayeh AU - Babineau, Jessica AU - How, Tuck-Voon AU - Mihailidis, Alex PY - 2023/10/12 TI - Researched Apps Used in Dementia Care for People Living With Dementia and Their Informal Caregivers: Systematic Review on App Features, Security, and Usability JO - J Med Internet Res SP - e46188 VL - 25 KW - mobile technologies KW - mobile apps KW - dementia KW - privacy KW - security KW - usability testing KW - informal caregivers KW - mobile phone N2 - Background: Studies have shown that mobile apps have the potential to serve as nonpharmacological interventions for dementia care, improving the quality of life of people living with dementia and their informal caregivers. However, little is known about the needs for and privacy aspects of these mobile apps in dementia care. Objective: This review seeks to understand the landscape of existing mobile apps in dementia care for people living with dementia and their caregivers with respect to app features, usability testing, privacy, and security. Methods: ACM Digital Library, Cochrane Central Register of Controlled Trials, Compendex, Embase, Inspec, Ovid MEDLINE, PsycINFO, and Scopus were searched. Studies were included if they included people with dementia living in the community, their informal caregivers, or both; focused on apps in dementia care using smartphones or tablet computers; and covered usability evaluation of the app. Records were independently screened, and 2 reviewers extracted the data. The Centre for Evidence-Based Medicine critical appraisal tool and Mixed Methods Appraisal Tool were used to assess the risk of bias in the included studies. Thematic synthesis was used, and the findings were summarized and tabulated based on each research aim. Results: Overall, 44 studies were included in this review, with 39 (89%) published after 2015. In total, 50 apps were included in the study, with more apps developed for people living with dementia as end users compared with caregivers. Most studies (27/44, 61%) used tablet computers. The most common app feature was cognitive stimulation. This review presented 9 app usability themes: user interface, physical considerations, screen size, interaction challenges, meeting user needs, lack of self-awareness of app needs, stigma, technological inexperience, and technical support. In total, 5 methods (questionnaires, interviews, observations, logging, and focus groups) were used to evaluate usability. There was little focus on the privacy and security aspects, including data transfer and protection, of mobile apps for people living with dementia. Conclusions: The limitations of this review include 1 reviewer conducting the full-text screening, its restriction to studies published in English, and the exclusion of apps that lacked empirical usability testing. As a result, there may be an incomplete representation of the available apps in the field of dementia care. However, this review highlights significant concerns related to the usability, privacy, and security of existing mobile apps for people living with dementia and their caregivers. The findings of this review provide a valuable framework to guide app developers and researchers in the areas of privacy policy development, app development strategies, and the importance of conducting thorough usability testing for their apps. By considering these factors, future work in this field can be advanced to enhance the quality and effectiveness of dementia care apps. Trial Registration: PROSPERO CRD42020216141; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216141 International Registered Report Identifier (IRRID): RR2-10.1159/000514838 UR - https://www.jmir.org/2023/1/e46188 UR - http://dx.doi.org/10.2196/46188 UR - http://www.ncbi.nlm.nih.gov/pubmed/37824187 ID - info:doi/10.2196/46188 ER - TY - JOUR AU - Fareed, Naleef AU - Swoboda, Christine AU - Wang, Yiting AU - Strouse, Robert AU - Hoseus, Jenelle AU - Baker, Carrie AU - Joseph, J. Joshua AU - Venkatesh, Kartik PY - 2023/10/12 TI - An Evidence-Based Framework for Creating Inclusive and Personalized mHealth Solutions?Designing a Solution for Medicaid-Eligible Pregnant Individuals With Uncontrolled Type 2 Diabetes JO - JMIR Diabetes SP - e46654 VL - 8 KW - personalization KW - mobile health KW - mHealth KW - pregnancy KW - pregnant KW - maternal KW - personalized KW - diabetic KW - algorithm KW - diabetes KW - rule-based algorithms KW - social determinants of health KW - inclusive KW - inclusivity KW - design UR - https://diabetes.jmir.org/2023/1/e46654 UR - http://dx.doi.org/10.2196/46654 UR - http://www.ncbi.nlm.nih.gov/pubmed/37824196 ID - info:doi/10.2196/46654 ER - TY - JOUR AU - Pyper, Evelyn AU - McKeown, Sarah AU - Hartmann-Boyce, Jamie AU - Powell, John PY - 2023/10/11 TI - Digital Health Technology for Real-World Clinical Outcome Measurement Using Patient-Generated Data: Systematic Scoping Review JO - J Med Internet Res SP - e46992 VL - 25 KW - real-world evidence KW - real-world data KW - digital tools KW - digital health KW - digital biomarkers KW - patient-generated health data KW - mobile health KW - mHealth KW - wearables KW - digital health management KW - clinical intervention KW - electronic health record KW - health outcomes KW - mobile phone N2 - Background: Digital health technologies (DHTs) play an ever-expanding role in health care management and delivery. Beyond their use as interventions, DHTs also serve as a vehicle for real-world data collection to characterize patients, their care journeys, and their responses to other clinical interventions. There is a need to comprehensively map the evidence?across all conditions and technology types?on DHT measurement of patient outcomes in the real world. Objective: We aimed to investigate the use of DHTs to measure real-world clinical outcomes using patient-generated data. Methods: We conducted this systematic scoping review in accordance with the Joanna Briggs Institute methodology. Detailed eligibility criteria documented in a preregistered protocol informed a search strategy for the following databases: MEDLINE (Ovid), CINAHL, Cochrane (CENTRAL), Embase, PsycINFO, ClinicalTrials.gov, and the EU Clinical Trials Register. We considered studies published between 2000 and 2022 wherein digital health data were collected, passively or actively, from patients with any specified health condition outside of clinical visits. Categories for key concepts, such as DHT type and analytical applications, were established where needed. Following screening and full-text review, data were extracted and analyzed using predefined fields, and findings were reported in accordance with established guidelines. Results: The search strategy identified 11,015 publications, with 7308 records after duplicates and reviews were removed. After screening and full-text review, 510 studies were included for extraction. These studies encompassed 169 different conditions in over 20 therapeutic areas and 44 countries. The DHTs used for mental health and addictions research (111/510, 21.8%) were the most prevalent. The most common type of DHT, mobile apps, was observed in approximately half of the studies (250/510, 49%). Most studies used only 1 DHT (346/510, 67.8%); however, the majority of technologies used were able to collect more than 1 type of data, with the most common being physiological data (189/510, 37.1%), clinical symptoms data (188/510, 36.9%), and behavioral data (171/510, 33.5%). Overall, there has been real growth in the depth and breadth of evidence, number of DHT types, and use of artificial intelligence and advanced analytics over time. Conclusions: This scoping review offers a comprehensive view of the variety of types of technology, data, collection methods, analytical approaches, and therapeutic applications within this growing body of evidence. To unlock the full potential of DHT for measuring health outcomes and capturing digital biomarkers, there is a need for more rigorous research that goes beyond technology validation to demonstrate whether robust real-world data can be reliably captured from patients in their daily life and whether its capture improves patient outcomes. This study provides a valuable repository of DHT studies to inform subsequent research by health care providers, policy makers, and the life sciences industry. Trial Registration: Open Science Framework 5TMKY; https://osf.io/5tmky/ UR - https://www.jmir.org/2023/1/e46992 UR - http://dx.doi.org/10.2196/46992 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819698 ID - info:doi/10.2196/46992 ER - TY - JOUR AU - Hamlin, Matilda AU - Holmén, Joacim AU - Wentz, Elisabet AU - Aiff, Harald AU - Ali, Lilas AU - Steingrimsson, Steinn PY - 2023/10/11 TI - Patient Experience of Digitalized Follow-up of Antidepressant Treatment in Psychiatric Outpatient Care: Qualitative Analysis JO - JMIR Ment Health SP - e48843 VL - 10 KW - major depressive disorder KW - digital psychiatry KW - mobile app KW - adherence KW - antidepressant KW - antidepressants KW - depressive KW - depression KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - experience KW - interview KW - interviews KW - medication KW - prescribe KW - prescription KW - dose N2 - Background: Nonadherence to pharmaceutical antidepressant treatment is common among patients with depression. Digitalized follow-up (ie, self-monitoring systems through mobile apps) has been suggested as an effective adjunct to conventional antidepressant treatment to increase medical adherence, improve symptoms of depression, and reduce health care resource use. Objective: The aim of this study was to determine patients? experience of digitalized follow-up using a mobile app as an adjunct to treatment concurrent with a new prescription, a change of antidepressant, or a dose increase. Methods: This was a qualitative, descriptive study. Patients at 2 psychiatric outpatient clinics were recruited at the time of changing antidepressant medication. After using a mobile app (either a commercial app or a public app) for 4-6 weeks with daily registrations of active data, such as medical intake and questions concerning general mental health status, individual semistructured interviews were conducted. Recorded data were transcribed and then analyzed using content analysis. Results: In total, 13 patients completed the study. The mean age was 35 (range 20-67) years, 8 (61.5%) were female, and all reported high digital literacy. Overall, the emerging themes indicated that the patients found the digital app to be a valuable adjunct to antidepressant treatment but with potential for improvement. Both user adherence and medical adherence were positively affected by a daily reminder and the app?s ease of use. User adherence was negatively affected by the severity of depression. The positive experience of visually presented data as graphs was a key finding, which was beneficial for self-awareness, the patient-physician relationship, and user adherence. Finally, the patients had mixed reactions to the app?s content and requested tailored content. Conclusions: The patients identified several factors addressing both medical adherence and user adherence to a digital app when using it for digitalized follow-up concurrent with the critical time related to changes in antidepressant medication. The findings highlight the need for rigorous evidence-based empirical studies to generate sustainable research results. UR - https://mental.jmir.org/2023/1/e48843 UR - http://dx.doi.org/10.2196/48843 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819697 ID - info:doi/10.2196/48843 ER - TY - JOUR AU - Fraterman, Itske AU - Wollersheim, M. Barbara AU - Tibollo, Valentina AU - Glaser, Catherina Savannah Lucia AU - Medlock, Stephanie AU - Cornet, Ronald AU - Gabetta, Matteo AU - Gisko, Vitali AU - Barkan, Ella AU - di Flora, Nicola AU - Glasspool, David AU - Kogan, Alexandra AU - Lanzola, Giordano AU - Leizer, Roy AU - Mallo, Henk AU - Ottaviano, Manuel AU - Peleg, Mor AU - van de Poll-Franse, V. Lonneke AU - Veggiotti, Nicole AU - ?niata?a, Konrad AU - Wilk, Szymon AU - Parimbelli, Enea AU - Quaglini, Silvana AU - Rizzo, Mimma AU - Locati, Deborah Laura AU - Boekhout, Annelies AU - Sacchi, Lucia AU - Wilgenhof, Sofie PY - 2023/10/11 TI - An eHealth App (CAPABLE) Providing Symptom Monitoring, Well-Being Interventions, and Educational Material for Patients With Melanoma Treated With Immune Checkpoint Inhibitors: Protocol for an Exploratory Intervention Trial JO - JMIR Res Protoc SP - e49252 VL - 12 KW - eHealth KW - melanoma KW - fatigue KW - quality of life KW - intervention KW - pilot study KW - QoL KW - cancer KW - oncology KW - HRQoL KW - symptom KW - symptoms KW - monitoring KW - adoption KW - acceptance KW - patient education KW - digital health KW - immune checkpoint inhibitors KW - immunotherapy N2 - Background: Since treatment with immune checkpoint inhibitors (ICIs) is becoming standard therapy for patients with high-risk and advanced melanoma, an increasing number of patients experience treatment-related adverse events such as fatigue. Until now, studies have demonstrated the benefits of using eHealth tools to provide either symptom monitoring or interventions to reduce treatment-related symptoms such as fatigue. However, an eHealth tool that facilitates the combination of both symptom monitoring and symptom management in patients with melanoma treated with ICIs is still needed. Objective: In this pilot study, we will explore the use of the CAPABLE (Cancer Patients Better Life Experience) app in providing symptom monitoring, education, and well-being interventions on health-related quality of life (HRQoL) outcomes such as fatigue and physical functioning, as well as patients? acceptance and usability of using CAPABLE. Methods: This prospective, exploratory pilot study will examine changes in fatigue over time in 36 patients with stage III or IV melanoma during treatment with ICI using CAPABLE (a smartphone app and multisensory smartwatch). This cohort will be compared to a prospectively collected cohort of patients with melanoma treated with standard ICI therapy. CAPABLE will be used for a minimum of 3 and a maximum of 6 months. The primary endpoint in this study is the change in fatigue between baseline and 3 and 6 months after the start of treatment. Secondary end points include HRQoL outcomes, usability, and feasibility parameters. Results: Study inclusion started in April 2023 and is currently ongoing. Conclusions: This pilot study will explore the effect, usability, and feasibility of CAPABLE in patients with melanoma during treatment with ICI. Adding the CAPABLE system to active treatment is hypothesized to decrease fatigue in patients with high-risk and advanced melanoma during treatment with ICIs compared to a control group receiving standard care. The Medical Ethics Committee NedMec (Amsterdam, The Netherlands) granted ethical approval for this study (reference number 22-981/NL81970.000.22). Trial Registration: ClinicalTrials.gov NCT05827289; https://clinicaltrials.gov/study/NCT05827289 International Registered Report Identifier (IRRID): DERR1-10.2196/49252 UR - https://www.researchprotocols.org/2023/1/e49252 UR - http://dx.doi.org/10.2196/49252 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819691 ID - info:doi/10.2196/49252 ER - TY - JOUR AU - Ndlovu, Kagiso AU - Stein, Nate AU - Gaopelo, Ruth AU - Annechino, Michael AU - Molwantwa, C. Mmoloki AU - Monkge, Mosadikhumo AU - Forrestel, Amy AU - Williams, L. Victoria PY - 2023/10/10 TI - Evaluating the Feasibility and Acceptance of a Mobile Clinical Decision Support System in a Resource-Limited Country: Exploratory Study JO - JMIR Form Res SP - e48946 VL - 7 KW - VisualDx KW - eHealth KW - technology acceptance model KW - clinical decision support KW - Botswana KW - dermatology KW - mobile phone N2 - Background: In resource-limited countries, access to specialized health care services such as dermatology is limited. Clinical decision support systems (CDSSs) offer innovative solutions to address this challenge. However, the implementation of CDSSs is commonly associated with unique challenges. VisualDx?an exemplar CDSS?was recently implemented in Botswana to provide reference materials in support of the diagnosis and management of dermatological conditions. To inform the sustainable implementation of VisualDx in Botswana, it is important to evaluate the intended users? perceptions about the technology. Objective: This study aims to determine health care workers? acceptance of VisualDx to gauge the feasibility of future adoption in Botswana and other similar health care systems. Methods: The study?s design was informed by constructs of the Technology Acceptance Model. An explanatory, sequential, mixed methods study involving surveys and semistructured interviews was conducted. The REDCap (Research Electronic Data Capture; Vanderbilt University) platform supported web-based data capture from March 2021 through August 2021. In total, 28 health care workers participated in the study. Descriptive statistics were generated and analyzed using Excel (Microsoft Corp), and thematic analysis of interview transcripts was performed using Delve software. Results: All survey respondents (N=28) expressed interest in using mobile health technology to support their work. Before VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants? survey responses showed their confidence in VisualDx (18/19, 95%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (330/681, 48.5% of total uses) or using the artificial intelligence feature to analyze skin conditions (150/681, 22% of total uses). Overall, 61% (17/28) of the survey respondents were also interviewed, and 4 thematic areas were derived. Conclusions: Participants? responses indicated their willingness to accept VisualDx. The ability to access information quickly without internet connection is crucial in resource-constrained environments. Selected enhancements to VisualDx may further increase its feasibility in Botswana. Study findings can serve as the basis for improving future CDSS studies and innovations in Botswana and similar resource-limited countries. UR - https://formative.jmir.org/2023/1/e48946 UR - http://dx.doi.org/10.2196/48946 UR - http://www.ncbi.nlm.nih.gov/pubmed/37815861 ID - info:doi/10.2196/48946 ER - TY - JOUR AU - Jenci?t?, Gabriel? AU - Kasputyt?, Gabriel? AU - Bunevi?ien?, Inesa AU - Korobeinikova, Erika AU - Vaitiekus, Domas AU - In?i?ra, Arturas AU - Jaru?evi?ius, Laimonas AU - Bunevi?ius, Romas AU - Krik?tolaitis, Ri?ardas AU - Krilavi?ius, Tomas AU - Juozaityt?, Elona AU - Bunevi?ius, Adomas PY - 2023/10/10 TI - Digital Phenotyping for Monitoring and Disease Trajectory Prediction of Patients With Cancer: Protocol for a Prospective Observational Cohort Study JO - JMIR Res Protoc SP - e49096 VL - 12 KW - cancer KW - digital phenotyping KW - biomarkers KW - oncology KW - digital phenotype KW - biomarker KW - data collection KW - data generation KW - monitor KW - monitoring KW - predict KW - prediction KW - model KW - models KW - mobile phone N2 - Background: Timely recognition of cancer progression and treatment complications is important for treatment guidance. Digital phenotyping is a promising method for precise and remote monitoring of patients in their natural environments by using passively generated data from sensors of personal wearable devices. Further studies are needed to better understand the potential clinical benefits of digital phenotyping approaches to optimize care of patients with cancer. Objective: We aim to evaluate whether passively generated data from smartphone sensors are feasible for remote monitoring of patients with cancer to predict their disease trajectories and patient-centered health outcomes. Methods: We will recruit 200 patients undergoing treatment for cancer. Patients will be followed up for 6 months. Passively generated data by sensors of personal smartphone devices (eg, accelerometer, gyroscope, GPS) will be continuously collected using the developed LAIMA smartphone app during follow-up. We will evaluate (1) mobility data by using an accelerometer (mean time of active period, mean time of exertional physical activity, distance covered per day, duration of inactive period), GPS (places of interest visited daily, hospital visits), and gyroscope sensors and (2) sociability indices (frequency of duration of phone calls, frequency and length of text messages, and internet browsing time). Every 2 weeks, patients will be asked to complete questionnaires pertaining to quality of life (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC QLQ-C30]), depression symptoms (Patient Health Questionnaire-9 [PHQ-9]), and anxiety symptoms (General Anxiety Disorder-7 [GAD-7]) that will be deployed via the LAIMA app. Clinic visits will take place at 1-3 months and 3-6 months of the study. Patients will be evaluated for disease progression, cancer and treatment complications, and functional status (Eastern Cooperative Oncology Group) by the study oncologist and will complete the questionnaire for evaluating quality of life (EORTC QLQ-C30), depression symptoms (PHQ-9), and anxiety symptoms (GAD-7). We will examine the associations among digital, clinical, and patient-reported health outcomes to develop prediction models with clinically meaningful outcomes. Results: As of July 2023, we have reached the planned recruitment target, and patients are undergoing follow-up. Data collection is expected to be completed by September 2023. The final results should be available within 6 months after study completion. Conclusions: This study will provide in-depth insight into temporally and spatially precise trajectories of patients with cancer that will provide a novel digital health approach and will inform the design of future interventional clinical trials in oncology. Our findings will allow a better understanding of the potential clinical value of passively generated smartphone sensor data (digital phenotyping) for continuous and real-time monitoring of patients with cancer for treatment side effects, cancer complications, functional status, and patient-reported outcomes as well as prediction of disease progression or trajectories. International Registered Report Identifier (IRRID): PRR1-10.2196/49096 UR - https://www.researchprotocols.org/2023/1/e49096 UR - http://dx.doi.org/10.2196/49096 UR - http://www.ncbi.nlm.nih.gov/pubmed/37815850 ID - info:doi/10.2196/49096 ER - TY - JOUR AU - Metzler-Baddeley, Claudia AU - Busse, Monica AU - Drew, Cheney AU - Pallmann, Philip AU - Cantera, Jaime AU - Ioakeimidis, Vasileios AU - Rosser, Anne PY - 2023/10/6 TI - HD-DRUM, a Tablet-Based Drumming Training App Intervention for People With Huntington Disease: App Development Study JO - JMIR Form Res SP - e48395 VL - 7 KW - Huntington disease KW - electronic health KW - intervention KW - training application KW - rhythm KW - timing KW - drumming KW - movement KW - cognition KW - integrated knowledge translation KW - gamification KW - Template for Intervention Description and Replication (TIDieR) KW - TIDieR KW - mobile phone N2 - Background: Huntington disease (HD) is a neurodegenerative condition that leads to progressive loss of cognitive-executive and motor functions, largely due to basal ganglia (BG) atrophy. Currently, there are no therapeutic interventions tailored to address executive and motor dysfunction in people with HD. Music-based interventions may aid executive abilities by compensating for impaired BG-reliant timing and rhythm generation using external rhythmic beats. Here, we applied an integrated knowledge translation (IKT) framework to co-design a tablet-based rhythmic drumming training app (HD-DRUM) to stimulate executive and motor abilities in people with HD. Objective: The primary aim was to develop the HD-DRUM app for at-home use that addressed the accessibility needs of people with HD and allowed for the quantification of performance improvements and adherence for controlled clinical evaluation. Methods: The IKT framework was applied to iteratively refine the design of HD-DRUM. This process involved 3 phases of knowledge user engagement and co-design: a web-based survey of people with HD (n=29) to inform about their accessibility needs, usability testing of tablet-based touch screens as hardware solutions, and usability testing of the design and build of HD-DRUM to meet the identified accessibility needs of people affected by HD and their clinicians (n=12). Results: The survey identified accessibility problems due to cognitive and motor control impairments such as difficulties in finding and navigating through information and using PC keyboards and mouses to interact with apps. Tablet-based touch screens were identified as feasible and accessible solutions for app delivery. Key elements to ensure that the app design and build met the needs of people with HD were identified and implemented. These included the facilitation of intuitive navigation through the app using large and visually distinctive buttons; the use of audio and visual cues as training guides; and gamification, positive feedback, and drumming to background music as a means to increase motivation and engagement. The co-design development process resulted in the proof-of-concept HD-DRUM app that is described here according to the Template for Intervention Description and Replication checklist. HD-DRUM can be used at home, allowing the quantification of performance improvements and adherence for clinical evaluation, matching of training difficulty to users? performance levels using gamification, and future scale-up to reach a wide range of interested users. Conclusions: Applying an IKT-based co-design framework involving knowledge user engagement allowed for the iterative refinement of the design and build of the tablet-based HD-DRUM app intervention, with the aim of stimulating BG-reliant cognitive and motor functions. Mapping the intervention against the Template for Intervention Description and Replication framework to describe complex interventions allowed for the detailed description of the HD-DRUM intervention and identification of areas that required refinement before finalizing the intervention protocol. UR - https://formative.jmir.org/2023/1/e48395 UR - http://dx.doi.org/10.2196/48395 UR - http://www.ncbi.nlm.nih.gov/pubmed/37801351 ID - info:doi/10.2196/48395 ER - TY - JOUR AU - Young, P. Nathan AU - Ridgeway, L. Jennifer AU - Haddad, C. Tufia AU - Harper, B. Sarah AU - Philpot, M. Lindsey AU - Christopherson, A. Laura AU - McColley, M. Samantha AU - Phillips, A. Sarah AU - Brown, K. Julie AU - Zimmerman, S. Kelly AU - Ebbert, O. Jon PY - 2023/10/5 TI - Feasibility and Usability of a Mobile App?Based Interactive Care Plan for Migraine in a Community Neurology Practice: Development and Pilot Implementation Study JO - JMIR Form Res SP - e48372 VL - 7 KW - migraine KW - mobile app KW - smartphone KW - care model KW - feasibility KW - usability KW - digital health KW - remote monitoring KW - care plan KW - pilot KW - mobile health KW - mHealth KW - mobile phone KW - patient-reported outcomes N2 - Background: Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app?based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. Objective: This study aims to describe a novel electronic health record?integrated mobile app?based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. Methods: Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3% (127/171) completing ?1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. Results: A total of 171 patients were enrolled, and of these, 127 (74.3%) patients completed ?1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6% (45/169) to 56.2% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35% (20/57) to 83% (15/18; response rate of 42/136, 30.9% to 28/68, 41%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7%) compared with controls (26/62, 42%; P<.001). Conclusions: We describe the successful implementation of an electronic health record?integrated mobile app?based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care. UR - https://formative.jmir.org/2023/1/e48372 UR - http://dx.doi.org/10.2196/48372 UR - http://www.ncbi.nlm.nih.gov/pubmed/37796560 ID - info:doi/10.2196/48372 ER - TY - JOUR AU - Li, Yongguang AU - Cen, Jue AU - Wu, Junxia AU - Tang, Min AU - Guo, Jingyi AU - Hang, Jingyu AU - Zhao, Qing AU - Zhao, Gang AU - Huang, Xiaoli AU - Han, Beibei PY - 2023/10/4 TI - The Degree of Anxiety and Depression in Patients With Cardiovascular Diseases as Assessed Using a Mobile App: Cross-Sectional Study JO - J Med Internet Res SP - e48750 VL - 25 KW - mobile app KW - anxiety KW - depression KW - cardiovascular diseases KW - Haodf platform N2 - Background: Depression and anxiety are common comorbidities in cardiovascular clinic outpatients. Timely identification and intervention of these mental and psychological disorders can contribute to correct diagnosis, better prognosis, less medical expenses, and improved quality of life. The convenience of online doctor-patient communication platforms has increasingly attracted patients to online consultations. However, online health care and offline health care are very different. Research on how to identify psychological disorders in patients who engage in an online cardiology consultation is lacking. Objective: This study aimed to explore the feasibility of using a self-rating scale to assess mental illness among patients who consult with a cardiologist online and to compare the differences in anxiety and depression between online and offline patients. Methods: From June 2022 to July 2022, we conducted follow-up visits with 10,173 patients on the Haodf platform. We conducted detailed consultations with 286 patients who visited the same cardiologist in the outpatient department. We used the self-rated Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scales to assess anxiety and depression, respectively. We analyzed the influencing factors related to the degree of coordination of online patients. We also compared the prevalence of anxiety or depression between online and offline patients and analyzed the factors related to anxiety or depression. Results: Of the 10,173 online consultation patients, only 186 (1.8%) responded effectively. The response rate of the offline consultation patients was 96.5% (276/286). Frequent online communication and watching live video broadcasts were significantly related to effective responses from online patients (P<.001). The prevalence of anxiety (70/160, 43.7% vs 69/266, 25.8%; P<.001) or depression (78/160, 48.7% vs 74/266, 27.7%; P<.001) in online consultation patients was significantly higher than that in offline patients. In bivariate analyses, the factors related to anxiety included female sex, unemployment, no confirmed cardiovascular disease, and the online consultation mode, while smokers and those who underwent COVID-19 quarantine were less likely to present with anxiety. The factors related to depression included female sex, divorced or separated individuals, and the online consultation mode. COVID-19 quarantine was related with a lower likelihood of depression. BMI was negatively correlated with depression. In multiple ordered logistic regression analysis, women were more likely than men to present with anxiety (odds ratio [OR] 2.181, 95% CI 1.365-3.486; P=.001). Women (OR 1.664, 95% CI 1.082-2.559; P=.02) and online patients (OR 2.631, 95% CI 1.305-5.304; P=.007) were more likely to have depression. Conclusions: Online patients had more anxiety or depression than offline patients. Anxiety was more prevalent in women, the unemployed, and those without confirmed cardiovascular disease. Women and divorced or separated individuals were more prone to depression. Increasing the frequency of doctor-patient communication and participating in video interactions can help improve patient cooperation. UR - https://www.jmir.org/2023/1/e48750 UR - http://dx.doi.org/10.2196/48750 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792455 ID - info:doi/10.2196/48750 ER - TY - JOUR AU - Sadler, Sean AU - Gerrard, James AU - Searle, Angela AU - Lanting, Sean AU - West, Matthew AU - Wilson, Rhonda AU - Ginige, Athula AU - Fang, Y. Kerry AU - Chuter, Vivienne PY - 2023/10/4 TI - The Use of mHealth Apps for the Assessment and Management of Diabetes-Related Foot Health Outcomes: Systematic Review JO - J Med Internet Res SP - e47608 VL - 25 KW - First Nations KW - Aboriginal KW - Torres Strait Islander KW - mobile health KW - mHealth KW - diabetes KW - diabetic KW - foot KW - systematic review KW - review methodology KW - mobile app KW - mobile apps KW - mobile phone N2 - Background: Globally, diabetes affects approximately 500 million people and is predicted to affect up to 700 million people by 2045. In Australia, the ongoing impact of colonization produces inequity in health care delivery and inequality in health care outcomes for First Nations Peoples, with diabetes rates 4 times those of non-Indigenous Australians. Evidence-based clinical practice has been shown to reduce complications of diabetes-related foot disease, including ulceration and amputation, by 50%. However, factors such as a lack of access to culturally safe care, geographical remoteness, and high costs associated with in-person care are key barriers for First Nations Peoples in accessing evidence-based care, leading to the development of innovative mobile health (mHealth) apps as a way to increase access to health services and improve knowledge and self-care management for people with diabetes. Objective: This study aims to evaluate studies investigating the use of mHealth apps for the assessment and management of diabetes-related foot health in First Nations Peoples in Australia and non-Indigenous populations globally. Methods: PubMed, Informit?s Indigenous Collection database, Ovid MEDLINE, Embase, CINAHL Complete, and Scopus were searched from inception to September 8, 2022. Hand searches of gray literature and reference lists of included studies were conducted. Studies describing mHealth apps developed for the assessment and management of diabetes-related foot health were eligible. Studies must include an evaluation (qualitative or quantitative) of the mHealth app. No language, publication date, or publication status restrictions were used. Quality appraisal was performed using the revised Cochrane risk-of-bias tool for randomized trials and the Health Evidence Bulletins Wales checklists for observational, cohort, and qualitative studies. Results: No studies specifically including First Nations Peoples in Australia were identified. Six studies in non-Indigenous populations with 361 participants were included. Foot care education was the main component of all mHealth apps. Of the 6 mHealth apps, 2 (33%) provided functionality for participants to enter health-related data; 1 (17%) included a messaging interface. The length of follow-up ranged from 1-6 months. Of the 6 studies, 1 (17%) reported high levels of acceptability of the mHealth app content for self-care by people with diabetes and diabetes specialists; the remaining 5 (83%) reported that participants had improved diabetes-related knowledge and self-management skills after using their mHealth app. Conclusions: The findings from this systematic review provide an overview of the features deployed in mHealth apps and indicate that this type of intervention can improve knowledge and self-care management skills in non-Indigenous people with diabetes. Future research needs to focus on mHealth apps for populations where there is inadequate or ineffective service delivery, including for First Nations Peoples and those living in geographically remote areas, as well as evaluate direct effects on diabetes-related foot disease outcomes. Trial Registration: PROSPERO CRD42022349087; https://tinyurl.com/35u6mmzd UR - https://www.jmir.org/2023/1/e47608 UR - http://dx.doi.org/10.2196/47608 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792467 ID - info:doi/10.2196/47608 ER - TY - JOUR AU - Giovanelli, Alison AU - Sanchez Karver, Tahilin AU - Roundfield, D. Katrina AU - Woodruff, Sean AU - Wierzba, Catherine AU - Wolny, J. AU - Kaufman, R. Michelle PY - 2023/10/4 TI - The Appa Health App for Youth Mental Health: Development and Usability Study JO - JMIR Form Res SP - e49998 VL - 7 KW - digital mental health KW - youth mentoring KW - cognitive behavioral therapy KW - teenager KW - adolescent KW - mobile phone N2 - Background: Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. Objective: The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa?s 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. Methods: The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers? characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Results: Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Conclusions: Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program. UR - https://formative.jmir.org/2023/1/e49998 UR - http://dx.doi.org/10.2196/49998 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792468 ID - info:doi/10.2196/49998 ER - TY - JOUR AU - Gómez-Restrepo, Carlos AU - Sarmiento-Suárez, José María AU - Alba-Saavedra, Magda AU - Calvo-Valderrama, Gabriela Maria AU - Rincón-Rodríguez, Javier Carlos AU - Bird, Jane Victoria AU - Priebe, Stefan AU - van Loggerenberg, Francois PY - 2023/10/4 TI - Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post?Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial JO - JMIR Form Res SP - e46757 VL - 7 KW - mental health KW - digital intervention KW - psychosocial intervention KW - armed conflict KW - adolescents KW - school KW - DIALOG+ KW - DIALOG+S KW - mobile phone N2 - Background: Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post?armed conflict areas, to reduce the burden of mental disorders in this population. Objective: This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. Methods: We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. Results: The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. Conclusions: Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374 International Registered Report Identifier (IRRID): RR2-10.2196/40286 UR - https://formative.jmir.org/2023/1/e46757 UR - http://dx.doi.org/10.2196/46757 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792465 ID - info:doi/10.2196/46757 ER - TY - JOUR AU - Eustis, H. Elizabeth AU - LoPresti, Jessica AU - Aguilera, Adrian AU - Schueller, M. Stephen PY - 2023/10/3 TI - Cultural Responsivity in Technology-Enabled Services: Integrating Culture Into Technology and Service Components JO - J Med Internet Res SP - e45409 VL - 25 KW - technology KW - mobile health KW - mHealth KW - mental health KW - cultural responsivity KW - human support KW - mobile phone UR - https://www.jmir.org/2023/1/e45409 UR - http://dx.doi.org/10.2196/45409 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788050 ID - info:doi/10.2196/45409 ER - TY - JOUR AU - Min, Beomjun AU - Park, Heyeon AU - Kim, Inhyang Johanna AU - Lee, Sungmin AU - Back, Soyoung AU - Lee, Eunhwa AU - Oh, Sohee AU - Yun, Je-Yeon AU - Kim, Bung-Nyun AU - Kim, Yonghoon AU - Hwang, JungHyun AU - Lee, Sanghyop AU - Kim, Jeong-Hyun PY - 2023/10/3 TI - The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e42851 VL - 11 KW - mindfulness KW - neurofeedback KW - stress KW - resilience KW - mobile app KW - employee N2 - Background: Mindfulness-based training programs have consistently shown efficacy in stress reduction. However, questions regarding the optimal duration and most effective delivery methods remain. Objective: This research explores a 4-week neurofeedback-assisted mindfulness training for employees via a mobile app. The study?s core query is whether incorporating neurofeedback can amplify the benefits on stress reduction and related metrics compared with conventional mindfulness training. Methods: A total of 92 full-time employees were randomized into 3 groups: group 1 received mobile mindfulness training with neurofeedback assistance (n=29, mean age 39.72 years); group 2 received mobile mindfulness training without neurofeedback (n=32, mean age 37.66 years); and group 3 were given self-learning paper materials on stress management during their first visit (n=31, mean age 38.65 years). The primary outcomes were perceived stress and resilience scales. The secondary outcomes were mindfulness awareness, emotional labor, occupational stress, insomnia, and depression. Heart rate variability and electroencephalography were measured for physiological outcomes. These measurements were collected at 3 different times, namely, at baseline, immediately after training, and at a 4-week follow-up. The generalized estimating equation model was used for data analysis. Results: The 4-week program showed significant stress reduction (Wald ?22=107.167, P<.001) and improvements in psychological indices including resilience, emotional labor, insomnia, and depression. A significant interaction was observed in resilience (time × group, Wald ?42=10.846, P=.02). The post hoc analysis showed a statistically significant difference between groups 1 (least squares mean [LSM] 21.62, SE 0.55) and 3 (LSM 19.90, SE 0.61) at the posttraining assessment (P=.008). Group 1 showed a significant improvement (P<.001) at the posttraining assessment, with continued improvements through the 1-month follow-up assessment period (LSM 21.55, SE 0.61). Physiological indices were analyzed only for data of 67 participants (22 in group 1, 22 in group 2, and 23 in group 3) due to the data quality. The relaxation index (ratio of alpha to high beta power) from the right electroencephalography channel showed a significant interaction (time × group, Wald ?22=6.947, P=.03), with group 1 revealing the highest improvement (LSM 0.43, SE 0.15) compared with groups 2 (LSM ?0.11, SE 0.10) and 3 (LSM 0.12, SE 0.10) at the 1-month follow-up assessment. Conclusions: The study demonstrated that the neurofeedback-assisted group achieved superior outcomes in resilience and relaxation during the 4-week mobile mindfulness program. Further research with larger samples and long-term follow-up is warranted. Trial Registration: ClinicalTrials.gov NCT03787407; https://clinicaltrials.gov/ct2/show/NCT03787407 UR - https://mhealth.jmir.org/2023/1/e42851 UR - http://dx.doi.org/10.2196/42851 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788060 ID - info:doi/10.2196/42851 ER - TY - JOUR AU - Lin, Kuei Yu AU - Aikens, E. James AU - de Zoysa, Nicole AU - Hall, Diana AU - Funnell, Martha AU - Nwankwo, Robin AU - Kloss, Kate AU - DeJonckheere, J. Melissa AU - Pop-Busui, Rodica AU - Piatt, A. Gretchen AU - Amiel, A. Stephanie AU - Piette, D. John PY - 2023/10/3 TI - An mHealth Text Messaging Program Providing Symptom Detection Training and Psychoeducation to Improve Hypoglycemia Self-Management: Intervention Development Study JO - JMIR Form Res SP - e50374 VL - 7 KW - behavioral intervention KW - CGM KW - continuous glucose monitor KW - design KW - develop KW - development KW - diabetes KW - diabetic KW - glucose KW - hypoglycemia KW - hypoglycemic KW - messaging KW - mHealth KW - mobile health KW - self-management KW - SMS text message KW - text message KW - type 1 diabetes KW - type 1 KW - user-centered N2 - Background: Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in people with T1D who use advanced diabetes technology. Objective: This study aims to develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in people with T1D who use advanced diabetes technology. Methods: We (a multidisciplinary team, including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycemia behavioral intervention program based on user-centered design principles. The following five iterative steps were taken: (1) conceptualization of hypoglycemia self-management processes and relevant interventions; (2) identification of text message themes and message content development; (3) message revision; (4) patient partner assessments for message readability, language acceptability, and trustworthiness; and (5) message finalization and integration with a CGM data?connected mHealth SMS text message delivery platform. An mHealth web-based SMS text message delivery platform that communicates with a CGM glucose information-sharing platform was also developed. Results: The mHealth SMS text messaging hypoglycemia behavioral intervention program HypoPals, directed by patients? own CGM data, delivers personalized intervention messages to (1) improve hypoglycemia symptom detection and (2) elicit self-reflection, provide fact-based education, and suggest practical health behaviors to address unhelpful hypoglycemia beliefs and promote hypoglycemia self-management. The program is designed to message patients up to 4 times per day over a 10-week period. Conclusions: A rigorous conceptual framework, a multidisciplinary team (including patient partners), and behavior change techniques were incorporated to create a scalable, personalized mHealth SMS text messaging behavioral intervention. This program was systematically developed to improve hypoglycemia self-management in advanced diabetes technology users with T1D. A clinical trial is needed to evaluate the program?s efficacy for future clinical implementation. UR - https://formative.jmir.org/2023/1/e50374 UR - http://dx.doi.org/10.2196/50374 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788058 ID - info:doi/10.2196/50374 ER - TY - JOUR AU - Brunet, Jennifer AU - Sharma, Sitara AU - Price, Jenson AU - Black, Melissa PY - 2023/10/3 TI - Acceptability and Usability of a Theory-Driven Intervention via Email to Promote Physical Activity in Women Who Are Overweight or Obese: Substudy Within a Randomized Controlled Trial JO - JMIR Form Res SP - e48301 VL - 7 KW - behavior change KW - motivation KW - overweight KW - obese KW - physical activity KW - women KW - digital KW - randomized trial KW - mobile phone N2 - Background: Insufficient physical activity (PA) and excess weight increase illness risk for women. Face-to-face interventions can increase PA levels; however, they are often inaccessible. With growing interest in digital interventions, a Self-Determination Theory (SDT)?driven intervention was developed and delivered via email to promote PA in women who were insufficiently active and overweight or obese. Objective: This substudy explores users? perspectives about the acceptability and usability of the intervention, which was coupled with a wearable activity monitor and PA recommendations. Methods: A 3-arm, parallel group, randomized controlled trial (unblinded) was conducted in Ontario, Canada. Recruitment occurred from September 2018 to March 2019 via advertising through social media, web-based boards, and posters in publicly accessible areas. In total, 47 women with a BMI of ?25 kg/m2 who were not meeting the Canadian PA guidelines were randomly assigned to 1 of 3 arms (arm 1: n=15, 32%; arm 2: n=16, 34%; arm 3: n=16, 34%). This substudy focused on the 15 participants allocated to the main intervention arm. Participants received an automated intervention consisting of (1) 6 weekly emails, (2) a Polar Electro Inc A300 activity monitor (with access to the Polar Flow website and companion smartphone app), and (3) a copy of the Canadian PA guidelines for adults. Emails were developed using SDT and designed to enhance autonomous motivation by fostering the psychological needs of competence, autonomy, and relatedness. Well-established motivational and behavior change techniques were embedded in the emails to promote needs satisfaction. After the intervention (ie, 7 weeks after randomization), participants were invited to complete a web-based acceptability and usability survey containing open-ended and closed-ended questions; responses were analyzed using descriptive and content analyses, respectively. Results: The analyses included data from 93% (14/15) of the women (age: mean 33.4, SD 7.5; range 24-44 years; BMI: mean 31.3, SD 5.8 kg/m2; range 25-40.5 kg/m2) who received the main intervention and completed the postintervention survey. Open-ended responses indicated that participants were generally satisfied with the intervention and appreciated that emails prompted self-reflection, kept them on track and accountable, provided informational support, and were nonpressuring. Furthermore, they suggested that the monitor was ?enjoyable? and ?helpful?; quantitative data corroborated this, as 71% (10/14) said that the monitor was ?very valuable/absolutely valuable,? 71% (10/14) would ?very probably/definitely? still use one, and 86% (12/14) wore it for ?5 days per week for ?8 hours per day and checked it ?occasionally/frequently/very frequently.? Potential threats to acceptability included ?long? and ?text-heavy? emails; lack of personal contact; and cumbersome, unaesthetic monitors. Conclusions: Results suggest that this SDT-driven, email-delivered intervention may be an acceptable low-contact approach to promote PA in women who are overweight or obese and insufficiently active; however, improvements are warranted and studies ascertaining its effectiveness are needed. Trial Registration: ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663 International Registered Report Identifier (IRRID): RR2-10.1177/20552076221093134 UR - https://formative.jmir.org/2023/1/e48301 UR - http://dx.doi.org/10.2196/48301 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788048 ID - info:doi/10.2196/48301 ER - TY - JOUR AU - Graves, S. Jennifer AU - Elantkowski, Marcin AU - Zhang, Yan-Ping AU - Dondelinger, Frank AU - Lipsmeier, Florian AU - Bernasconi, Corrado AU - Montalban, Xavier AU - Midaglia, Luciana AU - Lindemann, Michael PY - 2023/10/2 TI - Assessment of Upper Extremity Function in Multiple Sclerosis: Feasibility of a Digital Pinching Test JO - JMIR Form Res SP - e46521 VL - 7 KW - multiple sclerosis KW - smartphone sensor KW - digital health technology tools KW - upper extremity function KW - hand-motor dexterity N2 - Background: The development of touchscreen-based assessments of upper extremity function could benefit people with multiple sclerosis (MS) by allowing convenient, quantitative assessment of their condition. The Pinching Test forms a part of the Floodlight smartphone app (F. Hoffmann-La Roche Ltd, Basel, Switzerland) for people with MS and was designed to capture upper extremity function. Objective: This study aimed to evaluate the Pinching Test as a tool for remotely assessing upper extremity function in people with MS. Methods: Using data from the 24-week, prospective feasibility study investigating the Floodlight Proof-of-Concept app for remotely assessing MS, we examined 13 pinching, 11 inertial measurement unit (IMU)?based, and 13 fatigability features of the Pinching Test. We assessed the test-retest reliability using intraclass correlation coefficients [second model, first type; ICC(2,1)], age- and sex-adjusted cross-sectional Spearman rank correlation, and known-groups validity (data aggregation: median [all features], SD [fatigability features]). Results: We evaluated data from 67 people with MS (mean Expanded Disability Status Scale [EDSS]: 2.4 [SD 1.4]) and 18 healthy controls. In this cohort of early MS, pinching features were reliable [ICC(2,1)=0.54-0.81]; correlated with standard clinical assessments, including the Nine-Hole Peg Test (9HPT) (|r|=0.26-0.54; 10/13 features), EDSS (|r|=0.25-0.36; 7/13 features), and the arm items of the 29-item Multiple Sclerosis Impact Scale (MSIS-29) (|r|=0.31-0.52; 7/13 features); and differentiated people with MS-Normal from people with MS-Abnormal (area under the curve: 0.68-0.78; 8/13 features). IMU-based features showed similar test-retest reliability [ICC(2,1)=0.47-0.84] but showed little correlations with standard clinical assessments. In contrast, fatigability features (SD aggregation) correlated with 9HPT time (|r|=0.26-0.61; 10/13 features), EDSS (|r|=0.26-0.41; 8/13 features), and MSIS-29 arm items (|r|=0.32-0.46; 7/13 features). Conclusions: The Pinching Test provides a remote, objective, and granular assessment of upper extremity function in people with MS that can potentially complement standard clinical evaluation. Future studies will validate it in more advanced MS. Trial Registration: ClinicalTrials.gov NCT02952911; https://clinicaltrials.gov/study/NCT02952911 UR - https://formative.jmir.org/2023/1/e46521 UR - http://dx.doi.org/10.2196/46521 UR - http://www.ncbi.nlm.nih.gov/pubmed/37782540 ID - info:doi/10.2196/46521 ER - TY - JOUR AU - Thomas, Verghese AU - Kalidindi, Bharat AU - Waghmare, Abijeet AU - Bhatia, Abhishek AU - Raj, Tony AU - Balsari, Satchit PY - 2023/10/2 TI - The Vinyasa Tool for mHealth Solutions: Supporting Human-Centered Design in Nascent Digital Health Ecosystems JO - JMIR Form Res SP - e45250 VL - 7 KW - community health workers KW - digital health KW - focus group discussions KW - health care workers KW - human centered design KW - key informant interviews KW - LMICs KW - low- and middle-income countries KW - mHealth KW - mobile health KW - qualitative research N2 - Background: mHealth (mobile health) systems have been deployed widely in low- and middle-income countries (LMICs) for health system strengthening, requiring considerable resource allocation. However, most solutions have not achieved scale or sustainability. Poor usability and failure to address perceived needs are among the principal reasons mHealth systems fail to achieve acceptance and adoption by health care workers. A human-centered design approach to improving mHealth system use requires an exploration of users? perceptions of mHealth systems, including the environmental, user-related, and technological aspects of a system. At present, there is a dearth of contextually intelligent tools available to mHealth developers that can guide such exploration before full-scale development and deployment. Objective: To develop a tool to aid optimization of mHealth solutions in LMICs to facilitate human-centered design and, consequently, successful adoption. Methods: We collated findings and themes from key qualitative studies on mHealth deployment in LMICs. We then used the Informatics Stack framework by Lehmann to label, sort, and collate findings and themes into a list of questions that explore the environment, users, artifacts, information governance, and interoperability of mHealth systems deployed in LMICs. Results: We developed the Vinyasa Tool to aid qualitative research about the need and usability of mHealth solutions in LMICs. The tool is a guide for focus group discussions and key informant interviews with community-based health care workers and primary care medical personnel who use or are expected to use proposed mHealth solutions. The tool consists of 71 questions organized in 11 sections that unpack and explore multiple aspects of mHealth systems from the perspectives of their users. These include the wider world and organization in which an mHealth solution is deployed; the roles, functions, workflow, and adoption behavior of a system?s users; the security, privacy, and interoperability afforded by a system; and the artifacts of an information system?the data, information, knowledge, algorithms, and technology that constitute the system. The tool can be deployed in whole or in part, depending on the context of the study. Conclusions: The Vinyasa Tool is the first such comprehensive qualitative research instrument incorporating questions contextualized to the LMIC setting. We expect it to find wide application among mHealth developers, health system administrators, and researchers developing and deploying mHealth tools for use by patients, providers, and administrators. The tool is expected to guide users toward human-centered design with the goal of improving relevance, usability, and, therefore, adoption. UR - https://formative.jmir.org/2023/1/e45250 UR - http://dx.doi.org/10.2196/45250 UR - http://www.ncbi.nlm.nih.gov/pubmed/37607881 ID - info:doi/10.2196/45250 ER - TY - JOUR AU - Mitra, Sayan AU - Kroeger, M. Cynthia AU - Xu, Jing AU - Avery, Leah AU - Masedunskas, Andrius AU - Cassidy, Sophie AU - Wang, Tian AU - Hunyor, Imre AU - Wilcox, Ian AU - Huang, Robin AU - Chakraborty, Bibhas AU - Fontana, Luigi PY - 2023/10/2 TI - Testing the Effects of App-Based Motivational Messages on Physical Activity and Resting Heart Rate Through Smartphone App Compliance in Patients With Vulnerable Coronary Artery Plaques: Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e46082 VL - 12 KW - adherence KW - coronary artery disease KW - coronary heart disease KW - digital health KW - health behavior KW - heart rate KW - messages KW - mhealth KW - microrandomized trial KW - mobile app KW - physical activity KW - smartphone KW - telehealth KW - user motivation N2 - Background: Achieving the weekly physical activity recommendations of at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise is important for reducing cardiometabolic risk, but evidence shows that most people struggle to meet these goals, particularly in the mid to long term. Objective: The Messages Improving Resting Heart Health (MIRTH) study aims to determine if (1) sending daily motivational messages through a research app is effective in improving motivation and in promoting adherence to physical activity recommendations in men and women with coronary heart disease randomized to a 12-month intensive lifestyle intervention, and (2) the time of the day when the message is delivered impacts compliance with exercise training. Methods: We will conduct a single-center, microrandomized trial. Participants will be randomized daily to either receive or not receive motivational messages over two 90-day periods at the beginning (phase 1: months 4-6) and at the end (phase 2: months 10-12) of the Lifestyle Vulnerable Plaque Study. Wrist-worn devices (Fitbit Inspire 2) and Bluetooth pairing with smartphones will be used to passively collect data for proximal (ie, physical activity duration, steps walked, and heart rate within 180 minutes of receiving messages) and distal (ie, change values for resting heart rate and total steps walked within and across both phases 1 and 2 of the trial) outcomes. Participants will be recruited from a large academic cardiology office practice (Central Sydney Cardiology) and the Royal Prince Alfred Hospital Departments of Cardiology and Radiology. All clinical investigations will be undertaken at the Charles Perkins Centre Royal Prince Alfred clinic. Individuals aged 18-80 years (n=58) with stable coronary heart disease who have low attenuation plaques based on a coronary computed tomography angiography within the past 3 months and have been randomized to an intensive lifestyle intervention program will be included in MIRTH. Results: The Lifestyle Vulnerable Plaque Study was funded in 2020 and started enrolling participants in February 2022. Recruitment for MIRTH commenced in November 2022. As of September 2023, 2 participants were enrolled in the MIRTH study and provided baseline data. Conclusions: This MIRTH microrandomized trial will represent the single most detailed and integrated analysis of the effects of a comprehensive lifestyle intervention delivered through a customized mobile health app on smart devices on time-based motivational messaging for patients with coronary heart disease. This study will also help inform future studies optimizing for just-in-time adaptive interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000731796; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382861 International Registered Report Identifier (IRRID): DERR1-10.2196/46082 UR - https://www.researchprotocols.org/2023/1/e46082 UR - http://dx.doi.org/10.2196/46082 UR - http://www.ncbi.nlm.nih.gov/pubmed/37782531 ID - info:doi/10.2196/46082 ER - TY - JOUR AU - Søholm, Uffe AU - Zaremba, Natalie AU - Broadley, Melanie AU - Axelsen, Lundager Johanne AU - Divilly, Patrick AU - Martine-Edith, Gilberte AU - Amiel, A. Stephanie AU - Mader, K. Julia AU - Pedersen-Bjergaard, Ulrik AU - McCrimmon, J. Rory AU - Renard, Eric AU - Evans, Mark AU - de Galan, Bastiaan AU - Heller, Simon AU - Hendrieckx, Christel AU - Choudhary, Pratik AU - Speight, Jane AU - Pouwer, Frans AU - PY - 2023/9/29 TI - Assessing the Content Validity, Acceptability, and Feasibility of the Hypo-METRICS App: Survey and Interview Study JO - JMIR Diabetes SP - e42100 VL - 8 KW - hypoglycemia KW - diabetes KW - ecological momentary assessment KW - smartphone app KW - content validity KW - mobile phone N2 - Background: The Hypoglycaemia ? MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone app was developed to investigate the impact of hypoglycemia on daily functioning in adults with type 1 diabetes mellitus or insulin-treated type 2 diabetes mellitus. The app uses ecological momentary assessments, thereby minimizing recall bias and maximizing ecological validity. It was used in the Hypo-METRICS study, a European multicenter observational study wherein participants wore a blinded continuous glucose monitoring device and completed the app assessments 3 times daily for 70 days. Objective: The 3 aims of the study were to explore the content validity of the app, the acceptability and feasibility of using the app for the duration of the Hypo-METRICS study, and suggestions for future versions of the app. Methods: Participants who had completed the 70-day Hypo-METRICS study in the United Kingdom were invited to participate in a brief web-based survey and an interview (approximately 1h) to explore their experiences with the app during the Hypo-METRICS study. Thematic analysis of the qualitative data was conducted using both deductive and inductive methods. Results: A total of 18 adults with diabetes (type 1 diabetes: n=10, 56%; 5/10, 50% female; mean age 47, SD 16 years; type 2 diabetes: n=8, 44%; 2/8, 25% female; mean age 61, SD 9 years) filled out the survey and were interviewed. In exploring content validity, participants overall described the Hypo-METRICS app as relevant, understandable, and comprehensive. In total, 3 themes were derived: hypoglycemia symptoms and experiences are idiosyncratic; it was easy to select ratings on the app, but day-to-day changes were perceived as minimal; and instructions could be improved. Participants offered suggestions for changes or additional questions and functions that could increase engagement and improve content (such as providing more examples with the questions). In exploring acceptability and feasibility, 5 themes were derived: helping science and people with diabetes; easy to fit in, but more flexibility wanted; hypoglycemia delaying responses and increasing completion time; design, functionality, and customizability of the app; and limited change in awareness of symptoms and impact. Participants described using the app as a positive experience overall and as having a possible, although limited, intervention effect in terms of both hypoglycemia awareness and personal impact. Conclusions: The Hypo-METRICS app shows promise as a new research tool to assess the impact of hypoglycemia on an individual?s daily functioning. Despite suggested improvements, participants? responses indicated that the app has satisfactory content validity, overall fits in with everyday life, and is suitable for a 10-week research study. Although developed for research purposes, real-time assessments may have clinical value for monitoring and reviewing hypoglycemia symptom awareness and personal impact. UR - https://diabetes.jmir.org/2023/1/e42100 UR - http://dx.doi.org/10.2196/42100 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773626 ID - info:doi/10.2196/42100 ER - TY - JOUR AU - Willemsen, Fleur Romy AU - Meijer, Eline AU - van den Berg, Nicoline Liselot AU - van der Burg, Luuk AU - Chavannes, Henrik Niels AU - Aardoom, Joelle Jiska PY - 2023/9/29 TI - A Health App Platform Providing a Budget to Purchase Preselected Apps as an Innovative Way to Support Public Health: Qualitative Study With End Users and Other Stakeholders JO - JMIR Form Res SP - e49473 VL - 7 KW - eHealth KW - health apps KW - health app platform KW - prevention KW - public health KW - health platform KW - health promotion KW - digital health KW - app evaluation KW - Framework Method KW - focus group KW - focus groups KW - evaluate KW - evaluation KW - platform KW - acceptability KW - feasibility KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - mobile phone N2 - Background: eHealth has the potential to improve health outcomes. However, this potential is largely untapped. Individuals face an overload of apps and have difficulties choosing suitable apps for themselves. In the FitKnip experiment, individuals were given access to a health app platform, where they could purchase reliable preselected health apps with a personal budget of ?100 (US $107.35). By conducting a prospective study, we aimed to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. Objective: The aim of the experiment was to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. More specifically, we conducted an in-depth qualitative evaluation of the concept and acceptability of FitKnip, its perceived impact on health empowerment, as well as the roles of stakeholders for the future implementation of a health app platform through focus group interviews. Methods: This study followed a phenomenological research design and included 7 focus group interviews with end users and 1 with stakeholders, held between July and December 2020. End users were recruited through various institutions in the Netherlands, for example, insurance companies and local governments. All focus groups were semistructured using interview guides and were held via videoconferencing due to the COVID-19 pandemic measures. Each participant received access to a health app platform where they were enabled to purchase reliable, preselected health apps with a budget of ?100 (US $107.35). The budget was valid for the entire research period. The health app platform offered 38 apps. A third party, a health care coalition, selected the apps to be included in FitKnip. The analyses were conducted according to the principles of the Framework Method. Results: A priori formulated themes were concept, acceptability, health empowerment, and outcomes, and the roles of stakeholders for the future implementation of a health app platform. Both end users (n=31) and stakeholders (n=5) were enthusiastic about the concept of a health app platform. End users indicated missing apps regarding physical health and lifestyle and needing more guidance toward suitable apps. End users saw health empowerment as a precondition to using a health app platform and achieving health outcomes depending on the purchased mobile apps. End users and stakeholders identified potential providers and financing parties of FitKnip. Stakeholders recommended the establishment of a reputable national or international quality guidelines or certification for health and wellbeing apps, that can demonstrate the quality and reliability of mobile health applications. Conclusions: This study showed the need for a personalized and flexible platform. Next to this, a deeper understanding of the roles of stakeholders in such initiatives is needed especially on financing and reimbursement of health promotion and digital health services. A personalized, flexible health app platform is a promising initiative to support individuals in their health. UR - https://formative.jmir.org/2023/1/e49473 UR - http://dx.doi.org/10.2196/49473 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773608 ID - info:doi/10.2196/49473 ER - TY - JOUR AU - Stocks, B. Jacob AU - Calvetti, Sam AU - Rosso, T. Matthew AU - Slay, Lindsay AU - Kipke, Michele AU - Puentes, Manuel AU - Hightow-Weidman, B. Lisa PY - 2023/9/29 TI - Evaluating the Feasibility and Acceptability of a Digital Pre-Exposure Prophylaxis Navigation and Activation Intervention for Racially and Ethnically Diverse Sexual and Gender Minority Youth (PrEPresent): Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e50866 VL - 12 KW - PrEP KW - mobile health KW - LGBTQ KW - transgender KW - adolescent KW - mobile phone N2 - Background: To end the HIV epidemic by 2030, we must double down on efforts to tailor prevention interventions to both young men who have sex with men and transgender and nonbinary youth. There is an urgent need for interventions that specifically focus on pre-exposure prophylaxis (PrEP) uptake in sexual and gender minority youth (SGMY) populations. There are several factors that impact the ability of SGMY to successfully engage in the HIV prevention continuum, including uptake of PrEP. Patient activation, having the knowledge, skills, and self-efficacy to manage one?s health, is an important indicator of willingness and ability to manage one?s own health and care autonomously. Patient navigation also plays an important role in helping SGMY access PrEP and PrEP care, as navigators help guide patients through the health care system, set up medical appointments, and get financial, legal, and social support. Objective: This study aims to evaluate the feasibility and acceptability of a digital PrEP navigation and activation intervention among a racially and ethnically diverse sample of SGMY living in the Los Angeles area. Methods: In phase 1, we will conduct formative research to inform the development of PrEPresent using qualitative data from key informant interviews involving PrEP care providers and navigators and working groups with SGMY. In phase 2, we will complete 2 rounds of usability testing of PrEPresent with 8-10 SGMY assessing both the intervention content and mobile health delivery platform to ensure features are usable and content is understood. In phase 3, we will conduct a pilot randomized controlled trial to evaluate the feasibility and acceptability of PrEPresent. We will randomize, 1:1, a racially and ethnically diverse sample of 150 SGMY aged 16-26 years living in the Los Angeles area and follow participants for 6 months. Results: Phase 1 (formative work) was completed in April 2021. Usability testing was completed in December 2021. As of June 2023, 148 participants have been enrolled into the PrEPresent pilot randomized controlled trial (phase 3). Enrollment is expected to be completed in July 2023, with final results anticipated in December 2023. Conclusions: The PrEPresent intervention aims to bridge the gaps in PrEP eligibility and PrEP uptake among racially and ethnically diverse SGMY. By facilitating the delivery of PrEP navigation and focusing on improving patient activation, the PrEPresent intervention has the potential to positively impact the PrEP uptake cascade in the HIV care continuum as well as serve as a model for the tailoring of PrEP interventions based on behavior-based qualifications for PrEP instead of generalized gender-based eligibility. Trial Registration: ClinicalTrials.gov NCT05281393; https://clinicaltrials.gov/ct2/show/NCT05281393 International Registered Report Identifier (IRRID): DERR1-10.2196/50866 UR - https://www.researchprotocols.org/2023/1/e50866 UR - http://dx.doi.org/10.2196/50866 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773616 ID - info:doi/10.2196/50866 ER - TY - JOUR AU - Brown, A. Lily AU - Webster, L. Jessica AU - Tran, T. Jennifer AU - Wolfe, R. James AU - Golinkoff, Jesse AU - Patel, Esha AU - Arcomano, C. Amanda AU - Ben Nathan, Jennifer AU - Azat O'Connor, Alexander AU - Zhu, Yiqin AU - Oquendo, Maria AU - Brown, K. Gregory AU - Mandell, David AU - Mowery, Danielle AU - Bauermeister, A. José PY - 2023/9/29 TI - A Suicide Prevention Intervention for Emerging Adult Sexual and Gender Minority Groups: Protocol for a Pilot Hybrid Effectiveness Randomized Controlled Trial JO - JMIR Res Protoc SP - e48177 VL - 12 KW - lesbian, gay, bisexual, transgender, queer, plus KW - LGBTQ+ health KW - suicide KW - peer navigator KW - emerging adults KW - life skills KW - mobile phone N2 - Background: Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (age 18-24 years). However, suicide prevention strategies tailored for emerging adult sexual and gender minority (EA-SGM) groups are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing the risk for suicide in the general population, but it is unclear how best to support EA-SGM groups in their use of a safety plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide [STARS]) builds on content from an existing life skills mobile app for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM groups, namely, positive affect, discrimination, and social disconnection. The mobile app is delivered to participants randomized to STARS alongside 6 peer mentoring sessions to support the use of the safety plan and other life skills from the app to ultimately reduce suicide risk. Objective: We will pilot-test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intention to use SPI and overcome obstacles to its use. EA-SGM groups will be randomized to receive either SPI alone or STARS and will be assessed for 6 months. Methods: Guided by the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, we will recruit and enroll a racially and ethnically diverse sample of 60 EA-SGM individuals reporting past-month suicidal ideation. Using a type-1 effectiveness-implementation hybrid design, participants will be randomized to receive SPI (control arm) or to receive SPI alongside STARS (intervention arm). We will follow the participants for 6 months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants? willingness and adoption of SPI and STARS and staff?s experiences with delivering the program. Results: Study activities began in September 2021 and are ongoing. The study was approved by the institutional review board of the University of Pennsylvania (protocol number 849500). Study recruitment began on October 14, 2022. Conclusions: This project will be among the first tailored, mobile-based interventions for EA-SGM groups at risk for suicide. This project is responsive to the documented gaps for this population: approaches that address chosen family, focus on a life-course perspective, web approaches, and focus on health equity and provision of additional services relevant to sexual and gender minority youth. Trial Registration: ClinicalTrials.gov NCT05018143; https://classic.clinicaltrials.gov/ct2/show/NCT05018143 International Registered Report Identifier (IRRID): DERR1-10.2196/48177 UR - https://www.researchprotocols.org/2023/1/e48177 UR - http://dx.doi.org/10.2196/48177 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773618 ID - info:doi/10.2196/48177 ER - TY - JOUR AU - Liu, Jing AU - Peng, Junwei AU - Chen, Minyan AU - Zhang, Tao PY - 2023/9/28 TI - Mediating and Moderating Effects of Internet Use on Urban-Rural Disparities in Health Among Older Adults: Nationally Representative Cross-Sectional Survey in China JO - J Med Internet Res SP - e45343 VL - 25 KW - internet use KW - cognitive function KW - depressive symptoms KW - functional disability KW - mediation analysis KW - mobile phone N2 - Background: The urban-rural disparities in health outcomes in China are remarkable. The internet has shown the potential to reduce the likelihood of contracting a disease by increasing disease knowledge. However, little is known about the effects of internet use in alleviating health inequities between urban and rural areas. Objective: This study aimed to examine the mediation and moderation of health disparities between urban and rural older adults through internet use. Methods: A total of 8223 respondents were selected from the China Health and Retirement Longitudinal Study 2018 data set. Basic activities of daily living, a brief Community Screening Instrument for Dementia, and the Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function, and depressive symptoms, respectively. Logistic regressions testing ?internet use×urban-rural status? interactions for moderation and Karlson-Holm-Breen decomposition for mediation were performed. Results: Internet use moderated the urban-rural disparities in cognitive function (odds ratio 7.327, 95% CI 3.011-17.832) and depressive symptoms (odds ratio 1.070, 95% CI 1.037-1.787), but the moderating effects were significant only for those using the internet daily. Karlson-Holm-Breen results showed the suppression effects of using the internet daily (?=.012, 95% CI .002-.021) on the association between urban-rural status and cognitive function. The urban-rural inequality in depressive symptoms was partially attributed to the disparity in internet use (?=?.027, 95% CI ?.043 to ?.009). Conclusions: The urban-rural inequalities in mental health are partially attributable to disparities in the prevalence of internet use between the 2 groups. However, using the internet is more beneficial for the psychological health of rural users, thereby alleviating the urban-rural disparities in health. Providing convenient channels for rural older adults to use the internet, improving the ability of rural users to effectively use the internet, and promoting internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities. UR - https://www.jmir.org/2023/1/e45343 UR - http://dx.doi.org/10.2196/45343 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768721 ID - info:doi/10.2196/45343 ER - TY - JOUR AU - Osborne, Louise Emma AU - Ainsworth, Ben AU - Hooper, Nic AU - Atkinson, Jayne Melissa PY - 2023/9/28 TI - Experiences of Using Digital Mindfulness-Based Interventions: Rapid Scoping Review and Thematic Synthesis JO - J Med Internet Res SP - e44220 VL - 25 KW - mindfulness KW - digital intervention KW - dropout KW - eHealth KW - engagement KW - mobile health KW - mHealth KW - psychosocial intervention KW - qualitative research KW - scoping review KW - thematic synthesis KW - mobile phone N2 - Background: Digital mindfulness-based interventions (MBIs) are a promising approach to deliver accessible and scalable mindfulness training and have been shown to improve a range of health outcomes. However, the success of digital MBIs is reliant on adequate engagement, which remains a crucial challenge. Understanding people?s experiences of using digital MBIs and identifying the core factors that facilitate or act as barriers to engagement is essential to inform intervention development and maximize engagement and outcomes. Objective: This study aims to systematically map the literature on people?s experiences of using digital MBIs that target psychosocial variables (eg, anxiety, depression, distress, and well-being) and identify key barriers to and facilitators of engagement. Methods: We conducted a scoping review to synthesize empirical qualitative research on people?s experiences of using digital MBIs. We adopted a streamlined approach to ensure that the evidence could be incorporated into the early stages of intervention development. The search strategy identified articles with at least one keyword related to mindfulness, digital, user experience, and psychosocial variables in their title or abstract. Inclusion criteria specified that articles must have a qualitative component, report on participants? experiences of using a digital MBI designed to improve psychosocial variables, and have a sample age range that at least partially overlapped with 16 to 35 years. Qualitative data on user experience were charted and analyzed using inductive thematic synthesis to generate understandings that go beyond the content of the original studies. We used the Quality of Reporting Tool to critically appraise the included sources of evidence. Results: The search identified 530 studies, 22 (4.2%) of which met the inclusion criteria. Overall, the samples were approximately 78% female and 79% White; participants were aged between 16 and 69 years; and the most used measures in intervention studies were mindfulness, psychological flexibility, and variables related to mental health (including depression, anxiety, stress, and well-being). All studies were judged to be adequately reported. We identified 3 themes characterizing barriers to and facilitators of engagement: responses to own practice (ie, negative reactions to one?s own practice are common and can deplete motivation), making mindfulness a habit (ie, creating a consistent training routine is essential yet challenging), and leaning on others (ie, those engaging depend on someone else for support). Conclusions: The themes identified in this review provide crucial insights as to why people frequently stop engaging with digital MBIs. Researchers and developers should consider using person-based coparticipatory methods to improve acceptability of and engagement with digital MBIs, increase their effectiveness, and support their translation to real-world use. Such strategies must be grounded in relevant literature and meet the priorities and needs of the individuals who will use the interventions. UR - https://www.jmir.org/2023/1/e44220 UR - http://dx.doi.org/10.2196/44220 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768709 ID - info:doi/10.2196/44220 ER - TY - JOUR AU - Nguyen, Anna AU - Nagykaldi, Zsolt AU - Bui, Thanh AU - Chen, Sixia AU - Businelle, Michael AU - Eschiti, Valerie AU - Dwyer, Kathleen PY - 2023/9/28 TI - mHealth Intervention for Vietnamese Living With Diabetes: Protocol for a Stepped Wedge Pilot Study JO - JMIR Res Protoc SP - e48585 VL - 12 KW - Vietnamese KW - type 2 diabetes KW - diabetes self-management KW - mobile health technology KW - intervention study KW - stepped wedge design KW - mobile health KW - intervention KW - mobile app KW - digital health KW - diabetes KW - self-management KW - awareness KW - mhealth KW - implementation N2 - Background: Evidence indicates participation in a diabetes self-management education and support program improves self-care behaviors and hemoglobin A1c. Language and cultural differences may be barriers to program participation resulting in ineffective self-management, but these factors can be addressed with appropriate interventions. Given the high health care costs associated with diabetes complications, we developed a multicomponent, culturally tailored Self-Management Mobile Health Intervention for US Vietnamese With Diabetes (SMart-D). Objective: This study aims to evaluate the SMart-D intervention?s feasibility, acceptability, and effectiveness with intentions to scale up the intervention in the future. This mixed methods study incorporates the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate the intervention. Methods: This stepped wedge randomized controlled pilot study will be conducted over 2 years in collaboration with primary care clinics. Eligible participants are patients with type 2 diabetes who are receiving health care from participating clinics. Clinics will be randomly assigned to an implementation date and will begin with patients enrolling in the control period while receiving standard care, then cross over to the intervention period where patients receive standard care plus the SMart-D intervention for over 12 weeks. Focus groups or interviews will be conducted with clinicians and patients after study completion. Qualitative data will be analyzed using NVivo. Outcomes on self-care behavior changes will be measured with the Summary of Diabetes Self-Care Activities scale and clinical changes will be measured using laboratory tests. A generalized linear mixed-effect model will be used to compute time effect, clustering effect, and the interaction of the control and intervention periods using SAS (version 9.4; SAS Institute). Results: We hypothesize that (1) at least 50% (n=5) of eligible clinics and 50% (n=40) of eligible patients who are invited will participate, and at least 70% (n=56) of patients will complete the program, and (2) patients who receive the intervention will have improved self-care behaviors and clinical test results with at least 75% (n=60) of the patients maintaining improved outcomes at follow-up visits compared with baseline, and participants will verbalize that the intervention is feasible and acceptable. As of August 2023, we enrolled 10 clinics and 60 patients. Baseline data results will be available by the end of 2023 and outcome data will be published in 2025. Conclusions: This is the first Vietnamese diabetes self-management education and support intervention that leverages mobile health technology to address the barriers of language and culture differences through collaboration with primary care clinics. This study will provide a better understanding of the implementation process, demonstrate the potential effectiveness of the intervention, accelerate the pace of moving evidence-based interventions to practice among the US Vietnamese population, and potentially provide a replicable implementation model that can be culturally adapted to other non-English speaking ethnic minorities. International Registered Report Identifier (IRRID): DERR1-10.2196/48585 UR - https://www.researchprotocols.org/2023/1/e48585 UR - http://dx.doi.org/10.2196/48585 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768716 ID - info:doi/10.2196/48585 ER - TY - JOUR AU - Cornell, Samuel AU - Brander, Robert AU - Peden, Amy PY - 2023/9/27 TI - Selfie-Related Incidents: Narrative Review and Media Content Analysis JO - J Med Internet Res SP - e47202 VL - 25 KW - selfie KW - aquatic locations KW - death KW - injury KW - risk KW - communication KW - social media KW - drowning KW - mobile phone N2 - Background: Selfie-related injury has become a public health concern amid the near ubiquitous use of smartphones and social media apps. Of particular concern are selfie-related deaths at aquatic locations; areas often frequented because of their photogenic allure. Unfortunately, such places exhibit hazards inherent with their environment. Objective: This study aimed to ascertain current evidence regarding selfie-related injuries and recommended risk treatment measures in the academic literature as well as how selfie-related injuries and deaths were being reported by the media, allowing us to identify key challenges facing land managers and public health practitioners in mitigating selfie-related injuries and deaths. Methods: Between October and December 2022, we performed a narrative review of peer-reviewed literature published since January 2011. Literature was screened to identify causal factors implicated in selfie-related deaths and injuries, as well as risk treatments recommended. Furthermore, we used an environmental scan methodology to search for media reports of selfie-related injuries and deaths at aquatic locations in Australia and the United States. Individual cases of selfie-related aquatic injuries and deaths sourced from news reports were analyzed to assess epidemiological characteristics, and a thematic content analysis was conducted to identify key themes of news reporting on selfie-related deaths and injuries. Results: In total, 5 peer-reviewed studies were included. Four studies identified falls from height as the most common injury mechanism in selfie incidents. Drowning was the second most common cause of death. Recommended risk treatments were limited but included the adoption of ?no selfie zones,? physical barriers, signage, and provision of information on dangerous locations to social media users. In total, 12 cases were identified from media reports (4 injuries and 8 fatalities; 7 in Australia and 5 in the United States). The mean age of the reported victims was 22.1 (SD 6.93) years with victims more likely to be female tourists. Content analysis revealed 3 key themes from media reports: ?blame,? ?warning,? and ?prevention and education.? Few media reports (n=8) provided safety recommendations. Conclusions: The selfie-related incident phenomenon should be viewed as a public health problem that requires a public health risk communication response. To date, little attention has been paid to averting selfie-related incidents through behavior change methodologies or direct messaging to users, including through social media apps. Although previous research has recommended ?no selfie zones,? barriers, and signage as ways to prevent selfie incidents, our results suggest this may not be enough, and it may be prudent to also engage in direct safety messaging to social media users. Media reporting of selfie incidents should focus on preventive messaging rather than blame or warning. UR - https://www.jmir.org/2023/1/e47202 UR - http://dx.doi.org/10.2196/47202 UR - http://www.ncbi.nlm.nih.gov/pubmed/37756044 ID - info:doi/10.2196/47202 ER - TY - JOUR AU - Duarte-Díaz, Andrea AU - Perestelo-Pérez, Lilisbeth AU - Gelabert, Estel AU - Robles, Noemí AU - Pérez-Navarro, Antoni AU - Vidal-Alaball, Josep AU - Solà-Morales, Oriol AU - Sales Masnou, Ariadna AU - Carrion, Carme PY - 2023/9/27 TI - Efficacy, Safety, and Evaluation Criteria of mHealth Interventions for Depression: Systematic Review JO - JMIR Ment Health SP - e46877 VL - 10 KW - mobile health KW - mHealth KW - apps KW - depression KW - systematic review KW - meta-analysis N2 - Background: Depression is a significant public health issue that can lead to considerable disability and reduced quality of life. With the rise of technology, mobile health (mHealth) interventions, particularly smartphone apps, are emerging as a promising approach for addressing depression. However, the lack of standardized evaluation tools and evidence-based principles for these interventions remains a concern. Objective: In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of mHealth interventions for depression and identify the criteria and evaluation tools used for their assessment. Methods: A systematic review and meta-analysis of the literature was carried out following the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies that recruited adult patients exhibiting elevated depressive symptoms or those diagnosed with depressive disorders and aimed to assess the effectiveness or safety of mHealth interventions were eligible for consideration. The primary outcome of interest was the reduction of depressive symptoms, and only randomized controlled trials (RCTs) were included in the analysis. The risk of bias in the original RCTs was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. Results: A total of 29 RCTs were included in the analysis after a comprehensive search of electronic databases and manual searches. The efficacy of mHealth interventions in reducing depressive symptoms was assessed using a random effects meta-analysis. In total, 20 RCTs had an unclear risk of bias and 9 were assessed as having a high risk of bias. The most common element in mHealth interventions was psychoeducation, followed by goal setting and gamification strategies. The meta-analysis revealed a significant effect for mHealth interventions in reducing depressive symptoms compared with nonactive control (Hedges g=?0.62, 95% CI ?0.87 to ?0.37, I2=87%). Hybrid interventions that combined mHealth with face-to-face sessions were found to be the most effective. Three studies compared mHealth interventions with active controls and reported overall positive results. Safety analyses showed that most studies did not report any study-related adverse events. Conclusions: This review suggests that mHealth interventions can be effective in reducing depressive symptoms, with hybrid interventions achieving the best results. However, the high level of heterogeneity in the characteristics and components of mHealth interventions indicates the need for personalized approaches that consider individual differences, preferences, and needs. It is also important to prioritize evidence-based principles and standardized evaluation tools for mHealth interventions to ensure their efficacy and safety in the treatment of depression. Overall, the findings of this study support the use of mHealth interventions as a viable method for delivering mental health care. Trial Registration: PROSPERO CRD42022304684; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304684 UR - https://mental.jmir.org/2023/1/e46877 UR - http://dx.doi.org/10.2196/46877 UR - http://www.ncbi.nlm.nih.gov/pubmed/37756042 ID - info:doi/10.2196/46877 ER - TY - JOUR AU - Park, Y. Susanna AU - Huberty, Jennifer AU - Yourell, Jacqlyn AU - McAlister, L. Kelsey AU - Beatty, C. Clare PY - 2023/9/27 TI - A Spiritual Self-Care Mobile App (Skylight) for Mental Health, Sleep, and Spiritual Well-Being Among Generation Z and Young Millennials: Cross-Sectional Survey JO - JMIR Form Res SP - e50239 VL - 7 KW - Gen Z KW - millennial KW - spirituality KW - spiritual self-care KW - mental health KW - sleep KW - mobile health KW - mHealth KW - digital health KW - spiritual KW - self-care KW - app KW - apps KW - mental wellness KW - mental well-being KW - young adult KW - young adults KW - engagement KW - perception KW - perceptions N2 - Background: Generation Z (Gen Z) and young millennials (GenZennials) (ages 18-35 years) are unique in that they either have no memory of or were born shortly after the internet ?explosion.? They are constantly on the internet, face significant challenges with their mental health and sleep, and are frequent users of digital wellness apps. GenZennials also uniquely identify with and practice spirituality, which has been linked to better mental health and sleep in adult populations. Research has not examined digital approaches to spiritual self-care and its relationship to mental health and sleep in GenZennials. Objective: The purpose of this study was to describe a sample of adult GenZennials who use a spiritual self-care app (ie, Skylight), describe how users engage with and perceive the app, and assess the relationship between frequency of using the app with mental health, sleep, and spiritual well-being. Methods: Participants were 475 adult Gen Z (ages 18-28 years) and young millennial (ages 29-35 years) Skylight app users who responded to an anonymous survey on the web. The survey asked about demographics, spiritual self-care and practice, and user engagement and perceptions of the app. Outcome measures included 4 validated surveys for mental health (ie, depression, anxiety, and stress) and sleep disturbance, and one validated survey on spiritual well-being. Mean scores were calculated for all measures, and linear regressions were conducted to examine the relationship between the frequency of app use and mental health, sleep, and spiritual well-being outcomes. Results: Participants were predominantly White (324/475, 68.2%) and female (255/475, 53.7%), and approximately half Gen Z (260/475, 54.5%) and half young millennials (215/475, 45.3%). Most users engaged in spiritual self-care (399/475, 84%) and said it was important or very important to them (437/475, 92%). Users downloaded the app for spiritual well-being (130/475, 30%) and overall health (125/475, 26.3%). Users had normal, average depressive symptoms (6.9/21), borderline abnormal anxiety levels (7.7/21), slightly elevated stress (6.7/16), and nonclinically significant sleep disturbance (5.3/28). Frequency of app use was significantly associated with lower anxiety (Moderate use: ?=?2.01; P=.02; high use: ?=?2.58; P<.001). There were no significant relationships between the frequency of app use and mental health, sleep, and spiritual well-being outcomes except for the personal domain of spiritual well-being. Conclusions: This is the first study to describe a sample of adult GenZennials who use a spiritual self-care app and examine how the frequency of app use is related to their mental health, sleep, and spiritual well-being. Spiritual self-care apps like Skylight may be useful in addressing anxiety among GenZennials and be a resource to spiritually connect to their personal spiritual well-being. Future research is needed to determine how a spiritual self-care app may benefit mental health, sleep, and spiritual well-being in adult GenZennials. UR - https://formative.jmir.org/2023/1/e50239 UR - http://dx.doi.org/10.2196/50239 UR - http://www.ncbi.nlm.nih.gov/pubmed/37597179 ID - info:doi/10.2196/50239 ER - TY - JOUR AU - Sideropoulos, Vassilis AU - Vangeli, Eleni AU - Naughton, Felix AU - Cox, Sharon AU - Frings, Daniel AU - Notley, Caitlin AU - Brown, Jamie AU - Kimber, Catherine AU - Dawkins, Lynne PY - 2023/9/27 TI - Mobile Phone Text Messages to Support People to Stop Smoking by Switching to Vaping: Codevelopment, Coproduction, and Initial Testing Study JO - JMIR Form Res SP - e49668 VL - 7 KW - coproduction KW - SMS text messages KW - e-cigarette KW - smoking KW - eHealth KW - vaping KW - mobile phone KW - codevelopment KW - text message N2 - Background: SMS text messages are affordable, scalable, and effective smoking cessation interventions. However, there is little research on SMS text message interventions specifically designed to support people who smoke to quit by switching to vaping. Objective: Over 3 phases, with vapers and smokers, we codeveloped and coproduced a mobile phone SMS text message program. The coproduction paradigm allowed us to collaborate with researchers and the community to develop a more relevant, acceptable, and equitable SMS text message program. Methods: In phase 1, we engaged people who vape via Twitter and received 167 responses to our request to write SMS text messages for people who wish to quit smoking by switching to vaping. We screened, adjusted, refined, and themed the messages, resulting in a set of 95 that were mapped against the Capability, Opportunity, and Motivation?Behavior constructs. In phase 2, we evaluated the 95 messages from phase 1 via a web survey where participants (66/202, 32.7% woman) rated up to 20 messages on 7-point Likert scales on 9 constructs: being understandable, clear, believable, helpful, interesting, inoffensive, positive, and enthusiastic and how happy they would be to receive the messages. In phase 3, we implemented the final set of SMS text messages as part of a larger randomized optimization trial, in which 603 participants (mean age 38.33, SD 12.88 years; n=369, 61.2% woman) received SMS text message support and then rated their usefulness and frequency and provided free-text comments at the 12-week follow-up. Results: For phase 2, means and SDs were calculated for each message across the 9 constructs. Those with means below the neutral anchor of 4 or with unfavorable comments were discussed with vapers and further refined or removed. This resulted in a final set of 78 that were mapped against early, mid-, or late stages of quitting to create an order for the messages. For phase 3, a total of 38.5% (232/603) of the participants provided ratings at the 12-week follow-up. In total, 69.8% (162/232) reported that the SMS text messages had been useful, and a significant association between quit rates and usefulness ratings was found (?21=9.6; P=.002). A content analysis of free-text comments revealed that the 2 most common positive themes were helpful (13/47, 28%) and encouraging (6/47, 13%) and the 2 most common negative themes were too frequent (9/47, 19%) and annoying (4/47, 9%). Conclusions: In this paper, we describe the initial coproduction and codevelopment of a set of SMS text messages to help smokers stop smoking by transitioning to vaping. We encourage researchers to use, further develop, and evaluate the set of SMS text messages and adapt it to target populations and relevant contexts. UR - https://formative.jmir.org/2023/1/e49668 UR - http://dx.doi.org/10.2196/49668 UR - http://www.ncbi.nlm.nih.gov/pubmed/37756034 ID - info:doi/10.2196/49668 ER - TY - JOUR AU - Forman-Hoffman, L. Valerie AU - Pirner, C. Maddison AU - Flom, Megan AU - Kirvin-Quamme, Andrew AU - Durden, Emily AU - Kissinger, A. Jennifer AU - Robinson, Athena PY - 2023/9/27 TI - Engagement, Satisfaction, and Mental Health Outcomes Across Different Residential Subgroup Users of a Digital Mental Health Relational Agent: Exploratory Single-Arm Study JO - JMIR Form Res SP - e46473 VL - 7 KW - adoption KW - anxiety KW - chatbot KW - cognitive behavioral therapy KW - conversational agent KW - CBT KW - depression KW - digital health KW - medically underserved area KW - mental health KW - mhealth KW - mobile app KW - mobile health KW - mobile phone KW - mood KW - psychotherapy KW - relational agent KW - rural KW - satisfaction KW - smartphone app KW - smartphone KW - underserved KW - usage KW - vulnerable N2 - Background: Mental illness is a pervasive worldwide public health issue. Residentially vulnerable populations, such as those living in rural medically underserved areas (MUAs) or mental health provider shortage areas (MHPSAs), face unique access barriers to mental health care. Despite the growth of digital mental health interventions using relational agent technology, little is known about their use patterns, efficacy, and favorability among residentially vulnerable populations. Objective: This study aimed to explore differences in app use, therapeutic alliance, mental health outcomes, and satisfaction across residential subgroups (metropolitan, nonmetropolitan, or rural), MUAs (yes or no), and MHPSAs (yes or no) among users of a smartphone-based, digital mental health intervention, Woebot LIFE (WB-LIFE). WB-LIFE was designed to help users better understand and manage their moods and features a relational agent, Woebot, that converses through text-based messages. Methods: We used an exploratory study that examined data from 255 adults enrolled in an 8-week, single-arm trial of WB-LIFE. Analyses compared levels of app use and therapeutic alliance total scores as well as subscales (goal, task, and bond), mental health outcomes (depressive and anxiety symptoms, stress, resilience, and burnout), and program satisfaction across residential subgroups. Results: Few study participants resided in nonmetropolitan (25/255, 10%) or rural (3/255, 1%) areas, precluding estimates across this variable. Despite a largely metropolitan sample, nearly 39% (99/255) resided in an MUA and 55% (141/255) in an MHPSA. There were no significant differences in app use or satisfaction by MUA or MHPSA status. There also were no differences in depressive symptoms, anxiety, stress, resilience, or burnout, with the exception of MUA participants having higher baseline depressive symptoms among those starting in the moderate range or higher (Patient Health Questionnaire-8 item scale?10) than non-MUA participants (mean 16.50 vs 14.41, respectively; P=.01). Although working alliance scores did not differ by MHPSA status, those who resided in an MUA had higher goal (2-tailed t203.47=2.21; P=.03), and bond (t203.47=1.94; P=.05) scores at day 3 (t192.98=2.15; P=.03), and higher goal scores at week 8 (t186.19=2.28; P=.02) as compared with those not living in an MUA. Conclusions: Despite the study not recruiting many participants from rural or nonmetropolitan populations, sizable proportions resided in an MUA or an MHPSA. Analyses revealed few differences in app use, therapeutic alliance, mental health outcomes (including baseline levels), or satisfaction across MUA or MHPSA status over the 8-week study. Findings suggest that vulnerable residential populations may benefit from using digital agent?guided cognitive behavioral therapy. Trial Registration: ClinicalTrials.gov NCT05672745; https://clinicaltrials.gov/study/NCT05672745 UR - https://formative.jmir.org/2023/1/e46473 UR - http://dx.doi.org/10.2196/46473 UR - http://www.ncbi.nlm.nih.gov/pubmed/37756047 ID - info:doi/10.2196/46473 ER - TY - JOUR AU - Sun, Shufang AU - Nardi, William AU - Murphy, Matthew AU - Scott, Ty AU - Saadeh, Frances AU - Roy, Alexandra AU - Brewer, Judson PY - 2023/9/26 TI - Mindfulness-Based Mobile Health to Address Unhealthy Eating Among Middle-Aged Sexual Minority Women With Early Life Adversity: Mixed Methods Feasibility Trial JO - J Med Internet Res SP - e46310 VL - 25 KW - mobile health KW - mindfulness KW - obesity KW - sexual minority women KW - early life adversity KW - cell phone KW - mobile phone N2 - Background: Sexual minority women (lesbian, gay, bisexual, pansexual, queer, and other nonheterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma and psychological distress than their heterosexual peers. In addition, early life adversity (ELA) is prevalent among sexual minority women, which further increases risks for obesity, psychological distress, and poor cardiovascular health. App-based mindfulness interventions are potentially promising for this group in mitigating the adverse health effects of ELA, reducing food craving and unhealthy eating, addressing the risks associated with obesity. Objective: This mixed methods feasibility trial aimed to test a mindfulness-based mobile health approach for middle-aged sexual minority women (aged 30-55 years) with ELA and overweight or obesity (BMI ?25 kg/m2) to improve health outcomes. Methods: The single-arm trial was advertised on social media and various lesbian, gay, bisexual, transgender, and queer web-based groups. At baseline, after the intervention (2 months), and at the 4-month follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). A standardized weight measure was mailed to participants for weight reporting. Feasibility and acceptability were assessed after the intervention via surveys and semistructured exit interviews. Results: We screened 442 individuals, among which 30 eligible sexual minority women (mean age 40.20, SD 7.15 years) from various US regions were enrolled in the study. At baseline, 86% (26/30) and 80% (24/30) of participants had elevated depressive and anxiety symptoms, respectively. Among the 30 enrolled participants, 20 (66%) completed all intervention modules, 25 (83%) were retained at the 2-month follow-up, and 20 (66%) were retained at the 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (Cohen d=1.64) and reward-based eating (Cohen d=1.56), whereas small effects were found with weight (Cohen d=0.20; 4.21 kg on average). Significant improvements were also found in the secondary outcomes (depression, Cohen d=0.98; anxiety, Cohen d=0.50; mindfulness, Cohen d=0.49; and emotion dysregulation, Cohen d=0.44; all P<.05). Participants with higher levels of parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported that the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers to engagement included the need for diverse teachers, individualized support, and body positive language. Conclusions: This early phase feasibility trial provides proof-of-concept support for a mindfulness mobile health approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. The findings also suggest the need to address trauma and psychological health when addressing weight-related outcomes among sexual minority women. UR - https://www.jmir.org/2023/1/e46310 UR - http://dx.doi.org/10.2196/46310 UR - http://www.ncbi.nlm.nih.gov/pubmed/37751273 ID - info:doi/10.2196/46310 ER - TY - JOUR AU - Bakema, Robbert AU - Smirnova, Daria AU - Biri, Despina AU - Kocks, H. Janwillem W. AU - Postma, J. Maarten AU - de Jong, A. Lisa PY - 2023/9/26 TI - The Use of eHealth for Pharmacotherapy Management With Patients With Respiratory Disease, Cardiovascular Disease, or Diabetes: Scoping Review JO - J Med Internet Res SP - e42474 VL - 25 KW - telemedicine KW - polypharmacy KW - pharmacotherapy KW - diabetes mellitus KW - cardiovascular diseases KW - asthma KW - pulmonary disease, chronic obstructive KW - interventions e-health N2 - Background: eHealth is increasingly considered an important tool for supporting pharmacotherapy management. Objective: We aimed to assess the (1) use of eHealth in pharmacotherapy management with patients with asthma or chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD); (2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes; and (3) key factors contributing to the success of eHealth interventions for pharmacotherapy management. Methods: We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review) statement. Databases searched included Embase, MEDLINE (PubMed), and Cochrane Library. Screening was conducted by 2 independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared with usual care on pharmacotherapy management or clinical outcomes in patients with asthma or COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al (Health in our Hands, Interacting for Health, Data Enabling Health). The effectiveness on pharmacotherapy management outcomes and patient- and clinician-reported clinical outcomes was analyzed per type of intervention categorized by number of domains and features to identify trends. Results: Of 63 studies, 16 (25%), 31 (49%), 13 (21%), and 3 (5%) included patients with asthma or COPD, CVD, diabetes, or CVD and diabetes, respectively. Most (38/63, 60%) interventions targeted improving medication adherence, often combined for treatment plan optimization. Of the 16 asthma or COPD interventions, 6 aimed to improve inhaled medication use. The majority (48/63, 76%) of the studies provided an option for patient feedback. Most (20/63, 32%) eHealth interventions combined all 3 domains by Shaw et al, while 25% (16/63) combined Interacting for Health with Data Enabling Health. Two-thirds (42/63, 67%) of the studies showed a positive overall effect. Respectively, 48% (23/48), 57% (28/49), and 39% (12/31) reported a positive effect on pharmacotherapy management and clinician- and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes, but not clinician-reported clinical outcomes, were more often positive in interventions with ?3 features. There was a trend toward more studies reporting a positive effect on all 3 outcomes with more domains by Shaw et al. Of the studies with interventions providing patient feedback, more showed a positive clinical outcome, compared with studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes. Conclusions: There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma or COPD, CVD, and diabetes. Results suggest feedback is key for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains. UR - https://www.jmir.org/2023/1/e42474 UR - http://dx.doi.org/10.2196/42474 UR - http://www.ncbi.nlm.nih.gov/pubmed/37751232 ID - info:doi/10.2196/42474 ER - TY - JOUR AU - Park, Junghwan AU - Kim, Meelim AU - El Mistiri, Mohamed AU - Kha, Rachael AU - Banerjee, Sarasij AU - Gotzian, Lisa AU - Chevance, Guillaume AU - Rivera, E. Daniel AU - Klasnja, Predrag AU - Hekler, Eric PY - 2023/9/26 TI - Advancing Understanding of Just-in-Time States for Supporting Physical Activity (Project JustWalk JITAI): Protocol for a System ID Study of Just-in-Time Adaptive Interventions JO - JMIR Res Protoc SP - e52161 VL - 12 KW - just-in-time adaptive intervention KW - JITAI KW - just-in-time KW - JIT KW - walking KW - physical activity KW - needs KW - opportunity KW - receptivity KW - mobile phone N2 - Background: Just-in-time adaptive interventions (JITAIs) are designed to provide support when individuals are receptive and can respond beneficially to the prompt. The notion of a just-in-time (JIT) state is critical for JITAIs. To date, JIT states have been formulated either in a largely data-driven way or based on theory alone. There is a need for an approach that enables rigorous theory testing and optimization of the JIT state concept. Objective: The purpose of this system ID experiment was to investigate JIT states empirically and enable the empirical optimization of a JITAI intended to increase physical activity (steps/d). Methods: We recruited physically inactive English-speaking adults aged ?25 years who owned smartphones. Participants wore a Fitbit Versa 3 and used the study app for 270 days. The JustWalk JITAI project uses system ID methods to study JIT states. Specifically, provision of support systematically varied across different theoretically plausible operationalizations of JIT states to enable a more rigorous and systematic study of the concept. We experimentally varied 2 intervention components: notifications delivered up to 4 times per day designed to increase a person?s steps within the next 3 hours and suggested daily step goals. Notifications to walk were experimentally provided across varied operationalizations of JIT states accounting for need (ie, whether daily step goals were previously met or not), opportunity (ie, whether the next 3 h were a time window during which a person had previously walked), and receptivity (ie, a person previously walked after receiving notifications). Suggested daily step goals varied systematically within a range related to a person?s baseline level of steps per day (eg, 4000) until they met clinically meaningful targets (eg, averaging 8000 steps/d as the lower threshold across a cycle). A series of system ID estimation approaches will be used to analyze the data and obtain control-oriented dynamical models to study JIT states. The estimated models from all approaches will be contrasted, with the ultimate goal of guiding rigorous, replicable, empirical formulation and study of JIT states to inform a future JITAI. Results: As is common in system ID, we conducted a series of simulation studies to formulate the experiment. The results of our simulation studies illustrated the plausibility of this approach for generating informative and unique data for studying JIT states. The study began enrolling participants in June 2022, with a final enrollment of 48 participants. Data collection concluded in April 2023. Upon completion of the analyses, the results of this study are expected to be submitted for publication in the fourth quarter of 2023. Conclusions: This study will be the first empirical investigation of JIT states that uses system ID methods to inform the optimization of a scalable JITAI for physical activity. Trial Registration: ClinicalTrials.gov NCT05273437; https://clinicaltrials.gov/ct2/show/NCT05273437 International Registered Report Identifier (IRRID): DERR1-10.2196/52161 UR - https://www.researchprotocols.org/2023/1/e52161 UR - http://dx.doi.org/10.2196/52161 UR - http://www.ncbi.nlm.nih.gov/pubmed/37751237 ID - info:doi/10.2196/52161 ER - TY - JOUR AU - Oladele, Ayoola David AU - Iwelunmor, Juliet AU - Gbajabiamila, Titilola AU - Obiezu-Umeh, Chisom AU - Okwuzu, Ogoamaka Jane AU - Nwaozuru, Ucheoma AU - Musa, Zaidat Adesola AU - Tahlil, Kadija AU - Idigbe, Ifeoma AU - Ong, Jason AU - Tang, Weiming AU - Tucker, Joseph AU - Ezechi, Oliver PY - 2023/9/25 TI - An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility JO - JMIR Form Res SP - e44402 VL - 7 KW - adolescent KW - adolescents and young adults KW - Africa KW - AYA KW - development KW - feasibility KW - HIV self-testing KW - HIV KW - HIVST KW - information system KW - Nigeria KW - platform KW - testing KW - think aloud KW - unstructured supplementary service data KW - usability KW - user-centered KW - USSD KW - young adult KW - youth N2 - Background: Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth. Objective: The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria. Methods: We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform?s usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized. Results: A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit). Conclusions: This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach. UR - https://formative.jmir.org/2023/1/e44402 UR - http://dx.doi.org/10.2196/44402 UR - http://www.ncbi.nlm.nih.gov/pubmed/37747780 ID - info:doi/10.2196/44402 ER - TY - JOUR AU - Cardwell, Trey Ethan AU - Ludwick, Teralynn AU - Fairley, Christopher AU - Bourne, Christopher AU - Chang, Shanton AU - Hocking, S. Jane AU - Kong, S. Fabian Y. PY - 2023/9/22 TI - Web-Based STI/HIV Testing Services Available for Access in Australia: Systematic Search and Analysis JO - J Med Internet Res SP - e45695 VL - 25 KW - STI/HIV testing KW - STI/HIV KW - self-testing KW - sexual health KW - web-based STI testing KW - web-based STI/HIV testing N2 - Background: Sexually transmitted infection (STI) rates continue to rise in Australia, and timely access to testing and treatment is crucial to reduce transmission. Web-based services have been viewed as a way to improve timely access to STI/HIV testing and have proliferated in recent years. However, the regulation of these services in Australia is minimal, leading to concerns about their quality. The purpose of this review was to systematically identify web-based STI/HIV testing services available in Australia and assess them on aspects of quality, reliability, and accessibility. Objective: We aim to systematically identify and assess web-based STI/HIV testing services available in Australia. Methods: A Google search of Australian web-based services was conducted in March 2022 and repeated in September 2022 using Boolean operators and search terms related to test services (eg, on the internet or home), STIs (eg, chlamydia or gonorrhea), and test type (eg, self-test). The first 10 pages were assessed, and services were categorized as self-testing (ST; test at home), self-sampling (SS; sample at home and return to laboratory), or self-navigated pathology (SNP; specimens collected at pathology center). Website reliability was assessed against the Health on the Net Foundation code of conduct, and service quality was assessed using a scorecard that was developed based on similar reviews, Australian guidelines for in-person services, and UK standards. Additionally, we looked at measures of accessibility including cost, rural access, and time to test results. Results: Seventeen services were identified (8 ST, 2 SS, and 7 SNP). Only 4 services offered recommended testing for all 4 infections (chlamydia, gonorrhea, syphilis, and HIV) including genital, anorectal, and oropharyngeal sites, and 5 offered tests other than those recommended by Australian testing guidelines (eg, Ureaplasma). Nine services (1 SNP, 8 self-test) had no minimum age requirements for access. Reliability scores (scale 0-8) were similar between all services (range 4.75-8.0). Quality weighted scores (scale 0-58) were similar between SNP and SS services (average 44.89, SD 5.56 and 44.75, SD 1.77, respectively) but lower for ST services (22.66, SD 8.93; P=.002). Government-funded services were of higher quality than private services (43.54, SD 6.71 vs 29.43, SD 13.55; P=.03). The cost for services varied between SNP (Aus $0-$595; ie, US $0-$381.96), self-sample (Aus $0; ie, US $0), and ST (Aus $0-$135; ie, US $0-$86.66). The time to test results was much shorter for SNP services (~4 days) than for SS (~12 days) and ST (~14 days). Conclusions: This review identified considerable variability in the quality and reliability of the web-based STI/HIV testing services in Australia. Given the proliferation and use of these services will likely increase, it is imperative that Australia develops national standards to ensure the standard-of-care offered by web-based STI/HIV testing services is appropriate to protect Australian users from the impact of poorly performing and inappropriate tests. UR - https://www.jmir.org/2023/1/e45695 UR - http://dx.doi.org/10.2196/45695 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738083 ID - info:doi/10.2196/45695 ER - TY - JOUR AU - Jo, Eunkyung AU - Kouaho, Whitney-Jocelyn AU - Schueller, M. Stephen AU - Epstein, A. Daniel PY - 2023/9/22 TI - Exploring User Perspectives of and Ethical Experiences With Teletherapy Apps: Qualitative Analysis of User Reviews JO - JMIR Ment Health SP - e49684 VL - 10 KW - teletherapy KW - therapy KW - ethical guidelines KW - ethics KW - qualitative research KW - digital mental health KW - mobile phone N2 - Background: Teletherapy apps have emerged as a promising alternative to traditional in-person therapy, especially after the COVID-19 pandemic, as they help overcome a range of geographical and emotional barriers to accessing care. However, the rapid proliferation of teletherapy apps has occurred in an environment in which development has outpaced the various regulatory and ethical considerations of this space. Thus, researchers have raised concerns about the ethical implications and potential risks of teletherapy apps given the lack of regulation and oversight. Teletherapy apps have distinct aims to more directly replicate practices of traditional care, as opposed to mental health apps, which primarily provide supplemental support, suggesting a need to examine the ethical considerations of teletherapy apps from the lens of existing ethical guidelines for providing therapy. Objective: In this study, we examined user reviews of commercial teletherapy apps to understand user perceptions of whether and how ethical principles are followed and incorporated. Methods: We identified 8 mobile apps that (1) provided teletherapy on 2 dominant mobile app stores (Google Play and Apple App Store) and (2) had received >5000 app reviews on both app stores. We wrote Python scripts (Python Software Foundation) to scrape user reviews from the 8 apps, collecting 3268 user reviews combined across 2 app stores. We used thematic analysis to qualitatively analyze user reviews, developing a codebook drawing from the ethical codes of conduct for psychologists, psychiatrists, and social workers. Results: The qualitative analysis of user reviews revealed the ethical concerns and opportunities of teletherapy app users. Users frequently perceived unprofessionalism in their teletherapists, mentioning that their therapists did not listen to them, were distracted during therapy sessions, and did not keep their appointments. Users also noted technical glitches and therapist unavailability on teletherapy apps that might affect their ability to provide continuity of care. Users held varied opinions on the affordability of those apps, with some perceiving them as affordable and others not. Users further brought up that the subscription model resulted in unfair pricing and expressed concerns about the lack of cost transparency. Users perceived that these apps could help promote access to care by overcoming geographical and social constraints. Conclusions: Our study suggests that users perceive commercial teletherapy apps as adhering to many ethical principles pertaining to therapy but falling short in key areas regarding professionalism, continuity of care, cost fairness, and cost transparency. Our findings suggest that, to provide high-quality care, teletherapy apps should prioritize fair compensation for therapists, develop more flexible and transparent payment models, and invest in measures to ensure app stability and therapist availability. Future work is needed to develop standards for teletherapy and improve the quality and accessibility of those services. UR - https://mental.jmir.org/2023/1/e49684 UR - http://dx.doi.org/10.2196/49684 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738085 ID - info:doi/10.2196/49684 ER - TY - JOUR AU - Lim, Siew Yee AU - Quek, Hui Jia AU - Ching, Wei Xiu AU - Lim, Ran Dominic Tao AU - Lim, Ghee Kean AU - Thuraisingham, Chandramani AU - George, Philip Parikial PY - 2023/9/22 TI - Efficacy of a Text-Based Mental Health Coaching App in Improving the Symptoms of Stress, Anxiety, and Depression: Randomized Controlled Trial JO - JMIR Form Res SP - e46458 VL - 7 KW - digital mental health KW - mobile health KW - randomized control trial KW - mobile phone KW - mental health KW - Depression, Anxiety, and Stress Scale?21 items KW - DASS-21 KW - Asia KW - Malaysia N2 - Background: Stress, anxiety, and depression are major mental health concerns worldwide. A wide variety of digital mental health interventions have demonstrated efficacy in improving one?s mental health status, and digital interventions that involve some form of human involvement have been shown to demonstrate greater efficacy than self-guided digital interventions. Studies demonstrating the efficacy of digital mental health interventions within the Asian region are scarce. Objective: This study aimed to investigate the potential efficacy of the digital mental health intervention, ThoughtFullChat, which consists of one-on-one, asynchronous, text-based coaching with certified mental health professionals and self-guided tools, in improving self-reported symptoms of depression, anxiety, and stress. The study also aims to examine the potential differences in efficacy among occupational subgroups and between sexes. Methods: A randomized controlled study was conducted among housemen (trainee physicians), students, faculty members, and corporate staff at International Medical University, Malaysia. A total of 392 participants were enrolled and randomized to the intervention (n=197, 50.3%) and control (n=195, 49.7%) groups. Depression, anxiety, and stress symptoms were measured using the Depression, Anxiety, and Stress Scale?21 items at baseline and after the 3-month intervention period. The Satisfaction with Life Scale and Brief Resilience Scale were also included, along with a questionnaire about demographics. Results: Significant decrease was observed in depression (P=.02) and anxiety (P=.002) scores in the intervention group. A subgroup (corporate staff) also demonstrated significant decrease in stress (P=.005) alongside depression (P=.006) and anxiety (P=.002). Females showed significant improvements in depression (P=.02) and anxiety (P<.001) when compared with males. Conclusions: This study provides evidence that the ThoughtFullChat app is effective in improving the symptoms of depression, anxiety, and stress in individuals, particularly among corporate staff from the educational field. It also supports the notion that mobile mental health apps that connect users to mental health professionals in a discreet and cost-efficient manner can make important contributions to the improvement of mental health outcomes. The differential improvements among occupational subgroups and between sexes in this study indicate the need for future digital mental health app designs to consider an element of personalization focused on systemic components relating to occupation. Trial Registration: Clinicaltrials.gov NCT04944277; https://classic.clinicaltrials.gov/ct2/show/NCT04944277 UR - https://formative.jmir.org/2023/1/e46458 UR - http://dx.doi.org/10.2196/46458 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738081 ID - info:doi/10.2196/46458 ER - TY - JOUR AU - Chung, Hsueh-Wen AU - Tai, Chen-Jei AU - Chang, Polun AU - Su, Wen-Lin AU - Chien, Li-Yin PY - 2023/9/21 TI - Authors? Reply: Concerns on Generalizability JO - JMIR Mhealth Uhealth SP - e51852 VL - 11 KW - mHealth app KW - mobile health KW - mHealth KW - app KW - prediabetes KW - traditional Chinese medicine KW - TCM KW - health-related quality of life KW - body constitution KW - meridian energy UR - https://mhealth.jmir.org/2023/1/e51852 UR - http://dx.doi.org/10.2196/51852 UR - http://www.ncbi.nlm.nih.gov/pubmed/37733412 ID - info:doi/10.2196/51852 ER - TY - JOUR AU - Lin, Yongjian PY - 2023/9/21 TI - Concerns on Generalizability JO - JMIR Mhealth Uhealth SP - e50280 VL - 11 KW - mHealth app KW - mobile health KW - mHealth KW - app KW - prediabetes KW - traditional Chinese medicine KW - TCM KW - health-related quality of life KW - body constitution KW - meridian energy UR - https://mhealth.jmir.org/2023/1/e50280 UR - http://dx.doi.org/10.2196/50280 UR - http://www.ncbi.nlm.nih.gov/pubmed/37733387 ID - info:doi/10.2196/50280 ER - TY - JOUR AU - Jones, Jeb AU - Butler, Gareth AU - Woody, Meaghan AU - Castel, D. Amanda AU - Kulie, Paige AU - Sheets, Martha AU - Scheim, I. Ayden AU - Reisner, L. Sari AU - Valencia, Rachel AU - Wang, Minglun AU - Stekler, D. Joanne AU - Sullivan, S. Patrick AU - Stephenson, Rob PY - 2023/9/21 TI - Preferences for and Experiences of an HIV-Prevention Mobile App Designed for Transmasculine People: Pilot Feasibility Trial and Qualitative Investigation JO - JMIR Form Res SP - e51055 VL - 7 KW - transmasculine KW - HIV KW - mHealth KW - preference KW - prevention KW - mobile app KW - transgender KW - STI KW - meta-analyses KW - app-based intervention KW - cisgender KW - sexual health KW - sexual risk behavior KW - smartphone N2 - Background: Transmasculine people are at risk for HIV; yet few HIV prevention interventions have been developed for this population. We adapted an existing HIV prevention smartphone app for cisgender men who have sex with men to meet the sexual health needs of transmasculine people. Objective: This study aims to assess the acceptability of the adapted app, Transpire, among transmasculine people living in Atlanta, Georgia, and Washington, DC, via in-depth interviews of participants in a pilot feasibility trial. Methods: Participants used the Transpire app for 3 months as part of a pilot study of the app. Eligible participants were aged 18-34 years. There were no eligibility criteria with respect to race and ethnicity, and most participants were non-Hispanic White. At the end of the follow-up, participants were invited to participate in web-based in-depth interviews to discuss their experiences using the app and feedback on design and content. Interviews were transcribed and coded using a constant comparative approach. Three main themes were identified: sexual behavior, app experiences and feedback, and pre-exposure prophylaxis. Results: Overall, participants found the app acceptable and thought that it would be a useful tool for themselves and their peers. Participants reported appreciating having a comprehensive information source available to them on their phones and reported learning more about HIV, sexually transmitted infections, and pre-exposure prophylaxis via the app. They also reported appreciating the inclusive language that was used throughout the app. Although the app included some resources on mental health and substance use, participants reported that they would have appreciated more resources and information in these areas as well as more comprehensive information about other health concerns, including hormone therapy. Representative quotes are presented for each of the identified themes. Conclusions: There is a desire to have greater access to reliable sexual health information among transmasculine people. Mobile apps like Transpire are an acceptable intervention to increase access to this information and other resources. More evidence is needed, however, from more racially and ethnically diverse samples of transmasculine people. UR - https://formative.jmir.org/2023/1/e51055 UR - http://dx.doi.org/10.2196/51055 UR - http://www.ncbi.nlm.nih.gov/pubmed/37733430 ID - info:doi/10.2196/51055 ER - TY - JOUR AU - Choi, Soyoung PY - 2023/9/20 TI - Personal Health Tracking: A Paradigm Shift in the Self-Care Models in Nursing JO - JMIR Nursing SP - e50991 VL - 6 KW - personal health data KW - personal informatics KW - self-care KW - self-tracking KW - mobile health technology KW - human-technology KW - human-computer KW - human computer interaction KW - health tracking KW - framework KW - frameworks KW - model KW - models KW - mHealth KW - mobile health KW - informatics UR - https://nursing.jmir.org/2023/1/e50991 UR - http://dx.doi.org/10.2196/50991 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728970 ID - info:doi/10.2196/50991 ER - TY - JOUR AU - Ming, Y. David AU - Wong, Willis AU - Jones, A. Kelley AU - Antonelli, C. Richard AU - Gujral, Nitin AU - Gonzales, Sarah AU - Rogers, Ursula AU - Ratliff, William AU - Shah, Nirmish AU - King, A. Heather PY - 2023/9/20 TI - Feasibility of Implementation of a Mobile Digital Personal Health Record to Coordinate Care for Children and Youth With Special Health Care Needs in Primary Care: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e46847 VL - 12 KW - digital health KW - personal health record KW - children with special health care needs KW - care coordination KW - mixed methods KW - mobile phone N2 - Background: Electronic health record (EHR)?integrated digital personal health records (PHRs) via Fast Healthcare Interoperability Resources (FHIR) are promising digital health tools to support care coordination (CC) for children and youth with special health care needs but remain widely unadopted; as their adoption grows, mixed methods and implementation research could guide real-world implementation and evaluation. Objective: This study (1) evaluates the feasibility of an FHIR-enabled digital PHR app for CC for children and youth with special health care needs, (2) characterizes determinants of implementation, and (3) explores associations between adoption and patient- or family-reported outcomes. Methods: This nonrandomized, single-arm, prospective feasibility trial will test an FHIR-enabled digital PHR app?s use among families of children and youth with special health care needs in primary care settings. Key app features are FHIR-enabled access to structured data from the child?s medical record, families? abilities to longitudinally track patient- or family-centered care goals, and sharing progress toward care goals with the child?s primary care provider via a clinician dashboard. We shall enroll 40 parents or caregivers of children and youth with special health care needs to use the app for 6 months. Inclusion criteria for children and youth with special health care needs are age 0-16 years; primary care at a participating site; complex needs benefiting from CC; high hospitalization risk in the next 6 months; English speaking; having requisite technology at home (internet access, Apple iOS mobile device); and an active web-based EHR patient portal account to which a parent or caregiver has full proxy access. Digital prescriptions will be used to disseminate study recruitment materials directly to eligible participants via their existing EHR patient portal accounts. We will apply an intervention mixed methods design to link quantitative and qualitative (semistructured interviews and family engagement panels with parents of children and youth with special health care needs) data and characterize implementation determinants. Two CC frameworks (Pediatric Care Coordination Framework; Patient-Centered Medical Home) and 2 evaluation frameworks (Consolidated Framework for Implementation Research; Technology Acceptance Model) provide theoretical foundations for this study. Results: Participant recruitment began in fall 2022, before which we identified >300 potentially eligible patients in EHR data. A family engagement panel in fall 2021 generated formative feedback from family partners. Integrated analysis of pretrial quantitative and qualitative data informed family-centered enhancements to study procedures. Conclusions: Our findings will inform how to integrate an FHIR-enabled digital PHR app for children and youth with special health care needs into clinical care. Mixed methods and implementation research will help strengthen implementation in diverse clinical settings. The study is positioned to advance knowledge of how to use digital health innovations for improving care and outcomes for children and youth with special health care needs and their families. Trial Registration: ClinicalTrials.gov NCT05513235; https://clinicaltrials.gov/study/NCT05513235 International Registered Report Identifier (IRRID): DERR1-10.2196/46847 UR - https://www.researchprotocols.org/2023/1/e46847 UR - http://dx.doi.org/10.2196/46847 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728977 ID - info:doi/10.2196/46847 ER - TY - JOUR AU - Ader, Leonie AU - Schick, Anita AU - Löffler, Martin AU - Löffler, Annette AU - Beiner, Eva AU - Eich, Wolfgang AU - Vock, Stephanie AU - Sirazitdinov, Andrei AU - Malone, Christopher AU - Hesser, Jürgen AU - Hopp, Michael AU - Ruckes, Christian AU - Flor, Herta AU - Tesarz, Jonas AU - Reininghaus, Ulrich PY - 2023/9/20 TI - Refocusing of Attention on Positive Events Using Monitoring-Based Feedback and Microinterventions for Patients With Chronic Musculoskeletal Pain in the PerPAIN Randomized Controlled Trial: Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e43376 VL - 12 KW - experience sampling method KW - ESM KW - ecological momentary intervention KW - EMI KW - microrandomized trial KW - mobile health KW - mHealth KW - positive intervention KW - complex intervention KW - mobile phone N2 - Background: Chronic musculoskeletal pain (CMSP) affects between 13% and 47% of the population, with a global growth rate of 20.3% within the last 15 years, suggesting that there is a high need for effective treatments. Pain diaries have long been a common tool in nonpharmacological pain treatment for monitoring and providing feedback on patients? symptoms in daily life. More recently, positive refocusing techniques have come to be used, promoting pain-free episodes and positive outcomes rather than focusing on managing the pain. Objective: This study aims to evaluate the feasibility (ie, acceptability, intervention adherence, and fidelity) and initial signals of efficacy of the PerPAIN app, an ecological momentary intervention for patients with CMSP. The app comprises digitalized monitoring using the experience sampling method (ESM) and feedback. In addition, the patients receive 3 microinterventions targeted at refocusing of attention on positive events. Methods: In a microrandomized trial, we will recruit 35 patients with CMSP who will be offered the app for 12 weeks. Participants will be prompted to fill out 4 ESM monitoring questionnaires a day assessing information on their current context and the proximal outcome variables: absence of pain, positive mood, and subjective activity. Participants will be randomized daily and weekly to receive no feedback, verbal feedback, or visual feedback on proximal outcomes assessed by the ESM. In addition, the app will encourage participants to complete 3 microinterventions based on positive psychology and cognitive behavioral therapy techniques. These microinterventions are prompts to report joyful moments and everyday successes or to plan pleasant activities. After familiarizing themselves with each microintervention individually, participants will be randomized daily to receive 1 of the 3 exercises or none. We will assess whether the 2 feedback types and the 3 microinterventions increase proximal outcomes at the following time point. The microrandomized trial is part of the PerPAIN randomized controlled trial (German Clinical Trials Register DRKS00022792) investigating a personalized treatment approach to enhance treatment outcomes in CMSP. Results: Approval was granted by the Ethics Committee II of the University of Heidelberg on August 4, 2020. Recruitment for the microrandomized trial began in May 2021 and is ongoing at the time of submission. By October 10, 2022, a total of 24 participants had been enrolled in the microrandomized trial. Conclusions: This trial will provide evidence on the feasibility of the PerPAIN app and the initial signals of efficacy of the different intervention components. In the next step, the intervention would need to be further refined and investigated in a definitive trial. This ecological momentary intervention presents a potential method for offering low-level accessible treatment to a wide range of people, which could have substantial implications for public health by reducing disease burden of chronic pain in the population. International Registered Report Identifier (IRRID): DERR1-10.2196/43376 UR - https://www.researchprotocols.org/2023/1/e43376 UR - http://dx.doi.org/10.2196/43376 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728983 ID - info:doi/10.2196/43376 ER - TY - JOUR AU - Marciano, Laura AU - Vocaj, Emanuela AU - Bekalu, A. Mesfin AU - La Tona, Antonino AU - Rocchi, Giulia AU - Viswanath, Kasisomayajula PY - 2023/9/19 TI - The Use of Mobile Assessments for Monitoring Mental Health in Youth: Umbrella Review JO - J Med Internet Res SP - e45540 VL - 25 KW - mobile assessment KW - ecological momentary assessments KW - EMAs KW - digital phenotyping KW - umbrella review KW - youth KW - mental health KW - mobile phone N2 - Background: Improving mental health in youth is a major concern. Future approaches to monitor and intervene in youth mental health problems should rely on mobile tools that allow for the daily monitoring of mental health both actively (eg, using ecological momentary assessments [EMAs]) and passively (eg, digital phenotyping) by capturing individuals? data. Objective: This umbrella review aims to (1) report the main characteristics of existing reviews on mental health and young people, including mobile approaches to mental health; (2) describe EMAs and trace data and the mental health conditions investigated; (3) report the main results; and (4) outline promises, limitations, and directions for future research. Methods: A systematic literature search was carried out in 9 scientific databases (Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, ERIC, MEDLINE, the ProQuest Sociology Database, Web of Science, and PubMed) on January 30, 2022, coupled with a hand search and updated in July 2022. We included (systematic) reviews of EMAs and trace data in the context of mental health, with a specific focus on young populations, including children, adolescents, and young adults. The quality of the included reviews was evaluated using the AMSTAR (Assessment of Multiple Systematic Reviews) checklist. Results: After the screening process, 30 reviews (published between 2016 and 2022) were included in this umbrella review, of which 21 (70%) were systematic reviews and 9 (30%) were narrative reviews. The included systematic reviews focused on symptoms of depression (5/21, 24%); bipolar disorders, schizophrenia, or psychosis (6/21, 29%); general ill-being (5/21, 24%); cognitive abilities (2/21, 9.5%); well-being (1/21, 5%); personality (1/21, 5%); and suicidal thoughts (1/21, 5%). Of the 21 systematic reviews, 15 (71%) summarized studies that used mobile apps for tracing, 2 (10%) summarized studies that used them for intervention, and 4 (19%) summarized studies that used them for both intervention and tracing. Mobile tools used in the systematic reviews were smartphones only (8/21, 38%), smartphones and wearable devices (6/21, 29%), and smartphones with other tools (7/21, 33%). In total, 29% (6/21) of the systematic reviews focused on EMAs, including ecological momentary interventions; 33% (7/21) focused on trace data; and 38% (8/21) focused on both. Narrative reviews mainly focused on the discussion of issues related to digital phenotyping, existing theoretical frameworks used, new opportunities, and practical examples. Conclusions: EMAs and trace data in the context of mental health assessments and interventions are promising tools. Opportunities (eg, using mobile approaches in low- and middle-income countries, integration of multimodal data, and improving self-efficacy and self-awareness on mental health) and limitations (eg, absence of theoretical frameworks, difficulty in assessing the reliability and effectiveness of such approaches, and need to appropriately assess the quality of the studies) were further discussed. Trial Registration: PROSPERO CRD42022347717; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347717 UR - https://www.jmir.org/2023/1/e45540 UR - http://dx.doi.org/10.2196/45540 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725422 ID - info:doi/10.2196/45540 ER - TY - JOUR AU - Caldwell, Sylvia AU - Flickinger, Tabor AU - Hodges, Jacqueline AU - Waldman, D. Ava Lena AU - Garofalini, Chloe AU - Cohn, Wendy AU - Dillingham, Rebecca AU - Castel, Amanda AU - Ingersoll, Karen PY - 2023/9/19 TI - An mHealth Platform for People With HIV Receiving Care in Washington, District of Columbia: Qualitative Analysis of Stakeholder Feedback JO - JMIR Form Res SP - e48739 VL - 7 KW - HIV KW - mobile health KW - mHealth KW - cluster randomized controlled trial KW - formative KW - adaptation KW - qualitative methods KW - smartphone KW - mobile phone N2 - Background: HIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. Objective: This study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. Methods: We conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. Results: Emerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. Conclusions: Patient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks? efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. International Registered Report Identifier (IRRID): RR2-10.2196/37748 UR - https://formative.jmir.org/2023/1/e48739 UR - http://dx.doi.org/10.2196/48739 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725419 ID - info:doi/10.2196/48739 ER - TY - JOUR AU - Marini, Christina AU - Cruz, Jocelyn AU - Payano, Leydi AU - Flores, Patino Ronaldo AU - Arena, Gina-Maria AU - Mandal, Soumik AU - Leven, Eric AU - Mann, Devin AU - Schoenthaler, Antoinette PY - 2023/9/19 TI - Opening the Black Box of an mHealth Patient-Reported Outcome Tool for Diabetes Self-Management: Interview Study Among Patients With Type 2 Diabetes JO - JMIR Form Res SP - e47811 VL - 7 KW - mobile health KW - mHealth KW - patient-reported outcomes KW - diabetes KW - qualitative KW - patient engagement N2 - Background: Mobile health (mHealth) tools are used to collect data on patient-reported outcomes (PROs) and facilitate the assessment of patients? self-management behaviors outside the clinic environment. Despite the high availability of mHealth diabetes tools, there is a lack of understanding regarding the underlying reasons why these mHealth PRO tools succeed or fail in terms of changing patients? self-management behaviors. Objective: This study aims to identify the factors that drive engagement with an mHealth PRO tool and facilitate patients? adoption of self-management behaviors, as well as elicit suggestions for improvement. Methods: This qualitative study was conducted within the context of a randomized controlled trial designed to evaluate the efficacy of an mHealth PRO tool (known as i-Matter) versus usual care regarding reduction in glycated hemoglobin (HbA1c) levels and adherence to self-management behaviors at 12 months among patients with uncontrolled type 2 diabetes. Patients randomized to i-Matter participated in semistructured interviews about their experiences at the 3-, 6-, 9-, and 12-month study visits. A qualitative analysis of the interviews was conducted by 2 experienced qualitative researchers using conventional qualitative content analysis. Results: The sample comprised 71 patients, of whom 67 (94%) completed at least one interview (n=48, 72% female patients; n=25, 37% identified as African American or Black; mean age 56.65 [SD 9.79] years). We identified 4 overarching themes and 6 subthemes. Theme 1 showed that the patients? reasons for engagement with i-Matter were multifactorial. Patients were driven by internal motivating factors that bolstered their engagement and helped them feel accountable for their diabetes (subtheme 1) and external motivating factors that helped to serve as reminders to be consistent with their self-management behaviors (subtheme 2). Theme 2 revealed that the use of i-Matter changed patients? attitudes toward their disease and their health behaviors in 2 ways: patients developed more positive attitudes about their condition and their ability to effectively self-manage it (subtheme 3), and they also developed a better awareness of their current behaviors, which motivated them to adopt healthier lifestyle behaviors (subtheme 4). Theme 3 showed that patients felt more committed to their health as a result of using i-Matter. Theme 4 highlighted the limitations of i-Matter, which included its technical design (subtheme 5) and the need for more resources to support the PRO data collected and shared through the tool (subtheme 6). Conclusions: This study isolated internal and external factors that prompted patients to change their views about their diabetes, become more engaged with the intervention and their health, and adopt healthy behaviors. These behavioral mechanisms provide important insights to drive future development of mHealth interventions that could lead to sustained behavior change. UR - https://formative.jmir.org/2023/1/e47811 UR - http://dx.doi.org/10.2196/47811 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725427 ID - info:doi/10.2196/47811 ER - TY - JOUR AU - Mulawa, I. Marta AU - Hoare, Jacqueline AU - Knippler, T. Elizabeth AU - Mtukushe, Bulelwa AU - Matiwane, Mluleki AU - Muessig, E. Kathryn AU - Al-Mujtaba, Maryam AU - Wilkinson, Harper T. AU - Platt, Alyssa AU - Egger, R. Joseph AU - Hightow-Weidman, B. Lisa PY - 2023/9/19 TI - MASI, a Smartphone App to Improve Treatment Adherence Among South African Adolescents and Young Adults With HIV: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e47137 VL - 12 KW - HIV KW - adherence KW - mHealth KW - digital health KW - smartphone KW - adolescents and young adults KW - youths KW - South Africa KW - social support KW - randomized KW - controlled trial KW - pilot KW - antiretroviral therapy KW - sexually transmitted KW - app KW - apps KW - mobile phone N2 - Background: Adolescents and young adults with HIV repeatedly demonstrate low rates of antiretroviral therapy (ART) adherence as well as low rates of viral suppression. Digital health interventions are a promising way to engage adolescents and young adults with HIV to support ART adherence. However, few digital health interventions have been developed and tested with adolescents and young adults in countries like South Africa, where the HIV burden among adolescents and young adults is greatest. Masakhane Siphucule Impilo Yethu (MASI; Xhosa for ?Let's empower each other and improve our health?) is a comprehensive ART adherence-supporting app for South African adolescents and young adults with HIV. It was culturally adapted using the HealthMpowerment platform. Objective: The aim of this paper is to describe the protocol for a pilot randomized controlled trial examining the feasibility, acceptability, and preliminary efficacy of MASI on self-reported ART adherence and social support. Methods: We will enroll 50 adolescents and young adults with HIV ages 15-21 years. Participants will be recruited from public ART clinics linked to a large government-funded teaching hospital in Cape Town, South Africa. Participants will be randomized 1:1 into either the intervention arm receiving a full version of MASI or the control arm receiving an information-only version of the app (n=25 per arm). Participants will be asked to engage with MASI daily for 6 months. All participants will complete baseline and follow-up assessments at 3 and 6 months. Results: Study screening began in May 2022 and the first participant was enrolled on June 21, 2022. As of June 12, 2023, 81 participants have completed screeners, and 36 eligible participants have been enrolled in the pilot randomized controlled trial. Recruitment is anticipated to last through August 31, 2023, with study activities anticipated through February 29, 2024. Conclusions: There is an urgent need for innovative interventions to improve ART adherence among adolescents and young adults in settings like South Africa. If found to be feasible and acceptable, MASI could be implemented with adolescents and young adults with HIV in other parts of the country. Trial Registration: ClinicalTrials.gov NCT04661878; https://clinicaltrials.gov/ct2/show/study/NCT04661878 International Registered Report Identifier (IRRID): DERR1-10.2196/47137 UR - https://www.researchprotocols.org/2023/1/e47137 UR - http://dx.doi.org/10.2196/47137 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725409 ID - info:doi/10.2196/47137 ER - TY - JOUR AU - Marler, D. Jennifer AU - Fujii, A. Craig AU - Utley, T. MacKenzie AU - Balbierz, J. Daniel AU - Galanko, A. Joseph AU - Utley, S. David PY - 2023/9/18 TI - Long-Term Outcomes of a Comprehensive Mobile Smoking Cessation Program With Nicotine Replacement Therapy in Adult Smokers: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e48157 VL - 11 KW - smoking cessation KW - digital health KW - smartphone KW - digital sensor KW - carbon monoxide KW - breath sensor KW - biofeedback KW - mobile apps KW - health promotion KW - app KW - mobile phone N2 - Background: Increased smartphone ownership has led to the development of mobile smoking cessation programs. Although the related body of evidence, gathered through the conduct of randomized controlled trials (RCTs), has grown in quality and rigor, there is a need for longer-term data to assess associated smoking cessation durability. Objective: The primary aim was to compare smoking cessation outcomes at 52 weeks in adult smokers randomized to a mobile smoking cessation program, Pivot (intervention), versus QuitGuide (control). The secondary aims included comparison of other smoking-related behaviors, outcomes and participant feedback, and exploratory analyses of baseline factors associated with smoking cessation. Methods: In this remote pilot RCT, cigarette smokers in the United States were recruited on the web. Participants were offered 12 weeks of free nicotine replacement therapy (NRT). Data were self-reported via a web-based questionnaire with videoconference biovalidation in participants who reported 7-day point-prevalence abstinence (PPA). Outcomes focused on cessation rates with additional assessment of quit attempts, cigarettes per day (CPD), self-efficacy via the Smoking Abstinence Self-Efficacy Questionnaire, NRT use, and participant feedback. Cessation outcomes included self-reported 7- and 30-day PPA, abstinence from all tobacco products, and continuous abstinence. PPA and continuous abstinence were biovalidated using witnessed breath carbon monoxide samples. Exploratory post hoc regression analyses were performed to identify baseline variables associated with smoking cessation. Results: Participants comprised 188 smokers (n=94, 50% in the Pivot group and n=94, 50% in the QuitGuide group; mean age 46.4, SD 9.2 years; n=104, 55.3% women; n=128, 68.1% White individuals; mean CPD 17.6, SD 9.0). Several cessation rates were higher in the Pivot group (intention to treat): self-reported continuous abstinence was 20% (19/94) versus 9% (8/94; P=.03) for QuitGuide, biochemically confirmed abstinence was 31% (29/94) versus 18% (17/94; P=.04) for QuitGuide, and biochemically confirmed continuous abstinence was 19% (18/94) versus 9% (8/94; P=.046) for QuitGuide. More Pivot participants (93/94, 99% vs 80/94, 85% in the QuitGuide group; P<.001) placed NRT orders (mean 3.3, SD 2.0 vs 1.8, SD 1.6 for QuitGuide; P<.001). Pivot participants had increased self-efficacy via the Smoking Abstinence Self-Efficacy Questionnaire (mean point increase 3.2, SD 7.8, P<.001 vs 1.0, SD 8.5, P=.26 for QuitGuide). QuitGuide participants made more mean quit attempts (7.0, SD 6.3 for Pivot vs 9.5, SD 7.5 for QuitGuide; P=.01). Among those who did not achieve abstinence, QuitGuide participants reported greater CPD reduction (mean ?34.6%, SD 35.5% for Pivot vs ?46.1%, SD 32.3% for QuitGuide; P=.04). Among those who reported abstinence, 90% (35/39) of Pivot participants and 90% (26/29) of QuitGuide participants indicated that their cessation program helped them quit. Conclusions: This pilot RCT supports the long-term effectiveness of the Pivot mobile smoking cessation program, with abstinence rates durable to 52 weeks. Trial Registration: ClinicalTrials.gov NCT04955639; https://clinicaltrials.gov/ct2/show/NCT04955639 UR - https://mhealth.jmir.org/2023/1/e48157 UR - http://dx.doi.org/10.2196/48157 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585282 ID - info:doi/10.2196/48157 ER - TY - JOUR AU - Pienkowska, Anita AU - Ang, Chin-Siang AU - Mammadova, Maleyka AU - Mahadzir, Azlan Muhammad Daniel AU - Car, Josip PY - 2023/9/18 TI - A Diabetes Education App for People Living With Type 2 Diabetes: Co-Design Study JO - JMIR Form Res SP - e45490 VL - 7 KW - diabetes KW - health apps KW - co-design KW - chatbot KW - type 2 diabetes KW - self-management KW - mobile health KW - mHealth KW - chronic disease KW - digital education KW - mobile phone N2 - Background: Type 2 diabetes (T2D) is a growing global health concern, including in Singapore. Diabetes education programs have been shown to be effective in improving health outcomes and diabetes self-management skills. Mobile health apps have emerged as useful tools for diabetes education; however, their use and acceptance by the target population remain inconsistent. Therefore, end-user participation in the design and development of a mobile health app is crucial for designing an acceptable app that can improve outcomes for populations with a chronic disease. Objective: The objective of this study was to apply an end-user participatory approach to co-design a diabetes education app prototype for people living with T2D by exploring their perceptions, acceptance, and usability of an app prototype, as well as their diabetes experience and perspectives on digital diabetes education. Methods: A total of 8 people with T2D, who were recruited from diabetes management Facebook groups, participated in 4 web-based surveys via Qualtrics and 2 structured interviews via Zoom (Zoom Video Communications, Inc) between August 20, 2021, and January 28, 2022. Descriptive statistics and thematic analyses of the discussion and iterative feedback on the app prototype were used to assess the participants? perceptions of living with T2D, attitudes toward digital diabetes education, and acceptance of the prototype. Results: Analyses of the surveys and interview data revealed 3 themes: challenges of living with T2D; validation, acceptability, and usability of the diabetes education app prototype; and perspectives on digital diabetes education. In the first theme, participants highlighted the importance of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second theme indicated that the diabetes education app prototype was acceptable, with information and appearance being key; revealed ambivalent and polarized opinions toward the chatbot; and confirmed potential impact of the app on diabetes self-management skills and practice. The third theme comprised the necessity of using a variety of information-seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based design and content, gamification, guidance, integration, personalization, and up-to-date content. The findings were used to reiterate the app design. Conclusions: Despite a small sample size, the study demonstrated the feasibility of engaging and empowering people living with T2D to consider digital therapeutics for diabetes self-management skills and practice. Participants gave rather positive feedback on the design and content of the app prototype, with some recommendations for improvements. The findings suggest that incorporating end-user feedback into app design can lead to the creation of feasible and acceptable tools for diabetes education, potentially improving outcomes for populations with a chronic disease. Further research is needed to test the impact of the refined diabetes education app prototype on diabetes self-management skills and practice and quality of life. UR - https://formative.jmir.org/2023/1/e45490 UR - http://dx.doi.org/10.2196/45490 UR - http://www.ncbi.nlm.nih.gov/pubmed/37721799 ID - info:doi/10.2196/45490 ER - TY - JOUR AU - O'Reilly, L. Sharleen AU - Laws, Rachel AU - Maindal, Terkildsen Helle AU - Teede, Helena AU - Harrison, Cheryce AU - McAuliffe, M. Fionnuala AU - Geraghty, Aisling AU - Campoy, Cristina AU - Bermúdez, G. Mercedes AU - Pirhonen, Laura AU - Burden, Christy AU - Davies, Anna AU - Laursen, Hjorth Ditte AU - Skinner, Timothy AU - PY - 2023/9/18 TI - A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study JO - JMIR Res Protoc SP - e51431 VL - 12 KW - hybrid type 2 effectiveness-implementation KW - gestational diabetes KW - obesity KW - mHealth KW - mobile health KW - health behavior change KW - pregnancy KW - postpartum KW - weight management KW - health coaching KW - maternal health N2 - Background: Women with overweight and obesity are at higher risk of developing complications in pregnancy such as gestational diabetes and longer-term chronic conditions. Research concerning health behavior change interventions during pregnancy and postpartum shows promising effects, but implementation into routine services is sparsely investigated. Most interventions focus on the antenatal or postpartum life stages, failing to meet the needs of women. IMPACT DIABETES Bump2Baby is a multicenter project across 4 high-income countries developed to test the implementation of an antenatal and postpartum evidence-based mobile health (mHealth) coaching intervention called Bump2Baby and Me (B2B&Me) designed to sit alongside usual care in the perinatal period. Objective: We aim to explore the feasibility and implementation of the B2B&Me intervention and investigate the effectiveness of this intervention in women at risk of gestational diabetes. Methods: IMPACT DIABETES Bump2Baby is a hybrid type 2 effectiveness-implementation study, which integrates an evidence-based mHealth coaching app that includes personalized health behavior change coaching provided by health care professionals alongside antenatal care from the first antenatal visit to 12 months postpartum. The mHealth app offers the possibility of synchronous calls, asynchronous contact (including coach-participant text and video messaging exchanges tailored to the participant?s needs), and ongoing access to an extensive library of bespoke intervention materials. Participants will interact asynchronously with their health coach throughout the intervention via the app. This randomized controlled trial across 4 clinical sites within Ireland, the United Kingdom, Spain, and Australia will recruit 800 women in early pregnancy to evaluate the effectiveness on postpartum weight. The Exploration, Preparation, Implementation, and Sustainment implementation framework is the theoretical underpinning of the study. The implementation evaluation will be assessed at the individual, hospital staff, and broader community levels using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources for the RE-AIM evaluation will include app and platform analytics, screening and training records, participant medical records, key informant interviews, participant and partner exit interviews, cost data, study questionnaires, staff surveys, and blood sample analyses. Results: The study was approved and registered with the Australian New Zealand Clinical Trials Registry on November 19, 2020. Recruitment commenced on February 9, 2021, and data collection is ongoing. Publication of the results is expected in 2024. Conclusions: This is the first hybrid effectiveness-implementation study of an 18-month mHealth coaching intervention in at-risk women that we are aware of. As research aims to move toward real-world implementable solutions, it is critical that hybrid studies are conducted. The data from this large multicenter study will be useful in planning the potential implementation and scale-up of evidence-based perinatal health behavior change interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/51431 UR - https://www.researchprotocols.org/2023/1/e51431 UR - http://dx.doi.org/10.2196/51431 UR - http://www.ncbi.nlm.nih.gov/pubmed/37721798 ID - info:doi/10.2196/51431 ER - TY - JOUR AU - Verweij, Lynn AU - Metsemakers, M. Sanne J. J. P. AU - Ector, G. Geneviève I. C. AU - Rademaker, Peter AU - Bekker, L. Charlotte AU - van Vlijmen, Bas AU - van der Reijden, A. Bert AU - Blijlevens, A. Nicole M. AU - Hermens, G. Rosella P. M. PY - 2023/9/15 TI - Improvement, Implementation, and Evaluation of the CMyLife Digital Care Platform: Participatory Action Research Approach JO - J Med Internet Res SP - e45259 VL - 25 KW - eHealth KW - digital care platform KW - feasibility KW - patient experiences KW - usability KW - chronic myeloid leukemia KW - participatory action research KW - CMyLife N2 - Background: The evaluation of a continuously evolving eHealth tool in terms of improvement and implementation in daily practice is unclear. The CMyLife digital care platform provides patient-centered care by empowering patients with chronic myeloid leukemia, with a focus on making medication compliance insightful, discussable, and optimal, and achieving optimal control of the biomarker BCR-ABL1. Objective: The aim of this study was to investigate to what extent the participatory action research approach is suitable for the improvement and scientific evaluation of eHealth innovations in daily clinical practice (measured by user experiences) combined with the promotion of patient empowerment. Methods: The study used iterative cycles of planning, action, and reflection, whereby participants? experiences (patients, health care providers, the CMyLife team, and app suppliers) with the platform determined next actions. Co-design workshops were the foundation of this cyclic process. Moreover, patients filled in 2 sets of questionnaires for assessing experiences with CMyLife, the actual use of the platform, and the influence of the platform after 3 and at least 6 months. Data collected during the workshops were analyzed using content analysis, which is often used for making a practical guide to action. Descriptive statistics were used to characterize the study population in terms of information related to chronic myeloid leukemia and sociodemographics, and to describe experiences with the CMyLife digital care platform and the actual use of this platform. Results: The co-design workshops provided insights that contributed to the improvement, implementation, and evaluation of CMyLife and empowered patients with chronic myeloid leukemia (for example, simplification of language, and improvement of the user friendliness of functionalities). The results of the questionnaires indicated that (1) the platform improved information provision on chronic myeloid leukemia in 67% (33/49) of patients, (2) the use of the medication app improved medication compliance in 42% (16/38) of patients, (3) the use of the guideline app improved guideline adherence in 44% (11/25) of patients, and (4) the use of the platform caused patients to feel more empowered. Conclusions: A participatory action research approach is suited to scientifically evaluate digital care platforms in daily clinical practice in terms of improvement, implementation, and patient empowerment. Systematic iterative evaluation of users? needs and wishes is needed to keep care centered on patients and keep the innovation up-to-date and valuable for users. UR - https://www.jmir.org/2023/1/e45259 UR - http://dx.doi.org/10.2196/45259 UR - http://www.ncbi.nlm.nih.gov/pubmed/37713242 ID - info:doi/10.2196/45259 ER - TY - JOUR AU - Krasuska, Marta AU - Davidson, M. Emma AU - Beune, Erik AU - Jenum, Karen Anne AU - Gill, MR Jason AU - Stronks, Karien AU - van Valkengoed, GM Irene AU - Diaz, Esperanza AU - Sheikh, Aziz PY - 2023/9/15 TI - A Culturally Adapted Diet and Physical Activity Text Message Intervention to Prevent Type 2 Diabetes Mellitus for Women of Pakistani Origin Living in Scotland: Formative Study JO - JMIR Form Res SP - e33810 VL - 7 KW - diabetes KW - diet KW - ethnic minority populations KW - Pakistani KW - physical activity KW - prevention KW - South Asian KW - text messages KW - women KW - women?s health KW - health intervention KW - digital health KW - mobile health KW - minority KW - exercise KW - text message KW - text messaging KW - SMS KW - development KW - formative KW - diabetes mellitus N2 - Background: Individuals of South Asian origin are at an increased risk of developing type 2 diabetes mellitus (T2DM) compared with other ethnic minority groups. Therefore, there is a need to develop interventions to address, and reduce, this heightened risk. Objective: We undertook formative work to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. Methods: We used a stepwise approach that was informed by the Six Steps in Quality Intervention Development framework, which consisted of gathering evidence through literature review and focus groups (step 1), developing a program theory for the intervention (step 2), and finally developing the content of the text messages and an accompanying delivery plan (step 3). Results: In step 1, we reviewed 12 articles and identified 3 key themes describing factors impacting on diet and physical activity in the context of T2DM prevention: knowledge on ways to prevent T2DM through diet and physical activity; cultural, social, and gender norms; and perceived level of control and sense of inevitability over developing T2DM. The key themes that emerged from the 3 focus groups with a total of 25 women were the need for interventions to provide ?friendly encouragement,? ?companionship,? and a ?focus on the individual? and also for the text messages to ?set achievable goals? and include ?information on cooking healthy meals.? We combined the findings of the focus groups and literature review to create 13 guiding principles for culturally adapting the text messages. In step 2, we developed a program theory, which specified the main determinants of change that our text messages should aim to enhance: knowledge and skills, sense of control, goal setting and planning behavior, peer support, and norms and beliefs guiding behavior. In step 3, we used both the intervention program theory and guiding principles to develop a set of 73 text messages aimed at supporting a healthy diet and 65 text messages supporting increasing physical activity. Conclusions: We present a theory-based approach to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. This study outlines an approach that may also be applicable to the development of interventions for other ethnic minority populations in diverse settings. There is now a need to build on this formative work and undertake a feasibility trial of a text message?based diet and physical activity intervention to prevent T2DM for women of Pakistani origin living in Scotland. UR - https://formative.jmir.org/2023/1/e33810 UR - http://dx.doi.org/10.2196/33810 UR - http://www.ncbi.nlm.nih.gov/pubmed/37713245 ID - info:doi/10.2196/33810 ER - TY - JOUR AU - Chandler, Rasheeta AU - Farinu, O. Oluyemi T. AU - Guillaume, Dominique AU - Francis, Sherilyn AU - Parker, G. Andrea AU - Shah, Kewal AU - Hernandez, D. Natalie AU - PY - 2023/9/15 TI - Digital Health App to Address Disparate HIV Outcomes Among Black Women Living in Metro-Atlanta: Protocol for a Multiphase, Mixed Methods Pilot Feasibility Study JO - JMIR Res Protoc SP - e42712 VL - 12 KW - Black women KW - CBPR KW - community-based participatory research KW - HIV KW - human centered design KW - mhealth KW - pilot usability study N2 - Background: Cisgender Black women in the southern United States are at heightened risk for HIV and adverse sexual and reproductive health outcomes. Mobile health interventions that target HIV risk while being adapted to the needs and lived experiences of Black women are remarkably limited. Objective: The study aims to refine SavvyHER, a mobile app for HIV prevention, with Black women residing in high HIV incidence areas of Georgia and evaluate the feasibility, acceptability, and usability of SavvyHER. This paper describes the procedures implemented to conduct this research. Methods: Community-based participatory research tenets guide this multiphase study to finalize the development of what we hypothesize will be an effective, sustainable, and culturally relevant HIV prevention and optimal sexual health and reproductive wellness app for Black women. This multiphased, mixed methods study consists of 3 phases. The first phase entails focus groups with Black women to understand their preferences for the functionality and design of a beta prototype version of SavvyHER. In the second phase, an app usability pretest (N=10) will be used to refine and optimize the SavvyHER app. The final phase will entail a pilot randomized controlled trial (N=60) to evaluate the app?s feasibility and usability in preparation for a larger trial. Results: Findings from preliminary focus groups revealed educational content, app aesthetics, privacy considerations, and marketing preferred by Black women, thus informing the first functional SavvyHER prototype. As we adapt and test the feasibility of SavvyHER, we hypothesize that the app will be an effective, sustainable, and culturally relevant HIV prevention, sexual health, and reproductive wellness tool for Black women. Conclusions: The findings from this research substantiate the importance of developing health interventions curated for and by Black women to address critical HIV disparities. The knowledge gained from this research can reduce HIV disparities among Black women through a targeted intervention that centers on their health needs and priorities. International Registered Report Identifier (IRRID): DERR1-10.2196/42712 UR - https://www.researchprotocols.org/2023/1/e42712 UR - http://dx.doi.org/10.2196/42712 UR - http://www.ncbi.nlm.nih.gov/pubmed/37713259 ID - info:doi/10.2196/42712 ER - TY - JOUR AU - Harrison, Conrad AU - Trickett, Ryan AU - Wormald, Justin AU - Dobbs, Thomas AU - Lis, Przemys?aw AU - Popov, Vesselin AU - Beard, J. David AU - Rodrigues, Jeremy PY - 2023/9/14 TI - Remote Symptom Monitoring With Ecological Momentary Computerized Adaptive Testing: Pilot Cohort Study of a Platform for Frequent, Low-Burden, and Personalized Patient-Reported Outcome Measures JO - J Med Internet Res SP - e47179 VL - 25 KW - patient-reported outcome measures KW - ecological momentary assessment KW - computerized adaptive testing KW - EMCAT KW - symptom monitoring KW - monitoring KW - assessment KW - smartphone app KW - trauma KW - arthritis KW - usability KW - mobile phone N2 - Background: Remote patient-reported outcome measure (PROM) data capture can provide useful insights into research and clinical practice and deeper insights can be gained by administering assessments more frequently, for example, in ecological momentary assessment. However, frequent data collection can be limited by the burden of multiple, lengthy questionnaires. This burden can be reduced with computerized adaptive testing (CAT) algorithms that select only the most relevant items from a PROM for an individual respondent. In this paper, we propose ?ecological momentary computerized adaptive testing? (EMCAT): the use of CAT algorithms to reduce PROM response burden and facilitate high-frequency data capture via a smartphone app. We develop and pilot a smartphone app for performing EMCAT using a popular hand surgery PROM. Objective: The aim of this study is to determine the feasibility of EMCAT as a system for remote PROM administration. Methods: We built the EMCAT web app using Concerto, an open-source CAT platform maintained by the Psychometrics Centre, University of Cambridge, and hosted it on an Amazon Web Service cloud server. The platform is compatible with any questionnaire that has been parameterized with item response theory or Rasch measurement theory. For this study, the PROM we chose was the patient evaluation measure, which is commonly used in hand surgery. CAT algorithms were built using item response theory models derived from UK Hand Registry data. In the pilot study, we enrolled 40 patients with hand trauma or thumb-base arthritis, across 2 sites, between July 13, 2022, and September 14, 2022. We monitored their symptoms with the patient evaluation measure, via EMCAT, over a 12-week period. Patients were assessed thrice weekly, once daily, or thrice daily. We additionally administered full-length PROM assessments at 0, 6, and 12 weeks, and the User Engagement Scale at 12 weeks. Results: The use of EMCAT significantly reduced the length of the PROM (median 2 vs 11 items) and the time taken to complete it (median 8.8 seconds vs 1 minute 14 seconds). Very similar scores were obtained when EMCAT was administered concurrently with the full-length PROM, with a mean error of <0.01 on a logit (z score) scale. The median response rate in the daily assessment group was 93%. The median perceived usability score of the User Engagement Scale was 4.0 (maximum possible score 5.0). Conclusions: EMCAT reduces the burden of PROM assessments, enabling acceptable high-frequency, remote PROM data capture. This has potential applications in both research and clinical practice. In research, EMCAT could be used to study temporal variations in symptom severity, for example, recovery trajectories after surgery. In clinical practice, EMCAT could be used to monitor patients remotely, prompting early intervention if a patient?s symptom trajectory causes clinical concern. Trial Registration: ISRCTN 19841416; https://www.isrctn.com/ISRCTN19841416 UR - https://www.jmir.org/2023/1/e47179 UR - http://dx.doi.org/10.2196/47179 UR - http://www.ncbi.nlm.nih.gov/pubmed/37707947 ID - info:doi/10.2196/47179 ER - TY - JOUR AU - Oyedele, K. Natasha AU - Lansey, G. Dina AU - Chiew, Calvin AU - Chan, Cupid AU - Quon, Harry AU - Dean, T. Lorraine PY - 2023/9/14 TI - Development and Testing of a Mobile App to Collect Social Determinants of Health Data in Cancer Settings: Interview Study JO - JMIR Form Res SP - e48737 VL - 7 KW - social determinants of health KW - mobile apps KW - medical oncology KW - mobile phone N2 - Background: Social determinants of health (SDOH) such as lack of basic resources, housing, transportation, and social isolation play an important role for patients on the cancer care continuum. Health systems? current technological solutions for identifying and managing patients? SDOH data largely focus on information recorded in the electronic health record by providers, which is often inaccessible to patients to contribute to or modify. Objective: We developed and tested a patient-centric SDOH screening tool designed for use on patients? personal mobile phone that preserves patient privacy and confidentiality, collects information about the unmet social needs of patients with cancer, and communicates them to the provider. Methods: We interviewed 22 patients with cancer, oncologists, and social workers associated with a US-based comprehensive cancer center to better understand how patients? SDOH information is collected and reported. After triangulating data obtained from thematic analysis of interviews, an environmental scan, and a literature search of validated tools to collect SDOH data, we developed an SDOH screening tool mobile app and conducted a pilot study of 16 dyadic pairs of patients and cancer care team members at the same cancer center. We collected patient SDOH data using 36 survey items covering 7 SDOH domains and used validated scales and follow-up interviews to assess the app?s usability and acceptability among patients and cancer care team members. Results: Formative interviews with patients and care team members revealed that transportation, financial challenges, food insecurity, and low health literacy were common SDOH challenges and that a mobile app that collected those data, shared those data with care team members, and offered supportive resources could be useful and valuable. In the pilot study, 25% (4/16) of app-using patients reported having at least one of the abovementioned social needs; the most common social need was social isolation (7/16, 44%). Patients rated the mobile app as easy to use, accurately capturing their SDOH, and preserving their privacy but suggested that the app could be more helpful by connecting patients to actual resources. Providers reported high acceptability and usability of the app. Conclusions: Use of a brief, patient-centric, mobile app?based SDOH screening tool can effectively capture SDOH of patients with cancer for care team members in a way that preserves patient privacy and that is acceptable and usable for patients and care team members. However, only collecting SDOH information is not sufficient; usefulness can be increased by connecting patients directly to resources to address their unmet social needs. UR - https://formative.jmir.org/2023/1/e48737 UR - http://dx.doi.org/10.2196/48737 UR - http://www.ncbi.nlm.nih.gov/pubmed/37707880 ID - info:doi/10.2196/48737 ER - TY - JOUR AU - Sanabria, Gabriella AU - Bushover, Brady AU - Ashrafnia, Sarah AU - Cordoba, Evette AU - Schnall, Rebecca PY - 2023/9/14 TI - Understanding Physical Activity Determinants in an HIV Self-Management Intervention: Qualitative Analysis Guided by the Theory of Planned Behavior JO - JMIR Form Res SP - e47666 VL - 7 KW - HIV/AIDS KW - mobile Health KW - mHealth KW - fitness tracker KW - physical activity KW - self-management KW - HIV KW - AIDS KW - activity KW - mortality KW - app KW - fitness KW - qualitative KW - tracking KW - behavior KW - mobile phone N2 - Background: People living with HIV have long life expectancy and are experiencing more comorbid conditions, being at an increased risk for developing cardiovascular disease (CVD) and diabetes, further exacerbated due to the HIV or inflammatory process. One effective intervention shown to decrease mortality and improve health outcomes related to CVD and diabetes in people living with HIV is increased regular physical activity. However, people living with HIV often fall short of the daily recommended physical activity levels. While studies show that mobile health (mHealth) can potentially help improve people?s daily activity levels and reduce mortality rates due to comorbid conditions, these studies do not specifically focus on people living with HIV. As such, it is essential to understand how mHealth interventions, such as wearables, can improve the physical activity of people living with HIV. Objective: This study aimed to understand participants? experiences wearing a fitness tracker and an app to improve their physical activity. Methods: In total, 6 focus groups were conducted with participants who completed the control arm of a 6-month randomized controlled trial (ClinicalTrials.gov NCT03205982). The control arm received daily walk step reminders to walk at least 5000 steps per day and focused on the overall wellness of the individual. The analysis of the qualitative focus groups used inductive content analysis using the theory of planned behavior as a framework to guide and organize the analysis. Results: In total, 41 people living with HIV participated in the focus groups. The majority (n=26, 63%) of participants reported their race as Black or African American, and 32% (n=13) of them identified their ethnicity as Hispanic or Latino. In total, 9 major themes were identified and organized following the theory of planned behavior constructs. Overall, 2 major themes (positive attitude toward tracking steps and tracking steps is motivating) related to attitudes toward the behavior, 2 major themes (social support or motivation from the fitness tracker and app and encouragement from family and friends) related to participant?s subjective norms, 1 theme (you can adjust your daily habits with time) related to perceived behavioral control, 2 themes (reach their step goal and have a healthier lifestyle) related to participant?s intention, and 2 themes (continuing to walk actively and regularly wearing the fitness tracker) related to participant?s changed behavior. Participants highlighted how the mHealth interface with the avatar and daily step tracking motivated them to both begin and continue to engage in physical activity by adjusting their daily routines. Conclusions: Findings from this study illustrate how features of mHealth apps may motivate people living with HIV to start and continue sustained engagement in physical activities. This sustained increase in physical activity is crucial for reducing the risk of comorbid conditions such as diabetes or CVD. Trial Registration: ClinicalTrials.gov NCT03205982; https://classic.clinicaltrials.gov/ct2/show/NCT03205982 UR - https://formative.jmir.org/2023/1/e47666 UR - http://dx.doi.org/10.2196/47666 UR - http://www.ncbi.nlm.nih.gov/pubmed/37707942 ID - info:doi/10.2196/47666 ER - TY - JOUR AU - Wang, Jitao AU - Wu, Zhenke AU - Choi, Won Sung AU - Sen, Srijan AU - Yan, Xinghui AU - Miner, A. Jennifer AU - Sander, M. Angelle AU - Lyden, K. Angela AU - Troost, P. Jonathan AU - Carlozzi, E. Noelle PY - 2023/9/14 TI - The Dosing of Mobile-Based Just-in-Time Adaptive Self-Management Prompts for Caregivers: Preliminary Findings From a Pilot Microrandomized Study JO - JMIR Form Res SP - e43099 VL - 7 KW - caregiver KW - just-in-time adaptive intervention KW - JITAI KW - mobile health intervention KW - health-related quality of life KW - HRQOL KW - intervention KW - self-management KW - quality of life KW - psychological KW - effectiveness KW - acceptability KW - feasibility KW - design KW - anxiety KW - depression KW - QOL KW - affect KW - medication KW - pharma KW - rehab KW - wearable KW - ubiquitous KW - accelerometer KW - sleep KW - polysomnography KW - PROMIS Anxiety KW - PROMIS Depression KW - computer adaptive test KW - CAT KW - generalized estimating equations KW - GEE KW - weighted and centered least square KW - WCLS N2 - Background: Caregivers of people with chronic illnesses often face negative stress-related health outcomes and are unavailable for traditional face-to-face interventions due to the intensity and constraints of their caregiver role. Just-in-time adaptive interventions (JITAIs) have emerged as a design framework that is particularly suited for interventional mobile health studies that deliver in-the-moment prompts that aim to promote healthy behavioral and psychological changes while minimizing user burden and expense. While JITAIs have the potential to improve caregivers? health-related quality of life (HRQOL), their effectiveness for caregivers remains poorly understood. Objective: The primary objective of this study is to evaluate the dose-response relationship of a fully automated JITAI-based self-management intervention involving personalized mobile app notifications targeted at decreasing the level of caregiver strain, anxiety, and depression. The secondary objective is to investigate whether the effectiveness of this mobile health intervention was moderated by the caregiver group. We also explored whether the effectiveness of this intervention was moderated by (1) previous HRQOL measures, (2) the number of weeks in the study, (3) step count, and (4) minutes of sleep. Methods: We examined 36 caregivers from 3 disease groups (10 from spinal cord injury, 11 from Huntington disease, and 25 from allogeneic hematopoietic cell transplantation) in the intervention arm of a larger randomized controlled trial (subjects in the other arm received no prompts from the mobile app) designed to examine the acceptability and feasibility of this intensive type of trial design. A series of multivariate linear models implementing a weighted and centered least squares estimator were used to assess the JITAI efficacy and effect. Results: We found preliminary support for a positive dose-response relationship between the number of administered JITAI messages and JITAI efficacy in improving caregiver strain, anxiety, and depression; while most of these associations did not meet conventional levels of significance, there was a significant association between high-frequency JITAI and caregiver strain. Specifically, administering 5-6 messages per week as opposed to no messages resulted in a significant decrease in the HRQOL score of caregiver strain with an estimate of ?6.31 (95% CI ?11.76 to ?0.12; P=.046). In addition, we found that the caregiver groups and the participants? levels of depression in the previous week moderated JITAI efficacy. Conclusions: This study provides preliminary evidence to support the effectiveness of the self-management JITAI and offers practical guidance for designing future personalized JITAI strategies for diverse caregiver groups. Trial Registration: ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591 UR - https://formative.jmir.org/2023/1/e43099 UR - http://dx.doi.org/10.2196/43099 UR - http://www.ncbi.nlm.nih.gov/pubmed/37707948 ID - info:doi/10.2196/43099 ER - TY - JOUR AU - Chen, Yuling AU - Kruahong, Suratsawadee AU - Elias, Sabrina AU - Turkson-Ocran, Ruth-Alma AU - Commodore-Mensah, Yvonne AU - Koirala, Binu AU - Himmelfarb, Dennison Cheryl R. PY - 2023/9/13 TI - Racial Disparities in Shared Decision-Making and the Use of mHealth Technology Among Adults With Hypertension in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study in the United States JO - J Med Internet Res SP - e47566 VL - 25 KW - mobile health KW - disparities KW - shared decision-making KW - hypertension KW - association KW - decision-making KW - mHealth KW - technology KW - health disparity KW - adult KW - smartphone KW - racial KW - ethnic KW - health literacy KW - digital literacy N2 - Background: Mobile health (mHealth) technology has the potential to support shared decision-making (SDM) and improve hypertension control. However, our understanding of the variations in individuals? involvement in SDM and mHealth usage across different racial and ethnic groups in the United States is still limited. Objective: This study aimed to investigate the extent of involvement in SDM and the usage of mHealth technology in health-related activities among US adults with hypertension from diverse racial and ethnic backgrounds and to examine whether the mHealth usage differed by individuals? level of engagement in SDM. Methods: This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey, which was conducted on US adults with self-reported hypertension, and race and ethnicity data were included. The exposure of interest was race and ethnicity. The outcomes were SDM and mHealth usage. SDM was assessed using an item: ?In the past 12 months, how often did your health professional: involve you in decisions about your healthcare as much as you wanted?? mHealth usage was defined as using a smartphone or tablet to engage in (1) making health decisions, (2) discussing health decisions with health providers, (3) tracking health progress, and (4) sharing health information. Weighted multivariable logistic regression models were used to examine the association between race and ethnicity and SDM or mHealth usage adjusted for covariates and stratified by the level of engagement in SDM. Results: This study included 4893 adults with hypertension, and the mean age was 61 (SD 13) years. The sample was 53% female, 61% (n=3006) non-Hispanic White, 19% (n=907) non-Hispanic Black or African American, 12% (n=605) Hispanic, 4% (n=193) non-Hispanic Asian, and 4% (n=182) non-Hispanic other. Compared to the non-Hispanic White adults, non-Hispanic Black adults were more likely to use mHealth to make health decisions (adjusted odds ratio [aOR] 1.70, 95% CI 1.23-2.34), share health information (aOR 1.46, 95% CI 1.02-2.08), and discuss health decisions with health providers (aOR 1.38, 95% CI 1.02-1.87). Significant associations were observed specifically among those who were always involved in SDM. Asian adults were less likely to be involved in SDM (aOR 0.51, 95% CI 0.26-0.99) and were more likely to use mHealth to track progress on a health-related goal (aOR 2.07, 95% CI 1.28-3.34) than non-Hispanic White adults. Hispanic adults were less likely to use mHealth to share health information (aOR 0.47, 95% CI 0.33-0.67) and discuss health decisions with health providers (aOR 0.65, 95% CI 0.46-0.94) compared to non-Hispanic White adults. Conclusions: This study observed racial and ethnic disparities in SDM and mHealth usage among US adults with hypertension. These findings emphasize the significance of comprehending the involvement of SDM and the usage of mHealth technology within racially and ethnically diverse populations. UR - https://www.jmir.org/2023/1/e47566 UR - http://dx.doi.org/10.2196/47566 UR - http://www.ncbi.nlm.nih.gov/pubmed/37703088 ID - info:doi/10.2196/47566 ER - TY - JOUR AU - Finlay-Jones, Louise Amy AU - Parkinson, Asha AU - Sirois, Fuschia AU - Perry, Yael AU - Boyes, Mark AU - Rees, S. Clare PY - 2023/9/13 TI - Web-Based Self-Compassion Training to Improve the Well-Being of Youth With Chronic Medical Conditions: Randomized Controlled Trial JO - J Med Internet Res SP - e44016 VL - 25 KW - self-compassion KW - chronic illness KW - adolescent psychology KW - mental health KW - digital interventions KW - internet KW - well-being KW - mobile phone N2 - Background: Up to one-third of young people live with chronic physical conditions (eg, diabetes, asthma, and autoimmune disease) that frequently involve recurrent pain, fatigue, activity limitations, stigma, and isolation. These issues may be exacerbated as young people transition through adolescence. Accordingly, young people with chronic illness are at a high risk of psychological distress. Accessible, evidence-based interventions for young people with chronic illnesses are urgently needed to improve well-being, support adaptation, and enhance daily functioning. Self-compassion, which is an adaptive means of relating to oneself during times of difficulty, is a promising intervention target for this population. Objective: This study aims to test the efficacy of a 4-week, self-guided, web-based self-compassion training program for improving well-being among young Australians (aged 16-25 years) living with a chronic medical condition. The primary outcomes were self-compassion, emotion regulation difficulties, and coping; the secondary outcomes were well-being, distress, and quality of life. We also sought to test whether changes in primary outcomes mediated changes in secondary outcomes and gather feedback about the strengths and limitations of the program. Methods: We conducted a single-blind, parallel-group, randomized controlled trial comparing a 4-week, fully automated, web-based self-compassion training program with a waitlist control. Participants were recruited via the internet, and outcomes were self-assessed at 4 (T1) and 12 weeks (T2) after the baseline time point via a web-based survey. A mixed methods approach was used to evaluate the program feedback. Results: Overall, 151 patients (age: mean 21.15, SD 2.77 years; female patients: n=132, 87.4%) were randomized to the intervention (n=76, 50.3%) and control (n=75, 49.7%) groups. The loss?to?follow-up rate was 47.4%, and program use statistics indicated that only 29% (22/76) of young people in the experimental group completed 100% of the program. The main reported barrier to completion was a lack of time. As anticipated, treatment effects were observed for self-compassion (P=.01; partial ?2=0.05; small effect); well-being (P?.001; partial ?2=0.07; medium effect); and distress (P=.003; partial ?2=0.054; small-medium effect) at the posttest time point and maintained at follow-up. Contrary to our hypotheses, no intervention effects were observed for emotion regulation difficulties or maladaptive coping strategies. Improvements in adaptive coping were observed at the posttest time point but were not maintained at follow-up. Self-compassion, but not emotion regulation difficulties or coping, mediated the improvements in well-being. Conclusions: Minimal-contact, web-based self-compassion training can confer mental health benefits on young people with chronic conditions. This group experiences substantial challenges to participation in mental health supports, and program engagement and retention in this trial were suboptimal. Future work should focus on refining the program content, engagement, and delivery to optimize engagement and treatment outcomes for the target group. Trial Registration: Australian New Zealand Clinical Trials Registry 12619000572167; https://tinyurl.com/5n6hevt International Registered Report Identifier (IRRID): RR2-10.1186/s12889-020-8226-7 UR - https://www.jmir.org/2023/1/e44016 UR - http://dx.doi.org/10.2196/44016 UR - http://www.ncbi.nlm.nih.gov/pubmed/37703081 ID - info:doi/10.2196/44016 ER - TY - JOUR AU - Lynham, Joanne Amy AU - Jones, R. Ian AU - Walters, R. James T. PY - 2023/9/13 TI - Cardiff Online Cognitive Assessment in a National Sample: Cross-Sectional Web-Based Study JO - J Med Internet Res SP - e46675 VL - 25 KW - cognition KW - digital assessment KW - mental health KW - mobile phone KW - normative data KW - web-based KW - cognitive assessment KW - CONCA N2 - Background: Psychiatric disorders are associated with cognitive impairment. We have developed a web-based, 9-task cognitive battery to measure the core domains affected in people with psychiatric disorders. To date, this assessment has been used to collect data on a clinical sample of participants with psychiatric disorders. Objective: The aims of this study were (1) to establish a briefer version of the battery (called the Cardiff Online Cognitive Assessment [CONCA]) that can give a valid measure of cognitive ability (?g?) and (2) to collect normative data and demonstrate CONCA?s application in a health population sample. Methods: Based on 6 criteria and data from our previous study, we selected 5 out of the original 9 tasks to include in CONCA. These included 3 core tasks that were sufficient to derive a measure of ?g? and 2 optional tasks. Participants from a web-based national cohort study (HealthWise Wales) were invited to complete CONCA. Completion rates, sample characteristics, performance distributions, and associations between cognitive performance and demographic characteristics and mental health measures were examined. Results: A total of 3679 participants completed at least one CONCA task, of which 3135 completed all 3 core CONCA tasks. Performance on CONCA was associated with age (B=?0.05, SE 0.002; P<.001), device (tablet computer: B=?0.26, SE 0.05; P<.001; smartphone: B=?0.46, SE 0.05; P<.001), education (degree: B=1.68, SE 0.14; P<.001), depression symptoms (B=?0.04, SE 0.01; P<.001), and anxiety symptoms (B=?0.04, SE 0.01; P<.001). Conclusions: CONCA provides a valid measure of ?g,? which can be derived using as few as 3 tasks that take no more than 15 minutes. Performance on CONCA showed associations with demographic characteristics in the expected direction and was associated with current depression and anxiety symptoms. The effect of device on cognitive performance is an important consideration for research using web-based assessments. UR - https://www.jmir.org/2023/1/e46675 UR - http://dx.doi.org/10.2196/46675 UR - http://www.ncbi.nlm.nih.gov/pubmed/37703073 ID - info:doi/10.2196/46675 ER - TY - JOUR AU - Ulrich, Lauro AU - Thies, Phillip AU - Schwarz, Annika PY - 2023/9/13 TI - Availability, Quality, and Evidence-Based Content of mHealth Apps for the Treatment of Nonspecific Low Back Pain in the German Language: Systematic Assessment JO - JMIR Mhealth Uhealth SP - e47502 VL - 11 KW - mobile health KW - mobile apps KW - smartphone KW - nonspecific low back pain KW - German language KW - intervention KW - digital health KW - home exercise KW - digital rehabilitation KW - workout KW - mobile phone N2 - Background: Nonspecific low back pain (NSLBP) carries significant socioeconomic relevance and leads to substantial difficulties for those who are affected by it. The effectiveness of app-based treatments has been confirmed, and clinicians are recommended to use such interventions. As 88.8% of the German population uses smartphones, apps could support therapy. The available apps in mobile app stores are poorly regulated, and their quality can vary. Overviews of the availability and quality of mobile apps for Australia, Great Britain, and Spain have been compiled, but this has not yet been done for Germany. Objective: We aimed to provide an overview of the availability and content-related quality of apps for the treatment of NSLBP in the German language. Methods: A systematic search for apps on iOS and Android was conducted on July 6, 2022, in the Apple App Store and Google Play Store. The inclusion and exclusion criteria were defined before the search. Apps in the German language that were available in both stores were eligible. To check for evidence, the apps found were assessed using checklists based on the German national guideline for NSLBP and the British equivalent of the National Institute for Health and Care Excellence. The quality of the apps was measured using the Mobile Application Rating Scale. To control potential inaccuracies, a second reviewer resurveyed the outcomes for 30% (3/8) of the apps and checked the inclusion and exclusion criteria for these apps. The outcomes, measured using the assessment tools, are presented in tables with descriptive statistics. Furthermore, the characteristics of the included apps were summarized. Results: In total, 8 apps were included for assessment. Features provided with different frequencies were exercise tracking of prefabricated or adaptable workout programs, educational aspects, artificial intelligence?based therapy or workout programs, and motion detection. All apps met some recommendations by the German national guideline and used forms of exercises as recommended by the National Institute for Health and Care Excellence guideline. The mean value of items rated as ?Yes? was 5.75 (SD 2.71) out of 16. The best-rated app received an answer of ?Yes? for 11 items. The mean Mobile Application Rating Scale quality score was 3.61 (SD 0.55). The highest mean score was obtained in ?Section B?Functionality? (mean 3.81, SD 0.54). Conclusions: Available apps in the German language meet guideline recommendations and are mostly of acceptable or good quality. Their use as a therapy supplement could help promote the implementation of home-based exercise protocols. A new assessment tool to obtain ratings on apps for the treatment of NSLBP, combining aspects of quality and evidence-based best practices, could be useful. Trial Registration: Open Science Framework Registries sq435; https://osf.io/sq435 UR - https://mhealth.jmir.org/2023/1/e47502 UR - http://dx.doi.org/10.2196/47502 UR - http://www.ncbi.nlm.nih.gov/pubmed/37703072 ID - info:doi/10.2196/47502 ER - TY - JOUR AU - Sewpaul, Ronel AU - Resnicow, Ken AU - Crutzen, Rik AU - Dukhi, Natisha AU - Ellahebokus, Afzal AU - Reddy, Priscilla PY - 2023/9/13 TI - A Tailored mHealth Intervention for Improving Antenatal Care Seeking and Health Behavioral Determinants During Pregnancy Among Adolescent Girls and Young Women in South Africa: Development and Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e43654 VL - 12 KW - antenatal care KW - adolescent girls and young women KW - AGYW KW - adolescent pregnancy KW - mobile health KW - mHealth KW - tailoring KW - motivational interviewing KW - South Africa KW - mobile phone N2 - Background: South Africa, a middle-income country, has an adolescent fertility rate far higher than that of high-income countries. Adolescent girls and young women have an increased risk of pregnancy-related complications and lower antenatal appointment attendance rates than older adult pregnant women. Mobile health (mHealth) interventions to improve health behaviors among pregnant adolescent girls and young women in low- and middle-income countries are scarce. Objective: This paper describes the development and components of an mHealth intervention to improve antenatal appointment attendance and health behavioral determinants among pregnant adolescent girls and young women in South Africa and details the protocol for a pilot randomized controlled trial that evaluated the intervention?s efficacy and user acceptability. Methods: The intervention, Teen MomConnect, sent tailored motivational behavior change and behavioral reinforcement SMS text messages to participants about antenatal appointment keeping and pregnancy behaviors. The delivery methodology of the intervention was adapted from MomConnect, an mHealth education program for pregnant women in South Africa that has nationwide coverage. In addition, participants received a face-to-face motivational interviewing session delivered by a trained research assistant. Pregnant adolescent girls and young women aged 13 to 20 years were recruited from health facilities and community networks. Participants were randomized into the control group that received the standard MomConnect health SMS text messages or the experimental group that received the Teen MomConnect intervention. Participants completed a baseline questionnaire upon enrollment in the study and a follow-up questionnaire after the end of their pregnancy. The questionnaires assessed demographic characteristics, pregnancy behaviors, and the psychosocial determinants of antenatal appointment attendance (knowledge, attitudes, social support, risk perceptions, self-efficacy, intention, and action planning). Feasibility was assessed using descriptive analyses of acceptability, study implementation processes, and perceived satisfaction with the intervention. The number of appointments attended was obtained from the participants? clinic records. Appointment attendance was compared between the control and experimental groups, as were awareness of HIV status and the psychosocial determinants of antenatal appointment attendance. Results: Participant recruitment was conducted from May 2018 to December 2018, and the questionnaire-based data collection was completed by December 2019. Overall, 412 participants were enrolled. Conclusions: This paper describes the Teen MomConnect intervention to improve antenatal appointment attendance and pregnancy health behaviors among adolescent girls and young women. The results on the intervention?s preliminary efficacy and user acceptability will inform policy makers and health program officers on how tailored, age-appropriate, and motivational health behavior messages can be delivered via mobile phone to pregnant adolescent girls and young women. Trial Registration: Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565 International Registered Report Identifier (IRRID): DERR1-10.2196/43654 UR - https://www.researchprotocols.org/2023/1/e43654 UR - http://dx.doi.org/10.2196/43654 UR - http://www.ncbi.nlm.nih.gov/pubmed/37703092 ID - info:doi/10.2196/43654 ER - TY - JOUR AU - Gu, Yu AU - Guan, Yushan AU - Meng, Zhaolin PY - 2023/9/12 TI - Health Providers? Perceptions and Experiences of Using mHealth for Chronic Noncommunicable Diseases: Qualitative Systematic Review and Meta-Synthesis JO - J Med Internet Res SP - e45437 VL - 25 KW - mHealth KW - mobile health KW - health providers KW - adoption KW - chronic noncommunicable diseases KW - systematic review KW - meta-synthesis KW - mobile phone N2 - Background: Mobile health (mHealth) technology has great potential for addressing the epidemic of chronic noncommunicable diseases (CNCDs) by assisting health providers (HPs) with managing these diseases. However, there is currently limited evidence regarding the acceptance of mHealth among HPs, which is a key prerequisite for harnessing this potential. Objective: This review aimed to investigate the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Methods: A systematic search was conducted in MEDLINE (via Ovid), Embase, Web of Science, Google Scholar, and Cochrane Library (via Ovid) for studies that assessed the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Qualitative studies and mixed methods studies involving qualitative methods published in English were included. Data synthesis and interpretation were performed using a thematic synthesis approach. Results: A total of 18,242 studies were identified, of which 24 (0.13%) met the inclusion criteria. Overall, 6 themes related to facilitators were identified, namely empowering patient self-management, increasing efficiency, improving access to care, increasing the quality of care, improving satisfaction, and improving the usability of the internet and mobile software. Furthermore, 8 themes related to barriers were identified, namely limitation due to digital literacy, personal habits, or health problems; concern about additional burden; uncertainty around the value of mHealth technology; fear of medicolegal risks; lack of comfortable design and experience; lack of resources and incentives; lack of policy guidance and regulation; and worrisome side effects resulting from the use of mHealth. Conclusions: This study contributes to the understanding of the beneficial factors of and obstacles to mHealth adoption by HPs for CNCDs. The findings of this study may provide significant insights for health care workers and policy makers who seek ways to improve the adoption of mHealth by HPs for CNCDs. UR - https://www.jmir.org/2023/1/e45437 UR - http://dx.doi.org/10.2196/45437 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698902 ID - info:doi/10.2196/45437 ER - TY - JOUR AU - Inomata, Takenori AU - Sung, Jaemyoung AU - Nakamura, Masahiro AU - Iwagami, Masao AU - Akasaki, Yasutsugu AU - Fujio, Kenta AU - Ebihara, Nobuyuki AU - Ide, Takuma AU - Nagao, Masashi AU - Okumura, Yuichi AU - Nagino, Ken AU - Fujimoto, Keiichi AU - Eguchi, Atsuko AU - Hirosawa, Kunihiko AU - Midorikawa-Inomata, Akie AU - Muto, Kaori AU - Fujisawa, Kumiko AU - Kikuchi, Yota AU - Nojiri, Shuko AU - Murakami, Akira PY - 2023/9/12 TI - Using the AllerSearch Smartphone App to Assess the Association Between Dry Eye and Hay Fever: mHealth-Based Cross-Sectional Study JO - J Med Internet Res SP - e38481 VL - 25 KW - dry eye KW - hay fever KW - mobile health KW - personalized medicine KW - smartphone KW - pollinosis KW - rhinitis KW - allergic conjunctivitis KW - nasal symptom score KW - nonnasal symptom score KW - Ocular Surface Disease Index KW - Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire KW - mobile phone N2 - Background: Dry eye (DE) and hay fever (HF) show synergistic exacerbation of each other?s pathology through inflammatory pathways. Objective: This study aimed to investigate the association between DE and HF comorbidity and the related risk factors. Methods: A cross-sectional observational study was conducted using crowdsourced multidimensional data from individuals who downloaded the AllerSearch smartphone app in Japan between February 2018 and May 2020. AllerSearch collected the demographics, medical history, lifestyle and residential information, HF status, DE symptoms, and HF-related quality of life. HF symptoms were evaluated using the nasal symptom score (0-15 points) and nonnasal symptom score (0-12 points). HF was defined by the participants? responses to the questionnaire as HF, non-HF, or unknown. Symptomatic DE was defined as an Ocular Surface Disease Index total score (0-100 points), with a threshold score of 13 points. HF-related quality of life was assessed using the Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire (0-68 points). We conducted a multivariable linear regression analysis to examine the association between the severity of DE and HF symptoms. We subsequently conducted a multivariable logistic regression analysis to identify the factors associated with symptomatic DE (vs nonsymptomatic DE) among individuals with HF. Dimension reduction via Uniform Manifold Approximation and Projection stratified the comorbid DE and HF symptoms. The symptom profiles in each cluster were identified using hierarchical heat maps. Results: This study included 11,284 participants, classified into experiencing HF (9041 participants), non-HF (720 participants), and unknown (1523 participants) groups. The prevalence of symptomatic DE among individuals with HF was 49.99% (4429/9041). Severe DE symptoms were significantly associated with severe HF symptoms: coefficient 1.33 (95% CI 1.10-1.57; P<.001) for mild DE, coefficient 2.16 (95% CI 1.84-2.48; P<.001) for moderate DE, and coefficient 3.80 (95% CI 3.50-4.11; P<.001) for severe DE. The risk factors for comorbid symptomatic DE among individuals with HF were identified as female sex; lower BMI; medicated hypertension; history of hematologic, collagen, heart, liver, respiratory, or atopic disease; tomato allergy; current and previous mental illness; pet ownership; living room and bedrooms furnished with materials other than hardwood, carpet, tatami, and vinyl; discontinuation of contact lens use during the HF season; current contact lens use; smoking habits; and sleep duration of <6 hours per day. Uniform Manifold Approximation and Projection stratified the heterogeneous comorbid DE and HF symptoms into 14 clusters. In the hierarchical heat map, cluster 9 was comorbid with the most severe HF and DE symptoms, and cluster 1 showed severe HF symptoms with minimal DE-related symptoms. Conclusions: This crowdsourced study suggested a significant association between severe DE and HF symptoms. Detecting DE among individuals with HF could allow effective prevention and interventions through concurrent treatment for ocular surface management along with HF treatment. UR - https://www.jmir.org/2023/1/e38481 UR - http://dx.doi.org/10.2196/38481 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698897 ID - info:doi/10.2196/38481 ER - TY - JOUR AU - Chae, Joo Han AU - Kim, Ji-Been AU - Park, Gwanmo AU - O'Sullivan, Michael David AU - Seo, Jinwook AU - Park, Jung-Jun PY - 2023/9/12 TI - An Artificial Intelligence Exercise Coaching Mobile App: Development and Randomized Controlled Trial to Verify Its Effectiveness in Posture Correction JO - Interact J Med Res SP - e37604 VL - 12 KW - home workout KW - mobile assistant KW - deep-learning KW - posture correction KW - physical activity KW - exercise KW - social distance KW - COVID-19 KW - mobile device KW - workout N2 - Background: Insufficient physical activity due to social distancing and suppressed outdoor activities increases vulnerability to diseases like cardiovascular diseases, sarcopenia, and severe COVID-19. While bodyweight exercises, such as squats, effectively boost physical activity, incorrect postures risk abnormal muscle activation joint strain, leading to ineffective sessions or even injuries. Avoiding incorrect postures is challenging for novices without expert guidance. Existing solutions for remote coaching and computer-assisted posture correction often prove costly or inefficient. Objective: This study aimed to use deep neural networks to develop a personal workout assistant that offers feedback on squat postures using only mobile devices?smartphones and tablets. Deep learning mimicked experts? visual assessments of proper exercise postures. The effectiveness of the mobile app was evaluated by comparing it with exercise videos, a popular at-home workout choice. Methods: Twenty participants were recruited without squat exercise experience and divided into an experimental group (EXP) with n=10, age=21.90 (2.18), and BMI=20.75 (2.11); and a control group (CTL) with n=10, age=22.60 (1.95), and BMI=18.72 (1.23) using randomized controlled trials. A data set with over 20,000 squat videos annotated by experts was created and a deep-learning model was trained using pose estimation and video classification to analyze the workout postures. Subsequently, a mobile workout assistant app, Home Alone Exercise, was developed, and a 2-week interventional study, in which the EXP used the app while the CTL only followed workout videos, showed how the app helps people improve squat exercise. Results: The EXP significantly improved their squat postures evaluated by the app after 2 weeks (Pre: 0.20 vs Mid: 4.20 vs Post: 8.00, P=.001), whereas the CTL (without the app) showed no significant change in squat posture (Pre: 0.70 vs Mid: 1.30 vs Post: 3.80, P=.13). Significant differences were observed in the left (Pre: 75.06 vs Mid: 76.24 vs Post: 63.13, P=.02) and right (Pre: 71.99 vs Mid: 76.68 vs Post: 62.82, P=.03) knee joint angles in the EXP before and after exercise, with no significant effect found for the CTL in the left (Pre: 73.27 vs Mid: 74.05 vs Post: 70.70, P=.68) and right (Pre: 70.82 vs Mid: 74.02 vs Post: 70.23, P=.61) knee joint angles. Conclusions: EXP participants trained with the app experienced faster improvement and learned more nuanced details of the squat exercise. The proposed mobile app, offering cost-effective self-discovery feedback, effectively taught users about squat exercises without expensive in-person trainer sessions. Trial Registration: Clinical Research Information Service KCT0008178 (retrospectively registered); https://cris.nih.go.kr/cris/search/detailSearch.do/24006 UR - https://www.i-jmr.org/2023/1/e37604/ UR - http://dx.doi.org/10.2196/37604 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/37604 ER - TY - JOUR AU - Bin, Jia Kaio AU - De Pretto, Ramos Lucas AU - Sanchez, Beltrame Fábio AU - De Souza e Castro, Muniz Fabio Pacheco AU - Ramos, Delgado Vinicius AU - Battistella, Rizzo Linamara PY - 2023/9/12 TI - Digital Platform for Continuous Monitoring of Patients Using a Smartwatch: Longitudinal Prospective Cohort Study JO - JMIR Form Res SP - e47388 VL - 7 KW - smartwatch KW - digital health KW - telemedicine KW - wearable KW - telemonitoring KW - mobile health KW - General Data Protection Regulation KW - GDPR KW - Lei Geral de Proteção de Dados KW - LGPD KW - digital platform KW - clinical intervention KW - sensitive data KW - clinical trial KW - mobile phone N2 - Background: Since the COVID-19 pandemic, there has been a boost in the digital transformation of the human society, where wearable devices such as a smartwatch can already measure vital signs in a continuous and naturalistic way; however, the security and privacy of personal data is a challenge to expanding the use of these data by health professionals in clinical follow-up for decision-making. Similar to the European General Data Protection Regulation, in Brazil, the Lei Geral de Proteção de Dados established rules and guidelines for the processing of personal data, including those used for patient care, such as those captured by smartwatches. Thus, in any telemonitoring scenario, there is a need to comply with rules and regulations, making this issue a challenge to overcome. Objective: This study aimed to build a digital solution model for capturing data from wearable devices and making them available in a safe and agile manner for clinical and research use, following current laws. Methods: A functional model was built following the Brazilian Lei Geral de Proteção de Dados (2018), where data captured by smartwatches can be transmitted anonymously over the Internet of Things and be identified later within the hospital. A total of 80 volunteers were selected for a 24-week follow-up clinical trial divided into 2 groups, one group with a previous diagnosis of COVID-19 and a control group without a previous diagnosis of COVID-19, to measure the synchronization rate of the platform with the devices and the accuracy and precision of the smartwatch in out-of-hospital conditions to simulate remote monitoring at home. Results: In a 35-week clinical trial, >11.2 million records were collected with no system downtime; 66% of continuous beats per minute were synchronized within 24 hours (79% within 2 days and 91% within a week). In the limit of agreement analysis, the mean differences in oxygen saturation, diastolic blood pressure, systolic blood pressure, and heart rate were ?1.280% (SD 5.679%), ?1.399 (SD 19.112) mm Hg, ?1.536 (SD 24.244) mm Hg, and 0.566 (SD 3.114) beats per minute, respectively. Furthermore, there was no difference in the 2 study groups in terms of data analysis (neither using the smartwatch nor the gold-standard devices), but it is worth mentioning that all volunteers in the COVID-19 group were already cured of the infection and were highly functional in their daily work life. Conclusions: On the basis of the results obtained, considering the validation conditions of accuracy and precision and simulating an extrahospital use environment, the functional model built in this study is capable of capturing data from the smartwatch and anonymously providing it to health care services, where they can be treated according to the legislation and be used to support clinical decisions during remote monitoring. UR - https://formative.jmir.org/2023/1/e47388 UR - http://dx.doi.org/10.2196/47388 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698916 ID - info:doi/10.2196/47388 ER - TY - JOUR AU - Zhang, Xiaolong AU - Lewis, Shôn AU - Carter, Lesley-Anne AU - Bucci, Sandra PY - 2023/9/12 TI - A Digital System (YouXin) to Facilitate Self-Management by People With Psychosis in China: Protocol for a Nonrandomized Validity and Feasibility Study With a Mixed Methods Design JO - JMIR Res Protoc SP - e45170 VL - 12 KW - psychosis KW - self-management KW - digital KW - smartphone app KW - eHealth KW - mHealth KW - China N2 - Background: Psychosis is one of the most disabling mental health conditions and causes significant personal, social, and economic burden. Accurate and timely symptom monitoring is critical to offering prompt and time-sensitive clinical services. Digital health is a promising solution for the barriers encountered by conventional symptom monitoring approaches, including accessibility, the ecological validity of assessments, and recall bias. However, to date, there has been no digital health technology developed to support self-management for people with psychosis in China. Objective: We report the study protocol to evaluate the validity, feasibility, acceptability, usability, and safety of a symptom self-monitoring smartphone app (YouXin; Chinese name ??) for people with psychosis in China. Methods: This is a nonrandomized validity and feasibility study with a mixed methods design. The study was approved by the University of Manchester and Beijing Anding Hospital Research Ethics Committee. YouXin is a smartphone app designed to facilitate symptom self-monitoring for people with psychosis. YouXin has 2 core functions: active monitoring of symptoms (ie, smartphone survey) and passive monitoring of behavioral activity (ie, passive data collection via embedded smartphone sensors). The development process of YouXin utilized a systematic coproduction approach. A series of coproduction consultation meetings was conducted by the principal researcher with service users and clinicians to maximize the usability and acceptability of the app for end users. Participants with psychosis aged 16 years to 65 years were recruited from Beijing Anding Hospital, Beijing, China. All participants were invited to use the YouXin app to self-monitor symptoms for 4 weeks. At the end of the 4-week follow-up, we invited participants to take part in a qualitative interview to explore the acceptability of the app and trial procedures postintervention. Results: Recruitment to the study was initiated in August 2022. Of the 47 participants who were approached for the study from August 2022 to October 2022, 41 participants agreed to take part in the study. We excluded 1 of the 41 participants for not meeting the inclusion criteria, leaving a total of 40 participants who began the study. As of December 2022, 40 participants had completed the study, and the recruitment was complete. Conclusions: This study is the first to develop and test a symptom self-monitoring app specifically designed for people with psychosis in China. If the study shows the feasibility of YouXin, a potential future direction is to integrate the app into clinical workflows to facilitate digital mental health care for people with psychosis in China. This study will inform improvements to the app, trial procedures, and implementation strategies with this population. Moreover, the findings of this trial could lead to optimization of digital health technologies designed for people with psychosis in China. International Registered Report Identifier (IRRID): DERR1-10.2196/45170 UR - https://www.researchprotocols.org/2023/1/e45170 UR - http://dx.doi.org/10.2196/45170 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698905 ID - info:doi/10.2196/45170 ER - TY - JOUR AU - Noda, Masao AU - Kuroda, Tatsuaki AU - Nomura, Akihiro AU - Ito, Makoto AU - Yoshizaki, Tomokazu AU - Fushiki, Hiroaki PY - 2023/9/11 TI - Smartphone-Assisted Medical Care for Vestibular Dysfunction as a Telehealth Strategy for Digital Therapy Beyond COVID-19: Scoping Review JO - JMIR Mhealth Uhealth SP - e48638 VL - 11 KW - dizziness KW - vertigo KW - telemedicine KW - smartphone KW - digital therapy KW - telehealth KW - COVID-19 KW - information technology KW - scoping review KW - health device KW - remote diagnosis KW - medical care N2 - Background: Dizziness and vertigo can be caused by various factors, such as peripheral vestibular and central disorders. Although consultations with specialists are advisable when necessary, patients with severe vertigo symptoms may have limited mobility, which may interfere with hospital visits. The spread of COVID-19 has further limited the number of hospital visits for patients with dizziness; therefore, a method of medical care that enables more accurate treatment under time and geographical constraints is needed. Telemedicine has become widespread, owing to the popularity of smartphone and tablet devices in recent years, and the use of devices and systems has made it possible to provide efficient medical care. However, no previous scoping review has mapped existing studies on telemedicine for vertigo and dizziness, and no recommendations have been made regarding which devices and systems should be used for specific diseases. Objective: The aim of this review was to map and assess previous studies on the use of information communications technology, smartphones, and apps for treating patients with vertigo and discuss the added value of introducing telemedicine to improve the quality of medical care and create an environment that builds security and trust among patients. Methods: A scoping review was conducted with the methodological framework of Arksey and O?Malley and in accordance with the of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. The PubMed, MEDLINE, and Cochrane Library databases were searched to retrieve previous reports on smartphone-assisted telemedicine treatment for vertigo published between January 2000 and May 2023. Two authors independently assessed eligibility and extracted data. Results: This review included 20 papers that reported devices or systems for telemedicine for vestibular dysfunction. Among studies that reported the use of a device or app, 2 were related to anamnesis and subjective symptoms, 12 were related to objective examination, 7 were related to remote diagnosis, and 7 were related to treatment and rehabilitation. Conclusions: With the advancement of technology, the use of telemedicine in patients with dizziness may be feasible. In the future, it will be necessary to consider how telemedicine can be used in dizziness treatment and develop an effective treatment system combining in-person medical care and the effective use of devices for the management of severe vertigo and related diseases. The smooth introduction of telemedicine in vertigo treatment is expected to improve the quality of treatment, increase opportunities for patients to receive medical care, and reduce time and travel costs, leading to a sense of security and trust among patients. UR - https://mhealth.jmir.org/2023/1/e48638 UR - http://dx.doi.org/10.2196/48638 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695671 ID - info:doi/10.2196/48638 ER - TY - JOUR AU - Kumbara, B. Abhimanyu AU - Iyer, K. Anand AU - Green, R. Courtney AU - Jepson, H. Lauren AU - Leone, Keri AU - Layne, E. Jennifer AU - Shomali, Mansur PY - 2023/9/11 TI - Impact of a Combined Continuous Glucose Monitoring?Digital Health Solution on Glucose Metrics and Self-Management Behavior for Adults With Type 2 Diabetes: Real-World, Observational Study JO - JMIR Diabetes SP - e47638 VL - 8 KW - type 2 diabetes KW - digital health KW - continuous glucose monitoring KW - artificial intelligence KW - glycemic outcomes KW - engagement KW - digital health intervention KW - mHealth KW - diabetes management N2 - Background: The BlueStar (Welldoc) digital health solution for people with diabetes incorporates data from multiple devices and generates coaching messages using artificial intelligence. The BlueStar app syncs glucose data from the G6 (Dexcom) real-time continuous glucose monitoring (RT-CGM) system, which provides a glucose measurement every 5 minutes. Objective: The objective of this real-world study of people with type 2 diabetes (T2D) using the digital health solution and RT-CGM was to evaluate change in glycemic control and engagement with the program over 3 months. Methods: Participants were current or former enrollees in an employer-sponsored health plan, were aged 18 years or older, had a T2D diagnosis, and were not using prandial insulin. Outcomes included CGM-based glycemic metrics and engagement with the BlueStar app, including logging medications taken, exercise, food details, blood pressure, weight, and hours of sleep. Results: Participants in the program that met our analysis criteria (n=52) were aged a mean of 53 (SD 9) years; 37% (19/52) were female and approximately 50% (25/52) were taking diabetes medications. The RT-CGM system was worn 90% (SD 8%) of the time over 3 months. Among individuals with suboptimal glycemic control at baseline, defined as mean glucose >180 mg/dL, clinically meaningful improvements in glycemic control were observed, including reductions in a glucose management indicator (?0.8 percentage points), time above range 181-250 mg/dL (?4.4 percentage points) and time above range >250 mg/dL (?14 percentage points; all P<.05). Time in range 70-180 mg/dL also increased by 15 percentage points (P=.016) in this population, which corresponds to an increase of approximately 3.5 hours per day in the target range. Over the 3-month study, 29% (15/52) of participants completed at least one engagement activity per week. Medication logging was completed most often by participants (23/52, 44%) at a rate of 12.1 (SD 0.8) events/week, and this was closely followed by exercise and food logging. Conclusions: The combination of an artificial intelligence?powered digital health solution and RT-CGM helped people with T2D improve their glycemic outcomes and diabetes self-management behaviors. UR - https://diabetes.jmir.org/2023/1/e47638 UR - http://dx.doi.org/10.2196/47638 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590491 ID - info:doi/10.2196/47638 ER - TY - JOUR AU - Kostyrka-Allchorne, Katarzyna AU - Chu, Petrina AU - Ballard, Claire AU - Lean, Nancy AU - French, Blandine AU - Hedstrom, Ellen AU - Byford, Sarah AU - Cortese, Samuele AU - Daley, David AU - Downs, Johnny AU - Glazebrook, Cristine AU - Goldsmith, Kimberley AU - Hall, L. Charlotte AU - Kovshoff, Hanna AU - Kreppner, Jana AU - Sayal, Kapil AU - Shearer, James AU - Simonoff, Emily AU - Thompson, Margaret AU - Sonuga-Barke, S. Edmund J. PY - 2023/9/11 TI - Remote Recruitment Strategy and Structured E-Parenting Support (STEPS) App: Feasibility and Usability Study JO - JMIR Pediatr Parent SP - e47035 VL - 6 KW - parenting intervention KW - mobile app KW - attention-deficit/hyperactivity disorder KW - ADHD KW - behavior problems KW - mobile health KW - mHealth KW - children KW - usability KW - mobile phone N2 - Background: The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated hyperactivity, impulsivity, inattention, and conduct problems who are awaiting clinical assessment. STEPS will be evaluated in a randomized controlled trial (RCT) within the Online Parent Training for the Initial Management of ADHD Referrals (OPTIMA) research program in the United Kingdom. Phase 1 of the OPTIMA tested the feasibility of participants? recruitment and the app?s usability. Objective: This study aimed to adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; test using remote methods to screen and identify participants quickly and systematically; pilot the acceptability of the recruitment and assessment protocol; and explore the usability of STEPS. Methods: myHealthE was adapted to screen patients? data. Parents? and clinicians? feedback on myHealthE was collected, and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals using myHealthE and non-myHealthE methods. Descriptive statistics were used to summarize the demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirement (n=352). In addition to the feasibility study participants, another group of parents was recruited to assess the STEPS usability. They completed the adapted System Usability Scale and responded to open-ended questions about the app, which were coded using the Enlight quality construct template. Results: Overall, 124 potential participants were identified as eligible: 121 (97.6%) via myHealthE and 3 (2.4%) via non-myHealthE methods. In total, 107 parents were contacted, and 48 (44.9%) consented and were asked if, hypothetically, they would be willing to participate in the OPTIMA RCT. Of the 28 feasibility study participants who provided demographic data, 21 (75%) identified as White. Their children had an average age of 8.4 (SD 1.7) years and 65% (31/48) were male. During the primary recruitment period (June to July 2021) when 45 participants had consented, 38 (84%) participants agreed hypothetically to take part in the RCT (rate of 19/mo, 95% CI 13.5-26.1), meeting the stop-go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS? usability described it as easy to navigate and use and as having an attractive combination of colors and visual design. They described the content as useful, pitched at the right level, and sensitively presented. Suggested improvements included adding captions to videos or making the recorded reflections editable. Conclusions: Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. The parents felt that STEPS was a useful and easy-to-use digital parenting support tool. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-021-00959-0 UR - https://pediatrics.jmir.org/2023/1/e47035 UR - http://dx.doi.org/10.2196/47035 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695667 ID - info:doi/10.2196/47035 ER - TY - JOUR AU - Yang, Wenwen AU - Du, Yifei AU - Chen, Mengran AU - Li, Sufang AU - Zhang, Fan AU - Yu, Peiyang AU - Xu, Xiaoxia PY - 2023/9/8 TI - Effectiveness of Home-Based Telerehabilitation Interventions for Dysphagia in Patients With Head and Neck Cancer: Systematic Review JO - J Med Internet Res SP - e47324 VL - 25 KW - head and neck cancer KW - home-based rehabilitation KW - remote intervention KW - swallowing exercise KW - systematic review N2 - Background: Multimodal treatment?induced dysphagia has serious negative effects on survivors of head and neck cancer. Owing to advances in communication technologies, several studies have applied telecommunication-based interventions that incorporate swallowing exercises, education, monitoring, feedback, self-management, and communication. It is especially urgent to implement home-based remote rehabilitation in the context of the COVID-19 pandemic. However, the optimal strategy and effectiveness of remote interventions are unclear. Objective: This systematic review aimed to examine the evidence regarding the efficacy of telerehabilitation for reducing physiological and functional impairments related to swallowing and for improving adherence and related influencing factors among head and neck cancer survivors. Methods: The PubMed, MEDLINE, CINAHL, Embase, and Cochrane Library databases were systematically searched up to July 2023 to identify relevant articles. In total, 2 investigators independently extracted the data and assessed the methodological quality of the included studies using the quality assessment tool of the Joanna Briggs Institute. Results: A total of 1465 articles were initially identified; ultimately, 13 (0.89%) were included in the systematic review. The quality assessment indicated that the included studies were of moderate to good quality. The results showed that home-based telerehabilitation improved the safety of swallowing and oral feeding, nutritional status, and swallowing-related quality of life; reduced negative emotions; improved swallowing rehabilitation adherence; was rated by participants as highly satisfactory and supportive; and was cost-effective. In addition, this review investigated factors that influenced the efficacy of telerehabilitation, which included striking a balance among swallowing training strategy, intensity, frequency, duration, and individual motor ability; treating side effects of radiotherapy; providing access to medical, motivational, and educational information; providing feedback on training; providing communication and support from speech pathologists, families, and other survivors; and addressing technical problems. Conclusions: Home-based telerehabilitation has shown great potential in reducing the safety risks of swallowing and oral feeding, improving quality of life and adherence, and meeting information needs for dysphagia among survivors of head and neck cancer. However, this review highlights limitations in the current literature, and the current research is in its infancy. In addition, owing to the diversity of patient sociodemographic, medical, physiological and functional swallowing, and behavioral factors, we recommend the development of tailored telemedicine interventions to achieve the best rehabilitation effects with the fewest and most precise interventions. UR - https://www.jmir.org/2023/1/e47324 UR - http://dx.doi.org/10.2196/47324 UR - http://www.ncbi.nlm.nih.gov/pubmed/37682589 ID - info:doi/10.2196/47324 ER - TY - JOUR AU - Kanodia, Sweekrity AU - Thalabard, Christophe Jean AU - Lhoste, Kevin PY - 2023/9/7 TI - Categorization and Analysis of Primary Care mHealth Apps Related to Breast Health and Breast Cancer: Systematic Search in App Stores and Content Analysis JO - JMIR Cancer SP - e42044 VL - 9 KW - breast cancer KW - breast self-examination KW - BSE KW - primary care KW - mobile applications KW - mobile apps KW - breast health KW - early diagnosis N2 - Background: Breast cancer is the most common cause of cancer mortality among women globally. The use of mobile health tools such as apps and games is increasing rapidly, even in low- and middle-income countries, to promote early diagnosis and to manage care and support of survivors and patients. Objective: The primary objective of this review was to categorize selected mobile health apps related to breast health and prevention of breast cancer, based on features such as breast self-examination (BSE) training and reminders, and to analyze their current dissemination. An ancillary objective was to highlight the limitations of existing tools and suggest ways to improve them. Methods: We defined strict inclusion and exclusion criteria, which required apps to have titles or descriptions that suggest that they were designed for the general public, and not for patients with breast cancer or health workers. Apps that focused on awareness and primary care via self-check were included, while those that focused on topics such as alternative treatments and medical news were excluded. Apps that were not specifically related to breast cancer were also excluded. Apps (in any language) that appeared in the search with keywords were included. The database consisted of apps from AppAgg and Google Play Store. Only 85 apps met the inclusion criteria. Selected apps were categorized on the basis of their alleged interactive features. Descriptive statistics were obtained, and available language options, the number of downloads, and the cost of the apps were the main parameters reviewed. Results: The selected apps were categorized on the basis of the following features: education, BSE training, reminders, and recording. Of the 85 selected apps, 72 (84.7%) focused on disseminating breast cancer information. BSE training was provided by only 47% (n=40) of the apps, and very few had reminder (n=26, 30.5%) and recording (n=11, 12.9%) features. The median number of downloads was the highest for apps with recording features (>1000 downloads) than those with education, BSE training, reminder, and recording features (>5000 downloads). Most of these apps (n=74, 83.5%) were monolingual, and around 80.3% (n=49) of these apps were in English. Almost all the apps on Google Play Store were free of charge. Conclusions: Although there exist several apps on Google Play Store to promote awareness about breast health and cancer, the usefulness of most of them appears debatable. To provide a complete breast health package to the users, such apps must have all of the following features: reminders or notifications and symptom recording and tracking. There is still an urgent need to scientifically evaluate existing apps in the target populations in order to make them more functional and user-friendly. UR - https://cancer.jmir.org/2023/1/e42044 UR - http://dx.doi.org/10.2196/42044 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676704 ID - info:doi/10.2196/42044 ER - TY - JOUR AU - Ester, Manuel AU - Wagoner, W. Chad AU - Dreger, Julianna AU - Chen, Guanmin AU - McDonough, H. Meghan AU - McNeely, L. Margaret AU - Culos-Reed, Nicole S. PY - 2023/9/7 TI - Effectiveness of a Self-Monitoring App in Supporting Physical Activity Maintenance Among Rural Canadians With Cancer After an Exercise Oncology Program: Cluster Randomized Controlled Trial JO - JMIR Cancer SP - e47187 VL - 9 KW - eHealth KW - mHealth KW - mobile health KW - mobile apps KW - self-monitoring KW - cancer KW - oncology KW - physical activity KW - exercise KW - randomized controlled trial KW - intervention KW - mobile phone N2 - Background: Despite the benefits of physical activity (PA) for individuals with cancer, most remain insufficiently active. Exercise oncology interventions can improve PA levels. Individuals struggle to maintain PA levels after interventions because of persistent psychological and environmental PA barriers. Health technology (eHealth) may address some PA barriers and deliver effective, scalable PA interventions in oncology, yet its effectiveness for changing PA levels remains mixed. Using eHealth to support PA maintenance among rural populations with cancer, who may need greater PA support given lower PA levels and worse health outcomes, remains under-studied. Objective: This study examined the effectiveness of an app-based self-monitoring intervention in supporting PA maintenance among rural populations with cancer after a supervised web-based exercise oncology program. Methods: This 2-arm, cluster randomized controlled trial was embedded within the Exercise for Cancer to Enhance Living Well (EXCEL) effectiveness-implementation study. Upon consent, participants were randomized 1:1 by EXCEL class clusters to the intervention (24 weeks of app-based PA self-monitoring) or waitlist control (app access after 24 weeks). Both groups completed a 12-week supervised web-based exercise oncology program followed by a 12-week self-directed PA maintenance period. Baseline demographics, eHealth literacy, and patient-reported outcomes were compared using chi-square and 2-tailed t tests. App use was measured throughout the intervention. The primary outcome?self-reported moderate-to-vigorous PA (MVPA) minutes?and secondary outcomes?objective MVPA minutes and steps and app usability ratings?were collected at baseline, 12 weeks, and 24 weeks. Intervention effects on self-report MVPA maintenance were assessed via linear mixed modeling, with secondary outcomes explored descriptively. Results: Of the 359 eligible EXCEL participants, 205 (57.1%) consented, 199 (55.4%; intervention: 106/199, 53.3%; control: 93/199, 46.7%) started the study, and 183 (51%; intervention: 100/183, 54.6%; control: 83/183, 45.4%) and 141 (39.3%; intervention: 69/141, 48.9%; control: 72/141, 51.1%) completed 12- and 24-week measures, respectively. Mean age was 57.3 (SD 11.5) years. Most participants were female (174/199, 87.4%), White (163/199, 81.9%), and diagnosed with breast cancer (108/199, 54.3%). Median baseline self-report weekly MVPA minutes were 60.0 (IQR 0-180) and 40.0 (IQR 0-135) for the intervention and waitlist control groups, respectively (P=.74). Median app use duration was 10.3 (IQR 1.3-23.9) weeks, with 9.6 (IQR 4.4-17.8) self-monitoring entries/week. Both groups increased their weekly MVPA minutes significantly at 12 weeks (P<.001) and maintained the increases at 24 weeks (P<.001), relative to baseline, with no between-group differences (P=.87). The intervention group had significantly higher step counts for 7 of the 12 weeks during the PA maintenance period (P=.048 to <.001). Conclusions: The app-based self-monitoring intervention did not improve MVPA maintenance but may have contributed to increased step counts during the PA maintenance period. More work is needed to realize the full potential of eHealth in exercise oncology. Trial Registration: ClinicalTrials.gov NCT04790578; https://clinicaltrials.gov/study/NCT04790578 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2021.106474 UR - https://cancer.jmir.org/2023/1/e47187 UR - http://dx.doi.org/10.2196/47187 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676714 ID - info:doi/10.2196/47187 ER - TY - JOUR AU - Schulze, Annett AU - Lindemann, Ann-Kathrin AU - Brand, Fabian AU - Geppert, Johanna AU - Menning, Axel AU - Stehr, Paula AU - Reifegerste, Doreen AU - Rossmann, Constanze PY - 2023/9/6 TI - Mobile Apps Aimed at Preventing and Handling Unintentional Injuries in Children Aged <7 Years: Systematic Review JO - Interact J Med Res SP - e45258 VL - 12 KW - mobile health KW - mHealth KW - caregiver KW - parental KW - prevention KW - first aid KW - pediatric KW - review method KW - injuries KW - health app KW - needs KW - mobile phone N2 - Background: Despite various global health crises, the prevention and handling of unintentional childhood injuries remains an important public health objective. Although several systematic reviews have examined the effectiveness of different child injury prevention measures, these reviews did not address the evaluation of mobile communication intervention tools. Whether and how mobile apps were evaluated provides information on the extent to which communication theories, models, and evidence-based knowledge were considered. Previous studies have shown that the effectiveness of mobile apps increases when theories and evidence are considered during their development. Objective: This systematic review aimed to identify research on mobile apps dealing with the prevention and handling of unintentional injuries in children and examine the theoretical and methodological approaches thereof. In addition, this review analyzed the different needs of various target groups of the mobile apps described in the articles. Methods: In total, 8 electronic databases, ranging from interdisciplinary to medical and technical as well as social sciences databases, were searched for original research articles or brief reports in peer-reviewed journals or conference proceedings. Moreover, this review encompassed a systematic scan of articles published in the BMJ journal Injury Prevention. These steps were followed by a snowball search based on the literature references in the articles identified through the initial screening. The articles had to be written in English or German, published between 2008 and 2021, and evaluate mobile apps dealing with the prevention and handling of unintentional child injuries. The identified 5 studies were analyzed by 5 independent researchers using an inductive approach. Furthermore, the quality of the studies was assessed using the Mixed Methods Appraisal Tool. Results: A total of 5 articles were included and assessed with regard to overall quality of theoretical and methodological foundations, assessed variables, the focal app?s architecture, and the needs of the study participants. The overall study quality was moderate, although part of this classification was due to a lack of details reported in the studies. Each study examined 1 mobile app aimed at parents and other caregivers. Each study assessed at least 1 usability- or user experience-related variable, whereas the needs of the included study participants were detailed in only 20% (1/5) of the cases. However, none of the studies referred to theories such as the Technology Acceptance Model during the development of the apps. Conclusions: The future development and evaluation of apps dealing with the prevention and handling of child injuries should combine insights into existing models on user experience and usability with established theories on mobile information behavior. This theory-based approach will increase the validity of such evaluation studies. UR - https://www.i-jmr.org/2023/1/e45258 UR - http://dx.doi.org/10.2196/45258 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672312 ID - info:doi/10.2196/45258 ER - TY - JOUR AU - Väyrynen, Elina AU - Hakola, Sanna AU - Keski-Salmi, Anniina AU - Jämsä, Hannaleena AU - Vainionpää, Raija AU - Karki, Saujanya PY - 2023/9/6 TI - The Use of Patient-Oriented Mobile Phone Apps in Oral Health: Scoping Review JO - JMIR Mhealth Uhealth SP - e46143 VL - 11 KW - oral health KW - dentistry KW - mobile apps KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Oral health is a significant part of general health. Poor oral health can influence an individual?s appearance, self-esteem, eating, and speaking. The use of mobile phone apps has been growing in the field of medicine, including dentistry. However, to date, there is no evidence related to the availability of mobile apps focusing on various branches of dentistry. Objective: The aim of this study was to review the scientific literature on the use of patient-oriented mobile phone apps in oral health and summarize the key findings. Methods: A scoping review of published scientific literature on the use of patient-oriented mobile phone apps in oral health was conducted in accordance with the Joanna Briggs Institute. A search was performed in PubMed and Scopus for studies published between January 2000 and June 2021 that were written in English. All study types except for those reporting developmental protocols were included in this review. In total, 2 reviewers independently screened the studies using the eligibility criteria. The study protocol was registered in the Open Science Framework registries in June 2021. Results: The initial search yielded a total of 977 studies, 45 (4.6%) of which met the inclusion criteria. All the studies (45/45, 100%) were published after 2009. Most studies (31/45, 69%) concerned oral health promotion using mobile phone apps, followed by behavior management (5/45, 11%). More than half (23/45, 51%) of the included studies were conducted in Asian countries. Overall, 31% (14/45) of the studies focused on adolescents. A total of 51% (23/45) of the studies were randomized controlled trials (RCTs). Approximately 39% (9/23) of the included RCT studies reported a substantial reduction in dental plaque, and 26% (6/23) of the studies reported significant improvement in gingival health. Regarding dental anxiety management, 13% (3/23) of the RCT studies reported a significant decrease in mean heart rate and lower Facial Image Scale scores. Conclusions: According to the literature, the use of mobile apps in oral health is increasing among patients, mainly children and adolescents. Many studies that have used mobile apps have focused on promoting oral health. However, other areas such as diagnostic and remote consultations (teledentistry) have until recently been neglected despite their great potential. UR - https://mhealth.jmir.org/2023/1/e46143 UR - http://dx.doi.org/10.2196/46143 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672331 ID - info:doi/10.2196/46143 ER - TY - JOUR AU - Daryabeygi-Khotbehsara, Reza AU - Dunstan, W. David AU - Islam, Shariful Sheikh Mohammed AU - Zhang, Yuxin AU - Abdelrazek, Mohamed AU - Maddison, Ralph PY - 2023/9/6 TI - Just-In-Time Adaptive Intervention to Sit Less and Move More in People With Type 2 Diabetes: Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e41502 VL - 12 KW - diabetes KW - just-in-time adaptive intervention KW - JITAI KW - micro-randomized trial KW - MRT KW - physical activity KW - sedentary behavior N2 - Background: Reducing sedentary behavior and increasing physical activity in people with type 2 diabetes (T2D) are associated with various positive health benefits. Just-in-time adaptive interventions offer the potential to target both of these behaviors through more contextually aware, tailored, and personalized support. We have developed a just-in-time adaptive intervention to promote sitting less and moving more in people with T2D. Objective: This paper presents the study protocol for a microrandomized trial to investigate whether motivational messages are effective in reducing time spent sitting in people with T2D and to determine what behavior change techniques are effective and in which context (eg, location, etc). Methods: We will use a 6-week microrandomized trial design. A total of 22 adults with T2D will be recruited. The intervention aims to reduce sitting time and increase time spent standing and walking and comprises a mobile app (iMove), a bespoke activity sensor called Sedentary Behavior Detector (SORD), a messaging system, and a secured database. Depending on the randomization sequence, participants will potentially receive motivational messages 5 times a day. Results: Recruitment was initiated in October 2022. As of now, 6 participants (2 female and 4 male) have consented and enrolled in the study. Their baseline measurements have been completed, and they have started using iMove. The mean age of 6 participants is 56.8 years, and they were diagnosed with T2D for 9.4 years on average. Conclusions: This study will inform the optimization of digital behavior change interventions to support people with T2D Sit Less and Move More to increase daily physical activity. This study will generate new evidence about the immediate effectiveness of sedentary behavior interventions, their active ingredients, and associated factors. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12622000426785; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383664 International Registered Report Identifier (IRRID): DERR1-10.2196/41502 UR - https://www.researchprotocols.org/2023/1/e41502 UR - http://dx.doi.org/10.2196/41502 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672323 ID - info:doi/10.2196/41502 ER - TY - JOUR AU - Torres-Robles, Andrea AU - Allison, Karen AU - Poon, K. Simon AU - Shaw, Miranda AU - Hutchings, Owen AU - Britton, J. Warwick AU - Wilson, Andrew AU - Baysari, Melissa PY - 2023/9/5 TI - Patient and Clinician Perceptions of the Pulse Oximeter in a Remote Monitoring Setting for COVID-19: Qualitative Study JO - J Med Internet Res SP - e44540 VL - 25 KW - remote monitoring KW - patient experience KW - user experience KW - COVID-19 KW - pulse oximetry KW - usability KW - acceptability KW - oximetry KW - wearable device N2 - Background: As a response to the COVID-19 pandemic, the Sydney Local Health District in New South Wales, Australia, launched the rpavirtual program, the first full-scale virtual hospital in Australia, to remotely monitor and follow up stable patients with COVID-19. As part of the intervention, a pulse oximeter wearable device was delivered to patients to monitor their oxygen saturation levels, a critical indicator of COVID-19 patient deterioration. Understanding users? perceptions toward the device is fundamental to assessing its usability and acceptability and contributing to the effectiveness of the intervention, but no research to date has explored the user experience of the pulse oximeter for remote monitoring in this setting. Objective: This study aimed to explore the use, performance, and acceptability of the pulse oximeter by clinicians and patients in rpavirtual during COVID-19. Methods: Semistructured interviews and usability testing were conducted. Stable adult patients with COVID-19 (aged ?18 years) who used the pulse oximeter and were monitored by rpavirtual, and rpavirtual clinicians monitoring these patients were interviewed. Clinicians could be nurses, doctors, or staff who were part of the team that assisted patients with the use of the pulse oximeter. Usability testing was conducted with patients who had the pulse oximeter when they were contacted. Interviews were coded using the Theoretical Framework of Acceptability. Usability testing was conducted using a think-aloud protocol. Data were collected until saturation was reached. Results: Twenty-one patients (average age 51, SD 13 years) and 15 clinicians (average age 41, SD 11 years) completed the interview. Eight patients (average age 51, SD 13 years) completed the usability testing. All participants liked the device and thought it was easy to use. They also had a good understanding of how to use the device and the device?s purpose. Patients? age and device use?related characteristics (eg, the warmth of hands and hand steadiness) were identified by users as factors negatively impacting the accurate use of the pulse oximeter. Conclusions: Patients and clinicians had very positive perceptions of the pulse oximeter for COVID-19 remote monitoring, indicating high acceptability and usability of the device. However, factors that may impact the accuracy of the device should be considered when delivering interventions using the pulse oximeter for remote monitoring. Targeted instructions about the use of the device may be necessary for specific populations (eg, older people and patients unfamiliar with technology). Further research should focus on the integration of the pulse oximeter data into electronic medical records for real-time and secure patient monitoring. UR - https://www.jmir.org/2023/1/e44540 UR - http://dx.doi.org/10.2196/44540 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535831 ID - info:doi/10.2196/44540 ER - TY - JOUR AU - Joshi, Vibha AU - Joshi, Kumar Nitin AU - Bhardwaj, Pankaj AU - Singh, Kuldeep AU - Ojha, Deepika AU - Jain, Kumar Yogesh PY - 2023/9/4 TI - The Health Impact of mHealth Interventions in India: Systematic Review and Meta-Analysis JO - Online J Public Health Inform SP - e50927 VL - 15 KW - mobile applications KW - mobile apps KW - cost-benefit analysis KW - telemedicine KW - technology KW - India KW - patient satisfaction KW - pregnancy N2 - Background: Considerable use of mobile health (mHealth) interventions has been seen, and these interventions have beneficial effects on health and health service delivery processes, especially in resource-limited settings. Various functionalities of mobile phones offer a range of opportunities for mHealth interventions. Objective: This review aims to assess the health impact of mHealth interventions in India. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies conducted in India, and published between April 1, 2011, and March 31, 2021, were considered. A literature search was conducted using a combination of MeSH (Medical Subject Headings) terms in different databases to identify peer-reviewed publications. Thirteen out of 1350 articles were included for the final review. Risk of bias was assessed using the Risk of Bias 2 tool for RCTs and Risk Of Bias In Non-randomised Studies - of Interventions tool (for nonrandomized trials), and a meta-analysis was performed using RevMan for 3 comparable studies on maternal, neonatal, and child health. Results: The meta-analysis showed improved usage of maternal and child health services including iron?folic acid supplementation (odds ratio [OR] 14.30, 95% CI 6.65-30.75), administration of both doses of the tetanus toxoid (OR 2.47, 95% CI 0.22-27.37), and attending 4 or more antenatal check-ups (OR 1.82, 95% CI 0.65-5.09). Meta-analysis for studies concerning economic evaluation and chronic diseases could not be performed due to heterogeneity. However, a positive economic impact was observed from a societal perspective (ReMiND [reducing maternal and newborn deaths] and ImTeCHO [Innovative Mobile Technology for Community Health Operation] interventions), and chronic disease interventions showed a positive impact on clinical outcomes, patient and provider satisfaction, app usage, and improvement in health behaviors. Conclusions: This review provides a comprehensive overview of mHealth technology in all health sectors in India, analyzing both health and health care usage indicators for interventions focused on maternal and child health and chronic diseases. Trial Registration: PROSPERO 2021 CRD42021235315; https://tinyurl.com/yh4tp2j7 UR - https://ojphi.jmir.org/2023/1/e50927 UR - http://dx.doi.org/10.2196/50927 UR - http://www.ncbi.nlm.nih.gov/pubmed/38046564 ID - info:doi/10.2196/50927 ER - TY - JOUR AU - Barrigon, Luisa Maria AU - Romero-Medrano, Lorena AU - Moreno-Muñoz, Pablo AU - Porras-Segovia, Alejandro AU - Lopez-Castroman, Jorge AU - Courtet, Philippe AU - Artés-Rodríguez, Antonio AU - Baca-Garcia, Enrique PY - 2023/9/1 TI - One-Week Suicide Risk Prediction Using Real-Time Smartphone Monitoring: Prospective Cohort Study JO - J Med Internet Res SP - e43719 VL - 25 KW - e-health KW - m-health KW - Ecological Mometary Asssessment KW - risk prediction KW - sensor monitoring KW - suicidal KW - suicide attempt KW - suicide N2 - Background: Suicide is a major global public health issue that is becoming increasingly common despite preventive efforts. Though current methods for predicting suicide risk are not sufficiently accurate, technological advances provide invaluable tools with which we may evolve toward a personalized, predictive approach. Objective: We aim to predict the short-term (1-week) risk of suicide by identifying changes in behavioral patterns characterized through real-time smartphone monitoring in a cohort of patients with suicidal ideation. Methods: We recruited 225 patients between February 2018 and March 2020 with a history of suicidal thoughts and behavior as part of the multicenter SmartCrisis study. Throughout 6 months of follow-up, we collected information on the risk of suicide or mental health crises. All participants underwent voluntary passive monitoring using data generated by their own smartphones, including distance walked and steps taken, time spent at home, and app usage. The algorithm constructs daily activity profiles for each patient according to these data and detects changes in the distribution of these profiles over time. Such changes are considered critical periods, and their relationship with suicide-risk events was tested. Results: During follow-up, 18 (8%) participants attempted suicide, and 14 (6.2%) presented to the emergency department for psychiatric care. The behavioral changes identified by the algorithm predicted suicide risk in a time frame of 1 week with an area under the curve of 0.78, indicating good accuracy. Conclusions: We describe an innovative method to identify mental health crises based on passively collected information from patients? smartphones. This technology could be applied to homogeneous groups of patients to identify different types of crises. UR - https://www.jmir.org/2023/1/e43719 UR - http://dx.doi.org/10.2196/43719 UR - http://www.ncbi.nlm.nih.gov/pubmed/37656498 ID - info:doi/10.2196/43719 ER - TY - JOUR AU - Luo, Qianqian AU - Wu, Zunyou AU - Mi, Guodong AU - Xu, Jie AU - Scott, Robbins Sarah PY - 2023/9/1 TI - Using HIV Risk Self-Assessment Tools to Increase HIV Testing in Men Who Have Sex With Men in Beijing, China: App-Based Randomized Controlled Trial JO - J Med Internet Res SP - e45262 VL - 25 KW - app KW - China KW - HIV testing KW - men who have sex with men KW - risk assessment N2 - Background: Men who have sex with men (MSM) in China hold a low-risk perception of acquiring HIV. This has resulted in an inadequate HIV testing rate. Objective: This study aims to investigate whether administering HIV risk self-assessments with tailored feedback on a gay geosocial networking (GSN) app could improve HIV testing rates and reduce sexual risk behaviors in Chinese MSM. Methods: We recruited MSM from Beijing, China, who used the GSN platform Blued in October 2017 in this 12-month double-blinded randomized controlled trial. From October 2017 to September 2018, eligible participants were randomly assigned to use a self-reported HIV risk assessment tool that provided tailored feedback according to transmission risk (group 1), access to the same HIV risk assessment without feedback (group 2), or government-recommended HIV education materials (control). All interventions were remotely delivered through the mobile phone?based app Blued, and participants were followed up at 1, 3, 6, and 12 months from baseline. The number of HIV tests over the 12-month study was the primary outcome and was assessed using an intention-to-treat analysis with an incident rate ratio (IRR). Unprotected anal intercourse (UAI) over 6 months was assessed by a modified intention-to-treat analysis and was the secondary outcome. All statistical analyses were conducted in SAS 9.3 (SAS Institute, Inc.), and a P value <.05 was considered statistically significant. Results: In total, 9280 MSM were recruited from baseline and were randomly assigned to group 1 (n=3028), group 2 (n=3065), or controls (n=3187). After follow-up, 1034 (34.1%), 993 (32.4%), and 1103 (34.6%) remained in each group, respectively. Over 12 months, group 1 took 391 tests (mean of 2.51 tests per person), group 2 took 352 tests (mean of 2.01 tests per person), and controls took 295 tests (mean of 1.72 tests per person). Group 1 had significantly more HIV testing than the control group (IRR 1.32, 95% CI 1.09-4.58; P=.01), while group 2 did not differ significantly from the controls (IRR 1.06, 95% CI 0.86-1.30; P=.60). The proportion of UAI was not statistically different among different groups, but all 3 groups had UAI, which declined from baseline. Conclusions: Repeated HIV risk assessments coupled with tailored feedback through GSN apps improved HIV testing. Such interventions should be considered a simple way of improving HIV testing among MSM in China and increasing awareness of HIV status. Trial Registration: ClinicalTrials.gov NCT03320239; https://clinicaltrials.gov/study/NCT03320239 UR - https://www.jmir.org/2023/1/e45262 UR - http://dx.doi.org/10.2196/45262 UR - http://www.ncbi.nlm.nih.gov/pubmed/37656500 ID - info:doi/10.2196/45262 ER - TY - JOUR AU - Kelkar, Suneel Radhika AU - Currey, Danielle AU - Nagendra, Srilakshmi AU - Mehta, Meherwan Urvakhsh AU - Sreeraj, S. Vanteemar AU - Torous, John AU - Thirthalli, Jagadisha PY - 2023/9/1 TI - Utility of Smartphone-Based Digital Phenotyping Biomarkers in Assessing Treatment Response to Transcranial Magnetic Stimulation in Depression: Proof-of-Concept Study JO - JMIR Form Res SP - e40197 VL - 7 KW - theta burst stimulation KW - treatment response KW - predictive biomarker KW - outcome KW - digital phenotyping KW - transcranial magnetic stimulation KW - TMS KW - depression KW - smartphone KW - mobile phone N2 - Background: Identifying biomarkers of response to transcranial magnetic stimulation (TMS) in treatment-resistant depression is a priority for personalizing care. Clinical and neurobiological determinants of treatment response to TMS, while promising, have limited scalability. Therefore, evaluating novel, technologically driven, and potentially scalable biomarkers, such as digital phenotyping, is necessary. Objective: This study aimed to examine the potential of smartphone-based digital phenotyping and its feasibility as a predictive biomarker of treatment response to TMS in depression. Methods: We assessed the feasibility of digital phenotyping by examining the adherence and retention rates. We used smartphone data from passive sensors as well as active symptom surveys to determine treatment response in a naturalistic course of TMS treatment for treatment-resistant depression. We applied a scikit-learn logistic regression model (l1 ratio=0.5; 2-fold cross-validation) using both active and passive data. We analyzed related variance metrics throughout the entire treatment duration and on a weekly basis to predict responders and nonresponders to TMS, defined as ?50% reduction in clinician-rated symptom severity from baseline. Results: The adherence rate was 89.47%, and the retention rate was 73%. The area under the curve for correct classification of TMS response ranged from 0.59 (passive data alone) to 0.911 (both passive and active data) for data collected throughout the treatment course. Importantly, a model using the average of all features (passive and active) for the first week had an area under the curve of 0.7375 in predicting responder status at the end of the treatment. Conclusions: The results of our study suggest that it is feasible to use digital phenotyping data to assess response to TMS in depression. Early changes in digital phenotyping biomarkers, such as predicting response from the first week of data, as shown in our results, may also help guide the treatment course. UR - https://formative.jmir.org/2023/1/e40197 UR - http://dx.doi.org/10.2196/40197 UR - http://www.ncbi.nlm.nih.gov/pubmed/37656496 ID - info:doi/10.2196/40197 ER - TY - JOUR AU - Mishra, R. Sonali AU - Dempsey, Walter AU - Klasnja, Predrag PY - 2023/9/1 TI - A Text Messaging Intervention for Priming the Affective Rewards of Exercise in Adults: Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e46560 VL - 12 KW - mobile health KW - mHealth interventions KW - physical activity KW - affective attitudes KW - mobile phone N2 - Background: Physical activity is a critical target for health interventions, but effective interventions remain elusive. A growing body of work suggests that interventions targeting affective attitudes toward physical activity may be more effective for sustaining activity long term than those that rely on cognitive constructs alone, such as goal setting and self-monitoring. Anticipated affective response in particular is a promising target for intervention. Objective: We will evaluate the efficacy of an SMS text messaging intervention that manipulates anticipated affective response to exercise to promote physical activity. We hypothesize that reminding users of a positive postexercise affective state before their planned exercise sessions will increase their calories burned during this exercise session. We will deploy 2 forms of affective SMS text messages to explore the design space: low-reflection messages written by participants for themselves and high-reflection prompts that require users to reflect and respond. We will also explore the effect of the intervention on affective attitudes toward exercise. Methods: A total of 120 individuals will be enrolled in a 9-week microrandomized trial testing affective messages that remind users about feeling good after exercise (40% probability), control reminders (30% probability), or no message (30% probability). Two types of affective SMS text messages will be deployed: one requiring a response and the other in a read-only format. Participants will write the read-only messages themselves to ensure that the messages accurately reflect the participants? anticipated postexercise affective state. Affective attitudes toward exercise and intrinsic motivation for exercise will be measured at the beginning and end of the study. The weighted and centered least squares method will be used to analyze the effect of delivering the intervention versus not on calories burned over 4 hours around the time of the planned activity, measured by the Apple Watch. Secondary analyses will include the effect of the intervention on step count and active minutes, as well as an investigation of the effects of the intervention on affective attitudes toward exercise and intrinsic motivation for exercise. Participants will be interviewed to gain qualitative insights into intervention impact and acceptability. Results: Enrollment began in May 2023, with 57 participants enrolled at the end of July 2023. We anticipate enrolling 120 participants. Conclusions: This study will provide early evidence about the effect of a repeated manipulation of anticipated affective response to exercise. The use of 2 different types of messages will yield insight into optimal design strategies for improving affective attitudes toward exercise. Trial Registration: ClinicalTrials.gov NCT05582369; https://classic.clinicaltrials.gov/ct2/show/NCT05582369 International Registered Report Identifier (IRRID): PRR1-10.2196/46560 UR - https://www.researchprotocols.org/2023/1/e46560 UR - http://dx.doi.org/10.2196/46560 UR - http://www.ncbi.nlm.nih.gov/pubmed/37656493 ID - info:doi/10.2196/46560 ER - TY - JOUR AU - Ni, Chen-Xu AU - Lu, Wen-Jie AU - Ni, Min AU - Huang, Fang AU - Li, Dong-Jie AU - Shen, Fu-Ming PY - 2023/8/31 TI - Advanced Messaging Intervention for Medication Adherence and Clinical Outcomes Among Patients With Cancer: Randomized Controlled Trial JO - JMIR Cancer SP - e44612 VL - 9 KW - 5G messaging KW - fifth-generation KW - medication adherence KW - patients with cancer KW - clinical pharmacists KW - randomized controlled trial N2 - Background: Medication adherence is crucial for improving clinical outcomes in the treatment of patients with cancer. The lack of adherence and adverse drug reactions can reduce the effectiveness of cancer therapy including the quality of life. The commonly used intervention methods for medication adherence continue to evolve, and the age of fifth-generation (5G) messaging has arrived. Objective: In this study, we conducted a prospective, pilot randomized controlled trial to evaluate the effect of 5G messaging on medication adherence and clinical outcomes among patients with cancer in China. Methods: The research population was patients with nonsmall cell lung cancer undergoing pemetrexed chemotherapy who require regular folic acid (FA) and vitamin B12 supplements. The intervention and control groups were assigned to 5G messaging and second-generation (2G) messaging, respectively. The patients? medication adherence and quality of life were assessed at baseline and 1-month and 3-month time points. Moreover, the chemotherapy-related hematologic or nonhematologic toxicities, as well as the serum levels of FA and vitamin B12, were measured. Results: Of the 567 patients assessed for eligibility between January and May 2021, a total of 154 (27.2%) patients were included. Overall, 80 were randomized to the control group and 74 to the intervention group. The odds of adherence in the 5G messaging intervention group were significantly higher than the control group at the 1-month (62/69, 90% vs 56/74, 76%; adjusted odds ratio 2.67, 95% CI 1.02-7.71) and 3-month (50/60, 83% vs 48/64, 75%; adjusted odds ratio 2.36, 95% CI 1.00-5.23) time points. Correspondingly, the FA and vitamin B12 serum levels of patients in the 5G messaging group were higher than those of the control group. Regarding hematologic toxicities, only the incidence of leukopenia in the intervention group was lower than that in the control group (25/80, 31% in the control group vs 12/74, 16% in the intervention group; P=.04). There were no differences in nonhematologic toxicities and quality of life between the 2 groups. Conclusions: In summary, we conclude that compared with conventional 2G text-based messaging, a 5G messaging intervention can better improve medication adherence and clinical outcome among patients with cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200058188; https://www.chictr.org.cn/showproj.html?proj=164489 UR - https://cancer.jmir.org/2023/1/e44612 UR - http://dx.doi.org/10.2196/44612 UR - http://www.ncbi.nlm.nih.gov/pubmed/37651170 ID - info:doi/10.2196/44612 ER - TY - JOUR AU - Caparso, Cinzia AU - Ozkan, Gwynne AU - Kluge, Maxwell AU - Salim, Humza AU - Khaghany, Aidan AU - Blok, Amanda AU - Choi, Won Sung PY - 2023/8/31 TI - Mobile Technology to Monitor and Support Health and Well-Being: Qualitative Study of Perspectives and Design Suggestions From Patients Undergoing Hematopoietic Cell Transplantation JO - JMIR Form Res SP - e49806 VL - 7 KW - hematopoietic stem cell transplantation KW - bone marrow KW - surgery KW - surgical KW - recovery KW - mobile apps KW - mHealth KW - mobile health KW - app KW - apps KW - qualitative research KW - qualitative KW - experience KW - experiences KW - perception KW - perceptions KW - stem cell KW - stem cells KW - transplant KW - transplantation KW - transplants KW - hematopoietic KW - positive psychology KW - psychology N2 - Background: In the United States, hematopoietic stem cell transplant (HCT) surpasses 22,000 procedures annually. Due to the demanding and time-intensive process of an HCT, patients and family care partners face unique challenges involving their health and well-being. Positive psychology interventions (PPIs) may offer potential solutions to help boost health and well-being. Objective: This study aimed to explore and understand patients? experiences and perceptions about the use of the Roadmap 2.0 app, specifically its PPI features, during the acute phase of HCT. Methods: From an ongoing randomized controlled trial, HCT patients (n=17) were recruited to participate in semistructured qualitative interviews between October 2022 and January 2023 within a large academic medical center in the Midwestern states. Using a qualitative descriptive approach, interviews were conducted in person or via Zoom. The data were analyzed through constant comparative analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed. Results: The majority of the participants reported Roadmap 2.0 as easy to use and enjoyed the ability to track their health data (eg, steps, mood, sleep; 9/17). Regarding the use of PPIs during the acute phase of treatment, 88% of the participants reported interest in participating in PPIs, specifically the Pleasant Activity Scheduling (11/17) followed by Gratitude Journaling (7/17) activities. Additionally, participants provided recommendations on adapting Roadmap 2.0. The major recommendations were (1) ?Working Together: Need for Dyadic Involvement,? (2) ?Connectivity with Other Patients,? and (3) ?Gap in Nutritional Support.? Participants (10/17) expressed the importance of caregiver involvement in activities beyond treatment-related management for maintaining healthy patient-caregiver dyadic relationships. They also expressed their desire for connectivity with other patients undergoing HCT, primarily for comparing experiences and discussing topics such as symptom management (8/17). Lastly, participants identified a gap in nutritional support during the HCT process and expressed interest in an intervention that could promote healthy eating through education and notification reminders (9/17). Conclusions: Participants openly expressed their eagerness to participate in research studies that foster connection and positive relationships with their caregivers as well as with other HCT patients. They emphasized the significance of having access to nutritional support or guidance and highlighted the potential benefits of using mobile technology to enhance these collective efforts. Trial Registration: ClinicalTrials.gov NCT04094844; https://clinicaltrials.gov/study/NCT04094844 International Registered Report Identifier (IRRID): RR2-10.2196/19288 UR - https://formative.jmir.org/2023/1/e49806 UR - http://dx.doi.org/10.2196/49806 UR - http://www.ncbi.nlm.nih.gov/pubmed/37651172 ID - info:doi/10.2196/49806 ER - TY - JOUR AU - Asan, Onur AU - Choi, Euiji AU - Wang, Xiaomei PY - 2023/8/30 TI - Artificial Intelligence?Based Consumer Health Informatics Application: Scoping Review JO - J Med Internet Res SP - e47260 VL - 25 KW - consumer informatics KW - artificial intelligence KW - mobile health KW - mHealth KW - patient outcomes KW - personalized health care KW - machine learning KW - digital health KW - mobile phone N2 - Background: There is no doubt that the recent surge in artificial intelligence (AI) research will change the trajectory of next-generation health care, making it more approachable and accessible to patients. Therefore, it is critical to research patient perceptions and outcomes because this trend will allow patients to be the primary consumers of health technology and decision makers for their own health. Objective: This study aimed to review and analyze papers on AI-based consumer health informatics (CHI) for successful future patient-centered care. Methods: We searched for all peer-reviewed papers in PubMed published in English before July 2022. Research on an AI-based CHI tool or system that reports patient outcomes or perceptions was identified for the scoping review. Results: We identified 20 papers that met our inclusion criteria. The eligible studies were summarized and discussed with respect to the role of the AI-based CHI system, patient outcomes, and patient perceptions. The AI-based CHI systems identified included systems in mobile health (13/20, 65%), robotics (5/20, 25%), and telemedicine (2/20, 10%). All the systems aimed to provide patients with personalized health care. Patient outcomes and perceptions across various clinical disciplines were discussed, demonstrating the potential of an AI-based CHI system to benefit patients. Conclusions: This scoping review showed the trend in AI-based CHI systems and their impact on patient outcomes as well as patients? perceptions of these systems. Future studies should also explore how clinicians and health care professionals perceive these consumer-based systems and integrate them into the overall workflow. UR - https://www.jmir.org/2023/1/e47260 UR - http://dx.doi.org/10.2196/47260 UR - http://www.ncbi.nlm.nih.gov/pubmed/37647122 ID - info:doi/10.2196/47260 ER - TY - JOUR AU - Wang, Y. Angel AU - Vereschagin, Melissa AU - Richardson, G. Chris AU - Xie, Hui AU - Hudec, L. Kristen AU - Munthali, J. Richard AU - Munro, Lonna AU - Leung, Calista AU - Kessler, C. Ronald AU - Vigo, V. Daniel PY - 2023/8/30 TI - Evaluating the Effectiveness of a Codeveloped e-Mental Health Intervention for University Students: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e49364 VL - 12 KW - mental health KW - substance use KW - college students KW - digital interventions KW - randomized controlled trial KW - mobile phone N2 - Background: University life typically occurs during a period of life transition, where the incidence of mental health and substance use problems and disorders peaks. However, relatively few students obtain effective treatment and support. e-Interventions have proven effective in improving the psychological outcomes of university students and have the potential to provide scalable services that can easily integrate into existing models of care. Minder is a mobile app codeveloped with university students that offers users a collection of evidence-based interventions tailored to help university students maintain their mental health and well-being and manage their substance use. Objective: This paper describes the protocol for a randomized controlled trial (RCT) that aims to assess the effectiveness of the Minder app in improving the mental health and substance use outcomes of university students. Methods: This study is a 2-arm, parallel assignment, single-blinded, 30-day RCT with 1 intervention group and 1 waitlist control group. Overall, 1496 (748 per trial arm) university students from the University of British Columbia Vancouver Campus (N=54,000) who are aged ?17 years, have a smartphone with Wi-Fi or cellular data, and speak English will be recruited via a variety of web-based and offline strategies. Participants will be randomized into the intervention or control group after completing a baseline survey. Those randomized into the intervention group will gain immediate access to the Minder app and will be assessed at 2 weeks and 30 days. Those randomized into the control group will be given access to the app content after their follow-up assessment at 30 days. The primary outcomes are measured from baseline to follow-up at 30 days and include changes in general anxiety symptomology, depressive symptomology, and alcohol consumption risk measured by the General Anxiety Disorder 7-Item scale, Patient Health Questionnaire 9-Item scale, and US Alcohol Use Disorders Identification Test-Consumption Scale, respectively. Secondary outcomes include measures related to changes in the frequency of substance use, mental well-being, self-efficacy in managing mental health and substance use, readiness to change, and self-reported use of mental health services and supports (including referral) from baseline to follow-up at 30 days. Results: Trial recruitment and data collection began in September 2022, and the completion of data collection for the trial is anticipated by June 2023. As of May 10, 2023, a total of 1425 participants have been enrolled. Conclusions: The RCT described in this protocol paper will assess whether the Minder app is effective in improving the mental health and substance use outcomes of a general population of Canadian university students. Additional secondary outcome research aims to explore additional outcomes of interest for further research and better understand how to support students? general mental well-being. Trial Registration: ClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601 International Registered Report Identifier (IRRID): DERR1-10.2196/49364 UR - https://www.researchprotocols.org/2023/1/e49364 UR - http://dx.doi.org/10.2196/49364 UR - http://www.ncbi.nlm.nih.gov/pubmed/37647105 ID - info:doi/10.2196/49364 ER - TY - JOUR AU - Pagoto, Sherry AU - Xu, Ran AU - Bullard, Tiffany AU - Foster, D. Gary AU - Bannor, Richard AU - Arcangel, Kaylei AU - DiVito, Joseph AU - Schroeder, Matthew AU - Cardel, I. Michelle PY - 2023/8/29 TI - An Evaluation of a Personalized Multicomponent Commercial Digital Weight Management Program: Single-Arm Behavioral Trial JO - J Med Internet Res SP - e44955 VL - 25 KW - weight loss KW - digital behavioral weight management program KW - single-arm behavioral trial KW - personalized weight loss program KW - ZeroPoint foods KW - weight management KW - digital intervention KW - diet management KW - exercise N2 - Background: Digital behavioral weight loss programs are scalable and effective, and they provide an opportunity to personalize intervention components. However, more research is needed to test the acceptability and efficacy of personalized digital behavioral weight loss interventions. Objective: In a 6-month single-arm trial, we examined weight loss, acceptability, and secondary outcomes of a digital commercial weight loss program (WeightWatchers). This digital program included a personalized weight loss program based on sex, age, height, weight, and personal food preferences, as well as synchronous (eg, virtual workshops and individual weekly check-ins) and asynchronous (eg, mobile app and virtual group) elements. In addition to a personalized daily and weekly PersonalPoints target, the program provided users with personalized lists of ?300 ZeroPoint foods, which are foods that do not need to be weighed, measured, or tracked. Methods: We conducted a pre-post evaluation of this 6-month, digitally delivered, and personalized WeightWatchers weight management program on weight loss at 3 and 6 months in adults with overweight and obesity. The secondary outcomes included participation, satisfaction, fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, self-compassion, well-being, and behavioral automaticity. Results: Of the 153 participants, 107 (69.9%) were female, and 65 (42.5%) identified as being from a minoritized racial or ethnic group. Participants? mean age was 41.09 (SD 13.78) years, and their mean BMI was 31.8 (SD 5.0) kg/m2. Participants had an average weight change of ?4.25% (SD 3.93%) from baseline to 3 months and ?5.05% (SD 5.59%) from baseline to 6 months. At 6 months, the percentages of participants who experienced ?3%, ?5%, and ?10% weight loss were 63.4% (97/153), 51% (78/153), and 14.4% (22/153), respectively. The mean percentage of weeks in which participants engaged in ?1 aspects of the program was 87.53% (SD 23.40%) at 3 months and 77.67% (SD 28.69%) at 6 months. Retention was high (132/153, 86.3%), and more than two-thirds (94/140, 67.1%) of the participants reported that the program helped them lose weight. Significant improvements were observed in fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, and well-being (all P values <.01). Conclusions: This personalized, digital, and scalable behavioral weight management program resulted in clinically significant weight loss in half (78/153, 51%) of the participants as well as improvements in behavioral and psychosocial outcomes. Future research should compare personalized digital weight loss programs with generic programs on weight loss, participation, and acceptability. UR - https://www.jmir.org/2023/1/e44955 UR - http://dx.doi.org/10.2196/44955 UR - http://www.ncbi.nlm.nih.gov/pubmed/37642986 ID - info:doi/10.2196/44955 ER - TY - JOUR AU - Rahmillah, Ilma Fety AU - Tariq, Amina AU - King, Mark AU - Oviedo-Trespalacios, Oscar PY - 2023/8/29 TI - Evaluating the Effectiveness of Apps Designed to Reduce Mobile Phone Use and Prevent Maladaptive Mobile Phone Use: Multimethod Study JO - J Med Internet Res SP - e42541 VL - 25 KW - mobile phone KW - maladaptive mobile phone use KW - apps KW - features KW - problematic phone use N2 - Background: Mobile apps are a popular strategy for reducing mobile phone use and preventing maladaptive mobile phone use (MMPU). Previous research efforts have been made to understand the features of apps that have the potential to reduce mobile phone use and MMPU. However, there has been a lack of a comprehensive examination of the effectiveness of such apps and their features. Objective: This paper investigated existing apps designed to reduce mobile phone use and prevent MMPU and examined the evidence of their effectiveness. The research aimed to provide a comprehensive analysis of app features that can reduce mobile phone use and MMPU, while also assessing their effectiveness. In addition, we explored users? perceptions of these apps and the various features the apps offer to understand potential adoption issues and identify opportunities. Methods: This study used 3 methods: a review of scientific evidence, content analysis, and sentiment analysis. Results: Our study comprehensively examine the common features of 13 apps designed to reduce mobile phone use. We extracted and classified the features into 7 types: self-tracking, social tracking, goal setting, blocking, gamification, simplification, and assessment. The effectiveness of these apps in reducing mobile phone use and MMPU varied from weak to strong. On the basis of content analysis, self-tracking and goal setting were the most frequently used features, whereas gamification and assessment were used the least frequently. The intervention strategies that effectively reduce mobile phone use and MMPU included using grayscale mode, app limit features, and mixed interventions. Overall, users tended to accept these apps, as indicated by sentiment scores ranging from 61 to 86 out of 100. Conclusions: This study demonstrates that app-based management has the potential to reduce mobile phone use and MMPU. However, further research is required to evaluate the effectiveness of app-based interventions. Collaborations among researchers, app developers, mobile phone manufacturers, and policy makers could enhance the process of delivering, evaluating, and optimizing apps aimed at reducing mobile phone use and MMPU. UR - https://www.jmir.org/2023/1/e42541 UR - http://dx.doi.org/10.2196/42541 UR - http://www.ncbi.nlm.nih.gov/pubmed/37643002 ID - info:doi/10.2196/42541 ER - TY - JOUR AU - Paganini, Sarah AU - Meier, Evelyn AU - Terhorst, Yannik AU - Wurst, Ramona AU - Hohberg, Vivien AU - Schultchen, Dana AU - Strahler, Jana AU - Wursthorn, Max AU - Baumeister, Harald AU - Messner, Eva-Maria PY - 2023/8/29 TI - Stress Management Apps: Systematic Search and Multidimensional Assessment of Quality and Characteristics JO - JMIR Mhealth Uhealth SP - e42415 VL - 11 KW - stress management KW - mobile app KW - mHealth KW - mobile health KW - quality assessment KW - review KW - evidence base KW - availability N2 - Background: Chronic stress poses risks for physical and mental well-being. Stress management interventions have been shown to be effective, and stress management apps (SMAs) might help to transfer strategies into everyday life. Objective: This review aims to provide a comprehensive overview of the quality and characteristics of SMAs to give potential users or health professionals a guideline when searching for SMAs in common app stores. Methods: SMAs were identified with a systematic search in the European Google Play Store and Apple App Store. SMAs were screened and checked according to the inclusion criteria. General characteristics and quality were assessed by 2 independent raters using the German Mobile Application Rating Scale (MARS-G). The MARS-G assesses quality (range 1 to 5) on the following four dimensions: (1) engagement, (2) functionality, (3) esthetics, and (4) information. In addition, the theory-based stress management strategies, evidence base, long-term availability, and common characteristics of the 5 top-rated SMAs were assessed and derived. Results: Of 2044 identified apps, 121 SMAs were included. Frequently implemented strategies (also in the 5 top-rated SMAs) were psychoeducation, breathing, and mindfulness, as well as the use of monitoring and reminder functions. Of the 121 SMAs, 111 (91.7%) provided a privacy policy, but only 44 (36.4%) required an active confirmation of informed consent. Data sharing with third parties was disclosed in only 14.0% (17/121) of the SMAs. The average quality of the included apps was above the cutoff score of 3.5 (mean 3.59, SD 0.50). The MARS-G dimensions yielded values above this cutoff score (functionality: mean 4.14, SD 0.47; esthetics: mean 3.76, SD 0.73) and below this score (information: mean 3.42, SD 0.46; engagement: mean 3.05, SD 0.78). Most theory-based stress management strategies were regenerative stress management strategies. The evidence base for 9.1% (11/121) of the SMAs could be identified, indicating significant group differences in several variables (eg, stress or depressive symptoms) in favor of SMAs. Moreover, 38.0% (46/121) of the SMAs were no longer available after a 2-year period. Conclusions: The moderate information quality, scarce evidence base, constraints in data privacy and security features, and high volatility of SMAs pose challenges for users, health professionals, and researchers. However, owing to the scalability of SMAs and the few but promising results regarding their effectiveness, they have a high potential to reach and help a broad audience. For a holistic stress management approach, SMAs could benefit from a broader repertoire of strategies, such as more instrumental and mental stress management strategies. The common characteristics of SMAs with top-rated quality can be used as guidance for potential users and health professionals, but owing to the high volatility of SMAs, enhanced evaluation frameworks are needed. UR - https://mhealth.jmir.org/2023/1/e42415 UR - http://dx.doi.org/10.2196/42415 UR - http://www.ncbi.nlm.nih.gov/pubmed/37642999 ID - info:doi/10.2196/42415 ER - TY - JOUR AU - Prochaska, J. Judith AU - Wang, Yixin AU - Bowdring, A. Molly AU - Chieng, Amy AU - Chaudhary, P. Neha AU - Ramo, E. Danielle PY - 2023/8/28 TI - Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study JO - JMIR Mhealth Uhealth SP - e47183 VL - 11 KW - adolescents KW - mobile app KW - depression KW - anxiety KW - resilience KW - digital intervention KW - digital mental health KW - mobile phone N2 - Background: Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people?s mental health. Objective: This study aimed to describe the BeMe app-based platform to support adolescents? mental health and well-being and to examine app engagement, usability, and satisfaction. Methods: Adolescents in the United States, aged 13 to 20 years, were recruited via the web and enrolled between September 1 and October 31, 2022. App engagement, feature use, clinical functioning, and satisfaction with BeMe were examined for 30 days. BeMe provides content based on cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and positive psychology; interactive activities; live text-based coaching; links to clinical services; and crisis support tools (digital and live). Results: The average age of the sample (N=13,421) was 15.04 (SD 1.7) years, and 56.72% (7612/13,421) identified with she/her pronouns. For the subsample that completed the in-app assessments, the mean scores indicated concern for depression (8-item Patient Health Questionnaire mean 15.68/20, SD 5.9; n=239), anxiety (7-item Generalized Anxiety Disorder Questionnaire mean 13.37/17, SD 5.0; n=791), and poor well-being (World Health Organization?Five Well-being Index mean 30.15/100, SD 16.1; n=1923). Overall, the adolescents engaged with BeMe for an average of 2.38 (SD 2.7) days in 7.94 (SD 24.1) sessions and completed 11.26 (SD 19.8) activities. Most adolescents engaged with BeMe?s content (12,270/13,421, 91.42%), mood ratings (13,094/13,421, 97.56%), and interactive skills (10,098/13,421, 75.24%), and almost one-fifth of the adolescents engaged with coaching (2539/13,421, 18.92%), clinical resources (2411/13,421, 17.96%), and crisis support resources (2499/13,421, 18.62%). Overall app engagement (total activities) was highest among female and gender-neutral adolescents compared with male adolescents (all P<.001) and was highest among younger adolescents (aged 13-14 years) compared with all other ages (all P<.001). Satisfaction ratings were generally high for content (eg, 158/176, 89.8% rated as helpful and 1044/1139, 91.66% improved coping self-efficacy), activities (5362/8468, 63.32% helpful and 4408/6072, 72.6% useful in coping with big feelings), and coaching (747/894, 83.6% helpful and 747/894, 83.6% improved coping self-efficacy). Engagement (total activities completed) predicted the likelihood of app satisfaction (P<.001). Conclusions: Many adolescents downloaded the BeMe app and completed multiple sessions and activities. Engagement with BeMe was higher among female and younger adolescents. Ratings of BeMe?s content, activities, and coaching were very positive for cognitive precursors aimed at reducing depression and anxiety and improving well-being. The findings will inform future app development to promote more sustained engagement, and future evaluations will assess the effects of BeMe on changes in mental health outcomes. UR - https://mhealth.jmir.org/2023/1/e47183 UR - http://dx.doi.org/10.2196/47183 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639293 ID - info:doi/10.2196/47183 ER - TY - JOUR AU - Germain, Anne AU - Wolfson, Megan AU - Pulantara, Wayan I. AU - Wallace, L. Meredith AU - Nugent, Katie AU - Mesias, George AU - Clarke-Walper, Kristina AU - Quartana, J. Phillip AU - Wilk, Joshua PY - 2023/8/28 TI - Prototyping Apps for the Management of Sleep, Fatigue, and Behavioral Health in Austere Far-Forward Environments: Development Study JO - J Med Internet Res SP - e40640 VL - 25 KW - military digital health technology KW - operational environment KW - self-monitoring KW - self-management KW - connectivity protocol KW - evidence-based practice KW - deployment health KW - military KW - army KW - smartphone app KW - mHealth KW - mobile health KW - health app KW - feasibility KW - prototype KW - digital health KW - health technology KW - eHealth KW - decision support KW - medic KW - soldier KW - sleep KW - fatigue KW - behavioral health KW - operational setting KW - mental health KW - mental well-being N2 - Background: Military service inherently includes frequent periods of high-stress training, operational tempo, and sustained deployments to austere far-forward environments. These occupational requirements can contribute to acute and chronic sleep disruption, fatigue, and behavioral health challenges related to acute and chronic stress and disruption of team dynamics. To date, there is no centralized mobile health platform that supports self- and supervised detection, monitoring, and management of sleep and behavioral health issues in garrison and during and after deployments. Objective: The objective of this study was to adapt a clinical decision support platform for use outside clinical settings, in garrison, and during field exercises by medics and soldiers to monitor and manage sleep and behavioral health in operational settings. Methods: To adapt an existing clinical decision support digital health platform, we first gathered system, content, and context-related requirements for a sleep and behavioral health management system from experts. Sleep and behavioral health assessments were then adapted for prospective digital data capture. Evidence-based and operationally relevant educational and interventional modules were formatted for digital delivery. These modules addressed the management and mitigation of sleep, circadian challenges, fatigue, stress responses, and team communication. Connectivity protocols were adapted to accommodate the absence of cellular or Wi-Fi access in deployed settings. The resulting apps were then tested in garrison and during 2 separate field exercises. Results: Based on identified requirements, 2 Android smartphone apps were adapted for self-monitoring and management for soldiers (Soldier app) and team supervision and intervention by medics (Medic app). A total of 246 soldiers, including 28 medics, received training on how to use the apps. Both apps function as expected under conditions of limited connectivity during field exercises. Areas for future technology enhancement were also identified. Conclusions: We demonstrated the feasibility of adapting a clinical decision support platform into Android smartphone?based apps to collect, save, and synthesize sleep and behavioral health data, as well as share data using adaptive data transfer protocols when Wi-Fi or cellular data are unavailable. The AIRE (Autonomous Connectivity Independent System for Remote Environments) prototype offers a novel self-management and supervised tool to augment capabilities for prospective monitoring, detection, and intervention for emerging sleep, fatigue, and behavioral health issues that are common in military and nonmilitary high-tempo occupations (eg, submarines, long-haul flights, space stations, and oil rigs) where medical expertise is limited. UR - https://www.jmir.org/2023/1/e40640 UR - http://dx.doi.org/10.2196/40640 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639304 ID - info:doi/10.2196/40640 ER - TY - JOUR AU - Wyant, Kendra AU - Moshontz, Hannah AU - Ward, B. Stephanie AU - Fronk, E. Gaylen AU - Curtin, J. John PY - 2023/8/28 TI - Acceptability of Personal Sensing Among People With Alcohol Use Disorder: Observational Study JO - JMIR Mhealth Uhealth SP - e41833 VL - 11 KW - personal sensing KW - digital therapeutics KW - mobile health KW - smartphone KW - alcohol use disorder KW - self-report KW - alcohol use KW - symptom monitoring KW - mental health KW - acceptability KW - alcohol intake KW - mobile phone N2 - Background: Personal sensing may improve digital therapeutics for mental health care by facilitating early screening, symptom monitoring, risk prediction, and personalized adaptive interventions. However, further development and the use of personal sensing requires a better understanding of its acceptability to people targeted for these applications. Objective: We aimed to assess the acceptability of active and passive personal sensing methods in a sample of people with moderate to severe alcohol use disorder using both behavioral and self-report measures. This sample was recruited as part of a larger grant-funded project to develop a machine learning algorithm to predict lapses. Methods: Participants (N=154; n=77, 50% female; mean age 41, SD 11.9 years; n=134, 87% White and n=150, 97% non-Hispanic) in early recovery (1-8 weeks of abstinence) were recruited to participate in a 3-month longitudinal study. Participants were modestly compensated for engaging with active (eg, ecological momentary assessment [EMA], audio check-in, and sleep quality) and passive (eg, geolocation, cellular communication logs, and SMS text message content) sensing methods that were selected to tap into constructs from the Relapse Prevention model by Marlatt. We assessed 3 behavioral indicators of acceptability: participants? choices about their participation in the study at various stages in the procedure, their choice to opt in to provide data for each sensing method, and their adherence to a subset of the active methods (EMA and audio check-in). We also assessed 3 self-report measures of acceptability (interference, dislike, and willingness to use for 1 year) for each method. Results: Of the 192 eligible individuals screened, 191 consented to personal sensing. Most of these individuals (169/191, 88.5%) also returned 1 week later to formally enroll, and 154 participated through the first month follow-up visit. All participants in our analysis sample opted in to provide data for EMA, sleep quality, geolocation, and cellular communication logs. Out of 154 participants, 1 (0.6%) did not provide SMS text message content and 3 (1.9%) did not provide any audio check-ins. The average adherence rate for the 4 times daily EMA was .80. The adherence rate for the daily audio check-in was .54. Aggregate participant ratings indicated that all personal sensing methods were significantly more acceptable (all P<.001) compared with neutral across subjective measures of interference, dislike, and willingness to use for 1 year. Participants did not significantly differ in their dislike of active methods compared with passive methods (P=.23). However, participants reported a higher willingness to use passive (vs active) methods for 1 year (P=.04). Conclusions: These results suggest that active and passive sensing methods are acceptable for people with alcohol use disorder over a longer period than has previously been assessed. Important individual differences were observed across people and methods, indicating opportunities for future improvement. UR - https://mhealth.jmir.org/2023/1/e41833 UR - http://dx.doi.org/10.2196/41833 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639300 ID - info:doi/10.2196/41833 ER - TY - JOUR AU - Parkes, Steven AU - Croak, Bethany AU - Brooks, K. Samantha AU - Stevelink, M. Sharon A. AU - Leightley, Daniel AU - Fear, T. Nicola AU - Rafferty, Laura AU - Greenberg, Neil PY - 2023/8/28 TI - Evaluating a Smartphone App (MeT4VeT) to Support the Mental Health of UK Armed Forces Veterans: Feasibility Randomized Controlled Trial JO - JMIR Ment Health SP - e46508 VL - 10 KW - military KW - veteran KW - mental health KW - military to civilian transition KW - digital health KW - mobile apps KW - smartphone KW - mobile phone KW - mobile health KW - mHealth KW - digital intervention KW - support KW - app KW - feasibility KW - acceptability KW - engagement KW - usability N2 - Background: Previous research demonstrates that less than 50% of military veterans experiencing mental health difficulties seek formal support. Veterans often struggle to identify problems as mental health difficulties. In addition, they may fail to recognize the need for support before reaching a crisis point and face difficulties navigating care pathways to access support. Objective: A feasibility trial was conducted to assess a novel digital smartphone app (Mental Health Toolkit for Veterans Project [MeT4VeT]) for UK Armed Forces (UKAF) veterans experiencing mental health difficulties. The trial aimed to explore the feasibility and acceptability of trial procedures for a later randomized controlled trial (RCT) and to assess the acceptability of the MeT4VeT app. Methods: Participants were recruited at UK military medical centers, by advertising on social media, and through veteran third-sector organizations between February and November 2021, and assessed for eligibility (male, owned a smartphone, served at least 2 years in the UKAF, left the UKAF within the last 2 years, not undertaking formal mental health treatment). Eligible participants were assigned, on a 1:1 ratio, to either the intervention group (full app) or a control group (noninteractive app with signposting information). Three key objectives were determined a priori to assess the practicality of running an RCT including an assessment of recruitment and retention, evaluation of the technical app delivery and measurement processes, and acceptability and usability of the intervention. Results: In total, 791 individuals completed the participant information sheet, of which 261 (33%) were ineligible, 377 (48%) declined or were unable to be contacted for consent, and 103 (13%) did not download the app or complete the baseline measures. Of this, 50 participants completed baseline measures and were randomly assigned to the intervention group (n=24) or the control group (n=26). The trial was effective at enabling both the technical delivery of the intervention and collection of outcome measures, with improvements in mental health demonstrated for the intervention group from baseline to the 3-month follow-up. Recruitment and retention challenges were highlighted with only 50 out of the 530 eligible participants enrolled in the trial. The acceptability and usability of the MeT4VeT app were generally supported, and it was reported to be a useful, accessible way for veterans to monitor and manage their mental health. Conclusions: The results highlighted that further work is needed to refine recruitment processes and maintain engagement with the app. Following this, an RCT can be considered to robustly assess the ability of the app to positively affect mental health outcomes indicated within this trial. Trial Registration: ClinicalTrials.gov NCT05993676; https://clinicaltrials.gov/ct2/show/NCT05993676 UR - https://mental.jmir.org/2023/1/e46508 UR - http://dx.doi.org/10.2196/46508 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639295 ID - info:doi/10.2196/46508 ER - TY - JOUR AU - Meinlschmidt, Gunther AU - Grossert, Astrid AU - Meffert, Cornelia AU - Roemmel, Noa AU - Hess, Viviane AU - Rochlitz, Christoph AU - Pless, Miklos AU - Hunziker, Sabina AU - Wössmer, Brigitta AU - Geuter, Ulfried AU - Schaefert, Rainer PY - 2023/8/28 TI - Smartphone-Based Psychotherapeutic Interventions in Blended Care of Cancer Survivors: Nested Randomized Clinical Trial JO - JMIR Cancer SP - e38515 VL - 9 KW - digital therapeutics KW - ecological momentary assessment (EMA) KW - ecological momentary intervention (EMI) KW - internet- and mobile-based intervention KW - microintervention KW - neoplasm KW - smartphone-based intervention KW - postcancer treatment KW - body psychotherapy KW - mobile phone N2 - Background: Cancer is related to not only physical but also mental suffering. Notably, body image disturbances are highly relevant to cancer-related changes often persisting beyond recovery from cancer. Scalable and low-barrier interventions that can be blended with face-to-face psychotherapy for cancer survivors are highly warranted. Objective: The aim of the study is to investigate whether smartphone-based bodily interventions are more effective to improve the mood of patients with cancer than smartphone-based fairy tale interventions (control intervention). Methods: We recruited patients with cancer in 2 Swiss hospitals and conducted daily, fully automated smartphone-based interventions 6 times a week for 5 consecutive weeks, blended with weekly face-to-face group body psychotherapy. We applied 2 types of smartphone-based interventions using a within-subject design, randomly assigning patients daily to either bodily interventions or fairy tales. Each intervention type was presented 3 times a week. For this secondary analysis, 3-level mixed models were estimated with mood assessed by the 3 Multidimensional Mood Questionnaire subscales for good-bad mood, wakefulness, and calmness as key indicators. In addition, the effects on experience of presence, vitality, and burden assessed with visual analog scales were investigated. Results: Based on the data from s=732 interventions performed by 36 participants, good-bad mood improved (?=.27; 95% CI 0.062-0.483), and participants became calmer (?=.98; 95% CI 0.740-1.211) following smartphone-based interventions. Wakefulness did not significantly change from pre- to postsmartphone?based intervention (?=.17; 95% CI ?0.081 to 0.412). This was true for both intervention types. There was no interaction effect of intervention type with change in good-bad mood (?=?.01; 95% CI ?0.439 to 0.417), calmness (?=.22; 95% CI ?0.228 to 0.728), or wakefulness (?=.14; 95% CI ?0.354 to 0.644). Experience of presence (?=.34; 95% CI 0.271-0.417) and vitality (?=.35; 95% CI 0.268-0.426) increased from pre- to postsmartphone?based intervention, while experience of burden decreased (?=?0.40; 95% CI ?0.481 to 0.311). Again, these effects were present for both intervention types. There were no significant interaction effects of intervention type with pre- to postintervention changes in experience of presence (?=.14; 95% CI ?0.104 to 0.384), experience of vitality (?=.06; 95% CI ?0.152 to 0.265), and experience of burden (?=?.16; 95% CI ?0.358 to 0.017). Conclusions: Our results suggest that both smartphone-based audio-guided bodily interventions and fairy tales have the potential to improve the mood of cancer survivors. Trial Registration: ClinicalTrials.gov NCT03707548; https://clinicaltrials.gov/study/NCT03707548 International Registered Report Identifier (IRRID): RR2-10.1186/s40359-019-0357-1 UR - https://cancer.jmir.org/2023/1/e38515 UR - http://dx.doi.org/10.2196/38515 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639296 ID - info:doi/10.2196/38515 ER - TY - JOUR AU - Bisrat, Haileleul AU - Manyazewal, Tsegahun AU - Fekadu, Abebaw PY - 2023/8/28 TI - Mobile Health?Supported Active Syndrome Surveillance for COVID-19 Early Case Finding in Addis Ababa, Ethiopia: Comparative Study JO - Interact J Med Res SP - e43492 VL - 12 KW - mobile health KW - mHealth KW - digital health KW - COVID-19 KW - syndrome assessment KW - surveillance KW - Ethiopia KW - public health KW - syndrome surveillance KW - self-care KW - telemedicine KW - telecom, SARS-CoV-2 N2 - Background: Since most people in low-income countries do not have access to reliable laboratory services, early diagnosis of life-threatening diseases like COVID-19 remains challenging. Facilitating real-time assessment of the health status in a given population, mobile health (mHealth)?supported syndrome surveillance might help identify disease conditions earlier and save lives cost-effectively. Objective: This study aimed to evaluate the potential use of mHealth-supported active syndrome surveillance for COVID-19 early case finding in Addis Ababa, Ethiopia. Methods: A comparative cross-sectional study was conducted among adults randomly selected from the Ethio telecom list of mobile phone numbers. Participants underwent a comprehensive phone interview for COVID-19 syndromic assessments, and their symptoms were scored and interpreted based on national guidelines. Participants who exhibited COVID-19 syndromes were advised to have COVID-19 diagnostic testing at nearby health care facilities and seek treatment accordingly. Participants were asked about their test results, and these were cross-checked against the actual facility-based data. Estimates of COVID-19 detection by mHealth-supported syndromic assessments and facility-based tests were compared using Cohen Kappa (?), the receiver operating characteristic curve, sensitivity, and specificity analysis. Results: A total of 2741 adults (n=1476, 53.8% men and n=1265, 46.2% women) were interviewed through the mHealth platform during the period from December 2021 to February 2022. Among them, 1371 (50%) had COVID-19 symptoms at least once and underwent facility-based COVID-19 diagnostic testing as self-reported, with 884 (64.5%) confirmed cases recorded in facility-based registries. The syndrome assessment model had an optimal likelihood cut-off point sensitivity of 46% (95% CI 38.4-54.6) and specificity of 98% (95% CI 96.7-98.9). The area under the receiver operating characteristic curve was 0.87 (95% CI 0.83-0.91). The level of agreement between the mHealth-supported syndrome assessment and the COVID-19 test results was moderate (?=0.54, 95% CI 0.46-0.60). Conclusions: In this study, the level of agreement between the mHealth-supported syndromic assessment and the actual laboratory-confirmed results for COVID-19 was found to be reasonable, at 89%. The mHealth-supported syndromic assessment of COVID-19 represents a potential alternative method to the standard laboratory-based confirmatory diagnosis, enabling the early detection of COVID-19 cases in hard-to-reach communities, and informing patients about self-care and disease management in a cost-effective manner. These findings can guide future research efforts in developing and integrating digital health into continuous active surveillance of emerging infectious diseases. UR - https://www.i-jmr.org/2023/1/e43492 UR - http://dx.doi.org/10.2196/43492 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556182 ID - info:doi/10.2196/43492 ER - TY - JOUR AU - Wong, Willis AU - Ming, David AU - Pateras, Sara AU - Fee, Holmes Casey AU - Coleman, Cara AU - Docktor, Michael AU - Shah, Nirmish AU - Antonelli, Richard PY - 2023/8/28 TI - Outcomes of End-User Testing of a Care Coordination Mobile App With Families of Children With Special Health Care Needs: Simulation Study JO - JMIR Form Res SP - e43993 VL - 7 KW - mobile health KW - mHealth KW - complex care KW - care coordination KW - digital health tools KW - simulation KW - family-centered design KW - user-centered design KW - participatory design KW - co-design N2 - Background: Care for children with special health care needs relies on a network of providers who work to address the medical, behavioral, developmental, educational, social, and economic needs of the child and their family. Family-directed, manually created visual depictions of care team composition (ie, care mapping) and detailed note-taking curated by caregivers (eg, care binders) have been shown to enhance care coordination for families of these children, but they are difficult to implement in clinical settings owing to a lack of integration with electronic health records and limited visibility of family-generated insights for care providers. Caremap is an electronic health record?integrated digital personal health record mobile app designed to integrate the benefits of care mapping and care binders. Currently, there is sparse literature describing end-user participation in the co-design of digital health tools. In this paper, we describe a project that evaluated the usability and proof of concept of the Caremap app through end-user simulation. Objective: This study aimed to conduct proof-of-concept testing of the Caremap app to coordinate care for children with special health care needs and explore early end-user engagement in simulation testing. The specific aims included engaging end users in app co-design via app simulation, evaluating the usability of the app using validated measures, and exploring user perspectives on how to make further improvements to the app. Methods: Caregivers of children with special health care needs were recruited to participate in a simulation exercise using Caremap to coordinate care for a simulated case of a child with complex medical and behavioral needs. Participants completed a postsimulation questionnaire adapted from 2 validated surveys: the Pediatric Integrated Care Survey (PICS) and the user version of the Mobile Application Rating Scale (uMARS). A key informant interview was also conducted with a liaison to Spanish-speaking families regarding app accessibility for non?English-speaking users. Results: A Caremap simulation was successfully developed in partnership with families of children with special health care needs. Overall, 38 families recruited from 19 different US states participated in the simulation exercise and completed the survey. The average rating for the survey adapted from the PICS was 4.1 (SD 0.82) out of 5, and the average rating for the adapted uMARS survey was 4 (SD 0.83) out of 5. The highest-rated app feature was the ability to track progress toward short-term, patient- and family-defined care goals. Conclusions: Internet-based simulation successfully facilitated end-user engagement and feedback for a digital health care coordination app for families of children with special health care needs. The families who completed simulation with Caremap rated it highly across several domains related to care coordination. The simulation study results elucidated key areas for improvement that translated into actionable next steps in app development. UR - https://formative.jmir.org/2023/1/e43993 UR - http://dx.doi.org/10.2196/43993 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639303 ID - info:doi/10.2196/43993 ER - TY - JOUR AU - Berger, Mitchell PY - 2023/8/25 TI - Digital Health Tools Can Support Patient Access to Culturally and Linguistically Competent Behavioral Health Treatment JO - J Med Internet Res SP - e51799 VL - 25 KW - African American KW - women KW - depression KW - telemedicine KW - mobile health KW - mHealth KW - mobile apps KW - digital health KW - mental health KW - gender minority KW - mobile technology KW - mobile phone UR - https://www.jmir.org/2023/1/e51799 UR - http://dx.doi.org/10.2196/51799 UR - http://www.ncbi.nlm.nih.gov/pubmed/37624636 ID - info:doi/10.2196/51799 ER - TY - JOUR AU - Atik, Ece AU - Stricker, Johannes AU - Schückes, Magnus AU - Pittig, Andre PY - 2023/8/25 TI - Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study JO - JMIR Ment Health SP - e44742 VL - 10 KW - blended cognitive behavioral therapy KW - bCBT KW - digital mental health KW - e?mental health KW - depression KW - anxiety disorder KW - video psychotherapy KW - mobile phone N2 - Background: Blended cognitive behavioral therapy (bCBT)?the combination of cognitive behavioral therapy and digital mental health applications?has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental health care services, for example, as an early intervention before the chronification of symptoms. However, further research on the efficacy and feasibility of integrated bCBT interventions is needed. Objective: This study aimed to evaluate the efficacy of a novel bCBT program comprising short (25 min), weekly face-to-face therapy sessions combined with a smartphone-based digital health app for treating mild to moderate symptoms of depression or anxiety. Methods: This prospective uncontrolled trial comprised 2 measurement points (before and after treatment) and 2 intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. On the basis of the primary symptoms, participants were assigned to either a depression intervention group (n=67 completers) or an anxiety intervention group (n=33 completers). Participants in each group received 6 weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health app. Results: The depression group displayed medium to large improvements in the symptoms of depression (Cohen d=?0.70 to ?0.90; P<.001). The anxiety group experienced significant improvements in the symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder-7 scale with a large effect size (Cohen d=?0.80; P<.001) but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (Cohen d=?0.35; P=.06). In addition, both groups experienced significant improvements in their perceived self-efficacy (Cohen d=0.50; P<.001 in the depression group and Cohen d=0.71; P<.001 in the anxiety group) and quality of life related to psychological health (Cohen d=0.87; P<.001 in the depression group and Cohen d=0.40; P=.03 in the anxiety group). Work and social adjustment of patients improved significantly in the depression group (Cohen d=?0.49; P<.001) but not in the anxiety group (Cohen d=?0.06; P=.72). Patients? mental health literacy improved in the anxiety group (Cohen d=0.45; P=.02) but not in the depression group (Cohen d=0.21; P=.10). Patient satisfaction with the bCBT program and ratings of the usability of the digital app were high in both treatment groups. Conclusions: This study provides preliminary evidence for the feasibility and efficacy of a novel brief bCBT intervention. The intervention effects were generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults. UR - https://mental.jmir.org/2023/1/e44742 UR - http://dx.doi.org/10.2196/44742 UR - http://www.ncbi.nlm.nih.gov/pubmed/37624631 ID - info:doi/10.2196/44742 ER - TY - JOUR AU - Persson, Roland Dan AU - Zhukouskaya, Katiarina AU - Wegener, Karin Anne-Marie AU - Jørgensen, Kølle Lene AU - Bardram, Eyvind Jakob AU - Bækgaard, Per PY - 2023/8/25 TI - Exploring Patient Needs and Designing Concepts for Digitally Supported Health Solutions in Managing Type 2 Diabetes: Cocreation Study JO - JMIR Form Res SP - e49738 VL - 7 KW - cocreation KW - co-creation KW - participatory design KW - diabetes KW - type 2 diabetes mellitus KW - T2DM KW - chronic illness KW - personalized self-care KW - mobile health KW - mHealth KW - eHealth N2 - Background: Self-management of the progressive disease type 2 diabetes mellitus (T2DM) becomes part of the daily life of patients starting from the time of diagnosis. However, despite the availability of technical innovations, the uptake of digital solutions remains low. One reason that has been reported is that digital solutions often focus purely on clinical factors that may not align with the patient?s perspective. Objective: The aim of this study was to develop digital solutions that address the needs of patients with T2DM, designed from the user?s perspective. The goal was to address the patients? expressed real-world needs by having the users themselves choose the scope and format of the solutions. Methods: Using participatory methods, we conducted 3 cocreation workshops in collaboration with the Danish Diabetes Association, with 20 persons with T2DM and 11 stakeholders across workshops: user experience designers, researchers, and diabetes experts including a diabetes nurse. The overall structure of the 3 workshops was aligned with the 4 phases of the double diamond: initially discovering and mapping out key experienced issues, followed by a workshop on thematic mapping and definition of key concepts, and succeeded by an exploration and development of 2 prototypes. Subsequently, high-fidelity interactive prototypes were refined as part of the delivery phase, in which 7 formative usability tests were conducted. Results: The workshops mapped experiential topics over time from prediagnosis to the current state, resulting in a detailed exploration and understanding of 6 themes related to and based on the experiences of patients with T2DM: diabetes care, diabetes knowledge, glucose monitoring, diet, physical activity, and social aspects of diabetes. Two prototypes were developed by the participants to address some of their expressed needs over time related to the 6 themes: an activity-based continuous glucose monitoring app and a web-based guide to diabetes. Both prototypes emphasize periods of structured self-measurements of blood glucose to support evolving needs for self-exploration through distinct phases of learning, active use, and supporting use. Periods of low or intermittent use may thus not reflect a failure of design in a traditional sense but rather be a sign of evolving needs over time. Conclusions: Our results indicate that the needs of patients with T2DM differ between individuals and change over time. As a result, the suggested digitally supported empowering health prototypes can be personalized to support self-exploration, individual preference in long-term management, and changing needs over time. Despite individuals experiencing different journeys with diabetes, users perceive the self-measurement of blood glucose as a universally useful tool to empower everyday decision-making. UR - https://formative.jmir.org/2023/1/e49738 UR - http://dx.doi.org/10.2196/49738 UR - http://www.ncbi.nlm.nih.gov/pubmed/37624633 ID - info:doi/10.2196/49738 ER - TY - JOUR AU - An, Qingfan AU - Kelley, M. Marjorie AU - Hanners, Audra AU - Yen, Po-Yin PY - 2023/8/25 TI - Sustainable Development for Mobile Health Apps Using the Human-Centered Design Process JO - JMIR Form Res SP - e45694 VL - 7 KW - mHealth KW - mobile health KW - apps KW - human-centered design KW - sociotechnical KW - sustainability KW - mobile technology KW - speculative design KW - mobile phone UR - https://formative.jmir.org/2023/1/e45694 UR - http://dx.doi.org/10.2196/45694 UR - http://www.ncbi.nlm.nih.gov/pubmed/37624639 ID - info:doi/10.2196/45694 ER - TY - JOUR AU - Becker, Nozipho AU - Kim, C. Hyunjin AU - Bright, J. Darius AU - Williams III, Robert AU - Anguera, A. Joaquin AU - Arnold, A. Emily AU - Saberi, Parya AU - Neilands, B. Torsten AU - Pollack, M. Lance AU - Tan, Y. Judy PY - 2023/8/25 TI - Acceptability of the LetSync App Wireframes for an mHealth Intervention to Improve HIV Care Engagement and Treatment Among Black Partnered Sexual Minority Men: Findings from In-Depth Qualitative Interviews JO - JMIR Form Res SP - e43676 VL - 7 KW - digital health KW - mobile health KW - mHealth KW - mobile app KW - app KW - Black sexual minority men KW - couples KW - HIV care engagement KW - HIV treatment KW - United States KW - mobile phone N2 - Background: HIV disparities continue to be a significant challenge affecting Black sexual minority men in the United States. Inadequate engagement and retention of patients in HIV care has been associated with poor health outcomes. Interventions to improve sustained commitment to HIV care are needed. Mobile health interventions can help facilitate access to and use of HIV health services, particularly among individuals at risk for disengaging with care. Objective: We designed the LetSync app wireframes for a mobile health intervention using a couple-centered design approach to improve HIV engagement and treatment among Black sexual minority men and their partners. The objective of this study was to gauge future app user interest and elicit feedback to improve the design, development, and usability of the LetSync app. Methods: We conducted in-depth interviews with 24 Black sexual minority men to assess the acceptability of the LetSync app wireframes between May 2020 and January 2021. Participants reviewed the LetSync app wireframes and provided feedback regarding perceived usefulness and interest in future app use and suggestions for improvement. Results: Participants indicated interest in the future LetSync app and noted that the wireframes? features were acceptable and usable. In our study, the future LetSync app was frequently referred to as a potential resource that could help facilitate users? engagement in HIV care through the following mechanisms: enable scheduling of appointments and timely reminders for clinic visits; help improve HIV medication adherence; encourage and motivate participants to ask questions to their health care provider and stay engaged in conversations during clinic visits; facilitate effective communication by assisting couples with planning, coordination, and management of daily routines; help participants understand their partner?s health needs, including access to and use of health care services; and facilitate participants? ability to improve their relationship skills, partner support, and self-efficacy in managing conflict. In addition to near-universal interest in potential daily app use, study participants indicted that they would recommend the LetSync app to other family members, friends, and people in their social networks who are living with HIV. Conclusions: Our findings revealed considerable interest in future app use for HIV care management, which could possibly increase the chance of the LetSync app being successfully adopted by Black sexual minority men in couples. Owing to its interactive and couple-centered approach, the LetSync app could help improve communication between Black sexual minority men and their partners and health providers. In addition, the LetSync app could provide an acceptable modality for these men to receive support in accessing HIV care services. UR - https://formative.jmir.org/2023/1/e43676 UR - http://dx.doi.org/10.2196/43676 UR - http://www.ncbi.nlm.nih.gov/pubmed/37624634 ID - info:doi/10.2196/43676 ER - TY - JOUR AU - Hu, Yuanjia AU - Lu, Yang AU - Tian, Chenghua AU - He, Yunfan AU - Rong, Kaiyi AU - Pan, Sijia AU - Lei, Jianbo PY - 2023/8/24 TI - Current Status and Trends in mHealth-Based Research for Treatment and Intervention in Tinnitus: Bibliometric and Comparative Product Analysis JO - JMIR Mhealth Uhealth SP - e47553 VL - 11 KW - tinnitus KW - mobile health KW - mHealth KW - internet KW - application KW - software KW - bibliometrics KW - mobile phone N2 - Background: As a global medical problem, tinnitus can seriously harm human health and is difficult to alleviate, ranking among the top 3 complex diseases in the otolaryngology field. Traditional cognitive behavioral therapy and sound therapy require offline face-to-face treatment with medical staff and have limited effectiveness. Mobile health (mHealth), which, in recent decades, has been greatly applied in the field of rehabilitation health care, improving access to health care resources and the quality of services, has potential research value in the adjunctive treatment of tinnitus. Objective: This study aimed to understand the research trends, product characteristics, problems, and research transformation of tinnitus treatment software by analyzing the research progress of mHealth for tinnitus treatment based on the literature and related marketed apps. Methods: Bibliometric methods were used to describe the characteristics of the relevant literature in terms of the number and topics of publications, authors, and institutions. We further compared the features and limitations of the currently available tinnitus treatment software. Results: Data published until February 28, 2022, were collected. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standardized screening process, 75 papers were included. The country with the highest number of publications was Germany, followed by the United Kingdom and the United States, whereas China had only a single relevant study. The most frequently found journals were the American Journal of Audiology and the Journal of the American Academy of Audiology (18/75, 24%). With regard to publication topics, cognitive behavioral therapy started to become a hot topic in 2017, and research on mHealth apps has increased. In this study, 28 tinnitus treatment apps were obtained (n=24, 86% from product data and n=4, 14% from literature data); these apps were developed mainly in the United States (10/28, 36%) or China (9/28, 32%). The main treatment methods were sound therapy (10/28, 36%) and cognitive behavioral therapy (2/28, 7%). Of the 75 publications, 7 (9%) described apps in the market stage. Of the 28 apps, 22 (79%) lacked literature studies or evidence from professional bodies. Conclusions: We found that, as a whole, the use of mHealth for treatment and intervention in tinnitus was showing a rapid development, in which good progress had been made in studies around sound therapy and cognitive behavioral therapy, although most of the studies (50/75, 67%) focused on treatment effects. However, the field is poorly accepted in top medical journals, and the majority are in the research design phase, with a lack of translation of the literature results and clinical validation of the marketed apps. Furthermore, in the future, novel artificial intelligence techniques should be used to address the issue of staged monitoring of tinnitus. UR - https://mhealth.jmir.org/2023/1/e47553 UR - http://dx.doi.org/10.2196/47553 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616044 ID - info:doi/10.2196/47553 ER - TY - JOUR AU - Gautam, Kamal AU - Paudel, Kiran AU - Jacobs, Jerome AU - Wickersham, A. Jeffrey AU - Ikhtiaruddin, Mohd Wan AU - Azwa, Iskandar AU - Saifi, Rumana AU - Lim, How Sin AU - Shrestha, Roman PY - 2023/8/24 TI - An mHealth-Delivered Sexual Harm Reduction Tool (PartyPack) for Men Who Have Sex With Men in Malaysia: Usability Study JO - JMIR Form Res SP - e48113 VL - 7 KW - chemsex KW - party and play KW - sexualized drug use KW - PartyPack KW - harm reduction tool KW - men who have sex with men KW - Malaysia KW - health promotion KW - sexual health KW - mHealth intervention KW - HIV prevention N2 - Background: Chemsex?the use of psychoactive drugs to enhance the sexual experience?is an increasing phenomenon globally. Despite the increasing burden and associated harms of chemsex, evidence-based interventions (ie, behavioral and pharmacological) for chemsex users are nonexistent. Objective: In this study, we assessed the usability and acceptability of a mobile health (mHealth)?delivered safer chemsex package (?PartyPack?) as a sexual harm reduction strategy among men who have sex with men in Malaysia?a setting where chemsex is becoming increasingly prevalent. Methods: This study is part of a larger smartphone app-based intervention (ie, JomPrEP; University of Connecticut) designed to improve access to HIV prevention services among Malaysian men who have sex with men. A total of 50 participants were recruited from the Greater Kuala Lumpur region of Malaysia to use the JomPrEP app, which included a feature allowing participants to order PartyPack, for 30 days (March-April 2022). The usability and acceptability of the PartyPack were assessed using self-report, app analytics, and exit interviews (n=20). Results: Overall, 8% (4/50) of participants reported having engaged in chemsex in the past 6 months; however, engagement in condomless sex (34/50, 68%) and group sex (9/50, 18%) was much higher. A total of 43 (86%) participants ordered PartyPack, of which 27 (63%) made multiple orders during the 30 days. Most participants (41/43, 95%) reported being satisfied with the PartyPack order feature in the app, with 91% (39/43) indicating the order and tracking process was easy. Thematic data exploration further revealed important information for understanding (eg, items included in the package, use of mHealth platform to order package, and discreetness of the PartyPack box and order and delivery) and refining the logistical preferences (eg, using branded items and allowing customization during order). Conclusions: Our findings provide strong evidence of the usability and acceptability of a mHealth-delivered safer chemsex package as a potential sexual harm reduction tool among this underserved population. Replication in a study with a larger sample size to test the efficacy of the PartyPack is warranted. UR - https://formative.jmir.org/2023/1/e48113 UR - http://dx.doi.org/10.2196/48113 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616034 ID - info:doi/10.2196/48113 ER - TY - JOUR AU - Kreibig, D. Sylvia AU - ten Brink, Maia AU - Mehta, Ashish AU - Talmon, Anat AU - Zhang, Jin-Xiao AU - Brown, S. Alan AU - Lucas-Griffin, S. Sawyer AU - Axelrod, K. Ariel AU - Manber, Rachel AU - Lavigne, J. Gilles AU - Gross, J. James PY - 2023/8/24 TI - The Role of Emotion Regulation, Affect, and Sleep in Individuals With Sleep Bruxism and Those Without: Protocol for a Remote Longitudinal Observational Study JO - JMIR Res Protoc SP - e41719 VL - 12 KW - sleep bruxism KW - emotion regulation KW - ecological momentary assessment KW - rhythmic masticatory muscle activity KW - heart rate variability KW - wrist actigraphy N2 - Background: Sleep bruxism (SB) is an oral behavior characterized by high levels of repetitive jaw muscle activity during sleep, leading to teeth grinding and clenching, and may develop into a disorder. Despite its prevalence and negative outcomes on oral health and quality of life, there is currently no cure for SB. The etiology of SB remains poorly understood, but recent research suggests a potential role of negative emotions and maladaptive emotion regulation (ER). Objective: This study?s primary aim investigates whether ER is impaired in individuals with SB, while controlling for affective and sleep disturbances. The secondary aim tests for the presence of cross-sectional and longitudinal mediation pathways in the bidirectional relationships among SB, ER, affect, and sleep. Methods: The study used a nonrandomized repeated-measures observational design and was conducted remotely. Participants aged 18-49 years underwent a 14-day ambulatory assessment. Data collection was carried out using electronic platforms. We assessed trait and state SB and ER alongside affect and sleep variables. We measured SB using self-reported trait questionnaires, ecological momentary assessment (EMA) for real-time reports of SB behavior, and portable electromyography for multinight assessment of rhythmic masticatory muscle activity. We assessed ER through self-reported trait questionnaires, EMA for real-time reports of ER strategies, and heart rate variability derived from an electrocardiography wireless physiological sensor as an objective physiological measure. Participants? trait affect and real-time emotional experiences were obtained using self-reported trait questionnaires and EMA. Sleep patterns and quality were evaluated using self-reported trait questionnaires and sleep diaries, as well as actigraphy as a physiological measure. For the primary objective, analyses will test for maladaptive ER in terms of strategy use frequency and effectiveness as a function of SB using targeted contrasts in the general linear model. Control analyses will be conducted to examine the persistence of the SB-ER relationship after adjusting for affective and sleep measures, as well as demographic variables. For the secondary objective, cross-sectional and longitudinal mediation analyses will test various competing models of directional effects among self-reported and physiological measures of SB, ER, affect, and sleep. Results: This research received funding in April 2017. Data collection took place from August 2020 to March 2022. In all, 237 participants were eligible and completed the study. Data analysis has not yet started. Conclusions: We hope that the effort to thoroughly measure SB and ER using gold standard methods and cutting-edge technology will advance the knowledge of SB. The findings of this study may contribute to a better understanding of the relationship among SB, ER, affect, and sleep disturbances. By identifying the role of ER in SB, the results may pave the way for the development of targeted interventions for SB management to alleviate the pain and distress of those affected. International Registered Report Identifier (IRRID): DERR1-10.2196/41719 UR - https://www.researchprotocols.org/2023/1/e41719 UR - http://dx.doi.org/10.2196/41719 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616042 ID - info:doi/10.2196/41719 ER - TY - JOUR AU - Litke, Grace Shannon AU - Resnikoff, Annie AU - Anil, Ashley AU - Montgomery, Meredith AU - Matta, Rishabh AU - Huh-Yoo, Jina AU - Daly, P. Brian PY - 2023/8/23 TI - Mobile Technologies for Supporting Mental Health in Youths: Scoping Review of Effectiveness, Limitations, and Inclusivity JO - JMIR Ment Health SP - e46949 VL - 10 KW - mHealth KW - mobile app KW - children KW - adolescents KW - mental health KW - effectiveness KW - efficacy KW - scoping review KW - mobile phone N2 - Background: Over the past decade, there has been growing support for the use of mobile health (mHealth) technologies to improve the availability of mental health interventions. While mHealth is a promising tool for improving access to interventions, research on the effectiveness and efficacy of mHealth apps for youths is limited, particularly for underrepresented populations, including youths of color and economically marginalized youths. Objective: This scoping review study sought to evaluate the following research questions: (1) What is the extent of the current literature on mHealth apps that provide intervention for mental health problems in children and adolescents? (2) What is known from the existing literature about the effectiveness or efficacy of delivering mental health services via mHealth apps? (3) What are the gaps in the knowledge base in the fields of technology and mental health? (4) Do the reviewed mHealth apps address issues of cultural sensitivity or have they been tested with underrepresented groups (ie, youths of color or economically marginalized groups)? Methods: An electronic database search was conducted using relevant search terms. Seven independent reviewers screened identified studies, including title and abstract review to determine if studies met the following inclusion criteria: (1) targeted samples with mental health symptomology or disorders, (2) studied youth participants aged 6-17 years, and (3) examined the use of a mobile app?based platform for intervention. Relevant studies were subjected to full-text review to extract and chart relevant data based on a priori research questions. Results: The initial database search yielded 304 papers published from 2010 to 2021. After screening and selection, the final review included 10 papers on the effectiveness and efficacy of mental health intervention apps for youths aged 8 to 17 years. Identified apps targeted a broad range of mental health challenges in youths (ie, depression, self-harm, autism spectrum disorder, anxiety, and obsessive-compulsive disorder). Results identified only a small number of studies suggesting that current effectiveness and efficacy research in this area are limited. While some studies provided general support for the effectiveness of mHealth apps in improving mental health outcomes in youths, several notable limitations were present across the literature, reducing the generalizability of findings. Additionally, considerations around racial, ethnic, and socioeconomic diversity were scarce across studies. Conclusions: Although some studies cited in this scoping review provide support for the effectiveness and efficacy of mHealth apps targeting mental health concerns in youths, the overall body of literature remains quite limited. Moreover, mHealth apps expressly developed to be culturally responsive are almost nonexistent. Further efforts are needed to recruit youths who are typically underrepresented in research and invite stakeholder participation and collaborative input in the early stages of the mHealth app development process. UR - https://mental.jmir.org/2023/1/e46949 UR - http://dx.doi.org/10.2196/46949 UR - http://www.ncbi.nlm.nih.gov/pubmed/37610818 ID - info:doi/10.2196/46949 ER - TY - JOUR AU - Frisby, Caitlin AU - Eikelboom, H. Robert AU - Mahomed-Asmail, Faheema AU - Kuper, Hannah AU - Moore, R. David AU - de Kock, Tersia AU - Manchaiah, Vinaya AU - Swanepoel, Wet De PY - 2023/8/23 TI - Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study JO - JMIR Form Res SP - e46043 VL - 7 KW - community-based rehabilitation KW - community health care worker KW - text message KW - messaging KW - motivational KW - reminder KW - acclimatization KW - technology use KW - hearing aid acclimatization KW - hearing aid KW - hearing loss KW - low- and middle-income countries KW - LMIC KW - low income KW - developing country KW - low resource KW - hearing KW - audiology KW - mobile health KW - mHealth KW - health care workers KW - usability N2 - Background: The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. Objective: This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. Methods: An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. Results: A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. Conclusions: An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care. UR - https://formative.jmir.org/2023/1/e46043 UR - http://dx.doi.org/10.2196/46043 UR - http://www.ncbi.nlm.nih.gov/pubmed/37610802 ID - info:doi/10.2196/46043 ER - TY - JOUR AU - LaMonica, M. Haley AU - Crouse, J. Jacob AU - Song, C. Yun J. AU - Alam, Mafruha AU - Wilson, E. Chloe AU - Hindmarsh, Gabrielle AU - Yoon, Adam AU - Boulton, A. Kelsie AU - Ekambareshwar, Mahalakshmi AU - Loblay, Victoria AU - Troy, Jakelin AU - Torwali, Mujahid AU - Guastella, J. Adam AU - Banati, B. Richard AU - Hickie, B. Ian PY - 2023/8/23 TI - Developing Culturally Appropriate Content for a Child-Rearing App to Support Young Children?s Socioemotional and Cognitive Development in Afghanistan: Co-Design Study JO - JMIR Form Res SP - e44267 VL - 7 KW - child development KW - digital technology KW - global health KW - co-design KW - participatory research KW - stakeholder participation KW - mobile app KW - smartphone KW - mobile phone KW - Afghanistan N2 - Background: Optimal child-rearing practices can help mitigate the consequences of detrimental social determinants of health in early childhood. Given the ubiquity of personal digital technologies worldwide, the direct delivery of evidence-based information about early childhood development holds great promise. However, to make the content of these novel systems effective, it is crucial to incorporate place-based cultural beliefs, traditions, circumstances, and value systems of end users. Objective: This paper describes the iterative approach used to develop the Thrive by Five child-rearing app in collaboration with Afghan parents, caregivers (eg, grandparents, aunts, and nannies), and subject matter experts (SMEs). We outline how co-design methodologies informed the development and cultural contextualization of content to meet the specific needs of Afghan parents and the content was tested and refined in collaboration with key Afghan stakeholders. Methods: The preliminary content was developed based on a comprehensive literature review of the historical and sociocultural contexts in Afghanistan, including factors that influence child-rearing practices and early childhood development. After an initial review and refinement based on feedback from SMEs, this content was populated into a beta app for testing. Overall, 8 co-design workshops were conducted in July and August 2021 and February 2022 with 39 Afghan parents and caregivers and 6 SMEs to collect their feedback on the app and its content. The workshops were audio recorded and transcribed; detailed field notes were taken by 2 scribes. A theoretical thematic analysis using semantic codes was conducted to inform the refinement of existing content and development of new content to fulfill the needs identified by participants. Results: The following 4 primary themes were identified: child-rearing in the Afghan sociocultural context, safety concerns, emotion and behavior management, and physical health and nutrition. Overall, participants agreed that the app had the potential to deliver valuable information to Afghan parents; however, owing to the volatility in the country, participants recommended including more activities that could be safely done indoors, as mothers and children are required to spend most of their time at home. Additionally, restrictions on public engagement in music required the removal of activities referencing singing that might be performed outside the home. Further, activities to help parents reduce their children?s screen time, promote empathy, manage emotions, regulate behavior, and improve physical health and nutrition were requested. Conclusions: Direct engagement with Afghan parents, caregivers, and SMEs through co-design workshops enabled the development and refinement of evidence-based, localized, and contextually relevant child-rearing activities promoting healthy social, emotional, and cognitive development during the first 5 years of children?s lives. Importantly, the content was adapted for the ongoing conflict in Afghanistan with the aim of empowering Afghan parents and caregivers to support their children?s developmental potential despite the security concerns and situational stressors. UR - https://formative.jmir.org/2023/1/e44267 UR - http://dx.doi.org/10.2196/44267 UR - http://www.ncbi.nlm.nih.gov/pubmed/37610805 ID - info:doi/10.2196/44267 ER - TY - JOUR AU - Kouri, Andrew AU - Gupta, Samir AU - Straus, E. Sharon AU - Sale, M. Joanna E. PY - 2023/8/22 TI - Exploring the Perspectives and Experiences of Older Adults With Asthma and Chronic Obstructive Pulmonary Disease Toward Mobile Health: Qualitative Study JO - J Med Internet Res SP - e45955 VL - 25 KW - older adults KW - mHealth KW - asthma KW - chronic obstructive pulmonary disease KW - qualitative research KW - digital health KW - qualitative study KW - airway disease KW - barrier KW - health technology KW - interview KW - smartphone KW - airway KW - implementation KW - mobile phone N2 - Background: The use of mobile health (mHealth) in asthma and chronic obstructive pulmonary disease (COPD) is growing, and as the population ages, a greater number of older adults stand to benefit from mHealth-enhanced airway disease care. Though older adults are a heterogeneous population of health technology users, older age represents a potential barrier to health technology adoption, and there is currently a lack of knowledge on how older age influences mHealth use in asthma and COPD. Objective: In this qualitative study, we sought to explore the experiences and perspectives of adults who were aged 65 years and older with asthma and COPD toward mHealth use. Methods: Semistructured individual interviews were conducted with adults who were aged 65 years and older with asthma or COPD and owned a smartphone. Applying phenomenological methodology, we analyzed interview transcripts in order to develop themes and propose an essential experience of mHealth use among older adults with airway disease. We then summarized our qualitative findings and proposed strategies to leverage our results in order to guide future research and implementation efforts targeting older adults? use of airway mHealth. Results: Twenty participants (mean age 79.8, SD 4.4 years) were interviewed. Participants described a central tension between (1) the perception that mHealth could help maintain independence throughout aging and (2) an apprehension toward the ways in which mHealth could negatively affect established health care experiences. Several elements of these 2 themes are absent from previous research focusing on younger adults with asthma and COPD. The individual elements of these 2 themes informed potential strategies to optimize future older adults? use of asthma and COPD mHealth tools. Conclusions: Focusing on the perspectives and experiences of older adults with asthma and COPD in their use of mHealth identified novel understandings of health technology use in this important demographic in need of greater care. These lessons were translated into potential strategies that will need to be objectively evaluated in future airway mHealth research, development, and implementation efforts. UR - https://www.jmir.org/2023/1/e45955 UR - http://dx.doi.org/10.2196/45955 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606961 ID - info:doi/10.2196/45955 ER - TY - JOUR AU - Yang, Fan Ellie AU - Kornfield, Rachel AU - Liu, Yan AU - Chih, Ming-Yuan AU - Sarma, Prathusha AU - Gustafson, David AU - Curtin, John AU - Shah, Dhavan PY - 2023/8/22 TI - Using Machine Learning of Online Expression to Explain Recovery Trajectories: Content Analytic Approach to Studying a Substance Use Disorder Forum JO - J Med Internet Res SP - e45589 VL - 25 KW - supervised machine learning KW - online peer support forum KW - expression effects KW - content analysis KW - substance use disorder KW - mobile phone N2 - Background: Smartphone-based apps are increasingly used to prevent relapse among those with substance use disorders (SUDs). These systems collect a wealth of data from participants, including the content of messages exchanged in peer-to-peer support forums. How individuals self-disclose and exchange social support in these forums may provide insight into their recovery course, but a manual review of a large corpus of text by human coders is inefficient. Objective: The study sought to evaluate the feasibility of applying supervised machine learning (ML) to perform large-scale content analysis of an online peer-to-peer discussion forum. Machine-coded data were also used to understand how communication styles relate to writers? substance use and well-being outcomes. Methods: Data were collected from a smartphone app that connects patients with SUDs to online peer support via a discussion forum. Overall, 268 adult patients with SUD diagnoses were recruited from 3 federally qualified health centers in the United States beginning in 2014. Two waves of survey data were collected to measure demographic characteristics and study outcomes: at baseline (before accessing the app) and after 6 months of using the app. Messages were downloaded from the peer-to-peer forum and subjected to manual content analysis. These data were used to train supervised ML algorithms using features extracted from the Linguistic Inquiry and Word Count (LIWC) system to automatically identify the types of expression relevant to peer-to-peer support. Regression analyses examined how each expression type was associated with recovery outcomes. Results: Our manual content analysis identified 7 expression types relevant to the recovery process (emotional support, informational support, negative affect, change talk, insightful disclosure, gratitude, and universality disclosure). Over 6 months of app use, 86.2% (231/268) of participants posted on the app?s support forum. Of these participants, 93.5% (216/231) posted at least 1 message in the content categories of interest, generating 10,503 messages. Supervised ML algorithms were trained on the hand-coded data, achieving F1-scores ranging from 0.57 to 0.85. Regression analyses revealed that a greater proportion of the messages giving emotional support to peers was related to reduced substance use. For self-disclosure, a greater proportion of the messages expressing universality was related to improved quality of life, whereas a greater proportion of the negative affect expressions was negatively related to quality of life and mood. Conclusions: This study highlights a method of natural language processing with potential to provide real-time insights into peer-to-peer communication dynamics. First, we found that our ML approach allowed for large-scale content coding while retaining moderate-to-high levels of accuracy. Second, individuals? expression styles were associated with recovery outcomes. The expression types of emotional support, universality disclosure, and negative affect were significantly related to recovery outcomes, and attending to these dynamics may be important for appropriate intervention. UR - https://www.jmir.org/2023/1/e45589 UR - http://dx.doi.org/10.2196/45589 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606984 ID - info:doi/10.2196/45589 ER - TY - JOUR AU - Park, Sulki AU - Kum, Hye-Chung AU - Zheng, Qi AU - Lawley, A. Mark PY - 2023/8/22 TI - Real-World Adherence and Effectiveness of Remote Patient Monitoring Among Medicaid Patients With Diabetes: Retrospective Cohort Study JO - J Med Internet Res SP - e45033 VL - 25 KW - remote patient monitoring KW - telemonitoring KW - SMBG KW - telemedicine KW - Medicaid KW - blood glucose KW - diabetes KW - effectiveness KW - chronic condition KW - transmission rate KW - retrospective study N2 - Background: The prevalence of diabetes in the United States is high and increasing, and it is also the most expensive chronic condition in the United States. Self-monitoring of blood glucose or continuous glucose monitoring are potential solutions, but there are barriers to their use. Remote patient monitoring (RPM) with appropriate support has the potential to provide solutions. Objective: We aim to investigate the adherence of Medicaid patients with diabetes to daily RPM protocols, the relationship between adherence and changes in blood glucose levels, and the impact of daily testing time on blood glucose changes. Methods: This retrospective cohort study analyzed real-world data from an RPM company that provides services to Texas Medicaid patients with diabetes. Overall, 180 days of blood glucose data from an RPM company were collected to assess transmission rates and blood glucose changes, after the first 30 days of data were excluded due to startup effects. Patients were separated into adherent and nonadherent cohorts, where adherent patients transmitted data on at least 120 of the 150 days. z tests and t tests were performed to compare transmission rates and blood glucose changes between 2 cohorts. In addition, we analyzed blood glucose changes based on their testing time?between 1 AM and 10 AM, 10 AM and 6 PM, and 6 PM and 1 AM. Results: Mean patient age was 70.5 (SD 11.8) years, with 66.8% (n=255) of them being female, 91.9% (n=351) urban, and 89% (n=340) from south Texas (n=382). The adherent cohort (n=186, 48.7%) had a mean transmission rate of 82.8% before the adherence call and 91.1% after. The nonadherent cohort (n=196, 51.3%) had a mean transmission rate of 45.9% before and 60.2% after. The mean blood glucose levels of the adherent cohort decreased by an average of 9 mg/dL (P=.002) over 5 months. We also found that variability of blood glucose level of the adherent cohort improved 3 mg/dL (P=.03) over the 5-month period. Both cohorts had the majority of their transmissions between 1 AM and 10 AM, with 70.5% and 53.2% for the adherent and nonadherent cohorts, respectively. The adherent cohort had decreasing mean blood glucose levels over 5 months, with the largest decrease during the 6 PM to 1 AM time period (30.9 mg/dL). Variability of blood glucose improved only for those tested from 10 AM to 6 PM, with improvements of 6.9 mg/dL (P=.02). Those in the nonadherent cohort did not report significant changes. Conclusions: RPM can help manage diabetes in Medicaid clients by improving adherence rates and glycemic control. Adherence calls helped improve adherence rates, but some patients still faced challenges in transmitting blood glucose levels. Nonetheless, RPM has the potential to reduce the risk of adverse outcomes associated with diabetes. UR - https://www.jmir.org/2023/1/e45033 UR - http://dx.doi.org/10.2196/45033 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606977 ID - info:doi/10.2196/45033 ER - TY - JOUR AU - Haramati, Sharon AU - Firsow, Anastasia AU - Navarro, Abigail Daniela AU - Shechter, Ravid PY - 2023/8/22 TI - Novel At-Home Mother?s Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment JO - JMIR Pediatr Parent SP - e43837 VL - 6 KW - breastfeeding KW - feasibility KW - human milk KW - biomarker KW - remote sensing technology KW - mobile health KW - retrospective KW - secretory activation KW - lactogenesis KW - milk supply KW - milk KW - sensing technology KW - monitoring tool KW - lactation KW - exclusive breastfeeding KW - breastfeed KW - maternal health KW - maternal and infant health KW - infant health KW - maternal and child health KW - prolactin KW - lactation consultant KW - lactation support provider KW - mother KW - milk maturation N2 - Background: Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. Objective: The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. Methods: System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth?dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. Results: Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system?s results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth?dependent progress in individual mothers. Conclusions: This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals. UR - https://pediatrics.jmir.org/2023/1/e43837 UR - http://dx.doi.org/10.2196/43837 UR - http://www.ncbi.nlm.nih.gov/pubmed/37464893 ID - info:doi/10.2196/43837 ER - TY - JOUR AU - Krafft, Jelena AU - Barisch-Fritz, Bettina AU - Krell-Roesch, Janina AU - Trautwein, Sandra AU - Scharpf, Andrea AU - Woll, Alexander PY - 2023/8/22 TI - A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study JO - JMIR Aging SP - e46480 VL - 6 KW - dementia KW - individualized physical exercise KW - tailored exercise KW - physical activity KW - older adults KW - app KW - mobile health KW - mHealth KW - usability KW - mobile phone N2 - Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as ?good.? The main usability issues concerned navigation logic and comprehensibility of app content. Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ?50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study. UR - https://aging.jmir.org/2023/1/e46480 UR - http://dx.doi.org/10.2196/46480 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606974 ID - info:doi/10.2196/46480 ER - TY - JOUR AU - Park, Sangil AU - Woo, Geol Ho AU - Kim, Soeun AU - Kim, Sunyoung AU - Lim, Hyunjung AU - Yon, Keon Dong AU - Rhee, Youl Sang PY - 2023/8/21 TI - Real-World Evidence of a Hospital-Linked Digital Health App for the Control of Hypertension and Diabetes Mellitus in South Korea: Nationwide Multicenter Study JO - JMIR Form Res SP - e48332 VL - 7 KW - hypertension KW - blood pressure KW - diabetes KW - glucose KW - digital health technology KW - effectiveness KW - application KW - blood glucose KW - systolic KW - diastolic KW - management KW - consumer KW - cost KW - monitoring N2 - Background: Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence. Objective: We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus. Methods: Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks. Results: A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (?5.4 mm Hg, 95% CI ?7.0 to ?3.9) and DBP (?2.4 mm Hg, 95% CI ?3.4 to ?1.4) in participants without hypertension and FBG level in all participants (those without diabetes, ?4.4 mg/dL, 95% CI ?7.9 to ?1.0 and those with diabetes, ?3.2 mg/dL, 95% CI ?5.4 to ?1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (?10.9 mg/dL, 95% CI ?31.1 to ?5.3) compared to those using only a digital health app (P=.006). Conclusions: Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring. UR - https://formative.jmir.org/2023/1/e48332 UR - http://dx.doi.org/10.2196/48332 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603401 ID - info:doi/10.2196/48332 ER - TY - JOUR AU - Liu, Jen-Hsuan AU - Shih, Chih-Yuan AU - Huang, Hsien-Liang AU - Peng, Jen-Kuei AU - Cheng, Shao-Yi AU - Tsai, Jaw-Shiun AU - Lai, Feipei PY - 2023/8/18 TI - Evaluating the Potential of Machine Learning and Wearable Devices in End-of-Life Care in Predicting 7-Day Death Events Among Patients With Terminal Cancer: Cohort Study JO - J Med Internet Res SP - e47366 VL - 25 KW - artificial intelligence KW - end-of-life care KW - machine learning KW - palliative care KW - survival prediction KW - terminal cancer KW - wearable device N2 - Background: An accurate prediction of mortality in end-of-life care is crucial but presents challenges. Existing prognostic tools demonstrate moderate performance in predicting survival across various time frames, primarily in in-hospital settings and single-time evaluations. However, these tools may fail to capture the individualized and diverse trajectories of patients. Limited evidence exists regarding the use of artificial intelligence (AI) and wearable devices, specifically among patients with cancer at the end of life. Objective: This study aimed to investigate the potential of using wearable devices and AI to predict death events among patients with cancer at the end of life. Our hypothesis was that continuous monitoring through smartwatches can offer valuable insights into the progression of patients at the end of life and enable the prediction of changes in their condition, which could ultimately enhance personalized care, particularly in outpatient or home care settings. Methods: This prospective study was conducted at the National Taiwan University Hospital. Patients diagnosed with cancer and receiving end-of-life care were invited to enroll in wards, outpatient clinics, and home-based care settings. Each participant was given a smartwatch to collect physiological data, including steps taken, heart rate, sleep time, and blood oxygen saturation. Clinical assessments were conducted weekly. The participants were followed until the end of life or up to 52 weeks. With these input features, we evaluated the prediction performance of several machine learning?based classifiers and a deep neural network in 7-day death events. We used area under the receiver operating characteristic curve (AUROC), F1-score, accuracy, and specificity as evaluation metrics. A Shapley additive explanations value analysis was performed to further explore the models with good performance. Results: From September 2021 to August 2022, overall, 1657 data points were collected from 40 patients with a median survival time of 34 days, with the detection of 28 death events. Among the proposed models, extreme gradient boost (XGBoost) yielded the best result, with an AUROC of 96%, F1-score of 78.5%, accuracy of 93%, and specificity of 97% on the testing set. The Shapley additive explanations value analysis identified the average heart rate as the most important feature. Other important features included steps taken, appetite, urination status, and clinical care phase. Conclusions: We demonstrated the successful prediction of patient deaths within the next 7 days using a combination of wearable devices and AI. Our findings highlight the potential of integrating AI and wearable technology into clinical end-of-life care, offering valuable insights and supporting clinical decision-making for personalized patient care. It is important to acknowledge that our study was conducted in a relatively small cohort; thus, further research is needed to validate our approach and assess its impact on clinical care. Trial Registration: ClinicalTrials.gov NCT05054907; https://classic.clinicaltrials.gov/ct2/show/NCT05054907 UR - https://www.jmir.org/2023/1/e47366 UR - http://dx.doi.org/10.2196/47366 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594793 ID - info:doi/10.2196/47366 ER - TY - JOUR AU - Tam, William AU - Alajlani, Mohannad AU - Abd-alrazaq, Alaa PY - 2023/8/18 TI - An Exploration of Wearable Device Features Used in UK Hospital Parkinson Disease Care: Scoping Review JO - J Med Internet Res SP - e42950 VL - 25 KW - Parkinson disease KW - wearable devices KW - machine learning KW - hospital KW - secondary care KW - United Kingdom KW - scoping review N2 - Background: The prevalence of Parkinson disease (PD) is becoming an increasing concern owing to the aging population in the United Kingdom. Wearable devices have the potential to improve the clinical care of patients with PD while reducing health care costs. Consequently, exploring the features of these wearable devices is important to identify the limitations and further areas of investigation of how wearable devices are currently used in clinical care in the United Kingdom. Objective: In this scoping review, we aimed to explore the features of wearable devices used for PD in hospitals in the United Kingdom. Methods: A scoping review of the current research was undertaken and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The literature search was undertaken on June 6, 2022, and publications were obtained from MEDLINE or PubMed, Embase, and the Cochrane Library. Eligible publications were initially screened by their titles and abstracts. Publications that passed the initial screening underwent a full review. The study characteristics were extracted from the final publications, and the evidence was synthesized using a narrative approach. Any queries were reviewed by the first and second authors. Results: Of the 4543 publications identified, 39 (0.86%) publications underwent a full review, and 20 (0.44%) publications were included in the scoping review. Most studies (11/20, 55%) were conducted at the Newcastle upon Tyne Hospitals NHS Foundation Trust, with sample sizes ranging from 10 to 418. Most study participants were male individuals with a mean age ranging from 57.7 to 78.0 years. The AX3 was the most popular device brand used, and it was commercially manufactured by Axivity. Common wearable device types included body-worn sensors, inertial measurement units, and smartwatches that used accelerometers and gyroscopes to measure the clinical features of PD. Most wearable device primary measures involved the measured gait, bradykinesia, and dyskinesia. The most common wearable device placements were the lumbar region, head, and wrist. Furthermore, 65% (13/20) of the studies used artificial intelligence or machine learning to support PD data analysis. Conclusions: This study demonstrated that wearable devices could help provide a more detailed analysis of PD symptoms during the assessment phase and personalize treatment. Using machine learning, wearable devices could differentiate PD from other neurodegenerative diseases. The identified evidence gaps include the lack of analysis of wearable device cybersecurity and data management. The lack of cost-effectiveness analysis and large-scale participation in studies resulted in uncertainty regarding the feasibility of the widespread use of wearable devices. The uncertainty around the identified research gaps was further exacerbated by the lack of medical regulation of wearable devices for PD, particularly in the United Kingdom where regulations were changing due to the political landscape. UR - https://www.jmir.org/2023/1/e42950 UR - http://dx.doi.org/10.2196/42950 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594791 ID - info:doi/10.2196/42950 ER - TY - JOUR AU - Xiao, Jin AU - Kopycka-Kedzierawski, Dorota AU - Ragusa, Patricia AU - Mendez Chagoya, Alberto Luis AU - Funkhouser, Kimberly AU - Lischka, Tamara AU - Wu, Tong Tong AU - Fiscella, Kevin AU - Kar, Saswati Kumari AU - Al Jallad, Nisreen AU - Rashwan, Noha AU - Ren, Johana AU - Meyerowitz, Cyril AU - PY - 2023/8/18 TI - Acceptance and Usability of an Innovative mDentistry eHygiene Model Amid the COVID-19 Pandemic Within the US National Dental Practice-Based Research Network: Mixed Methods Study JO - JMIR Hum Factors SP - e45418 VL - 10 KW - teledentistry KW - mDentistry KW - oral diseases KW - virtual visit KW - intraoral camera KW - COVID-19 KW - pandemic response KW - mobile phone N2 - Background: Amid the COVID-19 pandemic and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care and ensure the safety of patients and dental health care personnel (DHCP). Objective: This study aims to assess the acceptance and usability of an innovative mDentistry eHygiene model amid the COVID-19 pandemic. Methods: This pilot study used a 2-stage implementation design to assess 2 critical components of an innovative mDentistry eHygiene model: virtual hygiene examination (eHygiene) and patient self-taken intraoral images (SELFIE), within the National Dental Practice-Based Research Network. Mixed methods (quantitative and qualitative) were used to assess the acceptance and usability of the eHygiene model. Results: A total of 85 patients and 18 DHCP participated in the study. Overall, the eHygiene model was well accepted by patients (System Usability Scale [SUS] score: mean 70.0, SD 23.7) and moderately accepted by dentists (SUS score: mean 51.3, SD 15.9) and hygienists (SUS score: mean 57.1, SD 23.8). Dentists and patients had good communication during the eHygiene examination, as assessed using the Dentist-Patient Communication scale. In the SELFIE session, patients completed tasks with minimum challenges and obtained diagnostic intraoral photos. Patients and DHCP suggested that although eHygiene has the potential to improve oral health care services, it should be used selectively depending on patients? conditions. Conclusions: The study results showed promise for the 2 components of the eHygiene model. eHygiene offers a complementary modality for oral health data collection and examination in dental offices, which would be particularly useful during an infectious disease outbreak. In addition, patients being able to capture critical oral health data in their home could facilitate dental treatment triage and oral health self-monitoring and potentially trigger oral health?promoting behaviors. UR - https://humanfactors.jmir.org/2023/1/e45418 UR - http://dx.doi.org/10.2196/45418 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594795 ID - info:doi/10.2196/45418 ER - TY - JOUR AU - Ross, Jamie AU - Hawkes, E. Rhiannon AU - Miles, M. Lisa AU - Cotterill, Sarah AU - Bower, Peter AU - Murray, Elizabeth PY - 2023/8/17 TI - Design and Early Use of the Nationally Implemented Healthier You National Health Service Digital Diabetes Prevention Programme: Mixed Methods Study JO - J Med Internet Res SP - e47436 VL - 25 KW - digital health KW - engagement KW - diabetes prevention KW - mobile phone N2 - Background: The Healthier You National Health Service Digital Diabetes Prevention Programme (NHS-digital-DPP) is a 9-month digital behavior change intervention delivered by 4 independent providers that is implemented nationally across England. No studies have explored the design features included by service providers of digital diabetes prevention programs to promote engagement, and little is known about how participants of nationally implemented digital diabetes prevention programs such as this one make use of them. Objective: This study aimed to understand engagement with the NHS-digital-DPP. The specific objectives were to describe how engagement with the NHS-digital-DPP is promoted via design features and strategies and describe participants? early engagement with the NHS-digital-DPP apps. Methods: Mixed methods were used. The qualitative study was a secondary analysis of documents detailing the NHS-digital-DPP intervention design and interviews with program developers (n=6). Data were deductively coded according to an established framework of engagement with digital health interventions. For the quantitative study, anonymous use data collected over 9 months for each provider representing participants? first 30 days of use of the apps were obtained for participants enrolled in the NHS-digital-DPP. Use data fields were categorized into 4 intervention features (Track, Learn, Coach Interactions, and Peer Support). The amount of engagement with the intervention features was calculated for the entire cohort, and the differences between providers were explored statistically. Results: Data were available for 12,857 participants who enrolled in the NHS-digital-DPP during the data collection phase. Overall, 94.37% (12,133/12,857) of those enrolled engaged with the apps in the first 30 days. The median (IQR) number of days of use was 11 (2-25). Track features were engaged with the most (number of tracking events: median 46, IQR 3-22), and Peer Support features were the least engaged with, a median value of 0 (IQR 0-0). Differences in engagement with features were observed across providers. Qualitative findings offer explanations for the variations, including suggesting the importance of health coaches, reminders, and regular content updates to facilitate early engagement. Conclusions: Almost all participants in the NHS-digital-DPP started using the apps. Differences across providers identified by the mixed methods analysis provide the opportunity to identify features that are important for engagement with digital health interventions and could inform the design of other digital behavior change interventions. UR - https://www.jmir.org/2023/1/e47436 UR - http://dx.doi.org/10.2196/47436 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590056 ID - info:doi/10.2196/47436 ER - TY - JOUR AU - Woo, Sarah AU - Jung, Sunho AU - Lim, Hyunjung AU - Kim, YoonMyung AU - Park, Hee Kyung PY - 2023/8/17 TI - Exploring the Effect of the Dynamics of Behavioral Phenotypes on Health Outcomes in an mHealth Intervention for Childhood Obesity: Longitudinal Observational Study JO - J Med Internet Res SP - e45407 VL - 25 KW - behavioral dynamics KW - behavioral phenotype KW - functional data analysis KW - FDA KW - machine learning analysis KW - mobile health KW - mHealth KW - obesity intervention KW - pediatric obesity KW - mobile phone N2 - Background: Advancements in mobile health technologies and machine learning approaches have expanded the framework of behavioral phenotypes in obesity treatment to explore the dynamics of temporal changes. Objective: This study aimed to investigate the dynamics of behavioral changes during obesity intervention and identify behavioral phenotypes associated with weight change using a hybrid machine learning approach. Methods: In total, 88 children and adolescents (ages 8-16 years; 62/88, 71% male) with age- and sex-specific BMI ?85th percentile participated in the study. Behavioral phenotypes were identified using a hybrid 2-stage procedure based on the temporal dynamics of adherence to the 5 behavioral goals during the intervention. Functional principal component analysis was used to determine behavioral phenotypes by extracting principal component factors from the functional data of each participant. Elastic net regression was used to investigate the association between behavioral phenotypes and weight change. Results: Functional principal component analysis identified 2 distinctive behavioral phenotypes, which were named the high or low adherence level and late or early behavior change. The first phenotype explained 47% to 69% of each factor, whereas the second phenotype explained 11% to 17% of the total behavioral dynamics. High or low adherence level was associated with weight change for adherence to screen time (?=?.0766, 95% CI ?.1245 to ?.0312), fruit and vegetable intake (?=.1770, 95% CI .0642-.2561), exercise (?=?.0711, 95% CI ?.0892 to ?.0363), drinking water (?=?.0203, 95% CI ?.0218 to ?.0123), and sleep duration. Late or early behavioral changes were significantly associated with weight loss for changes in screen time (?=.0440, 95% CI .0186-.0550), fruit and vegetable intake (?=?.1177, 95% CI ?.1441 to ?.0680), and sleep duration (?=?.0991, 95% CI ?.1254 to ?.0597). Conclusions: Overall level of adherence, or the high or low adherence level, and a gradual improvement or deterioration in health-related behaviors, or the late or early behavior change, were differently associated with weight loss for distinctive obesity-related lifestyle behaviors. A large proportion of health-related behaviors remained stable throughout the intervention, which indicates that health care professionals should closely monitor changes made during the early stages of the intervention. Trial Registration: Clinical Research Information Science KCT0004137; https://tinyurl.com/ytxr83ay UR - https://www.jmir.org/2023/1/e45407 UR - http://dx.doi.org/10.2196/45407 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590040 ID - info:doi/10.2196/45407 ER - TY - JOUR AU - Inchusri, Tharoj AU - Surangsrirat, Decho AU - Kwanmuang, Papichaya AU - Poomivanichakij, Prapasiri AU - Apiwatgaroon, Ponnapat AU - Ongprakobkul, Surathep AU - Kongchu, Apissara AU - Klinpikul, Anda AU - Taneeheng, Ammarin AU - Pruphetkaew, Nannapat AU - Thongseiratch, Therdpong AU - Ngamchaliew, Pitchayanont AU - Vichitkunakorn, Polathep PY - 2023/8/17 TI - Association of Generation and Group Size With the Usage of a Mobile Health App in Thailand: Secondary Analysis of the ThaiSook Cohort Study JO - J Med Internet Res SP - e45374 VL - 25 KW - application KW - cohort KW - generation group size KW - health care personnel KW - logging function KW - mobile health technology KW - Thailand N2 - Background: In Thailand, The National Science and Technology Development Agency developed ThaiSook, a behavior-tracking app, to promote healthy lifestyles. The Faculty of Medicine, Prince of Songkla University (MED PSU)×ThaiSook Healthier Challenge encouraged employees to use the app over a 28-day period (from July 11 to August 7, 2022). Until recently, no previous studies have examined the association of generations and group sizes with mobile health (mHealth) app use. Understanding these relationships can inform the design of effective mHealth interventions and facilitate targeted interventions. Objective: This study aimed to (1) compare the overall app usage and logging function across different generations and group sizes and (2) describe the demographic characteristics of the participants of the MED PSU×ThaiSook Healthier Challenge. Methods: We conducted a secondary data analysis of the data from the ThaiSook prospective cohort study. Data were collected through the app and comprised demographic characteristics (ie, age, sex, weight, height, and group size) and behaviors (ie, water consumption, fruit and vegetable consumption, sleep hours, and exercise). The outcomes consisted of users who used the app for at least 80% of the participation period (?23 days). Bivariate tests (Pearson chi-square test for categorical variables and Mann-Whitney U and Kruskal-Wallis tests for continuous variables) were conducted over sex, generations, initial BMI, and group size. Finally, multiple logistic regression models were used to examine the relationship between the independent variables used by the ThaiSook app and consistent users who had used the app for at least 80% of the participation period. Results: Of the 827 participants, most were female (734/827, 88.8%), belonged to a medium-sized group of 6-10 members (479/827, 57.9%), and belonged to generation Y (377/761, 49.5%). Multivariate analysis revealed that the overall app usage was 2.09 times higher in women than in men (adjusted odds ratio [AOR] 2.09, 95% CI 1.27-3.44). The older generations used all logging functions more frequently than did generation Y (baby boomers AOR 2.54, 95% CI 1.31-4.92; generation X AOR 1.96, 95% CI 1.42-2.72). The use of all logging functions was higher among participants belonging to larger groups than among those belonging to smaller groups (large groups AOR 2.85, 95% CI 1.58-5.16; medium groups AOR 2.06, 95% CI 1.47-2.88). Water logging was most used (806/827, 97.5% participants), followed by food, sleep, and workout logging. Conclusions: The MED PSU×ThaiSook Healthier Challenge participants were mostly females from generation Y and medium-sized groups. Water logging was most frequently used, followed by fruit and vegetable logging. The results indicate that generation and group size were significantly associated with consistent and daily usage (P<.05). Older generations and larger groups engaged with the app more consistently than younger generations and smaller groups and individuals. UR - https://www.jmir.org/2023/1/e45374 UR - http://dx.doi.org/10.2196/45374 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590057 ID - info:doi/10.2196/45374 ER - TY - JOUR AU - Ruf, Alea AU - Neubauer, B. Andreas AU - Koch, D. Elena AU - Ebner-Priemer, Ulrich AU - Reif, Andreas AU - Matura, Silke PY - 2023/8/17 TI - Microtemporal Dynamics of Dietary Intake, Physical Activity, and Impulsivity in Adult Attention-Deficit/Hyperactivity Disorder: Ecological Momentary Assessment Study Within Nutritional Psychiatry JO - JMIR Ment Health SP - e46550 VL - 10 KW - impulsivity KW - nutrition KW - macronutrient intake KW - physical activity KW - ecological momentary assessment KW - EMA KW - attention-deficit/hyperactivity disorder KW - ADHD KW - diet KW - neurodevelopmental KW - hyperactivity KW - macronutrient KW - psychiatry KW - symptoms KW - mobile KW - mobile phone N2 - Background: Increasing attention is being paid to lifestyle factors, such as nutrition and physical activity (PA), as potential complementary treatment options in attention-deficit/hyperactivity disorder (ADHD). Previous research indicates that sugar and saturated fat intake may be linked to increased impulsivity, a core symptom of ADHD, whereas protein intake and PA may be related to reduced impulsivity. However, most studies rely on cross-sectional data that lack microtemporal resolution and ecological validity, wherefore questions of microtemporal dynamics (eg, is the consumption of foods high in sugar associated with increased impulsivity within minutes or hours?) remain largely unanswered. Ecological momentary assessment (EMA) has the potential to bridge this gap. Objective: This study is the first to apply EMA to assess microtemporal associations among macronutrient intake, PA, and state impulsivity in the daily life of adults with and without ADHD. Methods: Over a 3-day period, participants reported state impulsivity 8 times per day (signal-contingent), recorded food and drink intake (event-contingent), and wore an accelerometer. Multilevel 2-part models were used to study the association among macronutrient intake, PA, and the probability to be impulsive as well as the intensity of impulsivity (ADHD: n=36; control: n=137). Results: No association between macronutrient intake and state impulsivity was found. PA was not related to the intensity of impulsivity but to a higher probability to be impulsive (ADHD: ?=?.09, 95% CI ?0.14 to ?0.04; control: ?=?.03, 95% CI ?0.05 to ?0.01). No evidence was found that the combined intake of saturated fat and sugar amplified the increase in state impulsivity and that PA alleviated the positive association between sugar or fat intake and state impulsivity. Conclusions: Important methodological considerations are discussed that can contribute to the optimization of future EMA protocols. EMA research in the emerging field of nutritional psychiatry is still in its infancy; however, EMA is a highly promising and innovative approach as it offers insights into the microtemporal dynamics of psychiatric symptomology, dietary intake, and PA in daily life. UR - https://mental.jmir.org/2023/1/e46550 UR - http://dx.doi.org/10.2196/46550 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590053 ID - info:doi/10.2196/46550 ER - TY - JOUR AU - von Kalckreuth, Niklas AU - Feufel, A. Markus PY - 2023/8/16 TI - Extending the Privacy Calculus to the mHealth Domain: Survey Study on the Intention to Use mHealth Apps in Germany JO - JMIR Hum Factors SP - e45503 VL - 10 KW - mHealth KW - mobile health KW - confidential KW - privacy calculus KW - privacy KW - intention to use KW - adoption KW - data autonomy KW - social norms KW - trust in the provider KW - trust KW - privacy concern KW - benefit KW - attitude to privacy KW - survey KW - intention N2 - Background: With the increasing digitalization of the health sector, more and more mobile health (mHealth) apps are coming to the market to continuously collect and process sensitive health data for the benefit of patients and providers. These technologies open up new opportunities to make the health care system more efficient and save costs but also pose potential threats such as loss of data or finances. Objective: This study aims to present an empirical review and adaptation of the extended privacy calculus model to the mHealth domain and to understand what factors influence the intended usage of mHealth technologies. Methods: A survey study was conducted to empirically validate our model, using a case vignette as cover story. Data were collected from 250 German participants and analyzed using a covariance-based structural equation model. Results: The model explains R2=79.3% of the variance in intention to use. The 3 main factors (social norms, attitude to privacy, and perceived control over personal data) influenced the intention to use mHealth apps, albeit partially indirectly. The intention to use mHealth apps is driven by the perceived benefits of the technology, trust in the provider, and social norms. Privacy concerns have no bearing on the intention to use. The attitude to privacy has a large inhibiting effect on perceived benefits, as well as on trust in the provider. Perceived control over personal data clearly dispels privacy concerns and supports the relationship of trust between the user and the provider. Conclusions: Based on the privacy calculus, our domain-specific model explains the intention to use mHealth apps better than previous, more general models. The findings allow health care providers to improve their products and to increase usage by targeting specific user groups. UR - https://humanfactors.jmir.org/2023/1/e45503 UR - http://dx.doi.org/10.2196/45503 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585259 ID - info:doi/10.2196/45503 ER - TY - JOUR AU - Van Dooren, Martijn AU - De Croon, Robin AU - Swillen, Ann AU - Verbert, Katrien PY - 2023/8/16 TI - Bridging the Communication Gap Between People With Cognitive Impairments and Their Caregivers Using mHealth Apps: User-Centered Design and Evaluation Study With People With 22q11 Deletion Syndrome JO - JMIR Hum Factors SP - e44290 VL - 10 KW - 22q11 deletion syndrome KW - 22q11 DS KW - cognitive impairments KW - communication gap KW - mHealth N2 - Background: In families with children with cognitive impairments, both parents and children experience tension and have questions because of a lack of communication and adequate information. Therefore, there is a great need to develop tools that can help bridge the communication gap between patients and caregivers by stimulating conversations and providing psychoeducational tools. mHealth apps show great potential in this context. Objective: The objective of this research is to discover the specific ways young people with cognitive impairments and their families interact with mHealth apps in the context of bridging the communication gap. This newly discovered information leads to potentially more impactful mHealth interventions in the future. Therefore, this paper documents the design and development of a mHealth app for a specific group of people with cognitive impairments?people with 22q11 deletion syndrome (22q11 DS)?and their caregivers, as well as key learnings from the evaluation of this app. Methods: An iterative, user-centered design approach is used to design and develop the app. Design and evaluation happens in 2 phases. During the design phase, feedback is gathered from 2 medical experts and 3 human computer interaction (HCI) experts using a low-fidelity paper prototype. During the evaluation phase, feedback is gathered from 8 families with a child with 22q11 DS using a fully working proof of concept. This phase consists of a semistructured interview, a 2-4?week trial period, and a concluding semistructured interview. Results: The evaluation results of the fully working proof of concept led to design recommendations related to four different topics: (1) overcoming usage barriers, (2) stimulating conversation through a mHealth app, (3) providing information, and (4) bringing continual added value. Results are presented according to six different categories obtained in a thematic analysis: (1) feedback about the app ?as is,? (2) difficulties, (3) comparison between physical and digital tool, (4) extensions, (5) intention, and (6) other. Conclusions: In this research, the need for apps that help bridge the communication gap between a person with cognitive impairment and their caregiver is confirmed. All participating families express their gratitude and mention the added value for other families. Therefore, it is highly encouraged for clinics and institutions to take action and develop an app to be used in practice. Furthermore, considerations when developing for people with 22q11 DS, or more broadly, people with cognitive impairments, are proposed. First, one should keep design principles in mind to overcome usage barriers. Next, recognition is a key concept when stimulating conversations through mobile apps. Third, information should be provided by a trusted source, and more than just clinical information can be considered valuable. Finally, having the possibility of using a digital tool that can be personalized brings continual added value. UR - https://humanfactors.jmir.org/2023/1/e44290 UR - http://dx.doi.org/10.2196/44290 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585257 ID - info:doi/10.2196/44290 ER - TY - JOUR AU - Jones, Grant AU - Herrmann, Felipe AU - Nock, K. Matthew PY - 2023/8/16 TI - A Digital Music-Based Mindfulness Intervention for Black Americans With Elevated Race-Based Anxiety: A Multiple-Baseline Pilot Study JO - JMIR Form Res SP - e49284 VL - 7 KW - Black music KW - mindfulness KW - meditation KW - single-case experiment KW - race KW - anxiety KW - digital health intervention KW - low income KW - Black community KW - racial disparity N2 - Background: Race-based anxiety is a substantial health issue for the Black community. Although mindfulness interventions have demonstrated efficacy for alleviating anxiety, three central barriers prevent Black Americans from accessing existing mindfulness treatments: high costs, excessive time commitments, and limited cultural relevance. There is a need for novel mindfulness interventions for the Black community that can overcome these barriers. Objective: The goal of this web-based study was to examine the preliminary efficacy, feasibility, and acceptability of a novel digital music-based mindfulness intervention for middle-to-low-income Black Americans with elevated race-based anxiety. Methods: This study used a nonconcurrent multiple-baseline design (n=5). The intervention featured contributions from Lama Rod Owens (a world-renowned meditation teacher and LA Times best-selling author) and Terry Edmonds (the former chief speechwriter for President Bill Clinton). We examined the effect of the intervention on state anxiety and assessed its feasibility and acceptability using quantitative and qualitative measures. Results: Results revealed that administration of the intervention led to significant decreases in state anxiety (Tau-U range ?0.75 to ?0.38; P values<.001). Virtually all feasibility and acceptability metrics were high (ie, the average likelihood of recommending the intervention was 98 out of 100). Conclusions: This study offers preliminary evidence that a digital music-based mindfulness intervention can decrease race-based anxiety in Black Americans. Future research is needed to replicate these results, test whether the intervention can elicit lasting changes in anxiety, assess mechanisms of change, and explore the efficacy of the intervention in real-world contexts. UR - https://formative.jmir.org/2023/1/e49284 UR - http://dx.doi.org/10.2196/49284 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585252 ID - info:doi/10.2196/49284 ER - TY - JOUR AU - Law, Wa Yik AU - Lok, Ting Rita Hui AU - Chiang, Byron AU - Lai, Shan Carmen Chui AU - Tsui, Matthew Sik Hon AU - Chung, Joseph Pui Yin AU - Leung, Chung Siu PY - 2023/8/16 TI - Effects of Community-Based Caring Contact in Reducing Thwarted Belongingness Among Postdischarge Young Adults With Self-Harm: Randomized Controlled Trial JO - JMIR Form Res SP - e43526 VL - 7 KW - self-harm KW - suicidal ideation KW - volunteers KW - mobile app KW - thwarted belongingness KW - suicide KW - youth KW - community KW - support KW - treatment KW - effectiveness KW - risk KW - patient KW - intervention KW - model KW - care KW - hospital N2 - Background: For patients with self-harm behaviors, the urge to hurt themselves persists after hospital discharge, leading to costly readmissions and even death. Hence, postdischarge intervention programs that reduce self-harm behavior among patients should be part of a cogent community mental health care policy. Objective: We aimed to determine whether a combination of a self-help mobile app and volunteer support could complement treatment as usual (TAU) to reduce the risk of suicide among these patients. Methods: We conducted a pragmatic randomized controlled trial on discharged patients aged between 18 and 45 years with self-harm episodes/suicide attempts, all of whom were recruited from 4 hospital emergency departments in Hong Kong. Participants were randomly assigned to one of three groups: (1) mobile app + TAU (?apps?), (2) mobile app + volunteer support + TAU (?volunteers?), or (3) TAU only as the control group (?TAU?). They were asked to submit a mobile app?based questionnaire during 4 measurement time points at monthly intervals. Results: A total of 40 participants were recruited. Blending volunteer care with a preprogrammed mobile app was found to be effective in improving service compliance. Drawing upon the interpersonal-psychological theory of suicide, our findings suggested that a reduction in perceived burdensomeness and thwarted belongingness through community-based caring contact are linked to improvement in hopelessness, albeit a transient one, and suicide risk. Conclusions: A combination of volunteer care with a self-help mobile app as a strategy for strengthening the continuity of care can be cautiously implemented for discharged patients at risk of self-harm during the transition from the hospital to a community setting. Trial Registration: ClinicalTrials.gov NCT03081078; https://clinicaltrials.gov/study/NCT03081078 UR - https://formative.jmir.org/2023/1/e43526 UR - http://dx.doi.org/10.2196/43526 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585260 ID - info:doi/10.2196/43526 ER - TY - JOUR AU - Xu, Huan Richard AU - Shi, Lushaobo AU - Shi, Zengping AU - Li, Ting AU - Wang, Dong PY - 2023/8/15 TI - Investigating Individuals? Preferences in Determining the Functions of Smartphone Apps for Fighting Pandemics: Best-Worst Scaling Survey Study JO - J Med Internet Res SP - e48308 VL - 25 KW - best-worst scaling KW - BWS KW - smartphone app KW - app KW - pandemic KW - preference KW - health care KW - survey N2 - Background: Smartphone apps have been beneficial in controlling and preventing the COVID-19 pandemic. However, there is a gap in research surrounding the importance of smartphone app functions from a user?s perspective. Although the insights and opinions of different stakeholders, such as policymakers and medical professionals, can influence the success of a public health policy, any strategy will face difficulty in achieving the expected effect if it is not based on a method that users can accept. Objective: This study aimed to assess the importance of a hypothetical smartphone app?s functions for managing health during a pandemic based on the perspective of user preferences. Methods: A cross-sectional and web-based survey using the best-worst scaling (BWS) method was used to investigate the general population?s preferences for important smartphone app functions. Participants were recruited from a professional surveying company?s web-based surveying panel. The attributes of the BWS questionnaire were developed based on a robust process, including literature review, interviews, and expert discussion. A balanced incomplete block design was used to construct the choice task to ensure the effectiveness of the research design. Count analysis, conditional logit model analysis, and mixed logit analysis were used to estimate preference heterogeneity among respondents. Results: The responses of 2153 participants were eligible for analysis. Nearly 55% (1192/2153) were female, and the mean age was 31.4 years. Most participants (1765/2153, 81.9%) had completed tertiary or higher education, and approximately 70% (1523/2153) were urban residents. The 3 most vital functions according to their selection were ?surveillance and monitoring of infected cases,? ?quick self-screening,? and ?early detection of infected cases.? The mixed logit regression model identified significant heterogeneity in preferences among respondents, and stratified analysis showed that some heterogeneities varied in respondents by demographics and COVID-19?related characteristics. Participants who preferred to use the app were more likely to assign a high weight to the preventive functions than those who did not prefer to use it. Conversely, participants who showed lower willingness to use the app tended to indicate a higher preference for supportive functions than those who preferred to use it. Conclusions: This study ranks the importance of smartphone app features that provide health care services during a pandemic based on the general population?s preferences in China. It provides empirical evidence for decision-makers to develop eHealth policies and strategies that address future public health crises from a person-centered care perspective. Continued use of apps and smart investment in digital health can help improve health outcomes and reduce the burden of disease on individuals and communities. UR - https://www.jmir.org/2023/1/e48308 UR - http://dx.doi.org/10.2196/48308 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581916 ID - info:doi/10.2196/48308 ER - TY - JOUR AU - Au, Jessica AU - Falloon, Caitlin AU - Ravi, Ayngaran AU - Ha, Phil AU - Le, Suong PY - 2023/8/15 TI - A Beta-Prototype Chatbot for Increasing Health Literacy of Patients With Decompensated Cirrhosis: Usability Study JO - JMIR Hum Factors SP - e42506 VL - 10 KW - chronic liver disease KW - chatbot KW - artificial intelligence KW - health literacy KW - acceptability N2 - Background: Health literacy is low among patients with chronic liver disease (CLD) and associated with poor health outcomes and increased health care use. Lucy LiverBot, an artificial intelligence chatbot was created by a multidisciplinary team at Monash Health, Australia, to improve health literacy and self-efficacy in patients with decompensated CLD. Objective: The aim of this study was to explore users? experience with Lucy LiverBot using an unmoderated, in-person, qualitative test. Methods: Lucy LiverBot is a simple, low cost, and scalable digital intervention, which was at the beta prototype development phase at the time of usability testing. The concept and prototype development was realized in 2 phases: concept development and usability testing. We conducted a mixed methods study to assess usability of Lucy LiverBot as a tool for health literacy education among ambulatory and hospitalized patients with decompensated CLD at Monash Health. Patients were provided with free reign to interact with Lucy LiverBot on an iPad device under moderator observation. A 3-part survey (preuser, user, and postuser) was developed using the Unified Acceptance Theory Framework to capture the user experience. Results: There were 20 participants with a median age of 55.5 (IQR 46.0-60.5) years, 55% (n=11) of them were female, and 85% (n=17) of them were White. In total, 35% (n=7) of them reported having difficulty reading and understanding written medical information. Alcohol was the predominant etiology in 70% (n=14) of users. Participants actively engaged with Lucy LiverBot and identified it as a potential educational tool and device that could act as a social companion to improve well-being. In total, 25% (n=5) of them reported finding it difficult to learn about their health problems and 20% (n=4) of them found it difficult to find medical information they could trust. Qualitative interviews revealed the conversational nature of Lucy LiverBot was considered highly appealing with improvement in mental health and well-being reported as an unintended benefit of Lucy LiverBot. Patients who had been managing their liver cirrhosis for several years identified that they would be less likely to use Lucy LiverBot, but that it would have been more useful at the time of their diagnosis. Overall, Lucy LiverBot was perceived as a reliable and trustworthy source of information. Conclusions: Lucy LiverBot was well received and may be used to improve health literacy and address barriers to health care provision in patients with decompensated CLD. The study revealed important feedback that has been used to further optimize Lucy LiverBot. Further acceptability and validation studies are being undertaken to investigate whether Lucy LiverBot can improve clinical outcomes and health related quality of life in patients with decompensated CLD. UR - https://humanfactors.jmir.org/2023/1/e42506 UR - http://dx.doi.org/10.2196/42506 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581920 ID - info:doi/10.2196/42506 ER - TY - JOUR AU - Bayshtok, Gabriella AU - Tiosano, Shmuel AU - Furer, Ariel PY - 2023/8/15 TI - Use of Wearable Devices for Peak Oxygen Consumption Measurement in Clinical Cardiology: Case Report and Literature Review JO - Interact J Med Res SP - e45504 VL - 12 KW - cardiac fitness KW - cardiac patient KW - cardiorespiratory fitness KW - CRF KW - clinical cardiology KW - oxygen consumption KW - peak VO2 KW - smartwatch KW - wearable device N2 - Background: Oxygen consumption is an important index to evaluate in cardiac patients, particularly those with heart failure, and is measured in the setting of advanced cardiopulmonary exercise testing. However, technological advances now allow for the estimation of this parameter in many consumer and medical-grade wearable devices, making it available for the medical provider at the initial evaluation of patients. We report a case of an apparently healthy male aged 40 years who presented for evaluation due to an Apple Watch (Apple Inc) notification of low cardiac fitness. This alert triggered a thorough workup, revealing a diagnosis of familial nonischemic cardiomyopathy with severely reduced left ventricular systolic function. While the use of wearable devices for the measurement of oxygen consumption and related parameters is promising, further studies are needed for validation. Objective: The aim of this report is to investigate the potential utility of wearable devices as a screening and risk stratification tool for cardiac fitness for the general population and those with increased cardiovascular risk, particularly through the measurement of peak oxygen consumption (VO2). We discuss the possible advantages of measuring oxygen consumption using wearables and propose its integration into routine patient evaluation and follow-up processes. With the current evidence and limitations, we encourage researchers and clinicians to explore bringing wearable devices into clinical practice. Methods: The case was identified at Sheba Medical Center, and the patient?s cardiac fitness was monitored through an Apple Watch Series 6. The patient underwent a comprehensive cardiac workup following his presentation. Subsequently, we searched the literature for articles relating to the clinical utility of peak VO2 monitoring and available wearable devices. Results: The Apple Watch data provided by the patient demonstrated reduced peak VO2, a surrogate index for cardiac fitness, which improved after treatment initiation. A cardiological workup confirmed familial nonischemic cardiomyopathy with severely reduced left ventricular systolic function. A review of the literature revealed the potential clinical benefit of peak VO2 monitoring in both cardiac and noncardiac scenarios. Additionally, several devices on the market were identified that could allow for accurate oxygen consumption measurement; however, future studies and approval by the Food and Drug Administration (FDA) are still necessary. Conclusions: This case report highlights the potential utility of peak VO2 measurements by wearable devices for early identification and screening of cardiac fitness for the general population and those at increased risk of cardiovascular disease. The integration of wearable devices into routine patient evaluation may allow for earlier presentation in the diagnostic workflow. Cardiac fitness can be serially measured using the wearable device, allowing for close monitoring of functional capacity parameters. Devices need to be used with caution, and further studies are warranted. UR - https://www.i-jmr.org/2023/1/e45504 UR - http://dx.doi.org/10.2196/45504 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581915 ID - info:doi/10.2196/45504 ER - TY - JOUR AU - Madujibeya, Ifeanyi AU - Lennie, A. Terry AU - Pelzel, Jamie AU - Moser, K. Debra PY - 2023/8/15 TI - Patients? Experiences Using a Mobile Health App for Self-Care of Heart Failure in a Real-World Setting: Qualitative Analysis JO - JMIR Form Res SP - e39525 VL - 7 KW - heart failure KW - patients? experiences KW - experience KW - satisfaction KW - facilitator KW - mobile health apps KW - mobile app KW - health app KW - app feature KW - mobile health KW - cardiology KW - cardiovascular KW - patient care KW - self-management KW - patient KW - heart KW - mHealth KW - self-care KW - medication KW - performance KW - feedback KW - personalized N2 - Background: Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)?related self-care. However, there is a dearth of research on patients? experiences using mHealth apps for self-care in real-world settings. Objective: The purpose of this study was to explore patients? experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting. Methods: Patient satisfaction, measured with a 5-point Likert scale, and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients? responses was conducted with the qualitative software Atlas.ti (version 8; ATLAS.ti Scientific Software Development GmbH). Results: Patients (median age 64, IQR 57-71 years; 17/23, 74% male) used OnTrack to Health for a median 164 (IQR 51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use and availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features). Conclusions: Patients were satisfied with using OnTrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end users is essential to ensure high-quality patient experiences related to app use for self-care. UR - https://formative.jmir.org/2023/1/e39525 UR - http://dx.doi.org/10.2196/39525 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581912 ID - info:doi/10.2196/39525 ER - TY - JOUR AU - Gagnon, W. Kelly AU - Baral, Stefan AU - Long, Dustin AU - Guzman, L. Alfredo AU - Johnson, Bernadette AU - Burkholder, Greer AU - Willig, James AU - Mugavero, Michael AU - Baldwin, Margaret AU - Fogger, Susanne AU - Creger, Thomas AU - Cropsey, Karen AU - Eaton, Ellen PY - 2023/8/15 TI - Delivery of the HIV Service and Telemedicine Through Effective Patient-Reported Outcomes (+STEP) Intervention to Increase Screening and Treatment of Mental Health and Substance Use Disorders for People Living With HIV in Alabama: Protocol for an Effectiveness-Implementation Study JO - JMIR Res Protoc SP - e40470 VL - 12 KW - clinics KW - diagnosis KW - engagement KW - HIV KW - implementation science KW - intervention KW - interview KW - mental health KW - patient reported outcomes KW - protocol KW - screening KW - substance use KW - telemedicine KW - treatment KW - USA KW - viral N2 - Background: The syndemic of mental health (MH) and substance use disorders (SUDs) is common among persons living with HIV and jeopardizes HIV treatment adherence, engagement in care, and viral load suppression. Electronic patient-reported outcomes (ePROs), completed through tablet or computer, and telemedicine are evidence- and technology-based interventions that have been used to successfully increase screening and treatment, respectively, a model that holds promise for persons living with HIV. To date, there is limited guidance on implementing ePROs and telemedicine into HIV clinical practice even though it is well known that these evidence-based tools improve diagnosis and access to care. Objective: To address this, we aim to conduct a multicomponent intervention for persons living with HIV, including the delivery of HIV services and telemedicine through effective ePROs (+STEP), to increase screening and treatment of MH and SUD in Ryan White HIV/AIDS Program (RWHAP)?funded clinics in Alabama. Methods: Through this intervention, we will conduct a readiness, acceptability, and accessibility assessment and implement +STEP to improve the diagnosis and treatment of MH and SUD at RWHAP clinics in Alabama. To describe implementation strategies that address barriers to the uptake of +STEP in RWHAP clinics, we will conduct qualitative interviews in years 1 (early implementation), 2 (scale up), and 4 (maintenance) with patients and key staff to evaluate barriers, facilitators, and implementation strategies. Our Results will enable us to modify strategies to enhance +STEP penetration over time and inform the implementation blueprint, which we will develop for both RWHAP clinics in Alabama and future sites. We will assess the impact of implementing +STEP on diagnoses, referrals, and health care use related to MH, SUD, and HIV by comparing clinical outcomes from patients receiving these interventions (ePROs and telemedicine) with historical controls. Results: The first study site began implementation in April 2022. A total of 2 additional sites have initiated ePROs. Final results are expected in 2026. The results of this study will provide a foundation for future research expanding access to ePROs for improved diagnosis linked to telemedicine access to accelerate patients along the continuum of care from MH and SUD diagnosis to treatment. Conclusions: Achieving the end of the HIV epidemic in the United States necessitates programs that accelerate movement across the MH and SUD care continuum from diagnosis to treatment for persons living with HIV. Scaling these services represents a path toward improved treatment outcomes with both individual health and population-level prevention benefits of sustained HIV viral suppression in the era of undetectable=untransmittable (U=U). This study will address this evidence gap through the evaluation of the implementation of +STEP to establish the necessary systems and processes to screen, identify, and better treat substance use and MH for people living with HIV. International Registered Report Identifier (IRRID): DERR1-10.2196/40470 UR - https://www.researchprotocols.org/2023/1/e40470 UR - http://dx.doi.org/10.2196/40470 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581919 ID - info:doi/10.2196/40470 ER - TY - JOUR AU - Sun, Shaoxiong AU - Folarin, A. Amos AU - Zhang, Yuezhou AU - Cummins, Nicholas AU - Garcia-Dias, Rafael AU - Stewart, Callum AU - Ranjan, Yatharth AU - Rashid, Zulqarnain AU - Conde, Pauline AU - Laiou, Petroula AU - Sankesara, Heet AU - Matcham, Faith AU - Leightley, Daniel AU - White, M. Katie AU - Oetzmann, Carolin AU - Ivan, Alina AU - Lamers, Femke AU - Siddi, Sara AU - Simblett, Sara AU - Nica, Raluca AU - Rintala, Aki AU - Mohr, C. David AU - Myin-Germeys, Inez AU - Wykes, Til AU - Haro, Maria Josep AU - Penninx, H. Brenda W. J. AU - Vairavan, Srinivasan AU - Narayan, A. Vaibhav AU - Annas, Peter AU - Hotopf, Matthew AU - Dobson, B. Richard J. AU - PY - 2023/8/14 TI - Challenges in Using mHealth Data From Smartphones and Wearable Devices to Predict Depression Symptom Severity: Retrospective Analysis JO - J Med Internet Res SP - e45233 VL - 25 KW - mobile health KW - depression KW - digital phenotypes KW - behavioral patterns KW - missing data KW - smartphones KW - wearable devices KW - mobile phone N2 - Background: Major depressive disorder (MDD) affects millions of people worldwide, but timely treatment is not often received owing in part to inaccurate subjective recall and variability in the symptom course. Objective and frequent MDD monitoring can improve subjective recall and help to guide treatment selection. Attempts have been made, with varying degrees of success, to explore the relationship between the measures of depression and passive digital phenotypes (features) extracted from smartphones and wearables devices to remotely and continuously monitor changes in symptomatology. However, a number of challenges exist for the analysis of these data. These include maintaining participant engagement over extended time periods and therefore understanding what constitutes an acceptable threshold of missing data; distinguishing between the cross-sectional and longitudinal relationships for different features to determine their utility in tracking within-individual longitudinal variation or screening individuals at high risk; and understanding the heterogeneity with which depression manifests itself in behavioral patterns quantified by the passive features. Objective: We aimed to address these 3 challenges to inform future work in stratified analyses. Methods: Using smartphone and wearable data collected from 479 participants with MDD, we extracted 21 features capturing mobility, sleep, and smartphone use. We investigated the impact of the number of days of available data on feature quality using the intraclass correlation coefficient and Bland-Altman analysis. We then examined the nature of the correlation between the 8-item Patient Health Questionnaire (PHQ-8) depression scale (measured every 14 days) and the features using the individual-mean correlation, repeated measures correlation, and linear mixed effects model. Furthermore, we stratified the participants based on their behavioral difference, quantified by the features, between periods of high (depression) and low (no depression) PHQ-8 scores using the Gaussian mixture model. Results: We demonstrated that at least 8 (range 2-12) days were needed for reliable calculation of most of the features in the 14-day time window. We observed that features such as sleep onset time correlated better with PHQ-8 scores cross-sectionally than longitudinally, whereas features such as wakefulness after sleep onset correlated well with PHQ-8 longitudinally but worse cross-sectionally. Finally, we found that participants could be separated into 3 distinct clusters according to their behavioral difference between periods of depression and periods of no depression. Conclusions: This work contributes to our understanding of how these mobile health?derived features are associated with depression symptom severity to inform future work in stratified analyses. UR - https://www.jmir.org/2023/1/e45233 UR - http://dx.doi.org/10.2196/45233 UR - http://www.ncbi.nlm.nih.gov/pubmed/37578823 ID - info:doi/10.2196/45233 ER - TY - JOUR AU - Forbes, Ainslie AU - Keleher, Rose Madeline AU - Venditto, Michael AU - DiBiasi, Faith PY - 2023/8/11 TI - Assessing Patient Adherence to and Engagement With Digital Interventions for Depression in Clinical Trials: Systematic Literature Review JO - J Med Internet Res SP - e43727 VL - 25 KW - digital therapeutics KW - digital interventions KW - digital health KW - mobile health KW - mobile phone KW - depression KW - major depressive disorder KW - engagement KW - adherence KW - systematic literature review N2 - Background: New approaches to the treatment of depression are necessary for patients who do not respond to current treatments or lack access to them because of barriers such as cost, stigma, and provider shortage. Digital interventions for depression are promising; however, low patient engagement could limit their effectiveness. Objective: This systematic literature review (SLR) assessed how participant adherence to and engagement with digital interventions for depression have been measured in the published literature, what levels of adherence and engagement have been reported, and whether higher adherence and increased engagement are linked to increased efficacy. Methods: We focused on a participant population of adults (aged ?18 years) with depression or major depressive disorder as the primary diagnosis and included clinical trials, feasibility studies, and pilot studies of digital interventions for treating depression, such as digital therapeutics. We screened 756 unique records from Ovid MEDLINE, Embase, and Cochrane published between January 1, 2000, and April 15, 2022; extracted data from and appraised the 94 studies meeting the inclusion criteria; and performed a primarily descriptive analysis. Otsuka Pharmaceutical Development & Commercialization, Inc (Princeton, New Jersey, United States) funded this study. Results: This SLR encompassed results from 20,111 participants in studies using 47 unique web-based interventions (an additional 10 web-based interventions were not described by name), 15 mobile app interventions, 5 app-based interventions that are also accessible via the web, and 1 CD-ROM. Adherence was most often measured as the percentage of participants who completed all available modules. Less than half (44.2%) of the participants completed all the modules; however, the average dose received was 60.7% of the available modules. Although engagement with digital interventions was measured differently in different studies, it was most commonly measured as the number of modules completed, the mean of which was 6.4 (means ranged from 1.0 to 19.7) modules. The mean amount of time participants engaged with the interventions was 3.9 (means ranged from 0.7 to 8.4) hours. Most studies of web-based (34/45, 76%) and app-based (8/9, 89%) interventions found that the intervention group had substantially greater improvement for at least 1 outcome than the control group (eg, care as usual, waitlist, or active control). Of the 14 studies that investigated the relationship between engagement and efficacy, 9 (64%) found that increased engagement with digital interventions was significantly associated with improved participant outcomes. The limitations of this SLR include publication bias, which may overstate engagement and efficacy, and low participant diversity, which reduces the generalizability. Conclusions: Patient adherence to and engagement with digital interventions for depression have been reported in the literature using various metrics. Arriving at more standardized ways of reporting adherence and engagement would enable more effective comparisons across different digital interventions, studies, and populations. UR - https://www.jmir.org/2023/1/e43727 UR - http://dx.doi.org/10.2196/43727 UR - http://www.ncbi.nlm.nih.gov/pubmed/37566447 ID - info:doi/10.2196/43727 ER - TY - JOUR AU - Jospe, R. Michelle AU - Marano, M. Kari AU - Bedoya, R. Arianna AU - Behrens, L. Nick AU - Cigan, Lacey AU - Villegas, Vanessa AU - Magee, F. Michelle AU - Marrero, G. David AU - Richardson, M. Kelli AU - Liao, Yue AU - Schembre, M. Susan PY - 2023/8/11 TI - Exploring the Impact of Dawn Phenomenon on Glucose-Guided Eating Thresholds in Individuals With Type 2 Diabetes Using Continuous Glucose Monitoring: Observational Study JO - JMIR Form Res SP - e46034 VL - 7 KW - glucose-guided eating KW - dawn phenomenon KW - eating timing KW - eating behavior KW - type 2 diabetes KW - appetite regulation KW - blood glucose self-monitoring KW - food intake regulation KW - glycemic control KW - continuous glucose monitoring KW - glucose KW - appetite KW - diabetes KW - diabetic KW - type 2 KW - monitoring KW - blood sugar KW - mobile phone N2 - Background: Glucose-guided eating (GGE) improves metabolic markers of chronic disease risk, including insulin resistance, in adults without diabetes. GGE is a timed eating paradigm that relies on experiencing feelings of hunger and having a preprandial glucose level below a personalized threshold computed from 2 consecutive morning fasting glucose levels. The dawn phenomenon (DP), which results in elevated morning preprandial glucose levels, could cause typically derived GGE thresholds to be unacceptable or ineffective among people with type 2 diabetes (T2DM). Objective: The aim of this study is to quantify the incidence and day-to-day variability in the magnitude of DP and examine its effect on morning preprandial glucose levels as a preliminary test of the feasibility of GGE in adults with T2DM. Methods: Study participants wore a single-blinded Dexcom G6 Pro continuous glucose monitoring (CGM) system for up to 10 days. First and last eating times and any overnight eating were reported using daily surveys over the study duration. DP was expressed as a dichotomous variable at the day level (DP day vs non-DP day) and as a continuous variable reflecting the percent of days DP was experienced on a valid day. A valid day was defined as having no reported overnight eating (between midnight and 6 AM). ? Glucose was computed as the difference in nocturnal glucose nadir (between midnight and 6 AM) to morning preprandial glucose levels. ? Glucose ?20 mg/dL constituted a DP day. Using multilevel modeling, we examined the between- and within-person effects of DP on morning preprandial glucose and the effect of evening eating times on DP. Results: In total, 21 adults (59% female; 13/21, 62%) with non?insulin-treated T2DM wore a CGM for an average of 10.5 (SD 1.1) days. Twenty out of 21 participants (95%) experienced DP for at least 1 day, with an average of 51% of days (SD 27.2; range 0%-100%). The mean ? glucose was 23.7 (SD 13.2) mg/dL. People who experience DP more frequently had a morning preprandial glucose level that was 54.1 (95% CI 17.0-83.9; P<.001) mg/dL higher than those who experienced DP less frequently. For within-person effect, morning preprandial glucose levels were 12.1 (95% CI 6.3-17.8; P=.008) mg/dL higher on a DP day than on a non-DP day. The association between ? glucose and preprandial glucose levels was 0.50 (95% CI 0.37-0.60; P<.001). There was no effect of the last eating time on DP. Conclusions: DP was experienced by most study participants regardless of last eating times. The magnitude of the within-person effect of DP on morning preprandial glucose levels was meaningful in the context of GGE. Alternative approaches for determining acceptable and effective GGE thresholds for people with T2DM should be explored and evaluated. UR - https://formative.jmir.org/2023/1/e46034 UR - http://dx.doi.org/10.2196/46034 UR - http://www.ncbi.nlm.nih.gov/pubmed/37566445 ID - info:doi/10.2196/46034 ER - TY - JOUR AU - Li, Qingchuan AU - Luximon, Yan AU - Zhang, Jiaxin PY - 2023/8/10 TI - The Influence of Anthropomorphic Cues on Patients? Perceived Anthropomorphism, Social Presence, Trust Building, and Acceptance of Health Care Conversational Agents: Within-Subject Web-Based Experiment JO - J Med Internet Res SP - e44479 VL - 25 KW - anthropomorphic cues KW - intelligent guidance conversational agents KW - social presence KW - trust KW - technology acceptance KW - mindful and mindless anthropomorphism N2 - Background: The last decade has witnessed the rapid development of health care conversational agents (CAs); however, there are still great challenges in making health care CAs trustworthy and acceptable to patients. Objective: Focusing on intelligent guidance CAs, a type of health care CA for web-based patient triage, this study aims to investigate how anthropomorphic cues influence patients? perceived anthropomorphism and social presence of such CAs and evaluate how these perceptions facilitate their trust-building process and acceptance behavior. Methods: To test the research hypotheses, the video vignette methodology was used to evaluate patients? perceptions and acceptance of various intelligent guidance CAs. The anthropomorphic cues of CAs were manipulated in a 3×2 within-subject factorial experiment with 103 participants, with the factors of agent appearance (high, medium, and low anthropomorphic levels) and verbal cues (humanlike and machine-like verbal cues) as the within-subject variables. Results: The 2-way repeated measures ANOVA analysis indicated that the higher anthropomorphic level of agent appearance significantly increased mindful anthropomorphism (high level>medium level: 4.57 vs 4.27; P=.01; high level>low level: 4.57 vs 4.04; P<.001; medium level>low level: 4.27 vs 4.04; P=.04), mindless anthropomorphism (high level>medium level: 5.39 vs 5.01; P<.001; high level>low level: 5.39 vs 4.85; P<.001), and social presence (high level>medium level: 5.19 vs 4.83; P<.001; high level>low level: 5.19 vs 4.72; P<.001), and the higher anthropomorphic level of verbal cues significantly increased mindful anthropomorphism (4.83 vs 3.76; P<.001), mindless anthropomorphism (5.60 vs 4.57; P<.001), and social presence (5.41 vs 4.41; P<.001). Meanwhile, a significant interaction between agent appearance and verbal cues (.004) was revealed. Second, the partial least squares results indicated that privacy concerns were negatively influenced by social presence (?=?.375; t312=4.494) and mindful anthropomorphism (?=?.112; t312=1.970). Privacy concerns (?=?.273; t312=9.558), social presence (?=.265; t312=4.314), and mindless anthropomorphism (?=.405; t312=7.145) predicted the trust in CAs, which further promoted the intention to disclose information (?=.675; t312=21.163), the intention to continuously use CAs (?=.190; t312=4.874), and satisfaction (?=.818; t312=46.783). Conclusions: The findings show that a high anthropomorphic level of agent appearance and verbal cues could improve the perceptions of mindful anthropomorphism and mindless anthropomorphism as well as social presence. Furthermore, mindless anthropomorphism and social presence significantly promoted patients? trust in CAs, and mindful anthropomorphism and social presence decreased privacy concerns. It is also worth noting that trust was an important antecedent and determinant of patients? acceptance of CAs, including their satisfaction, intention to disclose information, and intention to continuously use CAs. UR - https://www.jmir.org/2023/1/e44479 UR - http://dx.doi.org/10.2196/44479 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561567 ID - info:doi/10.2196/44479 ER - TY - JOUR AU - Guo, Monica AU - Brar Prayaga, Rena AU - Levitz, E. Carly AU - Kuo, S. Elena AU - Ruiz, Esmeralda AU - Torres-Ozadali, Evelyn AU - Escaron, Anne PY - 2023/8/10 TI - Tailoring a Text Messaging and Fotonovela Program to Increase Patient Engagement in Colorectal Cancer Screening in a Large Urban Community Clinic Population: Quality Improvement Project JO - JMIR Cancer SP - e43024 VL - 9 KW - colorectal cancer screening KW - texting program KW - fotonovela KW - fecal immunochemical test KW - FIT KW - FIT kit KW - thematic analysis KW - mobile phone N2 - Background: Appropriate annual screenings for colorectal cancer (CRC) are an essential preventive measure for the second-leading cause of cancer-related death in the United States. Studies have shown that CRC screening rates are influenced by various social determinants of health (SDOH) factors, including race, ethnicity, and geography. According to 2018 national data, participation in screening is lowest among Hispanic or Latinx individuals (56.1%). At an urban Federally Qualified Health Center, a quality improvement project was conducted to evaluate a texting program with a motivational fotonovela?a short narrative comic. Fotonovelas have previously been used in programs to improve knowledge of cervical cancer and human papillomavirus, vaccinations, and treatments for depression. Objective: This study aimed to encourage compliance with fecal immunochemical test (FIT) screening. Patient engagement involved a texting program with fotonovelas informed by behavior change techniques. This study sought to understand the qualitative characteristics of patient motivation, intention, and barriers to completing their screening. Methods: A total of 5241 English-speaking or Spanish-speaking Federally Qualified Health Center patients aged 50 to 75 years were randomized to either intervention (a 4-week tailored 2-way texting program with a fotonovela comic) or usual care (an SMS text message reminder and patient navigator phone call). The texting vendor used a proprietary algorithm to categorize patients in the intervention group into SDOH bands based on their home addresses (high impact=high social needs and low impact=low social needs). Over 4 weeks, patients were texted questions about receiving and returning their FIT, what barriers they may be experiencing, and their thoughts about the fotonovela. Results: The SDOH index analysis showed that most of the patient population was in the SDOH band categories of high impact (555/2597, 21.37%) and very high impact (1416/2597, 54.52%). Patients sent 1969 total responses to the texting system. Thematic analysis identified 3 major themes in these responses: messages as a reminder, where patients reported that they were motivated to return the FIT and had already done so or would do so as soon as possible; increasing patients? understanding of screening importance, where patients expressed an increased knowledge about the purpose and importance of the FIT; and expressing barriers, where patients shared reasons for not completing the FIT. Conclusions: The texting program and fotonovela engaged a subset of patients in each SDOH band, including the high and very high impact bands. Creating culturally tailored messages can encourage patient engagement for accepting the content of the messaging, confirming intentions to complete their FIT, and sharing insights about barriers to behavior change. To better support all patients across the continuum of care with CRC screening, it is important to continue to develop and assess strategies that engage patients who did not return their home-mailed FIT. UR - https://cancer.jmir.org/2023/1/e43024 UR - http://dx.doi.org/10.2196/43024 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561562 ID - info:doi/10.2196/43024 ER - TY - JOUR AU - Rai, Amneet AU - Riddle, Mark AU - Mishra, Rajendra AU - Nguyen, Nhien AU - Valine, Kelly AU - Fenney, Megan PY - 2023/8/10 TI - Use of a Smartphone-Based Medication Adherence Platform to Improve Outcomes in Uncontrolled Type 2 Diabetes Among Veterans: Prospective Case-Crossover Study JO - JMIR Diabetes SP - e44297 VL - 8 KW - application KW - biguanide KW - blood glucose KW - case-crossover KW - diabetes management KW - diabetes KW - diabetic KW - digital health intervention KW - epidemiology KW - glucose monitoring KW - glucose KW - HbgA1c KW - hemoglobin A1c KW - hemoglobin KW - hyperlipidemia KW - hypertension KW - interquartile range KW - IQR KW - MAS KW - Medication Adherence Scores KW - medication adherence KW - mobile health intervention KW - mobile phone KW - odds ratio KW - paired t test KW - quasi experimental KW - SEAMS KW - Self-Efficacy for Appropriate Medication Use Scale KW - smartphone KW - sulfonylurea KW - T2DM KW - Type 2 Diabetes Mellitus KW - veteran N2 - Background: Medication nonadherence is a problem that impacts both the patient and the health system. Objective: The objective of this study was to evaluate the impact of a novel smartphone app with patient-response-directed clinical intervention on medication adherence and blood glucose control in noninsulin-dependent patients with type 2 diabetes mellitus (T2DM). Methods: We enrolled 50 participants with T2DM not on insulin with smartphones from a rural health care center in Northern Nevada for participation in this case-crossover study. Participants underwent a standard of care arm and an intervention arm. Each study arm was 3 months long, for a total of 6 months of follow-up. Participants had a hemoglobin A1c (HbA1c) lab draw at enrollment, 3 months, and 6 months. Participants had monthly ?medication adherence scores? (MAS) and ?Self-Efficacy for Appropriate Medication Use Scale? (SEAMS) questionnaires completed at baseline and monthly for the duration of the study. Our primary outcomes of interest were the changes in HbA1c between study arms. Secondary outcomes included the evaluation of the difference in the proportion of participants achieving a clinically meaningful reduction in HbA1c and the difference in the number of participants requiring diabetes therapy escalation between study arms. Exploratory outcomes included the analysis of the variation in medication possession ratio (MPR), MAS, and SEAMS during each study arm. Results: A total of 30 participants completed both study arms and were included in the analysis. Dropouts were higher in participants enrolled in the standard of care arm first (9/25, 36% vs 4/25, 16%). Participants had a median HbA1c of 9.1%, had been living with T2DM for 6 years, had a median age of 66 years, and had a median of 8.5 medications. HbA1c reduction was 0.69% in the intervention arm versus 0.35% in the standard of care arm (P=.30). A total of 70% (21/30) of participants achieved a clinically meaningful reduction in HbA1c of 0.5% in the app intervention arm versus 40% (12/30) in the standard of care arm (odds ratio 2.29, 95% CI 0.94-5.6; P=.09). Participants had higher odds of a therapy escalation while in the standard of care arm (18/30, 60% vs 5/30, 16.7%, odds ratio 4.3, 95% CI 1.2-15.2; P=.02). The median MPR prior to enrollment was 109%, 112% during the study?s intervention arm, and 102% during the standard of care arm. The median real-time MAS was 93.2%. The change in MAS (1 vs ?0.1; P=.02) and SEAMS (1.9 vs ?0.2; P<.001) from baseline to month 3 was higher in the intervention arm compared to standard of care. Conclusions: A novel smartphone app with patient-response-directed provider intervention holds promise in the ability to improve blood glucose control in complex non?insulin-dependent T2DM and is worthy of additional study. UR - https://diabetes.jmir.org/2023/1/e44297 UR - http://dx.doi.org/10.2196/44297 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561555 ID - info:doi/10.2196/44297 ER - TY - JOUR AU - Wu, Chao-Yi AU - Tibbitts, Deanne AU - Beattie, Zachary AU - Dodge, Hiroko AU - Shannon, Jackilen AU - Kaye, Jeffrey AU - Winters-Stone, Kerri PY - 2023/8/10 TI - Using Continuous Passive Assessment Technology to Describe Health and Behavior Patterns Preceding and Following a Cancer Diagnosis in Older Adults: Proof-of-Concept Case Series Study JO - JMIR Form Res SP - e45693 VL - 7 KW - sensor KW - quality of life KW - physical activity KW - medication KW - monitoring KW - function KW - mobile phone N2 - Background: Describing changes in health and behavior that precede and follow a sentinel health event, such as a cancer diagnosis, is challenging because of the lack of longitudinal, objective measurements that are collected frequently enough to capture varying trajectories of change leading up to and following the event. A continuous passive assessment system that continuously monitors older adults? physical activity, weight, medication-taking behavior, pain, health events, and mood could enable the identification of more specific health and behavior patterns leading up to a cancer diagnosis and whether and how patterns change thereafter. Objective: In this study, we conducted a proof-of-concept retrospective analysis, in which we identified new cancer diagnoses in older adults and compared trajectories of change in health and behaviors before and after cancer diagnosis. Methods: Participants were 10 older adults (mean age 71.8, SD 4.9 years; 3/10, 30% female) with various self-reported cancer types from a larger prospective cohort study of older adults. A technology-agnostic assessment platform using multiple devices provided continuous data on daily physical activity via wearable sensors (actigraphy); weight via a Wi-Fi?enabled digital scale; daily medication-taking behavior using electronic Bluetooth-enabled pillboxes; and weekly pain, health events, and mood with online, self-report surveys. Results: Longitudinal linear mixed-effects models revealed significant differences in the pre- and postcancer trajectories of step counts (P<.001), step count variability (P=.004), weight (P<.001), pain severity (P<.001), hospitalization or emergency room visits (P=.03), days away from home overnight (P=.01), and the number of pillbox door openings (P<.001). Over the year preceding a cancer diagnosis, there were gradual reductions in step counts and weight and gradual increases in pain severity, step count variability, hospitalization or emergency room visits, and days away from home overnight compared with 1 year after the cancer diagnosis. Across the year after the cancer diagnosis, there was a gradual increase in the number of pillbox door openings compared with 1 year before the cancer diagnosis. There was no significant trajectory change from the pre? to post?cancer diagnosis period in terms of low mood (P=.60) and loneliness (P=.22). Conclusions: A home-based, technology-agnostic, and multidomain assessment platform could provide a unique approach to monitoring different types of behavior and health markers in parallel before and after a life-changing health event. Continuous passive monitoring that is ecologically valid, less prone to bias, and limits participant burden could greatly enhance research that aims to improve early detection efforts, clinical care, and outcomes for people with cancer. UR - https://formative.jmir.org/2023/1/e45693 UR - http://dx.doi.org/10.2196/45693 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561574 ID - info:doi/10.2196/45693 ER - TY - JOUR AU - Fischer, Ann-Kathrin AU - Mühlbacher, C. Axel PY - 2023/8/10 TI - Patient and Public Acceptance of Digital Technologies in Health Care: Protocol for a Discrete Choice Experiment JO - JMIR Res Protoc SP - e46056 VL - 12 KW - health preference research KW - stated preference survey KW - discrete choice experiment KW - study protocol KW - digital transformation KW - digital technologies KW - digital interventions KW - health care KW - rehabilitation KW - stroke KW - mobile phone N2 - Background: Strokes pose a particular challenge to the health care system. Although stroke-related mortality has declined in recent decades, the absolute number of new strokes (incidence), stroke deaths, and survivors of stroke has increased. With the increasing need of neurorehabilitation and the decreasing number of professionals, innovations are needed to ensure adequate care. Digital technologies are increasingly used to meet patients? unfilled needs during their patient journey. Patients must adhere to unfamiliar digital technologies to engage in health interventions. Therefore, the acceptance of the benefits and burdens of digital technologies in health interventions is a key factor in implementing these innovations. Objective: This study aims to describe the development of a discrete choice experiment (DCE) to weigh criteria that impact patient and public acceptance. Secondary study objectives are a benefit-burden assessment (estimation of the maximum acceptable burden of technical features and therapy-related characteristics for the patient or individual, eg, no human contact), overall comparison (assessment of the relative importance of attributes for comparing digital technologies), and adherence (identification of key attributes that influence patient adherence). The exploratory objectives include heterogeneity assessment and subgroup analysis. The methodological aims are to investigate the use of DCE. Methods: To obtain information on the criteria impacting acceptance, a DCE will be conducted including 7 attributes based on formative qualitative research. Patients with stroke (experimental group) and the general population (control group) are surveyed. The final instrument includes 6 best-best choice tasks in partial design. The experimental design is a fractional-factorial efficient Bayesian design (D-error). A conditional logit regression model and mixed logistic regression models will be used for analysis. To consider the heterogeneity of subgroups, a latent class analysis and an analysis of heteroscedasticity will be performed. Results: The literature review, qualitative preliminary study, survey development, and pretesting were completed. Data collection and analysis will be completed in the last quarter of 2023. Conclusions: Our results will inform decision makers about patients? and publics? acceptance of digital technologies used in innovative interventions. The patient preference information will improve decisions regarding the development, adoption, and pricing of innovative interventions. The behavioral changes in the choice of digital intervention alternatives are observable and can therefore be statistically analyzed. They can be translated into preferences, which define the value. This study will investigate the influences on the acceptance of digital interventions and thus support decisions and future research. International Registered Report Identifier (IRRID): DERR1-10.2196/46056 UR - https://www.researchprotocols.org/2023/1/e46056 UR - http://dx.doi.org/10.2196/46056 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561559 ID - info:doi/10.2196/46056 ER - TY - JOUR AU - Sarhaddi, Fatemeh AU - Azimi, Iman AU - Niela-Vilen, Hannakaisa AU - Axelin, Anna AU - Liljeberg, Pasi AU - Rahmani, M. Amir PY - 2023/8/9 TI - Maternal Social Loneliness Detection Using Passive Sensing Through Continuous Monitoring in Everyday Settings: Longitudinal Study JO - JMIR Form Res SP - e47950 VL - 7 KW - health monitoring KW - internet of things KW - maternal loneliness KW - passive sensing KW - wearable device N2 - Background: Maternal loneliness is associated with adverse physical and mental health outcomes for both the mother and her child. Detecting maternal loneliness noninvasively through wearable devices and passive sensing provides opportunities to prevent or reduce the impact of loneliness on the health and well-being of the mother and her child. Objective: The aim of this study is to use objective health data collected passively by a wearable device to predict maternal (social) loneliness during pregnancy and the postpartum period and identify the important objective physiological parameters in loneliness detection. Methods: We conducted a longitudinal study using smartwatches to continuously collect physiological data from 31 women during pregnancy and the postpartum period. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire in gestational week 36 and again at 12 weeks post partum. Responses to this questionnaire and background information of the participants were collected through our customized cross-platform mobile app. We leveraged participants? smartwatch data from the 7 days before and the day of their completion of the UCLA questionnaire for loneliness prediction. We categorized the loneliness scores from the UCLA questionnaire as loneliness (scores?12) and nonloneliness (scores<12). We developed decision tree and gradient-boosting models to predict loneliness. We evaluated the models by using leave-one-participant-out cross-validation. Moreover, we discussed the importance of extracted health parameters in our models for loneliness prediction. Results: The gradient boosting and decision tree models predicted maternal social loneliness with weighted F1-scores of 0.897 and 0.872, respectively. Our results also show that loneliness is highly associated with activity intensity and activity distribution during the day. In addition, resting heart rate (HR) and resting HR variability (HRV) were correlated with loneliness. Conclusions: Our results show the potential benefit and feasibility of using passive sensing with a smartwatch to predict maternal loneliness. Our developed machine learning models achieved a high F1-score for loneliness prediction. We also show that intensity of activity, activity pattern, and resting HR and HRV are good predictors of loneliness. These results indicate the intervention opportunities made available by wearable devices and predictive models to improve maternal well-being through early detection of loneliness. UR - https://formative.jmir.org/2023/1/e47950 UR - http://dx.doi.org/10.2196/47950 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556183 ID - info:doi/10.2196/47950 ER - TY - JOUR AU - Ngah, Emerencia Yayah AU - Raoufi, Ghazal AU - Amirkhani, Maral AU - Esmaeili, Ashkan AU - Nikooifard, Rasa AU - Ghaemi Mood, Shidrokh AU - Rahmanian, Ava AU - Boltena, Tadesse Minyahil AU - Aga, Eresso AU - Neogi, Ujjwal AU - Ikomey Mondinde, George AU - El-Khatib, Ziad PY - 2023/8/9 TI - Testing the Impact of Phone Texting Reminders for Children's Immunization Appointments in Rural Cameroon: Protocol for a Nonrandomized Controlled Trial JO - JMIR Res Protoc SP - e47018 VL - 12 KW - immunization KW - children KW - Cameroon KW - digital health KW - global health KW - nonrandomized controlled trial KW - child vaccination N2 - Background: Globally, over 20 million children are unvaccinated and over 25 million missed their follow-up doses during the COVID-19 pandemic; thus, they face vaccine-preventable diseases and unnecessary deaths. This is especially the case for those with HIV or living in vulnerable settings. Using cell phones to send reminders to parents has been shown to improve vaccination rates. Objective: We aim to determine whether implementation of an automated SMS reminder will improve child vaccination rates in a turbulent, semiurban/semirural setting in a low-income country. Methods: This will be a nonrandomized controlled trial that will be conducted at Azire Integrated Health Centre, Bamenda, Cameroon. Results: A total of 200 parents per study group (aged over 18 years) who are registered at the clinic at least one month prior to the study will be recruited. The intervention group will receive 2 reminders: 1 week and 2 days prior to the scheduled vaccination. For those who miss their appointments, a reminder will be sent 1 week after their missed appointment. The control group will receive the regular care provided at the clinic. Baseline information, clinical visit data, and vaccination records will be collected for both groups. Descriptive statistics will be used to summarize baseline characteristics between and within clusters and groups. The Fisher exact test will be used to compare parent-child units who return for follow-up visits (as a percentage) and children vaccinated as scheduled (as a percentage) between the study groups. Finally, we will compare how many members of both study groups return for 1 follow-up visit using Kaplan-Meier survival analysis. Conclusions: Due to limited effective child vaccination interventions in unstable settings, this study will be of high importance for suggesting a holistic approach to improve child vaccination and public health. International Registered Report Identifier (IRRID): DERR1-10.2196/47018 UR - https://www.researchprotocols.org/2023/1/e47018 UR - http://dx.doi.org/10.2196/47018 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556178 ID - info:doi/10.2196/47018 ER - TY - JOUR AU - Smith, M. Sharissa AU - Bais, Babette AU - Ismaili M'hamdi, Hafez AU - Schermer, N. Maartje H. AU - Steegers-Theunissen, M. Regine P. PY - 2023/8/9 TI - Stimulating the Uptake of Preconception Care by Women With a Vulnerable Health Status Through mHealth App?Based Nudging (Pregnant Faster): Cocreation Design and Protocol for a Cohort Study JO - JMIR Res Protoc SP - e45293 VL - 12 KW - preconception care KW - periconception KW - health inequality KW - socioeconomic status KW - lifestyle KW - ethics KW - mobile health KW - mHealth KW - mental stressor KW - pregnancy KW - mobile phone N2 - Background: Women with a low socioeconomic status often have a vulnerable health status due to an accumulation of health-deteriorating factors such as poor lifestyle behaviors, including inadequate nutrition, mental stressors, and impaired health literacy and agency, which puts them at an unnecessary high risk of adverse pregnancy outcomes. Adequately preparing for pregnancy through preconception care (PCC) uptake and lifestyle improvement can improve these outcomes. We hypothesize that nudging is a successful way of encouraging engagement in PCC. A nudge is a behavioral intervention that changes choice behavior through influencing incentives. The mobile health (mHealth) app?based loyalty program Pregnant Faster aims to reward women in an ethically justified way and nudges to engage in pregnancy preparation by visiting a PCC consultation. Objective: Here, we first describe the process of the cocreation of the mHealth app Pregnant Faster that aims to increase engagement in pregnancy preparation by women with a vulnerable health status. Second, we describe the cohort study design to assess the feasibility of Pregnant Faster. Methods: The content of the app is based on the eHealth lifestyle coaching program Smarter Pregnancy, which has proven to be effective in ameliorating preconceptional lifestyle behaviors (folic acid, vegetables, fruits, smoking, and alcohol) and an interview study pertaining to the preferences of the target group with regard to an mHealth app stimulating PCC uptake. For moral guidance on the design, an ethical framework was developed based on the bioethical principles of Beauchamp and Childress. The app was further developed through iterative cocreation with the target group and health care providers. For 4 weeks, participants will engage with Pregnant Faster, during which opportunities will arise to earn coins such as reading informative blogs and registering for a PCC consultation. Coins can be spent on small fun rewards, such as folic acid, fruits, and mascara. Pregnant Faster?s feasibility will be tested in a study including 40 women aged 18 to 45 years, who are preconceptional or <8 weeks pregnant, with a low educational level, and living in a deprived neighborhood. The latter 2 factors will serve as a proxy of a low socioeconomic status. Recruitment will take place through flyers, social media, and health care practices. After finalization, participants will evaluate the app through the ?mHealth App Usability Questionnaire? and additional interviews or questionnaires. Results: Results are expected to be published by December 2023. Conclusions: Pregnant Faster has been designed through iterative cocreation with the target group and health care professionals. With the designed study, we will test Pregnant Faster?s feasibility. If overall user satisfaction and PCC uptake is achieved, the app will be further developed and the cohort will be continued with an additional 400 inclusions to establish effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/45293 UR - https://www.researchprotocols.org/2023/1/e45293 UR - http://dx.doi.org/10.2196/45293 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556197 ID - info:doi/10.2196/45293 ER - TY - JOUR AU - Wanberg, J. Lindsey AU - Kim, Angela AU - Vogel, I. Rachel AU - Sadak, Thomas Karim AU - Teoh, Deanna PY - 2023/8/8 TI - Usability and Satisfaction Testing of Game-Based Learning Avatar-Navigated Mobile (GLAm), an App for Cervical Cancer Screening: Mixed Methods Study JO - JMIR Form Res SP - e45541 VL - 7 KW - cancer screening KW - cervical cancer screening KW - cervical cancer KW - Game-based Learning Avatar-navigated mobile KW - health care app KW - mixed methods study KW - mobile health KW - mobile technology KW - Pap test KW - usability testing KW - young adult health care N2 - Background: Barriers to cervical cancer screening in young adults include a lack of knowledge and negative perceptions of testing. Evidence shows that mobile technology reduces these barriers; thus, we developed a web app, Game-based Learning Avatar-navigated mobile (GLAm), to educate and motivate cervical cancer screening using the Fogg Behavioral Model as a theoretic guide. Users create avatars to navigate the app, answer short quizzes with education about cervical cancer and screening, watch videos of the screening process, and earn digital trophies. Objective: We tested ease of use, usefulness, and satisfaction with the GLAm app among young adults. Methods: This mixed methods study comprised a qualitative think-aloud play interview session and a quantitative survey study. Participants were cervical cancer screening?eligible US residents aged 21 to 29 years recruited through social media. Qualitative study participants explored the app in a think-aloud play session conducted through videoconference. Data were analyzed using directed content analysis to identify themes of ease of use, usefulness, and content satisfaction. Qualitative study participants and additional participants then used the app independently for 1 week and completed a web-based survey (the quantitative study). Ease of use, usefulness, and satisfaction were assessed using the validated Technology Acceptance Model and Computer System Usability Questionnaire adapted to use of an app. Mean (SD) scores (range 1-7) are presented. Results: A total of 23 individuals participated in one or both study components. The mean age was 25.6 years. A majority were cisgender women (21/23, 91%) and White (18/23, 78%), and 83% (19/23) had at least some secondary education. Nine participants completed the think-aloud play session. Direct content analysis showed desire for content that is concise, eases anxiety around screenings, and uses game features (avatars and rewards). Twenty-three individuals completed the quantitative survey study. Mean scores showed the app was perceived to be easy to use (mean score 6.17, SD 0.27) and moderately useful to increase cervical cancer screening knowledge and uptake (mean score 4.94, SD 0.27). Participants were highly satisfied with the app (mean score 6.21, SD 1.20). Conclusions: Survey results showed participants were satisfied with the app format and found it easy to use. The app was perceived to be moderately useful to inform and motivate cervical cancer screening; notably, the screening reminder function was not tested in this study. Qualitative study results demonstrated the app?s ability to ease anxiety about screening through demonstration of the screening process, and brevity of app components was favored. Interpretation of results is limited by the predominantly cisgender, White, and educated study population; additional testing in populations which historically have lower cervical cancer screening uptake is needed. A modified version of the app is undergoing efficacy testing in a randomized clinical trial. UR - https://formative.jmir.org/2023/1/e45541 UR - http://dx.doi.org/10.2196/45541 UR - http://www.ncbi.nlm.nih.gov/pubmed/37552527 ID - info:doi/10.2196/45541 ER - TY - JOUR AU - Jung, Miyeon AU - Lee, Byul Sae AU - Lee, Won Jong AU - Park, Rang Yu AU - Chung, Haekwon AU - Min, Ha Yul AU - Park, Jin Hye AU - Lee, Minsun AU - Chung, Seockhoon AU - Son, Ho Byung AU - Ahn, Sei-Hyun AU - Chung, Yong Il PY - 2023/8/7 TI - The Impact of a Mobile Support Group on Distress and Physical Activity in Breast Cancer Survivors: Randomized, Parallel-Group, Open-Label, Controlled Trial JO - J Med Internet Res SP - e47158 VL - 25 KW - breast neoplasms KW - mental distress KW - mobile apps KW - mobile health intervention KW - mobile phone KW - physical activity KW - randomized controlled trial KW - RCT KW - support group KW - survivorship KW - telemedicine N2 - Background: While mobile health apps have demonstrated their potential in revolutionizing health behavior changes, the impact of a mobile community built on these apps on the level of physical activity and mental well-being in cancer survivors remains unexplored. Objective: In this randomized controlled trial, we examine the effects of participation in a mobile health community specifically designed for breast cancer survivors on their physical activity levels and mental distress. Methods: We performed a single-center, randomized, parallel-group, open-label, controlled trial. This trial enrolled women between 20 and 60 years of age with stage 0 to III breast cancer, an Eastern Cooperative Oncology Group performance status of 0, and the capability of using their own smartphone apps. From January 7, 2019, to April 17, 2020, a total of 2,616 patients were consecutively screened for eligibility after breast cancer surgery. Overall, 202 patients were enrolled in this trial, and 186 patients were randomly assigned (1:1) to either the intervention group (engagement in a mobile peer support community using an app for tracking steps; n=93) or the control group (using the app for step tracking only; n=93) with a block size of 10 without stratification. The mobile app provides a visual interface of daily step counts, while the community function also provides rankings among its members and regular notifications encouraging physical activity. The primary end point was the rate of moderate to severe distress for the 24-week study period, measured through an app-based survey using the Distress Thermometer. The secondary end point was the total weekly steps during the 24-week period. Results: After excluding dropouts, 85 patients in the intervention group and 90 patients in the control group were included in the analysis. Multivariate analyses showed that patients in the intervention group had a significantly lower degree of moderate to severe distress (B=?0.558; odds ratio 0.572; P<.001) and a higher number of total weekly step counts (B=0.125; rate ratio 1.132; P<.001) during the 24-week period. Conclusions: Engagement in a mobile app?based patient community was effective in reducing mental distress and increasing physical activity in breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03783481; https://classic.clinicaltrials.gov/ct2/show/NCT03783481 UR - https://www.jmir.org/2023/1/e47158 UR - http://dx.doi.org/10.2196/47158 UR - http://www.ncbi.nlm.nih.gov/pubmed/37549004 ID - info:doi/10.2196/47158 ER - TY - JOUR AU - Viduani, Anna AU - Cosenza, Victor AU - Fisher, L. Helen AU - Buchweitz, Claudia AU - Piccin, Jader AU - Pereira, Rivka AU - Kohrt, A. Brandon AU - Mondelli, Valeria AU - van Heerden, Alastair AU - Araújo, Matsumura Ricardo AU - Kieling, Christian PY - 2023/8/7 TI - Assessing Mood With the Identifying Depression Early in Adolescence Chatbot (IDEABot): Development and Implementation Study JO - JMIR Hum Factors SP - e44388 VL - 10 KW - depression KW - adolescent KW - ambulatory assessment KW - chatbot KW - smartphone KW - digital mental health KW - mobile phone N2 - Background: Mental health status assessment is mostly limited to clinical or research settings, but recent technological advances provide new opportunities for measurement using more ecological approaches. Leveraging apps already in use by individuals on their smartphones, such as chatbots, could be a useful approach to capture subjective reports of mood in the moment. Objective: This study aimed to describe the development and implementation of the Identifying Depression Early in Adolescence Chatbot (IDEABot), a WhatsApp-based tool designed for collecting intensive longitudinal data on adolescents? mood. Methods: The IDEABot was developed to collect data from Brazilian adolescents via WhatsApp as part of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study. It supports the administration and collection of self-reported structured items or questionnaires and audio responses. The development explored WhatsApp?s default features, such as emojis and recorded audio messages, and focused on scripting relevant and acceptable conversations. The IDEABot supports 5 types of interactions: textual and audio questions, administration of a version of the Short Mood and Feelings Questionnaire, unprompted interactions, and a snooze function. Six adolescents (n=4, 67% male participants and n=2, 33% female participants) aged 16 to 18 years tested the initial version of the IDEABot and were engaged to codevelop the final version of the app. The IDEABot was subsequently used for data collection in the second- and third-year follow-ups of the IDEA-RiSCo study. Results: The adolescents assessed the initial version of the IDEABot as enjoyable and made suggestions for improvements that were subsequently implemented. The IDEABot?s final version follows a structured script with the choice of answer based on exact text matches throughout 15 days. The implementation of the IDEABot in 2 waves of the IDEA-RiSCo sample (140 and 132 eligible adolescents in the second- and third-year follow-ups, respectively) evidenced adequate engagement indicators, with good acceptance for using the tool (113/140, 80.7% and 122/132, 92.4% for second- and third-year follow-up use, respectively), low attrition (only 1/113, 0.9% and 1/122, 0.8%, respectively, failed to engage in the protocol after initial interaction), and high compliance in terms of the proportion of responses in relation to the total number of elicited prompts (12.8, SD 3.5; 91% out of 14 possible interactions and 10.57, SD 3.4; 76% out of 14 possible interactions, respectively). Conclusions: The IDEABot is a frugal app that leverages an existing app already in daily use by our target population. It follows a simple rule-based approach that can be easily tested and implemented in diverse settings and possibly diminishes the burden of intensive data collection for participants by repurposing WhatsApp. In this context, the IDEABot appears as an acceptable and potentially scalable tool for gathering momentary information that can enhance our understanding of mood fluctuations and development. UR - https://humanfactors.jmir.org/2023/1/e44388 UR - http://dx.doi.org/10.2196/44388 UR - http://www.ncbi.nlm.nih.gov/pubmed/37548996 ID - info:doi/10.2196/44388 ER - TY - JOUR AU - Guan, Vivienne AU - Zhou, Chenghuai AU - Wan, Hengyi AU - Zhou, Rengui AU - Zhang, Dongfa AU - Zhang, Sihan AU - Yang, Wangli AU - Voutharoja, Prakash Bhanu AU - Wang, Lei AU - Win, Than Khin AU - Wang, Peng PY - 2023/8/7 TI - A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study JO - JMIR Form Res SP - e46839 VL - 7 KW - food KW - diet KW - mobile health KW - mHealth KW - persuasive technology KW - gamification KW - computer vision KW - cloud computing KW - design science research KW - mobile phone N2 - Background: The Australian Dietary Guidelines (ADG) translate the best available evidence in nutrition into food choice recommendations. However, adherence to the ADG is poor in Australia. Given that following a healthy diet can be a potentially cost-effective strategy for lowering the risk of chronic diseases, there is an urgent need to develop novel technologies for individuals to improve their adherence to the ADG. Objective: This study describes the development process and design of a prototype mobile app for personalized dietary advice based on the ADG for adults in Australia, with the aim of exploring the usability of the prototype. The goal of the prototype was to provide personalized, evidence-based support for self-managing food choices in real time. Methods: The guidelines of the design science paradigm were applied to guide the design, development, and evaluation of a progressive web app using Amazon Web Services Elastic Compute Cloud services via iterations. The food layer of the Nutrition Care Process, the strategies of cognitive behavioral theory, and the ADG were translated into prototype features guided by the Persuasive Systems Design model. A gain-framed approach was adopted to promote positive behavior changes. A cross-modal image-to-recipe retrieval model under an Apache 2.0 license was deployed for dietary assessment. A survey using the Mobile Application Rating Scale and semistructured in-depth interviews were conducted to explore the usability of the prototype through convenience sampling (N=15). Results: The prominent features of the prototype included the use of image-based dietary assessment, food choice tracking with immediate feedback leveraging gamification principles, personal goal setting for food choices, and the provision of recipe ideas and information on the ADG. The overall prototype quality score was ?acceptable,? with a median of 3.46 (IQR 2.78-3.81) out of 5 points. The median score of the perceived impact of the prototype on healthy eating based on the ADG was 3.83 (IQR 2.75-4.08) out of 5 points. In-depth interviews identified the use of gamification for tracking food choices and innovation in the image-based dietary assessment as the main drivers of the positive user experience of using the prototype. Conclusions: A novel evidence-based prototype mobile app was successfully developed by leveraging a cross-disciplinary collaboration. A detailed description of the development process and design of the prototype enhances its transparency and provides detailed insights into its creation. This study provides a valuable example of the development of a novel, evidence-based app for personalized dietary advice on food choices using recent advancements in computer vision. A revised version of this prototype is currently under development. UR - https://formative.jmir.org/2023/1/e46839 UR - http://dx.doi.org/10.2196/46839 UR - http://www.ncbi.nlm.nih.gov/pubmed/37549000 ID - info:doi/10.2196/46839 ER - TY - JOUR AU - Schwartz, Katrin AU - Ganster, Marie Fabienne AU - Tran, S. Ulrich PY - 2023/8/4 TI - Mindfulness-Based Mobile Apps and Their Impact on Well-Being in Nonclinical Populations: Systematic Review of Randomized Controlled Trials JO - J Med Internet Res SP - e44638 VL - 25 KW - mindfulness KW - well-being KW - mobile app KW - systematic review KW - randomized controlled trial KW - RCT KW - mobile phone N2 - Background: Mindfulness-based mobile apps have become popular tools for enhancing well-being in today?s fast-paced world. Their ability to reduce geographical, financial, and social barriers makes them a promising alternative to traditional interventions. Objective: As most available apps lack a theoretical framework, this review aimed to evaluate their effectiveness and assess their quality. We expected to find small sample sizes, high dropout rates, and small effect sizes in the included studies. Methods: A systematic literature search was conducted using PsycInfo, PsycNet, PubMed, an institutional search engine (u:search), and Google Scholar. Randomized controlled trials assessing the impact of mobile mindfulness apps on well-being in nonclinical samples were included. Study selection, risk of bias (using the version 2 of the Cochrane risk-of-bias tool for randomized trials), and reporting quality (using selected CONSORT [Consolidated Standards of Reporting Trials] statement criteria) assessments were performed by 2 authors independently and discussed until a consensus was reached. Results: The 28 included randomized controlled trials differed in well-being measures, apps, and intervention duration (7 to 56 days; median duration 28 days). A wide range of sample sizes (12 to 2282; median 161) and attrition rates (0% to 84.7%; median rate 23.4%) were observed. Most studies (19/28, 68%) reported positive effects on at least one aspect of well-being. The effects were presented using different metrics but were primarily small or small to medium in size. Overall risk of bias was mostly high. Conclusions: The wide range of sample sizes, attrition rates, and intervention periods and the variation in well-being measures and mobile apps contributed to the limited comparability of the studies. Although most studies (16/28, 57%) reported small or small to medium effects for at least one well-being outcome, this review demonstrates that the generalizability of the results is limited. Further research is needed to obtain more consistent conclusions regarding the impact of mindfulness-based mobile apps on well-being in nonclinical populations. UR - https://www.jmir.org/2023/1/e44638 UR - http://dx.doi.org/10.2196/44638 UR - http://www.ncbi.nlm.nih.gov/pubmed/37540550 ID - info:doi/10.2196/44638 ER - TY - JOUR AU - Mehra, Richa AU - Pulman, Andy AU - Dogan, Huseyin AU - Murphy, Jane AU - Bitters, Fiona PY - 2023/8/4 TI - A Tailored mHealth App for Improving Health and Well-Being Behavioral Transformation in UK Police Workers: Usability Testing via a Mixed Methods Study JO - JMIR Hum Factors SP - e42912 VL - 10 KW - nutrition KW - activity KW - behavior change KW - telemedicine KW - mobile health KW - police KW - lifestyle management KW - management KW - usability testing KW - design KW - build KW - prototype KW - testing KW - survey KW - interview KW - development KW - user center KW - officer KW - law enforcement KW - cop KW - detective KW - policeman KW - policing KW - mobile phone N2 - Background: When considering the policing environment of 2022, many roles previously in the domain of warranted officers (police officer) are now performed by nonwarranted police staff equivalents. These police staff roles have expanded rapidly into other areas such as investigations, custody, and contact management, which were traditionally seen as police officer functions and put staff under some of the same stresses as police officers. A UK police force requested help in investigating technologies that could be used to improve health and well-being for both officers and staff. Objective: The aim of this study was to create a health and well-being app for police officers and staff, which considered the unique requirements of the users throughout the designing, building, prototyping, and testing stages. Methods: This study involved quantitative approaches (demographic web-based survey questions and the System Usability Scale) and qualitative approaches (open web-based survey questions and semistructured interviews). Unsupervised usability testing of a prototype app was undertaken by members (N=48) of the commissioning client using their smartphones. After completing a preregistration application for screening purposes, participants downloaded a trial version of the app. Then, they completed a web-based questionnaire after testing the app for 10 days. A subsample of participants (9/48, 19%) was interviewed. Deductive thematic analysis was undertaken to identify key themes and subthemes. Results: Data collected during usability testing concerned the 6 domains of the app?food and diet, activity, fluid intake, sleep, good mental health, and financial well-being?and informed the creation of improved design during prototyping. Some usability and design issues and suggestions for improvements were also addressed and implemented?including shift management and catch-up cards?during this cycle of development. Conclusions: This study highlights the importance of coparticipation with officers and staff across the entire development cycle, to coproduce a human-centered design methodology to enable the development of a considered and user-centered solution. It demonstrates the need for producing a multifunctional tool rather than focusing purely on an individual element for this user group. It also highlights how linking and being able to track optional, personalized elements of health data against one another, cross-referenced to individual shift patterns, might help to inform and provide users with a chance for reflection and therefore influence behavior change. UR - https://humanfactors.jmir.org/2023/1/e42912 UR - http://dx.doi.org/10.2196/42912 UR - http://www.ncbi.nlm.nih.gov/pubmed/37540549 ID - info:doi/10.2196/42912 ER - TY - JOUR AU - Kowahl, Nathan AU - Shin, Sooyoon AU - Barman, Poulami AU - Rainaldi, Erin AU - Popham, Sara AU - Kapur, Ritu PY - 2023/8/3 TI - Accuracy and Reliability of a Suite of Digital Measures of Walking Generated Using a Wrist-Worn Sensor in Healthy Individuals: Performance Characterization Study JO - JMIR Hum Factors SP - e48270 VL - 10 KW - digital measurements KW - wearable technology KW - mobility measurements KW - walking patterns KW - wearable KW - wearables KW - sensor KW - sensors KW - mobility KW - measurement KW - measurements KW - walk KW - walking KW - gait KW - step KW - wrist-worn KW - reliability KW - accuracy N2 - Background: Mobility is a meaningful aspect of an individual?s health whose quantification can provide clinical insights. Wearable sensor technology can quantify walking behaviors (a key aspect of mobility) through continuous passive monitoring. Objective: Our objective was to characterize the analytical performance (accuracy and reliability) of a suite of digital measures of walking behaviors as critical aspects in the practical implementation of digital measures into clinical studies. Methods: We collected data from a wrist-worn device (the Verily Study Watch) worn for multiple days by a cohort of volunteer participants without a history of gait or walking impairment in a real-world setting. On the basis of step measurements computed in 10-second epochs from sensor data, we generated individual daily aggregates (participant-days) to derive a suite of measures of walking: step count, walking bout duration, number of total walking bouts, number of long walking bouts, number of short walking bouts, peak 30-minute walking cadence, and peak 30-minute walking pace. To characterize the accuracy of the measures, we examined agreement with truth labels generated by a concurrent, ankle-worn, reference device (Modus StepWatch 4) with known low error, calculating the following metrics: intraclass correlation coefficient (ICC), Pearson r coefficient, mean error, and mean absolute error. To characterize the reliability, we developed a novel approach to identify the time to reach a reliable readout (time to reliability) for each measure. This was accomplished by computing mean values over aggregation scopes ranging from 1 to 30 days and analyzing test-retest reliability based on ICCs between adjacent (nonoverlapping) time windows for each measure. Results: In the accuracy characterization, we collected data for a total of 162 participant-days from a testing cohort (n=35 participants; median observation time 5 days). Agreement with the reference device?based readouts in the testing subcohort (n=35) for the 8 measurements under evaluation, as reflected by ICCs, ranged between 0.7 and 0.9; Pearson r values were all greater than 0.75, and all reached statistical significance (P<.001). For the time-to-reliability characterization, we collected data for a total of 15,120 participant-days (overall cohort N=234; median observation time 119 days). All digital measures achieved an ICC between adjacent readouts of >0.75 by 16 days of wear time. Conclusions: We characterized the accuracy and reliability of a suite of digital measures that provides comprehensive information about walking behaviors in real-world settings. These results, which report the level of agreement with high-accuracy reference labels and the time duration required to establish reliable measure readouts, can guide the practical implementation of these measures into clinical studies. Well-characterized tools to quantify walking behaviors in research contexts can provide valuable clinical information about general population cohorts and patients with specific conditions. UR - https://humanfactors.jmir.org/2023/1/e48270 UR - http://dx.doi.org/10.2196/48270 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535417 ID - info:doi/10.2196/48270 ER - TY - JOUR AU - Kangarloo, Tairmae AU - Mote, Jasmine AU - Abplanalp, Samuel AU - Gold, Alisa AU - James, Peter AU - Gard, David AU - Fulford, Daniel PY - 2023/8/3 TI - The Influence of Greenspace Exposure on Affect in People With and Those Without Schizophrenia: Exploratory Study JO - JMIR Form Res SP - e44323 VL - 7 KW - greenspace KW - mental health KW - mobile technology KW - affect KW - smartphone KW - sensing KW - schizophrenia KW - natural vegetation KW - exposure KW - assessment KW - mechanism N2 - Background: Exposure to natural vegetation (ie, ?greenspace?) is related to beneficial outcomes, including higher positive and lower negative affect, in individuals with and those without mental health concerns. Researchers have yet to examine dynamic associations between greenspace exposure and affect within individuals over time. Smartphone-based ecological momentary assessment (EMA) and passive sensors (eg, GPS, microphone) allow for frequent sampling of data that may reveal potential moment-to-moment mechanisms through which greenspace exposure impacts mental health. Objective: In this study, we examined associations between greenspace exposure and affect (both self-reported and inferred through speech) in people with and those without schizophrenia spectrum disorder (SSD) at the daily level using smartphones. Methods: Twenty people with SSD and 14 healthy controls reported on their current affect 3 times per day over 7 days using smartphone-based EMA. Affect expressed through speech was labeled from ambient audio data collected via the phone?s microphone using Linguistic Inquiry and Word Count (LIWC). Greenspace exposure, defined as the normalized difference vegetation index (NDVI), was quantified based on continuous geo-location data collected from the phone?s GPS. Results: Overall, people with SSD used significantly more positive affect words (P=.04) and fewer anger words (P=.04) than controls. Groups did not significantly differ in mean EMA-reported positive or negative affect, LIWC total word count, or NDVI exposure. Greater greenspace exposure showed small to moderate associations with lower EMA-reported negative affect across groups. In controls, greenspace exposure on a given day was associated with significantly lower EMA-reported anxiety on that day (b=?0.40, P=.03, 95% CI ?0.76 to ?0.04) but significantly higher use of negative affect words (b=0.66, P<.001, 95% CI 0.29-1.04). There were no significant associations between greenspace exposure and affect at the daily level among participants with SSD. Conclusions: Our findings speak to the utility of passive and active smartphone assessments for identifying potential mechanisms through which greenspace exposure influences mental health. We identified preliminary evidence that greenspace exposure could be associated with improved mental health by reducing experiences of negative affect. Future directions will focus on furthering our understanding of the relationship between greenspace exposure and affect on individuals with and those without SSD. UR - https://formative.jmir.org/2023/1/e44323 UR - http://dx.doi.org/10.2196/44323 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535418 ID - info:doi/10.2196/44323 ER - TY - JOUR AU - Zolnowski-Kolp, Victoria AU - Um Din, Nathavy AU - Havreng-Théry, Charlotte AU - Pariel, Sylvie AU - Veyron, Jacques-Henri AU - Lafuente-Lafuente, Carmelo AU - Belmin, Joel PY - 2023/8/2 TI - Assessment of Frailty by the French Version of the Vulnerable Elders Survey-13 on Digital Tablet: Validation Study JO - J Med Internet Res SP - e42017 VL - 25 KW - frailty KW - Vulnerable Elders Survey-13 (VES-13) KW - elderly KW - older people KW - family caregivers KW - French version KW - electronic assessment KW - digital technology KW - digital health KW - eHealth KW - tablet KW - validity N2 - Background: Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor. Objective: This study aims to design an electronic version of the Echelle de Vulnérabilité des Ainés-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it. Methods: The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0× 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the ? coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire. Results: In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5%) and 10 (25%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent (?=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95% CI?1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95% CI 0.994-0.998) for the paper and tablet group and 0.977 (95% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5% (31/40) of patients and by 96% (44/46) of caregivers. Finally, 85% (39/46) of family caregivers and 50% (20/40) of patients preferred the eEVA-13 to the original version. Conclusions: The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them. UR - https://www.jmir.org/2023/1/e42017 UR - http://dx.doi.org/10.2196/42017 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531175 ID - info:doi/10.2196/42017 ER - TY - JOUR AU - Labarta, I. José AU - Dimitri, Paul AU - Keiser, Matthew AU - Koledova, Ekaterina AU - Rivera-Romero, Octavio PY - 2023/8/2 TI - Evaluating the Usefulness and Ease of Use of a Next-Generation?Connected Drug Delivery Device for Growth Hormone Therapy: Qualitative Study of Health Care Professionals? Perceptions JO - JMIR Hum Factors SP - e46893 VL - 10 KW - connected health KW - growth hormone deficiency KW - participatory health informatics KW - recombinant human growth hormone KW - technology acceptance KW - mobile phone N2 - Background: Digital solutions targeting children?s health have become an increasingly important element in the provision of integrated health care. For the treatment of growth hormone deficiency (GHD), a unique connected device is available to facilitate the delivery of recombinant human growth hormone (r-hGH) by automating the daily injection process and collecting injection data such that accurate adherence information is available to health care professionals (HCPs), caregivers, and patients. The adoption of such digital solutions requires a good understanding of the perspectives of HCPs as key stakeholders because they leverage data collection and prescribe these solutions to their patients. Objective: This study aimed to evaluate the third generation of the easypod device (EP3) for the delivery of r-hGH treatment from the HCP perspective, with a focus on perceived usefulness and ease of use. Methods: A qualitative study was conducted, based on a participatory workshop conducted in Zaragoza, Spain, with 10 HCPs experienced in the management of pediatric GHD from 7 reference hospitals in Spain. Several activities were designed to promote discussion among participants about predefined topics based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology to provide their perceptions about the new device. Results: Participants reported 2 key advantages of EP3 over previous easypod generations: the touch screen interface and the real-time data transmission functionality. All participants (10/10, 100%) agreed that the new device should be part of a digital health ecosystem that provides complementary functionalities including data analysis. Conclusions: This study explored the perceived value of the EP3 autoinjector device for the treatment of GHD by HCPs. HCPs rated the new capabilities of the device as having substantial improvements and concluded that it was highly recommendable for clinical practice. EP3 will enhance decision-making and allow for more personalized care of patients receiving r-hGH. UR - https://humanfactors.jmir.org/2023/1/e46893 UR - http://dx.doi.org/10.2196/46893 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531173 ID - info:doi/10.2196/46893 ER - TY - JOUR AU - Soltero, Erica AU - Lopez, Callie AU - Mihail, Sandra AU - Hernandez, Ayleen AU - Musaad, M. Salma AU - O'Connor, M. Teresia AU - Thompson, Debbe PY - 2023/8/2 TI - An SMS Text Message?Based Type 2 Diabetes Prevention Program for Hispanic Adolescents With Obesity: Qualitative Co-Design Process JO - JMIR Form Res SP - e46606 VL - 7 KW - Hispanic health KW - adolescents KW - digital health KW - physical activity KW - sleep KW - type 2 diabetes KW - mobile phone KW - smartphone N2 - Background: SMS text message?based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators. Objective: This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity. Methods: The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message?based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement. Results: The background phase revealed that few SMS text message?based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages. Conclusions: Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message?based strategies among high-risk adolescents. International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2023.107117 UR - https://formative.jmir.org/2023/1/e46606 UR - http://dx.doi.org/10.2196/46606 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531191 ID - info:doi/10.2196/46606 ER - TY - JOUR AU - Sapanel, Yoann AU - Tadeo, Xavier AU - Brenna, A. Connor T. AU - Remus, Alexandria AU - Koerber, Florian AU - Cloutier, Martin L. AU - Tremblay, Gabriel AU - Blasiak, Agata AU - Hardesty, L. Chris AU - Yoong, Joanne AU - Ho, Dean PY - 2023/8/1 TI - Economic Evaluation Associated With Clinical-Grade Mobile App?Based Digital Therapeutic Interventions: Systematic Review JO - J Med Internet Res SP - e47094 VL - 25 KW - digital health KW - digital therapeutics KW - economic evaluation KW - cost-effectiveness KW - mobile phone KW - systematic review N2 - Background: Digital therapeutics (DTx), a class of software-based clinical interventions, are promising new technologies that can potentially prevent, manage, or treat a spectrum of medical disorders and diseases as well as deliver unprecedented portability for patients and scalability for health care providers. Their adoption and implementation were accelerated by the need for remote care during the COVID-19 pandemic, and awareness about their utility has rapidly grown among providers, payers, and regulators. Despite this, relatively little is known about the capacity of DTx to provide economic value in care. Objective: This study aimed to systematically review and summarize the published evidence regarding the cost-effectiveness of clinical-grade mobile app?based DTx and explore the factors affecting such evaluations. Methods: A systematic review of economic evaluations of clinical-grade mobile app?based DTx was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Major electronic databases, including PubMed, Cochrane Library, and Web of Science, were searched for eligible studies published from inception to October 28, 2022. Two independent reviewers evaluated the eligibility of all the retrieved articles for inclusion in the review. Methodological quality and risk of bias were assessed for each included study. Results: A total of 18 studies were included in this review. Of the 18 studies, 7 (39%) were nonrandomized study?based economic evaluations, 6 (33%) were model-based evaluations, and 5 (28%) were randomized clinical trial?based evaluations. The DTx intervention subject to assessment was found to be cost-effective in 12 (67%) studies, cost saving in 5 (28%) studies, and cost-effective in 1 (6%) study in only 1 of the 3 countries where it was being deployed in the final study. Qualitative deficiencies in methodology and substantial potential for bias, including risks of performance bias and selection bias in participant recruitment, were identified in several included studies. Conclusions: This systematic review supports the thesis that DTx interventions offer potential economic benefits. However, DTx economic analyses conducted to date exhibit important methodological shortcomings that must be addressed in future evaluations to reduce the uncertainty surrounding the widespread adoption of DTx interventions. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022358616; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022358616 UR - https://www.jmir.org/2023/1/e47094 UR - http://dx.doi.org/10.2196/47094 UR - http://www.ncbi.nlm.nih.gov/pubmed/37526973 ID - info:doi/10.2196/47094 ER - TY - JOUR AU - Bo, Yan AU - Liu, Ben Qianqian AU - Tong, Yu PY - 2023/7/28 TI - The Effects of Adopting Mobile Health and Fitness Apps on Hospital Visits: Quasi-Experimental Study JO - J Med Internet Res SP - e45681 VL - 25 KW - health and fitness apps KW - app adoption KW - app use KW - hospital visit KW - causal effect KW - health behavior KW - consumption level KW - city tier KW - digital literacy KW - hospitalization KW - admission KW - adoption KW - acceptance KW - mobile health KW - mHealth KW - fitness KW - exercise KW - physical activity KW - health app KW - fitness app KW - difference-in-differences N2 - Background: Overcrowding in public hospitals, a common issue in many countries, leads to a range of negative outcomes, such as insufficient access to medical services and patient dissatisfaction. Prior literature regarding solutions to reducing hospital overcrowding primarily focuses on organizational-level operational efficiency. However, few studies have investigated the strategies from the individual patient perspective. Specifically, we considered using mobile health and fitness apps to promote users? health behaviors and produce health benefits, thereby reducing hospital visits. Objective: This study estimated the causal effect of health and fitness app adoption on hospital visits by exploiting the staggered timing of adoption. We also investigated how the effect varied with users? socioeconomic status and digital literacy. This study provides causal evidence for the effects of health apps, extends the digital health literature, and sheds light on mobile health policies. Methods: This study used a data set containing health and fitness app use and hospital-related geolocation data of 267,651 Chinese mobile phone users from January to December 2019. We used the difference-in-differences and difference-in-difference-in-differences designs to estimate the causal effect. We performed a sensitivity analysis to establish the robustness of the findings. We also conducted heterogeneity analyses based on the interactions of postadoption indicators with users? consumption levels, city tiers, and digital literacy. Results: The preferred model (difference-in-difference-in-differences) showed a significant decrease in hospital visits after the adoption of health and fitness apps. App adoption led to a 5.8% (P<.001), 13.1% (P<.001), and 18.4% reduction (P<.001) in hospital visits 1, 2, and 3 months after adoption, respectively. In addition, the moderation analysis shows that the effect is greater for users with high consumption levels, in high-tier cities, or with high digital literacy. Conclusions: This study estimated the causal effect of health and fitness app adoption on hospital visits. The results and sensitivity analysis showed that app adoption can reduce users? hospital visits. The effect varies with users? consumption levels, city tiers, and digital literacy. These findings provide useful insights for multiple stakeholders in the Chinese health care context. UR - https://www.jmir.org/2023/1/e45681 UR - http://dx.doi.org/10.2196/45681 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505809 ID - info:doi/10.2196/45681 ER - TY - JOUR AU - Fang, E. Yichen AU - Zhang, Zhixian AU - Wang, Ray AU - Yang, Bolu AU - Chen, Chen AU - Nisa, Claudia AU - Tong, Xin AU - Yan, L. Lijing PY - 2023/7/28 TI - Effectiveness of eHealth Smoking Cessation Interventions: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e45111 VL - 25 KW - smoking cessation KW - systematic review KW - meta-analysis KW - electronic health KW - mobile health KW - eHealth KW - smoking KW - development KW - technology-assisted KW - effectiveness KW - screening KW - data extraction KW - user KW - design KW - mobile phone N2 - Background: Rapid advancements in eHealth and mobile health (mHealth) technologies have driven researchers to design and evaluate numerous technology-based interventions to promote smoking cessation. The evolving nature of cessation interventions emphasizes a strong need for knowledge synthesis. Objective: This systematic review and meta-analysis aimed to summarize recent evidence from randomized controlled trials regarding the effectiveness of eHealth-based smoking cessation interventions in promoting abstinence and assess nonabstinence outcome indicators, such as cigarette consumption and user satisfaction, via narrative synthesis. Methods: We searched for studies published in English between 2017 and June 30, 2022, in 4 databases: PubMed (including MEDLINE), PsycINFO, Embase, and Cochrane Library. Two independent reviewers performed study screening, data extraction, and quality assessment based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. We pooled comparable studies based on the population, follow-up time, intervention, and control characteristics. Two researchers performed an independent meta-analysis on smoking abstinence using the Sidik-Jonkman random-effects model and log risk ratio (RR) as the effect measurement. For studies not included in the meta-analysis, the outcomes were narratively synthesized. Results: A total of 464 studies were identified through an initial database search after removing duplicates. Following screening and full-text assessments, we deemed 39 studies (n=37,341 participants) eligible for this review. Of these, 28 studies were shortlisted for meta-analysis. According to the meta-analysis, SMS or app text messaging can significantly increase both short-term (3 months) abstinence (log RR=0.50, 95% CI 0.25-0.75; I2=0.72%) and long-term (6 months) abstinence (log RR=0.77, 95% CI 0.49-1.04; I2=8.65%), relative to minimal cessation support. The frequency of texting did not significantly influence treatment outcomes. mHealth apps may significantly increase abstinence in the short term (log RR=0.76, 95% CI 0.09-1.42; I2=88.02%) but not in the long term (log RR=0.15, 95% CI ?0.18 to 0.48; I2=80.06%), in contrast to less intensive cessation support. In addition, personalized or interactive interventions showed a moderate increase in cessation for both the short term (log RR=0.62, 95% CI 0.30-0.94; I2=66.50%) and long term (log RR=0.28, 95% CI 0.04-0.53; I2=73.42%). In contrast, studies without any personalized or interactive features had no significant impact. Finally, the treatment effect was similar between trials that used biochemically verified or self-reported abstinence. Among studies reporting outcomes besides abstinence (n=20), a total of 11 studies reported significantly improved nonabstinence outcomes in cigarette consumption (3/14, 21%) or user satisfaction (8/19, 42%). Conclusions: Our review of 39 randomized controlled trials found that recent eHealth interventions might promote smoking cessation, with mHealth being the dominant approach. Despite their success, the effectiveness of such interventions may diminish with time. The design of more personalized interventions could potentially benefit future studies. Trial Registration: PROSPERO CRD42022347104; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347104 UR - https://www.jmir.org/2023/1/e45111 UR - http://dx.doi.org/10.2196/45111 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505802 ID - info:doi/10.2196/45111 ER - TY - JOUR AU - Dai, Zhen AU - Mi, Guodong AU - Yu, Fei AU - Chen, Guodong AU - Wang, Xiaodong AU - He, Qinying PY - 2023/7/28 TI - Using a Geosocial Networking App to Investigate New HIV Infections and Related Risk Factors Among Student and Nonstudent Men Who Have Sex With Men in Chengdu, China: Open Cohort Study JO - J Med Internet Res SP - e43493 VL - 25 KW - geosocial networking app KW - GSN app KW - young men who have sex with men KW - MSM KW - HIV KW - incidence KW - risk factors KW - cohort study KW - smartphone KW - mobile phone N2 - Background: In China, condomless sex among men who have sex with men (MSM) is the primary route of HIV infection in young people. Chengdu is a hotspot for reported HIV cases among young people nationwide. Extensive use of geosocial networking (GSN) smartphone apps has dramatically changed the pattern of sexual behavior among young MSM (YMSM). However, data on HIV incidence and the risk behavior of YMSM using the GSN app are still obscure. Objective: This study aims to analyze and understand the HIV incidence and its risk factors among YMSM using GSN apps in Chengdu, China. Methods: An open cohort study was conducted among YMSM aged 18-24 years through a gay GSN smartphone app in Chengdu, China, from July 2018 to December 2020. Every participant completed a web-based questionnaire on sociodemographic characteristics, sexual behaviors, and other related statuses; made a reservation for a web-based HIV testing; and then voluntarily got tested at the designated testing site. At least one additional HIV test was taken via the app during the study period, and participants were evaluated at the end of the study or at the time of HIV seroconversion. By dividing the sum of the observed HIV seroconversions by the observed person-years, HIV incidence was calculated and compared between the student and nonstudent MSM. Univariate and multivariate (Cox proportional hazards regression) analyses were used to discuss the risk factors for new HIV infections. Results: In the study cohort, 24 seroconversions occurred among 625 YMSM who took at least two HIV tests through the app during the study period, contributing to 505 observed person-years. The HIV incidence rate per 100 person-years was 4.75 (95% CI 2.89-6.61) among all MSM, 3.60 (95% CI 1.27-5.93) among student MSM, and 5.88 (95% CI 2.97-8.79) among nonstudent MSM. In addition, the HIV incidence per 100 person-years was 11.11 (95% CI 4.49-17.73) among those who had resided in the area for 6 months or less and 7.14 (95% CI 1.52-12.77) among those with senior high school or less education. Two or more sexual partners (adjusted hazards ratio [HR] 3.63, 95% CI 1.08-12.23) in the preceding 6 months was a risk factor for new HIV infections. Consistent condom use for anal sex (adjusted HR 0.38, 95% CI 0.16-0.88) and insertive anal sex only (adjusted HR 0.10, 95% CI 0.01-0.75) in the preceding 6 months were protective factors for new HIV infections. Conclusions: The rate of new HIV infections among YMSM who actively used GSN smartphone apps was high, especially among migrant nonstudent MSM. Targeted interventions on GSN smartphone apps should be implemented to provide demand-adapted prevention and services to reduce the threat of HIV. UR - https://www.jmir.org/2023/1/e43493 UR - http://dx.doi.org/10.2196/43493 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505891 ID - info:doi/10.2196/43493 ER - TY - JOUR AU - Claessens, Janneau AU - Mueller-Schotte, Sigrid AU - van Weerden, Jeannette AU - Kort, Helianthe AU - Imhof, Saskia AU - Wisse, Robert PY - 2023/7/28 TI - The TeleTriageTeam, Offering Continuity of Personalized Care Through Telemedicine: Development and Evaluation JO - JMIR Hum Factors SP - e46145 VL - 10 KW - triaging KW - telehealth KW - telemedicine KW - remote care KW - ophthalmology KW - eye care KW - mobile phone KW - COVID-19 N2 - Background: The COVID-19 pandemic taught us how to rethink care delivery. It catalyzed creative solutions to amplify the potential of personnel and facilities. This paper presents and evaluates a promptly introduced triaging solution that evolved into a tool to tackle the ever-growing waiting lists at an academic ophthalmology department, the TeleTriageTeam (TTT). A team of undergraduate optometry students, tutor optometrists, and ophthalmologists collaborate to maintain continuity of eye care. In this ongoing project, we combine innovative interprofessional task allocation, teaching, and remote care delivery. Objective: In this paper, we described a novel approach, the TTT; reported its clinical effectiveness and impact on waiting lists; and discussed its transformation to a sustainable method for delivering remote eye care. Methods: Real-world clinical data of all patients assessed by the TTT between April 16, 2020, and December 31, 2021, are covered in this paper. Business data on waiting lists and patient portal access were collected from the capacity management team and IT department of our hospital. Interim analyses were performed at different time points during the project, and this study presents a synthesis of these analyses. Results: A total of 3658 cases were assessed by the TTT. For approximately half (1789/3658, 48.91%) of the assessed cases, an alternative to a conventional face-to-face consultation was found. The waiting lists that had built up during the first months of the pandemic diminished and have been stable since the end of 2020, even during periods of imposed lockdown restrictions and reduced capacity. Patient portal access decreased with age, and patients who were invited to perform a remote, web-based eye test at home were on average younger than patients who were not invited. Conclusions: Our promptly introduced approach to remotely review cases and prioritize urgency has been successful in maintaining continuity of care and education throughout the pandemic and has evolved into a telemedicine service that is of great interest for future purposes, especially in the routine follow-up of patients with chronic diseases. TTT appears to be a potentially preferred practice in other clinics and medical specialties. The paradox is that judicious clinical decision-making based on remotely collected data is possible, only if we as caregivers are willing to change our routines and cognitions regarding face-to-face care delivery. UR - https://humanfactors.jmir.org/2023/1/e46145 UR - http://dx.doi.org/10.2196/46145 UR - http://www.ncbi.nlm.nih.gov/pubmed/37311121 ID - info:doi/10.2196/46145 ER - TY - JOUR AU - Patel, S. Khushi AU - Corbett, F. Cynthia AU - Combs, M. Elizabeth AU - Donevant, B. Sara AU - Selph, J. Margaret AU - Gibson, M. Lynette AU - Dawson, M. Robin AU - Sheth, P. Amit AU - Hughes, G. Ronda PY - 2023/7/28 TI - Perceptions of COVID-19 and the Use of Health Information Technology Among People Who Are Uninsured: Multimethod Survey Study JO - JMIR Form Res SP - e45349 VL - 7 KW - COVID-19 KW - medically uninsured KW - medical informatics KW - telemedicine KW - mobile apps KW - health literacy KW - mobile phone N2 - Background: As of May 2023, the novel SARS-CoV-2 has claimed nearly 7 million lives globally and >1.1 million lives in the United States. Low-income populations are often disproportionately affected by risk factors such as lifestyle, employment, and limited health literacy. These populations may lack the knowledge of appropriate infection precautions or have reduced access to care during illness, particularly in countries without universal health care. Objective: We aimed to explore the perceptions and experiences of COVID-19, including symptoms and risk factors among uninsured individuals seeking care at a free medical clinic, and to obtain respondents? perceptions of and suggestions for adapting a mobile health (mHealth) app to an uninsured population known to have low health literacy. Methods: We conducted a prospective multimethod survey study with a convenience sample of uninsured adults seeking care at 3 free clinics in the United States. Respondents were questioned about their risk for and awareness of COVID-19 symptoms, COVID-19 testing, current technology use, and the use of technology to facilitate their health regarding COVID-19. Data were analyzed using descriptive statistics (eg, frequencies and mean differences). In addition, a small subset of respondents from one of the clinics (n=10) participated in interviews to provide feedback about the design of a COVID-19 web-based smartphone (mHealth) app. Results: The survey respondents (N=240) were 53.8% (n=129) female, were primarily White (n=113, 47.1%), and had a mean age of 50.0 (SD 11.67; range 19-72) years. Most respondents (162/222, 73%) did not think that they were at risk for COVID-19. Although respondents reported only moderate confidence in their knowledge of the short- and long-term symptoms of COVID-19, their knowledge of the symptoms aligned well with reports published by the Centers for Disease Control and Prevention of the most common acute (590/610, 96.7%) and long-term (217/271, 80.1%) symptoms. Most respondents (159/224, 71%) reported an interest in using the mHealth app to gain additional information regarding COVID-19 and available community resources. Respondents who were interviewed provided suggestions to improve the mHealth app but had overall positive perceptions about the potential usefulness and usability of the app. Conclusions: It was encouraging that the knowledge of COVID-19 symptoms aligned well with the reports published by the Centers for Disease Control and Prevention and that respondents were enthusiastic about using an mHealth app to monitor symptoms. However, it was concerning that most respondents did not think they were at a risk of contracting COVID-19. UR - https://formative.jmir.org/2023/1/e45349 UR - http://dx.doi.org/10.2196/45349 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505792 ID - info:doi/10.2196/45349 ER - TY - JOUR AU - Hietbrink, G. Eclaire A. AU - Oude Nijeweme-d?Hollosy, Wendy AU - Middelweerd, Anouk AU - Konijnendijk, J. Annemieke A. AU - Schrijver, K. Laura AU - ten Voorde, S. Anouk AU - Fokkema, S. Elise M. AU - Laverman, D. Gozewijn AU - Vollenbroek-Hutten, R. Miriam M. PY - 2023/7/28 TI - A Digital Coach (E-Supporter 1.0) to Support Physical Activity and a Healthy Diet in People With Type 2 Diabetes: Acceptability and Limited Efficacy Testing JO - JMIR Form Res SP - e45294 VL - 7 KW - eHealth KW - type 2 diabetes KW - physical activity KW - nutrition KW - lifestyle change KW - acceptability KW - limited efficacy KW - formative evaluation KW - mobile phone N2 - Background: A healthy lifestyle, including regular physical activity and a healthy diet, is increasingly part of type 2 diabetes (T2D) management. As many people with T2D have difficulty living and maintaining a healthy lifestyle, there is a need for effective interventions. eHealth interventions that incorporate behavior change theories and tailoring are considered effective tools for supporting a healthy lifestyle. The E-Supporter 1.0 digital coach contains eHealth content for app-based eHealth interventions and offers tailored coaching regarding physical activity and a healthy diet for people with T2D. Objective: This study aimed to assess the acceptability of E-Supporter 1.0 and explore its limited efficacy on physical activity, dietary behavior, the phase of behavior change, and self-efficacy levels. Methods: Over a span of 9 weeks, 20 individuals with T2D received daily motivational messages and weekly feedback derived from behavioral change theories and determinants through E-Supporter 1.0. The acceptability of the intervention was assessed using telephone-conducted, semistructured interviews. The interview transcripts were coded using inductive thematic analysis. The limited efficacy of E-Supporter 1.0 was explored using the Fitbit Charge 2 to monitor step count to assess physical activity and questionnaires to assess dietary behavior (using the Dutch Healthy Diet index), phase of behavior change (using the single-question Self-Assessment Scale Stages of Change), and self-efficacy levels (using the Exercise Self-Efficacy Scale). Results: In total, 5 main themes emerged from the interviews: perceptions regarding remote coaching, perceptions regarding the content, intervention intensity and duration, perceived effectiveness, and overall appreciation. The participants were predominantly positive about E-Supporter 1.0. Overall, they experienced E-Supporter 1.0 as a useful and easy-to-use intervention to support a better lifestyle. Participants expressed a preference for combining E-Supporter with face-to-face guidance from a health care professional. Many participants found the intensity and duration of the intervention to be acceptable, despite the coaching period appearing relatively short to facilitate long-term behavior maintenance. As expected, the degree of tailoring concerning the individual and external factors that influence a healthy lifestyle was perceived as limited. The limited efficacy testing showed a significant improvement in the daily step count (z=?2.040; P=.04) and self-efficacy levels (z=?1.997; P=.046) between baseline and postintervention. Diet was improved through better adherence to Dutch dietary guidelines. No significant improvement was found in the phase of behavior change (P=.17), as most participants were already in the maintenance phase at baseline. Conclusions: On the basis of this explorative feasibility study, we expect E-Supporter 1.0 to be an acceptable and potentially useful intervention to promote physical activity and a healthy diet in people with T2D. Additional work needs to be done to further tailor the E-Supporter content and evaluate its effects more extensively on lifestyle behaviors. UR - https://formative.jmir.org/2023/1/e45294 UR - http://dx.doi.org/10.2196/45294 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505804 ID - info:doi/10.2196/45294 ER - TY - JOUR AU - Maher, P. Jaclyn AU - Hevel, J. Derek AU - Bittel, M. Kelsey AU - Hudgins, L. Brynn AU - Labban, D. Jeffery AU - Kennedy-Malone, Laurie PY - 2023/7/28 TI - Studying Movement-Related Behavioral Maintenance and Adoption in Real Time: Protocol for an Intensive Ecological Momentary Assessment Study Among Older Adults JO - JMIR Res Protoc SP - e47320 VL - 12 KW - physical activity KW - sedentary behavior KW - aging KW - multiburst design KW - ambulatory assessment KW - experience sampling method KW - accelerometers KW - stage of change KW - dual process KW - motivation KW - mobile phone N2 - Background: Older adults struggle to maintain newly initiated levels of physical activity (PA) or sedentary behavior (SB) and often regress to baseline levels over time. This is partly because health behavior theories that inform interventions rarely address how the changing contexts of daily life influence the processes regulating PA and SB or how those processes differ across the behavior change continuum. Few studies have focused on motivational processes that regulate the dynamic nature of PA and SB adoption and maintenance on microtimescales (ie, across minutes, hours, or days). Objective: The overarching goal of Project Studying Maintenance and Adoption in Real Time (SMART) is to determine the motivational processes that regulate behavioral adoption versus maintenance over microtimescales, using a dual process framework combined with ecological momentary assessment and sensor-based monitoring of behavior. This paper describes the recruitment, enrollment, data collection, and analytics protocols for Project SMART. Methods: In Project SMART, older adults engaging in at least 30 minutes of moderate-to-vigorous intensity PA per week complete 3 data collection periods over 1 year, with each data collection period lasting 14 days. Across each data collection period, participants wear an ActiGraph GT3X accelerometer (ActiGraph, LLC) on their nondominant waist and an ActivPAL micro4 accelerometer (PAL Technologies, Ltd) on their anterior thigh to measure PA and SB, respectively. Ecological momentary assessment questionnaires are randomly delivered via smartphone 10 times per day on 4 selected days in each data collection period and assess reflective processes (eg, evaluating one?s efficacy and exerting self-control) and reactive processes (eg, contextual cues) within the dual process framework. At the beginning and end of each data collection period, participants complete a computer-based questionnaire to learn more about their typical motivation for PA and SB, physical and mental health, and life events over the course of the study. Results: Recruitment and enrollment began in January 2021; enrollment in the first data collection period was completed by February 2022; and all participants completed their second and third data collection by July 2022 and December 2022, respectively. Data were collected from 202 older adults during the first data collection period, with approximate retention rates of 90.1% (n=182) during the second data collection period and 88.1% (n=178) during the third data collection period. Multilevel models and mixed-effects location scale modeling will be used to evaluate the study aims. Conclusions: Project SMART seeks to predict and model the adoption and maintenance of optimal levels of PA and SB among older adults. In turn, this will inform the future delivery of personalized intervention content under conditions where the content will be most effective to promote sustained behavior change among older adults. International Registered Report Identifier (IRRID): DERR1-10.2196/47320 UR - https://www.researchprotocols.org/2023/1/e47320 UR - http://dx.doi.org/10.2196/47320 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505805 ID - info:doi/10.2196/47320 ER - TY - JOUR AU - Haddad, C. Tufia AU - Maita, C. Karla AU - Inselman, W. Jonathan AU - Avila, R. Francisco AU - Torres-Guzman, A. Ricardo AU - Coffey, D. Jordan AU - Christopherson, A. Laura AU - Leuenberger, M. Angela AU - Bell, J. Sarah AU - Pahl, F. Dominick AU - Garcia, P. John AU - Manka, Lukas AU - Forte, J. Antonio AU - Maniaci, J. Michael PY - 2023/7/27 TI - Patient Satisfaction With a Multisite, Multiregional Remote Patient Monitoring Program for Acute and Chronic Condition Management: Survey-Based Analysis JO - J Med Internet Res SP - e44528 VL - 25 KW - remote patient monitoring KW - patient satisfaction KW - postacute care KW - chronic conditions KW - acute conditions mobile phone N2 - Background: Remote patient monitoring (RPM) is an option for continuously managing the care of patients in the comfort of their homes or locations outside hospitals and clinics. Patient engagement with RPM programs is essential for achieving successful outcomes and high quality of care. When relying on technology to facilitate monitoring and shifting disease management to the home environment, it is important to understand the patients? experiences to enable quality improvement. Objective: This study aimed to describe patients? experiences and overall satisfaction with an RPM program for acute and chronic conditions in a multisite, multiregional health care system. Methods: Between January 1, 2021, and August 31, 2022, a patient experience survey was delivered via email to all patients enrolled in the RPM program. The survey encompassed 19 questions across 4 categories regarding comfort, equipment, communication, and overall experience, as well as 2 open-ended questions. Descriptive analysis of the survey response data was performed using frequency distribution and percentages. Results: Surveys were sent to 8535 patients. The survey response rate was 37.16% (3172/8535) and the completion rate was 95.23% (3172/3331). Survey results indicated that 88.97% (2783/3128) of participants agreed or strongly agreed that the program helped them feel comfortable managing their health from home. Furthermore, 93.58% (2873/3070) were satisfied with the RPM program and ready to graduate when meeting the program goals. In addition, patient confidence in this model of care was confirmed by 92.76% (2846/3068) of the participants who would recommend RPM to people with similar conditions. There were no differences in ease of technology use according to age. Those with high school or less education were more likely to agree that the equipment and educational materials helped them feel more informed about their care plans than those with higher education levels. Conclusions: This multisite, multiregional RPM program has become a reliable health care delivery model for the management of acute and chronic conditions outside hospitals and clinics. Program participants reported an excellent overall experience and a high level of satisfaction in managing their health from the comfort of their home environment. UR - https://www.jmir.org/2023/1/e44528 UR - http://dx.doi.org/10.2196/44528 UR - http://www.ncbi.nlm.nih.gov/pubmed/37343182 ID - info:doi/10.2196/44528 ER - TY - JOUR AU - Palmer, Melanie AU - Beckley-Hoelscher, Nicholas AU - Shearer, James AU - Kostyrka-Allchorne, Katarzyna AU - Robertson, Olly AU - Koch, Marta AU - Pearson, Oliver AU - Slovak, Petr AU - Day, Crispin AU - Byford, Sarah AU - Goldsmith, Kimberley AU - Waite, Polly AU - Creswell, Cathy AU - Sonuga-Barke, S. Edmund J. PY - 2023/7/27 TI - The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort JO - J Med Internet Res SP - e44079 VL - 25 KW - parenting KW - intervention KW - digital application KW - randomized controlled trial KW - COVID-19 pandemic KW - mobile phone N2 - Background: Children?s conduct and emotional problems increased during the COVID-19 pandemic. Objective: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). Methods: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families? mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. Results: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=?0.01) or T3 (secondary outcome; standardized effect=?0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=?0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. Conclusions: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 UR - https://www.jmir.org/2023/1/e44079 UR - http://dx.doi.org/10.2196/44079 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498669 ID - info:doi/10.2196/44079 ER - TY - JOUR AU - Woelfle, Tim AU - Bourguignon, Lucie AU - Lorscheider, Johannes AU - Kappos, Ludwig AU - Naegelin, Yvonne AU - Jutzeler, Ruth Catherine PY - 2023/7/27 TI - Wearable Sensor Technologies to Assess Motor Functions in People With Multiple Sclerosis: Systematic Scoping Review and Perspective JO - J Med Internet Res SP - e44428 VL - 25 KW - multiple sclerosis KW - digital biomarkers KW - digital health technologies KW - digital mobility outcomes KW - wearables KW - sensors KW - inertial motion unit KW - accelerometry KW - actigraphy KW - review N2 - Background: Wearable sensor technologies have the potential to improve monitoring in people with multiple sclerosis (MS) and inform timely disease management decisions. Evidence of the utility of wearable sensor technologies in people with MS is accumulating but is generally limited to specific subgroups of patients, clinical or laboratory settings, and functional domains. Objective: This review aims to provide a comprehensive overview of all studies that have used wearable sensors to assess, monitor, and quantify motor function in people with MS during daily activities or in a controlled laboratory setting and to shed light on the technological advances over the past decades. Methods: We systematically reviewed studies on wearable sensors to assess the motor performance of people with MS. We scanned PubMed, Scopus, Embase, and Web of Science databases until December 31, 2022, considering search terms ?multiple sclerosis? and those associated with wearable technologies and included all studies assessing motor functions. The types of results from relevant studies were systematically mapped into 9 predefined categories (association with clinical scores or other measures; test-retest reliability; group differences, 3 types; responsiveness to change or intervention; and acceptability to study participants), and the reporting quality was determined through 9 questions. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Results: Of the 1251 identified publications, 308 were included: 176 (57.1%) in a real-world context, 107 (34.7%) in a laboratory context, and 25 (8.1%) in a mixed context. Most publications studied physical activity (196/308, 63.6%), followed by gait (81/308, 26.3%), dexterity or tremor (38/308, 12.3%), and balance (34/308, 11%). In the laboratory setting, outcome measures included (in addition to clinical severity scores) 2- and 6-minute walking tests, timed 25-foot walking test, timed up and go, stair climbing, balance tests, and finger-to-nose test, among others. The most popular anatomical landmarks for wearable placement were the waist, wrist, and lower back. Triaxial accelerometers were most commonly used (229/308, 74.4%). A surge in the number of sensors embedded in smartphones and smartwatches has been observed. Overall, the reporting quality was good. Conclusions: Continuous monitoring with wearable sensors could optimize the management of people with MS, but some hurdles still exist to full clinical adoption of digital monitoring. Despite a possible publication bias and vast heterogeneity in the outcomes reported, our review provides an overview of the current literature on wearable sensor technologies used for people with MS and highlights shortcomings, such as the lack of harmonization, transparency in reporting methods and results, and limited data availability for the research community. These limitations need to be addressed for the growing implementation of wearable sensor technologies in clinical routine and clinical trials, which is of utmost importance for further progress in clinical research and daily management of people with MS. Trial Registration: PROSPERO CRD42021243249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=243249 UR - https://www.jmir.org/2023/1/e44428 UR - http://dx.doi.org/10.2196/44428 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498655 ID - info:doi/10.2196/44428 ER - TY - JOUR AU - Weis, Joachim AU - Wolf, Raphaela Lucy AU - Boerries, Melanie AU - Kassahn, Daniela AU - Boeker, Martin AU - Dresch, Carolin PY - 2023/7/27 TI - Identification of the Needs and Preferences of Patients With Cancer for the Development of a Clinic App: Qualitative Study JO - JMIR Cancer SP - e40891 VL - 9 KW - cancer KW - mobile app KW - mHealth KW - mobile health KW - needs assessment KW - patient-centered care KW - PROM KW - patient-reported outcome measures KW - qualitative methods N2 - Background: Mobile health (mHealth) tools were developed during the past decades and are increasingly used by patients in cancer care too. Scientific research in the development of mHealth services is required in order to meet the various needs of patients and test usability. Objective: The aim of this study is to assess patients? needs, preferences, and usability of an app (My University Clinic [MUC] app) developed by the Comprehensive Cancer Center Freiburg (CCCF) Germany. Methods: Based on a qualitative cross-sectional approach, we conducted semistructured interviews with patients with cancer, addressing their needs, preferences, and usability of the designed MUC app. Patients treated by the CCCF were recruited based on a purposive sampling technique focusing on age, sex, cancer diagnoses, and treatment setting (inpatient, outpatient). Data analysis followed the qualitative content analysis according to Kuckartz and was performed using computer-assisted software (MAXQDA). Results: For the interviews, 17 patients with cancer were selected, covering a broad range of sampling parameters. The results showed that patients expect benefits in terms of improved information about the disease and communication with the clinic staff. Demands for additional features were identified (eg, a list of contact persons and medication management). The most important concerns referred to data security and the potential restriction of personal contacts with health care professionals of the clinical departments of the CCCF. In addition, some features for improving the design of the MUC app with respect to usability or for inclusion of interacting tools were suggested by the patients. Conclusions: The results of this qualitative study were discussed within the multidisciplinary team and the MUC app providers. Patients? perspectives and needs will be included in further development of the MUC app. There will be a second study phase in which patients will receive a test version of the MUC app and will be asked about their experiences with it. Trial Registration: Deutsches Register Klinischer Studien DRKS00022162; https://drks.de/search/de/trial/DRKS00022162 UR - https://cancer.jmir.org/2023/1/e40891 UR - http://dx.doi.org/10.2196/40891 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498653 ID - info:doi/10.2196/40891 ER - TY - JOUR AU - McClure, A. Erin AU - Baker, Nathaniel AU - Walters, J. Kyle AU - Tomko, L. Rachel AU - Carpenter, J. Matthew AU - Bradley, Elizabeth AU - Squeglia, M. Lindsay AU - Gray, M. Kevin PY - 2023/7/27 TI - Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study JO - JMIR Form Res SP - e47662 VL - 7 KW - technology KW - mHealth KW - young adults KW - cessation KW - relapse KW - biochemical verification KW - cigarette KW - smoking KW - monitoring KW - abstinence KW - mobile phone N2 - Background: Technological advancements to study young adult smoking, relapse, and to deliver interventions remotely offer conceptual appeal, but the incorporation of technological enhancement must demonstrate benefit over traditional methods without adversely affecting outcomes. Further, integrating remote biochemical verification of smoking and abstinence may yield value in the confirmation of self-reported smoking, in addition to ecologically valid, real-time assessments. Objective: The goal of this study was to evaluate the impact of remote biochemical verification on 24-hour self-reported smoking and biochemical verification agreement, retention, compliance with remote sessions, and abstinence during a brief, 5-week cessation attempt and relapse monitoring phase. Methods: Participants (N=39; aged 18-25 years; mean age 21.6, SD 2.1 years; n=22, 56% male; n=29, 74% White) who smoked cigarettes daily engaged in a 5-week cessation and monitoring study (including a 48-hour quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence during the 2-day quit attempt only). Smoking (cigarettes per day) was self-reported through ecological momentary assessment (EMA) procedures, and participants were randomized to either (1) the inclusion of remote biochemical verification (EMA + remote carbon monoxide [rCO]) 2× per day or (2) in-person, weekly CO (wCO). Groups were compared on the following outcomes: (1) agreement in self-reported smoking and breath carbon monoxide (CO) at common study time points, (2) EMA session compliance, (3) retention in study procedures, and (4) abstinence from smoking during the 2-day quit attempt and at the end of the 5-week study. Results: No significant differences were demonstrated between the rCO group and the wCO (weekly in-person study visit) group on agreement between 24-hour self-reported smoking and breath CO (moderate to poor), compliance with remote sessions, or retention, though these outcomes numerically favored the wCO group. Abstinence was numerically higher in the wCO group after the 2-day quit attempt and significantly different at the end of treatment (day 35), favoring the wCO group. Conclusions: Though study results should be interpreted with caution given the small sample size, findings suggest that the inclusion of rCO breath added to EMA compared to EMA with weekly, in-person CO collection in young adults did not yield benefit and may have even adversely affected outcomes. Our results suggest that technological advancements may improve data accuracy through objective measurement but may also introduce barriers and burdens and could result in higher rates of missing data. The inclusion of technology to inform smoking cessation research and intervention delivery among young adults should consider (1) the research question and necessity of biochemical verification and then (2) how to seamlessly incorporate monitoring into personalized and dynamic systems to avoid the added burden and detrimental effects to compliance and honesty in self-report. UR - https://formative.jmir.org/2023/1/e47662 UR - http://dx.doi.org/10.2196/47662 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498643 ID - info:doi/10.2196/47662 ER - TY - JOUR AU - Duarte, Miguel AU - Pereira-Rodrigues, Pedro AU - Ferreira-Santos, Daniela PY - 2023/7/26 TI - The Role of Novel Digital Clinical Tools in the Screening or Diagnosis of Obstructive Sleep Apnea: Systematic Review JO - J Med Internet Res SP - e47735 VL - 25 KW - obstructive sleep apnea KW - diagnosis KW - digital tools KW - smartphone KW - wearables KW - sensor KW - polysomnography KW - systematic review KW - mobile phone N2 - Background: Digital clinical tools are a new technology that can be used in the screening or diagnosis of obstructive sleep apnea (OSA), notwithstanding the crucial role of polysomnography, the gold standard. Objective: This study aimed to identify, gather, and analyze the most accurate digital tools and smartphone-based health platforms used for OSA screening or diagnosis in the adult population. Methods: We performed a comprehensive literature search of PubMed, Scopus, and Web of Science databases for studies evaluating the validity of digital tools in OSA screening or diagnosis until November 2022. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for diagnostic test accuracy studies. The sensitivity, specificity, and area under the curve (AUC) were used as discrimination measures. Results: We retrieved 1714 articles, 41 (2.39%) of which were included in the study. From these 41 articles, we found 7 (17%) smartphone-based tools, 10 (24%) wearables, 11 (27%) bed or mattress sensors, 5 (12%) nasal airflow devices, and 8 (20%) other sensors that did not fit the previous categories. Only 8 (20%) of the 41 studies performed external validation of the developed tool. Of these, the highest reported values for AUC, sensitivity, and specificity were 0.99, 96%, and 92%, respectively, for a clinical cutoff of apnea-hypopnea index (AHI)?30. These values correspond to a noncontact audio recorder that records sleep sounds, which are then analyzed by a deep learning technique that automatically detects sleep apnea events, calculates the AHI, and identifies OSA. Looking at the studies that only internally validated their models, the work that reported the highest accuracy measures showed AUC, sensitivity, and specificity values of 1.00, 100%, and 96%, respectively, for a clinical cutoff AHI?30. It uses the Sonomat?a foam mattress that, aside from recording breath sounds, has pressure sensors that generate voltage when deformed, thus detecting respiratory movements, and uses it to classify OSA events. Conclusions: These clinical tools presented promising results with high discrimination measures (best results reached AUC>0.99). However, there is still a need for quality studies comparing the developed tools with the gold standard and validating them in external populations and other environments before they can be used in clinical settings. Trial Registration: PROSPERO CRD42023387748; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387748 UR - https://www.jmir.org/2023/1/e47735 UR - http://dx.doi.org/10.2196/47735 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494079 ID - info:doi/10.2196/47735 ER - TY - JOUR AU - Kuo, Ming-Hao AU - Lin, You-Jin AU - Huang, Wun-Wei AU - Chiang, Kwo-Tsao AU - Tu, Min-Yu AU - Chu, Chi-Ming AU - Lai, Chung-Yu PY - 2023/7/26 TI - G Tolerance Prediction Model Using Mobile Device?Measured Cardiac Force Index for Military Aircrew: Observational Study JO - JMIR Mhealth Uhealth SP - e48812 VL - 11 KW - G force KW - baroreflex KW - anti-G straining maneuver KW - G tolerance KW - cardiac force index KW - anti-G suit KW - relaxed G tolerance KW - straining G tolerance KW - cardiac force ratio N2 - Background: During flight, G force compels blood to stay in leg muscles and reduces blood flow to the heart. Cardiovascular responses activated by the autonomic nerve system and strengthened by anti-G straining maneuvers can alleviate the challenges faced during G loading. To our knowledge, no definite cardiac information measured using a mobile health device exists for analyzing G tolerance. However, our previous study developed the cardiac force index (CFI) for analyzing the G tolerance of military aircrew. Objective: This study used the CFI to verify participants? cardiac performance when walking and obtained a formula for predicting an individual?s G tolerance during centrifuge training. Methods: Participants from an air force aircrew undertook high-G training from January 2020 to December 2022. Their heart rate (HR) in beats per minute and activity level per second were recorded using the wearable BioHarness 3.0 device. The CFI was computed using the following formula: weight × activity / HR during resting or walking. Relaxed G tolerance (RGT) and straining G tolerance (SGT) were assessed at a slowly increasing rate of G loading (0.1 G/s) during training. Other demographic factors were included in the multivariate regression to generate a model for predicting G tolerance from the CFI. Results: A total of 213 eligible trainees from a military aircrew were recruited. The average age was 25.61 (SD 3.66) years, and 13.1% (28/213) of the participants were women. The mean resting CFI and walking CFI (WCFI) were 0.016 (SD 0.001) and 0.141 (SD 0.037) kg × G/beats per minute, respectively. The models for predicting RGT and SGT were as follows: RGT = 0.066 × age + 0.043 × (WCFI × 100) ? 0.037 × height + 0.015 × systolic blood pressure ? 0.010 × HR + 7.724 and SGT = 0.103 × (WCFI × 100) ? 0.069 × height + 0.018 × systolic blood pressure + 15.899. Thus, the WCFI is a positive factor for predicting the RGT and SGT before centrifuge training. Conclusions: The WCFI is a vital component of the formula for estimating G tolerance prior to training. The WCFI can be used to monitor physiological conditions against G stress. UR - https://mhealth.jmir.org/2023/1/e48812 UR - http://dx.doi.org/10.2196/48812 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494088 ID - info:doi/10.2196/48812 ER - TY - JOUR AU - Saevarsdottir, Rut Saeunn AU - Gudmundsdottir, Lara Sigridur PY - 2023/7/26 TI - Mobile Apps and Quality of Life in Patients With Breast Cancer and Survivors: Systematic Literature Review JO - J Med Internet Res SP - e42852 VL - 25 KW - mobile health KW - mHealth KW - breast cancer KW - quality of life KW - review KW - systematic review KW - cancer treatment KW - mobile app KW - patient care KW - survivorship KW - digital health intervention KW - lifestyle intervention KW - mobile phone N2 - Background: Side effects of breast cancer treatment may persist long into survivorship, reducing quality of life (QOL) in patients with breast cancer and survivors. There is growing evidence for the use of digital health technologies, such as mobile apps, to support self-management, decrease symptom burden, and improve QOL in patients with cancer. However, an updated overview of the effects of mobile apps on QOL and well-being in patients with breast cancer and survivors is needed. Objective: The aim of this review was to provide an overview of breast cancer?specific, mobile app?driven lifestyle or behavioral interventions in patient care through to survivorship and their impact on QOL and mental well-being. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. The inclusion criteria were limited to original studies involving a trial of a mobile app?driven lifestyle or behavioral intervention for patients with breast cancer or survivors and using QOL or well-being measures. The results of the studies that met the inclusion criterion were then synthesized in text and table format. The quality of the evidence was assessed with the Cochrane risk-of-bias tool. Results: A total of 17 studies with the number of participants ranging from 23 to 356 met the inclusion criterion. Of the 17 reviewed studies, 7 (41%) delivered an app-only intervention, and 10 (59%) combined an app with additional supporting materials, such as SMS text messaging, telecoaching, wearables, or printed materials. Among the 17 reviewed studies, 6 (35%) focused on aiding patients with breast cancer during the active treatment phase (excluding ongoing hormone therapy), whereas the remaining 11 (65%) focused on survivorship. The majority of the studies (14/17, 82%) observed some positive effects on QOL or well-being measures. Conclusions: The results of the review indicate that mobile apps are a promising avenue for improving QOL and well-being in breast cancer care. Positive effects were observed in patients undergoing active treatment in all reviewed studies, but effects were less clear after chemotherapy and in long-term survivors. Although lifestyle and behavioral digital interventions are still being developed, and further research should still be pursued, the available data suggest that current mobile health apps aid patients with breast cancer and survivors. UR - https://www.jmir.org/2023/1/e42852 UR - http://dx.doi.org/10.2196/42852 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494111 ID - info:doi/10.2196/42852 ER - TY - JOUR AU - Mey, T. Jacob AU - Karpinski, A. Christine AU - Yang, Shengping AU - Madere, D. Joseph AU - Piattoly, Tavis AU - Harper, Ronnie AU - Kirwan, P. John PY - 2023/7/26 TI - Factors Influencing Nutritional Intake and Interests in Educational Content of Athletes and Sport Professionals Toward the Development of a Clinician-Supported Mobile App to Combat Relative Energy Deficiency in Sport: Formative Research and a Description of App Functions JO - JMIR Form Res SP - e45098 VL - 7 KW - dietitian KW - malnutrition KW - mHealth KW - mobile health KW - performance KW - RED-S KW - relative energy deficiency in sport KW - sports nutrition KW - technology N2 - Background: Relative energy deficiency in sport (RED-S) as a consequence of athlete malnutrition remains a prominent issue. However, it remains underrecognized, in part due to the perceived outward health of athletes. The Eat2Win app was designed to combat RED-S and athlete malnutrition by providing education, behavior modification, and direct communication with expert sports dietitians to athletes and sport professionals (professionals who work with athletes, eg, sport coaches and athletic trainers). Objective: The purpose of this formative research was to gain critical insight on motivators and barriers to optimal nutritional intake from both the athletes? and sport professionals? perspectives. Additionally, since these 2 groups represent the primary end users of an app aimed at improving athlete nutrition and reducing the risk of RED-S, a secondary objective was to gain insight on the preferences and perceptions of app-based educational content and functionality. Methods: An electronic survey was developed by an interdisciplinary team of experts. Survey questions were established based upon prevailing literature, professional dietetic field experience, and app design considerations to obtain respondent knowledge on key sports nutrition topics along with motivations and barriers to meal choices. Additionally, the survey included questions about the development of an integrative, clinician-support app aimed at addressing RED-S. These questions included preferences for educational content, modes of in-app information, and communication delivery for the target population (app end users: athletes and sport professionals). The survey was distributed through Research Electronic Data Capture (REDCap) to athletes and sport professionals using targeted email, social media, and community engagement campaigns. The electronic survey was available from May 4 to August 2, 2022. Results: Survey respondents (n=1352) included athletes and professionals who work with athletes from a variety of settings, like high school, collegiate, professional, and club sports. Respondents reported high interest in 8 core sports nutrition topics. The preferred modes of information and communication delivery were visual formats (eg, videos and infographics) and in-app alerts (eg, direct messaging and meal reminders). Only athlete respondents were asked about motivators and barriers that influence meal choices. ?Health? and ?sports performance? were the highest scoring motivators, while the highest scoring barriers were ?cost of food,? ?easy access to unhealthy food,? and ?time to cook or prepare food.? Notably, survey respondents provided positive feedback and interest using a novel function of the app: real-time meal feedback through food photography. Conclusions: The Eat2Win app is designed to combat RED-S and athlete malnutrition. Results from this study provide critical information on end-user opinions and preferences and will be used to further develop the Eat2Win app. Future research will aim to determine whether the Eat2Win app can prevent RED-S and the risk of athlete malnutrition to improve both health and performance. UR - https://formative.jmir.org/2023/1/e45098 UR - http://dx.doi.org/10.2196/45098 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494083 ID - info:doi/10.2196/45098 ER - TY - JOUR AU - Schooley, L. Benjamin AU - Ahmed, Abdulaziz AU - Maxwell, Justine AU - Feldman, S. Sue PY - 2023/7/25 TI - Predictors of COVID-19 From a Statewide Digital Symptom and Risk Assessment Tool: Cross-Sectional Study JO - J Med Internet Res SP - e46026 VL - 25 KW - COVID-19 KW - risk assessment KW - symptom tracker KW - passport application KW - surveillance KW - mobile app KW - multiple linear regression KW - healthcheck KW - public health informatics KW - decision support system KW - health information technology N2 - Background: Some of the most vexing issues with the COVID-19 pandemic were the inability of facilities and events, such as schools and work areas, to track symptoms to mitigate the spread of the disease. To combat these challenges, many turned to the implementation of technology. Technology solutions to mitigate repercussions of the COVID-19 pandemic include tools that provide guidelines and interfaces to influence behavior, reduce exposure to the disease, and enable policy-driven avenues to return to a sense of normalcy. This paper presents the implementation and early evaluation of a return-to-work COVID-19 symptom and risk assessment tool. The system was implemented across 34 institutions of health and education in Alabama, including more than 174,000 users with over 4 million total uses and more than 86,000 reports of exposure risk between July 2020 and April 2021. Objective: This study aimed to explore the usage of technology, specifically a COVID-19 symptom and risk assessment tool, to mitigate exposure to COVID-19 within public spaces. More specifically, the objective was to assess the relationship between user-reported symptoms and exposure via a mobile health app, with confirmed COVID-19 cases reported by the Alabama Department of Public Health (ADPH). Methods: This cross-sectional study evaluated the relationship between confirmed COVID-19 cases and user-reported COVID-19 symptoms and exposure reported through the Healthcheck web-based mobile application. A dependent variable for confirmed COVID-19 cases in Alabama was obtained from ADPH. Independent variables (ie, health symptoms and exposure) were collected through Healthcheck survey data and included measures assessing COVID-19?related risk levels and symptoms. Multiple linear regression was used to examine the relationship between ADPH-confirmed diagnosis of COVID-19 and self-reported health symptoms and exposure via Healthcheck that were analyzed across the state population but not connected at the individual patient level. Results: Regression analysis showed that the self-reported information collected by Healthcheck significantly affects the number of COVID-19?confirmed cases. The results demonstrate that the average number of confirmed COVID-19 cases increased by 5 (high risk: ?=5.10; P=.001), decreased by 24 (sore throat: ?=?24.03; P=.001), and increased by 21 (nausea or vomiting: ?=21.67; P=.02) per day for every additional self-report of symptoms by Healthcheck survey respondents. Congestion or runny nose was the most frequently reported symptom. Sore throat, low risk, high risk, nausea, or vomiting were all statistically significant factors. Conclusions: The use of technology allowed organizations to remotely track a population as it is related to COVID-19. Healthcheck was a platform that aided in symptom tracking, risk assessment, and evaluation of status for admitting individuals into public spaces for people in the Alabama area. The confirmed relationship between symptom and exposure self-reporting using an app and population-wide confirmed cases suggests that further investigation is needed to determine the opportunity for such apps to mitigate disease spread at a community and individual level. UR - https://www.jmir.org/2023/1/e46026 UR - http://dx.doi.org/10.2196/46026 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490320 ID - info:doi/10.2196/46026 ER - TY - JOUR AU - Singleton, C. Anna AU - Raeside, Rebecca AU - Hyun, K. Karice AU - Hayes, Molly AU - Sherman, A. Kerry AU - Elder, Elisabeth AU - Redfern, Julie AU - Partridge, R. Stephanie PY - 2023/7/25 TI - A National Health and Wellness SMS Text Message Program for Breast Cancer Survivors During COVID-19 (EMPOWER-SMS COVID-19): Mixed Methods Evaluation Using the RE-AIM Framework JO - J Med Internet Res SP - e45164 VL - 25 KW - digital health KW - telemedicine KW - SMS text messaging KW - breast cancer KW - implementation science KW - cancer survivorship KW - supportive care KW - public health KW - COVID-19 N2 - Background: COVID-19 lockdowns caused widespread closures of supportive care services for breast cancer survivors in Australia. In a randomized controlled trial, our team?s lifestyle-focused, evidence-based SMS text message support program (EMPOWER-SMS COVID-19) was found to be acceptable and useful for breast cancer survivors, and it was ready for rapid widespread delivery. Objective: This study aims to evaluate the reach (uptake) of an adapted 3-month lifestyle-focused SMS text message program (EMPOWER-SMS COVID-19) and barriers and enablers to implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Methods: A mixed methods pre-post study was conducted to evaluate the EMPOWER-SMS COVID-19 program. The study evaluated the following aspects: (1) reach/representativeness, which refers to the proportion of participant enrollment (ie, number enrolled/number that visited the study website) and demographics (eg, age, sex, ethnicity, time since completing treatment, Index of Relative Socio-economic Advantage and Disadvantage [IRSAD; quintile 1, which refers to most disadvantaged areas, to quintile 5, which refers to least disadvantaged areas, and remoteness); (2) effectiveness, in which participant engagement and acceptability were evaluated using SMS text message reply data and a feedback survey (5-point Likert scale and free-text responses); (3) adoption, which corresponds to the proportion of organizations or health professionals who agreed to promote the program; (4) implementation fidelity and maintenance, which evaluated SMS text message delivery data, opt-outs, costs, and adaptations. Quantitative data were summarized using means and SDs or frequencies and percentages, while qualitative data were analyzed thematically. Results: With regard to the reach/representativeness of the program, 841/1340 (62.8%) participants enrolled and provided electronic consent. Participants had a mean age of 58.8 (SD 9.8; range 30-87) years. According to the data collected, most participants identified as female (837/840, 99.6%) and White (736/840, 87.6%) and nearly half (418/841, 49.7%) finished treatment ?18 months ago. Most resided in major cities (574/838, 68.5%) and 30% (251/838) in IRSAD quintile 1 or 2. In terms of effectiveness, 852 replies were received from 511 unique participants (median 1; range 1-26). The most common replies were participants stating how they heard about the program (467/852, 54.8%) or ?thank you? (131/852, 15.4%). None of the replies contained urgent safety concerns. Among participants who provided feedback (449/841, 53.4%), most ?(strongly) agreed? the SMS text messages were easy to understand (445/448, 99.3%), useful (373/440, 84.8%), helped participants feel supported (388/448, 86.6%), and motivated participants to be physically active (312/445, 70.1%) and eat healthier (313/457, 68.5%). Free-text responses revealed 5 factors influencing engagement: (1) feeling supported and less alone, (2) motivation and reassurance for health self-management, (3) the variety of information, (4) weblinks to information and resources, and (5) the option to save the SMS text messages. Concerning adoption, 50% (18/36) of organizations/health professionals agreed to promote the program. With regard to implementation/maintenance, SMS text messages were delivered as planned (97.43% [41,257/42,344] of SMS text messages were successfully delivered) with minimal opt-outs (62/838, 7.4%) and low cost (Aus $15.40/participant; Aus $1=US $0.67). No adaptations were made during the intervention period. Postintervention adaptations included adding weblinks and participant-selected customizations. Conclusions: EMPOWER-SMS COVID-19 was implemented quickly, had a broad reach, and had high engagement and acceptability among socioeconomically diverse participants. The program had high fidelity, low cost, and required minimal staff oversight, which may facilitate future implementation. However, further research is needed to evaluate barriers and enablers to adoption and implementation for health professionals and strategies for long-term maintenance. UR - https://www.jmir.org/2023/1/e45164 UR - http://dx.doi.org/10.2196/45164 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490319 ID - info:doi/10.2196/45164 ER - TY - JOUR AU - Lønfeldt, Nadine Nicole AU - Clemmensen, Harder Line Katrine AU - Pagsberg, Katrine Anne PY - 2023/7/24 TI - A Wearable Artificial Intelligence Feedback Tool (Wrist Angel) for Treatment and Research of Obsessive Compulsive Disorder: Protocol for a Nonrandomized Pilot Study JO - JMIR Res Protoc SP - e45123 VL - 12 KW - machine learning KW - signal processing KW - wearable biosensor KW - obsessive compulsive disorder KW - oxytocin KW - children KW - adolescents KW - family accommodation KW - psychiatric symptoms KW - clinical practice KW - automatic assessment tool KW - psychotherapy KW - mental health N2 - Background: Obsessive compulsive disorder (OCD) in youth is characterized by behaviors, emotions, physiological reactions, and family interaction patterns. An essential component of therapy involves increasing awareness of the links among thoughts, emotions, behaviors, bodily sensations, and family interactions. An automatic assessment tool using physiological signals from a wearable biosensor may enable continuous symptom monitoring inside and outside of the clinic and support cognitive behavioral therapy for OCD. Objective: The primary aim of this study is to evaluate the feasibility and acceptability of using a wearable biosensor to monitor OCD symptoms. The secondary aim is to explore the feasibility of developing clinical and research tools that can detect and predict OCD-relevant internal states and interpersonal processes with the use of speech and behavioral signals. Methods: Eligibility criteria for the study include children and adolescents between 8 and 17 years of age diagnosed with OCD, controls with no psychiatric diagnoses, and one parent of the participating youths. Youths and parents wear biosensors on their wrists that measure pulse, electrodermal activity, skin temperature, and acceleration. Patients and their parents mark OCD episodes, while control youths and their parents mark youth fear episodes. Continuous, in-the-wild data collection will last for 8 weeks. Controlled experiments designed to link physiological, speech, behavioral, and biochemical signals to mental states are performed at baseline and after 8 weeks. Interpersonal interactions in the experiments are filmed and coded for behavior. The films are also processed with computer vision and for speech signals. Participants complete clinical interviews and questionnaires at baseline, and at weeks 4, 7, and 8. Feasibility criteria were set for recruitment, retention, biosensor functionality and acceptability, adherence to wearing the biosensor, and safety related to the biosensor. As a first step in learning the associations between signals and OCD-related parameters, we will use paired t tests and mixed effects models with repeated measures to assess associations between oxytocin, individual biosignal features, and outcomes such as stress-rest and case-control comparisons. Results: The first participant was enrolled on December 3, 2021, and recruitment closed on December 31, 2022. Nine patient dyads and nine control dyads were recruited. Sixteen participating dyads completed follow-up assessments. Conclusions: The results of this study will provide preliminary evidence for the extent to which a wearable biosensor that collects physiological signals can be used to monitor OCD severity and events in youths. If we find the study to be feasible, further studies will be conducted to integrate biosensor signals output into machine learning algorithms that can provide patients, parents, and therapists with actionable insights into OCD symptoms and treatment progress. Future definitive studies will be tasked with testing the accuracy of machine learning models to detect and predict OCD episodes and classify clinical severity. Trial Registration: ClinicalTrials.gov NCT05064527; https://clinicaltrials.gov/ct2/show/NCT05064527 International Registered Report Identifier (IRRID): DERR1-10.2196/45123 UR - https://www.researchprotocols.org/2023/1/e45123 UR - http://dx.doi.org/10.2196/45123 UR - http://www.ncbi.nlm.nih.gov/pubmed/37486738 ID - info:doi/10.2196/45123 ER - TY - JOUR AU - Litvin, Silja AU - Saunders, Rob AU - Jefferies, Philip AU - Seely, Hayley AU - Pössel, Patrick AU - Lüttke, Stefan PY - 2023/7/21 TI - The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial JO - JMIR Ment Health SP - e47285 VL - 10 KW - mobile health KW - mHealth KW - gamification KW - resilience KW - randomized controlled trial KW - RCT KW - mental health KW - apps KW - mobile game KW - mobile games KW - serious game KW - depression KW - anxiety KW - university KW - college KW - student KW - students KW - controlled trial KW - controlled trials KW - young adult KW - mobile phone N2 - Background: With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs. Objective: This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population. Methods: In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder?7, and Patient Health Questionnaire?8 were administered to all participants at baseline and every 7 days until completion. Results: A repeated measures?ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups. Conclusions: Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes. Trial Registration: German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638 UR - https://mental.jmir.org/2023/1/e47285 UR - http://dx.doi.org/10.2196/47285 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477955 ID - info:doi/10.2196/47285 ER - TY - JOUR AU - Shibuta, Tomomi AU - Waki, Kayo AU - Miyake, Kana AU - Igarashi, Ayumi AU - Yamamoto-Mitani, Noriko AU - Sankoda, Akiko AU - Takeuchi, Yoshinori AU - Sumitani, Masahiko AU - Yamauchi, Toshimasa AU - Nangaku, Masaomi AU - Ohe, Kazuhiko PY - 2023/7/21 TI - Preliminary Efficacy, Feasibility, and Perceived Usefulness of a Smartphone-Based Self-Management System With Personalized Goal Setting and Feedback to Increase Step Count Among Workers With High Blood Pressure: Before-and-After Study JO - JMIR Cardio SP - e43940 VL - 7 KW - behavior change KW - blood pressure KW - feasibility studies KW - goal setting KW - mobile health KW - mHealth KW - self-control KW - self-efficacy KW - self-regulation KW - smartphone KW - step count KW - walking KW - workplace KW - mobile phone N2 - Background: High blood pressure (BP) and physical inactivity are the major risk factors for cardiovascular diseases. Mobile health is expected to support patients? self-management for improving cardiovascular health; the development of fully automated systems is necessary to minimize the workloads of health care providers. Objective: The objective of our study was to evaluate the preliminary efficacy, feasibility, and perceived usefulness of an intervention using a novel smartphone-based self-management system (DialBetes Step) in increasing steps per day among workers with high BP. Methods: On the basis of the Social Cognitive Theory, we developed personalized goal-setting and feedback functions and information delivery functions for increasing step count. Personalized goal setting and feedback consist of 4 components to support users? self-regulation and enhance their self-efficacy: goal setting for daily steps, positive feedback, action planning, and barrier identification and problem-solving. In the goal-setting component, users set their own step goals weekly in gradual increments based on the system?s suggestion. We added these fully automated functions to an extant system with the function of self-monitoring daily step count, BP, body weight, blood glucose, exercise, and diet. We conducted a single-arm before-and-after study of workers with high BP who were willing to increase their physical activity. After an educational group session, participants used only the self-monitoring function for 2 weeks (baseline) and all functions of DialBetes Step for 24 weeks. We evaluated changes in steps per day, self-reported frequencies of self-regulation and self-management behavior, self-efficacy, and biomedical characteristics (home BP, BMI, visceral fat area, and glucose and lipid parameters) around week 6 (P1) of using the new functions and at the end of the intervention (P2). Participants rated the usefulness of the system using a paper-based questionnaire. Results: We analyzed 30 participants (n=19, 63% male; mean age 52.9, SD 5.3 years); 1 (3%) participant dropped out of the intervention. The median percentage of step measurement was 97%. Compared with baseline (median 10,084 steps per day), steps per day significantly increased at P1 (median +1493 steps per day; P<.001), but the increase attenuated at P2 (median +1056 steps per day; P=.04). Frequencies of self-regulation and self-management behavior increased at P1 and P2. Goal-related self-efficacy tended to increase at P2 (median +5%; P=.05). Home BP substantially decreased only at P2. Of the other biomedical characteristics, BMI decreased significantly at P1 (P<.001) and P2 (P=.001), and high-density lipoprotein cholesterol increased significantly only at P1 (P<.001). DialBetes Step was rated as useful or moderately useful by 97% (28/29) of the participants. Conclusions: DialBetes Step intervention might be a feasible and useful way of increasing workers? step count for a short period and, consequently, improving their BP and BMI; self-efficacy?enhancing techniques of the system should be improved. UR - https://cardio.jmir.org/2023/1/e43940 UR - http://dx.doi.org/10.2196/43940 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477976 ID - info:doi/10.2196/43940 ER - TY - JOUR AU - Buchholz, W. Susan AU - Mowbray, I. Fabrice AU - Allman, Gabrielle AU - Verboncoeur, P. John AU - Beam, Lauren AU - Small, Leigh PY - 2023/7/21 TI - Wearable Devices and Nurses? Health: Protocol for an Integrative Review JO - JMIR Res Protoc SP - e48178 VL - 12 KW - nurse KW - wearable KW - wearable device KW - mHealth KW - mobile health KW - health technology adoption and use KW - health outcome KW - adoption KW - usage KW - health technology KW - digital health KW - integrative review KW - literature review N2 - Background: Nurses comprise over half of the global health care workforce, and the nursing care they provide is critical for the global population's health. High patient volumes and increased medical complexity have increased the workload and stress of nurses. As a result, the health of nurses is often negatively impacted. Wearables are used within the health care setting to assess patient outcomes; however, efforts to synthesize the use of wearable devices focusing on nurses? health are limited. Objective: The primary objective of our integrative review is to synthesize available data concerning the utility of wearable devices for evaluating or improving (or both) the health of nurses. Methods: We are conducting an integrative review synthesizing data specific to wearable devices and nurses? health. The research question for this review aims to answer how wearable devices are used to evaluate health outcomes among nurses. We searched the following electronic databases from inception until July 2022: PubMed, Embase, CINAHL, Web of Science, IEEE Explore, and AS&T. Titles and abstracts were imported into Covidence software, where citations were screened and duplicates removed. Title and abstract screening has been completed; however, full-text screening has not been started. Further screening is being conducted independently and in duplicate by 2 teams of 2 reviewers each. These reviewers will extract data independently. Results: Search strategies have been developed, and data were extracted from 6 databases. After the removal of duplicates, we collected 8603 studies for title and abstract screening. Two independent reviewers conducted the title and abstract review, and after resolving conflicts, 277 full-text articles are available for review to determine whether they meet the inclusion criteria. Conclusions: This integrative review will provide synthesized data to inform nurses and other stakeholders about the extent of wearable device?related work done with nurses and provide direction for future research. International Registered Report Identifier (IRRID): DERR1-10.2196/48178 UR - https://www.researchprotocols.org/2023/1/e48178 UR - http://dx.doi.org/10.2196/48178 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477950 ID - info:doi/10.2196/48178 ER - TY - JOUR AU - Roh, Soonhee AU - Lee, Yeon-Shim AU - Kenyon, B. DenYelle AU - Elliott, J. Amy AU - Petereit, G. Daniel AU - Gaba, Anu AU - Lee, Yun Hee PY - 2023/7/20 TI - Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study JO - JMIR Form Res SP - e47851 VL - 7 KW - American Indian women KW - breast cancer KW - mammogram KW - mHealth KW - mobile web app intervention N2 - Background: Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. Objective: This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. Methods: Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants? satisfaction with and acceptance of the intervention. Results: A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=?5.22; P<.001), increase in knowledge (t120=?4.75; P<.001), and satisfaction with the intervention (t120=?3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. Conclusions: This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. Trial Registration: ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603 UR - https://formative.jmir.org/2023/1/e47851 UR - http://dx.doi.org/10.2196/47851 UR - http://www.ncbi.nlm.nih.gov/pubmed/37471115 ID - info:doi/10.2196/47851 ER - TY - JOUR AU - Nagraj, Shobhana AU - Kennedy, Stephen AU - Jha, Vivekananda AU - Norton, Robyn AU - Hinton, Lisa AU - Billot, Laurent AU - Rajan, Eldho AU - Mohammed Abdul, Ameer AU - Phalswal, Anita AU - Arora, Varun AU - Praveen, Devarsetty AU - Hirst, Jane PY - 2023/7/20 TI - A Mobile Clinical Decision Support System for High-Risk Pregnant Women in Rural India (SMARThealth Pregnancy): Pilot Cluster Randomized Controlled Trial JO - JMIR Form Res SP - e44362 VL - 7 KW - decision support systems KW - clinical KW - telemedicine KW - community health workers KW - pregnancy KW - high risk KW - diabetes KW - gestational KW - cardiovascular diseases N2 - Background: Cardiovascular disease (CVD) is the leading cause of death in women in India. Early identification is crucial to reducing deaths. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) carry independent risks for future CVD, and antenatal care is a window to screen and counsel high-risk women. In rural India, community health workers (CHWs) deliver antenatal and postnatal care. We developed a complex intervention (SMARThealth Pregnancy) involving mobile clinical decision support for CHWs and evaluated it in a pilot cluster randomized controlled trial (cRCT). Objective: The aim of the study is to co-design a theory-informed intervention for CHWs to screen, refer, and counsel pregnant women at high risk of future CVD in rural India and evaluate its feasibility and acceptability. Methods: In phase 1, we used qualitative methods to explore community priorities for high-risk pregnant women in rural areas of 2 diverse states in India. In phase 2, informed by behavior change theory and human-centered design, we used these qualitative data to develop the intervention components and implementation strategies for SMARThealth Pregnancy in an iterative process with end users. In phase 3, using mixed methods, we evaluated the intervention in a cRCT with an embedded qualitative substudy across 4 primary health centres: 2 in Jhajjar district, Haryana, and 2 in Guntur district, Andhra Pradesh. Results: SMARThealth Pregnancy embedded a total of 15 behavior change techniques and included (1) community awareness programs; (2) targeted training, including point-of-care blood pressure and hemoglobin measurement; and (3) mobile clinical decision support for CHWs to screen women in their homes. The intervention focused on 3 priority conditions: anemia, HDP, and GDM. The evaluation involved a total of 200 pregnant women, equally randomized to intervention or enhanced standard care (control). Recruitment was completed within 5 months, with minimal loss to follow-up (4/200, 2%) at 6 weeks postpartum. A total of 4 primary care doctors and 54 CHWs in the intervention clusters took part in the study. Fidelity to intervention practices was 100% prepandemic. Over half the study population was affected by moderate to severe anemia at baseline. The prevalence of HDP (2.5%) and GDM (2%) was low in our study population. Results suggest a possible improvement in mean hemoglobin (anemia) in the intervention group, although an adequately powered trial is needed. The model of home-based care was feasible and acceptable for pregnant or postpartum women and CHWs, who perceived improvements in quality of care, self-efficacy, and professional recognition. Conclusions: SMARThealth Pregnancy is an innovative model of home-based care for high-risk pregnant women during the transitions between antenatal and postnatal care and adult health services. The use of theory and co-design during intervention development facilitated acceptability of the intervention and implementation strategies. Our experience has informed the decision to initiate a larger-scale cRCT. Trial Registration: ClinicalTrials.gov NCT03968952; https://clinicaltrials.gov/ct2/show/NCT03968952 International Registered Report Identifier (IRRID): RR2-10.3389/fgwh.2021.620759 UR - https://formative.jmir.org/2023/1/e44362 UR - http://dx.doi.org/10.2196/44362 UR - http://www.ncbi.nlm.nih.gov/pubmed/37471135 ID - info:doi/10.2196/44362 ER - TY - JOUR AU - Kim, Yoon Ji AU - Kim, Jin Kyoung AU - Kim, Jin Kyeong AU - Choi, Jimi AU - Seo, Jinhee AU - Lee, Jung-Been AU - Bae, Hyun Jae AU - Kim, Hoon Nam AU - Kim, Young Hee AU - Lee, Soo-Kyung AU - Kim, Gon Sin PY - 2023/7/19 TI - Effect of a Wearable Device?Based Physical Activity Intervention in North Korean Refugees: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e45975 VL - 25 KW - digital health intervention KW - wearable activity tracker KW - physical activity intervention KW - Fitbit KW - North Korean refugees KW - metabolic risk management KW - step counts N2 - Background: Effective health interventions for North Korean refugees vulnerable to metabolic disorders are currently unelucidated. Objective: This study aimed to evaluate the effects of digital health interventions in North Korean refugees using a wearable activity tracker (Fitbit device). Methods: We conducted a prospective, randomized, open-label study on North Korean refugees aged 19-59 years between June 2020 and October 2021 with a 12-week follow-up period. The participants were randomly assigned to either an intervention group or a control group in a 1:1 ratio. The intervention group received individualized health counseling based on Fitbit data every 4 weeks, whereas the control group wore the Fitbit device but did not receive individualized counseling. The primary and secondary outcomes were the change in the mean daily step count and changes in the metabolic parameters, respectively. Results: The trial was completed by 52 North Korean refugees, of whom 27 and 25 were in the intervention and control groups, respectively. The mean age was 43 (SD 10) years, and 41 (78.8%) participants were women. Most participants (44/52, 95.7%) had a low socioeconomic status. After the intervention, the daily step count in the intervention group increased, whereas that in the control group decreased. However, there were no significant differences between the 2 groups (+83 and ?521 steps in the intervention and control groups, respectively; P=.500). The effects of the intervention were more prominent in the participants with a lower-than-average daily step count at baseline (<11,667 steps/day). After the 12-week study period, 85.7% (12/14) and 46.7% (7/15) of the participants in the intervention and control groups, respectively, had an increased daily step count (P=.05). The intervention prevented the worsening of the metabolic parameters, including BMI, waist circumference, fasting blood glucose level, and glycated hemoglobin level, during the study period. Conclusions: The wearable device?based physical activity intervention did not significantly increase the average daily step count in the North Korean refugees in this study. However, the intervention was effective among the North Korean refugees with a lower-than-average daily step count; therefore, a large-scale, long-term study of this intervention type in an underserved population is warranted. Trial Registration: Clinical Research Information Service KCT0007999; https://cris.nih.go.kr/cris/search/detailSearch.do/23622 UR - https://www.jmir.org/2023/1/e45975 UR - http://dx.doi.org/10.2196/45975 UR - http://www.ncbi.nlm.nih.gov/pubmed/37467013 ID - info:doi/10.2196/45975 ER - TY - JOUR AU - McCall, Terika AU - Foster, Meagan AU - Schwartz, A. Todd PY - 2023/7/19 TI - Attitudes Toward Seeking Mental Health Services and Mobile Technology to Support the Management of Depression Among Black American Women: Cross-Sectional Survey Study JO - J Med Internet Res SP - e45766 VL - 25 KW - African American KW - women KW - depression KW - telemedicine KW - mobile health KW - mHealth KW - mobile apps KW - digital health KW - mental health KW - gender minority KW - mobile technology KW - mobile phone N2 - Background: Depression is a common mental health condition among Black American women. Many factors may contribute to the development of depressive symptoms, such as gender and racial discrimination, financial strain, chronic health conditions, and caregiving responsibilities. Barriers such as the stigmatization of mental illness, less access to treatment, the lack of or inadequate health insurance, mistrust of providers, and limited health literacy prevent marginalized populations from seeking care. Previous literature has shown that mobile health interventions are effective and can increase access to mental health services and resources. Objective: We aimed to understand the attitudes and perceptions of Black women toward using mental health services and determine the acceptability and concerns of using mobile technology (ie, voice call, video call, SMS text messaging, and mobile app) to support the management of depression. Methods: We launched a self-administered web-based questionnaire in October 2019 and closed it in January 2020. Women (aged ?18 years) who identify as Black or African American or multiracial (defined as Black or African American and another race) were eligible to participate. The survey consisted of approximately 70 questions and included topics such as attitudes toward seeking professional psychological help, the acceptability of using a mobile phone to receive mental health care, and screening for depression. Results: The findings (n=395) showed that younger Black women were more likely to have greater severity of depression than their older counterparts. The results also revealed that Black women have favorable views toward seeking mental health services. Respondents were the most comfortable with the use of voice calls or video calls to communicate with a professional to receive support for managing depression in comparison with SMS text messaging or mobile apps. The results revealed that higher help-seeking propensity increased the odds of indicating agreement with the use of voice calls and video calls to communicate with a professional to receive support for managing depression by 27% and 38%, respectively. However, no statistically significant odds ratios (all P>.05) were found between help-seeking propensity and respondents? agreement to use mobile apps or SMS text messaging. Moderate to severe depression severity increased the odds of using mobile apps to communicate with a professional to receive support for managing depression by 43%; however, no statistically significant odds ratios existed for the other modalities. Privacy and confidentiality, communication issues (eg, misinterpreting text), and the impersonal feeling of communicating by mobile phone (eg, SMS text messaging) were the primary concerns. Conclusions: Black American women, in general, have favorable views toward seeking mental health services and are comfortable with the use of mobile technology to receive support for managing depression. Future work should address the issues of access and consider the preferences and cultural appropriateness of the resources provided. UR - https://www.jmir.org/2023/1/e45766 UR - http://dx.doi.org/10.2196/45766 UR - http://www.ncbi.nlm.nih.gov/pubmed/37467027 ID - info:doi/10.2196/45766 ER - TY - JOUR AU - Lin, Xiaowen AU - Martinengo, Laura AU - Jabir, Ishqi Ahmad AU - Ho, Yan Andy Hau AU - Car, Josip AU - Atun, Rifat AU - Tudor Car, Lorainne PY - 2023/7/18 TI - Scope, Characteristics, Behavior Change Techniques, and Quality of Conversational Agents for Mental Health and Well-Being: Systematic Assessment of Apps JO - J Med Internet Res SP - e45984 VL - 25 KW - conversational agent KW - chatbot KW - mental health KW - mobile health KW - mHealth KW - behavior change KW - apps KW - Mobile Application Rating Scale KW - MARS KW - mobile phone N2 - Background: Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users? mental health. Objective: This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale. Methods: The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple?s App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs. Results: We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included open-ended questions). CAs used 48 different BCTs and included on average 15 (SD 8.77; range 4-30) BCTs. The most common BCTs were 3.3 ?Social support (emotional),? 4.1 ?Instructions for how to perform a behavior,? 11.2 ?Reduce negative emotions,? and 6.1 ?Demonstration of the behavior.? One-third (5/14, 36%) of the CAs claiming to be CBT based did not include core CBT concepts. Conclusions: Mental health CAs mostly targeted various mental health issues such as stress, anxiety, and depression, reflecting a broad intervention focus. The most common BCTs identified serve to promote the self-management of mental disorders with few therapeutic elements. CA developers should consider the quality of information, user confidentiality, access, and emergency management when designing mental health CAs. Future research should assess the role of artificial intelligence in promoting behavior change within CAs and determine the choice of BCTs in evidence-based psychotherapies to enable systematic, consistent, and transparent development and evaluation of effective digital mental health interventions. UR - https://www.jmir.org/2023/1/e45984 UR - http://dx.doi.org/10.2196/45984 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463036 ID - info:doi/10.2196/45984 ER - TY - JOUR AU - Frank, C. Adam AU - Li, Ruibei AU - Peterson, S. Bradley AU - Narayanan, S. Shrikanth PY - 2023/7/18 TI - Wearable and Mobile Technologies for the Evaluation and Treatment of Obsessive-Compulsive Disorder: Scoping Review JO - JMIR Ment Health SP - e45572 VL - 10 KW - wearable KW - smartphone KW - obsessive-compulsive disorder KW - OCD KW - digital KW - phenotype KW - biomarker KW - mobile phone N2 - Background: Smartphones and wearable biosensors can continuously and passively measure aspects of behavior and physiology while also collecting data that require user input. These devices can potentially be used to monitor symptom burden; estimate diagnosis and risk for relapse; predict treatment response; and deliver digital interventions in patients with obsessive-compulsive disorder (OCD), a prevalent and disabling psychiatric condition that often follows a chronic and fluctuating course and may uniquely benefit from these technologies. Objective: Given the speed at which mobile and wearable technologies are being developed and implemented in clinical settings, a continual reappraisal of this field is needed. In this scoping review, we map the literature on the use of wearable devices and smartphone-based devices or apps in the assessment, monitoring, or treatment of OCD. Methods: In July 2022 and April 2023, we conducted an initial search and an updated search, respectively, of multiple databases, including PubMed, Embase, APA PsycINFO, and Web of Science, with no restriction on publication period, using the following search strategy: (?OCD? OR ?obsessive? OR ?obsessive-compulsive?) AND (?smartphone? OR ?phone? OR ?wearable? OR ?sensing? OR ?biofeedback? OR ?neurofeedback? OR ?neuro feedback? OR ?digital? OR ?phenotyping? OR ?mobile? OR ?heart rate variability? OR ?actigraphy? OR ?actimetry? OR ?biosignals? OR ?biomarker? OR ?signals? OR ?mobile health?). Results: We analyzed 2748 articles, reviewed the full text of 77 articles, and extracted data from the 25 articles included in this review. We divided our review into the following three parts: studies without digital or mobile intervention and with passive data collection, studies without digital or mobile intervention and with active or mixed data collection, and studies with a digital or mobile intervention. Conclusions: Use of mobile and wearable technologies for OCD has developed primarily in the past 15 years, with an increasing pace of related publications. Passive measures from actigraphy generally match subjective reports. Ecological momentary assessment is well tolerated for the naturalistic assessment of symptoms, may capture novel OCD symptoms, and may also document lower symptom burden than retrospective recall. Digital or mobile treatments are diverse; however, they generally provide some improvement in OCD symptom burden. Finally, ongoing work is needed for a safe and trusted uptake of technology by patients and providers. UR - https://mental.jmir.org/2023/1/e45572 UR - http://dx.doi.org/10.2196/45572 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463010 ID - info:doi/10.2196/45572 ER - TY - JOUR AU - Crane, Nicole AU - Hagerman, Charlotte AU - Horgan, Olivia AU - Butryn, Meghan PY - 2023/7/18 TI - Patterns and Predictors of Engagement With Digital Self-Monitoring During the Maintenance Phase of a Behavioral Weight Loss Program: Quantitative Study JO - JMIR Mhealth Uhealth SP - e45057 VL - 11 KW - weight loss KW - digital technology KW - diet KW - exercise KW - behavior change KW - mobile phone N2 - Background: Long-term self-monitoring (SM) of weight, diet, and exercise is commonly recommended by behavioral weight loss (BWL) treatments. However, sustained SM engagement is notoriously challenging; therefore, more must be learned about patterns of engagement with digital SM tools during weight loss maintenance (WLM). In addition, insight into characteristics that may influence SM engagement could inform tailored approaches for participants at risk for poor adherence. Objective: This study explored patterns of digital SM of weight, diet, and exercise during WLM (aim 1) and examined timing, patterns, and rates of disengagement and reengagement (aim 2). This study also assessed relationships between individual-level factors (weight-related information avoidance and weight bias internalization) and SM engagement (aim 3). Methods: Participants were 72 adults enrolled in a BWL program consisting of a 3-month period of weekly treatment designed to induce weight loss (phase I), followed by a 9-month period of less frequent contact to promote WLM (phase II). Participants were prescribed daily digital SM of weight, diet, and exercise. At baseline, self-report measures assessed weight-related information avoidance and weight bias internalization. SM adherence was objectively measured with the days per month that participants tracked weight, diet, and exercise. Repeated-measures ANOVA examined differences in adherence across SM targets. Multilevel modeling examined changes in adherence across phase II. Relationships between individual-level variables and SM adherence were assessed with Pearson correlations, 2-tailed independent samples t tests, and multilevel modeling. Results: During WLM, consistently high rates of SM (?50% of the days in each month) were observed for 61% (44/72) of the participants for exercise, 40% (29/72) of the participants for weight, and 21% (15/72) of the participants for diet. Adherence for SM of exercise was higher than that for weight or diet (P<.001). Adherence decreased over time for all SM targets throughout phase II (P<.001), but SM of exercise dropped off later in WLM (mean 10.07, SD 2.83 months) than SM of weight (mean 7.92, SD 3.23 months) or diet (mean 7.58, SD 2.92 months; P<.001). Among participants with a period of low SM adherence (ie, <50% of the days in a month), only 33% (17/51 for weight, 19/57 for diet) to 46% (13/28 for exercise) subsequently had ?1 months with high adherence. High weight-related information avoidance predicted a faster rate of decrease in dietary SM (P<.001). Participants with high weight bias internalization had the highest rates of weight SM (P=.03). Conclusions: Participants in BWL programs have low adherence to the recommendation to sustain daily SM during WLM, particularly for SM of diet and weight. Weight-related information avoidance and weight bias internalization may be relevant indicators for SM engagement. Interventions may benefit from innovative strategies that target participants at key moments of risk for disengagement. UR - https://mhealth.jmir.org/2023/1/e45057 UR - http://dx.doi.org/10.2196/45057 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463017 ID - info:doi/10.2196/45057 ER - TY - JOUR AU - Wang, Xuzhi AU - Pathiravasan, H. Chathurangi AU - Zhang, Yuankai AU - Trinquart, Ludovic AU - Borrelli, Belinda AU - Spartano, L. Nicole AU - Lin, Honghuang AU - Nowak, Christopher AU - Kheterpal, Vik AU - Benjamin, J. Emelia AU - McManus, D. David AU - Murabito, M. Joanne AU - Liu, Chunyu PY - 2023/7/14 TI - Association of Depressive Symptom Trajectory With Physical Activity Collected by mHealth Devices in the Electronic Framingham Heart Study: Cohort Study JO - JMIR Ment Health SP - e44529 VL - 10 KW - depression KW - mobile health KW - risk factors KW - physical activity KW - eCohort KW - Framingham Heart Study N2 - Background: Few studies have examined the association between depressive symptom trajectories and physical activity collected by mobile health (mHealth) devices. Objective: We aimed to investigate if antecedent depressive symptom trajectories predict subsequent physical activity among participants in the electronic Framingham Heart Study (eFHS). Methods: We performed group-based multi-trajectory modeling to construct depressive symptom trajectory groups using both depressive symptoms (Center for Epidemiological Studies-Depression [CES-D] scores) and antidepressant medication use in eFHS participants who attended 3 Framingham Heart Study research exams over 14 years. At the third exam, eFHS participants were instructed to use a smartphone app for submitting physical activity index (PAI) surveys. In addition, they were provided with a study smartwatch to track their daily step counts. We performed linear mixed models to examine the association between depressive symptom trajectories and physical activity including app-based PAI and smartwatch-collected step counts over a 1-year follow-up adjusting for age, sex, wear hour, BMI, smoking status, and other health variables. Results: We identified 3 depressive symptom trajectory groups from 722 eFHS participants (mean age 53, SD 8.5 years; n=432, 60% women). The low symptom group (n=570; mean follow-up 287, SD 109 days) consisted of participants with consistently low CES-D scores, and a small proportion reported antidepressant use. The moderate symptom group (n=71; mean follow-up 280, SD 118 days) included participants with intermediate CES-D scores, who showed the highest and increasing likelihood of reporting antidepressant use across 3 exams. The high symptom group (n=81; mean follow-up 252, SD 116 days) comprised participants with the highest CES-D scores, and the proportion of antidepressant use fell between the other 2 groups. Compared to the low symptom group, the high symptom group had decreased PAI (mean difference ?1.09, 95% CI ?2.16 to ?0.01) and the moderate symptom group walked fewer daily steps (823 fewer, 95% CI ?1421 to ?226) during the 1-year follow-up. Conclusions: Antecedent depressive symptoms or antidepressant medication use was associated with lower subsequent physical activity collected by mHealth devices in eFHS. Future investigation of interventions to improve mood including via mHealth technologies to help promote people?s daily physical activity is needed. UR - https://mental.jmir.org/2023/1/e44529 UR - http://dx.doi.org/10.2196/44529 UR - http://www.ncbi.nlm.nih.gov/pubmed/37450333 ID - info:doi/10.2196/44529 ER - TY - JOUR AU - Pihlajamäki, Mika AU - Wickström, Sara AU - Puranen, Kaija AU - Helve, Otto AU - Yrttiaho, Aleksi AU - Siira, Lotta PY - 2023/7/13 TI - Implementing and Maintaining a SARS-CoV-2 Exposure Notification Application for Mobile Phones: The Finnish Experience JO - JMIR Public Health Surveill SP - e46563 VL - 9 KW - digital proximity tracing KW - DPT KW - exposure notification application KW - ENA KW - COVID-19 KW - Finland KW - digital health KW - mobile health KW - mHealth KW - contact tracing KW - user KW - data privacy KW - effectiveness KW - mobile app KW - technology KW - public health UR - https://publichealth.jmir.org/2023/1/e46563 UR - http://dx.doi.org/10.2196/46563 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440286 ID - info:doi/10.2196/46563 ER - TY - JOUR AU - Davergne, Thomas AU - Meidinger, Philippe AU - Dechartres, Agnès AU - Gossec, Laure PY - 2023/7/13 TI - The Effectiveness of Digital Apps Providing Personalized Exercise Videos: Systematic Review With Meta-Analysis JO - J Med Internet Res SP - e45207 VL - 25 KW - app KW - exercise program KW - telerehabilitation KW - rehabilitation KW - disability KW - disabilities KW - digital care KW - web-based KW - exercise KW - physical activity KW - fitness KW - health app KW - HRQoL KW - QoL KW - quality of life KW - physical therapy KW - physiotherapy KW - systematic review KW - review method KW - adherence KW - meta-analysis KW - meta-analyses N2 - Background: Among available digital apps, those providing personalized video exercises may be helpful for individuals undergoing functional rehabilitation. Objective: We aimed to assess the effectiveness of apps providing personalized video exercises to support rehabilitation for people with short- and long-term disabling conditions, on functional capacity, confidence in exercise performance, health care consumption, health-related quality of life, adherence, and adverse events. Methods: In this systematic review, we searched MEDLINE, CENTRAL, and Embase databases up to March 2022. All randomized controlled trials evaluating the effect of apps providing personalized video exercises to support rehabilitation for any condition requiring physical rehabilitation were included. Selection, extraction, and risk of bias assessment were performed by 2 independent reviewers. The primary outcome was functional capacity at the end of the intervention. The secondary outcomes included confidence in exercise performance, care consumption, health-related quality of life, adherence, and adverse events. A meta-analysis was performed where possible; the magnitude of the effect was assessed with the standardized mean difference (SMD). Results: From 1641 identified references, 10 papers (n=1050 participants, 93% adults) were included: 7 papers (n=906 participants) concerned musculoskeletal disorders and 3 (n=144 participants) concerned neurological disorders. Two (n=332 participants) were employee based. The apps were mostly commercial (7/10); the videos were mostly elaborated on by a physiotherapist (8/10). The duration of app use was 3-48 weeks. All included studies had a high overall risk of bias. Low-quality evidence suggested that the use of apps providing personalized video exercises led to a significant small to moderate improvement in physical function (SMD 0.35, 95% CI 0.19-0.51; Phet=.86; I2=0%) and confidence in exercise performance (SMD 0.67; 95% CI 0.37-0.96; Phet=.22; I2=33%). Because of the very low quality of the evidence, the effects on quality of life and exercise adherence were uncertain. Apps did not influence the rate of adverse events. Conclusions: Apps providing personalized video exercises to support exercise performance significantly improved physical function and confidence in exercise performance. However, the level of evidence was low; more robust studies are needed to confirm these results. Trial Registration: PROSPERO CRD42022323670; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323670 UR - https://www.jmir.org/2023/1/e45207 UR - http://dx.doi.org/10.2196/45207 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440300 ID - info:doi/10.2196/45207 ER - TY - JOUR AU - Bold, W. Krysten AU - Garrison, A. Kathleen AU - DeLucia, Angela AU - Horvath, Mark AU - Nguyen, Milton AU - Camacho, Erica AU - Torous, John PY - 2023/7/13 TI - Smartphone Apps for Smoking Cessation: Systematic Framework for App Review and Analysis JO - J Med Internet Res SP - e45183 VL - 25 KW - addict KW - app review KW - application KW - apps KW - cessation KW - cigarette KW - digital health KW - mhealth KW - mobile app KW - mobile health KW - quit KW - review of app KW - smartphone app KW - smoker KW - smoking cessation KW - smoking KW - tobacco N2 - Background: Cigarette smoking is a leading cause of preventable death, and identifying novel treatment approaches to promote smoking cessation is critical for improving public health. With the rise of digital health and mobile apps, these tools offer potential opportunities to address smoking cessation, yet the functionality of these apps and whether they offer scientifically based support for smoking cessation are unknown. Objective: The goal of this research was to use the American Psychiatric Association app evaluation model to evaluate the top-returned apps from Android and Apple app store platforms related to smoking cessation and investigate the common app features available for end users. Methods: We conducted a search of both Android and iOS app stores in July 2021 for apps related to the keywords ?smoking,? ?tobacco,? ?smoke,? and ?cigarette? to evaluate apps for smoking cessation. Apps were screened for relevance, and trained raters identified and analyzed features, including accessibility (ie, cost), privacy, clinical foundation, and features of the apps, using a systematic framework of 105 objective questions from the American Psychiatric Association app evaluation model. All app rating data were deposited in mindapps, a publicly accessible database that is continuously updated every 6 months given the dynamic nature of apps available in the marketplace. We characterized apps available in July 2021 and November 2022. Results: We initially identified 389 apps, excluded 161 due to irrelevance and nonfunctioning, and rated 228, including 152 available for Android platforms and 120 available for iOS platforms. Some of the top-returned apps (71/228, 31%) in 2021 were no longer functioning in 2022. Our analysis of rated apps revealed limitations in accessibility and features. While most apps (179/228, 78%) were free to download, over half had costs associated with in-app purchases or full use. Less than 65% (149/228) had a privacy policy addressing the data collected in the app. In terms of intervention features, more than 56% (128/228) of apps allowed the user to set and check in on goals, and more than 46% (106/228) of them provided psychoeducation, although few apps provided evidence-based support for smoking cessation, such as peer support or skill training, including mindfulness and deep breathing, and even fewer provided evidence-based interventions, such as acceptance and commitment therapy or cognitive behavioral therapy. Only 12 apps in 2021 and 11 in 2022 had published studies supporting the feasibility or efficacy for smoking cessation. Conclusions: Numerous smoking cessation apps were identified, but analysis revealed limitations, including high rates of irrelevant and nonfunctioning apps, high rates of turnover, and few apps providing evidence-based support for smoking cessation. Thus, it may be challenging for consumers to identify relevant, evidence-based apps to support smoking cessation in the app store, and a comprehensive evaluation system of mental health apps is critically important. UR - https://www.jmir.org/2023/1/e45183 UR - http://dx.doi.org/10.2196/45183 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440305 ID - info:doi/10.2196/45183 ER - TY - JOUR AU - Abdulhussein, S. Fatema AU - Pinkney, Susan AU - Görges, Matthias AU - van Rooij, Tibor AU - Amed, Shazhan PY - 2023/7/13 TI - Designing a Collaborative Patient-Centered Digital Health Platform for Pediatric Diabetes Care in British Columbia: Formative Needs Assessment by Caregivers of Children and Youths Living With Type 1 Diabetes and Health Care Providers JO - JMIR Pediatr Parent SP - e46432 VL - 6 KW - application design KW - challenge KW - child KW - design KW - development KW - diabetes KW - diabetic KW - digital health KW - digital solution KW - engagement KW - feature KW - needs assessment KW - patient engagement KW - patient need KW - pediatric KW - perception KW - privacy KW - secure KW - security KW - trust KW - Type 1 diabetes KW - Type 1 KW - usage KW - user centered KW - user need KW - youth N2 - Background: Digital health apps are becoming increasingly available for people living with diabetes, yet data silos continue to exist. This requires health care providers (HCPs) and patients to use multiple digital platforms to access health data. Objective: In this study, we gathered the perspectives of caregivers of children and youths living with type 1 diabetes (T1D) and pediatric diabetes HCPs in the user-centered design of TrustSphere, a secure, single-point-of-access, integrative digital health platform. Methods: We distributed web-based surveys to caregivers of children and youths living with T1D and pediatric diabetes HCPs in British Columbia, Canada. Surveys were designed using ordinal scales and had free-text questions. Survey items assessed key challenges, perceptions about digital trust and security, and potential desirable features for a digital diabetes platform. Results: Similar challenges were identified between caregivers of children and youths living with T1D (n=99) and HCPs (n=49), including access to mental health support, integration of diabetes technology and device data, and the ability to collaborate on care plans with their diabetes team. Caregivers and HCPs identified potential features that directly addressed their challenges, such as more accessible diabetes data and diabetes care plans. Caregivers had more trust in sharing their child?s data digitally than HCPs. Most caregivers and HCPs stated that an integrative platform for T1D would support collaborative patient care. Conclusions: Caregiver and HCP perspectives gathered in this study will inform the early prototype of an integrative digital health platform. This prototype will be presented and iterated upon through a series of usability testing sessions with caregivers and HCPs to ensure the platform meets end users? needs. UR - https://pediatrics.jmir.org/2023/1/e46432 UR - http://dx.doi.org/10.2196/46432 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440296 ID - info:doi/10.2196/46432 ER - TY - JOUR AU - Idrisov, Bulat AU - Hallgren, A. Kevin AU - Michaels, Alyssa AU - Soth, Sean AU - Darnton, James AU - Grekin, Paul AU - Woolworth, Steve AU - Saxon, J. Andrew AU - Tsui, I. Judith PY - 2023/7/13 TI - Workload, Usability, and Engagement with a Mobile App Supporting Video Observation of Methadone Take-Home Dosing: Usability Study JO - JMIR Hum Factors SP - e42654 VL - 10 KW - addiction KW - direct observed therapy KW - health app KW - methadone KW - mHealth KW - mobile app KW - mobile health KW - opioid KW - smartphone app KW - substance use KW - usability KW - user engagement KW - user testing KW - workload N2 - Background: Methadone, a cornerstone of opioid use disorder treatments for many decades, is an essential tool for combatting the opioid epidemic. However, requirements for observing methadone dosing in person through direct observed therapy (DOT) impose significant barriers for many patients. Digital technology can facilitate remote DOT, which could reduce barriers to methadone treatment. Currently, there are limited data on the usability of such technology among patients and counselors in methadone treatment settings. Objective: The primary objective of this study was to assess the workload, usability, and engagement of a video-based DOT mobile app for patients with opioid use disorder receiving methadone treatment. The secondary objective was to assess the workload, usability, and engagement of the provider-facing app portal used by counselors. Methods: Patients (n=12) and counselors (n=3) who previously tried video DOT for methadone through a smartphone app in an opioid treatment program participated in usability testing sessions. Participants completed essential tasks for video DOT, then provided ratings of workload (NASA Task Load Index), usability (modified System Usability Scale), and engagement (modified Engagement Scale) with the core features of the video DOT program Results: Patients and counselors reported low mental, physical, and temporal demands, successful performance, low effort, and low frustration associated with activities. Patients reported high usability (mean 85, SD 9.5) and engagement (mean 3.8, SD 1.1); counselors reported moderate usability (mean 43.3, SD 17.7) and engagement (mean 2.81, SD 0.63). Conclusions: A mobile health app that facilitates video-based DOT for methadone required a low workload for patients and counselors and was highly usable for patients in an opioid treatment program; however, there are opportunities to improve usability and engagement for the counselor-facing portal. UR - https://humanfactors.jmir.org/2023/1/e42654 UR - http://dx.doi.org/10.2196/42654 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440298 ID - info:doi/10.2196/42654 ER - TY - JOUR AU - Silva de Medeiros, Cármem Máyra AU - de Oliveira, Costa Maiara AU - Gurgel, Barbosa Leonandro Valério AU - Ribeiro Rodrigues, Dantas Anna Giselle Câmara AU - Micussi, Cabral Maria Thereza Albuquerque Barbosa AU - Magalhães, Gomes Adriana PY - 2023/7/13 TI - A Health App for Evidence-Based Postpartum Information: Development and Validation Study JO - JMIR Hum Factors SP - e38706 VL - 10 KW - women's health KW - postpartum period KW - comprehensive health care KW - health technology KW - mobile applications N2 - Background: After childbirth, women undergo substantial physical and emotional changes. Therefore, it is important to provide them with information that helps them identify what is expected during this stage, as well as signs and symptoms that indicate complications after they have been discharged from the hospital. Objective: This study aimed to develop a health app?Towards Motherhood?that provides evidence-based information about the postpartum period and evaluate the usability of the app with the target population. Methods: This was a validation study involving 80 participants, including 24 professionals from the obstetric health field, 15 professionals from the technology field, and 41 postpartum women. The app was developed using React Native technology. Health professionals evaluated the app?s content using the Content Validity Index, technology professionals completed a validated evaluation to assess the appearance of the app, and postpartum women completed the System Usability Scale (SUS) to measure the usability of the app. Results: The measurement of content validity using a Likert scale obtained an approval score of 99%. Regarding the app?s appearance, 92% of responses were positive, reflecting favorable approval. The SUS usability score was 86.2, which represents excellent acceptance. Conclusions: The Towards Motherhood mobile app is a valid tool for promoting self-care during the postpartum period. The app?s evidence-based information, user-friendly design, and high usability make it an essential resource for women during this critical stage of their live. UR - https://humanfactors.jmir.org/2023/1/e38706 UR - http://dx.doi.org/10.2196/38706 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440288 ID - info:doi/10.2196/38706 ER - TY - JOUR AU - Forbush, T. Kelsie AU - Christensen Pacella, A. Kara AU - Thomeczek, L. Marianna AU - Gould, R. Sara AU - A N Chapa, Danielle AU - Richson, N. Brianne AU - Perko, L. Victoria AU - Ayres, Joseph AU - Chen, Yiyang AU - Negi, Sonakshi PY - 2023/7/12 TI - The Building Healthy Eating and Self-Esteem Together for University Students Mobile App to Treat Eating Disorders: User-Centered Research Design and Feasibility Study JO - JMIR Form Res SP - e43504 VL - 7 KW - Building Healthy Eating and Self-Esteem Together for University Students KW - BEST-U KW - eating disorders KW - EDs KW - college KW - university KW - students KW - cognitive behavioral therapy KW - dialectical behavioral therapy KW - mobile health KW - mHealth KW - mental health KW - guided self-help KW - therapy KW - app KW - treatment KW - design KW - usability KW - testing KW - development KW - acceptability KW - cognitive KW - mobile phone N2 - Background: University students are an at-risk group for the development of eating disorders (EDs); however, many college campuses lack sufficient resources to provide ED specialty care. Students report unique reasons for not seeking ED treatment, including the desire to solve the problem on their own (eg, seeking help from friends, self-medicating, or waiting to see if their problems improve), inability to afford treatment, lack of time to participate in the treatment, fear of seeing their primary care physician, and lack of recognition of their issues as an ED. Mobile health (mHealth) apps may be a cost-effective, helpful adjunctive tool to overcome personal and systemic barriers and encourage help seeking. Objective: This paper describes the development, usability, and acceptability of the Building Healthy Eating and Self-Esteem Together for University Students (BEST-U) mHealth smartphone app, which is designed to fill critical gaps in access to ED treatment on college campuses. Methods: We undertook a 4-phase iterative development process that focused on user-centered design. The 4 phases included needs assessment based on literature reviews, prototype development and initial evaluation in a pilot trial, redesign, and further pilot-testing to assess the usability and acceptability of the final version of the mHealth app. Acceptability and user satisfaction were assessed using an ad hoc survey that ranged from 1 (strongly disagree) to 7 (strongly agree). Results: Our needs assessment identified a lack of accessible and affordable treatments for university students. To help meet this need, the BEST-U prototype was designed as an 11-week program that provided interactive, weekly modules that focused on second- and third-wave cognitive behavioral skills. The modules focused on topics such as psychoeducation, reducing thought distortions and body checking, improving body image, interpersonal effectiveness, and behavior chain analysis. The content included interactive quizzes, short answer questions, daily and weekly logs, and surveys completed in the app. BEST-U was paired with brief 25-30 minutes of weekly telehealth coaching sessions provided by a licensed provider or supervised trainee. Pilot-testing revealed minor issues with one module of the app content, which some participants viewed as having low relevance to their experience and therapist concerns about the organization of the app content. These issues were addressed through the removal, addition, and reorganization of BEST-U modules, with the help of therapists-in-training across 2 workshops. The revised version of the BEST-U app had a grand mean acceptability rating of 5.73 out of 7. The participants completed 90.1% (694/770) of the BEST-U modules, indicating high compliance. Conclusions: BEST-U is a new, acceptable, and user-friendly mHealth app to help therapists deliver brief, evidence-based cognitive behavioral interventions. Owing to its acceptability and user-friendly nature, BEST-U has high user compliance and holds promise for future implementation and dissemination in university mental health settings. UR - https://formative.jmir.org/2023/1/e43504 UR - http://dx.doi.org/10.2196/43504 UR - http://www.ncbi.nlm.nih.gov/pubmed/37436790 ID - info:doi/10.2196/43504 ER - TY - JOUR AU - Zheng, Hui PY - 2023/7/11 TI - Author?s Reply to: Environmental Influence and Recruitment Bias in Studies on Internet Addiction. Comment on ?Addiction Symptom Network of Young Internet Users: Network Analysis? JO - J Med Internet Res SP - e45607 VL - 25 KW - internet addiction KW - Internet Addiction Test KW - network analysis KW - adolescents UR - https://www.jmir.org/2023/1/e45607 UR - http://dx.doi.org/10.2196/45607 UR - http://www.ncbi.nlm.nih.gov/pubmed/37432733 ID - info:doi/10.2196/45607 ER - TY - JOUR AU - Huang, Yun Ting AU - Liaw, Yung-Po PY - 2023/7/11 TI - Environmental Influence and Recruitment Bias in Studies on Internet Addiction. Comment on ?Addiction Symptom Network of Young Internet Users: Network Analysis? JO - J Med Internet Res SP - e44438 VL - 25 KW - internet addiction KW - Internet Addiction Test KW - network analysis KW - adolescents UR - https://www.jmir.org/2023/1/e44438 UR - http://dx.doi.org/10.2196/44438 UR - http://www.ncbi.nlm.nih.gov/pubmed/37432717 ID - info:doi/10.2196/44438 ER - TY - JOUR AU - Zepeda-Echavarria, Alejandra AU - van de Leur, R. Rutger AU - van Sleuwen, Meike AU - Hassink, J. Rutger AU - Wildbergh, X. Thierry AU - Doevendans, A. Pieter AU - Jaspers, Joris AU - van Es, René PY - 2023/7/7 TI - Electrocardiogram Devices for Home Use: Technological and Clinical Scoping Review JO - JMIR Cardio SP - e44003 VL - 7 KW - electrocardiogram KW - mobile ECG KW - home use ECG KW - wearables KW - medical devices KW - ECG clinical validation, ECG technical characteristics N2 - Background: Electrocardiograms (ECGs) are used by physicians to record, monitor, and diagnose the electrical activity of the heart. Recent technological advances have allowed ECG devices to move out of the clinic and into the home environment. There is a great variety of mobile ECG devices with the capabilities to be used in home environments. Objective: This scoping review aimed to provide a comprehensive overview of the current landscape of mobile ECG devices, including the technology used, intended clinical use, and available clinical evidence. Methods: We conducted a scoping review to identify studies concerning mobile ECG devices in the electronic database PubMed. Secondarily, an internet search was performed to identify other ECG devices available in the market. We summarized the devices? technical information and usability characteristics based on manufacturer data such as datasheets and user manuals. For each device, we searched for clinical evidence on the capabilities to record heart disorders by performing individual searches in PubMed and ClinicalTrials.gov, as well as the Food and Drug Administration (FDA) 510(k) Premarket Notification and De Novo databases. Results: From the PubMed database and internet search, we identified 58 ECG devices with available manufacturer information. Technical characteristics such as shape, number of electrodes, and signal processing influence the capabilities of the devices to record cardiac disorders. Of the 58 devices, only 26 (45%) had clinical evidence available regarding their ability to detect heart disorders such as rhythm disorders, more specifically atrial fibrillation. Conclusions: ECG devices available in the market are mainly intended to be used for the detection of arrhythmias. No devices are intended to be used for the detection of other cardiac disorders. Technical and design characteristics influence the intended use of the devices and use environments. For mobile ECG devices to be intended to detect other cardiac disorders, challenges regarding signal processing and sensor characteristics should be solved to increase their detection capabilities. Devices recently released include the use of other sensors on ECG devices to increase their detection capabilities. UR - https://cardio.jmir.org/2023/1/e44003 UR - http://dx.doi.org/10.2196/44003 UR - http://www.ncbi.nlm.nih.gov/pubmed/37418308 ID - info:doi/10.2196/44003 ER - TY - JOUR AU - LeBlanc, R. Matthew AU - LeBlanc, W. Thomas AU - Yang, Qing AU - McLaughlin, Jennifer AU - Irish, Kerry AU - Smith, K. Sophia PY - 2023/7/6 TI - A Mobile App to Support Self-Management in Patients with Multiple Myeloma or Chronic Lymphocytic Leukemia: Pilot Randomized Controlled Trial JO - JMIR Cancer SP - e44533 VL - 9 KW - chronic lymphocytic leukemia KW - distress KW - intervention KW - leukemia KW - mHealth KW - mobile application KW - multiple myeloma KW - post-traumatic stress KW - self-management KW - symptoms KW - treatment N2 - Background: Patients with blood cancer experience serious physical and emotional symptoms throughout their cancer journey. Objective: Building on previous work, we aimed to develop an app designed to help patients with multiple myeloma and chronic lymphocytic leukemia self-manage symptoms and test it for acceptability and preliminary efficacy. Methods: We developed our Blood Cancer Coach app with input from clinicians and patients. Our 2-armed randomized controlled pilot trial recruited participants from Duke Health and nationally in partnerships with the Association of Oncology Social Work, Leukemia and Lymphoma Society, and other patient groups. Participants were randomized to the attention control (Springboard Beyond Cancer website) arm or the Blood Cancer Coach app intervention arm. The fully automated Blood Cancer Coach app included symptom and distress tracking with tailored feedback, medication reminders and adherence tracking, multiple myeloma and chronic lymphocytic leukemia education resources, and mindfulness activities. Patient-reported data were collected at baseline, 4 weeks, and 8 weeks for both arms through the Blood Cancer Coach app. Outcomes of interest were global health (Patient Reported Outcomes Measurement Information System Global Health), posttraumatic stress (Posttraumatic Stress Disorder Checklist for DSM-5), and cancer symptoms (Edmonton Symptom Assessment System Revised). Among participants in the intervention arm, satisfaction surveys and usage data were used to evaluate acceptability. Results: Among 180 patients who downloaded the app, 49% (89) of them consented to participate and 40% (72) of them completed baseline surveys. Of those who completed baseline surveys, 53% (38) of them completed week 4 surveys (16 intervention and 22 control) and 39% (28) of them completed week 8 surveys (13 intervention and 15 control). Most participants found the app at least moderately effective at helping manage symptoms (87%), feeling more comfortable seeking help (87%), increasing awareness of resources (73%), and reported being satisfied with the app overall (73%). Participants completed an average of 248.5 app tasks over the 8-week study period. The most used functions within the app were medication log, distress tracking, guided meditations, and symptom tracking. There were no significant differences between the control and intervention arms at week 4 or 8 on any outcomes. We also saw no significant improvement over time within the intervention arm. Conclusions: The results of our feasibility pilot were promising in which most participants found the app to be helpful in managing their symptoms, reported satisfaction with the app, and that it was helpful in several important areas. We did not, however, find significantly reduced symptoms or improved global mental and physical health over 2 months. Recruitment and retention were challenging for this app-based study, an experience echoed by others. Limitations included a predominantly White and college educated sample. Future studies would do well to include self-efficacy outcomes, target those with more symptoms, and emphasize diversity in recruitment and retention. Trial Registration: ClinicalTrials.gov NCT05928156; https://clinicaltrials.gov/study/NCT05928156 UR - https://cancer.jmir.org/2023/1/e44533 UR - http://dx.doi.org/10.2196/44533 UR - http://www.ncbi.nlm.nih.gov/pubmed/37410541 ID - info:doi/10.2196/44533 ER - TY - JOUR AU - Hallgren, A. Kevin AU - Duncan, H. Mark AU - Iles-Shih, D. Matthew AU - Cohn, B. Eliza AU - McCabe, J. Connor AU - Chang, M. Yanni AU - Saxon, J. Andrew PY - 2023/7/6 TI - Feasibility, Engagement, and Usability of a Remote, Smartphone-Based Contingency Management Program as a Treatment Add-On for Patients Who Use Methamphetamine: Single-Arm Pilot Study JO - JMIR Form Res SP - e47516 VL - 7 KW - contingency management KW - methamphetamine use disorder KW - mobile health KW - mHealth KW - mobile phone N2 - Background: In the United States, methamphetamine-related overdoses have tripled from 2015 to 2020 and continue to rise. However, efficacious treatments such as contingency management (CM) are often unavailable in health systems. Objective: We conducted a single-arm pilot study to evaluate the feasibility, engagement, and usability of a fully remotely delivered mobile health CM program offered to adult outpatients who used methamphetamine and were receiving health care within a large university health system. Methods: Participants were referred by primary care or behavioral health clinicians between September 2021 and July 2022. Eligibility criteria screening was conducted by telephone and included self-reported methamphetamine use on ?5 out of the past 30 days and a goal of reducing or abstaining from methamphetamine use. Eligible participants who agreed to take part then completed an initial welcome phase that included 2 videoconference calls to register for and learn about the CM program and 2 ?practice? saliva-based substance tests prompted by a smartphone app. Participants who completed these welcome phase activities could then receive the remotely delivered CM intervention for 12 consecutive weeks. The intervention included approximately 24 randomly scheduled smartphone alerts requesting a video recording of themselves taking a saliva-based substance test to verify recent methamphetamine abstinence, 12 weekly calls with a CM guide, 35 self-paced cognitive behavioral therapy modules, and multiple surveys. Financial incentives were disbursed via reloadable debit cards. An intervention usability questionnaire was completed at the midpoint. Results: Overall, 37 patients completed telephone screenings, with 28 (76%) meeting the eligibility criteria and consenting to participate. Most participants who completed a baseline questionnaire (21/24, 88%) self-reported symptoms consistent with severe methamphetamine use disorder, and most had other co-occurring non-methamphetamine substance use disorders (22/28, 79%) and co-occurring mental health disorders (25/28, 89%) according to existing electronic health records. Overall, 54% (15/28) of participants successfully completed the welcome phase and were able to receive the CM intervention. Among these participants, engagement with substance testing, calls with CM guides, and cognitive behavioral therapy modules varied. Rates of verified methamphetamine abstinence in substance testing were generally low but varied considerably across participants. Participants reported positive opinions about the intervention?s ease of use and satisfaction with the intervention. Conclusions: Fully remote CM can be feasibly delivered within health care settings lacking existing CM programs. Although remote delivery may help reduce barriers to treatment access, many patients who use methamphetamine may struggle to engage with initial onboarding. High rates of co-occurring psychiatric conditions in the patient population may also contribute to uptake and engagement challenges. Future efforts could leverage greater human-to-human connection, more streamlined onboarding procedures, larger incentives, longer durations, and the incentivization of non?abstinence-based recovery goals to increase uptake and engagement with fully remote mobile health?based CM. UR - https://formative.jmir.org/2023/1/e47516 UR - http://dx.doi.org/10.2196/47516 UR - http://www.ncbi.nlm.nih.gov/pubmed/37410529 ID - info:doi/10.2196/47516 ER - TY - JOUR AU - Presseller, K. Emily AU - Lampe, W. Elizabeth AU - Zhang, Fengqing AU - Gable, A. Philip AU - Guetterman, C. Timothy AU - Forman, M. Evan AU - Juarascio, S. Adrienne PY - 2023/7/6 TI - Using Wearable Passive Sensing to Predict Binge Eating in Response to Negative Affect Among Individuals With Transdiagnostic Binge Eating: Protocol for an Observational Study JO - JMIR Res Protoc SP - e47098 VL - 12 KW - affect KW - binge eating KW - heart rate KW - heart rate variability KW - electrodermal activity KW - ecological momentary assessment KW - wearable sensors KW - ecological momentary intervention N2 - Background: Binge eating (BE), characterized by eating a large amount of food accompanied by a sense of loss of control over eating, is a public health crisis. Negative affect is a well-established antecedent for BE. The affect regulation model of BE posits that elevated negative affect increases momentary risk for BE, as engaging in BE alleviates negative affect and reinforces the behavior. The eating disorder field?s capacity to identify moments of elevated negative affect, and thus BE risk, has exclusively relied on ecological momentary assessment (EMA). EMA involves the completion of surveys in real time on one?s smartphone to report behavioral, cognitive, and emotional symptoms throughout the day. Although EMA provides ecologically valid information, EMA surveys are often delivered only 5-6 times per day, involve self-report of affect intensity only, and are unable to assess affect-related physiological arousal. Wearable, psychophysiological sensors that measure markers of affect arousal including heart rate, heart rate variability, and electrodermal activity may augment EMA surveys to improve accurate real-time prediction of BE. These sensors can objectively and continuously measure biomarkers of nervous system arousal that coincide with affect, thus allowing them to measure affective trajectories on a continuous timescale, detect changes in negative affect before the individual is consciously aware of them, and reduce user burden to improve data completeness. However, it is unknown whether sensor features can distinguish between positive and negative affect states, given that physiological arousal may occur during both negative and positive affect states. Objective: The aims of this study are (1) to test the hypothesis that sensor features will distinguish positive and negative affect states in individuals with BE with >60% accuracy and (2) test the hypothesis that a machine learning algorithm using sensor data and EMA-reported negative affect to predict the occurrence of BE will predict BE with greater accuracy than an algorithm using EMA-reported negative affect alone. Methods: This study will recruit 30 individuals with BE who will wear Fitbit Sense 2 wristbands to passively measure heart rate and electrodermal activity and report affect and BE on EMA surveys for 4 weeks. Machine learning algorithms will be developed using sensor data to distinguish instances of high positive and high negative affect (aim 1) and to predict engagement in BE (aim 2). Results: This project will be funded from November 2022 to October 2024. Recruitment efforts will be conducted from January 2023 through March 2024. Data collection is anticipated to be completed in May 2024. Conclusions: This study is anticipated to provide new insight into the relationship between negative affect and BE by integrating wearable sensor data to measure affective arousal. The findings from this study may set the stage for future development of more effective digital ecological momentary interventions for BE. International Registered Report Identifier (IRRID): DERR1-10.2196/47098 UR - https://www.researchprotocols.org/2023/1/e47098 UR - http://dx.doi.org/10.2196/47098 UR - http://www.ncbi.nlm.nih.gov/pubmed/37410522 ID - info:doi/10.2196/47098 ER - TY - JOUR AU - Brady, Brooke AU - Zhou, Shally AU - Ashworth, Daniel AU - Zheng, Lidan AU - Eramudugolla, Ranmalee AU - Huque, Hamidul Md AU - Anstey, Jane Kaarin PY - 2023/7/6 TI - A Technology-Enriched Approach to Studying Microlongitudinal Aging Among Adults Aged 18 to 85 Years: Protocol for the Labs Without Walls Study JO - JMIR Res Protoc SP - e47053 VL - 12 KW - life-course aging KW - longitudinal research KW - subjective age KW - gender KW - cognition KW - sensory function KW - app KW - mobile app KW - eHealth KW - mobile health KW - mHealth KW - measurement burst design KW - ecological momentary assessment KW - health information technology KW - personalized health KW - mobile phone N2 - Background: Traditional longitudinal aging research involves studying the same individuals over a long period, with measurement intervals typically several years apart. App-based studies have the potential to provide new insights into life-course aging by improving the accessibility, temporal specificity, and real-world integration of data collection. We developed a new research app for iOS named Labs Without Walls to facilitate the study of life-course aging. Combined with data collected using paired smartwatches, the app collects complex data including data from one-time surveys, daily diary surveys, repeated game-like cognitive and sensory tasks, and passive health and environmental data. Objective: The aim of this protocol is to describe the research design and methods of the Labs Without Walls study conducted between 2021 and 2023 in Australia. Methods: Overall, 240 Australian adults will be recruited, stratified by age group (18-25, 26-35, 36-45, 46-55, 56-65, 66-75, and 76-85 years) and sex at birth (male and female). Recruitment procedures include emails to university and community networks, as well as paid and unpaid social media advertisements. Participants will be invited to complete the study onboarding either in person or remotely. Participants who select face-to-face onboarding (n=approximately 40) will be invited to complete traditional in-person cognitive and sensory assessments to be cross-validated against their app-based counterparts. Participants will be sent an Apple Watch and headphones for use during the study period. Participants will provide informed consent within the app and then begin an 8-week study protocol, which includes scheduled surveys, cognitive and sensory tasks, and passive data collection using the app and a paired watch. At the conclusion of the study period, participants will be invited to rate the acceptability and usability of the study app and watch. We hypothesize that participants will be able to successfully provide e-consent, input survey data through the Labs Without Walls app, and have passive data collected over 8 weeks; participants will rate the app and watch as user-friendly and acceptable; the app will allow for the study of daily variability in self-perceptions of age and gender; and data will allow for the cross-validation of app- and laboratory-based cognitive and sensory tasks. Results: Recruitment began in May 2021, and data collection was completed in February 2023. The publication of preliminary results is anticipated in 2023. Conclusions: This study will provide evidence regarding the acceptability and usability of the research app and paired watch for studying life-course aging processes on multiple timescales. The feedback obtained will be used to improve future iterations of the app, explore preliminary evidence for intraindividual variability in self-perceptions of aging and gender expression across the life span, and explore the associations between performance on app-based cognitive and sensory tests and that on similar traditional cognitive and sensory tests. International Registered Report Identifier (IRRID): DERR1-10.2196/47053 UR - https://www.researchprotocols.org/2023/1/e47053 UR - http://dx.doi.org/10.2196/47053 UR - http://www.ncbi.nlm.nih.gov/pubmed/37410527 ID - info:doi/10.2196/47053 ER - TY - JOUR AU - Gilbert, Stephanie AU - Irvine, Rachel AU - D'or, Melissa AU - Adam, P. Marc T. AU - Collins, E. Clare AU - Marriott, Rhonda AU - Rollo, Megan AU - Walker, Roz AU - Rae, Kym PY - 2023/7/6 TI - Indigenous Women and Their Nutrition During Pregnancy (the Mums and Bubs Deadly Diets Project): Protocol for a Co-designed mHealth Resource Development Study JO - JMIR Res Protoc SP - e45983 VL - 12 KW - co-design KW - community-based participatory research KW - mHealth KW - Aboriginal and Torres Strait Islander KW - maternal health KW - pregnancy KW - nutrition KW - Indigenous women KW - diet KW - health literacy KW - Indigenous KW - Indigenous people KW - mobile phone N2 - Background: Nutrition in pregnancy is pivotal to optimizing infant growth and maternal well-being. The factors affecting Indigenous people?s food and nutrition intake are complex with a history of colonization impacting the disproportionate effect of social determinants to this day. Literature regarding the dietary intake or dietary priorities of Indigenous women in Australia is scarce, with supportive, culturally appropriate resources developed for and with this group rare. Research suggests mobile health (mHealth) tools are effective in supporting health knowledge of Indigenous people and positive health behavior changes when designed and developed with the expertise of Indigenous communities. Objective: This study seeks to build the body of knowledge related to nutrition needs and priorities for Indigenous women in Australia during pregnancy. Further, this project team and its participants will co-design an mHealth digital tool to support these nutrition needs. Methods: The Mums and Bubs Deadly Diets study recruits Indigenous women and health care professionals who support Indigenous women during pregnancy into 2 phases. Phase 1 (predesign) uses a mixed methods convergent design using a biographical questionnaire and social or focus groups to inform phase 2 (generative). Phase 2 will use a participatory action research process during co-design workshops to iteratively develop the digital tool; the exact actions within a workshop will evolve according to the participant group decisions. Results: To date, this project has undertaken phase 1 focus groups at all Queensland sites, with New South Wales and Western Australia to begin in early to mid-2023. We have recruited 12 participants from Galangoor Duwalami, 18 participants from Carbal in Toowoomba, and 18 participants from Carbal in Warwick. We are expecting similar numbers of recruits in Western Australia and New South Wales. Participants have been both community members and health care professionals. Conclusions: This study is an iterative and adaptive research program that endeavors to develop real-world, impactful resources to support the nutrition needs and priorities of pregnant Indigenous women in Australia. This comprehensive project requires a combination of methods and methodologies to ensure Indigenous voices are heard at each stage and in all aspects of research output. The development of an mHealth resource for this cohort will provide a necessary bridge where there is often a gap in access to nutrition resources for women in pregnancy in Indigenous communities. International Registered Report Identifier (IRRID): DERR1-10.2196/45983 UR - https://www.researchprotocols.org/2023/1/e45983 UR - http://dx.doi.org/10.2196/45983 UR - http://www.ncbi.nlm.nih.gov/pubmed/37147188 ID - info:doi/10.2196/45983 ER - TY - JOUR AU - Wren, M. Gina AU - Koutoukidis, A. Dimitrios AU - Scragg, Jadine AU - Whitman, Michael AU - Jebb, Susan PY - 2023/7/5 TI - The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program JO - J Med Internet Res SP - e43869 VL - 25 KW - obesity KW - overweight KW - weight loss KW - goals KW - motivation KW - mobile app KW - mobile health KW - mHealth KW - behavior change KW - mobile phone N2 - Background: Goal setting aids health-related behavior changes; however, the influence of different types of goals on weight loss remains unclear. Objective: We aimed to investigate the association of 3 aspects of goal setting with weight and program dropout over a 24-week period. Methods: This study was a prospective longitudinal analysis of participants in a 12-week digital behavioral weight loss program. Weight and engagement data for eligible participants (N=36,794) were extracted from the database. Eligible participants were adults in the United Kingdom who had enrolled in the program, had a BMI ?25 kg/m2, and a weight reading recorded at baseline. Three aspects of goal setting were self-reported at enrollment: weight loss motivation (appearance, health, fitness, or self-efficacy), overall goal preference (low, medium, or high), and percentage weight loss goal (<5%, 5%-10%, or >10%). Weight was measured at 4, 12, and 24 weeks. Mixed models for repeated measures were used to explore the association between goals and weight across the 24-week period. To measure sustained weight change, the primary outcome was weight at 24 weeks. We explored dropout rates over the 24-week period by goal and whether engagement mediated the association between goals and weight loss. Results: Of the 36,794 participants (mean 46.7, SD 11.1 years; 33,902/36,794, 92.14% female) included in the cohort, 13.09% (n=4818) reported weight at 24 weeks. Most participants set goals of 5%-10% weight loss (23,629/36,794, 64.22%), but setting goals for >10% was associated with greater weight loss (mean difference 5.21 kg, 95% CI 5.01-5.41; P<.001). There was no difference between goals of 5%-10% and <5% (mean difference 0.59 kg, 95% CI 0.00-1.18; P=.05). Appearance was the most prevalent motivational factor (14,736/36,794, 40.05%), but health and fitness were associated with greater weight losses (mean difference health vs appearance 1.40 kg, 95% CI 1.15-1.65; P<.001 and mean difference fitness vs appearance 0.38 kg, 95% CI 0.05-0.70; P=.03). Goal preference had no association with weight. Engagement was an independent predictor of weight loss but not a mediator of the effect of goal setting. At 24 weeks, those who set goals of >10% were less likely to drop out compared with 5%-10% goals (odds ratio [OR] 0.40, 95% CI 0.38-0.42; P<.001); those who liked to set overall high goals were more likely to drop out compared with medium goals (OR 1.20, 95% CI 1.11-1.29; P<.001); and those motivated by fitness or health were less likely to drop out compared with appearance (OR 0.92, 95% CI 0.85-0.995; P=.04 and OR 0.84, 95% CI 0.78-0.89; P<.001, respectively). Conclusions: Setting higher weight loss goals and being motivated by health or fitness were associated with greater weight loss and lower likelihood of dropout. Randomized trials for setting these types of goals are required to confirm causality. UR - https://www.jmir.org/2023/1/e43869 UR - http://dx.doi.org/10.2196/43869 UR - http://www.ncbi.nlm.nih.gov/pubmed/37405833 ID - info:doi/10.2196/43869 ER - TY - JOUR AU - Shouldice, Claire Ainslie AU - Beatty, Madison AU - Adams, Sherri AU - Dharmaraj, Blossom AU - Moore, Clara AU - Stinson, Nan Jennifer AU - Desai, Arti AU - Bartlett, Leah AU - Culbert, Erin AU - Cohen, Eyal AU - Orkin, Julia PY - 2023/7/5 TI - Caregivers? Experiences With a Web- and Mobile-Based Platform for Children With Medical Complexity and the Role of a Live Platform Coach: Thematic Analysis JO - JMIR Pediatr Parent SP - e43214 VL - 6 KW - care coordination KW - care KW - children with medical complexity KW - children KW - chronic condition KW - electronic data KW - engagement KW - health information exchange KW - medical KW - patient care planning KW - pediatrics KW - usage KW - utilization N2 - Background: Children with medical complexity (CMC) are individuals with complex chronic conditions who have substantial health care needs, functional limitations, and significant use of health care. By nature of their health status, they have many care providers across multiple settings, making information sharing critical to their health and safety. Connecting2gether (C2), a web- and mobile-based patient-facing platform, was codeveloped with families to support and empower parental caregivers, improve information sharing, and facilitate care delivery. C2 also provided a live platform coach to conduct parental feedback and coaching sessions, which included answering questions, providing advice on usage, and addressing technological issues. Objective: This study was conducted to understand the experience of parental caregivers using the C2 platform and the role of the live platform coach. This study is a subset of a larger study assessing the feasibility of C2 in the care of CMC. Methods: Parental caregivers (n=33) participated in biweekly sessions to provide feedback and receive real-time platform use support from a trained research team member acting as a live platform coach. Parental caregivers were asked about the utility and usability of C2?s features. Questions, platform issues, and feedback were recorded on a standardized electronic data collection tool. A thematic analysis was performed to analyze parental comments, and codes were categorized into key themes. The number of comments corresponding with each code was quantified. Results: A total of 166 parental feedback and coaching sessions were conducted, with an average of 5 sessions per parental caregiver (range 1-7). There were 33 (85%) parental caregivers that participated in at least one coaching session. Technical issues and difficulties navigating C2 were addressed in real time during the sessions to encourage platform engagement. Four key themes were identified: (1) live platform coach, (2) barriers to platform usage and technical challenges, (3) platform requests and modifications, and (4) parent partnership and empowerment. Conclusions: Parental caregivers describe C2 as a valuable tool, acting as a facilitator for enhanced care coordination and communication. Parental caregiver feedback showed that the live platform coach was a critical tool in educating on platform use and addressing technological concerns. Further study of the use of the C2 platform and its role in the care of CMC is needed to understand the possible benefits and cost-effectiveness of this technology. UR - https://pediatrics.jmir.org/2023/1/e43214 UR - http://dx.doi.org/10.2196/43214 UR - http://www.ncbi.nlm.nih.gov/pubmed/37405834 ID - info:doi/10.2196/43214 ER - TY - JOUR AU - Shania, Mila AU - Handayani, Wuri Putu AU - Asih, Sali PY - 2023/7/3 TI - Designing High-Fidelity Mobile Health for Depression in Indonesian Adolescents Using Design Science Research: Mixed Method Approaches JO - JMIR Form Res SP - e48913 VL - 7 KW - mobile health KW - mental health KW - user interface KW - design science research KW - Indonesia KW - digital app KW - mHealth KW - depression KW - pandemic KW - adolescents N2 - Background: COVID-19 mitigation protocols, enacted to control the pandemic, have also been shown to have a negative impact on mental health, including the mental health of adolescents. The threat of being infected by SARS-CoV-2 and substantial changes in lifestyle, including limited social interaction due to stay-at-home orders, led to loneliness as well as depressive symptoms. However, offline psychological assistance is restricted, as psychologists are bounded by mitigation protocols. Further, not all adolescents? guardians are open to their children attending or have the means to pay for psychological service; thus, adolescents remain untreated. Having a mobile health (mHealth) app for mental health that uses monitoring, provides social networks, and delivers psychoeducation may provide a solution, especially in countries that have limited health facilities and mental health workers. Objective: This study aimed to design an mHealth app to help prevent and monitor depression in adolescents. The design of this mHealth app was carried out as a high-fidelity prototype. Methods: We used a design science research (DSR) methodology with 3 iterations and 8 golden rule guidelines. The first iteration used interviews, and the second and third iterations used mixed method approaches. The DSR stages include the following: (1) identify the problem; (2) define the solution; (3) define the solution objective; (4) develop, demonstrate, and evaluate the solution; and (5) communicate the solution. This study involved students and medical experts. Results: The first iteration resulted in a wireframe and prototype for the next iteration. The second iteration resulted in a System Usability Scale score of 67.27, indicating a good fit. In the third iteration, the system usefulness, information quality, interface quality, and overall values were 2.416, 2.341, 2.597, and 2.261, respectively, indicating a good design. Key features of this mHealth app include a mood tracker, community, activity target, and meditation, and supporting features that complement the design include education articles and early detection features. Conclusions: Our findings provide guidance for health facilities and to design and implement future mHealth apps to help treat adolescent depression. UR - https://formative.jmir.org/2023/1/e48913 UR - http://dx.doi.org/10.2196/48913 UR - http://www.ncbi.nlm.nih.gov/pubmed/37399059 ID - info:doi/10.2196/48913 ER - TY - JOUR AU - Grasa, Eva AU - Seppälä, Jussi AU - Alonso-Solis, Anna AU - Haapea, Marianne AU - Isohanni, Matti AU - Miettunen, Jouko AU - Caro Mendivelso, Johanna AU - Almazan, Cari AU - Rubinstein, Katya AU - Caspi, Asaf AU - Unoka, Zsolt AU - Farkas, Kinga AU - Usall, Judith AU - Ochoa, Susana AU - van der Graaf, Shenja AU - Jewell, Charlotte AU - Triantafillou, Anna AU - Stevens, Matthias AU - Reixach, Elisenda AU - Berdun, Jesus AU - AU - Corripio, Iluminada PY - 2023/6/30 TI - m-RESIST, a Mobile Therapeutic Intervention for Treatment-Resistant Schizophrenia: Feasibility, Acceptability, and Usability Study JO - JMIR Form Res SP - e46179 VL - 7 KW - schizophrenia KW - treatment-resistant KW - digital mental health KW - mHealth KW - mobile health KW - mental health KW - mental illness KW - mental disorder KW - psychosis KW - symptom management KW - adherence KW - acceptability KW - usability KW - feasibility KW - digital intervention KW - mobile intervention KW - mobile phone N2 - Background: In the European Union, around 5 million people are affected by psychotic disorders, and approximately 30%-50% of people with schizophrenia have treatment-resistant schizophrenia (TRS). Mobile health (mHealth) interventions may be effective in preventing relapses, increasing treatment adherence, and managing some of the symptoms of schizophrenia. People with schizophrenia seem willing and able to use smartphones to monitor their symptoms and engage in therapeutic interventions. mHealth studies have been performed with other clinical populations but not in populations with TRS. Objective: The purpose of this study was to present the 3-month prospective results of the m-RESIST intervention. This study aims to assess the feasibility, acceptability, and usability of the m-RESIST intervention and the satisfaction among patients with TRS after using this intervention. Methods: A prospective multicenter feasibility study without a control group was undertaken with patients with TRS. This study was performed at 3 sites: Sant Pau Hospital (Barcelona, Spain), Semmelweis University (Budapest, Hungary), and Sheba Medical Center and Gertner Institute of Epidemiology and Health Policy Research (Ramat-Gan, Israel). The m-RESIST intervention consisted of a smartwatch, a mobile app, a web-based platform, and a tailored therapeutic program. The m-RESIST intervention was delivered to patients with TRS and assisted by mental health care providers (psychiatrists and psychologists). Feasibility, usability, acceptability, and user satisfaction were measured. Results: This study was performed with 39 patients with TRS. The dropout rate was 18% (7/39), the main reasons being as follows: loss to follow-up, clinical worsening, physical discomfort of the smartwatch, and social stigma. Patients? acceptance of m-RESIST ranged from moderate to high. The m-RESIST intervention could provide better control of the illness and appropriate care, together with offering user-friendly and easy-to-use technology. In terms of user experience, patients indicated that m-RESIST enabled easier and quicker communication with clinicians and made them feel more protected and safer. Patients? satisfaction was generally good: 78% (25/32) considered the quality of service as good or excellent, 84% (27/32) reported that they would use it again, and 94% (30/32) reported that they were mostly satisfied. Conclusions: The m-RESIST project has provided the basis for a new modular program based on novel technology: the m-RESIST intervention. This program was well-accepted by patients in terms of acceptability, usability, and satisfaction. Our results offer an encouraging starting point regarding mHealth technologies for patients with TRS. Trial Registration: ClinicalTrials.gov NCT03064776; https://clinicaltrials.gov/ct2/show/record/NCT03064776 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2017-021346 UR - https://formative.jmir.org/2023/1/e46179 UR - http://dx.doi.org/10.2196/46179 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389933 ID - info:doi/10.2196/46179 ER - TY - JOUR AU - Sae-lee, Kittiya AU - Surangsrirat, Decho AU - Parlawong, Chanatip AU - Anawilkul, T-touch AU - Assawachamrun, Narinuch AU - Boonbandan, Pawanya AU - Ladapongpuwat, Paweerata AU - Chupetch, Bhawat AU - Thongchai, Supatcha AU - Pruphetkaew, Nannapat AU - Thongseiratch, Therdpong AU - Vichitkunakorn, Polathep AU - Ngamchaliew, Pitchayanont PY - 2023/6/30 TI - Workout Logging Through an mHealth App for Weight Reduction Among Different Generations: Secondary Analysis of the MED PSU×ThaiSook Healthier Challenge JO - JMIR Form Res SP - e45298 VL - 7 KW - generations KW - logging frequency KW - mobile health app KW - weight status KW - weight reduction N2 - Background: Being overweight or obese presents a major risk factor for noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, and musculoskeletal disorders. These problems are preventable and solvable via weight reduction and increased physical activity and exercise. The number of adults who are overweight or affected by obesity has tripled in the last 4 decades. Using mobile health (mHealth) apps can help users with health issues, including reducing their weight by restricting their daily calorie intake, which can be recorded along with other parameters, such as physical activity and exercise. These features could further enhance health and prevent NCDs. ThaiSook, a Thai mHealth app developed by the National Science and Technology Development Agency, aims to promote healthy lifestyles and reduce the risk behaviors of NCDs. Objective: This study aimed to determine whether ThaiSook users were successful in 1-month weight reduction and identify which demographic factors or logging functions were associated with significant weight reduction. Methods: A secondary data analysis was performed using data collected from the ?MED PSU×ThaiSook Healthier Challenge,? a month-long challenge to encourage a healthy lifestyle. We enrolled 376 participants to evaluate the study outcomes. The variables, comprising demographic characteristics (ie, sex, generation, group size, and BMI), were classified into 4 groups: normal (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), obese I (25-29.9 kg/m2), and obese II (BMI ?30 kg/m2). Logging functions (ie, water, fruit and vegetables, sleep, workout, step, and run) were classified into 2 groups: consistent (?80%) and inconsistent (<80%) users. Weight reduction was categorized into 3 groups: no weight reduction, slight weight reduction (0%-3%), and significant weight reduction (>3%). Results: Of 376 participants, most were female (n=346, 92%), had normal BMI (n=178, 47.3%), belonged to Generation Y (n=147, 46.7%), and had a medium group size (6-10 members; n=250, 66.5%). The results showed that 56 (14.9%) participants had 1-month significant weight loss, and the median weight reduction of the group was ?3.85% (IQR ?3.40% to ?4.50%). Most participants (264/376, 70.2%) experienced weight loss, with an overall median weight loss of ?1.08% (IQR ?2.40% to 0.00%). The factors associated with significant weight reduction were consistently logging workouts (adjusted odds ratio [AOR] 1.69, 95% CI 1.07-2.68), being Generation Z (AOR 3.06, 95% CI 1.01-9.33), and being overweight or being obese compared to those with normal BMI (AOR 2.66, 95% CI 1.41-5.07; AOR 1.76, 95% CI 1.08-2.87, respectively). Conclusions: More than half of the ?MED PSU×ThaiSook Healthier Challenge? participants achieved a slight weight reduction, and 14.9% (56/376) of users lost significant weight. Factors including workout logging, being Generation Z, being overweight, and being obese were associated with significant weight reduction. UR - https://formative.jmir.org/2023/1/e45298 UR - http://dx.doi.org/10.2196/45298 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389918 ID - info:doi/10.2196/45298 ER - TY - JOUR AU - Collier, Futterman Ann AU - Hagemann, Shelby AU - Trinidad, Brown Susan AU - Vigil-Hayes, Morgan PY - 2023/6/30 TI - Human-to-Computer Interactivity Features Incorporated Into Behavioral Health mHealth Apps: Systematic Search JO - JMIR Form Res SP - e44926 VL - 7 KW - app KW - behavioral app KW - behavioral health KW - consumers KW - engagement KW - health application KW - interactivity KW - mHealth KW - stickiness KW - support KW - therapeutic KW - user engagement KW - users N2 - Background: While there are thousands of behavioral health apps available to consumers, users often quickly discontinue their use, which limits their therapeutic value. By varying the types and number of ways that users can interact with behavioral health mobile health apps, developers may be able to support greater therapeutic engagement and increase app stickiness. Objective: The main objective of this analysis was to systematically characterize the types of user interactions that are available in behavioral health apps and then examine if greater interactivity was associated with greater user satisfaction, as measured by app metrics. Methods: Using a modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology, we searched several different app clearinghouse websites and identified 76 behavioral health apps that included some type of interactivity. We then filtered the results to ensure we were examining behavioral health apps and further refined our search to include apps that identified one or more of the following terms: peer or therapist forum, discussion, feedback, professional, licensed, buddy, friend, artificial intelligence, chatbot, counselor, therapist, provider, mentor, bot, coach, message, comment, chat room, community, games, care team, connect, share, and support in the app descriptions. In the final group of 34 apps, we examined the presence of 6 types of human-machine interactivities: human-to-human with peers, human-to-human with providers, human-to?artificial intelligence, human-to-algorithms, human-to-data, and novel interactive smartphone modalities. We also downloaded information on app user ratings and visibility, as well as reviewed other key app features. Results: We found that on average, the 34 apps reviewed included 2.53 (SD 1.05; range 1-5) features of interactivity. The most common types of interactivities were human-to-data (n=34, 100%), followed by human-to-algorithm (n=15, 44.2%). The least common type of interactivity was human?artificial intelligence (n=7, 20.5%). There were no significant associations between the total number of app interactivity features and user ratings or app visibility. We found that a full range of therapeutic interactivity features were not used in behavioral health apps. Conclusions: Ideally, app developers would do well to include more interactivity features in behavioral health apps in order to fully use the capabilities of smartphone technologies and increase app stickiness. Theoretically, increased user engagement would occur by using multiple types of user interactivity, thereby maximizing the benefits that a person would receive when using a mobile health app. UR - https://formative.jmir.org/2023/1/e44926 UR - http://dx.doi.org/10.2196/44926 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389916 ID - info:doi/10.2196/44926 ER - TY - JOUR AU - Denyer, Hayley AU - Deng, Qigang AU - Adanijo, Abimbola AU - Asherson, Philip AU - Bilbow, Andrea AU - Folarin, Amos AU - Groom, J. Madeleine AU - Hollis, Chris AU - Wykes, Til AU - Dobson, JB Richard AU - Kuntsi, Jonna AU - Simblett, Sara PY - 2023/6/30 TI - Barriers to and Facilitators of Using Remote Measurement Technology in the Long-Term Monitoring of Individuals With ADHD: Interview Study JO - JMIR Form Res SP - e44126 VL - 7 KW - attention-deficit/hyperactivity disorder KW - ADHD KW - remote measurement technology KW - engagement KW - barriers and facilitators KW - qualitative analysis KW - mobile phone N2 - Background: Remote measurement technology (RMT) has the potential to address current research and clinical challenges of attention-deficit/hyperactivity disorder (ADHD) symptoms and its co-occurring mental health problems. Despite research using RMT already being successfully applied to other populations, adherence and attrition are potential obstacles when applying RMT to a disorder such as ADHD. Hypothetical views and attitudes toward using RMT in a population with ADHD have previously been explored; however, to our knowledge, there is no previous research that has used qualitative methods to understand the barriers to and facilitators of using RMT in individuals with ADHD following participation in a remote monitoring period. Objective: We aimed to evaluate the barriers to and facilitators of using RMT in individuals with ADHD compared with a group of people who did not have a diagnosis of ADHD. We also aimed to explore participants? views on using RMT for 1 or 2 years in future studies. Methods: In total, 20 individuals with ADHD and 20 individuals without ADHD were followed up for 10 weeks using RMT that involved active (questionnaires and cognitive tasks) and passive (smartphone sensors and wearable devices) monitoring; 10 adolescents and adults with ADHD and 12 individuals in a comparison group completed semistructured qualitative interviews at the end of the study period. The interviews focused on potential barriers to and facilitators of using RMT in adults with ADHD. A framework methodology was used to explore the data qualitatively. Results: Barriers to and facilitators of using RMT were categorized as health-related, user-related, and technology-related factors across both participant groups. When comparing themes that emerged across the participant groups, both individuals with and without ADHD experienced similar barriers and facilitators in using RMT. The participants agreed that RMT can provide useful objective data. However, slight differences between the participant groups were identified as barriers to RMT across all major themes. Individuals with ADHD described the impact that their ADHD symptoms had on participating (health-related theme), commented on the perceived cost of completing the cognitive tasks (user-related theme), and described more technical challenges (technology-related theme) than individuals without ADHD. Hypothetical views on future studies using RMT in individuals with ADHD for 1 or 2 years were positive. Conclusions: Individuals with ADHD agreed that RMT, which uses repeated measurements with ongoing active and passive monitoring, can provide useful objective data. Although themes overlapped with previous research on barriers to and facilitators of engagement with RMT (eg, depression and epilepsy) and with a comparison group, there are unique considerations for people with ADHD, for example, understanding the impact that ADHD symptoms may have on engaging with RMT. Researchers need to continue working with people with ADHD to develop future RMT studies for longer periods. UR - https://formative.jmir.org/2023/1/e44126 UR - http://dx.doi.org/10.2196/44126 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389932 ID - info:doi/10.2196/44126 ER - TY - JOUR AU - Wynn, S. Chelsea AU - Fiks, G. Alexander AU - Localio, Russell AU - Shults, Justine AU - Nekrasova, Ekaterina AU - Shone, P. Laura AU - Torres, Alessandra AU - Griffith, Miranda AU - Unger, Rebecca AU - Ware, Ann Leigh AU - Kelly, Kate Mary AU - Stockwell, S. Melissa PY - 2023/6/30 TI - Examination of Text Message Plans and Baseline Usage of Families Enrolled in a Text Message Influenza Vaccine Reminder Trial: Survey Study JO - JMIR Form Res SP - e39576 VL - 7 KW - influenza vaccine KW - mHealth KW - mobile phone KW - pediatric KW - primary care KW - PROS KW - reminders KW - text message N2 - Background: Mobile health (mHealth) is quickly expanding as a method of health promotion, but some interventions may not be familiar or comfortable for potential users. SMS text messaging has been investigated as a low-cost, accessible way to provide vaccine reminders. Most (97%) US adults own a cellphone and of those adults most use SMS text messaging. However, understanding patterns of SMS text message plan type and use in diverse primary care populations needs more investigation. Objective: We sought to use a survey to examine baseline SMS text messaging and data plan patterns among families willing to accept SMS text message vaccine reminders. Methods: As part of a National Institutes of Health (NIH)?funded national study (Flu2Text) conducted during the 2017-2018 and 2018-2019 influenza seasons, families of children needing a second seasonal influenza vaccine dose were recruited in pediatric primary care offices at the time of their first dose. Practices were from the American Academy of Pediatrics? (AAP) Pediatric Research in Office Settings (PROS) research network, the Children?s Hospital of Philadelphia, and Columbia University. A survey was administered via telephone (Season 1) or electronically (Season 2) at enrollment. Standardized (adjusted) proportions for SMS text message plan type and texting frequency were calculated using logistic regression that was adjusted for child and caregiver demographics. Results: Responses were collected from 1439 participants (69% of enrolled). The mean caregiver age was 32 (SD 6) years, and most children (n=1355, 94.2%) were aged 6-23 months. Most (n=1357, 94.3%) families were English-speaking. Most (n=1331, 92.8%) but not all participants had an unlimited SMS text messaging plan and sent or received texts at least once daily (n=1313, 91.5%). SMS text messaging plan type and use at baseline was uniform across most but not all subgroups. However, there were some differences in the study population?s SMS text messaging plan type and usage. Caregivers who wanted Spanish SMS text messages were less likely than those who chose English to have an unlimited SMS text messaging plan (n=61, 86.7% vs n=1270, 94%; risk difference ?7.2%, 95% CI ?27.1 to ?1.8). There were no significant differences in having an unlimited plan associated with child?s race, ethnicity, age, health status, insurance type, or caregiver education level. SMS text messaging use at baseline was not uniform across all subgroups. Nearly three-quarters (n=1030, 71.9%) of participants had received some form of SMS text message from their doctor?s office; most common were appointment reminders (n=1014, 98.4%), prescription (n=300, 29.1%), and laboratory notifications (n=117, 11.4%). Even the majority (n=64, 61.5%) of those who did not have unlimited plans and who texted less than daily (n=72, 59%) reported receipt of these SMS text messages. Conclusions: In this study, most participants had access to unlimited SMS text messaging plans and texted at least once daily. However, infrequent texting and lack of access to an unlimited SMS text messaging plan did not preclude enrolling to receive SMS text message reminders in pediatric primary care settings. UR - https://formative.jmir.org/2023/1/e39576 UR - http://dx.doi.org/10.2196/39576 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389945 ID - info:doi/10.2196/39576 ER - TY - JOUR AU - Katapally, Reddy Tarun AU - Ibrahim, Tolulope Sheriff PY - 2023/6/30 TI - Digital Health Dashboards for Decision-Making to Enable Rapid Responses During Public Health Crises: Replicable and Scalable Methodology JO - JMIR Res Protoc SP - e46810 VL - 12 KW - big data KW - COVID-19 KW - digital citizen science KW - digital dashboards KW - digital epidemiology KW - digital health KW - digital health platforms KW - eHealth KW - health equity KW - mHealth KW - pandemics KW - public health surveillance KW - virtual health care KW - mobile phone N2 - Background: The COVID-19 pandemic has reiterated the need for cohesive, collective, and deliberate societal efforts to address inherent inefficiencies in our health systems and overcome decision-making gaps using real-time data analytics. To achieve this, decision makers need independent and secure digital health platforms that engage citizens ethically to obtain big data, analyze and convert big data into real-time evidence, and finally, visualize this evidence to inform rapid decision-making. Objective: The objective of this study is to develop replicable and scalable jurisdiction-specific digital health dashboards for rapid decision-making to ethically monitor, mitigate, and manage public health crises via systems integration beyond health care. Methods: The primary approach in the development of the digital health dashboard was the use of global digital citizen science to tackle pandemics like COVID-19. The first step in the development process was to establish an 8-member Citizen Scientist Advisory Council via Digital Epidemiology and Population Health Laboratory?s community partnerships. Based on the consultation with the council, three critical needs of citizens were prioritized: (1) management of household risk of COVID-19, (2) facilitation of food security, and (3) understanding citizen accessibility of public services. Thereafter, a progressive web application (PWA) was developed to provide daily services that address these needs. The big data generated from citizen access to these PWA services are set up to be anonymized, aggregated, and linked to the digital health dashboard for decision-making, that is, the dashboard displays anonymized and aggregated data obtained from citizen devices via the PWA. The digital health dashboard and the PWA are hosted on the Amazon Elastic Compute Cloud server. The digital health dashboard?s interactive statistical navigation was designed using the Microsoft Power Business Intelligence tool, which creates a secure connection with the Amazon Relational Database server to regularly update the visualization of jurisdiction-specific, anonymized, and aggregated data. Results: The development process resulted in a replicable and scalable digital health dashboard for decision-making. The big data relayed to the dashboard in real time reflect usage of the PWA that provides households the ability to manage their risk of COVID-19, request food when in need, and report difficulties and issues in accessing public services. The dashboard also provides (1) delegated community alert system to manage risks in real time, (2) bidirectional engagement system that allows decision makers to respond to citizen queries, and (3) delegated access that provides enhanced dashboard security. Conclusions: Digital health dashboards for decision-making can transform public health policy by prioritizing the needs of citizens as well as decision makers to enable rapid decision-making. Digital health dashboards provide decision makers the ability to directly communicate with citizens to mitigate and manage existing and emerging public health crises, a paradigm-changing approach, that is, inverting innovation by prioritizing community needs, and advancing digital health for equity. International Registered Report Identifier (IRRID): RR1-10.2196/46810 UR - https://www.researchprotocols.org/2023/1/e46810 UR - http://dx.doi.org/10.2196/46810 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389905 ID - info:doi/10.2196/46810 ER - TY - JOUR AU - Bui, Cong Thanh AU - Hoogland, E. Charles AU - Chhea, Chhorvann AU - Sopheab, Heng AU - Ouk, Vichea AU - Samreth, Sovannarith AU - Hor, Bunleng AU - Vidrine, I. Jennifer AU - Businelle, S. Michael AU - Shih, Tina Ya Chen AU - Sutton, K. Steven AU - Jones, R. Sarah AU - Shorey Fennell, Bethany AU - Cottrell-Daniels, Cherell AU - Frank-Pearce, G. Summer AU - Ngor, Chamnab AU - Kulkarni, Shweta AU - Vidrine, J. Damon PY - 2023/6/29 TI - Ending Tobacco Use Through Interactive Tailored Messaging for Cambodian People With HIV (Project EndIT): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e48923 VL - 12 KW - smoking cessation KW - HIV/AIDS KW - cost-effectiveness KW - low- and middle-income countries KW - Cambodia KW - Phase-Based Model KW - RCT KW - randomized controlled trial KW - mHealth N2 - Background: The prevalence of smoking remains high in many low- and middle-income countries (LMICs), including the Southeast Asian nation of Cambodia. Smoking is especially hazardous for people with HIV. In Cambodia, approximately 43%-65% of men with HIV and 3%-5% of women with HIV smoke cigarettes. Thus, there is a critical need for cost-effective smoking cessation interventions for Cambodian people with HIV. This paper describes the design, methods, and data analysis plans for a randomized controlled trial assessing the efficacy of a theory-based mobile health smoking cessation intervention in Cambodian people with HIV. Objective: This 2-group randomized controlled trial compares the efficacy of a mobile health?based automated messaging (AM) intervention versus standard care (SC) in facilitating smoking cessation among Cambodian people with HIV. Methods: Cambodian people with HIV who currently smoke and are receiving antiretroviral treatment (target, N=800) will be randomized to (1) SC or (2) the AM intervention. SC participants will receive brief advice to quit smoking, written self-help materials, nicotine patches, and will complete weekly app-delivered dietary assessments for 26 weeks. AM participants will receive all SC components (but will complete smoking-related weekly assessments instead of dietary assessments), in addition to a fully automated tailored messaging program driven by the weekly assessments to facilitate smoking cessation. In the Phase-Based Model of smoking cessation, the cessation process is partitioned into 4 phases: motivation, preparation (precessation), cessation (quit date to 2 weeks post quit), and maintenance (up to 6 months post quit). Our AM program targets processes within these phases, including increasing motivation to quit, enhancing self-efficacy, obtaining social support, skills to cope with nicotine withdrawal symptoms and stress, and skills to maintain abstinence. All participants will complete baseline and 3-, 6-, and 12-month in-person follow-up assessments. The primary outcome is biochemically confirmed abstinence at 12 months, with 3- and 6-month abstinence as secondary outcomes. Potential mediators and moderators underlying treatment effects will be explored, and cost-effectiveness will be assessed. Results: This study was approved by all relevant domestic and international institutional and ethical review boards. Participant recruitment commenced in January 2023. Data collection is expected to conclude by the end of 2025. Conclusions: By demonstrating the greater efficacy and cost-effectiveness of AM relative to SC, this study has the potential to transform HIV care in Cambodia and prevent tobacco-related diseases. Furthermore, it may be adapted for use in other Cambodian populations and in other low- and middle-income countries. Ultimately, the AM approach to smoking cessation could greatly improve public health in the developing world and beyond. Trial Registration: ClinicalTrials.gov NCT05746442; https://clinicaltrials.gov/ct2/show/NCT05746442 International Registered Report Identifier (IRRID): PRR1-10.2196/48923 UR - https://www.researchprotocols.org/2023/1/e48923 UR - http://dx.doi.org/10.2196/48923 UR - http://www.ncbi.nlm.nih.gov/pubmed/37384390 ID - info:doi/10.2196/48923 ER - TY - JOUR AU - McClure, B. Jennifer AU - Heffner, L. Jaimee AU - Krakauer, Chloe AU - Mun, Sophia AU - Klasnja, Predrag AU - Catz, L. Sheryl PY - 2023/6/28 TI - Feasibility, Acceptability, and Potential Impact of a Novel mHealth App for Smokers Ambivalent About Quitting: Randomized Pilot Study JO - JMIR Mhealth Uhealth SP - e46155 VL - 11 KW - ambivalence KW - app KW - digital health intervention KW - mHealth intervention KW - mHealth KW - motivation KW - nicotine KW - smoking KW - smoking cessation KW - tobacco N2 - Background: Most smokers are ambivalent about quitting?they want to quit someday, but not now. Interventions are needed that can engage ambivalent smokers, build their motivation for quitting, and support future quit attempts. Mobile health (mHealth) apps offer a cost-effective platform for such interventions, but research is needed to inform their optimal design and assess their acceptability, feasibility, and potential effectiveness. Objective: This study aims to assess the feasibility, acceptability, and potential impact of a novel mHealth app for smokers who want to quit smoking someday but are ambivalent about quitting in the near term. Methods: We enrolled adults across the United States who smoked more than 10 cigarettes a day and were ambivalent about quitting (n=60). Participants were randomly assigned to 1 of 2 versions of the GEMS app: standard care (SC) versus enhanced care (EC). Both had a similar design and identical evidence-based, best-practice smoking cessation advice and resources, including the ability to earn free nicotine patches. EC also included a series of exercises called experiments designed to help ambivalent smokers clarify their goals, strengthen their motivation, and learn important behavioral skills for changing smoking behavior without making a commitment to quit. Outcomes were analyzed using automated app data and self-reported surveys at 1 and 3 months post enrollment. Results: Participants who installed the app (57/60, 95%) were largely female, White, socioeconomically disadvantaged, and highly nicotine dependent. As expected, key outcomes trended in favor of the EC group. Compared to SC users, EC participants had greater engagement (mean sessions 19.9 for EC vs 7.3 for SC). An intentional quit attempt was reported by 39.3% (11/28) of EC users and 37.9% (11/29) of SC users. Seven-day point prevalence smoking abstinence at the 3-month follow-up was reported by 14.7% (4/28) of EC users and 6.9% (2/29) of SC users. Among participants who earned a free trial of nicotine replacement therapy based on their app usage, 36.4% (8/22) of EC participants and 11.1% (2/18) of SC participants requested the treatment. A total of 17.9% (5/28) of EC and 3.4% (1/29) of SC participants used an in-app feature to access a free tobacco quitline. Other metrics were also promising. EC participants completed an average of 6.9 (SD 3.1) out of 9 experiments. Median helpfulness ratings for completed experiments ranged from 3 to 4 on a 5-point scale. Finally, satisfaction with both app versions was very good (mean 4.1 on a 5-point Likert scale) and 95.3% (41/43) of all respondents would recommend their app version to others. Conclusions: Ambivalent smokers were receptive to the app-based intervention, but the EC version, which combined best-practice cessation advice with self-paced, experiential exercises, was associated with greater use and evidence of behavior change. Further development and evaluation of the EC program is warranted. Trial Registration: ClinicalTrials.gov NCT04560868; https://clinicaltrials.gov/ct2/show/NCT04560868 UR - https://mhealth.jmir.org/2023/1/e46155 UR - http://dx.doi.org/10.2196/46155 UR - http://www.ncbi.nlm.nih.gov/pubmed/37379059 ID - info:doi/10.2196/46155 ER - TY - JOUR AU - Chen, Ling AU - Zhang, Danli AU - Li, Tiantian AU - Liu, Sha AU - Hua, Jie AU - Cai, Wenzhi PY - 2023/6/27 TI - Effect of a Mobile App?Based Urinary Incontinence Self-Management Intervention Among Pregnant Women in China: Pragmatic Randomized Controlled Trial JO - J Med Internet Res SP - e43528 VL - 25 KW - mobile health KW - mHealth KW - mobile apps KW - urinary incontinence KW - pregnancy KW - pragmatic randomized controlled trial KW - mobile phone N2 - Background: Urinary incontinence (UI) is a highly prevalent health concern commonly observed during and after pregnancy that can substantially impact women?s physical and psychological well-being and quality of life. Owing to its numerous advantages, mobile health may be a promising solution; however, it is unclear whether the app-based intervention can effectively improve UI symptoms during and after pregnancy. Objective: This study aimed to evaluate the effectiveness of the Urinary Incontinence for Women (UIW) app?based intervention for UI symptom improvement among pregnant women in China. Methods: Singleton pregnant women without incontinence before pregnancy who were aged ?18 years and between 24 and 28?weeks of gestation were recruited from a tertiary public hospital in China and were randomly allocated (1:1) to either an experimental group (n=63) or a control group (n=63). The experimental group received the UIW app intervention and oral pelvic floor muscle training (PFMT) instructions, whereas the control group received oral PFMT instructions alone. Neither the participants nor the researchers were blinded to the intervention. The primary outcome was UI severity. The secondary outcomes included quality of life, self-efficacy with PFMT, and knowledge of UI. All data were collected at baseline, 2 months after randomization, and 6 weeks post partum through electronic questionnaires or by checking the electronic medical record system. Data analysis followed the intention-to-treat principle. A linear mixed model was used to examine the intervention effect on primary and secondary outcomes. Results: Participants in the experimental and control groups were comparable at baseline. Of the 126 overall participants, 117 (92.9%) and 103 (81.7%) women completed follow-up visits at 2 months after randomization and 6 weeks after delivery, respectively. A statistically significant difference in UI symptom severity was observed between the experimental group and control group (2 months after randomization: mean difference ?2.86, 95% CI ?4.09 to ?1.64, P<.001; 6 weeks post partum: mean difference ?2.68, 95% CI ?3.87 to ?1.49, P<.001). For the secondary outcomes, a statistically significant intervention effect on the quality of life, self-efficacy, and UI knowledge was found at the 2-month follow-up (all P<.05) and 6 weeks post partum (all P<.001). Conclusions: The app-based UI self-management intervention (UIW) effectively improved UI symptom severity, quality of life, self-efficacy with PFMT, and knowledge of UI during the late pregnancy and early postnatal periods. Larger multicenter studies with a longer postpartum follow-up are required to further extend these findings. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID): RR2-10.2196/22771 UR - https://www.jmir.org/2023/1/e43528 UR - http://dx.doi.org/10.2196/43528 UR - http://www.ncbi.nlm.nih.gov/pubmed/37368465 ID - info:doi/10.2196/43528 ER - TY - JOUR AU - Kim, Hyungsook AU - Lee, Kikwang AU - Lee, Hoon Ye AU - Park, Yoonjung AU - Park, Yonghyun AU - Yu, Yeonwoo AU - Park, Jaeyoung AU - Noh, Sihyeon PY - 2023/6/26 TI - The Effectiveness of a Mobile Phone?Based Physical Activity Program for Treating Depression, Stress, Psychological Well-Being, and Quality of Life Among Adults: Quantitative Study JO - JMIR Mhealth Uhealth SP - e46286 VL - 11 KW - depressive symptoms KW - mobile intervention KW - exercise KW - internet-based fitness KW - mental health N2 - Background: Depression is a substantial global health problem, affecting >300 million people and resulting in 12.7% of all deaths. Depression causes various physical and cognitive problems, leading to a 5-year to 10-year decrease in life expectancy compared with the general population. Physical activity is known to be an effective, evidence-based treatment for depression. However, people generally have difficulties with participating in physical activity owing to limitations in time and accessibility. Objective: To address this issue, this study aimed to contribute to the development of alternative and innovative intervention methods for depression and stress management in adults. More specifically, we attempted to investigate the effectiveness of a mobile phone?based physical activity program on depression, perceived stress, psychological well-being, and quality of life among adults in South Korea. Methods: Participants were recruited and randomly assigned to the mobile phone intervention or waitlist group. Self-report questionnaires were used to assess variables before and after treatment. The treatment group used the program around 3 times per week at home for 4 weeks, with each session lasting about 30 minutes. To evaluate the program?s impact, a 2 (condition) × 2 (time) repeated-measures ANOVA was conducted, considering pretreatment and posttreatment measures along with group as independent variables. For a more detailed analysis, paired-samples 2-tailed t tests were used to compare pretreatment and posttreatment measurements within each group. Independent-samples 2-tailed t tests were conducted to assess intergroup differences in pretreatment measurements. Results: The study included a total of 68 adults aged between 18 and 65 years, who were recruited both through web-based and offline methods. Of these 68 individuals, 41 (60%) were randomly assigned to the treatment group and 27 (40%) to the waitlist group. The attrition rate was 10.2% after 4 weeks. The findings indicated that there is a significant main effect of time (F1,60=15.63; P=.003; ?p2=0.21) in participants? depression scores, indicating that there were changes in depression level across time. No significant changes were observed in perceived stress (P=.25), psychological well-being (P=.35), or quality of life (P=.07). Furthermore, depression scores significantly decreased in the treatment group (from 7.08 to 4.64; P=.03; Cohen d=0.50) but not in the waitlist group (from 6.72 to 5.08; P=.20; Cohen d=0.36). Perceived stress score of the treatment group also significantly decreased (from 2.95 to 2.72; P=.04; Cohen d=0.46) but not in the waitlist group (from 2.82 to 2.74; P=.55; Cohen d=0.15). Conclusions: This study provided experimental evidence that mobile phone?based physical activity program affects depression significantly. By exploring the potential of mobile phone?based physical activity programs as a treatment option, this study sought to improve accessibility and encourage participation in physical activity, ultimately promoting better mental health outcomes for individuals with depression and stress. UR - https://mhealth.jmir.org/2023/1/e46286 UR - http://dx.doi.org/10.2196/46286 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358905 ID - info:doi/10.2196/46286 ER - TY - JOUR AU - Kekkonen, Markku AU - Korkiakangas, Eveliina AU - Laitinen, Jaana AU - Oinas-Kukkonen, Harri PY - 2023/6/26 TI - Factors Reducing the Use of a Persuasive mHealth App and How to Mitigate Them: Thematic Analysis JO - JMIR Hum Factors SP - e40579 VL - 10 KW - mobile phone KW - mobile health KW - mHealth KW - Persuasive Systems Design KW - behavior change KW - thematic analysis KW - microentrepreneurs KW - randomized controlled trial N2 - Background: Studies on which persuasive features may work for different users in health contexts are rare. The participants in this study were microentrepreneurs. We built a persuasive mobile app to help them to recover from work. Representatives of this target group tend to be very busy due to work, which was reflected in their use of the app during the randomized controlled trial intervention. Microentrepreneurs also often have dual roles; they are professionals in their line of work as well as entrepreneurs managing their own business, which may add to their workload. Objective: This study aimed to present users? views on the factors that hinder their use of the mobile health app that we developed and how these factors could be mitigated. Methods: We interviewed 59 users and conducted both data-driven and theory-driven analyses on the interviews. Results: Factors reducing app use could be divided into 3 categories: use context (problem domain?related issues, eg, the lack of time due to work), user context (user-related issues, eg, concurrent use of other apps), and technology context (technology-related issues, eg, bugs and usability). Due to the nature of the participants? entrepreneurship, which often interferes with personal life, it became clear that designs targeting similar target groups should avoid steep learning curves and should be easy (quick) to use. Conclusions: Personalized tunneling?guiding the user through a system via personalized solutions?could help similar target groups with similar issues better engage with and keep using health apps because of the easy learning curve. When developing health apps for interventions, background theories should not be interpreted too strictly. Applying theory in practice may require rethinking approaches for adaptation as technology has evolved rapidly and continues to evolve. Trial Registration: ClinicalTrials.gov NCT03648593; https://clinicaltrials.gov/ct2/show/NCT03648593 UR - https://humanfactors.jmir.org/2023/1/e40579 UR - http://dx.doi.org/10.2196/40579 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358883 ID - info:doi/10.2196/40579 ER - TY - JOUR AU - Kadirvelu, Balasundaram AU - Bellido Bel, Teresa AU - Wu, Xiaofei AU - Burmester, Victoria AU - Ananth, Shayma AU - Cabral C C Branco, Bianca AU - Girela-Serrano, Braulio AU - Gledhill, Julia AU - Di Simplicio, Martina AU - Nicholls, Dasha AU - Faisal, Aldo A. PY - 2023/6/26 TI - Mindcraft, a Mobile Mental Health Monitoring Platform for Children and Young People: Development and Acceptability Pilot Study JO - JMIR Form Res SP - e44877 VL - 7 KW - mobile mental health KW - passive sensing KW - smartphone apps for mental health KW - children and young people KW - adolescents KW - digital tools KW - mobile apps N2 - Background: Children and young people's mental health is a growing public health concern, which is further exacerbated by the COVID-19 pandemic. Mobile health apps, particularly those using passive smartphone sensor data, present an opportunity to address this issue and support mental well-being. Objective: This study aimed to develop and evaluate a mobile mental health platform for children and young people, Mindcraft, which integrates passive sensor data monitoring with active self-reported updates through an engaging user interface to monitor their well-being. Methods: A user-centered design approach was used to develop Mindcraft, incorporating feedback from potential users. User acceptance testing was conducted with a group of 8 young people aged 15-17 years, followed by a pilot test with 39 secondary school students aged 14-18 years, which was conducted for a 2-week period. Results: Mindcraft showed encouraging user engagement and retention. Users reported that they found the app to be a friendly tool helping them to increase their emotional awareness and gain a better understanding of themselves. Over 90% of users (36/39, 92.5%) answered all active data questions on the days they used the app. Passive data collection facilitated the gathering of a broader range of well-being metrics over time, with minimal user intervention. Conclusions: The Mindcraft app has shown promising results in monitoring mental health symptoms and promoting user engagement among children and young people during its development and initial testing. The app's user-centered design, the focus on privacy and transparency, and a combination of active and passive data collection strategies have all contributed to its efficacy and receptiveness among the target demographic. By continuing to refine and expand the app, the Mindcraft platform has the potential to contribute meaningfully to the field of mental health care for young people. UR - https://formative.jmir.org/2023/1/e44877 UR - http://dx.doi.org/10.2196/44877 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358901 ID - info:doi/10.2196/44877 ER - TY - JOUR AU - Palermo, H. Emma AU - Young, V. Amanda AU - Deswert, Sky AU - Brown, Alyssa AU - Goldberg, Miranda AU - Sultanik, Evan AU - Tan, Jessica AU - Mazefsky, A. Carla AU - Brookman-Frazee, Lauren AU - McPartland, C. James AU - Goodwin, S. Matthew AU - Pennington, Jeffrey AU - Marcus, C. Steven AU - Beidas, S. Rinad AU - Mandell, S. David AU - Nuske, J. Heather PY - 2023/6/26 TI - A Digital Mental Health App Incorporating Wearable Biosensing for Teachers of Children on the Autism Spectrum to Support Emotion Regulation: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e45852 VL - 12 KW - digital mental health KW - just-in-time adaptive intervention augmentation KW - JITAI KW - autism KW - heart rate tracking KW - emotion dysregulation KW - challenging behavior KW - evidence-based strategies KW - student progress monitoring KW - mobile phone N2 - Background: As much as 80% of children on the autism spectrum exhibit challenging behaviors (ie, behaviors dangerous to the self or others, behaviors that interfere with learning and development, and behaviors that interfere with socialization) that can have a devastating impact on personal and family well-being, contribute to teacher burnout, and even require hospitalization. Evidence-based practices to reduce these behaviors emphasize identifying triggers (events or antecedents that lead to challenging behaviors); however, parents and teachers often report that challenging behaviors surface with little warning. Exciting recent advances in biometric sensing and mobile computing technology allow the measurement of momentary emotion dysregulation using physiological indexes. Objective: We present the framework and protocol for a pilot trial that will test a mobile digital mental health app, the KeepCalm app. School-based approaches to managing challenging behaviors in children on the autism spectrum are limited by 3 key factors: children on the autism spectrum often have difficulties in communicating their emotions; it is challenging to implement evidence-based, personalized strategies for individual children in group settings; and it is difficult for teachers to track which strategies are successful for each child. KeepCalm aims to address those barriers by communicating children?s stress to their teachers using physiological signaling (emotion dysregulation detection), supporting the implementation of emotion regulation strategies via smartphone pop-up notifications of top strategies for each child according to their behavior (emotion regulation strategy implementation), and easing the task of tracking outcomes by providing the child?s educational team with a tool to track the most effective emotion regulation strategies for that child based on physiological stress reduction data (emotion regulation strategy evaluation). Methods: We will test KeepCalm with 20 educational teams of students on the autism spectrum with challenging behaviors (no exclusion based on IQ or speaking ability) in a pilot randomized waitlist-controlled field trial over a 3-month period. We will examine the usability, acceptability, feasibility, and appropriateness of KeepCalm as primary outcomes. Secondary preliminary efficacy outcomes include clinical decision support success, false positives or false negatives of stress alerts, and the reduction of challenging behaviors and emotion dysregulation. We will also examine technical outcomes, including the number of artifacts and the proportion of time children are engaged in high physical movement based on accelerometry data; test the feasibility of our recruitment strategies; and test the response rate and sensitivity to change of our measures, in preparation for a future fully powered large-scale randomized controlled trial. Results: The pilot trial will begin by September 2023. Conclusions: Results will provide key data about important aspects of implementing KeepCalm in preschools and elementary schools and will provide preliminary data about its efficacy to reduce challenging behaviors and support emotion regulation in children on the autism spectrum. Trial Registration: ClinicalTrials.gov NCT05277194; https://www.clinicaltrials.gov/ct2/show/NCT05277194 International Registered Report Identifier (IRRID): PRR1-10.2196/45852 UR - https://www.researchprotocols.org/2023/1/e45852 UR - http://dx.doi.org/10.2196/45852 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358908 ID - info:doi/10.2196/45852 ER - TY - JOUR AU - Goodman, Andrew AU - Mahoney, Ray AU - Spurling, Geoffrey AU - Lawler, Sheleigh PY - 2023/6/23 TI - Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review JO - JMIR Mhealth Uhealth SP - e45162 VL - 11 KW - mHealth KW - Indigenous KW - Canada KW - Australia KW - New Zealand KW - United States KW - Papua New Guinea KW - Samoa KW - qualitative KW - systematic review KW - feasibility KW - acceptability KW - users KW - design KW - workflow N2 - Background: The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. Objective: This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe. Methods: In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. Results: Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients? and service providers? perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. Conclusions: This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery. UR - https://mhealth.jmir.org/2023/1/e45162 UR - http://dx.doi.org/10.2196/45162 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351947 ID - info:doi/10.2196/45162 ER - TY - JOUR AU - Massa, Paula AU - de Souza Ferraz, Aurélia Dulce AU - Magno, Laio AU - Silva, Paula Ana AU - Greco, Marília AU - Dourado, Inês AU - Grangeiro, Alexandre PY - 2023/6/23 TI - A Transgender Chatbot (Amanda Selfie) to Create Pre-exposure Prophylaxis Demand Among Adolescents in Brazil: Assessment of Acceptability, Functionality, Usability, and Results JO - J Med Internet Res SP - e41881 VL - 25 KW - artificial intelligence KW - adolescent KW - HIV pre-exposure prophylaxis KW - transgender women KW - men who have sex with men KW - chatbot KW - PrEP KW - transgender KW - HIV KW - prevention KW - prophylaxis KW - acceptability N2 - Background: HIV incidence rates have increased in adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW). Thus, it is essential to promote access to HIV prevention, including pre-exposure prophylaxis (PrEP), among these groups. Moreover, using artificial intelligence and online social platforms to create demand and access to health care services are essential tools for adolescents and youth. Objective: This study aims to describe the participative process of developing a chatbot using artificial intelligence to create demand for PrEP use among AMSM and ATGW in Brazil. Furthermore, it analyzes the chatbot?s acceptability, functionality, and usability and its results on the demand creation for PrEP. Methods: The chatbot Amanda Selfie integrates the demand creation strategies based on social networks (DCSSNs) of the PrEP1519 study. She was conceived as a Black transgender woman and to function as a virtual peer educator. The development process occurred in 3 phases (conception, trial, and final version) and lasted 21 months. A mixed methodology was used for the evaluations. Qualitative approaches, such as in-depth adolescent interviews, were used to analyze acceptability and usability, while quantitative methods were used to analyze the functionality and result of the demand creation for PrEP based on interactions with Amanda and information from health care services about using PrEP. To evaluate Amanda?s result on the demand creation for PrEP, we analyzed sociodemographic profiles of adolescents who interacted at least once with her and developed a cascade model containing the number of people at various stages between the first interaction and initiation of PrEP (PrEP uptake). These indicators were compared with other DCSs developed in the PrEP1519 study using chi-square tests and residual analysis (P=.05). Results: Amanda Selfie was well accepted as a peer educator, clearly and objectively communicating on topics such as gender identity, sexual experiences, HIV, and PrEP. The chatbot proved appropriate for answering questions in an agile and confidential manner, using the language used by AMSM and ATGW and with a greater sense of security and less judgment. The interactions with Amanda Selfie combined with a health professional were well evaluated and improved the appointment scheduling. The chatbot interacted with most people (757/1239, 61.1%) reached by the DCSSNs. However, when compared with the other DCSSNs, Amanda was not efficient in identifying AMSM/ATGW (359/482, 74.5% vs 130/757, 17.2% of total interactions, respectively) and in PrEP uptake (90/359, 25.1% vs 19/130, 14.6%). The following profiles were associated (P<.001) with Amanda Selfie?s demand creation, when compared with other DCS: ATGW and adolescents with higher levels of schooling and White skin color. Conclusions: Using a chatbot to create PrEP demand among AMSM and ATGW was well accepted, especially for ATGW with higher levels of schooling. A complimentary dialog with a health professional increased PrEP uptake, although it remained lower than the results of the other DCSSNs. UR - https://www.jmir.org/2023/1/e41881 UR - http://dx.doi.org/10.2196/41881 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351920 ID - info:doi/10.2196/41881 ER - TY - JOUR AU - Khatib, Rasha AU - McCue, Maggie AU - Blair, Chris AU - Roy, Anit AU - Franco, John AU - Fehnert, Ben AU - King, James AU - Sarkey, Sara AU - Chrones, Lambros AU - Martin, Michael AU - Kabir, Christopher AU - Kemp, E. David PY - 2023/6/23 TI - Design and Implementation of a Digitally Enabled Care Pathway to Improve Management of Depression in a Large Health Care System: Protocol for the Implementation of a Patient Care Platform JO - JMIR Res Protoc SP - e43788 VL - 12 KW - mental health KW - depression KW - depressive KW - major depressive disorder KW - depression management KW - primary care KW - patient engagement KW - measurement-based care KW - shared decision-making KW - user-centered design KW - mobile app KW - digital platform KW - mobile phone KW - mobile health KW - adherence N2 - Background: Major depressive disorder (MDD) is a serious public health concern worldwide. A treatment approach that incorporates measurement-based care (MBC) and shared decision-making between patients with MDD and their providers may foster patient engagement and improve clinical outcomes. While digital tools such as mobile apps show promise for expanding health interventions, these apps are rarely integrated into clinical practice. Objective: The primary objective of this ongoing study is to determine whether implementation of a digital tool?the Pathway Platform?in primary care improves adherence to MBC practices; here, we present the study methods. Methods: This large-scale, real-world implementation study is based on a pilot study of an earlier iteration of a mobile app (the Pathway app) that confirmed the feasibility of using the app in patients with MDD and showed a positive trend in patient engagement in the app arm. In addition, a user-centered design approach that included qualitative assessments from patients and providers was used to improve understanding of the patient journey and care team workflows. User feedback highlighted the need for enhanced features, education modules, and real-time data sharing via integration with the electronic health record. The current iteration of the Platform includes the newest version of the Pathway app, education modules for both patients and providers, and real-time patient-level data sharing with the electronic health record. The study takes place in primary care sites within the Advocate Aurora Health system in Illinois and includes adult patients with MDD who were recently prescribed monotherapy antidepressant medication (defined as a new start, medication switch, or dose change in the past 3 months). Clinical performance and selected patient outcomes will be compared before and after the implementation of the Platform. Results: Patient recruitment was completed in July 2022, with initial results expected in mid-2023. Conclusions: This study will provide useful insights into real-world integration of a digital platform within a large health system. The methods presented here highlight the unique user-centric development of the Pathway Platform, which has resulted in an enhanced digital tool with the potential to foster MBC and shared decision-making, improve patient-provider communication, and ultimately lead to optimized treatment outcomes for patients with MDD. Trial Registration: ClinicalTrials.gov NCT04891224; https://clinicaltrials.gov/ct2/show/NCT04891224 International Registered Report Identifier (IRRID): DERR1-10.2196/43788 UR - https://www.researchprotocols.org/2023/1/e43788 UR - http://dx.doi.org/10.2196/43788 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351941 ID - info:doi/10.2196/43788 ER - TY - JOUR AU - Noholoza, Sandisiwe AU - Phillips, K. Tamsin AU - Madwayi, Sindiswa AU - Mrubata, Megan AU - Camlin, S. Carol AU - Myer, Landon AU - Clouse, Kate PY - 2023/6/22 TI - Smartphone Ownership and Usage Among Pregnant Women Living With HIV in South Africa: Secondary Analysis of CareConekta Trial Data JO - JMIR Form Res SP - e43855 VL - 7 KW - HIV KW - mHealth KW - mobile phone KW - ownership KW - smartphone KW - South Africa N2 - Background: Mobile health (mHealth) initiatives are increasingly common in low-resource settings, but the appropriateness of smartphone interventions in health care settings is uncertain. More research is needed to establish the appropriateness and feasibility of integrating new mHealth modalities (novel apps and social media apps) in the South African context. Objective: In this study, to inform future mHealth interventions, we describe smartphone ownership, preferences, and usage patterns among pregnant women living with HIV in Gugulethu, South Africa. Methods: We screened pregnant women living with HIV from December 2019 to February 2021 for the CareConekta trial. To be enrolled in the trial, respondents were required to be 18 years of age or older, living with HIV, ?28 weeks pregnant, and own a smartphone that met the technical requirements of the CareConekta app. In this secondary analysis, we describe mobile phone ownership and sociodemographic characteristics of all women screened for eligibility (n=639), and smartphone use patterns among those enrolled in the trial (n=193). Results: Overall, median age was 31 (IQR 27-35) years. Of the 582 women who owned smartphones, 580 responded to the question about whether or not it was a smartphone, 2 did not. Among those with smartphones, 92% (421/458) of them used the Android operating system of version 5.0 or above, 98% (497/506) of phones had a GPS, and 96% (485/506) of individuals charged their phones less than twice a day. Among women who were enrolled in the trial, nearly all (99%, 190/193) owned the smartphone themselves; however, 14% (26/193) shared their smartphone with someone. In this case, 96% (25/26) reported possessing the phone most of the day. Median duration of ownership of the smartphone was 12 (IQR 5-24) months, median duration with current phone number use was 25 (IQR 12-60) months, and median number of cell phone numbers owned 2 years prior to enrollment in the trial was 2 (IQR 1-2). Receiving (192/193, 99.5%) and making (190/193, 99%) phone calls were among the most common smartphone uses. The least used features were GPS (106/193, 55%) and email (91/193, 47%). WhatsApp was most frequently reported as a favorite app (181/193, 94%). Conclusions: Smartphone ownership is very common among pregnant women living with HIV in this low-resource, periurban setting. Phone sharing was uncommon, nearly all used the Android system, and phones retained sufficient battery life. These results are encouraging to the development of mHealth interventions. Existing messaging platforms?particularly WhatsApp?are exceedingly popular and could be leveraged for interventions. Findings of moderate smartphone ownership turnover and phone number turnover are considerations for mHealth interventions in similar settings. Trial Registration: ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625?term=NCT03836625 UR - https://formative.jmir.org/2023/1/e43855 UR - http://dx.doi.org/10.2196/43855 UR - http://www.ncbi.nlm.nih.gov/pubmed/37347521 ID - info:doi/10.2196/43855 ER - TY - JOUR AU - Suzuki, Mai AU - Yamanaka, Kou AU - Fukushima, Shinichi AU - Ogawa, Mayu AU - Nagaiwa, Yuki AU - Naito, Toshio PY - 2023/6/22 TI - A Mobile Medication Support App and Its Impact on People Living With HIV: 12-Week User Experience and Medication Compliance Pilot Study JO - JMIR Form Res SP - e43527 VL - 7 KW - human immunodeficiency virus KW - HIV KW - acquired immunodeficiency syndrome KW - mobile health KW - mHealth KW - medication compliance KW - satisfaction survey N2 - Background: The continuity of care between hospital visits conducted through mobile apps creates new opportunities for people living with HIV in situations where face-to-face interventions are difficult. Objective: This study investigated the user experience of a mobile medication support app and its impact on improving antiretroviral therapy compliance and facilitating teleconsultations between people living with HIV and medical staff. Methods: Two clinics in Japan were invited to participate in a 12-week trial of the medication support app between July 27, 2018, and March 31, 2021. Medication compliance was assessed based on responses to scheduled medication reminders; users, including people living with HIV and medical staff, were asked to complete an in-app satisfaction survey to rate their level of satisfaction with the app and its specific features on a 5-point Likert scale. Results: A total of 10 people living with HIV and 11 medical staff were included in this study. During the trial, the medication compliance rate was 90%, and the mean response rates to symptom and medication alerts were 73% and 76%, respectively. Overall, people living with HIV and medical staff were satisfied with the medication support app (agreement rate: mean 81% and 65%, respectively). Over 80% of medical staff and people living with HIV were satisfied with the ability to record medications taken (9/11 and 8/10 medical staff and people living with HIV, respectively), record symptoms of concern (10/11 and 8/10),and inquire about drug combinations (8/10, 10/10). And further, 90% of people living with HIV were satisfied with the function for communication with medical staff (9/10). Conclusions: Our preliminary results demonstrate the feasibility of the medication support app in improving medication compliance and enhancing communication between people living with HIV and medical staff. UR - https://formative.jmir.org/2023/1/e43527 UR - http://dx.doi.org/10.2196/43527 UR - http://www.ncbi.nlm.nih.gov/pubmed/37021843 ID - info:doi/10.2196/43527 ER - TY - JOUR AU - Koo, Hyuk Jun AU - Park, Hyun You AU - Kang, Ryong Dae PY - 2023/6/21 TI - Factors Predicting Older People?s Acceptance of a Personalized Health Care Service App and the Effect of Chronic Disease: Cross-Sectional Questionnaire Study JO - JMIR Aging SP - e41429 VL - 6 KW - environmental risk factor KW - personalized health care service app KW - chronic disease KW - unified theory of acceptance and use of technology KW - structural equation modeling KW - older adult KW - acceptance KW - adoption KW - technology use KW - mHealth KW - mobile health KW - mobile app KW - health app KW - gerontology KW - personalized KW - health care service KW - intention to use N2 - Background: Mobile health (mHealth) services enable real-time measurement of information on individuals? biosignals and environmental risk factors; accordingly, research on health management using mHealth is being actively conducted. Objective: The study aims to identify the predictors of older people?s intention to use mHealth in South Korea and verify whether chronic disease moderates the effect of the identified predictors on behavioral intentions. Methods: A cross-sectional questionnaire study was conducted among 500 participants aged 60 to 75 years. The research hypotheses were tested using structural equation modeling, and indirect effects were verified through bootstrapping. Bootstrapping was performed 10,000 times, and the significance of the indirect effects was confirmed through the bias-corrected percentile method. Results: Of 477 participants, 278 (58.3%) had at least 1 chronic disease. Performance expectancy (?=.453; P=.003) and social influence (?=.693; P<.001) were significant predictors of behavioral intention. Bootstrapping results showed that facilitating conditions (?=.325; P=.006; 95% CI 0.115-0.759) were found to have a significant indirect effect on behavioral intention. Multigroup structural equation modeling testing the presence or absence of chronic disease revealed a significant difference in the path of device trust to performance expectancy (critical ratio=?2.165). Bootstrapping also confirmed that device trust (?=.122; P=.039; 95% CI 0.007-0.346) had a significant indirect effect on behavioral intention in people with chronic disease. Conclusions: This study, which explored the predictors of the intention to use mHealth through a web-based survey of older people, suggests similar results to those of other studies that applied the unified theory of acceptance and use of technology model to the acceptance of mHealth. Performance expectancy, social influence, and facilitating conditions were revealed as predictors of accepting mHealth. In addition, trust in a wearable device for measuring biosignals was investigated as an additional predictor in people with chronic disease. This suggests that different strategies are needed, depending on the characteristics of users. UR - https://aging.jmir.org/2023/1/e41429 UR - http://dx.doi.org/10.2196/41429 UR - http://www.ncbi.nlm.nih.gov/pubmed/37342076 ID - info:doi/10.2196/41429 ER - TY - JOUR AU - Kopka, Marvin AU - Scatturin, Lennart AU - Napierala, Hendrik AU - Fürstenau, Daniel AU - Feufel, A. Markus AU - Balzer, Felix AU - Schmieding, L. Malte PY - 2023/6/20 TI - Characteristics of Users and Nonusers of Symptom Checkers in Germany: Cross-Sectional Survey Study JO - J Med Internet Res SP - e46231 VL - 25 KW - symptom checker KW - cross-sectional study KW - user characteristic KW - digital public health KW - health information seeking KW - decision support KW - eHealth KW - mHealth KW - Germany KW - mobile health KW - health app KW - information seeking KW - technology use KW - usage KW - demographic KW - perception KW - awareness KW - adoption N2 - Background: Previous studies have revealed that users of symptom checkers (SCs, apps that support self-diagnosis and self-triage) are predominantly female, are younger than average, and have higher levels of formal education. Little data are available for Germany, and no study has so far compared usage patterns with people?s awareness of SCs and the perception of usefulness. Objective: We explored the sociodemographic and individual characteristics that are associated with the awareness, usage, and perceived usefulness of SCs in the German population. Methods: We conducted a cross-sectional online survey among 1084 German residents in July 2022 regarding personal characteristics and people?s awareness and usage of SCs. Using random sampling from a commercial panel, we collected participant responses stratified by gender, state of residence, income, and age to reflect the German population. We analyzed the collected data exploratively. Results: Of all respondents, 16.3% (177/1084) were aware of SCs and 6.5% (71/1084) had used them before. Those aware of SCs were younger (mean 38.8, SD 14.6 years, vs mean 48.3, SD 15.7 years), were more often female (107/177, 60.5%, vs 453/907, 49.9%), and had higher formal education levels (eg, 72/177, 40.7%, vs 238/907, 26.2%, with a university/college degree) than those unaware. The same observation applied to users compared to nonusers. It disappeared, however, when comparing users to nonusers who were aware of SCs. Among users, 40.8% (29/71) considered these tools useful. Those considering them useful reported higher self-efficacy (mean 4.21, SD 0.66, vs mean 3.63, SD 0.81, on a scale of 1-5) and a higher net household income (mean EUR 2591.63, SD EUR 1103.96 [mean US $2798.96, SD US $1192.28], vs mean EUR 1626.60, SD EUR 649.05 [mean US $1756.73, SD US $700.97]) than those who considered them not useful. More women considered SCs unhelpful (13/44, 29.5%) compared to men (4/26, 15.4%). Conclusions: Concurring with studies from other countries, our findings show associations between sociodemographic characteristics and SC usage in a German sample: users were on average younger, of higher socioeconomic status, and more commonly female compared to nonusers. However, usage cannot be explained by sociodemographic differences alone. It rather seems that sociodemographics explain who is or is not aware of the technology, but those who are aware of SCs are equally likely to use them, independently of sociodemographic differences. Although in some groups (eg, people with anxiety disorder), more participants reported to know and use SCs, they tended to perceive them as less useful. In other groups (eg, male participants), fewer respondents were aware of SCs, but those who used them perceived them to be more useful. Thus, SCs should be designed to fit specific user needs, and strategies should be developed to help reach individuals who could benefit but are not aware of SCs yet. UR - https://www.jmir.org/2023/1/e46231 UR - http://dx.doi.org/10.2196/46231 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338970 ID - info:doi/10.2196/46231 ER - TY - JOUR AU - Chung, Hsueh-Wen AU - Tai, Chen-Jei AU - Chang, Polun AU - Su, Wen-Lin AU - Chien, Li-Yin PY - 2023/6/20 TI - The Effectiveness of a Traditional Chinese Medicine?Based Mobile Health App for Individuals With Prediabetes: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e41099 VL - 11 KW - mHealth app KW - prediabetes KW - traditional Chinese medicine KW - health-related quality of life KW - body constitution KW - meridian energy N2 - Background: Traditional Chinese medicine (TCM) theories assert that body constitution and meridian energy lay the foundation for disease prevention. TCM-based health concepts have not yet been incorporated into mobile health (mHealth) apps for individuals with prediabetes. Objective: The aim of this study was to examine the effectiveness of a TCM mHealth app for individuals with prediabetes. Methods: This randomized controlled trial recruited 121 individuals with prediabetes at a teaching hospital in New Taipei City between February 2020 and May 2021. The participants were randomly assigned to the TCM mHealth app group (n=42), ordinary mHealth app group (n=41), or control group (n=38). All participants received the usual care that included 15-20 minutes of health education about the disease, along with healthy diet and exercise encouragement. The ordinary mHealth app included physical activity (PA), diet, and disease education, along with individual records. The TCM mHealth app additionally included qi and body constitution information, along with constitution-based PA and diet advice. The control group received the usual care alone and did not have access to any app. Data were collected at baseline, at the end of the 12-week intervention, and 1 month after the intervention. Body constitution, including yang-deficiency, yin-deficiency, and phlegm-stasis, was measured according to the Body Constitution Questionnaire, with higher scores indicating a greater deficiency. Body energy was examined using the Meridian Energy Analysis Device. The Short-Form 36 questionnaire was used to evaluate health-related quality of life (HRQOL), which yielded physical component scores and mental component scores, with higher scores indicating better physical and mental aspects of HRQOL, respectively. Results: Compared to the control group, the TCM mHealth app group showed greater improvement in hemoglobin A1c (HbA1c), yang-deficiency and phlegm-stasis body constitution, and BMI; however, no significant differences were found in these outcomes between the TCM mHealth app and ordinary mHealth app groups. The TCM mHealth app group showed better improvement in body energy and mental component scores than the ordinary mHealth app group. There were no significant differences in fasting plasma glucose, yin-deficiency body constitution, Dietary Approaches to Stop Hypertension dietary behavior, and total PA among the three groups after the intervention. Conclusions: Use of either the ordinary or TCM mHealth app improved HRQOL among individuals with prediabetes. Compared to the outcomes of controls not using any app, use of the TCM mHealth app was effective at improving HbA1c, BMI, yang-deficiency and phlegm-stasis body constitution, and HRQOL. Moreover, using the TCM mHealth app seemed to improve the body energy and HRQOL more than when using the ordinary mHealth app. Further studies with a larger sample size and longer follow-up period may be necessary to determine whether the differences favoring the TCM app are clinically meaningful. Trial Registration: ClinicalTrials.gov NCT04096989; https://clinicaltrials.gov/ct2/show/NCT04096989 UR - https://mhealth.jmir.org/2023/1/e41099 UR - http://dx.doi.org/10.2196/41099 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338977 ID - info:doi/10.2196/41099 ER - TY - JOUR AU - van der Haar, Sandra AU - Raaijmakers, Ireen AU - Verain, D. Muriel C. AU - Meijboom, Saskia PY - 2023/6/20 TI - Incorporating Consumers? Needs in Nutrition Apps to Promote and Maintain Use: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e39515 VL - 11 KW - mobile health KW - mHealth KW - mHealth apps KW - nutrition apps KW - diet apps KW - consumer needs KW - app KW - use KW - nutrition KW - tool KW - consumer KW - eating KW - habit KW - users KW - dietary behavior KW - reliable KW - food KW - database KW - time KW - developers KW - mobile phone N2 - Background: Nutrition apps seem to be promising tools for supporting consumers toward healthier eating habits. There is a wide variety of nutrition apps available; however, users often discontinue app use at an early stage before a permanent change in dietary behavior can be achieved. Objective: The main objective of this study was to identify, from both a user and nonuser perspective, which functionalities should be included in nutrition apps to increase intentions to start and maintain use of these apps. A secondary objective was to gain insight into reasons to quit using nutrition apps at an early stage. Methods: This study used a mixed methods approach and included a qualitative and a quantitative study. The qualitative study (n=40) consisted of a home-use test with 6 commercially available nutrition apps, followed by 6 focus group discussions (FGDs) to investigate user experiences. The quantitative study was a large-scale survey (n=1420), which was performed in a representative sample of the Dutch population to quantify the FGDs? results. In the survey, several app functionalities were rated on 7-point Likert scales ranging from 1 (very unimportant) to 7 (very important). Results: A total of 3 different phases of app use, subdivided into 10 user-centric app aspects and 46 associated app functionalities, were identified as relevant nutrition app elements in the FGDs. Relevance was confirmed in the survey, as all user-centric aspects and almost all app functionalities were rated as important to include in a nutrition app. In the starting phase, a clear introduction (mean 5.45, SD 1.32), purpose (mean 5.40, SD 1.40), and flexible food tracking options (mean 5.33, SD 1.45) were the most important functionalities. In the use phase, a complete and reliable food product database (mean 5.58, SD 1.41), easy navigation (mean 5.56, SD 1.36), and limited advertisements (mean 5.53, SD 1.51) were the most important functionalities. In the end phase, the possibility of setting realistic goals (mean 5.23, SD 1.44), new personal goals (mean 5.13, SD 1.45), and continuously offering new information (mean 4.88, SD 1.44) were the most important functionalities. No large differences between users, former users, and nonusers were found. The main reason for quitting a nutrition app in the survey was the high time investment (14/38, 37%). This was also identified as a barrier in the FGDs. Conclusions: Nutrition apps should be supportive in all 3 phases of use (start, use, and end) to increase consumers? intentions to start and maintain the use of these apps and achieve a change in dietary behavior. Each phase includes several key app functionalities that require specific attention from app developers. High time investment is an important reason to quit nutrition app use at an early stage. UR - https://mhealth.jmir.org/2023/1/e39515 UR - http://dx.doi.org/10.2196/39515 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338978 ID - info:doi/10.2196/39515 ER - TY - JOUR AU - Hengst, M. Tessi AU - Lechner, Lilian AU - van der Laan, Nynke Laura AU - Hommersom, Arjen AU - Dohmen, Daan AU - Hooft, Lotty AU - Metting, Esther AU - Ebbers, Wolfgang AU - Bolman, W. Catherine A. PY - 2023/6/20 TI - The Adoption of a COVID-19 Contact-Tracing App: Cluster Analysis JO - JMIR Form Res SP - e41479 VL - 7 KW - contact-tracing app KW - CTA KW - CoronaMelder KW - intention KW - adoption KW - cluster analysis KW - application KW - psychosocial KW - data KW - risk KW - societal KW - social norm KW - norm KW - COVID-19 KW - adaptation KW - acceptance KW - mHealth KW - mobile health N2 - Background: During the COVID-19 pandemic, there was limited adoption of contact-tracing apps (CTAs). Adoption was particularly low among vulnerable people (eg, people with a low socioeconomic position or of older age), while this part of the population tends to have lesser access to information and communication technology and is more vulnerable to the COVID-19 virus. Objective: This study aims to understand the cause of this lagged adoption of CTAs in order to facilitate adoption and find indications to make public health apps more accessible and reduce health disparities. Methods: Because several psychosocial variables were found to be predictive of CTA adoption, data from the Dutch CTA CoronaMelder (CM) were analyzed using cluster analysis. We examined whether subgroups could be formed based on 6 psychosocial perceptions (ie, trust in the government, beliefs about personal data, social norms, perceived personal and societal benefits, risk perceptions, and self-efficacy) of (non)users concerning CM in order to examine how these clusters differ from each other and what factors are predictive of the intention to use a CTA and the adoption of a CTA. The intention to use and the adoption of CM were examined based on longitudinal data consisting of 2 time frames in October/November 2020 (N=1900) and December 2020 (N=1594). The clusters were described by demographics, intention, and adoption accordingly. Moreover, we examined whether the clusters and the variables that were found to influence the adoption of CTAs, such as health literacy, were predictive of the intention to use and the adoption of the CM app. Results: The final 5-cluster solution based on the data of wave 1 contained significantly different clusters. In wave 1, respondents in the clusters with positive perceptions (ie, beneficial psychosocial variables for adoption of a CTA) about the CM app were older (P<.001), had a higher education level (P<.001), and had higher intention (P<.001) and adoption (P<.001) rates than those in the clusters with negative perceptions. In wave 2, the intention to use and adoption were predicted by the clusters. The intention to use CM in wave 2 was also predicted using the adoption measured in wave 1 (P<.001, ?=?2.904). Adoption in wave 2 was predicted by age (P=.022, exp(B)=1.171), the intention to use in wave 1 (P<.001, exp(B)=1.770), and adoption in wave 1 (P<.001, exp(B)=0.043). Conclusions: The 5 clusters, as well as age and previous behavior, were predictive of the intention to use and the adoption of the CM app. Through the distinguishable clusters, insight was gained into the profiles of CM (non)intenders and (non)adopters. Trial Registration: OSF Registries osf.io/cq742; https://osf.io/cq742 UR - https://formative.jmir.org/2023/1/e41479 UR - http://dx.doi.org/10.2196/41479 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338969 ID - info:doi/10.2196/41479 ER - TY - JOUR AU - Hutchison, G. Michael AU - Di Battista, P. Alex AU - Loenhart, M. Matthew PY - 2023/6/19 TI - A Continuous Aerobic Resistance Exercise Protocol for Concussion Rehabilitation Delivered Remotely via a Mobile App: Feasibility Study JO - JMIR Form Res SP - e45321 VL - 7 KW - Bayesian modeling KW - concussion KW - exercise rehabilitation KW - mobile health KW - mild traumatic brain injury KW - persisting symptoms N2 - Background: In recent years, several studies have consistently reported the beneficial effects of aerobic exercise in alleviating symptoms following concussion. However, exercise modality recommendations by practitioners are often limited to traditional exercise equipment (eg, treadmills and stationary bikes). Advances in digital technologies may help to overcome this limitation, as mobile apps can now provide users with high-quality instructional videos, programs, and monitoring capabilities using alternative modalities such as resistance exercises. Mobile technologies are also rapidly expanding to deliver and complement in-person clinical care. Thus, it is imperative to evaluate this emerging technology on its feasibility, safety, and clinical utility for concussion care. Objective: The objective of the study was to determine the feasibility of a mobile app to deliver a resistance exercise protocol with minimal equipment to individuals following concussion. Feasibility was defined by retention, adverse events, and achievement of a target heart rate (HR) of 60%±5% (age-adjusted percentage of max: 220 ? age). HR data were collected using an Apple Watch, Series 6. Symptoms were evaluated before and after 3 exercise sessions. Methods: A 2-week, prospective, single-arm pilot study was conducted on 21 adults diagnosed with a concussion. Users were provided a continuous aerobic resistance exercise (CARE) protocol through a mobile app. Results: A total of 18 participants (14 female and 4 male) completed a 3-session exercise plan. The median age-adjusted percent of HR max for session 1 was 55.5% (IQR 49%-63%), 58.1% (IQR 50.8%-65.2%) for session 2, and 57.4% (IQR 49.5%-64.7%) for session 3. Individual median HR% across all sessions ranged from 46.9% to 67.4%; furthermore, 10 participants (55.5%) had a total mean HR% within the target HR%, 7 participants had a mean HR% below 55%, and 1 participant had a mean HR% above 65%. In addition, adherence to the plan resulted in a decrease in reported symptom burden with 94% posterior probability. Conclusions: Following concussion, a CARE protocol delivered through a mobile app resulted in no adverse effects with 14% (n=3/21) attrition over 3 sessions. CARE was successful in achieving an aerobic exercise intensity of 55%-65% of age-adjusted maximum HR in the majority of participants and resulted in a decrease in reported symptom burden. The potential for this platform in concussion rehabilitation warrants further investigation. Future studies are needed to assess the use of this technology throughout concussion recovery in both individuals with acute concussion, and those with persistent symptoms. UR - https://formative.jmir.org/2023/1/e45321 UR - http://dx.doi.org/10.2196/45321 UR - http://www.ncbi.nlm.nih.gov/pubmed/37335605 ID - info:doi/10.2196/45321 ER - TY - JOUR AU - Brewer, C. LaPrincess AU - Jones, Clarence AU - Slusser, P. Joshua AU - Pasha, Maarya AU - Lalika, Mathias AU - Chacon, Megan AU - Takawira, Patricia AU - Shanedling, Stanton AU - Erickson, Paul AU - Woods, Cynthia AU - Krogman, Ashton AU - Ferdinand, Daphne AU - Underwood, Paul AU - Cooper, A. Lisa AU - Patten, A. Christi AU - Hayes, N. Sharonne PY - 2023/6/16 TI - mHealth Intervention for Promoting Hypertension Self-management Among African American Patients Receiving Care at a Community Health Center: Formative Evaluation of the FAITH! Hypertension App JO - JMIR Form Res SP - e45061 VL - 7 KW - African Americans KW - hypertension KW - telemedicine KW - health promotion KW - community health workers KW - community-based participatory research KW - mobile phone KW - mobile health N2 - Background: African American individuals are at a higher risk of premature death from cardiovascular diseases than White American individuals, with disproportionate attributable risk from uncontrolled hypertension. Given their high use among African American individuals, mobile technologies, including smartphones, show promise in increasing reliable health information access. Culturally tailored mobile health (mHealth) interventions may promote hypertension self-management among this population. Objective: This formative study aimed to assess the feasibility of integrating an innovative mHealth intervention into clinical and community settings to improve blood pressure (BP) control among African American patients. Methods: A mixed methods study of African American patients with uncontrolled hypertension was conducted over 2 consecutive phases. In phase 1, patients and clinicians from 2 federally qualified health centers (FQHCs) in the Minneapolis-St Paul, Minnesota area, provided input through focus groups to refine an existing culturally tailored mHealth app (Fostering African-American Improvement in Total Health! [FAITH!] App) for promoting hypertension self-management among African American patients with uncontrolled hypertension (renamed as FAITH! Hypertension App). Phase 2 was a single-arm pre-post intervention pilot study assessing feasibility and patient satisfaction. Patients receiving care at an FQHC participated in a 10-week intervention using the FAITH! Hypertension App synchronized with a wireless BP monitor and community health worker (CHW) support to address social determinants of health?related social needs. The multimedia app consisted of a 10-module educational series focused on hypertension and cardiovascular risk factors with interactive self-assessments, medication and BP self-monitoring, and social networking. Primary outcomes were feasibility (app engagement and satisfaction) and preliminary efficacy (change in BP) at an immediate postintervention assessment. Results: In phase 1, thirteen African American patients (n=9, 69% aged ?50 years and n=10, 77% women) and 16 clinicians (n=11, 69% aged ?50 years; n=14, 88% women; and n=10, 63% African American) participated in focus groups. Their feedback informed app modifications, including the addition of BP and medication tracking, BP self-care task reminders, and culturally sensitive contexts. In phase 2, sixteen African American patients were enrolled (mean age 52.6, SD 12.3 years; 12/16, 75% women). Overall, 38% (6/16) completed ?50% of the 10 education modules, and 44% (7/16) completed the postintervention assessment. These patients rated the intervention a 9 (out of 10) on its helpfulness in hypertension self-management. Qualitative data revealed that they viewed the app as user-friendly, engaging, and informative, and CHWs were perceived as providing accountability and support. The mean systolic and diastolic BPs of the 7 patients decreased by 6.5 mm Hg (P=.15) and 2.8 mm Hg (P=.78), respectively, at the immediate postintervention assessment. Conclusions: A culturally tailored mHealth app reinforced by CHW support may improve hypertension self-management among underresourced African American individuals receiving care at FQHCs. A future randomized efficacy trial of this intervention is warranted. Trial Registration: ClinicalTrials.gov NCT04554147; https://clinicaltrials.gov/ct2/show/NCT04554147 UR - https://formative.jmir.org/2023/1/e45061 UR - http://dx.doi.org/10.2196/45061 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115658 ID - info:doi/10.2196/45061 ER - TY - JOUR AU - Amo, Victoria AU - Prentice, Mike AU - Lieder, Falk PY - 2023/6/16 TI - A Gamified Mobile App That Helps People Develop the Metacognitive Skills to Cope With Stressful Situations and Difficult Emotions: Formative Assessment of the InsightApp JO - JMIR Form Res SP - e44429 VL - 7 KW - ecological momentary interventions KW - serious games KW - mindfulness-based interventions KW - acceptance and commitment therapy KW - cognitive behavioral therapy KW - mobile phone N2 - Background: Ecological momentary interventions open up new and exciting possibilities for delivering mental health interventions and conducting research in real-life environments via smartphones. This makes designing psychotherapeutic ecological momentary interventions a promising step toward cost-effective and scalable digital solutions for improving mental health and understanding the effects and mechanisms of psychotherapy. Objective: The first objective of this study was to formatively assess and improve the usability and efficacy of a gamified mobile app, the InsightApp, for helping people learn some of the metacognitive skills taught in cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based interventions. The app aims to help people constructively cope with stressful situations and difficult emotions in everyday life. The second objective of this study was to test the feasibility of using the InsightApp as a research tool for investigating the efficacy of psychological interventions and their underlying mechanisms. Methods: We conducted 2 experiments. In experiment 1 (n=65; completion rate: 63/65, 97%), participants (mean age 27, SD 14.9; range 19-55 years; 41/60, 68% female) completed a single session with the InsightApp. The intervention effects on affect, belief endorsement, and propensity for action were measured immediately before and after the intervention. Experiment 2 (n=200; completion rate: 142/200, 71%) assessed the feasibility of conducting a randomized controlled trial using the InsightApp. We randomly assigned participants to an experimental or a control condition, and they interacted with the InsightApp for 2 weeks (mean age 37, SD 12.16; range 20-78 years; 78/142, 55% female). Experiment 2 included all the outcome measures of experiment 1 except for the self-reported propensity to engage in predefined adaptive and maladaptive behaviors. Both experiments included user experience surveys. Results: In experiment 1, a single session with the app seemed to decrease participants? emotional struggle, the intensity of their negative emotions, their endorsement of negative beliefs, and their self-reported propensity to engage in maladaptive coping behaviors (P<.001 in all cases; average effect size=?0.82). Conversely, participants? endorsement of adaptive beliefs and their self-reported propensity to act in accordance with their values significantly increased (P<.001 in all cases; average effect size=0.48). Experiment 2 replicated the findings of experiment 1 (P<.001 in all cases; average effect size=0.55). Moreover, experiment 2 identified a critical obstacle to conducting a randomized controlled trial (ie, asymmetric attrition) and how it might be overcome. User experience surveys suggested that the app?s design is suitable for helping people apply psychotherapeutic techniques to cope with everyday stress and anxiety. User feedback provided valuable information on how to further improve app usability. Conclusions: In this study, we tested the first prototype of the InsightApp. Our encouraging preliminary results show that it is worthwhile to continue developing the InsightApp and further evaluate it in a randomized controlled trial. UR - https://formative.jmir.org/2023/1/e44429 UR - http://dx.doi.org/10.2196/44429 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327040 ID - info:doi/10.2196/44429 ER - TY - JOUR AU - Gioia, Siena AU - Vlasac, M. Irma AU - Babazadeh, Demsina AU - Fryou, L. Noah AU - Do, Elizabeth AU - Love, Jessica AU - Robbins, Rebecca AU - Dashti, S. Hassan AU - Lane, M. Jacqueline PY - 2023/6/16 TI - Mobile Apps for Dietary and Food Timing Assessment: Evaluation for Use in Clinical Research JO - JMIR Form Res SP - e35858 VL - 7 KW - dietary assessment KW - mobile phone KW - smartphone KW - nutrition apps KW - dietary record KW - circadian rhythms KW - food diary KW - food timing N2 - Background: Over the last decade, health mobile apps have become an increasingly popular tool used by clinicians and researchers to track food consumption and exercise. However, many consumer apps lack the technological features for facilitating the capture of critical food timing details. Objective: This study aimed to introduce users to 11 apps from US app stores that recorded both dietary intake and food timing to establish which one would be the most appropriate for clinical research. Methods: To determine a viable app that recorded both dietary intake and food timing for use in a food timing?related clinical study, we evaluated the time stamp data, usability, privacy policies, the accuracy of nutrient estimates, and general features of 11 mobile apps for dietary assessment that were available on US app stores. The following apps were selected using a keyword search of related terms and reviewed: text entry apps?Cronometer, DiaryNutrition, DietDiary, FoodDiary, Macros, and MyPlate; image entry apps?FoodView and MealLogger; and text plus image entry apps?Bitesnap, myCircadianClock, and MyFitnessPal. Results: Our primary goal was to identify apps that recorded food time stamps, which 8 (73%) of the 11 reviewed apps did. Of the 11 apps, only 4 (36%) allowed users to edit the time stamps. Next, we sought to evaluate the usability of the apps using the System Usability Scale across 2 days, and 82% (9/11) of the apps received favorable scores for usability. To enable use in research and clinical settings, the privacy policies of each app were systematically reviewed using common criteria, with 1 (9%) Health Insurance Portability and Accountability Act?compliant app (Cronometer). Furthermore, protected health information was collected by 9 (82%) of the 11 apps. Finally, to assess the accuracy of the nutrient estimates generated by these apps, we selected 4 sample food items and a 3-day dietary record to input into each app. The caloric and macronutrient estimates of the apps were compared with the nutrient estimates provided by a registered dietitian using the Nutrition Data System for Research database. In terms of the 3-day food record, the apps were found to consistently underestimate daily calories and macronutrients compared with the Nutrition Data System for Research output. Conclusions: Overall, we found that the Bitesnap app provided flexible dietary and food timing functionality capable of being used in research and clinical settings, whereas most other apps lacked in the necessary food timing functionality or user privacy. UR - https://formative.jmir.org/2023/1/e35858 UR - http://dx.doi.org/10.2196/35858 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327038 ID - info:doi/10.2196/35858 ER - TY - JOUR AU - Schreiber, Mike AU - Dohle, Simone PY - 2023/6/15 TI - A Smartphone-Based Implicit Theories Intervention for Health Behavior Change: Randomized Trial JO - JMIR Mhealth Uhealth SP - e36578 VL - 11 KW - daily diary KW - ecological momentary assessment KW - health behavior KW - implicit theories KW - lay theories KW - mindsets KW - multiple health behavior change KW - randomized trial KW - smartphone-based intervention N2 - Background: Implicit theories of health describe individuals? beliefs about the malleability of health. Individuals with an incremental theory of health believe that health, in general, is malleable, whereas individuals with an entity theory of health endorse the idea that health is largely fixed and predetermined. Previous research has shown that an incremental theory of health is associated with beneficial health outcomes and behaviors. A mobile health implicit theories intervention could be an effective way to increase health-promoting behaviors in the general population. Objective: The aim of this study was to estimate the effect of a smartphone-based intervention designed to promote an incremental theory of health on the frequency of health-promoting behaviors in everyday life. The study used ecological momentary assessment to measure health behavior change. Methods: This 2-arm, single-blind, delayed intervention design included 149 German participants (mean age 30.58, SD 9.71 years; n=79 female). Participants were asked to report their engagement in 10 health-promoting behaviors throughout the day for 3 weeks. Participants were randomly assigned to either an early intervention group (n=72) or a delayed intervention group (n=77). The intervention materials, designed to promote an incremental theory of health, were provided to participants after 1 week (early intervention group) or 2 weeks (delayed intervention group) of baseline behavior measurement. Data for this study were collected between September 2019 and October 2019. Results: A paired-samples 2-tailed t test revealed that participants reported a stronger incremental theory after responding to the intervention materials (mean 5.58, SE 0.07) compared with incremental theory measured in an entry questionnaire (mean 5.29, SE 0.08; t148=4.07, SE 0.07; P<.001; 95% CI 0.15-0.43; d=0.33). Multilevel analyses showed that participants reported engaging in health-promoting behaviors more often after being presented with the intervention materials compared with baseline across conditions (b=0.14; t146.65=2.06, SE 0.07; P=.04; 95% CI 0.01-0.28). However, when the analysis was conducted separately for the early and delayed intervention groups, the intervention effect was only significant for the delayed intervention group (b=0.27; t1492.37=3.50, SE 0.08; P<.001; 95% CI 0.12-0.42). There was no significant increase in health-promoting behaviors for the early intervention group (b=0.02; t69.23=0.14, SE 0.11;P=.89; 95% CI ?0.2 to 0.23). Conclusions: This study suggests that a smartphone-based intervention designed to promote an incremental theory of health is a cost- and time-effective approach to increase the frequency of engaging in health-promoting behaviors. However, research is needed to understand the reasons for the difference in intervention effects between the early and delayed intervention groups. The results of this study can guide the development of future digital health interventions that focus on implicit theories to promote health behavior change. Trial Registration: DRKS ? German Clinical Trials Register DRKS00017379; https://drks.de/search/de/trial/DRKS00017379 UR - https://mhealth.jmir.org/2023/1/e36578 UR - http://dx.doi.org/10.2196/36578 UR - http://www.ncbi.nlm.nih.gov/pubmed/37318864 ID - info:doi/10.2196/36578 ER - TY - JOUR AU - Yotsu, R. Rie AU - Almamy, Diabate AU - Vagamon, Bamba AU - Ugai, Kazuko AU - Itoh, Sakiko AU - Koffi, Didier Yao AU - Kaloga, Mamadou AU - Dizoé, Sylvestre Ligué Agui AU - Kouadio, Kouamé AU - Aka, N?guetta AU - Yeboue, Gontran Luc Kowaci AU - Yao, Aubin Koffi AU - Blanton, E. Ronald PY - 2023/6/14 TI - An mHealth App (eSkinHealth) for Detecting and Managing Skin Diseases in Resource-Limited Settings: Mixed Methods Pilot Study JO - JMIR Dermatol SP - e46295 VL - 6 KW - dermatology KW - developing countries KW - digital health tool KW - LMICs KW - low- and middle-income countries KW - skin KW - teledermatology KW - eHealth application KW - skin disease KW - digital health intervention KW - health platform KW - system usability N2 - Background: In sub-Saharan Africa, the disease burden from skin diseases, including skin-related neglected tropical diseases (skin NTDs), is extremely high. These diseases often are overlooked due to limited access to health care stemming from, for example, remote geographical locations and a lack of experts. To address these gaps, we developed a mobile health app, eSkinHealth, which is a field-adapted platform to serve as a portable electronic patient chart and for teledermatology. Objective: The purpose of the study is to evaluate the usability and effectiveness of the app in rural Côte d?Ivoire for diagnosing and managing skin NTDs and other skin diseases. Methods: A 2-arm trial with local health care providers and patients with skin diseases was implemented over a 3-month period. The providers were assigned to an intervention receiving the eSkinHealth app or control with usual care. Four nurses and 8 community health care workers participated in each arm. The training was provided on the use of the app to the intervention arm only, while both arms were trained on skin diseases. For the usability study, we evaluated our approach with the System Usability Scale (SUS) and in-depth interviews. For the effectiveness study, our primary outcome was to evaluate the detection and management of 5 skin NTDs as our targeted diseases, namely, Buruli ulcer, leprosy, lymphatic filariasis, scabies, and yaws, using the eSkinHealth app. Procedures of our methods were reviewed and approved by the institutional review board of the Ministry of Health and by Tulane University. Results: The mean age of our participants (providers) was 40.5 and 42.5 years for the intervention and control arms, respectively, and all were male (n=24). The average SUS scores taken from the intervention arm at baseline, the midpoint (6 weeks), and the end of study (12 weeks) were 72.3 (SD 11.5), 72.3 (SD 12.4), and 86.3 (SD 10.8), respectively. All participants interviewed, including 4 dermatologists and program managers, were satisfied with the app. Especially community health care workers felt empowered by being equipped with the tool. A total of 79 cases of skin NTDs were reported in the intervention arm as compared to 17 cases in the control arm (P=.002). Besides the skin NTDs, more skin diseases and conditions were reported from the control than from the intervention arm (P<.001). However, 100 cases (66%) were not given any particular diagnosis in the control arm and were documented only as a ?dermatosis.? In the intervention arm, 151 cases (72.9%) were diagnosed within the eSkinHealth platform, and the remaining were diagnosed on-site by dermatologists. Conclusions: The study provided evidence for the usability and effectiveness of the eSkinHealth app embedded into our surveillance approach to improve the detection and management of skin NTDs and other skin diseases in Côte d?Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin diseases in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/NCT05300399 UR - https://derma.jmir.org/2023/1/e46295 UR - http://dx.doi.org/10.2196/46295 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632977 ID - info:doi/10.2196/46295 ER - TY - JOUR AU - Gudmundsdóttir, Lára Sigrídur AU - Ballarini, Tommaso AU - Ámundadóttir, L. María AU - Mészáros, Judit AU - Eysteinsdottir, Huld Jenna AU - Thorleifsdottir, H. Ragna AU - Hrafnkelsdóttir, K. Sigrídur AU - Helgadottir, Halla AU - Oddsson, Saemundur AU - Silverberg, I. Jonathan PY - 2023/6/14 TI - Engagement, Retention, and Acceptability in a Digital Health Program for Atopic Dermatitis: Prospective Interventional Study JO - JMIR Form Res SP - e41227 VL - 7 KW - digital therapeutics KW - DTX KW - eHealth KW - engagement KW - retention KW - atopic dermatitis KW - eczema KW - medication reminder KW - symptom tracking KW - patient-reported outcomes KW - quality of life KW - dermatology KW - feasibility KW - mobile phone N2 - Background: Patients with atopic dermatitis can experience chronic eczema with pruritus, skin pain, sleep problems, anxiety, and other problems that reduce their quality of life (QoL). Current treatments aim to improve these symptoms and reduce inflammation, but poor treatment adherence and disease understanding are key concerns in the long-term management of atopic dermatitis. Digital therapeutics can help with these and support patients toward a healthier lifestyle to improve their overall QoL. Objective: The aim of the study is to test the feasibility of a digital health program tailored for atopic dermatitis through program engagement, retention, and acceptability. Methods: Adults with atopic dermatitis were recruited in Iceland for a 6-week digital health program delivered through a smartphone app. Key components of the digital program were disease and trigger education; medication reminders; patient-reported outcomes (PROs) on energy levels, stress levels, and quality of sleep (referred to as QoL PROs); atopic dermatitis symptom PROs; guided meditation; and healthy lifestyle coaching. The primary outcome was program feasibility, as assessed by in-app retention and engagement. User satisfaction was assessed by the mHealth (ie, mobile health) App Usability Questionnaire (MAUQ). Results: A total of 21 patients were recruited (17 female, mean age 31 years), 20 (95%) completed the program. On average, users were active in the app 6.5 days per week and completed 8.2 missions per day. The education content, medication reminders, and PROs had high user engagement and retention; all users who were exposed to the QoL PROs (n=17) interacted with these, and 20/21 (95%) users were continuously engaged with the education missions, medication missions, and symptom PROs. Continued engagement with the step counter and mind missions among exposed users was lower (17/21 and 13/20 participants, respectively). Medication reminder and education task completion remained high over time (at least 18/20, 90%), but weekly interactions declined. All assigned users completed atopic dermatitis symptom PROs on weeks 1-5 and only one did not do so on week 6; the reported number and total severity of atopic dermatitis symptoms reduced during the program. Regarding the QoL PROs, 16/17 (94%) and 14/17 (82%) users interacted with these at least 3 times in the first and last week of the program, respectively, and all reported improvements over time. User satisfaction was high with a total score of 6.2/7. Conclusions: We found high overall engagement and retention in a targeted digital health program among patients with atopic dermatitis, as well as high compliance with missions relating to medication reminders, patient education, and PROs. Symptom number and severity were reduced, and QoL PROs improved over time. We conclude that a digital health program is feasible and may provide added benefits for patients with atopic dermatitis, including the tracking and improvement of atopic dermatitis symptoms. UR - https://formative.jmir.org/2023/1/e41227 UR - http://dx.doi.org/10.2196/41227 UR - http://www.ncbi.nlm.nih.gov/pubmed/36975050 ID - info:doi/10.2196/41227 ER - TY - JOUR AU - Barone Gibbs, Bethany AU - Kozai, C. Andrea AU - McAdoo, N. Shannon AU - Bastyr, C. Meghan AU - Davis, D. Kelliann AU - Hauspurg, Alisse AU - Catov, M. Janet PY - 2023/6/14 TI - Rationale, Design, and Methods for the Sedentary Behavior Reduction in Pregnancy Intervention (SPRING): Protocol for a Pilot and Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e48228 VL - 12 KW - pregnancy KW - behavioral intervention KW - pilot and feasibility trial KW - sedentary behavior KW - physical activity KW - mobile phone N2 - Background: Adverse pregnancy outcomes (APOs) identify cardiovascular disease risk, but few effective interventions are available. High sedentary behavior (SED) has recently been associated with APOs, but very few randomized controlled trials (RCTs) have tested SED reduction in pregnancy. Objective: The Sedentary Behavior Reduction in Pregnancy Intervention (SPRING) pilot and feasibility RCT addresses this gap by testing the feasibility, acceptability, and preliminary pregnancy health effects of an intervention to reduce SED in pregnant women. The objective of this manuscript is to describe the rationale and design of SPRING. Methods: Pregnant participants (n=53) in their first trimester, who are at risk for high SED and APO and without contraindications, are randomized in a 2:1 ratio to an intervention or control group. SED (primary outcome) and standing durations, and steps per day, are measured objectively in each trimester for 1 week with a thigh-mounted activPAL3 accelerometer. SPRING also seeks to demonstrate feasibility and acceptability while estimating preliminary effects on maternal-fetal health outcomes assessed during study visits and abstracted from medical records. The pregnancy-customized intervention promotes daily behavioral targets of less than 9 hours of SED and at least 7500 steps, achieved via increased standing and incorporating light-intensity movement breaks each hour. The multicomponent intervention provides a height-adjustable workstation, a wearable activity monitor, behavioral counseling every 2 weeks (through videoconference), and membership in a private social media group. Herein, we review the rationale, describe recruitment and screening processes, and detail the intervention, assessment protocols, and planned statistical analyses. Results: This study was funded by the American Heart Association (20TPA3549099), with a funding period of January 1, 2021, and until December 31, 2023. Institutional review board approval was obtained on February 24, 2021. Participants were randomized between October 2021 and September 2022, with final data collection planned for May 2023. Analyses and submission of results are expected for winter of 2023. Conclusions: The SPRING RCT will provide initial evidence on the feasibility and acceptability of an SED-reduction intervention to decrease SED in pregnant women. These data will inform the design of a large clinical trial testing SED reduction as a strategy to reduce APO risk. Trial Registration: ClincialTrials.gov NCT05093842; https://clinicaltrials.gov/ct2/show/NCT05093842 International Registered Report Identifier (IRRID): DERR1-10.2196/48228 UR - https://www.researchprotocols.org/2023/1/e48228 UR - http://dx.doi.org/10.2196/48228 UR - http://www.ncbi.nlm.nih.gov/pubmed/37314845 ID - info:doi/10.2196/48228 ER - TY - JOUR AU - Campbell, I. Cynthia AU - Chen, Ching-Hua AU - Adams, R. Sara AU - Asyyed, Asma AU - Athale, R. Ninad AU - Does, B. Monique AU - Hassanpour, Saeed AU - Hichborn, Emily AU - Jackson-Morris, Melanie AU - Jacobson, C. Nicholas AU - Jones, K. Heather AU - Kotz, David AU - Lambert-Harris, A. Chantal AU - Li, Zhiguo AU - McLeman, Bethany AU - Mishra, Varun AU - Stanger, Catherine AU - Subramaniam, Geetha AU - Wu, Weiyi AU - Zegers, Christopher AU - Marsch, A. Lisa PY - 2023/6/13 TI - Patient Engagement in a Multimodal Digital Phenotyping Study of Opioid Use Disorder JO - J Med Internet Res SP - e45556 VL - 25 KW - opioid use disorder KW - digital phenotyping KW - medication for opioid use disorder KW - MOUD KW - ecological momentary assessment KW - EMA KW - passive sensing KW - social media KW - opioid KW - OUD KW - data collection KW - smartphone KW - digital health N2 - Background: Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD. Objective: The aim is to examine patient engagement with multiple digital phenotyping methods among patients receiving buprenorphine medication for OUD. Methods: The study enrolled 65 patients receiving buprenorphine for OUD between June 2020 and January 2021 from 4 addiction medicine programs in an integrated health care delivery system in Northern California. Ecological momentary assessment (EMA), sensor data, and social media data were collected by smartphone, smartwatch, and social media platforms over a 12-week period. Primary engagement outcomes were meeting measures of minimum phone carry (?8 hours per day) and watch wear (?18 hours per day) criteria, EMA response rates, social media consent rate, and data sparsity. Descriptive analyses, bivariate, and trend tests were performed. Results: The participants? average age was 37 years, 47% of them were female, and 71% of them were White. On average, participants met phone carrying criteria on 94% of study days, met watch wearing criteria on 74% of days, and wore the watch to sleep on 77% of days. The mean EMA response rate was 70%, declining from 83% to 56% from week 1 to week 12. Among participants with social media accounts, 88% of them consented to providing data; of them, 55% of Facebook, 54% of Instagram, and 57% of Twitter participants provided data. The amount of social media data available varied widely across participants. No differences by age, sex, race, or ethnicity were observed for any outcomes. Conclusions: To our knowledge, this is the first study to capture these 3 digital data sources in this clinical population. Our findings demonstrate that patients receiving buprenorphine treatment for OUD had generally high engagement with multiple digital phenotyping data sources, but this was more limited for the social media data. International Registered Report Identifier (IRRID): RR2-10.3389/fpsyt.2022.871916 UR - https://www.jmir.org/2023/1/e45556 UR - http://dx.doi.org/10.2196/45556 UR - http://www.ncbi.nlm.nih.gov/pubmed/37310787 ID - info:doi/10.2196/45556 ER - TY - JOUR AU - Zhu, Jieting AU - Weng, Huiting AU - Ou, Peng AU - Li, Lezhi PY - 2023/6/13 TI - Use and Acceptance of Smart Elderly Care Apps Among Chinese Medical Staff and Older Individuals: Web-Based Hybrid Survey Study JO - JMIR Form Res SP - e41919 VL - 7 KW - smart elderly care app KW - mobile health KW - smartphone N2 - Background: With the advent of China?s aging population and the popularization of smartphones, there is a huge demand for smart elderly care apps. Along with older adults and their dependents, medical staff also need to use a health management platform to manage the health of patients. However, the development of health apps and the large and growing app market pose a problem of declining quality; in fact, important differences can be observed between apps, and patients currently do not have adequate information and formal evidence to discriminate among them. Objective: The aim of this study was to investigate the cognition and usage status of smart elderly care apps among older individuals and medical staff in China. Methods: From March 1, 2022, to March 30, 2022, we used the web survey tool Sojump to conduct snowball sampling through WeChat. The survey links were initially sent to communities in 23 representative major cities in China. We asked the medical staff of community clinics to post the survey link on their WeChat Moments. From April 1 to May 10, 2022, we contacted those who selected ?Have used a smart elderly care app? in the questionnaire through WeChat for a request to participate in semistructured interviews. Participants provided informed consent in advance and interviews were scheduled. After the interviews, the audio recordings were transcribed into text and the emerging themes were analyzed and summarized. Results: A total of 810 individuals participated in this study, 54.8% (n=444) of whom were medical staff, 33.1% (n=268) were older people, and the remaining participants were certified nursing assistants (CNAs) and community workers. Overall, 60.5% (490/810) of the participants had used a smart elderly care app on their smartphone. Among the 444 medical staff who participated in the study, the vast majority (n=313, 70.5%) had never used a smart elderly care app, although 34.7% of them recommended elderly care?related apps to patients. Among the 542 medical staff, CNAs, and community workers that completed the questionnaire, only 68 (12.6%) had used a smart elderly care app. We further interviewed 23 people about their feelings and opinions about smart elderly care apps. Three themes emerged with eight subthemes, including functional design, operation interface, and data security. Conclusions: In this survey, there was a huge difference in the usage rate and demand for smart elderly care apps by the participants. Respondents are mainly concerned with app function settings, interface simplicity, and data security. UR - https://formative.jmir.org/2023/1/e41919 UR - http://dx.doi.org/10.2196/41919 UR - http://www.ncbi.nlm.nih.gov/pubmed/37310777 ID - info:doi/10.2196/41919 ER - TY - JOUR AU - Bell, Lauren AU - Garnett, Claire AU - Bao, Yihan AU - Cheng, Zhaoxi AU - Qian, Tianchen AU - Perski, Olga AU - Potts, W. Henry W. AU - Williamson, Elizabeth PY - 2023/6/9 TI - How Notifications Affect Engagement With a Behavior Change App: Results From a Micro-Randomized Trial JO - JMIR Mhealth Uhealth SP - e38342 VL - 11 KW - mobile health KW - mHealth KW - digital health KW - behavior change KW - digital behavior change KW - engagement KW - micro-randomized trial KW - randomized trial KW - randomization KW - just-in-time adaptive intervention KW - adaptive intervention KW - push notification KW - notification KW - excessive alcohol consumption KW - smartphone app KW - alcohol KW - drinking KW - drinker KW - mobile phone N2 - Background: Drink Less is a behavior change app to help higher-risk drinkers in the United Kingdom reduce their alcohol consumption. The app includes a daily notification asking users to ?Please complete your drinks and mood diary,? yet we did not understand the causal effect of the notification on engagement nor how to improve this component of Drink Less. We developed a new bank of 30 new messages to increase users? reflective motivation to engage with Drink Less. This study aimed to determine how standard and new notifications affect engagement. Objective: Our objective was to estimate the causal effect of the notification on near-term engagement, to explore whether this effect changed over time, and to create an evidence base to further inform the optimization of the notification policy. Methods: We conducted a micro-randomized trial (MRT) with 2 additional parallel arms. Inclusion criteria were Drink Less users who consented to participate in the trial, self-reported a baseline Alcohol Use Disorders Identification Test score of ?8, resided in the United Kingdom, were aged ?18 years, and reported interest in drinking less alcohol. Our MRT randomized 350 new users to test whether receiving a notification, compared with receiving no notification, increased the probability of opening the app in the subsequent hour, over the first 30 days since downloading Drink Less. Each day at 8 PM, users were randomized with a 30% probability of receiving the standard message, a 30% probability of receiving a new message, or a 40% probability of receiving no message. We additionally explored time to disengagement, with the allocation of 60% of eligible users randomized to the MRT (n=350) and 40% of eligible users randomized in equal number to the 2 parallel arms, either receiving the no notification policy (n=98) or the standard notification policy (n=121). Ancillary analyses explored effect moderation by recent states of habituation and engagement. Results: Receiving a notification, compared with not receiving a notification, increased the probability of opening the app in the next hour by 3.5-fold (95% CI 2.91-4.25). Both types of messages were similarly effective. The effect of the notification did not change significantly over time. A user being in a state of already engaged lowered the new notification effect by 0.80 (95% CI 0.55-1.16), although not significantly. Across the 3 arms, time to disengagement was not significantly different. Conclusions: We found a strong near-term effect of engagement on the notification, but no overall difference in time to disengagement between users receiving the standard fixed notification, no notification at all, or the random sequence of notifications within the MRT. The strong near-term effect of the notification presents an opportunity to target notifications to increase ?in-the-moment? engagement. Further optimization is required to improve the long-term engagement. International Registered Report Identifier (IRRID): RR2-10.2196/18690 UR - https://mhealth.jmir.org/2023/1/e38342 UR - http://dx.doi.org/10.2196/38342 UR - http://www.ncbi.nlm.nih.gov/pubmed/37294612 ID - info:doi/10.2196/38342 ER - TY - JOUR AU - Dingwall, M. Kylie AU - Povey, Josie AU - Sweet, Michelle AU - Friel, Jaylene AU - Shand, Fiona AU - Titov, Nickolai AU - Wormer, Julia AU - Mirza, Tamoor AU - Nagel, Tricia PY - 2023/6/7 TI - Feasibility and Acceptability of the Aboriginal and Islander Mental Health Initiative for Youth App: Nonrandomized Pilot With First Nations Young People JO - JMIR Hum Factors SP - e40111 VL - 10 KW - digital mental health KW - First Nations KW - Indigenous KW - young people KW - feasibility study KW - digital health KW - mental health KW - depression KW - mHealth KW - mobile app KW - aboriginal KW - acceptibility KW - youth N2 - Background: Despite young First Nations Australians being typically healthy, happy, and connected to family and culture, high rates of emotional distress, suicide, and self-harm are also observed. Differing worldviews of service providers and First Nations young people regarding illness and treatment practices, language differences, culturally inappropriate service models, geographical remoteness, and stigma can all inhibit access to appropriate mental health support. Mental health treatments delivered digitally (digital mental health; dMH) offer flexible access to evidence-based, nonstigmatizing, low-cost treatment and early intervention on a broad scale. There is a rapidly growing use and acceptance of these technologies among young First Nations people. Objective: The objective was to assess the feasibility, acceptability, and use of the newly developed Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) app and determine the feasibility of study procedures in preparation for future assessments of effectiveness. Methods: This was a nonrandomized pre-post study using mixed methods. First Nations young people aged 12-25 years who provided consent (with parental consent where appropriate) and possessed the ability to navigate a simple app with basic English literacy were included. Researchers conducted one face-to-face 20-minute session with participants to introduce and orient them to the AIMhi-Y app. The app integrates culturally adapted low-intensity cognitive behavioral therapy (CBT), psychoeducation, and mindfulness-based activities. Participants received supportive text messages weekly throughout the 4-week intervention period and completed assessments of psychological distress, depression, anxiety, substance misuse, help-seeking, service use, and parent-rated strengths and difficulties at baseline and 4 weeks. Qualitative interviews and rating scales were completed at 4 weeks to gain feedback on subjective experience, look and style, content, overall rating, check-ins, and involvement in the study. App use data were collected. Results: Thirty young people (17 males and 13 females) aged between 12 and 18 (mean 14.0, SD 1.55) years were assessed at baseline and 4 weeks. Repeated measures 2-tailed t tests showed improvements in well-being measures that were statistically and clinically significant for psychological distress (Kessler Psychological Distress Scale, 10-item) and depressive symptoms (Patient Health Questionnaire, 2-item). Participants spent on average 37 minutes in the app. The app was rated positively, with mean ratings of 4 out of 5 points (on scales of 1-5). Participants reported that they found the app easy to use, culturally relevant, and useful. The feasibility of the study was demonstrated with a 62% recruitment rate, a 90% retention rate, and high study acceptability ratings. Conclusions: This study supports earlier research suggesting that dMH apps that are appropriately designed with and for the target populations are a feasible and acceptable means of lowering symptoms for mental health disorders among First Nations youth. UR - https://humanfactors.jmir.org/2023/1/e40111 UR - http://dx.doi.org/10.2196/40111 UR - http://www.ncbi.nlm.nih.gov/pubmed/37285184 ID - info:doi/10.2196/40111 ER - TY - JOUR AU - Norman-Nott, Nell AU - Hesam-Shariati, Negin AU - Wilks, R. Chelsey AU - Schroeder, Jessica AU - Suh, Jina AU - Briggs, E. Nancy AU - McAuley, H. James AU - Quidé, Yann AU - Gustin, M. Sylvia PY - 2023/6/7 TI - Internet-Delivered Dialectical Behavioral Therapy Skills Training for Chronic Pain: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e41890 VL - 12 KW - internet-delivered KW - dialectical behavioral therapy KW - chronic pain KW - emotion dysregulation KW - emotion-centric intervention KW - mobile phone N2 - Background: Emotion dysregulation is key to the development and maintenance of chronic pain, feeding into a cycle of worsening pain and disability. Dialectical behavioral therapy (DBT), an evidence-based treatment for complex transdiagnostic conditions presenting with high emotion dysregulation, may be beneficial to manage and mitigate the emotional and sensory aspects of chronic pain. Increasingly, DBT skills training as a key component of standard DBT is being delivered as a stand-alone intervention without concurrent therapy to help develop skills for effective emotion regulation. A previous repeated-measure single-case trial investigating a novel technologically driven DBT skills training, internet-delivered DBT skills training for chronic pain (iDBT-Pain), revealed promising findings to improve both emotion dysregulation and pain intensity. Objective: This randomized controlled trial aims to examine the efficacy of iDBT-Pain in comparison with treatment as usual to reduce emotion dysregulation (primary outcome) for individuals with chronic pain after 9 weeks and at the 21-week follow-up. The secondary outcomes include pain intensity, pain interference, anxiety symptoms, depressive symptoms, perceived stress, posttraumatic stress, harm avoidance, social cognition, sleep quality, life satisfaction, and well-being. The trial also examines the acceptability of the iDBT-Pain intervention for future development and testing. Methods: A total of 48 people with chronic pain will be randomly assigned to 1 of 2 conditions: treatment and treatment as usual. Participants in the treatment condition will receive iDBT-Pain, consisting of 6 live web-based group sessions led by a DBT skills trainer and supervised by a registered psychologist and the iDBT-Pain app. Participants in the treatment-as-usual condition will not receive iDBT-Pain but will still access their usual medication and health interventions. We predict that iDBT-Pain will improve the primary outcome of emotion dysregulation and the secondary outcomes of pain intensity, pain interference, anxiety symptoms, depressive symptoms, perceived stress, harm avoidance, social cognition, sleep quality, life satisfaction, and well-being. A linear mixed model with random effects of individuals will be conducted to investigate the differences between the baseline, 9-week (primary end point), and 21-week (follow-up) assessments as a function of experimental condition. Results: Recruitment started in February 2023, and the clinical trial started in March 2023. Data collection for the final assessment is planned to be completed by July 2024. Conclusions: If our hypothesis is confirmed, our findings will contribute to the evidence for the efficacy and acceptability of a viable intervention that may be used by health care professionals for people with chronic pain. The results will add to the chronic pain literature to inform about the potential benefits of DBT skills training for chronic pain and will contribute evidence about technologically driven interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000113752; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383208&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/41890 UR - https://www.researchprotocols.org/2023/1/e41890 UR - http://dx.doi.org/10.2196/41890 UR - http://www.ncbi.nlm.nih.gov/pubmed/37285187 ID - info:doi/10.2196/41890 ER - TY - JOUR AU - Purnell, Larissa AU - Sierra, Maribel AU - Lisker, Sarah AU - Lim, S. Melissa AU - Bailey, Emma AU - Sarkar, Urmimala AU - Lyles, R. Courtney AU - Nguyen, H. Kim PY - 2023/6/5 TI - Acceptability and Usability of a Wearable Device for Sleep Health Among English- and Spanish-Speaking Patients in a Safety Net Clinic: Qualitative Analysis JO - JMIR Form Res SP - e43067 VL - 7 KW - health equity KW - medical informatics KW - sleep disorders KW - user-centered design KW - wearable electronic devices N2 - Background: Sleep disorders are common and disproportionately affect marginalized populations. Technology, such as wearable devices, holds the potential to improve sleep quality and reduce sleep disparities, but most devices have not been designed or tested with racially, ethnically, and socioeconomically diverse patients. Inclusion and engagement of diverse patients throughout digital health development and implementation are critical to achieving health equity. Objective: This study aims to evaluate the usability and acceptability of a wearable sleep monitoring device?SomnoRing?and its accompanying mobile app among patients treated in a safety net clinic. Methods: The study team recruited English- and Spanish-speaking patients from a mid-sized pulmonary and sleep medicine practice serving publicly insured patients. Eligibility criteria included initial evaluation of obstructed sleep apnea, which is most appropriate for limited cardiopulmonary testing. Patients with primary insomnia or other suspected sleep disorders were not included. Patients tested the SomnoRing over a 7-night period and participated in a 1-hour semistructured web-based qualitative interview covering perceptions of the device, motivators and barriers to use, and general experiences with digital health tools. The study team used inductive or deductive processes to code interview transcripts, guided by the Technology Acceptance Model. Results: A total of 21 individuals participated in the study. All participants owned a smartphone, almost all (19/21) felt comfortable using their phone, and few already owned a wearable (6/21). Almost all participants wore the SomnoRing for 7 nights and found it comfortable. The following four themes emerged from qualitative data: (1) the SomnoRing was easy to use compared to other wearable devices or traditional home sleep testing alternatives, such as the standard polysomnogram technology for sleep studies; (2) the patient?s context and environment, such as family and peer influence, housing status, access to insurance, and device cost affected the overall acceptance of the SomnoRing; (3) clinical champions motivated use in supporting effective onboarding, interpretation of data, and, ongoing technical support; and (4) participants desired more assistance and information to best interpret their own sleep data summarized in the companion app. Conclusions: Racially, ethnically, and socioeconomically diverse patients with sleep disorders perceived a wearable as useful and acceptable for sleep health. Participants also uncovered external barriers related to the perceived usefulness of the technology, such as housing status, insurance coverage, and clinical support. Future studies should further examine how to best address these barriers so that wearables, such as the SomnoRing, can be successfully implemented in the safety net health setting. UR - https://formative.jmir.org/2023/1/e43067 UR - http://dx.doi.org/10.2196/43067 UR - http://www.ncbi.nlm.nih.gov/pubmed/37098152 ID - info:doi/10.2196/43067 ER - TY - JOUR AU - Singh, Shifali AU - Strong, Roger AU - Xu, Irene AU - Fonseca, M. Luciana AU - Hawks, Zoe AU - Grinspoon, Elizabeth AU - Jung, Lanee AU - Li, Frances AU - Weinstock, S. Ruth AU - Sliwinski, J. Martin AU - Chaytor, S. Naomi AU - Germine, T. Laura PY - 2023/6/2 TI - Ecological Momentary Assessment of Cognition in Clinical and Community Samples: Reliability and Validity Study JO - J Med Internet Res SP - e45028 VL - 25 KW - ecological momentary assessment KW - cognition KW - digital neuropsychology KW - remote assessment KW - digital technology KW - type 1 diabetes, teleneuropsychology KW - reliability KW - validity KW - cognitive functioning KW - psychological KW - physiological KW - glucose KW - community N2 - Background: The current methods of evaluating cognitive functioning typically rely on a single time point to assess and characterize an individual?s performance. However, cognitive functioning fluctuates within individuals over time in relation to environmental, psychological, and physiological contexts. This limits the generalizability and diagnostic utility of single time point assessments, particularly among individuals who may exhibit large variations in cognition depending on physiological or psychological context (eg, those with type 1 diabetes [T1D], who may have fluctuating glucose concentrations throughout the day). Objective: We aimed to report the reliability and validity of cognitive ecological momentary assessment (EMA) as a method for understanding between-person differences and capturing within-person variation in cognition over time in a community sample and sample of adults with T1D. Methods: Cognitive performance was measured 3 times a day for 15 days in the sample of adults with T1D (n=198, recruited through endocrinology clinics) and for 10 days in the community sample (n=128, recruited from TestMyBrain, a web-based citizen science platform) using ultrabrief cognitive tests developed for cognitive EMA. Our cognitive EMA platform allowed for remote, automated assessment in participants? natural environments, enabling the measurement of within-person cognitive variation without the burden of repeated laboratory or clinic visits. This allowed us to evaluate reliability and validity in samples that differed in their expected degree of cognitive variability as well as the method of recruitment. Results: The results demonstrate excellent between-person reliability (ranging from 0.95 to 0.99) and construct validity of cognitive EMA in both the sample of adults with T1D and community sample. Within-person reliability in both samples (ranging from 0.20 to 0.80) was comparable with that observed in previous studies in healthy older adults. As expected, the full-length baseline and EMA versions of TestMyBrain tests correlated highly with one another and loaded together on the expected cognitive domains when using exploratory factor analysis. Interruptions had higher negative impacts on accuracy-based outcomes (?=?.34 to ?.26; all P values <.001) than on reaction time?based outcomes (?=?.07 to ?.02; P<.001 to P=.40). Conclusions: We demonstrated that ultrabrief mobile assessments are both reliable and valid across 2 very different clinic versus community samples, despite the conditions in which cognitive EMAs are administered, which are often associated with more noise and variability. The psychometric characteristics described here should be leveraged appropriately depending on the goals of the cognitive assessment (eg, diagnostic vs everyday functioning) and the population being studied. UR - https://www.jmir.org/2023/1/e45028 UR - http://dx.doi.org/10.2196/45028 UR - http://www.ncbi.nlm.nih.gov/pubmed/37266996 ID - info:doi/10.2196/45028 ER - TY - JOUR AU - Tran, Hong Hai AU - Hong, Kyung Jung AU - Jang, Hyeryung AU - Jung, Jinhwan AU - Kim, Jongmok AU - Hong, Joonki AU - Lee, Minji AU - Kim, Jeong-Whun AU - Kushida, A. Clete AU - Lee, Dongheon AU - Kim, Daewoo AU - Yoon, In-Young PY - 2023/6/1 TI - Prediction of Sleep Stages Via Deep Learning Using Smartphone Audio Recordings in Home Environments: Model Development and Validation JO - J Med Internet Res SP - e46216 VL - 25 KW - respiratory sounds KW - sleep stages KW - deep learning KW - smartphone KW - home environment N2 - Background: The growing public interest and awareness regarding the significance of sleep is driving the demand for sleep monitoring at home. In addition to various commercially available wearable and nearable devices, sound-based sleep staging via deep learning is emerging as a decent alternative for their convenience and potential accuracy. However, sound-based sleep staging has only been studied using in-laboratory sound data. In real-world sleep environments (homes), there is abundant background noise, in contrast to quiet, controlled environments such as laboratories. The use of sound-based sleep staging at homes has not been investigated while it is essential for practical use on a daily basis. Challenges are the lack of and the expected huge expense of acquiring a sufficient size of home data annotated with sleep stages to train a large-scale neural network. Objective: This study aims to develop and validate a deep learning method to perform sound-based sleep staging using audio recordings achieved from various uncontrolled home environments. Methods: To overcome the limitation of lacking home data with known sleep stages, we adopted advanced training techniques and combined home data with hospital data. The training of the model consisted of 3 components: (1) the original supervised learning using 812 pairs of hospital polysomnography (PSG) and audio recordings, and the 2 newly adopted components; (2) transfer learning from hospital to home sounds by adding 829 smartphone audio recordings at home; and (3) consistency training using augmented hospital sound data. Augmented data were created by adding 8255 home noise data to hospital audio recordings. Besides, an independent test set was built by collecting 45 pairs of overnight PSG and smartphone audio recording at homes to examine the performance of the trained model. Results: The accuracy of the model was 76.2% (63.4% for wake, 64.9% for rapid-eye movement [REM], and 83.6% for non-REM) for our test set. The macro F1-score and mean per-class sensitivity were 0.714 and 0.706, respectively. The performance was robust across demographic groups such as age, gender, BMI, or sleep apnea severity (accuracy 73.4%-79.4%). In the ablation study, we evaluated the contribution of each component. While the supervised learning alone achieved accuracy of 69.2% on home sound data, adding consistency training to the supervised learning helped increase the accuracy to a larger degree (+4.3%) than adding transfer learning (+0.1%). The best performance was shown when both transfer learning and consistency training were adopted (+7.0%). Conclusions: This study shows that sound-based sleep staging is feasible for home use. By adopting 2 advanced techniques (transfer learning and consistency training) the deep learning model robustly predicts sleep stages using sounds recorded at various uncontrolled home environments, without using any special equipment but smartphones only. UR - https://www.jmir.org/2023/1/e46216 UR - http://dx.doi.org/10.2196/46216 UR - http://www.ncbi.nlm.nih.gov/pubmed/37261889 ID - info:doi/10.2196/46216 ER - TY - JOUR AU - Wang, Y. Elizabeth AU - Borno, T. Hala AU - Washington III, L. Samuel AU - Friedlander, Terence AU - Zhang, Sylvia AU - Trejo, Evelin AU - Van Blarigan, L. Erin AU - Chan, M. June AU - Shariff-Marco, Salma AU - Beatty, L. Alexis AU - Kenfield, A. Stacey PY - 2023/6/1 TI - Engaging Men of Diverse Racial and Ethnic Groups With Advanced Prostate Cancer in the Design of an mHealth Diet and Exercise Intervention: Focus Group Study JO - JMIR Cancer SP - e45432 VL - 9 KW - cancer survivorship KW - digital health KW - technology-based intervention KW - modifiable behaviors KW - metastatic KW - androgen deprivation therapy KW - race and ethnicity KW - social determinants of health KW - mobile phone N2 - Background: Healthy diet and exercise can improve quality of life and prognosis among men with prostate cancer. Understanding the perceived barriers to lifestyle change and patient preferences in a diverse cohort of men with prostate cancer is necessary to inform mobile health (mHealth) lifestyle interventions and increase health equity. Objective: We conducted a multisite study to understand the preferences, attitudes, and health behaviors related to diet and lifestyle in this patient population. This report focuses on the qualitative findings from 4 web-based focus groups comprising a racially and ethnically diverse group of patients with advanced prostate cancer who are on androgen deprivation therapy. Methods: We used grounded theory analyses including open, axial, and selective coding to generate codes. Qualitative data were analyzed as a whole rather than by focus group to optimize data saturation and the transferability of results. We present codes and themes that emerged for lifestyle intervention design and provide recommendations and considerations for future mHealth intervention studies. Results: Overall, 14 men participated in 4 racially and ethnically concordant focus groups (African American or Black: 3/14, 21%; Asian American: 3/14, 21%; Hispanic or Latino: 3/14, 21%; and White: 5/14, 36%). Analyses converged on 7 interwoven categories: context (home environment, access, competing priorities, and lifestyle programs), motivation (accountability, discordance, feeling supported, fear, and temptation), preparedness (health literacy, technological literacy, technological preferences, trust, readiness to change, identity, adaptability, and clinical characteristics), data-driven design (education, psychosocial factors, and quality of life), program mechanics (communication, materials, customization, and being holistic), habits (eg, dietary habits), and intervention impressions. These results suggest actionable pathways to increase program intuitiveness. Recommendations for future mHealth intervention design and implementation include but are not limited to assessment at the individual, household, and neighborhood levels to support a tailored intervention; prioritization of information to disseminate based on individuals? major concerns and the delivery of information based on health and technological literacy and communication preferences; prescribing a personalized intervention based on individuals? baseline responses, home and neighborhood environment, and support network; and incorporating strategies to foster engagement (eg, responsive and relevant feedback systems) to aid participant decision-making and behavior change. Conclusions: Assessing a patient?s social context, motivation, and preparedness is necessary when tailoring a program to each patient?s needs in all racial and ethnic groups. Addressing the patients? contexts and motivation and preparedness related to diet and exercise including the household, access (to food and exercise), competing priorities, health and technological literacy, readiness to change, and clinical characteristics will help to customize the intervention to the participant. These data support a tailored approach leveraging the identified components and their interrelationships to ensure that mHealth lifestyle interventions will engage and be effective in racially and ethnically diverse patients with cancer. Trial Registration: ClinicalTrials.gov NCT05324098; https://clinicaltrials.gov/ct2/show/NCT05324098 UR - https://cancer.jmir.org/2023/1/e45432 UR - http://dx.doi.org/10.2196/45432 UR - http://www.ncbi.nlm.nih.gov/pubmed/37261885 ID - info:doi/10.2196/45432 ER - TY - JOUR AU - Li, Kexin AU - Magnuson, I. Katherine AU - Beuley, Grace AU - Davis, Logan AU - Ryan-Pettes, R. Stacy PY - 2023/6/1 TI - Features, Design, and Adherence to Evidence-Based Behavioral Parenting Principles in Commercial mHealth Parenting Apps: Systematic Review JO - JMIR Pediatr Parent SP - e43626 VL - 6 KW - mobile phone KW - parent KW - behavioral parent training KW - parent management training KW - mobile apps KW - mobile health KW - mHealth KW - child KW - adolescent N2 - Background: There is a need to disseminate evidence-based parenting interventions for adolescent externalizing concerns. Although family-based treatments have demonstrated efficacy for such concerns, they have limitations and challenges when disseminated in the community. Behavioral-based parenting techniques form an integral part of well-established, family-based interventions for adolescent behavioral problems and are ideal for dissemination through coupling with smartphone technology. Despite the vast number of ?parent? apps currently available in commercial markets, there is a dearth of reviews focused on evaluating mobile health apps through the lens of behavioral parenting training (BPT). Objective: This study aimed to conduct a systematic review of commercial mobile health apps for parents to increase effective parenting skills that include behavioral components. Methods: A search of the Google Play and Apple App Stores identified 57 apps that were included in the review and coded for availability, popularity, and infrastructure. In total, 89% (51/57) of them were sufficiently functional to be assessed for app design quality (engagement, functionality, esthetics, and information), and 53% (30/57) proceeded to the final evaluation of level of adherence to BPT principles. Results: In total, 57 apps met the initial inclusion criteria. Accessibility was high across these apps given that 44% (25/57) were available on both the Google Play and Apple App Stores and 68% (39/57) were free of charge. However, privacy concerns were addressed inconsistently among the apps. App design quality was average across the included apps, and apps with positive user star ratings or a high number of downloads received higher ratings on app design quality. In contrast, the identified apps largely fell short in providing BPT components adequately and with high interactivity, with low levels of adherence to BPT (mean 20.74%, SD 11%) across all commercial apps evaluated. Commercially popular apps did not show higher levels of adherence to BPT. Overall, a moderate relationship between app design quality and adherence to BPT was found. App features that have been found to increase user engagement, such as gamification and individualization, were only observed in a small minority of apps. Overall, there was a lack of focus on teenage development. Conclusions: Future app developers hoping to increase the dissemination of BPT should aim for free and accessible apps that balance high-quality design features (eg, simple esthetics, interactivity, and individualization) with content consistent with BPT principles. They should also consider key issues that are inconsistently addressed in current apps, including privacy and teenage development. Future app developments will likely benefit from multisector (industry and academic) collaboration throughout the design process and involving end users (ie, parents) during different stages of app development. UR - https://pediatrics.jmir.org/2023/1/e43626 UR - http://dx.doi.org/10.2196/43626 UR - http://www.ncbi.nlm.nih.gov/pubmed/37261886 ID - info:doi/10.2196/43626 ER - TY - JOUR AU - Jackson, M. Hayley AU - Calear, L. Alison AU - Batterham, J. Philip AU - Ohan, L. Jeneva AU - Farmer, M. Glenda AU - Farrer, M. Louise PY - 2023/5/31 TI - Skill Enactment and Knowledge Acquisition in Digital Cognitive Behavioral Therapy for Depression and Anxiety: Systematic Review of Randomized Controlled Trials JO - J Med Internet Res SP - e44673 VL - 25 KW - cognitive behavioral therapy KW - technology KW - engagement KW - skill enactment KW - knowledge acquisition KW - depression KW - anxiety KW - adults KW - young people KW - systematic review KW - mobile phone N2 - Background: Digital cognitive behavioral therapy (CBT) interventions can effectively prevent and treat depression and anxiety, but engagement with these programs is often low. Although extensive research has evaluated program use as a proxy for engagement, the extent to which users acquire knowledge and enact skills from these programs has been largely overlooked. Objective: This study aimed to investigate how skill enactment and knowledge acquisition have been measured, evaluate postintervention changes in skill enactment and knowledge acquisition, examine whether mental health outcomes are associated with skill enactment or knowledge acquisition, and evaluate predictors of skill enactment and knowledge acquisition. Methods: PubMed, PsycINFO, and Cochrane CENTRAL were searched for randomized controlled trials (RCTs) published between January 2000 and July 2022. We included RCTs comparing digital CBT with any comparison group in adolescents or adults (aged ?12 years) for anxiety or depression. Eligible studies reported quantitative measures of skill enactment or knowledge acquisition. The methodological quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs. Narrative synthesis was used to address the review questions. Results: In total, 43 papers were included, of which 29 (67%) reported a skill enactment measure and 15 (35%) reported a knowledge acquisition measure. Skill enactment was typically operationalized as the frequency of enacting skills using the completion of in-program activities (ie, formal skill enactment; 13/29, 45%) and intervention-specific (9/29, 31%) or standardized (8/29, 28%) questionnaires. Knowledge measures included tests of CBT knowledge (6/15, 40%) or mental health literacy (5/15, 33%) and self-report questionnaires (6/15, 40%). In total, 17 studies evaluated postintervention changes in skill enactment or knowledge acquisition, and findings were mostly significant for skill enactment (6/8, 75% of the studies), CBT knowledge (6/6, 100%), and mental health literacy (4/5, 80%). Of the 12 studies that evaluated the association between skill enactment and postintervention mental health outcomes, most reported ?1 significant positive finding on standardized questionnaires (4/4, 100%), formal skill enactment indicators (5/7, 71%), or intervention-specific questionnaires (1/1, 100%). None of the 4 studies that evaluated the association between knowledge acquisition and primary mental health outcomes reported significant results. A total of 13 studies investigated predictors of skill enactment; only type of guidance and improvements in psychological variables were associated with increased skill enactment in ?2 analyses. Predictors of knowledge acquisition were evaluated in 2 studies. Conclusions: Digital CBT for depression and anxiety can improve skill enactment and knowledge acquisition. However, only skill enactment appears to be associated with mental health outcomes, which may depend on the type of measure examined. Additional research is needed to understand what types and levels of skill enactment and knowledge acquisition are most relevant for outcomes and identify predictors of these constructs. Trial Registration: PROSPERO CRD42021275270; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275270 UR - https://www.jmir.org/2023/1/e44673 UR - http://dx.doi.org/10.2196/44673 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256673 ID - info:doi/10.2196/44673 ER - TY - JOUR AU - Shade, Marcia AU - Kovaleva, Mariya AU - Harp, Kimberly AU - Martin-Hammond, Aqueasha PY - 2023/5/31 TI - Older Adults? Pain Outcomes After mHealth Interventions: Scoping Review JO - JMIR Aging SP - e46976 VL - 6 KW - mHealth KW - older adults KW - pain KW - self-management KW - pain management KW - mobile health KW - musculoskeletal pain KW - scoping review KW - pain outcomes KW - mobile phone N2 - Background: Pain is prevalent and poorly managed in older adults. Although pain self-management strategies are helpful, adoption and access are limited; thus, technology provides an opportunity for intervention delivery. Mobile health (mHealth) is feasible to use in older adults; however, we have yet to understand the effect of mHealth pain self-management interventions on pain outcomes in older adults. Objective: The purpose of this scoping review is to examine the characteristics of mHealth interventions and their efficacy on pain outcomes in older adults with musculoskeletal pain. Methods: With the assistance of a medical librarian, keywords and subject headings were generated, including but not limited to mobile health application, mHealth, digital, pain, pain management, and older. A search was conducted for papers in journal databases, including PubMed, Embase, CINAHL, Scopus, and IEEE Xplore, between 2000 and 2022. Papers were screened according to predetermined inclusion and exclusion criteria, and reference lists were reviewed for additional paper inclusion. Three authors appraised the methodology of papers independently, then collaboratively to synthesize the evidence. Results: Six publications were included in the scoping review. The design and methodology ranged widely from pilot studies to a comparative effectiveness trial. Older participants in the studies reported a variety of musculoskeletal conditions. Delivery of the mHealth pain self-management interventions incorporated mobile devices, such as a smartphone or tablet. Most mHealth-delivered interventions were multicomponent and incorporated elements of in-person and telephone access to an interventionist. The findings suggested mHealth interventions may reduce pain intensity; however, pain interference and other pain-related conditions did not have a statistically significant reduction. Conclusions: Research that has explored mHealth for pain self-management is beginning to move beyond feasibility. The few experimental studies conducted in older adults are heterogeneous, and the interventions are mostly multicomponent. It is premature to conclude the interventions? significant effect on pain or pain-related symptoms. As technology continues to integrate into health care, more experimental research is warranted to examine the efficacy of mHealth interventions on a variety of pain outcomes in older adults. UR - https://aging.jmir.org/2023/1/e46976 UR - http://dx.doi.org/10.2196/46976 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256667 ID - info:doi/10.2196/46976 ER - TY - JOUR AU - Hanson, Petra AU - Summers, Charlotte AU - Panesar, Arjun AU - Liarakos, Leonidas Alexandros AU - Oduro-Donkor, Dominic AU - Whyte Oshodi, Danniella AU - Hailston, Luke AU - Randeva, Harpal AU - Menon, Vinod AU - de la Fosse, Michaela AU - Kaura, Amit AU - Shuttlewood, Emma AU - Loveder, Mark AU - Poole, Donna AU - Barber, M. Thomas PY - 2023/5/31 TI - Implementation of a Digital Health Tool for Patients Awaiting Input From a Specialist Weight Management Team: Observational Study JO - JMIR Hum Factors SP - e41256 VL - 10 KW - weight management KW - precision health KW - digital health, hospital KW - secondary care KW - tier 3 weight management KW - National Health Service KW - weight KW - obese KW - obesity KW - focus group KW - perspective KW - opinion KW - attitude KW - behavior change KW - mHealth KW - mobile health KW - health app N2 - Background: Digital tools are increasingly used on a population level as a weight loss strategy for people living with overweight and obesity. Evidence supports the feasibility of digital tools for the management of obesity in a community setting, but there is only emerging evidence for the feasibility of such tools in specialist weight management services. No study has assessed the uptake of digital tools among patients awaiting their first appointment with a specialist weight management service. Objective: The objective of this study was to understand interest, acceptance, and engagement with a digital behavioral change platform to support specialist weight management. Methods: This was an observational study registered as a service innovation. All patients on the waiting list for a first appointment in the tier 3 weight management service at University Hospitals Coventry and Warwickshire National Health Service (NHS) Trust were eligible to access the NHS-approved digital tool. Data on interest and engagement with the digital tool were collected. Routine clinical data were used to describe patient demographics. Focus groups were held to explore patients? views on the use of digital tools as part of a specialist weight management service. Results: A total of 199 patients on the waiting list were informed about the available digital tool. Just over a half (n=102, 51.3%) of patients were interested in using the app, with over one-third (n=68, 34%) of all patients engaging with the app. Overall, a third of patients on the waiting list (n=63, 32%) did not respond to the invite and 34 (17%) of patients expressed no interest in the app. Emotional eating and higher BMI was associated with interest in the Gro Health app. Male gender was associated with reduced engagement with the app. There were no differences in interest in the Gro Health app according to age, ethnicity, metabolic measures of glycemia, and lipid profile. Conclusions: It is feasible to offer digital tools such as Gro Health to patients awaiting their first appointment with specialist weight management services. Future research should explore barriers and facilitators of engagement with digital tools. Additionally, there is a need to further evaluate the effectiveness of such tools in specialist weight management services. UR - https://humanfactors.jmir.org/2023/1/e41256 UR - http://dx.doi.org/10.2196/41256 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256653 ID - info:doi/10.2196/41256 ER - TY - JOUR AU - Leddy, Anna AU - Ggita, Joseph AU - Berger, A. Christopher AU - Kityamuwesi, Alex AU - Sanyu, Nakate Agnes AU - Tinka, Kunihira Lynn AU - Crowder, Rebecca AU - Turyahabwe, Stavia AU - Katamba, Achilles AU - Cattamanchi, Adithya PY - 2023/5/30 TI - Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study JO - J Med Internet Res SP - e38828 VL - 25 KW - digital adherence technology KW - gender norms KW - tuberculosis KW - adherence KW - sub-Saharan Africa N2 - Background: Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is a low-cost digital adherence technology that has emerged as a promising tool for monitoring and supporting TB treatment completion. Objective: We aimed to understand the feasibility and acceptability of 99DOTS, a mobile phone?based TB treatment support method, and characterize barriers and facilitators to its implementation during a pragmatic trial in Uganda. Methods: Between April 1 and August 31, 2021, we conducted in-depth interviews with people with TB and key informant interviews with health workers and district and regional TB officers involved in the implementation of 99DOTS at 18 health facilities in Uganda. Semistructured interview guides were informed by the capability, opportunity, motivation, and behavior (COM-B) model and explored perceptions of, and experiences with, 99DOTS, including barriers and facilitators to its use. Qualitative analysis was conducted using the framework approach. Results: Interviews were conducted with 30 people with TB, 12 health workers, and 7 TB officers. All people with TB, health workers, and TB officers noted that 99DOTS supported and encouraged people with TB to take their anti-TB medication, facilitated treatment monitoring, and improved relationships between people with TB and health workers. Participants also liked that the platform was free, easy to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation for some people with TB were related to limited literacy, including technology literacy; limited access to electricity to charge their mobile phone to make dosing confirmation calls; and poor network connection. Gender differences in 99DOTS uptake also emerged. Specifically, women with TB were described to be more concerned that 99DOTS use would expose them to TB stigma and to be more likely to have mobile phone?access issues than men with TB. By contrast, men with TB not only had access to mobile phones but also received substantial support from their female partners to take their anti-TB medication and make 99DOTS dosing confirmation calls. Finally, although women with TB were described to face more barriers to 99DOTS use than men with TB, the women?s narratives centered on the ways the platform facilitated and improved their adherence, whereas the men?s narratives did not. Conclusions: Overall, 99DOTS seems to be a feasible and acceptable strategy to support anti-TB medication adherence in Uganda. However, access to mobile phones, inability to charge mobile phones, and concerns about stigma should be considered and addressed as part of programmatic implementation to maximize uptake among all people with TB, particularly women and those with fewer financial resources. UR - https://www.jmir.org/2023/1/e38828 UR - http://dx.doi.org/10.2196/38828 UR - http://www.ncbi.nlm.nih.gov/pubmed/37252774 ID - info:doi/10.2196/38828 ER - TY - JOUR AU - Hernandez, Raymond AU - Hoogendoorn, Claire AU - Gonzalez, S. Jeffrey AU - Jin, Haomiao AU - Pyatak, A. Elizabeth AU - Spruijt-Metz, Donna AU - Junghaenel, U. Doerte AU - Lee, Pey-Jiuan AU - Schneider, Stefan PY - 2023/5/30 TI - Reliability and Validity of Noncognitive Ecological Momentary Assessment Survey Response Times as an Indicator of Cognitive Processing Speed in People?s Natural Environment: Intensive Longitudinal Study JO - JMIR Mhealth Uhealth SP - e45203 VL - 11 KW - cognitive performance KW - processing speed KW - ecological momentary assessment KW - ambulatory assessment KW - type 1 diabetes KW - survey response times KW - paradata KW - chronic illness KW - smartphone KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Various populations with chronic conditions are at risk for decreased cognitive performance, making assessment of their cognition important. Formal mobile cognitive assessments measure cognitive performance with greater ecological validity than traditional laboratory-based testing but add to participant task demands. Given that responding to a survey is considered a cognitively demanding task itself, information that is passively collected as a by-product of ecological momentary assessment (EMA) may be a means through which people?s cognitive performance in their natural environment can be estimated when formal ambulatory cognitive assessment is not feasible. We specifically examined whether the item response times (RTs) to EMA questions (eg, mood) can serve as approximations of cognitive processing speed. Objective: This study aims to investigate whether the RTs from noncognitive EMA surveys can serve as approximate indicators of between-person (BP) differences and momentary within-person (WP) variability in cognitive processing speed. Methods: Data from a 2-week EMA study investigating the relationships among glucose, emotion, and functioning in adults with type 1 diabetes were analyzed. Validated mobile cognitive tests assessing processing speed (Symbol Search task) and sustained attention (Go-No Go task) were administered together with noncognitive EMA surveys 5 to 6 times per day via smartphones. Multilevel modeling was used to examine the reliability of EMA RTs, their convergent validity with the Symbol Search task, and their divergent validity with the Go-No Go task. Other tests of the validity of EMA RTs included the examination of their associations with age, depression, fatigue, and the time of day. Results: Overall, in BP analyses, evidence was found supporting the reliability and convergent validity of EMA question RTs from even a single repeatedly administered EMA item as a measure of average processing speed. BP correlations between the Symbol Search task and EMA RTs ranged from 0.43 to 0.58 (P<.001). EMA RTs had significant BP associations with age (P<.001), as expected, but not with depression (P=.20) or average fatigue (P=.18). In WP analyses, the RTs to 16 slider items and all 22 EMA items (including the 16 slider items) had acceptable (>0.70) WP reliability. After correcting for unreliability in multilevel models, EMA RTs from most combinations of items showed moderate WP correlations with the Symbol Search task (ranged from 0.29 to 0.58; P<.001) and demonstrated theoretically expected relationships with momentary fatigue and the time of day. The associations between EMA RTs and the Symbol Search task were greater than those between EMA RTs and the Go-No Go task at both the BP and WP levels, providing evidence of divergent validity. Conclusions: Assessing the RTs to EMA items (eg, mood) may be a method of approximating people?s average levels of and momentary fluctuations in processing speed without adding tasks beyond the survey questions. UR - https://mhealth.jmir.org/2023/1/e45203 UR - http://dx.doi.org/10.2196/45203 UR - http://www.ncbi.nlm.nih.gov/pubmed/37252787 ID - info:doi/10.2196/45203 ER - TY - JOUR AU - Islam, Rezbaul A. B. M. AU - Khan, M. Khalid AU - Scarbrough, Amanda AU - Zimpfer, Jade Mariah AU - Makkena, Navya AU - Omogunwa, Adebola AU - Ahamed, Iqbal Sheikh PY - 2023/5/30 TI - An Artificial Intelligence?Based Smartphone App for Assessing the Risk of Opioid Misuse in Working Populations Using Synthetic Data: Pilot Development Study JO - JMIR Form Res SP - e45434 VL - 7 KW - opioid overused disorder KW - OUD KW - mobile health KW - mHealth KW - artificial intelligence KW - smartphone app KW - opioids KW - application KW - caregivers KW - mobile app N2 - Background: Opioid use disorder (OUD) is an addiction crisis in the United States. As recent as 2019, more than 10 million people have misused or abused prescription opioids, making OUD one of the leading causes of accidental death in the United States. Workforces that are physically demanding and laborious in the transportation, construction and extraction, and health care industries are prime targets for OUD due to high-risk occupational activities. Because of this high prevalence of OUD among working populations in the United States, elevated workers? compensation and health insurance costs, absenteeism, and declined productivity in workplaces have been reported. Objective: With the emergence of new smartphone technologies, health interventions can be widely used outside clinical settings via mobile health tools. The major objective of our pilot study was to develop a smartphone app that can track work-related risk factors leading to OUD with a specific focus on high-risk occupational groups. We used synthetic data analyzed by applying a machine learning algorithm to accomplish our objective. Methods: To make the OUD assessment process more convenient and to motivate potential patients with OUD, we developed a smartphone-based app through a step-by-step process. First, an extensive literature survey was conducted to list a set of critical risk assessment questions that can capture high-risk behaviors leading to OUD. Next, a review panel short-listed 15 questions after careful evaluation with specific emphasis on physically demanding workforces?9 questions had two, 5 questions had five, and 1 question had three response options. Instead of human participant data, synthetic data were used as user responses. Finally, an artificial intelligence algorithm, naive Bayes, was used to predict the OUD risk, trained with the synthetic data collected. Results: The smartphone app we have developed is functional as tested with synthetic data. Using the naive Bayes algorithm on collected synthetic data, we successfully predicted the risk of OUD. This would eventually create a platform to test the functionality of the app further using human participant data. Conclusions: The use of mobile health techniques, such as our mobile app, is highly promising in predicting and offering mitigation plans for disease detection and prevention. Using a naive Bayes algorithm model along with a representational state transfer (REST) application programming interface and cloud-based data encryption storage, respondents can guarantee their privacy and accuracy in estimating their risk. Our app offers a tailored mitigation strategy for specific workforces (eg, transportation and health care workers) that are most impacted by OUD. Despite the limitations of the study, we have developed a robust methodology and believe that our app has the potential to help reduce the opioid crisis. UR - https://formative.jmir.org/2023/1/e45434 UR - http://dx.doi.org/10.2196/45434 UR - http://www.ncbi.nlm.nih.gov/pubmed/37252763 ID - info:doi/10.2196/45434 ER - TY - JOUR AU - Enyioha, Chineme AU - Loufman, M. Larissa AU - Grewe, E. Mary AU - Cené, W. Crystal AU - Khairat, Saif AU - Goldstein, O. Adam AU - Kistler, E. Christine PY - 2023/5/30 TI - Black Smokers? Preferences for Features of a Smoking Cessation App: Qualitative Study JO - JMIR Form Res SP - e43603 VL - 7 KW - mobile health apps KW - smoking cessation KW - Black smokers KW - smoking KW - mobile health KW - intervention KW - application KW - development KW - online research KW - interview KW - functionality KW - social network N2 - Background: Mobile health (mHealth) interventions for smoking cessation have grown extensively over the last few years. Although these interventions improve cessation rates, studies of these interventions consistently lack sufficient Black smokers; hence knowledge of features that make mHealth interventions attractive to Black smokers is limited. Identifying features of mHealth interventions for smoking cessation preferred by Black smokers is critical to developing an intervention that they are likely to use. This may in turn address smoking cessation challenges and barriers to care, which may reduce smoking-related disparities that currently exist. Objective: This study aims to identify features of mHealth interventions that appeal to Black smokers using an evidence-based app developed by the National Cancer Institute, QuitGuide, as a reference. Methods: We recruited Black adult smokers from national web-based research panels with a focus on the Southeastern United States. Participants were asked to download and use QuitGuide for at least a week before participation in remote individual interviews. Participants gave their opinions about features of the QuitGuide app and other mHealth apps they may have used in the past and suggestions for future apps. Results: Of the 18 participants, 78% (n=14) were women, with age ranging from 32 to 65 years. Themes within five major areas relevant for developing a future mHealth smoking cessation app emerged from the individual interviews: (1) content needs including health and financial benefits of quitting, testimonials from individuals who were successful in quitting, and strategies for quitting; (2) format needs such as images, ability to interact with and respond to elements within the app, and links to other helpful resources; (3) functionality including tracking of smoking behavior and symptoms, provision of tailored feedback and reminders to users, and an app that allows for personalization of functions; (4) social network, such as connecting with friends and family through the app, connecting with other users on social media, and connecting with a smoking cessation coach or therapist; and (5) the need for inclusivity for Black individuals, which may be accomplished through the inclusion of smoking-related information and health statistics specific for Black individuals, the inclusion of testimonials from Black celebrities who successfully quit, and the inclusion of cultural relevance in messages contained in the app. Conclusions: Certain features of mHealth interventions for smoking cessation were highly preferred by Black smokers based on their use of a preexisting mHealth app, QuitGuide. Some of these preferences are similar to those already identified by the general population, whereas preferences for increasing the inclusivity of the app are more specific to Black smokers. These findings can serve as the groundwork for a large-scale experiment to evaluate preferences with a larger sample size and can be applied in developing mHealth apps that Black smokers may be more likely to use. UR - https://formative.jmir.org/2023/1/e43603 UR - http://dx.doi.org/10.2196/43603 UR - http://www.ncbi.nlm.nih.gov/pubmed/37252777 ID - info:doi/10.2196/43603 ER - TY - JOUR AU - Shusterman, Sara AU - Villarreal-Calderon, Rodolfo AU - Gunawan, Adrian AU - Gallardo Foreman, Alexis AU - O'Donnell, Charles AU - Wakeman, Cornelia AU - Javeed, Hadi AU - Keteyian, Jacob AU - Howard, Jinesa AU - Bulekova, Katia AU - de Silva, Shalen AU - Campbell, Trevor AU - Lasser, Karen AU - Kathuria, Hasmeena PY - 2023/5/29 TI - A Financial Incentives Program to Promote Smoking Cessation Among Recently Hospitalized Individuals: Feasibility and Acceptability Study JO - JMIR Form Res SP - e44979 VL - 7 KW - financial incentives KW - mobile application KW - smoking cessation KW - tobacco treatment intervention N2 - Background: Hospitalization is an opportunity to engage underserved individuals in tobacco treatment who may not otherwise have access to it. Tobacco treatment interventions that begin during hospitalization and continue for at least 1 postdischarge month are effective in promoting smoking cessation. However, there is low usage of postdischarge tobacco treatment services. Financial incentives for smoking cessation are an intervention in which participants receive incentives, such as cash payments or vouchers for goods, to encourage individuals to stop smoking or to reward individuals for maintaining abstinence. Objective: We sought to determine the feasibility and acceptability of a novel postdischarge financial incentive intervention that uses a smartphone application paired to measurements of exhaled carbon monoxide (CO) concentration levels to promote smoking cessation in individuals who smoke cigarettes. Methods: We collaborated with Vincere Health, Inc. to tailor their mobile application that uses facial recognition features, a portable breath test CO monitor, and smartphone technology to deliver financial incentives to a participant?s digital wallet after the completion of each CO test. The program includes 3 racks. Track 1: Noncontingent incentives for conducting CO tests. Track 2: Combination of noncontingent and contingent incentives for CO levels <10 parts per million (ppm). Track 3: Contingent incentives only for CO levels <10 ppm. After obtaining informed consent, we pilot-tested the program from September to November 2020 with a convenience sample of 33 hospitalized individuals at Boston Medical Center, a large safety-net hospital in New England. Participants received text reminders to conduct CO tests twice daily for 30 days postdischarge. We collected data on engagement, CO levels, and incentives earned. We measured feasibility and acceptability quantitatively and qualitatively at 2 and 4 weeks. Results: Seventy-six percent (25/33) completed the program and 61% (20/33) conducted at least 1 breath test each week. Seven patients had consecutive CO levels <10 ppm during the last 7 days of the program. Engagement with the financial incentive intervention as well as in-treatment abstinence was highest in Track 3 that delivered financial incentives contingent on CO levels <10 ppm. Participants reported high program satisfaction and that the intervention helped motivate smoking cessation. Participants suggested increasing program duration to at least 3 months and adding supplemental text messaging to increase motivation to stop smoking. Conclusions: Financial incentives paired to measurements of exhaled CO concentration levels is a novel smartphone-based tobacco cessation approach that is feasible and acceptable. Future studies should examine the efficacy of the intervention after it is refined to add a counseling or text-messaging component. UR - https://formative.jmir.org/2023/1/e44979 UR - http://dx.doi.org/10.2196/44979 UR - http://www.ncbi.nlm.nih.gov/pubmed/37247216 ID - info:doi/10.2196/44979 ER - TY - JOUR AU - Selder, L. Jasper AU - Te Kolste, Jan Henryk AU - Twisk, Jos AU - Schijven, Marlies AU - Gielen, Willem AU - Allaart, P. Cornelis PY - 2023/5/26 TI - Accuracy of a Standalone Atrial Fibrillation Detection Algorithm Added to a Popular Wristband and Smartwatch: Prospective Diagnostic Accuracy Study JO - J Med Internet Res SP - e44642 VL - 25 KW - smartwatch KW - atrial fibrillation KW - algorithm KW - fibrillation detection KW - wristband KW - diagnose KW - heart rhythm KW - cardioversion KW - environment KW - software algorithm KW - artificial intelligence KW - AI KW - electrocardiography KW - ECG KW - EKG N2 - Background: Silent paroxysmal atrial fibrillation (AF) may be difficult to diagnose, and AF burden is hard to establish. In contrast to conventional diagnostic devices, photoplethysmography (PPG)?driven smartwatches or wristbands allow for long-term continuous heart rhythm assessment. However, most smartwatches lack an integrated PPG-AF algorithm. Adding a standalone PPG-AF algorithm to these wrist devices might open new possibilities for AF screening and burden assessment. Objective: The aim of this study was to assess the accuracy of a well-known standalone PPG-AF detection algorithm added to a popular wristband and smartwatch, with regard to discriminating AF and sinus rhythm, in a group of patients with AF before and after cardioversion (CV). Methods: Consecutive consenting patients with AF admitted for CV in a large academic hospital in Amsterdam, the Netherlands, were asked to wear a Biostrap wristband or Fitbit Ionic smartwatch with Fibricheck algorithm add-on surrounding the procedure. A set of 1-min PPG measurements and 12-lead reference electrocardiograms was obtained before and after CV. Rhythm assessment by the PPG device-software combination was compared with the 12-lead electrocardiogram. Results: A total of 78 patients were included in the Biostrap-Fibricheck cohort (156 measurement sets) and 73 patients in the Fitbit-Fibricheck cohort (143 measurement sets). Of the measurement sets, 19/156 (12%) and 7/143 (5%), respectively, were not classifiable by the PPG algorithm due to bad quality. The diagnostic performance in terms of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy was 98%, 96%, 96%, 99%, 97%, and 97%, 100%, 100%, 97%, and 99%, respectively, at an AF prevalence of ~50%. Conclusions: This study demonstrates that the addition of a well-known standalone PPG-AF detection algorithm to a popular PPG smartwatch and wristband without integrated algorithm yields a high accuracy for the detection of AF, with an acceptable unclassifiable rate, in a semicontrolled environment. UR - https://www.jmir.org/2023/1/e44642 UR - http://dx.doi.org/10.2196/44642 UR - http://www.ncbi.nlm.nih.gov/pubmed/37234033 ID - info:doi/10.2196/44642 ER - TY - JOUR AU - Perkes, Jane Sarah AU - Huntriss, Belinda AU - Skinner, Noelene AU - Leece, Bernise AU - Dobson, Rosie AU - Mattes, Joerg AU - Hall, Kerry AU - Bonevski, Billie PY - 2023/5/26 TI - Evaluation of an mHealth Intervention (Growin? Up Healthy Jarjums) Designed With and for Aboriginal and Torres Strait Islander Mothers: Engagement and Acceptability Study JO - JMIR Pediatr Parent SP - e43673 VL - 6 KW - mobile health KW - mHealth KW - co-design KW - Aboriginal and Torres Strait Islander KW - mother KW - baby KW - young children KW - mobile phone N2 - Background: Aboriginal and Torres Strait Islander women have access to and interest in mobile health (mHealth), although few culturally relevant, evidence-based mHealth programs are available. We codeveloped an mHealth program in New South Wales with Aboriginal and Torres Strait Islander women, focusing on women?s and children's health and well-being. Objective: This study aims to assess the engagement with and acceptability of the Growin? Up Healthy Jarjums program among mothers caring for Aboriginal and Torres Strait Islander children aged <5 years and assess the acceptability of the program among professionals. Methods: Women were given access to Growin? Up Healthy Jarjums?a web-based application, a Facebook (Meta Platforms, Inc) page, and SMS text messages?for 4 weeks. Short videos of health professionals presenting health information were tested within the application and on the Facebook page. Engagement with the application was examined through the number of log-ins, page views, and links used on the application. Engagement with the Facebook page was examined through likes, follows, comments, and the reach of posts. Engagement with the SMS text messages was examined through the number of mothers who opted out, and engagement with the videos was examined through the number of plays and videos watched and duration of the video watched. The acceptability of the program was examined through posttest interviews with mothers and focus groups with professionals. Results: A total of 47 participants joined the study (n=41, 87%, mothers and n=6, 13%, health professionals). Interviews were completed by 78% (32/41) of the women and 100% (6/6) health professionals. Of the 41 mothers, 31 (76%) women accessed the application, 13 (42%) scrolled the main page only, and 18 (58%) clicked on other pages. There were 48 plays and 6 completions of the 12 videos. The Facebook page received 49 page likes and 51 followers. The post with the most reach was a supportive and affirming cultural post. No participants opted out of the SMS text messages. Almost all mothers (30/32, 94%) reported that Growin? Up Healthy Jarjums was useful, and all mothers reported that the program was culturally appropriate and easy to use. Of the 32 mothers, 6 (19%) mothers reported technical problems with accessing the application. Moreover, 44% (14/32) of mothers suggested improvements to the application. All the women reported that they would recommend the program to other families. Conclusions: This study demonstrated that the Growin? Up Healthy Jarjums program was perceived useful and culturally appropriate. SMS text messages had the highest engagement, followed by the Facebook page and then the application. This study identified areas for technical and engagement-related improvements to the application. A trial is needed to assess the effectiveness of the Growin? Up Healthy Jarjums program at improving health outcomes. UR - https://pediatrics.jmir.org/2023/1/e43673 UR - http://dx.doi.org/10.2196/43673 UR - http://www.ncbi.nlm.nih.gov/pubmed/37234043 ID - info:doi/10.2196/43673 ER - TY - JOUR AU - Rhodes, Alexandra AU - Pimprikar, Arya AU - Baum, Alison AU - Smith, D. Andrea AU - Llewellyn, H. Clare PY - 2023/5/26 TI - Using the Person-Based Approach to Develop a Digital Intervention Targeting Diet and Physical Activity in Pregnancy: Development Study JO - JMIR Form Res SP - e44082 VL - 7 KW - digital KW - app KW - dietary KW - physical activity KW - lifestyle KW - pregnancy KW - prenatal KW - person-based approach KW - behavior change habit formation KW - intervention N2 - Background: In pregnancy, eating well, keeping active, and avoiding excessive weight gain are associated with better maternal and fetal health outcomes. Dietary and physical activity (PA) interventions can be effective in changing behaviors and managing weight gain. The comparatively lower cost and greater accessibility of digital interventions make them an attractive alternative to in-person interventions. Baby Buddy is a free pregnancy and parenting app from the charity Best Beginnings. Designed to support parents, improve health outcomes, and reduce inequalities, the app is actively used within the UK National Health Service. It offers an ideal platform for delivering and evaluating a new prenatal dietary and PA intervention. Objective: The aim of this study was to create a theory-based intervention within Baby Buddy to empower, encourage, and support expectant parents to develop healthier dietary and PA habits for pregnancy and parenthood. Methods: The intervention?s development process was guided by the Behavior Change Wheel, with the person-based approach used to create and test its design. Three stages of qualitative research with pregnant and recently pregnant parents guided the intervention design. Study 1 (n=30), comprising 4 web-based focus groups and 12 telephone interviews, gauged response to the rudimentary concept and generated ideas for its development. Results were analyzed thematically. At this stage, the guiding principles for the intervention development were established, and regular team meetings ensured that the intervention design remained aligned with Best Beginnings? objectives, evidence-based approach, and feasibility criteria. Study 2 (n=29), comprising web-based individual and couple interviews, explored design ideas using wireframes and scripts and generated iterative feedback on the intervention content, branding, and tone. A table of changes analysis tracked design amendments. Study 3 (n=19) tested an app prototype using think-aloud interviews with current Baby Buddy users. A patient and public involvement and engagement activity (n=18) and other expert contributors (n=14) provided ad hoc input into the research process and design development. Results: Study 1 confirmed the appeal and relevance of the intervention concept and its novel approach of including partners. The identified themes underpinned the development of the intervention design. Iterative feedback from study 2, in conjunction with patient and public involvement and engagement and expert contributor input, helped refine the intervention design and ensure its relevance and appeal to a diverse target user group. Study 3 highlighted functionality, content, and design issues with the app prototype and identified ways of improving the user experience. Conclusions: This study illustrates the value of combining a theoretical method for intervention development with the person-based approach to create a theory-based intervention that is also user-friendly, appealing, and engaging for its target audience. Further research is needed to evaluate the effectiveness of the intervention in improving diet, PA, and weight management in pregnancy. UR - https://formative.jmir.org/2023/1/e44082 UR - http://dx.doi.org/10.2196/44082 UR - http://www.ncbi.nlm.nih.gov/pubmed/37234026 ID - info:doi/10.2196/44082 ER - TY - JOUR AU - Sullivan, Lindsay AU - McKenzie, B. Lara AU - Roberts, Kristin AU - Recker, Robyn AU - Schwebel, C. David AU - Pommering, Thomas AU - Yang, Jingzhen PY - 2023/5/26 TI - A Virtual Reality App Intervention to Improve Concussion Recognition and Reporting in Athletes Aged 9 to 12 Years: Development and Pilot Testing JO - JMIR Form Res SP - e43015 VL - 7 KW - concussion KW - education KW - sports KW - athlete KW - athletic KW - virtual reality KW - youth KW - child KW - pediatric KW - head injury KW - symptom reporting KW - symptom recognition KW - patient education KW - brain injury KW - user experience KW - user centered design N2 - Background: Existing concussion education programs for preteen athletes typically do not result in sustained improvements in concussion symptom recognition or reporting behaviors. Virtual reality (VR) technology offers an innovative tool that may improve concussion symptom recognition and reporting behaviors among preteen athletes. Objective: We aimed to describe the design and development of a VR concussion education app, Make Play Safe (MPS), and present findings on the usability and preliminary efficacy of MPS in improving concussion recognition and reporting intentions among soccer athletes aged 9-12 years. Methods: A collaborative user-centered design process was implemented to develop and evaluate MPS, a semi-immersive VR concussion education app designed to address two behavioral outcomes in preteen athletes aged 9-12 years: (1) recognizing concussion and (2) reporting concussion. The development of MPS occurred in three phases: (1) design and development, (2) usability testing, and (3) preliminary efficacy testing. During phase 1, consultations were completed with 6 experts. Additionally, 5 interviews with children who had a history of concussion were conducted to collect feedback about the proof of concept of MPS. During phase 2, a participatory workshop with 11 preteen athletes and a small group discussion with 6 parents and 2 coaches were conducted to explore the usefulness and acceptability of MPS from the perspective of end users. Finally, phase 3 included preliminary efficacy testing with 33 soccer athletes aged 9-12 years to examine changes in concussion-related knowledge, attitudes, and reporting intentions from pre- to postintervention. The data generated from each phase of this study informed the development of the final version of the proof of concept of the VR concussion education app, MPS. Results: Experts positively rated the features of MPS and noted that the design and content were innovative and age-appropriate. Preteens with a history of concussion indicated the scenarios and symptoms portrayed in the app represented well what they experienced while concussed. Further, they stated that the app would be an engaging way for children to learn about concussions. The 11 healthy children in the workshop perceived the app positively, noting that the scenarios were informative and engaging. Results from preliminary efficacy testing revealed increases in many athletes? knowledge and reporting intentions from pre- to postintervention. Others demonstrated no significant changes or a decrease in knowledge, attitudes, or reporting intentions from pre- to postintervention. Group-level changes in concussion knowledge and intention to report concussions were statistically significant (P<.05), while changes in attitudes toward reporting concussions were not (P=.08). Conclusions: Results suggest VR technology may be an effective and efficient tool to equip preteen athletes with the requisite knowledge and skills to recognize and report future concussions. Further research is recommended to examine the use of VR as an effective strategy to improve concussion-reporting behaviors in preteen athletes. UR - https://formative.jmir.org/2023/1/e43015 UR - http://dx.doi.org/10.2196/43015 UR - http://www.ncbi.nlm.nih.gov/pubmed/37234027 ID - info:doi/10.2196/43015 ER - TY - JOUR AU - Green, C. Sophie M. AU - French, P. David AU - Hall, H. Louise AU - Bartlett, Kiera Yvonne AU - Rousseau, Nikki AU - Raine, Erin AU - Parbutt, Catherine AU - Gardner, Benjamin AU - AU - Smith, G. Samuel PY - 2023/5/24 TI - Codevelopment of a Text Messaging Intervention to Support Adherence to Adjuvant Endocrine Therapy in Women With Breast Cancer: Mixed Methods Approach JO - J Med Internet Res SP - e38073 VL - 25 KW - breast cancer KW - medication adherence KW - habit formation KW - behavior change techniques KW - SMS text messages KW - intervention development N2 - Background: Adjuvant endocrine therapy (AET) reduces breast cancer recurrence and mortality in women with early-stage breast cancer. Unintentional nonadherence to AET is common (eg, forgetting to take medication). Forming habits surrounding medication taking could reduce reliance on memory and improve AET adherence. SMS text messaging interventions may offer a low-cost approach for promoting medication-taking habits. To optimize the likely effectiveness of such SMS text messages, the content should be developed using a transparent approach to ensure fidelity to relevant psychological theory and with user input to increase acceptability. Objective: This study aimed to develop a pool of brief SMS text messages promoting habit formation to support AET adherence, which are acceptable to women with breast cancer and show fidelity to theory-based behavior change techniques (BCTs). Methods: According to published literature, we selected 6 BCTs derived from the habit formation model: action planning, habit formation, restructuring the physical environment, adding objects to the environment, prompts/cues, and self-monitoring of behavior. In study 1, behavior change experts (n=10) created messages, each based on 1 of the 6 BCTs, in a web-based workshop and rated the fidelity of the messages to the intended BCT. In study 2, women with experience of taking AET discussed the acceptability of the messages in a focus group (n=5), and the messages were refined following this. In study 3, women with breast cancer rated the acceptability of each message in a web-based survey (n=60). In study 4, additional behavior change experts rated the fidelity of the remaining messages to the intended BCT in a web-based survey (n=12). Finally, a consultant pharmacist reviewed a selection of messages to ensure that they did not contradict general medical advice. Results: In study 1, 189 messages were created targeting the 6 BCTs. In total, 92 messages were removed because they were repetitious, unsuitable, or >160 characters, and 3 were removed because of low fidelity (scoring <5.5/10 on a fidelity rating scale). Following study 2, we removed 13 messages considered unacceptable to our target population. In study 3, all remaining messages scored above the midpoint on an acceptability scale (1-5); therefore, no messages were removed (mean 3.9/5, SD 0.9). Following study 4, we removed 13 messages owing to low fidelity (scoring <5.5/10 on a fidelity rating scale). All the remaining messages showed fidelity to the intended BCTs (mean 7.9/10, SD 1.3). Following the pharmacist review, 2 messages were removed, and 3 were amended. Conclusions: We developed a pool of 66 brief SMS text messages targeting habit formation BCTs to support AET adherence. These showed acceptability to women with breast cancer and fidelity to the intended BCTs. The delivery of the messages will be further evaluated to assess their effect on medication adherence. UR - https://www.jmir.org/2023/1/e38073 UR - http://dx.doi.org/10.2196/38073 UR - http://www.ncbi.nlm.nih.gov/pubmed/37223964 ID - info:doi/10.2196/38073 ER - TY - JOUR AU - Kim, Sung Jae AU - Wang, Bohyun AU - Kim, Meelim AU - Lee, Jung AU - Kim, Hyungjun AU - Roh, Danyeul AU - Lee, Hwa Kyung AU - Hong, Soon-Beom AU - Lim, Shik Joon AU - Kim, Jae-Won AU - Ryan, Neal PY - 2023/5/24 TI - Prediction of Diagnosis and Treatment Response in Adolescents With Depression by Using a Smartphone App and Deep Learning Approaches: Usability Study JO - JMIR Form Res SP - e45991 VL - 7 KW - major depressive disorder KW - adolescent KW - deep learning KW - smart health care KW - suicide KW - risk factor KW - antidepressant treatment KW - depression KW - machine learning KW - smartphone KW - mobile health KW - mHealth N2 - Background: Lack of quantifiable biomarkers is a major obstacle in diagnosing and treating depression. In adolescents, increasing suicidality during antidepressant treatment further complicates the problem. Objective: We sought to evaluate digital biomarkers for the diagnosis and treatment response of depression in adolescents through a newly developed smartphone app. Methods: We developed the Smart Healthcare System for Teens At Risk for Depression and Suicide app for Android-based smartphones. This app passively collected data reflecting the social and behavioral activities of adolescents, such as their smartphone usage time, physical movement distance, and the number of phone calls and text messages during the study period. Our study consisted of 24 adolescents (mean age 15.4 [SD 1.4] years, 17 girls) with major depressive disorder (MDD) diagnosed with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and 10 healthy controls (mean age 13.8 [SD 0.6] years, 5 girls). After 1 week?s baseline data collection, adolescents with MDD were treated with escitalopram in an 8-week, open-label trial. Participants were monitored for 5 weeks, including the baseline data collection period. Their psychiatric status was measured every week. Depression severity was measured using the Children?s Depression Rating Scale-Revised and Clinical Global Impressions-Severity. The Columbia Suicide Severity Rating Scale was administered in order to assess suicide severity. We applied the deep learning approach for the analysis of the data. Deep neural network was employed for diagnosis classification, and neural network with weighted fuzzy membership functions was used for feature selection. Results: We could predict the diagnosis of depression with training accuracy of 96.3% and 3-fold validation accuracy of 77%. Of the 24 adolescents with MDD, 10 responded to antidepressant treatments. We predicted the treatment response of adolescents with MDD with training accuracy of 94.2% and 3-fold validation accuracy of 76%. Adolescents with MDD tended to move longer distances and use smartphones for longer periods of time compared to controls. The deep learning analysis showed that smartphone usage time was the most important feature in distinguishing adolescents with MDD from controls. Prominent differences were not observed in the pattern of each feature between the treatment responders and nonresponders. The deep learning analysis revealed that the total length of calls received as the most important feature predicting antidepressant response in adolescents with MDD. Conclusions: Our smartphone app demonstrated preliminary evidence of predicting diagnosis and treatment response in depressed adolescents. This is the first study to predict the treatment response of adolescents with MDD by examining smartphone-based objective data with deep learning approaches. UR - https://formative.jmir.org/2023/1/e45991 UR - http://dx.doi.org/10.2196/45991 UR - http://www.ncbi.nlm.nih.gov/pubmed/37223978 ID - info:doi/10.2196/45991 ER - TY - JOUR AU - Blazey, Meghan AU - Marinac, Catherine AU - Whiteley, Jessica AU - Peterson, Sarah AU - Burns White, Karen AU - Jacques, Cathyanah AU - Lam, Helen AU - Halpenny, Barbara AU - Patel, Shree AU - Lamothe, Raymond AU - Wright, Julie PY - 2023/5/24 TI - Designing a Dyad-Based Digital Health Intervention to Reduce Sedentary Time in Black Breast Cancer Survivors and Their First-degree Relatives: Human-Centered Design Study JO - JMIR Form Res SP - e43592 VL - 7 KW - sedentary behavior KW - digital health KW - dyad-based intervention KW - breast cancer risk KW - breast cancer survivor KW - social support KW - mobile phone N2 - Background: Breast cancer, the most commonly diagnosed cancer and second leading cause of cancer-related death in women in the United States, disproportionately affects women from minoritized or low socioeconomic backgrounds. The average woman has an approximately 12% lifetime risk of developing breast cancer. Lifetime risk nearly doubles if a woman has a first-degree relative with breast cancer, and the risk increases as multiple family members are affected. Decreasing sedentary behaviors through moving more and sitting less reduces breast cancer risk and improves outcomes for cancer survivors and healthy adults. Digital health solutions, such as mobile apps that are culturally appropriate, designed with input from the target audience, and include social support, are effective at improving health behaviors. Objective: This study aimed to develop and evaluate the usability and acceptability of a prototype app designed with a human-centered approach to promote moving more and sitting less in Black breast cancer survivors and their first-degree relatives (parent, child, or sibling). Methods: This 3-phase study consisted of app development, user testing, and evaluation of user engagement and usability. Key community stakeholders were engaged in the first 2 (qualitative) phases to provide input into developing the prototype app (MoveTogether). After development and user testing, a usability pilot was conducted. Participants were adult breast cancer survivors who identified as Black and agreed to participate with a relative. Participants used the app and a step-tracking watch for 4 weeks. App components included goal setting and reporting, reminders, dyad messaging, and educational resources. Usability and acceptability were assessed with a questionnaire that included the System Usability Scale (SUS) and semistructured interviews. Data were analyzed with descriptive statistics and content analysis. Results: Participants in the usability pilot (n=10) were aged 30 to 50 years (6/10, 60%), not married (8/10, 80%), and college graduates (5/10, 50%). The app was used on average 20.2 (SD 8.9) out of 28 days?SUS score of 72 (range 55-95)?and 70% (7/10) agreed that the app was acceptable, helpful, and gave them new ideas. Additionally, 90% (9/10) found the dyad component helpful and would recommend the app to friends. Qualitative findings suggest that the goal-setting feature was helpful and that the dyad partner (buddy) provided accountability. Participants were neutral regarding the cultural appropriateness of the app. Conclusions: The MoveTogether app and related components were acceptable for promoting moving more in dyads of breast cancer survivors and their first-degree relatives. The human-centered approach, which involved engaging community members in the development, is a model for future technology development work. Future work should be done to further develop the intervention based on the findings and then test its efficacy to improve sedentary behavior while considering culturally informed strategies for adoption and implementation within the community. Trial Registration: ClinicalTrials.gov NCT05011279; https://clinicaltrials.gov/ct2/show/NCT05011279 UR - https://formative.jmir.org/2023/1/e43592 UR - http://dx.doi.org/10.2196/43592 UR - http://www.ncbi.nlm.nih.gov/pubmed/37223968 ID - info:doi/10.2196/43592 ER - TY - JOUR AU - Tuena, Cosimo AU - Borghesi, Francesca AU - Bruni, Francesca AU - Cavedoni, Silvia AU - Maestri, Sara AU - Riva, Giuseppe AU - Tettamanti, Mauro AU - Liperoti, Rosa AU - Rossi, Lorena AU - Ferrarin, Maurizio AU - Stramba-Badiale, Marco PY - 2023/5/22 TI - Technology-Assisted Cognitive Motor Dual-Task Rehabilitation in Chronic Age-Related Conditions: Systematic Review JO - J Med Internet Res SP - e44484 VL - 25 KW - dementia KW - Parkinson disease KW - falls KW - virtual reality KW - dual-task KW - aging KW - rehabilitation N2 - Background: Cognitive-motor dual-task (CMDT) is defined as the parallel processing of motor (eg, gait) and cognitive (eg, executive functions) activities and is an essential ability in daily life. Older adults living with frailty, chronic conditions (eg, neurodegenerative diseases), or multimorbidity pay high costs during CMDT. This can have serious consequences on the health and safety of older adults with chronic age-related conditions. However, CMDT rehabilitation can provide useful and effective therapies for these patients, particularly if delivered through technological devices. Objective: This review aims to describe the current technological applications, CMDT rehabilitative procedures, target populations, condition assessment, and efficacy and effectiveness of technology-assisted CMDT rehabilitation in chronic age-related conditions. Methods: We performed this systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, on 3 databases (Web of Science, Embase, and PubMed). Original articles that were published in English; involved older adults (>65 years) with ?1 chronic condition and/or frailty; and tested, with a clinical trial, a technology-assisted CMDT rehabilitation against a control condition were included. Risk of bias (Cochrane tool) and the RITES (Rating of Included Trials on the Efficacy-Effectiveness Spectrum) tool were used to evaluate the included studies. Results: A total of 1097 papers were screened, and 8 (0.73%) studies met the predefined inclusion criteria for this review. The target conditions for technology-assisted CMDT rehabilitation included Parkinson disease and dementia. However, little information regarding multimorbidity, chronicity, or frailty status is available. The primary outcomes included falls, balance, gait parameters, dual-task performance, and executive functions and attention. CMDT technology mainly consists of a motion-tracking system combined with virtual reality. CMDT rehabilitation involves different types of tasks (eg, obstacle negotiation and CMDT exercises). Compared with control conditions, CMDT training was found to be pleasant, safe, and effective particularly for dual-task performances, falls, gait, and cognition, and the effects were maintained at midterm follow-up. Conclusions: Despite further research being mandatory, technology-assisted CMDT rehabilitation is a promising method to enhance motor-cognitive functions in older adults with chronic conditions. UR - https://www.jmir.org/2023/1/e44484 UR - http://dx.doi.org/10.2196/44484 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213200 ID - info:doi/10.2196/44484 ER - TY - JOUR AU - Haque, Romael M. D. AU - Rubya, Sabirat PY - 2023/5/22 TI - An Overview of Chatbot-Based Mobile Mental Health Apps: Insights From App Description and User Reviews JO - JMIR Mhealth Uhealth SP - e44838 VL - 11 KW - chatbot KW - mobile mental health apps KW - consumer reviews KW - health care app KW - mental health app KW - app development KW - user experience KW - mHealth intervention KW - mobile health N2 - Background: Chatbots are an emerging technology that show potential for mental health care apps to enable effective and practical evidence-based therapies. As this technology is still relatively new, little is known about recently developed apps and their characteristics and effectiveness. Objective: In this study, we aimed to provide an overview of the commercially available popular mental health chatbots and how they are perceived by users. Methods: We conducted an exploratory observation of 10 apps that offer support and treatment for a variety of mental health concerns with a built-in chatbot feature and qualitatively analyzed 3621 consumer reviews from the Google Play Store and 2624 consumer reviews from the Apple App Store. Results: We found that although chatbots? personalized, humanlike interactions were positively received by users, improper responses and assumptions about the personalities of users led to a loss of interest. As chatbots are always accessible and convenient, users can become overly attached to them and prefer them over interacting with friends and family. Furthermore, a chatbot may offer crisis care whenever the user needs it because of its 24/7 availability, but even recently developed chatbots lack the understanding of properly identifying a crisis. Chatbots considered in this study fostered a judgment-free environment and helped users feel more comfortable sharing sensitive information. Conclusions: Our findings suggest that chatbots have great potential to offer social and psychological support in situations where real-world human interaction, such as connecting to friends or family members or seeking professional support, is not preferred or possible to achieve. However, there are several restrictions and limitations that these chatbots must establish according to the level of service they offer. Too much reliance on technology can pose risks, such as isolation and insufficient assistance during times of crisis. Recommendations for customization and balanced persuasion to inform the design of effective chatbots for mental health support have been outlined based on the insights of our findings. UR - https://mhealth.jmir.org/2023/1/e44838 UR - http://dx.doi.org/10.2196/44838 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213181 ID - info:doi/10.2196/44838 ER - TY - JOUR AU - Leong, Utek AU - Chakraborty, Bibhas PY - 2023/5/22 TI - Participant Engagement in Microrandomized Trials of mHealth Interventions: Scoping Review JO - JMIR Mhealth Uhealth SP - e44685 VL - 11 KW - microrandomized trials KW - engagement KW - adherence KW - mobile health KW - mHealth interventions KW - mobile phone N2 - Background: Microrandomized trials (MRTs) have emerged as the gold standard for the development and evaluation of multicomponent, adaptive mobile health (mHealth) interventions. However, not much is known about the state of participant engagement measurement in MRTs of mHealth interventions. Objective: In this scoping review, we aimed to quantify the proportion of existing or planned MRTs of mHealth interventions to date that have assessed (or have planned to assess) engagement. In addition, for the trials that have explicitly assessed (or have planned to assess) engagement, we aimed to investigate how engagement has been operationalized and to identify the factors that have been studied as determinants of engagement in MRTs of mHealth interventions. Methods: We conducted a broad search for MRTs of mHealth interventions in 5 databases and manually searched preprint servers and trial registries. Study characteristics of each included evidence source were extracted. We coded and categorized these data to identify how engagement has been operationalized and which determinants, moderators, and covariates have been assessed in existing MRTs. Results: Our database and manual search yielded 22 eligible evidence sources. Most of these studies (14/22, 64%) were designed to evaluate the effects of intervention components. The median sample size of the included MRTs was 110.5. At least 1 explicit measure of engagement was included in 91% (20/22) of the included MRTs. We found that objective measures such as system usage data (16/20, 80%) and sensor data (7/20, 35%) are the most common methods of measuring engagement. All studies included at least 1 measure of the physical facet of engagement, but the affective and cognitive facets of engagement have largely been neglected (only measured by 1 study each). Most studies measured engagement with the mHealth intervention (Little e) and not with the health behavior of interest (Big E). Only 6 (30%) of the 20 studies that measured engagement assessed the determinants of engagement in MRTs of mHealth interventions; notification-related variables were the most common determinants of engagement assessed (4/6, 67% studies). Of the 6 studies, 3 (50%) examined the moderators of participant engagement?2 studies investigated time-related moderators exclusively, and 1 study planned to investigate a comprehensive set of physiological and psychosocial moderators in addition to time-related moderators. Conclusions: Although the measurement of participant engagement in MRTs of mHealth interventions is prevalent, there is a need for future trials to diversify the measurement of engagement. There is also a need for researchers to address the lack of attention to how engagement is determined and moderated. We hope that by mapping the state of engagement measurement in existing MRTs of mHealth interventions, this review will encourage researchers to pay more attention to these issues when planning for engagement measurement in future trials. UR - https://mhealth.jmir.org/2023/1/e44685 UR - http://dx.doi.org/10.2196/44685 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213178 ID - info:doi/10.2196/44685 ER - TY - JOUR AU - Xiang, Tao AU - Zhang, Yong Pei AU - Zhuo, Ying Guang AU - Dai, Hang PY - 2023/5/22 TI - Contribution of the 5G Smart First-Aid Care Platform to Achieving High-Quality Prehospital Care JO - J Med Internet Res SP - e43374 VL - 25 KW - fifth generation KW - 5G KW - prehospital first-aid care KW - smart medical care KW - telemedicine UR - https://www.jmir.org/2023/1/e43374 UR - http://dx.doi.org/10.2196/43374 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213169 ID - info:doi/10.2196/43374 ER - TY - JOUR AU - Sanders, P. James AU - Gokal, Kajal AU - Thomas, C. Jonah J. AU - Rawstorn, C. Jonathan AU - Sherar, B. Lauren AU - Maddison, Ralph AU - Greaves, J. Colin AU - Esliger, Dale AU - Daley, J. Amanda AU - PY - 2023/5/22 TI - Development of a Mobile Health Snacktivity App to Promote Physical Activity in Inactive Adults (SnackApp): Intervention Mapping and User Testing Study JO - JMIR Form Res SP - e41114 VL - 7 KW - intervention development KW - physical activity KW - mobile health KW - mHealth KW - health app KW - user testing KW - intervention KW - behavior KW - smartphone KW - app KW - social KW - user KW - engagement KW - development KW - testing KW - mobile phone N2 - Background: Despite the unequivocal evidence demonstrating the benefits of being physically active, many people do not meet the recommended guidelines of at least 150 minutes of moderate- to vigorous-intensity physical activity per week. This can be changed with the development and implementation of innovative interventions. The use of mobile health (mHealth) technologies has been suggested as a mechanism to offer people innovative health behavior change interventions. Objective: This study aims to outline the systematic, theory-driven processes and user testing applied to the development of a smartphone-based physical activity app (SnackApp) to promote participation in a novel physical activity intervention called Snacktivity. The acceptability of the app was explored and reported. Methods: Intervention mapping involves a 6-step process, the first 4 of which were presented in this study. These steps were used to develop the SnackApp for use within the Snacktivity intervention. The first step involved a needs assessment, which included composing an expert planning group, patient and public involvement group, and gathering the views of the public on Snacktivity and the public perception of the use of wearable technology to support Snacktivity. This first step aimed to determine the overall purpose of the Snacktivity intervention. Steps 2 to 4 involved determining the intervention objectives, the behavior change theory and techniques on which the intervention is based, and the development of the intervention resources (ie, SnackApp). After the completion of steps 1 to 3 of the intervention mapping process, the SnackApp was developed and linked to a commercial physical activity tracker (Fitbit Versa Lite) for the automated capture of physical activity. SnackApp includes provisions for goal setting, activity planning, and social support. Stage 4 involved users (inactive adults, N=15) testing the SnackApp for 28 days. App engagement (mobile app use analytics) was analyzed to determine app use and to inform the further development of SnackApp. Results: Over the study period (step 4), participants engaged with SnackApp an average of 77 (SD 80) times. On average, participants used the SnackApp for 12.6 (SD 47) minutes per week, with most of the time spent on the SnackApp dashboard and engaging, on average, 14 (SD 12.1) times, lasting 7 to 8 minutes per week. Overall, male participants used the SnackApp more than female participants did. The app rating score was 3.5 (SD 0.6) out of 5, suggesting that SnackApp was rated as fair to good. Conclusions: This study outlines and reports data regarding the development of an innovative mHealth app using a systematic, theory-driven framework. This approach can guide the development of future mHealth programs. User testing of the SnackApp suggested that physically inactive adults will engage with the SnackApp, indicating its applicability of use in the Snacktivity physical activity intervention. UR - https://formative.jmir.org/2023/1/e41114 UR - http://dx.doi.org/10.2196/41114 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213198 ID - info:doi/10.2196/41114 ER - TY - JOUR AU - Haricharan, Jensen Hanne AU - Hacking, Damian AU - Lau, Kwan Yan AU - Heap, Marion PY - 2023/5/22 TI - Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging?Based Information Campaign: Mixed Methods Study JO - JMIR Pediatr Parent SP - e40561 VL - 6 KW - SMS text messages KW - cell phones KW - mobile health KW - mHealth KW - health information KW - health literacy KW - healthy behavior KW - maternal health KW - antenatal care KW - Deaf KW - South Africa N2 - Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging?based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants? knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging?based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women?s knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people?s health knowledge. However, attention should be paid to Deaf participants? specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe UR - https://pediatrics.jmir.org/2023/1/e40561 UR - http://dx.doi.org/10.2196/40561 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213174 ID - info:doi/10.2196/40561 ER - TY - JOUR AU - Concheiro-Moscoso, Patricia AU - Groba, Betania AU - Alvarez-Estevez, Diego AU - Miranda-Duro, Carmen María del AU - Pousada, Thais AU - Nieto-Riveiro, Laura AU - Mejuto-Muiño, Javier Francisco AU - Pereira, Javier PY - 2023/5/19 TI - Quality of Sleep Data Validation From the Xiaomi Mi Band 5 Against Polysomnography: Comparison Study JO - J Med Internet Res SP - e42073 VL - 25 KW - sleep KW - health promotion KW - occupation KW - polysomnography KW - Xiaomi Mi Band 5 KW - Internet of Things N2 - Background: Polysomnography is the gold standard for measuring and detecting sleep patterns. In recent years, activity wristbands have become popular because they record continuous data in real time. Hence, comprehensive validation studies are needed to analyze the performance and reliability of these devices in the recording of sleep parameters. Objective: This study compared the performance of one of the best-selling activity wristbands, the Xiaomi Mi Band 5, against polysomnography in measuring sleep stages. Methods: This study was carried out at a hospital in A Coruña, Spain. People who were participating in a polysomnography study at a sleep unit were recruited to wear a Xiaomi Mi Band 5 simultaneously for 1 night. The total sample consisted of 45 adults, 25 (56%) with sleep disorders (SDis) and 20 (44%) without SDis. Results: Overall, the Xiaomi Mi Band 5 displayed 78% accuracy, 89% sensitivity, 35% specificity, and a Cohen ? value of 0.22. It significantly overestimated polysomnography total sleep time (P=.09), light sleep (N1+N2 stages of non?rapid eye movement [REM] sleep; P=.005), and deep sleep (N3 stage of non-REM sleep; P=.01). In addition, it underestimated polysomnography wake after sleep onset and REM sleep. Moreover, the Xiaomi Mi Band 5 performed better in people without sleep problems than in those with sleep problems, specifically in detecting total sleep time and deep sleep. Conclusions: The Xiaomi Mi Band 5 can be potentially used to monitor sleep and to detect changes in sleep patterns, especially for people without sleep problems. However, additional studies are necessary with this activity wristband in people with different types of SDis. Trial Registration: ClinicalTrials.gov NCT04568408; https://clinicaltrials.gov/ct2/show/NCT04568408 International Registered Report Identifier (IRRID): RR2-10.3390/ijerph18031106 UR - https://www.jmir.org/2023/1/e42073 UR - http://dx.doi.org/10.2196/42073 UR - http://www.ncbi.nlm.nih.gov/pubmed/37204853 ID - info:doi/10.2196/42073 ER - TY - JOUR AU - Bolz, Janika AU - Löscher, Adrian AU - Muhl, Rainer AU - Badke, Andreas AU - Predel, Hans-Georg AU - Perret, Claudio PY - 2023/5/19 TI - Feasibility, Usability, and Safety of ParaGym, an Intelligent Mobile Exercise App for Individuals With Paraplegia: Protocol for a Pilot Block-Randomized Controlled Trial JO - JMIR Res Protoc SP - e45652 VL - 12 KW - spinal cord injury KW - mixed methods KW - exercise KW - fitness KW - home-based KW - algorithm KW - personalization KW - prototype KW - telemedicine KW - digital KW - mobile app KW - mobile phone N2 - Background: Exercise is crucial for individuals with paraplegia to reduce the risk of secondary diseases and improve independence and quality of life. However, numerous barriers such as inadequate accessibility restrict their participation in exercise programs. Digital exercise apps can help overcome these barriers. Personalization is considered a crucial feature of mobile exercise apps, as people with paraplegia have individual requirements regarding exercise programs depending on their level of impairment. Despite the increasing popularity of mobile exercise apps, there are none available that target the individual needs of this cohort. The ParaGym mobile exercise app prototype was designed to automatically tailor exercise sessions to the individual needs of users with paraplegia. Objective: This study aims to evaluate the feasibility, usability, safety, and preliminary effectiveness of the ParaGym mobile exercise app prototype. Methods: This pilot block-randomized controlled feasibility trial will include 45 adult participants with paraplegia. Eligible participants will be block randomized to either the intervention or waitlist control group. The intervention group will perform a 6-week exercise program using the ParaGym mobile exercise app, comprising three 35-minute exercise sessions per week. The waitlist control group will continue their usual care and receive access to the app after study completion. Participants will record all exercise sessions conducted with the app as well as additional exercise sessions conducted during the study period using exercise diaries. The primary outcomes include feasibility, usability, and safety. Feasibility will be assessed through semistructured interviews, study adherence, and retention rates. Usability will be measured using the System Usability Scale. Safety will be determined by the occurrence of adverse events. Secondary outcomes include the effects of the intervention on peak exercise capacity (VO2 peak); handgrip strength; independence, which will be measured using the Spinal Cord Independence Measure III (SCIM III); and health-related quality of life, which will be measured using the Short Form?36 Health Survey (SF-36). Results: Recruitment commenced in November 2022. Overall, 12 participants were enrolled at the time of submission. Data collection commenced in January 2023, with completion expected in April 2023. Conclusions: To the best of our knowledge, this is the first study to assess the feasibility, usability, and safety of an intelligent mobile exercise app for individuals with paraplegia. Thereafter, the app should be adapted according to the findings of this trial. Future trials with an updated version of the app should aim for a larger sample size, longer intervention duration, and more diverse target group. In the long term, a fully marketable version of the ParaGym app should be implemented. This would increase the access to personalized, independent, and evidence-based exercise training for this cohort and, in the future, other people who use wheelchairs. Trial Registration: German Clinical Trials Register DRKS00030370; https://drks.de/search/de/trial/DRKS00030370 International Registered Report Identifier (IRRID): DERR1-10.2196/45652 UR - https://www.researchprotocols.org/2023/1/e45652 UR - http://dx.doi.org/10.2196/45652 UR - http://www.ncbi.nlm.nih.gov/pubmed/37204855 ID - info:doi/10.2196/45652 ER - TY - JOUR AU - Mc Ardle, Ríona AU - Jabbar, Abdul Khalid AU - Del Din, Silvia AU - Thomas, J. Alan AU - Robinson, Louise AU - Kerse, Ngaire AU - Rochester, Lynn AU - Callisaya, Michele PY - 2023/5/18 TI - Using Digital Technology to Quantify Habitual Physical Activity in Community Dwellers With Cognitive Impairment: Systematic Review JO - J Med Internet Res SP - e44352 VL - 25 KW - dementia KW - cognitive dysfunction KW - physical activity KW - digital technology KW - wearable electronic devices KW - remote sensing technology KW - systematic review KW - community KW - wearables KW - cognitive impairment KW - support KW - clinicians KW - sensing N2 - Background: Participating in habitual physical activity (HPA) can support people with dementia and mild cognitive impairment (MCI) to maintain functional independence. Digital technology can continuously measure HPA objectively, capturing nuanced measures relating to its volume, intensity, pattern, and variability. Objective: To understand HPA participation in people with cognitive impairment, this systematic review aims to (1) identify digital methods and protocols; (2) identify metrics used to assess HPA; (3) describe differences in HPA between people with dementia, MCI, and controls; and (4) make recommendations for measuring and reporting HPA in people with cognitive impairment. Methods: Key search terms were input into 6 databases: Scopus, Web of Science, Psych Articles, PsychInfo, MEDLINE, and Embase. Articles were included if they included community dwellers with dementia or MCI, reported HPA metrics derived from digital technology, were published in English, and were peer reviewed. Articles were excluded if they considered populations without dementia or MCI diagnoses, were based in aged care settings, did not concern digitally derived HPA metrics, or were only concerned with physical activity interventions. Key outcomes extracted included the methods and metrics used to assess HPA and differences in HPA outcomes across the cognitive spectrum. Data were synthesized narratively. An adapted version of the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was used to assess the quality of articles. Due to significant heterogeneity, a meta-analysis was not feasible. Results: A total of 3394 titles were identified, with 33 articles included following the systematic review. The quality assessment suggested that studies were moderate-to-good quality. Accelerometers worn on the wrist or lower back were the most prevalent methods, while metrics relating to volume (eg, daily steps) were most common for measuring HPA. People with dementia had lower volumes, intensities, and variability with different daytime patterns of HPA than controls. Findings in people with MCI varied, but they demonstrated different patterns of HPA compared to controls. Conclusions: This review highlights limitations in the current literature, including lack of standardization in methods, protocols, and metrics; limited information on validity and acceptability of methods; lack of longitudinal research; and limited associations between HPA metrics and clinically meaningful outcomes. Limitations of this review include the exclusion of functional physical activity metrics (eg, sitting/standing) and non-English articles. Recommendations from this review include suggestions for measuring and reporting HPA in people with cognitive impairment and for future research including validation of methods, development of a core set of clinically meaningful HPA outcomes, and further investigation of socioecological factors that may influence HPA participation. Trial Registration: PROSPERO CRD42020216744; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216744? UR - https://www.jmir.org/2023/1/e44352 UR - http://dx.doi.org/10.2196/44352 UR - http://www.ncbi.nlm.nih.gov/pubmed/37200065 ID - info:doi/10.2196/44352 ER - TY - JOUR AU - Yau, W. Kiana AU - Tang, S. Tricia AU - Görges, Matthias AU - Pinkney, Susan AU - Amed, Shazhan PY - 2023/5/17 TI - Using Human-Centered Design and Cocreation to Create the Live 5-2-1-0 Mobile App to Promote Healthy Behaviors in Children: App Design and Development JO - JMIR Pediatr Parent SP - e44792 VL - 6 KW - childhood obesity KW - mobile health KW - health behaviors KW - prevention KW - mobile health app KW - mHealth app KW - human-centered design KW - cocreation KW - participatory approach KW - mobile phone N2 - Background: The prevalence of obesity among Canadian children is rising, partly because of increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multisectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message of consuming ?5 servings of vegetables and fruits, having <2 hours of recreational screen time, participating in ?1 hour of active play, and consuming 0 sugary drinks every day. A Live 5-2-1-0 Toolkit for health care providers (HCPs) was previously developed and piloted in 2 pediatric clinics at British Columbia Children?s Hospital. Objective: This study aimed to co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs. Methods: Three focus groups (FGs) were conducted using human-centered design and participatory approaches. In FG 1, children (separately) and parents and HCPs (together) participated in sessions on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG 1 in an ideation session, and key themes were subsequently presented separately to parents, children, and HCPs in FG-2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG 3, provided feedback on usability and content, and completed questionnaires. Thematic analysis and descriptive statistics were used for the qualitative and quantitative data, respectively. Results: In total, 14 children (mean age 10.2, SD 1.3 years; 5/14, 36% male; 5/14, 36% White), 12 parents (9/12, 75% aged 40-49 years; 2/12, 17% male; 7/12, 58% White), and 18 HCPs participated; most parents and children (20/26, 77%) participated in ?2 FGs. Parents wanted an app that empowered children to adopt healthy behaviors using internal motivation and accountability, whereas children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted baseline behavior assessments and to track users? behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median score of 7 (IQR 6-7) on a 7-point Likert scale (1=very difficult; 7=very easy). Children liked most suggested rewards (28/37, 76%) and found 79% (76/96) of suggested daily challenges (healthy behavior activities that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users? interest and content that further motivates healthy behavior change. Conclusions: Co-creating a mobile health app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision-making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 app. UR - https://pediatrics.jmir.org/2023/1/e44792 UR - http://dx.doi.org/10.2196/44792 UR - http://www.ncbi.nlm.nih.gov/pubmed/37195754 ID - info:doi/10.2196/44792 ER - TY - JOUR AU - Chikwetu, Lucy AU - Daily, Shaundra AU - Mortazavi, J. Bobak AU - Dunn, Jessilyn PY - 2023/5/16 TI - Automated Diet Capture Using Voice Alerts and Speech Recognition on Smartphones: Pilot Usability and Acceptability Study JO - JMIR Form Res SP - e46659 VL - 7 KW - automatic dietary monitoring KW - ADM KW - food logging KW - diet logging KW - voice technologies KW - voice alert KW - speech recognition KW - natural language processing KW - NLP N2 - Background: Effective monitoring of dietary habits is critical for promoting healthy lifestyles and preventing or delaying the onset and progression of diet-related diseases, such as type 2 diabetes. Recent advances in speech recognition technologies and natural language processing present new possibilities for automated diet capture; however, further exploration is necessary to assess the usability and acceptability of such technologies for diet logging. Objective: This study explores the usability and acceptability of speech recognition technologies and natural language processing for automated diet logging. Methods: We designed and developed base2Diet?an iOS smartphone application that prompts users to log their food intake using voice or text. To compare the effectiveness of the 2 diet logging modes, we conducted a 28-day pilot study with 2 arms and 2 phases. A total of 18 participants were included in the study, with 9 participants in each arm (text: n=9, voice: n=9). During phase I of the study, all 18 participants received reminders for breakfast, lunch, and dinner at preselected times. At the beginning of phase II, all participants were given the option to choose 3 times during the day to receive 3 times daily reminders to log their food intake for the remainder of the phase, with the ability to modify the selected times at any point before the end of the study. Results: The total number of distinct diet logging events per participant was 1.7 times higher in the voice arm than in the text arm (P=.03, unpaired t test). Similarly, the total number of active days per participant was 1.5 times higher in the voice arm than in the text arm (P=.04, unpaired t test). Furthermore, the text arm had a higher attrition rate than the voice arm, with only 1 participant dropping out of the study in the voice arm, while 5 participants dropped out in the text arm. Conclusions: The results of this pilot study demonstrate the potential of voice technologies in automated diet capturing using smartphones. Our findings suggest that voice-based diet logging is more effective and better received by users compared to traditional text-based methods, underscoring the need for further research in this area. These insights carry significant implications for the development of more effective and accessible tools for monitoring dietary habits and promoting healthy lifestyle choices. UR - https://formative.jmir.org/2023/1/e46659 UR - http://dx.doi.org/10.2196/46659 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191989 ID - info:doi/10.2196/46659 ER - TY - JOUR AU - Zhao, Xin AU - Stadnick, A. Nicole AU - Ceballos-Corro, Eduardo AU - Castro Jr, Jorge AU - Mallard-Swanson, Kera AU - Palomares, J. Kristina AU - Eikey, Elizabeth AU - Schneider, Margaret AU - Zheng, Kai AU - Mukamel, B. Dana AU - Schueller, M. Stephen AU - Sorkin, H. Dara PY - 2023/5/16 TI - Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses JO - JMIR Form Res SP - e45718 VL - 7 KW - digital mental health KW - mobile health KW - mHealth KW - implementation readiness KW - implementation science KW - qualitative analyses KW - mobile phone N2 - Background: Digital mental health interventions (DMHIs) represent a promising solution to address the growing unmet mental health needs and increase access to care. Integrating DMHIs into clinical and community settings is challenging and complex. Frameworks that explore a wide range of factors, such as the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, can be useful for examining multilevel factors related to DMHI implementation efforts. Objective: This paper aimed to identify the barriers to, facilitators of, and best practice recommendations for implementing DMHIs across similar organizational settings, according to the EPIS domains of inner context, outer context, innovation factors, and bridging factors. Methods: This study stems from a large state-funded project in which 6 county behavioral health departments in California explored the use of DMHIs as part of county mental health services. Our team conducted interviews with clinical staff, peer support specialists, county leaders, project leaders, and clinic leaders using a semistructured interview guide. The development of the semistructured interview guide was informed by expert input regarding relevant inner context, outer context, innovation factors, and bridging factors in the exploration, preparation, and implementation phases of the EPIS framework. We followed a recursive 6-step process to conduct qualitative analyses using inductive and deductive components guided by the EPIS framework. Results: On the basis of 69 interviews, we identified 3 main themes that aligned with the EPIS framework: readiness of individuals, readiness of innovations, and readiness of organizations and systems. Individual-level readiness referred to the extent to which clients had the necessary technological tools (eg, smartphones) and knowledge (digital literacy) to support the DMHI. Innovation-level readiness pertained to the accessibility, usefulness, safety, and fit of the DMHI. Organization- and system-level readiness concerned the extent to which providers and leadership collectively held positive views about DMHIs as well as the extent to which infrastructure (eg, staffing and payment model) was appropriate. Conclusions: The successful implementation of DMHIs requires readiness at the individual, innovation, and organization and system levels. To improve individual-level readiness, we recommend equitable device distribution and digital literacy training. To improve innovation readiness, we recommend making DMHIs easier to use and introduce, clinically useful, and safe and adapting them to fit into the existing client needs and clinical workflow. To improve organization- and system-level readiness, we recommend supporting providers and local behavioral health departments with adequate technology and training and exploring potential system transformations (eg, integrated care model). Conceptualizing DMHIs as services allows the consideration of both the innovation characteristics of DMHIs (eg, efficacy, safety, and clinical usefulness) and the ecosystem around DMHIs, such as individual and organizational characteristics (inner context), purveyors and intermediaries (bridging factor), client characteristics (outer context), as well as the fit between the innovation and implementation settings (innovation factor). UR - https://formative.jmir.org/2023/1/e45718 UR - http://dx.doi.org/10.2196/45718 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191975 ID - info:doi/10.2196/45718 ER - TY - JOUR AU - Thomas, Kroska Emily Brenny AU - Sagorac Gruichich, Tijana AU - Maronge, M. Jacob AU - Hoel, Sydney AU - Victory, Amanda AU - Stowe, N. Zachary AU - Cochran, Amy PY - 2023/5/15 TI - Mobile Acceptance and Commitment Therapy With Distressed First-Generation College Students: Microrandomized Trial JO - JMIR Ment Health SP - e43065 VL - 10 KW - acceptance and commitment therapy KW - randomized controlled trials KW - mobile health KW - mHealth KW - first-generation college students KW - psychological flexibility KW - distress KW - depression N2 - Background: Extant gaps in mental health services are intensified among first-generation college students. Improving access to empirically based interventions is critical, and mobile health (mHealth) interventions are growing in support. Acceptance and commitment therapy (ACT) is an empirically supported intervention that has been applied to college students, via mobile app, and in brief intervals. Objective: This study evaluated the safety, feasibility, and effectiveness of an ACT-based mHealth intervention using a microrandomized trial (MRT) design. Methods: Participants (N=34) were 18- to 19-year-old first-generation college students reporting distress, who participated in a 6-week intervention period of twice-daily assessments and randomization to intervention. Participants logged symptoms, moods, and behaviors on the mobile app Lorevimo. After the assessment, participants were randomized to an ACT-based intervention or no intervention. Analyses examined proximal change after randomization using a weighted and centered least squares approach. Outcomes included values-based and avoidance behavior, as well as depressive symptoms and perceived stress. Results: The findings indicated the intervention was safe and feasible. The intervention increased values-based behavior but did not decrease avoidance behavior. The intervention reduced depressive symptoms but not perceived stress. Conclusions: An MRT of an mHealth ACT-based intervention among distressed first-generation college students suggests that a larger MRT is warranted. Future investigations may tailor interventions to contexts where intervention is most impactful. Trial Registration: ClinicalTrials.gov NCT04081662; https://clinicaltrials.gov/show/NCT04081662 International Registered Report Identifier (IRRID): RR2-10.2196/17086 UR - https://mental.jmir.org/2023/1/e43065 UR - http://dx.doi.org/10.2196/43065 UR - http://www.ncbi.nlm.nih.gov/pubmed/37184896 ID - info:doi/10.2196/43065 ER - TY - JOUR AU - Oclaman, May Janah AU - Murray, L. Michelle AU - Grandis, J. Donald AU - Beatty, L. Alexis PY - 2023/5/15 TI - The Association Between Mobile App Use and Change in Functional Capacity Among Cardiac Rehabilitation Participants: Cohort Study JO - JMIR Cardio SP - e44433 VL - 7 KW - cardiac rehabilitation KW - mobile application KW - functional capacity KW - blood pressure KW - telemedicine KW - mHealth KW - telehealth assessment KW - e-health KW - youth KW - adolescence KW - EHR KW - electronic health record N2 - Background: Cardiac rehabilitation (CR) is underused in the United States and globally, with participation disparities across gender, socioeconomic status, race, and ethnicities. The pandemic led to greater adoption of telehealth CR and mobile app use. Objective: Our primary objective was to estimate the association between CR mobile app use and change in functional capacity from enrollment to completion in patients participating in a CR program that offered in-person, hybrid, and telehealth CR. Our secondary objectives were to study the association between mobile app use and changes in blood pressure (BP) or program completion. Methods: We conducted a retrospective cohort study of participants enrolled in CR at an urban CR program in the United States. Participants were English speaking, at least 18 years of age, participated in the program between May 22, 2020, and May 21, 2022, and downloaded the CR mobile app. Mobile app use was quantified by number of exercise logs, vitals logs, and education material views. The primary outcome was change in functional capacity, measured by change in 6-minute walk distance (6MWD) from enrollment to completion. The secondary outcome was change in BP from enrollment to completion. We estimated associations using multivariable linear or logistic regression models adjusted for age, sex, race, ethnicity, socioeconomic status by ZIP code, insurance, and primary diagnosis for CR referral. Results: A total of 107 participants (mean age 62.9, SD 13.02 years; 90/107, 84.1% male; and 57/105, 53.3% self-declared as White Caucasian) used the mobile app and completed the CR program. Participants had a mean 64.0 (SD 54.1) meter increase in 6MWD between enrollment and completion (P<.001). From enrollment to completion, participants with an elevated BP at baseline (?130/80 mmHg) experienced a significant decrease in BP (systolic BP ?11.5 mmHg; P=.002 and diastolic BP ?7.7 mmHg; P=.003). We found no significant association between total app interactions and change in 6MWD (coefficient ?0.03, 95% CI ?0.1 to 0.07; P=.59) or change in BP (systolic coefficient 0.002, 95% CI ?0.03 to 0.03; P=.87 and diastolic coefficient ?0.005, 95% CI ?0.03 to 0.02; P=.65). There was no significant association between total exercise logs and change in 6MWD (coefficient 0.1, 95% CI ?0.3 to 0.4; P=.57) or total BP logs and change in BP (systolic coefficient ?0.02, 95% CI ?0.1 to 0.06; P=.63 and diastolic coefficient ?0.02, 95% CI ?0.09 to 0.04; P=.50). There was no significant association between total app interactions and completion of CR (adjusted odds ratio 1.00, 95% CI 0.99-1.01; P=.44). Conclusions: CR mobile app use as part of an in-person, hybrid, or telehealth CR program was not associated with greater improvement in functional capacity or BP or with program completion. UR - https://cardio.jmir.org/2023/1/e44433 UR - http://dx.doi.org/10.2196/44433 UR - http://www.ncbi.nlm.nih.gov/pubmed/37184917 ID - info:doi/10.2196/44433 ER - TY - JOUR AU - Giebel, Denk Godwin AU - Speckemeier, Christian AU - Abels, Carina AU - Plescher, Felix AU - Börchers, Kirstin AU - Wasem, Jürgen AU - Blase, Nikola AU - Neusser, Silke PY - 2023/5/12 TI - Problems and Barriers Related to the Use of Digital Health Applications: Scoping Review JO - J Med Internet Res SP - e43808 VL - 25 KW - mobile health KW - mHealth KW - app KW - Digital Health Application KW - DHA KW - Digitale Gesundheitsanwendungen KW - DiGA KW - problem KW - barrier KW - mobile phone N2 - Background: The digitization of health care led to a steady increase in the adoption and use of mobile health (mHealth) apps. Germany is the first country in the world to cover the costs of mHealth apps through statutory health insurance. Although the benefits of mHealth apps are discussed in detail, aspects of problems and barriers are rarely studied. Objective: This scoping review aimed to map and categorize the evidence on problems and barriers related to the use of mHealth apps. Methods: Systematic searches were conducted in the MEDLINE, Embase, and PsycINFO databases. Additional searches were conducted on JMIR Publications and on websites of relevant international organizations. The inclusion criteria were publications dealing with apps similar to those approved in the German health care system, publications addressing problems and barriers related to the use of mHealth apps, and articles published between January 1, 2015, and June 8, 2021. Study selection was performed by 2 reviewers. The manuscript was drafted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The analysis of the included publications and categorization of problems and hurdles were performed using MAXQDA (VERBI Software GmbH). Results: The database search identified 1479 publications. Of the 1479 publications, 21 (1.42%) met the inclusion criteria. A further 8 publications were included from citation searching and searching in JMIR Publications. The identified publications were analyzed for problems and barriers. Problems and barriers were classified into 10 categories (?validity,? ?usability,? ?technology,? ?use and adherence,? ?data privacy and security,? ?patient-physician relationship,? ?knowledge and skills,? ?individuality,? ?implementation,? and ?costs?). The most frequently mentioned categories were use and adherence (eg, incorporating the app into daily life or dropouts from use; n=22) and usability (eg, ease of use and design; n=19). Conclusions: The search identified various problems and barriers in the context of mHealth apps. Although problems at the app level (such as usability) are studied frequently, problems at the system level are addressed rather vaguely. To ensure optimal use of and care with mHealth apps, it is essential to consider all types of problems and barriers. Therefore, researchers and policy makers should have a special focus on this issue to identify the needs for quality assurance. International Registered Report Identifier (IRRID): RR2-10.2196/32702 UR - https://www.jmir.org/2023/1/e43808 UR - http://dx.doi.org/10.2196/43808 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171838 ID - info:doi/10.2196/43808 ER - TY - JOUR AU - Hellec, Justine AU - Hayotte, Meggy AU - Chorin, Frédéric AU - Colson, S. Serge AU - d'Arripe-Longueville, Fabienne PY - 2023/5/12 TI - Applying the UTAUT2 Model to Smart Eyeglasses to Detect and Prevent Falls Among Older Adults and Examination of Associations With Fall-Related Functional Physical Capacities: Survey Study JO - J Med Internet Res SP - e41220 VL - 25 KW - Unified Theory of Acceptance and Use of Technology 2 KW - fall prevention KW - fall detection KW - older people KW - older adults KW - facilitating conditions KW - effort expectancy KW - smart eyeglasses N2 - Background: As people age, their physical capacities (eg, walking and balance) decline and the risk of falling rises. Yet, classic fall detection devices are poorly accepted by older adults. Because they often wear eyeglasses as they go about their daily activities, daily monitoring to detect and prevent falls with smart eyeglasses might be more easily accepted. Objective: On the basis of the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), this study evaluated (1) the acceptability of smart eyeglasses for the detection and prevention of falls by older adults and (2) the associations with selected fall-related functional physical capacities. Methods: A total of 142 volunteer older adults (mean age 74.9 years, SD 6.5 years) completed the UTAUT2 questionnaire adapted for smart eyeglasses and then performed several physical tests: a unipodal balance test with eyes open and closed, a 10-m walk test, and a 6-minute walk test. An unsupervised analysis classified the participants into physical performance groups. Multivariate ANOVAs were performed to identify differences in acceptability constructs according to the performance group. Results: The UTAUT2 questionnaire adapted for eyeglasses presented good psychometric properties. Performance expectancy (?=.21, P=.005), social influence (?=.18, P=.007), facilitating conditions (?=.17, P=.04), and habit (?=.40, P<.001) were significant contributors to the behavioral intention to use smart eyeglasses (R²=0.73). The unsupervised analysis based on fall-related functional physical capacities created 3 groups of physical performance: low, intermediate, and high. Effort expectancy in the low performance group (mean 3.99, SD 1.46) was lower than that in the other 2 groups (ie, intermediate: mean 4.68, SD 1.23; high: mean 5.09, SD 1.41). Facilitating conditions in the high performance group (mean 5.39, SD 1.39) were higher than those in the other 2 groups (ie, low: mean 4.31, SD 1.68; intermediate: mean 4.66, SD 1.51). Conclusions: To our knowledge, this study is the first to examine the acceptability of smart eyeglasses in the context of fall detection and prevention in older adults and to associate acceptability with fall-related functional physical capacities. The older adults with higher physical performances, and possibly lower risks of falling, reported greater acceptability of smart eyeglasses for fall prevention and detection than their counterparts exhibiting low physical performances. UR - https://www.jmir.org/2023/1/e41220 UR - http://dx.doi.org/10.2196/41220 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171835 ID - info:doi/10.2196/41220 ER - TY - JOUR AU - Masiero, Marianna AU - Filipponi, Chiara AU - Pizzoli, Maria Silvia Francesca AU - Munzone, Elisabetta AU - Guido, Luca AU - Guardamagna, Andrea Vittorio AU - Marceglia, Sara AU - Caruso, Annamaria AU - Prandin, Roberto AU - Prenassi, Marco AU - Manzelli, Vania AU - Savino, Chiara AU - Conti, Costanza AU - Rizzi, Federica AU - Casalino, Alice AU - Candiani, Giulia AU - Memini, Francesca AU - Chiveri, Luca AU - Vitali, Luigi Andrea AU - Corbo, Massimo AU - Milani, Alessandra AU - Grasso, Roberto AU - Traversoni, Silvia AU - Fragale, Elisa AU - Didier, Florence AU - Pravettoni, Gabriella PY - 2023/5/12 TI - Usability Testing of a New Digital Integrated Health Ecosystem (PainRELife) for the Clinical Management of Chronic Pain in Patients With Early Breast Cancer: Protocol for a Pilot Study JO - JMIR Res Protoc SP - e41216 VL - 12 KW - decision-making KW - decision aid KW - chronic pain KW - eHealth KW - patient electronic health record KW - clinical KW - technology KW - mobile application KW - pilot study KW - breast cancer KW - chronic KW - patient KW - cancer KW - pain N2 - Background: Chronic pain (CP) and its management are critical issues in the care pathway of patients with breast cancer. Considering the complexity of CP experience in cancer, the international scientific community has advocated identifying cutting-edge approaches for CP management. Recent advances in the field of health technology enable the adoption of a novel approach to care management by developing integrated ecosystems and mobile health apps. Objective: The primary end point of this pilot study is to evaluate patients? usability experience at 3 months of a new digital and integrated technological ecosystem, PainRELife, for CP in a sample of patients with breast cancer. The PainRELife ecosystem is composed of 3 main technological assets integrated into a single digital ecosystem: Fast Healthcare Interoperability Resources?based cloud platform (Nu platform) that enables care pathway definition and data collection; a big data infrastructure connected to the Fast Healthcare Interoperability Resources server that analyzes data and implements dynamic dashboards for aggregate data visualization; and an ecosystem of personalized applications for patient-reported outcomes collection, digital delivery of interventions and tailored information, and decision support of patients and caregivers (PainRELife app). Methods: This is an observational, prospective pilot study. Twenty patients with early breast cancer and chronic pain will be enrolled at the European Institute of Oncology at the Division of Medical Senology and the Division of Pain Therapy and Palliative Care. Each patient will use the PainRELife mobile app for 3 months, during which data extracted from the questionnaires will be sent to the Nu Platform that health care professionals will manage. This pilot study is nested in a large-scale project named ?PainRELife,? which aims to develop a cloud technology platform to interoperate with institutional systems and patients' devices to collect integrated health care data. The study received approval from the Ethical Committee of the European Cancer Institute in December 2021 (number R1597/21-IEO 1701). Results: The recruitment process started in May 2022 and ended in October 2022. Conclusions: The new integrated technological ecosystems might be considered an encouraging affordance to enhance a patient-centered approach to managing patients with cancer. This pilot study will inform about which features the health technological ecosystems should have to be used by cancer patients to manage CP. International Registered Report Identifier (IRRID): DERR1-10.2196/41216 UR - https://www.researchprotocols.org/2023/1/e41216 UR - http://dx.doi.org/10.2196/41216 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171843 ID - info:doi/10.2196/41216 ER - TY - JOUR AU - Weil, Marie-Theres AU - Spinler, Kristin AU - Lieske, Berit AU - Dingoyan, Demet AU - Walther, Carolin AU - Heydecke, Guido AU - Kofahl, Christopher AU - Aarabi, Ghazal PY - 2023/5/11 TI - An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach JO - JMIR Form Res SP - e36815 VL - 7 KW - oral health KW - health behavior KW - oral health knowledge KW - migration KW - mobile health KW - mHealth KW - preventive dentistry KW - intervention mapping KW - mobile phone N2 - Background: Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app. Objective: This study aims to describe the development process of the MuMi app. Methods: For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation. Results: On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group. Conclusions: The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background. UR - https://formative.jmir.org/2023/1/e36815 UR - http://dx.doi.org/10.2196/36815 UR - http://www.ncbi.nlm.nih.gov/pubmed/37166956 ID - info:doi/10.2196/36815 ER - TY - JOUR AU - Areemit, Rosawan AU - Saengnipanthkul, Suchaorn AU - Sutra, Sumitr AU - Lumbiganon, Pagakrong AU - Pornprasitsakul, Phenphitcha AU - Paopongsawan, Pongsatorn AU - Sripanidkulchai, Kunwadee PY - 2023/5/9 TI - Effectiveness of a Mobile App (KhunLook) Versus the Maternal and Child Health Handbook on Thai Parents? Health Literacy, Accuracy of Health Assessments, and Convenience of Use: Randomized Controlled Trial JO - J Med Internet Res SP - e43196 VL - 25 KW - health literacy KW - mobile app KW - mHealth KW - KhunLook KW - Maternal and Child Health Handbook KW - parent KW - health assessment KW - child health supervision KW - Thailand N2 - Background: Children of parents who have higher health literacy (HL) benefit more from preventive child health care. Digital interventions have been used to improve parents? HL with high satisfaction. KhunLook is a Thai mobile app conceived using strategies to improve HL. It was developed to assist parents in assessing and keeping track of their child?s health in complement to the standard Maternal and Child Health Handbook (MCHH). Objective: This trial focuses on the effectiveness of using the KhunLook app with the MCHH and standard care (intervention) compared with the conventional MCHH and standard care (control) on parents? HL. Data on accuracy of parents? assessment of their child?s health and growth as well as convenience of use of the tool (app or MCHH) in the well-child clinic were collected at 2 visits (immediate=visit 1, and intermediate=visit 2). Methods: Parents of children under 3 years of age who (1) had a smartphone or tablet and the MCHH and (2) could participate in 2 visits, 2-6 months apart at Srinagarind Hospital, Khon Kaen, Thailand, were enrolled in this 2-arm parallel randomized controlled trial between April 2020 and May 2021. Parents were randomized 1:1 to 2 groups. At visit 1, data on demographics and baseline HL (Thailand Health Literacy Scales) were collected. Parents in the app group used the KhunLook app and the control group used their child?s handbook to assess their child?s growth, development, nutrition and feeding, immunization status and rated the convenience of the tool they used. At visit 2, they repeated the assessments and completed the HL questionnaire. Results: A total of 358 parents completed the study (358/408, 87.7%). After the intervention, the number of parents with high total HL significantly increased from 94/182 (51.6%) to 109/182 (59.9%; 15/182; ? 8.2%; P=.04), specifically in the health management (30/182; ? 16.4%; P<.001) and child health management (18/182; ? 9.9%; P=.01) domains in the app group, but not in the control group. Parents in the app group could correctly assess their child?s head circumference (172/182, 94.5% vs 124/176, 70.5%; P<.001) and development (173/182, 95.1% vs 139/176, 79.0%; P<.001) better than those in the control group at both visits. A higher proportion of parents in the app group rated their tool as very easy or easy to use (174-181/182, 95.6%-99.5% vs 141-166/176, 80.1%-94.3%; P<.001) on every item since the first visit. Conclusions: Our results suggest the potential of a smartphone app (KhunLook) to improve parents? HL as well as to promote superior accuracy of parents? assessment of their child?s head circumference and development, with a similar effect on weight, height, nutrition and feeding, and immunization as in traditional interventions. Using the KhunLook app is useful and more convenient for parents in promoting a healthy child preventive care during early childhood. Trial Registration: Thai Clinical Trials Registry TCTR20200312003; https://www.thaiclinicaltrials.org/show/TCTR20200312003 UR - https://www.jmir.org/2023/1/e43196 UR - http://dx.doi.org/10.2196/43196 UR - http://www.ncbi.nlm.nih.gov/pubmed/37159258 ID - info:doi/10.2196/43196 ER - TY - JOUR AU - Kitagawa, Takashi AU - Hayashi, Masateru PY - 2023/5/8 TI - mHealth for the Self-management of Knee Osteoarthritis: Scoping Review JO - J Med Internet Res SP - e38798 VL - 25 KW - knee osteoarthritis KW - mobile health KW - mHealth KW - self-management KW - knee joint KW - scoping review KW - pain KW - physical function KW - quality of life KW - mobile phone app KW - patient education N2 - Background: Educating patients on the self-management of knee osteoarthritis (OA) reportedly reduces pain, improves activities of daily living, and even reduces health care costs. Objective: This scoping review will summarize the current evidence on mobile health (mHealth) and smartphone app?based disease self-management for patients with knee OA. Methods: PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and CINAHL were systematically searched in May 2021 using the keywords ?knee osteoarthritis,? ?mobile health,? and ?self-management.? Studies that investigated patients with knee OA based on radiography or clinical diagnosis were included. The following criteria were applied to the mobile phone apps included in the search-derived studies: the ability to (1) record and manage symptoms, (2) provide patient education, and (3) guide and record activities of daily living. Studies eligible for inclusion in this scoping review were interventional trials or observational studies published in English. Results: This scoping review included 8 reports, of which 3 were randomized controlled trials and 1 was a conference abstract. Most studies provided data on the outcomes of pain, physical function, and quality of life. Conclusions: An increasing number of reports are addressing the effectiveness of mHealth in patients with knee OA, and the data suggest that mHealth efficacy is similar to conventional management of health. International Registered Report Identifier (IRRID): RR2-10.17504/protocols.io.buuxnwxn UR - https://www.jmir.org/2023/1/e38798 UR - http://dx.doi.org/10.2196/38798 UR - http://www.ncbi.nlm.nih.gov/pubmed/37155233 ID - info:doi/10.2196/38798 ER - TY - JOUR AU - Bota, Brianne A. AU - Bettinger, A. Julie AU - Sarfo-Mensah, Shirley AU - Lopez, Jimmy AU - Smith, P. David AU - Atkinson, M. Katherine AU - Bell, Cameron AU - Marty, Kim AU - Serhan, Mohamed AU - Zhu, T. David AU - McCarthy, E. Anne AU - Wilson, Kumanan PY - 2023/5/8 TI - Comparing the Use of a Mobile App and a Web-Based Notification Platform for Surveillance of Adverse Events Following Influenza Immunization: Randomized Controlled Trial JO - JMIR Public Health Surveill SP - e39700 VL - 9 KW - active participant?centered reporting KW - health technology KW - adverse event reporting KW - mobile apps KW - immunization KW - vaccine KW - safety KW - influenza KW - campaign KW - apps KW - mobile KW - surveillance KW - pharmacovigilance N2 - Background: Vaccine safety surveillance is a core component of vaccine pharmacovigilance. In Canada, active, participant-centered vaccine surveillance is available for influenza vaccines and has been used for COVID-19 vaccines. Objective: The objective of this study is to evaluate the effectiveness and feasibility of using a mobile app for reporting participant-centered seasonal influenza adverse events following immunization (AEFIs) compared to a web-based notification system. Methods: Participants were randomized to influenza vaccine safety reporting via a mobile app or a web-based notification platform. All participants were invited to complete a user experience survey. Results: Among the 2408 randomized participants, 1319 (54%) completed their safety survey 1 week after vaccination, with a higher completion rate among the web-based notification platform users (767/1196, 64%) than among mobile app users (552/1212, 45%; P<.001). Ease-of-use ratings were high for the web-based notification platform users (99% strongly agree or agree) and 88.8% of them strongly agreed or agreed that the system made reporting AEFIs easier. Web-based notification platform users supported the statement that a web-based notification-only approach would make it easier for public health professionals to detect vaccine safety signals (91.4%, agreed or strongly agreed). Conclusions: Participants in this study were significantly more likely to respond to a web-based safety survey rather than within a mobile app. These results suggest that mobile apps present an additional barrier for use compared to the web-based notification?only approach. Trial Registration: ClinicalTrials.gov NCT05794113; https://clinicaltrials.gov/show/NCT05794113 UR - https://publichealth.jmir.org/2023/1/e39700 UR - http://dx.doi.org/10.2196/39700 UR - http://www.ncbi.nlm.nih.gov/pubmed/37155240 ID - info:doi/10.2196/39700 ER - TY - JOUR AU - Campbell, I. Jeffrey AU - Aturinda, Isaac AU - Mwesigwa, Evans AU - Habinka, Annabella AU - Kanyesigye, Michael AU - Holden, J. Richard AU - Siedner, J. Mark AU - Kraemer, D. John PY - 2023/5/5 TI - Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study JO - JMIR Hum Factors SP - e42952 VL - 10 KW - mobile health KW - mHealth KW - HIV KW - intention KW - SMS KW - cellular phone KW - cell phone KW - Africa KW - reminder KW - alert KW - notification KW - prompt N2 - Background: The expansion of cellular phones in sub-Saharan Africa spurred the development of SMS text message?based mobile health (mHealth) technology. Numerous SMS text message?based interventions have attempted to increase retention in care for people living with HIV in sub-Saharan Africa. Many of these interventions have failed to scale. Understanding theory-grounded factors leading to mHealth acceptability is needed to create scalable, contextually appropriate, and user-focused interventions to improve longitudinal HIV care for people living with HIV in sub-Saharan Africa. Objective: In this study, we aimed to understand the relationship between constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT), constructs identified in previous qualitative research, and behavioral intention to use a novel SMS text message?based mHealth intervention designed to improve care retention among people living with HIV initiating treatment in rural Uganda. Methods: We conducted a survey of people living with HIV who were newly initiating HIV care in Mbarara, Uganda, and had agreed to use a novel SMS text message?based system that notified them of abnormal laboratory results and reminded them to return to the clinic. Survey items assessed behavioral intention to use the SMS text messaging system; constructs from UTAUT; and demographics, literacy, SMS text messaging experience, HIV status disclosure, and social support. We used factor analysis and logistic regression to estimate the relationships between UTAUT constructs and the behavioral intention to use the SMS text messaging system. Results: A total of 249 participants completed the surveys, of whom 115 (46.2%) expressed high behavioral intention to use the SMS text messaging intervention. In a multivariable analysis, we found that performance expectancy (adjusted odds ratio [aOR] of the scaled factor score 5.69, 95% CI 2.64-12.25; P<.001), effort expectancy (aOR of the scaled factor score 4.87, 95% CI 1.75-13.51; P=.002), and social influence (measured as a 1-unit Likert score increase in the perception that clinical staff have been helpful in the use of the SMS text messaging program; aOR 3.03, 95% CI 1.21-7.54; P=.02) were significantly associated with high behavioral intention to use the SMS text messaging program. SMS text messaging experience (aOR/1-unit increase 1.48, 95% CI 1.11-1.96; P=.008) and age (aOR/1-year increase 1.07, 95% CI 1.03-1.13; P=.003) were also significantly associated with increased odds of high intention to use the system. Conclusions: Performance expectancy, effort expectancy, and social influence, as well as age and SMS experience, were drivers of high behavioral intention to use an SMS text messaging reminder system among people living with HIV initiating treatment in rural Uganda. These findings highlight salient factors associated with SMS intervention acceptability in this population and indicate attributes that are likely to be key to the successful development and scaling of novel mHealth interventions. UR - https://humanfactors.jmir.org/2023/1/e42952 UR - http://dx.doi.org/10.2196/42952 UR - http://www.ncbi.nlm.nih.gov/pubmed/37145834 ID - info:doi/10.2196/42952 ER - TY - JOUR AU - Hwang, Soohyun AU - Lazard, J. Allison AU - Reffner Collins, K. Meredith AU - Brenner, T. Alison AU - Heiling, M. Hillary AU - Deal, M. Allison AU - Crockett, D. Seth AU - Reuland, S. Daniel AU - Elston Lafata, Jennifer PY - 2023/5/5 TI - Exploring the Acceptability of Text Messages to Inform and Support Shared Decision-making for Colorectal Cancer Screening: Online Panel Survey JO - JMIR Cancer SP - e40917 VL - 9 KW - text messages KW - shared decision-making KW - colorectal cancer KW - cancer screening KW - mHealth KW - cancer KW - health care KW - marginalized groups N2 - Background: While online portals may be helpful to engage patients in shared decision-making at the time of cancer screening, because of known disparities in patient portal use, sole reliance on portals to support cancer screening decision-making could exacerbate well-known disparities in this health care area. Innovative approaches are needed to engage patients in health care decision-making and to support equitable shared decision-making. Objective: We assessed the acceptability of text messages to engage sociodemographically diverse individuals in colorectal cancer (CRC) screening decisions and support shared decision-making in practice. Methods: We developed a brief text message program offering educational information consisting of components of shared decision-making regarding CRC screening (eg, for whom screening is recommended, screening test options, and pros/cons of options). The program and postprogram survey were offered to members of an online panel. The outcome of interest was program acceptability measured by observed program engagement, participant-reported acceptability, and willingness to use similar programs (behavioral intent). We evaluated acceptability among historically marginalized categories of people defined by income, literacy, and race. Results: Of the 289 participants, 115 reported having a low income, 146 were Black/African American, and 102 had less than extreme confidence in their health literacy. With one exception, we found equal or greater acceptability, regardless of measure, within each of the marginalized categories of people compared to their counterparts. The exception was that participants reporting an income below US $50,000 were less likely to engage with sufficient content of the program to learn that there was a choice among different CRC screening tests (difference ?10.4%, 95% CI ?20.1 to ?0.8). Of note, Black/African American participants reported being more likely to sign up to receive text messages from their doctor?s office compared to white participants (difference 18.7%, 95% CI 7.0-30.3). Conclusions: Study findings demonstrate general acceptance of text messages to inform and support CRC screening shared decision-making. UR - https://cancer.jmir.org/2023/1/e40917 UR - http://dx.doi.org/10.2196/40917 UR - http://www.ncbi.nlm.nih.gov/pubmed/37145859 ID - info:doi/10.2196/40917 ER - TY - JOUR AU - Deniz-Garcia, Alejandro AU - Fabelo, Himar AU - Rodriguez-Almeida, J. Antonio AU - Zamora-Zamorano, Garlene AU - Castro-Fernandez, Maria AU - Alberiche Ruano, Pino Maria del AU - Solvoll, Terje AU - Granja, Conceição AU - Schopf, Roger Thomas AU - Callico, M. Gustavo AU - Soguero-Ruiz, Cristina AU - Wägner, M. Ana AU - PY - 2023/5/4 TI - Quality, Usability, and Effectiveness of mHealth Apps and the Role of Artificial Intelligence: Current Scenario and Challenges JO - J Med Internet Res SP - e44030 VL - 25 KW - artificial intelligence KW - chronic disease prevention and management KW - big data KW - mobile health KW - mHealth KW - noncommunicable diseases KW - mobile phone UR - https://www.jmir.org/2023/1/e44030 UR - http://dx.doi.org/10.2196/44030 UR - http://www.ncbi.nlm.nih.gov/pubmed/37140973 ID - info:doi/10.2196/44030 ER - TY - JOUR AU - Raj, Diana AU - Ahmad, Norliza AU - Mohd Zulkefli, Afiah Nor AU - Lim, Ying Poh PY - 2023/5/4 TI - Stop and Play Digital Health Education Intervention for Reducing Excessive Screen Time Among Preschoolers From Low Socioeconomic Families: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e40955 VL - 25 KW - child KW - preschool KW - screen time KW - mother-child KW - randomized controlled trial KW - mobile phone N2 - Background: High prevalence of excessive screen time among preschool children is attributable to certain parental factors such as lack of knowledge, false perception about screen time, and inadequate skills. Lack of strategies to implement screen time guidelines, in addition to multiple commitments that may hinder parents from face-to-face interventions, demands the need to develop a technology-based parent-friendly screen time reduction intervention. Objective: This study aims to develop, implement, and evaluate the effectiveness of Stop and Play, a digital parental health education intervention to reduce excessive screen time among preschoolers from low socioeconomic families in Malaysia. Methods: A single-blind, 2-arm cluster randomized controlled trial was conducted among 360 mother-child dyads attending government preschools in the Petaling district, who were randomly allocated into the intervention and waitlist control groups between March 2021 and December 2021. This 4-week intervention, developed using whiteboard animation videos, infographics, and a problem-solving session, was delivered via WhatsApp (WhatsApp Inc). Primary outcome was the child?s screen time, whereas secondary outcomes included mother?s screen time knowledge, perception about the influence of screen time on the child?s well-being, self-efficacy to reduce the child?s screen time and increase physical activity, mother?s screen time, and presence of screen device in the child?s bedroom. Validated self-administered questionnaires were administered at baseline, immediately after the intervention, and 3 months after the intervention. The intervention?s effectiveness was evaluated using generalized linear mixed models. Results: A total of 352 dyads completed the study, giving an attrition rate of 2.2% (8/360). At 3 months after the intervention, the intervention group showed significantly reduced child?s screen time compared with the control group (?=?202.29, 95% CI ?224.48 to ?180.10; P<.001). Parental outcome scores also improved in the intervention group as compared with that in the control group. Mother?s knowledge significantly increased (?=6.88, 95% CI 6.11-7.65; P<.001), whereas perception about the influence of screen time on the child?s well-being reduced (?=?.86, 95% CI ?0.98 to ?0.73; P<.001). There was also an increase in the mother?s self-efficacy to reduce screen time (?=1.59, 95% CI 1.48-1.70; P<.001) and increase physical activity (?=.07, 95% CI 0.06-0.09; P<.001), along with reduction in mother?s screen time (?=?70.43, 95% CI ?91.51 to ?49.35; P<.001). Conclusions: The Stop and Play intervention was effective in reducing screen time among preschool children from low socioeconomic families, while improving the associated parental factors. Therefore, integration into primary health care and preschool education programs is recommended. Mediation analysis is suggested to investigate the extent to which secondary outcomes are attributable to the child?s screen time, and long follow-up could evaluate the sustainability of this digital intervention. Trial Registration: Thai Clinical Trial Registry (TCTR) TCTR20201010002; https://tinyurl.com/5frpma4b UR - https://www.jmir.org/2023/1/e40955 UR - http://dx.doi.org/10.2196/40955 UR - http://www.ncbi.nlm.nih.gov/pubmed/37140970 ID - info:doi/10.2196/40955 ER - TY - JOUR AU - Lee, W. Jarrett G. AU - Lee, Kyungyeon AU - Lee, Bongshin AU - Choi, Soyoung AU - Seo, JooYoung AU - Choe, Kyoung Eun PY - 2023/5/4 TI - Personal Health Data Tracking by Blind and Low-Vision People: Survey Study JO - J Med Internet Res SP - e43917 VL - 25 KW - personal health data KW - self-tracking KW - blind and low vision KW - survey KW - consumer health information KW - mobile phone N2 - Background: Personal health technologies, including wearable tracking devices and mobile apps, have great potential to equip the general population with the ability to monitor and manage their health. However, being designed for sighted people, much of their functionality is largely inaccessible to the blind and low-vision (BLV) population, threatening the equitable access to personal health data (PHD) and health care services. Objective: This study aims to understand why and how BLV people collect and use their PHD and the obstacles they face in doing so. Such knowledge can inform accessibility researchers and technology companies of the unique self-tracking needs and accessibility challenges that BLV people experience. Methods: We conducted a web-based and phone survey with 156 BLV people. We reported on quantitative and qualitative findings regarding their PHD tracking practices, needs, accessibility barriers, and work-arounds. Results: BLV respondents had strong desires and needs to track PHD, and many of them were already tracking their data despite many hurdles. Popular tracking items (ie, exercise, weight, sleep, and food) and the reasons for tracking were similar to those of sighted people. BLV people, however, face many accessibility challenges throughout all phases of self-tracking, from identifying tracking tools to reviewing data. The main barriers our respondents experienced included suboptimal tracking experiences and insufficient benefits against the extended burden for BLV people. Conclusions: We reported the findings that contribute to an in-depth understanding of BLV people?s motivations for PHD tracking, tracking practices, challenges, and work-arounds. Our findings suggest that various accessibility challenges hinder BLV individuals from effectively gaining the benefits of self-tracking technologies. On the basis of the findings, we discussed design opportunities and research areas to focus on making PHD tracking technologies accessible for all, including BLV people. UR - https://www.jmir.org/2023/1/e43917 UR - http://dx.doi.org/10.2196/43917 UR - http://www.ncbi.nlm.nih.gov/pubmed/37140967 ID - info:doi/10.2196/43917 ER - TY - JOUR AU - Heidel, Alexandra AU - Hagist, Christian AU - Spinler, Stefan AU - Schoeneberger, Michael PY - 2023/5/4 TI - Removing Dust From the German Health Care System by Introducing Health Apps Into Standard Care: Semistructured Interview Study JO - JMIR Hum Factors SP - e42186 VL - 10 KW - health apps KW - DVG KW - Digitale Versorgung Gesetz KW - Digital Healthcare Act KW - mobile health KW - mHealth KW - German statutory health care system KW - interview study N2 - Background: In 2019, Germany launched the Digital Healthcare Act. The reform enables physicians to prescribe health apps as treatments to their statutory-insured patients. Objective: We aimed to determine the extent to which the integration of health apps into standard care could be considered beneficial and which aspects of the regulation could still be improved. Methods: We conducted a semistructured interview study with 23 stakeholders in Germany and analyzed them thematically. We used descriptive coding for the first-order codes and pattern coding for the second-order codes. Results: We created 79 first-order codes and 9 second-order codes following the interview study. Most stakeholders argued that the option of prescribing health apps could improve treatment quality. Conclusions: The inclusion of health apps into German standard care could improve the quality of treatment by expanding treatment portfolios. The educational elements of the apps might additionally lead to more patient emancipation through a better understanding of personal conditions. Location and time flexibility are the biggest advantages of the new technologies, but they also raise the most significant concerns for stakeholders because app use requires personal initiative and self-motivation. Overall, stakeholders agree that the Digital Healthcare Act has the potential to remove dust from the German health care system. UR - https://humanfactors.jmir.org/2023/1/e42186 UR - http://dx.doi.org/10.2196/42186 UR - http://www.ncbi.nlm.nih.gov/pubmed/37140980 ID - info:doi/10.2196/42186 ER - TY - JOUR AU - Li, Rui AU - Shen, Mingwang AU - Liu, Hanting AU - Bai, Lu AU - Zhang, Lei PY - 2023/5/3 TI - Do Infrared Thermometers Hold Promise for an Effective Early Warning System for Emerging Respiratory Infectious Diseases? JO - JMIR Form Res SP - e42548 VL - 7 KW - respiratory infectious diseases KW - early warning KW - infrared thermometer KW - theoretical framework KW - economic burden KW - outbreak prevention KW - warning system KW - community health KW - infectious disease KW - smartphone device KW - digital health surveillance N2 - Background: Major respiratory infectious diseases, such as influenza, SARS-CoV, and SARS-CoV-2, have caused historic global pandemics with severe disease and economic burdens. Early warning and timely intervention are key to suppress such outbreaks. Objective: We propose a theoretical framework for a community-based early warning (EWS) system that will proactively detect temperature abnormalities in the community based on a collective network of infrared thermometer?enabled smartphone devices. Methods: We developed a framework for a community-based EWS and demonstrated its operation with a schematic flowchart. We emphasize the potential feasibility of the EWS and potential obstacles. Results: Overall, the framework uses advanced artificial intelligence (AI) technology on cloud computing platforms to identify the probability of an outbreak in a timely manner. It hinges on the detection of geospatial temperature abnormalities in the community based on mass data collection, cloud-based computing and analysis, decision-making, and feedback. The EWS may be feasible for implementation considering its public acceptance, technical practicality, and value for money. However, it is important that the proposed framework work in parallel or in combination with other early warning mechanisms due to a relatively long initial model training process. Conclusions: The framework, if implemented, may provide an important tool for important decisions for early prevention and control of respiratory diseases for health stakeholders. UR - https://formative.jmir.org/2023/1/e42548 UR - http://dx.doi.org/10.2196/42548 UR - http://www.ncbi.nlm.nih.gov/pubmed/37133929 ID - info:doi/10.2196/42548 ER - TY - JOUR AU - Ehrler, Frederic AU - Tuor, Carlotta AU - Rey, Robin AU - Trompier, Rémy AU - Berger, Antoine AU - Ramusi, Michael AU - Courvoisier, S. Delphine AU - Siebert, N. Johan PY - 2023/5/3 TI - Effectiveness of a Mobile App (PIMPmyHospital) in Reducing Therapeutic Turnaround Times in an Emergency Department: Protocol for a Pre- and Posttest Study JO - JMIR Res Protoc SP - e43695 VL - 12 KW - clinical laboratory information systems KW - laboratory results KW - digital technology KW - emergency department KW - emergency service KW - hospital KW - length of stay KW - mobile app KW - mobile health KW - mHealth KW - pediatrics KW - therapeutic turnaround time N2 - Background: Delays in reviewing issued laboratory results in emergency departments (EDs) can adversely affect efficiency and quality of care. One opportunity to improve therapeutic turnaround time could be to provide real-time access to laboratory results on mobile devices available to every caregiver. We developed a mobile app named ?Patients In My Pocket in my Hospital? (PIMPmyHospital) to help ED caregivers automatically obtain and share relevant information about the patients they care for including laboratory results. Objective: This pre- and posttest study aims to explore whether the implementation of the PIMPmyHospital app impacts the timeliness with which ED physicians and nurses remotely access laboratory results while actively working in their real-world environment, including ED length of stay, technology acceptance and usability among users, and how specific in-app alerts impact on its effectiveness. Methods: This single-center study of nonequivalent pre- and posttest comparison group design will be conducted before and after the implementation of the app in a tertiary pediatric ED in Switzerland. The retrospective period will cover the previous 12 months, and the prospective period will cover the following 6 months. Participants will be postgraduate residents pursuing a ?6-year residency in pediatrics, pediatric emergency medicine fellows, and registered nurses from the pediatric ED. The primary outcome will be the mean elapsed time in minutes from delivery of laboratory results to caregivers? consideration by accessing them either through the hospital?s electronic medical records or through the app before and after the implementation of the app, respectively. As secondary outcomes, participants will be queried about the acceptance and usability of the app using the Unified Theory of Acceptance and Use of Technology model and the System Usability Scale. ED length of stay will be compared before and after the implementation of the app for patients with laboratory results. The impact of specific alerts on the app, such as a flashing icon or sound for reported pathological values, will be reported. Results: Retrospective data collection gathered from the institutional data set will span a 12-month period from October 2021 to October 2022, while the 6-month prospective collection will begin with the implementation of the app in November 2022 and is expected to cease at the end of April 2023. We expect the results of the study to be published in a peer-reviewed journal in late 2023. Conclusions: This study will show the potential reach, effectiveness, acceptance, and use of the PIMPmyHospital app among ED caregivers. The findings of this study will serve as the basis for future research on the app and any further development to improve its effectiveness.Trial Registration: ClinicalTrials.gov NCT05557331; https://clinicaltrials.gov/ct2/show/NCT05557331 Trial Registration: ClinicalTrials.gov NCT05557331; https://clinicaltrials.gov/ct2/show/NCT05557331 International Registered Report Identifier (IRRID): PRR1-10.2196/43695 UR - https://www.researchprotocols.org/2023/1/e43695 UR - http://dx.doi.org/10.2196/43695 UR - http://www.ncbi.nlm.nih.gov/pubmed/37133909 ID - info:doi/10.2196/43695 ER - TY - JOUR AU - Su, Zheng AU - Wei, Xiaowen AU - Cheng, Anqi AU - Zhou, Xinmei AU - Li, Jinxuan AU - Qin, Rui AU - Liu, Yi AU - Xia, Xin AU - Song, Qingqing AU - Liu, Zhao AU - Zhao, Liang AU - Xiao, Dan AU - Wang, Chen PY - 2023/5/2 TI - Utilization and Effectiveness of a Message-Based Tobacco Cessation Program (mCessation) in the Chinese General Population: Longitudinal, Real-world Study JO - J Med Internet Res SP - e44840 VL - 25 KW - smoking cessation KW - real-world evidence KW - text message KW - general population N2 - Background: Randomized controlled trials on text message interventions for smoking cessation have shown they are effective and recommended for tobacco control. However, the effectiveness in real-world settings is largely unknown, especially in low- and middle-income countries. Objective: This study aimed to provide real-world evidence about the utilization and effectiveness of a message-based tobacco cessation program (mCessation) in China. Methods: From May 2021 to September 2022, 16,746 people from the general population participated in the mCessation program provided by the World Health Organization. All participants received text messages on smoking cessation via instant messaging for 6 months, and they were also required to report smoking status. We randomly selected 2500 participants and interviewed them by telephone to determine the 7-day point prevalence abstinence rate at 6 months. Descriptive statistics were used to analyze population characteristics and abstinence rate. Logistic regression analysis was performed to explore risk factors for the abstinence rate. Results: Among the 2500 participants, the mean age was 35 years, and most (2407/2500, 96.20%) were male. The prevalence of tobacco dependence and light degree of tobacco dependence were 85.70% (2142/2500) and 89.10% (2228/2500), respectively. For respondents (953/2500, 38.10%), the 7-day point prevalence abstinence rate at 6 months was 21.90% (209/953). Participants older than 40 years or with tobacco dependence had significantly higher abstinence rates than those who were younger than 30 years old (odds ratio [OR] 1.77, 95% CI 1.06-3.29) or without dependence (OR 1.64, 95% CI 1.08-2.51), respectively. However, married people or heavily dependent smokers tended to find it more difficult to successfully quit smoking compared with unmarried people (OR 0.57, 95% CI 0.34-0.93) or lightly dependent smokers (OR 0.16, 95% CI 0.02-0.98), respectively. Conclusions: In a real-world setting, mCessation China was generally acceptable to men and lightly dependent smokers, and it could help 1 in 5 smokers aged 18 years to 67 years quit smoking. However, strategies to increase awareness of young and married adults may improve implementation and abstinence rates. UR - https://www.jmir.org/2023/1/e44840 UR - http://dx.doi.org/10.2196/44840 UR - http://www.ncbi.nlm.nih.gov/pubmed/37129934 ID - info:doi/10.2196/44840 ER - TY - JOUR AU - Yoon, Ho Chang AU - Nolan, Imogen AU - Humphrey, Gayl AU - Duffy, J. Eamon AU - Thomas, G. Mark AU - Ritchie, R. Stephen PY - 2023/5/2 TI - Long-Term Impact of a Smartphone App on Prescriber Adherence to Antibiotic Guidelines for Adult Patients With Community-Acquired Pneumonia: Interrupted Time-Series Study JO - J Med Internet Res SP - e42978 VL - 25 KW - app KW - antimicrobial stewardship KW - antibiotic adherence KW - community KW - pneumonia KW - smartphone KW - mobile health KW - mHealth KW - antibiotic KW - behavior KW - adults KW - diagnosis KW - pulmonary KW - patient N2 - Background: Mobile health platforms like smartphone apps that provide clinical guidelines are ubiquitous, yet their long-term impact on guideline adherence remains unclear. In 2016, an antibiotic guidelines app, called SCRIPT, was introduced in Auckland City Hospital, New Zealand, to provide local antibiotic guidelines to clinicians on their smartphones. Objective: We aimed to assess whether the provision of antibiotic guidelines in a smartphone app resulted in sustained changes in antibiotic guideline adherence by prescribers. Methods: We analyzed antibiotic guideline adherence rates during the first 24 hours of hospital admission in adults diagnosed with community-acquired pneumonia using an interrupted time-series study with 3 distinct periods post app implementation (ie, 3, 12, and 24 months). Results: Adherence increased from 23% (46/200) at baseline to 31% (73/237) at 3 months and 34% (69/200) at 12 months, reducing to 31% (62/200) at 24 months post app implementation (P=.07 vs baseline). However, increased adherence was sustained in patients with pulmonary consolidation on x-ray (9/63, 14% at baseline; 23/77, 30% after 3 months; 32/92, 35% after 12 month; and 32/102, 31% after 24 months; P=.04 vs baseline). Conclusions: An antibiotic guidelines app increased overall adherence, but this was not sustained. In patients with pulmonary consolidation, the increased adherence was sustained. UR - https://www.jmir.org/2023/1/e42978 UR - http://dx.doi.org/10.2196/42978 UR - http://www.ncbi.nlm.nih.gov/pubmed/37129941 ID - info:doi/10.2196/42978 ER - TY - JOUR AU - Ndlovu, Kagiso AU - Mars, Maurice AU - Scott, E. Richard PY - 2023/5/2 TI - Validation of an Interoperability Framework for Linking mHealth Apps to Electronic Record Systems in Botswana: Expert Survey Study JO - JMIR Form Res SP - e41225 VL - 7 KW - mobile health KW - mHealth KW - electronic record systems KW - eRecord systems KW - mHealth-eRecord Interoperability Framework KW - mHeRIF KW - interoperability architecture KW - validation KW - Botswana KW - mobile phone N2 - Background: Electronic record (eRecord) systems and mobile health (mHealth) apps have documented potential to improve health service delivery, resulting in increased global uptake. However, their interoperability remains a global challenge hindering diagnosis, monitoring of health conditions, and data access irrespective of geographic location. Given the widespread use of mobile devices by patients and health care providers, linking mHealth apps and eRecord systems could result in a comprehensive and seamless data exchange within a health care community. The Botswana National eHealth Strategy recognizes interoperability as an issue and mHealth as a potential solution for some health care needs but is silent on how to make mHealth apps interoperable with existing eRecord systems. A literature review and analysis of existing mHealth interoperability frameworks found none suitable for Botswana. As such, it was critical to conceptualize, design, and develop an mHealth-eRecord Interoperability Framework (mHeRIF) to enhance the interoperability pillar of the Botswana National eHealth Strategy and leverage the full benefits of linking mHealth apps with other health information systems. Objective: This study aimed to validate the developed mHeRIF and determine whether it requires further refinement before consideration towards enhancing the National eHealth Strategy. Methods: Published framework validation approaches guided the development of a survey administered to 12 purposively selected local and international eHealth experts. In total, 25% (3/12) of the experts were drawn from Botswana, 25% (3/12) were drawn from low- and middle-income countries in sub-Saharan Africa, 25% (3/12) were drawn from low- and middle-income countries outside Africa, and 25% (3/12) were drawn from high-income countries. Quantitative responses were collated in a Microsoft Excel (Microsoft Corp) spreadsheet for descriptive analysis, and the NVivo software (version 11; QSR International) was used to aid the thematic analysis of the qualitative open-ended questions. Results: The analysis of responses showed overall support for the content and format of the proposed mHeRIF. However, some experts? suggestions led to 4 modest revisions of the mHeRIF. Conclusions: Overall, the experts? reviews showed that the mHeRIF could contribute to the National eHealth Strategy by guiding the linking of mHealth apps to existing eRecord systems in Botswana. Similarly, the experts validated an architectural model derived from the mHeRIF in support of the first mobile telemedicine initiative considered for national rollout in Botswana. The mHeRIF helps identify key components to consider before and after linking mHealth apps to eRecord systems and is being considered for use as the foundation of such interoperability in Botswana. UR - https://formative.jmir.org/2023/1/e41225 UR - http://dx.doi.org/10.2196/41225 UR - http://www.ncbi.nlm.nih.gov/pubmed/37129939 ID - info:doi/10.2196/41225 ER - TY - JOUR AU - Wong, Ching Arkers Kwan AU - Bayuo, Jonathan AU - Wong, Yuet Frances Kam AU - Chow, Sum Karen Kit AU - Wong, Man Siu AU - Lau, Ki Avis Cheuk PY - 2023/5/1 TI - The Synergistic Effect of Nurse Proactive Phone Calls With an mHealth App Program on Sustaining App Usage: 3-Arm Randomized Controlled Trial JO - J Med Internet Res SP - e43678 VL - 25 KW - adults KW - application KW - apps KW - behavior KW - community KW - depression KW - diabetes KW - disease KW - hypertension KW - intervention KW - mHealth KW - older adults KW - proactive KW - program KW - self-efficacy KW - self-management KW - technology KW - usage N2 - Background: Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time. Objective: We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app. Methods: This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months? postintervention (T3) to ascertain the sustained effect. Results: A total of 37.8% of mHealth+I and 18.3% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant (?21=6.81, P=.009). Improvements in self-efficacy (?=4.30, 95% CI 0.25-8.35, P=.04) and depression levels (?=?1.98, 95% CI ?3.78 to ?0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 (?=?1.38, 95% CI ?1.98 to ?0.78, P<.001), with a marginal increase at T3. Conclusions: The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth. Trial Registration: ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212 International Registered Report Identifier (IRRID): RR2-10.1159/000509129 UR - https://www.jmir.org/2023/1/e43678 UR - http://dx.doi.org/10.2196/43678 UR - http://www.ncbi.nlm.nih.gov/pubmed/37126378 ID - info:doi/10.2196/43678 ER - TY - JOUR AU - Wang, Tongnian AU - Du, Yan AU - Gong, Yanmin AU - Choo, Raymond Kim-Kwang AU - Guo, Yuanxiong PY - 2023/5/1 TI - Applications of Federated Learning in Mobile Health: Scoping Review JO - J Med Internet Res SP - e43006 VL - 25 KW - decision support KW - distributed systems KW - federated learning KW - health monitoring KW - mHealth KW - privacy N2 - Background: The proliferation of mobile health (mHealth) applications is partly driven by the advancements in sensing and communication technologies, as well as the integration of artificial intelligence techniques. Data collected from mHealth applications, for example, on sensor devices carried by patients, can be mined and analyzed using artificial intelligence?based solutions to facilitate remote and (near) real-time decision-making in health care settings. However, such data often sit in data silos, and patients are often concerned about the privacy implications of sharing their raw data. Federated learning (FL) is a potential solution, as it allows multiple data owners to collaboratively train a machine learning model without requiring access to each other?s raw data. Objective: The goal of this scoping review is to gain an understanding of FL and its potential in dealing with sensitive and heterogeneous data in mHealth applications. Through this review, various stakeholders, such as health care providers, practitioners, and policy makers, can gain insight into the limitations and challenges associated with using FL in mHealth and make informed decisions when considering implementing FL-based solutions. Methods: We conducted a scoping review following the guidelines of PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). We searched 7 commonly used databases. The included studies were analyzed and summarized to identify the possible real-world applications and associated challenges of using FL in mHealth settings. Results: A total of 1095 articles were retrieved during the database search, and 26 articles that met the inclusion criteria were included in the review. The analysis of these articles revealed 2 main application areas for FL in mHealth, that is, remote monitoring and diagnostic and treatment support. More specifically, FL was found to be commonly used for monitoring self-care ability, health status, and disease progression, as well as in diagnosis and treatment support of diseases. The review also identified several challenges (eg, expensive communication, statistical heterogeneity, and system heterogeneity) and potential solutions (eg, compression schemes, model personalization, and active sampling). Conclusions: This scoping review has highlighted the potential of FL as a privacy-preserving approach in mHealth applications and identified the technical limitations associated with its use. The challenges and opportunities outlined in this review can inform the research agenda for future studies in this field, to overcome these limitations and further advance the use of FL in mHealth. UR - https://www.jmir.org/2023/1/e43006 UR - http://dx.doi.org/10.2196/43006 UR - http://www.ncbi.nlm.nih.gov/pubmed/37126398 ID - info:doi/10.2196/43006 ER - TY - JOUR AU - Woolley, E. Katherine AU - Bright, Diana AU - Ayres, Toby AU - Morgan, Fiona AU - Little, Kirsty AU - Davies, R. Alisha PY - 2023/4/28 TI - Mapping Inequities in Digital Health Technology Within the World Health Organization?s European Region Using PROGRESS PLUS: Scoping Review JO - J Med Internet Res SP - e44181 VL - 25 KW - digital health KW - health inequities KW - PROGRESS PLUS KW - health services accessibility KW - health care disparities KW - mobile phone N2 - Background: The use of digital technologies within health care rapidly increased as services transferred to web-based platforms during the COVID-19 pandemic. Inequalities in digital health across the domains of equity are not routinely examined; yet, the long-term integration of digitally delivered services needs to consider such inequalities to ensure equitable benefits. Objective: This scoping review aimed to map inequities in access, use, and engagement with digital health technologies across equity domains. Methods: We searched 4 electronic databases (MEDLINE, ASSIA, PsycINFO, and Scopus) for quantitative and mixed methods reviews and meta-analyses published between January 2016 and May 2022. Reviews were limited to those that included studies from the World Health Organization?s European region. Extracted data were mapped against Cochrane?s PROGRESS PLUS (place of residence, race, ethnicity, culture, and language, occupation, gender and sex, religion, education, socioeconomic status, social capital, and other characteristics) dimensions of equity. Results: In total, 404 unique citations were identified from the searches, and 2 citations were identified from other sources. After eligibility assessment, 22 reviews were included. Consistent evidence was found showing higher access to digital health technologies among patients who were of White ethnicity, were English speaking, and had no disability. There were no reviews that explored differences in access to digital health care by age, gender and sex, occupation, education, or homeless or substance misuse. Higher use of digital health technologies was observed among populations that were White, English speaking, younger, with a higher level of education, of higher economic status, and residents in urban areas. No clear evidence of differences in the use of digital technologies by occupation, gender and sex, disability, or homeless or substance misuse was found, nor was clear evidence found in the included reviews on inequalities in the engagement with digital technologies. Finally, no reviews were identified that explored differences by place of residence. Conclusions: Despite awareness of the potential impact of inequalities in digital health, there are important evidence gaps across multiple equity domains. The development of a common framework for evaluating digital health equity in new health initiatives and consistency in reporting findings is needed. UR - https://www.jmir.org/2023/1/e44181 UR - http://dx.doi.org/10.2196/44181 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115613 ID - info:doi/10.2196/44181 ER - TY - JOUR AU - He, Yuhao AU - Yang, Li AU - Qian, Chunlian AU - Li, Tong AU - Su, Zhengyuan AU - Zhang, Qiang AU - Hou, Xiangqing PY - 2023/4/28 TI - Conversational Agent Interventions for Mental Health Problems: Systematic Review and Meta-analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e43862 VL - 25 KW - chatbot and conversational agent KW - mental health KW - meta-analysis KW - depression KW - anxiety KW - quality of life KW - stress KW - mobile health KW - mHealth KW - digital medicine KW - meta-regression KW - mobile phone N2 - Background: Mental health problems are a crucial global public health concern. Owing to their cost-effectiveness and accessibility, conversational agent interventions (CAIs) are promising in the field of mental health care. Objective: This study aims to present a thorough summary of the traits of CAIs available for a range of mental health problems, find evidence of efficacy, and analyze the statistically significant moderators of efficacy via a meta-analysis of randomized controlled trial. Methods: Web-based databases (Embase, MEDLINE, PsycINFO, CINAHL, Web of Science, and Cochrane) were systematically searched dated from the establishment of the database to October 30, 2021, and updated to May 1, 2022. Randomized controlled trials comparing CAIs with any other type of control condition in improving depressive symptoms, generalized anxiety symptoms, specific anxiety symptoms, quality of life or well-being, general distress, stress, mental disorder symptoms, psychosomatic disease symptoms, and positive and negative affect were considered eligible. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were extracted by 2 independent reviewers, checked by a third reviewer, and pooled using both random effect models and fixed effects models. Hedges g was chosen as the effect size. Results: Of the 6900 identified records, a total of 32 studies were included, involving 6089 participants. CAIs showed statistically significant short-term effects compared with control conditions in improving depressive symptoms (g=0.29, 95% CI 0.20-0.38), generalized anxiety symptoms (g=0.29, 95% CI 0.21-0.36), specific anxiety symptoms (g=0.47, 95% CI 0.07-0.86), quality of life or well-being (g=0.27, 95% CI 0.16-0.39), general distress (g=0.33, 95% CI 0.20-0.45), stress (g=0.24, 95% CI 0.08-0.41), mental disorder symptoms (g=0.36, 95% CI 0.17-0.54), psychosomatic disease symptoms (g=0.62, 95% CI 0.14-1.11), and negative affect (g=0.28, 95% CI 0.05-0.51). However, the long-term effects of CAIs for the most mental health outcomes were not statistically significant (g=?0.04 to 0.39). Personalization and empathic response were 2 critical facilitators of efficacy. The longer duration of interaction with conversational agents was associated with the larger pooled effect sizes. Conclusions: The findings show that CAIs are research-proven interventions that ought to be implemented more widely in mental health care. CAIs are effective and easily acceptable for those with mental health problems. The clinical application of this novel digital technology will conserve human health resources and optimize the allocation of mental health services. Trial Registration: PROSPERO CRD42022350130; https://tinyurl.com/mvhk6w9p UR - https://www.jmir.org/2023/1/e43862 UR - http://dx.doi.org/10.2196/43862 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115595 ID - info:doi/10.2196/43862 ER - TY - JOUR AU - Zhang, Na AU - Zhou, Mingzhu AU - Li, Muxia AU - Ma, Guansheng PY - 2023/4/28 TI - Effects of Smartphone-Based Remote Interventions on Dietary Intake, Physical Activity, Weight Control, and Related Health Benefits Among the Older Population With Overweight and Obesity in China: Randomized Controlled Trial JO - J Med Internet Res SP - e41926 VL - 25 KW - overweight and obesity KW - remote interventions KW - older population KW - dietary intake KW - physical activity KW - weight management KW - health KW - mobile phone N2 - Background: Traditional health management requires many human and material resources and cannot meet the growing needs. Remote medical technology provides an opportunity for health management; however, the research on it is insufficient. Objective: The objective of this study was to assess the effects of remote interventions on weight management. Methods: In this randomized controlled study, 750 participants were randomly assigned to a remote dietary and physical activity intervention group (group DPI), remote physical activity intervention group (group PI), or control group (group C). At baseline (time 1), day 45 (time 2), and day 90 (time 3), data were collected, including data on dietary intake, physical activity, indexes related to weight control, and health benefits. Results: A total of 85.6% (642/750) of participants completed the follow-up. Compared with group C, group DPI showed a significant decrease in energy intake (?581 vs ?82 kcal; P<.05), protein intake (?17 vs ?3 g; P<.05), fat intake (?8 vs 3 g; P<.05), and carbohydrate intake (?106.5 vs ?4.7 g; P<.05) at time 3. Compared with time 1, groups DPI and PI showed a significant decrease in cereal and potato intake (P<.05). Compared with time 1, the physical activity levels related to transportation (group PI: 693 vs 597 metabolic equivalent [MET]?min/week, group C: 693 vs 594 MET-min/week; P<.05) and housework and gardening (group PI: 11 vs 0 MET-min/week, group C: 11 vs 4 MET-min/week; P<.05) in groups PI and C were improved at time 3. Compared with groups PI and C, group DPI showed a significant decrease in weight (?1.56 vs ?0.86 kg and ?1.56 vs ?0.66 kg, respectively; P<.05) and BMI (?0.61 vs ?0.33 kg/m2 and ?0.61 vs ?0.27 kg/m2, respectively; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in body weight (?4.11 vs ?1.01 kg and ?4.11 vs ?0.83 kg, respectively; P<.05) and BMI (?1.61 vs ?0.40 kg/m2 and ?1.61 vs ?0.33 kg/m2, respectively; P<.05) at time 3. Compared with group C, group DPI showed a significant decrease in triglyceride (?0.06 vs 0.32 mmol/L; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in systolic blood pressure (?8.15 vs ?3.04 mmHg and ?8.15 vs ?3.80 mmHg, respectively; P<.05), triglyceride (?0.48 vs 0.11 mmol/L and ?0.48 vs 0.18 mmol/L, respectively; P<.05), and fasting blood glucose (?0.77 vs 0.43 mmol/L and ?0.77 vs 0.14 mmol/L, respectively; P<.05). There were significant differences in high-density lipoprotein cholesterol (?0.00 vs ?0.07 mmol/L; P<.05) and hemoglobin A1c (?0.19% vs ?0.07%; P<.05) between groups DPI and C. Conclusions: Remote dietary and physical activity interventions can improve dietary intake among participants with overweight and obesity, are beneficial for weight control, and have potential health benefits. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023355; https://www.chictr.org.cn/showproj.html?proj=38976 UR - https://www.jmir.org/2023/1/e41926 UR - http://dx.doi.org/10.2196/41926 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115608 ID - info:doi/10.2196/41926 ER - TY - JOUR AU - Johansen, Kristoffer Simon AU - Kanstrup, Marie Anne AU - Haseli, Kian AU - Stenmo, Hildebrandt Visti AU - Thomsen, Laust Janus AU - Rathleff, Skovdal Michael PY - 2023/4/28 TI - Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study JO - JMIR Hum Factors SP - e44462 VL - 10 KW - mobile health KW - mHealth KW - design KW - patient physician relationship KW - collaborative care KW - shared decision-making KW - adolescents KW - parents KW - knee pain KW - patellofemoral pain KW - Osgood Schlatter KW - musculoskeletal KW - general practice KW - primary care KW - mobile phone N2 - Background: Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents? self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents? knee pain in a general practice setting. Objective: The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents? everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. Methods: Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. Results: Overall, 38% (9/24) young adults with chronic knee pain since adolescence, 25% (6/24) parents, and 38% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants? roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. Conclusions: An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance. UR - https://humanfactors.jmir.org/2023/1/e44462 UR - http://dx.doi.org/10.2196/44462 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115609 ID - info:doi/10.2196/44462 ER - TY - JOUR AU - Stecher, Chad AU - Cloonan, Sara AU - Linnemayr, Sebastian AU - Huberty, Jennifer PY - 2023/4/28 TI - Combining Behavioral Economics?Based Incentives With the Anchoring Strategy: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e39930 VL - 12 KW - habits KW - mindfulness meditation KW - mobile apps KW - mobile health KW - mHealth KW - adherence KW - meditation KW - mindfulness KW - intervention KW - apps KW - smartphone apps KW - stress KW - management KW - mobile phone N2 - Background: Chronic (ie, long-term) elevated stress is associated with a number of mental and physical health conditions. Mindfulness meditation mobile apps are a promising tool for stress self-management that can overcome several barriers associated with in-person interventions; however, to date, poor app-based intervention adherence has limited the efficacy of these mobile health tools. Anchoring, or pairing, a new behavior with an existing routine has been shown to effectively establish habits that are maintained over time, but this strategy typically only works for those with high initial motivation and has yet to be tested for maintaining meditation with a mobile app. Objective: This study will test novel combinations of behavioral economics?based incentives with the anchoring strategy for establishing and maintaining adherence to an effective dose of meditation with a mobile app. Methods: This 16-week study will use a 5-arm, parallel, partially blinded (participants only), randomized controlled design. We will implement a fractional factorial study design that varies the use of self-monitoring messages and financial incentives to support participants? use of their personalized anchoring strategy for maintaining adherence to a ?10 minute-per-day meditation prescription during an 8-week intervention period, followed by an 8-week postintervention observation period. Specifically, we will vary the use of self-monitoring messages of either the target behavior (ie, meditation tracking) or the outcome associated with the target behavior (ie, mood symptom tracking). We will also vary the use of financial incentives conditional on either meditation at any time of day or meditation performed at approximately the same time of day as participants? personalized anchors. Results: Continuous meditation app use data will be used to measure weekly meditation adherence over the 16-week study period as a binary variable equal to 1 if participants complete ?10 minutes of meditation for ?4 days per week and 0 otherwise. We will measure weekly anchoring plan adherence as a binary variable equal to 1 if participants complete ?10 minutes of meditation within +1 or ?1 hour of the timing of their chosen anchor on ?4 days per week and 0 otherwise. In addition to these primary measures of meditation and anchoring plan adherence, we will also assess the secondary measures of stress, anxiety, posttraumatic stress disorder, sleep disturbance, and meditation app habit strength at baseline, week 8, and week 16. Conclusions: This study will fill an important gap in the mobile health literature by testing novel intervention approaches for establishing and maintaining adherence to app-based mindfulness meditation. If successful, this study will identify an accessible and scalable stress self-management intervention that can help combat stress in the United States. Trial Registration: ClinicalTrials.gov NCT05217602; https://clinicaltrials.gov/ct2/show/NCT05217602 International Registered Report Identifier (IRRID): DERR1-10.2196/39930 UR - https://www.researchprotocols.org/2023/1/e39930 UR - http://dx.doi.org/10.2196/39930 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115610 ID - info:doi/10.2196/39930 ER - TY - JOUR AU - Alshagrawi, Salah AU - Abidi, Taha Syed PY - 2023/4/27 TI - Efficacy of an mHealth Behavior Change Intervention for Promoting Physical Activity in the Workplace: Randomized Controlled Trial JO - J Med Internet Res SP - e44108 VL - 25 KW - text messaging KW - mobile phones KW - physical activity KW - eHealth KW - pedometer KW - smartphone KW - activity tracker KW - accelerometer KW - behavioral KW - workplace KW - risk factor KW - noncommunicable disease KW - BMI KW - wellness N2 - Background: Insufficient physical activity (PA) is a well-established risk factor for several noncommunicable diseases such as cardiovascular diseases, cancer, diabetes, depression, and dementia. The World Health Organization (WHO) advises that individuals engage in 150 minutes of moderate PA per week or 75 minutes of intense PA per week. According to the WHO?s latest report, 23% of adults fail to meet the minimum recommended level of PA. The percentage was even higher in a recent global study that showed 27% of adults were insufficiently active and reported a 5% increase in the prevalence trend of insufficient PA between 2001 and 2016. The study also showed the rate of insufficient PA among countries varied significantly. For instance, it was estimated that 40% were insufficiently active in the United States, and the percentage was even higher in Saudi Arabia (more than 50%). Governments are actively developing policies and methods to successfully establish a PA-inducing environment that encourages a healthy lifestyle in order to address the global steady decline in PA. Objective: The purpose of this study was to determine the effectiveness of mobile health (mHealth) interventions, particularly SMS text messaging interventions, to improve PA and decrease BMI in healthy adults in the workplace. Methods: In this parallel, 2-arm randomized controlled trial, healthy adults (N=327) were randomized to receive an mHealth intervention (tailored text messages combined with self-monitoring (intervention; n=166) or no intervention (control; n=161). Adults who were fully employed in an academic institution and had limited PA during working hours were recruited for the study. Outcomes, such as PA and BMI, were assessed at baseline and 3 months later. Results: Results showed significant improvement in PA levels (weekly step counts) in the intervention group (?=1097, 95% CI 922-1272, P<.001). There was also a significant reduction in BMI (?=0.60, 95% CI 0.50-0.69, P<.001). Conclusions: Combining tailored text messages and self-monitoring interventions to improve PA and lower BMI was significantly effective and has the potential to leverage current methods to improve wellness among the public. UR - https://www.jmir.org/2023/1/e44108 UR - http://dx.doi.org/10.2196/44108 UR - http://www.ncbi.nlm.nih.gov/pubmed/37103981 ID - info:doi/10.2196/44108 ER - TY - JOUR AU - Tran, Xuan Bach AU - Bui, Minh Thu AU - Do, Linh Anh AU - Boyer, Laurent AU - Auquier, Pascal AU - Nguyen, Hoang Long AU - Nguyen, Tran Anh Hai AU - Ngo, Van Toan AU - Latkin, A. Carl AU - Zhang, B. Melvyn W. AU - Ho, H. Cyrus S. AU - Ho, M. Roger C. PY - 2023/4/27 TI - Efficacy of a Mobile Phone?Based Intervention on Health Behaviors and HIV/AIDS Treatment Management: Randomized Controlled Trial JO - J Med Internet Res SP - e43432 VL - 25 KW - mobile health KW - HIV/AIDS KW - treatment adherence KW - self-efficacy KW - behavior KW - HIV KW - AIDS KW - treatment KW - management KW - care KW - feasibility KW - efficacy KW - intervention KW - mHealth KW - Vietnam KW - application N2 - Background: Antiretroviral therapy (ART) is considered the most important intervention for HIV-positive patients; thus, encouraging the use of and adherence to ART are vital to HIV treatment outcomes. Advances in web and mobile technologies hold potential in supporting HIV treatment management. Objective: The aim of this study was to evaluate the feasibility and efficacy of a theory-based mobile health (mHealth) intervention on health behaviors and HIV treatment adherence among patients with HIV/AIDS in Vietnam. Methods: We performed a randomized controlled trial on 425 HIV patients in two of the largest HIV clinics in Hanoi, Vietnam. Both the intervention group (238 patients) and the control group (187 patients) received regular consultations with doctors and then participated in 1-month and 3-month follow-up visits. Patients in the intervention group received a theory-driven smartphone app to facilitate medication adherence and self-efficacy in HIV patients. Measurements were developed based on the Health Belief Model, which included the visual analog scale of ART Adherence, HIV Treatment Adherence Self-Efficacy Scale, and HIV Symptom Management Self-Efficacy Scale. We also included the 9-item Patient Health Questionnaire (PHQ-9) to assess patients? mental health throughout treatment. Results: In the intervention group, the adherence score increased significantly (?=1.07, 95% CI .24-1.90) after 1 month, whereas the HIV adherence self-efficacy was significantly higher after 3 months (?=2.17, 95% CI 2.07-2.27) compared to the control group. There was a positive but low level of change in risk behaviors such as drinking, smoking, and drug use. Factors related to positive change in adherence were being employed and having stable mental well-being (lower PHQ-9 scores). Factors associated with self-efficacy in treatment adherence and symptom management were gender, occupation, younger age, and having no other underlying conditions. A longer duration of ART increased treatment adherence but decreased self-efficacy in symptom management. Conclusions: Our study demonstrated that the mHealth app could improve the overall ART adherence self-efficacy of patients. Further studies with larger sample sizes and longer follow-up periods are needed to support our findings. Trial Registration: Thai Clinical Trials Registry TCTR20220928003; https://www.thaiclinicaltrials.org/show/TCTR20220928003 UR - https://www.jmir.org/2023/1/e43432 UR - http://dx.doi.org/10.2196/43432 UR - http://www.ncbi.nlm.nih.gov/pubmed/37104001 ID - info:doi/10.2196/43432 ER - TY - JOUR AU - Klemme, Isabel AU - Wrona, J. Kamil AU - de Jong, Marije Irja AU - Dockweiler, Christoph AU - Aschentrup, Leona AU - Albrecht, Joanna PY - 2023/4/27 TI - Integration of the Vision of People With Diabetes Into the Development Process to Improve Self-management via Diabetes Apps: Qualitative Interview Study JO - JMIR Diabetes SP - e38474 VL - 8 KW - people with type 1 diabetes KW - self-management KW - diabetes apps KW - vision assessment KW - anticipated stigma KW - qualitative research KW - Digitale Gesundheitsanwendungen KW - DiGA KW - mobile phone N2 - Background: Diabetes is a major global epidemic and serious public health problem. Diabetes self-management is a 24/7 challenge for people with type 1 diabetes that influences their quality of life (QoL). Certain apps can support the self-management of people with diabetes; however, current apps do not meet the needs of people with diabetes appropriately, and their safety is not ensured. Moreover, there are a multitude of hardware and software problems associated with diabetes apps and regulations. Clear guidelines are required to regulate medical care via apps. In Germany, apps must undergo 2 examination processes to be listed in the Digitale Gesundheitsanwendungen directory. However, neither examination process considers whether the medical use of the apps is sufficient for users? self-management. Objective: This study aims to contribute to the technology development process of diabetes apps by exploring individual perspectives on desired features and content of diabetes apps among people with diabetes. The vision assessment conducted is a first step toward creating a shared vision among all relevant stakeholders. To ensure adequate research and development processes for diabetes apps in the future, guiding visions from all relevant stakeholders are required. Methods: In a qualitative study, 24 semistructured interviews with patients with type 1 diabetes were conducted, among whom 10 (42%) were currently using an app. To clarify the perceptions of people with diabetes regarding the functions and content of diabetes apps, a vision assessment was conducted. Results: People with diabetes have concrete ideas of features and content in apps to improve their QoL and allow them to live as comfortably as possible, such as informative predictions through artificial intelligence, improvements in signal loss and value delay through smartwatches, improved communication and information-sharing capabilities, reliable information sources, and user-friendly and discreet messaging options through smartwatches. In addition, according to people with diabetes, future apps should show improved sensors and app connectivity to avoid incorrect values being displayed. They also wish for an explicit indication that displayed values are delayed. In addition, personalized information was found to be lacking in apps. Conclusions: People with type 1 diabetes want future apps to improve their self-management and QoL and reduce stigma. Desired key features include personalized artificial intelligence predictions of blood glucose levels, improved communication and information sharing through chat and forum options, comprehensive information resources, and smartwatch alerts. A vision assessment is the first step in creating a shared vision among stakeholders to responsibly guide the development of diabetes apps. Relevant stakeholders include patient organizations, health care professionals, insurers, policy makers, device manufacturers, app developers, researchers, medical ethicists, and data security experts. After the research and development process, new apps must be launched while considering regulations regarding data security, liability, and reimbursement. UR - https://diabetes.jmir.org/2023/1/e38474 UR - http://dx.doi.org/10.2196/38474 UR - http://www.ncbi.nlm.nih.gov/pubmed/37104003 ID - info:doi/10.2196/38474 ER - TY - JOUR AU - Lin, Haoxiang AU - Wang, Ying AU - Xing, Yanling AU - Han, Yinglian AU - Zhang, Chengqian AU - Luo, Ting AU - Chang, Chun PY - 2023/4/26 TI - A Personalized Mobile Cessation Intervention to Promote Smokers From the Preparation Stage to the Action Stage: Double-blind Randomized Controlled Trial JO - J Med Internet Res SP - e41911 VL - 25 KW - smoking cessation KW - mobile health KW - health education KW - smoking KW - behavior intervention KW - behavior change KW - support KW - text message KW - personalized KW - smoking abstinence KW - health behavior KW - health promotion N2 - Background: Most mobile cessation studies have found that such interventions have a higher quitting rate than interventions providing minimal smoking cessation support. However, why such interventions are effective has been almost unstudied by researchers. Objective: This paper describes the principles of the personalized mobile cessation intervention-based WeChat app and used generalized estimated equations to assess why a personalized mobile cessation intervention was more likely to promote smokers from the preparation stage to the action stage than a nonpersonalized intervention. Methods: This is a 2-arm, double-blind, randomized controlled trial in five cities in China. The intervention group received a personalized mobile cessation intervention. The control group received a nonpersonalized SMS text message smoking cessation intervention. All information was sent by the WeChat app. The outcomes were the change in protection motivation theory construct scores and the change in transtheoretical model stages. Results: A total of 722 participants were randomly assigned to the intervention or control group. Compared with those who received the nonpersonalized SMS text message intervention, smokers who received the personalized intervention presented lower intrinsic rewards, extrinsic rewards, and response costs. Intrinsic rewards were determinants of stage change, thus explaining why the intervention group was more likely to promote smokers from the preparation stage to the action stage (odds ratio 2.65, 95% CI 1.41-4.98). Conclusions: This study identified the psychological determinants at different stages to facilitate smokers moving forward to the next stage of quitting behavior and provides a framework to explore why a smoking cessation intervention is effective. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100041942; https://tinyurl.com/2hhx4m7f UR - https://www.jmir.org/2023/1/e41911 UR - http://dx.doi.org/10.2196/41911 UR - http://www.ncbi.nlm.nih.gov/pubmed/37099360 ID - info:doi/10.2196/41911 ER - TY - JOUR AU - Ghosh, Arka AU - Cherian, J. Rithwik AU - Wagle, Surbhit AU - Sharma, Parth AU - Kannan, R. Karthikeyan AU - Bajpai, Alok AU - Gupta, Nitin PY - 2023/4/26 TI - An Unguided, Computerized Cognitive Behavioral Therapy Intervention (TreadWill) in a Lower Middle-Income Country: Pragmatic Randomized Controlled Trial JO - J Med Internet Res SP - e41005 VL - 25 KW - computerized cognitive behavioral therapy KW - cCBT KW - depression KW - digital intervention KW - mobile phone N2 - Background: Globally, most individuals who are susceptible to depression do not receive adequate or timely treatment. Unguided computerized cognitive behavioral therapy (cCBT) has the potential to bridge this treatment gap. However, the real-world effectiveness of unguided cCBT interventions, particularly in low- and middle-income countries (LMICs), remains inconclusive. Objective: In this study, we aimed to report the design and development of a new unguided cCBT?based multicomponent intervention, TreadWill, and its pragmatic evaluation. TreadWill was designed to be fully automated, engaging, easy to use, and accessible to LMICs. Methods: To evaluate the effectiveness of TreadWill and the engagement level, we performed a double-blind, fully remote, and randomized controlled trial with 598 participants in India and analyzed the data using a completer?s analysis. Results: The users who completed at least half of the modules in TreadWill showed significant reduction in depression-related (P=.04) and anxiety-related (P=.02) symptoms compared with the waitlist control. Compared with a plain-text version with the same therapeutic content, the full-featured version of TreadWill showed significantly higher engagement (P=.01). Conclusions: Our study provides a new resource and evidence for the use of unguided cCBT as a scalable intervention in LMICs. Trial Registration: ClinicalTrials.gov NCT03445598; https://clinicaltrials.gov/ct2/show/NCT03445598 UR - https://www.jmir.org/2023/1/e41005 UR - http://dx.doi.org/10.2196/41005 UR - http://www.ncbi.nlm.nih.gov/pubmed/37099376 ID - info:doi/10.2196/41005 ER - TY - JOUR AU - Xia, Jizhe AU - Yin, Kun AU - Yue, Yang AU - Li, Qingquan AU - Wang, Xiling AU - Hu, Dongsheng AU - Wang, Xiong AU - Du, Zhanwei AU - Cowling, J. Ben AU - Chen, Erzhen AU - Zhou, Ying PY - 2023/4/26 TI - Impact of Human Mobility on COVID-19 Transmission According to Mobility Distance, Location, and Demographic Factors in the Greater Bay Area of China: Population-Based Study JO - JMIR Public Health Surveill SP - e39588 VL - 9 KW - COVID-19 KW - mobility restriction KW - mobility distance KW - demographic factors KW - locations N2 - Background: Mobility restriction was one of the primary measures used to restrain the spread of COVID-19 globally. Governments implemented and relaxed various mobility restriction measures in the absence of evidence for almost 3 years, which caused severe adverse outcomes in terms of health, society, and economy. Objective: This study aimed to quantify the impact of mobility reduction on COVID-19 transmission according to mobility distance, location, and demographic factors in order to identify hotspots of transmission and guide public health policies. Methods: Large volumes of anonymized aggregated mobile phone position data between January 1 and February 24, 2020, were collected for 9 megacities in the Greater Bay Area, China. A generalized linear model (GLM) was established to test the association between mobility volume (number of trips) and COVID-19 transmission. Subgroup analysis was also performed for sex, age, travel location, and travel distance. Statistical interaction terms were included in a variety of models that express different relations between involved variables. Results: The GLM analysis demonstrated a significant association between the COVID-19 growth rate ratio (GR) and mobility volume. A stratification analysis revealed a higher effect of mobility volume on the COVID-19 GR among people aged 50-59 years (GR decrease of 13.17% per 10% reduction in mobility volume; P<.001) than among other age groups (GR decreases of 7.80%, 10.43%, 7.48%, 8.01%, and 10.43% for those aged ?18, 19-29, 30-39, 40-49, and ?60 years, respectively; P=.02 for the interaction). The impact of mobility reduction on COVID-19 transmission was higher for transit stations and shopping areas (instantaneous reproduction number [Rt] decreases of 0.67 and 0.53 per 10% reduction in mobility volume, respectively) than for workplaces, schools, recreation areas, and other locations (Rt decreases of 0.30, 0.37, 0.44, and 0.32, respectively; P=.02 for the interaction). The association between mobility volume reduction and COVID-19 transmission was lower with decreasing mobility distance as there was a significant interaction between mobility volume and mobility distance with regard to Rt (P<.001 for the interaction). Specifically, the percentage decreases in Rt per 10% reduction in mobility volume were 11.97% when mobility distance increased by 10% (Spring Festival), 6.74% when mobility distance remained unchanged, and 1.52% when mobility distance declined by 10%. Conclusions: The association between mobility reduction and COVID-19 transmission significantly varied according to mobility distance, location, and age. The substantially higher impact of mobility volume on COVID-19 transmission for longer travel distance, certain age groups, and specific travel locations highlights the potential to optimize the effectiveness of mobility restriction strategies. The results from our study demonstrate the power of having a mobility network using mobile phone data for surveillance that can monitor movement at a detailed level to measure the potential impacts of future pandemics. UR - https://publichealth.jmir.org/2023/1/e39588 UR - http://dx.doi.org/10.2196/39588 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848228 ID - info:doi/10.2196/39588 ER - TY - JOUR AU - Zhaunova, Liudmila AU - Bamford, Ryan AU - Radovic, Tara AU - Wickham, Aidan AU - Peven, Kimberly AU - Croft, Jazz AU - Klepchukova, Anna AU - Ponzo, Sonia PY - 2023/4/26 TI - Characterization of Self-reported Improvements in Knowledge and Health Among Users of Flo Period Tracking App: Cross-sectional Survey JO - JMIR Mhealth Uhealth SP - e40427 VL - 11 KW - health knowledge KW - menstrual cycle KW - pregnancy KW - period-tracking app KW - digital health KW - women?s health N2 - Background: Research shows that poor knowledge and awareness of menstrual and pregnancy health among women are associated with adverse reproductive health and pregnancy outcomes. Menstrual cycle? and pregnancy-tracking mobile apps are promising tools for improving women?s awareness of and attitudes toward their reproductive health; however, there is little information about subscribers? perceptions of app functionality and its impact on their knowledge and health. Objective: This study aimed to explore knowledge and health improvements related to menstrual cycle and pregnancy, as well as improvements in general health among Flo app users. We also investigated what components of the Flo app were associated with the abovementioned improvements and evaluated whether those improvements differed based on education level, country of residence (low- and middle-income vs high-income countries), free or premium subscription to the app, short- or long-term use of the app, and frequency of use. Methods: Flo subscribers who had been using the app for no less than 30 days, completed a web-based survey. A total of 2212 complete survey responses were collected. The survey included demographic questions and questions about motivations guiding the use of the Flo app and which components of the app improved their knowledge and health, as well as to what extent. Results: Most study participants reported improvements in menstrual cycle (1292/1452, 88.98%) and pregnancy (698/824, 84.7%) knowledge from Flo app use. Participants with higher levels of education and those from high-income countries reported using the app predominantly for getting pregnant (?21=4.2, P=.04; ?21=52.3, P<.001, respectively) and pregnancy tracking (?21=19.3, P<.001; ?21=20.9, P=.001, respectively). Participants with less education reported using the app to avoid pregnancy (?21=4.2; P=.04) and to learn more about their body (?21=10.8; P=.001) and sexual health (?21=6.3; P=.01), while participants from low- and middle-income countries intended to mainly learn more about their sexual health (?21=18.2; P<.001). Importantly, the intended use of the app across education levels and country income levels matched areas in which they had gained knowledge and achieved their health goals upon use of the Flo app. Period, fertile days, and ovulation predictions as well as symptom tracking were consistently the top 3 components in the app that helped users with their cycle knowledge and general health. Reading articles or watching videos helped with users' education regarding their pregnancy. Finally, the strongest improvements in knowledge and health were observed in premium, frequent, and long-term users. Conclusions: This study suggests that menstrual health apps, such as Flo, could present revolutionary tools to promote consumer health education and empowerment on a global scale. UR - https://mhealth.jmir.org/2023/1/e40427 UR - http://dx.doi.org/10.2196/40427 UR - http://www.ncbi.nlm.nih.gov/pubmed/37099370 ID - info:doi/10.2196/40427 ER - TY - JOUR AU - Lind, N. Monika AU - Kahn, E. Lauren AU - Crowley, Ryann AU - Reed, Wyatt AU - Wicks, Geordie AU - Allen, B. Nicholas PY - 2023/4/26 TI - Reintroducing the Effortless Assessment Research System (EARS) JO - JMIR Ment Health SP - e38920 VL - 10 KW - mobile sensing KW - passive sensing KW - personal sensing KW - digital phenotyping KW - ecological momentary assessment KW - digital mental health UR - https://mental.jmir.org/2023/1/e38920 UR - http://dx.doi.org/10.2196/38920 UR - http://www.ncbi.nlm.nih.gov/pubmed/37099361 ID - info:doi/10.2196/38920 ER - TY - JOUR AU - Xie, Feng Li AU - Housni, Asmaa AU - Nakhla, Meranda AU - Cianci, Rosemarie AU - Leroux, Catherine AU - Da Costa, Deborah AU - Brazeau, Anne-Sophie PY - 2023/4/26 TI - Adaptation of an Adult Web Application for Type 1 Diabetes Self-management to Youth Using the Behavior Change Wheel to Tailor the Needs of Health Care Transition: Qualitative Interview Study JO - JMIR Diabetes SP - e42564 VL - 8 KW - type 1 diabetes KW - youth KW - eHealth KW - self-management KW - mobile phone KW - peer support N2 - Background: Youth (aged 14-24 years) living with type 1 diabetes (T1D) encounter increased challenges in their diabetes self-management (DSM), especially during the transition to adult care. Although DSM education and support are imperative, there is insufficient information on how web-based digital tools tailored to their demands can be developed. Objective: On the basis of the Behavior Change Wheel, this study aims to identify, among youth living with T1D, the needs and factors influencing their DSM in the context of health care transition and to inform the adaptation (content and features) of an adult self-guided web application (Support). Methods: Internet-based semistructured individual interviews based on a phenomenological study design were conducted with 21 youths, and transcripts were analyzed using an inductive approach with concept mapping. Results: Factors influencing T1D self-management were categorized into barriers and facilitators and then as external or internal. Features influencing the accessibility to information, increasing the sense of support, and use of the tool were positively accepted. Features unrelated to their expectations of digital tool use or difficulty navigating were viewed negatively. Participants expressed an interest in reliable, practical, and novel educational content. Although youth considered the information provided by medical professionals to be important, peer exchange was deemed necessary to obtain a practical perspective and real-life examples. Conclusions: Compared with the adult population, in addition to tailored content and a simplified information search process, when building a DSM education and support digital tool for youth, features should be selected to encourage supervised peer exchange. UR - https://diabetes.jmir.org/2023/1/e42564 UR - http://dx.doi.org/10.2196/42564 UR - http://www.ncbi.nlm.nih.gov/pubmed/37121571 ID - info:doi/10.2196/42564 ER - TY - JOUR AU - Tugault-Lafleur, N. Claire AU - De-Jongh González, Olivia AU - Macdonald, Janice AU - Bradbury, Jennifer AU - Warshawski, Tom AU - Ball, C. Geoff D. AU - Morrison, Katherine AU - Ho, Josephine AU - Hamilton, Jill AU - Buchholz, Annick AU - Mâsse, Louise PY - 2023/4/25 TI - Efficacy of the Aim2Be Intervention in Changing Lifestyle Behaviors Among Adolescents With Overweight and Obesity: Randomized Controlled Trial JO - J Med Internet Res SP - e38545 VL - 25 KW - mobile health KW - mHealth KW - childhood obesity KW - lifestyle management KW - adolescents KW - randomized controlled trial KW - RCT KW - mobile phone N2 - Background: Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. Objective: The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. Methods: A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents? assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. Results: A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. Conclusions: The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. Trial Registration: ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4080-2 UR - https://www.jmir.org/2023/1/e38545 UR - http://dx.doi.org/10.2196/38545 UR - http://www.ncbi.nlm.nih.gov/pubmed/37097726 ID - info:doi/10.2196/38545 ER - TY - JOUR AU - Simmons, A. Christina AU - Moretti, E. Abigail AU - Lobo, F. Andrea AU - Tremoulet, D. Patrice PY - 2023/4/25 TI - Direct Support Professionals? Perspectives on Using Technology to Help Support Adults With Autism Spectrum Disorder: Mixed Methods Study JO - JMIR Form Res SP - e40722 VL - 7 KW - technology KW - data collection KW - documentation KW - direct support professionals KW - autism KW - mobile phone N2 - Background: Documentation is a critical responsibility for direct support professionals (DSPs) who work with adults with autism spectrum disorder (ASD); however, it contributes significantly to their workload. Targeted efforts must be made to mitigate the burden of necessary data collection and documentation, which contributes to high DSP turnover rates and poor job satisfaction. Objective: This mixed methods study aimed to explore how technology could assist DSPs who work with adults with ASD and prioritize aspects of technology that would be most useful for future development efforts. Methods: In the first study, 15 DSPs who worked with adults with ASD participated in 1 of the 3 online focus groups. The topics included daily tasks, factors that would influence the adoption of technology, and how DSPs would like to interact with technologies to provide information about their clients. Responses were thematically analyzed across focus groups and ranked by salience. In the second study, 153 DSPs across the United States rated the usefulness of technology features and data entry methods and provided qualitative responses on their concerns regarding the use of technology for data collection and documentation. Quantitative responses were ranked based on their usefulness across participants, and rank-order correlations were calculated between different work settings and age groups. The qualitative responses were thematically analyzed. Results: In study 1, participants described difficulties with paper-and-pencil data collection, noted benefits and concerns about using technology instead, identified benefits and concerns about particular technology features, and specified work-environment factors that impact data collection. In study 2, participants rated multiple features of technology as useful, with the highest usefulness percentages endorsed for task views (ie, by shift, client, and DSP), logging completed tasks, and setting reminders for specific tasks. Participants also rated most data entry methods (eg, typing on a phone or tablet, typing on a keyboard, and choosing from options on a touch screen) as useful. Rank-order correlations indicated that the usefulness of technology features and data entry methods differed across work settings and age groups. Across both studies, DSPs cited some concerns with technology, such as confidentiality, reliability and accuracy, complexity and efficiency, and data loss from technology failure. Conclusions: Understanding the challenges faced by DSPs who work with adults with ASD, and their thoughts about using technology to meet those challenges, represents an essential first step toward developing technology solutions that can increase DSPs? effectiveness and job satisfaction. The survey results indicate that technology innovations should incorporate multiple features to account for different needs across DSPs, settings, and age groups. Future research should explore barriers to adopting data collection and documentation tools and elicit input from agency directors, families, and others interested in reviewing data about adults with ASD. UR - https://formative.jmir.org/2023/1/e40722 UR - http://dx.doi.org/10.2196/40722 UR - http://www.ncbi.nlm.nih.gov/pubmed/37097738 ID - info:doi/10.2196/40722 ER - TY - JOUR AU - McBride, Bronwyn AU - O'Neil, John AU - Nguyen, Chi Phuong AU - Linh, Thuy Dang AU - Trinh, Thi Hue AU - Vu, C. Nguyen AU - Nguyen, T. Liem PY - 2023/4/24 TI - Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project JO - JMIR Res Protoc SP - e44720 VL - 12 KW - mobile health KW - digital health KW - Vietnam KW - maternal health KW - maternal, newborn, and child health KW - MNCH, health equity, ethnic minority KW - maternal and child health KW - child health KW - ethnography KW - coronavirus KW - COVID-19 KW - perinatal KW - antenatal KW - woman KW - mother KW - pregnancy KW - newborn KW - infant KW - baby KW - ethnic KW - ethnicity KW - visible minority KW - culture N2 - Background: Due to interconnected structural determinants including low maternal health knowledge, economic marginalization, and remoteness from low-capacity health centers, ethnic minority women in remote areas of Vietnam face severe maternal, newborn, and child health (MNCH) inequities. As ethnic minorities represent 15% of the Vietnamese population, these disparities are significant. mMOM?a pilot mobile health (mHealth) intervention using SMS text messaging to improve MNCH outcomes among ethnic minority women in northern Vietnam?was implemented from 2013-2016 with promising results. Despite mMOM?s findings, exacerbated MNCH inequities, and digital health becoming more salient amid COVID-19, mHealth has not yet been scaled to address MNCH among ethnic minority women in Vietnam. Objective: We describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19?related MNCH guidance and novel technological components (mobile app and artificial intelligence chatbots) and quantitatively through broadening the geographical area to reach exponentially more participants, within the evolving COVID-19 context. Methods: dMOM will be conducted in 4 phases. (1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. (2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore ethnic minority women?s unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centers; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. (3) dMOM will be implemented and incrementally scaled across 71 project communes. (4) dMOM will be evaluated to assess whether SMS text messaging or mobile app delivery engenders better MNCH outcomes among ethnic minority women. The documentation of lessons learned and dMOM models will be shared with Vietnam?s Ministry of Health for adoption and further scaling up. Results: The dMOM study was funded by the International Development Research Centre (IDRC) in November 2021, cofacilitated by the Ministry of Health, and is being coimplemented by provincial health departments in 2 mountainous provinces. Phase 1 was initiated in May 2022, and phase 2 is planned to begin in December 2022. The study is expected to be complete in June 2025. Conclusions: dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among ethnic minority women in low-resource settings in Vietnam and provide critical information on the processes of adapting mHealth interventions to respond to COVID-19 and future pandemics. Finally, dMOM activities, models, and findings will inform a national intervention led by the Ministry of Health. International Registered Report Identifier (IRRID): PRR1-10.2196/44720 UR - https://www.researchprotocols.org/2023/1/e44720 UR - http://dx.doi.org/10.2196/44720 UR - http://www.ncbi.nlm.nih.gov/pubmed/37058576 ID - info:doi/10.2196/44720 ER - TY - JOUR AU - Lee, M. Alexandra AU - Hojjatinia, Sahar AU - Courtney, B. Jimikaye AU - Brunke-Reese, Deborah AU - Hojjatinia, Sarah AU - Lagoa, M. Constantino AU - Conroy, E. David PY - 2023/4/21 TI - Motivational Message Framing Effects on Physical Activity Dynamics in a Digital Messaging Intervention: Secondary Analysis JO - JMIR Form Res SP - e41414 VL - 7 KW - physical activity KW - exercise KW - fitness KW - Fitbit KW - tracking KW - patient-specific modeling KW - dynamical model KW - patient specific KW - fitness tracker KW - psychological theory KW - messaging KW - motivation KW - behavior change N2 - Background: Digital smartphone messaging can be used to promote physical activity to large populations with limited cost. It is not clear which psychological constructs should be targeted by digital messages to promote physical activity. This gap presents a challenge for developing optimal content for digital messaging interventions. Objective: The aim of this study is to compare affectively framed and social cognitively framed messages on subsequent changes in physical activity using dynamical modeling techniques. Methods: We conducted a secondary analysis of data collected from a digital messaging intervention in insufficiently active young adults (18-29 years) recruited between April 2019 and July 2020 who wore a Fitbit smartwatch for 6 months. Participants received 0 to 6 messages at random per day across the intervention period. Messages were drawn from 3 content libraries: affectively framed, social cognitively framed, or inspirational quotes. Person-specific dynamical models were identified, and model features of impulse response and cumulative step response were extracted for comparison. Two-way repeated-measures ANOVAs evaluated the main effects and interaction of message type and day type on model features. This early-phase work with novel dynamic features may have been underpowered to detect differences between message types so results were interpreted descriptively. Results: Messages (n=20,689) were paired with valid physical activity monitoring data from 45 participants for analysis. Received messages were distributed as 40% affective (8299/20,689 messages), 39% social-cognitive (8187/20,689 messages), and 20% inspirational quotes (4219/20,689 messages). There were no statistically significant main effects for message type when evaluating the steady state of step responses. Participants demonstrated heterogeneity in intervention response: some had their strongest responses to affectively framed messages, some had their strongest responses to social cognitively framed messages, and some had their strongest responses to the inspirational quote messages. Conclusions: No single type of digital message content universally promotes physical activity. Future work should evaluate the effects of multiple message types so that content can be continuously tuned based on person-specific responses to each message type. UR - https://formative.jmir.org/2023/1/e41414 UR - http://dx.doi.org/10.2196/41414 UR - http://www.ncbi.nlm.nih.gov/pubmed/37083710 ID - info:doi/10.2196/41414 ER - TY - JOUR AU - Shen, Alexander AU - Francisco, Luke AU - Sen, Srijan AU - Tewari, Ambuj PY - 2023/4/20 TI - Exploring the Relationship Between Privacy and Utility in Mobile Health: Algorithm Development and Validation via Simulations of Federated Learning, Differential Privacy, and External Attacks JO - J Med Internet Res SP - e43664 VL - 25 KW - privacy KW - data protection KW - machine learning KW - federated learning KW - neural networks KW - mobile health KW - mHealth KW - wearable electronic devices KW - differential privacy KW - learning KW - evidence KW - feasibility KW - applications KW - training KW - technology KW - mobile phone N2 - Background: Although evidence supporting the feasibility of large-scale mobile health (mHealth) systems continues to grow, privacy protection remains an important implementation challenge. The potential scale of publicly available mHealth applications and the sensitive nature of the data involved will inevitably attract unwanted attention from adversarial actors seeking to compromise user privacy. Although privacy-preserving technologies such as federated learning (FL) and differential privacy (DP) offer strong theoretical guarantees, it is not clear how such technologies actually perform under real-world conditions. Objective: Using data from the University of Michigan Intern Health Study (IHS), we assessed the privacy protection capabilities of FL and DP against the trade-offs in the associated model?s accuracy and training time. Using a simulated external attack on a target mHealth system, we aimed to measure the effectiveness of such an attack under various levels of privacy protection on the target system and measure the costs to the target system?s performance associated with the chosen levels of privacy protection. Methods: A neural network classifier that attempts to predict IHS participant daily mood ecological momentary assessment score from sensor data served as our target system. An external attacker attempted to identify participants whose average mood ecological momentary assessment score is lower than the global average. The attack followed techniques in the literature, given the relevant assumptions about the abilities of the attacker. For measuring attack effectiveness, we collected attack success metrics (area under the curve [AUC], positive predictive value, and sensitivity), and for measuring privacy costs, we calculated the target model training time and measured the model utility metrics. Both sets of metrics are reported under varying degrees of privacy protection on the target. Results: We found that FL alone does not provide adequate protection against the privacy attack proposed above, where the attacker?s AUC in determining which participants exhibit lower than average mood is over 0.90 in the worst-case scenario. However, under the highest level of DP tested in this study, the attacker?s AUC fell to approximately 0.59 with only a 10% point decrease in the target?s R2 and a 43% increase in model training time. Attack positive predictive value and sensitivity followed similar trends. Finally, we showed that participants in the IHS most likely to require strong privacy protection are also most at risk from this particular privacy attack and subsequently stand to benefit the most from these privacy-preserving technologies. Conclusions: Our results demonstrated both the necessity of proactive privacy protection research and the feasibility of the current FL and DP methods implemented in a real mHealth scenario. Our simulation methods characterized the privacy-utility trade-off in our mHealth setup using highly interpretable metrics, providing a framework for future research into privacy-preserving technologies in data-driven health and medical applications. UR - https://www.jmir.org/2023/1/e43664 UR - http://dx.doi.org/10.2196/43664 UR - http://www.ncbi.nlm.nih.gov/pubmed/37079370 ID - info:doi/10.2196/43664 ER - TY - JOUR AU - Guo, Yi-Qiang AU - Chen, Yuling AU - Dabbs, DeVito Annette AU - Wu, Ying PY - 2023/4/20 TI - The Effectiveness of Smartphone App?Based Interventions for Assisting Smoking Cessation: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e43242 VL - 25 KW - smartphone app KW - smoking cessation KW - meta-analysis KW - eHealth KW - mHealth KW - smoking KW - application KW - intervention KW - effectiveness KW - electronic KW - adult KW - pharmacotherapy N2 - Background: Smoking is a leading cause of premature death globally. Quitting smoking reduces the risk of all-cause mortality by 11%-34%. Smartphone app?based smoking cessation (SASC) interventions have been developed and are widely used. However, the evidence for the effectiveness of smartphone-based interventions for smoking cessation is currently equivocal. Objective: The purpose of this study was to synthesize the evidence for the effectiveness of smartphone app?based interventions for smoking cessation. Methods: We conducted a systematic review and meta-analysis of the effectiveness of smartphone interventions for smoking cessation based on the Cochrane methodology. An electronic literature search was performed using the Cochrane Library, Web of Science, PubMed, Embase, PsycINFO, China National Knowledge Infrastructure, and Wanfang databases to identify published papers in English or Chinese (there was no time limit regarding the publication date). The outcome was the smoking abstinence rate, which was either a 7-day point prevalence abstinence rate or a continuous abstinence rate. Results: A total of 9 randomized controlled trials involving 12,967 adults were selected for the final analysis. The selected studies from 6 countries (the United States, Spain, France, Switzerland, Canada, and Japan) were included in the meta-analysis between 2018 and 2022. Pooled effect sizes (across all follow-up time points) revealed no difference between the smartphone app group and the comparators (standard care, SMS text messaging intervention, web-based intervention, smoking cessation counseling, or apps as placebos without real function; odds ratio [OR] 1.25, 95% CI 0.99-1.56, P=.06, I2=73.6%). Based on the subanalyses, 6 trials comparing smartphone app interventions to comparator interventions reported no significant differences in effectiveness (OR 1.03, 95% CI 0.85-1.26, P=.74, I2=57.1%). However, the 3 trials that evaluated the combination of smartphone interventions combined with pharmacotherapy compared to pharmacotherapy alone found higher smoking abstinence rates in the combined intervention (OR 1.79, 95% CI 1.38-2.33, P=.74, I2=7.4%). All SASC interventions with higher levels of adherence were significantly more effective (OR 1.48, 95% CI 1.20-1.84, P<.001, I2=24.5%). Conclusions: This systematic review and meta-analysis did not support the effectiveness of delivering smartphone-based interventions alone to achieve higher smoking abstinence rates. However, the efficacy of smartphone-based interventions increased when combined with pharmacotherapy-based smoking cessation approaches. Trial Registration: PROSPERO CRD42021267615; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=267615 UR - https://www.jmir.org/2023/1/e43242 UR - http://dx.doi.org/10.2196/43242 UR - http://www.ncbi.nlm.nih.gov/pubmed/37079352 ID - info:doi/10.2196/43242 ER - TY - JOUR AU - Cochran, Amy AU - Maronge, M. Jacob AU - Victory, Amanda AU - Hoel, Sydney AU - McInnis, G. Melvin AU - Thomas, BK Emily PY - 2023/4/20 TI - Mobile Acceptance and Commitment Therapy in Bipolar Disorder: Microrandomized Trial JO - JMIR Ment Health SP - e43164 VL - 10 KW - acceptance and commitment therapy KW - bipolar disorder KW - mobile applications KW - randomized controlled trials KW - micro-randomized trial KW - precision medicine KW - mindfulness N2 - Background: Mobile interventions promise to fill in gaps in care with their broad reach and flexible delivery. Objective: Our goal was to investigate delivery of a mobile version of acceptance and commitment therapy (ACT) for individuals with bipolar disorder (BP). Methods: Individuals with BP (n=30) participated in a 6-week microrandomized trial. Twice daily, participants logged symptoms in the app and were repeatedly randomized (or not) to receive an ACT intervention. Self-reported behavior and mood were measured as the energy devoted to moving toward valued domains or away from difficult emotions and with depressive d and manic m scores from the digital survey of mood in BP survey (digiBP). Results: Participants completed an average of 66% of in-app assessments. Interventions did not significantly impact the average toward energy or away energy but did significantly increase the average manic score m (P=.008) and depressive score d (P=.02). This was driven by increased fidgeting and irritability and interventions focused on increasing awareness of internal experiences. Conclusions: The findings of the study do not support a larger study on the mobile ACT in BP but have significant implications for future studies seeking mobile therapy for individuals with BP. Trial Registration: ClinicalTrials.gov NCT04098497; https://clinicaltrials.gov/ct2/show/NCT04098497 UR - https://mental.jmir.org/2023/1/e43164 UR - http://dx.doi.org/10.2196/43164 UR - http://www.ncbi.nlm.nih.gov/pubmed/37079363 ID - info:doi/10.2196/43164 ER - TY - JOUR AU - Musgrave, Loretta AU - Cheney, Kate AU - Dorney, Edwina AU - Homer, E. Caroline S. AU - Gordon, Adrienne PY - 2023/4/19 TI - Addressing Preconception Behavior Change Through Mobile Phone Apps: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e41900 VL - 25 KW - apps KW - mobile KW - preconception KW - prenatal care KW - perinatal KW - reproductive health KW - reproductive age KW - maternal KW - interconception KW - behavior change KW - mobile phone N2 - Background: Positive health behavior changes before pregnancy can optimize perinatal outcomes for mothers, babies, and future generations. Women are often motivated to positively change their behavior in preparation for pregnancy to enhance their health and well-being. Mobile phone apps may provide an opportunity to deliver public health interventions during the preconception period. Objective: This review aimed to synthesize the evidence of the effectiveness of mobile phone apps in promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods), which may improve future outcomes for mothers and babies. Methods: Five databases were searched in February 2022 for studies exploring mobile phone apps as a prepregnancy intervention to promote positive behavior change. The identified studies were retrieved and exported to EndNote (Thomson Reuters). Using Covidence (Veritas Health Innovation), a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study flow diagram was generated to map the number of records identified, included, and excluded. Three independent reviewers assessed the risk of bias and conducted data extraction using the Review Manager software (version 5.4, The Cochrane Collaboration), and the data were then pooled using a random-effects model. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess the certainty of the evidence. Results: Of the 2973 publications identified, 7 (0.24%) were included. The total number of participants across the 7 trials was 3161. Of the 7 studies, 4 (57%) included participants in the interconception period, and 3 (43%) included women in the preconception period. Of the 7 studies, 5 (71%) studies focused on weight reduction, assessing the outcomes of reductions in adiposity and weight. Of the 7 studies, nutrition and dietary outcomes were evaluated in 2 (29%) studies, blood pressure outcomes were compared in 4 (57%) studies, and biochemical and marker outcomes associated with managing disease symptoms were included in 4 (57%) studies. Analysis showed that there were no statistically significant differences in energy intake; weight loss; body fat; and biomarkers such as glycated hemoglobin, total cholesterol, fasting lipid profiles, or blood pressure when compared with standard care. Conclusions: Owing to the limited number of studies and low certainty of the evidence, no firm conclusions can be drawn on the effects of mobile phone app interventions on promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods). Trial Registration: PROSPERO CRD42017065903; https://tinyurl.com/2p9dwk4a International Registered Report Identifier (IRRID): RR2-10.1186/s13643-019-0996-6 UR - https://www.jmir.org/2023/1/e41900 UR - http://dx.doi.org/10.2196/41900 UR - http://www.ncbi.nlm.nih.gov/pubmed/37074767 ID - info:doi/10.2196/41900 ER - TY - JOUR AU - Gosliner, Wendi AU - Felix, Celeste AU - Strochlic, Ron AU - Wright, Shana AU - Yates-Berg, Allison AU - Thompson, R. Hannah AU - Tang, Hao AU - Melendrez, Blanca PY - 2023/4/19 TI - Feasibility and Response to the San Diego County, California, Supplemental Nutrition Assistance Program (SNAP) Agency Sending Food and Nutrition Text Messages to All Participants: Quasi-Experimental Web-Based Survey Pilot Study JO - J Med Internet Res SP - e41021 VL - 25 KW - SNAP KW - CalFresh KW - text KW - SMS text messaging KW - nutrition KW - fruits KW - vegetables KW - mHealth N2 - Background: The Supplemental Nutrition Assistance Program (SNAP) provides over 40 million Americans with money for food without typically providing participants with food or nutrition information. Educational SMS text messages can reach large numbers of people, and studies suggest SNAP participants appreciate nutrition education and have access to mobile phones. Objective: Using a pre-post intervention design, we assessed the feasibility of, and program satisfaction and outcomes resulting from, the San Diego County, California SNAP agency sending monthly food and nutrition education SMS text messages to all SNAP participants to increase fruit and vegetable purchasing and consumption. Methods: We developed and sent 5 behavioral science?informed SMS text messages with links to a project website in English and Spanish with information about selecting, storing, and preparing seasonal fruits and vegetables. The San Diego County SNAP agency sent monthly texts to ~170,000 SNAP households from October 2020 to February 2021. SNAP participants completed web-based surveys in response to a text invitation from the SNAP agency in September 2020 (baseline, n=12,036) and April 2021 (follow-up, n=4927). Descriptive frequencies were generated, and adjusted multiple linear mixed models were run on a matched data set of participants that completed both baseline and follow-up surveys (n=875) assessing pre- or postattitudes, behaviors, knowledge, and self-efficacy. We used adjusted logistic regression models to assess differences between the matched (n=875) and nonmatched (n=4052) participants related to experiences with the intervention (questions asked only at follow-up). Results: After the intervention, matched participants reported significant increase in knowing where to get information about selecting, storing, and preparing fruits and vegetables (3.76 vs 4.02 on a 5-point Likert scale with 5=strongly agree, P<.001); feeling good about participating in SNAP (4.35 vs 4.43, P=.03); and thinking the CalFresh program helps them eat healthy (4.38 vs 4.48, P=.006). No significant pre- or postdifferences were found in fruit or vegetable consumption, though most participants at follow-up (n=1556, 64%) reported their consumption had increased. Among the sample that completed the follow-up survey only (n=4052, not including 875 participants who completed follow-up and baseline), 1583 (65%) and 1556 (64%) reported purchasing and eating more California-grown fruits and vegetables, respectively. Nearly all respondents appreciated the intervention (n=2203, 90%) and wanted it to continue (n=2037, 83%). Conclusions: SNAP can feasibly provide food and nutrition messages via text to participants. A monthly text campaign was well received by responding participants and improved some measures of their self-reported knowledge, self-efficacy, produce consumption, and perceptions of SNAP participation. Participants expressed interest in continuing to receive texts. While educational messages will not solve the complex food and nutrition challenges confronting SNAP participants, further work should employ rigorous methods to expand and test this intervention in other SNAP programs before considering to implement it at scale. UR - https://www.jmir.org/2023/1/e41021 UR - http://dx.doi.org/10.2196/41021 UR - http://www.ncbi.nlm.nih.gov/pubmed/37074786 ID - info:doi/10.2196/41021 ER - TY - JOUR AU - Chew, Jocelyn Han Shi AU - Rajasegaran, Nicole Nagadarshini AU - Chin, Han Yip AU - Chew, Nicholas W. S. AU - Kim, Mi Kyung PY - 2023/4/18 TI - Effectiveness of Combined Health Coaching and Self-Monitoring Apps on Weight-Related Outcomes in People With Overweight and Obesity: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e42432 VL - 25 KW - apps KW - BMI KW - cardiometabolic KW - database KW - diet behaviour KW - health coaching KW - monitoring KW - obesity KW - physical activity KW - waist circumference KW - weight loss KW - weight N2 - Background: Self-monitoring smartphone apps and health coaching have both individually been shown to improve weight-related outcomes, but their combined effects remain unclear. Objective: This study aims to examine the effectiveness of combining self-monitoring apps with health coaching on anthropometric, cardiometabolic, and lifestyle outcomes in people with overweight and obesity. Methods: Relevant articles published from inception till June 9, 2022, were searched through 8 databases (Embase, CINAHL, PubMed, PsycINFO, Scopus, The Cochrane Library, and Web of Science). Effect sizes were pooled using random-effects models. Behavioral strategies used were coded using the behavior change techniques taxonomy V1. Results: A total of 14 articles were included, representing 2478 participants with a mean age of 39.1 years and a BMI of 31.8 kg/m2. Using combined intervention significantly improved weight loss by 2.15 kg (95% CI ?3.17 kg to ?1.12 kg; P<.001; I2=60.3%), waist circumference by 2.48 cm (95% CI ?3.51 cm to ?1.44 cm; P<.001; I2=29%), triglyceride by 0.22 mg/dL (95% CI ?0.33 mg/dL to 0.11 mg/dL; P=.008; I2=0%), glycated hemoglobin by 0.12% (95% CI ?0.21 to ?0.02; P=.03; I2=0%), and total calorie consumption per day by 128.30 kcal (95% CI ?182.67 kcal to ?73.94 kcal; P=.003; I2=0%) kcal, but not BMI, blood pressure, body fat percentage, cholesterol, and physical activity. Combined interventional effectiveness was superior to receiving usual care and apps for waist circumference but only superior to usual care for weight loss. Conclusions: Combined intervention could improve weight-related outcomes, but more research is needed to examine its added benefits to using an app. Trial Registration: PROSPERO CRD42022345133; https://tinyurl.com/2zxfdpay UR - https://www.jmir.org/2023/1/e42432 UR - http://dx.doi.org/10.2196/42432 UR - http://www.ncbi.nlm.nih.gov/pubmed/37071452 ID - info:doi/10.2196/42432 ER - TY - JOUR AU - Ilyas, Yousaf AU - Hassanbeigi Daryani, Shahrzad AU - Kiriella, Dona AU - Pachwicewicz, Paul AU - Boley, A. Randy AU - Reyes, M. Karen AU - Smith, L. Dale AU - Zalta, K. Alyson AU - Schueller, M. Stephen AU - Karnik, S. Niranjan AU - Stiles-Shields, Colleen PY - 2023/4/18 TI - Geolocation Patterns, Wi-Fi Connectivity Rates, and Psychiatric Symptoms Among Urban Homeless Youth: Mixed Methods Study Using Self-report and Smartphone Data JO - JMIR Form Res SP - e45309 VL - 7 KW - mHealth KW - mobile health KW - smartphones KW - geolocation KW - Wi-Fi KW - youth experiencing homelessness KW - mobile phone KW - homelessness KW - youth N2 - Background: Despite significant research done on youth experiencing homelessness, few studies have examined movement patterns and digital habits in this population. Examining these digital behaviors may provide useful data to design new digital health intervention models for youth experiencing homelessness. Specifically, passive data collection (data collected without extra steps for a user) may provide insights into lived experience and user needs without putting an additional burden on youth experiencing homelessness to inform digital health intervention design. Objective: The objective of this study was to explore patterns of mobile phone Wi-Fi usage and GPS location movement among youth experiencing homelessness. Additionally, we further examined the relationship between usage and location as correlated with depression and posttraumatic stress disorder (PTSD) symptoms. Methods: A total of 35 adolescent and young adult participants were recruited from the general community of youth experiencing homelessness for a mobile intervention study that included installing a sensor data acquisition app (Purple Robot) for up to 6 months. Of these participants, 19 had sufficient passive data to conduct analyses. At baseline, participants completed self-reported measures for depression (Patient Health Questionnaire-9 [PHQ-9]) and PTSD (PTSD Checklist for DSM-5 [PCL-5]). Behavioral features were developed and extracted from phone location and usage data. Results: Almost all participants (18/19, 95%) used private networks for most of their noncellular connectivity. Greater Wi-Fi usage was associated with a higher PCL-5 score (P=.006). Greater location entropy, representing the amount of variability in time spent across identified clusters, was also associated with higher severity in both PCL-5 (P=.007) and PHQ-9 (P=.045) scores. Conclusions: Location and Wi-Fi usage both demonstrated associations with PTSD symptoms, while only location was associated with depression symptom severity. While further research needs to be conducted to establish the consistency of these findings, they suggest that the digital patterns of youth experiencing homelessness offer insights that could be used to tailor digital interventions. UR - https://formative.jmir.org/2023/1/e45309 UR - http://dx.doi.org/10.2196/45309 UR - http://www.ncbi.nlm.nih.gov/pubmed/37071457 ID - info:doi/10.2196/45309 ER - TY - JOUR AU - Rinn, Robin AU - Gao, Lingling AU - Schoeneich, Sarah AU - Dahmen, Alina AU - Anand Kumar, Vinayak AU - Becker, Petra AU - Lippke, Sonia PY - 2023/4/17 TI - Digital Interventions for Treating Post-COVID or Long-COVID Symptoms: Scoping Review JO - J Med Internet Res SP - e45711 VL - 25 KW - post-COVID/long-COVID symptom recovery KW - postacute COVID-19 symptoms KW - treatment KW - therapy KW - mHealth KW - mobile health KW - rehabilitation KW - COVID-19 N2 - Background: Patients with post-COVID/long-COVID symptoms need support, and health care professionals need to be able to provide evidence-based patient care. Digital interventions can meet these requirements, especially if personal contact is limited. Objective: We reviewed evidence-based digital interventions that are currently available to help manage physical and mental health in patients with post-COVID/long-COVID symptoms. Methods: A scoping review was carried out summarizing novel digital health interventions for treating post-COVID/long-COVID patients. Using the PICO (population, intervention, comparison, outcome) scheme, original studies were summarized, in which patients with post-COVID/long-COVID symptoms used digital interventions to help aid recovery. Results: From all scanned articles, 8 original studies matched the inclusion criteria. Of the 8 studies, 3 were ?pretest? studies, 3 described the implementation of a telerehabilitation program, 1 was a post-COVID/long-COVID program, and 1 described the results of qualitative interviews with patients who used an online peer-support group. Following the PICO scheme, we summarized previous studies. Studies varied in terms of participants (P), ranging from adults in different countries, such as former hospitalized patients with COVID-19, to individuals in disadvantaged communities in the United Kingdom, as well as health care workers. In addition, the studies included patients who had previously been infected with COVID-19 and who had ongoing symptoms. Some studies focused on individuals with specific symptoms, including those with either post?COVID-19 or long-term symptoms, while other studies included patients based on participation in online peer-support groups. The interventions (I) also varied. Most interventions used a combination of psychological and physical exercises, but they varied in duration, frequency, and social dimensions. The reviewed studies investigated the physical and mental health conditions of patients with post-COVID/long-COVID symptoms. Most studies had no control (C) group, and most studies reported outcomes (O) or improvements in physiological health perception, some physical conditions, fatigue, and some psychological aspects such as depression. However, some studies found no improvements in bowel or bladder problems, concentration, short-term memory, unpleasant dreams, physical ailments, perceived bodily pain, emotional ailments, and perceived mental health. Conclusions: More systematic research with larger sample sizes is required to overcome sampling bias and include health care professionals? perspectives, as well as help patients mobilize support from health care professionals and social network partners. The evidence so far suggests that patients should be provided with digital interventions to manage symptoms and reintegrate into everyday life, including work. UR - https://www.jmir.org/2023/1/e45711 UR - http://dx.doi.org/10.2196/45711 UR - http://www.ncbi.nlm.nih.gov/pubmed/36943909 ID - info:doi/10.2196/45711 ER - TY - JOUR AU - Zeng, Zhen AU - Peng, Jiale AU - Liu, Lu AU - Gong, Wenjie PY - 2023/4/17 TI - Translating Research Evidence Into Marketplace Application: Cohort Study of Internet-Based Intervention Platforms for Perinatal Depression JO - J Med Internet Res SP - e42777 VL - 25 KW - cohort KW - digital health KW - internet-based intervention platform KW - mhealth KW - perinatal depression KW - quality assessment N2 - Background: Internet-based intervention platforms may improve access to mental health care for women with perinatal depression (PND). Though the majority of platforms in the market lack an evidence base, a small number of them are supported by research evidence. Objective: This study aims to assess the current status of internet-based PND intervention platforms supported by published evidence, understand the reasons behind the disappearance of any of these previously accessible platforms, examine adjustments made by those active platforms between research trials and market implementation, and evaluate their current quality. Methods: A cohort of internet-based PND intervention platforms was first identified by systematic searches in multiple academic databases from database inception until March 26, 2021. We searched on the World Wide Web and the iOS and Android app stores to assess which of these were available in the marketplace between April and May 2021. The basic characteristics of all platforms were collected. For inaccessible platforms, inquiries were made via email to the authors of publications to determine the reasons for their unavailability. We compared the intervention-related information of accessible platforms in the marketplace with that reported in original publications and conducted quality assessments using the App Evaluation Model of the American Psychiatric Association. Fisher exact tests were used to compare the functional characteristics in publications of available and unavailable platforms and to investigate potential associations between functional adjustments or quality indices and platform survival time. Results: Out of 35 platforms supported by research evidence, only 19 (54%) were still accessible in the marketplace. The main reason for platforms disappearing was the termination of research projects. No statistically significant differences were found in functional characteristics between available and unavailable platforms. A total of 18 (95%) platforms adapted their core functions from what was reported in related publications. The adjustments included changes to intervention methods (11/19, 58%), target population (10/19, 53%), human resources for intervention support (9/19, 47%), mood assessment and monitoring (8/19, 42%), communication modality (4/19, 21%), and platform type (2/19, 11%). Quality issues across platforms included low frequency of update, lack of crisis management mechanism, poor user interactivity, and weak evidence base or absence of citation of supporting evidence. Platforms that survived longer than 10 years had a higher tendency to use external resources from third parties compared to those that survived less than 10 years (P=.04). No significant differences were found for functional adjustments or other quality indices. Conclusions: Internet-based platforms supported by evidence were not effectively translated into real-world practice. It is unclear if adjustments to accessible platforms made during actual operation may undermine the proven validity of the original research. Future research to explore the reasons behind the success of the implementation of evidence-based platforms in the marketplace is warranted. UR - https://www.jmir.org/2023/1/e42777 UR - http://dx.doi.org/10.2196/42777 UR - http://www.ncbi.nlm.nih.gov/pubmed/37067855 ID - info:doi/10.2196/42777 ER - TY - JOUR AU - Kaur, Savneet AU - Larsen, Erik AU - Harper, James AU - Purandare, Bharat AU - Uluer, Ahmet AU - Hasdianda, Adrian Mohammad AU - Umale, Arun Nikita AU - Killeen, James AU - Castillo, Edward AU - Jariwala, Sunit PY - 2023/4/14 TI - Development and Validation of a Respiratory-Responsive Vocal Biomarker?Based Tool for Generalizable Detection of Respiratory Impairment: Independent Case-Control Studies in Multiple Respiratory Conditions Including Asthma, Chronic Obstructive Pulmonary Disease, and COVID-19 JO - J Med Internet Res SP - e44410 VL - 25 KW - vocal biomarkers KW - COVID-19 KW - respiratory-responsive vocal biomarker KW - RRVB KW - artificial intelligence KW - machine learning KW - asthma KW - smartphones KW - mobile phone KW - eHealth KW - mobile health KW - mHealth KW - respiratory symptom KW - respiratory KW - voice KW - vocal KW - sound KW - speech N2 - Background: Vocal biomarker?based machine learning approaches have shown promising results in the detection of various health conditions, including respiratory diseases, such as asthma. Objective: This study aimed to determine whether a respiratory-responsive vocal biomarker (RRVB) model platform initially trained on an asthma and healthy volunteer (HV) data set can differentiate patients with active COVID-19 infection from asymptomatic HVs by assessing its sensitivity, specificity, and odds ratio (OR). Methods: A logistic regression model using a weighted sum of voice acoustic features was previously trained and validated on a data set of approximately 1700 patients with a confirmed asthma diagnosis and a similar number of healthy controls. The same model has shown generalizability to patients with chronic obstructive pulmonary disease, interstitial lung disease, and cough. In this study, 497 participants (female: n=268, 53.9%; <65 years old: n=467, 94%; Marathi speakers: n=253, 50.9%; English speakers: n=223, 44.9%; Spanish speakers: n=25, 5%) were enrolled across 4 clinical sites in the United States and India and provided voice samples and symptom reports on their personal smartphones. The participants included patients who are symptomatic COVID-19 positive and negative as well as asymptomatic HVs. The RRVB model performance was assessed by comparing it with the clinical diagnosis of COVID-19 confirmed by reverse transcriptase?polymerase chain reaction. Results: The ability of the RRVB model to differentiate patients with respiratory conditions from healthy controls was previously demonstrated on validation data in asthma, chronic obstructive pulmonary disease, interstitial lung disease, and cough, with ORs of 4.3, 9.1, 3.1, and 3.9, respectively. The same RRVB model in this study in COVID-19 performed with a sensitivity of 73.2%, specificity of 62.9%, and OR of 4.64 (P<.001). Patients who experienced respiratory symptoms were detected more frequently than those who did not experience respiratory symptoms and completely asymptomatic patients (sensitivity: 78.4% vs 67.4% vs 68%, respectively). Conclusions: The RRVB model has shown good generalizability across respiratory conditions, geographies, and languages. Results using data set of patients with COVID-19 demonstrate its meaningful potential to serve as a prescreening tool for identifying individuals at risk for COVID-19 infection in combination with temperature and symptom reports. Although not a COVID-19 test, these results suggest that the RRVB model can encourage targeted testing. Moreover, the generalizability of this model for detecting respiratory symptoms across different linguistic and geographic contexts suggests a potential path for the development and validation of voice-based tools for broader disease surveillance and monitoring applications in the future. UR - https://www.jmir.org/2023/1/e44410 UR - http://dx.doi.org/10.2196/44410 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881540 ID - info:doi/10.2196/44410 ER - TY - JOUR AU - Sunkara, Charvi AU - Thakkar, Rajvi AU - Ong, Triton AU - Bunnell, E. Brian PY - 2023/4/14 TI - Characterizing Consumer Smartphone Apps for Virtual Reality?Based Exposure Therapy: Content Analysis JO - J Med Internet Res SP - e41807 VL - 25 KW - virtual reality KW - exposure therapy KW - phobia KW - apps KW - smartphones KW - VR KW - smartphone apps KW - mobile phone apps KW - content analysis KW - treatment KW - clinical evaluation KW - consumer apps KW - mHealth apps N2 - Background: In vivo exposure therapy is the most effective treatment for phobias but is often impractical. Virtual reality exposure therapy (VRET) can help overcome critical barriers to in vivo exposure therapy. However, accessible mobile software related to VRET is not well understood. Objective: The purpose of our study is to describe the landscape of accessible smartphone apps with potential utility for clinical VRET. Methods: We conducted a content analysis of publicly available smartphone apps related to virtual reality on the Google Play Store and the Apple App Store as of March 2020. Results: The initial search yielded 525 apps, with 84 apps (52 on the Google Play Store and 32 on the Apple App Store) included for analysis. The most common phobic stimulus depicted was bodies of water or weather events (25/84, 29.8%), followed by heights (24/84, 28.6%), and animals (23/84, 27.4%). More than half of the apps were visually abstract (39/84, 53.5%). Most apps were free to use (48/84, 57.1%), while the rest were free to try (22/84, 26.2%) or required payment for use (14/84, 16.7%), with the highest cost for use being US $6. The average overall app rating was 2.9 stars out of 5, but the number of ratings ranged from 0 to 49,233. None of the 84 apps advertised compliance with the Health Insurance Portability and Accountability Act, offered the ability to monitor data, provided clinician control over variables in the app experiences, or explicitly stated use by or development with clinicians. Conclusions: None of the smartphone apps reviewed were explicitly developed for phobia therapy. However, 16 of the 84 included apps were considered ideal candidates to investigate further as part of treatment due to their accessibility, depiction of phobia-relevant stimuli, low or no cost, and high user scores. Most of these apps were visually abstract and free to use, making them accessible and potentially flexible as part of clinical exposure hierarchies. However, none of the apps were designed for clinical use, nor did they provide tools for clinician workflows. Formal evaluation of these accessible smartphone apps is needed to understand the clinical potential of accessible VRET solutions. UR - https://www.jmir.org/2023/1/e41807 UR - http://dx.doi.org/10.2196/41807 UR - http://www.ncbi.nlm.nih.gov/pubmed/37058343 ID - info:doi/10.2196/41807 ER - TY - JOUR AU - Kerr, I. Jasmine AU - Naegelin, Mara AU - Benk, Michaela AU - v Wangenheim, Florian AU - Meins, Erika AU - Viganò, Eleonora AU - Ferrario, Andrea PY - 2023/4/13 TI - Investigating Employees? Concerns and Wishes Regarding Digital Stress Management Interventions With Value Sensitive Design: Mixed Methods Study JO - J Med Internet Res SP - e44131 VL - 25 KW - value sensitive design KW - digital health intervention KW - stress KW - employee well-being KW - monitoring KW - machine learning KW - ethics KW - mobile phone N2 - Background: Work stress places a heavy economic and disease burden on society. Recent technological advances include digital health interventions for helping employees prevent and manage their stress at work effectively. Although such digital solutions come with an array of ethical risks, especially if they involve biomedical big data, the incorporation of employees? values in their design and deployment has been widely overlooked. Objective: To bridge this gap, we used the value sensitive design (VSD) framework to identify relevant values concerning a digital stress management intervention (dSMI) at the workplace, assess how users comprehend these values, and derive specific requirements for an ethics-informed design of dSMIs. VSD is a theoretically grounded framework that front-loads ethics by accounting for values throughout the design process of a technology. Methods: We conducted a literature search to identify relevant values of dSMIs at the workplace. To understand how potential users comprehend these values and derive design requirements, we conducted a web-based study that contained closed and open questions with employees of a Swiss company, allowing both quantitative and qualitative analyses. Results: The values health and well-being, privacy, autonomy, accountability, and identity were identified through our literature search. Statistical analysis of 170 responses from the web-based study revealed that the intention to use and perceived usefulness of a dSMI were moderate to high. Employees? moderate to high health and well-being concerns included worries that a dSMI would not be effective or would even amplify their stress levels. Privacy concerns were also rated on the higher end of the score range, whereas concerns regarding autonomy, accountability, and identity were rated lower. Moreover, a personalized dSMI with a monitoring system involving a machine learning-based analysis of data led to significantly higher privacy (P=.009) and accountability concerns (P=.04) than a dSMI without a monitoring system. In addition, integrability, user-friendliness, and digital independence emerged as novel values from the qualitative analysis of 85 text responses. Conclusions: Although most surveyed employees were willing to use a dSMI at the workplace, there were considerable health and well-being concerns with regard to effectiveness and problem perpetuation. For a minority of employees who value digital independence, a nondigital offer might be more suitable. In terms of the type of dSMI, privacy and accountability concerns must be particularly well addressed if a machine learning-based monitoring component is included. To help mitigate these concerns, we propose specific requirements to support the VSD of a dSMI at the workplace. The results of this work and our research protocol will inform future research on VSD-based interventions and further advance the integration of ethics in digital health. UR - https://www.jmir.org/2023/1/e44131 UR - http://dx.doi.org/10.2196/44131 UR - http://www.ncbi.nlm.nih.gov/pubmed/37052996 ID - info:doi/10.2196/44131 ER - TY - JOUR AU - Dittrich, Florian AU - Albrecht, Urs-Vito AU - Scherer, Julian AU - Becker, L. Sören AU - Landgraeber, Stefan AU - Back, Alexander David AU - Fessmann, Kai AU - Haversath, Marcel AU - Beck, Sascha AU - Abbara-Czardybon, Mona AU - Quitmann, Henning AU - Harren, Katharina Anna AU - Aitzetmüller, Matthias AU - Klietz, Luise Marie PY - 2023/4/13 TI - Development of Open Backend Structures for Health Care Professionals to Improve Participation in App Developments: Pilot Usability Study of a Medical App JO - JMIR Form Res SP - e42224 VL - 7 KW - smartphone KW - mHealth KW - backend KW - usability KW - UX KW - user experience KW - mobile health KW - health app KW - mobile app KW - app development KW - no-code N2 - Background: Efficient digitization in medicine still is in its infancy but undeniably has great potential for current and future challenges in health care. Thus far, the rollout of medical apps has not resulted in widespread use of smartphones in the German health care sector?the reasons for this have not been clarified so far. Nevertheless, the lack of user involvement in the development process and content creation might contribute to low acceptance of these products. Objective: This study aims to outline an approach to involve medical expertise without any coding knowledge for developing medical app content and functions. Methods: An end user?operable backend was built. Its usability was evaluated using a usability evaluation test protocol. The results of the usability tests were evaluated by the app development team, and the usability test was repeated for optimizing backend usability. In total, 40 criteria to measure the ease of app usage were defined a priori. The usability test comprised 20 tasks that had to be fulfilled. Usability tasks were analyzed for completion, dropout, and test duration. Due to the COVID-19 pandemic, digital videoconferencing platforms (Zoom and QuickTime Player) were used to complete usability questionnaires. Finally, several backend-based apps for several specialties (infectiology, plastic and reconstructive surgery, and orthopedics) were developed by health care professionals as prototypes. Results: Initial usability testing was conducted with 5 participants (4 men and 1 woman; mean age 39.2, SD 5.97 years). All of them could complete the assigned backend tasks with only a few workflow interruptions and some minor errors. After usability optimization, the workflow completion time decreased from 5.03 minutes to 3.50 minutes, indicating a time saving. The basic backend structure was clear to all test users and the handling was intuitive to learn. Some minor errors in the backend occurred during the test rounds. The apps developed using the aforementioned approach are in clinical use as a proof of concept. Conclusions: Backends offering operability for medical professionals might have great potential for app development in the mobile health sector. Sophisticated and time-saving usability are pivotal for the acceptance of medical software, as illustrated by the backend-based apps presented herein, which are in clinical use as a proof of concept. Basic interventions are essential and sufficient for adequate usability optimization. Practicable, well-structured software usability evaluation is possible based on the usability evaluation test protocol. UR - https://formative.jmir.org/2023/1/e42224 UR - http://dx.doi.org/10.2196/42224 UR - http://www.ncbi.nlm.nih.gov/pubmed/37052998 ID - info:doi/10.2196/42224 ER - TY - JOUR AU - Musiimenta, Angella AU - Tumuhimbise, Wilson AU - Atukunda, Esther AU - Mugaba, Aaron AU - Linnemayr, Sebastian AU - Haberer, Jessica PY - 2023/4/12 TI - Digital Adherence Technologies and Mobile Money Incentives for Management of Tuberculosis Medication Among People Living With Tuberculosis: Mixed Methods Formative Study JO - JMIR Form Res SP - e45301 VL - 7 KW - digital adherence technologies KW - real-time monitoring KW - SMS reminders KW - mobile money KW - financial incentives KW - tuberculosis KW - medication adherence KW - user-centered approach KW - mobile wallet KW - support medication KW - mobile phone N2 - Background: Although there is an increasing use of digital adherence technologies (DATs), such as real-time monitors and SMS reminders in tuberculosis medication adherence, suboptimal patient engagement with various DATs has been reported. Additionally, financial constraints can limit DAT?s utility. The perceived usefulness and the design mechanisms of DATs linked to mobile money financial incentives for tuberculosis medication management remain unclear. Objective: The aim of this study is to describe the perceived usefulness and design mechanisms for a DAT intervention called My Mobile Wallet, which is composed of real-time adherence monitors, SMS reminders, and mobile money incentives to support tuberculosis medication adherence in a low-income setting. Methods: This study used mixed methods approaches among persons with tuberculosis recruited from the Tuberculosis Clinic in the Mbarara Regional Referral Hospital. We purposively sampled 21 persons with tuberculosis aged 18 years and older, who owned cell phones and were able to use SMS text messaging interventions. We also enrolled 9 participants who used DATs in our previous study. We used focus group discussions with the 30 participants to solicit perceptions about the initial version of the My Mobile Wallet intervention, and then iteratively refined subsequent versions of the intervention following a user-centered design approach until the beta version of the intervention that suited their needs was developed. Surveys eliciting information about participants? cell phone use and perceptions of the intervention were also administered. Content analysis was used to inductively analyze qualitative data to derive categories describing the perceived usefulness of the intervention, concerns, and design mechanisms. Stata (version 13; StataCorp) was used to analyze survey data. Results: Participants expressed the perceived usefulness of the My Mobile Wallet intervention in terms of being reminded to take medication, supported with transport to the clinic, and money to meet other tuberculosis medication?related costs, all of which were perceived to imply care, which could create a sense of connectedness to health care workers. This could consequently cause participants to develop a self-perceived need to prove their commitment to adherence to health care workers who care for them, thereby motivating medication adherence. For fear of unintended tuberculosis status disclosure, 20 (67%) participants suggested using SMS language that is confidential?not easily related to tuberculosis. To reduce the possibilities of using the money for other competing demands, 25 (83%) participants preferred sending the money 1-2 days before the appointment to limit the time lag between receiving the money and visiting the clinic. Conclusions: DATs complemented with mobile money financial incentives could potentially provide acceptable approaches to remind, support, and motivate patients to adhere to taking their tuberculosis medication. Trial Registration: ClinicalTrials.gov NCT05656287; https://clinicaltrials.gov/ct2/show/NCT05656287 UR - https://formative.jmir.org/2023/1/e45301 UR - http://dx.doi.org/10.2196/45301 UR - http://www.ncbi.nlm.nih.gov/pubmed/37043263 ID - info:doi/10.2196/45301 ER - TY - JOUR AU - Son, Changwon AU - Hegde, Sudeep AU - Markert, Carl AU - Zahed, Karim AU - Sasangohar, Farzan PY - 2023/4/12 TI - Use of a Mobile Biofeedback App to Provide Health Coaching for Stress Self-management: Pilot Quasi-Experiment JO - JMIR Form Res SP - e41018 VL - 7 KW - mental health KW - health coaching KW - stress KW - biofeedback KW - mHealth KW - mobile apps KW - breathing exercises KW - students KW - veterans KW - COVID-19 KW - vulnerable population KW - college student KW - self-management KW - mobile health app KW - psychological well-being KW - digital health intervention N2 - Background: Mental health is an increasing concern among vulnerable populations, including college students and veterans. Objective: The purpose of this study was to determine if mobile health technology combined with health coaching can better enable a user to self-manage their mental health. Methods: This study evaluated the mobile app ?Biofeedback? that provided health coaching on stress self-management for college student veterans? mental health concerns. Twenty-four college student veterans were recruited from a large public university in Texas during the spring 2020 semester, impacted by COVID-19. Ten participants were assigned to the intervention group where they used the mobile Biofeedback app on their smartphones and smartwatches, and 14 were assigned to the control group without the app; assignment was based on mobile phone compatibility. Both groups participated in one initial lab session where they learned a deep-breathing exercise technique. The intervention group was then asked to use the mobile Biofeedback app during their daily lives and a smartwatch, and the control group was asked to perform the breathing exercises on their own. Both groups filled out Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) self-assessments at 2-week intervals. At the end of the semester, both groups were given an exit interview to provide user experience and perceived benefits of health coaching via the mobile biofeedback app. Results: The deep-breathing exercise in the initial lab session reduced stress in both groups. Over the course of the study, the app recorded 565 coached breathing exercises with a significant decrease (approximately 3 beats per minute) in participants? heart rate during the 6-minute time period immediately after conducting the breathing exercises (Spearman rank correlation coefficient ?0.61, P<.001; S=9,816,176). There was no significant difference between the two groups for PHQ-9 and GAD-7 scores over the course of the semester. Exit interview responses indicated that participants perceived that the mobile Biofeedback app improved their health and helped them address stress challenges. All participants reported that the intervention helped them manage their stress better and expressed that health coaching via a mobile device would improve their overall health. Conclusions: Participants reported a positive perception of the app for their mental health self-management during a stressful semester. Future work should examine long-term effects of the app with a larger sample size balanced between male and female participants, randomized participant allocation, real-time detection of mental health symptoms, and additional features of the app. UR - https://formative.jmir.org/2023/1/e41018 UR - http://dx.doi.org/10.2196/41018 UR - http://www.ncbi.nlm.nih.gov/pubmed/36952560 ID - info:doi/10.2196/41018 ER - TY - JOUR AU - Berardi, Vincent AU - Fowers, Rylan AU - Rubin, Gavriella AU - Stecher, Chad PY - 2023/4/10 TI - Time of Day Preferences and Daily Temporal Consistency for Predicting the Sustained Use of a Commercial Meditation App: Longitudinal Observational Study JO - J Med Internet Res SP - e42482 VL - 25 KW - behavioral habits KW - habit formation KW - mindfulness meditation KW - mobile health KW - health app KW - app usage KW - meditation app KW - temporal analysis KW - circadian rhythm KW - healthy life style KW - physical activity KW - mental well being KW - habit KW - mindfulness KW - meditation KW - wellbeing KW - mental health KW - longitudinal KW - observational KW - advice KW - morning N2 - Background: The intensive data typically collected by mobile health (mHealth) apps allows factors associated with persistent use to be investigated, which is an important objective given users? well-known struggles with sustaining healthy behavior. Objective: Data from a commercial meditation app (n=14,879; 899,071 total app uses) were analyzed to assess the validity of commonly given habit formation advice to meditate at the same time every day, preferably in the morning. Methods: First, the change in probability of meditating in 4 nonoverlapping time windows (morning, midday, evening, and late night) on a given day over the first 180 days after creating a meditation app account was calculated via generalized additive mixed models. Second, users? time of day preferences were calculated as the percentage of all meditation sessions that occurred within each of the 4 time windows. Additionally, the temporal consistency of daily meditation behavior was calculated as the entropy of the timing of app usage sessions. Linear regression was used to examine the effect of time of day preference and temporal consistency on two outcomes: (1) short-term engagement, defined as the number of meditation sessions completed within the sixth and seventh month of a user?s account, and (2) long-term use, defined as the days until a user?s last observed meditation session. Results: Large reductions in the probability of meditation at any time of day were seen over the first 180 days after creating an account, but this effect was smallest for morning meditation sessions (63.4% reduction vs reductions ranging from 67.8% to 74.5% for other times). A greater proportion of meditation in the morning was also significantly associated with better short-term engagement (regression coefficient B=2.76, P<.001) and long-term use (B=50.6, P<.001). The opposite was true for late-night meditation sessions (short-term: B=?2.06, P<.001; long-term: B=?51.7, P=.001). Significant relationships were not found for midday sessions (any outcome) or for evening sessions when examining long-term use. Additionally, temporal consistency in the performance of morning meditation sessions was associated with better short-term engagement (B=?1.64, P<.001) but worse long-term use (B=55.8, P<.001). Similar-sized temporal consistency effects were found for all other time windows. Conclusions: Meditating in the morning was associated with higher rates of maintaining a meditation practice with the app. This is consistent with findings from other studies that have hypothesized that the strength of existing morning routines and circadian rhythms may make the morning an ideal time to build new habits. In the long term, less temporal consistency in meditation sessions was associated with more persistent app use, suggesting there are benefits from maintaining flexibility in behavior performance. These findings improve our understanding of how to promote enduring healthy lifestyles and can inform the design of mHealth strategies for maintaining behavior changes. UR - https://www.jmir.org/2023/1/e42482 UR - http://dx.doi.org/10.2196/42482 UR - http://www.ncbi.nlm.nih.gov/pubmed/37036755 ID - info:doi/10.2196/42482 ER - TY - JOUR AU - Smolders, Karin AU - Druijff-van de Woestijne, Gerrieke AU - Meijer, Kim AU - Mcconchie, Hannah AU - de Kort, Yvonne PY - 2023/4/7 TI - Smartphone Keyboard Interaction Monitoring as an Unobtrusive Method to Approximate Rest-Activity Patterns: Experience Sampling Study Investigating Interindividual and Metric-Specific Variations JO - J Med Internet Res SP - e38066 VL - 25 KW - smartphone keyboard interactions monitoring KW - rest-activity patters KW - sleep quality KW - chronotype KW - trait self-control KW - mobile phone N2 - Background: Sleep is an important determinant of individuals? health and behavior during the wake phase. Novel research methods for field assessments are required to enable the monitoring of sleep over a prolonged period and across a large number of people. The ubiquity of smartphones offers new avenues for detecting rest-activity patterns in everyday life in a noninvasive an inexpensive manner and on a large scale. Recent studies provided evidence for the potential of smartphone interaction monitoring as a novel tracking method to approximate rest-activity patterns based on the timing of smartphone activity and inactivity throughout the 24-hour day. These findings require further replication and more detailed insights into interindividual variations in the associations and deviations with commonly used metrics for monitoring rest-activity patterns in everyday life. Objective: This study aimed to replicate and expand on earlier findings regarding the associations and deviations between smartphone keyboard?derived and self-reported estimates of the timing of the onset of the rest and active periods and the duration of the rest period. Moreover, we aimed to quantify interindividual variations in the associations and time differences between the 2 assessment modalities and to investigate to what extent general sleep quality, chronotype, and trait self-control moderate these associations and deviations. Methods: Students were recruited to participate in a 7-day experience sampling study with parallel smartphone keyboard interaction monitoring. Multilevel modeling was used to analyze the data. Results: In total, 157 students participated in the study, with an overall response rate of 88.9% for the diaries. The results revealed moderate to strong relationships between the keyboard-derived and self-reported estimates, with stronger associations for the timing-related estimates (? ranging from .61 to .78) than for the duration-related estimates (?=.51 and ?=.52). The relational strength between the time-related estimates was lower, but did not substantially differ for the duration-related estimates, among students experiencing more disturbances in their general sleep quality. Time differences between the keyboard-derived and self-reported estimates were, on average, small (<0.5 hours); however, large discrepancies were also registered for quite some nights. The time differences between the 2 assessment modalities were larger for both timing-related and rest duration?related estimates among students who reported more disturbances in their general sleep quality. Chronotype and trait self-control did not significantly moderate the associations and deviations between the 2 assessment modalities. Conclusions: We replicated the positive potential of smartphone keyboard interaction monitoring for estimating rest-activity patterns among populations of regular smartphone users. Chronotype and trait self-control did not significantly influence the metrics? accuracy, whereas general sleep quality did: the behavioral proxies obtained from smartphone interactions appeared to be less powerful among students who experienced lower general sleep quality. The generalization and underlying process of these findings require further investigation. UR - https://www.jmir.org/2023/1/e38066 UR - http://dx.doi.org/10.2196/38066 UR - http://www.ncbi.nlm.nih.gov/pubmed/37027202 ID - info:doi/10.2196/38066 ER - TY - JOUR AU - Kosowicz, Leona AU - Tran, Kham AU - Khanh, Tran Toan AU - Dang, Ha Thu AU - Pham, An Van AU - Ta Thi Kim, Hue AU - Thi Bach Duong, Hoang AU - Nguyen, Dong Tran AU - Phuong, Tuyet Anh AU - Le, Hieu Trong AU - Ta, Anh Van AU - Wickramasinghe, Nilmini AU - Schofield, Penelope AU - Zelcer, John AU - Pham Le, Tuan AU - Nguyen, Anh Tuan PY - 2023/4/5 TI - Lessons for Vietnam on the Use of Digital Technologies to Support Patient-Centered Care in Low- and Middle-Income Countries in the Asia-Pacific Region: Scoping Review JO - J Med Internet Res SP - e43224 VL - 25 KW - digital health technologies KW - digital health KW - eHealth KW - mobile health KW - mHealth KW - patient-centered care KW - Vietnam KW - Asia-Pacific region KW - digital KW - disease KW - technology KW - database KW - self-management KW - clinical KW - users N2 - Background: A rapidly aging population, a shifting disease burden and the ongoing threat of infectious disease outbreaks pose major concerns for Vietnam?s health care system. Health disparities are evident in many parts of the country, especially in rural areas, and the population faces inequitable access to patient-centered health care. Vietnam must therefore explore and implement advanced solutions to the provision of patient-centered care, with a view to reducing pressures on the health care system simultaneously. The use of digital health technologies (DHTs) may be one of these solutions. Objective: This study aimed to identify the application of DHTs to support the provision of patient-centered care in low- and middle-income countries in the Asia-Pacific region (APR) and to draw lessons for Vietnam. Methods: A scoping review was undertaken. Systematic searches of 7 databases were conducted in January 2022 to identify publications on DHTs and patient-centered care in the APR. Thematic analysis was conducted, and DHTs were classified using the National Institute for Health and Care Excellence evidence standards framework for DHTs (tiers A, B, and C). Reporting was in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: Of the 264 publications identified, 45 (17%) met the inclusion criteria. The majority of the DHTs were classified as tier C (15/33, 45%), followed by tier B (14/33, 42%) and tier A (4/33, 12%). At an individual level, DHTs increased accessibility of health care and health-related information, supported individuals in self-management, and led to improvements in clinical and quality-of-life outcomes. At a systems level, DHTs supported patient-centered outcomes by increasing efficiency, reducing strain on health care resources, and supporting patient-centered clinical practice. The most frequently reported enablers for the use of DHTs for patient-centered care included alignment of DHTs with users? individual needs, ease of use, availability of direct support from health care professionals, provision of technical support as well as user education and training, appropriate governance of privacy and security, and cross-sectorial collaboration. Common barriers included low user literacy and digital literacy, limited user access to DHT infrastructure, and a lack of policies and protocols to guide the implementation and use of DHTs. Conclusions: The use of DHTs is a viable option to increase equitable access to quality, patient-centered care across Vietnam and simultaneously reduce pressures on the health care system. Vietnam can take advantage of the lessons learned by other low- and middle-income countries in the APR when developing a national road map to digital health transformation. Recommendations that Vietnamese policy makers may consider include emphasizing stakeholder engagement, strengthening digital literacy, supporting the improvement of DHT infrastructure, increasing cross-sectorial collaboration, strengthening governance of cybersecurity, and leading the way in DHT uptake. UR - https://www.jmir.org/2023/1/e43224 UR - http://dx.doi.org/10.2196/43224 UR - http://www.ncbi.nlm.nih.gov/pubmed/37018013 ID - info:doi/10.2196/43224 ER - TY - JOUR AU - Hjorth-Johansen, Elin AU - Børøsund, Elin AU - Martinsen Østen, Ingeborg AU - Holmstrøm, Henrik AU - Moen, Anne PY - 2023/4/5 TI - Acceptability and Initial Adoption of the Heart Observation App for Infants With Congenital Heart Disease: Qualitative Study JO - JMIR Form Res SP - e45920 VL - 7 KW - congenital heart disease KW - readiness for discharge KW - mobile app KW - follow-up, health services KW - mHealth N2 - Background: Approximately 1% of all infants are born with a congenital heart disease (CHD). Internationally CHD remains a major cause of infant death, some of which occur unexpectedly after a gradual deterioration at home. Many parents find it difficult to recognize worsening of symptoms. Objective: This study aims to report the acceptability and initial adoption of a mobile app, the Heart Observation app (HOBS), aiming to support parents? understanding and management of their child?s condition and to increase quality in follow-up from health care professionals in complex health care services in Norway. Methods: A total of 9 families were interviewed on discharge from the neonatal intensive care unit and after 1 month at home. The infant?s primary nurse, community nurse, and cardiologist were also interviewed regarding their experiences about collaboration with the family. The interviews were analyzed inductively with thematic content analysis. Results: The analysis generated 4 main themes related to acceptability and adoption: (1) Individualize Initial Support, (2) Developing Confidence and Coping, (3) Normalize When Appropriate, and (4) Implementation in a Complex Service Pathway. The receptivity of parents to learn and attend in the intervention differs according to their present situation. Health care professionals emphasized the importance of adapting the introduction and guidance to parents? receptivity to ensure comprehension, self-efficacy, and thereby acceptance before discharge (Individualize Initial Support). Parents perceived that HOBS served them well and nurtured confidence by teaching them what to be aware of. Health care professionals reported most parents as confident and informed. This potential effect increased the possibility of adoption (Developing Confidence and Coping). Parents expressed that HOBS was not an ?everyday app? and wanted to normalize everyday life when appropriate. Health care professionals suggested differentiating use according to severity and reducing assessments after recovery to adapt the burden of assessments when appropriate (Normalize When Appropriate). Health care professionals? attitude to implement HOBS in their services was positive. They perceived HOBS as useful to systemize guidance, to enhance communication regarding an infant?s condition, and to increase understanding of heart defects in health care professionals with sparse experience (Implementation in a Complex Service Pathway). Conclusions: This feasibility study shows that both parents and health care professionals found HOBS as a positive addition to the health care system and follow-up. HOBS was accepted and potentially useful, but health care professionals should guide parents initially to ensure comprehension and adapt timing to parents? receptivity. By doing so, parents may be confident to know what to look for regarding their child?s health and cope at home. Differentiating between various diagnoses and severity is important to support normalization when appropriate. Further controlled studies are needed to assess adoption, usefulness, and benefits in the health care system. UR - https://formative.jmir.org/2023/1/e45920 UR - http://dx.doi.org/10.2196/45920 UR - http://www.ncbi.nlm.nih.gov/pubmed/37018028 ID - info:doi/10.2196/45920 ER - TY - JOUR AU - Willms, Amanda AU - Rhodes, E. Ryan AU - Liu, Sam PY - 2023/4/5 TI - The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a ?No-Code? Mobile App Builder: Development and Usability Study JO - JMIR Form Res SP - e43823 VL - 7 KW - mobile health KW - mHealth KW - usability study KW - financial incentive KW - physical activity KW - mobile phone KW - smartphone N2 - Background: Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive?driven M-PAC mHealth programs aimed at hypertension prevention. Objective: We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program. Methods: The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability. Results: Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results. Conclusions: The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the ?no-code? app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process. UR - https://formative.jmir.org/2023/1/e43823 UR - http://dx.doi.org/10.2196/43823 UR - http://www.ncbi.nlm.nih.gov/pubmed/37018038 ID - info:doi/10.2196/43823 ER - TY - JOUR AU - Brindal, Emily AU - Kakoschke, Naomi AU - Golley, Sinead AU - Rebuli, Megan AU - Baird, Danielle PY - 2023/4/3 TI - Effectiveness and Feasibility of a Self-guided Mobile App Targeting Emotional Well-being in Healthy Adults: 4-Week Randomized Controlled Trial JO - JMIR Ment Health SP - e44925 VL - 10 KW - emotional well-being KW - self-guided KW - smartphone app KW - mobile health KW - mHealth KW - affect KW - mobile phone N2 - Background: Commercial smartphone apps designed to promote emotional well-being are becoming increasingly popular, but few apps have been empirically validated. Objective: This study examined the feasibility and effectiveness of a self-guided app designed to reduce daily stress via positive messaging and tailored short inspirational talks (ie, peps). Methods: A total of 166 participants (n=112, 67.5% female; mean age 38.48, SD 6.73 years) were recruited through social media advertising and randomized into an intervention (Hey Lemonade app plus twice daily mood monitoring using the Multidimensional Mood Questionnaire [MDMQ]) or active control (twice daily mood monitoring [MDMQ]) group. Primary (coping self-efficacy [CSE]; 3 subscales) and secondary outcomes (vitality, satisfaction with life, perceived stress, positive and negative affect, and hassles and uplifts) were measured at the baseline (week 1) and end point (week 4). The app evaluation questions were assessed at week 2. All interactions and measurements were collected on the internet and through the apps. Results: In total, of 166 participants, 125 (75.3%) completed the trial. There were no differences in dropout rates between the groups (62/81, 76% intervention; 63/85, 74% control). There were significant group-by-time interactions for vitality and hassles but no significant effect for CSE total (P=.05). For the intervention group, the change from baseline to week 4 was significant for vitality (P=.002) and hassles (P=.004), CSE total (P=.008), and CSE Emotional subscale (P=.02). For the control group, any changes over 4 weeks were not significant for any outcome. There was a significant group-by-time interaction for MDMQ calmness (P=.04). By week 4, calmness was significantly higher in the intervention group (P=.046). Of those in the intervention group at week 2 (n=68), 39 (57%) participants recommended the app and 41 (60%) participants wanted to continue using it. Pep talks and customizable voice options were the most popular features. Conclusions: Participants who had access to the smartphone app on an as-needed basis over the 4-week trial showed significant improvements in emotional well-being indicators. More broadly, this suggests that simple accessible solutions may generate meaningful well-being outcomes. Whether these changes are sustained and can be generalized to other population groups is yet to be determined. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) 12622001005741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384304&isReview=true UR - https://mental.jmir.org/2023/1/e44925 UR - http://dx.doi.org/10.2196/44925 UR - http://www.ncbi.nlm.nih.gov/pubmed/37010898 ID - info:doi/10.2196/44925 ER - TY - JOUR AU - Newman, Christie AU - Adriaens, Els AU - Virgilio, Nicolina AU - Vleminckx, Sara AU - de Pelsmaeker, Sara AU - Prawitt, Janne AU - F Silva, I. Catarina PY - 2023/4/3 TI - Development of a Mobile App to Monitor the Effectiveness of a Hydrolyzed Cartilage Matrix Supplement on Joint Discomfort: Real-World Study JO - JMIR Form Res SP - e42967 VL - 7 KW - digital tool KW - hydrolyzed cartilage matrix KW - hydrolyzed collagen KW - chondroitin sulfate KW - joint discomfort KW - real-world study KW - dietary supplement KW - mobile application N2 - Background: Joint discomfort is a widespread and growing problem in active adults. The rising interest in preventative nutrition has increased the demand for supplements reducing joint discomfort. Protocols assessing the effect of a nutritional intervention on health commonly involve a series of face-to-face meetings between participants and study staff that can weigh on resources, participant availabilities, and even increase dropout rates. Digital tools are increasingly added to protocols to facilitate study conduct, but fully digitally run studies are still scarce. With the increasing interest in real-world studies, the development of health apps for mobile devices to monitor study outcomes is of great importance. Objective: The purpose of this real-world study was to develop a specific mobile app, Ingredients for Life, to conduct a 100% digital study testing the effectiveness of a hydrolyzed cartilage matrix (HCM) supplement on joint discomfort in a heterogeneous group of healthy, active consumers. Methods: The Ingredients for Life mobile app using a visual analog scale was specifically developed to monitor the variation in joint pain after exercise by the study participants. A total of 201 healthy and physically active women and men (18-72 years old) with joint pain completed the study over a period of 16 weeks. Participants were randomly allocated to the study groups and did not receive any dietary or lifestyle advice. Each participant indicated one area of joint pain and logged the type and duration of their weekly activities. They received blinded study supplements and took a daily regimen of 1 g of HCM (HCM group) or 1 g of maltodextrin (placebo group) for 12 weeks while weekly logging joint pain scores in the app. This was followed by a 4-week washout period during which participants continued reporting their joint pain scores (until the end of week 16). Results: Joint pain was reduced within 3 weeks of taking a low dosage of HCM (1 g/day), regardless of gender, age group, and activity intensity when compared with the placebo group. After stopping supplementation, joint pain scores gradually increased but still remained significantly lower than those of the placebo group after 4 weeks of washout. The low dropout rate (<6% of participants, mainly in the placebo group) demonstrates that the digital study was well received by the study population. Conclusions: The digital tool allowed us to measure a heterogeneous group of active adults in a real-world setting (without any lifestyle intervention), thus promoting inclusivity and diversity. With low dropout rates, it demonstrates that mobile apps can generate qualitative, quantifiable, real-world data showcasing supplement effectiveness. The study confirmed that the oral intake of a low dose (1 g/day) of HCM led to a significant reduction of joint pain from 3 weeks after starting supplementation. UR - https://formative.jmir.org/2023/1/e42967 UR - http://dx.doi.org/10.2196/42967 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848035 ID - info:doi/10.2196/42967 ER - TY - JOUR AU - Lee, Mauricette AU - Bin Mahmood, Shakran Abu Bakar AU - Lee, Sing Eng AU - Smith, Elizabeth Helen AU - Tudor Car, Lorainne PY - 2023/3/31 TI - Smartphone and Mobile App Use Among Physicians in Clinical Practice: Scoping Review JO - JMIR Mhealth Uhealth SP - e44765 VL - 11 KW - evidence-based medicine KW - specialist KW - general practitioners KW - GP KW - primary care physicians KW - mobile apps KW - consultants KW - surgeons KW - pediatricians KW - clinical care KW - mobile phone N2 - Background: Health care professionals are increasingly using smartphones in clinical care. Smartphone use can affect patient quality of care and clinical outcomes. Objective: This scoping review aimed to describe how physicians use smartphones and mobile apps in clinical settings. Methods: We conducted a scoping review using the Joanna Briggs Institute methodology and reported the results according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We used the following databases in our literature search: MEDLINE, Embase, Cochrane Library, Web of Science, Google Scholar, and gray literature for studies published since 2010. An additional search was also performed by scanning the reference lists of included studies. A narrative synthesis approach was used. Results: A total of 10 studies, published between 2016 and 2021, were included in this review. Of these studies, 8 used surveys and 2 used surveys with focus group study designs to explore smartphone use, its adoption, experience of using it, and views on the use of smartphones among physicians. There were studies with only general practitioners (n=3), studies with only specialists (n=3), and studies with both general practitioners and specialists (n=4). Physicians use smartphones and mobile apps for communication (n=9), clinical decision-making (n=7), drug compendium (n=7), medical education and training (n=7), maintaining health records (n=4), managing time (n=4), and monitoring patients (n=2) in clinical practice. The Medscape medical app was frequently used for information gathering. WhatsApp, a nonmedical app, was commonly used for physician-patient communication. The commonly reported barriers were lack of regulatory oversight, privacy concerns, and limited Wi-Fi or internet access. The commonly reported facilitator was convenience and having access to evidence-based medicine, clinical decision-making support, and a wide array of apps. Conclusions: Smartphones and mobile apps were used for communication, medical education and training, clinical decision-making, and drug compendia in most studies. Although the benefits of smartphones and mobile apps for physicians at work were promising, there were concerns about patient privacy and confidentiality. Legislation is urgently needed to protect the liability of health care professionals using smartphones. UR - https://mhealth.jmir.org/2023/1/e44765 UR - http://dx.doi.org/10.2196/44765 UR - http://www.ncbi.nlm.nih.gov/pubmed/37000498 ID - info:doi/10.2196/44765 ER - TY - JOUR AU - Brauneck, Alissa AU - Schmalhorst, Louisa AU - Kazemi Majdabadi, Mahdi Mohammad AU - Bakhtiari, Mohammad AU - Völker, Uwe AU - Baumbach, Jan AU - Baumbach, Linda AU - Buchholtz, Gabriele PY - 2023/3/30 TI - Federated Machine Learning, Privacy-Enhancing Technologies, and Data Protection Laws in Medical Research: Scoping Review JO - J Med Internet Res SP - e41588 VL - 25 KW - federated learning KW - data protection regulation KW - data protection by design KW - privacy protection KW - General Data Protection Regulation compliance KW - GDPR compliance KW - privacy-preserving technologies KW - differential privacy KW - secure multiparty computation N2 - Background: The collection, storage, and analysis of large data sets are relevant in many sectors. Especially in the medical field, the processing of patient data promises great progress in personalized health care. However, it is strictly regulated, such as by the General Data Protection Regulation (GDPR). These regulations mandate strict data security and data protection and, thus, create major challenges for collecting and using large data sets. Technologies such as federated learning (FL), especially paired with differential privacy (DP) and secure multiparty computation (SMPC), aim to solve these challenges. Objective: This scoping review aimed to summarize the current discussion on the legal questions and concerns related to FL systems in medical research. We were particularly interested in whether and to what extent FL applications and training processes are compliant with the GDPR data protection law and whether the use of the aforementioned privacy-enhancing technologies (DP and SMPC) affects this legal compliance. We placed special emphasis on the consequences for medical research and development. Methods: We performed a scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). We reviewed articles on Beck-Online, SSRN, ScienceDirect, arXiv, and Google Scholar published in German or English between 2016 and 2022. We examined 4 questions: whether local and global models are ?personal data? as per the GDPR; what the ?roles? as defined by the GDPR of various parties in FL are; who controls the data at various stages of the training process; and how, if at all, the use of privacy-enhancing technologies affects these findings. Results: We identified and summarized the findings of 56 relevant publications on FL. Local and likely also global models constitute personal data according to the GDPR. FL strengthens data protection but is still vulnerable to a number of attacks and the possibility of data leakage. These concerns can be successfully addressed through the privacy-enhancing technologies SMPC and DP. Conclusions: Combining FL with SMPC and DP is necessary to fulfill the legal data protection requirements (GDPR) in medical research dealing with personal data. Even though some technical and legal challenges remain, for example, the possibility of successful attacks on the system, combining FL with SMPC and DP creates enough security to satisfy the legal requirements of the GDPR. This combination thereby provides an attractive technical solution for health institutions willing to collaborate without exposing their data to risk. From a legal perspective, the combination provides enough built-in security measures to satisfy data protection requirements, and from a technical perspective, the combination provides secure systems with comparable performance with centralized machine learning applications. UR - https://www.jmir.org/2023/1/e41588 UR - http://dx.doi.org/10.2196/41588 UR - http://www.ncbi.nlm.nih.gov/pubmed/36995759 ID - info:doi/10.2196/41588 ER - TY - JOUR AU - Bianchini, Edoardo AU - Warmerdam, Elke AU - Romijnders, Robbin AU - Stürner, Hanja Klarissa AU - Baron, Ralf AU - Heinzel, Sebastian AU - Pontieri, Ernesto Francesco AU - Hansen, Clint AU - Maetzler, Walter PY - 2023/3/30 TI - Turning When Using Smartphone in Persons With and Those Without Neurologic Conditions: Observational Study JO - J Med Internet Res SP - e41082 VL - 25 KW - turning KW - turning coordination KW - smartphone KW - dual task KW - dual task cost KW - Parkinson disease KW - Parkinson KW - stroke KW - multiple sclerosis KW - low back pain KW - neurology KW - neurological KW - movement KW - biomechanics KW - gait KW - balance KW - walk KW - kinesiology KW - fall N2 - Background: Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions. Objective: This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases. Methods: Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm. Results: In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use. Conclusions: Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases. Trial Registration: German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998 UR - https://www.jmir.org/2023/1/e41082 UR - http://dx.doi.org/10.2196/41082 UR - http://www.ncbi.nlm.nih.gov/pubmed/36995756 ID - info:doi/10.2196/41082 ER - TY - JOUR AU - Tewari, Ambuj PY - 2023/3/30 TI - mHealth Systems Need a Privacy-by-Design Approach: Commentary on ?Federated Machine Learning, Privacy-Enhancing Technologies, and Data Protection Laws in Medical Research: Scoping Review? JO - J Med Internet Res SP - e46700 VL - 25 KW - mHealth KW - differential privacy KW - private synthetic data KW - federated learning KW - data protection regulation KW - data protection by design KW - privacy protection KW - General Data Protection Regulation KW - GDPR compliance KW - privacy-preserving technologies KW - secure multiparty computation KW - multiparty computation KW - machine learning KW - privacy UR - https://www.jmir.org/2023/1/e46700 UR - http://dx.doi.org/10.2196/46700 UR - http://www.ncbi.nlm.nih.gov/pubmed/36995757 ID - info:doi/10.2196/46700 ER - TY - JOUR AU - McGillivray, Lauren AU - Keng-Meng Hui, Nicholas AU - Wong, J. Quincy J. AU - Han, Jin AU - Qian, Jiahui AU - Torok, Michelle PY - 2023/3/30 TI - The Effectiveness of a Smartphone Intervention Targeting Suicidal Ideation in Young Adults: Randomized Controlled Trial Examining the Influence of Loneliness JO - JMIR Ment Health SP - e44862 VL - 10 KW - loneliness KW - suicidal ideation KW - suicide prevention KW - digital therapeutics KW - smartphone intervention KW - apps N2 - Background: Loneliness is commonly reported by young people and has been shown to contribute to the rapid onset and escalation of depression and suicidal ideation during adolescence. Lonely people may also be particularly susceptible to disengaging from treatment early given the likelihood of their more complex clinical profiles leading to cognitive fatigue. While a smartphone intervention (LifeBuoy) has been shown to effectively reduce suicidal ideation in young adults, poor engagement is a well-documented issue for this therapeutic modality and has been shown to result in poorer treatment outcomes. Objective: This study aims to determine whether loneliness affects how young people experiencing suicidal ideation engage with and benefit from a therapeutic smartphone intervention (LifeBuoy). Methods: A total of 455 community-based Australian young adults (aged 18-25 years) experiencing recent suicidal ideation were randomized to use a dialectical behavioral therapy?based smartphone intervention (LifeBuoy) or an attention-matched control app (LifeBuoy-C) for 6 weeks. Participants completed measures of suicidal ideation, depression, anxiety, and loneliness at baseline (T0), post intervention (T1), and 3 months post intervention (T2). Piecewise linear mixed models were used to examine whether loneliness levels moderated the effect of LifeBuoy and LifeBuoy-C on suicidal ideation and depression across time (T0 to T1; T1 to T2). This statistical method was then used to examine whether app engagement (number of modules completed) influenced the relationship between baseline loneliness and suicidal ideation and depression across time. Results: Loneliness was positively associated with higher levels of overall suicidal ideation (B=0.75, 95% CI 0.08-1.42; P=.03) and depression (B=0.88, 95% CI 0.45-1.32; P<.001), regardless of time point or allocated condition. However, loneliness did not affect suicidal ideation scores across time (time 1: B=1.10, 95% CI ?0.25 to 2.46; P=.11; time 2: B=0.43, 95% CI ?1.25 to 2.12; P=.61) and depression scores across time (time 1: B=0.00, 95% CI ?0.67 to 0.66; P=.99; time 2: B=0.41, 95% CI ?0.37 to 1.18; P=.30) in either condition. Similarly, engagement with the LifeBuoy app was not found to moderate the impact of loneliness on suicidal ideation (B=0.00, 95% CI ?0.17 to 0.18; P=.98) or depression (B=?0.08, 95% CI ?0.19 to 0.03; P=.14). Conclusions: Loneliness was not found to affect young adults? engagement with a smartphone intervention (LifeBuoy) nor any clinical benefits derived from the intervention. LifeBuoy, in its current form, can effectively engage and treat individuals regardless of how lonely they may be. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001671156; https://tinyurl.com/yvpvn5n8 International Registered Report Identifier (IRRID): RR2-10.2196/23655 UR - https://mental.jmir.org/2023/1/e44862 UR - http://dx.doi.org/10.2196/44862 UR - http://www.ncbi.nlm.nih.gov/pubmed/36995752 ID - info:doi/10.2196/44862 ER - TY - JOUR AU - Nasruddin, Nasriah Nur Izzatun AU - Murphy, Joey AU - Armstrong, Glynis Miranda Elaine PY - 2023/3/29 TI - Physical Activity Surveillance in Children and Adolescents Using Smartphone Technology: Systematic Review JO - JMIR Pediatr Parent SP - e42461 VL - 6 KW - physical activity KW - surveillance KW - children KW - adolescents KW - smartphone technology KW - smartphone apps KW - smartphone KW - technology KW - application KW - database KW - mobile phone N2 - Background: Self-reported physical activity (PA) questionnaires have traditionally been used for PA surveillance in children and adolescents, especially in free-living conditions. Objective measures are more accurate at measuring PA, but high cost often creates a barrier for their use in low- and middle-income settings. The advent of smartphone technology has greatly influenced mobile health and has offered new opportunities in health research, including PA surveillance. Objective: This review aimed to systematically explore the use of smartphone technology for PA surveillance in children and adolescents, specifically focusing on the use of smartphone apps. Methods: A literature search was conducted using 5 databases (PubMed, Scopus, CINAHL, MEDLINE, and Web of Science) and Google Scholar to identify articles relevant to the topic that were published from 2008 to 2023. Articles were included if they included children and adolescents within the age range of 5 to 18 years; used smartphone technology as PA surveillance; had PA behavioral outcomes such as energy expenditure, step count, and PA levels; were written in English; and were published between 2008 and 2023. Results: We identified and analyzed 8 studies (5 cross-sectional studies and 3 cohort studies). All participants were aged 12-18 years, and all studies were conducted in high-income countries only. Participants were recruited from schools, primary care facilities, and voluntarily. Five studies used mobile apps specifically and purposely developed for the study, whereas 3 studies used mobile apps downloadable from the Apple App Store and Android Play Store. PA surveillance using these apps was conducted from 24 hours to 4 weeks. Conclusions: Evidence of PA surveillance using smartphone technology in children and adolescents was insufficient, which demonstrated the knowledge gap. Additional research is needed to further study the feasibility and validity of smartphone apps for PA surveillance among children and adolescents, especially in low- and middle-income countries. UR - https://pediatrics.jmir.org/2023/1/e42461 UR - http://dx.doi.org/10.2196/42461 UR - http://www.ncbi.nlm.nih.gov/pubmed/36989033 ID - info:doi/10.2196/42461 ER - TY - JOUR AU - Willms, Amanda AU - Rhodes, E. Ryan AU - Liu, Sam PY - 2023/3/24 TI - Effects of Mobile-Based Financial Incentive Interventions for Adults at Risk of Developing Hypertension: Feasibility Randomized Controlled Trial JO - JMIR Form Res SP - e36562 VL - 7 KW - mHealth KW - physical activity KW - financial incentive KW - hypertension KW - mobile health KW - exercise KW - lifestyle health KW - cardiovascular disease KW - mortality KW - heart disease KW - incentive KW - motivation N2 - Background: Hypertension is the leading modifiable risk factor for cardiovascular disease and mortality. Adopting lifestyle modifications, like increasing physical activity (PA), can be an effective strategy in blood pressure (BP) control, but many adults do not meet the PA guidelines. Financial incentive interventions have the power to increase PA levels but are often limited due to cost. Further, mobile health technologies can make these programs more scalable. There is a gap in the literature about the most feasible and effective financial incentive PA framework; thus, pay-per-minute (PPM) and self-funded investment incentive (SFII) frameworks were explored. Objective: The aims were to (1) determine the feasibility (recruitment, engagement, and acceptability) of an 8-week mobile-based PPM and SFII hypertension prevention PA program and (2) explore the effects of PPM and SFII interventions relative to a control on the PA levels, BP, and PA motivation. Methods: In total, 55 adults aged 40-65 years not meeting the Canadian PA guidelines were recruited from Facebook and randomized into the following groups: financial incentive groups, PPM or SFII, receiving up to CAD $20 each (at the time of writing: CAD $1=US $0.74), or a control group without financial incentive. PPM participants received CAD $0.02 for each minute of moderate-to-vigorous PA (MVPA) per week up to the PA guidelines and the SFII received CAD $2.50 for each week they met the PA guidelines. Feasibility outcome measures (recruitment, engagement, and acceptability) were assessed. Secondary outcomes included changes in PA outcomes (MVPA and daily steps) relative to baseline were compared among PPM, SFII, and control groups at 4 and 8 weeks using linear regressions. Changes in BP and relative autonomy index relative to baseline were compared among the groups at follow-up. Results: Participants were randomized to the PPM (n=19), SFII (n=18), or control (n=18) groups. The recruitment, retention rate, and engagement were 77%, 75%, and 65%, respectively. The intervention received overall positive feedback, with 90% of comments praising the intervention structure, financial incentive, and educational materials. Relative to the control at 4 weeks, the PPM and SFII arms increased their MVPA with medium effect (PPM vs control: ?2p=0.06, mean 117.8, SD 514 minutes; SFII vs control: ?2p=0.08, mean 145.3, SD 616 minutes). At 8 weeks, PPM maintained a small effect in MVPA relative to the control (?2p=0.01, mean 22.8, SD 249 minutes) and SFII displayed a medium effect size (?2p=0.07, mean 113.8, SD 256 minutes). Small effects were observed for PPM and SFII relative to the control for systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PPM: ?2p=0.12, ?mean SBP 7.1, SD 23.61 mm Hg; ?2p=0.04, ?mean DBP 3.5, SD 6.2 mm Hg; SFII: ?2p=0.01, ?mean SBP ?0.4, SD 1.4 mm Hg; ?2p=0.02, ?mean DBP ?2.3, SD 7.7 mm Hg) and relative autonomy index (PPM: ?2p=0.01; SFII: ?2p=0.03). Conclusions: The feasibility metrics and preliminary findings suggest that a future full-scale randomized controlled trial examining the efficacy of PPM and SFII relative to a control is feasible, and studies with longer duration are warranted. UR - https://formative.jmir.org/2023/1/e36562 UR - http://dx.doi.org/10.2196/36562 UR - http://www.ncbi.nlm.nih.gov/pubmed/36961486 ID - info:doi/10.2196/36562 ER - TY - JOUR AU - Elledge, K. Daniel AU - Lee, Craddock Simon AU - Stewart, M. Sunita AU - Pop, Radu AU - Trivedi, H. Madhukar AU - Hughes, L. Jennifer PY - 2023/3/22 TI - Examining a Resilience Mental Health App in Adolescents: Acceptability and Feasibility Study JO - JMIR Form Res SP - e38042 VL - 7 KW - youth KW - prevention KW - resilience KW - mental health app KW - mobile phone N2 - Background: Resilience is defined as the ability to rely on internal characteristics and external strengths to adapt to adverse events. Although universal resilience-enhancing programs are effective for adolescents, there is a need for interventions that are more easily accessible and can be customized for individual teens. Phone apps are easy to use, can be tailored to individuals, and have demonstrated positive effects for mental health outcomes. Objective: This study aimed to examine the feasibility and acceptability of a resilience app for adolescents. This app aimed to enhance resilience through modules focused on depression prevention, stress management, and healthy lifestyle approaches containing videos, measures, and practice suggestions. Furthermore, the study aimed to evaluate the effect of short-term app use on changes in resilience. Methods: In study 1, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to discuss possible incentives for using a mental health app, the benefits of app use, and concerns associated with app use. Feedback from study 1 led to ideas for the prototype. In study 2, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to gather feedback about the resilience app prototype. Feedback from study 2 led to changes in the prototype, although not all suggestions could be implemented. In study 3, 40 adolescents used the app for 30 days to determine feasibility and acceptability. Additionally, resilience and secondary mental health outcomes were measured before and after app use. Dependent samples 2-tailed t tests were conducted to determine whether there were changes in resilience and secondary mental health outcomes among the adolescents before and after app use. Results: Multiple themes were identified through study 1 individual interviews and focus groups, including app content, features, engagement, benefits, concerns, and improvement. Specifically, the adolescents provided helpful suggestions for making the prototype more appealing and functional for teen users. Study 2 adolescents and adults reported that the prototype was feasible and acceptable through the Computer System Usability Questionnaire (mean 6.30, SD 1.03) and Mobile App Rating Scale (mean 4.08, SD 0.61). In study 2, there were no significant differences in resilience and mental health outcomes after using the app for 30 days. There was variation between the participants in the extent to which they used the app, which may have led to variation in the results. The users appeared to prefer the depression module and survey sections, which provided mental health feedback. Conclusions: Qualitative and quantitative data provide evidence that youth are interested in a resilience mental health app and that the current prototype is feasible. Although there were no significant mental health changes in study 3 users, practical implications and future directions are discussed for mental health app research. UR - https://formative.jmir.org/2023/1/e38042 UR - http://dx.doi.org/10.2196/38042 UR - http://www.ncbi.nlm.nih.gov/pubmed/36947113 ID - info:doi/10.2196/38042 ER - TY - JOUR AU - Vollert, Bianka AU - Müller, Luise AU - Jacobi, Corinna AU - Trockel, Mickey AU - Beintner, Ina PY - 2023/3/21 TI - Effectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial JO - JMIR Ment Health SP - e39052 VL - 10 KW - sleep KW - insomnia KW - cognitive behavioral treatment for insomnia KW - eHealth KW - mobile app N2 - Background: A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use. Objective: This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep. Methods: In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment. Results: We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good. Conclusions: An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed. Trial Registration: ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517 UR - https://mental.jmir.org/2023/1/e39052 UR - http://dx.doi.org/10.2196/39052 UR - http://www.ncbi.nlm.nih.gov/pubmed/36943337 ID - info:doi/10.2196/39052 ER - TY - JOUR AU - Banerjee, Agnik AU - Mutlu, Cezmi Onur AU - Kline, Aaron AU - Surabhi, Saimourya AU - Washington, Peter AU - Wall, Paul Dennis PY - 2023/3/21 TI - Training and Profiling a Pediatric Facial Expression Classifier for Children on Mobile Devices: Machine Learning Study JO - JMIR Form Res SP - e39917 VL - 7 KW - edge computing KW - affective computing KW - autism spectrum disorder KW - autism KW - ASD KW - classifier KW - classification KW - model KW - algorithm KW - mobile health KW - computer vision KW - deep learning KW - machine learning for health KW - pediatrics KW - emotion recognition KW - mHealth KW - diagnostic tool KW - digital therapy KW - child KW - developmental disorder KW - smartphone KW - image analysis KW - machine learning KW - Image classification KW - neural network N2 - Background: Implementing automated facial expression recognition on mobile devices could provide an accessible diagnostic and therapeutic tool for those who struggle to recognize facial expressions, including children with developmental behavioral conditions such as autism. Despite recent advances in facial expression classifiers for children, existing models are too computationally expensive for smartphone use. Objective: We explored several state-of-the-art facial expression classifiers designed for mobile devices, used posttraining optimization techniques for both classification performance and efficiency on a Motorola Moto G6 phone, evaluated the importance of training our classifiers on children versus adults, and evaluated the models? performance against different ethnic groups. Methods: We collected images from 12 public data sets and used video frames crowdsourced from the GuessWhat app to train our classifiers. All images were annotated for 7 expressions: neutral, fear, happiness, sadness, surprise, anger, and disgust. We tested 3 copies for each of 5 different convolutional neural network architectures: MobileNetV3-Small 1.0x, MobileNetV2 1.0x, EfficientNetB0, MobileNetV3-Large 1.0x, and NASNetMobile. We trained the first copy on images of children, second copy on images of adults, and third copy on all data sets. We evaluated each model against the entire Child Affective Facial Expression (CAFE) set and by ethnicity. We performed weight pruning, weight clustering, and quantize-aware training when possible and profiled each model?s performance on the Moto G6. Results: Our best model, a MobileNetV3-Large network pretrained on ImageNet, achieved 65.78% accuracy and 65.31% F1-score on the CAFE and a 90-millisecond inference latency on a Moto G6 phone when trained on all data. This accuracy is only 1.12% lower than the current state of the art for CAFE, a model with 13.91x more parameters that was unable to run on the Moto G6 due to its size, even when fully optimized. When trained solely on children, this model achieved 60.57% accuracy and 60.29% F1-score. When trained only on adults, the model received 53.36% accuracy and 53.10% F1-score. Although the MobileNetV3-Large trained on all data sets achieved nearly a 60% F1-score across all ethnicities, the data sets for South Asian and African American children achieved lower accuracy (as much as 11.56%) and F1-score (as much as 11.25%) than other groups. Conclusions: With specialized design and optimization techniques, facial expression classifiers can become lightweight enough to run on mobile devices and achieve state-of-the-art performance. There is potentially a ?data shift? phenomenon between facial expressions of children compared with adults; our classifiers performed much better when trained on children. Certain underrepresented ethnic groups (e.g., South Asian and African American) also perform significantly worse than groups such as European Caucasian despite similar data quality. Our models can be integrated into mobile health therapies to help diagnose autism spectrum disorder and provide targeted therapeutic treatment to children. UR - https://formative.jmir.org/2023/1/e39917 UR - http://dx.doi.org/10.2196/39917 UR - http://www.ncbi.nlm.nih.gov/pubmed/35962462 ID - info:doi/10.2196/39917 ER - TY - JOUR AU - Bucci, Sandra AU - Varese, Filippo AU - Quayle, Ethel AU - Cartwright, Kim AU - Machin, Matthew AU - Whelan, Pauline AU - Chitsabesan, Prathiba AU - Richards, Cathy AU - Green, Victoria AU - Norrie, John AU - Schwannauer, Matthias PY - 2023/3/21 TI - A Digital Intervention to Improve Mental Health and Interpersonal Resilience in Young People Who Have Experienced Technology-Assisted Sexual Abuse: Protocol for a Nonrandomized Feasibility Clinical Trial and Nested Qualitative Study JO - JMIR Res Protoc SP - e40539 VL - 12 KW - technology-assisted sexual abuse KW - digital KW - young people KW - abuse KW - eHealth KW - mobile health KW - mHealth KW - mobile phone N2 - Background: No evidence-based support has been offered to young people (YP) who have experienced technology-assisted sexual abuse (TASA). Interventions aimed at improving mentalization (the ability to understand the mental states of oneself and others) are increasingly being applied to treat YP with various clinical issues. Digital technology use among YP is now common. A digital intervention aimed at improving mentalization in YP who have experienced TASA may reduce the risk of revictimization and future harm and make YP more resilient and able to manage distress that might result from TASA experiences. Objective: In this paper, we describe a protocol for determining the feasibility of the i-Minds trial and the acceptability, safety, and usability of the digital intervention (the i-Minds app) and explore how to best integrate i-Minds into existing routine care pathways. Methods: This is a mixed methods nonrandomized study aimed to determine the feasibility, acceptability, safety, and usability of the intervention. Participants aged between 12 and 18 years who report distress associated with TASA exposure will be recruited from the United Kingdom from the National Health Service (NHS) Trust Child and Adolescent Mental Health Services, sexual assault referral centers, and a web-based e-therapy provider. All participants will receive the i-Minds app for 6 weeks. Coproduced with YP and a range of stakeholders, the i-Minds app focuses on 4 main topics: mentalization, TASA and its impact, emotional and mental health, and trauma. A daily prompt will encourage YP to use the app, which is designed to be used in a stand-alone manner alongside routine care. We will follow participants up after the intervention and conduct interviews with stakeholders to explore the acceptability of the app and trial procedures and identify areas for improvement. Informed by the normalization process theory, we will examine barriers and enablers relevant to the future integration of the intervention into existing care pathways, including traditional clinic-based NHS and NHS e-therapy providers. Results: This study was approved by the Research Ethics Board of Scotland. We expect data to be collected from up to 60 YP. We expect to conduct approximately 20 qualitative interviews with participants and 20 health care professionals who referred YP to the study. The results of this study have been submitted for publication. Conclusions: This study will provide preliminary evidence on the feasibility of recruiting YP to a trial of this nature and on the acceptability, safety, and usability of the i-Minds app, including how to best integrate it into existing routine care. The findings will inform the decision to proceed with a powered efficacy trial. Trial Registration: International Standard Randomised Controlled Trial Number Registry (ISRCTN) ISRCTN43130832; https://www.isrctn.com/ISRCTN43130832 International Registered Report Identifier (IRRID): DERR1-10.2196/40539 UR - https://www.researchprotocols.org/2023/1/e40539 UR - http://dx.doi.org/10.2196/40539 UR - http://www.ncbi.nlm.nih.gov/pubmed/36943343 ID - info:doi/10.2196/40539 ER - TY - JOUR AU - Kim, Jiyeong AU - Aryee, D. Lois M. AU - Bang, Heejung AU - Prajogo, Steffi AU - Choi, K. Yong AU - Hoch, S. Jeffrey AU - Prado, L. Elizabeth PY - 2023/3/20 TI - Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis JO - JMIR Ment Health SP - e43066 VL - 10 KW - digital mental health KW - mHealth KW - mobile health KW - digital health KW - low- and middle-income country KW - depression KW - anxiety KW - mobile phone N2 - Background: Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care. Objective: We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs. Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance. Results: Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were ?0.61 (95% CI ?0.78 to ?0.44; n=67 comparisons) for depression and ?0.73 (95% CI ?0.93 to ?0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I2=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high. Conclusions: Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal. Trial Registration: PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709 UR - https://mental.jmir.org/2023/1/e43066 UR - http://dx.doi.org/10.2196/43066 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939820 ID - info:doi/10.2196/43066 ER - TY - JOUR AU - Rozenberg, Dmitry AU - Al Kaabi, Noor AU - Camacho Perez, Encarna AU - Nourouzpour, Sahar AU - Lopez-Hernandez, Laura AU - McGillis, Laura AU - Goligher, Ewan AU - Reid, Darlene W. AU - Chow, Chung-Wai AU - Ryan, M. Clodagh AU - Kumbhare, Dinesh AU - Huszti, Ella AU - Champagne, Kateri AU - Raj, Satish AU - Mak, Susanna AU - Santa Mina, Daniel AU - Clarke, Hance AU - Mittal, Nimish PY - 2023/3/20 TI - Evaluation and Management of Dyspnea in Hypermobile Ehlers-Danlos Syndrome and Generalized Hypermobility Spectrum Disorder: Protocol for a Pilot and Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e44832 VL - 12 KW - Ehlers-Danlos Syndrome KW - generalized hypermobility spectrum disorders KW - inspiratory muscle training KW - rehabilitation KW - exercise KW - mobile phone N2 - Background: Dyspnea is a prevalent symptom in individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) and generalized hypermobility spectrum disorder (G-HSD), yet its contributors have not been identified. One known contributor to dyspnea is respiratory muscle weakness. The feasibility and effectiveness of inspiratory muscle training (IMT) in combination with standard-of-care rehabilitation (aerobic, resistance, neuromuscular stabilization, and balance and proprioception exercises) in improving respiratory muscle strength and patient-reported outcomes in patients with hEDS or G-HSD have not been evaluated. Objective: This study aims to evaluate dyspnea, respiratory muscle strength, and patient-reported outcome measures (PROMs) in hEDS or G-HSD compared with healthy controls and to assess the feasibility of a randomized controlled trial of IMT and standard-of-care rehabilitation for improving respiratory muscle strength, exercise capacity, and PROMs compared with standard-of-care rehabilitation in hEDS and G-HSD. Methods: The study will include 34 participants with hEDS or G-HSD and 17 healthy, age- and sex-matched controls to compare respiratory muscle structure and function and PROMs. After baseline assessments, participants with hEDS or G-HSD will be randomized into the intervention group and provided IMT combined with Ehlers-Danlos Syndrome standard-of-care rehabilitation or into the usual care group, and provided only standard-of-care rehabilitation for 8 weeks. The intervention group will be prescribed IMT in their home environment using the POWERbreathe K5 IMT device (POWERbreathe International Ltd). IMT will comprise 2 daily sessions of 30 breaths for 5 days per week, with IMT progressing from 20% to 60% of the baseline maximal inspiratory pressure (MIP) over an 8-week period. Feasibility will be assessed through rates of recruitment, attrition, adherence, adverse events, and participant satisfaction. The primary pilot outcome is MIP change over an 8-week period in hEDS or G-HSD. Secondary outcomes will include the evaluation of dyspnea using Medical Research Council Scale and 18-point qualitative dyspnea descriptors; diaphragmatic thickening fraction using ultrasound; respiratory muscle endurance; pulmonary function; prefrontal cortical activity using functional near-infrared spectroscopy; aerobic capacity during cardiopulmonary exercise testing; quality of life using Short Form-36; and scores from the Depression, Anxiety, and Stress scale-21. These measures will also be performed once in healthy controls to compare normative values. Multivariable regression will be used to assess the contributors to dyspnea. Paired 2-tailed t tests will be used to assess the changes in MIP and secondary measures after 8 weeks of IMT. Results: Study recruitment began in August 2021 and, with several disruptions owing to COVID-19, is expected to be completed by December 2023. Conclusions: This study will provide a better understanding of the factors associated with dyspnea and the feasibility and effectiveness of IMT combined with standard-of-care rehabilitation. IMT may be a novel therapeutic strategy for improving respiratory muscle function and patient-reported outcomes in individuals with hEDS or G-HSD. Trial Registration: ClinicalTrials.gov NCT04972565; https://clinicaltrials.gov/ct2/show/NCT04972565 International Registered Report Identifier (IRRID): DERR1-10.2196/44832 UR - https://www.researchprotocols.org/2023/1/e44832 UR - http://dx.doi.org/10.2196/44832 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939815 ID - info:doi/10.2196/44832 ER - TY - JOUR AU - Noda, Yuko AU - So, Ryuhei AU - Sonoda, Misaki AU - Tabuchi, Takahiro AU - Nomura, Akihiro PY - 2023/3/17 TI - The Usefulness of a Smartphone App?Based Smoking Cessation Program for Conventional Cigarette Users, Heated Tobacco Product Users, and Dual Users: Retrospective Study JO - J Med Internet Res SP - e42776 VL - 25 KW - smoking cessation KW - nicotine dependence KW - digital therapeutics KW - telemedicine KW - telecare KW - mobile phone KW - smoking cessation program KW - online counseling KW - online therapy KW - heated tobacco product KW - HTP N2 - Background: Heated tobacco products (HTPs) are widespread in Japan, and smoking cessation of such products has become an important issue owing to the spread of harmful effects from HTPs. The efficacy of online digital therapy has been reported in smoking cessation treatment; however, we have limited evidence of online smoking cessation programs for HTP users. Objective: In this study, we evaluate the usefulness of the Ascure program for HTP users (defined as exclusive HTP use or dual use of HTP and cigarettes) compared with exclusive cigarette users. Methods: This was a retrospective study. We recruited adult smokers participating in the Ascure online smoking cessation program in Japan from June 2019 to February 2021. The Ascure smartphone app provided four elements: (1) educational video tutorials to enhance the understanding of nicotine dependence, (2) a personalized to-do list for behavior change, (3) a digital diary for record keeping, and (4) interactive chat sessions for relief from cravings or withdrawal symptoms. The primary outcome was the continuous abstinence rate (CAR) at weeks 21 to 24, biochemically validated using salivary cotinine testing. We considered those who dropped out of the program as smoking cessation failures. We analyzed the primary outcome using inverse probability weighting against tobacco product type estimated by multinomial propensity scores. We also assessed CAR at weeks 9 to 12 and program adherence. Results: We analyzed data from 2952 participants, including 52% (1524/3478) in the cigarette group, 35% (1038/3478) in the HTP group, and 13% (390/3478) in the dual-use group, who had a mean age of 43.4 (SD 10.8) years and included 17% (513/2952) women. CAR at weeks 21 to 24 showed that exclusive HTP users were more likely to stop tobacco use than exclusive cigarette smokers (CAR 52.6% for cigarette users vs CAR 64.8% for HTP users; odds ratio [OR] 1.17, 95% CI 1.12-1.22; P<.001). There was no significant difference between the exclusive cigarette users and the dual users (CAR 52.6% for cigarette users vs CAR 48.7% for dual users; OR 0.99, 95% CI 0.93-1.05; P=.77). CAR at weeks 9 to 12 was 56.7% (95% CI 54.2%-59.2%) for the exclusive cigarette users, 68.3% (95% CI 65.5%-71.1%) for the exclusive HTP users, and 58.2% (95% CI 53.3%-63.1%) for the dual users. The program adherence rate at week 24 was 70.7% overall (68.4% for cigarette users, 75% for HTP users, and 67.9% for dual users). Conclusions: Exclusive HTP users had higher CARs and adherence compared with exclusive cigarette users, indicating a higher affinity for the Ascure online smoking cessation program. This program might be a useful smoking cessation option for HTP users, as well as for cigarette smokers. UR - https://www.jmir.org/2023/1/e42776 UR - http://dx.doi.org/10.2196/42776 UR - http://www.ncbi.nlm.nih.gov/pubmed/36930197 ID - info:doi/10.2196/42776 ER - TY - JOUR AU - Langener, M. Anna AU - Stulp, Gert AU - Kas, J. Martien AU - Bringmann, F. Laura PY - 2023/3/17 TI - Capturing the Dynamics of the Social Environment Through Experience Sampling Methods, Passive Sensing, and Egocentric Networks: Scoping Review JO - JMIR Ment Health SP - e42646 VL - 10 KW - social context KW - experience sampling method KW - egocentric network KW - digital phenotyping KW - passive measures KW - ambulatory assessment KW - mobile phone N2 - Background: Social interactions are important for well-being, and therefore, researchers are increasingly attempting to capture people?s social environment. Many different disciplines have developed tools to measure the social environment, which can be highly variable over time. The experience sampling method (ESM) is often used in psychology to study the dynamics within a person and the social environment. In addition, passive sensing is often used to capture social behavior via sensors from smartphones or other wearable devices. Furthermore, sociologists use egocentric networks to track how social relationships are changing. Each of these methods is likely to tap into different but important parts of people?s social environment. Thus far, the development and implementation of these methods have occurred mostly separately from each other. Objective: Our aim was to synthesize the literature on how these methods are currently used to capture the changing social environment in relation to well-being and assess how to best combine these methods to study well-being. Methods: We conducted a scoping review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: We included 275 studies. In total, 3 important points follow from our review. First, each method captures a different but important part of the social environment at a different temporal resolution. Second, measures are rarely validated (>70% of ESM studies and 50% of passive sensing studies were not validated), which undermines the robustness of the conclusions drawn. Third, a combination of methods is currently lacking (only 15/275, 5.5% of the studies combined ESM and passive sensing, and no studies combined all 3 methods) but is essential in understanding well-being. Conclusions: We highlight that the practice of using poorly validated measures hampers progress in understanding the relationship between the changing social environment and well-being. We conclude that different methods should be combined more often to reduce the participants? burden and form a holistic perspective on the social environment. UR - https://mental.jmir.org/2023/1/e42646 UR - http://dx.doi.org/10.2196/42646 UR - http://www.ncbi.nlm.nih.gov/pubmed/36930210 ID - info:doi/10.2196/42646 ER - TY - JOUR AU - Davanzo, Antonella AU - d´Huart, Delfine AU - Seker, Süheyla AU - Moessner, Markus AU - Zimmermann, Ronan AU - Schmeck, Klaus AU - Behn, Alex PY - 2023/3/15 TI - Study Features and Response Compliance in Ecological Momentary Assessment Research in Borderline Personality Disorder: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e44853 VL - 25 KW - borderline personality disorder KW - ecological momentary assessment KW - compliance KW - study design features KW - e?mental health KW - mobile phone N2 - Background: Borderline personality disorder (BPD) is characterized by frequent and intense moment-to-moment changes in affect, behavior, identity, and interpersonal relationships, which typically result in significant and negative deterioration of the person?s overall functioning and well-being. Measuring and characterizing the rapidly changing patterns of instability in BPD dysfunction as they occur in a person?s daily life can be challenging. Ecological momentary assessment (EMA) is a method that can capture highly dynamic processes in psychopathology research and, thus, is well suited to study intense variability patterns across areas of dysfunction in BPD. EMA studies are characterized by frequent repeated assessments that are delivered to participants in real-life, real-time settings using handheld devices capable of registering responses to short self-report questions in daily life. Compliance in EMA research is defined as the proportion of prompts answered by the participant, considering all planned prompts sent. Low compliance with prompt schedules can compromise the relative advantages of using this method. Despite the growing EMA literature on BPD in recent years, findings regarding study design features that affect compliance with EMA protocols have not been compiled, aggregated, and estimated. Objective: This systematic meta-analytic review aimed to investigate the relationship between study design features and participant compliance in EMA research of BPD. Methods: A systematic review was conducted on November 12, 2021, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analyses of Observational Studies in Epidemiology) guidelines to search for articles featuring EMA studies of BPD that reported compliance rates and included sufficient data to extract relevant design features. For studies with complete data, random-effect models were used to estimate the overall compliance rate and explore its association with design features. Results: In total, 28 peer-reviewed EMA studies comprising 2052 participants were included in the study. Design features (sampling strategy, average prompting frequency, number of items, response window, sampling device, financial incentive, and dropout rate) showed a large variability across studies, and many studies did not report design features. The meta-analytic synthesis was restricted to 64% (18/28) of articles and revealed a pooled compliance rate of 79% across studies. We did not find any significant relationship between design features and compliance rates. Conclusions: Our results show wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying setups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible nonspecific factors of study design that may have an impact on compliance. Given the promise of EMA research in BPD, we also discuss the importance of unifying standards for EMA reporting so that data stemming from this rich literature can be aggregated and interpreted jointly. UR - https://www.jmir.org/2023/1/e44853 UR - http://dx.doi.org/10.2196/44853 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920466 ID - info:doi/10.2196/44853 ER - TY - JOUR AU - Cobos-Campos, Raquel AU - Cordero-Guevara, Aurelio Jose AU - Apiñaniz, Antxon AU - de Lafuente, Sáez Arantza AU - Bermúdez Ampudia, Cristina AU - Argaluza Escudero, Julene AU - Pérez Llanos, Iraida AU - Parraza Diez, Naiara PY - 2023/3/15 TI - The Impact of Digital Health on Smoking Cessation JO - Interact J Med Res SP - e41182 VL - 12 KW - smoking cessation KW - smoking KW - cessation KW - smoker KW - quit KW - care delivery KW - service delivery KW - health technology KW - mHealth KW - mobile applications KW - mobile health KW - digital health KW - mobile app KW - health app KW - smartphone KW - health service KW - eHealth KW - trend N2 - Background: Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients? quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation?relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. Objective: This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. Methods: A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. Results: In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. Conclusions: mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resources. UR - https://www.i-jmr.org/2023/1/e41182 UR - http://dx.doi.org/10.2196/41182 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920468 ID - info:doi/10.2196/41182 ER - TY - JOUR AU - Zaleski, Amanda AU - Sigler, Brittany AU - Leggitt, Alan AU - Choudhary, Shruti AU - Berns, Ryan AU - Rhee, Kyu AU - Schwarzwald, Heidi PY - 2023/3/14 TI - The Influence of a Wearable-Based Reward Program on Health Care Costs: Retrospective, Propensity Score?Matched Cohort Study JO - J Med Internet Res SP - e45064 VL - 25 KW - digital health intervention KW - mobile app KW - wellness KW - physical activity KW - wearable KW - cost-effectiveness KW - mobile health app KW - health plan KW - medical cost KW - health care cost N2 - Background: Mobile health (mHealth) technology holds great promise as an easily accessible and effective solution to improve population health at scale. Despite the abundance of mHealth offerings, only a minority are grounded in evidence-based practice, whereas even fewer have line of sight into population-level health care spending, limiting the clinical utility of such tools. Objective: This study aimed to explore the influence of a health plan?sponsored, wearable-based, and reward-driven digital health intervention (DHI) on health care spending over 1 year. The DHI was delivered through a smartphone-based mHealth app available only to members of a large commercial health plan and leveraged a combination of behavioral economics, user-generated sensor data from the connected wearable device, and claims history to create personalized, evidence-based recommendations for each user. Methods: This study deployed a propensity score?matched, 2-group, and pre-post observational design. Adults (?18 years of age) enrolled in a large, national commercial health plan and self-enlisted in the DHI for ?7 months were allocated to the intervention group (n=56,816). Members who were eligible for the DHI but did not enlist were propensity score?matched to the comparison group (n=56,816). Average (and relative change from baseline) medical and pharmacy spending per user per month was computed for each member of the intervention and comparison groups during the pre- (ie, 12 months) and postenlistment (ie, 7-12 months) periods using claims data. Results: Baseline characteristics and medical spending were similar between groups (P=.89). On average, the total included sample population (N=113,632) consisted of young to middle-age (mean age 38.81 years), mostly White (n=55,562, 48.90%), male (n=46,731, 41.12%) and female (n=66,482, 58.51%) participants. Compared to a propensity score?matched cohort, DHI users demonstrated approximately US $10 per user per month lower average medical spending (P=.02) with a concomitant increase in preventive care activities and decrease in nonemergent emergency department admissions. These savings translated to approximately US $6.8 million in avoidable health care costs over the course of 1 year. Conclusions: This employer-sponsored, digital health engagement program has a high likelihood for return on investment within 1 year owing to clinically meaningful changes in health-seeking behaviors and downstream medical cost savings. Future research should aim to elucidate health behavior?related mechanisms in support of these findings and continue to explore novel strategies to ensure equitable access of DHIs to underserved populations that stand to benefit the most. UR - https://www.jmir.org/2023/1/e45064 UR - http://dx.doi.org/10.2196/45064 UR - http://www.ncbi.nlm.nih.gov/pubmed/36917152 ID - info:doi/10.2196/45064 ER - TY - JOUR AU - Khalid, Ayisha AU - Dong, Quanfang AU - Chuluunbaatar, Enkhzaya AU - Haldane, Victoria AU - Durrani, Hammad AU - Wei, Xiaolin PY - 2023/3/14 TI - Implementation Science Perspectives on Implementing Telemedicine Interventions for Hypertension or Diabetes Management: Scoping Review JO - J Med Internet Res SP - e42134 VL - 25 KW - telemedicine KW - hypertension KW - diabetes KW - implementation science KW - mobile phone N2 - Background: Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. Objective: We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. Methods: We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. Results: Of the 17,687 records identified, 35 (0.2%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. Conclusions: Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels. UR - https://www.jmir.org/2023/1/e42134 UR - http://dx.doi.org/10.2196/42134 UR - http://www.ncbi.nlm.nih.gov/pubmed/36917174 ID - info:doi/10.2196/42134 ER - TY - JOUR AU - Ahmed, Arfan AU - Aziz, Sarah AU - Abd-alrazaq, Alaa AU - Farooq, Faisal AU - Househ, Mowafa AU - Sheikh, Javaid PY - 2023/3/14 TI - The Effectiveness of Wearable Devices Using Artificial Intelligence for Blood Glucose Level Forecasting or Prediction: Systematic Review JO - J Med Internet Res SP - e40259 VL - 25 KW - diabetes KW - artificial intelligence KW - wearable devices KW - machine learning KW - blood glucose KW - forecasting KW - prediction N2 - Background: In 2021 alone, diabetes mellitus, a metabolic disorder primarily characterized by abnormally high blood glucose (BG) levels, affected 537 million people globally, and over 6 million deaths were reported. The use of noninvasive technologies, such as wearable devices (WDs), to regulate and monitor BG in people with diabetes is a relatively new concept and yet in its infancy. Noninvasive WDs coupled with machine learning (ML) techniques have the potential to understand and conclude meaningful information from the gathered data and provide clinically meaningful advanced analytics for the purpose of forecasting or prediction. Objective: The purpose of this study is to provide a systematic review complete with a quality assessment looking at diabetes effectiveness of using artificial intelligence (AI) in WDs for forecasting or predicting BG levels. Methods: We searched 7 of the most popular bibliographic databases. Two reviewers performed study selection and data extraction independently before cross-checking the extracted data. A narrative approach was used to synthesize the data. Quality assessment was performed using an adapted version of the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Results: From the initial 3872 studies, the features from 12 studies were reported after filtering according to our predefined inclusion criteria. The reference standard in all studies overall (n=11, 92%) was classified as low, as all ground truths were easily replicable. Since the data input to AI technology was highly standardized and there was no effect of flow or time frame on the final output, both factors were categorized in a low-risk group (n=11, 92%). It was observed that classical ML approaches were deployed by half of the studies, the most popular being ensemble-boosted trees (random forest). The most common evaluation metric used was Clarke grid error (n=7, 58%), followed by root mean square error (n=5, 42%). The wide usage of photoplethysmogram and near-infrared sensors was observed on wrist-worn devices. Conclusions: This review has provided the most extensive work to date summarizing WDs that use ML for diabetic-related BG level forecasting or prediction. Although current studies are few, this study suggests that the general quality of the studies was considered high, as revealed by the QUADAS-2 assessment tool. Further validation is needed for commercially available devices, but we envisage that WDs in general have the potential to remove the need for invasive devices completely for glucose monitoring in the not-too-distant future. Trial Registration: PROSPERO CRD42022303175; https://tinyurl.com/3n9jaayc UR - https://www.jmir.org/2023/1/e40259 UR - http://dx.doi.org/10.2196/40259 UR - http://www.ncbi.nlm.nih.gov/pubmed/36917147 ID - info:doi/10.2196/40259 ER - TY - JOUR AU - Deng, Wenrui AU - M J J van der Kleij, Rianne AU - Shen, Hongxia AU - Wei, Junjie AU - Brakema, A. Evelyn AU - Guldemond, Nick AU - Song, Xiaoyue AU - Li, Xiaoming AU - van Tol, Marie-José AU - Aleman, André AU - Chavannes, H. Niels PY - 2023/3/14 TI - eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e39250 VL - 25 KW - eHealth KW - psychosocial interventions KW - insomnia KW - adults KW - meta-analysis KW - mobile phone N2 - Background: Worldwide, insomnia remains a highly prevalent public health problem. eHealth presents a novel opportunity to deliver effective, accessible, and affordable insomnia treatments on a population-wide scale. However, there is no quantitative integration of evidence regarding the effectiveness of eHealth-based psychosocial interventions on insomnia. Objective: We aimed to evaluate the effectiveness of eHealth-based psychosocial interventions for insomnia and investigate the influence of specific study characteristics and intervention features on these effects. Methods: We searched PubMed, Embase, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials from database inception to February 16, 2021, for publications investigating eHealth-based psychosocial interventions targeting insomnia and updated the search of PubMed to December 6, 2021. We also screened gray literature for unpublished data. Eligible studies were randomized controlled trials of eHealth-based psychosocial interventions targeting adults with insomnia. Random-effects meta-analysis models were used to assess primary and secondary outcomes. Primary outcomes were insomnia severity and sleep quality. Meta-analyses were performed by pooling the effects of eHealth-based psychosocial interventions on insomnia compared with inactive and in-person conditions. We performed subgroup analyses and metaregressions to explore specific factors that affected the effectiveness. Secondary outcomes included sleep diary parameters and mental health?related outcomes. Results: Of the 19,980 identified records, 37 randomized controlled trials (13,227 participants) were included. eHealth-based psychosocial interventions significantly reduced insomnia severity (Hedges g=?1.01, 95% CI ?1.12 to ?0.89; P<.001) and improved sleep quality (Hedges g=?0.58, 95% CI ?0.75 to ?0.41; P<.001) compared with inactive control conditions, with no evidence of publication bias. We found no significant difference compared with in-person treatment in alleviating insomnia severity (Hedges g=0.41, 95% CI ?0.02 to 0.85; P=.06) and a significant advantage for in-person treatment in enhancing sleep quality (Hedges g=0.56, 95% CI 0.24-0.88; P<.001). eHealth-based psychosocial interventions had significantly larger effects (P=.01) on alleviating insomnia severity in clinical samples than in subclinical samples. eHealth-based psychosocial interventions that incorporated guidance from trained therapists had a significantly greater effect on insomnia severity (P=.05) and sleep quality (P=.02) than those with guidance from animated therapists or no guidance. Higher baseline insomnia severity and longer intervention duration were associated with a larger reduction in insomnia severity (P=.004). eHealth-based psychosocial interventions significantly improved each secondary outcome. Conclusions: eHealth interventions for insomnia are effective in improving sleep and mental health and can be considered a promising treatment for insomnia. Our findings support the wider dissemination of eHealth interventions and their further promotion in a stepped-care model. Offering blended care could improve treatment effectiveness. Future research needs to elucidate which specific intervention components are most important to achieve intervention effectiveness. Blended eHealth interventions may be tailored to benefit people with low socioeconomic status, limited access to health care, or lack of eHealth literacy. UR - https://www.jmir.org/2023/1/e39250 UR - http://dx.doi.org/10.2196/39250 UR - http://www.ncbi.nlm.nih.gov/pubmed/36917145 ID - info:doi/10.2196/39250 ER - TY - JOUR AU - Flood, M. Stephanie AU - Thompson, Brooke AU - Faulkner, Guy AU - Vanderloo, M. Leigh AU - Blackett, Beth AU - Dolf, Matt AU - Latimer-Cheung, E. Amy AU - Duggan, Mary AU - Di Sebastiano, M. Katie AU - Lane, N. Kirstin AU - Brouwers, C. Melissa AU - McKenna, Julia AU - Chulak-Bozzer, Tala AU - Fuller, Daniel AU - Ruissen, R. Geralyn AU - Sturrock, L. Shelby AU - Tomasone, R. Jennifer PY - 2023/3/14 TI - Development of a ParticipACTION App?Based Intervention for Improving Postsecondary Students? 24-Hour Movement Guideline Behaviors: Protocol for the Application of Intervention Mapping JO - JMIR Res Protoc SP - e39977 VL - 12 KW - 24-Hour Movement Guidelines KW - multiple behavior change KW - mobile health KW - mHealth KW - postsecondary students KW - physical activity KW - sedentary behavior KW - sleep KW - app KW - mobile phone N2 - Background: The Canadian 24-Hour Movement Guidelines for adults provide specific recommendations for levels of physical activity, sedentary behavior, and sleep (ie, the movement behaviors) required for optimal health. Performance of the movement behaviors is associated with improved mental well-being. However, most postsecondary students do not meet the movement behavior recommendations within the Canadian 24-Hour Movement Guidelines and experience increased stress and declining well-being, suggesting the need for an intervention targeting students? movement behaviors. Objective: We aimed to develop and implement a theory-informed intervention intended to improve the movement behaviors and mental well-being of first-year postsecondary students. Methods: The Intervention Mapping protocol was applied in the development and implementation of the intervention. Intervention Mapping entailed performing a needs assessment, determining the intervention outcomes, selecting theory- and evidence-based change methods and applications, preparing and producing intervention plans and materials, developing the implementation plan, and finally developing an evaluation plan. The Theoretical Domains Framework and the Behavior Change Wheel were also used in conjunction with the Intervention Mapping protocol to ensure a solid theoretical basis for the intervention. This protocol led to the development and implementation of a 6-week, theory-informed ParticipACTION app?based intervention aimed at helping first-year postsecondary students improve their movement behaviors and mental well-being. The developed app content provided students with information on each of the movement behaviors and behavioral strategies (ie, goal setting, action planning, monitoring, and coping planning). The use of Intervention Mapping allowed for the continuous involvement of various multidisciplinary partners and end users, ensuring that the intervention design and implementation was appropriate for the target audience. The feasibility, acceptability, and potential impact of the intervention will be examined in a subsequent proof-of-concept study at 2 Canadian university campuses. Results: Participant recruitment occurred during September 2021, and the intervention was conducted from October to December 2021. The deadline for completion of the postintervention questionnaire by participants was mid-December 2021. The analysis of data examining the feasibility, acceptability, and potential impact of the intervention began in January 2022, with the publication of the proof-of-concept evaluation expected in 2023. Conclusions: Intervention Mapping with the Theoretical Domains Framework and Behavior Change Wheel was a useful approach to combine evidence and theoretical concepts to guide the design and implementation of a ParticipACTION app?based intervention targeting postsecondary students? movement behaviors and mental well-being. This process may serve as an example for other researchers developing multiple behavior change app?based interventions. Should the forthcoming evaluation demonstrate the intervention?s acceptability, feasibility, and potential impact, the intervention may provide a scalable method of improving postsecondary students? movement behaviors and mental well-being. International Registered Report Identifier (IRRID): RR1-10.2196/39977 UR - https://www.researchprotocols.org/2023/1/e39977 UR - http://dx.doi.org/10.2196/39977 UR - http://www.ncbi.nlm.nih.gov/pubmed/36917173 ID - info:doi/10.2196/39977 ER - TY - JOUR AU - Steindal, A. Simen AU - Nes, Gonçalves Andréa Aparecida AU - Godskesen, E. Tove AU - Holmen, Heidi AU - Winger, Anette AU - Österlind, Jane AU - Dihle, Alfhild AU - Klarare, Anna PY - 2023/3/13 TI - Advantages and Challenges of Using Telehealth for Home-Based Palliative Care: Systematic Mixed Studies Review JO - J Med Internet Res SP - e43684 VL - 25 KW - digital health KW - eHealth KW - health care technology KW - home-based palliative care KW - review KW - systematic mixed studies review KW - telemedicine KW - mobile phone N2 - Background: Owing to the increasing number of people with palliative care needs and the current shortage of health care professionals (HCPs), providing quality palliative care has become challenging. Telehealth could enable patients to spend as much time as possible at home. However, no previous systematic mixed studies reviews have synthesized evidence on patients? experiences of the advantages and challenges of telehealth in home-based palliative care. Objective: In this systematic mixed studies review, we aimed to critically appraise and synthesize the findings from studies that investigated patients? use of telehealth in home-based palliative care, focusing on the advantages and challenges experienced by patients. Methods: This is a systematic mixed studies review with a convergent design. The review is reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in the following databases: Allied and Complementary Medicine Database, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, MEDLINE, PsycInfo, and Web of Science. The inclusion criteria were as follows: studies using quantitative, qualitative, or mixed methods; studies that investigated the experience of using telehealth with follow-up from HCPs of home-based patients aged ?18; studies published between January 2010 and June 2022; and studies published in Norwegian, Danish, Swedish, English, Portuguese, or Spanish in peer-reviewed journals. Five pairs of authors independently assessed eligibility of the studies, appraised methodological quality, and extracted data. The data were synthesized using thematic synthesis. Results: This systematic mixed studies review included 41 reports from 40 studies. The following 4 analytical themes were synthesized: potential for a support system and self-governance at home; visibility supports interpersonal relationships and a joint understanding of care needs; optimized information flow facilitates tailoring of remote caring practices; and technology, relationships, and complexity as perpetual obstacles in telehealth. Conclusions: The advantages of telehealth were that patients experience a potential support system that could enable them to remain at home, and the visual features of telehealth enable them to build interpersonal relationships with HCPs over time. Self-reporting provides HCPs with information about symptoms and circumstances that facilitates tailoring care to specific patients. Challenges with the use of telehealth were related to barriers to technology use and inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Few studies have included the self-reporting of existential or spiritual concerns, emotions, and well-being. Some patients perceived telehealth as intrusive and a threat to their privacy at home. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process. UR - https://www.jmir.org/2023/1/e43684 UR - http://dx.doi.org/10.2196/43684 UR - http://www.ncbi.nlm.nih.gov/pubmed/36912876 ID - info:doi/10.2196/43684 ER - TY - JOUR AU - Thabrew, Hiran AU - Kumar, Harshali AU - Steadman, Evandah PY - 2023/3/13 TI - Acceptability and Feasibility of ?Village,? a Digital Communication App for Young People Experiencing Low Mood, Thoughts of Self-harm, and Suicidal Ideation to Obtain Support From Family and Friends: Mixed Methods Pilot Open Trial JO - JMIR Form Res SP - e41273 VL - 7 KW - youth KW - suicide KW - self-harm KW - depression KW - support KW - application KW - mobile phone N2 - Background: Young people experiencing low mood, thoughts related to self-harm, and suicidal ideation often struggle to communicate their emotions and receive timely support from family and friends. Technologically delivered support interventions may be useful in addressing this need. Objective: This paper aimed to evaluate the acceptability and feasibility of ?Village,? a communication app co-designed with young people and their family and friends from New Zealand. Methods: A mixed methods pilot open trial design was adopted. Participants were primarily recruited via social media advertisements and clinicians in specialist mental health services over an 8-month period. The primary outcomes were acceptability of the app (via thematically analyzed qualitative feedback and retention rates) and feasibility of conducting a larger randomized controlled trial gauged via effectiveness of recruitment methods, completion of chosen outcome measures, and occurrence of unanticipated operational issues. Secondary outcomes were app usability, safety, and changes in symptoms of depression (via the Patient Health Questionnaire?9 modified for adolescents), suicidal ideation (on the Suicidal Ideation Questionnaire), and functioning (using the World Health Organization Disability Assessment Schedule 2.0 or Child and Youth version). Results: A total of 26 young people (?users?) were enrolled in the trial, of which 21 recruited friends and family members (?buddies?) and completed quantitative outcome measures at baseline, 4 weeks, and 3 months. Furthermore, 13 users and 12 buddies also provided qualitative feedback about the app, identifying the key themes of appeal of app features and layout, usefulness of its content, and technological challenges (primarily with onboarding and notifications). Users gave Village a mean rating of 3.8 (range 2.7-4.6) out of 5 on a 5-point scale for app quality and an overall star rating of 3.4 out of 5 for subjective quality. Within this limited sample, users reported a clinically significant reduction in depressive symptoms (P=.007), but nonsignificant changes in suicidal ideation and functioning. The embedded risk detection software was activated on 3 occasions, and no additional support was required for users. Conclusions: During this open trial, Village was found to be acceptable, usable, and safe. The feasibility of a larger randomized controlled trial was also confirmed after some modifications to the recruitment strategy and app. Trial Registration: Australian New Zealand Clinical Trials Network Registry ACTRN12620000241932p; https://tinyurl.com/ya6t4fx2 UR - https://formative.jmir.org/2023/1/e41273 UR - http://dx.doi.org/10.2196/41273 UR - http://www.ncbi.nlm.nih.gov/pubmed/36912882 ID - info:doi/10.2196/41273 ER - TY - JOUR AU - Ranjit, S. Yerina AU - Davis, M. Warren AU - Fentem, Andrea AU - Riordan, Raven AU - Roscoe, Rikki AU - Cavazos-Rehg, Patricia PY - 2023/3/10 TI - Text Messages Exchanged Between Individuals With Opioid Use Disorder and Their mHealth e-Coaches: Content Analysis Study JO - JMIR Hum Factors SP - e37351 VL - 10 KW - opioid use disorder KW - opioid KW - opium KW - overdose KW - drug KW - substance use KW - content analysis KW - text message intervention KW - text message KW - text messaging KW - mobile health KW - mHealth KW - social support KW - e-coach KW - counseling KW - mental health KW - depression KW - recovery support KW - eHealth KW - digital health N2 - Background: Opioid use disorder (OUD) has affected 2.2 million people in the United States. About 7.2 million people reported using illicit drugs in 2019, which contributed to over 70,000 overdose deaths. SMS text messaging interventions have been shown to be effective in OUD recovery. However, the interpersonal communication between individuals in OUD treatment and a support team on digital platforms has not been well examined. Objective: This study aims to understand the communication between participants undergoing OUD recovery and their e-coaches by examining the SMS text messages exchanged from the lens of social support and the issues related to OUD treatment. Methods: A content analysis of messages exchanged between individuals recovering from OUD and members of a support team was conducted. Participants were enrolled in a mobile health intervention titled ?uMAT-R,? a primary feature of which is the ability for patients to instantly connect with a recovery support staff or an ?e-coach? via in-app messaging. Our team analyzed dyadic text-based messages of over 12 months. In total, 70 participants? messages and 1196 unique messages were analyzed using a social support framework and OUD recovery topics. Results: Out of 70 participants, 44 (63%) were between the ages of 31 and 50 years, 47 (67%) were female, 41 (59%) were Caucasian, and 42 (60%) reported living in unstable housing conditions. An average of 17 (SD 16.05) messages were exchanged between each participant and their e-coach. Out of 1196 messages, 64% (n=766) messages were sent by e-coaches and 36% (n=430) by participants. Messages of emotional support occurred the most, with 196 occurrences (n=9, 0.8%) and e-coaches (n=187, 15.6%). Messages of material support had 110 occurrences (participants: n=8, 0.7%; e-coaches: n=102, 8.5%). With OUD recovery topics, opioid use risk factors appeared in most (n=72) occurrences (patient: n=66, 5.5%; e-coach: n=6, 0.5%), followed by a message of avoidance of drug use 3.9% (n=47), which occurred mainly from participants. Depression was correlated with messages of social support (r=0.27; P=.02). Conclusions: Individuals with OUD who had mobile health needs tended to engage in instant messaging with the recovery support staff. Participants who are engaged in messaging often engage in conversations around risk factors and avoidance of drug use. Instant messaging services can be instrumental in providing the social and educational support needs of individuals recovering from OUD. UR - https://humanfactors.jmir.org/2023/1/e37351 UR - http://dx.doi.org/10.2196/37351 UR - http://www.ncbi.nlm.nih.gov/pubmed/36897632 ID - info:doi/10.2196/37351 ER - TY - JOUR AU - Eyles, Helen AU - Grey, Jacqueline AU - Jiang, Yannan AU - Umali, Elaine AU - McLean, Rachael AU - Te Morenga, Lisa AU - Neal, Bruce AU - Rodgers, Anthony AU - Doughty, N. Robert AU - Ni Mhurchu, Cliona PY - 2023/3/9 TI - Effectiveness of a Sodium-Reduction Smartphone App and Reduced-Sodium Salt to Lower Sodium Intake in Adults With Hypertension: Findings From the Salt Alternatives Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e43675 VL - 11 KW - mobile health KW - mHealth KW - smartphone KW - smartphone app KW - cardiovascular disease KW - sodium KW - salt KW - blood pressure KW - technology KW - reduced-sodium salt KW - mobile phone N2 - Background: Even modest reductions in blood pressure (BP) can have an important impact on population-level morbidity and mortality from cardiovascular disease. There are 2 promising approaches: the SaltSwitch smartphone app, which enables users to scan the bar code of a packaged food using their smartphone camera and receive an immediate, interpretive traffic light nutrition label on-screen alongside a list of healthier, lower-salt options in the same food category; and reduced-sodium salts (RSSs), which are an alternative to regular table salt that are lower in sodium and higher in potassium but have a similar mouthfeel, taste, and flavor. Objective: Our aim was to determine whether a 12-week intervention with a sodium-reduction package comprising the SaltSwitch smartphone app and an RSS could reduce urinary sodium excretion in adults with high BP. Methods: A 2-arm parallel randomized controlled trial was conducted in New Zealand (target n=326). Following a 2-week baseline period, adults who owned a smartphone and had high BP (?140/85 mm Hg) were randomized in a 1:1 ratio to the intervention (SaltSwitch smartphone app + RSS) or control (generic heart-healthy eating information from The Heart Foundation of New Zealand). The primary outcome was 24-hour urinary sodium excretion at 12 weeks estimated via spot urine. Secondary outcomes were urinary potassium excretion, BP, sodium content of food purchases, and intervention use and acceptability. Intervention effects were assessed blinded using intention-to-treat analyses with generalized linear regression adjusting for baseline outcome measures, age, and ethnicity. Results: A total of 168 adults were randomized (n=84, 50% per group) between June 2019 and February 2020. Challenges associated with the COVID-19 pandemic and smartphone technology detrimentally affected recruitment. The adjusted mean difference between groups was 547 (95% CI ?331 to 1424) mg for estimated 24-hour urinary sodium excretion, 132 (95% CI ?1083 to 1347) mg for urinary potassium excretion, ?0.66 (95% CI ?3.48 to 2.16) mm Hg for systolic BP, and 73 (95% CI ?21 to 168) mg per 100 g for the sodium content of food purchases. Most intervention participants reported using the SaltSwitch app (48/64, 75%) and RSS (60/64, 94%). SaltSwitch was used on 6 shopping occasions, and approximately 1/2 tsp per week of RSS was consumed per household during the intervention. Conclusions: In this randomized controlled trial of a salt-reduction package, we found no evidence that dietary sodium intake was reduced in adults with high BP. These negative findings may be owing to lower-than-anticipated engagement with the trial intervention package. However, implementation and COVID-19?related challenges meant that the trial was underpowered, and it is possible that a real effect may have been missed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000352101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377044 and Universal Trial U1111-1225-4471 UR - https://mhealth.jmir.org/2023/1/e43675 UR - http://dx.doi.org/10.2196/43675 UR - http://www.ncbi.nlm.nih.gov/pubmed/36892914 ID - info:doi/10.2196/43675 ER - TY - JOUR AU - Kim, Chan Joo AU - Saguna, Saguna AU - Åhlund, Christer PY - 2023/3/8 TI - Acceptability of a Health Care App With 3 User Interfaces for Older Adults and Their Caregivers: Design and Evaluation Study JO - JMIR Hum Factors SP - e42145 VL - 10 KW - Internet of Things KW - health monitoring KW - older adults KW - augmented reality KW - user experience KW - independent living KW - design study KW - mobile phone N2 - Background: The older population needs solutions for independent living and reducing the burden on caregivers while maintaining the quality and dignity of life. Objective: The aim of this study was to design, develop, and evaluate an older adult health care app that supports trained caregivers (ie, formal caregivers) and relatives (ie, informal caregivers). We aimed to identify the factors that affect user acceptance of interfaces depending on the user?s role. Methods: We designed and developed an app with 3 user interfaces that enable remote sensing of an older adult?s daily activities and behaviors. We conducted user evaluations (N=25) with older adults and their formal and informal caregivers to obtain an overall impression of the health care monitoring app in terms of user experience and usability. In our design study, the participants had firsthand experience with our app, followed by a questionnaire and individual interview to express their opinions on the app. Through the interview, we also identified their views on each user interface and interaction modality to identify the relationship between the user?s role and their acceptance of a particular interface. The questionnaire answers were statistically analyzed, and we coded the interview answers based on keywords related to a participant?s experience, for example, ease of use and usefulness. Results: We obtained overall positive results in the user evaluation of our app regarding key aspects such as efficiency, perspicuity, dependability, stimulation, and novelty, with an average between 1.74 (SD 1.02) and 2.18 (SD 0.93) on a scale of ?3.0 to 3.0. The overall impression of our app was favorable, and we identified that ?simple? and ?intuitive? were the main factors affecting older adults? and caregivers? preference for the user interface and interaction modality. We also identified a positive user acceptance of the use of augmented reality by 91% (10/11) of the older adults to share information with their formal and informal caregivers. Conclusions: To address the need for a study to evaluate the user experience and user acceptance by older adults as well as both formal and informal caregivers regarding the user interfaces with multimodal interaction in the context of health monitoring, we designed, developed, and conducted user evaluations with the target user groups. Our results through this design study show important implications for designing future health monitoring apps with multiple interaction modalities and intuitive user interfaces in the older adult health care domain. UR - https://humanfactors.jmir.org/2023/1/e42145 UR - http://dx.doi.org/10.2196/42145 UR - http://www.ncbi.nlm.nih.gov/pubmed/36884275 ID - info:doi/10.2196/42145 ER - TY - JOUR AU - Abas, Aishah Siti AU - Ismail, Nurhuda AU - Zakaria, Yuslina AU - Ismail, Ismassabah AU - Mat Zain, Hidayah Nurul AU - Yasin, Munira Siti AU - Ibrahim, Khalid AU - Razali, Asmah AU - Mohd Yusoff, Sherzkawee Mas Ahmad AU - Ahmad, Norliza AU - Chinnayah, Thilaka PY - 2023/3/7 TI - A Gamified Real-time Video Observed Therapies (GRVOTS) Mobile App via the Modified Nominal Group Technique: Development and Validation Study JO - JMIR Serious Games SP - e43047 VL - 11 KW - video directly observed therapy KW - VDOT KW - mobile health KW - mHealth KW - tuberculosis KW - medication adherence KW - directly observed therapy KW - video-observed therapy KW - mobile app KW - mobile health app KW - gamification N2 - Background: The success rate of tuberculosis (TB) treatment in Malaysia remains below the recommended World Health Organization target of 90% despite the implementation of directly observed therapy, short-course, a physical drug monitoring system, since 1994. With increasing numbers of patients with TB in Malaysia defaulting on treatment, exploring another method to improve TB treatment adherence is vital. The use of gamification and real-time elements via video-observed therapies in mobile apps is one such method expected to induce motivation toward TB treatment adherence. Objective: This study aimed to document the process of designing, developing, and validating the gamification, motivation, and real-time elements in the Gamified Real-time Video Observed Therapies (GRVOTS) mobile app. Methods: The modified nominal group technique via a panel of 11 experts was used to validate the presence of the gamification and motivation elements inside the app, which were assessed based on the percentage of agreement among the experts. Results: The GRVOTS mobile app, which can be used by patients, supervisors, and administrators, was successfully developed. For validation purposes, the gamification and motivation features of the app were validated as they achieved a total mean percentage of agreement of 97.95% (SD 2.51%), which was significantly higher than the minimum agreement score of 70% (P<.001). Further, each component of gamification, motivation, and technology was also rated at 70% or more. Among the gamification elements, fun received the lowest scores, possibly because the nature of serious games does not prioritize the fun element and because the perception of fun varies by personality. The least popular element in motivation was relatedness, as stigma and discrimination hinder interaction features, such as leaderboards and chats, in the mobile app. Conclusions: It has been validated that the GRVOTS mobile app contains gamification and motivation elements, which are intended to encourage medication adherence to TB treatment. UR - https://games.jmir.org/2023/1/e43047 UR - http://dx.doi.org/10.2196/43047 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881449 ID - info:doi/10.2196/43047 ER - TY - JOUR AU - Bertholet, Nicolas AU - Schmutz, Elodie AU - Cunningham, A. John AU - McNeely, Jennifer AU - Gmel, Gerhard AU - Daeppen, Jean-Bernard AU - Grazioli, S. Véronique PY - 2023/3/7 TI - Development of a Secondary Prevention Smartphone App for Students With Unhealthy Alcohol Use: Results From a Qualitative Assessment JO - JMIR Hum Factors SP - e41088 VL - 10 KW - app KW - alcohol-related secondary prevention KW - university students KW - tertiary students KW - qualitative KW - alcohol KW - mHealth KW - mobile app KW - smartphone KW - mobile phone N2 - Background: Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population. Objective: This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population. Methods: The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ?18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing. Results: The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: ?General Acceptance of the App,? ?Importance of the Targeted and Relevant App Content,? ?Importance of Credibility,? ?Importance of the App Usability,? ?Importance of a Simple and Attractive Design,? ?Importance of Notifications to Ensure App Use over Time.? Besides a general acceptance of the app, these themes reflected participants? recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved. Conclusions: Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time. Trial Registration: ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4145-2 UR - https://humanfactors.jmir.org/2023/1/e41088 UR - http://dx.doi.org/10.2196/41088 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881448 ID - info:doi/10.2196/41088 ER - TY - JOUR AU - Niemeijer, Koen AU - Mestdagh, Merijn AU - Verdonck, Stijn AU - Meers, Kristof AU - Kuppens, Peter PY - 2023/3/7 TI - Combining Experience Sampling and Mobile Sensing for Digital Phenotyping With m-Path Sense: Performance Study JO - JMIR Form Res SP - e43296 VL - 7 KW - digital phenotyping KW - mobile health KW - mHealth KW - mobile sensing KW - passive sensing KW - ambulatory assessment KW - experience sampling KW - ecological momentary assessment KW - smartphones KW - mobile phone N2 - Background: The experience sampling methodology (ESM) has long been considered as the gold standard for gathering data in everyday life. In contrast, current smartphone technology enables us to acquire data that are much richer, more continuous, and unobtrusive than is possible via ESM. Although data obtained from smartphones, known as mobile sensing, can provide useful information, its stand-alone usefulness is limited when not combined with other sources of information such as data from ESM studies. Currently, there are few mobile apps available that allow researchers to combine the simultaneous collection of ESM and mobile sensing data. Furthermore, such apps focus mostly on passive data collection with only limited functionality for ESM data collection. Objective: In this paper, we presented and evaluated the performance of m-Path Sense, a novel, full-fledged, and secure ESM platform with background mobile sensing capabilities. Methods: To create an app with both ESM and mobile sensing capabilities, we combined m-Path, a versatile and user-friendly platform for ESM, with the Copenhagen Research Platform Mobile Sensing framework, a reactive cross-platform framework for digital phenotyping. We also developed an R package, named mpathsenser, which extracts raw data to an SQLite database and allows the user to link and inspect data from both sources. We conducted a 3-week pilot study in which we delivered ESM questionnaires while collecting mobile sensing data to evaluate the app?s sampling reliability and perceived user experience. As m-Path is already widely used, the ease of use of the ESM system was not investigated. Results: Data from m-Path Sense were submitted by 104 participants, totaling 69.51 GB (430.43 GB after decompression) or approximately 37.50 files or 31.10 MB per participant per day. After binning accelerometer and gyroscope data to 1 value per second using summary statistics, the entire SQLite database contained 84,299,462 observations and was 18.30 GB in size. The reliability of sampling frequency in the pilot study was satisfactory for most sensors, based on the absolute number of collected observations. However, the relative coverage rate?the ratio between the actual and expected number of measurements?was below its target value. This could mostly be ascribed to gaps in the data caused by the operating system pushing away apps running in the background, which is a well-known issue in mobile sensing. Finally, some participants reported mild battery drain, which was not considered problematic for the assessed participants? perceived user experience. Conclusions: To better study behavior in everyday life, we developed m-Path Sense, a fusion of both m-Path for ESM and Copenhagen Research Platform Mobile Sensing. Although reliable passive data collection with mobile phones remains challenging, it is a promising approach toward digital phenotyping when combined with ESM. UR - https://formative.jmir.org/2023/1/e43296 UR - http://dx.doi.org/10.2196/43296 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881444 ID - info:doi/10.2196/43296 ER - TY - JOUR AU - Emery, Joanne AU - Huang, Yue AU - Naughton, Felix AU - Cooper, Sue AU - McDaid, Lisa AU - Dickinson, Anne AU - Clark, Miranda AU - Kinahan-Goodwin, Darren AU - Thomson, Ross AU - Phillips, Lucy AU - Lewis, Sarah AU - Coleman, Tim PY - 2023/3/7 TI - Comparison of a Daily Smartphone App and Retrospective Questionnaire Measures of Adherence to Nicotine Replacement Therapy Among Pregnant Women: Observational Study JO - JMIR Form Res SP - e35045 VL - 7 KW - smoking cessation KW - pregnancy KW - nicotine replacement therapy KW - treatment adherence measurement KW - smartphone app KW - questionnaires KW - ecological momentary assessment KW - mHealth KW - mobile health KW - smoking KW - nicotine N2 - Background: Few studies have investigated how to best measure adherence to smoking cessation medications, but continuous usage measures are recommended. Objective: In this first study of its kind, we compared methods for measuring adherence to nicotine replacement therapy (NRT) among pregnant women, investigating the completeness and validity of data collected from daily assessments using a smartphone app versus data collected from retrospective questionnaires. Methods: Women aged ?16 years who were daily smokers and <25 weeks pregnant were offered smoking-cessation counseling and encouraged to use NRT. For 28 days after setting a quit date (QD), women were asked to report NRT use daily to a smartphone app and to questionnaires administered in person or remotely at 7 and 28 days. For both data collection methods, we provided up to £25 (~US $30) as compensation for the time taken providing research data. Data completeness and NRT use reported to the app and in questionnaires were compared. For each method, we also correlated mean daily nicotine doses reported within 7 days of the QD with Day 7 saliva cotinine concentrations. Results: Of the 438 women assessed for eligibility, 40 participated and 35 accepted NRT. More participants (31/35) submitted NRT usage data to the app by Day 28 (median 25, IQR 11 days) than completed the Day 28 questionnaire (24/35) or either of the two questionnaires (27/35). Data submitted to the app showed a lower reported duration of NRT use compared to that indicated in the questionnaire (median for app 24 days, IQR 10.25; median for questionnaire 28 days, IQR 4.75; P=.007), and there appeared to be specific cases of overreporting to the questionnaire. Mean daily nicotine doses between the QD and Day 7 were lower when calculated using app data (median for app 40 mg, IQR 52.1; median for questionnaire 40 mg, IQR 63.1; P=.001), and some large outliers were evident for the questionnaire. Mean daily nicotine doses, adjusted for cigarettes smoked, were not associated with cotinine concentrations for either method (app rs=0.184, P=.55; questionnaire rs=0.031, P=.92), but the small sample size meant that the analysis was likely underpowered. Conclusions: Daily assessment of NRT use via a smartphone app facilitated more complete data (a higher response rate) than questionnaires, and reporting rates over 28 days were encouraging among pregnant women. App data had better face validity; retrospective questionnaires appeared to overestimate NRT use for some participants. UR - https://formative.jmir.org/2023/1/e35045 UR - http://dx.doi.org/10.2196/35045 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881452 ID - info:doi/10.2196/35045 ER - TY - JOUR AU - Perkes, Jane Sarah AU - Bonevski, Billie AU - Hall, Kerry AU - Mattes, Joerg AU - Chamberlain, Catherine AU - Bennett, Jessica AU - Whittaker, Robyn AU - Palazzi, Kerrin AU - Lambkin, David AU - Kennedy, Michelle PY - 2023/3/6 TI - Aboriginal and Torres Strait Islander Women?s Access to and Interest in mHealth: National Web-based Cross-sectional Survey JO - J Med Internet Res SP - e42660 VL - 25 KW - mHealth KW - Aboriginal KW - Torres Strait Islander KW - public health KW - health literacy KW - digital literacy KW - Australia KW - native KW - cross-sectional KW - national survey KW - technology use KW - technology ownership KW - digital device KW - mobile device KW - usage KW - adoption KW - acceptance KW - digital divide N2 - Background: Health programs delivered through digital devices such as mobile phones (mobile health [mHealth]) have become an increasingly important component of the health care tool kit. Aboriginal and Torres Strait Islander women of reproductive age are likely to be caring for children and family members and needing health care, but little is known about their access to and interest in mHealth. Objective: The objectives of this study were to investigate Aboriginal and Torres Strait Islander women?s ownership of digital devices, access to the internet, current mHealth use, and interest and preferences for future mHealth. We examined the factors (age, remoteness, caring for a child younger than 5 years, and level of education) associated with the ownership of digital devices, use of internet, and interest in using a mobile phone to improve health. This study also examines if women are more likely to use mHealth for topics that they are less confident to talk about face-to-face with a health professional. Methods: A national web-based cross-sectional survey targeting Aboriginal and Torres Strait Islander women of reproductive age (16-49 years) was performed. Descriptive statistics were reported, and logistic regressions were used to examine the associations. Results: In total, 379 women completed the survey; 89.2% (338/379) owned a smartphone, 53.5% (203/379) a laptop or home computer, 35.6% (135/379) a tablet, and 93.1% (353/379) had access to the internet at home. Most women used social media (337/379, 88.9%) or the internet (285/379, 75.2%) everyday. The most common modality used on the mobile phone for health was Google (232/379, 61.2%), followed by social media (195/379, 51.5%). The most preferred modality for future programs was SMS text messaging (211/379, 55.7%) and social media (195/379, 51.4%). The most preferred topics for future mHealth programs were healthy eating (210/379, 55.4%) and cultural engagement (205/379, 54.1%). Women who were younger had greater odds of owning a smartphone, and women with tertiary education were more likely to own a tablet or laptop. Older age was associated with interest to use telehealth, and higher educational attainment was associated with interest for videoconferencing. Most women (269/379, 70.9%) used an Aboriginal medical service and overall reported high rates of confidence to discuss health topics with a health professional. Overall, women showed a similar likelihood of selecting a topic in mHealth whether they were or were not confident to talk to a health professional about that. Conclusions: Our study found that Aboriginal and Torres Strait Islander women were avid users of the internet and had strong interest in mHealth. Future mHealth programs for these women should consider utilizing SMS text messaging and social media modalities and including content on nutrition and culture. A noteworthy limitation of this study was that participant recruitment was web-based (due to COVID-19 restrictions). UR - https://www.jmir.org/2023/1/e42660 UR - http://dx.doi.org/10.2196/42660 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877565 ID - info:doi/10.2196/42660 ER - TY - JOUR AU - Leiner, Johannes AU - König, Sebastian AU - Mouratis, Konstantinos AU - Kim, Igor AU - Schmitz, Pia AU - Joshi, Tanvi AU - Schanner, Carolin AU - Wohlrab, Lisa AU - Hohenstein, Sven AU - Pellissier, Vincent AU - Nitsche, Anne AU - Kuhlen, Ralf AU - Hindricks, Gerhard AU - Bollmann, Andreas PY - 2023/3/3 TI - A Digital Infrastructure for Cardiovascular Patient Care Based on Mobile Health Data and Patient-Reported Outcomes: Concept Details of the Helios TeleWear Project Including Preliminary Experiences JO - JMIR Form Res SP - e41115 VL - 7 KW - mHealth KW - wearable KW - patient-reported outcomes KW - electrocardiogram KW - cardiovascular disease KW - atrial fibrillation KW - telemedicine KW - mobile health KW - telehealth N2 - Background: Mobile health (mHealth) approaches are already having a fundamental impact on clinical practice in cardiovascular medicine. A variety of different health apps and wearable devices for capturing health data such as electrocardiograms (ECGs) exist. However, most mHealth technologies focus on distinct variables without integrating patients? quality of life, and the impact on clinical outcome measures of implementing those digital solutions into cardiovascular health care is still to be determined. Objective: Within this document, we describe the TeleWear project, which was recently initiated as an approach for contemporary patient management integrating mobile-collected health data and the standardized mHealth-guided measurement of patient-reported outcomes (PROs) in patients with cardiovascular disease. Methods: The specifically designed mobile app and clinical frontend form the central elements of our TeleWear infrastructure. Because of its flexible framework, the platform allows far-reaching customization with the possibility to add different mHealth data sources and respective questionnaires (patient-reported outcome measures). Results: With initial focus on patients with cardiac arrhythmias, a feasibility study is currently carried out to assess wearable-recorded ECG and PRO transmission and its evaluation by physicians using the TeleWear app and clinical frontend. First experiences made during the feasibility study yielded positive results and confirmed the platform?s functionality and usability. Conclusions: TeleWear represents a unique mHealth approach comprising PRO and mHealth data capturing. With the currently running TeleWear feasibility study, we aim to test and further develop the platform in a real-world setting. A randomized controlled trial including patients with atrial fibrillation that investigates PRO- and ECG-based clinical management based on the established TeleWear infrastructure will evaluate its clinical benefits. Widening the spectrum of health data collection and interpretation beyond the ECG and use of the TeleWear infrastructure in different patient subcohorts with focus on cardiovascular diseases are further milestones of the project with the ultimate goal to establish a comprehensive telemedical center entrenched by mHealth. UR - https://formative.jmir.org/2023/1/e41115 UR - http://dx.doi.org/10.2196/41115 UR - http://www.ncbi.nlm.nih.gov/pubmed/36867450 ID - info:doi/10.2196/41115 ER - TY - JOUR AU - Rezaee, Rita AU - Khashayar, Mahboobeh AU - Saeedinezhad, Saeed AU - Nasiri, Mahdi AU - Zare, Sahar PY - 2023/3/2 TI - Critical Criteria and Countermeasures for Mobile Health Developers to Ensure Mobile Health Privacy and Security: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e39055 VL - 11 KW - telemedicine KW - mobile apps KW - privacy KW - computer security, confidentiality KW - mHealth KW - mobile health N2 - Background: Despite the importance of the privacy and confidentiality of patients? information, mobile health (mHealth) apps can raise the risk of violating users? privacy and confidentiality. Research has shown that many apps provide an insecure infrastructure and that security is not a priority for developers. Objective: This study aims to develop and validate a comprehensive tool to be considered by developers for assessing the security and privacy of mHealth apps. Methods: A literature search was performed to identify papers on app development, and those papers reporting criteria for the security and privacy of mHealth were assessed. The criteria were extracted using content analysis and presented to experts. An expert panel was held for determining the categories and subcategories of the criteria according to meaning, repetition, and overlap; impact scores were also measured. Quantitative and qualitative methods were used for validating the criteria. The validity and reliability of the instrument were calculated to present an assessment instrument. Results: The search strategy identified 8190 papers, of which 33 (0.4%) were deemed eligible. A total of 218 criteria were extracted based on the literature search; of these, 119 (54.6%) criteria were removed as duplicates and 10 (4.6%) were deemed irrelevant to the security or privacy of mHealth apps. The remaining 89 (40.8%) criteria were presented to the expert panel. After calculating impact scores, the content validity ratio (CVR), and the content validity index (CVI), 63 (70.8%) criteria were confirmed. The mean CVR and CVI of the instrument were 0.72 and 0.86, respectively. The criteria were grouped into 8 categories: authentication and authorization, access management, security, data storage, integrity, encryption and decryption, privacy, and privacy policy content. Conclusions: The proposed comprehensive criteria can be used as a guide for app designers, developers, and even researchers. The criteria and the countermeasures presented in this study can be considered to improve the privacy and security of mHealth apps before releasing the apps into the market. Regulators are recommended to consider an established standard using such criteria for the accreditation process, since the available self-certification of developers is not reliable enough. UR - https://mhealth.jmir.org/2023/1/e39055 UR - http://dx.doi.org/10.2196/39055 UR - http://www.ncbi.nlm.nih.gov/pubmed/36862494 ID - info:doi/10.2196/39055 ER - TY - JOUR AU - O'Connor, Antonia AU - Sharrad, Kelsey AU - King, Charmaine AU - Carson-Chahhoud, Kristin PY - 2023/3/2 TI - An Augmented Reality Technology to Provide Demonstrative Inhaler Technique Education for Patients With Asthma: Interview Study Among Patients, Health Professionals, and Key Community Stakeholders JO - JMIR Form Res SP - e34958 VL - 7 KW - augmented reality KW - asthma KW - disease management KW - smartphone KW - inhaler technique KW - mobile phone N2 - Background: Many people with asthma use incorrect inhaler technique, resulting in suboptimal disease management and increased health service use. Novel ways of delivering appropriate instructions are needed. Objective: This study explored stakeholder perspectives on the potential use of augmented reality (AR) technology to improve asthma inhaler technique education. Methods: On the basis of existing evidence and resources, an information poster displaying the images of 22 asthma inhaler devices was developed. Using AR technology via a free smartphone app, the poster launched video demonstrations of correct inhaler technique for each device. In total, 21 semistructured, one?on?one interviews with health professionals, people with asthma, and key community stakeholders were conducted, and data were analyzed thematically using the Triandis model of interpersonal behavior. Results: A total of 21 participants were recruited into the study, and data saturation was achieved. People with asthma were confident with inhaler technique (mean score 9.17, SD 1.33, out of 10). However, health professionals and key community stakeholders identified that this perception was misguided (mean 7.25, SD 1.39, and mean 4.5, SD 0.71, for health professionals and key community stakeholders, respectively) and facilitates persistent incorrect inhaler use and suboptimal disease management. Delivering inhaler technique education using AR was favored by all participants (21/21, 100%), particularly around ease of use, with the ability to visually display inhaler techniques for each device. There was a strongly held belief that the technology has the capacity for improving inhaler technique across all participant groups (mean 9.25, SD 0.89, for participants; mean 9.83, SD 0.41, for health professionals; and mean 9.5, SD 0.71, for key community stakeholders). However, all participants (21/21, 100%) identified some barriers, particularly regarding access and appropriateness of AR for older people. Conclusions: AR technology may be a novel means to address poor inhaler technique among certain cohorts of patients with asthma and serve as a prompt for health professionals to initiate review of inhaler devices. A randomized controlled trial design is needed to evaluate the efficacy of this technology for use in the clinical care setting. UR - https://formative.jmir.org/2023/1/e34958 UR - http://dx.doi.org/10.2196/34958 UR - http://www.ncbi.nlm.nih.gov/pubmed/36862496 ID - info:doi/10.2196/34958 ER - TY - JOUR AU - Fresán, Ujué AU - Bernard, Paquito AU - Fabregues, Sergi AU - Boronat, Anna AU - Araújo-Soares, Vera AU - König, M. Laura AU - Chevance, Guillaume PY - 2023/3/2 TI - A Smartphone Intervention to Promote a Sustainable Healthy Diet: Protocol for a Pilot Study JO - JMIR Res Protoc SP - e41443 VL - 12 KW - eating behavior change protocol KW - sustainable diet KW - dietary sustainability KW - eating behavior change KW - n-of-1 KW - nutritional education KW - eHealth KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Changing current dietary patterns into sustainable healthy diets (ie, healthy diets with low environmental impact and socioeconomic fairness) is urgent. So far, few eating behavior change interventions have addressed all the dimensions of sustainable healthy diets at once and used cutting-edge methods from the field of digital health behavior change. Objective: The primary objectives of this pilot study were to assess the feasibility and effectiveness of an individual behavior change intervention toward the adoption of a more environmentally sustainable healthy diet as a whole and changes in specific relevant food groups, food waste, and obtaining food from fair sources. The secondary objectives included the identification of mechanisms of action that potentially mediate the effect of the intervention on behaviors, identification of potential spillover effects and covariations among different food outcomes, and identification of the role of socioeconomic status in behavior changes. Methods: We will run a series of ABA n-of-1 trials over a year, with the first A phase corresponding to a 2-week baseline evaluation, the B phase to a 22-week intervention, and the second A phase to a 24-week postintervention follow-up. We plan to enroll 21 participants from low, middle, and high socioeconomic statuses, with 7 from each socioeconomic group. The intervention will involve sending text messages and providing brief individualized web-based feedback sessions based on regular app-based assessments of eating behavior. The text messages will contain brief educational messages on human health and the environmental and socioeconomic effects of dietary choices; motivational messages to encourage the adoption of sustainable healthy diets by participants, providing tips to achieve their own behavioral goals; or links to recipes. Both quantitative and qualitative data will be collected. Quantitative data (eg, on eating behaviors and motivation) will be collected through self-reported questionnaires on several weekly bursts spread through the study. Qualitative data will be collected through 3 individual semistructured interviews before the intervention period, at the end of the intervention period, and at the end of the study. Analyses will be performed at both the individual and group levels depending on the outcome and objective. Results: The first participants were recruited in October 2022. The final results are expected by October 2023. Conclusions: The results of this pilot study will be useful for designing future larger interventions on individual behavior change for sustainable healthy diets. International Registered Report Identifier (IRRID): PRR1-10.2196/41443 UR - https://www.researchprotocols.org/2023/1/e41443 UR - http://dx.doi.org/10.2196/41443 UR - http://www.ncbi.nlm.nih.gov/pubmed/36862497 ID - info:doi/10.2196/41443 ER - TY - JOUR AU - Hardesty, J. Jeffrey AU - Crespi, Elizabeth AU - Nian, Qinghua AU - Sinamo, K. Joshua AU - Breland, B. Alison AU - Eissenberg, Thomas AU - Welding, Kevin AU - Kennedy, David Ryan AU - Cohen, E. Joanna PY - 2023/3/2 TI - The Vaping and Patterns of e-Cigarette Use Research Study: Protocol for a Web-Based Cohort Study JO - JMIR Res Protoc SP - e38732 VL - 12 KW - internet KW - web-based KW - cohort KW - survey KW - e-cigarettes KW - electronic nicotine delivery systems KW - ENDS KW - tobacco KW - recruitment KW - data collection KW - strategies KW - lessons learned KW - mobile phone N2 - Background: In total, 3.2% of American adults report using e-cigarettes every day or some days. The Vaping and Patterns of E-cigarette Use Research (VAPER) Study is a web-based longitudinal survey designed to observe patterns in device and liquid use that suggest the benefits and unintended consequences of potential e-cigarette regulations. The heterogeneity of the e-cigarette devices and liquids on the market, the customizability of the devices and liquids, and the lack of standardized reporting requirements result in unique measurement challenges. Furthermore, bots and survey takers who submit falsified responses are threats to data integrity that require mitigation strategies. Objective: This paper aims to describe the protocols for 3 waves of the VAPER Study and discuss recruitment and data processing experiences and lessons learned, including the benefits and limitations of bot- and fraudulent survey taker?related strategies. Methods: American adults (aged ?21 years) who use e-cigarettes ?5 days per week are recruited from up to 404 Craigslist catchment areas covering all 50 states. The questionnaire measures and skip logic are designed to accommodate marketplace heterogeneity and user customization (eg, different skip logic pathways for different device types and customizations). To reduce reliance on self-report data, we also require participants to submit a photo of their device. All data are collected using REDCap (Research Electronic Data Capture; Vanderbilt University). Incentives are US $10 Amazon gift codes delivered by mail to new participants and electronically to returning participants. Those lost to follow-up are replaced. Several strategies are applied to maximize the odds that participants who receive incentives are not bots and are likely to possess an e-cigarette (eg, required identity check and photo of a device). Results: In total, 3 waves of data were collected between 2020 and 2021 (wave 1: n=1209; wave 2: n=1218; wave 3: n=1254). Retention from waves 1 to 2 was 51.94% (628/1209), and 37.55% (454/1209) of the wave 1 sample completed all 3 waves. These data were mostly generalizable to daily e-cigarette users in the United States, and poststratification weights were generated for future analyses. Our data offer a detailed examination of users? device features and specifications, liquid characteristics, and key behaviors, which can provide more insights into the benefits and unintended consequences of potential regulations. Conclusions: Relative to existing e-cigarette cohort studies, this study methodology has some advantages, including efficient recruitment of a lower-prevalence population and collection of detailed data relevant to tobacco regulatory science (eg, device wattage). The web-based nature of the study requires several bot- and fraudulent survey taker?related risk-mitigation strategies, which can be time-intensive. When these risks are addressed, web-based cohort studies can be successful. We will continue to explore methods for maximizing recruitment efficiency, data quality, and participant retention in subsequent waves. International Registered Report Identifier (IRRID): DERR1-10.2196/38732 UR - https://www.researchprotocols.org/2023/1/e38732 UR - http://dx.doi.org/10.2196/38732 UR - http://www.ncbi.nlm.nih.gov/pubmed/36862467 ID - info:doi/10.2196/38732 ER - TY - JOUR AU - Ko, Siyeon AU - Lee, Jisan AU - An, Doyeon AU - Woo, Hyekyung PY - 2023/3/1 TI - Menstrual Tracking Mobile App Review by Consumers and Health Care Providers: Quality Evaluations Study JO - JMIR Mhealth Uhealth SP - e40921 VL - 11 KW - mobile app KW - period KW - menstrual cycle KW - mHealth KW - mobile health KW - evaluation KW - women?s health KW - health care provider KW - consumer KW - menstrual app KW - digital health app KW - health screening KW - consumer satisfaction N2 - Background: Women?s menstrual cycle is an important component of their overall health. Physiological cycles and associated symptoms can be monitored continuously and used as indicators in various fields. Menstrual apps are accessible and can be used to promote overall female health. However, no study has evaluated these apps? functionality from both consumers? and health care providers? perspectives. As such, the evidence indicating whether the menstrual apps available on the market provide user satisfaction is insufficient. Objective: This study was performed to investigate the key content and quality of menstrual apps from the perspectives of health care providers and consumers. We also analyzed the correlations between health care provider and consumer evaluation scores. On the basis of this analysis, we offer technical and policy recommendations that could increase the usability and convenience of future app. Methods: We searched the Google Play Store and iOS App Store using the keywords ?period? and ?menstrual cycle? in English and Korean and identified relevant apps. An app that met the following inclusion criteria was selected as a research app: nonduplicate; with >10,000 reviews; last updated ?180 days ago; relevant to this topic; written in Korean or English; available free of charge; and currently operational. App quality was evaluated by 6 consumers and 4 health care providers using Mobile Application Rating Scale (MARS) and user version of the Mobile Application Rating Scale (uMARS). We then analyzed the correlations among MARS scores, uMARS scores, star ratings, and the number of reviews. Results: Of the 34 apps, 31 (91%) apps could be used to predict the menstrual cycle, and 2 (6%) apps provided information pertinent to health screening. All apps that scored highly in the MARS evaluation offer a symptom logging function and provide the user with personalized notifications. The ?Bom Calendar? app had the highest MARS (4.51) and uMARS (4.23) scores. The MARS (2.22) and uMARS (4.15) scores for the ?Menstrual calendar?ovulation & pregnancy calendar? app were different. In addition, there was no relationship between MARS and uMARS scores (r=0.32; P=.06). Conclusions: We compared consumer and health care provider ratings for menstrual apps. Continuous monitoring of app quality from consumer and health care provider perspectives is necessary to guide their development and update content. UR - https://mhealth.jmir.org/2023/1/e40921 UR - http://dx.doi.org/10.2196/40921 UR - http://www.ncbi.nlm.nih.gov/pubmed/36857125 ID - info:doi/10.2196/40921 ER - TY - JOUR AU - Whitehead, Lara AU - Talevski, Jason AU - Fatehi, Farhad AU - Beauchamp, Alison PY - 2023/2/28 TI - Barriers to and Facilitators of Digital Health Among Culturally and Linguistically Diverse Populations: Qualitative Systematic Review JO - J Med Internet Res SP - e42719 VL - 25 KW - culturally and linguistically diverse KW - ethnicity KW - indigenous KW - digital health KW - technology KW - eHealth KW - qualitative KW - mobile phone N2 - Background: Health care systems have become increasingly more reliant on patients? ability to navigate the digital world. However, little research has been conducted on why some communities are less able or less likely to successfully engage with digital health technologies (DHTs), particularly among culturally and linguistically diverse (CaLD) populations. Objective: This systematic review aimed to determine the barriers to and facilitators of interacting with DHTs from the perspectives of CaLD population groups, including racial or ethnic minority groups, immigrants and refugees, and Indigenous or First Nations people. Methods: A systematic review and thematic synthesis of qualitative studies was conducted. Peer-reviewed literature published between January 2011 and June 2022 was searched across 3 electronic databases. Terms for digital health were combined with terms for cultural or linguistic diversity, ethnic minority groups, or Indigenous and First Nations people and terms related to barriers to accessing digital technologies. A qualitative thematic synthesis was conducted to identify descriptive and analytical themes of barriers to and facilitators of interacting with DHTs. Quality appraisal was performed using the Mixed Methods Appraisal Tool. Results: Of the 1418 studies identified in the electronic search, a total of 34 (2.4%) were included in this review. Half of the included studies (17/34, 50%) were conducted in the United States. There was considerable variation in terms of the CaLD backgrounds of the participants. In total, 26% (9/34) of the studies focused on Indigenous or First Nations communities, 41% (14/34) were conducted among ethnic minority populations, 15% (5/34) of the studies were conducted among immigrants, and 18% (6/34) were conducted in refugee communities. Of the 34 studies, 21 (62%) described the development or evaluation of a digital health intervention, whereas 13 (38%) studies did not include an intervention but instead focused on elucidating participants? views and behaviors in relation to digital health. From the 34 studies analyzed, 18 descriptive themes were identified, each describing barriers to and facilitators of interacting with DHTs, which were grouped into 7 overarching analytical themes: using technology, design components, language, culture, health and medical, trustworthiness, and interaction with others. Conclusions: This study identified several analytic and descriptive themes influencing access to and uptake of DHTs among CaLD populations, including Indigenous and First Nations groups. We found that cultural factors affected all identified themes to some degree and that cultural and linguistic perspectives should be considered in the design and delivery of DHTs, with this best served through the inclusion of the target communities at all stages of development. This may improve the potential of DHTs to be more acceptable, appropriate, and accessible to population groups currently at risk of not obtaining the full benefits of digital health. UR - https://www.jmir.org/2023/1/e42719 UR - http://dx.doi.org/10.2196/42719 UR - http://www.ncbi.nlm.nih.gov/pubmed/36853742 ID - info:doi/10.2196/42719 ER - TY - JOUR AU - Ross, Jamie AU - Cotterill, Sarah AU - Bower, Peter AU - Murray, Elizabeth PY - 2023/2/28 TI - Influences on Patient Uptake of and Engagement With the National Health Service Digital Diabetes Prevention Programme: Qualitative Interview Study JO - J Med Internet Res SP - e40961 VL - 25 KW - diabetes prevention KW - digital health interventions KW - engagement KW - qualitative research KW - mobile phone N2 - Background: Digital diabetes prevention programs (digital-DPPs) are being implemented as population-based approaches to type 2 diabetes mellitus prevention in several countries to address problems with the uptake of traditional face-to-face diabetes prevention programs. However, assessments of digital-DPPs have largely focused on clinical outcomes and usability among those who have taken them up, whereas crucial information on decision-making about uptake (eg, whether a user downloads and registers on an app) and engagement (eg, the extent of use of an app or its components over time) is limited. Greater understanding of factors that influence uptake and engagement decisions may support large-scale deployments of digital-DPPs in real-world settings. Objective: This study aimed to explore the key influences on uptake and engagement decisions of individuals who were offered the National Health Service Healthier You: Digital Diabetes Prevention Programme (NHS-digital-DPP). Methods: A qualitative interview study was conducted using semistructured interviews. Participants were adults, aged ?18 years, diagnosed with nondiabetic hyperglycemia, and those who had been offered the NHS-digital-DPP. Recruitment was conducted via 4 providers of the NHS-digital-DPP and 3 primary care practices in England. Interviews were conducted remotely and were guided by a theoretically informed topic guide. Analysis of interviews was conducted using an inductive thematic analysis approach. Results: Interviews were conducted with 32 participants who had either accepted or declined the NHS-digital-DPP. In total, 7 overarching themes were identified as important factors in both decisions to take up and to engage with the NHS-digital-DPP. These were knowledge and understanding, referral process, self-efficacy, self-identity, motivation and support, advantages of digital service, and reflexive monitoring. Perceptions of accessibility and convenience of the NHS-digital-DPP were particularly important for uptake, and barriers in terms of the referral process and health care professionals? engagement were reported. Specific digital features including health coaches and monitoring tools were important for engagement. Conclusions: This study adds to the literature on factors that influence the uptake of and engagement with digital-DPPs and suggests that digital-DPPs can overcome many barriers to the uptake of face-to-face diabetes prevention programs in supporting lifestyle changes aimed at diabetes prevention. UR - https://www.jmir.org/2023/1/e40961 UR - http://dx.doi.org/10.2196/40961 UR - http://www.ncbi.nlm.nih.gov/pubmed/36853751 ID - info:doi/10.2196/40961 ER - TY - JOUR AU - Aune, Anders AU - Vartdal, Gunnar AU - Jimenez Diaz, Gabriela AU - Gierman, Marijn Lobke AU - Bergseng, Håkon AU - Darj, Elisabeth PY - 2023/2/28 TI - Iterative Development, Validation, and Certification of a Smartphone System to Assess Neonatal Jaundice: Development and Usability Study JO - JMIR Pediatr Parent SP - e40463 VL - 6 KW - neonatal jaundice KW - neonatal hyperbilirubinemia KW - newborns KW - mobile app KW - design KW - validation KW - regulatory processes KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Medical device development is an area facing multiple challenges, resulting in a high number of products not reaching the clinical setting. Neonatal hyperbilirubinemia, manifesting as neonatal jaundice (NNJ), is an important cause of newborn morbidity and mortality. It is important to identify infants with neonatal hyperbilirubinemia at an early stage, but currently there is a lack of tools that are both accurate and affordable. Objective: This study aimed to develop a novel system to assess the presence of NNJ. The device should provide accurate results, be approved as a medical device, be easy to use, and be produced at a price that is affordable even in low-resource settings. Methods: We used an iterative approach to develop a smartphone-based system to detect the presence of NNJ. We performed technical development, followed by clinical and usability testing in parallel, after which we initiated the regulatory processes for certification. We updated the system in each iteration, and the final version underwent a clinical validation study on healthy term newborns aged 1 to 15 days before all documentation was submitted for conformity assessment to obtain Conformité Européenne (CE) certification. We developed a system that incorporates a smartphone app, a color calibration card, and a server. Results: Three iterations of the smartphone-based system were developed; the final version was approved as a medical device after complying with Medical Device Regulation guidelines. A total of 201 infants were included in the validation study. Bilirubin values using the system highly correlated with total serum or plasma bilirubin levels (r=0.84). The system had a high sensitivity (94%) to detect severe jaundice, defined as total serum or plasma bilirubin >250 µmol/L, and maintained a high specificity (71%). Conclusions: Our smartphone-based system has a high potential as a tool for identifying NNJ. An iterative approach to product development, conducted by working on different tasks in parallel, resulted in a functional and successful product. By adhering to the requirements for regulatory approval from the beginning of the project, we were able to develop a market-ready mobile health solution. UR - https://pediatrics.jmir.org/2023/1/e40463 UR - http://dx.doi.org/10.2196/40463 UR - http://www.ncbi.nlm.nih.gov/pubmed/36853753 ID - info:doi/10.2196/40463 ER - TY - JOUR AU - Clement, Edwards Meredith AU - Lovett, Aish AU - Caldwell, Sylvia AU - Beckford, Jeremy AU - Hilgart, Michelle AU - Corneli, Amy AU - Flickinger, Tabor AU - Dillingham, Rebecca AU - Ingersoll, Karen PY - 2023/2/27 TI - Development of an mHealth App to Support the Prevention of Sexually Transmitted Infections Among Black Men Who Have Sex With Men Engaged in Pre-exposure Prophylaxis Care in New Orleans, Louisiana: Qualitative User-Centered Design Study JO - JMIR Form Res SP - e43019 VL - 7 KW - pre-exposure prophylaxis KW - HIV KW - mobile apps KW - mobile phone N2 - Background: Sexual health disparities exist for Black men who have sex with men (BMSM) in New Orleans, Louisiana. Rates of sexually transmitted infections (STIs) are high for both BMSM and those taking HIV pre-exposure prophylaxis (PrEP). Objective: In this study, we introduced an existing PrEP adherence app to new potential users?BMSM engaged in PrEP care in New Orleans?to guide app adaptation with STI prevention features and tailoring for the local context. Methods: Using a user-centered design, we conducted 4 focus group discussions (FGDs), with interim app adaptations from December 2020 to March 2021. During the FGDs, a video of the app, app website, and mock-ups were shown to participants. We asked about facilitators of and barriers to STI prevention in general, current app use, impressions of the existing app, new app features to potentially facilitate STI prevention, and how the app should be tailored for BMSM. We used applied qualitative thematic analysis to identify themes and needs of the population. Results: Overall, 4 FGDs were conducted with 24 BMSM taking PrEP. We grouped themes into 4 categories: STI prevention, current app use and preferences, preexisting features and impressions of the prep?d app, and new features and modifications for BMSM. Participants noted concern about STIs and shared that anxiety about some STIs was higher than that for others; some participants shared that since the emergence of PrEP, little thought is given to STIs. However, participants desired STI prevention strategies and suggested prevention methods to implement through the app, including access to resources, educational content, and sex diaries to follow their sexual activity. When discussing app preferences, they emphasized the need for an app to offer relevant features and be easy to use and expressed that some notifications were important to keep users engaged but that they should be limited to avoid notification fatigue. Participants thought that the current app was useful and generally liked the existing features, including the ability to communicate with providers, staff, and each other through the community forum. They had suggestions for modifications for STI prevention, such as the ability to comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Mental health emerged as an important need to be addressed through the app during discussion of almost all features. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. Conclusions: A PrEP adherence app was iteratively adapted with feedback from BMSM, resulting in a new app modified for the New Orleans context and with STI prevention features. Participants gave the app a new name, PCheck, to be more discreet. Next steps will assess PCheck use and STI prevention outcomes. UR - https://formative.jmir.org/2023/1/e43019 UR - http://dx.doi.org/10.2196/43019 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848209 ID - info:doi/10.2196/43019 ER - TY - JOUR AU - Chau, Long Siu AU - Wong, Cheong Yiu AU - Zeng, Pei Ying AU - Lee, Jae Jung AU - Wang, Ping Man PY - 2023/2/27 TI - Perceptions of Using Instant Messaging Apps for Alcohol Reduction Intervention Among University Student Drinkers: Semistructured Interview Study With Chinese University Students in Hong Kong JO - JMIR Form Res SP - e40207 VL - 7 KW - instant messaging apps KW - mobile phone KW - WhatsApp KW - alcohol reduction intervention KW - alcohol use KW - university students KW - young adults KW - instant messaging KW - alcohol reduction KW - adverse lifestyle KW - intervention KW - health promotion KW - text messages KW - health behaviours KW - health behaviors KW - apps N2 - Background: Mobile instant messaging (IM) apps (eg, WhatsApp and WeChat) have been widely used by the general population and are more interactive than text-based programs (SMS text messaging) to modify unhealthy lifestyles. Little is known about IM app use for health promotion, including alcohol reduction for university students. Objective: This study aims to explore university student drinkers' perceptions of using IM apps for alcohol reduction as they had high alcohol exposure (eg, drinking invitations from peers and alcohol promotion on campus) and the proportion of IM app use in Hong Kong. Methods: A qualitative study was conducted with 20 Hong Kong Chinese university students (current drinkers) with Alcohol Use Disorder Identification test scores of ?8 recruited using purposive sampling. Semistructured individual interviews were conducted from September to October 2019. Interview questions focused on drinking behaviors, quitting history, opinions toward IM app use as an intervention tool, perceived usefulness of IM apps for alcohol reduction, and opinions on the content and design of IM apps for alcohol reduction. Each interview lasted approximately 1 hour. All interviews were audio-taped and transcribed verbatim. Two researchers independently analyzed the transcripts using thematic analysis with an additional investigator to verify the consistency of the coding. Results: Participants considered IM apps a feasible and acceptable platform for alcohol reduction intervention. They preferred to receive IMs based on personalized problem-solving and drinking consequences with credible sources. Other perceived important components of instant messages included providing psychosocial support in time and setting goals with participants to reduce drinking. They further provided suggestions on the designs of IM interventions, in which they preferred simple and concise messages, chat styles based on participants' preferences (eg, adding personalized emojis and stickers in the chat), and peers as counselors. Conclusions: Qualitative interviews with Chinese university student drinkers showed high acceptability, engagement, and perceived utility of IM apps for alcohol reduction intervention. IM intervention can be an alternative for alcohol reduction intervention apart from traditional text-based programs. The study has implications for developing the IM intervention for other unhealthy behaviors and highlights important topics that warrant future research, including substance use and physical inactivity. Trial Registration: ClinicalTrials.gov NCT04025151; https://clinicaltrials.gov/ct2/show/NCT04025151?term=NCT04025151 UR - https://formative.jmir.org/2023/1/e40207 UR - http://dx.doi.org/10.2196/40207 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848207 ID - info:doi/10.2196/40207 ER - TY - JOUR AU - Aggarwal, Abhishek AU - Tam, Chi Cheuk AU - Wu, Dezhi AU - Li, Xiaoming AU - Qiao, Shan PY - 2023/2/24 TI - Artificial Intelligence?Based Chatbots for Promoting Health Behavioral Changes: Systematic Review JO - J Med Internet Res SP - e40789 VL - 25 KW - chatbot KW - artificial intelligence KW - AI KW - health behavior change KW - engagement KW - efficacy KW - intervention KW - feasibility KW - usability KW - acceptability KW - mobile phone N2 - Background: Artificial intelligence (AI)?based chatbots can offer personalized, engaging, and on-demand health promotion interventions. Objective: The aim of this systematic review was to evaluate the feasibility, efficacy, and intervention characteristics of AI chatbots for promoting health behavior change. Methods: A comprehensive search was conducted in 7 bibliographic databases (PubMed, IEEE Xplore, ACM Digital Library, PsycINFO, Web of Science, Embase, and JMIR publications) for empirical articles published from 1980 to 2022 that evaluated the feasibility or efficacy of AI chatbots for behavior change. The screening, extraction, and analysis of the identified articles were performed by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Of the 15 included studies, several demonstrated the high efficacy of AI chatbots in promoting healthy lifestyles (n=6, 40%), smoking cessation (n=4, 27%), treatment or medication adherence (n=2, 13%), and reduction in substance misuse (n=1, 7%). However, there were mixed results regarding feasibility, acceptability, and usability. Selected behavior change theories and expert consultation were used to develop the behavior change strategies of AI chatbots, including goal setting, monitoring, real-time reinforcement or feedback, and on-demand support. Real-time user-chatbot interaction data, such as user preferences and behavioral performance, were collected on the chatbot platform to identify ways of providing personalized services. The AI chatbots demonstrated potential for scalability by deployment through accessible devices and platforms (eg, smartphones and Facebook Messenger). The participants also reported that AI chatbots offered a nonjudgmental space for communicating sensitive information. However, the reported results need to be interpreted with caution because of the moderate to high risk of internal validity, insufficient description of AI techniques, and limitation for generalizability. Conclusions: AI chatbots have demonstrated the efficacy of health behavior change interventions among large and diverse populations; however, future studies need to adopt robust randomized control trials to establish definitive conclusions. UR - https://www.jmir.org/2023/1/e40789 UR - http://dx.doi.org/10.2196/40789 UR - http://www.ncbi.nlm.nih.gov/pubmed/36826990 ID - info:doi/10.2196/40789 ER - TY - JOUR AU - Tesema, Naomi AU - Guillaume, Dominique AU - Francis, Sherilyn AU - Paul, Sudeshna AU - Chandler, Rasheeta PY - 2023/2/23 TI - Mobile Phone Apps for HIV Prevention Among College-Aged Black Women in Atlanta: Mixed Methods Study and User-Centered Prototype JO - JMIR Form Res SP - e37987 VL - 7 KW - Black women KW - HIV prevention KW - mobile health KW - mHealth app KW - mobile technology KW - reproductive health KW - women?s health N2 - Background: Black women in college are disproportionately affected by HIV diagnoses. Mobile apps can facilitate the innovative delivery of accurate HIV and sexual and reproductive health information. However, mobile health interventions are severely underused in this population. Objective: We aimed to quantitatively and qualitatively explore the perspectives of college-aged Black women on using a mobile health app for HIV prevention and sexual and reproductive health. The data obtained from Black women were used to design preliminary mobile app wireframes and features. Methods: This explanatory, sequential mixed methods study took place from 2019 to 2020 and targeted Black women who were enrolled in college or who had recently graduated from college. Convenience sampling was used during the quantitative phase, followed by purposive sampling in the qualitative phase. A cross-sectional web-based survey evaluating the willingness to use a mobile app for HIV prevention was conducted in the quantitative phase. Descriptive statistics were used for all variables. A separate focus group discussion was conducted with Black women in college to expand on the quantitative results. Focus group discussions explored their perceptions on HIV and health content delivered through a mobile app along with potential features that participants desired within the app. Using the data obtained, we selected the primary features for the app prototype. Results: In total, we enrolled 34 participants in the survey, with 6 participating in focus group discussions. Over half of the respondents reported a willingness to use an app that contained pre-exposure prophylaxis content. Women who claimed recent sexual activity reported being more likely to use an app feature that would allow them to order an at-home HIV testing kit than their non?sexually active counterparts. The emerging themes from the focus group session were Black women?s health concerns, HIV risk, sources of health information, and preferred app features. The content in our prototype included speaking with a specialist, HIV and pre-exposure prophylaxis information, holistic wellness, and features promoting engagement and retention. Conclusions: The results of our study guided the design of wireframes for an app prototype targeting HIV prevention in college-aged Black women. The rapid growth of mobile devices in Black communities, coupled with high rates of smartphone ownership among Black youth, makes mobile health interventions a promising strategy for addressing sexual and reproductive health disparities. Participants in our sample were willing to use a culturally appropriate and gender-considerate app for their sexual health needs. Our findings indicate that Black women in college may be excellent candidates for mobile app?based interventions. UR - https://formative.jmir.org/2023/1/e37987 UR - http://dx.doi.org/10.2196/37987 UR - http://www.ncbi.nlm.nih.gov/pubmed/36821362 ID - info:doi/10.2196/37987 ER - TY - JOUR AU - Shorey, Shefaly AU - Chong, Seng Yap AU - Shi, Luming AU - Chua, Shi Jing AU - AU - Mathews, Jancy AU - Lim, Hoon Siew AU - Du, Ruochen AU - Chan, Huak Yiong AU - Tan, Chye Thiam AU - Chee, Cornelia AU - Law, Evelyn PY - 2023/2/22 TI - Evaluating the Effects of the Supportive Parenting App on Infant Developmental Outcomes: Longitudinal Study JO - JMIR Mhealth Uhealth SP - e43885 VL - 11 KW - infant development KW - parenting KW - mobile health technology KW - social support KW - psychoeducation KW - peer support KW - mobile phone N2 - Background: Previous studies have investigated the various effects of parenting on infant developmental outcomes. In particular, parental stress and social support have been found to significantly affect the growth of the newborn. Although many parents today use mobile apps to obtain more support in parenting and perinatal care, few studies have examined how these apps could affect infant development. Objective: This study aimed to examine the effectiveness of the Supportive Parenting App (SPA) in improving infant developmental outcomes during the perinatal period. Methods: This study adopted a 2-group parallel prospective longitudinal design and recruited 200 infants and their parents (N=400 mothers and fathers). The parents were recruited at 24 weeks of gestation for a randomized controlled trial conducted from February 2020 to July 2022. They were randomly allocated to either the intervention or control group. The infant outcome measures included cognition, language, motor skills, and social-emotional development. Data were collected from the infants when they were aged 2, 4, 6, 9, and 12 months. Linear and modified Poisson regressions were used to analyze the data to examine between- and within-group changes. Results: At 9 and 12 months post partum, the infants in the intervention group were found to have better communication and language skills than those in the control group. An analysis of motor development revealed that a larger proportion of the infants in the control group fell under the at-risk category, where they scored approximately 2 SDs below the normative scores. The control group infants scored higher on the problem solving domain at 6 months post partum. However, at 12 months postpartum, the infants in the intervention group performed better on cognitive tasks than those in the control group. Despite not being statistically significant, the intervention group infants were found to have consistently scored better on the social components of the questionnaires than the control group infants. Conclusions: Overall, the infants whose parents had received the SPA intervention tended to fare better in most developmental outcome measures than those whose parents had received standard care only. The findings of this study suggest that the SPA intervention exerted positive effects on the communication, cognition, motor, and socioemotional development of the infants. Further research is needed to improve the content and support provided by the intervention to maximize the benefits gained by infants and their parents. Trial Registration: ClinicalTrials.gov NCT04706442; https://clinicaltrials.gov/ct2/show/NCT04706442 UR - https://mhealth.jmir.org/2023/1/e43885 UR - http://dx.doi.org/10.2196/43885 UR - http://www.ncbi.nlm.nih.gov/pubmed/36811952 ID - info:doi/10.2196/43885 ER - TY - JOUR AU - Yang, Le AU - Wu, Jiadong AU - Mo, Xiaoxiao AU - Chen, Yaqin AU - Huang, Shanshan AU - Zhou, Linlin AU - Dai, Jiaqi AU - Xie, Linna AU - Chen, Siyu AU - Shang, Hao AU - Rao, Beibei AU - Weng, Bingtao AU - Abulimiti, Ayiguli AU - Wu, Siying AU - Xie, Xiaoxu PY - 2023/2/22 TI - Changes in Mobile Health Apps Usage Before and After the COVID-19 Outbreak in China: Semilongitudinal Survey JO - JMIR Public Health Surveill SP - e40552 VL - 9 KW - application KW - China KW - COVID-19 KW - mHealth KW - health management KW - mobile health KW - technology KW - app KW - survey KW - data KW - user KW - user experience KW - vaccination KW - download KW - healthcare KW - development N2 - Background: Mobile health (mHealth) apps are rapidly emerging technologies in China due to strictly controlled medical needs during the COVID-19 pandemic while continuing essential services for chronic diseases. However, there have been no large-scale, systematic efforts to evaluate relevant apps. Objective: We aim to provide a landscape of mHealth apps in China by describing and comparing digital health concerns before and after the COVID-19 outbreak, including mHealth app data flow and user experience, and analyze the impact of COVID-19 on mHealth apps. Methods: We conducted a semilongitudinal survey of 1593 mHealth apps to study the app data flow and clarify usage changes and influencing factors. We selected mHealth apps in app markets, web pages from the Baidu search engine, the 2018 top 100 hospitals with internet hospitals, and online shopping sites with apps that connect to smart devices. For user experience, we recruited residents from a community in southeastern China from October 2019 to November 2019 (before the outbreak) and from June 2020 to August 2020 (after the outbreak) comparing the attention of the population to apps. We also examined associations between app characteristics, functions, and outcomes at specific quantiles of distribution in download changes using quantile regression models. Results: Rehabilitation medical support was the top-ranked functionality, with a median 1.44 million downloads per app prepandemic and a median 2.74 million downloads per app postpandemic. Among the top 10 functions postpandemic, 4 were related to maternal and child health: pregnancy preparation (ranked second; fold change 4.13), women's health (ranked fifth; fold change 5.16), pregnancy (ranked sixth; fold change 5.78), and parenting (ranked tenth; fold change 4.03). Quantile regression models showed that rehabilitation (P75, P90), pregnancy preparation (P90), bodybuilding (P50, P90), and vaccination (P75) were positively associated with an increase in downloads after the outbreak. In the user experience survey, the attention given to health information (prepandemic: 249/375, 66.4%; postpandemic: 146/178, 82.0%; P=.006) steadily increased after the outbreak. Conclusions: mHealth apps are an effective health care approach gaining in popularity among the Chinese population following the COVID-19 outbreak. This research provides direction for subsequent mHealth app development and promotion in the postepidemic era, supporting medical model reformation in China as a reference, which may provide new avenues for designing and evaluating indirect public health interventions such as health education and health promotion. UR - https://publichealth.jmir.org/2023/1/e40552 UR - http://dx.doi.org/10.2196/40552 UR - http://www.ncbi.nlm.nih.gov/pubmed/36634256 ID - info:doi/10.2196/40552 ER - TY - JOUR AU - Yang, Lin AU - Kuang, Angela AU - Xu, Claire AU - Shewchuk, Brittany AU - Singh, Shaminder AU - Quan, Hude AU - Zeng, Yong PY - 2023/2/22 TI - Design Principles in mHealth Interventions for Sustainable Health Behavior Changes: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e39093 VL - 12 KW - behavior change KW - intervention KW - mHealth KW - personalization KW - dialogue KW - mobile health KW - mobile app KW - self-management N2 - Background: In recent years, mHealth has increasingly been used to deliver behavioral interventions for disease prevention and self-management. Computing power in mHealth tools can provide unique functions beyond conventional interventions in provisioning personalized behavior change recommendations and delivering them in real time, supported by dialogue systems. However, design principles to incorporate these features in mHealth interventions have not been systematically evaluated. Objective: The goal of this review is to identify best practices for the design of mHealth interventions targeting diet, physical activity, and sedentary behavior. We aim to identify and summarize the design characteristics of current mHealth tools with a focus on the following features: (1) personalization, (2) real-time functions, and (3) deliverable resources. Methods: We will conduct a systematic search of electronic databases, including MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science for studies published since 2010. First, we will use keywords that combine mHealth, interventions, chronic disease prevention, and self-management. Second, we will use keywords that cover diet, physical activity, and sedentary behavior. Literature found in the first and second steps will be combined. Finally, we will use keywords for personalization and real-time functions to limit the results to interventions that have reported these design features. We expect to perform narrative syntheses for each of the 3 target design features. Study quality will be evaluated using the Risk of Bias 2 assessment tool. Results: We have conducted a preliminary search of existing systematic reviews and review protocols on mHealth-supported behavior change interventions. We have identified several reviews that aimed to evaluate the efficacy of mHealth behavior change interventions in a range of populations, evaluate methodologies for assessing mHealth behavior change randomized trials, and assess the diversity of behavior change techniques and theories in mHealth interventions. However, syntheses on the unique features of mHealth intervention design are absent in the literature. Conclusions: Our findings will provide a basis for developing best practices for designing mHealth tools for sustainable behavior change. Trial Registration: PROSPERO CRD42021261078; https://tinyurl.com/m454r65t International Registered Report Identifier (IRRID): PRR1-10.2196/39093 UR - https://www.researchprotocols.org/2023/1/e39093 UR - http://dx.doi.org/10.2196/39093 UR - http://www.ncbi.nlm.nih.gov/pubmed/36811938 ID - info:doi/10.2196/39093 ER - TY - JOUR AU - Melia, Ruth AU - Francis, Kady AU - Duggan, Jim AU - Bogue, John AU - O'Sullivan, Mary AU - Young, Karen AU - Chambers, Derek AU - McInerney, J. Shane AU - O'Dea, Edmond AU - Bernert, Rebecca PY - 2023/2/21 TI - Using a Safety Planning Mobile App to Address Suicidality in Young People Attending Community Mental Health Services in Ireland: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e44205 VL - 12 KW - suicide prevention KW - mobile health KW - mHealth KW - safety planning KW - SafePlan KW - mobile phone N2 - Background: Over 700,000 people die by suicide annually, making it the fourth leading cause of death among those aged 15-29 years globally. Safety planning is recommended best practice when individuals at risk of suicide present to health services. A safety plan, developed in collaboration with a health care practitioner, details the steps to be taken in an emotional crisis. SafePlan, a safety planning mobile app, was designed to support young people experiencing suicidal thoughts and behaviors and to record their plan in a way that is accessible immediately and in situ. Objective: The aim of this study is to assess the feasibility and acceptability of the SafePlan mobile app for patients experiencing suicidal thoughts and behaviors and their clinicians within Irish community mental health services, examine the feasibility of study procedures for both patients and clinicians, and determine if the SafePlan condition yields superior outcomes when compared with the control condition. Methods: A total of 80 participants aged 16-35 years accessing Irish mental health services will be randomized (1:1) to receive the SafePlan app plus treatment as usual or treatment as usual plus a paper-based safety plan. The feasibility and acceptability of the SafePlan app and study procedures will be evaluated using both qualitative and quantitative methodologies. The primary outcomes are feasibility outcomes and include the acceptability of the app to participants and clinicians, the feasibility of delivery in this setting, recruitment, retention, and app use. The feasibility and acceptability of the following measures in a full randomized controlled trial will also be assessed: the Beck Scale for Suicide Ideation, Columbia Suicide Severity Rating Scale, Coping Self-Efficacy Scale, Interpersonal Needs Questionnaire, and Client Service Receipt Inventory. A repeated measures design with outcome data collected at baseline, post intervention (8 weeks), and at 6-month follow-up will be used to compare changes in suicidal ideation for the intervention condition relative to the waitlist control condition. A cost-outcome description will also be undertaken. Thematic analyses will be used to analyze the qualitative data gathered through semistructured interviews with patients and clinicians. Results: As of January 2023, funding and ethics approval have been acquired, and clinician champions across mental health service sites have been established. Data collection is expected to commence by April 2023. The submission of completed manuscript is expected by April 2025. Conclusions: The framework for Decision-making after Pilot and feasibility Trials will inform the decision to progress to a full trial. The results will inform patients, researchers, clinicians, and health services of the feasibility and acceptability of the SafePlan app in community mental health services. The findings will have implications for further research and policy regarding the broader integration of safety planning apps. Trial Registration: OSF Registries osf.io/3y54m; https://osf.io/3y54m International Registered Report Identifier (IRRID): PRR1-10.2196/44205 UR - https://www.researchprotocols.org/2023/1/e44205 UR - http://dx.doi.org/10.2196/44205 UR - http://www.ncbi.nlm.nih.gov/pubmed/36809171 ID - info:doi/10.2196/44205 ER - TY - JOUR AU - Wang, Xue AU - Wu, Yibo AU - Meng, Zhiyu AU - Li, Jiayuan AU - Xu, Li AU - Sun, Xinying AU - Zang, Shuang PY - 2023/2/17 TI - Willingness to Use Mobile Health Devices in the Post?COVID-19 Era: Nationwide Cross-sectional Study in China JO - J Med Internet Res SP - e44225 VL - 25 KW - mobile health KW - mHealth KW - mobile devices KW - willingness to use KW - post?COVID-19 era KW - socioecological model KW - China KW - mobile phone N2 - Background: Despite the increased development and use of mobile health (mHealth) devices during the COVID-19 pandemic, there is little knowledge of willingness of the Chinese people to use mHealth devices and the key factors associated with their use in the post?COVID-19 era. Therefore, a more comprehensive and multiangle investigation is required. Objective: We aimed to probe Chinese attitudes regarding the use of mHealth and analyze possible associations between the attitude of willingness to use mHealth devices and some factors based on the socioecological model. Methods: A survey was conducted using quota sampling to recruit participants from 148 cities in China between June 20 and August 31, 2022. Data from the survey were analyzed using multiple stepwise regression to examine the factors associated with willingness to use mHealth devices. Standardized regression coefficients (?) and 95% CIs were calculated using multiple stepwise regression. Results: The survey contained a collection of 21,916 questionnaires and 21,897 were valid questionnaires, with a 99.91% effective response rate. The median score of willingness to use mHealth in the post?COVID-19 era was 70 points on a scale from 0 to 100. Multiple stepwise regression results showed that the female gender (?=.03, 95% CI 1.04-2.35), openness personality trait (?=.05, 95% CI 0.53-0.96), higher household per capita monthly income (?=.03, 95% CI 0.77-2.24), and commercial and multiple insurance (?=.04, 95% CI 1.77-3.47) were factors associated with the willingness to use mHealth devices. In addition, people with high scores of health literacy (?=.13, 95% CI 0.53-0.68), self-reported health rating (?=.22, 95% CI 0.24-0.27), social support (?=.08, 95% CI 0.40-0.61), family health (?=.03, 95% CI 0.03-0.16), neighbor relations (?=.12, 95% CI 2.09-2.63), and family social status (?=.07, 95% CI 1.19-1.69) were more likely to use mHealth devices. Conclusions: On the basis of the theoretical framework of socioecological model, this study identified factors specifically associated with willingness of the Chinese people to use mHealth devices in the post?COVID-19 era. These findings provide reference information for the research, development, promotion, and application of future mHealth devices. UR - https://www.jmir.org/2023/1/e44225 UR - http://dx.doi.org/10.2196/44225 UR - http://www.ncbi.nlm.nih.gov/pubmed/36719823 ID - info:doi/10.2196/44225 ER - TY - JOUR AU - Kyaw, Lin Tun AU - Ng, Nawi AU - Theocharaki, Margarita AU - Wennberg, Patrik AU - Sahlen, Klas-Göran PY - 2023/2/16 TI - Cost-effectiveness of Digital Tools for Behavior Change Interventions Among People With Chronic Diseases: Systematic Review JO - Interact J Med Res SP - e42396 VL - 12 KW - digital tools KW - chronic diseases KW - cost-effectiveness KW - lifestyle KW - behavior KW - systematic review KW - mobile phone N2 - Background: Chronic diseases, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, and cerebrovascular diseases, contribute to the most significant disease burden worldwide, negatively impacting patients and their family members. People with chronic diseases have common modifiable behavioral risk factors, including smoking, alcohol overconsumption, and unhealthy diets. Digital-based interventions for promoting and sustaining behavioral changes have flourished in recent years, although evidence of the cost-effectiveness of such interventions remains inconclusive. Objective: In this study, we aimed to investigate the cost-effectiveness of digital health interventions for behavioral changes among people with chronic diseases. Methods: This systematic review evaluated published studies focused on the economic evaluation of digital tools for behavioral change among adults with chronic diseases. We followed the Population, Intervention, Comparator, and Outcomes framework to retrieve relevant publications from 4 databases: PubMed, CINAHL, Scopus, and Web of Science. We used the Joanna Briggs Institute?s criteria for economic evaluation and randomized controlled trials to assess the risk of bias in the studies. Two researchers independently screened, assessed the quality, and extracted data from the studies selected for the review. Results: In total, 20 studies published between 2003 and 2021 fulfilled our inclusion criteria. All the studies were conducted in high-income countries. These studies used telephones, SMS text messaging, mobile health apps, and websites as digital tools for behavior change communication. Most digital tools for interventions focused on diet and nutrition (17/20, 85%) and physical activity (16/20, 80%), and a few focused on smoking and tobacco control (8/20, 40%), alcohol reduction (6/20, 30%), and reduction of salt intake (3/20, 15%). Most studies (17/20, 85%) used the health care payer perspective for economic analysis, and only 15% (3/20) used the societal perspective. Only 45% (9/20) of studies conducted a full economic evaluation. Most studies (7/20, 35%) based on full economic evaluation and 30% (6/20) of studies based on partial economic evaluation found digital health interventions to be cost-effective and cost-saving. Most studies had short follow-ups and failed to include proper indicators for economic evaluation, such as quality-adjusted life-years, disability-adjusted life-years, lack of discounting, and sensitivity analysis. Conclusions: Digital health interventions for behavioral change among people with chronic diseases are cost-effective in high-income settings and can therefore be scaled up. Similar evidence from low- and middle-income countries based on properly designed studies for cost-effectiveness evaluation is urgently required. A full economic evaluation is needed to provide robust evidence for the cost-effectiveness of digital health interventions and their potential for scaling up in a wider population. Future studies should follow the National Institute for Health and Clinical Excellence recommendations to take a societal perspective, apply discounting, address parameter uncertainty, and apply a lifelong time horizon. UR - https://www.i-jmr.org/2023/1/e42396 UR - http://dx.doi.org/10.2196/42396 UR - http://www.ncbi.nlm.nih.gov/pubmed/36795470 ID - info:doi/10.2196/42396 ER - TY - JOUR AU - Oteo, Alberto AU - Daneshvar, Hadi AU - Baldacchino, Alexander AU - Matheson, Catriona PY - 2023/2/15 TI - Overdose Alert and Response Technologies: State-of-the-art Review JO - J Med Internet Res SP - e40389 VL - 25 KW - drug overdose KW - technology KW - opioids KW - telemedicine KW - mobile health KW - mHealth KW - apnea KW - sensor KW - naloxone KW - mobile phone N2 - Background: Drug overdose deaths, particularly from opioids, are a major global burden, with 128,000 deaths estimated in 2019. Opioid overdoses can be reversed through the timely administration of naloxone but only if responders are able to administer it. There is an emerging body of research and development in technologies that can detect the early signs of an overdose and facilitate timely responses. Objective: Our aim was to identify and classify overdose-specific digital technologies being developed, implemented, and evaluated. Methods: We conducted a ?state-of-the-art review.? A systematic search was conducted in MEDLINE, Embase, Web of Science, Scopus, ACM, IEEE Xplore, and SciELO. We also searched references from articles and scanned the gray literature. The search included terms related to telehealth and digital technologies, drugs, and overdose and papers published since 2010. We classified our findings by type of technology and its function, year of publication, country of study, study design, and theme. We performed a thematic analysis to classify the papers according to the main subject. Results: Included in the selection were 17 original research papers, 2 proof-of-concept studies, 4 reviews, 3 US government grant registries, and 6 commercial devices that had not been named in peer-reviewed literature. All articles were published between 2017 and 2022, with a marked increase since 2019. All were based in or referred to the United States or Canada and concerned opioid overdose. In total, 39% (9/23) of the papers either evaluated or described devices designed to monitor vital signs and prompt an alert once a certain threshold indicating a potential overdose has been reached. A total of 43% (10/23) of the papers focused on technologies to alert potential responders to overdoses and facilitate response. In total, 48% (11/23) of the papers and 67% (4/6) of the commercial devices described combined alert and response devices. Sensors monitor a range of vital signs, such as oxygen saturation level, respiratory rate, or movement. Response devices are mostly smartphone apps enabling responders to arrive earlier to an overdose site. Closed-loop devices that can detect an overdose through a sensor and automatically administer naloxone without any external intervention are still in the experimental or proof-of-concept phase. The studies were grouped into 4 themes: acceptability (7/23, 30%), efficacy or effectiveness (5/23, 22%), device use and decision-making (3/23, 13%), and description of devices (6/23, 26%). Conclusions: There has been increasing interest in the research and application of these technologies in recent years. Literature suggests willingness to use these devices by people who use drugs and affected communities. More real-life studies are needed to test the effectiveness of these technologies to adapt them to the different settings and populations that might benefit from them. UR - https://www.jmir.org/2023/1/e40389 UR - http://dx.doi.org/10.2196/40389 UR - http://www.ncbi.nlm.nih.gov/pubmed/36790860 ID - info:doi/10.2196/40389 ER - TY - JOUR AU - Ayyoubzadeh, Mohammad Seyed AU - Baniasadi, Tayebeh AU - Shirkhoda, Mohammad AU - Rostam Niakan Kalhori, Sharareh AU - Mohammadzadeh, Niloofar AU - Roudini, Kamran AU - Ghalehtaki, Reza AU - Memari, Fereidoon AU - Jalaeefar, Amirmohsen PY - 2023/2/15 TI - Remote Monitoring of Colorectal Cancer Survivors Using a Smartphone App and Internet of Things?Based Device: Development and Usability Study JO - JMIR Cancer SP - e42250 VL - 9 KW - eHealth KW - telemedicine KW - colorectal cancer KW - cancer survivor KW - IoT KW - mHealth KW - patient monitoring KW - remote monitoring KW - postdischarge care KW - cancer KW - patient care KW - cancer care KW - postoperative complications N2 - Background: Patients with colorectal cancer who undergo surgery face many postoperative problems. These problems include the risk of relapse, side effects, and long-term complications. Objective: This study sought to design and develop a remote monitoring system as a technological solution for the postdischarge care of these patients. Methods: This research was conducted in 3 main steps: system feature extraction, system design, and evaluation. After feature extraction from a systematic review, the necessary features were defined by 18 clinical experts in Iran. In the next step, the architecture of the system was designed based on the requirements; the software and hardware parts of the system were embedded in the architecture, then the software system components were drawn using the unified modeling language diagrams, and the details of software system implementation were identified. Regarding the hardware design, different accessible hardware modules were evaluated, and suitable ones were selected. Finally, the usability of the system was evaluated by demonstrating it over a Skype virtual meeting session and using Nilsen?s usability principles. Results: A total of 21 mandatory features in 5 main categories, including patient information registration, periodic monitoring of health parameters, education, reminders, and assessments, were defined and validated for the system. The software was developed using an ASP.Net core backend, a Microsoft SQL Server database, and an Ionic frontend alongside the Angular framework, to build an Android app. The user roles of the system included 3 roles: physicians, patients, and the system administrator. The hardware was designed to contain an Esp8266 as the Internet of Things module, an MLX90614 infrared temperature sensor, and the Maxim Integrated MAX30101 sensor for sensing the heartbeat. The hardware was designed in the shape of a wristband device using SolidWorks 2020 and printed using a 3D printer. The firmware of the hardware was developed in Arduino with the capability of firmware over the air. In evaluating the software system from the perspective of usability, the system received an average score of 3.8 out of 5 from 4 evaluators. Conclusions: Sensor-based telemonitoring systems for patients with colorectal cancer after surgery are possible solutions that can make the process automatic for patients and caregivers. The apps for remote colorectal patient monitoring could be designed to be useful; however, more research regarding the developed system?s implementation in clinic settings and hospitals is required to understand the probable barriers and limitations. UR - https://cancer.jmir.org/2023/1/e42250 UR - http://dx.doi.org/10.2196/42250 UR - http://www.ncbi.nlm.nih.gov/pubmed/36790851 ID - info:doi/10.2196/42250 ER - TY - JOUR AU - Hughes, David Jeffery AU - Chivers, Paola AU - Hoti, Kreshnik PY - 2023/2/13 TI - The Clinical Suitability of an Artificial Intelligence?Enabled Pain Assessment Tool for Use in Infants: Feasibility and Usability Evaluation Study JO - J Med Internet Res SP - e41992 VL - 25 KW - pain assessment KW - clinical utility KW - sensitivity KW - specificity KW - immunization KW - accuracy KW - precision KW - PainChek Infant KW - infant KW - newborn KW - baby KW - babies KW - pain KW - facial KW - artificial intelligence KW - machine learning KW - model KW - detection KW - assessment N2 - Background: Infants are unable to self-report their pain, which, therefore, often goes underrecognized and undertreated. Adequate assessment of pain, including procedural pain, which has short- and long-term consequences, is critical for its management. The introduction of mobile health?based (mHealth) pain assessment tools could address current challenges and is an area requiring further research. Objective: The purpose of this study is to evaluate the accuracy and feasibility aspects of PainChek Infant and, therefore, assess its applicability in the intended setting. Methods: By observing infants just before, during, and after immunization, we evaluated the accuracy and precision at different cutoff scores of PainChek Infant, which is a point-of-care mHealth?based solution that uses artificial intelligence to detect pain and intensity based solely on facial expression. We used receiver operator characteristic analysis to assess interpretability and establish a cutoff score. Clinician comprehensibility was evaluated using a standardized questionnaire. Other feasibility aspects were evaluated based on comparison with currently available observational pain assessment tools for use in infants with procedural pain. Results: Both PainChek Infant Standard and Adaptive modes demonstrated high accuracy (area under the curve 0.964 and 0.966, respectively). At a cutoff score of ?2, accuracy and precision were 0.908 and 0.912 for Standard and 0.912 and 0.897 for Adaptive modes, respectively. Currently available data allowed evaluation of 16 of the 17 feasibility aspects, with only the cost of the outcome measurement instrument unable to be evaluated since it is yet to be determined. PainChek Infant performed well across feasibility aspects, including interpretability (cutoff score defined), ease of administration, completion time (3 seconds), and clinician comprehensibility. Conclusions: This work provides information on the feasibility of using PainChek Infant in clinical practice for procedural pain assessment and monitoring, and demonstrates the accuracy and precision of the tool at the defined cutoff score. UR - https://www.jmir.org/2023/1/e41992 UR - http://dx.doi.org/10.2196/41992 UR - http://www.ncbi.nlm.nih.gov/pubmed/36780223 ID - info:doi/10.2196/41992 ER - TY - JOUR AU - Glanville, David AU - Hutchinson, Anastasia AU - Khaw, Damien PY - 2023/2/13 TI - Handheld Computer Devices to Support Clinical Decision-making in Acute Nursing Practice: Systematic Scoping Review JO - J Med Internet Res SP - e39987 VL - 25 KW - handheld computer devices KW - smartphones KW - mobile computing KW - mobile health KW - nursing KW - acute care KW - decision-making KW - clinical decision-making KW - scoping review KW - mobile phone N2 - Background: Nursing care is increasingly supported by computerized information systems and decision support aids. Since the advent of handheld computer devices (HCDs), there has been limited exploration of their use in nursing practice. Objective: The study aimed to understand the professional and clinical impacts of the use of mobile health apps in nursing to assist clinical decision-making in acute care settings. The study also aimed to explore the scope of published research and identify key nomenclature with respect to research in this emerging field within nursing practice. Methods: This scoping review involved a tripartite search of electronic databases (CINAHL, Embase, MEDLINE, and Google Scholar) using preliminary, broad, and comprehensive search terms. The included studies were hand searched for additional citations. Two researchers independently screened the studies for inclusion and appraised quality using structured critical appraisal tools. Results: Of the 2309 unique studies screened, 28 (1.21%) were included in the final analyses: randomized controlled trials (n=3, 11%) and quasi-experimental (n=9, 32%), observational (n=10, 36%), mixed methods (n=2, 7%), qualitative descriptive (n=2, 7%), and diagnostic accuracy (n=2, 7%) studies. Studies investigated the impact of HCDs on nursing decisions (n=12, 43%); the effectiveness, safety, and quality of care (n=9, 32%); and HCD usability, uptake, and acceptance (n=14, 50%) and were judged to contain moderate-to-high risk of bias. The terminology used to describe HCDs was heterogenous across studies, comprising 24 unique descriptors and 17 individual concepts that reflected 3 discrete technology platforms (?PDA technology,? ?Smartphone/tablet technology,? and ?Health care?specific technology?). Study findings varied, as did the range of decision-making modalities targeted by HCD interventions. Interventions varied according to the level of clinician versus algorithmic judgment: unstructured clinical judgment, structured clinical judgment, and computerized algorithmic judgment. Conclusions: The extant literature is varied but suggests that HCDs can be used effectively to support aspects of acute nursing care. However, there is a dearth of high-level evidence regarding this phenomenon and studies exploring the degree to which HCD implementation may affect acute nursing care delivery workflow. Additional targeted research using rigorous experimental designs is needed in this emerging field to determine the true potential of HCDs in optimizing acute nursing care. UR - https://www.jmir.org/2023/1/e39987 UR - http://dx.doi.org/10.2196/39987 UR - http://www.ncbi.nlm.nih.gov/pubmed/36780222 ID - info:doi/10.2196/39987 ER - TY - JOUR AU - Han, Dong AU - Ding, Y. Eric AU - Cho, Chaeho AU - Jung, Haewook AU - Dickson, L. Emily AU - Mohagheghian, Fahimeh AU - Peitzsch, G. Andrew AU - DiMezza, Danielle AU - Tran, Khanh-Van AU - McManus, D. David AU - Chon, H. Ki PY - 2023/2/13 TI - A Smartwatch System for Continuous Monitoring of Atrial Fibrillation in Older Adults After Stroke or Transient Ischemic Attack: Application Design Study JO - JMIR Cardio SP - e41691 VL - 7 KW - atrial fibrillation KW - stroke KW - smartwatch app KW - smartphone apps KW - wearable devices KW - user experience KW - older adults KW - mobile phone N2 - Background: The prevalence of atrial fibrillation (AF) increases with age and can lead to stroke. Therefore, older adults may benefit the most from AF screening. However, older adult populations tend to lag more than younger groups in the adoption of, and comfort with, the use of mobile health (mHealth) apps. Furthermore, although mobile apps that can detect AF are available to the public, most are designed for intermittent AF detection and for younger users. No app designed for long-term AF monitoring has released detailed system design specifications that can handle large data collections, especially in this age group. Objective: This study aimed to design an innovative smartwatch-based AF monitoring mHealth solution in collaboration with older adult participants and clinicians. Methods: The Pulsewatch system is designed to link smartwatches and smartphone apps, a website for data verification, and user data organization on a cloud server. The smartwatch in the Pulsewatch system is designed to continuously monitor the pulse rate with embedded AF detection algorithms, and the smartphone in the Pulsewatch system is designed to serve as the data-transferring hub to the cloud storage server. Results: We implemented the Pulsewatch system based on the functionality that patients and caregivers recommended. The user interfaces of the smartwatch and smartphone apps were specifically designed for older adults at risk for AF. We improved our Pulsewatch system based on feedback from focus groups consisting of patients with stroke and clinicians. The Pulsewatch system was used by the intervention group for up to 6 weeks in the 2 phases of our randomized clinical trial. At the conclusion of phase 1, 90 trial participants who had used the Pulsewatch app and smartwatch for 14 days completed a System Usability Scale to assess the usability of the Pulsewatch system; of 88 participants, 56 (64%) endorsed that the smartwatch app is ?easy to use.? For phases 1 and 2 of the study, we collected 9224.4 hours of smartwatch recordings from the participants. The longest recording streak in phase 2 was 21 days of consecutive recordings out of the 30 days of data collection. Conclusions: This is one of the first studies to provide a detailed design for a smartphone-smartwatch dyad for ambulatory AF monitoring. In this paper, we report on the system?s usability and opportunities to increase the acceptability of mHealth solutions among older patients with cognitive impairment. Trial Registration: ClinicalTrials.gov NCT03761394; https://www.clinicaltrials.gov/ct2/show/NCT03761394 International Registered Report Identifier (IRRID): RR2-10.1016/j.cvdhj.2021.07.002 UR - https://cardio.jmir.org/2023/1/e41691 UR - http://dx.doi.org/10.2196/41691 UR - http://www.ncbi.nlm.nih.gov/pubmed/36780211 ID - info:doi/10.2196/41691 ER - TY - JOUR AU - Yoshizaki, Arika AU - Murata, Emi AU - Yamamoto, Tomoka AU - Fujisawa, X. Takashi AU - Hanaie, Ryuzo AU - Hirata, Ikuko AU - Matsumoto, Sayuri AU - Mohri, Ikuko AU - Taniike, Masako PY - 2023/2/10 TI - Improving Children?s Sleep Habits Using an Interactive Smartphone App: Community-Based Intervention Study JO - JMIR Mhealth Uhealth SP - e40836 VL - 11 KW - infant sleep KW - app KW - mHealth KW - mobile health KW - behavioral intervention KW - sleep health KW - social implementation KW - mobile phone N2 - Background: Sleep problems are quite common among young children and are often a challenge for parents and a hinderance to children?s development. Although behavioral therapy has proven effective in reducing sleep problems in children, a lack of access to professionals who can provide effective support is a major barrier for many caregivers. Therefore, pediatric sleep experts have begun developing apps and web-based services for caregivers. Despite the substantial influence of cultural and familial factors on children?s sleep, little effort has gone into developing cultural or family-tailored interventions. Objective: This study aimed to examine the effectiveness of the interactive smartphone app ?Nenne Navi,? which provides culturally and family-tailored suggestions for improving sleep habits in young Japanese children through community-based long-term trials. The study also aimed to investigate the association between app-driven improvements in sleep and mental development in children. Methods: This study adopted a community-based approach to recruit individuals from the Higashi-Osaka city (Japan) who met ?1 of the following eligibility criteria for sleep problems: sleeping after 10 PM, getting <9 hours of nighttime sleep, and experiencing frequent nighttime awakenings. A total of 87 Japanese caregivers with young children (mean 19.50, SD 0.70 months) were recruited and assigned to the app use group (intervention group) or the video-only group (control group). Both groups received educational video content regarding sleep health literacy. The caregivers in the intervention group used the app, which provides family-tailored suggestions, once per month for 1 year. Results: A total of 92% (33/36) of the caregivers in the app use group completed 1 year of the intervention. The participants? overall evaluation of the app was positive. The wake-up time was advanced (base mean 8:06 AM; post mean 7:48 AM; F1,65=6.769; P=.01 and sleep onset latency was decreased (base mean 34.45 minutes; post mean 20.05 minutes; F1,65=23.219; P<.001) significantly in the app use group at the 13th month compared with the video-only group. Moreover, multiple regression analysis showed that decreased social jetlag (?=?0.302; P=.03) and increased sleep onset latency SD (?=.426; P=.02) in children predicted a significant enhancement in the development of social relationships with adults. At 6 months after the completion of the app use, all the caregivers reported continuation of the new lifestyle. Conclusions: The present findings suggest that the app ?Nenne Navi? has high continuity in community use and can improve sleep habits in young Japanese children and that interventions for sleep habits of young children may lead to the enhancement of children?s social development. Future studies must focus on the effectiveness of the app in other regions with different regional characteristics and neuroscientific investigations on how changes in sleep impact brain development. UR - https://mhealth.jmir.org/2023/1/e40836 UR - http://dx.doi.org/10.2196/40836 UR - http://www.ncbi.nlm.nih.gov/pubmed/36641237 ID - info:doi/10.2196/40836 ER - TY - JOUR AU - Shatwan, M. Israa AU - Alhefani, S. Rabab AU - Bukhari, F. Mawadah AU - Hanbazazah, A. Danah AU - Srour, K. Jumanah AU - Surendran, Shelini AU - Aljefree, M. Najlaa AU - Almoraie, M. Noha PY - 2023/2/9 TI - Effects of a Smartphone App on Fruit and Vegetable Consumption Among Saudi Adolescents: Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e43160 VL - 6 KW - smartphone app KW - fruit and vegetable consumption KW - Saudi Arabia KW - adolescents KW - nutrition KW - health outcome KW - digital health intervention KW - digital health app KW - pediatrics KW - youth N2 - Background: Dietary patterns and nutritional status during adolescence have a direct effect on future health outcomes. Objective: This study aimed to promote fruit and vegetable intake among adolescents using a smartphone app called MyPlate. Methods: This randomized intervention study was conducted in an urban area of Jeddah, Saudi Arabia. We included 104 adolescents aged 13 to 18 years, who were randomized into intervention (n=55) or control (n=49) arms. We examined the effects of MyPlate on fruit and vegetable intake over 6 weeks in the intervention group. Pre- and postintervention questionnaires were used in the intervention and control groups. Results: The control group showed a significant increase in fruit consumption scores between baseline (1.15, SD 0.68) and postintervention (1.64, SD 0.98; P=.01), but no significant difference in vegetable consumption scores was observed before (1.44, SD 0.97) and after intervention (1.55, SD 0.90; P=.54). However, there was no significant difference between scores at baseline and after 6 weeks of using the smartphone app for fruit (1.48, SD 0.99 and 1.70, SD 1.11, respectively; P=.31) or vegetables (1.50, SD 0.97 and 1.43, SD 1.03, respectively; P=.30) in the intervention group. Our findings showed no significant impact of using a smartphone app on fruit and vegetable consumption. Conclusions: These findings suggest that a smartphone app did not significantly improve fruit and vegetable intake among adolescents. Trial Registration: ClinicalTrials.gov NCT05692765; https://clinicaltrials.gov/ct2/show/NCT05692765 UR - https://pediatrics.jmir.org/2023/1/e43160 UR - http://dx.doi.org/10.2196/43160 UR - http://www.ncbi.nlm.nih.gov/pubmed/36757770 ID - info:doi/10.2196/43160 ER - TY - JOUR AU - Ali, Mustafa Syed AU - Lee, R. Rebecca AU - McBeth, John AU - James, Ben AU - McAlister, Sean AU - Chiarotto, Alessandro AU - Dixon, G. William AU - van der Veer, N. Sabine PY - 2023/2/8 TI - Exploring the Cross-cultural Acceptability of Digital Tools for Pain Self-reporting: Qualitative Study JO - JMIR Hum Factors SP - e42177 VL - 10 KW - chronic pain KW - pain perception KW - cross-cultural comparison KW - pain measurement KW - mobile app KW - mobile phone N2 - Background: Culture and ethnicity influence how people communicate about their pain. This makes it challenging to develop pain self-report tools that are acceptable across ethnic groups. Objective: We aimed to inform the development of cross-culturally acceptable digital pain self-report tools by better understanding the similarities and differences between ethnic groups in pain experiences and self-reporting needs. Methods: Three web-based workshops consisting of a focus group and a user requirement exercise with people who self-identified as being of Black African (n=6), South Asian (n=10), or White British (n=7) ethnicity were conducted. Results: Across ethnic groups, participants shared similar lived experiences and challenges in communicating their pain to health care professionals. However, there were differences in beliefs about the causes of pain, attitudes toward pain medication, and experiences of how stigma and gender norms influenced pain-reporting behavior. Despite these differences, they agreed on important aspects for pain self-report, but participants from non-White backgrounds had additional language requirements such as culturally appropriate pain terminologies to reduce self-reporting barriers. Conclusions: To improve the cross-cultural acceptability and equity of digital pain self-report tools, future developments should address the differences among ethnic groups on pain perceptions and beliefs, factors influencing pain reporting behavior, and language requirements. UR - https://humanfactors.jmir.org/2023/1/e42177 UR - http://dx.doi.org/10.2196/42177 UR - http://www.ncbi.nlm.nih.gov/pubmed/36753324 ID - info:doi/10.2196/42177 ER - TY - JOUR AU - Tenfelde, Kim AU - Antheunis, Marjolijn AU - Krahmer, Emiel AU - Bunt, Erik Jan PY - 2023/2/7 TI - Using Digital Communication Technology to Improve Neonatal Care: Two-Part Explorative Needs Assessment JO - JMIR Pediatr Parent SP - e38435 VL - 6 KW - mobile health KW - mHealth KW - physician-patient communication KW - questions asking KW - needs assessment KW - explorative KW - mobile phone N2 - Background: The birth of a premature infant and subsequent hospitalization are stressful events for parents. Therefore, accurate and easy-to-understand communication between parents and health care professionals is crucial during this period. Mobile health (mHealth) technologies have the potential to improve communication with parents at any time and place and possibly reduce their stress. Objective: We aimed to conduct a 2-part explorative needs assessment in which the interaction between the pediatrician and parents was examined along with their digital communication technology needs and interest in an mHealth app with the aim of improving interpersonal communication and information exchange. Methods: Overall, 19 consultations between parents of preterm infants and pediatricians were observed to determine which themes are discussed the most and the number of questions asked. Afterward, the parents and the pediatrician were interviewed to evaluate the process of communication and gauge their ideas about a neonatal communication mHealth app. Results: The observations revealed the following most prevalent themes: breastfeeding, criteria for discharge, medication, and parents? personal life. Interview data showed that the parents were satisfied with the communication with their pediatrician. Furthermore, both parents and pediatricians expected that a neonatal mHealth app could further improve the communication process and the hospital stay. Parents valued app features such as asking questions, growth graphs, a diary function, hospital-specific information, and medical rounds reports. Conclusions: Both parents of hospitalized preterm infants and pediatricians expect that the hypothetical mHealth app has the potential to cater to the most prevalent themes and improve communication and information exchange. Recommendations for developing such an app and its possible features are also discussed. On the basis of these promising results, it is suggested to further develop and study the effects of the mHealth app together with all stakeholders. UR - https://pediatrics.jmir.org/2023/1/e38435 UR - http://dx.doi.org/10.2196/38435 UR - http://www.ncbi.nlm.nih.gov/pubmed/36749606 ID - info:doi/10.2196/38435 ER - TY - JOUR AU - Trinidad, Brown Susan AU - Shane, L. Aliassa AU - Guinn, R. Tiffany AU - Apok, R. Charlene AU - Collier, F. Ann AU - Avey, P. Jaedon AU - Donovan, M. Dennis PY - 2023/2/7 TI - The Cultural Adaption of a Sobriety Support App for Alaska Native and American Indian People: Qualitative Feasibility and Acceptability Study JO - JMIR Form Res SP - e38894 VL - 7 KW - alcohol misuse KW - sobriety support KW - peer support KW - smartphone app KW - community reinforcement approach KW - mobile phone N2 - Background: Despite high rates of alcohol abstinence, Alaska Native and American Indian (ANAI) people experience a disproportionate burden of alcohol-related morbidity and mortality. Multiple barriers to treatment exist for this population, including a lack of culturally relevant resources; limited access to or delays in receiving treatment; and privacy concerns. Many ANAI people in the state of Alaska, United States, live in sparsely populated rural areas, where treatment access and privacy concerns regarding peer-support programs may be particularly challenging. In addition, prior research demonstrates that many ANAI people prefer a self-management approach to sobriety, rather than formal treatment. Taken together, these factors suggest a potential role for a culturally adapted smartphone app to support ANAI people interested in changing their behavior regarding alcohol use. Objective: This study was the first phase of a feasibility and acceptability study of a culturally tailored version of an off-the-shelf smartphone app to aid ANAI people in managing or reducing their use of alcohol. The aim of this qualitative needs assessment was to gather insights and preferences from ANAI people and health care providers serving ANAI people to guide feature development, content selection, and cultural adaptation before a pilot test of the smartphone app with ANAI people. Methods: From October 2018 to September 2019, we conducted semistructured interviews with 24 ANAI patients aged ?21 years and 8 providers in a tribal health care organization in south-central Alaska. Results: Participants generally endorsed the usefulness of a smartphone app for alcohol self-management. They cited anonymity, 24/7 access, peer support, and patient choice as key attributes of an app. The desired cultural adaptations included ANAI- and land-themed design elements, cultural content (eg, stories from elders), and spiritual resources. Participants considered an app especially useful for rural-dwelling ANAI people, as well as those who lack timely access to treatment services or prefer to work toward managing their alcohol use outside the clinical setting. Conclusions: This needs assessment identified key features, content, and cultural adaptations that are being implemented in the next phase of the study. In future work, we will determine the extent to which these changes can be accommodated in a commercially available app, the feasibility of implementation, and the acceptability of the culturally adapted version of the app among ANAI users. UR - https://formative.jmir.org/2023/1/e38894 UR - http://dx.doi.org/10.2196/38894 UR - http://www.ncbi.nlm.nih.gov/pubmed/36473107 ID - info:doi/10.2196/38894 ER - TY - JOUR AU - Werntz, Alexandra AU - Amado, Selen AU - Jasman, Megyn AU - Ervin, Ariel AU - Rhodes, E. Jean PY - 2023/2/6 TI - Providing Human Support for the Use of Digital Mental Health Interventions: Systematic Meta-review JO - J Med Internet Res SP - e42864 VL - 25 KW - digital mental health interventions KW - human support KW - supportive accountability KW - systematic meta-review N2 - Background: Digital mental health interventions (DMHIs) have been increasingly deployed to bridge gaps in mental health care, particularly given their promising efficacy. Nevertheless, attrition among DMHI users remains high. In response, human support has been studied as a means of improving retention to and outcomes of DMHIs. Although a growing number of studies and meta-analyses have investigated the effects of human support for DMHIs on mental health outcomes, systematic empirical evidence of its effectiveness across mental health domains remains scant. Objective: We aimed to summarize the results of meta-analyses of human support versus no support for DMHI use across various outcome domains, participant samples, and support providers. Methods: We conducted a systematic meta-review of meta-analyses, comparing the effects of human support with those of no support for DMHI use, with the goal of qualitatively summarizing data across various outcome domains, participant samples, and support providers. We used MEDLINE, PubMed, and PsycINFO electronic databases. Articles were included if the study had a quantitative meta-analysis study design; the intervention targeted mental health symptoms and was delivered via a technology platform (excluding person-delivered interventions mediated through telehealth, text messages, or social media); the outcome variables included mental health symptoms such as anxiety, depression, stress, posttraumatic stress disorder symptoms, or a number of these symptoms together; and the study included quantitative comparisons of outcomes in which human support versus those when no or minimal human support was provided. Results: The results of 31 meta-analyses (505 unique primary studies) were analyzed. The meta-analyses reported 45 effect sizes; almost half (n=22, 48%) of them showed that human-supported DMHIs were significantly more effective than unsupported DMHIs. A total of 9% (4/45) of effect sizes showed that unsupported DMHIs were significantly more effective. No clear patterns of results emerged regarding the efficacy of human support for the outcomes assessed (including anxiety, depression, posttraumatic stress disorder, stress, and multiple outcomes). Human-supported DMHIs may be more effective than unsupported DMHIs for individuals with elevated mental health symptoms. There were no clear results regarding the type of training for those providing support. Conclusions: Our findings highlight the potential of human support in improving the effects of DMHIs. Specifically, evidence emerged for stronger effects of human support for individuals with greater symptom severity. There was considerable heterogeneity across meta-analyses in the level of detail regarding the nature of the interventions, population served, and support delivered, making it difficult to draw strong conclusions regarding the circumstances under which human support is most effective. Future research should emphasize reporting detailed descriptions of sample and intervention characteristics and describe the mechanism through which they believe the coach will be most useful for the DMHI. UR - https://www.jmir.org/2023/1/e42864 UR - http://dx.doi.org/10.2196/42864 UR - http://www.ncbi.nlm.nih.gov/pubmed/36745497 ID - info:doi/10.2196/42864 ER - TY - JOUR AU - Van Velthoven, Helena Michelle AU - Oke, Jason AU - Kardos, Attila PY - 2023/2/6 TI - ChroniSense National Early Warning Score Study: Comparison Study of a Wearable Wrist Device to Measure Vital Signs in Patients Who Are Hospitalized JO - J Med Internet Res SP - e40226 VL - 25 KW - mobile health KW - digital health KW - wearable KW - medical device KW - cardiology KW - early warning score KW - user acceptance KW - vital sign KW - devices KW - monitoring KW - clinical decision-making KW - decision-making KW - respiration rate KW - blood pressure KW - body temperature KW - heart rate KW - safety KW - use N2 - Background: Wearable devices could be used to continuously monitor vital signs in patients who are hospitalized, but they require validation. Objective: This study aimed to evaluate the clinical validity of the prototype of a semiautomated wearable wrist device (ChroniSense Polso) to measure vital signs and provide National Early Warning Scores (NEWSs). Methods: Vital signs and NEWSs measured using the wearable device were compared with standard, nurse-lead manual measurements. We enrolled adult patients (aged ?18 years) who required vital sign measurements at least every 6 hours in a UK teaching district general hospital. Wearable device measurements were not used for clinical decision-making. The primary outcome was the agreement on the individual National Early Warning parameter scores and vital sign measurements: respiratory rate, oxygen saturation, body temperature, systolic blood pressure, and heart rate. Secondary outcomes were the agreement on the total NEWS, incidence of adverse events, and user acceptance. To compare the wearable device measurements with the standard measurements, we analyzed vital sign measurements by limits of agreement (Bland-Altman analysis) and conducted ? agreement analyses for NEWSs. A user experience survey was conducted with questions about comfort of the wrist device, safety, preference, and use. Results: We included 132 participants in the study, with a mean age of 62 (SD 15.81) years; most of them were men (102/132, 77.3%). The highest weighted ? values were found for heart rate (0.69, 95% CI 0.57-0.81 for all 385 measurements) and systolic blood pressure (0.39, 95% CI 0.30-0.47 for all 339 measurements). Weighted ? values were low for respiration rate (0.03, 95% CI ?0.001 to 0.05 for all 445 measurements), temperature (0, 95% CI 0-0 for all 231 measurements), and oxygen saturation (?0.11, 95% CI ?0.20 to ?0.02 for all 187 measurements). Weighted ? using Cicchetti-Allison weights showed ? of 0.20 (95% CI 0.03-0.38) when using all 56 total NEWSs. The user acceptance survey found that approximately half (45/91, 49%) of the participants found it comfortable to wear the device and liked its appearance. Most (85/92, 92%) of them said that they would wear the device during their next hospital visit, and many (74/92, 80%) said that they would recommend it to others. Conclusions: This study shows the promising use of a prototype wearable device to measure vital signs in a hospital setting. Agreement between the standard measurements and wearable device measurements was acceptable for systolic blood pressure and heart rate, but needed to be improved for respiration rate, temperature, and oxygen saturation. Future studies need to improve the clinical validity of this wearable device. Large studies are required to assess clinical outcomes and cost-effectiveness of wearable devices for vital sign measurement. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028219 UR - https://www.jmir.org/2023/1/e40226 UR - http://dx.doi.org/10.2196/40226 UR - http://www.ncbi.nlm.nih.gov/pubmed/36745491 ID - info:doi/10.2196/40226 ER - TY - JOUR AU - Ditton, Elizabeth AU - Knott, Brendon AU - Hodyl, Nicolette AU - Horton, Graeme AU - Oldmeadow, Christopher AU - Walker, Rohan Frederick AU - Nilsson, Michael PY - 2023/2/6 TI - Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial JO - JMIR Ment Health SP - e42566 VL - 10 KW - burnout KW - psychological KW - burnout interventions KW - well-being KW - medicine KW - medical student KW - digital intervention KW - app-delivered intervention KW - individualized intervention KW - randomized controlled trial KW - RCT KW - randomized KW - Acceptance and Commitment Training KW - stress KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority. Objective: This study aimed to evaluate the effectiveness of a stand-alone app?delivered Acceptance and Commitment Training intervention for improving medical students? self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version. Methods: This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students? identified psychological flexibility training needs. Results: The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: ?0.52, 95% CI ?3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI ?1.84 to 5.03, P=.37), cynicism (individualized: ?1.26, 95% CI ?4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI ?2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI ?0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI ?0.92 to ?0.04; P=.04), and reduced stress (?6.89, 95% CI ?12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (?6.36, 95% CI ?11.90 to ?0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed. Conclusions: This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods. Trial Registration: Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw International Registered Report Identifier (IRRID): RR2-10.2196/32992 UR - https://mental.jmir.org/2023/1/e42566 UR - http://dx.doi.org/10.2196/42566 UR - http://www.ncbi.nlm.nih.gov/pubmed/36745486 ID - info:doi/10.2196/42566 ER - TY - JOUR AU - Michaud, B. Jacob AU - Penny, Cameron AU - Cull, Olivia AU - Hervet, Eric AU - Chamard-Witkowski, Ludivine PY - 2023/2/6 TI - Remote Testing Apps for Multiple Sclerosis Patients: Scoping Review of Published Articles and Systematic Search and Review of Public Smartphone Apps JO - JMIR Neurotech SP - e37944 VL - 2 KW - multiple sclerosis KW - mobile application KW - mobile phone KW - app KW - mHealth KW - eHealth KW - digital health KW - telehealth N2 - Background: Many apps have been designed to remotely assess clinical status and monitor symptom evolution in persons with multiple sclerosis (MS). These may one day serve as an adjunct for in-person assessment of persons with MS, providing valuable insight into the disease course that is not well captured by cross-sectional snapshots obtained from clinic visits. Objective: This study sought to review the current literature surrounding apps used for remote monitoring of persons with MS. Methods: A scoping review of published articles was conducted to identify and evaluate the literature published regarding the use of apps for monitoring of persons with MS. PubMed/Medline, EMBASE, CINAHL, and Cochrane databases were searched from inception to January 2022. Cohort studies, feasibility studies, and randomized controlled trials were included in this review. All pediatric studies, single case studies, poster presentations, opinion pieces, and commentaries were excluded. Studies were assessed for risk of bias using the Scottish Intercollegiate Guidelines Network, when applicable. Key findings were grouped in categories (convergence to neurological exam, feasibility of implementation, impact of weather, and practice effect), and trends are presented. In a parallel systematic search, the Canadian Apple App Store and Google Play Store were searched to identify relevant apps that are available but have yet to be formally studied and published in peer-reviewed publications. Results: We included 18 articles and 18 apps. Although many MS-related apps exist, only 10 apps had published literature supporting their use. Convergence between app-based testing and the neurological exam was examined in 12 articles. Most app-based tests focused on physical disability and cognition, although other domains such as ambulation, balance, visual acuity, and fatigue were also evaluated. Overall, correlations between the app versions of standardized tests and their traditional counterparts were moderate to strong. Some novel app-based tests had a stronger correlation with clinician-derived outcomes than traditional testing. App-based testing correlated well with the Multiple Sclerosis Functional Composite but less so with the Expanded Disability Status Scale; the latter correlated to a greater extent with patient quality of life questionnaire scores. Conclusions: Although limited by a small number of included studies and study heterogeneity, the findings of this study suggest that app-based testing demonstrates adequate convergence to traditional in-person assessment and may be used as an adjunct to and perhaps in lieu of specific neurological exam metrics documented at clinic visits, particularly if the latter is not readily accessible for persons with MS. UR - https://neuro.jmir.org/2023/1/e37944 UR - http://dx.doi.org/10.2196/37944 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/37944 ER - TY - JOUR AU - Eppes, V. Elisabet AU - Augustyn, Marycatherine AU - Gross, M. Susan AU - Vernon, Paris AU - Caulfield, E. Laura AU - Paige, M. David PY - 2023/2/3 TI - Engagement With and Acceptability of Digital Media Platforms for Use in Improving Health Behaviors Among Vulnerable Families: Systematic Review JO - J Med Internet Res SP - e40934 VL - 25 KW - text messaging KW - social media KW - mobile app KW - low-income KW - engagement KW - health promotion KW - community KW - nutrition and physical activity KW - pregnancy KW - breastfeeding KW - maternal and child health KW - mobile phone N2 - Background: The use of digital communication platforms to improve health behaviors has increased dramatically over the last decade. Public health practitioners have adopted digital communication technologies such as text messages, mobile apps, and social media to reach diverse populations. However, the effectiveness of digital communication platforms used by community-serving agencies remains unclear, and patterns of engagement and acceptability of different platforms have not been studied. Objective: This review aimed to identify the types of digital communication strategies used by community-serving organizations to promote healthy behaviors, assess the strength of evidence for health behavioral change, and describe the degree of consumer engagement with and acceptability of these strategies. The study population included low-income pregnant women, parents of young children, and adolescents. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Scopus, Web of Science, CINAHL, and APA PsycInfo, covering research conducted from 2009 to 2022. Studies were included if they examined the use of digital communication (ie, texting, mobile apps, or social media) to promote healthy behaviors in the target population. Risk of bias and strength of evidence were assessed using the Effective Public Health Practice Project Risk of Bias tool and criteria from Agency for Healthcare Research and Quality, respectively. Results: Twenty-three peer-reviewed research studies published between 2012 and 2022, conducted in the United States, the United Kingdom, and Australia, were included in the review. The sample comprised studies exploring the use of texting (n=12), apps (n=6), social media (n=3), and multiple platforms (n=2; eg, texting and mobile apps). Targeted health behaviors included healthy diet, physical activity, obesity prevention, healthy pregnancy, breastfeeding, vaccine use, smoking cessation, and nutrition benefit redemption. The sample included 8 randomized controlled trials, 6 pretest-posttest design, 3 mixed methods studies, 2 pilot studies, 1 feasibility study, 1 prospective cohort study, 1 descriptive study, and 1 cross-sectional study. The median sample size was 77.5. There was no strong evidence to suggest the effectiveness of digital media campaigns in improving health behaviors; however, there were moderate to high levels of engagement and high levels of acceptability across digital platforms. Conclusions: Low-income pregnant women, parents of young children, and adolescents demonstrated moderate levels of engagement with and high levels of acceptability of digital media health campaigns conducted by community-serving agencies. The effectiveness of these strategies in improving health behaviors was inconclusive. Additional rigorous studies with larger sample sizes are required. In addition, more research is required to consistently measure and report participants? engagement with each platform. Digital communication platforms are critical tools for public health practitioners, and future investigations of the effectiveness of these platforms in engaging clients and improving health behaviors will maximize client services. UR - https://www.jmir.org/2023/1/e40934 UR - http://dx.doi.org/10.2196/40934 UR - http://www.ncbi.nlm.nih.gov/pubmed/36735286 ID - info:doi/10.2196/40934 ER - TY - JOUR AU - Richards, L. Veronica AU - Rajendran, Saahas AU - Cook, L. Robert AU - Leeman, F. Robert AU - Wang, Yan AU - Prins, Cindy AU - Cook, Christa PY - 2023/2/2 TI - Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor?Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily JO - J Med Internet Res SP - e38713 VL - 25 KW - transdermal KW - biosensor KW - alcohol KW - intervention KW - qualitative interview KW - patient preferences KW - mobile phone N2 - Background: Alcohol misuse is highly prevalent in the United States and results in a huge financial and public health burden. Current alcohol reduction treatments are underused, and there is a critical need for innovation in the field. Transdermal alcohol biosensors measure alcohol use passively and continuously and may be helpful tools in alcohol interventions. To date, however, alcohol biosensors have not been widely used to directly intervene on alcohol use. There is a new wrist-worn biosensor that could be used to help people reduce their drinking, although it is unclear how best to incorporate such a device into an alcohol intervention. Objective: We aimed to identify desired features that would be acceptable and helpful in a wrist-worn biosensor?based alcohol intervention for adults who drink heavily. Methods: Participants were recruited through an alcohol contingency management study, a contact registry, and participant referral. To qualify, participants had to be aged at least 40 years, report drinking at least twice per week, and indicate interest in reducing their drinking. We conducted a semistructured interview with each participant via Zoom (Zoom Video Communications, Inc). The interview guide addressed general thoughts on the wrist-worn biosensor, how participants thought a wrist-worn biosensor could be used to help people quit or reduce drinking, types of information that participants would want to receive from the biosensor, how they would want to receive this information, and how they thought this information could be used to change their behavior. Interviews were transcribed verbatim and analyzed using thematic analysis. Results: The sample comprised 20 adults (mean age 55.1, SD 6.1 years; 11/20, 55%, women; and 17/20, 85%, Black). Of the 20 participants, 9 (45%) had previous experience with the Secure Continuous Remote Alcohol Monitor continuous alcohol monitoring ankle biosensor from participating in an alcohol contingency management study. The desirable features could be grouped into 5 main themes: features that would influence willingness to use the biosensor (it should look attractive and be both comfortable to wear and accessible), personalized messaging (personalized biosensor-based prompts and feedback could be helpful), preference for time wearing the biosensor (for some, just wearing the biosensor could have an intervention effect), sharing data with others (this was appealing to many but not to all), and mental health support (many felt that mental health support could be incorporated into the biosensor). Conclusions: Five main themes that would maximize interest in using a wrist-worn biosensor for alcohol intervention were identified. Taken together, the identified themes could inform the development of a just-in-time adaptive intervention that uses a wrist-worn biosensor to help adults who drink heavily reduce their alcohol use. UR - https://www.jmir.org/2023/1/e38713 UR - http://dx.doi.org/10.2196/38713 UR - http://www.ncbi.nlm.nih.gov/pubmed/36729576 ID - info:doi/10.2196/38713 ER - TY - JOUR AU - Triplett, S. Noah AU - Johnson, Clara AU - Kiche, Sharon AU - Dastrup, Kara AU - Nguyen, Julie AU - Daniels, Alayna AU - Mbwayo, Anne AU - Amanya, Cyrilla AU - Munson, Sean AU - Collins, Y. Pamela AU - Weiner, J. Bryan AU - Dorsey, Shannon PY - 2023/2/2 TI - Understanding Lay Counselor Perspectives on Mobile Phone Supervision in Kenya: Qualitative Study JO - JMIR Form Res SP - e38822 VL - 7 KW - task shifting KW - human-centered design KW - supervision KW - global mental health KW - acceptability KW - feasibility KW - mobile phone N2 - Background: Task shifting is an effective model for increasing access to mental health treatment via lay counselors with less specialized training that deliver care under supervision. Mobile phones may present a low-technology opportunity to replace or decrease reliance on in-person supervision in task shifting, but important technical and contextual limitations must be examined and considered. Objective: Guided by human-centered design methods, we aimed to understand how mobile phones are currently used when supervising lay counselors, determine the acceptability and feasibility of mobile phone supervision, and generate solutions to improve mobile phone supervision. Methods: Participants were recruited from a large hybrid effectiveness implementation study in western Kenya wherein teachers and community health volunteers were trained to provide trauma-focused cognitive behavioral therapy. Lay counselors (n=24) and supervisors (n=3) participated in semistructured interviews in the language of the participants? choosing (ie, English or Kiswahili). Lay counselor participants were stratified by supervisor-rated frequency of mobile phone use such that interviews included high-frequency, average-frequency, and low-frequency phone users in equal parts. Supervisors rated lay counselors on frequency of phone contact (ie, calls and SMS text messages) relative to their peers. The interviews were transcribed, translated when needed, and analyzed using thematic analysis. Results: Participants described a range of mobile phone uses, including providing clinical updates, scheduling and coordinating supervision and clinical groups, and supporting research procedures. Participants liked how mobile phones decreased burden, facilitated access to clinical and personal support, and enabled greater independence of lay counselors. Participants disliked how mobile phones limited information transmission and relationship building between supervisors and lay counselors. Mobile phone supervision was facilitated by access to working smartphones, ease and convenience of mobile phone supervision, mobile phone literacy, and positive supervisor-counselor relationships. Limited resources, technical difficulties, communication challenges, and limitations on which activities can be effectively performed via mobile phone were barriers to mobile phone supervision. Lay counselors and supervisors generated 27 distinct solutions to increase the acceptability and feasibility of mobile phone supervision. Strategies ranged in terms of the resources required and included providing phones and airtime to support supervision, identifying quiet and private places to hold mobile phone supervision, and delineating processes for requesting in-person support. Conclusions: Lay counselors and supervisors use mobile phones in a variety of ways; however, there are distinct challenges to their use that must be addressed to optimize acceptability, feasibility, and usability. Researchers should consider limitations to implementing digital health tools and design solutions alongside end users to optimize the use of these tools. International Registered Report Identifier (IRRID): RR2-10.1186/s43058-020-00102-9 UR - https://formative.jmir.org/2023/1/e38822 UR - http://dx.doi.org/10.2196/38822 UR - http://www.ncbi.nlm.nih.gov/pubmed/36729591 ID - info:doi/10.2196/38822 ER - TY - JOUR AU - Rajani, B. Nikita AU - Bustamante, Luz AU - Weth, Dominik AU - Romo, Lucia AU - Mastellos, Nikolaos AU - Filippidis, T. Filippos PY - 2023/2/1 TI - Engagement With Gamification Elements in a Smoking Cessation App and Short-term Smoking Abstinence: Quantitative Assessment JO - JMIR Serious Games SP - e39975 VL - 11 KW - gamification KW - smoking cessation KW - smoking abstinence KW - mHealth KW - mobile apps KW - mobile phone KW - smartphone KW - digital health KW - user engagement KW - cognitive outcome KW - self-support KW - in-app metrics N2 - Background: Gamification in smoking cessation apps has been found to improve cognitive outcomes associated with higher odds of quitting. Although some research has shown that gamification can also positively impact behavioral outcomes such as smoking cessation, studies have largely focused on physical activity and mental health. Only a few studies have explored the effects of gamification on smoking cessation outcomes, of which the majority have adopted qualitative methodologies and/or assessed engagement with apps using self-report. Objective: This study aimed to explore levels of user engagement with gamification features in a smoking cessation app via in-app metrics. Specifically, the objective of this paper was to investigate whether higher engagement with gamification features is associated with the likelihood of quitting in the short term. Methods: Data from a larger online study that recruited smokers seeking to quit were analyzed to address the objectives presented in this paper. The study took place between June 2019 and July 2020, and participants were primarily recruited via social media posts. Participants who met the eligibility criteria used 1 of 2 mobile apps for smoking cessation. In-app metrics shared by the developer of one of the smoking cessation apps, called Kwit, were used to assess engagement with gamification features. Out of 58 participants who used the Kwit app, 14 were excluded due to missing data or low engagement with the app (ie, not opening the app once a week). For the remaining 44 participants, mean (SD) values were calculated for engagement with the app using in-app metrics. A logistic regression model was used to investigate the association between engagement with gamification and 7-day smoking abstinence. Results: In total, data from 44 participants who used the Kwit app were analyzed. The majority of participants were male, married, and employed. Almost 30% (n=13) of participants self-reported successful 7-day abstinence at the end of the study. On average, the Kwit app was opened almost 31 (SD 39) times during the 4-week study period, with the diary feature used the most often (mean 22.8, SD 49.3). Moreover, it was found that each additional level unlocked was associated with approximately 22% higher odds of achieving 7-day abstinence after controlling for other factors such as age and gender (odds ratio 1.22, 95% CI 1.01-1.47). Conclusions: This study highlights the likely positive effects of certain gamification elements such as levels and achievements on short-term smoking abstinence. Although more robust research with a larger sample size is needed, this research highlights the important role that gamification features integrated into mobile apps can play in facilitating and supporting health behavior change. UR - https://games.jmir.org/2023/1/e39975 UR - http://dx.doi.org/10.2196/39975 UR - http://www.ncbi.nlm.nih.gov/pubmed/36724003 ID - info:doi/10.2196/39975 ER - TY - JOUR AU - ter Harmsel, F. Janna AU - Smulders, M. Lisanne AU - Noordzij, L. Matthijs AU - Swinkels, A. Lise T. AU - Goudriaan, E. Anna AU - Popma, Arne AU - van der Pol, M. Thimo PY - 2023/2/1 TI - Forensic Psychiatric Outpatients? and Therapists? Perspectives on a Wearable Biocueing App (Sense-IT) as an Addition to Aggression Regulation Therapy: Qualitative Focus Group and Interview Study JO - JMIR Form Res SP - e40237 VL - 7 KW - biocueing KW - biofeedback KW - aggression KW - behavior change KW - forensic psychiatry KW - wearable technology KW - mobile health KW - mHealth KW - implementation KW - mobile phone N2 - Background: Given the increased use of smart devices and the advantages of individual behavioral monitoring and assessment over time, wearable sensor?based mobile health apps are expected to become an important part of future (forensic) mental health care. For successful implementation in clinical practice, consideration of barriers and facilitators is of utmost importance. Objective: The aim of this study was to provide insight into the perspectives of both psychiatric outpatients and therapists in a forensic setting on the use and implementation of the Sense-IT biocueing app in aggression regulation therapy. Methods: A combination of qualitative methods was used. First, we assessed the perspectives of forensic outpatients on the use of the Sense-IT biocueing app using semistructured interviews. Next, 2 focus groups with forensic therapists were conducted to gain a more in-depth understanding of their perspectives on facilitators of and barriers to implementation. Results: Forensic outpatients (n=21) and therapists (n=15) showed a primarily positive attitude toward the addition of the biocueing intervention to therapy, with increased interoceptive and emotional awareness as the most frequently mentioned advantage in both groups. In the semistructured interviews, patients mainly reported barriers related to technical or innovation problems (ie, connection and notification issues, perceived inaccuracy of the feedback, and limitations in the ability to personalize settings). In the focus groups with therapists, 92 facilitator and barrier codes were identified and categorized into technical or innovation level (n=13, 14%), individual therapist level (n=28, 30%), individual patient level (n=33, 36%), and environmental and organizational level (n=18, 20%). The predominant barriers were limitations in usability of the app, patients? motivation, and both therapists? and patients? knowledge and skills. Integration into treatment, expertise within the therapists? team, and provision of time and materials were identified as facilitators. Conclusions: The chances of successful implementation and continued use of sensor-based mobile health interventions such as the Sense-IT biocueing app can be increased by considering the barriers and facilitators from patients? and therapists? perspectives. Technical or innovation-related barriers such as usability issues should be addressed first. At the therapist level, increasing integration into daily routines and enhancing affinity with the intervention are highly recommended for successful implementation. Future research is expected to be focused on further development and personalization of biocueing interventions considering what works for whom at what time in line with the trend toward personalizing treatment interventions in mental health care. UR - https://formative.jmir.org/2023/1/e40237 UR - http://dx.doi.org/10.2196/40237 UR - http://www.ncbi.nlm.nih.gov/pubmed/36724008 ID - info:doi/10.2196/40237 ER - TY - JOUR AU - Morand, Ophélie AU - Larribau, Robert AU - Safin, Stéphane AU - Pages, Romain AU - Soichet, Hortense AU - Rizza, Caroline PY - 2023/2/1 TI - The Integration of Live Video Tools to Help Bystanders During an Emergency Call: Protocol for a Mixed Methods Simulation Study JO - JMIR Res Protoc SP - e40699 VL - 12 KW - emergency care KW - dispatcher KW - engaging citizens KW - living lab KW - apps KW - mobile phone N2 - Background: Early action by bystanders is particularly important for the survival of individuals in need of emergency care, especially those experiencing a cardiac arrest or an airway obstruction. However, only a few bystanders are willing to perform cardiopulmonary resuscitation. The use of a live video during emergency calls appears to have a positive effect on the number of cardiopulmonary resuscitations performed by bystanders. Objective: The objective of this study is to propose and evaluate the relevance of a living lab methodology involving video calls in simulated life-threatening emergency situations. Methods: The first study aimed at analyzing the process of dealing with out-of-hospital cardiac arrest at a dispatch center and identifying the needs of the dispatchers. The second study is a pretest of a living lab. The third study focuses on a living lab in which 16 situations of cardiac arrest and airway obstruction are simulated. The simulation includes both a live video and transmission of a video demonstration of emergency procedures. The measures focus on 3 areas: the impact of video tools, development of collaboration within the community, and evaluation of the method. Results: The results of the first study show that dispatchers have an interest in visualizing the scene with live video and in broadcasting a live demonstration video when possible. The initial results also show that collaboration within the community is enhanced by the shared simulation and debriefing experiences, clarifying regulation procedures, and improving communication. Finally, an iterative development based on the lessons learned, expectations, and constraints of each previous study promotes the existence of a living lab that aims to determine the place of live video tools in the sequence of care performed by dispatchers. Conclusions: Living labs offer the opportunity to grasp previously undetected insights and refine the use of the applications while potentially developing a sense of community among the stakeholders. International Registered Report Identifier (IRRID): DERR1-10.2196/40699 UR - https://www.researchprotocols.org/2023/1/e40699 UR - http://dx.doi.org/10.2196/40699 UR - http://www.ncbi.nlm.nih.gov/pubmed/36723999 ID - info:doi/10.2196/40699 ER - TY - JOUR AU - Nuo, Mingfu AU - Zheng, Shaojiang AU - Wen, Qinglian AU - Fang, Hongjuan AU - Wang, Tong AU - Liang, Jun AU - Han, Hongbin AU - Lei, Jianbo PY - 2023/1/31 TI - Mining the Influencing Factors and Their Asymmetrical Effects of mHealth Sleep App User Satisfaction From Real-world User-Generated Reviews: Content Analysis and Topic Modeling JO - J Med Internet Res SP - e42856 VL - 25 KW - sleep disorder KW - mobile health applications KW - topic modeling KW - Herzberg?s 2-factor theory KW - machine learning N2 - Background: Sleep disorders are a global challenge, affecting a quarter of the global population. Mobile health (mHealth) sleep apps are a potential solution, but 25% of users stop using them after a single use. User satisfaction had a significant impact on continued use intention. Objective: This China-US comparison study aimed to mine the topics discussed in user-generated reviews of mHealth sleep apps, assess the effects of the topics on user satisfaction and dissatisfaction with these apps, and provide suggestions for improving users? intentions to continue using mHealth sleep apps. Methods: An unsupervised clustering technique was used to identify the topics discussed in user reviews of mHealth sleep apps. On the basis of the two-factor theory, the Tobit model was used to explore the effect of each topic on user satisfaction and dissatisfaction, and differences in the effects were analyzed using the Wald test. Results: A total of 488,071 user reviews of 10 mainstream sleep apps were collected, including 267,589 (54.8%) American user reviews and 220,482 (45.2%) Chinese user reviews. The user satisfaction rates of sleep apps were poor (China: 56.58% vs the United States: 45.87%). We identified 14 topics in the user-generated reviews for each country. In the Chinese data, 13 topics had a significant effect on the positive deviation (PD) and negative deviation (ND) of user satisfaction. The 2 variables (PD and ND) were defined by the difference between the user rating and the overall rating of the app in the app store. Among these topics, the app?s sound recording function (?=1.026; P=.004) had the largest positive effect on the PD of user satisfaction, and the topic with the largest positive effect on the ND of user satisfaction was the sleep improvement effect of the app (?=1.185; P<.001). In the American data, all 14 topics had a significant effect on the PD and ND of user satisfaction. Among these, the topic with the largest positive effect on the ND of user satisfaction was the app?s sleep promotion effect (?=1.389; P<.001), whereas the app?s sleep improvement effect (?=1.168; P<.001) had the largest positive effect on the PD of user satisfaction. The Wald test showed that there were significant differences in the PD and ND models of user satisfaction in both countries (all P<.05), indicating that the influencing factors of user satisfaction with mHealth sleep apps were asymmetrical. Using the China-US comparison, hygiene factors (ie, stability, compatibility, cost, and sleep monitoring function) and 2 motivation factors (ie, sleep suggestion function and sleep promotion effects) of sleep apps were identified. Conclusions: By distinguishing between the hygiene and motivation factors, the use of sleep apps in the real world can be effectively promoted. UR - https://www.jmir.org/2023/1/e42856 UR - http://dx.doi.org/10.2196/42856 UR - http://www.ncbi.nlm.nih.gov/pubmed/36719730 ID - info:doi/10.2196/42856 ER - TY - JOUR AU - Denecke, Kerstin AU - May, Richard PY - 2023/1/30 TI - Developing a Technical-Oriented Taxonomy to Define Archetypes of Conversational Agents in Health Care: Literature Review and Cluster Analysis JO - J Med Internet Res SP - e41583 VL - 25 KW - mobile phone KW - user-computer interface KW - telemedicine KW - communication KW - delivery of health care and methods KW - delivery of health care and trends N2 - Background: The evolution of artificial intelligence and natural language processing generates new opportunities for conversational agents (CAs) that communicate and interact with individuals. In the health domain, CAs became popular as they allow for simulating the real-life experience in a health care setting, which is the conversation with a physician. However, it is still unclear which technical archetypes of health CAs can be distinguished. Such technical archetypes are required, among other things, for harmonizing evaluation metrics or describing the landscape of health CAs. Objective: The objective of this work was to develop a technical-oriented taxonomy for health CAs and characterize archetypes of health CAs based on their technical characteristics. Methods: We developed a taxonomy of technical characteristics for health CAs based on scientific literature and empirical data and by applying a taxonomy development framework. To demonstrate the applicability of the taxonomy, we analyzed the landscape of health CAs of the last years based on a literature review. To form technical design archetypes of health CAs, we applied a k-means clustering method. Results: Our taxonomy comprises 18 unique dimensions corresponding to 4 perspectives of technical characteristics (setting, data processing, interaction, and agent appearance). Each dimension consists of 2 to 5 characteristics. The taxonomy was validated based on 173 unique health CAs that were identified out of 1671 initially retrieved publications. The 173 CAs were clustered into 4 distinctive archetypes: a text-based ad hoc supporter; a multilingual, hybrid ad hoc supporter; a hybrid, single-language temporary advisor; and, finally, an embodied temporary advisor, rule based with hybrid input and output options. Conclusions: From the cluster analysis, we learned that the time dimension is important from a technical perspective to distinguish health CA archetypes. Moreover, we were able to identify additional distinctive, dominant characteristics that are relevant when evaluating health-related CAs (eg, input and output options or the complexity of the CA personality). Our archetypes reflect the current landscape of health CAs, which is characterized by rule based, simple systems in terms of CA personality and interaction. With an increase in research interest in this field, we expect that more complex systems will arise. The archetype-building process should be repeated after some time to check whether new design archetypes emerge. UR - https://www.jmir.org/2023/1/e41583 UR - http://dx.doi.org/10.2196/41583 UR - http://www.ncbi.nlm.nih.gov/pubmed/36716093 ID - info:doi/10.2196/41583 ER - TY - JOUR AU - Koeryaman, Trisyani Mira AU - Pallikadavath, Saseendran AU - Ryder, Helen Isobel AU - Kandala, Ngianga PY - 2023/1/30 TI - The Effectiveness of a Web-Based Application for a Balanced Diet and Healthy Weight Among Indonesian Pregnant Women: Randomized Controlled Trial JO - JMIR Form Res SP - e38378 VL - 7 KW - web-based application KW - nutrition KW - pregnant women KW - pregnancy KW - mobile app KW - diet KW - dietary intake KW - application KW - Indonesia KW - randomized controlled trial KW - tool KW - consumption KW - maternal KW - weight KW - weight gain KW - intervention KW - control group KW - treatment KW - vitamins KW - minerals KW - healthy diet KW - calorie KW - food N2 - Background: Pregnant women have self-declared that they have difficulties in estimating nutrient intakes. The Nutrition Information System for Indonesian Pregnant Women (SISFORNUTRIMIL) application was created as a dietary assessment and calorie-counting tool to guide pregnant women to eat the right portion sizes for each meal. Objective: The study aimed to examine the effectiveness of the SISFORNUTRIMIL application in helping users achieve a balanced diet and healthy maternal weight gain in comparison to nonusers in Indonesia. Methods:  First-pregnancy women in the second trimester aged 19-30 years (N=112) participated in the randomized controlled trial. Recruited women who were eligible and consented to participate in the study were allocated into the intervention group, or application user (n=56), and the control group, or application nonuser (n=56). The intervention recommended that pregnant women consume at least 5 food groups and calculate a recommended average portion size for 12 weeks. Both groups were self-monitored and recorded their intake in food records for 3 days every week. The dietary diversity consumed, macro- and micronutrient intake, and maternal weight gain were assessed pre- and postintervention. Data were collected three times during the intervention. Diversity food consumption was measured by the Minimum Dietary Diversity for Women of reproductive age. Furthermore, the Indonesian recommended dietary allowances were used to refer to and validate appropriate energy and nutrient amounts. Independent sample t test was used to compare differences between the intervention and control groups. Results: The mean dietary diversity score for the application user group (7.79, SD 1.20) was significantly greater than for the application nonuser group (7.02, SD 1.39; adjusted mean difference 0.77, 95% CI 0.28-1.25; d=0.28; P=.005). Macro- and micronutrient intake was significantly more in accordance with the dietary recommendations for the user group compared to the control group, including an energy daily intake of 156.88 kcal (95% CI 114.52-199.23; d=?1.39; P=.002), 102.43 g of carbohydrates (95% CI ?125.2 to ?79.60; d=?1.68; P=.02), 14.33 g of protein (95% CI 11.40-17.25; d=1.86; P<.001), and 10.96 g of fat (95% CI ?13.71 to ?8.20; d=?1.49; P<.001). Furthermore, there was a significantly higher intake of daily vitamins and minerals in the intervention group than in the control group. Other results showed that maternal weight gain in the intervention group was in accordance with the parameters of healthy weight gain. Conclusions:  Recording food intake using the application was significantly effective in improving the dietary diversity consumed, improving adequate energy and nutrient intake, and producing healthy maternal weight during pregnancy. Trial Registration: ISRCTN Registry ISRCTN42690828; https://www.isrctn.com/ISRCTN42690828 UR - https://formative.jmir.org/2023/1/e38378 UR - http://dx.doi.org/10.2196/38378 UR - http://www.ncbi.nlm.nih.gov/pubmed/36716078 ID - info:doi/10.2196/38378 ER - TY - JOUR AU - Mogaka, Nyabiage Jerusha AU - Otieno, Abuna Felix AU - Akim, Eunita AU - Beima-Sofie, Kristin AU - Dettinger, Julia AU - Gomez, Lauren AU - Marwa, Mary AU - Odhiambo, Ben AU - Ngure, Kenneth AU - Ronen, Keshet AU - Sharma, Monisha AU - John-Stewart, Grace AU - Richardson, Barbra AU - Stern, Joshua AU - Unger, Jennifer AU - Udren, Jenna AU - Watoyi, Salphine AU - Pintye, Jillian AU - Kinuthia, John PY - 2023/1/30 TI - A Text Messaging?Based Support Intervention to Enhance Pre-exposure Prophylaxis for HIV Prevention Adherence During Pregnancy and Breastfeeding: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e41170 VL - 12 KW - pre-exposure prophylaxis KW - text messaging KW - text message KW - mobile technology KW - PrEP adherence KW - adherence KW - prevention KW - pregnancy KW - pregnant KW - breastfeeding KW - maternal KW - randomized KW - RCT KW - peripartum KW - patient-provider KW - postpartum KW - HIV prevention KW - SMS KW - HIV KW - mHealth KW - mobile health N2 - Background: Cisgender women in Kenya are at elevated risk of HIV acquisition during pregnancy and post partum. Acute HIV infection during pregnancy and breastfeeding accounts for approximately one-third of all vertical HIV transmissions. The World Health Organization recommends offering oral tenofovir-based pre-exposure prophylaxis (PrEP) to pregnant and postpartum women who are HIV negative but at substantial and ongoing risk for HIV acquisition. PrEP delivery for pregnant and postpartum women is expanding within routine maternal child health clinics in Kenya. However, approximately half of pregnant women discontinue PrEP within 30 days of initiation. Therefore, it is crucial to develop PrEP adherence strategies that enhance support for adherence when peripartum events and health issues pose challenges to sustaining PrEP adherence. Objective: We are conducting a randomized controlled trial to determine the effect of a bidirectional communication platform named Mobile Solutions for Women?s and Children?s Health (mWACh), which utilizes two-way SMS text messaging between patients and remote nurses to support PrEP adherence and address maternal health concerns in real time during the peripartum period. Methods: The mWACh-PrEP study is a randomized trial designed to support PrEP adherence during the peripartum period by comparing mWACh-PrEP to the standard of care (ie, in-clinic adherence counseling) among women who are HIV negative and initiating PrEP. Purposive sampling was used to select 5 facilities offering PrEP in antenatal clinics in Kisumu and Siaya Counties, and block randomization will be used to divide participants into groups. Participants in the intervention arm will receive a customized messaging curriculum via SMS text messages targeted toward their particular perinatal stage. The primary outcome, PrEP adherence at 6 months post partum, will be evaluated using a log-binomial regression model, adjusting for imbalanced baseline characteristics. Based on a previous study of directly observed dosing conditions, we will use a hair tenofovir concentration cutoff of 0.038 ng/mg (corresponding to 7 doses/week) as the primary adherence outcome measured at 6 months post partum (binary outcome). Qualitative interviews and cost-effective analyses will be conducted to understand the feasibility, acceptability, and economic impact of the intervention. Results: Enrollment began in March 2022 and is projected to continue until July 2023, with follow-up through March 2024. The study results are expected to be reported in 2025. Conclusions: This trial will provide insights into using mobile health to enhance PrEP adherence among pregnant and postpartum mothers. Additionally, the findings will have implications for the use of mobile health technology to improve adherence to other daily medications during the peripartum period. Trial Registration: ClinicalTrials.gov NCT04472884; https://clinicaltrials.gov/ct2/show/NCT04472884 International Registered Report Identifier (IRRID): DERR1-10.2196/41170 UR - https://www.researchprotocols.org/2023/1/e41170 UR - http://dx.doi.org/10.2196/41170 UR - http://www.ncbi.nlm.nih.gov/pubmed/36716092 ID - info:doi/10.2196/41170 ER - TY - JOUR AU - Larkin, Celine AU - Djamasbi, Soussan AU - Boudreaux, D. Edwin AU - Varzgani, Fatima AU - Garner, Roscoe AU - Siddique, Mariam AU - Pietro, John AU - Tulu, Bengisu PY - 2023/1/27 TI - ReachCare Mobile Apps for Patients Experiencing Suicidality in the Emergency Department: Development and Usability Testing Using Mixed Methods JO - JMIR Form Res SP - e41422 VL - 7 KW - suicide KW - emergency department KW - mobile app KW - usability KW - engagement KW - mobile phone N2 - Background: Many individuals with suicide risk present to acute care settings such as emergency departments (EDs). However, staffing and time constraints mean that many EDs are not well equipped to deliver evidence-based interventions for patients experiencing suicidality. An existing intervention initiated in the ED for patients with suicide risk (Emergency Department Safety Assessment and Follow-up Evaluation [ED-SAFE]) has been found to be effective but faces trenchant barriers for widespread adoption. Objective: On the basis of the ED-SAFE intervention, we aimed to develop 2 apps for patients with suicide risk: a web app guiding patients through safety planning in the ED (ED app) and a smartphone app providing patients components of the ED-SAFE program on their phones after discharge (patient app). We then tested the usability of these apps with patients presenting to the ED with suicide risk. Methods: Using a user-centered design framework, we first developed user personas to explore the needs and characteristics of patients who are at risk for suicide using inputs from clinicians (n=3) and suicidologists (n=4). Next, we validated these personas during interviews with individuals with lived experience of suicidality (n=6) and used them to inform our application designs. We field-tested the apps with ED patients presenting with suicide risk (n=14) in 2 iterative cycles to assess their usability and engagement using a mixed methods approach. We also rated the quality and fidelity of the safety plans created. Results: We developed 2 interoperable and complementary apps. The first is a web app designed for use on a tablet device during ED admission that guides the patient by creating a safety plan using a chatbot-style interface. The second is a smartphone app for use after discharge and allows the patient to view, edit, and share their completed safety plan; access self-care education, helplines, and behavioral health referrals; and track follow-up appointments with the study clinician. The initial prototype usability testing (n=9) demonstrated satisfactory scores (ED app System Usability Scale [SUS], mean 78.6/100, SD 24.1; User Engagement Scale, mean 3.74/5, SD 0.72; patient app SUS, mean 81.7/100, SD 20.1). After refining the apps based on participant feedback, the second cycle testing (n=5) showed improvement (ED app SUS, mean 90.5/100, SD 9.9; User Engagement Scale, mean 4.07/5, SD 0.36; patient app SUS, mean 97.0/100, SD 1.9). The quality ratings for completed safety plans were satisfactory (Safety Planning Intervention Scoring Algorithm-Brief, mean 27.4, SD 3.4). Conclusions: By adopting a user-centered approach and creating personas to guide development, we were able to create apps for ED patients with suicide risk and obtain satisfactory usability, engagement, and quality scores. Developing digital health tools based on user-centered design principles that deliver evidence-based intervention components may help overcome trenchant implementation barriers in challenging health care settings. UR - https://formative.jmir.org/2023/1/e41422 UR - http://dx.doi.org/10.2196/41422 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705961 ID - info:doi/10.2196/41422 ER - TY - JOUR AU - Guala, Mercedes Maria AU - Bul, Kim AU - Skårderud, Finn AU - Søgaard Nielsen, Anette PY - 2023/1/27 TI - A Serious Game for Patients With Eating Disorders (Maze Out): Pilot User Experience and Acceptance Study JO - JMIR Form Res SP - e40594 VL - 7 KW - eating disorders KW - serious games KW - mHealth KW - coproduction KW - mobile health KW - mobile phone N2 - Background: Eating disorders (EDs) are severe mental disorders associated with notable impairments in the quality of life. Despite the severity of the disorders and extensive research in the field, effective treatment for EDs is lacking. Digital interventions are gaining an evidence-based position in mental health, providing new perspectives in psychiatric treatment. Maze Out is a serious game coproduced by patients and therapists that focuses on supporting patients with EDs. Objective: The aim of this study was to investigate the experiences of engaging in and acceptability of Maze Out among patients with EDs and therapists. Methods: This study is a qualitative pilot study involving data collected through focus groups and individual interviews and user analytics collected through the game. The participants were recruited from the Odense Mental Health Service of the Region of Southern Denmark. Qualitative interviews analyzed by thematical analysis and interpreted by interpretative phenomenological analysis were used to evaluate the acceptance and experience of Maze Out among patients and therapists. The mobile health evidence reporting and assessment checklist was used to describe the content, context, and technical features of the game in a standardized manner for mobile health apps. Results: The participants found Maze Out to be engaging, easy to use, and a good platform for reflecting on their disorder. They primarily used Maze Out as a conversational tool with their close relationships, giving them insights into the experiences and daily life struggles of someone with EDs. Conclusions: Maze Out seems to be a promising tool supplementing the current ED treatment. Further research should focus on evaluating the effectiveness of the game and its potential to support patients with different types of EDs. UR - https://formative.jmir.org/2023/1/e40594 UR - http://dx.doi.org/10.2196/40594 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705956 ID - info:doi/10.2196/40594 ER - TY - JOUR AU - Hakun, G. Jonathan AU - Roque, A. Nelson AU - Gerver, R. Courtney AU - Cerino, S. Eric PY - 2023/1/27 TI - Ultra-brief Assessment of Working Memory Capacity: Ambulatory Assessment Study Using Smartphones JO - JMIR Form Res SP - e40188 VL - 7 KW - ecological momentary assessment KW - EMA KW - mobile cognitive assessment KW - working memory capacity KW - measurement burst design KW - mobile phone N2 - Background: The development of mobile technology with substantial computing power (ie, smartphones) has enabled the adaptation of performance-based cognitive assessments to remote administration and novel intensive longitudinal study designs (eg, measurement burst designs). Although an ?ambulatory? cognitive assessment paradigm may provide new research opportunities, the adaptation of conventional measures to a mobile format conducive to intensive repeated measurement involves balancing measurement precision, administration time, and procedural consistency. Objective: Across 3 studies, we adapted ?complex span? tests of working memory capacity (WMC) for ultra-brief, smartphone-based administration and examined their reliability, sufficiency, and associations with full-length, laboratory-based computerized administrations. Methods: In a laboratory-based setting, study 1 examined associations between ultra-brief smartphone adaptations of the operation span, symmetry span, and rotation span tasks and full-length computerized versions. In study 2, we conducted a 4-day ecological momentary assessment (EMA) study (4 assessments per day), where we examined the reliability of ultra-brief, ambulatory administrations of each task. In study 3, we conducted a 7-day EMA study (5 assessments per day) involving the ultra-brief rotation span task, where we examined reliability in the absence of extensive onboarding and training. Results: Measurement models in study 1 suggest that comparable estimates of latent WMC can be recovered from ultra-brief complex span task performance on smartphones. Significant correlations between the ultra-brief tasks and respective full-length versions were observed in study 1 and 2, ranging from r=0.4 to r=0.57. Results of study 2 and study 3 suggest that reliable between-person estimates of operation span, symmetry span, rotation span, and latent WMC can be obtained in 2-3 ultra-brief administrations (equivalent to <1 day of testing in an EMA study design). The results of study 3 replicated our findings, showing that reliable between-person estimates of rotation span may be obtained in as few as 2 ultra-brief administrations in the absence of extensive onboarding and training. In addition, the modification of task parameterization for study 3 improved the estimates of reliability of within-person change. Conclusions: Ultra-brief administration of complex span tasks on smartphones in a measurement burst design can generate highly reliable cross-sectional estimates of WMC. Considerations for future mobile cognitive assessment designs and parameterizations are discussed. UR - https://formative.jmir.org/2023/1/e40188 UR - http://dx.doi.org/10.2196/40188 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705953 ID - info:doi/10.2196/40188 ER - TY - JOUR AU - Oh, Jung Yoo AU - Hoffmann, J. Thomas AU - Fukuoka, Yoshimi PY - 2023/1/27 TI - A Novel Approach to Assess Weekly Self-efficacy for Meeting Personalized Physical Activity Goals Via a Cellphone: 12-Week Longitudinal Study JO - JMIR Form Res SP - e38877 VL - 7 KW - self-efficacy KW - physical activity KW - exercise KW - cellphone KW - mobile phone KW - application KW - app KW - Ecological Momentary Assessment N2 - Background: Despite the health benefits of engaging in regular physical activity (PA), the majority of American adults do not meet the PA guidelines for aerobic and muscle-strengthening activities. Self-efficacy, the belief that one can execute specific actions, has been suggested to be a strong determinant of PA behaviors. With the increasing availability of digital technologies, collecting longitudinal real-time self-efficacy and PA data has become feasible. However, evidence in longitudinal real-time assessment of self-efficacy in relation to objectively measured PA is scarce. Objective: This study aimed to examine a novel approach to measure individuals' real-time weekly self-efficacy in response to their personalized PA goals and performance over the 12-week intervention period in community-dwelling women who were not meeting PA guidelines. Methods: In this secondary data analysis, 140 women who received a 12-week PA intervention were asked to report their real-time weekly self-efficacy via a study mobile app. PA (daily step counts) was measured by an accelerometer every day for 12 weeks. Participants rated their self-efficacy on meeting PA goals (ranging from ?not confident? to ?very confident?) at the end of each week via a mobile app. We used a logistic mixed model to examine the association between weekly self-efficacy and weekly step goal success, controlling for age, BMI, self-reported White race, having a college education or higher, being married, and being employed. Results: The mean age was 52.7 (SD 11.5, range 25-68) years. Descriptive analyses showed the dynamics of real-time weekly self-efficacy on meeting PA goals and weekly step goal success. The majority (74.4%) of participants reported being confident in the first week, whereas less than half of them (46.4%) reported confidence in the final week of the intervention. Participants who met weekly step goals were 4.41 times more likely to be confident about achieving the following week's step goals than those who did not meet weekly step goals (adjusted odds ratio 4.41; 95% CI 2.59-7.50; P<.001). Additional analysis revealed that participants who were confident about meeting the following week?s step goals were 2.07 times more likely to meet their weekly step goals in the following week (adjusted odds ratio 2.07; 95% CI 1.16-3.70; P=.01). The significant bidirectional association between real-time self-efficacy and weekly step goal success was confirmed in a series of sensitivity analyses. Conclusions: This study demonstrates the potential utility of a novel approach to examine self-efficacy in real time for analysis of self-efficacy in conjunction with objectively measured PA. Discovering the dynamic patterns and changes in weekly self-efficacy on meeting PA goals may aid in designing a personalized PA intervention. Evaluation of this novel approach in an RCT is warranted. UR - https://formative.jmir.org/2023/1/e38877 UR - http://dx.doi.org/10.2196/38877 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705945 ID - info:doi/10.2196/38877 ER - TY - JOUR AU - Pennou, Antoine AU - Lecomte, Tania AU - Potvin, Stéphane AU - Riopel, Gabrielle AU - Vézina, Camille AU - Villeneuve, Marie AU - Abdel-Baki, Amal AU - Khazaal, Yasser PY - 2023/1/27 TI - A Mobile Health App (ChillTime) Promoting Emotion Regulation in Dual Disorders: Acceptability and Feasibility Pilot Study JO - JMIR Form Res SP - e37293 VL - 7 KW - dual disorder KW - concomitant disorder KW - mental disorder KW - mental illness KW - satisfaction KW - mobile app KW - mHealth KW - mobile health KW - emotion regulation KW - distress management KW - substance use disorder KW - substance use KW - emotion KW - distress KW - mental health KW - acceptability KW - feasibility KW - psychosis KW - psychotic KW - schizophrenia KW - emotional health KW - pilot study N2 - Background: A growing number of studies highlight the importance of emotion regulation in the treatment and recovery of individuals with psychosis and concomitant disorders such as substance use disorder (SUD), for whom access to integrated dual-disorder treatments is particularly difficult. In this context, dedicated smartphone apps may be useful tools to provide immediate support to individuals in need. However, few studies to date have focused on the development and assessment of apps aimed at promoting emotional regulation for people with psychosis. Objective: The aim of this study was to evaluate the feasibility, acceptability, and potential clinical impact of a dedicated app (ChillTime) for individuals with psychotic disorders and concurrent SUD. The app design process followed recommendations for reducing cognitive effort on a mobile app. A total of 20 coping strategies regrouped in four categories (behavioral, emotional, cognitive, spiritual) were included in the app. Methods: This open pilot study followed a pre-post design. After the initial assessment, researchers asked participants to use the app as part of their treatment over a 30-day period. Feasibility was determined by the frequency of use of the app and measured using the number of completed strategies. Acceptability was determined by measuring ease of use, ease of learning, satisfaction, and perceived utility at the end of the 30-day study period based on responses to satisfaction questionnaires. Clinical scales measuring emotion regulation, substance use (ie, type of substance, amount taken, and frequency of use), and various psychiatric symptoms were administered at the beginning and end of the 30-day period. Results: A total of 13 participants were recruited from two first-episode psychosis clinics in Montreal, Quebec, Canada. All participants were symptomatically stable, were between 18 and 35 years of age (mostly men; 70% of the sample), and had a schizophrenia spectrum disorder with a comorbid substance use diagnosis. A total of 11 participants completed the study (attrition<20%). Approximately half of the participants used the tool at least 33% of the days (11-21 days). Cognitive and emotion-focused techniques were rated the highest in terms of usefulness and were the most frequently used. The majority of participants gave positive answers about the ease of use and the ease of learning the tool. A nonsignificant association of ChillTime use with negative symptoms and drug use was observed. No other statistically significant changes were observed. Conclusions: The ChillTime app showed good feasibility (approximately half of the participants used the tool at least 33% of the days) and acceptability among people with schizophrenia spectrum disorder and SUD. Trends suggesting a potential impact on certain clinical outcomes will need to be replicated in larger-sample studies before any conclusion can be drawn. UR - https://formative.jmir.org/2023/1/e37293 UR - http://dx.doi.org/10.2196/37293 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705963 ID - info:doi/10.2196/37293 ER - TY - JOUR AU - Sanchez, Sherald AU - Deck, Alicia AU - Baskerville, Bruce Neill AU - Chaiton, Michael PY - 2023/1/27 TI - Supporting Youth Vaping Cessation With the Crush the Crave Smartphone App: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e42956 VL - 12 KW - e-cigarettes KW - vaping cessation KW - youth and young adult health KW - adult KW - youth KW - effectiveness KW - smartphone KW - application KW - vaping KW - cessation KW - assessment KW - intervention N2 - Background: The use of e-cigarettes, or vaping, has increased exponentially in the past decade, particularly among youth. Emerging evidence indicates growing nicotine dependence among youth, revealing historically higher rates of dependence among current e-cigarette users compared to rates seen in earlier research. Despite the urgent need for youth vaping cessation interventions, there is limited knowledge about the process of vaping cessation, and few evidence-based interventions are available to young people seeking support. A notable literature review on vaping cessation resources for young people recommended technology-based interventions, such as smartphone apps and SMS text messaging services, as a promising area of vaping cessation research and intervention development. Objective: The primary aim of our study is to determine the effectiveness of the Crush the Crave app in supporting vaping cessation among youth recruited to the intervention arm via comparison with an assessment-only control group. The primary hypothesis is that participants in the intervention group?those using Crush the Crave?will be more likely to be abstinent at the 6-month follow-up point than participants in the assessment-only control arm. Methods: A 2-arm, single-blind, parallel randomized controlled trial will be conducted over 12 months. Study invitations will be sent to 600 youth (age: 16-18 years) and young adult (age: 19-29 years) e-cigarette users and randomized between an intervention arm, which will be using Crush the Crave (n=300), and an assessment-only control arm (n=300) in a 1:1 ratio. The primary hypothesis is that participants in the intervention group?those using Crush the Crave?will be more likely to be abstinent at the 6-month follow-up point. Results: Study recruitment began on March 4, 2022. Recruitment is anticipated to be completed in December 2022. Conclusions: This protocol describes one of the first-ever randomized controlled trial studies to evaluate the effectiveness of an app-based intervention for supporting vaping cessation among youth aged 16 to 18 years and young adults aged 19 to 29 years. The findings from our trial will help increase our understanding of the process of vaping cessation among youth and provide evidence on the effectiveness of an app-based intervention in helping young people quit vaping. The trial results will also have implications in the development of current and future approaches to youth vaping cessation. Trial Registration: OSF Registries osf.io/hmd87; https://doi.org/10.17605/OSF.IO/HMD87 International Registered Report Identifier (IRRID): DERR1-10.2196/42956 UR - https://www.researchprotocols.org/2023/1/e42956 UR - http://dx.doi.org/10.2196/42956 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705967 ID - info:doi/10.2196/42956 ER - TY - JOUR AU - Sinha, Chaitali AU - Meheli, Saha AU - Kadaba, Madhura PY - 2023/1/26 TI - Understanding Digital Mental Health Needs and Usage With an Artificial Intelligence?Led Mental Health App (Wysa) During the COVID-19 Pandemic: Retrospective Analysis JO - JMIR Form Res SP - e41913 VL - 7 KW - digital mental health KW - COVID-19 KW - engagement KW - retention KW - perceived needs KW - pandemic waves KW - chatbot KW - conversational agent KW - mental health app KW - mobile health KW - digital health intervention N2 - Background: There has been a surge in mental health concerns during the COVID-19 pandemic, which has prompted the increased use of digital platforms. However, there is little known about the mental health needs and behaviors of the global population during the pandemic. This study aims to fill this knowledge gap through the analysis of real-world data collected from users of a digital mental health app (Wysa) regarding their engagement patterns and behaviors, as shown by their usage of the service. Objective: This study aims to (1) examine the relationship between mental health distress, digital health uptake, and COVID-19 case numbers; (2) evaluate engagement patterns with the app during the study period; and (3) examine the efficacy of the app in improving mental health outcomes for its users during the pandemic. Methods: This study used a retrospective observational design. During the COVID-19 pandemic, the app?s installations and emotional utterances were measured from March 2020 to October 2021 for the United Kingdom, the United States of America, and India and were mapped against COVID-19 case numbers and their peaks. The engagement of the users from this period (N=4541) with the Wysa app was compared to that of equivalent samples of users from a pre?COVID-19 period (1000 iterations). The efficacy was assessed for users who completed pre-post assessments for symptoms of depression (n=2061) and anxiety (n=1995) on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) test measures, respectively. Results: Our findings demonstrate a significant positive correlation between the increase in the number of installs of the Wysa mental health app and the peaks of COVID-19 case numbers in the United Kingdom (P=.02) and India (P<.001). Findings indicate that users (N=4541) during the COVID period had a significantly higher engagement than the samples from the pre-COVID period, with a medium to large effect size for 80% of these 1000 iterative samples, as observed on the Mann-Whitney test. The PHQ-9 and GAD-7 pre-post assessments indicated statistically significant improvement with a medium effect size (PHQ-9: P=.57; GAD-7: P=.56). Conclusions: This study demonstrates that emotional distress increased substantially during the pandemic, prompting the increased uptake of an artificial intelligence?led mental health app (Wysa), and also offers evidence that the Wysa app could support its users and its usage could result in a significant reduction in symptoms of anxiety and depression. This study also highlights the importance of contextualizing interventions and suggests that digital health interventions can provide large populations with scalable and evidence-based support for mental health care. UR - https://formative.jmir.org/2023/1/e41913 UR - http://dx.doi.org/10.2196/41913 UR - http://www.ncbi.nlm.nih.gov/pubmed/36540052 ID - info:doi/10.2196/41913 ER - TY - JOUR AU - Venkatesan, Aarathi AU - Zimmermann, Gretchen AU - Rawlings, Kelly AU - Ryan, Claudia AU - Voelker, Louise AU - Edwards, Caitlyn PY - 2023/1/13 TI - Improvements in Glycemic Control and Depressive Symptoms Among Adults With Type 2 Diabetes: Retrospective Study JO - JMIR Form Res SP - e0 VL - 0 KW - type 2 diabetes KW - digital health KW - diabetes intervention KW - diabetes KW - diabetic KW - health app KW - coaching KW - patient education KW - mobile health KW - mHealth KW - app-based KW - health coaching KW - hemoglobin A1c KW - HbA1c KW - depression KW - depressive KW - anxiety KW - mental health KW - glycemic control KW - diabetes management KW - health management KW - digital health intervention N2 - Background: The prevalence of diabetes remains high, with traditional lifestyle interventions demonstrating limited success in improving diabetes-related outcomes, particularly among individuals with diabetes-related mental health comorbidities. Digital health interventions provide the ability to ease the sustained and rigorous self-management needs associated with diabetes care and treatment. Current interventions though, are plagued by small sample sizes, underpowered pilot studies, and immense heterogeneity in program intervention, duration, and measured outcomes. Objective: Therefore, this work aimed to evaluate the effectiveness of a mobile health diabetes management program on measures of glycemic control in a high-risk population with type 2 diabetes (hemoglobin A1c [HbA1c] ?8.0%), utilizing a sample of 1128 participants who provided baseline and follow-up data. The sustainability of this change in glycemic control was examined in a subset of participants (n=455) at 6 months and 1 year following program enrollment. A secondary analysis examined changes in glycemic control among a subset of participants with self-reported mild-to-moderate depression at baseline. Methods: This study utilized a single-arm, retrospective design. Participants were enrolled in the Vida Health Diabetes Management Program. This app-based intervention utilized one-on-one remote sessions with a health coach, registered dietitian nutritionist, and/or a certified diabetes care and education specialist and structured lessons and tools related to diabetes management and self-care. Participants provided baseline (?365 to 21 days of program enrollment) as well as follow-up (at least 90 days following program enrollment) HbA1c values. Paired t tests were used to evaluate changes in HbA1c between baseline and follow-up time points. The 8-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale were utilized to assess self-reported depressive and anxiety symptoms, respectively. Paired t tests and linear regression modeling accounting for pertinent covariates were used to evaluate changes in mental health symptom acuity and their relationship with changes in glycemic control. Results: We observed a significant decrease in HbA1c of ?1.35 points between baseline (mean 9.84, SD 1.64) and follow-up (mean 8.48, SD 1.77; t=22.56, P<.001) among this large, high-risk sample. This decrease was sustained up to 1 year following program enrollment. Additionally, a significant relationship between improvements in depressive symptom acuity and improvements in HbA1c was observed (?=?0.74, P=.03). Conclusions: This study demonstrates clinically meaningful improvements in glycemic control among participants enrolled in the Vida Health Diabetes Management Program. Additionally, this work presents one of the largest studied samples of participants enrolled in a digital health diabetes management program to date. UR - https://formative.jmir.org/2023/0/e0/ UR - http://dx.doi.org/10.2196/41880 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/41880 ER - TY - JOUR AU - Zahrt, Hedwig Octavia AU - Evans, Kristopher AU - Murnane, Elizabeth AU - Santoro, Erik AU - Baiocchi, Michael AU - Landay, James AU - Delp, Scott AU - Crum, Alia PY - 2023/1/25 TI - Effects of Wearable Fitness Trackers and Activity Adequacy Mindsets on Affect, Behavior, and Health: Longitudinal Randomized Controlled Trial JO - J Med Internet Res SP - e40529 VL - 25 KW - physical activity KW - health technology KW - psychology KW - mindset KW - mobile health KW - mHealth KW - activity trackers KW - fitness trackers KW - activity monitors KW - wearables KW - health behavior KW - digital health KW - health promotion KW - intervention KW - mobile phone N2 - Background: There is some initial evidence suggesting that mindsets about the adequacy and health consequences of one?s physical activity (activity adequacy mindsets [AAMs]) can shape physical activity behavior, health, and well-being. However, it is unknown how to leverage these mindsets using wearable technology and other interventions. Objective: This research examined how wearable fitness trackers and meta-mindset interventions influence AAMs, affect, behavior, and health. Methods: A total of 162 community-dwelling adults were recruited via flyers and web-based platforms (ie, Craigslist and Nextdoor; final sample size after attrition or exclusion of 45 participants). Participants received an Apple Watch (Apple Inc) to wear for 5 weeks, which was equipped with an app that recorded step count and could display a (potentially manipulated) step count on the watch face. After a baseline week of receiving no feedback about step count, participants were randomly assigned to 1 of 4 experimental groups: they received either accurate step count (reference group; 41/162, 25.3%), 40% deflated step count (40/162, 24.7%), 40% inflated step count (40/162, 24.7%), or accurate step count+a web-based meta-mindset intervention teaching participants the value of adopting more positive AAMs (41/162, 25.3%). Participants were blinded to the condition. Outcome measures were taken in the laboratory by an experimenter at the beginning and end of participation and via web-based surveys in between. Longitudinal analysis examined changes within the accurate step count condition from baseline to treatment and compared them with changes in the deflated step count, inflated step count, and meta-mindset conditions. Results: Participants receiving accurate step counts perceived their activity as more adequate and healthier, adopted a healthier diet, and experienced improved mental health (Patient-Reported Outcomes Measurement Information System [PROMIS]-29) and aerobic capacity but also reduced functional health (PROMIS-29; compared with their no-step-count baseline). Participants exposed to deflated step counts perceived their activity as more inadequate; ate more unhealthily; and experienced more negative affect, reduced self-esteem and mental health, and increased blood pressure and heart rate (compared with participants receiving accurate step counts). Inflated step counts did not change AAM or most other outcomes (compared with accurate step counts). Participants receiving the meta-mindset intervention experienced improved AAM, affect, functional health, and self-reported physical activity (compared with participants receiving accurate step counts only). Actual step count did not change in either condition. Conclusions: AAMs??induced by trackers or adopted deliberately??can influence affect, behavior, and health independently of actual physical activity. Trial Registration: ClinicalTrials.gov NCT03939572; https://www.clinicaltrials.gov/ct2/show/NCT03939572 UR - https://www.jmir.org/2023/1/e40529 UR - http://dx.doi.org/10.2196/40529 UR - http://www.ncbi.nlm.nih.gov/pubmed/36696172 ID - info:doi/10.2196/40529 ER - TY - JOUR AU - Kim, Young Ah AU - Jang, Hye Eun AU - Lee, Seung-Hwan AU - Choi, Kwang-Yeon AU - Park, Gue Jeon AU - Shin, Hyun-Chool PY - 2023/1/25 TI - Automatic Depression Detection Using Smartphone-Based Text-Dependent Speech Signals: Deep Convolutional Neural Network Approach JO - J Med Internet Res SP - e34474 VL - 25 KW - depression KW - major depressive disorder KW - MDD KW - automatic depression detection KW - ADD KW - mobile health KW - deep learning KW - speech analysis KW - acoustic KW - mobile phone KW - smartphone N2 - Background: Automatic diagnosis of depression based on speech can complement mental health treatment methods in the future. Previous studies have reported that acoustic properties can be used to identify depression. However, few studies have attempted a large-scale differential diagnosis of patients with depressive disorders using acoustic characteristics of non-English speakers. Objective: This study proposes a framework for automatic depression detection using large-scale acoustic characteristics based on the Korean language. Methods: We recruited 153 patients who met the criteria for major depressive disorder and 165 healthy controls without current or past mental illness. Participants' voices were recorded on a smartphone while performing the task of reading predefined text-based sentences. Three approaches were evaluated and compared to detect depression using data sets with text-dependent read speech tasks: conventional machine learning models based on acoustic features, a proposed model that trains and classifies log-Mel spectrograms by applying a deep convolutional neural network (CNN) with a relatively small number of parameters, and models that train and classify log-Mel spectrograms by applying well-known pretrained networks. Results: The acoustic characteristics of the predefined text-based sentence reading automatically detected depression using the proposed CNN model. The highest accuracy achieved with the proposed CNN on the speech data was 78.14%. Our results show that the deep-learned acoustic characteristics lead to better performance than those obtained using the conventional approach and pretrained models. Conclusions: Checking the mood of patients with major depressive disorder and detecting the consistency of objective descriptions are very important research topics. This study suggests that the analysis of speech data recorded while reading text-dependent sentences could help predict depression status automatically by capturing the characteristics of depression. Our method is smartphone based, is easily accessible, and can contribute to the automatic identification of depressive states. UR - https://www.jmir.org/2023/1/e34474 UR - http://dx.doi.org/10.2196/34474 UR - http://www.ncbi.nlm.nih.gov/pubmed/36696160 ID - info:doi/10.2196/34474 ER - TY - JOUR AU - Collombon, M. Eline H. G. AU - Peels, A. Denise AU - Bolman, W. Catherine A. AU - de Bruijn, Gert-Jan AU - Lechner, Lilian PY - 2023/1/25 TI - Adding Mobile Elements to Online Physical Activity Interventions for Adults Aged Over 50 Years: Prototype Development Study JO - JMIR Form Res SP - e42394 VL - 7 KW - prototype KW - pilot test KW - eHealth KW - mHealth KW - physical activity KW - older adults KW - development KW - usability N2 - Background: Only a minority of adults aged over 50 years meet physical activity (PA) guidelines of the World Health Organization (WHO). eHealth interventions are proven effective tools to help this population increase its PA levels in the short term, among which the Active Plus and I Move interventions have been developed by our own research group. To achieve long-term effects, increase intervention use, and decrease dropout rates, 3 emergent but different mobile elements (an activity tracker, an ecological momentary intervention [EMI] program, and a chatbot) were added separately to Active Plus and I Move. In this study, the prototype development and pilot-testing of these interventions is described. Objective: This study aims to enhance 2 existing PA-stimulating computer-based interventions with 3 mobile elements (an activity tracker, an EMI program, or a chatbot) and test the prototypes on usability and appreciation within a target population of adults aged over 50 years. Methods: A systematic design protocol consisting of development, evaluation, and adaptation procedures was followed with involvement of the target population. Literature searches separated per mobile element and interviews with the target population (N=11) led to 6 prototypes: Active Plus or I Move including (1) an activity tracker, (2) EMI, or (3) a chatbot. These prototypes were tested on usability and appreciation during pilot tests (N=47) and subsequently fine-tuned based on the results. Results: The literature searches and interviews provided important recommendations on the preferences of the target population, which enabled us to develop prototypes. The subsequent pilot tests showed that the mobile elements scored moderate to good on usability, with average System Usability Scale (SUS) scores of 52.2-82.2, and moderate to good on enjoyment and satisfaction, with average scores ranging from 5.1 to 8.1 on a scale of 1-10. The activity tracker received the best scores, followed by EMI, followed by the chatbot. Based on the findings, the activity tracker interventions were fine-tuned and technical difficulties regarding EMI and the chatbot were solved, which is expected to further improve usability and appreciation. Conclusions: During this study, 6 prototypes of online PA interventions with added mobile elements were developed and tested for usability and appreciation. Although all prototypes scored moderate to high on usability, enjoyment, and satisfaction, it can be concluded that the integration of an activity tracker with a computer-based PA intervention is the most promising option among the 3 mobile elements tested during this study. The prototype development steps of the systematic design protocol followed can be considered useful and successful for the purposes of this study. The interventions can now be evaluated on a larger scale through a randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.2196/31677 UR - https://formative.jmir.org/2023/1/e42394 UR - http://dx.doi.org/10.2196/42394 UR - http://www.ncbi.nlm.nih.gov/pubmed/36696157 ID - info:doi/10.2196/42394 ER - TY - JOUR AU - Nandy, Rajesh AU - Nandy, Karabi AU - Walters, T. Scott PY - 2023/1/25 TI - Relationship Between Valence and Arousal for Subjective Experience in a Real-life Setting for Supportive Housing Residents: Results From an Ecological Momentary Assessment Study JO - JMIR Form Res SP - e34989 VL - 7 KW - permanent supportive housing KW - circumplex model of affect KW - ecological momentary assessment KW - emotion KW - valence KW - arousal KW - mobile phone N2 - Background: The circumplex model of affect posits that valence and arousal are the principal dimensions of affect. The center of the 2D space represents a neutral state of valence and a medium state of arousal. The role of valence and arousal in human emotion has been studied extensively. However, no consistent relationship between valence and arousal has been established. Most of the prior studies investigating the relationship have been conducted in relatively controlled laboratory settings. Objective: Ecological momentary assessment (EMA) of affect from participants residing in permanent supportive housing was used to study the relationship between valence and arousal in real-life settings. The goal of this study was to explore the relationship between valence and arousal in a person?s natural environment. Methods: Participants were recruited from housing agencies in Fort Worth, Texas, United States. All participants had a history of chronic homelessness and reported at least one mental health condition. A subset of participants completed daily (morning) EMAs of emotions and other behaviors. The sample comprised 78 women and 77 men, and the average age was 52 (SD 8) years. From the circumplex model of affect, the EMA included 9 questions related to the participant?s current emotional state (happy, frustrated, sad, worried, restless, excited, calm, bored, and sluggish). The responses were used to calculate 2 composite scores for valence and arousal. Results: Statistical models uniformly showed a dominant linear relation between valence and arousal and a significant difference in the slopes among races. None of the other effects were statistically significant. Compared with previous studies, the effects were quite robust. Conclusions: Our findings may provide a window to the fundamental structure of affect. We found a strong positive linear relationship between valence and arousal at the nomothetic level, which may provide insight into a universal structure of affect. However, the study needs to be replicated for different populations to determine whether our findings can be generalized beyond the population studied here. UR - https://formative.jmir.org/2023/1/e34989 UR - http://dx.doi.org/10.2196/34989 UR - http://www.ncbi.nlm.nih.gov/pubmed/36696164 ID - info:doi/10.2196/34989 ER - TY - JOUR AU - Sparidaens, Marie Ellen AU - Logger, M. Jade G. AU - Nelen, M. Willianne L. D. AU - Braat, M. Didi D. AU - Fleischer, Kathrin AU - Hermens, M. Rosella P. PY - 2023/1/24 TI - Web-based Guidance for Assisted Reproductive Technology With an Online App (myFertiCare): Quantitative Evaluation With the HOT-fit Framework JO - J Med Internet Res SP - e38535 VL - 25 KW - eHealth KW - personalized KW - interactive KW - evaluation KW - HOT-fit framework KW - assisted reproductive technologies KW - reproductive KW - technology KW - online KW - app KW - application KW - tool KW - internet KW - usability KW - infertility KW - variables KW - treatment KW - women KW - care KW - stress N2 - Background: Assisted reproductive technologies (ARTs) are considered to be physically and mentally stressful. During their treatment trajectory, couples express high information and communication needs. They appreciate using the internet to obtain fertility-related information. In a previous study, we developed myFertiCare, an eHealth tool providing personalized information and interactive functionalities for infertile couples in order to improve patient-centered care. The app has already been successful in qualitative evaluations of usability. Objective: The aim of the current study is to quantitatively evaluate the implementation of myFertiCare by using the human, organizational, and technology?fit (HOT-fit) framework and to study the effects of using myFertiCare on couples? knowledge about infertility, their experience of the burden of infertility, and their experience of patient-centered care. With these results, implementation can be further improved, and patient-centered care can be enhanced. Methods: A quantitative study was performed based on the HOT-fit framework using validated questionnaires focusing on the human, organizational, and technology domains. Questions were added on the effect of using myFertiCare on couples? knowledge about infertility and treatment. Questions regarding the burden of infertility, the burden of infertility treatment, and the experience of patient-centeredness were based on the main items of the validated fertility quality of life (FertiQoL) and Patient-Centredness Questionnaire?Infertility questionnaires, respectively. Also, nonusers of the app were included to explore motivations for not using the app and identify opportunities for improvement. Finally, user data were analyzed to provide insight into multiple variables concerning app use. Results: In the human and technology domains, myFertiCare showed good system usability, high user satisfaction, and high information and interface quality. In the organizational domain, implementation was considered to be sufficient by both patients and staff. Use of the app increased knowledge about the treatment, improved coping with the treatment, and enhanced the experience of patient-centeredness. User data showed that women were the main app users and that use of the app gradually declined during the treatment trajectory. Conclusions: A multi-faceted online app, myFertiCare, has been successfully evaluated quantitatively for implementation by using the HOT-fit framework. Use of the app increased knowledge about the treatment, improved coping with the treatment, and enhanced the experience of patient-centeredness. App use could be improved by creating more publicity. By providing myFertiCare, professionals in fertility care are supported in guiding patients through their treatment trajectory and in delivering patient-centered care. UR - https://www.jmir.org/2023/1/e38535 UR - http://dx.doi.org/10.2196/38535 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692928 ID - info:doi/10.2196/38535 ER - TY - JOUR AU - de Angel, Valeria AU - Adeleye, Fadekemi AU - Zhang, Yuezhou AU - Cummins, Nicholas AU - Munir, Sara AU - Lewis, Serena AU - Laporta Puyal, Estela AU - Matcham, Faith AU - Sun, Shaoxiong AU - Folarin, A. Amos AU - Ranjan, Yatharth AU - Conde, Pauline AU - Rashid, Zulqarnain AU - Dobson, Richard AU - Hotopf, Matthew PY - 2023/1/24 TI - The Feasibility of Implementing Remote Measurement Technologies in Psychological Treatment for Depression: Mixed Methods Study on Engagement JO - JMIR Ment Health SP - e42866 VL - 10 KW - depression KW - anxiety KW - digital health KW - wearable devices KW - smartphone KW - passive sensing KW - mobile health KW - mHealth KW - digital phenotyping KW - mobile phone N2 - Background: Remote measurement technologies (RMTs) such as smartphones and wearables can help improve treatment for depression by providing objective, continuous, and ecologically valid insights into mood and behavior. Engagement with RMTs is varied and highly context dependent; however, few studies have investigated their feasibility in the context of treatment. Objective: A mixed methods design was used to evaluate engagement with active and passive data collection via RMT in people with depression undergoing psychotherapy. We evaluated the effects of treatment on 2 different types of engagement: study attrition (engagement with study protocol) and patterns of missing data (engagement with digital devices), which we termed data availability. Qualitative interviews were conducted to help interpret the differences in engagement. Methods: A total of 66 people undergoing psychological therapy for depression were followed up for 7 months. Active data were gathered from weekly questionnaires and speech and cognitive tasks, and passive data were gathered from smartphone sensors and a Fitbit (Fitbit Inc) wearable device. Results: The overall retention rate was 60%. Higher-intensity treatment (?21=4.6; P=.03) and higher baseline anxiety (t56.28=?2.80, 2-tailed; P=.007) were associated with attrition, but depression severity was not (t50.4=?0.18; P=.86). A trend toward significance was found for the association between longer treatments and increased attrition (U=339.5; P=.05). Data availability was higher for active data than for passive data initially but declined at a sharper rate (90%-30% drop in 7 months). As for passive data, wearable data availability fell from a maximum of 80% to 45% at 7 months but showed higher overall data availability than smartphone-based data, which remained stable at the range of 20%-40% throughout. Missing data were more prevalent among GPS location data, followed by among Bluetooth data, then among accelerometry data. As for active data, speech and cognitive tasks had lower completion rates than clinical questionnaires. The participants in treatment provided less Fitbit data but more active data than those on the waiting list. Conclusions: Different data streams showed varied patterns of missing data, despite being gathered from the same device. Longer and more complex treatments and clinical characteristics such as higher baseline anxiety may reduce long-term engagement with RMTs, and different devices may show opposite patterns of missingness during treatment. This has implications for the scalability and uptake of RMTs in health care settings, the generalizability and accuracy of the data collected by these methods, feature construction, and the appropriateness of RMT use in the long term. UR - https://mental.jmir.org/2023/1/e42866 UR - http://dx.doi.org/10.2196/42866 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692937 ID - info:doi/10.2196/42866 ER - TY - JOUR AU - Bults, Marloes AU - van Leersum, Margaretha Catharina AU - Olthuis, Josef Theodorus Johannes AU - Bekhuis, Marije Robin Enya AU - den Ouden, Maria Marjolein Elisabeth PY - 2023/1/24 TI - Mobile Health Apps for the Control and Self-management of Type 2 Diabetes Mellitus: Qualitative Study on Users? Acceptability and Acceptance JO - JMIR Diabetes SP - e41076 VL - 8 KW - type 2 diabetes KW - self-management KW - mobile health KW - mHealth KW - mobile apps KW - mobile phone KW - acceptability KW - acceptance KW - diabetes N2 - Background: Mobile health apps are promising tools to help patients with type 2 diabetes mellitus (T2DM) improve their health status and thereby achieve diabetes control and self-management. Although there is a wide array of mobile health apps for T2DM available at present, apps are not yet integrated into routine diabetes care. Acceptability and acceptance among patients with T2DM is a major challenge and prerequisite for the successful implementation of apps in diabetes care. Objective: This study provides an in-depth understanding of the perceptions of patients with T2DM before use (acceptability) and after use (acceptance) regarding 4 different mobile health apps for diabetes control and self-management. Methods: A descriptive qualitative research design was used in this study. Participants could choose 1 of the 4 selected apps for diabetes control and self-management (ie, Clear.bio in combination with FreeStyle Libre, mySugr, MiGuide, and Selfcare). The selection was based on a systematic analysis of the criteria for (functional) requirements regarding monitoring, data collection, provision of information, coaching, privacy, and security. To explore acceptability, 25 semistructured in-depth interviews were conducted with patients with T2DM before use. This was followed by 4 focus groups to discuss the acceptance after use. The study had a citizen science approach, that is, patients with T2DM collaborated with researchers as coresearchers. All coresearchers actively participated in the preparation of the study, data collection, and data analysis. Data were collected between April and September 2021. Thematic analysis was conducted using a deductive approach using AtlasTi9. Results: In total, 25 coresearchers with T2DM participated in this study. Of them, 12 coresearchers tested Clear, 5 MiGuide, 4 mySugr, and 4 Selfcare. All coresearchers participated in semistructured interviews, and 18 of them attended focus groups. Personal health was the main driver of app use. Most coresearchers were convinced that a healthy lifestyle would improve blood glucose levels. Although most coresearchers did not expect that they need to put much effort into using the apps, the additional effort to familiarize themselves with the app use was experienced as quite high. None of the coresearchers had a health care professional who provided suggestions on using the apps. Reimbursement from insurance companies and the acceptance of apps for diabetes control and self-management by the health care system were mentioned as important facilitating conditions. Conclusions: The research showed that mobile health apps provide support for diabetes control and self-management in patients with T2DM. Integrating app use in care as usual and guidelines for health care professionals are recommended. Future research is needed on how to increase the implementation of mobile health apps in current care pathways. In addition, health care professionals need to improve their digital skills, and lifelong learning is recommended. UR - https://diabetes.jmir.org/2023/1/e41076 UR - http://dx.doi.org/10.2196/41076 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692927 ID - info:doi/10.2196/41076 ER - TY - JOUR AU - Valinskas, Sarunas AU - Nakrys, Marius AU - Aleknavi?ius, Kasparas AU - Jonusas, Justinas AU - Lileikien?, Angel? PY - 2023/1/24 TI - User Engagement and Weight Loss Facilitated by a Mobile App: Retrospective Review of Medical Records JO - JMIR Form Res SP - e42266 VL - 7 KW - intermittent fasting KW - fasting KW - weight KW - weight loss KW - mobile application KW - body composition KW - mHealth KW - mobile health KW - diet KW - dietary intervention KW - weight loss outcome KW - adherence KW - engagement KW - mobile app KW - motivation KW - intervention outcome KW - fasting apps KW - dietary interventions KW - obesity KW - regression analysis N2 - Background: Intermittent fasting (IF) has gained popularity in recent years for its effect on weight loss and supposed additional health benefits, such as a positive effect on body composition and metabolic markers. Mobile apps can act as platforms that help deliver dietary interventions by improving adherence and motivation. Although the effect of IF on weight loss has been demonstrated in earlier trials, there is not much research about the engagement and weight loss results with IF apps. Objective: Our main objective was to compare how a nudging platform (including smart scales) influences engagement (the extent to which users interact with the app measured by the number of active days) with the app among users who had obesity at the beginning of use. The secondary objectives were to evaluate the body weight changes among active and nonactive users and, finally, to evaluate the body composition changes of users possessing smart scales during app usage. Through this study, we hope to provide (1) more insight into how nudging (using smart scales as a nudging platform) is associated with engagement with the mobile app, (2) how engagement with the mobile app is associated with weight loss, and (3) how IF is associated with body composition. Methods: We performed a retrospective analysis of data from 665 users with obesity (BMI?30) who started using the IF app DoFasting. Of them, 244 used body composition scales that estimated body fat and body muscle values. Users were stratified into engagement groups in accordance with their activity ratio (number of active days divided by the total time of use). Baseline and final users' weight (in kg), body fat (in %), and body muscle (in %) were compared. Results: Our findings suggest an association between the nudging platform (smart scales) and better engagement with the app. Smart scale users had a significantly higher activity ratio than regular users. Additionally, active DoFasting users lost significantly more weight. Further, body composition analysis showed that app usage might be related to body fat loss and an increase in muscle mass. Conclusions: We found a possible association between the nudging and gamified elements and higher app engagement. Additionally, increased app engagement is associated with increased weight loss. Thus, nudging and gamified elements of mobile health apps, such as interactive tools, goals, challenges, and progress tracking, are suggested to affect engagement positively and should be investigated further in future research. Finally, the IF regime delivered through the DoFasting app might be related to the body muscle mass gain and reduced fat mass. UR - https://formative.jmir.org/2023/1/e42266 UR - http://dx.doi.org/10.2196/42266 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692936 ID - info:doi/10.2196/42266 ER - TY - JOUR AU - Bricker, Jonathan AU - Miao, Zhen AU - Mull, Kristin AU - Santiago-Torres, Margarita AU - Vock, M. David PY - 2023/1/20 TI - Can a Single Variable Predict Early Dropout From Digital Health Interventions? Comparison of Predictive Models From Two Large Randomized Trials JO - J Med Internet Res SP - e43629 VL - 25 KW - acceptance and commitment therapy KW - ACT KW - attrition KW - digital interventions KW - dropout KW - eHealth KW - engagement KW - iCanQuit KW - mobile health KW - mHealth KW - QuitGuide KW - smartphone apps KW - smoking KW - tobacco KW - trajectories KW - mobile phone N2 - Background: A single generalizable metric that accurately predicts early dropout from digital health interventions has the potential to readily inform intervention targets and treatment augmentations that could boost retention and intervention outcomes. We recently identified a type of early dropout from digital health interventions for smoking cessation, specifically, users who logged in during the first week of the intervention and had little to no activity thereafter. These users also had a substantially lower smoking cessation rate with our iCanQuit smoking cessation app compared with users who used the app for longer periods. Objective: This study aimed to explore whether log-in count data, using standard statistical methods, can precisely predict whether an individual will become an iCanQuit early dropout while validating the approach using other statistical methods and randomized trial data from 3 other digital interventions for smoking cessation (combined randomized N=4529). Methods: Standard logistic regression models were used to predict early dropouts for individuals receiving the iCanQuit smoking cessation intervention app, the National Cancer Institute QuitGuide smoking cessation intervention app, the WebQuit.org smoking cessation intervention website, and the Smokefree.gov smoking cessation intervention website. The main predictors were the number of times a participant logged in per day during the first 7 days following randomization. The area under the curve (AUC) assessed the performance of the logistic regression models, which were compared with decision trees, support vector machine, and neural network models. We also examined whether 13 baseline variables that included a variety of demographics (eg, race and ethnicity, gender, and age) and smoking characteristics (eg, use of e-cigarettes and confidence in being smoke free) might improve this prediction. Results: The AUC for each logistic regression model using only the first 7 days of log-in count variables was 0.94 (95% CI 0.90-0.97) for iCanQuit, 0.88 (95% CI 0.83-0.93) for QuitGuide, 0.85 (95% CI 0.80-0.88) for WebQuit.org, and 0.60 (95% CI 0.54-0.66) for Smokefree.gov. Replacing logistic regression models with more complex decision trees, support vector machines, or neural network models did not significantly increase the AUC, nor did including additional baseline variables as predictors. The sensitivity and specificity were generally good, and they were excellent for iCanQuit (ie, 0.91 and 0.85, respectively, at the 0.5 classification threshold). Conclusions: Logistic regression models using only the first 7 days of log-in count data were generally good at predicting early dropouts. These models performed well when using simple, automated, and readily available log-in count data, whereas including self-reported baseline variables did not improve the prediction. The results will inform the early identification of people at risk of early dropout from digital health interventions with the goal of intervening further by providing them with augmented treatments to increase their retention and, ultimately, their intervention outcomes. UR - https://www.jmir.org/2023/1/e43629 UR - http://dx.doi.org/10.2196/43629 UR - http://www.ncbi.nlm.nih.gov/pubmed/36662550 ID - info:doi/10.2196/43629 ER - TY - JOUR AU - Trinquart, Ludovic AU - Liu, Chunyu AU - McManus, D. David AU - Nowak, Christopher AU - Lin, Honghuang AU - Spartano, L. Nicole AU - Borrelli, Belinda AU - Benjamin, J. Emelia AU - Murabito, M. Joanne PY - 2023/1/20 TI - Increasing Engagement in the Electronic Framingham Heart Study: Factorial Randomized Controlled Trial JO - J Med Internet Res SP - e40784 VL - 25 KW - smartphone notifications KW - digital device use KW - randomized trial KW - smartphone KW - apps KW - mobile health KW - mHealth KW - devices KW - cardiovascular KW - data KW - intervention KW - blood pressure KW - heart rate KW - digital KW - tool KW - notification KW - messaging KW - prompt KW - nudge KW - behavior change KW - self-monitoring KW - self care KW - cardiology N2 - Background: Smartphone apps and mobile health devices offer innovative ways to collect longitudinal cardiovascular data. Randomized evidence regarding effective strategies to maintain longitudinal engagement is limited. Objective: This study aimed to evaluate smartphone messaging interventions on remote transmission of blood pressure (BP) and heart rate (HR) data. Methods: We conducted a 2 × 2 × 2 factorial blinded randomized trial with randomization implemented centrally to ensure allocation concealment. We invited participants from the Electronic Framingham Heart Study (eFHS), an e-cohort embedded in the FHS, and asked participants to measure their BP (Withings digital cuff) weekly and wear their smartwatch daily. We assessed 3 weekly notification strategies to promote adherence: personalized versus standard; weekend versus weekday; and morning versus evening. Personalized notifications included the participant?s name and were tailored to whether or not data from the prior week were transmitted to the research team. Intervention notification messages were delivered weekly automatically via the eFHS app. We assessed if participants transmitted at least one BP or HR measurement within 7 days of each notification after randomization. Outcomes were adherence to BP and HR transmission at 3 months (primary) and 6 months (secondary). Results: Of the 791 FHS participants, 655 (82.8%) were eligible and randomized (mean age 53, SD 9 years; 392/655, 59.8% women; 596/655, 91% White). For the personalized versus standard notifications, 38.9% (126/324) versus 28.8% (94/327) participants sent BP data at 3 months (difference=10.1%, 95% CI 2.9%-17.4%; P=.006), but no significant differences were observed for HR data transmission (212/324, 65.4% vs 209/327, 63.9%; P=.69). Personalized notifications were associated with increased BP and HR data transmission versus standard at 6 months (BP: 107/291, 36.8% vs 66/295, 22.4%; difference=14.4%, 95% CI 7.1- 21.7%; P<.001; HR: 186/281, 66.2% vs 158/281, 56.2%; difference=10%, 95% CI 2%-18%; P=.02). For BP and HR primary or secondary outcomes, there was no evidence of differences in data transmission for notifications sent on weekend versus weekday or morning versus evening. Conclusions: Personalized notifications increased longitudinal adherence to BP and HR transmission from mobile and digital devices among eFHS participants. Our results suggest that personalized messaging is a powerful tool to promote adherence to mobile health systems in cardiovascular research. Trial Registration: ClinicalTrials.gov NCT03516019; https://clinicaltrials.gov/ct2/show/NCT03516019 UR - https://www.jmir.org/2023/1/e40784 UR - http://dx.doi.org/10.2196/40784 UR - http://www.ncbi.nlm.nih.gov/pubmed/36662544 ID - info:doi/10.2196/40784 ER - TY - JOUR AU - van der Windt, Melissa AU - van Zundert, Maria Sofie Karolina AU - Schoenmakers, Sam AU - van Rossem, Lenie AU - Steegers-Theunissen, Maria Régine Patricia PY - 2023/1/20 TI - Prototyping of a Digital Life Course Care Platform for Preconception and Pregnancy Care: Pilot Feasibility and Acceptability Study JO - J Med Internet Res SP - e37537 VL - 25 KW - eHealth KW - app KW - lifestyle KW - lifestyle care KW - life course care KW - preconception KW - periconception KW - pregnancy KW - health care KW - pilot N2 - Background: A healthy lifestyle plays a key role in the prevention of lifestyle-related diseases, including subfertility and pregnancy complications. Although the benefits of a healthy lifestyle are well-known, long-term adherence is limited. Moreover, memory for lifestyle-related information as well as medical information provided by the medical professional is often poor and insufficient. In order to innovate and improve health care for both the patients and health care professionals, we developed a prototype of a digital life course care platform (Smarter Health app), providing personalized lifestyle care trajectories integrated in medical care journeys. Objective: This pilot study aimed to evaluate the feasibility, defined as the actual app use, and the acceptability, which included patient satisfaction and appreciation, of the Smarter Health app. Methods: Between March 17, 2021, and September 30, 2021, pregnant women familiar with the Dutch language seeking tertiary preconception and pregnancy care were offered the app as part of standard medical care at the outpatient clinic Healthy Pregnancy of the Department of Obstetrics and Gynecology of the Erasmus University Medical Center. Three months after activation of the app, patients received a digital questionnaire consisting of aspects of feasibility and acceptability. Results: During this pilot study, 440 patients visited the outpatient clinic Healthy Pregnancy. Of the 440 patients, 293 (66.6%) activated the app. Of the 293 patients who activated the app, 125 (42.7%) filled out the questionnaire. Of these 125 patients, 48 (38.4%) used the app. Most app users used it occasionally and logged in 8 times during their medical care trajectory. Overall, app users were satisfied with the app (median 5-point Likert scale=2.4, IQR 2.0-3.3). Conclusions: Our findings showed that the Smarter Health app, which integrates lifestyle care in medical care, is a feasible health care innovation, and that patients were satisfied with the app. Follow-up and evaluation of pregnancy outcomes should be performed to further substantiate wider clinical implementation. UR - https://www.jmir.org/2023/1/e37537 UR - http://dx.doi.org/10.2196/37537 UR - http://www.ncbi.nlm.nih.gov/pubmed/36662557 ID - info:doi/10.2196/37537 ER - TY - JOUR AU - Abd-alrazaq, Alaa AU - AlSaad, Rawan AU - Aziz, Sarah AU - Ahmed, Arfan AU - Denecke, Kerstin AU - Househ, Mowafa AU - Farooq, Faisal AU - Sheikh, Javaid PY - 2023/1/19 TI - Wearable Artificial Intelligence for Anxiety and Depression: Scoping Review JO - J Med Internet Res SP - e42672 VL - 25 KW - wearable artificial intelligence KW - artificial intelligence KW - wearable devices KW - anxiety KW - depression KW - scoping review KW - mobile phone N2 - Background: Anxiety and depression are the most common mental disorders worldwide. Owing to the lack of psychiatrists around the world, the incorporation of artificial intelligence (AI) into wearable devices (wearable AI) has been exploited to provide mental health services. Objective: This review aimed to explore the features of wearable AI used for anxiety and depression to identify application areas and open research issues. Methods: We searched 8 electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, IEEE Xplore, ACM Digital Library, Scopus, and Google Scholar) and included studies that met the inclusion criteria. Then, we checked the studies that cited the included studies and screened studies that were cited by the included studies. The study selection and data extraction were carried out by 2 reviewers independently. The extracted data were aggregated and summarized using narrative synthesis. Results: Of the 1203 studies identified, 69 (5.74%) were included in this review. Approximately, two-thirds of the studies used wearable AI for depression, whereas the remaining studies used it for anxiety. The most frequent application of wearable AI was in diagnosing anxiety and depression; however, none of the studies used it for treatment purposes. Most studies targeted individuals aged between 18 and 65 years. The most common wearable device used in the studies was Actiwatch AW4 (Cambridge Neurotechnology Ltd). Wrist-worn devices were the most common type of wearable device in the studies. The most commonly used category of data for model development was physical activity data, followed by sleep data and heart rate data. The most frequently used data set from open sources was Depresjon. The most commonly used algorithm was random forest, followed by support vector machine. Conclusions: Wearable AI can offer great promise in providing mental health services related to anxiety and depression. Wearable AI can be used by individuals for the prescreening assessment of anxiety and depression. Further reviews are needed to statistically synthesize the studies? results related to the performance and effectiveness of wearable AI. Given its potential, technology companies should invest more in wearable AI for the treatment of anxiety and depression. UR - https://www.jmir.org/2023/1/e42672 UR - http://dx.doi.org/10.2196/42672 UR - http://www.ncbi.nlm.nih.gov/pubmed/36656625 ID - info:doi/10.2196/42672 ER - TY - JOUR AU - Muñoz Esquivel, Karla AU - Gillespie, James AU - Kelly, Daniel AU - Condell, Joan AU - Davies, Richard AU - McHugh, Catherine AU - Duffy, William AU - Nevala, Elina AU - Alamäki, Antti AU - Jalovaara, Juha AU - Tedesco, Salvatore AU - Barton, John AU - Timmons, Suzanne AU - Nordström, Anna PY - 2023/1/19 TI - Factors Influencing Continued Wearable Device Use in Older Adult Populations: Quantitative Study JO - JMIR Aging SP - e36807 VL - 6 KW - usability KW - older adults KW - remote sensing KW - sensor systems KW - wearable device KW - mobile phone N2 - Background: The increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services. Objective: This study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device. Methods: Older adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants? intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device. Results: The study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants? age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort (?=0.34) and whether the device was fit for purpose (?=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88%. Conclusions: This study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies. UR - https://aging.jmir.org/2023/1/e36807 UR - http://dx.doi.org/10.2196/36807 UR - http://www.ncbi.nlm.nih.gov/pubmed/36656636 ID - info:doi/10.2196/36807 ER - TY - JOUR AU - Lenoir, M. Kristin AU - Sandberg, C. Joanne AU - Miller, P. David AU - Wells, J. Brian PY - 2023/1/17 TI - Patient Perspectives on a Targeted Text Messaging Campaign to Encourage Screening for Diabetes: Qualitative Study JO - JMIR Form Res SP - e41011 VL - 7 KW - mobile health KW - diabetes screening KW - electronic health records KW - text messaging KW - clinical decision support KW - mHealth KW - diabetes KW - mHealth intervention N2 - Background: A sizeable proportion of prediabetes and diabetes cases among adults in the United States remain undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health records (EHRs) have the potential to increase diabetes screening. Given the widespread mobile phone ownership across diverse groups, text messages present a viable mode for delivering alerts directly to patients. The use of unsolicited text messages to offer hemoglobin A1c (HbA1c) screening has not yet been studied. It is imperative to gauge perceptions of ?cold texts? to ensure that information and language are optimized to promote engagement with text messages that affect follow-through with health behaviors. Objective: This study aims to gauge the perceptions of and receptiveness to text messages to inform content that would facilitate engagement with text messages intended to initiate a mobile health (mHealth) intervention for targeted screening. Messages were designed to invite those not already diagnosed with diabetes to make a decision to take part in HbA1c screening and walk them through the steps required to perform the behavior based solely on an automated text exchange. Methods: In total, 6 focus groups were conducted at Wake Forest Baptist Health (WFBH) between September 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine Clinic within the previous year. We displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Content was deductively coded with respect to the Health Belief Model (HBM) and inductively coded to identify other emergent themes that could potentially impact engagement with text messages. Results: Participants (N=36) were generally receptive to the idea of receiving a text-based alert for HbA1c screening. Plain language, personalization, and content, which highlighted perceived benefits over perceived susceptibility and perceived severity, were important to participants? understanding of and receptiveness to messages. The patient-physician relationship emerged as a recurring theme in which patients either had a desire or held an assumption that their provider would be working behind the scenes throughout each step of the process. Participants needed further clarification to understand the steps involved in following through with HbA1c screening and receiving results. Conclusions: Our findings suggest that patients may be receptive to text messages that alert them to a risk of having an elevated HbA1c in direct-to-patient alerts that use cold texting. Using plain and positive language, integrating elements of personalization, and defining new processes clearly were identified by participants as modifiable content elements that could act as facilitators that would help overcome barriers to engagement with these messages. A patient?s relationship with their provider and the financial costs associated with texts and screening may affect receptiveness and engagement in this process. UR - https://formative.jmir.org/2023/1/e41011 UR - http://dx.doi.org/10.2196/41011 UR - http://www.ncbi.nlm.nih.gov/pubmed/36649056 ID - info:doi/10.2196/41011 ER - TY - JOUR AU - Lal, Shalini AU - Elias, Sarah AU - Sieu, Vida AU - Peredo, Rossana PY - 2023/1/16 TI - The Use of Technology to Provide Mental Health Services to Youth Experiencing Homelessness: Scoping Review JO - J Med Internet Res SP - e41939 VL - 25 KW - digital equity KW - homelessness KW - telemedicine KW - telehealth KW - cellular phone KW - internet KW - e-mental health KW - digital health KW - mobile health KW - mHealth KW - literature review KW - mobile phone N2 - Background: There is growing interest in using information and communication technologies (ICTs) to improve access to mental health services for youth experiencing homelessness (YEH); however, limited efforts have been made to synthesize this literature. Objective: This study aimed to review the research on the use of ICTs to provide mental health services and interventions for YEH. Methods: We used a scoping review methodology following the Arksey and O?Malley framework and guidelines from the Joanna Briggs Institute Manual for Evidence Synthesis. The results are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A systematic search was conducted from 2005 to 2021 in MEDLINE, Embase, CINAHL, PsycInfo, Cochrane, Web of Science, and Maestro and in ProQuest Thesis and Dissertations, Papyrus, Homeless Hub, and Google Scholar for gray literature. Studies were included if participants? mean age was between 13 and 29 years, youth with mental health issues were experiencing homelessness or living in a shelter, ICTs were used as a means of intervention, and the study provided a description of the technology. The exclusion criteria were technology that did not allow for interaction (eg, television) and languages other than French or English. The data were analyzed using descriptive statistics and qualitative approaches. Two reviewers were involved in the screening and data extraction process in consultation with a third reviewer. The data were summarized in tables and by narrative synthesis. Results: From the 2153 abstracts and titles screened, 12 were included in the analysis. The most common types of ICTs used were communication technologies (eg, phone, video, and SMS text messages) and mobile apps. The intervention goals varied widely across studies; the most common goal was reducing risky behaviors, followed by addressing cognitive functioning, providing emotional support, providing vital resources, and reducing anxiety. Most studies (9/11, 82%) focused on the feasibility of interventions. Almost all studies reported high levels of acceptability (8/9, 89%) and moderate to high frequency of use (5/6, 83%). The principal challenges were related to technical problems such as the need to replace phones, issues with data services, and phone charging. Conclusions: Our results indicate the emerging role of ICTs in the delivery of mental health services to YEH and that there is a high level of acceptability based on early feasibility studies. However, our results should be interpreted cautiously, considering the limited number of studies included in the analysis and the elevated levels of dropout. There is a need to advance efficacy and effectiveness research in this area with larger and longer studies. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-061313 UR - https://www.jmir.org/2023/1/e41939 UR - http://dx.doi.org/10.2196/41939 UR - http://www.ncbi.nlm.nih.gov/pubmed/36645703 ID - info:doi/10.2196/41939 ER - TY - JOUR AU - Shorey, Shefaly AU - Law, Evelyn AU - AU - Mathews, Jancy AU - Lim, Hoon Siew AU - Shi, Luming AU - Chua, Shi Jing AU - Du, Ruochen AU - Chan, Huak Yiong AU - Tan, Chye Thiam AU - Chee, Cornelia AU - Chong, Seng Yap PY - 2023/1/16 TI - Evaluating the Effectiveness of the Supportive Parenting App on Parental Outcomes: Randomized Controlled Trial JO - J Med Internet Res SP - e41859 VL - 25 KW - postnatal depression KW - mobile health technology KW - social support KW - COVID-19 KW - psychoeducation KW - peer support KW - mobile phone N2 - Background: Adjusting to new or additional parenting responsibilities increases stress and affects parental well-being. Existing research has highlighted both parents? desire to receive more support. It has also been found that receiving sufficient social support enhances parenting outcomes. With the increasing popularity of mobile health apps, a Supportive Parenting App (SPA) intervention was developed to fulfill the support needs of parents during the perinatal period. Objective: This study aimed to examine the effectiveness of the SPA on parental outcomes during the perinatal period. Methods: A 2-group pretest and repeated posttest randomized controlled trial was conducted wherein 200 couples (N=400 mothers and fathers) were recruited from 2 public health care institutions in Singapore. Parents were randomly assigned to intervention (100/200, 50%) or control (100/200, 50%) groups. The SPA intervention consisted of a mobile app?based psychoeducation and peer support program to support parents from pregnancy to 6 months post partum. The outcome measures included postnatal depression, anxiety, parental bonding, parental self-efficacy, perceived social support, and parenting satisfaction. Data were collected at baseline (at >24 weeks of gestation?age of viability in Singapore) and at the first, second, fourth, sixth, ninth, and 12th month post partum. Linear mixed models were used to compare parental outcomes between the groups, and a linear mixed model for repeated measures was used to examine within-group changes. Results: Parents in the intervention group mostly showed better outcomes compared with those in the control group. Parents in the intervention group had higher perceived social support than those in the control group at the first (effect size=1.59, 95% CI 0.38-2.80; Cohen standardized effect size=1.31; P=.01), second (effect size=1.98, 95% CI 1.09-2.88; Cohen standardized effect size=2.21; P=.003), and fourth (effect size=2.57, 95% CI 1.62-3.51; Cohen standardized effect size=2.72; P=.048) months post partum. However, parents in the intervention group showed significantly poorer parental bonding (effect size=1.67, 95% CI 0.24-3.11; Cohen standardized effect size=1.16; P=.02). The other parental outcomes did not differ significantly between groups. The scores of mothers and fathers also differed significantly for all outcomes except parental self-efficacy. Conclusions: Parents in the intervention group generally fared better, especially regarding perceived social support. However, the lack of statistical significance in most outcomes showed the limited effectiveness of the SPA intervention, which may be because of the COVID-19 pandemic. Parental differences in outcome scores suggest that mothers and fathers have different support needs; therefore, interventions should be tailored accordingly. Further improvements and evaluations are needed to examine the effectiveness of the SPA intervention in enhancing parental outcomes. Despite statistically insignificant results, limitations should be considered to further improve mobile health app?based interventions such as SPA, as they could serve as reliable and convenient sources of support for parents. Trial Registration: Clinicaltrails.gov NCT4706442; https://clinicaltrials.gov/ct2/show/NCT04706442 UR - https://www.jmir.org/2023/1/e41859 UR - http://dx.doi.org/10.2196/41859 UR - http://www.ncbi.nlm.nih.gov/pubmed/36645699 ID - info:doi/10.2196/41859 ER - TY - JOUR AU - Rennie, L. Kirsten AU - Lawlor, R. Emma AU - Yassaee, Arrash AU - Booth, Adam AU - Westgate, Kate AU - Sharp, J. Stephen AU - Tyrrell, B. Carina S. AU - Aral, Mert AU - Wareham, J. Nicholas PY - 2023/1/13 TI - Engagement With mHealth COVID-19 Digital Biomarker Measurements in a Longitudinal Cohort Study: Mixed Methods Evaluation JO - J Med Internet Res SP - e40602 VL - 25 KW - smartphone KW - apps KW - engagement KW - COVID-19 KW - pandemic KW - cohort studies KW - epidemiology KW - mobile health KW - digital health KW - biomarker KW - mobile phone N2 - Background: The COVID-19 pandemic accelerated the interest in implementing mobile health (mHealth) in population-based health studies, but evidence is lacking on engagement and adherence in studies. We conducted a fully remote study for ?6 months tracking COVID-19 digital biomarkers and symptoms using a smartphone app nested within an existing cohort of adults. Objective: We aimed to investigate participant characteristics associated with initial and sustained engagement in digital biomarker collection from a bespoke smartphone app and if engagement changed over time or because of COVID-19 factors and explore participants? reasons for consenting to the smartphone substudy and experiences related to initial and continued engagement. Methods: Participants in the Fenland COVID-19 study were invited to the app substudy from August 2020 to October 2020 until study closure (April 30, 2021). Participants were asked to complete digital biomarker modules (oxygen saturation, body temperature, and resting heart rate [RHR]) and possible COVID-19 symptoms in the app 3 times per week. Participants manually entered the measurements, except RHR that was measured using the smartphone camera. Engagement was categorized by median weekly frequency of completing the 3 digital biomarker modules (categories: 0, 1-2, and ?3 times per week). Sociodemographic and health characteristics of those who did or did not consent to the substudy and by engagement category were explored. Semistructured interviews were conducted with 35 participants who were purposively sampled by sex, age, educational attainment, and engagement category, and data were analyzed thematically; 63% (22/35) of the participants consented to the app substudy, and 37% (13/35) of the participants did not consent. Results: A total of 62.61% (2524/4031) of Fenland COVID-19 study participants consented to the app substudy. Of those, 90.21% (2277/2524) completed the app onboarding process. Median time in the app substudy was 34.5 weeks (IQR 34-37) with no change in engagement from 0 to 3 months or 3 to 6 months. Completion rates (?1 per week) across the study between digital biomarkers were similar (RHR: 56,517/77,664, 72.77%; temperature: 56,742/77,664, 73.06%; oxygen saturation: 57,088/77,664, 73.51%). Older age groups and lower managerial and intermediate occupations were associated with higher engagement, whereas working, being a current smoker, being overweight or obese, and high perceived stress were associated with lower engagement. Continued engagement was facilitated through routine and personal motivation, and poor engagement was caused by user error and app or equipment malfunctions preventing data input. From these results, we developed key recommendations to improve engagement in population-based mHealth studies. Conclusions: This mixed methods study demonstrated both high initial and sustained engagement in a large mHealth COVID-19 study over a ?6-month period. Being nested in a known cohort study enabled the identification of participant characteristics and factors associated with engagement to inform future applications in population-based health research. UR - https://www.jmir.org/2023/1/e40602 UR - http://dx.doi.org/10.2196/40602 UR - http://www.ncbi.nlm.nih.gov/pubmed/36194866 ID - info:doi/10.2196/40602 ER - TY - JOUR AU - Becerro de Bengoa Vallejo, Ricardo AU - Losa Iglesias, Elena Marta AU - Robles Sanchez, David Oscar PY - 2023/1/12 TI - Repeatability, Reproducibility, and Concurrent Validity of a Stethoscope and Health App System for the Quantification of Breath Rate in Healthy Adults: Repeatability and Validity Study JO - J Med Internet Res SP - e41845 VL - 25 KW - breath rate KW - stethoscope KW - smartphone app KW - breathing rate KW - vital sign KW - respiration KW - mobile phone app KW - health app KW - mobile app KW - mHealth KW - mobile health KW - measurement KW - breathing KW - assessment KW - monitoring KW - reliability KW - validity KW - medical device KW - medical instrument N2 - Background: Apps for smartphones that can measure the breathing rate easily can be downloaded. Objective: The aim of this study was to demonstrate agreement in measuring breath rates between the stethoscope and Breath Counter health app. Methods: We performed a repeatability study with 56 healthy volunteers. The patient?s demographic data and breathing rates per minute were collected. Breathing rates were measured via two methods: (1) using a stethoscope placed in the upper area of the right lung and (2) a Breath Counter app developed by Vadion on a Samsung Fold smartphone. Results: This study demonstrated high repeatability and validity with respect to the breathing rate parameter of healthy adults using the aforementioned 2 systems. Intrasession repeatability measure using the intraclass correlation coefficient was >0.962, indicating excellent repeatability. Moreover, the intraclass correlation coefficient between methods was 0.793, indicating good repeatability, and coefficients of variation of method errors values were 1.83% with very low values in terms of other repeatability parameters. We found significant correlation coefficients and no systematic differences between the app and stethoscope methods. Conclusions: The app method may be attractive to individuals who require repeatability in a recreational setting. UR - https://www.jmir.org/2023/1/e41845 UR - http://dx.doi.org/10.2196/41845 UR - http://www.ncbi.nlm.nih.gov/pubmed/36633892 ID - info:doi/10.2196/41845 ER - TY - JOUR AU - Hietbrink, G. Eclaire A. AU - Middelweerd, Anouk AU - van Empelen, Pepijn AU - Preuhs, Katharina AU - Konijnendijk, J. Annemieke A. AU - Oude Nijeweme-d?Hollosy, Wendy AU - Schrijver, K. Laura AU - Laverman, D. Gozewijn AU - Vollenbroek-Hutten, R. Miriam M. PY - 2023/1/12 TI - A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study JO - JMIR Hum Factors SP - e40017 VL - 10 KW - eHealth KW - mHealth KW - diet KW - nutrition KW - physical activity KW - lifestyle change KW - coaching KW - dynamic tailoring KW - behavior change KW - blended care KW - type 2 diabetes KW - design KW - treatment KW - chronic disease KW - behavioral KW - theory KW - intervention KW - acceptability KW - usability KW - cost N2 - Background: A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). Objective: This paper aimed to describe the systematic development of E-Supporter 1.0. Methods: Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. Results: The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. Conclusions: The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness. UR - https://humanfactors.jmir.org/2023/1/e40017 UR - http://dx.doi.org/10.2196/40017 UR - http://www.ncbi.nlm.nih.gov/pubmed/36633898 ID - info:doi/10.2196/40017 ER - TY - JOUR AU - Morse, Brad AU - Soares, Andrey AU - Ytell, Kate AU - DeSanto, Kristen AU - Allen, Marvyn AU - Holliman, Dorsey Brooke AU - Lee, S. Rita AU - Kwan, M. Bethany AU - Schilling, M. Lisa PY - 2023/1/10 TI - Co-design of the Transgender Health Information Resource: Web-Based Participatory Design JO - J Particip Med SP - e38078 VL - 15 KW - transgender KW - gender diverse KW - participatory design KW - web-based design KW - co-design KW - health information resource KW - smartphone KW - app KW - mobile phone N2 - Background: There is an urgent and unmet need for accessible and credible health information within the transgender and gender-diverse (TGD) community. Currently, TGD individuals often seek and must find relevant resources by vetting social media posts. A resource that provides accessible and credible health-related resources and content via a mobile phone app may have a positive impact on and support the TGD population. Objective: COVID-19 stay-at-home orders forced a shift in the methods used in participatory design. In this paper, we aimed to describe the web-based participatory methods used to develop the Transgender Health Information Resource. We also described and characterized the web-based engagement that occurred during a single session of the overall design process. Methods: We planned and conducted web-based design sessions to replace the proposed in-person sessions. We used web-based collaborative tools, including Zoom (Zoom Video Communications), Mural (Mural), REDCap (Research Electronic Data Capture; Vanderbilt University), and Justinmind (Justinmind), to engage the participants in the design process. Zoom was used as an integrated platform for design activities. Mural was used to perform exercises, such as free listing, brainstorming, and grouping. REDCap allowed us to collect survey responses. Justinmind was used to create prototypes that were shared and discussed via Zoom. Recruitment was led by one of our community partners, One Colorado, who used private Facebook groups in which web-based flyers were dispersed. The design process took place in several workshops over a period of 10 months. We described and characterized engagement during a single design session by tracking the number of influential interactions among participants. We defined an influential interaction as communication, either verbal or web-based content manipulation, that advanced the design process. Results: We presented data from a single design session that lasted 1 hour and 48 minutes and included 4 participants. During the session, there were 301 influential interactions, consisting of 79 verbal comments and 222 web-based content manipulations. Conclusions: Web-based participatory design can elicit input and decisions from participants to develop a health information resource, such as a mobile app user interface. Overall, participants were highly engaged. This approach maintained the benefits and fidelity of traditional in-person design sessions, mitigated deficits, and exploited the previously unconsidered benefits of web-based methods, such as enhancing the ability to participate for those who live far from academic institutions. The web-based approach to participatory design was an efficient and feasible methodological design approach. UR - https://jopm.jmir.org/2023/1/e38078 UR - http://dx.doi.org/10.2196/38078 UR - http://www.ncbi.nlm.nih.gov/pubmed/36626222 ID - info:doi/10.2196/38078 ER - TY - JOUR AU - Young, Ruth Stephanie AU - Lattie, Gardiner Emily AU - Berry, L. Andrew B. AU - Bui, Lynn AU - Byrne, Joseph Greg AU - Yoshino Benavente, Noelani Julia AU - Bass, Michael AU - Gershon, C. Richard AU - Wolf, S. Michael AU - Nowinski, J. Cindy PY - 2023/1/10 TI - Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation JO - JMIR Form Res SP - e42416 VL - 7 KW - human-centered design KW - mobile health KW - mHealth KW - usability KW - cognitive screening KW - older adults KW - mobile phone N2 - Background: Annual cognitive screening in adults aged >65 years can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient?s own smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: We described the iterative design and proposed the implementation of a remote cognitive screening app, MyCog Mobile, to be completed on a patient?s smartphone before an annual wellness visit. The research questions were as follows: What would motivate primary care clinicians and clinic administrators to implement a remote cognitive screening process? How might we design a remote cognitive screener to fit well with existing primary care workflows? What would motivate an older adult patient to complete a cognitive screener on a smartphone before a primary care visit? How might we optimize the user experience of completing a remote cognitive screener on a smartphone for older adults? Methods: To address research questions 1 and 2, we conducted individual interviews with clinicians (n=5) and clinic administrators (n=3). We also collaborated with clinic administrators to create user journey maps of their existing and proposed MyCog Mobile workflows. To address research questions 3 and 4, we conducted individual semistructured interviews with cognitively healthy older adults (n=5) and solicited feedback from a community stakeholder panel (n=11). We also tested and refined high-fidelity prototypes of the MyCog Mobile app with the older adult interview participants, who rated the usability on the Simplified System Usability Scale and After-Scenario Questionnaire. Results: Clinicians and clinic administrators were motivated to adopt a remote cognitive screening process if it saved time in their workflows. Findings from interviews and user journey mapping informed the proposed implementation and core functionality of MyCog Mobile. Older adult participants were motivated to complete cognitive screeners to ensure that they were cognitively healthy and saw additional benefits to remote screening, such as saving time during their visit and privacy. Older adults also identified potential challenges to remote smartphone screening, which informed the user experience design of the MyCog Mobile app. The average rating across prototype versions was 91 (SD 5.18) on the Simplified System Usability Scale and 6.13 (SD 8.40) on the After-Scenario Questionnaire, indicating above-average usability. Conclusions: Through an iterative, human-centered design process, we developed a viable remote cognitive screening app and proposed an implementation strategy for primary care settings that was optimized for multiple stakeholders. The next steps include validating the cognitive screener in clinical and healthy populations and piloting the finalized app in a community primary care clinic. UR - https://formative.jmir.org/2023/1/e42416 UR - http://dx.doi.org/10.2196/42416 UR - http://www.ncbi.nlm.nih.gov/pubmed/36626223 ID - info:doi/10.2196/42416 ER - TY - JOUR AU - Dana, Ruth AU - Sullivan, Stephen AU - MacGowan, J. Robin AU - Chavez, R. Pollyanna AU - Wall, M. Kristin AU - Sanchez, H. Travis AU - Stephenson, Rob AU - Hightow-Weidman, Lisa AU - Johnson, A. Jeffrey AU - Smith, Amanda AU - Sharma, Akshay AU - Jones, Jeb AU - Hannah, Marissa AU - Trigg, Monica AU - Luo, Wei AU - Caldwell, Joanna AU - Sullivan, Sean Patrick PY - 2023/1/6 TI - Engaging Black or African American and Hispanic or Latino Men Who Have Sex With Men for HIV Testing and Prevention Services Through Technology: Protocol for the iSTAMP Comparative Effectiveness Trial JO - JMIR Res Protoc SP - e43414 VL - 12 KW - HIV self-testing KW - HIV self-test KW - prevention KW - men who have sex with men KW - internet KW - mobile phone N2 - Background: Gay, bisexual, and other men who have sex with men (MSM), particularly Black or African American MSM (BMSM) and Hispanic or Latino MSM (HLMSM), continue to be disproportionately affected by the HIV epidemic in the United States. Previous HIV self-testing programs have yielded high testing rates, although these studies predominantly enrolled White, non-Hispanic MSM. Mobile health tools can support HIV prevention, testing, and treatment. This protocol details an implementation study of mailing free HIV self-tests (HIVSTs) nested within a randomized controlled trial designed to assess the benefit of a mobile phone app for increasing the uptake of HIV prevention and other social services. Objective: This study was a comparative effectiveness trial of innovative recruitment and testing promotion strategies intended to effectively reach cisgender BMSM and HLMSM. We evaluated the use of a mobile app for increasing access to care. Methods: Study development began with individual and group consultations that elicited feedback from 3 core groups: HIV care practitioners and researchers, HIV service organization leaders from study states, and BMSM and HLMSM living in the study states. Upon completion of the formative qualitative work, participants from 11 states, based on the observed areas of highest rate of new HIV diagnoses among Black and Hispanic MSM, were recruited through social networking websites and smartphone apps. After eligibility was verified, participants consented and were randomized to the intervention arm (access to the Know@Home mobile app) or the control arm (referral to web resources). We provided all participants with HIVSTs. The evaluation of the efficacy of a mobile phone app to support linkage to posttest prevention services that included sexually transmitted infection testing, pre-exposure prophylaxis initiation, antiretroviral treatment, and acquisition of condoms and compatible lubricants has been planned. Data on these outcomes were obtained from several sources, including HIVST-reporting surveys, the 4-month follow-up survey, laboratory analyses of dried blood spot cards returned by the participant, and data obtained from the state health department surveillance systems. Where possible, relevant subgroup analyses were performed. Results: During the formative development phase, 9 consultations were conducted: 6 in-depth individual discussions and 3 group consultations. From February 2020 through February 2021, we enrolled 2093 MSM in the randomized controlled trial from 11 states, 1149 BMSM and 944 HLMSM. Conclusions: This study was designed and implemented to evaluate the effectiveness of recruitment strategies to reach BMSM and HMSM and of a mobile app with regard to linkage to HIV prevention or treatment services. Data were also obtained to allow for the analyses of cost and cost-effectiveness related to study enrollment, HIV testing uptake, identification of previously undiagnosed HIV, sexually transmitted infection testing and treatment, and linkage to HIV prevention or treatment services. Trial Registration: ClinicalTrials.gov (NCT04219878); https://clinicaltrials.gov/ct2/show/NCT04219878 International Registered Report Identifier (IRRID): DERR1-10.2196/43414 UR - https://www.researchprotocols.org/2023/1/e43414 UR - http://dx.doi.org/10.2196/43414 UR - http://www.ncbi.nlm.nih.gov/pubmed/36607707 ID - info:doi/10.2196/43414 ER - TY - JOUR AU - Wang, Liyuan AU - Miller, Lynn PY - 2023/1/5 TI - Assessment and Disruption of Ruminative Episodes to Enhance Mobile Cognitive Behavioral Therapy Just-in-Time Adaptive Interventions in Clinical Depression: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e37270 VL - 7 KW - depressive rumination KW - mobile health KW - mHealth KW - just-in-time adaptive intervention KW - depression KW - mental health KW - mobile phone N2 - Background: A just-in-time adaptive intervention (JITAI) is ?designed to address the dynamically changing needs of individuals via the provision of the type or amount of support needed, at the right time when needed.? If and how rumination-focused cognitive behavioral therapy (RFCBT), the gold standard, blocks emotional cascades underlying rumination is unclear. Furthermore, cognitive behavioral therapy has been successfully used as a mobile variant, but RFCBT has not been adapted for a mobile variant (mobile RFCBT [MRFCBT]) or for a JITAI variant. Objective: This study aimed to pilot-test a fully automated JITAI leveraging RFCBT and ways to identify and block cascading depressive rumination. Methods: Patients in therapy for clinical depression were recruited for a randomized controlled trial (RCT). After consenting to be part of the RCT, they were randomly assigned to either of the 2 mobile versions of the RFCBT conditions personalized to the individual?s rumination timing patterns (JITAI-MRFCBT) or a no-treatment control condition through a double-blind procedure. Although the initial design was to have a 3-armed trial with 2 JITAI conditions (a JITAI and a narrative JITAI condition), we later opted to collapse those 2 conditions into 1 JITAI condition because of the low number of participants. All participants were recruited and participated through their smartphones, receiving 5 SMS text message reminders on each of the 35 days to self-report their rumination-related symptoms (eg, rumination episodes and duration). In the JITAI-MRFCBT condition, they also received treatment materials. The first 7 days provided a rumination baseline, and the last 7 days provided a postintervention rumination value. In total, 42% (25/59) of volunteers were eligible and provided their phone numbers, 20% (5/25) of whom never replied to the SMS text message reminding them to start the RCT. A total of 90% (18/20) of volunteers completed it (ie, finishing, as prespecified, 80% of the questionnaires and training tasks) and, therefore, were included in the analysis. Results: Using independent 2-tailed t tests with bootstrapping, results showed that participants in the JITAI-MRFCBT condition, compared with those in the control condition, reported a greater reduction in counts of rumination episodes (mean ?25.28, SD 14.50 vs mean 1.44, SD 4.12, P<.001) and greater reduced average time (minutes) spent in rumination (mean ?21.53, SD 17.6 vs mean 1.47, SD 1.5; P=.04). Results also suggest that, compared with those in the control group, those in treatment reduced ruminative carryover from one episode to the next. Conclusions: The results suggest that JITAI-MRFCBT may reduce negative rumination by providing RFCBT just in time following rumination, thereby blocking the next rumination episode using the same trigger. This study supports a subsequent, full-scale JITAI and the importance of leveraging mobile smartphone technology with MRFCBT to curb depressive symptoms. Trial Registration: ClinicalTrials.gov NCT04554706; https://clinicaltrials.gov/ct2/show/NCT04554706 UR - https://formative.jmir.org/2023/1/e37270 UR - http://dx.doi.org/10.2196/37270 UR - http://www.ncbi.nlm.nih.gov/pubmed/36602841 ID - info:doi/10.2196/37270 ER - TY - JOUR AU - Gosetto, Laetitia AU - Pittavino, Marta AU - Falquet, Gilles AU - Ehrler, Frederic PY - 2023/1/5 TI - Personalization of Mobile Apps for Health Behavior Change: Protocol for a Cross-sectional Study JO - JMIR Res Protoc SP - e38603 VL - 12 KW - mobile health KW - mHealth KW - personalization KW - mobile app KW - behavior change theory KW - gamification KW - functionalities N2 - Background: Mobile health apps have the potential to motivate people to adopt healthier behavior, but many fail to maintain this behavior over time. However, it has been suggested that long-term adherence can be improved by personalizing the proposed interventions. Based on the literature, we created a conceptual framework for selecting appropriate functionalities according to the user's profile. Objective: This cross-sectional study aims to investigate if the relationships linking functionalities and profiles proposed in our conceptual framework are confirmed by user preferences. Methods: A web-based questionnaire comprising several sections was developed to determine the mobile app functionalities most likely to promote healthier behavior. First, participants completed questionnaires to define the user profile (Big Five Inventory-10, Hexad Scale, and perception of the social norm using dimensions of the Theory of Planned Behavior). Second, participants were asked to select the 5 functionalities they considered to be the most relevant to motivate healthier behavior and to evaluate them on a score ranging from 0 to 100. We will perform logistic regressions with the selected functionalities as dependent variables and with the 3 profile scales as predictors to allow us to understand the effect of the participants? scores on each of the 3 profile scales on the 5 selected functionalities. In addition, we will perform logistic ordinal regressions with the motivation score of the functionalities chosen as dependent variables and with scores of the 3 profile scales as predictors to determine whether the scores on the different profile scales predict the functionality score. Results: Data collection was conducted between July and December 2021. Analysis of responses began in January 2022, with the publication of results expected by the end of 2022. Conclusions: This study will allow us to validate our conceptual model by defining the preferred functionalities according to user profiles. International Registered Report Identifier (IRRID): RR1-10.2196/38603 UR - https://www.researchprotocols.org/2023/1/e38603 UR - http://dx.doi.org/10.2196/38603 UR - http://www.ncbi.nlm.nih.gov/pubmed/36602850 ID - info:doi/10.2196/38603 ER - TY - JOUR AU - Karimi, Nazgol AU - Opie, Rachelle AU - Crawford, David AU - O?Connell, Stella AU - Hamblin, Shane Peter AU - Steele, Cheryl AU - Ball, Kylie PY - 2023/1/4 TI - Participants? and Health Care Providers? Insights Regarding a Web-Based and Mobile-Delivered Healthy Eating Program for Disadvantaged People With Type 2 Diabetes: Descriptive Qualitative Study JO - JMIR Form Res SP - e37429 VL - 7 KW - type 2 diabetes KW - healthy eating KW - diet KW - dietary intervention KW - low socioeconomic position KW - digitally delivered KW - mobile health KW - mHealth KW - website KW - mobile phone KW - SMS text message KW - qualitative descriptive N2 - Background: Healthy eating is a key element of type 2 diabetes (T2D) self-management. Digital interventions offer new avenues to reach broad audiences to promote healthy eating behaviors. However, acceptance of these interventions by socioeconomically disadvantaged people (eg, those with lower levels of education and income or from ethnic minority groups) has not yet been fully evaluated. Objective: This study aimed to investigate the acceptability and usability of EatSmart, a 12-week web-based and mobile-delivered healthy eating behavior change support program, from the perspective of intervention participants living with T2D and health care providers (HCPs) involved in diabetes care. Methods: This study used a qualitative descriptive design. Overall, 60 disadvantaged adults with T2D, as determined by receipt of either a HealthCare Card or a pension or benefit as the main source of income, were recruited. Data from participants regarding their experiences with and perceptions of the program and longer-term maintenance of any behavior or attitudinal changes were collected through a web-based self-report survey with open-ended questions administered 12 weeks after baseline (54/60, 90%) and semistructured telephone interviews administered 36 weeks after baseline (16/60, 27%). Supplementary semistructured interviews with 6 HCPs involved in diabetes care (endocrinologists, accredited practicing dietitians, and diabetes nurse educators) were also conducted 36 weeks after baseline. These interviews aimed to understand HCPs? views on successful and unsuccessful elements of EatSmart as a technology-delivered intervention; any concerns or barriers regarding the use of these types of interventions; and feedback from their interactions with patients on the intervention?s content, impact, or observed benefits. All data from the surveys and interviews were pooled and thematically analyzed. Results: In total, 5 key themes emerged from the data: program impact on food-related behaviors and routines, satisfaction with the program, reasons for low engagement and suggestions for future programs, benefits and challenges of digital interventions, and cultural considerations. Results showed that EatSmart was acceptable to participants and contributed positively to improving food-related behaviors. Most participants (27/43, 63%) mentioned that they enjoyed their experience with EatSmart and expressed high satisfaction with its content and delivery. The educational and motivational content was considered the most useful part of the program. Benefits discussed by intervention participants included gaining health knowledge and skills, positive changes in their food purchasing and cooking, and eating greater quantities and varieties of fruits and vegetables. HCPs also described the intervention as beneficial and persuasive for the target audience and had specific suggestions for future tailoring of such programs. Conclusions: The findings suggested that this digitally delivered intervention with supportive educational modules and SMS text messages was generally appealing for both participants and HCPs. This intervention medium shows promise and could feasibly be rolled out on a broader scale to augment usual diabetes care. International Registered Report Identifier (IRRID): RR2-10.2196/19488 UR - https://formative.jmir.org/2023/1/e37429 UR - http://dx.doi.org/10.2196/37429 UR - http://www.ncbi.nlm.nih.gov/pubmed/36598815 ID - info:doi/10.2196/37429 ER - TY - JOUR AU - Helmer, Philipp AU - Hottenrott, Sebastian AU - Rodemers, Philipp AU - Leppich, Robert AU - Helwich, Maja AU - Pryss, Rüdiger AU - Kranke, Peter AU - Meybohm, Patrick AU - Winkler, E. Bernd AU - Sammeth, Michael PY - 2022/12/30 TI - Accuracy and Systematic Biases of Heart Rate Measurements by Consumer-Grade Fitness Trackers in Postoperative Patients: Prospective Clinical Trial JO - J Med Internet Res SP - e42359 VL - 24 IS - 12 KW - health tracker KW - smartwatch KW - internet of things KW - personalized medicine KW - photoplethysmography KW - wearable KW - Garmin Fenix 6 Pro KW - Apple Watch 7 KW - Fitbit Sense KW - Withings ScanWatch N2 - Background: Over the recent years, technological advances of wrist-worn fitness trackers heralded a new era in the continuous monitoring of vital signs. So far, these devices have primarily been used for sports. Objective: However, for using these technologies in health care, further validations of the measurement accuracy in hospitalized patients are essential but lacking to date. Methods: We conducted a prospective validation study with 201 patients after moderate to major surgery in a controlled setting to benchmark the accuracy of heart rate measurements in 4 consumer-grade fitness trackers (Apple Watch 7, Garmin Fenix 6 Pro, Withings ScanWatch, and Fitbit Sense) against the clinical gold standard (electrocardiography). Results: All devices exhibited high correlation (r?0.95; P<.001) and concordance (rc?0.94) coefficients, with a relative error as low as mean absolute percentage error <5% based on 1630 valid measurements. We identified confounders significantly biasing the measurement accuracy, although not at clinically relevant levels (mean absolute error<5 beats per minute). Conclusions: Consumer-grade fitness trackers appear promising in hospitalized patients for monitoring heart rate. Trial Registration: ClinicalTrials.gov NCT05418881; https://www.clinicaltrials.gov/ct2/show/NCT05418881 UR - https://www.jmir.org/2022/12/e42359 UR - http://dx.doi.org/10.2196/42359 UR - http://www.ncbi.nlm.nih.gov/pubmed/36583938 ID - info:doi/10.2196/42359 ER - TY - JOUR AU - Atik, Ece AU - Schückes, Magnus AU - Apolinário-Hagen, Jennifer PY - 2022/12/30 TI - Patient and Therapist Expectations for a Blended Cognitive Behavioral Therapy Program for Depression: Qualitative Exploratory Study JO - JMIR Ment Health SP - e36806 VL - 9 IS - 12 KW - blended cognitive behavioral therapy KW - bCBT KW - cognitive behavioral therapy KW - digital health KW - mental health KW - internet KW - mobile app KW - blended psychotherapy KW - depression KW - user perspectives KW - mobile phone N2 - Background: Blended cognitive behavioral therapy (bCBT)?the combination of digital elements and face-to-face psychotherapy?has been proposed to alleviate challenges that patients and therapists face in conventional cognitive behavioral therapy. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings, and knowledge on how to improve digital apps using a bCBT protocol is limited. Objective: This study aimed to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. Methods: We used a qualitative exploratory study design and conducted 3 focus group interviews (n=6 in each) and 5 semistructured in-depth interviews with therapists as well as 11 individual interviews with patients with a primary diagnosis of depression and currently undergoing cognitive behavioral therapy treatment in Germany. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. Results: Both therapists and patients expected a digital app to provide patients with the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments, and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital apps as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. Conclusions: Both patients and therapists had substantially positive attitudes toward the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists. UR - https://mental.jmir.org/2022/12/e36806 UR - http://dx.doi.org/10.2196/36806 UR - http://www.ncbi.nlm.nih.gov/pubmed/36583934 ID - info:doi/10.2196/36806 ER - TY - JOUR AU - Schlett, Christian AU - Röttele, Nicole AU - van der Keylen, Piet AU - Schöpf-Lazzarino, Christina Andrea AU - Klimmek, Miriam AU - Körner, Mirjam AU - Schnitzius, Kathrin AU - Voigt-Radloff, Sebastian AU - Maun, Andy AU - Sofroniou, Mario AU - Farin-Glattacker, Erik PY - 2022/12/29 TI - The Acceptance, Usability, and Utility of a Web Portal for Back Pain as Recommended by Primary Care Physicians: Qualitative Interview Study With Patients JO - JMIR Form Res SP - e38748 VL - 6 IS - 12 KW - general practice KW - primary care KW - lower back pain KW - digital health intervention KW - web-based health information KW - eHealth KW - patient education KW - adherence KW - qualitative research KW - framework analysis KW - mobile phone N2 - Background: An ever-increasing number of patients seek health information via the internet. However, there is an overabundance of differing, often low-quality information available, while a lack of health literacy makes it difficult for patients to understand and assess the quality and trustworthiness of the information at hand. The web portal tala-med was thus conceived as an evidence-based, up-to-date, and trustworthy information resource for lower back pain (LBP), which could be used by primary care physicians (PCPs) and patients during and following consultations for LBP. The current evidence demonstrates that patients with LBP could benefit from web portals. However, the use of such portals by patients remains low, thus limiting their effectiveness. Therefore, it is important to explore the factors that promote or hinder the use of web portals and investigate how patients perceive their usability and utility. Objective: In this study, we investigated the acceptance, usability, and utility of the web portal tala-med from the patient perspective. Methods: This qualitative study was based on telephone interviews with patients who had access to the web portal tala-med from their PCP. We used a semistructured interview guide that consisted of questions about the consultation in which patients were introduced to tala-med, in addition to questions regarding patient perceptions, experiences, and utilization of tala-med. The interviews were recorded, transcribed, and analyzed through framework analysis. Results: A total of 32 half-hour interviews were conducted with 16 female and 16 male patients with LBP. We identified 5 themes of interest: the use of tala-med by PCPs during the consultation, the use of tala-med by patients, its usability, added values derived from its use, and the resultant effects of using tala-med. PCPs used tala-med as an additional information resource for their patients and recommended the exercises. The patients appreciated these exercises and were willing to use tala-med at home. We also identified factors that promoted or hindered the use of tala-med by patients. Most patients rated tala-med positively and considered it a clear, comprehensible, trustworthy, and practical resource. In particular, the trustworthiness of tala-med was seen as an advantage over other information resources. The possibilities offered by tala-med to recap and reflect on the contents of consultations in a time-flexible and independent manner was perceived as an added value to the PCP consultation. Conclusions: Tala-med was well accepted by patients and appeared to be well suited to being used as an add-on to PCP consultations. Patient perception also supports its usability and utility. Tala-med may therefore enrich consultations and assist patients who would otherwise be unable to find good-quality web-based health information on LBP. In addition, our findings support the future development of digital health platforms and their successful use as a supplement to PCP consultations. International Registered Report Identifier (IRRID): RR2-10.1186/s12875-019-0925-8 UR - https://formative.jmir.org/2022/12/e38748 UR - http://dx.doi.org/10.2196/38748 UR - http://www.ncbi.nlm.nih.gov/pubmed/36580365 ID - info:doi/10.2196/38748 ER - TY - JOUR AU - Ndabu, Theophile AU - Agrawal, Lavlin AU - Sharman, Raj PY - 2022/12/27 TI - The Role of Access Type and Age Group in the Breadth of Use of Patient Portals: Observational Study JO - J Med Internet Res SP - e41972 VL - 24 IS - 12 KW - patient portal KW - mobile health apps KW - electronic medical records KW - personal health record functionalities KW - patient satisfaction KW - health information KW - Health Information National Trends Survey KW - healthcare delivery KW - app use KW - electronic medical record N2 - Background: Health care delivery and patient satisfaction are improved when patients engage with their medical information through patient portals. Despite their wide availability and multiple functionalities, patient portals and their functionalities are still underused. Objective: We seek to understand factors that lead to patient engagement through multiple portal functionalities. We provide recommendations that could lead to higher patients? usage of their portals. Methods: Using data from the Health Information National Trends Survey 5, Cycle 3 (N=2093), we performed descriptive statistics and used a chi-square test to analyze the association between the demographic variables and the use of mobile health apps for accessing medical records. We further fitted a generalized linear model to examine the association between access type and the use of portal functionalities. We further examined the moderation effects of age groups on the impact of access type on portal usage. Results: Our results show that accessing personal health records using a mobile health app is positively associated with greater patient usage of access capabilities (?=.52; P<.001), patient-provider interaction capabilities (?=.24, P=.006), and patient?personal health information interaction capabilities (?=.23, P=.009). Patients are more likely to interact with their records and their providers when accessing their electronic medical records using a mobile health app. The impacts of mobile health app usage fade with age for tasks consisting of viewing, downloading, and transmitting medical results to a third party (?=?.43, P=.005), but not for those involving patient-provider interaction (?=.05, P=.76) or patient?personal health information interaction (?=?.15, P=.19). Conclusions: These findings provide insights on how to increase engagement with diverse portal functionalities for different age groups and thus improve health care delivery and patient satisfaction. UR - https://www.jmir.org/2022/12/e41972 UR - http://dx.doi.org/10.2196/41972 UR - http://www.ncbi.nlm.nih.gov/pubmed/36574284 ID - info:doi/10.2196/41972 ER - TY - JOUR AU - Rowland, Sheri AU - Ramos, K. Athena AU - Trinidad, Natalia AU - Quintero, Sophia AU - Johnson Beller, Rebecca AU - Struwe, Leeza AU - Pozehl, Bunny PY - 2022/12/23 TI - Feasibility, Usability and Acceptability of a mHealth Intervention to Reduce Cardiovascular Risk in Rural Hispanic Adults: Descriptive Study JO - JMIR Form Res SP - e40379 VL - 6 IS - 12 KW - mHealth KW - health behavior KW - self-management KW - Hispanic/Latino KW - rural KW - apps KW - feasibility KW - acceptability KW - participation KW - engagement KW - wearable device KW - tracking KW - smartphone N2 - Background: Mobile health (mHealth) technology using apps or devices to self-manage health behaviors is an effective strategy to improve lifestyle-related health problems such as hypertension, obesity, and diabetes. However, few studies have tested an mHealth intervention with Hispanic/Latino adults, and no studies were found testing mHealth with rural Hispanic/Latino adults, the fastest-growing population in rural areas. Objective: The purpose of this study was to evaluate the feasibility, usability, and acceptability of an mHealth cardiovascular risk self-management intervention with rural Hispanic/Latino adults. Methods: A descriptive study using quantitative and qualitative methods was used to evaluate the feasibility, usability, and acceptability of delivering a 12-week mHealth self-management intervention to reduce cardiovascular risk with rural Hispanic/Latino adults who were randomized to 1 of 2 groups. Both groups were asked to use MyFitnessPal to self-monitor daily steps, weight, and calories. The intervention group received support to download, initiate, and troubleshoot technology challenges with MyFitnessPal (Under Armour) and a smart scale, while the enhanced usual care group received only a general recommendation to use MyFitnessPal to support healthy behaviors. The usability of MyFitnessPal and the smart scale was measured using an adapted Health Information Technology Usability EvaluationScale (Health-ITUES). Adherence data in the intervention group (daily steps, weight, and calories) were downloaded from MyFitnessPal. Acceptability was evaluated using semistructured interviews in a subsample (n=5) of intervention group participants. Results: A sample of 70 eligible participants (enhanced usual care group n=34; intervention group n=36) were enrolled between May and December 2019. The overall attrition was 28% at 12 weeks and 54% at 24 weeks. mHealth usability in the intervention group increased at each time point (6, 12, and 24 weeks). Adherence to self-monitoring using mHealth in the intervention group after week 1 was 55% for steps, 39% for calories, and 35% for weights; at the end of the 12-week intervention, the adherence to self-monitoring was 31% for steps, 11% for weight, and 8% for calories. Spikes in adherence coincided with scheduled in-person study visits. Structured interviews identified common technology challenges including scale and steps not syncing with the app and the need for additional technology support for those with limited mHealth experience. Conclusions: Recruitment of rural Hispanic/Latino adults into the mHealth study was feasible using provider and participant referrals. The use of MyFitnessPal, the smart scale, and SMS text messages to self-monitor daily steps, weights, and calories was acceptable and feasible if technology support was provided. Future research should evaluate and support participants? baseline technology skill level, provide training if needed, and use a phone call or SMS text message follow-ups as a strategy to minimize attrition. A wearable device, separate from the smartphone app, is recommended for activity tracking. UR - https://formative.jmir.org/2022/12/e40379 UR - http://dx.doi.org/10.2196/40379 UR - http://www.ncbi.nlm.nih.gov/pubmed/36563025 ID - info:doi/10.2196/40379 ER - TY - JOUR AU - Workman, Annabelle AU - Johnston, H. Fay AU - Campbell, L. Sharon AU - Williamson, J. Grant AU - Lucani, Chris AU - Bowman, S. David M. J. AU - Cooling, Nick AU - Jones, J. Penelope PY - 2022/12/22 TI - Evaluating User Preferences, Comprehension, and Trust in Apps for Environmental Health Hazards: Qualitative Case Study JO - JMIR Form Res SP - e38471 VL - 6 IS - 12 KW - health app KW - evaluation KW - air pollution KW - pollen KW - temperature KW - mobile phone N2 - Background: Climate change is projected to increase environmental health hazard risks through fire-related air pollution and increased airborne pollen levels. To protect vulnerable populations, it is imperative that evidence-based and accessible interventions are available. The environmental health app, AirRater, was developed in 2015 in Australia to provide information on multiple atmospheric health hazards in near real time. The app allows users to view local environmental conditions, and input and track their personal symptoms to enable behaviors that protect health in response to environmental hazards. Objective: This study aimed to develop insights into users? perceptions of engagement, comprehension, and trust in AirRater to inform the future development of environmental health apps. Specifically, this study explored which AirRater features users engaged with, what additional features or functionality needs users felt they required, users? self-perception of understanding app information, and their level of trust in the information provided. Methods: A total of 42 adult AirRater users were recruited from 3 locations in Australia to participate in semistructured interviews to capture location- or context-specific experiences. Participants were notified of the recruitment opportunity through multiple avenues including newsletter articles and social media. Informed consent was obtained before participation, and the participants were remunerated for their time and perspectives. A preinterview questionnaire collected data including age range, any preexisting conditions, and location (postcode). All participant data were deidentified. Interviews were recorded, transcribed, and analyzed using thematic analysis in NVivo 12 (QSR International). Results: Participants discussed app features and functionality, as well as their understanding of, and trust in, the information provided by the app. Most (26/42, 62%) participants used and valued visual environmental hazard features, especially maps, location settings, and hazard alerts. Most (33/42, 78%) found information in the app easy to understand and support their needs, irrespective of their self-reported literacy levels. Many (21/42, 50%) users reported that they did not question the accuracy of the data presented in the app. Suggested enhancements include the provision of meteorological information (eg, wind speed or direction, air pressure, UV rating, and humidity), functionality enhancements (eg, forecasting, additional alerts, and the inclusion of health advice), and clarification of existing information (eg, symptom triggers), including the capacity to download personal summary data for a specified period. Conclusions: Participants? perspectives can inform the future development of environmental health apps. Specifically, participants? insights support the identification of key elements for the optimal development of environmental health app design, including streamlining, capacity for users to customize, use of real time data, visual cues, credibility, and accuracy of data. The results also suggest that, in the future, iterative collaboration between developers, environmental agencies, and users will likely promote better functional design, user trust in the data, and ultimately better population health outcomes. UR - https://formative.jmir.org/2022/12/e38471 UR - http://dx.doi.org/10.2196/38471 UR - http://www.ncbi.nlm.nih.gov/pubmed/36548030 ID - info:doi/10.2196/38471 ER - TY - JOUR AU - Gonzales, Sarah AU - Okusaga, O. Olaoluwa AU - Reuteman-Fowler, Corey J. AU - Oakes, M. Megan AU - Brown, N. Jamie AU - Moore, Scott AU - Lewinski, A. Allison AU - Rodriguez, Cristin AU - Moncayo, Norma AU - Smith, A. Valerie AU - Malone, Shauna AU - List, Justine AU - Cho, Y. Raymond AU - Jeffreys, S. Amy AU - Bosworth, B. Hayden PY - 2022/12/22 TI - Digital Medicine System in Veterans With Severe Mental Illness: Feasibility and Acceptability Study JO - JMIR Form Res SP - e34893 VL - 6 IS - 12 KW - ABILIFY MYCITE KW - digital medicine KW - adherence KW - aripiprazole KW - Veterans KW - qualitative methods KW - mental illness KW - mental health KW - medication KW - mobile phone N2 - Background: Suboptimal medication adherence is a significant problem for patients with serious mental illness. Measuring medication adherence through subjective and objective measures can be challenging, time-consuming, and inaccurate. Objective: The primary purpose of this feasibility and acceptability study was to evaluate the impact of a digital medicine system (DMS) among Veterans (patients) with serious mental illness as compared with treatment as usual (TAU) on medication adherence. Methods: This open-label, 2-site, provider-randomized trial assessed aripiprazole refill adherence in Veterans with schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder. We randomized 26 providers such that their patients either received TAU or DMS for a period of 90 days. Semistructured interviews with patients and providers were used to examine the feasibility and acceptability of using the DMS. Results: We enrolled 46 patients across 2 Veterans Health Administration sites: 21 (46%) in DMS and 25 (54%) in TAU. There was no difference in the proportion of days covered by medication refill over 3 and 6 months (0.82, SD 0.24 and 0.75, SD 0.26 in DMS vs 0.86, SD 0.19 and 0.82, SD 0.21 in TAU, respectively). The DMS arm had 0.85 (SD 0.20) proportion of days covered during the period they were engaged with the DMS (mean 144, SD 100 days). Interviews with patients (n=14) and providers (n=5) elicited themes salient to using the DMS. Patient findings described the positive impact of the DMS on medication adherence, challenges with the DMS patch connectivity and skin irritation, and challenges with the DMS app that affected overall use. Providers described an overall interest in using a DMS as an objective measure to support medication adherence in their patients. However, providers described challenges with the DMS dashboard and integrating DMS data into their workflow, which decreased the usability of the DMS for providers. Conclusions: There was no observed difference in refill rates. Among those who engaged in the DMS arm, the proportion of days covered by refills were relatively high (mean 0.85, SD 0.20). The qualitative analyses highlighted areas for further refinement of the DMS. Trial Registration: ClinicalTrials.gov NCT03881449; https://clinicaltrials.gov/ct2/show/NCT03881449 UR - https://formative.jmir.org/2022/12/e34893 UR - http://dx.doi.org/10.2196/34893 UR - http://www.ncbi.nlm.nih.gov/pubmed/36548028 ID - info:doi/10.2196/34893 ER - TY - JOUR AU - Barbaric, Antonia AU - Munteanu, Cosmin AU - Ross, Heather AU - Cafazzo, A. Joseph PY - 2022/12/21 TI - A Voice App Design for Heart Failure Self-management: Proof-of-Concept Implementation Study JO - JMIR Form Res SP - e40021 VL - 6 IS - 12 KW - heart failure KW - self-management KW - digital therapeutics KW - voice-activated technology KW - smart speaker KW - formative evaluation KW - mobile phone N2 - Background: Voice user interfaces are becoming more prevalent in health care and are commonly being used for patient engagement. There is a growing interest in identifying the potential this form of interface has on patient engagement with digital therapeutics (DTx) in chronic disease management. Making DTx accessible through an alternative interaction model also has the potential to better meet the needs of some patients, such as older adults and those with physical and cognitive impairments, based on existing research. Objective: This study aimed to evaluate how participants with heart failure interacted with a voice app version of a DTx, Medly, through a proof-of-concept implementation study design. The objective was to understand whether the voice app would enable the participants to successfully interact with the DTx, with a focus on acceptability and feasibility. Methods: A mixed methods concurrent triangulation design was used to better understand the acceptability and feasibility of the use of the Medly voice app with the study participants (N=20) over a 4-week period. Quantitative data included engagement levels, accuracy rates, and questionnaires, which were analyzed using descriptive statistics. Qualitative data included semistructured interviews and were analyzed using a qualitative descriptive approach. Results: The overall average engagement level was 73% (SD 9.5%), with a 14% decline between results of weeks 1 and 4. The biggest difference was between the average engagement levels of the oldest and youngest demographics, 84% and 43%, respectively, but these results were not significant?Kruskal-Wallis test, H(2)=3.8 (P=.14). The Medly voice app had an overall accuracy rate of 97.8% and was successful in sending data to the clinic. From an acceptability perspective, the voice app was ranked in the 80th percentile, and overall, the users felt that the voice app was not a lot of work (average of 2.1 on a 7-point Likert scale). However, the overall average score for whether users would use it in the future declined by 13%. Thematic analysis revealed the following: the theme feasibility of clinical integration had 2 subthemes, namely users adapted to the voice app?s conversational style and device unreliability, and the theme voice app acceptability had 3 subthemes, namely the device integrated well within household and users? lives, users blamed themselves when problems arose with the voice app, and voice app was missing specific, desirable user features. Conclusions: In conclusion, participants were largely successful in using the Medly voice app despite some of the barriers faced, proving that an app such as this could be feasible to be deployed in the clinic. Our data begin to piece together the patient profile this technology may be most suitable for, namely those who are older, have flexible schedules, are confident in using technology, and are experiencing other medical conditions. UR - https://formative.jmir.org/2022/12/e40021 UR - http://dx.doi.org/10.2196/40021 UR - http://www.ncbi.nlm.nih.gov/pubmed/36542435 ID - info:doi/10.2196/40021 ER - TY - JOUR AU - Gagnon, Joel AU - Khau, Michelle AU - Lavoie-Hudon, Léandre AU - Vachon, François AU - Drapeau, Vicky AU - Tremblay, Sébastien PY - 2022/12/21 TI - Comparing a Fitbit Wearable to an Electrocardiogram Gold Standard as a Measure of Heart Rate Under Psychological Stress: A Validation Study JO - JMIR Form Res SP - e37885 VL - 6 IS - 12 KW - Fitbit device KW - wearable KW - heart rate KW - measurement accuracy KW - criterion validity KW - interdevice agreement KW - psychological stress KW - stress KW - physiological KW - behavioral KW - mental health KW - well-being N2 - Background: Wearable devices collect physiological and behavioral data that have the potential to identify individuals at risk of declining mental health and well-being. Past research has mainly focused on assessing the accuracy and the agreement of heart rate (HR) measurement of wearables under different physical exercise conditions. However, the capacity of wearables to sense physiological changes, assessed by increasing HR, caused by a stressful event has not been thoroughly studied. Objective: This study followed 3 objectives: (1) to test the ability of a wearable device (Fitbit Versa 2) to sense an increase in HR upon induction of psychological stress in the laboratory; (2) to assess the accuracy of the wearable device to capture short-term HR variations caused by psychological stress compared to a gold-standard electrocardiogram (ECG) measure (Biopac); and (3) to quantify the degree of agreement between the wearable device and the gold-standard ECG measure across different experimental conditions. Methods: Participants underwent the Trier Social Stress Test protocol, which consists of an oral phase, an arithmetic stress phase, an anticipation phase, and 2 relaxation phases (at the beginning and the end). During the stress protocol, the participants wore a Fitbit Versa 2 and were also connected to a Biopac. A mixed-effect modeling approach was used (1) to assess the effect of experimental conditions on HR, (2) to estimate several metrics of accuracy, and (3) to assess the agreement: the Bland-Altman limits of agreement (LoA), the concordance correlation coefficient, the coverage probability, the total deviation index, and the coefficient of an individual agreement. Mean absolute error and mean absolute percent error were calculated as accuracy indices. Results: A total of 34 university students were recruited for this study (64% of participants were female with a mean age of 26.8 years, SD 8.3). Overall, the results showed significant HR variations across experimental phases. Post hoc tests revealed significant pairwise differences for all phases. Accuracy analyses revealed acceptable accuracy according to the analyzed metrics of accuracy for the Fitbit Versa 2 to capture the short-term variations in psychological stress levels. However, poor indices of agreement between the Fitbit Versa 2 and the Biopac were found. Conclusions: Overall, the results support the use of the Fitbit Versa 2 to capture short-term stress variations. The Fitbit device showed acceptable levels of accuracy but poor agreement with an ECG gold standard. Greater inaccuracy and smaller agreement were found for stressful experimental conditions that induced a higher HR. Fitbit devices can be used in research to measure HR variations caused by stress, although they cannot replace an ECG instrument when precision is of utmost importance. UR - https://formative.jmir.org/2022/12/e37885 UR - http://dx.doi.org/10.2196/37885 UR - http://www.ncbi.nlm.nih.gov/pubmed/36542432 ID - info:doi/10.2196/37885 ER - TY - JOUR AU - Wu, Dezhi AU - Lowry, Benjamin Paul AU - Zhang, Dongsong AU - Tao, Youyou PY - 2022/12/20 TI - Patient Trust in Physicians Matters?Understanding the Role of a Mobile Patient Education System and Patient-Physician Communication in Improving Patient Adherence Behavior: Field Study JO - J Med Internet Res SP - e42941 VL - 24 IS - 12 KW - mobile health KW - mHealth KW - trust KW - patient adherence KW - mobile patient education system KW - MPES KW - patient-physician communication KW - theory of planned behavior KW - TPB KW - patient-centered care KW - mobile phone N2 - Background: The ultimate goal of any prescribed medical therapy is to achieve desired outcomes of patient care. However, patient nonadherence has long been a major problem detrimental to patient health, and thus is a concern for all health care providers. Moreover, nonadherence is extremely costly for global medical systems because of unnecessary complications and expenses. Traditional patient education programs often serve as an intervention tool to increase patients? self-care awareness, disease knowledge, and motivation to change patient behaviors for better adherence. Patient trust in physicians, patient-physician relationships, and quality of communication have also been identified as critical factors influencing patient adherence. However, little is known about how mobile patient education technologies help foster patient adherence. Objective: This study aimed to empirically investigate whether and how a mobile patient education system (MPES) juxtaposed with patient trust can increase patient adherence to prescribed medical therapies. Methods: This study was conducted based on a field survey of 125 patients in multiple states in the United States who have used an innovative mobile health care system for their health care education and information seeking. Partial least squares techniques were used to analyze the collected data. Results: The results revealed that patient-physician communication and the use of an MPES significantly increase patients? trust in their physicians. Furthermore, patient trust has a prominent effect on patient attitude toward treatment adherence, which in turn influences patients? behavioral intention and actual adherence behavior. Based on the theory of planned behavior, the results also indicated that behavioral intention, response efficacy, and self-efficacy positively influenced patients? actual treatment adherence behavior, whereas descriptive norms and subjective norms do not play a role in this process. Conclusions: Our study is one of the first that examines the relationship between patients who actively use an MPES and their trust in their physicians. This study contributes to this context by enriching the trust literature, addressing the call to identify key patient-centered technology determinants of trust, advancing the understanding of patient adherence mechanisms, adding a new explanation of the influence of education mechanisms delivered via mobile devices on patient adherence, and confirming that the theory of planned behavior holds in this patient adherence context. UR - https://www.jmir.org/2022/12/e42941 UR - http://dx.doi.org/10.2196/42941 UR - http://www.ncbi.nlm.nih.gov/pubmed/36538351 ID - info:doi/10.2196/42941 ER - TY - JOUR AU - Qin, Minghui AU - Chen, Bo AU - Sun, Shaohua AU - Liu, Xiaodong PY - 2022/12/19 TI - Effect of Mobile Phone App?Based Interventions on Quality of Life and Psychological Symptoms Among Adult Cancer Survivors: Systematic Review and Meta-analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e39799 VL - 24 IS - 12 KW - mobile health app KW - mHealth app KW - quality of life KW - psychological symptoms KW - cancer survivors KW - systematic review and meta-analysis KW - mobile phone N2 - Background: Most patients with cancer experience psychological or physical distress, which can adversely affect their quality of life (QOL). Smartphone app interventions are increasingly being used to improve QOL and psychological outcomes in patients with cancer. However, there is insufficient evidence regarding the effect of this type of intervention, with conflicting results in the literature. Objective: In this systematic review and meta-analysis, we investigated the effectiveness of mobile phone app interventions on QOL and psychological outcomes in adult patients with cancer, with a special focus on intervention duration, type of cancer, intervention theory, treatment strategy, and intervention delivery format. Methods: We conducted a literature search of PubMed, Web of Science, the Cochrane Library, Embase, Scopus, China National Knowledge Infrastructure, and WanFang to identify studies involving apps that focused on cancer survivors and QOL or psychological symptoms published from inception to October 30, 2022. We selected only randomized controlled trials that met the inclusion criteria and performed systematic review and meta-analysis. The standardized mean difference (SMD) with a 95% CI was pooled when needed. Sensitivity and subgroup analyses were also conducted. Results: In total, 30 randomized controlled trials with a total of 5353 participants were included in this meta-analysis. Compared with routine care, app interventions might improve QOL (SMD=0.39, 95% CI 0.27-0.51; P<.001); enhance self-efficacy (SMD=0.15, 95% CI 0.02-0.29; P=.03); and alleviate anxiety (SMD=?0.64, 95% CI ?0.73 to ?0.56; P<.001), depression (SMD=?0.33, 95% CI ?0.58 to ?0.08; P=.009), and distress (SMD=?0.34, 95% CI ?0.61 to ?0.08; P=.01). Short-term (duration of ?3 months), physician-patient interaction (2-way communication using a smartphone app), and cognitive behavioral therapy interventions might be the most effective for improving QOL and alleviating adverse psychological effects. Conclusions: Our study showed that interventions using mobile health apps might improve QOL and self-efficacy as well as alleviate anxiety, depression, and distress in adult cancer survivors. However, these results should be interpreted with caution because of the heterogeneity of the interventions and the study design. More rigorous trials are warranted to confirm the suitable duration and validate the different intervention theories as well as address methodological flaws in previous studies. Trial Registration: PROSPERO CRD42022370599; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=370599 UR - https://www.jmir.org/2022/12/e39799 UR - http://dx.doi.org/10.2196/39799 UR - http://www.ncbi.nlm.nih.gov/pubmed/36534460 ID - info:doi/10.2196/39799 ER - TY - JOUR AU - Gulec, Hayriye AU - Smahel, David PY - 2022/12/16 TI - Individual and Parental Factors of Adolescents? mHealth App Use: Nationally Representative Cross-sectional Study JO - JMIR Mhealth Uhealth SP - e40340 VL - 10 IS - 12 KW - mobile health KW - mHealth KW - eHealth literacy KW - parental mediation KW - health anxiety KW - sleep KW - body mass index KW - digital skills KW - phone attitudes KW - mobile phone N2 - Background: Knowledge of the characteristics of adolescents who use mobile health (mHealth) apps to monitor health and how these characteristics differ from those of app nonusers is limited. Objective: We aimed to determine mHealth app use based on adolescent and parental factors, including sociodemographics, digital skills, and health indicators, in a nationally representative sample of Czech adolescents (N=2500). Methods: Adolescents aged 11 to 16 years and one of their parents participated in an online survey in 2021. A professional research agency recruited the participants. Quotas were used to ensure the sample?s representativeness. The sociodemographic factors were the adolescents? age, gender, and parental perceived financial security. The adolescents also provided information about their screen time, eHealth literacy, BMI, health anxiety, physical activity, and sleep quality. Parents reported their digital skills, mobile phone attitudes, and the mediation of their children?s online health information?seeking behaviors. We evaluated the differences between the users and nonusers of mHealth apps and identified the significant predictors of mHealth app use. Next, we separately examined how these factors were associated with the use of mHealth apps that track calorie intake or expenditure, number of steps, weight, or sports activity (eg, exercise, running, and working out), as well as other mHealth apps (eg, those that track sleep and heart rate). Results: More than half of the adolescents (1429/2455, 58.21%) reported using mHealth apps. App users were relatively older and, more often, girls. Apps that counted the number of steps were used most frequently, and adolescents whose parents reported higher perceived financial security used them more regularly. Overall, being older and physically active and having higher eHealth literacy skills were associated with using mHealth apps. Adolescents with higher BMI, health anxiety, and lower sleep quality more frequently used mHealth apps to track calorie intake or expenditure, weight, and health indicators. mHealth apps to track physical activity were used more regularly by girls. There was a positive association between parental mediation of online health information?seeking behaviors and adolescents? mHealth app use. Conclusions: These findings demonstrated that older age, physical activity, and eHealth literacy skills were the common underlying factors of adolescents? mHealth app use. We initially showed parents as significant role models for their children?s adoption of, and engagement with, mHealth apps when they actively mediate their online health information?seeking behaviors. Improving the eHealth literacy skills of adolescents through parental guidance might enhance health technology use in this population. Tracking eating behaviors, weight, and health were more prevalent for adolescents who reported higher BMI, health anxiety, and lower sleep quality. Future research studies should examine the determinants and health outcomes of adolescents? mHealth app use longitudinally. UR - https://mhealth.jmir.org/2022/12/e40340 UR - http://dx.doi.org/10.2196/40340 UR - http://www.ncbi.nlm.nih.gov/pubmed/36525286 ID - info:doi/10.2196/40340 ER - TY - JOUR AU - Axelrad, Jordan AU - Long, Millie AU - Horst, Sara AU - Afzali, Anita AU - Sapir, Tamar AU - Fajardo, Kristina AU - De Felice, Kara AU - Sandler, Robert AU - Cross, Raymond PY - 2022/12/15 TI - A Novel Remote Patient and Medication Monitoring Solution to Improve Adherence and Persistence With Inflammatory Bowel Disease Therapy (ASSIST Study): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e40382 VL - 11 IS - 12 KW - remote therapy monitoring KW - connected health KW - patient engagement KW - Crohn disease KW - ulcerative colitis KW - inflammatory bowel disease KW - mobile phone N2 - Background: Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of the gastrointestinal tract. Although adherence to IBD therapies is associated with improved clinical outcomes, overall adherence is poor. Consequently, there is a critical need to develop interventions that monitor adherence in real time and identify reasons for nonadherence to support clinical teams in initiating effective interventions. Recently, electronic- and web-based platforms have been developed to monitor adherence and guide interventions. A novel remote therapy monitoring (RTM) technology, the Tappt digital health system, has been developed to monitor real-time medication adherence patterns through smart label technologies, capture patient-reported outcomes and barriers to care, and process patient data through algorithms that trigger personalized digital and human touch points between clinical visits. Such a digital health solution enables care teams to proactively identify and mitigate nonadherence and worsening clinical outcomes. Objective: We propose a 12-month multicenter randomized controlled trial to assess the effectiveness of the Tappt digital health system on adherence, clinical outcomes, and health care use among patients diagnosed with IBD starting a new oral or subcutaneous therapy. Methods: The digital health system intervention will provide automatic measurement of medication adherence via smart labels for pill bottles or injectors as well as a monitoring platform for providers. The system will prompt patients to complete a two-item assessment of symptoms monthly using the PRO-2 scales for UC and Crohn disease, from which increased symptoms will be alerted to providers. Participants will be randomized 2:1 to the intervention group or the control group, which will receive standard of care. All participants are required to complete questionnaires at baseline as well as at 12, 26, and 52 weeks. Assuming an adherence rate of 0.65 and 0.9 among control and intervention participants, respectively, we will need to enroll 123 participants: 82 (66.7%) in the intervention group and 41 (33.3%) controls. We will compare adherence as measured by the medication possession ratio, defined as the number of days of supply of medication obtained during the observation period out of the total number of days in the observation period, in participants using the RTM versus those receiving standard of care. We will also compare clinical outcomes and health care use in participants using the RTM versus those receiving standard of care. Results: We anticipate starting recruitment in December 2022. Conclusions: Effective medication adherence monitoring and intervention programs need to be cost-efficient, pose little or no burden to the patient, record reliable data in real time, and provide actionable insights to the health care team. We anticipate the Tappt digital health system to improve the medication possession ratio, clinical outcomes, and health care use compared with standard of care. Trial Registration: ClinicalTrials.gov NCT05316584; https://clinicaltrials.gov/ct2/show/NCT05316584 International Registered Report Identifier (IRRID): PRR1-10.2196/40382 UR - https://www.researchprotocols.org/2022/12/e40382 UR - http://dx.doi.org/10.2196/40382 UR - http://www.ncbi.nlm.nih.gov/pubmed/36520519 ID - info:doi/10.2196/40382 ER - TY - JOUR AU - Toh, Yang Sean Han AU - Tan, Yan Jessalin Hui AU - Kosasih, Roxanne Feodora AU - Sündermann, Oliver PY - 2022/12/14 TI - Efficacy of the Mental Health App Intellect to Reduce Stress: Randomized Controlled Trial With a 1-Month Follow-up JO - JMIR Form Res SP - e40723 VL - 6 IS - 12 KW - mobile health KW - mHealth KW - randomized controlled trial KW - RCT KW - self-guided interventions KW - cognitive behavioral therapy KW - CBT KW - stress coping KW - stress management KW - university students KW - psychological mindedness KW - coping self-efficacy KW - mobile phone N2 - Background: Excessive stress is a major global health concern, particularly in young adults. Short skills-focused self-guided interventions (SGIs) on smartphones are a scalable way to improve stress-coping skills at the population level. Objective: In this randomized controlled trial, we aimed to examine the possible efficacy of a recently developed stress-coping SGI (Intellect) in improving psychological distress, relative to an active control group and 2 potential moderators of this predicted relationship (ie, psychological mindedness [PM] and coping self-efficacy [CSE]). Methods: University students (N=321) were randomly assigned to either an 8-day SGI on stress-coping or an active control group. Self-reported measures were obtained at baseline, after the intervention, and at the 1-month follow-up. The primary outcome was psychological stress (Psychological Stress Measure-9). Secondary outcomes were anxiety (Generalized Anxiety Disorder-7) and depressive symptoms (Patient Health Questionnaire-9). PM and CSE were assessed as potential moderators at baseline. Results: The final sample (n=264) included 188 (71.2%) female, 66 (25%) male, 7 (2.7%) nonbinary, and 3 (1.1%) others participants with a mean age of 22.5 (SD 5.41) years. The intervention group reported significantly lower perceived stress (partial eta?squared [?p2]=0.018; P=.03) and anxiety (?p2=0.019; P=.03) levels after intervention relative to the active control group. The effects on perceived stress levels remained statistically significant at the 1-month follow-up (?p2=0.015; P=.05). Students with the lowest CSE and highest PM experienced the fastest decline in perceived stress levels (?=6.37, 95% Cl 2.98-9.75). Improvements in anxiety levels were not observed at 1-month follow-up. Similarly, no intervention effects were found for depression levels at postintervention and follow-up periods. Conclusions: This study provides evidence that the Intellect stress-coping SGI is effective in reducing perceived stress and anxiety levels among university students. Mobile health apps are brief, scalable, and can make important contributions to public mental health. Trial Registration: ClinicalTrials.gov NCT04978896; https://www.clinicaltrials.gov/ct2/show/NCT04978896 UR - https://formative.jmir.org/2022/12/e40723 UR - http://dx.doi.org/10.2196/40723 UR - http://www.ncbi.nlm.nih.gov/pubmed/36515984 ID - info:doi/10.2196/40723 ER - TY - JOUR AU - Patel, L. Michele AU - Cleare, E. Angel AU - Smith, M. Carly AU - Rosas, Goldman Lisa AU - King, C. Abby PY - 2022/12/13 TI - Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study JO - JMIR Form Res SP - e42191 VL - 6 IS - 12 KW - weight loss KW - obesity KW - behavioral intervention KW - self-monitoring KW - race KW - ethnicity KW - digital health KW - diet tracking KW - engagement KW - randomized controlled trial KW - RCT KW - mobile phone N2 - Background: Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment. Objective: In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring. Methods: We recruited racial and ethnic minority adults aged ?21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants? homes and reported descriptively. Results: The eligibility screen was completed by 248 individuals, of whom 38 (15.3%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58%) were identified as Hispanic of any race. The study retention rate was 92% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49% of days for detailed, 97% for simplified; self-monitoring steps: 99% for detailed, 100% for simplified; self-monitoring weight: 67% for detailed, 80% for simplified). Participants in both arms reported high satisfaction, with 89% indicating that they would recommend the intervention. Weight change was ?3.4 (95% CI ?4.6 to ?2.2) kg for detailed and ?3.3 (95% CI ?4.4 to ?2.2) kg for simplified. Conclusions: A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults. Trial Registration: ASPREDICTED #66674; https://aspredicted.org/ka478.pdf UR - https://formative.jmir.org/2022/12/e42191 UR - http://dx.doi.org/10.2196/42191 UR - http://www.ncbi.nlm.nih.gov/pubmed/36512404 ID - info:doi/10.2196/42191 ER - TY - JOUR AU - Rosenfeld, A. Eve AU - Lyman, Cassondra AU - Roberts, E. John PY - 2022/12/13 TI - Development of an mHealth App?Based Intervention for Depressive Rumination (RuminAid): Mixed Methods Focus Group Evaluation JO - JMIR Form Res SP - e40045 VL - 6 IS - 12 KW - depression KW - rumination KW - mobile health KW - mHealth KW - evidence-based treatment KW - focus group KW - mental health KW - mobile app KW - mobile phone N2 - Background: Depression is a common mental health condition that poses a significant public health burden. Effective treatments for depression exist; however, access to evidence-based care remains limited. Mobile health (mHealth) apps offer an avenue for improving access. However, few mHealth apps are informed by evidence-based treatments and even fewer are empirically evaluated before dissemination. To address this gap, we developed RuminAid, an mHealth app that uses evidence-based treatment components to reduce depression by targeting a single key depressogenic process?rumination. Objective: The primary objective of this study was to collect qualitative and quantitative feedback that could be used to improve the design of RuminAid before the software development phase. Methods: We reviewed empirically supported interventions for depression and rumination and used the key aspects of each to create a storyboard version of RuminAid. We distributed an audio-guided presentation of the RuminAid storyboard to 22 individuals for viewing and solicited user feedback on app content, design, and perceived functionality across 7 focus group sessions. Results: The consumer-rated quality of the storyboard version of RuminAid was in the acceptable to good range. Indeed, most participants reported that they thought RuminAid would be an engaging, functional, and informational app. Likewise, they endorsed overwhelming positive beliefs about the perceived impact of RuminAid; specifically, 96% (21/22) believed that RuminAid will help depressed ruminators with depression and rumination. Nevertheless, the results highlighted the need for improved app aesthetics (eg, a more appealing color scheme and modern design). Conclusions: Focus group members reported that the quality of information was quite good and had the potential to help adults who struggle with depression and rumination but expressed concern that poor aesthetics would interfere with users? desire to continue using the app. To address these comments, we hired a graphic designer and redesigned each screen to improve visual appeal. We also removed time gating from the app based on participant feedback and findings from related research. These changes helped elevate RuminAid and informed its initial software build for a pilot trial that focused on evaluating its feasibility and acceptability. UR - https://formative.jmir.org/2022/12/e40045 UR - http://dx.doi.org/10.2196/40045 UR - http://www.ncbi.nlm.nih.gov/pubmed/36512400 ID - info:doi/10.2196/40045 ER - TY - JOUR AU - Ntinga, Xolani AU - Musiello, Franco AU - Keter, Kipyegon Alfred AU - Barnabas, Ruanne AU - van Heerden, Alastair PY - 2022/12/12 TI - The Feasibility and Acceptability of an mHealth Conversational Agent Designed to Support HIV Self-testing in South Africa: Cross-sectional Study JO - J Med Internet Res SP - e39816 VL - 24 IS - 12 KW - HIV KW - HIV self-testing KW - HIVST KW - chatbot KW - conversational agents KW - mobile health KW - mHealth KW - mobile phone N2 - Background: HIV testing rates in sub-Saharan Africa remain below the targeted threshold, and primary care facilities struggle to provide adequate services. Innovative approaches that leverage digital technologies could improve HIV testing and access to treatment. Objective: This study aimed to examine the feasibility and acceptability of Nolwazi_bot. It is an isiZulu-speaking conversational agent designed to support HIV self-testing (HIVST) in KwaZulu-Natal, South Africa. Methods: Nolwazi_bot was designed with 4 different personalities that users could choose when selecting a counselor for their HIVST session. We recruited a convenience sample of 120 consenting adults and invited them to undertake an HIV self-test facilitated by the Nolwazi_bot. After testing, participants completed an interviewer-led posttest structured survey to assess their experience with the chatbot-supported HIVST. Results: Participants (N=120) ranged in age from 18 to 47 years, with half of them being men (61/120, 50.8%). Of the 120 participants, 111 (92.5%) had tested with a human counselor more than once. Of the 120 participants, 45 (37.5%) chose to be counseled by the female Nolwazi_bot personality aged between 18 and 25 years. Approximately one-fifth (21/120, 17.5%) of the participants who underwent an HIV self-test guided by the chatbot tested positive. Most participants (95/120, 79.2%) indicated that their HIV testing experience with a chatbot was much better than that with a human counselor. Many participants (93/120, 77.5%) reported that they felt as if they were talking to a real person, stating that the response tone and word choice of Nolwazi_bot reminded them of how they speak in daily conversations. Conclusions: The study provides insights into the potential of digital technology interventions to support HIVST in low-income and middle-income countries. Although we wait to see the full benefits of mobile health, technological interventions including conversational agents or chatbots provide us with an excellent opportunity to improve HIVST by addressing the barriers associated with clinic-based HIV testing. UR - https://www.jmir.org/2022/12/e39816 UR - http://dx.doi.org/10.2196/39816 UR - http://www.ncbi.nlm.nih.gov/pubmed/36508248 ID - info:doi/10.2196/39816 ER - TY - JOUR AU - Tang, Yiling AU - Gierc, Madelaine AU - Lam, W. Raymond AU - Liu, Sam AU - Faulkner, Guy PY - 2022/12/12 TI - The Effectiveness of Internet-Guided Self-help Interventions to Promote Physical Activity Among Individuals With Depression: Systematic Review JO - JMIR Ment Health SP - e38049 VL - 9 IS - 12 KW - physical activity KW - eHealth KW - mobile health KW - mHealth KW - depression KW - systematic review KW - internet KW - mobile phone N2 - Background: Depression is a prevalent and debilitating mental disorder and a leading cause of disability worldwide. Physical activity (PA) interventions have been shown to alleviate depressive symptoms. However, not all patients have access to PA programing tailored for depression. Internet-guided self-help (IGSH) interventions may be an effective option for increasing PA among people with depression who cannot or prefer not to access supervised exercise treatment. Objective: We aimed to evaluate the effectiveness of IGSH interventions in increasing PA and alleviating depressive symptoms in people with depression. Methods: A systematic literature search was conducted for randomized controlled trials and quasiexperimental studies using 9 electronic databases. The review was registered in PROSPERO (2020 CRD42020221713). Results: A total of 4 randomized controlled trials (430 participants) met the inclusion criteria. Of these, 3 were web-based and 1 was app-based. Three studies found IGSH interventions to have medium to large effects on decreasing depressive symptoms but not on increasing PA compared with waitlist or usual care. One study showed increased self-reported PA but no significant difference in depressive symptoms in the intervention group compared with the control group. Goal setting was the most common behavior change technique used in the interventions. Dropout rates within the intervention groups were relatively low (0%-19%). Conclusions: Our findings suggested that IGSH PA interventions are feasible and have the potential to reduce depressive symptoms in people with depression. More well-designed and tailored interventions with different combinations of behavior change techniques, particularly those targeting the emotion domain, are needed to assess the overall effectiveness and feasibility of using IGSH interventions to increase PA among people with depression. Trial Registration: PROSPERO CRD42020221713; https://tinyurl.com/ysaua5bu UR - https://mental.jmir.org/2022/12/e38049 UR - http://dx.doi.org/10.2196/38049 UR - http://www.ncbi.nlm.nih.gov/pubmed/36508243 ID - info:doi/10.2196/38049 ER - TY - JOUR AU - Simons, E. Laura AU - Hess, W. Courtney AU - Choate, S. Ellison AU - Van Orden, R. Amanda AU - Tremblay-McGaw, G. Alexandra AU - Menendez, Maria AU - Boothroyd, B. Derek AU - Parvathinathan, Gomathy AU - Griffin, Anya AU - Caruso, J. Thomas AU - Stinson, Jennifer AU - Weisman, Amy AU - Liu, Timothy AU - Koeppen, Kurt PY - 2022/12/12 TI - Virtual Reality?Augmented Physiotherapy for Chronic Pain in Youth: Protocol for a Randomized Controlled Trial Enhanced With a Single-Case Experimental Design JO - JMIR Res Protoc SP - e40705 VL - 11 IS - 12 KW - chronic pain KW - adolescents KW - physiotherapy KW - virtual reality KW - single-case experimental design KW - mobile phone N2 - Background: Chronic musculoskeletal (MSK) pain is a prominent health concern, resulting in pain-related disability, loss of functioning, and high health care costs. Physiotherapy rehabilitation is a gold-standard treatment for improving functioning in youth with chronic MSK pain. However, increasing physical activity can feel unattainable for many adolescents because of pain-related fear and movement avoidance. Virtual reality (VR) offers an immersive experience that can interrupt the fear-avoidance cycle and improve engagement in physiotherapy. Despite promising initial findings, data are limited and often lack the rigor required to establish VR as an evidence-based treatment for MSK pain. Objective: This trial evaluates physiorehabilitation with VR in adolescents with MSK pain. This protocol outlines the rationale, design, and implementation of a randomized controlled trial enhanced with a single-case experimental design. Methods: This study is a 2-group randomized controlled trial assessing the use of physiorehabilitation with VR in adolescents with MSK pain. The authors will collaborate with physical therapists to integrate VR into their standard clinical care. For participants enrolled in standard physiotherapy, there will be no VR integrated into their physical therapy program. Primary outcomes include physical function and engagement in VR. Secondary outcomes include pain-related fear and treatment adherence. Moreover, we will obtain clinician perspectives regarding the feasibility of integrating the intervention into the flow of clinical practice. Results: The pilot study implementing physiorehabilitation with VR demonstrated that high engagement and use of physiorehabilitation with VR were associated with improvements in pain, fear, avoidance, and function. Coupled with qualitative feedback from patients, families, and clinicians, the pilot study results provide support for this trial to evaluate physiorehabilitation with VR for youth with chronic MSK pain. Analysis of results from the main clinical trial will begin as recruitment progresses, and results are expected in early 2024. Conclusions: Significant breakthroughs for treating MSK pain require mechanistically informed innovative approaches. Physiorehabilitation with VR provides exposure to progressive challenges, real-time feedback, and reinforcement for movement and can include activities that are difficult to achieve in the real world. It has the added benefit of sustaining patient motivation and adherence while enabling clinicians to use objective benchmarks to influence progression. These findings will inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of physiorehabilitation with VR, serving as the basis for potential large-scale implementation of physiorehabilitation with VR. Trial Registration: ClinicalTrials.gov NCT04636177; https://clinicaltrials.gov/ct2/show/NCT04636177 International Registered Report Identifier (IRRID): DERR1-10.2196/40705 UR - https://www.researchprotocols.org/2022/12/e40705 UR - http://dx.doi.org/10.2196/40705 UR - http://www.ncbi.nlm.nih.gov/pubmed/36508251 ID - info:doi/10.2196/40705 ER - TY - JOUR AU - Sherman, Anne Kerry AU - Pehlivan, Jade Melissa AU - Singleton, Anna AU - Hawkey, Alexandra AU - Redfern, Julie AU - Armour, Mike AU - Dear, Blake AU - Duckworth, Jane Tanya AU - Ciccia, Donna AU - Cooper, Michael AU - Parry, Ann Kelly AU - Gandhi, Esther AU - Imani, A. Sara PY - 2022/12/9 TI - Co-design and Development of EndoSMS, a Supportive Text Message Intervention for Individuals Living With Endometriosis: Mixed Methods Study JO - JMIR Form Res SP - e40837 VL - 6 IS - 12 KW - text message KW - intervention KW - co-design KW - development KW - endometriosis KW - SMS KW - mHealth KW - self-management KW - mobile phone N2 - Background: Endometriosis, which affects 1 in 10 people assigned female at birth, is a chronic systemic inflammatory disease with a high symptom burden and adverse socioemotional impacts. There is a need for an accessible, cost-effective, and low-burden intervention to support individuals in managing their endometriosis condition. Objective: This study aimed to co-design and evaluate the acceptability, readability, and quality of a bank of supportive SMS text messages (EndoSMS) for individuals with endometriosis. Methods: In phase 1 of this mixed method design, 17 consumer representatives (individuals with endometriosis) participated across three 3-hour web-based (Zoom, Zoom Video Communications, Inc) focus groups. The transcripts were encoded and analyzed thematically. In phase 2, consumer representatives (n=14) and health care professionals (n=9) quantitatively rated the acceptability, readability, and appropriateness of the developed text messages in a web-based survey. All the participants initially completed a background survey assessing sociodemographic and medical factors. Results: Consumer representatives demonstrated diverse sociodemographic characteristics (Mage=33.29), varying in location (metropolitan vs rural or regional), employment, and relationship and educational statuses. Participants reached a consensus regarding the delivery of 4 SMS text messages per week, delivered randomly throughout the week and in one direction (ie, no reply), with customization for the time of day and use of personal names. Seven main areas of unmet need for which participants required assistance were identified, which subsequently became the topic areas for the developed SMS text messages: emotional health, social support, looking after and caring for your body, patient empowerment, interpersonal issues, general endometriosis information, and physical health. Through a web-based survey, 371 co-designed SMS text messages were highly rated by consumers and health care professionals as clear, useful, and appropriate for individuals with endometriosis. Readability indices (Flesch-Kincaid scale) indicated that the SMS text messages were accessible to individuals with a minimum of 7th grade high school education. Conclusions: On the basis of the needs and preferences of a diverse consumer representative group, we co-designed EndoSMS, a supportive SMS text message program for individuals with endometriosis. The initial evaluation of the SMS text messages by consumer representatives and health professionals suggested the high acceptability and suitability of the developed SMS text messages. Future studies should further evaluate the acceptability and effectiveness of EndoSMS in a broader population of individuals with endometriosis. UR - https://formative.jmir.org/2022/12/e40837 UR - http://dx.doi.org/10.2196/40837 UR - http://www.ncbi.nlm.nih.gov/pubmed/36485029 ID - info:doi/10.2196/40837 ER - TY - JOUR AU - Skiba, B. Meghan AU - Harker, Graham AU - Guidarelli, Carolyn AU - El-Gohary, Mahmoud AU - Horak, Fay AU - Roeland, J. Eric AU - Silbermann, Rebecca AU - Hayes-Lattin, Brandon AU - Winters-Stone, Kerri PY - 2022/12/8 TI - Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study JO - JMIR Cancer SP - e39271 VL - 8 IS - 4 KW - wearable inertial sensor KW - mobility KW - gait KW - induction chemotherapy KW - autologous hematopoietic stem cell transplant KW - autoHSCT KW - chemotherapy-related symptoms N2 - Background: Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. Objective: We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. Methods: Patients scheduled to receive autoHSCT (78/156, 50%) and controls (78/156, 50%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group?Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale?short form), and depression (Center for Epidemiological Studies?Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. Results: Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability (ß=.001; P=.005) and heel strike angle (ß=?.088; P=.02). Pain was associated with worse gait speed (ß=?.003; P=.003), stride time variability (ß=.012; P=.02), stride length (ß=?.002; P=.004), and distance traveled (ß=?.786; P=.005). Nausea and pain explained 17% to 33% and 14% to 36% of gait variance measured in patients, respectively. Conclusions: Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term. UR - https://cancer.jmir.org/2022/4/e39271 UR - http://dx.doi.org/10.2196/39271 UR - http://www.ncbi.nlm.nih.gov/pubmed/36480243 ID - info:doi/10.2196/39271 ER - TY - JOUR AU - Frej, Asmae AU - Cano, Mireia AU - Ruiz-Postigo, A. José AU - Macharia, Paul AU - Phillips, Odame Richard AU - Amoako, Ampem Yaw AU - Carrion, Carme PY - 2022/12/8 TI - Assessing the Quality of the World Health Organization?s Skin NTDs App as a Training Tool in Ghana and Kenya: Protocol for a Cross-sectional Study JO - JMIR Res Protoc SP - e39393 VL - 11 IS - 12 KW - Skin NTDs App KW - mHealth KW - mobile health KW - neglected tropical diseases KW - skin neglected tropical diseases KW - low- and middle-income countries N2 - Background: Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, the majority of them belonging to impoverished populations in low- and middle-income countries (LMICs). Skin NTDs are a subgroup of NTDs that manifest primarily as skin lesions. The diagnosis and treatment of skin NTDs entail considerable resources, including trained personnel and financial backing. Many interventions are being launched and evaluated, particularly mobile health (mHealth) interventions, such as Skin NTDs App, a training and decision support tool offered by the World Health Organization (WHO) for frontline health workers (FHWs). As most digital health guidelines prioritize the thorough evaluation of mHealth interventions, it is essential to conduct a rigorous and validated assessment of Skin NTDs App. Objective: We aim to assess the quality of version 3 of Skin NTDs App, developed for the WHO by Universal Doctor and Netherlands Leprosy Relief as a training and decision support tool for FHWs. Methods: A cross-sectional study will be conducted in 2 LMICs: Ghana and Kenya. We will use snowball sampling recruitment to select 48 participants from the target population of all FHWs dealing with skin NTDs. The sample group of FHWs will be asked to download and use Skin NTDs App for at least 5 days before answering a web-based survey containing demographic variables and the user Mobile App Rating Scale (uMARS) questionnaire. A semistructured interview will then be conducted. Quantitative and qualitative data will be analyzed using SPSS (version 25; SPSS Inc), with statistical significance for all tests set at a 95% CI and P?.05 considered significant. Data derived from the semistructured interviews will be clustered in themes and coded to enable analysis of various dimensions using ATLAS.ti. Results: The estimated completion date of the study is in the third quarter of 2022. The results are expected to show that Skin NTDs App version 3 has a good reported user experience, as assessed using the uMARS scale. No differences are expected to be found, except for those related to experience in dermatology and the use of mobile technology that could influence the final score. Semistructured interviews are expected to complete the results obtained on the uMARS scale. Moreover, they will be the previous step before assessing other aspects of the app, such as its efficiency and how it should be disseminated or implemented. Conclusions: This study is the first step in a qualitative and quantitative assessment of Skin NTDs App as a training and support tool for FHWs diagnosing and managing skin NTDs. Our results will serve to improve future versions of the App. International Registered Report Identifier (IRRID): PRR1-10.2196/39393 UR - https://www.researchprotocols.org/2022/12/e39393 UR - http://dx.doi.org/10.2196/39393 UR - http://www.ncbi.nlm.nih.gov/pubmed/36480252 ID - info:doi/10.2196/39393 ER - TY - JOUR AU - Benton, S. Jack AU - Cotterill, Sarah AU - Hawkes, E. Rhiannon AU - Miles, M. Lisa AU - French, P. David PY - 2022/12/7 TI - Changes in a Digital Type 2 Diabetes Self-management Intervention During National Rollout: Mixed Methods Study of Fidelity JO - J Med Internet Res SP - e39483 VL - 24 IS - 12 KW - type 2 diabetes KW - Healthy Living KW - digital interventions KW - behavior change KW - self-management KW - fidelity KW - implementation KW - mixed methods KW - mobile phone N2 - Background: ?Healthy Living for People with type 2 Diabetes (HeLP-Diabetes)? was a theory-based digital self-management intervention for people with type 2 diabetes mellitus that encouraged behavior change using behavior change techniques (BCTs) and promoted self-management. HeLP-Diabetes was effective in reducing HbA1c levels in a randomized controlled trial (RCT). National Health Service (NHS) England commissioned a national rollout of HeLP-Diabetes in routine care (now called ?Healthy Living?). Healthy Living presents a unique opportunity to examine the fidelity of the national rollout of an intervention originally tested in an RCT. Objective: This research aimed to describe the Healthy Living BCT and self-management content and features of intervention delivery, compare the fidelity of Healthy Living with the original HeLP-Diabetes intervention, and explain the reasons for any fidelity drift during national rollout through qualitative interviews. Methods: Content analysis of Healthy Living was conducted using 3 coding frameworks (objective 1): the BCT Taxonomy v1, a new coding framework for assessing self-management tasks, and the Template for Intervention Description and Replication. The extent to which BCTs and self-management tasks were included in Healthy Living was compared with published descriptions of HeLP-Diabetes (objective 2). Semistructured interviews were conducted with 9 stakeholders involved in the development of HeLP-Diabetes or Healthy Living to understand the reasons for any changes during national rollout (objective 3). Qualitative data were thematically analyzed using a modified framework approach. Results: The content analysis identified 43 BCTs in Healthy Living. Healthy Living included all but one of the self-regulatory BCTs (?commitment?) in the original HeLP-Diabetes intervention. Healthy Living was found to address all areas of self-management (medical, emotional, and role) in line with the original HeLP-Diabetes intervention. However, 2 important changes were identified. First, facilitated access by a health care professional was not implemented; interviews revealed this was because general practices had fewer resources in comparison with the RCT. Second, Healthy Living included an additional structured web-based learning curriculum that was developed by the HeLP-Diabetes team but was not included in the original RCT; interviews revealed that this was because of changes in NHS policy that encouraged referral to structured education. Interviewees described how the service provider had to reformat the content of the original HeLP-Diabetes website to make it more usable and accessible to meet the multiple digital standards required for implementation in the NHS. Conclusions: The national rollout of Healthy Living had good fidelity to the BCT and self-management content of HeLP-Diabetes. Important changes were attributable to the challenges of scaling up a digital intervention from an RCT to a nationally implemented intervention, mainly because of fewer resources available in practice and the length of time since the RCT. This study highlights the importance of considering implementation throughout all phases of intervention development. UR - https://www.jmir.org/2022/12/e39483 UR - http://dx.doi.org/10.2196/39483 UR - http://www.ncbi.nlm.nih.gov/pubmed/36476723 ID - info:doi/10.2196/39483 ER - TY - JOUR AU - Edwards, Caitlyn AU - Orellana, Elisa AU - Rawlings, Kelly AU - Rodriguez-Pla, Mirta AU - Venkatesan, Aarathi PY - 2022/12/7 TI - Changes in Glycemic Control Following Use of a Spanish-Language, Culturally Adapted Diabetes Program: Retrospective Study JO - JMIR Form Res SP - e40278 VL - 6 IS - 12 KW - type 2 diabetes KW - digital health KW - diabetes intervention KW - diabetes KW - mobile health KW - mhealth KW - app-based KW - health coaching KW - HbA1c KW - glycemic improvements KW - localization KW - Spanish KW - health application KW - health education KW - patient education KW - nutrition KW - digital health intervention KW - health management N2 - Background: Several barriers to diabetes treatment and care exist, particularly in underserved medical communities. Objective: This study aimed to evaluate a novel, culturally adapted, Spanish-language mHealth diabetes program for glycemic control. Methods: Professional Spanish translators, linguists, and providers localized the entirety of the Vida Health Diabetes Management Program into a culturally relevant Spanish-language version. The Spanish-language Vida Health Diabetes Management Program was used by 182 (n=119 women) Spanish-speaking adults with diabetes. This app-based program provided access to culturally adapted educational content on diabetes self-management, one-on-one remote counseling and coaching sessions, and on-demand in-app messaging with bilingual (Spanish and English) certified health coaches, registered dietitian nutritionists, and certified diabetes care and education specialists. Hemoglobin A1c (HbA1c) was the primary outcome measure, and a 2-tailed, paired t test was used to evaluate changes in HbA1c before and after program use. To determine the relationship between program engagement and changes in glycemic control, a cluster-robust multiple regression analysis was employed. Results: We observed a significant decrease in HbA1c of ?1.23 points between baseline (mean 9.65%, SD 1.56%) and follow-up (mean 8.42%, SD 1.44%; P<.001). Additionally, we observed a greater decrease in HbA1c among participants with high program engagement (high engagement: ?1.59%, SD 1.97%; low engagement: ?0.84%, SD 1.64%; P<.001). Conclusions: This work highlights improvements in glycemic control that were clinically as well as statistically significant among Spanish-preferring adults enrolled in the Vida Health Spanish Diabetes Management Program. Greater improvements in glycemic control were observed among participants with higher program engagement. These results provide needed support for the use of digital health interventions to promote meaningful improvements in glycemic control in a medically underserved community. UR - https://formative.jmir.org/2022/12/e40278 UR - http://dx.doi.org/10.2196/40278 UR - http://www.ncbi.nlm.nih.gov/pubmed/36476397 ID - info:doi/10.2196/40278 ER - TY - JOUR AU - Kajubi, Phoebe AU - Parkes-Ratanshi, Rosalind AU - Twimukye, Adelline AU - Bwanika Naggirinya, Agnes AU - Nabaggala, Sarah Maria AU - Kiragga, Agnes AU - Castelnuovo, Barbara AU - King, Rachel PY - 2022/12/6 TI - Perceptions and Attitudes Toward an Interactive Voice Response Tool (Call for Life Uganda) Providing Adherence Support and Health Information to HIV-Positive Ugandans: Qualitative Study JO - JMIR Form Res SP - e36829 VL - 6 IS - 12 KW - mobile health KW - mHealth KW - mobile communication technologies KW - people living with HIV KW - antiretroviral therapy KW - quality of life KW - Uganda N2 - Background: The continuing decline in AIDS-related deaths in the African region is largely driven by the steady scale-up of antiretroviral therapy. However, there are challenges to retaining people living with HIV on treatment. Call for Life Uganda (CFLU) is an interactive voice response tool using simple analogue phones. CFLU supports patients with daily pill reminders, preappointment reminders, symptom reporting and management, and weekly health promotion tips. Mobile health tools are being increasingly used in resource-limited settings but are often adopted without rigorous evaluation. Objective: This qualitative study conducted at 12 months after enrollment assessed patients? experiences, perceptions, and attitudes regarding CLFU. Methods: We conducted a qualitative substudy within an open-label randomized controlled trial titled ?Improving outcomes in HIV patients using mobile phone based interactive software support.? Data were collected through 6 focus group discussions with participants sampled based on proportion of calls responded to?<25%, between 25% and 50%, and >50%?conducted at the Infectious Diseases Institute, Mulago, and the Kasangati Health Centre IV. NVivo (version 11; QSR International) was used in the management of the data and in the coding of the emerging themes. The data were then analyzed using content thematic analysis. Results: There was consensus across all groups that they had more positive than negative experiences with the CFLU system. Participants who responded to >50% of the calls reported more frequent use of the specific elements of the CFLU tool and, consequently, experienced more benefits from the system than those who responded to calls less frequently. Irrespective of calls responded to, participants identified pill reminders as the most important aspect in improved quality of life, followed by health promotion tips. The most common challenge faced was difficulty with the secret personal identification number. Conclusions: Findings showed participants? appreciation, high willingness, and interest in the intervention, CFLU, that demonstrated great perceived potential to improve their access to health care; adherence to treatment; health awareness; and, consequently, quality of life. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 UR - https://formative.jmir.org/2022/12/e36829 UR - http://dx.doi.org/10.2196/36829 UR - http://www.ncbi.nlm.nih.gov/pubmed/36472904 ID - info:doi/10.2196/36829 ER - TY - JOUR AU - Pfammatter, Fidler Angela AU - Hughes, Olivia Bonnie AU - Tucker, Becky AU - Whitmore, Harry AU - Spring, Bonnie AU - Tasali, Esra PY - 2022/12/5 TI - The Development of a Novel mHealth Tool for Obstructive Sleep Apnea: Tracking Continuous Positive Airway Pressure Adherence as a Percentage of Time in Bed JO - J Med Internet Res SP - e39489 VL - 24 IS - 12 KW - obstructive sleep apnea KW - continuous positive airway pressure KW - CPAP adherence KW - weight loss KW - lifestyle N2 - Background: Continuous positive airway pressure (CPAP) is the mainstay obstructive sleep apnea (OSA) treatment; however, poor adherence to CPAP is common. Current guidelines specify 4 hours of CPAP use per night as a target to define adequate treatment adherence. However, effective OSA treatment requires CPAP use during the entire time spent in bed to optimally treat respiratory events and prevent adverse health effects associated with the time spent sleeping without wearing a CPAP device. Nightly sleep patterns vary considerably, making it necessary to measure CPAP adherence relative to the time spent in bed. Weight loss is an important goal for patients with OSA. Tools are required to address these clinical challenges in patients with OSA. Objective: This study aimed to develop a mobile health tool that combined weight loss features with novel CPAP adherence tracking (ie, percentage of CPAP wear time relative to objectively assessed time spent in bed) for patients with OSA. Methods: We used an iterative, user-centered process to design a new CPAP adherence tracking module that integrated with an existing weight loss app. A total of 37 patients with OSA aged 20 to 65 years were recruited. In phase 1, patients with OSA who were receiving CPAP treatment (n=7) tested the weight loss app to track nutrition, activity, and weight for 10 days. Participants completed a usability and acceptability survey. In phase 2, patients with OSA who were receiving CPAP treatment (n=21) completed a web-based survey about their interpretations and preferences for wireframes of the CPAP tracking module. In phase 3, patients with recently diagnosed OSA who were CPAP naive (n=9) were prescribed a CPAP device (ResMed AirSense10 AutoSet) and tested the integrated app for 3 to 4 weeks. Participants completed a usability survey and provided feedback. Results: During phase 1, participants found the app to be mostly easy to use, except for some difficulty searching for specific foods. All participants found the connected devices (Fitbit activity tracker and Fitbit Aria scale) easy to use and helpful. During phase 2, participants correctly interpreted CPAP adherence success, expressed as percentage of wear time relative to time spent in bed, and preferred seeing a clearly stated percentage goal (?Goal: 100%?). In phase 3, participants found the integrated app easy to use and requested push notification reminders to wear CPAP before bedtime and to sync Fitbit in the morning. Conclusions: We developed a mobile health tool that integrated a new CPAP adherence tracking module into an existing weight loss app. Novel features included addressing OSA-obesity comorbidity, CPAP adherence tracking via percentage of CPAP wear time relative to objectively assessed time spent in bed, and push notifications to foster adherence. Future research on the effectiveness of this tool in improving OSA treatment adherence is warranted. UR - https://www.jmir.org/2022/12/e39489 UR - http://dx.doi.org/10.2196/39489 UR - http://www.ncbi.nlm.nih.gov/pubmed/36469406 ID - info:doi/10.2196/39489 ER - TY - JOUR AU - Barzegari, Saeed AU - Sharifi Kia, Ali AU - Bardus, Marco AU - Stoyanov, R. Stoyan AU - GhaziSaeedi, Marjan AU - Rafizadeh, Mouna PY - 2022/12/5 TI - The Persian Version of the Mobile Application Rating Scale (MARS-Fa): Translation and Validation Study JO - JMIR Form Res SP - e42225 VL - 6 IS - 12 KW - mobile application rating scale KW - Farsi KW - mobile apps KW - validation KW - smartphone addiction KW - Persian KW - Iran KW - development KW - mobile health KW - mHealth KW - scale KW - validate KW - reliability KW - measurement tool KW - assessment tool N2 - Background: Approximately 110 million Farsi speakers worldwide have access to a growing mobile app market. Despite restrictions and international sanctions, Iran?s internal mobile health app market is growing, especially for Android-based apps. However, there is a need for guidelines for developing health apps that meet international quality standards. There are also no tools in Farsi that assess health app quality. Developers and researchers who operate in Farsi could benefit from such quality assessment tools to improve their outputs. Objective: This study aims to translate and culturally adapt the Mobile Application Rating Scale in Farsi (MARS-Fa). This study also evaluates the validity and reliability of the newly developed MARS-Fa tool. Methods: We used a well-established method to translate and back translate the MARS-Fa tool with a group of Iranian and international experts in Health Information Technology and Psychology. The final translated version of the tool was tested on a sample of 92 apps addressing smartphone addiction. Two trained reviewers completed an independent assessment of each app in Farsi and English. We reported reliability and construct validity estimates for the objective scales (engagement, functionality, aesthetics, and information quality). Reliability was based on the evaluation of intraclass correlation coefficients, Cronbach ? and Spearman-Brown split-half reliability indicators (for internal consistency), as well as Pearson correlations for test-retest reliability. Construct validity included convergent and discriminant validity (through item-total correlations within the objective scales) and concurrent validity using Pearson correlations between the objective and subjective scores. Results: After completing the translation and cultural adaptation, the MARS-Fa tool was used to assess the selected apps for smartphone addiction. The MARS-Fa total scale showed good interrater reliability (intraclass correlation coefficient=0.83, 95% CI 0.74-0.89) and good internal consistency (Cronbach ?=.84); Spearman-Brown split-half reliability for both raters was 0.79 to 0.93. The instrument showed excellent test-retest reliability (r=0.94). The correlations among the MARS-Fa subdomains and the total score were all significant and above r=0.40, suggesting good convergent and discriminant validity. The MARS-Fa was positively and significantly correlated with subjective quality (r=0.90, P<.001), and so were the objective subdomains of engagement (r=0.85, P<.001), information quality (r=0.80, P<.001), aesthetics (r=0.79, P<.001), and functionality (r=0.57, P<.001), indicating concurrent validity. Conclusions: The MARS-Fa is a reliable and valid instrument to assess mobile health apps. This instrument could be adopted by Farsi-speaking researchers and developers who want to evaluate the quality of mobile apps. While we tested the tool with a sample of apps addressing smartphone addiction, the MARS-Fa could assess other domains or issues since the Mobile App Rating Scale has been used to rate apps in different contexts and languages. UR - https://formative.jmir.org/2022/12/e42225 UR - http://dx.doi.org/10.2196/42225 UR - http://www.ncbi.nlm.nih.gov/pubmed/36469402 ID - info:doi/10.2196/42225 ER - TY - JOUR AU - Cruz-Cobo, Celia AU - Bernal-Jiménez, Ángeles María AU - Vázquez-García, Rafael AU - Santi-Cano, José María PY - 2022/12/2 TI - Effectiveness of mHealth Interventions in the Control of Lifestyle and Cardiovascular Risk Factors in Patients After a Coronary Event: Systematic Review and Meta-analysis JO - JMIR Mhealth Uhealth SP - e39593 VL - 10 IS - 12 KW - coronary disease KW - acute coronary syndrome KW - mobile health KW - smartphone KW - mobile apps KW - mobile phone N2 - Background: Coronary artery disease is the main cause of death and loss of disability-adjusted life years worldwide. Information and communication technology has become an important part of health care systems, including the innovative cardiac rehabilitation services through mobile phone and mobile health (mHealth) interventions. Objective: In this study, we aimed to determine the effectiveness of different kinds of mHealth programs in changing lifestyle behavior, promoting adherence to treatment, and controlling modifiable cardiovascular risk factors and psychosocial outcomes in patients who have experienced a coronary event. Methods: A systematic review of the literature was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A thorough search of the following biomedical databases was conducted: PubMed, Embase, Web of Science, SciELO, CINAHL, Scopus, The Clinical Trial, and Cochrane. Articles that were randomized clinical trials that involved an intervention consisting of an mHealth program using a mobile app in patients after a coronary event were included. The articles analyzed some of the following variables as outcome variables: changes in lifestyle behavior, cardiovascular risk factors, and anthropometric and psychosocial variables. A meta-analysis of the variables studied was performed with the Cochrane tool. The risk of bias was assessed using the Cochrane Collaboration tool; the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation tool; and heterogeneity was measured using the I2 test. Results: A total of 23 articles were included in the review, and 20 (87%) were included in the meta-analysis, with a total sample size of 4535 patients. Exercise capacity measured using the 6-minute walk test (mean difference=21.64, 95% CI 12.72-30.55; P<.001), physical activity (standardized mean difference [SMD]=0.42, 95% CI 0.04-0.81; P=.03), and adherence to treatment (risk difference=0.19, 95% CI 0.11-0.28; P<.001) were significantly superior in the mHealth group. Furthermore, both the physical and mental dimensions of quality of life were better in the mHealth group (SMD=0.26, 95% CI 0.09-0.44; P=.004 and SMD=0.27, 95% CI 0.06-0.47; P=.01, respectively). In addition, hospital readmissions for all causes and cardiovascular causes were statistically higher in the control group than in the mHealth group (SMD=?0.03, 95% CI ?0.05 to ?0.00; P=.04 vs SMD=?0.04, 95% CI ?0.07 to ?0.00; P=.05). Conclusions: mHealth technology has a positive effect on patients who have experienced a coronary event in terms of their exercise capacity, physical activity, adherence to medication, and physical and mental quality of life, as well as readmissions for all causes and cardiovascular causes. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022299931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299931 UR - https://mhealth.jmir.org/2022/12/e39593 UR - http://dx.doi.org/10.2196/39593 UR - http://www.ncbi.nlm.nih.gov/pubmed/36459396 ID - info:doi/10.2196/39593 ER - TY - JOUR AU - Shan, Yi AU - Ji, Meng AU - Xie, Wenxiu AU - Lam, Kam-Yiu AU - Chow, Chi-Yin PY - 2022/12/2 TI - Public Trust in Artificial Intelligence Applications in Mental Health Care: Topic Modeling Analysis JO - JMIR Hum Factors SP - e38799 VL - 9 IS - 4 KW - public trust KW - public opinion KW - AI application KW - artificial intelligence KW - mental health care KW - topic modeling KW - topic KW - theme KW - term KW - visualization KW - user feedback KW - user review KW - Google Play KW - health app: mHealth KW - mobile health KW - digital health KW - eHealth KW - mental health KW - mental illness KW - mental disorder N2 - Background: Mental disorders (MDs) impose heavy burdens on health care (HC) systems and affect a growing number of people worldwide. The use of mobile health (mHealth) apps empowered by artificial intelligence (AI) is increasingly being resorted to as a possible solution. Objective: This study adopted a topic modeling (TM) approach to investigate the public trust in AI apps in mental health care (MHC) by identifying the dominant topics and themes in user reviews of the 8 most relevant mental health (MH) apps with the largest numbers of reviewers. Methods: We searched Google Play for the top MH apps with the largest numbers of reviewers, from which we selected the most relevant apps. Subsequently, we extracted data from user reviews posted from January 1, 2020, to April 2, 2022. After cleaning the extracted data using the Python text processing tool spaCy, we ascertained the optimal number of topics, drawing on the coherence scores and used latent Dirichlet allocation (LDA) TM to generate the most salient topics and related terms. We then classified the ascertained topics into different theme categories by plotting them onto a 2D plane via multidimensional scaling using the pyLDAvis visualization tool. Finally, we analyzed these topics and themes qualitatively to better understand the status of public trust in AI apps in MHC. Results: From the top 20 MH apps with the largest numbers of reviewers retrieved, we chose the 8 (40%) most relevant apps: (1) Wysa: Anxiety Therapy Chatbot; (2) Youper Therapy; (3) MindDoc: Your Companion; (4) TalkLife for Anxiety, Depression & Stress; (5) 7 Cups: Online Therapy for Mental Health & Anxiety; (6) BetterHelp-Therapy; (7) Sanvello; and (8) InnerHour. These apps provided 14.2% (n=559), 11.0% (n=431), 13.7% (n=538), 8.8% (n=356), 14.1% (n=554), 11.9% (n=468), 9.2% (n=362), and 16.9% (n=663) of the collected 3931 reviews, respectively. The 4 dominant topics were topic 4 (cheering people up; n=1069, 27%), topic 3 (calming people down; n=1029, 26%), topic 2 (helping figure out the inner world; n=963, 25%), and topic 1 (being an alternative or complement to a therapist; n=870, 22%). Based on topic coherence and intertopic distance, topics 3 and 4 were combined into theme 3 (dispelling negative emotions), while topics 2 and 1 remained 2 separate themes: theme 2 (helping figure out the inner world) and theme 1 (being an alternative or complement to a therapist), respectively. These themes and topics, though involving some dissenting voices, reflected an overall high status of trust in AI apps. Conclusions: This is the first study to investigate the public trust in AI apps in MHC from the perspective of user reviews using the TM technique. The automatic text analysis and complementary manual interpretation of the collected data allowed us to discover the dominant topics hidden in a data set and categorize these topics into different themes to reveal an overall high degree of public trust. The dissenting voices from users, though only a few, can serve as indicators for health providers and app developers to jointly improve these apps, which will ultimately facilitate the treatment of prevalent MDs and alleviate the overburdened HC systems worldwide. UR - https://humanfactors.jmir.org/2022/4/e38799 UR - http://dx.doi.org/10.2196/38799 UR - http://www.ncbi.nlm.nih.gov/pubmed/36459412 ID - info:doi/10.2196/38799 ER - TY - JOUR AU - Kim, Sunghak AU - Park, Young Jin AU - Chung, Kyungmi PY - 2022/11/30 TI - The Relationship Between the Big Five Personality Traits and the Theory of Planned Behavior in Using Mindfulness Mobile Apps: Cross-sectional Survey JO - J Med Internet Res SP - e39501 VL - 24 IS - 11 KW - personality traits KW - Theory of Planned Behavior KW - mindfulness KW - mobile apps KW - mental health N2 - Background: Mindfulness has emerged as a promising approach toward improving mental health. Interest in mindfulness mobile app services has also increased in recent years. Understanding the determinants of mindfulness behavior is essential to predict people?s utilization of mindfulness mobile apps and beneficial for developing and implementing relevant intervention strategies. Nevertheless, little has been done to determine the predictors of mindfulness behavior. Objective: This study investigates the association between the Big Five personality traits and the Theory of Planned Behavior (TPB) variables in the context of using mindfulness mobile apps to explore the potential indirect effects of conscientiousness and neuroticism on people?s behavioral intention for mindfulness, mediated by their attitude toward mindfulness, subjective norm about mindfulness, and perceived behavior control over mindfulness. Methods: The authors conducted an online, cross-sectional survey in December 2021. Structural equation modeling was conducted to evaluate the overall model fit and test possible linkages among conscientiousness, neuroticism, attitude toward mindfulness, subjective norm about mindfulness, perceived behavior control over mindfulness, and behavioral intention for mindfulness. Bootstrapping mediation analyses were also conducted to test the potential mediating effect in the model. Results: A total of 297 Korean participants? responses (153 males and 144 females) were analyzed. The proposed model had a good fit. Conscientiousness was correlated with attitude toward mindfulness (?=.384, P<.001), subjective norm about mindfulness (?=.249, P<.001), and perceived behavior control over mindfulness (?=.443, P<.001). Neuroticism was not correlated with attitude toward mindfulness (?=?.072, P=.28), but was correlated with subjective norm about mindfulness (?=.217, P=.003) and perceived behavior control over mindfulness (?=?.235, P<.001). Attitude toward mindfulness (?=.508, P<.001), subjective norm about mindfulness (?=.132, P=.01), and perceived behavior control over mindfulness (?=.540, P<.001) were separately correlated with behavioral intention for mindfulness. Conscientiousness was not directly correlated with behavioral intention for mindfulness (?=?.082, P=.27), whereas neuroticism was directly correlated with behavioral intention for mindfulness (?=.194, P=.001). Conscientiousness was indirectly linked with behavioral intention for mindfulness through attitude toward mindfulness (B=0.171, 95% CI 0.103-0.251) and perceived behavior control over mindfulness (B=0.198, 95% CI 0.132-0.273) but not through subjective norm about mindfulness (B=0.023, 95% CI ?0.002 to 0.060). Neuroticism was indirectly linked with behavioral intention for mindfulness via perceived behavior control over mindfulness (B=?0.138, 95% CI ?0.197 to ?0.088) but not via subjective norm about mindfulness (B=0.021, 95% CI ?0.002 to 0.059). Conclusions: The results show that the integration of the Big Five personality traits and TPB constructs is useful in predicting the use of mindfulness mobile apps. Focusing on conscientiousness and neuroticism in developing information dissemination and implementation strategies for enhancing mindfulness behavior using mobile apps may lead to the successful promotion of mindfulness mobile apps and adherence to mindfulness techniques. UR - https://www.jmir.org/2022/11/e39501 UR - http://dx.doi.org/10.2196/39501 UR - http://www.ncbi.nlm.nih.gov/pubmed/36449344 ID - info:doi/10.2196/39501 ER - TY - JOUR AU - Dong, Aishu AU - Huang, Jing AU - Lin, Shudan AU - Zhu, Jianing AU - Zhou, Haitao AU - Jin, Qianqian AU - Zhao, Wei AU - Zhu, Lianlian AU - Guo, Wenjian PY - 2022/11/30 TI - Psychometric Properties of the Chinese Warwick-Edinburgh Mental Well-being Scale in Medical Staff: Cross-sectional Study JO - J Med Internet Res SP - e38108 VL - 24 IS - 11 KW - psychometric property KW - Chinese Warwick-Edinburgh Mental Well-being Scale KW - classical test theory KW - well-being KW - item response theory KW - medical staff KW - China N2 - Background: Worldwide, mental well-being is a critical issue for public health, especially among medical staff; it affects professionalism, efficiency, quality of care delivery, and overall quality of life. Nevertheless, assessing mental well-being is a complex problem. Objective: This study aimed to evaluate the psychometric properties of the Chinese-language version of the 14-item Warwick-Edinburgh Mental Well-being Scale (WEMWBS) in medical staff recruited mainly from 6 hospitals in China and provide a reliable measurement of positive mental well-being. Methods: A cross-sectional online survey was conducted of medical staff from 15 provinces in China from May 15 to July 15, 2020. Confirmatory factor analysis (CFA) was conducted to test the structure of the Chinese WEMWBS. The Spearman correlations of the Chinese WEMWBS with the 5-item World Health Organization Well-Being Index (WHO-5) were used to evaluate convergent validity. The Cronbach ? and split-half reliability (?) represented internal consistency. A graded response model was adopted for an item response theory (IRT) analysis. We report discrimination, difficulty, item characteristic curves (ICCs), and item information curves (IICs). ICCs and IICs were used to estimate reliability and validity based on the IRT analysis. Results: A total of 572 participants from 15 provinces in China finished the Chinese WEMWBS. The CFA showed that the 1D model was satisfactory and internal consistency reliability was excellent, with ?=.965 and ?=0.947, while the item-scale correlation coefficients ranged from r=0.727 to r=0.900. The correlation coefficient between the Chinese WEMWBS and the WHO-5 was significant, at r=0.746. The average variance extraction value was 0.656, and the composite reliability value was 0.964, with good aggregation validity. The discrimination of the Chinese WEMWBS items ranged from 2.026 to 5.098. The ICCs illustrated that the orders of the category thresholds for the 14 items were satisfactory. Conclusions: The Chinese WEMWBS showed good psychometric properties and can measure well-being in medical staff. UR - https://www.jmir.org/2022/11/e38108 UR - http://dx.doi.org/10.2196/38108 UR - http://www.ncbi.nlm.nih.gov/pubmed/36449336 ID - info:doi/10.2196/38108 ER - TY - JOUR AU - Tahsin, Farah AU - Austin, Tujuanna AU - McKinstry, Brian AU - Mercer, W. Stewart AU - Loganathan, Mayura AU - Thavorn, Kednapa AU - Upshur, Ross AU - Steele Gray, Carolyn PY - 2022/11/30 TI - Examining Use Behavior of a Goal-Supporting mHealth App in Primary Care Among Patients With Multiple Chronic Conditions: Qualitative Descriptive Study JO - JMIR Hum Factors SP - e37684 VL - 9 IS - 4 KW - mobile health KW - mHealth KW - multimorbidity KW - chronic disease management KW - goal-oriented care KW - multimorbid KW - app KW - primary care KW - telemedicine KW - use KW - usability KW - human factors KW - behavior KW - sociobehavioral KW - health technology KW - mobile phone N2 - Background: Although mobile health (mHealth) apps are increasingly being used to support patients with multiple chronic conditions (multimorbidity), most mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, when developing an mHealth program, it is important to understand the social-behavioral factors that affect patients? use behavior. Objective: The aim of this study was to explore the social and behavioral factors contributing to patients? use behavior of an mHealth app called the electronic Patient-Reported Outcome (ePRO). The ePRO app supports goal-oriented care delivery in interdisciplinary primary care models. Methods: A descriptive qualitative study was used to analyze interview data collected for a larger mixed methods pragmatic trial. The original 15-month trial was conducted in 6 primary care teams across Ontario, Canada, between 2018 and 2019. The eligibility criteria for patients were being aged ?60 years with ?10 visits within the previous 12 months of study enrollment. For this analysis, patients were classified as long-term or short-term users based on their length of use of the ePRO app during the trial. The Social Cognitive Theory by Bandura was used to categorize social-behavioral factors that contributed to patients? decision to continue or discontinue using the app. Results: The patient-provider relationship emerged as a key factor that shaped patients? experiences with the app and subsequent decision to continue using the app. Other factors that contributed to patients? decision to continue using the app were personal and social circumstances, perceived usefulness, patients? previous experience with goal-related behaviors, and confidence in one?s capability. There was an overlap of experience between long- and short-term app users but, in general, long-term users perceived the app to be more useful and their goals to be more meaningful than short-term app users. This observation was complicated by the fact that patient health-related goals were dynamic and changed over time. Conclusions: Complex patients? use behavior of a goal-supporting mHealth app is shaped by an array of sociobehavioral factors that can evolve. To tackle this dynamism, there should be an emphasis on creating adaptable health technologies that are easily customizable by patients and able to respond to their changing contexts and needs. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 UR - https://humanfactors.jmir.org/2022/4/e37684 UR - http://dx.doi.org/10.2196/37684 UR - http://www.ncbi.nlm.nih.gov/pubmed/36449335 ID - info:doi/10.2196/37684 ER - TY - JOUR AU - Watanabe, Kazuhiro AU - Tsutsumi, Akizumi PY - 2022/11/30 TI - The Passive Monitoring of Depression and Anxiety Among Workers Using Digital Biomarkers Based on Their Physical Activity and Working Conditions: 2-Week Longitudinal Study JO - JMIR Form Res SP - e40339 VL - 6 IS - 11 KW - digital biomarkers KW - mobile health KW - mental health KW - psychological distress KW - depression KW - anxiety KW - physical activity N2 - Background: Digital data on physical activity are useful for self-monitoring and preventing depression and anxiety. Although previous studies have reported machine or deep learning models that use physical activity for passive monitoring of depression and anxiety, there are no models for workers. The working population has different physical activity patterns from other populations, which is based on commuting, holiday patterns, physical demands, occupations, and industries. These working conditions are useful in optimizing the model used in predicting depression and anxiety. Further, recurrent neural networks increase predictive accuracy by using previous inputs on physical activity, depression, and anxiety. Objective: This study evaluated the performance of a deep learning model optimized for predicting depression and anxiety in workers. Psychological distress was considered a depression and anxiety indicator. Methods: A 2-week longitudinal study was conducted with workers in urban areas in Japan. Absent workers were excluded. In a daily survey, psychological distress was measured using a self-reported questionnaire. As features, activity time by intensity was determined using the Google Fit application. Additionally, we measured age, gender, occupations, employment status, work shift types, working hours, and whether the response date was a working or nonworking day. A deep learning model, using long short-term memory, was developed and validated to predict psychological distress the next day, using features of the previous day. Further, a 5-fold cross-validation method was used to evaluate the performance of the aforementioned model. As the primary indicator of performance, classification accuracy for the severity of the psychological distress (light, subthreshold, and severe) was considered. Results: A total of 1661 days of supervised data were obtained from 236 workers, who were aged between 20 and 69 years. The overall classification accuracy for psychological distress was 76.3% (SD 0.04%). The classification accuracy for severe-, subthreshold-, and light-level psychological distress was 51.1% (SD 0.05%), 60.6% (SD 0.05%), and 81.6% (SD 0.04%), respectively. The model predicted a light-level psychological distress the next day after the participants had been involved in 3 peaks of activity (in the morning, noon, and evening) on the previous day. Lower activity levels were predicted as subthreshold- and severe-level psychological distress. Different predictive results were observed on the basis of occupations and whether the previous day was a working or nonworking day. Conclusions: The developed deep learning model showed a similar performance as in previous studies and, in particular, high accuracy for light-level psychological distress. Working conditions and long short-term memory were useful in maintaining the model performance for monitoring depression and anxiety, using digitally recorded physical activity in workers. The developed model can be implemented in mobile apps and may further be practically used by workers to self-monitor and maintain their mental health state. UR - https://formative.jmir.org/2022/11/e40339 UR - http://dx.doi.org/10.2196/40339 UR - http://www.ncbi.nlm.nih.gov/pubmed/36449342 ID - info:doi/10.2196/40339 ER - TY - JOUR AU - Kawai, Yuki AU - Waki, Kayo AU - Yamaguchi, Satoko AU - Shibuta, Tomomi AU - Miyake, Kana AU - Kimura, Shigeko AU - Toyooka, Tsuguyoshi AU - Nakajima, Ryo AU - Uneda, Kazushi AU - Wakui, Hiromichi AU - Tamura, Kouichi AU - Nangaku, Masaomi AU - Ohe, Kazuhiko PY - 2022/11/28 TI - The Use of Information and Communication Technology?Based Self-management System DialBeticsLite in Treating Abdominal Obesity in Japanese Office Workers: Prospective Single-Arm Pilot Intervention Study JO - JMIR Diabetes SP - e40366 VL - 7 IS - 4 KW - abdominal obesity KW - self-management KW - telemedicine KW - mobile phone N2 - Background: Making lifestyle changes is an essential element of abdominal obesity (AO) reduction. To support lifestyle modification and self-management, we developed an information and communication technology?based self-management system?DialBeticsLite?with a fully automated dietary evaluation function for the treatment of AO. Objective: The objective of this study was to evaluate the preliminary efficacy and feasibility of DialBeticsLite among Japanese office workers with AO. Methods: A 2- to 3-month prospective single-arm pilot intervention study was designed to assess the effects of the intervention using DialBeticsLite. The information and communication technology system was composed of 4 modules: data transmission (body weight, blood pressure, blood glucose, and pedometer count); data evaluation; exercise input; and food recording and dietary evaluation. Eligible participants were workers who were aged ?20 years and with AO (waist circumference ?85 cm for men and ?90 cm for women). Physical parameters, blood tests, nutritional intake, and self-care behavior were compared at baseline and after the intervention. Results: A total of 48 participants provided completed data for analysis, which yielded a study retention rate of 100%. The average age was 46.8 (SD 6.8) years, and 92% (44/48) of participants were male. The overall average measurement rate of DialBeticsLite, calculated by dividing the number of days with at least one measurement by the number of days of the intervention, was 98.6% (SD 3.4%). In total, 85% (41/48) of the participants reported that their participation in the study helped them to improve their lifestyle. BMI, waist circumference, and visceral fat area decreased significantly after the intervention (P<.001). In addition, the daily calorie intake reduced significantly (P=.02). There was a significant improvement in self-care behavior in terms of exercise and diet (P=.001). Conclusions: Using DialBeticsLite was shown to be a feasible and potentially effective method for reducing AO by providing users with a motivational framework to evaluate their lifestyle behaviors. UR - https://diabetes.jmir.org/2022/4/e40366 UR - http://dx.doi.org/10.2196/40366 UR - http://www.ncbi.nlm.nih.gov/pubmed/36441577 ID - info:doi/10.2196/40366 ER - TY - JOUR AU - Yan, Qin AU - Gong, Yanhong AU - Luo, Qing AU - Yin, Xiaoxv AU - Yang, Ling AU - Wang, Honglin AU - Feng, Juan AU - Xing, Kaihui AU - Huang, Yan AU - Huang, Chuican AU - Fan, Lichun PY - 2022/11/23 TI - Effects of a Smartphone-Based Out-of-Hospital Screening App for Neonatal Hyperbilirubinemia on Neonatal Readmission Rates and Maternal Anxiety: Randomized Controlled Trial JO - J Med Internet Res SP - e37843 VL - 24 IS - 11 KW - eHealth KW - mHealth KW - mobile apps KW - maternal anxiety KW - neonatal jaundice KW - neonatal readmission KW - neonatal screening KW - mobile phone N2 - Background: Neonatal hyperbilirubinemia is one of the leading causes of neonatal readmission?especially severe hyperbilirubinemia and its complications?and it influences disease burden as well as neonatal and maternal health. Smartphones have been shown to have satisfactory accuracy in screening neonatal bilirubin levels, but the impact of this technology on neonatal health care service and maternal health outcomes is still unknown. Objective: The aim of this study was to evaluate the impact of a smartphone-based out-of-hospital neonatal jaundice screening program on neonatal readmission rates for jaundice and related maternal anxiety. Methods: This was a 2-arm, unblinded, randomized controlled trial with 30 days of intervention and follow-up periods. From August 2019 to August 2020, healthy mother-infant dyads were recruited on-site from 3 public hospitals in Hainan, China. Intervention group mothers used the smartphone app to routinely monitor neonatal jaundice at home under the web-based guidance of pediatricians. Control group participants received routine care. The primary study outcome was the neonatal readmission rate due to jaundice within 30 days of the first hospital discharge. The secondary outcome was the maternal anxiety score associated with neonatal jaundice. The data were collected through a self-assessed questionnaire. All participants were included in the analysis (intention-to-treat). Results: In this study, 1424 mother-infant dyads were recruited, comprising 1424 mothers and 1424 newborns. The median ageof the mothers was 29 (IQR 26-32) years, and there were 714 (50.1%) male neonates. These mother-infant dyads were randomlyassigned to the intervention group and the control group, with 712 dyads in each group; only 1187 of these dyads completed thefollow-up. We found that the adjusted 30-day neonatal readmission rate due to jaundice reduced by 10.5% (71/605, 11.7% vs141/582, 24.2%; 95% CI 5%-15.9%; odds ratio 0.4, 95% CI 0.3-0.5; P<.001) and the relevant maternal anxiety mean scoredecreased by 3.6 (95% CI ?4.4 to ?2.8; ?=?3.6, 95% CI ?4.5 to ?2.8; P<.001) in the intervention group compared to those in theroutine care group. Conclusions: Our study shows that the smartphone-based out-of-hospital screening method for neonatal hyperbilirubinemia decreased the neonatal readmission rate within 30 days from the first discharge and improved maternal mental health to some degree, thus demonstrating the usefulness of this screening app for follow-up in pediatric care. Trial Registration: China Clinical Trial Registration Center, ChiCTR2100049567; http://www.chictr.org.cn/showproj.aspx?proj=64245 UR - https://www.jmir.org/2022/11/e37843 UR - http://dx.doi.org/10.2196/37843 UR - http://www.ncbi.nlm.nih.gov/pubmed/36416882 ID - info:doi/10.2196/37843 ER - TY - JOUR AU - Huberty, Jennifer AU - Bhuiyan, Nishat AU - Puzia, Megan AU - Joeman, Lynda AU - Larkey, Linda AU - Mesa, Ruben PY - 2022/11/23 TI - Meditation Mobile App Developed for Patients With and Survivors of Cancer: Feasibility Randomized Controlled Trial JO - JMIR Cancer SP - e39228 VL - 8 IS - 4 KW - cancer KW - mobile health KW - mHealth KW - meditation KW - feasibility KW - mobile phone N2 - Background: To address the unmet need for a commercial cancer-specific meditation app, we leveraged a long-standing partnership with a consumer-based app (ie, Calm) to develop the first commercial meditation app prototype adapted specifically for the needs of patients with cancer. Input was obtained at both the individual user and clinic levels (ie, patients with and survivors of cancer and health care providers). Objective: This study aimed to determine the feasibility of a cancer-specific meditation app prototype. Methods: Patients with and survivors of cancer who were recruited and enrolled in the feasibility randomized controlled trial were asked to use the prototype app daily (?70 minutes per week) for 4 weeks. Participants completed web-based weekly questionnaires and a final poststudy questionnaire and were asked to participate in an optional web-based poststudy interview. The questionnaires and interviews covered the following feasibility categories: acceptability, demand, practicality, and adaptation. Results: A total of 36 patients with and survivors of cancer completed the baseline questionnaire, 18 completed the final questionnaire, and 6 completed the optional interviews. Weekly and poststudy questionnaires indicated high overall enjoyment, ease of use, and satisfaction with the app content, aesthetics, and graphics. The objective use data indicated that the average total app use rate was 73.39 (SD 7.12) minutes per week. Interviews (N=6) revealed positive and mixed responses to the app prototype and informative differences related to preferences for narrators, emotional content, and meditation teaching but an overall appreciation for the variety of options. Conclusions: The most likely candidates for moving from cancer-specific meditation apps to dissemination are through partnering with the industry, in which name recognition and market distribution are already established (even showing a base of users from the targeted population with cancer). This study established the feasibility of a cancer-specific mobile meditation app prototype for patients with and survivors of cancer, using a commercially available app. The quantitative and qualitative data demonstrated the acceptability, demand, practicality, and adaptation of the prototype. Improvements suggested by the participants will be considered in the final app design before testing the efficacy of the app in a future study. Trial Registration: Clinicaltrials.gov NCT05459168; https://clinicaltrials.gov/ct2/show/record/NCT05459168 UR - https://cancer.jmir.org/2022/4/e39228 UR - http://dx.doi.org/10.2196/39228 UR - http://www.ncbi.nlm.nih.gov/pubmed/36416880 ID - info:doi/10.2196/39228 ER - TY - JOUR AU - Polhemus, Ashley AU - Simblett, Sara AU - Dawe-Lane, Erin AU - Gilpin, Gina AU - Elliott, Benjamin AU - Jilka, Sagar AU - Novak, Jan AU - Nica, Ileana Raluca AU - Temesi, Gergely AU - Wykes, Til PY - 2022/11/23 TI - Health Tracking via Mobile Apps for Depression Self-management: Qualitative Content Analysis of User Reviews JO - JMIR Hum Factors SP - e40133 VL - 9 IS - 4 KW - depression KW - mental health KW - health tracking KW - self-management KW - data visualization KW - mobile phone N2 - Background: Tracking and visualizing health data using mobile apps can be an effective self-management strategy for mental health conditions. However, little evidence is available to guide the design of mental health?tracking mechanisms. Objective: The aim of this study was to analyze the content of user reviews of depression self-management apps to guide the design of data tracking and visualization mechanisms for future apps. Methods: We systematically reviewed depression self-management apps on Google Play and iOS App stores. English-language reviews of eligible apps published between January 1, 2018, and December 31, 2021, were extracted from the app stores. Reviews that referenced health tracking and data visualization were included in sentiment and qualitative framework analyses. Results: The search identified 130 unique apps, 26 (20%) of which were eligible for inclusion. We included 783 reviews in the framework analysis, revealing 3 themes. Impact of app-based mental health tracking described how apps increased reviewers? self-awareness and ultimately enabled condition self-management. The theme designing impactful mental health?tracking apps described reviewers? feedback and requests for app features during data reporting, review, and visualization. It also described the desire for customization and contexts that moderated reviewer preference. Finally, implementing impactful mental health?tracking apps described considerations for integrating apps into a larger health ecosystem, as well as the influence of paywalls and technical issues on mental health tracking. Conclusions: App-based mental health tracking supports depression self-management when features align with users? individual needs and goals. Heterogeneous needs and preferences raise the need for flexibility in app design, posing challenges for app developers. Further research should prioritize the features based on their importance and impact on users. UR - https://humanfactors.jmir.org/2022/4/e40133 UR - http://dx.doi.org/10.2196/40133 UR - http://www.ncbi.nlm.nih.gov/pubmed/36416875 ID - info:doi/10.2196/40133 ER - TY - JOUR AU - Moxley, Jerad AU - Sharit, Joseph AU - Czaja, J. Sara PY - 2022/11/23 TI - The Factors Influencing Older Adults? Decisions Surrounding Adoption of Technology: Quantitative Experimental Study JO - JMIR Aging SP - e39890 VL - 5 IS - 4 KW - aging KW - technology KW - design KW - older adult KW - application KW - independence KW - relationship KW - adopt KW - transportation KW - leisure KW - health KW - learning KW - adoption KW - cognition KW - cognitive KW - willingness KW - marketing KW - consumer KW - mobile phone N2 - Background: The rapid diffusion of technology apps may support older adults? independence and improve the quality of their lives. Models for predicting technology acceptance in older adults are sparse, based on broad questions related to general technology acceptance, and largely not grounded in theories of aging. Objective: This study aimed to use a mixed methods approach involving 5 technologies to comprehensively assess the causal relationships among factors that influence older adults? willingness to adopt the technologies. Methods: In total, 187 men and women aged 65 to 92 years participated in the study. Participants were given presentations on 5 different technologies spanning domains that included transportation, leisure, health, and new learning and provided ratings of each technology on various measures hypothesized to influence adoption. They were also administered other instruments to collect data on their actual and self-assessed cognitive abilities, rates of discounting of the technologies with respect to willingness to invest time to attain higher skills in the technologies, general technology experience, and attitudes toward technology. We used the machine learning technique of k-fold cross-validated regressions to select variables that predicted participants? willingness to adopt the technologies. Results: Willingness to adopt technologies was most impacted by 3 variables: perceived value of the technologies (?=.54), perceived improvement in quality of life attainable from the technologies (?=.24), and confidence in being able to use the technologies (?=.15). These variables, in turn, were mostly facilitated or inhibited by the perceived effort required to learn to use the technologies, a positive attitude toward technology as reflected in the optimism component of the technology readiness scale, the degree to which technologies were discounted, and the perceived help needed to learn to use the technologies. Conclusions: Our findings demonstrate that participants? willingness to adopt technologies is mainly determined by perceptions of 3 aspects of the technologies; these aspects possibly mediate many relationships with willingness to adopt. We discuss the implications of these findings for the design and marketing of technology products for older consumers. UR - https://aging.jmir.org/2022/4/e39890 UR - http://dx.doi.org/10.2196/39890 UR - http://www.ncbi.nlm.nih.gov/pubmed/36416885 ID - info:doi/10.2196/39890 ER - TY - JOUR AU - Khusial, Rishi AU - van Koppen, Sophia AU - Honkoop, Persijn AU - Rijssenbeek-Nouwens, Lucia AU - Fieten, Berthine Karin AU - Keij, Sascha AU - Drijver-Messelink, Marieke AU - Sont, Jacob PY - 2022/11/22 TI - Patients? and Health Care Providers? Perceptions on mHealth Use After High-Altitude Climate Therapy for Severe Asthma: Mixed Methods Study JO - JMIR Form Res SP - e26925 VL - 6 IS - 11 KW - eHealth KW - mobile health KW - mHealth KW - asthma KW - self-management KW - home monitoring KW - mobile phone N2 - Background: Asthma is a common chronic disease with various clinical presentations. Although most patients are able to reach good asthma control, some patients are not able to reach sufficient asthma control following the regular treatment guidelines and could be referred to high-altitude climate therapy (HACT). HACT includes environmental trigger avoidance in the alpine climate with multidisciplinary clinical treatment. Patients with severe and difficult-to-control asthma, who are unable to reach asthma control at sea level, can follow a 12-week lung rehabilitation program at 1600 m above sea level. Mobile health (mHealth) tools can be used to enhance self-management in these patients when they return home. For an mHealth system to be effective, it must meet the expectations of the end users. Objective: In this Davos@home study, we explored the attitudes toward mHealth aimed at supporting the self-management of patients with severe, difficult-to-control asthma who underwent HACT and asthma health care providers. Methods: In the first stage, interviews with referrers to HACT and focus groups with patients with asthma who participated in or completed HACT were conducted. The data were then analyzed thematically. On the basis of these results, a questionnaire was developed. In the second stage of the study, this questionnaire, combined with the Asthma Control Questionnaire and the Individual Innovativeness Questionnaire, was provided to patients who completed HACT. Results: In total, 11 interviews and 3 focus groups (n=18, age 47.6, SD 12.1 years, Asthma Control Questionnaire score 2.6, SD 1.0) were conducted. A total of 3 themes were identified: potential goals, useful measurements, and perceived barriers and facilitators. The questionnaire developed in stage 2 included items based on these results. The most agreed-upon goal among the 52 patients who completed the questionnaire was to increase their asthma control (45/52, 86% of the patients). Conclusions: Different patients reported that they would benefit the most from different functionalities. Therefore, it is important to tailor functionalities to individual (treatment) goals. When developing an mHealth intervention, it is important to allow personalization to avoid overwhelming the users. UR - https://formative.jmir.org/2022/11/e26925 UR - http://dx.doi.org/10.2196/26925 UR - http://www.ncbi.nlm.nih.gov/pubmed/36413384 ID - info:doi/10.2196/26925 ER - TY - JOUR AU - Moyen, Audrey AU - Rappaport, Ilysse Aviva AU - Fleurent-Grégoire, Chloé AU - Tessier, Anne-Julie AU - Brazeau, Anne-Sophie AU - Chevalier, Stéphanie PY - 2022/11/21 TI - Relative Validation of an Artificial Intelligence?Enhanced, Image-Assisted Mobile App for Dietary Assessment in Adults: Randomized Crossover Study JO - J Med Internet Res SP - e40449 VL - 24 IS - 11 KW - dietary intake KW - dietary assessment KW - food diary KW - food records KW - automated self-administered 24-hour recall KW - ASA24 KW - Keenoa N2 - Background: Thorough dietary assessment is essential to obtain accurate food and nutrient intake data yet challenging because of the limitations of current methods. Image-based methods may decrease energy underreporting and increase the validity of self-reported dietary intake. Keenoa is an image-assisted food diary that integrates artificial intelligence food recognition. We hypothesized that Keenoa is as valid for dietary assessment as the automated self-administered 24-hour recall (ASA24)?Canada and better appreciated by users. Objective: We aimed to evaluate the relative validity of Keenoa against a 24-hour validated web-based food recall platform (ASA24) in both healthy individuals and those living with diabetes. Secondary objectives were to compare the proportion of under- and overreporters between tools and to assess the user?s appreciation of the tools. Methods: We used a randomized crossover design, and participants completed 4 days of Keenoa food tracking and 4 days of ASA24 food recalls. The System Usability Scale was used to assess perceived ease of use. Differences in reported intakes were analyzed using 2-tailed paired t tests or Wilcoxon signed-rank test and deattenuated correlations by Spearman coefficient. Agreement and bias were determined using the Bland-Altman test. Weighted Cohen ? was used for cross-classification analysis. Energy underreporting was defined as a ratio of reported energy intake to estimated resting energy expenditure <0.9. Results: A total of 136 participants were included (mean 46.1, SD 14.6 years; 49/136, 36% men; 31/136, 22.8% with diabetes). The average reported energy intakes (kcal/d) were 2171 (SD 553) in men with Keenoa and 2118 (SD 566) in men with ASA24 (P=.38) and, in women, 1804 (SD 404) with Keenoa and 1784 (SD 389) with ASA24 (P=.61). The overall mean difference (kcal/d) was ?32 (95% CI ?97 to 33), with limits of agreement of ?789 to 725, indicating acceptable agreement between tools without bias. Mean reported macronutrient, calcium, potassium, and folate intakes did not significantly differ between tools. Reported fiber and iron intakes were higher, and sodium intake lower, with Keenoa than ASA24. Intakes in all macronutrients (r=0.48-0.73) and micronutrients analyzed (r=0.40-0.74) were correlated (all P<.05) between tools. Weighted Cohen ? scores ranged from 0.30 to 0.52 (all P<.001). The underreporting rate was 8.8% (12/136) with both tools. Mean System Usability Scale scores were higher for Keenoa than ASA24 (77/100, 77% vs 53/100, 53%; P<.001); 74.8% (101/135) of participants preferred Keenoa. Conclusions: The Keenoa app showed moderate to strong relative validity against ASA24 for energy, macronutrient, and most micronutrient intakes analyzed in healthy adults and those with diabetes. Keenoa is a new, alternative tool that may facilitate the work of dietitians and nutrition researchers. The perceived ease of use may improve food-tracking adherence over longer periods. UR - https://www.jmir.org/2022/11/e40449 UR - http://dx.doi.org/10.2196/40449 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409539 ID - info:doi/10.2196/40449 ER - TY - JOUR AU - Guo, C. Christine AU - Chiesa, Andrea Patrizia AU - de Moor, Carl AU - Fazeli, Sohail Mir AU - Schofield, Thomas AU - Hofer, Kimberly AU - Belachew, Shibeshih AU - Scotland, Alf PY - 2022/11/21 TI - Digital Devices for Assessing Motor Functions in Mobility-Impaired and Healthy Populations: Systematic Literature Review JO - J Med Internet Res SP - e37683 VL - 24 IS - 11 KW - motor function KW - medical devices KW - computers KW - handheld KW - smartwatch KW - smartphone KW - mobility KW - wearable electronic devices KW - Parkinson disease KW - Parkinsonian disorders KW - gait KW - mobile phone N2 - Background: With the advent of smart sensing technology, mobile and wearable devices can provide continuous and objective monitoring and assessment of motor function outcomes. Objective: We aimed to describe the existing scientific literature on wearable and mobile technologies that are being used or tested for assessing motor functions in mobility-impaired and healthy adults and to evaluate the degree to which these devices provide clinically valid measures of motor function in these populations. Methods: A systematic literature review was conducted by searching Embase, MEDLINE, CENTRAL (January 1, 2015, to June 24, 2020), the United States and European Union clinical trial registries, and the United States Food and Drug Administration website using predefined study selection criteria. Study selection, data extraction, and quality assessment were performed by 2 independent reviewers. Results: A total of 91 publications representing 87 unique studies were included. The most represented clinical conditions were Parkinson disease (n=51 studies), followed by stroke (n=5), Huntington disease (n=5), and multiple sclerosis (n=2). A total of 42 motion-detecting devices were identified, and the majority (n=27, 64%) were created for the purpose of health care?related data collection, although approximately 25% were personal electronic devices (eg, smartphones and watches) and 11% were entertainment consoles (eg, Microsoft Kinect or Xbox and Nintendo Wii). The primary motion outcomes were related to gait (n=30), gross motor movements (n=25), and fine motor movements (n=23). As a group, sensor-derived motion data showed a mean sensitivity of 0.83 (SD 7.27), a mean specificity of 0.84 (SD 15.40), a mean accuracy of 0.90 (SD 5.87) in discriminating between diseased individuals and healthy controls, and a mean Pearson r validity coefficient of 0.52 (SD 0.22) relative to clinical measures. We did not find significant differences in the degree of validity between in-laboratory and at-home sensor-based assessments nor between device class (ie, health care?related device, personal electronic devices, and entertainment consoles). Conclusions: Sensor-derived motion data can be leveraged to classify and quantify disease status for a variety of neurological conditions. However, most of the recent research on digital clinical measures is derived from proof-of-concept studies with considerable variation in methodological approaches, and much of the reviewed literature has focused on clinical validation, with less than one-quarter of the studies performing analytical validation. Overall, future research is crucially needed to further consolidate that sensor-derived motion data may lead to the development of robust and transformative digital measurements intended to predict, diagnose, and quantify neurological disease state and its longitudinal change. UR - https://www.jmir.org/2022/11/e37683 UR - http://dx.doi.org/10.2196/37683 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409538 ID - info:doi/10.2196/37683 ER - TY - JOUR AU - Anugu, Pramod AU - Ansari, Yusuf Md Abu AU - Min, Yuan-I AU - Benjamin, J. Emelia AU - Murabito, Joanne AU - Winters, Karen AU - Turner, Erica AU - Correa, Adolfo PY - 2022/11/21 TI - Digital Connectedness in the Jackson Heart Study: Cross-sectional Study JO - J Med Internet Res SP - e37501 VL - 24 IS - 11 KW - teleresearch KW - mobile technology KW - cardiovascular disease KW - Jackson Heart Study KW - mobile phone N2 - Background: Although new approaches for data collection, such as mobile technology and teleresearch, have demonstrated new opportunities for the conduct of more timely and less costly surveys in community-based studies, literature on the feasibility of conducing cardiovascular disease research using mobile health (mHealth) platforms among middle-aged and older African Americans has been limited. Objective: The purpose of this study was to contribute to the knowledge regarding the penetrance of internet and mobile technologies, such as cellphones or smartphones in existing large cohort studies of cardiovascular disease. Methods: A digital connectedness survey was conducted in the Jackson Heart Study (JHS), a Mississippi-based African American cohort study, as part of the annual follow-up calls with participants from July 2017 to February 2019. Results: Of the 4024 participants contacted, 2564 (63.7%) completed the survey. Among survey respondents, 2262 (88.2%) reported use of internet or cellphone, and 1593 (62.1%) had a smartphone. Compared to nonusers (n=302), internet or cellphone users (n=2262) were younger (mean age 80.1, SD 8.0 vs 68.2, SD 11.3 years), more likely to be affluent (n=778, 40.1% vs n=39, 15.4%), and had greater than high school education (n=1636, 72.5% vs n=85, 28.1%). Internet or cellphone users were less likely to have cardiovascular disease history compared to nonusers (136/2262, 6.6% vs 41/302, 15.8%). The prevalence of current smoking and average BMI were similar between internet or cellphone users and nonusers. Among internet or cellphone users, 1316 (58.3%) reported use of email, 504 (22.3%) reported use of apps to track or manage health, and 1269 (56.1%) expressed interest in using JHS-developed apps. Conclusions: Our findings suggest that it is feasible to use mHealth technologies to collect survey data among African Americans already enrolled in a longitudinal study. Our findings also highlight the need for more efforts to reduce the age and education divide in access and use of internet and smartphones for tracking health and research in African American communities. UR - https://www.jmir.org/2022/11/e37501 UR - http://dx.doi.org/10.2196/37501 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409531 ID - info:doi/10.2196/37501 ER - TY - JOUR AU - Ong, Yi Wen AU - Sündermann, Oliver PY - 2022/11/21 TI - Efficacy of the Mental Health App ?Intellect? to Improve Body Image and Self-compassion in Young Adults: A Randomized Controlled Trial With a 4-Week Follow-up JO - JMIR Mhealth Uhealth SP - e41800 VL - 10 IS - 11 KW - body image KW - body image program KW - mobile health app KW - mHealth app KW - mobile-based interventions KW - dissonance-based interventions KW - self-compassion N2 - Background: Body image concerns are prevalent among young adults, who may be vulnerable to developing body image concerns because of particular risk factors associated with this life period. With technological advancements, digital mobile health (mHealth) apps are cost-effective and scalable interventions. Thus, mHealth apps can be explored as a form of prevention effort to alleviate body image concerns in young adults. Objective: In this randomized controlled trial, we examined the effectiveness of a self-guided mHealth app in improving body image and self-compassion in a sample of university students. Methods: Participants (N=310) were randomized to a 9-day self-guided body image and self-compassion mHealth app (n=149) and to an active waitlist control group (n=161), where they completed a similarly structured 9-day program on cooperation. Both programs consisted of content learning and activities such as quizzes, with the number and length of activities matched for both programs. Measures were obtained at baseline, upon completion of the programs (after the intervention), and at 4-week follow-up. Results: The intervention group for female participants reported significant reduction in body dissatisfaction (P<.001) and improvements in body appreciation (P<.001) and self-compassion (P=.001) compared with the active waitlist control group after the intervention. Similarly, for male participants after the intervention, a significant reduction was found in the intervention group in body dissatisfaction (P<.001) after the intervention as well as improvements in body appreciation (P=.02) and self-compassion (P=.047). The effects were maintained at 4-week follow-up for female participants on body dissatisfaction (P<.001), body appreciation (P<.001), and self-compassion (P=.02) but not for male participants. On body image risk factors, significant reductions were found for female participants after the intervention for thin-ideal internalization (P<.001), peer pressure (P=.002), and media pressure (P<.001) after the intervention, while the effects were only maintained for thin-ideal internalization (P=.008) and media pressure (P=.01) at 4-week follow-up, compared with the active waitlist control group. As for male participants, no intervention effects were found both after the intervention and at follow-up for all body image risk factors of muscularity internalization, peer pressure, and media pressure. Both apps were acceptable and participants engaged equally across the intervention and active waitlist control groups, as indicated on a measure of app engagement (P=.76). Conclusions: This study provides preliminary evidence for a self-guided mHealth app in improving body image concerns and self-compassion in young adult university students. Future studies should include longer follow-ups, and examine its effects with the wider populations of young adults. Trial Registration: ClinicalTrials.gov NCT04977973; https://clinicaltrials.gov/ct2/show/NCT04977973 UR - https://mhealth.jmir.org/2022/11/e41800 UR - http://dx.doi.org/10.2196/41800 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409542 ID - info:doi/10.2196/41800 ER - TY - JOUR AU - Acien, Alejandro AU - Morales, Aythami AU - Vera-Rodriguez, Ruben AU - Fierrez, Julian AU - Mondesire-Crump, Ijah AU - Arroyo-Gallego, Teresa PY - 2022/11/21 TI - Detection of Mental Fatigue in the General Population: Feasibility Study of Keystroke Dynamics as a Real-world Biomarker JO - JMIR Biomed Eng SP - e41003 VL - 7 IS - 2 KW - fatigue KW - keystroke KW - biometrics KW - digital biomarker KW - TypeNet KW - domain adaptation KW - fatigue detection KW - typing patterns KW - circadian cycles KW - mental fatigue KW - psychomotor patterns KW - monitoring KW - mental health KW - keystroke dynamics N2 - Background: Mental fatigue is a common and potentially debilitating state that can affect individuals? health and quality of life. In some cases, its manifestation can precede or mask early signs of other serious mental or physiological conditions. Detecting and assessing mental fatigue can be challenging nowadays as it relies on self-evaluation and rating questionnaires, which are highly influenced by subjective bias. Introducing more objective, quantitative, and sensitive methods to characterize mental fatigue could be critical to improve its management and the understanding of its connection to other clinical conditions. Objective: This paper aimed to study the feasibility of using keystroke biometrics for mental fatigue detection during natural typing. As typing involves multiple motor and cognitive processes that are affected by mental fatigue, our hypothesis was that the information captured in keystroke dynamics can offer an interesting mean to characterize users? mental fatigue in a real-world setting. Methods: We apply domain transformation techniques to adapt and transform TypeNet, a state-of-the-art deep neural network, originally intended for user authentication, to generate a network optimized for the fatigue detection task. All experiments were conducted using 3 keystroke databases that comprise different contexts and data collection protocols. Results: Our preliminary results showed area under the curve performances ranging between 72.2% and 80% for fatigue versus rested sample classification, which is aligned with previously published models on daily alertness and circadian cycles. This demonstrates the potential of our proposed system to characterize mental fatigue fluctuations via natural typing patterns. Finally, we studied the performance of an active detection approach that leverages the continuous nature of keystroke biometric patterns for the assessment of users? fatigue in real time. Conclusions: Our results suggest that the psychomotor patterns that characterize mental fatigue manifest during natural typing, which can be quantified via automated analysis of users? daily interaction with their device. These findings represent a step towards the development of a more objective, accessible, and transparent solution to monitor mental fatigue in a real-world environment. UR - https://biomedeng.jmir.org/2022/2/e41003 UR - http://dx.doi.org/10.2196/41003 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875698 ID - info:doi/10.2196/41003 ER - TY - JOUR AU - Fee, Connie AU - Fuller, Julia AU - Guss, E. Carly AU - Woods, R. Elizabeth AU - Cooper, R. Ellen AU - Bhaumik, Urmi AU - Graham, Dionne AU - Burchett, K. Sandra AU - Dumont, Olivia AU - Martey, B. Emily AU - Narvaez, Maria AU - Haberer, E. Jessica AU - Swendeman, Dallas AU - Mulvaney, A. Shelagh AU - Kumar, S. Vikram AU - Jackson, L. Jonathan AU - Ho, Xian Y. PY - 2022/11/21 TI - A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study JO - JMIR Form Res SP - e39357 VL - 6 IS - 11 KW - HIV KW - case management KW - youth KW - young adult KW - mobile health KW - mHealth KW - digital health KW - mobile phone N2 - Background: Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. Objective: The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). Methods: We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. Results: The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study. Conclusions: Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life. Trial Registration: ClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT03758066 UR - https://formative.jmir.org/2022/11/e39357 UR - http://dx.doi.org/10.2196/39357 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409541 ID - info:doi/10.2196/39357 ER - TY - JOUR AU - Burbach, Frank AU - Lecce, Francesca AU - Allen, E. Victoria M. AU - Porter, M. Catherine PY - 2022/11/21 TI - A Conversational, Virtual, Avatar-Led Cognitive Behavioral Therapy App Intervention for Improving the Quality of Life and Mental Health of People With Epilepsy: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e40261 VL - 11 IS - 11 KW - epilepsy KW - mental health KW - anxiety KW - depression KW - quality of life KW - cognitive behavioral therapy KW - digital therapy KW - smartphone KW - mobile phone KW - app N2 - Background: Epilepsy is a common neurological disorder affecting about 1 in 100 people in the United Kingdom. Many individuals experience a lower quality of life as a result of their epilepsy diagnosis and are more likely to develop mental health problems, such as anxiety and depression. Medical interventions for this client group tend to focus on the treatment of seizures, whereas mental health disorders often remain undiagnosed and untreated. Early identification and treatment of mental health difficulties in people with epilepsy are vital to ensure better outcomes and improvements in quality of life. Objective: The aim of this exploratory randomized controlled trial is to evaluate whether an 8-week cognitive behavioral therapy?based intervention delivered through a mobile app?ThinkNinja for Epilepsy?is a clinically effective tool to improve quality of life, mental health, and emotional well-being in a large sample of people with epilepsy and anxiety or comorbid anxiety and depression. Methods: The study aims to recruit 184 individuals, 18 to 65 years of age, with a self-reported diagnosis of epilepsy and anxiety or comorbid anxiety and depression. Participants will be randomly assigned to the ThinkNinja for Epilepsy app condition (arm A) or the waiting-list control group (arm B). Participants in arm A will receive access to the ThinkNinja for Epilepsy app first. After 8 weeks, participants in arm B will receive the same full access to the ThinkNinja for Epilepsy app as the participants in arm A. This design will allow an initial between-subjects analysis between the two conditions as well as a within-subject analysis including all participants. The primary outcome is participants? quality of life, measured by the 10-item patient-weighted Quality of Life in Epilepsy questionnaire. The secondary outcomes include measures of anxiety, using the 7-item Generalized Anxiety Disorder assessment; depression, using the 9-item Patient Health Questionnaire; medication adherence, using the Medication Adherence Questionnaire; and impression of change, using the Patient Global Impression of Change questionnaire. Results: Recruitment for this study began in March 2022 and was completed in October 2022. We expect data collection to be finalized by May 2023 and study results to be available within 12 months of the final data collection date. Results of the study will be written up as soon as possible thereafter, with the intention of publishing the outcomes in high-quality peer-reviewed journals. Conclusions: This study aims to determine the clinical efficacy and safety of the ThinkNinja for Epilepsy intervention at improving the quality of life, mental health, and emotional well-being of people with epilepsy. The findings from our study will hopefully contribute to addressing the critical gap in universal provision and accessibility of mental health and emotional well-being support for people with epilepsy. Trial Registration: ISRCTN Registry 16270209 (04/03/2022); https://www.isrctn.com/ISRCTN16270209 International Registered Report Identifier (IRRID): DERR1-10.2196/40261 UR - https://www.researchprotocols.org/2022/11/e40261 UR - http://dx.doi.org/10.2196/40261 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409536 ID - info:doi/10.2196/40261 ER - TY - JOUR AU - Berdahl, T. Carl AU - Henreid, J. Andrew AU - Pevnick, M. Joshua AU - Zheng, Kai AU - Nuckols, K. Teryl PY - 2022/11/17 TI - Digital Tools Designed to Obtain the History of Present Illness From Patients: Scoping Review JO - J Med Internet Res SP - e36074 VL - 24 IS - 11 KW - anamnesis KW - informatics KW - emergency medicine KW - human-computer interaction KW - medical history taking KW - mobile phone N2 - Background: Many medical conditions, perhaps 80% of them, can be diagnosed by taking a thorough history of present illness (HPI). However, in the clinical setting, situational factors such as interruptions and time pressure may cause interactions with patients to be brief and fragmented. One solution for improving clinicians? ability to collect a thorough HPI and maximize efficiency and quality of care could be to use a digital tool to obtain the HPI before face-to-face evaluation by a clinician. Objective: Our objective was to identify and characterize digital tools that have been designed to obtain the HPI directly from patients or caregivers and present this information to clinicians before a face-to-face encounter. We also sought to describe outcomes reported in testing of these tools, especially those related to usability, efficiency, and quality of care. Methods: We conducted a scoping review using predefined search terms in the following databases: MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, IEEE Xplore Digital Library, ACM Digital Library, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts for relevance, performed full-text reviews of articles meeting the inclusion criteria, and used a pile-sorting procedure to identify distinguishing characteristics of the tools. Information describing the tools was primarily obtained from identified peer-reviewed sources; in addition, supplementary information was obtained from tool websites and through direct communications with tool creators. Results: We identified 18 tools meeting the inclusion criteria. Of these 18 tools, 14 (78%) used primarily closed-ended and multiple-choice questions, 1 (6%) used free-text input, and 3 (17%) used conversational (chatbot) style. More than half (10/18, 56%) of the tools were tailored to specific patient subpopulations; the remaining (8/18, 44%) tools did not specify a target subpopulation. Of the 18 tools, 7 (39%) included multilingual support, and 12 (67%) had the capability to transfer data directly into the electronic health record. Studies of the tools reported on various outcome measures related to usability, efficiency, and quality of care. Conclusions: The HPI tools we identified (N=18) varied greatly in their purpose and functionality. There was no consensus on how patient-generated information should be collected or presented to clinicians. Existing tools have undergone inconsistent levels of testing, with a wide variety of different outcome measures used in evaluation, including some related to usability, efficiency, and quality of care. There is substantial interest in using digital tools to obtain the HPI from patients, but the outcomes measured have been inconsistent. Future research should focus on whether using HPI tools can lead to improved patient experience and health outcomes, although surrogate end points could instead be used so long as patient safety is monitored. UR - https://www.jmir.org/2022/11/e36074 UR - http://dx.doi.org/10.2196/36074 UR - http://www.ncbi.nlm.nih.gov/pubmed/36394945 ID - info:doi/10.2196/36074 ER - TY - JOUR AU - Akinsulore, Adesanmi AU - Aloba, Olutayo AU - Oginni, Olakunle AU - Oloniniyi, Ibidunni AU - Ibigbami, Olanrewaju AU - Seun-Fadipe, Tobi Champion AU - Opakunle, Tolulope AU - Owojuyigbe, Muyiwa Afolabi AU - Olibamoyo, Olushola AU - Mapayi, Boladale AU - Okorie, Ogbonnaya Victor AU - Adewuya, Olugbenga Abiodun PY - 2022/11/16 TI - Developing an mHealth Intervention to Reduce COVID-19?Associated Psychological Distress Among Health Care Workers in Nigeria: Protocol for a Design and Feasibility Study JO - JMIR Res Protoc SP - e36174 VL - 11 IS - 11 KW - COVID-19 KW - psychological distress KW - Nigeria KW - health care workers KW - mental health KW - well-being KW - pandemic KW - mHealth KW - mobile health KW - digital health intervention KW - health intervention KW - health care KW - smartphone KW - mobile phone N2 - Background: Globally, COVID-19?related psychological distress is seriously eroding health care workers? mental health and well-being, especially in low-income countries like Nigeria. The use of mobile health (mHealth) interventions is now increasingly recognized as an innovative approach that may improve mental health and well-being. This project aims to develop an mHealth psychological intervention (mPsyI) to reduce COVID-19?related psychological distress among health care workers in Nigeria. Objective: Our objective is to present a study protocol to determine the level of COVID-19?related psychological distress among health care workers in Nigeria; explore health care workers? experience of COVID-19?related psychological distress; develop and pilot test mPsyI to reduce this distress; and assess the feasibility of this intervention (such as usability, engagement, and satisfaction). Methods: A mixed (quantitative and qualitative) methods approach is used in which health care workers will be recruited from 2 tertiary health care facilities in southwest Nigeria. The study is divided into 4 phases based on the study objectives. Phase 1 involves a quantitative survey to assess the type and levels of psychosocial distress. Phase 2 collects qualitative data on psychosocial distress among health care workers. Phase 3 involves development of the mHealth-based psychological intervention, and phase 4 is a mixed methods study to assess the feasibility and acceptability of the intervention. Results: This study was funded in November 2020 by the Global Effort on COVID-19 Health Research, and collection of preliminary baseline data started in July 2021. Conclusions: This is the first study to report the development of an mHealth-based intervention to reduce COVID-19?related psychological distress among health care workers in Nigeria. Using a mixed methods design in this study can potentially facilitate the adaptation of an evidence-based treatment method that is culturally sensitive and cost-effective for the management of COVID-19?related psychological distress among health care workers in Nigeria. International Registered Report Identifier (IRRID): DERR1-10.2196/36174 UR - https://www.researchprotocols.org/2022/11/e36174 UR - http://dx.doi.org/10.2196/36174 UR - http://www.ncbi.nlm.nih.gov/pubmed/36318638 ID - info:doi/10.2196/36174 ER - TY - JOUR AU - Vilasi, Antonio AU - Panuccio, Antonio Vincenzo AU - Morante, Salvatore AU - Villa, Antonino AU - Versace, Carmela Maria AU - Mezzatesta, Sabrina AU - Mercuri, Sergio AU - Inguanta, Rosalinda AU - Aiello, Giuseppe AU - Cutrupi, Demetrio AU - Puglisi, Rossella AU - Capria, Salvatore AU - Li Vigni, Maurizio AU - Tripepi, Giovanni AU - Torino, Claudia PY - 2022/11/15 TI - Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study JO - JMIR Bioinform Biotech SP - e36766 VL - 3 IS - 1 KW - SMIT-CKD KW - mHealth KW - eHealth KW - CKD KW - therapy adherence KW - risk factor KW - kidney KW - adherence KW - integrated system KW - health app KW - monitoring KW - cardiology KW - cardiac KW - renal KW - chronic kidney disease KW - cardiovascular KW - mobile health KW - mobile app N2 - Background: Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. Objective: With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. Methods: The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. Results: The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. Conclusions: Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population. UR - https://bioinform.jmir.org/2022/1/e36766 UR - http://dx.doi.org/10.2196/36766 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/36766 ER - TY - JOUR AU - Lightfoot, J. Courtney AU - Wilkinson, J. Thomas AU - Hadjiconstantinou, Michelle AU - Graham-Brown, Matthew AU - Barratt, Jonathan AU - Brough, Christopher AU - Burton, O. James AU - Hainsworth, Jenny AU - Johnson, Vicki AU - Martinez, Maria AU - Nixon, C. Andrew AU - Pursey, Victoria AU - Schreder, Sally AU - Vadaszy, Noemi AU - Wilde, Lucina AU - Willingham, Fiona AU - Young, L. Hannah M. AU - Yates, Thomas AU - Davies, J. Melanie AU - Smith, C. Alice PY - 2022/11/14 TI - The Codevelopment of ?My Kidneys & Me?: A Digital Self-management Program for People With Chronic Kidney Disease JO - J Med Internet Res SP - e39657 VL - 24 IS - 11 KW - kidney disease awareness KW - kidney disease knowledge KW - program development KW - eHealth KW - digital health KW - telehealth KW - mobile health KW - mHealth KW - health promotion KW - self-management behaviors KW - mobile phone N2 - Background: Health care self-management is important for people living with nondialysis chronic kidney disease (CKD). However, the few available resources are of variable quality. Objective: This work describes the systematic codevelopment of ?My Kidneys & Me? (MK&M), a theory-driven and evidence-based digital self-management resource for people with nondialysis CKD, guided by an established process used for the successful development of the diabetes education program MyDESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed, DESMOND). Methods: A multidisciplinary steering group comprising kidney health care professionals and researchers and specialists in the development of complex interventions and digital health provided expertise in the clinical and psychosocial aspects of CKD, self-management, digital health, and behavior change. A patient and public involvement group helped identify the needs and priorities of MK&M and co-design the resource. MK&M was developed in 2 sequential phases. Phase 1 involved the codevelopment process of the MK&M resource (content and materials), using Intervention Mapping (IM) as a framework. The first 4 IM steps guided the development process: needs assessment was conducted to describe the context of the intervention; intervention outcomes, performance objectives, and behavioral determinants were identified; theory- and evidence-based change methods and practical strategies to deliver change methods were selected; and program components were developed and refined. Phase 2 involved the adoption and adaptation of the existing MyDESMOND digital platform to suit the MK&M resource. Results: The needs assessment identified that individuals with CKD have multiple differing needs and that delivering a self-management program digitally would enable accessible, tailored, and interactive information and support. The intended outcomes of MK&M were to improve and maintain effective self-management behaviors, including physical activity and lifestyle, improve knowledge, promote self-care skills, increase self-efficacy, and enhance well-being. This was achieved through the provision of content and materials designed to increase CKD knowledge and patient activation, reduce health risks, manage symptoms, and improve physical function. Theories and behavior change techniques selected include Self-Management Framework, Capability, Opportunity, Motivation Behavior model components of Behaviour Change Wheel and taxonomy of behavior change techniques, Health Action Process Approach Model, Common Sense Model, and Social Cognitive Theory. The program components developed comprised educational and behavior change sessions, health trackers (eg, monitoring blood pressure, symptoms, and exercise), goal-setting features, and forums for social support. The MyDESMOND digital platform represented an ideal existing platform to host MK&M; thus, the MyDESMOND interface and features were adopted and adapted for MK&M. Conclusions: Applying the IM framework enabled the systematic application of theory, empirical evidence, and practical perspectives in the codevelopment of MK&M content and materials. Adopting and adapting a preexisting platform provided a cost- and time-efficient approach for developing our digital intervention. In the next stage of work, the efficacy of MK&M in increasing patient activation will be tested in a randomized controlled trial. UR - https://www.jmir.org/2022/11/e39657 UR - http://dx.doi.org/10.2196/39657 UR - http://www.ncbi.nlm.nih.gov/pubmed/36374538 ID - info:doi/10.2196/39657 ER - TY - JOUR AU - Li, Xueying Sophia AU - Halabi, Ramzi AU - Selvarajan, Rahavi AU - Woerner, Molly AU - Fillipo, Griffith Isabell AU - Banerjee, Sreya AU - Mosser, Brittany AU - Jain, Felipe AU - Areán, Patricia AU - Pratap, Abhishek PY - 2022/11/14 TI - Recruitment and Retention in Remote Research: Learnings From a Large, Decentralized Real-world Study JO - JMIR Form Res SP - e40765 VL - 6 IS - 11 KW - participant recruitment KW - participant retention KW - decentralized studies KW - active and passive data collection KW - retention KW - adherence KW - compliance KW - engagement KW - smartphone KW - mobile health KW - mHealth KW - sensor data KW - clinical research KW - data sharing KW - recruitment KW - mobile phone N2 - Background: Smartphones are increasingly used in health research. They provide a continuous connection between participants and researchers to monitor long-term health trajectories of large populations at a fraction of the cost of traditional research studies. However, despite the potential of using smartphones in remote research, there is an urgent need to develop effective strategies to reach, recruit, and retain the target populations in a representative and equitable manner. Objective: We aimed to investigate the impact of combining different recruitment and incentive distribution approaches used in remote research on cohort characteristics and long-term retention. The real-world factors significantly impacting active and passive data collection were also evaluated. Methods: We conducted a secondary data analysis of participant recruitment and retention using data from a large remote observation study aimed at understanding real-world factors linked to cold, influenza, and the impact of traumatic brain injury on daily functioning. We conducted recruitment in 2 phases between March 15, 2020, and January 4, 2022. Over 10,000 smartphone owners in the United States were recruited to provide 12 weeks of daily surveys and smartphone-based passive-sensing data. Using multivariate statistics, we investigated the potential impact of different recruitment and incentive distribution approaches on cohort characteristics. Survival analysis was used to assess the effects of sociodemographic characteristics on participant retention across the 2 recruitment phases. Associations between passive data-sharing patterns and demographic characteristics of the cohort were evaluated using logistic regression. Results: We analyzed over 330,000 days of engagement data collected from 10,000 participants. Our key findings are as follows: first, the overall characteristics of participants recruited using digital advertisements on social media and news media differed significantly from those of participants recruited using crowdsourcing platforms (Prolific and Amazon Mechanical Turk; P<.001). Second, participant retention in the study varied significantly across study phases, recruitment sources, and socioeconomic and demographic factors (P<.001). Third, notable differences in passive data collection were associated with device type (Android vs iOS) and participants? sociodemographic characteristics. Black or African American participants were significantly less likely to share passive sensor data streams than non-Hispanic White participants (odds ratio 0.44-0.49, 95% CI 0.35-0.61; P<.001). Fourth, participants were more likely to adhere to baseline surveys if the surveys were administered immediately after enrollment. Fifth, technical glitches could significantly impact real-world data collection in remote settings, which can severely impact generation of reliable evidence. Conclusions: Our findings highlight several factors, such as recruitment platforms, incentive distribution frequency, the timing of baseline surveys, device heterogeneity, and technical glitches in data collection infrastructure, that could impact remote long-term data collection. Combined together, these empirical findings could help inform best practices for monitoring anomalies during real-world data collection and for recruiting and retaining target populations in a representative and equitable manner. UR - https://formative.jmir.org/2022/11/e40765 UR - http://dx.doi.org/10.2196/40765 UR - http://www.ncbi.nlm.nih.gov/pubmed/36374539 ID - info:doi/10.2196/40765 ER - TY - JOUR AU - Kuo, Fong-Chy Elizabeth AU - Cho, Jacklyn AU - Olaye, Iredia AU - Delgado, Diana AU - Dell, Nicola AU - Sterling, R. Madeline PY - 2022/11/11 TI - Understanding the Technological Landscape of Home Health Aides: Scoping Literature Review and a Landscape Analysis of Existing mHealth Apps JO - J Med Internet Res SP - e39997 VL - 24 IS - 11 KW - home health aides KW - home care services KW - mobile health KW - mHealth KW - mobile apps KW - mobile phone apps KW - smartphones KW - educational technology KW - technology KW - mobile phone N2 - Background: Home health aides (HHAs) provide necessary hands-on care to older adults and those with chronic conditions in their homes. Despite their integral role, HHAs experience numerous challenges in their work, including their ability to communicate with other health care professionals about patient care while caring for patients and access to educational resources. Although technological interventions have the potential to address these challenges, little is known about the technological landscape and existing technology-based interventions designed for and used by this workforce. Objective: We conducted a scoping review of the scientific literature to identify existing studies that have described, designed, deployed, or tested technology-based tools and apps intended for use by HHAs to care for patients at home. To complement our literature review, we conducted a landscape analysis of existing mobile apps intended for HHAs providing in-home care. Methods: We searched the following databases from their inception to October 2020: Ovid MEDLINE, Ovid Embase, Cochrane Library, and CINAHL (EBSCO). A total of 3 researchers screened the yield using prespecified inclusion and exclusion criteria. In addition, 4 researchers independently reviewed these articles, and a fifth researcher arbitrated when needed. Among studies that met the inclusion criteria, data were extracted and summarized narratively. An analysis of mobile health apps designed for HHAs was performed using a predefined set of terms to search Google Play and Apple App stores. Overall, 2 researchers independently screened the resulting apps, and those that met the inclusion criteria were categorized according to their intended purpose and functionality. Results: Of the 8643 studies retrieved, 182 (2.11%) underwent full-text review, and 4.9% (9/182) met our inclusion criteria. Approximately half (4/9, 44%) of the studies were descriptive in nature, proposing technology-based systems (eg, web portals and dashboards) or prototypes without a technical or user-based evaluation of the technology. In most (7/9, 78%) papers, HHAs were just one of several users and not the sole or primary intended users of the technology. Our review of mobile apps yielded 166 Android and iOS apps, of which 48 (29%) met the inclusion criteria. These apps provided HHAs with one or more of the following functions: electronic visit verification (29/48, 60%), clocking in and out (23/48, 48%), documentation (22/48, 46%), task checklist (19/48, 40%), communication between HHA and agency (14/48, 29%), patient information (6/48, 13%), resources (5/48, 10%), and communication between HHA and patients (4/48, 8%). Of the 48 apps, 25 (52%) performed monitoring functions, 4 (8%) performed supporting functions, and 19 (40%) performed both. Conclusions: A limited number of studies and mobile apps have been designed to support HHAs in their work. Further research and rigorous evaluation of technology-based tools are needed to assess their impact on the work HHAs provide in patient?s homes. UR - https://www.jmir.org/2022/11/e39997 UR - http://dx.doi.org/10.2196/39997 UR - http://www.ncbi.nlm.nih.gov/pubmed/36176033 ID - info:doi/10.2196/39997 ER - TY - JOUR AU - Zhang, Lili AU - Monacelli, Greta AU - Vashisht, Himanshu AU - Schlee, Winfried AU - Langguth, Berthold AU - Ward, Tomas PY - 2022/11/11 TI - The Effects of Tinnitus in Probabilistic Learning Tasks: Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e36583 VL - 11 IS - 11 KW - chronic tinnitus KW - computational modeling KW - decision-making KW - ecological momentary assessment KW - mobile phone N2 - Background: Chronic tinnitus is an increasing worldwide health concern, causing a significant burden to the health care system each year. The COVID-19 pandemic has seen a further increase in reported cases. For people with tinnitus, symptoms are exacerbated because of social isolation and the elevated levels of anxiety and depression caused by quarantines and lockdowns. Although it has been reported that patients with tinnitus can experience changes in cognitive capabilities, changes in adaptive learning via decision-making tasks for people with tinnitus have not yet been investigated. Objective: In this study, we aim to assess state- and trait-related impairments in adaptive learning ability on probabilistic learning tasks among people with tinnitus. Given that performance in such tasks can be quantified through computational modeling methods using a small set of neural-informed model parameters, such approaches are promising in terms of the assessment of tinnitus severity. We will first examine baseline differences in the characterization of decision-making under uncertainty between healthy individuals and people with tinnitus in terms of differences in the parameters of computational models in a cross-sectional experiment. We will also investigate whether these computational markers, which capture characteristics of decision-making, can be used to understand the cognitive impact of tinnitus symptom fluctuations through a longitudinal experimental design. Methods: We have developed a mobile app, AthenaCX, to deliver e-consent and baseline tinnitus and psychological assessments as well as regular ecological momentary assessments (EMAs) of perceived tinnitus loudness and a web-based aversive version of a probabilistic decision-making task, which can be triggered based on the participants? responses to the EMA surveys. Computational models will be developed to fit participants? choice data in the task, and cognitive parameters will be estimated to characterize participants? current ability to adapt learning to the change of the simulated environment at each session when the task is triggered. Linear regression analysis will be conducted to evaluate the impacts of baseline tinnitus severity on adapting decision-making performance. Repeated measures linear regression analysis will be used to examine model-derived parameters of decision-making in measuring real-time perceived tinnitus loudness fluctuations. Results: Ethics approval was received in December 2020 from Dublin City University (DCUREC/2021/070). The implementation of the experiments, including both the surveys and the web-based decision-making task, has been prepared. Recruitment flyers have been shared with audiologists, and a video instruction has been created to illustrate to the participants how to participate in the experiment. We expect to finish data collection over 12 months and complete data analysis 6 months after this. The results are expected to be published in December 2023. Conclusions: We believe that EMA with context-aware triggering can facilitate a deeper understanding of the effects of tinnitus symptom severity upon decision-making processes as measured outside of the laboratory. International Registered Report Identifier (IRRID): PRR1-10.2196/36583 UR - https://www.researchprotocols.org/2022/11/e36583 UR - http://dx.doi.org/10.2196/36583 UR - http://www.ncbi.nlm.nih.gov/pubmed/36367761 ID - info:doi/10.2196/36583 ER - TY - JOUR AU - Oldham, Melissa AU - Perski, Olga AU - Loebenberg, Gemma AU - Brown, Jamie AU - Garnett, Claire PY - 2022/11/10 TI - The Effect of the First UK COVID-19 Lockdown on Users of the Drink Less App: Interrupted Time Series Analysis of Sociodemographic Characteristics, Engagement, and Alcohol Reduction JO - J Med Internet Res SP - e42320 VL - 24 IS - 11 KW - alcohol reduction KW - COVID-19 KW - digital intervention KW - smartphone app KW - United Kingdom KW - alcohol KW - app KW - Drink Less KW - engagement KW - users KW - lockdown KW - female N2 - Background: The first UK COVID-19 lockdown had a polarizing impact on drinking behavior and may have impacted engagement with digital interventions to reduce alcohol consumption. Objective: We examined the effect of lockdown on engagement, alcohol reduction, and the sociodemographic characteristics of users of the popular and widely available alcohol reduction app Drink Less. Methods: This was a natural experiment. The study period spanned 468 days between March 24, 2019, and July 3, 2020, with the introduction of UK lockdown measures beginning on March 24, 2020. Users were 18 years or older, based in the United Kingdom, and interested in drinking less. Interrupted time series analyses using generalized additive mixed models (GAMMs) were conducted for each outcome variable (ie, sociodemographic characteristics, app downloads and engagement levels, alcohol consumption, and extent of alcohol reduction) for existing (downloaded the app prelockdown) and new (downloaded the app during the lockdown) users of the app. Results: Among existing users of the Drink Less app, there were increases in the time spent on the app per day (B=0.01, P=.01), mean units of alcohol recorded per day (B>0.00 P=.02), and mean heavy drinking (>6 units) days (B>0.00, P=.02) during the lockdown. Previous declines in new app downloads plateaued during the lockdown (incidence rate ratio [IRR]=1.00, P=.18). Among new app users, there was an increase in the proportion of female users (B>0.00, P=.04) and those at risk of alcohol dependence (B>0.00, P=.01) and a decrease in the proportion of nonmanual workers (B>?0.00, P=.04). Among new app users, there were step increases in the mean number of alcohol units per day (B=20.12, P=.03), heavy-drinking days (B=1.38, P=.01), and the number of days the app was used (B=2.05, P=.02), alongside a step decrease in the percentage of available screens viewed (B=?0.03, P=.04), indicating users were using less of the intervention components within the app. Conclusions: Following the first UK lockdown, there was evidence of increases in engagement and alcohol consumption among new and existing users of the Drink Less app. UR - https://www.jmir.org/2022/11/e42320 UR - http://dx.doi.org/10.2196/42320 UR - http://www.ncbi.nlm.nih.gov/pubmed/36240461 ID - info:doi/10.2196/42320 ER - TY - JOUR AU - Lu, Jianxia AU - Zhang, Qinhan AU - Zhong, Na AU - Chen, Jin AU - Zhai, Yujia AU - Guo, Lei AU - Lu, Chunlei AU - Chen, Tianzhen AU - Jiang, Zhongli AU - Zheng, Hui PY - 2022/11/10 TI - Addiction Symptom Network of Young Internet Users: Network Analysis JO - J Med Internet Res SP - e38984 VL - 24 IS - 11 KW - internet addiction KW - Internet Addiction Test KW - network analysis KW - adolescents N2 - Background: An increasing number of people are becoming addicted to the internet as a result of overuse. The Internet Addiction Test (IAT) is a popular tool for evaluating internet use behaviors. The interaction between different symptoms and the relationship between IAT and clinical diagnostic criteria are not well understood. Objective: This study aimed to explore the core symptoms of internet addiction (IA) and the correlation between different symptoms of the IA symptom network. Network analysis was also conducted to explore the association between the IAT scale and the Diagnostic and Statistical Manual of Mental Disorders?5th edition (DSM-5) criteria for IA. Methods: We recruited 4480 internet users (aged 14-24 years), and they completed the IAT. The final analysis included 63.50% (2845/4480) of the participants after screening the submitted questionnaires. Participants were classified into IA group and non-IA (NIA) group. By using partial correlation with Lasso regularization networks, we identified the core symptoms of IA in each group and compared the group differences in network properties (strength, closeness, and betweenness). Then, we analyzed the symptom networks of the DSM-5 diagnostic criteria and IAT scale for IA. Results: A total of 12.47% (355/2845) of the patients were in the IA group and 87.52% (2490/2845) of the patients were in the NIA group, and both groups were evaluated for the following nodes: IAT_06 (school work suffers; strength=0.511), IAT_08 (job performance suffers; strength=0.531), IAT_15 (fantasize about being on the web; strength=0.474), IAT_17 (fail to stop being on the web; strength=0.526), and IAT_12 (fear about boredom if offline; strength=0.502). The IA groups had a stronger edge between IAT_09 (defensive or secretive about being on the web) and IAT_18 (hidden web time) than the NIA groups. The items in DSM-5 had a strong association with IAT_12 (weight=?0.066), IAT_15 (weight=?0.081), IAT_17 (weight=?0.106), IAT_09 (weight=?0.198), and IAT_18 (weight=?0.052). Conclusions: The internet use symptom network of the IA group is significantly different from that of the NIA group. Nodes IAT_06 (school work affected) and IAT_08 (work performance affected) are the resulting symptoms affected by other symptoms, whereas nodes IAT_12 (fear about boredom if offline), IAT_17 (inability to stop being on the web), and IAT_15 (fantasize about being on the web) are key symptoms that activate other symptoms of IA and are strongly linked to the inability to control the intention to play games in the DSM-5. UR - https://www.jmir.org/2022/11/e38984 UR - http://dx.doi.org/10.2196/38984 UR - http://www.ncbi.nlm.nih.gov/pubmed/36355402 ID - info:doi/10.2196/38984 ER - TY - JOUR AU - Sediva, Hana AU - Cartwright, Tina AU - Robertson, Claire AU - Deb, K. Sanjoy PY - 2022/11/9 TI - Behavior Change Techniques in Digital Health Interventions for Midlife Women: Systematic Review JO - JMIR Mhealth Uhealth SP - e37234 VL - 10 IS - 11 KW - menopause KW - midlife KW - women?s health KW - lifestyle KW - behavior change technique KW - BCT KW - behavioral intervention KW - digital health KW - mobile health KW - mHealth KW - menopausal symptom KW - behavior change KW - review KW - mobile phone N2 - Background: Digital health interventions are efficacious in health-promoting behaviors (eg, healthy eating and regular physical activity) that mitigate health risks and menopausal symptoms in midlife. However, integrated evidence-based knowledge about the mechanisms of change in these interventions is unclear. Objective: This systematic review aimed to evaluate studies on behavior change techniques (BCTs) and mechanisms of change in digital health interventions aimed at promoting health-enhancing behaviors in midlife women (aged 40-65 years). Methods: A systematic literature search of the electronic databases PubMed, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials in the Cochrane Library was conducted. In total, 2 independent reviewers selected the studies for inclusion, extracted data, and completed BCT mapping of eligible studies. The mechanism of action and intervention functions of eligible studies were evaluated using the behavior change wheel framework. Reporting of psychological theory use within these interventions was explored using the Theory Coding Scheme. Mode of delivery, psychological theory, and BCTs were presented as descriptive statistics. Results: In total, 13 interventions (including 1315 women) reviewed used 13 (SD 4.30, range 6-21) BCTs per intervention on average. The ?Shaping knowledge? and ?Repetition and substitution? behavior change categories were used most frequently, with 92% (12/13) of the interventions implementing at least one of the BCTs from these 2 categories. Only 13.98% (169/1209) of the 93 available BCTs were used, with ?Instructions on behaviour? most frequently used (12/13, 92%). The behavior change wheel mapping suggests that half of the intervention content aimed to increase ?Capability? (49/98, 50% of the intervention strategies), ?Motivation? (41/98, 42%), and ?Opportunity? (8/98, 8%). ?Behavioural Regulation? was the most frequently used mechanism of action (15/98, 15%), followed by increasing ?Knowledge? (13/98, 13%) and ?Cognitive and Interpersonal skills? (10/98, 10%). A total of 78% (7/9) of the intervention functions were used in the studies to change behavior, primarily through ?Enablement? (60/169, 35.5%), whereas no study used ?Restriction? or ?Modelling? functions. Although 69% (9/13) of the interventions mentioned a psychological theory or model, most (10/13, 77%) stated or suggested rather than demonstrated the use of a theoretical base, and none reported explicit links between all BCTs within the intervention and the targeted theoretical constructs. Technological components were primarily based on web-based (9/13, 69%) modes of delivery, followed by phone or SMS text message (8/13, 62%) and wearables (7/13, 54%). Conclusions: The findings of this review indicate an overall weak use of theory, low levels of treatment fidelity, insignificant outcomes, and insufficient description of several interventions to support the assessment of how specific BCTs were activated. Thus, the identified limitations in the current literature provide an opportunity to improve the design of lifestyle health-enhancing interventions for women in midlife. Trial Registration: PROSPERO CRD42021259246; https://tinyurl.com/4ph74a9u UR - https://mhealth.jmir.org/2022/11/e37234 UR - http://dx.doi.org/10.2196/37234 UR - http://www.ncbi.nlm.nih.gov/pubmed/36350694 ID - info:doi/10.2196/37234 ER - TY - JOUR AU - Oakley-Girvan, Ingrid AU - Docherty, P. John PY - 2022/11/9 TI - A New Approach to Enhancing Engagement in eHealth Apps JO - Interact J Med Res SP - e38886 VL - 11 IS - 2 KW - user engagement KW - eHealth KW - attrition KW - adherence KW - apps KW - app design KW - user experience UR - https://www.i-jmr.org/2022/2/e38886 UR - http://dx.doi.org/10.2196/38886 UR - http://www.ncbi.nlm.nih.gov/pubmed/36279587 ID - info:doi/10.2196/38886 ER - TY - JOUR AU - Webb, A. Christian AU - Hirshberg, J. Matthew AU - Davidson, J. Richard AU - Goldberg, B. Simon PY - 2022/11/8 TI - Personalized Prediction of Response to Smartphone-Delivered Meditation Training: Randomized Controlled Trial JO - J Med Internet Res SP - e41566 VL - 24 IS - 11 KW - precision medicine KW - prediction KW - machine learning KW - meditation KW - mobile technology KW - smartphone app KW - mobile phone N2 - Background: Meditation apps have surged in popularity in recent years, with an increasing number of individuals turning to these apps to cope with stress, including during the COVID-19 pandemic. Meditation apps are the most commonly used mental health apps for depression and anxiety. However, little is known about who is well suited to these apps. Objective: This study aimed to develop and test a data-driven algorithm to predict which individuals are most likely to benefit from app-based meditation training. Methods: Using randomized controlled trial data comparing a 4-week meditation app (Healthy Minds Program [HMP]) with an assessment-only control condition in school system employees (n=662), we developed an algorithm to predict who is most likely to benefit from HMP. Baseline clinical and demographic characteristics were submitted to a machine learning model to develop a ?Personalized Advantage Index? (PAI) reflecting an individual?s expected reduction in distress (primary outcome) from HMP versus control. Results: A significant group × PAI interaction emerged (t658=3.30; P=.001), indicating that PAI scores moderated group differences in outcomes. A regression model that included repetitive negative thinking as the sole baseline predictor performed comparably well. Finally, we demonstrate the translation of a predictive model into personalized recommendations of expected benefit. Conclusions: Overall, the results revealed the potential of a data-driven algorithm to inform which individuals are most likely to benefit from a meditation app. Such an algorithm could be used to objectively communicate expected benefits to individuals, allowing them to make more informed decisions about whether a meditation app is appropriate for them. Trial Registration: ClinicalTrials.gov NCT04426318; https://clinicaltrials.gov/ct2/show/NCT04426318 UR - https://www.jmir.org/2022/11/e41566 UR - http://dx.doi.org/10.2196/41566 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346668 ID - info:doi/10.2196/41566 ER - TY - JOUR AU - Bulzacchelli, T. Maria AU - Bellantoni, M. Jenna AU - McCue, Leigh AU - Dzugan, Jerry PY - 2022/11/8 TI - The Receptivity to Safety-Related Mobile Apps Among Commercial Fishing Captains: Descriptive Exploratory Study JO - JMIR Form Res SP - e33638 VL - 6 IS - 11 KW - mobile app KW - mobile device KW - mobile phone KW - smartphone KW - safety KW - workplace safety KW - occupational safety KW - mobile health KW - mHealth KW - commercial fishing KW - cross-sectional study N2 - Background: Mobile apps addressing a variety of workplace safety issues have proliferated over the last decade as mobile technology has advanced and smartphone ownership has increased. Workplace safety interventions are often designed for a specific work site. However, some of the most dangerous jobs are ones in which workers frequently change field locations, such as commercial fishing. Mobile apps may be particularly suitable for delivering safety interventions to these workers. Objective: We sought to gauge the potential for using mobile apps to deliver safety interventions to commercial fishing workers. The purpose of this paper is to describe how fishermen use their mobile devices during fishing operations and identify any mobile apps they already use for safety. Methods: Participants comprised commercial fishing captains who already owned an iOS or Android smartphone or tablet. They completed a questionnaire that asked about their current mobile device use and their use of safety-related mobile apps, in addition to questions about their fishing operations. We performed descriptive analyses of the data. Results: A total of 61 participants completed the questionnaire. The most common types of mobile devices participants reported owning were iPhones (n=36, 59%) and Android phones (n=24, 39%). Most participants (n=53, 87%) reported using their mobile device for both work and personal purposes, including while out at sea (n=52, 85%). Over half of the participants reported that they had either safety-related apps (n=17, 28%) or apps that help them with their work (n=35, 57%). The types of apps most frequently mentioned were apps for weather, wind, tides, and navigation. Conclusions: The results of this study indicate that some commercial fishing captains who own a mobile device are receptive to using safety-related apps for work. Apps that help avoid hazards by monitoring environmental conditions and apps optimized for use on smartphones may be most likely to be adopted and used. Overall, these results suggest that mobile apps are a promising avenue for improving safety among workers in commercial fishing and similar occupations. UR - https://formative.jmir.org/2022/11/e33638 UR - http://dx.doi.org/10.2196/33638 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346649 ID - info:doi/10.2196/33638 ER - TY - JOUR AU - Lam, Ka-Hoo AU - Twose, James AU - Lissenberg-Witte, Birgit AU - Licitra, Giovanni AU - Meijer, Kim AU - Uitdehaag, Bernard AU - De Groot, Vincent AU - Killestein, Joep PY - 2022/11/7 TI - The Use of Smartphone Keystroke Dynamics to Passively Monitor Upper Limb and Cognitive Function in Multiple Sclerosis: Longitudinal Analysis JO - J Med Internet Res SP - e37614 VL - 24 IS - 11 KW - multiple sclerosis KW - smartphone KW - mobile app KW - digital technology KW - keystroke dynamics KW - typing KW - upper extremity KW - cognition KW - outpatient monitoring N2 - Background: Typing on smartphones, which has become a near daily activity, requires both upper limb and cognitive function. Analysis of keyboard interactions during regular typing, that is, keystroke dynamics, could therefore potentially be utilized for passive and continuous monitoring of function in patients with multiple sclerosis. Objective: To determine whether passively acquired smartphone keystroke dynamics correspond to multiple sclerosis outcomes, we investigated the association between keystroke dynamics and clinical outcomes (upper limb and cognitive function). This association was investigated longitudinally in order to study within-patient changes independently of between-patient differences. Methods: During a 1-year follow-up, arm function and information processing speed were assessed every 3 months in 102 patients with multiple sclerosis with the Nine-Hole Peg Test and Symbol Digit Modalities Test, respectively. Keystroke-dynamics data were continuously obtained from regular typing on the participants? own smartphones. Press-and-release latency of the alphanumeric keys constituted the fine motor score cluster, while latency of the punctuation and backspace keys constituted the cognition score cluster. The association over time between keystroke clusters and the corresponding clinical outcomes was assessed with linear mixed models with subjects as random intercepts. By centering around the mean and calculating deviation scores within subjects, between-subject and within-subject effects were distinguished. Results: Mean (SD) scores for the fine motor score cluster and cognition score cluster were 0.43 (0.16) and 0.94 (0.41) seconds, respectively. The fine motor score cluster was significantly associated with the Nine-Hole Peg Test: between-subject ? was 15.9 (95% CI 12.2-19.6) and within-subject ? was 6.9 (95% CI 2.0-11.9). The cognition score cluster was significantly associated with the Symbol Digit Modalities Test between subjects (between-subject ? ?11.2, 95% CI ?17.3 to ?5.2) but not within subjects (within-subject ? ?0.4, 95% CI ?5.6 to 4.9). Conclusions: Smartphone keystroke dynamics were longitudinally associated with multiple sclerosis outcomes. Worse arm function corresponded with longer latency in typing both across and within patients. Worse processing speed corresponded with higher latency in using punctuation and backspace keys across subjects. Hence, keystroke dynamics are a potential digital biomarker for remote monitoring and predicting clinical outcomes in patients with multiple sclerosis. Trial Registration: Netherlands Trial Register NTR7268; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7268 UR - https://www.jmir.org/2022/11/e37614 UR - http://dx.doi.org/10.2196/37614 UR - http://www.ncbi.nlm.nih.gov/pubmed/36342763 ID - info:doi/10.2196/37614 ER - TY - JOUR AU - Hallgren, A. Kevin PY - 2022/11/7 TI - Remotely Assessing Mechanisms of Behavioral Change in Community Substance Use Disorder Treatment to Facilitate Measurement-Informed Care: Pilot Longitudinal Questionnaire Study JO - JMIR Form Res SP - e42376 VL - 6 IS - 11 KW - addiction KW - clinical pilot KW - measurement-based care KW - mechanisms of change KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Research shows that improvements in coping strategies, abstinence self-efficacy, craving, and depression are potential mechanisms of behavioral change (MOBC) in treatments for substance use disorders (SUDs). However, little is known about how these insights regarding MOBC can be applied to SUD treatment settings. One way to facilitate MOBC-informed care in frontline settings could be to measure and monitor changes in MOBC throughout treatment using brief, frequent questionnaires that patients complete by using mobile technologies (eg, smartphones). The results derived from these questionnaires could potentially be used for clinical monitoring (ie, measurement-based care) to better understand whether individual patients are experiencing treatment-related improvements on key clinical targets. Objective: This study evaluated whether brief, weekly MOBC questionnaires completed by patients remotely can potentially provide clinically meaningful information about changes in MOBC in the context of real-world, community-based SUD treatment. Methods: A total of 30 patients (14/30, 47% female; 13/30, 43% racial or ethnic minority) in a community SUD treatment clinic participated in a pilot study where they were invited to complete brief, weekly questionnaires that assessed various MOBC, including coping strategies, abstinence self-efficacy, craving, depression, and therapeutic alliance. Questionnaires were typically completed remotely via smartphone for up to 6 months; 618 questionnaires were completed in total. Participants also completed longer, psychometrically validated measures of the same MOBC at baseline and 6-month research appointments. Statistical analyses tested whether brief, weekly, remotely completed MOBC questionnaires exhibited characteristics that would be desirable for real-world longitudinal clinical monitoring, including a tendency to detect within-person changes in MOBC over time; cross-sectional and longitudinal associations with longer, psychometrically validated measures completed at research appointments; and similar patterns of associations with 6-month percentage of days abstinent as longer, psychometrically validated MOBC measures completed at research appointments. Results: The results of this study indicated that the brief, weekly, remotely completed MOBC measures exhibited characteristics that are desirable for clinical monitoring, including a tendency to vary longitudinally (within patients over time) more often than measures of alcohol and drug consumption, generally having medium to large cross-sectional and longitudinal correlations with longer psychometrically validated measures of MOBC completed at research appointments, and generally having similar patterns of association with 6-month percentage of days abstinent from alcohol and drugs as longer psychometrically validated MOBC measures completed at research appointments. Conclusions: The results of this pilot study provide initial evidence that incorporating brief, weekly, and remotely completed MOBC questionnaires into community SUD treatment may be a viable approach for facilitating MOBC-informed care. Such questionnaires can potentially support measurement-based care by providing meaningful information about within-patient changes in clinical domains that are often directly targeted in SUD treatments and predict long-term substance use outcomes. UR - https://formative.jmir.org/2022/11/e42376 UR - http://dx.doi.org/10.2196/42376 UR - http://www.ncbi.nlm.nih.gov/pubmed/36342773 ID - info:doi/10.2196/42376 ER - TY - JOUR AU - Stefancic, Ana AU - Rogers, Tyler R. AU - Styke, Sarah AU - Xu, Xiaoyan AU - Buchsbaum, Richard AU - Nossel, Ilana AU - Cabassa, J. Leopoldo AU - Stroup, Scott T. AU - Kimhy, David PY - 2022/11/4 TI - Development of the First Episode Digital Monitoring mHealth Intervention for People With Early Psychosis: Qualitative Interview Study With Clinicians JO - JMIR Ment Health SP - e41482 VL - 9 IS - 11 KW - first-episode psychosis KW - early psychosis KW - coordinated specialty care KW - mental health treatment KW - shared decision-making KW - mobile health KW - smartphone apps KW - qualitative KW - digital psychiatry KW - mobile phone N2 - Background: Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes. Objective: This qualitative study sought clinicians? input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM. Methods: Following the app?s initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app?s design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications?Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions. Results: The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers? clinical judgment (eg, need for clinically relevant information), and organizations? mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention?s scope, concerns regarding dilution of the intervention?s core components, and concerns about increasing patient burden while using the app. Conclusions: FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients?the enhancement of SDM and improvement of therapeutic relationships. This study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care. Trial Registration: ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6 UR - https://mental.jmir.org/2022/11/e41482 UR - http://dx.doi.org/10.2196/41482 UR - http://www.ncbi.nlm.nih.gov/pubmed/36331539 ID - info:doi/10.2196/41482 ER - TY - JOUR AU - Paetzold, Isabell AU - Schick, Anita AU - Rauschenberg, Christian AU - Hirjak, Dusan AU - Banaschewski, Tobias AU - Meyer-Lindenberg, Andreas AU - Butz, Sebastian AU - Floesser, Chiara AU - Schueltke, Leonie AU - Boehnke, Rasmus Jan AU - Boecking, Benjamin AU - Reininghaus, Ulrich PY - 2022/11/4 TI - A Hybrid Ecological Momentary Compassion?Focused Intervention for Enhancing Resilience in Help-Seeking Young People: Prospective Study of Baseline Characteristics in the EMIcompass Trial JO - JMIR Form Res SP - e39511 VL - 6 IS - 11 KW - mobile health intervention KW - mHealth intervention KW - digital intervention KW - just-in-time adaptive intervention KW - JITAI KW - blended care KW - public mental health KW - inclusiveness KW - transdiagnostic KW - clinical staging KW - intervention manual KW - mobile phone N2 - Background: Young people are a target population for mental health?related early intervention and prevention. Although evidence for early intervention is promising, availability of and access to youth mental health services remain limited. Therefore, the development of an evidence-based hybrid intervention is urgently needed. Objective: This study aimed to present a manual for a hybrid intervention, combining an ecological momentary intervention and face-to-face sessions aimed for enhancing resilience in help-seeking young people based on compassion-focused interventions, and explore whether participants? baseline characteristics are associated with putative mechanisms and outcomes of the EMIcompass intervention. Specifically, we aimed to explore initial signals as to whether participants? sociodemographic, clinical, and functional characteristics at baseline are associated with putative mechanisms (ie, change in self-compassion, change in emotion regulation, working alliance, training frequency); and whether participants? sociodemographic, clinical, and functional characteristics, self-compassion, and emotion regulation at baseline are associated with clinical outcomes (ie, psychological distress and general psychopathology at postintervention and 4-week follow-ups) in the experimental condition and obtain first parameter estimates. Methods: We recruited young people aged 14 to 25 years, with psychological distress, Clinical High At-Risk Mental State, or first episodes of severe mental disorder for an exploratory randomized controlled trial with assessments at baseline and postintervention and 4-week follow-ups. A structured manual was developed and optimized based on a pilot study?s manual, a scoping review of existing literature and manuals, exchange with experts, the team?s clinical experience of working with compassion-focused interventions, and the principles of ecological momentary interventions. This analysis focuses on the experimental condition receiving the EMIcompass intervention. Results: A total of 46 young individuals were randomized to the experimental condition. There was evidence for initial signals of effects of age (B=0.11, 95% CI 0.00-0.22), general psychopathology (B=0.08, 95% CI ?0.01 to 0.16), and clinical stage (B=1.50, 95% CI 0.06-2.93) on change in momentary self-compassion and change in emotion regulation from baseline to postintervention assessments. There was no evidence for associations of other baseline characteristics (eg, gender, minority status, and level of functioning) and putative mechanisms (eg, overall self-compassion, working alliance, and training frequency). In addition, except for an initial signal for an association of momentary self-compassion at baseline and psychological distress (B=?2.83, 95% CI ?5.66 to 0.00), we found no evidence that baseline characteristics related to clinical outcomes. Conclusions: The findings indicated the reach of participants by the intervention largely independent of sociodemographic, clinical, and functional baseline characteristics. The findings need to be confirmed in a definitive trial. Trial Registration: German Clinical Trials Register NDRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 International Registered Report Identifier (IRRID): RR2-10.2196/27462 UR - https://formative.jmir.org/2022/11/e39511 UR - http://dx.doi.org/10.2196/39511 UR - http://www.ncbi.nlm.nih.gov/pubmed/36331526 ID - info:doi/10.2196/39511 ER - TY - JOUR AU - Campo, David AU - Elie, Valery AU - de Gallard, Tristan AU - Bartet, Pierre AU - Morichau-Beauchant, Tristan AU - Genain, Nicolas AU - Fayol, Antoine AU - Fouassier, David AU - Pasteur-Rousseau, Adrien AU - Puymirat, Etienne AU - Nahum, Julien PY - 2022/11/4 TI - Atrial Fibrillation Detection With an Analog Smartwatch: Prospective Clinical Study and Algorithm Validation JO - JMIR Form Res SP - e37280 VL - 6 IS - 11 KW - atrial fibrillation KW - mobile health KW - mHealth KW - diagnosis KW - electrocardiogram KW - ECG KW - smartwatch KW - smart technology KW - wearable KW - cardiology KW - cardiac KW - heart failure KW - heart disease KW - cardiovascular KW - morbidity KW - automatic detection KW - algorithm KW - physician KW - sensor KW - digital health N2 - Background: Atrial fibrillation affects approximately 4% of the world?s population and is one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity. It can be difficult to diagnose when asymptomatic or in the paroxysmal stage, and its natural history is not well understood. New wearables and connected devices offer an opportunity to improve on this situation. Objective: We aimed to validate an algorithm for the automatic detection of atrial fibrillation from a single-lead electrocardiogram taken with a smartwatch. Methods: Eligible patients were recruited from 4 sites in Paris, France. Electrocardiograms (12-lead reference and single lead) were captured simultaneously. The electrocardiograms were reviewed by independent, blinded board-certified cardiologists. The sensitivity and specificity of the algorithm to detect atrial fibrillation and normal sinus rhythm were calculated. The quality of single-lead electrocardiograms (visibility and polarity of waves, interval durations, heart rate) was assessed in comparison with the gold standard (12-lead electrocardiogram). Results: A total of 262 patients (atrial fibrillation: n=100, age: mean 74.3 years, SD 12.3; normal sinus rhythm: n=113, age: 61.8 years, SD 14.3; other arrhythmia: n=45, 66.9 years, SD 15.2; unreadable electrocardiograms: n=4) were included in the final analysis; 6.9% (18/262) were classified as Noise by the algorithm. Excluding other arrhythmias and Noise, the sensitivity for atrial fibrillation detection was 0.963 (95% CI lower bound 0.894), and the specificity was 1.000 (95% CI lower bound 0.967). Visibility and polarity accuracies were similar (1-lead electrocardiogram: P waves: 96.9%, QRS complexes: 99.2%, T waves: 91.2%; 12-lead electrocardiogram: P waves: 100%, QRS complexes: 98.8%, T waves: 99.5%). P-wave visibility accuracy was 99% (99/100) for patients with atrial fibrillation and 95.7% (155/162) for patients with normal sinus rhythm, other arrhythmias, and unreadable electrocardiograms. The absolute values of the mean differences in PR duration and QRS width were <3 ms, and more than 97% were <40 ms. The mean difference between the heart rates from the 1-lead electrocardiogram calculated by the algorithm and those calculated by cardiologists was 0.55 bpm. Conclusions: The algorithm demonstrated great diagnostic performance for atrial fibrillation detection. The smartwatch?s single-lead electrocardiogram also demonstrated good quality for physician use in daily routine care. Trial Registration: ClinicalTrials.gov NCT04351386; http://clinicaltrials.gov/ct2/show/NCT04351386 UR - https://formative.jmir.org/2022/11/e37280 UR - http://dx.doi.org/10.2196/37280 UR - http://www.ncbi.nlm.nih.gov/pubmed/35481559 ID - info:doi/10.2196/37280 ER - TY - JOUR AU - Copen, E. Casey AU - Rushmore, Julie AU - De Voux, Alex AU - Kirkcaldy, D. Robert AU - Fakile, F. Yetunde AU - Tilchin, Carla AU - Duchen, Jessica AU - Jennings, M. Jacky AU - Spahnie, Morgan AU - Norris Turner, Abigail AU - Miller, C. William AU - Novak, M. Richard AU - Schneider, A. John AU - Trotter, B. Andrew AU - Bernstein, T. Kyle PY - 2022/11/4 TI - Factors Associated With Syphilis Transmission and Acquisition Among Men Who Have Sex With Men: Protocol for a Multisite Egocentric Network Study JO - JMIR Res Protoc SP - e40095 VL - 11 IS - 11 KW - sexually transmitted infection KW - HIV risk KW - men who have sex with men KW - sexual network KW - syphilis KW - mobile phone N2 - Background: In the United States, the rates of primary and secondary syphilis have increased more rapidly among men who have sex with men (MSM) than among any other subpopulation. Rising syphilis rates among MSM reflect changes in both individual behaviors and the role of sexual networks (eg, persons linked directly or indirectly by sexual contact) in the spread of the infection. Decades of research examined how sexual networks influence sexually transmitted infections (STIs) among MSM; however, few longitudinal data sources focusing on syphilis have collected network characteristics. The Centers for Disease Control and Prevention, in collaboration with 3 sites, enrolled a prospective cohort of MSM in 3 US cities to longitudinally study sexual behaviors and STIs, including HIV, for up to 24 months. Objective: The Network Epidemiology of Syphilis Transmission (NEST) study aimed to collect data on the factors related to syphilis transmission and acquisition among MSM. Methods: The NEST study was a prospective cohort study that enrolled 748 MSM in Baltimore, Maryland; Chicago, Illinois; and Columbus, Ohio. NEST recruitment used a combination of convenience sampling, venue-based recruitment, and respondent-driven sampling approaches. At quarterly visits, participants completed a behavioral questionnaire and were tested for syphilis, HIV, gonorrhea, and chlamydia. The participants also provided a list of their sexual partners and described their 3 most recent partners in greater detail. Results: The NEST participants were enrolled in the study from July 2018 to December 2021. At baseline, the mean age of the participants was 31.5 (SD 9.1) years. More than half (396/727. 54.5%) of the participants were non-Hispanic Black, 29.8% (217/727) were non-Hispanic White, and 8.8% (64/727) were Hispanic or Latino. Multiple recruitment strategies across the 3 study locations, including respondent-driven sampling, clinic referrals, flyers, and social media advertisements, strengthened NEST participation. Upon the completion of follow-up visits in March 2022, the mean number of visits per participant was 5.1 (SD 3.2; range 1-9) in Baltimore, 2.2 (SD 1.6; range 1-8) in Chicago, and 7.2 (SD 2.9; range 1-9) in Columbus. Using a community-based participatory research approach, site-specific staff were able to draw upon collaborations with local communities to address stigma concerning STIs, particularly syphilis, among potential NEST participants. Community-led efforts also provided a forum for staff to describe the NEST study objectives and plans for research dissemination to the target audience. Strategies to bolster data collection during the COVID-19 pandemic included telehealth visits (all sites) and adaptation to self-collection of STI specimens (Baltimore only). Conclusions: Data from NEST will be used to address important questions regarding individual and partnership-based sexual risk behaviors among MSM, with the goal of informing interventions to prevent syphilis in high-burden areas. International Registered Report Identifier (IRRID): RR1-10.2196/40095 UR - https://www.researchprotocols.org/2022/11/e40095 UR - http://dx.doi.org/10.2196/40095 UR - http://www.ncbi.nlm.nih.gov/pubmed/36331528 ID - info:doi/10.2196/40095 ER - TY - JOUR AU - Timmers, Thomas AU - van der Weegen, Walter AU - Janssen, Loes AU - Kremer, Jan AU - Kool, Bertijn Rudolf PY - 2022/11/3 TI - Importance of Patient Involvement in Creating Content for eHealth Interventions: Qualitative Case Report in Orthopedics JO - JMIR Form Res SP - e39637 VL - 6 IS - 11 KW - eHealth KW - qualitative research KW - qualitative KW - focus group KW - knee KW - surgery KW - feedback KW - user need KW - patient need KW - user centered KW - content codevelopment KW - patient involvement KW - co-design KW - participatory KW - app design KW - mobile health KW - mHealth KW - health app KW - orthopedic KW - mobile phone N2 - Background: In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients? priorities. Objective: In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. Methods: Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. Results: The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app?s content. Conclusions: In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app?s content from the patient?s perspective. Given the growing emphasis on patients? self-management, it is crucial that the information they receive is not only relevant from a health care provider?s perspective but also aligns with what really matters to patients. Trial Registration: Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295 UR - https://formative.jmir.org/2022/11/e39637 UR - http://dx.doi.org/10.2196/39637 UR - http://www.ncbi.nlm.nih.gov/pubmed/36326799 ID - info:doi/10.2196/39637 ER - TY - JOUR AU - Yun, Ke AU - Yu, Jiaming AU - Liu, Changyang AU - Zhang, Xinxin PY - 2022/11/2 TI - A Cost-effectiveness Analysis of a Mobile Phone?Based Integrated HIV-Prevention Intervention Among Men Who Have Sex With Men in China: Economic Evaluation JO - J Med Internet Res SP - e38855 VL - 24 IS - 11 KW - cost-effectiveness KW - digital intervention KW - men who have sex with men KW - mathematical model N2 - Background: Mobile phone?based digital interventions have been shown to be a promising strategy for HIV prevention among men who have sex with men (MSM). Objective: This study aimed to evaluate the cost-effectiveness of a mobile phone?based digital intervention for HIV prevention among MSM in China from the perspective of a public health provider. Methods: The cost-effectiveness of the mobile phone?based digital intervention was estimated for a hypothetical cohort of 10,000 HIV-negative MSM who were followed for 1 year. A model was developed with China-specific data to project the clinical impact and cost-effectiveness of two mobile phone?based digital strategies for HIV prevention among MSM. The intervention group received an integrated behavioral intervention that included 1) individualized HIV infection risk assessment, 2) recommendation of centers testing for HIV and other STIs, 3) free online order of condoms and HIV and syphilis self-test kits and 4) educational materials about HIV/AIDS. The control group was only given educational materials about HIV/AIDS. Outcomes of interest were the number of HIV infections among MSM averted by the intervention, intervention costs, cost per HIV infection averted by the mobile phone?based digital intervention, and quality-adjusted life-years (QALYs). Univariate and multivariate sensitivity analyses were also conducted to examine the robustness of the results. Results: It is estimated that the intervention can prevent 48 MSM from becoming infected with HIV and can save 480 QALYs. The cost of preventing 1 case of HIV infection was US $2599.87, and the cost-utility ratio was less than 0. Sensitivity analysis showed that the cost-effectiveness of the mobile phone?based digital intervention was mainly impacted by the average number of sexual behaviors with each sexual partner. Additionally, the higher the HIV prevalence among MSM, the greater the benefit of the intervention. Conclusions: Mobile phone?based digital interventions are a cost-effective HIV-prevention strategy for MSM and could be considered for promotion and application among high-risk MSM subgroups. UR - https://www.jmir.org/2022/11/e38855 UR - http://dx.doi.org/10.2196/38855 UR - http://www.ncbi.nlm.nih.gov/pubmed/36322123 ID - info:doi/10.2196/38855 ER - TY - JOUR AU - Alnooh, Ghadah AU - Alessa, Tourkiah AU - Hawley, Mark AU - de Witte, Luc PY - 2022/11/2 TI - The Use of Dietary Approaches to Stop Hypertension (DASH) Mobile Apps for Supporting a Healthy Diet and Controlling Hypertension in Adults: Systematic Review JO - JMIR Cardio SP - e35876 VL - 6 IS - 2 KW - DASH diet KW - Dietary Approaches to Stop Hypertension KW - smartphone app KW - mobile app KW - blood pressure N2 - Background: Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approaches to Stop Hypertension (DASH) diet is one of the most effective dietary approaches for lowering blood pressure (BP). Dietary mobile apps have gained popularity and are being used to support DASH diet self-management, aiming to improve DASH diet adherence and thus lower BP. Objective: This systematic review aimed to assess the effectiveness of smartphone apps that support self-management to improve DASH diet adherence and consequently reduce BP. A secondary aim was to assess engagement, satisfaction, acceptance, and usability related to DASH mobile app use. Methods: The Embase (OVID), Cochrane Library, CINAHL, Web of Science, Scopus, and Google Scholar electronic databases were used to conduct systematic searches for studies conducted between 2008 and 2021 that used DASH smartphone apps to support self-management. The reference lists of the included articles were also checked. Studies were eligible if they (1) were randomized controlled trials (RCTs) or pre-post studies of app-based interventions for adults (aged 18 years or above) with prehypertension or hypertension, without consideration of gender or sociodemographic characteristics; (2) used mobile phone apps alone or combined with another component, such as communication with others; (3) used or did not use any comparator; and (4) had the primary outcome measures of BP level and adherence to the DASH diet. For eligible studies, data were extracted and outcomes were organized into logical categories, including clinical outcomes (eg, systolic BP, diastolic BP, and weight loss), DASH diet adherence, app usability and acceptability, and user engagement and satisfaction. The quality of the studies was evaluated using the Cochrane Collaboration?s Risk of Bias tool for RCTs, and nonrandomized quantitative studies were evaluated using a tool provided by the US National Institutes of Health. Results: A total of 5 studies (3 RCTs and 2 pre-post studies) including 334 participants examined DASH mobile apps. All studies found a positive trend related to the use of DASH smartphone apps, but the 3 RCTs had a high risk of bias. One pre-post study had a high risk of bias, while the other had a low risk. As a consequence, no firm conclusions could be drawn regarding the effectiveness of DASH smartphone apps for increasing DASH diet adherence and lowering BP. All the apps appeared to be acceptable and easy to use. Conclusions: There is weak emerging evidence of a positive effect of using DASH smartphone apps for supporting self-management to improve DASH diet adherence and consequently lower BP. Further research is needed to provide high-quality evidence that can determine the effectiveness of DASH smartphone apps. UR - https://cardio.jmir.org/2022/2/e35876 UR - http://dx.doi.org/10.2196/35876 UR - http://www.ncbi.nlm.nih.gov/pubmed/36322108 ID - info:doi/10.2196/35876 ER - TY - JOUR AU - Rumi, Gabriele AU - Canonica, Walter G. AU - Foster, M. Juliet AU - Chavannes, H. Niels AU - Valenti, Giuseppe AU - Contiguglia, Rosario AU - Rapsomaniki, Eleni AU - Kocks, H. Janwillem W. AU - De Brasi, Dario AU - Braido, Fulvio PY - 2022/11/2 TI - Digital Coaching Using Smart Inhaler Technology to Improve Asthma Management in Patients With Asthma in Italy: Community-Based Study JO - JMIR Mhealth Uhealth SP - e25879 VL - 10 IS - 11 KW - asthma control KW - asthma management KW - connected devices KW - digital health KW - eHealth KW - inhalers KW - maintenance and reliever therapy KW - mobile phone N2 - Background: Reliance on short-acting ?-2 agonists and nonadherence to maintenance medication are associated with poor clinical outcomes in asthma. Digital health solutions could support optimal medication use and therefore disease control in patients with asthma; however, their use in community settings has not been determined. Objective: The primary objective of this study is to investigate community implementation of the Turbu+ program designed to support asthma self-management, including adherence to budesonide and formoterol (Symbicort) Turbuhaler, a combination inhaler for both maintenance therapy or maintenance and reliever therapy. The secondary objective is to provide health care professionals with insights into how patients were using their medication in real life. Methods: Patients with physician-diagnosed asthma were prescribed budesonide and formoterol as maintenance therapy, at a dose of either 1 inhalation twice daily (1-BID) or 2 inhalations twice daily (2-BID), or as maintenance and reliever therapy (1-BID and reliever or 2-BID and reliever in a single inhaler), and they received training on Turbu+ in secondary care centers across Italy. An electronic device attached to the patients? inhaler for ?90 days (data cutoff) securely uploaded medication use data to a smartphone app and provided reminders, visualized medication use, and motivational nudge messages. Average medication adherence was defined as the proportion of daily maintenance inhalations taken as prescribed (number of recorded maintenance actuations per day or maintenance inhalations prescribed per day) averaged over the monitoring period. The proportion of adherent days was defined as the proportion of days when all prescribed maintenance inhalations were taken on a given day. The Wilcoxon test was used to compare the proportion of adherent days between patients in the maintenance regimen and patients in the maintenance and reliever regimen of a given dose. Results: In 661 patients, the mean (SD) number of days monitored was 217.2 (SD 109.0) days. The average medication adherence (maintenance doses taken/doses prescribed) was 70.2% (108,040/153,820) overall and was similar across the groups (1-BID: 6332/9520, 66.5%; 1?BID and reliever: 43,578/61,360, 71.0%; 2-BID: 10,088/14,960, 67.4%; 2-BID and reliever: 48,042/67,980, 70.7%). The proportion of adherent days (prescribed maintenance doses/doses taken in a given day) was 56.6% (31,812/56,175) overall and was higher with maintenance and reliever therapy (1-BID and reliever vs 1-BID: 18,413/30,680, 60.0% vs 2510/4760, 52.7%; P<.001; 2-BID and reliever vs 2-BID: 8995/16,995, 52.9% vs 1894/3740, 50.6%; P=.02). Rates of discontinuation from the Turbu+ program were significantly lower with maintenance and reliever therapy compared with maintenance therapy alone (P=.01). Conclusions: Overall, the high medication adherence observed during the study might be attributed to the electronic monitoring and feedback mechanism provided by the Turbu+ program. UR - https://mhealth.jmir.org/2022/11/e25879 UR - http://dx.doi.org/10.2196/25879 UR - http://www.ncbi.nlm.nih.gov/pubmed/36322120 ID - info:doi/10.2196/25879 ER - TY - JOUR AU - Scheer, Justin AU - Costa, Fabíola AU - Molinos, Maria AU - Areias, Anabela AU - Janela, Dora AU - Moulder, G. Robert AU - Lains, Jorge AU - Bento, Virgílio AU - Yanamadala, Vijay AU - Cohen, P. Steven AU - Correia, Dias Fernando PY - 2022/10/31 TI - Racial and Ethnic Differences in Outcomes of a 12-Week Digital Rehabilitation Program for Musculoskeletal Pain: Prospective Longitudinal Cohort Study JO - J Med Internet Res SP - e41306 VL - 24 IS - 10 KW - physical therapy KW - telerehabilitation KW - digital therapy KW - eHealth KW - telehealth KW - musculoskeletal conditions KW - race KW - ethnicity KW - pain KW - diversity KW - equity KW - mobile phone N2 - Background: Musculoskeletal (MSK) pain disproportionately affects people from different ethnic backgrounds through higher burden and less access to care. Digital care programs (DCPs) can improve access and help reduce inequities. However, the outcomes of such programs based on race and ethnicity have yet to be studied. Objective: We aimed to assess the impact of race and ethnicity on engagement and outcomes in a multimodal DCP for MSK pain. Methods: This was an ad hoc analysis of an ongoing decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were stratified by self-reported racial and ethnic group, and their engagement and outcome changes between baseline and 12 weeks were compared using latent growth curve analysis. Outcomes included program engagement (number of sessions), self-reported pain scores, likelihood of surgery, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment. A minimum clinically important difference (MCID) of 30% was calculated for pain, and multivariable logistic regression was performed to evaluate race as an independent predictor of meeting the MCID. Results: A total of 6949 patients completed the program: 65.5% (4554/6949) of them were non-Hispanic White, 10.8% (749/6949) were Black, 9.7% (673/6949) were Asian, 9.2% (636/6949) were Hispanic, and 4.8% (337/6949) were of other racial or ethnic backgrounds. The population studied was diverse and followed the proportions of the US population. All groups reported high engagement and satisfaction, with Hispanic and Black patients ranking first among satisfaction despite lower engagement. Black patients had a higher likelihood to drop out (odds ratio [OR] 1.19, 95% CI 1.01-1.40, P=.04) than non-Hispanic White patients. Hispanic and Black patients reported the highest level of pain, surgical intent, work productivity, and impairment in activities of daily living at baseline. All race groups showed a significant improvement in all outcomes, with Black and Hispanic patients reporting the greatest improvements in clinical outcomes. Hispanic patients also had the highest response rate for pain (75.8%) and a higher OR of meeting the pain MCID (OR 1.74, 95% CI 1.24-2.45, P=.001), when compared with non-Hispanic White patients, independent of age, BMI, sex, therapy type, education level, and employment status. No differences in mental health outcomes were found between race and ethnic groups. Conclusions: This study advocates for the utility of a DCP in improving access to MSK care and promoting health equity. Engagement and satisfaction rates were high in all the groups. Black and Hispanic patients had higher MSK burden at baseline and lower engagement but also reported higher improvements, with Hispanic patients presenting a higher likelihood of pain improvement. UR - https://www.jmir.org/2022/10/e41306 UR - http://dx.doi.org/10.2196/41306 UR - http://www.ncbi.nlm.nih.gov/pubmed/36189963 ID - info:doi/10.2196/41306 ER - TY - JOUR AU - D'Amore, Cassandra AU - Reid, C. Julie AU - Chan, Matthew AU - Fan, Samuel AU - Huang, Amanda AU - Louie, Jonathan AU - Tran, Andy AU - Chauvin, Stephanie AU - Beauchamp, K. Marla PY - 2022/10/31 TI - Interventions Including Smart Technology Compared With Face-to-face Physical Activity Interventions in Older Adults: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e36134 VL - 24 IS - 10 KW - aging KW - exercise KW - mobile health KW - mHealth KW - wearables KW - mobile phone N2 - Background: This is a systematic review of randomized controlled trials and a meta-analysis comparing smart technology with face-to-face physical activity (PA) interventions in community-dwelling older adults (mean age 60 years). Objective: This study aims to determine the effect of interventions including smart technology components compared with face-to-face PA interventions on PA and physical function in older adults. The secondary outcomes are depression, anxiety, and health-related quality of life. Methods: We searched MEDLINE, Embase, CINAHL, and AMED electronic databases from inception to February 2021. Two independent reviewers screened titles, abstracts, and full texts and performed data extraction and risk of bias assessments using the Cochrane risk of bias tool. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the evidence. We provided a narrative synthesis on all included studies and, where possible, performed meta-analyses for similar outcomes. Results: This review included 19 studies with a total of 3455 participants. Random effects meta-analyses showed that interventions with smart technology components resulted in improved step count (mean difference 1440 steps, 95% CI 500-2390) and total PA (standardized mean difference 0.17, 95% CI 0.02-0.32) compared with face-to-face alone. There was no difference between groups in terms of the measures of physical function. Smart technology alone did not show significant differences between groups in any outcome. The quality of the evidence was very low based on the Grading of Recommendations Assessment, Development and Evaluation criteria. Conclusions: Interventions that include smart technology may improve daily step counts by an average of 1440 steps in community-dwelling older adults; however, the quality of the evidence was very low. Future studies are needed to improve the certainty of these results. Trial Registration: PROSPERO CRD42020135232; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=135232 UR - https://www.jmir.org/2022/10/e36134 UR - http://dx.doi.org/10.2196/36134 UR - http://www.ncbi.nlm.nih.gov/pubmed/36315229 ID - info:doi/10.2196/36134 ER - TY - JOUR AU - Chawla, Rajeev AU - Jaggi, Shalini AU - Gupta, Amit AU - Bantwal, Ganapathi AU - Patil, Suhas PY - 2022/10/31 TI - Clinical Utility of a Digital Therapeutic Intervention in Indian Patients With Type 2 Diabetes Mellitus: 12-Week Prospective Single-Arm Intervention Study JO - JMIR Diabetes SP - e41401 VL - 7 IS - 4 KW - HbA1c KW - type 2 diabetes KW - digital therapeutics KW - fasting blood glucose KW - postprandial blood glucose KW - mHealth KW - digital health intervention KW - glycemic control KW - mobile health N2 - Background: Patients with type 2 diabetes mellitus (T2DM) having elevated levels of blood glucose and glycated hemoglobin (HbA1c) are at higher risk of macro- and microvascular complications. Nonetheless, the goal of achieving glycemic control cannot be met with the use of pharmacotherapy alone. The recent emergence of digital therapeutic tools has shown the possibility of improving the modifiable risk factors and self-management of diabetes. Objective: The aim of this study was to examine the clinical utility of a digital therapeutic intervention as an add-on therapy to achieve glycemic control in patients with T2DM. Methods: This was a 12-week prospective, single-arm digital intervention study in patients with T2DM receiving regular antidiabetic treatment. The eligibility criteria included male and female patients with HbA1c?6.5%, functional English literacy, and a mobile phone capable of running the intervention app. Outcome measures of the study were mean changes in HbA1c, fasting blood glucose (FBG), postprandial blood glucose (PPBG), BMI, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index at the end of 12 weeks. Results: A total of 128 participants completed the study period of 12 weeks. There were 54.7% (70/128) men and 45.3% (58/128) women with a mean age of 48.48 years (SD 10.27). At the end of 12 weeks, the mean change in HbA1c, FBG, PPBG, and BMI for the overall study population was ?0.84% (P<.001), ?8.39 mg/dl (P=.02), ?14.97 mg/dl (P<.001), and ?0.24 kg/m2 (P=.06), respectively. Among the participants showing improvement in the HbA1c value at the end of 12 weeks (responders), the mean change in HbA1c, FBG, PPBG, and BMI was ?1.24% (P<.001), ?12.42 mg/dl (P=.003), ?21.45 mg/dl (P<.001), and ?0.34 kg/m2 (P=.007), respectively. There was an increase in HOMA-IR values for the overall study population (0.54, P=.29). HbA1c response showed a significant association with a baseline HbA1c level ?7.5%, no prior history of smoking, and no prior COVID-19 infection, as well as with higher levels of program engagement. Conclusions: A digital therapeutic intervention when used alongside standard medications significantly reduces HbA1c, FBG, and PPBG levels in patients with T2DM. UR - https://diabetes.jmir.org/2022/4/e41401 UR - http://dx.doi.org/10.2196/41401 UR - http://www.ncbi.nlm.nih.gov/pubmed/36226840 ID - info:doi/10.2196/41401 ER - TY - JOUR AU - Jarman, K. Hannah AU - McLean, A. Siân AU - Rodgers, Rachel AU - Fuller-Tyszkiewicz, Matthew AU - Paxton, Susan AU - O'Gorman, Beth AU - Harris, Emily AU - Shatte, Adrian AU - Bishop, Katie AU - Baumann, Tahlia AU - Mahoney, Danielle AU - Daugelat, Melissa-Claire AU - Yager, Zali PY - 2022/10/31 TI - Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches JO - JMIR Form Res SP - e38387 VL - 6 IS - 10 KW - eating disorders KW - app-based intervention KW - lived experience KW - design thinking KW - interviews KW - young women KW - co-design KW - mobile health KW - mHealth N2 - Background: App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. Objective: To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. Methods: In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user?s personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. Results: Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. Conclusions: Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population. UR - https://formative.jmir.org/2022/10/e38387 UR - http://dx.doi.org/10.2196/38387 UR - http://www.ncbi.nlm.nih.gov/pubmed/36315225 ID - info:doi/10.2196/38387 ER - TY - JOUR AU - Weise, Hannes AU - Zenner, Benedikt AU - Schmiedchen, Bettina AU - Benning, Leo AU - Bulitta, Michael AU - Schmitz, Daniel AU - Weise, Kuno PY - 2022/10/28 TI - The Effect of an App-Based Home Exercise Program on Self-reported Pain Intensity in Unspecific and Degenerative Back Pain: Pragmatic Open-label Randomized Controlled Trial JO - J Med Internet Res SP - e41899 VL - 24 IS - 10 KW - back pain KW - musculoskeletal health KW - primary care KW - exercise therapy KW - digital health KW - mobile health KW - mHealth KW - digital therapeutic KW - mobile phone N2 - Background: The recommended first-line treatment for unspecific and degenerative back pain consists of movement exercises and patient education. Objective: Using a pragmatic, randomized controlled trial, we evaluated the effectiveness of a digital home exercise program on self-reported pain intensity compared with the standard of care for physiotherapy. Methods: Participant recruitment was based on newspaper advertisements and a consecutive on-site assessment for eligibility and enrollment. Participants with unspecific and degenerative back pain aged ?18 years were randomly assigned in a 1:1 ratio to receive a 12-week stand-alone digital home exercise program or physiotherapy. The digital home exercise program included 4 exercises daily, while physiotherapy included 6 to 12 sessions, depending on the severity of symptoms. The primary outcome was pain, which was assessed using a verbal numerical rating scale. The clinical relevance of pain reduction was assessed using the following thresholds: improvement of at least 1.4 points on the verbal numerical rating scale and a pain reduction of at least 30%. Results: During the study period, 108 participants were assigned to the intervention group and 105 participants to the control group. The mean difference in pain scores between the 2 groups at 12 weeks was ?2.44 (95% CI ?2.92 to ?1.95; P<.01) in favor of the intervention group. The group receiving the digital therapeutic achieved a clinically relevant reduction in pain over the course of the study (baseline vs 12 weeks), with a mean change of ?3.35 (SD 2.05) score points or ?53.1% (SD 29.5). By contrast, this change did not reach clinical relevance in the control group (mean ?0.91, SD 1.5; ?14.6%, SD 25.3). Retention rates of 89.9% in the intervention group and 97.3% in the control group were maintained throughout the study. Conclusions: The use of the app-based home exercise program led to a significant and clinically relevant reduction in pain intensity throughout the 12-week duration of the program. The intervention studied showed superior improvement in self-reported pain intensity when compared with the standard of care. Given the great demand for standard physiotherapy for unspecific and degenerative back pain, digital therapeutics are evolving into a suitable therapeutic option that can overcome the limitations of access and availability of conventional modes of health care delivery into this spectrum of indications. However, further independent evaluations are required to support the growing body of evidence on the effectiveness of digital therapeutics in real-world care settings. Trial Registration: German Clinical Trials Register DRKS00022781; https://tinyurl.com/hpdraa89 UR - https://www.jmir.org/2022/10/e41899 UR - http://dx.doi.org/10.2196/41899 UR - http://www.ncbi.nlm.nih.gov/pubmed/36215327 ID - info:doi/10.2196/41899 ER - TY - JOUR AU - Liu, MingXin AU - Zhou, SiYu AU - Jin, Qun AU - Nishimura, Shoji AU - Ogihara, Atsushi PY - 2022/10/27 TI - Effectiveness, Policy, and User Acceptance of COVID-19 Contact-Tracing Apps in the Post?COVID-19 Pandemic Era: Experience and Comparative Study JO - JMIR Public Health Surveill SP - e40233 VL - 8 IS - 10 KW - COVID-19 KW - contact-tracing app KW - digital contact tracing KW - mobile phone N2 - Background: In the post?COVID-19 pandemic era, many countries have launched apps to trace contacts of COVID-19 infections. Each contact-tracing app (CTA) faces a variety of issues owing to different national policies or technologies for tracing contacts. Objective: In this study, we aimed to investigate all the CTAs used to trace contacts in various countries worldwide, including the technology used by each CTA, the availability of knowledge about the CTA from official websites, the interoperability of CTAs in various countries, and the infection detection rates and policies of the specific country that launched the CTA, and to summarize the current problems of the apps based on the information collected. Methods: We investigated CTAs launched in all countries through Google, Google Scholar, and PubMed. We experimented with all apps that could be installed and compiled information about apps that could not be installed or used by consulting official websites and previous literature. We compared the information collected by us on CTAs with relevant previous literature to understand and analyze the data. Results: After screening 166 COVID-19 apps developed in 197 countries worldwide, we selected 98 (59%) apps from 95 (48.2%) countries, of which 63 (66.3%) apps were usable. The methods of contact tracing are divided into 3 main categories: Bluetooth, geolocation, and QR codes. At the technical level, CTAs face 3 major problems. First, the distance and time for Bluetooth- and geolocation-based CTAs to record contact are generally set to 2 meters and 15 minutes; however, this distance should be lengthened, and the time should be shortened for more infectious variants. Second, Bluetooth- or geolocation-based CTAs also face the problem of lack of accuracy. For example, individuals in 2 adjacent vehicles during traffic jams may be at a distance of ?2 meters to make the CTA trace contact, but the 2 users may actually be separated by car doors, which could prevent transmission and infection. In addition, we investigated infection detection rates in 33 countries, 16 (48.5%) of which had significantly low infection detection rates, wherein CTAs could have lacked effectiveness in reducing virus propagation. Regarding policy, CTAs in most countries can only be used in their own countries and lack interoperability among other countries. In addition, 7 countries have already discontinued CTAs, but we believe that it was too early to discontinue them. Regarding user acceptance, 28.6% (28/98) of CTAs had no official source of information that could reduce user acceptance. Conclusions: We surveyed all CTAs worldwide, identified their technological policy and acceptance issues, and provided solutions for each of the issues we identified. This study aimed to provide useful guidance and suggestions for updating the existing CTAs and the subsequent development of new CTAs. UR - https://publichealth.jmir.org/2022/10/e40233 UR - http://dx.doi.org/10.2196/40233 UR - http://www.ncbi.nlm.nih.gov/pubmed/36190741 ID - info:doi/10.2196/40233 ER - TY - JOUR AU - McIntyre, S. Roger AU - Lipsitz, Orly AU - Rodrigues, B. Nelson AU - Subramaniapillai, Mehala AU - Nasri, Flora AU - Lee, Yena AU - Fehnert, Ben AU - King, James AU - Chrones, Lambros AU - Kratiuk, Kevin AU - Uddin, Sharif AU - Rosenblat, D. Joshua AU - Mansur, B. Rodrigo AU - McCue, Maggie PY - 2022/10/27 TI - An App-Based Digit Symbol Substitution Test for Assessment of Cognitive Deficits in Adults With Major Depressive Disorder: Evaluation Study JO - JMIR Ment Health SP - e33871 VL - 9 IS - 10 KW - depression KW - DSST KW - Digit Symbol Substitution Test KW - smartphone KW - technology KW - measurement-based care KW - cognition N2 - Background: Cognitive dysfunction is an impairing core symptom of depression. Among adults with major depressive disorder (MDD) treated with antidepressants, residual cognitive symptoms interfere with patient-reported outcomes. The foregoing characterization of cognitive symptoms provides the rationale for screening and assessing the severity of cognitive symptoms at point of care. However, clinical neurocognitive assessments are time-consuming and difficult, and they require specialist expertise to interpret them. A smartphone-delivered neurocognitive test may offer an effective and accessible tool that can be readily implemented into a measurement-based care framework. Objective: We aimed to evaluate the use of a smartphone-delivered app-based version of the established Cognition Kit Digit Symbol Substitution Test (DSST) neurocognitive assessment compared to a traditional paper-and-pencil version. Methods: Convergent validity and test-retest reliability of the 2 versions were evaluated. Patient satisfaction with the app was also assessed. Results: Assessments made using the app-based Cognition Kit DSST were highly correlated with the standard paper-and-pencil version of the test, both at the baseline visit (r=0.69, df=27; P<.001) and at the end-of-study visit (r=0.82, df=27; P<.001), and they were positively evaluated by 30 patients as being user-friendly, easy to navigate, and preferable over the paper-and-pencil version of the DSST. However, although the app-based Cognition Kit DSST was validated in patients with MDD, it still needs to be evaluated in healthy controls. Conclusions: App-based DSST may facilitate a more personalized, convenient, and cost-effective method of cognitive assessment, helping to guide measurement-based care and psychotherapeutic and pharmacologic treatment options for patients with MDD. Trial Registration: ClinicalTrials.gov NCT03999567; https://tinyurl.com/2p8pnyv7 UR - https://mental.jmir.org/2022/10/e33871 UR - http://dx.doi.org/10.2196/33871 UR - http://www.ncbi.nlm.nih.gov/pubmed/36301615 ID - info:doi/10.2196/33871 ER - TY - JOUR AU - Pape, Magdalena AU - Färber, Tanja AU - Seiferth, Caroline AU - Roth, Tanja AU - Schroeder, Stefanie AU - Wolstein, Joerg AU - Herpertz, Stephan AU - Steins-Loeber, Sabine PY - 2022/10/27 TI - A Tailored Gender-Sensitive mHealth Weight Loss Intervention (I-GENDO): Development and Process Evaluation JO - JMIR Form Res SP - e38480 VL - 6 IS - 10 KW - mobile health KW - mHealth KW - eHealth KW - tailoring KW - gender KW - weight loss intervention KW - mobile phone N2 - Background: Given the increase in the prevalence of overweight and obesity worldwide, the number of digital weight loss interventions has also risen. However, these interventions often lack theoretical background and data on long-term effectiveness. The consideration of individual and gender differences in weight-related psychological parameters might enhance the efficacy and sustainability of mobile-based weight loss interventions. Objective: This paper presented an introduction to and the process evaluation of a 12-week gender-sensitive mobile health (mHealth) weight loss intervention (I-GENDO) combining computer-based and self-tailoring features. Methods: Between August 2020 and August 2021, individuals with overweight (BMI 25.0-29.9 kg/m²), those with obesity class I (BMI 30.0-34.9 kg/m²), and those with obesity class II (BMI 35.0-39.9 kg/m²) were recruited to the I-GENDO project, a multicenter study in Germany. The mHealth intervention aimed at targeting individual psychological factors associated with the development and persistence of overweight and obesity (eg, emotional eating) using computer-based tailoring. Moreover, the intervention took a gender-sensitive approach by implementing self-tailoring of gender-targeted module versions. The computer-based assignment of the main modules, self-selection of gender-targeted module versions, and use patterns were evaluated while considering gender. Moreover, gender differences in the usability assessment were analyzed. Results: Data from the intervention arm of the study were processed. A total of 116 individuals with overweight and obesity (77/116, 66.4% women; age mean 47.28, SD 11.66 years; BMI mean 33.58, SD 3.79 kg/m2) were included in the analyses. Overall, the compliance (90/109, 82.6%) and satisfaction with the app (mean 86% approval) were high and comparable with those of other mobile weight loss interventions. The usability of the intervention was rated with 71% (5.0/7.0 points) satisfaction. More women obtained the main module that focused on emotion regulation skills. Most men and women selected women-targeted versions of the main modules. Women used the app more frequently and longer than men. However, women and men did not differ in the progress of use patterns throughout the intervention. Conclusions: We developed a tailored gender-sensitive mHealth weight loss intervention. The usability of and engagement with the intervention were satisfactory, and the overall satisfaction with the intervention was also high. Gender differences must be considered in the evaluation of the effectiveness and sustainability of the intervention. UR - https://formative.jmir.org/2022/10/e38480 UR - http://dx.doi.org/10.2196/38480 UR - http://www.ncbi.nlm.nih.gov/pubmed/36301614 ID - info:doi/10.2196/38480 ER - TY - JOUR AU - Vitger, Tobias AU - Hjorthøj, Carsten AU - Austin, F. Stephen AU - Petersen, Lone AU - Tønder, Sandvik Esben AU - Nordentoft, Merete AU - Korsbek, Lisa PY - 2022/10/26 TI - A Smartphone App to Promote Patient Activation and Support Shared Decision-making in People With a Diagnosis of Schizophrenia in Outpatient Treatment Settings (Momentum Trial): Randomized Controlled Assessor-Blinded Trial JO - J Med Internet Res SP - e40292 VL - 24 IS - 10 KW - mobile health KW - mHealth KW - digital intervention KW - shared decision-making KW - patient activation KW - schizophrenia KW - schizotypal KW - early intervention KW - randomized clinical trial KW - mobile phone N2 - Background: Shared decision-making (SDM) is a process aimed at facilitating patient-centered care by ensuring that the patient and provider are actively involved in treatment decisions. In mental health care, SDM has been advocated as a means for the patient to gain or regain control and responsibility over their life and recovery process. To support the process of patient-centered care and SDM, digital tools may have advantages in terms of accessibility, structure, and reminders. Objective: In this randomized controlled trial, we aimed to investigate the effect of a digital tool to support patient activation and SDM. Methods: The trial was designed as a randomized, assessor-blinded, 2-armed, parallel-group multicenter trial investigating the use of a digital SDM intervention for 6 months compared with treatment as usual. Participants with a diagnosis of schizophrenia, schizotypal or delusional disorder were recruited from 9 outpatient treatment sites in the Capital Region of Denmark. The primary outcome was the self-reported level of activation at the postintervention time point. The secondary outcomes included self-efficacy, hope, working alliance, satisfaction, preparedness for treatment consultation, symptom severity, and level of functioning. Explorative outcomes on the effect of the intervention at the midintervention time point along with objective data on the use of the digital tool were collected. Results: In total, 194 participants were included. The intention-to-treat analysis revealed a statistically significant effect favoring the intervention group on patient activation (mean difference 4.39, 95% CI 0.99-7.79; Cohen d=0.33; P=.01), confidence in communicating with one?s provider (mean difference 1.85, 95% CI 0.01-3.69; Cohen d=0.24; P=.05), and feeling prepared for decision-making (mean difference 5.12, 95% CI 0.16-10.08; Cohen d=0.27; P=.04). We found no effect of the digital SDM tool on treatment satisfaction, hope, self-efficacy, working alliance, severity of symptoms, level of functioning, use of antipsychotic medicine, and number or length of psychiatric hospital admissions. Conclusions: This trial showed a significant effect of a digital SDM tool on the subjective level of patient activation, confidence in communicating with one?s provider, and feeling prepared for decision-making at the postintervention time point. The effect size was smaller than the 0.42 effect size that we had anticipated and sampled for. The trial contributes to the evidence on how digital tools may support patient-centered care and SDM in mental health care. Trial Registration: ClinicalTrials.gov NCT03554655; https://clinicaltrials.gov/ct2/show/NCT03554655 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-019-2143-2 UR - https://www.jmir.org/2022/10/e40292 UR - http://dx.doi.org/10.2196/40292 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287604 ID - info:doi/10.2196/40292 ER - TY - JOUR AU - Sivakumar, Bridve AU - Lemonde, Manon AU - Stein, Matthew AU - Goldstein, Sarah AU - Mak, Susanna AU - Arcand, JoAnne PY - 2022/10/26 TI - Evaluating Health Care Provider Perspectives on the Use of Mobile Apps to Support Patients With Heart Failure Management: Qualitative Descriptive Study JO - JMIR Cardio SP - e40546 VL - 6 IS - 2 KW - heart failure KW - mobile health KW - mHealth KW - eHealth KW - mobile apps KW - adherence KW - self-management KW - mobile phone N2 - Background: Nonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice. However, little is known about HCPs? perspectives on the use of mobile apps to support HF management. Objective: The aim of this study is to determine HCPs? perspectives (needs, motivations, and challenges) on the use of mobile apps to support patients with HF management. Methods: A qualitative descriptive study using one-on-one semistructured interviews, informed by the diffusion of innovation theory, was conducted among HF HCPs, including cardiologists, nurses, and nurse practitioners. Transcripts were independently coded by 2 researchers and analyzed using content analysis. Results: The 21 HCPs (cardiologists: n=8, 38%; nurses: n=6, 29%; and nurse practitioners: n=7, 33%) identified challenges and opportunities for app adoption across 5 themes: participant-perceived factors that affect app adoption?these include patient age, technology savviness, technology access, and ease of use; improved delivery of care?apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care?apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education?apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients?HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes). Conclusions: HCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice. UR - https://cardio.jmir.org/2022/2/e40546 UR - http://dx.doi.org/10.2196/40546 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287588 ID - info:doi/10.2196/40546 ER - TY - JOUR AU - Maarj, Muhammad AU - Pacey, Verity AU - Tofts, Louise AU - Clapham, Matthew AU - Gironès Garcia, Xavier AU - Coda, Andrea PY - 2022/10/26 TI - Validation of an Electronic Visual Analog Scale App for Pain Evaluation in Children and Adolescents With Symptomatic Hypermobility: Cross-sectional Study JO - JMIR Pediatr Parent SP - e41930 VL - 5 IS - 4 KW - hypermobility syndrome KW - Ehlers-Danlos syndrome KW - hypermobility KW - hypermobile KW - mobile application KW - mobile app KW - pain measurement KW - pain KW - validation KW - validate KW - scale KW - measure KW - pain severity KW - pediatric KW - visual analogue scale KW - mHealth KW - mobile health KW - children KW - adolescent KW - youth KW - child KW - digital health tool N2 - Background: Rapid advances in mobile apps for clinical data collection for pain evaluation have resulted in more efficient data handling and analysis than traditional paper-based approaches. As paper-based visual analogue scale (p-VAS) scores are commonly used to assess pain levels, new emerging apps need to be validated prior to clinical application with symptomatic children and adolescents. Objective: This study aimed to assess the validity and reliability of an electronic visual analogue scale (e-VAS) method via a mobile health (mHealth) App in children and adolescents diagnosed with hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (HSD/HEDS) in comparison with the traditional p-VAS. Methods: Children diagnosed with HSD/HEDS aged 5-18 years were recruited from a sports medicine center in Sydney (New South Wales, Australia). Consenting participants assigned in random order to the e-VAS and p-VAS platforms were asked to indicate their current lower limb pain level and completed pain assessment e-VAS or p-VAS at one time point. Instrument agreement between the 2 methods was determined from the intraclass correlation coefficient (ICC) and through Bland?Altman analysis. Results: In total, 43 children with HSD/HEDS aged 11 (SD 3.8) years were recruited and completed this study. The difference between the 2 VAS platforms of median values was 0.20. Bland?Altman analysis revealed a difference of 0.19 (SD 0.95) with limits of agreement ranging ?1.67 to 2.04. An ICC of 0.87 (95% CI 0.78-0.93) indicated good reliability. Conclusions: These findings suggest that the e-VAS mHealth App is a validated tool and a feasible method of collecting pain recording scores when compared with the traditional paper format in children and adolescents with HSD/HEDS. The e-VAS App can be reliably used for pediatric pain evaluation, and it could potentially be introduced into daily clinical practice to improve real-time symptom monitoring. Further research is warranted to investigate the usage of the app for remote support in real clinical settings. UR - https://pediatrics.jmir.org/2022/4/e41930 UR - http://dx.doi.org/10.2196/41930 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287606 ID - info:doi/10.2196/41930 ER - TY - JOUR AU - Dinour, M. Lauren AU - Pole, Antoinette PY - 2022/10/26 TI - Evaluation of Breastfeeding App Features: Content Analysis Study JO - JMIR Pediatr Parent SP - e37581 VL - 5 IS - 4 KW - breastfeeding KW - breastmilk expression KW - bottle feeding KW - infant food KW - infant health KW - infant care KW - consumer health informatics KW - mobile apps KW - smartphone KW - cross-sectional study N2 - Background: While a variety of health apps abound, less than half of adults in the United States report using a health app, despite the ubiquity of smartphones among users aged 18 to 49 years. Several studies have examined the use of breastfeeding apps; however, less is known about the types of features found on these apps and what factors might influence app ratings. Objective: This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated. Methods: Using a cross-sectional design, a convenience sample of breastfeeding apps was culled from the Apple App Store (iOS) and Google Play Store (Android). Content analysis of the apps (N=82) was conducted using a schema of 87 items, which was then compiled into 9 topical indices for breastfeeding, bottle feeding, solid foods, infant health, infant care, technical characteristics, informatics, informational characteristics, and interactivity. Analysis consisted of descriptive statistics, the Mann-Whitney U test, and Spearman rank correlations. Linear regression and binary logistic regression analyses were conducted to determine which features predicted user star ratings. Results: On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (?4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times. Conclusions: Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users. UR - https://pediatrics.jmir.org/2022/4/e37581 UR - http://dx.doi.org/10.2196/37581 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287596 ID - info:doi/10.2196/37581 ER - TY - JOUR AU - Long, Zhiwen AU - Huang, Shan AU - Zhang, Jie AU - Zhang, Deng AU - Yin, Jun AU - He, Chengyuan AU - Zhang, Qinqiu AU - Xu, Huilin AU - He, Huimin AU - Sun, Ching Ho AU - Xie, Ke PY - 2022/10/26 TI - A Digital Smartphone-Based Self-administered Tool (R+ Dietitian) for Nutritional Risk Screening and Dietary Assessment in Hospitalized Patients With Cancer: Evaluation and Diagnostic Accuracy Study JO - JMIR Form Res SP - e40316 VL - 6 IS - 10 KW - digital tool KW - nutritional risk screening KW - dietary assessment KW - validity KW - cancer patients N2 - Background: Malnutrition is a common and severe problem in patients with cancer that directly increases the incidence of complications and significantly deteriorates quality of life. Nutritional risk screening and dietary assessment are critical because they are the basis for providing personalized nutritional support. No digital smartphone-based self-administered tool for nutritional risk screening and dietary assessment among hospitalized patients with cancer has been developed and evaluated. Objective: This study aims to develop a digital smartphone-based self-administered mini program for nutritional risk screening and dietary assessment for hospitalized patients with cancer and to evaluate the validity of the mini program. Methods: We have developed the R+ Dietitian mini program, which consists of 3 parts: (1) collection of basic information of patients, (2) nutritional risk screening, and (3) dietary energy and protein assessment. The face-to-face paper-based Nutritional Risk Screening (NRS-2002), the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and 3 days of 24-hour dietary recall (3d-24HRs) questionnaires were administered according to standard procedure by 2 trained dietitians as the reference methods. Sensitivity, specificity, positive predictive value, negative predictive value, ? value, and correlation coefficients (CCs) of nutritional risk screened in R+ Dietitian against the reference methods, as well as the difference and CCs of estimated dietary energy and protein intakes between R+ Dietitian and 3d-24HRs were calculated to evaluate the validity of R+ Dietitian. Results: A total of 244 hospitalized patients with cancer were recruited to evaluate the validity of R+ Dietitian. The NRS-2002 and PG-SGA-SF tools in R+ Dietitian showed high accuracy, sensitivity, and specificity (77.5%, 81.0%, and 76.7% and 69.3%, 84.5%, and 64.5%, respectively), and fair agreement (?=0.42 and 0.37, respectively; CC 0.62 and 0.56, respectively) with the NRS-2002 and PG-SGA-SF tools administered by dietitians. The estimated intakes of dietary energy and protein were significantly higher (P<.001 for both) in R+ Dietitian (mean difference of energy intake: 144.2 kcal, SD 454.8; median difference of protein intake: 10.7 g, IQR 9.5-39.8), and showed fair agreement (CC 0.59 and 0.47, respectively), compared with 3d-24HRs performed by dietitians. Conclusions: The identified nutritional risk and assessment of dietary intakes of energy and protein in R+ Dietitian displayed a fair agreement with the screening and assessment conducted by dietitians. R+ Dietitian has the potential to be a tool for nutritional risk screening and dietary intake assessment among hospitalized patients with cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026324; https://www.chictr.org.cn/showprojen.aspx?proj=41528 UR - https://formative.jmir.org/2022/10/e40316 UR - http://dx.doi.org/10.2196/40316 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287601 ID - info:doi/10.2196/40316 ER - TY - JOUR AU - Bendig, Jonas AU - Spanz, Anja AU - Leidig, Jana AU - Frank, Anika AU - Stahr, Marcus AU - Reichmann, Heinz AU - Loewenbrück, F. Kai AU - Falkenburger, H. Björn PY - 2022/10/25 TI - Measuring the Usability of eHealth Solutions for Patients With Parkinson Disease: Observational Study JO - JMIR Form Res SP - e39954 VL - 6 IS - 10 KW - eHealth KW - usability KW - Parkinson disease KW - telehealth and telemonitoring KW - older adults KW - aging KW - older population KW - neurodegenerative disease KW - digital solution KW - wearable sensor KW - mobile health KW - system usability KW - eHealth solution N2 - Background: Parkinson disease (PD) is a neurodegenerative disorder with a variety of motor and nonmotor symptoms. Many of these symptoms can be monitored by eHealth solutions, including smartphone apps, wearable sensors, and camera systems. The usability of such systems is a key factor in long-term use, but not much is known about the predictors of successful use and preferable methods to assess usability in patients with PD. Objective: This study tested methods to assess usability and determined prerequisites for successful use in patients with PD. Methods: We performed comprehensive usability assessments with 18 patients with PD using a mixed methods usability battery containing the System Usability Scale, a rater-based evaluation of device-specific tasks, and qualitative interviews. Each patient performed the usability battery with 2 of 3 randomly assigned devices: a tablet app, wearable sensors, and a camera system. The usability battery was administered at the beginning and at the end of a 4-day testing period. Between usability batteries, the systems were used by the patients during 3 sessions of motor assessments (wearable sensors and camera system) and at the movement disorder ward (tablet app). Results: In this study, the rater-based evaluation of tasks discriminated the best between the 3 eHealth solutions, whereas subjective modalities such as the System Usability Scale were not able to distinguish between the systems. Successful use was associated with different clinical characteristics for each system: eHealth literacy and cognitive function predicted successful use of the tablet app, and better motor function and lower age correlated with the independent use of the camera system. The successful use of the wearable sensors was independent of clinical characteristics. Unfortunately, patients who were not able to use the devices well provided few improvement suggestions in qualitative interviews. Conclusions: eHealth solutions should be developed with a specific set of patients in mind and subsequently tested in this cohort. For a complete picture, usability assessments should include a rater-based evaluation of task performance, and there is a need to develop strategies to circumvent the underrepresentation of poorly performing patients in qualitative usability research. UR - https://formative.jmir.org/2022/10/e39954 UR - http://dx.doi.org/10.2196/39954 UR - http://www.ncbi.nlm.nih.gov/pubmed/36282558 ID - info:doi/10.2196/39954 ER - TY - JOUR AU - Su, Langting AU - Anderson, Lyn Page PY - 2022/10/25 TI - User Behavior of a Publicly Available, Free-to-Use, Self-guided mHealth App for Depression: Observational Study in a Global Sample JO - JMIR Form Res SP - e35538 VL - 6 IS - 10 KW - mHealth KW - depression KW - smartphone KW - mobile app KW - digital health KW - global mental health KW - MoodTools KW - mobile health KW - mental health KW - mobile phone KW - low- and middle-income countries N2 - Background: Reducing the burden of depression is a global health concern. Self-guided mobile health (mHealth) apps are one approach to address this problem. However, there is little research on self-guided mHealth apps in a global sample or on how they are used in the real world. These gaps in our knowledge must be addressed to bring the promise of mHealth apps for reducing the global burden of depression closer to reality. Objective: The purpose of this study is to examine the naturalistic user behavior of MoodTools, a publicly available, free-to-use, self-guided mHealth app designed to improve symptoms of depression, in a global community sample. Methods: Mobile analytics data were collected from all unique downloads of the Android version of MoodTools between March 1, 2016, and February 28, 2018. Due to the deidentification and data aggregation process, no demographic or personal identifying information was tied to individual user data. All information was stored in aggregated, anonymized data files on Google Analytics? storage database. Google?s software development kit was used to securely capture data about the number of downloads, location of downloads, number of app sessions, frequency and duration of app sessions, time between app sessions, and user retention, allowing for examination of which app?s tools were viewed and for how long, including Information (psychoeducation), Test (self-monitoring using the Patient Health Questionnaire [PHQ-9]), Thought Diary (targeting negative cognitions), Activities (behavioral activation), Videos (curated from YouTube), and Safety Plan (safety plan development and links to quickly access crisis management resources). Results: MoodTools was used by 158,930 people from 198 countries, including countries where English was not the primary language and in low- and middle-income countries. After the initial download, 51.14% (n=81,277) of users returned to the app after the initial download, and retention rates decreased with each subsequent app session. The typical person used the app for 3 sessions for a total of 12 minutes over 90 days. The most frequently visited tools were Test and Thought Diary (n=393,549, 24.32%). On average, users completed and reviewed the results of the PHQ-9 for 49 seconds and 53 seconds, respectively, and spent 3 minutes and 5 seconds on Thought Diary. Conclusions: Self-guided mHealth apps could be one approach (among the many needed) to reduce the burden of depression. Observational data collected in this study show a global interest in MoodTools, including in low- and middle-income countries and countries where English is not the primary language. Future research is needed to determine whether people who use self-guided apps experience improvement in depressive symptoms, and if so, what ?dosage? provides a meaningful benefit. UR - https://formative.jmir.org/2022/10/e35538 UR - http://dx.doi.org/10.2196/35538 UR - http://www.ncbi.nlm.nih.gov/pubmed/36282559 ID - info:doi/10.2196/35538 ER - TY - JOUR AU - Yoshimura, Eiichi AU - Tajiri, Eri AU - Michiwaki, Ryota AU - Matsumoto, Naoyuki AU - Hatamoto, Yoichi AU - Tanaka, Shigeho PY - 2022/10/24 TI - Long-term Effects of the Use of a Step Count?Specific Smartphone App on Physical Activity and Weight Loss: Randomized Controlled Clinical Trial JO - JMIR Mhealth Uhealth SP - e35628 VL - 10 IS - 10 KW - step counts KW - weight loss KW - smartphone app KW - step count?specific mobile app KW - physical activity KW - moderate-to-vigorous intensity physical activity KW - lifestyle intervention KW - mHealth KW - mobile app: mobile phone N2 - Background: Some studies on weight loss promotion using smartphone apps have shown a weight loss effect but not an increase in physical activity. However, the long-term effects of smartphone apps on weight loss and increasing physical activity have not been rigorously examined to date. Objective: The aim of this study was to assess whether the use of a smartphone app will increase physical activity and reduce body weight. Methods: In this parallel randomized clinical trial, participants recruited between April 2018 and June 2019 were randomized in equal proportions to a smartphone app group (n=55) or a control group (n=54). The intention-to-treat approach was used to analyze the data from December 2019 through November 2021. Before the intervention, an hour-long lecture on weight loss instruction and increasing physical activity was conducted once for both groups. Participants in both groups were instructed to weigh themselves immediately after waking up at least once daily from the start of the intervention. Monthly emails were sent advising the participants in both groups on how to lose weight and increase physical activity in order to maintain or increase motivation. Participants in the smartphone app group were instructed to open the app at least once a day to check their step count and rank. The primary outcome was daily accelerometer-measured physical activity (step count) and the secondary outcome was body weight. Since there was a significant difference in the wear time of the accelerometer depending on the intervention period (P<.001), the number of steps and moderate-to-vigorous physical activity were also evaluated per wear time. Results: The mean age of the 109 participants in this study was 47 (SD 8) years. At baseline, the mean daily total steps were 7259 (SD 3256) steps per day for the smartphone app group and 8243 (SD 2815) steps per day for the control group. The difference in the step count per wear time between preintervention and postintervention was significantly different between the app group and the control group (average difference [95% CI], 65 [30 to 101] steps per hour vs ?9 [?56 to 39] steps per hour; P=.042). The weight loss was ?2.2 kg (SD ?3.1%) in the smartphone app group and ?2.2 kg (SD ?3.1%) in the control group, with no significant difference between the groups. In addition, when divided into weekdays (Monday through Friday) and weekends (Saturday and Sunday), there was a significant interaction between step counts (P=.004) and MVPA (P=.003) during the intervention, with the app group showing higher interaction on weekends than the control group. Conclusions: In this trial, the group with the smartphone app intervention showed increased physical activity, especially on weekends. However, this increased physical activity did not lead to increased weight loss. Trial Registration: University Hospital Medical Information Network UMIN000033397; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037956 UR - https://mhealth.jmir.org/2022/10/e35628 UR - http://dx.doi.org/10.2196/35628 UR - http://www.ncbi.nlm.nih.gov/pubmed/36279159 ID - info:doi/10.2196/35628 ER - TY - JOUR AU - Perez, Oriana AU - Kumar Vadathya, Anil AU - Beltran, Alicia AU - Barnett, Matthew R. AU - Hindera, Olivia AU - Garza, Tatyana AU - Musaad, M. Salma AU - Baranowski, Tom AU - Hughes, O. Sheryl AU - Mendoza, A. Jason AU - Sabharwal, Ashutosh AU - Veeraraghavan, Ashok AU - O'Connor, M. Teresia PY - 2022/10/21 TI - The Family Level Assessment of Screen Use?Mobile Approach: Development of an Approach to Measure Children?s Mobile Device Use JO - JMIR Form Res SP - e40452 VL - 6 IS - 10 KW - screen time KW - mobile media apps KW - children KW - mobile phone use KW - tablet use KW - mobile phone N2 - Background: There is a strong association between increased mobile device use and worse dietary habits, worse sleep outcomes, and poor academic performance in children. Self-report or parent-proxy report of children?s screen time has been the most common method of measuring screen time, which may be imprecise or biased. Objective: The objective of this study was to assess the feasibility of measuring the screen time of children on mobile devices using the Family Level Assessment of Screen Use (FLASH)?mobile approach, an innovative method that leverages the existing features of the Android platform. Methods: This pilot study consisted of 2 laboratory-based observational feasibility studies and 2 home-based feasibility studies in the United States. A total of 48 parent-child dyads consisting of a parent and child aged 6 to 11 years participated in the pilot study. The children had to have their own or shared Android device. The laboratory-based studies included a standardized series of tasks while using the mobile device or watching television, which were video recorded. Video recordings were coded by staff for a gold standard comparison. The home-based studies instructed the parent-child dyads to use their mobile device as they typically use it over 3 days. Parents received a copy of the use logs at the end of the study and completed an exit interview in which they were asked to review their logs and share their perceptions and suggestions for the improvement of the FLASH-mobile approach. Results: The final version of the FLASH-mobile approach resulted in user identification compliance rates of >90% for smartphones and >80% for tablets. For laboratory-based studies, a mean agreement of 73.6% (SD 16.15%) was achieved compared with the gold standard (human coding of video recordings) in capturing the target child?s mobile use. Qualitative feedback from parents and children revealed that parents found the FLASH-mobile approach useful for tracking how much time their child spends using the mobile device as well as tracking the apps they used. Some parents revealed concerns over privacy and provided suggestions for improving the FLASH-mobile approach. Conclusions: The FLASH-mobile approach offers an important new research approach to measure children?s use of mobile devices more accurately across several days, even when the child shares the device with other family members. With additional enhancement and validation studies, this approach can significantly advance the measurement of mobile device use among young children. UR - https://formative.jmir.org/2022/10/e40452 UR - http://dx.doi.org/10.2196/40452 UR - http://www.ncbi.nlm.nih.gov/pubmed/36269651 ID - info:doi/10.2196/40452 ER - TY - JOUR AU - Heron, E. Kristin AU - Braitman, L. Abby AU - Dawson, A. Charlotte AU - Sandoval, M. Cassidy AU - Butler, V. Lauren AU - Moulder, Alicia AU - Lewis, J. Robin PY - 2022/10/21 TI - Rationale and Design of an Ecological Momentary Assessment Study Examining Predictors of Binge Eating Among Sexual Minority and Heterosexual Young Women: Protocol for the Health and Experiences in Real Life (HER Life) Study JO - JMIR Res Protoc SP - e41199 VL - 11 IS - 10 KW - sexual minority women KW - ecological momentary assessment KW - binge eating KW - sexual minority stress KW - negative affective states KW - mobile phone N2 - Background: Previous research has identified health disparities between sexual minority and heterosexual women, including increased rates of obesity and binge eating in sexual minority women. Established predictors of binge eating behavior include negative emotions and sociocultural processes; however, these studies are generally conducted in samples of young women where sexual identity is not known or reported. There is a dearth of research evaluating how sexual minority?specific factors (eg, minority stress and connectedness to the lesbian, gay, bisexual, transgender, and queer community) may affect binge eating in sexual minority women. In addition, no studies have examined these processes in racially diverse samples or considered how intersecting minority identities (eg, Black and sexual minority) may affect eating behaviors. Objective: The Health and Experiences in Real Life (HER Life) Project aims to clarify real-world predictors of binge eating in young heterosexual and sexual minority women using ecological momentary assessment. The role of affective, social, and health behavior factors in binge eating will be examined for all women (aim 1), and sexual minority?specific predictors will also be considered for sexual minority women participants (aim 2). Person-level moderators of race, body- and eating-related factors, and sexual minority?specific factors will also be examined to better understand how real-world binge eating predictors may differ for various demographic groups (aim 3). Methods: Researchers aim to recruit 150 sexual minority and 150 heterosexual women from across the United States, including at least 50 Black women for each group, using web-based recruitment methods. The eligibility criteria include identifying as a woman, being aged between 18 and 30 years, and having had at least two binge eating episodes in the last 2 weeks. Participants must endorse being only or mostly attracted to men (considered heterosexual) or only or mostly attracted to women or having a current or most recent female partner (considered sexual minority). Eligible participants complete an initial web-based baseline survey and then 14 days of ecological momentary assessment involving the completion of a morning and before-bed survey and 5 prompted surveys per day as well as a user-initiated survey after binge eating episodes. The data will be analyzed using a series of multilevel models. Results: Data collection started in February 2021. We have currently enrolled 129 sexual minority women and 146 heterosexual women. Data collection is expected to conclude in fall 2022. Conclusions: The Health and Experiences in Real Life Project aims to elucidate potential differences between sexual minority and heterosexual women in within-person factors predicting binge eating and inform eating disorder interventions for sexual minority women. The challenges in recruiting sexual minority women, including the determination of eligibility criteria and considerations for remote data collection, are discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/41199 UR - https://www.researchprotocols.org/2022/10/e41199 UR - http://dx.doi.org/10.2196/41199 UR - http://www.ncbi.nlm.nih.gov/pubmed/36269642 ID - info:doi/10.2196/41199 ER - TY - JOUR AU - Aboujaoude, Elias AU - Vera Cruz, Germano AU - Rochat, Lucien AU - Courtois, Robert AU - Ben Brahim, Farah AU - Khan, Riaz AU - Khazaal, Yasser PY - 2022/10/20 TI - Assessment of the Popularity and Perceived Effectiveness of Smartphone Tools That Track and Limit Smartphone Use: Survey Study and Machine Learning Analysis JO - J Med Internet Res SP - e38963 VL - 24 IS - 10 KW - smartphone addiction KW - internet addiction KW - internet gaming disorder KW - smartphone tools KW - telepsychiatry KW - machine learning KW - telemedicine KW - social media KW - digital mental health interventions KW - mobile phone N2 - Background: Problematic smartphone use, like problematic internet use, is a condition for which treatment is being sought on the web. In the absence of established treatments, smartphone-provided tools that monitor or control smartphone use have become increasingly popular, and their dissemination has largely occurred without oversight from the mental health field. Objective: We aimed to assess the popularity and perceived effectiveness of smartphone tools that track and limit smartphone use. We also aimed to explore how a set of variables related to mental health, smartphone use, and smartphone addiction may influence the use of these tools. Methods: First, we conducted a web-based survey in a representative sample of 1989 US-based adults using the crowdsourcing platform Prolific. Second, we used machine learning and other statistical tools to identify latent user classes; the association between latent class membership and demographic variables; and any predictors of latent class membership from covariates such as daily average smartphone use, social problems from smartphone use, smartphone addiction, and other psychiatric conditions. Results: Smartphone tools that monitor and control smartphone use were popular among participants, including parents targeting their children; for example, over two-thirds of the participants used sleep-related tools. Among those who tried a tool, the highest rate of perceived effectiveness was 33.1% (58/175). Participants who experienced problematic smartphone use were more likely to be younger and more likely to be female. Finally, 3 latent user classes were uncovered: nonusers, effective users, and ineffective users. Android operating system users were more likely to be nonusers, whereas younger adults and females were more likely to be effective users. The presence of psychiatric symptoms did not discourage smartphone tool use. Conclusions: If proven effective, tools that monitor and control smartphone use are likely to be broadly embraced. Our results portend well for the acceptability of mobile interventions in the treatment of smartphone-related psychopathologies and, potentially, non?smartphone-related psychopathologies. Better tools, targeted marketing, and inclusive design, as well as formal efficacy trials, are required to realize their potential. UR - https://www.jmir.org/2022/10/e38963 UR - http://dx.doi.org/10.2196/38963 UR - http://www.ncbi.nlm.nih.gov/pubmed/36264627 ID - info:doi/10.2196/38963 ER - TY - JOUR AU - Abrantes, M. Ana AU - Meshesha, Z. Lidia AU - E Blevins, Claire AU - Battle, L. Cynthia AU - Lindsay, Clifford AU - Marsh, Eliza AU - Feltus, Sage AU - Buman, Matthew AU - Agu, Emmanuel AU - Stein, Michael PY - 2022/10/19 TI - A Smartphone Physical Activity App for Patients in Alcohol Treatment: Single-Arm Feasibility Trial JO - JMIR Form Res SP - e35926 VL - 6 IS - 10 KW - alcohol use disorder KW - AUD KW - physical activity KW - smartphone app KW - Fitbit KW - feasibility study KW - mobile phone N2 - Background: Alcohol use disorder (AUD) is a significant public health concern worldwide. Alcohol consumption is a leading cause of death in the United States and has a significant negative impact on individuals and society. Relapse following treatment is common, and adjunct intervention approaches to improve alcohol outcomes during early recovery continue to be critical. Interventions focused on increasing physical activity (PA) may improve AUD treatment outcomes. Given the ubiquity of smartphones and activity trackers, integrating this technology into a mobile app may be a feasible, acceptable, and scalable approach for increasing PA in individuals with AUD. Objective: This study aims to test the Fit&Sober app developed for patients with AUD. The goals of the app were to facilitate self-monitoring of PA engagement and daily mood and alcohol cravings, increase awareness of immediate benefits of PA on mood and cravings, encourage setting and adjusting PA goals, provide resources and increase knowledge for increasing PA, and serve as a resource for alcohol relapse prevention strategies. Methods: To preliminarily test the Fit&Sober app, we conducted an open pilot trial of patients with AUD in early recovery (N=22; 13/22, 59% women; mean age 43.6, SD 11.6 years). At the time of hospital admission, participants drank 72% of the days in the last 3 months, averaging 9 drinks per drinking day. The extent to which the Fit&Sober app was feasible and acceptable among patients with AUD during early recovery was examined. Changes in alcohol consumption, PA, anxiety, depression, alcohol craving, and quality of life were also examined after 12 weeks of app use. Results: Participants reported high levels of satisfaction with the Fit&Sober app. App metadata suggested that participants were still using the app approximately 2.5 days per week by the end of the intervention. Pre-post analyses revealed small-to-moderate effects on increase in PA, from a mean of 5784 (SD 2511) steps per day at baseline to 7236 (SD 3130) steps per day at 12 weeks (Cohen d=0.35). Moderate-to-large effects were observed for increases in percentage of abstinent days (Cohen d=2.17) and quality of life (Cohen d=0.58) as well as decreases in anxiety (Cohen d=?0.71) and depression symptoms (Cohen d=?0.58). Conclusions: The Fit&Sober app is an acceptable and feasible approach for increasing PA in patients with AUD during early recovery. A future randomized controlled trial is necessary to determine the efficacy of the Fit&Sober app for long-term maintenance of PA, ancillary mental health, and alcohol outcomes. If the efficacy of the Fit&Sober app could be established, patients with AUD would have a valuable adjunct to traditional alcohol treatment that can be delivered in any setting and at any time, thereby improving the overall health and well-being of this population. Trial Registration: ClinicalTrials.gov NCT02958280; https://www.clinicaltrials.gov/ct2/show/NCT02958280 UR - https://formative.jmir.org/2022/10/e35926 UR - http://dx.doi.org/10.2196/35926 UR - http://www.ncbi.nlm.nih.gov/pubmed/36260381 ID - info:doi/10.2196/35926 ER - TY - JOUR AU - Boccardi, Alyssa AU - Wu, Fangzheng AU - Pearlman, Jon AU - Mhatre, Anand PY - 2022/10/18 TI - Older Wheelchair Users Recommend Age-Friendly Design Improvements to a Wheelchair Maintenance App: Mixed Methods Development Study JO - JMIR Aging SP - e39301 VL - 5 IS - 4 KW - aging KW - older adults KW - maintenance KW - mobile phone KW - repair KW - smartphone KW - wheelchair N2 - Background: Wheelchair part failures have doubled over the past decade. Preventative wheelchair maintenance reduces wheelchair failures and prevents user consequences. We are developing a smartphone app called WheelTrak, which alerts users when maintenance is required, to encourage maintenance practices and compliance. Objective: This mixed methods study aimed to develop a wheelchair maintenance app using broad stakeholder advice and investigate older adults? interaction experience with the app and their perceived barriers to and facilitators of maintenance. Methods: Interviews were conducted with stakeholders, including mobility device users, to generate needs statements and app specifications. The app was designed in 2 stages. Stage 1 involved the development of the app according to the specifications and evaluation of the app interface by lead users. Stage 2 included the revision of the app screens and manual functionality testing. Usability testing and semistructured interviews were conducted with older wheelchair and scooter users. The System Usability Scale was used to measure app usability. Results: Interviews with power and manual wheelchair users (37/57, 65%), wheelchair service providers (15/57, 26%), manufacturers (2/57, 4%), seating and mobility researchers (1/57, 2%), and insurance plan providers (2/57, 4%) informed the needs and specifications of the app technology. The 2-stage development process delivered a fully functional app that met the design specifications. In total, 12 older adults (mean age 74.2, SD 9.1 years; n=10, 83% women; and n=2, 17% men) participated in the usability testing study. Of the 12 participants, 9 (75%) agreed to use WheelTrak for preventative maintenance. WheelTrak scored an average System Usability Scale score of 60.25 (SD 16). Four overarching themes were identified: WheelTrak app improvements, barriers to maintenance, consequences related to mobility device failure, and smart technology use and acceptance. Older adults preferred the simplicity, readability, personalization, and availability of educational resources in the app. Barriers to maintenance pertained to health issues and lack of maintenance knowledge among older adults. Facilitators of maintenance included notification for maintenance, app connectivity with the service provider, reporting of device failure, and the presence of a caregiver for maintenance. Conclusions: This study highlighted age-friendly design improvements to the app, making it easy to be used and adopted by older wheelchair users. The WheelTrak app has close to average system usability. Additional usability testing will be conducted following app revision in the future. UR - https://aging.jmir.org/2022/4/e39301 UR - http://dx.doi.org/10.2196/39301 UR - http://www.ncbi.nlm.nih.gov/pubmed/36256830 ID - info:doi/10.2196/39301 ER - TY - JOUR AU - Agapie, Elena AU - Chang, Katherine AU - Patrachari, Sneha AU - Neary, Martha AU - Schueller, M. Stephen PY - 2022/10/18 TI - Understanding Mental Health Apps for Youth: Focus Group Study With Latinx Youth JO - JMIR Form Res SP - e40726 VL - 6 IS - 10 KW - mental health KW - mental health apps KW - youth KW - child KW - teenager KW - focus group KW - human-centered design KW - mobile health KW - mHealth KW - health app KW - cognitive behavioral therapy KW - CBT KW - perspective KW - qualitative KW - mindfulness KW - digital health tool KW - Latino KW - Latinx KW - mobile phone N2 - Background: An increasing number of mental health apps (MHapps) are being developed for youth. In addition, youth are high users of both technologies and MHapps. However, little is known about their perspectives on MHapps. MHapps might be particularly well suited to reach the youth underserved by traditional mental health resources, and incorporating their perspectives is especially critical to ensure such tools are useful to them. Objective: The goal of this study was to develop and pilot a process for eliciting youth perspectives on MHapps in a structured and collaborative way. We also sought to generate learnings on the perspectives of Latinx youth on MHapps and their use in ways that might facilitate discovery, activation, or engagement in MHapps, especially in Latinx populations. Methods: We created a series of focus groups consisting of 5 sessions. The groups introduced different categories of MHapps (cognitive behavioral therapy apps, mindfulness apps, and miscellaneous apps). Within each category, we selected 4 MHapps that participants chose to use for a week and provided feedback through both between-session and in-session activities. We recruited 5 youths ranging in age from 15 to 21 (mean 18, SD 2.2) years. All the participants identified as Hispanic or Latinx. After completing all 5 focus groups, the participants completed a brief questionnaire to gather their impressions of the apps they had used. Results: Our focus group methodology collected detailed and diverse information about youth perspectives on MHapps. However, we did identify some aspects of our methods that were less successful at engaging the youth, such as our between-session activities. The Latinx youth in our study wanted apps that were accessible, relatable, youth centric, and simple and could be integrated with their offline lives. We also found that the mindfulness apps were viewed most favorably but that the miscellaneous and cognitive behavioral therapy apps were viewed as more impactful. Conclusions: Eliciting youth feedback on MHapps is critical if these apps are going to serve a role in supporting their mental health and well-being. We refined a process for collecting feedback from the youth and identified factors that were important to a set of Latinx youth. Future work could be broader, that is, recruit larger samples of more diverse youth, or deeper, that is, collect more information from each youth around interests, needs, barriers, or facilitators or better understand the various impacts of MHapps by using qualitative and quantitative measures. Nevertheless, this study advances the formative understanding of how the youth, particularly Latinx youth, might be viewing these tools. UR - https://formative.jmir.org/2022/10/e40726 UR - http://dx.doi.org/10.2196/40726 UR - http://www.ncbi.nlm.nih.gov/pubmed/36256835 ID - info:doi/10.2196/40726 ER - TY - JOUR AU - Herbert, Carly AU - Broach, John AU - Heetderks, William AU - Qashu, Felicia AU - Gibson, Laura AU - Pretz, Caitlin AU - Woods, Kelsey AU - Kheterpal, Vik AU - Suvarna, Thejas AU - Nowak, Christopher AU - Lazar, Peter AU - Ayturk, Didem AU - Barton, Bruce AU - Achenbach, Chad AU - Murphy, Robert AU - McManus, David AU - Soni, Apurv PY - 2022/10/18 TI - Feasibility of At-Home Serial Testing Using Over-the-Counter SARS-CoV-2 Tests With a Digital Smartphone App for Assistance: Longitudinal Cohort Study JO - JMIR Form Res SP - e35426 VL - 6 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - rapid tests KW - MyDataHelps smartphone app KW - mHealth KW - mobile health KW - serial self-testing KW - digital health KW - pandemic KW - self test N2 - Background: The ongoing SARS-CoV-2 pandemic necessitates the development of accurate, rapid, and affordable diagnostics to help curb disease transmission, morbidity, and mortality. Rapid antigen tests are important tools for scaling up testing for SARS-CoV-2; however, little is known about individuals? use of rapid antigen tests at home and how to facilitate the user experience. Objective: This study aimed to describe the feasibility and acceptability of serial self-testing with rapid antigen tests for SARS-CoV-2, including need for assistance and the reliability of self-interpretation. Methods: A total of 206 adults in the United States with smartphones were enrolled in this single-arm feasibility study in February and March 2021. All participants were asked to self-test for COVID-19 at home using rapid antigen tests daily for 14 days and use a smartphone app for testing assistance and to report their results. The main outcomes were adherence to the testing schedule, the acceptability of testing and smartphone app experiences, and the reliability of participants versus study team?s interpretation of test results. Descriptive statistics were used to report the acceptability, adherence, overall rating, and experience of using the at-home test and MyDataHelps app. The usability, acceptability, adherence, and quality of at-home testing were analyzed across different sociodemographic, age, and educational attainment groups. Results: Of the 206 enrolled participants, 189 (91.7%) and 159 (77.2%) completed testing and follow-up surveys, respectively. In total, 51.3% (97/189) of study participants were women, the average age was 40.7 years, 34.4% (65/189) were non-White, and 82% (155/189) had a bachelor?s degree or higher. Most (n=133/206, 64.6%) participants showed high testing adherence, meaning they completed over 75% of the assigned tests. Participants? interpretations of test results demonstrated high agreement (2106/2130, 98.9%) with the study verified results, with a ? score of 0.29 (P<.001). Participants reported high satisfaction with self-testing and the smartphone app, with 98.7% (157/159) reporting that they would recommend the self-test and smartphone app to others. These results were consistent across age, race/ethnicity, and gender. Conclusions: Participants? high adherence to the recommended testing schedule, significant reliability between participants and study staff?s test interpretation, and the acceptability of the smartphone app and self-test indicate that self-tests for SARS-CoV-2 with a smartphone app for assistance and reporting is a highly feasible testing modality among a diverse population of adults in the United States. UR - https://formative.jmir.org/2022/10/e35426 UR - http://dx.doi.org/10.2196/35426 UR - http://www.ncbi.nlm.nih.gov/pubmed/36041004 ID - info:doi/10.2196/35426 ER - TY - JOUR AU - Pasta, Alessandro AU - Szatmari, Tiberiu-Ioan AU - Christensen, Høy Jeppe AU - Jensen, Juul Kasper AU - Pontoppidan, Henrik Niels AU - Sun, Kang AU - Larsen, Eg Jakob PY - 2022/10/17 TI - Investigating the Provision and Context of Use of Hearing Aid Listening Programs From Real-world Data: Observational Study JO - J Med Internet Res SP - e36671 VL - 24 IS - 10 KW - personalized medicine KW - hearing aids KW - data logging KW - listening programs KW - sound environment KW - mobile phone N2 - Background: Listening programs enable hearing aid (HA) users to change device settings for specific listening situations and thereby personalize their listening experience. However, investigations into real-world use of such listening programs to support clinical decisions and evaluate the success of HA treatment are lacking. Objective: We aimed to investigate the provision of listening programs among a large group of in-market HA users and the context in which the programs are typically used. Methods: First, we analyzed how many and which programs were provided to 32,336 in-market HA users. Second, we explored 332,271 program selections from 1312 selected users to investigate the sound environments in which specific programs were used and whether such environments reflect the listening intent conveyed by the name of the used program. Our analysis was based on real-world longitudinal data logged by smartphone-connected HAs. Results: In our sample, 57.71% (18,663/32,336) of the HA users had programs for specific listening situations, which is a higher proportion than previously reported, most likely because of the inclusion criteria. On the basis of association rule mining, we identified a primary additional listening program, Speech in Noise, which is frequent among users and often provided when other additional programs are also provided. We also identified 2 secondary additional programs (Comfort and Music), which are frequent among users who get ?3 programs and usually provided in combination with Speech in Noise. In addition, 2 programs (TV and Remote Mic) were related to the use of external accessories and not found to be associated with other programs. On average, users selected Speech in Noise, Comfort, and Music in louder, noisier, and less-modulated (all P<.01) environments compared with the environment in which they selected the default program, General. The difference from the sound environment in which they selected General was significantly larger in the minutes following program selection than in the minutes preceding it. Conclusions: This study provides a deeper insight into the provision of listening programs on a large scale and demonstrates that additional listening programs are used as intended and according to the sound environment conveyed by the program name. UR - https://www.jmir.org/2022/10/e36671 UR - http://dx.doi.org/10.2196/36671 UR - http://www.ncbi.nlm.nih.gov/pubmed/36251349 ID - info:doi/10.2196/36671 ER - TY - JOUR AU - Tran-Nguyen, Kevin AU - Berger, Caroline AU - Bennett, Roxanne AU - Wall, Michelle AU - Morin, N. Suzanne AU - Rajabiyazdi, Fateme PY - 2022/10/17 TI - Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach JO - JMIR Aging SP - e37772 VL - 5 IS - 4 KW - older adults KW - mobile app KW - skeletal fracture KW - usability KW - patient-centered KW - human-centered design KW - digital health KW - eHealth KW - mobile health KW - mHealth KW - acute pain self-management KW - mobile phone N2 - Background: Postfracture acute pain is often inadequately managed in older adults. Mobile health (mHealth) technologies can offer opportunities for self-management of pain; however, insufficient apps exist for acute pain management after a fracture, and none are designed for an older adult population. Objective: This study aims to design, develop, and evaluate an mHealth app prototype using a human-centered design approach to support older adults in the self-management of postfracture acute pain. Methods: This study used a multidisciplinary and user-centered design approach. Overall, 7 stakeholders (ie, 1 clinician-researcher specialized in internal medicine, 2 user experience designers, 1 computer science researcher, 1 clinical research assistant researcher, and 2 pharmacists) from the project team, together with 355 external stakeholders, were involved throughout our user-centered development process that included surveys, requirement elicitation, participatory design workshops, mobile app design and development, mobile app content development, and usability testing. We completed this study in 3 phases. We analyzed data from prior surveys administered to 305 members of the Canadian Osteoporosis Patient Network and 34 health care professionals to identify requirements for designing a low-fidelity prototype. Next, we facilitated 4 participatory design workshops with 6 participants for feedback on content, presentation, and interaction with our proposed low-fidelity prototype. After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. Results: We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. Conclusions: We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future. UR - https://aging.jmir.org/2022/4/e37772 UR - http://dx.doi.org/10.2196/37772 UR - http://www.ncbi.nlm.nih.gov/pubmed/36251348 ID - info:doi/10.2196/37772 ER - TY - JOUR AU - Martindale-Adams, Lynn Jennifer AU - Clark, Davis Carolyn AU - Martin, Roxy Jessica AU - Henderson, Richard Charles AU - Nichols, Olivia Linda PY - 2022/10/17 TI - Text Messages to Support Caregivers in a Health Care System: Development and Pilot and National Rollout Evaluation JO - J Particip Med SP - e35318 VL - 14 IS - 1 KW - mobile health KW - mHealth KW - self-care KW - veterans KW - family caregivers KW - emotional stress KW - burden of illness KW - self-efficacy KW - mobile phone N2 - Background: Although there are many interventions to support caregivers, SMS text messaging has not been used widely. Objective: In this paper, we aimed to describe development of the Department of Veterans Affairs (VA) Annie Stress Management SMS text messaging protocol for caregivers of veterans, its pilot test, and subsequent national rollout. Methods: The stress management protocol was developed with text messages focusing on education, motivation, and stress-alleviating activities based on the Resources for Enhancing All Caregivers Health (REACH) VA caregiver intervention. This protocol was then tested in a pilot study. On the basis of the pilot study results, a national rollout of the protocol was executed and evaluated. Caregivers were referred from VA facilities nationally for the pilot and national rollout. Pilot caregivers were interviewed by telephone; national rollout caregivers were sent a web-based evaluation link at 6 months. For both evaluations, questions were scored on a Likert scale ranging from completely disagree to completely agree. For both the pilot and national rollout, quantitative data were analyzed with frequencies and means; themes were identified from open-ended qualitative responses. Results: Of the 22 caregivers in the pilot study, 18 (82%) provided follow-up data. On a 5-point scale, they reported text messages had been useful in managing stress (mean score 3.8, SD 1.1), helping them take care of themselves (mean score 3.7, SD 1.3), and making them feel cared for (mean score 4.1, SD 1.7). Texts were easy to read (mean score 4.5, SD 1.2), did not come at awkward times (mean score 2.2, SD 1.4), were not confusing (mean score 1.1, SD 0.2), and did not cause problems in responding (mean score 1.9, 1.1); however, 83% (15/18) of caregivers did not want to request an activity when stressed. Consequently, the national protocol did not require caregivers to respond. In the national rollout, 22.17% (781/3522) of the eligible caregivers answered the web-based survey and reported that the messages had been useful in managing stress (mean score 4.3, SD 0.8), helping them take care of themselves (mean score 4.3, SD 0.8) and loved ones (mean score 4.2, SD 0.8), and making them feel cared for (mean score 4.5, SD 0.8). Almost two-thirds (509/778, 65.4%) of the participants tried all or most of the strategies. A total of 5 themes were identified. The messages were appreciated, helped with self-care, and made them feel less alone, looking on Annie as a friend. The caregivers reported that the messages were on target and came when they were most needed and did not want them to stop. This success has led to four additional caregiver texting protocols: bereavement, dementia behaviors and stress management, (posttraumatic stress disorder) PTSD behaviors, and taking care of you, with 7274 caregivers enrolled as of February 2022. Conclusions: Caregivers reported the messages made them feel cared for and more confident. SMS text messaging, which is incorporated into clinical settings and health care systems, may represent a low-cost way to provide useful and meaningful support to caregivers. UR - https://jopm.jmir.org/2022/1/e35318 UR - http://dx.doi.org/10.2196/35318 UR - http://www.ncbi.nlm.nih.gov/pubmed/36251368 ID - info:doi/10.2196/35318 ER - TY - JOUR AU - Al-Hussain, Ghada AU - Shuweihdi, Farag AU - Alali, Haitham AU - Househ, Mowafa AU - Abd-alrazaq, Alaa PY - 2022/10/14 TI - The Effectiveness of Supervised Machine Learning in Screening and Diagnosing Voice Disorders: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e38472 VL - 24 IS - 10 KW - machine learning KW - voice disorders KW - systematic review KW - meta-analysis KW - diagnose KW - screening KW - mobile phone N2 - Background: When investigating voice disorders a series of processes are used when including voice screening and diagnosis. Both methods have limited standardized tests, which are affected by the clinician?s experience and subjective judgment. Machine learning (ML) algorithms have been used as an objective tool in screening or diagnosing voice disorders. However, the effectiveness of ML algorithms in assessing and diagnosing voice disorders has not received sufficient scholarly attention. Objective: This systematic review aimed to assess the effectiveness of ML algorithms in screening and diagnosing voice disorders. Methods: An electronic search was conducted in 5 databases. Studies that examined the performance (accuracy, sensitivity, and specificity) of any ML algorithm in detecting pathological voice samples were included. Two reviewers independently selected the studies, extracted data from the included studies, and assessed the risk of bias. The methodological quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool via RevMan 5 software (Cochrane Library). The characteristics of studies, population, and index tests were extracted, and meta-analyses were conducted to pool the accuracy, sensitivity, and specificity of ML techniques. The issue of heterogeneity was addressed by discussing possible sources and excluding studies when necessary. Results: Of the 1409 records retrieved, 13 studies and 4079 participants were included in this review. A total of 13 ML techniques were used in the included studies, with the most common technique being least squares support vector machine. The pooled accuracy, sensitivity, and specificity of ML techniques in screening voice disorders were 93%, 96%, and 93%, respectively. Least squares support vector machine had the highest accuracy (99%), while the K-nearest neighbor algorithm had the highest sensitivity (98%) and specificity (98%). Quadric discriminant analysis achieved the lowest accuracy (91%), sensitivity (89%), and specificity (89%). Conclusions: ML showed promising findings in the screening of voice disorders. However, the findings were not conclusive in diagnosing voice disorders owing to the limited number of studies that used ML for diagnostic purposes; thus, more investigations are needed. While it might not be possible to use ML alone as a substitute for current diagnostic tools, it may be used as a decision support tool for clinicians to assess their patients, which could improve the management process for assessment. Trial Registration: PROSPERO CRD42020214438; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214438 UR - https://www.jmir.org/2022/10/e38472 UR - http://dx.doi.org/10.2196/38472 UR - http://www.ncbi.nlm.nih.gov/pubmed/36239999 ID - info:doi/10.2196/38472 ER - TY - JOUR AU - Lipschitz, M. Jessica AU - Van Boxtel, Rachel AU - Torous, John AU - Firth, Joseph AU - Lebovitz, G. Julia AU - Burdick, E. Katherine AU - Hogan, P. Timothy PY - 2022/10/14 TI - Digital Mental Health Interventions for Depression: Scoping Review of User Engagement JO - J Med Internet Res SP - e39204 VL - 24 IS - 10 KW - mHealth KW - mobile apps KW - engagement KW - adherence KW - randomized controlled trials KW - depression N2 - Background: While many digital mental health interventions (DMHIs) have been found to be efficacious, patient engagement with DMHIs has increasingly emerged as a concern for implementation in real-world clinical settings. To address engagement, we must first understand what standard engagement levels are in the context of randomized controlled trials (RCTs) and how these compare with other treatments. Objective: This scoping review aims to examine the state of reporting on intervention engagement in RCTs of mobile app?based interventions intended to treat symptoms of depression. We sought to identify what engagement metrics are and are not routinely reported as well as what the metrics that are reported reflect about standard engagement levels. Methods: We conducted a systematic search of 7 databases to identify studies meeting our eligibility criteria, namely, RCTs that evaluated use of a mobile app?based intervention in adults, for which depressive symptoms were a primary outcome of interest. We then extracted 2 kinds of information from each article: intervention details and indices of DMHI engagement. A 5-element framework of minimum necessary DMHI engagement reporting was derived by our team and guided our data extraction. This framework included (1) recommended app use as communicated to participants at enrollment and, when reported, app adherence criteria; (2) rate of intervention uptake among those assigned to the intervention; (3) level of app use metrics reported, specifically number of uses and time spent using the app; (4) duration of app use metrics (ie, weekly use patterns); and (5) number of intervention completers. Results: Database searching yielded 2083 unique records. Of these, 22 studies were eligible for inclusion. Only 64% (14/22) of studies included in this review specified rate of intervention uptake. Level of use metrics was only reported in 59% (13/22) of the studies reviewed. Approximately one-quarter of the studies (5/22, 23%) reported duration of use metrics. Only half (11/22, 50%) of the studies reported the number of participants who completed the app-based components of the intervention as intended or other metrics related to completion. Findings in those studies reporting metrics related to intervention completion indicated that between 14.4% and 93.0% of participants randomized to a DMHI condition completed the intervention as intended or according to a specified adherence criteria. Conclusions: Findings suggest that engagement was underreported and widely varied. It was not uncommon to see completion rates at or below 50% (11/22) of those participants randomized to a treatment condition or to simply see completion rates not reported at all. This variability in reporting suggests a failure to establish sufficient reporting standards and limits the conclusions that can be drawn about level of engagement with DMHIs. Based on these findings, the 5-element framework applied in this review may be useful as a minimum necessary standard for DMHI engagement reporting. UR - https://www.jmir.org/2022/10/e39204 UR - http://dx.doi.org/10.2196/39204 UR - http://www.ncbi.nlm.nih.gov/pubmed/36240001 ID - info:doi/10.2196/39204 ER - TY - JOUR AU - Badawy, M. Sherif AU - DiMartino, Lisa AU - Brambilla, Donald AU - Klesges, Lisa AU - Baumann, Ana AU - Burns, Ebony AU - DeMartino, Terri AU - Jacobs, Sara AU - Khan, Hamda AU - Nwosu, Chinonyelum AU - Shah, Nirmish AU - Hankins, S. Jane AU - PY - 2022/10/14 TI - Impact of the COVID-19 Pandemic on the Implementation of Mobile Health to Improve the Uptake of Hydroxyurea in Patients With Sickle Cell Disease: Mixed Methods Study JO - JMIR Form Res SP - e41415 VL - 6 IS - 10 KW - sickle cell anemia KW - implementation science KW - adherence KW - hydroxycarbamide KW - self-efficacy N2 - Background: Hydroxyurea therapy is effective for reducing complications related to sickle cell disease (SCD) and is recommended by National Health Lung and Blood Institute care guidelines. However, hydroxyurea is underutilized, and adherence is suboptimal. We wanted to test a multilevel mobile health (mHealth) intervention to increase hydroxyurea adherence among patients and improve prescribing among providers in a multicenter clinical trial. In the first 2 study sites, participants were exposed to the early phases of the COVID-19 pandemic, which included disruption to their regular SCD care. Objective: We aimed to describe the impact of the COVID-19 pandemic on the implementation of an mHealth behavioral intervention for improving hydroxyurea adherence among patients with SCD. Methods: The first 2 sites initiated enrollment 3 months prior to the start of the pandemic (November 2019 to March 2020). During implementation, site A clinics shut down for 2 months and site B clinics shut down for 9 months. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to evaluate the implementation and effectiveness of the intervention. mHealth implementation was assessed based on patients? daily app use. Adherence to hydroxyurea was calculated as the proportion of days covered (PDC) from prescription records over the first 12 and 24 weeks after implementation. A linear model examined the relationship between app usage and PDC change, adjusting for baseline PDC, lockdown duration, and site. We conducted semistructured interviews with patients, health care providers, administrators, and research staff to identify factors associated with mHealth implementation and effectiveness. We used a mixed methods approach to investigate the convergence of qualitative and quantitative findings. Results: The percentage of patients accessing the app decreased after March 15, 2020 from 86% (n=55) to 70% (n=45). The overall mean PDC increase from baseline to week 12 was 4.5% (P=.32) and to week 24 was 1.5% (P=.70). The mean PDC change was greater at site A (12 weeks: 20.9%; P=.003; 24 weeks: 16.7%; P=.01) than site B (12 weeks: ?8.2%; P=.14; 24 weeks: ?10.3%; P=.02). After adjustment, PDC change was 13.8% greater in those with increased app use after March 15, 2020. Interview findings indicated that site B?s closure during COVID-19 had a greater impact, but almost all patients reported that the InCharge Health app helped support more consistent medication use. Conclusions: We found significant impacts of the early clinic lockdowns, which reduced implementation of the mHealth intervention and led to reduced patient adherence to hydroxyurea. However, disruptions were lower among participants who experienced shorter clinic lockdowns and were associated with higher hydroxyurea adherence. Investigation of added strategies to mitigate the effects of care interruptions during major emergencies (eg, patient coaching and health navigation) may ?insulate? the implementation of interventions to increase medication adherence. Trial Registration: ClinicalTrials.gov NCT04080167; https://clinicaltrials.gov/ct2/show/NCT04080167 International Registered Report Identifier (IRRID): RR2-10.2196/16319 UR - https://formative.jmir.org/2022/10/e41415 UR - http://dx.doi.org/10.2196/41415 UR - http://www.ncbi.nlm.nih.gov/pubmed/36240004 ID - info:doi/10.2196/41415 ER - TY - JOUR AU - Browne, D. Jonathan AU - Vaninetti, Michael AU - Giard, David AU - Kostas, Konstantinos AU - Dave, Ankur PY - 2022/10/13 TI - An Evaluation of a Mobile App for Chronic Low Back Pain Management: Prospective Pilot Study JO - JMIR Form Res SP - e40869 VL - 6 IS - 10 KW - back pain KW - chronic pain KW - mobile KW - app KW - multidisciplinary care KW - biopsychosocial KW - self-management KW - mHealth KW - mobile health KW - mobile app N2 - Background: Chronic low back pain is challenging to manage due to multidisciplinary considerations. It has substantial socioeconomic impacts and cannot be simply treated with pharmacotherapy, nonsurgical intervention, or spine surgery. Medical consensus recommends optimizing conservative self-management therapies (eg, home exercise, wellness strategies, yoga, etc) as first-line treatment options for chronic low back pain. However, access to these modalities is often limited and secondary to cost, convenience, and ease of use. Mobile health apps have emerged as a cost-effective and accessible option for chronic low back pain self-management. Established in-person pain programs can provide the structure for an optimal mobile app adaptation. PainNavigator (PainNavigator, Inc) is an example of a mobile app that is based on an Ascension-Illinois group?based pain program?Pain Rehabilitation Outpatient-Camp. Objective: This was a prospective pilot clinical trial that evaluated the PainNavigator platform?s utility in low back pain management to inform future trial development. Methods: A total of 75 participants who used PainNavigator were studied. Pain, Enjoyment, and General Activity (PEG-3) scale scores and scores from a brief anxiety and depression scale based on the Patient Health Questionnaire-4 (PHQ-4) were obtained at baseline and following program completion. The PEG-3 total score was used, in addition to individual items?Average Pain, Pain Effect on Enjoyment, and Pain Effect on Activity. The PHQ-4 total score was also used, in addition to other individual items, including Felt Depressed, Loss of Interest, Felt Anxious, and Difficult to Control Worry. Paired sample t tests (2-tailed) compared mean differences in scores from before and after participants received the intervention. Results: The analysis found that PEG-3 (n=27) and PHQ-4 (n=27) total scores were significantly lower upon the completion of PainNavigator (P<.001 and P=.001, respectively). The findings showed a 36% reduction in PEG-3 total scores, a 40% reduction in pain intensity, and a 40% reduction in PHQ-4 total scores. Scores for individual PEG-3 scale and PHQ-4 items also significantly decreased. All PEG-3 measures had large effect sizes. The PHQ-4 total score and Difficult to Control Worry item had large effect sizes, while the other three measures had medium effect sizes. Conclusions: These findings show that PainNavigator has clinical significance in managing chronic low back pain and can be easily utilized to improve patient care. All PEG-3 scale and PHQ-4 measures significantly improved following the use of the platform, supporting the multidimensional, biopsychosocial approach to low back pain management. Differences in effect sizes may inform quality improvement investigations, such as optimizing features that impact measures with only medium effect sizes. This feasibility study demonstrates an effective protocol, and it will inform future, more extensive randomized controlled trials. UR - https://formative.jmir.org/2022/10/e40869 UR - http://dx.doi.org/10.2196/40869 UR - http://www.ncbi.nlm.nih.gov/pubmed/36227637 ID - info:doi/10.2196/40869 ER - TY - JOUR AU - Gudmundsson, Haukur G. AU - Mészáros, Judit AU - Björnsdóttir, E. Ágústa AU - Ámundadóttir, L. María AU - Thorvardardottir, E. Gudrun AU - Magnusdottir, Erna AU - Helgadottir, Halla AU - Oddsson, Saemundur PY - 2022/10/13 TI - Evaluating the Feasibility of a Digital Therapeutic Program for Patients With Cancer During Active Treatment: Pre-Post Interventional Study JO - JMIR Form Res SP - e39764 VL - 6 IS - 10 KW - cancer KW - lifestyle KW - quality of life KW - mobile app KW - digital therapeutics KW - self-management KW - physical activity KW - mobile phone N2 - Background: Increasing evidence shows that lifestyle interventions can improve the symptoms, quality of life (QoL), and even overall survival of patients with cancer. Digital therapeutics (DTx) can help implement behavioral modifications and empower patients through education, lifestyle support, and remote symptom monitoring. Objective: We aimed to test the feasibility of a DTx program for patients with cancer, as measured by engagement, retention, and acceptability. In addition, we explored the effects of the program on cancer-related QoL. Methods: We conducted a 4-week single-arm trial in Iceland, where DTx was delivered through a smartphone app. The intervention consisted of patient education about mindfulness, sleep, stress, and nutrition; lifestyle coaching; and the completion of daily missions for tracking physical activity and exercise, reporting patient-reported outcomes (PROs), practicing mindfulness, and logging healthy food intake. Information on program engagement and retention, step goal attainment, as well as PROs were collected throughout the study. QoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 at baseline and follow-up. Results: In total, 30 patients with cancer undergoing active therapy were enrolled, and 29 registered in the app (23 female, 18 with breast cancer; mean age 52.6, SD 11.5 years). Overall, 97% (28/29) of participants were active in 3 of the 4 weeks and completed the pre- and postprogram questionnaires. The weekly active days (median) were 6.8 (IQR 5.8-6.8), and 72% (21/29) of participants were active at least 5 days a week. Users interacted with the app on average 7.7 (SD 1.9) times per day. On week 1, all 29 participants used the step counter and logged an average of 20,306 steps; 21 (72%) participants reached their step goals of at least 3000 steps per day. On week 4, of the 28 active users, 27 (96%) were still logging their steps, with 19 (68%) reaching their step goals. Of the 28 participants who completed the satisfaction questionnaire, 25 (89%) were likely to recommend the program, 23 (82%) said the program helped them deal with the disease, and 24 (86%) said it helped them remember their medication. QoL assessment showed that the average global health status, functioning, and symptom burden remained stable from baseline to follow-up. In all, 50% (14/28) of participants reported less pain, and the average pain score decreased from 31 (SD 20.1) to 22.6 (SD 23.2; P=.16). There was no significant change in PROs on the quality of sleep, energy, and stress levels from the first to the last week. Conclusions: The high retention, engagement, and acceptability found in this study demonstrate that multidisciplinary DTx is feasible for patients with cancer. A longer, full-scale randomized controlled trial is currently being planned to evaluate the efficacy of the intervention. UR - https://formative.jmir.org/2022/10/e39764 UR - http://dx.doi.org/10.2196/39764 UR - http://www.ncbi.nlm.nih.gov/pubmed/36227639 ID - info:doi/10.2196/39764 ER - TY - JOUR AU - Carrouel, Florence AU - du Sartz de Vigneulles, Benjamin AU - Bourgeois, Denis AU - Kabuth, Bernard AU - Baltenneck, Nicolas AU - Nusbaum, Fanny AU - Burge, Valérie AU - Roy, Sylvain AU - Buchheit, Sophie AU - Carrion-Martinaud, Marie-Line AU - Massoubre, Catherine AU - Fraticelli, Laurie AU - Dussart, Claude PY - 2022/10/12 TI - Mental Health Mobile Apps in the French App Store: Assessment Study of Functionality and Quality JO - JMIR Mhealth Uhealth SP - e41282 VL - 10 IS - 10 KW - mobile apps KW - behavior change KW - mental KW - prevention KW - mobile health KW - mHealth KW - lifestyle KW - French KW - well-being N2 - Background: Approximately 800 million people, representing 11% of the world?s population, are affected by mental health problems. The COVID-19 pandemic exacerbated problems and triggered a decline in well-being, with drastic increase in the incidence of conditions such as anxiety, depression, and stress. Approximately 20,000 mental health apps are listed in mobile app stores. However, no significant evaluation of mental health apps in French, spoken by approximately 300 million people, has been identified in the literature yet. Objective: This study aims to review the mental health mobile apps currently available on the French Apple App Store and Google Play Store and to evaluate their quality using Mobile App Rating Scale?French (MARS-F). Methods: Screening of mental health apps was conducted from June 10, 2022, to June 17, 2022, on the French Apple App Store and Google Play Store. A shortlist of 12 apps was identified using the criteria of selection and assessed using MARS-F by 9 mental health professionals. Intraclass correlation was used to evaluate interrater agreement. Mean (SD) scores and their distributions for each section and item were calculated. Results: The highest scores for MARS-F quality were obtained by Soutien psy avec Mon Sherpa (mean 3.85, SD 0.48), Evoluno (mean 3.54, SD 0.72), and Teale (mean 3.53, SD 0.87). Mean engagement scores (section A) ranged from 2.33 (SD 0.69) for Reflexe reussite to 3.80 (SD 0.61) for Soutien psy avec Mon Sherpa. Mean aesthetics scores (section C) ranged from 2.52 (SD 0.62) for Mental Booster to 3.89 (SD 0.69) for Soutien psy avec Mon Sherpa. Mean information scores (section D) ranged from 2.00 (SD 0.75) for Mental Booster to 3.46 (SD 0.77) for Soutien psy avec Mon Sherpa. Mean Mobile App Rating Scale subjective quality (section E) score varied from 1.22 (SD 0.26) for VOS ? journal de l?humeur to 2.69 (SD 0.84) for Soutien psy avec Mon Sherpa. Mean app specificity (section F) score varied from 1.56 (SD 0.97) for Mental Booster to 3.31 (SD 1.22) for Evoluno. For all the mental health apps studied, except Soutien psy avec Mon Sherpa (11/12, 92%), the subjective quality score was always lower than the app specificity score, which was always lower than the MARS-F quality score, and that was lower than the rating score from the iPhone Operating System or Android app stores. Conclusions: Mental health professionals assessed that, despite the lack of scientific evidence, the mental health mobile apps available on the French Apple App Store and Google Play Store were of good quality. However, they are reluctant to use them in their professional practice. Additional investigations are needed to assess their compliance with recommendations and their long-term impact on users. UR - https://mhealth.jmir.org/2022/10/e41282 UR - http://dx.doi.org/10.2196/41282 UR - http://www.ncbi.nlm.nih.gov/pubmed/36223178 ID - info:doi/10.2196/41282 ER - TY - JOUR AU - Guinart, Daniel AU - Sobolev, Michael AU - Patil, Bhagyashree AU - Walsh, Megan AU - Kane, M. John PY - 2022/10/12 TI - A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study JO - JMIR Ment Health SP - e37184 VL - 9 IS - 10 KW - antipsychotic KW - adherence KW - digital KW - mobile health KW - mHealth KW - financial incentives N2 - Background: Medication nonadherence is prevalent in severe mental illness and is associated with multiple negative outcomes. Mobile technology and financial incentives show promise to improve medication adherence; however, studies in mental health, especially with oral medications, are lacking. Objective: The aim of this paper is to assess the feasibility and effectiveness of offering financial incentives through a mobile app based on behavioral economics principles to improve medication adherence in severe mental illness. Methods: A 10-week, single-arm longitudinal pilot study was conducted. Patients earned rewards in the context of app-based adherence incentives. The reward was split into biweekly payments made in increments of US $15, minus any US $2 per day penalties for missed check-ins. Time-varying effect modeling was used to summarize the patients? response during the study. Results: A total of 25 patients were enrolled in this pilot study, of which 72% (n=18) were female, and 48% (n=12) were of a White racial background. Median age was 24 (Q1-Q3: 20.5-30) years. Participants were more frequently diagnosed with schizophrenia and related disorders (n=9, 36%), followed by major depressive disorder (n=8, 32%). App engagement and medication adherence in the first 2 weeks were higher than in the last 8 weeks of the study. At study endpoint, app engagement remained high (n=24, Z=?3.17; P<.001), but medication adherence was not different from baseline (n=24, Z=?0.59; P=.28). Conclusions: Financial incentives were effectively delivered using an app and led to high engagement throughout the study and a significantly increased medication adherence for 2 weeks. Leveraging behavioral economics and mobile health technology can increase medication adherence in the short term. Trial Registration: ClinicalTrials.gov NCT04191876; https://clinicaltrials.gov/ct2/show/NCT04191876 UR - https://mental.jmir.org/2022/10/e37184 UR - http://dx.doi.org/10.2196/37184 UR - http://www.ncbi.nlm.nih.gov/pubmed/36222818 ID - info:doi/10.2196/37184 ER - TY - JOUR AU - Yang, Shanyin AU - Huang, Jiegang AU - Ye, Li AU - Lin, Jianyan AU - Xie, Zhiman AU - Guo, Baodong AU - Li, Yanjun AU - Liang, Bingyu AU - Zheng, Zhigang AU - Lunze, Karsten AU - Abdullah, S. Abu AU - Liang, Hao AU - Quintiliani, M. Lisa PY - 2022/10/12 TI - Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service?Delivered Smoking Cessation Intervention for People With HIV in China: Qualitative Study JO - JMIR Form Res SP - e35923 VL - 6 IS - 10 KW - mobile health KW - mHealth KW - China KW - smoking KW - smoking cessation KW - HIV KW - qualitative research KW - SMS text messages KW - WeChat N2 - Background: China, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population. Objective: This study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)?delivered messages. Methods: We recruited people with HIV from the People?s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups. Results: A total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level. Conclusions: We identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)?delivered messages approach among people with HIV who smoke in China. UR - https://formative.jmir.org/2022/10/e35923 UR - http://dx.doi.org/10.2196/35923 UR - http://www.ncbi.nlm.nih.gov/pubmed/36222795 ID - info:doi/10.2196/35923 ER - TY - JOUR AU - Shaw Jr, George AU - Nadkarni, Devaki AU - Phann, Eric AU - Sielaty, Rachel AU - Ledenyi, Madeleine AU - Abnowf, Razaan AU - Xu, Qian AU - Arredondo, Paul AU - Chen, Shi PY - 2022/10/11 TI - Separating Features From Functionality in Vaccination Apps: Computational Analysis JO - JMIR Form Res SP - e36818 VL - 6 IS - 10 KW - vaccines KW - mobile health KW - mHealth KW - principal component analysis KW - PCA KW - k-means clustering KW - information exchange KW - mobile phone N2 - Background: Some latest estimates show that approximately 95% of Americans own a smartphone with numerous functions such as SMS text messaging, the ability to take high-resolution pictures, and mobile software apps. Mobile health apps focusing on vaccination and immunization have proliferated in the digital health information technology market. Mobile health apps have the potential to positively affect vaccination coverage. However, their general functionality, user and disease coverage, and exchange of information have not been comprehensively studied or evaluated computationally. Objective: The primary aim of this study is to develop a computational method to explore the descriptive, usability, information exchange, and privacy features of vaccination apps, which can inform vaccination app design. Furthermore, we sought to identify potential limitations and drawbacks in the apps? design, readability, and information exchange abilities. Methods: A comprehensive codebook was developed to conduct a content analysis on vaccination apps? descriptive, usability, information exchange, and privacy features. The search and selection process for vaccination-related apps was conducted from March to May 2019. We identified a total of 211 apps across both platforms, with iOS and Android representing 62.1% (131/211) and 37.9% (80/211) of the apps, respectively. Of the 211 apps, 119 (56.4%) were included in the final study analysis, with 42 features evaluated according to the developed codebook. The apps selected were a mix of apps used in the United States and internationally. Principal component analysis was used to reduce the dimensionality of the data. Furthermore, cluster analysis was used with unsupervised machine learning to determine patterns within the data to group the apps based on preselected features. Results: The results indicated that readability and information exchange were highly correlated features based on principal component analysis. Of the 119 apps, 53 (44.5%) were iOS apps, 55 (46.2%) were for the Android operating system, and 11 (9.2%) could be found on both platforms. Cluster 1 of the k-means analysis contained 22.7% (27/119) of the apps; these were shown to have the highest percentage of features represented among the selected features. Conclusions: We conclude that our computational method was able to identify important features of vaccination apps correlating with end user experience and categorize those apps through cluster analysis. Collaborating with clinical health providers and public health officials during design and development can improve the overall functionality of the apps. UR - https://formative.jmir.org/2022/10/e36818 UR - http://dx.doi.org/10.2196/36818 UR - http://www.ncbi.nlm.nih.gov/pubmed/36222791 ID - info:doi/10.2196/36818 ER - TY - JOUR AU - Dambi, Jermaine AU - Norman, Clara AU - Doukani, Asmae AU - Potgieter, Stephan AU - Turner, Jean AU - Musesengwa, Rosemary AU - Verhey, Ruth AU - Chibanda, Dixon PY - 2022/10/7 TI - A Digital Mental Health Intervention (Inuka) for Common Mental Health Disorders in Zimbabwean Adults in Response to the COVID-19 Pandemic: Feasibility and Acceptability Pilot Study JO - JMIR Ment Health SP - e37968 VL - 9 IS - 10 KW - acceptability KW - COVID-19 KW - feasibility KW - Friendship Bench KW - Inuka KW - pilot KW - task-shifting KW - Zimbabwe N2 - Background: Common mental health disorders (CMDs) are leading causes of disability globally. The ongoing COVID-19 pandemic has further exacerbated the burden of CMDs. COVID-19 containment measures, including lockdowns, have disrupted access to in-person mental health care. It is therefore imperative to explore the utility of digital mental health interventions to bridge the treatment gap. Mobile health technologies are effective tools for increasing access to treatment at a lower cost. This study explores the utility of Inuka, a chat-based app hinged on the Friendship Bench problem-solving therapy intervention. The Inuka app offers double anonymity, and clients can book or cancel a session at their convenience. Inuka services can be accessed either through a mobile app or the web. Objective: We aimed to explore the feasibility of conducting a future clinical trial. Additionally, we evaluated the feasibility, acceptability, appropriateness, scalability, and preliminary effectiveness of Inuka. Methods: Data were collected using concurrent mixed methods. We used a pragmatic quasiexperimental design to compare the feasibility, acceptability, and preliminary clinical effectiveness of Inuka (experimental group) and WhatsApp chat-based counseling (control). Participants received 6 problem-solving therapy sessions delivered by lay counselors. A reduction in CMDs was the primary clinical outcome. The secondary outcomes were health-related quality of life (HRQoL), disability and functioning, and social support. Quantitative outcomes were analyzed using descriptive and bivariate statistics. Finally, we used administrative data and semistructured interviews to gather data on acceptability and feasibility; this was analyzed using thematic analysis. Results: Altogether, 258 participants were screened over 6 months, with 202 assessed for eligibility, and 176 participants were included in the study (recruitment ratio of 29 participants/month). The participants? mean age was 24.4 (SD 5.3) years, and most participants were female and had tertiary education. The mean daily smartphone usage was 8 (SD 3.5) hours. Eighty-three users signed up and completed at least one session. The average completion rate was 3 out of 4 sessions. Inuka was deemed feasible and acceptable in the local context, with connectivity challenges, app instability, expensive mobile data, and power outages cited as potential barriers to scale up. Generally, there was a decline in CMDs (F2,73=2.63; P=.08), depression (F2,73=7.67; P<.001), and anxiety (F2,73=2.95; P=.06) and a corresponding increase in HRQoL (F2,73=7.287; P<.001) in both groups. Conclusions: Study outcomes showed that it is feasible to run a future large-scale randomized clinical trial (RCT) and lend support to the feasibility and acceptability of Inuka, including evidence of preliminary effectiveness. The app?s double anonymity and structured support were the most salient features. There is a great need for iterative app updates before scaling up. Finally, a large-scale hybrid RCT with a longer follow-up to evaluate the clinical implementation and cost-effectiveness of the app is needed. UR - https://mental.jmir.org/2022/10/e37968 UR - http://dx.doi.org/10.2196/37968 UR - http://www.ncbi.nlm.nih.gov/pubmed/35960595 ID - info:doi/10.2196/37968 ER - TY - JOUR AU - de Buisonjé, R. David AU - Reijnders, Thomas AU - Cohen Rodrigues, R. Talia AU - Prabhakaran, Santhanam AU - Kowatsch, Tobias AU - Lipman, A. Stefan AU - Bijmolt, A. Tammo H. AU - Breeman, D. Linda AU - Janssen, R. Veronica AU - Kraaijenhagen, A. Roderik AU - Kemps, C. Hareld M. AU - Evers, M. Andrea W. PY - 2022/10/6 TI - Investigating Rewards and Deposit Contract Financial Incentives for Physical Activity Behavior Change Using a Smartphone App: Randomized Controlled Trial JO - J Med Internet Res SP - e38339 VL - 24 IS - 10 KW - eHealth KW - behavior change KW - rewards KW - reward learning KW - financial incentives KW - deposit contracts KW - commitment contracts KW - physical activity KW - mobile phone N2 - Background: Financial incentive interventions for improving physical activity have proven to be effective but costly. Deposit contracts (in which participants pledge their own money) could be an affordable alternative. In addition, deposit contracts may have superior effects by exploiting the power of loss aversion. Previous research has often operationalized deposit contracts through loss framing a financial reward (without requiring a deposit) to mimic the feelings of loss involved in a deposit contract. Objective: This study aimed to disentangle the effects of incurring actual losses (through self-funding a deposit contract) and loss framing. We investigated whether incentive conditions are more effective than a no-incentive control condition, whether deposit contracts have a lower uptake than financial rewards, whether deposit contracts are more effective than financial rewards, and whether loss frames are more effective than gain frames. Methods: Healthy participants (N=126) with an average age of 22.7 (SD 2.84) years participated in a 20-day physical activity intervention. They downloaded a smartphone app that provided them with a personalized physical activity goal and either required a ?10 (at the time of writing: ?1=US $0.98) deposit up front (which could be lost) or provided ?10 as a reward, contingent on performance. Daily feedback on incentive earnings was provided and framed as either a loss or gain. We used a 2 (incentive type: deposit or reward) × 2 (feedback frame: gain or loss) between-subjects factorial design with a no-incentive control condition. Our primary outcome was the number of days participants achieved their goals. The uptake of the intervention was a secondary outcome. Results: Overall, financial incentive conditions (mean 13.10, SD 6.33 days goal achieved) had higher effectiveness than the control condition (mean 8.00, SD 5.65 days goal achieved; P=.002; ?p2=0.147). Deposit contracts had lower uptake (29/47, 62%) than rewards (50/50, 100%; P<.001; Cramer V=0.492). Furthermore, 2-way analysis of covariance showed that deposit contracts (mean 14.88, SD 6.40 days goal achieved) were not significantly more effective than rewards (mean 12.13, SD 6.17 days goal achieved; P=.17). Unexpectedly, loss frames (mean 10.50, SD 6.22 days goal achieved) were significantly less effective than gain frames (mean 14.67, SD 5.95 days goal achieved; P=.007; ?p2=0.155). Conclusions: Financial incentives help increase physical activity, but deposit contracts were not more effective than rewards. Although self-funded deposit contracts can be offered at low cost, low uptake is an important obstacle to large-scale implementation. Unexpectedly, loss framing was less effective than gain framing. Therefore, we urge further research on their boundary conditions before using loss-framed incentives in practice. Because of limited statistical power regarding some research questions, the results of this study should be interpreted with caution, and future work should be done to confirm these findings. Trial Registration: Open Science Framework Registries osf.io/34ygt; https://osf.io/34ygt UR - https://www.jmir.org/2022/10/e38339 UR - http://dx.doi.org/10.2196/38339 UR - http://www.ncbi.nlm.nih.gov/pubmed/36201384 ID - info:doi/10.2196/38339 ER - TY - JOUR AU - Lieser, Tyler AU - Huang, Yungui AU - Sezgin, Emre PY - 2022/10/6 TI - The Current State of Mobile Apps Owned by Large Pediatric Hospitals in the United States: Systematic Search and Analysis on Google Play and Apple App Stores JO - JMIR Pediatr Parent SP - e38940 VL - 5 IS - 4 KW - pediatric KW - child KW - hospital KW - mobile app KW - mobile health KW - mHealth KW - health app KW - digital health KW - eHealth KW - hospital-owned app KW - telehealth KW - review KW - app feature KW - accessibility KW - patient experience KW - functionality N2 - Background: Pediatric hospitals in the United States are increasingly leveraging patient-facing mobile apps as their digital front doors for patients, families, and caretakers. These mobile health apps are sanctioned by pediatric hospitals to inform the public or populations about pediatric care to provide individualized information, to enhance communication, and to improve patient experience. Yet the functionalities and user feedback of these hospital mobile apps have not been systematically investigated. Objective: Our aim was to understand the current state of hospital-owned mobile apps provided by large pediatric hospitals, comparatively analyze and report the services provided, and identify potential gaps to inform developers and providers. The American Hospital Association defines large hospitals as those having a bed count of more than 400. Methods: We conducted a systematic search on Google Play and Apple App Store to identify all hospital-owned mobile apps from the large pediatric hospitals included in our review. Our inclusion criteria were (1) apps provided by large pediatric hospitals; (2) hospital-owned apps available in Apple App Store and Google Play; and (3) apps that are provided for general populations. Specialty apps that serve specific user groups or populations focusing on education, telehealth, specific conditions or procedures, or apps intended for research or clinician use were excluded. The features and functionality of the included apps were examined. Results: Of the 16 pediatric hospitals included in our review, 4 (25%) had no general patient-facing apps, 4 (25%) had one app, and 8 (50%) had more than one app available on Google Play or Apple App Store. The 12 hospitals with at least one mobile app had a combined total of 72 apps. Of these 72 apps, 61 (85%) were considered specialty and were excluded from our review, leaving a total of 11 (15%) apps to analyze. Among the 11 apps analyzed, the most common feature was appointment scheduling or reminder (n=9, 82%). Doctor search (n=8, 73%) and patient resources (n=8, 73%) were the second most common, followed by payment, billing, or claims (n=7, 64%), patient portal integration (n=6, 55%), personal health management (n=6, 55%), hospital way finding (n=5, 45%), message a provider (n=4, 36%), urgent care wait times (n=4, 36%), video chat (n=4, 36%), and health information access (n=4, 36%). Parking information (n=3, 27%) was the least common. Conclusions: Out of the 16 pediatric hospitals identified for our review, 75% (n=12) offer mobile apps. Based on the most common features, these apps were intended to help improve accessibility for patients and families in terms of finding providers, scheduling appointments, and accessing patient resources. We believe the findings will inform pediatric hospital administrators, developers, and other stakeholders to improve app feature offerings and increase their impact on service accessibility and patient experience. UR - https://pediatrics.jmir.org/2022/4/e38940 UR - http://dx.doi.org/10.2196/38940 UR - http://www.ncbi.nlm.nih.gov/pubmed/36201385 ID - info:doi/10.2196/38940 ER - TY - JOUR AU - DeWitt, Akeiylah AU - Kientz, Julie AU - Coker, R. Tumaini AU - Liljenquist, Kendra PY - 2022/10/6 TI - mHealth Technology Design and Evaluation for Early Childhood Health Promotion: Systematic Literature Review JO - JMIR Pediatr Parent SP - e37718 VL - 5 IS - 4 KW - mobile health technologies KW - early childhood health promotion KW - child development KW - parent support technologies KW - mobile phone N2 - Background: Recent increases in smartphone ownership among underserved populations have inspired researchers in medicine, computing, and health informatics to design and evaluate mobile health (mHealth) interventions, specifically for those supporting child development and growth. Although these interventions demonstrate possible effectiveness at larger scales, few of these interventions are evaluated to address racial disparities and health equity, which are known factors that affect relevance, uptake, and adherence in target populations. Objective: In this study, we aimed to identify and document the current design and evaluation practices of mHealth technologies that promote early childhood health, with a specific focus on opportunities for those processes to address health disparities and health equity. Methods: We completed a systematic literature review of studies that design and evaluate mHealth interventions for early childhood health promotion. We then analyzed these studies to identify opportunities to address racial disparities in early- and late-stage processes and to understand the potential efficacy of these interventions. Results: Across the literature from medical, computing, and health informatics fields, we identified 15 articles that presented a design or evaluation of a parent-facing health intervention. We found that using mobile-based systems to deliver health interventions was generally well accepted by parents of children aged <5 years. We also found that, when measured, parenting knowledge of early childhood health topics and confidence to engage in health-promoting behaviors improved. Design and evaluation methods held internal consistency within disciplines (eg, experimental study designs were the most prevalent in medical literature, while computing researchers used user-centered design methods in computing fields). However, there is little consistency in design or evaluation methods across fields. Conclusions: To support more interventions with a comprehensive design and evaluation process, we recommend attention to design at the intervention (eg, reporting content sources) and system level; interdisciplinary collaboration in early childhood health intervention development can lead to large-scale deployment and success among populations. Trial Registration: PROSPERO CRD42022359797; https://tinyurl.com/586nx9a2 UR - https://pediatrics.jmir.org/2022/4/e37718 UR - http://dx.doi.org/10.2196/37718 UR - http://www.ncbi.nlm.nih.gov/pubmed/36201391 ID - info:doi/10.2196/37718 ER - TY - JOUR AU - Villalobos, Paola Jennifer AU - Bull, Salyers Sheana AU - Portz, Dickman Jennifer PY - 2022/10/6 TI - Usability and Acceptability of a Palliative Care Mobile Intervention for Older Adults With Heart Failure and Caregivers: Observational Study JO - JMIR Aging SP - e35592 VL - 5 IS - 4 KW - mHealth KW - older adult KW - symptom KW - heart failure KW - palliative care KW - app KW - digital health KW - cardiology KW - heart KW - Convoy-Pal KW - mobile KW - tablet KW - smartwatch KW - adult KW - aging N2 - Background: Heart failure is a leading cause of death among older adults. Digital health can increase access to and awareness of palliative care for patients with advanced heart failure and their caregivers. However, few palliative care digital interventions target heart failure or patients? caregivers, family, and friends, termed here as the social convoy. To address this need, the Social Convoy Palliative Care (Convoy-Pal) mobile intervention was developed to deliver self-management tools and palliative care resources to older adults with advanced heart failure and their social convoys. Objective: The goal of the research was to test the acceptability and usability of Convoy-Pal among older adults with advanced heart failure and their social convoys. Methods: Convoy-Pal includes tablet-based and smartwatch tools facilitating self-management and access to palliative care resources. Older adults and social convoy caregivers completed an acceptability and usability interview via Zoom, including open-ended questions and the Mobile Application Rating Scale: User Version (uMARS). Descriptive analysis was conducted to summarize the results of open-ended feedback and self-reported acceptability and usability. Results: A total of 26 participants (16 older adults and 10 social convoy caregivers) participated in the interview. Overall, the feedback from users was good (uMARS mean 3.96/5 [SD 0.81]). Both older adults and social convoy caregivers scored information provided by Convoy-Pal the highest (mean 4.22 [SD 0.75] and mean 4.21 [SD 0.64], respectively). Aesthetics, functionality, and engagement were also perceived as acceptable (mean >3.5). Open-ended feedback resulted in 5 themes including improvements to goal setting, monitoring tools, daily check-in call feature, portal and mobile app, and convoy assessment. Conclusions: Convoy-Pal was perceived as acceptable with good usability among older adults with heart failure and their social convoy caregivers. With good acceptability, Convoy-Pal may ultimately lead to increased access to palliative care resources and facilitate self-management among older adults with heart failure and their social convoy caregivers. UR - https://aging.jmir.org/2022/4/e35592 UR - http://dx.doi.org/10.2196/35592 UR - http://www.ncbi.nlm.nih.gov/pubmed/36201402 ID - info:doi/10.2196/35592 ER - TY - JOUR AU - Messner, Eva-Maria AU - Sturm, Niklas AU - Terhorst, Yannik AU - Sander, B. Lasse AU - Schultchen, Dana AU - Portenhauser, Alexandra AU - Schmidbaur, Simone AU - Stach, Michael AU - Klaus, Jochen AU - Baumeister, Harald AU - Walter, M. Benjamin PY - 2022/10/5 TI - Mobile Apps for the Management of Gastrointestinal Diseases: Systematic Search and Evaluation Within App Stores JO - J Med Internet Res SP - e37497 VL - 24 IS - 10 KW - gastrointestinal diseases KW - mHealth KW - mobile health KW - MARS KW - Mobile Application Rating Scale KW - systematic review KW - app quality KW - gastrointestinal KW - mobile app KW - app N2 - Background: Gastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear. Objective: This systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases. Methods: A web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality. Results: The overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05). Conclusions: Mobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps. UR - https://www.jmir.org/2022/10/e37497 UR - http://dx.doi.org/10.2196/37497 UR - http://www.ncbi.nlm.nih.gov/pubmed/36197717 ID - info:doi/10.2196/37497 ER - TY - JOUR AU - Proctor, L. Steven AU - Rigg, K. Khary AU - Tien, Y. Allen PY - 2022/10/5 TI - Acceptability and Usability of a Reward-Based Mobile App for Opioid Treatment Settings: Mixed Methods Pilot Study JO - JMIR Form Res SP - e37474 VL - 6 IS - 10 KW - opioids KW - contingency management KW - mHealth KW - digital health KW - mobile app KW - innovation KW - opioid use disorder KW - recovery KW - acceptability N2 - Background: Contingency management is an evidence-based yet underutilized approach for opioid use disorder (OUD). Reasons for limited adoption in real-world practice include ethical, moral, and philosophical concerns regarding use of monetary incentives, and lack of technological innovation. In light of surging opioid overdose deaths, there is a need for development of technology-enabled solutions leveraging the power of contingency management in a way that is viewed by both patients and providers as acceptable and feasible. Objective: This mixed methods pilot study sought to determine the perceived acceptability and usability of PROCare Recovery, a reward-based, technology-enabled recovery monitoring smartphone app designed to automate contingency management by immediately delivering micropayments to patients for achieving recovery goals via smart debit card with blocking capabilities. Methods: Participants included patients receiving buprenorphine for OUD (n=10) and licensed prescribers (n=5). Qualitative interviews were conducted by 2 PhD-level researchers via video conferencing to explore a priori hypotheses. Thematic analysis of interviews was conducted and synthesized into major themes. Results: Participants were overwhelmingly in favor of microrewards (eg, US $1) to incentivize treatment participation (up to US $150 monthly). Participants reported high acceptability of the planned debit card spending restrictions (blocking cash withdrawals and purchases at bars or liquor stores, casinos or online gambling). Quantitative data revealed a high level of perceived usability of the PROCare Recovery app. Conclusions: Patients and providers alike appear receptive to microfinancial incentives in standard OUD treatment practices. Further pilot testing of PROCare is underway to determine acceptability, feasibility, and preliminary effectiveness in a rigorous randomized controlled trial. UR - https://formative.jmir.org/2022/10/e37474 UR - http://dx.doi.org/10.2196/37474 UR - http://www.ncbi.nlm.nih.gov/pubmed/36197705 ID - info:doi/10.2196/37474 ER - TY - JOUR AU - Torres, Luisa AU - Lee, L. Joy AU - Park, Seho AU - Di Lorenzo, Christian R. AU - Branam, P. Jonathan AU - Fraser, A. Shelagh AU - Salisbury, A. Benjamin PY - 2022/10/4 TI - Retention, Fasting Patterns, and Weight Loss With an Intermittent Fasting App: Large-Scale, 52-Week Observational Study JO - JMIR Mhealth Uhealth SP - e35896 VL - 10 IS - 10 KW - intermittent fasting KW - time-restricted eating KW - weight loss KW - obesity KW - mobile apps KW - diet trackers KW - retention N2 - Background: Intermittent fasting (IF) is an increasingly popular approach to dietary control that focuses on the timing of eating rather than the quantity and content of caloric intake. IF practitioners typically seek to improve their weight and other health factors. Millions of practitioners have turned to purpose-built mobile apps to help them track and adhere to their fasts and monitor changes in their weight and other biometrics. Objective: This study aimed to quantify user retention, fasting patterns, and weight loss by users of 2 IF mobile apps. We also sought to describe and model starting BMI, amount of fasting, frequency of weight tracking, and other demographics as correlates of retention and weight change. Methods: We assembled height, weight, fasting, and demographic data of adult users (ages 18-100 years) of the LIFE Fasting Tracker and LIFE Extend apps from 2018 to 2020. Retention for up to 52 weeks was quantified based on recorded fasts and correlated with user demographics. Users who provided height and at least 2 readings of weight and whose first fast and weight records were contemporaneous were included in the weight loss analysis. Fasting was quantified as extended fasting hours (EFH; hours beyond 12 in a fast) averaged per day (EFH per day). Retention was modeled using a Cox proportional hazards regression. Weight loss was analyzed using linear regression. Results: A total of 792,692 users were followed for retention based on 26 million recorded fasts. Of these, 132,775 (16.7%) users were retained at 13 weeks, 54,881 (6.9%) at 26 weeks, and 16,478 (2.1%) at 52 weeks, allowing 4 consecutive weeks of inactivity. The survival analysis using Cox regression indicated that retention was positively associated with age and exercise and negatively associated with stress and smoking. Weight loss in the qualifying cohort (n=161,346) was strongly correlated with starting BMI and EFH per day, which displayed a positive interaction. Users with a BMI ?40 kg/m2 lost 13.9% of their starting weight by 52 weeks versus a slight weight gain on average for users with starting BMI <23 kg/m2. EFH per day was an approximately linear predictor of weight loss. By week 26, users lost over 1% of their starting weight per EFH per day on average. The regression analysis using all variables was highly predictive of weight change at 26 weeks (R2=0.334) with starting BMI and EFH per day as the most significant predictors. Conclusions: IF with LIFE mobile apps appears to be a sustainable approach to weight reduction in the overweight and obese population. Healthy weight and underweight individuals do not lose much weight on average, even with extensive fasting. Users who are obese lose substantial weight over time, with more weight loss in those who fast more. UR - https://mhealth.jmir.org/2022/10/e35896 UR - http://dx.doi.org/10.2196/35896 UR - http://www.ncbi.nlm.nih.gov/pubmed/36194463 ID - info:doi/10.2196/35896 ER - TY - JOUR AU - Benoit, Andrew James Russell AU - Louie-Poon, Samantha AU - Kauser, Samar AU - Meherali, Salima PY - 2022/10/4 TI - Promoting Adolescent Sexual and Reproductive Health in North America Using Free Mobile Apps: Environmental Scan JO - JMIR Pediatr Parent SP - e33826 VL - 5 IS - 4 KW - mHealth KW - mobile health KW - adolescent KW - sexual and reproductive health KW - environmental scan KW - mobile app KW - sexual health KW - reproductive health KW - health KW - sexual KW - reproductive KW - MARS KW - Mobile App Rating Scale KW - digital health KW - adolescents N2 - Background: Neglecting adolescents? sexual and reproductive health (SRH) can affect multiple domains of development. Promoting healthy adolescent SRH is increasingly done using mobile phone apps. Providing SRH information via mobile phones can positively influence SRH outcomes including improving knowledge, reducing sexual risk behavior, and increasing the use of health services. A systematic approach to establishing and evaluating the quality of adolescent SRH mobile apps is urgently needed to rigorously evaluate whether they are a viable and effective strategy for reaching adolescents and improving adolescent SRH knowledge and behaviors in particular. Objective: This study aimed to conduct an environmental scan to produce an inventory of adolescent SRH?specific mobile apps with descriptions of their purpose, structure, operations, and quality of evidence. Methods: We used a literature review to develop 15 search terms for adolescent SRH?related apps in the Canadian and US Apple and Google app stores. After generating the search results, inclusion and exclusion criteria were applied. Using the remaining apps, we built an evidence table of app information, and app reviewers assessed each included app using the Mobile App Rating Scale. App assessments were then used to highlight trends between apps and identify gaps in app quality. Results: In total, 2761 apps were identified by our searches, of which 1515 were duplicates. Of the 1246 remaining apps, 15 met the criteria for further assessment. Across all subdomains, on a scale of 1-5, the mean app score was 3.4/5. The Functionality subdomain had the highest mean score of 4.1/5, whereas the Engagement subdomain had the lowest score of 2.9/5. The top 4 apps were Tia: Female Health Advisor (4.7/5), Under the Stethoscope (4.2/5), Condom Credit Card (4.1/5), and Shnet (3.7/5). Conclusions: This environmental scan aimed to provide a comprehensive overview of the mobile apps developed to promote adolescent SRH knowledge and outcomes. Of the 15 mobile apps available to provide information related to adolescent SRH, few provided comprehensive, reliable, and evidence-based SRH information. Areas of strength included the apps? gestural design, performance, ease of use, and navigation. Areas of weakness included app goals, evidence base, and app customization options. These results can be used to conduct future studies evaluating the use and efficacy of mobile apps on health knowledge and behaviors and promote adolescent SRH. UR - https://pediatrics.jmir.org/2022/4/e33826 UR - http://dx.doi.org/10.2196/33826 UR - http://www.ncbi.nlm.nih.gov/pubmed/36194450 ID - info:doi/10.2196/33826 ER - TY - JOUR AU - Lim, Lin Su AU - Tay, Juan Melissa Hui AU - Ong, Wen Kai AU - Johal, Jolyn AU - Yap, Ven Qai AU - Chan, Huak Yiong AU - Yeo, Ning Genevieve Kai AU - Khoo, Meng Chin AU - Yaxley, Alison PY - 2022/9/30 TI - Association Between Mobile Health App Engagement and Weight Loss and Glycemic Control in Adults With Type 2 Diabetes and Prediabetes (D?LITE Study): Prospective Cohort Study JO - JMIR Diabetes SP - e35039 VL - 7 IS - 3 KW - engagement KW - diabetes KW - prediabetes KW - mobile health KW - mHealth KW - mobile apps KW - weight loss KW - glycemic control KW - glycated hemoglobin KW - HbA1c change KW - mobile phone N2 - Background: Mobile health apps are increasingly used as early intervention to support behavior change for diabetes prevention and control, with the overarching goal of lowering the overall disease burden. Objective: This prospective cohort study conducted in Singapore aimed to investigate app engagement features and their association with weight loss and improved glycemic control among adults with diabetes and prediabetes from the intervention arm of the Diabetes Lifestyle Intervention using Technology Empowerment randomized controlled trial. Methods: Diabetes and prediabetes participants (N=171) with a median age of 52 years, BMI of 29.3 kg/m2, and glycated hemoglobin (HbA1c) level of 6.5% and who were being assigned the Nutritionist Buddy Diabetes app were included. Body weight and HbA1c were measured at baseline, 3 months, and 6 months. A total of 476,300 data points on daily app engagement were tracked via the backend dashboard and developer?s report. The app engagement data were analyzed by quartiles and weekly means expressed in days per week. Linear mixed model analysis was used to determine the associations between the app engagements with percentage weight and HbA1c change. Results: The median overall app engagement rate was maintained above 90% at 6 months. Participants who were actively engaged in ?5 app features were associated with the greatest overall weight reduction of 10.6% from baseline (mean difference ?6, 95% CI ?8.9 to ?3.2; P<.001) at 6 months. Adhering to the carbohydrate limit of >5.9 days per week and choosing healthier food options for >4.3 days per week had the most impact, eliciting weight loss of 9.1% (mean difference ?5.2, 95% CI ?8.2 to ?2.2; P=.001) and 8.8% (mean difference ?4.2, 95% CI ?7.1 to ?1.3; P=.005), respectively. Among the participants with diabetes, those who had a complete meal log for >5.1 days per week or kept within their carbohydrate limit for >5.9 days per week each achieved greater HbA1c reductions of 1.2% (SD 1.3%; SD 1.5%), as compared with 0.2% (SD 1%; SD 0.6%). in the reference groups who used the features <1.1 or ?2.5 days per week, respectively. Conclusions: Higher app engagement led to greater weight loss and HbA1c reduction among adults with overweight or obesity with type 2 diabetes or prediabetes. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001112358; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617001112358 UR - https://diabetes.jmir.org/2022/3/e35039 UR - http://dx.doi.org/10.2196/35039 UR - http://www.ncbi.nlm.nih.gov/pubmed/36178718 ID - info:doi/10.2196/35039 ER - TY - JOUR AU - Hong, Alicia Y. AU - Shen, Kang AU - Lu, Kate Huixing AU - Chen, Hsiaoyin AU - Gong, Yang AU - Ta Park, Van AU - Han, Hae-Ra PY - 2022/9/29 TI - A Social Media?Based Intervention for Chinese American Caregivers of Persons With Dementia: Protocol Development JO - JMIR Aging SP - e40171 VL - 5 IS - 3 KW - Alzheimer disease KW - dementia KW - caregivers KW - Chinese Americans KW - mHealth intervention KW - mobile health KW - WeChat KW - social media KW - aging N2 - Background: Racial/ethnic minority and immigrant caregivers of persons with dementia experience high rates of psychosocial stress and adverse health outcomes. Few culturally tailored mobile health (mHealth) programs were designed for these vulnerable populations. Objective: This study reports the development of a culturally tailored mHealth program called Wellness Enhancement for Caregivers (WECARE) to improve caregiving skills, reduce distress, and improve the psychosocial well-being of Chinese American family caregivers of persons with dementia. Methods: Community-based user-centered design principles were applied in the program development. First, the structure and curriculum of the WECARE program were crafted based on existing evidence-based interventions for caregivers with input from 4 experts. Second, through working closely with 8 stakeholders, we culturally adapted evidence-based programs into multimedia program components. Lastly, 5 target users tested the initial WECARE program; their experience and feedback were used to further refine the program. Results: The resulting WECARE is a 7-week mHealth program delivered via WeChat, a social media app highly popular in Chinese Americans. By subscribing to the official WECARE account, users can receive 6 interactive multimedia articles pushed to their WeChat accounts each week for 7 weeks. The 7 major themes include (1) facts of dementia and caregiving; (2) the enhancement of caregiving skills; (3) effective communication with health care providers, care partners, and family members; (4) problem-solving skills for caregiving stress management; (5) stress reduction and depression prevention; (6) the practice of self-care and health behaviors; and (7) social support and available resources. Users also have the option of joining group chats for peer support. The WECARE program also includes a back-end database that manages intervention delivery and tracks user engagement. Conclusions: The WECARE program represents one of the first culturally tailored social media?based interventions for Chinese American caregivers of persons with dementia. It demonstrates the use of community-based user-centered design principles in developing an mHealth intervention program in underserved communities. We call for more cultural adaptation and development of mHealth interventions for immigrant and racial/ethnic minority caregivers of persons with dementia. UR - https://aging.jmir.org/2022/3/e40171 UR - http://dx.doi.org/10.2196/40171 UR - http://www.ncbi.nlm.nih.gov/pubmed/36173667 ID - info:doi/10.2196/40171 ER - TY - JOUR AU - Espel-Huynh, Hallie AU - Baldwin, Matthew AU - Puzia, Megan AU - Huberty, Jennifer PY - 2022/9/28 TI - The Indirect Effects of a Mindfulness Mobile App on Productivity Through Changes in Sleep Among Retail Employees: Secondary Analysis JO - JMIR Mhealth Uhealth SP - e40500 VL - 10 IS - 9 KW - mindfulness KW - mobile apps KW - workforce KW - workplace KW - sleep KW - presenteeism KW - mobile phone N2 - Background: Chronic sleep disturbance is prevalent among United States employees and associated with costly productivity impairment. Mindfulness interventions improve sleep (ie, insomnia and daytime sleepiness) and productivity outcomes, and mobile apps provide scalable means of intervention delivery. However, few studies have examined the effects of mindfulness mobile apps on employees, and no research to date has tested the role of sleep improvement as a potential mechanism of action for productivity outcomes. Objective: This study examined the effects of Calm, a consumer-based mindfulness app, and sleep coaching, on productivity impairment among retail employees through the indirect effects of changes in insomnia and daytime sleepiness. Methods: This study was a secondary analysis of data from a randomized controlled trial (N=1029) comparing the use of Calm (n=585, 56.9%) to a waitlist control (n=444, 43.2%) for 8 weeks among employees of a large retail employer in the United States. A subset of individuals with elevated insomnia symptoms also had access to brief sleep coaching with Calm (n=101, 9.8%). Insomnia symptom severity, daytime sleepiness, and productivity impairment (ie, absenteeism, presenteeism, overall productivity impairment, and non?work activity impairment) were assessed at baseline and weeks 2, 4, 6, and 8. Indirect effects were evaluated with latent growth curve modeling to test whether the Calm intervention (Calm group vs waitlist control) was effective in reducing work productivity impairment through changes in sleep disturbance. Results: No significant main effects of Calm intervention on productivity impairment were detected for any outcome at ? level of .05, with the exception of non?work activity impairment models, in which Calm intervention reduced non?work activity impairment over time (P=.01 and P=.02 for insomnia and sleepiness models, respectively). Significant indirect effects of insomnia were detected for presenteeism (P=.002), overall work productivity (P=.01), and non?work activity impairment (P=.002); Calm intervention produced significantly greater reductions in insomnia symptoms (relative to waitlist control), and decreases in insomnia were associated with decreases in work productivity impairment. There was no significant indirect effect of change in insomnia on changes in absenteeism (P=.20). Furthermore, we detected no significant indirect effects of daytime sleepiness on productivity impairment. Conclusions: We found that Calm (plus sleep coaching for a small subset of individuals) had beneficial effects on employee sleep, and these benefits on sleep were related to indirect effects on productivity impairment (ie, presenteeism, overall work productivity impairment, and non?work activity impairment). There were no overall main effects of Calm intervention on productivity impairment; however, insomnia appears to be a mechanism associated with benefits for employee productivity. This is one of the first studies to suggest that sleep benefits of a mindfulness mobile app may also indirectly relate to benefits for workplace productivity. Trial Registration: ClinicalTrials.gov NCT05120310; https://clinicaltrials.gov/ct2/show/NCT05120310 UR - https://mhealth.jmir.org/2022/9/e40500 UR - http://dx.doi.org/10.2196/40500 UR - http://www.ncbi.nlm.nih.gov/pubmed/36169994 ID - info:doi/10.2196/40500 ER - TY - JOUR AU - Reesor-Oyer, Layton AU - Parker, Hannah AU - Burkart, Sarah AU - Smith, T. Michal AU - Dugger, Roddrick AU - von Klinggraeff, Lauren AU - Weaver, Glenn R. AU - Beets, W. Michael AU - Armstrong, Bridget PY - 2022/9/28 TI - Measuring Microtemporal Processes Underlying Preschoolers? Screen Use and Behavioral Health: Protocol for the Tots and Tech Study JO - JMIR Res Protoc SP - e36240 VL - 11 IS - 9 KW - ecological momentary assessment KW - accelerometery KW - objective screen time monitoring KW - mobile phone N2 - Background: Excessive screen time is associated with poor health and behavioral outcomes in children. However, research on screen time use has been hindered by methodological limitations, including retrospective reports of usual screen time and lack of momentary etiologic processes occurring within each day. Objective: This study is designed to assess the feasibility and utility of a comprehensive multibehavior protocol to measure the digital media use and screen time context among a racially and economically diverse sample of preschoolers and their families. This paper describes the recruitment, data collection, and analytical protocols for the Tots and Tech study. Methods: The Tots and Tech study is a longitudinal, observational study of 100 dyads: caregivers and their preschool-age children (aged 3-5 years). Both caregivers and children will wear an Axivity AX3 accelerometer (Axivity Ltd) for 30 days to assess their physical activity, sedentary behavior, and sleep. Caregivers will complete ecological momentary assessments (EMAs) for 1 week to measure child behavioral problems, caregiver stress, and child screen time. Results: The Tots and Tech study was funded in March 2020. This study maintains rolling recruitment, with each dyad on their own assessment schedule, depending on the time of enrollment. Enrollment was scheduled to take place between September 2020 and May 2022. We aim to enroll 100 caregiver-child dyads. The Tots and Tech outcome paper is expected to be published in 2022. Conclusions: The Tots and Tech study attempts to overcome previous methodological limitations by using objective measures of screen time, physical activity, sedentary behavior, and sleep behaviors with contextual factors measured by EMA. The results will be used to evaluate the feasibility and utility of a comprehensive multibehavior protocol using objective measures of mobile screen time and accelerometry in conjunction with EMA among caregiver-child dyads. Future observational and intervention studies will be able to use this study protocol to better measure screen time and its context. International Registered Report Identifier (IRRID): DERR1-10.2196/36240 UR - https://www.researchprotocols.org/2022/9/e36240 UR - http://dx.doi.org/10.2196/36240 UR - http://www.ncbi.nlm.nih.gov/pubmed/36169993 ID - info:doi/10.2196/36240 ER - TY - JOUR AU - Hudson, Georgie AU - Negbenose, Esther AU - Neary, Martha AU - Jansli, M. Sonja AU - Schueller, M. Stephen AU - Wykes, Til AU - Jilka, Sagar PY - 2022/9/23 TI - Comparing Professional and Consumer Ratings of Mental Health Apps: Mixed Methods Study JO - JMIR Form Res SP - e39813 VL - 6 IS - 9 KW - well-being KW - apps KW - patient and public involvement KW - coproduction KW - mental health KW - service user KW - technology KW - mobile health KW - mHealth KW - digital KW - mobile phone N2 - Background: As the number of mental health apps has grown, increasing efforts have been focused on establishing quality tailored reviews. These reviews prioritize clinician and academic views rather than the views of those who use them, particularly those with lived experiences of mental health problems. Given that the COVID-19 pandemic has increased reliance on web-based and mobile mental health support, understanding the views of those with mental health conditions is of increasing importance. Objective: This study aimed to understand the opinions of people with mental health problems on mental health apps and how they differ from established ratings by professionals. Methods: A mixed methods study was conducted using a web-based survey administered between December 2020 and April 2021, assessing 11 mental health apps. We recruited individuals who had experienced mental health problems to download and use 3 apps for 3 days and complete a survey. The survey consisted of the One Mind PsyberGuide Consumer Review Questionnaire and 2 items from the Mobile App Rating Scale (star and recommendation ratings from 1 to 5). The consumer review questionnaire contained a series of open-ended questions, which were thematically analyzed and using a predefined protocol, converted into binary (positive or negative) ratings, and compared with app ratings by professionals and star ratings from app stores. Results: We found low agreement between the participants? and professionals? ratings. More than half of the app ratings showed disagreement between participants and professionals (198/372, 53.2%). Compared with participants, professionals gave the apps higher star ratings (3.58 vs 4.56) and were more likely to recommend the apps to others (3.44 vs 4.39). Participants? star ratings were weakly positively correlated with app store ratings (r=0.32, P=.01). Thematic analysis found 11 themes, including issues of user experience, ease of use and interactivity, privacy concerns, customization, and integration with daily life. Participants particularly valued certain aspects of mental health apps, which appear to be overlooked by professional reviewers. These included functions such as the ability to track and measure mental health and providing general mental health education. The cost of apps was among the most important factors for participants. Although this is already considered by professionals, this information is not always easily accessible. Conclusions: As reviews on app stores and by professionals differ from those by people with lived experiences of mental health problems, these alone are not sufficient to provide people with mental health problems with the information they desire when choosing a mental health app. App rating measures must include the perspectives of mental health service users to ensure ratings represent their priorities. Additional work should be done to incorporate the features most important to mental health service users into mental health apps. UR - https://formative.jmir.org/2022/9/e39813 UR - http://dx.doi.org/10.2196/39813 UR - http://www.ncbi.nlm.nih.gov/pubmed/36149733 ID - info:doi/10.2196/39813 ER - TY - JOUR AU - Story, M. Kristin AU - Bravata, M. Dawn AU - Robb, L. Sheri AU - Wasmuth, Sally AU - Slaven, E. James AU - Whitmire, Leah AU - Barker, Barry AU - Menen, Tetla AU - Bair, J. Matthew PY - 2022/9/22 TI - Feasibility and Acceptability of Music Imagery and Listening Interventions for Analgesia: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e38788 VL - 11 IS - 9 KW - chronic pain KW - music therapy KW - veterans KW - clinical trial KW - music imagery KW - pilot study KW - feasibility KW - acceptability KW - mobile phone N2 - Background: Chronic pain and access to care are identified as critical needs of the Veterans Health Administration. Music imagery and music listening interventions have shown promise as effective nonpharmacological options for pain management. However, most studies have focused on acute pain, passive music experiences, and in-person delivery. Objective: In this study, we aimed to examine the feasibility and acceptability of 2 music interventions delivered through telehealth for chronic musculoskeletal pain, trial design, and theoretical model before conducting a fully powered efficacy or comparative effectiveness trial. Methods: FAMILIA (Feasibility and Acceptability of Music Imagery and Listening Interventions for Analgesia) is a 3-arm, parallel group, pilot trial. A total of 60 veterans will be randomized to one of the three conditions: music imagery, music listening, or usual care. Aim 1 is to test the feasibility and acceptability of a multicomponent, interactive music imagery intervention (8-weekly, individual sessions) and a single-component, minimally interactive music learning intervention (independent music listening). Feasibility metrics related to recruitment, retention, engagement, and completion of the treatment protocol and questionnaires will be assessed. Up to 20 qualitative interviews will be conducted to assess veteran experiences with both interventions, including perceived benefits, acceptability, barriers, and facilitators. Interview transcripts will be coded and analyzed for emergent themes. Aim 2 is to explore the effects of music imagery and music listening versus usual care on pain and associated patient-centered outcomes. These outcomes and potential mediators will be explored through changes from baseline to follow-up assessments at 1, 3, and 4 months. Descriptive statistics will be used to describe outcomes; this pilot study is not powered to detect differences in outcomes. Results: Recruitment for FAMILIA began in March 2022, and as of July 2022, 16 participants have been enrolled. We anticipate that enrollment will be completed by May 2023. We expect that music imagery and music listening will prove acceptable to veterans and that feasibility benchmarks will be reached. We hypothesize that music imagery and music listening will be more effective than usual care on pain and related outcomes. Conclusions: FAMILIA addresses four limitations in music intervention research for chronic pain: limited studies in veterans, evaluation of a multicomponent music intervention, methodological rigor, and internet-based delivery. Findings from FAMILIA will inform a fully powered trial to identify putative mechanisms and test efficacy. Trial Registration: ClinicalTrials.gov NCT05426941; https://tinyurl.com/3jdhx28u International Registered Report Identifier (IRRID): DERR1-10.2196/38788 UR - https://www.researchprotocols.org/2022/9/e38788 UR - http://dx.doi.org/10.2196/38788 UR - http://www.ncbi.nlm.nih.gov/pubmed/36136377 ID - info:doi/10.2196/38788 ER - TY - JOUR AU - Chew, Jocelyn Han Shi AU - Koh, Ling Wee AU - Ng, Yi Janelle Shaina Hui AU - Tan, Kan Ker PY - 2022/9/21 TI - Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes JO - J Med Internet Res SP - e40141 VL - 24 IS - 9 KW - smartphone app KW - mobile app KW - mobile health KW - mHealth KW - eHealth KW - weight management KW - weight loss KW - obesity KW - app KW - diet KW - eating KW - mobile phone N2 - Background: Evidence on the long-term effects of weight management smartphone apps on various weight-related outcomes remains scarce. Objective: In this review, we aimed to examine the effects of smartphone apps on anthropometric, metabolic, and dietary outcomes at various time points. Methods: Articles published from database inception to March 10, 2022 were searched, from 7 databases (Embase, CINAHL, PubMed, PsycINFO, Cochrane Library, Scopus, and Web of Science) using forward and backward citation tracking. All randomized controlled trials that reported weight change as an outcome in adults with overweight and obesity were included. We performed separate meta-analyses using random effects models for weight, waist circumference, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, blood glucose level, blood pressure, and total energy intake per day. Methodological quality was assessed using the Cochrane Risk of Bias tool. Results: Based on our meta-analyses, weight loss was sustained between 3 and 12 months, with a peak of 2.18 kg at 3 months that tapered down to 1.63 kg at 12 months. We did not find significant benefits of weight loss on the secondary outcomes examined, except for a slight improvement in systolic blood pressure at 3 months. Most of the included studies covered app-based interventions that comprised of components beyond food logging, such as real-time diet and exercise self-monitoring, personalized and remote progress tracking, timely feedback provision, smart devices that synchronized activity and weight data to smartphones, and libraries of diet and physical activity ideas. Conclusions: Smartphone weight loss apps are effective in initiating and sustaining weight loss between 3 and 12 months, but their effects are minimal in their current states. Future studies could consider the various aspects of the socioecological model. Conversational and dialectic components that simulate health coaches could be useful to enhance user engagement and outcome effectiveness. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42022329197; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329197 UR - https://www.jmir.org/2022/9/e40141 UR - http://dx.doi.org/10.2196/40141 UR - http://www.ncbi.nlm.nih.gov/pubmed/36129739 ID - info:doi/10.2196/40141 ER - TY - JOUR AU - Sanatkar, Samineh AU - Counson, Isabelle AU - Mackinnon, Andrew AU - Bartholomew, Alexandra AU - Glozier, Nick AU - Harvey, Samuel PY - 2022/9/21 TI - Preliminary Investigation of Shift, a Novel Smartphone App to Support Junior Doctors? Mental Health and Well-being: Examination of Symptom Progression, Usability, and Acceptability After 1 Month of Use JO - J Med Internet Res SP - e38497 VL - 24 IS - 9 KW - digital mental health KW - mobile health apps KW - mHealth apps KW - help seeking KW - junior doctors KW - depression KW - mobile phone N2 - Background: Shift is a novel smartphone app for providing a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioral modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues. Objective: This study aimed to conduct a preliminary investigation of the use and potential effectiveness of Shift on depressive and anxiety symptoms (primary outcomes) and work and social functioning, COVID-19 safety concerns, and help seeking (secondary outcomes). This study also sought feedback on whether Shift was seen as an acceptable tool. Methods: Junior doctors in New South Wales, Australia, were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided web-based baseline data, used the Shift app for 30 days, and were asked to complete a poststudy web-based questionnaire. Outcomes were analyzed under the intention-to-treat principle. Results: A total of 222 (n=156 female, 70.3%; mean age 29.2, SD 4.61 years) junior doctors provided full baseline data. Of these, 89.2% (198/222) downloaded the app, logged into the app approximately 6 times (mean 5.68, SD 7.51), completed 4 in-app activities (mean 3.77, SD 4.36), and spent a total of 1 hour on in-app activities (mean 52:23, SD 6:00:18) over 30 days. Postintervention and app use data were provided by 24.3% (54/222) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and postassessment points as expected; however, physicians? COVID-19 safety concerns significantly increased. Work and social functioning, COVID-19 concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app use (number of log-ins, days between first and last log-in, and total activity time). Most poststudy completers (31/54, 57%) rated Shift highly or very highly. Conclusions: Despite high levels of nonresponse to the poststudy assessment and increases in COVID-19 safety concerns, junior doctors who used the app reported some improvements in depression and anxiety, which warrant further exploration in a robust manner. UR - https://www.jmir.org/2022/9/e38497 UR - http://dx.doi.org/10.2196/38497 UR - http://www.ncbi.nlm.nih.gov/pubmed/36129745 ID - info:doi/10.2196/38497 ER - TY - JOUR AU - Garcia, O. David AU - Valdez, A. Luis AU - Aceves, Benjamin AU - Bell, L. Melanie AU - Rabe, A. Brooke AU - Villavicencio, A. Edgar AU - Marrero, G. David AU - Melton, Forest AU - Hooker, P. Steven PY - 2022/9/21 TI - mHealth-Supported Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men With Overweight and Obesity: Single-Arm Pilot Study JO - JMIR Form Res SP - e37637 VL - 6 IS - 9 KW - Hispanic KW - mobile health KW - mHealth KW - overweight KW - obesity KW - weight loss N2 - Background: Hispanic men have disproportionate rates of overweight and obesity compared with other racial and ethnic subpopulations. However, few weight loss interventions have been developed specifically for this high-risk group. Furthermore, the use of mobile health (mHealth) technologies to support lifestyle behavior changes in weight loss interventions for Hispanic men is largely untested. Objective: This single-arm pilot study examined the feasibility and acceptability of integrating mHealth technology into a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) for Hispanic men with overweight and obesity. Methods: A total of 18 Hispanic men (mean age 38, SD 10.9 years; mean BMI 34.3, SD 5.5 kg/m²; 10/18, 56% Spanish monolingual) received a GCSWLI, including weekly in-person individual sessions, a daily calorie goal, and prescription of ?225 minutes of moderate-intensity physical activity per week. mHealth technology support included tailored SMS text messaging, behavior self-monitoring support using Fitbit Charge 2, and weight tracking using a Fitbit Aria Wi-Fi Smart Scale. Changes in weight from baseline to 12 weeks were estimated using a paired 2-tailed t test. Descriptive analyses characterized the use of Fitbit and smart scales. Semistructured interviews were conducted immediately after intervention to assess the participants? weight loss experiences and perspectives on mHealth technologies. Results: Of 18 participants, 16 (89%) completed the 12-week assessments; the overall attrition rate was 11.1%. The mean weight loss at week 12 was ?4.7 kg (95% CI 7.1 to ?2.4 kg; P<.001). Participants wore the Fitbit 71.58% (962/1344) of the intervention days and logged their body weight using the smart scale (410/1344, 30.51% of the intervention days). Participants identified barriers to the use of the technology, such as lack of technological literacy and unreliable internet access for the smart scale. Conclusions: Although clinically significant weight loss was achieved by integrating mHealth technology into the GCSWLI, adherence to the prescribed use of technology was modest. Addressing barriers to the use of such technologies identified in our work may help to refine an mHealth intervention approach for Hispanic men. Trial Registration: ClinicalTrials.gov NCT02783521; https://clinicaltrials.gov/ct2/show/NCT02783521 UR - https://formative.jmir.org/2022/9/e37637 UR - http://dx.doi.org/10.2196/37637 UR - http://www.ncbi.nlm.nih.gov/pubmed/36129735 ID - info:doi/10.2196/37637 ER - TY - JOUR AU - O'Daffer, Alison AU - Colt, F. Susannah AU - Wasil, R. Akash AU - Lau, Nancy PY - 2022/9/20 TI - Efficacy and Conflicts of Interest in Randomized Controlled Trials Evaluating Headspace and Calm Apps: Systematic Review JO - JMIR Ment Health SP - e40924 VL - 9 IS - 9 KW - mHealth KW - psychological interventions KW - mobile health KW - mental health KW - health applications KW - health apps KW - mindfulness KW - meditation app KW - digital health application KW - digital health intervention N2 - Background: Although there are thousands of mental health apps, 2 apps, Headspace and Calm, claim a large percentage of the marketplace. These two mindfulness and meditation apps have reached tens of millions of active users. To guide consumers, clinicians, and researchers, we performed a systematic review of randomized controlled trials (RCTs) of Headspace and Calm. Objective: Our study aimed to evaluate intervention efficacy, risk of bias, and conflicts of interest (COIs) in the evidence base for Headspace and Calm, the two most popular mental health apps at the time of our search. Methods: To identify studies, we searched academic databases (Google Scholar, MEDLINE, and PsycINFO) and the websites of Headspace and Calm in May 2021 for RCTs of Headspace and Calm testing efficacy via original data collection, published in English in peer-reviewed journals. For each study, we coded (1) study characteristics (eg, participants, sample size, and outcome measures), (2) intervention characteristics (eg, free vs paid version of the app and intended frequency of app usage), (3) all study outcomes, (4) Cochrane risk of bias variables, and (5) COI variables (eg, presence or absence of a preregistration and the presence or absence of a COI statement involving the company). Results: We identified 14 RCTs of Headspace and 1 RCT of Calm. Overall, 93% (13/14) of RCTs of Headspace and 100% (1/1) of RCTs of Calm recruited participants from a nonclinical population. Studies commonly measured mindfulness, well-being, stress, depressive symptoms, and anxiety symptoms. Headspace use improved depression in 75% of studies that evaluated it as an outcome. Findings were mixed for mindfulness, well-being, stress, and anxiety, but at least 40% of studies showed improvement for each of these outcomes. Studies were generally underpowered to detect ?small? or ?medium? effect sizes. Furthermore, 50% (7/14) of RCTs of Headspace and 0% (0/1) of RCTs of Calm reported a COI that involved Headspace or Calm (the companies). The most common COI was the app company providing premium app access for free for participants, and notably, 14% (2/14) of RCTs of Headspace reported Headspace employee involvement in study design, execution, and data analysis. Only 36% (5/14) of RCTs of Headspace were preregistered, and the 1 RCT of Calm was not preregistered. Conclusions: The empirical research on Headspace appears promising, whereas there is an absence of randomized trials on Calm. Limitations of this study include an inability to compare Headspace and Calm owing to the dearth of RCTs studying Calm and the reliance on author reports to evaluate COIs. When determining whether or not mental health apps are of high quality, identification of high-quality apps and evaluation of their effectiveness and investigators? COIs should be ensured. UR - https://mental.jmir.org/2022/9/e40924 UR - http://dx.doi.org/10.2196/40924 UR - http://www.ncbi.nlm.nih.gov/pubmed/36125880 ID - info:doi/10.2196/40924 ER - TY - JOUR AU - McKeown, Eamonn AU - McGraw, Caroline AU - Holder, Pru AU - Shand, Jenny AU - Hirani, P. Shashivadan PY - 2022/9/16 TI - Acceptability and Impact of an Educational App (iCare) for Informal Carers Looking After People at Risk of Pressure Ulceration: Mixed Methods Pilot Study JO - JMIR Form Res SP - e36517 VL - 6 IS - 9 KW - pressure ulcers KW - informal carers KW - smartphone apps KW - mobile health KW - mHealth KW - educational technology KW - health education KW - mobile phone N2 - Background: Pressure ulcers are areas of skin damage resulting from sustained pressure. Informal carers play a central role in preventing pressure ulcers among older and disabled people living at home. Studies highlight the paucity of pressure ulcer training for informal carers and suggest that pressure ulcer risk is linked to high levels of carer burden. Objective: This pilot study evaluated a smartphone app with a specific focus on pressure ulcer prevention education for informal carers. The app was developed based on the principles of microlearning. The study aimed to explore carer perspectives on the acceptability of the app and determine whether the app increased knowledge and confidence in their caring role. Methods: In this concurrent mixed methods study, participants completed quantitative questionnaires at baseline and at the end of weeks 2 and 6, which examined caregiving self-efficacy, preparedness for caregiving, caregiver strain, pressure ulcer knowledge, and app acceptability and usability. A subsample of participants participated in a ?think aloud? interview in week 1 and semistructured interviews at the end of weeks 2 and 6. Results: Of the 32 participants, 23 (72%) participants completed the week 2 and 16 (50%) completed the week 6 questionnaires; 66% (21/32) of carers participated in qualitative ?think aloud? interviews, and 18 (56%) also participated in semistructured interviews at week 2, and 13 (41%) at week 6. Pressure ulcer knowledge scores significantly changed (F1,6.112=21.624; P=.001) from baseline (mean 37.5; SE 2.926) to the second follow-up (mean 59.72, SE 3.985). Regarding the qualitative data, the theme ?I?m more careful now and would react to signs of redness? captured participants? reflections on the new knowledge they had acquired, the changes they had made to their caring routines, their increased vigilance for signs of skin damage, and their intentions toward the app going forward. There were no significant results pertaining to improved preparedness for caregiving or caregiving self-efficacy or related to the Caregiver Strain Index. Participants reported above average usability scores on a scale of 0 to 100 (mean 69.94, SD 18.108). The app functionality and information quality were also rated relatively high on a scale of 0 to 5 (mean 3.84, SD 0.704 and mean 4.13, SD 0.452, respectively). Overall, 2 themes pertaining to acceptability and usability were identified: ?When you?re not used to these things, they take time to get the hang of? and ?It?s not a fun app but it is informative.? All participants (n=32, 100%) liked the microlearning approach. Conclusions: The iCare app offers a promising way to improve informal carers? pressure ulcer knowledge. However, to better support carers, the findings may reflect the need for future iterations of the app to use more interactive elements and the introduction of gamification and customization based on user preferences. UR - https://formative.jmir.org/2022/9/e36517 UR - http://dx.doi.org/10.2196/36517 UR - http://www.ncbi.nlm.nih.gov/pubmed/36112413 ID - info:doi/10.2196/36517 ER - TY - JOUR AU - Toyama, Mauricio AU - Cavero, Victoria AU - Araya, Ricardo AU - Menezes, Rossi Paulo AU - Mohr, C. David AU - Miranda, Jaime J. AU - Diez-Canseco, Francisco PY - 2022/9/15 TI - Participants? and Nurses? Experiences With a Digital Intervention for Patients With Depressive Symptoms and Comorbid Hypertension or Diabetes in Peru: Qualitative Post?Randomized Controlled Trial Study JO - JMIR Hum Factors SP - e35486 VL - 9 IS - 3 KW - mobile intervention KW - depression KW - diabetes KW - hypertension KW - comorbidity KW - qualitative research KW - mobile phone N2 - Background: Depression is one of the most prevalent mental disorders and a leading cause of disability, disproportionately affecting specific groups, such as patients with noncommunicable diseases. Over the past decade, digital interventions have been developed to provide treatment for these patients. CONEMO (Emotional Control in Spanish) is an 18-session psychoeducational digital intervention delivered through a smartphone app and minimally supported by a nurse. CONEMO demonstrated effectiveness in reducing depressive symptoms through a randomized controlled trial (RCT) among patients with diabetes, hypertension, or both, in Lima, Peru. However, in addition to clinical outcomes, it is important to explore users? experiences, satisfaction, and perceptions of usability and acceptability, which can affect their engagement with the intervention. Objective: This study aimed to explore the RCT participants? experiences with CONEMO in Peru, complemented with information provided by the nurses who monitored them. Methods: In 2018, semistructured interviews were conducted with a sample of 29 (13.4%) patients from the 217 patients who participated in the CONEMO intervention in Peru and the 3 hired nurses who supported its delivery. Interviewees were selected at random based on their adherence to the digital intervention (0-5, 10-14, and 15-18 sessions completed), to include different points of view. Content analysis was conducted to analyze the interviews. Results: Participants? mean age was 64.4 (SD 8.5) years, and 79% (23/29) of them were women. Most of the interviewed participants (21/29, 72%) stated that CONEMO fulfilled their expectations and identified positive changes in their physical and mental health after using it. Some of these improvements were related to their thoughts and feelings (eg, think differently, be more optimistic, and feel calmer), whereas others were related to their routines (eg, go out more and improve health-related habits). Most participants (19/29, 66%) reported not having previous experience with using smartphones, and despite experiencing some initial difficulties, they managed to use CONEMO. The most valued features of the app were the videos and activities proposed for the participant to perform. Most participants (27/29, 93%) had a good opinion about the study nurses and reported feeling supported by them. A few participants provided suggestions to improve the intervention, which included adding more videos, making the sessions? text simple, extending the length of the intervention, and improving the training session with long explanations. Conclusions: The findings of this qualitative study provide further support and contextualize the positive results found in the CONEMO RCT, including insights into the key features that made the intervention effective and engaging. The participants? experience with the smartphone and CONEMO app reveal that it is feasible to be used by people with little knowledge of technology. In addition, the study identified suggestions to improve the CONEMO intervention for its future scale-up. Trial Registration: ClinicalTrials.gov NCT03026426; https://clinicaltrials.gov/ct2/show/NCT03026426 UR - https://humanfactors.jmir.org/2022/3/e35486 UR - http://dx.doi.org/10.2196/35486 UR - http://www.ncbi.nlm.nih.gov/pubmed/36107482 ID - info:doi/10.2196/35486 ER - TY - JOUR AU - Aemissegger, Vera AU - Lopez-Alcalde, Jesus AU - Witt, M. Claudia AU - Barth, Jürgen PY - 2022/9/14 TI - Comparability of Patients in Trials of eHealth and Face-to-Face Psychotherapeutic Interventions for Depression: Meta-synthesis JO - J Med Internet Res SP - e36978 VL - 24 IS - 9 KW - depression KW - mental health KW - digital intervention KW - eHealth KW - web-based KW - randomized controlled trial KW - RCT KW - meta-analysis KW - epidemiology KW - epidemiological KW - depressive disorder KW - mental illness KW - mental condition KW - mental disorder KW - psychotherapy KW - psychotherapeutic intervention KW - CBT KW - iCBT KW - cognitive behavioral therapy KW - face-to-face KW - cognitive therapy KW - interpersonal therapy N2 - Background: Depressive disorders (DDs) are a public health problem. Face-to-face psychotherapeutic interventions are a first-line option for their treatment in adults. There is a growing interest in eHealth interventions to maximize accessibility for effective treatments. Thus, the number of randomized controlled trials (RCTs) of eHealth psychotherapeutic interventions has increased, and these interventions are being offered to patients. However, it is unknown whether patients with DDs differ in internet-based and face-to-face intervention trials. This information is essential to gain knowledge about eHealth trials? external validity. Objective: We aimed to compare the baseline characteristics of patients with DDs included in the RCTs of eHealth and face-to-face psychotherapeutic interventions with a cognitive component. Methods: In this meta-epidemiological study, we searched 5 databases between 1990 and November 2017 (MEDLINE, Embase, PsycINFO, Google Scholar, and the database of Cuijpers et al). We included RCTs of psychotherapeutic interventions with a cognitive component (eg, cognitive therapy, cognitive behavioral therapy [CBT], or interpersonal therapy) delivered face-to-face or via the internet to adults with DDs. Each included study had a matching study for predefined criteria to allow a valid comparison of characteristics and was classified as a face-to-face (CBT) or eHealth (internet CBT) intervention trial. Two authors selected the studies, extracted data, and resolved disagreements by discussion. We tested whether predefined baseline characteristics differed in face-to-face and internet-based trials using a mixed-effects model and testing for differences with z tests (statistical significance set at .05). For continuous outcomes, we also estimated the difference in means between subgroups with 95% CI. Results: We included 58 RCTs (29 matching pairs) with 3846 participants (female: n=2803, 72.9%) and mean ages ranging from 20-74 years. White participants were the most frequent (from 63.6% to 100%). Other socioeconomic characteristics were poorly described. The participants presented DDs of different severity measured with heterogeneous instruments. Internet CBT trials had a longer depression duration at baseline (7.19 years higher, CI 95% 2.53-11.84; 10.0 vs 2.8 years; P=.002), but the proportion of patients with previous depression treatment was lower (24.8% vs 42%; P=.04). Subgroup analyses found no evidence of differences for the remaining baseline characteristics: age, gender, education, living area, depression severity, history of depression, actual antidepressant medication, actual physical comorbidity, actual mental comorbidity, study dropout, quality of life, having children, family status, and employment. We could not compare proficiency with computers due to the insufficient number of studies. Conclusions: The baseline characteristics of patients with DDs included in the RCTs of eHealth and face-to-face psychotherapeutic interventions are generally similar. However, patients in eHealth trials had a longer duration of depression, and a lower proportion had received previous depression treatment, which might indicate that eHealth trials attract patients who postpone earlier treatment attempts. Trial Registration: PROSPERO CRD42019085880; https://tinyurl.com/4xufwcyr UR - https://www.jmir.org/2022/9/e36978 UR - http://dx.doi.org/10.2196/36978 UR - http://www.ncbi.nlm.nih.gov/pubmed/36103217 ID - info:doi/10.2196/36978 ER - TY - JOUR AU - Xie, Zhenzhen AU - Chen, Jiayin AU - Or, Kalun Calvin PY - 2022/9/14 TI - Consumers? Willingness to Pay for eHealth and Its Influencing Factors: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e25959 VL - 24 IS - 9 KW - systematic review KW - meta-analysis KW - willingness to pay KW - eHealth KW - contingent valuation KW - discrete choice experiment KW - mobile phone N2 - Background: Despite the great potential of eHealth, substantial costs are involved in its implementation, and it is essential to know whether these costs can be justified by its benefits. Such needs have led to an increased interest in measuring the benefits of eHealth, especially using the willingness to pay (WTP) metric as an accurate proxy for consumers? perceived benefits of eHealth. This offered us an opportunity to systematically review and synthesize evidence from the literature to better understand WTP for eHealth and its influencing factors. Objective: This study aimed to provide a systematic review of WTP for eHealth and its influencing factors. Methods: This study was performed and reported as per the Cochrane Collaboration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, CINAHL Plus, Cochrane Library, EconLit, and PsycINFO databases were searched from their inception to April 19, 2022. We conducted random-effects meta-analyses to calculate WTP values for eHealth (at 2021 US dollar rates) and meta-regression analyses to examine the factors affecting WTP. Results: A total of 30 articles representing 35 studies were included in the review. We found that WTP for eHealth varied across studies; when expressed as a 1-time payment, it ranged from US $0.88 to US $191.84, and when expressed as a monthly payment, it ranged from US $5.25 to US $45.64. Meta-regression analyses showed that WTP for eHealth was negatively associated with the percentages of women (?=?.76; P<.001) and positively associated with the percentages of college-educated respondents (?=.63; P<.001) and a country?s gross domestic product per capita (multiples of US $1000; ?=.03; P<.001). Compared with eHealth provided through websites, people reported a lower WTP for eHealth provided through asynchronous communication (?=?1.43; P<.001) and a higher WTP for eHealth provided through medical devices (?=.66; P<.001), health apps (?=.25; P=.01), and synchronous communication (?=.58; P<.001). As for the methods used to measure WTP, single-bounded dichotomous choice (?=2.13; P<.001), double-bounded dichotomous choice (?=2.20; P<.001), and payment scale (?=1.11; P<.001) were shown to obtain higher WTP values than the open-ended format. Compared with ex ante evaluations, ex post evaluations were shown to obtain lower WTP values (?=?.37; P<.001). Conclusions: WTP for eHealth varied significantly depending on the study population, modality used to provide eHealth, and methods used to measure it. WTP for eHealth was lower among certain population segments, suggesting that these segments may be at a disadvantage in terms of accessing and benefiting from eHealth. We also identified the modalities of eHealth that were highly valued by consumers and offered suggestions for the design of eHealth interventions. In addition, we found that different methods of measuring WTP led to significantly different WTP estimates, highlighting the need to undertake further methodological explorations of approaches to elicit WTP values. UR - https://www.jmir.org/2022/9/e25959 UR - http://dx.doi.org/10.2196/25959 UR - http://www.ncbi.nlm.nih.gov/pubmed/36103227 ID - info:doi/10.2196/25959 ER - TY - JOUR AU - Huang, Haley AU - Aschettino, Sofia AU - Lari, Nasim AU - Lee, Ting-Hsuan AU - Rosenberg, Stothers Sarah AU - Ng, Xinyi AU - Muthuri, Stella AU - Bakshi, Anirudh AU - Bishop, Korrin AU - Ezzeldin, Hussein PY - 2022/9/14 TI - A Versatile and Scalable Platform That Streamlines Data Collection for Patient-Centered Studies: Usability and Feasibility Study JO - JMIR Form Res SP - e38579 VL - 6 IS - 9 KW - mobile app KW - patient experience data KW - data-collection app KW - mobile phone KW - usability KW - mHealth app KW - feasibility KW - user centered KW - eHealth KW - patient-generated data N2 - Background: The Food and Drug Administration Center for Biologics Evaluation and Research (CBER) established the Biologics Effectiveness and Safety (BEST) Initiative with several objectives, including the expansion and enhancement of CBER?s access to fit-for-purpose data sources, analytics, tools, and infrastructures to improve the understanding of patient experiences with conditions related to CBER-regulated products. Owing to existing challenges in data collection, especially for rare disease research, CBER recognized the need for a comprehensive platform where study coordinators can engage with study participants and design and deploy studies while patients or caregivers could enroll, consent, and securely participate as well. Objective: This study aimed to increase awareness and describe the design, development, and novelty of the Survey of Health and Patient Experience (SHAPE) platform, its functionality and application, quality improvement efforts, open-source availability, and plans for enhancement. Methods: SHAPE is hosted in a Google Cloud environment and comprises 3 parts: the administrator application, participant app, and application programming interface. The administrator can build a study comprising a set of questionnaires and self-report entries through the app. Once the study is deployed, the participant can access the app, consent to the study, and complete its components. To build SHAPE to be scalable and flexible, we leveraged the open-source software development kit, Ionic Framework. This enabled the building and deploying of apps across platforms, including iOS, Android, and progressive web applications, from a single codebase by using standardized web technologies. SHAPE has been integrated with a leading Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) application programming interface platform, 1upHealth, which allows participants to consent to 1-time data pull of their electronic health records. We used an agile-based process that engaged multiple stakeholders in SHAPE?s design and development. Results: SHAPE allows study coordinators to plan, develop, and deploy questionnaires to obtain important end points directly from patients or caregivers. Electronic health record integration enables access to patient health records, which can validate and enhance the accuracy of data-capture methods. The administrator can then download the study data into HL7® FHIR®?formatted JSON files. In this paper, we illustrate how study coordinators can use SHAPE to design patient-centered studies. We demonstrate its broad applicability through a hypothetical type 1 diabetes cohort study and an ongoing pilot study on metachromatic leukodystrophy to implement best practices for designing a regulatory-grade natural history study for rare diseases. Conclusions: SHAPE is an intuitive and comprehensive data-collection tool for a variety of clinical studies. Further customization of this versatile and scalable platform allows for multiple use cases. SHAPE can capture patient perspectives and clinical data, thereby providing regulators, clinicians, researchers, and patient advocacy organizations with data to inform drug development and improve patient outcomes. UR - https://formative.jmir.org/2022/9/e38579 UR - http://dx.doi.org/10.2196/38579 UR - http://www.ncbi.nlm.nih.gov/pubmed/36103218 ID - info:doi/10.2196/38579 ER - TY - JOUR AU - Chamorro-de-Vega, Esther AU - Romero-Jiménez, Rosa AU - Escudero-Vilaplana, Vicente AU - Ais-Larisgoitia, Arantza AU - Lobato Matilla, Elena María AU - González, M. Carlos AU - Menchén, Luis AU - Baniandrés, Ofelia AU - Ibares-Frias, Lucía AU - Lobo-Rodríguez, Carmen AU - Herranz-Alonso, Ana AU - Sanjurjo, María PY - 2022/9/13 TI - Information and Communication Technologies in Patients With Immune-Mediated Inflammatory Diseases: Cross-sectional Survey JO - J Med Internet Res SP - e37445 VL - 24 IS - 9 KW - mHealth KW - app KW - information and communication technologies KW - immune-mediated inflammatory diseases KW - IMID KW - cross-sectional survey KW - survey KW - monitoring KW - clinical support KW - clinicians KW - quality of care KW - patient care KW - mobile app KW - tool KW - management tool N2 - Background: Information and communication technologies (ICTs) are changing the traditional health care model and redefining personalized health. ICTs offer effective communication and real-time monitoring of patients and provide additional data to support clinical decision-making, improve the quality of care, and contribute to the empowerment of patients. However, evidence on the use of ICTs and digital preferences of immune-mediated inflammatory disease (IMID) patients is scarce. Objective: The aim of this study is to describe the degree of use of ICTs in patients with IMIDs (including rheumatic diseases, inflammatory bowel diseases, and psoriasis), identify their needs, and analyze their interest in the use of apps as tools for better management of their disease. Methods: A questionnaire was created by a multidisciplinary team including pharmacists, rheumatologists, gastroenterologists, dermatologists, and nurses with experience in ICTs applied to the field of IMID. The survey included 27 questions organized into 3 blocks: (1) sociodemographic characteristics, (2) ICT use for health-related information, and (3) patient expectations about mobile health. Results: A total of 472 questionnaires were analyzed. Overall, 52.9% (250/472) of patients were diagnosed with a rheumatologic disease, 39.4% (186/472) with inflammatory bowel disease, and 12.3% (58/472) with psoriasis. The state of health was considered good by 45.6% (215/472) of patients. Patients were interested in staying informed about health issues in 86.9% (410/427) of cases and sought health-related information mainly from the internet (334/472, 70.8%) and health care professionals (318/472, 67.4%). Overall, 13.6% (64/472) did not trust the health information they found in internet. Of the patients, 42.8% (202/472) had a health app, and 42.2% (199/472) had found it on their own. Patients would like a health app to help mainly to manage appointments (281/472, 59.5%), obtain information about their diseases and treatments (274/472, 58.1%), and get in contact with health professionals (250/472, 53.0%). Overall, 90.0% (425/472) of patients reported they would use an app to manage their IMID if their health professional recommended it, and 58.0% (274/472) would pay or probably be willing to pay for it. Conclusions: IMID patients were very interested in finding health-related information via ICTs, especially using smartphones and apps recommended by health professionals. Appointment management, advice on disease and treatment management, and personalized communication with health professionals were the most desired app features identified. Health professionals should play an essential role in recommending and validating these tools to ensure they are of high quality. UR - https://www.jmir.org/2022/9/e37445 UR - http://dx.doi.org/10.2196/37445 UR - http://www.ncbi.nlm.nih.gov/pubmed/36099018 ID - info:doi/10.2196/37445 ER - TY - JOUR AU - Arensman, Remco AU - Kloek, Corelien AU - Pisters, Martijn AU - Koppenaal, Tjarco AU - Ostelo, Raymond AU - Veenhof, Cindy PY - 2022/9/13 TI - Patient Perspectives on Using a Smartphone App to Support Home-Based Exercise During Physical Therapy Treatment: Qualitative Study JO - JMIR Hum Factors SP - e35316 VL - 9 IS - 3 KW - patient perspectives KW - mobile health KW - mHealth KW - home-based exercise KW - adherence KW - low back pain KW - physical therapy N2 - Background: Home-based exercise is an important part of physical therapy treatment for patients with low back pain. However, treatment effectiveness depends heavily on patient adherence to home-based exercise recommendations. Smartphone apps designed to support home-based exercise have the potential to support adherence to exercise recommendations and possibly improve treatment effects. A better understanding of patient perspectives regarding the use of smartphone apps to support home-based exercise during physical therapy treatment can assist physical therapists with optimal use and implementation of these apps in clinical practice. Objective: The aim of this study was to investigate patient perspectives on the acceptability, satisfaction, and performance of a smartphone app to support home-based exercise following recommendations from a physical therapist. Methods: Using an interpretivist phenomenology approach, 9 patients (4 males and 5 females; aged 20-71 years) with nonspecific low back pain recruited from 2 primary care physical therapy practices were interviewed within 2 weeks after treatment ended. An interview guide was used for the interviews to ensure that different aspects of the patients? perspectives were discussed. The Physitrack smartphone app was used to support home-based exercise as part of treatment for all patients. Data were analyzed using the ?Framework Method? to assist with interpretation of the data. Results: Data analysis revealed 11 categories distributed among the 3 themes ?acceptability,? ?satisfaction,? and ?performance.? Patients were willing to accept the app as part of treatment when it was easy to use, when it benefited the patient, and when the physical therapist instructed the patient in its use. Satisfaction with the app was determined by users? perceived support from the app when exercising at home and the perceived increase in adherence. The video and text instructions, reminder functions, and self-monitor functions were considered the most important aspects for performance during treatment. The patients did not view the Physitrack app as a replacement for the physical therapist and relied on their therapist for instructions and support when needed. Conclusions: Patients who use an app to support home-based exercise as part of treatment are accepting of the app when it is easy to use, when it benefits the patient, and when the therapist instructs the patient in its use. Physical therapists using an app to support home-based exercise can use the findings from this study to effectively support their patients when exercising at home during treatment. UR - https://humanfactors.jmir.org/2022/3/e35316 UR - http://dx.doi.org/10.2196/35316 UR - http://www.ncbi.nlm.nih.gov/pubmed/36098993 ID - info:doi/10.2196/35316 ER - TY - JOUR AU - Saeidnia, Reza Hamid AU - Kozak, Marcin AU - Ausloos, Marcel AU - Herteliu, Claudiu AU - Mohammadzadeh, Zahra AU - Ghorbi, Ali AU - Karajizadeh, Mehrdad AU - Hassanzadeh, Mohammad PY - 2022/9/13 TI - Development of a Mobile App for Self-Care Against COVID-19 Using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) Model: Methodological Study JO - JMIR Form Res SP - e39718 VL - 6 IS - 9 KW - self-care KW - mobile app KW - ADDIE model KW - COVID-19 KW - underdeveloped countries N2 - Background: Mobile apps have been shown to play an important role in the management, care, and prevention of infectious diseases. Thus, skills for self-care?one of the most effective ways to prevent illness?can be improved through mobile health apps. Objective: This study aimed to design, develop, and evaluate an educational mobile-based self-care app in order to help the self-prevention of COVID-19 in underdeveloped countries. We intended the app to be easy to use, quick, and inexpensive. Methods: In 2020 and 2021, we conducted a methodological study. Using the ADDIE (analysis, design, development, implementation, and evaluation) educational model, we developed a self-care management mobile app. According to the ADDIE model, an effective training and performance support tool is built through the 5 phases that comprise its name. There were 27 participants who conducted 2 evaluations of the mobile app?s usability and impact using the mobile health app usability and self-care inventory scales. The study design included pre- and posttesting. Results: An Android app called MyShield was developed. The results of pre- and posttests showed that on a scale from 0 to 5, MyShield scored a performance average of 4.17 in the physical health dimension and an average of 3.88 in the mental well-being dimension, thereby showing positive effects on self-care skills. MyShield scored highly on the ?interface and satisfaction,? ?ease of use,? and ?usefulness? components. Conclusions: MyShield facilitates learning self-care skills at home, even during quarantine, increasing acquisition of information. Given its low development cost and the ADDIE educational design on which it is based, the app can be helpful in underdeveloped countries. Thus, low-income countries?often lacking other tools?can use the app as an effective tool for fighting COVID-19, if it becomes a standard mobile app recommended by the government. UR - https://formative.jmir.org/2022/9/e39718 UR - http://dx.doi.org/10.2196/39718 UR - http://www.ncbi.nlm.nih.gov/pubmed/36054441 ID - info:doi/10.2196/39718 ER - TY - JOUR AU - Maleki, Ghobad AU - Zhuparris, Ahnjili AU - Koopmans, Ingrid AU - Doll, J. Robert AU - Voet, Nicoline AU - Cohen, Adam AU - van Brummelen, Emilie AU - Groeneveld, Jan Geert AU - De Maeyer, Joris PY - 2022/9/13 TI - Objective Monitoring of Facioscapulohumeral Dystrophy During Clinical Trials Using a Smartphone App and Wearables: Observational Study JO - JMIR Form Res SP - e31775 VL - 6 IS - 9 KW - facioscapulohumeral dystrophy KW - FSHD KW - smartphone KW - wearables KW - machine learning KW - classification KW - mobile phone N2 - Background: Facioscapulohumeral dystrophy (FSHD) is a progressive muscle dystrophy disorder leading to significant disability. Currently, FSHD symptom severity is assessed by clinical assessments such as the FSHD clinical score and the Timed Up-and-Go test. These assessments are limited in their ability to capture changes continuously and the full impact of the disease on patients? quality of life. Real-world data related to physical activity, sleep, and social behavior could potentially provide additional insight into the impact of the disease and might be useful in assessing treatment effects on aspects that are important contributors to the functioning and well-being of patients with FSHD. Objective: This study investigated the feasibility of using smartphones and wearables to capture symptoms related to FSHD based on a continuous collection of multiple features, such as the number of steps, sleep, and app use. We also identified features that can be used to differentiate between patients with FSHD and non-FSHD controls. Methods: In this exploratory noninterventional study, 58 participants (n=38, 66%, patients with FSHD and n=20, 34%, non-FSHD controls) were monitored using a smartphone monitoring app for 6 weeks. On the first and last day of the study period, clinicians assessed the participants? FSHD clinical score and Timed Up-and-Go test time. Participants installed the app on their Android smartphones, were given a smartwatch, and were instructed to measure their weight and blood pressure on a weekly basis using a scale and blood pressure monitor. The user experience and perceived burden of the app on participants? smartphones were assessed at 6 weeks using a questionnaire. With the data collected, we sought to identify the behavioral features that were most salient in distinguishing the 2 groups (patients with FSHD and non-FSHD controls) and the optimal time window to perform the classification. Results: Overall, the participants stated that the app was well tolerated, but 67% (39/58) noticed a difference in battery life using all 6 weeks of data, we classified patients with FSHD and non-FSHD controls with 93% accuracy, 100% sensitivity, and 80% specificity. We found that the optimal time window for the classification is the first day of data collection and the first week of data collection, which yielded an accuracy, sensitivity, and specificity of 95.8%, 100%, and 94.4%, respectively. Features relating to smartphone acceleration, app use, location, physical activity, sleep, and call behavior were the most salient features for the classification. Conclusions: Remotely monitored data collection allowed for the collection of daily activity data in patients with FSHD and non-FSHD controls for 6 weeks. We demonstrated the initial ability to detect differences in features in patients with FSHD and non-FSHD controls using smartphones and wearables, mainly based on data related to physical and social activity. Trial Registration: ClinicalTrials.gov NCT04999735; https://www.clinicaltrials.gov/ct2/show/NCT04999735 UR - https://formative.jmir.org/2022/9/e31775 UR - http://dx.doi.org/10.2196/31775 UR - http://www.ncbi.nlm.nih.gov/pubmed/36098990 ID - info:doi/10.2196/31775 ER - TY - JOUR AU - Duffy, Anthony AU - Christie, J. Gregory AU - Moreno, Sylvain PY - 2022/9/9 TI - The Challenges Toward Real-world Implementation of Digital Health Design Approaches: Narrative Review JO - JMIR Hum Factors SP - e35693 VL - 9 IS - 3 KW - digital health KW - end users KW - user experience KW - health behavior KW - intervention KW - co-design KW - mobile health KW - mobile phone N2 - Background: Digital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group. Objective: In this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology. Methods: A narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as ?digital health design,? ?mHealth design,? ?e-Health design,? ?agile health,? and ?agile healthcare.? The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review. Results: A review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios. Conclusions: Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos. UR - https://humanfactors.jmir.org/2022/3/e35693 UR - http://dx.doi.org/10.2196/35693 UR - http://www.ncbi.nlm.nih.gov/pubmed/36083628 ID - info:doi/10.2196/35693 ER - TY - JOUR AU - Obro, Faurholt Louise AU - Osther, Sloth Palle Jörn AU - Ammentorp, Jette AU - Pihl, Thybo Gitte AU - Heiselberg, Kvols Kasper AU - Krogh, Gall Peter AU - Handberg, Charlotte PY - 2022/9/8 TI - An Intervention Offering Self-management Support Through mHealth and Health Coaching to Patients With Prostate Cancer: Interpretive Description of Patients? Experiences and Perspectives JO - JMIR Form Res SP - e34471 VL - 6 IS - 9 KW - mobile phone KW - mobile health KW - mHealth KW - prostate cancer KW - self-management KW - health coaching KW - coaching N2 - Background: Observational management strategies such as active surveillance and watchful waiting are considered to be acceptable approaches in patients with low-risk localized prostate cancer and a safe alternative to aggressive treatment. During observational management, treatment is postponed until the disease progresses, which often never occurs. However, approximately 90% of patients with a low-risk disease choose aggressive treatment owing to anxiety. Strategies to address anxiety are needed for optimal management of this population and to improve the quality of life of patients with low-risk localized prostate cancer. A review highlighted that mobile health (mHealth) in tandem with health coaching can support patients? self-management of health behaviors and improve well-being. Objective: This study aims to explore patients? experiences with and perspectives on an intervention offering self-management support through the use of mHealth devices and health coaching to identify supportive features that enable patients to perform sustainable changes that improve well-being. Methods: We used an interpretive description approach, combining semistructured interviews with 13 purposively selected patients with prostate cancer and participant observations of patient-coach interactions in coaching sessions. The interviews were transcribed and analyzed. The self-determination theory was used as a theoretical lens. Field notes and coaching notes from each session were used to orient data generation and confirm or challenge the analysis. Results: Our analysis suggested that patients? self-awareness and psychological identity influenced their experiences with and perspectives on the self-management support offered by mHealth and health coaching in clinical practice. The patients? individual experiences and perspectives indicated that they placed themselves in a dynamic continuum of sustaining or repressing their identity, self-awareness, and individual qualities. Our analysis revealed 4 interacting themes, all related to the psychological identity of the patients. Conclusions: For the group of patients with prostate cancer to experience well-being, we found it important for them to sustain their self-image when offered a self-management intervention. Motivation and autonomy were important aspects for the individual patients to sustain their self-image throughout the intervention. In contrast, demotivation and a sense of paternalism could result in fostering an experience of having to repress self-awareness. UR - https://formative.jmir.org/2022/9/e34471 UR - http://dx.doi.org/10.2196/34471 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925751 ID - info:doi/10.2196/34471 ER - TY - JOUR AU - Ma, Tony AU - Chang, Katie AU - Alyusuf, Amal AU - Bajracharya, Elina AU - Washio, Yukiko AU - Kelly, J. Patricia AU - Bellad, M. Roopa AU - Mahantashetti, S. Niranjana AU - Charantimath, Umesh AU - Short, L. Vanessa AU - Lalakia, Parth AU - Jaeger, Frances AU - Goudar, Shivaprasad AU - Derman, Richard PY - 2022/9/8 TI - Design, Development, and Testing of BEST4Baby, an mHealth Technology to Support Exclusive Breastfeeding in India: Pilot Study JO - JMIR Form Res SP - e32795 VL - 6 IS - 9 KW - mobile health KW - mHealth KW - peer counselors KW - breastfeeding KW - rural KW - usability KW - low- and middle-income countries KW - agile KW - task shifting KW - user-centered design KW - mobile phone N2 - Background: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries. Objective: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. Methods: A user-centered design process with an agile development methodology was used. The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby?s design and development, including the app?s content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs who supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months post partum. BEST4Baby?s usability from the PCs? perspective was assessed using the translated System Usability Scale (SUS). Results: The findings of this study align with best practices in user-centered design (ie, understanding user experience, including context with iterative design with stakeholders) to address EBF barriers. This led to the cultural tailoring and contextual alignment of an evidence-based World Health Organization breastfeeding program with an iterative design and agile development of the BEST4Baby app. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The approach translated into a highly usable BEST4Baby app for use by PCs in breastfeeding counseling, which also statistically increased EBF practices. Conclusions: The findings suggest that BEST4Baby was highly usable and accepted by mothers serving as PCs to support other mothers in their EBF practices and led to positive outcomes in the intervention group?s EBF rates. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs during the 9 home visits. Trial Registration: Clinicaltrials.gov NCT03533725; https://clinicaltrials.gov/ct2/show/NCT03533725 UR - https://formative.jmir.org/2022/9/e32795 UR - http://dx.doi.org/10.2196/32795 UR - http://www.ncbi.nlm.nih.gov/pubmed/36074546 ID - info:doi/10.2196/32795 ER - TY - JOUR AU - Lu, Sheng-Chieh AU - Xu, Mindy AU - Wang, Mei AU - Hardi, Angela AU - Cheng, L. Abby AU - Chang, Su-Hsin AU - Yen, Po-Yin PY - 2022/9/7 TI - Effectiveness and Minimum Effective Dose of App-Based Mobile Health Interventions for Anxiety and Depression Symptom Reduction: Systematic Review and Meta-Analysis JO - JMIR Ment Health SP - e39454 VL - 9 IS - 9 KW - mental health KW - mobile health KW - smartphone apps KW - intervention dose effectiveness KW - systematic review and meta-analysis N2 - Background: Mobile health (mHealth) apps offer new opportunities to deliver psychological treatments for mental illness in an accessible, private format. The results of several previous systematic reviews support the use of app-based mHealth interventions for anxiety and depression symptom management. However, it remains unclear how much or how long the minimum treatment ?dose? is for an mHealth intervention to be effective. Just-in-time adaptive intervention (JITAI) has been introduced in the mHealth domain to facilitate behavior changes and is positioned to guide the design of mHealth interventions with enhanced adherence and effectiveness. Objective: Inspired by the JITAI framework, we conducted a systematic review and meta-analysis to evaluate the dose effectiveness of app-based mHealth interventions for anxiety and depression symptom reduction. Methods: We conducted a literature search on 7 databases (ie, Ovid MEDLINE, Embase, PsycInfo, Scopus, Cochrane Library (eg, CENTRAL), ScienceDirect, and ClinicalTrials, for publications from January 2012 to April 2020. We included randomized controlled trials (RCTs) evaluating app-based mHealth interventions for anxiety and depression. The study selection and data extraction process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We estimated the pooled effect size using Hedge g and appraised study quality using the revised Cochrane risk-of-bias tool for RCTs. Results: We included 15 studies involving 2627 participants for 18 app-based mHealth interventions. Participants in the intervention groups showed a significant effect on anxiety (Hedge g=?.10, 95% CI ?0.14 to ?0.06, I2=0%) but not on depression (Hedge g=?.08, 95% CI ?0.23 to 0.07, I2=4%). Interventions of at least 7 weeks? duration had larger effect sizes on anxiety symptom reduction. Conclusions: There is inconclusive evidence for clinical use of app-based mHealth interventions for anxiety and depression at the current stage due to the small to nonsignificant effects of the interventions and study quality concerns. The recommended dose of mHealth interventions and the sustainability of intervention effectiveness remain unclear and require further investigation. UR - https://mental.jmir.org/2022/9/e39454 UR - http://dx.doi.org/10.2196/39454 UR - http://www.ncbi.nlm.nih.gov/pubmed/36069841 ID - info:doi/10.2196/39454 ER - TY - JOUR AU - Godia, Jordi AU - Pifarré, Marc AU - Vilaplana, Jordi AU - Solsona, Francesc AU - Abella, Francesc AU - Calvo, Antoni AU - Mitjans, Anna AU - Gonzalez-Olmedo, Pau Maria PY - 2022/9/6 TI - A Free App for Diagnosing Burnout (BurnOut App): Development Study JO - JMIR Med Inform SP - e30094 VL - 10 IS - 9 KW - diagnose burnout KW - Android app KW - medical informatics KW - health care KW - health professionals KW - mobile health KW - digital health KW - health applications KW - online health KW - mobile phone N2 - Background: Health specialists take care of us, but who takes care of them? These professionals are the most vulnerable to the increasingly common syndrome known as burnout. Burnout is a syndrome conceptualized as a result of chronic workplace stress that has not been successfully managed. Objective: This study aims to develop a useful app providing burnout self-diagnosis and tracking of burnout through a simple, intuitive, and user-friendly interface. Methods: We present the BurnOut app, an Android app developed using the Xamarin and MVVMCross platforms, which allows users to detect critical cases of psychological discomfort by implementing the Goldberg and Copenhagen Burnout Inventory tests. Results: The BurnOut app is robust, user-friendly, and ef?cient. The good performance of the app was demonstrated by comparing its features with those of similar apps in the literature. Conclusions: The BurnOut app is very useful for health specialists or users, in general, to detect burnout early and track its evolution. UR - https://medinform.jmir.org/2022/9/e30094 UR - http://dx.doi.org/10.2196/30094 UR - http://www.ncbi.nlm.nih.gov/pubmed/36066932 ID - info:doi/10.2196/30094 ER - TY - JOUR AU - Agbadje, Tatiana Titilayo AU - Pilon, Chantale AU - Bérubé, Pierre AU - Forest, Jean-Claude AU - Rousseau, François AU - Rahimi, Abbasgholizadeh Samira AU - Giguère, Yves AU - Légaré, France PY - 2022/9/6 TI - User Experience of a Computer-Based Decision Aid for Prenatal Trisomy Screening: Mixed Methods Explanatory Study JO - JMIR Pediatr Parent SP - e35381 VL - 5 IS - 3 KW - shared decision-making KW - computer-based decision aid KW - prenatal screening KW - trisomy KW - Down syndrome KW - mixed methods N2 - Background: Mobile health tools can support shared decision-making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed, value-congruent decisions regarding prenatal screening for trisomy. Objective: This study aims to assess the usability and usefulness of computer-based DA among pregnant women, clinicians, and policy makers. Methods: For this mixed methods sequential explanatory study, we planned to recruit a convenience sample of 45 pregnant women, 45 clinicians from 3 clinical sites, and 15 policy makers. Eligible women were aged >18 years and >16 weeks pregnant or had recently given birth. Eligible clinicians and policy makers were involved in prenatal care. We asked the participants to navigate a computer-based DA. We asked the women about the usefulness of the DA and their self-confidence in decision-making. We asked all participants about usability, quality, acceptability, satisfaction with the content of the DA, and collected sociodemographic data. We explored participants? reactions to the computer-based DA and solicited suggestions. Our interview guide was based on the Mobile App Rating Scale. We performed descriptive analyses of the quantitative data and thematic deductive and inductive analyses of the qualitative data for each participant category. Results: A total of 45 pregnant women, 14 clinicians, and 8 policy makers participated. Most pregnant women were aged between 25 and 34 years (34/45, 75%) and White (42/45, 94%). Most clinicians were aged between 35 and 44 years (5/14, 36%) and women (11/14, 79%), and all were White (14/14, 100%); the largest proportion of policy makers was aged between 45 and 54 years (4/8, 50%), women (5/8, 62%), and White (8/8, 100%). The mean usefulness score for preparing for decision-making for women was 80/100 (SD 13), and the mean self-efficacy score was 88/100 (SD 11). The mean usability score was 84/100 (SD 14) for pregnant women, 77/100 (SD 14) for clinicians, and 79/100 (SD 23) for policy makers. The mean global score for quality was 80/100 (SD 9) for pregnant women, 72/100 (SD 12) for clinicians, and 80/100 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (52/66, 79%), balanced (58/66, 88%), useful (38/66, 58%), and sufficient (50/66, 76%). The mean satisfaction score with the content was 84/100 (SD 13) for pregnant women, 73/100 (SD 16) for clinicians, and 73/100 (SD 20) for policy makers. Participants thought the DA could be more engaging (eg, more customizable) and suggested strategies for implementation, such as incorporating it into clinical guidelines. Conclusions: Pregnant women, clinicians, and policy makers found the DA usable and useful. The next steps are to incorporate user suggestions for improving engagement and implementing the computer-based DA in clinical practice. UR - https://pediatrics.jmir.org/2022/3/e35381 UR - http://dx.doi.org/10.2196/35381 UR - http://www.ncbi.nlm.nih.gov/pubmed/35896164 ID - info:doi/10.2196/35381 ER - TY - JOUR AU - Oyibo, Kiemute AU - Morita, Pelegrini Plinio PY - 2022/9/6 TI - The Effect of Persuasive Design on the Adoption of Exposure Notification Apps: Quantitative Study Based on COVID Alert JO - JMIR Form Res SP - e34212 VL - 6 IS - 9 KW - contact tracing app KW - exposure notification app KW - COVID Alert KW - COVID-19 KW - persuasive technology KW - behavior change KW - exposure KW - behavior KW - effect KW - design KW - adoption KW - use KW - case study KW - effectiveness KW - user interface KW - mobile phone N2 - Background: The adoption of contact tracing apps worldwide has been low. Although considerable research has been conducted on technology acceptance, little has been done to show the benefit of incorporating persuasive principles. Objective: This research aimed to investigate the effect of persuasive features in the COVID Alert app, created by Health Canada, by focusing on the no-exposure status, exposure status, and diagnosis report interfaces. Methods: We conducted a study among 181 Canadian residents, including 65 adopters and 116 nonadopters. This study was based on screenshots of the 3 interfaces, of which each comprised a persuasive design and a control design. The persuasive versions of the first two interfaces supported self-monitoring (of exposure levels), and that of the third interface supported social learning (about how many other users have reported their diagnosis). The 6 screenshots were randomly assigned to 6 groups of participants to provide feedback on perceived persuasiveness and adoption willingness. Results: A multivariate repeated-measure ANOVA showed that there is an interaction among interface, app design, and adoption status regarding the perceived persuasiveness of the interfaces. This resulted in a 2-way ANOVA for each interface. For the no-exposure interface, there was an interaction between adoption status and app design. Among adopters, there was no significant difference P=.31 between the persuasive design (mean 5.36, SD 1.63) and the control design (mean 5.87, SD 1.20). However, among nonadopters, there was an effect of app design (P<.001), with participants being more motivated by the persuasive design (mean 5.37, SD 1.30) than by the control design (mean 4.57, SD 1.19). For the exposure interface, adoption status had a main effect (P<.001), with adopters (mean 5.91, SD 1.01) being more motivated by the designs than nonadopters (mean 4.96, SD 1.43). For the diagnosis report interface, there was an interaction between adoption status and app design. Among nonadopters, there was no significant difference P=.99 between the persuasive design (mean 4.61, SD 1.84) and the control design (mean 4.77, SD 1.21). However, among adopters, there was an effect of app design (P=.006), with participants being more likely to report their diagnosis using the persuasive design (mean 6.00, SD 0.97) than using the control design (mean 5.03, SD 1.22). Finally, with regard to willingness to download the app, pairwise comparisons showed that nonadopters were more likely to adopt the app after viewing the persuasive version of the no-exposure interface (13/21, 62% said yes) and the diagnosis report interface (12/17, 71% said yes) than after viewing the control versions (3/17, 18% and 7/16, 44%, respectively, said yes). Conclusions: Exposure notification apps are more likely to be effective if equipped with persuasive features. Incorporating self-monitoring into the no-exposure status interface and social learning into the diagnosis report interface can increase adoption by >30%. UR - https://formative.jmir.org/2022/9/e34212 UR - http://dx.doi.org/10.2196/34212 UR - http://www.ncbi.nlm.nih.gov/pubmed/35580138 ID - info:doi/10.2196/34212 ER - TY - JOUR AU - Mathisen, Fostervold Therese AU - Johansen, Ramstad Frode PY - 2022/9/2 TI - The Impact of Smartphone Apps Designed to Reduce Food Waste on Improving Healthy Eating, Financial Expenses and Personal Food Waste: Crossover Pilot Intervention Trial Studying Students? User Experiences JO - JMIR Form Res SP - e38520 VL - 6 IS - 9 KW - smartphone app KW - food waste KW - healthy eating KW - diet KW - automatic KW - registration KW - global sustainability KW - financial expenses N2 - Background: Global sustainability and individual health need coordinated attention. While individuals are recommended a healthy diet to reduce the burden of noncommunicable diseases, global attention to natural resource conservation is also needed. The latter specifically means effective measures to reduce food waste. Objective: This pilot study evaluates the experiences of students and effect from using smartphone apps designed to reduce food waste on personal healthy eating, financial expenses, and food waste. Methods: A total of 6 students from different study programs (mean age 24.7, SD 2.9) were recruited to evaluate 2 different apps designed to reduce food waste and to register food consumption, food waste, and financial food expenses before and after the app trials. The apps evaluated were the commercially available TotalCtrl Home and Too-Good-To-Go. Results were analyzed by mixed methods, comprising statistical analyses for quantifiable data and thematic analyses for qualitative data. The apps were used separately in random order, each for 1 month. Primary outcome was user expectations to and experiences from the use of the apps, which were obtained by semistructured interviews. Secondary outcomes were changes in food waste volume, financial food expenses, and healthy eating. While information on food waste and food expenses was obtained by weighing food waste and registering food costs for 2 weeks before and after app trials, scores for consuming healthy diets were calculated from registered food records by scoring criteria matched to national recommendations for healthy eating. Results: Awareness on food waste increased after app trials, but experiences with apps pointed toward several potential for technical and content improvements. The students reported that there were too many manual operations in the apps to induce permanent use (TotalCtrl Home), that services seemed more concerned about the producers? interests than the individual?s needs (Too-Good-To-Go), and that they missed a composite app that included functions to promote healthy eating and overview of budget and expenses as well as of food waste (both apps). Use of apps designed to reduce food waste and personal costs and to improve healthy eating did not result in any measurable effects, that is, no change in food waste (mean change 0.81, SD 1.5 kg; P=.13), healthy eating (mean change ?0.24, SD 0.43; P=.24), or personal food expenses (mean change 47.5 NOK or US $4.8, SD 416.9 NOK or US $42.5; P=.39). Conclusions: Apps may aid in increased awareness of food waste at the producer and consumer levels. Large-scale studies with longer duration are needed to see if apps may induce measurable changes in food waste, healthy eating, and financial expenses. UR - https://formative.jmir.org/2022/9/e38520 UR - http://dx.doi.org/10.2196/38520 UR - http://www.ncbi.nlm.nih.gov/pubmed/36053667 ID - info:doi/10.2196/38520 ER - TY - JOUR AU - Boucher, Eliane AU - Honomichl, Ryan AU - Ward, Haley AU - Powell, Tyler AU - Stoeckl, Elizabeth Sarah AU - Parks, Acacia PY - 2022/9/2 TI - The Effects of a Digital Well-being Intervention on Older Adults: Retrospective Analysis of Real-world User Data JO - JMIR Aging SP - e39851 VL - 5 IS - 3 KW - mobile apps KW - mental health KW - older adults KW - technology adoption KW - digital health KW - mobile phone N2 - Background: Digital interventions have been shown to be effective for a variety of mental health disorders and problems. However, few studies have examined the effects of digital interventions in older adults; therefore, little is known about how older adults engage with or benefit from these interventions. Given that adoption rates for technology among people aged ?65 years remain substantially lower than in the general population and that approximately 20% of older adults are affected by mental health disorders, research exploring whether older adults will use and benefit from digital interventions is needed. Objective: This study aimed to examine the extent to which older adults engaged with a digital well-being intervention (Happify) and whether engaging with this program led to improvements in both subjective well-being and anxiety symptoms. Methods: In this retrospective analysis, we analyzed data from 375 real-world Happify users aged ?65 years who signed up for the platform between January 1, 2019, and December 23, 2021. Changes in well-being and anxiety symptoms across 42 to 182 days were assessed using responses to the in-app assessment, which users were prompted to take every 2 weeks, and were compared among users who engaged with the program at the recommended level (ie, 2 or more activities per week) or below the recommended level. Results: In all, 30% (113/375) of the sample engaged with the platform at the recommended level (ie, completed an average of 2 or more activities per week), and overall, users completed an average of 43.35 (SD 87.80) activities, ranging from 1 to 786, between their first and last assessment. Users were also active on the platform for an average of 19.36 (SD 27.16) days, ranging from 1 to 152 days. Moreover, older adults who engaged at the recommended level experienced significantly greater improvements in subjective well-being (P=.002) and anxiety symptoms (P<.001) relative to those who completed fewer activities. Conclusions: These data provide preliminary evidence that older adults engage with and benefit from digital well-being interventions. We believe that these findings highlight the importance of considering older adult populations in digital health research. More research is needed to understand potential barriers to using digital interventions among older adults and whether digital interventions should be modified to account for this population?s particular needs (eg, ensuring that the intervention is accessible using a variety of devices). However, these results are an important step in demonstrating the feasibility of such interventions in a population that is assumed to be less inclined toward digital approaches. UR - https://aging.jmir.org/2022/3/e39851 UR - http://dx.doi.org/10.2196/39851 UR - http://www.ncbi.nlm.nih.gov/pubmed/36053569 ID - info:doi/10.2196/39851 ER - TY - JOUR AU - Kathuria, Hasmeena AU - Shankar, Divya AU - Cobb, Vinson AU - Newman, Julia AU - Bulekova, Katia AU - Werntz, Scott AU - Borrelli, Belinda PY - 2022/9/1 TI - Integrating Social Determinants of Health With Tobacco Treatment for Individuals With Opioid Use Disorder: Feasibility and Acceptability Study of Delivery Through Text Messaging JO - JMIR Form Res SP - e36919 VL - 6 IS - 9 KW - text message KW - smoking cessation KW - opioid use disorder KW - tobacco dependence KW - tobacco treatment interventions KW - mobile phone N2 - Background: Individuals with opioid use disorder (OUD) have a high prevalence of smoking and frequently experience unmet social determinants of health (SDOH), which may be barriers to smoking cessation. Hospitalization is an opportunity to encourage smoking cessation. Unfortunately, many clinicians do not provide tobacco treatment to support the maintenance of cessation achieved during hospitalization. Interventions are required to support these high-risk individuals after hospital discharge. Objective: This study aimed to test the feasibility and acceptability of a 28-day SMS text messaging program tailored to individuals with OUD, which provides smoking cessation support and addresses unmet SDOH needs. Methods: From July to December 2019, we enrolled 25 individuals who were hospitalized with tobacco dependence and OUD at our large safety net hospital. The SMS text messaging program was initiated during hospitalization and continued for 28 days. Participants were enrolled in either the ready to quit within 30 days or the not ready to quit within 30 days program based on their readiness to quit. Automated SMS text messages were sent twice daily for 4 weeks. The topics included health and cost benefits of quitting, both general and opioid specific (16 messages); managing mood and stress (8 messages); motivation, coping strategies, and encouragement (18 messages); addressing medication misconceptions (5 messages); links to resources to address substance use (2 messages providing links to the Massachusetts Substance Use Helpline and Boston Medical Center resources), tobacco dependence (1 message providing a link to the Massachusetts Quitline), and unmet SDOH needs (6 messages assessing SDOH needs with links to resources if unmet SDOH needs were identified). Questionnaires and interviews were conducted at baseline and at 2 and 4 weeks after enrollment. Results: The participants were 56% (14/25) female, 36% (9/25) African American, 92% (23/25) unemployed, and 96% (24/25) Medicaid insured. Approximately 84% (21/25) activated the program, and none of the participants unsubscribed. Approximately 57% (12/21) completed either the 2- or 4-week questionnaires. Program satisfaction was high (overall mean 6.7, SD 0.8, range 1-7). Many perceived that the SMS text messaging program provided social support, companionship, and motivation to stop smoking. Messages about the health benefits of quitting were well received, whereas messages on how quitting cigarettes may prevent relapse from other substances had mixed views, highlighting the importance of tailoring interventions to patient preferences. Conclusions: SMS text messaging to promote smoking cessation and address SDOH needs may be an effective tool for improving quit rates and health outcomes in individuals with tobacco dependence and OUD. Our study adds to the growing body of evidence that SMS text messaging approaches are feasible and acceptable for providing tobacco treatment to all individuals who smoke, even among low-income populations who have OUD and are not ready to quit. UR - https://formative.jmir.org/2022/9/e36919 UR - http://dx.doi.org/10.2196/36919 UR - http://www.ncbi.nlm.nih.gov/pubmed/36048509 ID - info:doi/10.2196/36919 ER - TY - JOUR AU - Williams, A. Kofoworola D. AU - Wijaya, Clarisa AU - Stamatis, A. Caitlin AU - Abbott, Gabriel AU - Lattie, G. Emily PY - 2022/8/31 TI - Insights Into Needs and Preferences for Mental Health Support on Social Media and Through Mobile Apps Among Black Male University Students: Exploratory Qualitative Study JO - JMIR Form Res SP - e38716 VL - 6 IS - 8 KW - Black or African American men KW - college KW - mental health KW - social media KW - mobile apps KW - mobile phone N2 - Background: Black college-aged men are less likely than their peers to use formal, therapeutic in-person services for mental health concerns. As the use of mobile technologies and social media platforms is steadily increasing, it is important to conduct work that examines the future utility of digital tools and technologies to improve access to and uptake of mental health services for Black men and Black men in college. Objective: The aim of this study was to identify and understand college-attending Black men?s needs and preferences for using digital health technologies and social media for stress and mental health symptom management. Methods: Interviews were conducted with Black male students (N=11) from 2 racially diverse universities in the Midwestern United States. Participants were asked questions related to their current mental health needs and interest in using social media platforms and mobile-based apps for their mental health concerns. A thematic analysis was conducted. Results: Four themes emerged from the data: current stress relief strategies, technology-based support needs and preferences (subthemes: mobile-based support and social media?based support), resource information dissemination considerations (subthemes: information-learning expectations and preferences and information-sharing preferences and behaviors), and technology-based mental health support design considerations (subtheme: relatability and representation). Participants were interested in using social media and digital technologies for their mental health concerns and needs, for example, phone notifications and visual-based mental health advertisements that promote awareness. Relatability in the context of representation was emphasized as a key factor for participants interested in using digital mental health tools. Examples of methods for increasing relatability included having tools disseminated by minority-serving organizations and including components explicitly portraying Black men engaging in mental health support strategies. The men also discussed wanting to receive recommendations for stress relief that have been proven successful, particularly for Black men. Conclusions: The findings from this study provide insights into design and dissemination considerations for future work geared toward developing mental health messaging and digital interventions for young Black men. UR - https://formative.jmir.org/2022/8/e38716 UR - http://dx.doi.org/10.2196/38716 UR - http://www.ncbi.nlm.nih.gov/pubmed/36044261 ID - info:doi/10.2196/38716 ER - TY - JOUR AU - Stephan, Paul AU - Wortmann, Felix AU - Koch, Kevin PY - 2022/8/30 TI - Understanding the Interactions Between Driving Behavior and Well-being in Daily Driving: Causal Analysis of a Field Study JO - J Med Internet Res SP - e36314 VL - 24 IS - 8 KW - well-being KW - daily driving KW - causal inference KW - commute KW - field study KW - directed acyclic graph KW - just-in-time interventions KW - mental well-being KW - stress KW - mental health N2 - Background: Investigating ways to improve well-being in everyday situations as a means of fostering mental health has gained substantial interest in recent years. For many people, the daily commute by car is a particularly straining situation of the day, and thus researchers have already designed various in-vehicle well-being interventions for a better commuting experience. Current research has validated such interventions but is limited to isolating effects in controlled experiments that are generally not representative of real-world driving conditions. Objective: The aim of the study is to identify cause?effect relationships between driving behavior and well-being in a real-world setting. This knowledge should contribute to a better understanding of when to trigger interventions. Methods: We conducted a field study in which we provided a demographically diverse sample of 10 commuters with a car for daily driving over a period of 4 months. Before and after each trip, the drivers had to fill out a questionnaire about their state of well-being, which was operationalized as arousal and valence. We equipped the cars with sensors that recorded driving behavior, such as sudden braking. We also captured trip-dependent factors, such as the length of the drive, and predetermined factors, such as the weather. We conducted a causal analysis based on a causal directed acyclic graph (DAG) to examine cause?effect relationships from the observational data and to isolate the causal chains between the examined variables. We did so by applying the backdoor criterion to the data-based graphical model. The hereby compiled adjustment set was used in a multiple regression to estimate the causal effects between the variables. Results: The causal analysis showed that a higher level of arousal before driving influences driving behavior. Higher arousal reduced the frequency of sudden events (P=.04) as well as the average speed (P=.001), while fostering active steering (P<.001). In turn, more frequent braking (P<.001) increased arousal after the drive, while a longer trip (P<.001) with a higher average speed (P<.001) reduced arousal. The prevalence of sunshine (P<.001) increased arousal and of occupants (P<.001) increased valence (P<.001) before and after driving. Conclusions: The examination of cause?effect relationships unveiled significant interactions between well-being and driving. A low level of predriving arousal impairs driving behavior, which manifests itself in more frequent sudden events and less anticipatory driving. Driving has a stronger effect on arousal than on valence. In particular, monotonous driving situations at high speeds with low cognitive demand increase the risk of the driver becoming tired (low arousal), thus impairing driving behavior. By combining the identified causal chains, states of vulnerability can be inferred that may form the basis for timely delivered interventions to improve well-being while driving. UR - https://www.jmir.org/2022/8/e36314 UR - http://dx.doi.org/10.2196/36314 UR - http://www.ncbi.nlm.nih.gov/pubmed/36040791 ID - info:doi/10.2196/36314 ER - TY - JOUR AU - Tahsina, Tazeen AU - Iqbal, Afrin AU - Rahman, Ehsanur Ahmed AU - Chowdhury, Kanti Suman AU - Chowdhury, Iqbal Atique AU - Billah, Masum Sk AU - Rahman, Ataur AU - Parveen, Monira AU - Ahmed, Lubana AU - Rahman, Sadequr Qazi AU - Ashrafi, Akbar Shah Ali AU - Arifeen, El Shams PY - 2022/8/29 TI - Birth and Death Notifications for Improving Civil Registration and Vital Statistics in Bangladesh: Pilot Exploratory Study JO - JMIR Public Health Surveill SP - e25735 VL - 8 IS - 8 KW - notification KW - registration KW - birth KW - death KW - CRVS KW - mobile phone KW - mobile app KW - mobile technology KW - technology-based platform KW - community health KW - low- and middle-income countries KW - mHealth KW - Bangladesh N2 - Background: Effective health policy formulation requires sound information of the numerical data and causes of deaths in a population. Currently, in Bangladesh, neither births nor deaths are fully and promptly registered. Birth registration in Bangladesh is around 54% nationally. Although the legal requirements are to register within 45 days of an event, only 4.5% of births and 35.9% of deaths were reported within the required time frame in 2020. This study adopted an innovative digital notification approach to improve the coverage of registration of these events at the community level. Objective: Our primary objective was to assess (1) the proportion of events identified by the new notification systems (success rate) and the contribution of the different notifiers individually and in combination (completeness) and (2) the proportion of events notified within specific time limits (timeliness of notifications) after introducing the innovative approach. Methods: We conducted a pilot study in 2016 in 2 subdistricts of Bangladesh to understand whether accurate, timely, and complete information on births and deaths can be collected and notified by facility-based service providers; community health workers, including those who routinely visit households; local government authorities; and key informants from the community. We designed a mobile technology?based platform, an app, and a call center through which the notifications were recorded. All notifications were verified through the confirmation of events by family members during visits to the concerned households. We undertook a household survey?based assessment at the end of the notification period. Results: Our innovative system gathered 13,377 notifications for births and deaths from all channels, including duplicate reports from multiple sources. Project workers were able to verify 92% of the births and 93% of the deaths through household visits. The household survey conducted among a subsample of the project population identified 1204 births and 341 deaths. After matching the notifications with the household survey, we found that the system was able to capture over 87% of the births in the survey areas. Health assistants and family welfare assistants were the primary sources of information. Notifications from facilities were very low for both events. Conclusions: The Global Civil Registration and Vital Statistics: Scaling Up Investment Plan 2015-2024 and the World Health Organization reiterated the importance of building an evidence base for improving civil registration and vital statistics. Our pilot innovation revealed that it is possible to coordinate with the routine health information system to note births and deaths as the first step to ensure registration. Health assistants could capture more than half of the notifications as a stand-alone source. UR - https://publichealth.jmir.org/2022/8/e25735 UR - http://dx.doi.org/10.2196/25735 UR - http://www.ncbi.nlm.nih.gov/pubmed/36036979 ID - info:doi/10.2196/25735 ER - TY - JOUR AU - Breckner, Amanda AU - Litke, Nicola AU - Göbl, Linda AU - Wiezorreck, Lars AU - Miksch, Antje AU - Szecsenyi, Joachim AU - Wensing, Michel AU - Weis, Aline PY - 2022/8/25 TI - Effects and Processes of an mHealth Intervention for the Management of Chronic Diseases: Prospective Observational Study JO - JMIR Form Res SP - e34786 VL - 6 IS - 8 KW - telemedicine KW - multimorbidity KW - primary health care KW - symptom assessment KW - chronic disease KW - mobile phone N2 - Background: Mobile health (mHealth) interventions for self-management are a promising way to meet the needs of patients with chronic diseases in primary care practices. Therefore, an mHealth intervention, TelePraCMan, was developed and evaluated for patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, high blood pressure, or heart failure in a German primary care setting. TelePraCMan entails a symptom diary, an appointment manager, a manager to document goals, and a warning system. The app should foster the self-management of participating patients. Objective: We aimed to examine the effects of TelePraCMan on patient activation and quality of life and explored the underlying contextual factors, impacts, and degree of implementation. Methods: In a prospective observational study design, we collected data by using interviews and written questionnaires from participating patients (intervention and control groups) and primary care workers (physicians and practice assistants). The primary outcomes of interest were patient-reported quality of life (12-Item Short Form Survey) and patient activation (patient activation measure). The quantitative analysis focused on differences between patients in the intervention and control groups, as well as before (T0) and after (T1) the intervention. Interviews were analyzed by using qualitative content analysis via MAXQDA (VERBI GmbH). Results: At baseline, 25 patients and 24 primary care workers completed the questionnaire, and 18 patients and 21 primary care workers completed the follow-up survey. The patients were predominantly male and, on average, aged 64 (SD 11) years (T0). The primary care workers were mostly female (62%) and, on average, aged 47 (SD 10) years (T0). No differences were observed in the outcomes before and after the intervention or between the intervention and control groups. In the additional interviews, 4 patients and 11 primary care workers were included. The interviewees perceived that the intervention was useful for some patients. However, contextual factors and problems with implementation activities negatively affected the use of the app with patients. The main reasons for the low participation were the COVID-19 pandemic and the target group, which seemed to have less interest in mHealth; the interviewees attributed this to the older age of patients. However, the respondents felt that the app would be better accepted in 5 or 10 years. Conclusions: Although the TelePraCMan app was rated as very good and important by the participants, few patients used it. The digital intervention was hardly implemented and had limited impact in the current setting of German primary care. Trial Registration: German Clinical Trials Register DRKS00017320; https://tinyurl.com/4uwrzu85 UR - https://formative.jmir.org/2022/8/e34786 UR - http://dx.doi.org/10.2196/34786 UR - http://www.ncbi.nlm.nih.gov/pubmed/36006666 ID - info:doi/10.2196/34786 ER - TY - JOUR AU - Chikersal, Prerna AU - Venkatesh, Shruthi AU - Masown, Karman AU - Walker, Elizabeth AU - Quraishi, Danyal AU - Dey, Anind AU - Goel, Mayank AU - Xia, Zongqi PY - 2022/8/24 TI - Predicting Multiple Sclerosis Outcomes During the COVID-19 Stay-at-home Period: Observational Study Using Passively Sensed Behaviors and Digital Phenotyping JO - JMIR Ment Health SP - e38495 VL - 9 IS - 8 KW - mobile sensing KW - sensor KW - sensing KW - mobile health KW - mHealth KW - algorithm KW - multiple sclerosis KW - disability KW - mental health KW - depression KW - sleep KW - fatigue KW - tiredness KW - predict KW - machine learning KW - feature selection KW - neurological disorder KW - COVID-19 KW - isolation KW - behavior change KW - health outcome KW - fitness KW - movement KW - physical activity KW - exercise KW - tracker KW - digital phenotyping N2 - Background: The COVID-19 pandemic has broad negative impact on the physical and mental health of people with chronic neurological disorders such as multiple sclerosis (MS). Objective: We presented a machine learning approach leveraging passive sensor data from smartphones and fitness trackers of people with MS to predict their health outcomes in a natural experiment during a state-mandated stay-at-home period due to a global pandemic. Methods: First, we extracted features that capture behavior changes due to the stay-at-home order. Then, we adapted and applied an existing algorithm to these behavior-change features to predict the presence of depression, high global MS symptom burden, severe fatigue, and poor sleep quality during the stay-at-home period. Results: Using data collected between November 2019 and May 2020, the algorithm detected depression with an accuracy of 82.5% (65% improvement over baseline; F1-score: 0.84), high global MS symptom burden with an accuracy of 90% (39% improvement over baseline; F1-score: 0.93), severe fatigue with an accuracy of 75.5% (22% improvement over baseline; F1-score: 0.80), and poor sleep quality with an accuracy of 84% (28% improvement over baseline; F1-score: 0.84). Conclusions: Our approach could help clinicians better triage patients with MS and potentially other chronic neurological disorders for interventions and aid patient self-monitoring in their own environment, particularly during extraordinarily stressful circumstances such as pandemics, which would cause drastic behavior changes. UR - https://mental.jmir.org/2022/8/e38495 UR - http://dx.doi.org/10.2196/38495 UR - http://www.ncbi.nlm.nih.gov/pubmed/35849686 ID - info:doi/10.2196/38495 ER - TY - JOUR AU - Akasaki, Yasutsugu AU - Inomata, Takenori AU - Sung, Jaemyoung AU - Okumura, Yuichi AU - Fujio, Kenta AU - Miura, Maria AU - Hirosawa, Kunihiko AU - Iwagami, Masao AU - Nakamura, Masahiro AU - Ebihara, Nobuyuki AU - Ide, Takuma AU - Nagino, Ken AU - Murakami, Akira PY - 2022/8/23 TI - Reliability and Validity of Electronic Patient-Reported Outcomes Using the Smartphone App AllerSearch for Hay Fever: Prospective Observational Study JO - JMIR Form Res SP - e38475 VL - 6 IS - 8 KW - hay fever KW - AllerSearch KW - smartphone app KW - mobile health KW - mHealth KW - patient-reported outcome KW - reliability KW - validity KW - Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire KW - JACQLQ KW - questionnaire KW - allergic conjunctivitis N2 - Background: Hay fever is a highly prevalent, heterogenous, and multifactorial disease. Patients may benefit from longitudinal assessments using mobile health (mHealth) principles. We have previously attempted to establish an effective mHealth platform for patients with hay fever through AllerSearch, our in-house smartphone app that assesses electronic patient-reported outcomes through a questionnaire on hay fever and provides evidence-based advice. To be used by the public, an investigation on its reliability and validity is necessary. Objective: The aim of this paper is to assess the reliability and validity of subjective symptom data on hay fever collected through our app, AllerSearch. Methods: This study used a prospective observational design. The participants were patients aged ?20 years recruited from a single university hospital between June 2, 2021, and January 26, 2022. We excluded patients who could not use smartphones as well as those with incomplete data records and outlier data. All participants answered the Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire (JACQLQ), first in the paper-and-pencil format and subsequently on AllerSearch on the same day. The JACQLQ comprises the following three domains: Domain I, with 9 items on ocular or nasal symptoms; Domain II, with 17 items on daily activity and psychological well-being; and Domain III, with 3 items on overall condition by face score. The concordance rate of each domain between the 2 platforms was calculated. The internal consistency of Domains I and II of the 2 platforms was assessed using Cronbach alpha coefficients, the concurrent validity of Domains I and II was assessed by calculating Pearson correlation coefficients, and the mean differences between the 2 platforms were assessed using Bland-Altman analysis. Results: In total, 22 participants were recruited; the data of 20 (91%) participants were analyzed. The average age was 65.4 (SD 12.8) years, and 80% (16/20) of the participants were women. The concordance rate of Domains I, II, and III between the paper-based and app-based JACQLQ was 0.78, 0.85, and 0.90, respectively. The internal consistency of Domains I and II between the 2 platforms was satisfactory (Cronbach alpha of .964 and .919, respectively). Pearson correlation analysis yielded a significant positive correlation between Domains I and II across the 2 platforms (r=0.920 and r=0.968, respectively). The mean difference in Domains I and II between the 2 platforms was 3.35 units (95% limits of agreement: ?6.51 to 13.2). Conclusions: Our findings indicate that AllerSearch is a valid and reliable tool for the collection of electronic patient-reported outcomes to assess hay fever, contributing to the advantages of the mHealth platform. UR - https://formative.jmir.org/2022/8/e38475 UR - http://dx.doi.org/10.2196/38475 UR - http://www.ncbi.nlm.nih.gov/pubmed/35998022 ID - info:doi/10.2196/38475 ER - TY - JOUR AU - Adong, Julian AU - Fatch, Robin AU - Emenyonu, Nneka AU - Muyindike, Winnie AU - Ngabirano, Christine AU - Cheng, Debbie AU - Hahn, Judith PY - 2022/8/23 TI - Cell Phone Availability and Usage for mHealth and Intervention Delivery to Persons Living With HIV in a Low-Resource Setting: Cross-sectional Study JO - JMIR Form Res SP - e35631 VL - 6 IS - 8 KW - cell phone use KW - phone usage KW - cell phone KW - mHealth KW - HIV KW - low resource setting KW - low resource KW - mobile health KW - antiretroviral KW - Uganda KW - Africa KW - alcohol KW - text message KW - text messaging KW - cellphone KW - low income KW - LMIC KW - TB KW - tuberculosis KW - viral infection KW - infectious disease KW - sexually transmitted KW - STD N2 - Background: HIV/AIDS is now a manageable chronic illness owing to effective antiretroviral therapy (ART), which involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mobile health (mHealth), which includes cell phone?delivered services for medical and public health practice. Objective: Here we describe cell phone use and its relationship with alcohol use in a cohort of persons living with HIV and latent tuberculosis (TB). Methods: We performed a cross-sectional analysis of baseline data from a cohort of persons living with HIV and latent TB in HIV care in southwestern Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use?a common modifiable behavior among persons living with HIV. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months or a phosphatidylethanol (an alcohol biomarker) level of ?8 ng/mL. Results: A total of 300 participants (median age 40 years; n=146, 48.7% male) were included in the analysis. Most (n=267, 89.0%) participants had access to a phone and of them, 26 (9.7%) shared the phone with someone else. In total, 262/300 (87.3%) of participants owned a cell phone that is turned on at least half of the time; the majority (n=269, 89.7%) rarely or never sent text messages, and over two-thirds (n=200, 66.9%) rarely or never received text messages. Most (n=214, 71.3%) had any alcohol use in the prior 3 months. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted odds ratio [aOR] 0.48, 95% CI 0.18-1.25; P=.13) or sending (aOR 0.82, 95% CI 0.28-2.37; P=.71) or receiving (aOR 1.31, 95% CI 0.70-2.47; P=.40) text messages. Conclusions: There is hope that mHealth interventions in this population can be carried out using cell phones owing to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only. UR - https://formative.jmir.org/2022/8/e35631 UR - http://dx.doi.org/10.2196/35631 UR - http://www.ncbi.nlm.nih.gov/pubmed/35998023 ID - info:doi/10.2196/35631 ER - TY - JOUR AU - Dowling, A. Nicki AU - Merkouris, S. Stephanie AU - Youssef, J. George AU - Lubman, I. Dan AU - Bagot, L. Kathleen AU - Hawker, O. Chloe AU - Portogallo, J. Hannah AU - Thomas, C. Anna AU - Rodda, N. Simone PY - 2022/8/23 TI - A Gambling Just-In-Time Adaptive Intervention (GamblingLess: In-The-Moment): Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e38958 VL - 11 IS - 8 KW - mobile health KW - mHealth KW - just-in-time adaptive intervention KW - ecological momentary intervention KW - microrandomized trial KW - gambling KW - addiction KW - treatment KW - intervention KW - protocol KW - relapse KW - mobile phone N2 - Background: The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. Objective: This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. Methods: GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. Results: The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. Conclusions: GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI?s optimization to make it a more effective, efficient, and scalable tailored intervention. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False International Registered Report Identifier (IRRID): PRR1-10.2196/38958 UR - https://www.researchprotocols.org/2022/8/e38958 UR - http://dx.doi.org/10.2196/38958 UR - http://www.ncbi.nlm.nih.gov/pubmed/35998018 ID - info:doi/10.2196/38958 ER - TY - JOUR AU - Powell-Wiley, M. Tiffany AU - Martinez, F. Marie AU - Tamura, Kosuke AU - Neally, J. Sam AU - O'Shea, J. Kelly AU - Curlin, Kaveri AU - Albarracin, Yardley AU - Vijayakumar, P. Nithya AU - Morgan, Matthew AU - Ortiz-Chaparro, Erika AU - Bartsch, M. Sarah AU - Osei Baah, Foster AU - Wedlock, T. Patrick AU - Ortiz-Whittingham, R. Lola AU - Scannell, Sheryl AU - Potharaju, A. Kameswari AU - Randall, Samuel AU - Solano Gonzales, Mario AU - Domino, Molly AU - Ranganath, Kushi AU - Hertenstein, Daniel AU - Syed, Rafay AU - Weatherwax, Colleen AU - Lee, Y. Bruce PY - 2022/8/22 TI - The Impact of a Place-Tailored Digital Health App Promoting Exercise Classes on African American Women?s Physical Activity and Obesity: Simulation Study JO - J Med Internet Res SP - e30581 VL - 24 IS - 8 KW - computational modeling KW - digital health KW - physical activity KW - BMI KW - obesity KW - built environment KW - impact KW - app KW - exercise KW - simulation KW - intervention KW - women KW - African American KW - agent N2 - Background: The increasing prevalence of smartphone apps to help people find different services raises the question of whether apps to help people find physical activity (PA) locations would help better prevent and control having overweight or obesity. Objective: The aim of this paper is to determine and quantify the potential impact of a digital health intervention for African American women prior to allocating financial resources toward implementation. Methods: We developed our Virtual Population Obesity Prevention, agent-based model of Washington, DC, to simulate the impact of a place-tailored digital health app that provides information about free recreation center classes on PA, BMI, and overweight and obesity prevalence among African American women. Results: When the app is introduced at the beginning of the simulation, with app engagement at 25% (eg, 25% [41,839/167,356] of women aware of the app; 25% [10,460/41,839] of those aware downloading the app; and 25% [2615/10,460] of those who download it receiving regular push notifications), and a 25% (25/100) baseline probability to exercise (eg, without the app), there are no statistically significant increases in PA levels or decreases in BMI or obesity prevalence over 5 years across the population. When 50% (83,678/167,356) of women are aware of the app; 58.23% (48,725/83,678) of those who are aware download it; and 55% (26,799/48,725) of those who download it receive regular push notifications, in line with existing studies on app usage, introducing the app on average increases PA and decreases weight or obesity prevalence, though the changes are not statistically significant. When app engagement increased to 75% (125,517/167,356) of women who were aware, 75% (94,138/125,517) of those who were aware downloading it, and 75% (70,603/94,138) of those who downloaded it opting into the app?s push notifications, there were statistically significant changes in PA participation, minutes of PA and obesity prevalence. Conclusions: Our study shows that a digital health app that helps identify recreation center classes does not result in substantive population-wide health effects at lower levels of app engagement. For the app to result in statistically significant increases in PA and reductions in obesity prevalence over 5 years, there needs to be at least 75% (125,517/167,356) of women aware of the app, 75% (94,138/125,517) of those aware of the app download it, and 75% (70,603/94,138) of those who download it opt into push notifications. Nevertheless, the app cannot fully overcome lack of access to recreation centers; therefore, public health administrators as well as parks and recreation agencies might consider incorporating this type of technology into multilevel interventions that also target the built environment and other social determinants of health. UR - https://www.jmir.org/2022/8/e30581 UR - http://dx.doi.org/10.2196/30581 UR - http://www.ncbi.nlm.nih.gov/pubmed/35994313 ID - info:doi/10.2196/30581 ER - TY - JOUR AU - Bricker, B. Jonathan AU - Mull, E. Kristin AU - Santiago-Torres, Margarita AU - Miao, Zhen AU - Perski, Olga AU - Di, Chongzhi PY - 2022/8/18 TI - Smoking Cessation Smartphone App Use Over Time: Predicting 12-Month Cessation Outcomes in a 2-Arm Randomized Trial JO - J Med Internet Res SP - e39208 VL - 24 IS - 8 KW - acceptance and commitment therapy KW - ACT KW - digital interventions KW - eHealth KW - engagement KW - iCanQuit KW - QuitGuide KW - mobile health KW - mHealth KW - smartphone apps KW - trajectories KW - tobacco KW - smoking KW - mobile phone N2 - Background: Little is known about how individuals engage over time with smartphone app interventions and whether this engagement predicts health outcomes. Objective: In the context of a randomized trial comparing 2 smartphone apps for smoking cessation, this study aimed to determine distinct groups of smartphone app log-in trajectories over a 6-month period, their association with smoking cessation outcomes at 12 months, and baseline user characteristics that predict data-driven trajectory group membership. Methods: Functional clustering of 182 consecutive days of smoothed log-in data from both arms of a large (N=2415) randomized trial of 2 smartphone apps for smoking cessation (iCanQuit and QuitGuide) was used to identify distinct trajectory groups. Logistic regression was used to determine the association of group membership with the primary outcome of 30-day point prevalence of smoking abstinence at 12 months. Finally, the baseline characteristics associated with group membership were examined using logistic and multinomial logistic regression. The analyses were conducted separately for each app. Results: For iCanQuit, participants were clustered into 3 groups: ?1-week users? (610/1069, 57.06%), ?4-week users? (303/1069, 28.34%), and ?26-week users? (156/1069, 14.59%). For smoking cessation rates at the 12-month follow-up, compared with 1-week users, 4-week users had 50% higher odds of cessation (30% vs 23%; odds ratio [OR] 1.50, 95% CI 1.05-2.14; P=.03), whereas 26-week users had 397% higher odds (56% vs 23%; OR 4.97, 95% CI 3.31-7.52; P<.001). For QuitGuide, participants were clustered into 2 groups: ?1-week users? (695/1064, 65.32%) and ?3-week users? (369/1064, 34.68%). The difference in the odds of being abstinent at 12 months for 3-week users versus 1-week users was minimal (23% vs 21%; OR 1.16, 95% CI 0.84-1.62; P=.37). Different baseline characteristics predicted the trajectory group membership for each app. Conclusions: Patterns of 1-, 3-, and 4-week smartphone app use for smoking cessation may be common in how people engage in digital health interventions. There were significantly higher odds of quitting smoking among 4-week users and especially among 26-week users of the iCanQuit app. To improve study outcomes, strategies for detecting users who disengage early from these interventions (1-week users) and proactively offering them a more intensive intervention could be fruitful. UR - https://www.jmir.org/2022/8/e39208 UR - http://dx.doi.org/10.2196/39208 UR - http://www.ncbi.nlm.nih.gov/pubmed/35831180 ID - info:doi/10.2196/39208 ER - TY - JOUR AU - Clare, M. Isabelle AU - Francis, Jacinta AU - Gamage, Nisali AU - Nguyen, Rebecca AU - Gorman, Shelley PY - 2022/8/18 TI - A Gender Lens on User Quality Ratings From Young Teenagers Assessing the Sun Safe App: Comparing Responses From Co-researchers and Participants of Pilot Intervention Studies JO - JMIR Dermatol SP - e35203 VL - 5 IS - 3 KW - app development KW - co-design KW - sun exposure KW - sun protection KW - teenager KW - uMARS KW - UV index KW - vitamin D KW - young adolescents KW - sunburn KW - adolescent KW - smartphone KW - gender KW - sun KW - protection KW - app KW - engagement KW - risk KW - melanoma KW - decision-making UR - https://derma.jmir.org/2022/3/e35203 UR - http://dx.doi.org/10.2196/35203 ID - info:doi/10.2196/35203 ER - TY - JOUR AU - Choi, Isabella AU - Petrie, Katherine AU - Einboden, Rochelle AU - Collins, Daniel AU - Ryan, Rose AU - Johnston, David AU - Harvey, B. Samuel AU - Glozier, Nicholas AU - Wray, Alexis AU - Deady, Mark PY - 2022/8/18 TI - Apprentices? Attitudes Toward Using a Mental Health Mobile App to Support Healthy Coping: Mixed Methods Study JO - JMIR Hum Factors SP - e35661 VL - 9 IS - 3 KW - apprentice KW - coping strategies KW - mental health KW - app KW - wellbeing KW - focus group KW - coping behaviour N2 - Background: Apprenticeships are a common pathway for young people transitioning into the workforce. Apprentices often face many employment-related challenges and have high levels of psychological distress, drug and alcohol use, and suicidal ideation. Little is known about the attitudes of apprentices toward using smartphone apps to support their mental health and the content that would engage them. Objective: This study explored (1) apprentices? interest in using an app to support their mental health and (2) the healthy coping strategies used to manage their mental well-being in the face of workplace challenges, in order to inform future app content. Methods: A mixed methods study was conducted with 54 apprentices (50/54 male, 93%) with a mean age of 22.7 (SD 5.7) years. Participants completed a survey on preferred ways of using an app to support mental health. Across 8 focus groups, participants were asked to describe healthy strategies they used to cope with occupational stressors. Results: Only 11% (6/54) of participants currently used a well-being app, but there was high interest in using an app to support their friends (47/54 participants, 87%) and develop self-help strategies to manage or prevent mental health issues (42/54 participants, 78%). Four major types of coping behaviors were identified: (1) social connection for disclosure, advice, and socializing; (2) pleasurable activities, such as engaging in hobbies, time-outs, and developing work-life separation; (3) cognitive approaches, including defusing from thoughts and cognitive reframing; and (4) self-care approaches, including exercise, a healthy diet, and getting adequate sleep. Conclusions: There is interest among apprentices to use an app with a positive well-being focus that helps them to develop self-management skills and support their friends. Apprentices utilized a range of healthy behaviors to cope with workplace stressors that can be incorporated into mental health apps to improve uptake and engagement. However, many of the preferred coping strategies identified are not those focused on by currently available apps, indicating the need for more targeted digital interventions for this group. UR - https://humanfactors.jmir.org/2022/3/e35661 UR - http://dx.doi.org/10.2196/35661 UR - http://www.ncbi.nlm.nih.gov/pubmed/35980733 ID - info:doi/10.2196/35661 ER - TY - JOUR AU - Soepnel, M. Larske AU - McKinley, C. Michelle AU - Klingberg, Sonja AU - Draper, E. Catherine AU - Prioreschi, Alessandra AU - Norris, A. Shane AU - Ware, J. Lisa PY - 2022/8/18 TI - Evaluation of a Text Messaging Intervention to Promote Preconception Micronutrient Supplement Use: Feasibility Study Nested in the Healthy Life Trajectories Initiative Study in South Africa JO - JMIR Form Res SP - e37309 VL - 6 IS - 8 KW - preconception health KW - micronutrient supplements KW - adherence KW - behavioral KW - SMS text messaging intervention KW - mobile health KW - mHealth KW - radio serial KW - mobile phone N2 - Background: Social messaging strategies such as SMS text messaging and radio are promising avenues for health promotion and behavior change in low- to middle-income settings. However, evidence of their acceptability, feasibility, and impact in the context of young women?s health and micronutrient deficiencies is lacking. Objective: This study aimed to evaluate the feasibility of an automated 2-way text messaging intervention nested in an ongoing preconception health trial, the Healthy Life Trajectories Initiative (HeLTI; HeLTI Bukhali) in Soweto, South Africa. Second, we aimed to evaluate the acceptability of a health promotion radio serial, which aired concurrently in the region. Methods: In this feasibility study, 120 participants enrolled in HeLTI Bukhali between November 2020 and February 2021 received the 6-month 2-way text messaging intervention. Quantitative and qualitative data on intervention acceptability, usability, interaction, perceived benefit, and fidelity were collected during 5 focus group discussions (FGDs) and from study data logs. During the FGDs, data were collected on the acceptability of the radio serial. Following the text messaging intervention, capillary hemoglobin levels were assessed, and a participant questionnaire provided information on adherence and attitudes toward supplements. The text messaging control group comprised the first 120 women recruited from November 2019 to February 2020, who received the Bukhali intervention but not the text messages. Statistical significance testing and a linear mixed model were used for indicative effect comparisons between the text message?receiving and control groups. Results: The text messaging intervention was found to be acceptable and to have perceived benefits, including being reminded to take supplements, gaining knowledge, and feeling supported by the study team. The use of the 2-way text messaging reply function was limited, with only a 10.8% (13/120) response rate by week 24. Barriers to replying included a lack of interest or phone credit and technical issues. Regarding the indicative effect, participants receiving the text messages had higher self-reported adherence at follow-up than the text messaging control group (42/63, 67% vs 33/85, 39% taking supplements every time; P=.02), and altitude-adjusted hemoglobin increased more between baseline and follow-up in the SMS text message?receiving group than in the text messaging control group (1.03, 95% CI 0.49-1.57; P<.001). The radio serial content was acceptable, although few participants reported exposure before the FGD. Conclusions: Women reported that the text messaging intervention was useful and described the benefits of receiving the messages. Examination of hemoglobin status indicated a promising beneficial effect of text messaging support on adherence to micronutrient supplementation, requiring further exploration through randomized controlled studies. Health promotion through radio and text messages were both found to be acceptable, although more research into the radio serial reach among young women is needed. Trial Registration: Pan African Clinical Trials Registry (PACTR) PACTR201903750173871; https://tinyurl.com/4x6n32ff UR - https://formative.jmir.org/2022/8/e37309 UR - http://dx.doi.org/10.2196/37309 UR - http://www.ncbi.nlm.nih.gov/pubmed/35980731 ID - info:doi/10.2196/37309 ER - TY - JOUR AU - Schnall, Rebecca AU - Liu, Jianfang AU - Alvarez, Gabriella AU - Porras, Tiffany AU - Ganzhorn, Sarah AU - Boerner, Samantha AU - Huang, Ming-Chun AU - Trujillo, Paul AU - Cioe, Patricia PY - 2022/8/18 TI - A Smoking Cessation Mobile App for Persons Living With HIV: Preliminary Efficacy and Feasibility Study JO - JMIR Form Res SP - e28626 VL - 6 IS - 8 KW - HIV KW - mHealth KW - smoking cessation KW - intervention KW - smoking KW - persons with HIV KW - pilot KW - pilot test KW - mobile app KW - smartwatch N2 - Background: The prevalence of smoking in the United States general population has gradually declined to the lowest rate ever recorded; however, this has not been true for persons with HIV. Objective: We conducted a pilot test to assess the feasibility and efficacy of the Lumme Quit Smoking mobile app and smartwatch combination with sensing capabilities to improve smoking cessation in persons with HIV. Methods: A total of 40 participants were enrolled in the study and randomly assigned 1:1 to the control arm, which received an 8-week supply of nicotine replacement therapy, a 30-minute smoking cessation counseling session, and weekly check-in calls with study staff, or to the intervention arm, which additionally received the Lumme Quit Smoking app and smartwatch. Results: Of the 40 participants enrolled, 37 completed the follow-up study assessments and 16 used the app every day during the 56-day period. During the 6-month recruitment and enrollment period, 122 people were screened for eligibility, with 67.2% (82/122) deemed ineligible. Smoking criteria and incompatible tech were the major reasons for ineligibility. There was no difference in the proportion of 7-day point prevalence abstinence by study arm and no significant decrease in exhaled carbon monoxide for the intervention and control arms separately. However, the average exhaled carbon monoxide decreased over time when analyzing both arms together (P=.02). Conclusions: Results suggest excellent feasibility and acceptability of using a smoking sensor app among this smoking population. The knowledge gained from this research will enable the scientific community, clinicians, and community stakeholders to improve tobacco cessation outcomes for persons with HIV. Trial Registration: ClinicalTrials.gov NCT04808609; https://clinicaltrials.gov/ct2/show/NCT04808609 UR - https://formative.jmir.org/2022/8/e28626 UR - http://dx.doi.org/10.2196/28626 UR - http://www.ncbi.nlm.nih.gov/pubmed/35980739 ID - info:doi/10.2196/28626 ER - TY - JOUR AU - Ramadurai, Ramya AU - Beckham, Erin AU - McHugh, Kathryn R. AU - Björgvinsson, Thröstur AU - Beard, Courtney PY - 2022/8/17 TI - Operationalizing Engagement With an Interpretation Bias Smartphone App Intervention: Case Series JO - JMIR Ment Health SP - e33545 VL - 9 IS - 8 KW - engagement KW - mental health apps KW - cognitive bias modification KW - human support KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Engagement with mental health smartphone apps is an understudied but critical construct to understand in the pursuit of improved efficacy. Objective: This study aimed to examine engagement as a multidimensional construct for a novel app called HabitWorks. HabitWorks delivers a personalized interpretation bias intervention and includes various strategies to enhance engagement such as human support, personalization, and self-monitoring. Methods: We examined app use in a pilot study (n=31) and identified 5 patterns of behavioral engagement: consistently low, drop-off, adherent, high diary, and superuser. Results: We present a series of cases (5/31, 16%) from this trial to illustrate the patterns of behavioral engagement and cognitive and affective engagement for each case. With rich participant-level data, we emphasize the diverse engagement patterns and the necessity of studying engagement as a heterogeneous and multifaceted construct. Conclusions: Our thorough idiographic exploration of engagement with HabitWorks provides an example of how to operationalize engagement for other mental health apps. UR - https://mental.jmir.org/2022/8/e33545 UR - http://dx.doi.org/10.2196/33545 UR - http://www.ncbi.nlm.nih.gov/pubmed/35976196 ID - info:doi/10.2196/33545 ER - TY - JOUR AU - Strutz, Nicole AU - Brodowski, Hanna AU - Kiselev, Joern AU - Heimann-Steinert, Anika AU - Müller-Werdan, Ursula PY - 2022/8/16 TI - App-Based Evaluation of Older People?s Fall Risk Using the mHealth App Lindera Mobility Analysis: Exploratory Study JO - JMIR Aging SP - e36872 VL - 5 IS - 3 KW - mobility KW - fall risk KW - smartphone KW - app KW - analysis KW - older people KW - accuracy KW - mobility restriction N2 - Background: Falls and the risk of falling in older people pose a high risk for losing independence. As the risk of falling progresses over time, it is often not adequately diagnosed due to the long intervals between contacts with health care professionals. This leads to the risk of falling being not properly detected until the first fall. App-based software able to screen fall risks of older adults and to monitor the progress and presence of fall risk factors could detect a developing fall risk at an early stage prior to the first fall. As smartphones become more common in the elderly population, this approach is easily available and feasible. Objective: The aim of the study is to evaluate the app Lindera Mobility Analysis (LIN). The reference standards determined the risk of falling and validated functional assessments of mobility. Methods: The LIN app was utilized in home- and community-dwelling older adults aged 65 years or more. The Berg Balance Scale (BBS), the Tinetti Test (TIN), and the Timed Up & Go Test (TUG) were used as reference standards. In addition to descriptive statistics, data correlation and the comparison of the mean difference of analog measures (reference standards) and digital measures were tested. Spearman rank correlation analysis was performed and Bland-Altman (B-A) plots drawn. Results: Data of 42 participants could be obtained (n=25, 59.5%, women). There was a significant correlation between the LIN app and the BBS (r=?0.587, P<.001), TUG (r=0.474, P=.002), and TIN (r=?0.464, P=.002). B-A plots showed only few data points outside the predefined limits of agreement (LOA) when combining functional tests and results of LIN. Conclusions: The digital app LIN has the potential to detect the risk of falling in older people. Further steps in establishing the validity of the LIN app should include its clinical applicability. Trial Registration: German Clinical Trials Register DRKS00025352; https://tinyurl.com/65awrd6a UR - https://aging.jmir.org/2022/3/e36872 UR - http://dx.doi.org/10.2196/36872 UR - http://www.ncbi.nlm.nih.gov/pubmed/35972785 ID - info:doi/10.2196/36872 ER - TY - JOUR AU - Schliemann, Désirée AU - Tan, Min Min AU - Hoe, Kok Wilfred Mok AU - Mohan, Devi AU - Taib, Aishah Nur AU - Donnelly, Michael AU - Su, Tin Tin PY - 2022/8/15 TI - mHealth Interventions to Improve Cancer Screening and Early Detection: Scoping Review of Reviews JO - J Med Internet Res SP - e36316 VL - 24 IS - 8 KW - mobile health KW - mHealth KW - cancer screening KW - scoping review of reviews KW - cancer KW - cancer detection KW - oncology KW - digital health KW - scoping review KW - review KW - mobile phone N2 - Background: Cancer screening provision in resource-constrained settings tends to be opportunistic, and uptake tends to be low, leading to delayed presentation and treatment and poor survival. Objective: The aim of this study was to identify, review, map, and summarize findings from different types of literature reviews on the use of mobile health (mHealth) technologies to improve the uptake of cancer screening. Methods: The review methodology was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Ovid MEDLINE, PyscINFO, and Embase were searched from inception to May 2021. The eligible criteria included reviews that focused on studies of interventions that used mobile phone devices to promote and deliver cancer screening and described the effectiveness or implementation of mHealth intervention outcomes. Key data fields such as study aims, types of cancer, mHealth formats, and outcomes were extracted, and the data were analyzed to address the objective of the review. Results: Our initial search identified 1981 titles, of which 12 (0.61%) reviews met the inclusion criteria (systematic reviews: n=6, 50%; scoping reviews: n=4, 33%; rapid reviews: n=1, 8%; narrative reviews: n=1, 8%). Most (57/67, 85%) of the interventions targeted breast and cervical cancer awareness and screening uptake. The most commonly used mHealth technologies for increasing cancer screening uptake were SMS text messages and telephone calls. Overall, mHealth interventions increased knowledge about screening and had high acceptance among participants. The likelihood of achieving improved uptake-related outcomes increased when interventions used >1 mode of communication (telephone reminders, physical invitation letters, and educational pamphlets) together with mHealth. Conclusions: mHealth interventions increase cancer screening uptake, although multiple modes used in combination seem to be more effective. UR - https://www.jmir.org/2022/8/e36316 UR - http://dx.doi.org/10.2196/36316 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969450 ID - info:doi/10.2196/36316 ER - TY - JOUR AU - Nardi, William AU - Roy, Alexandra AU - Dunsiger, Shira AU - Brewer, Judson PY - 2022/8/15 TI - Analyzing the Impact of Mobile App Engagement on Mental Health Outcomes: Secondary Analysis of the Unwinding Anxiety Program JO - J Med Internet Res SP - e33696 VL - 24 IS - 8 KW - anxiety KW - worry KW - engagement KW - mobile app KW - mental health KW - mobile phone N2 - Background: App-based interventions provide a promising avenue for mitigating the burden on mental health services by complimenting therapist-led treatments for anxiety. However, it remains unclear how specific systems? use of app features may be associated with changes in mental health outcomes (eg, anxiety and worry). Objective: This study was a secondary analysis of engagement data from a stage 1 randomized controlled trial testing the impact of the Unwinding Anxiety mobile app among adults with generalized anxiety disorder. The aims of this study were 2-fold: to investigate whether higher microengagement with the primary intervention feature (ie, educational modules) is associated with positive changes in mental health outcomes at 2 months (ie, anxiety, worry, interoceptive awareness, and emotional reactivity) and to investigate whether the use of adjunctive app features is also associated with changes in mental health outcomes. Methods: We analyzed the intervention group during the stage 1 trial of the Unwinding Anxiety mobile app. The total use of specific mobile app features and the use specific to each feature were calculated. We used multivariate linear models with a priori significance of ?=.05 to investigate the impact of cumulative app use on anxiety, worry, interoceptive awareness, and emotional regulation at 2 months, controlling for baseline scores, age, and education level in all models. Significant relationships between system use metrics and baseline participant characteristics were assessed for differences in use groupings using between-group testing (ie, 2-tailed t tests for continuous data and chi-square analyses for categorical data). Results: The sample was primarily female (25/27, 93%), and the average age was 42.9 (SD 15.6) years. Educational module completion, the central intervention component, averaged 20.2 (SD 11.4) modules out of 32 for the total sample. Multivariate models revealed that completing >75% of the program was associated with an average 22.6-point increase in interoceptive awareness (b=22.6; SE 8.32; P=.01; 95% CI 5.3-39.8) and an 11.6-point decrease in worry (b=?11.6; SE 4.12; P=.01; 95% CI ?20.2 to ?3.1). In addition, a single log unit change in the total number of meditations was associated with a 0.62-point reduction in the Generalized Anxiety Disorder-7 scale scores (b=0.62; SE 0.27; P=.005; 95% CI ?1.2 to ?0.6), whereas a single log unit use of the stress meter was associated with an average of a 0.5-point increase in emotional regulation scores (Five Facet Mindfulness Questionnaire; b=0.5; SE 0.21; P=.03; 95% CI 0.1-0.9). Conclusions: This study offers a clearer understanding of the impact of engagement with app features on broader engagement with the health outcomes of interest. This study highlights the importance of comprehensive investigations of engagement during the development of evidence-based mobile apps. UR - https://www.jmir.org/2022/8/e33696 UR - http://dx.doi.org/10.2196/33696 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969440 ID - info:doi/10.2196/33696 ER - TY - JOUR AU - de Angel, Valeria AU - Lewis, Serena AU - White, M. Katie AU - Matcham, Faith AU - Hotopf, Matthew PY - 2022/8/15 TI - Clinical Targets and Attitudes Toward Implementing Digital Health Tools for Remote Measurement in Treatment for Depression: Focus Groups With Patients and Clinicians JO - JMIR Ment Health SP - e38934 VL - 9 IS - 8 KW - depression KW - digital health tools KW - implementation KW - qualitative KW - wearable devices KW - smartphone KW - passive sensing KW - sensor data KW - mobile health KW - mHealth KW - mood disorders KW - digital phenotyping KW - mobile phone N2 - Background: Remote measurement technologies, such as smartphones and wearable devices, can improve treatment outcomes for depression through enhanced illness characterization and monitoring. However, little is known about digital outcomes that are clinically meaningful to patients and clinicians. Moreover, if these technologies are to be successfully implemented within treatment, stakeholders? views on the barriers to and facilitators of their implementation in treatment must be considered. Objective: This study aims to identify clinically meaningful targets for digital health research in depression and explore attitudes toward their implementation in psychological services. Methods: A grounded theory approach was used on qualitative data from 3 focus groups of patients with a current diagnosis of depression and clinicians with >6 months of experience with delivering psychotherapy (N=22). Results: Emerging themes on clinical targets fell into the following two main categories: promoters and markers of change. The former are behaviors that participants engage in to promote mental health, and the latter signal a change in mood. These themes were further subdivided into external changes (changes in behavior) or internal changes (changes in thoughts or feelings) and mapped with potential digital sensors. The following six implementation acceptability themes emerged: technology-related factors, information and data management, emotional support, cognitive support, increased self-awareness, and clinical utility. Conclusions: The promoters versus markers of change differentiation have implications for a causal model of digital phenotyping in depression, which this paper presents. Internal versus external subdivisions are helpful in determining which factors are more susceptible to being measured by using active versus passive methods. The implications for implementation within psychotherapy are discussed with regard to treatment effectiveness, service provision, and patient and clinician experience. UR - https://mental.jmir.org/2022/8/e38934 UR - http://dx.doi.org/10.2196/38934 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969448 ID - info:doi/10.2196/38934 ER - TY - JOUR AU - O'Connor, Cara AU - Leyritana, Katerina AU - Doyle, M. Aoife AU - Birdthistle, Isolde AU - Lewis, J. James AU - Gill, Randeep AU - Salvaña, Maurice Edsel PY - 2022/8/12 TI - Delivering an mHealth Adherence Support Intervention for Patients With HIV: Mixed Methods Process Evaluation of the Philippines Connect for Life Study JO - JMIR Form Res SP - e37163 VL - 6 IS - 8 KW - mobile health KW - mHealth KW - adherence KW - HIV KW - antiretroviral therapy KW - process evaluation KW - Philippines KW - men who have sex with men KW - MSM KW - mobile phone N2 - Background: The Philippines HIV epidemic is one of the fastest growing epidemics globally, and infections among men who have sex with men are increasing at an alarming rate. Connect for Life Philippines is a mobile health (mHealth) intervention that supports antiretroviral therapy (ART) adherence in this key population through individualized voice calls and SMS text messages. Objective: The objective of this process evaluation is to assess the intervention reach, dose delivered and received, fidelity, and acceptability and to describe contextual factors affecting the implementation of an mHealth adherence support intervention for patients on ART in a clinic in Metro Manila, Philippines. Methods: A mixed methods process evaluation approach was used in an observational cohort study. Quantitative data sources for the process evaluation were call and SMS text message logs obtained from the mHealth platform and questionnaires collected at 12-, 24-, and 48-week study visits. Qualitative data were collected from process reports and through a series of focus group discussions conducted with a subset of participants during the intervention development phase, after an initial 8-week pilot phase, and at the end of the study. Results: The 462 study participants received 31,095 interactive voice calls and 8234 SMS text messages during the study. Owing to technical issues, intervention fidelity was low, with only 22.1% (102/462) of the participants receiving reminders via voice calls and others (360/462, 77.9%) receiving only SMS text messages during the intervention. After 48 weeks in the study, 63.5% (293/462) of the participants reported that they would be quite likely or very likely to recommend the program to a friend, and 53.8% (249/462) of the participants reported that they benefited quite a bit or very much from the intervention. Participants who were on ART for <6 months at the beginning of the study and those who received the daily or weekly pill reminders were more likely to report that they benefited from the intervention (P=.02 and P=.01, respectively). Conclusions: The Connect for Life intervention had high participant satisfaction and acceptability, especially among those who received high dose of the intervention. However, poor reliability of local telecommunication networks had a large impact on the intervention?s usability, fidelity, and dose received. UR - https://formative.jmir.org/2022/8/e37163 UR - http://dx.doi.org/10.2196/37163 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969425 ID - info:doi/10.2196/37163 ER - TY - JOUR AU - Sysko, Robyn AU - Bibeau, Jessica AU - Boyar, Allison AU - Costello, Kayla AU - Michaelides, Andreas AU - Mitchell, Siobhan Ellen AU - Susanin, Annabel AU - Hildebrandt, Tom PY - 2022/8/12 TI - A 2.5-Year Weight Management Program Using Noom Health: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e37541 VL - 11 IS - 8 KW - weight loss KW - weight loss maintenance KW - digital health KW - Noom KW - Diabetes Prevention Program KW - DPP KW - mobile phone N2 - Background: Overweight and obesity are serious public health concerns. As the prevalence of excess weight among individuals continues to increase, there is a parallel need for inexpensive, highly accessible, and evidence-based weight loss programs. Objective: This weight loss trial will aim to examine the efficacy of the Noom weight loss program in comparison to a digital control after a 6-month intervention phase and a 24-month maintenance phase, with assessments continuing for 2 years beyond the intervention (to 30 months?after the baseline). The secondary outcomes include quality of life, psychosocial functioning, sleep quality, physical activity, diet, and health status. This trial will also examine the severity of obesity-related functional impairment, weight loss history, and demographic moderators, along with adherence and self-efficacy as mediators of the outcome. Methods: A total of 600 participants were randomized in a parallel-group, controlled trial to either Noom Healthy Weight Program (intervention) or Noom Healthy Weight Control (control) for a 6-month intervention. Both intervention and control groups include diet and exercise recommendations, educational content, daily logging capabilities, and daily weigh-in entries. The Noom Healthy Weight Program also includes a coach support for weight loss. Remote follow-up assessments of eating, physical activity, psychosocial factors, app use data, and weight will be conducted at 1, 4, 6, 12, 18, 24, and 30 months after baseline. Weight is measured at each follow-up point during a Zoom call using the participants? scales. Results: Enrollment began in March 2021 and the 6-month intervention phase ended in March 2022. Data collection for the final assessment will be completed in March 2024. Conclusions: This study tests commercially available digital lifestyle interventions for individuals with overweight and obesity seeking weight loss support. Data obtained from the study will evaluate whether the Noom Healthy Weight Control Program can help individuals overcome weight loss, achieve long-term maintenance, adhere to lifestyle changes, and feature use barriers that are present in other traditional weight loss treatments. Trial Registration: ClinicalTrials.gov NCT04797169; https://clinicaltrials.gov/ct2/show/NCT04797169 International Registered Report Identifier (IRRID): DERR1-10.2196/37541 UR - https://www.researchprotocols.org/2022/8/e37541 UR - http://dx.doi.org/10.2196/37541 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969439 ID - info:doi/10.2196/37541 ER - TY - JOUR AU - Sarker, Rahman Mohammad Habibur AU - Moriyama, Michiko AU - Rashid, Ur Harun AU - Rahman, Moshiur Md AU - Chisti, Jobayer Mohammod AU - Das, Kumar Sumon AU - Saha, Kumar Samir AU - Arifeen, El Shams AU - Ahmed, Tahmeed AU - Faruque, G. A. S. PY - 2022/8/11 TI - Chronic Kidney Disease Awareness Campaign and Mobile Health Education to Improve Knowledge, Quality of Life, and Motivation for a Healthy Lifestyle Among Patients With Chronic Kidney Disease in Bangladesh: Randomized Controlled Trial JO - J Med Internet Res SP - e37314 VL - 24 IS - 8 KW - Bangladesh KW - health education KW - health knowledge KW - quality of life KW - motivation KW - randomized controlled trial KW - RCT KW - campaign KW - chronic kidney disease KW - knowledge KW - mobile health KW - mHealth KW - kidney KW - chronic disease KW - chronic condition KW - patient education KW - patient knowledge KW - low- and middle-income countries KW - LMIC N2 - Background: Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. Objective: This study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD. Methods: This study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio. Results: The study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P<.001), between groups (P<.001), and the interaction of group × time factor (P<.001) for knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001 and P=.01, respectively) and the interaction of group × time factor (P=.001 and P=.02, respectively); food salinity and hip circumferences showed significant differences arising from within groups (P=.001 and P=.03, respectively) and between groups (P=.001 and P=.02, respectively). Moreover, systolic BP and waist circumference showed significant differences from within groups (P<.001 and P=.003, respectively). However, no significant differences were found arising from within groups, between groups, and the interactions of group × time for QOL, urine salinity, and mid-upper arm circumference. Regarding the laboratory findings, from baseline to 6 months, the mean (SD) FBS decreased by 0.51 (3.77) mmol/L in the intervention group and 0.10 (1.44) mmol/L in the control group (P=.03); however, blood urea nitrogen increased by 3.64 (7.17) mg/dL in the intervention group and 1.68 (10.10) mg/dL in the control group (P=.01). Conclusions: The health education strategy, which included a campaign and mobile health, showed promise for enhancing CKD knowledge among patients with CKD. This strategy may also aid patients with CKD in controlling their FBS and BP. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings. Trial Registration: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. International Registered Report Identifier (IRRID): RR2-10.2196/30191 UR - https://www.jmir.org/2022/8/e37314 UR - http://dx.doi.org/10.2196/37314 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969429 ID - info:doi/10.2196/37314 ER - TY - JOUR AU - Kamstra, M. Regina J. AU - Boorsma, André AU - Krone, Tanja AU - van Stokkum, M. Robin AU - Eggink, M. Hannah AU - Peters, Ton AU - Pasman, J. Wilrike PY - 2022/8/11 TI - Validation of the Mobile App Version of the EQ-5D-5L Quality of Life Questionnaire Against the Gold Standard Paper-Based Version: Randomized Crossover Study JO - JMIR Form Res SP - e37303 VL - 6 IS - 8 KW - quality of life assessment KW - EQ-5D-5L questionnaire KW - mobile app KW - test-retest reliability KW - mobile phone N2 - Background: Study participants and patients often perceive (long) questionnaires as burdensome. In addition, paper-based questionnaires are prone to errors such as (unintentionally) skipping questions or filling in a wrong type of answer. Such errors can be prevented with the emergence of mobile questionnaire apps. Objective: This study aimed to validate an innovative way to measure the quality of life using a mobile app based on the EQ-5D-5L questionnaire. This validation study compared the EQ-5D-5L questionnaire requested by a mobile app with the gold standard paper-based version of the EQ-5D-5L. Methods: This was a randomized, crossover, and open study. The main criteria for participation were participants should be aged ?18 years, healthy at their own discretion, in possession of a smartphone with at least Android version 4.1 or higher or iOS version 9 or higher, digitally skilled in downloading the mobile app, and able to read and answer questionnaires in Dutch. Participants were recruited by a market research company that divided them into 2 groups balanced for age, gender, and education. Each participant received a digital version of the EQ-5D-5L questionnaire via a mobile app and the EQ-5D-5L paper-based questionnaire by postal mail. In the mobile app, participants received, for 5 consecutive days, 1 question in the morning and 1 question in the afternoon; as such, all questions were asked twice (at time point 1 [App T1] and time point 2 [App T2]). The primary outcomes were the correlations between the answers (scores) of each EQ-5D-5L question answered via the mobile app compared with the paper-based questionnaire to assess convergent validity. Results: A total of 255 participants (healthy at their own discretion), 117 (45.9%) men and 138 (54.1%) women in the age range of 18 to 64 years, completed the study. To ensure randomization, the measured demographics were checked and compared between groups. To compare the results of the electronic and paper-based questionnaires, polychoric correlation analysis was performed. All questions showed a high correlation (0.64-0.92; P<.001) between the paper-based and the mobile app?based questions at App T1 and App T2. The scores and their variance remained similar over the questionnaires, indicating no clear difference in the answer tendency. In addition, the correlation between the 2 app-based questionnaires was high (>0.73; P<.001), illustrating a high test-retest reliability, indicating it to be a reliable replacement for the paper-based questionnaire. Conclusions: This study indicates that the mobile app is a valid tool for measuring the quality of life and is as reliable as the paper-based version of the EQ-5D-5L, while reducing the response burden. UR - https://formative.jmir.org/2022/8/e37303 UR - http://dx.doi.org/10.2196/37303 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969437 ID - info:doi/10.2196/37303 ER - TY - JOUR AU - van Keulen, Hilde AU - Voogt, Carmen AU - Kleinjan, Marloes AU - Kramer, Jeannet AU - Andree, Rosa AU - van Empelen, Pepijn PY - 2022/8/11 TI - Development of a Dynamically Tailored mHealth Intervention (What Do You Drink) to Reduce Excessive Drinking Among Dutch Lower-Educated Students: User-Centered Design Approach JO - JMIR Form Res SP - e36969 VL - 6 IS - 8 KW - alcohol consumption KW - excessive drinking KW - lower-educated students KW - adolescents KW - young adults KW - dynamic tailoring KW - mobile health intervention KW - intervention mapping KW - health promotion N2 - Background: The high prevalence and adverse consequences of excessive drinking among lower-educated adolescents and young adults are public concerns in the Netherlands. Evidence-based alcohol prevention programs targeting adolescents and young adults with a low educational background are sparse. Objective: This study aimed to describe the planned process for the theory- and evidence-based development, implementation, and evaluation of a dynamically tailored mobile alcohol intervention, entitled What Do You Drink (WDYD), aimed at lower-educated students from secondary vocational education and training (Middelbaar Beroepsonderwijs in Dutch). Methods: We used intervention mapping as the framework for the systematic development of WDYD. It consists of the following six steps: assessing needs (step 1), formulating intervention objectives (step 2), translating theoretical methods into practical applications (step 3), integrating these into a coherent program (step 4), anticipating future implementation and adoption (step 5), and developing an evaluation plan (step 6). Results: Reducing excessive drinking among Dutch lower-educated students aged 16 to 24 years was defined as the desired behavioral outcome and subdivided into the following five program objectives: make the decision to reduce drinking, set realistic drinking goals, use effective strategies to achieve drinking goals, monitor own drinking behavior, and evaluate own drinking behavior and adjust goals. Risk awareness, motivation, social norms, and self-efficacy were identified as the most important and changeable individual determinants related to excessive drinking and, therefore, were incorporated into WDYD. Dynamic tailoring was selected as the basic intervention method for changing these determinants. A user-centered design strategy was used to enhance the fit of the intervention to the needs of students. The intervention was developed in 4 iterations, and the prototypes were subsequently tested with the students and refined. This resulted in a completely automated, standalone native app in which students received dynamically tailored feedback regarding their alcohol use and goal achievement via multiple sessions within 17 weeks based on diary data assessing their alcohol consumption, motivation, confidence, and mood. A randomized controlled trial with ecological momentary assessments will be used to examine the effects, use, and acceptability of the intervention. Conclusions: The use of intervention mapping led to the development of an innovative, evidence-based intervention to reduce excessive alcohol consumption among lower-educated Dutch adolescents and young adults. Developing an intervention based on theory and empirical evidence enables researchers and program planners to identify and retain effective intervention elements and to translate the intervention to new populations and settings. This is important, as black boxes, or poorly described interventions, have long been a criticism of the eHealth field, and effective intervention elements across mobile health alcohol interventions are still largely unknown. Trial Registration: Netherlands Trial Registry NTR6619; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6619 UR - https://formative.jmir.org/2022/8/e36969 UR - http://dx.doi.org/10.2196/36969 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969428 ID - info:doi/10.2196/36969 ER - TY - JOUR AU - Boateng, George AU - Petersen, L. Curtis AU - Kotz, David AU - Fortuna, L. Karen AU - Masutani, Rebecca AU - Batsis, A. John PY - 2022/8/10 TI - A Smartwatch Step-Counting App for Older Adults: Development and Evaluation Study JO - JMIR Aging SP - e33845 VL - 5 IS - 3 KW - step tracking KW - step counting KW - pedometer KW - wearable KW - smartwatch KW - older adults KW - physical activity KW - machine learning KW - walking KW - mHealth KW - mobile health KW - mobile app KW - mobile application KW - app KW - uHealth N2 - Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have been shown to be inaccurate in clinical settings. Step-counting algorithms have been developed for smartwatches, but only using data from younger adults and, often, were only validated in controlled laboratory settings. Objective: We sought to develop and validate a smartwatch step-counting app for older adults and evaluate the algorithm in free-living settings over a long period of time. Methods: We developed and evaluated a step-counting app for older adults on an open-source wrist-worn device (Amulet). The app includes algorithms to infer the level of physical activity and to count steps. We validated the step-counting algorithm in the lab (counting steps from a video recording, n=20) and in free-living conditions?one 2-day field study (n=6) and two 12-week field studies (using the Fitbit as ground truth, n=16). During app system development, we evaluated 4 walking patterns: normal, fast, up and down a staircase, and intermittent speed. For the field studies, we evaluated 5 different cut-off values for the algorithm, using correlation and error rate as the evaluation metrics. Results: The step-counting algorithm performed well. In the lab study, for normal walking (R2=0.5), there was a stronger correlation between the Amulet steps and the video-validated steps; for all activities, the Amulet?s count was on average 3.2 (2.1%) steps lower (SD 25.9) than the video-validated count. For the 2-day field study, the best parameter settings led to an association between Amulet and Fitbit (R2=0.989) and 3.1% (SD 25.1) steps lower than Fitbit, respectively. For the 12-week field study, the best parameter setting led to an R2 value of 0.669. Conclusions: Our findings demonstrate the importance of an iterative process in algorithm development before field-based deployment. This work highlights various challenges and insights involved in developing and validating monitoring systems in real-world settings. Nonetheless, our step-counting app for older adults had good performance relative to the ground truth (a commercial Fitbit step counter). Our app could potentially be used to help improve physical activity among older adults. UR - https://aging.jmir.org/2022/3/e33845 UR - http://dx.doi.org/10.2196/33845 UR - http://www.ncbi.nlm.nih.gov/pubmed/35947445 ID - info:doi/10.2196/33845 ER - TY - JOUR AU - Pedamallu, Havisha AU - Ehrhardt, J. Matthew AU - Maki, Julia AU - Carcone, Idalski April AU - Hudson, M. Melissa AU - Waters, A. Erika PY - 2022/8/9 TI - Technology-Delivered Adaptations of Motivational Interviewing for the Prevention and Management of Chronic Diseases: Scoping Review JO - J Med Internet Res SP - e35283 VL - 24 IS - 8 KW - motivational interviewing KW - technology KW - telehealth KW - health behavior KW - chronic disease KW - socioeconomic factors KW - health promotion KW - disease management KW - primary prevention KW - secondary prevention KW - minority health N2 - Background: Motivational interviewing (MI) can increase health-promoting behaviors and decrease health-damaging behaviors. However, MI is often resource intensive, precluding its use with people with limited financial or time resources. Mobile health?based versions of MI interventions or technology-delivered adaptations of MI (TAMIs) might increase reach. Objective: We aimed to understand the characteristics of existing TAMIs. We were particularly interested in the inclusion of people from marginalized sociodemographic groups, whether the TAMI addressed sociocontextual factors, and how behavioral and health outcomes were reported. Methods: We employed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews to conduct our scoping review. We searched PubMed, CINAHL, and PsycInfo from January 1, 1996, to April 6, 2022, to identify studies that described interventions incorporating MI into a mobile or electronic health platform. For inclusion, the study was required to (1) describe methods/outcomes of an MI intervention, (2) feature an intervention delivered automatically via a mobile or electronic health platform, and (3) report a behavioral or health outcome. The exclusion criteria were (1) publication in a language other than English and (2) description of only in-person intervention delivery (ie, no TAMI). We charted results using Excel (Microsoft Corp). Results: Thirty-four studies reported the use of TAMIs. Sample sizes ranged from 10 to 2069 participants aged 13 to 70 years. Most studies (n=27) directed interventions toward individuals engaging in behaviors that increased chronic disease risk. Most studies (n=22) oversampled individuals from marginalized sociodemographic groups, but few (n=3) were designed specifically with marginalized groups in mind. TAMIs used text messaging (n=8), web-based intervention (n=22), app + text messaging (n=1), and web-based intervention + text messaging (n=3) as delivery platforms. Of the 34 studies, 30 (88%) were randomized controlled trials reporting behavioral and health-related outcomes, 23 of which reported statistically significant improvements in targeted behaviors with TAMI use. TAMIs improved targeted health behaviors in the remaining 4 studies. Moreover, 11 (32%) studies assessed TAMI feasibility, acceptability, or satisfaction, and all rated TAMIs highly in this regard. Among 20 studies with a disproportionately high number of people from marginalized racial or ethnic groups compared with the general US population, 16 (80%) reported increased engagement in health behaviors or better health outcomes. However, no TAMIs included elements that addressed sociocontextual influences on behavior or health outcomes. Conclusions: Our findings suggest that TAMIs may improve some health promotion and disease management behaviors. However, few TAMIs were designed specifically for people from marginalized sociodemographic groups, and none included elements to help address sociocontextual challenges. Research is needed to determine how TAMIs affect individual health outcomes and how to incorporate elements that address sociocontextual factors, and to identify the best practices for implementing TAMIs into clinical practice. UR - https://www.jmir.org/2022/8/e35283 UR - http://dx.doi.org/10.2196/35283 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943775 ID - info:doi/10.2196/35283 ER - TY - JOUR AU - Six, G. Stephanie AU - Byrne, A. Kaileigh AU - Aly, Heba AU - Harris, W. Maggie PY - 2022/8/9 TI - The Effect of Mental Health App Customization on Depressive Symptoms in College Students: Randomized Controlled Trial JO - JMIR Ment Health SP - e39516 VL - 9 IS - 8 KW - depression KW - mental health apps KW - customization KW - personalization KW - cognitive behavioral therapy KW - avatars KW - mobile phone N2 - Background: Mental health apps have shown promise in improving mental health symptoms, including depressive symptoms. However, limited research has been aimed at understanding how specific app features and designs can optimize the therapeutic benefits and adherence to such mental health apps. Objective: The primary purpose of this study is to investigate the effect of avatar customization on depressive symptoms and adherence to use a novel cognitive behavioral therapy (CBT)?based mental health app. The secondary aim is to examine whether specific app features, including journaling, mood tracking, and reminders, affect the usability of the mental health app. Methods: College students were recruited from a university study recruitment pool website and via flyer advertisements throughout campus. A total of 94 participants completed a randomized controlled trial in which they were randomized to either customization or no customization version of the app. Customization involved personalizing a virtual avatar and a travel vehicle to one?s own preferences and use of one?s name throughout the app. Participants completed a 14-day trial using a novel CBT-based mental health app called AirHeart. Self-report scores for depressive symptoms, anxiety, and stress were measured at baseline and after the intervention. Postintervention survey measures also included usability and avatar identification questionnaires. Results: Of the 94 enrolled participants, 83 (88%) completed the intervention and postintervention assessments. AirHeart app use significantly reduced symptoms of depression (P=.006) from baseline to the end of the 2-week intervention period for all participants, regardless of the customization condition. However, no differences in depressive symptoms (P=.17) or adherence (P=.80) were observed between the customization (39/83, 47%) and no customization (44/83, 53%) conditions. The frequency of journaling, usefulness of mood tracking, and helpfulness of reminders were not associated with changes in depressive symptoms or adherence (P>.05). Exploratory analyses showed that there were 3 moderate positive correlations between avatar identification and depressive symptoms (identification: r=?0.312, P=.02; connection: r=?0.305, P=.02; and lack of relatability: r=0.338, P=.01). Conclusions: These results indicate that CBT mental health apps, such as AirHeart, have the potential to reduce depressive symptoms over a short intervention period. The randomized controlled trial results demonstrated that customization of app features, such as avatars, does not further reduce depressive symptoms over and above the CBT modules and standard app features, including journal, reminders, and mood tracking. However, further research elucidating the relationship between virtual avatar identification and mental health systems is needed as society becomes increasingly more digitized. These findings have potential implications for improving the optimization of mental health app designs. Trial Registration: Open Science Framework t28gm; https://osf.io/t28gm UR - https://mental.jmir.org/2022/8/e39516 UR - http://dx.doi.org/10.2196/39516 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943788 ID - info:doi/10.2196/39516 ER - TY - JOUR AU - Martinko, Antonio AU - Karuc, Josip AU - Juri?, Petra AU - Podnar, Hrvoje AU - Sori?, Maroje PY - 2022/8/9 TI - Accuracy and Precision of Consumer-Grade Wearable Activity Monitors for Assessing Time Spent in Sedentary Behavior in Children and Adolescents: Systematic Review JO - JMIR Mhealth Uhealth SP - e37547 VL - 10 IS - 8 KW - accuracy KW - precision KW - sedentary behavior KW - children KW - adolescents KW - wearable activity monitor KW - eHealth KW - digital health KW - mobile health KW - mHealth KW - mobile phone N2 - Background: A large number of wearable activity monitor models are released and used each year by consumers and researchers. As more studies are being carried out on children and adolescents in terms of sedentary behavior (SB) assessment, knowledge about accurate and precise monitoring devices becomes increasingly important. Objective: The main aim of this systematic review was to investigate and communicate findings on the accuracy and precision of consumer-grade physical activity monitors in assessing the time spent in SB in children and adolescents. Methods: Searches of PubMed (MEDLINE), Scopus, SPORTDiscus (full text), ProQuest, Open Access Theses and Dissertations, DART Europe E-theses Portal, and Networked Digital Library of Theses and Dissertations electronic databases were performed. All relevant studies that compared different types of consumer-grade monitors using a comparison method in the assessment of SB, published in European languages from 2015 onward were considered for inclusion. The risk of bias was estimated using Consensus-Based Standards for the Selection of Health Status Measurement Instruments. For enabling comparisons of accuracy measures within the studied outcome domain, measurement accuracy interpretation was based on group mean or percentage error values and 90% CI. Acceptable limits were predefined as ?10% to +10% error in controlled and free-living settings. For determining the number of studies with group error percentages that fall within or outside one of the sides from previously defined acceptable limits, two 1-sided tests of equivalence were carried out, and the direction of measurement error was examined. Results: A total of 8 studies complied with the predefined inclusion criteria, and 3 studies provided acceptable data for quantitative analyses. In terms of the presented accuracy comparisons, 14 were subsequently identified, with 6 of these comparisons being acceptable in terms of quantitative analysis. The results of the Cochran Q test indicated that the included studies did not share a common effect size (Q5=82.86; P<.001). I2, which represents the percentage of total variation across studies due to heterogeneity, amounted to 94%. The summary effect size based on the random effects model was not statistically significant (effect size=14.36, SE 12.04, 90% CI ?5.45 to 34.17; P=.23). According to the equivalence test results, consumer-grade physical activity monitors did not generate equivalent estimates of SB in relation to the comparison methods. Majority of the studies (3/7, 43%) that reported the mean absolute percentage errors have reported values of <30%. Conclusions: This is the first study that has attempted to synthesize available evidence on the accuracy and precision of consumer-grade physical activity monitors in measuring SB in children and adolescents. We found very few studies on the accuracy and almost no evidence on the precision of wearable activity monitors. The presented results highlight the large heterogeneity in this area of research. Trial Registration: PROSPERO CRD42021251922; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=251922 UR - https://mhealth.jmir.org/2022/8/e37547 UR - http://dx.doi.org/10.2196/37547 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943763 ID - info:doi/10.2196/37547 ER - TY - JOUR AU - Matthews, Stacey AU - Atkins, Brooke AU - Walton, Natalie AU - Mitchell, Julie-Anne AU - Jennings, Garry AU - Buttery, K. Amanda PY - 2022/8/5 TI - Development and Use of a Cardiac Clinical Guideline Mobile App in Australia: Acceptability and Multi-Methods Study JO - JMIR Form Res SP - e35599 VL - 6 IS - 8 KW - mHealth KW - mobile heath KW - apps KW - app KW - guideline KW - cardiovascular disease KW - atrial fibrillation KW - heart failure KW - heart KW - cardiac KW - cardiovascular KW - acute coronary syndrome KW - smartphone KW - implementation KW - digital health KW - develop KW - evaluate KW - evaluation KW - Australia N2 - Background: Implementation of clinical guidelines into routine practice remains highly variable. Strategies to increase guideline uptake include developing digital tools and mobile apps for use in clinical practice. The National Heart Foundation of Australia in collaboration with the Cardiac Society of Australia and New Zealand published 3 key cardiac clinical guidelines, including the Australian clinical guidelines for the (1) prevention and detection of atrial fibrillation, (2) detection and management of heart failure, and (3) management of acute coronary syndromes. To improve access and uptake for health care providers, we developed the Smart Heart Guideline App. Objective: This study aims to evaluate the acceptability, implementation, and usability of an Australian-specific cardiac guidelines mobile app. Methods: We used an iterative multiple methods development and implementation approach. First, we conducted a cross-sectional web-based survey with end users (n=504 health professionals) in 2017 to determine the acceptability of an Australian-specific cardiac clinical guidelines mobile app. Second, the Smart Heart Guidelines app was created using a design, user testing, and revision process. The app includes interactive algorithms and flowcharts to inform diagnosis and management at the point of care. The freely available app was launched in October 2019 on iOS and Android operating systems and promoted and implemented using multiple methods. Third, data from 2 annual national cross-sectional general practitioner (GP) surveys in 2019 and 2020 were evaluated to understand the awareness and use of the clinical guidelines and the app. Fourth, data from the app stores were analyzed between October 1, 2019, and June 30, 2021, to evaluate usage. Results: Most health professionals surveyed (447/504, 89%) reported accessing resources electronically, and most (318/504, 63%) reported that they would use an Australian-specific cardiac guidelines app. GPs surveyed in 2019 were aware of the heart failure (159/312, 51%) and atrial fibrillation (140/312, 45%) guidelines, and in 2020, a total of 34 of 189 (18%) reported that they were aware of the app. The app was downloaded 11,313 times (7483, 66% from the Apple App Store; 3830, 34% from Google Play) during the first 20-month period. Most downloads (6300/7483, 84%) were a result of searching for the app in the stores. Monthly download rates varied. App Store data showed that people used the app twice (on average 2.06 times) during the 20 months. Many (3256/3830, 85%) Android users deleted the app. Conclusions: Health professionals supported the development of the Smart Heart Guidelines app. Although initial downloads were promising, the frequency of using the app was low and deletion rates were high. Further evaluation of users? experience of the most and least useful components of the app is needed. UR - https://formative.jmir.org/2022/8/e35599 UR - http://dx.doi.org/10.2196/35599 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930350 ID - info:doi/10.2196/35599 ER - TY - JOUR AU - Young, S. Alexander AU - Choi, Abigail AU - Cannedy, Shay AU - Hoffmann, Lauren AU - Levine, Lionel AU - Liang, Li-Jung AU - Medich, Melissa AU - Oberman, Rebecca AU - Olmos-Ochoa, T. Tanya PY - 2022/8/5 TI - Passive Mobile Self-tracking of Mental Health by Veterans With Serious Mental Illness: Protocol for a User-Centered Design and Prospective Cohort Study JO - JMIR Res Protoc SP - e39010 VL - 11 IS - 8 KW - serious mental illness KW - mobile health KW - mental health KW - passive sensing KW - health informatics KW - behavior KW - sensor KW - self-tracking KW - predict KW - assessment N2 - Background: Serious mental illnesses (SMI) are common, disabling, and challenging to treat, requiring years of monitoring and treatment adjustments. Stress or reduced medication adherence can lead to rapid worsening of symptoms and behaviors. Illness exacerbations and relapses generally occur with little or no clinician awareness in real time, leaving limited opportunity to modify treatments. Previous research suggests that passive mobile sensing may be beneficial for individuals with SMI by helping them monitor mental health status and behaviors, and quickly detect worsening mental health for prompt assessment and intervention. However, there is too little research on its feasibility and acceptability and the extent to which passive data can predict changes in behaviors or symptoms. Objective: The aim of this research is to study the feasibility, acceptability, and safety of passive mobile sensing for tracking behaviors and symptoms of patients in treatment for SMI, as well as developing analytics that use passive data to predict changes in behaviors and symptoms. Methods: A mobile app monitors and transmits passive mobile sensor and phone utilization data, which is used to track activity, sociability, and sleep in patients with SMI. The study consists of a user-centered design phase and a mobile sensing phase. In the design phase, focus groups, interviews, and usability testing inform further app development. In the mobile sensing phase, passive mobile sensing occurs with participants engaging in weekly assessments for 9 months. Three- and nine-month interviews study the perceptions of passive mobile sensing and ease of app use. Clinician interviews before and after the mobile sensing phase study the usefulness and feasibility of app utilization in clinical care. Predictive analytic models are built, trained, and selected, and make use of machine learning methods. Models use sensor and phone utilization data to predict behavioral changes and symptoms. Results: The study started in October 2020. It has received institutional review board approval. The user-centered design phase, consisting of focus groups, usability testing, and preintervention clinician interviews, was completed in June 2021. Recruitment and enrollment for the mobile sensing phase began in October 2021. Conclusions: Findings may inform the development of passive sensing apps and self-tracking in patients with SMI, and integration into care to improve assessment, treatment, and patient outcomes. Trial Registration: ClinicalTrials.gov NCT05023252; https://clinicaltrials.gov/ct2/show/NCT05023252 International Registered Report Identifier (IRRID): DERR1-10.2196/39010 UR - https://www.researchprotocols.org/2022/8/e39010 UR - http://dx.doi.org/10.2196/39010 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930336 ID - info:doi/10.2196/39010 ER - TY - JOUR AU - Martinez, J. Gonzalo AU - Grover, Ted AU - Mattingly, M. Stephen AU - Mark, Gloria AU - D?Mello, Sidney AU - Aledavood, Talayeh AU - Akbar, Fatema AU - Robles-Granda, Pablo AU - Striegel, Aaron PY - 2022/8/4 TI - Alignment Between Heart Rate Variability From Fitness Trackers and Perceived Stress: Perspectives From a Large-Scale In Situ Longitudinal Study of Information Workers JO - JMIR Hum Factors SP - e33754 VL - 9 IS - 3 KW - stress measurement KW - heart rate variability KW - HRV KW - perceived stress KW - ecological momentary assessment KW - EMA KW - wearables KW - fitness tracker N2 - Background: Stress can have adverse effects on health and well-being. Informed by laboratory findings that heart rate variability (HRV) decreases in response to an induced stress response, recent efforts to monitor perceived stress in the wild have focused on HRV measured using wearable devices. However, it is not clear that the well-established association between perceived stress and HRV replicates in naturalistic settings without explicit stress inductions and research-grade sensors. Objective: This study aims to quantify the strength of the associations between HRV and perceived daily stress using wearable devices in real-world settings. Methods: In the main study, 657 participants wore a fitness tracker and completed 14,695 ecological momentary assessments (EMAs) assessing perceived stress, anxiety, positive affect, and negative affect across 8 weeks. In the follow-up study, approximately a year later, 49.8% (327/657) of the same participants wore the same fitness tracker and completed 1373 EMAs assessing perceived stress at the most stressful time of the day over a 1-week period. We used mixed-effects generalized linear models to predict EMA responses from HRV features calculated over varying time windows from 5 minutes to 24 hours. Results: Across all time windows, the models explained an average of 1% (SD 0.5%; marginal R2) of the variance. Models using HRV features computed from an 8 AM to 6 PM time window (namely work hours) outperformed other time windows using HRV features calculated closer to the survey response time but still explained a small amount (2.2%) of the variance. HRV features that were associated with perceived stress were the low frequency to high frequency ratio, very low frequency power, triangular index, and SD of the averages of normal-to-normal intervals. In addition, we found that although HRV was also predictive of other related measures, namely, anxiety, negative affect, and positive affect, it was a significant predictor of stress after controlling for these other constructs. In the follow-up study, calculating HRV when participants reported their most stressful time of the day was less predictive and provided a worse fit (R2=0.022) than the work hours time window (R2=0.032). Conclusions: A significant but small relationship between perceived stress and HRV was found. Thus, although HRV is associated with perceived stress in laboratory settings, the strength of that association diminishes in real-life settings. HRV might be more reflective of perceived stress in the presence of specific and isolated stressors and research-grade sensing. Relying on wearable-derived HRV alone might not be sufficient to detect stress in naturalistic settings and should not be considered a proxy for perceived stress but rather a component of a complex phenomenon. UR - https://humanfactors.jmir.org/2022/3/e33754 UR - http://dx.doi.org/10.2196/33754 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925662 ID - info:doi/10.2196/33754 ER - TY - JOUR AU - Chu, Cherry AU - Stamenova, Vess AU - Fang, Jiming AU - Shakeri, Ahmad AU - Tadrous, Mina AU - Bhatia, Sacha R. PY - 2022/8/4 TI - The Association Between Telemedicine Use and Changes in Health Care Usage and Outcomes in Patients With Congestive Heart Failure: Retrospective Cohort Study JO - JMIR Cardio SP - e36442 VL - 6 IS - 2 KW - telemedicine KW - telehealth KW - eHealth KW - digital health KW - population KW - outcomes KW - health service KW - health system KW - utilization KW - congestive heart failure KW - cardiology KW - health outcome KW - clinical outcome KW - patient outcome KW - heart KW - cardiac KW - ambulatory KW - COVID-19 N2 - Background: Telemedicine use has become widespread owing to the COVID-19 pandemic, but its impact on patient outcomes remains unclear. Objective: We sought to investigate the effect of telemedicine use on changes in health care usage and clinical outcomes in patients diagnosed with congestive heart failure (CHF). Methods: We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14 and September 30, 2020, and a heart failure diagnosis any time prior to March 14, 2020. Telemedicine users were propensity score?matched with unexposed users based on several baseline characteristics. Monthly use of various health care services was compared between the 2 groups during 12 months before to 3 months after their index in-person or telemedicine ambulatory visit after March 14, 2020, using generalized estimating equations. Results: A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49% male; mean age 78.9, SD 12.0 years). All patients showed significant reductions in health service usage from pre- to postindex visit. There was a greater decline across time in the unexposed group than in the telemedicine group for CHF admissions (ratio of slopes for high- vs low-frequency users 1.02, 95% CI 1.02-1.03), cardiovascular admissions (1.03, 95% CI 1.02-1.04), any-cause admissions (1.03, 95% CI 1.02-1.04), any-cause ED visits (1.03, 95% CI 1.03-1.04), visits with any cardiologist (1.01, 95% CI 1.01-1.02), laboratory tests (1.02, 95% CI 1.02-1.03), diagnostic tests (1.04, 95% CI 1.03-1.05), and new prescriptions (1.02, 95% CI 1.01-1.03). However, the decline in primary care visit rates was steeper among telemedicine patients than among unexposed patients (ratio of slopes 0.99, 95% CI 0.99-1.00). Conclusions: Overall health care usage over time appeared higher among telemedicine users than among low-frequency users or nonusers, suggesting that telemedicine was used by patients with the greatest need or that it allowed patients to have better access or continuity of care among those who received it. UR - https://cardio.jmir.org/2022/2/e36442 UR - http://dx.doi.org/10.2196/36442 UR - http://www.ncbi.nlm.nih.gov/pubmed/35881831 ID - info:doi/10.2196/36442 ER - TY - JOUR AU - Albuquerque de Almeida, Fernando AU - Corro Ramos, Isaac AU - Al, Maiwenn AU - Rutten-van Mölken, Maureen PY - 2022/8/4 TI - Home Telemonitoring and a Diagnostic Algorithm in the Management of Heart Failure in the Netherlands: Cost-effectiveness Analysis JO - JMIR Cardio SP - e31302 VL - 6 IS - 2 KW - discrete event simulation KW - cost-effectiveness KW - early warning systems KW - home telemonitoring KW - diagnostic algorithm KW - heart failure N2 - Background: Heart failure is a major health concern associated with significant morbidity, mortality, and reduced quality of life in patients. Home telemonitoring (HTM) facilitates frequent or continuous assessment of disease signs and symptoms, and it has shown to improve compliance by involving patients in their own care and prevent emergency admissions by facilitating early detection of clinically significant changes. Diagnostic algorithms (DAs) are predictive mathematical relationships that make use of a wide range of collected data for calculating the likelihood of a particular event and use this output for prioritizing patients with regard to their treatment. Objective: This study aims to assess the cost-effectiveness of HTM and a DA in the management of heart failure in the Netherlands. Three interventions were analyzed: usual care, HTM, and HTM plus a DA. Methods: A previously published discrete event simulation model was used. The base-case analysis was performed according to the Dutch guidelines for economic evaluation. Sensitivity, scenario, and value of information analyses were performed. Particular attention was given to the cost-effectiveness of the DA at various levels of diagnostic accuracy of event prediction and to different patient subgroups. Results: HTM plus the DA extendedly dominates HTM alone, and it has a deterministic incremental cost-effectiveness ratio compared with usual care of ?27,712 (currency conversion rate in purchasing power parity at the time of study: ?1=US $1.29; further conversions are not applicable in cost-effectiveness terms) per quality-adjusted life year. The model showed robustness in the sensitivity and scenario analyses. HTM plus the DA had a 96.0% probability of being cost-effective at the appropriate ?80,000 per quality-adjusted life year threshold. An optimal point for the threshold value for the alarm of the DA in terms of its cost-effectiveness was estimated. New York Heart Association class IV patients were the subgroup with the worst cost-effectiveness results versus usual care, while HTM plus the DA was found to be the most cost-effective for patients aged <65 years and for patients in New York Heart Association class I. Conclusions: Although the increased costs of adopting HTM plus the DA in the management of heart failure may seemingly be an additional strain on scarce health care resources, the results of this study demonstrate that, by increasing patient life expectancy by 1.28 years and reducing their hospitalization rate by 23% when compared with usual care, the use of this technology may be seen as an investment, as HTM plus the DA in its current form extendedly dominates HTM alone and is cost-effective compared with usual care at normally accepted thresholds in the Netherlands. UR - https://cardio.jmir.org/2022/2/e31302 UR - http://dx.doi.org/10.2196/31302 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925670 ID - info:doi/10.2196/31302 ER - TY - JOUR AU - Helgerud, Jan AU - Haglo, Håvard AU - Hoff, Jan PY - 2022/8/4 TI - Prediction of VO2max From Submaximal Exercise Using the Smartphone Application Myworkout GO: Validation Study of a Digital Health Method JO - JMIR Cardio SP - e38570 VL - 6 IS - 2 KW - high-intensity interval training KW - cardiovascular health KW - physical inactivity KW - endurance training KW - measurement accuracy N2 - Background: Physical inactivity remains the largest risk factor for the development of cardiovascular disease worldwide. Wearable devices have become a popular method of measuring activity-based outcomes and facilitating behavior change to increase cardiorespiratory fitness (CRF) or maximal oxygen consumption (VO2max) and reduce weight. However, it is critical to determine their accuracy in measuring these variables. Objective: This study aimed to determine the accuracy of using a smartphone and the application Myworkout GO for submaximal prediction of VO2max. Methods: Participants included 162 healthy volunteers: 58 women and 104 men (17-73 years old). The study consisted of 3 experimental tests randomized to 3 separate days. One-day VO2max was assessed with Metamax II, with the participant walking or running on the treadmill. On the 2 other days, the application Myworkout GO used standardized high aerobic intensity interval training (HIIT) on the treadmill to predict VO2max. Results: There were no significant differences between directly measured VO2max (mean 49, SD 14 mL/kg/min) compared with the VO2max predicted by Myworkout GO (mean 50, SD 14 mL/kg/min). The direct and predicted VO2max values were highly correlated, with an R2 of 0.97 (P<.001) and standard error of the estimate (SEE) of 2.2 mL/kg/min, with no sex differences. Conclusions: Myworkout GO accurately calculated VO2max, with an SEE of 4.5% in the total group. The submaximal HIIT session (4 x 4 minutes) incorporated in the application was tolerated well by the participants. We present health care providers and their patients with a more accurate and practical version of health risk estimation. This might increase physical activity and improve exercise habits in the general population. UR - https://cardio.jmir.org/2022/2/e38570 UR - http://dx.doi.org/10.2196/38570 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925653 ID - info:doi/10.2196/38570 ER - TY - JOUR AU - van de Vijver, Steven AU - Hummel, Deirdre AU - van Dijk, Hester Annericht AU - Cox, Jan AU - van Dijk, Oscar AU - Van den Broek, Nicoline AU - Metting, Esther PY - 2022/8/3 TI - Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders? Perspectives JO - JMIR Form Res SP - e38424 VL - 6 IS - 8 KW - primary care KW - chronic disease KW - telemonitoring KW - digital health KW - self-management KW - patient-centered care KW - chronic care KW - chronic care management KW - illness KW - healthcare KW - healthcare professional KW - user KW - patient KW - platform KW - tool KW - communication KW - empowerment KW - online N2 - Background: Population aging and multimorbidity has led to increasing chronic care needs associated with new challenges in managing growing costs, rising health care professional workloads, and the adoption of rigorous guidelines. These issues could all benefit from greater digitalization and a more patient-centered approach to chronic care, a situation brought to the fore by the COVID-19 pandemic. Little is known about real-life use in primary care. Objective: This study aimed to explore the views, thoughts, usability, and experiences concerning a recently introduced digital self-care platform for chronic conditions in 3 Dutch primary care practices. Methods: We conducted an explorative study combining questionnaires and interviews among patients and general practitioners from 3 general practices that used the digital platform. Questionnaires were sent to patients in each practice to seek the views and experiences of both patient nonusers (n=20) and patient users (n=58) of the platform, together with standardized questionnaires about illness perception and quality of life. In addition, patients (n=15) and general practitioners (n=4) who used the platform took part in semistructured interviews. We transcribed interviews verbatim and performed qualitative content analysis using a deductive approach. The results of the questionnaires were analyzed with descriptive analysis. Results: Among patients who had not actively used the platform but had received an explanation, only 35% (7/20) would recommend its use due to concerns over communication and handling. However, this percentage increased to 76.3% (45/59) among the people who actively used the platform. Interviews with patients and general practitioners who used the platform uncovered several key benefits, including reduced time requirements, reduced workload, improved care quality, and improved accessibility due to the greater patient-centeredness and use of different communication tools. In addition, the self-management tool led to greater patient autonomy and empowerment. Although users considered the platform feasible, usable, and easy to use, some technical issues remained and some patients expressed concerns about the reduction in human contact and feedback. Conclusions: The overall experience and usability of the platform was good. Support for the online self-management platform for chronic care increased when patients actively used the tool and could experience or identify important advantages. However, patients still noted several areas for improvement that need to be tackled in future iterations. To ensure benefit in the wider population, we must also evaluate this platform in cohorts with lower digital and health literacy. UR - https://formative.jmir.org/2022/8/e38424 UR - http://dx.doi.org/10.2196/38424 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921145 ID - info:doi/10.2196/38424 ER - TY - JOUR AU - Almeqbaali, Mariam AU - Ouhbi, Sofia AU - Serhani, Adel Mohamed AU - Amiri, Leena AU - Jan, K. Reem AU - Zaki, Nazar AU - Sharaf, Ayman AU - Al Helali, Abdulla AU - Almheiri, Eisa PY - 2022/8/2 TI - A Biofeedback-Based Mobile App With Serious Games for Young Adults With Anxiety in the United Arab Emirates: Development and Usability Study JO - JMIR Serious Games SP - e36936 VL - 10 IS - 3 KW - connected mental health KW - mental health KW - anxiety KW - digital game KW - biofeedback KW - app KW - serious game KW - gaming KW - gamification KW - young adult KW - user-centered design KW - stress KW - stress relief KW - user-centred design KW - youth KW - user feedback KW - user experience KW - usability KW - user need KW - development KW - mHealth KW - mobile health N2 - Background: Following the outbreak of COVID-19, several studies have reported that young adults encountered a rise in anxiety symptoms, which could negatively affect their quality of life. Promising evidence suggests that mobile apps with biofeedback, serious games, breathing exercises, and positive messaging, among other features, are useful for anxiety self-management and treatment. Objective: This study aimed to develop and evaluate the usability of a biofeedback-based app with serious games for young adults with anxiety in the United Arab Emirates (UAE). Methods: This study consists of two phases: Phase I describes the design and development of the app, while Phase II presents the results of a usability evaluation by experts. To elicit the app?s requirements during Phase I, we conducted (1) a survey to investigate preferences of young adults in the UAE for mobile games for stress relief; (2) an analysis of serious games for anxiety; and (3) interviews with mental health professionals and young adults in the UAE. In Phase II, five experts tested the usability of the developed app using a set of Nielsen?s usability heuristics. Results: A fully functional biofeedback-based app with serious games was co-designed with mental health professionals. The app included 4 games (ie, a biofeedback game, card game, arcade game, and memory game), 2 relaxation techniques (ie, a breathing exercise and yoga videos), and 2 additional features (ie, positive messaging and a mood tracking calendar). The results of Phase II showed that the developed app is efficient, simple, and easy to use. Overall, the app design scored an average of 4 out of 5. Conclusions: The elicitation techniques used in Phase I resulted in the development of an easy-to-use app for the self-management of anxiety. Further research is required to determine the app?s usability and effectiveness in the target population. UR - https://games.jmir.org/2022/3/e36936 UR - http://dx.doi.org/10.2196/36936 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916692 ID - info:doi/10.2196/36936 ER - TY - JOUR AU - Schönfeld, Simone AU - Rathmer, Ines AU - Michaelsen, M. Maren AU - Hoetger, Cosima AU - Onescheit, Miriam AU - Lange, Silke AU - Werdecker, Lena AU - Esch, Tobias PY - 2022/8/2 TI - Effects of a Mindfulness Intervention Comprising an App, Web-Based Workshops, and a Workbook on Perceived Stress Among Nurses and Nursing Trainees: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e37195 VL - 11 IS - 8 KW - nurses KW - nursing trainee KW - nursing student KW - acute care KW - inpatient KW - health promotion KW - mindfulness KW - mobile KW - web-based KW - stress KW - mobile phone N2 - Background: Previous research has found digitally supported mindfulness interventions to be effective when used for stress management among workers in high-stress occupations. Findings on digitally supported mindfulness interventions among nurses working in acute inpatient care settings are heterogeneous, lack long-term follow-up, and do not assess adherence and acceptability. Objective: This study aimed to investigate the effectiveness and efficacy of a digitally supported mindfulness intervention designed to improve health- and work-related outcomes among nurses and nursing trainees working in acute inpatient care settings. Methods: We will conduct a multicenter randomized controlled trial using a wait-list control group design. Randomization will be stratified by hospital and job status (nurse or nursing trainee). Recruitment will take place on the web and offline during the working hours of nurses and nursing trainees. The intervention group will receive a digitally supported mindfulness intervention, which will comprise an app, 2 web-based workshops, and a workbook, whereas the wait-list control group will be scheduled to receive the same intervention 14 weeks later. The 2 web-based workshops will be led by a certified mindfulness-based stress reduction trainer. Nurses will use the app and the workbook independently. Self-report web-based surveys will be conducted on the web at baseline, at 10 weeks after allocation, at 24 weeks after allocation, and at 38 weeks after allocation. Outcomes of interest will include perceived stress (primary outcome), health- and work-related variables, and variables related to adherence and acceptability of the digitally supported mindfulness intervention. We will perform intention-to-treat and per-protocol analyses. Results: Data collection will be completed by the beginning of August 2022. Data analyses will be completed by December 2022. Conclusions: Our study design, including long-term follow-up and the investigation of variables related to adherence and acceptability, will ensure rigorous evaluation of effectiveness and efficacy. Relative to costly in-person intervention efforts, this program may present a cost-effective and potentially highly scalable alternative. Findings regarding effectiveness, efficacy, adherence, and acceptability will inform stakeholders? decisions regarding the implementation of similar interventions to promote the well-being of nurses and nursing trainees, which may, in turn, alleviate detrimental stress-related outcomes (eg, burnout) because of work-related demands. Trial Registration: German Clinical Trials Register DRKS00025997; https://tinyurl.com/433cas7u International Registered Report Identifier (IRRID): DERR1-10.2196/37195 UR - https://www.researchprotocols.org/2022/8/e37195 UR - http://dx.doi.org/10.2196/37195 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916708 ID - info:doi/10.2196/37195 ER - TY - JOUR AU - Ryan, Shíofra AU - Ní Chasaide, Noirín AU - O' Hanrahan, Shane AU - Corcoran, Darragh AU - Caulfield, Brian AU - Argent, Rob PY - 2022/8/1 TI - mHealth Apps for Musculoskeletal Rehabilitation: Systematic Search in App Stores and Content Analysis JO - JMIR Rehabil Assist Technol SP - e34355 VL - 9 IS - 3 KW - mHealth KW - musculoskeletal rehabilitation KW - app KW - home exercise program KW - home exercise KW - telehealth KW - mobile health KW - connected health N2 - Background: The number of mobile health (mHealth) apps released for musculoskeletal (MSK) injury treatment and self-management with home exercise programs (HEPs) has risen rapidly in recent years as digital health interventions are explored and researched in more detail. As this number grows, it is becoming increasingly difficult for users to navigate the market and select the most appropriate app for their use case. It is also unclear what features the developers of these apps are harnessing to support patient self-management and how they fit into clinical care pathways. Objective: The objective of this study was to scope the current market of mHealth apps for MSK rehabilitation and to report on their features, claims, evidence base, and functionalities. Methods: A cross-sectional study of apps for MSK rehabilitation was performed across the iTunes App Store and Google Play Store. Four search terms were used, namely, physiotherapy rehabilitation, physical therapy rehabilitation, rehabilitation exercise, and therapeutic exercise to identify apps, which were then cross-referenced against set selection criteria by 4 reviewers. Each reviewer, where possible, downloaded the app and accessed supplementary literature available on the product to assist in data extraction. Results: A total of 1322 apps were identified. After applying the inclusion and exclusion criteria and removing duplicates, 144 apps were included in the study. Over half (n=81, 56.3%) of the included apps had been released within the past 3 years. Three quarters (n=107, 74.3%) of the apps made no reference to evidence supporting the design or efficacy of the app, with only 11.1% (n=16) providing direct citations to research. Most of the apps did utilize exercise pictures (n=138, 95.8%) or videos (n=97, 67.4%); however, comparatively few harnessed additional features to encourage engagement and support self-management, such as an adherence log (n=66, 45.8%), communication portal (n=32, 22.2%), patient-reported outcome capture (n=36, 25%), or direct feedback (n=57, 39.6%). Of note and concern, many of these apps prescribed generic exercises (n=93, 64.6%) in the absence of individualized input to the user, with few providing specific patient education (n=43, 34%) and safety advice or disclaimers (n=38, 26.4%). Conclusions: The cohort of apps included in this study contained a large heterogeneity of features, so it is difficult for users to identify the most appropriate or effective app. Many apps are missing the opportunity to offer key features that could promote exercise adherence and encourage self-management in MSK rehabilitation. Furthermore, very few developers currently offering products on the market are providing evidence to support the design and efficacy of their technologies. UR - https://rehab.jmir.org/2022/3/e34355 UR - http://dx.doi.org/10.2196/34355 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916688 ID - info:doi/10.2196/34355 ER - TY - JOUR AU - Spears, A. Claire AU - Mhende, Josephine AU - Hawkins, China AU - Do, Van Vuong AU - Hayat, J. Matthew AU - Eriksen, P. Michael AU - Hedeker, Donald AU - Abroms, C. Lorien AU - Wetter, W. David PY - 2022/8/1 TI - Mindfulness-Based Smoking Cessation Delivered Through Telehealth and Text Messaging for Low-Income Smokers: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e35688 VL - 11 IS - 8 KW - mobile health KW - mHealth KW - telehealth KW - SMS text messaging KW - mindfulness KW - smoking cessation KW - tobacco KW - health disparities KW - mobile phone N2 - Background: Tobacco use is the leading cause of preventable morbidity and mortality. Adults with low income and members of certain racial and ethnic minority groups are less likely to quit, and therefore, they experience profound tobacco-related health disparities. Mindfulness training can increase the rates of smoking cessation and lapse recovery, and telehealth and SMS text messaging have the potential to provide more accessible treatment. Objective: This study aims to test the efficacy of delivering mindfulness-based smoking cessation treatment through text messaging (iQuit Mindfully) and telehealth (group videoconferencing), both as stand-alone interventions and in combination. In addition, it aims to examine the underlying mechanisms of mindfulness treatment. Methods: In this 2×2 randomized controlled trial, participants are randomized into 1 of 4 groups based on assignment to iQuit Mindfully text messages (yes or no) and mindfulness videoconference groups (yes or no). The primary outcomes are biochemically verified smoking abstinence at 8, 12, and 24 weeks after the start of treatment. Secondary outcomes include the frequency of home mindfulness practice and self-reported levels of mindfulness, emotions, craving, withdrawal, dependence, self-efficacy, and social support. Results: Recruitment, treatment, and assessment began in spring and summer 2021, and data collection is expected to continue through spring 2024. Conclusions: This project aims to improve smoking cessation outcomes for low-income, racially and ethnically diverse smokers through mindfulness-based telehealth group counseling and text messaging support. We also aim to advance the scientific study of the mechanisms of action of mindfulness treatment, which could inform the development of more efficacious and efficient treatments to reduce tobacco disparities. Trial Registration: Clinicaltrials.gov NCT04965181; https://clinicaltrials.gov/ct2/show/NCT04965181 International Registered Report Identifier (IRRID): PRR1-10.2196/35688 UR - https://www.researchprotocols.org/2022/8/e35688 UR - http://dx.doi.org/10.2196/35688 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916707 ID - info:doi/10.2196/35688 ER - TY - JOUR AU - Moore, C. Raeanne AU - Parrish, M. Emma AU - Van Patten, Ryan AU - Paolillo, Emily AU - Filip, F. Tess AU - Bomyea, Jessica AU - Lomas, Derek AU - Twamley, W. Elizabeth AU - Eyler, T. Lisa AU - Depp, A. Colin PY - 2022/7/29 TI - Initial Psychometric Properties of 7 NeuroUX Remote Ecological Momentary Cognitive Tests Among People With Bipolar Disorder: Validation Study JO - J Med Internet Res SP - e36665 VL - 24 IS - 7 KW - neuropsychology KW - mobile health KW - ambulatory assessment KW - ecological momentary assessment KW - practice effects KW - validity KW - testing KW - serious mental illness KW - mobile phone N2 - Background: As smartphone technology has become nearly ubiquitous, there is a growing body of literature suggesting that ecological momentary cognitive testing (EMCT) offers advantages over traditional pen-and-paper psychological assessment. We introduce a newly developed platform for the self-administration of cognitive tests in ecologically valid ways. Objective: The aim of this study is to develop a Health Insurance Portability and Accountability Act?compliant EMCT smartphone-based platform for the frequent and repeated testing of cognitive abilities in everyday life. This study examines the psychometric properties of 7 mobile cognitive tests covering domains of processing speed, visual working memory, recognition memory, and response inhibition within our platform among persons with and without bipolar disorder (BD). Ultimately, if shown to have adequate psychometric properties, EMCTs may be useful in research on BD and other neurological and psychiatric illnesses. Methods: A total of 45 persons with BD and 21 demographically comparable healthy volunteer participants (aged 18-65 years) completed smartphone-based EMCTs 3 times daily for 14 days. Each EMCT session lasted approximately 1.5 minutes. Only 2 to 3 tests were administered in any given session, no test was administered more than once per day, and alternate test versions were administered in each session. Results: The mean adherence to the EMCT protocol was 69.7% (SD 20.5%), resulting in 3965 valid and complete tests across the full sample. Participants were significantly more likely to miss tests on later versus earlier study days. Adherence did not differ by diagnostic status, suggesting that BD does not interfere with EMCT participation. In most tests, age and education were related to EMCT performance in expected directions. The average performances on most EMCTs were moderately to strongly correlated with the National Institutes of Health Toolbox Cognition Battery. Practice effects were observed in 5 tests, with significant differences in practice effects by BD status in 3 tests. Conclusions: Although additional reliability and validity data are needed, this study provides initial psychometric support for EMCTs in the assessment of cognitive performance in real-world contexts in BD. UR - https://www.jmir.org/2022/7/e36665 UR - http://dx.doi.org/10.2196/36665 UR - http://www.ncbi.nlm.nih.gov/pubmed/35904876 ID - info:doi/10.2196/36665 ER - TY - JOUR AU - Conley, S. Colleen AU - Raposa, B. Elizabeth AU - Bartolotta, Kate AU - Broner, E. Sarah AU - Hareli, Maya AU - Forbes, Nicola AU - Christensen, M. Kirsten AU - Assink, Mark PY - 2022/7/29 TI - The Impact of Mobile Technology-Delivered Interventions on Youth Well-being: Systematic Review and 3-Level Meta-analysis JO - JMIR Ment Health SP - e34254 VL - 9 IS - 7 KW - meta-analysis KW - mental health KW - well-being KW - intervention KW - treatment KW - youth KW - technology KW - smartphone KW - mobile phone KW - app KW - mobile health N2 - Background: Rates of mental health problems among youth are high and rising, whereas treatment seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be promising avenues for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples have primarily been limited to computer and internet interventions, whereas meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, have primarily focused on adult samples. Objective: This study aimed to evaluate the effectiveness of mTDIs for a broad range of well-being outcomes in unselected, at-risk, and clinical samples of youth. Methods: The systematic review used 5 major search strategies to identify 80 studies evaluating 83 wellness- and mental health-focused mTDIs for 19,748 youth (mean age 2.93-26.25 years). We conducted a 3-level meta-analysis on the full sample and a subsample of the 38 highest-quality studies. Results: Analyses demonstrated significant benefits of mTDIs for youth both at posttest (g=0.27) and follow-up (range 1.21-43.14 weeks; g=0.26) for a variety of psychosocial outcomes, including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by the type of comparison group (strongest for no intervention, followed by inert placebo or information-only, and only marginal for clinical comparison) but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes; however, effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (eg, tailoring, social elements, or gamification) or support features (eg, orientation, reminders, or coaching), although the use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer suggestion, or clinician referral. Only mTDIs with a clear prescription for frequent use (ie, at least once per week) showed significant effects, although this effect was evident only in the higher-quality subsample. Moderation analyses did not detect statistically significant differences in effect sizes based on the prescribed duration of mTDI use (weeks or sessions), and reporting issues in primary studies limited the analysis of completed duration, thereby calling for improved methodology, assessment, and reporting to clarify true effects. Conclusions: Overall, this study?s findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development of mTDIs for youth, particularly in more naturalistic and ecologically valid settings. UR - https://mental.jmir.org/2022/7/e34254 UR - http://dx.doi.org/10.2196/34254 UR - http://www.ncbi.nlm.nih.gov/pubmed/35904845 ID - info:doi/10.2196/34254 ER - TY - JOUR AU - Holst, Christine AU - Stelzle, Dominik AU - Diep, My Lien AU - Sukums, Felix AU - Ngowi, Bernard AU - Noll, Josef AU - Winkler, Sylvia Andrea PY - 2022/7/28 TI - Improving Health Knowledge Through Provision of Free Digital Health Education to Rural Communities in Iringa, Tanzania: Nonrandomized Intervention Study JO - J Med Internet Res SP - e37666 VL - 24 IS - 7 KW - digital health KW - digital health promotion KW - eHealth KW - mobile health KW - mHealth KW - Tanzania KW - health education KW - HIV/AIDS KW - tuberculosis KW - cysticercosis KW - tapeworm KW - mobile phone N2 - Background: Community health education is one of the most effective measures to increase health literacy worldwide and can contribute to the achievement of specific targets of the Sustainable Development Goal 3. Digitalized health education materials can improve health knowledge as a dimension of health literacy and play an important role in disease prevention in rural sub-Saharan settings. Objective: The objective of this research is to assess the effect of a digital health education intervention on the uptake and retention of knowledge related to HIV/AIDS, tuberculosis (TB), and Taenia solium (neuro)cysticercosis and taeniosis in rural communities in Iringa, Tanzania. Methods: We conducted a nonrandomized intervention study of participants aged 15 to 45 years, randomly selected from 4 villages in Iringa, Tanzania. The intervention consisted of 2 parts. After the baseline assessment, we showed the participants 3 animated health videos on a tablet computer. After a period of 6 months, free access to community information spots (InfoSpots) with an integrated digital health education platform was provided to the intervention villages. Participants in the control group did not receive the intervention. The primary outcome was the difference in disease knowledge between the intervention and control groups, 12 months after baseline. Data were collected using an open-ended questionnaire, with correct or incorrect answers before and after intervention. Results: Between April and May 2019, a total of 600 participants were recruited into the intervention (n=298, 49.7%) or control (n=302, 50.3%) groups. At baseline, no statistically significant differences in knowledge of the target diseases were observed. At 12 months after intervention, knowledge about HIV/AIDS, TB, and T. solium (neuro)cysticercosis and taeniosis was 10.2% (95% CI 5.0%-15.4%), 12% (95% CI 7.7%-16.2%), and 31.5% (95% CI 26.8%-36.2%) higher in the intervention group than in the control group, respectively. In all 4 domains (transmission, symptoms, treatment, and prevention), an increase in knowledge was observed in all the 3 diseases, albeit to varying degrees. The results were adjusted for potential confounders, and the significance of the primary results was maintained in the sensitivity analysis to assess dropouts. The participants who reported using the InfoSpots in the 12-month assessment further increased their knowledge about the target diseases by 6.8% (HIV/AIDS), 7.5% (TB), and 13.9% higher mean proportion of correct answers compared with the participants who did not use the InfoSpots. Conclusions: Digital health education based on animated health videos and the use of free InfoSpots has significant potential to improve health knowledge, especially in rural areas of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597 International Registered Report Identifier (IRRID): RR2-10.2196/25128 UR - https://www.jmir.org/2022/7/e37666 UR - http://dx.doi.org/10.2196/37666 UR - http://www.ncbi.nlm.nih.gov/pubmed/35900820 ID - info:doi/10.2196/37666 ER - TY - JOUR AU - Hoepper, B. Bettina AU - Siegel, R. Kaitlyn AU - Carlon, A. Hannah AU - Kahler, W. Christopher AU - Park, R. Elyse AU - Taylor, Trevor Steven AU - Simpson, V. Hazel AU - Hoeppner, S. Susanne PY - 2022/7/28 TI - Feature-Level Analysis of a Smoking Cessation Smartphone App Based on a Positive Psychology Approach: Prospective Observational Study JO - JMIR Form Res SP - e38234 VL - 6 IS - 7 KW - mHealth KW - smartphone KW - smartphone app KW - smoking KW - smoking cessation KW - nondaily smoking KW - positive psychology KW - happiness KW - positive affect KW - clinical trial KW - feasibility KW - acceptability KW - app usage KW - mobile health N2 - Background: Smoking cessation smartphone apps have emerged as highly accessible tools to support smoking cessation efforts. It is unknown how specific app features contribute to user engagement over time and relate to smoking outcomes. Objective: To provide a feature-level analysis of the Smiling Instead of Smoking app (version 2) and to link feature use to subsequent smoking cessation. Methods: Nondaily smokers (N=100) used the app for a period of 49 days (1 week before quitting and 6 weeks after quitting). Participants self-reported 30-day point-prevalence abstinence at the end of this period and at a 6-month follow up (the survey response rate was 94% and 89% at these points, respectively). Self-reported 30-day point prevalence abstinence rates were 40% at the end of treatment and 56% at the 6-month follow up. The app engaged users in both positive psychology content and traditional behavioral smoking cessation content. The app sent push notifications to prompt participants to complete prescribed content (ie, a ?happiness exercise? every day and a ?behavioral challenge? to use the app?s smoking cessation tools on 15 out of 49 days). Actions that participants took within the app were timestamped and recorded. Results: Participants used the app on 24.7 (SD 13.8) days out of the 49 prescribed days, interacting with the happiness content on more days than the smoking content (23.8, SD 13.8 days vs 17.8, SD 10.3 days; t99=9.28 [2-tailed]; P<.001). The prescribed content was frequently completed (45% of happiness exercises; 57% of behavioral challenges) and ad libitum tools were used on ?7 days. Most participants used each ad libitum smoking cessation tool at least once, with higher use of personalized content (?92% used ?strategies,? ?cigarette log,? ?smoke alarms,? and ?personal reasons?) than purely didactic content (79% viewed ?benefits of quitting smoking?). The number of days participants used the app significantly predicted 30-day point-prevalence abstinence at the end of treatment (odds ratio [OR] 1.05, 95% CI 1.02-1.09; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.008-1.07; P=.01). The number of days participants engaged with the happiness content significantly predicted smoking abstinence at the end of treatment (OR 1.05, 95% CI 1.02-1.08; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.007-1.07; P=.02). This effect was not significant for the number of days participants engaged with the smoking cessation content of the app, either at the end of treatment (OR 1.04, 95% CI 0.996-1.08, P=.08) or at the 6-month follow up (OR 1.02, 95% CI 0.98-1.06; P=.29). Conclusions: Greater app usage predicted greater odds of self-reported 30-day point-prevalence abstinence at both the end of treatment and over the long term, suggesting that the app had a therapeutic benefit. Positive psychology content and prescriptive clarity may promote sustained app engagement over time. Trial Registration: ClinicalTrials.gov NCT03951766; https://clinicaltrials.gov/ct2/show/NCT03951766 UR - https://formative.jmir.org/2022/7/e38234 UR - http://dx.doi.org/10.2196/38234 UR - http://www.ncbi.nlm.nih.gov/pubmed/35900835 ID - info:doi/10.2196/38234 ER - TY - JOUR AU - Johnson, K. Amy AU - Haider, Sadia AU - Nikolajuk, Katie AU - Kuhns, M. Lisa AU - Ott, Emily AU - Motley, Darnell AU - Hill, Brandon AU - Hirschhorn, Lisa PY - 2022/7/28 TI - An mHealth Intervention to Improve Pre-Exposure Prophylaxis Knowledge Among Young Black Women in Family Planning Clinics: Development and Usability Study JO - JMIR Form Res SP - e37738 VL - 6 IS - 7 KW - mHealth KW - adolescent health KW - young Black women KW - pre-exposure prophylaxis KW - HIV KW - mobile health KW - PrEP KW - mobile app N2 - Background: Young Black women between the ages of 18 and 24 years are disproportionately impacted by HIV, yet they have a low self-perception of HIV risk and limited exposure to prevention strategies. Pre-exposure prophylaxis (PrEP) is a safe and effective biomedical HIV prevention strategy for those at risk for HIV infection, but uptake has been slow among cisgender women. Family planning clinics are a primary source of health care access for young women, providing an ideal opportunity to integrate PrEP information and care into existing clinic practices. Objective: The aim of this study was to use a multistage, community-engaged process to develop a mobile health app and to evaluate the feasibility and acceptability of the app. Methods: Using user-centered design, the In the Loop app was developed in collaboration with a community advisory board of young Black women. This study employed a multistage design, which included community-engaged app development, user testing, and evaluation of the app?s feasibility and acceptability. A pre- and postdesign was used to assess the impact of the app on PrEP knowledge immediately after app use. Descriptive statistics (eg, mean, SD, and percentage values) were used to describe the sample, and Wilcoxon matched-pairs signed-ranks test was used to detect changes in PrEP knowledge before and immediately after using the app. Results: A total of 50 sexually active, young Black women, aged 18-24 (mean 21, SD 1.9) years, were enrolled in this study. Analysis comparing scores before and immediately after use of the app revealed a significant increase in PrEP content knowledge scores on a 7-item true or false scale (z=?6.04, P<.001). Overall, participants considered the In the Loop app feasible and acceptable to use while waiting for a family planning visit. The majority of participants (n=46, 92%) agreed that they would recommend In the Loop to friends to learn more about PrEP. Participants rated the overall quality of the app 4.3 on a 1-5 scale (1=very poor and 5=very good). Of 50 participants, 40 (80%) agreed that the app was easy to use, and 48 (96%) agreed that they found the information in the app easy to understand. Finally, 40 (80%) agreed that they had enjoyed using the app while waiting for their family planning visit. Conclusions: Our findings suggest that young Black women waiting for family planning visits found the In the Loop app to be feasible and acceptable. This study demonstrates the value of engaging young Black women in the app design process. As family planning clinics are a primary source of health care access for young women, they provide an ideal setting to integrate PrEP information and care into existing clinic practices. Next steps in the development of the In the Loop app include implementing user-suggested improvements and conducting efficacy testing in a randomized controlled trial to determine the app?s impact on PrEP uptake. UR - https://formative.jmir.org/2022/7/e37738 UR - http://dx.doi.org/10.2196/37738 UR - http://www.ncbi.nlm.nih.gov/pubmed/35900830 ID - info:doi/10.2196/37738 ER - TY - JOUR AU - Kunchay, Sahiti AU - Linden-Carmichael, N. Ashley AU - Lanza, T. Stephanie AU - Abdullah, Saeed PY - 2022/7/28 TI - Understanding Design Approaches and Evaluation Methods in mHealth Apps Targeting Substance Use: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e35749 VL - 11 IS - 7 KW - substance use KW - mHealth KW - human-centered design KW - use disorder KW - substance KW - design rationale KW - theoretical framing KW - protocol KW - systematic review KW - mobile health KW - smartphone KW - mobile phone KW - digital health N2 - Background: Substance use and use disorders in the United States have had significant and devastating impacts on individuals and communities. This escalating substance use crisis calls for urgent and innovative solutions to effectively detect and provide interventions for individuals in times of need. Recent mobile health (mHealth)?based approaches offer promising new opportunities to address these issues through ubiquitous devices. However, the design rationales, theoretical frameworks, and mechanisms through which users? perspectives and experiences guide the design and deployment of such systems have not been analyzed in any prior systematic reviews. Objective: In this paper, we systematically review these approaches and apps for their feasibility, efficacy, and usability. Further, we evaluate whether human-centered research principles and techniques guide the design and development of these systems and examine how the current state-of-the-art systems apply to real-world contexts. In an effort to gauge the applicability of these systems, we also investigate whether these approaches consider the effects of stigma and privacy concerns related to collecting data on substance use. Lastly, we examine persistent challenges in the design and large-scale adoption of substance use intervention apps and draw inspiration from other domains of mHealth to suggest actionable reforms for the design and deployment of these apps. Methods: Four databases (PubMed, IEEE Xplore, JMIR, and ACM Digital Library) were searched over a 5-year period (2016-2021) for articles evaluating mHealth approaches for substance use (alcohol use, marijuana use, opioid use, tobacco use, and substance co-use). Articles that will be included describe an mHealth detection or intervention targeting substance use, provide outcomes data, and include a discussion of design techniques and user perspectives. Independent evaluation will be conducted by one author, followed by secondary reviewer(s) who will check and validate themes and data. Results: This is a protocol for a systematic review; therefore, results are not yet available. We are currently in the process of selecting the studies for inclusion in the final analysis. Conclusions: To the best of our knowledge, this is the first systematic review to assess real-world applicability, scalability, and use of human-centered design and evaluation techniques in mHealth approaches targeting substance use. This study is expected to identify gaps and opportunities in current approaches used to develop and assess mHealth technologies for substance use detection and intervention. Further, this review also aims to highlight various design processes and components that result in engaging, usable, and effective systems for substance use, informing and motivating the future development of such systems. International Registered Report Identifier (IRRID): DERR1-10.2196/35749 UR - https://www.researchprotocols.org/2022/7/e35749 UR - http://dx.doi.org/10.2196/35749 UR - http://www.ncbi.nlm.nih.gov/pubmed/35900813 ID - info:doi/10.2196/35749 ER - TY - JOUR AU - Hatem, Sarah AU - Long, C. Janet AU - Best, Stephanie AU - Fehlberg, Zoe AU - Nic Giolla Easpaig, Bróna AU - Braithwaite, Jeffrey PY - 2022/7/26 TI - Mobile Apps for People With Rare Diseases: Review and Quality Assessment Using Mobile App Rating Scale JO - J Med Internet Res SP - e36691 VL - 24 IS - 7 KW - mobile apps KW - self-management KW - social support KW - rare disease KW - mobile phone N2 - Background: Mobile apps are becoming increasingly popular, with 5.70 million apps available in early 2021. Smartphones can provide portable and convenient access to health apps. Here, we consider apps for people with one of the estimated 7000 rare conditions, which are defined as having an incidence of <1 in 2000. The needs of people with rare conditions are known to be different from those of people with more common conditions. The former may be socially isolated (not knowing anyone else who has the condition) and may not be able to find reliable information about the disorder. Objective: The aim of this review is to search for apps developed specifically for people diagnosed with a rare disease and to assess them for quality using the Mobile App Rating Scale (MARS). We examine features that address 6 identified needs of people with a rare disorder and make recommendations for future developers. Methods: Google Play Store (Android) and Apple App Store (iOS) were searched for relevant health-related apps specifically for rare diseases. The search included the names of 10 rare disease groups. App quality was determined using MARS, assessing app engagement, functionality, aesthetics, and information. Results: We found 29 relevant apps (from a total of 2272) addressing 14 rare diseases or disease groups. The most common rare conditions addressed were cystic fibrosis (n=6), hemophilia (n=5), and thalassemia (n=5). The most common app features were web-based information and symptom trackers. The mean MARS score was 3.44 (SD 0.84). Lowest scores were for engagement. Conclusions: Most apps provided factual and visual information, providing tools for self-monitoring and resources to help improve interactions during health consultations. App origin and quality varied greatly. Developers are recommended to consider ways to make appropriate apps more easily identifiable to consumers, to always include high-quality information, improve engagement, provide qualitative evaluations of the app, and include consumers and clinicians in the design. UR - https://www.jmir.org/2022/7/e36691 UR - http://dx.doi.org/10.2196/36691 UR - http://www.ncbi.nlm.nih.gov/pubmed/35881435 ID - info:doi/10.2196/36691 ER - TY - JOUR AU - Rodda, N. Simone AU - Bagot, L. Kathleen AU - Merkouris, S. Stephanie AU - Youssef, George AU - Lubman, I. Dan AU - Thomas, C. Anna AU - Dowling, A. Nicki PY - 2022/7/26 TI - Smartphone App Delivery of a Just-In-Time Adaptive Intervention for Adult Gamblers (Gambling Habit Hacker): Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e38919 VL - 11 IS - 7 KW - Just-In-Time Adaptive Intervention KW - JITAI KW - ecological momentary assessment KW - EMA KW - ecological momentary intervention KW - EMI KW - gambling KW - behavior change technique KW - implementation intentions KW - action planning KW - coping planning KW - microrandomized trial KW - mobile phone N2 - Background: People with gambling problems frequently report repeated unsuccessful attempts to change their behavior. Although many behavior change techniques are available to individuals to reduce gambling harm, they can be challenging to implement or maintain. The provision of implementation support tailored for immediate, real-time, individualized circumstances may improve attempts at behavior change. Objective: We aimed to develop and evaluate a Just-In-Time Adaptive Intervention (JITAI) for individuals who require support to adhere to their gambling limits. JITAI development is based on the principles of the Health Action Process Approach with delivery, in alignment with the principles of self-determination theory. The primary objective was to determine the effect of action- and coping planning compared with no intervention on the goal of subsequently adhering to gambling expenditure limits. Methods: Gambling Habit Hacker is delivered as a JITAI providing in-the-moment support for adhering to gambling expenditure limits (primary proximal outcome). Delivered via a smartphone app, this JITAI delivers tailored behavior change techniques related to goal setting, action planning, coping planning, and self-monitoring. The Gambling Habit Hacker app will be evaluated using a 28-day microrandomized trial. Up to 200 individuals seeking support for their own gambling from Australia and New Zealand will set a gambling expenditure limit (ie, goal). They will then be asked to complete 3 time-based ecological momentary assessments (EMAs) per day over a 28-day period. EMAs will assess real-time adherence to gambling limits, strength of intention to adhere to goals, goal self-efficacy, urge self-efficacy, and being in high-risk situations. On the basis of the responses to each EMA, participants will be randomized to the control (a set of 25 self-enactable strategies containing names only and no implementation information) or intervention (self-enactable strategy implementation information with facilitated action- and coping planning) conditions. This microrandomized trial will be supplemented with a 6-month within-group follow-up that explores the long-term impact of the app on gambling expenditure (primary distal outcome) and a range of secondary outcomes, as well as an evaluation of the acceptability of the JITAI via postintervention surveys, app use and engagement indices, and semistructured interviews. This trial has been approved by the Deakin University Human Research Ethics Committee (2020-304). Results: The intervention has been subject to expert user testing, with high acceptability scores. The results will inform a more nuanced version of the Gambling Habit Hacker app for wider use. Conclusions: Gambling Habit Hacker is part of a suite of interventions for addictive behaviors that deliver implementation support grounded in lived experience. This study may inform the usefulness of delivering implementation intentions in real time and in real-world settings. It potentially offers people with gambling problems new support to set their gambling intentions and adhere to their limits. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000497707; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383568 International Registered Report Identifier (IRRID): DERR1-10.2196/38919 UR - https://www.researchprotocols.org/2022/7/e38919 UR - http://dx.doi.org/10.2196/38919 UR - http://www.ncbi.nlm.nih.gov/pubmed/35881441 ID - info:doi/10.2196/38919 ER - TY - JOUR AU - Shrestha, Roman AU - Maviglia, Francesca AU - Altice, L. Frederick AU - DiDomizio, Elizabeth AU - Khati, Antoine AU - Mistler, Colleen AU - Azwa, Iskandar AU - Kamarulzaman, Adeeba AU - Halim, Ab Mohd Akbar AU - Wickersham, A. Jeffrey PY - 2022/7/25 TI - Mobile Health Technology Use and the Acceptability of an mHealth Platform for HIV Prevention Among Men Who Have Sex With Men in Malaysia: Cross-sectional Respondent-Driven Sampling Survey JO - J Med Internet Res SP - e36917 VL - 24 IS - 7 KW - HIV KW - mHealth KW - men who have sex with men KW - mobile phone KW - Malaysia KW - mobile health KW - HIV prevention KW - sexual health KW - public health KW - digital health KW - communication technology KW - health technology KW - technology accessibility KW - smartphone app KW - HIV treatment N2 - Background: The growth in mobile technology access, utilization, and services holds great promise in facilitating HIV prevention efforts through mobile health (mHealth) interventions in Malaysia. Despite these promising trends, there is a dearth of evidence on the use of mHealth platforms that addresses HIV prevention among Malaysian men who have sex with men. Objective: The goal of this study was to gain insight into (1) access and utilization of communication technology (eg, landline phone, internet, mobile phone), (2) acceptability of mHealth-based interventions for HIV prevention services, and (3) preferences regarding the format and frequency of mHealth interventions among Malaysian men who have sex with men. Methods: We conducted a cross-sectional survey with Malaysian men who have sex with men between July 2018 and March 2020. Participants were recruited using respondent-driven sampling in the Greater Kuala Lumpur region of Malaysia. We collected information on demographic characteristics, HIV risk-related behaviors, access to and the frequency of use of communication technology, and acceptability of using mHealth for HIV prevention using a self-administered questionnaire with a 5-point scale (1, never; 2, rarely; 3, sometimes; 4, often; 5, all the time). Results: A total of 376 men participated in the survey. Almost all respondents owned or had access to a smartphone with internet access (368/376, 97.9%) and accessed the internet daily (373/376, 99.2%), mainly on a smartphone (334/376, 88.8%). Participants on average used smartphones primarily for social networking (mean 4.5, SD 0.8), followed by sending or receiving emails (mean 4.0, SD 1.0), and searching for health-related information (mean 3.5, SD 0.9). There was high acceptance of the use of mHealth for HIV prevention (mean 4.1, SD 1.5), including for receiving HIV prevention information (345/376, 91.8%), receiving medication reminders (336/376, 89.4%), screening and monitoring sexual activity (306/376, 81.4%) or illicit drug use (281/376, 74.7%), and monitoring drug cravings (280/376, 74.5%). Participants overwhelmingly preferred a smartphone app over other modalities (eg, text, phone call, email) for engaging in mHealth HIV prevention tools. Preference for app notifications ranged from 186/336 (53.9%), for receiving HIV prevention information, to 212/336 (69.3%), for screening and monitoring sexual activity. Acceptance of mHealth was higher for those who were university graduates (P=.003), living in a relationship with a partner (P=.04), engaged in sexualized drug use (P=.01), and engaged in receptive anal sex (P=.006). Conclusions: Findings from this study provide support for developing and deploying mHealth strategies for HIV prevention using a smartphone app in men who have sex with men?a key population with suboptimal engagement in HIV prevention and treatment. UR - https://www.jmir.org/2022/7/e36917 UR - http://dx.doi.org/10.2196/36917 UR - http://www.ncbi.nlm.nih.gov/pubmed/35877172 ID - info:doi/10.2196/36917 ER - TY - JOUR AU - Kirkwood, K. Elizabeth AU - Clymer, Caitlin AU - Imbulana, Kheminda AU - Mozumder, Sumaya AU - Dibley, J. Michael AU - Alam, Ashraful Neeloy PY - 2022/7/21 TI - The Role of mHealth Interventions in Changing Gender Relations: Systematic Review of Qualitative Findings JO - JMIR Hum Factors SP - e32330 VL - 9 IS - 3 KW - mobile health KW - mHealth KW - gender relations KW - systematic review KW - low- and middle-income countries KW - mobile phone N2 - Background: The rapid and widespread growth of mobile technologies in low- and middle-income countries can offer groundbreaking ways of disseminating public health interventions. However, gender-based inequalities present a challenge for women in accessing mobile technology. Research has shown that mobile health (mHealth) interventions can affect gender relations in both positive and negative ways; however, few mHealth programs use a gender-sensitive lens when designing, implementing, or analyzing programs. Objective: This systematic review aims to identify and summarize the findings of qualitative research studies that explore the impact of mHealth interventions on gender relations as a result of participating in such initiatives in low- and middle-income countries. Methods: We performed a systematic literature review to examine empirical evidence of changes in gender relations attributed to participation in an mHealth intervention in low- and middle-income countries. Peer-reviewed articles were included based on whether they evaluated an mHealth intervention and were published between 2013 and 2020. Articles using mHealth that solely targeted health workers, did not assess a specific intervention, used mobile technology for data collection only, or were formative or exploratory in nature were excluded. The search terms were entered into 4 key electronic databases?MEDLINE, EMBASE, PsycINFO, and Scopus?generating a comprehensive list of potentially relevant peer-reviewed articles. Thematic analysis was used to identify, analyze, and report the themes that emerged from our data. Results: Of the 578 full-text articles retrieved, 14 (2.4%) were eligible for inclusion in the study. None of the articles appraised gender from the outset. The articles uncovered findings on gender relations through the course of the intervention or postprogram evaluation. Most studies took place in sub-Saharan Africa, with the remainder in South and Southeast Asia. The articles focused on maternal and child health, HIV diagnosis and treatment, and reproductive health. This review found that mHealth programs could enhance spousal communication, foster emotional support between couples, improve women?s self-efficacy and autonomy in seeking health information and services, and increase their involvement in health-related decision-making. Despite the positive impacts, some mHealth interventions had an adverse effect, reinforcing the digital divide, upholding men as gatekeepers of information and sole decision-makers, and exacerbating relationship problems. Conclusions: These results suggest that given the rapid and persistent upscale of mHealth interventions in low- and middle-income settings, it is imperative to design interventions that consider their impact on power dynamics and gender relations. Future research is needed to fill the evidence gaps on gender and mHealth, acknowledging that women are not passive beneficiaries and that they need to actively participate and be empowered by mHealth interventions. UR - https://humanfactors.jmir.org/2022/3/e32330 UR - http://dx.doi.org/10.2196/32330 UR - http://www.ncbi.nlm.nih.gov/pubmed/35862143 ID - info:doi/10.2196/32330 ER - TY - JOUR AU - C Braga, Bianca AU - Nguyen, H. Phuong AU - Aberman, Noora-Lisa AU - Doyle, Frank AU - Folson, Gloria AU - Hoang, Nga AU - Huynh, Phuong AU - Koch, Bastien AU - McCloskey, Peter AU - Tran, Lan AU - Hughes, David AU - Gelli, Aulo PY - 2022/7/21 TI - Exploring an Artificial Intelligence?Based, Gamified Phone App Prototype to Track and Improve Food Choices of Adolescent Girls in Vietnam: Acceptability, Usability, and Likeability Study JO - JMIR Form Res SP - e35197 VL - 6 IS - 7 KW - adolescent KW - dietary quality KW - food choice KW - gamification KW - low- and middle-income country KW - smartphone app KW - mobile phone N2 - Background: Adolescents? consumption of healthy foods is suboptimal in low- and middle-income countries. Adolescents? fondness for games and social media and the increasing access to smartphones make apps suitable for collecting dietary data and influencing their food choices. Little is known about how adolescents use phones to track and shape their food choices. Objective: This study aimed to examine the acceptability, usability, and likability of a mobile phone app prototype developed to collect dietary data using artificial intelligence?based image recognition of foods, provide feedback, and motivate users to make healthier food choices. The findings were used to improve the design of the app. Methods: A total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory. Results: Adolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users? medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app?s feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent?s feedback to improve its acceptability, usability, and likability. Conclusions: A phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale. UR - https://formative.jmir.org/2022/7/e35197 UR - http://dx.doi.org/10.2196/35197 UR - http://www.ncbi.nlm.nih.gov/pubmed/35862147 ID - info:doi/10.2196/35197 ER - TY - JOUR AU - Bito, Seiji AU - Hayashi, Yachie AU - Fujita, Takanori AU - Yonemura, Shigeto PY - 2022/7/20 TI - Public Attitudes Regarding Trade-offs Between the Functional Aspects of a Contact-Confirming App for COVID-19 Infection Control and the Benefits to Individuals and Public Health: Cross-sectional Survey JO - JMIR Form Res SP - e37720 VL - 6 IS - 7 KW - internet questionnaire survey KW - contact-confirming app KW - COVID-19 KW - privacy KW - ethics in public health KW - health application KW - application development KW - health service KW - mobile phone KW - survey platform KW - public health KW - digital information KW - health information N2 - Background: It is expected that personal health information collected through mobile information terminals will be used to develop health strategies that benefit the public. Against this background, several countries have actively attempted to use mobile phones to control infectious diseases. These collected data, such as activity logs and contact history, are countermeasures against diseases such as COVID-19. In Japan, the Ministry of Health, Labor, and Welfare has developed and disseminated a contact-confirming app (COVID-19 Contact-Confirming Application [COCOA]) to the public, which detects and notifies individuals whether they have been near someone who had subsequently tested positive for COVID-19. However, there are concerns about leakage and misuse of the personal information collected by such information terminals. Objective: This study aimed to investigate the possible trade-off between effectiveness in preventing infectious diseases and infringement of personal privacy in COCOA. In addition, we analyzed whether resistance to COCOA would reduce if the app contributed to public health or if a discount was provided on mobile phone charges. Methods: A cross-sectional, quantitative survey of Japanese citizens was conducted using Survey Monkey, a general-purpose web-based survey platform. When developing the questions for the questionnaire, we included the installation status of COCOA and recorded the anxiety stemming from the potential leakage or misuse of personal information collected for COVID-19 infection control. The respondents were asked to rate various factors to determine their perceptions on a 5-point scale. Results: In total, 1058 participants were included in the final analysis. In response to the question of whether the spread of the disease was being controlled by the infection control measures taken by the government, 25.71% (272/1058) of the respondents answered that they strongly agreed or agreed. One-quarter of the respondents indicated that they had already installed COCOA. This study found that the sense of resistance to government intervention was not alleviated by the benefits provided to individuals when using the app. The only factors that were positively associated with the response absolutely opposed to use of the app, even with a discount on mobile phone use charges, were those regarding leaks and misuse of personal information, which was true for all functions (function A: odds ratio [OR] 1.8, 95% CI 1.3-2.4; function B: OR 1.9, 95% CI 1.5-2.6; function C: OR 1.8, 95% CI 1.4-2.4). Conclusions: Public organizations need to emphasize the general benefits of allowing them to manage personal information and assure users that this information is being managed safely rather than offering incentives to individuals to provide such personal information. When collecting and using citizens? health information, it is essential that governments and other entities focus on contributing to the public good and ensuring safety rather than returning benefits to individual citizens. UR - https://formative.jmir.org/2022/7/e37720 UR - http://dx.doi.org/10.2196/37720 UR - http://www.ncbi.nlm.nih.gov/pubmed/35610182 ID - info:doi/10.2196/37720 ER - TY - JOUR AU - Giebel, Denk Godwin AU - Schrader, Frederik Nils AU - Speckemeier, Christian AU - Abels, Carina AU - Börchers, Kirstin AU - Wasem, Jürgen AU - Blase, Nikola AU - Neusser, Silke PY - 2022/7/20 TI - Quality Assessment of Digital Health Applications: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e36974 VL - 11 IS - 7 KW - digital health application KW - mHealth KW - mHealth app KW - quality assurance KW - quality assessment KW - mobile health KW - application KW - protocol KW - app KW - digital health KW - telehealth KW - eHealth N2 - Background: All over the world, development and usage of mobile health (mHealth) apps is increasing. While apps offer numerous opportunities to improve health care, there are associated problems that differ significantly from those of traditional health care services. Further investigations on the quality of mHealth apps are needed to address these problems. Objective: This study aims to identify and map research on quality assessment and quality assurance of mHealth apps and their transferability to continuous quality assurance of mHealth apps. Methods: The scoping review will follow published methodological frameworks for scoping studies as well as Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews criteria. Electronic databases (Medline, EMBASE, and PsycINFO), reference lists of relevant articles, and websites of relevant institutions will be searched. Two reviewers will independently assess eligibility of articles. Therefore, a 2-stage (title and abstract, followed by full text) screening process was conducted. Quality management systems and quality assessment tools will be analyzed and included in our review. Particular focus is placed on quality dimensions. Results: This scoping review provides an overview of the available evidence and identifies research gaps regarding continuous quality assessment of mHealth apps. Thereby, relevant quality dimensions and criteria can be identified and their eligibility and relevance for the development of a continuous quality assurance system of mHealth apps can be determined. Our results are planned to be submitted to an indexed, peer-reviewed journal in the second half of 2022. Conclusions: This is the first review in the context of continuous quality assurance of mHealth apps. Our results will be used within the research ?Continuous quality assurance of Digital Health Applications? (?QuaSiApps?) project funded by the German Federal Joint Committee. International Registered Report Identifier (IRRID): DERR1-10.2196/36974 UR - https://www.researchprotocols.org/2022/7/e36974 UR - http://dx.doi.org/10.2196/36974 UR - http://www.ncbi.nlm.nih.gov/pubmed/35857359 ID - info:doi/10.2196/36974 ER - TY - JOUR AU - Ahmed, Naheed AU - Boxley, Christian AU - Dixit, Ram AU - Krevat, Seth AU - Fong, Allan AU - Ratwani, M. Raj AU - Wesley, B. Deliya PY - 2022/7/18 TI - Evaluation of a Text Message?Based COVID-19 Vaccine Outreach Program Among Older Patients: Cross-sectional Study JO - JMIR Form Res SP - e33260 VL - 6 IS - 7 KW - vaccine outreach KW - text messaging KW - elderly patients KW - evaluation KW - smartphone KW - text message KW - SMS KW - appointment KW - elderly KW - older adults KW - vaccine KW - effectiveness KW - engagement KW - cross-sectional N2 - Background: COVID-19 vaccines are vital tools in the defense against infection and serious disease due to SARS-CoV-2. There are many challenges to implementing mass vaccination campaigns for large, diverse populations from crafting vaccine promotion messages to reaching individuals in a timely and effective manner. During this unprecedented period, with COVID-19 mass vaccination campaigns essential for protecting vulnerable patient populations and attaining herd immunity, health care systems were faced with the dual challenges of vaccine outreach and distribution. Objective: The aim of this cross-sectional study was to assess the effectiveness of a COVID-19 vaccine text outreach approach for patients aged 65 years and older. Our goal was to determine whether this approach was successful in scheduling patients for COVID-19 vaccine appointments. Methods: We developed SMS text messages using the Tavoca platform. These messages informed patients of their vaccine eligibility and allowed them to indicate their interest in scheduling an appointment via a specific method (email or phone) or indicate their lack of interest in the vaccine. We tracked the status of these messages and how patients responded. Messages were sent to patients aged 65 years and older (N=30,826) at a nonprofit health care system in Washington, DC. Data were collected and examined from January 14 to May 10, 2021. Data were analyzed using multivariate multinomial and binary logistic regression models in SAS (version 9.4; SAS Institute Inc). Results: Approximately 57% of text messages were delivered to patients, but many messages received no response from patients (40%). Additionally, 42.1% (12,978/30,826) of messages were not delivered. Of the patients who expressed interest in the vaccine (2938/30,826, 9.5%), Black or African American patients preferred a phone call rather than an email for scheduling their appointment (odds ratio [OR] 1.69, 95% CI 1.29-2.21) compared to White patients. Patients aged 70-74 years were more likely to schedule an appointment (OR 1.38, 95% CI 1.01-1.89) than those aged 65-69 years, and Black or African American patients were more likely to schedule an appointment (OR 2.90, 95% CI 1.72-4.91) than White patients. Conclusions: This study provides insights into some advantages and challenges of using a text messaging vaccine outreach for patients aged 65 years and older. Lessons learned from this vaccine campaign underscore the importance of using multiple outreach methods and sharing of patient vaccination status between health systems, along with a patient-centered approach to address vaccine hesitancy and access issues. UR - https://formative.jmir.org/2022/7/e33260 UR - http://dx.doi.org/10.2196/33260 UR - http://www.ncbi.nlm.nih.gov/pubmed/35724339 ID - info:doi/10.2196/33260 ER - TY - JOUR AU - Norden, Matthias AU - Hofmann, Gerard Amin AU - Meier, Martin AU - Balzer, Felix AU - Wolf, T. Oliver AU - Böttinger, Erwin AU - Drimalla, Hanna PY - 2022/7/15 TI - Inducing and Recording Acute Stress Responses on a Large Scale With the Digital Stress Test (DST): Development and Evaluation Study JO - J Med Internet Res SP - e32280 VL - 24 IS - 7 KW - stress induction KW - smartphone KW - stress reactivity KW - Trier Social Stress Test KW - TSST KW - remote KW - video recording KW - acute stress KW - digital health KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Valuable insights into the pathophysiology and consequences of acute psychosocial stress have been gained using standardized stress induction experiments. However, most protocols are limited to laboratory settings, are labor-intensive, and cannot be scaled to larger cohorts or transferred to daily life scenarios. Objective: We aimed to provide a scalable digital tool that enables the standardized induction and recording of acute stress responses in outside-the-laboratory settings without any experimenter contact. Methods: On the basis of well-described stress protocols, we developed the Digital Stress Test (DST) and evaluated its feasibility and stress induction potential in a large web-based study. A total of 284 participants completed either the DST (n=103; 52/103, 50.5% women; mean age 31.34, SD 9.48 years) or an adapted control version (n=181; 96/181, 53% women; mean age 31.51, SD 11.18 years) with their smartphones via a web application. We compared their affective responses using the international Positive and Negative Affect Schedule Short Form before and after stress induction. In addition, we assessed the participants? stress-related feelings indicated in visual analogue scales before, during, and after the procedure, and further analyzed the implemented stress-inducing elements. Finally, we compared the DST participants? stress reactivity with the results obtained in a classic stress test paradigm using data previously collected in 4 independent Trier Social Stress Test studies including 122 participants overall. Results: Participants in the DST manifested significantly higher perceived stress indexes than the Control-DST participants at all measurements after the baseline (P<.001). Furthermore, the effect size of the increase in DST participants? negative affect (d=0.427) lay within the range of effect sizes for the increase in negative affect in the previously conducted Trier Social Stress Test experiments (0.281-1.015). Conclusions: We present evidence that a digital stress paradigm administered by smartphone can be used for standardized stress induction and multimodal data collection on a large scale. Further development of the DST prototype and a subsequent validation study including physiological markers are outlined. UR - https://www.jmir.org/2022/7/e32280 UR - http://dx.doi.org/10.2196/32280 UR - http://www.ncbi.nlm.nih.gov/pubmed/35838765 ID - info:doi/10.2196/32280 ER - TY - JOUR AU - Lim, Xiang Wei AU - Fook-Chong, Stephanie AU - Lim, Wah John AU - Gan, Hoe Wee PY - 2022/7/15 TI - The Outcomes of App-Based Health Coaching to Improve Dietary Behavior Among Nurses in a Tertiary Hospital: Pilot Intervention Study JO - JMIR Nursing SP - e36811 VL - 5 IS - 1 KW - smartphone app KW - weight loss KW - dietary behavior KW - nurse KW - app KW - mobile health KW - mHealth KW - app-based health KW - health coaching KW - diet KW - dietary choice N2 - Background: At the workplace, health care workers face multiple challenges in maintaining healthy dietary behaviors, which is the major factor behind obesity. A hospital-wide mass health screening exercise showed an increasing trend in the prevalence of obesity and median BMI from 2004 to 2019, as well as a higher crude obesity rate among shift workers. Objective: We aimed to evaluate the effectiveness of mobile app?based health coaching and incentives for achieving weight loss from better dietary choices among hospital nurses. Methods: We conducted a pilot study from June 2019 to March 2020, involving the use of a health-coaching app by 145 hospital nurses over 6 months. Weight and BMI were self-reported, and food scores were calculated. Data among overweight nurses, shift work nurses, and incentive groups were analyzed. Results: A total of 61 nurses were included in the final analysis. Of these 61 nurses, 38 (62%) lost weight. The median percentage weight loss was 1.2% (IQR 0%-2.9%; P<.001), and the median decrease in BMI was 0.35 (IQR ?0.15 to 0.82; P<.001), but they were not clinically significant. The median improvement in the food score was 0.4 (IQR 0-0.8). There was no difference between the incentive and nonincentive groups. A total of 49 (34%) participants engaged for ?8 weeks. Conclusions: The study demonstrated an association between the use of app-based health coaching and the attainment of some weight loss in nurses, without a significant improvement in the food score. Incentives may nudge on-boarding, but do not sustain engagement. UR - https://nursing.jmir.org/2022/1/e36811 UR - http://dx.doi.org/10.2196/36811 UR - http://www.ncbi.nlm.nih.gov/pubmed/35838811 ID - info:doi/10.2196/36811 ER - TY - JOUR AU - Bao, Yuhan AU - Wang, Chunxiang AU - Xu, Haiping AU - Lai, Yongjie AU - Yan, Yupei AU - Ma, Yuanyuan AU - Yu, Ting AU - Wu, Yibo PY - 2022/7/14 TI - Effects of an mHealth Intervention for Pulmonary Tuberculosis Self-management Based on the Integrated Theory of Health Behavior Change: Randomized Controlled Trial JO - JMIR Public Health Surveill SP - e34277 VL - 8 IS - 7 KW - ITHBC KW - mHealth KW - RCT KW - pulmonary tuberculosis N2 - Background: Improving the health self-management level of patients with tuberculosis (TB) is significant for reducing drug resistance, improving the cure rate, and controlling the prevalence of TB. Mobile health (mHealth) interventions based on behavioral science theories may be promising to achieve this goal. Objective: This study aims to explore and conduct an mHealth intervention based on the Integrated Theory of Health Behavior Change (ITHBC) in patients with pulmonary TB to increase their ability of self-care management. Methods: A prospective randomized controlled study was conducted from May to November 2020. A total of 114 patients who were admitted consecutively to the TB clinic of Harbin Chest Hospital, China from May 2020 to August 2020 were recruited by convenience sampling. Patients were divided into the control group and intervention group, and all received a 3-month intervention. Patients in the intervention group and the control group received routine medical and nursing care in the TB clinic, including the supervision of their medications. In addition, pharmacist-assisted mHealth (WeChat) intervention based on the ITHBC theory about TB management was provided to the intervention group. The primary outcome was self-management behavior, while the secondary outcomes were TB awareness, self-efficacy, social support, and degree of satisfaction with health education. The outcomes were measured using web-based self-designed and standard questionnaires administered at baseline and at the end point of the study. Intergroup data were assessed using the Mann-Whitney U test, whereas intragroup data were assessed with the Wilcoxon test (for paired samples). Results: A total of 112 patients (59 in intervention group and 53 in control group) completed the study. After the intervention, a statistically significant increase was noted in the scores of each item of self-care management behaviors compared with the scores at the baseline (P<.001) in the intervention group. The scores of all self-care management behaviors of the control group were lower than those of all self-care management behaviors in the intervention group (all P<.05), except for the item ?cover your mouth and nose when coughing or sneezing? (P=.23) and item ?wash hands properly? (P=.60), which had no statistically significant difference from those in the intervention group. Compared with those at baseline, TB knowledge awareness, self-efficacy, social support, and degree of satisfaction with health education in the intervention group increased significantly (P<.001), and the intervention group had significantly higher scores than the control group (P<.001). Conclusions: mHealth intervention for TB self-management based on ITHBC could deepen the understanding of patients with TB about their disease and improve their objective initiative and self-care management behaviors, which were beneficial for promoting compliance behavior and quality of prevention and control for pulmonary TB. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055557; https://tinyurl.com/4ray3xnw UR - https://publichealth.jmir.org/2022/7/e34277 UR - http://dx.doi.org/10.2196/34277 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834302 ID - info:doi/10.2196/34277 ER - TY - JOUR AU - Gustafson Sr, David AU - Horst, Julie AU - Boss, Deanne AU - Fleddermann, Kathryn AU - Jacobson, Nora AU - Roosa, Mathew AU - Ross, Charles J. AU - Gicquelais, Rachel AU - Vjorn, Olivia AU - Siegler, Tracy AU - Molfenter, Todd PY - 2022/7/14 TI - Implementation of Smartphone Systems to Improve Quality of Life for People With Substance Use Disorder: Interim Report on a Randomized Controlled Trial JO - JMIR Hum Factors SP - e35125 VL - 9 IS - 3 KW - mobile technology KW - coaching KW - substance use disorder (SUD) treatment KW - technology implementation model KW - NIATx N2 - Background: Researchers have conducted numerous studies seeking to understand how to improve the implementation of changes in health care organizations, but less focus has been given to applying lessons already learned from implementation science. Finding innovative ways to apply these findings efficiently and consistently will improve current research on implementation strategies and allow organizations utilizing these techniques to make changes more effectively. Objective: This research aims to compare a practical implementation approach that uses principles from prior implementation studies to more traditional ways of implementing change. Methods: A total of 43 addiction treatment sites in Iowa were randomly assigned to 2 different implementation strategies in a randomized comparative effectiveness trial studying the implementation of an eHealth substance use disorder treatment technology. One strategy used an adaptation of the Network for the Improvement of Addiction Treatment (NIATx) improvement approach, while the other used a traditional product training model. This paper discusses lessons learned about implementation. Results: This midterm report indicates that use of the NIATx approach appears to be leading to improved outcomes on several measures, including initial and sustained use of new technology by both counselors and patients. Additionally, this research indicates that seamlessly integrating organizational changes into existing workflows and using coaching to overcome hurdles and assess progress are important to improve implementation projects. Conclusions: At this interim point in the study, it appears that the use of the NIATx improvement process leads to better outcomes in implementation of changes within health care organizations. Moreover, some strategies used in this improvement process are particularly useful and should be drawn on more heavily in future implementation efforts. Trial Registration: ClinicalTrials.gov NCT03954184; https://clinicaltrials.gov/ct2/show/NCT03954184 UR - https://humanfactors.jmir.org/2022/3/e35125 UR - http://dx.doi.org/10.2196/35125 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834315 ID - info:doi/10.2196/35125 ER - TY - JOUR AU - Naor, Navot AU - Frenkel, Alex AU - Winsberg, Mirène PY - 2022/7/12 TI - Improving Well-being With a Mobile Artificial Intelligence?Powered Acceptance Commitment Therapy Tool: Pragmatic Retrospective Study JO - JMIR Form Res SP - e36018 VL - 6 IS - 7 KW - Acceptance Commitment Therapy KW - well-being KW - WHO-5 KW - World Health Organization-Five Well-Being Index KW - mHealth KW - mobile health KW - smartphone KW - health application KW - mental health KW - quality of life KW - artificial intelligence N2 - Background: Research and dissemination of smartphone apps to deliver coaching and psychological driven intervention had seen a great surge in recent years. Notably, Acceptance Commitment Therapy (ACT) protocols were shown to be uniquely effective in treating symptoms for both depression and anxiety when delivered through smartphone apps. The aim of this study is to expand on that work and test the suitability of artificial intelligence?driven interventions delivered directly through popular texting apps. Objective: This study evaluated our hypothesis that using Kai.ai will result in improved well-being. Methods: We performed a pragmatic retrospective analysis of 2909 users who used Kai.ai on one of the top messaging apps (iMessage, WhatsApp, Discord, Telegram, etc). Users? well-being levels were tracked using the World Health Organization-Five Well-Being Index throughout the engagement with service. A 1-tailed paired samples t test was used to assess well-being levels before and after usage, and hierarchical linear modeling was used to examine the change in symptoms over time. Results: The median well-being score at the last measurement was higher (median 52) than that at the start of the intervention (median 40), indicating a significant improvement (W=2682927; P<.001). Furthermore, HLM results showed that the improvement in well-being was linearly related to the number of daily messages a user sent (?=.029; t81.36=4; P<.001), as well as the interaction between the number of messages and unique number of days (?=?.0003; t81.36=?2.2; P=.03). Conclusions: Mobile-based ACT interventions are effective means to improve individuals? well-being. Our findings further demonstrate Kai.ai?s great promise in helping individuals improve and maintain high levels of well-being and thus improve their daily lives. UR - https://formative.jmir.org/2022/7/e36018 UR - http://dx.doi.org/10.2196/36018 UR - http://www.ncbi.nlm.nih.gov/pubmed/35598216 ID - info:doi/10.2196/36018 ER - TY - JOUR AU - Knowles, Kayla AU - Dowshen, Nadia AU - Lee, Susan AU - Tanner, Amanda PY - 2022/7/12 TI - Developing a Consensus for Adolescent and Young Adult mHealth HIV Prevention Interventions in the United States: A Delphi Method Study JO - JMIR Form Res SP - e25982 VL - 6 IS - 7 KW - HIV prevention and care KW - adolescents KW - mHealth KW - mobile apps KW - Delphi method KW - health application KW - HIV care KW - HIV prevention KW - health intervention KW - public health KW - health care KW - health accessibility KW - health technology KW - digital health KW - HIV N2 - Background: Engaging adolescents and young adults (AYAs) who are at elevated risk for HIV acquisition or who are living with HIV in health care has posed a major challenge in HIV prevention and care efforts. Mobile health (mHealth) interventions are a popular and accessible strategy to support AYA engagement despite barriers to care present along the HIV care continuum. Even with progress in the field of mHealth research, expert recommendations for the process of designing, evaluating, and implementing HIV-related mHealth interventions are underdeveloped. Objective: The aim of this study was to compile expert recommendations on the development, evaluation, and implementation of AYA-focused HIV prevention and care mHealth interventions. Methods: Experts from adolescent mHealth HIV research networks and investigators of recently funded HIV mHealth projects and programs were identified and invited to complete a series of electronic surveys related to the design, implementation, and evaluation of HIV-related mHealth interventions. A modified Delphi method was used to ask experts to score 35 survey items on a 4-point Likert scale from not important to very important and encouraged experts to leave additional comments in textboxes. Responses were reviewed by the researchers, a team of 4 HIV mHealth intervention experts. The average importance ratings from survey responses were calculated and then categorized as retained (high importance), flagged (mid-level importance), or dropped (no/low importance). Additionally, thematic analysis of expert comments helped modify survey items for the next survey round. An evaluation of the level of agreement among experts on the most important items followed each round until consensus was reached. Results: Of the 35 invited experts, 23 completed the first survey representing a variety of roles within a research team. Following two rounds of Delphi surveys, experts scored 24 of the 28 (86%) survey items included in round two as important to very important. The final consensus items included 24 recommendations related to the mHealth intervention design process (n=15), evaluation (n=2), and implementation (n=7). The 3 survey items with the highest average scores focused on the design process, specifically, (1) the creation of a diverse team including researchers, app software developers, and youth representation; (2) the importance of AYA-focused content; and (3) the value of an iterative process. Additionally, experts highlighted the importance of establishing the best ways to collect data and the types of data for collection during the evaluation process as well as constructing a plan for participant technology disruption when implementing an mHealth intervention. Conclusions: The modified Delphi method was a useful tool to convene experts to determine recommendations for AYA-focused HIV prevention and care mHealth interventions. These recommendations can inform future mHealth interventions. To ensure the acceptability, feasibility, and efficacy of these AYA HIV prevention interventions, the focus must be on the specific needs of AYAs by including representation of AYAs in the process, including consistent and relevant content, ensuring appropriate data is collected, and considering technology and health accessibility barriers. UR - https://formative.jmir.org/2022/7/e25982 UR - http://dx.doi.org/10.2196/25982 UR - http://www.ncbi.nlm.nih.gov/pubmed/35819824 ID - info:doi/10.2196/25982 ER - TY - JOUR AU - Khadjesari, Zarnie AU - Brown, J. Tracey AU - Ramsey, T. Alex AU - Goodfellow, Henry AU - El-Toukhy, Sherine AU - Abroms, C. Lorien AU - Jopling, Helena AU - Dierker Viik, Arden AU - Amato, S. Michael PY - 2022/7/11 TI - Novel Implementation Strategy to Electronically Screen and Signpost Patients to Health Behavior Apps: Mixed Methods Implementation Study (OptiMine Study) JO - JMIR Form Res SP - e34271 VL - 6 IS - 7 KW - electronic health record KW - EHR KW - alcohol reduction KW - electronic messages KW - proactive messages KW - proactive outreach KW - smoking cessation KW - tobacco use KW - alcohol use KW - alcohol KW - smoking KW - mobile health KW - mHealth KW - mobile app N2 - Background: Behavior change apps have the potential to provide individual support on a population scale at low cost, but they face numerous barriers to implementation. Electronic health records (EHRs) in acute care hospitals provide a valuable resource for identifying patients at risk, who may benefit from behavior change apps. A novel, emerging implementation strategy is to use digital technologies not only for providing support to help-seeking individuals but also for signposting patients at risk to support services (also called proactive referral in the United States). Objective: The OptiMine study aimed to increase the reach of behavior change apps by implementing electronic signposting for smoking cessation and alcohol reduction in a large, at-risk population that was identified through an acute care hospital EHR. Methods: This 3-phase, mixed methods implementation study assessed the acceptability, feasibility, and reach of electronic signposting to behavior change apps by using a hospital?s EHR system to identify patients who are at risk. Phase 1 explored the acceptability of the implementation strategy among the patients and staff through focus groups. Phase 2 investigated the feasibility of using the hospital EHR to identify patients with target risk behaviors and contact them via SMS text message, email, or patient portal. Phase 3 assessed the impact of SMS text messages sent to patients who were identified as smokers or risky drinkers, which signposted them to behavior change apps. The primary outcome was the proportion of participants who clicked on the embedded link in the SMS text message to access information about the apps. The acceptability of the SMS text messages among the patients who had received them was also explored in a web-based survey. Results: Our electronic signposting strategy?using SMS text messages to promote health behavior change apps to patients at risk?was found to be acceptable and feasible and had good reach. The hospital sent 1526 SMS text messages, signposting patients to either the National Health Service Smokefree or Drink Free Days apps. A total of 13.56% (207/1526) of the patients clicked on the embedded link to the apps, which exceeded our 5% a priori success criterion. Patients and staff contributed to the SMS text message content and delivery approach, which were perceived as acceptable before and after the delivery of the SMS text messages. The feasibility of the SMS text message format was determined and the target population was identified by mining the EHR. Conclusions: The OptiMine study demonstrated the proof of concept for this novel implementation strategy, which used SMS text messages to signpost at-risk individuals to behavior change apps at scale. The level of reach exceeded our a priori success criterion in a non?help-seeking population of patients receiving unsolicited SMS text messages, disconnected from hospital visits. International Registered Report Identifier (IRRID): RR2-10.2196/23669 UR - https://formative.jmir.org/2022/7/e34271 UR - http://dx.doi.org/10.2196/34271 UR - http://www.ncbi.nlm.nih.gov/pubmed/35816374 ID - info:doi/10.2196/34271 ER - TY - JOUR AU - Brandl, C. Lea AU - Liebram, Claudia AU - Schramm, Wendelin AU - Pobiruchin, Monika PY - 2022/7/7 TI - A German Smartphone-Based Self-management Tool for Psoriasis: Community-Driven Development and Evaluation of Quality-of-Life Effects JO - JMIR Form Res SP - e32593 VL - 6 IS - 7 KW - psoriasis KW - self-management KW - mobile apps KW - quality of life KW - mobile phones KW - smartphones N2 - Background: Psoriasis is a chronic disease characterized by inflammation, increased scaling, itching, and other symptoms. Psoriasis is not contagious, but patients have often felt shunned. Therefore, in addition to psoriasis symptoms, stress, anxiety, and depression can also affect quality of life (QoL). Surveys show that only a quarter of patients are satisfied with the success of their therapy. However, in addition to medical therapy, self-management can also make it easier to deal with chronic diseases like psoriasis. Objective: The aim of this project was to develop a smartphone-based self-management tool (SMT) specifically for patients with psoriasis using a community-driven process. The impact of the SMT on QoL as well as its acceptance and usability were evaluated. Methods: In collaboration with an internet-based self-help community, 2 user surveys were conducted to determine the requirements for a smartphone-based SMT. The surveys consisted of semistructured questionnaires asking for desired features in an SMT for psoriasis. A pilot study was conducted to evaluate QoL, acceptance, and usability. Community users were recruited to use the app for 21 days and complete the Dermatology Life Quality Index (DLQI) questionnaire at the beginning (T0) and end (T1). Afterward, participants were asked to complete another questionnaire on usability and ease of use. Results: SMT requirements were collected from 97 members of an internet-based community. The SMT was built as a progressive web app that communicates with a server back end and an Angular web app for content management. The app was used by 15 participants who also provided qualitative feedback, and 10 participants answered all questionnaires. The average DLQI score was 7.1 (SD 6.2) at T0 and 6.9 (SD 6.6) at T1. The minimal required sample size of 27 was not reached. Conclusions: The high degree of community participation in the development process and the responses during the requirement engineering process indicated that there is a general need for an independently developed SMT for patients with psoriasis. However, the feedback received after app use shows that the SMT does not meet the needs of the community. It can be concluded that a more customizable app is needed. The focus and needs of the users were very heterogeneous. Similar developments and research could benefit from the findings of this project. UR - https://formative.jmir.org/2022/7/e32593 UR - http://dx.doi.org/10.2196/32593 UR - http://www.ncbi.nlm.nih.gov/pubmed/35797109 ID - info:doi/10.2196/32593 ER - TY - JOUR AU - Shan, Yi AU - Ji, Meng AU - Xie, Wenxiu AU - Li, Rongying AU - Qian, Xiaobo AU - Zhang, Xiaomin AU - Hao, Tianyong PY - 2022/7/6 TI - Chinese Version of the Mobile Health App Usability Questionnaire: Translation, Adaptation, and Validation Study JO - JMIR Form Res SP - e37933 VL - 6 IS - 7 KW - mHealth app KW - usability KW - Chinese version of MAUQ KW - improved translation KW - validity KW - stability KW - reliability KW - cross-cultural adaptability KW - mobile phone N2 - Background: The usability of mobile health (mHealth) apps needs to be effectively evaluated before they are officially approved to be used to deliver health interventions. To this end, the mHealth App Usability Questionnaire (MAUQ) has been designed and proved valid and reliable in assessing the usability of mHealth apps. However, this English questionnaire needs to be translated into other languages, adapted, and validated before being utilized to evaluate the usability of mHealth apps. Objective: This study aims to improve, further adapt, and validate the Chinese version of the MAUQ (C-MAUQ; interactive for patients) on Left-handed Doctor, one of the most popular ?reaching out to patients? interactive mHealth apps with chatbot function in China, to test the reliability and cross-cultural adaptability of the questionnaire. Methods: The MAUQ (interactive for patients) has been translated into Chinese and validated for its reliability on Good Doctor, one of the most influential ?reaching out to patients? mHealth apps without chatbot function in China. After asking for the researchers? approval to use this Chinese version, we adjusted and further adapted the C-MAUQ by checking it against the original English version and improving its comprehensibility, readability, idiomaticity, and cross-cultural adaptability. Following a trial survey completed by 50 respondents on wenjuanxing, the most popular online questionnaire platform in China, the improved version of the C-MAUQ (I-C-MAUQ) was finally used to evaluate the usability of Left-handed Doctor through an online questionnaire survey (answered by 322 participants) on wenjuanxing, to test its internal consistency, reliability, and validity. Results: The I-C-MAUQ still retained the 21 items and 3 dimensions of the original MAUQ: 8 items for usability and satisfaction, 6 items for system information arrangement, and 7 items for efficiency. The translation problems in the C-MAUQ, including (1) redundancy, (2) incompleteness, (3) misuse of parts of speech, (4) choice of inappropriate words, (5) incomprehensibility, and (6) cultural difference?induced improper translation, were improved. As shown in the analysis of data obtained through the online survey, the I-C-MAUQ had a better internal consistency (ie, the correlation coefficient between the score of each item and the total score of the questionnaire determined within the range of 0.861-0.938; P<.01), reliability (Cronbach ?=.988), and validity (Kaiser?Meyer?Olkin=0.973), compared with the C-MAUQ. It was effectively used to test the usability of Left-handed Doctor, eliciting over 80% of informants? positive attitudes toward this mHealth app. Conclusions: The I-C-MAUQ is highly reliable and valid for Left-handed Doctor, and suitable for testing the usability of interactive mHealth apps used by patients in China. This finding further confirms the cross-cultural validity, reliability, and adaptability of the MAUQ. We identified certain factors influencing the perceived usability of mHealth apps, including users? age, gender, education, profession, and possibly previous experience with mHealth apps and the chatbot function of such apps. Most notably, we found a wider acceptance of this new technology among young Chinese female college students who were more engaged in the interaction with health care chatbots. The age-, gender-, and profession-induced preference for new digital health interventions in China aligns with the findings in other similar studies in America and Malaysia. This preference identifies areas for further research on the social, cultural, and gender adaptation of health technologies. UR - https://formative.jmir.org/2022/7/e37933 UR - http://dx.doi.org/10.2196/37933 UR - http://www.ncbi.nlm.nih.gov/pubmed/35793132 ID - info:doi/10.2196/37933 ER - TY - JOUR AU - Fukaguchi, Kiyomitsu AU - Goto, Tadahiro AU - Yamamoto, Tadatsugu AU - Yamagami, Hiroshi PY - 2022/7/6 TI - Experimental Implementation of NSER Mobile App for Efficient Real-Time Sharing of Prehospital Patient Information With Emergency Departments: Interrupted Time-Series Analysis JO - JMIR Form Res SP - e37301 VL - 6 IS - 7 KW - emergency department KW - emergency medical services KW - mobile apps KW - interrupted time series analysis KW - emergency KW - patient record KW - implementation KW - patient care KW - app KW - implement KW - medical informatics KW - clinical informatics KW - decision support KW - electronic health record KW - eHealth KW - digital health N2 - Background: With the aging society, the number of emergency transportations has been growing. Although it is important that a patient be immediately transported to an appropriate hospital for proper management, accurate diagnosis in the prehospital setting is challenging. However, at present, patient information is mainly communicated by telephone, which has a potential risk of communication errors such as mishearing. Sharing correct and detailed prehospital information with emergency departments (EDs) should facilitate optimal patient care and resource use. Therefore, the implementation of an app that provides on-site, real-time information to emergency physicians could be useful for early preparation, intervention, and effective use of medical and human resources. Objective: In this paper, we aimed to examine whether the implementation of a mobile app for emergency medical service (EMS) would improve patient outcomes and reduce transportation time as well as communication time by phone (ie, phone-communication time). Methods: We performed an interrupted time-series analysis (ITSA) on the data from a tertiary care hospital in Japan from July 2021 to October 2021 (8 weeks before and 8 weeks after the implementation period). We included all patients transported by EMS. Using the mobile app, EMS can send information on patient demographics, vital signs, medications, and photos of the scene to the ED. The outcome measure was inpatient mortality and transportation time, as well as phone-communication time, which was the time for EMS to negotiate with ED staffs for transport requests. Results: During the study period, 1966 emergency transportations were made (n=1033, 53% patients during the preimplementation period and n=933, 47% patients after the implementation period). The ITSA did not reveal a significant decrease in patient mortality and transportation time before and after the implementation. However, the ITSA revealed a significant decrease in mean phone-communication time between pre- and postimplementation periods (from 216 to 171 seconds; ?45 seconds; 95% CI ?71 to ?18 seconds). From the pre- to postimplementation period, the mean transportation time from EMS request to ED arrival decreased by 0.29 minutes (from 36.1 minutes to 35.9 minutes; 95% CI ?2.20 to 1.60 minutes), without change in time trends. We also introduced cases where the app allowed EMS to share accurate and detailed prehospital information with the emergency department, resulting in timely intervention and reducing the burden on the ED. Conclusions: The implementation of a mobile app for EMS was associated with reduced phone-communication time by 45 seconds (22%) without increasing mortality or overall transportation time despite the implementation of new methods in the real clinical setting. In addition, real-time patient information sharing, such as the transfer of monitor images and photos of the accident site, could facilitate optimal patient care and resource use. UR - https://formative.jmir.org/2022/7/e37301 UR - http://dx.doi.org/10.2196/37301 UR - http://www.ncbi.nlm.nih.gov/pubmed/35793142 ID - info:doi/10.2196/37301 ER - TY - JOUR AU - Wagneur, Nicolas AU - Callier, Patrick AU - Zeitoun, Jean-David AU - Silber, Denise AU - Sabatier, Remi AU - Denis, Fabrice PY - 2022/7/5 TI - Assessing a New Prescreening Score for the Simplified Evaluation of the Clinical Quality and Relevance of eHealth Apps: Instrument Validation Study JO - J Med Internet Res SP - e39590 VL - 24 IS - 7 KW - scoring KW - eHealth KW - clinical relevance KW - solution KW - digital solution KW - clinical validation KW - prescreening KW - eHealth app KW - medical digital solution KW - scoring tool KW - health app KW - information quality N2 - Background: In 2020, more than 250 eHealth solutions were added to app stores each day, or 90,000 in the year; however, the vast majority of these solutions have not undergone clinical validation, their quality is unknown, and the user does not know if they are effective and safe. We sought to develop a simple prescreening scoring method that would assess the quality and clinical relevance of each app. We designed this tool with 3 health care stakeholder groups in mind: eHealth solution designers seeking to evaluate a potential competitor or their own tool, investors considering a fundraising candidate, and a hospital clinician or IT department wishing to evaluate a current or potential eHealth solution. Objective: We built and tested a novel prescreening scoring tool (the Medical Digital Solution scoring tool). The tool, which consists of 26 questions that enable the quick assessment and comparison of the clinical relevance and quality of eHealth apps, was tested on 68 eHealth solutions. Methods: The Medical Digital Solution scoring tool is based on the 2021 evaluation criteria of the French National Health Authority, the 2022 European Society of Medical Oncology recommendations, and other provided scores. We built the scoring tool with patient association and eHealth experts and submitted it to eHealth app creators, who evaluated their apps via the web-based form in January 2022. After completing the evaluation criteria, their apps obtained an overall score and 4 categories of subscores. These criteria evaluated the type of solution and domain, the solution?s targeted population size, the level of clinical assessment, and information about the provider. Results: In total, 68 eHealth solutions were evaluated with the scoring tool. Oncology apps (22%, 20/90) and general health solutions (23%, 21/90) were the most represented. Of the 68 apps, 32 (47%) were involved in remote monitoring by health professionals. Regarding clinical outcomes, 5% (9/169) of the apps assessed overall survival. Randomized studies had been conducted for 21% (23/110) of the apps to assess their benefit. Of the 68 providers, 38 (56%) declared the objective of obtaining reimbursement, and 7 (18%) out of the 38 solutions seeking reimbursement were assessed as having a high probability of reimbursement. The median global score was 11.2 (range 4.7-17.4) out of 20 and the distribution of the scores followed a normal distribution pattern (Shapiro-Wilk test: P=.33). Conclusions: This multidomain prescreening scoring tool is simple, fast, and can be deployed on a large scale to initiate an assessment of the clinical relevance and quality of a clinical eHealth app. This simple tool can help a decision-maker determine which aspects of the app require further analysis and improvement. UR - https://www.jmir.org/2022/7/e39590 UR - http://dx.doi.org/10.2196/39590 UR - http://www.ncbi.nlm.nih.gov/pubmed/35788102 ID - info:doi/10.2196/39590 ER - TY - JOUR AU - Burke, E. Lora AU - Sereika, M. Susan AU - Bizhanova, Zhadyra AU - Parmanto, Bambang AU - Kariuki, Jacob AU - Cheng, Jessica AU - Beatrice, Britney AU - Cedillo, Maribel AU - Pulantara, Wayan I. AU - Wang, Yuhan AU - Loar, India AU - Conroy, B. Molly PY - 2022/7/5 TI - The Effect of Tailored, Daily, Smartphone Feedback to Lifestyle Self-Monitoring on Weight Loss at 12 Months: the SMARTER Randomized Clinical Trial JO - J Med Internet Res SP - e38243 VL - 24 IS - 7 KW - self-monitoring KW - behavioral intervention/weight loss KW - feedback messages KW - engagement KW - mHealth KW - adherence KW - obesity KW - randomized clinical trial KW - smart scales KW - physical activity trackers KW - digital health N2 - Background: Self-monitoring (SM) is the centerpiece of behavioral weight loss treatment, but the efficacy of smartphone-delivered SM feedback (FB) has not been tested in large, long-term, randomized trials. Objective: The aim of this study was to establish the efficacy of providing remote FB to diet, physical activity (PA), and weight SM on improving weight loss outcomes when comparing the SM plus FB (SM+FB) condition to the SM-only condition in a 12-month randomized controlled trial. The study was a single-site, population-based trial that took place in southwestern Pennsylvania, USA, conducted between 2018 and 2021. Participants were smartphone users age ?18 years, able to engage in moderate PA, with a mean BMI between 27 and 43 kg/m2. Methods: All participants received a 90-minute, one-to-one, in-person behavioral weight loss counseling session addressing behavioral strategies, establishing participants? dietary and PA goals, and instructing on use of the PA tracker (Fitbit Charge 2), smart scale, and diet SM app. Only SM+FB participants had access to an investigator-developed smartphone app that read SM data, in which an algorithm selected tailored messages sent to the smartphone up to 3 times daily. The SM-only participants did not receive any tailored FB based on SM data. The primary outcome was percent weight change from baseline to 12 months. Secondary outcomes included engagement with digital tools (eg, monthly percentage of FB messages opened and monthly percentage of days adherent to the calorie goal). Results: Participants (N=502) were on average 45.0 (SD 14.4) years old with a mean BMI of 33.7 (SD 4.0) kg/m2. The sample was 79.5% female (n=399/502) and 82.5% White (n=414/502). At 12 months, retention was 78.5% (n=394/502) and similar by group (SM+FB: 202/251, 80.5%; SM: 192/251, 76.5%; P=.28). There was significant percent weight loss from baseline in both groups (SM+FB: ?2.12%, 95% CI ?3.04% to ?1.21%, P<.001; SM: ?2.39%, 95% CI ?3.32% to ?1.47%; P<.001), but no difference between the groups (?0.27%; 95% CI ?1.57% to 1.03%; t =?0.41; P=.68). Similarly, 26.3% (66/251) of the SM+FB group and 29.1% (73/251) of the SM group achieved ?5% weight loss (chi-square value=0.49; P=.49). A 1% increase in FB messages opened was associated with a 0.10 greater percent weight loss at 12 months (b=?0.10; 95% CI ?0.13 to ?0.07; t =?5.90; P<.001). A 1% increase in FB messages opened was associated with 0.12 greater percentage of days adherent to the calorie goal per month (b=0.12; 95% CI 0.07-0.17; F=22.19; P<.001). Conclusions: There were no significant between-group differences in weight loss; however, the findings suggested that the use of commercially available digital SM tools with or without FB resulted in a clinically significant weight loss in over 25% of participants. Future studies need to test additional strategies that will promote greater engagement with digital tools. Trial Registration: Clinicaltrials.gov NCT03367936; https://clinicaltrials.gov/ct2/show/NCT03367936 UR - https://www.jmir.org/2022/7/e38243 UR - http://dx.doi.org/10.2196/38243 UR - http://www.ncbi.nlm.nih.gov/pubmed/35787516 ID - info:doi/10.2196/38243 ER - TY - JOUR AU - Latulippe, Karine AU - Giroux, Dominique AU - Guay, Manon AU - Kairy, Dahlia AU - Vincent, Claude AU - Boivin, Katia AU - Morales, Ernesto AU - Obradovic, Natasa AU - Provencher, Véronique PY - 2022/7/5 TI - Mobile Videoconferencing for Occupational Therapists? Assessments of Patients? Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study JO - JMIR Aging SP - e24376 VL - 5 IS - 3 KW - caregivers KW - feasibility KW - mixed methods KW - mobile videoconferencing KW - mobile phone KW - occupational therapy KW - discharge planning KW - home assessment N2 - Background: Occupational therapists who work in hospitals need to assess patients? home environment in preparation for hospital discharge in order to provide recommendations (eg, technical aids) to support their independence and safety. Home visits increase performance in everyday activities and decrease the risk of falls; however, in some countries, home visits are rarely made prior to hospital discharge due to the cost and time involved. In most cases, occupational therapists rely on an interview with the patient or a caregiver to assess the home. The use of videoconferencing to assess patients? home environments could be an innovative solution to allow better and more appropriate recommendations. Objective: The aim of this study was (1) to explore the added value of using mobile videoconferencing compared with standard procedure only and (2) to document the clinical feasibility of using mobile videoconferencing to assess patients? home environments. Methods: Occupational therapists assessed home environments using, first, the standard procedure (interview), and then, videoconferencing (with the help of a family caregiver located in patients? homes, using an electronic tablet). We used a concurrent mixed methods design. The occupational therapist's responsiveness to telehealth, time spent on assessment, patient?s occupational performance and satisfaction, and major events influencing the variables were collected as quantitative data. The perceptions of occupational therapists and family caregivers regarding the added value of using this method and the nature of changes made to recommendations as a result of the videoconference (if any) were collected as qualitative data, using questionnaires and semistructured interviews. Results: Eight triads (6 occupational therapists, 8 patients, and 8 caregivers) participated. The use of mobile videoconferencing generally led occupational therapists to modify the initial intervention plan (produced after the standard interview). Occupational therapists and caregivers perceived benefits in using mobile videoconferencing (eg, the ability to provide real-time comments or feedback), and they also perceived disadvantages (eg, videoconferencing requires additional time and greater availability of caregivers). Some occupational therapists believed that mobile videoconferencing added value to assessments, while others did not. Conclusions: The use of mobile videoconferencing in the context of hospital discharge planning has raised questions of clinical feasibility. Although mobile videoconferencing provides multiple benefits to hospital discharge, including more appropriate occupational therapist recommendations, time constraints made it more difficult to perceive the added value. However, with smartphone use, interdisciplinary team involvement, and patient participation in the videoconference visit, mobile videoconferencing can become an asset to hospital discharge planning. International Registered Report Identifier (IRRID): RR2-10.2196/11674 UR - https://aging.jmir.org/2022/3/e24376 UR - http://dx.doi.org/10.2196/24376 UR - http://www.ncbi.nlm.nih.gov/pubmed/35787486 ID - info:doi/10.2196/24376 ER - TY - JOUR AU - Hardy, Amy AU - Ward, Thomas AU - Emsley, Richard AU - Greenwood, Kathryn AU - Freeman, Daniel AU - Fowler, David AU - Kuipers, Elizabeth AU - Bebbington, Paul AU - Garety, Philippa PY - 2022/7/1 TI - Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis JO - JMIR Hum Factors SP - e29725 VL - 9 IS - 3 KW - paranoia KW - psychosis KW - digital health KW - apps KW - human-centered design KW - user experience KW - adherence KW - engagement KW - therapy N2 - Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the ?digital divide.? Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the ?digital divide.? SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the ?digital divide? and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the ?digital divide.? Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the ?digital divide? on therapy outcomes. Trial Registration: ISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671 UR - https://humanfactors.jmir.org/2022/3/e29725 UR - http://dx.doi.org/10.2196/29725 UR - http://www.ncbi.nlm.nih.gov/pubmed/35776506 ID - info:doi/10.2196/29725 ER - TY - JOUR AU - Moon, Chelidze Khatiya AU - Sobolev, Michael AU - Grella, Megan AU - Alvarado, George AU - Sapra, Manish AU - Ball, Trever PY - 2022/7/1 TI - An mHealth Platform for Augmenting Behavioral Health in Primary Care: Longitudinal Feasibility Study JO - JMIR Form Res SP - e36021 VL - 6 IS - 7 KW - collaborative care KW - mobile health KW - psychiatry KW - depression KW - virtual care KW - psychoeducation KW - mobile app KW - mobile phone N2 - Background: The collaborative care model is a well-established system of behavioral health care within primary care settings. There is potential for mobile health (mHealth) technology to augment collaborative behavioral health care in primary care settings, thereby improving scalability, efficiency, and clinical outcomes. Objective: We aimed to assess the feasibility of engaging with and the preliminary clinical outcomes of an mHealth platform that was used to augment an existing collaborative care program in primary care settings. Methods: We performed a longitudinal, single-arm feasibility study of an mHealth platform that was used to augment collaborative care. A total of 3 behavioral health care managers, who were responsible for coordinating disease management in 6 primary care practices, encouraged participants to use a mobile app to augment the collaborative model of behavioral health care. The mHealth platform?s functions included asynchronous chats with the behavioral health care managers, depression self-report assessments, and psychoeducational content. The primary outcome was the feasibility of engagement, which was based on the number and type of participant-generated actions that were completed in the app. The primary clinical end point was a comparison of the baseline and final assessments of the Patient Health Questionnaire-9. Results: Of the 245 individuals who were referred by their primary care provider for behavioral health services, 89 (36.3%) consented to app-augmented behavioral health care. Only 12% (11/89) never engaged with the app during the study period. Across all participants, we observed a median engagement of 7 (IQR 12; mean 10.4; range 0-130) actions in the app (participants: n=78). The chat function was the most popular, followed by psychoeducational content and assessments. The subgroup analysis revealed no significant differences in app usage by age (P=.42) or sex (P=.84). The clinical improvement rate in our sample was 73% (32/44), although follow-up assessments were only available for 49% (44/89) of participants. Conclusions: Our preliminary findings indicate the moderate feasibility of using mHealth technology to augment behavioral health care in primary care settings. The results of this study are applicable to improving the design and implementation of mobile apps in collaborative care. UR - https://formative.jmir.org/2022/7/e36021 UR - http://dx.doi.org/10.2196/36021 UR - http://www.ncbi.nlm.nih.gov/pubmed/35776491 ID - info:doi/10.2196/36021 ER - TY - JOUR AU - Huberty, Jennifer AU - Bhuiyan, Nishat AU - Eckert, Ryan AU - Larkey, Linda AU - Petrov, Megan AU - Todd, Michael AU - Mesa, Ruben PY - 2022/7/1 TI - Insomnia as an Unmet Need in Patients With Chronic Hematological Cancer: Protocol for a Randomized Controlled Trial Evaluating a Consumer-Based Meditation App for Treatment of Sleep Disturbance JO - JMIR Res Protoc SP - e39007 VL - 11 IS - 7 KW - hematological cancers KW - mobile health KW - mHealth KW - meditation KW - sleep disturbance KW - mobile phone N2 - Background: To address the need for long-term, accessible, nonpharmacologic interventions targeting sleep in patients with chronic hematological cancer, we propose the first randomized controlled trial to determine the effects of a consumer-based mobile meditation app, Calm, on sleep disturbance in this population. Objective: This study aims to test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group in improving the primary outcome of self-reported sleep disturbance, as well as secondary sleep outcomes, including sleep impairment and sleep efficiency; test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group on inflammatory markers, fatigue, and emotional distress; and explore free-living use during a 12-week follow-up period and the sustained effects of Calm in patients with chronic hematological cancer. Methods: In a double-blinded randomized controlled trial, we will recruit 276 patients with chronic hematological cancer to an 8-week app-based wellness intervention?the active, daily, app-based meditation intervention or the health education podcast app control group, followed by a 12-week follow-up period. Participants will be asked to use their assigned app for at least 10 minutes per day during the 8-week intervention period; complete web-based surveys assessing self-reported sleep disturbance, fatigue, and emotional distress at baseline, 8 weeks, and 20 weeks; complete sleep diaries and wear an actigraphy device during the 8-week intervention period and at 20 weeks; and complete blood draws to assess inflammatory markers (tumor necrosis factor-?, interleukin-6, interleukin-8, and C-reactive protein) at baseline, 8 weeks, and 20 weeks. Results: This project was funded by the National Institutes of Health National Cancer Institute (R01CA262041). The projects began in April 2022, and study recruitment is scheduled to begin in October 2022, with a total project duration of 5 years. We anticipate that we will be able to achieve our enrollment goal of 276 patients with chronic hematological cancers within the allotted project time frame. Conclusions: This research will contribute to broader public health efforts by providing researchers and clinicians with an evidence-based commercial product to improve sleep in the long term in an underserved and understudied cancer population with a high incidence of sleep disturbance. Trial Registration: ClinicalTrials.gov NCT05294991; https://clinicaltrials.gov/ct2/show/NCT05294991 International Registered Report Identifier (IRRID): PRR1-10.2196/39007 UR - https://www.researchprotocols.org/2022/7/e39007 UR - http://dx.doi.org/10.2196/39007 UR - http://www.ncbi.nlm.nih.gov/pubmed/35776489 ID - info:doi/10.2196/39007 ER - TY - JOUR AU - Davoudi, Anahita AU - Lee, S. Natalie AU - Luong, ThaiBinh AU - Delaney, Timothy AU - Asch, Elizabeth AU - Chaiyachati, Krisda AU - Mowery, Danielle PY - 2022/6/29 TI - Identifying Medication-Related Intents From a Bidirectional Text Messaging Platform for Hypertension Management Using an Unsupervised Learning Approach: Retrospective Observational Pilot Study JO - J Med Internet Res SP - e36151 VL - 24 IS - 6 KW - chatbots KW - secure messaging systems KW - unsupervised learning KW - latent Dirichlet allocation KW - natural language processing N2 - Background: Free-text communication between patients and providers plays an increasing role in chronic disease management, through platforms varying from traditional health care portals to novel mobile messaging apps. These text data are rich resources for clinical purposes, but their sheer volume render them difficult to manage. Even automated approaches, such as natural language processing, require labor-intensive manual classification for developing training data sets. Automated approaches to organizing free-text data are necessary to facilitate use of free-text communication for clinical care. Objective: The aim of this study was to apply unsupervised learning approaches to (1) understand the types of topics discussed and (2) learn medication-related intents from messages sent between patients and providers through a bidirectional text messaging system for managing participant blood pressure (BP). Methods: This study was a secondary analysis of deidentified messages from a remote, mobile, text-based employee hypertension management program at an academic institution. We trained a latent Dirichlet allocation (LDA) model for each message type (ie, inbound patient messages and outbound provider messages) and identified the distribution of major topics and significant topics (probability >.20) across message types. Next, we annotated all medication-related messages with a single medication intent. Then, we trained a second medication-specific LDA (medLDA) model to assess how well the unsupervised method could identify more fine-grained medication intents. We encoded each medication message with n-grams (n=1-3 words) using spaCy, clinical named entities using Stanza, and medication categories using MedEx; we then applied chi-square feature selection to learn the most informative features associated with each medication intent. Results: In total, 253 participants and 5 providers engaged in the program, generating 12,131 total messages: 46.90% (n=5689) patient messages and 53.10% (n=6442) provider messages. Most patient messages corresponded to BP reporting, BP encouragement, and appointment scheduling; most provider messages corresponded to BP reporting, medication adherence, and confirmatory statements. Most patient and provider messages contained 1 topic and few contained more than 3 topics identified using LDA. In total, 534 medication messages were annotated with a single medication intent. Of these, 282 (52.8%) were patient medication messages: most referred to the medication request intent (n=134, 47.5%). Most of the 252 (47.2%) provider medication messages referred to the medication question intent (n=173, 68.7%). Although the medLDA model could identify a majority intent within each topic, it could not distinguish medication intents with low prevalence within patient or provider messages. Richer feature engineering identified informative lexical-semantic patterns associated with each medication intent class. Conclusions: LDA can be an effective method for generating subgroups of messages with similar term usage and facilitating the review of topics to inform annotations. However, few training cases and shared vocabulary between intents precludes the use of LDA for fully automated, deep, medication intent classification. International Registered Report Identifier (IRRID): RR2-10.1101/2021.12.23.21268061 UR - https://www.jmir.org/2022/6/e36151 UR - http://dx.doi.org/10.2196/36151 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767327 ID - info:doi/10.2196/36151 ER - TY - JOUR AU - Taylor, E. Madison AU - Lozy, Olivia AU - Conti, Kaileigh AU - Wacha-Montes, Annmarie AU - Bentley, H. Kate AU - Kleiman, M. Evan PY - 2022/6/29 TI - The Effectiveness of a Brief Telehealth and Smartphone Intervention for College Students Receiving Traditional Therapy: Longitudinal Study Using Ecological Momentary Assessment Data JO - JMIR Ment Health SP - e33750 VL - 9 IS - 6 KW - college students KW - digital mental health KW - brief interventions N2 - Background: Brief interventions such as mental health apps and single-session interventions are increasingly popular, efficacious, and accessible delivery formats that may be beneficial for college students whose mental health needs may not be adequately met by college counseling centers. However, no studies so far have examined the effectiveness of these modes of treatment for college students who are already receiving traditional therapy, despite it being common among this population. Objective: The aim of this study was to compare the differences in self-reported momentary negative affect between college students in therapy and not in therapy who received a brief single-session intervention delivered by counseling center staff and a supplemental mobile app. Methods: Data for this study were drawn from E-Manage, a brief mobile health intervention geared toward college students. Participants in the study were 173 college students who indicated whether they had received therapy. We conducted a multilevel model to determine whether there were differences between those in therapy versus not in therapy in negative affect reported throughout the study. Following this, we conducted multilevel models with therapy status as the predictor and negative affect as the outcome. Results: Results of the multilevel model testing showed that the cross-level interaction between the time point (ie, pre- vs postexercise) and therapy status was significant (P=.008), with the reduction in negative affect from pre- to postexercise greater for those in therapy (b=?0.65, 95% CI ?0.91 to ?0.40; P<.001) than it was for those not in therapy (b=?0.31, 95% CI ?0.43 to ?0.19; P<.001). Therapy status was unassociated with both the pre-exercise (b=?1.69, 95% CI ?3.51 to 0.13; P=.07) and postexercise (b=?1.37, 95% CI ?3.17 to 0.43; P=.14) ratings of negative affect. Conclusions: These findings suggest that app-based and single-session interventions are also appropriate to use among college students who are receiving traditional therapy. A randomized controlled trial comparing students receiving therapy to students receiving therapy and E-Manage will be necessary to determine to what extent E-Manage contributed to the reductions in negative affect that therapy-attending college students experienced. UR - https://mental.jmir.org/2022/6/e33750 UR - http://dx.doi.org/10.2196/33750 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767338 ID - info:doi/10.2196/33750 ER - TY - JOUR AU - Johnson, Grødem Susanne AU - Potrebny, Thomas AU - Larun, Lillebeth AU - Ciliska, Donna AU - Olsen, Rydland Nina PY - 2022/6/29 TI - Usability Methods and Attributes Reported in Usability Studies of Mobile Apps for Health Care Education: Scoping Review JO - JMIR Med Educ SP - e38259 VL - 8 IS - 2 KW - user-computer interface KW - mobile apps KW - online learning KW - health education KW - students N2 - Background: Mobile devices can provide extendable learning environments in higher education and motivate students to engage in adaptive and collaborative learning. Developers must design mobile apps that are practical, effective, and easy to use, and usability testing is essential for understanding how mobile apps meet users? needs. No previous reviews have investigated the usability of mobile apps developed for health care education. Objective: The aim of this scoping review is to identify usability methods and attributes in usability studies of mobile apps for health care education. Methods: A comprehensive search was carried out in 10 databases, reference lists, and gray literature. Studies were included if they dealt with health care students and usability of mobile apps for learning. Frequencies and percentages were used to present the nominal data, together with tables and graphical illustrations. Examples include a figure of the study selection process, an illustration of the frequency of inquiry usability evaluation and data collection methods, and an overview of the distribution of the identified usability attributes. We followed the Arksey and O?Malley framework for scoping reviews. Results: Our scoping review collated 88 articles involving 98 studies, mainly related to medical and nursing students. The studies were conducted from 22 countries and were published between 2008 and 2021. Field testing was the main usability experiment used, and the usability evaluation methods were either inquiry-based or based on user testing. Inquiry methods were predominantly used: 1-group design (46/98, 47%), control group design (12/98, 12%), randomized controlled trials (12/98, 12%), mixed methods (12/98, 12%), and qualitative methods (11/98, 11%). User testing methods applied were all think aloud (5/98, 5%). A total of 17 usability attributes were identified; of these, satisfaction, usefulness, ease of use, learning performance, and learnability were reported most frequently. The most frequently used data collection method was questionnaires (83/98, 85%), but only 19% (19/98) of studies used a psychometrically tested usability questionnaire. Other data collection methods included focus group interviews, knowledge and task performance testing, and user data collected from apps, interviews, written qualitative reflections, and observations. Most of the included studies used more than one data collection method. Conclusions: Experimental designs were the most commonly used methods for evaluating usability, and most studies used field testing. Questionnaires were frequently used for data collection, although few studies used psychometrically tested questionnaires. The usability attributes identified most often were satisfaction, usefulness, and ease of use. The results indicate that combining different usability evaluation methods, incorporating both subjective and objective usability measures, and specifying which usability attributes to test seem advantageous. The results can support the planning and conduct of future usability studies for the advancement of mobile learning apps in health care education. International Registered Report Identifier (IRRID): RR2-10.2196/19072 UR - https://mededu.jmir.org/2022/2/e38259 UR - http://dx.doi.org/10.2196/38259 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767323 ID - info:doi/10.2196/38259 ER - TY - JOUR AU - El Ayadi, M. Alison AU - Duggal, Mona AU - Bagga, Rashmi AU - Singh, Pushpendra AU - Kumar, Vijay AU - Ahuja, Alka AU - Kankaria, Ankita AU - Hosapatna Basavarajappa, Darshan AU - Kaur, Jasmeet AU - Sharma, Preetika AU - Gupta, Swati AU - Pendse, S. Ruchita AU - Weil, Laura AU - Swendeman, Dallas AU - Diamond-Smith, G. Nadia PY - 2022/6/29 TI - A Mobile Education and Social Support Group Intervention for Improving Postpartum Health in Northern India: Development and Usability Study JO - JMIR Form Res SP - e34087 VL - 6 IS - 6 KW - mHealth KW - group care KW - postpartum KW - postnatal KW - antenatal KW - India KW - pilot KW - mobile phone N2 - Background: Structural and cultural barriers limit Indian women?s access to adequate postnatal care and support despite their importance for maternal and neonatal health. Targeted postnatal education and support through a mobile health intervention may improve postnatal recovery, neonatal care practices, nutritional status, knowledge and care seeking, and mental health. Objective: We sought to understand the feasibility and acceptability of our first pilot phase, a flexible 6-week postnatal mobile health intervention delivered to 3 groups of women in Punjab, India, and adapt our intervention for our next pilot phase, which will formally assess intervention feasibility, acceptability, and preliminary efficacy. Methods: Our intervention prototype was designed to deliver culturally tailored educational programming via a provider-moderated, voice- and text-based group approach to connect new mothers with a social support group of other new mothers, increase their health-related communication with providers, and refer them to care needed. We targeted deployment using feature phones to include participants from diverse socioeconomic groups. We held moderated group calls weekly, disseminated educational audios, and created SMS text messaging groups. We varied content delivery, group discussion participation, and chat moderation. Three groups of postpartum women from Punjab were recruited for the pilot through community health workers. Sociodemographic data were collected at baseline. Intervention feasibility and acceptability were assessed through weekly participant check-ins (N=29), weekly moderator reports, structured end-line in-depth interviews among a subgroup of participants (15/29, 52%), and back-end technology data. Results: The participants were aged 24 to 28 years and 1 to 3 months postpartum. Of the 29 participants, 17 (59%) had their own phones. Half of the participants (14/29, 48%) attended ?3 of the 6 calls; the main barriers were childcare and household responsibilities and network or phone issues. Most participants were very satisfied with the intervention (16/19, 84%) and found the educational content (20/20, 100%) and group discussions (17/20, 85%) very useful. The participants used the SMS text messaging chat, particularly when facilitator-moderated. Sustaining participation and fostering group interactions was limited by technological and sociocultural challenges. Conclusions: The intervention was considered generally feasible and acceptable, and protocol adjustments were identified to improve intervention delivery and engagement. To address technological issues, we engaged a cloud-based service provider for group calls and an interactive voice response service provider for educational recordings and developed a smartphone app for the participants. We seek to overcome sociocultural challenges through new strategies for increasing group engagement, including targeting midlevel female community health care providers as moderators. Our second pilot will assess intervention feasibility, acceptability, and preliminary effectiveness at 6 months. Ultimately, we seek to support the health and well-being of postpartum women and their infants in South Asia and beyond through the development of efficient, acceptable, and effective intervention strategies. UR - https://formative.jmir.org/2022/6/e34087 UR - http://dx.doi.org/10.2196/34087 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767348 ID - info:doi/10.2196/34087 ER - TY - JOUR AU - Bergevi, Julia AU - Andermo, Susanne AU - Woldamanuel, Yohannes AU - Johansson, Unn-Britt AU - Hagströmer, Maria AU - Rossen, Jenny PY - 2022/6/28 TI - User Perceptions of eHealth and mHealth Services Promoting Physical Activity and Healthy Diets: Systematic Review JO - JMIR Hum Factors SP - e34278 VL - 9 IS - 2 KW - acceptability KW - behavior change KW - engagement KW - health technology KW - noncommunicable diseases KW - usability KW - user feedback KW - qualitative studies KW - physical activity KW - healthy diet N2 - Background: Physical activity and a diet that follows general recommendations can help to prevent noncommunicable diseases. However, most adults do not meet current recommended guidelines, and support for behavior change needs to be strengthened. There is growing evidence that shows the benefits of eHealth and mobile health (mHealth) services in promoting healthy habits; however, their long-term effectiveness is uncertain because of nonadherence. Objective: We aimed to explore users? perceptions of acceptability, engagement, and usability of eHealth and mHealth services that promote physical activity, healthy diets, or both in the primary or secondary prevention of noncommunicable diseases. Methods: We conducted a systematic review with a narrative synthesis. We performed the literature search in PubMed, PsycINFO, and CINAHL electronic databases in February 2021 and July 2021. The search was limited to papers published in English between 2016 and 2021. Papers on qualitative and mixed method studies that encompassed eHealth and mHealth services for adults with a focus on physical activity, healthy diet, or both in the primary or secondary prevention of noncommunicable diseases were included. Three authors screened the studies independently, and 2 of the authors separately performed thematic analysis of qualitative data. Results: With an initial finding of 6308 articles and the removal of 427 duplicates, 23 articles were deemed eligible for inclusion in the review. Based on users? preferences, an overarching theme?eHealth and mHealth services provide value but need to be tailored to individual needs?and 5 subthemes?interactive and integrated; varying and multifunctional; easy, pedagogic, and attractive; individualized and customizable; and reliable?emerged. Conclusions: New evidence on the optimization of digital services that promote physical activity and healthy diets has been synthesized. The findings represent users? perceptions of acceptability, engagement, and usability of eHealth and mHealth services and show that services should be personalized, dynamic, easily manageable, and reliable. These findings can help improve adherence to digital health-promoting services. UR - https://humanfactors.jmir.org/2022/2/e34278 UR - http://dx.doi.org/10.2196/34278 UR - http://www.ncbi.nlm.nih.gov/pubmed/35763339 ID - info:doi/10.2196/34278 ER - TY - JOUR AU - Lin, Kuei Yu AU - Richardson, Caroline AU - Dobrin, Iulia AU - Pop-Busui, Rodica AU - Piatt, Gretchen AU - Piette, John PY - 2022/6/24 TI - Accessibility and Openness to Diabetes Management Support With Mobile Phones: Survey Study of People With Type 1 Diabetes Using Advanced Diabetes Technologies JO - JMIR Diabetes SP - e36140 VL - 7 IS - 2 KW - type 1 diabetes KW - diabetes technology KW - diabetes self-management KW - diabetes KW - self-management KW - cross-sectional KW - glucose monitor KW - insulin pump KW - mHealth KW - mobile health KW - access KW - acceptability KW - feasibility KW - cell phone KW - text message KW - smartphone KW - cellphone KW - mobile device KW - patient communication KW - interactive voice response call KW - glycemic control N2 - Background: Little is known about the feasibility of mobile health (mHealth) support among people with type 1 diabetes (T1D) using advanced diabetes technologies including continuous glucose monitoring (CGM) systems and hybrid closed-loop insulin pumps (HCLs). Objective: This study aims to evaluate patient access and openness to receiving mHealth diabetes support in people with T1D using CGM systems or HCLs. Methods: We conducted a cross-sectional survey among patients with T1D using CGM systems or HCLs managed in an academic medical center. Participants reported information regarding their mobile device use; cellular call, SMS text message, or internet connectivity; and openness to various channels of mHealth communication (smartphone apps, SMS text messages, and interactive voice response [IVR] calls). Participants? demographic characteristics and CGM data were collected from medical records. The analyses focused on differences in openness to mHealth and mHealth communication channels across groups defined by demographic variables and measures of glycemic control. Results: Among all participants (N=310; female: n=198, 63.9%; mean age 45, SD 16 years), 98.1% (n=304) reported active cellphone use and 80% (n=248) were receptive to receiving mHealth support to improve glucose control. Among participants receptive to mHealth support, 98% (243/248) were willing to share CGM glucose data for mHealth diabetes self-care assistance. Most (176/248, 71%) were open to receiving messages via apps, 56% (139/248) were open to SMS text messages, and 12.1% (30/248) were open to IVR calls. Older participants were more likely to prefer SMS text messages (P=.009) and IVR calls (P=.03) than younger participants. Conclusions: Most people with T1D who use advanced diabetes technologies have access to cell phones and are receptive to receiving mHealth support to improve diabetes control. UR - https://diabetes.jmir.org/2022/2/e36140 UR - http://dx.doi.org/10.2196/36140 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749207 ID - info:doi/10.2196/36140 ER - TY - JOUR AU - Tan, Xuan Sarah Yi AU - Chia, Airu AU - Tai, Choo Bee AU - Natarajan, Padmapriya AU - Goh, Lin Claire Marie Jie AU - Shek, P. Lynette AU - Saw, Mei Seang AU - Chong, Foong-Fong Mary AU - Müller-Riemenschneider, Falk PY - 2022/6/24 TI - A Web-Based, Time-Use App To Assess Children?s Movement Behaviors: Validation Study of My E-Diary for Activities and Lifestyle (MEDAL) JO - JMIR Pediatr Parent SP - e33312 VL - 5 IS - 2 KW - children KW - accelerometer KW - MEDAL KW - web-based app KW - self-report KW - validity KW - physical activity KW - movement behavior KW - pediatrics KW - sleep KW - digital health KW - behavior N2 - Background: Existing modes of collecting self-reported 24-hour movement information from children, including digital assessments, have not been demonstrated to be of acceptable validity when compared to objective measurements. My E-Diary for Activities and Lifestyle (MEDAL) is an interactive web-based diary developed to collect time-use information from children aged 10 years and older. Objective: This study evaluated the validity of MEDAL for assessing children?s movement behaviors by comparing self-reported and accelerometer-measured time spent in movement behavior among children in Singapore aged 10-11 years. Methods: Funding for this study was obtained in October 2017, and data were collected between April and August 2020. Participants recorded their daily activities using MEDAL over 2 specified weekdays and 2 weekend days and wore an Actigraph accelerometer on their nondominant wrist throughout the study to objectively assess movement behaviors. Spearman correlation coefficient and intraclass correlation coefficient (ICC) were used to compare the accelerometer measurements and self-reports for each movement behavior. Bland-Altman plots were generated to investigate trends of bias in the self-reports. Results: Among the participants aged 10-11 years (29/49, 59% boys), we observed that children reported lower light physical activity (LPA) and higher moderate-to-vigorous physical activity (MVPA), inactivity, and night sleep than that measured by the accelerometer. There was a moderate-to-strong correlation between self-reported and accelerometer-measured MVPA (r=0.37; 95% CI 0.20-0.54), inactivity (r=0.36; 95% CI 0.18-0.54), and night sleep (r=0.58; 95% CI 0.43-0.74); the correlation for LPA was poor (r=0.19; 95% CI 0.02-0.36). Agreement was poor for all behaviors (MVPA: ICC=0.24, 95% CI 0.07-0.40; LPA: ICC=0.19, 95% CI 0.01-0.36; inactivity: ICC=0.29, 95% CI 0.11-0.44; night sleep: ICC=0.45, 95% CI 0.29-0.58). There was stronger correlation and agreement on weekdays for inactivity and night sleep; conversely, there was stronger correlation and agreement for MVPA and LPA on weekend days. Finally, based on Bland-Altman plots, we observed that with increasing MVPA, children tended to report higher MVPA than that measured by the accelerometer. There were no clear trends for the other behaviors. Conclusions: MEDAL may be used to assess the movement behaviors of children. Based on self-reports, the children are able to estimate their time spent in MVPA, inactivity, and night sleep although actual time spent in these behaviors may differ from accelerometer-derived estimates; self-reported LPA warrant cautious interpretation. Observable differences in reporting accuracy exist between weekdays and weekend days. UR - https://pediatrics.jmir.org/2022/2/e33312 UR - http://dx.doi.org/10.2196/33312 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749208 ID - info:doi/10.2196/33312 ER - TY - JOUR AU - de Leeuwerk, Elizabeth Marijke AU - Botjes, Martine AU - van Vliet, Vincent AU - Geleijn, Edwin AU - de Groot, Vincent AU - van Wegen, Erwin AU - van der Schaaf, Marike AU - Tuynman, Jurriaan AU - Dickhoff, Chris AU - van der Leeden, Marike PY - 2022/6/24 TI - Self-monitoring of Physical Activity After Hospital Discharge in Patients Who Have Undergone Gastrointestinal or Lung Cancer Surgery: Mixed Methods Feasibility Study JO - JMIR Cancer SP - e35694 VL - 8 IS - 2 KW - mobile phone KW - physical activity KW - self-monitoring KW - fitness trackers KW - telemedicine KW - cancer KW - physical therapy N2 - Background: Self-monitoring of physical activity (PA) using an accelerometer is a promising intervention to stimulate PA after hospital discharge. Objective: This study aimed to evaluate the feasibility of PA self-monitoring after discharge in patients who have undergone gastrointestinal or lung cancer surgery. Methods: A mixed methods study was conducted in which 41 patients with cancer scheduled for lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy were included. Preoperatively, patients received an ankle-worn accelerometer and the corresponding mobile health app to familiarize themselves with its use. The use was continued for up to 6 weeks after surgery. Feasibility criteria related to the study procedures, the System Usability Scale, and user experiences were established. In addition, 6 patients were selected to participate in semistructured interviews. Results: The percentage of patients willing to participate in the study (68/90, 76%) and the final participation rate (57/90, 63%) were considered good. The retention rate was acceptable (41/57, 72%), whereas the rate of missing accelerometer data was relatively high (31%). The mean System Usability Scale score was good (77.3). Interviewed patients mentioned that the accelerometer and app were easy to use, motivated them to be more physically active, and provided postdischarge support. The technical shortcomings and comfort of the ankle straps should be improved. Conclusions: Self-monitoring of PA after discharge appears to be feasible based on good system usability and predominantly positive user experiences in patients with cancer after lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy. Solving technical problems and improving the comfort of the ankle strap may reduce the number of dropouts and missing data in clinical use and follow-up studies. UR - https://cancer.jmir.org/2022/2/e35694 UR - http://dx.doi.org/10.2196/35694 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749165 ID - info:doi/10.2196/35694 ER - TY - JOUR AU - Horgan, Z. Olivia AU - Crane, T. Nicole AU - Forman, M. Evan AU - Milliron, Brandy-Joe AU - Simone, L. Nicole AU - Zhang, Fengqing AU - Butryn, L. Meghan PY - 2022/6/24 TI - Optimizing an mHealth Intervention to Change Food Purchasing Behaviors for Cancer Prevention: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e39669 VL - 11 IS - 6 KW - mHealth KW - cancer prevention KW - grocery shopping KW - diet KW - eating KW - mobile phone N2 - Background: Dietary intake is a powerful modifiable factor that influences cancer risk; however, most US adults do not adhere to dietary guidelines for cancer prevention. One promising pathway for improving dietary adherence is targeting grocery shopping habits. Interventions might facilitate healthy grocery choices, with a combination of mHealth and traditional methods, by promoting the salience of dietary goals while shopping, enhancing motivation to make dietary changes, and increasing household support for healthy food purchasing. Objective: This pilot study will assess feasibility and acceptability of intervention components designed to improve adherence to dietary guidelines for cancer prevention (preliminary aim). The primary aim of the study is to quantify the effect of each intervention component, individually and in combination, on dietary intake (primary aim) and grocery store food purchases (exploratory aim). Mediation analyses will be conducted to understand the mechanisms of action (goal salience, motivation, and household support?secondary aims). The overarching goal is to optimize an mHealth intervention to be tested in a future fully powered clinical trial. Methods: The study enrolled adults (N=62) with low adherence to dietary recommendations for cancer prevention. In a 20-week program, all participants attend a nutrition education workshop and receive weekly educational messages through an app. A factorial design is used to test 4 intervention components: (1) location-triggered messages: educational messages are delivered when arriving at grocery stores; (2) reflections on the benefits of change: content is added to messages to encourage reflection on anticipated benefits of healthy eating, and participants attend an additional workshop session and 3 coach calls on this topic; (3) coach monitoring: food purchases are monitored digitally by a coach who sends personalized weekly app messages and conducts 3 coaching calls that focus on feedback about purchases; and (4) household support: another adult in the household receives messages designed to elicit support for healthy food purchasing, and support is addressed in 3 coach calls and an extra workshop session attended by the index participant and household member. Assessments are completed at weeks 0, 10, and 20 using self-report measures, as well as objective capture of grocery data from the point of purchase using store loyalty accounts. Results: The National Cancer Institute funded this study (R21CA252933) on July 7, 2020. Participant recruitment began in the spring of 2021 and concluded with the successful enrollment of 62 participants. Data collection is expected to be completed in the summer of 2022, and results are expected to be disseminated in the summer of 2023. Conclusions: The results of this study will inform the development of scalable interventions to lower cancer risk via changes in dietary intake. Trial Registration: ClinicalTrials.gov NCT04947150; https://clinicaltrials.gov/ct2/show/NCT04947150 International Registered Report Identifier (IRRID): DERR1-10.2196/39669 UR - https://www.researchprotocols.org/2022/6/e39669 UR - http://dx.doi.org/10.2196/39669 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749216 ID - info:doi/10.2196/39669 ER - TY - JOUR AU - Sun, Chen AU - Xu, Jing AU - Tao, Junxian AU - Dong, Yu AU - Chen, Haiyan AU - Jia, Zhe AU - Ma, Yingnan AU - Zhang, Mingming AU - Wei, Siyu AU - Tang, Guoping AU - Lyu, Hongchao AU - Jiang, Yongshuai PY - 2022/6/23 TI - Mobile-Based and Self-Service Tool (iPed) to Collect, Manage, and Visualize Pedigree Data: Development Study JO - JMIR Form Res SP - e36914 VL - 6 IS - 6 KW - pedigree KW - pedigree data KW - visualization KW - self-service KW - mobile-based N2 - Background: Pedigree data (family history) are indispensable for genetics studies and the assessment of individuals' disease susceptibility. With the popularity of genetics testing, the collection of pedigree data is becoming more common. However, it can be time-consuming, laborious, and tedious for clinicians to investigate all pedigree data for each patient. A self-service robot could inquire about patients' family history in place of professional clinicians or genetic counselors. Objective: The aim of this study was to develop a mobile-based and self-service tool to collect and visualize pedigree data, not only for professionals but also for those who know little about genetics. Methods: There are 4 main aspects in the iPed construction, including interface building, data processing, data storage, and data visualization. The user interface was built using HTML, JavaScript libraries, and Cascading Style Sheets (version 3; Daniel Eden). Processing of the submitted data is carried out by PHP programming language. MySQL is used to document and manage the pedigree data. PHP calls the R script to accomplish the visualization. Results: iPed is freely available to all users through the iPed website. No software is required to be installed, no pedigree files need to be prepared, and no knowledge of genetics or programs is required. The users can easily complete their pedigree data collection and visualization on their own and through a dialogue with iPed. Meanwhile, iPed provides a database that stores all users? information. Therefore, when the users need to construct new pedigree trees for other genetic traits or modify the pedigree trees that have already been created, unnecessary duplication of operations can be avoided. Conclusions: iPed is a mobile-based and self-service tool that could be used by both professionals and nonprofessionals at any time and from any place. It reduces the amount of time required to collect, manage, and visualize pedigree data. UR - https://formative.jmir.org/2022/6/e36914 UR - http://dx.doi.org/10.2196/36914 UR - http://www.ncbi.nlm.nih.gov/pubmed/35737451 ID - info:doi/10.2196/36914 ER - TY - JOUR AU - Al-Mondhiry, Jafar AU - D'Ambruoso, Sarah AU - Pietras, Christopher AU - Strouse, Thomas AU - Benzeevi, Dikla AU - Arevian, C. Armen AU - Wells, B. Kenneth PY - 2022/6/23 TI - Co-created Mobile Apps for Palliative Care Using Community-Partnered Participatory Research: Development and Usability Study JO - JMIR Form Res SP - e33849 VL - 6 IS - 6 KW - mobile phone KW - mobile apps KW - mobile health KW - mHealth KW - eHealth KW - digital health KW - palliative care KW - quality of life KW - survivorship KW - patient advocacy KW - oncology KW - patient-reported outcomes KW - PRO KW - community-partnered participatory research KW - CPPR N2 - Background: Open design formats for mobile apps help clinicians and stakeholders bring their needs to direct, co-creative solutions. Palliative care for patients with advanced cancers requires intensive monitoring and support and remains an area in high need for innovation. Objective: This study aims to use community-partnered participatory research to co-design and pretest a mobile app that focuses on palliative care priorities of clinicians and patients with advanced cancer. Methods: In-person and teleconference workshops were held with patient and family stakeholders, researchers, and clinicians in palliative care and oncology. Question prompts, written feedback, semistructured interviews, and facilitated group discussions identified the core palliative care needs. Using Chorus, a no-code app-building platform, a mobile app was co-designed with the stakeholders. A pretest with 11 patients was conducted, with semistructured interviews of clinician and patient users for feedback. Results: Key themes identified from the focus groups included needs for patient advocacy and encouragement, access to vetted information, patient-clinician communication support, and symptom management. The initial prototype, My Wellness App, contained a weekly wellness journal to track patient-reported symptoms, goals, and medication use; information on self-management of symptoms; community resources; and patient and caregiver testimonial videos. Initial pretesting identified value in app-based communication for clinicians, patients, and caregivers, with suggestions for improving user interface, feedback and presentation of symptom reports, and gamification and staff coordinators to support patient app engagement. Conclusions: The development of a mobile app using community-partnered participatory research is a low-technology and feasible intervention for palliative care. Iterative redesign and user interface expertise may improve implementation. UR - https://formative.jmir.org/2022/6/e33849 UR - http://dx.doi.org/10.2196/33849 UR - http://www.ncbi.nlm.nih.gov/pubmed/35737441 ID - info:doi/10.2196/33849 ER - TY - JOUR AU - Schinle, Markus AU - Erler, Christina AU - Kaliciak, Mayumi AU - Milde, Christopher AU - Stock, Simon AU - Gerdes, Marius AU - Stork, Wilhelm PY - 2022/6/22 TI - Digital Health Apps in the Context of Dementia: Questionnaire Study to Assess the Likelihood of Use Among Physicians JO - JMIR Form Res SP - e35961 VL - 6 IS - 6 KW - digital health applications KW - likelihood of use KW - usability KW - adherence KW - dementia KW - screening KW - treatment KW - physician KW - eHealth KW - questionnaire KW - mobile phone N2 - Background: Age-related diseases such as dementia are playing an increasingly important role in global population development. Thus, prevention, diagnostics, and interventions require more accessibility, which can be realized through digital health apps. With the app on prescription, Germany made history by being the first country worldwide to offer physicians the possibility to prescribe and reimburse digital health apps as of the end of the year 2020. Objective: Considering the lack of knowledge about correlations with the likelihood of use among physicians, this study aimed to address the question of what makes the use of a digital health app by physicians more likely. Methods: We developed and validated a novel measurement tool?the Digital Health Compliance Questionnaire (DHCQ)?in an interdisciplinary collaboration of experts to assess the role of proposed factors in the likelihood of using a health app. Therefore, a web-based survey was conducted to evaluate the likelihood of using a digital app called DemPredict to screen for Alzheimer dementia. Within this survey, 5 latent dimensions (acceptance, attitude toward technology, technology experience, payment for time of use, and effort of collection), the dependent variable likelihood of use, and answers to exploratory questions were recorded and tested within directed correlations. Following a non?probability-sampling strategy, the study was completed by 331 physicians from Germany in the German language, of whom 301 (90.9%) fulfilled the study criteria (eg, being in regular contact with patients with dementia). These data were analyzed using a range of statistical methods to validate the dimensions of the DHCQ. Results: The DHCQ revealed good test theoretical measures?it showed excellent fit indexes (Tucker-Lewis index=0.98; comparative fit index=0.982; standardized root mean square residual=0.073; root mean square error of approximation=0.037), good internal consistency (Cronbach ?=.83), and signs of moderate to large correlations between the DHCQ dimensions and the dependent variable. The correlations between the variables acceptance, attitude toward technology, technology experience, and payment for the time of use and the dependent variable likelihood of use ranged from 0.29 to 0.79, and the correlation between effort of the collection and likelihood of use was ?0.80. In addition, we found high levels of skepticism regarding data protection, and the age of the participants was found to be negatively related to their technical experience and attitude toward technology. Conclusions: In the context of the results, increased communication between the medical and technology sectors and significantly more awareness raising are recommended to make the use of digital health apps more attractive to physicians as they can be adjusted to their everyday needs. Further research could explore the connection between areas such as adherence on the patient side and its impact on the likelihood of use by physicians. UR - https://formative.jmir.org/2022/6/e35961 UR - http://dx.doi.org/10.2196/35961 UR - http://www.ncbi.nlm.nih.gov/pubmed/35731567 ID - info:doi/10.2196/35961 ER - TY - JOUR AU - Dang, Ting AU - Han, Jing AU - Xia, Tong AU - Spathis, Dimitris AU - Bondareva, Erika AU - Siegele-Brown, Chloë AU - Chauhan, Jagmohan AU - Grammenos, Andreas AU - Hasthanasombat, Apinan AU - Floto, Andres R. AU - Cicuta, Pietro AU - Mascolo, Cecilia PY - 2022/6/21 TI - Exploring Longitudinal Cough, Breath, and Voice Data for COVID-19 Progression Prediction via Sequential Deep Learning: Model Development and Validation JO - J Med Internet Res SP - e37004 VL - 24 IS - 6 KW - COVID-19 KW - audio KW - COVID-19 progression KW - deep learning KW - mobile health KW - longitudinal study N2 - Background: Recent work has shown the potential of using audio data (eg, cough, breathing, and voice) in the screening for COVID-19. However, these approaches only focus on one-off detection and detect the infection, given the current audio sample, but do not monitor disease progression in COVID-19. Limited exploration has been put forward to continuously monitor COVID-19 progression, especially recovery, through longitudinal audio data. Tracking disease progression characteristics and patterns of recovery could bring insights and lead to more timely treatment or treatment adjustment, as well as better resource management in health care systems. Objective: The primary objective of this study is to explore the potential of longitudinal audio samples over time for COVID-19 progression prediction and, especially, recovery trend prediction using sequential deep learning techniques. Methods: Crowdsourced respiratory audio data, including breathing, cough, and voice samples, from 212 individuals over 5-385 days were analyzed, alongside their self-reported COVID-19 test results. We developed and validated a deep learning?enabled tracking tool using gated recurrent units (GRUs) to detect COVID-19 progression by exploring the audio dynamics of the individuals? historical audio biomarkers. The investigation comprised 2 parts: (1) COVID-19 detection in terms of positive and negative (healthy) tests using sequential audio signals, which was primarily assessed in terms of the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity, with 95% CIs, and (2) longitudinal disease progression prediction over time in terms of probability of positive tests, which was evaluated using the correlation between the predicted probability trajectory and self-reported labels. Results: We first explored the benefits of capturing longitudinal dynamics of audio biomarkers for COVID-19 detection. The strong performance, yielding an AUROC of 0.79, a sensitivity of 0.75, and a specificity of 0.71 supported the effectiveness of the approach compared to methods that do not leverage longitudinal dynamics. We further examined the predicted disease progression trajectory, which displayed high consistency with longitudinal test results with a correlation of 0.75 in the test cohort and 0.86 in a subset of the test cohort with 12 (57.1%) of 21 COVID-19?positive participants who reported disease recovery. Our findings suggest that monitoring COVID-19 evolution via longitudinal audio data has potential in the tracking of individuals? disease progression and recovery. Conclusions: An audio-based COVID-19 progression monitoring system was developed using deep learning techniques, with strong performance showing high consistency between the predicted trajectory and the test results over time, especially for recovery trend predictions. This has good potential in the postpeak and postpandemic era that can help guide medical treatment and optimize hospital resource allocations. The changes in longitudinal audio samples, referred to as audio dynamics, are associated with COVID-19 progression; thus, modeling the audio dynamics can potentially capture the underlying disease progression process and further aid COVID-19 progression prediction. This framework provides a flexible, affordable, and timely tool for COVID-19 tracking, and more importantly, it also provides a proof of concept of how telemonitoring could be applicable to respiratory diseases monitoring, in general. UR - https://www.jmir.org/2022/6/e37004 UR - http://dx.doi.org/10.2196/37004 UR - http://www.ncbi.nlm.nih.gov/pubmed/35653606 ID - info:doi/10.2196/37004 ER - TY - JOUR AU - Minen, T. Mia AU - George, Alexis AU - Camacho, Erica AU - Yao, Leslie AU - Sahu, Ananya AU - Campbell, Maya AU - Soviero, Mia AU - Hossain, Quazi AU - Verma, Deepti AU - Torous, John PY - 2022/6/21 TI - Assessment of Smartphone Apps for Common Neurologic Conditions (Headache, Insomnia, and Pain): Cross-sectional Study JO - JMIR Mhealth Uhealth SP - e36761 VL - 10 IS - 6 KW - headache KW - pain KW - insomnia KW - mobile health KW - smartphone apps KW - mobile phone N2 - Background: There are thousands of apps for individuals struggling with headache, insomnia, and pain, but it is difficult to establish which of these apps are best suited for patients? specific needs. If clinicians were to have access to a platform that would allow them to make an informed decision on the efficacy and feasibility of smartphone apps for patient care, they would feel confident in prescribing specific apps. Objective: We sought to evaluate the quality of apps for some of the top common, disabling neurologic conditions (headache, insomnia, and pain) based on principles derived from the American Psychiatric Association?s (APA) app evaluation model. Methods: We used the Mobile Health Index and Navigation database and expanded upon the database?s current supported conditions by adding 177 new app entries. Each app was rated for consistency with the APA?s app evaluation model, which includes 105 objective questions based on the following 5 major classes of consideration: (1) accessibility, (2) privacy and security, (3) clinical foundation, (4) engagement style, and (5) interoperability. These characteristics were evaluated to gain a broader understanding of the significant features of each app category in comparison against a control group. Results: Approximately 90% (187/201) of all apps evaluated were free to download, but only 50% (63/201) of headache- and pain-related apps were truly free. Most (87/106, 81%) sleep apps were not truly free to use. The apps had similar limitations with limited privacy, accessibility, and crisis management resources. For example, only 17% (35/201) of the apps were available in Spanish. The apps offered mostly self-help tools with little tailoring; symptom tracking was the most common feature in headache- (32/48, 67%) and pain-related apps (21/47, 45%), whereas mindfulness was the most common feature in sleep-related apps (73/106, 69%). Conclusions: Although there are many apps for headache, pain, and insomnia, all 3 types of apps have room for improvement around accessibility and privacy. Pain and headache apps share many common features, whereas insomnia apps offer mostly mindfulness-based resources. Given the many available apps to pick from, clinicians and patients should seek apps that offer the highest-quality features, such as complete privacy, remedial features, and the ability to download the app at no cost. These results suggest that there are many opportunities for the improvement of apps centered on headache, insomnia, and pain. UR - https://mhealth.jmir.org/2022/6/e36761 UR - http://dx.doi.org/10.2196/36761 UR - http://www.ncbi.nlm.nih.gov/pubmed/35727625 ID - info:doi/10.2196/36761 ER - TY - JOUR AU - Islam, Shariful Sheikh Mohammed AU - Mishra, Vinaytosh AU - Siddiqui, Umer Muhammad AU - Moses, Chandir Jeban AU - Adibi, Sasan AU - Nguyen, Lemai AU - Wickramasinghe, Nilmini PY - 2022/6/21 TI - Smartphone Apps for Diabetes Medication Adherence: Systematic Review JO - JMIR Diabetes SP - e33264 VL - 7 IS - 2 KW - smartphones KW - digital health KW - diabetes KW - medication adherence KW - applications KW - apps KW - mHealth KW - mobile health KW - task-technology fit N2 - Background: Diabetes is one of the leading noncommunicable chronic diseases globally. In people with diabetes, blood glucose levels need to be monitored regularly and managed adequately through healthy lifestyles and medications. However, various factors contribute to poor medication adherence. Smartphone apps can improve medication adherence in people with diabetes, but it is not clear which app features are most beneficial. Objective: This study aims to systematically review and evaluate high-quality apps for diabetes medication adherence, which are freely available to the public in Android and Apple app stores and present the technical features of the apps. Methods: We systematically searched Apple App Store and Google Play for apps that assist in diabetes medication adherence, using predefined selection criteria. We assessed apps using the Mobile App Rating Scale (MARS) and calculated the mean app-specific score (MASS) by taking the average of app-specific scores on 6 dimensions, namely, awareness, knowledge, attitudes, intention to change, help-seeking, and behavior change rated on a 5-point scale (1=strongly disagree and 5=strongly agree). We used the mean of the app?s performance on these 6 dimensions to calculate the MASS. Apps that achieved a total MASS mean quality score greater than 4 out of 5 were considered to be of high quality in our study. We formulated a task-technology fit matrix to evaluate the apps for diabetes medication adherence. Results: We identified 8 high-quality apps (MASS score?4) and presented the findings under 3 main categories: characteristics of the included apps, app features, and diabetes medication adherence. Our framework to evaluate smartphone apps in promoting diabetes medication adherence considered physiological factors influencing diabetes and app features. On evaluation, we observed that 25% of the apps promoted high adherence and another 25% of the apps promoted moderate adherence. Finally, we found that 50% of the apps provided low adherence to diabetes medication. Conclusions: Our findings show that almost half of the high-quality apps publicly available for free did not achieve high to moderate medication adherence. Our framework could have positive implications for the future design and development of apps for patients with diabetes. Additionally, apps need to be evaluated using a standardized framework, and only those promoting higher medication adherence should be prescribed for better health outcomes. UR - https://diabetes.jmir.org/2022/2/e33264 UR - http://dx.doi.org/10.2196/33264 UR - http://www.ncbi.nlm.nih.gov/pubmed/35727613 ID - info:doi/10.2196/33264 ER - TY - JOUR AU - Praus, Friederike AU - Krzowski, Bartosz AU - Walther, Tabea AU - Gratzke, Christian AU - Balsam, Pawe? AU - Miernik, Arkadiusz AU - Pohlmann, Fabian Philippe PY - 2022/6/21 TI - Smartphone Apps for Managing Antithrombotic Therapy: Scoping Literature Review JO - JMIR Cardio SP - e29481 VL - 6 IS - 1 KW - anticoagulation KW - mobile app KW - telehealth KW - telemedicine KW - mHealth KW - smartphone KW - educational apps KW - digital tools KW - physician support N2 - Background: Antithrombotic therapy is complex and requires informed decisions and high therapy adherence. Several mobile phone apps exist to either support physicians in the management of antithrombotic therapies or to educate and support patients. For the majority of these apps, both their medical evidence and their development background are unknown. Objective: This review aims to investigate the available literature describing high-quality apps for managing antithrombotic therapy based on professional scientific information. Methods: Keywords and Medical Subject Heading terms were used to search MEDLINE via PubMed and Ovid between December 2019 and January 2022. Inclusion criteria were the availability of full text and publications in the English language. Apps that solely focused on atrial fibrillation were excluded. Qualitative findings were thematically synthesized and reported narratively. Results: Out of 149 identified records, 32 were classified as eligible. We identified four groups: (1) apps for patients supporting self-management of vitamin K antagonists, (2) apps for patients increasing therapy adherence, (3) educational apps for patients, and (4) apps for physicians in supporting guideline adherence. Conclusions: Throughout the evaluated data, patients from all age groups receiving antithrombotic drugs expressed the desire for a digital tool that could support their therapy management. In addition, physicians using mobile guideline-based apps may have contributed to decreased adverse event rates among their patients. In general, digital apps encompassing both user-friendly designs and scientific backgrounds may enhance the safety of antithrombotic therapies. However, our evaluation did not identify any apps that addressed all antithrombotic drugs in combination with perioperative stratification strategies. Currently, strict regulations for smartphone apps seem to negatively affect the development of new apps. Therefore, new legal policies for medical digital apps are urgently needed. UR - https://cardio.jmir.org/2022/1/e29481 UR - http://dx.doi.org/10.2196/29481 UR - http://www.ncbi.nlm.nih.gov/pubmed/35727608 ID - info:doi/10.2196/29481 ER - TY - JOUR AU - Houwen, Thymen AU - Vugts, P. Miel A. AU - Lansink, W. Koen W. AU - Theeuwes, P. Hilco AU - Neequaye, Nicky AU - Beerekamp, H. M. Susan AU - Joosen, W. Margot C. AU - de Jongh, C. Mariska A. PY - 2022/6/20 TI - Developing mHealth to the Context and Valuation of Injured Patients and Professionals in Hospital Trauma Care: Qualitative and Quantitative Formative Evaluations JO - JMIR Hum Factors SP - e35342 VL - 9 IS - 2 KW - wounds and injuries KW - telemedicine KW - recovery of function KW - rehabilitation KW - patient care management KW - qualitative research KW - evaluation study KW - holistic health N2 - Background: Trauma care faces challenges to innovating their services, such as with mobile health (mHealth) app, to improve the quality of care and patients? health experience. Systematic needs inquiries and collaborations with professional and patient end users are highly recommended to develop and prepare future implementations of such innovations. Objective: This study aimed to develop a trauma mHealth app for patient information and support in accordance with the Center for eHealth Research and Disease Management road map and describe experiences of unmet information and support needs among injured patients with trauma, barriers to and facilitators of the provision of information and support among trauma care professionals, and drivers of value of an mHealth app in patients with trauma and trauma care professionals. Methods: Formative evaluations were conducted using quantitative and qualitative methods. Ten semistructured interviews with patients with trauma and a focus group with 4 trauma care professionals were conducted for contextual inquiry and value specification. User requirements and value drivers were applied in prototyping. Furthermore, a complementary quantitative discrete choice experiment (DCE) was conducted with 109 Dutch trauma surgeons, which enabled triangulation on value specification results. In the DCE, preferences were stated for hypothetical mHealth products with various attributes. Panel data from the DCE were analyzed using conditional and mixed logit models. Results: Patients disclosed a need for more psychosocial support and easy access to more extensive information on their injury, its consequences, and future prospects. Health care professionals designated workload as an essential issue; a digital solution should not require additional time. The conditional logit model of DCE results suggested that access to patient app data through electronic medical record integration (odds ratio [OR] 3.3, 95% CI 2.55-4.34; P<.001) or a web viewer (OR 2.3, 95% CI 1.64-3.31; P<.001) was considered the most important for an mHealth solution by surgeons, followed by the inclusion of periodic self-measurements (OR 2, 95% CI 1.64-2.46; P<.001), the local adjustment of patient information (OR 1.8, 95% CI 1.42-2.33; P<.001), local hospital identification (OR 1.7, 95% CI 1.31-2.10; P<.001), complication detection (OR 1.5, 95% CI 1.21-1.84; P<.001), and the personalization of rehabilitation through artificial intelligence (OR 1.4, 95% CI 1.13-1.62; P=.001). Conclusions: In the context of trauma care, end users have many requirements for an mHealth solution that addresses psychosocial functioning; dependable information; and, possibly, a prediction of how a patient?s recovery trajectory is evolving. A structured development approach provided insights into value drivers and facilitated mHealth prototype enhancement. The findings imply that iterative development should move on from simple and easily implementable mHealth solutions to those that are suitable for broader innovations of care pathways that most?but plausibly not yet all?end users in trauma care will value. This study could inspire the trauma care community. UR - https://humanfactors.jmir.org/2022/2/e35342 UR - http://dx.doi.org/10.2196/35342 UR - http://www.ncbi.nlm.nih.gov/pubmed/35723928 ID - info:doi/10.2196/35342 ER - TY - JOUR AU - Sibuyi, Idon-Nkhenso AU - de la Harpe, Retha AU - Nyasulu, Peter PY - 2022/6/16 TI - A Stakeholder-Centered mHealth Implementation Inquiry Within the Digital Health Innovation Ecosystem in South Africa: MomConnect as a Demonstration Case JO - JMIR Mhealth Uhealth SP - e18188 VL - 10 IS - 6 KW - MomConnect KW - mHealth KW - patient-facing eHealth KW - digital health innovation ecosystem KW - practitioner-researcher KW - stakeholder-centered design KW - re-engineering in health services KW - sustainable development goals KW - principles of digital development KW - global digital health index KW - strong structuration theory N2 - Background: The internet is a useful web-based multimedia platform for accessing and disseminating information unconstrained by time, distance, and place. To the health care sector?s benefit, the advent and proliferation of mobile devices have provided an opportunity for interventions that combine asynchronous technology-aided health services to improve the lives of the less privileged and marginalized people and their communities, particularly in developing societies. Objective: This study aimed to report on the perspectives of the different stakeholders involved in the study and to review an existing government mobile health (mHealth) program. It forms part of a study to design a re-engineered strategy based on the best demonstrated practices (considerations and methods) and learned experiences from the perspectives of multiple stakeholders within the digital health innovation ecosystem in South Africa. Methods: This study used an ethnographic approach involving document review, stakeholder mapping, semistructured individual interviews, focus group discussions, and participant observations to explore, describe, and analyze the perspectives of its heterogeneous participant categories representing purposively sampled but different constituencies. Results: Overall, 80 participants were involved in the study, in addition to the 6 meetings the researcher attended with members of a government-appointed task team. In addition, 46 archived records and reports were consulted and reviewed as part of gathering data relating to the government?s MomConnect project. Among the consulted stakeholders, there was general consensus that the existing government-sponsored MomConnect program should be implemented beyond mere piloting, to as best as possible capacity within the available resources and time. It was further intimated that the scalability and sustainability of mHealth services as part of an innovative digital health ecosystem was hamstrung by challenges that included stakeholder mismanagement, impact assessment inadequacies, management of data, lack of effective leadership and political support, inappropriate technology choices, eHealth and mHealth funding, integration of mHealth to existing health programs in tandem with Goal 3 of the Sustainable Development Goals, integration of lessons learned from other mHealth initiatives to avoid resource wastage and duplication of efforts, proactive evaluation of both mHealth and eHealth strategies, and change management and developing human resources for eHealth. Conclusions: This study has only laid a foundation for the re-engineering of mHealth services within the digital health innovation ecosystem. This study articulated the need for stakeholder collaboration, such as continuous engagement among academics, technologists, and mHealth fieldwork professionals. Such compelling collaboration is accentuated more by the South African realities of the best practices in the fieldwork, which may not necessarily be documented in peer-reviewed or systematic research documents from which South African professionals, research experts, and practitioners could learn. Further research is needed for the retrospective analysis of mHealth initiatives and forecasting of the sustainability of current and future mHealth initiatives in South Africa. UR - https://mhealth.jmir.org/2022/6/e18188 UR - http://dx.doi.org/10.2196/18188 UR - http://www.ncbi.nlm.nih.gov/pubmed/35708756 ID - info:doi/10.2196/18188 ER - TY - JOUR AU - Herbert, Carly AU - Kheterpal, Vik AU - Suvarna, Thejas AU - Broach, John AU - Marquez, Luis Juan AU - Gerber, Ben AU - Schrader, Summer AU - Nowak, Christopher AU - Harman, Emma AU - Heetderks, William AU - Fahey, Nisha AU - Orvek, Elizabeth AU - Lazar, Peter AU - Ferranto, Julia AU - Noorishirazi, Kamran AU - Valpady, Shivakumar AU - Shi, Qiming AU - Lin, Honghuang AU - Marvel, Kathryn AU - Gibson, Laura AU - Barton, Bruce AU - Lemon, Stephenie AU - Hafer, Nathaniel AU - McManus, David AU - Soni, Apurv PY - 2022/6/16 TI - Design and Preliminary Findings of Adherence to the Self-Testing for Our Protection From COVID-19 (STOP COVID-19) Risk-Based Testing Protocol: Prospective Digital Study JO - JMIR Form Res SP - e38113 VL - 6 IS - 6 KW - COVID-19 KW - rapid antigen tests KW - COVID-19 testing KW - infectious disease KW - disease spread KW - prevention KW - coronavirus KW - adherence KW - reporting KW - mHealth KW - health application KW - mobile health KW - digital health KW - public health KW - surveillance KW - health care KW - smartphone app KW - vaccination KW - digital surveillance N2 - Background: Serial testing for SARS-CoV-2 is recommended to reduce spread of the virus; however, little is known about adherence to recommended testing schedules and reporting practices to health departments. Objective: The Self-Testing for Our Protection from COVID-19 (STOP COVID-19) study aims to examine adherence to a risk-based COVID-19 testing strategy using rapid antigen tests and reporting of test results to health departments. Methods: STOP COVID-19 is a 12-week digital study, facilitated using a smartphone app for testing assistance and reporting. We are recruiting 20,000 participants throughout the United States. Participants are stratified into high- and low-risk groups based on history of COVID-19 infection and vaccination status. High-risk participants are instructed to perform twice-weekly testing for COVID-19 using rapid antigen tests, while low-risk participants test only in the case of symptoms or exposure to COVID-19. All participants complete COVID-19 surveillance surveys, and rapid antigen results are recorded within the smartphone app. Primary outcomes include participant adherence to a risk-based serial testing protocol and percentage of rapid tests reported to health departments. Results: As of February 2022, 3496 participants have enrolled, including 1083 high-risk participants. Out of 13,730 tests completed, participants have reported 13,480 (98.18%, 95% CI 97.9%-98.4%) results to state public health departments with full personal identifying information or anonymously. Among 622 high-risk participants who finished the study period, 35.9% showed high adherence to the study testing protocol. Participants with high adherence reported a higher percentage of test results to the state health department with full identifying information than those in the moderate- or low-adherence groups (high: 71.7%, 95% CI 70.3%-73.1%; moderate: 68.3%, 95% CI 66.0%-70.5%; low: 63.1%, 59.5%-66.6%). Conclusions: Preliminary results from the STOP COVID-19 study provide important insights into rapid antigen test reporting and usage, and can thus inform the use of rapid testing interventions for COVID-19 surveillance. UR - https://formative.jmir.org/2022/6/e38113 UR - http://dx.doi.org/10.2196/38113 UR - http://www.ncbi.nlm.nih.gov/pubmed/35649180 ID - info:doi/10.2196/38113 ER - TY - JOUR AU - Paradis, Sabrina AU - Roussel, Jeremy AU - Bosson, Jean-Luc AU - Kern, Jean-Baptiste PY - 2022/6/16 TI - Use of Smartphone Health Apps Among Patients Aged 18 to 69 Years in Primary Care: Population-Based Cross-sectional Survey JO - JMIR Form Res SP - e34882 VL - 6 IS - 6 KW - smartphone KW - health applications KW - mHealth KW - apps KW - mobile health KW - digital health KW - well-being KW - epidemiology KW - primary care KW - population survey KW - fitness KW - physical activity KW - health behavior KW - patient N2 - Background: The World Health Organization has defined mobile health (mHealth) as the ?use of mobile and wireless technologies to support the achievement of health objectives.? Smartphones currently represent one of the main media forms for mHealth democratization. Health apps can be an interesting tool for changing health behaviors. However, their use in France is still poorly documented. Objective: The main aim of this study was to evaluate the frequency of use of health apps among patients consulting in the primary care setting in France. The secondary aims were to evaluate the use of health apps according to the sociodemographic and medical characteristics of patients and to determine their use. Methods: A population-based cross-sectional survey was carried out between November 2017 and January 2018 in the Grenoble area of France among patients aged between 18 and 69 years who were consulting at 13 primary care physician offices. Patients were provided with anonymous paper self-questionnaires. The main criterion for participation was the use of a smartphone health app, defined for the purpose of this study as any app supporting patients in efforts to be healthy. Results: The participation rate was 49.27% (739/1500; 95% CI 46.7%-51.8%). The smartphone use was estimated at 82.6% (597/723; 95% CI 79.6%-85.2%). Of 597 smartphone owners, 47.7% (283/595; CI 43.6%-51.6%) used at least one smartphone health app. Health apps identified in this study were mainly related to wellness, prevention, and fitness (66.1%), as well as medication, treatments, and follow-up care (50.0%). The main factors associated with health app use were: use of social networks (odds ratio [OR] 3.4, 95% CI 2.1-5.3), age under 30 years (OR 2.7, CI 1.4-4.9), city size between 5001 and 10,000 inhabitants (OR 1.8, CI 1.1-2.8), and city size more than 10,000 inhabitants (OR 2.1, CI 1.4-3.2). Conclusions: In this survey, nearly one out of two patients reported the use of smartphone health apps, which are currently focused on wellness, prevention, and fitness, and are largely used by the younger population. Trial Registration: ClinicalTrials.gov NCT03351491; https://clinicaltrials.gov/ct2/show/NCT03351491 UR - https://formative.jmir.org/2022/6/e34882 UR - http://dx.doi.org/10.2196/34882 UR - http://www.ncbi.nlm.nih.gov/pubmed/35708744 ID - info:doi/10.2196/34882 ER - TY - JOUR AU - Pinto, V. Janaina AU - Hunt, Caroline AU - O'Toole, Brian PY - 2022/6/15 TI - Advancing Posttraumatic Stress Disorder Diagnosis and the Treatment of Trauma in Humanitarian Emergencies via Mobile Health: Protocol for a Proof-of-Concept Nonrandomized Controlled Trial JO - JMIR Res Protoc SP - e38223 VL - 11 IS - 6 KW - posttraumatic stress disorder KW - PTSD KW - trauma KW - humanitarian KW - emergencies KW - mobile health KW - mHealth KW - technology KW - neuroscience KW - electrophysiology KW - electroencephalogram KW - EEG KW - cognition KW - health system KW - biometric KW - health application KW - mental health KW - health intervention KW - mobile phone N2 - Background: Decentralized health systems in low- and middle-income countries (LMICs) affected by humanitarian crises lack resources and a qualified workforce to attend to the overwhelming demand for mental health care in emergencies. Innovative approaches that are safe, cost-effective, and scalable are needed to address the burden of traumatic stress caused by emergencies. High mobile phone ownership rates combined with the precision of neural, cognitive, and biometric measures of trauma and their feasible integration with artificial intelligence makes digital app interventions a promising pathway to promote precision diagnosis and high-impact care. Objective: This study aimed to advance methods for the objective diagnosis and treatment of trauma in emergencies across LMICs by examining neural, cognitive, and biometric markers and the efficacy of the eResilience app, a neuroscience-informed mobile health mental health app intervention, via changes in clinical symptomatology, cognitive performance, and brain activity. Methods: Trauma-exposed African refugees residing in Australia were selected for this study. A research software version of the eResilience app with advanced monitoring capabilities was designed for this trial. Participants completed the eResilience app at home during a 7-day period. Clinical, cognitive, and electrophysiological data were collected at baseline, along with posttest measurements to examine biomarkers of trauma and the efficacy of the proposed digital intervention for the treatment of trauma and its potential outcomes, including depression, anxiety, physical symptoms, self-harm, substance misuse, and cognitive impairment. In addition, biofeedback, well-being, and subjective stress data points were collected via the app during the treatment week, followed by clinical interviews at 1, 3, 6, and 12 months after the intervention. Results: Data collection was conducted between 2018 and 2020. A total of 100 participants exposed to war were screened; 75 (75%) were enrolled and assigned to a trauma-exposed control (38/75, 51%) or posttraumatic stress disorder condition (37/75, 49%); and 70 (70%) completed all baseline, treatment, and posttest assessments. A total of 89% (62/70) of those who completed the intervention opted to enroll in the 3-, 6-, and 12-month follow-ups. Data collection is complete. As of May 2022, the results of all proposed analyses are being prepared for publication. If proven efficacious, this proof-of-concept clinical trial will inform fully powered randomized clinical trials in LMICs to further develop artificial intelligence?powered, app-based diagnostic and prognostic features and determine the app?s cross-cultural efficacy for the treatment of trauma in emergency settings. Conclusions: This protocol provides researchers with a comprehensive background of the study rationale, a detailed guideline for replication studies interested in examining the feasibility and efficacy of the eResilience app across varied demographics, and a robust framework for investigating low-cost objective diagnostic markers in mental health interventions. Methodological limitations and suggestions are also provided. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001205426; https://tinyurl.com/yckwc4d7 International Registered Report Identifier (IRRID): RR1-10.2196/38223 UR - https://www.researchprotocols.org/2022/6/e38223 UR - http://dx.doi.org/10.2196/38223 UR - http://www.ncbi.nlm.nih.gov/pubmed/35596546 ID - info:doi/10.2196/38223 ER - TY - JOUR AU - Elnakib, Shatha AU - Vecino-Ortiz, I. Andres AU - Gibson, G. Dustin AU - Agarwal, Smisha AU - Trujillo, J. Antonio AU - Zhu, Yifan AU - Labrique, B. Alain PY - 2022/6/14 TI - A Novel Score for mHealth Apps to Predict and Prevent Mortality: Further Validation and Adaptation to the US Population Using the US National Health and Nutrition Examination Survey Data Set JO - J Med Internet Res SP - e36787 VL - 24 IS - 6 KW - C-Score KW - validation KW - mortality KW - predictive models KW - mobile phone N2 - Background: The C-Score, which is an individual health score, is based on a predictive model validated in the UK and US populations. It was designed to serve as an individualized point-in-time health assessment tool that could be integrated into clinical counseling or consumer-facing digital health tools to encourage lifestyle modifications that reduce the risk of premature death. Objective: Our study aimed to conduct an external validation of the C-Score in the US population and expand the original score to improve its predictive capabilities in the US population. The C-Score is intended for mobile health apps on wearable devices. Methods: We conducted a literature review to identify relevant variables that were missing in the original C-Score. Subsequently, we used data from the 2005 to 2014 US National Health and Nutrition Examination Survey (NHANES; N=21,015) to test the capacity of the model to predict all-cause mortality. We used NHANES III data from 1988 to 1994 (N=1440) to conduct an external validation of the test. Only participants with complete data were included in this study. Discrimination and calibration tests were conducted to assess the operational characteristics of the adapted C-Score from receiver operating curves and a design-based goodness-of-fit test. Results: Higher C-Scores were associated with reduced odds of all-cause mortality (odds ratio 0.96, P<.001). We found a good fit of the C-Score for all-cause mortality with an area under the curve (AUC) of 0.72. Among participants aged between 40 and 69 years, C-Score models had a good fit for all-cause mortality and an AUC >0.72. A sensitivity analysis using NHANES III data (1988-1994) was performed, yielding similar results. The inclusion of sociodemographic and clinical variables in the basic C-Score increased the AUCs from 0.72 (95% CI 0.71-0.73) to 0.87 (95% CI 0.85-0.88). Conclusions: Our study shows that this digital biomarker, the C-Score, has good capabilities to predict all-cause mortality in the general US population. An expanded health score can predict 87% of the mortality in the US population. This model can be used as an instrument to assess individual mortality risk and as a counseling tool to motivate behavior changes and lifestyle modifications. UR - https://www.jmir.org/2022/6/e36787 UR - http://dx.doi.org/10.2196/36787 UR - http://www.ncbi.nlm.nih.gov/pubmed/35483022 ID - info:doi/10.2196/36787 ER - TY - JOUR AU - Jones, Jeb AU - Edwards, Winslow O. AU - Merrill, Leland AU - Sullivan, S. Patrick AU - Stephenson, Rob PY - 2022/6/13 TI - Interest in HIV Prevention Mobile Phone Apps: Focus Group Study With Sexual and Gender Minority Persons Living in the Rural Southern United States JO - JMIR Form Res SP - e38075 VL - 6 IS - 6 KW - men who have sex with men KW - transgender persons KW - nonbinary persons KW - mHealth KW - mobile app KW - HIV KW - pre-exposure prophylaxis KW - PrEP KW - sexually transmitted infection testing KW - STI testing KW - HIV testing KW - mobile phone N2 - Background: Mobile health (mHealth) interventions, including smartphone apps, have been found to be an effective means of increasing the uptake of HIV prevention tools, including HIV and sexually transmitted infection (STI) tests and pre-exposure prophylaxis. However, most HIV prevention mHealth apps tested in the United States have been tested among populations living in areas surrounding urban centers. Owing to reduced access to broadband internet and reliable cellular data services, it remains unclear how accessible and effective these interventions will be in rural areas. In addition, gay and bisexual men who have sex with men and gender minority populations in rural areas experience enhanced stigma when compared with their more urban counterparts, and these experiences might affect their willingness and interest in mHealth apps. Objective: This study aimed to conduct online focus groups with men who have sex with men and transgender and gender diverse populations in the rural southern United States to assess their interest in mHealth HIV prevention apps and the features that they would be the most interested in using. Methods: Focus group participants were recruited from a larger pool of sexual and gender minority respondents to a web-based research survey. The participants indicated that they would be willing to participate in an online focus group discussion. Focus groups were conducted via secure Zoom (Zoom Video Communications Inc) videoconferencing. During the focus group discussions, participants were asked to discuss their experiences with HIV and STI prevention and how these experiences were affected by living in a rural area. They were then shown screenshots of a new app to promote HIV and STI prevention among rural populations and asked to provide their opinions on the app?s features. The transcripts of the discussions were reviewed and coded using a constant comparative approach. Results: A total of 6 focus groups were conducted with 26 participants. Most participants were cisgender gay and bisexual men who have sex with men (19/26, 73%); the remaining participants were transgender men (2/26, 8%), were nonbinary people (2/26, 8%), or had multiple gender identities (3/26, 12%). Participants reported numerous barriers to accessing HIV and STI prevention services and accurate information about HIV and STI prevention options. Overall, the participants reported a high degree of interest in mHealth interventions for HIV and STI prevention and suggested several recommendations for the features of an app-based intervention that would be the most useful for rural residents. Conclusions: These focus group discussions indicate that rural residence is not a major barrier to mHealth HIV and STI prevention intervention implementation and that there is a high degree of interest in these approaches to HIV and STI prevention. UR - https://formative.jmir.org/2022/6/e38075 UR - http://dx.doi.org/10.2196/38075 UR - http://www.ncbi.nlm.nih.gov/pubmed/35699980 ID - info:doi/10.2196/38075 ER - TY - JOUR AU - Gibson, P. Laurel AU - Kramer, B. Emily AU - Bryan, D. Angela PY - 2022/6/13 TI - Geosocial Networking App Use Associated With Sexual Risk Behavior and Pre-exposure Prophylaxis Use Among Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-sectional Web-Based Survey JO - JMIR Form Res SP - e35548 VL - 6 IS - 6 KW - dating app KW - mobile dating KW - hookup KW - gay KW - pre-exposure prophylaxis KW - sexual risk KW - HIV KW - STI KW - mobile phone N2 - Background: In the United States, geosocial networking (GSN) apps (ie, mobile dating apps) have become central to dating and sexual interactions in recent years. Among gay, bisexual, and other men who have sex with men (GBM), these apps play an important role in reducing barriers and facilitating partner seeking. However, despite these benefits, there are concerns that these apps may facilitate risky sexual behavior and transmission of sexually transmitted infections (STIs) among GBM. Objective: This study aimed to examine the association between GSN app use and sexual risk in a US sample of GBM. Methods: Using a cross-sectional design, respondents (N=223) completed a web-based survey assessing their use of GSN apps, sexual risk and protective behaviors, HIV serostatus, and previous STI diagnoses. Results: Respondents were aged 21-78 (mean 31.90, SD 10.06) years and 69.5% (155/223) were non-Hispanic White. The sample included respondents from 40 states and the District of Columbia. Nearly half (104/223, 47%) of the participants reported using GSN apps. GSN users were more likely to report past-year condomless anal intercourse (P<.001), 3 or more sexual partners in the previous year (P<.001), and a previous STI diagnosis (P=.001) than nonusers. GSN users also reported more frequent use of recreational drugs before sex (P=.001), alcohol use before sex (P<.001), and cannabis use before sex (P=.01). Interestingly, GSN users were also more likely to report having ever taken an HIV test (P<.001) and using pre-exposure prophylaxis (P=.03). The rates of HIV seropositivity did not differ significantly between GSN users and nonusers (P=.53). Among the subset of GSN users, 38 participants reported using only GBM-specific GSN apps (eg, Grindr), whereas 27 participants reported using only sexuality nonspecific GSN apps (eg, Tinder). Exclusive users of GBM?specific apps reported more frequent recreational drug use before sex (P=.01) and were also more likely to report past-year condomless anal intercourse (P<.001), 3 or more sexual partners in the previous year (P=.004), a previous STI diagnosis (P=.002), and HIV testing (P=.003). Alcohol use before sex, cannabis use before sex, pre-exposure prophylaxis use, and HIV rates were similar between both groups (P>.11). Conclusions: The findings suggest that GSN apps may be a useful pathway for interventions aimed at reducing STI risk in GBM. Future prospective studies should examine how risk levels change after the initiation of GSN app use. UR - https://formative.jmir.org/2022/6/e35548 UR - http://dx.doi.org/10.2196/35548 UR - http://www.ncbi.nlm.nih.gov/pubmed/35699992 ID - info:doi/10.2196/35548 ER - TY - JOUR AU - Avram, Robert AU - So, Derek AU - Iturriaga, Erin AU - Byrne, Julia AU - Lennon, Ryan AU - Murthy, Vishakantha AU - Geller, Nancy AU - Goodman, Shaun AU - Rihal, Charanjit AU - Rosenberg, Yves AU - Bailey, Kent AU - Farkouh, Michael AU - Bell, Malcolm AU - Cagin, Charles AU - Chavez, Ivan AU - El-Hajjar, Mohammad AU - Ginete, Wilson AU - Lerman, Amir AU - Levisay, Justin AU - Marzo, Kevin AU - Nazif, Tamim AU - Olgin, Jeffrey AU - Pereira, Naveen PY - 2022/6/13 TI - Patient Onboarding and Engagement to Build a Digital Study After Enrollment in a Clinical Trial (TAILOR-PCI Digital Study): Intervention Study JO - JMIR Form Res SP - e34080 VL - 6 IS - 6 KW - digital study KW - clinical trial KW - cardiology KW - smartphone KW - digital health KW - mobile health KW - mobile phone N2 - Background: The Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention (TAILOR-PCI) Digital Study is a novel proof-of-concept study that evaluated the feasibility of extending the TAILOR-PCI randomized controlled trial (RCT) follow-up period by using a remote digital platform. Objective: The aim of this study is to describe patients? onboarding, engagement, and results in a digital study after enrollment in an RCT. Methods: In this intervention study, previously enrolled TAILOR-PCI patients in the United States and Canada within 24 months of randomization were invited by letter to download the study app. Those who did not respond to the letter were contacted by phone to survey the reasons for nonparticipation. A direct-to-patient digital research platform (the Eureka Research Platform) was used to onboard patients, obtain consent, and administer activities in the digital study. The patients were asked to complete health-related surveys and digitally provide follow-up data. Our primary end points were the consent rate, the duration of participation, and the monthly activity completion rate in the digital study. The hypothesis being tested was formulated before data collection began. Results: After the parent trial was completed, letters were mailed to 907 eligible patients (representing 18.8% [907/4837] of total enrolled in the RCT) within 15.6 (SD 5.2) months of randomization across 24 sites. Among the 907 patients invited, 290 (32%) visited the study website and 110 (12.1%) consented?40.9% (45/110) after the letter, 33.6% (37/110) after the first phone call, and 25.5% (28/110) after the second call. Among the 47.4% (409/862) of patients who responded, 41.8% (171/409) declined to participate because of a lack of time, 31.2% (128/409) declined because of the lack of a smartphone, and 11.5% (47/409) declined because of difficulty understanding what was expected of them in the study. Patients who consented were older (aged 65.3 vs 62.5 years; P=.006) and had a lower prevalence of diabetes (19% vs 30%; P=.02) or tobacco use (6.4% vs 24.8%; P<.001). A greater proportion had bachelor?s degrees (47.2% vs 25.7%; P<.001) and were more computer literate (90.5% vs 62.3% of daily internet use; P<.001) than those who did not consent. The average completion rate of the 920 available monthly electronic visits was 64.9% (SD 7.6%); there was no decrease in this rate throughout the study duration. Conclusions: Extended follow-up after enrollment in an RCT by using a digital study was technically feasible but was limited because of the inability to contact most eligible patients or a lack of time or access to a smartphone. Among the enrolled patients, most completed the required electronic visits. Enhanced recruitment methods, such as the introduction of a digital study at the time of RCT consent, smartphone provision, and robust study support for onboarding, should be explored further. Trial Registration: Clinicaltrails.gov NCT01742117; https://clinicaltrials.gov/ct2/show/NCT01742117 UR - https://formative.jmir.org/2022/6/e34080 UR - http://dx.doi.org/10.2196/34080 UR - http://www.ncbi.nlm.nih.gov/pubmed/35699977 ID - info:doi/10.2196/34080 ER - TY - JOUR AU - Pravosud, Vira AU - Ballard, M. April AU - Holloway, W. Ian AU - Young, M. April PY - 2022/6/10 TI - Online Partner Seeking and Sexual Behaviors Among Men Who Have Sex With Men From Small and Midsized Towns: Cross-sectional Study JO - JMIR Form Res SP - e35056 VL - 6 IS - 6 KW - men who have sex with men KW - MSM KW - sexual risk behaviors KW - social networking and dating apps KW - online tools KW - HIV KW - sexually transmitted infection KW - STI prevention KW - mobile phone N2 - Background: Men who have sex with men (MSM) residing outside of large urban areas are underrepresented in research on online partner seeking and sexual behaviors related to transmission of HIV. Objective: We aimed to determine associations between the use of the internet or social networking apps (online tools) to meet partners for sex, dating, or for both purposes (online partner seeking) and sexual behaviors among MSM residing in small and midsized towns in Kentucky, United States. Methods: Using peer-referral sampling and online self-administered questionnaires, data were collected from 252 men, aged 18 to 34 years, who had recently (past 6 months) engaged in anal sex with another man and resided in Central Kentucky. Using multivariable logistic regression models, we assessed associations of online partner seeking and HIV-related sexual behaviors. Results: Most (181/252, 71.8%) of the participants reported using online tools for partner seeking. Of these 181 respondents, 166 (91.7%) had used online tools to meet partners for sex (n=45, 27.1% for sex only; and n=121, 72.9% for sex and dating) and 136 (75.1%) had used online tools to meet partners for dating (n=15, 11% for dating only; and n=121, 89% for sex and dating). Adjusted analyses revealed that MSM who had engaged in condomless insertive and receptive anal intercourse were less likely to report online partner seeking (adjusted odds ratio [aOR] 0.22, 95% CI 0.07-0.68; P=.009 and aOR 0.25, 95% CI 0.10-0.66; P=.005, respectively). Increased number of insertive and receptive anal sex partners and substance use before or during sex were associated with higher odds of online partner seeking (aOR 1.31, 95% CI 1.11-1.55; P=.001; aOR 1.20, 95% CI 1.05-1.39; P=.008; and aOR 2.50, 95% CI 1.41-4.44; P=.002, respectively). Conclusions: Among MSM who reside outside of large urban areas and practice online partner seeking, HIV risk-reduction interventions should address safer sex practices, including the risks for HIV transmission associated with alcohol or drug use before or during sex. MSM who do not practice online partner seeking are in need of continued outreach to reduce condomless anal sex. UR - https://formative.jmir.org/2022/6/e35056 UR - http://dx.doi.org/10.2196/35056 UR - http://www.ncbi.nlm.nih.gov/pubmed/35687395 ID - info:doi/10.2196/35056 ER - TY - JOUR AU - Domin, Alex AU - Ouzzahra, Yacine AU - Vögele, Claus PY - 2022/6/9 TI - Features and Components Preferred by Adolescents in Smartphone Apps for the Promotion of Physical Activity: Focus Group Study JO - JMIR Hum Factors SP - e33972 VL - 9 IS - 2 KW - mHealth KW - physical activity KW - mobile phone KW - health KW - qualitative research KW - focus groups KW - smartphone apps KW - behavior change KW - mobile health KW - adolescents N2 - Background: There is solid evidence that lack of physical activity (PA) is a risk factor for chronic diseases. Sufficient levels of PA in childhood and adolescence are particularly important, as they can set the standards for PA levels in adulthood. The latest reports show that only a small percentage of adolescents reach the recommended levels of PA in European Union countries at the age of 15 years. In view of the scale of the problem, it is crucial to develop interventions that promote and support PA in adolescents. Considering their low implementation costs and ubiquitous presence, smartphone apps could be advantageous as a part of PA interventions. Objective: This study aimed at investigating the attitudes and preferences of adolescents aged 16-18 years toward various PA app features and components that could (1) make the app more attractive for them and consequently (2) increase their interest and engagement with the app. Methods: Two separate focus group discussions were conducted in 2 groups of adolescents (n=4 each) aged 16-18 years. Focus groups were carried out online via video conference. The discussions were conducted using a semistructured interview. Participants (n=8; 4 males and 4 females) had a mean age of 17.25 years (SD 0.82 years). Transcripts were analyzed following the approach by Krueger and Casey, that is, categorizing participants? answers and comments according to the questions and themes from the focus group schedule. Results: Features, such as ?goal setting and planning,? ?coaching and training programs,? ?activity tracking,? ?feedback,? and ?location tracking? were appraised as attractive, motivating, and interesting. An ?automatic activity recognition? feature was perceived as useful only under the condition that its precision was high. The ?reminders? component was also deemed as useful only if a range of conditions was fulfilled (timeliness, opportunity for customization, etc). The features ?mood and sleep tracking,? ?sharing workout results via social networks,? ?digital avatar and coach,? and ?rewards? were generally perceived negatively and considered as useless and not motivating. In general, participants preferred features with an easy-to-navigate interface and a clear, simplistic, and straightforward layout with a modern design. Customization and personalization qualities were highly appreciated throughout an app, together with data precision. Conclusions: This study contributes to the understanding of the features and components preferred by adolescents in apps promoting PA. Such apps should provide users with precise data, and have a simplistic modern design and a straightforward easy-to-use interface. Apps should be personalized and customizable. Desired features to be included in an app are goal setting and planning, feedback, coaching and training programs, and activity tracking. The features should involve high levels of data precision and timely delivery while taking into consideration the real-life context. UR - https://humanfactors.jmir.org/2022/2/e33972 UR - http://dx.doi.org/10.2196/33972 UR - http://www.ncbi.nlm.nih.gov/pubmed/35679113 ID - info:doi/10.2196/33972 ER - TY - JOUR AU - Kwun, Ju-Seung AU - Yoon, Chang-Hwan AU - Kim, Sun-Hwa AU - Jeon, Ki-Hyun AU - Kang, Si-Hyuck AU - Lee, Wonjae AU - Youn, Tae-Jin AU - Chae, In-Ho PY - 2022/6/9 TI - Surveillance of Arrhythmia in Patients After Myocardial Infarction Using Wearable Electrocardiogram Patch Devices: Prospective Cohort Study JO - JMIR Cardio SP - e35615 VL - 6 IS - 1 KW - myocardial infarction KW - arrhythmia KW - wearable electronic device KW - wearable KW - ECG KW - electrocardiogram KW - patch KW - patch devices KW - atrial fibrillation KW - heart KW - rhythm KW - cardiology KW - cardiologist KW - cohort study KW - tachycardia KW - beta-blocker N2 - Background: Acute myocardial infarction may be associated with new-onset arrhythmias. Patients with myocardial infarction may manifest serious arrhythmias such as ventricular tachyarrhythmias or atrial fibrillation. Frequent, prolonged electrocardiogram (ECG) monitoring can prevent devastating outcomes caused by these arrhythmias. Objective: We aimed to investigate the incidence of arrhythmias in patients following myocardial infarction using a patch-type device?AT-Patch (ATP-C120; ATsens). Methods: This study is a nonrandomized, single-center, prospective cohort study. We evaluated 71 patients who had had a myocardial infarction and had been admitted to our hospital. The ATP-C120 device was attached to the patient for 11 days and analyzed by 2 cardiologists for new-onset arrhythmic events. Results: One participant was concordantly diagnosed with atrial fibrillation. The cardiologists diagnosed atrial premature beats in 65 (92%) and 60 (85%) of 71 participants, and ventricular premature beats in 38 (54%) and 44 (62%) participants, respectively. Interestingly, 40 (56%) patients showed less than 2 minutes of sustained paroxysmal atrial tachycardia confirmed by both cardiologists. Among participants with atrial tachycardia, the use of ?-blockers was significantly lower compared with patients without tachycardia (70% vs 90%, P=.04). However, different dosages of ?-blockers did not make a significant difference. Conclusions: Wearable ECG monitoring patch devices are easy to apply and can correlate symptoms and ECG rhythm disturbances in patients following myocardial infarction. Further study is necessary regarding clinical implications and appropriate therapies for arrhythmias detected early after myocardial infarction to prevent adverse outcomes. UR - https://cardio.jmir.org/2022/1/e35615 UR - http://dx.doi.org/10.2196/35615 UR - http://www.ncbi.nlm.nih.gov/pubmed/35679117 ID - info:doi/10.2196/35615 ER - TY - JOUR AU - Wu, Chieh-Chen AU - Huang, Chih-Wei AU - Wang, Yao-Chin AU - Islam, Md.Mohaimenul AU - Kung, Woon-Man AU - Weng, Yung-Ching AU - Su, Chun-Hsien PY - 2022/6/8 TI - mHealth Research for Weight Loss, Physical Activity, and Sedentary Behavior: Bibliometric Analysis JO - J Med Internet Res SP - e35747 VL - 24 IS - 6 KW - mobile health KW - weight loss KW - physical activity KW - sedentary behavior KW - bibliometric analysis KW - mHealth KW - weight KW - behavior KW - research KW - literature KW - bibliometric KW - journal KW - trend KW - app N2 - Background: Research into mobile health (mHealth) technologies on weight loss, physical activity, and sedentary behavior has increased substantially over the last decade; however, no research has been published showing the research trend in this field. Objective: The purpose of this study was to provide a dynamic and longitudinal bibliometric analysis of recent trends of mHealth research for weight loss, physical activity, and sedentary behavior. Methods: A comprehensive search was conducted through Web of Science to retrieve all existing relevant documents published in English between January 1, 2010, and November 1, 2021. We developed appropriate research questions; based on the proven bibliometric approaches, a search strategy was formulated to screen the title for eligibility. Finally, we conducted bibliometric analyses to explore the growth rate of publications; publication patterns; and the most productive authors, institutions, and countries, and visualized the trends in the field using a keyword co-occurrence network. Results: The initial search identified 8739 articles, of which 1035 were included in the analyses. Our findings show an exponential growth trend in the number of annual publications of mHealth technology research in these fields. JMIR mHealth and uHealth (n=214, 20.67%), Journal of Medical Internet Research (n=71, 6.86%), and BMC Public Health (n=36, 3.47%) were the top 3 journals, publishing higher numbers of articles. The United States remained the leading contributor in these areas (n=405, 39.13%), followed by Australia (n=154, 14.87%) and England (n=125, 12.07%). Among the universities, the University of Sydney (n=36, 3.47%) contributed the most mHealth technology research in these areas; however, Deakin University (n=25, 2.41%) and the National University of Singapore (n=23, 2.22%) were in the second and third positions, respectively. Conclusions: Although the number of papers published on mobile technologies for weight loss, physical activity, and sedentary behavior was initially low, there has been an overall increase in these areas in recent years. The findings of the study indicate that mobile apps and technologies have substantial potential to reduce weight, increase physical activity, and change sedentary behavior. Indeed, this study provides a useful overview of the publication trends and valuable guidance on future research directions and perspectives in this rapidly developing field. UR - https://www.jmir.org/2022/6/e35747 UR - http://dx.doi.org/10.2196/35747 UR - http://www.ncbi.nlm.nih.gov/pubmed/35675126 ID - info:doi/10.2196/35747 ER - TY - JOUR AU - Yang, Yang AU - Boulton, Elisabeth AU - Todd, Chris PY - 2022/6/8 TI - Measurement of Adherence to mHealth Physical Activity Interventions and Exploration of the Factors That Affect the Adherence: Scoping Review and Proposed Framework JO - J Med Internet Res SP - e30817 VL - 24 IS - 6 KW - mobile health KW - mHealth KW - physical activity KW - adherence KW - framework KW - scoping review KW - mobile phone N2 - Background: Mobile health (mHealth) is widely used as an innovative approach to delivering physical activity (PA) programs. Users? adherence to mHealth programs is important to ensure the effectiveness of mHealth-based programs. Objective: Our primary aim was to review the literature on the methods used to assess adherence, factors that could affect users? adherence, and the investigation of the association between adherence and health outcomes. Our secondary aim was to develop a framework to understand the role of adherence in influencing the effectiveness of mHealth PA programs. Methods: MEDLINE, PsycINFO, EMBASE, and CINAHL databases were searched to identify studies that evaluated the use of mHealth to promote PA in adults aged ?18 years. We used critical interpretive synthesis methods to summarize the data collected. Results: In total, 54 papers were included in this review. We identified 31 specific adherence measurement methods, which were summarized into 8 indicators; these indicators were mapped to 4 dimensions: length, breadth, depth, and interaction. Users? characteristics (5 factors), technology-related factors (12 factors), and contextual factors (1 factor) were reported to have impacts on adherence. The included studies reveal that adherence is significantly associated with intervention outcomes, including health behaviors, psychological indicators, and clinical indicators. A framework was developed based on these review findings. Conclusions: This study developed an adherence framework linking together the adherence predictors, comprehensive adherence assessment, and clinical effectiveness. This framework could provide evidence for measuring adherence comprehensively and guide further studies on adherence to mHealth-based PA interventions. Future research should validate the utility of this proposed framework. UR - https://www.jmir.org/2022/6/e30817 UR - http://dx.doi.org/10.2196/30817 UR - http://www.ncbi.nlm.nih.gov/pubmed/35675111 ID - info:doi/10.2196/30817 ER - TY - JOUR AU - Okaniwa, Fusae AU - Yoshida, Hiroshi PY - 2022/6/8 TI - Evaluation of Dietary Management Using Artificial Intelligence and Human Interventions: Nonrandomized Controlled Trial JO - JMIR Form Res SP - e30630 VL - 6 IS - 6 KW - health promotion KW - dietary management KW - intervention KW - artificial intelligence KW - body fat percentage KW - body mass index KW - behavioral economics KW - nonprofessional KW - Japan N2 - Background: There has been an increase in personal health records with the increased use of wearable devices and smartphone apps to improve health. Traditional health promotion programs by human professionals have limitations in terms of cost and reach. Due to labor shortages and to save costs, there has been a growing emphasis in the medical field on building health guidance systems using artificial intelligence (AI). AI will replace advanced human tasks to some extent in the future. However, it is difficult to sustain behavioral change through technology alone at present. Objective: This study investigates whether AI alone can effectively encourage healthy behaviors or whether human interventions are needed to achieve and sustain health-related behavioral change. We examined the effectiveness of AI and human interventions to encourage dietary management behaviors. In addition, we elucidated the conditions for maximizing the effect of AI on health improvement. We hypothesized that the combination of AI and human interventions will maximize their effectiveness. Methods: We conducted a 3-month experiment by recruiting participants who were users of a smartphone diet management app. We recruited 102 participants and divided them into 3 groups. Treatment group I received text messages using the standard features of the app (AI-based text message intervention). Treatment group II received video messages from a companion, in addition to the text messages (combined text message and human video message intervention by AI). The control group used the app to keep a dietary record, but no feedback was provided (no intervention). We examine the participants? continuity and the effects on physical indicators. Results: Combined AI and video messaging (treatment group II) led to a lower dropout rate from the program compared to the control group, and the Cox proportional-hazards model estimate showed a hazard ratio (HR) of 0.078, which was statistically significant at the 5% level. Further, human intervention with AI and video messaging significantly reduced the body fat percentage (BFP) of participants after 3 months compared to the control group, and the rate of reduction was greater in the group with more individualized intervention. The AI-based text messages affected the BMI but had no significant effect on the BFP. Conclusions: This experiment shows that it is challenging to sustain participants' healthy behavior with AI intervention alone. The results also suggest that even if the health information conveyed is the same, the information conveyed by humans and AI is more effective in improving health than the information sent by AI alone. The support received from the companion in the form of video messages may have promoted voluntary health behaviors. It is noteworthy that companions were competent, even though they were nonexperts. This means that person-to-person communication is crucial for health interventions. UR - https://formative.jmir.org/2022/6/e30630 UR - http://dx.doi.org/10.2196/30630 UR - http://www.ncbi.nlm.nih.gov/pubmed/35675107 ID - info:doi/10.2196/30630 ER - TY - JOUR AU - Guillaume, Dominique AU - Troncoso, Erica AU - Duroseau, Brenice AU - Bluestone, Julia AU - Fullerton, Judith PY - 2022/6/7 TI - Mobile-Social Learning for Continuing Professional Development in Low- and Middle-Income Countries: Integrative Review JO - JMIR Med Educ SP - e32614 VL - 8 IS - 2 KW - digital learning KW - continuing medical education KW - mHealth KW - peer learning KW - mentorship KW - health systems KW - global health KW - mobile phone N2 - Background: Access to continuing professional development (CPD) for health care workers in low- and middle-income countries (LMICs) is severely limited. Digital technology serves as a promising platform for supporting CPD for health care workers by providing educational content virtually and enabling virtual peer-to-peer and mentor interaction for enhanced learning. Digital strategies for CPD that foster virtual interaction can increase workforce retention and bolster the health workforce in LMICs. Objective: The objective of this integrative review was to evaluate the evidence on which digital platforms were used to provide CPD to health care workers and clinical students in LMICs, which was complemented with virtual peer-to-peer or mentor interaction. We phrased this intersection of virtual learning and virtual interaction as mobile-social learning. Methods: A comprehensive database and gray literature search was conducted to identify qualitative, quantitative, and mixed methods studies, along with empirical evidence, that used digital technology to provide CPD and virtual interaction with peers or mentors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible articles were written in English, conducted in an LMIC, and used a mobile device to provide CPD and facilitate virtual peer-to-peer or mentor interaction. Titles, abstracts, and full texts were screened, followed by an assessment of the quality of evidence and an appraisal of the articles. A content analysis was then used to deductively code the data into emerging themes. Results: A total of 750 articles were identified, and 31 (4.1%) were included in the review. SMS text messaging and mobile instant messaging were the most common methods used to provide continuing education and virtual interaction between peers and mentors (25/31, 81%). Across the included articles, participants had high acceptability for using digital platforms for learning and interaction. Virtual peer interaction and mentorship were found to contribute to positive learning outcomes in most studies (27/31, 87%) through increased knowledge sharing, knowledge gains, improved clinical skills, and improved service delivery. Peer-to-peer and mentor interaction were found to improve social support and reduce feelings of isolation (9/31, 29%). There were several challenges in the implementation and use of digital technology for mobile-social learning, including limited access to resources (eg, internet coverage and stable electricity), flexibility in scheduling to participate in CPD, and sociobehavioral challenges among students. Conclusions: The summary suggests that mobile-social learning is a useful modality for curriculum dissemination and skill training and that the interface of mobile and social learning serves as a catalyst for improved learning outcomes coupled with increased social capital. UR - https://mededu.jmir.org/2022/2/e32614 UR - http://dx.doi.org/10.2196/32614 UR - http://www.ncbi.nlm.nih.gov/pubmed/35671080 ID - info:doi/10.2196/32614 ER - TY - JOUR AU - Treacy-Abarca, Sean AU - Mercado, Janisse AU - Serrano, Jorge AU - Gonzalez, Jennifer AU - Menchine, Michael AU - Arora, Sanjay AU - Wu, Shinyi AU - Burner, Elizabeth PY - 2022/6/6 TI - Technological Proficiencies, Engagement, and Practical Considerations for mHealth Programs at an Urban Safety-Net Hospital Emergency Departments: Data Analysis JO - JMIR Diabetes SP - e23641 VL - 7 IS - 2 KW - mHealth KW - engagement KW - practical considerations KW - safety-net hospital KW - emergency department KW - minority health KW - low income N2 - Background: Safety-net emergency departments often serve as the primary entry point for medical care for low income predominantly minority patient populations. Herein, we sought to provide insight into the feasibility, technological proficiencies, engagement characteristics, and practical considerations for a mHealth intervention at a safety-net emergency department. Objective: We aimed to analyze patient technological proficiency to understand the feasibility of and draw practical considerations for mobile phone technology (mHealth) solutions for patients with chronic disease served by safety-net emergency departments. Methods: We analyzed data from a previous diabetes randomized clinical mHealth trial for a diabetes social support intervention. Patients from a safety-net emergency department with preexisting diabetes who used SMS text messages, owned a mobile phone, and with hemoglobin A1c levels >8.5% were enrolled. A text message?based mHealth program to improve disease self-management was provided to all patients. Supporters of patients were randomized to receive a mailed copy or mHealth-based curriculum designed to improve diabetes support. Among enrolled patients, we surveyed mobile technological capacity and frequency of use. We performed latent class analysis to identify classes of patients by level of technological proficiency and compared demographic characteristics between the latent classes to identify demographic subgroups that may require more training or tailoring of the mHealth approach. Study engagement between classes was assessed by comparing the mean number of text messages exchanged, loss to follow-up, and early termination. Results: Of 1876 patients who were approached, 44.2% (n=829) of patients had a stable mobile phone and were able to use text messages. Among them 166 met the trial inclusion and enrolled, 90% (149/166) of the cohort were ethnically diverse. Significant variance was found in technology capacity and frequency of use. Our latent class analysis classified 75% (124/166) of patients as highly technologically proficient and 25% (42/166) patients as minimally technologically proficient. Age (P<.001) and level of education (P<.001) were associated with class membership. Highly technologically proficient patients were younger and had higher levels of education (45.74 years old; high school or more: 90%) than minimally technologically proficient patients (53.64 years old; high school or more: 18%). Highly technologically proficient participants exchanged a mean of 40 text messages with the system coordinators compared to a mean of 10 text messages by minimally technologically proficient patients (P<.001). Conclusions: This study found that nearly half of the patients screened at the safety-net emergency department were equipped for an SMS text message?based mHealth intervention. In the small sample of patients who were enrolled, the majority were classified as highly technologically proficient. These highly proficient patients had greater study engagement. mHealth use in emergency departments may be an opportunity to improve health of ethnically diverse populations by pairing sophisticated chronic disease self-management program with SMS text message?based and traditional in-person interventions to reach patients through the method that is most familiar and comfortable. International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2019.03.003 UR - https://diabetes.jmir.org/2022/2/e23641 UR - http://dx.doi.org/10.2196/23641 UR - http://www.ncbi.nlm.nih.gov/pubmed/35666555 ID - info:doi/10.2196/23641 ER - TY - JOUR AU - Baglione, N. Anna AU - Cai, Lihua AU - Bahrini, Aram AU - Posey, Isabella AU - Boukhechba, Mehdi AU - Chow, I. Philip PY - 2022/6/2 TI - Understanding the Relationship Between Mood Symptoms and Mobile App Engagement Among Patients With Breast Cancer Using Machine Learning: Case Study JO - JMIR Med Inform SP - e30712 VL - 10 IS - 6 KW - breast cancer KW - digital intervention KW - mobile intervention KW - mobile health KW - mHealth KW - app engagement KW - user engagement KW - mental health KW - depression KW - anxiety N2 - Background: Health interventions delivered via smart devices are increasingly being used to address mental health challenges associated with cancer treatment. Engagement with mobile interventions has been associated with treatment success; however, the relationship between mood and engagement among patients with cancer remains poorly understood. A reason for this is the lack of a data-driven process for analyzing mood and app engagement data for patients with cancer. Objective: This study aimed to provide a step-by-step process for using app engagement metrics to predict continuously assessed mood outcomes in patients with breast cancer. Methods: We described the steps involved in data preprocessing, feature extraction, and data modeling and prediction. We applied this process as a case study to data collected from patients with breast cancer who engaged with a mobile mental health app intervention (IntelliCare) over 7 weeks. We compared engagement patterns over time (eg, frequency and days of use) between participants with high and low anxiety and between participants with high and low depression. We then used a linear mixed model to identify significant effects and evaluate the performance of the random forest and XGBoost classifiers in predicting weekly mood from baseline affect and engagement features. Results: We observed differences in engagement patterns between the participants with high and low levels of anxiety and depression. The linear mixed model results varied by the feature set; these results revealed weak effects for several features of engagement, including duration-based metrics and frequency. The accuracy of predicting depressed mood varied according to the feature set and classifier. The feature set containing survey features and overall app engagement features achieved the best performance (accuracy: 84.6%; precision: 82.5%; recall: 64.4%; F1 score: 67.8%) when used with a random forest classifier. Conclusions: The results from the case study support the feasibility and potential of our analytic process for understanding the relationship between app engagement and mood outcomes in patients with breast cancer. The ability to leverage both self-report and engagement features to analyze and predict mood during an intervention could be used to enhance decision-making for researchers and clinicians and assist in developing more personalized interventions for patients with breast cancer. UR - https://medinform.jmir.org/2022/6/e30712 UR - http://dx.doi.org/10.2196/30712 UR - http://www.ncbi.nlm.nih.gov/pubmed/35653183 ID - info:doi/10.2196/30712 ER - TY - JOUR AU - Fletcher, Kathryn AU - Lindblom, Katrina AU - Seabrook, Elizabeth AU - Foley, Fiona AU - Murray, Greg PY - 2022/5/31 TI - Pilot Testing in the Wild: Feasibility, Acceptability, Usage Patterns, and Efficacy of an Integrated Web and Smartphone Platform for Bipolar II Disorder JO - JMIR Form Res SP - e32740 VL - 6 IS - 5 KW - bipolar disorder KW - smartphone KW - app KW - web-based intervention KW - ecological momentary assessment KW - mobile phone N2 - Background: Bipolar II disorder (BD-II) is associated with significant burden, disability, and mortality; however, there continues to be a dearth of evidence-based psychological interventions for this condition. Technology-mediated interventions incorporating self-management have untapped potential to help meet this need as an adjunct to usual clinical care. Objective: The objective of this pilot study is to assess the feasibility, acceptability, and clinical utility of a novel intervention for BD-II (Tailored Recovery-oriented Intervention for Bipolar II Experiences; TRIBE), in which mindfulness-based psychological content is delivered via an integrated web and smartphone platform. The focus of the study is evaluation of the dynamic use patterns emerging from ecological momentary assessment and intervention to assist the real-world application of mindfulness skills learned from web-delivered modules. Methods: An open trial design using pretest and posttest assessments with nested qualitative evaluation was used. Individuals (aged 18-65 years) with a diagnosis of BD-II were recruited worldwide and invited to use a prototype of the TRIBE intervention over a 3-week period. Data were collected via web-based questionnaires and phone interviews at baseline and 3-week follow-up. Results: A total of 25 participants completed baseline and follow-up assessments. Adherence rates (daily app use) were 65.6% across the 3-week study, with up to 88% (22/25) of participants using the app synergistically alongside the web-based program. Despite technical challenges with the prototype intervention (from user, hardware, and software standpoints), acceptability was adequate, and most participants rated the intervention positively in terms of concept (companion app with website: 19/25, 76%), content (19/25, 76%), and credibility and utility in supporting their management of bipolar disorder (17/25, 68%). Evaluation using behavioral archetypes identified important use pathways and a provisional model to inform platform refinement. As hypothesized, depression scores significantly decreased after the intervention (Montgomery-Asberg Depression Rating Scale baseline mean 8.60, SD 6.86, vs follow-up mean 6.16, SD 5.11; t24=2.63; P=.01; Cohen d=0.53, 95% CI 0.52-4.36). Conclusions: Our findings suggest that TRIBE is feasible and represents an appropriate and acceptable self-management program for patients with BD-II. Preliminary efficacy results are promising and support full development of TRIBE informed by the present behavioral archetype analysis. Modifications suggested by the pilot study include increasing the duration of the intervention and increasing technical support. UR - https://formative.jmir.org/2022/5/e32740/ UR - http://dx.doi.org/10.2196/32740 UR - http://www.ncbi.nlm.nih.gov/pubmed/35639462 ID - info:doi/10.2196/32740 ER - TY - JOUR AU - Businelle, S. Michael AU - Garey, Lorra AU - Gallagher, W. Matthew AU - Hébert, T. Emily AU - Vujanovic, Anka AU - Alexander, Adam AU - Kezbers, Krista AU - Matoska, Cameron AU - Robison, Jillian AU - Montgomery, Audrey AU - Zvolensky, J. Michael PY - 2022/5/30 TI - An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e38905 VL - 11 IS - 5 KW - smoking cessation KW - treatment KW - Black KW - African American KW - anxiety sensitivity KW - mHealth KW - just-in-time adaptive intervention KW - mobile phone N2 - Background: Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation. Objective: This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation. Methods: In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones. Results: This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022. Conclusions: If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation. Trial Registration: ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236 International Registered Report Identifier (IRRID): DERR1-10.2196/38905 UR - https://www.researchprotocols.org/2022/5/e38905 UR - http://dx.doi.org/10.2196/38905 UR - http://www.ncbi.nlm.nih.gov/pubmed/35635746 ID - info:doi/10.2196/38905 ER - TY - JOUR AU - Birrell, Louise AU - Furneaux-Bate, Ainsley AU - Debenham, Jennifer AU - Spallek, Sophia AU - Newton, Nicola AU - Chapman, Catherine PY - 2022/5/27 TI - Development of a Peer Support Mobile App and Web-Based Lesson for Adolescent Mental Health (Mind Your Mate): User-Centered Design Approach JO - JMIR Form Res SP - e36068 VL - 6 IS - 5 KW - mobile health KW - depression KW - anxiety KW - psychosocial support system KW - alcohol drinking KW - adolescent KW - digital technology KW - mobile intervention KW - intervention KW - social KW - economic KW - development KW - mind your mate KW - app KW - application KW - mHealth KW - mobile phone N2 - Background: Digital technologies and mobile interventions are possible tools for prevention initiatives to target the substantial social and economic impacts that anxiety, mood, and substance use disorders have on young people. Objective: This paper described the design and development of the Mind your Mate program, a smartphone app and introductory classroom lesson enhancing peer support around the topics of anxiety, depression, and substance use for adolescents. Methods: The development of Mind your Mate was an iterative process conducted in collaboration with adolescents (n=23), experts, school staff, and software developers. The development process consisted of 3 stages: scoping; end-user consultations, including a web-based survey and 2 focus groups with 23 adolescents (mean age 15.9, SD 0.6 years); and app development and beta-testing. Results: This process resulted in a smartphone peer support app and introductory classroom lesson aimed at empowering adolescents to access evidence-based information and tools to better support peers regarding mental health and substance use?related issues. The program contains links to external support services and encourages adolescents to reach out for help if they are concerned about themselves or a friend. Conclusions: The Mind your Mate program was developed in collaboration with a number of key stakeholders in youth mental health, including adolescents. The resulting program has the potential to be taken to scale to aid prevention efforts for youth mental health and substance use. The next step is to conduct a randomized controlled trial testing the feasibility, acceptability, and efficacy of the program. UR - https://formative.jmir.org/2022/5/e36068 UR - http://dx.doi.org/10.2196/36068 UR - http://www.ncbi.nlm.nih.gov/pubmed/35622401 ID - info:doi/10.2196/36068 ER - TY - JOUR AU - Agnew, R. Jonathon M. AU - Nugent, Chris AU - Hanratty, E. Catherine AU - Martin, Elizabeth AU - Kerr, P. Daniel AU - McVeigh, G. Joseph PY - 2022/5/26 TI - Rating the Quality of Smartphone Apps Related to Shoulder Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale JO - JMIR Form Res SP - e34339 VL - 6 IS - 5 KW - mobile app KW - shoulder pain KW - mHealth KW - Mobile App Rating Scale KW - mobile phone N2 - Background: The successful rehabilitation of musculoskeletal pain requires more than medical input alone. Conservative treatment, including physiotherapy and exercise therapy, can be an effective way of decreasing pain associated with musculoskeletal pain. However, face-to-face appointments are currently not feasible. New mobile technologies, such as mobile health technologies in the form of an app for smartphones, can be a solution to this problem. In many cases, these apps are not backed by scientific literature. Therefore, it is important that they are reviewed and quality assessed. Objective: The aim is to evaluate and measure the quality of apps related to shoulder pain by using the Mobile App Rating Scale. Methods: This study included 25 free and paid apps?8 from the Apple Store and 17 from the Google Play Store. A total of 5 reviewers were involved in the evaluation process. A descriptive analysis of the Mobile App Rating Scale results provided a general overview of the quality of the apps. Results: Overall, app quality was generally low, with an average star rating of 1.97 out of 5. The best scores were in the ?Functionality? and ?Aesthetics? sections, and apps were scored poorer in the ?Engagement? and ?Information? sections. The apps were also rated poorly in the ?Subjective Quality? section. Conclusions: In general, the apps were well built technically and were aesthetically pleasing. However, the apps failed to provide quality information to users, which resulted in a lack of engagement. Most of the apps were not backed by scientific literature (24/25, 96%), and those that contained scientific references were vastly out-of-date. Future apps would need to address these concerns while taking simple measures to ensure quality control. UR - https://formative.jmir.org/2022/5/e34339 UR - http://dx.doi.org/10.2196/34339 UR - http://www.ncbi.nlm.nih.gov/pubmed/35617008 ID - info:doi/10.2196/34339 ER - TY - JOUR AU - Jakob, Robert AU - Harperink, Samira AU - Rudolf, Maria Aaron AU - Fleisch, Elgar AU - Haug, Severin AU - Mair, Louise Jacqueline AU - Salamanca-Sanabria, Alicia AU - Kowatsch, Tobias PY - 2022/5/25 TI - Factors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review JO - J Med Internet Res SP - e35371 VL - 24 IS - 5 KW - intended use KW - adherence KW - engagement KW - attrition KW - retention KW - mHealth KW - eHealth KW - digital health intervention KW - noncommunicable disease KW - NCD KW - mobile phone N2 - Background: Mobile health (mHealth) apps show vast potential in supporting patients and health care systems with the increasing prevalence and economic costs of noncommunicable diseases (NCDs) worldwide. However, despite the availability of evidence-based mHealth apps, a substantial proportion of users do not adhere to them as intended and may consequently not receive treatment. Therefore, understanding the factors that act as barriers to or facilitators of adherence is a fundamental concern in preventing intervention dropouts and increasing the effectiveness of digital health interventions. Objective: This review aimed to help stakeholders develop more effective digital health interventions by identifying factors influencing the continued use of mHealth apps targeting NCDs. We further derived quantified adherence scores for various health domains to validate the qualitative findings and explore adherence benchmarks. Methods: A comprehensive systematic literature search (January 2007 to December 2020) was conducted on MEDLINE, Embase, Web of Science, Scopus, and ACM Digital Library. Data on intended use, actual use, and factors influencing adherence were extracted. Intervention-related and patient-related factors with a positive or negative influence on adherence are presented separately for the health domains of NCD self-management, mental health, substance use, nutrition, physical activity, weight loss, multicomponent lifestyle interventions, mindfulness, and other NCDs. Quantified adherence measures, calculated as the ratio between the estimated intended use and actual use, were derived for each study and compared with the qualitative findings. Results: The literature search yielded 2862 potentially relevant articles, of which 99 (3.46%) were included as part of the inclusion criteria. A total of 4 intervention-related factors indicated positive effects on adherence across all health domains: personalization or tailoring of the content of mHealth apps to the individual needs of the user, reminders in the form of individualized push notifications, user-friendly and technically stable app design, and personal support complementary to the digital intervention. Social and gamification features were also identified as drivers of app adherence across several health domains. A wide variety of patient-related factors such as user characteristics or recruitment channels further affects adherence. The derived adherence scores of the included mHealth apps averaged 56.0% (SD 24.4%). Conclusions: This study contributes to the scarce scientific evidence on factors that positively or negatively influence adherence to mHealth apps and is the first to quantitatively compare adherence relative to the intended use of various health domains. As underlying studies mostly have a pilot character with short study durations, research on factors influencing adherence to mHealth apps is still limited. To facilitate future research on mHealth app adherence, researchers should clearly outline and justify the app?s intended use; report objective data on actual use relative to the intended use; and, ideally, provide long-term use and retention data. UR - https://www.jmir.org/2022/5/e35371 UR - http://dx.doi.org/10.2196/35371 UR - http://www.ncbi.nlm.nih.gov/pubmed/35612886 ID - info:doi/10.2196/35371 ER - TY - JOUR AU - Alwakeel, Lyan AU - Lano, Kevin PY - 2022/5/25 TI - Functional and Technical Aspects of Self-management mHealth Apps: Systematic App Search and Literature Review JO - JMIR Hum Factors SP - e29767 VL - 9 IS - 2 KW - mHealth KW - mobile health apps KW - mobile apps KW - apps KW - systematic literature review KW - SLR KW - Mobile App Rating Scale KW - MARS KW - smartphone KW - iOS KW - Android KW - mobile phone N2 - Background: Although the past decade has witnessed the development of many self-management mobile health (mHealth) apps that enable users to monitor their health and activities independently, there is a general lack of empirical evidence on the functional and technical aspects of self-management mHealth apps from a software engineering perspective. Objective: This study aims to systematically identify the characteristics and challenges of self-management mHealth apps, focusing on functionalities, design, development, and evaluation methods, as well as to specify the differences and similarities between published research papers and commercial and open-source apps. Methods: This research was divided into 3 main phases to achieve the expected goal. The first phase involved reviewing peer-reviewed academic research papers from 7 digital libraries, and the second phase involved reviewing and evaluating apps available on Android and iOS app stores using the Mobile Application Rating Scale. Finally, the third phase involved analyzing and evaluating open-source apps from GitHub. Results: In total, 52 research papers, 42 app store apps, and 24 open-source apps were analyzed, synthesized, and reported. We found that the development of self-management mHealth apps requires significant time, effort, and cost because of their complexity and specific requirements, such as the use of machine learning algorithms, external services, and built-in technologies. In general, self-management mHealth apps are similar in their focus, user interface components, navigation and structure, services and technologies, authentication features, and architecture and patterns. However, they differ in terms of the use of machine learning, processing techniques, key functionalities, inference of machine learning knowledge, logging mechanisms, evaluation techniques, and challenges. Conclusions: Self-management mHealth apps may offer an essential means of managing users? health, expecting to assist users in continuously monitoring their health and encourage them to adopt healthy habits. However, developing an efficient and intelligent self-management mHealth app with the ability to reduce resource consumption and processing time, as well as increase performance, is still under research and development. In addition, there is a need to find an automated process for evaluating and selecting suitable machine learning algorithms for the self-management of mHealth apps. We believe that these issues can be avoided or significantly reduced by using a model-driven engineering approach with a decision support system to accelerate and ameliorate the development process and quality of self-management mHealth apps. UR - https://humanfactors.jmir.org/2022/2/e29767 UR - http://dx.doi.org/10.2196/29767 UR - http://www.ncbi.nlm.nih.gov/pubmed/35612887 ID - info:doi/10.2196/29767 ER - TY - JOUR AU - Perkins, C. Ryan AU - Sawicki, S. Gregory PY - 2022/5/25 TI - Author Reply to: Empowering Without Misinforming Adolescents and Young Adults with Cystic Fibrosis. Comment on ?Perceptions of Social Media Use to Augment Health Care Among Adolescents and Young Adults With Cystic Fibrosis: Survey Study? JO - JMIR Pediatr Parent SP - e39450 VL - 5 IS - 2 KW - Cystic fibrosis KW - Social media KW - mobile health KW - adherence KW - adolescents KW - young adults KW - Medical misinformation UR - https://pediatrics.jmir.org/2022/2/e39450 UR - http://dx.doi.org/10.2196/39450 UR - http://www.ncbi.nlm.nih.gov/pubmed/35612884 ID - info:doi/10.2196/39450 ER - TY - JOUR AU - Thumber, Navandeep AU - Bhandari, Prerana PY - 2022/5/25 TI - Empowering Without Misinforming Adolescents and Young Adults with Cystic Fibrosis. Comment on ?Perceptions of Social Media Use to Augment Health Care Among Adolescents and Young Adults With Cystic Fibrosis: Survey Study? JO - JMIR Pediatr Parent SP - e33457 VL - 5 IS - 2 KW - cystic fibrosis KW - social media KW - mobile health KW - adherence KW - adolescents KW - young adults KW - medical misinformation UR - https://pediatrics.jmir.org/2022/2/e33457 UR - http://dx.doi.org/10.2196/33457 UR - http://www.ncbi.nlm.nih.gov/pubmed/35612889 ID - info:doi/10.2196/33457 ER - TY - JOUR AU - Simblett, Sara AU - Pennington, Mark AU - Quaife, Matthew AU - Theochari, Evangelia AU - Burke, Patrick AU - Brichetto, Giampaolo AU - Devonshire, Julie AU - Lees, Simon AU - Little, Ann AU - Pullen, Angie AU - Stoneman, Amanda AU - Thorpe, Sarah AU - Weyer, Janice AU - Polhemus, Ashley AU - Novak, Jan AU - Dawe-Lane, Erin AU - Morris, Daniel AU - Mutepua, Magano AU - Odoi, Clarissa AU - Wilson, Emma AU - Wykes, Til PY - 2022/5/23 TI - Key Drivers and Facilitators of the Choice to Use mHealth Technology in People With Neurological Conditions: Observational Study JO - JMIR Form Res SP - e29509 VL - 6 IS - 5 KW - mobile technology KW - neurological conditions KW - multiple sclerosis KW - epilepsy KW - discrete choice experiment KW - digital health KW - mHealth KW - wearable technology KW - wearable biosensors KW - health economics KW - health data N2 - Background: There is increasing interest in the potential uses of mobile health (mHealth) technologies, such as wearable biosensors, as supplements for the care of people with neurological conditions. However, adherence is low, especially over long periods. If people are to benefit from these resources, we need a better long-term understanding of what influences patient engagement. Previous research suggests that engagement is moderated by several barriers and facilitators, but their relative importance is unknown. Objective: To determine preferences and the relative importance of user-generated factors influencing engagement with mHealth technologies for 2 common neurological conditions with a relapsing-remitting course: multiple sclerosis (MS) and epilepsy. Methods: In a discrete choice experiment, people with a diagnosis of MS (n=141) or epilepsy (n=175) were asked to select their preferred technology from a series of 8 vignettes with 4 characteristics: privacy, clinical support, established benefit, and device accuracy; each of these characteristics was greater or lower in each vignette. These characteristics had previously been emphasized by people with MS and or epilepsy as influencing engagement with technology. Mixed multinomial logistic regression models were used to establish which characteristics were most likely to affect engagement. Subgroup analyses explored the effects of demographic factors (such as age, gender, and education), acceptance of and familiarity with mobile technology, neurological diagnosis (MS or epilepsy), and symptoms that could influence motivation (such as depression). Results: Analysis of the responses to the discrete choice experiment validated previous qualitative findings that a higher level of privacy, greater clinical support, increased perceived benefit, and better device accuracy are important to people with a neurological condition. Accuracy was perceived as the most important factor, followed by privacy. Clinical support was the least valued of the attributes. People were prepared to trade a modest amount of accuracy to achieve an improvement in privacy, but less likely to make this compromise for other factors. The type of neurological condition (epilepsy or MS) did not influence these preferences, nor did the age, gender, or mental health status of the participants. Those who were less accepting of technology were the most concerned about privacy and those with a lower level of education were prepared to trade accuracy for more clinical support. Conclusions: For people with neurological conditions such as epilepsy and MS, accuracy (ie, the ability to detect symptoms) is of the greatest interest. However, there are individual differences, and people who are less accepting of technology may need far greater reassurance about data privacy. People with lower levels of education value greater clinician involvement. These patient preferences should be considered when designing mHealth technologies. UR - https://formative.jmir.org/2022/5/e29509 UR - http://dx.doi.org/10.2196/29509 UR - http://www.ncbi.nlm.nih.gov/pubmed/35604761 ID - info:doi/10.2196/29509 ER - TY - JOUR AU - Zhang, Huimin AU - Liao, Yuhua AU - Han, Xue AU - Fan, Beifang AU - Liu, Yifeng AU - Lui, W. Leanna M. AU - Lee, Yena AU - Subramaniapillai, Mehala AU - Li, Lingjiang AU - Guo, Lan AU - Lu, Ciyong AU - McIntyre, S. Roger PY - 2022/5/20 TI - Screening Depressive Symptoms and Incident Major Depressive Disorder Among Chinese Community Residents Using a Mobile App?Based Integrated Mental Health Care Model: Cohort Study JO - J Med Internet Res SP - e30907 VL - 24 IS - 5 KW - screening KW - depressive symptoms KW - incident major depressive disorder KW - Chinese community residents KW - electronic-based integrated mental health care model N2 - Background: Depression is associated with significant morbidity and human capital costs globally. Early screening for depressive symptoms and timely depressive disorder case identification and intervention may improve health outcomes and cost-effectiveness among affected individuals. China?s public and academic communities have reached a consensus on the need to improve access to early screening, diagnosis, and treatment of depression. Objective: This study aims to estimate the screening prevalence and associated factors of subthreshold depressive symptoms among Chinese residents enrolled in the cohort study using a mobile app?based integrated mental health care model and investigate the 12-month incidence rate and related factors of major depressive disorder (MDD) among those with subthreshold depressive symptoms. Methods: Data were drawn from the Depression Cohort in China (DCC) study. A total of 4243 community residents aged 18 to 64 years living in Nanshan district, Shenzhen city, in Guangdong province, China, were encouraged to participate in the DCC study when visiting the participating primary health care centers, and 4066 (95.83%) residents who met the DCC study criteria were screened for subthreshold depressive symptoms using the Patient Health Questionnaire-9 at baseline. Of the 4066 screened residents, 3168 (77.91%) with subthreshold depressive symptoms were referred to hospitals to receive a psychiatric diagnosis of MDD within 12 months. Sleep duration, anxiety symptoms, well-being, insomnia symptoms, and resilience were also investigated. The diagnosis of MDD was provided by trained psychiatrists using the Mini-International Neuropsychiatric Interview. Univariate and multivariate logistic regression models were performed to explore the potential factors related to subthreshold depressive symptoms at baseline, and Cox proportional hazards models were performed to explore the potential factors related to incident MDD. Results: Anxiety symptoms (adjusted odds ratio [AOR] 1.63, 95% CI 1.42-1.87) and insomnia symptoms (AOR 1.13, 95% CI 1.05-1.22) were associated with an increased risk of subthreshold depressive symptoms, whereas well-being (AOR 0.93, 95% CI 0.87-0.99) was negatively associated with depressive symptoms. During the follow-up period, the 12-month incidence rate of MDD among participants with subthreshold depressive symptoms was 5.97% (189/3168). After incorporating all significant variables from the univariate analyses, the multivariate Cox proportional hazards model reported that a history of comorbidities (adjusted hazard ratio [AHR] 1.49, 95% CI 1.04-2.14) and anxiety symptoms (AHR 1.13, 95% CI 1.09-1.17) were independently associated with an increased risk of incident MDD. The 5-item World Health Organization Well-Being Index was associated with a decreased risk of incident MDD (AHR 0.90, 95% CI 0.86-0.94). Conclusions: Elevated anxiety symptoms and unfavorable general well-being were significantly associated with subthreshold depressive symptoms and incident MDD among Chinese residents in Shenzhen. Early screening for subthreshold depressive symptoms and related factors may be helpful for identifying populations at high risk of incident MDD. UR - https://www.jmir.org/2022/5/e30907 UR - http://dx.doi.org/10.2196/30907 UR - http://www.ncbi.nlm.nih.gov/pubmed/35594137 ID - info:doi/10.2196/30907 ER - TY - JOUR AU - Muurling, Marijn AU - Reus, M. Lianne AU - de Boer, Casper AU - Wessels, C. Sterre AU - Jagesar, R. Raj AU - Vorstman, S. Jacob A. AU - Kas, H. Martien J. AU - Visser, Jelle Pieter PY - 2022/5/20 TI - Assessment of Social Behavior Using a Passive Monitoring App in Cognitively Normal and Cognitively Impaired Older Adults: Observational Study JO - JMIR Aging SP - e33856 VL - 5 IS - 2 KW - passive monitoring KW - smartphone app KW - cognitive impairment KW - social behavior KW - dementia KW - mHealth KW - mobile app KW - cognitive KW - mental health KW - social withdrawal KW - well-being N2 - Background: In people with cognitive impairment, loss of social interactions has a major impact on well-being. Therefore, patients would benefit from early detection of symptoms of social withdrawal. Current measurement techniques such as questionnaires are subjective and rely on recall, in contradiction to smartphone apps, which measure social behavior passively and objectively. Objective: This study uses the remote monitoring smartphone app Behapp to assess social behavior, and aims to investigate (1) the association between social behavior, demographic characteristics, and neuropsychiatric symptoms in cognitively normal (CN) older adults, and (2) if social behavior is altered in cognitively impaired (CI) participants. In addition, we explored in a subset of individuals the association between Behapp outcomes and neuropsychiatric symptoms. Methods: CN, subjective cognitive decline (SCD), and CI older adults installed the Behapp app on their own Android smartphone for 7 to 42 days. CI participants had a clinical diagnosis of mild cognitive impairment (MCI) or Alzheimer-type dementia. The app continuously measured communication events, app use and location. Neuropsychiatric Inventory (NPI) total scores were available for 20 SCD and 22 CI participants. Linear models were used to assess group differences on Behapp outcomes and to assess the association of Behapp outcomes with the NPI. Results: We included CN (n=209), SCD (n=55) and CI (n=22) participants. Older cognitively normal participants called less frequently and made less use of apps (P<.05). No sex effects were found. Compared to the CN and SCD groups, CI individuals called less unique contacts (?=?0.7 [SE 0.29], P=.049) and contacted the same contacts relatively more often (?=0.8 [SE 0.25], P=.004). They also made less use of apps (?=?0.83 [SE 0.25], P=.004). Higher total NPI scores were associated with further traveling (?=0.042 [SE 0.015], P=.03). Conclusions: CI individuals show reduced social activity, especially those activities that are related to repeated and unique behavior, as measured by the smartphone app Behapp. Neuropsychiatric symptoms seemed only marginally associated with social behavior as measured with Behapp. This research shows that the Behapp app is able to objectively and passively measure altered social behavior in a cognitively impaired population. UR - https://aging.jmir.org/2022/2/e33856 UR - http://dx.doi.org/10.2196/33856 UR - http://www.ncbi.nlm.nih.gov/pubmed/35594063 ID - info:doi/10.2196/33856 ER - TY - JOUR AU - McDonall, Jo AU - Redley, Bernice AU - Livingston, Patricia AU - Hutchinson, Ana AU - de Steiger, Richard AU - Botti, Mari PY - 2022/5/19 TI - A Nurse-Led Multimedia Intervention to Increase Patient Participation in Recovery After Knee Arthroplasty: Hybrid Type II Implementation Study JO - JMIR Hum Factors SP - e36959 VL - 9 IS - 2 KW - patient participation KW - multimedia KW - nurse-facilitated KW - knee arthroplasty KW - orthopedic surgery KW - acute care KW - nurse KW - participatory medicine KW - digital technology N2 - Background: Advances in digital technology and the use of multimedia platforms to deliver information provide clinicians with a unique opportunity to develop innovative ways to consistently provide high-quality, accessible, and evidence-based information to support patient participation. Introducing new technologies into everyday acute care clinical practice can be difficult. Objective: The aim of this paper was to provide a description of an implementation strategy and the subsequent evaluation undertaken to examine the contextual factors important to the successful adoption of new technology by nurses in the context of acute postoperative care. Methods: Implementation of the intervention and process evaluation was undertaken in 3 phases: phase 1, preimplementation stakeholder engagement and identification of barriers and enablers to implementation; phase 2, supported implementation of the intervention; and phase 3, evaluation of uptake, usability, and acceptability of the intervention in clinical practice. Results: The outcomes of the implementation of the multimedia intervention in the context of acute postoperative care were positive. Of the 104 patients in the intervention group, 103 (99%) received the intervention. All 103 patients completed the 8-item intervention questionnaire and 93.3% (97/103) were interviewed on day 3 to evaluate usability, uptake, and acceptability. Of these 97 patients, almost all (n=94, 91%) found the program easy to use and most (n=64, 62%) could view the MyStay Total Knee Replacement program as often as they wanted. The findings also suggest that the time to implement the program was minimal (5-10 minutes). Collaboration with nurses and patients before and during implementation to identify potential barriers to successful implementation of the intervention was essential to develop timely strategies to overcome these barriers. To ensure end-user engagement, careful consideration was given to nurses? views on who was responsible for facilitating this intervention. Conclusions: The findings provide evidence that the structured implementation of the multimedia intervention was robust and successful in terms of patient participant recruitment and application; however, it was difficult to assess the level of engagement by nurse clinicians with the program. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000340639; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000340639 UR - https://humanfactors.jmir.org/2022/2/e36959 UR - http://dx.doi.org/10.2196/36959 UR - http://www.ncbi.nlm.nih.gov/pubmed/35588363 ID - info:doi/10.2196/36959 ER - TY - JOUR AU - Miguel Cruz, Antonio AU - Lopez Portillo, Perez Hector AU - Daum, Christine AU - Rutledge, Emily AU - King, Sharla AU - Liu, Lili PY - 2022/5/18 TI - Technology Acceptance and Usability of a Mobile App to Support the Workflow of Health Care Aides Who Provide Services to Older Adults: Pilot Mixed Methods Study JO - JMIR Aging SP - e37521 VL - 5 IS - 2 KW - usability KW - technology acceptance KW - Unified Theory of Acceptance and Use of Technology KW - UTAUT KW - older adults KW - caregivers KW - health care aides KW - mobile phone N2 - Background: Health care aides are unlicensed support personnel who provide direct care, personal assistance, and support to people with health conditions. The shortage of health care aides has been attributed to recruitment challenges, high turnover, an aging population, the COVID-19 pandemic, and low retention rates. Mobile apps are among the many information communication technologies that are paving the way for eHealth solutions to help address this workforce shortage by enhancing the workflow of health care aides. In collaboration with Clinisys EMR Inc, we developed a mobile app (Mobile Smart Care System [mSCS]) to support the workflow of health care aides who provide services to older adult residents of a long-term care facility. Objective: The purpose of this study was to investigate the technology acceptance and usability of a mobile app in a real-world environment, while it is used by health care aides who provide services to older adults. Methods: This pilot study used a mixed methods design: sequential mixed methods (QUANTITATIVE, qualitative). Our study included a pre? and post?paper-based questionnaire with no control group (QUAN). Toward the end of the study, 2 focus groups were conducted with a subsample of health care aides (qual, qualitative description design). Technology acceptance and usability questionnaires used a 5-point Likert scale ranging from disagree (1) to agree (5). The items included in the questionnaires were validated in earlier research as having high levels of internal consistency for the Unified Theory of Acceptance and Use of Technology constructs. A total of 60 health care aides who provided services to older adults as part of their routine caseloads used the mobile app for 1 month. Comparisons of the Unified Theory of Acceptance and Use of Technology constructs? summative scores at pretest and posttest were calculated using a paired t test (2-tailed). We used the partial least squares structural regression model to determine the factors influencing mobile app acceptance and usability for health care aides. The ? level of significance for all tests was set at P?.05 (2-tailed). Results: We found that acceptance of the mSCS was high among health care aides, performance expectancy construct was the strongest predictor of intention to use the mSCS, intention to use the mSCS predicted usage behavior. The qualitative data support the quantitative findings and showed health care aides? strong belief that the mSCS was useful, portable, and reliable, although there were still opportunities for improvement, especially with regard to the mSCS user interface. Conclusions: Overall, these results support the assertion that mSCS technology acceptance and usability are high among health care aides. In other words, health care aides perceived that the mSCS assisted them in addressing their workflow issues. UR - https://aging.jmir.org/2022/2/e37521 UR - http://dx.doi.org/10.2196/37521 UR - http://www.ncbi.nlm.nih.gov/pubmed/35583930 ID - info:doi/10.2196/37521 ER - TY - JOUR AU - Rajamani, Sripriya AU - Austin, Robin AU - Geiger-Simpson, Elena AU - Jantraporn, Ratchada AU - Park, Suhyun AU - Monsen, A. Karen PY - 2022/5/16 TI - Understanding Whole-Person Health and Resilience During the COVID-19 Pandemic and Beyond: A Cross-sectional and Descriptive Correlation Study JO - JMIR Nursing SP - e38063 VL - 5 IS - 1 KW - Omaha System KW - whole-person health KW - strengths KW - resilience KW - assessment KW - app KW - health information technology KW - health informatics KW - nursing KW - health care KW - mobile health KW - health application KW - mHealth KW - health data KW - health community KW - digital health N2 - Background: The COVID-19 pandemic has prompted an interest in whole-person health and emotional well-being. Informatics solutions through user-friendly tools such as mobile health apps offer immense value. Prior research developed a consumer-facing app MyStrengths + MyHealth using Simplified Omaha System Terms (SOST) to assess whole-person health. The MyStrengths + MyHealth app assesses strengths, challenges, and needs (SCN) for 42 concepts across four domains (My Living, My Mind and Networks, My Body, My Self-care; eg, Income, Emotions, Pain, and Nutrition, respectively). Given that emotional well-being was a predominant concern during the COVID-19 pandemic, we sought to understand whole-person health for participants with/without Emotions challenges. Objective: This study aims to use visualization techniques and data from attendees at a Midwest state fair to examine SCN overall and by groups with/without Emotions challenges, and to explore the resilience of participants. Methods: This cross-sectional and descriptive correlational study surveyed adult attendees at a 2021 Midwest state fair. Data were visualized using Excel and analyzed using descriptive and inferential statistics using SPSS. Results: The study participants (N=182) were primarily female (n=123, 67.6%), aged ?45 years (n=112, 61.5%), White (n=154, 84.6%), and non-Hispanic (n=177, 97.3%). Compared to those without Emotions challenges, those with Emotions challenges were aged 18-44 (P<.001) years, more often female (P=.02), and not married (P=.01). Overall, participants had more strengths (mean 28.6, SD 10.5) than challenges (mean 12, SD 7.5) and needs (mean 4.2, SD 7.5). The most frequent needs were in Emotions, Nutrition, Income, Sleeping, and Exercising. Compared to those without Emotions challenges, those with Emotions challenges had fewer strengths (P<.001), more challenges (P<.001), and more needs (P<.001), along with fewer strengths for Emotions (P<.001) and for the cluster of health-related behaviors domain concepts, Sleeping (P=.002), Nutrition (P<.001), and Exercising (P<.001). Resilience was operationalized as correlations among strengths for SOST concepts and visualized for participants with/without an Emotions challenge. Those without Emotions challenges had more positive strengths correlations across multiple concepts/domains. Conclusions: This survey study explored a large community-generated data set to understand whole-person health and showed between-group differences in SCN and resilience for participants with/without Emotions challenges. It contributes to the literature regarding an app-aided and data-driven approach to whole-person health and resilience. This research demonstrates the power of health informatics and provides researchers with a data-driven methodology for additional studies to build evidence on whole-person health and resilience. UR - https://nursing.jmir.org/2022/1/e38063 UR - http://dx.doi.org/10.2196/38063 UR - http://www.ncbi.nlm.nih.gov/pubmed/35576563 ID - info:doi/10.2196/38063 ER - TY - JOUR AU - Moreno, P. Jennette AU - Dadabhoy, Hafza AU - Musaad, Salma AU - Baranowski, Tom AU - Thompson, Debbe AU - Alfano, A. Candice AU - Crowley, J. Stephanie PY - 2022/5/16 TI - Evaluation of a Circadian Rhythm and Sleep-Focused Mobile Health Intervention for the Prevention of Accelerated Summer Weight Gain Among Elementary School?Age Children: Protocol for a Randomized Controlled Feasibility Study JO - JMIR Res Protoc SP - e37002 VL - 11 IS - 5 KW - summer KW - circadian rhythms KW - sleep KW - child obesity KW - elementary school N2 - Background: The i?rhythm project is a mobile health adaptation of interpersonal and social rhythm therapy designed to promote healthy sleep and behavioral rhythms among 5-8-year olds during summer for the prevention of accelerated summer weight gain. Objective: This pilot study will examine the feasibility, acceptability, and preliminary efficacy of the i?rhythm intervention. This will ensure that the research protocol and procedures work as desired and are acceptable to families in preparation for the fully powered randomized controlled trial. The proposed study will examine the willingness of participants to participate in the intervention and determine whether modifications to the intervention, procedures, and measures are needed before conducting a fully powered study. We will assess our ability to (1) recruit, consent, and retain participants; (2) deliver the intervention; (3) implement the study and assessment procedures; (4) assess the reliability of the proposed measures; and (5) assess the acceptability of the intervention and assessment protocol. Methods: This study will employ a single-blinded 2-group randomized control design (treatment and no-treatment control) with randomization occurring after baseline (Time 0) and 3 additional evaluation periods (postintervention [Time 1], and 9 months [Time 2] and 12 months after intervention [Time 3]). A sample of 40 parent-child dyads will be recruited. Results: This study was approved by the institutional review board of Baylor College of Medicine (H-47369). Recruitment began in March 2021. As of March 2022, data collection and recruitment are ongoing. Conclusions: This study will address the role of sleep and circadian rhythms in the prevention of accelerated summer weight gain and assess the intervention?s effects on the long-term prevention of child obesity. Trial Registration: ClinicalTrials.gov NCT04445740; https://clinicaltrials.gov/ct2/show/NCT04445740. International Registered Report Identifier (IRRID): DERR1-10.2196/37002 UR - https://www.researchprotocols.org/2022/5/e37002 UR - http://dx.doi.org/10.2196/37002 UR - http://www.ncbi.nlm.nih.gov/pubmed/35576573 ID - info:doi/10.2196/37002 ER - TY - JOUR AU - Tsoi, S. Emily W. AU - Mak, S. Winnie W. AU - Ho, Y. Connie Y. AU - Yeung, Y. Gladys T. PY - 2022/5/13 TI - A Web-Based Stratified Stepped Care Mental Health Platform (TourHeart): Semistructured Interviews With Stakeholders JO - JMIR Hum Factors SP - e35057 VL - 9 IS - 2 KW - stepped care KW - recovery KW - engagement KW - eHealth KW - mental health KW - mental well-being KW - psychological intervention N2 - Background: TourHeart, a web-based stratified stepped care mental health platform, is a one-stop solution that integrates psychoeducation and other well-being promotional tools for mental health promotion and mental illness prevention and evidence-based, low-intensity psychological interventions for the treatment of people with anxiety and depressive symptoms. Instead of focusing only on symptom reduction, the platform aims to be person-centered and recovery-oriented, and continual feedback from stakeholders is sought. Understanding the perspectives of users and service providers enables platform developers to fine-tune both the design and content of the services for enhanced service personalization and personal recovery. Objective: This qualitative study evaluated a web-based mental health platform by incorporating the perspectives of both users and service providers who administered the platform and provided coaching services. The platform included both web-based and offline services targeting adults along the mental health spectrum based on the two-continua model of mental health and mental illness. Methods: Interview questions were designed based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM). Views on offline services, the design of the web-based platform, user experience, and the contents of the platform were explored using semistructured interviews. A total of 27 service users and 22 service providers were recruited using purposive criterion sampling. A hybrid thematic analysis was performed to identify salient aspects of users? and providers? experiences with and views of the platform. Results: Totally, 3 broad themes (namely, the quality of the platform, drivers for platform use, and coaching services) emerged from the interview data that highlighted users? views of and experiences with the web-based platform. The platform?s general esthetics, operations, and contents were found to be critical features and drivers for continued use. Although coaching services were indispensable, participants preferred the autonomy and anonymity associated with web-based mental health services. Conclusions: This study highlights the importance of web-based mental health services being easy to navigate and understand, being user-centric, and providing adequate guidance in self-help. It also confirms existing design standards and recommendations and suggests that more rigorous, iterative user experience research and robust evaluation should be conducted in the future adaptation of web-based stratified stepped care services, so that they can be more personalized and better promote personal recovery. UR - https://humanfactors.jmir.org/2022/2/e35057 UR - http://dx.doi.org/10.2196/35057 UR - http://www.ncbi.nlm.nih.gov/pubmed/35560109 ID - info:doi/10.2196/35057 ER - TY - JOUR AU - Alley, J. Stephanie AU - van Uffelen, Jannique AU - Schoeppe, Stephanie AU - Parkinson, Lynne AU - Hunt, Susan AU - Power, Deborah AU - Waterman, Natasha AU - Waterman, Courtney AU - To, G. Quyen AU - Duncan, J. Mitch AU - Schneiders, Anthony AU - Vandelanotte, Corneel PY - 2022/5/12 TI - The Effectiveness of a Computer-Tailored Web-Based Physical Activity Intervention Using Fitbit Activity Trackers in Older Adults (Active for Life): Randomized Controlled Trial JO - J Med Internet Res SP - e31352 VL - 24 IS - 5 KW - internet KW - online KW - activity trackers KW - activity monitors KW - wearables KW - physical activity KW - mobile phone N2 - Background: Physical activity is an integral part of healthy aging; yet, most adults aged ?65 years are not sufficiently active. Preliminary evidence suggests that web-based interventions with computer-tailored advice and Fitbit activity trackers may be well suited for older adults. Objective: The aim of this study was to examine the effectiveness of Active for Life, a 12-week web-based physical activity intervention with 6 web-based modules of computer-tailored advice to increase physical activity in older Australians. Methods: Participants were recruited both through the web and offline and were randomly assigned to 1 of 3 trial arms: tailoring+Fitbit, tailoring only, or a wait-list control. The computer-tailored advice was based on either participants? Fitbit data (tailoring+Fitbit participants) or self-reported physical activity (tailoring-only participants). The main outcome was change in wrist-worn accelerometer (ActiGraph GT9X)?measured moderate to vigorous physical activity (MVPA) from baseline to after the intervention (week 12). The secondary outcomes were change in self-reported physical activity measured by means of the Active Australia Survey at the midintervention point (6 weeks), after the intervention (week 12), and at follow-up (week 24). Participants had a face-to-face meeting at baseline for a demonstration of the intervention and at baseline and week 12 to return the accelerometers. Generalized linear mixed model analyses were conducted with a ? distribution and log link to compare MVPA and self-reported physical activity changes over time within each trial arm and between each of the trial arms. Results: A total of 243 participants were randomly assigned to tailoring+Fitbit (n=78, 32.1%), tailoring only (n=96, 39.5%), and wait-list control (n=69, 28.4%). Attrition was 28.8% (70/243) at 6 weeks, 31.7% (77/243) at 12 weeks, and 35.4% (86/243) at 24 weeks. No significant overall time by group interaction was observed for MVPA (P=.05). There were no significant within-group changes for MVPA over time in the tailoring+Fitbit group (+3%, 95% CI ?24% to 40%) or the tailoring-only group (?4%, 95% CI ?24% to 30%); however, a significant decline was seen in the control group (?35%, 95% CI ?52% to ?11%). The tailoring+Fitbit group participants increased their MVPA 59% (95% CI 6%-138%) more than those in the control group. A significant time by group interaction was observed for self-reported physical activity (P=.02). All groups increased their self-reported physical activity from baseline to week 6, week 12, and week 24, and this increase was greater in the tailoring+Fitbit group than in the control group at 6 weeks (+61%, 95% CI 11%-133%). Conclusions: A computer-tailored physical activity intervention with Fitbit integration resulted in improved MVPA outcomes in comparison with a control group in older adults. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000646246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000646246 UR - https://www.jmir.org/2022/5/e31352 UR - http://dx.doi.org/10.2196/31352 UR - http://www.ncbi.nlm.nih.gov/pubmed/35552166 ID - info:doi/10.2196/31352 ER - TY - JOUR AU - Chen, Lijuan AU - Zhang, Danyang AU - Hou, Mutian PY - 2022/5/11 TI - The Influence of Perceived Social Presence on the Willingness to Communicate in Mobile Medical Consultations: Experimental Study JO - J Med Internet Res SP - e31797 VL - 24 IS - 5 KW - mobile medical consultation KW - mobile medical service KW - perceived social presence KW - willingness to communicate about health KW - COVID-19 N2 - Background: With the rise of online health care service, there is growing discussion on the relationship between physicians and patients online, yet few researchers have paid attention to patients? perception of social presence, especially its influence on their willingness to communicate (WTC). Objective: The goal of the research is to investigate the influence of perceived social presence (PSP) on WTC in mobile medical consultations. Methods: Participants living in Yunnan province during the period of middle to high risk of COVID-19 infection were recruited via the internet. They were assigned randomly into 2 groups interacting with a virtual physician presenting high and low levels of social presence and then asked to complete a questionnaire. Based on the theoretical framework, the study puts forward a model evaluating the relationships among participants? PSP, communication apprehension (CA), self-perceived communication competence (SPCC), and willingness to communicate about health (WTCH) in the computer-mediated communication between virtual physicians and patients. Results: In total 206 (106 in group 1 and 100 in group 2) valid samples were gathered (from 276 log-ins) and 88.8% (183/206) of them were aged 18 to 44 years, which approximately resembles the age distribution of the main population engaging in online medical consultation in China. Independent t test shows that there is significant difference between the PSP of the 2 groups (P=.04), indicating a successful manipulation of social presence. The total effect of PSP on WTCH is 0.56 (P<.001), among which 74.4% is direct effect (P<.001). Among the indirect effects between PSP and WTCH, the mediating effect of SPCC accounts for 68.8% (P<.001) and the sequential mediating effect of CA?SPCC accounts for 19.2% (P<.001), while the mediating effect of CA alone is not significant (P=.08). Conclusions: This study provides a comprehensible model, demonstrating that PSP is an important antecedent of WTCH, and the sequential mediating effect of CA and SPCC found in this study also proves that in the environment of online mobile medical services, CA cannot affect communication directly. The findings will provide some practical inspiration for the popularization of online medical service, especially for the promotion of online physician-patient communication. UR - https://www.jmir.org/2022/5/e31797 UR - http://dx.doi.org/10.2196/31797 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544293 ID - info:doi/10.2196/31797 ER - TY - JOUR AU - Selvaraj, Nathan Shanmuga AU - Sriram, Arulchelvan PY - 2022/5/11 TI - The Quality of Indian Obesity-Related mHealth Apps: PRECEDE-PROCEED Model?Based Content Analysis JO - JMIR Mhealth Uhealth SP - e15719 VL - 10 IS - 5 KW - obesity KW - mHealth apps KW - PRECEDE-PROCEED Model KW - Mobile App Rating Scale KW - health communication KW - health behavior change techniques KW - health information N2 - Background: The prevalence of obesity in India is increasing at an alarming rate. Obesity-related mHealth apps have proffered an exciting opportunity to remotely deliver obesity-related information. This opportunity raises the question of whether such apps are truly effective. Objective: The aim of this study was to identify existing obesity-related mHealth apps in India and evaluate the potential of the apps? contents to promote health behavior change. This study also aimed to discover the general quality of obesity-related mHealth apps. Methods: A systematic search for obesity-related mHealth apps was conducted in both the Google Play Store and the Apple App Store. The features and quality of the sample apps were assessed using the Mobile Application Rating Scale (MARS) and the potential of the sample apps? contents to promote health behavior change was assessed using the PRECEDE-PROCEED Model (PPM). Results: A total of 13 apps (11 from the Google Play Store and 2 from the Apple App Store) were considered eligible for the study. The general quality of the 13 apps assessed using MARS resulted in mean scores ranging from 1.8 to 3.7. The bivariate Pearson correlation between the MARS rating and app user rating failed to establish statistically significant results. The multivariate regression analysis result indicated that the PPM factors are significant determinants of health behavior change (F3,9=63.186; P<.001) and 95.5% of the variance (R2=0.955; P<.001) in the dependent variable (health behavior change) can be explained by the independent variables (PPM factors). Conclusions: In general, mHealth apps are found to be more effective when they are based on theory. The presence of PPM factors in an mHealth app can greatly influence the likelihood of health behavior change among users. So, we suggest mHealth app developers consider this to develop efficient apps. Also, mHealth app developers should consider providing health information from credible sources and indicating the sources of the information, which will increase the perceived credibility of the apps among the users. We strongly recommend health professionals and health organizations be involved in the development of mHealth apps. Future research should include mHealth app users to understand better the apps? effectiveness in bringing about health behavior change. UR - https://mhealth.jmir.org/2022/5/e15719 UR - http://dx.doi.org/10.2196/15719 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544318 ID - info:doi/10.2196/15719 ER - TY - JOUR AU - Morcillo-Muñoz, Yolanda AU - Sánchez-Guarnido, José Antonio AU - Calzón-Fernández, Silvia AU - Baena-Parejo, Isabel PY - 2022/5/11 TI - Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial JO - J Med Internet Res SP - e36114 VL - 24 IS - 5 KW - chronic pain KW - eHealth KW - multimodal intervention KW - catastrophizing KW - self-management KW - mHealth KW - mobile phone KW - randomized controlled trials N2 - Background: Combination therapies delivered remotely via the internet or mobile devices are increasingly being used to improve and promote the self-management of chronic conditions. However, little is known regarding the long-term effects of these interventions. Objective: The aim of this study is to evaluate the effectiveness of a multimodal intervention program that measures associated variables such as catastrophizing, pain acceptance, and quality of life using a mobile device in people with chronic pain in an outpatient setting. Methods: A randomized controlled clinical trial was performed using parallel treatment groups. A total of 209 patients with chronic musculoskeletal pain were randomly assigned to one of the two study arms. The intervention group received a standard web-based psychosocial therapy-type program of activities through a smartphone for 6 weeks. The control group only had access to the Find out more section of the app, which contained audiovisual material for pain management based on a self-help approach. The primary outcome was catastrophizing measured using the Pain Catastrophizing Scale (PCS). Secondary outcomes were pain acceptance measured using the Chronic Pain Acceptance Questionnaire and health-related quality of life measured using the EuroQol Visual Analogue Scale. Assessments were conducted at baseline (T1), after treatment (T2), and at the 3-month follow-up (T3). The variations between the different phases were assessed using the percentage change rescaled with log base 2. The Cohen d was calculated based on the results of the linear mixed model. The investigators of the study who evaluated the results were not involved in patient recruitment and were blinded to the group assignment. Results: Positive effects were found in the intervention group (T2?T1) in catastrophizing between the baseline and posttreatment phases (P<.001) and in helplessness (?0.72 vs 0.1; P=.002), rumination (?1.59 vs ?0.53; P<.001), acceptance (0.38 vs 0.05; P=.001), and quality of life (0.43 vs ?0.01; P=.002), although no significant changes were found for magnification (0.2 vs 0.77; P=.14) and satisfaction with health (0.25 vs ?0.27; P=.13). Three months after treatment, significant differences were observed in the intervention group for the outcome variable of catastrophizing (PCS; ?0.59 vs 0.2; P=.006) and the PCS subscales of helplessness (?0.65 vs 0.01; P=.07), rumination (1.23 vs ?0.59; P=.04), and magnification (0.1 vs 0.86; P=.02). Conclusions: The results of our study suggest that app-based mobile multidimensional treatments for adults with chronic pain improve catastrophizing, quality of life, and psychological flexibility immediately after treatment and that the effects are maintained for the primary outcome of catastrophizing for at least 3 months following treatment. Moreover, they promote self-management and can be used to complement face-to-face pain treatments. Trial Registration: ClinicalTrials.gov NCT04509154; https://clinicaltrials.gov/ct2/show/NCT04509154 UR - https://www.jmir.org/2022/5/e36114 UR - http://dx.doi.org/10.2196/36114 UR - http://www.ncbi.nlm.nih.gov/pubmed/35373 ID - info:doi/10.2196/36114 ER - TY - JOUR AU - Yeung, Kan Andy Wai AU - Kulnik, Tino Stefan AU - Parvanov, D. Emil AU - Fassl, Anna AU - Eibensteiner, Fabian AU - Völkl-Kernstock, Sabine AU - Kletecka-Pulker, Maria AU - Crutzen, Rik AU - Gutenberg, Johanna AU - Höppchen, Isabel AU - Niebauer, Josef AU - Smeddinck, David Jan AU - Willschke, Harald AU - Atanasov, G. Atanas PY - 2022/5/11 TI - Research on Digital Technology Use in Cardiology: Bibliometric Analysis JO - J Med Internet Res SP - e36086 VL - 24 IS - 5 KW - cardiovascular KW - heart KW - hypertension KW - atrial fibrillation KW - cardiopulmonary resuscitation KW - electrocardiography KW - photoplethysmography KW - wearable device, digital health, mHealth KW - cardiology KW - cardiac KW - health application N2 - Background: Digital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area. Objective: We used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field. Methods: The Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, abstracts, and keywords. A term map was constructed for findings visualization. Results: The analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7%), followed by United Kingdom (1136/12,529, 9.1%), Germany (1067/12,529, 8.5%), China (682/12,529, 5.4%), and Italy (622/12,529, 5.0%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2%), atrial fibrillation (122/12,529, 1.0%), atherosclerosis (116/12,529, 0.9%), heart failure (106/12,529, 0.8%), and arterial stiffness (80/12,529, 0.6%). Recurring modalities were electrocardiography (170/12,529, 1.4%), angiography (127/12,529, 1.0%), echocardiography (127/12,529, 1.0%), digital subtraction angiography (111/12,529, 0.9%), and photoplethysmography (80/12,529, 0.6%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2%) and other JMIR portfolio journals (51/632, 8.0%) were the major publishing venues. Conclusions: Digital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth. UR - https://www.jmir.org/2022/5/e36086 UR - http://dx.doi.org/10.2196/36086 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544307 ID - info:doi/10.2196/36086 ER - TY - JOUR AU - Schmieding, L. Malte AU - Kopka, Marvin AU - Schmidt, Konrad AU - Schulz-Niethammer, Sven AU - Balzer, Felix AU - Feufel, A. Markus PY - 2022/5/10 TI - Triage Accuracy of Symptom Checker Apps: 5-Year Follow-up Evaluation JO - J Med Internet Res SP - e31810 VL - 24 IS - 5 KW - digital health KW - triage KW - symptom checker KW - patient-centered care KW - eHealth apps KW - mobile phone N2 - Background: Symptom checkers are digital tools assisting laypersons in self-assessing the urgency and potential causes of their medical complaints. They are widely used but face concerns from both patients and health care professionals, especially regarding their accuracy. A 2015 landmark study substantiated these concerns using case vignettes to demonstrate that symptom checkers commonly err in their triage assessment. Objective: This study aims to revisit the landmark index study to investigate whether and how symptom checkers? capabilities have evolved since 2015 and how they currently compare with laypersons? stand-alone triage appraisal. Methods: In early 2020, we searched for smartphone and web-based applications providing triage advice. We evaluated these apps on the same 45 case vignettes as the index study. Using descriptive statistics, we compared our findings with those of the index study and with publicly available data on laypersons? triage capability. Results: We retrieved 22 symptom checkers providing triage advice. The median triage accuracy in 2020 (55.8%, IQR 15.1%) was close to that in 2015 (59.1%, IQR 15.5%). The apps in 2020 were less risk averse (odds 1.11:1, the ratio of overtriage errors to undertriage errors) than those in 2015 (odds 2.82:1), missing >40% of emergencies. Few apps outperformed laypersons in either deciding whether emergency care was required or whether self-care was sufficient. No apps outperformed the laypersons on both decisions. Conclusions: Triage performance of symptom checkers has, on average, not improved over the course of 5 years. It decreased in 2 use cases (advice on when emergency care is required and when no health care is needed for the moment). However, triage capability varies widely within the sample of symptom checkers. Whether it is beneficial to seek advice from symptom checkers depends on the app chosen and on the specific question to be answered. Future research should develop resources (eg, case vignette repositories) to audit the capabilities of symptom checkers continuously and independently and provide guidance on when and to whom they should be recommended. UR - https://www.jmir.org/2022/5/e31810 UR - http://dx.doi.org/10.2196/31810 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536633 ID - info:doi/10.2196/31810 ER - TY - JOUR AU - Scherer, A. Emily AU - Kim, Jung Sunny AU - Metcalf, A. Stephen AU - Sweeney, Ann Mary AU - Wu, Jialing AU - Xie, Haiyi AU - Mazza, L. Gina AU - Valente, J. Matthew AU - MacKinnon, P. David AU - Marsch, A. Lisa PY - 2022/5/10 TI - Momentary Self-regulation: Scale Development and Preliminary Validation JO - JMIR Ment Health SP - e35273 VL - 9 IS - 5 KW - self-regulation KW - momentary self-regulation KW - ecological momentary assessment KW - psychometric KW - health behavior change KW - health risk behaviors KW - mobile phone N2 - Background: Self-regulation refers to a person?s ability to manage their cognitive, emotional, and behavioral processes to achieve long-term goals. Most prior research has examined self-regulation at the individual level; however, individual-level assessments do not allow the examination of dynamic patterns of intraindividual variability in self-regulation and thus cannot aid in understanding potential malleable processes of self-regulation that may occur in response to the daily environment. Objective: This study aims to develop a brief, psychometrically sound momentary self-regulation scale that can be practically administered through participants? mobile devices at a momentary level. Methods: This study was conducted in 2 phases. In the first phase, in a sample of 522 adults collected as part of a larger self-regulation project, we examined 23 previously validated assessments of self-regulation containing 594 items in total to evaluate the underlying structure of self-regulation via exploratory and confirmatory factor analyses. We then selected 20 trait-level items to be carried forward to the second phase. In the second phase, we converted each item into a momentary question and piloted the momentary items in a sample of 53 adults over 14 days. Using the results from the momentary pilot study, we explored the psychometric properties of the items and assessed their underlying structure. We then proposed a set of subscale and total score calculations. Results: In the first phase, the selected individual-level items appeared to measure 4 factors of self-regulation. The factors identified were perseverance, sensation seeking, emotion regulation, and mindfulness. In the second phase of the ecological momentary assessment pilot, the selected items demonstrated strong construct validity as well as predictive validity for health risk behaviors. Conclusions: Our findings provide preliminary evidence for a 12-item momentary self-regulation scale comprising 4 subscales designed to capture self-regulatory dynamics at the momentary level. UR - https://mental.jmir.org/2022/5/e35273 UR - http://dx.doi.org/10.2196/35273 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536605 ID - info:doi/10.2196/35273 ER - TY - JOUR AU - Buss, Helen Vera AU - Varnfield, Marlien AU - Harris, Mark AU - Barr, Margo PY - 2022/5/10 TI - A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study JO - JMIR Hum Factors SP - e35065 VL - 9 IS - 2 KW - mobile health KW - behavior change intervention KW - primary prevention KW - health promotion KW - cardiovascular disease KW - diabetes mellitus, type 2 KW - mobile phone N2 - Background: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective: This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods: The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results: The target population was Australians aged ?45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants? feedback to improve these aspects. Conclusions: We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing. UR - https://humanfactors.jmir.org/2022/2/e35065 UR - http://dx.doi.org/10.2196/35065 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536603 ID - info:doi/10.2196/35065 ER - TY - JOUR AU - Baptist, Alan AU - Gibson-Scipio, Wanda AU - Carcone, Idalski April AU - Ghosh, Samiran AU - Jacques-Tiura, J. Angela AU - Hall, Amy AU - MacDonell, Kolmodin Karen PY - 2022/5/10 TI - Asthma and Technology in Emerging African American Adults (The ATHENA Project): Protocol for a Trial Using the Multiphase Optimization Strategy Framework JO - JMIR Res Protoc SP - e37946 VL - 11 IS - 5 KW - African American emerging adults KW - asthma management KW - mHealth KW - mobile health KW - motivational interviewing KW - asthma control KW - physical activity N2 - Background: Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population. Objective: The purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs. Methods: We will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant?s activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing?based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months. Results: At study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed. Conclusions: AAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging. International Registered Report Identifier (IRRID): PRR1-10.2196/37946 UR - https://www.researchprotocols.org/2022/5/e37946 UR - http://dx.doi.org/10.2196/37946 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536642 ID - info:doi/10.2196/37946 ER - TY - JOUR AU - Kwon, Soonil AU - Lee, So-Ryoung AU - Choi, Eue-Keun AU - Ahn, Hyo-Jeong AU - Song, Hee-Seok AU - Lee, Young-Shin AU - Oh, Seil AU - Lip, H. Gregory Y. PY - 2022/5/9 TI - Comparison Between the 24-hour Holter Test and 72-hour Single-Lead Electrocardiogram Monitoring With an Adhesive Patch-Type Device for Atrial Fibrillation Detection: Prospective Cohort Study JO - J Med Internet Res SP - e37970 VL - 24 IS - 5 KW - atrial fibrillation KW - diagnosis KW - electrocardiogram KW - wearable device KW - health monitoring KW - Holter KW - cardiac KW - arrhythmia KW - ECG KW - EKG KW - digital tool KW - cardiology KW - patient monitoring KW - outpatient clinic KW - cardiac health KW - diagnostic KW - patient KW - clinician KW - digital health N2 - Background: There is insufficient evidence for the use of single-lead electrocardiogram (ECG) monitoring with an adhesive patch-type device (APD) over an extended period compared to that of the 24-hour Holter test for atrial fibrillation (AF) detection. Objective: In this paper, we aimed to compare AF detection by the 24-hour Holter test and 72-hour single-lead ECG monitoring using an APD among patients with AF. Methods: This was a prospective, single-center cohort study. A total of 210 patients with AF with clinical indications for the Holter test at cardiology outpatient clinics were enrolled in the study. The study participants were equipped with both the Holter device and APD for the first 24 hours. Subsequently, only the APD continued ECG monitoring for an additional 48 hours. AF detection during the first 24 hours was compared between the two devices. The diagnostic benefits of extended monitoring using the APD were evaluated. Results: A total of 200 patients (mean age 60 years; n=141, 70.5% male; and n=59, 29.5% female) completed 72-hour ECG monitoring with the APD. During the first 24 hours, both monitoring methods detected AF in the same 40/200 (20%) patients (including 20 patients each with paroxysmal and persistent AF). Compared to the 24-hour Holter test, the APD increased the AF detection rate by 1.5-fold (58/200; 29%) and 1.6-fold (64/200; 32%) with 48- and 72-hour monitoring, respectively. With the APD, the number of newly discovered patients with paroxysmal AF was 20/44 (45.5%), 18/44 (40.9%), and 6/44 (13.6%) at 24-, 48-, and 72-hour monitoring, respectively. Compared with 24-hour Holter monitoring, 72-hour monitoring with the APD increased the detection rate of paroxysmal AF by 2.2-fold (44/20). Conclusions: Compared to the 24-hour Holter test, AF detection could be improved with 72-hour single-lead ECG monitoring with the APD. UR - https://www.jmir.org/2022/5/e37970 UR - http://dx.doi.org/10.2196/37970 UR - http://www.ncbi.nlm.nih.gov/pubmed/35532989 ID - info:doi/10.2196/37970 ER - TY - JOUR AU - Watkins, L. Rebecca AU - Browne, A. Felicia AU - Kizakevich, N. Paul AU - Howard, N. Brittni AU - Turner, B. Leslie AU - Eckhoff, Randall AU - Wechsberg, M. Wendee PY - 2022/5/9 TI - An Evidence-Based HIV Risk?Reduction Intervention for Young African American Women in the US South Using mHealth: Adaptation and Development Study JO - JMIR Form Res SP - e34041 VL - 6 IS - 5 KW - substance use KW - prevention KW - e-learning KW - adaptation KW - mobile apps KW - health risk behaviors KW - self-directed learning KW - HIV KW - women KW - young women KW - violence KW - mHealth app KW - gamification KW - mobile phone N2 - Background: Young African American women have higher rates of sexually transmitted infections, including HIV, than those of young women of other racial and ethnic groups. Gender-, culture-, and age-specific interventions are needed to end the HIV epidemic. The Women?s CoOp (WC) is an HIV risk?reduction intervention that is proven to be efficacious in various face-to-face formats. Objective: This study aims to adapt the delivery method of an evidence-based intervention, the WC, from an in-person format to a self-guided mobile health (mHealth) format while ensuring that core elements are maintained for intervention comparability and fidelity. Methods: Several adaptation phases were conducted by using the Personal Health Informatics and Intervention Toolkit (PHIT) as a guiding point to create the mobile app version of the WC. Throughout 5 phases, we established the implementation groundwork for the app; conducted formative research activities to test the initial draft of the app and obtain feedback; applied the PHIT toolkit programming structure to produce the mHealth version of the WC intervention; conducted usability testing and pretesting with interested parties, followed by in-house testing by WC interventionists and PHIT developers; and deployed the app to tablets and distributed it to study participants. The app underwent regular maintenance updates during the study. Results: The team converted the seven elements of the WC as accurately as possible for comparability to determine efficacy in a mobile app format while changing little about the basic delivery methods. For instance, cue card presentations of the materials delivered by the intervention staff were presented within the app but with voice-over narration and in a self-guided format rather than being led by a staff member. Other aspects of the intervention did not lend themselves to such straightforward adaptation, such as hands-on condom proficiency practice and one-on-one goal-setting activities. In these cases, the subject matter experts and app developers worked together to find comparable analogs to be used within the app. Once developed, tested, and finalized, the mHealth WC app was deployed into local health departments as part of a randomized trial. Conclusions: This systematic adaptation process created an accurate mHealth equivalent of an existing, in-person behavioral health intervention. Although participants? reception of the app during the formative developmental phase was overall positive, maintaining fidelity to the in-person delivery compromised the natural capabilities of a mobile app, such as further gamification, different types of interactivity, and integrated notifications and messaging, which could be helpful for participants? adherence to the intervention schedule. Given the development and implementation of the app, the next step is to examine the impact of the app and its efficacy in HIV and substance use risk-reduction. UR - https://formative.jmir.org/2022/5/e34041 UR - http://dx.doi.org/10.2196/34041 UR - http://www.ncbi.nlm.nih.gov/pubmed/35532978 ID - info:doi/10.2196/34041 ER - TY - JOUR AU - Rohde, A. Jacob AU - Fisher, B. Edwin AU - Boynton, H. Marcella AU - Freelon, Deen AU - Frohlich, O. Dennis AU - Barnes, L. Edward AU - Noar, M. Seth PY - 2022/5/6 TI - A Self-management SMS Text Messaging Intervention for People With Inflammatory Bowel Disease: Feasibility and Acceptability Study JO - JMIR Form Res SP - e34960 VL - 6 IS - 5 KW - inflammatory bowel disease KW - mHealth KW - self-management KW - SMS text messaging KW - mobile phone N2 - Background: Mobile health technologies can be useful for providing disease self-management information and support to people with inflammatory bowel disease (IBD). Objective: The aim of this study was to test a self-management SMS text messaging intervention for people with IBD. Our goal was to examine intervention feasibility, acceptability, and engagement and to preliminarily evaluate improvements in certain self-reported health outcomes among participants. Methods: We developed an SMS text messaging program called Text4IBD. The program sent daily support messages and resources about disease self-management over the course of a 2-week, single-group, pretest-posttest intervention to participants (N=114) diagnosed with IBD. We examined intervention feasibility, acceptability, and engagement through Text4IBD message topic recall and use of resources (ie, visiting supplemental websites recommended by the Text4IBD program). We also assessed pretest-posttest measures of IBD-related distress, self-efficacy, perceived support, use of coping strategies, and medication adherence. Analyses examined participants? evaluations of the intervention and compared pretest-posttest changes in secondary outcomes using paired-samples statistics. Results: Approximately all participants who completed the intervention (n=105) were receptive to Text4IBD and viewed the program as feasible and acceptable. In addition, most participants (103/105, 98.1%) recalled at least one of the message topics sent by the program, and 79% (83/105) of them self-reported engaging with at least one of the external self-management resources recommended by the Text4IBD program. Pretest-posttest results showed reduced IBD-related distress (mean 3.33, SD 0.68 vs mean 2.86, SD 0.73; P<.001) and improvements in most other secondary outcomes. Conclusions: Findings from this study highlight the value of SMS text messaging as a useful digital medium for providing support to people with IBD, particularly to those who may struggle with disease-related distress. Text4IBD was highly feasible and acceptable and may help people self-manage their IBD. Future studies should aim to evaluate this program in a randomized controlled trial in clinical settings. UR - https://formative.jmir.org/2022/5/e34960 UR - http://dx.doi.org/10.2196/34960 UR - http://www.ncbi.nlm.nih.gov/pubmed/35522471 ID - info:doi/10.2196/34960 ER - TY - JOUR AU - Gustafson, H. David AU - Mares, Marie-Louise AU - Johnston, C. Darcie AU - Landucci, Gina AU - Pe-Romashko, Klaren AU - Vjorn, J. Olivia AU - Hu, Yaxin AU - Maus, Adam AU - Mahoney, E. Jane AU - Mutlu, Bilge PY - 2022/5/5 TI - Using Smart Displays to Implement an eHealth System for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e37522 VL - 11 IS - 5 KW - eHealth KW - aged KW - geriatrics KW - multiple chronic conditions KW - chronic pain KW - smart displays KW - smart speakers KW - quality of life KW - primary care KW - health expenditures KW - mobile phone N2 - Background: Voice-controlled smart speakers and displays have a unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale rigorous trials. Older adults with multiple chronic health conditions, who need tools to help with their daily management, may be especially good candidates for interventions on voice-controlled devices because these patients often have physical limitations, such as tremors or vision problems, that make the use of laptops and smartphones challenging. Objective: The aim of this study is to assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison with participants using ElderTree on a laptop and control participants who are given no device or access to ElderTree. Methods: A total of 291 adults aged ?60 years with chronic pain and ?3 additional chronic conditions will be recruited from primary care clinics and community organizations and randomized 1:1:1 to ElderTree access on a smart display along with their usual care, ElderTree access on a touch screen laptop along with usual care, or usual care alone. All patients will be followed for 8 months. The primary outcomes are differences between groups in measures of pain interference and psychosocial quality of life. The secondary outcomes are between-group differences in system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of the effects of ElderTree on both platforms. At baseline, 4 months, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations. ElderTree use data will be collected continuously in system logs. We will use linear mixed-effects models to evaluate outcomes over time, with treatment condition and time acting as between-participant factors. Separate analyses will be conducted for each outcome. Results: Recruitment began in August 2021 and will run through April 2023. The intervention period will end in December 2023. The findings will be disseminated via peer-reviewed publications. Conclusions: To our knowledge, this is the first study with a large sample and long time frame to examine whether a voice-controlled smart device can perform as well as or better than a laptop in implementing a health intervention for older patients with multiple chronic health conditions. As patients with multiple conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort. Trial Registration: ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196 International Registered Report Identifier (IRRID): PRR1-10.2196/37522 UR - https://www.researchprotocols.org/2022/5/e37522 UR - http://dx.doi.org/10.2196/37522 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511229 ID - info:doi/10.2196/37522 ER - TY - JOUR AU - Yamada, Yasunori AU - Shinkawa, Kaoru AU - Kobayashi, Masatomo AU - Badal, D. Varsha AU - Glorioso, Danielle AU - Lee, E. Ellen AU - Daly, Rebecca AU - Nebeker, Camille AU - Twamley, W. Elizabeth AU - Depp, Colin AU - Nemoto, Miyuki AU - Nemoto, Kiyotaka AU - Kim, Ho-Cheol AU - Arai, Tetsuaki AU - Jeste, V. Dilip PY - 2022/5/5 TI - Automated Analysis of Drawing Process to Estimate Global Cognition in Older Adults: Preliminary International Validation on the US and Japan Data Sets JO - JMIR Form Res SP - e37014 VL - 6 IS - 5 KW - tablet KW - behavior analysis KW - digital biomarkers KW - digital health KW - motor control KW - cognitive impairment KW - dementia KW - machine learning KW - multicohort KW - multination N2 - Background: With the aging of populations worldwide, early detection of cognitive impairments has become a research and clinical priority, particularly to enable preventive intervention for dementia. Automated analysis of the drawing process has been studied as a promising means for lightweight, self-administered cognitive assessment. However, this approach has not been sufficiently tested for its applicability across populations. Objective: The aim of this study was to evaluate the applicability of automated analysis of the drawing process for estimating global cognition in community-dwelling older adults across populations in different nations. Methods: We collected drawing data with a digital tablet, along with Montreal Cognitive Assessment (MoCA) scores for assessment of global cognition, from 92 community-dwelling older adults in the United States and Japan. We automatically extracted 6 drawing features that characterize the drawing process in terms of the drawing speed, pauses between drawings, pen pressure, and pen inclinations. We then investigated the association between the drawing features and MoCA scores through correlation and machine learning?based regression analyses. Results: We found that, with low MoCA scores, there tended to be higher variability in the drawing speed, a higher pause:drawing duration ratio, and lower variability in the pen?s horizontal inclination in both the US and Japan data sets. A machine learning model that used drawing features to estimate MoCA scores demonstrated its capability to generalize from the US dataset to the Japan dataset (R2=0.35; permutation test, P<.001). Conclusions: This study presents initial empirical evidence of the capability of automated analysis of the drawing process as an estimator of global cognition that is applicable across populations. Our results suggest that such automated analysis may enable the development of a practical tool for international use in self-administered, automated cognitive assessment. UR - https://formative.jmir.org/2022/5/e37014 UR - http://dx.doi.org/10.2196/37014 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511253 ID - info:doi/10.2196/37014 ER - TY - JOUR AU - Timon, M. Claire AU - Heffernan, Emma AU - Kilcullen, M. Sophia AU - Lee, Hyowon AU - Hopper, Louise AU - Quinn, Joe AU - McDonald, David AU - Gallagher, Pamela AU - Smeaton, F. Alan AU - Moran, Kieran AU - Hussey, Pamela AU - Murphy, Catriona PY - 2022/5/5 TI - Development of an Internet of Things Technology Platform (the NEX System) to Support Older Adults to Live Independently: Protocol for a Development and Usability Study JO - JMIR Res Protoc SP - e35277 VL - 11 IS - 5 KW - independent living KW - older adults KW - Internet of Things KW - wearable electronic devices KW - activities of daily living KW - mobile phone N2 - Background: In a rapidly aging population, new and efficient ways of providing health and social support to older adults are required that not only preserve independence but also maintain quality of life and safety. Objective: The NEX project aims to develop an integrated Internet of Things system coupled with artificial intelligence to offer unobtrusive health and wellness monitoring to support older adults living independently in their home environment. The primary objective of this study is to develop and evaluate the technical performance and user acceptability of the NEX system. The secondary objective is to apply machine learning algorithms to the data collected via the NEX system to identify and eventually predict changes in the routines of older adults in their own home environment. Methods: The NEX project commenced in December 2019 and is expected to be completed by August 2022. Mixed methods research (web-based surveys and focus groups) was conducted with 426 participants, including older adults (aged ?60 years), family caregivers, health care professionals, and home care workers, to inform the development of the NEX system (phase 1). The primary outcome will be evaluated in 2 successive trials (the Friendly trial [phase 2] and the Action Research Cycle trial [phase 3]). The secondary objective will be explored in the Action Research Cycle trial (phase 3). For the Friendly trial, 7 older adult participants aged ?60 years and living alone in their own homes for a 10-week period were enrolled. A total of 30 older adult participants aged ?60 years and living alone in their own homes will be recruited for a 10-week data collection period (phase 3). Results: Phase 1 of the project (n=426) was completed in December 2020, and phase 2 (n=7 participants for a 10-week pilot study) was completed in September 2021. The expected completion date for the third project phase (30 participants for the 10-week usability study) is June 2022. Conclusions: The NEX project has considered the specific everyday needs of older adults and other stakeholders, which have contributed to the design of the integrated system. The innovation of the NEX system lies in the use of Internet of Things technologies and artificial intelligence to identify and predict changes in the routines of older adults. The findings of this project will contribute to the eHealth research agenda, focusing on the improvement of health care provision and patient support in home and community environments. International Registered Report Identifier (IRRID): DERR1-10.2196/35277 UR - https://www.researchprotocols.org/2022/5/e35277 UR - http://dx.doi.org/10.2196/35277 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511224 ID - info:doi/10.2196/35277 ER - TY - JOUR AU - Braund, A. Taylor AU - Zin, The May AU - Boonstra, W. Tjeerd AU - Wong, J. Quincy J. AU - Larsen, E. Mark AU - Christensen, Helen AU - Tillman, Gabriel AU - O?Dea, Bridianne PY - 2022/5/4 TI - Smartphone Sensor Data for Identifying and Monitoring Symptoms of Mood Disorders: A Longitudinal Observational Study JO - JMIR Ment Health SP - e35549 VL - 9 IS - 5 KW - depression KW - bipolar disorder KW - sensors KW - mobile app KW - circadian rhythm KW - mobile phone N2 - Background: Mood disorders are burdensome illnesses that often go undetected and untreated. Sensor technologies within smartphones may provide an opportunity for identifying the early changes in circadian rhythm and social support/connectedness that signify the onset of a depressive or manic episode. Objective: Using smartphone sensor data, this study investigated the relationship between circadian rhythm, which was determined by GPS data, and symptoms of mental health among a clinical sample of adults diagnosed with major depressive disorder or bipolar disorder. Methods: A total of 121 participants were recruited from a clinical setting to take part in a 10-week observational study. Self-report questionnaires for mental health outcomes, social support, social connectedness, and quality of life were assessed at 6 time points throughout the study period. Participants consented to passively sharing their smartphone GPS data for the duration of the study. Circadian rhythm (ie, regularity of location changes in a 24-hour rhythm) was extracted from GPS mobility patterns at baseline. Results: Although we found no association between circadian rhythm and mental health functioning at baseline, there was a positive association between circadian rhythm and the size of participants? social support networks at baseline (r=0.22; P=.03; R2=0.049). In participants with bipolar disorder, circadian rhythm was associated with a change in anxiety from baseline; a higher circadian rhythm was associated with an increase in anxiety and a lower circadian rhythm was associated with a decrease in anxiety at time point 5. Conclusions: Circadian rhythm, which was extracted from smartphone GPS data, was associated with social support and predicted changes in anxiety in a clinical sample of adults with mood disorders. Larger studies are required for further validations. However, smartphone sensing may have the potential to monitor early symptoms of mood disorders. UR - https://mental.jmir.org/2022/5/e35549 UR - http://dx.doi.org/10.2196/35549 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507385 ID - info:doi/10.2196/35549 ER - TY - JOUR AU - Li, CM Amanda AU - Wong, KL Keith AU - Chio, HN Floria AU - Mak, WS Winnie AU - Poon, WH Loretta PY - 2022/5/3 TI - Delivering Mindfulness-Based Interventions for Insomnia, Pain, and Dysfunctional Eating Through a Text Messaging App: Three Randomized Controlled Trials Investigating the Effectiveness and Mediating Mechanisms JO - J Med Internet Res SP - e30073 VL - 24 IS - 5 KW - text messaging KW - mindfulness KW - insomnia KW - pain KW - dysregulated eating KW - mHealth KW - mental health KW - SMS KW - distress KW - intervention KW - outcome KW - mobile interventions N2 - Background: Although text messaging has the potential to be the core intervention modality, it is often used as an adjunct only. To improve health and alleviate the distress related to insomnia, pain, and dysregulated eating of people living in urban areas, text messaging?based mindfulness-based interventions were designed and evaluated in 3 randomized controlled trials. Objective: This study investigated the effectiveness and mediating mechanisms of text messaging?based mindfulness-based interventions for people with distress related to insomnia, pain, or dysregulated eating. Methods: In these trials, 333, 235, and 351 participants were recruited online and randomized to intervention and wait-list control conditions for insomnia, pain, and dysregulated eating, respectively. Participants experienced 21 days of intervention through WhatsApp Messenger. Participants completed pre-, post-, 1-month follow-up, and 3-month follow-up self-report questionnaires online. The retention rates at postmeasurements were 83.2% (139/167), 77.1% (91/118), and 72.9% (129/177) for intervention groups of insomnia, pain, and dysregulated eating, respectively. Participants? queries were answered by a study technician. Primary outcomes included insomnia severity, presleep arousal, pain intensity, pain acceptance, and eating behaviors. Secondary outcomes included mindfulness, depression, anxiety, mental well-being, and functional impairments. Mindfulness, dysfunctional beliefs and attitudes about sleep, pain catastrophizing, and reactivity to food cues were hypothesized to mediate the relationship between the intervention and outcomes. Results: For all 3 studies, the intervention groups showed significant improvement on most outcomes at 1-month follow-up compared to their respective wait-list control groups; some primary outcomes (eg, insomnia, pain, dysregulated eating indicators) and secondary outcomes (eg, depression, anxiety symptoms) were sustained at 3-month follow-up. Medium-to-large effect sizes were found at postassessments in most outcomes in all studies. In the intervention for insomnia, mediation analyses showed that dysfunctional beliefs and attitudes about sleep mediated the effect of the intervention on all primary outcomes and most secondary outcomes at both 1-month and 3-month follow-ups, whereas mindfulness mediated the intervention effect on presleep arousal at 1-month and 3-month follow-ups. In the intervention for pain, pain catastrophizing mediated the effect of intervention on pain intensity and functioning at both 1-month and 3-month follow-ups, whereas mindfulness only mediated the effect of intervention on anxiety and depressive symptoms. In the intervention for dysregulated eating, power of food mediated the effect of intervention on both uncontrolled and emotional eating at both 1-month and 3-month follow-ups and mindfulness was found to mediate the effect on depressive symptoms at both 1-month and 3-month follow-ups. Conclusions: These 3 studies converged and provided empirical evidence that mindfulness-based interventions delivered through text messaging are effective in improving distress related to sleep, pain, and dysregulated eating. Text messaging has the potential to be a core intervention modality to improve various common health outcomes for people living a fast-paced lifestyle. Trial Registration: Clinical Research and Biostatistics Clinical Trials Registry CUHK_CCRB00559; https://tinyurl.com/24rkwarz UR - https://www.jmir.org/2022/5/e30073 UR - http://dx.doi.org/10.2196/30073 UR - http://www.ncbi.nlm.nih.gov/pubmed/35503653 ID - info:doi/10.2196/30073 ER - TY - JOUR AU - Kopka, Marvin AU - Schmieding, L. Malte AU - Rieger, Tobias AU - Roesler, Eileen AU - Balzer, Felix AU - Feufel, A. Markus PY - 2022/5/3 TI - Determinants of Laypersons? Trust in Medical Decision Aids: Randomized Controlled Trial JO - JMIR Hum Factors SP - e35219 VL - 9 IS - 2 KW - symptom checkers KW - disposition advice KW - anthropomorphism KW - artificial intelligence KW - urgency assessment KW - patient-centered care KW - human-computer interaction KW - consumer health KW - information technology KW - IT KW - mobile phone N2 - Background: Symptom checker apps are patient-facing decision support systems aimed at providing advice to laypersons on whether, where, and how to seek health care (disposition advice). Such advice can improve laypersons? self-assessment and ultimately improve medical outcomes. Past research has mainly focused on the accuracy of symptom checker apps? suggestions. To support decision-making, such apps need to provide not only accurate but also trustworthy advice. To date, only few studies have addressed the question of the extent to which laypersons trust symptom checker app advice or the factors that moderate their trust. Studies on general decision support systems have shown that framing automated systems (anthropomorphic or emphasizing expertise), for example, by using icons symbolizing artificial intelligence (AI), affects users? trust. Objective: This study aims to identify the factors influencing laypersons? trust in the advice provided by symptom checker apps. Primarily, we investigated whether designs using anthropomorphic framing or framing the app as an AI increases users? trust compared with no such framing. Methods: Through a web-based survey, we recruited 494 US residents with no professional medical training. The participants had to first appraise the urgency of a fictitious patient description (case vignette). Subsequently, a decision aid (mock symptom checker app) provided disposition advice contradicting the participants? appraisal, and they had to subsequently reappraise the vignette. Participants were randomized into 3 groups: 2 experimental groups using visual framing (anthropomorphic, 160/494, 32.4%, vs AI, 161/494, 32.6%) and a neutral group without such framing (173/494, 35%). Results: Most participants (384/494, 77.7%) followed the decision aid?s advice, regardless of its urgency level. Neither anthropomorphic framing (odds ratio 1.120, 95% CI 0.664-1.897) nor framing as AI (odds ratio 0.942, 95% CI 0.565-1.570) increased behavioral or subjective trust (P=.99) compared with the no-frame condition. Even participants who were extremely certain in their own decisions (ie, 100% certain) commonly changed it in favor of the symptom checker?s advice (19/34, 56%). Propensity to trust and eHealth literacy were associated with increased subjective trust in the symptom checker (propensity to trust b=0.25; eHealth literacy b=0.2), whereas sociodemographic variables showed no such link with either subjective or behavioral trust. Conclusions: Contrary to our expectation, neither the anthropomorphic framing nor the emphasis on AI increased trust in symptom checker advice compared with that of a neutral control condition. However, independent of the interface, most participants trusted the mock app?s advice, even when they were very certain of their own assessment. Thus, the question arises as to whether laypersons use such symptom checkers as substitutes rather than as aids in their own decision-making. With trust in symptom checkers already high at baseline, the benefit of symptom checkers depends on interface designs that enable users to adequately calibrate their trust levels during usage. Trial Registration: Deutsches Register Klinischer Studien DRKS00028561; https://tinyurl.com/rv4utcfb (retrospectively registered). UR - https://humanfactors.jmir.org/2022/2/e35219 UR - http://dx.doi.org/10.2196/35219 UR - http://www.ncbi.nlm.nih.gov/pubmed/35503248 ID - info:doi/10.2196/35219 ER - TY - JOUR AU - Imrisek, D. Steven AU - Lee, Matthew AU - Goldner, Dan AU - Nagra, Harpreet AU - Lavaysse, M. Lindsey AU - Hoy-Rosas, Jamillah AU - Dachis, Jeff AU - Sears, E. Lindsay PY - 2022/5/3 TI - Effects of a Novel Blood Glucose Forecasting Feature on Glycemic Management and Logging in Adults With Type 2 Diabetes Using One Drop: Retrospective Cohort Study JO - JMIR Diabetes SP - e34624 VL - 7 IS - 2 KW - blood glucose forecast KW - health forecasting KW - machine learning KW - model KW - precision health KW - blood glucose KW - blood glucose logging KW - type 2 diabetes KW - forecast KW - mHealth KW - digital health KW - smartphone KW - precision KW - monitoring KW - cohort KW - retrospective KW - diabetes N2 - Background: Personalized feedback is an effective behavior change technique frequently incorporated into mobile health (mHealth) apps. Innovations in data science create opportunities for leveraging the wealth of user data accumulated by mHealth apps to generate personalized health forecasts. One Drop?s digital program is one of the first to implement blood glucose forecasts for people with type 2 diabetes. The impact of these forecasts on behavior and glycemic management has not been evaluated to date. Objective: This study sought to evaluate the impact of exposure to blood glucose forecasts on blood glucose logging behavior, average blood glucose, and percentage of glucose points in range. Methods: This retrospective cohort study examined people with type 2 diabetes who first began using One Drop to record their blood glucose between 2019 and 2021. Cohorts included those who received blood glucose forecasts and those who did not receive forecasts. The cohorts were compared to evaluate the effect of exposure to blood glucose forecasts on logging activity, average glucose, and percentage of glucose readings in range, after controlling for potential confounding factors. Data were analyzed using analysis of covariance (ANCOVA) and regression analyses. Results: Data from a total of 1411 One Drop users with type 2 diabetes and elevated baseline glucose were analyzed. Participants (60.6% male, 795/1311; mean age 50.2 years, SD 11.8) had diabetes for 7.1 years on average (SD 7.9). After controlling for potential confounding factors, blood glucose forecasts were associated with more frequent blood glucose logging (P=.004), lower average blood glucose (P<.001), and a higher percentage of readings in range (P=.03) after 12 weeks. Blood glucose logging partially mediated the relationship between exposure to forecasts and average glucose. Conclusions: Individuals who received blood glucose forecasts had significantly lower average glucose, with a greater amount of glucose measurements in a healthy range after 12 weeks compared to those who did not receive forecasts. Glucose logging was identified as a partial mediator of the relationship between forecast exposure and week-12 average glucose, highlighting a potential mechanism through which glucose forecasts exert their effect. When administered as a part of a comprehensive mHealth program, blood glucose forecasts may significantly improve glycemic management among people living with type 2 diabetes. UR - https://diabetes.jmir.org/2022/2/e34624 UR - http://dx.doi.org/10.2196/34624 UR - http://www.ncbi.nlm.nih.gov/pubmed/35503521 ID - info:doi/10.2196/34624 ER - TY - JOUR AU - King, Leya Sayde AU - Lebert, Jana AU - Karpisek, Anne Lacey AU - Phillips, Amelia AU - Neal, Tempestt AU - Kosyluk, Kristin PY - 2022/5/3 TI - Characterizing User Experiences With an SMS Text Messaging?Based mHealth Intervention: Mixed Methods Study JO - JMIR Form Res SP - e35699 VL - 6 IS - 5 KW - text messaging KW - SMS KW - mobile health KW - mHealth KW - stigma KW - user perceptions KW - ubiquitous sensing KW - low-intensity intervention KW - coping KW - mental health KW - cognitive restructuring KW - mobile phone N2 - Background: Limited access to mental health care services due to provider shortages, geographic limitations, and cost has driven the area of mobile health (mHealth) care to address these access gaps. Reports from the Cohen Veterans Network and National Council for Behavioral Health show that in states where mental health care is more accessible, 38% of people still do not receive the care they need. mHealth strategies help to provide care to individuals experiencing these barriers at lower cost and greater convenience, making mHealth a great resource to bridge the gaps. Objective: We present a mixed methods study to evaluate user experiences with the mental mHealth service, Cope Notes. Specifically, we aimed to investigate the following research questions: How do users perceive the service in relation to stigma, impact of the intervention, and perceived usefulness? How do users rate the Cope Notes service and SMS text messaging along various dimensions of acceptability? What is the relationship between Cope Notes SMS text message ratings, user personality, and coping strategies? What are user perspectives of leveraging ubiquitous sensing technologies to improve delivery and provide tailored content? Methods: We performed qualitative interviews with Cope Notes users (N=14) who have used the service for at least 30 days to evaluate their experiences and usefulness of the service. These interviews were coded by 2 raters (SLK and JL), and the interrater reliability was calculated with SPSS (IBM Corp) at 61.8%. In addition, participants completed quantitative measures, including a user experiences survey, personality inventory (Big Five Inventory-10), and coping assessment (Brief Coping Orientation to Problems Experienced). Results: We derived 7 themes from our qualitative interviews: Likes or Perceived Benefits, Dislikes or Limitations, Suggested Changes, Stigma or Help Seeking, Perceptions of Ubiquitous Sensing, Cultural Sensitivity, and Alternative mHealth Resources. Exploratory analyses between acceptability ratings of Cope Notes and personality factors showed statistically significant positive relationships between seeing oneself as someone who is generally trusting and acceptability items, the most significant being item 7 (I fully understood the sentiment behind Cope Notes Messages) with (rs(10)=0.82, P=.001). We also found statistically significant relationships between acceptability and Brief Coping Orientation to Problems Experienced items, with the strongest positive correlation between participants strongly endorsing coping by accepting the reality that an event has happened and acceptability item 7 (rs(8)=0.86, P=.001). Conclusions: Our study found that Cope Notes subscribers appreciate the service for reframing their mental wellness with statistically significant correlations between personality and acceptability of the service. We found that some users prefer a more personalized experience with neutral to positive reactions to a potential companion app that continuously monitors user behavior via smartphone sensors to provide just-in-time interventions when users need it most. UR - https://formative.jmir.org/2022/5/e35699 UR - http://dx.doi.org/10.2196/35699 UR - http://www.ncbi.nlm.nih.gov/pubmed/35503524 ID - info:doi/10.2196/35699 ER - TY - JOUR AU - Pit, Sabrina AU - Ramsden, Robyn AU - Tan, JH Aaron AU - Payne, Kristy AU - Barr, James AU - Eames, Benjamin AU - Edwards, Mike AU - Colbran, Richard PY - 2022/5/2 TI - Persuasive Design Techniques and App Design Recommendations to Improve Health Workforce Capability in Rural Health Professionals: What Do Users Want and How Does an App Help? JO - JMIR Hum Factors SP - e35094 VL - 9 IS - 2 KW - health KW - wellness KW - mobile apps KW - persuasive strategies KW - behavior change KW - review KW - health workforce KW - capability KW - career KW - employment KW - rural KW - workforce planning KW - mHealth KW - mobile health KW - digital health KW - health professional KW - user experience KW - health application KW - task support KW - social support KW - dialog support N2 - Background: Health professionals? perceptions of persuasive design techniques for use in technological solutions to improve health workforce capability have not been previously explored. Objective: This study aims to explore rural health professionals? perceptions of health workforce capability and persuasive design techniques; and translate these into recommendations for designing a health workforce capability app to increase their impact and usefulness. Methods: Qualitative interviews with 13 rural health professionals were conducted. Subsequently, 32 persuasive techniques were used as a framework to deductively analyze the data. Persuasive design technique domains were Primary Task Support, Dialog Support, System Credibility Support, Social Support, and Cialdini?s Principles of Persuasion. Results: Persuasive design techniques can be applied across the factors that influence health workforce capability including health and personal qualities; competencies and skills; values, attitudes, and motivation; and factors that operate outside of work and at the team, organizational, and labor market levels. The majority of the 32 persuasive design techniques were reflected in the data from the interviews and led to recommendations as to how these could be translated into practice, with the exception of scarcity. Many suggestions and persuasive design techniques link back to the need for tailored and localized solutions such as the need for country-specific?based evidence, the wish for localized communities of practice, learning from other rural health professionals, and referral pathways to other clinicians. Participants identified how persuasive design techniques can optimize the user experience to help meet rural health professionals needs for more efficient systems to improve patient access to care, quality care, and to enable working in interprofessional team-based care. Social inclusion plays a vital role for health professionals, indicating the importance of the Social Support domain of persuasive techniques. Overall, health professionals were open to self-monitoring of their work performance and some professionals used wearables to monitor their health. Conclusions: Rural health professionals? perceptions of health workforce capability informed which persuasive design techniques can be used to optimize the user experience of an app. These were translated into recommendations for designing a health workforce capability app to increase likelihood of adoption. This study has also contributed to the further validation of the Persuasive Systems Design model through empirically aligning elements of the model to increase persuasive system content and functionality with real-world applied data, in this case the health workforce capability of rural health professionals. Our findings confirm that these techniques can be used to develop a future prototype of an app that may assist health professionals in improving or maintaining their health workforce capability which in turn may increase recruitment and retention in rural areas. Health professionals need to be central during the design phase. Interventions are needed to provide a supportive environment to rural and remote health professionals to increase their rural health workforce capability. UR - https://humanfactors.jmir.org/2022/2/e35094 UR - http://dx.doi.org/10.2196/35094 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499866 ID - info:doi/10.2196/35094 ER - TY - JOUR AU - Hunter, Alex AU - Leckie, Todd AU - Coe, Oliver AU - Hardy, Benjamin AU - Fitzpatrick, Daniel AU - Gonçalves, Ana-Carolina AU - Standing, Mary-Kate AU - Koulouglioti, Christina AU - Richardson, Alan AU - Hodgson, Luke PY - 2022/5/2 TI - Using Smartwatches to Observe Changes in Activity During Recovery From Critical Illness Following COVID-19 Critical Care Admission: 1-Year, Multicenter Observational Study JO - JMIR Rehabil Assist Technol SP - e25494 VL - 9 IS - 2 KW - COVID-19 KW - telemedicine KW - rehabilitation KW - critical illness KW - smartphone KW - digital health KW - mobile health KW - remote therapy KW - device usability N2 - Background: As a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions. Objective: We aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this. Methods: We conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site?the MDT site (n=19)?had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis. Results: Of the 50 participants recruited, 35 (70%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74% (14/19) of smartwatch users uploaded smartwatch data, whereas 68% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup?s mean step count increased more than that of the control group (176% increase vs 42% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71% (10/14) of smartwatch users at the MDT site and 48% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86% (12/14) and 48% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time. Conclusions: This is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post?critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness. International Registered Report Identifier (IRRID): RR2-10.12968/ijtr.2020.0102 UR - https://rehab.jmir.org/2022/2/e25494 UR - http://dx.doi.org/10.2196/25494 UR - http://www.ncbi.nlm.nih.gov/pubmed/35417402 ID - info:doi/10.2196/25494 ER - TY - JOUR AU - Bartlett, Kiera Yvonne AU - Farmer, Andrew AU - Newhouse, Nikki AU - Miles, Lisa AU - Kenning, Cassandra AU - French, P. David PY - 2022/4/29 TI - Effects of Using a Text Message Intervention on Psychological Constructs and the Association Between Changes to Psychological Constructs and Medication Adherence in People With Type 2 Diabetes: Results From a Randomized Controlled Feasibility Study JO - JMIR Form Res SP - e30058 VL - 6 IS - 4 KW - medication adherence KW - type 2 diabetes mellitus KW - behavior change techniques KW - text messaging KW - feasibility studies KW - diabetes KW - medication KW - digital health N2 - Background: Poor adherence to oral medications is common in people with type 2 diabetes and can lead to an increased chance of health complications. Text messages may provide an effective delivery method for an intervention; however, thus far, the majority of these interventions do not specify either a theoretical basis or propose specific mechanisms of action. This makes it hard to determine how and whether an intervention is having an effect. The text messages included in the current intervention have been developed to deliver specific behavior change techniques. These techniques are the ?active ingredients? of the intervention and were selected to target psychological constructs identified as predictors of medication adherence. Objective: There are 2 aims of this study: (1) to assess whether a text message intervention with specified behavior change techniques can change the constructs that predict medication adherence behaviors in people with type 2 diabetes and (2) to assess whether changes to psychological constructs are associated with changes in self-reported medication adherence. Methods: We conducted a randomized controlled, 6-month feasibility trial. Adults prescribed oral medication for type 2 diabetes (N=209) were recruited from general practice and randomized to either receive a text message?based intervention or care as usual. Data were analyzed with repeated measures analysis of covariance and Spearman rho correlation coefficients. Results: For 8 of the 14 constructs that were measured, a significant time-by-condition interaction was found: necessity beliefs, intention, maintenance self-efficacy, recovery self-efficacy, action control, prompts and cues, social support, and satisfaction with experienced consequences all increased in the intervention group compared to the control group. Changes in action self-efficacy, intention, automaticity, maintenance self-efficacy, and satisfaction with experienced consequences were positively associated with changes in self-reported medication adherence. Conclusions: A relatively low-cost, scalable, text message?only intervention targeting medication adherence using behavior change techniques can influence psychological constructs that predict adherence. Not only do these constructs predict self-reported medication adherence, but changes in these constructs are correlated with changes in self-reported medication adherence. These findings support the promise of text message?based interventions for medication adherence in this population and suggest likely mechanisms of action. Trial Registration: ISRCTN Registry ISRCTN13404264; https://www.isrctn.com/ISRCTN13404264 UR - https://formative.jmir.org/2022/4/e30058 UR - http://dx.doi.org/10.2196/30058 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486430 ID - info:doi/10.2196/30058 ER - TY - JOUR AU - Krishnamurti, Tamar AU - Birru Talabi, Mehret AU - Callegari, S. Lisa AU - Kazmerski, M. Traci AU - Borrero, Sonya PY - 2022/4/28 TI - A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States JO - J Med Internet Res SP - e36338 VL - 24 IS - 4 KW - United States KW - North America KW - femtech KW - mHealth KW - health equity KW - pregnancy KW - women's health KW - preterm birth KW - contraception KW - family planning KW - reproductive care KW - sterilization KW - cystic fibrosis KW - rheumatic disease KW - eHealth KW - mobile health KW - reproductive health KW - digital health KW - health technology KW - health outcomes UR - https://www.jmir.org/2022/4/e36338 UR - http://dx.doi.org/10.2196/36338 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482371 ID - info:doi/10.2196/36338 ER - TY - JOUR AU - Hart, Alexander AU - Reis, Dorota AU - Prestele, Elisabeth AU - Jacobson, C. Nicholas PY - 2022/4/28 TI - Using Smartphone Sensor Paradata and Personalized Machine Learning Models to Infer Participants? Well-being: Ecological Momentary Assessment JO - J Med Internet Res SP - e34015 VL - 24 IS - 4 KW - digital biomarkers KW - machine learning KW - ecological momentary assessment KW - smartphone sensors KW - internal states KW - paradata KW - accelerometer KW - gyroscope KW - mood KW - mobile phone N2 - Background: Sensors embedded in smartphones allow for the passive momentary quantification of people?s states in the context of their daily lives in real time. Such data could be useful for alleviating the burden of ecological momentary assessments and increasing utility in clinical assessments. Despite existing research on using passive sensor data to assess participants? moment-to-moment states and activity levels, only limited research has investigated temporally linking sensor assessment and self-reported assessment to further integrate the 2 methodologies. Objective: We investigated whether sparse movement-related sensor data can be used to train machine learning models that are able to infer states of individuals? work-related rumination, fatigue, mood, arousal, life engagement, and sleep quality. Sensor data were only collected while the participants filled out the questionnaires on their smartphones. Methods: We trained personalized machine learning models on data from employees (N=158) who participated in a 3-week ecological momentary assessment study. Results: The results suggested that passive smartphone sensor data paired with personalized machine learning models can be used to infer individuals? self-reported states at later measurement occasions. The mean R2 was approximately 0.31 (SD 0.29), and more than half of the participants (119/158, 75.3%) had an R2 of ?0.18. Accuracy was only slightly attenuated compared with earlier studies and ranged from 38.41% to 51.38%. Conclusions: Personalized machine learning models and temporally linked passive sensing data have the capability to infer a sizable proportion of variance in individuals? daily self-reported states. Further research is needed to investigate factors that affect the accuracy and reliability of the inference. UR - https://www.jmir.org/2022/4/e34015 UR - http://dx.doi.org/10.2196/34015 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482397 ID - info:doi/10.2196/34015 ER - TY - JOUR AU - Crespi, Elizabeth AU - Hardesty, J. Jeffrey AU - Nian, Qinghua AU - Sinamo, Joshua AU - Welding, Kevin AU - Kennedy, David Ryan AU - Cohen, E. Joanna PY - 2022/4/27 TI - Agreement Between Self-reports and Photos to Assess e-Cigarette Device and Liquid Characteristics in Wave 1 of the Vaping and Patterns of e-Cigarette Use Research Study: Web-Based Longitudinal Cohort Study JO - J Med Internet Res SP - e33656 VL - 24 IS - 4 KW - tobacco KW - e-cigarette KW - methodology KW - internet KW - photo KW - survey KW - self-report N2 - Background: e-Cigarette device and liquid characteristics are highly customizable; these characteristics impact nicotine delivery and exposure to toxic constituents. It is critical to understand optimal methods for measuring these characteristics to accurately assess their impacts on user behavior and health. Objective: To inform future survey development, we assessed the agreement between responses from survey participants (self-reports) and photos uploaded by participants and the quantity of usable data derived from each approach. Methods: Adult regular e-cigarette users (?5 days per week) aged ?21 years (N=1209) were asked questions about and submitted photos of their most used e-cigarette device (1209/1209, 100%) and liquid (1132/1209, 93.63%). Device variables assessed included brand, model, reusability, refillability, display, and adjustable power. Liquid variables included brand, flavor, nicotine concentration, nicotine formulation, and bottle size. For each variable, percentage agreement was calculated where self-report and photo data were available. Krippendorff ? and intraclass correlation coefficient (ICC) were calculated for categorical and continuous variables, respectively. Results were stratified by device (disposable, reusable with disposable pods or cartridges, and reusable with refillable pods, cartridges, or tanks) and liquid (customized and noncustomized) type. The sample size for each calculation ranged from 3.89% (47/1209; model of disposable devices) to 95.12% (1150/1209; device reusability). Results: Percentage agreement between photos and self-reports was substantial to very high across device and liquid types for all variables except nicotine concentration. These results are consistent with Krippendorff ? calculations, except where prevalence bias was suspected. ICC results for nicotine concentration and bottle size were lower than percentage agreement, likely because ICC accounts for the level of disagreement between values. Agreement varied by device and liquid type. For example, percentage agreement for device brand was higher among users of reusable devices (94%) than among users of disposable devices (75%). Low percentage agreement may result from poor participant knowledge of characteristics, user modifications of devices inconsistent with manufacturer-intended use, inaccurate or incomplete information on websites, or photo submissions that are not a participant?s most used device or liquid. The number of excluded values (eg, self-report was ?don?t know? or no photo submitted) differed between self-reports and photos; for questions asked to participants, self-reports had more usable data than photos for all variables except device model and nicotine formulation. Conclusions: Photos and self-reports yield data of similar accuracy for most variables assessed in this study: device brand, device model, reusability, adjustable power, display, refillability, liquid brand, flavor, and bottle size. Self-reports provided more data for all variables except device model and nicotine formulation. Using these approaches simultaneously may optimize data quantity and quality. Future research should examine how to assess nicotine concentration and variables not included in this study (eg, wattage and resistance) and the resource requirements of these approaches. UR - https://www.jmir.org/2022/4/e33656 UR - http://dx.doi.org/10.2196/33656 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475727 ID - info:doi/10.2196/33656 ER - TY - JOUR AU - Meheli, Saha AU - Sinha, Chaitali AU - Kadaba, Madhura PY - 2022/4/27 TI - Understanding People With Chronic Pain Who Use a Cognitive Behavioral Therapy?Based Artificial Intelligence Mental Health App (Wysa): Mixed Methods Retrospective Observational Study JO - JMIR Hum Factors SP - e35671 VL - 9 IS - 2 KW - chronic pain KW - digital mental health KW - mobile health KW - mHealth KW - pain management KW - artificial intelligence KW - cognitive behavioral therapy KW - conversational agent KW - software agent KW - pain conditions KW - depression KW - anxiety N2 - Background: Digital health interventions can bridge barriers in access to treatment among individuals with chronic pain. Objective: This study aimed to evaluate the perceived needs, engagement, and effectiveness of the mental health app Wysa with regard to mental health outcomes among real-world users who reported chronic pain and engaged with the app for support. Methods: Real-world data from users (N=2194) who reported chronic pain and associated health conditions in their conversations with the mental health app were examined using a mixed methods retrospective observational study. An inductive thematic analysis was used to analyze the conversational data of users with chronic pain to assess perceived needs, along with comparative macro-analyses of conversational flows to capture engagement within the app. Additionally, the scores from a subset of users who completed a set of pre-post assessment questionnaires, namely Patient Health Questionnaire-9 (PHQ-9) (n=69) and Generalized Anxiety Disorder Assessment-7 (GAD-7) (n=57), were examined to evaluate the effectiveness of Wysa in providing support for mental health concerns among those managing chronic pain. Results: The themes emerging from the conversations of users with chronic pain included health concerns, socioeconomic concerns, and pain management concerns. Findings from the quantitative analysis indicated that users with chronic pain showed significantly greater app engagement (P<.001) than users without chronic pain, with a large effect size (Vargha and Delaney A=0.76-0.80). Furthermore, users with pre-post assessments during the study period were found to have significant improvements in group means for both PHQ-9 and GAD-7 symptom scores, with a medium effect size (Cohen d=0.60-0.61). Conclusions: The findings indicate that users look for tools that can help them address their concerns related to mental health, pain management, and sleep issues. The study findings also indicate the breadth of the needs of users with chronic pain and the lack of support structures, and suggest that Wysa can provide effective support to bridge the gap. UR - https://humanfactors.jmir.org/2022/2/e35671 UR - http://dx.doi.org/10.2196/35671 UR - http://www.ncbi.nlm.nih.gov/pubmed/35314422 ID - info:doi/10.2196/35671 ER - TY - JOUR AU - Hammond, M. Michael AU - Zhang, Yuankai AU - Pathiravasan, H. Chathurangi AU - Lin, Honghuang AU - Sardana, Mayank AU - Trinquart, Ludovic AU - Benjamin, J. Emelia AU - Borrelli, Belinda AU - Manders, S. Emily AU - Fusco, Kelsey AU - Kornej, Jelena AU - Spartano, L. Nicole AU - Kheterpal, Vik AU - Nowak, Christopher AU - McManus, D. David AU - Liu, Chunyu AU - Murabito, M. Joanne PY - 2022/4/27 TI - Relations Between BMI Trajectories and Habitual Physical Activity Measured by a Smartwatch in the Electronic Cohort of the Framingham Heart Study: Cohort Study JO - JMIR Cardio SP - e32348 VL - 6 IS - 1 KW - mobile health KW - BMI KW - smartwatch KW - physical activity KW - cardiovascular diseases KW - cardiology KW - digital health KW - mHealth KW - mobile health apps N2 - Background: The prevalence of obesity is rising. Most previous studies that examined the relations between BMI and physical activity (PA) measured BMI at a single timepoint. The association between BMI trajectories and habitual PA remains unclear. Objective: This study assesses the relations between BMI trajectories and habitual step-based PA among participants enrolled in the electronic cohort of the Framingham Heart Study (eFHS). Methods: We used a semiparametric group-based modeling to identify BMI trajectories from eFHS participants who attended research examinations at the Framingham Research Center over 14 years. Daily steps were recorded from the smartwatch provided at examination 3. We excluded participants with <30 days or <5 hours of smartwatch wear data. We used generalized linear models to examine the association between BMI trajectories and daily step counts. Results: We identified 3 trajectory groups for the 837 eFHS participants (mean age 53 years; 57.8% [484/837] female). Group 1 included 292 participants whose BMI was stable (slope 0.005; P=.75), group 2 included 468 participants whose BMI increased slightly (slope 0.123; P<.001), and group 3 included 77 participants whose BMI increased greatly (slope 0.318; P<.001). The median follow-up period for step count was 516 days. Adjusting for age, sex, wear time, and cohort, participants in groups 2 and 3 took 422 (95% CI ?823 to ?21) and 1437 (95% CI ?2084 to ?790) fewer average daily steps, compared with participants in group 1. After adjusting for metabolic and social risk factors, group 2 took 382 (95% CI ?773 to 10) and group 3 took 1120 (95% CI ?1766 to ?475) fewer steps, compared with group 1. Conclusions: In this community-based eFHS, participants whose BMI trajectory increased greatly over time took significantly fewer steps, compared with participants with stable BMI trajectories. Our findings suggest that greater weight gain may correlate with lower levels of step-based physical activity. UR - https://cardio.jmir.org/2022/1/e32348 UR - http://dx.doi.org/10.2196/32348 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476038 ID - info:doi/10.2196/32348 ER - TY - JOUR AU - Amagai, Saki AU - Pila, Sarah AU - Kaat, J. Aaron AU - Nowinski, J. Cindy AU - Gershon, C. Richard PY - 2022/4/26 TI - Challenges in Participant Engagement and Retention Using Mobile Health Apps: Literature Review JO - J Med Internet Res SP - e35120 VL - 24 IS - 4 KW - mobile phone KW - mHealth KW - retention KW - engagement N2 - Background: Mobile health (mHealth) apps are revolutionizing the way clinicians and researchers monitor and manage the health of their participants. However, many studies using mHealth apps are hampered by substantial participant dropout or attrition, which may impact the representativeness of the sample and the effectiveness of the study. Therefore, it is imperative for researchers to understand what makes participants stay with mHealth apps or studies using mHealth apps. Objective: This study aimed to review the current peer-reviewed research literature to identify the notable factors and strategies used in adult participant engagement and retention. Methods: We conducted a systematic search of PubMed, MEDLINE, and PsycINFO databases for mHealth studies that evaluated and assessed issues or strategies to improve the engagement and retention of adults from 2015 to 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Notable themes were identified and narratively compared among different studies. A binomial regression model was generated to examine the factors affecting retention. Results: Of the 389 identified studies, 62 (15.9%) were included in this review. Overall, most studies were partially successful in maintaining participant engagement. Factors related to particular elements of the app (eg, feedback, appropriate reminders, and in-app support from peers or coaches) and research strategies (eg, compensation and niche samples) that promote retention were identified. Factors that obstructed retention were also identified (eg, lack of support features, technical difficulties, and usefulness of the app). The regression model results showed that a participant is more likely to drop out than to be retained. Conclusions: Retaining participants is an omnipresent challenge in mHealth studies. The insights from this review can help inform future studies about the factors and strategies to improve participant retention. UR - https://www.jmir.org/2022/4/e35120 UR - http://dx.doi.org/10.2196/35120 UR - http://www.ncbi.nlm.nih.gov/pubmed/35471414 ID - info:doi/10.2196/35120 ER - TY - JOUR AU - Thiel, Bram AU - Iao, Inez AU - Smid, Joris AU - de Wit, Emmy AU - Koopman, Seppe AU - Geerts, Bart AU - Godfried, Marc AU - Kalkman, Cor PY - 2022/4/26 TI - Adoption of a Postoperative Pain Self-Report Tool: Qualitative Study JO - JMIR Hum Factors SP - e33706 VL - 9 IS - 2 KW - innovation KW - eHealth adoption model, mobile health KW - pain KW - self-report KW - perioperative medicine KW - postoperative pain KW - surgery N2 - Background: With electronic technologies, patients are provided with tools to easily acquire information and to manage and record their own health status. eHealth interventions are already broadly applied to perioperative care. In a similar way, we aimed to utilize a smartphone application to enable postoperative patients to partially self-manage their postoperative pain. The results of a previously performed proof-of-concept study regarding the application were promising, and nurses as well as patients were optimistic regarding this innovative mobile application. Nevertheless, in reality, it appears that the usage and overall implementation of this application have stagnated since its introduction. Problems with innovation adoption are not novel; various studies have been conducted to explore the reasons for low implementation success of eHealth applications and indicated that adoption is influenced by multiple organizational factors. This study investigated the influence of these organizational factors on the adoption process, aiming to provide more insight in the dos and don?ts for implementing eHealth in the working processes of hospital care. Objective: This study aimed to provide insight in how to successfully implement a technological eHealth innovation in a general nonacademic hospital. Methods: A qualitative study was conducted to explore organizational factors affecting the innovation adoption process. Data were collected by conducting semistructured one-on-one interviews with 11 stakeholders. The data were analyzed using thematic analysis identifying overarching themes. Results: Absorptive capacity, referred to as an organization?s dynamic capability pertaining to knowledge creation and utilization that enhances an organization?s ability to gain and sustain a competitive advantage, was regarded as the most influential factor on the application?s adoption. Accordingly, it appeared that innovation adoption is mainly determined by the capability and willingness to assimilate and transform new information into productive use and the ability to absorb a novel innovation. Absorptive capacity was found to be influenced by the innovation?s benefit and the sense of ownership and responsibility. Organizational readiness and management support were also regarded as essential since absorptive capacity seemed to be mediated by these factors. The size of the hospital influenced eHealth adoption by the amount of resources available and by its organizational structure. Conclusions: In conclusion, absorptive capacity is essential for eHealth adoption, and it is mediated by management support and organizational readiness. It is recommended to increase the degree of willingness and ability to adopt an eHealth innovation by enhancing the relevance, engaging stakeholders, and assigning appropriate leaders to offer guidance. UR - https://humanfactors.jmir.org/2022/2/e33706 UR - http://dx.doi.org/10.2196/33706 UR - http://www.ncbi.nlm.nih.gov/pubmed/35471472 ID - info:doi/10.2196/33706 ER - TY - JOUR AU - Zenun Franco, Rodrigo AU - Fallaize, Rosalind AU - Weech, Michelle AU - Hwang, Faustina AU - Lovegrove, A. Julie PY - 2022/4/25 TI - Effectiveness of Web-Based Personalized Nutrition Advice for Adults Using the eNutri Web App: Evidence From the EatWellUK Randomized Controlled Trial JO - J Med Internet Res SP - e29088 VL - 24 IS - 4 KW - personalized nutrition KW - web-based KW - nutrition app KW - app KW - dietary intervention KW - eNutri KW - precision nutrition KW - mHealth KW - healthy eating index KW - diet quality scores KW - FFQ KW - food frequency questionnaire KW - EatWellUK N2 - Background: Evidence suggests that eating behaviors and adherence to dietary guidelines can be improved using nutrition-related apps. Apps delivering personalized nutrition (PN) advice to users can provide individual support at scale with relatively low cost. Objective: This study aims to investigate the effectiveness of a mobile web app (eNutri) that delivers automated PN advice for improving diet quality, relative to general population food-based dietary guidelines. Methods: Nondiseased UK adults (aged >18 years) were randomized to PN advice or control advice (population-based healthy eating guidelines) in a 12-week controlled, parallel, single-blinded dietary intervention, which was delivered on the web. Dietary intake was assessed using the eNutri Food Frequency Questionnaire (FFQ). An 11-item US modified Alternative Healthy Eating Index (m-AHEI), which aligned with UK dietary and nutritional recommendations, was used to derive the automated PN advice. The primary outcome was a change in diet quality (m-AHEI) at 12 weeks. Participant surveys evaluated the PN report (week 12) and longer-term impact of the PN advice (mean 5.9, SD 0.65 months, after completion of the study). Results: Following the baseline FFQ, 210 participants completed at least 1 additional FFQ, and 23 outliers were excluded for unfeasible dietary intakes. The mean interval between FFQs was 10.8 weeks. A total of 96 participants were included in the PN group (mean age 43.5, SD 15.9 years; mean BMI 24.8, SD 4.4 kg/m2) and 91 in the control group (mean age 42.8, SD 14.0 years; mean BMI 24.2, SD 4.4 kg/m2). Compared with that in the control group, the overall m-AHEI score increased by 3.5 out of 100 (95% CI 1.19-5.78) in the PN group, which was equivalent to an increase of 6.1% (P=.003). Specifically, the m-AHEI components nuts and legumes and red and processed meat showed significant improvements in the PN group (P=.04). At follow-up, 64% (27/42) of PN participants agreed that, compared with baseline, they were still following some (any) of the advice received and 31% (13/42) were still motivated to improve their diet. Conclusions: These findings suggest that the eNutri app is an effective web-based tool for the automated delivery of PN advice. Furthermore, eNutri was demonstrated to improve short-term diet quality and increase engagement in healthy eating behaviors in UK adults, as compared with population-based healthy eating guidelines. This work represents an important landmark in the field of automatically delivered web-based personalized dietary interventions. Trial Registration: ClinicalTrials.gov NCT03250858; https://clinicaltrials.gov/ct2/show/NCT03250858 UR - https://www.jmir.org/2022/4/e29088 UR - http://dx.doi.org/10.2196/29088 UR - http://www.ncbi.nlm.nih.gov/pubmed/35468093 ID - info:doi/10.2196/29088 ER - TY - JOUR AU - Vega, Julio AU - Bell, T. Beth AU - Taylor, Caitlin AU - Xie, Jue AU - Ng, Heidi AU - Honary, Mahsa AU - McNaney, Roisin PY - 2022/4/25 TI - Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating JO - JMIR Ment Health SP - e32146 VL - 9 IS - 4 KW - eating disorder KW - binge eating KW - mental health KW - mobile sensing KW - context-aware computing KW - NAP KW - EMA KW - mobile phone N2 - Background: Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting). Objective: The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions. Methods: This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38% binge eating and n=5, 63% comparisons) consented. Results: The findings showed unique differences in the types of sensor data that were triangulated with the individuals? episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants? awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet. Conclusions: This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population. UR - https://mental.jmir.org/2022/4/e32146 UR - http://dx.doi.org/10.2196/32146 UR - http://www.ncbi.nlm.nih.gov/pubmed/35086064 ID - info:doi/10.2196/32146 ER - TY - JOUR AU - Adams, T. Alexander AU - Mandel, Ilan AU - Gao, Yixuan AU - Heckman, W. Bryan AU - Nandakumar, Rajalakshmi AU - Choudhury, Tanzeem PY - 2022/4/22 TI - Equity-Driven Sensing System for Measuring Skin Tone?Calibrated Peripheral Blood Oxygen Saturation (OptoBeat): Development, Design, and Evaluation Study JO - JMIR Biomed Eng SP - e34934 VL - 7 IS - 1 KW - mobile health KW - ubiquitous health KW - health equity KW - bias KW - pulse oximetry KW - oximetry KW - mHealth KW - health app KW - skin tone KW - oximeter KW - smartphone KW - sensor KW - heart rate KW - oxygen level KW - oxygen saturation KW - pulse KW - mobile phone N2 - Background: Many commodity pulse oximeters are insufficiently calibrated for patients with darker skin. We demonstrate a quantitative measurement of this disparity in peripheral blood oxygen saturation (SpO2) with a controlled experiment. To mitigate this, we present OptoBeat, an ultra?low-cost smartphone-based optical sensing system that captures SpO2 and heart rate while calibrating for differences in skin tone. Our sensing system can be constructed from commodity components and 3D-printed clips for approximately US $1. In our experiments, we demonstrate the efficacy of the OptoBeat system, which can measure SpO2 within 1% of the ground truth in levels as low as 75%. Objective: The objective of this work is to test the following hypotheses and implement an ultra?low-cost smartphone adapter to measure SpO2: skin tone has a significant effect on pulse oximeter measurements (hypothesis 1), images of skin tone can be used to calibrate pulse oximeter error (hypothesis 2), and SpO2 can be measured with a smartphone camera using the screen as a light source (hypothesis 3). Methods: Synthetic skin with the same optical properties as human skin was used in ex vivo experiments. A skin tone scale was placed in images for calibration and ground truth. To achieve a wide range of SpO2 for measurement, we reoxygenated sheep blood and pumped it through synthetic arteries. A custom optical system was connected from the smartphone screen (flashing red and blue) to the analyte and into the phone?s camera for measurement. Results: The 3 skin tones were accurately classified according to the Fitzpatrick scale as types 2, 3, and 5. Classification was performed using the Euclidean distance between the measured red, green, and blue values. Traditional pulse oximeter measurements (n=2000) showed significant differences between skin tones in both alternating current and direct current measurements using ANOVA (direct current: F2,5997=3.1170 × 105, P<.01; alternating current: F2,5997=8.07 × 106, P<.01). Continuous SpO2 measurements (n=400; 10-second samples, 67 minutes total) from 95% to 75% were captured using OptoBeat in an ex vivo experiment. The accuracy was measured to be within 1% of the ground truth via quadratic support vector machine regression and 10-fold cross-validation (R2=0.97, root mean square error=0.7, mean square error=0.49, and mean absolute error=0.5). In the human-participant proof-of-concept experiment (N=3; samples=3 × N, duration=20-30 seconds per sample), SpO2 measurements were accurate to within 0.5% of the ground truth, and pulse rate measurements were accurate to within 1.7% of the ground truth. Conclusions: In this work, we demonstrate that skin tone has a significant effect on SpO2 measurements and the design and evaluation of OptoBeat. The ultra-low-cost OptoBeat system enables smartphones to classify skin tone for calibration, reliably measure SpO2 as low as 75%, and normalize to avoid skin tone?based bias. UR - https://biomedeng.jmir.org/2022/1/e34934 UR - http://dx.doi.org/10.2196/34934 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875699 ID - info:doi/10.2196/34934 ER - TY - JOUR AU - Broetje, Sylvia AU - Bauer, F. Georg AU - Jenny, J. Gregor PY - 2022/4/22 TI - Acceptance of an Internet-Based Team Development Tool Aimed at Improving Work-Related Well-being in Nurses: Cross-sectional Study JO - JMIR Nursing SP - e36702 VL - 5 IS - 1 KW - digital intervention KW - eHealth KW - nurses KW - online intervention KW - organizational health KW - technology acceptance KW - UTAUT KW - workplace health promotion KW - mHealth N2 - Background: Workplace health interventions can produce beneficial health- and business-related outcomes. However, such interventions have traditionally focused on lifestyle behaviors of individuals, mostly not considering the role of working conditions. The wecoach intervention is an internet-based tool that combines both a digital and a participatory team development approach aimed at addressing critical job demands and resources as key aspects of health-promoting working conditions. Nursing staff are particularly affected by challenging working conditions and could potentially benefit greatly. Understanding the acceptance of novel workplace health promotion approaches is a critical precursor to their successful implementation and use. Objective: This study aims to examine the factors influencing the acceptance of a digitally supported team development tool among nurse managers. Methods: A sample of 32 nurse managers from 3 German-speaking countries tested wecoach and completed our online questionnaire. Hypotheses were based on the unified theory of acceptance and use of technology (UTAUT) and the organizational health development (OHD) model and were tested using multiple regression analyses. Results: Our analyses found that merely capacities on the team level (CapTeam) significantly contributed to the acceptance of wecoach, although only after the other variables were excluded in the stepwise multiple regression analysis. The UTAUT predictors were unable to add significant variance explanation beyond that, and their inclusion masked the contribution of CapTeam. Conclusions: For the acceptance of a digitally supported participatory tool, the fit with the team, its culture, and its motivation are of critical importance, while aspects proposed by traditional acceptance models, such as the UTAUT, may not be applicable. UR - https://nursing.jmir.org/2022/1/e36702 UR - http://dx.doi.org/10.2196/36702 UR - http://www.ncbi.nlm.nih.gov/pubmed/35452403 ID - info:doi/10.2196/36702 ER - TY - JOUR AU - Rahman, Obaidur Md AU - Yamaji, Noyuri AU - Nagamatsu, Yasuko AU - Ota, Erika PY - 2022/4/22 TI - Effects of mHealth Interventions on Improving Antenatal Care Visits and Skilled Delivery Care in Low- and Middle-Income Countries: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e34061 VL - 24 IS - 4 KW - mobile health KW - ANC KW - skilled delivery care KW - LMICs KW - systematic review and meta-analysis N2 - Background: The poor coverage of essential maternal services, such as antenatal care (ANC) and skilled delivery care utilization, accounts for higher maternal and infant mortality in low- and middle-income countries (LMICs). Although mobile health (mHealth) interventions could potentially improve the service utilization in resource-limited settings, their effectiveness remains unclear. Objective: This review aimed to summarize the effect of mHealth interventions on improving the uptake of ANC visits, skilled birth attendance at the time of delivery, and facility delivery among pregnant women in LMICs. Methods: We conducted a comprehensive search on 9 electronic databases and other resources from inception to October 2020. We included individual randomized controlled trials and cluster randomized controlled trials that assessed the effectiveness of mHealth interventions for improving perinatal health care utilization among healthy pregnant women in LMICs. We performed a random-effects meta-analysis and estimated the pooled effect size by using risk ratios (RRs) with 95% CIs. In addition, 2 reviewers independently assessed the risk of bias of the included studies by using the Cochrane risk of bias tool and the certainty of the evidence by using the Grading of Recommendation, Assessment, Development and Evaluation approach. Results: A total of 9 studies (10 articles) that randomized 10,348 pregnant women (n=6254, 60.44% in the intervention group; n=4094, 39.56% in the control group) were included in this synthesis. The pooled estimates showed a positive effect of mHealth interventions on improving 4 or more ANC visit utilizations among pregnant women in LMICs, irrespective of the direction of interventions (1-way communications: RR 2.14, 95% CI 1.76-2.60, I2=36%, 2 studies, moderate certainty; 2-way communications: RR 1.17, 95% CI 1.08-1.27, I2=59%, 3 studies, low certainty). Only 2-way mHealth interventions were effective in improving the use of skilled birth attendance during delivery (RR 1.23, 95% CI 1.14-1.33, I2=0%, 2 studies, moderate certainty), but the effects were unclear for 1-way mHealth interventions (RR 1.04, 95% CI 0.97-1.10, I2=73%, 3 studies, very low certainty) when compared with standard care. For facility delivery, the interventions were effective in settings where fewer pregnant women used facility delivery (RR 1.68, 95% CI 1.30-2.19, I2=36%, 2 studies, moderate certainty); however, the effects were unclear in settings where most pregnant women already used facility delivery (RR 1.01, 95% CI 0.97-1.04, I2=0%, 1 study, low certainty). Conclusions: mHealth interventions may contribute to improving ANC and skilled delivery care utilization among pregnant women in LMICs. However, more studies are required to improve their reproducibility and efficiency or strengthen the evidence of different forms of mHealth interventions because of the considerable heterogeneity observed in the meta-analyses. Trial Registration: PROSPERO CRD42020210813; https://tinyurl.com/2n7ny9a7 UR - https://www.jmir.org/2022/4/e34061 UR - http://dx.doi.org/10.2196/34061 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451987 ID - info:doi/10.2196/34061 ER - TY - JOUR AU - McBeth, John AU - Dixon, G. William AU - Moore, Mary Susan AU - Hellman, Bruce AU - James, Ben AU - Kyle, D. Simon AU - Lunt, Mark AU - Cordingley, Lis AU - Yimer, Birlie Belay AU - Druce, L. Katie PY - 2022/4/22 TI - Sleep Disturbance and Quality of Life in Rheumatoid Arthritis: Prospective mHealth Study JO - J Med Internet Res SP - e32825 VL - 24 IS - 4 KW - mobile health KW - sleep KW - rheumatoid arthritis KW - pain KW - fatigue KW - mood KW - sleep disturbance KW - HRQoL KW - quality of life KW - health-related quality of life KW - QoL KW - sleep efficiency KW - WHOQoL-BREF KW - mobile phone N2 - Background: Sleep disturbances and poor health-related quality of life (HRQoL) are common in people with rheumatoid arthritis (RA). Sleep disturbances, such as less total sleep time, more waking periods after sleep onset, and higher levels of nonrestorative sleep, may be a driver of HRQoL. However, understanding whether these sleep disturbances reduce HRQoL has, to date, been challenging because of the need to collect complex time-varying data at high resolution. Such data collection is now made possible by the widespread availability and use of mobile health (mHealth) technologies. Objective: This mHealth study aimed to test whether sleep disturbance (both absolute values and variability) causes poor HRQoL. Methods: The quality of life, sleep, and RA study was a prospective mHealth study of adults with RA. Participants completed a baseline questionnaire, wore a triaxial accelerometer for 30 days to objectively assess sleep, and provided daily reports via a smartphone app that assessed sleep (Consensus Sleep Diary), pain, fatigue, mood, and other symptoms. Participants completed the World Health Organization Quality of Life-Brief (WHOQoL-BREF) questionnaire every 10 days. Multilevel modeling tested the relationship between sleep variables and the WHOQoL-BREF domains (physical, psychological, environmental, and social). Results: Of the 268 recruited participants, 254 were included in the analysis. Across all WHOQoL-BREF domains, participants? scores were lower than the population average. Consensus Sleep Diary sleep parameters predicted the WHOQoL-BREF domain scores. For example, for each hour increase in the total time asleep physical domain scores increased by 1.11 points (?=1.11, 95% CI 0.07-2.15) and social domain scores increased by 1.65 points. These associations were not explained by sociodemographic and lifestyle factors, disease activity, medication use, anxiety levels, sleep quality, or clinical sleep disorders. However, these changes were attenuated and no longer significant when pain, fatigue, and mood were included in the model. Increased variability in total time asleep was associated with poorer physical and psychological domain scores, independent of all covariates. There was no association between actigraphy-measured sleep and WHOQoL-BREF. Conclusions: Optimizing total sleep time, increasing sleep efficiency, decreasing sleep onset latency, and reducing variability in total sleep time could improve HRQoL in people with RA. UR - https://www.jmir.org/2022/4/e32825 UR - http://dx.doi.org/10.2196/32825 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451978 ID - info:doi/10.2196/32825 ER - TY - JOUR AU - Turmaine, Kathleen AU - Dumas, Agnès AU - Chevreul, Karine AU - PY - 2022/4/22 TI - Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis JO - J Med Internet Res SP - e30218 VL - 24 IS - 4 KW - eHealth KW - internet-based intervention KW - community participation KW - health promotion KW - prevention KW - mental health N2 - Background: For over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation. Objective: To understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool. Methods: The study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool. Results: Three distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context. Conclusions: These findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04464-2 UR - https://www.jmir.org/2022/4/e30218 UR - http://dx.doi.org/10.2196/30218 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451977 ID - info:doi/10.2196/30218 ER - TY - JOUR AU - Hodges, Jacqueline AU - Caldwell, Sylvia AU - Cohn, Wendy AU - Flickinger, Tabor AU - Waldman, Lena Ava AU - Dillingham, Rebecca AU - Castel, Amanda AU - Ingersoll, Karen PY - 2022/4/22 TI - Evaluation of the Implementation and Effectiveness of a Mobile Health Intervention to Improve Outcomes for People With HIV in the Washington, DC Cohort: Study Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e37748 VL - 11 IS - 4 KW - human immunodeficiency virus KW - HIV KW - mobile health KW - mHealth KW - implementation science KW - cluster randomized controlled trial KW - smartphone N2 - Background: Gaps remain in achieving retention in care and durable HIV viral load suppression for people with HIV in Washington, DC (hereafter DC). Although people with HIV seeking care in DC have access to a range of supportive services, innovative strategies are needed to enhance patient engagement in this setting. Mobile health (mHealth) interventions have shown promise in reaching previously underengaged groups and improving HIV-related outcomes in various settings. Objective: This study will evaluate the implementation and effectiveness of a clinic-deployed, multifeature mHealth intervention called PositiveLinks (PL) among people with HIV enrolled in the DC Cohort, a longitudinal cohort of people with HIV receiving care in DC. A cluster randomized controlled trial will be conducted using a hybrid effectiveness-implementation design and will compare HIV-related outcomes between clinics randomized to PL versus usual care. Methods: The study aims are threefold: (1) We will perform a formative evaluation of PL in the context of DC Cohort clinics to test the feasibility, acceptability, and usability of PL and tailor the platform for use in this context. (2) We will conduct a cluster randomized controlled trial with 12 DC Cohort clinics randomized to PL or usual care (n=6 [50%] per arm) and measure the effectiveness of PL by the primary outcomes of patient visit constancy, retention in care, and HIV viral load suppression. We aim to enroll a total of 482 participants from DC Cohort clinic sites, specifically including people with HIV who show evidence of inconsistent retention in care or lack of viral suppression. (3) We will use the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to measure implementation success and identify site, patient, provider, and system factors associated with successful implementation. Evaluation activities will occur pre-, mid-, and postimplementation. Results: Formative data collection was completed between April 2021 and January 2022. Preliminary mHealth platform modifications have been performed, and the first round of user testing has been completed. A preimplementation evaluation was performed to identify relevant implementation outcomes and design a suite of instruments to guide data collection for evaluation of PL implementation throughout the trial period. Instruments include those already developed to support DC Cohort Study activities and PL implementation in other cohorts, which required modification for use in the study, as well as novel instruments designed to complete data collection, as guided by the CFIR and RE-AIM frameworks. Conclusions: Formative and preimplementation evaluations will be completed in spring 2022 when the trial is planned to launch. Specifically, comprehensive formative data analysis will be completed following data collection, coding, preliminary review, and synthesis. Corresponding platform modifications are ready for beta testing within the DC Cohort. Finalization of the platform for use in the trial will follow beta testing. Trial Registration: ClinicalTrials.gov NCT04998019; https://clinicaltrials.gov/ct2/show/NCT04998019 International Registered Report Identifier (IRRID): PRR1-10.2196/37748 UR - https://www.researchprotocols.org/2022/4/e37748 UR - http://dx.doi.org/10.2196/37748 UR - http://www.ncbi.nlm.nih.gov/pubmed/35349466 ID - info:doi/10.2196/37748 ER - TY - JOUR AU - Puthusseryppady, Vaisakh AU - Morrissey, Sol AU - Aung, Hane Min AU - Coughlan, Gillian AU - Patel, Martyn AU - Hornberger, Michael PY - 2022/4/21 TI - Using GPS Tracking to Investigate Outdoor Navigation Patterns in Patients With Alzheimer Disease: Cross-sectional Study JO - JMIR Aging SP - e28222 VL - 5 IS - 2 KW - Alzheimer disease KW - dementia KW - spatial disorientation KW - getting lost KW - outdoor navigation KW - risk factors KW - environmental KW - GPS tracking KW - community KW - mobile phone N2 - Background: Spatial disorientation is one of the earliest and most distressing symptoms seen in patients with Alzheimer disease (AD) and can lead to them getting lost in the community. Although it is a prevalent problem worldwide and is associated with various negative consequences, very little is known about the extent to which outdoor navigation patterns of patients with AD explain why spatial disorientation occurs for them even in familiar surroundings. Objective: This study aims to understand the outdoor navigation patterns of patients with AD in different conditions (alone vs accompanied; disoriented vs not disoriented during the study) and investigate whether patients with AD experienced spatial disorientation when navigating through environments with a high outdoor landmark density and complex road network structure (road intersection density, intersection complexity, and orientation entropy). Methods: We investigated the outdoor navigation patterns of community-dwelling patients with AD (n=15) and age-matched healthy controls (n=18) over a 2-week period using GPS tracking and trajectory mining analytical techniques. Here, for the patients, the occurrence of any spatial disorientation behavior during this tracking period was recorded. We also used a spatial buffer methodology to capture the outdoor landmark density and features of the road network in the environments that the participants visited during the tracking period. Results: The patients with AD had outdoor navigation patterns similar to those of the controls when they were accompanied; however, when they were alone, they had significantly fewer outings per day (total outings: P<.001; day outings: P=.003; night outings: P<.001), lower time spent moving per outing (P=.001), lower total distance covered per outing (P=.009), lower walking distance per outing (P=.02), and lower mean distance from home per outing (P=.004). Our results did not identify any mobility risk factors for spatial disorientation. We also found that the environments visited by patients who experienced disorientation versus those who maintained their orientation during the tracking period did not significantly differ in outdoor landmark density (P=.60) or road network structure (road intersection density: P=.43; intersection complexity: P=.45; orientation entropy: P=.89). Conclusions: Our findings suggest that when alone, patients with AD restrict the spatial and temporal extent of their outdoor navigation in the community to successfully reduce their perceived risk of spatial disorientation. Implications of this work highlight the importance for future research to identify which of these individuals may be at an actual high risk for spatial disorientation as well as to explore the implementation of health care measures to help maintain a balance between patients? right to safety and autonomy when making outings alone in the community. UR - https://aging.jmir.org/2022/2/e28222 UR - http://dx.doi.org/10.2196/28222 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451965 ID - info:doi/10.2196/28222 ER - TY - JOUR AU - Kavanagh, E. Meaghan AU - Chiavaroli, Laura AU - Glenn, J. Andrea AU - Heijmans, Genevieve AU - Grant, M. Shannan AU - Chow, Chi-Ming AU - Josse, G. Robert AU - Malik, S. Vasanti AU - Watson, William AU - Lofters, Aisha AU - Holmes, Candice AU - Rackal, Julia AU - Srichaikul, Kristie AU - Sherifali, Diana AU - Snelgrove-Clarke, Erna AU - Udell, A. Jacob AU - Juni, Peter AU - Booth, L. Gillian AU - Farkouh, E. Michael AU - Leiter, A. Lawrence AU - Kendall, C. Cyril W. AU - Jenkins, A. David J. AU - Sievenpiper, L. John PY - 2022/4/21 TI - A Web-Based Health Application to Translate Nutrition Therapy for Cardiovascular Risk Reduction in Primary Care (PortfolioDiet.app): Quality Improvement and Usability Testing Study JO - JMIR Hum Factors SP - e34704 VL - 9 IS - 2 KW - portfolio diet KW - dietary portfolio KW - nutrition therapy KW - dietary application KW - eHealth KW - usability testing KW - quality improvement KW - mobile phone N2 - Background: The Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for PCs and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure that the PortfolioDiet.app meets the needs of its target end users. Objective: The main objective of this project is to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). Methods: We undertook a 2-phase QI project from February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, and dietitians, as well as nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for 7 days. In phase 1, a mixed-form questionnaire was administered to evaluate the users? perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative and qualitative data, including 2 open-ended questions. The responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale was used to assess the usability of the updated PortfolioDiet.app, with a score higher than 70 being considered acceptable. Results: A total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users? perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed-logout frustration, request for step-by-step pop-up windows, and request for a mobile app version; when looking at positive feedback, the recipe section was the most commonly praised feature. Between the project phases, 6 modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average System Usability Scale score was 85.39 (SD 11.47), with 100 being the best possible. Conclusions: By undertaking user testing of the PortfolioDiet.app, its limitations and strengths were able to be identified, informing modifications to the application, which resulted in a clinical tool that better meets users? needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. Although further refinements to the PortfolioDiet.app will continue to be made before its evaluation in a clinical trial, the result of this QI project is an improved clinical tool. UR - https://humanfactors.jmir.org/2022/2/e34704 UR - http://dx.doi.org/10.2196/34704 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451981 ID - info:doi/10.2196/34704 ER - TY - JOUR AU - Giebel, Denk Godwin AU - Speckemeier, Christian AU - Abels, Carina AU - Börchers, Kirstin AU - Wasem, Jürgen AU - Blase, Nikola AU - Neusser, Silke PY - 2022/4/21 TI - Problems and Barriers Related to the Use of Digital Health Applications: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e32702 VL - 11 IS - 4 KW - digital health application KW - DHA KW - mHealth, problems, barriers, scoping review KW - mobile health KW - health insurance KW - electronic database KW - health database KW - mHealth app N2 - Background: The use of mobile health (mHealth) apps is increasing rapidly worldwide. More and more institutions and organizations develop regulations and guidelines to enable an evidence-based and safe use. In Germany, mHealth apps fulfilling predefined criteria (Digitale Gesundheitsanwendungen [DiGA]) can be prescribed and are reimbursable by the German statutory health insurance scheme. Due to the increasing distribution of DiGA, problems and barriers should receive special attention. Objective: This study aims to identify the relevant problems and barriers related to the use of mHealth apps fulfilling the criteria of DiGA. Methods: This scoping review will follow published methodological frameworks and the PRISMA-Scr (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews) criteria. Electronic databases (MEDLINE, EMBASE, PsycINFO, and JMIR), reference lists of relevant articles, and grey literature sources will be searched. Two reviewers will assess the eligibility of the articles by a two-stage (title and abstract as well as full text) screening process. Only problems and barriers related to mHealth apps fulfilling the criteria of DiGA are included for this research. The identified studies will be categorized and analyzed with MAXQDA. Results: This scoping review gives an overview of the available evidence and identifies research gaps regarding problems and barriers related to DiGA. The results are planned to be submitted to an indexed, peer-reviewed journal in the first quarter of 2022. Conclusions: This is the first review to identify the problems and barriers related to the use of mHealth apps fulfilling the German definition of DiGA. Nevertheless, the findings can be applied to other contexts and health care systems as well. International Registered Report Identifier (IRRID): DERR1-10.2196/32702 UR - https://www.researchprotocols.org/2022/4/e32702 UR - http://dx.doi.org/10.2196/32702 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451979 ID - info:doi/10.2196/32702 ER - TY - JOUR AU - Burda, Václav AU - Mráz, Milo? AU - Schneider, Jakub AU - Novák, Daniel PY - 2022/4/20 TI - Managing Diabetes Using Mobiab: Long-Term Case Study of the Impact of a Mobile App on Self-management JO - JMIR Diabetes SP - e36675 VL - 7 IS - 2 KW - diabetes mellitus KW - self-management KW - mobile app KW - case study KW - long-term data N2 - Background: This paper describes the development of a mobile app for diabetes mellitus (DM) control and self-management and presents the results of long-term usage of this system in the Czech Republic. DM is a chronic disease affecting large numbers of people worldwide, and this number is continuously increasing. There is massive potential to increase adherence to self-management of DM with the use of smartphones and digital therapeutics interventions. Objective: This study aims to describe the process of development of a mobile app, called Mobiab, for DM management and to investigate how individual features are used and how the whole system benefits its long-term users. Using at least 1 year of daily records from users, we analyzed the impact of the app on self-management of DM. Methods: We have developed a mobile app that serves as an alternative form to the classic paper-based protocol or diary. The development was based on cooperation with both clinicians and people with DM. The app consists of independent individual modules. Therefore, the user has the possibility to use only selected features that they find useful. Mobiab was available free of charge on Google Play Store from mid-2014 until 2019. No targeted recruitment was performed to attract users. Results: More than 500 users from the Czech Republic downloaded and signed up for the mobile app. Approximately 80% of the users used Mobiab for less than 1 week. The rest of the users used it for a longer time and 8 of the users produced data that were suitable for long-term analysis. Additionally, one of the 8 users provided their medical records, which were compared with the gathered data, and the improvements in their glucose levels and overall metabolic stability were consistent with the way in which the mobile app was used. Conclusions: The results of this study showed that the usability of a DM-centered self-management smartphone mobile app and server-based systems could be satisfactory and promising. Nonetheless, some better ways of motivating people with diabetes toward participation in self-management are needed. Further studies involving a larger number of participants are warranted to assess the effect on long-term diabetes management. UR - https://diabetes.jmir.org/2022/2/e36675 UR - http://dx.doi.org/10.2196/36675 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442201 ID - info:doi/10.2196/36675 ER - TY - JOUR AU - Bezerra Giordan, Leticia AU - Ronto, Rimante AU - Chau, Josephine AU - Chow, Clara AU - Laranjo, Liliana PY - 2022/4/20 TI - Use of Mobile Apps in Heart Failure Self-management: Qualitative Study Exploring the Patient and Primary Care Clinician Perspective JO - JMIR Cardio SP - e33992 VL - 6 IS - 1 KW - mobile app KW - mHealth KW - heart failure KW - self-management KW - eHealth KW - telehealth N2 - Background: Mobile apps have the potential to support patients with heart failure and facilitate disease self-management, but this area of research is recent and rapidly evolving, with inconsistent results for efficacy. So far, most of the published studies evaluated the feasibility of a specific app or assessed the quality of apps available in app stores. Research is needed to explore patients? and clinicians? perspectives to guide app development, evaluation, and implementation into models of care. Objective: This study aims to explore the patient and primary care clinician perspective on the facilitators and barriers to using mobile apps, as well as desired features, to support heart failure self-management. Methods: This is a qualitative phenomenological study involving face-to-face semistructured interviews. Interviews were conducted in a general practice clinic in Sydney, Australia. Eligible participants were adult patients with heart failure and health care professionals who provided care to these patients at the clinic. Patients did not need to have previous experience using heart failure mobile apps to be eligible for this study. The interviews were audio-recorded, transcribed, and analyzed using inductive thematic data analysis in NVivo 12. Results: A total of 12 participants were interviewed: 6 patients (mean age 69 [SD 7.9] years) and 6 clinicians. The interviews lasted from 25 to 45 minutes. The main facilitators to the use of apps to support heart failure self-management were communication ability, personalized feedback and education, and automated self-monitoring. Patients mentioned that chat-like features and ability to share audio-visual information can be helpful for getting support outside of clinical appointments. Clinicians considered helpful to send motivational messages to patients and ask them about signs and symptoms of heart failure decompensation. Overall, participants highlighted the importance of personalization, particularly in terms of feedback and educational content. Automated self-monitoring with wireless devices was seen to alleviate the burden of tracking measures such as weight and blood pressure. Other desired features included tools to monitor patient-reported outcomes and support patients? mental health and well-being. The main barriers identified were the patients? unwillingness to engage in a new strategy to manage their condition using an app, particularly in the case of low digital literacy. However, clinicians mentioned this barrier could potentially be overcome by introducing the app soon after an exacerbation, when patients might be more willing to improve their self-management and avoid rehospitalization. Conclusions: The use of mobile apps to support heart failure self-management may be facilitated by features that increase the usefulness and utility of the app, such as communication ability in-between consultations and personalized feedback. Also important is facilitating ease of use by supporting automated self-monitoring through integration with wireless devices. Future research should consider these features in the co-design and testing of heart failure mobile apps with patients and clinicians. UR - https://cardio.jmir.org/2022/1/e33992 UR - http://dx.doi.org/10.2196/33992 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442205 ID - info:doi/10.2196/33992 ER - TY - JOUR AU - Miranda, N. Rafael AU - Bhuiya, R. Aunima AU - Thraya, Zak AU - Hancock-Howard, Rebecca AU - Chan, CF Brian AU - Steele Gray, Carolyn AU - Wodchis, P. Walter AU - Thavorn, Kednapa PY - 2022/4/20 TI - An Electronic Patient-Reported Outcomes Tool for Older Adults With Complex Chronic Conditions: Cost-Utility Analysis JO - JMIR Aging SP - e35075 VL - 5 IS - 2 KW - eHealth KW - multimorbidity KW - primary care KW - cost-effectiveness KW - older adult KW - elder KW - cost KW - patient reported outcome KW - community KW - complex care KW - aging KW - Canada KW - North America KW - chronic disease KW - chronic condition KW - decision tree KW - model KW - sensitivity analysis N2 - Background: eHealth technologies for self-management can improve quality of life, but little is known about whether the benefits gained outweigh their costs. The electronic patient-reported outcome (ePRO) mobile app and portal system supports patients with multiple chronic conditions to collaborate with primary health care providers to set and monitor health-related goals. Objective: This study aims to estimate the cost of ePRO and the cost utility of the ePRO intervention compared with usual care provided to patients with multiple chronic conditions and complex needs living in the community, from the perspective of the publicly funded health care payer in Ontario, Canada. Methods: We developed a decision tree model to estimate the incremental cost per quality-adjusted life year (QALY) gained for the ePRO tool versus usual care over a time horizon of 15 months. Resource utilization and effectiveness of the ePRO tool were drawn from a randomized clinical trial with 6 family health teams involving 45 participants. Unit costs associated with health care utilization (adjusted to 2020 Canadian dollars) were drawn from literature and publicly available sources. A series of sensitivity analyses were conducted to assess the robustness of the findings. Results: The total cost of the ePRO tool was CAD $79,467 (~US $ 63,581; CAD $1733 [~US $1386] per person). Compared with standard care, the ePRO intervention was associated with higher costs (CAD $1710 [~US $1368]) and fewer QALYs (?0.03). The findings were consistent with the clinical evidence, suggesting no statistical difference in health-related quality of life between ePRO and usual care groups. However, the tool would be considered a cost-effective option if it could improve by at least 0.03 QALYs. The probability that the ePRO is cost-effective was 17.3% at a willingness-to-pay (WTP) threshold of CAD $50,000 (~US $40,000)/QALY. Conclusions: The ePRO tool is not a cost-effective technology at the commonly used WTP value of CAD $50,000 (~US $40,000)/QALY, but long-term and the societal impacts of ePRO were not included in this analysis. Further research is needed to better understand its impact on long-term outcomes and in real-world settings. The present findings add to the growing evidence about eHealth interventions? capacity to respond to complex aging populations within finite-resourced health systems. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 UR - https://aging.jmir.org/2022/2/e35075 UR - http://dx.doi.org/10.2196/35075 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442194 ID - info:doi/10.2196/35075 ER - TY - JOUR AU - Luo, Xueyan AU - Xu, Wei AU - Ming, Wai-Kit AU - Jiang, Xinchan AU - Yuan, Quan AU - Lai, Han AU - Huang, Chunji AU - Zhong, Xiaoni PY - 2022/4/19 TI - Cost-Effectiveness of Mobile Health?Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis JO - J Med Internet Res SP - e29408 VL - 24 IS - 4 KW - mobile health KW - integrated care KW - ABC pathway KW - atrial fibrillation KW - model-based KW - cost-effectiveness KW - health economic evaluation N2 - Background: Mobile health (mHealth) technology is increasingly used in disease management. Using mHealth tools to integrate and streamline care has improved clinical outcomes of patients with atrial fibrillation (AF). Objective: The aim of this study was to investigate the potential clinical and health economic outcomes of mHealth-based integrated care for AF from the perspective of a public health care provider in China. Methods: A Markov model was designed to compare outcomes of mHealth-based care and usual care in a hypothetical cohort of patients with AF in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to examine the robustness of the base-case results. Results: In the base-case analysis, mHealth-based care gained higher QALYs of 0.0730 with an incurred cost of US $1090. Using US $33,438 per QALY (three times the gross domestic product) as the willingness-to-pay threshold, mHealth-based care was cost-effective, with an ICER of US $14,936 per QALY. In one-way sensitivity analysis, no influential factor with a threshold value was identified. In probabilistic sensitivity analysis, mHealth-based care was accepted as cost-effective in 92.33% of 10,000 iterations. Conclusions: This study assessed the expected cost-effectiveness of applying mHealth-based integrated care for AF according to a model-based health economic evaluation. The exploration suggested the potential cost-effective use of mHealth apps in streamlining and integrating care via the Atrial fibrillation Better Care (ABC) pathway for AF in China. Future economic evaluation alongside randomized clinical trials is highly warranted to verify the suggestion and investigate affecting factors such as geographical variations in patient characteristics, identification of subgroups, and constraints on local implementation. UR - https://www.jmir.org/2022/4/e29408 UR - http://dx.doi.org/10.2196/29408 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438646 ID - info:doi/10.2196/29408 ER - TY - JOUR AU - Powell, Leigh AU - Nizam, Zayan Mohammed AU - Nour, Radwa AU - Zidoun, Youness AU - Sleibi, Randa AU - Kaladhara Warrier, Sreelekshmi AU - Al Suwaidi, Hanan AU - Zary, Nabil PY - 2022/4/19 TI - Conversational Agents in Health Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e31923 VL - 11 IS - 4 KW - conversational agents KW - artificial intelligence chatbots KW - chatbots KW - health education KW - health promotion KW - classification KW - artificial intelligence assistants KW - conversational artificial intelligence N2 - Background: Conversational agents have the ability to reach people through multiple mediums, including the online space, mobile phones, and hardware devices like Alexa and Google Home. Conversational agents provide an engaging method of interaction while making information easier to access. Their emergence into areas related to public health and health education is perhaps unsurprising. While the building of conversational agents is getting more simplified with time, there are still requirements of time and effort. There is also a lack of clarity and consistent terminology regarding what constitutes a conversational agent, how these agents are developed, and the kinds of resources that are needed to develop and sustain them. This lack of clarity creates a daunting task for those seeking to build conversational agents for health education initiatives. Objective: This scoping review aims to identify literature that reports on the design and implementation of conversational agents to promote and educate the public on matters related to health. We will categorize conversational agents in health education in alignment with current classifications and terminology emerging from the marketplace. We will clearly define the variety levels of conversational agents, categorize currently existing agents within these levels, and describe the development models, tools, and resources being used to build conversational agents for health care education purposes. Methods: This scoping review will be conducted by employing the Arksey and O?Malley framework. We will also be adhering to the enhancements and updates proposed by Levac et al and Peters et al. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews will guide the reporting of this scoping review. A systematic search for published and grey literature will be undertaken from the following databases: (1) PubMed, (2) PsychINFO, (3) Embase, (4) Web of Science, (5) SCOPUS, (6) CINAHL, (7) ERIC, (8) MEDLINE, and (9) Google Scholar. Data charting will be done using a structured format. Results: Initial searches of the databases retrieved 1305 results. The results will be presented in the final scoping review in a narrative and illustrative manner. Conclusions: This scoping review will report on conversational agents being used in health education today, and will include categorization of the levels of the agents and report on the kinds of tools, resources, and design and development methods used. International Registered Report Identifier (IRRID): DERR1-10.2196/31923 UR - https://www.researchprotocols.org/2022/4/e31923 UR - http://dx.doi.org/10.2196/31923 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258006 ID - info:doi/10.2196/31923 ER - TY - JOUR AU - Almoallim, Sultan AU - Sas, Corina PY - 2022/4/19 TI - Toward Research-Informed Design Implications for Interventions Limiting Smartphone Use: Functionalities Review of Digital Well-being Apps JO - JMIR Form Res SP - e31730 VL - 6 IS - 4 KW - digital well-being KW - smartphone apps KW - tracking use KW - monitoring against set use limits KW - interventions for limiting use KW - barriers KW - design for friction KW - screen time KW - attention KW - self-regulation KW - mobile phone N2 - Background: Much research in human-computer interaction has focused on well-being and how it can be better supported through a range of technologies, from affective interfaces to mindfulness systems. At the same time, we have seen a growing number of commercial digital well-being apps. However, there has been limited scholarly work reviewing these apps. Objective: This paper aims to report on an autoethnographic study and functionality review of the 39 most popular commercial digital well-being apps on Google Play Store and 17 apps described in academic papers. Methods: From 1250 apps on Google Play Store, we selected 39 (3.12%) digital well-being apps, and from Google Scholar, we identified 17 papers describing academic apps. Both sets of digital well-being apps were analyzed through a review of their functionalities based on their descriptions. The commercial apps were also analyzed through autoethnography, wherein the first author interacted with them to understand how these functionalities work and how they may be experienced by users in their daily lives. Results: Our findings indicate that these apps focus mostly on limiting screen time, and we advanced a richer conversation about such apps, articulating the distinctions among monitoring use, tracking use against set limits, and 4 specific interventions supporting limited use. Conclusions: We conclude with 6 implications for designing digital well-being apps, namely calling to move beyond screen time and support the broader focus of digital well-being; supporting meaningful use rather than limiting meaningless use; leveraging (digital) navigation in design for friction; supporting collaborative interaction to limit phone overuse; supporting explicit, time-based visualizations for monitoring functionality; and supporting the ethical design of digital well-being apps. UR - https://formative.jmir.org/2022/4/e31730 UR - http://dx.doi.org/10.2196/31730 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188897 ID - info:doi/10.2196/31730 ER - TY - JOUR AU - Jones, C. Amanda AU - Grout, Leah AU - Wilson, Nick AU - Nghiem, Nhung AU - Cleghorn, Christine PY - 2022/4/19 TI - The Cost-effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Weight Loss: Updated Modeling Study JO - JMIR Form Res SP - e29291 VL - 6 IS - 4 KW - mass media KW - smartphone apps KW - weight loss KW - cost-effectiveness KW - simulation modeling KW - health equity KW - mobile phone N2 - Background: Evidence suggests that smartphone apps can be effective in the self-management of weight. Given the low cost, broad reach, and apparent effectiveness of weight loss apps, governments may seek to encourage their uptake as a tool to reduce excess weight in the population. Mass media campaigns are 1 mechanism for promoting app use. However, the cost and potential cost-effectiveness are important considerations. Objective: The aim of our study was to use modeling to assess the health impacts, health system costs, cost-effectiveness, and health equity of a mass media campaign to promote high-quality smartphone apps for weight loss in New Zealand. Methods: We used an established proportional multistate life table model that simulates the 2011 New Zealand adult population over the lifetime, subgrouped by age, sex, and ethnicity (M?ori [Indigenous] or non-M?ori). The risk factor was BMI. The model compared business as usual to a one-off mass media campaign intervention, which included the pooled effect size from a recent meta-analysis of smartphone weight loss apps. The resulting impact on BMI and BMI-related diseases was captured through changes in health gain (quality-adjusted life years) and in health system costs. The difference in total health system costs was the net sum of intervention costs and downstream cost offsets because of altered disease rates. An annual discount rate of 3% was applied to health gains and health system costs. Multiple scenarios and sensitivity analyses were conducted, including an equity adjustment. Results: Across the remaining lifetime of the modeled 2011 New Zealand population, the mass media campaign to promote weight loss app use had an estimated overall health gain of 181 (95% uncertainty interval 113-270) quality-adjusted life years and health care costs of ?NZ $606,000 (?US $408,000; 95% uncertainty interval ?NZ $2,540,000 [?US $1,709,000] to NZ $907,000 [US $610,000]). The mean health care costs were negative, representing overall savings to the health system. Across the outcomes examined in this study, the modeled mass media campaign to promote weight loss apps among the general population would be expected to provide higher per capita health gain for M?ori and hence reduce health inequities arising from high BMI, assuming that the intervention would be as effective for M?ori as it is for non-M?ori. Conclusions: A modeled mass media campaign to encourage the adoption of smartphone apps to promote weight loss among the New Zealand adult population is expected to yield an overall gain in health and to be cost-saving to the health system. Although other interventions in the nutrition and physical activity space are even more beneficial to health and produce larger cost savings (eg, fiscal policies and food reformulation), governments may choose to include strategies to promote health app use as complementary measures. UR - https://formative.jmir.org/2022/4/e29291 UR - http://dx.doi.org/10.2196/29291 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438643 ID - info:doi/10.2196/29291 ER - TY - JOUR AU - Kim, Heon Ho AU - Kim, Youngin AU - Michaelides, Andreas AU - Park, Rang Yu PY - 2022/4/15 TI - Weight Loss Trajectories and Related Factors in a 16-Week Mobile Obesity Intervention Program: Retrospective Observational Study JO - J Med Internet Res SP - e29380 VL - 24 IS - 4 KW - clustering KW - mobile health KW - weight loss KW - weight management KW - behavior management KW - time series analysis KW - mHealth KW - obesity KW - outcomes KW - machine learning KW - mobile app KW - adherence KW - prediction KW - mobile phone N2 - Background: In obesity management, whether patients lose ?5% of their initial weight is a critical factor in clinical outcomes. However, evaluations that take only this approach are unable to identify and distinguish between individuals whose weight changes vary and those who steadily lose weight. Evaluation of weight loss considering the volatility of weight changes through a mobile-based intervention for obesity can facilitate understanding of an individual?s behavior and weight changes from a longitudinal perspective. Objective: The aim of this study is to use a machine learning approach to examine weight loss trajectories and explore factors related to behavioral and app use characteristics that induce weight loss. Methods: We used the lifelog data of 13,140 individuals enrolled in a 16-week obesity management program on the health care app Noom in the United States from August 8, 2013, to August 8, 2019. We performed k-means clustering with dynamic time warping to cluster the weight loss time series and inspected the quality of clusters with the total sum of distance within the clusters. To identify use factors determining clustering assignment, we longitudinally compared weekly use statistics with effect size on a weekly basis. Results: The initial average BMI value for the participants was 33.6 (SD 5.9) kg/m2, and it ultimately reached 31.6 (SD 5.7) kg/m2. Using the weight log data, we identified five clusters: cluster 1 (sharp decrease) showed the highest proportion of participants who reduced their weight by >5% (7296/11,295, 64.59%), followed by cluster 2 (moderate decrease). In each comparison between clusters 1 and 3 (yo-yo) and clusters 2 and 3, although the effect size of the difference in average meal record adherence and average weight record adherence was not significant in the first week, it peaked within the initial 8 weeks (Cohen d>0.35) and decreased after that. Conclusions: Using a machine learning approach and clustering shape-based time series similarities, we identified 5 weight loss trajectories in a mobile weight management app. Overall adherence and early adherence related to self-monitoring emerged as potential predictors of these trajectories. UR - https://www.jmir.org/2022/4/e29380 UR - http://dx.doi.org/10.2196/29380 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436211 ID - info:doi/10.2196/29380 ER - TY - JOUR AU - Chua, Valerie AU - Koh, Hean Jin AU - Koh, Gerald Choon Huat AU - Tyagi, Shilpa PY - 2022/4/13 TI - The Willingness to Pay for Telemedicine Among Patients With Chronic Diseases: Systematic Review JO - J Med Internet Res SP - e33372 VL - 24 IS - 4 KW - willingness to pay KW - telemedicine KW - chronic disease KW - patients KW - systematic review KW - mobile phone N2 - Background: Telemedicine is increasingly being leveraged, as the need for remote access to health care has been driven by the rising chronic disease incidence and the COVID-19 pandemic. It is also important to understand patients? willingness to pay (WTP) for telemedicine and the factors contributing toward it, as this knowledge may inform health policy planning processes, such as resource allocation or the development of a pricing strategy for telemedicine services. Currently, most of the published literature is focused on cost-effectiveness analysis findings, which guide health care financing from the health system?s perspective. However, there is limited exploration of the WTP from a patient?s perspective, despite it being pertinent to the sustainability of telemedicine interventions. Objective: To address this gap in research, this study aims to conduct a systematic review to describe the WTP for telemedicine interventions and to identify the factors influencing WTP among patients with chronic diseases in high-income settings. Methods: We systematically searched 4 databases (PubMed, PsycINFO, Embase, and EconLit). A total of 2 authors were involved in the appraisal. Studies were included if they reported the WTP amounts or identified the factors associated with patients? WTP, involved patients aged ?18 years who were diagnosed with chronic diseases, and were from high-income settings. Results: A total of 11 studies from 7 countries met this study?s inclusion criteria. The proportion of people willing to pay for telemedicine ranged from 19% to 70% across the studies, whereas the values for WTP amounts ranged from US $0.89 to US $821.25. We found a statistically significant correlation of age and distance to a preferred health facility with the WTP for telemedicine. Higher age was associated with a lower WTP, whereas longer travel distance was associated with a higher WTP. Conclusions: On the basis of our findings, the following are recommendations that may enhance the WTP: exposure to the telemedicine intervention before assessing the WTP, the lowering of telemedicine costs, and the provision of patient education to raise awareness on telemedicine?s benefits and address patients? concerns. In addition, we recommend that future research be directed at standardizing the reporting of WTP studies with the adoption of a common metric for WTP amounts, which may facilitate the generalization of findings and effect estimates. UR - https://www.jmir.org/2022/4/e33372 UR - http://dx.doi.org/10.2196/33372 UR - http://www.ncbi.nlm.nih.gov/pubmed/35416779 ID - info:doi/10.2196/33372 ER - TY - JOUR AU - Hamberger, Marietta AU - Ikonomi, Nensi AU - Schwab, D. Julian AU - Werle, D. Silke AU - Fürstberger, Axel AU - Kestler, MR Angelika AU - Holderried, Martin AU - Kaisers, X. Udo AU - Steger, Florian AU - Kestler, A. Hans PY - 2022/4/13 TI - Interaction Empowerment in Mobile Health: Concepts, Challenges, and Perspectives JO - JMIR Mhealth Uhealth SP - e32696 VL - 10 IS - 4 KW - mHealth KW - mobile apps KW - patient empowerment KW - digital health KW - interaction empowerment KW - patient-doctor relationship KW - health care network KW - intersectoral communication UR - https://mhealth.jmir.org/2022/4/e32696 UR - http://dx.doi.org/10.2196/32696 UR - http://www.ncbi.nlm.nih.gov/pubmed/35416786 ID - info:doi/10.2196/32696 ER - TY - JOUR AU - Aronoff-Spencer, Eliah AU - McComsey, Melanie AU - Chih, Ming-Yuan AU - Hubenko, Alexandra AU - Baker, Corey AU - Kim, John AU - Ahern, K. David AU - Gibbons, Christopher Michael AU - Cafazzo, A. Joseph AU - Nyakairu, Pia AU - Vanderpool, C. Robin AU - Mullett, W. Timothy AU - Hesse, W. Bradford PY - 2022/4/12 TI - Designing a Framework for Remote Cancer Care Through Community Co-design: Participatory Development Study JO - J Med Internet Res SP - e29492 VL - 24 IS - 4 KW - cancer care KW - distress screening KW - human-centered design KW - participatory design KW - Appalachia KW - mobile phone N2 - Background: Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking. Objective: The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders. Methods: We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback. Results: We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=?0.311; P=.76). Notable differences by patient and provider scoring and feedback were found. Conclusions: Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches. UR - https://www.jmir.org/2022/4/e29492 UR - http://dx.doi.org/10.2196/29492 UR - http://www.ncbi.nlm.nih.gov/pubmed/35412457 ID - info:doi/10.2196/29492 ER - TY - JOUR AU - Malik, Tanya AU - Ambrose, Jacques Adrian AU - Sinha, Chaitali PY - 2022/4/12 TI - Evaluating User Feedback for an Artificial Intelligence?Enabled, Cognitive Behavioral Therapy?Based Mental Health App (Wysa): Qualitative Thematic Analysis JO - JMIR Hum Factors SP - e35668 VL - 9 IS - 2 KW - digital mental health KW - artificial intelligence KW - user reviews KW - cognitive behavioral therapy KW - CBT N2 - Background: Digital mental health apps are rapidly becoming a common source of accessible support across the world, but their effectiveness is often influenced by limited helpfulness and engagement. Objective: This study?s primary objective was to analyze feedback content to understand users? experiences with engaging with a digital mental health app. As a secondary objective, an exploratory analysis captured the types of mental health app users. Methods: This study utilized a user-led approach to understanding factors for engagement and helpfulness in digital mental health by analyzing feedback (n=7929) reported on Google Play Store about Wysa, a mental health app (1-year period). The analysis of keywords in the user feedback categorized and evaluated the reported user experience into the core domains of acceptability, usability, usefulness, and integration. The study also captured key deficits and strengths of the app and explored salient characteristics of the types of users who benefit from accessible digital mental health support. Results: The analysis of user feedback found the app to be overwhelmingly positively reviewed (6700/7929, 84.50% 5-star rating). The themes of engaging exercises, interactive interface, and artificial intelligence (AI) conversational ability indicated the acceptability of the app, while the nonjudgmentality and ease of conversation highlighted its usability. The app?s usefulness was portrayed by themes such as improvement in mental health, convenient access, and cognitive restructuring exercises. Themes of privacy and confidentiality underscored users? preference for the integrated aspects of the app. Further analysis revealed 4 predominant types of individuals who shared app feedback on the store. Conclusions: Users reported therapeutic elements of a comfortable, safe, and supportive environment through using the digital mental health app. Digital mental health apps may expand mental health access to those unable to access traditional forms of mental health support and treatments. UR - https://humanfactors.jmir.org/2022/2/e35668 UR - http://dx.doi.org/10.2196/35668 UR - http://www.ncbi.nlm.nih.gov/pubmed/35249886 ID - info:doi/10.2196/35668 ER - TY - JOUR AU - Mande, Archana AU - Moore, L. Susan AU - Banaei-Kashani, Farnoush AU - Echalier, Benjamin AU - Bull, Sheana AU - Rosenberg, A. Michael PY - 2022/4/12 TI - Assessment of a Mobile Health iPhone App for Semiautomated Self-management of Chronic Recurrent Medical Conditions Using an N-of-1 Trial Framework: Feasibility Pilot Study JO - JMIR Form Res SP - e34827 VL - 6 IS - 4 KW - mHealth KW - patient-specific modeling KW - chronic disease KW - smartphone KW - implementation and deployment KW - facilitators and barriers N2 - Background: Management of chronic recurrent medical conditions (CRMCs), such as migraine headaches, chronic pain, and anxiety/depression, remains a major challenge for modern providers. Our team has developed an edge-based, semiautomated mobile health (mHealth) technology called iMTracker that employs the N-of-1 trial approach to allow self-management of CRMCs. Objective: This study examines the patterns of adoption, identifies CRMCs that users selected for self-application, and explores barriers to use of the iMTracker app. Methods: This is a feasibility pilot study with internet-based recruitment that ran from May 15, 2019, to December 23, 2020. We recruited 180 patients to pilot test the iMTracker app for user-selected CRMCs for a 3-month period. Patients were administered surveys before and after the study. Results: We found reasonable usage rates: a total of 73/103 (70.9%) patients who were not lost to follow-up reported the full 3-month use of the app. Most users chose to use the iMTracker app to self-manage chronic pain (other than headaches; 80/212, 37.7%), followed by headaches in 36/212 (17.0%) and mental health (anxiety and depression) in 27/212 (12.8%). The recurrence rate of CRMCs was at least weekly in over 93% (169/180) of patients, with 36.1% (65/180) of CRMCs recurring multiple times in a day, 41.7% (75/180) daily, and 16.1% (29/180) weekly. We found that the main barriers to use were the design and technical function of the app, but that use of the app resulted in an improvement in confidence in the efficiency and safety/privacy of this approach. Conclusions: The iMTracker app provides a feasible platform for the N-of-1 trial approach to self-management of CRMCs, although internet-based recruitment provided limited follow-up, suggesting that in-person evaluation may be needed. The rate of CRMC recurrence was high enough to allow the N-of-1 trial assessment for most traits. UR - https://formative.jmir.org/2022/4/e34827 UR - http://dx.doi.org/10.2196/34827 UR - http://www.ncbi.nlm.nih.gov/pubmed/35412460 ID - info:doi/10.2196/34827 ER - TY - JOUR AU - Ozluk, Pelin AU - Cobb, Rebecca AU - Hoots, Alyson AU - Sylwestrzak, Malgorzata PY - 2022/4/11 TI - Association Between Mobile App Use and Caregivers? Support System, Time Spent on Caregiving, and Perceived Well-being: Survey Study From a Large Employer JO - J Med Internet Res SP - e28504 VL - 24 IS - 4 KW - caregiving KW - mobile app KW - mobile phone N2 - Background: Mobile technology to address caregiver needs has been on the rise. There is limited evidence of effectiveness of such technologies on caregiver experiences. Objective: This study evaluates the effectiveness of ianacare, a mobile app, among employees of a large employer. ianacare mobilizes personal social circles to help with everyday tasks. Through the use of ianacare, we evaluate the associations between coordinating caregiving tasks among a caregiver?s personal support network and outcomes related to the caregiver?s support system, time use, perceived productivity, and perceived health and well-being. Caregiver tasks include tasks such as meal preparation, respite care, pet care, and transportation. Time use is the measure of a caregiver?s time spent on caregiving tasks and how much time they had to take off from work to attend planned or unplanned caregiving tasks. Methods: We conducted 2 surveys to assess within-participant changes in outcomes for the unpaid, employed, caregivers after 6 weeks of using the mobile app (n=176) between March 30, 2020, and May 11, 2020. The surveys contained questions in three domains: the caregiver?s support system, time use and perceived productivity, and perceived health and well-being. The results of the linear probability models are presented below. Results: App use was significantly associated with decreasing the probability of doing most caregiving tasks alone by 9.1% points (SE 0.04; P=.01) and increasing the probability of at least one person helping the primary caregiver by 8.0% points (SE 0.035; P=.02). App use was also associated with improving the time use of the primary caregiver who took significantly less time off work to attend to caregiving duties by 12.5% points (SE 0.04; P=.003) and decreased the probability of spending more than 30 hours weekly on caregiving by 9.1% points (SE 0.04; P=.02). Additional findings on the positive impact of the app included a decrease in the probability of reporting feeling overwhelmed by caregiving tasks by 12.5% points (SE 0.04; P=.003) and a decrease in the probability of reporting negative health effects by 6.8% points (SE 0.04; P=.07) because of caregiving. Although subjects reported that COVID-19 increased their stress attributed to caregiving and prevented them from requesting help for some caregiving tasks, using the app was still associated with improvements in receiving help and lessening of the negative effects of caregiving on the caregivers. Conclusions: App use was associated with improvements in 7 of 11 caregiver outcomes across three main categories: their support system, time spent on caregiving, and perceived health and well-being. These findings provide encouraging evidence that the mobile app can significantly reduce caregiver burden by leveraging a caregiver?s support network despite the additional challenges brought by COVID-19 on caregivers. UR - https://www.jmir.org/2022/4/e28504 UR - http://dx.doi.org/10.2196/28504 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404266 ID - info:doi/10.2196/28504 ER - TY - JOUR AU - Oh, Soyeon Sarah AU - Moon, Youn Jong AU - Chon, Doukyoung AU - Mita, Carol AU - Lawrence, A. Jourdyn AU - Park, Eun-Cheol AU - Kawachi, Ichiro PY - 2022/4/11 TI - Effectiveness of Digital Interventions for Preventing Alcohol Consumption in Pregnancy: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e35554 VL - 24 IS - 4 KW - fetal alcohol spectrum disorders KW - fetal alcohol syndrome KW - digital health KW - pregnancy KW - alcohol consumption KW - text message KW - text messaging KW - alcohol KW - digital intervention KW - mother KW - systematic review KW - meta-analysis KW - mobile health KW - mHealth KW - computer-based intervention KW - internet-based intervention N2 - Background: Alcohol consumption in pregnancy has been associated with serious fetal health risks and maternal complications. While previous systematic reviews of digital interventions during pregnancy have targeted smoking cessation and flu vaccine uptake, few studies have sought to evaluate their effectiveness in preventing alcohol consumption during pregnancy. Objective: This systematic review aims to assess (1) whether digital interventions are effective in preventing alcohol consumption during the pregnancy/pregnancy-planning period, and (2) the differential effectiveness of alternative digital intervention platforms (ie, computers, mobiles, and text messaging services). Methods: PubMed, Embase, CINAHL, and Web of Science were searched for studies with digital interventions aiming to prevent alcohol consumption among pregnant women or women planning to become pregnant. A random effects primary meta-analysis was conducted to estimate the combined effect size and extent to which different digital platforms were successful in preventing alcohol consumption in pregnancy. Results: Six studies were identified and included in the final review. The primary meta-analysis produced a sample-weighted odds ratio (OR) of 0.62 (95% CI 0.42-0.91; P=.02) in favor of digital interventions decreasing the risk of alcohol consumption during pregnancy when compared to controls. Computer/internet-based interventions (OR 0.59, 95% CI 0.38-0.93) were an effective platform for preventing alcohol consumption. Too few studies of text messaging (OR 0.29, 95% CI 0.29-2.52) were available to draw a conclusion. Conclusions: Overall, our review highlights the potential for digital interventions to prevent alcohol consumption among pregnant women and women planning to become pregnant. Considering the advantages of digital interventions in promoting healthy behavioral changes, future research is necessary to understand how certain platforms may increase user engagement and intervention effectiveness to prevent women from consuming alcohol during their pregnancies. UR - https://www.jmir.org/2022/4/e35554 UR - http://dx.doi.org/10.2196/35554 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404257 ID - info:doi/10.2196/35554 ER - TY - JOUR AU - Borghouts, Judith AU - Neary, Martha AU - Palomares, Kristina AU - De Leon, Cinthia AU - Schueller, M. Stephen AU - Schneider, Margaret AU - Stadnick, Nicole AU - Mukamel, B. Dana AU - Sorkin, H. Dara AU - Brown, Dakota AU - McCleerey-Hooper, Shannon AU - Moriarty, Gloria AU - Eikey, V. Elizabeth PY - 2022/4/11 TI - Understanding the Potential of Mental Health Apps to Address Mental Health Needs of the Deaf and Hard of Hearing Community: Mixed Methods Study JO - JMIR Hum Factors SP - e35641 VL - 9 IS - 2 KW - mental health KW - deaf and hard of hearing community KW - mHealth KW - digital health KW - needs assessment KW - deaf KW - hard of hearing KW - hearing KW - focus group KW - survey KW - mixed methods KW - intervention KW - health app KW - user needs N2 - Background: Mental health concerns are a significant issue among the deaf and hard of hearing (D/HH) community, but community members can face several unique challenges to accessing appropriate resources. Objective: The aim of this study was to investigate the mental health needs of the D/HH community and how mental health apps may be able to support these needs. Methods: A total of 10 members of the D/HH community participated in a focus group and survey to provide their perspectives and experiences. Participants were members of the Center on Deafness Inland Empire team, which comprises people with lived experience as members of and advocates for the D/HH community. Results: Findings identified a spectrum of needs for mental health apps, including offering American Sign Language and English support, increased education of mental health to reduce stigma around mental health, direct communication with a Deaf worker, and apps that are accessible to a range of community members in terms of culture, resources required, and location. Conclusions: These findings can inform the development of digital mental health resources and outreach strategies that are appropriate for the D/HH community. UR - https://humanfactors.jmir.org/2022/2/e35641 UR - http://dx.doi.org/10.2196/35641 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404259 ID - info:doi/10.2196/35641 ER - TY - JOUR AU - Antoun, Jumana AU - Itani, Hala AU - Alarab, Natally AU - Elsehmawy, Amir PY - 2022/4/8 TI - The Effectiveness of Combining Nonmobile Interventions With the Use of Smartphone Apps With Various Features for Weight Loss: Systematic Review and Meta-analysis JO - JMIR Mhealth Uhealth SP - e35479 VL - 10 IS - 4 KW - obesity KW - weight loss KW - mobile app KW - self-monitoring KW - behavioral KW - tracker KW - behavioral coaching KW - coach KW - dietitian KW - mobile phone N2 - Background: The effectiveness of smartphone apps for weight loss is limited by the diversity of interventions that accompany such apps. This research extends the scope of previous systematic reviews by including 2 subgroup analyses based on nonmobile interventions that accompanied smartphone use and human-based versus passive behavioral interventions. Objective: The primary objective of this study is to systematically review and perform a meta-analysis of studies that evaluated the effectiveness of smartphone apps on weight loss in the context of other interventions combined with app use. The secondary objective is to measure the impact of different mobile app features on weight loss and mobile app adherence. Methods: We conducted a systematic review and meta-analysis of relevant studies after an extensive search of the PubMed, MEDLINE, and EBSCO databases from inception to January 31, 2022. Gray literature, such as abstracts and conference proceedings, was included. Working independently, 2 investigators extracted the data from the articles, resolving disagreements by consensus. All randomized controlled trials that used smartphone apps in at least 1 arm for weight loss were included. The weight loss outcome was the change in weight from baseline to the 3- and 6-month periods for each arm. Net change estimates were pooled across the studies using random-effects models to compare the intervention group with the control group. The risk of bias was assessed independently by 2 authors using the Cochrane Collaboration tool for assessing the risk of bias in randomized trials. Results: Overall, 34 studies were included that evaluated the use of a smartphone app in at least 1 arm. Compared with controls, the use of a smartphone app?based intervention showed a significant weight loss of ?1.99 kg (95% CI ?2.19 to ?1.79 kg; I2=81%) at 3 months and ?2.80 kg (95% CI ?3.03 to ?2.56 kg; I2=91%) at 6 months. In the subgroup analysis, based on the various intervention components that were added to the mobile app, the combination of the mobile app, tracker, and behavioral interventions showed a statistically significant weight loss of ?2.09 kg (95% CI ?2.32 to ?1.86 kg; I2=91%) and ?3.77 kg (95% CI ?4.05 to ?3.49 kg; I2=90%) at 3 and 6 months, respectively. When a behavioral intervention was present, only the combination of the mobile app with intensive behavior coaching or feedback by a human coach showed a statistically significant weight loss of ?2.03 kg (95% CI ?2.80 to ?1.26 kg; I2=83%) and ?2.63 kg (95% CI ?2.97 to ?2.29 kg; I2=91%) at 3 and 6 months, respectively. Neither the type nor the number of mobile app features was associated with weight loss. Conclusions: Smartphone apps have a role in weight loss management. Nevertheless, the human-based behavioral component remained key to higher weight loss results. UR - https://mhealth.jmir.org/2022/4/e35479 UR - http://dx.doi.org/10.2196/35479 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394443 ID - info:doi/10.2196/35479 ER - TY - JOUR AU - Rodríguez Sánchez-Laulhé, Pablo AU - Luque-Romero, Gabriel Luis AU - Barrero-García, José Francisco AU - Biscarri-Carbonero, Ángela AU - Blanquero, Jesús AU - Suero-Pineda, Alejandro AU - Heredia-Rizo, Marcos Alberto PY - 2022/4/7 TI - An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e35462 VL - 10 IS - 4 KW - rheumatoid arthritis KW - telerehabilitation KW - self-management KW - mHealth KW - primary health care KW - physical therapy KW - exercise therapy KW - mobile applications KW - telehealth KW - health education KW - mobile phone N2 - Background: Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated. Objective: This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands. Methods: A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups. Results: In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45%; control group: 32/58, 55%), were included in the analysis; 53% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time×group effect for the total score of the MHQ (F1.62,85.67=9.163; P<.001; ?2=0.15) and for several of its subscales: overall hand function, work performance, pain, and satisfaction (all P<.05), with mean differences between groups for the total score of 16.86 points (95% CI 8.70-25.03) at 3 months and 17.21 points (95% CI 4.78-29.63) at 6 months. No time×group interaction was observed for the secondary measures (all P>.05). Conclusions: Adults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes. Trial Registration: ClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04713-4 UR - https://mhealth.jmir.org/2022/4/e35462 UR - http://dx.doi.org/10.2196/35462 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389367 ID - info:doi/10.2196/35462 ER - TY - JOUR AU - Campbell, Benjamin AU - Heitner, Jesse AU - Amos Mwelelo, Peter AU - Fogel, Alexis AU - Mujumdar, Vaidehi AU - Adams, V. Lisa AU - Boniface, Respicious AU - Su, Yanfang PY - 2022/4/7 TI - Impact of SMS Text Messaging Reminders on Helmet Use Among Motorcycle Drivers in Dar es Salaam, Tanzania: Randomized Controlled Trial JO - J Med Internet Res SP - e27387 VL - 24 IS - 4 KW - road traffic injury KW - behavior change KW - SMS reminders KW - mobile health KW - vehicle safety KW - mHealth KW - SMS KW - traffic injuries KW - transportation KW - public transportation KW - safety KW - automotive KW - automotive safety N2 - Background: Road traffic injury is a pressing public health issue in Tanzania. Increasing helmet use among motorcycle drivers can help reduce the burden due to road traffic injuries in the country. Helmet adherence can be supported through mobile health interventions. Objective: The aim of this study is to evaluate the comparative impact of two different types of SMS text messaging reminders on motorcycle helmet use. Methods: Participants were 391 commercial motorcycle taxi drivers in Dar es Salaam, Tanzania. Participants were randomized into three groups, each receiving a different set of messages: (1) social norming messages aimed at emphasizing society?s positive stance on helmet wearing, (2) fear appeal messages that emphasized the dangers of riding without a helmet, and (3) control group messages, which included basic road safety messages unrelated to helmet use. Every participant received the control messages. Adherence to helmet use was evaluated by self-report through surveys conducted at baseline, 3 weeks, and 6 weeks. Results: At 6 weeks, the odds of self-reporting consistent helmet use were estimated to be 1.58 times higher in the social norming group than in the control group (P=.04), though this difference was not significant after accounting for multiple testing. There was little difference between fear appeal and control group recipients (odds ratio 1.03, P=.47). Subgroup analysis suggests that both fear appeal and social norming message types might have been associated with increased helmet use among participants who did not consistently wear helmets at baseline (odds ratio 1.66 and odds ratio 1.84, respectively), but this was not significant (P=.11 and P=.07, respectively). Among those who were consistent wearers at baseline, the social norming messages performed better than the fear appeal messages, and this difference reached traditional significance (P=.03), but was not significant after accounting for multiple testing. Conclusions: The use of SMS text messaging reminders may improve helmet use among motorcycle drivers when framed as social norming messages. Given that nearly half of the drivers in our sample did not consistently wear their helmets on every trip, strategies to increase consistent usage could greatly benefit public safety. Trial Registration: ClinicalTrials.gov NCT02120742; https://clinicaltrials.gov/ct2/show/NCT02120742 UR - https://www.jmir.org/2022/4/e27387 UR - http://dx.doi.org/10.2196/27387 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389364 ID - info:doi/10.2196/27387 ER - TY - JOUR AU - Melendez-Torres, GJ AU - Meiksin, Rebecca AU - Witzel, Charles T. AU - Weatherburn, Peter AU - Falconer, Jane AU - Bonell, Chris PY - 2022/4/6 TI - eHealth Interventions to Address HIV and Other Sexually Transmitted Infections, Sexual Risk Behavior, Substance Use, and Mental Ill-health in Men Who Have Sex With Men: Systematic Review and Meta-analysis JO - JMIR Public Health Surveill SP - e27061 VL - 8 IS - 4 KW - men who have sex with men KW - HIV and sexually transmitted infections KW - mental health KW - substance use KW - mobile apps KW - HIV KW - eHealth KW - electronic media KW - mobile phone apps KW - sexual risk N2 - Background: Men who have sex with men experience disproportionately high levels of HIV and other sexually transmitted infections (STIs), sexual risk behavior, substance use, and mental ill-health. These experiences are interrelated, and these interrelations are potentiated by structural conditions of discrimination, stigma, and unequal access to appropriate health services, and they magnify each other and have intersecting causal pathways, worsening both risk for each condition and risk for the negative sequelae of each condition. eHealth interventions could address these issues simultaneously and thus have wide-ranging and greater effects than would be for any 1 outcome alone. Objective: We systematically reviewed the evidence for the effectiveness of eHealth interventions in addressing these outcomes separately or together. Methods: We searched 19 databases for randomized trials of interactive or noninteractive eHealth interventions delivered via mobile phone apps, internet, or other electronic media to populations consisting entirely or principally of men who have sex with men to prevent HIV, STIs, sexual risk behavior, alcohol and drug use, or common mental illnesses. We extracted data and appraised each study, estimated meta-analyses where possible by using random effects and robust variance estimation, and assessed the certainty of our findings (closeness of the estimated effect to the true effect) by using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results: We included 14 trials, of which 13 included active versus control comparisons; none reported mental health outcomes, and all drew from 12 months or less of follow-up postintervention. Findings for STIs drew on low numbers of studies and did not suggest consistent short-term (<3 months postintervention; d=0.17, 95% CI ?0.18 to 0.52; I2=0%; 2 studies) or midterm (3-12 months postintervention, no meta-analysis, 1 study) evidence of effectiveness. Eight studies considering sexual risk behavior outcomes suggested a short-term, nonsignificant reduction (d=?0.14, 95% CI ?0.30 to 0.03) with very low certainty, but 6 studies reporting midterm follow-ups suggested a significant impact on reducing sexual risk behavior (d=?0.12, 95% CI ?0.19 to ?0.05) with low certainty. Meta-analyses could not be undertaken for alcohol and drug use (2 heterogeneous studies) or for HIV infections (1 study for each of short-term or midterm follow-up), and alcohol outcomes alone were not captured in the included studies. Certainty was graded as low to very low for most outcomes, including all meta-analyses. Conclusions: To create a comprehensive eHealth intervention that targets multiple outcomes, intervention evaluations should seek to generalize both mechanisms and components that are successfully used to achieve change in 1 outcome over multiple outcomes. However, additional evaluations of interventions seeking to address outcomes other than sexual risk behavior are needed before development and evaluation of a joined-up intervention. UR - https://publichealth.jmir.org/2022/4/e27061 UR - http://dx.doi.org/10.2196/27061 UR - http://www.ncbi.nlm.nih.gov/pubmed/35384845 ID - info:doi/10.2196/27061 ER - TY - JOUR AU - Vajravelu, Ellen Mary AU - Hitt, Alyssa Talia AU - Mak, NaDea AU - Edwards, Aliya AU - Mitchell, Jonathan AU - Schwartz, Lisa AU - Kelly, Andrea AU - Amaral, Sandra PY - 2022/4/6 TI - Text Messages and Financial Incentives to Increase Physical Activity in Adolescents With Prediabetes and Type 2 Diabetes: Web-Based Group Interviews to Inform Intervention Design JO - JMIR Diabetes SP - e33082 VL - 7 IS - 2 KW - diabetes mellitus type 2 KW - adolescent KW - young adult KW - text messaging KW - physical activity KW - motivation KW - mobile phone N2 - Background: Physical activity is a major component of treatment for adolescents with obesity and prediabetes or type 2 diabetes; however, sedentary behavior remains pervasive. An SMS text message?based intervention paired with financial incentives may be an effective way to promote physical activity in this population. Objective: This study aims to obtain end-user feedback on SMS text message content and assess the acceptability of a planned SMS text messaging intervention with financial incentives to motivate youth with prediabetes or type 2 diabetes to increase physical activity. Methods: Adolescents with overweight or obesity and prediabetes or type 2 diabetes who attended a large academic pediatric endocrinology clinic were recruited to participate in group interviews (2-4/group) via videoconferencing. Participants were asked to share their thoughts on the use of SMS text messages and financial incentives to remind and motivate them to be more physically active. They rated and provided feedback on specific messages to be used in clinical trials. Participants were also asked about their personal experience with rewards to motivate behavior change and their anticipated reactions to rewards provided for goal attainment (gain-framing) versus those provided and then taken away if a goal was not met (loss-framing). The interviews were conducted by 2 trained interviewers and a note-taker. Content analysis was used to explore themes. Results: Group interviews were completed with 20 participants (11/20, 55% women; 15/20, 75% with type 2 diabetes; 5/20, 25% with prediabetes) with a mean age of 15 (SD 1; range 12-18) years and a mean BMI of 41 (SD 5) kg/m2 (all >95th percentile for age and sex). Most participants were non-Hispanic Black (14/20, 70%) and 10% (2/20) were Hispanics. Participants frequently cited near-continuous smartphone use and agreed that SMS text messages would serve as good reminders to be physically active, but the consensus about the need for short messages was strong. Favorable content included references to what they were likely to be doing when messages were sent (eg, homework or watching television) and messages that were upbeat or informative. Specific physical activity suggestions were rated favorably. Attitudes toward financial incentives varied, with differing opinions about whether loss-framed incentives would be motivating or discouraging. Many participants highlighted the role of intrinsic, rather than extrinsic, motivation in achieving and sustaining behavior change. Conclusions: The engagement of adolescents with obesity and diabetes or prediabetes allowed for the refinement of SMS text messages for our planned intervention, with an emphasis on short, upbeat, relatable, and informative messages. Although an SMS text messaging intervention using financial incentives to motivate youth with prediabetes or type 2 diabetes to be more physically active is theoretically acceptable, the impact on actual activity levels in this population requires prospective evaluation in a clinical trial. UR - https://diabetes.jmir.org/2022/2/e33082 UR - http://dx.doi.org/10.2196/33082 UR - http://www.ncbi.nlm.nih.gov/pubmed/35384850 ID - info:doi/10.2196/33082 ER - TY - JOUR AU - Menon, Rijuta AU - Meyer, Julien AU - Nippak, Pria AU - Begum, Housne PY - 2022/4/1 TI - Smartphone Alcohol Use Disorder Recovery Apps: Cross-sectional Survey of Behavioral Intention to Use JO - JMIR Hum Factors SP - e33493 VL - 9 IS - 2 KW - mobile health KW - alcohol use disorder KW - disease management KW - mobile apps KW - Unified Theory of Acceptance and Use of Technology N2 - Background: Alcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused. Objective: The aim of this survey study is to explore the beliefs that determine the intention to use AUDRA. Methods: We conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020. Results: The final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4% of the variance in the behavioral intention to use AUDRA and 11.1% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA. Conclusions: This study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA. UR - https://humanfactors.jmir.org/2022/2/e33493 UR - http://dx.doi.org/10.2196/33493 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363145 ID - info:doi/10.2196/33493 ER - TY - JOUR AU - Huma, E. Zil AU - Struik, Laura AU - Bottorff, L. Joan AU - Hasan, Khalad Mohammad PY - 2022/4/1 TI - Preferences for Mobile-Supported e-Cigarette Cessation Interventions Among Young Adults: Qualitative Descriptive Study JO - JMIR Form Res SP - e33640 VL - 6 IS - 4 KW - qualitative research KW - electronic nicotine delivery systems KW - e-cigarette KW - cessation KW - young adults KW - smartphone apps KW - mHealth KW - mobile phone N2 - Background: Despite the steady rise in electronic cigarette (e-cigarette) uptake among young adults, increasingly more young people want to quit. Given the popularity of smartphones among young adults, mobile-based e-cigarette cessation interventions hold significant promise. Smartphone apps are particularly promising due to their varied and complex capabilities to engage end users. However, evidence around young adults? preferences and expectations from an e-cigarette cessation smartphone app remains unexplored. Objective: The purpose of this study was to take an initial step toward understanding young adults? preferences and perceptions on app-based e-cigarette cessation interventions. Methods: Using a qualitative descriptive approach, we interviewed 12 young adults who used e-cigarettes and wanted to quit. We inductively derived themes using the framework analysis approach and NVivo 12 qualitative data analysis software. Results: All participants agreed that a smartphone app for supporting cessation was desirable. In addition, we found 4 key themes related to their preferences for app components: (1) flexible personalization (being able to enter and modify goals); (2) e-cigarette behavior tracking (progress and benefits of quitting); (3) safely managed social support (moderated and anonymous); and (4) positively framed notifications (encouraging and motivational messages). Some gender-based differences indicate that women were more likely to use e-cigarettes to cope with stress, preferred more aesthetic tailoring in the app, and were less likely to quit cold turkey compared with men. Conclusions: The findings provide direction for the development and testing of app-based e-cigarette cessation interventions for young adults. UR - https://formative.jmir.org/2022/4/e33640 UR - http://dx.doi.org/10.2196/33640 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363140 ID - info:doi/10.2196/33640 ER - TY - JOUR AU - Sarlon, Jan AU - Doll, K. Jessica P. AU - Schmassmann, Aline AU - Brand, Serge AU - Ferreira, Naomi AU - Muehlhauser, Markus AU - Urech-Meyer, Stefanie AU - Schweinfurth, Nina AU - Lang, Emmi Undine AU - Bruehl, Beatrix Annette PY - 2022/3/31 TI - Effectiveness of a Mindfulness-Based Mobile Application for the Treatment of Depression in Ambulatory Care: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e33423 VL - 11 IS - 3 KW - depression KW - mindfulness KW - mhealth KW - ehealth KW - stress level N2 - Background: Patients with major depressive disorder (MDD) often experience relapses despite regular treatment with pharmacotherapy and psychotherapy. Further, long waiting lists and more demand than treatment capacity characterize ambulatory settings. Mindfulness-based interventions proved to be effective in relapse prevention in MDD. Next, mindfulness-based interventions in the form of free mobile applications can be an effective augmentation of the treatment as usual and can fill a gap in ambulatory care. Objective: Given this background, the aim of this randomized controlled study is to assess the effectiveness of additional MBI via a mobile app on the symptom severity and stress levels, compared to treatment as usual. Methods: A total of 140 individuals with MDD will be randomly allocated to the intervention or control condition. The intervention consists of the daily use of the mindfulness mobile application Headspace for thirty days (up to 10 minutes a day). The control condition will be treatment as usual. At baseline and four weeks later, the following key outcome dimensions will be assessed: self-rated (Beck Depression Inventory) and experts? rated symptoms of MDD (Hamilton Depression Rating Scale); secondary outcome variables will be blood pressure, heart rate, and respiratory rate and changes in tobacco and alcohol consumption and medication as a proxy of perceived stress. Results: This study was funded in February 2021 and approved by the institutional review board on April 15, 2021, and it started in May 2021. As of December 2021, we enrolled 30 participants. The findings are expected to be published in spring 2023. Conclusions: We hypothesize that compared to the control conditions, individuals with MDD of the mobile app-condition will have both lower self- and experts? rated symptoms of MDD and more favorable stress-related levels. While the risk for medical events is low, the immediate benefit for participants could be a decrease in symptom severity and reduction of the stress level. Trial Registration: Clinical Trials.gov NCT05060393; https://clinicaltrials.gov/ct2/show/NCT05060393. International Registered Report Identifier (IRRID): DERR1-10.2196/33423 UR - https://www.researchprotocols.org/2022/3/e33423 UR - http://dx.doi.org/10.2196/33423 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357325 ID - info:doi/10.2196/33423 ER - TY - JOUR AU - Thorpe, Dan AU - Fouyaxis, John AU - Lipschitz, M. Jessica AU - Nielson, Amy AU - Li, Wenhao AU - Murphy, A. Susan AU - Bidargaddi, Niranjan PY - 2022/3/31 TI - Cost and Effort Considerations for the Development of Intervention Studies Using Mobile Health Platforms: Pragmatic Case Study JO - JMIR Form Res SP - e29988 VL - 6 IS - 3 KW - health informatics KW - human computer interaction KW - digital health KW - mobile health KW - ecological momentary assessment KW - ecological momentary intervention KW - behavioral activation KW - interventional research KW - mobile health costs N2 - Background: The research marketplace has seen a flood of open-source or commercial mobile health (mHealth) platforms that can collect and use user data in real time. However, there is a lack of practical literature on how these platforms are developed, integrated into study designs, and adopted, including important information around cost and effort considerations. Objective: We intend to build critical literacy in the clinician-researcher readership into the cost, effort, and processes involved in developing and operationalizing an mHealth platform, focusing on Intui, an mHealth platform that we developed. Methods: We describe the development of the Intui mHealth platform and general principles of its operationalization across sites. Results: We provide a worked example in the form of a case study. Intui was operationalized in the design of a behavioral activation intervention in collaboration with a mental health service provider. We describe the design specifications of the study site, the developed software, and the cost and effort required to build the final product. Conclusions: Study designs, researcher needs, and technical considerations can impact effort and costs associated with the use of mHealth platforms. Greater transparency from platform developers about the impact of these factors on practical considerations relevant to end users such as clinician-researchers is crucial to increasing critical literacy around mHealth, thereby aiding in the widespread use of these potentially beneficial technologies and building clinician confidence in these tools. UR - https://formative.jmir.org/2022/3/e29988 UR - http://dx.doi.org/10.2196/29988 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357313 ID - info:doi/10.2196/29988 ER - TY - JOUR AU - Hensler, Ida AU - Sveen, Josefin AU - Cernvall, Martin AU - Arnberg, K. Filip PY - 2022/3/30 TI - Efficacy, Benefits, and Harms of a Self-management App in a Swedish Trauma-Exposed Community Sample (PTSD Coach): Randomized Controlled Trial JO - J Med Internet Res SP - e31419 VL - 24 IS - 3 KW - PTSD KW - self-management app KW - mHealth KW - RCT KW - negative effects KW - mobile phone N2 - Background: Self-guided interventions may complement and overcome obstacles to in-person treatment options. The efficacy of app interventions targeting posttraumatic stress disorder (PTSD) is unclear, and results from previous studies on PTSD Coach?an app for managing trauma-related distress?are inconsistent. Objective: This study investigates whether access to the Swedish version of the PTSD Coach affects posttraumatic stress, depressive, and somatic symptoms. In addition, we aim to assess the perceived helpfulness, satisfaction, negative effects, response, and remission related to PTSD Coach. Methods: Adults who had experienced potentially traumatic events in the past 2 years were randomized (1:1) to have access to PTSD Coach (n=89) or be on the waitlist (n=90). We assessed clinical characteristics at baseline (semistructured interviews and self-rating scales) and after 3 months (self-rating scales). We analyzed the data in R software using linear mixed effects models, chi-square tests, and Fisher exact test. Results: Intention-to-treat analyses indicated that access to PTSD Coach decreased posttraumatic stress and depressive symptoms but not somatic symptoms. More participants who had access to PTSD Coach responded with clinically significant improvement and fewer instances of probable PTSD after 3 months compared with waitlist controls. Overall, participants found that PTSD Coach was slightly to moderately helpful and moderately satisfactory. Half of the intervention group (36/71, 51%) reported at least one negative reaction related to using PTSD Coach (eg, disappointment with the app or its results, arousal of stress, or distressing memories). Conclusions: Using PTSD Coach may trigger symptoms among a few users; however, most of them perceived PTSD Coach as helpful and satisfactory. This study showed that having access to PTSD Coach helped improve psychological trauma-related symptoms. In addition, we have discussed implications for future research and clinical practice. Trial Registration: ClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922 UR - https://www.jmir.org/2022/3/e31419 UR - http://dx.doi.org/10.2196/31419 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353052 ID - info:doi/10.2196/31419 ER - TY - JOUR AU - Marcu, Gabriela AU - Ondersma, J. Steven AU - Spiller, N. Allison AU - Broderick, M. Brianna AU - Kadri, Reema AU - Buis, R. Lorraine PY - 2022/3/30 TI - Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis JO - J Med Internet Res SP - e34301 VL - 24 IS - 3 KW - computers KW - mobile apps KW - screening KW - brief interventions KW - diagnosis KW - computer-assisted/methods KW - surveys and questionnaires KW - motivational interviewing KW - therapy KW - implementation KW - qualitative KW - mobile phone N2 - Background: Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and adherence to recommended care. However, digital intervention development is impeded by challenges such as limited technical skills, limited access to developers, and cost. The purpose of this study is to elicit in-depth qualitative feedback from intervention developers who have interest in digital behavioral interventions but lack programming skills regarding the barriers they experience and key considerations in the design and implementation of digital interventions. Objective: This study aims to understand barriers in the design and implementation of digital behavioral interventions, as well as to identify key considerations for researchers who are developing these interventions. Methods: We conducted semistructured qualitative interviews with 18 researchers who had experience either designing (but not coding) digital behavioral interventions or running research studies with them. Participants were a convenience sample of users of the Computerized Intervention Authoring System platform, an existing no-code development platform for building digital intervention content, and were recruited through either direct email solicitation or snowball sampling. All interviews were conducted and recorded over videoconference between February and April 2020. Recordings from interviews were transcribed and thematically analyzed by multiple coders. Results: Interviews were completed with 18 participants and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project/study staff. Three key barriers in the development of digital behavior interventions were identified during interviews: lack of cross-disciplinary understanding; variability in recipients? technology access, infrastructure, and literacy; and the idea that evidence-based in-person interactions do not translate directly to digital interactions. Interviewees identified several key considerations that interventionists learned to prioritize, which have the potential to overcome these barriers and lead to successful interventions. Conclusions: Barriers in the development of digital behavioral interventions are often created by a lack of cross-disciplinary understanding, which can lead to difficulties conceptualizing interventions, unrealistic expectations in terms of cost, and confusion about the development process. Moreover, concerns about research study participant characteristics and access to technology, as well as the translation of in-person interventions to digital, are apparent. Appropriate training in how to work with software development teams may help future digital behavior intervention creators overcome these barriers and may lead to new, exciting innovations in this space. UR - https://www.jmir.org/2022/3/e34301 UR - http://dx.doi.org/10.2196/34301 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353043 ID - info:doi/10.2196/34301 ER - TY - JOUR AU - Marcu, Gabriela AU - Ondersma, J. Steven AU - Spiller, N. Allison AU - Broderick, M. Brianna AU - Kadri, Reema AU - Buis, R. Lorraine PY - 2022/3/30 TI - The Perceived Benefits of Digital Interventions for Behavioral Health: Qualitative Interview Study JO - J Med Internet Res SP - e34300 VL - 24 IS - 3 KW - computers KW - mobile apps KW - screening KW - brief interventions KW - diagnosis KW - computer-assisted/methods KW - surveys and questionnaires KW - motivational interviewing KW - therapy KW - implementation KW - qualitative KW - mobile phone N2 - Background: Digital interventions have gained momentum in terms of behavioral health. However, owing to lacking standard approaches or tools for creating digital behavioral interventions, clinical researchers follow widely varying conceptions of how best to go about digital intervention development. Researchers also face significant cost-, time-, and expertise-related challenges in digital intervention development. Improving the availability of tools and guidance for researchers will require a thorough understanding of the motivations and needs of researchers seeking to create digital interventions. Objective: This study aims to understand the perceptions of behavioral researchers toward digital interventions, and inform the use of these interventions, by documenting the reasons why researchers are increasingly focusing their efforts on digital interventions and their perspectives on the perceived benefits that digital approaches can provide for researchers and intervention recipients. Methods: We conducted semistructured qualitative interviews with 18 researchers who had experience designing digital behavioral interventions or running studies with them. A convenience sample of interviewees was recruited from among users of the Computerized Intervention Authoring System platform, a web-based tool that facilitates the process of creating and deploying digital interventions in behavioral research. Interviews were conducted over teleconference between February and April 2020. Recordings from the interviews were transcribed and thematically analyzed by multiple coders. Results: Interviews were completed with 18 individuals and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project or study staff. Four major themes came out of the interviews concerning the benefits of digital interventions for behavioral health: convenience and flexibility for interventionists and recipients, support for implementing evidence-based interventions with fidelity, scaling and improving access to interventions, and getting a foot in the door despite stigma and disenfranchisement. Conclusions: Interviewees described a number of important potential benefits of digital interventions, particularly with respect to scientific rigor, scalability, and overcoming barriers to reaching more people. There are complex considerations with regard to translating behavior change strategies into digital forms of delivery, and interventionists make individual, sometimes unexpected, choices with minimal evidence of their relative effectiveness. Future research should investigate how behavioral researchers can be supported in making these choices toward usability, ease of access, and approachability of digital interventions. Our study underscores the need for authoring platforms that can facilitate the process of creating and deploying digital interventions to reach their full potential for interventionists and recipients alike. UR - https://www.jmir.org/2022/3/e34300 UR - http://dx.doi.org/10.2196/34300 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353045 ID - info:doi/10.2196/34300 ER - TY - JOUR AU - Wilson-Anumudu, Folasade AU - Quan, Ryan AU - Cerrada, Christian AU - Juusola, Jessie AU - Castro Sweet, Cynthia AU - Bradner Jasik, Carolyn AU - Turken, Michael PY - 2022/3/30 TI - Pilot Results of a Digital Hypertension Self-management Program Among Adults With Excess Body Weight: Single-Arm Nonrandomized Trial JO - JMIR Form Res SP - e33057 VL - 6 IS - 3 KW - hypertension KW - self-management KW - digital health KW - home measurement KW - lifestyle N2 - Background: Home-measured blood pressure (HMBP) in combination with comprehensive medication support and lifestyle change are the mainstays of evidence-based hypertension (HTN) management. To date, the precise components needed for effective HTN self-management programs have yet to be defined, and access to multicomponent targeted support for HTN management that include telemonitoring remain inaccessible and costly. Objective: The aim of this pilot study was to evaluate the impact of a digital HTN self-management program on blood pressure (BP) control among adults with excess body weight. Methods: A single-arm, nonrandomized trial was performed to evaluate a digital HTN self-management program that combines comprehensive lifestyle counseling with HTN education, guided HMBP, support for taking medications, and led by either a registered nurse or certified diabetes care and education specialist. A sample of 151 participants were recruited using a web-based research platform (Achievement Studies, Evidation Health Inc). The primary outcome was change in systolic BP from baseline to 3 months, and secondary outcomes included change in diastolic BP and medication adherence. Results: Participants? mean age was 44.0 (SD 9.3) years and mean BP was 139/85 mm Hg. At follow-up, systolic and diastolic BP decreased by 7 mm Hg (P<.001, 95% CI ?9.3 to ?4.7) and 4.7 mm Hg (P<.001, 95% CI ?6.3 to ?3.2), respectively. Participants who started with baseline BP at goal remained at goal. For participants with stage 1 HTN, systolic and diastolic BP decreased by 3.6 mm Hg (P=.09, 95% CI ?7.8 to 0.6) and 2.5 mm Hg (P=.03, 95% CI ?4.9 to ?0.3). Systolic and diastolic BP decreased by 10.3 mm Hg (P<.001, 95% CI ?13.4 to ?7.1) and 6.5 mm Hg (P<.001, 95% CI ?8.6 to ?4.4), respectively, for participants with stage 2 HTN. Medication adherence significantly improved (P=.02). Conclusions: This pilot study provides initial evidence that a digital HTN self-management program improves BP and medication adherence. UR - https://formative.jmir.org/2022/3/e33057 UR - http://dx.doi.org/10.2196/33057 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353040 ID - info:doi/10.2196/33057 ER - TY - JOUR AU - Hallenbeck, Wu Haijing AU - Jaworski, K. Beth AU - Wielgosz, Joseph AU - Kuhn, Eric AU - Ramsey, M. Kelly AU - Taylor, Katherine AU - Juhasz, Katherine AU - McGee-Vincent, Pearl AU - Mackintosh, Margaret-Anne AU - Owen, E. Jason PY - 2022/3/29 TI - PTSD Coach Version 3.1: A Closer Look at the Reach, Use, and Potential Impact of This Updated Mobile Health App in the General Public JO - JMIR Ment Health SP - e34744 VL - 9 IS - 3 KW - posttraumatic stress disorder KW - trauma KW - mental health KW - mHealth KW - mobile app KW - public health KW - self-management KW - mobile phone N2 - Background: With widespread smartphone ownership, mobile health apps (mHealth) can expand access to evidence-based interventions for mental health conditions, including posttraumatic stress disorder (PTSD). Research to evaluate new features and capabilities in these apps is critical but lags behind app development. The initial release of PTSD Coach, a free self-management app developed by the US Departments of Veterans Affairs and Defense, was found to have a positive public health impact. However, major stakeholder-driven updates to the app have yet to be evaluated. Objective: We aimed to characterize the reach, use, and potential impact of PTSD Coach Version 3.1 in the general public. As part of characterizing use, we investigated the use of specific app features, which extended previous work on PTSD Coach. Methods: We examined the naturalistic use of PTSD Coach during a 1-year observation period between April 20, 2020, and April 19, 2021, using anonymous in-app event data to generate summary metrics for users. Results: During the observation period, PTSD Coach was broadly disseminated to the public, reaching approximately 150,000 total users and 20,000 users per month. On average, users used the app 3 times across 3 separate days for 18 minutes in total, with steep drop-offs in use over time; a subset of users, however, demonstrated high or sustained engagement. More than half of users (79,099/128,691, 61.46%) accessed one or more main content areas of the app (ie, Manage Symptoms, Track Progress, Learn, or Get Support). Among content areas, features under Manage Symptoms (including coping tools) were accessed most frequently, by over 40% of users (53,314/128,691, 41.43% to 56,971/128,691, 44.27%, depending on the feature). Users who provided initial distress ratings (56,971/128,691, 44.27%) reported relatively high momentary distress (mean 6.03, SD 2.52, on a scale of 0-10), and the use of a coping tool modestly improved momentary distress (mean ?1.38, SD 1.70). Among users who completed at least one PTSD Checklist for DSM-5 (PCL-5) assessment (17,589/128,691, 13.67%), PTSD symptoms were largely above the clinical threshold (mean 49.80, SD 16.36). Among users who completed at least two PCL-5 assessments (4989/128,691, 3.88%), PTSD symptoms decreased from the first to last assessment (mean ?4.35, SD 15.29), with approximately one-third (1585/4989, 31.77%) of these users experiencing clinically significant improvements. Conclusions: PTSD Coach continues to fulfill its mission as a public health resource. Version 3.1 compares favorably with version 1 on most metrics related to reach, use, and potential impact. Although benefits appear modest on an individual basis, the app provides these benefits to a large population. For mHealth apps to reach their full potential in supporting trauma recovery, future research should aim to understand the utility of individual app features and identify strategies to maximize overall effectiveness and engagement. UR - https://mental.jmir.org/2022/3/e34744 UR - http://dx.doi.org/10.2196/34744 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348458 ID - info:doi/10.2196/34744 ER - TY - JOUR AU - Milne-Ives, Madison AU - Homer, Sophie AU - Andrade, Jackie AU - Meinert, Edward PY - 2022/3/29 TI - Associations Between Behavior Change Techniques and Engagement With Mobile Health Apps: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e35172 VL - 11 IS - 3 KW - engagement KW - behavior change techniques KW - telemedicine KW - mobile apps N2 - Background: Digitally enabled care along with an emphasis on self-management of health is steadily growing. Mobile health apps provide a promising means of supporting health behavior change; however, engagement with them is often poor and evidence of their impact on health outcomes is lacking. As engagement is a key prerequisite to health behavior change, it is essential to understand how engagement with mobile health apps and their target health behaviors can be better supported. Although the importance of engagement is emphasized strongly in the literature, the understanding of how different components of engagement are associated with specific techniques that aim to change behaviors is lacking. Objective: The purpose of this systematic review protocol is to provide a synthesis of the associations between various behavior change techniques (BCTs) and the different components and measures of engagement with mobile health apps. Methods: The review protocol was structured using the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) and the PICOS (Population, Intervention, Comparator, Outcome, and Study type) frameworks. The following seven databases will be systematically searched: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo, ScienceDirect, Cochrane Library, and Web of Science. Title and abstract screening, full-text review, and data extraction will be conducted by 2 independent reviewers. Data will be extracted into a predetermined form, any disagreements in screening or data extraction will be discussed, and a third reviewer will be consulted if consensus cannot be reached. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias 2 and the Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tools; descriptive and thematic analyses will be conducted to summarize the relationships between BCTs and the different components of engagement. Results: The systematic review has not yet started. It is expected to be completed and submitted for publication by May 2022. Conclusions: This systematic review will summarize the associations between different BCTs and various components and measures of engagement with mobile health apps. This will help identify areas where further research is needed to examine BCTs that could potentially support effective engagement and help inform the design and evaluation of future mobile health apps. Trial Registration: PROSPERO CRD42022312596; https://tinyurl.com/nhzp8223 International Registered Report Identifier (IRRID): PRR1-10.2196/35172 UR - https://www.researchprotocols.org/2022/3/e35172 UR - http://dx.doi.org/10.2196/35172 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348460 ID - info:doi/10.2196/35172 ER - TY - JOUR AU - Ghaemi, Nassir S. AU - Sverdlov, Oleksandr AU - van Dam, Joris AU - Campellone, Timothy AU - Gerwien, Robert PY - 2022/3/28 TI - A Smartphone-Based Intervention as an Adjunct to Standard-of-Care Treatment for Schizophrenia: Randomized Controlled Trial JO - JMIR Form Res SP - e29154 VL - 6 IS - 3 KW - digital therapeutics KW - schizophrenia KW - smartphones KW - randomized controlled trial KW - mobile phone N2 - Background: Antipsychotic medications have limited benefits in schizophrenia, and cognitive behavioral therapy may be beneficial as an adjunct. There may be potential for implementing mobile cognitive behavioral therapy?based treatment for schizophrenia in addition to standard antipsychotic medications. Objective: This study aims to determine whether PEAR-004, a smartphone-based investigational digital therapeutic, improves the symptoms of an acute psychotic exacerbation of schizophrenia when it is added to standard treatments. Methods: This was a 12-week, multicenter, randomized, sham-controlled, rater-blinded, parallel group proof?of?concept study of 112 participants with moderate acute psychotic exacerbation in schizophrenia. This study was conducted in 6 clinical trial research sites in the United States from December 2018 to September 2019. The primary outcome, change in Positive and Negative Syndrome Scale (PANSS) from baseline to week 12 or the last available visit, was analyzed using the mixed-effects regression model for repeated measures, applied to an intent-to-treat sample. Results: The total PANSS scores slightly decreased from baseline over the study period in both groups; the treatment difference at day 85 between PEAR-004 and sham was 2.7 points, in favor of the sham (2-sided P=.09). The secondary scales found no benefit, except for transient improvement in depressive symptoms with PEAR-004. Application engagement was good, and patient and clinical investigator satisfaction was high. No safety concerns were observed. There was some evidence of study site heterogeneity for the onboarding processes and directions on PEAR-004 product use at baseline and throughout the study. However, these differences did not affect the efficacy results. Conclusions: In the largest-to-date randomized, sham-controlled study of a digital therapeutic in schizophrenia, PEAR-004 did not demonstrate an effect on the primary outcome?total PANSS scores?when compared with a nonspecific digital sham control. The secondary and exploratory results also did not demonstrate any notable benefits, except for possible temporary improvement in depressive symptoms. This study provided many useful scientific and operational insights that can be used in the further clinical development of PEAR-004 and other investigational digital therapeutics. Trial Registration: ClinicalTrials.gov NCT03751280; https://clinicaltrials.gov/ct2/show/NCT03751280 UR - https://formative.jmir.org/2022/3/e29154 UR - http://dx.doi.org/10.2196/29154 UR - http://www.ncbi.nlm.nih.gov/pubmed/35343910 ID - info:doi/10.2196/29154 ER - TY - JOUR AU - Rosen, K. Rochelle AU - Garbern, C. Stephanie AU - Gainey, Monique AU - Lantini, Ryan AU - Nasrin, Sabiha AU - Nelson, J. Eric AU - Elshabassi, Nour AU - Alam, H. Nur AU - Sultana, Sufia AU - Hasnin, Tahmida AU - Qu, Kexin AU - Schmid, H. Christopher AU - Levine, C. Adam PY - 2022/3/25 TI - Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Study JO - JMIR Hum Factors SP - e33325 VL - 9 IS - 1 KW - clinical decision support tools KW - diarrhea management KW - focus group KW - formative qualitative research KW - low- and middle-income countries KW - mobile phone N2 - Background: The availability of mobile clinical decision support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and apps. Although health care providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns have been raised, including perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider?s perspective on the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle-income countries. Objective: This study aims to describe providers? perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on the preliminary components of the mobile CDS tool to address clinicians? concerns and incorporate their preferences. Methods: From November to December 2020, qualitative data were gathered through 8 web-based focus group discussions with physicians and nurses from 3 Bangladeshi hospitals. Each discussion was conducted in the local language?Bangla?and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo (version 12; QSR International), and applied thematic analysis was used to identify themes that explore the clinical utility of an mHealth app for assessing dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data; thematic memos were written and used for the final analysis. Results: Of the 27 focus group participants, 14 (52%) were nurses and 13 (48%) were physicians; 15 (56%) worked at a diarrhea specialty hospital and 12 (44%) worked in government district or subdistrict hospitals. Participants? experience in their current position ranged from 2 to 14 years, with an average of 10.3 (SD 9.0) years. Key themes from the qualitative data analysis included current experience with CDS, overall perception of the app?s utility and its potential role in clinical care, barriers to and facilitators of app use, considerations of overtreatment and undertreatment, and guidelines for the app?s clinical recommendations. Participants felt that the tool would initially take time to use, but once learned, it could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. In addition, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. Conclusions: Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to revise the mobile CDS tool. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh. UR - https://humanfactors.jmir.org/2022/1/e33325 UR - http://dx.doi.org/10.2196/33325 UR - http://www.ncbi.nlm.nih.gov/pubmed/35333190 ID - info:doi/10.2196/33325 ER - TY - JOUR AU - Lahtio, Heli AU - Rintala, Aki AU - Immonen, Jaakko AU - Sjögren, Tuulikki PY - 2022/3/24 TI - The Effectiveness of Physical Activity-Promoting Web- and Mobile-Based Distance Weight Loss Interventions on Body Composition in Rehabilitation Settings: Systematic Review, Meta-analysis, and Meta-Regression Analysis JO - J Med Internet Res SP - e25906 VL - 24 IS - 3 KW - technology KW - weight loss KW - rehabilitation KW - overweight KW - obesity KW - body mass index KW - waist circumference KW - body fat percentage KW - mobile phone N2 - Background: Overweight and obesity are major problems worldwide, and they lead to an increased risk for several diseases. The use of technology in the treatment of obesity is promising, but in the existing literature, there is considerable uncertainty regarding its efficacy. In this review, we included web- and mobile-based weight loss interventions that were implemented remotely in rehabilitation settings. Objective: The aim of this systematic review is to study the effectiveness of physical activity-promoting web- and mobile-based distance weight loss interventions in rehabilitation settings on body composition in comparison with control groups that did not use technology. Methods: Studies were searched from 9 databases. The inclusion criteria were as follows: population: age 18-65 years; intervention: physical activity-promoting web- and mobile-based distance weight loss interventions; comparison: control groups without the use of technology; outcome: changes in BMI, waist circumference, or body fat percentage; study design: randomized controlled trial. The quality of the studies was assessed by 2 researchers. Meta-analysis was performed, and we also conducted a meta-regression analysis to evaluate the factors associated with the changes in body composition outcomes if statistical heterogeneity was observed. Results: The meta-analysis included 30 studies. The mean quality of the studies was 7 of 13 (SD 1.9; range 3-10). A statistically significant difference was observed in BMI (mean difference [MD] 0.83, 95% CI 0.51-1.15 kg/m2; P<.001), waist circumference (MD 2.45, 95% CI 1.83-3.07 cm; P<.001), and body fat percentage (MD 1.07%, 95% CI 0.74%-1.41%; P<.001) in favor of the weight loss groups using web- or mobile-based interventions. Meta-regression analyses found an association between personal feedback and BMI (P=.04), but other factors did not play a role in explaining statistical heterogeneity. Conclusions: Web- and mobile-based distance weight loss interventions significantly reduced BMI, waist circumference, and body fat percentage. Future studies should focus on the comparability of the intervention content. Future studies are needed to better understand weight loss and identify which components are essential in achieving it. Trial Registration: PROSPERO CRD42016035831; https://tinyurl.com/7c93tvd4 UR - https://www.jmir.org/2022/3/e25906 UR - http://dx.doi.org/10.2196/25906 UR - http://www.ncbi.nlm.nih.gov/pubmed/35323126 ID - info:doi/10.2196/25906 ER - TY - JOUR AU - Kondo, Masahiro AU - Okitsu, Teru AU - Waki, Kayo AU - Yamauchi, Toshimasa AU - Nangaku, Masaomi AU - Ohe, Kazuhiko PY - 2022/3/24 TI - Effect of Information and Communication Technology?Based Self-management System DialBeticsLite on Treating Abdominal Obesity in the Specific Health Guidance in Japan: Randomized Controlled Trial JO - JMIR Form Res SP - e33852 VL - 6 IS - 3 KW - mHealth KW - smartphone app KW - abdominal obesity KW - self-management KW - telemedicine KW - digital health KW - app KW - obesity KW - overweight KW - weight KW - randomized controlled trial KW - intervention KW - lifestyle KW - behavior KW - mobile phone N2 - Background: Mobile health (mHealth) interventions, a more cost-effective approach compared with traditional methods of delivering lifestyle coaching in person, have been shown to improve physical parameters and lifestyle behavior among overweight populations. In Japan, the Specific Health Checkups and Specific Health Guidance (SHG) started in 2008 to treat obesity and abdominal obesity. However, the effectiveness of SHG is limited owing to its in-person counseling. The effect of mHealth on SHG has yet to be demonstrated. Objective: This study aims to determine whether a mobile self-management app (DialBeticsLite) could make the SHG more beneficial among patients with abdominal obesity to achieve a reduction in visceral fat area (VFA). Methods: This study was an open-label, 2-arm, parallel-design randomized controlled trial. We recruited 122 people in September 2017 and randomly assigned them into either the intervention or control group. All participants attended an educational group session that delivered information regarding diet and exercise. In addition, participants in the intervention group were asked to use DialBeticsLite for 3 months. DialBeticsLite facilitated the daily recording of several physical parameters and lifestyle behavior and provided feedback to encourage an improvement in behavior. The primary outcome was the change in VFA from baseline to the 3-month follow-up. Secondary outcomes included changes in both physical and metabolic parameters from baseline to the 3-month follow-up. The Welch 2-tailed t test was conducted to analyze the effects of DialBeticsLite on both the primary and secondary outcomes. Results: Of the 122 participants recruited, 75 (61.5%) were analyzed because 47 (38.5%) were excluded: 37 (30.3%) because of ineligibility and 10 (8.2%) because of withdrawal of consent. The mean age was 49.3 (SD 6.1) years in the intervention group (41/75, 55%) and 48.5 (SD 5.3) years in the control group (34/75, 45%), and all participants were men, although unintentionally. The baseline characteristics did not differ significantly between the intervention and control groups, except for VFA. The average change of VFA was ?23.5 (SD 20.6) cm2 in the intervention group and +1.9 (SD 16.2) cm2 in the control group (P<.001). Statistically significant differences were also found for the change of body weight, BMI, and waist circumference. These findings did not change after adjusting for VFA at the baseline. The intervention had no significant effect on any of the metabolic parameters. An exploratory analysis showed significant associations between the change in VFA and steps per day and between the change in VFA and calorie intake per day within the intervention group. Conclusions: Our findings indicate that an mHealth intervention facilitating the daily monitoring of several physical parameters and lifestyle behavior can be highly effective in inducing visceral fat loss and weight loss among adults eligible for SHG. Trial Registration: UMIN Clinical Trials Registry UMIN000042045; https://tinyurl.com/4vat3v53 UR - https://formative.jmir.org/2022/3/e33852 UR - http://dx.doi.org/10.2196/33852 UR - http://www.ncbi.nlm.nih.gov/pubmed/35323122 ID - info:doi/10.2196/33852 ER - TY - JOUR AU - Resnick, Daniel AU - Kearney, D. Matthew AU - Smith, M. Jazmine AU - Bautista, Allison AU - Jones, Liz AU - Schapira, M. Marilyn AU - Aysola, Jaya PY - 2022/3/24 TI - Designing a Cancer Prevention Collaborative Goal-Setting Mobile App for Non-Hispanic Black Primary Care Patients: An Iterative, Qualitative Patient-Led Process JO - JMIR Form Res SP - e28157 VL - 6 IS - 3 KW - mHealth KW - cancer prevention KW - goal setting KW - social networks KW - health disparities KW - primary care KW - accessibility KW - development KW - feasibility KW - mobile phone N2 - Background: There remains a need to engage at-risk primary care populations in cancer prevention behaviors, yet primary care physicians often lack the time or resources to discuss these behaviors with their patients. Objective: The objective of this study is to evaluate the content, usability, and acceptability of a mobile app that leverages insights from goal-setting and social network literature to facilitate cancer prevention goal setting, tracking, and sharing between non-Hispanic Black primary care patients and their social ties. Methods: We recruited eligible non-Hispanic Black primary care patients (aged ?18 years) from 2 practice sites in West Philadelphia, using nonprobabilistic purposive sampling. We conducted semistructured interviews with 5 to 7 participants over 3 weeks to solicit feedback on paper mock-ups of the app, iteratively adapting these mock-ups after each set of interviews. Thereafter, and informed by initial feedback, we created an electronic beta version of the app and sought acceptability and usability feedback from a different set of participants. Then, we conducted content analysis of all user responses to search for unifying themes on acceptability and usability of both the initial mock-ups and beta version of the app. We further assessed app usability using questions derived from the System Usability Scale. Results: A total of 33 non-Hispanic Black primary care patients participated in this study. The mean age was 49 (SD 13) years, and 26 (79%) out of 33 participants identified as female. Semistructured interviews revealed three primary generalizable insights from our target population: the framing of each goal and its relevance to cancer impacted the likelihood that the goal would be chosen, participants thought that sharing health goals with others facilitates health behaviors, and most participants found it motivating to see other users? goal progress, while still collaborating with these users on their health goals. An overarching insight that permeated across each theme was the participants? desire to customize and personalize the app. Usability testing revealed that 100% (33/33) of participants found the app easy to use, and 76% (25/33) of participants reported that they would like to use this app frequently. Conclusions: Cancer prevention in the modern era must include options that are accessible to all, but this does not mean that all options must be universal. This study?s iterative process led to the development of a cancer prevention mobile app that non-Hispanic Black primary care patients deemed usable and acceptable and yielded noteworthy insights about what intended end users value in setting and accomplishing health goals. UR - https://formative.jmir.org/2022/3/e28157 UR - http://dx.doi.org/10.2196/28157 UR - http://www.ncbi.nlm.nih.gov/pubmed/35323124 ID - info:doi/10.2196/28157 ER - TY - JOUR AU - Evans, Kerry AU - Donelan, Jasper AU - Rennick-Egglestone, Stefan AU - Cox, Serena AU - Kuipers, Yvonne PY - 2022/3/23 TI - Review of Mobile Apps for Women With Anxiety in Pregnancy: Maternity Care Professionals? Guide to Locating and Assessing Anxiety Apps JO - J Med Internet Res SP - e31831 VL - 24 IS - 3 KW - anxiety KW - pregnancy KW - antenatal KW - mobile applications KW - digital interventions KW - mHealth KW - mobile app KW - psychological well-being KW - maternity KW - evaluation KW - quality assessment N2 - Background: Mental health and pregnancy apps are widely available and have the potential to improve health outcomes and enhance women?s experience of pregnancy. Women frequently access digital information throughout their pregnancy. However, health care providers and women have little information to guide them toward potentially helpful or effective apps. Objective: This review aimed to evaluate a methodology for systematically searching and reviewing commercially available apps that support pregnant women with symptoms of anxiety in order to assist maternity care professionals in identifying resources that they could recommend for these women. Methods: A stepwise systematic approach was used to identify, select, describe, and assess the most popular and highly user-rated apps available in the United Kingdom from January to March 2021. This included developing a script-based search strategy and search process, writing evaluation criteria, and conducting a narrative description and evaluation of the selected apps. Results: Useful search terms were identified, which included nonclinical, aspirational, and problem-based phrases. There were 39 apps selected for inclusion in the review. No apps specifically targeted women with anxiety in pregnancy. Of the 39 apps included in the review, 33 (85%) focused solely on mind-body techniques to promote relaxation, stress reduction, and psychological well-being. Only 8 of the 39 (21%) apps included in the review reported that health care professionals had contributed to app development and only 1/39 (3%) provided empirical evidence on the effectiveness and acceptability of the app. The top 12/39 (31%) apps were evaluated by 2 independent reviewers using the developed criteria and scores. There was a small negative correlation between the reviewers? scores and app user rating scores, with higher user rating scores associated with lower reviewer scores. Conclusions: App developers, publishers, and maternity care professionals should seek advice from women with lived experience of anxiety symptoms in pregnancy to locate, promote, and optimize the visibility of apps for pregnant women. There is a lack of resources that provide coping strategies based on current evidence for the treatment of anxiety in pregnancy. Maternity care providers are limited in their ability to locate and recommend acceptable and trustworthy apps because of the lack of information on the evidence base, development, and testing of apps. Maternity care professionals and women need access to libraries of trusted apps that have been evaluated against relevant and established criteria. UR - https://www.jmir.org/2022/3/e31831 UR - http://dx.doi.org/10.2196/31831 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319482 ID - info:doi/10.2196/31831 ER - TY - JOUR AU - Tatham, Iona AU - Clarke, Ellisiv AU - Grieve, Ann Kelly AU - Kaushal, Pulkit AU - Smeddinck, Jan AU - Millar, Barron Evelyn AU - Sharma, Narain Aditya PY - 2022/3/23 TI - Process and Outcome Evaluations of Smartphone Apps for Bipolar Disorder: Scoping Review JO - J Med Internet Res SP - e29114 VL - 24 IS - 3 KW - child and adolescent mental health KW - scoping review KW - bipolar disorder KW - mental health N2 - Background: Mental health apps (MHAs) provide opportunities for accessible, immediate, and innovative approaches to better understand and support the treatment of mental health disorders, especially those with a high burden, such as bipolar disorder (BD). Many MHAs have been developed, but few have had their effectiveness evaluated. Objective: This systematic scoping review explores current process and outcome measures of MHAs for BD with the aim to provide a comprehensive overview of current research. This will identify the best practice for evaluating MHAs for BD and inform future studies. Methods: A systematic literature search of the health science databases PsycINFO, MEDLINE, Embase, EBSCO, Scopus, and Web of Science was undertaken up to January 2021 (with no start date) to narratively assess how studies had evaluated MHAs for BD. Results: Of 4051 original search results, 12 articles were included. These 12 studies included 435 participants, and of these, 343 had BD type I or II. Moreover, 11 of the 12 studies provided the ages (mean 37 years) of the participants. One study did not report age data. The male to female ratio of the 343 participants was 137:206. The most widely employed validated outcome measure was the Young Mania Rating Scale, being used 8 times. The Hamilton Depression Rating Scale-17/Hamilton Depression Rating Scale was used thrice; the Altman Self-Rating Mania Scale, Quick Inventory of Depressive Symptomatology, and Functional Assessment Staging Test were used twice; and the Coping Inventory for Stressful Situations, EuroQoL 5-Dimension Health Questionnaire, Generalized Anxiety Disorder Scale-7, Inventory of Depressive Symptomatology, Mindfulness Attention Awareness Scale, Major Depression Index, Morisky-Green 8-item, Perceived Stress Scale, and World Health Organization Quality of Life-BREF were used once. Self-report measures were captured in 9 different studies, 6 of which used MONARCA. Mood and energy levels were the most commonly used self-report measures, being used 4 times each. Furthermore, 11 of the 12 studies discussed the various confounding factors and barriers to the use of MHAs for BD. Conclusions: Reported low adherence rates, usability challenges, and privacy concerns act as barriers to the use of MHAs for BD. Moreover, as MHA evaluation is itself developing, guidance for clinicians in how to aid patient choices in mobile health needs to develop. These obstacles could be ameliorated by incorporating co-production and co-design using participatory patient approaches during the development and evaluation stages of MHAs for BD. Further, including qualitative aspects in trials that examine patient experience of both mental ill health and the MHA itself could result in a more patient-friendly fit-for-purpose MHA for BD. UR - https://www.jmir.org/2022/3/e29114 UR - http://dx.doi.org/10.2196/29114 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319470 ID - info:doi/10.2196/29114 ER - TY - JOUR AU - Lee, M. Jennifer AU - Woon, Rex AU - Ramsum, Mandy AU - Halperin, S. Daniel AU - Jain, Roshini PY - 2022/3/23 TI - User Engagement and Assessment of Treatment Effectiveness in Patients Using a Novel Digital mHealth App During Spinal Cord Stimulation Screening Trials JO - JMIR eHum Factors SP - e35134 VL - 9 IS - 1 KW - spinal cord stimulation KW - SCS KW - chronic pain KW - digital health KW - smartphone app KW - mobile health KW - mHealth KW - smart device KW - digital application KW - application KW - app KW - spine N2 - Background: Patient outcomes and experience during a Spinal Cord Stimulation (SCS) screening trial can have a significant effect on whether to proceed with long-term, permanent implantation of an SCS device for the treatment of chronic pain. Enhancing the ability to track and assess patients during this initial trial evaluation offers the potential for improved understanding regarding the suitability of permanent device implantation as well as identification of the SCS-based neurostimulative modalities and parameters that may provide substantial analgesia in a patient-specific manner. Objective: In this report, we aimed to describe a preliminary, real-world assessment of a new, real time tracking, smart, device-based digital app used by patients with chronic pain undergoing trial screening for SCS therapy. Methods: This is a real-world, retrospective evaluation of 13,331 patients diagnosed with chronic pain who used the new ?mySCS? mobile app during an SCS screening trial. The app design is health insurance portability and accountability act (HIPAA)-compliant and compatible with most commercially available smartphones (eg, Apple, iPhone, and Android). The app enables tracking of user-inputted health-related responses (ie, pain relief, activity level, and sleep quality) in addition to personal trial goals and a summary of overall experience during the SCS trial. A deidentified, aggregate analysis of user engagement, user-submitted responses, and overall trial success was conducted. Results: When provided the opportunity, the percentage of users who engaged with the tracking app for ?50% of the time during their trial was found to be 64.43% (n=8589). Among the 13,331 patients who used the app, 58.24% (n=7764) entered a trial goal. Most patients underwent SCS screening with a trial duration of at least 7 days (n=7739, 58.05%). Of those patients who undertook a 7-day SCS trial, 62.30% (n=3456) engaged the app for 4 days or more. In addition, among all who submitted descriptive responses using the app, health-related improvements were reported by 77.84% (n=10,377) of patients who reached day 3 of the screening phase assessment and by 83.04% (n=11,070) of those who reached trial completion. A trial success rate of 91% was determined for those who used the app (versus 85% success rate for nonusers). Conclusions: Data from this initial, real-world examination of a mobile, digital-health?based tracking app (?mySCS?), as used during the SCS screening phase, demonstrate that substantial patient engagement can be achieved while also providing for the acquisition of more real time patient-outcome measures that may help facilitate improved SCS trial success. UR - https://humanfactors.jmir.org/2022/1/e35134 UR - http://dx.doi.org/10.2196/35134 UR - http://www.ncbi.nlm.nih.gov/pubmed/35167484 ID - info:doi/10.2196/35134 ER - TY - JOUR AU - Krohn, Holly AU - Guintivano, Jerry AU - Frische, Rachel AU - Steed, Jamie AU - Rackers, Hannah AU - Meltzer-Brody, Samantha PY - 2022/3/23 TI - App-Based Ecological Momentary Assessment to Enhance Clinical Care for Postpartum Depression: Pilot Acceptability Study JO - JMIR Form Res SP - e28081 VL - 6 IS - 3 KW - postpartum care KW - depression KW - mobile health KW - mHealth KW - ecological momentary assessment (EMA) KW - mobile apps KW - personalized care KW - mobile phone N2 - Background: Wearable tracking devices and mobile health technology are increasingly used in an effort to enhance clinical care and the delivery of personalized medical treatment. Postpartum depression is the most frequently diagnosed complication of childbirth; however, significant gaps in screening and treatment remain. Objective: This study aims to investigate the clinical utility, predictive ability, and acceptability of using ecological momentary assessment to collect daily mood, sleep, and activity data through the use of an Apple Watch and mobile app among women with postpartum depression. Methods: This was a pilot study consisting of 3 in-person research visits over the course of a 6-week enrollment period. Questionnaires to assess depression, anxiety, and maternal functioning were periodically collected, along with daily self-reported symptoms and passively collected physiological data via an Apple Watch. Feedback was collected from study participants and the study clinician to determine the utility and acceptability of daily tracking. Logistic regression was used to determine whether mood scores in the 2 weeks before a visit predicted scores at follow-up. Compliance with daily assessments was also measured. Results: Of the 26 women enrolled, 23 (88%) completed the 6-week study period. On average, the participants completed 67% (34.4/51.5 days) of all active daily assessments and 74% (38/51.5 days) of all passive measures. Furthermore, all 23 participants completed the 3 required visits with the research team. Predictive correlations were found between self-reported mood and Edinburgh Postnatal Depression Scale score at follow-up, self-reported anxiety and EDPS, and sleep quality and Edinburgh Postnatal Depression Scale. Conclusions: Using ecological momentary assessment to track daily symptoms of postpartum depression using a wearable device was largely endorsed as acceptable and clinically useful by participants and the study clinician and could be an innovative solution to increase care access during the COVID-19 pandemic. UR - https://formative.jmir.org/2022/3/e28081 UR - http://dx.doi.org/10.2196/28081 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319483 ID - info:doi/10.2196/28081 ER - TY - JOUR AU - Bonn, Stephanie AU - Licitra, Gabriella AU - Bellocco, Rino AU - Trolle Lagerros, Ylva PY - 2022/3/21 TI - Clinical Outcomes Among Working Adults Using the Health Integrator Smartphone App: Analyses of Prespecified Secondary Outcomes in a Randomized Controlled Trial JO - J Med Internet Res SP - e24725 VL - 24 IS - 3 KW - adults KW - body composition KW - exercise KW - HbA1c KW - healthy lifestyle KW - metabolic health KW - mobile app KW - randomized controlled trial KW - smartphone N2 - Background: There is a need to find new methods that can enhance the individuals? engagement in self-care and increase compliance to a healthy lifestyle for the prevention of noncommunicable diseases and improved quality of life. Mobile health (mHealth) apps could provide large-scale, cost-efficient digital solutions to implement lifestyle change, which as a corollary may enhance quality of life. Objective: Here we evaluate if the use of a smartphone-based self-management system, the Health Integrator app, with or without telephone counseling by a health coach, had an effect on clinical variables (secondary outcomes) of importance for noncommunicable diseases. Methods: The study was a 3-armed parallel randomized controlled trial. Participants were randomized to a control group or to 1 of 2 intervention groups using the Health Integrator app with or without additional telephone counseling for 3 months. Clinical variables were assessed before the start of the intervention (baseline) and after 3 months. Due to the nature of the intervention, targeting lifestyle changes, participants were not blinded to their allocation. Robust linear regression with complete case analysis was performed to study the intervention effect among the intervention groups, both in the entire sample and stratifying by type of work (office worker vs bus driver) and sex. Results: Complete data at baseline and follow-up were obtained from 205 and 191 participants, respectively. The mean age of participants was 48.3 (SD 10) years; 61.5% (126/205) were men and 52.2% (107/205) were bus drivers. Improvements were observed at follow-up among participants in the intervention arms. There was a small statistically significant effect on waist circumference (?=?0.97, 95% CI ?1.84 to ?0.10) in the group receiving the app and additional coach support compared to the control group, but no other statistically significant differences were seen. However, participants receiving only the app had statistically significantly lower BMI (?=?0.35, 95% CI ?0.61 to ?0.09), body weight (?=?1.08, 95% CI ?1.92 to ?0.26), waist circumference (?=?1.35, 95% CI ?2.24 to ?0.45), and body fat percentage (?=?0.83, 95% CI ?1.65 to ?0.02) at follow-up compared to the controls. There was a statistically significant difference in systolic blood pressure between the two intervention groups at follow-up (?=?3.74, 95% CI ?7.32 to ?0.16); no other statistically significant differences in outcome variables were seen. Conclusions: Participants randomized to use the Health Integrator smartphone app showed small but statistically significant differences in body weight, BMI, waist circumference, and body fat percentage compared to controls after a 3-month intervention. The effect of additional coaching together with use of the app is unclear. Trial Registration: ClinicalTrials.gov NCT03579342; https://clinicaltrials.gov/ct2/show/NCT03579342 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-6595-6 UR - https://www.jmir.org/2022/3/e24725 UR - http://dx.doi.org/10.2196/24725 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311677 ID - info:doi/10.2196/24725 ER - TY - JOUR AU - Johnson, E. Amber AU - Routh, Shuvodra AU - Taylor, N. Christy AU - Leopold, Meagan AU - Beatty, Kathryn AU - McNamara, M. Dennis AU - Davis, M. Esa PY - 2022/3/21 TI - Developing and Implementing an mHealth Heart Failure Self-care Program to Reduce Readmissions: Randomized Controlled Trial JO - JMIR Cardio SP - e33286 VL - 6 IS - 1 KW - mHealth KW - heart failure KW - self-care KW - remote monitoring KW - telehealth KW - cardiology KW - hospital readmission KW - self-management KW - mobile health KW - patient-centered N2 - Background: Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life during the discharge period. Lifestyle behavior modifications that promote the self-management of chronic cardiac diseases have been associated with an improved quality of life. However, whether a mobile health (mHealth) program can assist patients in the self-management of HF during the acute posthospital discharge period is unknown. Objective: We aimed to develop an mHealth program designed to enhance patients? self-management of HF by increasing knowledge, self-efficacy, and symptom detection. We hypothesized that patients hospitalized with HF would be willing to use a feasibly deployed mHealth program after their hospital discharge. Methods: We employed a patient-centered outcomes research methodology to design a stakeholder-informed mHealth program. Adult patients with HF admitted to a large academic hospital were enrolled and randomized to receive the mHealth intervention versus usual care. Our feasibility outcomes included ease of program deployment, use of the clinical escalation process, duration of participant recruitment, and participant attrition. Surveys assessing the demographics and clinical characteristics of HF were measured at baseline and at 30 and 90 days after discharge. Results: The study period was between July 1, 2019, and April 7, 2020. The mean cohort (N=31) age was 60.4 (range 22-85) years. Over half of the participants were men (n=18, 58%) and 77% (n=24) were White. There were no significant differences in baseline measures. We determined that an educational mHealth program tailored for patients with HF is feasibly deployed and acceptable by patients. Though not significant, we found notable trends including a higher mean quality of life at 30 days posthospitalization among program users and a longer duration before rehospitalization, which are suggestive of better HF prognosis. Conclusions: Our mHealth tool should be further assessed in a larger comparative effectiveness trial. Our pilot intervention offers promise as an innovative means to help HF patients lead healthy, independent lives. These preliminary data suggest that patient-centered mHealth tools can enable high-risk patients to play a role in the management of their HF after discharge. Trial Registration: ClinicalTrials.gov NCT03982017; https://clinicaltrials.gov/ct2/show/NCT03982017 UR - https://cardio.jmir.org/2022/1/e33286 UR - http://dx.doi.org/10.2196/33286 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311679 ID - info:doi/10.2196/33286 ER - TY - JOUR AU - Kranenburg, W. Leonieke AU - Gillis, Jamie AU - Mayer, Birgit AU - Hoogendijk, G. Witte J. PY - 2022/3/18 TI - The Effectiveness of a Nonguided Mindfulness App on Perceived Stress in a Nonclinical Dutch Population: Randomized Controlled Trial JO - JMIR Ment Health SP - e32123 VL - 9 IS - 3 KW - mHealth KW - mindfulness KW - stress KW - burnout KW - non-clinical population KW - nonclinical N2 - Background: Mindfulness has become increasingly popular, and positive outcomes have been reported for mindfulness-based interventions (MBIs) in reducing stress. These findings make room for innovative perspectives on how MBIs could be applied, for instance through mobile health (mHealth). Objective: The aim of this study is to investigate whether a nonguided mindfulness mobile app can decrease perceived stress in a nonclinical Dutch population over the course of 8 weeks, with follow-up at 6 months. Methods: A randomized controlled trial was performed to compare an experimental group that made use of a structured 8-week mHealth mindfulness program and a control group after 8 weeks, with follow-up after 6 months. Participants were recruited via a national television program. The primary outcome measure was perceived stress as measured by the Perceived Stress Scale, secondary outcomes were symptoms of burnout (measured using the visual analog scale [VAS]) and psychological symptoms (measured using the Four-Dimensional Symptom Questionnaire [4DSQ] at follow-up). Outcomes were analyzed using a multilevel regression model. Results: At baseline, 587 respondents were included. Results showed no postintervention differences between groups for the level of perceived stress. With regard to the secondary outcome measures, the VAS for emotional exhaustion and physical exhaustion showed significantly lower scores for the experimental group after 8 weeks (P=.04 and P=.01, respectively), but not at follow-up. There were no differences between groups for psychological symptoms measured using the 4DSQ. Conclusions: These findings do not support our hypothesis that using the mindfulness app would reduce stress levels. However, our findings related to diminished exhaustion at 8 weeks are encouraging and require further investigation. Trial Registration: ClinicalTrials.gov NCT05246800; https://clinicaltrials.gov/show/NCT05246800 UR - https://mental.jmir.org/2022/3/e32123 UR - http://dx.doi.org/10.2196/32123 UR - http://www.ncbi.nlm.nih.gov/pubmed/35302504 ID - info:doi/10.2196/32123 ER - TY - JOUR AU - Budenz, Alexandra AU - Coa, Kisha AU - Grenen, Emily AU - Keefe, Brian AU - Sanders, Amy AU - Wiseman, P. Kara AU - Roditis, Maria PY - 2022/3/18 TI - User Experiences With an SMS Text Messaging Program for Smoking Cessation: Qualitative Study JO - JMIR Form Res SP - e32342 VL - 6 IS - 3 KW - smoking cessation KW - text messaging interventions KW - qualitative research KW - mobile phone N2 - Background: Mobile health strategies for smoking cessation (eg, SMS text messaging?based interventions) have been shown to be effective in helping smokers quit. However, further research is needed to better understand user experiences with these platforms. Objective: This qualitative study aims to explore the experiences of real-world users of a publicly available smoking cessation program (SmokefreeTXT). Methods: Semistructured phone interviews were conducted with 36 SmokefreeTXT users between March and July 2014. Of these 36 participants, 50% (18/36) of participants completed the SmokefreeTXT program (ie, did not opt out of the program before the 6- to 8-week completion period), and 50% (18/36) did not complete the program (ie, requested to opt out of the program before the completion period). Interview questions focused on smoking behaviors, quitting history, opinions on the program?s content and structure, answering assessment questions, using keywords, reasons for opting out, and perceived usefulness of the program for quitting smoking. A thematic content analysis was conducted, with a focus on themes to increase program engagement and optimization. Results: The findings highlighted features of the program that participants found beneficial, as well as some elements that showed opportunities for improvement to boost program retention and successful cessation. Specifically, most participants found the SmokefreeTXT program to be convenient and supportive of cessation; however, some found the messages to be repetitive and reported a desire for more flexibility based on their readiness to quit and cessation progress. We also found that program completion did not necessarily indicate successful smoking cessation and that program opt out, which might be interpreted as a less positive outcome, may occur because of successful cessation. Finally, several participants reported using SmokefreeTXT together with other evidence-based cessation methods or non?evidence-based strategies. Conclusions: Qualitative interviews with real-world SmokefreeTXT users showed high program acceptability, engagement with program features, and perceived utility for smoking cessation. Our findings directly informed several program updates, such as adding an adaptive quit date feature and offering supplemental information on live support services for users who prefer human interaction during the cessation process. The study has implications for other digital tobacco cessation interventions and highlights important topics that warrant future research, such as the relationship between program engagement (eg, opt out and retention) and successful cessation. UR - https://formative.jmir.org/2022/3/e32342 UR - http://dx.doi.org/10.2196/32342 UR - http://www.ncbi.nlm.nih.gov/pubmed/35302505 ID - info:doi/10.2196/32342 ER - TY - JOUR AU - Jenkins, L. Catherine AU - Imran, Sumayyah AU - Mahmood, Aamina AU - Bradbury, Katherine AU - Murray, Elizabeth AU - Stevenson, Fiona AU - Hamilton, L. Fiona PY - 2022/3/18 TI - Digital Health Intervention Design and Deployment for Engaging Demographic Groups Likely to Be Affected by the Digital Divide: Protocol for a Systematic Scoping Review JO - JMIR Res Protoc SP - e32538 VL - 11 IS - 3 KW - digital divide KW - digital health interventions KW - DHIs KW - eHealth KW - digital health literacy KW - health inequalities KW - health inequities KW - mHealth KW - mobile health N2 - Background: Digital health interventions refer to interventions designed to support health-related knowledge transfer and are delivered via digital technologies, such as mobile apps. Digital health interventions are a double-edged sword: they have the potential to reduce health inequalities, for example, by making treatments available remotely to rural populations underserved by health care facilities or by helping to overcome language barriers via in-app translation services; however, if not designed and deployed with care, digital health interventions also have the potential to increase health inequalities and exacerbate the effects of the digital divide. Objective: The aim of this study is to review ways to mitigate the digital divide through digital health intervention design, deployment, and engagement mechanisms sensitive to the needs of digitally excluded populations. Methods: This protocol outlines the procedure for a systematic scoping review that follows the methodology recommended by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidance. The following databases will be searched for primary research studies published in English from October 1, 2011, to October 1, 2021: Cochrane Library, Epistemonikos, NICE Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC), and Trip. In addition, the following sources of gray literature will be searched: Conference Proceedings Citation Index, Health Management Information Consortium, International HTA Database, OpenGrey, The Grey Literature Report, Google Scholar Basic Search UK, MedNar Deep Web Search Engine, and Carrot2. We will select publications that meet the following inclusion criteria: primary research papers that evaluated digital health interventions that describe features of digital health intervention design and deployment that enable or hinder access to and engagement with digital health interventions by adults from demographic groups likely to be affected by the digital divide (eg, older age, minority ethnic groups, lower income, and lower education level). A random selection of 25 publications identified from the search will be double screened by four reviewers. If there is >75% agreement for included/excluded publications, the team will continue to screen all the identified publications. For all included publications, study characteristics will be extracted by one author and checked for agreement by a second author, with any disagreements resolved by consensus among the study team. Consultation digital health intervention design and deployment, and digital health intervention users will also be conducted in parallel. Results: The review is underway and is anticipated to be completed by September 2022. Conclusions: The results will have implications for researchers and policy makers using digital health interventions for health improvement peripandemic and post pandemic, and will inform best practices in the design and delivery of digital health interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/32538 UR - https://www.researchprotocols.org/2022/3/e32538 UR - http://dx.doi.org/10.2196/32538 UR - http://www.ncbi.nlm.nih.gov/pubmed/35302946 ID - info:doi/10.2196/32538 ER - TY - JOUR AU - Gelbman, D. Brian AU - Reed, R. Carol PY - 2022/3/17 TI - An Integrated, Multimodal, Digital Health Solution for Chronic Obstructive Pulmonary Disease: Prospective Observational Pilot Study JO - JMIR Form Res SP - e34758 VL - 6 IS - 3 KW - COPD KW - patient engagement KW - mHealth KW - digital health KW - mobile phone KW - telemedicine KW - mobile apps KW - remote monitoring KW - spirometry KW - pulse oximetry N2 - Background: Chronic obstructive pulmonary disease (COPD) affects millions of Americans and has a high economic impact partially due to frequent emergency room visits and hospitalizations. Advances in digital health have made it possible to collect data remotely from multiple devices to assist in managing chronic diseases such as COPD. Objective: In this pilot study, we evaluated the ability of patients with COPD to use the Wellinks mHealth platform to collect information from multiple modalities important to the management of COPD. We also assessed patient satisfaction and engagement with the platform. Methods: A single-site, observational, prospective pilot study (N=19) was conducted using the Wellinks platform in adults with COPD. All patients were aged over 30 years at screening, owned an iPhone, and were currently undergoing a treatment regimen that included nebulized therapy. Enrolled patients received a study kit consisting of the Flyp nebulizer, Smart One spirometer, the Nonin pulse oximeter, plus the Wellinks mHealth app, and training for all devices. For 8 weeks, participants were to enter daily symptoms and medication use manually; spirometry, nebulizer, and pulse oximeter data were automatically recorded. Data were sent to the attending physician in a monthly report. Patient satisfaction was measured via a 5-point scale and the Net Promoter Score (NPS) captured in interviews at the end of the observation period. Results: Average age of the patients was 79.6 (range 65-95) years. Participants (10 female; 9 male) had an average FEV1% (forced expiratory volume in 1 second as % of predicted for the patient) of 56.2% of predicted (range 23%-113%) and FEV1/forced vital capacity of 65%. COPD severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, was mild in 2 patients, moderate in 6, and severe/very severe in 11; 9 patients were on home oxygen. During this 8-week study, average use of the spirometer was 2.5 times/week, and the pulse oximeter 4.2 times/week. Medication use was manually documented 9.0 times/week, nebulizer use 1.9 times/week, and symptoms recorded 1.2 times/week on average. The correlation coefficients of home to office measurements for peak flow and FEV1 were high (r=0.94 and 0.96, respectively). Patients found the app valuable (13/16, 81%) and easy to use (15/16, 94%). The NPS was 59. Conclusions: This study demonstrates that our cohort of patients with COPD engaged with the Wellinks mHealth platform avidly and consistently over the 8-week period, and that patient satisfaction was high, as indicated by the satisfaction survey and the NPS of 59. In this small, selected sample, patients were both willing to use the technology and capable of doing so successfully regardless of disease severity, age, or gender. The Wellinks mHealth platform was considered useful and valuable by patients, and can assist clinicians in improved, timely decision making for better COPD management. UR - https://formative.jmir.org/2022/3/e34758 UR - http://dx.doi.org/10.2196/34758 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142291 ID - info:doi/10.2196/34758 ER - TY - JOUR AU - Miyashita, Ayano AU - Nakamura, Keiko AU - Ohnishi, Mayumi AU - Bintabara, Deogratius AU - Shayo, K. Festo AU - Maro, I. Isaac AU - Sato, Hideko AU - Seino, Kaoruko AU - Kibusi, Stephen PY - 2022/3/17 TI - Reaching Patients With Noncommunicable Diseases in Rural Tanzania Using Mobile Devices and Community Trust: Qualitative Study JO - JMIR Mhealth Uhealth SP - e29407 VL - 10 IS - 3 KW - noncommunicable disease KW - community health workers KW - Tanzania KW - communication KW - rural KW - community KW - trust KW - disease KW - acceptability KW - usability KW - text message KW - SMS KW - mobile phone KW - implementation N2 - Background: A health service using mobile devices, mobile health (mHealth), has been widely applied to programs focusing on maternal and child health and communicable diseases in sub-Saharan African countries. However, mHealth apps for noncommunicable disease (NCD) services remain limited. Objective: This study aimed to explore the acceptability and potential usability of SMS text messaging for patients and health care providers for the management of NCDs as part of an implementation research in rural Tanzania. Methods: Nine focus group discussions were conducted with 56 participants (21 community health workers [CHWs], 17 patients, and 18 health care professionals [HPs]) in 3 districts in the Dodoma region, Tanzania. The interview guides were prepared in Swahili, and each session was recorded, transcribed, and translated into English. The focus group discussions consisted of the following topics: (1) perceptions of the participants about the possible use of mobile devices and SMS text messages as an mHealth platform in community health services; and (2) experiences of mobile device use in health activities or receiving health services via a mobile phone in the past. Results: CHWs and HPs reported having familiarity using mobile devices to provide health services, especially for reaching or tracing patients in remote settings; however, patients with NCDs were less familiar with the use of mobile devices compared with the other groups. Hesitation to receive health services via SMS text messaging was seen in the patient group, as they wondered who would send health advice to them. Some patients expected services beyond what mHealth could do, such as aiding in recovery from a disease or sending notifications about the availability of prescription medications. CHWs showed interest in using text messaging to provide health services in the community; however, the concerns raised by CHWs included the cost of using their own mobile devices. Moreover, they demanded training about NCD management before engaging in such an activity. Conclusions: This study explored views and experiences regarding the possible installation of an mHealth intervention for managing NCDs in rural Tanzania. Although HPs and CHWs had experience using mobile devices to provide health services in non-NCD projects, only a few patients (3/17, 17%) had heard about the use of mobile devices to receive health services. To improve the suitability and acceptability of the intervention design for patients with NCDs, their trust must be earned. Involving CHWs in the intervention is recommended because they have already been appointed in the community and already know how to communicate effectively with patients in the area. UR - https://mhealth.jmir.org/2022/3/e29407 UR - http://dx.doi.org/10.2196/29407 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297772 ID - info:doi/10.2196/29407 ER - TY - JOUR AU - Pearson, Nicole AU - Finch, Meghan AU - Sutherland, Rachel AU - Kingsland, Melanie AU - Wolfenden, Luke AU - Wedesweiler, Taya AU - Herrmann, Vanessa AU - Yoong, Lin Sze PY - 2022/3/17 TI - An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children?s Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e27760 VL - 24 IS - 3 KW - nutrition KW - mHealth KW - child KW - preschool KW - parents N2 - Background: Interventions in early childhood education and care (ECEC) services have the potential to improve children?s diet at the population level. Objective: This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children?s (aged 3-6 years) lunch boxes. Methods: A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children?s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children?s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results: Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI ?163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (?1.98 kJ, 95% CI ?343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). Conclusions: The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children?s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379 UR - https://www.jmir.org/2022/3/e27760 UR - http://dx.doi.org/10.2196/27760 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297768 ID - info:doi/10.2196/27760 ER - TY - JOUR AU - Clare, M. Isabelle AU - Gamage, Nisali AU - Alvares, A. Gail AU - Black, J. Lucinda AU - Francis, Jacinta AU - Jaimangal, Mohinder AU - Lucas, M. Robyn AU - Strickland, Mark AU - White, James AU - Nguyen, Rebecca AU - Gorman, Shelley PY - 2022/3/16 TI - The Effects of Using the Sun Safe App on Sun Health Knowledge and Behaviors of Young Teenagers: Results of Pilot Intervention Studies JO - JMIR Dermatol SP - e35137 VL - 5 IS - 1 KW - app development KW - co-design KW - knowledge gain KW - sun exposure KW - sun protection KW - sun behaviors KW - teenagers KW - UV Index KW - vitamin D KW - young adolescents KW - mobile phone N2 - Background: A balanced approach toward sun exposure and protection is needed by young people. Excessive sun exposure increases their risk for skin cancers such as melanoma, whereas some exposure is necessary for vitamin D and healthy bones. We have developed a new iOS smartphone app?Sun Safe?through a co-design process, which aims to support healthy and balanced decision-making by young teenagers (aged 12-13 years). Objective: The aim of this study was to test the capacity of Sun Safe to improve sun health knowledge and behaviors of young teenagers in 3 pilot intervention studies completed in 2020. Methods: Young teenagers (aged 12-13 years; N=57) were recruited through the web or through a local school via an open-access website and given access to Sun Safe (29/57, 51%) or a placebo (SunDial) app (28/57, 49%). Participants completed sun health questionnaires and knowledge quizzes before and after the 6-week intervention (either on the web or in class) and rated the quality of the app they used via a survey. Results: Of the 57 participants, 51 (89%) participants (26, 51% for placebo arm and 25, 49% for the Sun Safe arm) completed these studies, with most (>50%) reporting that they used a smartphone to access their designated app either ?once a fortnight? or ?once/twice in total.? Improved sun health knowledge?particularly about the UV Index?was observed in participants who were given access to Sun Safe compared with those who used the placebo (?6.2 [percentage correct] difference in predicted means, 95% CI ?12.4 to ?0.03; P=.049; 2-way ANOVA). Unexpectedly, there were significantly more sunburn events in the Sun Safe group (relative risk 1.7, 95% CI 1.1-1.8; P=.02; Fisher exact test), although no differences in time spent outdoors or sun-protective behaviors were reported. COVID-19 pandemic?related community-wide shutdowns during April 2020 (when schools were closed) reduced the time spent outdoors by >100 minutes per day (?105 minutes per day difference in predicted means, 95% CI ?150 to ?59 minutes per day; P=.002; paired 2-tailed Student t test). Sun Safe was well-rated by participants, particularly for information (mean 4.2, SD 0.6 out of 5). Conclusions: Access to the Sun Safe app increased sun health knowledge among young teenagers in these pilot intervention studies. Further investigations with larger sample sizes are required to confirm these observations and further test the effects of Sun Safe on sun-protective behaviors. UR - https://derma.jmir.org/2022/1/e35137 UR - http://dx.doi.org/10.2196/35137 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632872 ID - info:doi/10.2196/35137 ER - TY - JOUR AU - Mueller, L. Emily AU - Cochrane, R. Anneli AU - Campbell, E. Madison AU - Nikkhah, Sarah AU - Miller, D. Andrew PY - 2022/3/16 TI - An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Co-design and User Testing Study JO - JMIR Cancer SP - e33152 VL - 8 IS - 1 KW - child KW - adolescent KW - oncology KW - supportive care KW - mHealth KW - mobile health KW - cancer KW - pediatrics KW - children KW - digital health KW - health applications KW - parent KW - caregiver N2 - Background: Caregivers face new challenges and tasks when their child is diagnosed with cancer, which can be overwhelming. Mobile technology has the capacity to provide immediate support at their fingertips to aid in tracking symptoms, managing medication, and planning for emergencies. Objective: The objective of this study is to engage directly with end users and proxies to co-design and create a mobile technology app to support caregivers in the medical management of their child with cancer. Methods: We engaged directly with caregivers of children with cancer and pediatric oncology nurse coordinators (proxy end users) to co-design and create the prototype of the Cope 360 mobile health app. Alpha testing was accomplished by walking the users through a series of predetermined tasks that encompassed all aspects of the app including tracking symptoms, managing medications, and planning or practicing for a medical emergency that required seeking care in the emergency department. Evaluation was accomplished through recorded semistructured interviews and quantitative surveys to capture demographic information and measure the system usability score. Interviews were transcribed and analyzed iteratively using NVivo (version 12; QSR International). Results: This study included 8 caregivers (aged 33-50 years) of children with cancer, with most children receiving chemotherapy, and 6 nurse coordinators, with 3 (50%) of them having 11 to 20 years of nursing experience. The mean system usability score given by caregivers was 89.4 (95% CI 80-98.8). Results were grouped by app function assessed with focus on specific attributes that were well received and those that required refinement. The major issues requiring refinement included clarity in the medical information and terminology, improvement in design of tasks, tracking of symptoms including adjusting the look and feel of certain buttons, and changing the visual graph used to monitor symptoms to include date anchors. Conclusions: The Cope 360 app was well received by caregivers of children with cancer but requires further refinement for clarity and visual representation. After refinement, testing among caregivers in a real-world environment is needed to finalize the Cope 360 app before its implementation in a randomized controlled trial. UR - https://cancer.jmir.org/2022/1/e33152 UR - http://dx.doi.org/10.2196/33152 UR - http://www.ncbi.nlm.nih.gov/pubmed/35293867 ID - info:doi/10.2196/33152 ER - TY - JOUR AU - Cederberg, Matilda AU - Alsén, Sara AU - Ali, Lilas AU - Ekman, Inger AU - Glise, Kristina AU - Jonsdottir, H. Ingibjörg AU - Gyllensten, Hanna AU - Swedberg, Karl AU - Fors, Andreas PY - 2022/3/15 TI - Effects of a Person-Centered eHealth Intervention for Patients on Sick Leave Due to Common Mental Disorders (PROMISE Study): Open Randomized Controlled Trial JO - JMIR Ment Health SP - e30966 VL - 9 IS - 3 KW - depression KW - anxiety KW - stress KW - patient-centered care KW - person-centered care KW - telehealth KW - mHealth KW - sickness absence KW - intervention KW - randomized controlled trial KW - mobile phone N2 - Background: Sick leave due to common mental disorders (CMDs) is a public health problem in several countries, including Sweden. Given that symptom relief does not necessarily correspond to return to work, health care interventions focusing on factors that have proven important to influence the return to work process, such as self-efficacy, are warranted. Self-efficacy is also a central concept in person-centered care. Objective: The aim of this study is to evaluate the effects of a person-centered eHealth intervention for patients on sick leave due to CMDs. Methods: A randomized controlled trial of 209 patients allocated to either a control group (107/209, 51.2%) or an intervention group (102/209, 48.8%) was conducted. The control group received usual care, whereas the intervention group received usual care with the addition of a person-centered eHealth intervention. The intervention was built on person-centered care principles and consisted of telephone support and a web-based platform. The primary outcome was a composite score of changes in general self-efficacy (GSE) and level of sick leave at the 6-month follow-up. An intention-to-treat analysis included all participants, and a per-protocol analysis consisted of those using both the telephone support and the web-based platform. Results: At the 3-month follow-up, in the intention-to-treat analysis, more patients in the intervention group improved on the composite score than those in the control group (20/102, 19.6%, vs 10/107, 9.3%; odds ratio [OR] 2.37, 95% CI 1.05-5.34; P=.04). At the 6-month follow-up, the difference was no longer significant between the groups (31/100, 31%, vs 25/107, 23.4%; OR 1.47, 95% CI 0.80-2.73; P=.22). In the per-protocol analysis, a significant difference was observed between the intervention and control groups at the 3-month follow-up (18/85, 21.2%, vs 10/107, 9.3%; OR 2.6, 95% CI 1.13-6.00; P=.02) but not at 6 months (30/84, 35.7%, vs 25/107, 23.4%; OR 1.8, 95% CI 0.97-3.43; P=.06). Changes in GSE drove the effects in the composite score, but the intervention did not affect the level of sick leave. Conclusions: A person-centered eHealth intervention for patients on sick leave due to CMDs improved GSE but did not affect the level of sick leave. Trial Registration: ClinicalTrials.gov NCT03404583; https://clinicaltrials.gov/ct2/show/NCT03404583 UR - https://mental.jmir.org/2022/3/e30966 UR - http://dx.doi.org/10.2196/30966 UR - http://www.ncbi.nlm.nih.gov/pubmed/35289756 ID - info:doi/10.2196/30966 ER - TY - JOUR AU - Welch, Victoria AU - Wy, Joshua Tom AU - Ligezka, Anna AU - Hassett, C. Leslie AU - Croarkin, E. Paul AU - Athreya, P. Arjun AU - Romanowicz, Magdalena PY - 2022/3/14 TI - Use of Mobile and Wearable Artificial Intelligence in Child and Adolescent Psychiatry: Scoping Review JO - J Med Internet Res SP - e33560 VL - 24 IS - 3 KW - mobile computing KW - artificial intelligence KW - wearable technologies KW - child psychiatry N2 - Background: Mental health disorders are a leading cause of medical disabilities across an individual?s lifespan. This burden is particularly substantial in children and adolescents because of challenges in diagnosis and the lack of precision medicine approaches. However, the widespread adoption of wearable devices (eg, smart watches) that are conducive for artificial intelligence applications to remotely diagnose and manage psychiatric disorders in children and adolescents is promising. Objective: This study aims to conduct a scoping review to study, characterize, and identify areas of innovations with wearable devices that can augment current in-person physician assessments to individualize diagnosis and management of psychiatric disorders in child and adolescent psychiatry. Methods: This scoping review used information from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of several databases from 2011 to June 25, 2021, limited to the English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE and Epub ahead of print, in-process and other nonindexed citations, and daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; Web of Science; and Scopus. Results: The initial search yielded 344 articles, from which 19 (5.5%) articles were left on the final source list for this scoping review. Articles were divided into three main groups as follows: studies with the main focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, and internalizing disorders such as anxiety disorders. Most of the studies used either cardio-fitness chest straps with electrocardiogram sensors or wrist-worn biosensors, such as watches by Fitbit. Both allowed passive data collection of the physiological signals. Conclusions: Our scoping review found a large heterogeneity of methods and findings in artificial intelligence studies in child psychiatry. Overall, the largest gap identified in this scoping review is the lack of randomized controlled trials, as most studies available were pilot studies and feasibility trials. UR - https://www.jmir.org/2022/3/e33560 UR - http://dx.doi.org/10.2196/33560 UR - http://www.ncbi.nlm.nih.gov/pubmed/35285812 ID - info:doi/10.2196/33560 ER - TY - JOUR AU - Limmroth, Volker AU - Bayer-Gersmann, Kirsten AU - Mueller, Christian AU - Schürks, Markus PY - 2022/3/14 TI - Ascertaining Medication Use and Patient-Reported Outcomes via an App and Exploring Gamification in Patients With Multiple Sclerosis Treated With Interferon ?-1b: Observational Study JO - JMIR Form Res SP - e31972 VL - 6 IS - 3 KW - digital observational study KW - BETACONNECT KW - app KW - interferon ?-1b KW - multiple sclerosis KW - medication adherence KW - medication compliance KW - medication persistence KW - health-related quality of life KW - gamification KW - mobile phone N2 - Background: The BETACONNECT autoinjector and myBETAapp app were designed to support patients with multiple sclerosis receiving interferon ?-1b and are an ideal platform for digital observational studies. A recent pilot study in Germany demonstrated the feasibility of using the app to recruit patients, obtain informed consent, and evaluate medication-taking behavior over 6 months. Objective: This study aims to describe medication-taking behavior for 1 year in patients with multiple sclerosis receiving interferon ?-1b based on data collected from the app and to provide information on patient-reported outcomes (PROs). The optional use of the cognitive training tool PEAK (Peak, formerly Brainbow Ltd) is included to test the feasibility of gamification in this setting. Methods: A prospective and retrospective, exploratory, digital, observational cohort study was conducted among users of the app in Germany. Invitations to participate were sent to patients? apps between February and May 2019. Participants provided electronic informed consent. Injection-related data from consenting patients? devices were collected prospectively for 1 year following the consent date and retrospectively for ?1 year from the first day of use (if historical data were available). Participants also completed three electronic PRO instruments every 3 months: the EuroQol 5-Dimension, 5-Level questionnaire (EQ-5D-5L); the Treatment Satisfaction Questionnaire for Medication (TSQM; version II); and a questionnaire on satisfaction with treatment support (on a server accessed via an emailed hyperlink). All patients were offered optional access to the professional version of PEAK. Results: Of 1778 registered app accounts (May 2019), 79 patients (4.44%) provided informed consent; 62 (3.49%) were eligible for inclusion in the prospective analysis, of whom, 60 (97%) also had retrospective data. The mean age of the 62 participants was 43.2 (SD 11.5) years and 41 (66%) were women. Compliance over the 1-year prospective observational period (primary end point) was high (median 98.9%, IQR 94.3%-100%) and similar among men and women. Persistence and adherence (coprimary end points) decreased from 85% (53/62) and 74% (46/62), respectively, at 6 months to 76% (47/62) and 65% (40/62), respectively, at 12 months; both were higher in men than in women. A retrospective analysis showed similar patterns. The PRO questionnaires were answered by 79% (49/62) of the participants at baseline and 50% (31/62) of them at month 12. Women had more severe problems in some EQ-5D-5L dimensions (mobility, usual activities, and pain/discomfort) and lower median convenience scores on the TSQM (version II) than men. At month 12, 84% (26/31) of the patients were satisfied or very satisfied with the app. PEAK was used by 67% (14/21) of men and 49% (20/41) of women. Conclusions: This study showed high compliance and decreasing persistence and adherence over 1 year and demonstrated the feasibility of including remotely completed electronic PRO instruments in digital observational studies. UR - https://formative.jmir.org/2022/3/e31972 UR - http://dx.doi.org/10.2196/31972 UR - http://www.ncbi.nlm.nih.gov/pubmed/35285806 ID - info:doi/10.2196/31972 ER - TY - JOUR AU - Schlieter, Hannes AU - Marsch, A. Lisa AU - Whitehouse, Diane AU - Otto, Lena AU - Londral, Rita Ana AU - Teepe, Wilhelm Gisbert AU - Benedict, Martin AU - Ollier, Joseph AU - Ulmer, Tom AU - Gasser, Nathalie AU - Ultsch, Sabine AU - Wollschlaeger, Bastian AU - Kowatsch, Tobias PY - 2022/3/11 TI - Scale-up of Digital Innovations in Health Care: Expert Commentary on Enablers and Barriers JO - J Med Internet Res SP - e24582 VL - 24 IS - 3 KW - digital health KW - health care delivery KW - health interventions KW - digital health services KW - enablers KW - barriers UR - https://www.jmir.org/2022/3/e24582 UR - http://dx.doi.org/10.2196/24582 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275065 ID - info:doi/10.2196/24582 ER - TY - JOUR AU - Zhang, Yuezhou AU - Folarin, A. Amos AU - Sun, Shaoxiong AU - Cummins, Nicholas AU - Vairavan, Srinivasan AU - Bendayan, Rebecca AU - Ranjan, Yatharth AU - Rashid, Zulqarnain AU - Conde, Pauline AU - Stewart, Callum AU - Laiou, Petroula AU - Sankesara, Heet AU - Matcham, Faith AU - White, M. Katie AU - Oetzmann, Carolin AU - Ivan, Alina AU - Lamers, Femke AU - Siddi, Sara AU - Vilella, Elisabet AU - Simblett, Sara AU - Rintala, Aki AU - Bruce, Stuart AU - Mohr, C. David AU - Myin-Germeys, Inez AU - Wykes, Til AU - Haro, Maria Josep AU - Penninx, WJH Brenda AU - Narayan, A. Vaibhav AU - Annas, Peter AU - Hotopf, Matthew AU - Dobson, JB Richard AU - PY - 2022/3/11 TI - Longitudinal Relationships Between Depressive Symptom Severity and Phone-Measured Mobility: Dynamic Structural Equation Modeling Study JO - JMIR Ment Health SP - e34898 VL - 9 IS - 3 KW - depression KW - mobile health KW - location data KW - mobility KW - dynamic structural equation modeling KW - mHealth KW - mental health KW - medical informatics KW - modeling N2 - Background: The mobility of an individual measured by phone-collected location data has been found to be associated with depression; however, the longitudinal relationships (the temporal direction of relationships) between depressive symptom severity and phone-measured mobility have yet to be fully explored. Objective: We aimed to explore the relationships and the direction of the relationships between depressive symptom severity and phone-measured mobility over time. Methods: Data used in this paper came from a major EU program, called the Remote Assessment of Disease and Relapse?Major Depressive Disorder, which was conducted in 3 European countries. Depressive symptom severity was measured with the 8-item Patient Health Questionnaire (PHQ-8) through mobile phones every 2 weeks. Participants? location data were recorded by GPS and network sensors in mobile phones every 10 minutes, and 11 mobility features were extracted from location data for the 2 weeks prior to the PHQ-8 assessment. Dynamic structural equation modeling was used to explore the longitudinal relationships between depressive symptom severity and phone-measured mobility. Results: This study included 2341 PHQ-8 records and corresponding phone-collected location data from 290 participants (age: median 50.0 IQR 34.0, 59.0) years; of whom 215 (74.1%) were female, and 149 (51.4%) were employed. Significant negative correlations were found between depressive symptom severity and phone-measured mobility, and these correlations were more significant at the within-individual level than the between-individual level. For the direction of relationships over time, Homestay (time at home) (?=0.09, P=.01), Location Entropy (time distribution on different locations) (?=?0.04, P=.02), and Residential Location Count (reflecting traveling) (?=0.05, P=.02) were significantly correlated with the subsequent changes in the PHQ-8 score, while changes in the PHQ-8 score significantly affected (?=?0.07, P<.001) the subsequent periodicity of mobility. Conclusions: Several phone-derived mobility features have the potential to predict future depression, which may provide support for future clinical applications, relapse prevention, and remote mental health monitoring practices in real-world settings. UR - https://mental.jmir.org/2022/3/e34898 UR - http://dx.doi.org/10.2196/34898 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275087 ID - info:doi/10.2196/34898 ER - TY - JOUR AU - Agnew, R. Jonathon M. AU - Hanratty, E. Catherine AU - McVeigh, G. Joseph AU - Nugent, Chris AU - Kerr, P. Daniel PY - 2022/3/11 TI - An Investigation Into the Use of mHealth in Musculoskeletal Physiotherapy: Scoping Review JO - JMIR Rehabil Assist Technol SP - e33609 VL - 9 IS - 1 KW - physiotherapy KW - musculoskeletal KW - mHealth KW - rehabilitation KW - scoping review KW - mobile phone N2 - Background: Musculoskeletal physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programs because of the lack of supervision and low self-efficacy. The use of mobile health (mHealth) interventions could be a possible solution to this problem, helping promote self-management at home. However, there is little evidence for musculoskeletal physiotherapy on the most effective forms of mHealth. Objective: The aim of this review is to investigate the literature focusing on the use of mHealth in musculoskeletal physiotherapy and summarize the evidence. Methods: A scoping review of 6 peer-reviewed databases was conducted in March 2021. No date limits were applied, and only articles written in the English language were selected. A reviewer screened all the articles, followed by 2 additional researchers screening a random sample before data extraction. Results: Of the 1393 studies, 28 (2.01%) were identified. Intervention characteristics comprised stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions (5/28, 18%). The most reported use of mHealth included telephone and videoconferencing calls to provide a home exercise program or being used as an adjunct to physiotherapy musculoskeletal assessment (14/28, 50%). Although patient satisfaction with mHealth was reported to be high, reasons for disengagement included a lack of high-quality information and poor internet speeds. Barriers to clinical uptake included insufficient training with the intervention and a lack of time to become familiar. Conclusions: mHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost-effective. The current use of mHealth is most effective when ongoing feedback from a health care professional is available. UR - https://rehab.jmir.org/2022/1/e33609 UR - http://dx.doi.org/10.2196/33609 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275089 ID - info:doi/10.2196/33609 ER - TY - JOUR AU - Denecke, Kerstin AU - Schmid, Nicole AU - Nüssli, Stephan PY - 2022/3/10 TI - Implementation of Cognitive Behavioral Therapy in e?Mental Health Apps: Literature Review JO - J Med Internet Res SP - e27791 VL - 24 IS - 3 KW - cognitive behavioral therapy KW - mHealth KW - e?mental health KW - chatbot KW - mobile phone N2 - Background: To address the matter of limited resources for treating individuals with mental disorders, e?mental health has gained interest in recent years. More specifically, mobile health (mHealth) apps have been suggested as electronic mental health interventions accompanied by cognitive behavioral therapy (CBT). Objective: This study aims to identify the therapeutic aspects of CBT that have been implemented in existing mHealth apps and the technologies used. From these, we aim to derive research gaps that should be addressed in the future. Methods: Three databases were screened for studies on mHealth apps in the context of mental disorders that implement techniques of CBT: PubMed, IEEE Xplore, and ACM Digital Library. The studies were independently selected by 2 reviewers, who then extracted data from the included studies. Data on CBT techniques and their technical implementation in mHealth apps were synthesized narratively. Results: Of the 530 retrieved citations, 34 (6.4%) studies were included in this review. mHealth apps for CBT exploit two groups of technologies: technologies that implement CBT techniques for cognitive restructuring, behavioral activation, and problem solving (exposure is not yet realized in mHealth apps) and technologies that aim to increase user experience, adherence, and engagement. The synergy of these technologies enables patients to self-manage and self-monitor their mental state and access relevant information on their mental illness, which helps them cope with mental health problems and allows self-treatment. Conclusions: There are CBT techniques that can be implemented in mHealth apps. Additional research is needed on the efficacy of the mHealth interventions and their side effects, including inequalities because of the digital divide, addictive internet behavior, lack of trust in mHealth, anonymity issues, risks and biases for user groups and social contexts, and ethical implications. Further research is also required to integrate and test psychological theories to improve the impact of mHealth and adherence to the e?mental health interventions. UR - https://www.jmir.org/2022/3/e27791 UR - http://dx.doi.org/10.2196/27791 UR - http://www.ncbi.nlm.nih.gov/pubmed/35266875 ID - info:doi/10.2196/27791 ER - TY - JOUR AU - Ni, Zhao AU - Wu, Bei AU - Yang, Qing AU - Yan, L. Lijing AU - Liu, Changqing AU - Shaw, J. Ryan PY - 2022/3/9 TI - An mHealth Intervention to Improve Medication Adherence and Health Outcomes Among Patients With Coronary Heart Disease: Randomized Controlled Trial JO - J Med Internet Res SP - e27202 VL - 24 IS - 3 KW - mHealth KW - medication adherence KW - coronary disease KW - blood pressure KW - China KW - randomized controlled trial N2 - Background: The treatment of many chronic illnesses involves long-term pharmaceutical therapy, but it is an ongoing challenge to find effective ways to improve medication adherence to promote good health outcomes. Cardioprotective medications can prevent the enlargement of harmful clots, cardiovascular symptoms, and poor therapeutic outcomes, such as uncontrolled high blood pressure and hyperlipidemia, for patients with coronary heart disease. Poor adherence to cardioprotective medications, however, has been reported as a global health concern among patients with coronary heart disease, and it is particularly a concern in China. Objective: This study aimed to evaluate the efficacy of a mobile health (mHealth) intervention using 2 mobile apps to improve medication adherence and health outcomes. Methods: A randomized, placebo-controlled, 2-arm parallel study was conducted in a major university-affiliated medical center located in Chengdu, China. Participants were recruited by flyers and health care provider referrals. Each participant was observed for 90 days, including a 60-day period of mHealth intervention and a 30-day period of nonintervention follow-up. The study coordinator used WeChat and Message Express to send educational materials and reminders to take medication, respectively. Participants used WeChat to receive both the educational materials and reminders. Participants in the control group only received educational materials. This study received ethics approval from the Duke Health Institutional Review Board (Pro00073395) on May 5, 2018, and was approved by West China Hospital (20170331180037). Recruitment began on May 20, 2018. The pilot phase of this study was registered on June 8, 2016, and the current, larger-scale study was retrospectively registered on January 11, 2021 (ClinicalTrials.gov). Results: We recruited 230 patients with coronary heart disease. Of these patients, 196 completed the baseline survey and received the intervention. The majority of participants were married (181/196, 92.4%), male (157/196, 80.1%), and lived in urban China (161/196, 82.1%). Participants? average age was 61 years, and half were retired (103/191, 53.9%). More than half the participants (121/196, 61.7%) were prescribed at least 5 medications. The mean decrease in medication nonadherence score was statistically significant at both 60 days (t179=2.04, P=.04) and 90 days (t155=3.48, P<.001). Systolic blood pressure and diastolic blood pressure decreased in the experimental group but increased in the control group. The mean decrease in diastolic blood pressure was statistically significant at both 60 days (t160=2.07, P=.04) and 90 days (t164=2.21, P=.03). The mean decrease in systolic blood pressure was significantly different in the groups at 90 days (t165=3.12, P=.002). Conclusions: The proposed mHealth intervention can improve medication adherence and health outcomes, including systolic blood pressure and diastolic blood pressure. Trial Registration: ClinicalTrials.gov NCT02793830; https://clinicaltrials.gov/ct2/show/NCT02793830 and ClinicalTrials.gov NCT04703439; https://clinicaltrials.gov/ct2/show/NCT04703439 UR - https://www.jmir.org/2022/3/e27202 UR - http://dx.doi.org/10.2196/27202 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262490 ID - info:doi/10.2196/27202 ER - TY - JOUR AU - Fradkin, Nick AU - Zbikowski, M. Susan AU - Christensen, Trevor PY - 2022/3/9 TI - Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study JO - JMIR Public Health Surveill SP - e32499 VL - 8 IS - 3 KW - mobile applications KW - mHealth KW - eHealth KW - smartphone app KW - tobacco KW - smoking cessation KW - public health KW - smoking KW - application N2 - Background: Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco ?quitline? services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective: The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods: This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results: Participants were primarily non-Hispanic White (978/1218, 80.3%), identified as female (780/1236, 63.1%), were between ages 25-54 years (903/1186, 76.1%), had at least some college education (836/1222, 68.4%), and reported a household income under US $50,000 (742/1055, 70.3%). Fewer respondents were from rural counties (359/1220, 29.4%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5%); were uninsured (147/1206, 12.2%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions: A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups. UR - https://publichealth.jmir.org/2022/3/e32499 UR - http://dx.doi.org/10.2196/32499 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262491 ID - info:doi/10.2196/32499 ER - TY - JOUR AU - Martinengo, Laura AU - Stona, Anne-Claire AU - Tudor Car, Lorainne AU - Lee, Jimmy AU - Griva, Konstadina AU - Car, Josip PY - 2022/3/9 TI - Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines JO - J Med Internet Res SP - e28942 VL - 24 IS - 3 KW - health literacy KW - mental health literacy KW - depression KW - mobile apps KW - apps KW - telemedicine KW - mHealth KW - self-management KW - mobile phone N2 - Background: Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of the included information is unclear. Objective: The aim of this study is to systematically evaluate adherence to clinical guidelines on depression of the information offered by mental health apps available in major commercial app stores. Methods: A systematic assessment of the educational content regarding depression in the apps available in the Apple App Store and Google Play was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting the inclusion criteria were downloaded and assessed using two smartphones: an iPhone 7 (iOS version 14.0.1) and a Sony XPERIA XZs (Android version 8.0.0). The 156-question assessment checklist comprised general characteristics of apps, appraisal of 38 educational topics and their adherence to evidence-based clinical guidelines, as well as technical aspects and quality assurance. The results were tabulated and reported as a narrative review, using descriptive statistics. Results: The app search retrieved 2218 apps, of which 58 were included in the analysis (Android apps: n=29, 50%; iOS apps: n=29, 50%). Of the 58 included apps, 37 (64%) apps offered educational content within a more comprehensive depression or mental health management app. Moreover, 21% (12/58) of apps provided non?evidence-based information. Furthermore, 88% (51/58) of apps included up to 20 of the educational topics, the common ones being listing the symptoms of depression (52/58, 90%) and available treatments (48/58, 83%), particularly psychotherapy. Depression-associated stigma was mentioned by 38% (22/58) of the apps, whereas suicide risk was mentioned by 71% (41/58), generally as an item in a list of symptoms. Of the 58 included apps, 44 (76%) highlighted the importance of help seeking, 29 (50%) emphasized the importance of involving the user?s support network. In addition, 52% (30/58) of apps referenced their content, and 17% (10/58) included advertisements. Conclusions: Information in mental health and depression apps is often brief and incomplete, with 1 in 5 apps providing non?evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education or point the users to relevant resources. A multistakeholder consensus on a more stringent development and publication process for mental health apps is essential. UR - https://www.jmir.org/2022/3/e28942 UR - http://dx.doi.org/10.2196/28942 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262489 ID - info:doi/10.2196/28942 ER - TY - JOUR AU - Ma, Zhuo AU - Huang, Sijia AU - Wu, Xiaoqing AU - Huang, Yinying AU - Chan, Wai-Chi Sally AU - Lin, Yilan AU - Zheng, Xujuan AU - Zhu, Jiemin PY - 2022/3/9 TI - Development of a Prognostic App (iCanPredict) to Predict Survival for Chinese Women With Breast Cancer: Retrospective Study JO - J Med Internet Res SP - e35768 VL - 24 IS - 3 KW - app KW - breast cancer KW - survival prediction model KW - iCanPredict N2 - Background: Accurate prediction of survival is crucial for both physicians and women with breast cancer to enable clinical decision making on appropriate treatments. The currently available survival prediction tools were developed based on demographic and clinical data obtained from specific populations and may underestimate or overestimate the survival of women with breast cancer in China. Objective: This study aims to develop and validate a prognostic app to predict the overall survival of women with breast cancer in China. Methods: Nine-year (January 2009-December 2017) clinical data of women with breast cancer who received surgery and adjuvant therapy from 2 hospitals in Xiamen were collected and matched against the death data from the Xiamen Center of Disease Control and Prevention. All samples were randomly divided (7:3 ratio) into a training set for model construction and a test set for model external validation. Multivariable Cox regression analysis was used to construct a survival prediction model. The model performance was evaluated by receiver operating characteristic (ROC) curve and Brier score. Finally, by running the survival prediction model in the app background thread, the prognostic app, called iCanPredict, was developed for women with breast cancer in China. Results: A total of 1592 samples were included for data analysis. The training set comprised 1114 individuals and the test set comprised 478 individuals. Age at diagnosis, clinical stage, molecular classification, operative type, axillary lymph node dissection, chemotherapy, and endocrine therapy were incorporated into the model, where age at diagnosis (hazard ratio [HR] 1.031, 95% CI 1.011-1.051; P=.002), clinical stage (HR 3.044, 95% CI 2.347-3.928; P<.001), and endocrine therapy (HR 0.592, 95% CI 0.384-0.914; P=.02) significantly influenced the survival of women with breast cancer. The operative type (P=.81) and the other 4 variables (molecular classification [P=.91], breast reconstruction [P=.36], axillary lymph node dissection [P=.32], and chemotherapy [P=.84]) were not significant. The ROC curve of the training set showed that the model exhibited good discrimination for predicting 1- (area under the curve [AUC] 0.802, 95% CI 0.713-0.892), 5- (AUC 0.813, 95% CI 0.760-0.865), and 10-year (AUC 0.740, 95% CI 0.672-0.808) overall survival. The Brier scores at 1, 5, and 10 years after diagnosis were 0.005, 0.055, and 0.103 in the training set, respectively, and were less than 0.25, indicating good predictive ability. The test set externally validated model discrimination and calibration. In the iCanPredict app, when physicians or women input women?s clinical information and their choice of surgery and adjuvant therapy, the corresponding 10-year survival prediction will be presented. Conclusions: This survival prediction model provided good model discrimination and calibration. iCanPredict is the first tool of its kind in China to provide survival predictions to women with breast cancer. iCanPredict will increase women?s awareness of the similar survival rate of different surgeries and the importance of adherence to endocrine therapy, ultimately helping women to make informed decisions regarding treatment for breast cancer. UR - https://www.jmir.org/2022/3/e35768 UR - http://dx.doi.org/10.2196/35768 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262503 ID - info:doi/10.2196/35768 ER - TY - JOUR AU - Schretzlmaier, Patrik AU - Hecker, Achim AU - Ammenwerth, Elske PY - 2022/3/9 TI - Suitability of the Unified Theory of Acceptance and Use of Technology 2 Model for Predicting mHealth Acceptance Using Diabetes as an Example: Qualitative Methods Triangulation Study JO - JMIR Hum Factors SP - e34918 VL - 9 IS - 1 KW - mHealth KW - mobile health KW - mobile apps KW - diabetes mellitus KW - technology acceptance KW - UTAUT2 KW - mobile phone N2 - Background: In recent years, the use of mobile health (mHealth) apps to manage chronic diseases has increased significantly. Although mHealth apps have many benefits, their acceptance is still low in certain areas and groups. Most mHealth acceptance studies are based on technology acceptance models. In particular, the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was developed to predict technology acceptance in a consumer context. However, to date, only a few studies have used the UTAUT2 model to predict mHealth acceptance and confirm its suitability for the health sector. Thus, it is unclear whether the UTAUT2 model is suitable for predicting mHealth acceptance and whether essential variables for a health-related context are missing. Objective: This study aims to validate the suitability of UTAUT2 for predicting mHealth acceptance. Methods: In this study, diabetes was used as an example as mHealth apps are a significant element of diabetes self-management. In addition, diabetes is one of the most common chronic diseases affecting young and older people worldwide. An explorative literature review and guided interviews with 11 mHealth or technology acceptance experts and 8 mHealth users in Austria and Germany were triangulated to identify all relevant constructs for predicting mHealth acceptance. The interview participants were recruited by purposive sampling until theoretical saturation was reached. Data were analyzed using structured content analysis based on inductive and deductive approaches. Results: This study was able to confirm the relevance of all exogenous UTAUT2 constructs. However, it revealed two additional constructs that may also need to be considered to better predict mHealth acceptance: trust and perceived disease threat. Conclusions: This study showed that the UTAUT2 model is suitable for predicting mHealth acceptance. However, the model should be extended to include 2 additional constructs for use in the mHealth context. UR - https://humanfactors.jmir.org/2022/1/e34918 UR - http://dx.doi.org/10.2196/34918 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262493 ID - info:doi/10.2196/34918 ER - TY - JOUR AU - Jackson, N. Devlon AU - Sehgal, Neil AU - Baur, Cynthia PY - 2022/3/9 TI - Benefits of mHealth Co-design for African American and Hispanic Adults: Multi-Method Participatory Research for a Health Information App JO - JMIR Form Res SP - e26764 VL - 6 IS - 3 KW - mHealth app design KW - health literacy KW - health disparities KW - health equity KW - African Americans KW - Hispanics KW - mobile phone N2 - Background: Participatory research methodologies can provide insight into the use of mobile health (mHealth) apps, cultural preferences and needs, and health literacy issues for racial and ethnic groups, such as African Americans and Hispanics who experience health disparities. Objective: This methodological paper aims to describe a 1-year multi-method participatory research process that directly engaged English-speaking African American and bilingual or Spanish-speaking Hispanic adults in designing a prevention-focused, personalized mHealth, information-seeking smartphone app. We report design team participants? experiences with the methods to show why our approach is valuable in producing apps that are more aligned with their needs. Methods: Three design sessions were conducted to inform the iteration of a prevention-focused, personalized mHealth, information-seeking app. The research team led sessions with 2 community member design teams. Design team participants described their goals, motives, and interests regarding prevention information using different approaches, such as collage and card sorting (design session 1), interaction with the app prototype (design session 2), and rating of cultural appropriateness strategies (design session 3). Results: Each design team had 5 to 6 participants: 2 to 3 male participants and 3 female participants aged between 30 and 76 years. Design team participants shared their likes and dislikes about the sessions and the overall experience of the design sessions. Both African American and Hispanic teams reported positive participation experience. The primary reasons included the opportunity for their views to be heard, collectively working together in the design process, having their apprehension about mHealth reduced, and an opportunity to increase their knowledge of how they could manage their health through mHealth. The feedback from each session informed the following design sessions and a community-engaged process. In addition, the specific findings for each design session informed the design of the app for both communities. Conclusions: This multi-method participatory research process revealed 4 key lessons learned and recommendations for future research in mHealth app design for African Americans and Hispanics. Lesson 1?community partnerships are key because they provide the chain of trust that helps African American and Hispanic participants feel comfortable participating in app research. Lesson 2?community-based participatory research principles continue to yield promising results to engage these populations in mHealth research. Lesson 3?interactive design sessions uncover participants? needs and development opportunities for mHealth tools. Lesson 4?multiple design sessions with different methods provide an in-depth understanding of participants? mHealth preferences and needs. Future developers should consider these methods and lessons to ensure health apps in the marketplace contribute to eliminating health disparities and achieving health equity. UR - https://formative.jmir.org/2022/3/e26764 UR - http://dx.doi.org/10.2196/26764 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262496 ID - info:doi/10.2196/26764 ER - TY - JOUR AU - Alsahli, Mohammed AU - Abd-Alrazaq, Alaa AU - Househ, Mowafa AU - Konstantinidis, Stathis AU - Blake, Holly PY - 2022/3/8 TI - The Effectiveness of Mobile Phone Messaging?Based Interventions to Promote Physical Activity in Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e29663 VL - 24 IS - 3 KW - type 2 diabetes mellitus KW - physical activity KW - mobile phone messaging KW - systematic review KW - meta-analysis N2 - Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Physical activity (PA) is an important aspect of self-care and first line management for T2DM. SMS text messaging can be used to support self-management in people with T2DM, but the effectiveness of mobile text message?based interventions in increasing PA is still unclear. Objective: This study aims to assess the effectiveness of mobile phone messaging on PA in people with T2DM by summarizing and pooling the findings of previous literature. Methods: A systematic review was conducted to accomplish this objective. Search sources included 5 bibliographic databases (MEDLINE, Cochrane Library, CINAHL, Web of Science, and Embase), the search engine Google Scholar (Google Inc), and backward and forward reference list checking of the included studies and relevant reviews. A total of 2 reviewers (MA and AA) independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence evaluation. The results of the included studies were synthesized narratively and statistically, as appropriate. Results: We included 3.8% (6/151) of the retrieved studies. The results of individual studies were contradictory regarding the effectiveness of mobile text messaging on PA. However, a meta-analysis of the results of 5 studies showed no statistically significant effect (P=.16) of text messages on PA in comparison with no intervention. A meta-analysis of the findings of 2 studies showed a nonsignificant effect (P=.14) of text messages on glycemic control. Of the 541 studies, 2 (0.4%) found a nonsignificant effect of text messages on anthropometric measures (weight and BMI). Conclusions: We could not draw a definitive conclusion regarding the effectiveness of text messaging on PA, glycemic control, weight, or BMI among patients with T2MD, given the limited number of included studies and their high risk of bias. Therefore, there is a need for more high-quality primary studies. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020156465; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=156465 UR - https://www.jmir.org/2022/3/e29663 UR - http://dx.doi.org/10.2196/29663 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258463 ID - info:doi/10.2196/29663 ER - TY - JOUR AU - Meyer, Ashley AU - Wisniewski, Hannah AU - Torous, John PY - 2022/3/8 TI - Coaching to Support Mental Health Apps: Exploratory Narrative Review JO - JMIR Hum Factors SP - e28301 VL - 9 IS - 1 KW - smartphone KW - apps KW - mental health KW - coaching KW - engagement N2 - Background: The therapeutic alliance is crucial for the success of face-to-face therapies. Little is known about how coaching functions and fosters the therapeutic alliance in asynchronous treatment modalities such as smartphone apps. Objective: The aim of this paper was to assess how coaching functions and fosters the therapeutic alliance in asynchronous treatment modalities. Methods: We conducted a selected review to gather preliminary data about the role of coaching in mobile technology use for mental health care. We identified 26 trials using a 2019 review by Tønning et al and a 2021 scoping review by Tokgöz et al to assess how coaching is currently being used across different studies. Results: Our results showed a high level of heterogeneity as studies used varying types of coaching methods but provided little information about coaching protocols and training. Coaching was feasible by clinicians and nonclinicians, scheduled and on demand, and across all technologies ranging from phone calls to social media. Conclusions: Further research is required to better understand the effects of coaching in mobile mental health treatments, but examples offered from reviewed papers suggest several options to implement coaching today. Coaching based on replicable protocols that are verifiable for fidelity will enable the scaling of this model and a better exploration of the digital therapeutic alliance. UR - https://humanfactors.jmir.org/2022/1/e28301 UR - http://dx.doi.org/10.2196/28301 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258468 ID - info:doi/10.2196/28301 ER - TY - JOUR AU - Romero-Jimenez, Rosa AU - Escudero-Vilaplana, Vicente AU - Chamorro-De-Vega, Esther AU - Ais-Larisgoitia, Arantza AU - Lobato Matilla, Elena Maria AU - Herranz-Alonso, Ana AU - Sanjurjo, Maria PY - 2022/3/4 TI - The Characteristics and Functionalities of Mobile Apps Aimed at Patients Diagnosed With Immune-Mediated Inflammatory Diseases: Systematic App Search JO - J Med Internet Res SP - e31016 VL - 24 IS - 3 KW - immune-mediated inflammatory disease KW - mobile app KW - mHealth KW - mobile health KW - chronic disease KW - disease management KW - outcomes KW - functionality KW - quality KW - patient education KW - health outcomes KW - reliability N2 - Background: Immune-mediated inflammatory diseases (IMIDs) are systemic conditions associated with a high social and health impact. New treatments have changed the prognosis of IMIDs and have increased patient autonomy in disease management. Mobile apps have enormous potential to improve health outcomes in patients with IMIDs. Although a large number of IMID apps are available, the app market is not regulated, and functionality and reliability remain uncertain. Objective: Our aims are to review available apps for patients with IMIDs or caregivers and to describe the main characteristics and functionalities of these apps. Methods: We performed an observational, cross-sectional, descriptive study of all apps for patients with IMIDs. Between April 5 and 14, 2021, we conducted a search of the App Store (iOS) and Play Store (Android) platforms. We used the names of the different IMIDs as search terms. The inclusion criteria were as follows: content related to IMIDs, English or Spanish language, and user population consisting of patients and health care consumers, including family and caregivers. The variables analyzed were as follows: app name, type of IMID, platform (Android or iOS), country of origin, language, category of the app, cost, date of the last update, size, downloads, author affiliation, and functionalities. Results: We identified 713 apps in the initial search, and 243 apps met the criteria and were analyzed. Of these, 37% (n=90) were on Android, 27.2% (n=66) on iOS, and 35.8% (n=87) on both platforms. The most frequent categories were health and well-being/fitness apps (n=188, 48.5%) and medicine (n=82, 37.9%). A total of 211 (82.3%) apps were free. The mean time between the date of the analysis and the date of the most recent update was 18.5 (SD 19.3) months. Health care professionals were involved in the development of 100 (41.1%) apps. We found differences between Android and iOS in the mean time since the last update (16.2, SD 14.7 months vs 30.3, SD 25.7 months) and free apps (85.6% vs 75.8%; respectively). The functionalities were as follows: general information about lifestyles, nutrition, or exercises (n=135, 55.6%); specific information about the disease or treatment (n=102, 42%); recording of symptoms or adverse events (n=51, 21%); agenda/calendar (n=44, 18.1%); reminder medication (n=41, 16.9%); and recording of patient-reported outcomes (n=41, 16.9%). A total of 147 (60.5%) apps had more than one functionality. Conclusions: IMID-related apps are heterogeneous in terms of functionality and reliability. Apps may be a useful complement to IMID care, especially inpatient education (their most frequent functionality). However, more than half of the IMID apps had not been developed by health care professionals or updated in the last year. UR - https://www.jmir.org/2022/3/e31016 UR - http://dx.doi.org/10.2196/31016 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254286 ID - info:doi/10.2196/31016 ER - TY - JOUR AU - Ward, E. Rebecca AU - Setiawan, Agus I. Made AU - Quinby, Eleanor AU - Fair, Melva AU - Ambadar, Zara AU - Parmanto, Bambang AU - Dicianno, E. Brad PY - 2022/3/4 TI - Mobile Health to Support Community-Integration of Individuals With Disabilities Using iMHere 2.0: Focus Group Study JO - JMIR Hum Factors SP - e31376 VL - 9 IS - 1 KW - community integration KW - self-care KW - mobile health KW - smartphone KW - rehabilitation KW - disability KW - mobile phone N2 - Background: Mobile health (mHealth) systems that support self-management can improve medical, functional, and psychosocial outcomes for individuals with disabilities and chronic conditions. The mHealth systems can potentially be expanded to support community integration. Objective: The purposes of this study were to (1) partner with a community-based organization that supports community integration of individuals with disabilities; (2) identify software requirements needed to support community participation; and (3) iteratively refine an existing mHealth application to include new requirements. Methods: Community Living and Support Services (CLASS), a nonprofit organization that serves individuals with disabilities in Pittsburgh, Pennsylvania, was identified as the focus group for this study. Key stakeholders within the Community Partners Program at CLASS proposed design requirements for an existing mHealth application, Interactive Mobile Health and Rehabilitation (iMHere) 2.0, that has been used to support self-management. Results: We gathered qualitative data from a focus group composed of CLASS members to develop and iteratively revise iMHere 2.0 to include new modules and features to support community integration. A caregiver app was also developed. The new system contains features to support finance, transportation, client and caregiver communication, calendar and checklist management, upcoming medical and nonmedical appointments, social engagement, pain management, and access to a personal profile. Modifications were made to the following existing modules: education, mood, personal health record, goals, medications, and nutrition. Conclusions: A successful partnership with a community-based organization that supports individuals with disabilities resulted in a newly designed mHealth system with features to support community integration. UR - https://humanfactors.jmir.org/2022/1/e31376 UR - http://dx.doi.org/10.2196/31376 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254274 ID - info:doi/10.2196/31376 ER - TY - JOUR AU - Economides, Marcos AU - Bolton, Heather AU - Male, Rhian AU - Cavanagh, Kate PY - 2022/3/3 TI - Feasibility and Preliminary Efficacy of Web-Based and Mobile Interventions for Common Mental Health Problems in Working Adults: Multi-Arm Randomized Pilot Trial JO - JMIR Form Res SP - e34032 VL - 6 IS - 3 KW - mHealth KW - workplace KW - CBT KW - ACT KW - feasibility KW - stress KW - anxiety KW - depression KW - resilience KW - mobile phone N2 - Background: There is growing interest in digital platforms as a means of implementing scalable, accessible, and cost-effective mental health interventions in the workplace. However, little is known about the efficacy of such interventions when delivered to employee groups. Objective: This study aims to evaluate the feasibility and preliminary efficacy of a digital mental health platform for the workplace, which incorporates evidence-based practices such as cognitive behavioral therapy and acceptance and commitment therapy. A total of 3 brief, unguided interventions designed to address stress, anxiety, and resilience, respectively, are evaluated. The primary aim is to determine the feasibility of the study methods and interventions in preparation for a definitive randomized controlled trial. Methods: The study used a fully remote, parallel, multi-arm, external pilot randomized controlled trial, with 3 intervention arms and a no-intervention control group. Participants were working adults representative of the general UK population with respect to age, sex, and ethnicity who were recruited from a web-based participant platform. Primary outcomes included objective and self-report measures of feasibility, acceptability, engagement, transferability, relevance, and negative effects. Secondary outcomes included 4 self-report measures of mental health and well-being, completed at baseline (time point 0 [t0]), postintervention (time point 1 [t1]), and the 1-month follow-up (time point 2 [t2]). Secondary outcomes were analyzed via linear mixed-effects models using intention-to-treat principles. Preregistered criteria for progression to a definitive trial were evaluated. Results: Data were collected between January and March of 2021. A total of 383 working adult participants meeting trial eligibility were randomized, of whom 356 (93%) were retained at t2. Objective engagement data showed that 67.8% (196/289) of participants randomized to an intervention arm completed their intervention. Overall, 87.1% (203/233) of participants reported being satisfied or very satisfied with their intervention and rated the quality of their intervention as good or excellent. All intervention groups reported significantly greater improvements than the control group on at least one secondary outcome at t1, with between-group Hedges g effect sizes for the pooled interventions ranging from 0.25 (95% CI 0.05-0.46) to 0.43 (95% CI 0.23-0.64). All the improvements were maintained at t2. Conclusions: The study methods were feasible, and all preregistered criteria for progression to a definitive trial were met. Several minor protocol amendments were noted. Preliminary efficacy findings suggest that the study interventions may result in improved mental health outcomes when offered to working adults. Trial Registration: ISRCTN Registry 80309011; http://www.isrctn.com/ISRCTN80309011 UR - https://formative.jmir.org/2022/3/e34032 UR - http://dx.doi.org/10.2196/34032 UR - http://www.ncbi.nlm.nih.gov/pubmed/35238794 ID - info:doi/10.2196/34032 ER - TY - JOUR AU - Germini, Federico AU - Borg Debono, Victoria AU - Page, David AU - Zuk, Victoria AU - Kucher, Alexandra AU - Cotoi, Chris AU - Hobson, Nicholas AU - Sevestre, Michael AU - Skinner, W. Mark AU - Iorio, Alfonso AU - PY - 2022/3/2 TI - User-Centered Development and Testing of the Online Patient-Reported Outcomes, Burdens, and Experiences (PROBE) Survey and the myPROBE App and Integration With the Canadian Bleeding Disorder Registry: Mixed Methods Study JO - JMIR Hum Factors SP - e30797 VL - 9 IS - 1 KW - health-related quality of life KW - EQ-5D KW - mobile app KW - Patient-Reported Outcomes, Burdens, and Experiences (PROBE) KW - hemophilia KW - mobile health KW - mHealth KW - eHealth KW - telehealth KW - user-centered design N2 - Background: The Patient-Reported Outcomes, Burdens, and Experiences (PROBE) questionnaire is a tool for assessing the quality of life and disease burden in people living with hemophilia. Objective: The objectives of our study were (1) to assess the needs of relevant stakeholders involved in the use of PROBE, (2) to develop the software infrastructure needed to meet these needs, and (3) to test the usability of the final product. Methods: We conducted a series of semistructured interviews of relevant stakeholders, including PROBE investigators, people with hemophilia, and representatives of the sponsor. Based on these, we developed an online survey and a mobile app for iOS and Android. A user group evaluated the final product using the System Usability Scale (SUS) and an open feedback framework. Results: The online survey was updated, and the myPROBE app for mobile devices and a new application programming interface were developed. The app was tested and modified according to user feedback over multiple cycles. The final version of the app was released in July 2019. Seventeen users aged 23 to 67 years evaluated the final version of the app using the SUS. The median (first, third quartile) SUS score for the app was 85 (68, 88) out of 100. The newly introduced functionalities were as follows: (1) capability to longitudinally track repeated fillings of the questionnaire at different time points by the same participant (as opposed to anonymous completion); (2) linking of the questionnaire with hemophilia registries, starting with the Canadian Bleeding Disorders Registry as a proof of concept; (3) removing or adding questions as needed; and (4) sending notifications to the users (eg, reminders). A new secure database was built for securely storing personal information separately from the questionnaire data. The PROBE online survey is currently available in 96 countries and 34 languages. Conclusions: The online survey was updated successfully, and the myPROBE app was developed, with a SUS score of 85 (out of 100). The app has been released in 81 countries and 34 languages. This will facilitate data collection for research and advocacy purposes, and the use of this tool in everyday clinical practice. UR - https://humanfactors.jmir.org/2022/1/e30797 UR - http://dx.doi.org/10.2196/30797 UR - http://www.ncbi.nlm.nih.gov/pubmed/35234648 ID - info:doi/10.2196/30797 ER - TY - JOUR AU - Kela, Neta AU - Eytam, Eleanor AU - Katz, Adi PY - 2022/3/2 TI - Supporting Management of Noncommunicable Diseases With Mobile Health (mHealth) Apps: Experimental Study JO - JMIR Hum Factors SP - e28697 VL - 9 IS - 1 KW - mHealth KW - digital health KW - instrumentality KW - aesthetics KW - symbolic value KW - preference N2 - Background: Noncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications. Objective: This research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users? considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings. Methods: A total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the ?human touch? of a human physician regarding analyzing data collected by an mHealth app. Results: As shown by the responses, the involvement of a human physician in the application had a significant effect (P<.001) on the perceived instrumentality of the simple model. The complex model with more controls was rated significantly more aesthetic when associated with a physician performing data analysis rather than an AI algorithm (P=.03). Conclusions: Generally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value. UR - https://humanfactors.jmir.org/2022/1/e28697 UR - http://dx.doi.org/10.2196/28697 UR - http://www.ncbi.nlm.nih.gov/pubmed/35234653 ID - info:doi/10.2196/28697 ER - TY - JOUR AU - Kerckhove, Nicolas AU - Delage, Noémie AU - Cambier, Sébastien AU - Cantagrel, Nathalie AU - Serra, Eric AU - Marcaillou, Fabienne AU - Maindet, Caroline AU - Picard, Pascale AU - Martiné, Gaelle AU - Deleens, Rodrigue AU - Trouvin, Anne-Priscille AU - Fourel, Lauriane AU - Espagne-Dubreuilh, Gaelle AU - Douay, Ludovic AU - Foulon, Stéphane AU - Dufraisse, Bénédicte AU - Gov, Christian AU - Viel, Eric AU - Jedryka, François AU - Pouplin, Sophie AU - Lestrade, Cécile AU - Combe, Emmanuel AU - Perrot, Serge AU - Perocheau, Dominique AU - De Brisson, Valentine AU - Vergne-Salle, Pascale AU - Mertens, Patrick AU - Pereira, Bruno AU - Djiberou Mahamadou, Jalil Abdoul AU - Antoine, Violaine AU - Corteval, Alice AU - Eschalier, Alain AU - Dualé, Christian AU - Attal, Nadine AU - Authier, Nicolas PY - 2022/3/2 TI - eDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study JO - JMIR Form Res SP - e30052 VL - 6 IS - 3 KW - mHealth KW - chronic pain KW - feasibility study KW - eHealth KW - self-monitoring N2 - Background: Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. Objective: We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. Methods: We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. Results: Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. Conclusions: This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. Trial Registration: ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694 UR - https://formative.jmir.org/2022/3/e30052 UR - http://dx.doi.org/10.2196/30052 UR - http://www.ncbi.nlm.nih.gov/pubmed/35234654 ID - info:doi/10.2196/30052 ER - TY - JOUR AU - Skvortsova, Aleksandrina AU - Cohen Rodrigues, Talia AU - de Buisonjé, David AU - Kowatsch, Tobias AU - Santhanam, Prabhakaran AU - Veldhuijzen, S. Dieuwke AU - van Middendorp, Henriët AU - Evers, Andrea PY - 2022/3/1 TI - Increasing the Effectiveness of a Physical Activity Smartphone Intervention With Positive Suggestions: Randomized Controlled Trial JO - J Med Internet Res SP - e32130 VL - 24 IS - 3 KW - eHealth KW - mobile health KW - physical activity KW - walking KW - positive suggestions KW - outcome expectations KW - mobile phone N2 - Background: eHealth interventions have the potential to increase the physical activity of users. However, their effectiveness varies, and they often have only short-term effects. A possible way of enhancing their effectiveness is to increase the positive outcome expectations of users by giving them positive suggestions regarding the effectiveness of the intervention. It has been shown that when individuals have positive expectations regarding various types of interventions, they tend to benefit from these interventions more. Objective: The main objective of this web-based study is to investigate whether positive suggestions can change the expectations of participants regarding the effectiveness of a smartphone physical activity intervention and subsequently enhance the number of steps the participants take during the intervention. In addition, we study whether suggestions affect perceived app effectiveness, engagement with the app, self-reported vitality, and fatigue of the participants. Methods: This study involved a 21-day fully automated physical activity intervention aimed at helping participants to walk more steps. The intervention was delivered via a smartphone-based app that delivered specific tasks to participants (eg, setting activity goals or looking for social support) and recorded their daily step count. Participants were randomized to either a positive suggestions group (69/133, 51.9%) or a control group (64/133, 48.1%). Positive suggestions emphasizing the effectiveness of the intervention were implemented in a web-based flyer sent to the participants before the intervention. Suggestions were repeated on days 8 and 15 of the intervention via the app. Results: Participants significantly increased their daily step count from baseline compared with 21 days of the intervention (t107=?8.62; P<.001) regardless of the suggestions. Participants in the positive suggestions group had more positive expectations regarding the app (B=?1.61, SE 0.47; P<.001) and higher expected engagement with the app (B=3.80, SE 0.63; P<.001) than the participants in the control group. No effects of suggestions on the step count (B=?22.05, SE 334.90; P=.95), perceived effectiveness of the app (B=0.78, SE 0.69; P=.26), engagement with the app (B=0.78, SE 0.75; P=.29), and vitality (B=0.01, SE 0.11; P=.95) were found. Positive suggestions decreased the fatigue of the participants during the 3 weeks of the intervention (B=0.11, SE 0.02; P<.001). Conclusions: Although the suggestions did not affect the number of daily steps, they increased the positive expectations of the participants and decreased their fatigue. These results indicate that adding positive suggestions to eHealth physical activity interventions might be a promising way of influencing subjective but not objective outcomes of interventions. Future research should focus on finding ways of strengthening the suggestions, as they have the potential to boost the effectiveness of eHealth interventions. Trial Registration: Open Science Framework 10.17605/OSF.IO/CWJES; https://osf.io/cwjes UR - https://www.jmir.org/2022/3/e32130 UR - http://dx.doi.org/10.2196/32130 UR - http://www.ncbi.nlm.nih.gov/pubmed/35230245 ID - info:doi/10.2196/32130 ER - TY - JOUR AU - Siebert, N. Johan AU - Gosetto, Laëtitia AU - Sauvage, Manon AU - Bloudeau, Laurie AU - Suppan, Laurent AU - Rodieux, Frédérique AU - Haddad, Kevin AU - Hugon, Florence AU - Gervaix, Alain AU - Lovis, Christian AU - Combescure, Christophe AU - Manzano, Sergio AU - Ehrler, Frederic AU - PY - 2022/3/1 TI - Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials JO - JMIR Hum Factors SP - e35399 VL - 9 IS - 1 KW - cardiopulmonary resuscitation KW - drugs KW - emergency medical services KW - medication errors KW - mobile health KW - mobile apps KW - out-of-hospital cardiac arrest KW - paramedics KW - pediatrics KW - System Usability Scale KW - Unified Theory of Acceptance and Use of Technology KW - smartphone KW - mobile phone N2 - Background: Mobile apps are increasingly being used in various domains of medicine. Few are evidence-based, and their benefits can only be achieved if end users intend to adopt and use them. To date, only a small fraction of mobile apps have published data on their field usability and end user acceptance results, especially in emergency medicine. Objective: This study aims to determine the usability and acceptance of an evidence-based mobile app while safely preparing emergency drugs at the point of care during pediatric in- and out-of-hospital cardiopulmonary resuscitations by frontline caregivers. Methods: In 2 multicenter randomized controlled parent trials conducted at 6 pediatric emergency departments from March 1 to December 31, 2017, and 14 emergency medical services from September 3, 2019, to January 21, 2020, the usability and technology acceptance of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app were evaluated among skilled pediatric emergency nurses and advanced paramedics when preparing continuous infusions of vasoactive drugs and direct intravenous emergency drugs at pediatric dosages during standardized, simulation-based, pediatric in- and out-of-hospital cardiac arrest scenarios, respectively. Usability was measured using the 10-item System Usability Scale. A 26-item technology acceptance self-administered survey (5-point Likert-type scales), adapted from the Unified Theory of Acceptance and Use of Technology model, was used to measure app acceptance and intention to use. Results: All 100% (128/128) of nurses (crossover trial) and 49.3% (74/150) of paramedics (parallel trial) were assigned to the mobile app. Mean total scores on the System Usability Scale were excellent and reached 89.5 (SD 8.8; 95% CI 88.0-91.1) for nurses and 89.7 (SD 8.7; 95% CI 87.7-91.7) for paramedics. Acceptance of the technology was very good and rated on average >4.5/5 for 5 of the 8 independent constructs evaluated. Only the image construct scored between 3.2 and 3.5 by both participant populations. Conclusions: The results provide evidence that dedicated mobile apps can be easy to use and highly accepted at the point of care during in- and out-of-hospital cardiopulmonary resuscitations by frontline emergency caregivers. These findings can contribute to the implementation and valorization of studies aimed at evaluating the usability and acceptance of mobile apps in the field by caregivers, even in critical situations. Trial Registration: ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122. ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3726-4 UR - https://humanfactors.jmir.org/2022/1/e35399 UR - http://dx.doi.org/10.2196/35399 UR - http://www.ncbi.nlm.nih.gov/pubmed/35230243 ID - info:doi/10.2196/35399 ER - TY - JOUR AU - Cristiano, Alessia AU - Musteata, Stela AU - De Silvestri, Sara AU - Bellandi, Valerio AU - Ceravolo, Paolo AU - Cesari, Matteo AU - Azzolino, Domenico AU - Sanna, Alberto AU - Trojaniello, Diana PY - 2022/2/28 TI - Older Adults? and Clinicians? Perspectives on a Smart Health Platform for the Aging Population: Design and Evaluation Study JO - JMIR Aging SP - e29623 VL - 5 IS - 1 KW - smart health KW - remote monitoring KW - requirement elicitation KW - older population KW - age-related chronic conditions KW - healthy aging KW - Internet of Things KW - mobile phone N2 - Background: Over recent years, interest in the development of smart health technologies aimed at supporting independent living for older populations has increased. The integration of innovative technologies, such as the Internet of Things, wearable technologies, artificial intelligence, and ambient-assisted living applications, represents a valuable solution for this scope. Designing such an integrated system requires addressing several aspects (eg, equipment selection, data management, analytics, costs, and users? needs) and involving different areas of expertise (eg, medical science, service design, biomedical and computer engineering). Objective: The objective of this study is 2-fold; we aimed to design the functionalities of a smart health platform addressing 5 chronic conditions prevalent in the older population (ie, hearing loss, cardiovascular diseases, cognitive impairments, mental health problems, and balance disorders) by considering both older adults? and clinicians? perspectives and to evaluate the identified smart health platform functionalities with a small group of older adults. Methods: Overall, 24 older adults (aged >65 years) and 118 clinicians were interviewed through focus group activities and web-based questionnaires to elicit the smart health platform requirements. Considering the elicited requirements, the main functionalities of smart health platform were designed. Then, a focus group involving 6 older adults was conducted to evaluate the proposed solution in terms of usefulness, credibility, desirability, and learnability. Results: Eight main functionalities were identified and assessed?cognitive training and hearing training (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 6/6, 100%; learnability: 6/6, 100%), monitoring of physiological parameters (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 6/6, 100%; learnability: 5/6, 83%), physical training (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 5/6, 83%; learnability: 2/6, 33%), psychoeducational intervention (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 4/6, 67%; learnability: 2/6, 33%), mood monitoring (usefulness: 4/6, 67%; credibility: 4/6, 67%; desirability: 3/6, 50%; learnability: 5/6, 50%), diet plan (usefulness: 5/6, 83%; credibility: 4/6, 67%; desirability: 1/6, 17%; learnability: 2/6, 33%), and environment monitoring and adjustment (usefulness: 1/6, 17%; credibility: 1/6, 17%; desirability: 0/6, 0%; learnability: 0/6, 0%). Most of them were highly appreciated by older participants, with the only exception being environment monitoring and adjustment. The results showed that the proposed functionalities met the needs and expectations of users (eg, improved self-management of patients? disease and enhanced patient safety). However, some aspects need to be addressed (eg, technical and privacy issues). Conclusions: The presented smart health platform functionalities seem to be able to meet older adults? needs and desires to enhance their self-awareness and self-management of their medical condition, encourage healthy and independent living, and provide evidence-based support for clinicians? decision-making. Further research with a larger and more heterogeneous pool of stakeholders in terms of demographics and clinical conditions is needed to assess system acceptability and overall user experience in free-living conditions. UR - https://aging.jmir.org/2022/1/e29623 UR - http://dx.doi.org/10.2196/29623 UR - http://www.ncbi.nlm.nih.gov/pubmed/35225818 ID - info:doi/10.2196/29623 ER - TY - JOUR AU - Chowdhary, Kuntal AU - Yu, Xie Daihua AU - Pramana, Gede AU - Mesoros, Matthew AU - Fairman, Andrea AU - Dicianno, Edward Brad AU - Parmanto, Bambang PY - 2022/2/24 TI - User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study JO - JMIR Hum Factors SP - e23794 VL - 9 IS - 1 KW - cellular phone KW - mobile apps KW - telemedicine KW - adaptive mHealth KW - rehabilitation KW - self-care KW - spinal cord injury KW - spina bifida KW - chronic disease KW - persons with disability KW - accessibility KW - dexterity impairments KW - mobile phone N2 - Background: Mobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly. Objective: In this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app. Methods: We evaluated the original and redesigned iMHere modules?MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants? dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. Results: In total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules. Conclusions: This study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles. UR - https://humanfactors.jmir.org/2022/1/e23794 UR - http://dx.doi.org/10.2196/23794 UR - http://www.ncbi.nlm.nih.gov/pubmed/35200144 ID - info:doi/10.2196/23794 ER - TY - JOUR AU - Stavaux, Edouard AU - Goupil, François AU - Barreau, Guillaume AU - Septans, Lise Anne AU - Dautzenberg, Bertrand AU - Foulet-Rogé, Armelle AU - Padilla, Norbert AU - Urban, Thierry AU - Denis, Fabrice PY - 2022/2/23 TI - Use of a Smartphone Self-assessment App for a Tobacco-Induced Disease (COPD, Cardiovascular Diseases, Cancer) Screening Strategy and to Encourage Smoking Cessation: Observational Study JO - JMIR Public Health Surveill SP - e19877 VL - 8 IS - 2 KW - smoking cessation KW - mobile health KW - self-assessment, lung cancer KW - early detection KW - tobacco-induced pathologies N2 - Background: Patient self-assessment via a mobile app detects actionable symptoms and has been shown to detect lung cancer relapses early, thereby lengthening survival. Objective: The purpose of this study was to assess the incidence of chief symptoms associated with the main tobacco-induced pathologies in both current and ex-smokers through a self-assessment smartphone app and to evaluate the app?s capacity to encourage users to quit smoking or reduce consumption, as well as its impact on early lung cancer stages at the time of diagnosis. Methods: Current and ex-smokers were recruited through an advertising campaign in Sarthe county (France) proposing the free download of a smartphone app. App users were asked to answer 13 questions related to symptoms associated with tobacco-induced diseases (chronic obstructive pulmonary disease [COPD], cardiovascular diseases, cancer). In the event of any positive answer, a message was displayed recommending the user to consult a physician. In addition, they were asked about smoking cessation intention before and after answering these 13 questions. Finally, incidence of stage 1 or 2 lung cancers diagnosed during the launch period of our application was evaluated by comparing data from various sources to those from the same period during the previous year. Results: Of the 5671 users who were eligible for evaluation, an alert was sent to the majority (4118/5671, 72.6%), with a higher incidence for current smokers (2833/3679, 77.0% vs 1298/1992, 65.2%; P<.001). The most frequent symptoms triggering the notifications were fatigue (2023/5671, 35.7%), cough (1658/5671, 29.2%), dyspnea (1502/5671, 26.5%), and persistent chest pain (1286/5671, 22.7%). Of the current smokers, 14.0% (515/3679) showed symptoms suggesting COPD, 15.5% (571/3679) showed symptoms suggesting stable angina, 12.4% (455/3679) probably had lower extremity artery disease, and 6.8% (249/3679) had possible cancer. Of the users, 36.5% (1343/3679) claimed that they thought about quitting smoking, and 48.7% (1795/3679) had thought about reducing their consumption. Surgery-eligible stage 1 and 2 lung cancer incidence was 24% (14/58) during the study period versus 9% (5/54) during the previous year in Sarthe county (P=.04), whereas it remained unchanged in the neighboring county of Maine-et-Loire. Conclusions: A majority of current and ex-smokers showed worrying symptoms, and the use of a self-assessment smartphone app may drive a majority of smokers toward the intention of smoking cessation or decreasing consumption. A randomized study should be performed to confirm this intention and to support the potential increase of symptomatic lung cancer detection at early, surgery-accessible stages. Trial Registration: ClinicalTrials.gov NCT04048954; https://www.clinicaltrials.gov/ct2/show/NCT04048954 UR - https://publichealth.jmir.org/2022/2/e19877 UR - http://dx.doi.org/10.2196/19877 UR - http://www.ncbi.nlm.nih.gov/pubmed/35195530 ID - info:doi/10.2196/19877 ER - TY - JOUR AU - Agarwal, K. Anish AU - Southwick, Lauren AU - Schneider, Rachelle AU - Pelullo, Arthur AU - Ortiz, Robin AU - Klinger, V. Elissa AU - Gonzales, E. Rachel AU - Rosin, Roy AU - Merchant, M. Raina PY - 2022/2/23 TI - Crowdsourced Community Support Resources Among Patients Discharged From the Emergency Department During the COVID-19 Pandemic: Pilot Feasibility Study JO - JMIR Ment Health SP - e31909 VL - 9 IS - 2 KW - COVID-19 KW - mHealth KW - CHW KW - digital health KW - platform KW - crowdsource KW - support KW - community KW - health system KW - monitoring KW - virtual care KW - text message KW - model KW - community health worker KW - pilot study KW - feasibility N2 - Background: The COVID-19 pandemic has placed strains on communities. During this public health crisis, health systems have created remote methods of monitoring symptom progression and delivering care virtually. Objective: Using an SMS text message-based system, we sought to build and test a remote model to explore community needs, connect individuals to curated resources, and facilitate community health worker intervention when needed during the pandemic. The primary aims of this pilot study were to establish the feasibility (ie, engagement with the text line) and acceptability (ie, participant ratings of resources and service) of delivering automated well-being resources via smartphone technology. Methods: Eligible patients (aged 18 years or older, having a cell phone with SMS text messaging capability, and recently visited the emergency department) were identified using the electronic health record. The patients were consented to enroll and begin receiving COVID-19?related information and links to community resources. We collected open-ended and close-ended resource and mood ratings. We calculated the frequencies and conducted a thematic review of the open-ended responses. Results: In 7 weeks, 356 participants were enrolled; 13,917 messages were exchanged including 333 resource ratings (mean 4) and 673 well-being scores (mean 6.8). We received and coded 386 open-ended responses, most of which elaborated upon their self-reported mood score (29%). Overall, 77% (n=274) of our participants rated the platform as a service they would highly recommend to a family member or friend. Conclusions: This approach is designed to broaden the reach of health systems, tailor to community needs in real time, and connect at-risk individuals with robust community health support. UR - https://mental.jmir.org/2022/2/e31909 UR - http://dx.doi.org/10.2196/31909 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037886 ID - info:doi/10.2196/31909 ER - TY - JOUR AU - Blair, A. Rachel AU - Horn, E. Christine AU - Dias, M. Jennifer AU - McDonnell, E. Marie AU - Seely, W. Ellen PY - 2022/2/22 TI - Development and Usability of a Text Messaging Program for Women With Gestational Diabetes: Mixed Methods Study JO - JMIR Hum Factors SP - e32815 VL - 9 IS - 1 KW - gestational diabetes mellitus KW - SMS text messaging KW - mobile phone KW - mobile health KW - pregnancy KW - blood glucose self-monitoring N2 - Background: Gestational diabetes mellitus (GDM) affects 5%-10% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM. Objective: This study aimed to perform user experience testing and assess usability and acceptability of an SMS text messaging program (Text 4 Success) for women with GDM. Methods: An automated 2-way texting program was developed. It included (1) reminders to check blood glucose levels, (2) positive feedback to user-reported glucose levels, (3) weekly educational messages, and (4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semistructured interviews. For women in the usability study, data from glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percentage of recommended SMBG checks performed (a secondary outcome). Results: Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon, which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (222/238 recommended checks, 93%). In comparing the week prior to the trial with the 2 weeks during the trial, there was a small but statistically insignificant difference (P=.48) in the percentage of recommended SMBG performed (median 93% [25th-75th IQR 89%-100%] vs median 97% [25th-75th IQR 92%-100%]). Conclusions: Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have low levels of adherence to SMBG at baseline or to women at time of their diagnosis of GDM. Adaptations to the program will be made based on user suggestions. Further study of SMS text messaging to improve SMBG in GDM is needed. UR - https://humanfactors.jmir.org/2022/1/e32815 UR - http://dx.doi.org/10.2196/32815 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191851 ID - info:doi/10.2196/32815 ER - TY - JOUR AU - Goulding, H. Evan AU - Dopke, A. Cynthia AU - Rossom, C. Rebecca AU - Michaels, Tania AU - Martin, R. Clair AU - Ryan, Chloe AU - Jonathan, Geneva AU - McBride, Alyssa AU - Babington, Pamela AU - Bernstein, Mary AU - Bank, Andrew AU - Garborg, Spencer C. AU - Dinh, M. Jennifer AU - Begale, Mark AU - Kwasny, J. Mary AU - Mohr, C. David PY - 2022/2/21 TI - A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Empirical and Theoretical Framework, Intervention Design, and Study Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e30710 VL - 11 IS - 2 KW - bipolar disorder KW - self-management KW - mHealth KW - eHealth KW - smartphone KW - mobile phone KW - mental health KW - mobile health N2 - Background: Bipolar disorder is a severe mental illness with high morbidity and mortality rates. Even with pharmacological treatment, frequent recurrence of episodes, long episode durations, and persistent interepisode symptoms are common and disruptive. Combining psychotherapy with pharmacotherapy improves outcomes; however, many individuals with bipolar disorder do not receive psychotherapy. Mental health technologies can increase access to self-management strategies derived from empirically supported bipolar disorder psychotherapies while also enhancing treatment by delivering real-time assessments, personalized feedback, and provider alerts. In addition, mental health technologies provide a platform for self-report, app use, and behavioral data collection to advance understanding of the longitudinal course of bipolar disorder, which can then be used to support ongoing improvement of treatment. Objective: A description of the theoretical and empirically supported framework, design, and protocol for a randomized controlled trial (RCT) of LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder, is provided to facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar disorder. The goal of the trial is to determine the effectiveness of LiveWell for reducing relapse risk and symptom burden as well as improving quality of life (QOL) while simultaneously clarifying behavioral targets involved in staying well and better characterizing the course of bipolar disorder and treatment response. Methods: The study is a single-blind RCT (n=205; 2:3 ratio of usual care vs usual care plus LiveWell). The primary outcome is the time to relapse. Secondary outcomes are percentage time symptomatic, symptom severity, and QOL. Longitudinal changes in target behaviors proposed to mediate the primary and secondary outcomes will also be determined, and their relationships with the outcomes will be assessed. A database of clinical status, symptom severity, real-time self-report, behavioral sensor, app use, and personalized content will be created to better predict treatment response and relapse risk. Results: Recruitment and screening began in March 2017 and ended in April 2019. Follow-up ended in April 2020. The results of this study are expected to be published in 2022. Conclusions: This study will examine whether LiveWell reduces relapse risk and symptom burden and improves QOL for individuals with bipolar disorder by increasing access to empirically supported self-management strategies. The role of selected target behaviors (medication adherence, sleep duration, routine, and management of signs and symptoms) in these outcomes will also be examined. Simultaneously, a database will be created to initiate the development of algorithms to personalize and improve treatment for bipolar disorder. In addition, we hope that this description of the theoretical and empirically supported framework, intervention design, and study protocol for the RCT of LiveWell will facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar and other mental health disorders. Trial Registration: ClinicalTrials.gov NCT03088462; https://www.clinicaltrials.gov/ct2/show/NCT03088462 International Registered Report Identifier (IRRID): DERR1-10.2196/30710 UR - https://www.researchprotocols.org/2022/2/e30710 UR - http://dx.doi.org/10.2196/30710 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188473 ID - info:doi/10.2196/30710 ER - TY - JOUR AU - Zhai, DongHui AU - van Stiphout, Ruud AU - Schiavone, Giuseppina AU - De Raedt, Walter AU - Van Hoof, Chris PY - 2022/2/18 TI - Characterizing and Modeling Smoking Behavior Using Automatic Smoking Event Detection and Mobile Surveys in Naturalistic Environments: Observational Study JO - JMIR Mhealth Uhealth SP - e28159 VL - 10 IS - 2 KW - smoking behavior modeling KW - ambulatory study KW - wearable sensors KW - temporal patterns of smoking KW - Poisson mixed-effects model KW - mobile phone N2 - Background: There are 1.1 billion smokers worldwide, and each year, more than 8 million die prematurely because of cigarette smoking. More than half of current smokers make a serious quit every year. Nonetheless, 90% of unaided quitters relapse within the first 4 weeks of quitting due to the lack of limited access to cost-effective and efficient smoking cessation tools in their daily lives. Objective: This study aims to enable quantified monitoring of ambulatory smoking behavior 24/7 in real life by using continuous and automatic measurement techniques and identifying and characterizing smoking patterns using longitudinal contextual signals. This work also intends to provide guidance and insights into the design and deployment of technology-enabled smoking cessation applications in naturalistic environments. Methods: A 4-week observational study consisting of 46 smokers was conducted in both working and personal life environments. An electric lighter and a smartphone with an experimental app were used to track smoking events and acquire concurrent contextual signals. In addition, the app was used to prompt smoking-contingent ecological momentary assessment (EMA) surveys. The smoking rate was assessed based on the timestamps of smoking and linked statistically to demographics, time, and EMA surveys. A Poisson mixed-effects model to predict smoking rate in 1-hour windows was developed to assess the contribution of each predictor. Results: In total, 8639 cigarettes and 1839 EMA surveys were tracked over 902 participant days. Most smokers were found to have an inaccurate and often biased estimate of their daily smoking rate compared with the measured smoking rate. Specifically, 74% (34/46) of the smokers made more than one (mean 4.7, SD 4.2 cigarettes per day) wrong estimate, and 70% (32/46) of the smokers overestimated it. On the basis of the timestamp of the tracked smoking events, smoking rates were visualized at different hours and were found to gradually increase and peak at 6 PM in the day. In addition, a 1- to 2-hour shift in smoking patterns was observed between weekdays and weekends. When moderate and heavy smokers were compared with light smokers, their ages (P<.05), Fagerström Test of Nicotine Dependence (P=.01), craving level (P<.001), enjoyment of cigarettes (P<.001), difficulty resisting smoking (P<.001), emotional valence (P<.001), and arousal (P<.001) were all found to be significantly different. In the Poisson mixed-effects model, the number of cigarettes smoked in a 1-hour time window was highly dependent on the smoking status of an individual (P<.001) and was explained by hour (P=.02) and age (P=.005). Conclusions: This study reported the high potential and challenges of using an electronic lighter for smoking annotation and smoking-triggered EMAs in an ambulant environment. These results also validate the techniques for smoking behavior monitoring and pave the way for the design and deployment of technology-enabled smoking cessation applications. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028284 UR - https://mhealth.jmir.org/2022/2/e28159 UR - http://dx.doi.org/10.2196/28159 UR - http://www.ncbi.nlm.nih.gov/pubmed/35179512 ID - info:doi/10.2196/28159 ER - TY - JOUR AU - Park, S. Linda AU - Chih, Ming-Yuan AU - Stephenson, Christine AU - Schumacher, Nicholas AU - Brown, Randall AU - Gustafson, David AU - Barrett, Bruce AU - Quanbeck, Andrew PY - 2022/2/18 TI - Testing an mHealth System for Individuals With Mild to Moderate Alcohol Use Disorders: Protocol for a Type 1 Hybrid Effectiveness-Implementation Trial JO - JMIR Res Protoc SP - e31109 VL - 11 IS - 2 KW - mHealth KW - mobile health KW - alcohol use disorder KW - alcohol reduction KW - wellness KW - risky drinking KW - quality of life KW - protocol N2 - Background: The extent of human interaction needed to achieve effective and cost-effective use of mobile health (mHealth) apps for individuals with mild to moderate alcohol use disorder (AUD) remains largely unexamined. This study seeks to understand how varying levels of human interaction affect the ways in which an mHealth intervention for the prevention and treatment of AUDs works or does not work, for whom, and under what circumstances. Objective: The primary aim is to detect the effectiveness of an mHealth intervention by assessing differences in self-reported risky drinking patterns and quality of life between participants in three study groups (self-monitored, peer-supported, and clinically integrated). The cost-effectiveness of each approach will also be assessed. Methods: This hybrid type 1 study is an unblinded patient-level randomized clinical trial testing the effects of using an evidence-based mHealth system on participants? drinking patterns and quality of life. There are two groups of participants for this study: individuals receiving the intervention and health care professionals practicing in the broader health care environment. The intervention is a smartphone app that encourages users to reduce their alcohol consumption within the context of integrative medicine using techniques to build healthy habits. The primary outcomes for quantitative analysis will be participant data on their risky drinking days and quality of life as well as app use from weekly and quarterly surveys. Cost measures include intervention and implementation costs. The cost per participant will be determined for each study arm, with intervention and implementation costs separated within each group. There will also be a qualitative assessment of health care professionals? engagement with the app as well as their thoughts on participant experience with the app. Results: This protocol was approved by the Health Sciences Minimal Risk Institutional Review Board on November 18, 2019, with subsequent annual reviews. Recruitment began on March 6, 2020, but was suspended on March 13, 2020, due to the COVID-19 pandemic restrictions. Limited recruitment resumed on July 6, 2020. Trial status as of November 17, 2021, is as follows: 357 participants were enrolled in the study for a planned enrollment of 546 participants. Conclusions: The new knowledge gained from this study could have wide and lasting benefits related to the integration of mHealth systems for individuals with mild to moderate AUDs. The results of this study will guide policy makers and providers toward cost-effective ways to incorporate technology in health care and community settings. Trial Registration: ClinicalTrials.gov NCT04011644; https://clinicaltrials.gov/ct2/show/NCT04011644 International Registered Report Identifier (IRRID): DERR1-10.2196/31109 UR - https://www.researchprotocols.org/2022/2/e31109 UR - http://dx.doi.org/10.2196/31109 UR - http://www.ncbi.nlm.nih.gov/pubmed/35179502 ID - info:doi/10.2196/31109 ER - TY - JOUR AU - Seo, Suin AU - Cho, Sung-Il AU - Yoon, Wonjeong AU - Lee, Min Cheol PY - 2022/2/17 TI - Classification of Smoking Cessation Apps: Quality Review and Content Analysis JO - JMIR Mhealth Uhealth SP - e17268 VL - 10 IS - 2 KW - smoking cessation KW - app KW - type KW - content and functions KW - MARS KW - quality KW - score KW - mobile phone N2 - Background: Many people use apps for smoking cessation, and the effectiveness of these apps has been proven in several studies. However, no study has classified these apps and only few studies have analyzed the characteristics of these apps that influence their quality. Objective: The purpose of this study was to analyze the content and the quality of smoking cessation apps by type and identify the characteristics that affect their overall quality. Methods: Two app marketplaces (App Store and Google Play) were searched in January 2018, and the search was completed by May 2020. The search terms used were ?stop smoking,? ?quit smoking,? and ?smoking cessation.? The apps were categorized into 3 types (combined, multifunctional, and informational). The tailored guideline of Clinical Practice Guideline for Treating Tobacco Use and Dependence was utilized for evaluating app content (or functions), and the Mobile App Rating Scale (MARS) was used to evaluate the quality. Chi-square test was performed for the general characteristics, and one-way analysis of variance was performed for MARS analysis. To identify the general features of the apps that could be associated with the MARS and content scores, multiple regression analysis was done. All analyses were performed using SAS software (ver. 9.3). Results: Among 1543 apps, 104 apps met the selection criteria of this study. These 104 apps were categorized as combined type (n=44), functional type (n=31), or informational type (n=29). A large amount of content specified in the guideline was included in the apps, most notably in the combined type, followed by the multifunctional and informational type; the MARS scores followed the same order (3.64, 3.26, and 3.0, respectively). Regression analysis showed that the sector in which the developer was situated and the feedback channel with the developer had a significant impact on both the content and MARS scores. In addition, problematic apps such as those made by unknown developers or copied and single-function apps were shown to have a large market share. Conclusions: This study is the first to evaluate the content and quality of smoking cessation apps by classification. The combined type had higher-quality content and functionality than other app types. The app developer type and feedback channel with the app developer had a significant impact on the overall quality of the apps. In addition, problematic apps and single-function apps were shown to have a large market share. Our results will contribute to the use and development of better smoking cessation apps after considering the problems identified in this study. UR - https://mhealth.jmir.org/2022/2/e17268 UR - http://dx.doi.org/10.2196/17268 UR - http://www.ncbi.nlm.nih.gov/pubmed/35175213 ID - info:doi/10.2196/17268 ER - TY - JOUR AU - Thornton, Louise AU - Osman, Bridie AU - Champion, Katrina AU - Green, Olivia AU - Wescott, B. Annie AU - Gardner, A. Lauren AU - Stewart, Courtney AU - Visontay, Rachel AU - Whife, Jesse AU - Parmenter, Belinda AU - Birrell, Louise AU - Bryant, Zachary AU - Chapman, Cath AU - Lubans, David AU - Slade, Tim AU - Torous, John AU - Teesson, Maree AU - Van de Ven, Pepijn PY - 2022/2/17 TI - Measurement Properties of Smartphone Approaches to Assess Diet, Alcohol Use, and Tobacco Use: Systematic Review JO - JMIR Mhealth Uhealth SP - e27337 VL - 10 IS - 2 KW - smartphone KW - app KW - alcohol KW - smoking KW - diet KW - measurement KW - mobile phone N2 - Background: Poor diet, alcohol use, and tobacco smoking have been identified as strong determinants of chronic diseases, such as cardiovascular disease, diabetes, and cancer. Smartphones have the potential to provide a real-time, pervasive, unobtrusive, and cost-effective way to measure these health behaviors and deliver instant feedback to users. Despite this, the validity of using smartphones to measure these behaviors is largely unknown. Objective: The aim of our review is to identify existing smartphone-based approaches to measure these health behaviors and critically appraise the quality of their measurement properties. Methods: We conducted a systematic search of the Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsycINFO (EBSCOhost), CINAHL (EBSCOHost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost), and IEEE Xplore Digital Library databases in March 2020. Articles that were written in English; reported measuring diet, alcohol use, or tobacco use via a smartphone; and reported on at least one measurement property (eg, validity, reliability, and responsiveness) were eligible. The methodological quality of the included studies was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias checklist. Outcomes were summarized in a narrative synthesis. This systematic review was registered with PROSPERO, identifier CRD42019122242. Results: Of 12,261 records, 72 studies describing the measurement properties of smartphone-based approaches to measure diet (48/72, 67%), alcohol use (16/72, 22%), and tobacco use (8/72, 11%) were identified and included in this review. Across the health behaviors, 18 different measurement techniques were used in smartphones. The measurement properties most commonly examined were construct validity, measurement error, and criterion validity. The results varied by behavior and measurement approach, and the methodological quality of the studies varied widely. Most studies investigating the measurement of diet and alcohol received very good or adequate methodological quality ratings, that is, 73% (35/48) and 69% (11/16), respectively, whereas only 13% (1/8) investigating the measurement of tobacco use received a very good or adequate rating. Conclusions: This review is the first to provide evidence regarding the different types of smartphone-based approaches currently used to measure key behavioral risk factors for chronic diseases (diet, alcohol use, and tobacco use) and the quality of their measurement properties. A total of 19 measurement techniques were identified, most of which assessed dietary behaviors (48/72, 67%). Some evidence exists to support the reliability and validity of using smartphones to assess these behaviors; however, the results varied by behavior and measurement approach. The methodological quality of the included studies also varied. Overall, more high-quality studies validating smartphone-based approaches against criterion measures are needed. Further research investigating the use of smartphones to assess alcohol and tobacco use and objective measurement approaches is also needed. International Registered Report Identifier (IRRID): RR2-10.1186/s13643-020-01375-w UR - https://mhealth.jmir.org/2022/2/e27337 UR - http://dx.doi.org/10.2196/27337 UR - http://www.ncbi.nlm.nih.gov/pubmed/35175212 ID - info:doi/10.2196/27337 ER - TY - JOUR AU - Sonney, Jennifer AU - Cho, E. Emily AU - Zheng, Qiming AU - Kientz, A. Julie PY - 2022/2/17 TI - Refinement of a Parent?Child Shared Asthma Management Mobile Health App: Human-Centered Design Study JO - JMIR Pediatr Parent SP - e34117 VL - 5 IS - 1 KW - parent?child shared management KW - school-age children KW - asthma KW - participatory design KW - mHealth KW - prototype KW - usability KW - family health informatics N2 - Background: The school-age years, approximately ages 7 through 11, represent a natural transition when children begin assuming some responsibility for their asthma management. Previously, we designed a theoretically derived, tailored parent?child shared asthma management mobile health app prototype, Improving Asthma Care Together (IMPACT). Objective: The purpose of this study was to use human-centered design (HCD) to iteratively refine IMPACT to optimize user experience and incorporate evidence-based longitudinal engagement strategies. Methods: This study used a mixed methods design from December 2019 to April 2021. Our app refinement used the HCD process of research, ideation, design, evaluation, and implementation, including 6 cycles of design and evaluation. The design and evaluation cycles focused on core app functionality, child engagement, and overall refinement. Evaluation with parent?child dyads entailed in-person and remote concept testing and usability testing sessions, after which rapid cycle thematic analyses identified key insights that informed future design refinement. Results: Twelve parent?child dyads enrolled in at least one round of this study. Eight of the 12 child participants were male with a mean age of 9.9 (SD 1.6) years and all parent participants were female. Throughout evaluation cycles, dyads selected preferred app layouts, gamification concepts, and overall features with a final design prototype emerging for full-scale development and implementation. Conclusions: A theoretically derived, evidence-based shared asthma management app was co-designed with end users to address real-world pain points and priorities. An 8-week pilot study testing app feasibility, acceptability, and preliminary efficacy is forthcoming. UR - https://pediatrics.jmir.org/2022/1/e34117 UR - http://dx.doi.org/10.2196/34117 UR - http://www.ncbi.nlm.nih.gov/pubmed/35175214 ID - info:doi/10.2196/34117 ER - TY - JOUR AU - Moon, Khatiya AU - Sobolev, Michael AU - Kane, M. John PY - 2022/2/16 TI - Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review JO - JMIR Ment Health SP - e30810 VL - 9 IS - 2 KW - collaborative care KW - integrated care KW - augmented care KW - digital health KW - mobile health KW - behavioral health KW - review N2 - Background: The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. Objective: This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. Methods: This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. Results: A total of 3982 nonduplicate reports were identified, of which 20 (0.5%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35%), there were no differences between groups, or the differences were modest. Conclusions: The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials. UR - https://mental.jmir.org/2022/2/e30810 UR - http://dx.doi.org/10.2196/30810 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171105 ID - info:doi/10.2196/30810 ER - TY - JOUR AU - Gonzalez-Plaza, Elena AU - Bellart, Jordi AU - Arranz, Ángela AU - Luján-Barroso, Leila AU - Crespo Mirasol, Esther AU - Seguranyes, Gloria PY - 2022/2/15 TI - Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e28886 VL - 10 IS - 2 KW - obesity KW - maternal KW - pregnancy KW - mHealth KW - mobile apps KW - telemedicine KW - telenursing KW - physical activity KW - gestational weight gain KW - lifestyle KW - mobile phone N2 - Background: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. Objective: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. Methods: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire?Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. Results: We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI ?0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks?minutes per week vs 1386 metabolic equivalents of tasks?minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. Conclusions: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. Trial Registration: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872 UR - https://mhealth.jmir.org/2022/2/e28886 UR - http://dx.doi.org/10.2196/28886 UR - http://www.ncbi.nlm.nih.gov/pubmed/35166684 ID - info:doi/10.2196/28886 ER - TY - JOUR AU - Hwang, Hyunchan AU - Kim, Mi Sun AU - Netterstrøm, Bo AU - Han, Hyun Doug PY - 2022/2/15 TI - The Efficacy of a Smartphone-Based App on Stress Reduction: Randomized Controlled Trial JO - J Med Internet Res SP - e28703 VL - 24 IS - 2 KW - stress reduction KW - third-wave cognitive behavioral therapy KW - individual tailored treatment KW - randomized controlled trial KW - digital therapeutics N2 - Background: Stress management in the workplace is essential for a healthy mental and physical state. Due to technological advancements, individually tailored therapy and online cognitive behavioral therapy (CBT) are on the rise. Objective: This study analyzed the efficacy of a smartphone app based on third-wave CBT tailored to an individual. Methods: A randomized controlled trial was conducted with 126 participants who were divided into 2 groups. The intervention group used the smartphone app BetterLife for 10 weeks, while the control group was placed on a waiting list for the same duration. The Perceived Stress Scale?10 (PSS), Korean Utrecht Work Engagement Scale?9 (UWES), World Health Organization Quality of Life Assessment (WHOQOL), Beck Depression Inventory?II (BDI), and Beck Anxiety Inventory (BAI) were administered at baseline and after 10 weeks to both groups. Results: Of the 126 participants, 11 dropped out during the trial. A 2-way repeated measure analysis of covariance was conducted, controlling for baseline BDI. There were greater improvements in PSS (F=24.33, P<.001, ?2=0.17) and UWESK scores (F=8.32, P=.0046, ?2=0.06) in the intervention group than in the control group. WHOQOL scores exhibited statistically significant improvement in the intervention group in the overall quality of life (F=8.19, P=.0049, ?2=0.06), physical health (F=8.87, P=.003, ?2=0.07), psychological health (F=13.32, P<.001, ?2=0.10), social relationships (F=19.43, P<.001, ?2=0.14), and environmental domains (F=10.14, P=.002, ?2=0.08) but not overall health (F=1.68, P=.20). BDI (F=7.17, P=.008, ?2=0.06) and BAI (F=6.00, P=.02, ?2=0.05) showed a statistically significant improvement in the intervention group, but this significance did not survive the Bonferroni correction (P<.005). Conclusions: These results provide evidence that smartphone-based CBT is a viable option for reducing stress in the workplace. Trial Registration: Clinical Research Information Service KCT0003231; https://cris.nih.go.kr/cris/search/detailSearch.do/15137 UR - https://www.jmir.org/2022/2/e28703 UR - http://dx.doi.org/10.2196/28703 UR - http://www.ncbi.nlm.nih.gov/pubmed/35166687 ID - info:doi/10.2196/28703 ER - TY - JOUR AU - Varma, Maya AU - Washington, Peter AU - Chrisman, Brianna AU - Kline, Aaron AU - Leblanc, Emilie AU - Paskov, Kelley AU - Stockham, Nate AU - Jung, Jae-Yoon AU - Sun, Woo Min AU - Wall, P. Dennis PY - 2022/2/15 TI - Identification of Social Engagement Indicators Associated With Autism Spectrum Disorder Using a Game-Based Mobile App: Comparative Study of Gaze Fixation and Visual Scanning Methods JO - J Med Internet Res SP - e31830 VL - 24 IS - 2 KW - mobile health KW - autism spectrum disorder KW - social phenotyping KW - computer vision KW - gaze KW - mobile diagnostics KW - pattern recognition KW - autism KW - diagnostic KW - pattern KW - engagement KW - gaming KW - app KW - insight KW - vision KW - video N2 - Background: Autism spectrum disorder (ASD) is a widespread neurodevelopmental condition with a range of potential causes and symptoms. Standard diagnostic mechanisms for ASD, which involve lengthy parent questionnaires and clinical observation, often result in long waiting times for results. Recent advances in computer vision and mobile technology hold potential for speeding up the diagnostic process by enabling computational analysis of behavioral and social impairments from home videos. Such techniques can improve objectivity and contribute quantitatively to the diagnostic process. Objective: In this work, we evaluate whether home videos collected from a game-based mobile app can be used to provide diagnostic insights into ASD. To the best of our knowledge, this is the first study attempting to identify potential social indicators of ASD from mobile phone videos without the use of eye-tracking hardware, manual annotations, and structured scenarios or clinical environments. Methods: Here, we used a mobile health app to collect over 11 hours of video footage depicting 95 children engaged in gameplay in a natural home environment. We used automated data set annotations to analyze two social indicators that have previously been shown to differ between children with ASD and their neurotypical (NT) peers: (1) gaze fixation patterns, which represent regions of an individual?s visual focus and (2) visual scanning methods, which refer to the ways in which individuals scan their surrounding environment. We compared the gaze fixation and visual scanning methods used by children during a 90-second gameplay video to identify statistically significant differences between the 2 cohorts; we then trained a long short-term memory (LSTM) neural network to determine if gaze indicators could be predictive of ASD. Results: Our results show that gaze fixation patterns differ between the 2 cohorts; specifically, we could identify 1 statistically significant region of fixation (P<.001). In addition, we also demonstrate that there are unique visual scanning patterns that exist for individuals with ASD when compared to NT children (P<.001). A deep learning model trained on coarse gaze fixation annotations demonstrates mild predictive power in identifying ASD. Conclusions: Ultimately, our study demonstrates that heterogeneous video data sets collected from mobile devices hold potential for quantifying visual patterns and providing insights into ASD. We show the importance of automated labeling techniques in generating large-scale data sets while simultaneously preserving the privacy of participants, and we demonstrate that specific social engagement indicators associated with ASD can be identified and characterized using such data. UR - https://www.jmir.org/2022/2/e31830 UR - http://dx.doi.org/10.2196/31830 UR - http://www.ncbi.nlm.nih.gov/pubmed/35166683 ID - info:doi/10.2196/31830 ER - TY - JOUR AU - Winter, Natalie AU - Green, Anna AU - Jongebloed, Hannah AU - Ralph, Nicholas AU - Chambers, Suzanne AU - Livingston, Patricia PY - 2022/2/15 TI - Designing Supportive e-Interventions for Partners of Men With Prostate Cancer Using Female Partners? Experiences: Qualitative Exploration Study JO - JMIR Cancer SP - e31218 VL - 8 IS - 1 KW - prostate cancer KW - prostatic neoplasms KW - e-intervention KW - smartphone KW - qualitative research KW - caregivers KW - mHealth KW - mobile phone N2 - Background: Partners of men living with prostate cancer (PCa) can experience a variety of unmet needs that are largely unaddressed by health care professionals. There is limited evidence to suggest which approach may be most effective in supporting partners? unmet needs and further research is required to determine how to provide support to caregivers and how technology solutions can be designed. Objective: This study aims to explore the experience of partners of men living with PCa and their perceptions of the potential role of information technology in supporting their needs. Methods: A qualitative descriptive methodology using focus groups and phone interviews was used. Purposive sampling was used to recruit people attending a national conference supported by a national PCa organization. Interview guides were adapted from an existing evidence-based smartphone app for caregivers of people with colorectal cancer. Sessions were audio recorded and transcribed verbatim. A coding framework was developed, and transcripts were coded line by line into the framework. Codes within the framework were grouped into descriptive categories that were then developed into analytical themes. Results: A total of 17 female partners participated in the study, with an average age of 64 (SD 8.5) years. The following two main themes emerged: In the first theme, that is, How technology can be shaped to support female partners of prostate cancer survivors, the content and design of the smartphone app was discussed in addressing female partners? needs. The following four subthemes were developed: getting support from social networks and resources, the lack of relevant information, demystifying future care expectations during and following a PCa diagnosis, and delivering the smartphone app?to whom and from whom. In the second theme, that is, The benefits and barriers of technology, the suitability of smartphone apps as a supportive modality for female partners was described. This included three subthemes: the smartphone app as an appropriate modality for supporting female partners, the future anticipated benefits of using the smartphone app, and concerns for storing and accessing information on the internet. Conclusions: A smartphone app may be a suitable modality for providing information and peer support to female partners of men living with PCa. There is a need to provide peer support for female partners in future interventions to ensure that female partners? intimacy and daily practical needs are met. UR - https://cancer.jmir.org/2022/1/e31218 UR - http://dx.doi.org/10.2196/31218 UR - http://www.ncbi.nlm.nih.gov/pubmed/35166677 ID - info:doi/10.2196/31218 ER - TY - JOUR AU - Kouvari, Matina AU - Karipidou, Melina AU - Tsiampalis, Thomas AU - Mamalaki, Eirini AU - Poulimeneas, Dimitrios AU - Bathrellou, Eirini AU - Panagiotakos, Demosthenes AU - Yannakoulia, Mary PY - 2022/2/14 TI - Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e30675 VL - 24 IS - 2 KW - childhood obesity KW - eHealth KW - mHealth KW - digital health KW - youth KW - mobile phone N2 - Background: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. Objective: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. Methods: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. Results: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference ?0.61, 95% CI ?1.10 to ?0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference ?0.36, 95% CI ?0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. Conclusions: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations. UR - https://www.jmir.org/2022/2/e30675 UR - http://dx.doi.org/10.2196/30675 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156934 ID - info:doi/10.2196/30675 ER - TY - JOUR AU - Ponnada, Aditya AU - Wang, Shirlene AU - Chu, Daniel AU - Do, Bridgette AU - Dunton, Genevieve AU - Intille, Stephen PY - 2022/2/9 TI - Intensive Longitudinal Data Collection Using Microinteraction Ecological Momentary Assessment: Pilot and Preliminary Results JO - JMIR Form Res SP - e32772 VL - 6 IS - 2 KW - intensive longitudinal data KW - ecological momentary assessment KW - experience sampling KW - microinteractions KW - smartwatch KW - health behavior research KW - mobile phone N2 - Background: Ecological momentary assessment (EMA) uses mobile technology to enable in situ self-report data collection on behaviors and states. In a typical EMA study, participants are prompted several times a day to answer sets of multiple-choice questions. Although the repeated nature of EMA reduces recall bias, it may induce participation burden. There is a need to explore complementary approaches to collecting in situ self-report data that are less burdensome yet provide comprehensive information on an individual?s behaviors and states. A new approach, microinteraction EMA (?EMA), restricts EMA items to single, cognitively simple questions answered on a smartwatch with single-tap assessments using a quick, glanceable microinteraction. However, the viability of using ?EMA to capture behaviors and states in a large-scale longitudinal study has not yet been demonstrated. Objective: This paper describes the ?EMA protocol currently used in the Temporal Influences on Movement & Exercise (TIME) Study conducted with young adults, the interface of the ?EMA app used to gather self-report responses on a smartwatch, qualitative feedback from participants after a pilot study of the ?EMA app, changes made to the main TIME Study ?EMA protocol and app based on the pilot feedback, and preliminary ?EMA results from a subset of active participants in the TIME Study. Methods: The TIME Study involves data collection on behaviors and states from 246 individuals; measurements include passive sensing from a smartwatch and smartphone and intensive smartphone-based hourly EMA, with 4-day EMA bursts every 2 weeks. Every day, participants also answer a nightly EMA survey. On non?EMA burst days, participants answer ?EMA questions on the smartwatch, assessing momentary states such as physical activity, sedentary behavior, and affect. At the end of the study, participants describe their experience with EMA and ?EMA in a semistructured interview. A pilot study was used to test and refine the ?EMA protocol before the main study. Results: Changes made to the ?EMA study protocol based on pilot feedback included adjusting the single-question selection method and smartwatch vibrotactile prompting. We also added sensor-triggered questions for physical activity and sedentary behavior. As of June 2021, a total of 81 participants had completed at least 6 months of data collection in the main study. For 662,397 ?EMA questions delivered, the compliance rate was 67.6% (SD 24.4%) and the completion rate was 79% (SD 22.2%). Conclusions: The TIME Study provides opportunities to explore a novel approach for collecting temporally dense intensive longitudinal self-report data in a sustainable manner. Data suggest that ?EMA may be valuable for understanding behaviors and states at the individual level, thus possibly supporting future longitudinal interventions that require within-day, temporally dense self-report data as people go about their lives. UR - https://formative.jmir.org/2022/2/e32772 UR - http://dx.doi.org/10.2196/32772 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138253 ID - info:doi/10.2196/32772 ER - TY - JOUR AU - Fundoiano-Hershcovitz, ?Yifat AU - Bacher, Dror AU - Ritholz, D. Marilyn AU - Horwitz, L. David AU - Manejwala, Omar AU - Goldstein, Pavel PY - 2022/2/8 TI - Blood Pressure Monitoring as a Digital Health Tool for Improving Diabetes Clinical Outcomes: Retrospective Real-world Study JO - J Med Internet Res SP - e32923 VL - 24 IS - 2 KW - blood glucose KW - blood pressure KW - monitoring KW - digital therapeutic KW - diabetes KW - hypertension KW - app KW - model KW - chronic disease KW - health data N2 - Background: Remote data capture for blood glucose (BG) or blood pressure (BP) monitoring and the use of a supportive digital app are becoming the model in diabetes and hypertension chronic care. One of the goals in chronic condition management is to increase awareness and generate behavioral change in order to improve outcomes in diabetes and related comorbidities, such as hypertension. In addition, there is a lack of understanding of the association between BG and BP levels when using digital health tools. Objective: By applying a rigorous study framework to digital health data, this study investigated the relationship between BP monitoring and BG and BP levels, as well as a lagged association between BP and BG. We hypothesized that during the first 6 months of BP monitoring, BG and BP levels would decrease. Finally, we suggested a positive association between BP levels and the following month?s BG levels. Methods: In this retrospective, real-world case-control study, we extracted the data of 269 people with type 2 diabetes (T2D) who tracked their BG levels using the Dario digital platform for a chronic condition. We analyzed the digital data of the users who, in addition to BG, monitored their BP using the same app (BP-monitoring [BPM] group, n=137) 6 months before and after starting their BP monitoring. Propensity score matching established a control group, no blood pressure monitoring (NBPM, n=132), matched on demographic and baseline clinical measures to the BPM group. A piecewise mixed model was used for analyzing the time trajectories of BG, BP, and their lagged association. Results: Analysis revealed a significant difference in BG time trajectories associated with BP monitoring in BPM and NBPM groups (t=?2.12, P=.03). The BPM group demonstrated BG reduction improvement in the monthly average BG levels during the first 6 months (t=?3.57, P<.001), while BG did not change for the NBPM group (t=0.39, P=.70). Both groups showed similarly stable BG time trajectories (B=0.98, t=1.16, P=.25) before starting the use of the BP-monitoring system. In addition, the BPM group showed a significant reduction in systolic (t=?6.42, P<.001) and diastolic (t=?4.80, P<.001) BP during the first 6 months of BP monitoring. Finally, BG levels were positively associated with systolic (B=0.24, t=2.77, P=.001) and diastolic (B=0.30, t=2.41, P=.02) BP. Conclusions: The results of this study shed light on the association between BG and BP levels and on the role of BP self-monitoring in diabetes management. Our findings also underscore the need and provide a basis for a comprehensive approach to understanding the mechanism of BP regulation associated with BG. UR - https://www.jmir.org/2022/2/e32923 UR - http://dx.doi.org/10.2196/32923 UR - http://www.ncbi.nlm.nih.gov/pubmed/35133284 ID - info:doi/10.2196/32923 ER - TY - JOUR AU - Draughon Moret, Jessica AU - Todd, Angela AU - Rose, Lauren AU - Pollitt, Erin AU - Anderson, Jocelyn PY - 2022/2/8 TI - Mobile Phone Apps for Intimate Partner and Sexual Violence Prevention and Response: Systematic Search on App Stores JO - JMIR Form Res SP - e28959 VL - 6 IS - 2 KW - rape KW - intimate partner violence KW - gender-based violence KW - smartphone KW - mobile phone app N2 - Background: Since the 2008 advent of the smartphone, more than 180 billion copies of apps have been downloaded from Apple App Store, with more than 2.6 million apps available for Android and 2.2 million apps available for iOS. Many violence prevention and response apps have been developed as part of this app proliferation. Objective: This study aims to evaluate the prevalence and quality of freely available mobile phone apps targeting intimate partner violence (IPV) and sexual violence (SV) prevention and response. Methods: We conducted a systematic search of violence prevention and response mobile phone apps freely available in Apple App Store (iOS; March 2016) and Google Play Store (Android; July 2016). Search terms included violence prevention, sexual assault, domestic violence, intimate partner violence, sexual violence, forensic nursing, wife abuse, and rape. Apps were included for review if they were freely available, were available in English, and had a primary purpose of prevention of or response to SV or IPV regardless of app target end users. Results: Using the Mobile Application Rating Scale (MARS), we evaluated a total of 132 unique apps. The majority of included apps had a primary purpose of sharing information or resources. Included apps were of low-to-moderate quality, with the overall subjective quality mean for the reviewed apps being 2.65 (95% CI 2.58-2.72). Quality scores for each of the 5 MARS categories ranged from 2.80 (engagement) to 4.75 (functionality). An incidental but important finding of our review was the difficulty in searching for apps and the plethora of nonrelated apps that appear when searching for keywords such as ?rape? and ?domestic violence? that may be harmful to people seeking help. Conclusions: Although there are a variety of mobile apps available designed to provide information or other services related to SV and IPV, they range greatly in quality. They are also challenging to find, given the current infrastructure of app store searches, keyword prioritization, and highlighting based on user rating. It is important for providers to be aware of these resources and be knowledgeable about how to review and recommend mobile phone apps to patients, when appropriate. UR - https://formative.jmir.org/2022/2/e28959 UR - http://dx.doi.org/10.2196/28959 UR - http://www.ncbi.nlm.nih.gov/pubmed/35133285 ID - info:doi/10.2196/28959 ER - TY - JOUR AU - Enyioha, Chineme AU - Hall, Matthew AU - Voisin, Christiane AU - Jonas, Daniel PY - 2022/2/4 TI - Effectiveness of Mobile Phone and Web-Based Interventions for Diabetes and Obesity Among African American and Hispanic Adults in the United States: Systematic Review JO - JMIR Public Health Surveill SP - e25890 VL - 8 IS - 2 KW - mHealth KW - mobile health KW - technology KW - diabetes KW - obesity KW - African American KW - Hispanic N2 - Background: Mobile health (mHealth) and web-based technological advances allow for new approaches to deliver behavioral interventions for chronic diseases such as obesity and diabetes. African American and Hispanic adults experience a disproportionate burden of major chronic diseases. Objective: This paper reviews the evidence for mHealth and web-based interventions for diabetes and obesity in African American and Hispanic adults. Methods: Literature searches of PubMed/Medline, The Cochrane Library, EMBASE, CINAHL Plus, Global Health, Scopus, and Library & Information Science Source were conducted for relevant English-language articles. Articles identified through searches were reviewed by 2 investigators and, if they met the inclusion criteria, were extracted and assessed for risk of bias. Findings were summarized in tabular and narrative format. The overall strength of the evidence was assessed as high, moderate, low, or insufficient on the basis of risk of bias, consistency of findings, directness, precision, and other limitations. Results: Searches yielded 2358 electronic publications, 196 reports were found to be eligible for inclusion, and 7 studies met the eligibility criteria. All 7 included studies were randomized control trials. Five studies evaluated the effectiveness of an mHealth intervention for weight loss, including one that evaluated the effectiveness for diabetes and two studies focused on diabetes. Of all the studies that focused on weight loss, 3 reported significant differences in weight loss in participants in the intervention group compared with those in the usual care group. Although all studies on diabetes control showed greater improvement in glycemic control for the intervention group compared to that in the control group, only one study showed a significant difference between the 2 groups. Conclusions: This analysis indicates that there are few published studies that assessed mHealth interventions among minority populations and focused on weight or diabetes. Although the overall strength of evidence was low for diabetes control, it was moderate for weight loss, and our findings suggest that mHealth and web-based interventions may provide a promising approach for interventions among African American and Hispanic adults who have obesity or diabetes. UR - https://publichealth.jmir.org/2022/2/e25890 UR - http://dx.doi.org/10.2196/25890 UR - http://www.ncbi.nlm.nih.gov/pubmed/35119368 ID - info:doi/10.2196/25890 ER - TY - JOUR AU - Leong, Ying Qiao AU - Sridhar, Shreya AU - Blasiak, Agata AU - Tadeo, Xavier AU - Yeo, GeckHong AU - Remus, Alexandria AU - Ho, Dean PY - 2022/2/4 TI - Characteristics of Mobile Health Platforms for Depression and Anxiety: Content Analysis Through a Systematic Review of the Literature and Systematic Search of Two App Stores JO - J Med Internet Res SP - e27388 VL - 24 IS - 2 KW - mHealth KW - digital medicine KW - anxiety KW - depression KW - systematic review KW - mental health conditions KW - mobile phone N2 - Background: Mobile health (mHealth) platforms show promise in the management of mental health conditions such as anxiety and depression. This has resulted in an abundance of mHealth platforms available for research or commercial use. Objective: The objective of this review is to characterize the current state of mHealth platforms designed for anxiety or depression that are available for research, commercial use, or both. Methods: A systematic review was conducted using a two-pronged approach: searching relevant literature with prespecified search terms to identify platforms in published research and simultaneously searching 2 major app stores?Google Play Store and Apple App Store?to identify commercially available platforms. Key characteristics of the mHealth platforms were synthesized, such as platform name, targeted condition, targeted group, purpose, technology type, intervention type, commercial availability, and regulatory information. Results: The literature and app store searches yielded 169 and 179 mHealth platforms, respectively. Most platforms developed for research purposes were designed for depression (116/169, 68.6%), whereas the app store search reported a higher number of platforms developed for anxiety (Android: 58/179, 32.4%; iOS: 27/179, 15.1%). The most common purpose of platforms in both searches was treatment (literature search: 122/169, 72.2%; app store search: 129/179, 72.1%). With regard to the types of intervention, cognitive behavioral therapy and referral to care or counseling emerged as the most popular options offered by the platforms identified in the literature and app store searches, respectively. Most platforms from both searches did not have a specific target age group. In addition, most platforms found in app stores lacked clinical and real-world evidence, and a small number of platforms found in the published research were available commercially. Conclusions: A considerable number of mHealth platforms designed for anxiety or depression are available for research, commercial use, or both. The characteristics of these mHealth platforms greatly vary. Future efforts should focus on assessing the quality?utility, safety, and effectiveness?of the existing platforms and providing developers, from both commercial and research sectors, a reporting guideline for their platform description and a regulatory framework to facilitate the development, validation, and deployment of effective mHealth platforms. UR - https://www.jmir.org/2022/2/e27388 UR - http://dx.doi.org/10.2196/27388 UR - http://www.ncbi.nlm.nih.gov/pubmed/35119370 ID - info:doi/10.2196/27388 ER - TY - JOUR AU - Collins, Tracie AU - Geana, Mugur AU - Overton, Kathryn AU - Benton, Mary AU - Lu, Liuqiang AU - Khan, Faarina AU - Rohleder, Mason AU - Ahluwalia, Jasjit AU - Resnicow, Ken AU - Zhu, Yiliang PY - 2022/2/3 TI - Use of a Smartphone App Versus Motivational Interviewing to Increase Walking Distance and Weight Loss in Overweight/Obese Adults With Peripheral Artery Disease: Pilot Randomized Trial JO - JMIR Form Res SP - e30295 VL - 6 IS - 2 KW - mobile health KW - smartphone app KW - peripheral artery disease KW - motivational interviewing N2 - Background: Walking therapy improves functional outcomes in patients with peripheral artery disease (PAD). Less is known about the additive benefit of a dietary intervention. Objective: Our objectives were to develop a smartphone app and, as a pilot, explore its potential efficacy as compared to motivational interviewing (MI) to increase walking distance and promote weight loss in overweight/obese adults with PAD. Methods: We conducted a 3-month, 2-arm randomized pilot study at the University of Kansas. Inclusion criteria were BMI >27 kg/m2 and symptomatic PAD, defined by an ankle-brachial index <0.9. Patients were randomized into 2 groups: MI, delivered through in-person and telephone counseling, and app, a mobile smartphone app. Both interventions encouraged walking for exercise and healthy dietary habits (increasing fruits and vegetables and whole grains while reducing fat and sugary drinks). We assessed medical history at baseline. At baseline and 3 months, participants completed an assessment of 6-minute walking distance, weight, quality of life, exercise behaviors, and dietary habits. The primary outcome was 3-month change in walking distance. Secondary outcomes were changes in weight, quality of life, exercise behaviors, and dietary habits. We used a Wilcoxon rank-sum test to analyze the primary and secondary outcomes at 3 months within the MI and app groups and to compare the changes between the groups with adjustment for baseline. Results: We randomized 29 participants with a mean age of 66.03 (SD 8.12) years; 25 participants completed the trial. At baseline, mean walking distance among completers was 260.40 (SD 94.32) meters and 326.15 (SD 69.28) meters for MI and app participants, respectively. At 3 months, the mean walking distance was 298.67 (SD 101.20) meters and 331.19 (SD 58.63) meters for MI and app participants, respectively (group difference P=.03, adjusting for baseline). Increase in walking distance at 3 months was 40.5 meters (95% CI 6.77 to 61.34; P=.02) in MI group. At baseline, mean body weight was 253.10 (SD 59.45) lbs and 225.13 (SD 58.93) lbs for MI and app participants, respectively. At 3 months, mean body weight was 242.14 (SD 58.54) lbs and 223.44 (SD 59.54) lbs for MI and app, respectively (group difference P=.006, adjusting for baseline). Pre-post study decrease in weight was 10.1 lbs (95% CI ?17.9 to ?3.0) and 2.3 lbs (95% CI ?3.4 to ?0.7) in MI and app group, respectively. Comparing baseline to 3 months, there were no statistically significant differences in quality of life, exercise behaviors, or dietary habits. Conclusions: Our study demonstrates that MI can promote walking and weight loss in overweight/obese adults with PAD. The smartphone app showed a small weight loss but no statistically significant increase in walking distance. As this was a pilot study, future large-scale studies are needed to replicate the efficacy of MI to promote weight loss in overweight or obese adults with PAD. Trial Registration: ClinicalTrials.gov NCT03694652; https://clinicaltrials.gov/ct2/show/NCT03694652 UR - https://formative.jmir.org/2022/2/e30295 UR - http://dx.doi.org/10.2196/30295 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113020 ID - info:doi/10.2196/30295 ER - TY - JOUR AU - Jaffar, Aida AU - Mohd-Sidik, Sherina AU - Foo, Nien Chai AU - Admodisastro, Novia AU - Abdul Salam, Nur Sobihatun AU - Ismail, Diana Noor PY - 2022/2/3 TI - Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study JO - JMIR Hum Factors SP - e30989 VL - 9 IS - 1 KW - User-centered design KW - mHealth app KW - Digital intervention KW - mHealth Development and Evaluation Framework KW - Usability KW - Acceptability KW - Pelvic Floor Muscle Training KW - Urinary incontinence KW - Pregnancy N2 - Background: Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. Methods: We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. Results: A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design?11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. Conclusions: The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study. UR - https://humanfactors.jmir.org/2022/1/e30989 UR - http://dx.doi.org/10.2196/30989 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113025 ID - info:doi/10.2196/30989 ER - TY - JOUR AU - McGinnis, Ellen AU - O'Leary, Aisling AU - Gurchiek, Reed AU - Copeland, E. William AU - McGinnis, Ryan PY - 2022/2/3 TI - A Digital Therapeutic Intervention Delivering Biofeedback for Panic Attacks (PanicMechanic): Feasibility and Usability Study JO - JMIR Form Res SP - e32982 VL - 6 IS - 2 KW - mental health KW - mHealth KW - biofeedback KW - panic attack KW - digital medicine KW - app KW - mobile health KW - application KW - mobile phone N2 - Background: Panic attacks (PAs) are an impairing mental health problem that affects >11% of adults every year. PAs are episodic, and it is difficult to predict when or where they may occur; thus, they are challenging to study and treat. Objective: The aim of this study is to present PanicMechanic, a novel mobile health app that captures heart rate?based data and delivers biofeedback during PAs. Methods: In our first analysis, we leveraged this tool to capture profiles of real-world PAs in the largest sample to date (148 attacks from 50 users). In our second analysis, we present the results from a pilot study to assess the usefulness of PanicMechanic as a PA intervention (N=18). Results: The results demonstrate that heart rate fluctuates by about 15 beats per minute during a PA and takes approximately 30 seconds to return to baseline from peak, cycling approximately 4 times during each attack despite the consistently decreasing anxiety ratings. Thoughts about health were the most common trigger and potential lifestyle contributors include slightly worse stress, sleep, and eating habits and slightly less exercise and drug or alcohol consumption than typical. Conclusions: The pilot study revealed that PanicMechanic is largely feasible to use but would be made more so with modifications to the app and the integration of consumer wearables. Similarly, participants found PanicMechanic useful, with 94% (15/16) indicating that they would recommend PanicMechanic to others who have PAs. These results highlight the need for future development and a controlled trial to establish the effectiveness of this digital therapeutic for preventing PAs. UR - https://formative.jmir.org/2022/2/e32982 UR - http://dx.doi.org/10.2196/32982 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113031 ID - info:doi/10.2196/32982 ER - TY - JOUR AU - Butler, Sonia AU - Sculley, Dean AU - Santos, Derek AU - Fellas, Antoni AU - Gironès, Xavier AU - Singh-Grewal, Davinder AU - Coda, Andrea PY - 2022/2/2 TI - Effectiveness of eHealth and mHealth Interventions Supporting Children and Young People Living With Juvenile Idiopathic Arthritis: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e30457 VL - 24 IS - 2 KW - eHealth KW - mobile health KW - mHealth KW - juvenile idiopathic arthritis KW - pediatric KW - effectiveness KW - pain KW - physical activity KW - health-related quality of life KW - self-management KW - education KW - mobile phone N2 - Background: Juvenile idiopathic arthritis (JIA) management aims to promote remission through timely, individualized, well-coordinated interdisciplinary care using a range of pharmacological, physical, psychological, and educational interventions. However, achieving this goal is workforce-intensive. Harnessing the burgeoning eHealth and mobile health (mHealth) interventions could be a resource-efficient way of supplementing JIA management. Objective: This systematic review aims to identify the eHealth and mHealth interventions that have been proven to be effective in supporting health outcomes for children and young people (aged 1-18 years) living with JIA. Methods: We systematically searched 15 databases (2018-2021). Studies were eligible if they considered children and young people (aged 1-18 years) diagnosed with JIA, an eHealth or mHealth intervention, any comparator, and health outcomes related to the used interventions. Independently, 2 reviewers screened the studies for inclusion and appraised the study quality using the Downs and Black (modified) checklist. Study outcomes were summarized using a narrative, descriptive method and, where possible, combined for a meta-analysis using a random-effects model. Results: Of the 301 studies identified in the search strategy, 15 (5%) fair-to-good?quality studies met the inclusion criteria, which identified 10 interventions for JIA (age 4-18.6 years). Of these 10 interventions, 5 (50%) supported symptom monitoring by capturing real-time data using health applications, electronic diaries, or web-based portals to monitor pain or health-related quality of life (HRQoL). Within individual studies, a preference was demonstrated for real-time pain monitoring over recall pain assessments because of a peak-end effect, improved time efficiency (P=.002), and meeting children?s and young people?s HRQoL needs (P<.001) during pediatric rheumatology consultations. Furthermore, 20% (2/10) of interventions supported physical activity promotion using a web-based program or a wearable activity tracker. The web-based program exhibited a moderate effect, which increased endurance time, physical activity levels, and moderate to vigorous physical activity (standardized mean difference [SMD] 0.60, SD 0.02-1.18; I2=79%; P=.04). The final 30% (3/10) of interventions supported self-management development through web-based programs, or apps, facilitating a small effect, reducing pain intensity (SMD ?0.14, 95% CI ?0.43 to 0.15; I2=53%; P=.33), and increasing disease knowledge and self-efficacy (SMD 0.30, 95% CI 0.03-0.56; I2=74%; P=.03). These results were not statistically significant. No effect was seen regarding pain interference, HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence. Conclusions: Evidence that supports the inclusion of eHealth and mHealth interventions in JIA management is increasing. However, this evidence needs to be considered cautiously because of the small sample size, wide CIs, and moderate to high statistical heterogeneity. More rigorous research is needed on the longitudinal effects of real-time monitoring, web-based pediatric rheumatologist?children and young people interactions, the comparison among different self-management programs, and the use of wearable technologies as an objective measurement for monitoring physical activity before any recommendations that inform current practice can be given. UR - https://www.jmir.org/2022/2/e30457 UR - http://dx.doi.org/10.2196/30457 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107431 ID - info:doi/10.2196/30457 ER - TY - JOUR AU - García-Estela, Aitana AU - Cantillo, Jordi AU - Angarita-Osorio, Natalia AU - Mur-Milà, Estanislao AU - Anmella, Gerard AU - Pérez, Víctor AU - Vieta, Eduard AU - Hidalgo-Mazzei, Diego AU - Colom, Francesc PY - 2022/2/2 TI - Real-world Implementation of a Smartphone-Based Psychoeducation Program for Bipolar Disorder: Observational Ecological Study JO - J Med Internet Res SP - e31565 VL - 24 IS - 2 KW - bipolar disorder KW - psychoeducation KW - smartphone KW - app KW - SIMPLe KW - Intervention KW - mobile phone N2 - Background: SIMPLe is an internet?delivered self?management mobile app for bipolar disorder (BD) designed to combine technology with evidence-based interventions and facilitate access to psychoeducational content. The SIMPLe app was launched to the real world to make it available worldwide within the context of BD treatment. Objective: The main aims of this study are as follows: to describe app use, engagement, and retention rates based on server data; to identify patterns of user retention over the first 6-month follow-up of use; and to explore potential factors contributing to discontinuation of app use. Methods: This was an observational ecological study in which we pooled available data from a real-world implementation of the SIMPLe app. Participation was open on the project website, and the data-collection sources were a web-based questionnaire on clinical data and treatment history administered at inclusion and at 6 months, subjective data gathered through continuous app use, and the use patterns captured by the app server. Characteristics and engagement of regular users, occasional users, and no users were compared using 2-tailed t tests or analysis of variance or their nonparametric equivalent. Survival analysis and risk functions were applied to regular users? data to examine and compare use and user retention. In addition, a user evaluation analysis was performed based on satisfaction, perceived usefulness, and reasons to discontinue app use. Results: We included 503 participants with data collected between 2016 and 2018, of whom 77.5% (n=390) used the app. Among the app users, 44.4% (173/390) completed the follow-up assessment, and data from these participants were used in our analyses. Engagement declined gradually over the first 6 months of use. The probability of retention of the regular users after 1 month of app use was 67.4% (263/390; 95% CI 62.7%-72.4%). Age (P=.002), time passed since illness onset (P<.001), and years since diagnosis of BD (P=.048) correlate with retention duration. In addition, participants who had been diagnosed with BD for longer used the app on more days (mean 97.73, SD 69.15 days; P=.002) than those who had had a more recent onset (mean 66.49, SD 66.18 days; P=.002) or those who had been diagnosed more recently (mean 73.45, SD 66 days; P=.01). Conclusions: The user retention rate of the app decreased rapidly after each month until reaching only one-third of the users at 6 months. There exists a strong association between age and app engagement of individuals with BD. Other variables such as years lived with BD, diagnosis of an anxiety disorder, and taking antipsychotics seem relevant as well. Understanding these associations can help in the definition of the most suitable user profiles for predicting trends of engagement, optimization of app prescription, and management. UR - https://www.jmir.org/2022/2/e31565 UR - http://dx.doi.org/10.2196/31565 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107440 ID - info:doi/10.2196/31565 ER - TY - JOUR AU - Sullivan, Sean Patrick AU - Stephenson, Rob AU - Hirshfield, Sabina AU - Mehta, Christina Cyra AU - Zahn, Ryan AU - Bauermeister, A. Jose AU - Horvath, Keith AU - Chiasson, Ann Mary AU - Gelaude, Deborah AU - Mullin, Shelby AU - Downing Jr, J. Martin AU - Olansky, Jolene Evelyn AU - Wiatrek, Sarah AU - Rogers, Q. Erin AU - Rosenberg, Eli AU - Siegler, J. Aaron AU - Mansergh, Gordon PY - 2022/2/2 TI - Behavioral Efficacy of a Sexual Health Mobile App for Men Who Have Sex With Men: Randomized Controlled Trial of Mobile Messaging for Men JO - J Med Internet Res SP - e34574 VL - 24 IS - 2 KW - HIV prevention KW - mHealth KW - tool KW - video KW - randomized clinical trial KW - app KW - prevention KW - HIV KW - PrEP KW - STI KW - testing KW - behavior KW - efficacy KW - men who have sex with men KW - MSM KW - sexuality KW - gay KW - bisexual KW - United States N2 - Background: Gay, bisexual, and other men who have sex with men (GBMSM) face the highest burden of HIV in the United States, and there is a paucity of efficacious mobile health (mHealth) HIV prevention and care interventions tailored specifically for GBMSM. We tested a mobile app combining prevention messages and access to core prevention services for GBMSM. Objective: This study aims to measure the efficacy of the Mobile Messaging for Men (M-cubed) app and related services to increase HIV prevention and care behaviors in diverse US GBMSM. Methods: We conducted a randomized open-label study with a waitlist control group among GBMSM in 3 groups (low-risk HIV-negative group, high-risk HIV-negative group, and living-with-HIV [LWH] group) recruited online and in venues in Atlanta, Detroit, and New York City. Participants were randomly assigned to receive access to the app immediately or at 9 months after randomization. The app provided prevention messages in 6 domains of sexual health and offered ordering of at-home HIV and sexually transmitted infection test kits, receiving preexposure prophylaxis (PrEP) evaluations and navigation, and service locators. Serostatus- and risk-specific prevention outcomes were evaluated at baseline, at the end of the intervention period, and at 3, 6, and 9 months after the intervention period. Results: In total, 1226 GBMSM were enrolled and randomized; of these 611 (49.84%) were assigned to the intervention group and 608 (99.51%) were analyzed, while 615 (50.16%) were assigned to the control group and 612 (99.51%) were analyzed. For high-risk GBMSM, allocation to the intervention arm was associated with higher odds of HIV testing during the intervention period (adjusted odds ratio [aOR] 2.02, 95% CI 1.11-3.66) and with higher odds of using PrEP in the 3 months after the intervention period (aOR 2.41, 95% CI 1.00-5.76, P<.05). No changes in HIV prevention or care were associated with allocation to the intervention arm for the low-risk HIV-negative and LWH groups. Conclusions: Access to the M-cubed app was associated with increased HIV testing and PrEP use among high-risk HIV-negative GBMSM in 3 US cities. The app could be made available through funded HIV prevention providers; additional efforts are needed to understand optimal strategies to implement the app outside of the research setting. Trial Registration: ClinicalTrials.gov NCT03666247; https://clinicaltrials.gov/ct2/show/NCT03666247 International Registered Report Identifier (IRRID): RR2-10.2196/16439 UR - https://www.jmir.org/2022/2/e34574 UR - http://dx.doi.org/10.2196/34574 UR - http://www.ncbi.nlm.nih.gov/pubmed/35025755 ID - info:doi/10.2196/34574 ER - TY - JOUR AU - Agachi, Elena AU - Bijmolt, A. Tammo H. AU - Mierau, O. Jochen AU - van Ittersum, Koert PY - 2022/2/2 TI - Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study JO - JMIR Hum Factors SP - e32112 VL - 9 IS - 1 KW - eHealth KW - mHealth KW - mobile health KW - mobile app KW - internet KW - preventive health program KW - health disparities KW - NSES KW - program adoption KW - survival analysis N2 - Background: Socioeconomic disparities in the adoption of preventive health programs represent a well-known challenge, with programs delivered via the web serving as a potential solution. The preventive health program examined in this study is a large-scale, open-access web-based platform operating in the Netherlands, which aims to improve the health behaviors and wellness of its participants. Objective: This study aims to examine the differences in the adoption of the website and mobile app of a web-based preventive health program across socioeconomic groups. Methods: The 83,466 participants in this longitudinal, nonexperimental study were individuals who had signed up for the health program between July 2012 and September 2019. The rate of program adoption per delivery means was estimated using the Prentice, Williams, and Peterson Gap?Time model, with the measure of neighborhood socioeconomic status (NSES) used to distinguish between population segments with different socioeconomic characteristics. Registration to the health program was voluntary and free, and not within a controlled study setting, allowing the observation of the true rate of adoption. Results: The estimation results indicate that program adoption across socioeconomic groups varies depending on the program?s delivery means. For the website, higher NSES groups have a higher likelihood of program adoption compared with the lowest NSES group (hazard ratio 1.03, 95% CI 1.01-1.05). For the mobile app, the opposite holds: higher NSES groups have a lower likelihood of program adoption compared with the lowest NSES group (hazard ratio 0.94, 95% CI 0.91-0.97). Conclusions: Promoting preventive health programs using mobile apps can help to increase program adoption among the lowest socioeconomic segments. Given the increasing use of mobile phones among disadvantaged population groups, structuring future health interventions to include mobile apps as means of delivery can support the stride toward diminishing health disparities. UR - https://humanfactors.jmir.org/2022/1/e32112 UR - http://dx.doi.org/10.2196/32112 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107433 ID - info:doi/10.2196/32112 ER - TY - JOUR AU - Beresford, Lauren AU - Norwood, Todd PY - 2022/2/2 TI - The Effect of Mobile Care Delivery on Clinically Meaningful Outcomes, Satisfaction, and Engagement Among Physical Therapy Patients: Observational Retrospective Study JO - JMIR Rehabil Assist Technol SP - e31349 VL - 9 IS - 1 KW - physical therapy KW - mobile apps KW - engagement KW - health care delivery N2 - Background: Musculoskeletal care is now delivered via mobile apps as a health care benefit. Although preliminary evidence shows that the clinical outcomes of mobile musculoskeletal care are comparable with those of in-person care, no research has examined the features of app-based care that secure these outcomes. Objective: Drawing on the literature around in-person physical therapy, this study examines how patient-provider relationships and program engagement in app-based physical therapy affect clinically meaningful improvements in pain, function, and patient satisfaction. It then evaluates the effects of patient-provider relationships forged through in-app messages or video visits and timely, direct access to care on patients? engagement in their recovery. Methods: We conducted an observational, retrospective study of 814 pre- and postsurveyed participants enrolled in a mobile app physical therapy program where physical therapists prescribed workouts, education, and therapeutic activities after a video evaluation from February 2019 to December 2020. We estimated generalized linear models with logit functions to evaluate the effect of program engagement on clinical outcomes, minimal clinically important differences (MCIDs) in pain (?Visual Analogue Scale ??1.5) and function (?Patient Specific Functional Scale ?1.3), and the effects of patient-provider relationships and clinical outcomes on patient satisfaction?participant reported likelihood to recommend the program (Net Promoter Scores of 9-10). We estimated Poisson generalized linear models to evaluate the effects of stronger patient-provider relationships and timely access to physical therapy within 24 hours on engagement including the number of weekly workouts and weeks in the program. Results: The odds that participants (N=814) had a pain MCID increased by 13% (odds ratio [OR] 1.13, 95% CI 1.04-1.23; P=.003) with each weekly workout and the odds of a function MCID by 4% (OR 1.04, 95% CI 1.00-1.08; P=.03) with each week in the program. Participants with MCIDs in function and large changes in pain (? Visual Analogue Scale ??3.5) were 1.85 (95% CI 1.17-2.93; P=.01) and 2.84 times (95% CI 1.68-4.78; P<.001) more satisfied, respectively. Those with video follow-up visits were 2 to 3 times (P=.01) more satisfied. Each physical therapist?s message increased weekly workouts by 11% (OR 1.11, 95% CI 1.07-1.16; P<.001). Video follow-up visits increased weekly workouts by at least 16% (OR 1.16, 95% CI 1.04-1.29; P=.01) and weeks in the program at least 8% (OR 1.08, 95% CI 1.01-1.14; P=.02). Access was associated with a 14% increase (OR 1.14, 95% CI 1.05-1.24; P=.003) in weekly workouts. Conclusions: Similar to in-person care, program engagement positively affects clinical outcomes, and strong patient-provider relationships positively affect satisfaction. In app-based physical therapy, clinical outcomes positively affect patient satisfaction. Timely access to care and strong patient-provider relationships, particularly those forged through video visits, affect engagement. UR - https://rehab.jmir.org/2022/1/e31349 UR - http://dx.doi.org/10.2196/31349 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107436 ID - info:doi/10.2196/31349 ER - TY - JOUR AU - Lalla-Edward, Tresha Samanta AU - Mashabane, Nonkululeko AU - Stewart-Isherwood, Lynsey AU - Scott, Lesley AU - Fyvie, Kyle AU - Duncan, Dana AU - Haile, Betiel AU - Chugh, Kamal AU - Zhou, Yiyong AU - Reimers, Jacob AU - Pan, Matteus AU - Venkatraman, Maya AU - Stevens, Wendy PY - 2022/2/2 TI - Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study JO - JMIR Form Res SP - e26033 VL - 6 IS - 2 KW - HIV KW - virological suppression KW - mHealth KW - digital health KW - South Africa KW - patient-centric KW - disease management KW - mobile phone N2 - Background: South Africa has the largest HIV treatment program worldwide. Retention in care and medication adherence remain problematic necessitating innovative solutions for improving HIV care. The increasing availability and use of mobile technology can support positive clinical outcomes for persons living with HIV. iThemba Life is a mobile health app designed with input from South African health professionals and patients, promoting engagement with HIV care through access to medical results. Objective: This study aimed to test the feasibility and acceptability of receiving HIV viral load (VL) results through the app and compare the time to HIV VL result return for study participants before and after app use. Methods: Using convenience sampling, adults having routine VL phlebotomy were recruited from 2 Johannesburg health facilities. After signed consent, the app was downloaded on their Android smartphones, phlebotomy was performed, and the sample barcode was scanned through their phone to link the sample and app. Participants received a notification of the result availability and logged into the app to view results, their explanation and recommended action. Results: Overall, 750 people were screened to enroll 500 participants. Of 750, 113 (15.1%) failed eligibility screening. 21.5% (137/637) had smartphone technical limitations preventing enrollment. Results were released to 92.2% (461/500) of participants? phones. App technical issues and laboratory operational issues limited the number of released results. Approximately 78.1% (360/461) results were viewed in the app. Median time from notification of availability to result viewed being 15.5 hours (0.6; range 0-150 days). Turnaround time from phlebotomy to the result being received was 6 (range 1-167) days for users versus 56 days (range 10-430 days; P<.001) before app use. Overall, 4% (20/500) of participants received unsuppressed results (VL>1000 copies/mL). Turnaround time for unsuppressed results was 7 days for participants versus 37.5 days before app use (P<.001). The difference before and after app use in the suppressed and unsuppressed users for time from sample collection to result delivery was statistically significant. Of 20 participants, 12 (60%) returned for a confirmatory VL during the study period. The time from an unsuppressed VL to a confirmatory VL was 106 days for app users versus 203 days before app use (P<.001). Overall, 52.4% (262/500) of participants completed an exit survey; 23.2% (58/250) reported challenges in viewing their VL results. Moreover, 58% (35/60) reported that they overcame challenges with technical assistance from others, and 97.3% (255/262) wanted to continue using the app for VL results. Conclusions: Using iThemba Life for VL results was well-received despite limited smartphone access for some participants. App users received results 10 times sooner than before the app and 5 times sooner if their VL >1000 copies/mL. This increased notification speed led to participants wanting to continue using iThemba Life. UR - https://formative.jmir.org/2022/2/e26033 UR - http://dx.doi.org/10.2196/26033 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107427 ID - info:doi/10.2196/26033 ER - TY - JOUR AU - Lugones-Sanchez, Cristina AU - Recio-Rodriguez, I. Jose AU - Agudo-Conde, Cristina AU - Repiso-Gento, Irene AU - G Adalia, Esther AU - Ramirez-Manent, Ignacio José AU - Sanchez-Calavera, Antonia Maria AU - Rodriguez-Sanchez, Emiliano AU - Gomez-Marcos, A. Manuel AU - Garcia-Ortiz, Luis AU - PY - 2022/2/1 TI - Long-term Effectiveness of a Smartphone App Combined With a Smart Band on Weight Loss, Physical Activity, and Caloric Intake in a Population With Overweight and Obesity (Evident 3 Study): Randomized Controlled Trial JO - J Med Internet Res SP - e30416 VL - 24 IS - 2 KW - mobile app KW - telemedicine KW - eHealth KW - weight control KW - exercise KW - obesity KW - mobile phone N2 - Background: Multicomponent mobile health approaches can improve lifestyle intervention results, although little is known about their long-term effectiveness. Objective: This study aims to evaluate the long-term effectiveness (12 months) of a multicomponent mobile health intervention?combining a smartphone app, an activity tracker wristband, and brief counseling, compared with a brief counseling group only?on weight loss and improving body composition, physical activity, and caloric intake in Spanish sedentary adults with overweight or obesity. Methods: We conducted a randomized controlled, multicenter clinical trial (Evident 3). A total of 650 participants were recruited from 5 primary care centers, with 318 participants in the intervention group (IG) and 332 in the control group (CG). All participants were briefly counseled about a healthy diet and physical activity at the baseline visit. For the 3-month intervention period, the IG received training to use the app to promote healthy lifestyles and the smart band (Mi Band 2, Xiaomi). All measurements were performed at baseline and at 3 and 12 months. Physical activity was measured using the International Physical Activity Questionnaire?Short Form. Nutritional habits were assessed using the Food Frequency Questionnaire and Adherence to Mediterranean diet questionnaire. Results: Of the 650 participants included, 563 (86.6%) completed the 3-month visit and 443 (68.2%) completed the 12-month visit. After 12 months, the IG showed net differences in weight (?0.26, 95% CI ?1.21 to 0.70 kg; P=.02), BMI (?0.06, 95% CI ?0.41 to 0.28 points; P=.01), waist-height ratio (?0.25, 95% CI ?0.94 to 0.44; P=.03), body adiposity index (?0.33, 95% CI ?0.77 to 0.11; P=.03), waist circumference (?0.48, 95% CI ?1.62 to 0.66 cm, P=.04) and hip circumference (?0.69, 95% CI ?1.62 to 0.25 cm; P=.03). Both groups lowered daily caloric intake and increased adherence to the Mediterranean diet, with no differences between the groups. The IG increased light physical activity time (32.6, 95% CI ?30.3 to 95.04 min/week; P=.02) compared with the CG. Analyses by subgroup showed changes in body composition variables in women, people aged >50 years, and married people. Conclusions: The low-intensity intervention of the Evident 3 study showed, in the IG, benefits in weight loss, some body composition variables, and time spent in light physical activity compared with the CG at 3 months, but once the devices were collected, the downward trend was not maintained at the 12-month follow-up. No differences in nutritional outcomes were observed between the groups. Trial Registration: ClinicalTrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614 International Registered Report Identifier (IRRID): RR2-10.1097/MD.0000000000009633 UR - https://www.jmir.org/2022/2/e30416 UR - http://dx.doi.org/10.2196/30416 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103609 ID - info:doi/10.2196/30416 ER - TY - JOUR AU - Kaveladze, T. Benjamin AU - Wasil, R. Akash AU - Bunyi, B. John AU - Ramirez, Veronica AU - Schueller, M. Stephen PY - 2022/1/31 TI - User Experience, Engagement, and Popularity in Mental Health Apps: Secondary Analysis of App Analytics and Expert App Reviews JO - JMIR Hum Factors SP - e30766 VL - 9 IS - 1 KW - mental health apps KW - engagement KW - user experience KW - digital mental health KW - user retention N2 - Background: User experience and engagement are critical elements of mental health apps? abilities to support users. However, work examining the relationships among user experience, engagement, and popularity has been limited. Understanding how user experience relates to engagement with and popularity of mental health apps can demonstrate the relationship between subjective and objective measures of app use. In turn, this may inform efforts to develop more effective and appealing mental health apps and ensure that they reach wide audiences. Objective: We aimed to examine the relationship among subjective measures of user experience, objective measures of popularity, and engagement in mental health apps. Methods: We conducted a preregistered secondary data analysis in a sample of 56 mental health apps. To measure user experience, we used expert ratings on the Mobile App Rating Scale (MARS) and consumer ratings from the Apple App Store and Google Play. To measure engagement, we acquired estimates of monthly active users (MAU) and user retention. To measure app popularity, we used download count, total app revenue, and MAU again. Results: MARS total score was moderately positively correlated with app-level revenue (Kendall rank [T]=0.30, P=.002), MAU (T=0.39, P<.001), and downloads (T=0.41, P<.001). However, the MARS total score and each of its subscales (Engagement, Functionality, Aesthetics, and Information) showed extremely small correlations with user retention 1, 7, and 30 days after downloading. Furthermore, the total MARS score only correlated with app store rating at T=0.12, which, at P=.20, did not meet our threshold for significance. Conclusions: More popular mental health apps receive better ratings of user experience than less popular ones. However, user experience does not predict sustained engagement with mental health apps. Thus, mental health app developers and evaluators need to better understand user experience and engagement, as well as to define sustained engagement, what leads to it, and how to create products that achieve it. This understanding might be supported by better collaboration between industry and academic teams to advance a science of engagement. UR - https://humanfactors.jmir.org/2022/1/e30766 UR - http://dx.doi.org/10.2196/30766 UR - http://www.ncbi.nlm.nih.gov/pubmed/35099398 ID - info:doi/10.2196/30766 ER - TY - JOUR AU - Serrano-Ripoll, J. Maria AU - Zamanillo-Campos, Rocío AU - Fiol-DeRoque, A. Maria AU - Castro, Adoración AU - Ricci-Cabello, Ignacio PY - 2022/1/27 TI - Impact of Smartphone App?Based Psychological Interventions for Reducing Depressive Symptoms in People With Depression: Systematic Literature Review and Meta-analysis of Randomized Controlled Trials JO - JMIR Mhealth Uhealth SP - e29621 VL - 10 IS - 1 KW - smartphone technology KW - mental health interventions KW - depression KW - eHealth KW - mHealth KW - apps KW - systematic review KW - meta-analysis KW - mobile phone N2 - Background: Depression is a serious, disabling mental disorder that severely affects quality of life. Patients with depression often do not receive adequate treatment. App-based psychotherapy is considered to have great potential to treat depression owing to its reach and easy accessibility. Objective: We aim to analyze the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Methods: We conducted a systematic literature review and meta-analysis. We searched Medline, Embase, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials from inception to December 23, 2020. We selected randomized controlled trials to examine the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Study selection, data extraction, and critical appraisal (using the Cochrane Risk of Bias tool for randomized studies and the ROBINS-I tool for nonrandomized studies) were conducted independently by 2 reviewers. Where possible, we pooled data using random effects meta-analyses to obtain estimates of the effect size of the intervention. We conducted post hoc meta-regression analyses to explore the factors associated with intervention success. Results: After screening 3468 unique references retrieved from bibliographic searches and assessing the eligibility of 79 full texts, we identified 12 trials (2859 participants) evaluating 14 different interventions. Of 14 trials, 7 (58%) were conducted in the United States; 3 (25%) trials, in Asia (Japan, South Korea, and China); 1 (8%) trial, in Australia; and 1 (8%) trial, in Germany. Of the 12 trials, 5 (42%) trials presented a low risk of bias. The mean duration of the interventions was 6.6 (SD 2.8) weeks. Two-thirds of the interventions were based on cognitive behavioral therapy alone or included it in combination with cognitive control therapy, positive psychology, brief behavioral activation, or mindfulness- and acceptance-based therapy. With no evidence of publication bias, a pooled analysis of 83% (10/12) of the trials and 86% (12/14) of the interventions showed that app-based interventions, compared with a control group receiving usual care or minimal intervention, produced a moderate reduction in depressive symptoms (standardized mean difference [SMD] ?0.51, 95% CI ?0.69 to ?0.33; 2018/2859, 70.58% of the participants; I2=70%). Our meta-regression analyses indicated that there was a greater reduction in symptoms of depression (P=.04) in trials that included participants with moderate to severe depression (SMD ?0.67, 95% CI ?0.79 to ?0.55), compared with trials with participants exhibiting mild to moderate depression (SMD ?0.15, 95% CI ?0.43 to ?0.12). Conclusions: App-based interventions targeted at people with depression produce moderate reductions in the symptoms of depression. More methodologically robust trials are needed to confirm our findings, determine which intervention features are associated with greater improvements, and identify those populations most likely to benefit from this type of intervention. Trial Registration: PROSPERO CRD42019145689; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=145689 UR - https://mhealth.jmir.org/2022/1/e29621 UR - http://dx.doi.org/10.2196/29621 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084346 ID - info:doi/10.2196/29621 ER - TY - JOUR AU - Hendricks-Sturrup, Rachele PY - 2022/1/27 TI - Pulse Oximeter App Privacy Policies During COVID-19: Scoping Assessment JO - JMIR Mhealth Uhealth SP - e30361 VL - 10 IS - 1 KW - COVID-19 KW - pulse oximeters KW - mobile apps KW - mHealth KW - privacy N2 - Background: Pulse oximeter apps became of interest to consumers during the COVID-19 pandemic, particularly when traditional over-the-counter pulse oximeter devices were in short supply. Yet, no study to date has examined or scoped the state of privacy policies and notices for the top-rated and most downloaded pulse oximeter apps during COVID-19. Objective: The aim of this study was to examine, through a high-level qualitative assessment, the state and nature of privacy policies for the downloaded and top-rated pulse oximeter apps during the COVID-19 pandemic to (1) compare findings against comparable research involving other mobile health (mHealth) apps and (2) begin discussions on opportunities for future research or investigation. Methods: During August-October 2020, privacy policies were reviewed for pulse oximeter apps that had either at least 500 downloads (Google Play Store apps only) or a three out of five-star rating (Apple Store apps only). In addition to determining if the apps had an accessible privacy policy, other key privacy policy?related details that were extracted included, but were not limited to, app developer location (country); whether the app was free or required paid use/subscription; whether an ads disclosure was provided on the app?s site; the scope of personal data collected; proportionality, fundamental rights, and data protection and privacy issues; and privacy safeguards. Results: Six pulse oximeter apps met the inclusion criteria and only 33% (n=2) of the six apps had an accessible privacy policy that was specific to the pulse oximeter app feature (vs the app developer?s website or at all). Variation was found in both the regulatory nature and data privacy protections offered by pulse oximeter apps, with notable privacy protection limitations and gaps, although each app provided at least some information about the scope of personal data collected upon installing the app. Conclusions: Pulse oximeter app developers should invest in offering stronger privacy protections for their app users, and should provide more accessible and transparent privacy policies. This is a necessary first step to ensure that the data privacy of mHealth consumers is not exploited during public health emergency situations such as the COVID-19 pandemic, where over-the-counter personal health monitoring devices could be in short supply and patients and consumers may, as a result, turn to mHealth apps to fill such supply gaps. Future research considerations and recommendations are also suggested for mHealth technology and privacy researchers who are interested in examining privacy implications associated with the use of pulse oximeter apps during and after the COVID-19 pandemic. UR - https://mhealth.jmir.org/2022/1/e30361 UR - http://dx.doi.org/10.2196/30361 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084348 ID - info:doi/10.2196/30361 ER - TY - JOUR AU - Sowon, Karen AU - Maliwichi, Priscilla AU - Chigona, Wallace PY - 2022/1/27 TI - The Influence of Design and Implementation Characteristics on the Use of Maternal Mobile Health Interventions in Kenya: Systematic Literature Review JO - JMIR Mhealth Uhealth SP - e22093 VL - 10 IS - 1 KW - human-technology interaction KW - maternal health KW - mHealth KW - mobile phone KW - utilization KW - Kenya N2 - Background: The growth of mobile technology in developing countries, coupled with pressing maternal health care challenges, has led to a widespread implementation of maternal mobile health (mHealth) innovations. However, reviews generating insights on how the characteristics of the interventions influence use are scarce. Objective: This study aims to review maternal mHealth interventions in Kenya to explore the influence of intervention design and implementation characteristics on use by maternal health clients. We also provide a starting inventory for maternal mHealth interventions in the country. Methods: Using a systematic approach, we retrieved a total of 1100 citations from both peer-reviewed and gray sources. Articles were screened on the basis of an inclusion and exclusion criterion, and the results synthesized by categorizing and characterizing the interventions presented in the articles. The first phase of the literature search was conducted between January and April 2019, and the second phase was conducted between April and June 2021. Results: A total of 16 articles were retrieved, comprising 13 maternal mHealth interventions. The study highlighted various mHealth design and implementation characteristics that may influence the use of these interventions. Conclusions: In addition to elaborating on insights that would be useful in the design and implementation of future interventions, this study contributes to a local inventory of maternal mHealth interventions that may be useful to researchers and implementers in mHealth. This study highlights the need for explanatory studies to elucidate maternal mHealth use, while complementing existing evidence on mHealth effectiveness. UR - https://mhealth.jmir.org/2022/1/e22093 UR - http://dx.doi.org/10.2196/22093 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084356 ID - info:doi/10.2196/22093 ER - TY - JOUR AU - Trang, Kathy AU - Le, X. Lam AU - Brown, A. Carolyn AU - To, Q. Margaret AU - Sullivan, S. Patrick AU - Jovanovic, Tanja AU - Worthman, M. Carol AU - Giang, Minh Le PY - 2022/1/27 TI - Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study JO - JMIR Form Res SP - e30360 VL - 6 IS - 1 KW - men who have sex with men KW - HIV KW - mental disorder KW - ecological momentary assessment KW - mobile phone KW - mHealth KW - sexual minorities KW - pilot projects N2 - Background: Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people?s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. Objective: This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. Methods: Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants? perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. Results: Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). Conclusions: Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM. UR - https://formative.jmir.org/2022/1/e30360 UR - http://dx.doi.org/10.2196/30360 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084340 ID - info:doi/10.2196/30360 ER - TY - JOUR AU - Ware, Patrick AU - Shah, Amika AU - Ross, Joan Heather AU - Logan, Gordon Alexander AU - Segal, Phillip AU - Cafazzo, Antony Joseph AU - Szacun-Shimizu, Katarzyna AU - Resnick, Myles AU - Vattaparambil, Tessy AU - Seto, Emily PY - 2022/1/26 TI - Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study JO - J Med Internet Res SP - e31754 VL - 24 IS - 1 KW - telemonitoring KW - telemedicine KW - heart failure KW - diabetes KW - hypertension KW - tertiary health care KW - multiple chronic conditions KW - mobile phone N2 - Background: Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective: This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods: A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ?1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results: A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions: We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration: ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8367 UR - https://www.jmir.org/2022/1/e31754 UR - http://dx.doi.org/10.2196/31754 UR - http://www.ncbi.nlm.nih.gov/pubmed/35080502 ID - info:doi/10.2196/31754 ER - TY - JOUR AU - Passardi, Alessandro AU - Foca, Flavia AU - Caffo, Orazio AU - Tondini, Alberto Carlo AU - Zambelli, Alberto AU - Vespignani, Roberto AU - Bartolini, Giulia AU - Sullo, Giulio Francesco AU - Andreis, Daniele AU - Dianti, Marco AU - Eccher, Claudio AU - Piras, Maria Enrico AU - Forti, Stefano PY - 2022/1/26 TI - A Remote Monitoring System to Optimize the Home Management of Oral Anticancer Therapies (ONCO-TreC): Prospective Training?Validation Trial JO - J Med Internet Res SP - e27349 VL - 24 IS - 1 KW - adherence KW - oral anticancer drug KW - mHealth KW - ONCO-TreC KW - electronic diary N2 - Background: A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient?health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. Objective: The overall aims of the trial are to customize the platform; assess the system?s ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. Methods: Patients aged ?18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. Results: A total of 40 patients were enrolled, 38 (95%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3% (95% CI 86.1%-99.9%) between the investigator and system pill count. Only 60% (3/5) of grade 3, 54% (13/24) of grade 2, and 19% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94% (33/35) of patients had ?1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71% (27/38) and 68% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. Conclusions: ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved. Trial Registration: ClinicalTrials.gov NCT02921724; https://www.clinicaltrials.gov/ct2/show/NCT02921724 UR - https://www.jmir.org/2022/1/e27349 UR - http://dx.doi.org/10.2196/27349 UR - http://www.ncbi.nlm.nih.gov/pubmed/35080505 ID - info:doi/10.2196/27349 ER - TY - JOUR AU - Huhn, Sophie AU - Axt, Miriam AU - Gunga, Hanns-Christian AU - Maggioni, Anna Martina AU - Munga, Stephen AU - Obor, David AU - Sié, Ali AU - Boudo, Valentin AU - Bunker, Aditi AU - Sauerborn, Rainer AU - Bärnighausen, Till AU - Barteit, Sandra PY - 2022/1/25 TI - The Impact of Wearable Technologies in Health Research: Scoping Review JO - JMIR Mhealth Uhealth SP - e34384 VL - 10 IS - 1 KW - wearable KW - consumer-grade wearables KW - commercially available wearables KW - public health KW - global health KW - population health KW - fitness trackers KW - big data KW - low-resource setting KW - tracker KW - review KW - mHealth KW - research KW - mobile phone N2 - Background: Wearable devices hold great promise, particularly for data generation for cutting-edge health research, and their demand has risen substantially in recent years. However, there is a shortage of aggregated insights into how wearables have been used in health research. Objective: In this review, we aim to broadly overview and categorize the current research conducted with affordable wearable devices for health research. Methods: We performed a scoping review to understand the use of affordable, consumer-grade wearables for health research from a population health perspective using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. A total of 7499 articles were found in 4 medical databases (PubMed, Ovid, Web of Science, and CINAHL). Studies were eligible if they used noninvasive wearables: worn on the wrist, arm, hip, and chest; measured vital signs; and analyzed the collected data quantitatively. We excluded studies that did not use wearables for outcome assessment and prototype studies, devices that cost >?500 (US $570), or obtrusive smart clothing. Results: We included 179 studies using 189 wearable devices covering 10,835,733 participants. Most studies were observational (128/179, 71.5%), conducted in 2020 (56/179, 31.3%) and in North America (94/179, 52.5%), and 93% (10,104,217/10,835,733) of the participants were part of global health studies. The most popular wearables were fitness trackers (86/189, 45.5%) and accelerometer wearables, which primarily measure movement (49/189, 25.9%). Typical measurements included steps (95/179, 53.1%), heart rate (HR; 55/179, 30.7%), and sleep duration (51/179, 28.5%). Other devices measured blood pressure (3/179, 1.7%), skin temperature (3/179, 1.7%), oximetry (3/179, 1.7%), or respiratory rate (2/179, 1.1%). The wearables were mostly worn on the wrist (138/189, 73%) and cost 28 weeks? gestation at the study hospitals were sequentially recruited from postnatal wards from October 2017 to January 2018. Information was collected on the women?s self-reported MCH app use during their pregnancy, along with clinical outcomes. Women were categorized as nonusers of MCH apps and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 g, birth defects, stillbirth, and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis. Results: The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 24.7% (457/1850); intermittent, 47.4% (876/1850); and continuous, 27.9% (517/1850). Among app users, the most common reasons for app use were health education (1393/1393, 100%), self-monitoring (755/1393, 54.2%), and antenatal appointment reminders (602/1393, 43.2%). Nonusers were older, with fewer years of education, lower incomes, and higher parity (P<.01). No association was found between any app use and CAPO (6.8% in nonusers compared with 6.3% in any app users; odds ratio 0.77, 95% CI 0.48-1.25). Conclusions: Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. Any app use was not found to be associated with improved pregnancy outcomes, highlighting the need for rigorous development and testing of apps before recommendation for use in clinical settings. UR - https://formative.jmir.org/2022/1/e29644 UR - http://dx.doi.org/10.2196/29644 UR - http://www.ncbi.nlm.nih.gov/pubmed/35076402 ID - info:doi/10.2196/29644 ER - TY - JOUR AU - Eze, E. Chinwe AU - West, T. Brady AU - Dorsch, P. Michael AU - Coe, B. Antoinette AU - Lester, A. Corey AU - Buis, R. Lorraine AU - Farris, Karen PY - 2022/1/24 TI - Predictors of Smartphone and Tablet Use Among Patients With Hypertension: Secondary Analysis of Health Information National Trends Survey Data JO - J Med Internet Res SP - e33188 VL - 24 IS - 1 KW - hypertension KW - mHealth KW - remote monitoring KW - telemonitoring KW - smartphones KW - tablets KW - text messaging KW - Health Information National Trends Survey KW - mobile health KW - digital health KW - mobile phone N2 - Background: Uncontrolled hypertension leads to significant morbidity and mortality. The use of mobile health technology, such as smartphones, for remote blood pressure (BP) monitoring has improved BP control. An increase in BP control is more significant when patients can remotely communicate with their health care providers through technologies and receive feedback. Little is known about the predictors of remote BP monitoring among hypertensive populations. Objective: The objective of this study is to quantify the predictors of smartphone and tablet use in achieving health goals and communicating with health care providers via SMS text messaging among hypertensive patients in the United States. Methods: This study was a cross-sectional, secondary analysis of the 2017 and 2018 Health Information National Trends Survey 5, cycles 1 and 2 data. A total of 3045 respondents answered ?Yes? to the question ?Has a doctor or other healthcare provider ever told you that you had high blood pressure or hypertension??, which defined the subpopulation used in this study. We applied the Health Information National Trends Survey full sample weight to calculate the population estimates and 50 replicate weights to calculate the SEs of the estimates. We used design-adjusted descriptive statistics to describe the characteristics of respondents who are hypertensive based on relevant survey items. Design-adjusted multivariable logistic regression models were fitted to estimate predictors of achieving health goals with the help of smartphone or tablet and sending or receiving an SMS text message to or from a health care provider in the last 12 months. Results: An estimated 36.9%, SE 0.9% (183,285,150/497,278,883) of the weighted adult population in the United States had hypertension. The mean age of the hypertensive population was 58.3 (SE 0.48) years. Electronic communication with the doctor or doctor?s office through email or internet (odds ratio 2.93, 95% CI 1.85-4.63; P<.001) and having a wellness app (odds ratio 1.82, 95% CI 1.16-2.86; P=.02) were significant predictors of using SMS text message communication with a health care professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age (P<.001) and ownership of basic cellphones (P=.04). However, they increased significantly with being a woman (P=.045) or with being married (P=.03), having a wellness app (P<.001), using devices other than smartphones or tablets to monitor health (P=.008), making health treatment decisions (P=.048), and discussing with a provider (P=.02) with the help of a tablet or smartphone. Conclusions: Intervention measures accounting for age, gender, marital status, and the patient?s technology-related health behaviors are required to increase smartphone and tablet use in self-care and SMS text message communication with health care providers. UR - https://www.jmir.org/2022/1/e33188 UR - http://dx.doi.org/10.2196/33188 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072647 ID - info:doi/10.2196/33188 ER - TY - JOUR AU - Svendsen, Jagd Malene AU - Sandal, Fleng Louise AU - Kjær, Per AU - Nicholl, I. Barbara AU - Cooper, Kay AU - Mair, Frances AU - Hartvigsen, Jan AU - Stochkendahl, Jensen Mette AU - Søgaard, Karen AU - Mork, Jarle Paul AU - Rasmussen, Charlotte PY - 2022/1/24 TI - Using Intervention Mapping to Develop a Decision Support System?Based Smartphone App (selfBACK) to Support Self-management of Nonspecific Low Back Pain: Development and Usability Study JO - J Med Internet Res SP - e26555 VL - 24 IS - 1 KW - intervention mapping KW - behavior change KW - low back pain KW - self-management KW - mHealth KW - app-based intervention KW - decision support system KW - digital health intervention KW - mobile phone N2 - Background: International guidelines consistently endorse the promotion of self-management for people with low back pain (LBP); however, implementation of these guidelines remains a challenge. Digital health interventions, such as those that can be provided by smartphone apps, have been proposed as a promising mode of supporting self-management in people with chronic conditions, including LBP. However, the evidence base for digital health interventions to support self-management of LBP is weak, and detailed descriptions and documentation of the interventions are lacking. Structured intervention mapping (IM) constitutes a 6-step process that can be used to guide the development of complex interventions. Objective: The aim of this paper is to describe the IM process for designing and creating an app-based intervention designed to support self-management of nonspecific LBP to reduce pain-related disability. Methods: The first 5 steps of the IM process were systematically applied. The core processes included literature reviews, brainstorming and group discussions, and the inclusion of stakeholders and representatives from the target population. Over a period of >2 years, the intervention content and the technical features of delivery were created, tested, and revised through user tests, feasibility studies, and a pilot study. Results: A behavioral outcome was identified as a proxy for reaching the overall program goal, that is, increased use of evidence-based self-management strategies. Physical exercises, education, and physical activity were the main components of the self-management intervention and were designed and produced to be delivered via a smartphone app. All intervention content was theoretically underpinned by the behavior change theory and the normalization process theory. Conclusions: We describe a detailed example of the application of the IM approach for the development of a theory-driven, complex, and digital intervention designed to support self-management of LBP. This description provides transparency in the developmental process of the intervention and can be a possible blueprint for designing and creating future digital health interventions for self-management. UR - https://www.jmir.org/2022/1/e26555 UR - http://dx.doi.org/10.2196/26555 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072645 ID - info:doi/10.2196/26555 ER - TY - JOUR AU - Germini, Federico AU - Noronha, Noella AU - Borg Debono, Victoria AU - Abraham Philip, Binu AU - Pete, Drashti AU - Navarro, Tamara AU - Keepanasseril, Arun AU - Parpia, Sameer AU - de Wit, Kerstin AU - Iorio, Alfonso PY - 2022/1/21 TI - Accuracy and Acceptability of Wrist-Wearable Activity-Tracking Devices: Systematic Review of the Literature JO - J Med Internet Res SP - e30791 VL - 24 IS - 1 KW - diagnosis KW - measurement KW - wrist-wearable devices KW - mobile phone N2 - Background: Numerous wrist-wearable devices to measure physical activity are currently available, but there is a need to unify the evidence on how they compare in terms of acceptability and accuracy. Objective: The aim of this study is to perform a systematic review of the literature to assess the accuracy and acceptability (willingness to use the device for the task it is designed to support) of wrist-wearable activity trackers. Methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and SPORTDiscus for studies measuring physical activity in the general population using wrist-wearable activity trackers. We screened articles for inclusion and, for the included studies, reported data on the studies? setting and population, outcome measured, and risk of bias. Results: A total of 65 articles were included in our review. Accuracy was assessed for 14 different outcomes, which can be classified in the following categories: count of specific activities (including step counts), time spent being active, intensity of physical activity (including energy expenditure), heart rate, distance, and speed. Substantial clinical heterogeneity did not allow us to perform a meta-analysis of the results. The outcomes assessed most frequently were step counts, heart rate, and energy expenditure. For step counts, the Fitbit Charge (or the Fitbit Charge HR) had a mean absolute percentage error (MAPE) <25% across 20 studies. For heart rate, the Apple Watch had a MAPE <10% in 2 studies. For energy expenditure, the MAPE was >30% for all the brands, showing poor accuracy across devices. Acceptability was most frequently measured through data availability and wearing time. Data availability was ?75% for the Fitbit Charge HR, Fitbit Flex 2, and Garmin Vivofit. The wearing time was 89% for both the GENEActiv and Nike FuelBand. Conclusions: The Fitbit Charge and Fitbit Charge HR were consistently shown to have a good accuracy for step counts and the Apple Watch for measuring heart rate. None of the tested devices proved to be accurate in measuring energy expenditure. Efforts should be made to reduce the heterogeneity among studies. UR - https://www.jmir.org/2022/1/e30791 UR - http://dx.doi.org/10.2196/30791 UR - http://www.ncbi.nlm.nih.gov/pubmed/35060915 ID - info:doi/10.2196/30791 ER - TY - JOUR AU - Cao, Xinxi AU - Cheng, Yangyang AU - Xu, Chenjie AU - Hou, Yabing AU - Yang, Hongxi AU - Li, Shu AU - Gao, Ying AU - Jia, Peng AU - Wang, Yaogang PY - 2022/1/20 TI - Risk of Accidents or Chronic Disorders From Improper Use of Mobile Phones: A Systematic Review and Meta-analysis JO - J Med Internet Res SP - e21313 VL - 24 IS - 1 KW - cell phone KW - mobile phone KW - accident KW - neoplasm KW - radiation N2 - Background: Mobile phone use has brought convenience, but the long or improper use of mobile phones can cause harm to the human body. Objective: We aimed to assess the impact of improper mobile phone use on the risks of accidents and chronic disorders. Methods: We systematically searched in PubMed, EMBASE, Cochrane, and Web of Science databases for studies published prior to April 5, 2019; relevant reviews were also searched to identify additional studies. A random-effects model was used to calculate the overall pooled estimates. Results: Mobile phone users had a higher risk of accidents (relative risk [RR] 1.37, 95% CI 1.22 to 1.55). Long-term use of mobile phones increased accident risk relative to nonuse or short-term use (RR 2.10, 95% CI 1.63 to 2.70). Compared with nonuse, mobile phone use resulted in a higher risk for neoplasms (RR 1.07, 95% CI 1.01 to 1.14), eye diseases (RR 2.03, 95% CI 1.27 to 3.23), mental health disorders (RR 1.16, 95% CI 1.02 to 1.32), and headaches (RR 1.25, 95% CI 1.18 to 1.32); the pooled risk of other chronic disorders was 1.20 (95% CI 0.90 to 1.59). Subgroup analyses also confirmed the increased risk of accidents and chronic disorders. Conclusions: Improper use of mobile phones can harm the human body. While enjoying the convenience brought by mobile phones, people have to use mobile phones properly and reasonably. UR - https://www.jmir.org/2022/1/e21313 UR - http://dx.doi.org/10.2196/21313 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049511 ID - info:doi/10.2196/21313 ER - TY - JOUR AU - Agher, Dahbia AU - Sedki, Karima AU - Despres, Sylvie AU - Albinet, Jean-Pierre AU - Jaulent, Marie-Christine AU - Tsopra, Rosy PY - 2022/1/20 TI - Encouraging Behavior Changes and Preventing Cardiovascular Diseases Using the Prevent Connect Mobile Health App: Conception and Evaluation of App Quality JO - J Med Internet Res SP - e25384 VL - 24 IS - 1 KW - digital health KW - mHealth, mobile application KW - IT KW - technology KW - prevention KW - cardiovascular risk factor KW - behavior change KW - primary care N2 - Background: Cardiovascular diseases are a major cause of death worldwide. Mobile health apps could help in preventing cardiovascular diseases by improving modifiable risk factors such as eating habits, physical activity levels, and alcohol or tobacco consumption. Objective: The aim of this study was to design a mobile health app, Prevent Connect, and to assess its quality for (1) assessing patient behavior for 4 cardiovascular risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and (2) suggesting personalized recommendations and mobile health interventions for risky behaviors. Methods: The knowledge base of the app is based on French national recommendations for healthy eating, physical activity, and limiting alcohol and tobacco consumption. It contains a list of patient behaviors and related personalized recommendations and digital health interventions. The interface was designed according to usability principles. Its quality was assessed by a panel of 52 users in a 5-step process: completion of the demographic form, visualization of a short presentation of the app, testing of the app, completion of the user version of the Mobile App Rating Scale (uMARS), and an open group discussion. Results: This app assesses patient behaviors through specific questionnaires about 4 risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and suggests personalized recommendations and digital health interventions for improving behavior. The app was deemed to be of good quality, with a mean uMARS quality score of 4 on a 5-point Likert scale. The functionality and information content of the app were particularly appreciated, with a mean uMARS score above 4. Almost all the study participants appreciated the navigation system and found the app easy to use. More than three-quarters of the study participants found the app content relevant, concise, and comprehensive. The aesthetics and the engagement of the app were also appreciated (uMARS score, 3.7). Overall, 80% (42/52) of the study participants declared that the app helped them to become aware of the importance of addressing health behavior, and 65% (34/52) said that the app helped motivate them to change lifestyle habits. Conclusions: The app assessed the risky behaviors of the patients and delivered personalized recommendations and digital health interventions for multiple risk factors. The quality of the app was considered to be good, but the impact of the app on behavior changes is yet to be demonstrated and will be assessed in further studies. UR - https://www.jmir.org/2022/1/e25384 UR - http://dx.doi.org/10.2196/25384 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049508 ID - info:doi/10.2196/25384 ER - TY - JOUR AU - Hogan, P. Timothy AU - Etingen, Bella AU - McMahon, Nicholas AU - Bixler, R. Felicia AU - Am, Linda AU - Wacks, E. Rachel AU - Shimada, L. Stephanie AU - Reilly, D. Erin AU - Frisbee, L. Kathleen AU - Smith, M. Bridget PY - 2022/1/20 TI - Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation JO - JMIR Form Res SP - e33716 VL - 6 IS - 1 KW - mobile health applications KW - pain KW - veterans KW - usability N2 - Background: The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. Objective: Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. Methods: Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. Results: Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1%). These veterans received our outreach program; 236 (236/393, 60.1%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2% (24/236) used Pain Coach, and 58% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3%). Conclusions: Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study. UR - https://formative.jmir.org/2022/1/e33716 UR - http://dx.doi.org/10.2196/33716 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049515 ID - info:doi/10.2196/33716 ER - TY - JOUR AU - Dominiak, Monika AU - Kaczmarek-Majer, Katarzyna AU - Antosik-Wójci?ska, Z. Anna AU - Opara, R. Karol AU - Olwert, Anna AU - Radziszewska, Weronika AU - Hryniewicz, Olgierd AU - ?wi?cicki, ?ukasz AU - Wojnar, Marcin AU - Mierzejewski, Pawe? PY - 2022/1/19 TI - Behavioral and Self-reported Data Collected From Smartphones for the Assessment of Depressive and Manic Symptoms in Patients With Bipolar Disorder: Prospective Observational Study JO - J Med Internet Res SP - e28647 VL - 24 IS - 1 KW - bipolar disorder KW - generalized linear model KW - mixed-effects regression KW - classification KW - manic episodes KW - depressive episodes KW - smartphone KW - behavioral markers KW - mHealth KW - remote monitoring N2 - Background: Smartphones allow for real-time monitoring of patients? behavioral activities in a naturalistic setting. These data are suggested as markers for the mental state of patients with bipolar disorder (BD). Objective: We assessed the relations between data collected from smartphones and the clinically rated depressive and manic symptoms together with the corresponding affective states in patients with BD. Methods: BDmon, a dedicated mobile app, was developed and installed on patients? smartphones to automatically collect the statistics about their phone calls and text messages as well as their self-assessments of sleep and mood. The final sample for the numerical analyses consisted of 51 eligible patients who participated in at least two psychiatric assessments and used the BDmon app (mean participation time, 208 [SD 132] days). In total, 196 psychiatric assessments were performed using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Generalized linear mixed-effects models were applied to quantify the strength of the relation between the daily statistics on the behavioral data collected automatically from smartphones and the affective symptoms and mood states in patients with BD. Results: Objective behavioral data collected from smartphones were found to be related with the BD states as follows: (1) depressed patients tended to make phone calls less frequently than euthymic patients (?=?.064, P=.01); (2) the number of incoming answered calls during depression was lower than that during euthymia (?=?.15, P=.01) and, concurrently, missed incoming calls were more frequent and increased as depressive symptoms intensified (?=4.431, P<.001; ?=4.861, P<.001, respectively); (3) the fraction of outgoing calls was higher in manic states (?=2.73, P=.03); (4) the fraction of missed calls was higher in manic/mixed states as compared to that in the euthymic state (?=3.53, P=.01) and positively correlated to the severity of symptoms (?=2.991, P=.02); (5) the variability of the duration of the outgoing calls was higher in manic/mixed states (?=.0012, P=.045) and positively correlated to the severity of symptoms (?=.0017, P=.02); and (6) the number and length of the sent text messages was higher in manic/mixed states as compared to that in the euthymic state (?=.031, P=.01; ?=.015, P=.01; respectively) and positively correlated to the severity of manic symptoms (?=.116, P<.001; ?=.022, P<.001; respectively). We also observed that self-assessment of mood was lower in depressive (?=?1.452, P<.001) and higher in manic states (?=.509, P<.001). Conclusions: Smartphone-based behavioral parameters are valid markers for assessing the severity of affective symptoms and discriminating between mood states in patients with BD. This technology opens a way toward early detection of worsening of the mental state and thereby increases the patient?s chance of improving in the course of the illness. UR - https://www.jmir.org/2022/1/e28647 UR - http://dx.doi.org/10.2196/28647 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874015 ID - info:doi/10.2196/28647 ER - TY - JOUR AU - Paz Castro, Raquel AU - Haug, Severin AU - Debelak, Rudolf AU - Jakob, Robert AU - Kowatsch, Tobias AU - Schaub, P. Michael PY - 2022/1/19 TI - Engagement With a Mobile Phone?Based Life Skills Intervention for Adolescents and Its Association With Participant Characteristics and Outcomes: Tree-Based Analysis JO - J Med Internet Res SP - e28638 VL - 24 IS - 1 KW - engagement KW - life skills KW - adolescents KW - mobile phone KW - machine learning KW - decision tree N2 - Background: Mobile phone?delivered life skills programs are an emerging and promising way to promote mental health and prevent substance use among adolescents, but little is known about how adolescents actually use them. Objective: The aim of this study is to determine engagement with a mobile phone?based life skills program and its different components, as well as the associations of engagement with adolescent characteristics and intended substance use and mental health outcomes. Methods: We performed secondary data analysis on data from the intervention group (n=750) from a study that compared a mobile phone?based life skills intervention for adolescents recruited in secondary and upper secondary school classes with an assessment-only control group. Throughout the 6-month intervention, participants received 1 SMS text message prompt per week that introduced a life skills topic or encouraged participation in a quiz or individual life skills training or stimulated sharing messages with other program participants through a friendly contest. Decision trees were used to identify predictors of engagement (use and subjective experience). The stability of these decision trees was assessed using a resampling method and by graphical representation. Finally, associations between engagement and intended substance use and mental health outcomes were examined using logistic and linear regression analyses. Results: The adolescents took part in half of the 50 interactions (mean 23.6, SD 15.9) prompted by the program, with SMS text messages being the most used and contests being the least used components. Adolescents who did not drink in a problematic manner and attended an upper secondary school were the ones to use the program the most. Regarding associations between engagement and intended outcomes, adolescents who used the contests more frequently were more likely to be nonsmokers at follow-up than those who did not (odds ratio 0.86, 95% CI 0.76-0.98; P=.02). In addition, adolescents who read the SMS text messages more attentively were less likely to drink in a problematic manner at follow-up (odds ratio 0.43, 95% CI 1.29-3.41; P=.003). Finally, participants who used the program the most and least were more likely to increase their well-being from baseline to 6-month follow-up compared with those with average engagement (?s=.39; t586=2.66; P=.008; R2=0.24). Conclusions: Most of the adolescents participating in a digital life skills program that aimed to prevent substance use and promote mental health engaged with the intervention. However, measures to increase engagement in problem drinkers should be considered. Furthermore, efforts must be made to ensure that interventions are engaging and powerful across different educational levels. First results indicate that higher engagement with digital life skills programs could be associated with intended outcomes. Future studies should apply further measures to improve the reach of lower-engaged participants at follow-up to establish such associations with certainty. UR - https://www.jmir.org/2022/1/e28638 UR - http://dx.doi.org/10.2196/28638 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044309 ID - info:doi/10.2196/28638 ER - TY - JOUR AU - Voth, Melissa AU - Chisholm, Shannon AU - Sollid, Hannah AU - Jones, Chelsea AU - Smith-MacDonald, Lorraine AU - Brémault-Phillips, Suzette PY - 2022/1/19 TI - Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation JO - JMIR Mhealth Uhealth SP - e26453 VL - 10 IS - 1 KW - occupational stress injury KW - trauma KW - mHealth KW - resilience KW - mental health KW - military KW - veteran KW - public safety personnel KW - OSI KW - PTSD KW - mental health intervention KW - mobile phone N2 - Background: Military members (MMs) and public safety personnel (PSP) are vulnerable to occupational stress injuries because of their job demands. When MMs and PSP transition out of these professions, they may continue to experience mental health challenges. The development and implementation of resilience-building mobile health (mHealth) apps as an emergent mental health intervention platform has allowed for targeted, cost-effective, and easily accessible treatment when in-person therapy may be limited or unavailable. However, current mHealth app development is not regulated, and often lacks both clear evidence-based research and the input of health care professionals. Objective: This study aims to evaluate the evidence-based quality, efficacy, and effectiveness of resilience-building mobile apps targeted toward the MMs, PSP, and veteran populations via a scoping literature review of the current evidence base regarding resilience apps for these populations and an evaluation of free resilience apps designed for use among these populations. Methods: The studies were selected using a comprehensive search of MEDLINE, CINAHL Plus, PsycINFO, SocINDEX, Academic Search Complete, Embase, and Google and were guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A narrative synthesis of the resulting papers was performed. The Alberta Rating Index for Apps was used to conduct a review of each of the identified apps. The inclusion criteria consisted of apps that were free to download in either the Google Play Store or the Apple App Store; updated within the last 3 years; available in English and in Canada; and intended for use by MMs, veterans, and PSP. Results: In total, 22 apps met the inclusion criteria for evaluation. The resilience strategies offered by most apps included psychoeducation, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy. Overall, 50% (11/22) of apps had been tested in randomized controlled trials, 7 (32%) apps had been evaluated using other research methods, and 5 (23%) apps had not been studied. Using the Alberta Rating Index for Apps, the app scores ranged from 37 to 56 out of 72, with higher rated apps demonstrating increased usability and security features. Conclusions: The mHealth apps reviewed are well-suited to providing resilience strategies for MMs, PSP, and veterans. They offer easy accessibility to evidence-based tools while working to encourage the use of emotional and professional support with safety in mind. Although not intended to function as a substitute for professional services, research has demonstrated that mHealth apps have the potential to foster a significant reduction in symptom severity for posttraumatic stress disorder, depression, anxiety, and other mental health conditions. In clinical practice, apps can be used to supplement treatment and provide clients with population-specific confidential tools to increase engagement in the treatment process. UR - https://mhealth.jmir.org/2022/1/e26453 UR - http://dx.doi.org/10.2196/26453 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044307 ID - info:doi/10.2196/26453 ER - TY - JOUR AU - Schomakers, Eva-Maria AU - Lidynia, Chantal AU - Vervier, Sophie Luisa AU - Calero Valdez, André AU - Ziefle, Martina PY - 2022/1/18 TI - Applying an Extended UTAUT2 Model to Explain User Acceptance of Lifestyle and Therapy Mobile Health Apps: Survey Study JO - JMIR Mhealth Uhealth SP - e27095 VL - 10 IS - 1 KW - technology acceptance KW - UTAUT2 KW - mHealth KW - privacy concerns KW - trust N2 - Background: Mobile health (mHealth) care apps are a promising technology to monitor and control health individually and cost-effectively with a technology that is widely used, affordable, and ubiquitous in many people?s lives. Download statistics show that lifestyle apps are widely used by young and healthy users to improve fitness, nutrition, and more. While this is an important aspect for the prevention of future chronic diseases, the burdened health care systems worldwide may directly profit from the use of therapy apps by those patients already in need of medical treatment and monitoring. Objective: We aimed to compare the factors influencing the acceptance of lifestyle and therapy apps to better understand what drives and hinders the use of mHealth apps. Methods: We applied the established unified theory of acceptance and use of technology 2 (UTAUT2) technology acceptance model to evaluate mHealth apps via an online questionnaire with 707 German participants. Moreover, trust and privacy concerns were added to the model and, in a between-subject study design, the influence of these predictors on behavioral intention to use apps was compared between lifestyle and therapy apps. Results: The results show that the model only weakly predicted the intention to use mHealth apps (R2=0.019). Only hedonic motivation was a significant predictor of behavioral intentions regarding both app types, as determined by path coefficients of the model (lifestyle: 0.196, P=.004; therapy: 0.344, P<.001). Habit influenced the behavioral intention to use lifestyle apps (0.272, P<.001), while social influence (0.185, P<.001) and trust (0.273, P<.001) predicted the intention to use therapy apps. A further exploratory correlation analysis of the relationship between user factors on behavioral intention was calculated. Health app familiarity showed the strongest correlation to the intention to use (r=0.469, P<.001), stressing the importance of experience. Also, age (r=?0.15, P=.004), gender (r=?0.075, P=.048), education level (r=0.088, P=.02), app familiarity (r=0.142, P=.007), digital health literacy (r=0.215, P<.001), privacy disposition (r=?0.194, P>.001), and the propensity to trust apps (r=0.191, P>.001) correlated weakly with behavioral intention to use mHealth apps. Conclusions: The results indicate that, rather than by utilitarian factors like usefulness, mHealth app acceptance is influenced by emotional factors like hedonic motivation and partly by habit, social influence, and trust. Overall, the findings give evidence that for the health care context, new and extended acceptance models need to be developed with an integration of user diversity, especially individuals? prior experience with apps and mHealth. UR - https://mhealth.jmir.org/2022/1/e27095 UR - http://dx.doi.org/10.2196/27095 UR - http://www.ncbi.nlm.nih.gov/pubmed/35040801 ID - info:doi/10.2196/27095 ER - TY - JOUR AU - Sierk, Anika AU - Travers, Eoin AU - Economides, Marcos AU - Loe, Sheng Bao AU - Sun, Luning AU - Bolton, Heather PY - 2022/1/17 TI - A New Digital Assessment of Mental Health and Well-being in the Workplace: Development and Validation of the Unmind Index JO - JMIR Ment Health SP - e34103 VL - 9 IS - 1 KW - mental health KW - well-being KW - mHealth KW - measurement N2 - Background: Unmind is a workplace, digital, mental health platform with tools to help users track, maintain, and improve their mental health and well-being (MHWB). Psychological measurement plays a key role on this platform, providing users with insights on their current MHWB, the ability to track it over time, and personalized recommendations, while providing employers with aggregate information about the MHWB of their workforce. Objective: Due to the limitations of existing measures for this purpose, we aimed to develop and validate a novel well-being index for digital use, to capture symptoms of common mental health problems and key aspects of positive well-being. Methods: In Study 1A, questionnaire items were generated by clinicians and screened for face validity. In Study 1B, these items were presented to a large sample (n=1104) of UK adults, and exploratory factor analysis was used to reduce the item pool and identify coherent subscales. In Study 2, the final measure was presented to a new nationally representative UK sample (n=976), along with a battery of existing measures, with 238 participants retaking the Umind Index after 1 week. The factor structure and measurement invariance of the Unmind Index was evaluated using confirmatory factor analysis, convergent and discriminant validity by estimating correlations with existing measures, and reliability by examining internal consistency and test-retest intraclass correlations. Results: Studies 1A and 1B yielded a 26-item measure with 7 subscales: Calmness, Connection, Coping, Happiness, Health, Fulfilment, and Sleep. Study 2 showed that the Unmind Index is fitted well by a second-order factor structure, where the 7 subscales all load onto an overall MHWB factor, and established measurement invariance by age and gender. Subscale and total scores correlate well with existing mental health measures and generally diverge from personality measures. Reliability was good or excellent across all subscales. Conclusions: The Unmind Index is a robust measure of MHWB that can help to identify target areas for intervention in nonclinical users of a mental health app. We argue that there is value in measuring mental ill health and mental well-being together, rather than treating them as separate constructs. UR - https://mental.jmir.org/2022/1/e34103 UR - http://dx.doi.org/10.2196/34103 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037895 ID - info:doi/10.2196/34103 ER - TY - JOUR AU - Rivers, T. John AU - Smith, Carla AU - Smith, Ian AU - Cameron, James PY - 2022/1/17 TI - The Impact of a Mobile App on Participation in Cardiac Rehabilitation and Understanding Barriers to Success: Comparative Cohort Study JO - JMIR Cardio SP - e24174 VL - 6 IS - 1 KW - cardiac rehabilitation KW - digital health KW - smartphone app KW - Cardihab KW - participation rates KW - rehabilitation KW - cardiology KW - heart KW - app KW - barrier N2 - Background: Poor patient uptake of cardiac rehabilitation (CR) remains a challenge for multiple reasons including geographic, time, cultural, cost, and psychological constraints. Objective: We evaluated the impact on CR participation rates associated with the addition of the option of mobile app?based CR (Cardihab) for patients declining conventional CR. Methods: A total of 204 consecutive patients were offered CR following angioplasty; of these, 99 were in cohort 1 (offered conventional CR only) and 105 were in cohort 2 (app-based CR offered to those declining conventional CR). Patients in each cohort were followed throughout a 6-week CR program and participation rates were compared for both groups. Patients in cohort 2 declining both forms of CR were interviewed to assess reasons for nonparticipation. Results: CR participation improved from 21% (95% CI 14%-30%) to 63% (95% CI 53%-71%) with the addition of the app (P<.001). Approximately 25% (9/39) of the group declining the app-based program identified technology issues as the reason for nonparticipation. The remainder declined both CR programs or were ineligible due to frailty or comorbidities. Conclusions: Providing patients with the additional option of an app-based CR program substantially improved CR participation. Technology and psychological barriers can limit CR participation. Further innovation in CR delivery systems is required to improve uptake. UR - https://cardio.jmir.org/2022/1/e24174 UR - http://dx.doi.org/10.2196/24174 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037891 ID - info:doi/10.2196/24174 ER - TY - JOUR AU - Wu, Xi Vivien AU - Dong, Yanhong AU - Tan, Choo Poh AU - Gan, Peiying AU - Zhang, Di AU - Chi, Yuchen AU - Chao, Ting Felicia Fang AU - Lu, Jinhua AU - Teo, Dennis Boon Heng AU - Tan, Qian Yue PY - 2022/1/17 TI - Development of a Community-Based e-Health Program for Older Adults With Chronic Diseases: Pilot Pre-Post Study JO - JMIR Aging SP - e33118 VL - 5 IS - 1 KW - eHealth KW - self-management KW - older adults KW - chronic disease KW - community care KW - elderly KW - community KW - innovation KW - development KW - pilot KW - evaluation KW - health literacy KW - empowerment KW - feasibility KW - engagement N2 - Background: Chronic diseases may impact older adults? health outcomes, health care costs, and quality of life. Self-management is expected to encourage individuals to make autonomous decisions, adhere to treatment plans, deal with emotional and social consequences, and provide choices for healthy lifestyle. New eHealth solutions significantly increase the health literacy and empower patients in self-management of chronic conditions. Objective: This study aims to develop a Community-Based e-Health Program (CeHP) for older adults with chronic diseases and conduct a pilot evaluation. Methods: A pilot study with a 2-group pre- and posttest repeated measures design was adopted. Community-dwelling older adults with chronic diseases were recruited from senior activity centers in Singapore. A systematic 3-step process of developing CeHP was coupled with a smart-device application. The development of the CeHP intervention consists of theoretical framework, client-centric participatory action research process, content validity assessment, and pilot testing. Self-reported survey questionnaires and health outcomes were measured before and after the CeHP. The instruments used were the Self-care of Chronic Illness Inventory (SCCII), Healthy Aging Instrument (HAI), Short-Form Health Literacy Scale, 12 Items (HLS-SF 12), Patient Empowerment Scale (PES), and Social Support Questionnaire, 6 items. The following health outcomes were measured: Montreal Cognitive Assessment, Symbol Digit Modalities Test, total cholesterol (TC), high-density lipoproteins, low-density lipoproteins/very-low-density lipoproteins (LDL/VLDL), fasting glucose, glycated hemoglobin (HbA1c), and BMI. Results: The CeHP consists of health education, monitoring, and an advisory system for older adults to manage their chronic conditions. It is an 8-week intensive program, including face-to-face and eHealth (Care4Senior App) sessions. Care4Senior App covers health education topics focusing on the management of hypertension, hyperlipidemia, and diabetes, brain health, healthy diet, lifestyle modification, medication adherence, exercise, and mindfulness practice. Content validity assessment indicated that the content of the CeHP is valid, with a content validity index (CVI) ranging 0.86-1 and a scale-CVI of 1. Eight participants in the CeHP group and 4 in the control group completed both baseline and post intervention assessments. Participants in the CeHP group showed improvements in fasting glucose, HbA1c, TC, LDL/VLDL, BMI, SCCII indices (Maintenance, Monitoring, and Management), HAI, and PES scores post intervention, although these changes were not significant. For the participants in the control group, the scores for SCCII (management and confidence) and HLS-SF 12 decreased post intervention. Conclusions: The CeHP is feasible, and it engages and empowers community-dwelling older adults to manage their chronic conditions. The rigorous process of program development and pilot evaluation provided valid evidence to expand the CeHP to a larger-scale implementation to encourage self-management, reduce debilitating complications of poorly controlled chronic diseases, promote healthy longevity and social support, and reduce health care costs. UR - https://aging.jmir.org/2022/1/e33118 UR - http://dx.doi.org/10.2196/33118 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037882 ID - info:doi/10.2196/33118 ER - TY - JOUR AU - Lee, Jaegyeong AU - Lim, Min Jung PY - 2022/1/14 TI - Factors Associated With the Experience of Cognitive Training Apps for the Prevention of Dementia: Cross-sectional Study Using an Extended Health Belief Model JO - J Med Internet Res SP - e31664 VL - 24 IS - 1 KW - cognitive training apps KW - dementia knowledge KW - health belief model KW - middle-aged KW - logistic regression analysis KW - dementia KW - Alzheimer disease KW - cognition KW - mobile apps KW - health apps N2 - Background: The prevalence and economic burden of dementia are increasing dramatically. Using information communication technology to improve cognitive functions is proven to be effective and holds the potential to serve as a new and efficient method for the prevention of dementia. Objective: The aim of this study was to identify factors associated with the experience of mobile apps for cognitive training in middle-aged adults. We evaluated the relationships between the experience of cognitive training apps and structural variables using an extended health belief model. Methods: An online survey was conducted on South Korean participants aged 40 to 64 years (N=320). General characteristics and dementia knowledge were measured along with the health belief model constructs. Statistical analysis and logistic regression analysis were performed. Results: Higher dementia knowledge (odds ratio [OR] 1.164, P=.02), higher perceived benefit (OR 1.373, P<.001), female gender (OR 0.499, P=.04), and family history of dementia (OR 1.933, P=.04) were significantly associated with the experience of cognitive training apps for the prevention of dementia. Conclusions: This study may serve as a theoretical basis for the development of intervention strategies to increase the use of cognitive training apps for the prevention of dementia. UR - https://www.jmir.org/2022/1/e31664 UR - http://dx.doi.org/10.2196/31664 UR - http://www.ncbi.nlm.nih.gov/pubmed/35029540 ID - info:doi/10.2196/31664 ER - TY - JOUR AU - Wang, Xiaohui AU - Shi, Jingyuan AU - Lee, Min Kwan PY - 2022/1/13 TI - The Digital Divide and Seeking Health Information on Smartphones in Asia: Survey Study of Ten Countries JO - J Med Internet Res SP - e24086 VL - 24 IS - 1 KW - smartphone KW - health information seeking KW - Asia KW - user profile KW - digital divide N2 - Background: Although recent developments in mobile health have elevated the importance of how smartphones empower individuals to seek health information, research investigating this phenomenon in Asian countries has been rare. Objective: The goal of our study was to provide a comprehensive profile of mobile health information seekers and to examine the individual- and country-level digital divide in Asia. Methods: With survey data from 10 Asian countries (N=9086), we ran multilevel regression models to assess the effect of sociodemographic factors, technological factors, and country-level disparities on using smartphones to seek health information. Results: Respondents who were women (?=.13, P<.001), parents (?=.16, P<.001), employed (?=.08, P=.002), of higher social status (?=.08, P<.001), and/or from countries with low health expenditures (?=.19, P=.02) were more likely to use smartphones to seek health information. In terms of technological factors, technology innovativeness (?=.10, P<.001) and frequency of smartphone use (?=.42, P<.001) were important factors of health information seeking, whereas the effect of online information quality was marginal (?=?.04, P<.001). Conclusions: Among smartphone users in Asia, health information seeking varies according to individuals? socioeconomic status, their innovativeness toward technology, and their frequency of smartphone use. Although smartphones widen the digital divide among individuals with different socioeconomic status, they also bridge the divide between countries with varying health expenditures. Smartphones appear to be a particularly useful complement to manage health in developing countries. UR - https://www.jmir.org/2022/1/e24086 UR - http://dx.doi.org/10.2196/24086 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023845 ID - info:doi/10.2196/24086 ER - TY - JOUR AU - Kruzan, Payne Kaylee AU - Whitlock, Janis AU - Bazarova, N. Natalya AU - Bhandari, Aparajita AU - Chapman, Julia PY - 2022/1/10 TI - Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial JO - JMIR Form Res SP - e26526 VL - 6 IS - 1 KW - nonsuicidal self-injury KW - randomized controlled trial KW - mobile app KW - peer support KW - urges KW - digital intervention N2 - Background: Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery. Objective: The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help?seeking. Methods: Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help?seeking. Results: A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; ?2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; ?2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help?seeking. Conclusions: Use of the peer support app was related to reduced NSSI frequency and greater confidence in one?s ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help?seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials. Trial Registration: Open Science Foundation; https://osf.io/3uay9 UR - https://formative.jmir.org/2022/1/e26526 UR - http://dx.doi.org/10.2196/26526 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006076 ID - info:doi/10.2196/26526 ER - TY - JOUR AU - Lee, WJ Edmund AU - McCloud, F. Rachel AU - Viswanath, Kasisomayajula PY - 2022/1/7 TI - Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment JO - J Med Internet Res SP - e25419 VL - 24 IS - 1 KW - eHealth KW - mobile health KW - communication inequalities KW - health disparities KW - health informatics KW - mobile phone UR - https://www.jmir.org/2022/1/e25419 UR - http://dx.doi.org/10.2196/25419 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994700 ID - info:doi/10.2196/25419 ER - TY - JOUR AU - Vaidyam, Aditya AU - Halamka, John AU - Torous, John PY - 2022/1/7 TI - Enabling Research and Clinical Use of Patient-Generated Health Data (the mindLAMP Platform): Digital Phenotyping Study JO - JMIR Mhealth Uhealth SP - e30557 VL - 10 IS - 1 KW - digital phenotyping KW - mHealth KW - apps KW - FHIR KW - digital health KW - health data KW - patient-generated health data KW - mobile health KW - smartphones KW - wearables KW - mobile apps KW - mental health, mobile phone N2 - Background: There is a growing need for the integration of patient-generated health data (PGHD) into research and clinical care to enable personalized, preventive, and interactive care, but technical and organizational challenges, such as the lack of standards and easy-to-use tools, preclude the effective use of PGHD generated from consumer devices, such as smartphones and wearables. Objective: This study outlines how we used mobile apps and semantic web standards such as HTTP 2.0, Representational State Transfer, JSON (JavaScript Object Notation), JSON Schema, Transport Layer Security (version 1.3), Advanced Encryption Standard-256, OpenAPI, HTML5, and Vega, in conjunction with patient and provider feedback to completely update a previous version of mindLAMP. Methods: The Learn, Assess, Manage, and Prevent (LAMP) platform addresses the abovementioned challenges in enhancing clinical insight by supporting research, data analysis, and implementation efforts around PGHD as an open-source solution with freely accessible and shared code. Results: With a simplified programming interface and novel data representation that captures additional metadata, the LAMP platform enables interoperability with existing Fast Healthcare Interoperability Resources?based health care systems as well as consumer wearables and services such as Apple HealthKit and Google Fit. The companion Cortex data analysis and machine learning toolkit offer robust support for artificial intelligence, behavioral feature extraction, interactive visualizations, and high-performance data processing through parallelization and vectorization techniques. Conclusions: The LAMP platform incorporates feedback from patients and clinicians alongside a standards-based approach to address these needs and functions across a wide range of use cases through its customizable and flexible components. These range from simple survey-based research to international consortiums capturing multimodal data to simple delivery of mindfulness exercises through personalized, just-in-time adaptive interventions. UR - https://mhealth.jmir.org/2022/1/e30557 UR - http://dx.doi.org/10.2196/30557 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994710 ID - info:doi/10.2196/30557 ER - TY - JOUR AU - Han, Sang Jae AU - Park, Yong-Ho AU - Song, Jae-Jun AU - Moon, Joon Il AU - Lee, Woojoo AU - Kim, Yoonjoong AU - Cho, Sang Young AU - Seo, Jae-Hyun AU - Park, Kyun Moo PY - 2022/1/7 TI - Knowledge and Expectations of Hearing Aid Apps Among Smartphone Users and Hearing Professionals: Cross-sectional Survey JO - JMIR Mhealth Uhealth SP - e27809 VL - 10 IS - 1 KW - smartphone KW - hearing aids KW - app KW - perception KW - survey KW - hearing loss KW - mobile phone N2 - Background: Despite the increasing prevalence of hearing loss, the cost and psychological barriers to the use of hearing aids may prevent their use in individuals with hearing loss. Patients with hearing loss can benefit from smartphone-based hearing aid apps (SHAAs), which are smartphone apps that use a mobile device as a sound amplifier. Objective: The aim of this study is to determine how ear, nose, and throat outpatients perceive SHAAs, analyze the factors that affect their perceptions, and estimate the costs of an annual subscription to an app through a self-administered questionnaire survey of smartphone users and hearing specialists. Methods: This study used a cross-sectional, multicenter survey of both ear, nose, and throat outpatients and hearing specialists. The questionnaire was designed to collect personal information about the respondents and their responses to 18 questions concerning SHAAs in five domains: knowledge, needs, cost, expectations, and information. Perception questions were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). Questions about the expected cost of SHAAs were included in the questionnaire distributed to hearing experts. Results: Among the 219 smartphone users and 42 hearing specialists, only 8 (3.7%) respondents recognized SHAAs, whereas 18% (47/261) of respondents reported considering the use of an assistive device to improve their hearing capacity. The average perception score was 2.81 (SD 1.22). Among the factors that shaped perceptions of SHAAs, the needs category received the lowest scores (2.02, SD 1.42), whereas the cost category received the highest scores (3.29, SD 1.14). Age was correlated with the information domain (P<.001), and an increased level of hearing impairment resulted in significantly higher points in the needs category (P<.001). Patients expected the cost of an annual app subscription to an SHAA to be approximately US $86, and the predicted cost was associated with economic status (P=.02) and was higher than the prices expected by hearing specialists (P<.001). Conclusions: Outpatients expected SHAAs to cost more than hearing specialists. However, the perception of the SHAA was relatively low. In this regard, enhanced awareness is required to popularize SHAAs. UR - https://mhealth.jmir.org/2022/1/e27809 UR - http://dx.doi.org/10.2196/27809 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994699 ID - info:doi/10.2196/27809 ER - TY - JOUR AU - Rao, Nema AU - Perdomo, Sophy AU - Jonassaint, Charles PY - 2022/1/7 TI - A Novel Method for Digital Pain Assessment Using Abstract Animations: Human-Centered Design Approach JO - JMIR Hum Factors SP - e27689 VL - 9 IS - 1 KW - pain KW - pain measurement KW - chronic pain KW - animations KW - mobile apps KW - human-centered design N2 - Background: Patients with chronic pain face several challenges in using clinical tools to help them monitor, understand, and make meaningful decisions about their pain conditions. Our group previously presented data on Painimation, a novel electronic tool for communicating and assessing pain. Objective: This paper describes the human-centered design and development approach (inspiration, ideation, and implementation) that led to the creation of Painimation. Methods: We planned an iterative and cyclical development process that included stakeholder engagement and feedback from users. Stakeholders included patients with acute and chronic pain, health care providers, and design students. Target users were adults with acute or chronic pain who needed clinical assessment and tracking of the course of their pain over time. Phase I (inspiration) consisted of empathizing with users, understanding how patients experience pain, and identifying the barriers to accurately expressing and assessing pain. This phase involved understanding how patients communicate pain symptoms to providers, as well as defining limitations of current models of clinical pain assessment tools. In Phase II (ideate) we conceptualized and evaluated different approaches to expressing and assessing pain. The most promising concept was developed through an iterative process that involved end users and stakeholders. In Phase III (implementation), based on stakeholder feedback from initial designs and prototypes of abstract pain animations (painimations), we incorporated all concepts to test a minimally viable product, a fully functioning pain assessment app. We then gathered feedback through an agile development process and applied this feedback to finalizing a testable version of the app that could ultimately be used in a pain clinic. Results: Engaging intended users and stakeholders in an iterative, human-centered design process identified 5 criteria that a pain assessment tool would need to meet to be effective in the medical setting. These criteria were used as guiding design principles to generate a series of pain assessment concept ideas. This human-centered approach generated 8 highly visual painimations that were found to be acceptable and useable for communicating pain with medical providers, by both patients with general pain and patients with sickle cell disease (SCD). While these initial steps continued refinement of the tool, further data are needed. Agile development will allow us to continue to incorporate precision medicine tools that are validated in the clinical research arena. Conclusions: A multiphase, human-centered design approach successfully resulted in the development of an innovation that has potential to improve the quality of medical care, particularly for underserved populations. The use of Painimation may especially benefit the medical care of minority populations with chronic and difficult-to-treat pain, such as adults with SCD. The insights generated from this study can be applied to the development of patient-reported outcomes tools that are more patient-centered, engaging, and effective. UR - https://humanfactors.jmir.org/2022/1/e27689 UR - http://dx.doi.org/10.2196/27689 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994697 ID - info:doi/10.2196/27689 ER - TY - JOUR AU - Paalimäki-Paakki, Karoliina AU - Virtanen, Mari AU - Henner, Anja AU - Nieminen, T. Miika AU - Kääriäinen, Maria PY - 2022/1/6 TI - Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review JO - J Med Internet Res SP - e30077 VL - 24 IS - 1 KW - mHealth KW - mobile health KW - eHealth KW - digital health KW - mobile apps KW - smartphone apps KW - web-based KW - telemedicine KW - chronic diseases KW - noncommunicable diseases KW - web-based interventions KW - mobile phone N2 - Background: Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients? anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions. Objective: This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill. Methods: Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ?18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results. Results: Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment. Conclusions: This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling. UR - https://www.jmir.org/2022/1/e30077 UR - http://dx.doi.org/10.2196/30077 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989681 ID - info:doi/10.2196/30077 ER - TY - JOUR AU - Breil, Bernhard AU - Salewski, Christel AU - Apolinário-Hagen, Jennifer PY - 2022/1/6 TI - Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey JO - JMIR Cardio SP - e31617 VL - 6 IS - 1 KW - patient acceptance of health care KW - mobile apps KW - blood pressure KW - mobile health KW - health applications KW - technology acceptance KW - patients KW - physicians KW - digital health N2 - Background: High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison. Objective: The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients? preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc). Methods: Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses. Results: As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians. Conclusions: In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research. UR - https://cardio.jmir.org/2022/1/e31617 UR - http://dx.doi.org/10.2196/31617 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989683 ID - info:doi/10.2196/31617 ER - TY - JOUR AU - Kenny, Lorna AU - Moore, Kevin AU - O' Riordan, Clíona AU - Fox, Siobhan AU - Barton, John AU - Tedesco, Salvatore AU - Sica, Marco AU - Crowe, Colum AU - Alamäki, Antti AU - Condell, Joan AU - Nordström, Anna AU - Timmons, Suzanne PY - 2022/1/6 TI - The Views and Needs of People With Parkinson Disease Regarding Wearable Devices for Disease Monitoring: Mixed Methods Exploration JO - JMIR Form Res SP - e27418 VL - 6 IS - 1 KW - Parkinson disease KW - wearable devices KW - technology KW - mixed method KW - focus group KW - survey KW - mobile phone N2 - Background: Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. Objective: This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. Methods: This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. Results: Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. Conclusions: Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease?related health barriers and the users? confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management. UR - https://formative.jmir.org/2022/1/e27418 UR - http://dx.doi.org/10.2196/27418 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989693 ID - info:doi/10.2196/27418 ER - TY - JOUR AU - Kruse, Clemens AU - Heinemann, Katharine PY - 2022/1/4 TI - Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review JO - J Med Internet Res SP - e31752 VL - 24 IS - 1 KW - telemedicine KW - pandemic KW - technology acceptance KW - COVID-19 KW - digital health KW - telehealth KW - health policy KW - health care N2 - Background: The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled the rapid adoption of telemedicine around the world. Thus, it is important to now assess the effects of this rapid adoption and to determine whether the barriers to such adoption are the same today as they were under prepandemic conditions. Objective: The objective of this systematic literature review was to examine the research literature published during the COVID-19 pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine, and to determine if changes have occurred in the industry during this time. Methods: The systematic review was performed in accordance with the Kruse protocol and the results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic that were retrieved from searches in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. Results: Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, and 14 results (compared to a control group) themes and observations. Overall, 22% of the articles analyzed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction), 27% reported an improvement in administrative or efficiency results (as compared with a control group), 14% reported no statistically significant difference from the control group, and 40% and 10% reported an improvement or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. Conclusions: The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges identified in previous research. Several barriers remain for health policymakers to address; however, health care administrators can feel confident in the modality as the evidence largely shows that it is safe, effective, and widely accepted. UR - https://www.jmir.org/2022/1/e31752 UR - http://dx.doi.org/10.2196/31752 UR - http://www.ncbi.nlm.nih.gov/pubmed/34854815 ID - info:doi/10.2196/31752 ER - TY - JOUR AU - Bai, Yang AU - Copeland, E. William AU - Burns, Ryan AU - Nardone, Hilary AU - Devadanam, Vinay AU - Rettew, Jeffrey AU - Hudziak, James PY - 2022/1/4 TI - Ecological Momentary Assessment of Physical Activity and Wellness Behaviors in College Students Throughout a School Year: Longitudinal Naturalistic Study JO - JMIR Public Health Surveill SP - e25375 VL - 8 IS - 1 KW - young adulthood KW - wellness KW - substance use KW - Apple Watch N2 - Background: The Wellness Environment app study is a longitudinal study focused on promoting health in college students. Objective: The two aims of this study were (1) to assess physical activity (PA) variation across the days of the week and throughout the academic year and (2) to explore the correlates that were associated with PA, concurrently and longitudinally. Methods: The participants were asked to report their wellness and risk behaviors on a 14-item daily survey through a smartphone app. Each student was provided an Apple Watch to track their real time PA. Data were collected from 805 college students from Sept 2017 to early May 2018. PA patterns across the days of the week and throughout the academic year were summarized. Concurrent associations of daily steps with wellness or risk behavior were tested in the general linear mixed-effects model. The longitudinal, reciprocal association between daily steps and health or risk behaviors were tested with cross-lagged analysis. Results: Female college students were significantly more active than male ones. The students were significantly more active during the weekday than weekend. Temporal patterns also revealed that the students were less active during Thanksgiving, winter, and spring breaks. Strong concurrent positive correlations were found between higher PA and self-reported happy mood, 8+ hours of sleep, ?1 fruit and vegetable consumption, ?4 bottles of water intake, and ?2 hours of screen time (P<.001). Similar longitudinal associations found that the previous day?s wellness behaviors independently predicted the following day?s higher PA except for mood. Conversely, the higher previous-day PA levels were associated with better mood, more fruit and vegetable consumption, and playing less music, but with higher liquor consumption the next day. Conclusions: This study provides a comprehensive surveillance of longitudinal PA patterns and their independent association with a variety of wellness and risk behaviors in college students. UR - https://publichealth.jmir.org/2022/1/e25375 UR - http://dx.doi.org/10.2196/25375 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982721 ID - info:doi/10.2196/25375 ER - TY - JOUR AU - Wu, Xiaoqian AU - Xu, Lin AU - Li, PengFei AU - Tang, TingTing AU - Huang, Cheng PY - 2022/1/4 TI - Multipurpose Mobile Apps for Mental Health in Chinese App Stores: Content Analysis and Quality Evaluation JO - JMIR Mhealth Uhealth SP - e34054 VL - 10 IS - 1 KW - mobile apps KW - app KW - mental health KW - mHealth KW - content analysis N2 - Background: Mental disorders impose varying degrees of burden on patients and their surroundings. However, people are reluctant to take the initiative to seek mental health services because of the uneven distribution of resources and stigmatization. Thus, mobile apps are considered an effective way to eliminate these obstacles and improve mental health awareness. Objective: This study aims to evaluate the quality, function, privacy measures, and evidence-based and professional background of multipurpose mental health apps in Chinese commercial app stores. Methods: A systematic search was conducted on iOS and Android platforms in China to identify multipurpose mental health apps. Two independent reviewers evaluated the identified mobile apps using the Mobile App Rating Scale (MARS). Each app was downloaded, and the general characteristics, privacy and security measures, development background, and functional characteristics of each app were evaluated. Results: A total of 40 apps were analyzed, of which 35 (87.5%) were developed by companies and 33 (82.5%) provided links to access the privacy policy; 21 (52.5%) apps did not mention the involvement of relevant professionals or the guidance of a scientific basis in the app development process. The main built-in functions of these apps include psychological education (38/40, 95%), self-assessment (34/40, 85%), and counseling (33/40, 82.5%). The overall quality average MARS score of the 40 apps was 3.54 (SD 0.39), and the total score was between 2.96 and 4.30. The total MARS score was significantly positively correlated with the scores of each subscale (r=0.62-0.88, P<.001). However, the user score of the app market was not significantly correlated with the total MARS score (r=0.17, P=.33). Conclusions: The quality of multipurpose mental health apps in China?s main app market is generally good. However, health professionals are less involved in the development of these apps, and the privacy protection policy of the apps also needs to be described in more detail. This study provides a reference for the development of multipurpose mental health apps. UR - https://mhealth.jmir.org/2022/1/e34054 UR - http://dx.doi.org/10.2196/34054 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982717 ID - info:doi/10.2196/34054 ER - TY - JOUR AU - Wang, Hua AU - Gupta, Sneha AU - Singhal, Arvind AU - Muttreja, Poonam AU - Singh, Sanghamitra AU - Sharma, Poorva AU - Piterova, Alice PY - 2022/1/3 TI - An Artificial Intelligence Chatbot for Young People?s Sexual and Reproductive Health in India (SnehAI): Instrumental Case Study JO - J Med Internet Res SP - e29969 VL - 24 IS - 1 KW - artificial intelligence KW - chatbot KW - Facebook KW - affordance KW - sex education KW - sexual and reproductive health KW - contraception KW - case study KW - young people KW - India KW - transmedia KW - mobile apps KW - mobile health KW - technology design KW - user engagement KW - digital health KW - mobile phone N2 - Background: Leveraging artificial intelligence (AI)?driven apps for health education and promotion can help in the accomplishment of several United Nations sustainable development goals. SnehAI, developed by the Population Foundation of India, is the first Hinglish (Hindi + English) AI chatbot, deliberately designed for social and behavioral changes in India. It provides a private, nonjudgmental, and safe space to spur conversations about taboo topics (such as safe sex and family planning) and offers accurate, relatable, and trustworthy information and resources. Objective: This study aims to use the Gibson theory of affordances to examine SnehAI and offer scholarly guidance on how AI chatbots can be used to educate adolescents and young adults, promote sexual and reproductive health, and advocate for the health entitlements of women and girls in India. Methods: We adopted an instrumental case study approach that allowed us to explore SnehAI from the perspectives of technology design, program implementation, and user engagement. We also used a mix of qualitative insights and quantitative analytics data to triangulate our findings. Results: SnehAI demonstrated strong evidence across fifteen functional affordances: accessibility, multimodality, nonlinearity, compellability, queriosity, editability, visibility, interactivity, customizability, trackability, scalability, glocalizability, inclusivity, connectivity, and actionability. SnehAI also effectively engaged its users, especially young men, with 8.2 million messages exchanged across a 5-month period. Almost half of the incoming user messages were texts of deeply personal questions and concerns about sexual and reproductive health, as well as allied topics. Overall, SnehAI successfully presented itself as a trusted friend and mentor; the curated content was both entertaining and educational, and the natural language processing system worked effectively to personalize the chatbot response and optimize user experience. Conclusions: SnehAI represents an innovative, engaging, and educational intervention that enables vulnerable and hard-to-reach population groups to talk and learn about sensitive and important issues. SnehAI is a powerful testimonial of the vital potential that lies in AI technologies for social good. UR - https://www.jmir.org/2022/1/e29969 UR - http://dx.doi.org/10.2196/29969 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982034 ID - info:doi/10.2196/29969 ER - TY - JOUR AU - Mariakakis, Alex AU - Karkar, Ravi AU - Patel, N. Shwetak AU - Kientz, A. Julie AU - Fogarty, James AU - Munson, A. Sean PY - 2022/1/3 TI - Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology JO - JMIR Hum Factors SP - e30474 VL - 9 IS - 1 KW - mobile health KW - survey instrument KW - health screening KW - health belief model KW - path analysis KW - user design KW - health technology KW - health intervention technology KW - digital health KW - mobile phone N2 - Background: Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. Objective: In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. Methods: We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. Results: We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people?s decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. Conclusions: Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations. UR - https://humanfactors.jmir.org/2022/1/e30474 UR - http://dx.doi.org/10.2196/30474 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982038 ID - info:doi/10.2196/30474 ER - TY - JOUR AU - Ahadzadeh, Sadat Ashraf AU - Wu, Ling Shin AU - Ong, Sim Fon AU - Deng, Ruolan PY - 2021/12/29 TI - The Mediating Influence of the Unified Theory of Acceptance and Use of Technology on the Relationship Between Internal Health Locus of Control and Mobile Health Adoption: Cross-sectional Study JO - J Med Internet Res SP - e28086 VL - 23 IS - 12 KW - mobile health KW - mHealth KW - internal health locus of control KW - performance expectancy KW - effort expectancy KW - social influence KW - mediation N2 - Background: Mobile health (mHealth) as an innovative form of information and communications technology can efficiently deliver high-quality health care by enhancing communication and health management, reducing costs, and increasing access to health services. An individual?s internal health locus of control (HLOC) is found to be associated with the behavioral intent to adopt mHealth. However, little is known about the underlying mechanism of this association. Objective: The primary objective of this study was to test the mediation influence of the Unified Theory of Acceptance and Use of Technology (UTAUT) on the relationship between internal HLOC and the behavioral intention to use mHealth. Methods: A total of 374 responses were collected from Malaysian adult users of mHealth, using convenience and snowball sampling methods. Partial least squares structural equation modeling was used to analyze the data. Data were collected for variables, including demographics, internal HLOC, and modified UTAUT constructs (ie, performance expectancy, effort expectancy, and social influence). Results: The results showed that there was no direct relationship between internal HLOC and the behavioral intention to use mHealth (?=?0.039, P=.32). The indirect relationship between internal HLOC and the intent to adopt mHealth was supported, indicating that the UTAUT constructs performance expectancy (?=0.104, P<.001), effort expectancy (?=0.056, P=.02), and social influence (?=0.057, P=.002) mediated this relationship. The results showed full mediation, with total variance explained at 47.2%. Conclusions: This study developed an integrative model, where a health-related disposition (internal HLOC), mHealth-related beliefs (performance expectancy and effort expectancy), and normative pressure (social influence) were combined to explain the underlying mechanism of the behavioral intent to adopt mHealth. The results showed that the intention to adopt mHealth is mediated by the influence of UTAUT factors, while HLOC has no direct effect on adoption intention. The findings provide insights into augmenting mHealth adoption among the public by enhancing the perceived benefits of mHealth, helping design more effective and user-friendly mHealth tools, and capitalizing on social normative influence to adopt mHealth. This study utilized the constructs of the UTAUT model to determine the intention to use mHealth. Future research should focus on other health- and technology-related theories to ascertain other possible factors influencing the behavioral intent of mHealth adoption. UR - https://www.jmir.org/2021/12/e28086 UR - http://dx.doi.org/10.2196/28086 UR - http://www.ncbi.nlm.nih.gov/pubmed/34964718 ID - info:doi/10.2196/28086 ER - TY - JOUR AU - Shorey, Shefaly AU - Tan, Chye Thiam AU - AU - Mathews, Jancy AU - Yu, Yan Chun AU - Lim, Hoon Siew AU - Shi, Luming AU - Ng, Debby Esperanza AU - Chan, Huak Yiong AU - Law, Evelyn AU - Chee, Cornelia AU - Chong, Seng Yap PY - 2021/12/24 TI - Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study JO - J Med Internet Res SP - e27033 VL - 23 IS - 12 KW - depression KW - development KW - education KW - parent KW - perinatal KW - support KW - telehealth KW - mobile phone N2 - Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child?s development. Given the rise in technology and parents? preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles?the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development. UR - https://www.jmir.org/2021/12/e27033 UR - http://dx.doi.org/10.2196/27033 UR - http://www.ncbi.nlm.nih.gov/pubmed/36260376 ID - info:doi/10.2196/27033 ER - TY - JOUR AU - Wang, Hsiao-Han AU - Lin, Yu-Hsuan PY - 2021/12/24 TI - Assessing Physicians? Recall Bias of Work Hours With a Mobile App: Interview and App-Recorded Data Comparison JO - J Med Internet Res SP - e26763 VL - 23 IS - 12 KW - smartphone KW - mobile app KW - work hours KW - recall bias KW - time perception KW - physicians KW - labor policy N2 - Background: Previous studies have shown inconsistencies in the accuracy of self-reported work hours. However, accurate documentation of work hours is fundamental for the formation of labor policies. Strict work-hour policies decrease medical errors, improve patient safety, and promote physicians? well-being. Objective: The aim of this study was to estimate physicians? recall bias of work hours with a mobile app, and to examine the association between the recall bias and physicians? work hours. Methods: We quantified recall bias by calculating the differences between the app-recorded and self-reported work hours of the previous week and the penultimate week. We recruited 18 physicians to install the ?Staff Hours? app, which automatically recorded GPS-defined work hours for 2 months, contributing 1068 person-days. We examined the association between work hours and two recall bias indicators: (1) the difference between self-reported and app-recorded work hours and (2) the percentage of days for which work hours were not precisely recalled during interviews. Results: App-recorded work hours highly correlated with self-reported counterparts (r=0.86-0.88, P<.001). Self-reported work hours were consistently significantly lower than app-recorded hours by ?8.97 (SD 8.60) hours and ?6.48 (SD 8.29) hours for the previous week and the penultimate week, respectively (both P<.001). The difference for the previous week was significantly correlated with work hours in the previous week (r=?0.410, P=.01), whereas the correlation of the difference with the hours in the penultimate week was not significant (r=?0.119, P=.48). The percentage of hours not recalled (38.6%) was significantly higher for the penultimate week (38.6%) than for the first week (16.0%), and the former was significantly correlated with work hours of the penultimate week (r=0.489, P=.002) Conclusions: Our study identified the existence of recall bias of work hours, the extent to which the recall was biased, and the influence of work hours on recall bias. UR - https://www.jmir.org/2021/12/e26763 UR - http://dx.doi.org/10.2196/26763 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951600 ID - info:doi/10.2196/26763 ER - TY - JOUR AU - Zhang, Dongsong AU - Lim, Jaewan AU - Zhou, Lina AU - Dahl, A. Alicia PY - 2021/12/24 TI - Breaking the Data Value-Privacy Paradox in Mobile Mental Health Systems Through User-Centered Privacy Protection: A Web-Based Survey Study JO - JMIR Ment Health SP - e31633 VL - 8 IS - 12 KW - mobile apps KW - mental health KW - privacy concerns KW - privacy protection KW - mobile phone N2 - Background: Mobile mental health systems (MMHS) have been increasingly developed and deployed in support of monitoring, management, and intervention with regard to patients with mental disorders. However, many of these systems rely on patient data collected by smartphones or other wearable devices to infer patients? mental status, which raises privacy concerns. Such a value-privacy paradox poses significant challenges to patients? adoption and use of MMHS; yet, there has been limited understanding of it. Objective: To address the significant literature gap, this research aims to investigate both the antecedents of patients? privacy concerns and the effects of privacy concerns on their continuous usage intention with regard to MMHS. Methods: Using a web-based survey, this research collected data from 170 participants with MMHS experience recruited from online mental health communities and a university community. The data analyses used both repeated analysis of variance and partial least squares regression. Results: The results showed that data type (P=.003), data stage (P<.001), privacy victimization experience (P=.01), and privacy awareness (P=.08) have positive effects on privacy concerns. Specifically, users report higher privacy concerns for social interaction data (P=.007) and self-reported data (P=.001) than for biometrics data; privacy concerns are higher for data transmission (P=.01) and data sharing (P<.001) than for data collection. Our results also reveal that privacy concerns have an effect on attitude toward privacy protection (P=.001), which in turn affects continuous usage intention with regard to MMHS. Conclusions: This study contributes to the literature by deepening our understanding of the data value-privacy paradox in MMHS research. The findings offer practical guidelines for breaking the paradox through the design of user-centered and privacy-preserving MMHS. UR - https://mental.jmir.org/2021/12/e31633 UR - http://dx.doi.org/10.2196/31633 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951604 ID - info:doi/10.2196/31633 ER - TY - JOUR AU - Kruzan, Payne Kaylee AU - Meyerhoff, Jonah AU - Biernesser, Candice AU - Goldstein, Tina AU - Reddy, Madhu AU - Mohr, C. David PY - 2021/12/24 TI - Centering Lived Experience in Developing Digital Interventions for Suicide and Self-injurious Behaviors: User-Centered Design Approach JO - JMIR Ment Health SP - e31367 VL - 8 IS - 12 KW - user-centered design KW - intervention KW - suicide KW - nonsuicidal self-injury KW - lived experience KW - technology-enabled services KW - digital intervention KW - engagement KW - mobile phone N2 - Background: The prevalence of self-injurious thoughts and behaviors (SITB) signals a growing public health crisis. Despite a recognized need for improved and scalable interventions, the field of SITB intervention faces several challenges: existing interventions are often time and resource intensive, most individuals with SITB do not seek formal mental health care, and efficacious treatments are characterized by small effects. Combined, these challenges indicate a need for improved SITB interventions for individuals in formal treatment and those who are not treatment engaged but are at high risk of worsening mental health and future suicide attempts. Objective: We present a methodological approach and set of techniques that may address these challenges by centering the lived experience of individuals with SITB in the process of developing needed services: user-centered design (UCD). Methods: We highlight the value of UCD in the context of digital interventions for SITB by describing the UCD approach and explicating how it can be leveraged to include lived experience throughout the development and evaluation process. We provide a detailed case example highlighting 3 phases of the early development process that can be used to design an intervention that is engaging and meets end-user needs. In addition, we point to novel applications of UCD to complement new directions in SITB research. Results: In this paper, we offer a 2-pronged approach to meet these challenges. First, in terms of addressing access to effective interventions, digital interventions hold promise to extend the reach of evidence-based treatments outside of brick-and-mortar health care settings. Second, to address challenges related to treatment targets and engagement, we propose involving individuals with lived experience in the design and research process. Conclusions: UCD offers a well-developed and systematic process to center the unique needs, preferences, and perceived barriers of individuals with lived SITB experience in the development and evaluation of digital interventions. UR - https://mental.jmir.org/2021/12/e31367 UR - http://dx.doi.org/10.2196/31367 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951602 ID - info:doi/10.2196/31367 ER - TY - JOUR AU - Wang, Y. Elizabeth AU - Breyer, N. Benjamin AU - Lee, W. Austin AU - Rios, Natalie AU - Oni-Orisan, Akinyemi AU - Steinman, A. Michael AU - Sim, Ida AU - Kenfield, A. Stacey AU - Bauer, R. Scott PY - 2021/12/24 TI - Perceptions of Older Men Using a Mobile Health App to Monitor Lower Urinary Tract Symptoms and Tamsulosin Side Effects: Mixed Methods Study JO - JMIR Hum Factors SP - e30767 VL - 8 IS - 4 KW - BPH KW - mobile health KW - mHealth KW - telehealth KW - telemedicine N2 - Background: Mobile health (mHealth) apps may provide an efficient way for patients with lower urinary tract symptoms (LUTS) to log and communicate symptoms and medication side effects with their clinicians. Objective: The aim of this study was to explore the perceptions of older men with LUTS after using an mHealth app to track their symptoms and tamsulosin side effects. Methods: Structured phone interviews were conducted after a 2-week study piloting the daily use of a mobile app to track the severity of patient-selected LUTS and tamsulosin side effects. Quantitative and qualitative data were considered. Results: All 19 (100%) pilot study participants completed the poststudy interviews. Most of the men (n=13, 68%) reported that the daily questionnaires were the right length, with 32% (n=6) reporting that the questionnaires were too short. Men with more severe symptoms were less likely to report changes in perception of health or changes in self-management; 47% (n=9) of the men reported improved awareness of symptoms and 5% (n=1) adjusted fluid intake based on the questionnaire. All of the men were willing to share app data with their clinicians. Thematic analysis of qualitative data yielded eight themes: (1) orientation (setting up app, format, symptom selection, and side-effect selection), (2) triggers (routine or habit and symptom timing), (3) daily questionnaire (reporting symptoms, reporting side effects, and tailoring), (4) technology literacy, (5) perceptions (awareness, causation or relevance, data quality, convenience, usefulness, and other apps), (6) self-management, (7) clinician engagement (communication and efficiency), and (8) improvement (reference materials, flexibility, language, management recommendations, and optimize clinician engagement). Conclusions: We assessed the perceptions of men using an mHealth app to monitor and improve management of LUTS and medication side effects. LUTS management may be further optimized by tailoring the mobile app experience to meet patients? individual needs, such as tracking a greater number of symptoms and integrating the app with clinicians? visits. mHealth apps are likely a scalable modality to monitor symptoms and improve care of older men with LUTS. Further study is required to determine the best ways to tailor the mobile app and to communicate data to clinicians or incorporate data into the electronical medical record meaningfully. UR - https://humanfactors.jmir.org/2021/4/e30767 UR - http://dx.doi.org/10.2196/30767 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951599 ID - info:doi/10.2196/30767 ER - TY - JOUR AU - Yu, Yi-Fang AU - Wu, Huei-Jiuan AU - Ku, Wen-Wei Stephane AU - Huang, Po-Hsien AU - Li, Chia-Wen AU - Huang, Poyao AU - Strong, Carol PY - 2021/12/23 TI - Condomless Anal Sex Associated With Heterogeneous Profiles Of HIV Pre-Exposure Prophylaxis Use and Sexual Activities Among Men Who Have Sex With Men: A Latent Class Analysis Using Sex Diary Data on a Mobile App JO - J Med Internet Res SP - e33877 VL - 23 IS - 12 KW - mobile apps KW - pre-exposure prophylaxis KW - PrEP KW - latent class analysis KW - men who have sex with men KW - MSM KW - condom KW - sex diaries KW - adherence KW - app KW - sex KW - diary KW - sexual health KW - HIV KW - Taiwan KW - risk KW - prevention N2 - Background: New innovative technologies, such as mobile apps, have been developed to increase pre-exposure prophylaxis (PrEP) adherence and the use of log sex diaries. The contiguity of mobile apps reduces the recall bias that generally affects reported condom and PrEP use. However, none of the currently used mobile apps were designed for event-driven PrEP users, and few studies have demonstrated the potential usage of sex diary data to facilitate the understanding of the different HIV risks among heterogeneous profiles of sex diaries and PrEP use. Objective: We aim to discriminate the heterogeneous profiles of sex events and PrEP use and examine the risk of condomless anal sex among different types of sex events. Methods: We recruited 35 adult men who have sex with men from two medical centers in Taiwan since May 2020 and followed up for four months. Participants were on PrEP or willing to take PrEP. They were asked to log their sex events, PrEP use, and dosing regimens on a mobile app to improve their PrEP adherence. Latent class analysis was used to distinguish profiles of sex events and PrEP use. Indicators included correct intake of PrEP for each sex event, participants? sexual positioning, partner?s HIV status, and age. Results: A total of 551 sex events were classified into three classes by latent class analysis: PrEP nonadherent flip-flopping (234/551, 42%), PrEP imperfect-adherent power bottoming (284/551, 52%), and PrEP adherent serodiscordant topping (33/551, 6%). ?PrEP nonadherent flip-flopping? sex events were more likely to involve condomless anal sex than ?PrEP imperfect-adherent power bottoming? (OR 1.83, 95% CI 1.03-3.25) after considering random intercepts for individuals, and this class needed to increase their PrEP adherence and use of condoms. ?PrEP imperfect-adherent power bottoming? realized their own risk and packaged PrEP with condoms to protect themselves. Up to 99% (32/33) of sex events in ?PrEP adherent serodiscordant topping? were protected by PrEP, but all of the sex events in this group were condomless. Conclusions: Using the sex diary data could advance the capacity to identify high-risk groups. HIV prevention strategy should be more flexible and combine PrEP with condom use for future HIV prevention. UR - https://www.jmir.org/2021/12/e33877 UR - http://dx.doi.org/10.2196/33877 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941560 ID - info:doi/10.2196/33877 ER - TY - JOUR AU - Wang, Yang AU - Wu, Tailai AU - Chen, Zhuo PY - 2021/12/22 TI - Active Usage of Mobile Health Applications: Cross-sectional Study JO - J Med Internet Res SP - e25330 VL - 23 IS - 12 KW - active usage KW - mobile health KW - 3-factor theory KW - consumer satisfaction KW - consumer dissatisfaction KW - medical informatics N2 - Background: Mobile health applications are being increasingly used for people?s health management. The different uses of mobile health applications lead to different health outcomes. Although active usage of mobile health applications is shown to be linked to the effectiveness of mobile health services, the factors that influence people?s active usage of mobile health applications are not well studied. Objective: This paper aims to examine the antecedents of active usage of mobile health applications. Methods: Grounded on the 3-factor theory, we proposed 10 attributes of mobile health applications that influence the active usage of mobile health applications through consumers? satisfaction and dissatisfaction. We classified these 10 attributes into 3 categories (ie, excitement attributes, performance attributes, and basic attributes). Using the survey method, 494 valid responses were collected and analyzed using structural equation modeling. Results: Our analysis results revealed that both consumer satisfaction (?=0.351, t=6.299, P<.001) and dissatisfaction (?=?0.251, t=5.119, P<.001) significantly influenced active usage. With regard to the effect of attributes, excitement attributes (?=0.525, t=12.861, P<.001) and performance attributes (?=0.297, t=6.508, P<.001) positively influenced consumer satisfaction, while performance attributes (?=?0.231, t=3.729, P<.001) and basic attributes (?=?0.412, t=7.132, P<.001) negatively influenced consumer dissatisfaction. The results of the analysis confirmed our proposed hypotheses. Conclusions: Our study provides a novel perspective to study the active usage of mobile health applications. By categorizing the attributes of mobile health applications into 3 categories, the differential effects of different attributes can be tested. Meanwhile, consumer satisfaction and dissatisfaction are confirmed to be independent from each other. UR - https://www.jmir.org/2021/12/e25330 UR - http://dx.doi.org/10.2196/25330 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941545 ID - info:doi/10.2196/25330 ER - TY - JOUR AU - Acharya, Amish AU - Judah, Gaby AU - Ashrafian, Hutan AU - Sounderajah, Viknesh AU - Johnstone-Waddell, Nick AU - Stevenson, Anne AU - Darzi, Ara PY - 2021/12/22 TI - Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study JO - JMIR Res Protoc SP - e32660 VL - 10 IS - 12 KW - mobile messaging KW - digital communication KW - population screening KW - SMS KW - implementation N2 - Background: The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. Objective: The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England. Methods: This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public?s perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work. Results: The Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field. Conclusions: The use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area. International Registered Report Identifier (IRRID): PRR1-10.2196/32660 UR - https://www.researchprotocols.org/2021/12/e32660 UR - http://dx.doi.org/10.2196/32660 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941542 ID - info:doi/10.2196/32660 ER - TY - JOUR AU - Peyroteo, Mariana AU - Ferreira, Augusto Inês AU - Elvas, Brito Luís AU - Ferreira, Carlos João AU - Lapão, Velez Luís PY - 2021/12/21 TI - Remote Monitoring Systems for Patients With Chronic Diseases in Primary Health Care: Systematic Review JO - JMIR Mhealth Uhealth SP - e28285 VL - 9 IS - 12 KW - sensors KW - wearables KW - remote monitoring KW - digital health KW - primary health care KW - chronic diseases N2 - Background: The digital age, with digital sensors, the Internet of Things (IoT), and big data tools, has opened new opportunities for improving the delivery of health care services, with remote monitoring systems playing a crucial role and improving access to patients. The versatility of these systems has been demonstrated during the current COVID-19 pandemic. Health remote monitoring systems (HRMS) present various advantages such as the reduction in patient load at hospitals and health centers. Patients that would most benefit from HRMS are those with chronic diseases, older adults, and patients that experience less severe symptoms recovering from SARS-CoV-2 viral infection. Objective: This paper aimed to perform a systematic review of the literature of HRMS in primary health care (PHC) settings, identifying the current status of the digitalization of health processes, remote data acquisition, and interactions between health care personnel and patients. Methods: A systematic literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify articles that explored interventions with HRMS in patients with chronic diseases in the PHC setting. Results: The literature review yielded 123 publications, 18 of which met the predefined inclusion criteria. The selected articles highlighted that sensors and wearables are already being used in multiple scenarios related to chronic disease management at the PHC level. The studies focused mostly on patients with diabetes (9/26, 35%) and cardiovascular diseases (7/26, 27%). During the evaluation of the implementation of these interventions, the major difficulty that stood out was the integration of information into already existing systems in the PHC infrastructure and in changing working processes of PHC professionals (83%). Conclusions: The PHC context integrates multidisciplinary teams and patients with often complex, chronic pathologies. Despite the theoretical framework, objective identification of problems, and involvement of stakeholders in the design and implementation processes, these interventions mostly fail to scale up. Despite the inherent limitations of conducting a systematic literature review, the small number of studies in the PHC context is a relevant limitation. This study aimed to demonstrate the importance of matching technological development to the working PHC processes in interventions regarding the use of sensors and wearables for remote monitoring as a source of information for chronic disease management, so that information with clinical value is not lost along the way. UR - https://mhealth.jmir.org/2021/12/e28285 UR - http://dx.doi.org/10.2196/28285 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932000 ID - info:doi/10.2196/28285 ER - TY - JOUR AU - O'Campo, Patricia AU - Velonis, Alisa AU - Buhariwala, Pearl AU - Kamalanathan, Janisha AU - Hassan, Awaiz Maha AU - Metheny, Nicholas PY - 2021/12/21 TI - Design and Development of a Suite of Intimate Partner Violence Screening and Safety Planning Web Apps: User-Centered Approach JO - J Med Internet Res SP - e24114 VL - 23 IS - 12 KW - intimate partner violence KW - web-based applications KW - women KW - user-centered design N2 - Background: The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. Objective: The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users. Methods: A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions. Results: This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions. Conclusions: Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions. UR - https://www.jmir.org/2021/12/e24114 UR - http://dx.doi.org/10.2196/24114 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931998 ID - info:doi/10.2196/24114 ER - TY - JOUR AU - White, M. Katie AU - Matcham, Faith AU - Leightley, Daniel AU - Carr, Ewan AU - Conde, Pauline AU - Dawe-Lane, Erin AU - Ranjan, Yatharth AU - Simblett, Sara AU - Henderson, Claire AU - Hotopf, Matthew PY - 2021/12/21 TI - Exploring the Effects of In-App Components on Engagement With a Symptom-Tracking Platform Among Participants With Major Depressive Disorder (RADAR-Engage): Protocol for a 2-Armed Randomized Controlled Trial JO - JMIR Res Protoc SP - e32653 VL - 10 IS - 12 KW - app KW - engagement KW - major depressive disorder KW - remote measurement technologies KW - research KW - mobile phone N2 - Background: Multi-parametric remote measurement technologies (RMTs) comprise smartphone apps and wearable devices for both active and passive symptom tracking. They hold potential for understanding current depression status and predicting future depression status. However, the promise of using RMTs for relapse prediction is heavily dependent on user engagement, which is defined as both a behavioral and experiential construct. A better understanding of how to promote engagement in RMT research through various in-app components will aid in providing scalable solutions for future remote research, higher quality results, and applications for implementation in clinical practice. Objective: The aim of this study is to provide the rationale and protocol for a 2-armed randomized controlled trial to investigate the effect of insightful notifications, progress visualization, and researcher contact details on behavioral and experiential engagement with a multi-parametric mobile health data collection platform, Remote Assessment of Disease and Relapse (RADAR)?base. Methods: We aim to recruit 140 participants upon completion of their participation in the RADAR Major Depressive Disorder study in the London site. Data will be collected using 3 weekly tasks through an active smartphone app, a passive (background) data collection app, and a Fitbit device. Participants will be randomly allocated at a 1:1 ratio to receive either an adapted version of the active app that incorporates insightful notifications, progress visualization, and access to researcher contact details or the active app as usual. Statistical tests will be used to assess the hypotheses that participants using the adapted app will complete a higher percentage of weekly tasks (behavioral engagement: primary outcome) and score higher on self-awareness measures (experiential engagement). Results: Recruitment commenced in April 2021. Data collection was completed in September 2021. The results of this study will be communicated via publication in 2022. Conclusions: This study aims to understand how best to promote engagement with RMTs in depression research. The findings will help determine the most effective techniques for implementation in both future rounds of the RADAR Major Depressive Disorder study and, in the long term, clinical practice. Trial Registration: ClinicalTrials.gov NCT04972474; http://clinicaltrials.gov/ct2/show/NCT04972474 International Registered Report Identifier (IRRID): DERR1-10.2196/32653 UR - https://www.researchprotocols.org/2021/12/e32653 UR - http://dx.doi.org/10.2196/32653 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932005 ID - info:doi/10.2196/32653 ER - TY - JOUR AU - Grout, Leah AU - Telfer, Kendra AU - Wilson, Nick AU - Cleghorn, Christine AU - Mizdrak, Anja PY - 2021/12/20 TI - Prescribing Smartphone Apps for Physical Activity Promotion in Primary Care: Modeling Study of Health Gain and Cost Savings JO - J Med Internet Res SP - e31702 VL - 23 IS - 12 KW - physical activity KW - smartphone apps KW - mobile health KW - mHealth KW - modeling KW - primary care KW - mobile phone N2 - Background: Inadequate physical activity is a substantial cause of health loss worldwide, and this loss is attributable to diseases such as coronary heart disease, diabetes, stroke, and certain forms of cancer. Objective: This study aims to assess the potential impact of the prescription of smartphone apps in primary care settings on physical activity levels, health gains (in quality-adjusted life years [QALYs]), and health system costs in New Zealand (NZ). Methods: A proportional multistate lifetable model was used to estimate the change in physical activity levels and predict the resultant health gains in QALYs and health system costs over the remaining life span of the NZ population alive in 2011 at a 3% discount rate. Results: The modeled intervention resulted in an estimated 430 QALYs gained (95% uncertainty interval 320-550), with net cost savings of 2011 NZ $2.2 million (2011 US $1.5 million) over the remaining life span of the 2011 NZ population. On a per capita basis, QALY gains were generally larger in women than in men and larger in M?ori than in non-M?ori. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions on intervention uptake and decay. For example, the scenario analysis with the largest benefits, which assumed a 5-year maintenance of additional physical activity levels, delivered 1750 QALYs and 2011 NZ $22.5 million (2011 US $15.1 million) in cost savings. Conclusions: The prescription of smartphone apps for promoting physical activity in primary care settings is likely to generate modest health gains and cost savings at the population level in this high-income country. Such gains may increase with ongoing improvements in app design and increased health worker promotion of the apps to patients. UR - https://www.jmir.org/2021/12/e31702 UR - http://dx.doi.org/10.2196/31702 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931993 ID - info:doi/10.2196/31702 ER - TY - JOUR AU - van Wier, F. Marieke AU - Urry, Emily AU - Lissenberg-Witte, I. Birgit AU - Kramer, E. Sophia PY - 2021/12/20 TI - A Comparison of the Use of Smart Devices, Apps, and Social Media Between Adults With and Without Hearing Impairment: Cross-sectional Web-Based Study JO - J Med Internet Res SP - e27599 VL - 23 IS - 12 KW - hearing impairment KW - social media use KW - app use KW - benefits from social media KW - eHealth KW - mobile phone N2 - Background: eHealth and social media could be of particular benefit to adults with hearing impairment, but it is unknown whether their use of smart devices, apps, and social media is similar to that of the general population. Objective: Our aim is to study whether adults with normal hearing and those with impaired hearing differ in their weekly use of smart devices, apps, and social media; reasons for using social media; and benefits from using social media. Methods: We used data from a Dutch cohort, the National Longitudinal Study on Hearing. Data were collected from September 2016 to April 2020 using a web-based questionnaire and speech-in-noise test. The results from this test were used to categorize normal hearing and hearing impairment. Outcomes were compared using (multiple) logistic regression models. Results: Adults with impaired hearing (n=384) did not differ from normal hearing adults (n=341) in their use of a smartphone or tablet. They were less likely to make use of social media apps on a smartphone, tablet, or smartwatch (age-adjusted odds ratio [OR] 0.67, 95% CI 0.48-0.92; P=.02). Use of social media on all devices and use of other apps did not differ. Adults with hearing impairment were more likely to agree with using social media to stay in touch with family members (OR 1.54, 95% CI 1.16-2.07; P=.003) and friends (age-adjusted OR 1.35, 95% CI 1.01-1.81; P=.046). Furthermore, they were more likely to agree with using social media to perform their work (age-adjusted OR 1.51, 95% CI 1.04-2.18; P=.03). There were no differences in the experienced benefits from social media. Conclusions: The potential for eHealth is confirmed because adults with hearing impairment are not less likely to use smart devices than their normal hearing peers. Adults with hearing impairment are less likely to use social media apps on a smart device but not less likely to use social media on all types of internet-connected devices. This warrants further research on the types of social media platforms that adults with hearing impairment use and on the type of device on which they prefer to use social media. Given that participants with hearing impairment are more likely than their normal hearing peers to use social media to perform their work, use of social media may be seen as an opportunity to enhance vocational rehabilitation services for persons with hearing impairment. UR - https://www.jmir.org/2021/12/e27599 UR - http://dx.doi.org/10.2196/27599 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932013 ID - info:doi/10.2196/27599 ER - TY - JOUR AU - Choemprayong, Songphan AU - Charoenlap, Chris AU - Piromsopa, Krerk PY - 2021/12/20 TI - Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study JO - JMIR Hum Factors SP - e31130 VL - 8 IS - 4 KW - teleconsultation KW - remote consultation KW - mobile applications KW - usability KW - orthopedics KW - physician-to-physician consultation KW - electronic medical records KW - mobile phone N2 - Background: Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. Objective: This study aimed to explore usability issues emerging from users? interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. Methods: Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semistructured interviews were conducted after each task and prior to the exit. Quantitative and qualitative measures were used to identify usability issues in 7 domains based on the People At the Centre of Mobile Application Development model: effectiveness, efficiency, satisfaction, learnability, memorability, error, and cognitive load. Results: Several measures indicate various aspects of usability of the app, including completion rates, time to completion, number of clicks, number of screens, errors, incidents where participants were unable to perform tasks, which had previously been completed, and perceived task difficulty. Major and critical usability issues based on participant feedback were rooted from the limitation of screen size and resolution. Errors in data input (eg, typing errors, miscalculation), action failures, and misinterpretation of data (ie, radiography) were the most critical and common issues found in this study. A few participants did not complete the assigned tasks mostly owing to the navigation design and misreading/misunderstanding icons. However, the novice users were quite positive that they would be able to become familiar with the app in a short period of time. Conclusions: The usability issues in physician-to-physician teleconsultation systems in smartphones, in general, are derived from the limitations of smartphones and their operating systems. Although some recommendations were devised to handle these usability issues, usability evaluation for additional development should still be further investigated. UR - https://humanfactors.jmir.org/2021/4/e31130 UR - http://dx.doi.org/10.2196/31130 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931991 ID - info:doi/10.2196/31130 ER - TY - JOUR AU - Cooray, Nipuna AU - Sun, Louise Si AU - Ho, Catherine AU - Adams, Susan AU - Keay, Lisa AU - Nassar, Natasha AU - Brown, Julie PY - 2021/12/20 TI - Toward a Behavior Theory?Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study JO - JMIR Pediatr Parent SP - e29731 VL - 4 IS - 4 KW - child injury KW - Behaviour Change Wheel KW - mobile app KW - mobile phone N2 - Background: Falls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory?informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. Objective: This study aims to develop a behavior theory? and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Methods: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. Results: The target behaviors identified in phase 1 were adequate rest for the newborn?s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. Conclusions: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory?informed mobile intervention for injury prevention refined using the person-based approach. UR - https://pediatrics.jmir.org/2021/4/e29731 UR - http://dx.doi.org/10.2196/29731 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932004 ID - info:doi/10.2196/29731 ER - TY - JOUR AU - Chu, Wai Joanna Ting AU - Wadham, Angela AU - Jiang, Yannan AU - Stasiak, Karolina AU - Shepherd, Matthew AU - Bullen, Christopher PY - 2021/12/20 TI - Recruitment and Retention of Parents of Adolescents in a Text Messaging Trial (MyTeen): Secondary Analysis From a Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e17723 VL - 4 IS - 4 KW - parenting KW - mHealth KW - text messaging KW - recruitment N2 - Background: Parenting programs are well established as an effective strategy for enhancing both parenting skills and the well-being of the child. However, recruitment for family programs in clinical and nonclinical settings remains low. Objective: This study aims to describe the recruitment and retention methods used in a text messaging program (MyTeen) trial for parents of adolescents (10-15 years) and identify key lessons learned. We aim to provide insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials. Methods: A recruitment plan was developed, monitored, and modified as needed throughout the course of the project. Strategies to facilitate recruitment were identified (eg, program content and recruitment material, staff characteristics, and study procedures). Traditional and web-based recruitment strategies were used. Results: Over a 5-month period, 319 parents or caregivers expressed interest in our study, of which 221 agreed to participate in the study, exceeding our recruitment target of 214 participants. Attrition was low at the 1-month (4.5% overall; intervention group: n=5, 4.6%; control group: n=5, 4.5%) and 3-month follow-ups (9% overall; intervention group: n=10, 9.2%; control group: n=10, 8.9%). Conclusions: The use of web-based recruitment strategies appeared to be most effective for recruiting and retaining parents in a text-messaging program trial. However, we encountered recruitment challenges (ie, underrepresentation of ethnic minority groups and fathers) similar to those reported in the literature. Therefore, efforts to engage ethnic minorities and fathers are needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000117213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374307 UR - https://pediatrics.jmir.org/2021/4/e17723 UR - http://dx.doi.org/10.2196/17723 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932007 ID - info:doi/10.2196/17723 ER - TY - JOUR AU - Szinay, Dorothy AU - Perski, Olga AU - Jones, Andy AU - Chadborn, Tim AU - Brown, Jamie AU - Naughton, Felix PY - 2021/12/16 TI - Perceptions of Factors Influencing Engagement With Health and Well-being Apps in the United Kingdom: Qualitative Interview Study JO - JMIR Mhealth Uhealth SP - e29098 VL - 9 IS - 12 KW - behavior change KW - health apps KW - mHealth KW - smartphone app KW - framework analysis KW - COM-B KW - TDF KW - user engagement KW - motivation KW - usability KW - engagement KW - mobile phone N2 - Background: Digital health devices, such as health and well-being smartphone apps, could offer an accessible and cost-effective way to deliver health and well-being interventions. A key component of the effectiveness of health and well-being apps is user engagement. However, engagement with health and well-being apps is typically poor. Previous studies have identified a list of factors that could influence engagement; however, most of these studies were conducted on a particular population or for an app targeting a particular behavior. An understanding of the factors that influence engagement with a wide range of health and well-being apps can inform the design and the development of more engaging apps in general. Objective: The aim of this study is to explore user experiences of and reasons for engaging and not engaging with a wide range of health and well-being apps. Methods: A sample of adults in the United Kingdom (N=17) interested in using a health or well-being app participated in a semistructured interview to explore experiences of engaging and not engaging with these apps. Participants were recruited via social media platforms. Data were analyzed with the framework approach, informed by the Capability, Opportunity, Motivation?Behaviour (COM-B) model and the Theoretical Domains Framework, which are 2 widely used frameworks that incorporate a comprehensive set of behavioral influences. Results: Factors that influence the capability of participants included available user guidance, statistical and health information, reduced cognitive load, well-designed reminders, self-monitoring features, features that help establish a routine, features that offer a safety net, and stepping-stone app characteristics. Tailoring, peer support, and embedded professional support were identified as important factors that enhance user opportunities for engagement with health and well-being apps. Feedback, rewards, encouragement, goal setting, action planning, self-confidence, and commitment were judged to be the motivation factors that affect engagement with health and well-being apps. Conclusions: Multiple factors were identified across all components of the COM-B model that may be valuable for the development of more engaging health and well-being apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load, support self-monitoring (capability), provide embedded social support (opportunity), and provide goal setting with action planning (motivation). This research provides recommendations for policy makers, industry, health care providers, and app developers for increasing effective engagement. UR - https://mhealth.jmir.org/2021/12/e29098 UR - http://dx.doi.org/10.2196/29098 UR - http://www.ncbi.nlm.nih.gov/pubmed/34927597 ID - info:doi/10.2196/29098 ER - TY - JOUR AU - Biersteker, Tom AU - Hilt, Alexander AU - van der Velde, Enno AU - Schalij, Jan Martin AU - Treskes, Willem Roderick PY - 2021/12/16 TI - Real-World Experience of mHealth Implementation in Clinical Practice (the Box): Design and Usability Study JO - JMIR Cardio SP - e26072 VL - 5 IS - 2 KW - eHealth KW - mHealth KW - remote patient monitoring KW - cardiology KW - patient satisfaction KW - patient empowerment KW - mobile phone N2 - Background: Mobile health (mHealth) is an emerging field of scientific interest worldwide. Potential benefits include increased patient engagement, improved clinical outcomes, and reduced health care costs. However, mHealth is often studied in projects or trials, and structural implantation in clinical practice is less common. Objective: The purpose of this paper is to outline the design of the Box and its implementation and use in an outpatient clinic setting. The impact on logistical outcomes and patient and provider satisfaction is discussed. Methods: In 2016, an mHealth care track including smartphone-compatible devices, named the Box, was implemented in the cardiology department of a tertiary medical center in the Netherlands. Patients with myocardial infarction, rhythm disorders, cardiac surgery, heart failure, and congenital heart disease received devices to measure daily weight, blood pressure, heart rate, temperature, and oxygen saturation. In addition, professional and patient user comments on the experience with the care track were obtained via structured interviews. Results: From 2016 to April 2020, a total of 1140 patients were connected to the mHealth care track. On average, a Box cost ?350 (US $375), not including extra staff costs. The median patient age was 60.8 (IQR 52.9-69.3) years, and 73.59% (839/1140) were male. A median of 260 (IQR 105-641) measurements was taken on a median of 189 (IQR 98-372) days. Patients praised the ease of use of the devices and felt more involved with their illness and care. Professionals reported more productive outpatient consultations as well as improved insight into health parameters such as blood pressure and weight. A feedback loop from the hospital to patient to focus on measurements was commented as an important improvement by both patients and professionals. Conclusions: In this study, the design and implementation of an mHealth care track for outpatient follow-up of patients with various cardiovascular diseases is described. Data from these 4 years indicate that mHealth is feasible to incorporate in outpatient management and is generally well-accepted by patients and providers. Limitations include the need for manual measurement data checks and the risk of data overload. Moreover, the tertiary care setting in which the Box was introduced may limit the external validity of logistical and financial end points to other medical centers. More evidence is needed to show the effects of mHealth on clinical outcomes and on cost-effectiveness. UR - https://cardio.jmir.org/2021/2/e26072 UR - http://dx.doi.org/10.2196/26072 UR - http://www.ncbi.nlm.nih.gov/pubmed/34642159 ID - info:doi/10.2196/26072 ER - TY - JOUR AU - Whitton, Clare AU - Healy, D. Janelle AU - Collins, E. Clare AU - Mullan, Barbara AU - Rollo, E. Megan AU - Dhaliwal, S. Satvinder AU - Norman, Richard AU - Boushey, J. Carol AU - Delp, J. Edward AU - Zhu, Fengqing AU - McCaffrey, A. Tracy AU - Kirkpatrick, I. Sharon AU - Atyeo, Paul AU - Mukhtar, Aqif Syed AU - Wright, L. Janine AU - Ramos-García, César AU - Pollard, M. Christina AU - Kerr, A. Deborah PY - 2021/12/16 TI - Accuracy and Cost-effectiveness of Technology-Assisted Dietary Assessment Comparing the Automated Self-administered Dietary Assessment Tool, Intake24, and an Image-Assisted Mobile Food Record 24-Hour Recall Relative to Observed Intake: Protocol for a Randomized Crossover Feeding Study JO - JMIR Res Protoc SP - e32891 VL - 10 IS - 12 KW - 24-hour recall KW - Automated Self-Administered Dietary Assessment Tool KW - Intake24 KW - mobile food record KW - image-assisted dietary assessment KW - validation KW - controlled feeding KW - accuracy KW - dietary measurement error KW - self-report KW - energy intake KW - adult KW - cost-effectiveness KW - acceptability KW - mobile technology KW - diet surveys KW - mobile phone N2 - Background: The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however, they need to be evaluated to inform large-scale use. Objective: The aim of this study is to compare the accuracy, acceptability, and cost-effectiveness of 3 technology-assisted 24-hour dietary recall (24HR) methods relative to observed intake across 3 meals. Methods: Using a controlled feeding study design, 24HR data collected using 3 methods will be obtained for comparison with observed intake. A total of 150 healthy adults, aged 18 to 70 years, will be recruited and will complete web-based demographic and psychosocial questionnaires and cognitive tests. Participants will attend a university study center on 3 separate days to consume breakfast, lunch, and dinner, with unobtrusive documentation of the foods and beverages consumed and their amounts. Following each feeding day, participants will complete a 24HR process using 1 of 3 methods: the Automated Self-Administered Dietary Assessment Tool, Intake24, or the Image-Assisted mobile Food Record 24-Hour Recall. The sequence of the 3 methods will be randomized, with each participant exposed to each method approximately 1 week apart. Acceptability and the preferred 24HR method will be assessed using a questionnaire. Estimates of energy, nutrient, and food group intake and portion sizes from each 24HR method will be compared with the observed intake for each day. Linear mixed models will be used, with 24HR method and method order as fixed effects, to assess differences in the 24HR methods. Reporting bias will be assessed by examining the ratios of reported 24HR intake to observed intake. Food and beverage omission and intrusion rates will be calculated, and differences by 24HR method will be assessed using chi-square tests. Psychosocial, demographic, and cognitive factors associated with energy misestimation will be evaluated using chi-square tests and multivariable logistic regression. The financial costs, time costs, and cost-effectiveness of each 24HR method will be assessed and compared using repeated measures analysis of variance tests. Results: Participant recruitment commenced in March 2021 and is planned to be completed by the end of 2021. Conclusions: This protocol outlines the methodology of a study that will evaluate the accuracy, acceptability, and cost-effectiveness of 3 technology-enabled dietary assessment methods. This will inform the selection of dietary assessment methods in future studies on nutrition surveillance and epidemiology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000209897; https://tinyurl.com/2p9fpf2s International Registered Report Identifier (IRRID): DERR1-10.2196/32891 UR - https://www.researchprotocols.org/2021/12/e32891 UR - http://dx.doi.org/10.2196/32891 UR - http://www.ncbi.nlm.nih.gov/pubmed/34924357 ID - info:doi/10.2196/32891 ER - TY - JOUR AU - Doyle, Julie AU - Murphy, Emma AU - Gavin, Shane AU - Pascale, Alessandra AU - Deparis, Stéphane AU - Tommasi, Pierpaolo AU - Smith, Suzanne AU - Hannigan, Caoimhe AU - Sillevis Smitt, Myriam AU - van Leeuwen, Cora AU - Lastra, Julia AU - Galvin, Mary AU - McAleer, Patricia AU - Tompkins, Lorraine AU - Jacobs, An AU - M Marques, Marta AU - Medina Maestro, Jaime AU - Boyle, Gordon AU - Dinsmore, John PY - 2021/12/15 TI - A Digital Platform to Support Self-management of Multiple Chronic Conditions (ProACT): Findings in Relation to Engagement During a One-Year Proof-of-Concept Trial JO - J Med Internet Res SP - e22672 VL - 23 IS - 12 KW - digital health KW - aging KW - multimorbidity KW - chronic disease KW - self-management KW - integrated care KW - longitudinal study KW - engagement KW - usability KW - mobile phone N2 - Background: Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, offer a promising solution to help people monitor their conditions and lifestyle, maintain good health, and reduce unscheduled clinical visits. However, despite high prevalence rates of multimorbidity or multiple chronic conditions, most platforms tend to focus on a single disease. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement. Objective: The objectives of this study are to design and develop a digital health platform, ProACT, for facilitating older adults self-managing multimorbidity, with support from their care network, and evaluate end user engagement and experiences with this platform through a 12-month trial. Methods: The ProACT digital health platform is presented in this paper. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement. Semistructured interviews were conducted with participants and analyzed using inductive thematic analysis, whereas usability and user burden were examined using validated questionnaires. Results: This paper presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who participated, 24 (20%) withdrew before the end of the study, whereas 3 (2.5%) died. The remaining 93 participants actively used the platform until the end of the trial, on average, taking 2 or 3 health readings daily over the course of the trial in Ireland and Belgium, respectively. The participants reported ProACT to be usable and of low burden. Findings from interviews revealed that participants experienced multiple benefits as a result of using ProACT, including improved self-management, health, and well-being and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected. Conclusions: This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multimorbidity. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for these results include a strong focus on user-centered design and engagement throughout the project lifecycle, resulting in a platform that meets user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. International Registered Report Identifier (IRRID): RR2-10.2196/22125 UR - https://www.jmir.org/2021/12/e22672 UR - http://dx.doi.org/10.2196/22672 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914612 ID - info:doi/10.2196/22672 ER - TY - JOUR AU - Dinsmore, John AU - Hannigan, Caoimhe AU - Smith, Suzanne AU - Murphy, Emma AU - Kuiper, L. Janneke M. AU - O'Byrne, Emma AU - Galvin, Mary AU - Jacobs, An AU - Sillevis Smitt, Myriam AU - van Leeuwen, Cora AU - McAleer, Patricia AU - Tompkins, Lorraine AU - Brady, Anne-Marie AU - McCarron, Mary AU - Doyle, Julie PY - 2021/12/15 TI - A Digital Health Platform for Integrated and Proactive Patient-Centered Multimorbidity Self-management and Care (ProACT): Protocol for an Action Research Proof-of-Concept Trial JO - JMIR Res Protoc SP - e22125 VL - 10 IS - 12 KW - multimorbidity KW - digital health KW - chronic disease KW - self-management KW - older adults KW - integrated care KW - behaviour change KW - mobile phone KW - smart phone KW - smart device N2 - Background: Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practices around the provision of well-coordinated, person-centered care for persons with multimorbidities. Present health systems across the European Union (EU) focus on supporting a single-disease framework of care; the primary challenge is to create a patient-centric, integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale project funded by the European Commission under the Horizon 2020 programme, that involved the design, development, and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged ?65 years) living with multimorbidity. Objective: This paper describes the trial implementation protocol of a proof-of-concept digital health platform (ProACT) in 2 EU member states (Ireland and Belgium) to support older persons with multimorbidities self-managing at home, supported by their care network (CN). Methods: Research was conducted across 2 EU member states, Ireland and Belgium. A 12-month action research trial design, divided into 3 evaluation cycles and lasting 3 months each, with a reflective redesign and development phase of 1 month after cycles 1 and 2 was conducted. Participants were 120 (60/120, 50% in Ireland and 60/120, 50% in Belgium) older persons with multimorbidities diagnosed with two or more of the following chronic conditions: diabetes, chronic obstructive pulmonary disease, chronic heart failure, and cardiovascular diseases. With permission from persons with multimorbidities, members of their CN were invited to participate in the study. Persons with multimorbidities were provided with ProACT technologies (tablet, devices, or sensors) to support them in self-managing their conditions. CN members also received access to an app to remotely support their persons with multimorbidity. Qualitative and quantitative feedback and evaluation data from persons with multimorbidity and CN participants were collected across four time points: baseline (T1), at the end of each 3-month action research cycle (T2 and T3), and in a final posttrial interview (T4). Thematic analysis was used to analyze the qualitative interview data. Quantitative data were analyzed via platform use statistics (to assess engagement) and standardized questionnaires (using descriptive and inferential statistics). This study is approved by the ethics committees of Ireland and Belgium. Results: The trial implementation phase for this 44-month (2016-2019) funded study was April 2018 to June 2019. The trial outcomes are at various stages of publication since 2021. Conclusions: ProACT aims to co-design and develop a digital intervention with persons with multimorbidities and their CN, incorporating clinical guidelines with the state of the art in human-computer interaction, behavioral science, health psychology, and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive, integrated model of supported person-centered care. International Registered Report Identifier (IRRID): RR1-10.2196/22125 UR - https://www.researchprotocols.org/2021/12/e22125 UR - http://dx.doi.org/10.2196/22125 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914613 ID - info:doi/10.2196/22125 ER - TY - JOUR AU - Markossian, W. Talar AU - Boyda, Jason AU - Taylor, Jennifer AU - Etingen, Bella AU - Modave, François AU - Price, Ron AU - Kramer, J. Holly PY - 2021/12/15 TI - A Mobile App to Support Self-management of Chronic Kidney Disease: Development Study JO - JMIR Hum Factors SP - e29197 VL - 8 IS - 4 KW - chronic kidney disease KW - mobile app KW - self-management KW - mHealth KW - mobile apps KW - digital health KW - kidney disease KW - smartphone N2 - Background: Chronic kidney disease (CKD) is a common and costly condition that is usually accompanied by multiple comorbidities including type 2 diabetes, hypertension, and obesity. Proper management of CKD can delay or prevent kidney failure and help mitigate cardiovascular disease risk, which increases as kidney function declines. Smart device apps hold potential to enhance patient self-management of chronic conditions including CKD. Objective: The objective of this study was to develop a mobile app to facilitate self-management of nondialysis-dependent CKD. Methods: Our stakeholder team included 4 patients with stage 3-4 nondialysis-dependent CKD; a kidney transplant recipient; a caretaker; CKD care providers (pharmacists, a nurse, primary care physicians, a nephrologist, and a cardiologist); 2 health services and CKD researchers; a researcher in biomedical informatics, nutrition, and obesity; a system developer; and 2 programmers. Focus groups and in-person interviews with the patients and providers were conducted using a focus group and interview guide based on existing literature on CKD self-management and the mobile app quality criteria from the Mobile App Rating Scale. Qualitative analytic methods including the constant comparative method were used to analyze the focus group and interview data. Results: Patients and providers identified and discussed a list of requirements and preferences regarding the content, features, and technical aspects of the mobile app, which are unique for CKD self-management. Requirements and preferences centered along themes of communication between patients and caregivers, partnership in care, self-care activities, adherence to treatment regimens, and self-care self-efficacy. These identified themes informed the features and content of our mobile app. The mobile app user can enter health data including blood pressure, weight, and blood glucose levels. Symptoms and their severity can also be entered, and users are prompted to contact a physician as indicated by the symptom and its severity. Next, mobile app users can select biweekly goals from a set of predetermined goals with the option to enter customized goals. The user can also keep a list of medications and track medication use. Our app includes feedback mechanisms where in-range values for health data are depicted in green and out-of-range values are depicted in red. We ensured that data entered by patients could be downloaded into a user-friendly report, which could be emailed or uploaded to an electronic health record. The mobile app also includes a mechanism that allows either group or individualized video chat meetings with a provider to facilitate either group support, education, or even virtual clinic visits. The CKD app also includes educational material on CKD and its symptoms. Conclusions: Patients with CKD and CKD care providers believe that a mobile app can enhance CKD self-management by facilitating patient-provider communication and enabling self-care activities including treatment adherence. UR - https://humanfactors.jmir.org/2021/4/e29197 UR - http://dx.doi.org/10.2196/29197 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914614 ID - info:doi/10.2196/29197 ER - TY - JOUR AU - Were, Chieng Martin AU - Savai, Simon AU - Mokaya, Benard AU - Mbugua, Samuel AU - Ribeka, Nyoman AU - Cholli, Preetam AU - Yeung, Ada PY - 2021/12/14 TI - mUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale JO - J Med Internet Res SP - e26381 VL - 23 IS - 12 KW - mobile health KW - electronic medical records KW - developing countries KW - digital divide KW - digital health KW - global health N2 - Background: The predominant implementation paradigm of electronic health record (EHR) systems in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. Mobile health (mHealth) technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHR systems that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHR systems are needed to improve access, improve quality of care, and ameliorate the digital divide. Objective: We report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHR system in LMICs (OpenMRS). Methods: The ?Guidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA)? checklist was employed to report on the mUzima application. The World Health Organization (WHO) Principles for Digital Development framework was used as a secondary reference framework. Details of mUzima?s architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems. Results: mUzima is an open-source, highly configurable Android application with robust features including offline management, deduplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geolocate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO?s Principles of Digital Development, and its scaled implementation success has led to its recognition as a digital global public good and its listing in the WHO Digital Health Atlas. Conclusions: Greater emphasis should be placed on mHealth applications that robustly extend reach of EHR systems within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. The mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains. UR - https://www.jmir.org/2021/12/e26381 UR - http://dx.doi.org/10.2196/26381 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904952 ID - info:doi/10.2196/26381 ER - TY - JOUR AU - Sajnani, Jocelyn AU - Swan, Kimberly AU - Wolff, Sharon AU - Drummond, Kelsi PY - 2021/12/14 TI - Discharge Instruction Reminders Via Text Messages After Benign Gynecologic Surgery: Quasi-Experimental Feasibility Study JO - JMIR Perioper Med SP - e22681 VL - 4 IS - 2 KW - communication KW - hysterectomy KW - minimally invasive KW - laparoscopy KW - postoperative KW - patient satisfaction N2 - Background: With the implementation of enhanced recovery after surgery protocols and same-day hospital discharge, patients are required to take on increasing responsibility for their postoperative care. Various approaches to patient information delivery have been investigated and have demonstrated improvement in patient retention of instructions and patient satisfaction. Objective:  This study aimed to evaluate the feasibility of implementing a postoperative text messaging service in the benign gynecologic population. Methods:  We used a quasi-experimental study design to evaluate patients undergoing outpatient laparoscopic surgery for benign disease with a minimally invasive gynecologist at an academic medical center between October 2017 and March 2018. In addition to routine postoperative instructions, 19 text messages were designed to provide education and support to postoperative gynecologic patients. Patients were contacted by telephone 3 weeks postoperatively and surveyed about their satisfaction and feelings of connectedness during their recovery experience. Demographic and operative information was gathered through chart review. The cost to implement text messages was US $2.85 per patient. Results:  A total of 185 patients were eligible to be included in this study. Of the 100 intended intervention participants, 20 failed to receive text messages, leaving an 80% success in text delivery. No patients opted out of messaging. A total of 28 patients did not participate in the postrecovery survey, leaving 137 patients with outcome data (control, n=75; texting, n=62). Satisfaction, determined by a score ?9 on a 10-point scale, was 74% (46/62) in the texting group and 63% (47/75) in the control group (P=.15). Connectedness (score ?9) was reported by 64% (40/62) in the texting group compared with 44% (33/75) in the control group (P=.02). Overall, 65% (40/62) of those in the texting group found the texts valuable (score ?9). Conclusions:  Postoperative text messages increased patients? perceptions of connection with their health care team and may also increase their satisfaction with their recovery process. Errors in message delivery were identified. Given the increasing emphasis on patient experience and cost effectiveness in health care, an adequately powered future study to determine statistically significant differences in patient experience and resource use would be appropriate. UR - https://periop.jmir.org/2021/2/e22681 UR - http://dx.doi.org/10.2196/22681 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904957 ID - info:doi/10.2196/22681 ER - TY - JOUR AU - Meyer, Julien AU - Okuboyejo, Senanu PY - 2021/12/14 TI - User Reviews of Depression App Features: Sentiment Analysis JO - JMIR Form Res SP - e17062 VL - 5 IS - 12 KW - mHealth KW - depression KW - app reviews KW - natural language processing KW - app features KW - emotions KW - use KW - linguistic inquiry word count KW - mobile phone N2 - Background: Mental health in general, and depression in particular, remain undertreated conditions. Mobile health (mHealth) apps offer tremendous potential to overcome the barriers to accessing mental health care and millions of depression apps have been installed and used. However, little is known about the effect of these apps on a potentially vulnerable user population and the emotional reactions that they generate, even though emotions are a key component of mental health. App reviews, spontaneously posted by the users on app stores, offer up-to-date insights into the experiences and emotions of this population and are increasingly decisive in influencing mHealth app adoption. Objective: This study aims to investigate the emotional reactions of depression app users to different app features by systematically analyzing the sentiments expressed in app reviews. Methods: We extracted 3261 user reviews of depression apps. The 61 corresponding apps were categorized by the features they offered (psychoeducation, medical assessment, therapeutic treatment, supportive resources, and entertainment). We then produced word clouds by features and analyzed the reviews using the Linguistic Inquiry Word Count 2015 (Pennebaker Conglomerates, Inc), a lexicon-based natural language analytical tool that analyzes the lexicons used and the valence of a text in 4 dimensions (authenticity, clout, analytic, and tone). We compared the language patterns associated with the different features of the underlying apps. Results: The analysis highlighted significant differences in the sentiments expressed for the different features offered. Psychoeducation apps exhibited more clout but less authenticity (ie, personal disclosure). Medical assessment apps stood out for the strong negative emotions and the relatively negative ratings that they generated. Therapeutic treatment app features generated more positive emotions, even though user feedback tended to be less authentic but more analytical (ie, more factual). Supportive resources (connecting users to physical services and people) and entertainment apps also generated fewer negative emotions and less anxiety. Conclusions: Developers should be careful in selecting the features they offer in their depression apps. Medical assessment features may be riskier as users receive potentially disturbing feedback on their condition and may react with strong negative emotions. In contrast, offering information, contacts, or even games may be safer starting points to engage people with depression at a distance. We highlight the necessity to differentiate how mHealth apps are assessed and vetted based on the features they offer. Methodologically, this study points to novel ways to investigate the impact of mHealth apps and app features on people with mental health issues. mHealth apps exist in a rapidly changing ecosystem that is driven by user satisfaction and adoption decisions. As such, user perceptions are essential and must be monitored to ensure adoption and avoid harm to a fragile population that may not benefit from traditional health care resources. UR - https://formative.jmir.org/2021/12/e17062 UR - http://dx.doi.org/10.2196/17062 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904955 ID - info:doi/10.2196/17062 ER - TY - JOUR AU - Koldeweij, Charlotte AU - Clarke, Jonathan AU - Nijman, Joppe AU - Feather, Calandra AU - de Wildt, N. Saskia AU - Appelbaum, Nicholas PY - 2021/12/13 TI - CE Accreditation and Barriers to CE Marking of Pediatric Drug Calculators for Mobile Devices: Scoping Review and Qualitative Analysis JO - J Med Internet Res SP - e31333 VL - 23 IS - 12 KW - pediatric KW - drug dosage calculator KW - European regulations KW - safety KW - medical devices KW - medical errors KW - app KW - application KW - mobile health KW - pharmacy N2 - Background: Pediatric drug calculators (PDCs) intended for clinical use qualify as medical devices under the Medical Device Directive and the Medical Device Regulation. The extent to which they comply with European standards on quality and safety is unknown. Objective: This study determines the number of PDCs available as mobile apps for use in the Netherlands that bear a CE mark, and explore the factors influencing the CE marking of such devices among app developers. Methods: A scoping review of Google Play Store and Apple App Store was conducted to identify PDCs available for download in the Netherlands. CE accreditation of the sampled apps was determined by consulting the app landing pages on app stores, by screening the United Kingdom Medicines and Healthcare products Regulatory Agency?s online registry of medical devices, and by surveying app developers. The barriers to CE accreditation were also explored through a survey of app developers. Results: Of 632 screened apps, 74 were eligible, including 60 pediatric drug dosage calculators and 14 infusion rate calculators. One app was CE marked. Of the 20 (34%) respondents to the survey, 8 considered their apps not to be medical devices based on their intent of use or functionality. Three developers had not aimed to make their app available for use in Europe. Other barriers that may explain the limited CE accreditation of sampled PDC apps included poor awareness of European regulations among developers and a lack of restrictions when placing PDCs in app stores. Conclusions: The compliance of PDCs with European standards on medical devices is poor. This puts clinicians and their patients at risk of medical errors resulting from the largely unrestricted use of these apps. UR - https://www.jmir.org/2021/12/e31333 UR - http://dx.doi.org/10.2196/31333 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898456 ID - info:doi/10.2196/31333 ER - TY - JOUR AU - Rising, J. Camella AU - Gaysynsky, Anna AU - Blake, D. Kelly AU - Jensen, E. Roxanne AU - Oh, April PY - 2021/12/13 TI - Willingness to Share Data From Wearable Health and Activity Trackers: Analysis of the 2019 Health Information National Trends Survey Data JO - JMIR Mhealth Uhealth SP - e29190 VL - 9 IS - 12 KW - mobile health KW - population health KW - health communication KW - survey methodology KW - mobile apps KW - devices KW - online social networking KW - mobile phone N2 - Background: Sharing data from wearable health and activity trackers (wearables) with others may improve the health and behavioral outcomes of wearable users by generating social support and improving their ability to manage their health. Investigating individual factors that influence US adults? willingness to share wearable data with different types of individuals may provide insights about the population subgroups that are most or least likely to benefit from wearable interventions. Specifically, it is necessary to identify digital health behaviors potentially associated with willingness to share wearable data given that the use of and engagement with various technologies may broadly influence web-based health information?sharing behaviors. Objective: This study aims to identify sociodemographic, health, and digital health behavior correlates of US adults? willingness to share wearable data with health care providers and family or friends. Methods: Data for the analytic sample (N=1300) were obtained from the 2019 Health Information National Trends Survey of the National Cancer Institute. Digital health behavior measures included frequency of wearable device use, use of smartphones or tablets to help communicate with providers, use of social networking sites to share health information, and participation in a web-based health community. Multivariable logistic regression analysis of weighted data examined the associations between digital health behaviors and willingness to share wearable device data, controlling for sociodemographics and health-related characteristics. Results: Most US adults reported willingness to share wearable data with providers (81.86%) and with family or friends (69.51%). Those who reported higher health self-efficacy (odds ratio [OR] 1.97, 95% CI 1.11-3.51), higher level of trust in providers as a source of health information (OR 1.98, 95% CI 1.12-3.49), and higher level of physical activity (OR 2.00, 95% CI 1.21-3.31) had greater odds of willingness to share data with providers. In addition, those with a higher frequency of wearable use (OR 2.15, 95% CI 1.35-3.43) and those who reported use of smartphones or tablets to help communicate with providers (OR 1.99, 95% CI 1.09-3.63) had greater odds of willingness to share data with providers. Only higher level of physical activity was associated with greater odds of willingness to share wearable data with family or friends (OR 1.70, 95% CI 1.02-2.84). Sociodemographic factors were not significantly associated with willingness to share wearable data. Conclusions: The findings of this study suggest that, among US adult wearable users, behavior-related factors, rather than sociodemographic characteristics, are key drivers of willingness to share health information obtained from wearables with others. Moreover, behavioral correlates of willingness to share wearable data are unique to the type of recipient (ie, providers vs family or friends). Future studies could use these findings to inform the development of interventions that aim to improve the use of patient-generated data from wearable devices in health care settings. UR - https://mhealth.jmir.org/2021/12/e29190 UR - http://dx.doi.org/10.2196/29190 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898448 ID - info:doi/10.2196/29190 ER - TY - JOUR AU - Manning, Victoria AU - Piercy, Hugh AU - Garfield, Bernard Joshua Benjamin AU - Clark, Gregory Stuart AU - Andrabi, Noor Mah AU - Lubman, Ian Dan PY - 2021/12/10 TI - A Personalized Approach Bias Modification Smartphone App (?SWiPE?) to Reduce Alcohol Use: Open-Label Feasibility, Acceptability, and Preliminary Effectiveness Study JO - JMIR Mhealth Uhealth SP - e31353 VL - 9 IS - 12 KW - alcohol KW - hazardous alcohol use KW - alcohol use disorder KW - approach bias modification KW - cognitive bias modification KW - smartphone app KW - ehealth KW - mobile phone app KW - mhealth KW - digital health N2 - Background: Approach bias modification (ApBM), a computerized cognitive intervention that trains people to ?avoid? alcohol-related images and ?approach? nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement. Objective: We examined the feasibility, acceptability, and preliminary effectiveness of ?SWiPE,? a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ?8) who wanted to reduce their alcohol use. Methods: In this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training. Results: We recruited 1309 participants (mean age 47.0, SD 10.0 years; 758/1309, 57.9% female; mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9); 31.2% (409/1309) completed ?8 sessions; and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P<.001). Conclusions: The findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking sample of adult Australians drinking at hazardous levels. SWiPE?s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000638932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID): RR2-10.2196/21278 UR - https://mhealth.jmir.org/2021/12/e31353 UR - http://dx.doi.org/10.2196/31353 UR - http://www.ncbi.nlm.nih.gov/pubmed/34890355 ID - info:doi/10.2196/31353 ER - TY - JOUR AU - Goodday, M. Sarah AU - Karlin, Emma AU - Alfarano, Alexandria AU - Brooks, Alexa AU - Chapman, Carol AU - Desille, Rachelle AU - Rangwala, Shazia AU - Karlin, R. Daniel AU - Emami, Hoora AU - Woods, Fugate Nancy AU - Boch, Adrien AU - Foschini, Luca AU - Wildman, Mackenzie AU - Cormack, Francesca AU - Taptiklis, Nick AU - Pratap, Abhishek AU - Ghassemi, Marzyeh AU - Goldenberg, Anna AU - Nagaraj, Sujay AU - Walsh, Elaine AU - AU - Friend, Stephen PY - 2021/12/10 TI - An Alternative to the Light Touch Digital Health Remote Study: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study JO - JMIR Form Res SP - e32165 VL - 5 IS - 12 KW - stress KW - wearable KW - digital health KW - frontline KW - COVID-19 KW - health care worker KW - alternative KW - design KW - app KW - assessment KW - sensor KW - engagement KW - support KW - knowledge N2 - Background: Several app-based studies share similar characteristics of a light touch approach that recruit, enroll, and onboard via a smartphone app and attempt to minimize burden through low-friction active study tasks while emphasizing the collection of passive data with minimal human contact. However, engagement is a common challenge across these studies, reporting low retention and adherence. Objective: This study aims to describe an alternative to a light touch digital health study that involved a participant-centric design including high friction app-based assessments, semicontinuous passive data from wearable sensors, and a digital engagement strategy centered on providing knowledge and support to participants. Methods: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study included US frontline health care workers followed between May and November 2020. The study comprised 3 main components: (1) active and passive assessments of stress and symptoms from a smartphone app, (2) objective measured assessments of acute stress from wearable sensors, and (3) a participant codriven engagement strategy that centered on providing knowledge and support to participants. The daily participant time commitment was an average of 10 to 15 minutes. Retention and adherence are described both quantitatively and qualitatively. Results: A total of 365 participants enrolled and started the study, and 81.0% (n=297) of them completed the study for a total study duration of 4 months. Average wearable sensor use was 90.6% days of total study duration. App-based daily, weekly, and every other week surveys were completed on average 69.18%, 68.37%, and 72.86% of the time, respectively. Conclusions: This study found evidence for the feasibility and acceptability of a participant-centric digital health study approach that involved building trust with participants and providing support through regular phone check-ins. In addition to high retention and adherence, the collection of large volumes of objective measured data alongside contextual self-reported subjective data was able to be collected, which is often missing from light touch digital health studies. Trial Registration: ClinicalTrials.gov NCT04713111; https://clinicaltrials.gov/ct2/show/NCT04713111 UR - https://formative.jmir.org/2021/12/e32165 UR - http://dx.doi.org/10.2196/32165 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726607 ID - info:doi/10.2196/32165 ER - TY - JOUR AU - Reilly, Dawna Erin AU - Robinson, A. Stephanie AU - Petrakis, Ann Beth AU - Gardner, M. Melissa AU - Wiener, Soylemez Renda AU - Castaneda-Sceppa, Carmen AU - Quigley, S. Karen PY - 2021/12/9 TI - Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial JO - JMIR Form Res SP - e29573 VL - 5 IS - 12 KW - cognitive behavioral therapy KW - mobile app KW - physical activity KW - insomnia N2 - Background: Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity (PA), offer affordable and accessible self-management alternatives to in-person CBTI. Objective: This study aims to extend and replicate prior pilot work to examine whether the use of a mobile app for CBTI (cognitive behavioral therapy for insomnia coach app [CBT-i Coach]) improves subjective and objective sleep outcomes. This study also aims to investigate whether the use of the CBT-i Coach app with adjunctive PA improves sleep outcomes more than CBT-i Coach alone. Methods: A total of 33 veterans (mean age 37.61 years, SD 9.35 years) reporting chronic insomnia were randomized to use either the CBT-i Coach app alone or the CBT-i Coach app with a PA intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and posttreatment. Results: Although the PA manipulation was unsuccessful, both groups of veterans using the CBT-i Coach app showed significant improvement from baseline to postintervention on insomnia (P<.001), sleep quality (P<.001), and functional sleep outcomes (P=.002). Improvements in subjective sleep outcomes were similar in those with and without posttraumatic stress disorder and mild-to-moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P=.02). Conclusions: These findings suggest that the use of a mobile app?delivered CBTI is feasible and beneficial for improving sleep outcomes in veterans with insomnia, including those with comorbid conditions such as posttraumatic stress disorder or mild-to-moderate sleep apnea. Trial Registration: ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354 UR - https://formative.jmir.org/2021/12/e29573 UR - http://dx.doi.org/10.2196/29573 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889746 ID - info:doi/10.2196/29573 ER - TY - JOUR AU - MacKinnon, Ross Kinnon AU - Kia, Hannah AU - Lacombe-Duncan, Ashley PY - 2021/12/9 TI - Examining TikTok?s Potential for Community-Engaged Digital Knowledge Mobilization With Equity-Seeking Groups JO - J Med Internet Res SP - e30315 VL - 23 IS - 12 KW - trans KW - nonbinary KW - marginalized communities KW - gender-affirming care KW - digital health KW - community-engaged research KW - knowledge mobilization KW - mobile phone UR - https://www.jmir.org/2021/12/e30315 UR - http://dx.doi.org/10.2196/30315 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889739 ID - info:doi/10.2196/30315 ER - TY - JOUR AU - Schroeder, Kristin AU - Maiarana, James AU - Gisiri, Mwitasrobert AU - Joo, Emma AU - Muiruri, Charles AU - Zullig, Leah AU - Masalu, Nestory AU - Vasudevan, Lavanya PY - 2021/12/8 TI - Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study JO - JMIR Pediatr Parent SP - e27988 VL - 4 IS - 4 KW - mHealth KW - literacy KW - smartphone use KW - developing countries KW - pediatric cancer KW - cancer KW - pediatrics KW - children KW - parents KW - caregivers KW - mobile health KW - smartphone KW - SMS KW - education KW - knowledge transfer KW - communication N2 - Background: There is a 60% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. Objective: The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. Methods: In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. Results: All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98%), receiving laboratory results (n=37, 93%), receiving reminders for upcoming appointments (n=38, 95%), and receiving educational information on cancer (n=35, 88%). Although only 9% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74% (25/34) self-reported they could view and read SMS text messages. Conclusions: To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone?based education and communication strategy suggests that a mobile phone?based intervention, particularly one that utilizes SMS technology, could be feasible in this setting. UR - https://pediatrics.jmir.org/2021/4/e27988 UR - http://dx.doi.org/10.2196/27988 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889763 ID - info:doi/10.2196/27988 ER - TY - JOUR AU - Breland, Y. Jessica AU - Agha, Khizran AU - Mohankumar, Rakshitha PY - 2021/12/8 TI - Adoption and Appropriateness of mHealth for Weight Management in the Real World: A Qualitative Investigation of Patient Perspectives JO - JMIR Form Res SP - e29916 VL - 5 IS - 12 KW - mHealth KW - implementation KW - adoption KW - engagement KW - weight management KW - obesity KW - weight loss KW - mobile health KW - veterans KW - barriers N2 - Background: Mobile health (mHealth) interventions for weight management can result in weight loss outcomes comparable to in-person treatments. However, there is little information on implementing these treatments in real-world settings. Objective: This work aimed to answer two implementation research questions related to mHealth for weight management: (1) what are barriers and facilitators to mHealth adoption (initial use) and engagement (continued use)? and (2) what are patient beliefs about the appropriateness (ie, perceived fit, relevance, or compatibility) of mHealth for weight management? Methods: We conducted semistructured interviews with patients with obesity at a single facility in an integrated health care system (the Veterans Health Administration). All participants had been referred to a new mHealth program, which included access to a live coach. We performed a rapid qualitative analysis of interviews to identify themes related to the adoption of, engagement with, and appropriateness of mHealth for weight management. Results: We interviewed 24 veterans, seven of whom used the mHealth program. Almost all participants were ?45 years of age and two-thirds were White. Rapid analysis identified three themes: (1) coaching both facilitates and prevents mHealth adoption and engagement by promoting accountability but leading to guilt among those not meeting goals; (2) preferences regarding the mode of treatment delivery, usability, and treatment content were barriers to mHealth appropriateness and adoption, including preferences for in-person care and a dislike of self-monitoring; and (3) a single invitation was not sufficient to facilitate adoption of a new mHealth program. Themes were unrelated to participants? age, race, or ethnicity. Conclusions: In a study assessing real-world use of mHealth in a group of middle-aged and older adults, we found that?despite free access to mHealth with a live coach?most did not complete the registration process. Our findings suggest that implementing mHealth for weight management requires more than one information session. Findings also suggest that focusing on the coaching relationship and how users? lives and goals change over time may be an important way to facilitate engagement and improved health. Most participants thought mHealth was appropriate for weight management, with some nevertheless preferring in-person care. Therefore, the best way to guarantee equitable care will be to ensure multiple routes to achieving the same behavioral health goals. Veterans Health Administration patients have the option of using mHealth for weight management, but can also attend group weight management programs or single-session nutrition classes or access fitness facilities. Health care policy does not allow such access for most people in the United States; however, expanded access to behavioral weight management is an important long-term goal to ensure health for all. UR - https://formative.jmir.org/2021/12/e29916 UR - http://dx.doi.org/10.2196/29916 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889761 ID - info:doi/10.2196/29916 ER - TY - JOUR AU - Xu, Yuepei AU - Yue, Ling-Zi AU - Wang, Wei AU - Wu, Xiao-Ju AU - Liang, Zhu-Yuan PY - 2021/12/7 TI - Gender-Specific Impact of Self-Monitoring and Social Norm Information on Walking Behavior Among Chinese College Students Assessed Using WeChat: Longitudinal Tracking Study JO - J Med Internet Res SP - e29167 VL - 23 IS - 12 KW - self-monitoring KW - social norm KW - group identity KW - gender differences KW - mHealth KW - mobile health N2 - Background: Walking is a simple but beneficial form of physical activity (PA). Self-monitoring and providing information about social norms are the 2 most widely used ?mobile health (mHealth)? strategies to promote walking behavior. However, previous studies have failed to discriminate the effect of self-monitoring from the combination of the 2 strategies, and provide practical evidence within Chinese culture. Some essential moderators, such as gender and group identity, were also overlooked. Objective: We aimed to investigate the effectiveness of social norm and self-monitoring interventions for walking behavior and assess the moderating effects of gender and group identity, which could guide optimal mHealth intervention projects in China. Methods: In 2 longitudinal tracking studies (study 1, 22 days; study 2, 31 days), Chinese college students wore trackers for at least 8 hours per day (MASAI 3D Pedometer and Xiaomi Wristband 2) to record their daily step counts in baseline, intervention, and follow-up stages. In each study, participants (study 1: n=117, 54% female, mean age 25.60 years; study 2: n=180, 51% female, mean age 22.60 years) were randomly allocated to 1 of the following 3 groups: a self-monitoring group and 2 social norm intervention groups. In the 2 intervention groups and during the intervention stage, participants received different social norm information regarding group member step rankings corresponding to their grouping type of social norm information. In study 1, participants were grouped by within-group member PA levels (PA consistent vs PA inconsistent), and in study 2, participants were grouped by their received gender-specific social norm information (gender consistent vs gender inconsistent). Piece-wise linear mixed models were used to compare the difference in walking steps between groups. Results: In study 1, for males in the self-monitoring group, walking steps significantly decreased from the baseline stage to the intervention stage (change in slope=?1422.16; P=.02). However, additional social norm information regardless of group consistency kept their walking unchanged. For females, social norm information did not provide any extra benefit beyond self-monitoring. Females exposed to PA-inconsistent social norm information even walked less (slope during the intervention=?122.18; P=.03). In study 2, for males, a similar pattern was observed, with a decrease in walking steps in the self-monitoring group (change in slope=?151.33; P=.08), but there was no decrease in the 2 social norm intervention groups. However, for females, gender-consistent social norm information decreased walking steps (slope during the intervention=?143.68; P=.03). Conclusions: Both gender and group identity moderated the effect of social norm information on walking. Among females, social norm information showed no benefit for walking behavior and may have exerted a backfire effect. Among males, while walking behavior decreased with self-monitoring only, the inclusion of social norm information held the level of walking behavior steady. UR - https://www.jmir.org/2021/12/e29167 UR - http://dx.doi.org/10.2196/29167 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878992 ID - info:doi/10.2196/29167 ER - TY - JOUR AU - Dorsch, P. Michael AU - Farris, B. Karen AU - Rowell, E. Brigid AU - Hummel, L. Scott AU - Koelling, M. Todd PY - 2021/12/7 TI - The Effects of the ManageHF4Life Mobile App on Patients With Chronic Heart Failure: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e26185 VL - 9 IS - 12 KW - mHealth KW - remote monitoring KW - self-management KW - self-care KW - heart failure KW - medical therapy KW - mobile app N2 - Background: The successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. Objective: The aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions. Methods: A single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group (?app group?) used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group (?no-app group?) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions. Results: A total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26% vs no-app group 12/41, 29%; hazard ratio 0.89, 95% CI 0.39-2.02; P=.78) over 12 weeks. Conclusions: The adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study. Trial Registration: ClinicalTrials.gov NCT03149510; https://clinicaltrials.gov/ct2/show/NCT03149510 UR - https://mhealth.jmir.org/2021/12/e26185 UR - http://dx.doi.org/10.2196/26185 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878990 ID - info:doi/10.2196/26185 ER - TY - JOUR AU - Taylor, Salima AU - Korpusik, Mandy AU - Das, Sai AU - Gilhooly, Cheryl AU - Simpson, Ryan AU - Glass, James AU - Roberts, Susan PY - 2021/12/6 TI - Use of Natural Spoken Language With Automated Mapping of Self-reported Food Intake to Food Composition Data for Low-Burden Real-time Dietary Assessment: Method Comparison Study JO - J Med Internet Res SP - e26988 VL - 23 IS - 12 KW - energy intake KW - macronutrient intakes KW - 24-hour recall KW - machine learning KW - convolutional neural networks KW - nutrition KW - diet KW - app KW - natural language processing N2 - Background: Self-monitoring food intake is a cornerstone of national recommendations for health, but existing apps for this purpose are burdensome for users and researchers, which limits use. Objective: We developed and pilot tested a new app (COCO Nutritionist) that combines speech understanding technology with technologies for mapping foods to appropriate food composition codes in national databases, for lower-burden and automated nutritional analysis of self-reported dietary intake. Methods: COCO was compared with the multiple-pass, interviewer-administered 24-hour recall method for assessment of energy intake. COCO was used for 5 consecutive days, and 24-hour dietary recalls were obtained for two of the days. Participants were 35 women and men with a mean age of 28 (range 20-58) years and mean BMI of 24 (range 17-48) kg/m2. Results: There was no significant difference in energy intake between values obtained by COCO and 24-hour recall for days when both methods were used (mean 2092, SD 1044 kcal versus mean 2030, SD 687 kcal, P=.70). There were also no significant differences between the methods for percent of energy from protein, carbohydrate, and fat (P=.27-.89), and no trend in energy intake obtained with COCO over the entire 5-day study period (P=.19). Conclusions: This first demonstration of a dietary assessment method using natural spoken language to map reported foods to food composition codes demonstrates a promising new approach to automate assessments of dietary intake. UR - https://www.jmir.org/2021/12/e26988 UR - http://dx.doi.org/10.2196/26988 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874885 ID - info:doi/10.2196/26988 ER - TY - JOUR AU - Bughin, François AU - Bui, Gaspard AU - Ayoub, Bronia AU - Blervaque, Leo AU - Saey, Didier AU - Avignon, Antoine AU - Brun, Frédéric Jean AU - Molinari, Nicolas AU - Pomies, Pascal AU - Mercier, Jacques AU - Gouzi, Fares AU - Hayot, Maurice PY - 2021/12/6 TI - Impact of a Mobile Telerehabilitation Solution on Metabolic Health Outcomes and Rehabilitation Adherence in Patients With Obesity: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e28242 VL - 9 IS - 12 KW - telerehabilitation KW - mHealth KW - rehabilitation KW - obesity KW - mobile phone N2 - Background: Obesity is a major public health issue. Combining exercise training, nutrition, and therapeutic education in metabolic rehabilitation (MR) is recommended for obesity management. However, evidence from randomized controlled studies is lacking. In addition, MR is associated with poor patient adherence. Mobile health devices improve access to MR components. Objective: The aim of this study is to compare the changes in body composition, anthropometric parameters, exercise capacity, and quality of life (QOL) within 12 weeks of patients in the telerehabilitation (TR) program to those of usual care patients with obesity. Methods: This was a parallel-design randomized controlled study. In total, 50 patients with obesity (BMI>30 kg/m²) were included in a TR group (TRG) or a usual care group (UCG) for 12 weeks. Patients underwent biometric impedance analyses, metabolic exercise tests, actimetry, and QOL and satisfaction questionnaires. The primary outcome was the change in fat mass at 12 weeks from baseline. Secondary outcomes were changes in body weight, metabolic parameters, exercise capacity, QOL, patients? adhesion, and satisfaction. Results: A total of 49 patients completed the study. No significant group × time interaction was found for fat mass (TRG: mean 1.7 kg, SD 2.6 kg; UCG: mean 1.2 kg, SD 2.4 kg; P=.48). Compared with the UCG, TRG patients tended to significantly improve their waist to hip ratios (TRG: ?0.01 kg, SD 0.04; UCG: +0.01 kg, SD 0.06; P=.07) and improved QOL physical impact (TRG: +21.8, SD 43.6; UCG: ?1.2, SD 15.4; P=.005). Significant time effects were observed for body composition, 6-minute walk test distance, exercise metabolism, sedentary time, and QOL. Adherence (95%) and satisfaction in the TRG were good. Conclusions: In adults with obesity, the TR program was not superior to usual care for improving body composition. However, TR was able to deliver full multidisciplinary rehabilitation to patients with obesity and improve some health outcomes. Given the patients? adherence and satisfaction, pragmatic programs should consider mobile health devices to improve access to MR. Further studies are warranted to further establish the benefits that TR has over usual care. Trial Registration: ClinicalTrials.gov NCT03396666; http://clinicaltrials.gov/ct2/show/NCT03396666 UR - https://mhealth.jmir.org/2021/12/e28242 UR - http://dx.doi.org/10.2196/28242 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874887 ID - info:doi/10.2196/28242 ER - TY - JOUR AU - Goldstein, P. Stephanie AU - Zhang, Fengqing AU - Klasnja, Predrag AU - Hoover, Adam AU - Wing, R. Rena AU - Thomas, Graham John PY - 2021/12/6 TI - Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e33568 VL - 10 IS - 12 KW - obesity KW - weight loss KW - dietary adherence KW - just-in-time adaptive intervention KW - microrandomized trial KW - mobile phone N2 - Background: Behavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT. Objective: The aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions. Methods: Adults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment. Results: The recruitment for the microrandomized trial began on April 19, 2021, and is ongoing. Conclusions: This study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss). Trial Registration: ClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585 International Registered Report Identifier (IRRID): DERR1-10.2196/33568 UR - https://www.researchprotocols.org/2021/12/e33568 UR - http://dx.doi.org/10.2196/33568 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874892 ID - info:doi/10.2196/33568 ER - TY - JOUR AU - Marques, M. Marta AU - Matos, Marcela AU - Mattila, Elina AU - Encantado, Jorge AU - Duarte, Cristiana AU - Teixeira, J. Pedro AU - Stubbs, James R. AU - Sniehotta, F. Falko AU - Ermes, Miikka AU - Harjumaa, Marja AU - Leppänen, Juha AU - Välkkynen, Pasi AU - Silva, N. Marlene AU - Ferreira, Cláudia AU - Carvalho, Sérgio AU - Palmeira, Lara AU - Horgan, Graham AU - Heitmann, Lilienthal Berit AU - Evans, H. Elizabeth AU - Palmeira, L. António PY - 2021/12/3 TI - A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study JO - J Med Internet Res SP - e25305 VL - 23 IS - 12 KW - mHealth KW - behavior change techniques KW - weight management KW - motivation KW - self-regulation KW - emotion regulation KW - self-monitoring KW - user testing KW - logic models N2 - Background: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union?s Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ?5% of their body weight in the preceding 12 months before enrollment into the intervention. Objective: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. Methods: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. Results: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. Conclusions: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance. UR - https://www.jmir.org/2021/12/e25305 UR - http://dx.doi.org/10.2196/25305 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870602 ID - info:doi/10.2196/25305 ER - TY - JOUR AU - Vanderloo, M. Leigh AU - Carsley, Sarah AU - Agarwal, Payal AU - Marini, Flavia AU - Dennis, Cindy-Lee AU - Birken, Catherine PY - 2021/12/2 TI - Selecting and Evaluating Mobile Health Apps for the Healthy Life Trajectories Initiative: Development of the eHealth Resource Checklist JO - JMIR Mhealth Uhealth SP - e27533 VL - 9 IS - 12 KW - eHealth resources KW - applications KW - quality assessment KW - preconception health N2 - Background: The ubiquity of smartphones and mobile devices in the general population presents an unprecedented opportunity for preventative health. Not surprisingly, the use of electronic health (eHealth) resources accessed through mobile devices in clinical trials is becoming more prevalent; the selection, screening, and collation of quality eHealth resources is necessary to clinical trials using these technologies. However, the constant creation and turnover of new eHealth resources can make this task difficult. Although syntheses of eHealth resources are becoming more common, their methodological and reporting quality require improvement so as to be more accessible to nonexperts. Further, there continues to be significant variation in quality criteria employed for assessment, with no clear method for developing the included criteria. There is currently no single existing framework that addresses all six dimensions of mobile health app quality identified in Agarwal et al?s recent scoping review (ie, basic descriptions of the design and usage of the resource; technical features and accessibility; health information quality; usability; evidence of impact; and user engagement and behavior change). In instances where highly systematic tactics are not possible (due to time constraints, cost, or lack of expertise), there may be value in adopting practical and pragmatic approaches to helping researchers and clinicians identify and disseminate e-resources. Objective: The study aimed to create a set of guidelines (ie, a checklist) to aid the members of the Healthy Life Trajectories Initiative (HeLTI) Canada trial?a preconception randomized controlled clinical trial to prevent child obesity?to assist their efforts in searching, identifying, screening, and including selected eHealth resources for participant use in the study intervention. Methods: A framework for searching, screening, and selecting eHealth resources was adapted from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist for systematic and scoping reviews to optimize the rigor, clarity, and transparency of the process. Details regarding searching, selecting, extracting, and assessing quality of eHealth resources are described. Results: This study resulted in the systematic development of a checklist consisting of 12 guiding principles, organized in a chronological versus priority sequence to aid researchers in searching, screening, and assessing the quality of various eHealth resources. Conclusions: The eHealth Resource Checklist will assist researchers in navigating the eHealth resource space by providing a mechanism to detail their process of developing inclusion criteria, identifying search location, selecting and reviewing evidence, extracting information, evaluating the quality of the evidence, and synthesizing the extracted evidence. The overarching goal of this checklist is to provide researchers or generalists new to the eHealth field with a tool that balances pragmatism with rigor and that helps standardize the process of searching and critiquing digital material?a particularly important aspect given the recent explosion of and reliance on eHealth resources. Moreover, this checklist may be useful to other researchers and practitioners developing similar health interventions. UR - https://mhealth.jmir.org/2021/12/e27533 UR - http://dx.doi.org/10.2196/27533 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860681 ID - info:doi/10.2196/27533 ER - TY - JOUR AU - Petrenko, McGee Christie Lynn AU - Kautz-Turnbull, Christine Carson AU - Roth, Rose Alicia AU - Parr, Elizabeth Jennifer AU - Tapparello, Cristiano AU - Demir, Utku AU - Olson, Carmichael Heather PY - 2021/12/2 TI - Initial Feasibility of the ?Families Moving Forward Connect? Mobile Health Intervention for Caregivers of Children With Fetal Alcohol Spectrum Disorders: Mixed Method Evaluation Within a Systematic User-Centered Design Approach JO - JMIR Form Res SP - e29687 VL - 5 IS - 12 KW - fetal alcohol spectrum disorders KW - fetal alcohol syndrome KW - intervention KW - mobile health KW - mHealth KW - parenting KW - children KW - prenatal alcohol KW - digital health KW - user-centered design KW - mobile phone N2 - Background: Fetal alcohol spectrum disorders (FASD) are prevalent neurodevelopmental conditions. Significant barriers prevent family access to FASD-informed care. To improve accessibility, a scalable mobile health intervention for caregivers of children with FASD is under development. The app, called Families Moving Forward (FMF) Connect, is derived from the FMF Program, a parenting intervention tailored for FASD. FMF Connect has 5 components: Learning Modules, Family Forum, Library, Notebook, and Dashboard. Objective: This study assesses the feasibility of FMF Connect intervention prototypes. This includes examining app usage data and evaluating user experience to guide further refinements. Methods: Two rounds of beta-testing were conducted as part of a systematic approach to the development and evaluation of FMF Connect: (1) an iOS prototype was tested with 20 caregivers of children (aged 3-17 years) with FASD and 17 providers for the first round (April-May 2019) and (2) iOS and Android prototypes were tested with 25 caregivers and 1 provider for the second round (November-December 2019). After each 6-week trial, focus groups or individual interviews were completed. Usage analytics and thematic analysis were used to address feasibility objectives. Results: Across beta-test trials, 84% (38/45) of caregivers and 94% (17/18) of providers installed the FMF Connect app. Technological issues were tracked in real time with updates to address problems and expand app functionalities. On use days, caregivers averaged 20 minutes using the app; most of the time was spent watching videos in Learning Modules. Caregiver engagement with the Learning Modules varied across 5 usage pattern tiers. Overall, 67% (30/45) of caregivers posted at least once in the Family Forum. Interviews were completed by 26 caregivers and 16 providers. App evaluations generally did not differ according to usage pattern tier or demographic characteristics. Globally, app users were very positive, with 2.5 times more positive- than negative-coded segments across participants. Positive evaluations emphasized the benefits of accessible information and practical utility of the app. Informational and video content were described as especially valuable to caregivers. A number of affective and social benefits of the app were identified, aligning well with the caregivers? stated motivators for app use. Negative evaluations of user experience generally emphasized technical and navigational aspects. Refinements were made on the basis of feedback during the first beta test, which were positively received during the second round. Participants offered many valuable recommendations for continuing app refinement, which is useful in improving user experience. Conclusions: The results demonstrate that the FMF Connect intervention is acceptable and feasible for caregivers raising children with FASD. They will guide subsequent app refinement before large-scale randomized testing. This study used a systematic, user-centered design approach for app development and evaluation. The approach used here may illustrate a model that can broadly inform the development of mobile health and digital parenting interventions. UR - https://formative.jmir.org/2021/12/e29687 UR - http://dx.doi.org/10.2196/29687 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860661 ID - info:doi/10.2196/29687 ER - TY - JOUR AU - Li, Jane AU - Silvera-Tawil, David AU - Varnfield, Marlien AU - Hussain, Sazzad M. AU - Math, Vanitha PY - 2021/12/2 TI - Users? Perceptions Toward mHealth Technologies for Health and Well-being Monitoring in Pregnancy Care: Qualitative Interview Study JO - JMIR Form Res SP - e28628 VL - 5 IS - 12 KW - pregnancy care KW - wearable sensors KW - mobile health KW - acceptance KW - mHealth service KW - design KW - mobile phone N2 - Background: Mobile health (mHealth) technologies, such as wearable sensors, smart health devices, and mobile apps, that are capable of supporting pregnancy care are emerging. Although mHealth could be used to facilitate the tracking of health changes during pregnancy, challenges remain in data collection compliance and technology engagement among pregnant women. Understanding the interests, preferences, and requirements of pregnant women and those of clinicians is needed when designing and introducing mHealth solutions for supporting pregnant women?s monitoring of health and risk factors throughout their pregnancy journey. Objective: This study aims to understand clinicians? and pregnant women?s perceptions on the potential use of mHealth, including factors that may influence their engagement with mHealth technologies and the implications for technology design and implementation. Methods: A qualitative study using semistructured interviews was conducted with 4 pregnant women, 4 postnatal women, and 13 clinicians working in perinatal care. Results: Clinicians perceived the potential benefit of mHealth in supporting different levels of health and well-being monitoring, risk assessment, and care provision in pregnancy care. Most pregnant and postnatal female participants were open to the use of wearables and health monitoring devices and were more likely to use these technologies if they knew that clinicians were monitoring their data. Although it was acknowledged that some pregnancy-related medical conditions are suitable for an mHealth model of remote monitoring, the clinical and technical challenges in the introduction of mHealth for pregnancy care were also identified. Incorporating appropriate health and well-being measures, intelligently detecting any abnormalities, and providing tailored information for pregnant women were the critical aspects, whereas usability and data privacy were among the main concerns of the participants. Moreover, this study highlighted the challenges of engaging pregnant women in longitudinal mHealth monitoring, the additional work required for clinicians to monitor the data, and the need for an evidence-based technical solution. Conclusions: Clinical, technical, and practical factors associated with the use of mHealth to monitor health and well-being in pregnant women need to be considered during the design and feasibility evaluation stages. Technical solutions and appropriate strategies for motivating pregnant women are critical to supporting their long-term data collection compliance and engagement with mHealth technology during pregnancy. UR - https://formative.jmir.org/2021/12/e28628 UR - http://dx.doi.org/10.2196/28628 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860665 ID - info:doi/10.2196/28628 ER - TY - JOUR AU - Counson, Isabelle AU - Bartholomew, Alexandra AU - Crawford, Joanna AU - Petrie, Katherine AU - Basarkod, Geetanjali AU - Moynihan, Victoria AU - Pires, Josie AU - Cohen, Rachel AU - Glozier, Nicholas AU - Harvey, Samuel AU - Sanatkar, Samineh PY - 2021/12/2 TI - Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing JO - JMIR Form Res SP - e26370 VL - 5 IS - 12 KW - digital mental health KW - mHealth apps KW - help-seeking KW - junior physicians KW - co-design KW - user-centered design KW - mobile phone N2 - Background: Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. Objective: This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. Methods: A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were?needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians. Results: Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians? needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. Conclusions: This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale. UR - https://formative.jmir.org/2021/12/e26370 UR - http://dx.doi.org/10.2196/26370 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860662 ID - info:doi/10.2196/26370 ER - TY - JOUR AU - Muro-Culebras, Antonio AU - Escriche-Escuder, Adrian AU - Martin-Martin, Jaime AU - Roldán-Jiménez, Cristina AU - De-Torres, Irene AU - Ruiz-Muñoz, Maria AU - Gonzalez-Sanchez, Manuel AU - Mayoral-Cleries, Fermin AU - Biró, Attila AU - Tang, Wen AU - Nikolova, Borjanka AU - Salvatore, Alfredo AU - Cuesta-Vargas, Ignacio Antonio PY - 2021/12/1 TI - Tools for Evaluating the Content, Efficacy, and Usability of Mobile Health Apps According to the Consensus-Based Standards for the Selection of Health Measurement Instruments: Systematic Review JO - JMIR Mhealth Uhealth SP - e15433 VL - 9 IS - 12 KW - mobile health KW - mHealth KW - eHealth KW - mobile apps KW - assessment KW - rating KW - smartphone KW - questionnaire design KW - mobile phone N2 - Background: There are several mobile health (mHealth) apps in mobile app stores. These apps enter the business-to-customer market with limited controls. Both, apps that users use autonomously and those designed to be recommended by practitioners require an end-user validation to minimize the risk of using apps that are ineffective or harmful. Prior studies have reviewed the most relevant aspects in a tool designed for assessing mHealth app quality, and different options have been developed for this purpose. However, the psychometric properties of the mHealth quality measurement tools, that is, the validity and reliability of the tools for their purpose, also need to be studied. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) initiative has developed tools for selecting the most suitable measurement instrument for health outcomes, and one of the main fields of study was their psychometric properties. Objective: This study aims to address and psychometrically analyze, following the COSMIN guideline, the quality of the tools that are used to measure the quality of mHealth apps. Methods: From February 1, 2019, to December 31, 2019, 2 reviewers searched PubMed and Embase databases, identifying mHealth app quality measurement tools and all the validation studies associated with each of them. For inclusion, the studies had to be meant to validate a tool designed to assess mHealth apps. Studies that used these tools for the assessment of mHealth apps but did not include any psychometric validation were excluded. The measurement tools were analyzed according to the 10 psychometric properties described in the COSMIN guideline. The dimensions and items analyzed in each tool were also analyzed. Results: The initial search showed 3372 articles. Only 10 finally met the inclusion criteria and were chosen for analysis in this review, analyzing 8 measurement tools. Of these tools, 4 validated ?5 psychometric properties defined in the COSMIN guideline. Although some of the tools only measure the usability dimension, other tools provide information such as engagement, esthetics, or functionality. Furthermore, 2 measurement tools, Mobile App Rating Scale and mHealth Apps Usability Questionnaire, have a user version, as well as a professional version. Conclusions: The Health Information Technology Usability Evaluation Scale and the Measurement Scales for Perceived Usefulness and Perceived Ease of Use were the most validated tools, but they were very focused on usability. The Mobile App Rating Scale showed a moderate number of validated psychometric properties, measures a significant number of quality dimensions, and has been validated in a large number of mHealth apps, and its use is widespread. It is suggested that the continuation of the validation of this tool in other psychometric properties could provide an appropriate option for evaluating the quality of mHealth apps. UR - https://mhealth.jmir.org/2021/12/e15433 UR - http://dx.doi.org/10.2196/15433 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855618 ID - info:doi/10.2196/15433 ER - TY - JOUR AU - DeLaughter, L. Kathryn AU - Fix, M. Gemmae AU - McDannold, E. Sarah AU - Pope, Charlene AU - Bokhour, G. Barbara AU - Shimada, L. Stephanie AU - Calloway, Rodney AU - Gordon, S. Howard AU - Long, A. Judith AU - Miano, A. Danielle AU - Cutrona, L. Sarah PY - 2021/12/1 TI - Incorporating African American Veterans? Success Stories for Hypertension Management: Developing a Behavioral Support Texting Protocol JO - JMIR Res Protoc SP - e29423 VL - 10 IS - 12 KW - texting KW - African American KW - hypertension KW - self-management KW - mobile phone N2 - Background: Peer narratives engage listeners through personally relevant content and have been shown to promote lifestyle change and effective self-management among patients with hypertension. Incorporating key quotations from these stories into follow-up text messages is a novel way to continue the conversation, providing reinforcement of health behaviors in the patients? daily lives. Objective: In our previous work, we developed and tested videos in which African American Veterans shared stories of challenges and success strategies related to hypertension self-management. This study aims to describe our process for developing a text-messaging protocol intended for use after viewing videos that incorporate the voices of these Veterans. Methods: We used a multistep process, transforming video-recorded story excerpts from 5 Veterans into 160-character texts. We then integrated these into comprehensive 6-month texting protocols. We began with an iterative review of story transcripts to identify vernacular features and key self-management concepts emphasized by each storyteller. We worked with 2 Veteran consultants who guided our narrative text message development in substantive ways, as we sought to craft culturally sensitive content for texts. Informed by Veteran input on timing and integration, supplementary educational and 2-way interactive assessment text messages were also developed. Results: Within the Veterans Affairs texting system Annie, we programmed five 6-month text-messaging protocols that included cycles of 3 text message types: narrative messages, nonnarrative educational messages, and 2-way interactive messages assessing self-efficacy and behavior related to hypertension self-management. Each protocol corresponds to a single Veteran storyteller, allowing Veterans to choose the story that most resonates with their own life experiences. Conclusions: We crafted a culturally sensitive text-messaging protocol using narrative content referenced in Veteran stories to support effective hypertension self-management. Integrating narrative content into a mobile health texting intervention provides a low-cost way to support longitudinal behavior change. A randomized trial is underway to test its impact on the lifestyle changes and blood pressure of African American Veterans. Trial Registration: ClinicalTrials.gov NCT03970590; https://clinicaltrials.gov/ct2/show/NCT03970590 International Registered Report Identifier (IRRID): DERR1-10.2196/29423 UR - https://www.researchprotocols.org/2021/12/e29423 UR - http://dx.doi.org/10.2196/29423 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855617 ID - info:doi/10.2196/29423 ER - TY - JOUR AU - Gadde, Sindhura Naga AU - Yap, Yi-Lwern Kevin PY - 2021/11/30 TI - Mobile Health Apps That Act as Surgical Preparatory Guides: App Store Search and Quality Evaluation JO - JMIR Perioper Med SP - e27037 VL - 4 IS - 2 KW - mHealth apps KW - surgical apps KW - surgery preparation KW - operating room personnel KW - quality assessment KW - quality evaluation KW - perioperative KW - operative KW - mobile health KW - surgery KW - post-operative N2 - Background: Mobile health (mHealth) apps are becoming increasingly common in surgical practices for training, education, and communication. Factors leading to increased delays, morbidity, and mortality in surgery include inadequate preoperative patient preparation due to a failure to identify patients and procedure details, and missing instruments and equipment required for the procedure. Many apps are available for supporting preoperative, intraoperative, and postoperative care. However, there is a lack of studies that assess the quality of apps that act as surgical preparatory guides. Objective: The aim of this study is to evaluate the quality of apps that act as surgical preparatory guides for operating room personnel through an in-house quality assessment tool. Methods: The quality assessment tool comprises 35 questions categorized into 5 sections: (1) engagement (customization, interactivity, target audience; 19 points), (2) functionality (performance, ease of use, navigation; 12 points), (3) aesthetics (layout, visual appeal; 6 points), (4) information (quality and quantity of information, visual information, credibility; 29 points), and (5) privacy and security (4 points). An app search was conducted in the Australian Apple and Google Play stores using the following keywords: ?surgical apps?, ?surgical preferences?, ?surgeon preferences?, ?operating room?, and ?perioperative procedures?. The overall total scores and scores for each section were reported as medians and IQRs, expressed as raw scores and percentages. Results: A total of 5 unique apps were evaluated on both iOS and Android platforms. The median overall score across all apps was 35/70 (50%; IQR 38.6%-64.3%). ScrubUp (48/70, 69%) and MySurgeon (42/70, 60%) had the highest overall scores, followed by PrefCard (35/70, 50%) and Scrubnote (28/70, 40%). The lowest scoring app was BrainPadd (26/70, 37%). The sections with the highest median scores, in decreasing order, were privacy and security (4/4, 100%; IQR 75%-100%), aesthetics (5/6, 83%; IQR 75%-91.7%), engagement (15/19, 79%; IQR 57.9%-86.8%), functionality (7/12, 58%; IQR 29.2%-75%), and information (5/29, 17%; IQR 15.5%-34.5%). Most apps scored well (4/4, 100%) on privacy and security, except for Scrubnote (2/4, 50%). ScrubUp received a perfect score for aesthetics (6/6, 100%). MySurgeon (17/19, 90%) had the highest engagement score, while ScrubUp and MySurgeon had the highest functionality scores (9/12, 75% each). All apps scored below 50% for the information section, with ScrubUp having the highest score of 13/29 (45%). Conclusions: ScrubUp and MySurgeon had the highest quality scores and can be used as adjuncts to hospital protocols by operating room personnel for their surgical preparation. Developers are encouraged to develop appropriate apps for surgical preparation based on relevant guidelines and standards, as well as the quality evaluation criteria in our tool. Operating room personnel can also use this tool as a guide to select and assess their preferred apps in their practices. UR - https://periop.jmir.org/2021/2/e27037 UR - http://dx.doi.org/10.2196/27037 UR - http://www.ncbi.nlm.nih.gov/pubmed/34851296 ID - info:doi/10.2196/27037 ER - TY - JOUR AU - Chudyk, M. Anna AU - Ragheb, Sandra AU - Kent, David AU - Duhamel, A. Todd AU - Hyra, Carole AU - Dave, G. Mudra AU - Arora, C. Rakesh AU - Schultz, SH Annette PY - 2021/11/30 TI - Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study JO - JMIR Perioper Med SP - e26597 VL - 4 IS - 2 KW - cardiac surgery KW - perioperative care KW - enhanced recovery protocols KW - mobile app KW - smartphone app KW - mHealth KW - development KW - patient and public involvement KW - patient engagement in research N2 - Background: Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective: The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods: Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results: The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions: Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users. UR - https://periop.jmir.org/2021/2/e26597 UR - http://dx.doi.org/10.2196/26597 UR - http://www.ncbi.nlm.nih.gov/pubmed/34851299 ID - info:doi/10.2196/26597 ER - TY - JOUR AU - Mayo-Gamble, L. Tilicia AU - Quasie-Woode, Delores AU - Cunningham-Erves, Jennifer AU - Rollins, Margo AU - Schlundt, David AU - Bonnet, Kemberlee AU - Murry, McBride Velma PY - 2021/11/30 TI - Preferences for Using a Mobile App in Sickle Cell Disease Self-management: Descriptive Qualitative Study JO - JMIR Form Res SP - e28678 VL - 5 IS - 11 KW - sickle cell disease KW - digital technology KW - rural KW - mHealth app KW - patient-centered technology KW - mobile health KW - health outcomes KW - hematology KW - mobile phone N2 - Background: Individuals with sickle cell disease (SCD) and their caregivers may benefit from technology-based resources to improve disease self-management. Objective: This study explores the preferences regarding a mobile health (mHealth) app to facilitate self-management in adults with SCD and their caregivers living in urban and rural communities. Methods: Five community listening sessions were conducted in 2 urban and rural communities among adults with SCD and their caregivers (N=43). Each session comprised 4 to 15 participants. Participants were asked questions on methods of finding information about SCD self-care, satisfaction with current methods for finding SCD management information, support for SCD management, important features for development of an mHealth app, and areas of benefit for using an mHealth app for SCD self-management. An inductive-deductive content analysis approach was implemented to identify the critical themes. Results: Seven critical themes emerged, including the current methods for receiving self-management information, desired information, recommendations for communicating sickle cell self-management information, challenges of disease management, types of support received for disease management, barriers to and facilitators of using an mHealth app, and feature preferences for an mHealth app. In addition, we found that the participants were receptive to using mHealth apps in SCD self-management. Conclusions: This study expands our knowledge on the use of mHealth technology to reduce information access barriers pertaining to SCD. The findings can be used to develop a patient-centered, user-friendly mHealth app to facilitate disease self-management, thus increasing access to resources for families of patients with SCD residing in rural communities. UR - https://formative.jmir.org/2021/11/e28678 UR - http://dx.doi.org/10.2196/28678 UR - http://www.ncbi.nlm.nih.gov/pubmed/34851295 ID - info:doi/10.2196/28678 ER - TY - JOUR AU - Six, G. Stephanie AU - Byrne, A. Kaileigh AU - Tibbett, P. Thomas AU - Pericot-Valverde, Irene PY - 2021/11/29 TI - Examining the Effectiveness of Gamification in Mental Health Apps for Depression: Systematic Review and Meta-analysis JO - JMIR Ment Health SP - e32199 VL - 8 IS - 11 KW - depression KW - reward KW - gamification KW - mental health apps KW - apps N2 - Background: Previous research showed that computerized cognitive behavioral therapy can effectively reduce depressive symptoms. Some mental health apps incorporate gamification into their app design, yet it is unclear whether features differ in their effectiveness to reduce depressive symptoms over and above mental health apps without gamification. Objective: The aim of this study was to determine whether mental health apps with gamification elements differ in their effectiveness to reduce depressive symptoms when compared to those that lack these elements. Methods: A meta-analysis of studies that examined the effect of app-based therapy, including cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness, on depressive symptoms was performed. A total of 5597 articles were identified via five databases. After screening, 38 studies (n=8110 participants) remained for data extraction. From these studies, 50 total comparisons between postintervention mental health app intervention groups and control groups were included in the meta-analysis. Results: A random effects model was performed to examine the effect of mental health apps on depressive symptoms compared to controls. The number of gamification elements within the apps was included as a moderator. Results indicated a small to moderate effect size across all mental health apps in which the mental health app intervention effectively reduced depressive symptoms compared to controls (Hedges g=?0.27, 95% CI ?0.36 to ?0.17; P<.001). The gamification moderator was not a significant predictor of depressive symptoms (?=?0.03, SE=0.03; P=.38), demonstrating no significant difference in effectiveness between mental health apps with and without gamification features. A separate meta-regression also did not show an effect of gamification elements on intervention adherence (?=?1.93, SE=2.28; P=.40). Conclusions: The results show that both mental health apps with and without gamification elements were effective in reducing depressive symptoms. There was no significant difference in the effectiveness of mental health apps with gamification elements on depressive symptoms or adherence. This research has important clinical implications for understanding how gamification elements influence the effectiveness of mental health apps on depressive symptoms. UR - https://mental.jmir.org/2021/11/e32199 UR - http://dx.doi.org/10.2196/32199 UR - http://www.ncbi.nlm.nih.gov/pubmed/34847058 ID - info:doi/10.2196/32199 ER - TY - JOUR AU - Domhardt, Matthias AU - Engler, Sophie AU - Nowak, Hannah AU - Lutsch, Arne AU - Baumel, Amit AU - Baumeister, Harald PY - 2021/11/26 TI - Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review JO - J Med Internet Res SP - e29742 VL - 23 IS - 11 KW - children and adolescents KW - mental disorders KW - mediator KW - mechanisms of change KW - digital health intervention KW - psychotherapy KW - mobile phone N2 - Background: Digital health interventions (DHIs) are efficacious for several mental disorders in youth; however, integrated, evidence-based knowledge about the mechanisms of change in these interventions is lacking. Objective: This systematic review aims to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents. Methods: A systematic literature search of the electronic databases Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and PsycINFO was conducted, complemented by backward and forward searches. Two independent reviewers selected studies for inclusion, extracted the data, and rated the methodological quality of eligible studies (ie, risk of bias and 8 quality criteria for process research). Results: A total of 25 studies that have evaluated 39 potential mediators were included in this review. Cognitive mediators were the largest group of examined intervening variables, followed by a broad range of emotional and affective, interpersonal, parenting behavior, and other mediators. The mediator categories with the highest percentages of significant intervening variables were the groups of affective mediators (4/4, 100%) and combined cognitive mediators (13/19, 68%). Although more than three-quarters of the eligible studies met 5 or more quality criteria, causal conclusions have been widely precluded. Conclusions: The findings of this review might guide the empirically informed advancement of DHIs, contributing to improved intervention outcomes, and the discussion of methodological recommendations for process research might facilitate mediation studies with more pertinent designs, allowing for conclusions with higher causal certainty in the future. UR - https://www.jmir.org/2021/11/e29742 UR - http://dx.doi.org/10.2196/29742 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842543 ID - info:doi/10.2196/29742 ER - TY - JOUR AU - Saad, Anthony AU - Bruno, Deanna AU - Camara, Bettina AU - D?Agostino, Josephine AU - Bolea-Alamanac, Blanca PY - 2021/11/26 TI - Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review JO - JMIR Ment Health SP - e27404 VL - 8 IS - 11 KW - digital therapeutics KW - self-directed KW - mental health KW - telehealth KW - technology KW - mobile applications KW - telemedicine KW - internet KW - mobile phone N2 - Background: Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in mental health. Although many technologies are currently being implemented, research supporting their usability, efficacy, and risk requires further examination, especially for those interventions that can be used without support. Objective: This review aims to identify the evidence-based, self-directed, technology-based methods of care that can be used in adult patients after they are discharged from mental health services. The interventions reviewed are automated with no human input required (either at the patient?s or at the technology?s end), so the patients can implement them without any support. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines in 3 databases: PubMed, Web of Science, and OVID. The inclusion criteria were self-directed, automated, and technology-based interventions related to mental health, primarily for adults, having a solid evaluation process. The interventions had to be self-directed, in that the participants could use the technology without any external guidance. Results: We identified 36 papers that met the inclusion criteria: 26 randomized controlled trials, 9 nonrandomized controlled trial quantitative studies, and 1 qualitative study. The technologies used included websites, automated text messaging, phone apps, videos, computer software, and integrated voice response. There were 22 studies focused on internet-based cognitive behavioral therapies as a therapeutic paradigm compared with the waitlist, web-based human-delivered therapy, and other interventions. Among these studies, 14 used paradigms other than the internet-based cognitive behavioral therapy. Of the 8 studies comparing guided and unguided digital care, 3 showed no differences, 3 favored guided interventions, and 2 favored unguided interventions. The research also showed that dropout rates were as high as 80%, citing potential problems with the acceptability of the suggested technologies. Conclusions: There is limited research on the efficacy and suitability of self-directed technology-based care options for mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. However, these interventions may need to be developed collaboratively with the users to encourage their acceptability and to avoid high dropout rates. UR - https://mental.jmir.org/2021/11/e27404 UR - http://dx.doi.org/10.2196/27404 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842556 ID - info:doi/10.2196/27404 ER - TY - JOUR AU - Hopkins, M. Christina AU - Miller, N. Hailey AU - Brooks, L. Taylor AU - Mo-Hunter, Lihua AU - Steinberg, M. Dori AU - Bennett, G. Gary PY - 2021/11/25 TI - Designing Ruby: Protocol for a 2-Arm, Brief, Digital Randomized Controlled Trial for Internalized Weight Bias JO - JMIR Res Protoc SP - e31307 VL - 10 IS - 11 KW - obesity KW - stigma KW - mHealth KW - mindfulness KW - self-compassion KW - mobile phone N2 - Background: Weight bias internalization, also known as weight self-stigma, is a serious health concern for individuals with higher body weight. Weight bias internalization is associated with the greater avoidance of health care and health-promoting activities, disordered eating, social isolation, and weight gain. Elevated weight bias internalization has been associated with low self-compassion, yet few investigations have explored self-compassion as a potential mechanism for reducing internalized weight bias. Objective: Ruby is a 2-arm randomized controlled trial that was designed to test the efficacy of a 4-week digital self-compassion intervention to reduce internalized weight bias compared with a wait-list control. Methods: Adults with elevated internalized weight bias and a BMI of >30 kg/m2 (N=80) were recruited. Ruby is a standalone digital trial that will be delivered entirely via a smartphone and will involve web-based data collection and text messages. The intervention content will include psychoeducation and daily mindfulness practices with a focus on self-compassion and body concerns. We will use intent-to-treat analyses to examine changes in weight bias internalization throughout time by treatment arm. The analyses will be conducted by using one-way analysis of covariance models and linear mixed models. Results: The protocol was designed in May 2020 and approved in December 2020. Data collection is currently underway. Conclusions: Ruby will be the first digital standalone, self-compassion?based intervention designed to reduce internalized weight bias. Owing to its standalone digital delivery, Ruby may be a highly scalable treatment for internalized weight bias that can be delivered on its own or combined with other treatments. We expect Ruby to be accessible to many, as participants can access the digital intervention at times of the day that are the most convenient in their schedule and are not burdened by in-person time commitments, which can be a barrier for participants with competing demands on their time and resources. If efficacious, Ruby will be poised to expand a burgeoning body of literature related to psychological intervention in this area. Trial Registration: ClinicalTrials.gov NCT04678973; https://clinicaltrials.gov/ct2/show/NCT04678973 International Registered Report Identifier (IRRID): DERR1-10.2196/31307 UR - https://www.researchprotocols.org/2021/11/e31307 UR - http://dx.doi.org/10.2196/31307 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842549 ID - info:doi/10.2196/31307 ER - TY - JOUR AU - Artanian, Veronica AU - Ware, Patrick AU - Rac, E. Valeria AU - Ross, J. Heather AU - Seto, Emily PY - 2021/11/25 TI - Experiences and Perceptions of Patients and Providers Participating in Remote Titration of Heart Failure Medication Facilitated by Telemonitoring: Qualitative Study JO - JMIR Cardio SP - e28259 VL - 5 IS - 2 KW - telemonitoring KW - remote KW - titration KW - monitoring KW - mHealth KW - heart failure KW - qualitative KW - mobile phone N2 - Background: Guideline-directed medical therapy (GDMT), optimized to target doses, improves health outcomes in patients with heart failure. However, GDMT remains underused, with <25% of patients receiving target doses in clinical practice. A randomized controlled trial was conducted at the Peter Munk Cardiac Centre in Toronto to compare a remote GDMT titration intervention with standard in-office titration. This randomized controlled trial found that remote titration increased the proportion of patients who achieved optimal GDMT doses, decreased the time to dose optimization, and reduced the number of essential clinic visits. This paper presents findings from the qualitative component of the mixed methods study, which evaluated the implementation of the remote titration intervention. Objective: The objective of the qualitative component is to assess the perceptions and experiences of clinicians and patients with heart failure who participated in the remote titration intervention to identify factors that affected the implementation of the intervention. Methods: We conducted semistructured interviews with clinicians (n=5) and patients (n=11) who participated in the remote titration intervention. Questions probed the experiences of the participants to identify factors that can serve as barriers and facilitators to its implementation. Conventional content analysis was first used to analyze the interviews and gain direct information based on the participants? unique perspectives. Subsequently, the generated themes were delineated and mapped following a multilevel framework. Results: Patients and clinicians indicated that the intervention was easy to use, integrated well into their routines, and removed practical barriers to titration. Key implementation facilitators from the patients? perspective included the reduction in clinic visits and daily monitoring of their condition, whereas clinicians emphasized the benefits of rapid drug titration and efficient patient management. Key implementation barriers included the resources necessary to support the intervention and lack of physician remuneration. Conclusions: This study presents results from a real-world implementation assessment of remote titration facilitated by telemonitoring. It is among the first to provide insight into the perception of the remote titration process by clinicians and patients. Our findings indicate that the relative advantages that remote titration presents over standard care strongly appeal to both clinicians and patients. However, to ensure uptake and adherence, it is important to ensure that suitable patients are enrolled and the impact on the physicians? workload is minimized. The implementation of remote titration is now more critical than ever, as it can help provide access to care for patients during times when physical distancing is required. Trial Registration: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID): RR2-10.2196/19705 UR - https://cardio.jmir.org/2021/2/e28259 UR - http://dx.doi.org/10.2196/28259 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842546 ID - info:doi/10.2196/28259 ER - TY - JOUR AU - Zhang, Zhan AU - Kmoth, Lukas AU - Luo, Xiao AU - He, Zhe PY - 2021/11/25 TI - User-Centered System Design for Communicating Clinical Laboratory Test Results: Design and Evaluation Study JO - JMIR Hum Factors SP - e26017 VL - 8 IS - 4 KW - clinical laboratory results KW - patient-centered care KW - patient portal KW - health communication N2 - Background: Personal clinical data, such as laboratory test results, are increasingly being made available to patients via patient portals. However, laboratory test results are presented in a way that is difficult for patients to interpret and use. Furthermore, the indications of laboratory test results may vary among patients with different characteristics and from different medical contexts. To date, little is known about how to design patient-centered technology to facilitate the interpretation of laboratory test results. Objective: The aim of this study is to explore design considerations for supporting patient-centered communication and comprehension of laboratory test results, as well as discussions between patients and health care providers. Methods: We conducted a user-centered, multicomponent design research consisting of user studies, an iterative prototype design, and pilot user evaluations, to explore design concepts and considerations that are useful for supporting patients in not only viewing but also interpreting and acting upon laboratory test results. Results: The user study results informed the iterative design of a system prototype, which had several interactive features: using graphical representations and clear takeaway messages to convey the concerning nature of the results; enabling users to annotate laboratory test reports; clarifying medical jargon using nontechnical verbiage and allowing users to interact with the medical terms (eg, saving, favoriting, or sorting); and providing pertinent and reliable information to help patients comprehend test results within their medical context. The results of a pilot user evaluation with 8 patients showed that the new patient-facing system was perceived as useful in not only presenting laboratory test results to patients in a meaningful way but also facilitating in situ patient-provider interactions. Conclusions: We draw on our findings to discuss design implications for supporting patient-centered communication of laboratory test results and how to make technology support informative, trustworthy, and empathetic. UR - https://humanfactors.jmir.org/2021/4/e26017 UR - http://dx.doi.org/10.2196/26017 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842529 ID - info:doi/10.2196/26017 ER - TY - JOUR AU - Shewchuk, Brittany AU - Green, A. Lee AU - Barber, Tanya AU - Miller, Jean AU - Teare, Sylvia AU - Campbell-Scherer, Denise AU - Mrklas, J. Kelly AU - Li, C. Linda AU - Marlett, Nancy AU - Wasylak, Tracy AU - Lopatina, Elena AU - McCaughey, Deirdre AU - Marshall, A. Deborah PY - 2021/11/25 TI - Patients? Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study JO - JMIR Form Res SP - e30495 VL - 5 IS - 11 KW - mobile health KW - mHealth KW - app KW - self-management KW - osteoarthritis N2 - Background: In a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA). Objective: This study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs). Methods: Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ?20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients? perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype. Results: Interviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (rs) calculations revealed that the follow-up PAM scores were weakly correlated (rs=?0.32) with the number of goals achieved and the number (rs=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability. Conclusions: This evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality. UR - https://formative.jmir.org/2021/11/e30495 UR - http://dx.doi.org/10.2196/30495 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842526 ID - info:doi/10.2196/30495 ER - TY - JOUR AU - Atukunda, Cathyln Esther AU - Matthews, T. Lynn AU - Musiimenta, Angella AU - Mugyenyi, Rwambuka Godfrey AU - Mugisha, Samuel AU - Ware, C. Norma AU - Obua, Celestino AU - Siedner, J. Mark PY - 2021/11/25 TI - mHealth-Based Health Promotion Intervention to Improve Use of Maternity Care Services Among Women in Rural Southwestern Uganda: Iterative Development Study JO - JMIR Form Res SP - e29214 VL - 5 IS - 11 KW - mHealth app KW - app development KW - messaging KW - health education KW - health promotion KW - mobile phone N2 - Background: Antenatal care (ANC) prevents perinatal morbidity and mortality, but use of these services in Uganda remains low and maternal mortality rates are among the highest in the world. There is growing evidence that mobile health (mHealth) approaches improve timely communication of health-related information and produce positive health behavior change as well as health outcomes. However, there are limited data to guide development of such interventions in settings where ANC attendance and uptake of skilled maternity care are low. Objective: The aim of this study is to develop a novel patient-centered mHealth intervention to encourage and support women to use maternity care services in Mbarara district, southwestern Uganda. Methods: Using an iterative development approach, we conducted formative stakeholder interviews with 30 women and 5 health care providers (HCPs) to identify preferred key ANC topics and characterize the preferred messaging intervention; developed content for SMS text messaging and audio messaging with the help of 4 medical experts based on the identified topics; designed an app prototype through partnership with an mHealth development company; and pilot-tested the prototype and sought user experiences and feedback to refine the intervention through 3 sets of iterative interviews, a focus group discussion, and 5 cognitive interviews. Qualitative data were coded and analyzed using NVivo (version 12.0; QSR International). Results: Of the 75 women who completed interviews during the development of the prototype, 39 (52%) had at least a primary education and 75 (100%) had access to a mobile phone. The formative interviews identified 20 preferred perinatal health topics, ranging from native medicine use to comorbid disorders and danger signs during pregnancy. In all, 6 additional topics were identified by the interviewed HCPs, including birth preparedness, skilled delivery, male partner?s involvement, HCP interaction, immunization, and caring for the baby. Positive audio messaging and SMS text messaging content without authoritative tones was developed as characterized by the interviewed women. The postpilot iterative interviews and focus group discussion revealed a preference for customized messaging, reflecting an individual need to be included and connected. The women preferred short, concise, clear actionable messages that guided, supported, and motivated them to keep alert and seek professional help. Complementary weekly reminders to the women?s significant others were also preferred to encourage continuity or prompt the needed social support for care seeking. Conclusions: We used an iterative approach with diffuse stakeholders to develop a patient-centered audio messaging and SMS text messaging app designed to communicate important targeted health-related information and support rural pregnant women in southwestern Uganda. Involving both HCPs and end users in developing and formulating the mHealth intervention allowed us to tailor the intervention characteristics to the women?s preferences. Future work will address the feasibility, acceptability, and effectiveness of this design approach. UR - https://formative.jmir.org/2021/11/e29214 UR - http://dx.doi.org/10.2196/29214 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842541 ID - info:doi/10.2196/29214 ER - TY - JOUR AU - Beckers, B. Abraham AU - Snijkers, W. Johanna T. AU - Weerts, M. Zsa Zsa R. AU - Vork, Lisa AU - Klaassen, Tim AU - Smeets, M. Fabienne G. AU - Masclee, M. Ad A. AU - Keszthelyi, Daniel PY - 2021/11/24 TI - Digital Instruments for Reporting of Gastrointestinal Symptoms in Clinical Trials: Comparison of End-of-Day Diaries Versus the Experience Sampling Method JO - JMIR Form Res SP - e31678 VL - 5 IS - 11 KW - irritable bowel syndrome KW - functional dyspepsia KW - digital diary KW - experience sampling method KW - smartphone app KW - mobile phone application KW - mHealth KW - eHealth KW - compliance KW - patient-reported outcome measures N2 - Background: Questionnaires are necessary tools for assessing symptoms of disorders of the brain-gut interaction in clinical trials. We previously reported on the excellent adherence to a smartphone app used as symptom diary in a randomized clinical trial on irritable bowel syndrome (IBS). Other sampling methods, such as the experience sampling method (ESM), are better equipped to measure symptom variability over time and provide useful information regarding possible symptom triggers, and they are free of ecological and recall bias. The high frequency of measurements, however, could limit the feasibility of ESM in clinical trials. Objective: This study aimed to compare the adherence rates of a smartphone-based end-of-day diary and ESM for symptom assessment in IBS and functional dyspepsia (FD). Methods: Data from 4 separate studies were included. Patients with IBS participated in a randomized controlled trial, which involved a smartphone end-of-day diary for a 2+8-week (pretreatment + treatment) period, and an observational study in which patients completed ESM assessments using a smartphone app for 1 week. Patients with FD participated in a randomized controlled trial, which involved a smartphone end-of-day diary for a 2+12-week (pretreatment + treatment) period, and an observational study in which patients completed ESM assessments using a smartphone app for 1 week. Adherence rates were compared between these 2 symptom sampling methods. Results: In total, 25 patients with IBS and 15 patients with FD were included. Overall adherence rates for the end-of-day diaries were significantly higher than those for ESM (IBS: 92.7% vs 69.8%, FD: 90.1% vs 61.4%, respectively). Conclusions: This study demonstrates excellent adherence rates for smartphone app?based end-of-day diaries as used in 2 separate clinical trials. Overall adherence rates for ESM were significantly lower, rendering it more suitable for intermittent sampling periods rather than continuous sampling during longer clinical trials. UR - https://formative.jmir.org/2021/11/e31678 UR - http://dx.doi.org/10.2196/31678 UR - http://www.ncbi.nlm.nih.gov/pubmed/34821561 ID - info:doi/10.2196/31678 ER - TY - JOUR AU - ter Harmsel, Annemieke AU - van der Pol, Thimo AU - Swinkels, Lise AU - Goudriaan, E. Anna AU - Popma, Arne AU - Noordzij, L. Matthijs PY - 2021/11/24 TI - Development of a Wearable Biocueing App (Sense-IT) Among Forensic Psychiatric Outpatients With Aggressive Behavior: Design and Evaluation Study JO - JMIR Form Res SP - e29267 VL - 5 IS - 11 KW - biocueing KW - biosensing KW - biofeedback KW - aggression KW - forensic psychiatry KW - wearable technology KW - mobile apps KW - usability KW - evaluation KW - mHealth N2 - Background: The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges. Objective: The aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior. Methods: First, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app?s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures. Results: The design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient?s own smartphone devices were recommended. Conclusions: This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy. UR - https://formative.jmir.org/2021/11/e29267 UR - http://dx.doi.org/10.2196/29267 UR - http://www.ncbi.nlm.nih.gov/pubmed/34821567 ID - info:doi/10.2196/29267 ER - TY - JOUR AU - Keller, Jan AU - Roitzheim, Christina AU - Radtke, Theda AU - Schenkel, Konstantin AU - Schwarzer, Ralf PY - 2021/11/23 TI - A Mobile Intervention for Self-Efficacious and Goal-Directed Smartphone Use in the General Population: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e26397 VL - 9 IS - 11 KW - problematic smartphone use KW - smartphone unlocks KW - smartphone time KW - behavior change KW - self-efficacy KW - action planning KW - digital detox KW - time-out KW - randomized controlled trial N2 - Background: People spend large parts of their everyday life using their smartphones. Despite various advantages of the smartphone for daily life, problematic forms of smartphone use exist that are related to negative psychological and physiological consequences. To reduce problematic smartphone use, existing interventions are oftentimes app-based and include components that help users to monitor and restrict their smartphone use by setting timers and blockers. These kinds of digital detox interventions, however, fail to exploit psychological resources, such as through promoting self-efficacious and goal-directed smartphone use. Objective: The aim of this study is to evaluate the theory-based smartphone app ?Not Less But Better? that was developed to make people aware of psychological processes while using the smartphone and to support them in using their smartphone in accordance with their goals and values. Methods: In a randomized controlled trial, effects of a 20-day intervention app consisting of five 4-day training modules to foster a goal-directed smartphone use were evaluated. In the active control condition (treatment as usual), participants received a digital detox treatment and planned daily time-outs of at least 1 hour per day. Up to a 3-week follow-up, self-reported problematic smartphone use, objectively measured daily smartphone unlocks, time of smartphone use, self-efficacy, and planning towards goal-directed smartphone use were assessed repeatedly. Linear 2-level models tested intervention effects. Mediation models served to analyze self-efficacy and planning as potential mechanisms of the intervention. Results: Out of 232 enrolled participants, 110 (47.4%; 55 participants in each condition) provided data at postintervention and 88 (37.9%; 44 participants in each condition) at 3-week follow-up. Both conditions manifested substantial reductions in problematic smartphone use and in the amount of time spent with the smartphone. The number of daily unlocks did not change over time. Further, modelling changes in self-efficacy as a mediator between the intervention and problematic smartphone use at follow-up fit well to the data and showed an indirect effect (b=?0.09; 95% bias-corrected bootstrap CI ?0.26 to ?0.01), indicating that self-efficacy was an important intervention mechanism. Another mediation model revealed an indirect effect from changes in planning via smartphone unlocks at postintervention on problematic smartphone use at follow-up (b=?0.029, 95% bias-corrected bootstrap CI ?0.078 to ?0.003). Conclusions: An innovative, theory-based intervention app on goal-directed smartphone use has been found useful in lowering problematic smartphone use and time spent with the smartphone. However, observed reductions in both outcomes were not superior to the active control condition (ie, digital detox treatment). Nonetheless, the present findings highlight the importance in promoting self-efficacy and planning goal-directed smartphone use to achieve improvements in problematic smartphone use. This scalable intervention app appears suitable for practical use and as an alternative to common digital detox apps. Future studies should address issues of high attrition by adding just-in-time procedures matched to smartphone users? needs. Trial Registration: German Clinical Trials Register DRKS00017606; https://tinyurl.com/27c9kmwy UR - https://mhealth.jmir.org/2021/11/e26397 UR - http://dx.doi.org/10.2196/26397 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817388 ID - info:doi/10.2196/26397 ER - TY - JOUR AU - Dahlhausen, Florian AU - Zinner, Maximillian AU - Bieske, Linn AU - Ehlers, P. Jan AU - Boehme, Philip AU - Fehring, Leonard PY - 2021/11/23 TI - Physicians? Attitudes Toward Prescribable mHealth Apps and Implications for Adoption in Germany: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e33012 VL - 9 IS - 11 KW - mobile health KW - mHealth KW - digital health KW - apps KW - physicians KW - general practitioners KW - technology acceptance KW - adoption N2 - Background: In October 2020, Germany became the first country, worldwide, to approve certain mobile health (mHealth) apps, referred to as DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health applications), for prescription with costs covered by standard statutory health insurance. Yet, this option has only been used to a limited extent so far. Objective: The aim of this study was to investigate physicians? and psychotherapists? current attitudes toward mHealth apps, barriers to adoption, and potential remedies. Methods: We conducted a two-stage sequential mixed methods study. In phase one, semistructured interviews were conducted with physicians and psychotherapists for questionnaire design. In phase two, an online survey was conducted among general practitioners, physicians, and psychotherapists. Results: A total of 1308 survey responses by mostly outpatient-care general practitioners, physicians, and psychotherapists from across Germany who could prescribe DiGA were recorded, making this the largest study on mHealth prescriptions to date. A total of 62.1% (807/1299) of respondents supported the opportunity to prescribe DiGA. Improved adherence (997/1294, 77.0%), health literacy (842/1294, 65.1%), and disease management (783/1294, 60.5%) were most frequently seen as benefits of DiGA. However, only 30.3% (393/1299) of respondents planned to prescribe DiGA, varying greatly by medical specialty. Professionals are still facing substantial barriers, such as insufficient information (1135/1295, 87.6%), reimbursement for DiGA-related medical services (716/1299, 55.1%), medical evidence (712/1298, 54.9%), legal uncertainties (680/1299, 52.3%), and technological uncertainties (658/1299, 50.7%). To support professionals who are unsure of prescribing DiGA, extended information campaigns (1104/1297, 85.1%) as well as recommendations from medical associations (1041/1297, 80.3%) and medical colleagues (1024/1297, 79.0%) were seen as the most impactful remedies. Conclusions: To realize the benefits from DiGA through increased adoption, additional information sharing about DiGA from trusted bodies, reimbursement for DiGA-related medical services, and further medical evidence are recommended. UR - https://mhealth.jmir.org/2021/11/e33012 UR - http://dx.doi.org/10.2196/33012 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817385 ID - info:doi/10.2196/33012 ER - TY - JOUR AU - Jonathan, K. Geneva AU - Dopke, A. Cynthia AU - Michaels, Tania AU - Martin, R. Clair AU - Ryan, Chloe AU - McBride, Alyssa AU - Babington, Pamela AU - Goulding, H. Evan PY - 2021/11/22 TI - A Smartphone-Based Self-Management Intervention for Individuals with Bipolar Disorder (LiveWell): Qualitative Study on User Experiences of the Behavior Change Process JO - JMIR Ment Health SP - e32306 VL - 8 IS - 11 KW - behavioral intervention technology KW - mHealth KW - bipolar disorder KW - depression KW - illness management KW - smartphone KW - behavior change KW - early warning signs KW - self-management KW - qualitative KW - behavior KW - intervention KW - management KW - user experience KW - perception KW - utilization N2 - Background: Bipolar disorder is a severe mental illness characterized by recurrent episodes of depressed, elevated, and mixed mood states. The addition of psychotherapy to pharmacological management can decrease symptoms, lower relapse rates, and improve quality of life; however, access to psychotherapy is limited. Mental health technologies such as smartphone apps are being studied as a means to increase access to and enhance the effectiveness of adjunctive psychotherapies for bipolar disorder. Individuals with bipolar disorder find this intervention format acceptable, but our understanding of how people utilize and integrate these tools into their behavior change and maintenance processes remains limited. Objective: The objective of this study was to explore how individuals with bipolar disorder perceive and utilize a smartphone intervention for health behavior change and maintenance. Methods: Individuals with bipolar disorder were recruited via flyers placed at university-affiliated and private outpatient mental health practices to participate in a pilot study of LiveWell, a smartphone-based self-management intervention. At the end of the study, all participants completed in-depth qualitative exit interviews. The behavior change framework developed to organize the intervention design was used to deductively code behavioral targets and determinants involved in target engagement. Inductive coding was used to identify themes not captured by this framework. Results: In terms of behavioral targets, participants emphasized the importance of managing mood episode?related signs and symptoms. They also discussed the importance of maintaining regular routines, sleep duration, and medication adherence. Participants emphasized that receiving support from a coach as well as seeking and receiving assistance from family, friends, and providers were important for managing behavioral targets and staying well. In terms of determinants, participants stressed the important role of monitoring for their behavior change and maintenance efforts. Monitoring facilitated self-awareness and reflection, which was considered valuable for staying well. Some participants also felt that the intervention facilitated learning information necessary for managing bipolar disorder but others felt that the information provided was too basic. Conclusions: In addition to addressing acceptability, satisfaction, and engagement, a person-based design of mental health technologies can be used to understand how people experience the impact of these technologies on their behavior change and maintenance efforts. This understanding may then be used to guide ongoing intervention development. The participants? perceptions aligned with the intervention?s primary behavioral targets and use of a monitoring tool as a core intervention feature. Participant feedback further indicates that developing additional content and tools to address building and engaging social support may be an important avenue for improving LiveWell. A comprehensive behavior change framework to understand participant perceptions of their behavior change and maintenance efforts may help facilitate ongoing intervention development. UR - https://mental.jmir.org/2021/11/e32306 UR - http://dx.doi.org/10.2196/32306 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813488 ID - info:doi/10.2196/32306 ER - TY - JOUR AU - Dao, Phuong Kim AU - De Cocker, Katrien AU - Tong, Ly Huong AU - Kocaballi, Baki A. AU - Chow, Clara AU - Laranjo, Liliana PY - 2021/11/19 TI - Smartphone-Delivered Ecological Momentary Interventions Based on Ecological Momentary Assessments to Promote Health Behaviors: Systematic Review and Adapted Checklist for Reporting Ecological Momentary Assessment and Intervention Studies JO - JMIR Mhealth Uhealth SP - e22890 VL - 9 IS - 11 KW - ecological momentary assessment KW - ecological momentary intervention KW - behavior change KW - health behavior KW - mHealth KW - mobile health KW - smartphone apps KW - mobile phone N2 - Background: Healthy behaviors are crucial for maintaining a person?s health and well-being. The effects of health behavior interventions are mediated by individual and contextual factors that vary over time. Recently emerging smartphone-based ecological momentary interventions (EMIs) can use real-time user reports (ecological momentary assessments [EMAs]) to trigger appropriate support when needed in daily life. Objective: This systematic review aims to assess the characteristics of smartphone-delivered EMIs using self-reported EMAs in relation to their effects on health behaviors, user engagement, and user perspectives. Methods: We searched MEDLINE, Embase, PsycINFO, and CINAHL in June 2019 and updated the search in March 2020. We included experimental studies that incorporated EMIs based on EMAs delivered through smartphone apps to promote health behaviors in any health domain. Studies were independently screened. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. We performed a narrative synthesis of intervention effects, user perspectives and engagement, and intervention design and characteristics. Quality appraisal was conducted for all included studies. Results: We included 19 papers describing 17 unique studies and comprising 652 participants. Most studies were quasi-experimental (13/17, 76%), had small sample sizes, and great heterogeneity in intervention designs and measurements. EMIs were most popular in the mental health domain (8/17, 47%), followed by substance abuse (3/17, 18%), diet, weight loss, physical activity (4/17, 24%), and smoking (2/17, 12%). Of the 17 studies, the 4 (24%) included randomized controlled trials reported nonstatistically significant effects on health behaviors, and 4 (24%) quasi-experimental studies reported statistically significant pre-post improvements in self-reported primary outcomes, namely depressive (P<.001) and psychotic symptoms (P=.03), drinking frequency (P<.001), and eating patterns (P=.01). EMA was commonly used to capture subjective experiences as well as behaviors, whereas sensors were rarely used. Generally, users perceived EMIs to be helpful. Common suggestions for improvement included enhancing personalization, multimedia and interactive capabilities (eg, voice recording), and lowering the EMA reporting burden. EMI and EMA components were rarely reported and were not described in a standardized manner across studies, hampering progress in this field. A reporting checklist was developed to facilitate the interpretation and comparison of findings and enhance the transparency and replicability of future studies using EMAs and EMIs. Conclusions: The use of smartphone-delivered EMIs using self-reported EMAs to promote behavior change is an emerging area of research, with few studies evaluating efficacy. Such interventions could present an opportunity to enhance health but need further assessment in larger participant cohorts and well-designed evaluations following reporting checklists. Future research should explore combining self-reported EMAs of subjective experiences with objective data passively collected via sensors to promote personalization while minimizing user burden, as well as explore different EMA data collection methods (eg, chatbots). Trial Registration: PROSPERO CRD42019138739; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=138739 UR - https://mhealth.jmir.org/2021/11/e22890 UR - http://dx.doi.org/10.2196/22890 UR - http://www.ncbi.nlm.nih.gov/pubmed/34806995 ID - info:doi/10.2196/22890 ER - TY - JOUR AU - Greulich, Leonard AU - Hegselmann, Stefan AU - Dugas, Martin PY - 2021/11/19 TI - An Open-Source, Standard-Compliant, and Mobile Electronic Data Capture System for Medical Research (OpenEDC): Design and Evaluation Study JO - JMIR Med Inform SP - e29176 VL - 9 IS - 11 KW - electronic data capture KW - open science KW - data interoperability KW - metadata reuse KW - mobile health KW - data standard KW - mobile phone N2 - Background: Medical research and machine learning for health care depend on high-quality data. Electronic data capture (EDC) systems have been widely adopted for metadata-driven digital data collection. However, many systems use proprietary and incompatible formats that inhibit clinical data exchange and metadata reuse. In addition, the configuration and financial requirements of typical EDC systems frequently prevent small-scale studies from benefiting from their inherent advantages. Objective: The aim of this study is to develop and publish an open-source EDC system that addresses these issues. We aim to plan a system that is applicable to a wide range of research projects. Methods: We conducted a literature-based requirements analysis to identify the academic and regulatory demands for digital data collection. After designing and implementing OpenEDC, we performed a usability evaluation to obtain feedback from users. Results: We identified 20 frequently stated requirements for EDC. According to the International Organization for Standardization/International Electrotechnical Commission (ISO/IEC) 25010 norm, we categorized the requirements into functional suitability, availability, compatibility, usability, and security. We developed OpenEDC based on the regulatory-compliant Clinical Data Interchange Standards Consortium Operational Data Model (CDISC ODM) standard. Mobile device support enables the collection of patient-reported outcomes. OpenEDC is publicly available and released under the MIT open-source license. Conclusions: Adopting an established standard without modifications supports metadata reuse and clinical data exchange, but it limits item layouts. OpenEDC is a stand-alone web app that can be used without a setup or configuration. This should foster compatibility between medical research and open science. OpenEDC is targeted at observational and translational research studies by clinicians. UR - https://medinform.jmir.org/2021/11/e29176 UR - http://dx.doi.org/10.2196/29176 UR - http://www.ncbi.nlm.nih.gov/pubmed/34806987 ID - info:doi/10.2196/29176 ER - TY - JOUR AU - Böttcher, Sebastian AU - Bruno, Elisa AU - Manyakov, V. Nikolay AU - Epitashvili, Nino AU - Claes, Kasper AU - Glasstetter, Martin AU - Thorpe, Sarah AU - Lees, Simon AU - Dümpelmann, Matthias AU - Van Laerhoven, Kristof AU - Richardson, P. Mark AU - Schulze-Bonhage, Andreas AU - PY - 2021/11/19 TI - Detecting Tonic-Clonic Seizures in Multimodal Biosignal Data From Wearables: Methodology Design and Validation JO - JMIR Mhealth Uhealth SP - e27674 VL - 9 IS - 11 KW - wearables KW - epilepsy KW - seizure detection KW - multimodal data KW - mHealth KW - mobile health KW - digital health KW - eHealth N2 - Background: Video electroencephalography recordings, routinely used in epilepsy monitoring units, are the gold standard for monitoring epileptic seizures. However, monitoring is also needed in the day-to-day lives of people with epilepsy, where video electroencephalography is not feasible. Wearables could fill this gap by providing patients with an accurate log of their seizures. Objective: Although there are already systems available that provide promising results for the detection of tonic-clonic seizures (TCSs), research in this area is often limited to detection from 1 biosignal modality or only during the night when the patient is in bed. The aim of this study is to provide evidence that supervised machine learning can detect TCSs from multimodal data in a new data set during daytime and nighttime. Methods: An extensive data set of biosignals from a multimodal watch worn by people with epilepsy was recorded during their stay in the epilepsy monitoring unit at 2 European clinical sites. From a larger data set of 243 enrolled participants, those who had data recorded during TCSs were selected, amounting to 10 participants with 21 TCSs. Accelerometry and electrodermal activity recorded by the wearable device were used for analysis, and seizure manifestation was annotated in detail by clinical experts. Ten accelerometry and 3 electrodermal activity features were calculated for sliding windows of variable size across the data. A gradient tree boosting algorithm was used for seizure detection, and the optimal parameter combination was determined in a leave-one-participant-out cross-validation on a training set of 10 seizures from 8 participants. The model was then evaluated on an out-of-sample test set of 11 seizures from the remaining 2 participants. To assess specificity, we additionally analyzed data from up to 29 participants without TCSs during the model evaluation. Results: In the leave-one-participant-out cross-validation, the model optimized for sensitivity could detect all 10 seizures with a false alarm rate of 0.46 per day in 17.3 days of data. In a test set of 11 out-of-sample TCSs, amounting to 8.3 days of data, the model could detect 10 seizures and produced no false positives. Increasing the test set to include data from 28 more participants without additional TCSs resulted in a false alarm rate of 0.19 per day in 78 days of wearable data. Conclusions: We show that a gradient tree boosting machine can robustly detect TCSs from multimodal wearable data in an original data set and that even with very limited training data, supervised machine learning can achieve a high sensitivity and low false-positive rate. This methodology may offer a promising way to approach wearable-based nonconvulsive seizure detection. UR - https://mhealth.jmir.org/2021/11/e27674 UR - http://dx.doi.org/10.2196/27674 UR - http://www.ncbi.nlm.nih.gov/pubmed/34806993 ID - info:doi/10.2196/27674 ER - TY - JOUR AU - Pan, Jing AU - Dong, Hua AU - Bryan-Kinns, Nick PY - 2021/11/19 TI - Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation JO - JMIR Aging SP - e30420 VL - 4 IS - 4 KW - older adults KW - mHealth KW - initial adoption KW - technology acceptance KW - design KW - mobile phone N2 - Background: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective: The aims of this study are to understand older adults? perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults? perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults? perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults? adoption of mHealth services. Conclusions: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults. UR - https://aging.jmir.org/2021/4/e30420 UR - http://dx.doi.org/10.2196/30420 UR - http://www.ncbi.nlm.nih.gov/pubmed/34807836 ID - info:doi/10.2196/30420 ER - TY - JOUR AU - Lewkowicz, Daniel AU - Slosarek, Tamara AU - Wernicke, Sarah AU - Winne, Antonia AU - Wohlbrandt, M. Attila AU - Bottinger, Erwin PY - 2021/11/19 TI - Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review JO - JMIR Rehabil Assist Technol SP - e26612 VL - 8 IS - 4 KW - digital therapeutic care KW - decision support interventions KW - low back pain KW - behavior change techniques KW - back KW - orthopedic KW - systematic review KW - digital therapy KW - decision support KW - mobile phone N2 - Background: Low back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change. Objective: This systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates. Methods: We searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates. Results: We retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50%) were RCTs and 6 (50%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials. Conclusions: This systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants? ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs. UR - https://rehab.jmir.org/2021/4/e26612 UR - http://dx.doi.org/10.2196/26612 UR - http://www.ncbi.nlm.nih.gov/pubmed/34807837 ID - info:doi/10.2196/26612 ER - TY - JOUR AU - Woelfle, Tim AU - Pless, Silvan AU - Wiencierz, Andrea AU - Kappos, Ludwig AU - Naegelin, Yvonne AU - Lorscheider, Johannes PY - 2021/11/18 TI - Practice Effects of Mobile Tests of Cognition, Dexterity, and Mobility on Patients With Multiple Sclerosis: Data Analysis of a Smartphone-Based Observational Study JO - J Med Internet Res SP - e30394 VL - 23 IS - 11 KW - multiple sclerosis KW - digital biomarkers KW - practice effects KW - learning effects KW - learning curves KW - nonlinear mixed models KW - quantile regression KW - information processing speed KW - symbol digit modalities test KW - smartphones KW - wearable electronic devices KW - mobile phones N2 - Background: Smartphones and their built-in sensors allow for measuring functions in disease-related domains through mobile tests. This could improve disease characterization and monitoring, and could potentially support treatment decisions for multiple sclerosis (MS), a multifaceted chronic neurological disease with highly variable clinical manifestations. Practice effects can complicate the interpretation of both improvement over time by potentially exaggerating treatment effects and stability by masking deterioration. Objective: The aim of this study is to identify short-term learning and long-term practice effects in 6 active tests for cognition, dexterity, and mobility in user-scheduled, high-frequency smartphone-based testing. Methods: We analyzed data from 264 people with self-declared MS with a minimum of 5 weeks of follow-up and at least 5 repetitions per test in the Floodlight Open study, a self-enrollment study accessible by smartphone owners from 16 countries. The collected data are openly available to scientists. Using regression and bounded growth mixed models, we characterized practice effects for the following tests: electronic Symbol Digit Modalities Test (e-SDMT) for cognition; Finger Pinching and Draw a Shape for dexterity; and Two Minute Walk, U-Turn, and Static Balance for mobility. Results: Strong practice effects were found for e-SDMT (n=4824 trials), Finger Pinching (n=19,650), and Draw a Shape (n=19,019) with modeled boundary improvements of 40.8% (39.9%-41.6%), 86.2% (83.6%-88.7%), and 23.1% (20.9%-25.2%) over baseline, respectively. Half of the practice effect was reached after 11 repetitions for e-SDMT, 28 repetitions for Finger Pinching, and 17 repetitions for Draw a Shape; 90% was reached after 35, 94, and 56 repetitions, respectively. Although baseline performance levels were highly variable across participants, no significant differences between the short-term learning effects in low performers (5th and 25th percentile), median performers, and high performers (75th and 95th percentile) were found for e-SDMT up to the fifth trial (?=1.50-2.00). Only small differences were observed for Finger Pinching (?=1.25-2.5). For U-Turn (n=15,051) and Static Balance (n=16,797), only short-term learning effects could be observed, which ceased after a maximum of 5 trials. For Two Minute Walk (n=14,393), neither short-term learning nor long-term practice effects were observed. Conclusions: Smartphone-based tests are promising for monitoring the disease trajectories of MS and other chronic neurological diseases. Our findings suggest that strong long-term practice effects in cognitive and dexterity functions have to be accounted for to identify disease-related changes in these domains, especially in the context of personalized health and in studies without a comparator arm. In contrast, changes in mobility may be more easily interpreted because of the absence of long-term practice effects, even though short-term learning effects might have to be considered. UR - https://www.jmir.org/2021/11/e30394 UR - http://dx.doi.org/10.2196/30394 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792480 ID - info:doi/10.2196/30394 ER - TY - JOUR AU - Strubbia, Carla AU - Levack, MM William AU - Grainger, Rebecca AU - Takahashi, Kayoko AU - Tomori, Kounosuke PY - 2021/11/18 TI - Use of an iPad App (Aid for Decision-making in Occupational Choice) for Collaborative Goal Setting in Interprofessional Rehabilitation: Qualitative Descriptive Study JO - JMIR Rehabil Assist Technol SP - e33027 VL - 8 IS - 4 KW - rehabilitation KW - goals KW - digital technology KW - mobile health KW - mobile phone N2 - Background: Goal setting is a key part of the rehabilitation process. The use of technology and electronic tools such as smartphone apps and websites has been suggested as a way of improving the engagement of users in meaningful goal setting and facilitating shared decision-making between patients and health professionals. Objective: This study aims to describe experiences of health professionals and patients in the use of the English language version of the iPad app Aid for Decision-making in Occupational Choice (ADOC) to facilitate collaborative goal setting in rehabilitation. Methods: We recruited participants from 3 acute and postacute care rehabilitation wards in both public and private organizations in New Zealand. Participants were registered allied health professionals, including physiotherapists, occupational therapists, and speech-language therapists, who engage in goal setting as part of their normal work, and their adult patients. We collected data via semistructured interviews to gather information about the experiences of the participants in the use of ADOC for goal setting. Data were analyzed with thematic analysis. Results: A total of 8 health professionals and 8 patients participated in the study. Six main themes emerged from the data: changing patients? perspective on what is possible, changing health professionals? perspective on what is important, facilitating shared decision-making, lack of guides for users, logistic and organizational barriers, and app-related and technical issues. Conclusions: Health professionals and patients found ADOC to be a valuable tool when setting shared rehabilitation goals. The use of ADOC promoted a patient-centered approach that empowered patients to engage in collaborative goal setting. The technological limitations of the app that negatively impacted experiences can be addressed in the future implementation of ADOC in rehabilitation settings. UR - https://rehab.jmir.org/2021/4/e33027 UR - http://dx.doi.org/10.2196/33027 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792475 ID - info:doi/10.2196/33027 ER - TY - JOUR AU - Barrera, Z. Alinne AU - Hamil, Jaime AU - Tandon, Darius PY - 2021/11/18 TI - Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study JO - JMIR Form Res SP - e30995 VL - 5 IS - 11 KW - perinatal mental health KW - postpartum depression KW - public health KW - SMS KW - technology N2 - Background: The Mothers and Babies (MB) Course is recognized by the US Preventive Services Task Force as an evidence-based preventive intervention for postpartum depression (PPD) that should be recommended to pregnant women at risk for PPD. Objective: This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention by adding 36 SMS text messages that target 3 areas: reinforcement of skills, between-session homework reminders, and responding to self-monitoring texts (ie, MB Plus Text Messaging [MB-TXT]). Methods: In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (mean 25.6, SD 9.0 weeks) received MB-TXT. Feasibility was defined by home visitors? adherence to logging into the HealthySMS platform to enter session data and trigger SMS text messages within 7 days of the in-person session. The acceptability of MB-TXT was measured by participants? usefulness and understanding ratings of the SMS text messages and responses to the self-monitoring SMS text messages. Results: On average, home visitors followed the study protocol and entered session-specific data between 5.50 and 61.17 days following the MB 1-on-1 sessions. A high proportion of participants responded to self-monitoring texts (25/28, 89%) and rated the text message content as very useful and understandable. Conclusions: This report contributes to a growing body of research focusing on digital adaptations of the MB course. SMS is a low-cost, accessible digital tool that can be integrated into existing interventions. With appropriate resources to support staff, it can be implemented in community-based organizations and health care systems that serve women at risk for PPD. Trial Registration: ClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT03420755 UR - https://formative.jmir.org/2021/11/e30995 UR - http://dx.doi.org/10.2196/30995 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792478 ID - info:doi/10.2196/30995 ER - TY - JOUR AU - Park, Jihyun AU - Park, Mi-Jeong AU - Seo, Young-Gyun PY - 2021/11/17 TI - Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e29003 VL - 23 IS - 11 KW - ICT KW - eHealth KW - mHealth KW - weight loss KW - obesity KW - BMI KW - meta-analysis KW - randomized controlled trial KW - children KW - adolescents KW - mobile phone N2 - Background: Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions. Objective: The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes. Methods: Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Results: In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=?1.26 kg/m2, 95% CI ?2.24 to ?0.28), lifestyle modification comparator (WMD=?1.75, 95% CI ?2.76 to ?0.74), intervention involving both boys and girls (WMD=?1.30, 95% CI ?2.14 to ?0.46), and intervention involving obesity only (WMD=?1.92, 95% CI ?3.75 to ?0.09). Conclusions: The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity. UR - https://www.jmir.org/2021/11/e29003 UR - http://dx.doi.org/10.2196/29003 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787572 ID - info:doi/10.2196/29003 ER - TY - JOUR AU - Chatterjee, Ayan AU - Prinz, Andreas AU - Gerdes, Martin AU - Martinez, Santiago PY - 2021/11/17 TI - Digital Interventions on Healthy Lifestyle Management: Systematic Review JO - J Med Internet Res SP - e26931 VL - 23 IS - 11 KW - eHealth KW - digital intervention KW - lifestyle KW - obesity KW - challenges KW - mobile phone N2 - Background: Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. Objective: This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). Methods: We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. Results: Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. Conclusions: This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions. UR - https://www.jmir.org/2021/11/e26931 UR - http://dx.doi.org/10.2196/26931 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787575 ID - info:doi/10.2196/26931 ER - TY - JOUR AU - Hoeppner, B. Bettina AU - Siegel, R. Kaitlyn AU - Carlon, A. Hannah AU - Kahler, W. Christopher AU - Park, R. Elyse AU - Hoeppner, S. Susanne PY - 2021/11/17 TI - A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study JO - JMIR Form Res SP - e29760 VL - 5 IS - 11 KW - nondaily KW - smoking cessation KW - smartphone app KW - positive psychology KW - mHealth KW - happiness KW - mobile phone N2 - Background: Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations; however, little work has been done to develop treatments specifically geared toward quitting nondaily smoking. Objective: This study aims to test the feasibility, acceptability, and conceptual underpinnings of version 2 of the Smiling Instead of Smoking (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. Methods: In a prospective, single-group study, nondaily smokers (N=100) were prescribed use of the SiS2 app for 7 weeks while undergoing a quit attempt. The app assigned daily positive psychology exercises and behavioral tasks every 2 to 3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and at 2, 6, 12, and 24 weeks postquit. Feasibility was evaluated based on app use and acceptability based on survey responses. The underlying conceptual framework was tested by examining whether theorized within-person changes occurred from baseline to end of treatment on scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (ie, pros and cons of smoking, importance of the pros and cons of quitting, and motivation). Results: Participants used the SiS2 app on an average of 24.7 (SD 13.8) days out of the 49 prescribed days. At the end of treatment, most participants rated the functions of the app as very easy to use (eg, 70/95, 74% regarding cigarette log and 59/95, 62% regarding happiness exercises). The average score on the System Usability Scale was 79.8 (SD 17.3; A grade; A+ ?84.1, B+ <78.8). Most participants reported that the app helped them in their quit attempt (83/95, 87%), and helped them stay positive while quitting (78/95, 82%). Large effects were found for within-person decreases in the desire to smoke (b=?1.5, 95% CI ?1.9 to ?1.1; P<.001; gav=1.01), the importance of the pros of smoking (b=-20.7, 95% CI ?27.2 to ?14.3; P<.001; gav=0.83), and perceived psychoactive benefits of smoking (b=?0.8, 95% CI ?1.0 to ?0.5; P<.001; gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1, 95% CI 7.6 to 18.7; P<.001; gav=0.53) and external (b=11.2, 95% CI 6.1 to 16.1; P<.001; gav=0.49) smoking cues. Smaller effects, contrary to expectations, were found for decreases in motivation to quit smoking (P=.005) and the perceived importance of the pros of quitting (P=.009). Self-reported 30-day point prevalence abstinence rates were 40%, 56%, and 56% at 6, 12, and 24 weeks after the quit day, respectively. Conclusions: The SiS2 app was feasible and acceptable, showed promising changes in constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial. UR - https://formative.jmir.org/2021/11/e29760 UR - http://dx.doi.org/10.2196/29760 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787577 ID - info:doi/10.2196/29760 ER - TY - JOUR AU - Muñoz-Mancisidor, Aranzazu AU - Martin-Payo, Ruben AU - Gonzalez-Mendez, Xana AU - Fernández-Álvarez, Mar María Del PY - 2021/11/17 TI - Content, Behavior Change Techniques, and Quality of Pregnancy Apps in Spain: Systematic Search on App Stores JO - JMIR Mhealth Uhealth SP - e27995 VL - 9 IS - 11 KW - pregnancy KW - mobile apps KW - behavior KW - technology assessment, biomedical KW - telemedicine N2 - Background: Women consult information in mobile apps (apps) during pregnancy, and even obstetrics specialists highlight that pregnancy is the ideal moment for the use of apps as consultation sources. However, the high number of apps designed for pregnancy requires a careful assessment to determine their suitability before recommendation. Objective: The aim of this study is to identify the apps available in Spanish that can be recommended based on their content, behavior change techniques (BCTs), and quality as a complementary tool during pregnancy. Methods: A systematic search on app stores to identify apps was performed in the Apple App Store and Google Play with the subject term ?pregnancy.? The apps meeting the following criteria were chosen: pregnancy-related content, free, and available in Spanish. An app was excluded if it was classified as a game or entertainment and thus lacking an educational or health aim and if it did not target the population under study. The selected apps were downloaded, and their quality was assessed using the Mobile Application Rating Scale (MARS), with the BCTs included evaluated using the BCT taxonomy version 1 and its content. Results: A total of 457 apps were identified, 25 of which were downloaded for assessment (5.6%). The median for objective and subjective quality was 2.94 (IQR 2.71-3.46) and 1.75 (IQR 1.25-2.25), respectively. Regarding content, the median of topics included in the apps was 23 (IQR 16-23), with weight gain, nutrition, fetal development, and physical activity being the most common. The median number of BCTs was 12 (IQR 0.5-3.5). The most frequently identified BCTs in the apps were ?Self-Monitoring of Outcomes,? followed by ?Goal Behavior? and ?Instructions.? Statistically significant correlations were observed between objective quality and content (?=0.624; P=.001), subjective quality and content (?=0.638; P=.001), objective quality and BCTs (?=0.672; P<.001), subjective quality and BCTs (?=0.623; P<.001), and BCTs and content (?=0.580; P=.002). Conclusions: The results of this study suggest that only a small percentage of free pregnancy apps available in Spanish should be recommended. The apps with the best MARS scores were those that addressed a higher number of topics and included a higher number of BCTs. Those with the best content and quality, and a higher number of BCTs included could be recommended by health professionals. UR - https://mhealth.jmir.org/2021/11/e27995 UR - http://dx.doi.org/10.2196/27995 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787587 ID - info:doi/10.2196/27995 ER - TY - JOUR AU - Alessa, Tourkiah AU - Hawley, Mark AU - de Witte, Luc PY - 2021/11/17 TI - Identification of the Most Suitable App to Support the Self-Management of Hypertension: Systematic Selection Approach and Qualitative Study JO - JMIR Mhealth Uhealth SP - e29207 VL - 9 IS - 11 KW - app KW - hypertension KW - self-management KW - mHealth KW - blood pressure KW - support KW - Saudi Arabia KW - cardiology KW - heart KW - effective KW - security N2 - Background: Smartphone apps are increasingly being used to aid in hypertension self-management, and a large and ever-growing number of self-management apps have been commercially released. However, very few of these are potentially effective and secure, and researchers have yet to establish the suitability of specific hypertension apps to particular contexts. Objective: The aim of this study is to identify the most suitable hypertension app in the context of Saudi Arabia and its health system. Methods: This study used a 2-stage approach to selecting the most suitable app for hypertension self-management. First, a systematic selection approach was followed to identify a shortlist of the most suitable apps according to the criteria of potential effectiveness, theoretical underpinning, and privacy and security. Second, an exploratory qualitative study was conducted to select the most suitable from the shortlist: 12 doctors were interviewed, and 22 patients participated in 4 focus groups. These explored participants? attitudes towards self-management apps in general, and their views towards the apps identified via the systematic selection process. The qualitative data were analyzed using framework analysis. Results: In the first stage, only 5 apps were found to be potentially effective while also having a theoretical underpinning and protecting users? data. In the second stage, both doctors and patients were generally interested in using hypertension apps, but most had no experience with these apps due to a lack of awareness of their availability and suitability. Patients and doctors liked apps that combine intuitive interfaces with a pleasant and clear visual design, in-depth features (eg, color-coded feedback accompanied with textual explanations), activity-specific reminders, and educational content regarding hypertension and potential complications. When the pros and cons of the 5 apps were discussed, 3 apps were identified as being more suitable, with Cora Health rated the highest by the participants. Conclusions: Only 5 apps were deemed potentially effective and secure. Patients? and doctors? discussions of the pros and cons of these 5 apps revealed that 3 out of the 5 are clearly more suitable, with the Cora Health app being judged most suitable overall. UR - https://mhealth.jmir.org/2021/11/e29207 UR - http://dx.doi.org/10.2196/29207 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787586 ID - info:doi/10.2196/29207 ER - TY - JOUR AU - Lancioni, E. Giulio AU - Singh, N. Nirbhay AU - O'Reilly, F. Mark AU - Sigafoos, Jeff AU - Alberti, Gloria AU - Chiariello, Valeria AU - Campodonico, Francesca AU - Desideri, Lorenzo PY - 2021/11/17 TI - Technology-Aided Spatial Cues, Instructions, and Preferred Stimulation for Supporting People With Intellectual and Visual Disabilities in Their Occupational Engagement and Mobility: Usability Study JO - JMIR Rehabil Assist Technol SP - e33481 VL - 8 IS - 4 KW - technology KW - smartphone KW - motion sensors KW - intellectual disability KW - visual impairments KW - occupational engagement KW - mobility KW - mobile phone N2 - Background: Persons with severe or profound intellectual disability and visual impairment tend to be passive and sedentary, and technology-aided intervention may be required to improve their condition without excessive demands on staff time. Objective: This study aims to extend the assessment of technology-aided interventions for supporting functional occupational engagement and mobility in 7 people with intellectual disability and visual impairment and to use a technology system that is simpler and less expensive than those previously used. Methods: The technology system involved a Samsung Galaxy A10, 4 Philips Hue indoor motion sensors, and 4 mini speakers. Within each session, the participants were to collect 18 objects (ie, one at a time) from 3 different areas (stations) located within a large room, bring each of the objects to a central desk, and put away each of those objects there. For each object, the participants received verbal (spatial) cues for guiding them to the area where the object was to be collected, a verbal instruction (ie, request) to take an object, verbal (spatial) cues for guiding them to the central desk, a verbal instruction to put away the object collected, and praise and preferred stimulation. Results: During baseline, the frequency of responses completed correctly (objects collected and put away independently) was 0 or near 0. During the intervention phase (ie, with the support of the technology setup), the frequency increased for all participants, reaching a mean of almost 18 (out of 18 response opportunities) for 6 participants and about 13 for the remaining participant. The mean session duration ranged from 12 to 30 minutes. Conclusions: A program, such as the one used in this study, can be useful in promoting occupational engagement and mobility in persons with intellectual disability and visual impairment. UR - https://rehab.jmir.org/2021/4/e33481 UR - http://dx.doi.org/10.2196/33481 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787588 ID - info:doi/10.2196/33481 ER - TY - JOUR AU - Jessen, Stian AU - Mirkovic, Jelena AU - Halvorsen Brendmo, Elanor AU - Solberg Nes, Lise PY - 2021/11/17 TI - Evaluating a Strengths-Based mHealth Tool (MyStrengths): Explorative Feasibility Trial JO - JMIR Form Res SP - e30572 VL - 5 IS - 11 KW - mHealth KW - personal strengths KW - gameful design KW - gamification KW - user engagement KW - explorative KW - feasibility KW - usefulness KW - usability KW - design KW - self-management KW - chronic illness N2 - Background: As the number of people living with chronic illnesses increases, providing wide-reaching and easy-to-use support tools is becoming increasingly important. Supporting people in this group to recognize and use more of their personal strengths has the potential to improve their quality of life. With this in mind, we have developed the MyStrengths app prototype, a gamefully designed app aimed at aiding users in both identifying their strengths and using these strengths more actively in their daily life. Objective: The goal of this study was to evaluate the user-reported feasibility and usefulness of the MyStrengths app. The study additionally aimed to explore whether the use of MyStrengths could be associated with selected psychosocial outcomes. Methods: A 31-day explorative feasibility trial with a pretest-posttest design and an optional end of study interview was conducted. Data collection included system-use log data, demographic information, pre? and post?psychosocial measures (ie, strengths use, self-efficacy, health-related quality of life, depression), user experience measures (ie, usability, engagement, flow), and interview data. Results: In total, 34 people with at least 1 chronic condition were enrolled in the study, with 26 participants (mean age 48 years, range 29-62 years; 1 male) completing the trial. Among these individuals, 18 were also interviewed posttrial. Participants used the MyStrengths app an average of 6 days during the trial period, with 54% (14/26) using the app over a period of at least 19 days. In total, 8738 unique app actions were registered. Of the psychosocial outcome measures, only 1 subscale, general health in the RAND 36-Item Health Survey, yielded significant pre- and posttest changes. Posttrial interviews showed that the number of participants who considered the MyStrengths app to be useful, somewhat useful, or not useful was evenly distributed across 3 groups. However, every participant did voice support for the strengths approach. All participants were able to identify a multitude of personal strengths using the MyStrengths app. Most participants that reported it to be useful had little or no previous experience with the personal strengths approach. A multitude of users welcomed the gameful design choices, particularly the rolling die feature, suggesting strengths exercises, activities that use a specific strength, were well received. Conclusions: Although the reported usefulness and feedback from use varied, most participants were favorable to the strengths-focused approach to care and support. Consequently, low-threshold and wide-reaching mobile health tools that use a strengths-focused approach, such as MyStrengths, hold the potential to support people living with chronic illness in performing self-management and achieving mastery of their life. UR - https://formative.jmir.org/2021/11/e30572 UR - http://dx.doi.org/10.2196/30572 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787580 ID - info:doi/10.2196/30572 ER - TY - JOUR AU - Vidrine, J. Damon AU - Bui, C. Thanh AU - Businelle, S. Michael AU - Shih, Tina Ya-Chen AU - Sutton, K. Steven AU - Shahani, Lokesh AU - Hoover, Stewart Diana AU - Bowles, Kristina AU - Vidrine, I. Jennifer PY - 2021/11/17 TI - Evaluating the Efficacy of Automated Smoking Treatment for People With HIV: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e33183 VL - 10 IS - 11 KW - smoking cessation KW - health disparities KW - HIV/AIDS KW - mHealth KW - mobile phone N2 - Background: Smoking prevalence rates among people with HIV are nearly 3 times higher than those in the general population. Nevertheless, few smoking cessation trials targeting smokers with HIV have been reported in the literature. Efforts to develop and evaluate sustainable, low-cost, and evidence-based cessation interventions for people with HIV are needed. Given the widespread proliferation of mobile phones, the potential of using mobile health apps to improve the reach and efficacy of cessation interventions is promising, but evidence of efficacy is lacking, particularly among people with HIV. Objective: This study will consist of a 2-group randomized controlled trial to evaluate a fully automated smartphone intervention for people with HIV seeking cessation treatment. Methods: Participants (N=500) will be randomized to receive either standard treatment (ST; 250/500, 50%) or automated treatment (AT; 250/500, 50%). ST participants will be connected to the Florida Quitline and will receive nicotine replacement therapy in the form of transdermal patches and lozenges. This approach, referred to as Ask Advise Connect, was developed by our team and has been implemented in numerous health systems. ST will be compared with AT, a fully automated behavioral treatment approach. AT participants will receive nicotine replacement therapy and an interactive smartphone-based intervention that comprises individually tailored audiovisual and text content. The major goal is to determine whether AT performs better in terms of facilitating long-term smoking abstinence than the more resource-intensive ST approach. Our primary aim is to evaluate the efficacy of AT in facilitating smoking cessation among people with HIV. As a secondary aim, we will explore potential mediators and moderators and conduct economic evaluations to assess the cost and cost-effectiveness of AT compared with ST. Results: The intervention content has been developed and finalized. Recruitment and enrollment will begin in the fall of 2021. Conclusions: There is a critical need for efficacious, cost-effective, and sustainable cessation treatments for people with HIV who smoke. The AT intervention was designed to help fill this need. If efficacy is established, the AT approach will be readily adoptable by HIV clinics and community-based organizations, and it will offer an efficient way to allocate limited public health resources to tobacco control interventions. Trial Registration: ClinicalTrials.gov NCT05014282; https://clinicaltrials.gov/ct2/show/NCT05014282 International Registered Report Identifier (IRRID): PRR1-10.2196/33183 UR - https://www.researchprotocols.org/2021/11/e33183 UR - http://dx.doi.org/10.2196/33183 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787590 ID - info:doi/10.2196/33183 ER - TY - JOUR AU - Abdelhamid, Mohamed PY - 2021/11/16 TI - Fitness Tracker Information and Privacy Management: Empirical Study JO - J Med Internet Res SP - e23059 VL - 23 IS - 11 KW - privacy KW - information sharing KW - fitness trackers KW - wearable devices N2 - Background: Fitness trackers allow users to collect, manage, track, and monitor fitness-related activities, such as distance walked, calorie intake, sleep quality, and heart rate. Fitness trackers have become increasingly popular in the past decade. One in five Americans use a device or an app to track their fitness-related activities. These devices generate massive and important data that could help physicians make better assessments of their patients? health if shared with health providers. This ultimately could lead to better health outcomes and perhaps even lower costs for patients. However, sharing personal fitness information with health care providers has drawbacks, mainly related to the risk of privacy loss and information misuse. Objective: This study investigates the influence of granting users granular privacy control on their willingness to share fitness information. Methods: The study used 270 valid responses collected from Mtrurkers through Amazon Mechanical Turk (MTurk). Participants were randomly assigned to one of two groups. The conceptual model was tested using structural equation modeling (SEM). The dependent variable was the intention to share fitness information. The independent variables were perceived risk, perceived benefits, and trust in the system. Results: SEM explained about 60% of the variance in the dependent variable. Three of the four hypotheses were supported. Perceived risk and trust in the system had a significant relationship with the dependent variable, while trust in the system was not significant. Conclusions: The findings show that people are willing to share their fitness information if they have granular privacy control. This study has practical and theoretical implications. It integrates communication privacy management (CPM) theory with the privacy calculus model. UR - https://www.jmir.org/2021/11/e23059 UR - http://dx.doi.org/10.2196/23059 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783672 ID - info:doi/10.2196/23059 ER - TY - JOUR AU - Ang, Min Siew AU - Chen, Juliana AU - Liew, Huan Jia AU - Johal, Jolyn AU - Dan, Young Yock AU - Allman-Farinelli, Margaret AU - Lim, Lin Su PY - 2021/11/16 TI - Efficacy of Interventions That Incorporate Mobile Apps in Facilitating Weight Loss and Health Behavior Change in the Asian Population: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e28185 VL - 23 IS - 11 KW - systematic review KW - meta-analysis KW - mobile app KW - obesity KW - weight loss KW - Asian KW - diet KW - physical activity KW - adults KW - mobile phone N2 - Background: Smartphone apps have shown potential in enhancing weight management in Western populations in the short to medium term. With a rapidly growing obesity burden in Asian populations, researchers are turning to apps as a service delivery platform to reach a larger target audience to efficiently address the problem. Objective: This systematic review and meta-analysis aims to determine the efficacy of interventions that incorporate apps in facilitating weight loss and health behavior change in the Asian population. Methods: A total of 6 databases were searched in June 2020. The eligible studies included controlled trials in which an app was used in the intervention. The participants were aged 18 years or older and were of Asian ethnicity. A meta-analysis to test intervention efficacy, subgroup analyses, and post hoc analyses was conducted to determine the effects of adding an app to usual care and study duration. The primary outcome was absolute or percentage weight change, whereas the secondary outcomes were changes to lifestyle behaviors. Results: A total of 21 studies were included in this review, and 17 (81%) were selected for the meta-analysis. The pooled effect size across 82% (14/17) of the randomized controlled trials for weight change was small to moderate (Hedges g=?0.26; 95% CI ?0.41 to ?0.11), indicating slightly greater weight loss achieved in the intervention group; however, this may not be representative of long-term studies (lasting for more than a year). Supplementing multicomponent usual care with an app led to greater weight loss (Hedges g=?0.28; 95% CI ?0.47 to ?0.09). Asian apps were largely culturally adapted and multifunctional, with the most common app features being communication with health professionals and self-monitoring of behaviors and outcomes. Conclusions: More evidence is required to determine the efficacy of apps in the long term and address the low uptake of apps to maximize the potential of the intervention. Future research should determine the efficacy of each component of the multicomponent intervention to facilitate the designing of studies that are most effective and cost-efficient for weight management. Trial Registration: PROSPERO CRD42020165240; https://tinyurl.com/2db4tvn6 UR - https://www.jmir.org/2021/11/e28185 UR - http://dx.doi.org/10.2196/28185 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783674 ID - info:doi/10.2196/28185 ER - TY - JOUR AU - Beukenhorst, L. Anna AU - Sergeant, C. Jamie AU - Schultz, M. David AU - McBeth, John AU - Yimer, B. Belay AU - Dixon, G. Will PY - 2021/11/16 TI - Understanding the Predictors of Missing Location Data to Inform Smartphone Study Design: Observational Study JO - JMIR Mhealth Uhealth SP - e28857 VL - 9 IS - 11 KW - geolocation KW - global positioning system KW - smartphones KW - mobile phone KW - mobile health KW - environmental exposures KW - data analysis KW - digital epidemiology KW - missing data KW - location data KW - mobile application N2 - Background: Smartphone location data can be used for observational health studies (to determine participant exposure or behavior) or to deliver a location-based health intervention. However, missing location data are more common when using smartphones compared to when using research-grade location trackers. Missing location data can affect study validity and intervention safety. Objective: The objective of this study was to investigate the distribution of missing location data and its predictors to inform design, analysis, and interpretation of future smartphone (observational and interventional) studies. Methods: We analyzed hourly smartphone location data collected from 9665 research participants on 488,400 participant days in a national smartphone study investigating the association between weather conditions and chronic pain in the United Kingdom. We used a generalized mixed-effects linear model with logistic regression to identify whether a successfully recorded geolocation was associated with the time of day, participants? time in study, operating system, time since previous survey completion, participant age, sex, and weather sensitivity. Results: For most participants, the app collected a median of 2 out of a maximum of 24 locations (1760/9665, 18.2% of participants), no location data (1664/9665, 17.2%), or complete location data (1575/9665, 16.3%). The median locations per day differed by the operating system: participants with an Android phone most often had complete data (a median of 24/24 locations) whereas iPhone users most often had a median of 2 out of 24 locations. The odds of a successfully recorded location for Android phones were 22.91 times higher than those for iPhones (95% CI 19.53-26.87). The odds of a successfully recorded location were lower during weekends (odds ratio [OR] 0.94, 95% CI 0.94-0.95) and nights (OR 0.37, 95% CI 0.37-0.38), if time in study was longer (OR 0.99 per additional day in study, 95% CI 0.99-1.00), and if a participant had not used the app recently (OR 0.96 per additional day since last survey entry, 95% CI 0.96-0.96). Participant age and sex did not predict missing location data. Conclusions: The predictors of missing location data reported in our study could inform app settings and user instructions for future smartphone (observational and interventional) studies. These predictors have implications for analysis methods to deal with missing location data, such as imputation of missing values or case-only analysis. Health studies using smartphones for data collection should assess context-specific consequences of high missing data, especially among iPhone users, during the night and for disengaged participants. UR - https://mhealth.jmir.org/2021/11/e28857 UR - http://dx.doi.org/10.2196/28857 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783661 ID - info:doi/10.2196/28857 ER - TY - JOUR AU - Horvath, Mark AU - Grutman, Aurora AU - O'Malley, S. Stephanie AU - Gueorguieva, Ralitza AU - Khan, Nashmia AU - Brewer, A. Judson AU - Garrison, A. Kathleen PY - 2021/11/16 TI - Smartband-Based Automatic Smoking Detection and Real-time Mindfulness Intervention: Protocol for a Feasibility Trial JO - JMIR Res Protoc SP - e32521 VL - 10 IS - 11 KW - smartband KW - smartphone KW - smoking KW - mindfulness KW - craving KW - mHealth N2 - Background: Smoking is the leading cause of preventable death in the United States. Smoking cessation interventions delivered by smartphone apps are a promising tool for helping smokers quit. However, currently available smartphone apps for smoking cessation have not exploited their unique potential advantages to aid quitting. Notably, few to no available apps use wearable technologies, most apps require users to self-report their smoking, and few to no apps deliver treatment automatically contingent upon smoking. Objective: This pilot trial tests the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver brief mindfulness interventions in real time to reduce smoking. Methods: Daily smokers (N=100, ?5 cigarettes per day) wear a smartband for 60 days to monitor and detect smoking, notify them about their smoking events in real time, and deliver real-time brief mindfulness exercises triggered by detected smoking events or targeted at predicted smoking events. Smokers set a quit date at 30 days. A three-step intervention to reduce smoking is tested. First, participants wear a smartband to monitor and detect smoking, and notify them of smoking events in real time to bring awareness to smoking and triggers for 21 days. Next, a ?mindful smoking? exercise is triggered by detected smoking events to bring a clear recognition of the actual effects of smoking for 7 days. Finally, after their quit date, a ?RAIN? (recognize, allow, investigate, nonidentification) exercise is delivered to predicted smoking events (based on the initial 3 weeks of tracking smoking data) to help smokers learn to work mindfully with cravings rather than smoke for 30 days. The primary outcomes are feasibility measures of treatment fidelity, adherence, and acceptability. The secondary outcomes are smoking rates at end of treatment. Results: Recruitment for this trial started in May 2021 and will continue until November 2021 or until enrollment is completed. Data monitoring and management are ongoing for enrolled participants. The final 60-day end of treatment data is anticipated in January 2022. We expect that all trial results will be available in April 2022. Conclusions: Findings will provide data and information on the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver real-time brief mindfulness interventions, and whether the intervention warrants additional testing for smoking cessation. Trial Registration: ClinicalTrials.gov NCT03995225; https://clinicaltrials.gov/ct2/show/NCT03995225 International Registered Report Identifier (IRRID): DERR1-10.2196/32521 UR - https://www.researchprotocols.org/2021/11/e32521 UR - http://dx.doi.org/10.2196/32521 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783663 ID - info:doi/10.2196/32521 ER - TY - JOUR AU - Yakovchenko, Vera AU - McInnes, Keith D. AU - Petrakis, Ann Beth AU - Gillespie, Chris AU - Lipschitz, M. Jessica AU - McCullough, B. Megan AU - Richardson, Lorilei AU - Vetter, Brian AU - Hogan, P. Timothy PY - 2021/11/15 TI - Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework JO - JMIR Mhealth Uhealth SP - e31037 VL - 9 IS - 11 KW - implementation science KW - implementation facilitation KW - texting KW - veterans KW - eHealth KW - self-management KW - digital health KW - digital medicine N2 - Background: The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective: We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods: Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results: We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions: VHA?s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration: ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349 UR - https://mhealth.jmir.org/2021/11/e31037 UR - http://dx.doi.org/10.2196/31037 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779779 ID - info:doi/10.2196/31037 ER - TY - JOUR AU - Whale, Katie AU - Beasant, Lucy AU - Wright, J. Anne AU - Yardley, Lucy AU - Wallace, M. Louise AU - Moody, Louise AU - Joinson, Carol PY - 2021/11/15 TI - A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp JO - JMIR Pediatr Parent SP - e26212 VL - 4 IS - 4 KW - incontinence KW - urinary incontinence KW - digital intervention KW - child health KW - pediatric KW - pediatric incontinence KW - smartphone KW - intervention development KW - mobile phone N2 - Background: Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. Objective: This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. Methods: URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. Results: Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. Conclusions: The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life. UR - https://pediatrics.jmir.org/2021/4/e26212 UR - http://dx.doi.org/10.2196/26212 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779780 ID - info:doi/10.2196/26212 ER - TY - JOUR AU - Ben-Zeev, Dror AU - Chander, Ayesha AU - Tauscher, Justin AU - Buck, Benjamin AU - Nepal, Subigya AU - Campbell, Andrew AU - Doron, Guy PY - 2021/11/12 TI - A Smartphone Intervention for People With Serious Mental Illness: Fully Remote Randomized Controlled Trial of CORE JO - J Med Internet Res SP - e29201 VL - 23 IS - 11 KW - mobile health KW - schizophrenia KW - bipolar disorder KW - depression KW - mobile phone N2 - Background: People with serious mental illness (SMI) have significant unmet mental health needs. Development and testing of digital interventions that can alleviate the suffering of people with SMI is a public health priority. Objective: The aim of this study is to conduct a fully remote randomized waitlist-controlled trial of CORE, a smartphone intervention that comprises daily exercises designed to promote reassessment of dysfunctional beliefs in multiple domains. Methods: Individuals were recruited via the web using Google and Facebook advertisements. Enrolled participants were randomized into either active intervention or waitlist control groups. Participants completed the Beck Depression Inventory-Second Edition (BDI-II), Generalized Anxiety Disorder-7 (GAD-7), Hamilton Program for Schizophrenia Voices, Green Paranoid Thought Scale, Recovery Assessment Scale (RAS), Rosenberg Self-Esteem Scale (RSES), Friendship Scale, and Sheehan Disability Scale (SDS) at baseline (T1), 30-day (T2), and 60-day (T3) assessment points. Participants in the active group used CORE from T1 to T2, and participants in the waitlist group used CORE from T2 to T3. Both groups completed usability and accessibility measures after they concluded their intervention periods. Results: Overall, 315 individuals from 45 states participated in this study. The sample comprised individuals with self-reported bipolar disorder (111/315, 35.2%), major depressive disorder (136/315, 43.2%), and schizophrenia or schizoaffective disorder (68/315, 21.6%) who displayed moderate to severe symptoms and disability levels at baseline. Participants rated CORE as highly usable and acceptable. Intent-to-treat analyses showed significant treatment×time interactions for the BDI-II (F1,313=13.38; P<.001), GAD-7 (F1,313=5.87; P=.01), RAS (F1,313=23.42; P<.001), RSES (F1,313=19.28; P<.001), and SDS (F1,313=10.73; P=.001). Large effects were observed for the BDI-II (d=0.58), RAS (d=0.61), and RSES (d=0.64); a moderate effect size was observed for the SDS (d=0.44), and a small effect size was observed for the GAD-7 (d=0.20). Similar changes in outcome measures were later observed in the waitlist control group participants following crossover after they received CORE (T2 to T3). Approximately 41.5% (64/154) of participants in the active group and 60.2% (97/161) of participants in the waitlist group were retained at T2, and 33.1% (51/154) of participants in the active group and 40.3% (65/161) of participants in the waitlist group were retained at T3. Conclusions: We successfully recruited, screened, randomized, treated, and assessed a geographically dispersed sample of participants with SMI entirely via the web, demonstrating that fully remote clinical trials are feasible in this population; however, study retention remains challenging. CORE showed promise as a usable, acceptable, and effective tool for reducing the severity of psychiatric symptoms and disability while improving recovery and self-esteem. Rapid adoption and real-world dissemination of evidence-based mobile health interventions such as CORE are needed if we are to shorten the science-to-service gap and address the significant unmet mental health needs of people with SMI during the COVID-19 pandemic and beyond. Trial Registration: ClinicalTrials.gov NCT04068467; https://clinicaltrials.gov/ct2/show/NCT04068467 UR - https://www.jmir.org/2021/11/e29201 UR - http://dx.doi.org/10.2196/29201 UR - http://www.ncbi.nlm.nih.gov/pubmed/34766913 ID - info:doi/10.2196/29201 ER - TY - JOUR AU - Martinez, J. Gonzalo AU - Mattingly, M. Stephen AU - Robles-Granda, Pablo AU - Saha, Koustuv AU - Sirigiri, Anusha AU - Young, Jessica AU - Chawla, Nitesh AU - De Choudhury, Munmun AU - D'Mello, Sidney AU - Mark, Gloria AU - Striegel, Aaron PY - 2021/11/12 TI - Predicting Participant Compliance With Fitness Tracker Wearing and Ecological Momentary Assessment Protocols in Information Workers: Observational Study JO - JMIR Mhealth Uhealth SP - e22218 VL - 9 IS - 11 KW - adherence KW - compliance KW - wearables KW - smartphones KW - research design KW - ecological momentary assessment KW - mobile sensing KW - mobile phone N2 - Background: Studies that use ecological momentary assessments (EMAs) or wearable sensors to track numerous attributes, such as physical activity, sleep, and heart rate, can benefit from reductions in missing data. Maximizing compliance is one method of reducing missing data to increase the return on the heavy investment of time and money into large-scale studies. Objective: This paper aims to identify the extent to which compliance can be prospectively predicted from individual attributes and initial compliance. Methods: We instrumented 757 information workers with fitness trackers for 1 year and conducted EMAs in the first 56 days of study participation as part of an observational study. Their compliance with the EMA and fitness tracker wearing protocols was analyzed. Overall, 31 individual characteristics (eg, demographics and personalities) and behavioral variables (eg, early compliance and study portal use) were considered, and 14 variables were selected to create beta regression models for predicting compliance with EMAs 56 days out and wearable compliance 1 year out. We surveyed study participation and correlated the results with compliance. Results: Our modeling indicates that 16% and 25% of the variance in EMA compliance and wearable compliance, respectively, could be explained through a survey of demographics and personality in a held-out sample. The likelihood of higher EMA and wearable compliance was associated with being older (EMA: odds ratio [OR] 1.02, 95% CI 1.00-1.03; wearable: OR 1.02, 95% CI 1.01-1.04), speaking English as a first language (EMA: OR 1.38, 95% CI 1.05-1.80; wearable: OR 1.39, 95% CI 1.05-1.85), having had a wearable before joining the study (EMA: OR 1.25, 95% CI 1.04-1.51; wearable: OR 1.50, 95% CI 1.23-1.83), and exhibiting conscientiousness (EMA: OR 1.25, 95% CI 1.04-1.51; wearable: OR 1.34, 95% CI 1.14-1.58). Compliance was negatively associated with exhibiting extraversion (EMA: OR 0.74, 95% CI 0.64-0.85; wearable: OR 0.67, 95% CI 0.57-0.78) and having a supervisory role (EMA: OR 0.65, 95% CI 0.54-0.79; wearable: OR 0.66, 95% CI 0.54-0.81). Furthermore, higher wearable compliance was negatively associated with agreeableness (OR 0.68, 95% CI 0.56-0.83) and neuroticism (OR 0.85, 95% CI 0.73-0.98). Compliance in the second week of the study could help explain more variance; 62% and 66% of the variance in EMA compliance and wearable compliance, respectively, was explained. Finally, compliance correlated with participants? self-reflection on the ease of participation, usefulness of our compliance portal, timely resolution of issues, and compensation adequacy, suggesting that these are avenues for improving compliance. Conclusions: We recommend conducting an initial 2-week pilot to measure trait-like compliance and identify participants at risk of long-term noncompliance, performing oversampling based on participants? individual characteristics to avoid introducing bias in the sample when excluding data based on noncompliance, using an issue tracking portal, and providing special care in troubleshooting to help participants maintain compliance. UR - https://mhealth.jmir.org/2021/11/e22218 UR - http://dx.doi.org/10.2196/22218 UR - http://www.ncbi.nlm.nih.gov/pubmed/34766911 ID - info:doi/10.2196/22218 ER - TY - JOUR AU - Chukwu, Emeka AU - Gilroy, Sonia AU - Addaquay, Kojo AU - Jones, Nafisa Nki AU - Karimu, Gbadia Victor AU - Garg, Lalit AU - Dickson, Eva Kim PY - 2021/11/12 TI - Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey JO - JMIR Form Res SP - e23874 VL - 5 IS - 11 KW - young people KW - short message service KW - SMS KW - chatbot KW - text message KW - interactive voice response KW - IVR KW - WhatsApp KW - Facebook KW - family planning KW - contraceptives KW - Sierra Leone N2 - Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media?only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. UR - https://formative.jmir.org/2021/11/e23874 UR - http://dx.doi.org/10.2196/23874 UR - http://www.ncbi.nlm.nih.gov/pubmed/34766908 ID - info:doi/10.2196/23874 ER - TY - JOUR AU - Klein, Arno AU - Clucas, Jon AU - Krishnakumar, Anirudh AU - Ghosh, S. Satrajit AU - Van Auken, Wilhelm AU - Thonet, Benjamin AU - Sabram, Ihor AU - Acuna, Nino AU - Keshavan, Anisha AU - Rossiter, Henry AU - Xiao, Yao AU - Semenuta, Sergey AU - Badioli, Alessandra AU - Konishcheva, Kseniia AU - Abraham, Ann Sanu AU - Alexander, M. Lindsay AU - Merikangas, R. Kathleen AU - Swendsen, Joel AU - Lindner, B. Ariel AU - Milham, P. Michael PY - 2021/11/11 TI - Remote Digital Psychiatry for Mobile Mental Health Assessment and Therapy: MindLogger Platform Development Study JO - J Med Internet Res SP - e22369 VL - 23 IS - 11 KW - mental health KW - mHealth KW - mobile health KW - digital health KW - eHealth KW - digital psychiatry KW - digital phenotyping KW - teletherapy KW - mobile device KW - mobile phone KW - smartphone KW - ecological momentary assessment KW - ecological momentary intervention KW - EMA KW - EMI KW - ESM KW - experience sampling KW - experience sampling methods N2 - Background: Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health. Objective: This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations. Methods: We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform?s configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study. Results: Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users? data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser?based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings. Conclusions: We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health?related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population. UR - https://www.jmir.org/2021/11/e22369 UR - http://dx.doi.org/10.2196/22369 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762054 ID - info:doi/10.2196/22369 ER - TY - JOUR AU - Lee, Bohee AU - Ibrahim, Aishah Siti AU - Zhang, Tiying PY - 2021/11/11 TI - Mobile Apps Leveraged in the COVID-19 Pandemic in East and South-East Asia: Review and Content Analysis JO - JMIR Mhealth Uhealth SP - e32093 VL - 9 IS - 11 KW - mobile apps KW - applications KW - eHealth KW - mHealth KW - mobile health KW - digital health KW - telemedicine KW - telehealth KW - COVID-19 KW - coronavirus KW - pandemic KW - public health KW - health policy N2 - Background: The COVID-19 pandemic increased attention to digital tools to support governmental public health policies in East and South-East Asia. Mobile apps related to the COVID-19 pandemic continue to emerge and evolve with a wide variety of characteristics and functions. However, there is a paucity of studies evaluating such apps in this region, with most of the available studies conducted in the early days of the pandemic. Objective: This study aimed to examine free apps developed or supported by governments in the East and South-East Asian region and highlight their key characteristics and functions. We also sought to interpret how the release dates of these apps were related to the commencement dates of other COVID-19 public health policies. Methods: We systematically searched for apps in Apple App Store and Google Play Store and analyzed the contents of eligible apps. Mobile apps released or updated with COVID-19?related functions between March 1 and May 7, 2021, in Singapore, Taiwan, South Korea, China (mainland), Japan, Thailand, Hong Kong, Vietnam, Malaysia, Indonesia, and the Philippines were included. The CoronaNet Research Project database was also examined to determine the timeline of public health policy commencement dates in relation to the release dates of the included apps. We assessed each app?s official website, media reports, and literature through content analysis. Descriptive statistics were used to summarize relevant information gathered from the mobile apps using RStudio. Results: Of the 1943 mobile apps initially identified, 46 were eligible, with almost 70% of the apps being intended for the general public. Most apps were from Vietnam (n=9, 20%), followed by Malaysia, Singapore, and Thailand (n=6 each, 13%). Of note, most apps for quarantine monitoring (n=6, 13%) were mandatory for the target users or a population subset. The most common function was health monitoring (32/46, 70%), followed by raising public health awareness (19/46, 41%) through education and information dissemination. Other functions included monitoring quarantine (12/46, 26%), providing health resources (12/46, 26%). COVID-19 vaccination management functions began to appear in parallel with vaccine rollout (7/46, 15%). Regarding the timing of the introduction of mobile solutions, the majority of mobile apps emerged close to the commencement dates of other public health policies in the early stages of the pandemic between March and April 2020. Conclusions: In East and South-East Asia, most governments used mobile health apps as adjuncts to public health measures for tracking COVID-19 cases and delivering credible information. In addition, these apps have evolved by expanding their functions for COVID-19 vaccination. UR - https://mhealth.jmir.org/2021/11/e32093 UR - http://dx.doi.org/10.2196/32093 UR - http://www.ncbi.nlm.nih.gov/pubmed/34748515 ID - info:doi/10.2196/32093 ER - TY - JOUR AU - Przybylko, Geraldine AU - Morton, Darren AU - Morton, Jason AU - Renfrew, Melanie PY - 2021/11/11 TI - The Influence of Gender and Age on the Outcomes of and Adherence to a Digital Interdisciplinary Mental Health Promotion Intervention in an Australasian Nonclinical Setting: Cohort Study JO - JMIR Ment Health SP - e29866 VL - 8 IS - 11 KW - age KW - gender KW - adherence KW - digital health KW - interdisciplinary KW - mental health KW - promotion KW - intervention KW - lifestyle medicine KW - positive psychology KW - multicomponent KW - lifestyle KW - outcome KW - cohort study N2 - Background: The global prevalence of mental health disorders is at a crisis point, particularly in the wake of COVID-19, prompting calls for the development of digital interdisciplinary mental health promotion interventions (MHPIs) for nonclinical cohorts. However, the influence of gender and age on the outcomes of and adherence to MHPIs is not well understood. Objective: The aim of this study was to determine the influence of gender and age on the outcomes of and adherence to a 10-week digital interdisciplinary MHPI that integrates strategies from positive psychology and lifestyle medicine and utilizes persuasive systems design (PSD) principles in a nonclinical setting. Methods: This study involved 488 participants who completed the digital interdisciplinary MHPI. Participants completed a pre and postintervention questionnaire that used: (1) the ?mental health? and ?vitality? subscales from the Short Form 36 (SF-36) Health Survey; (2) the Depression, Anxiety and Stress Scale (DASS-21); and (3) Satisfaction With Life Scale (SWL). Adherence to the digital interdisciplinary MHPI was measured by the number of educational videos the participants viewed and the extent to which they engaged in experiential challenge activities offered as part of the program. Results: On average, the participants (N=488; mean age 47.1 years, SD 14.1; 77.5% women) demonstrated statistically significant improvements in all mental health and well-being outcome measures, and a significant gender and age interaction was observed. Women tended to experience greater improvements than men in the mental health and well-being measures, and older men experienced greater improvements than younger men in the mental health and vitality subscales. Multiple analysis of variance results of the adherence measures indicated a significant difference for age but not gender. No statistically significant interaction between gender and age was observed for adherence measures. Conclusions: Digital interdisciplinary MHPIs that utilize PSD principles can improve the mental health and well-being of nonclinical cohorts, regardless of gender or age. Hence, there may be a benefit in utilizing PSD principles to develop universal MHPIs such as that employed in this study, which can be used across gender and age groups. Future research should examine which PSD principles optimize universal digital interdisciplinary MHPIs. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000993190; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377889 and Australian New Zealand Clinical Trials Registry ACTRN12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx UR - https://mental.jmir.org/2021/11/e29866 UR - http://dx.doi.org/10.2196/29866 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762058 ID - info:doi/10.2196/29866 ER - TY - JOUR AU - Noorbergen, J. Tyler AU - Adam, P. Marc T. AU - Teubner, Timm AU - Collins, E. Clare PY - 2021/11/10 TI - Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development JO - JMIR Mhealth Uhealth SP - e27896 VL - 9 IS - 11 KW - co-design KW - mHealth KW - guidelines KW - qualitative study KW - mobile phone N2 - Background: The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development. Objective: Despite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems. Methods: Tapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development. Results: The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact. Conclusions: System designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research. UR - https://mhealth.jmir.org/2021/11/e27896 UR - http://dx.doi.org/10.2196/27896 UR - http://www.ncbi.nlm.nih.gov/pubmed/34757323 ID - info:doi/10.2196/27896 ER - TY - JOUR AU - Klimis, Harry AU - Nothman, Joel AU - Lu, Di AU - Sun, Chao AU - Cheung, Wah N. AU - Redfern, Julie AU - Thiagalingam, Aravinda AU - Chow, K. Clara PY - 2021/11/10 TI - Text Message Analysis Using Machine Learning to Assess Predictors of Engagement With Mobile Health Chronic Disease Prevention Programs: Content Analysis JO - JMIR Mhealth Uhealth SP - e27779 VL - 9 IS - 11 KW - mHealth KW - machine learning KW - chronic disease KW - cardiovascular KW - text messaging KW - SMS KW - digital health KW - mobile phone KW - engagement KW - prevention N2 - Background: SMS text messages as a form of mobile health are increasingly being used to support individuals with chronic diseases in novel ways that leverage the mobility and capabilities of mobile phones. However, there are knowledge gaps in mobile health, including how to maximize engagement. Objective: This study aims to categorize program SMS text messages and participant replies using machine learning (ML) and to examine whether message characteristics are associated with premature program stopping and engagement. Methods: We assessed communication logs from SMS text message?based chronic disease prevention studies that encouraged 1-way (SupportMe/ITM) and 2-way (TEXTMEDS [Text Messages to Improve Medication Adherence and Secondary Prevention]) communication. Outgoing messages were manually categorized into 5 message intents (informative, instructional, motivational, supportive, and notification) and replies into 7 groups (stop, thanks, questions, reporting healthy, reporting struggle, general comment, and other). Grid search with 10-fold cross-validation was implemented to identify the best-performing ML models and evaluated using nested cross-validation. Regression models with interaction terms were used to compare the association of message intent with premature program stopping and engagement (replied at least 3 times and did not prematurely stop) in SupportMe/ITM and TEXTMEDS. Results: We analyzed 1550 messages and 4071 participant replies. Approximately 5.49% (145/2642) of participants responded with stop, and 11.7% (309/2642) of participants were engaged. Our optimal ML model correctly classified program message intent with 76.6% (95% CI 63.5%-89.8%) and replies with 77.8% (95% CI 74.1%-81.4%) balanced accuracy (average area under the curve was 0.95 and 0.96, respectively). Overall, supportive (odds ratio [OR] 0.53, 95% CI 0.35-0.81) messages were associated with reduced chance of stopping, as were informative messages in SupportMe/ITM (OR 0.35, 95% CI 0.20-0.60) but not in TEXTMEDS (for interaction, P<.001). Notification messages were associated with a higher chance of stopping in SupportMe/ITM (OR 5.76, 95% CI 3.66-9.06) but not TEXTMEDS (for interaction, P=.01). Overall, informative (OR 1.76, 95% CI 1.46-2.12) and instructional (OR 1.47, 95% CI 1.21-1.80) messages were associated with higher engagement but not motivational messages (OR 1.18, 95% CI 0.82-1.70; P=.37). For supportive messages, the association with engagement was opposite with SupportMe/ITM (OR 1.77, 95% CI 1.21-2.58) compared with TEXTMEDS (OR 0.77, 95% CI 0.60-0.98; for interaction, P<.001). Notification messages were associated with reduced engagement in SupportMe/ITM (OR 0.07, 95% CI 0.05-0.10) and TEXTMEDS (OR 0.28, 95% CI 0.20-0.39); however, the strength of the association was greater in SupportMe/ITM (for interaction P<.001). Conclusions: ML models enable monitoring and detailed characterization of program messages and participant replies. Outgoing message intent may influence premature program stopping and engagement, although the strength and direction of association appear to vary by program type. Future studies will need to examine whether modifying message characteristics can optimize engagement and whether this leads to behavior change. UR - https://mhealth.jmir.org/2021/11/e27779 UR - http://dx.doi.org/10.2196/27779 UR - http://www.ncbi.nlm.nih.gov/pubmed/34757324 ID - info:doi/10.2196/27779 ER - TY - JOUR AU - Elavsky, Steriani AU - Klocek, Adam AU - Knapova, Lenka AU - Smahelova, Martina AU - Smahel, David AU - Cimler, Richard AU - Kuhnova, Jitka PY - 2021/11/10 TI - Feasibility of Real-time Behavior Monitoring Via Mobile Technology in Czech Adults Aged 50 Years and Above: 12-Week Study With Ecological Momentary Assessment JO - JMIR Aging SP - e15220 VL - 4 IS - 4 KW - mHealth KW - mobile phone KW - older adults KW - health behavior KW - physical activity KW - Fitbit N2 - Background: Czech older adults have lower rates of physical activity than the average population and lag behind in the use of digital technologies, compared with their peers from other European countries. Objective: This study aims to assess the feasibility of intensive behavior monitoring through technology in Czech adults aged ?50 years. Methods: Participants (N=30; mean age 61.2 years, SD 6.8 years, range 50-74 years; 16/30, 53% male; 7/30, 23% retired) were monitored for 12 weeks while wearing a Fitbit Charge 2 monitor and completed three 8-day bursts of intensive data collection through surveys presented on a custom-made mobile app. Web-based surveys were also completed before and at the end of the 12-week period (along with poststudy focus groups) to evaluate participants? perceptions of their experience in the study. Results: All 30 participants completed the study. Across the three 8-day bursts, participants completed 1454 out of 1744 (83% compliance rate) surveys administered 3 times per day on a pseudorandom schedule, 451 out of 559 (81% compliance rate) end-of-day surveys, and 736 episodes of self-reported planned physical activity (with 29/736, 3.9% of the reports initiated but returned without data). The overall rating of using the mobile app and Fitbit was above average (74.5 out of 100 on the System Usability Scale). The majority reported that the Fitbit (27/30, 90%) and mobile app (25/30, 83%) were easy to use and rated their experience positively (25/30, 83%). Focus groups revealed that some surveys were missed owing to notifications not being noticed or that participants needed a longer time window for survey completion. Some found wearing the monitor in hot weather or at night uncomfortable, but overall, participants were highly motivated to complete the surveys and be compliant with the study procedures. Conclusions: The use of a mobile survey app coupled with a wearable device appears feasible for use among Czech older adults. Participants in this study tolerated the intensive assessment schedule well, but lower compliance may be expected in studies of more diverse groups of older adults. Some difficulties were noted with the pairing and synchronization of devices on some types of smartphones, posing challenges for large-scale studies. UR - https://aging.jmir.org/2021/4/e15220 UR - http://dx.doi.org/10.2196/15220 UR - http://www.ncbi.nlm.nih.gov/pubmed/34757317 ID - info:doi/10.2196/15220 ER - TY - JOUR AU - Li, Yiran AU - Guo, Yan AU - Hong, Alicia Y. AU - Zeng, Chengbo AU - Zeng, Yu AU - Zhang, Hanxi AU - Zhu, Mengting AU - Qiao, Jiaying AU - Cai, Weiping AU - Li, Linghua AU - Liu, Cong PY - 2021/11/9 TI - Mediating Effects of Stigma and Depressive Symptoms in a Social Media?Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial JO - J Med Internet Res SP - e27897 VL - 23 IS - 11 KW - mHealth KW - HIV KW - depressive symptoms KW - quality of life KW - structural equation model N2 - Background: Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions. Objective: This study aims to explore the intervention mechanisms of a social media?based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period. Methods: We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants? QOL. Results: About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported. Conclusions: These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media?based interventions that can address HIV-related stigma and alleviate depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019 UR - https://www.jmir.org/2021/11/e27897 UR - http://dx.doi.org/10.2196/27897 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751654 ID - info:doi/10.2196/27897 ER - TY - JOUR AU - Bricker, B. Jonathan AU - Levin, Michael AU - Lappalainen, Raimo AU - Mull, Kristin AU - Sullivan, Brianna AU - Santiago-Torres, Margarita PY - 2021/11/9 TI - Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial JO - JMIR Mhealth Uhealth SP - e32847 VL - 9 IS - 11 KW - mediation KW - engagement KW - digital KW - mHealth: smartphone KW - acceptance KW - smoking KW - cessation KW - app KW - randomized controlled trial KW - model KW - intervention N2 - Background: Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. Objective: This study aimed to test a serial mediation model of an Acceptance and Commitment Therapy (ACT) smartphone intervention for smoking cessation. Methods: In this randomized controlled trial, participants (N=2415) from 50 US states were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the apps (primary measure: number of logins) was measured during the first 3 months, ACT processes were measured at baseline and 3 months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12 months with 87% follow-up retention. Results: There was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (ie, total number of logins, total number of minutes used, and total number of unique days of use) and in turn through increases in mean acceptance of internal cues to smoke from baseline to 3 months. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated through changes in valued living. Conclusions: In this first study of serial mediators underlying the efficacy of smartphone apps for smoking cessation, our results suggest the effect of the iCanQuit ACT-based smartphone app on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in the acceptance of physical sensations and emotions that cue smoking. Trial Registration: Clinical Trials.gov NCT02724462; https://clinicaltrials.gov/ct2/show/NCT02724462 UR - https://mhealth.jmir.org/2021/11/e32847 UR - http://dx.doi.org/10.2196/32847 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751662 ID - info:doi/10.2196/32847 ER - TY - JOUR AU - Jain, Deeptee AU - Norman, Kevin AU - Werner, Zachary AU - Makovoz, Bar AU - Baker, Turner AU - Huber, Stephan PY - 2021/11/9 TI - Using Postmarket Surveillance to Assess Safety-Related Events in a Digital Rehabilitation App (Kaia App): Observational Study JO - JMIR Hum Factors SP - e25453 VL - 8 IS - 4 KW - lower back pain KW - digital therapeutics KW - adverse event KW - pain KW - safety KW - digital health KW - multidisciplinary pain treatment N2 - Background: Low back pain (LBP) affects nearly 4 out of 5 individuals during their lifetime and is the leading cause of disability globally. Digital therapeutics are emerging as effective treatment options for individuals experiencing LBP. Despite the growth of evidence demonstrating the benefits of these therapeutics in reducing LBP and improving functional outcomes, little data has been systematically collected on their safety profiles. Objective: This study aims to evaluate the safety profile of a multidisciplinary digital therapeutic for LBP, the Kaia App, by performing a comprehensive assessment of reported adverse events (AEs) by users as captured by a standardized process for postmarket surveillance. Methods: All users of a multidisciplinary digital app that includes physiotherapy, mindfulness techniques, and education for LBP (Kaia App) from 2018 to 2019 were included. Relevant messages sent by users via the app were collected according to a standard operating procedure regulating postmarket surveillance of the device. These messages were then analyzed to determine if they described an adverse event (AE). Messages describing an AE were then categorized based on the type of AE, its seriousness, and its relatedness to the app, and they were described by numerical counts. User demographics, including age and gender, and data on app use were collected and evaluated to determine if they were risk factors for increased AE reporting. Results: Of the 138,337 active users of the Kaia App, 125 (0.09%) reported at least one AE. Users reported 0.00014 AEs per active day on the app. The most common nonserious AE reported was increased pain. Other nonserious AEs reported included muscle issues, unpleasant sensations, headache, dizziness, and sleep disturbances. One serious AE, a surgery, was reported. Details of the event and its connection to the intervention were not obtainable, as the user did not provide more information when asked to do so; therefore, it was considered to be possibly related to the intervention. There was no relationship between gender and AE reporting (P>.99). Users aged 25 to 34 years had reduced odds (odds ratio [OR] 0.31, 95% CI 0.08-0.95; P=.03) of reporting AEs, while users aged 55 to 65 years (OR 2.53, 95% CI 1.36-4.84, P=.002) and ?75 years (OR 4.36, 95% CI 1.07-13.26; P=.02) had increased odds. AEs were most frequently reported by users who had 0 to 99 active days on the app, and less frequently reported by users with more active days on the app. Conclusions: This study on the Kaia App provides the first comprehensive assessment of reported AEs associated with real-world use of digital therapeutics for lower back pain. The overall rate of reported AEs was very low, but significant reporting bias is likely to be present. The AEs reported were generally consistent with those described for in-person therapies for LBP. UR - https://humanfactors.jmir.org/2021/4/e25453 UR - http://dx.doi.org/10.2196/25453 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751664 ID - info:doi/10.2196/25453 ER - TY - JOUR AU - Malamsha, Proches Maria AU - Sauli, Elingarami AU - Luhanga, Talina Edith PY - 2021/11/8 TI - Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study JO - JMIR Serious Games SP - e30350 VL - 9 IS - 4 KW - child sexual abuse KW - social cultural belief KW - ecological setting KW - prevention KW - parents KW - caretakers KW - child experts KW - mobile game N2 - Background: Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa?where sexual education is still taboo?that would be engaging, effective, and acceptable to parents and caretakers. Objective: This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention. Methods:  HappyToto children?s game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game?s interface, storylines, and options. To validate the application?s prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game. Results: Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities. Conclusions: The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education. UR - https://games.jmir.org/2021/4/e30350 UR - http://dx.doi.org/10.2196/30350 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747703 ID - info:doi/10.2196/30350 ER - TY - JOUR AU - Eisenstadt, Mia AU - Liverpool, Shaun AU - Infanti, Elisa AU - Ciuvat, Maria Roberta AU - Carlsson, Courtney PY - 2021/11/8 TI - Mobile Apps That Promote Emotion Regulation, Positive Mental Health, and Well-being in the General Population: Systematic Review and Meta-analysis JO - JMIR Ment Health SP - e31170 VL - 8 IS - 11 KW - systematic review KW - MHapp, mHealth KW - mental health KW - well-being KW - emotion regulation KW - mobile apps KW - effectiveness KW - monitoring KW - management KW - mental health app N2 - Background: Among the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being. Objective: We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness. Methods: A comprehensive literature search of key databases, including MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL), was performed until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. The quality of all studies was assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane Risk-of-Bias tool (RoB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form from the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis were then undertaken to address the review aims. Results: In total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together, the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified suggesting some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding the pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k=19, Hedges g=?0.24, 95% CI ?0.34 to ?0.14; P<.001) and improving well-being (k=13, g=0.17, 95% CI 0.05-0.29, P=.004), and a medium effect for emotion regulation (k=6, g=0.49, 95% CI 0.23-0.74, P<.001). There is also a wide knowledge base of creative and innovative ways to engage users in techniques such as mood monitoring and guided exercises. Studies were generally assessed to contribute unclear or a high risk of bias, or to be of medium to low methodological quality. Conclusions: The emerging evidence for MHapps that promote positive mental health and well-being suggests promising outcomes. Despite a wide range of MHapps, few apps specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future MHapps. A fair proportion of the included studies were pilot or feasibility trials (k=17, 33%), and full-scale RCTs reported high attrition rates and nondiverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs. UR - https://mental.jmir.org/2021/11/e31170 UR - http://dx.doi.org/10.2196/31170 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747713 ID - info:doi/10.2196/31170 ER - TY - JOUR AU - Carey, Alissa AU - Yang, Qiuchen AU - DeLuca, Laura AU - Toro-Ramos, Tatiana AU - Kim, Youngin AU - Michaelides, Andreas PY - 2021/11/8 TI - The Relationship Between Weight Loss Outcomes and Engagement in a Mobile Behavioral Change Intervention: Retrospective Analysis JO - JMIR Mhealth Uhealth SP - e30622 VL - 9 IS - 11 KW - engagement KW - mHealth KW - obesity KW - weight management KW - Noom KW - application KW - app KW - behavioral change KW - digital behavior change interventions N2 - Background: There is large variance in weight loss outcomes of digital behavior change interventions (DBCIs). It has been suggested that different patterns of engagement in the program could be responsible for this variance in outcomes. Previous studies have found that the amount of engagement on DBCIs, such as the number of meals logged or articles read, is positively associated with weight loss. Objective: This retrospective study extends previous research by observing how important weight loss outcomes (high weight loss: 10% or greater body weight loss; moderate weight loss: between 5% to 10%; stable weight: 0 plus or minus 1%) are associated with engagement on a publicly available mobile DBCI (Noom) from 9 to 52 weeks. Methods: Engagement and weight data for eligible participants (N=11,252) were extracted from the Noom database. Engagement measures included the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with 1 meal logged per week. Weight was self-reported on the program. Multiple linear regressions examined how weight loss outcome (moderate and high vs stable) was associated with each engagement measure across 3 study time periods: 9-16 weeks, 17-32 weeks, and 33-52 weeks. Results: At 9-16 weeks, among the 11,252 participants, 2594 (23.05%) had stable weight, 6440 (57.23%) had moderate weight loss, and 2218 (19.71%) had high weight loss. By 33-52 weeks, 525 (18.21%) had stable weight, 1214 (42.11%) had moderate weight loss, and 1144 (39.68%) had high weight loss. Regression results showed that moderate weight loss and high weight loss outcomes were associated with all engagement measures to a significantly greater degree than was stable weight (all P values <.001). These differences held across all time periods with the exception of exercise for the moderate weight loss category at 1 time period of 33-52 weeks. Exercise logging increased from 9 to 52 weeks regardless of the weight loss group. Conclusions: Our results suggest that these clinically important weight loss outcomes are related to the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with 1 meal logged per week both in the short-term and long-term (ie, 1 year) on Noom. This provides valuable data on engagement patterns over time on a self-directed mobile DBCI, can help inform how interventions tailor recommendations for engagement depending on how much weight individuals have lost, and raises important questions for future research on engagement in DBCIs. UR - https://mhealth.jmir.org/2021/11/e30622 UR - http://dx.doi.org/10.2196/30622 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747706 ID - info:doi/10.2196/30622 ER - TY - JOUR AU - Walker, Jan AU - Leveille, Suzanne AU - Kriegel, Gila AU - Lin, Chen-Tan AU - Liu, K. Stephen AU - Payne, H. Thomas AU - Harcourt, Kendall AU - Dong, Zhiyong AU - Fitzgerald, Patricia AU - Germak, Matthew AU - Markson, Lawrence AU - Jackson, L. Sara AU - Shucard, Hannah AU - Elmore, G. Joann AU - Delbanco, Tom PY - 2021/11/8 TI - Patients Contributing to Visit Notes: Mixed Methods Evaluation of OurNotes JO - J Med Internet Res SP - e29951 VL - 23 IS - 11 KW - electronic health record KW - previsit information KW - physician-patient relations KW - patient portal KW - mobile phone N2 - Background: Secure patient portals are widely available, and patients use them to view their electronic health records, including their clinical notes. We conducted experiments asking them to cogenerate notes with their clinicians, an intervention called OurNotes. Objective: This study aims to assess patient and provider experiences and attitudes after 12 months of a pilot intervention. Methods: Before scheduled primary care visits, patients were asked to submit a word-constrained, unstructured interval history and an agenda for what they would like to discuss at the visit. Using site-specific methods, their providers were invited to incorporate the submissions into notes documenting the visits. Sites served urban, suburban, and rural patients in primary care practices in 4 academic health centers in Boston (Massachusetts), Lebanon (New Hampshire), Denver (Colorado), and Seattle (Washington). Each practice offered electronic access to visit notes (open notes) to its patients for several years. A mixed methods evaluation used tracking data and electronic survey responses from patients and clinicians. Participants were 174 providers and 1962 patients who submitted at least 1 previsit form. We asked providers about the usefulness of the submissions, effects on workflow, and ideas for the future. We asked patients about difficulties and benefits of providing the requested information and ideas for future improvements. Results: Forms were submitted before 9.15% (5365/58,652) eligible visits, and 43.7% (76/174) providers and 26.76% (525/1962) patients responded to the postintervention evaluation surveys; 74 providers and 321 patients remembered receiving and completing the forms and answered the survey questions. Most clinicians thought interim patient histories (69/74, 93%) and patient agendas (72/74, 97%) as good ideas, 70% (52/74) usually or always incorporated them into visit notes, 54% (40/74) reported no change in visit length, and 35% (26/74) thought they saved time. Their most common suggestions related to improving notifications when patient forms were received, making it easier to find the form and insert it into the note, and educating patients about how best to prepare their submissions. Patient respondents were generally well educated, most found the history (259/321, 80.7%) and agenda (286/321, 89.1%) questions not difficult to answer; more than 92.2% (296/321) thought sending answers before the visit a good idea; 68.8% (221/321) thought the questions helped them prepare for the visit. Common suggestions by patients included learning to write better answers and wanting to know that their submissions were read by their clinicians. At the end of the pilot, all participating providers chose to continue the OurNotes previsit form, and sites considered expanding the intervention to more clinicians and adapting it for telemedicine visits. Conclusions: OurNotes interests patients, and providers experience it as a positive intervention. Participation by patients, care partners, clinicians, and electronic health record experts will facilitate further development. UR - https://www.jmir.org/2021/11/e29951 UR - http://dx.doi.org/10.2196/29951 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747710 ID - info:doi/10.2196/29951 ER - TY - JOUR AU - Kaiser, Sabine AU - Martinussen, Monica AU - Adolfsen, Frode AU - Breivik, Kyrre AU - Kyrrestad, Henriette PY - 2021/11/8 TI - An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e31789 VL - 10 IS - 11 KW - cyberbullying KW - intervention KW - mobile app KW - adolescents KW - NettOpp KW - mental health KW - health care N2 - Background: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. Objective: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. Methods: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. Results: Recruitment will start in January 2022. The results from this study will be available in 2023. Conclusions: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field. Trial Registration: ClinicalTrials.gov NCT04176666; https://clinicaltrials.gov/ct2/show/NCT04176666 International Registered Report Identifier (IRRID): PRR1-10.2196/31789 UR - https://www.researchprotocols.org/2021/11/e31789 UR - http://dx.doi.org/10.2196/31789 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747704 ID - info:doi/10.2196/31789 ER - TY - JOUR AU - Kim, Ben AU - Ghasemi, Peyman AU - Stolee, Paul AU - Lee, Joon PY - 2021/11/5 TI - Clinicians and Older Adults? Perceptions of the Utility of Patient-Generated Health Data in Caring for Older Adults: Exploratory Mixed Methods Study JO - JMIR Aging SP - e29788 VL - 4 IS - 4 KW - mobile health KW - mHealth KW - older adults KW - wearables KW - patient generated health data KW - chronic disease management KW - home care KW - self-care KW - activities of daily living KW - sleep N2 - Background: Many people are motivated to self-track their health and optimize their well-being through mobile health apps and wearable devices. The diversity and complexity of these systems have evolved over time, resulting in a large amount of data referred to as patient-generated health data (PGHD), which has recently emerged as a useful set of data elements in health care systems around the world. Despite the increased interest in PGHD, clinicians and older adults? perceptions of PGHD are poorly understood. In particular, although some clinician barriers to using PGHD have been identified, such as concerns about data quality, ease of use, reliability, privacy, and regulatory issues, little is known from the perspectives of older adults. Objective: This study aims to explore the similarities and differences in the perceptions of older adults and clinicians with regard to how various types of PGHD can be used to care for older adults. Methods: A mixed methods study was conducted to explore clinicians and older adults? perceptions of PGHD. Focus groups were conducted with older adults and health care providers from the Greater Toronto area and the Kitchener-Waterloo region. The participants were asked to discuss their perceptions of PGHD, including facilitators and barriers. A questionnaire aimed at exploring the perceived usefulness of a range of different PGHD was also embedded in the study design. Focus group interviews were transcribed for thematic analysis, whereas the questionnaire results were analyzed using descriptive statistics. Results: Of the 9 participants, 4 (44%) were clinicians (average age 38.3 years, SD 7 years), and 5 (56%) were older adults (average age 81.0 years, SD 9.1 years). Four main themes were identified from the focus group interviews: influence of PGHD on patient-provider trust, reliability of PGHD, meaningful use of PGHD and PGHD-based decision support systems, and perceived clinical benefits and intrusiveness of PGHD. The questionnaire results were significantly correlated with the frequency of PGHD mentioned in the focus group interviews (r=0.42; P=.03) and demonstrated that older adults and clinicians perceived blood glucose, step count, physical activity, sleep, blood pressure, and stress level as the most useful data for managing health and delivering high-quality care. Conclusions: This embedded mixed methods study generated several important findings about older adults and clinicians? perceptions and perceived usefulness of a range of PGHD. Owing to the exploratory nature of this study, further research is needed to understand the concerns about data privacy, potential negative impact on the trust between older adults and clinicians, data quality and quantity, and usability of PGHD-related technologies for older adults. UR - https://aging.jmir.org/2021/4/e29788 UR - http://dx.doi.org/10.2196/29788 UR - http://www.ncbi.nlm.nih.gov/pubmed/34738913 ID - info:doi/10.2196/29788 ER - TY - JOUR AU - Stecher, Chad AU - Berardi, Vincent AU - Fowers, Rylan AU - Christ, Jaclyn AU - Chung, Yunro AU - Huberty, Jennifer PY - 2021/11/4 TI - Identifying App-Based Meditation Habits and the Associated Mental Health Benefits: Longitudinal Observational Study JO - J Med Internet Res SP - e27282 VL - 23 IS - 11 KW - behavioral habits KW - habit formation KW - mindfulness meditation KW - mental health KW - mHealth KW - mobile health KW - dynamic time warping KW - mobile phone N2 - Background: Behavioral habits are often initiated by contextual cues that occur at approximately the same time each day; so, it may be possible to identify a reflexive habit based on the temporal similarity of repeated daily behavior. Mobile health tools provide the detailed, longitudinal data necessary for constructing such an indicator of reflexive habits, which can improve our understanding of habit formation and help design more effective mobile health interventions for promoting healthier habits. Objective: This study aims to use behavioral data from a commercial mindfulness meditation mobile phone app to construct an indicator of reflexive meditation habits based on temporal similarity and estimate the association between temporal similarity and meditation app users? perceived health benefits. Methods: App-use data from June 2019 to June 2020 were analyzed for 2771 paying subscribers of a meditation mobile phone app, of whom 86.06% (2359/2771) were female, 72.61% (2012/2771) were college educated, 86.29% (2391/2771) were White, and 60.71% (1664/2771) were employed full-time. Participants volunteered to complete a survey assessing their perceived changes in physical and mental health from using the app. Receiver operating characteristic curve analysis was used to evaluate the ability of the temporal similarity measure to predict future behavior, and variable importance statistics from random forest models were used to corroborate these findings. Logistic regression was used to estimate the association between temporal similarity and self-reported physical and mental health benefits. Results: The temporal similarity of users? daily app use before completing the survey, as measured by the dynamic time warping (DTW) distance between app use on consecutive days, significantly predicted app use at 28 days and at 6 months after the survey, even after controlling for users? demographic and socioeconomic characteristics, total app sessions, duration of app use, and number of days with any app use. In addition, the temporal similarity measure significantly increased in the area under the receiver operating characteristic curve (AUC) for models predicting any future app use in 28 days (AUC=0.868 with DTW and 0.850 without DTW; P<.001) and for models predicting any app use in 6 months (AUC=0.821 with DTW and 0.802 without DTW; P<.001). Finally, a 1% increase in the temporal similarity of users? daily meditation practice with the app over 6 weeks before the survey was associated with increased odds of reporting mental health improvements, with an odds ratio of 2.94 (95% CI 1.832-6.369). Conclusions: The temporal similarity of the meditation app use was a significant predictor of future behavior, which suggests that this measure can identify reflexive meditation habits. In addition, temporal similarity was associated with greater perceived mental health benefits, which demonstrates that additional mental health benefits may be derived from forming reflexive meditation habits. UR - https://www.jmir.org/2021/11/e27282 UR - http://dx.doi.org/10.2196/27282 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734826 ID - info:doi/10.2196/27282 ER - TY - JOUR AU - Songtaweesin, Natalie Wipaporn AU - LeGrand, Sara AU - Bandara, Shashika AU - Piccone, Caitlin AU - Wongharn, Prissana AU - Moonwong, Juthamanee AU - Jupimai, Thidarat AU - Saisaengjan, Chutima AU - Theerawit, Tuangtip AU - Muessig, Kathryn AU - Hightow-Weidman, Lisa AU - Puthanakit, Thanyawee AU - Phanuphak, Nittaya AU - Tangmunkongvorakul, Arunrat PY - 2021/11/4 TI - Adaptation of a Theory-Based Social Networking and Gamified App-Based Intervention to Improve Pre-Exposure Prophylaxis Adherence Among Young Men Who Have Sex With Men in Bangkok, Thailand: Qualitative Study JO - J Med Internet Res SP - e23852 VL - 23 IS - 11 KW - mobile health KW - young men who have sex with men KW - pre-exposure prophylaxis KW - adherence KW - mobile phone N2 - Background: HIV disproportionately affects young Thai men who have sex with men (YMSM). Recent studies report a high incidence and prevalence of HIV among Thai YMSM. The Thai national guidelines have recommended pre-exposure prophylaxis (PrEP) since 2014 for key populations; free PrEP has been piloted since 2019. Smartphone-based mobile health (mHealth) interventions provide an optimal platform for innovative PrEP adherence interventions for Thai YMSM. Objective: This study aims to adapt the P3 (Prepared, Protected, emPowered) app, developed with YMSM and transwomen in the United States to improve PrEP adherence and persistence for YMSM in Thailand. The app aims to provide daily adherence support and addresses gaps in staff available for large-scale PrEP rollout needed to see population-level effects of HIV prevention. Methods: We conducted focus group discussions (FGDs) with YMSM and key informant interviews (KIIs) with PrEP care providers in Bangkok, Thailand, to investigate PrEP adherence facilitators and barriers, preferences for functions and features in mHealth apps among YMSM, and how to best adapt the P3 app to the Thai context. We conducted four FGDs with 4-8 participants per group and 15 KIIs. Results: For FGDs, 23 YMSM participated with a mean age of 20 years (range 18-21), 96% (22/23) enrolled in full-time education, and all owned smartphones. The mean age of KII participants was 40 (range 26-60) years; most were state health service providers, with the majority being counselors (6/15, 40%) and physicians (6/15, 40%). Overall, the facilitators and barriers for PrEP adherence identified were similar to those of MSM and YMSM globally including the United States. Key themes included general recommendations for improving mHealth apps in Thailand, such as presenting reliable information in an appealing format, minimizing privacy risks, and addressing connectivity challenges. Additional themes focused on P3 Thailand adaptations and were related to cultural and stylistic preferences, engagement strategies, and recommendations for new functions. To develop the adapted app, P3 Thailand, these findings were balanced with resource limitations resulting in the prioritization of minor modifications: changes in app esthetics (color scheme, iconography, and imagery) and changes in the presentation of information in two of the app?s features. FGDs identified similar PrEP adherence facilitators and barriers to those already addressed within the app. Conclusions: The core elements of the P3 app address major PrEP facilitators and barriers for Thai YMSM; however, changes to the app features, including stylistic presentation, were needed to appropriately customize the app to the Thai context. Given the similarities of facilitators and barriers for PrEP adherence globally, adapting existing PrEP mHealth solutions based on input from end users and key informants provides a promising approach. However, partnerships with local app designers and developers can improve the adaptation process and final product. Trial Registration: ClinicalTrials.gov NCT04413708; http://clinicaltrials.gov/ct2/show/NCT04413708 UR - https://www.jmir.org/2021/11/e23852 UR - http://dx.doi.org/10.2196/23852 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734828 ID - info:doi/10.2196/23852 ER - TY - JOUR AU - Romeiser, L. Jamie AU - Cavalcante, James AU - Richman, C. Deborah AU - Singh, M. Sunitha AU - Liang, Xiaohui AU - Pei, Allison AU - Sharma, Samanvaya AU - Lazarus, Zoe AU - Gan, J. Tong AU - Bennett-Guerrero, Elliott PY - 2021/11/4 TI - Comparing Email, SMS, and Concurrent Mixed Modes Approaches to Capture Quality of Recovery in the Perioperative Period: Retrospective Longitudinal Cohort Study JO - JMIR Form Res SP - e25209 VL - 5 IS - 11 KW - concurrent mixed modes KW - recovery after surgery KW - text messages KW - SMS KW - email KW - perioperative recovery KW - mobile phone N2 - Background: As patients are discharged from the hospital more quickly, the ability to monitor patient recovery between hospital discharge and the first follow-up clinic visit is becoming increasingly important. Despite substantial increase in both internet use and smartphone ownership over the past 5 years, clinicians have been slow to embrace the use of these devices to capture patient recovery information in the period between hospital discharge and the first clinical follow-up appointment. Objective: This study aims to investigate the generalizability of using a web-based platform to capture patient recovery in a broad surgical patient population and compare response rates for 3 different web-based strategies for delivering recovery surveys over the perioperative period: email, SMS text messaging, and a concurrent mixed approach of using both email and SMS text messaging. Methods: Patients undergoing surgeries managed with an enhanced recovery after surgery pathway were asked to participate in a web-based quality assurance monitoring program at the time of their preoperative surgery appointment. Different follow-up methods were implemented over 3 sequential phases. Patients received Health Insurance Portability and Accountability Act?compliant web-based survey links via email (phase 1), SMS text messaging (phase 2), or concurrently using both email and SMS text messaging (phase 3) using REDCap and Twilio software. Recovery assessments using the established Quality of Recovery-9 instrument were performed 4 days before surgery and at 7 and 30 days postoperatively. Generalizability of the web-based system was examined by comparing characteristics of those who participated versus those who did not. Differences in response rates by the web-based collection method were analyzed using adjusted models. Results: A total of 615 patients were asked to participate, with 526 (85.5%) opting for the follow-up program. Those who opted in were younger, slightly healthier, and more likely to be in a partnership. The concurrent mixed modes method was the most successful for obtaining responses at each time point compared with text or email alone (pre: 119/160, 74.4% vs 116/173, 67.1% vs 56/130, 43.1%, P<.001; 7 days: 115/172, 66.9% vs 82/164, 50.0% vs 59/126, 46.8%, P=.001; 30 days: 152/234, 65.0% vs 52/105, 49.5% vs 53/123, 43.1%, P=.001, respectively). In the adjusted model, the concurrent mixed modes method significantly predicted response compared with using email alone (odds ratio 3.4; P<.001) and SMS text messaging alone (odds ratio 1.9; P<.001). Additional significant predictors of response were race, partnership, and time. Conclusions: For internet users and smartphone owners, electronic capture of recovery surveys appear to be possible through this mechanism. Discrepancies in both inclusion and response rates still exist among certain subgroups of patients, but the concurrent approach of using both email and text messages was the most effective approach to reach the largest number of patients across all subgroups. UR - https://formative.jmir.org/2021/11/e25209 UR - http://dx.doi.org/10.2196/25209 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734827 ID - info:doi/10.2196/25209 ER - TY - JOUR AU - Engelhard, M. Matthew AU - D'Arcy, Joshua AU - Oliver, A. Jason AU - Kozink, Rachel AU - McClernon, Joseph F. PY - 2021/11/1 TI - Prediction of Smoking Risk From Repeated Sampling of Environmental Images: Model Validation JO - J Med Internet Res SP - e27875 VL - 23 IS - 11 KW - smoking KW - smoking cessation KW - machine learning KW - computer vision KW - digital health KW - eHealth KW - behavior KW - CNN KW - neural network KW - artificial intelligence KW - AI KW - images KW - environment KW - ecological momentary assessment KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Viewing their habitual smoking environments increases smokers? craving and smoking behaviors in laboratory settings. A deep learning approach can differentiate between habitual smoking versus nonsmoking environments, suggesting that it may be possible to predict environment-associated smoking risk from continuously acquired images of smokers? daily environments. Objective: In this study, we aim to predict environment-associated risk from continuously acquired images of smokers? daily environments. We also aim to understand how model performance varies by location type, as reported by participants. Methods: Smokers from Durham, North Carolina and surrounding areas completed ecological momentary assessments both immediately after smoking and at randomly selected times throughout the day for 2 weeks. At each assessment, participants took a picture of their current environment and completed a questionnaire on smoking, craving, and the environmental setting. A convolutional neural network?based model was trained to predict smoking, craving, whether smoking was permitted in the current environment and whether the participant was outside based on images of participants? daily environments, the time since their last cigarette, and baseline data on daily smoking habits. Prediction performance, quantified using the area under the receiver operating characteristic curve (AUC) and average precision (AP), was assessed for out-of-sample prediction as well as personalized models trained on images from days 1 to 10. The models were optimized for mobile devices and implemented as a smartphone app. Results: A total of 48 participants completed the study, and 8008 images were acquired. The personalized models were highly effective in predicting smoking risk (AUC=0.827; AP=0.882), craving (AUC=0.837; AP=0.798), whether smoking was permitted in the current environment (AUC=0.932; AP=0.981), and whether the participant was outside (AUC=0.977; AP=0.956). The out-of-sample models were also effective in predicting smoking risk (AUC=0.723; AP=0.785), whether smoking was permitted in the current environment (AUC=0.815; AP=0.937), and whether the participant was outside (AUC=0.949; AP=0.922); however, they were not effective in predicting craving (AUC=0.522; AP=0.427). Omitting image features reduced AUC by over 0.1 when predicting all outcomes except craving. Prediction of smoking was more effective for participants whose self-reported location type was more variable (Spearman ?=0.48; P=.001). Conclusions: Images of daily environments can be used to effectively predict smoking risk. Model personalization, achieved by incorporating information about daily smoking habits and training on participant-specific images, further improves prediction performance. Environment-associated smoking risk can be assessed in real time on a mobile device and can be incorporated into device-based smoking cessation interventions. UR - https://www.jmir.org/2021/11/e27875 UR - http://dx.doi.org/10.2196/27875 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723819 ID - info:doi/10.2196/27875 ER - TY - JOUR AU - Yin, Zenong AU - Martinez, E. Cristina AU - Li, Shiyu AU - Martinez, Martha AU - Peng, Kezhi AU - Land, M. William AU - Ullevig, L. Sarah AU - Cantu, Adelita AU - Falk, Sharon AU - Hernández, E. Arthur AU - Ortega, Catherine AU - Parra-Medina, Deborah AU - Simmonds, J. Maureen PY - 2021/11/1 TI - Adapting Chinese Qigong Mind-Body Exercise for Healthy Aging in Older Community-Dwelling Low-income Latino Adults: Pilot Feasibility Study JO - JMIR Aging SP - e29188 VL - 4 IS - 4 KW - mHealth KW - community-based participatory research KW - five animal play KW - wuqinxi N2 - Background: Research translating the evidence for the benefit of mind-body exercise in older Latinos with limited access to community-based healthy aging programs is sparse. Objective: This study aimed to evaluate the feasibility of Function Improvement Exercises for Older Sedentary Community-Dwelling Latino Residents (FITxOlder), a Community Health Worker (CHW)-led, mobile technology-facilitated Chinese Qigong mind-body exercise program for healthy aging and to explore its impact on physical and cognitive function and quality of life (QoL) in older community-dwelling low-income Latino adults. Methods: This study was designed as a Stage 1 feasibility study to develop and pilot-test FITxOlder. In Phase 1 (Stage 1A), a working group of seniors, CHWs, and senior center staff guided the adaptation of Chinese Qigong into a healthy aging program. In Phase 2 (Stage 1B), 49 older Latino adults participated in a 3-arm controlled study to test the feasibility and preliminary effect of CHW-led FITxOlder on physical and cognitive function and QoL measures over 16 weeks. Results: Although the COVID-19 pandemic disrupted the implementation of the study protocol, we found favorable results regarding participant recruitment, retention, and fidelity of implementation. Notable findings included an 89.3% participant retention, 79.4% of the participants completed at least 70% of the weekly exercise goal, and no report of adverse events. The effects on intervention outcome measures were modest. Conclusions: FITxOlder is feasible for promoting healthy aging in older Latino adults; future research needs to compare its feasibility with other low-impact exercise programs for healthy aging using a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04284137; https://clinicaltrials.gov/ct2/show/NCT04284137 UR - https://aging.jmir.org/2021/4/e29188 UR - http://dx.doi.org/10.2196/29188 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723824 ID - info:doi/10.2196/29188 ER - TY - JOUR AU - Aguilera, Adrian AU - Hernandez-Ramos, Rosa AU - Haro-Ramos, Y. Alein AU - Boone, Elizabeth Claire AU - Luo, Christina Tiffany AU - Xu, Jing AU - Chakraborty, Bibhas AU - Karr, Chris AU - Darrow, Sabrina AU - Figueroa, Astrid Caroline PY - 2021/11/1 TI - A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study JO - JMIR Ment Health SP - e25298 VL - 8 IS - 11 KW - mobile health KW - COVID-19 KW - text messaging KW - cognitive behavioral therapy KW - anxiety KW - depression KW - microrandomized trials KW - mHealth KW - intervention KW - mental health KW - SMS N2 - Background: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19?related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective: This paper describes the changes in StayWell participants? anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of ?1.72 (95% CI ?2.35 to ?1.09) in PHQ-8 scores and ?0.48 (95% CI ?0.71 to ?0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. Conclusions: StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): RR2-10.2196/23592 UR - https://mental.jmir.org/2021/11/e25298 UR - http://dx.doi.org/10.2196/25298 UR - http://www.ncbi.nlm.nih.gov/pubmed/34543230 ID - info:doi/10.2196/25298 ER - TY - JOUR AU - Chae, Steve AU - Lee, Yoon-Jae AU - Han, Hae-Ra PY - 2021/10/29 TI - Sources of Health Information, Technology Access, and Use Among Non?English-Speaking Immigrant Women: Descriptive Correlational Study JO - J Med Internet Res SP - e29155 VL - 23 IS - 10 KW - technology use KW - internet KW - text messaging KW - health literacy KW - English proficiency KW - immigrant KW - health disparities KW - Korean American KW - women KW - mobile phone N2 - Background: As the world is becoming increasingly connected by the World Wide Web, the internet is becoming the main source of health information. With the novel COVID-19 pandemic, ubiquitous use of the internet has changed the daily lives of individuals, from working from home to seeking and meeting with health care providers through web-based sites. Such heavy reliance on internet-based technologies raises concerns regarding the accessibility of the internet for minority populations who are likely to already face barriers when seeking health information. Objective: This study aims to examine the level of technology access and common modes of technology used by Korean American women and to investigate how key psychosocial determinants of health such as age, education, English proficiency, and health literacy are correlated with sources of health information used by Korean American women and by their use of the internet. Methods: We used data from a subsample of Korean American women (N=157) who participated in a community-based randomized trial designed to test a health literacy?focused cancer screening intervention. In addition to descriptive statistics to summarize Korean American women?s internet access and common modes of technology use, we conducted backward stepwise logistic regression analyses to substantiate the association between the psychosocial determinants of health and internet use. Results: Approximately two-thirds (103/157, 65.6%) of the sample had access to the internet, and nearly all had access to a mobile phone. The internet was the most commonly used channel to obtain health information 63% (99/157), and 70% (110/157) of the sample used text messaging. Nevertheless, only approximately 38.8% (40/103) of the sample were very confident in using the internet, and only 29.9% (47/157) were very confident in using text messaging. Multivariate analyses revealed that older age (>50 years) was associated with 79% lower odds of using the internet to seek health information (adjusted odds ratio [AOR] 0.21, 95% CI 0.10-0.46). The higher health literacy group (19+ on Rapid Estimate of Adult Literacy in Medicine) had 56% lower odds of using the internet to acquire health information (AOR 0.44, 95% CI 1.13-11.18). Higher education (college+) was associated with both internet use (AOR 4.42, 95% CI 1.88-9.21) and text messaging (AOR 3.42, 95% CI 1.55-7.54). Finally, English proficiency was associated with text messaging (AOR 4.20, 95% CI 1.44-12.24). Conclusions: The differences in modes of technology access, use, and confidence by some of the key psychosocial determinants, as observed in our study sample, have important implications when health care teams develop dissemination plans. UR - https://www.jmir.org/2021/10/e29155 UR - http://dx.doi.org/10.2196/29155 UR - http://www.ncbi.nlm.nih.gov/pubmed/34714249 ID - info:doi/10.2196/29155 ER - TY - JOUR AU - Loureiro, F. Sabrina AU - Pulvers, Kim AU - Gosdin, M. Melissa AU - Clift, Keavagh AU - Rice, Myra AU - Tong, K. Elisa PY - 2021/10/29 TI - The Development of a Web-Based Tobacco Tracker Tool to Crowdsource Campus Environmental Reports for Smoke and Tobacco?Free College Policies: Mixed Methods Study JO - J Med Internet Res SP - e26280 VL - 23 IS - 10 KW - tobacco cessation KW - college smoke and tobacco?free policies KW - crowdsourcing KW - environmental reporting KW - public health KW - smoke and tobacco research N2 - Background: College campuses in the United States have begun implementing smoke and tobacco?free policies to discourage the use of tobacco. Smoke and tobacco?free policies, however, are contingent upon effective policy enforcement. Objective: This study aimed to develop an empirically derived web-based tracking tool (Tracker) for crowdsourcing campus environmental reports of tobacco use and waste to support smoke and tobacco?free college policies. Methods: An exploratory sequential mixed methods approach was utilized to inform the development and evaluation of Tracker. In October 2018, three focus groups across 2 California universities were conducted and themes were analyzed, guiding Tracker development. After 1 year of implementation, users were asked in April 2020 to complete a survey about their experience. Results: In the focus groups, two major themes emerged: barriers and facilitators to tool utilization. Further Tracker development was guided by focus group input to address these barriers (eg, information, policing, and logistical concerns) and facilitators (eg, environmental motivators and positive reinforcement). Amongst 1163 Tracker reports, those who completed the user survey (n=316) reported that the top motivations for using the tool had been having a cleaner environment (212/316, 79%) and health concerns (185/316, 69%). Conclusions: Environmental concerns, a motivator that emerged in focus groups, shaped Tracker?s development and was cited by the majority of users surveyed as a top motivator for utilization. UR - https://www.jmir.org/2021/10/e26280 UR - http://dx.doi.org/10.2196/26280 UR - http://www.ncbi.nlm.nih.gov/pubmed/34714248 ID - info:doi/10.2196/26280 ER - TY - JOUR AU - Marthick, Michael AU - McGregor, Deborah AU - Alison, Jennifer AU - Cheema, Birinder AU - Dhillon, Haryana AU - Shaw, Tim PY - 2021/10/29 TI - Supportive Care Interventions for People With Cancer Assisted by Digital Technology: Systematic Review JO - J Med Internet Res SP - e24722 VL - 23 IS - 10 KW - digital health KW - telehealth KW - eHealth KW - neoplasm KW - supportive care KW - systematic review KW - mobile phone N2 - Background: Although relatively new, digital health interventions are demonstrating rapid growth because of their ability to facilitate access and overcome issues of location, time, health status, and most recently, the impact of a major pandemic. With the increased uptake of digital technologies, digital health has the potential to improve the provision of supportive cancer care. Objective: This systematic review aims to evaluate digital health interventions for supportive cancer care. Methods: Published literature between 2000 and 2020 was systematically searched in MEDLINE, PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, and Scopus. Eligible publications were randomized controlled trials of clinician-led digital health interventions to support adult cancer patients. The interventions included were determined by applying a digital health conceptual model. Studies were appraised for quality using the revised Cochrane risk of bias tool. Results: Twenty randomized controlled trials met the inclusion criteria for the analysis. Interventions varied by duration, frequency, degree of technology use, and applied outcome measures. Interventions targeting a single tumor stream, predominantly breast cancer, and studies involving the implementation of remote symptom monitoring have dominated the results. In most studies, digital intervention resulted in significant positive outcomes in patient-reported symptoms, levels of fatigue and pain, health-related quality of life, functional capacity, and depression levels compared with the control. Conclusions: Digital health interventions are helpful and effective for supportive care of patients with cancer. There is a need for high-quality research. Future endeavors could focus on the use of valid, standardized outcome measures, maintenance of methodological rigor, and strategies to improve patient and health professional engagement in the design and delivery of supportive digital health interventions. Trial Registration: PROSPERO CRD42020149730; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=149730 UR - https://www.jmir.org/2021/10/e24722 UR - http://dx.doi.org/10.2196/24722 UR - http://www.ncbi.nlm.nih.gov/pubmed/34714246 ID - info:doi/10.2196/24722 ER - TY - JOUR AU - Sushko, Katelyn AU - Wang, Rui Qi AU - Tschirhart Menezes, Holly AU - Fitzpatrick-Lewis, Donna AU - Sherifali, Diana PY - 2021/10/29 TI - Patient-Reported Benefits and Limitations of Mobile Health Technologies for Diabetes in Pregnancy: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e29727 VL - 10 IS - 10 KW - diabetes KW - pregnancy KW - type 1 diabetes KW - type 2 diabetes KW - gestational diabetes mellitus KW - mobile health KW - mHealth KW - virtual care KW - scoping review N2 - Background: For women with pre-existing and gestational diabetes mellitus, pregnancy involves specialized and intensive medical care to improve maternal and infant outcomes. Medical management for patients with diabetes in pregnancy typically occurs via frequent face-to-face outpatient appointments. Barriers to face-to-face care during the COVID-19 pandemic have signaled the need for high-quality, patient-centered virtual health care modalities, such as mobile health (mHealth). Objective: The objective of the proposed scoping review is to identify the patient-reported benefits and limitations of mHealth technology among women with diabetes in pregnancy. We also aim to determine how the women?s experiences align with the best practice standards for patient-centered communication. Methods: Arksey and O?Malley?s framework for conducting scoping reviews with refinements by Levac et al will be used to guide the conduct of this scoping review. Relevant studies will be identified through comprehensive database searches of MEDLINE, Embase, Emcare, and PsycINFO. Following database searches, studies will be screened for eligibility at the title, abstract, and full-text level by two independent reviewers, with the inclusion of a third reviewer if required to reach consensus. Data charting of included studies will be conducted by one reviewer using a standardized data extraction form and verified independently by a second reviewer. Synthesis of results will be guided by Thomas and Harden?s ?Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews.? Results: As of August 2020, we have carried out the qualitative searches in the electronic databases MEDLINE, Embase, Emcare, and PsycINFO (Ovid interface) for a combined total of 8207 articles. Next, we plan to conduct the quantitative searches in the electronic databases MEDLINE, Embase, and Emcare (Ovid interface). We also plan to review the reference lists of relevant studies to identify additional eligible studies. Conclusions: With the results of this review, we hope to describe the patient-reported benefits and limitations of mHealth technology for women with diabetes in pregnancy. Furthermore, we aim to determine how women?s experiences align with the best practice standards for patient-centered communication. Ultimately, our review can provide valuable information for guideline developers, policy makers, and clinicians related to mobile technologies to support virtual care delivery for women with diabetes in pregnancy. International Registered Report Identifier (IRRID): PRR1-10.2196/29727 UR - https://www.researchprotocols.org/2021/10/e29727 UR - http://dx.doi.org/10.2196/29727 UR - http://www.ncbi.nlm.nih.gov/pubmed/34714251 ID - info:doi/10.2196/29727 ER - TY - JOUR AU - Shi, Boqun AU - Liu, Xi AU - Dong, Qiuting AU - Yang, Yuxiu AU - Cai, Zhongxing AU - Wang, Haoyu AU - Yin, Dong AU - Wang, Hongjian AU - Dou, Kefei AU - Song, Weihua PY - 2021/10/27 TI - The Effect of a WeChat-Based Tertiary A-Level Hospital Intervention on Medication Adherence and Risk Factor Control in Patients With Stable Coronary Artery Disease: Multicenter Prospective Study JO - JMIR Mhealth Uhealth SP - e32548 VL - 9 IS - 10 KW - WeChat KW - telemedicine KW - coronary artery disease KW - medication adherence KW - mobile phone N2 - Background: In China, ischemic heart disease is the main cause of mortality. Having cardiac rehabilitation and a secondary prevention program in place is a class IA recommendation for individuals with coronary artery disease. WeChat-based interventions seem to be feasible and efficient for the follow-up and management of chronic diseases. Objective: This study aims to evaluate the effectiveness of a tertiary A-level hospital, WeChat-based telemedicine intervention in comparison with conventional community hospital follow-up on medication adherence and risk factor control in individuals with stable coronary artery disease. Methods: In this multicenter prospective study, 1424 patients with stable coronary artery disease in Beijing, China, were consecutively enrolled between September 2018 and September 2019 from the Fuwai Hospital and 4 community hospitals. At 1-, 3-, 6-, and 12-month follow-up, participants received healthy lifestyle recommendations and medication advice. Subsequently, the control group attended an offline outpatient clinic at 4 separate community hospitals. The intervention group had follow-up visits through WeChat-based telemedicine management. The main end point was medication adherence, which was defined as participant compliance in taking all 4 cardioprotective medications that would improve the patient?s outcome (therapies included antiplatelet therapy, ?-blockers, statins, and angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers). Multivariable generalized estimating equations were used to compare the primary and secondary outcomes between the 2 groups and to calculate the relative risk (RR) at 12 months. Propensity score matching and inverse probability of treatment weighting were performed as sensitivity analyses, and propensity scores were calculated using a multivariable logistic regression model. Results: At 1 year, 88% (565/642) of patients in the intervention group and 91.8% (518/564) of patients in the control group had successful follow-up data. We matched 257 pairs of patients between the intervention and control groups. There was no obvious advantage in medication adherence with the 4 cardioprotective drugs in the intervention group (172/565, 30.4%, vs 142/518, 27.4%; RR 0.99, 95% CI 0.97-1.02; P=.65). The intervention measures improved smoking cessation (44/565, 7.8%, vs 118/518, 22.8%; RR 0.48, 95% CI 0.44-0.53; P<.001) and alcohol restriction (33/565, 5.8%, vs 91/518, 17.6%; RR 0.47, 95% CI 0.42-0.54; P<.001). Conclusions: The tertiary A-level hospital, WeChat-based intervention did not improve adherence to the 4 cardioprotective medications compared with the traditional method. Tertiary A-level hospital, WeChat-based interventions have a positive effect on improving lifestyle, such as quitting drinking and smoking, in patients with stable coronary artery disease and can be tried as a supplement to community hospital follow-up. Trial Registration: ClinicalTrials.gov NCT04795505; https://clinicaltrials.gov/ct2/show/NCT04795505 UR - https://mhealth.jmir.org/2021/10/e32548 UR - http://dx.doi.org/10.2196/32548 UR - http://www.ncbi.nlm.nih.gov/pubmed/34569467 ID - info:doi/10.2196/32548 ER - TY - JOUR AU - Kuhathasan, Nirushi AU - Minuzzi, Luciano AU - MacKillop, James AU - Frey, N. Benicio PY - 2021/10/27 TI - The Use of Cannabinoids for Insomnia in Daily Life: Naturalistic Study JO - J Med Internet Res SP - e25730 VL - 23 IS - 10 KW - medicinal cannabis KW - insomnia KW - symptom management KW - linear mixed-effects N2 - Background: Insomnia is a prevalent condition that presents itself at both the symptom and diagnostic levels. Although insomnia is one of the main reasons individuals seek medicinal cannabis, little is known about the profile of cannabinoid use or the perceived benefit of the use of cannabinoids in daily life. Objective: We conducted a retrospective study of medicinal cannabis users to investigate the use profile and perceived efficacy of cannabinoids for the management of insomnia. Methods: Data were collected using the Strainprint app, which allows medicinal cannabis users to log conditions and symptoms, track cannabis use, and monitor symptom severity pre- and postcannabis use. Our analyses examined 991 medicinal cannabis users with insomnia across 24,189 tracked cannabis use sessions. Sessions were analyzed, and both descriptive statistics and linear mixed-effects modeling were completed to examine use patterns and perceived efficacy. Results: Overall, cannabinoids were perceived to be efficacious across all genders and ages, and no significant differences were found among product forms, ingestion methods, or gender groups. Although all strain categories were perceived as efficacious, predominant indica strains were found to reduce insomnia symptomology more than cannabidiol (CBD) strains (estimated mean difference 0.59, SE 0.11; 95% CI 0.36-0.81; adjusted P<.001) and predominant sativa strains (estimated mean difference 0.74, SE 0.16; 95% CI 0.43-1.06; adjusted P<.001). Indica hybrid strains also presented a greater reduction in insomnia symptomology than CBD strains (mean difference 0.52, SE 0.12; 95% CI 0.29-0.74; adjusted P<.001) and predominant sativa strains (mean difference 0.67, SE 0.16; 95% CI 0.34-1.00; adjusted P=.002). Conclusions: Medicinal cannabis users perceive a significant improvement in insomnia with cannabinoid use, and this study suggests a possible advantage with the use of predominant indica strains compared with predominant sativa strains and exclusively CBD in this population. This study emphasizes the need for randomized placebo-controlled trials assessing the efficacy and safety profile of cannabinoids for the treatment of insomnia. UR - https://www.jmir.org/2021/10/e25730 UR - http://dx.doi.org/10.2196/25730 UR - http://www.ncbi.nlm.nih.gov/pubmed/34704957 ID - info:doi/10.2196/25730 ER - TY - JOUR AU - Sekandi, Nabbuye Juliet AU - Kasiita, Vicent AU - Onuoha, Amara Nicole AU - Zalwango, Sarah AU - Nakkonde, Damalie AU - Kaawa-Mafigiri, David AU - Turinawe, Julius AU - Kakaire, Robert AU - Davis-Olwell, Paula AU - Atuyambe, Lynn AU - Buregyeya, Esther PY - 2021/10/27 TI - Stakeholders? Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study JO - JMIR Mhealth Uhealth SP - e27131 VL - 9 IS - 10 KW - tuberculosis KW - adherence KW - mHealth KW - video directly observed therapy KW - Uganda KW - mobile phone N2 - Background: Nonadherence to treatment remains a barrier to tuberculosis (TB) control. Directly observed therapy (DOT) is the standard for monitoring adherence to TB treatment worldwide, but its implementation is challenging, especially in resource-limited settings. DOT is labor-intensive and inconvenient to both patients and health care workers. Video DOT (VDOT) is a novel patient-centered alternative that uses mobile technology to observe patients taking medication remotely. However, the perceptions and acceptability of potential end users have not been evaluated in Africa. Objective: This study explores stakeholders? acceptability of, as well as perceptions of potential benefits of and barriers to, using VDOT to inform a pilot study for monitoring patients with TB in urban Uganda. Methods: An exploratory, qualitative, cross-sectional study with an exit survey was conducted in Kampala, Uganda, from April to May 2018. We conducted 5 focus group discussions, each comprising 6 participants. Groups included patients with TB (n=2 groups; male and female), health care providers (n=1), caregivers (n=1), and community DOT volunteer workers (n=1). The questions that captured perceived benefits and barriers were guided by domains adopted from the Technology Acceptance Model. These included perceived usefulness, ease of use, and intent to use technology. Eligible participants were aged ?18 years and provided written informed consent. For patients with TB, we included only those who had completed at least 2 months of treatment to minimize the likelihood of infection. A purposive sample of patients, caregivers, health care providers, and community DOT workers was recruited at 4 TB clinics in Kampala. Trained interviewers conducted unstructured interviews that were audio-recorded, transcribed, and analyzed using inductive content analysis to generate emerging themes. Results: The average age of participants was 34.5 (SD 10.7) years. VDOT was acceptable to most participants on a scale of 1 to 10. Of the participants, 70% (21/30) perceived it as highly acceptable, with scores ?8, whereas 30% (9/30) scored between 5 and 7. Emergent themes on perceived benefits of VDOT were facilitation of easy adherence monitoring, timely follow-up on missed doses, patient-provider communication, and saving time and money because of minimal travel to meet in person. Perceived barriers included limited technology usability skills, inadequate cellular connectivity, internet access, availability of electricity, cost of the smartphone, and use of the internet. Some female patients raised concerns about the disruption of their domestic work routines to record videos. The impact of VDOT on privacy and confidentiality emerged as both a perceived benefit and barrier. Conclusions: VDOT was acceptable and perceived as beneficial by most study participants, despite potential technical and cost barriers. Mixed perceptions emerged about the impact of VDOT on privacy and confidentiality. Future efforts should focus on training users, ensuring adequate technical infrastructure, assuring privacy, and performing comparative cost analyses in the local context. UR - https://mhealth.jmir.org/2021/10/e27131 UR - http://dx.doi.org/10.2196/27131 UR - http://www.ncbi.nlm.nih.gov/pubmed/34704961 ID - info:doi/10.2196/27131 ER - TY - JOUR AU - MacLeod, Lucy AU - Suruliraj, Banuchitra AU - Gall, Dominik AU - Bessenyei, Kitti AU - Hamm, Sara AU - Romkey, Isaac AU - Bagnell, Alexa AU - Mattheisen, Manuel AU - Muthukumaraswamy, Viswanath AU - Orji, Rita AU - Meier, Sandra PY - 2021/10/26 TI - A Mobile Sensing App to Monitor Youth Mental Health: Observational Pilot Study JO - JMIR Mhealth Uhealth SP - e20638 VL - 9 IS - 10 KW - mobile sensing KW - youth KW - psychiatry KW - feasibility KW - mobile phone N2 - Background: Internalizing disorders are the most common psychiatric problems observed among youth in Canada. Sadly, youth with internalizing disorders often avoid seeking clinical help and rarely receive adequate treatment. Current methods of assessing internalizing disorders usually rely on subjective symptom ratings, but internalizing symptoms are frequently underreported, which creates a barrier to the accurate assessment of these symptoms in youth. Therefore, novel assessment tools that use objective data need to be developed to meet the highest standards of reliability, feasibility, scalability, and affordability. Mobile sensing technologies, which unobtrusively record aspects of youth behaviors in their daily lives with the potential to make inferences about their mental health states, offer a possible method of addressing this assessment barrier. Objective: This study aims to explore whether passively collected smartphone sensor data can be used to predict internalizing symptoms among youth in Canada. Methods: In this study, the youth participants (N=122) completed self-report assessments of symptoms of anxiety, depression, and attention-deficit hyperactivity disorder. Next, the participants installed an app, which passively collected data about their mobility, screen time, sleep, and social interactions over 2 weeks. Then, we tested whether these passive sensor data could be used to predict internalizing symptoms among these youth participants. Results: More severe depressive symptoms correlated with more time spent stationary (r=0.293; P=.003), less mobility (r=0.271; P=.006), higher light intensity during the night (r=0.227; P=.02), and fewer outgoing calls (r=?0.244; P=.03). In contrast, more severe anxiety symptoms correlated with less time spent stationary (r=?0.249; P=.01) and greater mobility (r=0.234; P=.02). In addition, youths with higher anxiety scores spent more time on the screen (r=0.203; P=.049). Finally, adding passively collected smartphone sensor data to the prediction models of internalizing symptoms significantly improved their fit. Conclusions: Passively collected smartphone sensor data provide a useful way to monitor internalizing symptoms among youth. Although the results replicated findings from adult populations, to ensure clinical utility, they still need to be replicated in larger samples of youth. The work also highlights intervention opportunities via mobile technology to reduce the burden of internalizing symptoms early on. UR - https://mhealth.jmir.org/2021/10/e20638 UR - http://dx.doi.org/10.2196/20638 UR - http://www.ncbi.nlm.nih.gov/pubmed/34698650 ID - info:doi/10.2196/20638 ER - TY - JOUR AU - Domogalla, Lena AU - Beck, Alena AU - Schulze-Hagen, Theresa AU - Herr, Raphael AU - Benecke, Johannes AU - Schmieder, Astrid PY - 2021/10/25 TI - Impact of an eHealth Smartphone App on the Mental Health of Patients With Psoriasis: Prospective Randomized Controlled Intervention Study JO - JMIR Mhealth Uhealth SP - e28149 VL - 9 IS - 10 KW - psoriasis KW - eHealth KW - mHealth KW - telemedicine KW - teledermatology KW - patient educational program KW - disease management KW - smartphone app KW - mental health KW - mobile phone N2 - Background: Psoriasis has a negative impact on patients? physical and mental health and can lead to anxiety and depression. Disease management strategies, including educational programs and eHealth devices, have been shown to improve health care for several chronic diseases. However, such disease management strategies are lacking in the routine care of patients with psoriasis. Objective: This study aims to study the impact of a novel intervention that combines an educational program with a disease management smartphone app on the mental health of patients with psoriasis. Methods: Patients with psoriasis in the intervention group received an educational program; attended visits on weeks 0, 12, 24, 36, and 60; and had access to the study app. Patients in the control group only attended the visits. The primary endpoint was a significant reduction of scores on the Hospital Anxiety and Depression Scale (HADS). Secondary end points were reductions in Dermatology Life Quality Index score, Psoriasis Area and Severity Index score, pruritus, and pain, as well as improvements in mood and daily activities. In addition, modulating effects of sex, age, disease duration, and app use frequency were evaluated. Results: A total of 107 patients were included in the study and randomized into the control group (53/107, 49.5%) or intervention group (54/107, 50.5%). Approximately 71.9% (77/107) of the patients completed the study. A significant reduction in HADS-Depression (HADS-D) in the intervention group was found at weeks 12 (P=.04) and 24 (P=.005) but not at weeks 36 (P=.12) and 60 (P=.32). Patient stratification according to app use frequency showed a significant improvement in HADS-D score at weeks 36 (P=.004) and 60 (P=.04) and in HADS-Anxiety (HADS-A) score at weeks 36 (P=.04) and 60 (P=.05) in the group using the app less than once every 5 weeks. However, in patients using the app more than once every 5 weeks, no significant reduction in HADS-D (P=.84) or HADS-A (P=.20) score was observed over the 60-week study period compared with that observed in patients in the control group. All findings were independent of sex, age, and disease duration. Conclusions: These findings support the use of a disease management smartphone app as a valid tool to achieve long-term improvement in the mental health of patients with psoriasis if it is not used too frequently. Further studies are needed to analyze the newly observed influence of app use frequency. Trial Registration: Deutsches Register Klinischer Studien DRKS00020755; https://tinyurl.com/nyzjyvvk UR - https://mhealth.jmir.org/2021/10/e28149 UR - http://dx.doi.org/10.2196/28149 UR - http://www.ncbi.nlm.nih.gov/pubmed/34431478 ID - info:doi/10.2196/28149 ER - TY - JOUR AU - Bente, E. Britt AU - Wentzel, Jobke AU - Groeneveld, GH Rik AU - IJzerman, VH Renée AU - de Buisonjé, R. David AU - Breeman, D. Linda AU - Janssen, R. Veronica AU - Kraaijenhagen, Roderik AU - Pieterse, E. Marcel AU - Evers, WM Andrea AU - van Gemert-Pijnen, EWC Julia PY - 2021/10/22 TI - Values of Importance to Patients With Cardiovascular Disease as a Foundation for eHealth Design and Evaluation: Mixed Methods Study JO - JMIR Cardio SP - e33252 VL - 5 IS - 2 KW - patient values KW - health behavior KW - lifestyle KW - mobile app KW - user-centered design KW - eHealth KW - cardiovascular disease KW - behavior KW - app KW - design KW - cardiovascular KW - evaluation KW - platform KW - support KW - intervention N2 - Background: eHealth interventions are developed to support and facilitate patients with lifestyle changes and self-care tasks after being diagnosed with a cardiovascular disease (CVD). Creating long-lasting effects on lifestyle change and health outcomes with eHealth interventions is challenging and requires good understanding of patient values. Objective: The aim of the study was to identify values of importance to patients with CVD to aid in designing a technological lifestyle platform. Methods: A mixed method?design was applied,?combining?data from usability testing?with an additional online survey study, to validate?the outcomes of the usability tests. Results: A total of 11 relevant patient values were identified, including the need for security, support, not wanting to feel anxious, tailoring of treatment, and personalized, accessible care. The validation survey shows that all values but one (value 9: To have extrinsic motivation to accomplish goals or activities [related to health/lifestyle]) were regarded as important/very important. A rating of very unimportant or unimportant was given by less than 2% of the respondents (value 1: 4/641, 0.6%; value 2: 10/641, 1.6%; value 3: 9/641, 1.4%; value 4: 5/641, 0.8%; value 5: 10/641, 1.6%; value 6: 4/641, 0.6%; value 7: 10/639, 1.6%; value 8: 4/639, 0.6%; value 10: 3/636, 0.5%; value 11: 4/636, 0.6%) to all values except but one (value 9: 56/636, 8.8%). Conclusions: There is a high consensus among patients regarding the identified values reflecting goals and themes central to their lives, while living with or managing their CVD. The identified values can serve as a foundation for future research to translate and integrate these values into the design of the eHealth technology. This may call for prioritization of values, as not all values can be met equally. UR - https://cardio.jmir.org/2021/2/e33252 UR - http://dx.doi.org/10.2196/33252 UR - http://www.ncbi.nlm.nih.gov/pubmed/34677130 ID - info:doi/10.2196/33252 ER - TY - JOUR AU - Murray, R. Kevin AU - Foroutan, Farid AU - Amadio, M. Jennifer AU - Posada, Duero Juan AU - Kozuszko, Stella AU - Duhamel, Joseph AU - Tsang, Katherine AU - Farkouh, E. Michael AU - McDonald, Michael AU - Billia, Filio AU - Barber, Edward AU - Hershman, G. Steven AU - Bhat, Mamatha AU - Tinckam, J. Kathryn AU - Ross, J. Heather AU - McIntosh, Christopher AU - Moayedi, Yasbanoo PY - 2021/10/22 TI - Remote Mobile Outpatient Monitoring in Transplant (Reboot) 2.0: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e26816 VL - 10 IS - 10 KW - mobile health KW - telemonitoring, transplantation KW - wearable sensors KW - solid organ transplant N2 - Background: The number of solid organ transplants in Canada has increased 33% over the past decade. Hospital readmissions are common within the first year after transplant and are linked to increased morbidity and mortality. Nearly half of these admissions to the hospital appear to be preventable. Mobile health (mHealth) technologies hold promise to reduce admission to the hospital and improve patient outcomes, as they allow real-time monitoring and timely clinical intervention. Objective: This study aims to determine whether an innovative mHealth intervention can reduce hospital readmission and unscheduled visits to the emergency department or transplant clinic. Our second objective is to assess the use of clinical and continuous ambulatory physiologic data to develop machine learning algorithms to predict the risk of infection, organ rejection, and early mortality in adult heart, kidney, and liver transplant recipients. Methods: Remote Mobile Outpatient Monitoring in Transplant (Reboot) 2.0 is a two-phased single-center study to be conducted at the University Health Network in Toronto, Canada. Phase one will consist of a 1-year concealed randomized controlled trial of 400 adult heart, kidney, and liver transplant recipients. Participants will be randomized to receive either personalized communication using an mHealth app in addition to standard of care phone communication (intervention group) or standard of care communication only (control group). In phase two, the prior collected data set will be used to develop machine learning algorithms to identify early markers of rejection, infection, and graft dysfunction posttransplantation. The primary outcome will be a composite of any unscheduled hospital admission, visits to the emergency department or transplant clinic, following discharge from the index admission. Secondary outcomes will include patient-reported outcomes using validated self-administered questionnaires, 1-year graft survival rate, 1-year patient survival rate, and the number of standard of care phone voice messages. Results: At the time of this paper?s completion, no results are available. Conclusions: Building from previous work, this project will aim to leverage an innovative mHealth app to improve outcomes and reduce hospital readmission in adult solid organ transplant recipients. Additionally, the development of machine learning algorithms to better predict adverse health outcomes will allow for personalized medicine to tailor clinician-patient interactions and mitigate the health care burden of a growing patient population. Trial Registration: ClinicalTrials.gov NCT04721288; https://www.clinicaltrials.gov/ct2/show/NCT04721288 International Registered Report Identifier (IRRID): PRR1-10.2196/26816 UR - https://www.researchprotocols.org/2021/10/e26816 UR - http://dx.doi.org/10.2196/26816 UR - http://www.ncbi.nlm.nih.gov/pubmed/34528885 ID - info:doi/10.2196/26816 ER - TY - JOUR AU - Middleton, Timothy AU - Constantino, Maria AU - McGill, Margaret AU - D'Souza, Mario AU - Twigg, M. Stephen AU - Wu, Ted AU - Thiagalingam, Aravinda AU - Chow, Clara AU - Wong, Jencia PY - 2021/10/21 TI - An Enhanced SMS Text Message?Based Support and Reminder Program for Young Adults With Type 2 Diabetes (TEXT2U): Randomized Controlled Trial JO - J Med Internet Res SP - e27263 VL - 23 IS - 10 KW - young-onset type 2 diabetes KW - SMS KW - clinic attendance KW - engagement KW - diabetes KW - digital health KW - mobile health KW - adolescents N2 - Background: Clinic attendance, metabolic control, engagement in self-management, and psychological health are suboptimal in young-onset (age of onset <40 years) type 2 diabetes. Objective: We examined the effectiveness of an enhanced SMS text message?based support and reminder program in improving clinic attendance, metabolic control, engagement in self-management, and psychological health in young-onset type 2 diabetes. Methods: A 12-month, parallel-arm, randomized controlled trial comparing an enhanced, semipersonalized SMS text message?based intervention (incorporating 1-8 supportive and/or informative text messages per month) against standard care was conducted in a specialized clinic for young adult type 2 diabetes. The primary outcome was maintenance of 100% attendance at scheduled quarterly clinical appointments. Secondary outcomes included (1) metabolic indices, (2) pathology and self-monitored blood glucose (SMBG) data availability, and (3) psychosocial well-being. Results: A total of 40 participants were randomized, and 32 completed their 12-month study visit. The average participant age was 32.7 (SD 5.1) years, 50% (20/40) were male, and baseline glycated hemoglobin A1c (HbA1c) was 7.3% (SD 1.9%) (56 mmol/mol, SD 20). A higher proportion of the intervention group achieved 100% attendance (12/21, 57%, vs 5/19, 26%, for the control group); Kaplan-Meier analysis demonstrated significantly greater cumulative attendance in the intervention group (P=.04). There were no between-group differences in HbA1c, BMI, lipids, or availability of pathology and SMBG data. Odds of recording an improvement in the Diabetes Empowerment Scale?Short Form score were higher in the intervention group at 6 months (odds ratio [OR] 4.3, 95% CI 1.1-17), with attenuation of this effect at study end (OR 3.1, 95% CI 0.9-11). Program acceptability was high; >90% of participants would recommend the program to new patients. Conclusions: An enhanced SMS text message?based support and reminder program doubled scheduled clinic attendance rates for patients with young-onset type 2 diabetes. The program was highly acceptable and provided early support for patient empowerment but had no significant effect on measures of metabolic control or self-management. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12618000479202); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373579 UR - https://www.jmir.org/2021/10/e27263 UR - http://dx.doi.org/10.2196/27263 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524102 ID - info:doi/10.2196/27263 ER - TY - JOUR AU - Chirambo, Baxter Griphin AU - Thompson, Matthew AU - Hardy, Victoria AU - Ide, Nicole AU - Hwang, H. Phillip AU - Dharmayat, Kanika AU - Mastellos, Nikolaos AU - Heavin, Ciara AU - O'Connor, Yvonne AU - Muula, S. Adamson AU - Andersson, Bo AU - Carlsson, Sven AU - Tran, Tammy AU - Hsieh, Chen-Ling Jenny AU - Lee, Hsin-Yi AU - Fitzpatrick, Annette AU - Joseph Wu, Tsung-Shu AU - O'Donoghue, John PY - 2021/10/20 TI - Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial JO - J Med Internet Res SP - e25777 VL - 23 IS - 10 KW - community case management KW - mobile health KW - pediatrics KW - childhood infection KW - mobile phone N2 - Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Objective: We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Methods: We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ?2 months to <5 years who presented with acute illness were enrolled consecutively by health surveillance assistants. The primary outcome of urgent referrals to higher-level facilities was evaluated by using multilevel mixed effects models. A logistic regression model with the random effects of the cluster and the fixed effects for each step was fitted. The adjustment for potential confounders included baseline factors, such as patient age, sex, and the geographical location of the village clinics. Calendar time was adjusted for in the analysis. Results: A total of 6965 children were recruited?49.11% (3421/6965) in the control phase and 50.88% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95% CI 0.34-0.59; P<.001) or being admitted to a hospital (OR 0.75, 95% CI 0.62-0.90; P=.002), but after adjusting for time, these differences were not significant (P=.07 for consultation; P=.30 for hospital admission). Conclusions: The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies. Trial Registration: ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345 UR - https://www.jmir.org/2021/10/e25777 UR - http://dx.doi.org/10.2196/25777 UR - http://www.ncbi.nlm.nih.gov/pubmed/34668872 ID - info:doi/10.2196/25777 ER - TY - JOUR AU - Benoit, James AU - Hartling, Lisa AU - Chan, Michelle AU - Scott, Shannon PY - 2021/10/19 TI - Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan JO - J Med Internet Res SP - e29441 VL - 23 IS - 10 KW - internet KW - mHealth KW - mobile health KW - digital health KW - ehealth KW - app KW - mobile application KW - Android KW - Apple KW - marketplace KW - environmental scan KW - review KW - acute childhood illness KW - knowledge translation KW - child KW - parent KW - caregiver KW - mobile phone N2 - Background: Providing parents with resources that aid in the identification and management of acute childhood illnesses helps those parents feel better equipped to assess their children?s health and significantly changes parental health-seeking behaviors. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access their child?s health information. Mobile health apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices.  Objective: The aim of our study is to create an inventory of acute childhood illness apps that are available to North American parents and caregivers, assess their quality, and identify the areas in which future apps can be improved. Methods: We conducted an environmental scan to identify and summarize app information for parents and digital health researchers. The Google and Apple app marketplaces were used as search platforms. We built a list of search terms and searched the platforms for apps targeted at parents and related to acute pediatric illnesses in the United States and Canada. We assessed apps meeting the inclusion criteria using the Mobile App Rating Scale (MARS), a validated tool for assessing the quality of health apps. The MARS examines apps on 5 subscales: engagement, functionality, aesthetics, information quality, and subjective quality. Data were analyzed by MARS subscale averages and individual item scores. Results: Overall, 650 unique apps were screened, and 53 (8.2%) were included. On a scale of 1-5, apps had an average engagement score of 2.82/5 (SD 0.86), functionality score of 3.98/5 (SD 0.72), aesthetics score of 3.09/5 (SD 0.87), information quality score of 2.73/5 (SD 1.32), and subjective quality score of 2.20/5 (SD 0.79). On the same scale of 1-5, app scores ranged from 2.2/5 to 4.5/5 (mean 3.2, SD 0.6). The top 3 MARS-scored apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top 3 apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces; this space was filled with content originating primarily in the United Kingdom and the United States. In addition, published evidence of the impact of the included apps was poor: of 53 apps, only 5 (9%) had an evidence base showing that the app had been trialed for usability or efficacy. Conclusions: There is a need for evidence-based acute childhood illness apps of Canadian origin. This environmental scan offers a comprehensive picture of the health app landscape by examining trends in acute childhood illness apps that are readily available to parents and by identifying gaps in app design. UR - https://www.jmir.org/2021/10/e29441 UR - http://dx.doi.org/10.2196/29441 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665144 ID - info:doi/10.2196/29441 ER - TY - JOUR AU - Brogly, Chris AU - Shoemaker, Kevin J. AU - Lizotte, J. Daniel AU - Kueper, K. Jacqueline AU - Bauer, Michael PY - 2021/10/19 TI - A Mobile App to Identify Lifestyle Indicators Related to Undergraduate Mental Health (Smart Healthy Campus): Observational App-Based Ecological Momentary Assessment JO - JMIR Form Res SP - e29160 VL - 5 IS - 10 KW - smartphones KW - undergraduates KW - mental health KW - lifestyle KW - postsecondary institutions KW - mHealth KW - mobile application KW - ecological momentary assessment KW - mobile phone N2 - Background: Undergraduate studies are challenging, and mental health issues can frequently occur in undergraduate students, straining campus resources that are already in demand for somatic problems. Cost-effective measures with ubiquitous devices, such as smartphones, offer the potential to deliver targeted interventions to monitor and affect lifestyle, which may result in improvements to student mental health. However, the avenues by which this can be done are not particularly well understood, especially in the Canadian context. Objective: The aim of this study is to deploy an initial version of the Smart Healthy Campus app at Western University, Canada, and to analyze corresponding data for associations between psychosocial factors (measured by a questionnaire) and behaviors associated with lifestyle (measured by smartphone sensors). Methods: This preliminary study was conducted as an observational app-based ecological momentary assessment. Undergraduate students were recruited over email, and sampling using a custom 7-item questionnaire occurred on a weekly basis. Results: First, the 7-item Smart Healthy Campus questionnaire, derived from fully validated questionnaires?such as the Brief Resilience Scale; General Anxiety Disorder-7; and Depression, Anxiety, and Stress Scale?21?was shown to significantly correlate with the mental health domains of these validated questionnaires, illustrating that it is a viable tool for a momentary assessment of an overview of undergraduate mental health. Second, data collected through the app were analyzed. There were 312 weekly responses and 813 sensor samples from 139 participants from March 2019 to March 2020; data collection concluded when COVID-19 was declared a pandemic. Demographic information was not collected in this preliminary study because of technical limitations. Approximately 69.8% (97/139) of participants only completed one survey, possibly because of the absence of any incentive. Given the limited amount of data, analysis was not conducted with respect to time, so all data were analyzed as a single collection. On the basis of mean rank, students showing more positive mental health through higher questionnaire scores tended to spend more time completing questionnaires, showed more signs of physical activity based on pedometers, and had their devices running less and plugged in charging less when sampled. In addition, based on mean rank, students on campus tended to report more positive mental health through higher questionnaire scores compared with those who were sampled off campus. Some data from students found in or near residences were also briefly examined. Conclusions: Given these limited data, participants tended to report a more positive overview of mental health when on campus and when showing signs of higher levels of physical activity. These early findings suggest that device sensors related to physical activity and location are useful for monitoring undergraduate students and designing interventions. However, much more sensor data are needed going forward, especially given the sweeping changes in undergraduate studies due to COVID-19. UR - https://formative.jmir.org/2021/10/e29160 UR - http://dx.doi.org/10.2196/29160 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665145 ID - info:doi/10.2196/29160 ER - TY - JOUR AU - Frid, Gabriela AU - Bogaert, Kelly AU - Chen, T. Katherine PY - 2021/10/18 TI - Mobile Health Apps for Pregnant Women: Systematic Search, Evaluation, and Analysis of Features JO - J Med Internet Res SP - e25667 VL - 23 IS - 10 KW - app KW - app store KW - mHealth KW - mobile health KW - prenatal KW - pregnancy KW - women's health N2 - Background: Many pregnant women use the internet to obtain information about pregnancy and childbirth. Over 50% of pregnant women use pregnancy apps and must search through thousands of pregnancy or women?s health?related apps available on app stores. The COVID-19 pandemic is changing how women receive prenatal care. Mobile health apps may help maintain women?s satisfaction with their prenatal care. Objective: Our objective is to identify pregnancy mobile apps and to evaluate the apps using a modified APPLICATIONS (app comprehensiveness, price, privacy, literature used, in-app purchases, connectivity, advertisements, text search field, images/videos, other special features, navigation ease, subjective presentation) scoring system. Methods: A list of pregnancy apps was identified in the first 20 Google search results using the search term ?pregnancy app.? After excluding irrelevant, inaccurate, malfunctioning, or no longer available apps, all unique apps were downloaded and evaluated with the modified APPLICATIONS scoring system, which includes both objective and subjective criteria and evaluation of special features. Results: A list of 57 unique pregnancy apps was generated. After 28 apps were excluded, the remaining 29 apps were evaluated, with a mean score of 9.4 points out of a maximum of 16. The highest scoring app scored 15 points. Over 60% (18/29) of apps did not have comprehensive information for every stage of pregnancy or did not contain all four desired components of pregnancy apps: health promotion/patient education, communication, health tracking, and notifications and reminders. Only 24% (7/29) of apps included a text search field, and only 28% (8/29) of apps cited literature. Conclusions: Our search yielded many high-scoring apps, but few contained all desired components and features. This list of identified and rated apps can lessen the burden on pregnant women and providers to find available apps on their own. Although health care providers should continue to vet apps before recommending them to patients, these findings also highlight that a Google search is a successful way for patients and providers to find useful and comprehensive pregnancy apps. UR - https://www.jmir.org/2021/10/e25667 UR - http://dx.doi.org/10.2196/25667 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524100 ID - info:doi/10.2196/25667 ER - TY - JOUR AU - Wade, E. Natasha AU - Ortigara, M. Joseph AU - Sullivan, M. Ryan AU - Tomko, L. Rachel AU - Breslin, J. Florence AU - Baker, C. Fiona AU - Fuemmeler, F. Bernard AU - Delrahim Howlett, Katia AU - Lisdahl, M. Krista AU - Marshall, T. Andrew AU - Mason, J. Michael AU - Neale, C. Michael AU - Squeglia, M. Lindsay AU - Wolff-Hughes, L. Dana AU - Tapert, F. Susan AU - Bagot, S. Kara AU - PY - 2021/10/18 TI - Passive Sensing of Preteens? Smartphone Use: An Adolescent Brain Cognitive Development (ABCD) Cohort Substudy JO - JMIR Ment Health SP - e29426 VL - 8 IS - 10 KW - preadolescents KW - smartphone use KW - passive sensing KW - screen use KW - screen time KW - mobile phone N2 - Background: Concerns abound regarding childhood smartphone use, but studies to date have largely relied on self-reported screen use. Self-reporting of screen use is known to be misreported by pediatric samples and their parents, limiting the accurate determination of the impact of screen use on social, emotional, and cognitive development. Thus, a more passive, objective measurement of smartphone screen use among children is needed. Objective: This study aims to passively sense smartphone screen use by time and types of apps used in a pilot sample of children and to assess the feasibility of passive sensing in a larger longitudinal sample. Methods: The Adolescent Brain Cognitive Development (ABCD) study used passive, objective phone app methods for assessing smartphone screen use over 4 weeks in 2019-2020 in a subsample of 67 participants (aged 11-12 years; 31/67, 46% female; 23/67, 34% White). Children and their parents both reported average smartphone screen use before and after the study period, and they completed a questionnaire regarding the acceptability of the study protocol. Descriptive statistics for smartphone screen use, app use, and protocol feasibility and acceptability were reviewed. Analyses of variance were run to assess differences in categorical app use by demographics. Self-report and parent report were correlated with passive sensing data. Results: Self-report of smartphone screen use was partly consistent with objective measurement (r=0.49), although objective data indicated that children used their phones more than they reported. Passive sensing revealed the most common types of apps used were for streaming (mean 1 hour 57 minutes per day, SD 1 hour 32 minutes), communication (mean 48 minutes per day, SD 1 hour 17 minutes), gaming (mean 41 minutes per day, SD 41 minutes), and social media (mean 36 minutes per day, SD 1 hour 7 minutes). Passive sensing of smartphone screen use was generally acceptable to children (43/62, 69%) and parents (53/62, 85%). Conclusions: The results of passive, objective sensing suggest that children use their phones more than they self-report. Therefore, use of more robust methods for objective data collection is necessary and feasible in pediatric samples. These data may then more accurately reflect the impact of smartphone screen use on behavioral and emotional functioning. Accordingly, the ABCD study is implementing a passive sensing protocol in the full ABCD cohort. Taken together, passive assessment with a phone app provided objective, low-burden, novel, informative data about preteen smartphone screen use. UR - https://mental.jmir.org/2021/10/e29426 UR - http://dx.doi.org/10.2196/29426 UR - http://www.ncbi.nlm.nih.gov/pubmed/34661541 ID - info:doi/10.2196/29426 ER - TY - JOUR AU - Seiler, Amber AU - Biundo, Eliana AU - Di Bacco, Marco AU - Rosemas, Sarah AU - Nicolle, Emmanuelle AU - Lanctin, David AU - Hennion, Juliette AU - de Melis, Mirko AU - Van Heel, Laura PY - 2021/10/15 TI - Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation JO - JMIR Cardio SP - e27720 VL - 5 IS - 2 KW - cardiac implantable electronic devices KW - remote monitoring KW - patient management KW - clinic efficiency KW - digital health KW - mobile phone N2 - Background: The number of patients with cardiac implantable electronic device (CIED) is increasing, creating a substantial workload for device clinics. Objective: This study aims to characterize the workflow and quantify clinic staff time requirements for managing patients with CIEDs. Methods: A time and motion workflow evaluation was performed in 11 US and European CIEDs clinics. Workflow tasks were repeatedly timed during 1 business week of observation at each clinic; these observations included all device models and manufacturers. The mean cumulative staff time required to review a remote device transmission and an in-person clinic visit were calculated, including all necessary clinical and administrative tasks. The annual staff time to manage a patient with a CIED was modeled using CIED transmission volumes, clinical guidelines, and the published literature. Results: A total of 276 in-person clinic visits and 2173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4 to 13.5 minutes for therapeutic devices (pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy) and from 11.3 to 12.9 minutes for diagnostic devices such as insertable cardiac monitors (ICMs). Mean staff time per in-person visit ranged from 37.8 to 51.0 and from 39.9 to 45.8 minutes for therapeutic devices and ICMs, respectively. Including all remote and in-person follow-ups, the estimated annual time to manage a patient with a CIED ranged from 1.6 to 2.4 hours for therapeutic devices and from 7.7 to 9.3 hours for ICMs. Conclusions: The CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs the implementation of efficiency improvements, including remote solutions. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow. UR - https://cardio.jmir.org/2021/2/e27720 UR - http://dx.doi.org/10.2196/27720 UR - http://www.ncbi.nlm.nih.gov/pubmed/34156344 ID - info:doi/10.2196/27720 ER - TY - JOUR AU - Shetty, B. Vinutha AU - Soon, K. Wayne H. AU - Roberts, G. Alison AU - Fried, Leanne AU - Roby, C. Heather AU - Smith, J. Grant AU - Fournier, A. Paul AU - Jones, W. Timothy AU - Davis, A. Elizabeth PY - 2021/10/14 TI - A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study JO - JMIR Diabetes SP - e29739 VL - 6 IS - 4 KW - mobile health app KW - exercise KW - acT1ve KW - type 1 diabetes KW - young people KW - blood glucose level N2 - Background: Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. Objective: Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. Methods: A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA1c, 54 mmol/mol, SD 5.5 mmol/mol [7.1%, SD 0.5%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. Results: The main themes arising from the interview analysis were ?increased knowledge,? ?increased confidence to exercise,? and ?suitability? for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). Conclusions: The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373 UR - https://diabetes.jmir.org/2021/4/e29739 UR - http://dx.doi.org/10.2196/29739 UR - http://www.ncbi.nlm.nih.gov/pubmed/34647896 ID - info:doi/10.2196/29739 ER - TY - JOUR AU - Spadaro, Benedetta AU - Martin-Key, A. Nayra AU - Bahn, Sabine PY - 2021/10/13 TI - Building the Digital Mental Health Ecosystem: Opportunities and Challenges for Mobile Health Innovators JO - J Med Internet Res SP - e27507 VL - 23 IS - 10 KW - digital implementation KW - digital mental health KW - digital psychiatry KW - digital technology KW - viewpoint UR - https://www.jmir.org/2021/10/e27507 UR - http://dx.doi.org/10.2196/27507 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643537 ID - info:doi/10.2196/27507 ER - TY - JOUR AU - Cruz, da Flávia Oliveira de Almeida Marques AU - Faria, Tostes Edison AU - Ghobad, Cardelino Pabblo AU - Alves, Mano Leandro Yukio AU - Reis, dos Paula Elaine Diniz PY - 2021/10/13 TI - A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study JO - J Med Internet Res SP - e24865 VL - 23 IS - 10 KW - mobile applications KW - health education KW - nursing care KW - oncology nursing KW - educational technology KW - breast neoplasms KW - radiation therapy N2 - Background: Mobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care. Objective: The aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy. Methods: The evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80% was considered to ensure the adequacy of the material. Results: After the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80%. Conclusions: The mobile app titled ?AMOR Mama? was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use. UR - https://www.jmir.org/2021/10/e24865 UR - http://dx.doi.org/10.2196/24865 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643531 ID - info:doi/10.2196/24865 ER - TY - JOUR AU - Rodriguez, Marcus AU - Eisenlohr-Moul, A. Tory AU - Weisman, Jared AU - Rosenthal, Zachary M. PY - 2021/10/13 TI - The Use of Task Shifting to Improve Treatment Engagement in an Internet-Based Mindfulness Intervention Among Chinese University Students: Randomized Controlled Trial JO - JMIR Form Res SP - e25772 VL - 5 IS - 10 KW - mindfulness KW - mental health KW - social support KW - internet-based intervention KW - treatment outcome KW - university students KW - smartphone KW - mobile phone N2 - Background: Traditional in-person psychotherapies are incapable of addressing global mental health needs. Use of computer-based interventions is one promising solution for closing the gap between the amount of global mental health treatment needed and received. Objective: Although many meta-analyses have provided evidence supporting the efficacy of self-guided, computer-based interventions, most report low rates of treatment engagement (eg, high attrition and low adherence). The aim of this study is to investigate the efficacy of an adjunctive treatment component that uses task shifting, wherein mental health care is provided by nonspecialist peer counselors to enhance engagement in an internet-based, self-directed, evidence-based mindfulness intervention among Chinese university students. Methods: From 3 universities across China, 54 students who reported at least mild stress, anxiety, or depression were randomly assigned to a 4-week internet-based mindfulness intervention (MIND) or to the intervention plus peer counselor support (MIND+), respectively. Be Mindful delivers all the elements of mindfulness-based cognitive therapy in an internet-based, 4-week course. Participants completed daily monitoring of mindfulness practice and mood, as well as baseline and posttreatment self-reported levels of depression, anxiety, stress, and trait mindfulness. We screened 56 volunteer peer counselor candidates who had no former training in the delivery of mental health services. Of these, 10 were invited to participate in a day-long training, and 4 were selected. Peer counselors were instructed to provide 6 brief (15-20 minute) sessions each week, to help encouraging participants to complete the internet-based intervention. Peer counselors received weekly web-based group supervision. Results: For both conditions, participation in the internet-based intervention was associated with significant improvements in mindfulness and mental health outcomes. The pre-post effect sizes (Cohen d) for mindfulness, depression, anxiety, and stress were 0.55, 0.95, 0.89, and 1.13, respectively. Participants assigned to the MIND+ (vs MIND) condition demonstrated significantly less attrition and more adherence, as indicated by a greater likelihood of completing posttreatment assessments (16/27, 59% vs 7/27, 26%; ?21=6.1; P=.01) and a higher percentage of course completion (72.6/100, 72.6% vs 50.7/100, 50.7%; t52=2.10; P=.04), respectively. No significant between-group differences in daily frequency and duration of mindfulness practice were observed. Multilevel logistic growth models showed that MIND+ participants reported significantly greater pre-post improvements in daily stress ratings (interaction estimate 0.39, SE 0.18; t317=2.29; P=.02) and depression (interaction estimate 0.38, SE 0.16; t330=2.37; P=.02) than those in the MIND condition. Conclusions: This study provides new insights into effective ways of leveraging technology and task shifting to implement large-scale mental health initiatives that are financially feasible, easily transportable, and quickly scalable in low-resource settings. The findings suggest that volunteer peer counselors receiving low-cost, low-intensity training and supervision may significantly improve participants? indices of treatment engagement and mental health outcomes in an internet-based mindfulness intervention among Chinese university students. UR - https://formative.jmir.org/2021/10/e25772 UR - http://dx.doi.org/10.2196/25772 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643532 ID - info:doi/10.2196/25772 ER - TY - JOUR AU - Vera Cruz dos Santos, Daniela AU - Coelho de Soárez, Patrícia AU - Cavero, Victoria AU - U Rocha, I. Thaís AU - Aschar, Suzana AU - Daley, Louise Kate AU - Garcia Claro, Heloísa AU - Abud Scotton, George AU - Fernandes, Ivan AU - Diez-Canseco, Francisco AU - Brandt, Rebeca Lena AU - Toyama, Mauricio AU - Martins Castro, Carolina Hellen AU - Miranda, Jaime J. AU - Araya, Ricardo AU - Quayle, Julieta AU - Rossi Menezes, Paulo PY - 2021/10/13 TI - A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru JO - JMIR Res Protoc SP - e26164 VL - 10 IS - 10 KW - cost-effectiveness KW - depression KW - diabetes KW - hypertension KW - noncommunicable diseases KW - randomized trials KW - low- and middle-income countries KW - mHealth KW - task shifting KW - behavioral activation N2 - Background: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. Objective: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. Methods: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top?down and bottom?up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. Results: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. Conclusions: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426 International Registered Report Identifier (IRRID): DERR1-10.2196/26164 UR - https://www.researchprotocols.org/2021/10/e26164 UR - http://dx.doi.org/10.2196/26164 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643538 ID - info:doi/10.2196/26164 ER - TY - JOUR AU - Dolcini, Margaret M. AU - Canchola, A. Jesse AU - Catania, A. Joseph AU - Song Mayeda, M. Marissa AU - Dietz, L. Erin AU - Cotto-Negrón, Coral AU - Narayanan, Vasudha PY - 2021/10/12 TI - National-Level Disparities in Internet Access Among Low-Income and Black and Hispanic Youth: Current Population Survey JO - J Med Internet Res SP - e27723 VL - 23 IS - 10 KW - internet access KW - smartphone use KW - Black youth KW - Hispanic youth KW - low-income youth KW - disparities KW - mobile phone N2 - Background: Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. Objective: The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. Methods: Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). Results: Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. Conclusions: Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities. UR - https://www.jmir.org/2021/10/e27723 UR - http://dx.doi.org/10.2196/27723 UR - http://www.ncbi.nlm.nih.gov/pubmed/34636728 ID - info:doi/10.2196/27723 ER - TY - JOUR AU - Hu, Xiao-Su AU - Beard, Katherine AU - Sherbel, Catherine Mary AU - Nascimento, D. Thiago AU - Petty, Sean AU - Pantzlaff, Eddie AU - Schwitzer, David AU - Kaciroti, Niko AU - Maslowski, Eric AU - Ashman, M. Lawrence AU - Feinberg, E. Stephen AU - DaSilva, F. Alexandre PY - 2021/10/12 TI - Brain Mechanisms of Virtual Reality Breathing Versus Traditional Mindful Breathing in Pain Modulation: Observational Functional Near-infrared Spectroscopy Study JO - J Med Internet Res SP - e27298 VL - 23 IS - 10 KW - virtual reality breathing KW - traditional mindful breathing KW - pain KW - functional near-infrared spectroscopy KW - mobile phone N2 - Background: Pain is a complex experience that involves sensory-discriminative and cognitive-emotional neuronal processes. It has long been known across cultures that pain can be relieved by mindful breathing (MB). There is a common assumption that MB exerts its analgesic effect through interoception. Interoception refers to consciously refocusing the mind?s attention to the physical sensation of internal organ function. Objective: In this study, we dissect the cortical analgesic processes by imaging the brains of healthy subjects exposed to traditional MB (TMB) and compare them with another group for which we augmented MB to an outside sensory experience via virtual reality breathing (VRB). Methods: The VRB protocol involved in-house?developed virtual reality 3D lungs that synchronized with the participants? breathing cycles in real time, providing them with an immersive visual-auditory exteroception of their breathing. Results: We found that both breathing interventions led to a significant increase in pain thresholds after week-long practices, as measured by a thermal quantitative sensory test. However, the underlying analgesic brain mechanisms were opposite, as revealed by functional near-infrared spectroscopy data. In the TMB practice, the anterior prefrontal cortex uniquely modulated the premotor cortex. This increased its functional connection with the primary somatosensory cortex (S1), thereby facilitating the S1-based sensory-interoceptive processing of breathing but inhibiting its other role in sensory-discriminative pain processing. In contrast, virtual reality induced an immersive 3D exteroception with augmented visual-auditory cortical activations, which diminished the functional connection with the S1 and consequently weakened the pain processing function of the S1. Conclusions: In summary, our study suggested two analgesic neuromechanisms of VRB and TMB practices?exteroception and interoception?that distinctively modulated the S1 processing of the ascending noxious inputs. This is in line with the concept of dualism (Yin and Yang). UR - https://www.jmir.org/2021/10/e27298 UR - http://dx.doi.org/10.2196/27298 UR - http://www.ncbi.nlm.nih.gov/pubmed/34636731 ID - info:doi/10.2196/27298 ER - TY - JOUR AU - Woo, MinJae AU - Mishra, Prabodh AU - Lin, Ju AU - Kar, Snigdhaswin AU - Deas, Nicholas AU - Linduff, Caleb AU - Niu, Sufeng AU - Yang, Yuzhe AU - McClendon, Jerome AU - Smith, Hudson D. AU - Shelton, L. Stephen AU - Gainey, E. Christopher AU - Gerard, C. William AU - Smith, C. Melissa AU - Griffin, F. Sarah AU - Gimbel, W. Ronald AU - Wang, Kuang-Ching PY - 2021/10/12 TI - Complete and Resilient Documentation for Operational Medical Environments Leveraging Mobile Hands-free Technology in a Systems Approach: Experimental Study JO - JMIR Mhealth Uhealth SP - e32301 VL - 9 IS - 10 KW - emergency medical services KW - prehospital documentation KW - speech recognition software KW - natural language processing KW - military medicine KW - documentation KW - development KW - challenge KW - paramedic KW - disruption KW - attention KW - medical information KW - audio KW - speech recognition KW - qualitative KW - simulation N2 - Background: Prehospitalization documentation is a challenging task and prone to loss of information, as paramedics operate under disruptive environments requiring their constant attention to the patients. Objective: The aim of this study is to develop a mobile platform for hands-free prehospitalization documentation to assist first responders in operational medical environments by aggregating all existing solutions for noise resiliency and domain adaptation. Methods: The platform was built to extract meaningful medical information from the real-time audio streaming at the point of injury and transmit complete documentation to a field hospital prior to patient arrival. To this end, the state-of-the-art automatic speech recognition (ASR) solutions with the following modular improvements were thoroughly explored: noise-resilient ASR, multi-style training, customized lexicon, and speech enhancement. The development of the platform was strictly guided by qualitative research and simulation-based evaluation to address the relevant challenges through progressive improvements at every process step of the end-to-end solution. The primary performance metrics included medical word error rate (WER) in machine-transcribed text output and an F1 score calculated by comparing the autogenerated documentation to manual documentation by physicians. Results: The total number of 15,139 individual words necessary for completing the documentation were identified from all conversations that occurred during the physician-supervised simulation drills. The baseline model presented a suboptimal performance with a WER of 69.85% and an F1 score of 0.611. The noise-resilient ASR, multi-style training, and customized lexicon improved the overall performance; the finalized platform achieved a medical WER of 33.3% and an F1 score of 0.81 when compared to manual documentation. The speech enhancement degraded performance with medical WER increased from 33.3% to 46.33% and the corresponding F1 score decreased from 0.81 to 0.78. All changes in performance were statistically significant (P<.001). Conclusions: This study presented a fully functional mobile platform for hands-free prehospitalization documentation in operational medical environments and lessons learned from its implementation. UR - https://mhealth.jmir.org/2021/10/e32301 UR - http://dx.doi.org/10.2196/32301 UR - http://www.ncbi.nlm.nih.gov/pubmed/34636729 ID - info:doi/10.2196/32301 ER - TY - JOUR AU - Kruglova, Katya AU - O'Connell, Laura Siobhan Bernadette AU - Dawadi, Shrinkhala AU - Gelgoot, Noah Eden AU - Miner, A. Skye AU - Robins, Stephanie AU - Schinazi, Joy AU - Zelkowitz, Phyllis PY - 2021/10/12 TI - An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study JO - JMIR Form Res SP - e28136 VL - 5 IS - 10 KW - mHealth app KW - mHealth development process KW - infertility KW - intervention design KW - mobile phone N2 - Background: The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective: This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods: To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app?s content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app?s content based on participants? feedback and searched for partners to disseminate the app to the broader public. Results: This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions: By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps. UR - https://formative.jmir.org/2021/10/e28136 UR - http://dx.doi.org/10.2196/28136 UR - http://www.ncbi.nlm.nih.gov/pubmed/34636741 ID - info:doi/10.2196/28136 ER - TY - JOUR AU - Kang, Min-gu AU - Kang, Seong-Ji AU - Roh, Hye-Kang AU - Jung, Hwa-Young AU - Kim, Sun?wook AU - Choi, Jung-Yeon AU - Kim, Kwang-il PY - 2021/10/11 TI - Accuracy and Diversity of Wearable Device?Based Gait Speed Measurement Among Older Men: Observational Study JO - J Med Internet Res SP - e29884 VL - 23 IS - 10 KW - gait speed KW - sarcopenia KW - skeletal muscle mass KW - wearable device N2 - Background: Gait speed measurements are widely used in clinical practice, as slow gait is a major predictor of frailty and a diagnostic criterion for sarcopenia. With the development of wearable devices, it is possible to estimate the gait speed in daily life by simply wearing the device. Objective: This study aims to accurately determine the characteristics of daily life gait speed and analyze their association with sarcopenia. Methods: We invited community-dwelling men aged >50 years who had visited the outpatient clinic at a tertiary university hospital to participate in the study. Daily life gait speed was assessed using a wearable smart belt (WELT) for a period of 4 weeks. Data from participants who wore the smart belt for at least 10 days during this period were included. After 4 weeks, data from a survey about medical and social history, usual gait speed measurements, handgrip strength measurements, and dual-energy x-ray absorptiometry were analyzed. Results: A total of 217,578 daily life gait speed measurements from 106 participants (mean age 71.1, SD 7.6 years) were analyzed. The mean daily life gait speed was 1.23 (SD 0.26) m/s. The daily life gait speed of the participants varied according to the time of the day and day of the week. Daily life gait speed significantly slowed down with age (P<.001). Participants with sarcopenia had significantly lower mean daily life gait speed (mean 1.12, SD 0.11 m/s) than participants without sarcopenia (mean 1.23, SD 0.08 m/s; P<.001). Analysis of factors related to mean daily life gait speed showed that age and skeletal muscle mass of the lower limbs were significantly associated characteristics. Conclusions: More diverse and accurate information about gait speed can be obtained by measuring daily life gait speed using a wearable device over an appropriate period, compared with one-time measurements performed in a laboratory setting. Importantly, in addition to age, daily life gait speed is significantly associated with skeletal muscle mass of the lower limbs. UR - https://www.jmir.org/2021/10/e29884 UR - http://dx.doi.org/10.2196/29884 UR - http://www.ncbi.nlm.nih.gov/pubmed/34633293 ID - info:doi/10.2196/29884 ER - TY - JOUR AU - Ehn, Maria AU - Richardson, X. Matt AU - Landerdahl Stridsberg, Sara AU - Redekop, Ken AU - Wamala-Andersson, Sarah PY - 2021/10/11 TI - Mobile Safety Alarms Based on GPS Technology in the Care of Older Adults: Systematic Review of Evidence Based on a General Evidence Framework for Digital Health Technologies JO - J Med Internet Res SP - e27267 VL - 23 IS - 10 KW - GPS KW - older adults KW - dementia KW - evidence KW - digital health KW - NICE KW - mobile phone N2 - Background: GPS alarms aim to support users in independent activities. Previous systematic reviews have reported a lack of clear evidence of the effectiveness of GPS alarms for the health and welfare of users and their families and for social care provision. As GPS devices are currently being implemented in social care, it is important to investigate whether the evidence of their clinical effectiveness remains insufficient. Standardized evidence frameworks have been developed to ensure that new technologies are clinically effective and offer economic value. The frameworks for analyzing existing evidence of the clinical effectiveness of GPS devices can be used to identify the risks associated with their implementation and demonstrate key aspects of successful piloting or implementation. Objective: The principal aim of this study is to provide an up-to-date systematic review of evidence based on existing studies of the effects of GPS alarms on health, welfare, and social provision in the care of older adults compared with non?GPS-based standard care. In addition, the study findings were assessed by using the evidence standards framework for digital health technologies (DHTs) established by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. Methods: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Primary studies published in peer-reviewed journals and gray literature from January 2005 to August 2020 were identified through searches in 13 databases and several sources of gray literature. Included studies had individuals (aged ?50 years) who were receiving social care for older adults or for persons with dementia; used GPS devices as an intervention; were performed in Canada, the United States, European Union, Singapore, Australia, New Zealand, Hong Kong, South Korea, or Japan; and addressed quantitative outcomes related to health, welfare, and social care. The study findings were analyzed by using the NICE framework requirements for active monitoring DHTs. Results: Of the screened records, 1.6% (16/986) were included. Following the standards of the NICE framework, practice evidence was identified for the tier 1 categories Relevance to current pathways in health/social care system and Acceptability with users, and minimum evidence was identified for the tier 1 category Credibility with health, social care professionals. However, several evidence categories for tiers 1 and 2 could not be assessed, and no clear evidence demonstrating effectiveness could be identified. Thus, the evidence required for using DHTs to track patient location according to the NICE framework was insufficient. Conclusions: Evidence of the beneficial effects of GPS alarms on the health and welfare of older adults and social care provision remains insufficient. This review illustrated the application of the NICE framework in analyses of evidence, demonstrated successful piloting and acceptability with users of GPS devices, and identified implications for future research. UR - https://www.jmir.org/2021/10/e27267 UR - http://dx.doi.org/10.2196/27267 UR - http://www.ncbi.nlm.nih.gov/pubmed/34633291 ID - info:doi/10.2196/27267 ER - TY - JOUR AU - Chen, Hung-Chang AU - Tzeng, Shin-Shi AU - Hsiao, Yen-Chang AU - Chen, Ruei-Feng AU - Hung, Erh-Chien AU - Lee, K. Oscar PY - 2021/10/8 TI - Smartphone-Based Artificial Intelligence?Assisted Prediction for Eyelid Measurements: Algorithm Development and Observational Validation Study JO - JMIR Mhealth Uhealth SP - e32444 VL - 9 IS - 10 KW - artificial intelligence KW - AI KW - deep learning KW - margin reflex distance 1 KW - margin reflex distance 2 KW - levator muscle function KW - smartphone KW - measurement KW - eye KW - prediction KW - processing KW - limit KW - image KW - algorithm KW - observational N2 - Background: Margin reflex distance 1 (MRD1), margin reflex distance 2 (MRD2), and levator muscle function (LF) are crucial metrics for ptosis evaluation and management. However, manual measurements of MRD1, MRD2, and LF are time-consuming, subjective, and prone to human error. Smartphone-based artificial intelligence (AI) image processing is a potential solution to overcome these limitations. Objective: We propose the first smartphone-based AI-assisted image processing algorithm for MRD1, MRD2, and LF measurements. Methods: This observational study included 822 eyes of 411 volunteers aged over 18 years from August 1, 2020, to April 30, 2021. Six orbital photographs (bilateral primary gaze, up-gaze, and down-gaze) were taken using a smartphone (iPhone 11 Pro Max). The gold-standard measurements and normalized eye photographs were obtained from these orbital photographs and compiled using AI-assisted software to create MRD1, MRD2, and LF models. Results: The Pearson correlation coefficients between the gold-standard measurements and the predicted values obtained with the MRD1 and MRD2 models were excellent (r=0.91 and 0.88, respectively) and that obtained with the LF model was good (r=0.73). The intraclass correlation coefficient demonstrated excellent agreement between the gold-standard measurements and the values predicted by the MRD1 and MRD2 models (0.90 and 0.84, respectively), and substantial agreement with the LF model (0.69). The mean absolute errors were 0.35 mm, 0.37 mm, and 1.06 mm for the MRD1, MRD2, and LF models, respectively. The 95% limits of agreement were ?0.94 to 0.94 mm for the MRD1 model, ?0.92 to 1.03 mm for the MRD2 model, and ?0.63 to 2.53 mm for the LF model. Conclusions: We developed the first smartphone-based AI-assisted image processing algorithm for eyelid measurements. MRD1, MRD2, and LF measures can be taken in a quick, objective, and convenient manner. Furthermore, by using a smartphone, the examiner can check these measurements anywhere and at any time, which facilitates data collection. UR - https://mhealth.jmir.org/2021/10/e32444 UR - http://dx.doi.org/10.2196/32444 UR - http://www.ncbi.nlm.nih.gov/pubmed/34538776 ID - info:doi/10.2196/32444 ER - TY - JOUR AU - Jiang, Nan AU - Nguyen, Nam AU - Siman, Nina AU - Cleland, M. Charles AU - Nguyen, Trang AU - Doan, Thi Hue AU - Abroms, C. Lorien AU - Shelley, R. Donna PY - 2021/10/8 TI - Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e27478 VL - 9 IS - 10 KW - smoking cessation KW - text messaging KW - mHealth KW - mobile health KW - low- and middle-income country KW - smoking KW - developing countries KW - SMS KW - Vietnam N2 - Background: Text message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam. Objective: The goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers. Methods: The study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm. Results: Participants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8%) reset the quit date and 19 (38%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98% [49/50] vs 82% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20% [10/50] vs 2% [1/50]; P=.01), but the effect was not significant at 12 weeks (12% [6/50] vs 6% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking. Conclusions: The study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence. Trial Registration: ClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541 UR - https://mhealth.jmir.org/2021/10/e27478 UR - http://dx.doi.org/10.2196/27478 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623318 ID - info:doi/10.2196/27478 ER - TY - JOUR AU - Lacour, Matthieu AU - Bloudeau, Laurie AU - Combescure, Christophe AU - Haddad, Kevin AU - Hugon, Florence AU - Suppan, Laurent AU - Rodieux, Frédérique AU - Lovis, Christian AU - Gervaix, Alain AU - Ehrler, Frédéric AU - Manzano, Sergio AU - Siebert, N. Johan AU - PY - 2021/10/7 TI - Impact of a Mobile App on Paramedics? Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e31748 VL - 9 IS - 10 KW - cardiopulmonary resuscitation KW - drugs KW - emergency medical services KW - medication errors KW - mobile health KW - mobile apps KW - out-of-hospital cardiac arrest KW - paramedics KW - pediatrics KW - State-Trait Anxiety Inventory KW - stress N2 - Background: Out-of-hospital cardiac arrests (OHCAs) are stressful, high-stake events that are associated with low survival rates. Acute stress experienced in this situation is associated with lower cardiopulmonary resuscitation performance in calculating drug dosages by emergency medical services. Children are particularly vulnerable to such errors. To date, no app has been validated to specifically support emergency drug preparation by paramedics through reducing the stress level of this procedure and medication errors. Objective: This study aims to determine the effectiveness of an evidence-based mobile app compared with that of the conventional preparation methods in reducing acute stress in paramedics at the psychological and physiological levels while safely preparing emergency drugs during simulated pediatric OHCA scenarios. Methods: In a parent, multicenter, randomized controlled trial of 14 emergency medical services, perceived and physiologic stress of advanced paramedics with drug preparation autonomy was assessed during a 20-minute, standardized, fully video-recorded, and highly realistic pediatric OHCA scenario in an 18-month-old child. The primary outcome was participants? self-reported psychological stress perceived during sequential preparations of 4 intravenous emergency drugs (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate) with the support of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app designed to help pediatric drug preparation (intervention) or conventional methods (control). The State-Trait Anxiety Inventory and Visual Analog Scale questionnaires were used to measure perceived stress. The secondary outcome was physiologic stress, measured by a single continuous measurement of the participants? heart rate with optical photoplethysmography. Results: From September 3, 2019, to January 21, 2020, 150 advanced paramedics underwent randomization. A total of 74 participants were assigned to the mobile app (intervention group), and 76 did not use the app (control group). A total of 600 drug doses were prepared. Higher State-Trait Anxiety Inventory?perceived stress increase from baseline was observed during the scenario using the conventional methods (mean 35.4, SD 8.2 to mean 49.8, SD 13.2; a 41.3%, 35.0 increase) than when using the app (mean 36.1, SD 8.1 to mean 39.0, SD 8.4; a 12.3%, 29.0 increase). This revealed a 30.1% (95% CI 20.5%-39.8%; P<.001) lower relative change in stress response in participants who used the app. On the Visual Analog Scale questionnaire, participants in the control group reported a higher increase in stress at the peak of the scenario (mean 7.1, SD 1.8 vs mean 6.4, SD 1.9; difference: ?0.8, 95% CI ?1.3 to ?0.2; P=.005). Increase in heart rate during the scenario and over the 4 drugs was not different between the 2 groups. Conclusions: Compared with the conventional method, dedicated mobile apps can reduce acute perceived stress during the preparation of emergency drugs in the prehospital setting during critical situations. These findings can help advance the development and evaluation of mobile apps for OHCA management and should be encouraged. Trial Registration: ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3726-4 UR - https://mhealth.jmir.org/2021/10/e31748 UR - http://dx.doi.org/10.2196/31748 UR - http://www.ncbi.nlm.nih.gov/pubmed/34617916 ID - info:doi/10.2196/31748 ER - TY - JOUR AU - Kelly, J. Peter AU - Beck, K. Alison AU - Deane, P. Frank AU - Larance, Briony AU - Baker, L. Amanda AU - Hides, Leanne AU - Manning, Victoria AU - Shakeshaft, Anthony AU - Neale, Joanne AU - Kelly, F. John AU - Oldmeadow, Christopher AU - Searles, Andrew AU - Palazzi, Kerrin AU - Lawson, Kenny AU - Treloar, Carla AU - Gray, M. Rebecca AU - Argent, Angela AU - McGlaughlin, Ryan PY - 2021/10/6 TI - Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in SMART Recovery Mutual Support Groups: Stage 1 Mixed Methods Pilot Study JO - J Med Internet Res SP - e25217 VL - 23 IS - 10 KW - mHealth KW - SMART Recovery KW - mutual support group KW - mutual aid KW - routine outcome monitoring KW - treatment progress feedback KW - addiction KW - mobile phone N2 - Background: Mutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM. Objective: The aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (SMART Track) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks. Methods: SMART Track was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the SMART Track app. Four modes of data collection were used: ROM data directly entered by participants into the app; app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention); baseline, 2-, and 8-week follow-up assessments conducted through telephone; and qualitative telephone interviews with a convenience sample of study participants (20/72, 28%) and facilitators (n=8). Results: Of the 72 study participants, 68 (94%) created a SMART Track account, 64 (88%) used SMART Track at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (Urges screen and Overall Progress screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02; 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31; 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97; 95% CI ?2.02 to 2.24) was reported. Conclusions: Findings support the feasibility, acceptability, and utility of SMART Track. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. SMART Track offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336 International Registered Report Identifier (IRRID): RR2-10.2196/15113 UR - https://www.jmir.org/2021/10/e25217 UR - http://dx.doi.org/10.2196/25217 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612829 ID - info:doi/10.2196/25217 ER - TY - JOUR AU - Gonsalves, P. Pattie AU - Sharma, Rhea AU - Hodgson, Eleanor AU - Bhat, Bhargav AU - Jambhale, Abhijeet AU - Weiss, A. Helen AU - Fairburn, G. Christopher AU - Cavanagh, Kate AU - Cuijpers, Pim AU - Michelson, Daniel AU - Patel, Vikram PY - 2021/10/6 TI - A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e30339 VL - 10 IS - 10 KW - randomized controlled trial KW - internet-based intervention KW - smartphone KW - adolescent KW - schools KW - mental health KW - COVID-19 KW - app KW - protocol KW - problem-solving KW - intervention KW - teenager KW - young adult KW - India KW - feasibility KW - effective N2 - Background: ?POD Adventures? is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective: Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods: We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results: The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions: This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID): DERR1-10.2196/30339 UR - https://www.researchprotocols.org/2021/10/e30339 UR - http://dx.doi.org/10.2196/30339 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586075 ID - info:doi/10.2196/30339 ER - TY - JOUR AU - Rigamonti, Lia AU - Secchi, Matteo AU - Lawrence, B. Jimmy AU - Labianca, Luca AU - Wolfarth, Bernd AU - Peters, Harm AU - Bonaventura, Klaus AU - Back, Alexander David PY - 2021/10/5 TI - An Augmented Reality Device for Remote Supervision of Ultrasound Examinations in International Exercise Science Projects: Usability Study JO - J Med Internet Res SP - e28767 VL - 23 IS - 10 KW - augmented reality KW - ultrasound KW - social media KW - remote KW - exercise science N2 - Background: Support for long-distance research and clinical collaborations is in high demand and has increased owing to COVID-19?related restrictions on travel and social contact. New digital approaches are required for remote scientific exchange. Objective: This study aims to analyze the options of using an augmented reality device for remote supervision of exercise science examinations. Methods: A mobile ultrasound examination of the diameter and intima-media thickness of the femoral and carotid arteries was remotely supervised using a head-mounted augmented reality device. All participants were provided with a link to a YouTube video of the technique in advance. In part 1, 8 international experts from the fields of engineering and sports science were remotely connected to the study setting. Internet connection speed was noted, and a structured interview was conducted. In part 2, 2 remote supervisors evaluated 8 physicians performing an examination on a healthy human subject. The results were recorded, and an evaluation was conducted using a 25-item questionnaire. Results: In part 1, the remote experts were connected over a mean distance of 1587 km to the examination site. Overall transmission quality was good (mean upload speed: 28.7 Mbps, mean download speed: 97.3 Mbps, mean ping: 21.6 milliseconds). In the interview, participants indicated that the main potential benefits would be to the fields of education, movement analysis, and supervision. Challenges regarding internet connection stability and previous training with the devices used were reported. In part 2, physicians? examinations showed good interrater correlation (interclass correlation coefficient: 0.84). Participants valued the experienced setting as highly positive. Conclusions: The study showed the good feasibility of the chosen design and a highly positive attitude of all participants toward this digital approach. Head-mounted augmented reality devices are generally recommended for collaborative research projects with physical examination?based research questions. UR - https://www.jmir.org/2021/10/e28767 UR - http://dx.doi.org/10.2196/28767 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609312 ID - info:doi/10.2196/28767 ER - TY - JOUR AU - Stucky, Benjamin AU - Clark, Ian AU - Azza, Yasmine AU - Karlen, Walter AU - Achermann, Peter AU - Kleim, Birgit AU - Landolt, Hans-Peter PY - 2021/10/5 TI - Validation of Fitbit Charge 2 Sleep and Heart Rate Estimates Against Polysomnographic Measures in Shift Workers: Naturalistic Study JO - J Med Internet Res SP - e26476 VL - 23 IS - 10 KW - wearables KW - actigraphy KW - polysomnography KW - validation KW - multisensory KW - mobile phone N2 - Background: Multisensor fitness trackers offer the ability to longitudinally estimate sleep quality in a home environment with the potential to outperform traditional actigraphy. To benefit from these new tools for objectively assessing sleep for clinical and research purposes, multisensor wearable devices require careful validation against the gold standard of sleep polysomnography (PSG). Naturalistic studies favor validation. Objective: This study aims to validate the Fitbit Charge 2 against portable home PSG in a shift-work population composed of 59 first responder police officers and paramedics undergoing shift work. Methods: A reliable comparison between the two measurements was ensured through the data-driven alignment of a PSG and Fitbit time series that was recorded at night. Epoch-by-epoch analyses and Bland-Altman plots were used to assess sensitivity, specificity, accuracy, the Matthews correlation coefficient, bias, and limits of agreement. Results: Sleep onset and offset, total sleep time, and the durations of rapid eye movement (REM) sleep and non?rapid-eye movement sleep stages N1+N2 and N3 displayed unbiased estimates with nonnegligible limits of agreement. In contrast, the proprietary Fitbit algorithm overestimated REM sleep latency by 29.4 minutes and wakefulness after sleep onset (WASO) by 37.1 minutes. Epoch-by-epoch analyses indicated better specificity than sensitivity, with higher accuracies for WASO (0.82) and REM sleep (0.86) than those for N1+N2 (0.55) and N3 (0.78) sleep. Fitbit heart rate (HR) displayed a small underestimation of 0.9 beats per minute (bpm) and a limited capability to capture sudden HR changes because of the lower time resolution compared to that of PSG. The underestimation was smaller in N2, N3, and REM sleep (0.6-0.7 bpm) than in N1 sleep (1.2 bpm) and wakefulness (1.9 bpm), indicating a state-specific bias. Finally, Fitbit suggested a distribution of all sleep episode durations that was different from that derived from PSG and showed nonbiological discontinuities, indicating the potential limitations of the staging algorithm. Conclusions: We conclude that by following careful data processing processes, the Fitbit Charge 2 can provide reasonably accurate mean values of sleep and HR estimates in shift workers under naturalistic conditions. Nevertheless, the generally wide limits of agreement hamper the precision of quantifying individual sleep episodes. The value of this consumer-grade multisensor wearable in terms of tackling clinical and research questions could be enhanced with open-source algorithms, raw data access, and the ability to blind participants to their own sleep data. UR - https://www.jmir.org/2021/10/e26476 UR - http://dx.doi.org/10.2196/26476 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609317 ID - info:doi/10.2196/26476 ER - TY - JOUR AU - de Vries, Herman AU - Kamphuis, Wim AU - Oldenhuis, Hilbrand AU - van der Schans, Cees AU - Sanderman, Robbert PY - 2021/10/4 TI - Moderation of the Stressor-Strain Process in Interns by Heart Rate Variability Measured With a Wearable and Smartphone App: Within-Subject Design Using Continuous Monitoring JO - JMIR Cardio SP - e28731 VL - 5 IS - 2 KW - stress KW - strain KW - burnout KW - resilience KW - heart rate variability KW - sleep KW - wearables KW - digital health KW - sensors KW - ecological momentary assessment KW - mobile phone N2 - Background: The emergence of smartphones and wearable sensor technologies enables easy and unobtrusive monitoring of physiological and psychological data related to an individual?s resilience. Heart rate variability (HRV) is a promising biomarker for resilience based on between-subject population studies, but observational studies that apply a within-subject design and use wearable sensors in order to observe HRV in a naturalistic real-life context are needed. Objective: This study aims to explore whether resting HRV and total sleep time (TST) are indicative and predictive of the within-day accumulation of the negative consequences of stress and mental exhaustion. The tested hypotheses are that demands are positively associated with stress and resting HRV buffers against this association, stress is positively associated with mental exhaustion and resting HRV buffers against this association, stress negatively impacts subsequent-night TST, and previous-evening mental exhaustion negatively impacts resting HRV, while previous-night TST buffers against this association. Methods: In total, 26 interns used consumer-available wearables (Fitbit Charge 2 and Polar H7), a consumer-available smartphone app (Elite HRV), and an ecological momentary assessment smartphone app to collect resilience-related data on resting HRV, TST, and perceived demands, stress, and mental exhaustion on a daily basis for 15 weeks. Results: Multiple linear regression analysis of within-subject standardized data collected on 2379 unique person-days showed that having a high resting HRV buffered against the positive association between demands and stress (hypothesis 1) and between stress and mental exhaustion (hypothesis 2). Stress did not affect TST (hypothesis 3). Finally, mental exhaustion negatively predicted resting HRV in the subsequent morning but TST did not buffer against this (hypothesis 4). Conclusions: To our knowledge, this study provides first evidence that having a low within-subject resting HRV may be both indicative and predictive of the short-term accumulation of the negative effects of stress and mental exhaustion, potentially forming a negative feedback loop. If these findings can be replicated and expanded upon in future studies, they may contribute to the development of automated resilience interventions that monitor daily resting HRV and aim to provide users with an early warning signal when a negative feedback loop forms, to prevent the negative impact of stress on long-term health outcomes. UR - https://cardio.jmir.org/2021/2/e28731 UR - http://dx.doi.org/10.2196/28731 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319877 ID - info:doi/10.2196/28731 ER - TY - JOUR AU - Noddin, Katie AU - Bradley, Dani AU - Wolfberg, Adam PY - 2021/10/4 TI - Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study JO - JMIR Pediatr Parent SP - e27769 VL - 4 IS - 4 KW - digital health KW - COVID-19 KW - maternal health KW - obstetrics KW - COVID KW - pandemic KW - pregnant women KW - birth KW - hospital KW - delivery KW - women's health KW - Cesarean sections N2 - Background: The COVID-19 pandemic has presented obstacles for providers and patients in the maternal health care setting, causing changes to many pregnant women?s birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal health care landscape at the national level in the United States. Objective: The aim of this study is to assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, and home births) and length of hospital stay during the COVID-19 pandemic as compared to the 6 months prior. Methods: We conducted a retrospective cohort study of women aged 18-44 years in the United States who delivered between October 1, 2019, and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile app. Women were assigned to the prepandemic cohort if they delivered between October 2019 and March 2020, and the pandemic cohort if they delivered between April and September 2020. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared. Results: A total of 304,023 birth reports were collected, with 152,832 (50.26%) in the prepandemic cohort and 151,191 (49.73%) in the pandemic cohort. Compared to the prepandemic cohort, principal findings indicate a 5.67% decrease in preterm delivery rates in the pandemic cohort (P<.001; odds ratio [OR] 0.94, 95% CI 0.91-0.96), a 30.0% increase in home birth rates (P<.001; OR 1.3, 95% CI 1.23-1.4), and a 7.81% decrease in the average hospital length of stay postdelivery (mean 2.48 days, SD 1.35). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age, race, and ethnicity subgroups. Conclusions: Results suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses and underline the important role of digital data collection, particularly during the pandemic. UR - https://pediatrics.jmir.org/2021/4/e27769 UR - http://dx.doi.org/10.2196/27769 UR - http://www.ncbi.nlm.nih.gov/pubmed/34509975 ID - info:doi/10.2196/27769 ER - TY - JOUR AU - Gordon, S. Judith AU - Sbarra, David AU - Armin, Julie AU - Pace, W. Thaddeus W. AU - Gniady, Chris AU - Barraza, Yessenya PY - 2021/10/4 TI - Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19?Related Stress: Pilot Feasibility Study JO - JMIR Form Res SP - e32353 VL - 5 IS - 10 KW - COVID-19 KW - stress KW - anxiety KW - isolation KW - intervention KW - guided imagery KW - mobile app N2 - Background: The SARS-CoV-2 pandemic has led to concerns about mental health resulting from regional and national lockdowns, social isolation, job loss, and concern about disease exposure. Objective: We describe results of the pilot feasibility study of the See Me Serene mHealth app. The app provides users with immersive, vivid, nature experiences to reduce stress and anxiety related to COVID-19 and other isolation. The goals of the study were to develop the See Me Serene app and test the feasibility and acceptability of study procedures, and explore the potential impact of the app on stress and anxiety. Methods: We developed and tested the See Me Serene app and our study procedures for feasibility, and gathered preliminary data with a goal of 100 participants. The research was conducted in 2 phases: (1) development and internal testing of the app; and (2) feasibility and pilot testing with participants recruited online through earned media (eg, news stories), presentations at a university campus, and social media (eg, online sharing of earned media and presentations). The feasibility study employed a mixed methods, within-subjects, pre-/posttest design. At baseline and 30-day follow-up, we assessed stress-related variables via validated self-report measures and saliva samples for determination of cortisol concentrations. Results: We met or surpassed all our feasibility benchmarks for recruitment (101 participants recruited), retention (91% [90/99] of 30-day assessment completed), and data collection (99 participants completed all baseline data; 85% [84/99] of salivary cortisol samples returned). Participants adhered to the intervention. On average, participants listened to 48.2 audio files over 30 days or approximately 1.6 audio files per day. Participants were satisfied with the app, with 87% (78/90) rating the app as helpful in dealing with stress and anxiety. The app showed the potential to reduce stress, anxiety, loneliness, and worry. We did not find significant differences (P=.41) in cortisol levels over time. Our findings suggest that future research is warranted to test the efficacy of the See Me Serene app with a representative, diverse sample. Conclusions: There is a need for evidence-based and easily disseminable stress-reduction interventions. See Me Serene is a feasible intervention and has the potential to reduce stress related to COVID-19 and other forms of social isolation. More research on See Me Serene is warranted. UR - https://formative.jmir.org/2021/10/e32353 UR - http://dx.doi.org/10.2196/32353 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546941 ID - info:doi/10.2196/32353 ER - TY - JOUR AU - Wisk, E. Lauren AU - Magane, M. Kara AU - Nelson, B. Eliza AU - Tsevat, K. Rebecca AU - Levy, Sharon AU - Weitzman, R. Elissa PY - 2021/9/30 TI - Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial JO - J Med Internet Res SP - e26418 VL - 23 IS - 9 KW - adolescent KW - young adult KW - diabetes mellitus KW - type 1 KW - binge drinking KW - alcohol drinking KW - self care KW - risk-taking KW - universities KW - students KW - attitude KW - mobile phone N2 - Background: College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating. Objective: The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician). Methods: We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery. Results: Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol?s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator. Conclusions: The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants? perceptions of expertise and credibility differed by narrator. Trial Registration: ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829 International Registered Report Identifier (IRRID): RR2-10.1177/1932296819839503 UR - https://www.jmir.org/2021/9/e26418 UR - http://dx.doi.org/10.2196/26418 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591022 ID - info:doi/10.2196/26418 ER - TY - JOUR AU - Marengo, Davide AU - Sariyska, Rayna AU - Schmitt, Sophia Helena AU - Messner, Eva-Maria AU - Baumeister, Harald AU - Brand, Matthias AU - Kannen, Christopher AU - Montag, Christian PY - 2021/9/30 TI - Exploring the Associations Between Self-reported Tendencies Toward Smartphone Use Disorder and Objective Recordings of Smartphone, Instant Messaging, and Social Networking App Usage: Correlational Study JO - J Med Internet Res SP - e27093 VL - 23 IS - 9 KW - smartphone use disorder KW - smartphone use KW - social media KW - objective measures KW - mediation model KW - smartphone KW - web-based communication KW - social networking KW - mobile phone N2 - Background: Social communication via instant messaging (IM) and social networking (SN) apps makes up a large part of the time that smartphone users spend on their devices. Previous research has indicated that the excessive use of these apps is positively associated with problematic smartphone use behaviors. In particular, image-based SN apps, such as Instagram (Facebook Inc) and Snapchat (Snap Inc), have been shown to exert stronger detrimental effects than those exerted by traditional apps, such as Facebook (Facebook Inc) and Twitter (Twitter Inc). Objective: In this study, we investigated the correlation between individuals? tendencies toward smartphone use disorder (SmUD) and objective measures of the frequency of smartphone usage. Additionally, we put to test the hypothesis that the pathway linking the frequency of actual smartphone usage to self-reported tendencies toward SmUD was mediated by the increased frequency of IM and SN app usage. Methods: We recruited a sample of 124 adult smartphone users (females: 78/124, 62.9%; age: mean 23.84 years, SD 8.29 years) and collected objective information about the frequency of smartphone and SN app usage over 1 week. Participants also filled in a self-report measure for assessing the multiple components of tendencies toward SmUD. Bivariate associations were investigated by using Spearman correlation analyses. A parallel mediation analysis was conducted via multiple regression analysis. Results: The frequency of smartphone usage, as well as the use of IM apps (Messenger, Telegram, and WhatsApp [Facebook Inc]), Facebook, and image-based apps (Instagram and Snapchat), had significant positive associations with at least 1 component of SmUD, and the cyberspace-oriented relationships factor exhibited the strongest associations overall. We found support for an indirect effect that linked actual smartphone usage to SmUD tendencies via the frequency of the use of image-based SN apps. Conclusions: Our novel results shed light on the factors that promote SmUD tendencies and essentially indicate that image-based SN apps seem to be more strongly associated with problematic smartphone behaviors compared to IM apps and traditional SN apps, such as Facebook. UR - https://www.jmir.org/2021/9/e27093 UR - http://dx.doi.org/10.2196/27093 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591025 ID - info:doi/10.2196/27093 ER - TY - JOUR AU - Mouchabac, Stephane AU - Leray, Philippe AU - Adrien, Vladimir AU - Gollier-Briant, Fanny AU - Bonnot, Olivier PY - 2021/9/30 TI - Prevention of Suicidal Relapses in Adolescents With a Smartphone Application: Bayesian Network Analysis of a Preclinical Trial Using In Silico Patient Simulations JO - J Med Internet Res SP - e24560 VL - 23 IS - 9 KW - suicide KW - bayesian network KW - smartphone application KW - digital psychiatry KW - artificial intelligence N2 - Background: Recently, artificial intelligence technologies and machine learning methods have offered attractive prospects to design and manage crisis response processes, especially in suicide crisis management. In other domains, most algorithms are based on big data to help diagnose and suggest rational treatment options in medicine. But data in psychiatry are related to behavior and clinical evaluation. They are more heterogeneous, less objective, and incomplete compared to other fields of medicine. Consequently, the use of psychiatric clinical data may lead to less accurate and sometimes impossible-to-build algorithms and provide inefficient digital tools. In this case, the Bayesian network (BN) might be helpful and accurate when constructed from expert knowledge. Medical Companion is a government-funded smartphone application based on repeated questions posed to the subject and algorithm-matched advice to prevent relapse of suicide attempts within several months. Objective: Our paper aims to present our development of a BN algorithm as a medical device in accordance with the American Psychiatric Association digital healthcare guidelines and to provide results from a preclinical phase. Methods: The experts are psychiatrists working in university hospitals who are experienced and trained in managing suicidal crises. As recommended when building a BN, we divided the process into 2 tasks. Task 1 is structure determination, representing the qualitative part of the BN. The factors were chosen for their known and demonstrated link with suicidal risk in the literature (clinical, behavioral, and psychometrics) and therapeutic accuracy (advice). Task 2 is parameter elicitation, with the conditional probabilities corresponding to the quantitative part. The 4-step simulation (use case) process allowed us to ensure that the advice was adapted to the clinical states of patients and the context. Results: For task 1, in this formative part, we defined clinical questions related to the mental state of the patients, and we proposed specific factors related to the questions. Subsequently, we suggested specific advice related to the patient?s state. We obtained a structure for the BN with a graphical representation of causal relations between variables. For task 2, several runs of simulations confirmed the a priori model of experts regarding mental state, refining the precision of our model. Moreover, we noticed that the advice had the same distribution as the previous state and was clinically relevant. After 2 rounds of simulation, the experts found the exact match. Conclusions: BN is an efficient methodology to build an algorithm for a digital assistant dedicated to suicidal crisis management. Digital psychiatry is an emerging field, but it needs validation and testing before being used with patients. Similar to psychotropics, any medical device requires a phase II (preclinical) trial. With this method, we propose another step to respond to the American Psychiatric Association guidelines. Trial Registration: ClinicalTrials.gov NCT03975881; https://clinicaltrials.gov/ct2/show/NCT03975881 UR - https://www.jmir.org/2021/9/e24560 UR - http://dx.doi.org/10.2196/24560 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591030 ID - info:doi/10.2196/24560 ER - TY - JOUR AU - Joyce, M. Caroline AU - Saulsgiver, Kathryn AU - Mohanty, Salini AU - Bachireddy, Chethan AU - Molfetta, Carin AU - Steffy, Mary AU - Yoder, Alice AU - Buttenheim, M. Alison PY - 2021/9/30 TI - Remote Patient Monitoring and Incentives to Support Smoking Cessation Among Pregnant and Postpartum Medicaid Members: Three Randomized Controlled Pilot Studies JO - JMIR Form Res SP - e27801 VL - 5 IS - 9 KW - maternal smoking KW - smoking cessation KW - financial incentives KW - smoking KW - pregnant KW - postpartum KW - incentives KW - mHealth KW - mobile health KW - mobile phone KW - smart devices N2 - Background: Smoking rates among low-income individuals, including those eligible for Medicaid, have not shown the same decrease that is observed among high-income individuals. The rate of smoking among pregnant women enrolled in Medicaid is almost twice that among privately insured women, which leads to significant disparities in birth outcomes and a disproportionate cost burden placed on Medicaid. Several states have identified maternal smoking as a key target for improving birth outcomes and reducing health care expenditures; however, efficacious, cost-effective, and feasible cessation programs have been elusive. Objective: This study aims to examine the feasibility, acceptability, and effectiveness of a smartwatch-enabled, incentive-based smoking cessation program for Medicaid-eligible pregnant smokers. Methods: Pilot 1 included a randomized pilot study of smartwatch-enabled remote monitoring versus no remote monitoring for 12 weeks. Those in the intervention group also received the SmokeBeat program. Pilot 2 included a randomized pilot study of pay-to-wear versus pay-to-quit for 4 weeks. Those in a pay-to-wear program could earn daily incentives for wearing the smartwatch, whereas those in pay-to-quit program could earn daily incentives if they wore the smartwatch and abstained from smoking. Pilot 3, similar to pilot 2, had higher incentives and a duration of 3 weeks. Results: For pilot 1 (N=27), self-reported cigarettes per week among the intervention group declined by 15.1 (SD 27) cigarettes over the study; a similar reduction was observed in the control group with a decrease of 17.2 (SD 19) cigarettes. For pilot 2 (N=8), self-reported cigarettes per week among the pay-to-wear group decreased by 43 cigarettes (SD 12.6); a similar reduction was seen in the pay-to-quit group, with an average of 31 (SD 45.6) fewer cigarettes smoked per week. For pilot 3 (N=4), one participant in the pay-to-quit group abstained from smoking for the full study duration and received full incentives. Conclusions: Decreases in smoking were observed in both the control and intervention groups during all pilots. The use of the SmokeBeat program did not significantly improve cessation. The SmokeBeat program, remote cotinine testing, and remote delivery of financial incentives were considered feasible and acceptable. Implementation challenges remain for providing evidence-based cessation incentives to low-income pregnant smokers. The feasibility and acceptability of the SmokeBeat program were moderately high. Moreover, the feasibility and acceptability of remote cotinine testing and the remotely delivered contingent financial incentives were successful. Trial Registration: ClinicalTrials.gov NCT03209557; https://clinicaltrials.gov/ct2/show/NCT03209557. UR - https://formative.jmir.org/2021/9/e27801 UR - http://dx.doi.org/10.2196/27801 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591023 ID - info:doi/10.2196/27801 ER - TY - JOUR AU - Thurman, Whitney AU - Semwal, Monika AU - Moczygemba, R. Leticia AU - Hilbelink, Mark PY - 2021/9/29 TI - Smartphone Technology to Empower People Experiencing Homelessness: Secondary Analysis JO - J Med Internet Res SP - e27787 VL - 23 IS - 9 KW - homelessness KW - self-management KW - smartphone technology KW - social needs KW - mobile phone N2 - Background: In the United States, the number of people experiencing homelessness has continually increased over the last 3 years. Homelessness is associated with poor health, and people experiencing homelessness are often burdened with high rates of chronic and mental health conditions, functional limitations, and cognitive impairment. Despite the high burden of chronic illness and functional limitations, there is limited literature exploring self-management among homeless populations. Objective: This study aims to investigate how access to smartphone technology facilitates self-management, including the attainment of social needs within the context of homelessness. Methods: A secondary analysis of 33 exit interviews from 2 feasibility studies related to mobile health interventions among people experiencing homelessness was conducted. Iterative thematic analysis was used to identify themes representative of participants? experiences using smartphone technology. Results: Collectively, participants revealed not only how the context of homelessness constrained their ability to engage in activities necessary to self-manage health and meet social needs but also how consistent and predictable access to the tools available through a smartphone changed their behaviors and outlook. The global theme of empowered by technology was identified and defined as how having a smartphone with a plan for unlimited text, calling, data, and transportation allowed participants to navigate homelessness and facilitated self-management. Conclusions: People experiencing homelessness used the tools on a smartphone to make decisions, take action, solve problems, and use the resources?skills necessary for fulfilling tasks required for effective self-management. Further, consistent access to smartphone technology and transportation empowered participants to meet the requirements for the attainment of social needs. UR - https://www.jmir.org/2021/9/e27787 UR - http://dx.doi.org/10.2196/27787 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586073 ID - info:doi/10.2196/27787 ER - TY - JOUR AU - Teepe, W. Gisbert AU - Da Fonseca, Ashish AU - Kleim, Birgit AU - Jacobson, C. Nicholas AU - Salamanca Sanabria, Alicia AU - Tudor Car, Lorainne AU - Fleisch, Elgar AU - Kowatsch, Tobias PY - 2021/9/28 TI - Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review JO - J Med Internet Res SP - e29412 VL - 23 IS - 9 KW - depression KW - digital mental health KW - smartphone applications KW - just-in-time adaptive interventions KW - effectiveness KW - mobile phone N2 - Background: The number of smartphone apps that focus on the prevention, diagnosis, and treatment of depression is increasing. A promising approach to increase the effectiveness of the apps while reducing the individual?s burden is the use of just-in-time adaptive intervention (JITAI) mechanisms. JITAIs are designed to improve the effectiveness of the intervention and reduce the burden on the person using the intervention by providing the right type of support at the right time. The right type of support and the right time are determined by measuring the state of vulnerability and the state of receptivity, respectively. Objective: The aim of this study is to systematically assess the use of JITAI mechanisms in popular apps for individuals with depression. Methods: We systematically searched for apps addressing depression in the Apple App Store and Google Play Store, as well as in curated lists from the Anxiety and Depression Association of America, the United Kingdom National Health Service, and the American Psychological Association in August 2020. The relevant apps were ranked according to the number of reviews (Apple App Store) or downloads (Google Play Store). For each app, 2 authors separately reviewed all publications concerning the app found within scientific databases (PubMed, Cochrane Register of Controlled Trials, PsycINFO, Google Scholar, IEEE Xplore, Web of Science, ACM Portal, and Science Direct), publications cited on the app?s website, information on the app?s website, and the app itself. All types of measurements (eg, open questions, closed questions, and device analytics) found in the apps were recorded and reviewed. Results: None of the 28 reviewed apps used JITAI mechanisms to tailor content to situations, states, or individuals. Of the 28 apps, 3 (11%) did not use any measurements, 20 (71%) exclusively used self-reports that were insufficient to leverage the full potential of the JITAIs, and the 5 (18%) apps using self-reports and passive measurements used them as progress or task indicators only. Although 34% (23/68) of the reviewed publications investigated the effectiveness of the apps and 21% (14/68) investigated their efficacy, no publication mentioned or evaluated JITAI mechanisms. Conclusions: Promising JITAI mechanisms have not yet been translated into mainstream depression apps. Although the wide range of passive measurements available from smartphones were rarely used, self-reported outcomes were used by 71% (20/28) of the apps. However, in both cases, the measured outcomes were not used to tailor content and timing along a state of vulnerability or receptivity. Owing to this lack of tailoring to individual, state, or situation, we argue that the apps cannot be considered JITAIs. The lack of publications investigating whether JITAI mechanisms lead to an increase in the effectiveness or efficacy of the apps highlights the need for further research, especially in real-world apps. UR - https://www.jmir.org/2021/9/e29412 UR - http://dx.doi.org/10.2196/29412 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309569 ID - info:doi/10.2196/29412 ER - TY - JOUR AU - Wu, Dan AU - An, Jiye AU - Yu, Ping AU - Lin, Hui AU - Ma, Li AU - Duan, Huilong AU - Deng, Ning PY - 2021/9/28 TI - Patterns for Patient Engagement with the Hypertension Management and Effects of Electronic Health Care Provider Follow-up on These Patterns: Cluster Analysis JO - J Med Internet Res SP - e25630 VL - 23 IS - 9 KW - hypertension KW - health care services KW - mHealth KW - patient engagement KW - electronic follow-up KW - cluster analysis N2 - Background: Hypertension is a long-term medical condition. Electronic and mobile health care services can help patients to self-manage this condition. However, not all management is effective, possibly due to different levels of patient engagement (PE) with health care services. Health care provider follow-up is an intervention to promote PE and blood pressure (BP) control. Objective: This study aimed to discover and characterize patterns of PE with a hypertension self-management app, investigate the effects of health care provider follow-up on PE, and identify the follow-up effects on BP in each PE pattern. Methods: PE was represented as the number of days that a patient recorded self-measured BP per week. The study period was the first 4 weeks for a patient to engage in the hypertension management service. K-means algorithm was used to group patients by PE. There was compliance follow-up, regular follow-up, and abnormal follow-up in management. The follow-up effect was calculated by the change in PE (CPE) and the change in systolic blood pressure (CSBP, SBP) before and after each follow-up. Chi-square tests and z scores were used to ascertain the distribution of gender, age, education level, SBP, and the number of follow-ups in each cluster. The follow-up effect was identified by analysis of variances. Once a significant effect was detected, Bonferroni multiple comparisons were further conducted to identify the difference between 2 clusters. Results: Patients were grouped into 4 clusters according to PE: (1) PE started low and dropped even lower (PELL), (2) PE started high and remained high (PEHH), (3) PE started high and dropped to low (PEHL), and (4) PE started low and rose to high (PELH). Significantly more patients over 60 years old were found in the PEHH cluster (P?.05). Abnormal follow-up was significantly less frequent (P?.05) in the PELL cluster. Compliance follow-up and regular follow-up can improve PE. In the clusters of PEHH and PELH, the improvement in PE in the first 3 weeks and the decrease in SBP in all 4 weeks were significant after follow-up. The SBP of the clusters of PELL and PELH decreased more (?6.1 mmHg and ?8.4 mmHg) after follow-up in the first week. Conclusions: Four distinct PE patterns were identified for patients engaging in the hypertension self-management app. Patients aged over 60 years had higher PE in terms of recording self-measured BP using the app. Once SBP reduced, patients with low PE tended to stop using the app, and a continued decline in PE occurred simultaneously with the increase in SBP. The duration and depth of the effect of health care provider follow-up were more significant in patients with high or increased engagement after follow-up. UR - https://www.jmir.org/2021/9/e25630 UR - http://dx.doi.org/10.2196/25630 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581680 ID - info:doi/10.2196/25630 ER - TY - JOUR AU - Chew, Elaine Chu Shan AU - Davis, Courtney AU - Lim, Ethel Jie Kai AU - Lim, Micheal Chee Meng AU - Tan, Henny Yi Zhen AU - Oh, Yin Jean AU - Rajasegaran, Kumudhini AU - Chia, Michael Yong Hwa AU - Finkelstein, Andrew Eric PY - 2021/9/28 TI - Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study JO - J Med Internet Res SP - e20520 VL - 23 IS - 9 KW - pediatric obesity KW - mobile health KW - apps KW - health behavior KW - mHealth KW - obesity KW - adolescent KW - lifestyle KW - well-being KW - mobile phone N2 - Background: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective: This study aims to assess the effectiveness of and adolescent engagement with a mobile app?based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods: This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo?s health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results: Of the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions: The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake. UR - https://www.jmir.org/2021/9/e20520 UR - http://dx.doi.org/10.2196/20520 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581672 ID - info:doi/10.2196/20520 ER - TY - JOUR AU - Silfee, Valerie AU - Williams, Kelly AU - Leber, Brett AU - Kogan, Jane AU - Nikolajski, Cara AU - Szigethy, Eva AU - Serio, Catherine PY - 2021/9/28 TI - Health Care Provider Perspectives on the Use of a Digital Behavioral Health App to Support Patients: Qualitative Study JO - JMIR Form Res SP - e28538 VL - 5 IS - 9 KW - digital health KW - mHealth KW - implementation KW - cognitive behavioral therapy KW - anxiety KW - depression KW - smartphone KW - mobile phone N2 - Background: Despite the growing evidence indicating the efficacy of digital cognitive behavioral interventions (dCBIs) for behavioral health (BH) treatment, broad and consistent use of such interventions has been limited by knowledge obtained in real-world settings, including factors that impact provider uptake/referral. Engaging providers early in the implementation process offers an opportunity to explore their needs and behaviors, integrate interventions into workflows, and better understand provider setting capabilities. Objective: This study assessed providers? views on the feasibility and acceptability of delivering a cognitive behavioral therapy (CBT)-based mobile app in multiple care settings. Methods: Participating providers included BH and physical health (PH) providers from a women?s health center, an outpatient BH clinic, and both rural/urban primary care settings. All participating providers cocreated workflows through facilitated workshops, including establishing feedback loops between the project team and providers and identifying clinical champions at each site. Over a 12-week period, the providers referred adult patients experiencing anxiety or depression to a mobile app-based dCBI, RxWell, and provided other indicated treatments as part of usual care. Referrals were completed by the providers through the electronic medical record. To better understand facilitators of and challenges in integrating RxWell into routine practice and perceptions of sustainability, a series of qualitative interviews was conducted. Interview data were analyzed to identify major themes using an inductive content analysis approach. Results: A total of 19 provider interviews were conducted to discover motivators and barriers for referring RxWell. The providers benefited from a focused discussion on how to incorporate the referral process into their workflow, and knowing the app content was rooted in evidence. Although the providers believed engaging in experiential learning was important, they indicated that more education on the digital health coach role and how to monitor patient progress is needed. The providers thought patient engagement may be impacted by motivation, a lack of comfort using a smartphone, or preference for in-person therapy. The providers also expressed enthusiasm in continuing to refer the app. They liked the ability to provide patients with support between sessions, to have an extra treatment option that teaches BH exercises, and to have a CBT treatment option that overcomes barriers (eg, wait times, copays, travel) to traditional therapy modalities. Conclusions: Digital intervention success in health care settings relies heavily on engagement of key stakeholders, such as providers, in both design and implementation of the intervention and focused evaluation within intended care setting(s). Scaling digital interventions to meet the mental health needs of patients in usual care settings leans on thoughtfully constructed and streamlined workflows to enable seamless referral of patients by providers. Our findings strongly suggest that providers are supportive of digital tool integration to support the mental health of patients and endorse its use within their routine workflow. UR - https://formative.jmir.org/2021/9/e28538 UR - http://dx.doi.org/10.2196/28538 UR - http://www.ncbi.nlm.nih.gov/pubmed/34529583 ID - info:doi/10.2196/28538 ER - TY - JOUR AU - Leung, Shun Phil Wai AU - Li, Xin Shirley AU - Tsang, Oi Carmen Sze AU - Chow, Ching Bellavista Long AU - Wong, Wai William Chi PY - 2021/9/28 TI - Effectiveness of Using Mobile Technology to Improve Cognitive and Social Skills Among Individuals With Autism Spectrum Disorder: Systematic Literature Review JO - JMIR Ment Health SP - e20892 VL - 8 IS - 9 KW - autism spectrum disorder KW - mobile devices KW - systematic review KW - randomized controlled trial KW - social skills KW - cognitive skills N2 - Background: Mobile technology has become a necessity in the lives of people in many countries. Its characteristics and advantages also make it a potential medium of intervention for people with autism spectrum disorder (ASD). Objective: The objective of this review was to evaluate previous evidence, obtained in randomized controlled trials (RCTs), on the effectiveness of using mobile devices as the medium of intervention targeting social and cognitive skills among individuals with ASD. Methods: Literature search was conducted on electronic databases including Medline, PsycInfo, PsycArticles, Education Resources Information Centre, and Social Science Citation Index. Only RCTs published in English and after year 2000 were included for this review. Data extraction was carried out by 2 independent reviewers using constant comparative methods. Results: Totally 10 RCTs were identified. Most of the findings indicated that mobile devices could be an effective medium of intervention for people with ASD, among which 6 indicated significant intervention effects and 2 showed mixed findings. Effective intervention was more likely to be achieved in the studies that recruited older participants (aged over 9 years), targeting practical skills that could be readily applied in real life, or using pictures or materials that were highly relevant in daily life in the apps or mobile devices. Furthermore, the use of mobile devices was also reported to promote participation in the intervention among individuals with ASD. Conclusions: The results suggested that mobile devices could be a promising means for the delivery of interventions targeting people with ASD. Although including a small number of studies was a limitation of this review, the results provided useful implications for designing effective mobile technology?assisted interventions for the ASD population in future studies. UR - https://mental.jmir.org/2021/9/e20892 UR - http://dx.doi.org/10.2196/20892 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581681 ID - info:doi/10.2196/20892 ER - TY - JOUR AU - Shade, Marcia AU - Rector, Kyle AU - Kupzyk, Kevin PY - 2021/9/28 TI - Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study JO - JMIR Form Res SP - e26361 VL - 5 IS - 9 KW - adherence KW - pain medications KW - older adults KW - reminders KW - mHealth KW - voice assistants N2 - Background: Pain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports. Objective: We aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain. Methods: A total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample?s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed. Results: In the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder. Conclusions: Voice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions. UR - https://formative.jmir.org/2021/9/e26361 UR - http://dx.doi.org/10.2196/26361 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581677 ID - info:doi/10.2196/26361 ER - TY - JOUR AU - Matthes, Jörg AU - Koban, Kevin AU - Neureiter, Ariadne AU - Stevic, Anja PY - 2021/9/27 TI - Longitudinal Relationships Among Fear of COVID-19, Smartphone Online Self-Disclosure, Happiness, and Psychological Well-being: Survey Study JO - J Med Internet Res SP - e28700 VL - 23 IS - 9 KW - COVID-19 pandemic KW - fear KW - self-disclosure KW - happiness, well-being KW - panel study KW - smartphones KW - online platform KW - social media N2 - Background: Given that governmental prevention measures restricted most face-to-face communications, online self-disclosure via smartphones emerged as an alternative coping strategy that aimed at reducing the impact of the COVID-19 pandemic on people?s psychological health. Prepandemic research demonstrated that online self-disclosure benefits people?s psychological health by establishing meaningful relationships, obtaining social support, and achieving self-acceptance, particularly in times of crisis. However, it is unclear whether these dynamics transition well to lockdown conditions where online self-disclosure must stand almost entirely on its own. Longitudinal investigations are needed to gain insights into the psychological functionalities of online self-disclosure during the COVID-19 pandemic. Objective: This study aimed to determine the temporal associations between smartphone online self-disclosure (as a communicative behavior) and critical indicators of psychological health (including psychopathological, as well as hedonic and eudaimonic states) during the first COVID-19 lockdown in Austria. Methods: We conducted a representative 2-wave panel survey between late March/April 2020 and May 2020. A total of 416 participants completed both waves (43.1% attrition rate, given n=731 participants who completed the first wave). A partially metric measurement invariant overtime structural equation model was used to determine the temporal associations among online self-disclosure, fear of COVID-19, happiness, and psychological well-being. Results: The analysis revealed that fear of COVID-19 significantly predicted online self-disclosure over time (b=0.24, P=.003) and happiness over time (b=?0.14, P=.04), but not psychological well-being (b=0.03, P=.48), that is, stronger COVID-19 fears at T1 prompted more online self-disclosure and less happiness at T2. Online self-disclosure, on the other hand, significantly predicted happiness (b=0.09, P=.02), but neither fear of COVID-19 (b=?0.01, P=.57) nor psychological well-being (b=?0.01, P=.57) over time. Participants who engaged more strongly in online self-disclosure at T1 felt happier at T2, but they did not differ from less-disclosing participants concerning COVID-19 fears and psychological well-being at T2. Importantly, happiness and psychological well-being were significantly related over time (happiness T1 ? psychological well-being T2: b=0.11, P<.001; psychological well-being T1 ? happiness T2: b=0.42, P<.001). Conclusions: Our findings suggest that online self-disclosure might play a pivotal role in coping with pandemic stressors. With restrictions on their options, individuals increasingly turn to their smartphones and social media to disclose their feelings, problems, and concerns during lockdown. While online self-disclosure might not alleviate fears or improve psychological well-being, our results demonstrate that it made people experience more happiness during this crisis. This psychological resource may help them withstand the severe psychological consequences of the COVID-19 crisis over longer timeframes. UR - https://www.jmir.org/2021/9/e28700 UR - http://dx.doi.org/10.2196/28700 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519657 ID - info:doi/10.2196/28700 ER - TY - JOUR AU - Perez-Ramos, G. Jose AU - McIntosh, Scott AU - Barrett, S. Emily AU - Velez Vega, M. Carmen AU - Dye, D. Timothy PY - 2021/9/23 TI - Attitudes Toward the Environment and Use of Information and Communication Technologies to Address Environmental Health Risks in Marginalized Communities: Prospective Cohort Study JO - J Med Internet Res SP - e24671 VL - 23 IS - 9 KW - community engagement KW - environmental health risk KW - epidemiology KW - ICT KW - mHealth KW - mobile phone KW - Puerto Rico N2 - Background: Information and communication technologies, including mobile health (mHealth), can help isolated communities address environmental health challenges. The Puerto Rican island of Culebra has faced multiple sociopolitical and economic factors that have distressed the island?s environment and health. Culebrenses are technologically engaged and have demonstrated a use of technology that transcends socioeconomic barriers. As a result, technological interventions could potentially help manage environmental risks on the island. Objective: This study aims to test and evaluate the potential benefits of an mHealth tool, termed ¡mZAP! (Zonas, Acción y Protección), for engaging communities with environmental risks through technology. Methods: Participants using ¡mZAP! (N=111) were surveyed. Bivariate analyses were used to examine associations of mHealth use with sociodemographics, technology use, an adapted environmental attitudes inventory, and the multidimensional health locus of control. Logistic regression was used to examine associations between attitudes toward environmental health risks and mHealth use. Results: Higher positive attitudes toward the environment were significantly associated with the use of ¡mZAP! (odds ratio 5.3, 95% CI 1.6-17.0). Environmental attitudes were also associated with the multidimensional health locus of control powerful others subscale (P=.02), indicating that attitudes toward the environment become more negative as feelings controlled by others increase. Participants felt that the authorities would resolve the challenges (63/111, 56.7%). Conclusions: Perceived lack of control could present barriers to collective actions to address salient environmental health challenges in communities. The ongoing dependency on government-based solutions to community problems is worrisome, especially after the hurricane experiences of 2017 (which may potentially continue to be an issue subsequent to the more recent 2020 earthquakes). UR - https://www.jmir.org/2021/9/e24671 UR - http://dx.doi.org/10.2196/24671 UR - http://www.ncbi.nlm.nih.gov/pubmed/34554103 ID - info:doi/10.2196/24671 ER - TY - JOUR AU - Hanson, Petra AU - Summers, Charlotte AU - Panesar, Arjun AU - Oduro-Donkor, Dominic AU - Lange, Maria AU - Menon, Vinod AU - Barber, M. Thomas PY - 2021/9/23 TI - Low Carb Program Health App Within a Hospital-Based Obesity Setting: Observational Service Evaluation JO - JMIR Form Res SP - e29110 VL - 5 IS - 9 KW - obesity KW - low carb program KW - eHealth KW - mobile app KW - digital health KW - health intervention KW - mobile health KW - COVID-19 N2 - Background: Obesity underlies much chronic disease. Digitalization of obesity management provides an opportunity to innovate our traditional model of health care delivery within this setting, and to transform its scalability potentially to the population level. Objective: The objective was to assess the feasibility and effectiveness of the Low Carb Program app for weight loss, applied within our hospital-based (tier 3) obesity service. Due to the disrupting effects of the COVID-19 pandemic on our obesity service, we compared the clinical outcomes from the Low Carb Program app applied in the context of remote patient appointments over the telephone with the prepandemic traditional standard of care. Methods: We invited patients who attended our hospital-based obesity service to engage with the Low Carb Program smartphone app. We combined this approach with remote delivery (over the telephone) of obesity management from medical and psychology members of our obesity team during the COVID-19 pandemic. Outcome variables included changes in body weight and changes in HbA1c as a marker of glycemic control. We compared data from the Low Carb Program group with a retrospective control group (n=126) that had received traditional face-to-face obesity management from our team without concomitant use of the Low Carb Program app in the pre?COVID-19 era. T test comparisons were employed, with P<.05 considered significant. Results: The mean weight of participants (n=105) was 130.2 kg, with 59% (n=62) females and a mean age of 48.8 years. Most participants (90/105, 86%) completed the Low Carb Program app registration process and engaged with the Low Carb Program app program; at follow-up, most participants (88/105, 84%) had actively engaged with the Low Carb Program app within the prior 30 days. The majority of participants (58/105, 55%) self-reported outcomes within the app. Mean duration of clinical follow-up for recruited participants who received the app was 7.4 months. Paired data were available for 48 participants for body weight and 41 participants for HbA1c. Paired sample t test analysis revealed a statistically significant mean loss of body weight of 2.7 kg (P=.001) and improvement in HbA1c of 3.3 mmol/mol (P=.01). The mean weight of control group patients (n=126) was 137.1 kg, with 74% (93/126) females and a mean age of 44.4 years. The mean follow-up for this group was 6 months. Data comparisons between the app user group and the pre?COVID-19 retrospective control group revealed equivalence for loss of body weight and change in HbA1c between the two groups. Conclusions: We provide evidence to support the feasibility of implementing the Low Carb Program app combined with remote management; this is the first proof of concept for digitalized management within a hospital-based (tier 3) obesity service. We demonstrate the potential clinical efficacy of the approach in terms of improvements in body weight and glycemic control. UR - https://formative.jmir.org/2021/9/e29110 UR - http://dx.doi.org/10.2196/29110 UR - http://www.ncbi.nlm.nih.gov/pubmed/34449405 ID - info:doi/10.2196/29110 ER - TY - JOUR AU - Moskowitz, Tedlie Judith AU - Addington, L. Elizabeth AU - Shiu, Eva AU - Bassett, M. Sarah AU - Schuette, Stephanie AU - Kwok, Ian AU - Freedman, E. Melanie AU - Leykin, Yan AU - Saslow, R. Laura AU - Cohn, A. Michael AU - Cheung, O. Elaine PY - 2021/9/22 TI - Facilitator Contact, Discussion Boards, and Virtual Badges as Adherence Enhancements to a Web-Based, Self-guided, Positive Psychological Intervention for Depression: Randomized Controlled Trial JO - J Med Internet Res SP - e25922 VL - 23 IS - 9 KW - mHealth KW - adherence KW - depression KW - discussion board KW - gamification KW - positive psychological intervention KW - mobile phone N2 - Background: Adherence to self-guided interventions tends to be very low, especially in people with depression. Prior studies have demonstrated that enhancements may increase adherence, but little is known about the efficacy of various enhancements in comparison to, or in combination with, one another. Objective: The aim of our study is to test whether 3 enhancements?facilitator contact (FC), an online discussion board, and virtual badges (VB)?alone, or in combination, improve adherence to a self-guided, web-based intervention for depression. We also examined whether age, gender, race, ethnicity, comfort with technology, or baseline depression predicted adherence or moderated the effects that each enhancement had on adherence. Methods: Participants were recruited through web-based sources and, after completing at least 4 out of 7 daily emotion reports, were sequentially assigned to 1 of 9 conditions?the intervention alone; the intervention plus 1, 2, or all 3 enhancements; or an emotion reporting control condition. The intervention was a positive psychological program consisting of 8 skills that specifically targeted positive emotions, and it was delivered over 5 weeks in a self-guided, web-based format. We operationalized adherence as the number of skills accessed. Results: A total of 602 participants were enrolled in this study. Participants accessed, on average, 5.61 (SD 2.76) of 8 skills. The total number of enhancements participants received (0-3) did not predict the number of skills accessed. Participants who were assigned to the VB+FC condition accessed significantly more skills than those in the intervention only conditions. Furthermore, participants in arms that received the combination of both the VB and FC enhancements (VB+FC and VB+FC+online discussion board) accessed a greater number of skills relative to the number of skills accessed by participants who received either VB or FC without the other. Moderation analyses revealed that the receipt of VB (vs no VB) predicted higher adherence among participants with moderately severe depression at baseline. Conclusions: The results suggested that the VB+FC combination significantly increased the number of skills accessed in a self-guided, web-based intervention for elevated depression. We have provided suggestions for refinements to these enhancements, which may further improve adherence. Trial Registration: ClinicalTrials.gov NCT02861755; http://clinicaltrials.gov/ct2/show/NCT02861755 UR - https://www.jmir.org/2021/9/e25922 UR - http://dx.doi.org/10.2196/25922 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550076 ID - info:doi/10.2196/25922 ER - TY - JOUR AU - Neves, Luísa Ana AU - Jácome, Cristina AU - Taveira-Gomes, Tiago AU - Pereira, Margarida Ana AU - Almeida, Rute AU - Amaral, Rita AU - Alves-Correia, Magna AU - Mendes, Sandra AU - Chaves-Loureiro, Cláudia AU - Valério, Margarida AU - Lopes, Cristina AU - Carvalho, Joana AU - Mendes, Ana AU - Ribeiro, Carmelita AU - Prates, Sara AU - Ferreira, Alberto José AU - Teixeira, Fernanda Maria AU - Branco, Joana AU - Santalha, Marta AU - Vasconcelos, João Maria AU - Lozoya, Carlos AU - Santos, Natacha AU - Cardia, Francisca AU - Moreira, Sofia Ana AU - Taborda-Barata, Luís AU - Pinto, Sofia Cláudia AU - Ferreira, Rosário AU - Morais Silva, Pedro AU - Monteiro Ferreira, Tania AU - Câmara, Raquel AU - Lobo, Rui AU - Bordalo, Diana AU - Guimarães, Cristina AU - Espírito Santo, Maria AU - Ferraz de Oliveira, José AU - Cálix Augusto, José Maria AU - Gomes, Ricardo AU - Vieira, Inês AU - da Silva, Sofia AU - Marques, Maria AU - Cardoso, João AU - Morete, Ana AU - Aroso, Margarida AU - Cruz, Margarida Ana AU - Nunes, Carlos AU - Câmara, Rita AU - Rodrigues, Natalina AU - Abreu, Carmo AU - Albuquerque, Luísa Ana AU - Vieira, Claúdia AU - Santos, Carlos AU - Páscoa, Rosália AU - Chaves-Loureiro, Carla AU - Alves, Adelaide AU - Neves, Ângela AU - Varanda Marques, José AU - Reis, Bruno AU - Ferreira-Magalhães, Manuel AU - Almeida Fonseca, João PY - 2021/9/22 TI - Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies JO - J Med Internet Res SP - e25472 VL - 23 IS - 9 KW - mobile apps KW - smartphone KW - patient participation KW - self-management KW - asthma N2 - Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients? daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ?40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users? general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use. UR - https://www.jmir.org/2021/9/e25472 UR - http://dx.doi.org/10.2196/25472 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550077 ID - info:doi/10.2196/25472 ER - TY - JOUR AU - Anton, T. Margaret AU - Greenberger, Mochari Heidi AU - Andreopoulos, Evie AU - Pande, L. Reena PY - 2021/9/21 TI - Evaluation of a Commercial Mobile Health App for Depression and Anxiety (AbleTo Digital+): Retrospective Cohort Study JO - JMIR Form Res SP - e27570 VL - 5 IS - 9 KW - digital mental health KW - mHealth KW - iCBT KW - coaching KW - depression KW - generalized anxiety KW - social anxiety KW - mobile phone N2 - Background: Digital solutions, such as web-based and mobile interventions, have the potential to streamline pathways to mental health services and improve access to mental health care. Although a growing number of randomized trials have established the efficacy of digital interventions for common mental health problems, less is known about the real-world impact of these tools. AbleTo Digital+, a commercially available mental health app for depression and anxiety, offers a unique opportunity to understand the clinical impact of such tools delivered in a real-world context. Objective: The primary aim of this study is to examine the magnitude of change in depression and anxiety symptoms among individuals who used AbleTo Digital+ programs. The secondary aim is to evaluate Digital+ module completion, including the use of 1:1 coaching. Methods: In this retrospective cohort study, we analyzed previously collected and permanently deidentified data from a consecutive cohort of 1896 adults who initiated using one of the three Digital+ eight-module programs (depression, generalized anxiety, or social anxiety) between January 1 and June 30, 2020. Depression, generalized anxiety, and social anxiety symptoms were assessed within each program using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Social Phobia Inventory, respectively. Linear mixed effects models were built to assess the association between module completion and symptom change among users who completed at least four modules and had at least mild baseline symptom elevations, controlling for age, gender, and baseline symptom severity. Digital+ use, including module completion, 1:1 coaching calls, and in-app coach messaging, was also evaluated. Results: Significant effects were observed among depression (Cohen d=1.5), generalized anxiety (Cohen d=1.2), and social anxiety (Cohen d=1.0) program participants who completed at least four modules and had mild baseline elevations (n=470). Associations between module completion and change in depression (?=?1.2; P<.001), generalized anxiety (?=?1.1; P<.001), and social anxiety (?=?2.4; P<.001) symptom scores retained significance with covariate adjustment. Participants completed an average of 2.6 (SD 2.7) modules. The average total length of app use was 52.2 (SD 83.5) days. Approximately two-thirds of the users engaged in at least 1 coaching call (66.82%, 1267/1896) or in-app text messaging (66.09%, 1253/1896). Participants who completed at least four modules participated in significantly more coaching calls per module (mean 1.1, SD 0.7) than users who completed fewer than four modules (mean 1.0, SD 1.2; t1407=?2.1; P=.03). Conclusions: This study demonstrated that AbleTo Digital+ users experienced significant reductions in depression, generalized anxiety, and social anxiety symptoms throughout the program. UR - https://formative.jmir.org/2021/9/e27570 UR - http://dx.doi.org/10.2196/27570 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546170 ID - info:doi/10.2196/27570 ER - TY - JOUR AU - Feng, Shan AU - Mäntymäki, Matti AU - Dhir, Amandeep AU - Salmela, Hannu PY - 2021/9/21 TI - How Self-tracking and the Quantified Self Promote Health and Well-being: Systematic Review JO - J Med Internet Res SP - e25171 VL - 23 IS - 9 KW - self-tracking KW - quantified self KW - health KW - well-being KW - systematic literature review KW - literature review N2 - Background: Self-tracking technologies are widely used in people?s daily lives and health care. Academic research on self-tracking and the quantified self has also accumulated rapidly in recent years. Surprisingly, there is a paucity of research that reviews, classifies, and synthesizes the state of the art with respect to self-tracking and the quantified self. Objective: Our objective was to identify the state of the art of self-tracking and the quantified self in terms of health and well-being. Methods: We have undertaken a systematic literature review on self-tracking and the quantified self in promoting health and well-being. After a rigorous literature search, followed by inclusions, exclusions, and the application of article quality assessment protocols, 67 empirical studies qualified for the review. Results: Our results demonstrate that prior research has focused on 3 stakeholders with respect to self-tracking and the quantified self, namely end users, patients and people with illnesses, and health care professionals and caregivers. We used these stakeholder groups to cluster the research themes of the reviewed studies. We identified 11 research themes. There are 6 themes under the end-user cluster: user motivation and goal setting, usage and effects of self-tracking, continuance intention and long-term usage, management of personal data, rejection and discontinuance, and user characteristics. The patient and people with illnesses cluster contains three themes: usage experience of patients and people with illnesses, management of patient-generated data, and advantages and disadvantages in the clinical context. The health care professional and caregiver cluster contains two themes: collaboration among patients, health care professionals, and caregivers, and changes in the roles of patients and professionals. Moreover, we classified the future research suggestions given in the literature into 5 directions in terms of research designs and research topics. Finally, based on our reflections on the observations from the review, we suggest four future research directions: (1) users? cognitions and emotions related to processing and interpreting the information produced by tracking devices and apps; (2) the dark side of self-tracking (eg, its adverse psychosocial consequences); (3) self-tracking as a societal phenomenon; and (4) systemic impacts of self-tracking on health care and the actors involved. Conclusions: This systematic literature review contributes to research and practice by assisting future research activities and providing practitioners with a concise overview of the state of the art of self-tracking and the quantified self. UR - https://www.jmir.org/2021/9/e25171 UR - http://dx.doi.org/10.2196/25171 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546176 ID - info:doi/10.2196/25171 ER - TY - JOUR AU - Shpigelman, Noa Carmit AU - Tal, Amir AU - Zisman-Ilani, Yaara PY - 2021/9/21 TI - Digital Community Inclusion of Individuals With Serious Mental Illness: A National Survey to Map Digital Technology Use and Community Participation Patterns in the Digital Era JO - JMIR Ment Health SP - e28123 VL - 8 IS - 9 KW - mobile health KW - technology KW - digital community participation KW - digital community inclusion KW - serious mental illness KW - recovery N2 - Background: Despite the growing interest in developing and using mobile health (mHealth) and digital technologies in mental health, little is known about the scope and nature of virtual community inclusion. Objective: The overarching goal of this study was to understand and conceptualize virtual community inclusion of individuals with serious mental illness (SMI). Specific objectives of this study were as follows: (1) mapping the prevalence, trends, and experiences related to mHealth and digital technology use among individuals with SMI; (2) comparing patterns of technology use by individuals with and those without SMI; and (3) examining whether use of mHealth and digital technologies predicts recovery among individuals with SMI. Methods: A web-based survey of technology use and virtual participation was developed and distributed among adults with and those without SMI via social media, national email discussion lists, nonprofit organizations, and advocacy groups. Results: A total of 381 adults aged 18 years or older participated in the survey, of whom 199 (52%) identified as having a SMI. Participants with SMI reported significantly greater access to technology and significantly fewer days of face-to-face participation in community activities than those without SMI. Among participants with SMI, greater technology use was positively associated with positive emotions and significantly predicted recovery. Conclusions: This study is the first to explore, map, and conceptualize virtual community inclusion among adults with SMI. Our findings indicate a gap in the literature and research on community inclusion and participation, and emphasize the need for virtual community inclusion, particularly during the COVID-19 pandemic and its future implications. UR - https://mental.jmir.org/2021/9/e28123 UR - http://dx.doi.org/10.2196/28123 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546177 ID - info:doi/10.2196/28123 ER - TY - JOUR AU - Choi, Michael AU - Raeside, Rebecca AU - Hyun, Karice AU - Partridge, R. Stephanie AU - Thiagalingam, Aravinda AU - Redfern, Julie PY - 2021/9/20 TI - Understanding Preferences for Lifestyle-Focused Visual Text Messages in Patients With Cardiovascular and Chronic Respiratory Disease: Discrete Choice Experiment JO - J Med Internet Res SP - e26224 VL - 23 IS - 9 KW - mHealth KW - cardiovascular disease KW - respiratory disease KW - visual communication KW - lifestyle change KW - consumer preferences KW - secondary prevention KW - rehabilitation KW - persuasive health technology N2 - Background: Supporting healthy lifestyle changes is a key aim of cardiovascular and pulmonary rehabilitation programs. SMS text messaging programs have demonstrated effectiveness in cardiovascular disease risk reduction, weight loss, increasing physical activity, and smoking cessation. The optimization of SMS text messaging programs may deliver greater population benefits as mobile phone use becomes ubiquitous. Visual messaging (ie, image-based messages) has the potential to communicate health messages via digital technology and result in enhanced engagement. Objective: This study aims to determine and understand patient preferences for lifestyle-focused visual text messages that support cardiovascular and pulmonary rehabilitation. Methods: A discrete choice experiment was conducted in a 4-stage iterative process to elicit patient preferences for visual message features. Attribute and level development yielded 3 attributes (purpose, image type, and web address), and 16 choice sets were subsequently constructed according to a full factorial design. Patients participating in cardiovascular and pulmonary rehabilitation were surveyed (on the web) for their preferences regarding the visual message choice sets. Respondents were asked to choose among 16 pairs of visual messages regarding key lifestyle behaviors, namely, physical activity and nutrition. The data were analyzed using a conditional logit model. Results: There was a total of 1728 observations from 54 unique respondents. Two factors that were associated with patient preference were gain-framed purpose compared with no purpose (odds ratio [OR] 1.93, 95% CI 1.40-2.65) and real images compared with cartoon images (OR 1.26, 95% CI 1.04-1.54). A loss-framed purpose was less preferred than no purpose (OR 0.55, 95% CI 0.42-0.74). Overall, patients preferred positive images that were colorful and engaged with text that supported the image and had a preference for images of real people rather than cartoons. Conclusions: A discrete choice experiment is a scientific method for eliciting patient preferences for a visual messaging intervention that is designed to support changes in lifestyle behaviors. SMS text messaging programs that use visual aids may result in greater patient satisfaction by using a gain frame, using real images, and avoiding a loss frame. Further research is needed to explore the feasibility of implementation and the health and behavioral outcomes associated with such visual messaging programs. UR - https://www.jmir.org/2021/9/e26224 UR - http://dx.doi.org/10.2196/26224 UR - http://www.ncbi.nlm.nih.gov/pubmed/34542413 ID - info:doi/10.2196/26224 ER - TY - JOUR AU - Dowthwaite, Liz AU - Fischer, Joel AU - Perez Vallejos, Elvira AU - Portillo, Virginia AU - Nichele, Elena AU - Goulden, Murray AU - McAuley, Derek PY - 2021/9/17 TI - Public Adoption of and Trust in the NHS COVID-19 Contact Tracing App in the United Kingdom: Quantitative Online Survey Study JO - J Med Internet Res SP - e29085 VL - 23 IS - 9 KW - trust KW - technology adoption KW - COVID-19 KW - digital contact tracing KW - coronavirus KW - vulnerable populations KW - attitudes KW - SARS-CoV-2 KW - digital proximity tracing KW - compliance N2 - Background: Digital contact tracing is employed to monitor and manage the spread of COVID-19. However, to be effective the system must be adopted by a substantial proportion of the population. Studies of mostly hypothetical contact tracing apps show generally high acceptance, but little is known about the drivers and barriers to adoption of deployed systems. Objective: The aim of this study was to investigate adoption of and attitudes toward the NHS (National Health Service) COVID-19 smartphone app, the digital contact tracing solution in the United Kingdom. Methods: An online survey based on the extended Technology Acceptance Model with the added factor of trust was carried out with a representative sample of the UK population. Statistical analysis showed adoption rates, attitudes toward and trust in the app, and compliance with self-isolation advice and highlighted differences for vulnerable populations (ie, older adults aged 65 years and over and members of Black, Asian, and minority ethnic [BAME] communities). Results: A total of 1001 participants took part in the study. Around half of the participants who had heard of the NHS COVID-19 mobile phone app (490/963, 50.9%; 95% CI 47.8%-54.0%) had downloaded and kept the app, but more than one-third (345/963, 35.8%; 95% CI 32.8%-38.8%) either did not intend to download it or had deleted it. Significantly more BAME respondents than White respondents had deleted the app (16/115, 13.9%; 95% CI 11.8%-16.0%, vs 65/876, 7.4%; 95% CI 5.8%-9.0%), and significantly more older adults 65 years and over than those under 65 years did not intend to download it (44/127, 34.6%; 95% CI 31.7%-37.5%, vs 220/874, 25.2%; 95% CI 22.5%-27.9%). Broadly, one of the reasons for uptake was to help the NHS and other people, especially among older adults, although significantly fewer BAME participants agreed that they did so to help the NHS. Reported compliance with received notifications to self-isolate was high but was significantly lower than reported intended compliance without received notifications. Only one-fifth (136/699, 19.5%; 95% CI 17.0%-22.0%) of participants understood that the decision to send self-isolation notifications was automated by the app. There were a range of significantly more negative views among BAME participants, including lower trust in the NHS, while older adults were often significantly more positive. Respondents without the app reported significantly lower trust and more negative views toward the app and were less likely to report that they understood how the app works. Conclusions: While compliance on the part of the approximately 50% of participants who had the app was fairly high, there were issues surrounding trust and understanding that hindered adoption and, therefore, the effectiveness of digital contact tracing, particularly among BAME communities. This study highlights that more needs to be done to improve adoption among groups who are more vulnerable to the effects of the virus in order to enhance uptake and acceptance of contact tracing apps. UR - https://www.jmir.org/2021/9/e29085 UR - http://dx.doi.org/10.2196/29085 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406960 ID - info:doi/10.2196/29085 ER - TY - JOUR AU - Pan, Sabrina AU - Rong, Qia Lisa PY - 2021/9/17 TI - Mobile Applications in Clinical and Perioperative Care for Anesthesia: Narrative Review JO - J Med Internet Res SP - e25115 VL - 23 IS - 9 KW - mobile applications KW - mHealth KW - perioperative medicine KW - anesthesia N2 - Background: The increasing use of smartphones by providers and patients alike demonstrates that digital health utilizing mobile applications has the potential to transform perioperative care and education in anesthesia. Objective: This literature review describes the current scope of the use of mobile applications in anesthesiology. Methods: Literature was searched using PubMed, Scopus, and clinicaltrials.gov for articles published from January 1, 2010, through April 1, 2020. Only English language studies were included. Articles were included if they examined the use of a mobile health application in the setting of anesthesia or the perioperative (immediate preoperative, intraoperative, and postoperative) period. Studies were excluded if they explored video interventions or did not examine the feasibility or efficacy of the mobile app. Results: We included 29 articles, and three areas of clinical functionality were identified: patient-centered care (preoperative, intraoperative, and postoperative), systems-based improvement, and medical education. Several studies demonstrate the feasibility and reliability of mobile apps in these areas, but many are only tested for efficacy in simulated environments or with small patient samples Conclusions: Mobile health applications show promise in improving communication between anesthesiologists, improving workflow efficiency, enhancing medical education, and reducing hospital costs. However, there is a need for validation and improvement before full implementation by the provider, patients, and hospital systems. Future studies are needed to demonstrate meaningful health outcomes to create guidelines and recommendations specific to the application of mobile technology to health care. UR - https://www.jmir.org/2021/9/e25115 UR - http://dx.doi.org/10.2196/25115 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533468 ID - info:doi/10.2196/25115 ER - TY - JOUR AU - Keijsers, Merel AU - Vega-Corredor, Cecilia Maria AU - Tomintz, Melanie AU - Hoermann, Simon PY - 2021/9/17 TI - Virtual Reality Technology Use in Cigarette Craving and Smoking Interventions (I ?Virtually? Quit): Systematic Review JO - J Med Internet Res SP - e24307 VL - 23 IS - 9 KW - virtual reality technology KW - nicotine dependency KW - nicotine addiction KW - smoking addiction KW - smoking intervention KW - smoking therapy KW - Electronic Nicotine Delivery Systems N2 - Background: Over the last 2 decades, virtual reality technologies (VRTs) have been proposed as a way to enhance and improve smoking cessation therapy. Objective: This systematic review aims to evaluate and summarize the current knowledge on the application of VRT in various smoking cessation therapies, as well as to explore potential directions for future research and intervention development. Methods: A literature review of smoking interventions using VRT was conducted. Results: Not all intervention studies included an alternative therapy or a placebo condition against which the effectiveness of the intervention could be benchmarked, or a follow-up measure to ensure that the effects were lasting. Virtual reality (VR) cue exposure therapy was the most extensively studied intervention, but its effect on long-term smoking behavior was inconsistent. Behavioral therapies such as a VR approach-avoidance task or gamified interventions were less common but reported positive results. Notably, only 1 study combined Electronic Nicotine Delivery Devices with VRT. Conclusions: The inclusion of a behavioral component, as is done in the VR approach-avoidance task and gamified interventions, may be an interesting avenue for future research on smoking interventions. As Electronic Nicotine Delivery Devices are still the subject of much controversy, their potential to support smoking cessation remains unclear. For future research, behavioral or multicomponent interventions are promising avenues of exploration. Future studies should improve their validity by comparing their intervention group with at least 1 alternative or placebo control group, as well as incorporating follow-up measures. UR - https://www.jmir.org/2021/9/e24307 UR - http://dx.doi.org/10.2196/24307 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533471 ID - info:doi/10.2196/24307 ER - TY - JOUR AU - Levey, J. Elizabeth AU - Onyeaka, Henry AU - Bartles, M. Sophia AU - Sanchez Calderon, Elena AU - Sanchez, E. Sixto AU - Prom, C. Maria AU - Fesseha, M. Eden AU - Gelaye, Bizu PY - 2021/9/17 TI - Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study JO - JMIR Pediatr Parent SP - e30240 VL - 4 IS - 3 KW - access to care KW - adolescent motherhood KW - LMICs KW - mobile phone KW - perinatal mental health KW - telehealth N2 - Background: Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. Objective: This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. Methods: This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. Results: All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. Conclusions: These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed. UR - https://pediatrics.jmir.org/2021/3/e30240 UR - http://dx.doi.org/10.2196/30240 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533473 ID - info:doi/10.2196/30240 ER - TY - JOUR AU - Yu, Jing AU - Wu, Jiayi AU - Huang, Ou AU - Chen, Xiaosong AU - Shen, Kunwei PY - 2021/9/16 TI - A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study JO - J Med Internet Res SP - e27576 VL - 23 IS - 9 KW - breast cancer KW - adherence KW - multidisciplinary treatment KW - adjuvant treatment KW - smartphone-based app KW - mobile phone N2 - Background: Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. Objective: This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. Methods: Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. Results: A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). Conclusions: This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy. UR - https://www.jmir.org/2021/9/e27576 UR - http://dx.doi.org/10.2196/27576 UR - http://www.ncbi.nlm.nih.gov/pubmed/34528890 ID - info:doi/10.2196/27576 ER - TY - JOUR AU - Bonnot, Olivier AU - Adrien, Vladimir AU - Venelle, Veronique AU - Bonneau, Dominique AU - Gollier-Briant, Fanny AU - Mouchabac, Stephane PY - 2021/9/15 TI - Mobile App for Parental Empowerment for Caregivers of Children With Autism Spectrum Disorders: Prospective Open Trial JO - JMIR Ment Health SP - e27803 VL - 8 IS - 9 KW - autism spectrum disorders KW - empowerment, smartphone application KW - autism KW - smartphone KW - app KW - children KW - caregivers N2 - Background: Conflicting data emerge from literature regarding the actual use of smartphone apps in medicine; some considered the introduction of smartphone apps in medicine to be a breakthrough, while others suggested that, in real-life, the use of smartphone apps in medicine is disappointingly low. Yet, digital tools become more present in medicine daily. To empower parents of a child with autism spectrum disorder, we developed the Smartautism smartphone app, which asks questions and provides feedback, using a screen with simple curves. Objective: The purpose of this study was to evaluate usage of the app by caregivers of individuals with autism spectrum disorders. Methods: We conducted a prospective longitudinal exploratory open study with families that have a child with autism spectrum disorder. Data were recorded over a period of 6 months, and the outcome criteria were (1) overall response rates for a feedback screen and qualitative questionnaires, and (2) response rates by degree of completion and by user interest, based on attrition. Results: Participants (n=65) had a very high intent to use the app during the 6-month period (3698/3900 instances, 94.8%); however, secondary analysis showed that only 46% of participants (30/65) had constant response rates over 50%. Interestingly, these users were characterized by higher use and satisfaction with the feedback screen when compared to low (P<.001) and moderate (P=.007) users. Conclusions: We found that real or perceived utility is an important incentive for parents who use empowerment smartphone apps. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-012135 UR - https://mental.jmir.org/2021/9/e27803 UR - http://dx.doi.org/10.2196/27803 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524101 ID - info:doi/10.2196/27803 ER - TY - JOUR AU - Morgado Areia, Carlos AU - Santos, Mauro AU - Vollam, Sarah AU - Pimentel, Marco AU - Young, Louise AU - Roman, Cristian AU - Ede, Jody AU - Piper, Philippa AU - King, Elizabeth AU - Gustafson, Owen AU - Harford, Mirae AU - Shah, Akshay AU - Tarassenko, Lionel AU - Watkinson, Peter PY - 2021/9/15 TI - A Chest Patch for Continuous Vital Sign Monitoring: Clinical Validation Study During Movement and Controlled Hypoxia JO - J Med Internet Res SP - e27547 VL - 23 IS - 9 KW - clinical validation KW - chest patch KW - vital signs KW - remote monitoring KW - wearable KW - heart rate KW - respiratory rate N2 - Background: The standard of care in general wards includes periodic manual measurements, with the data entered into track-and-trigger charts, either on paper or electronically. Wearable devices may support health care staff, improve patient safety, and promote early deterioration detection in the interval between periodic measurements. However, regulatory standards for ambulatory cardiac monitors estimating heart rate (HR) and respiratory rate (RR) do not specify performance criteria during patient movement or clinical conditions in which the patient?s oxygen saturation varies. Therefore, further validation is required before clinical implementation and deployment of any wearable system that provides continuous vital sign measurements. Objective: The objective of this study is to determine the agreement between a chest-worn patch (VitalPatch) and a gold standard reference device for HR and RR measurements during movement and gradual desaturation (modeling a hypoxic episode) in a controlled environment. Methods: After the VitalPatch and gold standard devices (Philips MX450) were applied, participants performed different movements in seven consecutive stages: at rest, sit-to-stand, tapping, rubbing, drinking, turning pages, and using a tablet. Hypoxia was then induced, and the participants? oxygen saturation gradually reduced to 80% in a controlled environment. The primary outcome measure was accuracy, defined as the mean absolute error (MAE) of the VitalPatch estimates when compared with HR and RR gold standards (3-lead electrocardiography and capnography, respectively). We defined these as clinically acceptable if the rates were within 5 beats per minute for HR and 3 respirations per minute (rpm) for RR. Results: Complete data sets were acquired for 29 participants. In the movement phase, the HR estimates were within prespecified limits for all movements. For RR, estimates were also within the acceptable range, with the exception of the sit-to-stand and turning page movements, showing an MAE of 3.05 (95% CI 2.48-3.58) rpm and 3.45 (95% CI 2.71-4.11) rpm, respectively. For the hypoxia phase, both HR and RR estimates were within limits, with an overall MAE of 0.72 (95% CI 0.66-0.78) beats per minute and 1.89 (95% CI 1.75-2.03) rpm, respectively. There were no significant differences in the accuracy of HR and RR estimations between normoxia (?90%), mild (89.9%-85%), and severe hypoxia (<85%). Conclusions: The VitalPatch was highly accurate throughout both the movement and hypoxia phases of the study, except for RR estimation during the two types of movements. This study demonstrated that VitalPatch can be safely tested in clinical environments to support earlier detection of cardiorespiratory deterioration. Trial Registration: ISRCTN Registry ISRCTN61535692; https://www.isrctn.com/ISRCTN61535692 UR - https://www.jmir.org/2021/9/e27547 UR - http://dx.doi.org/10.2196/27547 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524087 ID - info:doi/10.2196/27547 ER - TY - JOUR AU - Craig Rushing, Stephanie AU - Kelley, Allyson AU - Bull, Sheana AU - Stephens, David AU - Wrobel, Julia AU - Silvasstar, Joshva AU - Peterson, Roger AU - Begay, Corey AU - Ghost Dog, Thomas AU - McCray, Celena AU - Love Brown, Danica AU - Thomas, Morgan AU - Caughlan, Colbie AU - Singer, Michelle AU - Smith, Paige AU - Sumbundu, Kanku PY - 2021/9/15 TI - Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial JO - JMIR Ment Health SP - e26158 VL - 8 IS - 9 KW - American Indian KW - Alaska Native KW - adolescent KW - mental health KW - help-seeking skills, text messaging KW - mHealth, behavioral intervention KW - Indian health KW - mobile phone N2 - Background: Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective: We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. Methods: From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. Results: A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping (P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1% (427/618) at 3 months to 76% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members increased from 22.4% (138/616) at 3 months to 54.6% (272/498) at 8 months. Conclusions: This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. Trial Registration: ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481 UR - https://mental.jmir.org/2021/9/e26158 UR - http://dx.doi.org/10.2196/26158 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524092 ID - info:doi/10.2196/26158 ER - TY - JOUR AU - Shandhi, Hasan Md Mobashir AU - Goldsack, C. Jennifer AU - Ryan, Kyle AU - Bennion, Alexandra AU - Kotla, V. Aditya AU - Feng, Alina AU - Jiang, Yihang AU - Wang, Ke Will AU - Hurst, Tina AU - Patena, John AU - Carini, Simona AU - Chung, Jeanne AU - Dunn, Jessilyn PY - 2021/9/15 TI - Recent Academic Research on Clinically Relevant Digital Measures: Systematic Review JO - J Med Internet Res SP - e29875 VL - 23 IS - 9 KW - digital clinical measures KW - academic research KW - funding KW - biosensor KW - digital measures KW - digital health KW - health outcomes N2 - Background: Digital clinical measures collected via various digital sensing technologies such as smartphones, smartwatches, wearables, ingestibles, and implantables are increasingly used by individuals and clinicians to capture health outcomes or behavioral and physiological characteristics of individuals. Although academia is taking an active role in evaluating digital sensing products, academic contributions to advancing the safe, effective, ethical, and equitable use of digital clinical measures are poorly characterized. Objective: We performed a systematic review to characterize the nature of academic research on digital clinical measures and to compare and contrast the types of sensors used and the sources of funding support for specific subareas of this research. Methods: We conducted a PubMed search using a range of search terms to retrieve peer-reviewed articles reporting US-led academic research on digital clinical measures between January 2019 and February 2021. We screened each publication against specific inclusion and exclusion criteria. We then identified and categorized research studies based on the types of academic research, sensors used, and funding sources. Finally, we compared and contrasted the funding support for these specific subareas of research and sensor types. Results: The search retrieved 4240 articles of interest. Following the screening, 295 articles remained for data extraction and categorization. The top five research subareas included operations research (research analysis; n=225, 76%), analytical validation (n=173, 59%), usability and utility (data visualization; n=123, 42%), verification (n=93, 32%), and clinical validation (n=83, 28%). The three most underrepresented areas of research into digital clinical measures were ethics (n=0, 0%), security (n=1, 0.5%), and data rights and governance (n=1, 0.5%). Movement and activity trackers were the most commonly studied sensor type, and physiological (mechanical) sensors were the least frequently studied. We found that government agencies are providing the most funding for research on digital clinical measures (n=192, 65%), followed by independent foundations (n=109, 37%) and industries (n=56, 19%), with the remaining 12% (n=36) of these studies completely unfunded. Conclusions: Specific subareas of academic research related to digital clinical measures are not keeping pace with the rapid expansion and adoption of digital sensing products. An integrated and coordinated effort is required across academia, academic partners, and academic funders to establish the field of digital clinical measures as an evidence-based field worthy of our trust. UR - https://www.jmir.org/2021/9/e29875 UR - http://dx.doi.org/10.2196/29875 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524089 ID - info:doi/10.2196/29875 ER - TY - JOUR AU - Borghouts, Judith AU - Eikey, V. Elizabeth AU - Mark, Gloria AU - De Leon, Cinthia AU - Schueller, M. Stephen AU - Schneider, Margaret AU - Stadnick, Nicole AU - Zheng, Kai AU - Mukamel, B. Dana AU - Sorkin, H. Dara PY - 2021/9/14 TI - Understanding Mental Health App Use Among Community College Students: Web-Based Survey Study JO - J Med Internet Res SP - e27745 VL - 23 IS - 9 KW - mHealth KW - mental health KW - community college KW - students KW - structural equation modeling KW - mobile apps KW - services KW - mental health services KW - stress KW - privacy N2 - Background: Mental health concerns are a significant issue among community college students, who often have less access to resources than traditional university college students. Mobile apps have the potential to increase access to mental health care, but there has been little research investigating factors associated with mental health app use within the community college population. Objective: This study aimed to understand facilitators of and barriers to mental health app use among community college students. Methods: A web-based survey was administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Structural equation modeling was used to test the relationships between the use of mental health apps, perceived stress, perceived need to seek help for mental health concerns, perceived stigma, past use of professional mental health services, privacy concerns, and social influence of other people in using mental health apps. Results: Of the 500 participants, 106 (21.2%) reported use of mental health apps. Perceived stress, perceived need to seek help, past use of professional services, and social influence were positively associated with mental health app use. Furthermore, the effect of stress was mediated by a perceived need to seek help. Privacy concerns were negatively associated with mental health app use. Stigma, age, and gender did not have a statistically significant effect. Conclusions: These findings can inform development of new digital interventions and appropriate outreach strategies to engage community college students in using mental health apps. UR - https://www.jmir.org/2021/9/e27745 UR - http://dx.doi.org/10.2196/27745 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519668 ID - info:doi/10.2196/27745 ER - TY - JOUR AU - Dharanikota, Spurthy AU - LeRouge, M. Cynthia AU - Lyon, Victoria AU - Durneva, Polina AU - Thompson, Matthew PY - 2021/9/14 TI - Identifying Enablers of Participant Engagement in Clinical Trials of Consumer Health Technologies: Qualitative Study of Influenza Home Testing JO - J Med Internet Res SP - e26869 VL - 23 IS - 9 KW - consumer health care technologies KW - CHTs KW - smartphone-supported home tests KW - Smart-HT KW - premarket clinical trials KW - trial engagement KW - at-home diagnostic testing KW - mobile phone N2 - Background: A rise in the recent trend of self-managing health using consumer health technologies highlights the importance of efficient and successful consumer health technology trials. Trials are particularly essential to support large-scale implementations of consumer health technologies, such as smartphone-supported home tests. However, trials are generally fraught with challenges, such as inadequate enrollment, lack of fidelity to interventions, and high dropout rates. Understanding the reasons underlying individuals? participation in trials can inform the design and execution of future trials of smartphone-supported home tests. Objective: This study aims to identify the enablers of potential participants? trial engagement for clinical trials of smartphone-supported home tests. We use influenza home testing as our instantiation of a consumer health technology subject to trial to investigate the dispositional and situational enablers that influenced trial engagement. Methods: We conducted semistructured interviews with 31 trial participants using purposive sampling to facilitate demographic diversity. The interviews included a discussion of participants? personal characteristics and external factors that enabled their trial engagement with a smartphone-supported home test for influenza. We performed both deductive and inductive thematic analyses to analyze the interview transcripts and identify enabler themes. Results: Our thematic analyses revealed a structure of dispositional and situational enablers that enhanced trial engagement. Situationally, clinical affiliation, personal advice, promotional recruitment strategies, financial incentives, and insurance status influenced trial engagement. In addition, digital health literacy, motivation to advance medical research, personal innovativeness, altruism, curiosity, positive attitude, and potential to minimize doctors? visits were identified as the dispositional enablers for trial engagement in our study. Conclusions: We organized the identified themes for dispositional and situational enablers of trial engagement with a smartphone-supported home test into a research framework that can guide future research as well as the trial design and execution of smartphone-supported home tests. We suggest several trial design and engagement strategies to enhance the financial and scientific viability of these trials that pave the way for advancements in patient care. Furthermore, our study also offers practical strategies to trial organizers to enhance participants? enrollment and engagement in clinical trials of these home tests. UR - https://www.jmir.org/2021/9/e26869 UR - http://dx.doi.org/10.2196/26869 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519664 ID - info:doi/10.2196/26869 ER - TY - JOUR AU - Luo, Christina Tiffany AU - Aguilera, Adrian AU - Lyles, Rees Courtney AU - Figueroa, Astrid Caroline PY - 2021/9/14 TI - Promoting Physical Activity Through Conversational Agents: Mixed Methods Systematic Review JO - J Med Internet Res SP - e25486 VL - 23 IS - 9 KW - physical activity KW - health behavior KW - behavior change KW - conversational agent KW - virtual agent KW - chatbot KW - digital health KW - eHealth KW - mHealth KW - mobile health KW - mobile phone N2 - Background: Regular physical activity (PA) is crucial for well-being; however, healthy habits are difficult to create and maintain. Interventions delivered via conversational agents (eg, chatbots or virtual agents) are a novel and potentially accessible way to promote PA. Thus, it is important to understand the evolving landscape of research that uses conversational agents. Objective: This mixed methods systematic review aims to summarize the usability and effectiveness of conversational agents in promoting PA, describe common theories and intervention components used, and identify areas for further development. Methods: We conducted a mixed methods systematic review. We searched seven electronic databases (PsycINFO, PubMed, Embase, CINAHL, ACM Digital Library, Scopus, and Web of Science) for quantitative, qualitative, and mixed methods studies that conveyed primary research on automated conversational agents designed to increase PA. The studies were independently screened, and their methodological quality was assessed using the Mixed Methods Appraisal Tool by 2 reviewers. Data on intervention impact and effectiveness, treatment characteristics, and challenges were extracted and analyzed using parallel-results convergent synthesis and narrative summary. Results: In total, 255 studies were identified, 7.8% (20) of which met our inclusion criteria. The methodological quality of the studies was varied. Overall, conversational agents had moderate usability and feasibility. Those that were evaluated through randomized controlled trials were found to be effective in promoting PA. Common challenges facing interventions were repetitive program content, high attrition, technical issues, and safety and privacy concerns. Conclusions: Conversational agents hold promise for PA interventions. However, there is a lack of rigorous research on long-term intervention effectiveness and patient safety. Future interventions should be based on evidence-informed theories and treatment approaches and should address users? desires for program variety, natural language processing, delivery via mobile devices, and safety and privacy concerns. UR - https://www.jmir.org/2021/9/e25486 UR - http://dx.doi.org/10.2196/25486 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519653 ID - info:doi/10.2196/25486 ER - TY - JOUR AU - Lukic, Xavier Yanick AU - Klein, Shirin Shari AU - Brügger, Victoria AU - Keller, Clare Olivia AU - Fleisch, Elgar AU - Kowatsch, Tobias PY - 2021/9/14 TI - The Impact of a Gameful Breathing Training Visualization on Intrinsic Experiential Value, Perceived Effectiveness, and Engagement Intentions: Between-Subject Online Experiment JO - JMIR Serious Games SP - e22803 VL - 9 IS - 3 KW - breathing training KW - serious game KW - digital health KW - mobile health KW - mHealth KW - mobile phone KW - experiential value KW - instrumental value KW - online experiment N2 - Background: Slow-paced breathing has been shown to be positively associated with psychological and physiological health. In practice, however, there is little long-term engagement with breathing training, as shown by the usage statistics of breathing training apps. New research suggests that gameful smartphone-delivered breathing training may address this challenge. Objective: This study assesses the impact of breathing training, guided by a gameful visualization, on perceived experiential and instrumental values and the intention to engage in such training. Methods: A between-subject online experiment with 170 participants was conducted, and one-way multiple analysis of variance and two-tailed t test analyses were used to test for any difference in intrinsic experiential value, perceived effectiveness, and the intention to engage in either a breathing training with a gameful or a nongameful guidance visualization. Moreover, prior experience in gaming and meditation practices were assessed as moderator variables for a preliminary analysis. Results: The intrinsic experiential value for the gameful visualization was found to be significantly higher compared to the nongameful visualization (P=.001), but there was no difference in either perceived effectiveness (P=.50) or the intention to engage (P=.44). The preliminary analysis of the influence of meditation and gaming experience on the outcomes indicates that people with more meditation experience yielded higher intrinsic experiential values from using the gameful visualization than people with no or little meditation experience (P=.03). This analysis did not find any additional evidence of gaming time or meditation experience impacting the outcomes. Conclusions: The gameful visualization was found to increase the intrinsic experiential value of the breathing training without decreasing the perceived effectiveness. However, there were no differences in intentions to engage in both breathing training conditions. Furthermore, gaming and meditation experiences seem to have no or only a small positive moderating effect on the relationship between the gameful visualization and the intrinsic experiential value. Future longitudinal field studies are required to assess the impact of gameful breathing training on actual behavior, that is, long-term engagement and outcomes. UR - https://games.jmir.org/2021/3/e22803 UR - http://dx.doi.org/10.2196/22803 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519662 ID - info:doi/10.2196/22803 ER - TY - JOUR AU - Hirten, P. Robert AU - Danieletto, Matteo AU - Tomalin, Lewis AU - Choi, Hyewon Katie AU - Zweig, Micol AU - Golden, Eddye AU - Kaur, Sparshdeep AU - Helmus, Drew AU - Biello, Anthony AU - Pyzik, Renata AU - Calcagno, Claudia AU - Freeman, Robert AU - Sands, E. Bruce AU - Charney, Dennis AU - Bottinger, P. Erwin AU - Murrough, W. James AU - Keefer, Laurie AU - Suarez-Farinas, Mayte AU - Nadkarni, N. Girish AU - Fayad, A. Zahi PY - 2021/9/13 TI - Factors Associated With Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data JO - J Med Internet Res SP - e31295 VL - 23 IS - 9 KW - wearable device KW - COVID-19 KW - stress KW - heart rate variability KW - psychological KW - psychology KW - physiology KW - mental health KW - health care worker KW - observational KW - app KW - heart rate KW - nervous system KW - resilience KW - emotion KW - support KW - quality of life N2 - Background: The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact. Objective: This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress. Methods: HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally. Results: A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City?s COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial. Conclusions: High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic. UR - https://www.jmir.org/2021/9/e31295 UR - http://dx.doi.org/10.2196/31295 UR - http://www.ncbi.nlm.nih.gov/pubmed/34379602 ID - info:doi/10.2196/31295 ER - TY - JOUR AU - Sahandi Far, Mehran AU - Eickhoff, B. Simon AU - Goni, Maria AU - Dukart, Juergen PY - 2021/9/13 TI - Exploring Test-Retest Reliability and Longitudinal Stability of Digital Biomarkers for Parkinson Disease in the m-Power Data Set: Cohort Study JO - J Med Internet Res SP - e26608 VL - 23 IS - 9 KW - health sciences KW - medical research KW - biomarkers KW - diagnostic markers KW - neurological disorders KW - Parkinson disease KW - mobile phone N2 - Background: Digital biomarkers (DB), as captured using sensors embedded in modern smart devices, are a promising technology for home-based sign and symptom monitoring in Parkinson disease (PD). Objective: Despite extensive application in recent studies, test-retest reliability and longitudinal stability of DB have not been well addressed in this context. We utilized the large-scale m-Power data set to establish the test-retest reliability and longitudinal stability of gait, balance, voice, and tapping tasks in an unsupervised and self-administered daily life setting in patients with PD and healthy controls (HC). Methods: Intraclass correlation coefficients were computed to estimate the test-retest reliability of features that also differentiate between patients with PD and healthy volunteers. In addition, we tested for longitudinal stability of DB measures in PD and HC, as well as for their sensitivity to PD medication effects. Results: Among the features differing between PD and HC, only a few tapping and voice features had good to excellent test-retest reliabilities and medium to large effect sizes. All other features performed poorly in this respect. Only a few features were sensitive to medication effects. The longitudinal analyses revealed significant alterations over time across a variety of features and in particular for the tapping task. Conclusions: These results indicate the need for further development of more standardized, sensitive, and reliable DB for application in self-administered remote studies in patients with PD. Motivational, learning, and other confounders may cause variations in performance that need to be considered in DB longitudinal applications. UR - https://www.jmir.org/2021/9/e26608 UR - http://dx.doi.org/10.2196/26608 UR - http://www.ncbi.nlm.nih.gov/pubmed/34515645 ID - info:doi/10.2196/26608 ER - TY - JOUR AU - Daryabeygi-Khotbehsara, Reza AU - Shariful Islam, Mohammed Sheikh AU - Dunstan, David AU - McVicar, Jenna AU - Abdelrazek, Mohamed AU - Maddison, Ralph PY - 2021/9/13 TI - Smartphone-Based Interventions to Reduce Sedentary Behavior and Promote Physical Activity Using Integrated Dynamic Models: Systematic Review JO - J Med Internet Res SP - e26315 VL - 23 IS - 9 KW - smartphone KW - mobile phone KW - physical activity KW - sedentary behavior KW - computational models KW - control systems KW - systematic review N2 - Background: Traditional psychological theories are inadequate to fully leverage the potential of smartphones and improve the effectiveness of physical activity (PA) and sedentary behavior (SB) change interventions. Future interventions need to consider dynamic models taken from other disciplines, such as engineering (eg, control systems). The extent to which such dynamic models have been incorporated in the development of interventions for PA and SB remains unclear. Objective: This review aims to quantify the number of studies that have used dynamic models to develop smartphone-based interventions to promote PA and reduce SB, describe their features, and evaluate their effectiveness where possible. Methods: Databases including PubMed, PsycINFO, IEEE Xplore, Cochrane, and Scopus were searched from inception to May 15, 2019, using terms related to mobile health, dynamic models, SB, and PA. The included studies involved the following: PA or SB interventions involving human adults; either developed or evaluated integrated psychological theory with dynamic theories; used smartphones for the intervention delivery; the interventions were adaptive or just-in-time adaptive; included randomized controlled trials (RCTs), pilot RCTs, quasi-experimental, and pre-post study designs; and were published from 2000 onward. Outcomes included general characteristics, dynamic models, theory or construct integration, and measured SB and PA behaviors. Data were synthesized narratively. There was limited scope for meta-analysis because of the variability in the study results. Results: A total of 1087 publications were screened, with 11 publications describing 8 studies included in the review. All studies targeted PA; 4 also included SB. Social cognitive theory was the major psychological theory upon which the studies were based. Behavioral intervention technology, control systems, computational agent model, exploit-explore strategy, behavioral analytic algorithm, and dynamic decision network were the dynamic models used in the included studies. The effectiveness of quasi-experimental studies involved reduced SB (1 study; P=.08), increased light PA (1 study; P=.002), walking steps (2 studies; P=.06 and P<.001), walking time (1 study; P=.02), moderate-to-vigorous PA (2 studies; P=.08 and P=.81), and nonwalking exercise time (1 study; P=.31). RCT studies showed increased walking steps (1 study; P=.003) and walking time (1 study; P=.06). To measure activity, 5 studies used built-in smartphone sensors (ie, accelerometers), 3 of which used the phone?s GPS, and 3 studies used wearable activity trackers. Conclusions: To our knowledge, this is the first systematic review to report on smartphone-based studies to reduce SB and promote PA with a focus on integrated dynamic models. These findings highlight the scarcity of dynamic model?based smartphone studies to reduce SB or promote PA. The limited number of studies that incorporate these models shows promising findings. Future research is required to assess the effectiveness of dynamic models in promoting PA and reducing SB. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42020139350; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=139350. UR - https://www.jmir.org/2021/9/e26315 UR - http://dx.doi.org/10.2196/26315 UR - http://www.ncbi.nlm.nih.gov/pubmed/34515637 ID - info:doi/10.2196/26315 ER - TY - JOUR AU - Chen, Chih-Hao AU - Lin, Haley Heng-Yu AU - Wang, Mao-Che AU - Chu, Yuan-Chia AU - Chang, Chun-Yu AU - Huang, Chii-Yuan AU - Cheng, Yen-Fu PY - 2021/9/10 TI - Diagnostic Accuracy of Smartphone-Based Audiometry for Hearing Loss Detection: Meta-analysis JO - JMIR Mhealth Uhealth SP - e28378 VL - 9 IS - 9 KW - audiometry KW - hearing loss KW - hearing test KW - mhealth KW - mobile health KW - digital health KW - meta-analysis KW - mobile phone KW - smartphone diagnostic test accuracy N2 - Background: Hearing loss is one of the most common disabilities worldwide and affects both individual and public health. Pure tone audiometry (PTA) is the gold standard for hearing assessment, but it is often not available in many settings, given its high cost and demand for human resources. Smartphone-based audiometry may be equally effective and can improve access to adequate hearing evaluations. Objective: The aim of this systematic review is to synthesize the current evidence of the role of smartphone-based audiometry in hearing assessments and further explore the factors that influence its diagnostic accuracy. Methods: Five databases?PubMed, Embase, Cochrane Library, Web of Science, and Scopus?were queried to identify original studies that examined the diagnostic accuracy of hearing loss measurement using smartphone-based devices with conventional PTA as a reference test. A bivariate random-effects meta-analysis was performed to estimate the pooled sensitivity and specificity. The factors associated with diagnostic accuracy were identified using a bivariate meta-regression model. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: In all, 25 studies with a total of 4470 patients were included in the meta-analysis. The overall sensitivity, specificity, and area under the receiver operating characteristic curve for smartphone-based audiometry were 89% (95% CI 83%-93%), 93% (95% CI 87%-97%), and 0.96 (95% CI 0.93-0.97), respectively; the corresponding values for the smartphone-based speech recognition test were 91% (95% CI 86%-94%), 88% (95% CI 75%-94%), and 0.93 (95% CI 0.90-0.95), respectively. Meta-regression analysis revealed that patient age, equipment used, and the presence of soundproof booths were significantly related to diagnostic accuracy. Conclusions: We have presented comprehensive evidence regarding the effectiveness of smartphone-based tests in diagnosing hearing loss. Smartphone-based audiometry may serve as an accurate and accessible approach to hearing evaluations, especially in settings where conventional PTA is unavailable. UR - https://mhealth.jmir.org/2021/9/e28378/ UR - http://dx.doi.org/10.2196/28378 UR - http://www.ncbi.nlm.nih.gov/pubmed/34515644 ID - info:doi/10.2196/28378 ER - TY - JOUR AU - Han, Changho AU - Song, Youngjae AU - Lim, Hong-Seok AU - Tae, Yunwon AU - Jang, Jong-Hwan AU - Lee, Tak Byeong AU - Lee, Yeha AU - Bae, Woong AU - Yoon, Dukyong PY - 2021/9/10 TI - Automated Detection of Acute Myocardial Infarction Using Asynchronous Electrocardiogram Signals?Preview of Implementing Artificial Intelligence With Multichannel Electrocardiographs Obtained From Smartwatches: Retrospective Study JO - J Med Internet Res SP - e31129 VL - 23 IS - 9 KW - wearables KW - smartwatches KW - asynchronous electrocardiogram KW - artificial intelligence KW - deep learning KW - automatic diagnosis KW - myocardial infarction KW - timely diagnosis KW - machine learning KW - digital health KW - cardiac health KW - cardiology N2 - Background: When using a smartwatch to obtain electrocardiogram (ECG) signals from multiple leads, the device has to be placed on different parts of the body sequentially. The ECG signals measured from different leads are asynchronous. Artificial intelligence (AI) models for asynchronous ECG signals have barely been explored. Objective: We aimed to develop an AI model for detecting acute myocardial infarction using asynchronous ECGs and compare its performance with that of the automatic ECG interpretations provided by a commercial ECG analysis software. We sought to evaluate the feasibility of implementing multiple lead?based AI-enabled ECG algorithms on smartwatches. Moreover, we aimed to determine the optimal number of leads for sufficient diagnostic power. Methods: We extracted ECGs recorded within 24 hours from each visit to the emergency room of Ajou University Medical Center between June 1994 and January 2018 from patients aged 20 years or older. The ECGs were labeled on the basis of whether a diagnostic code corresponding to acute myocardial infarction was entered. We derived asynchronous ECG lead sets from standard 12-lead ECG reports and simulated a situation similar to the sequential recording of ECG leads via smartwatches. We constructed an AI model based on residual networks and self-attention mechanisms by randomly masking each lead channel during the training phase and then testing the model using various targeting lead sets with the remaining lead channels masked. Results: The performance of lead sets with 3 or more leads compared favorably with that of the automatic ECG interpretations provided by a commercial ECG analysis software, with 8.1%-13.9% gain in sensitivity when the specificity was matched. Our results indicate that multiple lead-based AI-enabled ECG algorithms can be implemented on smartwatches. Model performance generally increased as the number of leads increased (12-lead sets: area under the receiver operating characteristic curve [AUROC] 0.880; 4-lead sets: AUROC 0.858, SD 0.008; 3-lead sets: AUROC 0.845, SD 0.011; 2-lead sets: AUROC 0.813, SD 0.018; single-lead sets: AUROC 0.768, SD 0.001). Considering the short amount of time needed to measure additional leads, measuring at least 3 leads?ideally more than 4 leads?is necessary for minimizing the risk of failing to detect acute myocardial infarction occurring in a certain spatial location or direction. Conclusions: By developing an AI model for detecting acute myocardial infarction with asynchronous ECG lead sets, we demonstrated the feasibility of multiple lead-based AI-enabled ECG algorithms on smartwatches for automated diagnosis of cardiac disorders. We also demonstrated the necessity of measuring at least 3 leads for accurate detection. Our results can be used as reference for the development of other AI models using sequentially measured asynchronous ECG leads via smartwatches for detecting various cardiac disorders. UR - https://www.jmir.org/2021/9/e31129 UR - http://dx.doi.org/10.2196/31129 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505839 ID - info:doi/10.2196/31129 ER - TY - JOUR AU - Schwaninger, Philipp AU - Berli, Corina AU - Scholz, Urte AU - Lüscher, Janina PY - 2021/9/9 TI - Effectiveness of a Dyadic Buddy App for Smoking Cessation: Randomized Controlled Trial JO - J Med Internet Res SP - e27162 VL - 23 IS - 9 KW - mHealth KW - smartphone app KW - smoking cessation KW - buddy KW - social support KW - mobile phone N2 - Background: Tobacco smoking is one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real time. This randomized controlled trial investigated the effectiveness of an app that encourages individuals to quit smoking with the help of a social network member (buddy) in daily life. Objective: The objective of this study is to test the effectiveness of the SmokeFree buddy app compared with a control group with self-reported smoking abstinence and carbon monoxide (CO)?verified smoking abstinence as primary outcomes and self-reports of smoked cigarettes per day (CPD) as a secondary outcome. Methods: A total of 162 adults who smoked participated in this single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Around a self-set quit date (ie, 7 days before the self-set quit date and 20 days after) and 6 months later, participants of the intervention and control groups reported on daily smoking abstinence and CPD in end-of-day diaries. Daily smoking abstinence was verified via daily exhaled CO assessments. This assessment was administered via an app displaying results of exhaled CO, thus addressing self-monitoring in both groups. In addition, participants in the intervention group used the SmokeFree buddy app, a multicomponent app that facilitates social support from a buddy of choice. Results: A significant reduction in CPD from baseline to the 6-month follow-up was observed among participants in both groups. Multilevel analyses revealed no significant intervention effect on self-reported and CO-verified daily smoking abstinence at the quit date and 3 weeks later. However, CPD was lower at the quit date and 3 weeks later in the intervention group than in the control group. No significant differences between groups were found for any outcome measures 6 months after the quit date. Overall, low app engagement and low perceived usefulness were observed. Conclusions: Despite some encouraging short-term findings on the amount of smoking, the SmokeFree buddy app did not have beneficial effects on smoking abstinence over and above the self-monitoring control condition. Future studies should examine whether and what support processes can be effectively stimulated and how app use can be improved to better achieve this goal. Trial Registration: ISRCTN Registry 11154315; https://www.isrctn.com/ISRCTN11154315 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7723-z UR - https://www.jmir.org/2021/9/e27162 UR - http://dx.doi.org/10.2196/27162 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499045 ID - info:doi/10.2196/27162 ER - TY - JOUR AU - Palos-Sanchez, R. Pedro AU - Saura, Ramon Jose AU - Rios Martin, Ángel Miguel AU - Aguayo-Camacho, Mariano PY - 2021/9/9 TI - Toward a Better Understanding of the Intention to Use mHealth Apps: Exploratory Study JO - JMIR Mhealth Uhealth SP - e27021 VL - 9 IS - 9 KW - mHealth apps KW - mobile apps KW - eHealth KW - promotion of health KW - TAM KW - PLS?SEM KW - COVID-19 N2 - Background: An increasing number of mobile health (mHealth) apps are becoming available for download and use on mobile devices. Even with the increase in availability and use of mHealth apps, there has still not been a lot of research into understanding the intention to use this kind of apps. Objective: The purpose of this study was to investigate a technology acceptance model (TAM) that has been specially designed for primary health care applications. Methods: The proposed model is an extension of the TAM, and was empirically tested using data obtained from a survey of mHealth app users (n=310). The research analyzed 2 additional external factors: promotion of health and health benefits. Data were analyzed with a PLS?SEM software and confirmed that gender moderates the adoption of mHealth apps in Spain. The explanatory capacity (R2 for behavioral intention to use) of the proposed model was 76.4%. Likewise, the relationships of the external constructs of the extended TAM were found to be significant. Results: The results show the importance of healthy habits developed by using mHealth apps. In addition, communication campaigns for these apps should be aimed at transferring the usefulness of eHealth as an agent for transforming attitudes; additionally, as more health benefits are obtained, ease of use becomes greater. Perceived usefulness (PU; ?=.415, t0.001;4999=3.442, P=.001), attitude toward using (?=.301, t0.01;499=2.299, P=.02), and promotion of health (?=.210, t0.05;499=2.108, P=.03) were found to have a statistically significant impact on behavior intention to use eHealth apps (R2=76.4%). Perceived ease of use (PEOU; ?=.179, t0.01;499=2.623, P=.009) and PU (?=.755, t0.001;499=12.888, P<.001) were found to have a statistically significant impact on attitude toward using (R2>=78.2%). Furthermore, PEOU (?=.203, t0.01;499=2.810, P=.005), health benefits (?=.448, t0.001;499=4.010, P<.001), and promotion of health (?=.281, t0.01;499=2.393, P=.01) exerted a significant impact on PU (R2=72.7%). Finally, health benefits (?=.640, t0.001;499=14.948, P<.001) had a statistically significant impact on PEOU (R2=40.9%), while promotion of health (?=.865, t0.001;499=29.943, P<.001) significantly influenced health benefits (R2=74.7%). Conclusions: mHealth apps could be used to predict the behavior of patients in the face of recommendations to prevent pandemics, such as COVID-19 or SARS, and to track users? symptoms while they stay at home. Gender is a determining factor that influences the intention to use mHealth apps, so perhaps different interfaces and utilities could be designed according to gender. UR - https://mhealth.jmir.org/2021/9/e27021 UR - http://dx.doi.org/10.2196/27021 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499044 ID - info:doi/10.2196/27021 ER - TY - JOUR AU - Salim, Hani AU - Lee, Yein Ping AU - Sharif-Ghazali, Sazlina AU - Cheong, Theng Ai AU - Wong, Jasmine AU - Young, Ingrid AU - Pinnock, Hilary AU - PY - 2021/9/9 TI - Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach JO - J Med Internet Res SP - e26434 VL - 23 IS - 9 KW - asthma KW - self-management KW - design sprint KW - health literacy KW - mobile phone N2 - Background: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing. UR - https://www.jmir.org/2021/9/e26434 UR - http://dx.doi.org/10.2196/26434 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499039 ID - info:doi/10.2196/26434 ER - TY - JOUR AU - Park, Sulki AU - Kum, Hye-Chung AU - Morrisey, A. Michael AU - Zheng, Qi AU - Lawley, A. Mark PY - 2021/9/6 TI - Adherence to Telemonitoring Therapy for Medicaid Patients With Hypertension: Case Study JO - J Med Internet Res SP - e29018 VL - 23 IS - 9 KW - telemedicine KW - hypertension KW - Medicaid KW - blood pressure KW - pulse KW - telemonitoring KW - mobile phone N2 - Background: Almost 50% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems. Objective: The aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control. Methods: This study targeted Medicaid patients with hypertension from the state of Texas. A total of 180 days of blood pressure and pulse data in 2016-2018 from a telemonitoring company were analyzed for mean transmission rate and mean blood pressure change. The first 30 days of data were excluded because of startup effects. The protocols required the patients to transmit readings by a specified time daily. Patients not transmitting their readings received an adherence reminder call to troubleshoot problems and encourage transmission. The patients were classified into adherent and nonadherent cohorts; adherent patients were those who transmitted data on at least 80% of the days. Results: The mean patient age was 73.2 (SD 11.7) years. Of the 823 patients, 536 (65.1%) were women, and 660 (80.2%) were urban residents. The adherent cohort (475/823, 57.7%) had mean transmission rates of 74.9% before the adherence reminder call and 91.3% after the call, whereas the nonadherent cohort (348/823, 42.3%) had mean transmission rates of 39% and 58% before and after the call, respectively. From month 1 to month 5, the transmission rates dropped by 1.9% and 10.2% for the adherent and nonadherent cohorts, respectively. The systolic and diastolic blood pressure values improved by an average of 2.2 and 0.7 mm Hg (P<.001 and P=.004), respectively, for the adherent cohort during the study period, whereas only the systolic blood pressure value improved by an average of 1.6 mm Hg (P=.02) for the nonadherent cohort. Conclusions: Although we found that patients can achieve high levels of adherence, many experience adherence problems. Although adherence reminder calls help, they may not be sufficient. Telemonitoring lowered blood pressure, as has been observed in clinical trials. Furthermore, blood pressure control was positively associated with adherence. UR - https://www.jmir.org/2021/9/e29018 UR - http://dx.doi.org/10.2196/29018 UR - http://www.ncbi.nlm.nih.gov/pubmed/34486977 ID - info:doi/10.2196/29018 ER - TY - JOUR AU - Meyerhoff, Jonah AU - Liu, Tony AU - Kording, P. Konrad AU - Ungar, H. Lyle AU - Kaiser, M. Susan AU - Karr, J. Chris AU - Mohr, C. David PY - 2021/9/3 TI - Evaluation of Changes in Depression, Anxiety, and Social Anxiety Using Smartphone Sensor Features: Longitudinal Cohort Study JO - J Med Internet Res SP - e22844 VL - 23 IS - 9 KW - mHealth KW - personal sensing KW - digital phenotyping KW - passive sensing KW - ecological momentary assessment KW - depression KW - anxiety KW - digital biomarkers KW - mental health assessment KW - mobile device KW - mobile phone KW - internet technology KW - psychiatric disorders N2 - Background: The assessment of behaviors related to mental health typically relies on self-report data. Networked sensors embedded in smartphones can measure some behaviors objectively and continuously, with no ongoing effort. Objective: This study aims to evaluate whether changes in phone sensor?derived behavioral features were associated with subsequent changes in mental health symptoms. Methods: This longitudinal cohort study examined continuously collected phone sensor data and symptom severity data, collected every 3 weeks, over 16 weeks. The participants were recruited through national research registries. Primary outcomes included depression (8-item Patient Health Questionnaire), generalized anxiety (Generalized Anxiety Disorder 7-item scale), and social anxiety (Social Phobia Inventory) severity. Participants were adults who owned Android smartphones. Participants clustered into 4 groups: multiple comorbidities, depression and generalized anxiety, depression and social anxiety, and minimal symptoms. Results: A total of 282 participants were aged 19-69 years (mean 38.9, SD 11.9 years), and the majority were female (223/282, 79.1%) and White participants (226/282, 80.1%). Among the multiple comorbidities group, depression changes were preceded by changes in GPS features (Time: r=?0.23, P=.02; Locations: r=?0.36, P<.001), exercise duration (r=0.39; P=.03) and use of active apps (r=?0.31; P<.001). Among the depression and anxiety groups, changes in depression were preceded by changes in GPS features for Locations (r=?0.20; P=.03) and Transitions (r=?0.21; P=.03). Depression changes were not related to subsequent sensor-derived features. The minimal symptoms group showed no significant relationships. There were no associations between sensor-based features and anxiety and minimal associations between sensor-based features and social anxiety. Conclusions: Changes in sensor-derived behavioral features are associated with subsequent depression changes, but not vice versa, suggesting a directional relationship in which changes in sensed behaviors are associated with subsequent changes in symptoms. UR - https://www.jmir.org/2021/9/e22844 UR - http://dx.doi.org/10.2196/22844 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477562 ID - info:doi/10.2196/22844 ER - TY - JOUR AU - Vellinga, Akke AU - Farrell, Karen AU - Fallon, Roisin AU - Hare, Daniel AU - Sutton-Fitzpatrick, Una AU - Cormican, Martin PY - 2021/9/3 TI - Presentation, Treatment, and Natural Course of Severe Symptoms of Urinary Tract Infections Measured by a Smartphone App: Observational and Feasibility Study JO - J Med Internet Res SP - e25364 VL - 23 IS - 9 KW - urinary tract infections KW - general practice KW - smartphone application KW - mobile phone N2 - Background: Urinary tract infections (UTIs) are one of the most common conditions in women. Current information on the presentation, management, and natural course of the infection is based on paper diaries filled out and subsequently posted by patients. Objective: The aim of this study is to explore the feasibility of a smartphone app to assess the natural course and management of UTIs. Methods: A smartphone app was developed to collect data from study participants presenting with symptoms of UTI in general practice. After initial demographic and treatment information, symptom severity was recorded by the patient after a reminder on their smartphone, which occurred twice daily for a period of 7 days or until symptom resolution. Results: A total of 181 women aged 18-76 years downloaded the smartphone app. The duration of symptoms was determined from the results of 178 participants. All patients submitted a urine sample, most patients were prescribed an antibiotic (163/181, 90.1%), and 38.7% (70/181) of the patients had a positive culture. Moderately bad or worse symptoms lasted a mean of 3.8 (SD 3.2; median 4) days, and 70.2% (125/178) of the patients indicated that they were cured on day 4 after consultation. This compares with other research assessing symptom duration and management of UTIs using paper diaries. Patients were very positive about the usability of the smartphone app and often found the reminders supportive. On the basis of the feedback and the analysis of the data, some suggestions for improvement were made. Conclusions: Smartphone diaries for symptom scores over the course of infections are an efficient and acceptable means of collecting data in research. UR - https://www.jmir.org/2021/9/e25364 UR - http://dx.doi.org/10.2196/25364 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477567 ID - info:doi/10.2196/25364 ER - TY - JOUR AU - Colomina, Jordi AU - Drudis, Reis AU - Torra, Montserrat AU - Pallisó, Francesc AU - Massip, Mireia AU - Vargiu, Eloisa AU - Nadal, Nuria AU - Fuentes, Araceli AU - Ortega Bravo, Marta AU - Miralles, Felip AU - Barbé, Ferran AU - Torres, Gerard AU - de Batlle, Jordi AU - PY - 2021/9/2 TI - Implementing mHealth-Enabled Integrated Care for Complex Chronic Patients With Osteoarthritis Undergoing Primary Hip or Knee Arthroplasty: Prospective, Two-Arm, Parallel Trial JO - J Med Internet Res SP - e28320 VL - 23 IS - 9 KW - mHealth KW - osteoarthritis KW - arthroplasty KW - health plan implementation KW - chronic disease KW - mobile phone N2 - Background: Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. Objective: This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)?enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. Methods: As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. Results: A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. Conclusions: Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery. UR - https://www.jmir.org/2021/9/e28320 UR - http://dx.doi.org/10.2196/28320 UR - http://www.ncbi.nlm.nih.gov/pubmed/34473068 ID - info:doi/10.2196/28320 ER - TY - JOUR AU - Yerushalmi, Mor AU - Sixsmith, Andrew AU - Pollock Star, Ariel AU - King, B. David AU - O'Rourke, Norm PY - 2021/9/2 TI - Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study JO - JMIR Form Res SP - e30472 VL - 5 IS - 9 KW - bipolar disorder KW - couples KW - dyadic analyses KW - ecological momentary assessment KW - EMA KW - partner KW - relationships KW - mHealth KW - mobile apps KW - mental health KW - depression KW - BPD KW - mood N2 - Background: The World Health Organization ranks bipolar disorder (BD) as the 7th leading cause of disability. Although the effects on those with BD are well described, less is reported on the impact of BD on cohabiting partners or any interactions between the two; this requires in vivo data collection measured each day over several months. Objective: We set out to demonstrate the utility of ecological momentary assessment with BD couples measured using yoked smartphone apps. When randomly prompted over time, we assumed distinct patterns of association would emerge between BD symptoms (both depression and hypo/mania) and partner mood (positive and negative affect). Methods: For this pilot study, we recruited an international sample of young and older adults with BD and their cohabiting partners where available. Both participants and partners downloaded separate apps onto their respective smartphones. Within self-specified ?windows of general availability,? participants with BD were randomly prompted to briefly report symptoms of depression and hypo/mania (ie, BDSx), positive and negative mood (ie, POMS-15; partners), and any important events of the day (both). The partner app was yoked to the participant app so that the former was prompted roughly 30 minutes after the participant with BD or the next morning if outside the partner?s specified availability. Results: Four couples provided 312 matched BD symptom and partner mood responses over an average of 123 days (range 65-221 days). Both were GPS- and time-stamped (mean 3:11 hrs between questionnaires, SD 4:51 hrs). Total depression had a small but significant association with positive (r=?.14; P=.02) and negative partner affect (r=.15; P=.01]. Yet total hypo/mania appeared to have no association with positive partner affect (r=?.01; P=.87); instead, negative partner affect was significantly correlated with total hypo/mania (r=.26; P=.01). However, when we look specifically at BD factors, we see that negative partner affect is associated only with affrontive symptoms of hypo/mania (r=.38; P=.01); elation or loss of insight appears unrelated to either positive (r=.10; P=.09) or negative partner affect (r=.02; P=.71). Yet affrontive symptoms of hypo/mania were significantly correlated with negative affect, but only when couples were together (r=.41; P=.01), not when apart (r=.22; P=.12). That is, these angry interpersonal symptoms of hypo/mania appear to be experienced most negatively by spouses when couples are together. Conclusions: These initial findings demonstrate the utility of in vivo ambulatory data collection in longitudinal mental health research. Preliminary analyses suggest different BD symptoms are associated with negative and positive partner mood. These negative effects appear greater for hypo/mania than depressive symptoms, but proximity to the person with BD is important. UR - https://formative.jmir.org/2021/9/e30472 UR - http://dx.doi.org/10.2196/30472 UR - http://www.ncbi.nlm.nih.gov/pubmed/34473069 ID - info:doi/10.2196/30472 ER - TY - JOUR AU - Biviji, Rizwana AU - Williams, S. Karmen AU - Vest, R. Joshua AU - Dixon, E. Brian AU - Cullen, Theresa AU - Harle, A. Christopher PY - 2021/9/1 TI - Consumer Perspectives on Maternal and Infant Health Apps: Qualitative Content Analysis JO - J Med Internet Res SP - e27403 VL - 23 IS - 9 KW - mHealth KW - mobile applications KW - maternal and infant health KW - smartphones KW - mobile phone N2 - Background: Despite the popularity of maternal and infant health mobile apps, ongoing consumer engagement and sustained app use remain barriers. Few studies have examined user experiences or perceived benefits of maternal and infant health app use from consumer perspectives. Objective: This study aims to assess users? self-reported experiences with maternal and infant health apps, perceived benefits, and general feedback by analyzing publicly available user reviews on two popular app stores?Apple App Store and Google Play Store. Methods: We conducted a qualitative assessment of publicly available user reviews (N=2422) sampled from 75 maternal and infant health apps designed to provide health education or decision-making support to pregnant women or parents and caregivers of infants. The reviews were coded and analyzed using a general inductive qualitative content analysis approach. Results: The three major themes included the following: app functionality, where users discussed app features and functions; technical aspects, where users talked about technology-based aspects of an app; and app content, where users specifically focused on the app content and the information it provides. The six minor themes included the following: patterns of use, where users highlighted the frequency and type of use; social support, where users talked about receiving social support from friends, family and community of other users; app cost, where users talked about the cost of an app within the context of being cost-effective or a potential waste of money; app comparisons, where users compared one app with others available in app stores; assistance in health care, where users specifically highlighted the role of an app in offering clinical assistance; and customer care support, where users specifically talked about their interaction with the app customer care support team. Conclusions: Users generally tend to value apps that are of low cost and preferably free, with high-quality content, superior features, enhanced technical aspects, and user-friendly interfaces. Users also find app developer responsiveness to be integral, as it offers them an opportunity to engage in the app development and delivery process. These findings may be beneficial for app developers in designing better apps, as no best practice guidelines currently exist for the app environment. UR - https://www.jmir.org/2021/9/e27403 UR - http://dx.doi.org/10.2196/27403 UR - http://www.ncbi.nlm.nih.gov/pubmed/34468323 ID - info:doi/10.2196/27403 ER - TY - JOUR AU - Sneha, Sweta AU - Thalla, Srivarun AU - Rischie, Ishaan AU - Shahriar, Hossain PY - 2021/8/31 TI - Health Internet Technology for Chronic Conditions: Review of Diabetes Management Apps JO - JMIR Diabetes SP - e17431 VL - 6 IS - 3 KW - chronic disease KW - diabetes KW - blood glucose KW - diabetes management KW - mHealth disease apps KW - diabetes apps KW - best Apple diabetes apps N2 - Background: Mobile health (mHealth) smartphone apps have shown promise in the self-management of chronic disease. In today?s oversaturated health app market, selection criteria that consumers are employing to choose mHealth apps for disease self-management are of paramount importance. App quality is critical in monitoring disease controls but is often linked to consumer popularity rather than clinical recommendations of effectiveness in disease management. Management of key disease variances can be performed through these apps to increase patient engagement in disease self-management. This paper provides a comprehensive review of features found in mHealth apps frequently used in the self- management of diabetes. Objective: The purpose of this study was to review features of frequently used and high consumer-rated mHealth apps used in the self-management of diabetes. This study aimed to highlight key features of consumer-favored mHealth apps used in the self-management of diabetes. Methods: A 2-fold approach was adopted involving the Apple iOS store and the Google search engine. The primary search was conducted on the Apple iOS store using the term ?diabetes apps? (device used: Apple iPad). The top 5 most frequently used mHealth apps were identified and rated by the number of consumer reviews, app ratings, and the presence of key diabetes management features, such as dietary blood glucose, A1C, insulin, physical activity, and prescription medication. A subsequent Google search was conducted using the search term ?best Apple diabetes apps.? The top 3 search results??Healthline,? ?Everyday Health,? and ?Diabetes Apps?American Diabetes Association??were explored. Results: In total, 12 mHealth apps were reviewed due to their appearing across 4 evaluated sources. Only 1 health app?Glucose Buddy Diabetes Tracker?appeared as the most frequently used within the Apple iOS store and across the other 3 sources. The OneTouch Reveal app ranked first on the list in the iOS store with 39,000 consumer reviews and a rating of 4.7 out of 5.0 stars but only appeared in 1 of the other 3 sources. Blood glucose tracking was present across all apps, but other disease management features varied in type with at least 3 of the 5 key features being present across the 12 reviewed apps. Subscription cost and integration needs were present in the apps which could impact consumers? decision to select apps. Although mobile app preference was assessed and defined by the number of consumer reviews and star ratings, there were no scientific standards used in the selection and ranking of the health apps within this study. Conclusions: mHealth apps have shown promise in chronic disease management, but a surge in development of these nonregulated health solutions points to a need for regulation, standardization, and quality control. A governing body of health IT professionals, clinicians, policymakers, payors, and patients could be beneficial in defining health app standards for effective chronic disease management. Variabilities in features, cost, and other aspects of management could be reduced by regulatory uniformity, which would increase patient engagement and improve disease outcomes. UR - https://diabetes.jmir.org/2021/3/e17431 UR - http://dx.doi.org/10.2196/17431 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463627 ID - info:doi/10.2196/17431 ER - TY - JOUR AU - Timmers, Thomas AU - Keijsers, Manouk AU - Kremer, M. Jan A. AU - Janssen, Loes AU - Smeenk, Jesper PY - 2021/8/27 TI - Supporting Women Undergoing IVF Treatment With Timely Patient Information Through an App: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e28104 VL - 9 IS - 8 KW - patient education KW - fertilization in vitro KW - mobile health KW - health literacy KW - gynecology N2 - Background: Since the introduction of assisted reproductive technologies in 1978, over 2 million in vitro fertilization (IVF) babies have been born worldwide. Patients play a vital role in the success of this treatment. They are required to take fertility medication (hormone injections) to activate the ovaries to produce a sufficient number of oocytes. Later, they need to take medication to increase the chance of the embryo surviving inside the uterus. Patients are educated during an intake consultation at the start of the treatment to minimize the emotional burden and reduce noncompliance. The consultation lasts about 30 to 45 minutes and covers all essential subjects. Even though ample time and energy is spent on patient education, patients still feel anxious, unknowledgeable, and unsupported. As such, electronic health utilizing a smartphone or tablet app can offer additional support, as it allows health care professionals to provide their patients with the correct information at the right time by using push notifications. Objective: This randomized controlled trial aimed to evaluate the capacity of an app to support IVF patients throughout the different phases of their treatment and assess its effectiveness. The study's primary outcome was to determine the patients? level of satisfaction with the information provided. The secondary outcomes included their level of knowledge, ability to administer the medication, overall experienced quality of the treatment, health care consumption, and app usage. Methods: This study was performed at a specialized fertility clinic of the nonacademic teaching hospital Elisabeth-TweeSteden Ziekenhuis in Tilburg, the Netherlands. Patients who were scheduled for IVF or intracytoplasmic sperm injection treatments between April 2018 and August 2019 were invited to participate in a physician-blinded, randomized controlled trial. Results: In total, 54 patients participated (intervention group: n=29). Patients in the intervention group demonstrated a higher level of satisfaction on a 0 to 10 scale (mean 8.43, SD 1.03 vs mean 7.70, SD 0.66; P=.004). In addition, they were more knowledgeable about the different elements of the treatment on a 7 to 35 scale (mean 27.29, SD 2.94 vs mean 23.05, SD 2.76; P<.001). However, the difference disappeared over time. There were no differences between the two patient groups on the other outcomes. In total, 25 patients in the intervention group used the app 1425 times, an average of 57 times per patient. Conclusions: Our study demonstrates that, in comparison with standard patient education, using an app to provide patients with timely information increases their level of satisfaction. Furthermore, using the app leads to a higher level of knowledge about the steps and procedures of IVF treatment. Finally, the app?s usage statistics demonstrate patients? informational needs and their willingness to use an electronic health application as part of their treatment. Trial Registration: Netherlands Trial Register (NTR) 6959; https://www.trialregister.nl/trial/6959 UR - https://mhealth.jmir.org/2021/8/e28104 UR - http://dx.doi.org/10.2196/28104 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448725 ID - info:doi/10.2196/28104 ER - TY - JOUR AU - Yang, Kyungmi AU - Oh, Dongryul AU - Noh, Myoung Jae AU - Yoon, Gyul Han AU - Sun, Jong-Mu AU - Kim, Kwan Hong AU - Zo, Ill Jae AU - Shim, Mog Young AU - Ko, Hyunyoung AU - Lee, Jungeun AU - Kim, Youngin PY - 2021/8/27 TI - Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study JO - J Med Internet Res SP - e28695 VL - 23 IS - 8 KW - esophageal cancer KW - malnutrition KW - muscle loss KW - sarcopenia KW - mobile app KW - mHealth N2 - Background: Excessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT), as reported in our previous research. Objective: In this pilot study, we prospectively tested the feasibility of a health coaching mobile app for preventing malnutrition and muscle loss in this patient population. Methods: Between July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used Noom, a health coaching mobile app that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured based on computed tomography and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes in the SMI, nutrition, and inflammatory factors between the patient group that used the mobile app (mHealth group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the app. Results: Two patients dropped out of the study (no app usage; treatment changed to a definitive aim). The use (or activation) of the app was noted in approximately 70% (25/36) of the patients until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with their age, primary tumor location, tumor stage, pre-RT BMI, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (?6.7 vs ?9.8; P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (?SMI/50 days >10%). In patients with excessive muscle loss, the walk steps significantly decreased in the last 4 weeks compared to those in the first 4 weeks. Age affected the absolute number of walk steps (P=.01), whereas pre-RT sarcopenia was related to the recovery of the reduced walk steps (P=.03). Conclusions: For esophageal cancer patients receiving NACRT, a health care mobile app helped nutritional self-care with less decrease in the PNI, although it did not prevent excessive muscle loss. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition. UR - https://www.jmir.org/2021/8/e28695 UR - http://dx.doi.org/10.2196/28695 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448714 ID - info:doi/10.2196/28695 ER - TY - JOUR AU - Yu, Jessica AU - Chiu, Carter AU - Wang, Yajuan AU - Dzubur, Eldin AU - Lu, Wei AU - Hoffman, Julia PY - 2021/8/27 TI - A Machine Learning Approach to Passively Informed Prediction of Mental Health Risk in People with Diabetes: Retrospective Case-Control Analysis JO - J Med Internet Res SP - e27709 VL - 23 IS - 8 KW - diabetes mellitus KW - mental health KW - risk detection KW - passive sensing KW - ecological momentary assessment KW - machine learning N2 - Background: Proactive detection of mental health needs among people with diabetes mellitus could facilitate early intervention, improve overall health and quality of life, and reduce individual and societal health and economic burdens. Passive sensing and ecological momentary assessment are relatively newer methods that may be leveraged for such proactive detection. Objective: The primary aim of this study was to conceptualize, develop, and evaluate a novel machine learning approach for predicting mental health risk in people with diabetes mellitus. Methods: A retrospective study was designed to develop and evaluate a machine learning model, utilizing data collected from 142,432 individuals with diabetes enrolled in the Livongo for Diabetes program. First, participants? mental health statuses were verified using prescription and medical and pharmacy claims data. Next, four categories of passive sensing signals were extracted from the participants? behavior in the program, including demographics and glucometer, coaching, and event data. Data sets were then assembled to create participant-period instances, and descriptive analyses were conducted to understand the correlation between mental health status and passive sensing signals. Passive sensing signals were then entered into the model to train and test its performance. The model was evaluated based on seven measures: sensitivity, specificity, precision, area under the curve, F1 score, accuracy, and confusion matrix. SHapley Additive exPlanations (SHAP) values were computed to determine the importance of individual signals. Results: In the training (and validation) and three subsequent test sets, the model achieved a confidence score greater than 0.5 for sensitivity, specificity, area under the curve, and accuracy. Signals identified as important by SHAP values included demographics such as race and gender, participant?s emotional state during blood glucose checks, time of day of blood glucose checks, blood glucose values, and interaction with the Livongo mobile app and web platform. Conclusions: Results of this study demonstrate the utility of a passively informed mental health risk algorithm and invite further exploration to identify additional signals and determine when and where such algorithms should be deployed. UR - https://www.jmir.org/2021/8/e27709 UR - http://dx.doi.org/10.2196/27709 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448707 ID - info:doi/10.2196/27709 ER - TY - JOUR AU - Haggenmüller, Sarah AU - Krieghoff-Henning, Eva AU - Jutzi, Tanja AU - Trapp, Nicole AU - Kiehl, Lennard AU - Utikal, Sven Jochen AU - Fabian, Sascha AU - Brinker, Josef Titus PY - 2021/8/27 TI - Digital Natives? Preferences on Mobile Artificial Intelligence Apps for Skin Cancer Diagnostics: Survey Study JO - JMIR Mhealth Uhealth SP - e22909 VL - 9 IS - 8 KW - artificial intelligence KW - skin cancer KW - skin cancer screening KW - diagnostics KW - digital natives KW - acceptance KW - concerns KW - preferences KW - online survey N2 - Background: Artificial intelligence (AI) has shown potential to improve diagnostics of various diseases, especially for early detection of skin cancer. Studies have yet to investigate the clear application of AI technology in clinical practice or determine the added value for younger user groups. Translation of AI-based diagnostic tools can only be successful if they are accepted by potential users. Young adults as digital natives may offer the greatest potential for successful implementation of AI into clinical practice, while at the same time, representing the future generation of skin cancer screening participants. Objective: We conducted an anonymous online survey to examine how and to what extent individuals are willing to accept AI-based mobile apps for skin cancer diagnostics. We evaluated preferences and relative influences of concerns, with a focus on younger age groups. Methods: We recruited participants below 35 years of age using three social media channels?Facebook, LinkedIn, and Xing. Descriptive analysis and statistical tests were performed to evaluate participants? attitudes toward mobile apps for skin examination. We integrated an adaptive choice-based conjoint to assess participants? preferences. We evaluated potential concerns using maximum difference scaling. Results: We included 728 participants in the analysis. The majority of participants (66.5%, 484/728; 95% CI 0.631-0.699) expressed a positive attitude toward the use of AI-based apps. In particular, participants residing in big cities or small towns (P=.02) and individuals that were familiar with the use of health or fitness apps (P=.02) were significantly more open to mobile diagnostic systems. Hierarchical Bayes estimation of the preferences of participants with a positive attitude (n=484) revealed that the use of mobile apps as an assistance system was preferred. Participants ruled out app versions with an accuracy of ?65%, apps using data storage without encryption, and systems that did not provide background information about the decision-making process. However, participants did not mind their data being used anonymously for research purposes, nor did they object to the inclusion of clinical patient information in the decision-making process. Maximum difference scaling analysis for the negative-minded participant group (n=244) showed that data security, insufficient trust in the app, and lack of personal interaction represented the dominant concerns with respect to app use. Conclusions: The majority of potential future users below 35 years of age were ready to accept AI-based diagnostic solutions for early detection of skin cancer. However, for translation into clinical practice, the participants? demands for increased transparency and explainability of AI-based tools seem to be critical. Altogether, digital natives between 18 and 24 years and between 25 and 34 years of age expressed similar preferences and concerns when compared both to each other and to results obtained by previous studies that included other age groups. UR - https://mhealth.jmir.org/2021/8/e22909 UR - http://dx.doi.org/10.2196/22909 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448722 ID - info:doi/10.2196/22909 ER - TY - JOUR AU - Ribanszki, Robert AU - Saez Fonseca, Andres Jose AU - Barnby, Matthew Joseph AU - Jano, Kimberly AU - Osmani, Fatima AU - Almasi, Soma AU - Tsakanikos, Elias PY - 2021/8/27 TI - Preferences for Digital Smartphone Mental Health Apps Among Adolescents: Qualitative Interview Study JO - JMIR Form Res SP - e14004 VL - 5 IS - 8 KW - qualitative KW - adolescents KW - mental health KW - digital smartphone app KW - digital mental health KW - mobile phone N2 - Background: Mental health digital apps hold promise for providing scalable solutions to individual self-care, education, and illness prevention. However, a problem with these apps is that they lack engaging user interfaces and experiences and thus potentially result in high attrition. Although guidelines for new digital interventions for adults have begun to examine engagement, there is a paucity of evidence on how to best address digital interventions for adolescents. As adolescence is a period of transition, during which the onset of many potentially lifelong mental health conditions frequently occurs, understanding how best to engage this population is crucial. Objective: The study aims to detect potential barriers to engagement and to gather feedback on the current elements of app design regarding user experience, user interface, and content. Methods: This study used a qualitative design. A sample of 14 adolescents was asked to use the app for 1 week and was interviewed using a semistructured interview schedule. The interviews were transcribed and analyzed using thematic analysis. Results: Overall, 13 participants completed the interviews. The authors developed 6 main themes and 20 subthemes based on the data that influenced engagement with and the perceived usefulness of the app. Our main themes were timing, stigma, perception, congruity, usefulness, and user experience. Conclusions: In line with previous research, we suggest how these aspects of app development should be considered for future apps that aim to prevent and manage mental health conditions. UR - https://formative.jmir.org/2021/8/e14004 UR - http://dx.doi.org/10.2196/14004 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128814 ID - info:doi/10.2196/14004 ER - TY - JOUR AU - Mackert, Michael AU - Mandell, Dorothy AU - Donovan, Erin AU - Walker, Lorraine AU - Henson-García, Mike AU - Bouchacourt, Lindsay PY - 2021/8/17 TI - Mobile Apps as Audience-Centered Health Communication Platforms JO - JMIR Mhealth Uhealth SP - e25425 VL - 9 IS - 8 KW - health communication KW - mHealth KW - mobile apps KW - mobile health KW - prenatal health KW - pregnancy KW - audience-centered UR - https://mhealth.jmir.org/2021/8/e25425 UR - http://dx.doi.org/10.2196/25425 UR - http://www.ncbi.nlm.nih.gov/pubmed/34402797 ID - info:doi/10.2196/25425 ER - TY - JOUR AU - Hettiachchi, Danula AU - Hayes, Lachie AU - Goncalves, Jorge AU - Kostakos, Vassilis PY - 2021/8/16 TI - Team Dynamics in Hospital Workflows: An Exploratory Study of a Smartphone Task Manager JO - JMIR Med Inform SP - e28245 VL - 9 IS - 8 KW - task assignment KW - smartphones KW - hospital communication KW - clinical workflows KW - mobile app KW - clinical platform KW - mHealth N2 - Background: Although convenient and reliable modern messaging apps like WhatsApp enable efficient communication among hospital staff, hospitals are now pivoting toward purpose-built structured communication apps for various reasons, including security and privacy concerns. However, there is limited understanding of how we can examine and improve hospital workflows using the data collected through such apps as an alternative to costly and challenging research methods like ethnography and patient record analysis. Objective: We seek to identify whether the structure of the collected communication data provides insights into hospitals? workflows. Our analysis also aims to identify ways in which task management platforms can be improved and designed to better support clinical workflows. Methods: We present an exploratory analysis of clinical task records collected over 22 months through a smartphone app that enables structured communication between staff to manage and execute clinical workflows. We collected over 300,000 task records between July 2018 and May 2020 completed by staff members including doctors, nurses, and pharmacists across all wards in an Australian hospital. Results: We show that important insights into how teams function in a clinical setting can be readily drawn from task assignment data. Our analysis indicates that predefined labels such as urgency and task type are important and impact how tasks are accepted and completed. Our results show that both task sent-to-accepted (P<.001) and sent-to-completed (P<.001) times are significantly higher for routine tasks when compared to urgent tasks. We also show how task acceptance varies across teams and roles and that internal tasks are more efficiently managed than external tasks, possibly due to increased trust among team members. For example, task sent-to-accepted time (minutes) is significantly higher (P<.001) for external assignments (mean 22.10, SD 91.45) when compared to internal assignments (mean 19.03, SD 82.66). Conclusions: Smartphone-based task assignment apps can provide unique insights into team dynamics in clinical settings. These insights can be used to further improve how well these systems support clinical work and staff. UR - https://medinform.jmir.org/2021/8/e28245 UR - http://dx.doi.org/10.2196/28245 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398797 ID - info:doi/10.2196/28245 ER - TY - JOUR AU - Perkins, C. Ryan AU - Gross, Rachel AU - Regan, Kayla AU - Bishay, Lara AU - Sawicki, S. Gregory PY - 2021/8/16 TI - Perceptions of Social Media Use to Augment Health Care Among Adolescents and Young Adults With Cystic Fibrosis: Survey Study JO - JMIR Pediatr Parent SP - e25014 VL - 4 IS - 3 KW - cystic fibrosis KW - social media KW - mobile health KW - adherence KW - adolescents KW - young adults N2 - Background: For individuals with cystic fibrosis (CF), adolescence and young adulthood are times of significant vulnerability and have been associated with clinical and psychosocial challenges. Social media may offer innovative care delivery solutions to address these challenges. Objective: This study explored motivations and attitudes regarding current social media use and preferences for a social media platform in a sample of adolescents and young adults (AYA) with CF. Methods: A cross-sectional survey was administered to 50 AYA with CF followed at a large pediatric-adult CF center. The survey included questions regarding social media platform utilization, attitudes toward general and CF-specific online activities, and preferences for a CF-specific care delivery platform. Results: YouTube, Snapchat, and Instagram were the most commonly used social media platforms. AYA with CF do not report routinely using social media for health-related information acquisition, social support, or help with adherence. However, their perceptions of social media utilization and preferences for platform development suggest interest in doing so in the future. Conclusions: AYA with CF use social media and expressed interest in the development of a social media platform. Platform development will allow for gaps in health care delivery to be addressed by improving social support and adherence while augmenting current methods of health information acquisition. UR - https://pediatrics.jmir.org/2021/3/e25014 UR - http://dx.doi.org/10.2196/25014 UR - http://www.ncbi.nlm.nih.gov/pubmed/34232121 ID - info:doi/10.2196/25014 ER - TY - JOUR AU - Habgood, Emily AU - McCormack, Christopher AU - Walter, M. Fiona AU - Emery, D. Jon PY - 2021/8/13 TI - Patients? Experiences of Using Skin Self-monitoring Apps With People at Higher Risk of Melanoma: Qualitative Study JO - JMIR Dermatol SP - e22583 VL - 4 IS - 2 KW - melanoma KW - skin cancer KW - early detection KW - mobile apps KW - qualitative KW - mHealth KW - mobile phone N2 - Background: Melanoma is the fourth most commonly diagnosed cancer in Australia. Up to 75% of melanomas are first detected by patients or their family or friends. Many mobile apps for melanoma exist, including apps to encourage skin self-monitoring to improve the likelihood of early detection. Previous research in this area has focused on their development, diagnostic accuracy, or validation. Little is known about patients? views and experiences of using these apps. Objective: This study aims to understand patients? views and experiences of using commercially available melanoma skin self-monitoring mobile apps for a period of 3 months. Methods: This qualitative study was conducted in two populations: primary care (where the MelatoolsQ tool was used to identify patients who were at increased risk of melanoma) and secondary care (where patients had a previous diagnosis of melanoma, stages T0-T3a). Participants downloaded 2 of the 4 mobile apps for skin self-monitoring (SkinVision, UMSkinCheck, Mole Monitor, or MySkinPal) and were encouraged to use them for 3 months. After 3 months, a semistructured interview was conducted with participants to discuss their experiences of using the skin self-monitoring mobile apps. Results: A total of 54 participants were recruited in the study, with 37% (20) of participants from primary care and 62% (34) from secondary care. Interviews were conducted with 34 participants when data saturation was reached. Most participants did not use the apps at all (n=12) or tried them once but did not continue (n=14). Only 8 participants used the apps to assist with skin self-monitoring for the entire duration of the study. Patients discussed the apps in the context of the importance of early detection and their current skin self-monitoring behaviors. A range of features of perceived quality of each app affected engagement to support skin self-monitoring. Participants described their skin self-monitoring routines and potential mismatches with the app reminders. They also described the technical and practical difficulties experienced when using the apps for skin self-monitoring. The app?s positioning within existing relationships with health care providers was crucial to understand the use of the apps. Conclusions: This study of patients at increased risk of melanoma highlights several barriers to engagement with apps to support skin self-monitoring. The results highlight the wide-ranging and dynamic influences on engagement with mobile apps, which extend beyond app design and relate to broader contextual factors about skin self-monitoring routines and relationships with health care providers. UR - https://derma.jmir.org/2021/2/e22583 UR - http://dx.doi.org/10.2196/22583 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632821 ID - info:doi/10.2196/22583 ER - TY - JOUR AU - Oakley-Girvan, Ingrid AU - Davis, Watkins Sharon AU - Kurian, Allison AU - Rosas, G. Lisa AU - Daniels, Jena AU - Palesh, Gronskaya Oxana AU - Mesia, J. Rachel AU - Kamal, H. Arif AU - Longmire, Michelle AU - Divi, Vasu PY - 2021/8/13 TI - Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study JO - JMIR Form Res SP - e22608 VL - 5 IS - 8 KW - cancer KW - oncology KW - mHealth KW - caregiver KW - cancer survivor KW - mobile app KW - smartphone KW - feasibility KW - caregiver burden KW - symptom reporting N2 - Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors? care partners to monitor the survivors? health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient?s health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner?s health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. Trial Registration: ClinicalTrials.gov NCT04018677; https://clinicaltrials.gov/ct2/show/NCT04018677 UR - https://formative.jmir.org/2021/8/e22608 UR - http://dx.doi.org/10.2196/22608 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398787 ID - info:doi/10.2196/22608 ER - TY - JOUR AU - Wang, Tong AU - Fan, Lingye AU - Zheng, Xu AU - Wang, Wei AU - Liang, Jun AU - An, Kai AU - Ju, Mei AU - Lei, Jianbo PY - 2021/8/12 TI - The Impact of Gamification-Induced Users' Feelings on the Continued Use of mHealth Apps: A Structural Equation Model With the Self-Determination Theory Approach JO - J Med Internet Res SP - e24546 VL - 23 IS - 8 KW - mHealth app KW - continued use KW - continuance intention KW - gamification KW - self-determination theory (SDT) KW - expectation confirmation model of information system continuance (ECM-ISC) KW - PLS-SEM N2 - Background: Continued use of mHealth apps can achieve better effects in health management. Gamification is an important factor in promoting users? intention to continue using mHealth apps. Past research has rarely explored the factors underlying the continued use of mobile health (mHealth) apps and gamification?s impact mechanism or path on continued use. Objective: This study aimed to explore the factors influencing mHealth app users? intention to continue using mHealth apps and the impact mechanism and path of users? feelings induced by gamification on continued mHealth app use. Methods: First, based on the expectation confirmation model of information system continuance, we built a theoretical model for continued use of mHealth apps based on users? feelings toward gamification. We used self-determination theory to analyze gamification?s impact on user perceptions and set the resulting feelings (competence, autonomy, and relatedness) as constructs in the model. Second, we used the survey method to validate the research model, and we used partial least squares to analyze the data. Results: A total of 2988 responses were collected from mHealth app users, and 307 responses were included in the structural equation model after passing the acceptance criteria. The intrinsic motivation for using mHealth apps is significantly affected by autonomy (?=.312; P<.001), competence (?=.346; P<.001), and relatedness (?=.165; P=.004) induced by gamification. The intrinsic motivation for using mHealth apps has a significant impact on satisfaction (?=.311, P<.001) and continuance intention (?=.142; P=.045); furthermore, satisfaction impacts continuance intention significantly (?=.415; P<.001). Confirmation has a significant impact on perceived usefulness (?=.859; P<.001) and satisfaction (?=.391; P<.001), and perceived usefulness has a significant impact on satisfaction (?=.269; P<.001) and continuance intention (?=.273; P=.001). The mediating effect analysis showed that in the impact path of the intrinsic motivation for using the mHealth apps on continuance intention, satisfaction plays a partial mediating role (?=.129; P<.001), with a variance accounted for of 0.466. Conclusions: This study explored the impact path of users? feelings induced by gamification on the intention of continued mHealth app use. We confirmed that perceived usefulness, confirmation, and satisfaction in the classical continued use theory for nonmedical information systems positively affect continuance intention. We also found that the path and mechanism of users' feelings regarding autonomy, competence, and relatedness generated during interactions with different gamification elements promote the continued use of mHealth apps. UR - https://www.jmir.org/2021/8/e24546 UR - http://dx.doi.org/10.2196/24546 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387550 ID - info:doi/10.2196/24546 ER - TY - JOUR AU - Imeri, Hyllore AU - Desselle, Shane AU - Hetemi, Dardan AU - Hoti, Kreshnik PY - 2021/8/11 TI - Mobile Electronic Devices as Means of Facilitating Patient Activation and Health Professional Empowerment Related to Information Seeking on Chronic Conditions and Medications: Qualitative Study JO - JMIR Mhealth Uhealth SP - e26300 VL - 9 IS - 8 KW - patient activation KW - mobile electronic devices KW - health professionals KW - chronic conditions KW - medications N2 - Background: Patient activation has an impact on the management of patients? health, clinical outcomes, and treatment costs. Mobile electronic devices (MEDs) have shown the potential to engage patients in wellness behavior. Furthermore, the potentially positive role of MEDs is evident in supporting health professionals in their practice. Objective: This study aims to explore the impact of MEDs on patient activation to search for information on chronic conditions and medications and the impact of MEDs on the empowerment of health professionals or future health professionals. Methods: We conducted 6 focus groups?2 with health sciences students, 2 with health professionals, and 2 with hospitalized patients with chronic conditions. A protocol comprising eight questions was used to guide discussions. Audio-recorded data were transcribed verbatim and analyzed thematically; a ranking system was used to analyze the relevance of identified themes and subthemes, using a coding system depicted by the + symbol, to indicate different relevance levels. Results: Our results suggest that MEDs can positively affect patient activation to search for chronic conditions and medication information by facilitating patients? information-seeking behavior. Key drivers leading to patients? activation to seek information related to chronic conditions and medications through MEDs were the accessibility and abundance of available and detailed information, reduced search time, information updates, and convenience in finding information at any time and place. The lack of accurate information in one?s native language, access to incorrect information, and limited access to the internet were key obstacles to seeking information related to chronic conditions and medications via MEDs. In addition, findings of this study suggest that MEDs in general and mobile apps, in particular, may have a positive impact on the work routine of health care professionals as they enable them to make quicker decisions by accessing the required information faster, thus improving practice efficiency. Furthermore, the appropriate usage of MEDs by patients for seeking information about their chronic conditions and medications may positively impact the physician-patient relationship. All focus groups recognized the questionable reliability of health information on the internet and its potential negative effects on patients. Therefore, our findings suggest the need for an additional role of health professionals in assisting patients in using MEDs to search for health and medication information, such as providing reliable websites and mobile apps where patients can safely search for health-related information on the web. Conclusions: The use of MEDs may help activate patients to seek chronic conditions and medication-related information, potentially leading to better management of their chronic conditions and medications. Our findings also highlight the positive impact MEDs may have on empowering health professionals in their practice and the need for health professionals to help patients through specific education that addresses MEDs utilization for chronic conditions and medication information seeking. UR - https://mhealth.jmir.org/2021/8/e26300 UR - http://dx.doi.org/10.2196/26300 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383686 ID - info:doi/10.2196/26300 ER - TY - JOUR AU - Schueller, M. Stephen AU - Neary, Martha AU - Lai, Jocelyn AU - Epstein, A. Daniel PY - 2021/8/11 TI - Understanding People?s Use of and Perspectives on Mood-Tracking Apps: Interview Study JO - JMIR Ment Health SP - e29368 VL - 8 IS - 8 KW - mental health KW - mobile apps KW - mHealth KW - emotions KW - affect KW - self-tracking N2 - Background: Supporting mental health and wellness is of increasing interest due to a growing recognition of the prevalence and burden of mental health issues. Mood is a central aspect of mental health, and several technologies, especially mobile apps, have helped people track and understand it. However, despite formative work on and dissemination of mood-tracking apps, it is not well understood how mood-tracking apps used in real-world contexts might benefit people and what people hope to gain from them. Objective: To address this gap, the purpose of this study was to understand motivations for and experiences in using mood-tracking apps from people who used them in real-world contexts. Methods: We interviewed 22 participants who had used mood-tracking apps using a semistructured interview and card sorting task. The interview focused on their experiences using a mood-tracking app. We then conducted a card sorting task using screenshots of various data entry and data review features from mood-tracking apps. We used thematic analysis to identify themes around why people use mood-tracking apps, what they found useful about them, and where people felt these apps fell short. Results: Users of mood-tracking apps were primarily motivated by negative life events or shifts in their own mental health that prompted them to engage in tracking and improve their situation. In general, participants felt that using a mood-tracking app facilitated self-awareness and helped them to look back on a previous emotion or mood experience to understand what was happening. Interestingly, some users reported less inclination to document their negative mood states and preferred to document their positive moods. There was a range of preferences for personalization and simplicity of tracking. Overall, users also liked features in which their previous tracked emotions and moods were visualized in figures or calendar form to understand trends. One gap in available mood-tracking apps was the lack of app-facilitated recommendations or suggestions for how to interpret their own data or improve their mood. Conclusions: Although people find various features of mood-tracking apps helpful, the way people use mood-tracking apps, such as avoiding entering negative moods, tracking infrequently, or wanting support to understand or change their moods, demonstrate opportunities for improvement. Understanding why and how people are using current technologies can provide insights to guide future designs and implementations. UR - https://mental.jmir.org/2021/8/e29368 UR - http://dx.doi.org/10.2196/29368 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383678 ID - info:doi/10.2196/29368 ER - TY - JOUR AU - Brunelli, Laura AU - De Vita, Chiara AU - Cenedese, Fabrizio AU - Cinello, Michela AU - Paris, Marta AU - Samogizio, Francesca AU - Starec, Anja AU - Bava, Michele AU - Dal Cin, Margherita AU - Zanchiello, Sara AU - Stampalija, Tamara PY - 2021/8/10 TI - Gaps and Future Challenges of Italian Apps for Pregnancy and Postnatal Care: Systematic Search on App Stores JO - J Med Internet Res SP - e29151 VL - 23 IS - 8 KW - pregnancy KW - postnatal care KW - app KW - mHealth KW - mobile health KW - newborn N2 - Background: Despite the availability of thousands of health apps worldwide, when considering those addressing children?s first 1000 days of life, most apps fail to consider the continuity between the prenatal and postnatal stages, and their joint impact on maternal and child health. The reliability, quality, and effectiveness of these apps are largely unknown, and the provided content seems questionable in terms of completeness, updating, and trustworthiness. Objective: This study evaluates available Italian pregnancy and postnatal care apps to highlight the main gaps to be overcome and the resulting future challenges to be met in this mobile health?related field. Methods: A systematic search was conducted on the Apple App Store and Google Play Store, and basic information was collected for all identified apps. After deduplication and further selection based on the exclusion criteria, an in-depth analysis of each app was performed by two researchers independently. A 71-item six-domain questionnaire about the desirable features of apps was used to assess information, functionalities, and technical features, while the Mobile Application Rating Scale (MARS) was employed for app quality evaluation. Results: From an initial sample of 684 apps, 22 were deeply analyzed. Most apps did not fulfill the expectations, as just one achieved 50% of all desirable aspects. Postnatal care and counselling for both the mother and child was the least accomplished domain. Moreover, the quality of app information was generally rated more negatively than the quality of their functionality and esthetic features. The lacking aspects were information about methods for postpartum family planning and birth spacing (1/22, 5%) and immunization (2/22, 9%). Conclusions: The identified gaps could serve as a basis for designing and implementing increasingly high-quality, targeted, and effective apps for pregnancy and postnatal health care, which provide comprehensive, reliable, and evidence-based information, as well as appropriate esthetic and functional characteristics, with relevant implications in terms of maternal and newborn health prevention and promotion. UR - https://www.jmir.org/2021/8/e29151 UR - http://dx.doi.org/10.2196/29151 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383668 ID - info:doi/10.2196/29151 ER - TY - JOUR AU - Nickels, Stefanie AU - Edwards, D. Matthew AU - Poole, F. Sarah AU - Winter, Dale AU - Gronsbell, Jessica AU - Rozenkrants, Bella AU - Miller, P. David AU - Fleck, Mathias AU - McLean, Alan AU - Peterson, Bret AU - Chen, Yuanwei AU - Hwang, Alan AU - Rust-Smith, David AU - Brant, Arthur AU - Campbell, Andrew AU - Chen, Chen AU - Walter, Collin AU - Arean, A. Patricia AU - Hsin, Honor AU - Myers, J. Lance AU - Marks Jr, J. William AU - Mega, L. Jessica AU - Schlosser, A. Danielle AU - Conrad, J. Andrew AU - Califf, M. Robert AU - Fromer, Menachem PY - 2021/8/10 TI - Toward a Mobile Platform for Real-world Digital Measurement of Depression: User-Centered Design, Data Quality, and Behavioral and Clinical Modeling JO - JMIR Ment Health SP - e27589 VL - 8 IS - 8 KW - mental health KW - mobile sensing KW - mobile phone KW - mHealth KW - depression KW - location KW - GPS KW - app usage KW - voice diaries KW - adherence KW - engagement KW - mobility KW - sleep KW - physical activity KW - digital phenotyping KW - user-centered design N2 - Background: Although effective mental health treatments exist, the ability to match individuals to optimal treatments is poor, and timely assessment of response is difficult. One reason for these challenges is the lack of objective measurement of psychiatric symptoms. Sensors and active tasks recorded by smartphones provide a low-burden, low-cost, and scalable way to capture real-world data from patients that could augment clinical decision-making and move the field of mental health closer to measurement-based care. Objective: This study tests the feasibility of a fully remote study on individuals with self-reported depression using an Android-based smartphone app to collect subjective and objective measures associated with depression severity. The goals of this pilot study are to develop an engaging user interface for high task adherence through user-centered design; test the quality of collected data from passive sensors; start building clinically relevant behavioral measures (features) from passive sensors and active inputs; and preliminarily explore connections between these features and depression severity. Methods: A total of 600 participants were asked to download the study app to join this fully remote, observational 12-week study. The app passively collected 20 sensor data streams (eg, ambient audio level, location, and inertial measurement units), and participants were asked to complete daily survey tasks, weekly voice diaries, and the clinically validated Patient Health Questionnaire (PHQ-9) self-survey. Pairwise correlations between derived behavioral features (eg, weekly minutes spent at home) and PHQ-9 were computed. Using these behavioral features, we also constructed an elastic net penalized multivariate logistic regression model predicting depressed versus nondepressed PHQ-9 scores (ie, dichotomized PHQ-9). Results: A total of 415 individuals logged into the app. Over the course of the 12-week study, these participants completed 83.35% (4151/4980) of the PHQ-9s. Applying data sufficiency rules for minimally necessary daily and weekly data resulted in 3779 participant-weeks of data across 384 participants. Using a subset of 34 behavioral features, we found that 11 features showed a significant (P<.001 Benjamini-Hochberg adjusted) Spearman correlation with weekly PHQ-9, including voice diary?derived word sentiment and ambient audio levels. Restricting the data to those cases in which all 34 behavioral features were present, we had available 1013 participant-weeks from 186 participants. The logistic regression model predicting depression status resulted in a 10-fold cross-validated mean area under the curve of 0.656 (SD 0.079). Conclusions: This study finds a strong proof of concept for the use of a smartphone-based assessment of depression outcomes. Behavioral features derived from passive sensors and active tasks show promising correlations with a validated clinical measure of depression (PHQ-9). Future work is needed to increase scale that may permit the construction of more complex (eg, nonlinear) predictive models and better handle data missingness. UR - https://mental.jmir.org/2021/8/e27589 UR - http://dx.doi.org/10.2196/27589 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383685 ID - info:doi/10.2196/27589 ER - TY - JOUR AU - Aný?, Ji?í AU - Bak?tein, Eduard AU - Dally, Andrea AU - Koleni?, Marián AU - Hlinka, Jaroslav AU - Hartmannová, Tereza AU - Urbanová, Kate?ina AU - Correll, U. Christoph AU - Novák, Daniel AU - ?paniel, Filip PY - 2021/8/9 TI - Validity of the Aktibipo Self-rating Questionnaire for the Digital Self-assessment of Mood and Relapse Detection in Patients With Bipolar Disorder: Instrument Validation Study JO - JMIR Ment Health SP - e26348 VL - 8 IS - 8 KW - bipolar disorder KW - symptom monitoring KW - ecological mood assessment KW - relapse detection KW - mobile application KW - mobile phone N2 - Background: Self-reported mood is a valuable clinical data source regarding disease state and course in patients with mood disorders. However, validated, quick, and scalable digital self-report measures that can also detect relapse are still not available for clinical care. Objective: In this study, we aim to validate the newly developed ASERT (Aktibipo Self-rating) questionnaire?a 10-item, mobile app?based, self-report mood questionnaire consisting of 4 depression, 4 mania, and 2 nonspecific symptom items, each with 5 possible answers. The validation data set is a subset of the ongoing observational longitudinal AKTIBIPO400 study for the long-term monitoring of mood and activity (via actigraphy) in patients with bipolar disorder (BD). Patients with confirmed BD are included and monitored with weekly ASERT questionnaires and monthly clinical scales (Montgomery-Åsberg Depression Rating Scale [MADRS] and Young Mania Rating Scale [YMRS]). Methods: The content validity of the ASERT questionnaire was assessed using principal component analysis, and the Cronbach ? was used to assess the internal consistency of each factor. The convergent validity of the depressive or manic items of the ASERT questionnaire with the MADRS and YMRS, respectively, was assessed using a linear mixed-effects model and linear correlation analyses. In addition, we investigated the capability of the ASERT questionnaire to distinguish relapse (YMRS?15 and MADRS?15) from a nonrelapse (interepisode) state (YMRS<15 and MADRS<15) using a logistic mixed-effects model. Results: A total of 99 patients with BD were included in this study (follow-up: mean 754 days, SD 266) and completed an average of 78.1% (SD 18.3%) of the requested ASERT assessments (completion time for the 10 ASERT questions: median 24.0 seconds) across all patients in this study. The ASERT depression items were highly associated with MADRS total scores (P<.001; bootstrap). Similarly, ASERT mania items were highly associated with YMRS total scores (P<.001; bootstrap). Furthermore, the logistic mixed-effects regression model for scale-based relapse detection showed high detection accuracy in a repeated holdout validation for both depression (accuracy=85%; sensitivity=69.9%; specificity=88.4%; area under the receiver operating characteristic curve=0.880) and mania (accuracy=87.5%; sensitivity=64.9%; specificity=89.9%; area under the receiver operating characteristic curve=0.844). Conclusions: The ASERT questionnaire is a quick and acceptable mood monitoring tool that is administered via a smartphone app. The questionnaire has a good capability to detect the worsening of clinical symptoms in a long-term monitoring scenario. UR - https://mental.jmir.org/2021/8/e26348 UR - http://dx.doi.org/10.2196/26348 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383689 ID - info:doi/10.2196/26348 ER - TY - JOUR AU - Hoevenaars, Dirk AU - Holla, M. Jasmijn F. AU - te Loo, Leonie AU - Koedijker, M. Johan AU - Dankers, Sarah AU - Houdijk, Han AU - Visser, Bart AU - Janssen, J. Thomas W. AU - de Groot, Sonja AU - Deutekom, Marije AU - PY - 2021/8/9 TI - Mobile App (WHEELS) to Promote a Healthy Lifestyle in Wheelchair Users With Spinal Cord Injury or Lower Limb Amputation: Usability and Feasibility Study JO - JMIR Form Res SP - e24909 VL - 5 IS - 8 KW - mHealth KW - mobile app KW - lifestyle KW - usability KW - feasibility KW - wheelchair users KW - spinal cord injury KW - lower limb amputation N2 - Background: Maintaining a healthy lifestyle is important for wheelchair users? well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population. Objective: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness. Methods: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g). Results: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57). Conclusions: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale. UR - https://formative.jmir.org/2021/8/e24909 UR - http://dx.doi.org/10.2196/24909 UR - http://www.ncbi.nlm.nih.gov/pubmed/34379056 ID - info:doi/10.2196/24909 ER - TY - JOUR AU - Rauschenberg, Christian AU - Boecking, Benjamin AU - Paetzold, Isabell AU - Schruers, Koen AU - Schick, Anita AU - van Amelsvoort, Thérèse AU - Reininghaus, Ulrich PY - 2021/8/5 TI - A Compassion-Focused Ecological Momentary Intervention for Enhancing Resilience in Help-Seeking Youth: Uncontrolled Pilot Study JO - JMIR Ment Health SP - e25650 VL - 8 IS - 8 KW - mental health KW - adolescent psychopathology KW - digital interventions KW - mobile health KW - self-compassion KW - ecological momentary assessment KW - mobile phone N2 - Background: Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals. Objective: This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass). Methods: In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session). Results: In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65). Conclusions: Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy. UR - https://mental.jmir.org/2021/8/e25650 UR - http://dx.doi.org/10.2196/25650 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383687 ID - info:doi/10.2196/25650 ER - TY - JOUR AU - Clark, Viktor AU - Kim, Jung Sunny PY - 2021/8/3 TI - Ecological Momentary Assessment and mHealth Interventions Among Men Who Have Sex With Men: Scoping Review JO - J Med Internet Res SP - e27751 VL - 23 IS - 8 KW - mHealth KW - men who have sex with men KW - mobile health KW - interventions KW - mental health KW - sexual health KW - ecological momentary assessment KW - behavior N2 - Background: Ecological momentary assessment (EMA) is a research design that allows for the measurement of nearly instantaneous experiences within the participant?s natural environment. Using EMA can help improve recall bias, ecological validity, and patient engagement while enhancing personalization and the ubiquity of interventions. People that can benefit from the use of EMA are men who have sex with men (MSM). Previous EMA studies have been successful in capturing patterns of depression, anxiety, substance use, and risky sexual behavior. These findings are directly relevant to MSM, who have high rates of each of these psychological and behavioral outcomes. Although there is a driving force behind the growing literature surrounding EMAs among MSM, no synthesizing reviews yet exist. Objective: The aims of this study were to (1) synthesize the literature across fields on how EMA methods have been used among MSM, (2) better understand the feasibility and acceptability of EMA interventions among MSM, and (3) inform designs for future research studies on best evidence-based practices for EMA interventions. Methods: Based on 4 library databases, we conducted a scoping review of EMAs used within interventions among MSM. The eligibility criteria included peer-reviewed studies conducted in the United States and the use of EMA methodology in an intervention for MSM. Modeling after the Centers for Disease Control and Prevention?s Compendium of Evidence-Based Interventions as the framework, we applied a typology that used 8 distinct review criteria, for example, sample size, design of the intervention, random assignment, design of the follow-up investigation, rate of retention, and rate of engagement. Results: Our results (k=15, N=952) indicated a range of sample sizes; the smallest sample size was 12, while the largest sample size was 120. Of the 15 studies, 7 (47%) focused on outcomes related to substance use or outcomes related to psychological experiences. Of the 15 studies, 5 (33%) implemented an EMA intervention across 30 days. Of the 15 studies, 2 studies (13%) used random assignment, and 2 studies (13%) had quasi-experimental designs. Of the 15 studies, 10 studies (67%) reported acceptable retention rates greater than 70%. The outcomes that had event-contingent prompts (ie, prompts after engaging in substance use) were not as effective in engaging participants, with overall engagement rates as low as 37%. Conclusions: Our systematic scoping review indicates strong evidence that the EMA methodology is both feasible and acceptable at high rates among MSM, especially, when examining psychological and behavioral outcomes such as negative or positive affect, risky sexual behavior, or substance use. Further research on optimal designs of EMA interventions for MSM is warranted. UR - https://www.jmir.org/2021/8/e27751 UR - http://dx.doi.org/10.2196/27751 UR - http://www.ncbi.nlm.nih.gov/pubmed/34342585 ID - info:doi/10.2196/27751 ER - TY - JOUR AU - Sparidaens, Marie Ellen AU - Hermens, M. Rosella P. AU - Braat, M. Didi D. AU - Nelen, M. Willianne L. D. AU - Fleischer, Kathrin PY - 2021/8/3 TI - Web-Based Guidance Through Assisted Reproductive Technology (myFertiCare): Patient-Centered App Development and Qualitative Evaluation JO - J Med Internet Res SP - e25389 VL - 23 IS - 8 KW - eHealth KW - infertility KW - interactive KW - mobile apps KW - patient education KW - patient-centered care KW - personalized KW - topic N2 - Background: Providing patient-centered fertility care is known to improve quality of life and can reduce anxiety and depression. In a previous study, we established the need for a web-based app providing personalized information and interactive functionalities among couples undergoing intracytoplasmic sperm injection with surgically retrieved sperm. Objective: This study aimed to design, develop, and qualitatively evaluate a multifaceted web-based app for infertile couples undergoing intracytoplasmic sperm injection with surgically retrieved sperm during their treatment trajectory. Methods: The web-based app was developed in three phases: (1) we established a patient-centered functional design, (2) developed the app in collaboration with medical and technical professionals, and (3) qualitatively evaluated the app among couples using a think-aloud method. Results: The basis of the app is the couple?s visualized treatment trajectory. The app provides personalized and interactive functionalities; for example, customized information and communication options. During qualitative evaluation, myFertiCare was highly appreciated and received a median score of 8 out of 10. The main improvements made upon conclusion of the think-aloud sessions were related to faster login and easier app navigation. Conclusions: A patient-centered web-based app aimed at guiding couples through their fertility treatment course was systematically designed, developed, and positively evaluated by patients and medical and technical professionals. UR - https://www.jmir.org/2021/8/e25389 UR - http://dx.doi.org/10.2196/25389 UR - http://www.ncbi.nlm.nih.gov/pubmed/34342591 ID - info:doi/10.2196/25389 ER - TY - JOUR AU - Cho, Ho Jae AU - Choi, Jung-Yeon AU - Kim, Nak-Hyun AU - Lim, Yejee AU - Ohn, Hun Jung AU - Kim, Sun Eun AU - Ryu, Jiwon AU - Kim, Jangsun AU - Kim, Yiseob AU - Kim, Sun-wook AU - Kim, Kwang-Il PY - 2021/7/30 TI - A Smart Diaper System Using Bluetooth and Smartphones to Automatically Detect Urination and Volume of Voiding: Prospective Observational Pilot Study in an Acute Care Hospital JO - J Med Internet Res SP - e29979 VL - 23 IS - 7 KW - smart diaper KW - urinary incontinence KW - enuresis KW - voided volume KW - diaper rash KW - smartphone KW - mobile phone KW - app KW - eHealth KW - mHealth KW - urine KW - medical device KW - sensor KW - prospective KW - pilot study KW - observational N2 - Background: Caregivers of patients who wear conventional diapers are required to check for voiding every hour because prolonged wearing of wet diapers causes health problems including diaper dermatitis and urinary tract infections. However, frequent checking is labor intensive and disturbs patients? and caregivers? sleep. Furthermore, assessing patients? urine output with diapers in an acute care setting is difficult. Recently, a smart diaper system with wetness detection technology was developed to solve these issues. Objective: We aimed to evaluate the applicability of the smart diaper system for urinary detection, its accuracy in measuring voiding volume, and its effect on incontinence-associated dermatitis (IAD) occurrence in an acute care hospital. Methods: This prospective, observational, single-arm pilot study was conducted at a single tertiary hospital. We recruited 35 participants aged ?50 years who were wearing diapers due to incontinence between August and November 2020. When the smart diaper becomes wet, the smart diaper system notifies the caregiver to change the diaper and measures voiding volume automatically. Caregivers were instructed to record the weight of wet diapers on frequency volume charts (FVCs). We determined the voiding detection rate of the smart diaper system and compared the urine volume as automatically calculated by the smart diaper system with the volume recorded on FVCs. Agreement between the two measurements was estimated using a Bland-Altman plot. We also checked for the occurrence or aggravation of IAD and bed sores. Results: A total of 30 participants completed the protocol and 390 episodes of urination were recorded. There were 108 records (27.7%) on both the FVCs and the smart diaper system, 258 (66.2%) on the FVCs alone, 18 (4.6%) on the smart diaper system alone, and 6 (1.5%) on the FVCs with sensing device lost. The detection rate of the smart diaper system was 32.8% (126/384). When analyzing records concurrently listed in both the FVCs and the smart diaper system, linear regression showed a strong correlation between the two measurements (R2=0.88, P<.001). The Bland-Altman assessment showed good agreement between the two measurements, with a mean difference of ?4.2 mL and 95% limits of agreement of ?96.7 mL and 88.3 mL. New occurrence and aggravation of IAD and bed sores were not observed. Bed sores improved in one participant. Conclusions: The smart diaper system showed acceptable accuracy for measuring urine volume and it could replace conventional FVCs in acute setting hospitals. Furthermore, the smart diaper system has the potential advantage of preventing IAD development and bed sore worsening. However, the detection rate of the smart diaper system was lower than expected. Detection rate polarization among participants was observed, and improvements in the user interface and convenience are needed for older individuals who are unfamiliar with the smart diaper system. UR - https://www.jmir.org/2021/7/e29979 UR - http://dx.doi.org/10.2196/29979 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328427 ID - info:doi/10.2196/29979 ER - TY - JOUR AU - Herrmann, Susan AU - Power, Brad AU - Rashidi, Amineh AU - Cypher, Mark AU - Mastaglia, Frank AU - Grace, Amy AU - McKinnon, Elizabeth AU - Sarrot, Pierre AU - Michau, Christophe AU - Skinner, Matthew AU - Desai, Renae AU - Duracinsky, Martin PY - 2021/7/30 TI - Supporting Patient-Clinician Interaction in Chronic HIV Care: Design and Development of a Patient-Reported Outcomes Software Application JO - J Med Internet Res SP - e27861 VL - 23 IS - 7 KW - physician-patient communication KW - eHealth KW - primary care KW - ambulatory care KW - information systems KW - user-centered design KW - user context KW - patient reported outcomes KW - qualitative research KW - health care KW - HIV care KW - mobile phone N2 - Background: The consideration of health-related quality of life (HRQL) is a hallmark of best practice in HIV care. Information technology offers an opportunity to more closely engage patients with chronic HIV infection in their long-term management and support a focus on HRQL. However, the implementation of patient-reported outcome (PRO) measures, such as HRQL in routine care, is challenged by the need to synthesize data generated by questionnaires, the complexity of collecting data between patient visits, and the integration of results into clinical decision-making processes. Objective: Our aim is to design and pilot-test a multimedia software platform to overcome these challenges and provide a vehicle to increase focus on HRQL issues in HIV management. Methods: A multidisciplinary team in France and Australia conducted the study with 120 patients and 16 doctors contributing to the design and development of the software. We used agile development principles, user-centered design, and qualitative research methods to develop and pilot the software platform. We developed a prototype application to determine the acceptability of the software and piloted the final version with 41 Australian and 19 French residents using 2 validated electronic questionnaires, the Depression, Anxiety and Stress Scale-21 Items, and the Patient Reported Outcomes Quality of Life-HIV. Results: Testing of the prototype demonstrated that patients wanted an application that was intuitive and without excessive instruction, so it felt effortless to use, as well as secure and discreet. Clinicians wanted the PRO data synthesized, presented clearly and succinctly, and clinically actionable. Safety concerns for patients and clinicians included confidentiality, and the potential for breakdown in communication if insufficient user training was not provided. The final product, piloted with patients from both countries, showed that most respondents found the application easy to use and comprehend. The usability testing survey administered found that older Australians had reduced scores for understanding the visual interface (P=.004) and finding the buttons organized (P=.02). Three-fourths of the respondents were concerned with confidentiality (P=.007), and this result was more prevalent in participants with higher anxiety and stress scores (P=.01), as measured by the Depression, Anxiety and Stress Scale-21 Items. These statistical associations were not observed in 15 French patients who completed the same questionnaire. Conclusions: Digital applications in health care should be safe and fit for purpose. Our software was acceptable to patients and shows potential to overcome some barriers to the implementation of PROs in routine care. The design of the clinicians? interface presents a solution to the problem of voluminous data, both synthesizing and providing a snapshot of longitudinal data. The next stage is to conduct a randomized controlled trial to determine whether patients experience increased satisfaction with care and whether doctors perceive that they deliver better clinical care without compromising efficiency. UR - https://www.jmir.org/2021/7/e27861 UR - http://dx.doi.org/10.2196/27861 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328442 ID - info:doi/10.2196/27861 ER - TY - JOUR AU - Martinengo, Laura AU - Stona, Anne-Claire AU - Griva, Konstadina AU - Dazzan, Paola AU - Pariante, Maria Carmine AU - von Wangenheim, Florian AU - Car, Josip PY - 2021/7/30 TI - Self-guided Cognitive Behavioral Therapy Apps for Depression: Systematic Assessment of Features, Functionality, and Congruence With Evidence JO - J Med Internet Res SP - e27619 VL - 23 IS - 7 KW - cognitive behavioral therapy KW - CBT KW - depression KW - mobile applications KW - apps KW - telemedicine KW - mHealth KW - self-guided CBT-based apps KW - self-management KW - mobile phone N2 - Background: Mental health disorders affect 1 in 10 people globally, of whom approximately 300 million are affected by depression. At least half of the people affected by depression remain untreated. Although cognitive behavioral therapy (CBT) is an effective treatment, access to mental health specialists, habitually challenging, has worsened because of the COVID-19 pandemic. Internet-based CBT is an effective and feasible strategy to increase access to treatment for people with depression. Mental health apps may further assist in facilitating self-management for people affected by depression; however, accessing the correct app may be cumbersome given the large number and wide variety of apps offered by public app marketplaces. Objective: This study aims to systematically assess the features, functionality, data security, and congruence with evidence of self-guided CBT-based apps targeting users affected by depression that are available in major app stores. Methods: We conducted a systematic assessment of self-guided CBT-based apps available in Google Play and the Apple App Store. Apps launched or updated since August 2018 were identified through a systematic search in the 42matters database using CBT-related terms. Apps meeting the inclusion criteria were downloaded and assessed using a Samsung Galaxy J7 Pro (Android 9) and iPhone 7 (iOS 13.3.1). Apps were appraised using a 182-question checklist developed by the research team, assessing their general characteristics, technical aspects and quality assurance, and CBT-related features, including 6 evidence-based CBT techniques (ie, psychoeducation, behavioral activation, cognitive restructuring, problem solving, relaxation, and exposure for comorbid anxiety) as informed by a CBT manual, CBT competence framework, and a literature review of internet-based CBT clinical trial protocols. The results were reported as a narrative review using descriptive statistics. Results: The initial search yielded 3006 apps, of which 98 met the inclusion criteria and were systematically assessed. There were 20 well-being apps; 65 mental health apps, targeting two or more common mental health disorders, including depression; and 13 depression apps. A total of 28 apps offered at least four evidence-based CBT techniques, particularly depression apps. Cognitive restructuring was the most common technique, offered by 79% (77/98) of the apps. Only one-third of the apps offered suicide risk management resources, whereas 17% (17/98) of the apps offered COVID-19?related information. Although most apps included a privacy policy, only a third of the apps presented it before account creation. In total, 82% (74/90) of privacy policies stated sharing data with third-party service providers. Half of the app development teams included academic institutions or health care providers. Conclusions: Only a few self-guided CBT-based apps offer comprehensive CBT programs or suicide risk management resources. Sharing of users? data is widespread, highlighting shortcomings in health app market governance. To fulfill their potential, self-guided CBT-based apps should follow evidence-based clinical guidelines, be patient centered, and enhance users? data security. UR - https://www.jmir.org/2021/7/e27619 UR - http://dx.doi.org/10.2196/27619 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328431 ID - info:doi/10.2196/27619 ER - TY - JOUR AU - Ruco, Arlinda AU - Dossa, Fahima AU - Tinmouth, Jill AU - Llovet, Diego AU - Jacobson, Jenna AU - Kishibe, Teruko AU - Baxter, Nancy PY - 2021/7/30 TI - Social Media and mHealth Technology for Cancer Screening: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e26759 VL - 23 IS - 7 KW - social media KW - mHealth KW - cancer screening KW - digital health KW - mass screening KW - mobile phone N2 - Background: Cancer is a leading cause of death, and although screening can reduce cancer morbidity and mortality, participation in screening remains suboptimal. Objective: This systematic review and meta-analysis aims to evaluate the effectiveness of social media and mobile health (mHealth) interventions for cancer screening. Methods: We searched for randomized controlled trials and quasi-experimental studies of social media and mHealth interventions promoting cancer screening (breast, cervical, colorectal, lung, and prostate cancers) in adults in MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, and Communication & Mass Media Complete from January 1, 2000, to July 17, 2020. Two independent reviewers screened the titles, abstracts, and full-text articles and completed the risk of bias assessments. We pooled odds ratios for screening participation using the Mantel-Haenszel method in a random-effects model. Results: We screened 18,008 records identifying 39 studies (35 mHealth and 4 social media). The types of interventions included peer support (n=1), education or awareness (n=6), reminders (n=13), or mixed (n=19). The overall pooled odds ratio was 1.49 (95% CI 1.31-1.70), with similar effect sizes across cancer types. Conclusions: Screening programs should consider mHealth interventions because of their promising role in promoting cancer screening participation. Given the limited number of studies identified, further research is needed for social media interventions. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019139615; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139615 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-035411 UR - https://www.jmir.org/2021/7/e26759 UR - http://dx.doi.org/10.2196/26759 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328423 ID - info:doi/10.2196/26759 ER - TY - JOUR AU - Zhang, Yuezhou AU - Folarin, A. Amos AU - Sun, Shaoxiong AU - Cummins, Nicholas AU - Ranjan, Yatharth AU - Rashid, Zulqarnain AU - Conde, Pauline AU - Stewart, Callum AU - Laiou, Petroula AU - Matcham, Faith AU - Oetzmann, Carolin AU - Lamers, Femke AU - Siddi, Sara AU - Simblett, Sara AU - Rintala, Aki AU - Mohr, C. David AU - Myin-Germeys, Inez AU - Wykes, Til AU - Haro, Maria Josep AU - Penninx, H. Brenda W. J. AU - Narayan, A. Vaibhav AU - Annas, Peter AU - Hotopf, Matthew AU - Dobson, B. Richard J. AU - PY - 2021/7/30 TI - Predicting Depressive Symptom Severity Through Individuals? Nearby Bluetooth Device Count Data Collected by Mobile Phones: Preliminary Longitudinal Study JO - JMIR Mhealth Uhealth SP - e29840 VL - 9 IS - 7 KW - mental health KW - depression KW - digital biomarkers KW - digital phenotyping KW - digital health KW - Bluetooth KW - hierarchical Bayesian model KW - mobile health KW - mHealth KW - monitoring N2 - Background: Research in mental health has found associations between depression and individuals? behaviors and statuses, such as social connections and interactions, working status, mobility, and social isolation and loneliness. These behaviors and statuses can be approximated by the nearby Bluetooth device count (NBDC) detected by Bluetooth sensors in mobile phones. Objective: This study aimed to explore the value of the NBDC data in predicting depressive symptom severity as measured via the 8-item Patient Health Questionnaire (PHQ-8). Methods: The data used in this paper included 2886 biweekly PHQ-8 records collected from 316 participants recruited from three study sites in the Netherlands, Spain, and the United Kingdom as part of the EU Remote Assessment of Disease and Relapse-Central Nervous System (RADAR-CNS) study. From the NBDC data 2 weeks prior to each PHQ-8 score, we extracted 49 Bluetooth features, including statistical features and nonlinear features for measuring the periodicity and regularity of individuals? life rhythms. Linear mixed-effect models were used to explore associations between Bluetooth features and the PHQ-8 score. We then applied hierarchical Bayesian linear regression models to predict the PHQ-8 score from the extracted Bluetooth features. Results: A number of significant associations were found between Bluetooth features and depressive symptom severity. Generally speaking, along with depressive symptom worsening, one or more of the following changes were found in the preceding 2 weeks of the NBDC data: (1) the amount decreased, (2) the variance decreased, (3) the periodicity (especially the circadian rhythm) decreased, and (4) the NBDC sequence became more irregular. Compared with commonly used machine learning models, the proposed hierarchical Bayesian linear regression model achieved the best prediction metrics (R2=0.526) and a root mean squared error (RMSE) of 3.891. Bluetooth features can explain an extra 18.8% of the variance in the PHQ-8 score relative to the baseline model without Bluetooth features (R2=0.338, RMSE=4.547). Conclusions: Our statistical results indicate that the NBDC data have the potential to reflect changes in individuals? behaviors and statuses concurrent with the changes in the depressive state. The prediction results demonstrate that the NBDC data have a significant value in predicting depressive symptom severity. These findings may have utility for the mental health monitoring practice in real-world settings. UR - https://mhealth.jmir.org/2021/7/e29840 UR - http://dx.doi.org/10.2196/29840 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328441 ID - info:doi/10.2196/29840 ER - TY - JOUR AU - Park, Jihwan AU - Han, Jinhyun AU - Kim, Yerin AU - Rho, Jung Mi PY - 2021/7/30 TI - Development, Acceptance, and Concerns Surrounding App-Based Services to Overcome the COVID-19 Outbreak in South Korea: Web-Based Survey Study JO - JMIR Med Inform SP - e29315 VL - 9 IS - 7 KW - COVID-19 KW - app-based services KW - acceptance KW - concerns KW - epidemiological investigation, self-route management app, privacy N2 - Background: Since the COVID-19 outbreak, South Korea has been engaged in various efforts to overcome the pandemic. One of them is to provide app-based COVID-19?related services to the public. As the pandemic continues, a need for various apps has emerged, including COVID-19 apps that can support activities aimed at overcoming the COVID-19 pandemic. Objective: We aimed to determine which apps were considered the most necessary according to users and evaluate the current status of the development of COVID-19?related apps in South Korea. We also aimed to determine users? acceptance and concerns related to using apps to support activities to combat COVID-19. Methods: We collected data from 1148 users from a web-based survey conducted between November 11 and December 6, 2020. Basic statistical analysis, multiple response analysis, and the Wilcoxon rank sum test were performed using R software. We then manually classified the current status of the development of COVID-19?related apps. Results: In total, 68.4% (785/1148) of the respondents showed high willingness to protect themselves from COVID-19 by using related apps. Users considered the epidemiological investigation app to be the most necessary app (709/1148, 61.8%) overall, followed by the self-management app for self-isolation (613/1148, 53.4%), self-route management app (605/1148, 52.7%), COVID-19 symptom management app (483/1148, 42.1%), COVID-19?related information provision app (339/1148, 29.5%), and mental health management app (270/1148, 23.5%). Despite the high intention to use these apps, users were also concerned about privacy issues and media exposure. Those who had an underlying disease and had experience using COVID-19?related apps showed significantly higher intentions to use those apps (P=.05 and P=.01, respectively). Conclusions: Targeting users is very important in order to design and develop the most necessary apps. Furthermore, to gain the public?s trust and make the apps available to as many people as possible, it is vital to develop diverse apps in which privacy protection is maximized. UR - https://medinform.jmir.org/2021/7/e29315 UR - http://dx.doi.org/10.2196/29315 UR - http://www.ncbi.nlm.nih.gov/pubmed/34137726 ID - info:doi/10.2196/29315 ER - TY - JOUR AU - Bischoff, Luise Laura AU - Baumann, Hannes AU - Meixner, Charlotte AU - Nixon, Patricia AU - Wollesen, Bettina PY - 2021/7/30 TI - App-Tailoring Requirements to Increase Stress Management Competencies Within Families: Cross-sectional Survey Study JO - J Med Internet Res SP - e26376 VL - 23 IS - 7 KW - mhealth KW - ehealth KW - mobile applications KW - stress management KW - app features KW - gamification KW - family KW - personality traits N2 - Background: Families experiencing high levels of psychological distress are considered a particularly vulnerable population for adverse effects on mental and physical health. Moreover, highly stressed individuals engage less in mental health promoting activities and show low stress management competencies. App-based stress interventions seem promising for the treatment and prevention of stress outcomes and might be a low-threshold solution. Objective: The aim of this study was to identify the requirements for a tailored app to reduce stress in a cohort of highly stressed families that have low stress management skills. Methods: Parents (n=1008; age: mean 47.7 years, SD 6.1; female: 599/1008, 59.7%) completed an extensive web-based survey and were subdivided into a target (stressed individuals with low stress competency) and nontarget group according to their reported stress level and stress management competencies. Group differences were analyzed using analysis of variance. In principal component analysis with Kaiser varimax rotation, personally defined stress management goals were grouped into components. Linear regression models were also calculated. Results: A 3-factor solution cumulatively explained 56% of the variance in personally defined goals of interest for stress management with (1) active strategies (25.61% explained variance), (2) general competency (17.95% explained variance) and (3) passive strategies (12.45% explained variance). The groups differed in age (F1,978=27.67, P<.001), health index (F1,958=246.14, P<.001), personally defined general-competency goal (F1,958=94.16 P<.001), as well as ?information acquisition? (F1,971=14.75, P<.001) and ?need for stimulation? (F1,981=54.49, P<.001) personality traits. A regression model showed that for the active strategies goals of interest, only app feature information or instructional videos had a significant effect (P=.02). The general competency factor showed none, and the passive strategies factor showed significant effects for 2 app features?suggestions for planning possible activities with the family (P=.01) and diaries for documentation and development of strategies (P=.03). Conclusions: The results of this survey study highlight the need to develop an app to increase stress management competencies that takes into consideration perceived stress level, stress management skills, personality, and personally defined goals of the user. The content of the app should be tailored to previously detected personality traits, especially selective information acquisition and low need for stimulation. Furthermore, personally defined stress management goals seem to affect interest in some features. UR - https://www.jmir.org/2021/7/e26376 UR - http://dx.doi.org/10.2196/26376 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328439 ID - info:doi/10.2196/26376 ER - TY - JOUR AU - Nuijten, Yannic Raoul Ceasar AU - Van Gorp, Pieter AU - Borghouts, Tom AU - Le Blanc, Pascale AU - Van den Berg, Pauline AU - Kemperman, Astrid AU - Hadian, Ehsan AU - Simons, Monique PY - 2021/7/29 TI - Preadolescent Students? Engagement With an mHealth Intervention Fostering Social Comparison for Health Behavior Change: Crossover Experimental Study JO - J Med Internet Res SP - e21202 VL - 23 IS - 7 KW - mHealth KW - health promotion KW - social comparison KW - competitiveness KW - collaboration KW - gamification KW - preadolescents KW - high school students N2 - Background: Contemporary mobile health (mHealth) interventions use various behavior change techniques to promote healthier lifestyles. Social comparison is one of the techniques that is consensually agreed to be effective in engaging the general population in mHealth interventions. However, it is unclear how this strategy can be best used to engage preadolescents. Nevertheless, this strategy has great potential for this target audience, as they are particularly developing their social skills. Objective: This study aims to evaluate how social comparison drives preadolescents? engagement with an mHealth app. Methods: We designed a 12-week crossover experiment in which we studied 3 approaches to implementing behavior change via social comparison. This study was hosted in a school environment to leverage naturally existing social structures among preadolescents. During the experiment, students and teachers used an mHealth tool that awarded points for performing healthy activities. Participants could read their aggregated scores on a leaderboard and compare their performance with others. In particular, these leaderboards were tweaked to implement 3 approaches of the social comparison technique. The first approach focused on intragroup comparison (ie, students and teachers competing against each other to obtain the most points), whereas the other two approaches focused on intergroup comparison (ie, classes of students and their mentoring teachers collaborating to compete against other classes). Additionally, in the third approach, the performance of teachers was highlighted to further increase students? engagement through teachers? natural exemplary function. To obtain our results, we used linear modeling techniques to analyze the dropout rates and engagement levels for the different approaches. In such analyses, we also considered individual participant traits. Results: Our sample included 313 participants?290 students (92.7%) and 23 teachers (7.3%). It was found that student engagement levels dropped over time and declined during holidays. However, students seemed to monitor the intergroup competitions more closely than the intragroup competitions, as they, on average, checked the mHealth app more often when they were engaged in team-based comparisons. Students, on average, performed the most unique activities when they were engaged in the second intergroup setting, perhaps because their teachers were most active in this setting. Moreover, teachers seemed to play an important role in engaging their students, as their relationship with their students influenced the engagement of the students. Conclusions: When using social comparison to engage preadolescents with an mHealth tool, an intergroup setting, rather than an intragroup competition, motivated them to engage with the app but did not necessarily motivate them to perform more activities. It seems that the number of unique activities that preadolescents perform depends on the activeness of a role model. Moreover, this effect is amplified by preadolescents? perceptions of closeness to that role model. UR - https://www.jmir.org/2021/7/e21202 UR - http://dx.doi.org/10.2196/21202 UR - http://www.ncbi.nlm.nih.gov/pubmed/34326041 ID - info:doi/10.2196/21202 ER - TY - JOUR AU - Ingvaldsen, Hegna Sigrid AU - Tronvik, Erling AU - Brenner, Eiliv AU - Winnberg, Ingunn AU - Olsen, Alexander AU - Gravdahl, Bruvik Gøril AU - Stubberud, Anker PY - 2021/7/28 TI - A Biofeedback App for Migraine: Development and Usability Study JO - JMIR Form Res SP - e23229 VL - 5 IS - 7 KW - mHealth KW - headache KW - wearables KW - smartphone N2 - Background: Biofeedback is effective in treating migraines. It is believed to have a beneficial effect on autonomous nervous system activity and render individuals resilient to stressors that may trigger a migraine. However, widespread use of biofeedback is hampered by the need for a trained therapist and specialized equipment. Emerging digital health technology, including smartphones and wearables (mHealth), enables new ways of administering biofeedback. Currently, mHealth interventions for migraine appear feasible, but development processes and usability testing remain insufficient. Objective: The objective of this study was to evaluate and improve the feasibility and usability of an mHealth biofeedback treatment app for adults with migraine. Methods: In a prospective development and usability study, 18 adults with migraine completed a 4-week testing period of self-administered therapist-independent biofeedback treatment consisting of a smartphone app connected to wearable sensors (Cerebri, Nordic Brain Tech AS). The app included biofeedback training, instructions for self-delivery, and a headache diary. Two wearable sensors were used to measure surface electromyographic voltage at the trapezius muscle and peripheral skin temperature and heart rate at the right second fingertip. Participants were instructed to complete a daily headache diary entry and biofeedback session of 10 minutes duration. The testing period was preceded by a preusability expectation interview and succeeded by a postusability experience interview. In addition, an evaluation questionnaire was completed at weeks 2 and 4. Adherence was calculated as the proportion of 10-minute sessions completed within the first 28 days of treatment. Usability and feasibility were analyzed and summarized quantitatively and qualitatively. Results: A total of 391 biofeedback sessions were completed with a median of 25 (IQR 17-28) per participant. The mean adherence rate was 0.76 (SD 0.26). The evaluation questionnaire revealed that functionality and design had the highest scores, whereas engagement and biofeedback were lower. Qualitative preexpectation analysis revealed that participants expected to become better familiar with physical signals and gain more understanding of their migraine attacks and noted that the app should be simple and understandable. Postusability analysis indicated that participants had an overall positive user experience with some suggestions for improvement regarding the design of the wearables and app content. The intervention was safe and tolerable. One case of prespecified adverse events was recorded in which a patient developed a skin rash from the sticky surface electromyography electrodes. Conclusions: The app underwent a rigorous development process that indicated an overall positive user experience, good usability, and high adherence rate. This study highlights the value of usability testing in the development of mHealth apps. UR - https://formative.jmir.org/2021/7/e23229 UR - http://dx.doi.org/10.2196/23229 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319243 ID - info:doi/10.2196/23229 ER - TY - JOUR AU - Lopez-Morinigo, Javier-David AU - Barrigón, Luisa María AU - Porras-Segovia, Alejandro AU - Ruiz-Ruano, González Verónica AU - Escribano Martínez, Sánchez Adela AU - Escobedo-Aedo, Jhoana Paula AU - Sánchez Alonso, Sergio AU - Mata Iturralde, Laura AU - Muñoz Lorenzo, Laura AU - Artés-Rodríguez, Antonio AU - David, S. Anthony AU - Baca-García, Enrique PY - 2021/7/26 TI - Use of Ecological Momentary Assessment Through a Passive Smartphone-Based App (eB2) by Patients With Schizophrenia: Acceptability Study JO - J Med Internet Res SP - e26548 VL - 23 IS - 7 KW - ecological momentary assessment KW - acceptability KW - schizophrenia spectrum disorders KW - eB2 KW - digital tools KW - mental health KW - schizophrenia KW - real-time data KW - patients KW - digital health KW - internet KW - mobile apps N2 - Background: Ecological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients? behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability. Objective: The aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance. Methods: The participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on ?being user versus nonuser? (acceptability), which was the main outcome measure. Results: Out of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=.048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=.01) survived the multivariable regression model, thus predicting eB2 acceptability. Conclusions: Acceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment. Trial Registration: ClinicalTrials.gov NCT04104347; https://clinicaltrials.gov/ct2/show/NCT04104347 UR - https://www.jmir.org/2021/7/e26548 UR - http://dx.doi.org/10.2196/26548 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309576 ID - info:doi/10.2196/26548 ER - TY - JOUR AU - van der Kamp, Mattienne AU - Reimering Hartgerink, Pamela AU - Driessen, Jean AU - Thio, Bernard AU - Hermens, Hermie AU - Tabak, Monique PY - 2021/7/26 TI - Feasibility, Efficacy, and Efficiency of eHealth-Supported Pediatric Asthma Care: Six-Month Quasi-Experimental Single-Arm Pretest-Posttest Study JO - JMIR Form Res SP - e24634 VL - 5 IS - 7 KW - telemedicine KW - feasibility studies KW - child KW - self-management KW - asthma KW - patient acceptance of health care KW - ambulatory care KW - remote sensing technology KW - cost-benefit analysis KW - health care costs N2 - Background: Early detection of loss of asthma control can effectively reduce the burden of the disease. However, broad implementation in clinical practice has not been accomplished so far. We are in need of research investigating the operationalization of eHealth pediatric asthma care in practice, which can provide the most potential benefits in terms of adoption, efficiency, and effectiveness. Objective: The aim of this study was to investigate the technical and clinical feasibility, including an exploration of the efficacy and cost-efficiency, of an eHealth program implemented in daily clinical pediatric asthma practice. Methods: We designed an eHealth-supported pediatric asthma program facilitating early detection of loss of asthma control while increasing symptom awareness and self-management. In the 6-month program, asthma control was monitored by 4 health care professionals (HCPs) by using objective home measurements and the web-based Puffer app to allow timely medical anticipation and prevent treatment delay. Technical feasibility was assessed by technology use, system usability, and technology acceptance. Clinical feasibility was assessed by participation and patient-reported health and care outcomes and via a focus group with HCPs regarding their experiences of implementing eHealth in daily practice. The efficacy and cost-efficiency were explored by comparing pretest-posttest program differences in asthma outcomes (asthma control, lung function, and therapy adherence) and medical consumption. Results: Of 41 children, 35 children with moderate-to-severe asthma volunteered for participation. With regard to technical feasibility, the Puffer app scored a good usability score of 78 on the System Usability Scale and a score of 70 for technology acceptance on a scale of 1 to 100. Approximately 75% (18/24) of the children indicated that eHealth helped them to control their asthma during the program. HCPs indicated that home measurements and real time communication enabled them to make safe and substantiated medical decisions during symptom manifestations. With an average time commitment of 15 minutes by patients, eHealth care led to a 80% gross reduction (from ?71,784 to ?14,018, US $1=?0.85) in health care utilization, 8.6% increase (from 18.6 to 20.2, P=.40) in asthma control, 25.0% increase (from 2.8 to 3.5, P=.04) in the self-management level, and 20.4% improved (from 71.2 to 76.8, P=.02) therapy adherence. Conclusions: eHealth asthma care seems to be technically and clinically feasible, enables safe remote care, and seems to be beneficial for pediatric asthma care in terms of health outcomes and health care utilization. Follow-up research should focus on targeted effectiveness studies with the lessons learned, while also enabling individualization of eHealth for personalized health care. UR - https://formative.jmir.org/2021/7/e24634 UR - http://dx.doi.org/10.2196/24634 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309568 ID - info:doi/10.2196/24634 ER - TY - JOUR AU - Domin, Alex AU - Spruijt-Metz, Donna AU - Theisen, Daniel AU - Ouzzahra, Yacine AU - Vögele, Claus PY - 2021/7/21 TI - Smartphone-Based Interventions for Physical Activity Promotion: Scoping Review of the Evidence Over the Last 10 Years JO - JMIR Mhealth Uhealth SP - e24308 VL - 9 IS - 7 KW - scoping review KW - smartphone application KW - physical activity KW - behavior change KW - mobile health KW - research design KW - mHealth KW - adolescents KW - adults KW - BCT KW - mobile phonescoping review KW - mobile phone N2 - Background: Several reviews of mobile health (mHealth) physical activity (PA) interventions suggest their beneficial effects on behavior change in adolescents and adults. Owing to the ubiquitous presence of smartphones, their use in mHealth PA interventions seems obvious; nevertheless, there are gaps in the literature on the evaluation reporting processes and best practices of such interventions. Objective: The primary objective of this review is to analyze the development and evaluation trajectory of smartphone-based mHealth PA interventions and to review systematic theory- and evidence-based practices and methods that are implemented along this trajectory. The secondary objective is to identify the range of evidence (both quantitative and qualitative) available on smartphone-based mHealth PA interventions to provide a comprehensive tabular and narrative review of the available literature in terms of its nature, features, and volume. Methods: We conducted a scoping review of qualitative and quantitative studies examining smartphone-based PA interventions published between 2008 and 2018. In line with scoping review guidelines, studies were not rejected based on their research design or quality. This review, therefore, includes experimental and descriptive studies, as well as reviews addressing smartphone-based mHealth interventions aimed at promoting PA in all age groups (with a subanalysis conducted for adolescents). Two groups of studies were additionally included: reviews or content analyses of PA trackers and meta-analyses exploring behavior change techniques and their efficacy. Results: Included articles (N=148) were categorized into 10 groups: commercial smartphone app content analyses, smartphone-based intervention review studies, activity tracker content analyses, activity tracker review studies, meta-analyses of PA intervention studies, smartphone-based intervention studies, qualitative formative studies, app development descriptive studies, qualitative follow-up studies, and other related articles. Only 24 articles targeted children or adolescents (age range: 5-19 years). There is no agreed evaluation framework or taxonomy to code or report smartphone-based PA interventions. Researchers did not state the coding method, used various evaluation frameworks, or used different versions of behavior change technique taxonomies. In addition, there is no consensus on the best behavior change theory or model that should be used in smartphone-based interventions for PA promotion. Commonly reported systematic practices and methods have been successfully identified. They include PA recommendations, trial designs (randomized controlled trials, experimental trials, and rapid design trials), mixed methods data collection (surveys, questionnaires, interviews, and focus group discussions), scales to assess app quality, and industry-recognized reporting guidelines. Conclusions: Smartphone-based mHealth interventions aimed at promoting PA showed promising results for behavior change. Although there is a plethora of published studies on the adult target group, the number of studies and consequently the evidence base for adolescents is limited. Overall, the efficacy of smartphone-based mHealth PA interventions can be considerably improved through a more systematic approach of developing, reporting, and coding of the interventions. UR - https://mhealth.jmir.org/2021/7/e24308 UR - http://dx.doi.org/10.2196/24308 UR - http://www.ncbi.nlm.nih.gov/pubmed/34287209 ID - info:doi/10.2196/24308 ER - TY - JOUR AU - Grau-Corral, Inmaculada AU - Pantoja, Efrain Percy AU - Grajales III, J. Francisco AU - Kostov, Belchin AU - Aragunde, Valentín AU - Puig-Soler, Marta AU - Roca, Daria AU - Couto, Elvira AU - Sisó-Almirall, Antoni PY - 2021/7/21 TI - Assessing Apps for Health Care Workers Using the ISYScore-Pro Scale: Development and Validation Study JO - JMIR Mhealth Uhealth SP - e17660 VL - 9 IS - 7 KW - assessment KW - mobile app KW - mobile application KW - mHealth KW - health care professionals KW - mobile application rating scale KW - scale development N2 - Background: The presence of mobile phone and smart devices has allowed for the use of mobile apps to support patient care. However, there is a paucity in our knowledge regarding recommendations for mobile apps specific to health care professionals. Objective: The aim of this study is to establish a validated instrument to assess mobile apps for health care providers and health systems. Our objective is to create and validate a tool that evaluates mobile health apps aimed at health care professionals based on a trust, utility, and interest scale. Methods: A five-step methodology framework guided our approach. The first step consisted of building a scale to evaluate apps for health care professionals based on a literature review. This was followed with expert panel validation through a Delphi method of (rated) web-based questionnaires to empirically evaluate the inclusion and weight of the indicators identified through the literature review. Repeated iterations were followed until a consensus greater than 75% was reached. The scale was then tested using a pilot to assess reliability. Interrater agreement of the pilot was measured using a weighted Cohen kappa. Results: Using a literature review, a first draft of the scale was developed. This was followed with two Delphi rounds between the local research group and an external panel of experts. After consensus was reached, the resulting ISYScore-Pro 17-item scale was tested. A total of 280 apps were originally identified for potential testing (140 iOS apps and 140 Android apps). These were categorized using International Statistical Classification of Diseases, Tenth Revision. Once duplicates were removed and they were downloaded to confirm their specificity to the target audience (ie, health care professionals), 66 remained. Of these, only 18 met the final criteria for inclusion in validating the ISYScore-Pro scale (interrator reliabilty 92.2%; kappa 0.840, 95% CI 0.834-0.847; P<.001). Conclusions: We have developed a reproducible methodology to objectively evaluate mobile health apps targeted to health care professionals and providers, the ISYScore-Pro scale. Future research will be needed to adapt the scale to other languages and across other domains (eg, legal compliance or security). UR - https://mhealth.jmir.org/2021/7/e17660 UR - http://dx.doi.org/10.2196/17660 UR - http://www.ncbi.nlm.nih.gov/pubmed/34287216 ID - info:doi/10.2196/17660 ER - TY - JOUR AU - Alinia, Parastoo AU - Sah, Kumar Ramesh AU - McDonell, Michael AU - Pendry, Patricia AU - Parent, Sara AU - Ghasemzadeh, Hassan AU - Cleveland, John Michael PY - 2021/7/21 TI - Associations Between Physiological Signals Captured Using Wearable Sensors and Self-reported Outcomes Among Adults in Alcohol Use Disorder Recovery: Development and Usability Study JO - JMIR Form Res SP - e27891 VL - 5 IS - 7 KW - alcohol relapse prevention KW - stress markers KW - alcohol consumption KW - electrodermal activity KW - heart rate variability KW - emotion KW - mobile phone N2 - Background: Previous research has highlighted the role of stress in substance misuse and addiction, particularly for relapse risk. Mobile health interventions that incorporate real-time monitoring of physiological markers of stress offer promise for delivering tailored interventions to individuals during high-risk states of heightened stress to prevent alcohol relapse. Before such interventions can be developed, measurements of these processes in ambulatory, real-world settings are needed. Objective: This research is a proof-of-concept study to establish the feasibility of using a wearable sensor device to continuously monitor stress in an ambulatory setting. Toward that end, we first aimed to examine the quality of 2 continuously monitored physiological signals?electrodermal activity (EDA) and heart rate variability (HRV)?and show that the data follow standard quality measures according to the literature. Next, we examined the associations between the statistical features extracted from the EDA and HRV signals and self-reported outcomes. Methods: Participants (N=11; female: n=10) were asked to wear an Empatica E4 wearable sensor for continuous unobtrusive physiological signal collection for up to 14 days. During the same time frame, participants responded to a daily diary study using ecological momentary assessment of self-reported stress, emotions, alcohol-related cravings, pain, and discomfort via a web-based survey, which was conducted 4 times daily. Participants also participated in structured interviews throughout the study to assess daily alcohol use and to validate self-reported and physiological stress markers. In the analysis, we first used existing artifact detection methods and physiological signal processing approaches to assess the quality of the physiological data. Next, we examined the descriptive statistics for self-reported outcomes. Finally, we investigated the associations between the features of physiological signals and self-reported outcomes. Results: We determined that 87.86% (1,032,265/1,174,898) of the EDA signals were clean. A comparison of the frequency of skin conductance responses per minute with previous research confirmed that the physiological signals collected in the ambulatory setting were successful. The results also indicated that the statistical features of the EDA and HRV measures were significantly correlated with the self-reported outcomes, including the number of stressful events marked on the sensor device, positive and negative emotions, and experienced pain and discomfort. Conclusions: The results demonstrated that the physiological data collected via an Empatica E4 wearable sensor device were consistent with previous literature in terms of the quality of the data and that features of these physiological signals were significantly associated with several self-reported outcomes among a sample of adults diagnosed with alcohol use disorder. These results suggest that ambulatory assessment of stress is feasible and can be used to develop tailored mobile health interventions to enhance sustained recovery from alcohol use disorder. UR - https://formative.jmir.org/2021/7/e27891 UR - http://dx.doi.org/10.2196/27891 UR - http://www.ncbi.nlm.nih.gov/pubmed/34287205 ID - info:doi/10.2196/27891 ER - TY - JOUR AU - Alshehri, Fayz AU - Alshaikh, Fahdah PY - 2021/7/20 TI - Exploring the Constituent Elements of a Successful Mobile Health Intervention for Prediabetic Patients in King Saud University Medical City Hospitals in Saudi Arabia: Cross-sectional Study JO - JMIR Form Res SP - e22968 VL - 5 IS - 7 KW - prediabetes KW - mHealth KW - CeHRes roadmap KW - Saudi Arabia N2 - Background: Self-management of prediabetic patients is crucial since they are at high risk of developing type 2 diabetes. Mobile health (mHealth) apps could contribute to potentially reducing the burden of diabetes by supporting the self-management of prediabetic patients. Objective: This study aimed to explore the constituent elements of a successful mHealth intervention for prediabetic patients in King Saud University Medical City (KSUMC) hospitals in Saudi Arabia using the Centre for eHealth Research (CeHRes) roadmap. Methods: This study used the CeHRes roadmap as a developmental guideline for proposing mHealth app features for self-management of prediabetic patients and was performed in 3 phases with one round in each phase. First, a contextual inquiry was conducted via an online self-administered questionnaire for both health care providers and patients. Second, the value specification phase elaborated on the outcomes from the contextual inquiry phase. Finally, prototype user design was performed in cocreation with end users. The design phase was also conducted via an online self-administered questionnaire to evaluate the proposed features of mHealth apps by prediabetic patients. Results: A total of 20 health care providers participated in the study. The results revealed that the most powerful intervention for prediabetes was a combination of medication, physical activity, and healthy diet plans (12/20, 60%). Furthermore, the most common challenge faced by prediabetes patients was patient adherence to healthy diet and physical activity recommendations (10/20, 50%). Almost all patients believed that mHealth apps would be useful for prediabetic patients. A total of 48 prediabetic patients participated in the study. The results indicated that the most powerful intervention for prediabetic patients is a combination of healthy diet and physical activity plans (21/48, 44%), and the most frequent challenge that may lead the patients to discontinue the current intervention was the commitment to a physical activity plan (35/48, 75%). Furthermore, 15% (17/48) of patients use well-being and health apps to manage their current health status. The most common difficulties faced by the patients were navigating app features (mean 2.02 [SD 1.7]) followed by the app language (mean 1.88 [SD 2.0]); these difficulties occurred at a significantly higher rate among those with secondary or lower educational levels as compared to undergraduate and postgraduate levels (P<.05). Finally, the features proposed in the prototype design scored more than 2.5 points higher and indicate the need for these features to be included in the mHealth app. Conclusions: This study aimed to provide real-world insights into the development of an mHealth app for a diabetes prevention intervention by involving both health care providers and prediabetic patients in KSUMC hospitals. Therefore, the proposed app, which comprises all necessary features, may aid patients with prediabetes in self-management and making changes in their lifestyle. UR - https://formative.jmir.org/2021/7/e22968 UR - http://dx.doi.org/10.2196/22968 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061762 ID - info:doi/10.2196/22968 ER - TY - JOUR AU - Beres, K. Laura AU - Mbabali, Ismail AU - Anok, Aggrey AU - Katabalwa, Charles AU - Mulamba, Jeremiah AU - Thomas, G. Alvin AU - Bugos, Eva AU - Nakigozi, Gertrude AU - Grabowski, K. Mary AU - Chang, W. Larry PY - 2021/7/20 TI - Mobile Ecological Momentary Assessment and Intervention and Health Behavior Change Among Adults in Rakai, Uganda: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e22693 VL - 5 IS - 7 KW - ecological momentary assessment KW - ecological momentary intervention KW - mHealth KW - digital health KW - smartphone KW - mobile phone KW - randomized trial KW - Uganda KW - Africa N2 - Background: An extraordinary increase in mobile phone ownership has revolutionized the opportunities to use mobile health approaches in lower- and middle-income countries (LMICs). Ecological momentary assessment and intervention (EMAI) uses mobile technology to gather data and deliver timely, personalized behavior change interventions in an individual?s natural setting. To our knowledge, there have been no previous trials of EMAI in sub-Saharan Africa. Objective: To advance the evidence base for mobile health (mHealth) interventions in LMICs, we conduct a pilot randomized trial to assess the feasibility of EMAI and establish estimates of the potential effect of EMAI on a range of health-related behaviors in Rakai, Uganda. Methods: This prospective, parallel-group, randomized pilot trial compared health behaviors between adult participants submitting ecological momentary assessment (EMA) data and receiving behaviorally responsive interventional health messaging (EMAI) with those submitting EMA data alone. Using a fully automated mobile phone app, participants submitted daily reports on 5 different health behaviors (fruit consumption, vegetable consumption, alcohol intake, cigarette smoking, and condomless sex with a non?long-term partner) during a 30-day period before randomization (P1). Participants were then block randomized to the control arm, continuing EMA reporting through exit, or the intervention arm, EMA reporting and behavioral health messaging receipt. Participants exited after 90 days of follow-up, divided into study periods 2 (P2: randomization + 29 days) and 3 (P3: 30 days postrandomization to exit). We used descriptive statistics to assess the feasibility of EMAI through the completeness of data and differences in reported behaviors between periods and study arms. Results: The study included 48 participants (24 per arm; 23/48, 48% women; median age 31 years). EMA data collection was feasible, with 85.5% (3777/4418) of the combined days reporting behavioral data. There was a decrease in the mean proportion of days when alcohol was consumed in both arms over time (control: P1, 9.6% of days to P2, 4.3% of days; intervention: P1, 7.2% of days to P3, 2.4% of days). Decreases in sex with a non?long-term partner without a condom were also reported in both arms (P1 to P3 control: 1.9% of days to 1% of days; intervention: 6.6% of days to 1.3% of days). An increase in vegetable consumption was found in the intervention (vegetable: 65.6% of days to 76.6% of days) but not in the control arm. Between arms, there was a significant difference in the change in reported vegetable consumption between P1 and P3 (control: 8% decrease in the mean proportion of days vegetables consumed; intervention: 11.1% increase; P=.01). Conclusions: Preliminary estimates suggest that EMAI may be a promising strategy for promoting behavior change across a range of behaviors. Larger trials examining the effectiveness of EMAI in LMICs are warranted. Trial Registration: ClinicalTrials.gov NCT04375423; https://www.clinicaltrials.gov/ct2/show/NCT04375423 UR - https://formative.jmir.org/2021/7/e22693 UR - http://dx.doi.org/10.2196/22693 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283027 ID - info:doi/10.2196/22693 ER - TY - JOUR AU - Tu, Yu-Zhen AU - Chang, Ya-Ting AU - Chiou, Hung-Yi AU - Lai, Ken PY - 2021/7/15 TI - The Effects of Continuous Usage of a Diabetes Management App on Glycemic Control in Real-world Clinical Practice: Retrospective Analysis JO - J Med Internet Res SP - e23227 VL - 23 IS - 7 KW - app KW - diabetes care KW - diabetes KW - digital intervention KW - digital therapeutics KW - glycemic control KW - mobile app KW - mHealth KW - real-world data KW - therapy N2 - Background: The efficacy of digital technology in improving diabetes management has typically been demonstrated through studies such as randomized controlled trials, which have reported a steeper reduction in hemoglobin A1c (HbA1c) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited. Objective: This study aimed to evaluate the effectiveness of digital interventions by tracking HbA1c improvements over 1 year in real-world clinical settings. Methods: Patients used the Health2Sync mobile app to track self-measured outcomes and communicate with health care professionals (HCPs). HCPs used the web-based Patient Management Platform to monitor patient data, view test results from clinical laboratories, and communicate with patients. Patients who have been onboarded for at least 13 months and have consecutive HbA1c findings for 5 quarters were included in the analysis. They were then stratified into 3 groups (high, mid, and low retention) based on their level of use of Health2Sync in the first 6 months of onboarding. A mixed model was built to compare the slopes of the rate of reduction in HbA1c among the groups. In addition, these patients? retention on the app from the seventh to the 12th month was verified through multiple comparisons. Results: A sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA1c percentage reductions as the passed quarter count increased (t=?9.869; P<.001), and that effectiveness increased in the high (t=?5.173) and mid retention (t=?6.620) groups as the interaction effects were significantly negative compared to that in the low retention group (P<.001) in the passed quarter count. The low retention group also had the highest average HbA1c value at the end of 13 months (high: 7.01%, SD 1.02%; mid: 6.99%, SD 1.00%; low: 7.17%, SD 1.14%) (Bonferroni correction: high vs low, P=.07; mid vs low, P=.02; high vs mid, P>.99). The level of use of the app remained consistent in the seventh to the 12th month after onboarding (high: 5.23 [SD 1.37] months, mid: 2.43 [SD 1.68] months, low: 0.41 [SD 0.97] months) (P<.001). Conclusions: Our analysis shows that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice. Further studies are required to reveal the efficacy for specific diabetes types and to observe effects beyond 1 year. UR - https://www.jmir.org/2021/7/e23227 UR - http://dx.doi.org/10.2196/23227 UR - http://www.ncbi.nlm.nih.gov/pubmed/34264192 ID - info:doi/10.2196/23227 ER - TY - JOUR AU - Shelby, Tyler AU - Zhou, Xin AU - Barber, Douglas AU - Altice, Frederick PY - 2021/7/14 TI - Acceptability of an mHealth App That Provides Harm Reduction Services Among People Who Inject Drugs: Survey Study JO - J Med Internet Res SP - e25428 VL - 23 IS - 7 KW - people who inject drugs KW - mHealth KW - patient preferences KW - syringe services programs KW - service access KW - mobile phone N2 - Background: Harm reduction services reduce the negative consequences of drug injection and are often embedded within syringe service programs (SSPs). However, people who inject drugs (PWID) suboptimally engage with such services because of stigma, fear, transportation restrictions, and limited hours of operation. Mobile health (mHealth) apps may provide an opportunity to overcome these barriers and extend the reach of SSPs beyond that of the traditional brick-and-mortar models. Objective: This study aims to assess the prevalence of smartphone ownership, the level of comfort in providing the personal information required to use mHealth apps, and interest in using an mHealth app to access harm reduction services among PWID to guide the development of an app. Methods: We administered a survey to 115 PWID who were enrolled via respondent-driven sampling from July 2018 to July 2019. We examined the extent to which PWID had access to smartphones; were comfortable in providing personal information such as name, email, and address; and expressed interest in various app-based services. We measured participant characteristics (demographics, health status, and behaviors) and used binary logistic and Poisson regressions to identify independent correlates of mHealth-related variables. The primary regression outcomes included summary scores for access, comfort, and interest. The secondary outcomes included binary survey responses for individual comfort or interest components. Results: Most participants were White (74/105, 70.5%), male (78/115, 67.8%), and middle-aged (mean=41.7 years), and 67.9% (74/109) owned a smartphone. Participants reported high levels of comfort in providing personal information to use an mHealth app, including name (96/109, 88.1%), phone number (92/109, 84.4%), email (85/109, 77.9%), physical address (85/109, 77.9%), and linkage to medical records (72/109, 66.1%). Participants also reported strong interest in app-based services, including medication or sterile syringe delivery (100/110, 90.9%), lab or appointment scheduling (90/110, 81.8%), medication reminders (77/110, 70%), educational material (65/110, 59.1%), and group communication forums (64/110, 58.2%). Most participants were comfortable with the idea of home delivery of syringes (93/109, 85.3%). Homeless participants had lower access to smartphones (adjusted odds ratio [AOR] 0.15, 95% CI 0.05-0.46; P=.001), but no other participant characteristics were associated with primary outcomes. Among secondary outcomes, recent SSP use was positively associated with comfort with the home delivery of syringes (AOR 3.29, 95% CI 1.04-10.3 P=.04), and being older than 50 years was associated with an increased interest in educational materials (AOR 4.64, 95% CI 1.31-16.5; P=.02) and group communication forums (AOR 3.69, 95% CI 1.10-12.4; P=.04). Conclusions: Our findings suggest that aside from those experiencing homelessness or unstable housing, PWID broadly have access to smartphones, are comfortable with sharing personal information, and express interest in a wide array of services within an app. Given the suboptimal access to and use of SSPs among PWID, an mHealth app has a high potential to address the harm reduction needs of this vulnerable population. UR - https://www.jmir.org/2021/7/e25428 UR - http://dx.doi.org/10.2196/25428 UR - http://www.ncbi.nlm.nih.gov/pubmed/34259640 ID - info:doi/10.2196/25428 ER - TY - JOUR AU - Resnick, Daniel AU - Schapira, M. Marilyn AU - Smith, M. Jazmine AU - Bautista, Allison AU - Xu, Chang AU - Jones, Liz AU - Aysola, Jaya PY - 2021/7/14 TI - Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients Through mHealth: Mixed Methods Evaluation of a New App JO - JMIR Form Res SP - e22510 VL - 5 IS - 7 KW - mHealth KW - cancer prevention KW - goal setting KW - social networks KW - health disparities KW - mobile phone N2 - Background: Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. However, primary care providers rarely discuss cancer prevention behaviors with their patients. Objective: This study aims to assess the usability, acceptability, and user engagement of the Healthier Together mobile app, which is designed to promote cancer prevention behaviors among non-Hispanic Black primary care patients, by using social networks and goal-setting theories of behavior change. Methods: In an 8-week pilot study, we enrolled primary care patients (N=41) and provided them with a cancer prevention mobile app that allowed them to select, track, and share progress on cancer prevention goals with other users. App usability was assessed using the System Usability Scale. We assessed the app?s acceptability by qualitatively analyzing open-ended responses regarding participants? overall experience with the app. We assessed participants? engagement by analyzing the built-in data capture device, which included the number of times participants checked in (out of a maximum of 8) during the study. Results: The mean age of the 41 participants was 51 years (SD 12), and 76% (31/41) were women. App use data were captured from all participants, and 83% (34/41) completed the exit survey and interview. The mean System Usability Scale score was 87 (SD 12; median 90; IQR 78-95). The analysis of open-ended responses revealed several key themes, and participants complemented the app?s ease of use and health behavior?promoting features while also commenting on the need for more feedback and social interactions through the app. On average, participants checked in 5.7 times (SD 2.7) out of 8 possible opportunities. Of the 41 participants, 76% (31/41) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goals (mean 5.1, SD 2.7) for each week. The qualitative analysis of comments given by participants within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants created exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during this study. Conclusions: The implementation of a mobile cancer prevention goal?setting app in a primary care setting was feasible, and the app achieved high usability, acceptability, and engagement among participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the Healthier Together app in facilitating behavioral change to reduce cancer risk among non-Hispanic Black primary care patients. UR - https://formative.jmir.org/2021/7/e22510 UR - http://dx.doi.org/10.2196/22510 UR - http://www.ncbi.nlm.nih.gov/pubmed/34259162 ID - info:doi/10.2196/22510 ER - TY - JOUR AU - Song, Ting AU - Deng, Ning AU - Cui, Tingru AU - Qian, Siyu AU - Liu, Fang AU - Guan, Yingping AU - Yu, Ping PY - 2021/7/13 TI - Measuring Success of Patients? Continuous Use of Mobile Health Services for Self-management of Chronic Conditions: Model Development and Validation JO - J Med Internet Res SP - e26670 VL - 23 IS - 7 KW - mobile health KW - service KW - smartphone KW - mobile application KW - continuous use KW - high blood pressure KW - chronic disease KW - PLS N2 - Background: Mobile health services are gradually being introduced to support patients? self-management of chronic conditions. The success of these services is contingent upon patients? continuous use of them. Objective: This study aims to develop a model to measure the success of patients? continuous use of mobile health services for the self-management of chronic conditions. Methods: The proposed model was derived from the information systems continuance model and the information systems success model. This model contains 7 theoretical constructs: information quality, system quality, service quality, perceived usefulness, user satisfaction, perceived health status, and continuous use intention. A web-based questionnaire survey instrument was developed to test the model. The survey was conducted to collect data from 129 patients who used a mobile health app for hypertension management from 2017 to 2019. The questionnaire items were derived from validated instruments and were measured using a 5-point Likert scale. The partial least squares modelling method was used to test the theoretical model. Results: The model accounted for 58.5% of the variance in perceived usefulness (R2=0.585), 52.3% of the variance in user satisfaction (R2=0.523), and 41.4% of the variance in patients? intention to make continuous use of mobile health services (R2=0.414). The continuous use intention was significantly influenced by their perceived health status (?=.195, P=.03), perceived usefulness (?=.307, P=.004), and user satisfaction (?=.254, P=.04) with the mobile health service. Information quality (?=.235, P=.005), system quality (?=.192, P=.02), and service quality (?=.494, P<.001) had a significantly positive influence on perceived usefulness but not on user satisfaction. Perceived usefulness had a significantly positive influence on user satisfaction (?=.664, P<.001). In a result opposite to the original hypothesis, perceived health status did not negatively influence patients? intention to continue using the mobile health service but showed a significantly positive correlation. Conclusions: This study developed a theoretical model to predict and explain patients? continuous use of mobile health services for self-management of chronic conditions and empirically tested the model. Perceived usefulness, user satisfaction, and health status contributed to patients? intention to make continuous use of mobile health services for self-managing their chronic conditions. UR - https://www.jmir.org/2021/7/e26670 UR - http://dx.doi.org/10.2196/26670 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255685 ID - info:doi/10.2196/26670 ER - TY - JOUR AU - Biebl, Theresia Johanna AU - Rykala, Marzena AU - Strobel, Maximilian AU - Kaur Bollinger, Pawandeep AU - Ulm, Bernhard AU - Kraft, Eduard AU - Huber, Stephan AU - Lorenz, Andreas PY - 2021/7/13 TI - App-Based Feedback for Rehabilitation Exercise Correction in Patients With Knee or Hip Osteoarthritis: Prospective Cohort Study JO - J Med Internet Res SP - e26658 VL - 23 IS - 7 KW - mHealth KW - digital health KW - digital rehabilitation KW - machine learning KW - smartphone KW - osteoarthritis KW - exercise therapy N2 - Background: The use of digital therapeutic solutions for rehabilitation of conditions such as osteoarthritis provides scalable access to rehabilitation. Few validated technological solutions exist to ensure supervision of users while they exercise at home. Motion Coach (Kaia Health GmbH) provides audiovisual feedback on exercise execution in real time on conventional smartphones. Objective: We hypothesized that the interrater agreement between physiotherapists and Motion Coach would be noninferior to physiotherapists? interrater agreement for exercise evaluations in a cohort with osteoarthritis. Methods: Patients diagnosed with osteoarthritis of the knee or hip were recruited at a university hospital to perform a set of 6 exercises. Agreement between Motion Coach and 2 physiotherapists? corrections for segments of the exercises were compared using Cohen ? and percent agreement. Results: Participants (n=24) were enrolled and evaluated. There were no significant differences between interrater agreements (Motion Coach app vs physiotherapists: percent agreement 0.828; physiotherapist 1 vs physiotherapist 2: percent agreement 0.833; P<.001). Age (70 years or under, older than 70 years), gender (male, female), or BMI (30 kg/m2 or under, greater than 30 kg/m2) subgroup analysis revealed no detectable difference in interrater agreement. There was no detectable difference in levels of interrater agreement between Motion Coach vs physiotherapists and between physiotherapists in any of the 6 exercises. Conclusions: The results demonstrated that Motion Coach is noninferior to physiotherapist evaluations. Interrater agreement did not differ between 2 physiotherapists or between physiotherapists and the Motion Coach app. This finding was valid for all investigated exercises and subgroups. These results confirm the ability of Motion Coach to detect user form during exercise and provide valid feedback to users with musculoskeletal disorders. UR - https://www.jmir.org/2021/7/e26658 UR - http://dx.doi.org/10.2196/26658 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255677 ID - info:doi/10.2196/26658 ER - TY - JOUR AU - Haug, Severin AU - Paz Castro, Raquel AU - Wenger, Andreas AU - Schaub, Patrick Michael PY - 2021/7/13 TI - A Mobile Phone?Based Life-Skills Training Program for Substance Use Prevention Among Adolescents: Cluster-Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e26951 VL - 9 IS - 7 KW - life skills KW - substance use KW - prevention KW - adolescents KW - mobile phone N2 - Background: Life skills are abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life. Life-skills training programs conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones may provide a more economic and scalable approach. Objective: The goal of this study was to test the appropriateness (ie, acceptance, use, and evaluation) and short-term efficacy of a mobile phone?based life-skills training program to prevent substance use among adolescents within a controlled trial. Methods: The study design was a two-arm, parallel-group, cluster-randomized controlled trial with assessments at baseline and follow-up assessments after 6 and 18 months. This report includes outcomes measured up to the 6-month follow-up. The efficacy of the intervention was tested in comparison to an assessment-only control group. The automated intervention program SmartCoach included online feedback and individually tailored text messages provided over 22 weeks. The contents were based on social cognitive theory and addressed self-management skills, social skills, and substance use resistance skills. Linear mixed models and generalized linear mixed models, as well as logistic or linear regressions, were used to investigate changes between baseline and 6-month follow-up in the following outcomes: 30-day prevalence rates of problem drinking, tobacco use, and cannabis use as well as quantity of alcohol use, quantity of cigarettes smoked, cannabis use days, perceived stress, well-being, and social skills. Results: A total of 1759 students from 89 Swiss secondary and upper secondary school classes were invited to participate in the study. Of these, 1473 (83.7%) students participated in the study; the mean age was 15.4 years (SD 1.0) and 55.2% (813/1473) were female. Follow-up assessments at 6 months were completed by 1233 (83.7%) study participants. On average, program participants responded to half (23.6 out of 50) of the prompted activities. Program evaluations underlined its appropriateness for the target group of secondary school students, with the majority rating the program as helpful and individually tailored. The results concerning the initial effectiveness of this program based on 6-month follow-up data are promising, with three of nine outcomes of the intention-to-treat analyses showing beneficial developments of statistical significance (ie, quantity of alcohol use, quantity of tobacco use, and perceived stress; P<.05) and another three outcomes (ie, problem drinking prevalence, cannabis use days, and social skills) showing beneficial developments of borderline significance (P<.10). Conclusions: The results showed good acceptance of this intervention program that could be easily and economically implemented in school classes. Initial results on program efficacy indicate that it might be effective in both preventing or reducing substance use and fostering life skills; however, data from the final 18-month follow-up assessments will be more conclusive. Trial Registration: ISRCTN Registry ISRCTN41347061; https://doi.org/10.1186/ISRCTN41347061 UR - https://mhealth.jmir.org/2021/7/e26951 UR - http://dx.doi.org/10.2196/26951 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255703 ID - info:doi/10.2196/26951 ER - TY - JOUR AU - Karakoyun, Toeresin AU - Podhaisky, Hans-Peter AU - Frenz, Ann-Kathrin AU - Schuhmann-Giampieri, Gabriele AU - Ushikusa, Thais AU - Schröder, Daniel AU - Zvolanek, Michal AU - Lopes Da Silva Filho, Agnaldo PY - 2021/7/13 TI - Digital Medical Device Companion (MyIUS) for New Users of Intrauterine Systems: App Development Study JO - JMIR Med Inform SP - e24633 VL - 9 IS - 7 KW - medical device KW - levonorgestrel-releasing intrauterine system KW - mobile medical app KW - mobile phone N2 - Background: Women choosing a levonorgestrel-releasing intrauterine system may experience changes in their menstrual bleeding pattern during the first months following placement. Objective: Although health care professionals (HCPs) can provide counseling, no method of providing individualized information on the expected bleeding pattern or continued support is currently available for women experiencing postplacement bleeding changes. We aim to develop a mobile phone?based medical app (MyIUS) to meet this need and provide a digital companion to women after the placement of the intrauterine system. Methods: The MyIUS app is classified as a medical device and uses an artificial intelligence?based bleeding pattern prediction algorithm to estimate a woman?s future bleeding pattern in terms of intensity and regularity. We developed the app with the help of a multidisciplinary team by using a robust and high-quality design process in the context of a constantly evolving regulatory landscape. The development framework consisted of a phased approach including ideation, feasibility and concept finalization, product development, and product deployment or localization stages. Results: The MyIUS app was considered useful by HCPs and easy to use by women who were consulted during the development process. Following the launch of the sustainable app in selected pilot countries, performance metrics will be gathered to facilitate further technical and feature updates and enhancements. A real-world performance study will also be conducted to allow us to upgrade the app in accordance with the new European Commission Medical Device legislation and to validate the bleeding pattern prediction algorithm in a real-world setting. Conclusions: By providing a meaningful estimation of bleeding patterns and allowing an individualized approach to counseling and discussions about contraceptive method choice, the MyIUS app offers a useful tool that may benefit both women and HCPs. Further work is needed to validate the performance of the prediction algorithm and MyIUS app in a real-world setting. UR - https://medinform.jmir.org/2021/7/e24633 UR - http://dx.doi.org/10.2196/24633 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255688 ID - info:doi/10.2196/24633 ER - TY - JOUR AU - Bruhns, Alina AU - Lüdtke, Thies AU - Moritz, Steffen AU - Bücker, Lara PY - 2021/7/12 TI - A Mobile-Based Intervention to Increase Self-esteem in Students With Depressive Symptoms: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e26498 VL - 9 IS - 7 KW - mHealth KW - depression KW - depressive symptoms KW - students? mental health KW - self-help smartphone app KW - mobile phone KW - self-esteem N2 - Background: Depressive symptoms are one of the most common and ever-increasing mental health problems among students worldwide. Conventional treatment options, particularly psychotherapy, do not reach all students in need of help. Internet- and mobile-based interventions are promising alternatives for narrowing the treatment gap. Objective: In the framework of a randomized controlled trial, we aim to investigate the effectiveness, acceptance, and side effects of a self-help smartphone app (MCT & More) based on cognitive behavioral therapy, mindfulness, acceptance and commitment therapy, and metacognitive training in a sample of students with self-reported depressive symptoms. Furthermore, we were interested in examining the influence of treatment expectations and attitudes toward internet- and mobile-based interventions on treatment adherence and effectiveness. Methods: A total of 400 students were recruited via open access websites and randomized to either the intervention group (n=200), who received access to the self-help smartphone app MCT & More for a period of 4 weeks, or to a wait-list control group (n=200). The Patient Health Questionnaire-9 (depression) served as the primary outcome parameter, and the Rosenberg Self-esteem Scale (self-esteem) and the global item of the World Health Organization Quality of Life-abbreviated version (quality of life) served as the secondary outcome parameters. The Attitudes Towards Psychological Online Interventions was used to measure attitudes toward internet- and mobile-based interventions. Outcome expectations were assessed using the Patient Questionnaire on Therapy Expectation and Evaluation, and side effects were assessed using the Inventory for Assessing Negative Effects of Psychotherapy. Results: Per-protocol (PP), complete-case, and intention-to-treat analyses showed a significantly higher reduction in depressive symptoms (PP: F1,222=3.98; P=.047; d=0.26) and a significantly higher increase in self-esteem (PP: F1,220=8.79; P=.003; d=0.40) in the intervention group than in the wait-list control group. Most participants regularly used the self-help smartphone app (91/120, 75.8%, at least once a week). The more positive the attitude toward internet- and mobile-based interventions (r=0.260; P=.004) and the more positive the outcome expectation (r=0.236; P=.009), the more frequently the self-help smartphone app was used. Conclusions: The effectiveness of the self-help smartphone app MCT & More was demonstrated among students with depressive symptoms compared with a wait-list control group. The app could be offered regularly as a low-threshold intervention to enhance students? health. Trial Registration: German Clinical Trials Register DRKS00020941; https://tinyurl.com/pr84w6er UR - https://mhealth.jmir.org/2021/7/e26498 UR - http://dx.doi.org/10.2196/26498 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255711 ID - info:doi/10.2196/26498 ER - TY - JOUR AU - Cui, Fangfang AU - He, Xianying AU - Zhai, Yunkai AU - Lyu, Minzhao AU - Shi, Jinming AU - Sun, Dongxu AU - Jiang, Shuai AU - Li, Chenchen AU - Zhao, Jie PY - 2021/7/12 TI - Application of Telemedicine Services Based on a Regional Telemedicine Platform in China From 2014 to 2020: Longitudinal Trend Analysis JO - J Med Internet Res SP - e28009 VL - 23 IS - 7 KW - telemedicine KW - regional telemedicine service platform KW - remote consultation KW - efficiency KW - satisfaction degree KW - telehealth KW - mobile health KW - mHealth KW - remote KW - China N2 - Background: Telemedicine that combines information technology and health care augments the operational model of traditional medical services and brings new opportunities to the medical field. China promotes telemedicine with great efforts, and its practices in the deployment of telemedicine platforms and delivery of services have become important references for the research and development in this field. Objective: Our work described in this paper focuses on a regional telemedicine platform that was built in 2014. We analyzed the system design scheme and remote consultations that were conducted via the system to understand the deployment and service delivery processes of a representative telemedicine platform in China. Methods: We collected information on remote consultations conducted from 2015 to 2020 via the regional telemedicine platform that employs a centralized architectural system model. We used graphs and statistical methods to describe the changing trends of service volume of remote consultation, geographical and demographic distribution of patients, and waiting time and duration of consultations. The factors that affect consultation duration and patient referral were analyzed by multivariable linear regression models and binary logistic regression models, respectively. The attitudes toward telemedicine of 225 medical practitioners and 225 patients were collected using the snowball sampling method. Results: The regional telemedicine platform covers all levels of medical institutions and hospitals in all 18 cities of Henan Province as well as some interprovince hospitals. From 2015 to 2020, 103,957 remote medical consultations were conducted via the platform with an annual increasing rate of 0.64%. A total of 86.64% (90,069/103,957) of medical institutions (as clients) that applied for remote consultations were tier 1 or 2 and from less-developed regions; 65.65% (68,243/103,945) of patients who applied for remote consultations were aged over 50 years. The numbers of consultations were high for departments focusing in the treatment of chronic diseases such as neurology, respiratory medicine, and oncology. The invited experts were mainly experienced doctors with senior professional titles. Year of consultation, tier of hospital, consultation department, and necessity of patient referral were the main factors affecting the duration of consultations. In surveys, we found that 60.4% (136/225) of medical practitioners and 53.8% (121/225) of patients had high satisfaction and believed that telemedicine is of vital importance for the treatment of illness. Conclusions: The development of telemedicine in China shows a growing trend and provides great benefits especially to medical institutions located in less developed regions and senior citizens who have less mobility. Cases of remote consultations are mainly for chronic diseases. At present, the importance and necessity of telemedicine are well recognized by both patients and medical practitioners. However, the waiting time needs to be further reduced to improve the efficiency of remote medical services. UR - https://www.jmir.org/2021/7/e28009 UR - http://dx.doi.org/10.2196/28009 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255686 ID - info:doi/10.2196/28009 ER - TY - JOUR AU - Ang, Han Ian Yi AU - Tan, Quan Kyle Xin AU - Tan, Clive AU - Tan, Hoon Chiew AU - Kwek, Ming James Wei AU - Tay, Joanne AU - Toh, Anne Sue PY - 2021/7/9 TI - A Personalized Mobile Health Program for Type 2 Diabetes During the COVID-19 Pandemic: Single-Group Pre?Post Study JO - JMIR Diabetes SP - e25820 VL - 6 IS - 3 KW - type 2 diabetes KW - prediabetic state KW - text messaging KW - mobile applications KW - glycated hemoglobin A KW - HbA1c KW - blood glucose KW - body mass index KW - mHealth KW - COVID-19 KW - diabetes KW - intervention KW - self-management KW - chronic disease KW - outcome N2 - Background: With increasing type 2 diabetes prevalence, there is a need for effective programs that support diabetes management and improve type 2 diabetes outcomes. Mobile health (mHealth) interventions have shown promising results. With advances in wearable sensors and improved integration, mHealth programs could become more accessible and personalized. Objective: The study aimed to evaluate the feasibility, acceptability, and effectiveness of a personalized mHealth-anchored intervention program in improving glycemic control and enhancing care experience in diabetes management. The program was coincidentally implemented during the national-level lockdown for COVID-19 in Singapore, allowing for a timely study of the use of mHealth for chronic disease management. Methods: Patients with type 2 diabetes or prediabetes were enrolled from the Singapore Armed Forces and offered a 3-month intervention program in addition to the usual care they received. The program was standardized to include (1) in-person initial consultation with a clinical dietitian; (2) in-person review with a diabetes specialist doctor; (3) 1 continuous glucose monitoring device; (4) access to the mobile app for dietary intake and physical activity tracking, and communication via messaging with the dietitian and doctor; and (5) context-sensitive digital health coaching over the mobile app. Medical support was rendered to the patients on an as-needed basis when they required advice on adjustment of medications. Measurements of weight, height, and glycated hemoglobin A1c (HbA1c) were conducted at 2 in-person visits at the start and end of the program. At the end of the program, patients were asked to complete a short acceptability feedback survey to understand the motivation for joining the program, their satisfaction, and suggestions for improvement. Results: Over a 4-week recruitment period, 130 individuals were screened, the enrollment target of 30 patients was met, and 21 patients completed the program and were included in the final analyses; 9 patients were lost to follow-up (full data were not available for the final analyses). There were no differences in the baseline characteristics between patients who were included and excluded from the final analyses (age category: P=.23; gender: P=.21; ethnicity: P>.99; diabetes status category: P=.52, medication adjustment category: P=.65; HbA1c category: P=.69; BMI: P>.99). The 21 patients who completed the study rated a mean of 9.0 out of 10 on the Likert scale for both satisfaction questions. For the Yes-No question on benefit of the program, all of the patients selected ?Yes.? Mean HbA1c decreased from 7.6% to 7.0% (P=.004). There were no severe hypoglycemia events (glucose level <3.0 mmol/L) reported. Mean weight decreased from 76.8 kg to 73.9 kg (P<.001), a mean decrease of 3.5% from baseline weight. Mean BMI decreased from 27.8 kg/m2 to 26.7 kg/m2 (P<.001). Conclusions: The personalized mHealth program was feasible, acceptable, and produced significant reductions in HbA1c (P=.004) and body weight (P<.001) in individuals with type 2 diabetes. Such mHealth programs could overcome challenges posed to chronic disease management by COVID-19, including disruptions to in-person health care access. UR - https://diabetes.jmir.org/2021/3/e25820 UR - http://dx.doi.org/10.2196/25820 UR - http://www.ncbi.nlm.nih.gov/pubmed/34111018 ID - info:doi/10.2196/25820 ER - TY - JOUR AU - Mushquash, R. Aislin AU - Pearson, S. Erin AU - Waddington, Kayla AU - MacIsaac, Angela AU - Mohammed, Shakira AU - Grassia, Elizabeth AU - Smith, Savanah AU - Wekerle, Christine PY - 2021/7/8 TI - User Perspectives on a Resilience-Building App (JoyPop): Qualitative Study JO - JMIR Mhealth Uhealth SP - e28677 VL - 9 IS - 7 KW - resilience KW - smartphone KW - app KW - innovation KW - qualitative KW - perspective KW - mHealth KW - emotion KW - mental health N2 - Background: Resilience is the capability, resources, and processes that are available to a person or system to adapt successfully in the face of stress or adversity. Given that resilience can be enhanced, using advances in technology to deliver and evaluate the impact of resilience interventions is warranted. Evidence supports the effectiveness of the resilience-building JoyPop app in improving resilience-related outcomes after use; however, experiential data from users is also needed to provide a more comprehensive account of its utility. Objective: The aim of this study was to explore users? experiences with the JoyPop app and their perspectives on its utility. Methods: This qualitative description study involved a combination of group and one-on-one semistructured interviews with a subset of first-year undergraduate students who participated in a larger evaluation of the JoyPop app. Participants used the app for a 4-week period and were subsequently asked about their frequency of app use, most and least used features (and associated reasons), most and least helpful features (and associated reasons), barriers to use, facilitators of use and continuation, and recommendations for improvement. Data were coded and categorized through inductive content analysis. Results: The sample of 30 participants included 24 females and 6 males, with a mean age of 18.77 years (SD 2.30). App use ranged from 1 to 5 times daily (mean 2.11, SD 0.74), with the majority indicating that they used the app at least twice daily. The Rate My Mood, Journal, and SquareMoves features were reported to be used most often, while the Rate My Mood, Journal, and Breathing Exercises features were identified as the most helpful. A number of themes and subthemes pertaining to facilitators of app use (prompts, creating routine, self-monitoring opportunities, expressive opportunities), barriers to app use (editing, lack of variety, student lifestyle), outcomes of app use (increased awareness, checking in with oneself, helpful distraction, emotional control), and recommendations for app improvement (adding more features, enhancing existing features, enhancing tracking abilities, providing personalization) were identified. Conclusions: This study provides insight into the aspects of the JoyPop app that motivated and benefitted users, as well as measures that can be taken to improve user experiences and promote longer-term uptake. Users were willing to engage with the app and incorporate it into their routine, and they valued the ability to self-monitor, express emotion, and engage in distraction. UR - https://mhealth.jmir.org/2021/7/e28677 UR - http://dx.doi.org/10.2196/28677 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255696 ID - info:doi/10.2196/28677 ER - TY - JOUR AU - Killian, Daniel AU - Gibson, Emma AU - Kachule, Mphatso AU - Palamountain, Kara AU - Bangoh, Bitilinyu Joseph AU - Deo, Sarang AU - Jonasson, Oddur Jonas PY - 2021/7/6 TI - An Unstructured Supplementary Service Data System for Daily Tracking of Patient Samples and Diagnostic Results in a Diagnostic Network in Malawi: System Development and Field Trial JO - J Med Internet Res SP - e26582 VL - 23 IS - 7 KW - diagnostic networks KW - mobile phone KW - sample transportation KW - sub-Saharan Africa KW - data collection N2 - Background: Diagnostics in many low- and middle-income countries are conducted through centralized laboratory networks. Samples are collected from patients at remote point-of-care health facilities, and diagnostic tests are performed at centralized laboratories. Sample transportation systems that deliver diagnostic samples and test results are crucial for timely diagnosis and treatment in such diagnostic networks. However, they often lack the timely and accurate data (eg, the quantity and location of samples prepared for collection) required for efficient operation. Objective: This study aims to demonstrate the feasibility, adoption, and accuracy of a distributed data collection system that leverages basic mobile phone technology to gather reports on the quantity and location of patient samples and test results prepared for delivery in the diagnostic network of Malawi. Methods: We designed a system that leverages unstructured supplementary service data (USSD) technology to enable health workers to submit daily reports describing the quantity of transportation-ready diagnostic samples and test results at specific health care facilities, free of charge with any mobile phone, and aggregate these data for sample transportation administrators. We then conducted a year-long field trial of this system in 51 health facilities serving 3 districts in Malawi. Between July 2019 and July 2020, the participants submitted daily reports containing the number of patient samples or test results designated for viral load, early infant diagnosis, and tuberculosis testing at each facility. We monitored daily participation and compared the submitted USSD reports with program data to assess system feasibility, adoption, and accuracy. Results: The participating facilities submitted 37,771 reports over the duration of the field trial. Daily facility participation increased from an average of 50% (26/51) in the first 2 weeks of the trial to approximately 80% (41/51) by the midpoint of the trial and remained at or above 80% (41/51) until the conclusion of the trial. On average, more than 80% of the reports submitted by a facility for a specific type of sample matched the actual number of patient samples collected from that facility by a courier. Conclusions: Our findings suggest that a USSD-based system is a feasible, adoptable, and accurate solution to the challenges of untimely, inaccurate, or incomplete data in diagnostic networks. Certain design characteristics of our system, such as the use of USSD, and implementation characteristics, such as the supportive role of the field team, were necessary to ensure high participation and accuracy rates without any explicit financial incentives. UR - https://www.jmir.org/2021/7/e26582 UR - http://dx.doi.org/10.2196/26582 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255690 ID - info:doi/10.2196/26582 ER - TY - JOUR AU - Glass, E. Joseph AU - Matson, E. Theresa AU - Lim, Catherine AU - Hartzler, L. Andrea AU - Kimbel, Kilian AU - Lee, K. Amy AU - Beatty, Tara AU - Parrish, Rebecca AU - Caldeiro, M. Ryan AU - Garza McWethy, Angela AU - Curran, M. Geoffrey AU - Bradley, A. Katharine PY - 2021/7/6 TI - Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives JO - J Med Internet Res SP - e25866 VL - 23 IS - 7 KW - user-centered design KW - qualitative KW - drug use disorders KW - stimulants KW - cannabis KW - opioids KW - primary care KW - mHealth KW - mobile phone N2 - Background: Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. Objective: This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. Methods: The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. Results: Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). Conclusions: A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients? needs for structure, support in and outside of visits, and desire for convenience. UR - https://www.jmir.org/2021/7/e25866 UR - http://dx.doi.org/10.2196/25866 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255666 ID - info:doi/10.2196/25866 ER - TY - JOUR AU - Chen, Ciao-Sin AU - Kim, Judith AU - Garg, Noemi AU - Guntupalli, Harsha AU - Jagsi, Reshma AU - Griggs, J. Jennifer AU - Sabel, Michael AU - Dorsch, P. Michael AU - Callaghan, C. Brian AU - Hertz, L. Daniel PY - 2021/7/5 TI - Chemotherapy-Induced Peripheral Neuropathy Detection via a Smartphone App: Cross-sectional Pilot Study JO - JMIR Mhealth Uhealth SP - e27502 VL - 9 IS - 7 KW - chemotherapy-induced peripheral neuropathy KW - smartphone KW - mobile health KW - gait KW - balance KW - 9-Hole Peg Test N2 - Background: Severe chemotherapy-induced peripheral neuropathy (CIPN) can cause long-term dysfunction of the hands and feet, interfere with activities of daily living, and diminish the quality of life. Monitoring to identify CIPN and adjust treatment before it progressing to a life-altering severity relies on patients self-reporting subjective symptoms to their clinical team. Objective assessment is not a standard component of CIPN monitoring due to the requirement for specially trained health care professionals and equipment. Smartphone apps have the potential to conveniently collect both subjective and objective CIPN data directly from patients, which could improve CIPN monitoring. Objective: The objective of this cross-sectional pilot study was to assess the feasibility of functional CIPN assessment via a smartphone app in patients with cancer that have received neurotoxic chemotherapy. Methods: A total of 26 patients who had completed neurotoxic chemotherapy were enrolled and classified as CIPN cases (n=17) or controls (n=9) based on self-report symptoms. All participants completed CIPN assessments within the NeuroDetect app a single time, including patient-reported surveys (CIPN20 [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Chemotherapy-induced Peripheral Neuropathy 20-item scale] and PRO-CTCAE [Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events]) and functional assessments (Gait and Balance and 9-Hole Peg Test). Functional assessment data were decomposed into features. The primary analysis was done to identify features indicative of the difference between CIPN cases and controls using partial least squares analyses. Exploratory analyses were performed to test if any features were associated with specific symptom subtypes or patient-reported survey scores. Patient interviews were also conducted to understand the challenges they experienced with the app. Results: Comparisons between CIPN cases and controls indicate that CIPN cases had shorter step length (P=.007), unique swaying acceleration patterns during a walking task, and shorter hand moving distance in the dominant hands during a manual dexterity task (variable importance in projection scores ?2). Exploratory analyses showed similar signatures associated with symptoms subtypes, CIPN20, and PRO-CTCAE. The interview results showed that some patients had difficulties due to technical issues, which indicated a need for additional training or oversight during the initial app download. Conclusions: Our results supported the feasibility of remote CIPN assessment via a smartphone app and suggested that functional assessments may indicate CIPN manifestations in the hands and feet. Additional work is needed to determine which functional assessments are most indicative of CIPN and could be used for CIPN monitoring within clinical care. UR - https://mhealth.jmir.org/2021/7/e27502 UR - http://dx.doi.org/10.2196/27502 UR - http://www.ncbi.nlm.nih.gov/pubmed/36260403 ID - info:doi/10.2196/27502 ER - TY - JOUR AU - Ruf, Alea AU - Koch, Doris Elena AU - Ebner-Priemer, Ulrich AU - Knopf, Monika AU - Reif, Andreas AU - Matura, Silke PY - 2021/7/5 TI - Studying Microtemporal, Within-Person Processes of Diet, Physical Activity, and Related Factors Using the APPetite-Mobile-App: Feasibility, Usability, and Validation Study JO - J Med Internet Res SP - e25850 VL - 23 IS - 7 KW - diet KW - physical activity KW - microtemporal processes KW - within-person factors KW - ecological momentary assessment KW - smartphone-app KW - mobile phone KW - mHealth KW - dietary assessment KW - feasibility KW - usability KW - validity N2 - Background: Diet and physical activity (PA) have a major impact on physical and mental health. However, there is a lack of effective strategies for sustaining these health-protective behaviors. A shift to a microtemporal, within-person approach is needed to capture dynamic processes underlying eating behavior and PA, as they change rapidly across minutes or hours and differ among individuals. However, a tool that captures these microtemporal, within-person processes in daily life is currently not present. Objective: The APPetite-mobile-app is developed for the ecological momentary assessment of microtemporal, within-person processes of complex dietary intake, objectively recorded PA, and related factors. This study aims to evaluate the feasibility and usability of the APPetite-mobile-app and the validity of the incorporated APPetite-food record. Methods: The APPetite-mobile-app captures dietary intake event-contingently through a food record, captures PA continuously through accelerometers, and captures related factors (eg, stress) signal-contingently through 8 prompts per day. Empirical data on feasibility (n=157), usability (n=84), and validity (n=44) were collected within the Eat2beNICE-APPetite-study. Feasibility and usability were examined in healthy participants and psychiatric patients. The relative validity of the APPetite-food record was assessed with a subgroup of healthy participants by using a counterbalanced crossover design. The reference method was a 24-hour recall. In addition, the energy intake was compared with the total energy expenditure estimated from accelerometry. Results: Good feasibility, with compliance rates above 80% for prompts and the accelerometer, as well as reasonable average response and recording durations (prompt: 2.04 min; food record per day: 17.66 min) and latencies (prompts: 3.16 min; food record: 58.35 min) were found. Usability was rated as moderate, with a score of 61.9 of 100 on the System Usability Scale. The evaluation of validity identified large differences in energy and macronutrient intake between the two methods at the group and individual levels. The APPetite-food record captured higher dietary intakes, indicating a lower level of underreporting, compared with the 24-hour recall. Energy intake was assessed fairly accurately by the APPetite-food record at the group level on 2 of 3 days when compared with total energy expenditure. The comparison with mean total energy expenditure (2417.8 kcal, SD 410) showed that the 24-hour recall (1909.2 kcal, SD 478.8) underestimated habitual energy intake to a larger degree than the APPetite-food record (2146.4 kcal, SD 574.5). Conclusions: The APPetite-mobile-app is a promising tool for capturing microtemporal, within-person processes of diet, PA, and related factors in real time or near real time and is, to the best of our knowledge, the first of its kind. First evidence supports the good feasibility and moderate usability of the APPetite-mobile-app and the validity of the APPetite-food record. Future findings in this context will build the foundation for the development of personalized lifestyle modification interventions, such as just-in-time adaptive interventions. UR - https://www.jmir.org/2021/7/e25850 UR - http://dx.doi.org/10.2196/25850 UR - http://www.ncbi.nlm.nih.gov/pubmed/34342268 ID - info:doi/10.2196/25850 ER - TY - JOUR AU - Ben-Zeev, Dror AU - Meller, Suzanne AU - Snyder, Jaime AU - Attah, A. Dzifa AU - Albright, Liam AU - Le, Hoa AU - Asafo, M. Seth AU - Collins, Y. Pamela AU - Ofori-Atta, Angela PY - 2021/7/2 TI - A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study JO - JMIR Ment Health SP - e28526 VL - 8 IS - 7 KW - mobile phone KW - low- and middle-income country KW - schizophrenia KW - bipolar disorder N2 - Background: The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining. Objective: The aim of this study is to partner with healers in Ghana to develop a smartphone toolkit designed to support the dissemination of evidence-based psychosocial interventions and the strengthening of human rights awareness in the healer community. Methods: We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build-out, and usability testing. Results: A total of 18 healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based app to help introduce them to alternative practices. A total of 12 healers participated in the co-design session. Of the 12 participants, 8 (67%) reported having a smartphone. Participants reported that they preferred spiritual guidance but that it was acceptable that M-Healer would provide mostly nonspiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed mood board prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community or medical, and Ghanaian culture. The content was organized into modules, including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contained several scripted digital animation videos, with audio narration in English or Twi. The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable. Conclusions: This study is the first to develop a digital mental health toolkit for healers in West Africa. Engaging healers in user-centered development produced an accessible and acceptable resource. Future field testing will determine whether M-Healer can improve healer practices and reduce human rights abuses. UR - https://mental.jmir.org/2021/7/e28526 UR - http://dx.doi.org/10.2196/28526 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255712 ID - info:doi/10.2196/28526 ER - TY - JOUR AU - Kim, Meelim AU - Yang, Jaeyeong AU - Ahn, Woo-Young AU - Choi, Jin Hyung PY - 2021/6/24 TI - Machine Learning Analysis to Identify Digital Behavioral Phenotypes for Engagement and Health Outcome Efficacy of an mHealth Intervention for Obesity: Randomized Controlled Trial JO - J Med Internet Res SP - e27218 VL - 23 IS - 6 KW - digital phenotype KW - clinical efficacy KW - in-app engagement KW - machine learning analysis KW - mobile phone N2 - Background: The digital health care community has been urged to enhance engagement and clinical outcomes by analyzing multidimensional digital phenotypes. Objective: This study aims to use a machine learning approach to investigate the performance of multivariate phenotypes in predicting the engagement rate and health outcomes of digital cognitive behavioral therapy. Methods: We leveraged both conventional phenotypes assessed by validated psychological questionnaires and multidimensional digital phenotypes within time-series data from a mobile app of 45 participants undergoing digital cognitive behavioral therapy for 8 weeks. We conducted a machine learning analysis to discriminate the important characteristics. Results: A higher engagement rate was associated with higher weight loss at 8 weeks (r=?0.59; P<.001) and 24 weeks (r=?0.52; P=.001). Applying the machine learning approach, lower self-esteem on the conventional phenotype and higher in-app motivational measures on digital phenotypes commonly accounted for both engagement and health outcomes. In addition, 16 types of digital phenotypes (ie, lower intake of high-calorie food and evening snacks and higher interaction frequency with mentors) predicted engagement rates (mean R2 0.416, SD 0.006). The prediction of short-term weight change (mean R2 0.382, SD 0.015) was associated with 13 different digital phenotypes (ie, lower intake of high-calorie food and carbohydrate and higher intake of low-calorie food). Finally, 8 measures of digital phenotypes (ie, lower intake of carbohydrate and evening snacks and higher motivation) were associated with a long-term weight change (mean R2 0.590, SD 0.011). Conclusions: Our findings successfully demonstrated how multiple psychological constructs, such as emotional, cognitive, behavioral, and motivational phenotypes, elucidate the mechanisms and clinical efficacy of a digital intervention using the machine learning method. Accordingly, our study designed an interpretable digital phenotype model, including multiple aspects of motivation before and during the intervention, predicting both engagement and clinical efficacy. This line of research may shed light on the development of advanced prevention and personalized digital therapeutics. Trial Registration: ClinicalTrials.gov NCT03465306; https://clinicaltrials.gov/ct2/show/NCT03465306 UR - https://www.jmir.org/2021/6/e27218/ UR - http://dx.doi.org/10.2196/27218 UR - http://www.ncbi.nlm.nih.gov/pubmed/34184991 ID - info:doi/10.2196/27218 ER - TY - JOUR AU - Sutherland, Rachel AU - Brown, Alison AU - Nathan, Nicole AU - Yoong, Serene AU - Janssen, Lisa AU - Chooi, Amelia AU - Hudson, Nayerra AU - Wiggers, John AU - Kerr, Nicola AU - Evans, Nicole AU - Gillham, Karen AU - Oldmeadow, Christopher AU - Searles, Andrew AU - Reeves, Penny AU - Davies, Marc AU - Reilly, Kathryn AU - Cohen, Brad AU - Wolfenden, Luke PY - 2021/6/24 TI - A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness?Implementation Hybrid Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e25256 VL - 23 IS - 6 KW - childhood obesity KW - lunchboxes KW - children KW - child nutrition KW - mHealth KW - schools KW - hybrid KW - randomized controlled trial KW - technology N2 - Background: There is significant opportunity to improve the nutritional quality of foods packed in children?s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. Objective: This study aimed to assess the effectiveness of a multicomponent, mobile health?based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. Methods: A type I effectiveness?implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children?s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. Results: A total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (?117.26 kJ; 95% CI ?195.59 to ?39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (?88.38 kJ; 95% CI ?172.84 to ?3.92; P=.04) and consumed (?117.17 kJ; 95% CI ?233.72 to ?0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children?s lunchboxes. Conclusions: The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school?aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school?aged children, impacting weight status and associated health care costs. Trial Registration: Australian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191&isReview=true International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7725-x UR - https://www.jmir.org/2021/6/e25256/ UR - http://dx.doi.org/10.2196/25256 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185013 ID - info:doi/10.2196/25256 ER - TY - JOUR AU - Mehta, Ashish AU - Niles, Nicole Andrea AU - Vargas, Hamilton Jose AU - Marafon, Thiago AU - Couto, Dotta Diego AU - Gross, Jonathan James PY - 2021/6/22 TI - Acceptability and Effectiveness of Artificial Intelligence Therapy for Anxiety and Depression (Youper): Longitudinal Observational Study JO - J Med Internet Res SP - e26771 VL - 23 IS - 6 KW - digital mental health treatment KW - acceptability KW - effectiveness KW - anxiety KW - depression N2 - Background: Youper is a widely used, commercially available mobile app that uses artificial intelligence therapy for the treatment of anxiety and depression. Objective: Our study examined the acceptability and effectiveness of Youper. Further, we tested the cumulative regulation hypothesis, which posits that cumulative emotion regulation successes with repeated intervention engagement will predict longer-term anxiety and depression symptom reduction. Methods: We examined data from paying Youper users (N=4517) who allowed their data to be used for research. To characterize the acceptability of Youper, we asked users to rate the app on a 5-star scale and measured retention statistics for users? first 4 weeks of subscription. To examine effectiveness, we examined longitudinal measures of anxiety and depression symptoms. To test the cumulative regulation hypothesis, we used the proportion of successful emotion regulation attempts to predict symptom reduction. Results: Youper users rated the app highly (mean 4.36 stars, SD 0.84), and 42.66% (1927/4517) of users were retained by week 4. Symptoms decreased in the first 2 weeks of app use (anxiety: d=0.57; depression: d=0.46). Anxiety improvements were maintained in the subsequent 2 weeks, but depression symptoms increased slightly with a very small effect size (d=0.05). A higher proportion of successful emotion regulation attempts significantly predicted greater anxiety and depression symptom reduction. Conclusions: Youper is a low-cost, completely self-guided treatment that is accessible to users who may not otherwise access mental health care. Our findings demonstrate the acceptability and effectiveness of Youper as a treatment for anxiety and depression symptoms and support continued study of Youper in a randomized clinical trial. UR - https://www.jmir.org/2021/6/e26771 UR - http://dx.doi.org/10.2196/26771 UR - http://www.ncbi.nlm.nih.gov/pubmed/34155984 ID - info:doi/10.2196/26771 ER - TY - JOUR AU - Song, Ting AU - Liu, Fang AU - Deng, Ning AU - Qian, Siyu AU - Cui, Tingru AU - Guan, Yingping AU - Arnolda, Leonard AU - Zhang, Zhenyu AU - Yu, Ping PY - 2021/6/21 TI - A Comprehensive 6A Framework for Improving Patient Self-Management of Hypertension Using mHealth Services: Qualitative Thematic Analysis JO - J Med Internet Res SP - e25522 VL - 23 IS - 6 KW - patient experience KW - mHealth KW - mobile phone KW - mobile app KW - intervention KW - self-management KW - high blood pressure KW - chronic disease management KW - qualitative research N2 - Background: Hypertension affects over 15% of the world?s population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications. Objective: This study aims to explore patients? perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension. Methods: A semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes. Results: The patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services. Conclusions: The mHealth service extended the traditional hypertension care model beyond the hospital and clinician?s office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions. UR - https://www.jmir.org/2021/6/e25522 UR - http://dx.doi.org/10.2196/25522 UR - http://www.ncbi.nlm.nih.gov/pubmed/34152272 ID - info:doi/10.2196/25522 ER - TY - JOUR AU - Aljedaani, Bakheet AU - Babar, Ali M. PY - 2021/6/21 TI - Challenges With Developing Secure Mobile Health Applications: Systematic Review JO - JMIR Mhealth Uhealth SP - e15654 VL - 9 IS - 6 KW - systematic literature review KW - mHealth apps KW - secure apps KW - developers KW - security knowledge N2 - Background: Mobile health (mHealth) apps have gained significant popularity over the last few years due to their tremendous benefits, such as lowering health care costs and increasing patient awareness. However, the sensitivity of health care data makes the security of mHealth apps a serious concern. Poor security practices and lack of security knowledge on the developers? side can cause several vulnerabilities in mHealth apps. Objective: In this review paper, we aimed to identify and analyze the reported challenges concerning security that developers of mHealth apps face. Additionally, our study aimed to develop a conceptual framework with the challenges for developing secure apps faced by mHealth app development organizations. The knowledge of such challenges can help to reduce the risk of developing insecure mHealth apps. Methods: We followed the systematic literature review method for this review. We selected studies that were published between January 2008 and October 2020 since the major app stores launched in 2008. We selected 32 primary studies using predefined criteria and used a thematic analysis method for analyzing the extracted data. Results: Of the 1867 articles obtained, 32 were included in this review based on the predefined criteria. We identified 9 challenges that can affect the development of secure mHealth apps. These challenges include lack of security guidelines and regulations for developing secure mHealth apps (20/32, 63%), developers? lack of knowledge and expertise for secure mHealth app development (18/32, 56%), lack of stakeholders? involvement during mHealth app development (6/32, 19%), no/little developer attention towards the security of mHealth apps (5/32, 16%), lack of resources for developing a secure mHealth app (4/32, 13%), project constraints during the mHealth app development process (4/32, 13%), lack of security testing during mHealth app development (4/32, 13%), developers? lack of motivation and ethical considerations (3/32, 9%), and lack of security experts? engagement during mHealth app development (2/32, 6%). Based on our analysis, we have presented a conceptual framework that highlights the correlation between the identified challenges. Conclusions: While mHealth app development organizations might overlook security, we conclude that our findings can help them to identify the weaknesses and improve their security practices. Similarly, mHealth app developers can identify the challenges they face to develop mHealth apps that do not pose security risks for users. Our review is a step towards providing insights into the development of secure mHealth apps. Our proposed conceptual framework can act as a practice guideline for practitioners to enhance secure mHealth app development. UR - https://mhealth.jmir.org/2021/6/e15654 UR - http://dx.doi.org/10.2196/15654 UR - http://www.ncbi.nlm.nih.gov/pubmed/34152277 ID - info:doi/10.2196/15654 ER - TY - JOUR AU - Rayward, T. Anna AU - Vandelanotte, Corneel AU - Van Itallie, Anetta AU - Duncan, J. Mitch PY - 2021/6/18 TI - The Association Between Logging Steps Using a Website, App, or Fitbit and Engaging With the 10,000 Steps Physical Activity Program: Observational Study JO - J Med Internet Res SP - e22151 VL - 23 IS - 6 KW - physical activity intervention KW - activity trackers KW - engagement KW - Fitbit KW - pedometer KW - eHealth KW - mobile phone N2 - Background: Engagement is positively associated with the effectiveness of digital health interventions. It is unclear whether tracking devices that automatically synchronize data (eg, Fitbit) produce different engagement levels compared with manually entering data. Objective: This study examines how different step logging methods in the freely available 10,000 Steps physical activity program differ according to age and gender and are associated with program engagement. Methods: A subsample of users (n=22,142) of the free 10,000 Steps physical activity program were classified into one of the following user groups based on the step-logging method: Website Only (14,617/22,142, 66.01%), App Only (2100/22,142, 9.48%), Fitbit Only (1705/22,142, 7.7%), Web and App (2057/22,142, 9.29%), and Fitbit Combination (combination of web, app, and Fitbit; 1663/22,142, 7.51%). Generalized linear regression and binary logistic regression were used to examine differences between user groups? engagement and participation parameters. The time to nonusage attrition was assessed using Cox proportional hazards regression. Results: App Only users were significantly younger and Fitbit user groups had higher proportions of women compared with other groups. The following outcomes were significant and relative to the Website Only group. The App Only group had fewer website sessions (odds ratio [OR] ?6.9, 95% CI ?7.6 to ?6.2), whereas the Fitbit Only (OR 10.6, 95% CI 8.8-12.3), Web and App (OR 1.5, 95% CI 0.4-2.6), and Fitbit Combination (OR 8.0; 95% CI 6.2-9.7) groups had more sessions. The App Only (OR ?0.7, 95% CI ?0.9 to ?0.4) and Fitbit Only (OR ?0.5, 95% CI ?0.7 to ?0.2) groups spent fewer minutes on the website per session, whereas the Fitbit Combination group (OR 0.2, 95% CI 0.0-0.5) spent more minutes. All groups, except the Fitbit Combination group, viewed fewer website pages per session. The mean daily step count was lower for the App Only (OR ?201.9, 95% CI ?387.7 to ?116.0) and Fitbit Only (OR ?492.9, 95% CI ?679.9 to ?305.8) groups but higher for the Web and App group (OR 258.0, 95% CI 76.9-439.2). The Fitbit Only (OR 5.0, 95% CI 3.4-6.6), Web and App (OR 7.2, 95% CI 5.9-8.6), and Fitbit Combination (OR 15.6, 95% CI 13.7-17.5) groups logged a greater number of step entries. The App Only group was less likely (OR 0.65, 95% CI 0.46-0.94) and other groups were more likely to participate in Challenges. The mean time to nonusage attrition was 35 (SD 26) days and was lower than average in the Website Only and App Only groups and higher than average in the Web and App and Fitbit Combination groups. Conclusions: Using a Fitbit in combination with the 10,000 Steps app or website enhanced engagement with a real-world physical activity program. Integrating tracking devices that synchronize data automatically into real-world physical activity interventions is one strategy for improving engagement. UR - https://www.jmir.org/2021/6/e22151 UR - http://dx.doi.org/10.2196/22151 UR - http://www.ncbi.nlm.nih.gov/pubmed/34142966 ID - info:doi/10.2196/22151 ER - TY - JOUR AU - Kim, Youngkyu AU - Oh, Jeongmin AU - Choi, Seung-Ho AU - Jung, Ahra AU - Lee, June-Goo AU - Lee, Se Yoon AU - Kim, Ki Jun PY - 2021/6/18 TI - A Portable Smartphone-Based Laryngoscope System for High-Speed Vocal Cord Imaging of Patients With Throat Disorders: Instrument Validation Study JO - JMIR Mhealth Uhealth SP - e25816 VL - 9 IS - 6 KW - smartphone KW - mobile phone KW - endoscope KW - high-speed imaging KW - vocal cord KW - low-cost device KW - mHealth KW - otorhinolaryngology KW - head and neck KW - throat N2 - Background: Currently, high-speed digital imaging (HSDI), especially endoscopic HSDI, is routinely used for the diagnosis of vocal cord disorders. However, endoscopic HSDI devices are usually large and costly, which limits access to patients in underdeveloped countries and in regions with inadequate medical infrastructure. Modern smartphones have sufficient functionality to process the complex calculations that are required for processing high-resolution images and videos with a high frame rate. Recently, several attempts have been made to integrate medical endoscopes with smartphones to make them more accessible to people in underdeveloped countries. Objective: This study aims to develop a smartphone adaptor for endoscopes, which enables smartphone-based vocal cord imaging, to demonstrate the feasibility of performing high-speed vocal cord imaging via the high-speed imaging functions of a high-performance smartphone camera, and to determine the acceptability of the smartphone-based high-speed vocal cord imaging system for clinical applications in developing countries. Methods: A customized smartphone adaptor optical relay was designed for clinical endoscopy using selective laser melting?based 3D printing. A standard laryngoscope was attached to the smartphone adaptor to acquire high-speed vocal cord endoscopic images. Only existing basic functions of the smartphone camera were used for HSDI of the vocal cords. Extracted still frames were observed for qualitative glottal volume and shape. For image processing, segmented glottal and vocal cord areas were calculated from whole HSDI frames to characterize the amplitude of the vibrations on each side of the glottis, including the frequency, edge length, glottal areas, base cord, and lateral phase differences over the acquisition time. The device was incorporated into a preclinical videokymography diagnosis routine to compare functionality. Results: Smartphone-based HSDI with the smartphone-endoscope adaptor could achieve 940 frames per second and a resolution of 1280 by 720 frames, which corresponds to the detection of 3 to 8 frames per vocal cycle at double the spatial resolution of existing devices. The device was used to image the vocal cords of 4 volunteers: 1 healthy individual and 3 patients with vocal cord paralysis, chronic laryngitis, or vocal cord polyps. The resultant image stacks were sufficient for most diagnostic purposes. The cost of the device including the smartphone was lower than that of existing HSDI devices. The image processing and analytics demonstrated the successful calculation of relevant diagnostic variables from the acquired images. Patients with vocal pathologies were easily differentiable in the quantitative data. Conclusions: A smartphone-based HSDI endoscope system can function as a point-of-care clinical diagnostic device. The resulting analysis is of higher quality than that accessible by videostroboscopy and promises comparable quality and greater accessibility than HSDI. In particular, this system is suitable for use as an accessible diagnostic tool in underdeveloped areas with inadequate medical service infrastructure. UR - https://mhealth.jmir.org/2021/6/e25816 UR - http://dx.doi.org/10.2196/25816 UR - http://www.ncbi.nlm.nih.gov/pubmed/34142978 ID - info:doi/10.2196/25816 ER - TY - JOUR AU - Ragan, J. Elizabeth AU - Gill, J. Christopher AU - Banos, Matthew AU - Bouton, C. Tara AU - Rooney, Jennifer AU - Horsburgh, R. Charles AU - Warren, M. Robin AU - Myers, Bronwyn AU - Jacobson, R. Karen PY - 2021/6/16 TI - Directly Observed Therapy to Measure Adherence to Tuberculosis Medication in Observational Research: Protocol for a Prospective Cohort Study JO - JMIR Res Protoc SP - e24510 VL - 10 IS - 6 KW - tuberculosis KW - directly observed therapy KW - treatment adherence and compliance KW - medication adherence KW - mobile applications N2 - Background: A major challenge for prospective, clinical tuberculosis (TB) research is accurately defining a metric for measuring medication adherence. Objective: We aimed to design a method to capture directly observed therapy (DOT) via mobile health carried out by community workers. The program was created specifically to measure TB medication adherence for a prospective TB cohort in Western Cape Province, South Africa. Methods: Community workers collect daily adherence data on mobile smartphones. Participant-level adherence, program-level adherence, and program function are systematically monitored to assess DOT program implementation. A data dashboard allows for regular visualization of indicators. Numerous design elements aim to prevent or limit data falsification and ensure study data integrity. Results: The cohort study is ongoing and data collection is in progress. Enrollment began on May 16, 2017, and as of January 12, 2021, a total of 236 participants were enrolled. Adherence data will be used to analyze the study?s primary aims and to investigate adherence as a primary outcome. Conclusions: The DOT program includes a mobile health application for data collection as well as a monitoring framework and dashboard. This approach has potential to be adapted for other settings to improve the capture of medication adherence in clinical TB research. Trial Registration: Clinicaltrials.gov NCT02840877; https://clinicaltrials.gov/ct2/show/NCT02840877 UR - https://www.researchprotocols.org/2021/6/e24510 UR - http://dx.doi.org/10.2196/24510 UR - http://www.ncbi.nlm.nih.gov/pubmed/34132642 ID - info:doi/10.2196/24510 ER - TY - JOUR AU - Mekonnen, Abebaw Zeleke AU - Gelaye, Alemu Kassahun AU - Were, Martin AU - Tilahun, Binyam PY - 2021/6/15 TI - Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia JO - JMIR Mhealth Uhealth SP - e27603 VL - 9 IS - 6 KW - mHealth KW - eHealth KW - mobile phone KW - text message KW - short message service KW - reminder KW - immunization KW - vaccination KW - Ethiopia N2 - Background: Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message?based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. Objective: This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. Methods: A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. Results: A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. Conclusions: Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. Trial Registration: Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839 UR - https://mhealth.jmir.org/2021/6/e27603 UR - http://dx.doi.org/10.2196/27603 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128813 ID - info:doi/10.2196/27603 ER - TY - JOUR AU - Stampe, Kathrine AU - Kishik, Sharon AU - Müller, Dueholm Sune PY - 2021/6/15 TI - Mobile Health in Chronic Disease Management and Patient Empowerment: Exploratory Qualitative Investigation Into Patient-Physician Consultations JO - J Med Internet Res SP - e26991 VL - 23 IS - 6 KW - compliance KW - empowerment KW - mHealth KW - patient-physician consultation KW - power N2 - Background: Chronic diseases often present severe consequences for those affected. The management and treatment of chronic diseases largely depend on patients? lifestyle choices and how they cope with the disease in their everyday lives. Accordingly, the ability of patients to self-manage diseases is a highly relevant topic. In relation to self-management, studies refer to patient empowerment as strengthening patients? voices and enabling them to assert control over their health and treatment. Mobile health (mHealth) provides cost-efficient means to support self-management and foster empowerment. Objective: There is a scarcity of research investigating how mHealth affects patient empowerment during patient-physician consultations. The objective of this study is to address this knowledge gap by investigating how mHealth affects consultations and patient empowerment. Methods: We relied on data from an ethnographic field study of 6 children and adolescents diagnosed with juvenile idiopathic arthritis. We analyzed 6 patient-physician consultations and drew on Michel Foucault?s concepts of power and power technology. Results: Our results suggest that the use of mHealth constitutes practices that structure the consultations around deviations and noncompliant patient behavior. Our analysis shows how mHealth is used to discipline patients and correct their behavior. We argue that the use of mHealth during consultations may unintentionally lead to relevant aspects of patients? lives related to the disease being ignored; thus, inadvertently, patients? voices may be silenced. Conclusions: Our results show that concrete uses of mHealth may conflict with extant literature on empowerment, which emphasizes the importance of strengthening the patients? voices and enabling patients to take more control of their health and treatment. We contribute to the state-of-the-art knowledge by showing that the use of mHealth may have unintended consequences that do not lead to empowerment. Our analysis underscores the need for further research to investigate how mHealth impacts patient empowerment during consultations. UR - https://www.jmir.org/2021/6/e26991 UR - http://dx.doi.org/10.2196/26991 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128817 ID - info:doi/10.2196/26991 ER - TY - JOUR AU - Singleton, Anna AU - Raeside, Rebecca AU - Partridge, R. Stephanie AU - Hayes, Molly AU - Maka, Katherine AU - Hyun, K. Karice AU - Thiagalingam, Aravinda AU - Chow, K. Clara AU - Sherman, A. Kerry AU - Elder, Elisabeth AU - Redfern, Julie PY - 2021/6/14 TI - Co-designing a Lifestyle-Focused Text Message Intervention for Women After Breast Cancer Treatment: Mixed Methods Study JO - J Med Internet Res SP - e27076 VL - 23 IS - 6 KW - breast neoplasms KW - cancer survivors KW - text messaging KW - telemedicine KW - mobile health KW - co-design N2 - Background: Breast cancer is the most common cancer among women globally. Recovery from breast cancer treatment can be mentally and physically challenging. SMS text message programs offer a novel way to provide health information and support, but few programs are co-designed with consumer representatives. Objective: This study aims to report the procedures and outcomes of a co-design process of a lifestyle-focused SMS text message program to support women?s mental and physical health after breast cancer treatment. Methods: We followed an iterative mixed methods two-step process: (1) co-design workshop with consumers and health professionals and researchers to draft text messages and (2) evaluation of message content, which was scored (5-point Likert scale; 1=strongly disagree to 5=strongly agree) for ease of understanding, usefulness, and appropriateness, and readability (Flesch-Kincaid score). Additional free-text responses and semistructured interviews were coded into themes. Messages were edited or deleted based on the evaluations, with consumers? evaluations prioritized. Results: In step 1, co-designed text messages (N=189) were semipersonalized, and the main content themes were (1) physical activity and healthy eating, (2) medications and side effects, (3) mental health, and (4) general breast cancer information. In step 2, consumers (n=14) and health professionals and researchers (n=14) provided 870 reviews of 189 messages and found that most messages were easy to understand (799/870, 91.8%), useful (746/870, 85.7%), and appropriate (732/870, 84.1%). However, consumers rated 50 messages differently from health professionals and researchers. On the basis of evaluations, 37.6% (71/189) of messages were deleted, 36.5% (69/189) were edited, and 12 new messages related to fatigue, self-care, and cognition were created. The final 130 text messages had a mean 7.12 (SD 2.8) Flesch-Kincaid grade level and 68.9 (SD 15.5) ease-of-reading score, which represents standard reading ease. Conclusions: Co-designing and evaluating a bank of evidence-based mental and physical health-themed text messages with breast cancer survivors, health professionals, and researchers was feasible and resulted in a bank of 130 text messages evaluated highly by participants. Some consumer evaluations differed from health professionals and researchers, supporting the importance of co-design. UR - https://www.jmir.org/2021/6/e27076 UR - http://dx.doi.org/10.2196/27076 UR - http://www.ncbi.nlm.nih.gov/pubmed/34125072 ID - info:doi/10.2196/27076 ER - TY - JOUR AU - Willis, Matthew AU - Brand Hein, Leah AU - Hu, Zhaoxian AU - Saran, Rajiv AU - Argentina, Marissa AU - Bragg-Gresham, Jennifer AU - Krein, L. Sarah AU - Gillespie, Brenda AU - Zheng, Kai AU - Veinot, C. Tiffany PY - 2021/6/14 TI - Usability Evaluation of a Tablet-Based Intervention to Prevent Intradialytic Hypotension in Dialysis Patients During In-Clinic Dialysis: Mixed Methods Study JO - JMIR Hum Factors SP - e26012 VL - 8 IS - 2 KW - user interaction KW - dialysis KW - usability KW - informatics intervention N2 - Background: Patients on hemodialysis receive dialysis thrice weekly for about 4 hours per session. Intradialytic hypotension (IDH)?low blood pressure during hemodialysis?is a serious but common complication of hemodialysis. Although patients on dialysis already participate in their care, activating patients toward IDH prevention may reduce their risk of IDH. Interactive, technology-based interventions hold promise as a platform for patient activation. However, little is known about the usability challenges that patients undergoing hemodialysis may face when using tablet-based informatics interventions, especially while dialyzing. Objective: This study aims to test the usability of a patient-facing, tablet-based intervention that includes theory-informed educational modules and motivational interviewing?based mentoring from patient peers via videoconferencing. Methods: We conducted a cross-sectional, mixed methods usability evaluation of the tablet-based intervention by using think-aloud methods, field notes, and structured observations. These qualitative data were evaluated by trained researchers using a structured data collection instrument to capture objective observational data. We calculated descriptive statistics for the quantitative data and conducted inductive content analysis using the qualitative data. Results: Findings from 14 patients cluster around general constraints such as the use of one arm, dexterity issues, impaired vision, and lack of experience with touch screen devices. Our task-by-task usability results showed that specific sections with the greatest difficulty for users were logging into the intervention (difficulty score: 2.08), interacting with the quizzes (difficulty score: 1.92), goal setting (difficulty score: 2.28), and entering and exiting videoconference rooms (difficulty score: 2.07) that are used to engage with peers during motivational interviewing sessions. Conclusions: In this paper, we present implications for designing informatics interventions for patients on dialysis and detail resulting changes to be implemented in the next version of this intervention. We frame these implications first through the context of the role the patients? physical body plays when interacting with the intervention and then through the digital considerations for software and interface interaction. UR - https://humanfactors.jmir.org/2021/2/e26012 UR - http://dx.doi.org/10.2196/26012 UR - http://www.ncbi.nlm.nih.gov/pubmed/34121664 ID - info:doi/10.2196/26012 ER - TY - JOUR AU - Twimukye, Adelline AU - Bwanika Naggirinya, Agnes AU - Parkes-Ratanshi, Rosalind AU - Kasirye, Ronnie AU - Kiragga, Agnes AU - Castelnuovo, Barbara AU - Wasswa, Jacob AU - Nabaggala, Sarah Maria AU - Katabira, Elly AU - Lamorde, Mohammed AU - King, Lisa Rachel PY - 2021/6/14 TI - Acceptability of a Mobile Phone Support Tool (Call for Life Uganda) for Promoting Adherence to Antiretroviral Therapy Among Young Adults in a Randomized Controlled Trial: Exploratory Qualitative Study JO - JMIR Mhealth Uhealth SP - e17418 VL - 9 IS - 6 KW - HIV KW - mHealth KW - young adults KW - adherence KW - qualitative KW - Uganda N2 - Background: Adherence to treatment is critical for successful treatment outcomes. Although factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere owing to psychosocial issues such as stigma, ART-related side effects, and a lack of access to treatment. The Call for Life Uganda (CFLU) mobile health (mHealth) tool is a mobile phone?based technology that provides text messages or interactive voice response functionalities through a web interface and offers 4 modules of support. Objective: This study aims to describe the acceptability and feasibility of a mobile phone support tool to promote adherence to ART among young adults in a randomized controlled trial. Methods: An exploratory qualitative design with a phenomenological approach at 2 study sites was used. A total of 17 purposively selected young adults with HIV infection who had used the mHealth tool CFLU from 2 clinics were included. In total, 11 in-depth interviews and 1 focus group discussion were conducted to examine the following topics: experience with the CFLU tool (benefits and challenges), components of the tool, the efficiency of the system (level of comfort, ease, or difficulty in using the system), how CFLU resolved adherence challenges, and suggestions to improve CFLU. Participants belonged to 4 categories of interest: young adults on ART for the prevention of mother-to-child transmission, young adults switching to or on the second-line ART, positive partners in an HIV-discordant relationship, and young adults initiating the first-line ART. All young adults had 12 months of daily experience using the tool. Data were analyzed using NVivo version 11 software (QSR International Limited) based on a thematic approach. Results: The CFLU mHealth tool was perceived as an acceptable intervention; young adults reported improvement in medication adherence, strengthened clinician-patient relationships, and increased health knowledge from health tips. Appointment reminders and symptom reporting were singled out as beneficial and helped to address the problems of forgetfulness and stigma-related issues. HIV-related stigma was reported by a few young people. Participants requested extra support for scaling up CFLU to make it more youth friendly. Improving the tool to reduce technical issues, including network outages and a period of software failure, was suggested. They suggested that in addition to digital solutions, other support, including the promotion of peer support meetings and the establishment of a designated space and staff members for youth, was also important. Conclusions: This mHealth tool was an acceptable and feasible strategy for improving ART adherence and retention among young adults in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 UR - https://mhealth.jmir.org/2021/6/e17418 UR - http://dx.doi.org/10.2196/17418 UR - http://www.ncbi.nlm.nih.gov/pubmed/34121665 ID - info:doi/10.2196/17418 ER - TY - JOUR AU - Chen, Mingrong AU - Wu, Tingting AU - Lv, Meina AU - Chen, Chunmei AU - Fang, Zongwei AU - Zeng, Zhiwei AU - Qian, Jiafen AU - Jiang, Shaojun AU - Chen, Wenjun AU - Zhang, Jinhua PY - 2021/6/11 TI - Efficacy of Mobile Health in Patients With Low Back Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials JO - JMIR Mhealth Uhealth SP - e26095 VL - 9 IS - 6 KW - mobile health KW - mHealth KW - low back pain KW - meta-analysis KW - pain intensity KW - disability N2 - Background: Low back pain is one of the most common health problems and a main cause of disability, which imposes a great burden on patients. Mobile health (mHealth) affects many aspects of people?s lives, and it has progressed rapidly, showing promise as an effective intervention for patients with low back pain. However, the efficacy of mHealth interventions for patients with low back pain remains unclear; thus, further exploration is necessary. Objective: The purpose of this study was to evaluate the efficacy of mHealth interventions in patients with low back pain compared to usual care. Methods: This was a systematic review and meta-analysis of randomized controlled trials designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. We searched for studies published in English before October 2020 in the PubMed, EMBASE, Web of Science, and Cochrane Library databases. Two researchers independently scanned the literature, extracted data, and assessed the methodological quality of the included studies. Bias risks were assessed using the Cochrane Collaboration tool. We used RevMan 5.4 software to perform the meta-analysis. Results: A total of 9 studies with 792 participants met the inclusion criteria. The simultaneous use of mHealth and usual care showed a better reduction in pain intensity than usual care alone, as measured by the numeric rating scale (mean difference [MD] ?0.85, 95% CI ?1.29 to ?0.40; P<.001), and larger efficacy in reducing disability, as measured by the Rolland-Morris Disability Questionnaire (MD ?1.54, 95% CI ?2.35 to ?0.73; P<.001). Subgroup analyses showed that compared with usual care, mHealth using telephone calls significantly reduced pain intensity (MD ?1.12, 95% CI ?1.71 to ?0.53; P<.001) and disability score (MD ?1.68, 95% CI ?2.74 to ?0.63; P<.001). However, without the use of telephone calls, mHealth had no obvious advantage over usual care in improving pain intensity (MD ?0.48, 95% CI ?1.16 to 0.20; P=.16) and the disability score (MD ?0.41, 95% CI ?1.88 to 1.05; P=.58). The group that received a more sensitive feedback intervention showed a significantly reduced disability score (MD ?4.30, 95% CI ?6.95 to ?1.69; P=.001). Conclusions: The use of simultaneous mHealth and usual care interventions has better efficacy than usual care alone in reducing pain intensity and disability in patients with low back pain. Moreover, the results of subgroup analysis revealed that mHealth using telephone calls might play a positive role in improving pain intensity and disability in patients with low back pain. UR - https://mhealth.jmir.org/2021/6/e26095 UR - http://dx.doi.org/10.2196/26095 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114965 ID - info:doi/10.2196/26095 ER - TY - JOUR AU - Lauffenburger, C. Julie AU - Barlev, A. Renee AU - Sears, S. Ellen AU - Keller, A. Punam AU - McDonnell, E. Marie AU - Yom-Tov, Elad AU - Fontanet, P. Constance AU - Hanken, Kaitlin AU - Haff, Nancy AU - Choudhry, K. Niteesh PY - 2021/6/11 TI - Preferences for mHealth Technology and Text Messaging Communication in Patients With Type 2 Diabetes: Qualitative Interview Study JO - J Med Internet Res SP - e25958 VL - 23 IS - 6 KW - diabetes KW - technology KW - mobile health KW - medication adherence KW - mobile phone N2 - Background: Individuals with diabetes need regular support to help them manage their diabetes on their own, ideally delivered via mechanisms that they already use, such as their mobile phones. One reason for the modest effectiveness of prior technology-based interventions may be that the patient perspective has been insufficiently incorporated. Objective: This study aims to understand patients? preferences for mobile health (mHealth) technology and how that technology can be integrated into patients? routines, especially with regard to medication use. Methods: We conducted semistructured qualitative individual interviews with patients with type 2 diabetes from an urban health care system to elicit and explore their perspectives on diabetes medication?taking behaviors, daily patterns of using mobile technology, use of mHealth technology for diabetes care, acceptability of text messages to support medication adherence, and preferred framing of information within text messages to support diabetes care. The interviews were digitally recorded and transcribed. The data were analyzed using codes developed by the study team to generate themes, with representative quotations selected as illustrations. Results: We conducted interviews with 20 participants, of whom 12 (60%) were female and 9 (45%) were White; in addition, the participants? mean glycated hemoglobin A1c control was 7.8 (SD 1.1). Overall, 5 key themes were identified: patients try to incorporate cues into their routines to help them with consistent medication taking; many patients leverage some form of technology as a cue to support adherence to medication taking and diabetes self-management behaviors; patients value simplicity and integration of technology solutions used for diabetes care, managing medications, and communicating with health care providers; some patients express reluctance to rely on mobile technology for these diabetes care behaviors; and patients believe they prefer positively framed communication, but communication preferences are highly individualized. Conclusions: The participants expressed some hesitation about using mobile technology in supporting diabetes self-management but have largely incorporated it or are open to incorporating it as a cue to make medication taking more automatic and less burdensome. When using technology to support diabetes self-management, participants exhibited individualized preferences, but overall, they preferred simple and positively framed communication. mHealth interventions may be improved by focusing on integrating them easily into daily routines and increasing the customization of content. UR - https://www.jmir.org/2021/6/e25958 UR - http://dx.doi.org/10.2196/25958 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114964 ID - info:doi/10.2196/25958 ER - TY - JOUR AU - Poort, Hanneke AU - Ryan, Annelise AU - MacDougall, Katelyn AU - Malinowski, Paige AU - MacDonald, Anna AU - Markin, Zach AU - Pirl, William AU - Greer, Joseph AU - Fasciano, Karen PY - 2021/6/11 TI - Feasibility and Acceptability of a Mobile Phone App Intervention for Coping With Cancer as a Young Adult: Pilot Trial and Thematic Analysis JO - J Med Internet Res SP - e25069 VL - 23 IS - 6 KW - mobile phone KW - mobile phone application KW - cancer KW - feasibility N2 - Background: Many young adult patients do not receive adequate psychosocial services to help them cope with cancer. Objective: This study aims to assess the feasibility and acceptability of a smartphone app (iaya) intervention that was designed to create an engaged community of young adult patients and help them learn emotional coping skills. Methods: For this single-group pilot trial, 25 young adult patients aged 18-39 years who were receiving active cancer treatment were asked to use the iaya app for 12 weeks. To collect app use data, we used Mixpanel, an analytics platform for apps. Feasibility was assessed through rates of app sessions and the number of coping exercises engaged, and intervention acceptability was evaluated by using an app usability questionnaire and through qualitative interviews at study completion. We collected patient-reported outcome data at baseline and at week 12 to explore self-efficacy for coping with cancer, self-efficacy for managing emotions, perceived emotional support, and quality of life. Results: Baseline patient-reported outcome data indicated that participants scored relatively low on perceived emotional support but reasonably high on self-efficacy for coping with cancer and managing emotions as well as quality of life. Participants had a mean of 13 app sessions (SD 14) and 2 coping exercises (SD 3.83) in 12 weeks. Only 9% (2/23) of participants met our combined feasibility definition of ?10 app sessions and ?3 coping skills from different categories. The participants? mean usability score was 73.7% (SD 10.84), which exceeded our predefined threshold of ?70%, and qualitative feedback was generally positive. Conclusions: Although perceived acceptable by patients, the iaya smartphone app did not meet the a priori feasibility criteria as a stand-alone app intervention. Future studies should screen participants for unmet coping needs and consider integrating the app as part of psychosocial care for young adult patients. UR - https://www.jmir.org/2021/6/e25069 UR - http://dx.doi.org/10.2196/25069 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114957 ID - info:doi/10.2196/25069 ER - TY - JOUR AU - Odukoya, Ololade Oluwakemi AU - Ohazurike, Chidumga AU - Akanbi, Maxwell AU - O'Dwyer, C. Linda AU - Isikekpei, Brenda AU - Kuteyi, Ewemade AU - Ameh, O. Idaomeh AU - Osadiaye, Olanlesi AU - Adebayo, Khadijat AU - Usinoma, Adewunmi AU - Adewole, Ajoke AU - Odunukwe, Nkiruka AU - Okuyemi, Kola AU - Kengne, Pascal Andre PY - 2021/6/9 TI - mHealth Interventions for Treatment Adherence and Outcomes of Care for Cardiometabolic Disease Among Adults Living With HIV: Systematic Review JO - JMIR Mhealth Uhealth SP - e20330 VL - 9 IS - 6 KW - mHealth KW - HIV KW - cardiometabolic disease KW - text messaging KW - mobile KW - systematic review KW - telephone calls KW - wearable devices KW - smartphones KW - desktop KW - web-based KW - mobile apps N2 - Background: The success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV. Objective: Our aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV. Methods: A systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV. Results: Our search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. Conclusions: Due to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018086940 UR - https://mhealth.jmir.org/2021/6/e20330 UR - http://dx.doi.org/10.2196/20330 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106075 ID - info:doi/10.2196/20330 ER - TY - JOUR AU - Maddison, Ralph AU - Jiang, Yannan AU - Stewart, Ralph AU - Scott, Tony AU - Kerr, Andrew AU - Whittaker, Robyn AU - Benatar, Jocelyn AU - Rolleston, Anna AU - Estabrooks, Paul AU - Dale, Leila PY - 2021/6/9 TI - An Intervention to Improve Medication Adherence in People With Heart Disease (Text4HeartII): Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e24952 VL - 9 IS - 6 KW - cardiovascular disease KW - self-management KW - text messaging KW - risk factors N2 - Background: Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease. Objective: This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks. Methods: A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks. Results: Participants were predominantly male (113/306, 80.3%) and European New Zealanders (210/306, 68.6%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing recordswere available for all participants; 92% (282/306, 92.1%) of participants completed a 24-week questionnaire and 95.1% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8% vs 105/153, 68.6%, odds ratio 0.60, 95% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9% vs 83/153, 54.2%; odds ratio 0.56, 95% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups. Conclusions: Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2468-z UR - https://mhealth.jmir.org/2021/6/e24952 UR - http://dx.doi.org/10.2196/24952 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106081 ID - info:doi/10.2196/24952 ER - TY - JOUR AU - Zhu, Y. Tracy AU - Rothenbühler, Martina AU - Hamvas, Györgyi AU - Hofmann, Anja AU - Welter, JoEllen AU - Kahr, Maike AU - Kimmich, Nina AU - Shilaih, Mohaned AU - Leeners, Brigitte PY - 2021/6/8 TI - The Accuracy of Wrist Skin Temperature in Detecting Ovulation Compared to Basal Body Temperature: Prospective Comparative Diagnostic Accuracy Study JO - J Med Internet Res SP - e20710 VL - 23 IS - 6 KW - ovulation KW - basal body temperature KW - BBT KW - oral temperature KW - wrist skin temperature KW - diagnostic accuracy KW - thermometer KW - fertility KW - menstruation KW - wearable KW - sensor KW - mobile phone N2 - Background: As a daily point measurement, basal body temperature (BBT) might not be able to capture the temperature shift in the menstrual cycle because a single temperature measurement is present on the sliding scale of the circadian rhythm. Wrist skin temperature measured continuously during sleep has the potential to overcome this limitation. Objective: This study compares the diagnostic accuracy of these two temperatures for detecting ovulation and to investigate the correlation and agreement between these two temperatures in describing thermal changes in menstrual cycles. Methods: This prospective study included 193 cycles (170 ovulatory and 23 anovulatory) collected from 57 healthy women. Participants wore a wearable device (Ava Fertility Tracker bracelet 2.0) that continuously measured the wrist skin temperature during sleep. Daily BBT was measured orally and immediately upon waking up using a computerized fertility tracker with a digital thermometer (Lady-Comp). An at-home luteinizing hormone test was used as the reference standard for ovulation. The diagnostic accuracy of using at least one temperature shift detected by the two temperatures in detecting ovulation was evaluated. For ovulatory cycles, repeated measures correlation was used to examine the correlation between the two temperatures, and mixed effect models were used to determine the agreement between the two temperature curves at different menstrual phases. Results: Wrist skin temperature was more sensitive than BBT (sensitivity 0.62 vs 0.23; P<.001) and had a higher true-positive rate (54.9% vs 20.2%) for detecting ovulation; however, it also had a higher false-positive rate (8.8% vs 3.6%), resulting in lower specificity (0.26 vs 0.70; P=.002). The probability that ovulation occurred when at least one temperature shift was detected was 86.2% for wrist skin temperature and 84.8% for BBT. Both temperatures had low negative predictive values (8.8% for wrist skin temperature and 10.9% for BBT). Significant positive correlation between the two temperatures was only found in the follicular phase (rmcorr correlation coefficient=0.294; P=.001). Both temperatures increased during the postovulatory phase with a greater increase in the wrist skin temperature (range of increase: 0.50 °C vs 0.20 °C). During the menstrual phase, the wrist skin temperature exhibited a greater and more rapid decrease (from 36.13 °C to 35.80 °C) than BBT (from 36.31 °C to 36.27 °C). During the preovulatory phase, there were minimal changes in both temperatures and small variations in the estimated daily difference between the two temperatures, indicating an agreement between the two curves. Conclusions: For women interested in maximizing the chances of pregnancy, wrist skin temperature continuously measured during sleep is more sensitive than BBT for detecting ovulation. The difference in the diagnostic accuracy of these methods was likely attributed to the greater temperature increase in the postovulatory phase and greater temperature decrease during the menstrual phase for the wrist skin temperatures. UR - https://www.jmir.org/2021/6/e20710 UR - http://dx.doi.org/10.2196/20710 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100763 ID - info:doi/10.2196/20710 ER - TY - JOUR AU - Haque, M. Munirul AU - Rabbani, Masud AU - Dipal, Das Dipranjan AU - Zarif, Islam Md Ishrak AU - Iqbal, Anik AU - Schwichtenberg, Amy AU - Bansal, Naveen AU - Soron, Rashid Tanjir AU - Ahmed, Ishtiaque Syed AU - Ahamed, Iqbal Sheikh PY - 2021/6/8 TI - Informing Developmental Milestone Achievement for Children With Autism: Machine Learning Approach JO - JMIR Med Inform SP - e29242 VL - 9 IS - 6 KW - autism spectrum disorders KW - machine learning KW - digital health KW - mobile health KW - mhealth KW - predictive modeling KW - milestone parameters KW - Autism and Developmental Disabilities Monitoring (ADDM) KW - early intervention N2 - Background: Care for children with autism spectrum disorder (ASD) can be challenging for families and medical care systems. This is especially true in low- and- middle-income countries such as Bangladesh. To improve family?practitioner communication and developmental monitoring of children with ASD, mCARE (Mobile-Based Care for Children with Autism Spectrum Disorder Using Remote Experience Sampling Method) was developed. Within this study, mCARE was used to track child milestone achievement and family sociodemographic assets to inform mCARE feasibility/scalability and family asset?informed practitioner recommendations. Objective: The objectives of this paper are threefold. First, it documents how mCARE can be used to monitor child milestone achievement. Second, it demonstrates how advanced machine learning models can inform our understanding of milestone achievement in children with ASD. Third, it describes family/child sociodemographic factors that are associated with earlier milestone achievement in children with ASD (across 5 machine learning models). Methods: Using mCARE-collected data, this study assessed milestone achievement in 300 children with ASD from Bangladesh. In this study, we used 4 supervised machine learning algorithms (decision tree, logistic regression, K-nearest neighbor [KNN], and artificial neural network [ANN]) and 1 unsupervised machine learning algorithm (K-means clustering) to build models of milestone achievement based on family/child sociodemographic details. For analyses, the sample was randomly divided in half to train the machine learning models and then their accuracy was estimated based on the other half of the sample. Each model was specified for the following milestones: Brushes teeth, Asks to use the toilet, Urinates in the toilet or potty, and Buttons large buttons. Results: This study aimed to find a suitable machine learning algorithm for milestone prediction/achievement for children with ASD using family/child sociodemographic characteristics. For Brushes teeth, the 3 supervised machine learning models met or exceeded an accuracy of 95% with logistic regression, KNN, and ANN as the most robust sociodemographic predictors. For Asks to use toilet, 84.00% accuracy was achieved with the KNN and ANN models. For these models, the family sociodemographic predictors of ?family expenditure? and ?parents? age? accounted for most of the model variability. The last 2 parameters, Urinates in toilet or potty and Buttons large buttons, had an accuracy of 91.00% and 76.00%, respectively, in ANN. Overall, the ANN had a higher accuracy (above ~80% on average) among the other algorithms for all the parameters. Across the models and milestones, ?family expenditure,? ?family size/type,? ?living places,? and ?parent?s age and occupation? were the most influential family/child sociodemographic factors. Conclusions: mCARE was successfully deployed in a low- and middle-income country (ie, Bangladesh), providing parents and care practitioners a mechanism to share detailed information on child milestones achievement. Using advanced modeling techniques this study demonstrates how family/child sociodemographic elements can inform child milestone achievement. Specifically, families with fewer sociodemographic resources reported later milestone attainment. Developmental science theories highlight how family/systems can directly influence child development and this study provides a clear link between family resources and child developmental progress. Clinical implications for this work could include supporting the larger family system to improve child milestone achievement. UR - https://medinform.jmir.org/2021/6/e29242 UR - http://dx.doi.org/10.2196/29242 UR - http://www.ncbi.nlm.nih.gov/pubmed/33984830 ID - info:doi/10.2196/29242 ER - TY - JOUR AU - Trettin, Bettina AU - Danbjørg, Boe Dorthe AU - Andersen, Flemming AU - Feldman, Steven AU - Agerskov, Hanne PY - 2021/6/8 TI - An mHealth App to Support Patients With Psoriasis in Relation to Follow-up Consultations: Qualitative Study JO - JMIR Dermatol SP - e28882 VL - 4 IS - 1 KW - psoriasis KW - teledermatology KW - qualitative KW - video consultations KW - app KW - participatory design KW - mHealth KW - telehealth KW - patient-physician relationship KW - dermatology N2 - Background: Teledermatology has the potential to help deliver health care by transforming the relationship between patients and health care professionals (HCPs), shifting the power of consultation so that patients can become more informed, assertive, and involved in their care. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis on systemic treatment. In an attempt to facilitate a more patient-centered approach in clinical practice, we designed and developed an mHealth solution to support patients with self-management and empowerment. Objective: The aim of this study is to explore the experiences and perceptions of patients and health care professionals of using an mHealth solution that was developed using a participatory design approach. Methods: This was an exploratory qualitative study. Data were collected through semistructured interviews with patients and focus group interviews with HCPs. Results: All participants found it easy to use the mHealth solution, and the patients found it convenient. Patients? reflexivity was improved because they could prepare ahead of consultations. Video consultations provided patients with a degree of freedom in their everyday lives, with not having to attend in-person visits. Among the HCPs, there were concerns regarding their medical responsibilities, as they could not assess the patients? skin as they used to. The mHealth solution required new workflows and procedures that were not part of the existing consultation routines. Conclusions: The mHealth solution can strengthen the relationship between HCPs and patients and facilitate patients to become more active in their care. Alignment and structure in relation to the selection of eligible patient candidates for being offered the mHealth solution could reduce social health inequalities. In addition, video consultations changed HCPs? work practice, necessitating new types of skills to communicate with patients. UR - https://derma.jmir.org/2021/1/e28882 UR - http://dx.doi.org/10.2196/28882 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632803 ID - info:doi/10.2196/28882 ER - TY - JOUR AU - Lau, Nancy AU - O'Daffer, Alison AU - Yi-Frazier, Joyce AU - Rosenberg, R. Abby PY - 2021/6/7 TI - Goldilocks and the Three Bears: A Just-Right Hybrid Model to Synthesize the Growing Landscape of Publicly Available Health-Related Mobile Apps JO - J Med Internet Res SP - e27105 VL - 23 IS - 6 KW - telemedicine KW - smartphone KW - mobile phones KW - mHealth KW - mobile apps KW - health services UR - https://www.jmir.org/2021/6/e27105 UR - http://dx.doi.org/10.2196/27105 UR - http://www.ncbi.nlm.nih.gov/pubmed/34096868 ID - info:doi/10.2196/27105 ER - TY - JOUR AU - Quilty, Lena AU - Agic, Branka AU - Coombs, Michelle AU - Kristy, Betty-Lou AU - Shakespeare, Jill AU - Spafford, Adrienne AU - Besa, Reena AU - Dematagoda, Shadini AU - Patel, Alina AU - Persaud, Rebecca AU - Buckley, Leslie PY - 2021/6/7 TI - Benefits of Digital Health Resources for Substance Use Concerns in Women: Scoping Review JO - JMIR Ment Health SP - e25952 VL - 8 IS - 6 KW - women KW - female KW - gender-specific KW - digital health KW - internet KW - mobile app KW - technology KW - technology interventions KW - technology-based intervention KW - web-based intervention KW - substance use concerns KW - trauma N2 - Background: Digital health resources are being increasingly used to support women with substance use concerns. Although empirical research has demonstrated that these resources have promise, the available evidence for their benefit in women requires further investigation. Evidence supports the capacity of interventions that are sex-, gender-, and trauma-informed to improve treatment access and outcomes and to reduce health system challenges and disparities. Indeed, both sex- and gender-specific approaches are critical to improve health and gender equity. Violence and trauma are frequent among those with substance use concerns, but they disproportionately affect those who identify as female or women, further underscoring the need for trauma-informed care as well. Objective: The objective of this investigation was to evaluate the evidence supporting the efficacy or effectiveness of online or mobile interventions for risky or harmful substance use in adults who identify as female or women, or who report a history of trauma. Methods: This scoping review is based on an academic search in MEDLINE, APA PsycINFO, Embase, Cochrane Central, and CINAHL, as well as a grey literature search in US and Canadian government and funding agency websites. Of the 7807 records identified, 465 remained following title and abstract screening. Of these, 159 met all eligibility criteria and were reviewed and synthesized. Results: The 159 records reflected 141 distinct studies and 125 distinct interventions. Investigations and the interventions evaluated predominantly focused on alcohol use or general substance use. Evaluated digital health resources included multisession and brief-session interventions, with a wide range of therapeutic elements. Multisession online and mobile interventions exhibited beneficial effects in 86.1% (105/122) of studies. Single-session interventions similarly demonstrated beneficial effects in 64.2% (43/67) of study conditions. Most investigations did not assess gender identity or conduct sex- or gender-based analyses. Only 13 investigations that included trauma were identified. Conclusions: Despite the overall promise of digital health interventions for substance use concerns, direct or quantitative evidence on the efficacy or effectiveness of interventions in females or women specifically is weak. UR - https://mental.jmir.org/2021/6/e25952 UR - http://dx.doi.org/10.2196/25952 UR - http://www.ncbi.nlm.nih.gov/pubmed/34096879 ID - info:doi/10.2196/25952 ER - TY - JOUR AU - Boumparis, Nikolaos AU - Schulte, H. Mieke AU - Kleiboer, Annet AU - Huizink, Anja AU - Riper, Heleen PY - 2021/6/7 TI - A Mobile Intervention to Promote Low-Risk Drinking Habits in Young Adults: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e29750 VL - 10 IS - 6 KW - alcohol KW - lifestyle KW - drinking KW - young adults KW - digital KW - mobile app KW - COVID-19 N2 - Background: Young adults? drinking habits commonly exceed recommendations for low-risk drinking, which may have a negative effect on their mental, social, and physical health. As smartphones are highly accessible to young adults, mobile apps could be used to support young adults to develop low-risk drinking habits and improve their general health. Objective: The objective of this study is to evaluate the effectiveness of Boozebuster, a self-guided mobile app based on healthy lifestyle?related components that aim to develop and maintain low-risk drinking habits among young adults. Methods: This two-arm, parallel-group randomized controlled trial will investigate whether a 6-week self-guided mobile intervention (Boozebuster) targeting drinking behavior is more effective than a minimal intervention consisting of an educational website on alcohol use and its consequences for young adults. We will recruit 506 young adults (aged 18-30 years) from the Netherlands via an open recruitment strategy by using an open access website. All outcomes will be self-assessed through questionnaires. The primary outcome is the quantity and frequency of alcohol consumption in standard drinks (10 g ethanol per standard drink) per month (timeline follow-back [TLFB]). Secondary outcomes include binge-drinking sessions per month, alcohol-related problem severity (Rutgers Alcohol Problem Index), cannabis use frequency and quantity in grams (TLFB), depressive symptoms (Center for Epidemiological Studies Depression Scale), perceived stress (Perceived Stress Scale), engagement (Twente Engagement with eHealth Technologies Scale), readiness to change (Readiness to Change Questionnaire), mental well-being (Warwick-Edinburgh Mental Wellbeing Scale), trauma and COVID-19?related trauma (Short-Form Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), impulsivity (Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behavior Scale), study or work performance (Individual Work Performance Questionnaire), and treatment adherence. Baseline (T0), 6-week postbaseline (T1), and 3-month postbaseline (T2) assessments will be conducted and analyzed on the basis of the intention-to-treat principle using multilevel mixed modeling analyses. Results: Recruitment began in September 2020. We received 933 registrations via our study information website; 506 participants have completed the T0 assessment, 336 participants have completed the T1 assessment, and 308 participants have completed the T2 assessment as of May 2021. The study is still in progress, and results will be reported in 2021 and 2022. Conclusions: Self-guided mobile interventions based on a lifestyle approach might be an attractive approach for young adults due to their preference on self-reliance, healthy living, and increased perceived anonymity. Such interventions are yet understudied, and it is known that interventions addressing solely problem drinking are less appealing to young adults. We hypothesize that the Boozebuster mobile app will effectively reduce drinking levels compared to an alcohol educational website (control condition). If effective, our intervention could be an inexpensive and scalable public health intervention to improve drinking habits in young adults. Trial Registration: Netherlands Trial Register NL8828; https://www.trialregister.nl/trial/8828 International Registered Report Identifier (IRRID): DERR1-10.2196/29750 UR - https://www.researchprotocols.org/2021/6/e29750 UR - http://dx.doi.org/10.2196/29750 UR - http://www.ncbi.nlm.nih.gov/pubmed/34033583 ID - info:doi/10.2196/29750 ER - TY - JOUR AU - Mack, L. Dante AU - DaSilva, W. Alex AU - Rogers, Courtney AU - Hedlund, Elin AU - Murphy, I. Eilis AU - Vojdanovski, Vlado AU - Plomp, Jane AU - Wang, Weichen AU - Nepal, K. Subigya AU - Holtzheimer, E. Paul AU - Wagner, D. Dylan AU - Jacobson, C. Nicholas AU - Meyer, L. Meghan AU - Campbell, T. Andrew AU - Huckins, F. Jeremy PY - 2021/6/4 TI - Mental Health and Behavior of College Students During the COVID-19 Pandemic: Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study, Part II JO - J Med Internet Res SP - e28892 VL - 23 IS - 6 KW - anxiety KW - college KW - COVID-19 KW - COVID fatigue KW - depression KW - George Floyd KW - mobile sensing KW - phone usage KW - sleep KW - digital phenotyping N2 - Background: Since late 2019, the lives of people across the globe have been disrupted by COVID-19. Millions of people have become infected with the disease, while billions of people have been continually asked or required by local and national governments to change their behavioral patterns. Previous research on the COVID-19 pandemic suggests that it is associated with large-scale behavioral and mental health changes; however, few studies have been able to track these changes with frequent, near real-time sampling or compare these changes to previous years of data for the same individuals. Objective: By combining mobile phone sensing and self-reported mental health data in a cohort of college-aged students enrolled in a longitudinal study, we seek to understand the behavioral and mental health impacts associated with the COVID-19 pandemic, measured by interest across the United States in the search terms coronavirus and COVID fatigue. Methods: Behaviors such as the number of locations visited, distance traveled, duration of phone use, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments, including the Patient Health Questionnaire-4. The participants were 217 undergraduate students. Differences in behaviors and self-reported mental health collected during the Spring 2020 term, as compared to previous terms in the same cohort, were modeled using mixed linear models. Results: Linear mixed models demonstrated differences in phone use, sleep, sedentary time and number of locations visited associated with the COVID-19 pandemic. In further models, these behaviors were strongly associated with increased interest in COVID fatigue. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, phone use, sedentary time), both anxiety and depression (P<.001) were significantly associated with interest in COVID fatigue. Notably, these behavioral and mental health changes are consistent with those observed around the initial implementation of COVID-19 lockdowns in the spring of 2020. Conclusions: In the initial lockdown phase of the COVID-19 pandemic, people spent more time on their phones, were more sedentary, visited fewer locations, and exhibited increased symptoms of anxiety and depression. As the pandemic persisted through the spring, people continued to exhibit very similar changes in both mental health and behaviors. Although these large-scale shifts in mental health and behaviors are unsurprising, understanding them is critical in disrupting the negative consequences to mental health during the ongoing pandemic. UR - https://www.jmir.org/2021/6/e28892 UR - http://dx.doi.org/10.2196/28892 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900935 ID - info:doi/10.2196/28892 ER - TY - JOUR AU - Ray, Katherine Mary AU - McMichael, Alana AU - Rivera-Santana, Maria AU - Noel, Jacob AU - Hershey, Tamara PY - 2021/6/3 TI - Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies JO - JMIR Diabetes SP - e27027 VL - 6 IS - 2 KW - ecological momentary assessment KW - continuous glucose monitoring KW - actigraphy KW - accelerometer KW - ambulatory blood pressure monitoring KW - personal digital assistant KW - mobile phone KW - smartphone KW - mHealth UR - https://diabetes.jmir.org/2021/2/e27027 UR - http://dx.doi.org/10.2196/27027 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081017 ID - info:doi/10.2196/27027 ER - TY - JOUR AU - Salari, Raheleh AU - R Niakan Kalhori, Sharareh AU - GhaziSaeedi, Marjan AU - Jeddi, Marjan AU - Nazari, Mahin AU - Fatehi, Farhad PY - 2021/6/2 TI - Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation JO - J Med Internet Res SP - e18167 VL - 23 IS - 6 KW - type 2 diabetes KW - mobile health KW - mHealth KW - mobile app, self-management KW - behavior change N2 - Background: As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis. Objective: This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers. Methods: The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire. Results: The developed mobile app includes modules that support several features. A person?s data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician?s portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app. Conclusions: Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up. UR - https://www.jmir.org/2021/6/e18167 UR - http://dx.doi.org/10.2196/18167 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076579 ID - info:doi/10.2196/18167 ER - TY - JOUR AU - Sun, Ruo-Ting AU - Han, Wencui AU - Chang, Hsin-Lu AU - Shaw, J. Michael PY - 2021/6/2 TI - Motivating Adherence to Exercise Plans Through a Personalized Mobile Health App: Enhanced Action Design Research Approach JO - JMIR Mhealth Uhealth SP - e19941 VL - 9 IS - 6 KW - adherence KW - mobile health KW - motivation KW - personality KW - MBTI KW - action design research KW - mobile phone N2 - Background: Physical inactivity is a global issue that affects people?s health and productivity. With the advancement of mobile technologies, many apps have been developed to facilitate health self-management. However, few studies have examined the effectiveness of these mobile health (mHealth) apps in motivating exercise adherence. Objective: This study aims to demonstrate the enhanced action design research (ADR) process and improve the design of mHealth apps for exercise self-management. Specifically, we investigate whether sending motivational messages improves adherence to exercise plans, whether the motivational effect is affected by personality, the impact of message type and repetition, and the process of involving a field experiment in the design process and learning new design principles from the results. Methods: This formative research was conducted by proposing an enhanced ADR process. We incorporated a field experiment into the process to iteratively refine and evaluate the design until it converges into a final mHealth app. We used the Apple ResearchKit to develop the mHealth app and promoted it via trainers at their gyms. We targeted users who used the app for at least two months. Participants were randomly assigned to 1 of the 12 groups in a 2×3×2 factorial design and remained blinded to the assigned intervention. The groups were defined based on personality type (thinking or feeling), message type (emotional, logical, or none), and repetition (none or once). Participants with different personality types received tailored and repeated messages. Finally, we used the self-reported completion rate to measure participants? adherence level to exercise plans. By analyzing users? usage patterns, we could verify, correct, and enhance the mHealth app design principles. Results: In total, 160 users downloaded the app, and 89 active participants remained during the 2-month period. The results suggest a significant main effect of personality type and repetition and a significant interaction effect between personality type and repetition. The adherence rate of people with feeling personality types was 18.15% higher than that of people with thinking types. Emotional messages were more effective than logical messages in motivating exercise adherence. Although people received repeated messages, they were more likely to adhere to exercise plans. With repeated reminders, the adherence rates of people with thinking personality types were significantly improved by 27.34% (P<.001). Conclusions: This study contributes to the literature on mHealth apps. By incorporating a field experiment into the ADR process, we demonstrate the benefit of combining design science and field experiments. This study also contributes to the research on mHealth apps. The principles learned from this study can be applied to improve the effectiveness of mHealth apps. The app design can be considered a foundation for the development of more advanced apps for specific diseases, such as diabetes and asthma, in future research. UR - https://mhealth.jmir.org/2021/6/e19941 UR - http://dx.doi.org/10.2196/19941 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076580 ID - info:doi/10.2196/19941 ER - TY - JOUR AU - Yoon, Sungwon AU - Goh, Hendra AU - Nadarajan, Devi Gayathri AU - Sung, Sharon AU - Teo, Irene AU - Lee, Jungup AU - Ong, H. Marcus E. AU - Graves, Nicholas AU - Teo, Lin Tess PY - 2021/5/31 TI - Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study JO - J Med Internet Res SP - e26282 VL - 23 IS - 5 KW - COVID-19 KW - frontline health care workers KW - mHealth KW - well-being KW - psychosocial N2 - Background: Frontline health care workers are experiencing a myriad of physical and psychosocial challenges amid the COVID-19 pandemic. There is growing recognition that digital technologies have the potential to improve the well-being of frontline workers. However, there has been limited development of wellness interventions using mobile health (mHealth) technology. More importantly, little research has been conducted on how frontline workers perceive mHealth-based support to promote their well-being. Objective: This study aimed to explore frontline workers? experience of conventional psychological wellness programs and their perceptions of the usefulness of mHealth apps and features for promoting well-being. It also sought to identify factors that could potentially influence uptake and retention of an mHealth-based wellness program. Methods: We conducted semistructured interviews using purposive sampling with frontline workers involved in the COVID-19 response. Various visual materials, collated from existing mHealth app features, were presented to facilitate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis based on grounded theory was undertaken. Themes were subsequently mapped to key nudge strategies?those commonly used for mHealth development?to assess participants? preferences for particular features and their reasoning. Results: A total of 42 frontline workers participated in 12 one-on-one interviews or focus group discussions. Frontline workers generally had a limited ability to identify their own psychological problems and liked the reminders functionality of the app to track their mood over time. A personalized goal-setting feature (ie, tailoring) and in-app resources were generally valued, while frequent coaching and messages (ie, framing) were seen as a distraction. The majority of participants desired a built-in chat function with a counselor (ie, guidance) for reasons of accessibility and protection of privacy. Very few participants appreciated a gamification function. Frontline workers commonly reported the need for ongoing social support and desired access to an in-app peer support community (ie, social influence). There were, however, concerns regarding potential risks from virtual peer interactions. Intrinsic motivational factors, mHealth app technicality, and tangible rewards were identified as critical for uptake and retention. Conclusions: Our study highlights the potential of mHealth apps with relevant features to be used as wellness tools by frontline health care workers. Future work should focus on developing a nonintrusive and personalized mHealth app with in-app counseling, peer support to improve well-being, and tangible and extrinsic rewards to foster continued use. UR - https://www.jmir.org/2021/5/e26282 UR - http://dx.doi.org/10.2196/26282 UR - http://www.ncbi.nlm.nih.gov/pubmed/33979296 ID - info:doi/10.2196/26282 ER - TY - JOUR AU - Alzamanan, Zaied Mohsen AU - Lim, Kheng-Seang AU - Akmar Ismail, Maizatul AU - Abdul Ghani, Norjihan PY - 2021/5/28 TI - Self-Management Apps for People With Epilepsy: Systematic Analysis JO - JMIR Mhealth Uhealth SP - e22489 VL - 9 IS - 5 KW - mobile health KW - epilepsy KW - self-management KW - smartphone N2 - Background: Patients with epilepsy (PWEs) are motivated to manage and cope with their disorder themselves (ie, self-management [SM] is encouraged). Mobile health (mHealth) apps have multiple features that have a huge potential to improve SM of individuals with chronic disorders such as epilepsy. Objective: This study aimed to review all freely available apps related to the SM of PWEs and to determine the SM domains covered in these apps. Methods: We performed a search of apps on Google Play and App Store using the keywords ?epilepsy? or ?seizures? from May to August 2018. Apps were included if they were free and in English language. We excluded apps with installation-related issues and not related to epilepsy self-management (eSM). Results: A total of 22 eSM apps were identified in our search: 6 of these run only on iOS, 7 only on Android, and 9 run on both operating systems. Of the 11 domains of SM, seizure tracking and seizure response features were covered by most apps (n=22 and n=19, respectively), followed by treatment management (n=17) and medication adherence (n=15). Three apps (Epilepsy Journal, Epilepsy Tool Kit, and EpiDiary) were installed more than 10,000 times, with features focused specifically on a few domains (treatment management, medication adherence, health care communication, and seizure tracking). Two apps (Young Epilepsy and E-Epilepsy Inclusion) covered more than 6 SM domains but both had lower installation rates (5000+ and 100+, respectively). Conclusions: Both Android and iOS mHealth apps are available to improve SM in epilepsy, but the installation rate of most apps remains low. The SM features of these apps were different from one another, making it difficult to recommend a single app that completely fulfills the needs of PWEs. The common features of the apps evaluated included seizure tracking and seizure response. To improve the efficacy and availability of these apps, we propose the following: (1) involve the stakeholders, such as physicians, pharmacists, and PWEs, during the development of mHealth apps; (2) assess the efficacy and acceptance of the apps objectively by performing a usability analysis; and (3) promote the apps so that they benefit more PWEs. UR - https://mhealth.jmir.org/2021/5/e22489 UR - http://dx.doi.org/10.2196/22489 UR - http://www.ncbi.nlm.nih.gov/pubmed/34047709 ID - info:doi/10.2196/22489 ER - TY - JOUR AU - Karim, Lynn Jalisa AU - Talhouk, Aline PY - 2021/5/28 TI - Person-Generated Health Data in Women?s Health: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e26110 VL - 10 IS - 5 KW - digital health KW - women?s health KW - mobile health KW - health app KW - wearables KW - femtech KW - self-tracking KW - personalized health KW - person-generated health data KW - patient-generated health data KW - scoping review N2 - Background: Due to their ability to collect person-generated health data, digital tools and connected health devices may hold great utility in disease prevention, chronic disease self-monitoring and self-tracking, as well as in tailoring information and educational content to fit individual needs. Facilitators and barriers to the use of digital health technologies vary across demographics, including sex. The ?femtech? market is growing rapidly, and women are some of the largest adopters of digital health technologies. Objective: This paper aims to provide the background and methods for conducting a scoping review on the use of person-generated health data from connected devices in women?s health. The objectives of the scoping review are to identify the various contexts of digital technologies in women?s health and to consolidate women?s views on the usability and acceptability of the devices. Methods: Searches were conducted in the following databases: Medline, Embase, APA PsycInfo, CINAHL Complete, and Web of Science Core Collection. We included articles from January 2015 to February 2020. Screening of articles was done independently by at least two authors in two stages. Data charting is being conducted in duplicate. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Results: Our search identified 9102 articles after deduplication. As of November 2020, the full-text screening stage is almost complete and data charting is in progress. The scoping review is expected to be completed by Fall 2021. Conclusions: This scoping review will broadly map the literature regarding the contexts and acceptability of digital health tools for women. The results from this review will be useful in guiding future digital health and women?s health research. International Registered Report Identifier (IRRID): DERR1-10.2196/26110 UR - https://www.researchprotocols.org/2021/5/e26110 UR - http://dx.doi.org/10.2196/26110 UR - http://www.ncbi.nlm.nih.gov/pubmed/34047708 ID - info:doi/10.2196/26110 ER - TY - JOUR AU - Charles, Ashleigh AU - Nixdorf, Rebecca AU - Ibrahim, Nashwa AU - Meir, Gai Lion AU - Mpango, S. Richard AU - Ngakongwa, Fileuka AU - Nudds, Hannah AU - Pathare, Soumitra AU - Ryan, Grace AU - Repper, Julie AU - Wharrad, Heather AU - Wolf, Philip AU - Slade, Mike AU - Mahlke, Candelaria PY - 2021/5/27 TI - Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation JO - JMIR Ment Health SP - e25528 VL - 8 IS - 5 KW - peer support work KW - peer support worker training KW - Delphi consultation KW - mental health KW - mobile phone N2 - Background: Initial training is essential for the mental health peer support worker (PSW) role. Training needs to incorporate recent advances in digital peer support and the increase of peer support work roles internationally. There is a lack of evidence on training topics that are important for initial peer support work training and on which training topics can be provided on the internet. Objective: The objective of this study is to establish consensus levels about the content of initial training for mental health PSWs and the extent to which each identified topic can be delivered over the internet. Methods: A systematized review was conducted to identify a preliminary list of training topics from existing training manuals. Three rounds of Delphi consultation were then conducted to establish the importance and web-based deliverability of each topic. In round 1, participants were asked to rate the training topics for importance, and the topic list was refined. In rounds 2 and 3, participants were asked to rate each topic for importance and the extent to which they could be delivered over the internet. Results: The systematized review identified 32 training manuals from 14 countries: Argentina, Australia, Brazil, Canada, Chile, Germany, Ireland, the Netherlands, Norway, Scotland, Sweden, Uganda, the United Kingdom, and the United States. These were synthesized to develop a preliminary list of 18 topics. The Delphi consultation involved 110 participants (49 PSWs, 36 managers, and 25 researchers) from 21 countries (14 high-income, 5 middle-income, and 2 low-income countries). After the Delphi consultation (round 1: n=110; round 2: n=89; and round 3: n=82), 20 training topics (18 universal and 2 context-specific) were identified. There was a strong consensus about the importance of five topics: lived experience as an asset, ethics, PSW well-being, and PSW role focus on recovery and communication, with a moderate consensus for all other topics apart from the knowledge of mental health. There was no clear pattern of differences among PSW, manager, and researcher ratings of importance or between responses from participants in countries with different resource levels. All training topics were identified with a strong consensus as being deliverable through blended web-based and face-to-face training (rating 1) or fully deliverable on the internet with moderation (rating 2), with none identified as only deliverable through face-to-face teaching (rating 0) or deliverable fully on the web as a stand-alone course without moderation (rating 3). Conclusions: The 20 training topics identified can be recommended for inclusion in the curriculum of initial training programs for PSWs. Further research on web-based delivery of initial training is needed to understand the role of web-based moderation and whether web-based training better prepares recipients to deliver web-based peer support. UR - https://mental.jmir.org/2021/5/e25528 UR - http://dx.doi.org/10.2196/25528 UR - http://www.ncbi.nlm.nih.gov/pubmed/34042603 ID - info:doi/10.2196/25528 ER - TY - JOUR AU - Venkatesan, Aarathi AU - Krymis, Holly AU - Scharff, Jenny AU - Waber, Art PY - 2021/5/25 TI - Changes in Perceived Stress Following a 10-Week Digital Mindfulness-Based Stress Reduction Program: Retrospective Study JO - JMIR Form Res SP - e25078 VL - 5 IS - 5 KW - perceived stress KW - health coaching KW - digital mental health intervention KW - digital therapeutics KW - mobile phone N2 - Background: As the need for effective scalable interventions for mental health conditions such as depression, anxiety, and stress has grown, the digital delivery of mindfulness-based stress reduction (MBSR) has gained interest as a promising intervention in this domain. Objective: This study aims to evaluate the changes in perceived stress following a 10-week digital MBSR program that combined an app-based digital program with weekly one-on-one remote sessions with a health coach. Methods: This study used a retrospective, observational design. A total of 229 participants with moderate-to-high perceived stress scores as assessed by the Perceived Stress Scale (PSS)-10 enrolled in the 10-week Vida Health MBSR program. The program included weekly remote sessions with a certified health coach and digital content based on concepts fundamental to mindfulness practice. The PSS-10 was used to evaluate perceived stress. Of the 229 participants, 131 (57.2%) were considered program completers and provided at least one follow-up PSS-10. A secondary analysis examined the changes in stress scores at 6 months. This analysis was restricted to participants who had been enrolled in the program for at least 6 months (n=121). To account for random and fixed effects, linear mixed effects modeling was used to assess changes in stress scores over time. An intention-to-treat approach was used to evaluate the changes in perceived stress across the entire study cohort, including those who were lost to follow-up. In addition, a reliable change index was computed to evaluate the changes in scores from the baseline. Results: The findings revealed a significant positive association between program time and stress reduction (B=?0.365; P<.001) at 12 weeks. We observed an average reduction in stress scores of 3.17 points (95% CI ?3.93 to ?2.44) by program week 6 and 4.86 points (95% CI ?5.86 to ?3.85) by program week 12. Overall, 83.2% (109/131) of participants showed a reduction in stress scores by week 12, with 40.5% (53/131) of participants showing reliable improvement at 12 weeks and 47.8% (56/131) of participants showing a shift to a lower stress level category (ie, moderate-to-low stress). The intention-to-treat analysis revealed a significant, although attenuated, reduction in stress scores at 12 weeks (B=?0.23; P<.001). Participants who completed more lessons had an increased likelihood of moving down at least one stress level category (odds ratio 1.512, 95% CI 1.056 to 2.166; P=.02). In assessing medium-term outcomes, among participants who had completed at least 6 months in the program, 48.8% (59/121) of members provided a 6-month assessment. We observed a significant reduction in stress scores at 6 months (t58=10.24; P<.001), with 61% (36/59) of participants showing reliable improvement. Conclusions: The findings of this retrospective, observational study suggest that a blended, digital mindfulness-based intervention may support program uptake and meaningful, sustained reduction in stress outcomes. UR - https://formative.jmir.org/2021/5/e25078 UR - http://dx.doi.org/10.2196/25078 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032571 ID - info:doi/10.2196/25078 ER - TY - JOUR AU - Al-Arkee, Shahd AU - Mason, Julie AU - Lane, A. Deirdre AU - Fabritz, Larissa AU - Chua, Winnie AU - Haque, Sayeed M. AU - Jalal, Zahraa PY - 2021/5/25 TI - Mobile Apps to Improve Medication Adherence in Cardiovascular Disease: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e24190 VL - 23 IS - 5 KW - mobile health care applications KW - medication adherence KW - cardiovascular disease KW - systematic review KW - mobile phone N2 - Background: Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. Objective: The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps? functionality and usability and the involvement of health care professionals in their use. Methods: Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. Results: This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. Conclusions: Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385 UR - https://www.jmir.org/2021/5/e24190 UR - http://dx.doi.org/10.2196/24190 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032583 ID - info:doi/10.2196/24190 ER - TY - JOUR AU - Hunt, Melissa AU - Miguez, Sofia AU - Dukas, Benji AU - Onwude, Obinna AU - White, Sarah PY - 2021/5/20 TI - Efficacy of Zemedy, a Mobile Digital Therapeutic for the Self-management of Irritable Bowel Syndrome: Crossover Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e26152 VL - 9 IS - 5 KW - digital health KW - irritable bowel syndrome KW - cognitive behavioral therapy KW - CBT KW - efficacy KW - mHealth KW - self-management KW - IBS KW - randomized controlled trial KW - app N2 - Background: Patients with irritable bowel syndrome (IBS) experience abdominal pain, altered bowel habits, and defecation-related anxiety, which can result in reduced productivity and impaired health-related quality of life (HRQL). Cognitive behavioral therapy (CBT) has been shown to reduce symptoms of IBS and to improve HRQL, but access to qualified therapists is limited. Smartphone-based digital therapeutic interventions have potential to increase access to guided CBT at scale, but require careful study to assess their benefits and risks. Objective: The aim of this study was to test the efficacy of a novel app, Zemedy, as a mobile digital therapeutic that delivers a comprehensive CBT program to individuals with IBS. Methods: This was a crossover randomized controlled trial. Participants were recruited online and randomly allocated to either immediate treatment (n=62) or waitlist control (n=59) groups. The Zemedy app consists of 8 modules focusing on psychoeducation, relaxation training, exercise, the cognitive model of stress management, applying CBT to IBS symptoms, reducing avoidance through exposure therapy, behavioral experiments, and information about diet. Users interact with a chatbot that presents the information and encourages specific plans, homework, and exercises. The treatment was fully automated, with no therapist involvement or communication. At baseline and after 8 weeks, participants were asked to complete the battery of primary (Irritable Bowel Syndrome Quality of Life [IBS-QOL], Gastrointestinal Symptom Rating Scale [GSRS]) and secondary (Fear of Food Questionnaire [FFQ], Visceral Sensitivity Index [VSI], Gastrointestinal Cognition Questionnaire [GI-COG], Depression Anxiety Stress Scale [DASS], and Patient Health Questionnaire-9 [PHQ-9]) outcome measures. Waitlist controls were then offered the opportunity to crossover to treatment. All participants were assessed once more at 3 months posttreatment. Results: Both intention-to-treat and completer analyses at posttreatment revealed significant improvement for the immediate treatment group compared to the waitlist control group on both primary and secondary outcome measures. Gains were generally maintained at 3 months posttreatment. Scores on the GSRS, IBS-QoL, GI-COG, VSI, and FFQ all improved significantly more in the treatment group (F1,79=20.49, P<.001, Cohen d=1.01; F1,79=20.12, P<.001, d=1.25; F1,79=34.71, P<.001, d=1.47; F1,79=18.7, P<.001, d=1.07; and F1,79=12.13, P=.001, d=0.62, respectively). Depression improved significantly as measured by the PHQ-9 (F1,79=10.5, P=.002, d=1.07), and the DASS Depression (F1,79=6.03, P=.02, d=.83) and Stress (F1,79=4.47, P=.04, d=0.65) subscales in the completer analysis but not in the intention-to-treat analysis. The impact of treatment on HRQL was mediated by reductions in catastrophizing and visceral sensitivity. Conclusions: Despite its relatively benign physical profile, IBS can be an extraordinarily debilitating condition. Zemedy is an effective modality to deliver CBT for individuals with IBS, and could increase accessibility of this evidence-based treatment. Trial Registration: ClinicalTrials.gov NCT04170686; https://www.clinicaltrials.gov/ct2/show/NCT04170686 UR - https://mhealth.jmir.org/2021/5/e26152 UR - http://dx.doi.org/10.2196/26152 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872182 ID - info:doi/10.2196/26152 ER - TY - JOUR AU - Lorenz, Arnold Kent AU - Yeshurun, Shlomo AU - Aziz, Richard AU - Ortiz-Delatorre, Julissa AU - Bagley, Robert James AU - Mor, Merav AU - Kern, Marialice PY - 2021/5/17 TI - A Handheld Metabolic Device (Lumen) to Measure Fuel Utilization in Healthy Young Adults: Device Validation Study JO - Interact J Med Res SP - e25371 VL - 10 IS - 2 KW - resting metabolic rate KW - Lumen KW - ParvoMedics TrueOne 2400 KW - validation KW - respiratory exchange ratio KW - metabolism KW - fuel utilization KW - indirect calorimetry KW - breath KW - lung KW - respiratory KW - young adult KW - measurement KW - testing N2 - Background: Metabolic carts measure the carbon dioxide (CO2) produced and oxygen consumed by an individual when breathing to assess metabolic fuel usage (carbohydrates versus fats). However, these systems are expensive, time-consuming, and only available in health care laboratory settings. A small handheld device capable of determining metabolic fuel usage via CO2 from exhaled air has been developed. Objective: The aim of this study is to evaluate the validity of a novel handheld device (Lumen) for measuring metabolic fuel utilization in healthy young adults. Methods: Metabolic fuel usage was assessed in healthy participants (n=33; mean age 23.1 years, SD 3.9 years) via respiratory exchange ratio (RER) values obtained from a metabolic cart as well as % CO2 from the Lumen device. Measurements were performed at rest in two conditions: fasting, and after consuming 150 grams of glucose, in order to determine changes in metabolic fuel usage. Reduced major axis regression and simple linear regression were performed to test for agreement between RER and Lumen % CO2. Results: Both RER and Lumen % CO2 significantly increased after glucose intake (P<.001 for both) compared with fasting conditions, by 0.089 and 0.28, respectively. Regression analyses revealed an agreement between the two measurements (F1,63=18.54; P<.001). Conclusions: This study shows the validity of Lumen for detecting changes in metabolic fuel utilization in a comparable manner with a laboratory standard metabolic cart, providing the ability for real-time metabolic information for users under any circumstances. UR - https://www.i-jmr.org/2021/2/e25371 UR - http://dx.doi.org/10.2196/25371 UR - http://www.ncbi.nlm.nih.gov/pubmed/33870899 ID - info:doi/10.2196/25371 ER - TY - JOUR AU - Badawy, M. Sherif AU - Abebe, Z. Kaleab AU - Reichman, A. Charlotte AU - Checo, Grace AU - Hamm, E. Megan AU - Stinson, Jennifer AU - Lalloo, Chitra AU - Carroll, Patrick AU - Saraf, L. Santosh AU - Gordeuk, R. Victor AU - Desai, Payal AU - Shah, Nirmish AU - Liles, Darla AU - Trimnell, Cassandra AU - Jonassaint, R. Charles PY - 2021/5/14 TI - Comparing the Effectiveness of Education Versus Digital Cognitive Behavioral Therapy for Adults With Sickle Cell Disease: Protocol for the Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications (CaRISMA) Study JO - JMIR Res Protoc SP - e29014 VL - 10 IS - 5 KW - sickle cell anemia KW - sickle cell disease KW - pain KW - depression KW - depressive symptoms KW - quality of life KW - digital KW - mHealth KW - eHealth KW - CBT KW - cognitive behavioral therapy KW - education KW - mobile phone N2 - Background: Patients with sickle cell disease (SCD) experience significant medical and psychological stressors that affect their mental health, well-being, and disease outcomes. Digital cognitive behavioral therapy (CBT) has been used in other patient populations and has demonstrated clinical benefits. Although evidence-based, nonpharmacological interventions for pain management are widely used in other populations, these treatments have not been well studied in SCD. Currently, there are no adequately powered large-scale clinical trials to evaluate the effectiveness and dissemination potential of behavioral pain management for adults with SCD. Furthermore, some important details regarding behavioral therapies in SCD remain unclear?in particular, what works best for whom and when. Objective: Our primary goal is to compare the effectiveness of two smartphone?delivered programs for reducing SCD pain symptoms: digital CBT versus pain and SCD education (Education). Our secondary goal is to assess whether baseline depression symptoms moderate the effect of interventions on pain outcomes. We hypothesize that digital CBT will confer greater benefits on pain outcomes and depressive symptoms at 6 months and a greater reduction in health care use (eg, opioid prescriptions or refills or acute care visits) over 12 months. Methods: The CaRISMA (Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications) study is a multisite comparative effectiveness trial funded by the Patient-Centered Outcomes Research Institute. CaRISMA is conducted at six clinical academic sites, in partnership with four community-based organizations. CaRISMA will evaluate the effectiveness of two 12-week health coach?supported digital health programs with a total of 350 participants in two groups: CBT (n=175) and Education (n=175). Participants will complete a series of questionnaires at baseline and at 3, 6, and 12 months. The primary outcome will be the change in pain interference between the study arms. We will also evaluate changes in pain intensity, depressive symptoms, other patient-reported outcomes, and health care use as secondary outcomes. We have 80% power to detect a difference of 0.37 SDs between study arms on 6-month changes in the outcomes with 15% expected attrition at 6 months. An exploratory analysis will examine whether baseline depression symptoms moderate the effect of the intervention on pain interference. Results: This study will be conducted from March 2021 through February 2022, with results expected to be available in February 2023. Conclusions: Patients with SCD experience significant disease burden, psychosocial stress, and impairment of their quality of life. CaRISMA proposes to leverage digital technology and overcome barriers to the routine use of behavioral treatments for pain and depressive symptoms in the treatment of adults with SCD. The study will provide data on the comparative effectiveness of digital CBT and Education approaches and evaluate the potential for implementing evidence-based behavioral interventions to manage SCD pain. Trial Registration: ClinicalTrials.gov NCT04419168; https://clinicaltrials.gov/ct2/show/NCT04419168. International Registered Report Identifier (IRRID): PRR1-10.2196/29014 UR - https://www.researchprotocols.org/2021/5/e29014 UR - http://dx.doi.org/10.2196/29014 UR - http://www.ncbi.nlm.nih.gov/pubmed/33988517 ID - info:doi/10.2196/29014 ER - TY - JOUR AU - Luo, Gang AU - Pundlik, Shrinivas PY - 2021/5/12 TI - Influence of COVID-19 Lockdowns on the Usage of a Vision Assistance App Among Global Users With Visual Impairment: Big Data Analytics Study JO - J Med Internet Res SP - e26283 VL - 23 IS - 5 KW - assistance KW - assistive technology KW - COVID-19 KW - development KW - eye KW - low vision KW - needs KW - smartphone apps KW - usage KW - vision assistance KW - vision KW - visual impairment N2 - Background: Millions of individuals with visual impairment use vision assistance apps to help with their daily activities. The most widely used vision assistance apps are magnifier apps. It is still largely unknown what the apps are used for. Lack of insight into the visual needs of individuals with visual impairment is a hurdle for the development of more effective assistive technologies. Objective: This study aimed to investigate how needs for visual aids may vary with social activities, by observing the changes in the usage of a smartphone magnifier app when many users take breaks from work. Methods: The number of launches of the SuperVision Magnifier app was determined retrospectively from 2018 to 2020 from among active users worldwide. The fluctuation in app usage was examined by comparing weekday vs weekend periods, Christmas and new year vs nonholiday seasons, and COVID-19 lockdowns vs the easing of restriction during the pandemic. Results: On average, the app was used 262,466 times by 38,237 users each month in 2020 worldwide. There were two major trough points on the timeline of weekly app usage, one aligned with the COVID-19 lockdowns in April 2020 and another aligned with the Christmas and new year week in 2018 and 2019. The app launches declined by 6947 (11% decline; P<.001) during the lockdown and by 5212 (9% decline; P=.001) during the holiday weeks. There was no significant decline during March to May 2019. App usage compensated for seasonal changes was 8.6% less during weekends than during weekdays (P<.001). Conclusions: The need for vision assistance technology was slightly lower during breaks and lockdowns, probably because the activities at home were different and less visually demanding. Nevertheless, for the entire user population, the needs for visual aids are still substantial. UR - https://www.jmir.org/2021/5/e26283 UR - http://dx.doi.org/10.2196/26283 UR - http://www.ncbi.nlm.nih.gov/pubmed/33945492 ID - info:doi/10.2196/26283 ER - TY - JOUR AU - Greene, M. Ellen AU - O'Brien, C. Eileen AU - Kennelly, A. Maria AU - O'Brien, A. Orna AU - Lindsay, L. Karen AU - McAuliffe, M. Fionnuala PY - 2021/5/12 TI - Acceptability of the Pregnancy, Exercise, and Nutrition Research Study With Smartphone App Support (PEARS) and the Use of Mobile Health in a Mixed Lifestyle Intervention by Pregnant Obese and Overweight Women: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e17189 VL - 9 IS - 5 KW - pregnancy KW - mHealth KW - nutrition KW - lifestyle KW - acceptability KW - app KW - mobile phone N2 - Background: Dietary interventions can improve pregnancy outcomes among women with increased BMI. Although the interest in mobile health interventions is growing, little is known about the acceptability of smartphone apps to support lifestyle interventions in such a cohort. Objective: We aimed to assess the acceptability of the pregnancy, exercise, and nutrition research study with smartphone app support (PEARS) and the use of mobile health in a mixed lifestyle intervention delivered to overweight and obese pregnant women. Methods: PEARS was a randomized controlled trial of a low glycemic index dietary intervention with exercise prescription and a smartphone app, which was delivered to pregnant women who were overweight or obese. Acceptability questionnaires were completed by the intervention group at 28 weeks of gestation (n=149) and at postintervention (n=123). Maternal characteristics were recorded (ie, age, ethnicity, BMI, socioeconomic status). Associations between maternal characteristics and acceptability of the intervention and app were analyzed using two-tailed t tests, Mann-Whitney U tests, chi-square test, and logistic regression. One-on-one semistructured interviews were conducted with a subcohort of the intervention participants (n=28) at 34 weeks of gestation, in which the participants shared their experiences of the PEARS intervention. Results: The intervention was generally accepted, with respondents agreeing that the diet was easy to follow (98/148, 68.5%), enjoyable (106/148, 74.1%), and affordable (110/148, 76.9%). Qualitative and quantitative results were consistent with each another, both demonstrating that app acceptability was high. The participants agreed that the app was enjoyable (96/120, 80.0%) and easy to use (116/119, 97.5%). Compared to those with tertiary education, those with lower education levels were more likely to enjoy the dietary changes (P=.04). Enjoyment of the app was associated with disadvantaged neighborhood deprivation index (P=.01) and higher BMI (P=.03). Conclusions: The PEARS intervention and use of a supportive smartphone app were accepted by pregnant women, particularly by those from vulnerable subgroups of this population. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 29316280; https://www.isrctn.com/ISRCTN29316280 UR - https://mhealth.jmir.org/2021/5/e17189 UR - http://dx.doi.org/10.2196/17189 UR - http://www.ncbi.nlm.nih.gov/pubmed/33978597 ID - info:doi/10.2196/17189 ER - TY - JOUR AU - Sezgin, Emre AU - Noritz, Garey AU - Lin, Simon AU - Huang, Yungui PY - 2021/5/11 TI - Feasibility of a Voice-Enabled Medical Diary App (SpeakHealth) for Caregivers of Children With Special Health Care Needs and Health Care Providers: Mixed Methods Study JO - JMIR Form Res SP - e25503 VL - 5 IS - 5 KW - children with special health care needs KW - care management KW - care coordination KW - voice-enabled mobile app KW - health information technology KW - voice assistant KW - voice interaction KW - mobile phone N2 - Background: Children with special health care needs (CSHCN) require more than the usual care management and coordination efforts from caregivers and health care providers (HCPs). Health information and communication technologies can potentially facilitate these efforts to increase the quality of care received by CSHCN. Objective: In this study, we aim to assess the feasibility of a voice-enabled medical diary app (SpeakHealth) by investigating its potential use among caregivers and HCPs. Methods: Following a mixed methods approach, caregivers of CSHCN were interviewed (n=10) and surveyed (n=86) about their care management and communication technology use. Only interviewed participants were introduced to the SpeakHealth app prototype, and they tested the app during the interview session. In addition, we interviewed complex care HCPs (n=15) to understand their perception of the value of a home medical diary such as the SpeakHealth app. Quantitative data were analyzed using descriptive statistics and correlational analyses. Theoretical thematic analysis was used to analyze qualitative data. Results: The survey results indicated a positive attitude toward voice-enabled technology and features; however, there was no strong correlation among the measured items. The caregivers identified communication, information sharing, tracking medication, and appointments as fairly and highly important features of the app. Qualitative analysis revealed the following two overarching themes: enablers and barriers in care communication and enablers and barriers in communication technologies. The subthemes included parent roles, care communication technologies, and challenges. HCPs found the SpeakHealth app to be a promising tool for timely information collection that could be available for sharing information with the health system. Overall, the findings demonstrated a variety of needs and challenges for caregivers of CSHCN and opportunities for voice-enabled, interactive medical diary apps in care management and coordination. Caregivers fundamentally look for better information sharing and communication with HCPs. Health care and communication technologies can potentially improve care communication and coordination in addressing the patient and caregiver needs. Conclusions: The perspectives of caregivers and providers suggested both benefits and challenges in using the SpeakHealth app for medical note-taking and tracking health events at home. Our findings could inform researchers and developers about the potential development and use of a voice-enabled medical diary app. UR - https://formative.jmir.org/2021/5/e25503 UR - http://dx.doi.org/10.2196/25503 UR - http://www.ncbi.nlm.nih.gov/pubmed/33865233 ID - info:doi/10.2196/25503 ER - TY - JOUR AU - Mauch, E. Chelsea AU - Laws, A. Rachel AU - Prichard, Ivanka AU - Maeder, J. Anthony AU - Wycherley, P. Thomas AU - Golley, K. Rebecca PY - 2021/5/7 TI - Commercially Available Apps to Support Healthy Family Meals: User Testing of App Utility, Acceptability, and Engagement JO - JMIR Mhealth Uhealth SP - e22990 VL - 9 IS - 5 KW - diet KW - nutrition KW - family KW - mobile applications KW - behavior modification N2 - Background: Parents juggling caregiving and paid employment encounter a range of barriers in providing healthy food to their families. Mobile apps have the potential to help parents in planning, purchasing, and preparing healthy family food. The utility and acceptability of apps for supporting parents are unknown. User perspectives of existing technology, such as commercially available apps, can guide the development of evidence-based apps in the future. Objective: This study aims to determine the feasibility of existing commercially available apps for supporting the healthy food provision practices of working parents. Methods: Working parents (N=133) were recruited via the web and completed a 10-item Capability, Opportunity, Motivation, and Behavior (COM-B) self-evaluation survey assessing their needs in relation to the provision of healthy family meals. A total of 5 apps were selected for testing, including a meal planning app, recipe app, recipe manager app, family organizer app, and barcode scanning app. Survey items were mapped to app features, with a subsample of parents (67/133, 50.4%) allocated 2 apps each to trial simultaneously over 4 weeks. A semistructured interview exploring app utility and acceptability and a web-based survey, including the System Usability Scale and the user version of the Mobile App Rating Scale, followed app testing. The interview data were analyzed using a theoretical thematic approach. Results: Survey participants (N=133; mean age 34 years, SD 4 years) were mainly mothers (130/133, 97.7%) and partnered (122/133, 91.7%). Participants identified a need for healthy recipes (109/133, 82% agreed or strongly agreed) and time for food provision processes (107/133, 80.5%). Engagement quality was the lowest rated domain of the user version of the Mobile App Rating Scale across all 5 apps (mean score per app ranging from 3.0 to 3.7 out of a maximum of 5). The family organizer, requiring a high level of user input, was rated the lowest for usability (median 48, IQR 34-73). In the interviews, participants weighed the benefits of the apps (ie, time saving) against the effort involved in using them in determining their acceptability. Organization was a subtheme emerging from interviews, associated with the use of meal planners and shopping lists. Meal planners and shopping lists were used in time, while behavior was occurring. Conclusions: Meal planning apps and features promoting organization present feasible, time-saving solutions to support healthy food provision practices. Attention must be paid to enhancing app automation and integration, as well as recipe and nutrition content, to ensure that apps do not add to the time burden of food provision and are supportive of healthy food provision behavior in time. UR - https://mhealth.jmir.org/2021/5/e22990 UR - http://dx.doi.org/10.2196/22990 UR - http://www.ncbi.nlm.nih.gov/pubmed/33960951 ID - info:doi/10.2196/22990 ER - TY - JOUR AU - Robinson, K. June AU - Patel, Shiv AU - Heo, Yun Seung AU - Gray, Elizabeth AU - Lim, Jaeman AU - Kwon, Kyeongha AU - Christiansen, Zach AU - Model, Jeffrey AU - Trueb, Jacob AU - Banks, Anthony AU - Kwasny, Mary AU - Rogers, A. John PY - 2021/5/6 TI - Real-Time UV Measurement With a Sun Protection System for Warning Young Adults About Sunburn: Prospective Cohort Study JO - JMIR Mhealth Uhealth SP - e25895 VL - 9 IS - 5 KW - sun protection KW - UV dosimeter KW - health promotion technology KW - melanoma KW - sunburn KW - preventive medicine KW - mobile phone N2 - Background: Melanoma is attributable to predisposing phenotypical factors, such as skin that easily sunburns and unprotected exposure to carcinogenic UV radiation. Reducing the proportion of young adults who get sunburned may reduce the incidence of melanoma, a deadly form of skin cancer. Advances in technology have enabled the delivery of real-time UV light exposure and content-relevant health interventions. Objective: This study aims to examine the feasibility of young adults performing the following tasks daily: wearing a UV dosimeter, receiving text messages and real-time UV-B doses on their smartphone, and responding to daily web-based surveys about sunburn and sun protection. Methods: Young adults aged 18-39 years (n=42) were recruited in the United States in June 2020 via social media. Participants received the UV Guard sun protection system, which consisted of a UV dosimeter and a smartphone app. During 3 consecutive periods, intervention intensity increased as follows: real-time UV-B dose; UV-B dose and daily behavioral facilitation text messages; and UV-B dose, goal setting, and daily text messages to support self-efficacy and self-regulation. Data were self-reported through daily web-based surveys for 28 days, and UV-B doses were transmitted to cloud-based storage. Results: Patients? median age was 22 years (IQR 20, 29), and all patients had sun-sensitive skin. Sunburns were experienced during the study by fewer subjects (n=18) than those in the preceding 28 days (n=30). In July and August, the face was the most commonly sunburned area among 13 body locations; 52% (22/42) of sunburns occurred before the study and 45% (19/42) occurred during the study. The mean daily UV-B dose decreased during the 3 periods; however, this was not statistically significant. Young adults were most often exercising outdoors from 2 to 6 PM, walking from 10 AM to 6 PM, and relaxing from noon to 2 PM. Sunburn was most often experienced during exercise (odds ratio [OR] 5.65, 95% CI 1.60-6.10) and relaxation (OR 3.69, 95% CI 1.03-4.67) relative to those that did not exercise or relax in each category. The self-reported exit survey indicated that participants felt that they spent less time outdoors this summer compared to the last summer because of the COVID-19 pandemic and work. In addition, 38% (16/42) of the participants changed their use of sun protection based on their app-reported UV exposure, and 48% (20/42) shifted the time they went outside to periods with less-intense UV exposure. A total of 79% (33/42) of the participants were willing to continue using the UV Guard system outside of a research setting. Conclusions: In this proof-of-concept research, young adults demonstrated that they used the UV Guard system; however, optimization was needed. Although some sun protection behaviors changed, sunburn was not prevented in all participants, especially during outdoor exercise. Trial Registration: ClinicalTrials.gov NCT03344796; http://clinicaltrials.gov/ct2/show/NCT03344796 UR - https://mhealth.jmir.org/2021/5/e25895 UR - http://dx.doi.org/10.2196/25895 UR - http://www.ncbi.nlm.nih.gov/pubmed/33955844 ID - info:doi/10.2196/25895 ER - TY - JOUR AU - Mönninghoff, Annette AU - Kramer, Niklas Jan AU - Hess, Jan Alexander AU - Ismailova, Kamila AU - Teepe, W. Gisbert AU - Tudor Car, Lorainne AU - Müller-Riemenschneider, Falk AU - Kowatsch, Tobias PY - 2021/4/30 TI - Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e26699 VL - 23 IS - 4 KW - mHealth KW - physical activity KW - systematic review KW - meta-analysis KW - mobile phone N2 - Background: Mobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood. Objective: The primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators. Methods: We performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ?6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool. Results: Of the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P<.001; MVPA SMD 0.28, 95% CI 0.21-0.35; P<.001; TPA SMD 0.34, 95% CI 0.20-0.47; P<.001; energy expenditure SMD 0.44, 95% CI 0.13-0.75; P=.01). Only 33 studies reported short-term follow-up measurements, and 8 studies reported long-term follow-up measurements in addition to end-of-intervention results. In the short term, effects were sustained for walking (SMD 0.26, 95% CI 0.09-0.42; P=.002), MVPA (SMD 0.20, 95% CI 0.05-0.35; P=.008), and TPA (SMD 0.53, 95% CI 0.13-0.93; P=.009). In the long term, effects were also sustained for walking (SMD 0.25, 95% CI 0.10-0.39; P=.001) and MVPA (SMD 0.19, 95% CI 0.11-0.27; P<.001). We found the study population to be an effect moderator, with higher effect scores in sick and at-risk populations. PA was increased both in scalable and nonscalable mHealth intervention designs and regardless of the control group type. The risk of bias was rated high in 80.3% (94/117) of the studies. Heterogeneity was significant, resulting in low to very low quality of evidence. Conclusions: mHealth interventions can foster small to moderate increases in PA. The effects are maintained long term; however, the effect size decreases over time. The results encourage using mHealth interventions in at-risk and sick populations and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given the low evidence quality, further methodologically rigorous studies are warranted to evaluate the long-term effects. UR - https://www.jmir.org/2021/4/e26699 UR - http://dx.doi.org/10.2196/26699 UR - http://www.ncbi.nlm.nih.gov/pubmed/33811021 ID - info:doi/10.2196/26699 ER - TY - JOUR AU - Cliffe, Bethany AU - Tingley, Jessica AU - Greenhalgh, Isobel AU - Stallard, Paul PY - 2021/4/30 TI - mHealth Interventions for Self-Harm: Scoping Review JO - J Med Internet Res SP - e25140 VL - 23 IS - 4 KW - mHealth KW - self-harm KW - digital interventions KW - self-injury KW - NSSI KW - mobile phone N2 - Background: Self-harm is a growing issue with increasing prevalence rates; however, individuals who self-harm do not often receive treatment. Mobile health (mHealth) interventions are a possible solution to some of the barriers that individuals face when seeking support, and they have also been found to be effective in improving mental health. Thus far, reviews of mHealth interventions for self-harm have been limited by study type. Therefore, we determined that a broader scoping review will provide a more exhaustive understanding of mHealth interventions for self-harm. Objective: This scoping review aims to identify mHealth interventions for self-harm within the literature, understand the types and features of interventions that have been developed and evaluated, highlight research findings around mHealth interventions for self-harm, and determine what outcomes are typically used to assess the efficacy of interventions. Methods: A search was conducted using Embase, PubMed, PsycINFO, PsycEXTRA, Web of Science, and the Cochrane Library. Studies were included if they described an mHealth intervention designed to have a direct (ie, if the intervention was designed for self-harm or for people who self-harm) or indirect (ie, if self-harm was measured as an outcome) treatment effect and if the paper was available in English. There were no exclusion criteria based on the study design. Results: A total of 36 papers were included in the review, and most of them were randomized controlled trials published within the last 4 years. The interventions were mostly smartphone apps and calling or texting services, with 62% (21/34) having underlying therapeutic models to inform the intervention content. They were generally shown to be promising and appealing, but only 5 were widely available for use. Outcomes focused on a reduction of self-harm and suicidality, mood, and the users? experiences of the intervention. Samples were typically nondiverse, and there was limited variety in the study designs and in the measurements of self-harm recovery. Conclusions: Promising and appealing mHealth interventions have been developed but are not widely available. Research could benefit from greater diversity as well as a broader and more nuanced understanding of recovery from self-harm. UR - https://www.jmir.org/2021/4/e25140 UR - http://dx.doi.org/10.2196/25140 UR - http://www.ncbi.nlm.nih.gov/pubmed/33929329 ID - info:doi/10.2196/25140 ER - TY - JOUR AU - Cohn, F. Wendy AU - Canan, E. Chelsea AU - Knight, Sarah AU - Waldman, Lena Ava AU - Dillingham, Rebecca AU - Ingersoll, Karen AU - Schexnayder, Julie AU - Flickinger, E. Tabor PY - 2021/4/28 TI - An Implementation Strategy to Expand Mobile Health Use in HIV Care Settings: Rapid Evaluation Study Using the Consolidated Framework for Implementation Research JO - JMIR Mhealth Uhealth SP - e19163 VL - 9 IS - 4 KW - mHealth KW - smartphone KW - mobile health KW - implementation strategy KW - implementation science KW - Consolidated Framework for Implementation Research KW - HIV care engagement KW - viral suppression N2 - Background: Mobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve the health of people with HIV. In a pilot study, PL users experienced considerable improvements in care engagement and viral load suppression. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support. Objective: The objective of our study was to conduct an interim analysis of the barriers and facilitators to PL implementation at early adopting sites to guide optimization of our implementation strategy. Methods: Semistructured interviews with stakeholders at PL expansion sites were conducted. Analysis of interviews identified facilitators and barriers that were mapped to 22 constructs of the Consolidated Framework for Implementation Research (CFIR). The purpose of the analysis was to identify the facilitators and barriers to PL implementation in order to adapt the PL implementation strategy. Four Ryan White HIV clinics were included. Interviews were conducted with one health care provider, two clinic managers, and five individuals who coordinated site PL activities. Results: Ten common facilitators and eight common barriers were identified. Facilitators to PL implementation included PL?s fit with patient and clinic needs, PL training resources, and sites? early engagement with their information technology personnel. Most barriers were specific to mHealth, including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use. Conclusions: The CFIR is a useful framework for evaluating mHealth interventions. Although PL training resources were viewed favorably, we identified important barriers to PL implementation in a sample of Ryan White clinics. This enabled our team to expand guidance on identifying information technology stakeholders and procuring and managing mobile resources. Ongoing evaluation results continue to inform improvements to the PL implementation strategy, facilitating PL access for future expansion sites. UR - https://mhealth.jmir.org/2021/4/e19163 UR - http://dx.doi.org/10.2196/19163 UR - http://www.ncbi.nlm.nih.gov/pubmed/33908893 ID - info:doi/10.2196/19163 ER - TY - JOUR AU - Szinay, Dorothy AU - Perski, Olga AU - Jones, Andy AU - Chadborn, Tim AU - Brown, Jamie AU - Naughton, Felix PY - 2021/4/27 TI - Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study JO - JMIR Mhealth Uhealth SP - e27173 VL - 9 IS - 4 KW - behavior change KW - health apps KW - mHealth KW - smartphone app KW - framework analysis KW - Capability, Opportunity, Motivation-Behavior model KW - Theoretical Domains Framework KW - think aloud KW - mobile phone N2 - Background: Health and well-being smartphone apps can provide a cost-effective solution to addressing unhealthy behaviors. The selection of these apps tends to occur in commercial app stores, where thousands of health apps are available. Their uptake is often influenced by popularity indicators. However, these indicators are not necessarily associated with app effectiveness or evidence-based content. Alternative routes to app selection are increasingly available, such as via curated app portals, but little is known about people?s experiences of them. Objective: The aim of this study is to explore how people select health apps on the internet and their views on curated app portals. Methods: A total of 18 UK-based adults were recruited through social media and asked during an in-person meeting to verbalize their thoughts while searching for a health or well-being app on the internet on a platform of their choice. The search was then repeated on 2 curated health app portals: the National Health Service Apps Library and the Public Health England One You App portal. This was followed by semistructured interviews. Data were analyzed using framework analysis, informed by the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework. Results: Searching for health and well-being apps on the internet was described as a minefield. App uptake appeared to be influenced by participants? capabilities such as app literacy skills and health and app awareness, and opportunities including the availability of apps, app esthetics, the price of an app, and social influences. Motivation factors that seemed to affect the uptake were perceived competence, time efficiency, perceived utility and accuracy of an app, transparency about data protection, commitment and social identity, and a wide range of emotions. Social influences and the perceived utility of an app were highlighted as particularly important. Participants were not previously aware of curated portals but found the concept appealing. Curated health app portals appeared to engender trust and alleviate data protection concerns. Although apps listed on these were perceived as more trustworthy, their presentation was considered disappointing. This disappointment seemed to stem from the functionality of the portals, lack of user guidance, and lack of tailored content to an individual?s needs. Conclusions: The uptake of health and well-being apps appears to be primarily affected by social influences and the perceived utility of an app. App uptake via curated health app portals perceived as credible may mitigate concerns related to data protection and accuracy, but their implementation must better meet user needs and expectations. UR - https://mhealth.jmir.org/2021/4/e27173 UR - http://dx.doi.org/10.2196/27173 UR - http://www.ncbi.nlm.nih.gov/pubmed/33904827 ID - info:doi/10.2196/27173 ER - TY - JOUR AU - Rajani, B. Nikita AU - Mastellos, Nikolaos AU - Filippidis, T. Filippos PY - 2021/4/27 TI - Impact of Gamification on the Self-Efficacy and Motivation to Quit of Smokers: Observational Study of Two Gamified Smoking Cessation Mobile Apps JO - JMIR Serious Games SP - e27290 VL - 9 IS - 2 KW - gamification KW - smoking cessation KW - mobile applications KW - self-efficacy KW - motivation to quit KW - mHealth KW - mobile phone N2 - Background: The proportion of smokers making quit attempts and the proportion of smokers successfully quitting have been decreasing over the past few years. Previous studies have shown that smokers with high self-efficacy and motivation to quit have an increased likelihood of quitting and staying quit. Consequently, further research on strategies that can improve the self-efficacy and motivation of smokers seeking to quit could lead to substantially higher cessation rates. Some studies have found that gamification can positively impact the cognitive components of behavioral change, including self-efficacy and motivation. However, the impact of gamification in the context of smoking cessation and mobile health has been sparsely investigated. Objective: This study aims to examine the association between perceived usefulness, perceived ease of use, and frequency of use of gamification features embedded in smoking cessation apps on self-efficacy and motivation to quit smoking. Methods: Participants were assigned to use 1 of the 2 mobile apps for a duration of 4 weeks. App-based questionnaires were provided to participants before app use and 2 weeks and 4 weeks after they started using the app. Gamification was quantitatively operationalized based on the Cugelman gamification framework and concepts from the technology acceptance model. The mean values of perceived frequency, ease of use, and usefulness of gamification features were calculated at midstudy and end-study. Two linear regression models were used to investigate the impact of gamification on self-efficacy and motivation to quit. Results: A total of 116 participants completed the study. The mean self-efficacy increased from 37.38 (SD 13.3) to 42.47 (SD 11.5) points and motivation to quit increased from 5.94 (SD 1.4) to 6.32 (SD 1.7) points after app use. Goal setting was perceived to be the most useful gamification feature, whereas sharing was perceived to be the least useful. Participants self-reported that they used the progress dashboards the most often, whereas they used the sharing feature the least often. The average perceived frequency of gamification features was statistically significantly associated with change in self-efficacy (?=3.35; 95% CI 0.31-6.40) and change in motivation to quit (?=.54; 95% CI 0.15-0.94) between baseline and end-study. Conclusions: Gamification embedded in mobile apps can have positive effects on self-efficacy and motivation to quit smoking. The findings of this study can provide important insights for tobacco control policy makers, mobile app developers, and smokers seeking to quit. UR - https://games.jmir.org/2021/2/e27290 UR - http://dx.doi.org/10.2196/27290 UR - http://www.ncbi.nlm.nih.gov/pubmed/33904824 ID - info:doi/10.2196/27290 ER - TY - JOUR AU - Low, A. Carissa AU - Li, Meng AU - Vega, Julio AU - Durica, C. Krina AU - Ferreira, Denzil AU - Tam, Vernissia AU - Hogg, Melissa AU - Zeh III, Herbert AU - Doryab, Afsaneh AU - Dey, K. Anind PY - 2021/4/27 TI - Digital Biomarkers of Symptom Burden Self-Reported by Perioperative Patients Undergoing Pancreatic Surgery: Prospective Longitudinal Study JO - JMIR Cancer SP - e27975 VL - 7 IS - 2 KW - mobile sensing KW - symptom KW - cancer KW - surgery KW - wearable device KW - smartphone KW - mobile phone N2 - Background: Cancer treatments can cause a variety of symptoms that impair quality of life and functioning but are frequently missed by clinicians. Smartphone and wearable sensors may capture behavioral and physiological changes indicative of symptom burden, enabling passive and remote real-time monitoring of fluctuating symptoms Objective: The aim of this study was to examine whether smartphone and Fitbit data could be used to estimate daily symptom burden before and after pancreatic surgery. Methods: A total of 44 patients scheduled for pancreatic surgery participated in this prospective longitudinal study and provided sufficient sensor and self-reported symptom data for analyses. Participants collected smartphone sensor and Fitbit data and completed daily symptom ratings starting at least two weeks before surgery, throughout their inpatient recovery, and for up to 60 days after postoperative discharge. Day-level behavioral features reflecting mobility and activity patterns, sleep, screen time, heart rate, and communication were extracted from raw smartphone and Fitbit data and used to classify the next day as high or low symptom burden, adjusted for each individual?s typical level of reported symptoms. In addition to the overall symptom burden, we examined pain, fatigue, and diarrhea specifically. Results: Models using light gradient boosting machine (LightGBM) were able to correctly predict whether the next day would be a high symptom day with 73.5% accuracy, surpassing baseline models. The most important sensor features for discriminating high symptom days were related to physical activity bouts, sleep, heart rate, and location. LightGBM models predicting next-day diarrhea (79.0% accuracy), fatigue (75.8% accuracy), and pain (79.6% accuracy) performed similarly. Conclusions: Results suggest that digital biomarkers may be useful in predicting patient-reported symptom burden before and after cancer surgery. Although model performance in this small sample may not be adequate for clinical implementation, findings support the feasibility of collecting mobile sensor data from older patients who are acutely ill as well as the potential clinical value of mobile sensing for passive monitoring of patients with cancer and suggest that data from devices that many patients already own and use may be useful in detecting worsening perioperative symptoms and triggering just-in-time symptom management interventions. UR - https://cancer.jmir.org/2021/2/e27975 UR - http://dx.doi.org/10.2196/27975 UR - http://www.ncbi.nlm.nih.gov/pubmed/33904822 ID - info:doi/10.2196/27975 ER - TY - JOUR AU - Yeo, Shi Pei AU - Nguyen, Ngoc Tu AU - Ng, Ern Mary Pei AU - Choo, Munn Robin Wai AU - Yap, Kiat Philip Lin AU - Ng, Pin Tze AU - Wee, Liang Shiou PY - 2021/4/27 TI - Evaluation of the Implementation and Effectiveness of Community-Based Brain-Computer Interface Cognitive Group Training in Healthy Community-Dwelling Older Adults: Randomized Controlled Implementation Trial JO - JMIR Form Res SP - e25462 VL - 5 IS - 4 KW - group-based computerized cognitive training KW - cognition KW - gait KW - community program implementation KW - healthy older adults KW - cognitive KW - community program KW - cognitive training KW - elderly KW - aging N2 - Background: Cognitive training can improve cognition in healthy older adults. Objective: The objectives are to evaluate the implementation of community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults. Methods: A single-blind randomized controlled trial with baseline and follow-up assessments was conducted at two community centers in Singapore. Healthy community-dwelling adults aged 55 years and older participated in a 10-week CCT program with 2-hour instructor-led group classes twice a week. Participants used a mobile app to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant, provider, and community level (eg, reach, implementation, and facilitators and barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test 2 (CTT-2), Berg Balance Scale, and GAITRite walkway measures (single and dual task gait speed, dual task cost, and single and dual task gait variability index [GVI]). Results: A total of 94 healthy community-dwelling adults participated in the CCT program (mean age 68.8 [SD 6.3] years). Implementation measures revealed high reach (125/155, 80.6%) and moderate adherence but poor penetration of sedentary older adults (43/125, 34.4%). The effectiveness data were based on intention-to-treat (ITT) and per-protocol (PP) analysis. In the ITT analysis, single task GVI increased (b=2.32, P=.02, 95% CI [0.30 to 4.35]) and RBANS list recognition subtest deteriorated (b=?0.57, P=.01, 95% CI [?1.00 to ?0.14]) in both groups. In the PP analysis, time taken to complete CTT-2 (b=?13.5, P=.01, 95% CI [?23.95 to ?3.14]; Cohen d effect size = 0.285) was faster in the intervention group. Single task gait speed was not statistically significantly maintained in the intervention group (b=5.38, P=.06, 95% CI [?0.30 to 11.36]) and declined in the control group (Cohen d effect size = 0.414). PP analyses also showed interaction terms for RBANS list recall subtest (b=?0.36, P=.08, 95% CI [?0.75 to 0.04]) and visuospatial domain (b=0.46, P=.08, 95% CI [?0.05 to 0.96]) that were not statistically significant. Conclusions: CCT can be implemented in community settings to improve attention and executive function among healthy older adults. Findings help to identify suitable healthy aging programs that can be implemented on a larger scale within communities. Trial Registration: ClinicalTrials.gov NCT04439591; https://clinicaltrials.gov/ct2/show/NCT04439591 UR - https://formative.jmir.org/2021/4/e25462 UR - http://dx.doi.org/10.2196/25462 UR - http://www.ncbi.nlm.nih.gov/pubmed/33904819 ID - info:doi/10.2196/25462 ER - TY - JOUR AU - Kirszenblat, Romain AU - Edouard, Paul PY - 2021/4/26 TI - Validation of the Withings ScanWatch as a Wrist-Worn Reflective Pulse Oximeter: Prospective Interventional Clinical Study JO - J Med Internet Res SP - e27503 VL - 23 IS - 4 KW - connected watch KW - COPD KW - COVID-19 KW - neural network KW - pulse oxygen saturation KW - reflective pulse oximeter KW - sleep apnea syndrome KW - SpO2 KW - Withings ScanWatch KW - wearable KW - respiratory KW - oxygen KW - respiratory disease KW - oximeter KW - validation KW - accuracy KW - safety N2 - Background: A decrease in the level of pulse oxygen saturation as measured by pulse oximetry (SpO2) is an indicator of hypoxemia that may occur in various respiratory diseases, such as chronic obstructive pulmonary disease (COPD), sleep apnea syndrome, and COVID-19. Currently, no mass-market wrist-worn SpO2 monitor meets the medical standards for pulse oximeters. Objective: The main objective of this monocentric and prospective clinical study with single-blind analysis was to test and validate the accuracy of the reflective pulse oximeter function of the Withings ScanWatch to measure SpO2 levels at different stages of hypoxia. The secondary objective was to confirm the safety of this device when used as intended. Methods: To achieve these objectives, we included 14 healthy participants aged 23-39 years in the study, and we induced several stable plateaus of arterial oxygen saturation (SaO2) ranging from 100%-70% to mimic nonhypoxic conditions and then mild, moderate, and severe hypoxic conditions. We measured the SpO2 level with a Withings ScanWatch on each participant?s wrist and the SaO2 from blood samples with a co-oximeter, the ABL90 hemoximeter (Radiometer Medical ApS). Results: After removal of the inconclusive measurements, we obtained 275 and 244 conclusive measurements with the two ScanWatches on the participants? right and left wrists, respectively, evenly distributed among the 3 predetermined SpO2 groups: SpO2?80%, 80%.05), but the calorie tracking condition gave their app higher helpfulness and usability ratings (all values of P<.05). Technical issues were the most common type of negative feedback, whereas simplicity was the most common type of positive feedback. Weight losses of ?5% of baseline weight were achieved by 31% (10/32) of Slip Buddy participants and 34% (11/32) of calorie tracking participants. Conclusions: Self-monitoring of dietary lapses and the contextual factors associated with them may be an alternative for people who do not prefer calorie tracking. Future research should examine patient characteristics associated with adherence to different forms of dietary self-monitoring. Trial Registration: ClinicalTrials.gov NCT02615171; https://clinicaltrials.gov/ct2/show/NCT02615171 UR - https://mhealth.jmir.org/2021/4/e24249 UR - http://dx.doi.org/10.2196/24249 UR - http://www.ncbi.nlm.nih.gov/pubmed/33792547 ID - info:doi/10.2196/24249 ER - TY - JOUR AU - Kuhns, M. Lisa AU - Hereth, Jane AU - Garofalo, Robert AU - Hidalgo, Marco AU - Johnson, K. Amy AU - Schnall, Rebecca AU - Reisner, L. Sari AU - Belzer, Marvin AU - Mimiaga, J. Matthew PY - 2021/3/31 TI - A Uniquely Targeted, Mobile App-Based HIV Prevention Intervention for Young Transgender Women: Adaptation and Usability Study JO - J Med Internet Res SP - e21839 VL - 23 IS - 3 KW - transgender persons KW - HIV KW - mobile app KW - mHealth KW - mobile phone N2 - Background: Young transgender women (YTW) are a key population for HIV-related risk reduction, yet very few interventions have been developed to meet their needs. Mobile health interventions with the potential for both efficacy and wide reach are a promising strategy to reduce HIV risk among YTW. Objective: This study aims to adapt an efficacious group-based intervention to a mobile app, Project LifeSkills, to reduce HIV risk among YTW, and to test its acceptability and usability. Methods: The group-based intervention was adapted to a mobile app, LifeSkills Mobile, with input from an expert advisory group and feedback from YTW collected during user-centered design sessions. A beta version of the app was then tested in a usability evaluation using a think-aloud protocol with debriefing interviews, recordings of screen activity, and assessments of usability via the Post-Study System Usability Questionnaire (PSSUQ) and the Health Information Technology Usability Evaluation Scale (Health-ITUES). Results: YTW (n=8; age: mean 24 years, SD 3 years; racial or ethnic minority: 7/8, 88%) provided feedback on the app prototype in design sessions and then tested a beta version of the app in a usability trial (n=10; age: mean 24 years, SD 3 years; racial or ethnic minority: 8/10, 80%). Both usability ratings (Health-ITUES: mean 4.59, SD 0.86; scale range: 1-5) and ratings for satisfaction and accessibility (PSSUQ: mean 4.64, SD 0.90; scale range 1-5) were in the good to excellent range. No functional bugs were identified, and all mobile activities were deployed as expected. Participant feedback from the usability interviews indicated very good salience of the intervention content among the focal population. Participants? suggestions to further increase app engagement included adding animation, adding audio, and reducing the amount text. Conclusions: We conclude that the LifeSkills Mobile app is a highly usable and engaging mobile app for HIV prevention among YTW. UR - https://www.jmir.org/2021/3/e21839 UR - http://dx.doi.org/10.2196/21839 UR - http://www.ncbi.nlm.nih.gov/pubmed/33787503 ID - info:doi/10.2196/21839 ER - TY - JOUR AU - Hawker, O. Chloe AU - Merkouris, S. Stephanie AU - Youssef, J. George AU - Dowling, A. Nicki PY - 2021/3/26 TI - A Smartphone-Delivered Ecological Momentary Intervention for Problem Gambling (GamblingLess: Curb Your Urge): Single-Arm Acceptability and Feasibility Trial JO - J Med Internet Res SP - e25786 VL - 23 IS - 3 KW - gambling KW - craving KW - urge KW - self-efficacy KW - relapse KW - smartphone KW - self-help KW - treatment KW - ecological momentary assessment KW - ecological momentary intervention KW - mobile phone N2 - Background: Low uptake rates of traditional gambling treatments highlight the need for innovative treatment modalities. Smartphone apps can provide unprecedented access to real-time ecological momentary interventions (EMIs) delivered in people?s everyday lives. Objective: This study aims to examine the acceptability, feasibility, and preliminary effectiveness of GamblingLess: Curb Your Urge, the first smartphone app?delivered EMI that aims to prevent gambling episodes by reducing craving intensity in people seeking help for gambling problems. Methods: This study was a single-arm, 5-week acceptability and feasibility trial (1-week baseline and 4-week intervention periods) involving ecological momentary assessments (EMAs) delivered 3 times daily. The EMAs measured gambling episodes, cravings, and self-efficacy. Web-based evaluations at baseline, postintervention, and 1-month follow-up measured gambling outcomes (severity, cravings, frequency, expenditure, and self-efficacy) and the intervention?s perceived helpfulness, relevance, burden, satisfaction, and impact in relation to gambling cravings. Results: A total of 36 participants, of whom 22/36 (61%) were male and 34/36 (94%) were problem gamblers, completed the baseline measures, with 61% (22/36) completing the postintervention evaluation and 58% (21/36) completing the follow-up evaluation. The intervention was considered acceptable, as participants perceived all intervention content to be above average in helpfulness and the EMA to be highly relevant but somewhat burdensome. Participants reported that they were satisfied with the intervention and that the intervention improved their knowledge, attitudes, awareness, behavior change, intention to change, and help-seeking behavior for gambling cravings. Regarding the intervention?s feasibility, compliance rates for the EMA (51%) and EMI (15%) were low; however, the intervention was used 166 times, including 59 uses within 60 minutes of EMA completion and 107 on-demand uses. Regarding the intervention?s preliminary effectiveness, descriptive EMA data showed that, compared with the baseline period, 71% and 72% reductions in the average number of gambling episodes and craving occurrences were reported in the intervention period, respectively. In addition, clustered paired-sample two-tailed t tests revealed a significant 5.4% reduction in real-time craving intensity (P=.01) immediately after intervention use, which increased to 10.5% (P=.01), where use was recommended based on craving occurrence. At the group level, significant medium-to-large reductions were observed in mean gambling symptom severity (P=.01 and .003), cravings (P=.03 and .02), frequency (P=.01 and .004), and expenditure (P=.04 and .003) at postintervention and follow-up; moreover, increased mean gambling self-efficacy and craving self-efficacy (P=.01 and .01) were observed at postintervention and increased gambling self-efficacy (P=.04) was observed at follow-up. At the individual level, over a quarter of participants (6/22, 27% to 10/21, 48%) could be categorized as recovered or improved regarding their gambling symptom severity and cravings. Conclusions: The results support the acceptability, feasibility, and preliminary effectiveness of this app-delivered EMI for preventing gambling episodes through craving management in people with gambling problems, which has implications for extending the reach of evidence-based treatment to moments of vulnerability in people?s everyday lives. UR - https://www.jmir.org/2021/3/e25786 UR - http://dx.doi.org/10.2196/25786 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769294 ID - info:doi/10.2196/25786 ER - TY - JOUR AU - Saparamadu, Samandika Amarasinghe Arachchige Don Nalin AU - Fernando, Piyum AU - Zeng, Peizi AU - Teo, Henry AU - Goh, Andrew AU - Lee, Yin Joanne Mee AU - Lam, Leslie Choong Weng PY - 2021/3/26 TI - User-Centered Design Process of an mHealth App for Health Professionals: Case Study JO - JMIR Mhealth Uhealth SP - e18079 VL - 9 IS - 3 KW - user-centered design KW - participatory design KW - mobile health applications KW - mHealth KW - smartphones KW - health professionals KW - healthcare KW - human-computer interaction KW - mobile phones N2 - Background: User-centered design processes are infrequently employed and not fully explored for building mobile health (mHealth) apps that are particularly targeted to health professionals as end users. The authors have used a user-centered design?based approach to build an mHealth app for health professionals, tasked to deliver medical laboratory-related information on a daily basis. Objective: Our objective is to generate a simple and functional user-centered design process for mHealth apps for health professionals. This paper presents the key learnings from design activities. Methods: A stratified random sample of doctors and nurses was recruited for the study. The design activities were planned in the following sequence: focus group discussion for situation analysis and information architecture, design activity 1 for wireframe designing, design activity 2 for wireframe testing, and user testing sessions 1 and 2. Results: The final design and functions of the app, information architecture, and interactive elements were largely influenced by the participatory design?based user-centered design activities. As a result of the design process, we could identify the mental models of processing requests for information and personal preferences based on the experience. These findings were directly or indirectly incorporated into the app design. Furthermore, finding alternative ways of working within time constraints and cultural barriers and the methods employed to manage the challenges of interdisciplinary discourse stood out among the lessons learned. Conclusions: We recommend a user-centered design process based on a participatory design approach in mHealth app design, enriched with focus group discussions where possible. UR - https://mhealth.jmir.org/2021/3/e18079 UR - http://dx.doi.org/10.2196/18079 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769297 ID - info:doi/10.2196/18079 ER - TY - JOUR AU - Teferi, Hailiye Gizaw AU - Tilahun, Cheklu Binyam AU - Guadie, Alganeh Habtamu AU - Amare, Tazebew Ashenafi PY - 2021/3/26 TI - Smartphone Medical App Use and Associated Factors Among Physicians at Referral Hospitals in Amhara Region, North Ethiopia, in 2019: Cross-sectional Study JO - JMIR Mhealth Uhealth SP - e19310 VL - 9 IS - 3 KW - application KW - medical KW - physician KW - smartphone KW - mobile phone N2 - Background: Information in health care is rapidly expanding and is updated very regularly, especially with the increasing use of technology in the sector. Due to this, health care providers require timely access to the latest scientific evidence anywhere. Smartphone medical apps are tools to access the latest reputable scientific evidence in the discipline. In addition, smartphone medical apps could lead to improved decision making, reduced numbers of medical errors, and improved communication between hospital medical staff. Objective: The aim of this study was to assess smartphone medical app use and associated factors among physicians working at referral hospitals of the Amhara region, Ethiopia. Methods: An institution-based cross-sectional study design was conducted among physicians working at 5 referral hospitals in the Amhara region, Ethiopia, from February 5 to May 27, 2019. A simple random sampling method was used to select 423 physicians. A self-administered questionnaire was used to collect the data and analyzed using SPSS, version 21 (IBM Corp). Binary and multivariable logistic regression analysis was performed to assess factors associated with smartphone medical app use among physicians. A value of P<.05, corresponding to a 95% CI, was considered statistically significant. The validity of the questionnaire was determined based on the view of experts and the reliability of it obtained by calculating the value of Cronbach alpha (?=.78) Results: In this study, most of the 417 respondents (375, 89.9%) had medical apps installed on their smartphones. Of those 375 respondents, 264 (70.4%) had used medical apps during clinical practice. The medical apps most commonly used by the respondents were UpToDate, Medscape, MedCalc, and Doximity. According to multivariable logistic regression analysis, attitude (adjusted odds ratio [AOR] 1.64, 95% CI 1.05-2.55), internet access (AOR 2.82, 95% CI 1.75-4.54), computer training (AOR 1.71, 95% CI 1.09-2.67), perceived usefulness of the app (AOR 1.64, 95% CI 1.05-2.54), information technology support staff (AOR 2.363, 95% CI 1.5-3.08), and technical skill (AOR 2.52, 95% CI 1.50-4.25) were significantly associated with smartphone medical app use. Conclusions: Most respondents have a smartphone medical app and have used it in clinical practice. Attitude, internet access, computer training, perceived usefulness of the app, information technology support staff, and technical skill are the most notable factors that are associated with smartphone medical app use by physicians.  UR - https://mhealth.jmir.org/2021/3/e19310 UR - http://dx.doi.org/10.2196/19310 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769303 ID - info:doi/10.2196/19310 ER - TY - JOUR AU - Muggeridge, Joseph David AU - Hickson, Kirsty AU - Davies, Victoria Aimie AU - Giggins, M. Oonagh AU - Megson, L. Ian AU - Gorely, Trish AU - Crabtree, R. Daniel PY - 2021/3/25 TI - Measurement of Heart Rate Using the Polar OH1 and Fitbit Charge 3 Wearable Devices in Healthy Adults During Light, Moderate, Vigorous, and Sprint-Based Exercise: Validation Study JO - JMIR Mhealth Uhealth SP - e25313 VL - 9 IS - 3 KW - heart rate KW - photoplethysmography KW - wearable electronic devices KW - validation study KW - exercise KW - mobile phone N2 - Background: Accurate, continuous heart rate measurements are important for health assessment, physical activity, and sporting performance, and the integration of heart rate measurements into wearable devices has extended its accessibility. Although the use of photoplethysmography technology is not new, the available data relating to the validity of measurement are limited, and the range of activities being performed is often restricted to one exercise domain and/or limited intensities. Objective: The primary objective of this study was to assess the validity of the Polar OH1 and Fitbit Charge 3 devices for measuring heart rate during rest, light, moderate, vigorous, and sprint-type exercise. Methods: A total of 20 healthy adults (9 female; height: mean 1.73 [SD 0.1] m; body mass: mean 71.6 [SD 11.0] kg; and age: mean 40 [SD 10] years) volunteered and provided written informed consent to participate in the study consisting of 2 trials. Trial 1 was split into 3 components: 15-minute sedentary activities, 10-minute cycling on a bicycle ergometer, and incremental exercise test to exhaustion on a motorized treadmill (18-42 minutes). Trial 2 was split into 2 components: 4 × 15-second maximal sprints on a cycle ergometer and 4 × 30- to 50-m sprints on a nonmotorized resistance treadmill. Data from the 3 devices were time-aligned, and the validity of Polar OH1 and Fitbit Charge 3 was assessed against Polar H10 (criterion device). Validity was evaluated using the Bland and Altman analysis, Pearson moment correlation coefficient, and mean absolute percentage error. Results: Overall, there was a very good correlation between the Polar OH1 and Polar H10 devices (r=0.95), with a mean bias of ?1 beats·min-1 and limits of agreement of ?20 to 19 beats·min-1. The Fitbit Charge 3 device underestimated heart rate by 7 beats·min-1 compared with Polar H10, with a limit of agreement of ?46 to 33 beats·min-1 and poor correlation (r=0.8). The mean absolute percentage error for both devices was deemed acceptable (<5%). Polar OH1 performed well across each phase of trial 1; however, validity was worse for trial 2 activities. Fitbit Charge 3 performed well only during rest and nonsprint-based treadmill activities. Conclusions: Compared with our criterion device, Polar OH1 was accurate at assessing heart rate, but the accuracy of Fitbit Charge 3 was generally poor. Polar OH1 performed worse during trial 2 compared with the activities in trial 1, and the validity of the Fitbit Charge 3 device was particularly poor during our cycling exercises. UR - https://mhealth.jmir.org/2021/3/e25313 UR - http://dx.doi.org/10.2196/25313 UR - http://www.ncbi.nlm.nih.gov/pubmed/33764310 ID - info:doi/10.2196/25313 ER - TY - JOUR AU - Krishnakumar, Arjun AU - Verma, Ritika AU - Chawla, Rajeev AU - Sosale, Aravind AU - Saboo, Banshi AU - Joshi, Shilpa AU - Shaikh, Maaz AU - Shah, Abhishek AU - Kolwankar, Siddhesh AU - Mattoo, Vinod PY - 2021/3/25 TI - Evaluating Glycemic Control in Patients of South Asian Origin With Type 2 Diabetes Using a Digital Therapeutic Platform: Analysis of Real-World Data JO - J Med Internet Res SP - e17908 VL - 23 IS - 3 KW - digital therapeutics KW - type 2 diabetes KW - behavior change KW - diabetes self-management KW - lifestyle intervention KW - mobile phone N2 - Background: Digital therapeutics are evidence-based therapeutic interventions driven by high-quality software programs for the treatment, prevention, or management of a medical disorder or disease. Many studies in the western population have shown the effectiveness of mobile app?based digital therapeutics for improving glycemic control in patients with type 2 diabetes (T2D). However, few studies have assessed similar outcomes in the South Asian population. Objective: This study aims to investigate the real-world effectiveness of the Wellthy CARE digital therapeutic for improving glycemic control among the South Asian population of Indian origin. Methods: We analyzed deidentified data from 102 patients with T2D from India enrolled in a 16-week structured self-management program delivered using the Wellthy CARE mobile app. Patients recorded their meals, weight, physical activity, and blood sugar in the app, and they received lessons on self-care behaviors (healthy eating, being active, monitoring, medication adherence, problem solving, healthy coping, and reducing risks); feedback provided by an artificial intelligence?powered chatbot; and periodic interactions with certified diabetes educators via voice calls and chats. The primary outcome of the program was a change in glycated hemoglobin A1c (HbA1c). Secondary outcomes included the difference between preintervention and postintervention fasting blood glucose (FBG) and postprandial blood glucose (PPBG) levels; changes in BMI and weight at the completion of 16 weeks; and the association between program engagement and the changes in HbA1c, FBG, and PPBG levels. Results: At the end of 16 weeks, the average change in HbA1c was ?0.49% (n=102; 95% CI ?0.73 to 0.25; P<.001). Of all the patients, 63.7% (65/102) had improved HbA1c levels, with a mean change of ?1.16% (n=65; 95% CI ?1.40 to ?0.92; P<.001). The mean preintervention and postintervention FBG levels were 145 mg/dL (n=51; 95% CI 135-155) and 134 mg/dL (n=51; 95% CI 122-146; P=.02) and PPBG levels were 188 mg/dL (n=51; 95% CI 172-203) and 166 mg/dL (n=51; 95% CI 153-180; P=.03), respectively. The mean changes in BMI and weight were ?0.47 kg/m2 (n=59; 95% CI ?0.22 to ?0.71; P<.001) and ?1.32 kg (n=59; 95% CI ?0.63 to ?2.01; P<.001), respectively. There was a stepwise decrease in HbA1c, FBG, and PPBG levels as the program engagement increased. Patients in the highest tertile of program engagement had a significantly higher reduction in HbA1c (?0.84% vs ?0.06%; P=.02), FBG (?21.4 mg/dL vs ?0.18 mg/dL; P=.02), and PPBG levels (?22.03 mg/dL vs 2.35 mg/dL; P=.002) than those in the lowest tertile. Conclusions: The use of the Wellthy CARE digital therapeutic for patients with T2D showed a significant reduction in the levels of HbA1c, FBG, and PPBG after 16 weeks. A higher level of participation showed improved glycemic control, suggesting the potential of the Wellthy CARE platform for better management of the disease. UR - https://www.jmir.org/2021/3/e17908 UR - http://dx.doi.org/10.2196/17908 UR - http://www.ncbi.nlm.nih.gov/pubmed/33764306 ID - info:doi/10.2196/17908 ER - TY - JOUR AU - Dubov, Alex AU - Fraenkel, Liana AU - Goldstein, Zil AU - Arroyo, Hansel AU - McKellar, Derek AU - Shoptaw, Steve PY - 2021/3/24 TI - Development of a Smartphone App to Predict and Improve the Rates of Suicidal Ideation Among Transgender Persons (TransLife): Qualitative Study JO - J Med Internet Res SP - e24023 VL - 23 IS - 3 KW - mobile health KW - mHealth KW - mobile app KW - pilot study KW - qualitative research KW - user-centered design KW - acceptability study KW - health services for transgender persons KW - suicide prevention KW - mental health KW - mobile phone N2 - Background: Transgender people are at a high risk of suicidal ideation, suicide attempts, and deaths. Among transgender individuals, 77% and 41% engage in suicidal ideation and suicide attempt in their lifetime, respectively, which exceeds the general population rates (9.2% and 2.7%, respectively). Traditionally, suicide risk factors have been studied over a long period between measurements, making it difficult to understand the short-term variability in suicide risk. Mobile phone apps offer an opportunity to understand the immediate precursors of suicidality through the assessment of behaviors and moods in real time. This is the first study to use a mobile phone app (TransLife) to understand the short-term risk factors for suicide among transgender individuals. Objective: This study aims to beta test the usability of an evidence-informed mobile health (mHealth) suicide prevention phone app, TransLife. The primary aims are to obtain preliminary data on user engagement and satisfaction with the app, and to assess the feasibility of completing ecological momentary assessments (mood logs) within the app. Methods: We used qualitative methods and an exploratory research approach that combined naturalistic app use, focus groups, and semistructured phone interviews. The focus group was informed about the development of the prototype. We conducted a 3-week evaluation to determine engagement and obtain detailed user feedback about the app. After participation in the pilot, phone-based, semistructured, and audio-recorded exit interviews were conducted with the research participants. Results: In total, 16 transgender individuals participated in this study. On average, users logged in 4 (SD 2.7) times a week and spent approximately 5 (SD 3.5) minutes on the app per log-in. A total of 6 major themes emerged in this study. These themes focused on the app?s functionality, satisfaction with using the app, perceived ease of use, perceived safety of providing personal data within the app, trusting the app enough to share personal feelings, and features that make this app engaging. These themes suggest that TransLife is an engaging, useful, and acceptable mHealth intervention. Participants reported that the app was easy to use and understand, supported mental self-care, promoted self-awareness, and helped them identify triggers of negative moods. Conclusions: The results of this pilot study indicate that TransLife is an engaging, acceptable, and potentially effective mHealth intervention. Transgender participants reported many advantages of using TransLife, such as being able to track their mood, connecting to the community, and accessing local resources. This study provides initial support for the acceptability and usability of TransLife as an mHealth intervention designed for the transgender community. UR - https://www.jmir.org/2021/3/e24023 UR - http://dx.doi.org/10.2196/24023 UR - http://www.ncbi.nlm.nih.gov/pubmed/33596181 ID - info:doi/10.2196/24023 ER - TY - JOUR AU - Zucchelli, Fabio AU - Donnelly, Olivia AU - Rush, Emma AU - Smith, Harriet AU - Williamson, Heidi AU - PY - 2021/3/24 TI - Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders? Input JO - JMIR Form Res SP - e26355 VL - 5 IS - 3 KW - mobile health KW - acceptance and commitment therapy KW - appearance KW - qualitative KW - participatory design KW - mobile phone N2 - Background: Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective: The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention?s design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders? design preferences and ideas based on initial author-created content. Methods: Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results: Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions: The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords. UR - https://formative.jmir.org/2021/3/e26355 UR - http://dx.doi.org/10.2196/26355 UR - http://www.ncbi.nlm.nih.gov/pubmed/33759791 ID - info:doi/10.2196/26355 ER - TY - JOUR AU - Morse, S. Robert AU - Lambden, Kaley AU - Quinn, Erin AU - Ngoma, Twalib AU - Mushi, Beatrice AU - Ho, Xian Yun AU - Ngoma, Mamsau AU - Mahuna, Habiba AU - Sagan, B. Sarah AU - Mmari, Joshua AU - Miesfeldt, Susan PY - 2021/3/23 TI - A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach JO - JMIR Cancer SP - e24062 VL - 7 IS - 1 KW - mobile health KW - mHealth KW - user-centered design KW - palliative care KW - pain KW - cancer KW - sub-Saharan Africa KW - mobile phone N2 - Background: Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. Objective: The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. Methods: A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life?focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app?s effectiveness in symptom control among cancer patients. Results: mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. Conclusions: We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users?patients or caregivers, LHWs, and members of the palliative care team?and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas. UR - https://cancer.jmir.org/2021/1/e24062 UR - http://dx.doi.org/10.2196/24062 UR - http://www.ncbi.nlm.nih.gov/pubmed/33755022 ID - info:doi/10.2196/24062 ER - TY - JOUR AU - Hsieh, Katherine AU - Fanning, Jason AU - Frechette, Mikaela AU - Sosnoff, Jacob PY - 2021/3/22 TI - Usability of a Fall Risk mHealth App for People With Multiple Sclerosis: Mixed Methods Study JO - JMIR Hum Factors SP - e25604 VL - 8 IS - 1 KW - smartphone KW - user center design KW - falls KW - mobile phone N2 - Background: Multiple sclerosis (MS) is a chronic, neurodegenerative disease that causes a range of motor, sensory, and cognitive symptoms. Due to these symptoms, people with MS are at a high risk for falls, fall-related injuries, and reductions in quality of life. There is no cure for MS, and managing symptoms and disease progression is important to maintain a high quality of life. Mobile health (mHealth) apps are commonly used by people with MS to help manage their health. However, there are limited health apps for people with MS designed to evaluate fall risk. A fall risk app can increase access to fall risk assessments and improve self-management. When designing mHealth apps, a user-centered approach is critical for improving use and adoption. Objective: The purpose of this study is to undergo a user-centered approach to test and refine the usability of the app through an iterative design process. Methods: The fall risk app Steady-MS is an extension of Steady, a fall risk app for older adults. Steady-MS consists of 2 components: a 25-item questionnaire about demographics and MS symptoms and 5 standing balance tasks. Data from the questionnaire and balance tasks were inputted into an algorithm to compute a fall risk score. Two iterations of semistructured interviews (n=5 participants per iteration) were performed to evaluate usability. People with MS used Steady-MS on a smartphone, thinking out loud. Interviews were recorded, transcribed, and developed into codes and themes. People with MS also completed the System Usability Scale. Results: A total of 3 themes were identified: intuitive navigation, efficiency of use, and perceived value. Overall, the participants found Steady-MS efficient to use and useful to learn their fall risk score. There were challenges related to cognitive overload during the balance tasks. Modifications were made, and after the second iteration, people with MS reported that the app was intuitive and efficient. Average System Usability Scale scores were 95.5 in both iterations, representing excellent usability. Conclusions: Steady-MS is the first mHealth app for people with MS to assess their overall risk of falling and is usable by a subset of people with MS. People with MS found Steady-MS to be usable and useful for understanding their risk of falling. When developing future mHealth apps for people with MS, it is important to prevent cognitive overload through simple and clear instructions and present scores that are understood and interpreted correctly through visuals and text. These findings underscore the importance of user-centered design and provide a foundation for the future development of tools to assess and prevent scalable falls for people with MS. Future steps include understanding the validity of the fall risk algorithm and evaluating the clinical utility of the app. UR - https://humanfactors.jmir.org/2021/1/e25604 UR - http://dx.doi.org/10.2196/25604 UR - http://www.ncbi.nlm.nih.gov/pubmed/33749609 ID - info:doi/10.2196/25604 ER - TY - JOUR AU - Teckie, Sewit AU - Solomon, Jeffrey AU - Kadapa, Karthik AU - Sanchez, Keisy AU - Orner, David AU - Kraus, Dennis AU - Kamdar, P. Dev AU - Pereira, Lucio AU - Frank, Douglas AU - Diefenbach, Michael PY - 2021/3/19 TI - A Mobile Patient-Facing App for Tracking Patient-Reported Outcomes in Head and Neck Cancer Survivors: Single-Arm Feasibility Study JO - JMIR Form Res SP - e24667 VL - 5 IS - 3 KW - mHealth KW - ePROs KW - head and neck cancer KW - mobile phone N2 - Background: Patients with head and neck cancer (HNC) frequently experience disease-related symptoms and treatment adverse effects that impact their overall quality of life. Cancer-specific mobile health apps for patient-related outcomes allow patients to communicate with their clinicians and proactively track their symptoms, which have been shown to improve clinical management and disease outcomes. Objective: The purpose of this study was to evaluate the feasibility of LogPAL, a novel iPhone-based mobile health app designed to help HNC survivors track and manage their posttreatment symptoms. Methods: Patients who completed curative treatment for HNC in the preceding 24 months were recruited from 2 clinical sites within a single institution. Upon enrollment, participants completed a brief sociodemographic survey, downloaded the app onto their iPhone devices, and were asked to complete a series of biweekly questionnaires (based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) via the app for an 8-week study period. The primary feasibility endpoints included retention (retaining >80% of the enrolled participants for the duration of the study period), adherence (>50% of the participants completing 100% of the questionnaires over the study period), and usability (a mean system usability scale [SUS] score >68). Additional postintervention questions were collected to assess perceived usefulness, acceptance, and overall satisfaction. Results: Between January and October 2019, 38 participants were enrolled in the study. Three participants dropped out, and 3 were classified as nonusers. The remaining 32 (87%) were eligible for analysis. Their mean age was 57.8 (SD 12.3) years (range 24-77 years, 81% [26/32] male). Overall, 375 of 512 (73.2%) questionnaires were completed, with 17 (53%) of the 32 participants adherent. Participant-reported usability was acceptable; the mean SUS score was 71.9 (95% CI 64.3-79.5) with high satisfaction of LogPAL usefulness and likelihood to recommend to other cancer survivors. Conclusions: This single-arm prospective pilot study showed that LogPAL is a feasible, regularly used, accepted app for HNC survivors, justifying a full-scale pilot. Based on the findings from this study, future iterations will aim to improve usability and test intervention efficacy. UR - https://formative.jmir.org/2021/3/e24667 UR - http://dx.doi.org/10.2196/24667 UR - http://www.ncbi.nlm.nih.gov/pubmed/33739291 ID - info:doi/10.2196/24667 ER - TY - JOUR AU - Ghahramani, Fereshteh AU - Wang, Jingguo PY - 2021/3/17 TI - Intention to Adopt mHealth Apps Among Informal Caregivers: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e24755 VL - 9 IS - 3 KW - mobile health KW - cross-sectional study KW - informal caregivers KW - mobile app KW - caregiving app KW - mobile phone N2 - Background: Caregiving responsibility can change caregivers? lives; modify their emotions; and make them feel frustrated, fearful, and nervous, thereby imposing physical and mental stress. Caregiving-related mobile apps provide a platform for obtaining valuable and trusted information, connecting more easily with other caregivers, monitoring medications, and managing appointments, and assessing health requirements and conditions of care receivers. Such apps also incorporate valuable resources that address care for the caregivers. Despite the potential benefits of caregiving-related apps, only a limited number of caregivers have adopted and used them. Objective: The aim of this study is to explore the important factors that affect caregivers? intentions to integrate related mobile apps into their routine caregiving responsibilities. Methods: Using the protection motivation theory, we conducted a cross-sectional study among 249 participants. Purposive sampling was used to target participants who met 4 inclusion criteria: US residents, owning and using a smartphone, informal caregivers (individuals who give care to a friend or family member without payment) who provided at least 8 hours of care per week in the past year, and those currently not using any mobile app for caregiving purposes. We created a survey using Qualtrics and posted it on Amazon?s Mechanical Turk website. Participants received monetary compensation after successful completion of the survey. Results: We found that capabilities and skills of caregivers to use mobile apps, the app?s effectiveness in responding to the needs of caregivers, the degree of control of caregivers over their responsibilities, and the decisions they make for their care receivers can predict their willingness to adopt caregiving-related apps. In addition, the severity of health status and vulnerability of care receivers to unexpected health changes indirectly shape their caregivers? decisions to adopt and use mobile apps for caregiving purposes. Conclusions: This study explores the important factors that affect informal caregivers? intentions to adopt related mobile apps into their routine caregiving responsibilities. The results contribute to both mobile health adoption and the caregiving literature, and they offer significant implications for developers, health care practitioners, and policy makers. UR - https://mhealth.jmir.org/2021/3/e24755 UR - http://dx.doi.org/10.2196/24755 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729166 ID - info:doi/10.2196/24755 ER - TY - JOUR AU - Ratnanather, Tilak J. AU - Bhattacharya, Rohit AU - Heston, B. Margo AU - Song, Joanne AU - Fernandez, R. Lindsey AU - Lim, Seo Hong AU - Lee, Seung-Wook AU - Tam, Edric AU - Yoo, Sungho AU - Bae, Seung-Ho AU - Lam, Inez AU - Jeon, Won Hyoung AU - Chang, A. Son AU - Koo, Ja-Won PY - 2021/3/15 TI - An mHealth App (Speech Banana) for Auditory Training: App Design and Development Study JO - JMIR Mhealth Uhealth SP - e20890 VL - 9 IS - 3 KW - speech therapy KW - mobile phone KW - computers, handheld KW - cochlear implants KW - hearing aids N2 - Background: With the growing adult population using electronic hearing devices such as cochlear implants or hearing aids, there is an increasing worldwide need for auditory training (AT) to promote optimal device use. However, financial resources and scheduling conflicts make clinical AT infeasible. Objective: To address this gap between need and accessibility, we primarily aimed to develop a mobile health (mHealth) app called Speech Banana for AT. The app would be substantially more affordable and portable than clinical AT; would deliver a validated training model that is reflective of modern techniques; and would track users? progress in speech comprehension, providing greater continuity between periodic in-person visits. To improve international availability, our secondary aim was to implement the English language training model into Korean as a proof of concept for worldwide usability. Methods: A problem- and objective-centered Design Science Research Methodology approach was adopted to develop the Speech Banana app. A review of previous literature and computer-based learning programs outlined current AT gaps, whereas interviews with speech pathologists and users clarified the features that were addressed in the app. Past and present users were invited to evaluate the app via community forums and the System Usability Scale. Results: Speech Banana has been implemented in English and Korean languages for iPad and web use. The app comprises 38 lessons, which include analytic exercises pairing visual and auditory stimuli, and synthetic quizzes presenting auditory stimuli only. During quizzes, users type the sentence heard, and the app provides visual feedback on performance. Users may select a male or female speaker and the volume of background noise, allowing for training with a range of frequencies and signal-to-noise ratios. There were more than 3200 downloads of the English iPad app and almost 100 downloads of the Korean app; more than 100 users registered for the web apps. The English app received a System Usability Scale rating of ?good? from 6 users, and the Korean app received a rating of ?OK? from 16 users. Conclusions: Speech Banana offers AT accessibility with a validated curriculum, allowing users to develop speech comprehension skills with the aid of a mobile device. This mHealth app holds potential as a supplement to clinical AT, particularly in this era of global telemedicine. UR - https://mhealth.jmir.org/2021/3/e20890 UR - http://dx.doi.org/10.2196/20890 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720025 ID - info:doi/10.2196/20890 ER - TY - JOUR AU - Mussetti, Alberto AU - Salas, Queralt Maria AU - Condom, Maria AU - Antonio, Maite AU - Ochoa, Cristian AU - Ivan, Iulia AU - Jimenez Ruiz-De la Torre, David AU - Sanz Linares, Gabriela AU - Ansoleaga, Belen AU - Patiño-Gutierrez, Beatriz AU - Jimenez-Prat, Laura AU - Parody, Rocio AU - Sureda-Balari, Ana PY - 2021/3/12 TI - Use of Telehealth for Domiciliary Follow-up After Hematopoietic Cell Transplantation During the COVID-19 Pandemic: Prospective Pilot Study JO - JMIR Form Res SP - e26121 VL - 5 IS - 3 KW - SARS-CoV-2 KW - COVID-19 KW - hematology KW - hematopoietic cell transplantation KW - telemedicine KW - mortality KW - surveillance KW - monitoring KW - stem cell KW - transplant KW - app KW - medical device N2 - Background: Patients who have recently received a hematopoietic cell transplant (HCT) are at higher risk of acute complications in the first weeks after discharge, especially during the COVID-19 pandemic. Objective: The aim of this study was to test the use of a telehealth platform for the follow-up of HCT patients during the first two weeks after discharge. Methods: In total, 21 patients who received autologous or allogeneic HCT for hematological malignancies were screened from April 30, 2020, to July 15, 2020. The telehealth platform assisted in the daily collection of vital signs as well as physical and psychological symptoms for two weeks after hospital discharge. The required medical devices (oximeter and blood pressure monitor) were given to patients and a dedicated smartphone app was developed to collect this data. The data were reviewed daily through web-based software by a hematologist specializing in HCT. Results: Only 12 of 21 patients were able to join and complete the study. Technological barriers were the most frequent limiting factor in this study. Among the 12 patients who completed the study, adherence to data reporting was high. The patients? experience of using such a system was considered good. In two cases, the system enabled the early recognition of acute complications. Conclusions: This pilot study showed that telehealth systems can be applied in the early posttransplant setting, with evident advantages for physicians and patients for both medical and psychological aspects. Technological issues still represent a challenge for the applicability of such a system, especially for older adult patients. Easier-to-use technologies could help to expand the use of telehealth systems in this setting in the future. UR - https://formative.jmir.org/2021/3/e26121 UR - http://dx.doi.org/10.2196/26121 UR - http://www.ncbi.nlm.nih.gov/pubmed/33600351 ID - info:doi/10.2196/26121 ER - TY - JOUR AU - Sandborg, Johanna AU - Söderström, Emmie AU - Henriksson, Pontus AU - Bendtsen, Marcus AU - Henström, Maria AU - Leppänen, H. Marja AU - Maddison, Ralph AU - Migueles, H. Jairo AU - Blomberg, Marie AU - Löf, Marie PY - 2021/3/11 TI - Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e26091 VL - 9 IS - 3 KW - gestational weight gain KW - physical activity KW - diet KW - pregnancy KW - mHealth KW - smartphone app KW - mobile phone app KW - telemedicine KW - randomized controlled trial N2 - Background: Excessive gestational weight gain (GWG) during pregnancy is a major public health concern associated with negative health outcomes for both mother and child. Scalable interventions are needed, and digital interventions have the potential to reach many women and promote healthy GWG. Most previous studies of digital interventions have been small pilot studies or have not included women from all BMI categories. We therefore examined the effectiveness of a smartphone app in a large sample (n=305) covering all BMI categories. Objective: To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG, body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia, and insulin resistance in comparison to standard maternity care. Methods: A 2-arm parallel randomized controlled trial was conducted. Women in early pregnancy at maternity clinics in Östergötland, Sweden, were recruited. Eligible women who provided written informed consent completed baseline measures, before being randomized in a 1:1 ratio to either an intervention (n=152) or control group (n=153). The control group received standard maternity care while the intervention group received the HealthyMoms smartphone app for 6 months (which includes multiple features, eg, information; push notifications; self-monitoring; and feedback features for GWG, diet, and physical activity) in addition to standard care. Outcome measures were assessed at Linköping University Hospital at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). The primary outcome was GWG and secondary outcomes were body fatness (Bod Pod), dietary habits (Swedish Healthy Eating Index) using the web-based 3-day dietary record Riksmaten FLEX, MVPA using the ActiGraph wGT3x-BT accelerometer, glycemia, and insulin resistance. Results: Overall, we found no statistically significant effect on GWG (P=.62); however, the data indicate that the effect of the intervention differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group as compared with the control group in the imputed analyses (?1.33 kg; 95% CI ?2.92 to 0.26; P=.10) and completers-only analyses (?1.67 kg; 95% CI ?3.26 to ?0.09; P=.031]). Bayesian analyses showed that there was a 99% probability of any intervention effect on GWG among women with overweight and obesity, and an 81% probability that this effect was over 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27; 95% CI 0.05-0.50; P=.017). We observed no statistically significant differences in body fatness, MVPA, glycemia, and insulin resistance between the intervention and control group at follow up (P?.21). Conclusions: Although we found no overall effect on GWG, our results demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors as well as to decrease weight gain during pregnancy in women with overweight and obesity. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 UR - https://mhealth.jmir.org/2021/3/e26091 UR - http://dx.doi.org/10.2196/26091 UR - http://www.ncbi.nlm.nih.gov/pubmed/33704075 ID - info:doi/10.2196/26091 ER - TY - JOUR AU - Henson, Philip AU - Rodriguez-Villa, Elena AU - Torous, John PY - 2021/3/10 TI - Investigating Associations Between Screen Time and Symptomatology in Individuals With Serious Mental Illness: Longitudinal Observational Study JO - J Med Internet Res SP - e23144 VL - 23 IS - 3 KW - mHealth KW - schizophrenia KW - apps KW - mobile KW - screen time N2 - Background: Increasing screen time exposure from digital devices like smartphones has shown a variety of mixed associations with cognition, behavior, and well-being in adults and children but little is known about its associations with symptomatology in individuals with serious mental illness. Objective: To determine the range of associations between screen time and symptoms of individuals with mental illness, we utilized a method called specification curve analysis. Methods: In this observational study, we recruited smartphone-owning adults (?18 years old) with schizophrenia and healthy controls. We installed 2 research-source smartphone apps, mindLAMP and Beiwe, to collect survey results, cognitive test results, and screen time metrics over a period of 3 months. Surveys were scheduled for twice a week, but participants were instructed to take the surveys naturally as much or as little as they wanted. Screen time was collected continuously in the background. A total of 140 participants was recruited from the outpatient clinic population as well as through general public advertising. Age-matched, smartphone-owning healthy controls were also part of the recruitment pool. A specification curve analysis was a priori designed to explore the relationship between every combination of independent variable and dependent variable in order to demonstrate to what degree screen time relates to symptoms in individuals with serious mental illness. Results: The sample consisted of 88 participants (54 with schizophrenia and 34 healthy controls) who completed both the initial and follow-up visits, completed at least one self-reported survey, and had a minimum passive data cutoff of 5 consecutive days. While we found an association between smartphone screen time metrics and cognition (adjusted R2=0.107, P<.001), specification curve analysis revealed a wide range of heterogenous associations with screen time from very negative to very positive. The effects differed based on diagnostic group, age bracket, type of regression model used, and the specific independent and dependent variables selected for analysis. Conclusions: The associations between screen time and mental health in patients with schizophrenia are heterogenous when examined with methods that reduce analytical bias. The heterogeneity in associations suggests that complex and personalized potential effects must be understood in the greater context of an individual. This analysis of longitudinally collected screen time data shows potential for future research that could benefit from high resolution metrics on smartphone use. UR - https://www.jmir.org/2021/3/e23144 UR - http://dx.doi.org/10.2196/23144 UR - http://www.ncbi.nlm.nih.gov/pubmed/33688835 ID - info:doi/10.2196/23144 ER - TY - JOUR AU - Ponnada, Aditya AU - Thapa-Chhetry, Binod AU - Manjourides, Justin AU - Intille, Stephen PY - 2021/3/10 TI - Measuring Criterion Validity of Microinteraction Ecological Momentary Assessment (Micro-EMA): Exploratory Pilot Study With Physical Activity Measurement JO - JMIR Mhealth Uhealth SP - e23391 VL - 9 IS - 3 KW - ecological momentary assessment (EMA) KW - experience sampling KW - physical activity KW - smartwatch KW - microinteractions KW - criterion validity KW - activity monitor KW - ?EMA N2 - Background: Ecological momentary assessment (EMA) is an in situ method of gathering self-report on behaviors using mobile devices. In typical phone-based EMAs, participants are prompted repeatedly with multiple-choice questions, often causing participation burden. Alternatively, microinteraction EMA (micro-EMA or ?EMA) is a type of EMA where all the self-report prompts are single-question surveys that can be answered using a 1-tap glanceable microinteraction conveniently on a smartwatch. Prior work suggests that ?EMA may permit a substantially higher prompting rate than EMA, yielding higher response rates and lower participation burden. This is achieved by ensuring ?EMA prompt questions are quick and cognitively simple to answer. However, the validity of participant responses from ?EMA self-report has not yet been formally assessed. Objective: In this pilot study, we explored the criterion validity of ?EMA self-report on a smartwatch, using physical activity (PA) assessment as an example behavior of interest. Methods: A total of 17 participants answered 72 ?EMA prompts each day for 1 week using a custom-built ?EMA smartwatch app. At each prompt, they self-reported whether they were doing sedentary, light/standing, moderate/walking, or vigorous activities by tapping on the smartwatch screen. Responses were compared with a research-grade activity monitor worn on the dominant ankle simultaneously (and continuously) measuring PA. Results: Participants had an 87.01% (5226/6006) ?EMA completion rate and a 74.00% (5226/7062) compliance rate taking an average of only 5.4 (SD 1.5) seconds to answer a prompt. When comparing ?EMA responses with the activity monitor, we observed significantly higher (P<.001) momentary PA levels on the activity monitor when participants self-reported engaging in moderate+vigorous activities compared with sedentary or light/standing activities. The same comparison did not yield any significant differences in momentary PA levels as recorded by the activity monitor when the ?EMA responses were randomly generated (ie, simulating careless taps on the smartwatch). Conclusions: For PA measurement, high-frequency ?EMA self-report could be used to capture information that appears consistent with that of a research-grade continuous sensor for sedentary, light, and moderate+vigorous activity, suggesting criterion validity. The preliminary results show that participants were not carelessly answering ?EMA prompts by randomly tapping on the smartwatch but were reporting their true behavior at that moment. However, more research is needed to examine the criterion validity of ?EMA when measuring vigorous activities. UR - https://mhealth.jmir.org/2021/3/e23391 UR - http://dx.doi.org/10.2196/23391 UR - http://www.ncbi.nlm.nih.gov/pubmed/33688843 ID - info:doi/10.2196/23391 ER - TY - JOUR AU - Li, Tiantian AU - Chen, Xiaomin AU - Wang, Jia AU - Chen, Ling AU - Cai, Wenzhi PY - 2021/3/10 TI - Mobile App-Based Intervention for Pregnant Women With Stress Urinary Incontinence: Protocol for a Hybrid Effectiveness-Implementation Trial JO - JMIR Res Protoc SP - e22771 VL - 10 IS - 3 KW - mHealth KW - stress urinary incontinence KW - pregnancy KW - randomized controlled trial KW - process evaluation KW - mixed methods KW - study protocol N2 - Background: Stress urinary incontinence (SUI) is a common source of distress among women during and after pregnancy. It has a negative effect on quality of life but with poor care-seeking. Mobile health (mHealth) may be a promising solution with potential advantages. However, there is uncertainty whether a mobile app is effective for SUI symptom improvement during and after pregnancy. The implementation is also unclear. We developed an app named UIW (Urinary Incontinence for Women) aimed at improving perinatal incontinence. Objective: The objective of this study is to evaluate the effectiveness of the UIW app-based intervention in improving SUI symptoms among pregnant women and explore the facilitators and barriers to using the UIW app to help refine and optimize the intervention. Methods: This study is a hybrid effectiveness-implementation trial with a randomized controlled trial alongside a mixed-methods process evaluation according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Pregnant women with SUI (n=336) will be recruited from a university-affiliated hospital in China. They will be randomly allocated (1:1) to either the intervention group that receive usual care plus UIW app or control group that receive usual care alone. The intervention period will last 2 months. The 5 dimensions of the RE-AIM framework will be evaluated at recruitment (-T1), baseline (T0), immediately after intervention (T1), 42 days after delivery (T2), 3 months after delivery (T3), and 6 months after delivery (T4) through project documents, online questionnaires and a pelvic floor muscle training diary, surface electromyography, log data in the background management system, and qualitative interviews. Data analysis will follow the intention-to-treat principle. Descriptive statistics, t tests, chi-square tests, and a linear mixed model will be used to analyze the quantitative data. Deductive and inductive content analysis will be used to analyze the qualitative data. Results: The effectiveness-implementation trial started in June 2020, trial recruitment was completed in October 2020, and the intervention will last for a 2-month period. Completion of the 6-month follow-up will be in July 2021, and we anticipate that the results of this study will be published in December 2021. Conclusions: This study will evaluate both effectiveness and implementation of the UIW app-based intervention among pregnant women. The hybrid effectiveness-implementation trial design according to the RE-AIM framework with a mixed-methods approach will give valuable insights into the effects as well as facilitators and barriers to the implementation that will influence the effects of the UIW app-based intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID): PRR1-10.2196/22771 UR - https://www.researchprotocols.org/2021/3/e22771 UR - http://dx.doi.org/10.2196/22771 UR - http://www.ncbi.nlm.nih.gov/pubmed/33688842 ID - info:doi/10.2196/22771 ER - TY - JOUR AU - Sharp, Kay Lisa AU - Biggers, Alana AU - Perez, Rosanne AU - Henkins, Julia AU - Tilton, Jessica AU - Gerber, S. Ben PY - 2021/3/10 TI - A Pharmacist and Health Coach?Delivered Mobile Health Intervention for Type 2 Diabetes: Protocol for a Randomized Controlled Crossover Study JO - JMIR Res Protoc SP - e17170 VL - 10 IS - 3 KW - mHealth KW - type 2 diabetes mellitus KW - community health workers KW - clinical pharmacists N2 - Background: Aggressive management of blood glucose, blood pressure, and cholesterol through medication and lifestyle adherence is necessary to minimize the adverse health outcomes of type 2 diabetes. However, numerous psychosocial and environmental barriers to adherence prevent low-income, urban, and ethnic minority populations from achieving their management goals, resulting in diabetes complications. Health coaches working with clinical pharmacists represent a promising strategy for addressing common diabetes management barriers. Mobile health (mHealth) tools may further enhance their ability to support vulnerable minority populations in diabetes management. Objective: The aim of this study is to evaluate the impact of an mHealth clinical pharmacist and health coach?delivered intervention on hemoglobin A1c (HbA1c, primary outcome), blood pressure, and low-density lipoprotein (secondary outcomes) in African-Americans and Latinos with poorly controlled type 2 diabetes. Methods: A 2-year, randomized controlled crossover study will evaluate the effectiveness of an mHealth diabetes intervention delivered by a health coach and clinical pharmacist team compared with usual care. All patients will receive 1 year of team intervention, including lifestyle and medication support delivered in the home with videoconferencing and text messages. All patients will also receive 1 year of usual care without team intervention and no home visits. The order of the conditions received will be randomized. Our recruitment goal is 220 urban African-American or Latino adults with uncontrolled type 2 diabetes (HbA1c ?8%) receiving care from a largely minority-serving, urban academic medical center. The intervention includes the following: health coaches supporting patients through home visits, phone calls, and text messaging and clinical pharmacists supporting patients through videoconferences facilitated by health coaches. Data collection includes physiologic (HbA1c, blood pressure, weight, and lipid profile) and survey measures (medication adherence, diabetes-related behaviors, and quality of life). Data collection during the second year of study will determine the maintenance of any physiological improvement among participants receiving the intervention during the first year. Results: Participant enrollment began in March 2017. We have recruited 221 patients. Intervention delivery and data collection will continue until November 2021. The results are expected to be published by May 2022. Conclusions: This is among the first trials to incorporate health coaches, clinical pharmacists, and mHealth technologies to increase access to diabetes support among urban African-Americans and Latinos to achieve therapeutic goals. International Registered Report Identifier (IRRID): DERR1-10.2196/17170 UR - https://www.researchprotocols.org/2021/3/e17170 UR - http://dx.doi.org/10.2196/17170 UR - http://www.ncbi.nlm.nih.gov/pubmed/33688847 ID - info:doi/10.2196/17170 ER - TY - JOUR AU - op den Buijs, Jorn AU - Pijl, Marten AU - Landgraf, Andreas PY - 2021/3/8 TI - Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States JO - JMIR Med Inform SP - e25121 VL - 9 IS - 3 KW - emergency hospital transport KW - predictive modeling KW - personal emergency response system KW - population health management KW - emergency transport KW - emergency response system KW - emergency response KW - health management N2 - Background: Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. Objective: The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. Methods: Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. Results: German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. Conclusions: Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use. UR - https://medinform.jmir.org/2021/3/e25121 UR - http://dx.doi.org/10.2196/25121 UR - http://www.ncbi.nlm.nih.gov/pubmed/33682679 ID - info:doi/10.2196/25121 ER - TY - JOUR AU - Sandborg, Johanna AU - Henriksson, Pontus AU - Larsen, Erica AU - Lindqvist, Anna-Karin AU - Rutberg, Stina AU - Söderström, Emmie AU - Maddison, Ralph AU - Löf, Marie PY - 2021/3/5 TI - Participants? Engagement and Satisfaction With a Smartphone App Intended to Support Healthy Weight Gain, Diet, and Physical Activity During Pregnancy: Qualitative Study Within the HealthyMoms Trial JO - JMIR Mhealth Uhealth SP - e26159 VL - 9 IS - 3 KW - pregnancy KW - gestational weight gain KW - mHealth KW - telemedicine KW - digital health KW - mobile health KW - eHealth KW - smartphone intervention KW - mobile application KW - smartphone application KW - engagement KW - physical activity KW - exercise KW - nutrition KW - diet KW - qualitative KW - thematic analysis N2 - Background: Excessive gestational weight gain (GWG) is common and associated with negative health outcomes for both mother and child. Mobile health?delivered lifestyle interventions offer the potential to mitigate excessive GWG. The effectiveness of a smartphone app (HealthyMoms) was recently evaluated in a randomized controlled trial. To explore the users? experiences of using the app, a qualitative study within the HealthyMoms trial was performed. Objective: This qualitative study explored participants? engagement and satisfaction with the 6-month usage of the HealthyMoms app. Methods: A total of 19 women (mean age: 31.7, SD 4.4 years; mean BMI: 24.6, SD 3.4 kg/m2; university degree attainment: 13/19, 68%; primiparous: 11/19, 58%) who received the HealthyMoms app in a randomized controlled trial completed semistructured exit interviews. The interviews were audiorecorded and fully transcribed, coded, and analyzed using thematic analysis with an inductive approach. Results: Thematic analysis revealed a main theme and 2 subthemes. The main theme, ?One could suit many: a multifunctional tool to strengthen women?s health during pregnancy,? and the 2 subthemes, ?Factors within and beyond the app influence app engagement? and ?Trust, knowledge, and awareness: aspects that can motivate healthy habits,? illustrated that a trustworthy and appreciated health and pregnancy app that is easy to use can inspire a healthy lifestyle during pregnancy. The first subtheme discussed how factors within the app (eg, regular updates and feedback) were perceived to motivate both healthy habits and app engagement. Additionally, factors beyond the app were described to both motivate (eg, interest, motivation, and curiosity) and limit (eg, pregnancy-related complications, lack of time) app engagement. The second subtheme reflected important aspects, such as high trustworthiness of the app, increased knowledge, and awareness from using the app, which motivated participants to improve or maintain healthy habits during pregnancy. Conclusions: The HealthyMoms app was considered a valuable and trustworthy tool to mitigate excessive GWG, with useful features and relevant information to initiate and maintain healthy habits during pregnancy. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 UR - https://mhealth.jmir.org/2021/3/e26159 UR - http://dx.doi.org/10.2196/26159 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666554 ID - info:doi/10.2196/26159 ER - TY - JOUR AU - Lu?trek, Mitja AU - Bohanec, Marko AU - Cavero Barca, Carlos AU - Ciancarelli, Costanza Maria AU - Clays, Els AU - Dawodu, Adeyemo Amos AU - Derboven, Jan AU - De Smedt, Delphine AU - Dovgan, Erik AU - Lampe, Jure AU - Marino, Flavia AU - Mlakar, Miha AU - Pioggia, Giovanni AU - Puddu, Emilio Paolo AU - Rodríguez, Mario Juan AU - Schiariti, Michele AU - Slapni?ar, Ga?per AU - Slegers, Karin AU - Tartarisco, Gennaro AU - Vali?, Jakob AU - Vodopija, Aljo?a PY - 2021/3/5 TI - A Personal Health System for Self-Management of Congestive Heart Failure (HeartMan): Development, Technical Evaluation, and Proof-of-Concept Randomized Controlled Trial JO - JMIR Med Inform SP - e24501 VL - 9 IS - 3 KW - congestive heart failure KW - personal health system KW - mobile application KW - mobile phone KW - wearable electronic devices KW - decision support techniques KW - psychological support KW - human centered design N2 - Background: Congestive heart failure (CHF) is a disease that requires complex management involving multiple medications, exercise, and lifestyle changes. It mainly affects older patients with depression and anxiety, who commonly find management difficult. Existing mobile apps supporting the self-management of CHF have limited features and are inadequately validated. Objective: The HeartMan project aims to develop a personal health system that would comprehensively address CHF self-management by using sensing devices and artificial intelligence methods. This paper presents the design of the system and reports on the accuracy of its patient-monitoring methods, overall effectiveness, and patient perceptions. Methods: A mobile app was developed as the core of the HeartMan system, and the app was connected to a custom wristband and cloud services. The system features machine learning methods for patient monitoring: continuous blood pressure (BP) estimation, physical activity monitoring, and psychological profile recognition. These methods feed a decision support system that provides recommendations on physical health and psychological support. The system was designed using a human-centered methodology involving the patients throughout development. It was evaluated in a proof-of-concept trial with 56 patients. Results: Fairly high accuracy of the patient-monitoring methods was observed. The mean absolute error of BP estimation was 9.0 mm Hg for systolic BP and 7.0 mm Hg for diastolic BP. The accuracy of psychological profile detection was 88.6%. The F-measure for physical activity recognition was 71%. The proof-of-concept clinical trial in 56 patients showed that the HeartMan system significantly improved self-care behavior (P=.02), whereas depression and anxiety rates were significantly reduced (P<.001), as were perceived sexual problems (P=.01). According to the Unified Theory of Acceptance and Use of Technology questionnaire, a positive attitude toward HeartMan was seen among end users, resulting in increased awareness, self-monitoring, and empowerment. Conclusions: The HeartMan project combined a range of advanced technologies with human-centered design to develop a complex system that was shown to help patients with CHF. More psychological than physical benefits were observed. Trial Registration: ClinicalTrials.gov NCT03497871; https://clinicaltrials.gov/ct2/history/NCT03497871. International Registered Report Identifier (IRRID): RR2-10.1186/s12872-018-0921-2 UR - https://medinform.jmir.org/2021/3/e24501 UR - http://dx.doi.org/10.2196/24501 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666562 ID - info:doi/10.2196/24501 ER - TY - JOUR AU - Seaman, L. Elizabeth AU - Robinson, D. Cendrine AU - Crane, David AU - Taber, M. Jennifer AU - Ferrer, A. Rebecca AU - Harris, R. Peter AU - Klein, P. William M. PY - 2021/3/5 TI - Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App: Randomized Controlled Trial JO - J Med Internet Res SP - e18433 VL - 23 IS - 3 KW - smoking cessation KW - smartphone KW - mHealth KW - sadness KW - self-affirmation KW - spontaneous self-affirmation KW - apps KW - mobile phone N2 - Background: Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual?s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats. Objective: This study examines whether self-affirmation is associated with smoking cessation in the context of a cessation app. Two types of self-affirmation are examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly available smoking cessation app (Smoke-Free Quit Smoking Now). In addition, this study explores whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking cessation. Methods: All users who met the inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to 1 of 4 conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half of the participants were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully automated, and all data were collected through self-assessments in the app. Self-reported smoking cessation was assessed 1 month and 3 months following study entry. Results: The study enrolled 7899 participants; 647 completed the 1-month follow-up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of participants self-reported not smoking in the previous week and 6.4% (503/7899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted a greater likelihood of cessation (P<.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. In addition, spontaneous self-affirmation did not moderate the relationship between self-affirmation inductions and cessation. Greater baseline sadness was associated with a lower likelihood of reporting successful cessation. Optimism predicted past-week cessation at the 1-month follow-up, and both happiness and anger predicted past-month cessation at the 1-month follow-up; however, none of these potential predictors moderated the relationship between self-affirmation conditions and successful cessation. Conclusions: Spontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced self-affirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmation interventions. Trial Registration: ISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695 UR - https://www.jmir.org/2021/3/e18433 UR - http://dx.doi.org/10.2196/18433 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666561 ID - info:doi/10.2196/18433 ER - TY - JOUR AU - Lee, Sungchul AU - Walker, M. Ryan AU - Kim, Yoohwan AU - Lee, Hyunhwa PY - 2021/3/5 TI - Measurement of Human Walking Movements by Using a Mobile Health App: Motion Sensor Data Analysis JO - JMIR Mhealth Uhealth SP - e24194 VL - 9 IS - 3 KW - mobile health KW - mHealth KW - walking balance KW - smartphone KW - motion sensor KW - sensor KW - walking KW - mobile phone N2 - Background: This study presents a new approach to measure and analyze the walking balance of humans by collecting motion sensor data in a smartphone. Objective: We aimed to develop a mobile health (mHealth) app that can measure the walking movements of human individuals and analyze the differences in the walking movements of different individuals based on their health conditions. A smartphone?s motion sensors were used to measure the walking movements and analyze the rotation matrix data by calculating the variation of each xyz rotation, which shows the variables in walking-related movement data over time. Methods: Data were collected from 3 participants, that is, 2 healthy individuals (1 female and 1 male) and 1 male with back pain. The participant with back pain injured his back during strenuous exercise but he did not have any issues in walking. The participants wore the smartphone in the middle of their waistline (as the center of gravity) while walking. They were instructed to walk straight at their own pace in an indoor hallway of a building. The walked a distance of approximately 400 feet. They walked for 2-3 minutes in a straight line and then returned to the starting location. A rotation vector in the smartphone, calculated by the rotation matrix, was used to measure the pitch, roll, and yaw angles of the human body while walking. Each xyz-rotation vector datum was recalculated to find the variation in each participant?s walking movement. Results: The male participant with back pain showed a diminished level of walking balance with a wider range of xyz-axis variations in the rotations compared to those of the healthy participants. The standard deviation in the xyz-axis of the male participant with back pain was larger than that of the healthy male participant. Moreover, the participant with back pain had the widest combined range of right-to-left and forward-to-backward motions. The healthy male participant showed smaller standard deviation while walking than the male participant with back pain and the female healthy participant, indicating that the healthy male participant had a well-balanced walking movement. The walking movement of the female healthy participant showed symmetry in the left-to-right (x-axis) and up-to-down (y-axis) motions in the x-y variations of rotation vectors, indicating that she had lesser bias in gait than the others. Conclusions: This study shows that our mHealth app based on smartphone sensors and rotation vectors can measure the variations in the walking movements of different individuals. Further studies are needed to measure and compare walking movements by age, gender, as well as types of health problems or disease. This app can help in finding differences in gait in people with diseases that affect gait. UR - https://mhealth.jmir.org/2021/3/e24194 UR - http://dx.doi.org/10.2196/24194 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666557 ID - info:doi/10.2196/24194 ER - TY - JOUR AU - Bhatia, Anuj AU - Kara, Jamal AU - Janmohamed, Tahir AU - Prabhu, Atul AU - Lebovic, Gerald AU - Katz, Joel AU - Clarke, Hance PY - 2021/3/4 TI - User Engagement and Clinical Impact of the Manage My Pain App in Patients With Chronic Pain: A Real-World, Multi-site Trial JO - JMIR Mhealth Uhealth SP - e26528 VL - 9 IS - 3 KW - pain KW - psychology KW - patient-oriented research KW - quality of life KW - digital health KW - chronic pain KW - pain app KW - virtual care KW - mHealth KW - pain management KW - chronic disease management KW - remote monitoring KW - app KW - engagement KW - impact KW - outcome N2 - Background: Chronic pain imposes a large burden on individuals and society. A patient-centric digital chronic pain management app called Manage My Pain (MMP) can be used to enhance communication between providers and patients and promote self-management. Objective: The purpose of this study was to evaluate the real-world engagement of patients in urban and rural settings in Ontario, Canada with the MMP app alongside their standard of care and assess the impact of its usage on clinical outcomes of pain and related mental health. Methods: A total of 246 participants with chronic pain at a rural and 2 urban pain clinics were recruited into this prospective, open-label, exploratory study that compared the use of MMP, a digital health app for pain that incorporates validated questionnaires and provides patients with summarized reports of their progress in combination with standard care (app group), against data entered on paper-based questionnaires (nonapp group). Participants completed validated questionnaires on anxiety, depression, pain catastrophizing, satisfaction, and daily opioid consumption up to 4.5 months after the initial visit (short-term follow-up) and between 4.5 and 7 months after the initial visit (long-term follow-up). Engagement and clinical outcomes were compared between participants in the two groups. Results: A total of 73.6% (181/246) of the participants agreed to use the app, with 63.4% (111/175) of them using it for at least one month. Individuals who used the app rated lower anxiety (reduction in Generalized Anxiety Disorder 7-item questionnaire score by 2.10 points, 95% CI ?3.96 to ?0.24) at short-term follow-up and had a greater reduction in pain catastrophizing (reduction in Pain Catastrophizing Scale score by 5.23 points, 95% CI ?9.55 to ?0.91) at long-term follow-up relative to patients with pain who did not engage with the MMP app. Conclusions: The use of MMP by patients with chronic pain is associated with engagement and improvements in self-reported anxiety and pain catastrophizing. Further research is required to understand factors that impact continued engagement and clinical outcomes in patients with chronic pain. Trial Registration: ClinicalTrials.gov NCT04762329; https://clinicaltrials.gov/ct2/show/NCT04762329 UR - https://mhealth.jmir.org/2021/3/e26528 UR - http://dx.doi.org/10.2196/26528 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661130 ID - info:doi/10.2196/26528 ER - TY - JOUR AU - Sarradon-Eck, Aline AU - Bouchez, Tiphanie AU - Auroy, Lola AU - Schuers, Matthieu AU - Darmon, David PY - 2021/3/4 TI - Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study JO - JMIR Mhealth Uhealth SP - e21795 VL - 9 IS - 3 KW - mobile applications KW - qualitative research KW - general practitioners KW - France KW - mobile phone N2 - Background: Mobile health (mHealth) apps are a potential means of empowering patients, especially in the case of multimorbidity, which complicates patients? care needs. Previous studies have shown that general practitioners (GPs) have both expectations and concerns regarding patients? use of mHealth apps that could impact their willingness to recommend the apps to patients. Objective: The aim of this qualitative study is to investigate French GPs? attitudes toward the prescription of mHealth apps or devices aimed toward patients by analyzing GPs? perceptions and expectations of mHealth technologies. Methods: A total of 36 GPs were interviewed individually (n=20) or in a discussion group (n=16). All participants were in private practice. A qualitative analysis of each interview and focus group was conducted using grounded theory analysis. Results: Considering the value assigned to mHealth apps by participants and their willingness or resistance to prescribe them, 3 groups were defined based on the attitudes or positions adopted by GPs: digital engagement (favorable attitude; mHealth apps are perceived as additional resources and complementary tools that facilitate the medical work, the follow-up care, and the monitoring of patients; and apps increase patients? compliance and empowerment); patient protection (related to the management of patient care and fear of risks for patients, concerns about patient data privacy and security, doubt about the usefulness for empowering patients, standardization of the medical decision process, overmedicalization, risks for individual freedom, and increasing social inequalities in health); doctor protection (fear of additional tasks and burden, doubt about the actionability of patient-gathered health data, risk for medical liability, dehumanization of the patient-doctor relationship, fear of increased drug prescription, and commodification of patient data). Conclusions: A deep understanding of both the expectations and fears of GPs is essential to motivate them to recommend mHealth apps to their patients. The results of this study show the need to provide appropriate education and training to enhance GPs? digital skills. Certification of the apps by an independent authority should be encouraged to reassure physicians about ethical and data security issues. Our results highlight the need to overcome technical issues such as interoperability between data collection and medical records to limit the disruption of medical work because of data flow. UR - https://mhealth.jmir.org/2021/3/e21795 UR - http://dx.doi.org/10.2196/21795 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661123 ID - info:doi/10.2196/21795 ER - TY - JOUR AU - Roux de Bézieux, Hector AU - Bullard, James AU - Kolterman, Orville AU - Souza, Michael AU - Perraudeau, Fanny PY - 2021/3/4 TI - Medical Food Assessment Using a Smartphone App With Continuous Glucose Monitoring Sensors: Proof-of-Concept Study JO - JMIR Form Res SP - e20175 VL - 5 IS - 3 KW - clinical trials KW - continuous glucose monitoring KW - lifestyle modification KW - mobile app KW - telemedicine KW - diabetes N2 - Background: Novel wearable biosensors, ubiquitous smartphone ownership, and telemedicine are converging to enable new paradigms of clinical research. A new generation of continuous glucose monitoring (CGM) devices provides access to clinical-grade measurement of interstitial glucose levels. Adoption of these sensors has become widespread for the management of type 1 diabetes and is accelerating in type 2 diabetes. In parallel, individuals are adopting health-related smartphone-based apps to monitor and manage care. Objective: We conducted a proof-of-concept study to investigate the potential of collecting robust, annotated, real-time clinical study measures of glucose levels without clinic visits. Methods: Self-administered meal-tolerance tests were conducted to assess the impact of a proprietary synbiotic medical food on glucose control in a 6-week, double-blind, placebo-controlled, 2×2 cross-over pilot study (n=6). The primary endpoint was incremental glucose measured using Abbott Freestyle Libre CGM devices associated with a smartphone app that provided a visual diet log. Results: All subjects completed the study and mastered CGM device usage. Over 40 days, 3000 data points on average per subject were collected across three sensors. No adverse events were recorded, and subjects reported general satisfaction with sensor management, the study product, and the smartphone app, with an average self-reported satisfaction score of 8.25/10. Despite a lack of sufficient power to achieve statistical significance, we demonstrated that we can detect meaningful changes in the postprandial glucose response in real-world settings, pointing to the merits of larger studies in the future. Conclusions: We have shown that CGM devices can provide a comprehensive picture of glucose control without clinic visits. CGM device usage in conjunction with our custom smartphone app can lower the participation burden for subjects while reducing study costs, and allows for robust integration of multiple valuable data types with glucose levels remotely. Trial Registration: ClinicalTrials.gov NCT04424888; http://clinicaltrials.gov/ct2/show/NCT04424888. UR - https://formative.jmir.org/2021/3/e20175 UR - http://dx.doi.org/10.2196/20175 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661120 ID - info:doi/10.2196/20175 ER - TY - JOUR AU - Montagni, Ilaria AU - Roussel, Nicolas AU - Thiébaut, Rodolphe AU - Tzourio, Christophe PY - 2021/3/3 TI - Health Care Students? Knowledge of and Attitudes, Beliefs, and Practices Toward the French COVID-19 App: Cross-sectional Questionnaire Study JO - J Med Internet Res SP - e26399 VL - 23 IS - 3 KW - contact tracing KW - COVID-19 KW - mobile app KW - students KW - field survey KW - app KW - survey KW - monitoring KW - knowledge KW - attitude KW - belief KW - practice KW - communication KW - use N2 - Background: Many countries worldwide have developed mobile phone apps capable of supporting instantaneous contact tracing to control the COVID-19 pandemic. In France, a few people have downloaded and are using the StopCovid contact tracing app. Students in the health domain are of particular concern in terms of app uptake. Exploring their use and opinions about the app can inform improvements and diffusion of StopCovid among young people. Objective: The aim of this study is to investigate health care students? knowledge of and attitudes, beliefs, and practices (KABP) toward the StopCovid app. Methods: A field survey was conducted among 318 students at the health sciences campus of the University of Bordeaux, France, between September 25 and October 16, 2020. A quota sampling method was used, and descriptive statistics and univariate analyses were performed. Results: Of the 318 respondents, 77.3% (n=246) had heard about the app, but only 11.3% (n=36) had downloaded it, and 4.7% (n=15) were still using it at the time of the survey. Among the 210 participants who had heard about the app but did not download it, the main reasons for not using the app were a belief that it was not effective given its limited diffusion (n=37, 17.6%), a lack of interest (n=37, 17.6%), and distrust in the data security and fear of being geolocated (n=33, 15.7%). Among the 72 students who had not heard of the app and were given a brief description of its functioning and confidentiality policy, 52.7% (n=38) said they would use it. Participants reported that the main solution for increasing the use of the app would be better communication about it (227/318, 71.4%). Conclusions: Even among health students, the contact tracing app was poorly used. The findings suggest that improved communication about its advantages and simplicity of use as well as clarifying false beliefs about it could help improve uptake. UR - https://www.jmir.org/2021/3/e26399 UR - http://dx.doi.org/10.2196/26399 UR - http://www.ncbi.nlm.nih.gov/pubmed/33566793 ID - info:doi/10.2196/26399 ER - TY - JOUR AU - Strudwick, Gillian AU - Sockalingam, Sanjeev AU - Kassam, Iman AU - Sequeira, Lydia AU - Bonato, Sarah AU - Youssef, Alaa AU - Mehta, Rohan AU - Green, Nadia AU - Agic, Branka AU - Soklaridis, Sophie AU - Impey, Danielle AU - Wiljer, David AU - Crawford, Allison PY - 2021/3/2 TI - Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review JO - JMIR Ment Health SP - e26550 VL - 8 IS - 3 KW - digital health KW - psychiatry KW - mental health KW - informatics KW - pandemic KW - COVID-19 KW - telemedicine KW - eHealth KW - public health KW - virtual care KW - mobile apps KW - population health N2 - Background: The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial. Objective: The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention. Methods: This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada?s guidance on app assessment and selection. Results: A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity. Conclusions: A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area. UR - https://mental.jmir.org/2021/3/e26550 UR - http://dx.doi.org/10.2196/26550 UR - http://www.ncbi.nlm.nih.gov/pubmed/33650985 ID - info:doi/10.2196/26550 ER - TY - JOUR AU - Athanas, Argus AU - McCorrison, Jamison AU - Campistron, Julie AU - Bender, Nick AU - Price, Jamie AU - Smalley, Susan AU - Schork, J. Nicholas PY - 2021/3/2 TI - Characterizing Emotional State Transitions During Prolonged Use of a Mindfulness and Meditation App: Observational Study JO - JMIR Ment Health SP - e19832 VL - 8 IS - 3 KW - mental health KW - mobile apps KW - smartphone KW - mobile phone KW - emotional distress KW - mindfulness N2 - Background: The increasing demand for mental health care, a lack of mental health care providers, and unequal access to mental health care services have created a need for innovative approaches to mental health care. Digital device apps, including digital therapeutics, that provide recommendations and feedback for dealing with stress, depression, and other mental health issues can be used to adjust mood and ultimately show promise to help meet this demand. In addition, the recommendations delivered through such apps can also be tailored to an individual?s needs (ie, personalized) and thereby potentially provide greater benefits than traditional ?one-size-fits-all? recommendations. Objective: This study aims to characterize individual transitions from one emotional state to another during the prolonged use of a digital app designed to provide a user with guided meditations based on their initial, potentially negative, emotional state. Understanding the factors that mediate such transitions can lead to improved recommendations for specific mindfulness and meditation interventions or activities (MMAs) provided in mental health apps. Methods: We analyzed data collected during the use of the Stop, Breathe & Think (SBT) mindfulness app. The SBT app prompts users to input their emotional state before and immediately after engaging with MMAs recommended by the app. Data were collected from more than 650,000 SBT users engaging in nearly 5 million MMAs. We limited the scope of our analysis to users with 10 or more MMA sessions that included at least 6 basal emotional state evaluations. Using clustering techniques, we grouped emotions recorded by individual users and then applied longitudinal mixed effect models to assess the associations between individual recommended MMAs and transitions from one group of emotions to another. Results: We found that basal emotional states have a strong influence on transitions from one emotional state to another after MMA engagement. We also found that different MMAs impact these transitions, and many were effective in eliciting a healthy transition but only under certain conditions. In addition, we observed gender and age effects on these transitions. Conclusions: We found that the initial emotional state of an SBT app user determines the type of SBT MMAs that will have a favorable effect on their transition from one emotional state to another. Our results have implications for the design and use of guided mental health recommendations for digital device apps. UR - https://mental.jmir.org/2021/3/e19832 UR - http://dx.doi.org/10.2196/19832 UR - http://www.ncbi.nlm.nih.gov/pubmed/33650986 ID - info:doi/10.2196/19832 ER - TY - JOUR AU - Jaworski, K. Beth AU - Taylor, Katherine AU - Ramsey, M. Kelly AU - Heinz, Adrienne AU - Steinmetz, Sarah AU - Pagano, Ian AU - Moraja, Giovanni AU - Owen, E. Jason PY - 2021/3/1 TI - Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data JO - J Med Internet Res SP - e26559 VL - 23 IS - 3 KW - COVID-19 KW - coronavirus KW - mobile app KW - mHealth KW - digital health KW - mental health KW - public mental health KW - stress KW - coping KW - public health KW - app N2 - Background: The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable and useful tools in large-scale disaster responses and are particularly promising for reaching vulnerable populations. COVID Coach is a free, evidence-informed mobile app designed specifically to provide tools and resources for addressing COVID-19?related stress. Objective: The purpose of this study was to characterize the overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals who may benefit from mental health resources. Methods: Anonymous usage data collected from COVID Coach between May 1, 2020, through October 31, 2020, were extracted and analyzed for this study. The sample included 49,287 unique user codes and 3,368,931 in-app events. Results: Usage of interactive tools for coping and stress management comprised the majority of key app events (n=325,691, 70.4%), and the majority of app users tried a tool for managing stress (n=28,009, 58.8%). COVID Coach was utilized for ?3 days by 80.9% (n=34,611) of the sample whose first day of app use occurred within the 6-month observation window. Usage of the key content in COVID Coach predicted returning to the app for a second day. Among those who tried at least one coping tool on their first day of app use, 57.2% (n=11,444) returned for a second visit; whereas only 46.3% (n=10,546) of those who did not try a tool returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were prevalent among app users. For example, among app users who completed an anxiety assessment on their first day of app use (n=4870, 11.4% of users), 55.1% (n=2680) reported levels of anxiety that were moderate to severe, and 29.9% (n=1455) of scores fell into the severe symptom range. On average, those with moderate levels of depression on their first day of app use returned to the app for a greater number of days (mean 3.72 days) than those with minimal symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD symptoms on their first day of app use utilized the app for a significantly greater number of days (mean 3.79 days) than those with fewer symptoms (mean 3.13 days; t1=2.29, P=.02). Conclusions: As the mental health impacts of the pandemic continue to be widespread and increasing, digital health resources, such as apps like COVID Coach, are a scalable way to provide evidence-informed tools and resources. Future research is needed to better understand for whom and under what conditions the app is most helpful and how to increase and sustain engagement. UR - https://www.jmir.org/2021/3/e26559 UR - http://dx.doi.org/10.2196/26559 UR - http://www.ncbi.nlm.nih.gov/pubmed/33606656 ID - info:doi/10.2196/26559 ER - TY - JOUR AU - Hong, Ho Taek AU - Kim, Ku Myung AU - Ryu, Jin Dong AU - Park, Sung Jun AU - Bae, Cheol Gi AU - Jeon, Sang Yoon PY - 2021/3/1 TI - The Reliability of Remote Patient-Reported Outcome Measures via Mobile Apps to Replace Outpatient Visits After Rotator Cuff Repair Surgery: Repetitive Test-Retest Comparison Study for 1-Year Follow-up JO - J Med Internet Res SP - e20989 VL - 23 IS - 3 KW - patient-reported outcome measures (PROMs) KW - location KW - remote PROMs using mobile application KW - smartphone KW - mobile phone KW - follow-up loss N2 - Background: With the development of health care?related mobile apps, attempts have been made to implement remote patient-reported outcome measures (PROMs). In order for remote PROMs to be widely used by mobile apps, the results should not be different depending on the location; that is, remote PROM results performed in locations other than hospitals should be able to obtain reliable results equivalent to those performed in hospitals, and this is very important. However, to our knowledge, there are no studies that have assessed the reliability of PROMs using mobile apps according to the location by comparing the results performed remotely from the hospital and performed at the outpatient visits. Objective: The purpose of this study was to evaluate the reliability of remote PROMs using mobile apps compared to PROMs performed during outpatient follow-up visits after arthroscopic shoulder surgery. Methods: A total of 174 patients who underwent arthroscopic rotator cuff repair completed questionnaires 2 days before visiting the clinic for the 1-, 2-, 3-, 6-, and 12-month follow-ups (test A). The patients completed the questionnaires at the clinic (test B) using the same mobile app and device for the 1-, 2-, 3-, 6-, and 12-month follow-ups. Test-retest comparisons were performed to analyze the differences and reliability of the PROMs according to the period. Results: Comparisons of tests A and B showed statistically significant differences at 1, 2, and 3 months (all Ps<.05 except for the ASES function scale at 3-months) but not 6 or 12 months after surgery (all Ps>.05). The intraclass correlation values between the two groups were relatively low at the 1-, 2-, and 3-month follow-ups but were within the reliable range at 6 and 12 months after surgery. The rate of completion of tests A and B using the mobile app was significantly lower in the group older than 70 years than in the other groups for all postoperative periods (P<.001). Conclusions: PROMs using mobile apps with different locations differed soon after surgery but were reliably similar after 6 months. The remote PROMs using mobile apps could be used reliably for the patient more than 6 months after surgery. However, it is to be expected that the use of mobile app?based questionnaires is not as useful in the group older than 70 years as in other age groups. UR - https://www.jmir.org/2021/3/e20989 UR - http://dx.doi.org/10.2196/20989 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646133 ID - info:doi/10.2196/20989 ER - TY - JOUR AU - Militello, Lisa AU - Sezgin, Emre AU - Huang, Yungui AU - Lin, Simon PY - 2021/3/1 TI - Delivering Perinatal Health Information via a Voice Interactive App (SMILE): Mixed Methods Feasibility Study JO - JMIR Form Res SP - e18240 VL - 5 IS - 3 KW - perinatal care KW - infant mortality KW - health education KW - mobile health KW - feasibility studies KW - family KW - mobile phone KW - webcasts as topic KW - user-computer interface N2 - Background: Perinatal health care is critically important for maternal health outcomes in infants. The United States fares considerably worse than comparable countries for maternal and infant mortality rates. As such, alternative models of care or engagement are warranted. Ubiquitous digital devices and increased use of digital health tools have the potential to extend the reach to women and infants in their everyday lives and make a positive impact on their health outcomes. As voice technology becomes more mainstream, research is prudent to establish evidence-based practice on how to best leverage voice technology to promote maternal-infant health. Objective: The aim of this study is to assess the feasibility of using voice technology to support perinatal health and infant care practices. Methods: Perinatal women were recruited from a large Midwest Children?s Hospital via hospital email announcements and word of mouth. Owing to the technical aspects of the intervention, participants were required to speak English and use an iPhone. Demographics, patterns of technology use, and technology use specific to perinatal health or self-care practices were assessed at baseline. Next, participants were onboarded and asked to use the intervention, Self-Management Intervention?Life Essentials (SMILE), over the course of 2 weeks. SMILE provided users with perinatal health content delivered through mini podcasts (ranging from 3 to 8 minutes in duration). After each podcast, SMILE prompted users to provide immediate verbal feedback to the content. An exit interview was conducted with participants to gather feedback on the intervention and further explore participants? perceptions of voice technology as a means to support perinatal health in the future. Results: In total, 19 pregnant women (17 to 36 weeks pregnant) were consented. Themes identified as important for perinatal health information include establishing routines, expected norms, and realistic expectations and providing key takeaways. Themes identified as important for voice interaction include customization and user preferences, privacy, family and friends, and context and convenience. Qualitative analysis suggested that perinatal health promotion content delivered by voice should be accurate and succinctly delivered and highlight key takeaways. Perinatal health interventions that use voice should provide users with the ability to customize the intervention but also provide opportunities to engage family members, particularly spouses. As a number of women multitasked while the intervention was being deployed, future interventions should leverage the convenience of voice technology while also balancing the influence of user context (eg, timing or ability to listen or talk versus nonvoice interaction with the system). Conclusions: Our findings demonstrate the short-term feasibility of disseminating evidence-based perinatal support via podcasts and curate voice-captured data from perinatal women. However, key areas of improvement have been identified specifically for perinatal interventions leveraging voice technology. Findings contribute to future content, design, and delivery considerations of perinatal digital health interventions. UR - https://formative.jmir.org/2021/3/e18240 UR - http://dx.doi.org/10.2196/18240 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646136 ID - info:doi/10.2196/18240 ER - TY - JOUR AU - Balbim, M. Guilherme AU - Marques, G. Isabela AU - Marquez, X. David AU - Patel, Darshilmukesh AU - Sharp, K. Lisa AU - Kitsiou, Spyros AU - Nyenhuis, M. Sharmilee PY - 2021/3/1 TI - Using Fitbit as an mHealth Intervention Tool to Promote Physical Activity: Potential Challenges and Solutions JO - JMIR Mhealth Uhealth SP - e25289 VL - 9 IS - 3 KW - physical activity KW - fitness trackers KW - Fitbit KW - smartphones KW - interventional studies KW - adults KW - older adults KW - wearable KW - intervention UR - https://mhealth.jmir.org/2021/3/e25289 UR - http://dx.doi.org/10.2196/25289 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646135 ID - info:doi/10.2196/25289 ER - TY - JOUR AU - Schoenberg, Nancy AU - Dunfee, Madeline AU - Yeager, Hannah AU - Rutledge, Matthew AU - Pfammatter, Angela AU - Spring, Bonnie PY - 2021/2/26 TI - Rural Residents? Perspectives on an mHealth or Personalized Health Coaching Intervention: Qualitative Study With Focus Groups and Key Informant Interviews JO - JMIR Form Res SP - e18853 VL - 5 IS - 2 KW - rural populations KW - technology KW - exercise KW - diet KW - community-based participatory research KW - mobile phone N2 - Background: Compared with national averages, rural Appalachians experience extremely elevated rates of premature morbidity and mortality. New opportunities, including approaches incorporating personal technology, may help improve lifestyles and overcome health inequities. Objective: This study aims to gather perspectives on whether a healthy lifestyle intervention, specifically an app originally designed for urban users, may be feasible and acceptable to rural residents. In addition to a smartphone app, this program?Make Better Choices 2?consists of personalized health coaching, accelerometer use, and financial incentives. Methods: We convened 4 focus groups and 16 key informant interviews with diverse community stakeholders to assess perspectives on this novel, evidence-based diet and physical activity intervention. Participants were shown a slide presentation and asked open-ended follow-up questions. The focus group and key informant interview sessions were audiotaped, transcribed, and subjected to thematic analysis. Results: We identified 3 main themes regarding Appalachian residents? perspectives on this mobile health (mHealth) intervention: personal technology is feasible and desirable; challenges persist in implementing mHealth lifestyle interventions in Appalachian communities; and successful mHealth interventions should include personal connections, local coaches, and educational opportunities. Although viewed as feasible and acceptable overall, lack of healthy lifestyle awareness, habitual behavior, and financial constraints may challenge the success of mHealth lifestyle interventions in Appalachia. Finally, participants described several minor elements that require modification, including expanding the upper age inclusion, providing extra coaching on technology use, emphasizing personal and supportive connections, employing local coaches, and ensuring adequate educational content for the program. Conclusions: Blending new technologies, health coaching, and other features is not only acceptable but may be essential to reach vulnerable rural residents. UR - https://formative.jmir.org/2021/2/e18853 UR - http://dx.doi.org/10.2196/18853 UR - http://www.ncbi.nlm.nih.gov/pubmed/33635278 ID - info:doi/10.2196/18853 ER - TY - JOUR AU - Fucito, M. Lisa AU - Ash, I. Garrett AU - DeMartini, S. Kelly AU - Pittman, Brian AU - Barnett, P. Nancy AU - Li, R. Chiang-Shan AU - Redeker, S. Nancy AU - O'Malley, S. Stephanie PY - 2021/2/26 TI - A Multimodal Mobile Sleep Intervention for Young Adults Engaged in Risky Drinking: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e26557 VL - 10 IS - 2 KW - sleep KW - binge drinking KW - young adults KW - mHealth KW - biosensor KW - behavior therapy KW - mobile phone N2 - Background: This paper describes the research protocol for a randomized controlled trial of a multimodal mobile sleep intervention for heavy-drinking young adults. Young adults report the highest rates of heavy, risky alcohol consumption and are a priority population for alcohol prevention and intervention efforts. Alcohol strategies that leverage other health concerns and use technology may offer an innovative solution. Poor sleep is common among young adults and is a risk factor for developing an alcohol use disorder. Moreover, young adults are interested in information to help them sleep better, and behavioral sleep interventions address alcohol use as a standard practice. Objective: The primary aim of this study is to assess the effectiveness of a 2-week multimodal mobile sleep intervention for reducing drinks consumed per week among heavy-drinking young adults. We will explore the effects on alcohol-related consequences, assessing quantitative and qualitative sleep characteristics as secondary aims. The study?s goals are to identify the optimal combination of sleep intervention components for improving drinking outcomes, the feasibility and acceptability of these components, and the potential mechanisms by which these components may promote alcohol behavior change. Methods: Young adults (aged 18-25 years) who report recent heavy drinking will be randomly assigned to one of three conditions: mobile sleep hygiene advice (n=30), mobile sleep hygiene advice and sleep and alcohol diary self-monitoring (n=30), or mobile sleep hygiene advice, sleep and alcohol diary self-monitoring, and sleep and alcohol data feedback (n=60). For the feedback component, participants will complete two web-based sessions with a health coach during which they will receive summaries of their sleep and alcohol data, and the potential association between them along with brief advice tailored to their data. All participants will wear sleep and alcohol biosensors daily for 2 weeks for objective assessments of these outcomes. Results: The study was funded by the National Institutes of Health in May 2018. Recruitment began in December 2018 and will be concluded in Spring 2021. As of February 4, 2021, we have enrolled 110 participants. Conclusions: Ultimately, this research could result in an efficacious, low-cost intervention with broad population reach through the use of technology. In addition, this intervention may substantially impact public health by reducing alcohol use disorder risk at a crucial developmental stage. Trial Registration: ClinicalTrials.gov NCT03658954; https://clinicaltrials.gov/ct2/show/NCT03658954 International Registered Report Identifier (IRRID): DERR1-10.2196/26557 UR - https://www.researchprotocols.org/2021/2/e26557 UR - http://dx.doi.org/10.2196/26557 UR - http://www.ncbi.nlm.nih.gov/pubmed/33635276 ID - info:doi/10.2196/26557 ER - TY - JOUR AU - Vitolo, Regina Marcia PY - 2021/2/25 TI - The Kurbo App: The Freemium Model and Developmental Behavior Concerns. Comment on ?Impact of a Mobile App?Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study? JO - JMIR Mhealth Uhealth SP - e17492 VL - 9 IS - 2 KW - childhood obesity KW - intervention KW - app UR - https://mhealth.jmir.org/2021/2/e17492 UR - http://dx.doi.org/10.2196/17492 UR - http://www.ncbi.nlm.nih.gov/pubmed/33629965 ID - info:doi/10.2196/17492 ER - TY - JOUR AU - Sasaki, Natsu AU - Imamura, Kotaro AU - Tran, Thu Thuy Thi AU - Nguyen, Thanh Huong AU - Kuribayashi, Kazuto AU - Sakuraya, Asuka AU - Bui, Minh Thu AU - Nguyen, Thuy Quynh AU - Nguyen, Thi Nga AU - Nguyen, Huong Giang Thi AU - Zhang, Weibin Melvyn AU - Minas, Harry AU - Sekiya, Yuki AU - Watanabe, Kazuhiro AU - Tsutsumi, Akizumi AU - Shimazu, Akihito AU - Kawakami, Norito PY - 2021/2/23 TI - Effects of Smartphone-Based Stress Management on Improving Work Engagement Among Nurses in Vietnam: Secondary Analysis of a Three-Arm Randomized Controlled Trial JO - J Med Internet Res SP - e20445 VL - 23 IS - 2 KW - stress management KW - mental health KW - occupational health KW - digital health KW - workplace KW - LMICs KW - South-East Asia KW - health care professionals N2 - Background: Work engagement is important for employee well-being and work performance. However, no intervention study has investigated the effect of an eMental Health intervention on work engagement among workers in low- and middle-income countries (LMICs). Objective: The aim of the study was to examine the effects of a newly developed smartphone-based stress management program (ABC Stress Management) on improving work engagement among hospital nurses in Vietnam, an LMIC. Methods: Full-time registered nurses (n=949) were randomly assigned to one of 2 intervention groups or a control group. The intervention groups were a 6-week, 6-lesson program offering basic cognitive behavioral therapy (CBT-based stress management skills), provided in either free-choice (program A) or fixed order (program B). Work engagement was assessed at baseline and 3-month and 7-month follow-ups in each of the 3 groups. Results: The scores of work engagement in both intervention groups improved from baseline to 3-month follow-up, and then decreased at the 7-month follow-up, while the score steadily increased from baseline to 7-month follow-up in the control group. Program B showed a significant intervention effect on improving work engagement at the 3-month follow-up (P=.049) with a small effect size (Cohen d= 0.16; 95% CI 0.001 to 0.43]). Program A showed nonsignificant trend (d=0.13; 95% CI ?0.014 to 0.41; P=.07) toward improved engagement at 3 months. Neither program achieved effectiveness at the 7-month follow-up. Conclusions: The study demonstrated that a fixed order (program B) delivery of a smartphone-based stress management program was effective in improving work engagement in nurses in Vietnam. However, the effect was small and only temporary. Further improvement of this program is required to achieve a greater effect size and more sustained, longer lasting impact on work engagement. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000033139; tinyurl.com/55gxo253 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025138 UR - https://www.jmir.org/2021/2/e20445 UR - http://dx.doi.org/10.2196/20445 UR - http://www.ncbi.nlm.nih.gov/pubmed/33620328 ID - info:doi/10.2196/20445 ER - TY - JOUR AU - Anyanwu, C. Emeka AU - Ward, Parker R. AU - Shah, Atman AU - Arora, Vineet AU - Umscheid, A. Craig PY - 2021/2/23 TI - A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience JO - JMIR Mhealth Uhealth SP - e24452 VL - 9 IS - 2 KW - adoption KW - communication KW - COVID-19 KW - hospital KW - inpatient KW - mHealth KW - mobile app KW - telemedicine N2 - Background: COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding. Objective: This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19. Methods: We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020. Results: On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number?related suggestions through moblMD. Conclusions: We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team?s familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care. UR - https://mhealth.jmir.org/2021/2/e24452 UR - http://dx.doi.org/10.2196/24452 UR - http://www.ncbi.nlm.nih.gov/pubmed/33513562 ID - info:doi/10.2196/24452 ER - TY - JOUR AU - Muhindo, Mary AU - Bress, Joshua AU - Kalanda, Rogers AU - Armas, Jean AU - Danziger, Elon AU - Kamya, R. Moses AU - Butler, M. Lisa AU - Ruel, Theodore PY - 2021/2/19 TI - Implementation of a Newborn Clinical Decision Support Software (NoviGuide) in a Rural District Hospital in Eastern Uganda: Feasibility and Acceptability Study JO - JMIR Mhealth Uhealth SP - e23737 VL - 9 IS - 2 KW - clinical decision support KW - neonatology KW - neonatal mortality KW - mHealth KW - mobile phone N2 - Background: Lack of trained health care workers and nonadherence to national guidelines are key barriers to achieving high-quality newborn care in health care facilities in low- and middle-income countries. Traditional didactic approaches addressing these barriers fail to account for high staff turnover rates and result in temporary behavior change. NoviGuide, a clinical decision support software designed to standardize neonatal care through point-of-care assessments, has the potential to align bedside practice to national guidelines in settings lacking subspecialty neonatal providers. Objective: This study aims to determine the adaptation, adoption, feasibility, acceptability, and sustainability of NoviGuide and its impact on nurse-midwives? knowledge in a rural hospital in eastern Uganda. Methods: This mixed methods observational study was guided by the Proctor framework. Experts reviewed the clinical content of NoviGuide to ensure fidelity to Uganda guidelines. We enrolled nurses and midwives providing newborn care at Tororo District Hospital, trained them on NoviGuide use, and followed them for 12 months. We assessed adoption, feasibility, acceptability, and sustainability by analyzing NoviGuide use data, comparing it with maternity registry data and administering the System Usability Scale (SUS) and the Center for Health Care Evaluation Provider Satisfaction Questionnaire. We compared the mean knowledge assessment score at baseline, 6 months, and 12 months using a two-tailed t test. Results: Five Ugandan experts suggested two minor changes to NoviGuide: the inclusion of an unsterile birth environment as an indication for empiric antibiotics and the addition of a reminder to follow-up with newborns with temperatures between 37.7°C and 37.9°C. Of the 19 nurse-midwives enrolled in February 2017, 74% (n=14) completed the follow-up in March 2018. The participants entered a total of 1705 assessments of varying newborn characteristics into NoviGuide throughout the day, evening, and night nursing shifts. The SUS score at the end of the study was very high (93.5, above the average of 68). Participants had a positive perception about NoviGuide, reporting that NoviGuide saved time (mean 5, SD 0) and prevented mistakes (mean 5, SD 0), and that they felt more confident in taking care of newborns when they used NoviGuide (mean 5, SD 0). Participants were highly satisfied with NoviGuide (mean 4.86, SD 0.36), although they lacked medical supplies and materials needed to follow NoviGuide recommendations (mean 3.3, SD 1.22). The participants? knowledge scores improved by a mean change of 3.7 (95% CI 2.6-4.8) at 6 months and 6.7 (95% CI 4.6-8.2) at 12 months (P<.001). Conclusions: NoviGuide was easily adapted to the Uganda guidelines. Nurse-midwives used NoviGuide frequently and reported high levels of satisfaction despite challenges with medical supplies and high staff turnover. NoviGuide improved knowledge and confidence in newborn care without in-person didactic training. NoviGuide use has the potential to scale up quality newborn care by facilitating adherence to national guidelines. UR - http://mhealth.jmir.org/2021/2/e23737/ UR - http://dx.doi.org/10.2196/23737 UR - http://www.ncbi.nlm.nih.gov/pubmed/33605886 ID - info:doi/10.2196/23737 ER - TY - JOUR AU - Su, Dongning AU - Liu, Zhu AU - Jiang, Xin AU - Zhang, Fangzhao AU - Yu, Wanting AU - Ma, Huizi AU - Wang, Chunxue AU - Wang, Zhan AU - Wang, Xuemei AU - Hu, Wanli AU - Manor, Brad AU - Feng, Tao AU - Zhou, Junhong PY - 2021/2/19 TI - Simple Smartphone-Based Assessment of Gait Characteristics in Parkinson Disease: Validation Study JO - JMIR Mhealth Uhealth SP - e25451 VL - 9 IS - 2 KW - smartphone KW - gait KW - stride time (variability) KW - validity KW - Parkinson disease N2 - Background: Parkinson disease (PD) is a common movement disorder. Patients with PD have multiple gait impairments that result in an increased risk of falls and diminished quality of life. Therefore, gait measurement is important for the management of PD. Objective: We previously developed a smartphone-based dual-task gait assessment that was validated in healthy adults. The aim of this study was to test the validity of this gait assessment in people with PD, and to examine the association between app-derived gait metrics and the clinical and functional characteristics of PD. Methods: Fifty-two participants with clinically diagnosed PD completed assessments of walking, Movement Disorder Society Unified Parkinson Disease Rating Scale III (UPDRS III), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scale tests. Participants followed multimedia instructions provided by the app to complete two 20-meter trials each of walking normally (single task) and walking while performing a serial subtraction dual task (dual task). Gait data were simultaneously collected with the app and gold-standard wearable motion sensors. Stride times and stride time variability were derived from the acceleration and angular velocity signal acquired from the internal motion sensor of the phone and from the wearable sensor system. Results: High correlations were observed between the stride time and stride time variability derived from the app and from the gold-standard system (r=0.98-0.99, P<.001), revealing excellent validity of the app-based gait assessment in PD. Compared with those from the single-task condition, the stride time (F1,103=14.1, P<.001) and stride time variability (F1,103=6.8, P=.008) in the dual-task condition were significantly greater. Participants who walked with greater stride time variability exhibited a greater UPDRS III total score (single task: ?=.39, P<.001; dual task: ?=.37, P=.01), HAM-A (single-task: ?=.49, P=.007; dual-task: ?=.48, P=.009), and HAM-D (single task: ?=.44, P=.01; dual task: ?=.49, P=.009). Moreover, those with greater dual-task stride time variability (?=.48, P=.001) or dual-task cost of stride time variability (?=.44, P=.004) exhibited lower MoCA scores. Conclusions: A smartphone-based gait assessment can be used to provide meaningful metrics of single- and dual-task gait that are associated with disease severity and functional outcomes in individuals with PD. UR - http://mhealth.jmir.org/2021/2/e25451/ UR - http://dx.doi.org/10.2196/25451 UR - http://www.ncbi.nlm.nih.gov/pubmed/33605894 ID - info:doi/10.2196/25451 ER - TY - JOUR AU - Heneghan, B. Mallorie AU - Hussain, Tasmeen AU - Barrera, Leonardo AU - Cai, W. Stephanie AU - Haugen, Maureen AU - Morgan, Elaine AU - Rossoff, Jenna AU - Weinstein, Joanna AU - Hijiya, Nobuko AU - Cella, David AU - Badawy, M. Sherif PY - 2021/2/18 TI - Access to Technology and Preferences for an mHealth Intervention to Promote Medication Adherence in Pediatric Acute Lymphoblastic Leukemia: Approach Leveraging Behavior Change Techniques JO - J Med Internet Res SP - e24893 VL - 23 IS - 2 KW - acute lymphoblastic leukemia KW - medication adherence KW - behavior change technique KW - oral chemotherapy KW - mHealth KW - patient-centered N2 - Background: Suboptimal adherence to 6-mercaptopurine (6-MP) is prevalent in pediatric acute lymphoblastic leukemia (ALL) and associated with increased risk of relapse. Rapid uptake of personal technology makes mobile health (mHealth) an attractive platform to promote adherence. Objective: Study objectives were to examine access to mobile technology and preferences for an mHealth intervention to improve medication adherence in pediatric ALL. Methods: A cross-sectional survey was administered in oncology clinic to parents of children with ALL as well as adolescents and young adults (AYAs) with ALL receiving maintenance chemotherapy. Results: A total of 49 parents (median age [IQR] 39 [33-42] years; female 76% [37/49]) and 15 patients (median age [IQR] 17 [16-19]; male 80% [12/15]) participated. All parents and AYAs owned electronic tablets, smartphones, or both. Parents? most endorsed mHealth app features included a list of medications (71%, 35/49), information about 6-MP (71%, 35/49), refill reminders (71%, 35/49), and reminders to take 6-MP (71%, 35/49). AYAs' most endorsed features included refill reminders (73%, 11/15), reminders to take 6-MP (73%, 11/15), and tracking 6-MP (73%, 11/15). Conclusions: Parents and AYAs reported ubiquitous access to mobile technology and strong interest in multiple adherence-specific mHealth app features. Parents and AYAs provided valuable insight into preferred features for a multifunctional behavioral intervention (mHealth app) to promote medication adherence in pediatric ALL. UR - http://www.jmir.org/2021/2/e24893/ UR - http://dx.doi.org/10.2196/24893 UR - http://www.ncbi.nlm.nih.gov/pubmed/33599621 ID - info:doi/10.2196/24893 ER - TY - JOUR AU - Aji, Melissa AU - Gordon, Christopher AU - Stratton, Elizabeth AU - Calvo, A. Rafael AU - Bartlett, Delwyn AU - Grunstein, Ronald AU - Glozier, Nick PY - 2021/2/17 TI - Framework for the Design Engineering and Clinical Implementation and Evaluation of mHealth Apps for Sleep Disturbance: Systematic Review JO - J Med Internet Res SP - e24607 VL - 23 IS - 2 KW - mobile applications KW - sleep KW - insomnia KW - internet-based intervention KW - mHealth KW - mobile health KW - systematic review N2 - Background: Mobile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. Objective: The aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. Methods: A systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). Results: A total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. Conclusions: This is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation. UR - http://www.jmir.org/2021/2/e24607/ UR - http://dx.doi.org/10.2196/24607 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595441 ID - info:doi/10.2196/24607 ER - TY - JOUR AU - Difrancesco, Sonia AU - Riese, Harriëtte AU - Merikangas, R. Kathleen AU - Shou, Haochang AU - Zipunnikov, Vadim AU - Antypa, Niki AU - van Hemert, M. Albert AU - Schoevers, A. Robert AU - Penninx, H. Brenda W. J. AU - Lamers, Femke PY - 2021/2/17 TI - Sociodemographic, Health and Lifestyle, Sampling, and Mental Health Determinants of 24-Hour Motor Activity Patterns: Observational Study JO - J Med Internet Res SP - e20700 VL - 23 IS - 2 KW - actigraphy KW - functional data analysis KW - mental health KW - well-being KW - activity N2 - Background: Analyzing actigraphy data using standard circadian parametric models and aggregated nonparametric indices may obscure temporal information that may be a hallmark of the circadian impairment in psychiatric disorders. Functional data analysis (FDA) may overcome such limitations by fully exploiting the richness of actigraphy data and revealing important relationships with mental health outcomes. To our knowledge, no studies have extensively used FDA to study the relationship between sociodemographic, health and lifestyle, sampling, and psychiatric clinical characteristics and daily motor activity patterns assessed with actigraphy in a sample of individuals with and without depression/anxiety. Objective: We aimed to study the association between daily motor activity patterns assessed via actigraphy and (1) sociodemographic, health and lifestyle, and sampling factors, and (2) psychiatric clinical characteristics (ie, presence and severity of depression/anxiety disorders). Methods: We obtained 14-day continuous actigraphy data from 359 participants from the Netherlands Study of Depression and Anxiety with current (n=93), remitted (n=176), or no (n=90) depression/anxiety diagnosis, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Associations between patterns of daily motor activity, quantified via functional principal component analysis (fPCA), and sociodemographic, health and lifestyle, sampling, and psychiatric clinical characteristics were assessed using generalized estimating equation regressions. For exploratory purposes, function-on-scalar regression (FoSR) was applied to quantify the time-varying association of sociodemographic, health and lifestyle, sampling, and psychiatric clinical characteristics on daily motor activity. Results: Four components of daily activity patterns captured 77.4% of the variability in the data: overall daily activity level (fPCA1, 34.3% variability), early versus late morning activity (fPCA2, 16.5% variability), biphasic versus monophasic activity (fPCA3, 14.8% variability), and early versus late biphasic activity (fPCA4, 11.8% variability). A low overall daily activity level was associated with a number of sociodemographic, health and lifestyle, and psychopathology variables: older age (P<.001), higher education level (P=.005), higher BMI (P=.009), greater number of chronic diseases (P=.02), greater number of cigarettes smoked per day (P=.02), current depressive and/or anxiety disorders (P=.05), and greater severity of depressive symptoms (P<.001). A high overall daily activity level was associated with work/school days (P=.02) and summer (reference: winter; P=.03). Earlier morning activity was associated with older age (P=.02), having a partner (P=.009), work/school days (P<.001), and autumn and spring (reference: winter; P=.02 and P<.001, respectively). Monophasic activity was associated with older age (P=.005). Biphasic activity was associated with work/school days (P<.001) and summer (reference: winter; P<.001). Earlier biphasic activity was associated with older age (P=.005), work/school days (P<.001), and spring and summer (reference: winter; P<.001 and P=.005, respectively). In FoSR analyses, age, work/school days, and season were the main determinants having a time-varying association with daily motor activity (all P<.05). Conclusions: Features of daily motor activity extracted with fPCA reflect commonly studied factors such as the intensity of daily activity and preference for morningness/eveningness. The presence and severity of depression/anxiety disorders were found to be associated mainly with a lower overall activity pattern but not with the time of the activity. Age, work/school days, and season were the variables most strongly associated with patterns and time of activity, and thus future epidemiological studies on motor activity in depression/anxiety should take these variables into account. UR - http://www.jmir.org/2021/2/e20700/ UR - http://dx.doi.org/10.2196/20700 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595445 ID - info:doi/10.2196/20700 ER - TY - JOUR AU - Stalujanis, Esther AU - Neufeld, Joel AU - Glaus Stalder, Martina AU - Belardi, Angelo AU - Tegethoff, Marion AU - Meinlschmidt, Gunther PY - 2021/2/17 TI - Induction of Efficacy Expectancies in an Ambulatory Smartphone-Based Digital Placebo Mental Health Intervention: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e20329 VL - 9 IS - 2 KW - digital placebo effect KW - efficacy expectancies KW - ecological momentary assessment KW - mHealth KW - mobile phone KW - placebo effect KW - randomized controlled trial KW - smartphone-based intervention N2 - Background: There is certain evidence on the efficacy of smartphone-based mental health interventions. However, the mechanisms of action remain unclear. Placebo effects contribute to the efficacy of face-to-face mental health interventions and may also be a potential mechanism of action in smartphone-based interventions. Objective: This study aimed to investigate whether different types of efficacy expectancies as potential factors underlying placebo effects could be successfully induced in a smartphone-based digital placebo mental health intervention, ostensibly targeting mood and stress. Methods: We conducted a randomized, controlled, single-blinded, superiority trial with a multi-arm parallel design. Participants underwent an Android smartphone-based digital placebo mental health intervention for 20 days. We induced prospective efficacy expectancies via initial instructions on the purpose of the intervention and retrospective efficacy expectancies via feedback on the success of the intervention at days 1, 4, 7, 10, and 13. A total of 132 healthy participants were randomized to a prospective expectancy?only condition (n=33), a retrospective expectancy?only condition (n=33), a combined expectancy condition (n=34), or a control condition (n=32). As the endpoint, we assessed changes in efficacy expectancies with the Credibility Expectancy Questionnaire, before the intervention and on days 1, 7, 14, and 20. For statistical analyses, we used a random effects model for the intention-to-treat sample, with intervention day as time variable and condition as two factors: prospective expectancy (yes vs no) and retrospective expectancy (yes vs no), allowed to vary over participant and intervention day. Results: Credibility (?=?1.63; 95% CI ?2.37 to ?0.89; P<.001) and expectancy (?=?0.77; 95% CI ?1.49 to ?0.05; P=.04) decreased across the intervention days. For credibility and expectancy, we found significant three-way interactions: intervention day×prospective expectancy×retrospective expectancy (credibility: ?=2.05; 95% CI 0.60-3.50; P=.006; expectancy: ?=1.55; 95% CI 0.14-2.95; P=.03), suggesting that efficacy expectancies decreased least in the combined expectancy condition and the control condition. Conclusions: To our knowledge, this is the first empirical study investigating whether efficacy expectancies can be successfully induced in a specifically designed placebo smartphone-based mental health intervention. Our findings may pave the way to diminish or exploit digital placebo effects and help to improve the efficacy of digital mental health interventions. Trial Registration: Clinicaltrials.gov NCT02365220; https://clinicaltrials.gov/ct2/show/NCT02365220. UR - http://mhealth.jmir.org/2021/2/e20329/ UR - http://dx.doi.org/10.2196/20329 UR - http://www.ncbi.nlm.nih.gov/pubmed/33594991 ID - info:doi/10.2196/20329 ER - TY - JOUR AU - Groarke, M. Jenny AU - Richmond, Janice AU - Mc Sharry, Jenny AU - Groarke, AnnMarie AU - Harney, M. Owen AU - Kelly, Grace Mary AU - Walsh, C. Jane PY - 2021/2/16 TI - Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e18288 VL - 9 IS - 2 KW - mHealth KW - self-management KW - text messaging KW - activity tracker KW - exercise KW - diet KW - overweight KW - obesity KW - cancer survivors KW - qualitative research KW - mobile phone N2 - Background: A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation. Objective: The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants. Methods: The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey. Results: The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17%) or low (5/36, 14%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94%). Most respondents said that they understood how the intervention works (35/36, 97%), and qualitative data show that participants? understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer. Conclusions: On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention. International Registered Report Identifier (IRRID): RR2-10.2196/13214 UR - http://mhealth.jmir.org/2021/2/e18288/ UR - http://dx.doi.org/10.2196/18288 UR - http://www.ncbi.nlm.nih.gov/pubmed/33591290 ID - info:doi/10.2196/18288 ER - TY - JOUR AU - Queiroz, Nunes Artur Acelino Francisco Luz AU - Mendes, Costa Isabel Amélia AU - de Godoy, Simone AU - Velez Lapão, Luís AU - Dias, Sónia PY - 2021/2/16 TI - mHealth Strategies Related to HIV Postexposure Prophylaxis Knowledge and Access: Systematic Literature Review, Technology Prospecting of Patent Databases, and Systematic Search on App Stores JO - JMIR Mhealth Uhealth SP - e23912 VL - 9 IS - 2 KW - HIV KW - eHealth KW - mHealth KW - postexposure prophylaxis KW - PEP KW - prevention KW - mobile phone N2 - Background: Globally, the number of HIV cases continue to increase, despite the development of multiple prevention strategies. New cases of HIV have been reported disproportionately more in men who have sex with men and other vulnerable populations. Issues such as internalized and structural homophobia prevent these men from accessing prevention strategies such as postexposure prophylaxis (PEP). Mobile health (mHealth) interventions are known to be one of the newest and preferred options to enhance PEP knowledge and access. Objective: The aim of this study was to identify and analyze the mobile apps addressing PEP for HIV infections. Methods: We conducted a descriptive exploratory study in 3 sequential phases: systematic literature review, patent analysis, and systematic search of app stores. For the systematic review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines adapted for an integrative review in the databases of PubMed, Web of Knowledge, Scopus, Cochrane, Embase, Science Direct, Eric, Treasure, and CINAHL. The patent analysis was performed by exploring the databases of the Brazilian National Institute of Industrial Property, the United States Patent and Trademark Office, and the European Patent Office. For the systematic search, we analyzed mHealth apps related to HIV in 2 major app libraries, that is, Google Play Store and App Store. The apps were evaluated by name, characteristics, functions, and availability in iPhone operating system/Android phones. Results: We analyzed 22 studies, of which 2 were selected for the final stage. Both studies present the use of apps as mHealth strategies aimed at improving the sexual health of men who have sex with men, and they were classified as decision support systems. The search in the patent databases showed only 1 result, which was not related to the topic since it was a drug intervention. In the app libraries, 25 apps were found and analyzed, with 15 (60%) apps available for Android systems but only 3 (12%) addressing PEP. In general, the apps inform about HIV and HIV prevention and treatment, with the focus users being health care providers, people with HIV, or the general population, but they have only limited features available, that is, mainly text, images, and videos. The 3 apps exclusively focusing on PEP were created by researchers from Brazilian universities. Conclusions: Our review found no connection between the scientific studies, registered patents, and the available apps related to PEP; this finding indicates that these available apps do not have a theoretical or a methodological background in their creation. Thus, since the scientific knowledge on HIV is not translated into technological products, preventing the emergence of new infections, especially in the more vulnerable groups, is difficult. In the future, researchers and the community must work in synergy to create more mHealth tools aimed at PEP. UR - http://mhealth.jmir.org/2021/2/e23912/ UR - http://dx.doi.org/10.2196/23912 UR - http://www.ncbi.nlm.nih.gov/pubmed/33591289 ID - info:doi/10.2196/23912 ER - TY - JOUR AU - Clift, K. Ashley AU - Le Lannou, Erwann AU - Tighe, P. Christian AU - Shah, S. Sachin AU - Beatty, Matthew AU - Hyvärinen, Arsi AU - Lane, J. Stephen AU - Strauss, Tamir AU - Dunn, D. Devin AU - Lu, Jiahe AU - Aral, Mert AU - Vahdat, Dan AU - Ponzo, Sonia AU - Plans, David PY - 2021/2/16 TI - Development and Validation of Risk Scores for All-Cause Mortality for a Smartphone-Based ?General Health Score? App: Prospective Cohort Study Using the UK Biobank JO - JMIR Mhealth Uhealth SP - e25655 VL - 9 IS - 2 KW - C-Score KW - mortality KW - risk score KW - smartphone KW - health score KW - medical informatics KW - public health KW - mobile health KW - development KW - validation KW - app KW - prospective KW - cohort KW - machine learning N2 - Background: Given the established links between an individual?s behaviors and lifestyle factors and potentially adverse health outcomes, univariate or simple multivariate health metrics and scores have been developed to quantify general health at a given point in time and estimate risk of negative future outcomes. However, these health metrics may be challenging for widespread use and are unlikely to be successful at capturing the broader determinants of health in the general population. Hence, there is a need for a multidimensional yet widely employable and accessible way to obtain a comprehensive health metric. Objective: The objective of the study was to develop and validate a novel, easily interpretable, points-based health score (?C-Score?) derived from metrics measurable using smartphone components and iterations thereof that utilize statistical modeling and machine learning (ML) approaches. Methods: A literature review was conducted to identify relevant predictor variables for inclusion in the first iteration of a points-based model. This was followed by a prospective cohort study in a UK Biobank population for the purposes of validating the C-Score and developing and comparatively validating variations of the score using statistical and ML models to assess the balance between expediency and ease of interpretability and model complexity. Primary and secondary outcome measures were discrimination of a points-based score for all-cause mortality within 10 years (Harrell c-statistic) and discrimination and calibration of Cox proportional hazards models and ML models that incorporate C-Score values (or raw data inputs) and other predictors to predict the risk of all-cause mortality within 10 years. Results: The study cohort comprised 420,560 individuals. During a cohort follow-up of 4,526,452 person-years, there were 16,188 deaths from any cause (3.85%). The points-based model had good discrimination (c-statistic=0.66). There was a 31% relative reduction in risk of all-cause mortality per decile of increasing C-Score (hazard ratio of 0.69, 95% CI 0.663-0.675). A Cox model integrating age and C-Score had improved discrimination (8 percentage points; c-statistic=0.74) and good calibration. ML approaches did not offer improved discrimination over statistical modeling. Conclusions: The novel health metric (?C-Score?) has good predictive capabilities for all-cause mortality within 10 years. Embedding the C-Score within a smartphone app may represent a useful tool for democratized, individualized health risk prediction. A simple Cox model using C-Score and age balances parsimony and accuracy of risk predictions and could be used to produce absolute risk estimations for app users. UR - http://mhealth.jmir.org/2021/2/e25655/ UR - http://dx.doi.org/10.2196/25655 UR - http://www.ncbi.nlm.nih.gov/pubmed/33591285 ID - info:doi/10.2196/25655 ER - TY - JOUR AU - Eberle, Claudia AU - Löhnert, Maxine AU - Stichling, Stefanie PY - 2021/2/15 TI - Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review JO - JMIR Mhealth Uhealth SP - e23477 VL - 9 IS - 2 KW - diabetes mellitus KW - mobile apps KW - mHealth apps KW - medical apps N2 - Background: According to the World Health Organization, the worldwide prevalence of diabetes mellitus (DM) is increasing dramatically and DM comprises a large part of the global burden of disease. At the same time, the ongoing digitalization that is occurring in society today offers novel possibilities to deal with this challenge, such as the creation of mobile health (mHealth) apps. However, while a great variety of DM-specific mHealth apps exist, the evidence in terms of their clinical effectiveness is still limited. Objective: The objective of this review was to evaluate the clinical effectiveness of mHealth apps in DM management by analyzing health-related outcomes in patients diagnosed with type 1 DM (T1DM), type 2 DM (T2DM), and gestational DM. Methods: A scoping review was performed. A systematic literature search was conducted in MEDLINE (PubMed), Cochrane Library, EMBASE, CINAHL, and Web of Science Core Collection databases for studies published between January 2008 and October 2020. The studies were categorized by outcomes and type of DM. In addition, we carried out a meta-analysis to determine the impact of DM-specific mHealth apps on the management of glycated hemoglobin (HbA1c). Results: In total, 27 studies comprising 2887 patients were included. We analyzed 19 randomized controlled trials, 1 randomized crossover trial, 1 exploratory study, 1 observational study, and 5 pre-post design studies. Overall, there was a clear improvement in HbA1c values in patients diagnosed with T1DM and T2DM. In addition, positive tendencies toward improved self-care and self-efficacy as a result of mHealth app use were found. The meta-analysis revealed an effect size, compared with usual care, of a mean difference of ?0.54% (95% CI ?0.8 to ?0.28) for T2DM and ?0.63% (95% CI ?0.93 to ?0.32) for T1DM. Conclusions: DM-specific mHealth apps improved the glycemic control by significantly reducing HbA1c values in patients with T1DM and T2DM patients. In general, mHealth apps effectively enhanced DM management. However, further research in terms of clinical effectiveness needs to be done in greater detail. UR - http://mhealth.jmir.org/2021/2/e23477/ UR - http://dx.doi.org/10.2196/23477 UR - http://www.ncbi.nlm.nih.gov/pubmed/33587045 ID - info:doi/10.2196/23477 ER - TY - JOUR AU - Marler, D. Jennifer AU - Fujii, A. Craig AU - Galanko, A. Joseph AU - Balbierz, J. Daniel AU - Utley, S. David PY - 2021/2/15 TI - Durability of Abstinence After Completing a Comprehensive Digital Smoking Cessation Program Incorporating a Mobile App, Breath Sensor, and Coaching: Cohort Study JO - J Med Internet Res SP - e25578 VL - 23 IS - 2 KW - smoking cessation KW - digital health KW - smartphone KW - digital sensor KW - carbon monoxide KW - breath sensor KW - biofeedback KW - mobile apps KW - health promotion KW - app N2 - Background: Despite decreasing prevalence over the last several decades, cigarette smoking remains the leading cause of preventable death and disease, underscoring the need for innovative, effective solutions. Pivot is a novel, inclusive smoking cessation program designed for smokers along the entire spectrum of readiness to quit. Pivot leverages proven methods and technological advancements, including a personal portable breath carbon monoxide sensor, smartphone app, and in-app text-based coaching. We previously reported outcomes from the end of active Pivot program participation in 319 adult smokers. Herein, we report longer-term follow up in this cohort. Objective: The aim of this study was to assess and report participant outcomes 3 months after completion of Pivot, including smoking behavior, quit rates, continuous abstinence rates and durability, and predictors of abstinence. Methods: This prospective remote cohort study included US-based cigarette smokers aged 18 to 65 years who smoked ?5 cigarettes per day (CPD). Three months after completion of active participation in Pivot, final follow-up data were collected via an online questionnaire. Outcomes included smoking behavior (CPD and quit attempts), self-reported quit rates (7- and 30-day point prevalence abstinence [PPA]), and continuous abstinence rates (proportion who achieved uninterrupted abstinence) and duration. Exploratory regression analyses were performed to identify baseline characteristics associated with achievement of 7-day PPA, 30-day PPA, and continuous abstinence. Results: A total of 319 participants completed onboarding (intention-to-treat [ITT]); 288/319 participants (90.3%) completed follow up (completers) at a mean of 7.2 (SD 1.2) months after onboarding. At final follow up, CPD were reduced by 52.6% (SE 2.1; P<.001) among all 319 participants, and most completers (152/288, 52.8%) reduced their CPD by at least 50%. Overall, most completers (232/288, 80.6%) made at least one quit attempt. Quit rates increased after the end of Pivot; using ITT analyses, 35.4% (113/319) achieved 7-day PPA and 31.3% (100/319) achieved 30-day PPA at final follow up compared with 32.0% (102/319) and 27.6% (88/319), respectively, at the end of the Pivot program. Continuous abstinence was achieved in about a quarter of those who onboarded (76/319, 23.8%) and in most who reported 30-day PPA at the end of Pivot (76/88, 86.4%), with a mean abstinence duration of 5.8 (SD 0.6) months. In exploratory regression analyses, lower baseline CPD, more positive baseline attitudes reflecting higher self-efficacy (higher confidence to quit and lower perceived difficulty of quitting), and higher education were associated with achieving abstinence. Conclusions: This study provides the first longer-term outcomes of the Pivot smoking cessation program. At final follow up, quit rates increased and continuous abstinence was favorable; the majority who achieved abstinence at the end of Pivot sustained abstinence throughout follow up. Decreases in CPD persisted and most participants made a quit attempt. Overall, final follow-up outcomes were stable or improved when compared to previous outcomes from the end of the program. These findings validate earlier results, and suggest that Pivot is an effective and durable solution for smoking cessation. Trial Registration: ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643 UR - http://www.jmir.org/2021/2/e25578/ UR - http://dx.doi.org/10.2196/25578 UR - http://www.ncbi.nlm.nih.gov/pubmed/33482628 ID - info:doi/10.2196/25578 ER - TY - JOUR AU - McKenna, Christopher Kevin AU - Geoghegan, Cindy AU - Swezey, Teresa AU - Perry, Brian AU - Wood, A. William AU - Nido, Virginia AU - Morin, L. Steve AU - Grabert, K. Brigid AU - Hallinan, P. Zachary AU - Corneli, L. Amy PY - 2021/2/12 TI - Investigator Experiences Using Mobile Technologies in Clinical Research: Qualitative Descriptive Study JO - JMIR Mhealth Uhealth SP - e19242 VL - 9 IS - 2 KW - mHealth KW - mobile technology KW - mobile clinical trials KW - digital health KW - clinical research KW - mobile devices KW - digital health technology KW - mobile applications KW - clinical trial N2 - Background: The successful adoption of mobile technology for use in clinical trials relies on positive reception from key stakeholders, including clinical investigators; however, little information is known about the perspectives of investigators using mobile technologies in clinical trials. Objective: The aim of this study was to seek investigators? insights on the advantages and challenges of mobile clinical trials (MCTs); site-level budgetary, training, and other support needs necessary to adequately prepare for and implement MCTs; and the advantages and disadvantages for trial participants using mobile technologies in clinical trials. Methods: Using a qualitative descriptive study design, we conducted in-depth interviews with investigators involved in the conduct of MCTs. Data were analyzed using applied thematic analysis. Results: We interviewed 12 investigators who represented a wide variety of clinical specialties and reported using a wide range of mobile technologies. Investigators most commonly cited 3 advantages of MCTs over traditional clinical trials: more streamlined study operations, remote data capture, and improvement in the quality of studies and data collected. Investigators also reported that MCTs can be designed around the convenience of trial participants, and individuals may be more willing to participate in MCTs because they can take part from their homes. In addition, investigators recognized that MCTs can also involve additional burden for participants and described that operational challenges, technology adoption barriers, uncertainties about data quality, and time burden made MCTs more challenging than traditional clinical trials. Investigators stressed that additional training and dedicated staff effort may be needed to select a particular technology for use in a trial, helping trial participants learn and use the technology, and for staff troubleshooting the technology. Investigators also expressed that sharing data collected in real time with investigators and trial participants is an important aspect of MCTs that warrants consideration and potentially additional training and education. Conclusions: Investigator perspectives can inform the use of mobile technologies in future clinical trials by proactively identifying and addressing potential challenges. UR - http://mhealth.jmir.org/2021/2/e19242/ UR - http://dx.doi.org/10.2196/19242 UR - http://www.ncbi.nlm.nih.gov/pubmed/33576742 ID - info:doi/10.2196/19242 ER - TY - JOUR AU - Liu, Guihua AU - Wang, Shuo AU - Liao, Jinhua AU - Ou, Ping AU - Huang, Longsheng AU - Xie, Namei AU - He, Yingshuang AU - Lin, Jinling AU - He, Hong-Gu AU - Hu, Rongfang PY - 2021/2/10 TI - The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study JO - JMIR Ment Health SP - e23917 VL - 8 IS - 2 KW - coronavirus disease 2019 KW - autism spectrum disorder KW - parenting training KW - psychological well-being KW - social media KW - WeChat KW - COVID-19 KW - autism KW - parenting KW - mental health KW - well-being KW - anxiety KW - depression KW - stress N2 - Background: During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated. Objective: The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic. Methods: This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2). Results: In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group × time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0% (26/65) logged their progress in home training each week and 61.5% (40/65) logged their progress more than 80% of the time for all 20 weeks. Conclusions: The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165 UR - https://mental.jmir.org/2021/2/e23917 UR - http://dx.doi.org/10.2196/23917 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481751 ID - info:doi/10.2196/23917 ER - TY - JOUR AU - Wu, Yiqun AU - Chen, Fei AU - Song, Haiqing AU - Feng, Wuwei AU - Sun, Jinping AU - Liu, Ruisen AU - Li, Dongmei AU - Liu, Ying PY - 2021/2/9 TI - Use of a Smartphone Platform to Help With Emergency Management of Acute Ischemic Stroke: Observational Study JO - JMIR Mhealth Uhealth SP - e25488 VL - 9 IS - 2 KW - acute ischemic stroke KW - door-to-needle time KW - smartphone platform KW - emergency management KW - smartphone KW - mHealth KW - stroke KW - management KW - emergency KW - first aid KW - utility KW - digital health N2 - Background: To improve the outcomes of acute ischemic stroke (AIS), timely thrombolytic therapy is crucial. Series strategies were recommended to reduce door-to-needle (DTN) time for AIS. Mobile technologies are feasible and have been used in stroke management for various purposes. However, the use of smartphone platforms that integrate series strategies through the entire first aid process to improve emergency management of AIS remains to be verified. Objective: This study aims to describe the utility and application of a smartphone platform in the emergency management of AIS and report the DTN time for patients with AIS during its 2-year application period. Our results are relevant to digital health management. Methods: A smartphone platform named ?Green? was developed to incorporate the field assessment, hospital recommendation, prehospital notification, real-time communication, clinical records creation, key time-stamping, and quality control to streamline and standardize overall AIS emergency management processes. The emergency medical system (EMS) and all the emergency departments in Beijing have used this platform since 2018. From January 1, 2018, to December 31, 2019, 8457 patients diagnosed with AIS received intravenous tissue-type plasminogen activator therapy. The median DTN time and the proportions of patients with DTN times of ?60 minutes and ?45 minutes were reported. Results: During the 2-year application period of this platform, the median DTN time was 45 minutes, and the proportions of patients with DTN times of ?60 minutes and ?45 minutes were 74.6% and 50.5%, respectively. The median DTN time was significantly reduced from 50 minutes in 2018 to 42 minutes in 2019 (P<.001). The proportions of patients with DTN times of ?60 minutes and ?45 minutes increased from 66.1% and 40.7%, respectively, in 2018 to 80.7% and 57.3%, respectively, in 2019 (both P<.001). Sustained improvement in DTN time was seen during all the observed months. The improvement occurred across all facilities, and the variations among hospitals also decreased. The median DTN time for patients transferred by ambulances (43 minutes) was significantly shorter than those who reached hospitals by themselves (47 minutes; P<.001). Conclusions: Sustained reductions in DTN time reflected the improvement in AIS emergency management processes. The use of a smartphone platform integrating recommended strategies throughout all first aid stages is a practical way to help the emergency management of AIS. UR - http://mhealth.jmir.org/2021/2/e25488/ UR - http://dx.doi.org/10.2196/25488 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560236 ID - info:doi/10.2196/25488 ER - TY - JOUR AU - Wang, Huanlin AU - Liang, LanYu AU - Du, ChunLin AU - Wu, YongKang PY - 2021/2/5 TI - Implementation of Online Hospitals and Factors Influencing the Adoption of Mobile Medical Services in China: Cross-Sectional Survey Study JO - JMIR Mhealth Uhealth SP - e25960 VL - 9 IS - 2 KW - COVID-19 KW - online hospital KW - mobile medical service KW - Unified Theory of Acceptance and Use of Technology KW - UTAUT N2 - Background: Online hospitals are part of an innovative model that allows China to explore telemedicine services based on national conditions with large populations, uneven distribution of medical resources, and lack of quality medical resources, especially among residents needing to be protected from COVID-19 infection. Objective: In this study, we built a hypothesis model based on the Unified Theory of Acceptance and Use of Technology (UTAUT) in order to analyze the factors that may influence patients? willingness to use mobile medical services. This research was designed to assist in the development of mobile medical services. Residents who do not live in urban areas and cannot access medical assistance would greatly benefit from this research, as they could immediately go to the online hospital when needed. Methods: A cross-sectional study based at the West China Hospital, Sichuan University, was conducted in July 2020. A total of 407 respondents, 18 to 59 years old, in Western China were recruited by convenience sampling. We also conducted an empirical test for the hypothesis model and applied structural equation modeling to estimate the significance of path coefficients so that we could better understand the influencing factors. Results: Out of 407 respondents, 95 (23.3%) were aware of online hospitals, while 312 (76.7%) indicated that they have never heard of online hospitals before. Gender (P=.048) and education level (P=.04) affected people?s willingness to use online hospitals, and both of these factors promoted the use of online hospitals (odds ratio [OR] 2.844, 95% CI 1.010-8.003, and OR 2.187, 95% CI 1.031-4.636, respectively). According to structural equation modeling, the results of the path coefficient analysis indicated that performance expectancy, effort expectancy, and facilitating conditions have positive effects on patients? willingness to use online hospitals. Conclusions: The goal of our research was to determine the factors that influence patients? awareness and willingness to use online hospitals. Currently, the public?s awareness and usage of online hospitals is low. In fact, effort expectancy was the most important factor that influenced the use of online hospitals; being female and having a high education also played positive roles toward the use of mobile medical services. UR - http://mhealth.jmir.org/2021/2/e25960/ UR - http://dx.doi.org/10.2196/25960 UR - http://www.ncbi.nlm.nih.gov/pubmed/33444155 ID - info:doi/10.2196/25960 ER - TY - JOUR AU - Kim, Kwanho AU - Lee, Chul-Joo PY - 2021/2/3 TI - Examining an Integrative Cognitive Model of Predicting Health App Use: Longitudinal Observational Study JO - JMIR Mhealth Uhealth SP - e24539 VL - 9 IS - 2 KW - mHealth KW - health apps KW - digital divide KW - integrative model of behavioral prediction KW - path analysis N2 - Background: Specifying the determinants of using health apps has been an important research topic for health scholars as health apps have proliferated during the past decade. Socioeconomic status (SES) has been revealed as a significant determinant of using health apps, but the cognitive mechanisms underlying the relationship between SES and health app use are unknown. Objective: This study aims to examine the cognitive mechanisms underlying the relationships between SES and use of health apps, applying the integrative model of behavioral prediction (IM). The model hypothesizes the indirect influences of SES on intentions to use health apps, which in turn predict actual use of health apps. The relationships between SES and intentions to use health apps were assumed to be mediated by proximal variables (attitudes, perceived behavioral control [PBC], injunctive norms, and descriptive norms). Methods: We conducted path analyses using data from a two-wave opt-in panel survey of Korean adults who knew about health apps. The number of respondents was 605 at baseline and 440 at follow-up. We compared our model with two alternative theoretical models based on modified IM to further clarify the roles of determinants of health app use. Results: Attitudes (?=.220, P<.001), PBC (?=.461, P<.001), and injunctive norms (?=.186, P<.001) were positively associated with intentions to use health apps, which, in turn, were positively related to actual use of health apps (?=.106, P=.03). Income was positively associated with intentions to use health apps, and this relationship was mediated by attitudes (B=0.012, 95% CI 0.001-0.023) and PBC (B=0.026, 95% CI 0.004-0.048). Education was positively associated with descriptive norms (?=.078, P=.03), but descriptive norms were not significantly related to intentions to use health apps. We also found that PBC interacted with attitudes (B=0.043, SE 0.022, P=.046) and jointly influenced intentions to use health apps, whereas the results did not support direct influences of education, income, and PBC on health app use. Conclusions: We found that PBC over using health apps may be the most important factor in predicting health app use. This suggests the necessity of designing and promoting health apps in a user-friendly way. Our findings also imply that socioeconomic inequalities in using health apps may be reduced by increasing positive attitudes toward, and boosting PBC over, health app use among individuals with low income. UR - https://mhealth.jmir.org/2021/2/e24539 UR - http://dx.doi.org/10.2196/24539 UR - http://www.ncbi.nlm.nih.gov/pubmed/33533724 ID - info:doi/10.2196/24539 ER - TY - JOUR AU - Kreniske, Philip AU - Basmajian, Alyssa AU - Nakyanjo, Neema AU - Ddaaki, William AU - Isabirye, Dauda AU - Ssekyewa, Charles AU - Nakubulwa, Rosette AU - Hirsch, S. Jennifer AU - Deisher, Andrea AU - Nalugoda, Fred AU - Chang, W. Larry AU - Santelli, S. John PY - 2021/2/2 TI - The Promise and Peril of Mobile Phones for Youth in Rural Uganda: Multimethod Study of Implications for Health and HIV JO - J Med Internet Res SP - e17837 VL - 23 IS - 2 KW - adolescence KW - youth KW - mobile phones KW - cell phones KW - mobility KW - HIV KW - East Africa N2 - Background: In East Africa, where landlines are used by 1% of the population and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote the health of adolescents and young adults (AYAs) and to prevent HIV infection. Objective: The aim of this study is to describe the current state of AYAs? phone use in the region and trace out the implications for mobile health interventions. Methods: We identified 2 trading centers that were representative of southern Uganda in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19 years and 20-24 years), gender, and phone ownership and randomly sampled 31 key informant interview participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYAs in the communities of study. Results: AYA frequently reported barriers to using their phones, such as difficulty accessing electricity. Nearly all AYAs used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners, with many AYAs reporting that their sexual partners associated phone use with infidelity. Few AYAs reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYAs reported an instance when they used their phone in an emergency, with childbirth-related emergencies being the most common. Finally, most AYAs reported that they would like to use their phones for health purposes and specifically stated that they would like to use their mobile phones to access current HIV prevention information. Conclusions: This study demonstrates how mobile phones are related to income-generating practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our previous study, which suggested an association between mobile phone ownership, having multiple sexual partners, and HIV risk. Mobile phones have untapped potential to serve as tools for health promotion and HIV prevention. UR - https://www.jmir.org/2021/2/e17837 UR - http://dx.doi.org/10.2196/17837 UR - http://www.ncbi.nlm.nih.gov/pubmed/33528375 ID - info:doi/10.2196/17837 ER - TY - JOUR AU - Moura, João AU - Almeida, Pisco Ana Margarida AU - Roque, Fátima AU - Figueiras, Adolfo AU - Herdeiro, Teresa Maria PY - 2021/1/28 TI - A Mobile App to Support Clinical Diagnosis of Upper Respiratory Problems (eHealthResp): Co-Design Approach JO - J Med Internet Res SP - e19194 VL - 23 IS - 1 KW - mHealth KW - Clinical Decision Support Systems KW - respiratory system KW - diagnose KW - interface KW - mobile phone N2 - Background: The misuse of antibiotics is a global public health issue that fosters bacterial resistance and jeopardizes generational health. The development of validated tools such as web-based courses and mobile apps to enhance clinical decisions in upper respiratory infections is of great importance in reducing the incorrect use of antibiotics in these situations. Objective: The aim of this study was to design and prevalidate the interface of a mobile app to assist and provide clinical support in the diagnosis of upper respiratory problems. We aimed to assess the adequacy and usability of the interface of the tool in the belief that it could be beneficial to health care delivery in the clinical decision setting. Methods: Using a co-design approach that brought together professionals in interface design and experts in pharmacology and pharmacoepidemiology, the mobile app interface was evaluated through peer review sessions held by interface design professionals on a heuristic survey. The reviewers accessed a high-fidelity interactive mock-up of the interface and filled in a questionnaire to assess the dimensions of layout and visual design and navigation and tasks. The resulting feedback of this evaluation supported the redesign of the primary interface, which was assessed for the second time by 2 of the previously mentioned reviewers. Results: With 4 as the highest score, the interface scored a mean of 3.16 (SD 0.45; median of the means 3.2) for layout and visual design and a mean of 3.43 (SD 0.33; median of the means 3.51) for navigation and tasks, reflecting an overall positive evaluation. The open-ended commentaries allowed us to better understand specific recommendations of the reviewers. Throughout this section, approximately 0.98 comments per parameter were registered, reflecting a high level of effectiveness of the chosen parameters in identifying potential problems. The resultant beta version of the interface, addressing the majority of the detected problems, was further assessed by 2 of the previous reviewers, validating the new design. Future tests with physicians and pharmacists will help assess credibility and user experience dimensions. Conclusions: Our study revealed that the designed interface is easy to interpret and use. Peer reviewers raised important issues that could be easily fixed and positively reassessed. As a result, the study enabled us to produce a new tool for interface usability assessment and a set of recommendations for developing mobile interfaces for clinical decision support systems in the scope of upper respiratory problems. UR - http://www.jmir.org/2021/1/e19194/ UR - http://dx.doi.org/10.2196/19194 UR - http://www.ncbi.nlm.nih.gov/pubmed/33507153 ID - info:doi/10.2196/19194 ER - TY - JOUR AU - Kabukye, K. Johnblack AU - Ilozumba, Onaedo AU - Broerse, W. Jacqueline E. AU - de Keizer, Nicolette AU - Cornet, Ronald PY - 2021/1/26 TI - Implementation of an Interactive Voice Response System for Cancer Awareness in Uganda: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e22061 VL - 9 IS - 1 KW - telemedicine KW - medical oncology KW - health promotion KW - low-and-middle-income countries KW - participatory research KW - mobile phone N2 - Background: Cancer awareness is crucial for cancer care and prevention. However, cancer awareness in Uganda is low, and access to cancer information is limited. Objective: This study aims to (1) understand the cancer awareness situation in Uganda (perceptions, beliefs, information needs, and challenges to accessing cancer information) and opinions about interactive voice response (IVR) systems; (2) develop cancer awareness messages and implement them in an IVR system; and (3) evaluate user acceptance and use of the IVR system. Methods: A participatory design approach was adopted. To understand cancer awareness needs and challenges, 3 interviews and 7 focus group discussions (FGDs) were conducted with cancer health care providers, patients with cancer, caregivers and survivors, administrators, and lay citizens (n=73). On the basis of the resulting qualitative data, audio messages addressing cancer information needs were developed and implemented in an IVR system. The system and messages were tested with users (n=12) during 2 co-design workshops before final rollout. Finally, the system was evaluated over 6 months after going live, using call records and user feedback from telephone interviews with callers (n=40). Results: The cancer information needs included general topics such as what cancer is, what causes it, cancer screening and diagnosis, cancer treatment, and practical information on what to expect during cancer care. There were also myths and misconceptions that need to be addressed, such as that cancer is due to witchcraft and has no treatment. Information on COVID-19 was also sought after following the outbreak. We developed 20 audio cancer messages (approximately 2 minutes each) in English and Luganda, along with 14 IVR navigation instructions. These were implemented in an IVR system with 24/7 availability from all over Uganda via a toll-free multi-channel telephone number. The total number of calls made to the IVR system 6 months after going live was 3820. Of these, 2437 (63.8%) lasted at least 30 seconds and were made from 1230 unique telephone numbers. There were 191 voice messages and 760 calls to live agents, most of which (681/951, 71.6%) were in Luganda. Call volumes peaked following advertisement of the system and lockdowns due to COVID-19. Participants were generally familiar with IVR technology, and caller feedback was largely positive. Cited benefits included convenience, toll-free access, and detailed information. Recommendations for improvement of the system included adding live agents and marketing of the system to target users. Conclusions: IVR technology provides an acceptable and accessible method for providing cancer information to patients and the general public in Uganda. However, a need remains for health system reforms to provide additional cancer information sources and improve cancer care services in general. UR - http://mhealth.jmir.org/2021/1/e22061/ UR - http://dx.doi.org/10.2196/22061 UR - http://www.ncbi.nlm.nih.gov/pubmed/33496672 ID - info:doi/10.2196/22061 ER - TY - JOUR AU - Batch, C. Bryan AU - Spratt, E. Susan AU - Blalock, V. Dan AU - Benditz, Chad AU - Weiss, Andi AU - Dolor, J. Rowena AU - Cho, H. Alex PY - 2021/1/20 TI - General Behavioral Engagement and Changes in Clinical and Cognitive Outcomes of Patients with Type 2 Diabetes Using the Time2Focus Mobile App for Diabetes Education: Pilot Evaluation JO - J Med Internet Res SP - e17537 VL - 23 IS - 1 KW - mobile technology KW - diabetes KW - self management support KW - self efficacy KW - illness perception N2 - Background: Type 2 diabetes affects 30 million Americans, representing a significant cause of morbidity and mortality. Self-management support is an important component of chronic illness care and is a key pillar of the chronic care model. Face-to-face teaching and patient education materials suffer from being static or incompatible with mobile lifestyles. Digital apps provide a self-management support alternative that is convenient and scalable. Objective: This pilot study tested the real-world deployment of a self-guided mobile app for diabetes education (Time2Focus app; MicroMass Communications Inc, Cary, NC), which utilizes evidence-based content and gamification to deliver an interactive learning experience. Methods: Primary care providers were approached for permission to invite their patients to participate. Eligible patients were 18 to 89 years of age, had a diagnosis of type 2 diabetes, hemoglobin A1c (HbA1c) ?8% and <12% in the past 3 months, an active online patient portal account (tied to the electronic health record), and access to an iOS or Android smartphone. Interested patients were emailed a baseline survey, and once this was completed, were sent instructions for downloading the Time2Focus app. After completing all 12 levels, participants were sent a follow-up survey. The primary outcome was the change in HbA1c. Secondary outcomes included medication adherence, self-care activities, self-reporting of physical activities, diabetes self-efficacy, illness perceptions, diabetes distress scale, and users? engagement with and rating of the app. Results: Of 1355 potentially eligible patients screened, 201 were consented. Of these 201 patients, 101 (50.2%) did not download the app. Of the 100 participants (49.8%) who downloaded the app, 16 (16.0%) completed 0 levels, 26 (26.0%) completed 1 to 4 levels, 10 (10.0%) completed 5 to 11 levels, and 48 (48.0%) completed all 12 levels of the app and the follow-up survey. Those completing one or more levels had a mean pre/post-HbA1c change of ?0.41% (compared to ?0.32% among those who completed zero levels); however, the unadjusted two-tailed t test indicated no significant difference between the two groups (P=.73). Diabetes self-efficacy showed a large and significant increase during app usage for completers (mean change 1.28, P<.001, d=.83). Severity of illness perceptions showed a small but significant decrease during app usage for completers (mean change ?0.51, P=.004, d=.43). Diabetes distress showed a small but significant decrease during app usage for completers (mean change ?0.45, P=.006, d=.41). The net promoter score was 62.5, indicating that those who completed all levels of the app rated it highly and would recommend it to others. Conclusions: Participants who engaged in all 12 levels of the Time2Focus mobile app showed an improvement in diabetes self-efficacy and a decrease in severity of illness perceptions. The decrease in HbA1c observed in app users relative to nonusers during this limited pilot study was not statistically significant. However, uptake and application of lessons learned from self-management support may be delayed. Further research is needed to address how to increase engagement through self-management support and to investigate if follow up over a longer period demonstrates a significant change in outcomes such as HbA1c. UR - http://www.jmir.org/2021/1/e17537/ UR - http://dx.doi.org/10.2196/17537 UR - http://www.ncbi.nlm.nih.gov/pubmed/33470947 ID - info:doi/10.2196/17537 ER - TY - JOUR AU - Mwaisaka, Jefferson AU - Gonsalves, Lianne AU - Thiongo, Mary AU - Waithaka, Michael AU - Sidha, Hellen AU - Alfred, Otieno AU - Mukiira, Carol AU - Gichangi, Peter PY - 2021/1/15 TI - Young People?s Experiences Using an On-Demand Mobile Health Sexual and Reproductive Health Text Message Intervention in Kenya: Qualitative Study JO - JMIR Mhealth Uhealth SP - e19109 VL - 9 IS - 1 KW - mHealth KW - mobile phones KW - sexual and reproductive health KW - Kenya N2 - Background: Digital health usability assessments can help explain how well mobile health (mHealth) apps targeting young people with sexual and reproductive health (SRH) information performed and whether the intended purpose was achieved. However, few digital health assessments have been conducted to evaluate young people?s perceptions regarding mHealth system interactions and content relevance on a wide range of SRH topics. In addition, the majority of randomized controlled trials (RCTs) have focused on push messaging platforms; therefore, the mHealth field lacks sufficient RCTs investigating on-demand mHealth SRH platforms. Objective: The objective of this study was to explore young people?s experiences using an on-demand SRH mHealth platform in Kenya. Methods: We used qualitative data related to the usability of an mHealth platform, Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcome (ARMADILLO), collected at the end of the intervention period. A total of 30 in-depth interviews (IDIs) were held with the intervention participants (15 women and 15 men) to elicit their experiences, opinions, and perspectives on the design and content of the ARMADILLO platform. The study participants were randomly selected from a list of intervention arm participants to participate in the IDIs. The interviews were later transcribed verbatim, translated into English, and coded and analyzed thematically using NVivo version 12 software (QSR International). Results: Respondents reported varied user experiences and levels of satisfaction, ranging from ease of use by the majority of the respondents to systematic frustrations that prevented some participants from progressing to other stages. Interesting features of the mHealth platform included the immediate response participants received when requesting messages, weekly remunerated quizzes, and perceived ability of educative and informative content and messages to change behaviors. Proposed enhancements to the platform included revising some concepts and words for easy understanding and increasing the interactivity of the platform, whereby young people could seek clarity when they came across difficult terms or had additional questions about the information they received. Conclusions: The importance of understanding the range of health literacy and technological variations when dealing with young people cannot be overemphasized. Young people, as mHealth end users, must be considered throughout intervention development to achieve optimum functionality. In addition, young people targeted with mHealth SRH interventions must be sensitized to the interactions on mHealth platforms or any other digital health apps if implemented in a nonresearch setting for optimal use by the targeted audience. UR - http://mhealth.jmir.org/2021/1/e19109/ UR - http://dx.doi.org/10.2196/19109 UR - http://www.ncbi.nlm.nih.gov/pubmed/33448930 ID - info:doi/10.2196/19109 ER - TY - JOUR AU - Shah, Shailendra Sachin AU - Gvozdanovic, Andrew AU - Knight, Matthew AU - Gagnon, Julien PY - 2021/1/15 TI - Mobile App?Based Remote Patient Monitoring in Acute Medical Conditions: Prospective Feasibility Study Exploring Digital Health Solutions on Clinical Workload During the COVID Crisis JO - JMIR Form Res SP - e23190 VL - 5 IS - 1 KW - mHealth KW - remote patient monitoring KW - digital health KW - COVID-19 KW - service improvement KW - cost-effectiveness KW - monitoring N2 - Background: Digital remote patient monitoring can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Health care providers are overwhelmed, resulting in clinical teams spread more thinly. We aimed to assess the impact of introducing an app-based remote patient monitoring system (Huma Therapeutics) on a clinician?s workload in the context of a COVID-19?specific virtual ward. Objective: This prospective feasibility study aimed to evaluate the health economic effects (in terms of clinical workload) of a mobile app on a telephone-based virtual ward used in the monitoring of patients with COVID-19 who are clinically ready for discharge from the hospital. Methods: A prospective feasibility study was carried out over 1 month where clinician workload was monitored, and full-time equivalents savings were determined. An NHS hospital repurposed a telephone-based respiratory virtual ward for COVID-19. Patients with COVID-19 in the amber zone (according to the National Health Service definition) were monitored for 14 days postdischarge to help identify deteriorating patients earlier. A smartphone-based app was introduced to monitor data points submitted by the patients via communication over telephone calls. We then comparatively evaluated the clinical workload between patients monitored by telephone only (cohort 1) with those monitored via mobile app and telephone (cohort 2). Results: In all, 56 patients were enrolled in the app-based virtual ward (cohort 2). Digital remote patient monitoring resulted in a reduction in the number of phone calls from a mean total of 9 calls to 4 calls over the monitoring period. There was no change in the mean duration of phone calls (8.5 minutes) and no reports of readmission or mortality. These results equate to a mean saving of 47.60 working hours. Moreover, it translates to 3.30 fewer full-time equivalents (raw phone call data), resulting in 1.1 fewer full-time equivalents required to monitor 100 patients when adjusted for time spent reviewing app data. Individual clinicians spent an average of 10.9 minutes per day reviewing data. Conclusions: Smartphone-based remote patient monitoring technologies may offer tangible reductions in clinician workload at a time when service is severely strained. In this small-scale pilot study, we demonstrated the economic and operational impact that digital remote patient monitoring technology can have in improving working efficiency and reducing operational costs. Although this particular RPM solution was deployed for the COVID-19 pandemic, it may set a precedent for wider utilization of digital, remote patient monitoring solutions in other clinical scenarios where increased care delivery efficiency is sought. UR - http://formative.jmir.org/2021/1/e23190/ UR - http://dx.doi.org/10.2196/23190 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400675 ID - info:doi/10.2196/23190 ER - TY - JOUR AU - Röhr, Susanne AU - Jung, U. Franziska AU - Pabst, Alexander AU - Grochtdreis, Thomas AU - Dams, Judith AU - Nagl, Michaela AU - Renner, Anna AU - Hoffmann, Rahel AU - König, Hans-Helmut AU - Kersting, Anette AU - Riedel-Heller, G. Steffi PY - 2021/1/13 TI - A Self-Help App for Syrian Refugees With Posttraumatic Stress (Sanadak): Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e24807 VL - 9 IS - 1 KW - app KW - cost-utility analysis KW - mHealth KW - posttraumatic stress KW - PTSD KW - quality-adjusted life years KW - randomized controlled trial KW - refugees KW - stimga KW - Syrian refugees KW - usability N2 - Background: Syrian refugees residing in Germany often develop posttraumatic stress as a result of the Syrian civil war, their escape, and postmigration stressors. At the same time, there is a lack of adequate treatment options. The smartphone-based app Sanadak was developed to provide cognitive behavioral therapy?based self-help in the Arabic language for Syrian refugees with posttraumatic stress. Objective: The aim of this study was to evaluate the effectiveness and cost-effectiveness of the app. Methods: In a randomized controlled trial, eligible individuals were randomly allocated to the intervention group (IG; app use) or control group (CG; psychoeducational reading material). Data were collected during structured face-to-face interviews at 3 assessments (preintervention/baseline, postintervention/after 4 weeks, follow-up/after 4 months). Using adjusted mixed-effects linear regression models, changes in posttraumatic stress and secondary outcomes were investigated as intention-to-treat (ITT) and per-protocol (PP) analysis. Cost-effectiveness was evaluated based on adjusted mean total costs, quality-adjusted life years (QALYs), and cost-effectiveness acceptability curves using the net benefit approach. Results: Of 170 screened individuals (aged 18 to 65 years), 133 were eligible and randomized to the IG (n=65) and CG (n=68). Although there was a pre-post reduction in posttraumatic stress, ITT showed no significant differences between the IG and CG after 4 weeks (Posttraumatic Diagnostic Scale for DSM-5, Diff ?0.90, 95% CI ?0.24 to 0.47; P=.52) and after 4 months (Diff ?0.39, 95% CI ?3.24 to 2.46; P=.79). The same was true for PP. Regarding secondary outcomes, ITT indicated a treatment effect for self-stigma: after 4 weeks (Self-Stigma of Mental Illness Scale/SSMIS?stereotype agreement: d=0.86, 95% CI 0.46 to 1.25; stereotype application: d=0.60, 95% CI 0.22 to 0.99) and after 4 months (d=0.52, 95% CI 0.12 to 0.92; d=0.50, 95% CI 0.10 to 0.90), the IG showed significantly lower values in self-stigma than the CG. ITT showed no significant group differences in total costs and QALYs. The probability of cost-effectiveness was 81% for a willingness-to-pay of ?0 per additional QALY but decreased with increasing willingness-to-pay. Conclusions: Sanadak was not more effective in reducing mild to moderate posttraumatic stress in Syrian refugees than the control condition nor was it likely to be cost-effective. Therefore, Sanadak is not suitable as a standalone treatment. However, as the app usability was very good, no harms detected, and stigma significantly reduced, Sanadak has potential as a bridging aid within a stepped and collaborative care approach. Trial Registration: German Clinical Trials Register DRKS00013782; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013782 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-019-2110-y UR - http://mhealth.jmir.org/2021/1/e24807/ UR - http://dx.doi.org/10.2196/24807 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439140 ID - info:doi/10.2196/24807 ER - TY - JOUR AU - Sharif, Owaise Mohammad AU - Newton, Timothy Jonathon AU - Cunningham, J. Susan PY - 2021/1/13 TI - Assessing the Effectiveness and Acceptability of a Personalized Mobile Phone App in Improving Adherence to Oral Hygiene Advice in Orthodontic Patients: Protocol for a Feasibility Study and a Randomized Controlled Trial JO - JMIR Res Protoc SP - e18021 VL - 10 IS - 1 KW - orthodontics KW - adherence KW - smartphone apps KW - mobile phone apps KW - personalized health care KW - information provision N2 - Background: Orthodontic treatment is a common health care intervention; treatment duration can be lengthy (2-3 years on average), and adherence to treatment advice is therefore essential for successful outcomes. It has been reported that up to 43% of patients fail to complete treatment, and there are currently no useful predictors of noncompletion. Given that the National Health Service England annual expenditure on primary-care orthodontic treatment is in excess of £200 million (US $267 million), noncompletion of treatment represents a significant inefficient use of public resources. Improving adherence to treatment is therefore essential. This necessitates behavior change, and interventions that improve adherence and are designed to elicit behavioral change must address an individual?s capability, opportunity, and motivation. Mobile phones are potentially an invaluable tool in this regard, as they are readily available and can be used in a number of ways to address an individual?s capability, opportunity, and motivation. Objective: This study will assess the effectiveness and acceptability of a personalized mobile phone app in improving adherence to orthodontic treatment advice by way of a randomized controlled trial. Methods: This study will be conducted in 2 phases at the Eastman Dental Hospital, University College London Hospitals Foundation Trust. Phase 1 is feasibility testing of the My Braces app. Participants will be asked to complete the user version of the Mobile Application Rating Scale. The app will be amended following analysis of the responses, if appropriate. Phase 2 is a randomized controlled trial to test the effectiveness and acceptability of the My Braces app. Results: This study was approved by the London ? Bloomsbury Research Ethics Committee on November 5, 2019 (reference 19/LO/1555). No patients have been recruited to date. The anticipated start date for recruitment to phase 1 is October 2020. Conclusions: Given the availability, affordability, and versatility of mobile phones, it is proposed that they will aid in improving adherence to treatment advice and hence improve treatment completion rates. If effective, the applicability of this methodology to developing behavior change/modification interventions and improving adherence to treatment across health care provides an exciting opportunity. Trial Registration: ClinicalTrials.gov NCT04184739; https://clinicaltrials.gov/ct2/show/NCT04184739 International Registered Report Identifier (IRRID): PRR1-10.2196/18021 UR - http://www.researchprotocols.org/2021/1/e18021/ UR - http://dx.doi.org/10.2196/18021 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439142 ID - info:doi/10.2196/18021 ER - TY - JOUR AU - Sjöberg, Veronica AU - Westergren, Jens AU - Monnier, Andreas AU - Lo Martire, Riccardo AU - Hagströmer, Maria AU - Äng, Olov Björn AU - Vixner, Linda PY - 2021/1/12 TI - Wrist-Worn Activity Trackers in Laboratory and Free-Living Settings for Patients With Chronic Pain: Criterion Validity Study JO - JMIR Mhealth Uhealth SP - e24806 VL - 9 IS - 1 KW - chronic pain KW - energy expenditure KW - heart rate KW - physical activity KW - step count KW - validity KW - wearable devices KW - wearable KW - pain KW - rehabilitation N2 - Background: Physical activity is evidently a crucial part of the rehabilitation process for patients with chronic pain. Modern wrist-worn activity tracking devices seemingly have a great potential to provide objective feedback and assist in the adoption of healthy physical activity behavior by supplying data of energy expenditure expressed as metabolic equivalent of task units (MET). However, no studies of any wrist-worn activity tracking devices? have examined criterion validity in estimating energy expenditure, heart rate, or step count in patients with chronic pain. Objective: The aim was to determine the criterion validity of wrist-worn activity tracking devices for estimations of energy expenditure, heart rate, and step count in a controlled laboratory setting and free-living settings for patients with chronic pain. Methods: In this combined laboratory and field validation study, energy expenditure, heart rate, and step count were simultaneously estimated by a wrist-worn activity tracker (Fitbit Versa), indirect calorimetry (Jaeger Oxycon Pro), and a research-grade hip-worn accelerometer (ActiGraph GT3X) during treadmill walking at 3 speeds (3.0 km/h, 4.5 km/h, and 6.0 km/h) in the laboratory setting. Energy expenditure and step count were also estimated by the wrist-worn activity tracker in free-living settings for 72 hours. The criterion validity of each measure was determined using intraclass and Spearman correlation, Bland-Altman plots, and mean absolute percentage error. An analysis of variance was used to determine whether there were any significant systematic differences between estimations. Results: A total of 42 patients (age: 25-66 years; male: 10/42, 24%; female: 32/42, 76%), living with chronic pain (duration, in years: mean 9, SD 6.72) were included. At baseline, their mean pain intensity was 3.5 (SD 1.1) out of 6 (Multidimensional Pain Inventory, Swedish version). Results showed that the wrist-worn activity tracking device (Fitbit Versa) systematically overestimated energy expenditure when compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X). Poor agreement and poor correlation were shown between Fitbit Versa and both Jaeger Oxycon Pro and ActiGraph GT3X for estimated energy expenditure at all treadmill speeds. Estimations of heart rate demonstrated poor to fair agreement during laboratory-based treadmill walks. For step count, the wrist-worn devices showed fair agreement and fair correlation at most treadmill speeds. In free-living settings; however, the agreement for step count between the wrist-worn device and waist-worn accelerometer was good, and the correlation was excellent. Conclusions: The wrist-worn device systematically overestimated energy expenditure and showed poor agreement and correlation compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X), which needs to be considered when used clinically. Step count measured with a wrist-worn device, however, seemed to be a valid estimation, suggesting that future guidelines could include such variables in this group with chronic pain. UR - http://mhealth.jmir.org/2021/1/e24806/ UR - http://dx.doi.org/10.2196/24806 UR - http://www.ncbi.nlm.nih.gov/pubmed/33433391 ID - info:doi/10.2196/24806 ER - TY - JOUR AU - Chan, C. Eric AU - Sun, Yuting AU - Aitchison, J. Katherine AU - Sivapalan, Sudhakar PY - 2021/1/8 TI - Mobile App?Based Self-Report Questionnaires for the Assessment and Monitoring of Bipolar Disorder: Systematic Review JO - JMIR Form Res SP - e13770 VL - 5 IS - 1 KW - mobile apps KW - mental health KW - bipolar disorder KW - smartphone KW - cell phone N2 - Background: Bipolar disorder is a chronic, progressive illness characterized by recurrent episodes of mania and depression. Self-report scales have historically played a significant role in the monitoring of bipolar symptoms. However, these tools rely on episodic memory, which can be unreliable and do not allow the clinician to monitor brief episodic symptoms or the course of symptoms over shorter periods of time. Mobile app?based questionnaires have been suggested as a tool to improve monitoring of patients with bipolar disorder. Objective: This paper aims to determine the feasibility and validity of mobile app?based self-report questionnaires. Methods: We performed a systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, PsycInfo, Web of Science, Ovid MEDLINE, and EMBASE databases were searched for papers published in English that assessed adherence to and the validity of mobile app?based self-report questionnaires. Relevant studies published from database creation to May 22, 2020, were identified, and results examining the validity of and rates of adherence to app-based self-report questionnaires are reported. Results: A total of 13 records were identified for inclusion in this review. Of these studies, 4 assessed the concurrent validity of mobile app?based self-report tools, with the majority of findings indicating significant associations between data collected using these tools and the Young Mania Rating Scale, Hamilton Depression Rating Scale-17, or Montgomery-Åsberg Depression Rating Scale (P<.001 to P=.24). Three studies comparing the variability or range of symptoms between patients with bipolar disorder and healthy controls suggested that these data are capable of differentiating between known groups. Two studies demonstrated statistically significant associations between data collected via mobile app?based self-report tools and instruments assessing other clinically important factors. Adherence rates varied across the studies examined. However, good adherence rates (>70%) were observed in all but 1 study using a once-daily assessment. There was a wide range of adherence rates observed in studies using twice-daily assessments (42%-95%). Conclusions: These findings suggest that mobile app?based self-report tools are valid in the assessment of symptoms of mania and depression in euthymic patients with bipolar disorder. Data collected using these tools appear to differ between patients with bipolar disorder and healthy controls and are significantly associated with other clinically important measures. It is unclear at this time whether these tools can be used to detect acute episodes of mania or depression in patients with bipolar disorder. Adherence data indicate that patients with bipolar disorder show good adherence to self-report assessments administered daily for the duration of the study periods evaluated. UR - https://formative.jmir.org/2021/1/e13770 UR - http://dx.doi.org/10.2196/13770 UR - http://www.ncbi.nlm.nih.gov/pubmed/33416510 ID - info:doi/10.2196/13770 ER - TY - JOUR AU - Kongshaug, Nina AU - Skolbekken, John-Arne AU - Faxvaag, Arild AU - Hofsli, Eva PY - 2021/1/6 TI - Cancer Patients? Perceived Value of a Smartphone App to Enhance the Safety of Home-Based Chemotherapy: Feasibility Study JO - JMIR Form Res SP - e20636 VL - 5 IS - 1 KW - mhealth KW - mobile app KW - smartphone app KW - oral chemotherapy KW - patient safety KW - home-based cancer treatment N2 - Background: Oral anticancer therapies can be self-administered by patients outside the hospital setting, which poses challenges of adherence to a drug plan and monitoring of side effects. Modern information technology may be developed and implemented to address these pertinent issues. Objective: The aim of this study was to explore how a smartphone app developed through a stepwise, iterative process can help patients using oral chemotherapy to take their drug, and to report adherence and side effects in a reliable and verifiable manner. Methods: Fourteen patients starting capecitabine treatment were included in this study and used the smartphone app in addition to regular follow up of capecitabine treatment. Nine of these patients fulfilled the treatment plan and were interviewed based on a semistructured interview guide and the System Usability Scale (SUS). In addition, two focus groups were completed with 7 oncologists and 7 oncology nurses, respectively. Interview data were analyzed in accordance with the principles of systematic text condensation. Features of the app were also assessed. Results: The smartphone app provided the patients with a feeling of reassurance regarding correct adherence of their oral chemotherapy treatment. They used the app as a memory tool about their treatment and possible serious side effects, as well as for treatment education. Patients expressed concerns about using the app to report side effects that were not considered to be obviously serious, fearing overreporting. The health personnel expressed an overall positive attitude to integrate this new tool in their everyday work. Conclusions: Patients on oral chemotherapy treatment at home felt safe and found the app to be helpful. The app promoted learning about their treatment and made the patients more independent of the cancer clinic, reducing the need for the clinic?s limited resources for follow up of patients on oral anticancer medications. UR - https://formative.jmir.org/2021/1/e20636 UR - http://dx.doi.org/10.2196/20636 UR - http://www.ncbi.nlm.nih.gov/pubmed/33404505 ID - info:doi/10.2196/20636 ER - TY - JOUR AU - Karystianis, George AU - Simpson, Annabeth AU - Adily, Armita AU - Schofield, Peter AU - Greenberg, David AU - Wand, Handan AU - Nenadic, Goran AU - Butler, Tony PY - 2020/12/24 TI - Prevalence of Mental Illnesses in Domestic Violence Police Records: Text Mining Study JO - J Med Internet Res SP - e23725 VL - 22 IS - 12 KW - text mining KW - mental illnesses KW - domestic violence KW - police data KW - trend analysis N2 - Background: The New South Wales Police Force (NSWPF) records details of significant numbers of domestic violence (DV) events they attend each year as both structured quantitative data and unstructured free text. Accessing information contained in the free text such as the victim?s and persons of interest (POI's) mental health status could be useful in the better management of DV events attended by the police and thus improve health, justice, and social outcomes. Objective: The aim of this study is to present the prevalence of extracted mental illness mentions for POIs and victims in police-recorded DV events. Methods: We applied a knowledge-driven text mining method to recognize mental illness mentions for victims and POIs from police-recorded DV events. Results: In 416,441 police-recorded DV events with single POIs and single victims, we identified 64,587 events (15.51%) with at least one mental illness mention versus 4295 (1.03%) recorded in the structured fixed fields. Two-thirds (67,582/85,880, 78.69%) of mental illnesses were associated with POIs versus 21.30% (18,298/85,880) with victims; depression was the most common condition in both victims (2822/12,589, 22.42%) and POIs (7496/39,269, 19.01%). Mental illnesses were most common among POIs aged 0-14 years (623/1612, 38.65%) and in victims aged over 65 years (1227/22,873, 5.36%). Conclusions: A wealth of mental illness information exists within police-recorded DV events that can be extracted using text mining. The results showed mood-related illnesses were the most common in both victims and POIs. Further investigation is required to determine the reliability of the mental illness mentions against sources of diagnostic information. UR - http://www.jmir.org/2020/12/e23725/ UR - http://dx.doi.org/10.2196/23725 UR - http://www.ncbi.nlm.nih.gov/pubmed/33361056 ID - info:doi/10.2196/23725 ER - TY - JOUR AU - Maassen, Oliver AU - Fritsch, Sebastian AU - Gantner, Julia AU - Deffge, Saskia AU - Kunze, Julian AU - Marx, Gernot AU - Bickenbach, Johannes PY - 2020/12/21 TI - Future Mobile Device Usage, Requirements, and Expectations of Physicians in German University Hospitals: Web-Based Survey JO - J Med Internet Res SP - e23955 VL - 22 IS - 12 KW - mobile devices KW - mobile applications KW - apps KW - mHealth KW - smartphones KW - tablets KW - device usage KW - requirements KW - expectations KW - hospital KW - working equipment N2 - Background: The use of mobile devices in hospital care constantly increases. However, smartphones and tablets have not yet widely become official working equipment in medical care. Meanwhile, the parallel use of private and official devices in hospitals is common. Medical staff use smartphones and tablets in a growing number of ways. This mixture of devices and how they can be used is a challenge to persons in charge of defining strategies and rules for the usage of mobile devices in hospital care. Objective: Therefore, we aimed to examine the status quo of physicians? mobile device usage and concrete requirements and their future expectations of how mobile devices can be used. Methods: We performed a web-based survey among physicians in 8 German university hospitals from June to October 2019. The online survey was forwarded by hospital management personnel to physicians from all departments involved in patient care at the local sites. Results: A total of 303 physicians from almost all medical fields and work experience levels completed the web-based survey. The majority regarded a tablet (211/303, 69.6%) and a smartphone (177/303, 58.4%) as the ideal devices for their operational area. In practice, physicians are still predominantly using desktop computers during their worktime (mean percentage of worktime spent on a desktop computer: 56.8%; smartphone: 12.8%; tablet: 3.6%). Today, physicians use mobile devices for basic tasks such as oral (171/303, 56.4%) and written (118/303, 38.9%) communication and to look up dosages, diagnoses, and guidelines (194/303, 64.0%). Respondents are also willing to use mobile devices for more advanced applications such as an early warning system (224/303, 73.9%) and mobile electronic health records (211/303, 69.6%). We found a significant association between the technical affinity and the preference of device in medical care (?s2=53.84, P<.001) showing that with increasing self-reported technical affinity, the preference for smartphones and tablets increases compared to desktop computers. Conclusions: Physicians in German university hospitals have a high technical affinity and positive attitude toward the widespread implementation of mobile devices in clinical care. They are willing to use official mobile devices in clinical practice for basic and advanced mobile health uses. Thus, the reason for the low usage is not a lack of willingness of the potential users. Challenges that hinder the wider adoption of mobile devices might be regulatory, financial and organizational issues, and missing interoperability standards of clinical information systems, but also a shortage of areas of application in which workflows are adapted for (small) mobile devices. UR - http://www.jmir.org/2020/12/e23955/ UR - http://dx.doi.org/10.2196/23955 UR - http://www.ncbi.nlm.nih.gov/pubmed/33346735 ID - info:doi/10.2196/23955 ER - TY - JOUR AU - Chen, Alan I-Hsuan AU - Chu, Chi-Hsiang AU - Lin, Jen-Tai AU - Tsai, Jeng-Yu AU - Yu, Chia-Cheng AU - Sridhar, Narasimha Ashwin AU - Sooriakumaran, Prasanna AU - Loureiro, V. Rui C. AU - Chand, Manish PY - 2020/12/18 TI - Prostate Cancer Risk Calculator Apps in a Taiwanese Population Cohort: Validation Study JO - J Med Internet Res SP - e16322 VL - 22 IS - 12 KW - diagnosis KW - mHealth KW - mobile apps KW - prostate cancer KW - prostate-specific antigen KW - risk calculator N2 - Background: Mobile health apps have emerged as useful tools for patients and clinicians alike, sharing health information or assisting in clinical decision-making. Prostate cancer (PCa) risk calculator mobile apps have been introduced to assess risks of PCa and high-grade PCa (Gleason score ?7). The Rotterdam Prostate Cancer Risk Calculator and Coral?Prostate Cancer Nomogram Calculator apps were developed from the 2 most-studied PCa risk calculators, the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the North American Prostate Cancer Prevention Trial (PCPT) risk calculators, respectively. A systematic review has indicated that the Rotterdam and Coral apps perform best during the prebiopsy stage. However, the epidemiology of PCa varies among different populations, and therefore, the applicability of these apps in a Taiwanese population needs to be evaluated. This study is the first to validate the PCa risk calculator apps with both biopsy and prostatectomy cohorts in Taiwan. Objective: The study?s objective is to validate the PCa risk calculator apps using a Taiwanese cohort of patients. Additionally, we aim to utilize postprostatectomy pathology outcomes to assess the accuracy of both apps with regard to high-grade PCa. Methods: All male patients who had undergone transrectal ultrasound prostate biopsies in a single Taiwanese tertiary medical center from 2012 to 2018 were identified retrospectively. The probabilities of PCa and high-grade PCa were calculated utilizing the Rotterdam and Coral apps, and compared with biopsy and prostatectomy results. Calibration was graphically evaluated with the Hosmer-Lemeshow goodness-of-fit test. Discrimination was analyzed utilizing the area under the receiver operating characteristic curve (AUC). Decision curve analysis was performed for clinical utility. Results: Of 1134 patients, 246 (21.7%) were diagnosed with PCa; of these 246 patients, 155 (63%) had high-grade PCa, according to the biopsy results. After confirmation with prostatectomy pathological outcomes, 47.2% (25/53) of patients were upgraded to high-grade PCa, and 1.2% (1/84) of patients were downgraded to low-grade PCa. Only the Rotterdam app demonstrated good calibration for detecting high-grade PCa in the biopsy cohort. The discriminative ability for both PCa (AUC: 0.779 vs 0.687; DeLong?s method: P<.001) and high-grade PCa (AUC: 0.862 vs 0.758; P<.001) was significantly better for the Rotterdam app. In the prostatectomy cohort, there was no significant difference between both apps (AUC: 0.857 vs 0.777; P=.128). Conclusions: The Rotterdam and Coral apps can be applied to the Taiwanese cohort with accuracy. The Rotterdam app outperformed the Coral app in the prediction of PCa and high-grade PCa. Despite the small size of the prostatectomy cohort, both apps, to some extent, demonstrated the predictive capacity for true high-grade PCa, confirmed by the whole prostate specimen. Following our external validation, the Rotterdam app might be a good alternative to help detect PCa and high-grade PCa for Taiwanese men. UR - http://www.jmir.org/2020/12/e16322/ UR - http://dx.doi.org/10.2196/16322 UR - http://www.ncbi.nlm.nih.gov/pubmed/33337340 ID - info:doi/10.2196/16322 ER - TY - JOUR AU - Kellett, Stephen AU - Easton, Katherine AU - Cooper, Martin AU - Millings, Abigail AU - Simmonds-Buckley, Melanie AU - Parry, Glenys PY - 2020/12/18 TI - Evaluation of a Mobile App to Enhance Relational Awareness and Change During Cognitive Analytic Therapy: Mixed Methods Case Series JO - JMIR Ment Health SP - e19888 VL - 7 IS - 12 KW - cognitive analytic therapy KW - case series KW - effectiveness KW - outcome KW - eHealth KW - app KW - awareness KW - mHealth KW - innovation KW - therapy N2 - Background: There has been a lack of technological innovation regarding improving the delivery of integrative psychotherapies. This project sought to evaluate an app designed to replace previous paper-based methods supporting relational awareness and change during cognitive analytic therapy (CAT). Objective: We aimed to assess patients? and therapists? experience of using the technology (ie, the ?CAT-App?) and to evaluate the relationship between app usage and clinical outcome. Methods: The design was a mixed methods case series. Patients completed the Clinical Outcomes in Routine Evaluation-Outcome Measure pre- and post-CAT. Mood data plus the frequency and effectiveness of relational awareness and change were collected via the app. Therapists and patients were interviewed about their experiences using the app. Results: Ten patients (treated by 3 therapists) were enrolled; seven completed treatment and 4 had a reliable improvement in their mental health. App usage and mood change did not differ according to clinical outcome, but there was a statistically significant difference in app usage between completers and dropouts. The qualitative themes described by the therapists were (1) the challenge of incorporating the technology into their clinical practice and (2) the barriers and benefits of the technology. Clients? themes were (1) data protection, (2) motivation and engagement, and (3) restrictions versus flexibility. Conclusions: The CAT-App is capable of supporting relational awareness and change and is an upgrade on older, paper-based formats. Further clinical evaluation is required. UR - http://mental.jmir.org/2020/12/e19888/ UR - http://dx.doi.org/10.2196/19888 UR - http://www.ncbi.nlm.nih.gov/pubmed/33337342 ID - info:doi/10.2196/19888 ER - TY - JOUR AU - Bashi, Nazli AU - Varnfield, Marlien AU - Karunanithi, Mohanraj PY - 2020/12/18 TI - A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach JO - JMIR Form Res SP - e17542 VL - 4 IS - 12 KW - mobile health KW - mHealth KW - mobile health apps KW - smartphone KW - mobile phone KW - self-management KW - patient education KW - cardiovascular disease KW - acute coronary syndrome N2 - Background: Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. Objective: The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. Methods: The content of Mobile Technology?Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists? survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. Results: The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients? data and provide support. Conclusions: The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS. UR - http://formative.jmir.org/2020/12/e17542/ UR - http://dx.doi.org/10.2196/17542 UR - http://www.ncbi.nlm.nih.gov/pubmed/33337339 ID - info:doi/10.2196/17542 ER - TY - JOUR AU - Li, Wen-Yi AU - Chiu, Fu-Chun AU - Zeng, Jyun-Kai AU - Li, Yao-Wei AU - Huang, Su-Hua AU - Yeh, Hui-Chin AU - Cheng, Bor-Wen AU - Yang, Feng-Jung PY - 2020/12/15 TI - Mobile Health App With Social Media to Support Self-Management for Patients With Chronic Kidney Disease: Prospective Randomized Controlled Study JO - J Med Internet Res SP - e19452 VL - 22 IS - 12 KW - chronic kidney disease KW - self-management KW - self-efficacy KW - quality of life KW - health management platform KW - wearable device N2 - Background: Chronic kidney disease (CKD) is a global health burden. Self-management plays a key role in improving modifiable risk factors. Objective: The aim of this study was to evaluate the effectiveness of wearable devices, a health management platform, and social media at improving the self-management of CKD, with the goal of establishing a new self-management intervention model. Methods: In a 90-day prospective experimental study, a total of 60 people with CKD at stages 1-4 were enrolled in the intervention group (n=30) and control group (n=30). All participants were provided with wearable devices that collected exercise-related data. All participants maintained dietary diaries using a smartphone app. All dietary and exercise information was then uploaded to a health management platform. Suggestions about diet and exercise were provided to the intervention group only, and a social media group was created to inspire the participants in the intervention group. Participants? self-efficacy and self-management questionnaire scores, Kidney Disease Quality of Life scores, body composition, and laboratory examinations before and after the intervention were compared between the intervention and control groups. Results: A total of 49 participants completed the study (25 in the intervention group and 24 in the control group); 74% of the participants were men and the mean age was 51.22 years. There were no differences in measured baseline characteristics between the groups except for educational background. After the intervention, the intervention group showed significantly higher scores for self-efficacy (mean 171.28, SD 22.92 vs mean 142.21, SD 26.36; P<.001) and self-management (mean 54.16, SD 6.71 vs mean 47.58, SD 6.42; P=.001). Kidney Disease Quality of Life scores were also higher in the intervention group (mean 293.16, SD 34.21 vs mean 276.37, SD 32.21; P=.02). The number of steps per day increased in the intervention group (9768.56 in week 1 and 11,389.12 in week 12). The estimated glomerular filtration rate (eGFR) of the intervention group was higher than that of the control group (mean 72.47, SD 24.28 vs mean 59.69, SD 22.25 mL/min/1.73m2; P=.03) and the decline in eGFR was significantly slower in the intervention group (?0.56 vs ?4.58 mL/min/1.73m2). There were no differences in body composition between groups postintervention. Conclusions: The use of wearable devices, a health management platform, and social media support not only strengthened self-efficacy and self-management but also improved quality of life and a slower eGFR decline in people with CKD at stages 1-4. These results outline a new self-management model to promote healthy lifestyle behaviors for patients with CKD. Trial Registration: ClinicalTrials.gov NCT04617431; https://www.clinicaltrials.gov/ct2/show/NCT04617431 UR - http://www.jmir.org/2020/12/e19452/ UR - http://dx.doi.org/10.2196/19452 UR - http://www.ncbi.nlm.nih.gov/pubmed/33320101 ID - info:doi/10.2196/19452 ER - TY - JOUR AU - Huang, Yong Zhi AU - Wang, Yujie AU - Wang, Linling PY - 2020/12/9 TI - ISO/IEEE 11073 Treadmill Interoperability Framework and its Test Method: Design and Implementation JO - JMIR Med Inform SP - e22000 VL - 8 IS - 12 KW - ISO/IEEE 11073-PHD KW - treadmill KW - standard frame model KW - test standard KW - sports health data N2 - Background: Regular physical activity is proven to help prevent and treat noncommunicable diseases such as heart disease, stroke, diabetes, and breast and colon cancer. The exercise data generated by health and fitness devices (eg, treadmill, exercise bike) are very important for health management service providers to develop personalized training programs. However, at present, there is little research on a unified interoperability framework in the health and fitness domain, and there are not many solutions; besides, the privatized treadmill data transmission scheme is not conducive to data integration and analysis. Objective: This article will expand the IEEE 11073-PHD standard protocol family, develop standards for health and fitness device (using treadmill as an example) based on the latest version of the 11073-20601 optimized exchange protocol, and design protocol standards compliance testing process and inspection software, which can automatically detect whether the instantiated object of the treadmill meets the standard. Methods: The study includes the following steps: (1) Map the data transmitted by the treadmill to the 11073-PHD objects; (2) Construct a programming language structure corresponding to the 11073-PHD application protocol data unit (APDU) to complete the coding and decoding part of the test software; and (3) Transmit the instantiated simulated treadmill data to the gateway test software through transmission control protocol for standard compliance testing. Results: According to the characteristics of the treadmill, a data exchange framework conforming to 11073-PHD is constructed, and a corresponding testing framework is developed; a treadmill agent simulation is implemented, and the interoperability test is performed. Through the designed testing process, the corresponding testing software was developed to complete the standard compliance testing of the treadmill. Conclusions: The extended research of IEEE 11073-PHD in the field of health and fitness provides a potential new idea for the data transmission framework of sports equipment such as treadmills, which may also provide some help for the development of sports health equipment interoperability standards. UR - http://medinform.jmir.org/2020/12/e22000/ UR - http://dx.doi.org/10.2196/22000 UR - http://www.ncbi.nlm.nih.gov/pubmed/33295293 ID - info:doi/10.2196/22000 ER - TY - JOUR AU - Wang, Jian AU - Li, Mei AU - Zhu, Daqiao AU - Cao, Yang PY - 2020/12/8 TI - Smartphone Overuse and Visual Impairment in Children and Young Adults: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e21923 VL - 22 IS - 12 KW - visual impairment KW - smartphone KW - mobile phone KW - overuse KW - child KW - young adult KW - systematic review KW - meta-analysis N2 - Background: Smartphone overuse has been cited as a potentially modifiable risk factor that can result in visual impairment. However, reported associations between smartphone overuse and visual impairment have been inconsistent. Objective: The aim of this systematic review was to determine the association between smartphone overuse and visual impairment, including myopia, blurred vision, and poor vision, in children and young adults. Methods: We conducted a systematic search in the Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, and ScienceDirect databases since the beginning of the databases up to June 2020. Fourteen eligible studies (10 cross-sectional studies and 4 controlled trials) were identified, which included a total of 27,110 subjects with a mean age ranging from 9.5 to 26.0 years. We used a random-effects model for meta-analysis of the 10 cross-sectional studies (26,962 subjects) and a fixed-effects model for meta-analysis of the 4 controlled trials (148 subjects) to combine odds ratios (ORs) and effect sizes (ES). The I2 statistic was used to assess heterogeneity. Results: A pooled OR of 1.05 (95% CI 0.98-1.13, P=.16) was obtained from the cross-sectional studies, suggesting that smartphone overuse is not significantly associated with myopia, poor vision, or blurred vision; however, these visual impairments together were more apparent in children (OR 1.06, 95% CI 0.99-1.14, P=.09) than in young adults (OR 0.91, 95% CI 0.57-1.46,P=.71). For the 4 controlled trials, the smartphone overuse groups showed worse visual function scores compared with the reduced-use groups. The pooled ES was 0.76 (95% CI 0.53-0.99), which was statistically significant (P<.001). Conclusions: Longer smartphone use may increase the likelihood of ocular symptoms, including myopia, asthenopia, and ocular surface disease, especially in children. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms. Further research on the patterns of use, with longer follow up on the longitudinal associations, will help to inform detailed guidelines and recommendations for smartphone use in children and young adults. UR - https://www.jmir.org/2020/12/e21923 UR - http://dx.doi.org/10.2196/21923 UR - http://www.ncbi.nlm.nih.gov/pubmed/33289673 ID - info:doi/10.2196/21923 ER - TY - JOUR AU - Laranjo, Liliana AU - Quiroz, C. Juan AU - Tong, Ly Huong AU - Arevalo Bazalar, Maria AU - Coiera, Enrico PY - 2020/12/8 TI - A Mobile Social Networking App for Weight Management and Physical Activity Promotion: Results From an Experimental Mixed Methods Study JO - J Med Internet Res SP - e19991 VL - 22 IS - 12 KW - mobile apps KW - fitness trackers KW - exercise KW - social networking KW - body weight maintenance KW - mobile phone N2 - Background: Smartphone apps, fitness trackers, and online social networks have shown promise in weight management and physical activity interventions. However, there are knowledge gaps in identifying the most effective and engaging interventions and intervention features preferred by their users. Objective: This 6-month pilot study on a social networking mobile app connected to wireless weight and activity tracking devices has 2 main aims: to evaluate changes in BMI, weight, and physical activity levels in users from different BMI categories and to assess user perspectives on the intervention, particularly on social comparison and automated self-monitoring and feedback features. Methods: This was a mixed methods study involving a one-arm, pre-post quasi-experimental pilot with postintervention interviews and focus groups. Healthy young adults used a social networking mobile app intervention integrated with wireless tracking devices (a weight scale and a physical activity tracker) for 6 months. Quantitative results were analyzed separately for 2 groups?underweight-normal and overweight-obese BMI?using t tests and Wilcoxon sum rank, Wilcoxon signed rank, and chi-square tests. Weekly BMI change in participants was explored using linear mixed effects analysis. Interviews and focus groups were analyzed inductively using thematic analysis. Results: In total, 55 participants were recruited (mean age of 23.6, SD 4.6 years; 28 women) and 45 returned for the final session (n=45, 82% retention rate). There were no differences in BMI from baseline to postintervention (6 months) and between the 2 BMI groups. However, at 4 weeks, participants? BMI decreased by 0.34 kg/m2 (P<.001), with a loss of 0.86 kg/m2 in the overweight-obese group (P=.01). Participants in the overweight-obese group used the app significantly less compared with individuals in the underweight-normal BMI group, as they mentioned negative feelings and demotivation from social comparison, particularly from upward comparison with fitter people. Participants in the underweight-normal BMI group were avid users of the app?s self-monitoring and feedback (P=.02) and social (P=.04) features compared with those in the overweight-obese group, and they significantly increased their daily step count over the 6-month study duration by an average of 2292 steps (95% CI 898-3370; P<.001). Most participants mentioned a desire for a more personalized intervention. Conclusions: This study shows the effects of different interventions on participants from higher and lower BMI groups and different perspectives regarding the intervention, particularly with respect to its social features. Participants in the overweight-obese group did not sustain a short-term decrease in their BMI and mentioned negative emotions from app use, while participants in the underweight-normal BMI group used the app more frequently and significantly increased their daily step count. These differences highlight the importance of intervention personalization. Future research should explore the role of personalized features to help overcome personal barriers and better match individual preferences and needs. UR - http://www.jmir.org/2020/12/e19991/ UR - http://dx.doi.org/10.2196/19991 UR - http://www.ncbi.nlm.nih.gov/pubmed/33289670 ID - info:doi/10.2196/19991 ER - TY - JOUR AU - Steinberg, M. Dori AU - Kay, C. Melissa AU - Svetkey, P. Laura AU - Askew, Sandy AU - Christy, Jacob AU - Burroughs, Jasmine AU - Ahmed, Hira AU - Bennett, G. Gary PY - 2020/12/7 TI - Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial JO - JMIR Mhealth Uhealth SP - e17536 VL - 8 IS - 12 KW - hypertension KW - DASH dietary pattern KW - digital health KW - nutrition KW - women?s health KW - mHealth N2 - Background: Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed. Objective: This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension. Methods: We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure. Results: The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: ?2.8 mmHg, 95% CI ?1.8 to 7.4; P=.23) and diastolic (mean difference: ?3.6 mmHg, 95% CI ?0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals. Conclusions: A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. Trial Registration: ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472 UR - https://mhealth.jmir.org/2020/12/e17536 UR - http://dx.doi.org/10.2196/17536 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284116 ID - info:doi/10.2196/17536 ER - TY - JOUR AU - Jahan, Yasmin AU - Rahman, Moshiur Md AU - Faruque, G. Abu S. AU - Chisti, Jobayer Mohammod AU - Kazawa, Kana AU - Matsuyama, Ryota AU - Moriyama, Michiko PY - 2020/12/7 TI - Awareness Development and Usage of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Randomized Controlled Trial JO - J Med Internet Res SP - e19137 VL - 22 IS - 12 KW - mobile health KW - hypertension KW - behavior changes KW - awareness development KW - lifestyle KW - Bangladesh N2 - Background: Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management. Objective: The study aimed to develop awareness and knowledge in order to enhance lifestyle behavior changes among individuals with HTN in a rural community of Bangladesh by using health education and mobile health (mHealth) technology (SMS text messaging). Methods: A prospective randomized 5-month intervention, open-label (1:1), parallel-group trial was implemented among the individuals with HTN aged 35 years or older. Both men and women were included. Between August 2018 and July 2019, we enrolled 420 participants, selected from a tertiary level health facility and through door-to-door visits by community health workers. After block randomization, they were assigned to either the intervention group (received SMS text messaging and health education; n=209) or the control group (received only health education; n=211). The primary outcome was the evaluation of self-reported behavior changes (salt intake, fruits and vegetables intake, physical activity, and blood pressure [BP], and body weight monitoring behaviors). The secondary outcomes were measurements of actual salt intake and dietary salt excretion, blood glucose level, BP values, and quality of life (QOL). Results: During the study period, a total of 8 participants were dropped, and the completion rate was 98.0% (412/420). The adherence rates were significantly higher (9%) among the control group regarding salt intake (P=.04) and physical activity behaviors (P<.03), and little differences were observed in other behaviors. In primary outcome, the focused behavior, salt intake less than 6 g/day, showed significant chronological improvement in both groups (P<.001). The fruits intake behavior steadily improved in both groups (P<.001). Participants in both groups had a custom of vegetables intake everyday/week. Physical activity suddenly increased and continued until the study end (P<.001 in both groups). Both BP and body weight monitoring status increased from baseline to 1 month but decreased afterward (P<.001). In case of secondary outcomes, significant chronological changes were observed in food salt concentration and urinary salinity between the groups (P=.01). The mean systolic BP and diastolic BP significantly chronologically decreased in both groups (systolic BP, P=.04; diastolic BP, P=.02.P<.05). All of these supported self-reported behavior changes. For the QOL, both groups showed significant improvement over the study periods (P<.001). Conclusions: Based on these results, we suggest that face-to-face health education requires integration of home health care provision and more relevant and timely interactive SMS text messages to increase the effectiveness of the intervention. Besides, community awareness can be created to encourage ?low-salt culture? and educate family members. Trial Registration: Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104; https://clinicaltrials.gov/ct2/show/NCT03614104 and UMIN-CTR R000033736; https://tinyurl.com/y48yfcoo International Registered Report Identifier (IRRID): RR2-10.2196/15523 UR - https://www.jmir.org/2020/12/e19137 UR - http://dx.doi.org/10.2196/19137 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284129 ID - info:doi/10.2196/19137 ER - TY - JOUR AU - Van Asbroeck, Stephanie AU - Matthys, Christophe PY - 2020/12/7 TI - Use of Different Food Image Recognition Platforms in Dietary Assessment: Comparison Study JO - JMIR Form Res SP - e15602 VL - 4 IS - 12 KW - image recognition KW - dietary assessment KW - automated food recognition KW - accuracy N2 - Background: In the domain of dietary assessment, there has been an increasing amount of criticism of memory-based techniques such as food frequency questionnaires or 24 hour recalls. One alternative is logging pictures of consumed food followed by an automatic image recognition analysis that provides information on type and amount of food in the picture. However, it is currently unknown how well commercial image recognition platforms perform and whether they could indeed be used for dietary assessment. Objective: This is a comparative performance study of commercial image recognition platforms. Methods: A variety of foods and beverages were photographed in a range of standardized settings. All pictures (n=185) were uploaded to selected recognition platforms (n=7), and estimates were saved. Accuracy was determined along with totality of the estimate in the case of multiple component dishes. Results: Top 1 accuracies ranged from 63% for the application programming interface (API) of the Calorie Mama app to 9% for the Google Vision API. None of the platforms were capable of estimating the amount of food. These results demonstrate that certain platforms perform poorly while others perform decently. Conclusions: Important obstacles to the accurate estimation of food quantity need to be overcome before these commercial platforms can be used as a real alternative for traditional dietary assessment methods. UR - https://formative.jmir.org/2020/12/e15602 UR - http://dx.doi.org/10.2196/15602 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284118 ID - info:doi/10.2196/15602 ER - TY - JOUR AU - Grau-Corral, Inmaculada AU - Gascon, Pau AU - Grajales III, J. Francisco AU - Kostov, Belchin AU - Sisó Almirall, Antoni PY - 2020/12/3 TI - Availability of Spanish-Language Medical Apps in Google Play and the App Store: Retrospective Descriptive Analysis Using Google Tools JO - JMIR Mhealth Uhealth SP - e17139 VL - 8 IS - 12 KW - apps KW - mobile health KW - mHealth assessment KW - evaluation studies KW - health apps KW - ratings KW - mobile apps, Spanish apps KW - patient apps KW - Google Advanced Search KW - mobile phone N2 - Background: The number of medical and health apps in the App Store and Google Play repositories has been increasing in the recent years, and most of these apps are in English. However, little is known about the domain of Spanish health apps and their evolution. Objective: The aim of this study was to perform a retrospective descriptive analysis of medical apps for patients in the Spanish language by using Google search tools over a 5-year period and to compare the results by using a reproducible methodology to obtain a better knowledge of the medical apps available in the Spanish Language. Methods: Over a 5-year period, medical apps were catalogued using a Google-based methodology. Keywords of the first 14 categories of the International Classification of Diseases, Tenth Revision, were selected, and in December of each year, searches of the URLs of Google Play and the App Store were conducted using Google Advanced Search. The first 10 results were taken, and apps meeting the inclusion criteria were selected and rated with the iSYScore method. Results: Out of a sample of 1358 apps, 136 met the inclusion criteria. The 3 main categories of the medical apps were in the fields of endocrinology (diabetes), respiratory (chronic obstructive pulmonary disease, asthma, and allergies), and neurology (multiple sclerosis, Parkinson disease, and Alzheimer disease). Few apps were maintained over the 5 years. Only 10 of the 136 apps were maintained for 3 years or more. There was a large number of original apps in other languages that were translated into Spanish (56/136, 41.2%). In the last year of the study, the main reason (73/280, 26.1%) for discarding an app was the date of the last update. Conclusions: The market of Spanish apps is poor; only few apps have appeared repeatedly over 5 years. Differences were found with the international market in terms of apps related to mental health, heart and circulatory system, and cancer, and coincidences were found in the relevance of apps for diabetes control. UR - https://mhealth.jmir.org/2020/12/e17139 UR - http://dx.doi.org/10.2196/17139 UR - http://www.ncbi.nlm.nih.gov/pubmed/33270031 ID - info:doi/10.2196/17139 ER - TY - JOUR AU - Wang, Chi-Te AU - Han, Ji-Yan AU - Fang, Shih-Hau AU - Lai, Ying-Hui PY - 2020/12/3 TI - Ambulatory Phonation Monitoring With Wireless Microphones Based on the Speech Energy Envelope: Algorithm Development and Validation JO - JMIR Mhealth Uhealth SP - e16746 VL - 8 IS - 12 KW - voice disorder KW - speech envelope KW - phonation habits KW - background noise KW - noise reduction KW - adaptive threshold KW - dosimetry KW - phonotrauma N2 - Background: Voice disorders mainly result from chronic overuse or abuse, particularly in occupational voice users such as teachers. Previous studies proposed a contact microphone attached to the anterior neck for ambulatory voice monitoring; however, the inconvenience associated with taping and wiring, along with the lack of real-time processing, has limited its clinical application. Objective: This study aims to (1) propose an automatic speech detection system using wireless microphones for real-time ambulatory voice monitoring, (2) examine the detection accuracy under controlled environment and noisy conditions, and (3) report the results of the phonation ratio in practical scenarios. Methods: We designed an adaptive threshold function to detect the presence of speech based on the energy envelope. We invited 10 teachers to participate in this study and tested the performance of the proposed automatic speech detection system regarding detection accuracy and phonation ratio. Moreover, we investigated whether the unsupervised noise reduction algorithm (ie, log minimum mean square error) can overcome the influence of environmental noise in the proposed system. Results: The proposed system exhibited an average accuracy of speech detection of 89.9%, ranging from 81.0% (67,357/83,157 frames) to 95.0% (199,201/209,685 frames). Subsequent analyses revealed a phonation ratio between 44.0% (33,019/75,044 frames) and 78.0% (68,785/88,186 frames) during teaching sessions of 40-60 minutes; the durations of most of the phonation segments were less than 10 seconds. The presence of background noise reduced the accuracy of the automatic speech detection system, and an adjuvant noise reduction function could effectively improve the accuracy, especially under stable noise conditions. Conclusions: This study demonstrated an average detection accuracy of 89.9% in the proposed automatic speech detection system with wireless microphones. The preliminary results for the phonation ratio were comparable to those of previous studies. Although the wireless microphones are susceptible to background noise, an additional noise reduction function can alleviate this limitation. These results indicate that the proposed system can be applied for ambulatory voice monitoring in occupational voice users. UR - https://mhealth.jmir.org/2020/12/e16746 UR - http://dx.doi.org/10.2196/16746 UR - http://www.ncbi.nlm.nih.gov/pubmed/33270033 ID - info:doi/10.2196/16746 ER - TY - JOUR AU - Faisal, Sadaf AU - Ivo, Jessica AU - McDougall, Aidan AU - Patel, Tejal PY - 2020/12/1 TI - Stakeholder Feedback of Electronic Medication Adherence Products: Qualitative Analysis JO - J Med Internet Res SP - e18074 VL - 22 IS - 12 KW - medication nonadherence KW - technology KW - aged KW - patient preferences KW - eHealth KW - qualitative research KW - adherence N2 - Background: Medication management among older adults continues to be a challenge, and innovative electronic medication adherence products have been developed to address this need. Objective: The aim of this study is to examine user experience with electronic medication adherence products, with particular emphasis on features, usefulness, and preferences. Methods: Older adults, caregivers, and health care providers tested the usability of 22 electronic medication adherence products. After testing 5 products, participants were invited to participate in a one-on-one interview to investigate their perceptions and experiences with the features, usefulness, and preference for electronic medication adherence products tested. The interviews were audio recorded, transcribed, and analyzed using exploratory inductive coding to generate themes. The first 13 interviews were independently coded by 2 researchers. The percentage agreement and Cohen kappa after analyzing those interviews were 79% and 0.79, respectively. A single researcher analyzed the remaining interviews. Results: Of the 37 participants, 21 (57%) were older adults, 5 (14%) were caregivers, and 11 (30%) were health care providers. The themes and subthemes generated from the qualitative analysis included product factors (subthemes: simplicity and product features, including availability and usability of alarms, portability, restricted access to medications, and storage capacity) and user factors (subthemes: sentiment, affordability, physical and cognitive capability, and technology literacy and learnability). Conclusions: Electronic medication adherence products have the potential to enable independent medication management in older adults. The choice of a particular product should be made after considering individual preferences for product features, affordability, and the sentiment of the users. Older adults, caregivers, and health care providers prefer electronic medication adherence products that are simple to set up and use, are portable, have easy-to-access medication compartments, are secure, and have adequate storage capacity. UR - https://www.jmir.org/2020/12/e18074 UR - http://dx.doi.org/10.2196/18074 UR - http://www.ncbi.nlm.nih.gov/pubmed/33258778 ID - info:doi/10.2196/18074 ER - TY - JOUR AU - Dittrich, Florian AU - Back, Alexander David AU - Harren, Katharina Anna AU - Landgraeber, Stefan AU - Reinecke, Felix AU - Serong, Sebastian AU - Beck, Sascha PY - 2020/11/30 TI - Smartphone and App Usage in Orthopedics and Trauma Surgery: Survey Study of Physicians Regarding Acceptance, Risks, and Future Prospects in Germany JO - JMIR Form Res SP - e14787 VL - 4 IS - 11 KW - mHealth KW - smartphone KW - communication KW - medicine KW - surveys and questionnaires KW - technology KW - orthopedics KW - trauma surgery N2 - Background: In the course of digitization, smartphones are affecting an increasing number of areas of users? lives, giving them almost ubiquitous access to the internet and other web applications. Mobile health (mHealth) has become an integral part of some areas of patient care. In contrast to other disciplines, routine integration of mobile devices in orthopedics and trauma surgery in Germany is still in its infancy. Objective: This study aimed to investigate physicians? current state of opinion regarding acceptance, future prospects, and risks of medical apps in the field of orthopedics and trauma surgery in Germany. Methods: A web-based survey among orthopedics and trauma surgeons in German university hospitals on the use of medical apps in everyday clinical practice was conducted between September 2018 and February 2019. The survey consisted of 13 open- and closed-ended or multiple-choice questions. A logistic regression analysis was performed to ascertain the effects of interindividual characteristics on the likelihood of participants? app and smartphone usage behavior. Results: A total of 206 physicians participated in the survey. All of the participants (206/206, 100%) owned a smartphone, and 79.1% (159/201) used the device, while 64.7% (130/201) used apps regularly in everyday clinical practice. Medical apps were perceived as beneficial, given their substantial future promise, by 90.1% (181/201) of the participants. However, 62.5% (120/192) of the participants were not satisfied with the current supply of medical apps in app stores. Desired specifications for future apps were ?intuitive usability? (167/201, 83.1%), ?no advertising? (145/201, 72.1%), and ?free apps? (92/201, 45.8%). The attributes ?transparent app development and app sponsoring? (75/201, 37.3%) and the existence of an ?easy-to-understand privacy statement? (50/201, 24.9%) were of minor relevance. The majority of the participants (162/194, 83.5%) considered that future apps in the field of ?medical research? would provide the greatest benefit. The greatest predicted risks were ?data misuse? (147/189, 77.8%), ?usage of untrustworthy apps? (135/189, 71.4%), and ?alienation from patients? (51/189, 27.0%). Increasing age was significantly associated with a reduction in the likelihood of regular smartphone (odds ratio [OR] 0.91, 95% CI 0.86-0.97; P=.002) and app (OR 0.90, 95% CI 0.85-0.96; P=.001) usage, while the medical profession grade had no significant impact on the usage behavior. Conclusions: The study demonstrates that young German doctors in orthopedics and trauma surgery already use smartphones and apps in everyday clinical practice. Medical apps are considered to play an important role in the future. However, a significant discrepancy exists between the supply and demand of mHealth applications, which creates a legal and ethical vacuum with regard to data protection. UR - http://formative.jmir.org/2020/11/e14787/ UR - http://dx.doi.org/10.2196/14787 UR - http://www.ncbi.nlm.nih.gov/pubmed/33252340 ID - info:doi/10.2196/14787 ER - TY - JOUR AU - Nittas, Vasileios AU - Mütsch, Margot AU - Braun, Julia AU - Puhan, Alan Milo PY - 2020/11/27 TI - Self-Monitoring App Preferences for Sun Protection: Discrete Choice Experiment Survey Analysis JO - J Med Internet Res SP - e18889 VL - 22 IS - 11 KW - preventive medicine KW - mHealth KW - telemedicine KW - health informatics KW - health economics KW - preferences KW - sun protection N2 - Background: The availability and use of health apps continues to increase, revolutionizing the way mobile health interventions are delivered. Apps are increasingly used to prevent disease, improve well-being, and promote healthy behavior. On a similar rise is the incidence of skin cancers. Much of the underlying risk can be prevented through behavior change and adequate sun protection. Self-monitoring apps have the potential to facilitate prevention by measuring risk (eg, sun intensity) and encouraging protective behavior (eg, seeking shade). Objective: Our aim was to assess health care consumer preferences for sun protection with a self-monitoring app that tracks the duration and intensity of sun exposure and provides feedback on when and how to protect the skin. Methods: We conducted an unlabeled discrete choice experiment with 8 unique choice tasks, in which participants chose among 2 app alternatives, consisting of 5 preidentified 2-level attributes (self-monitoring method, privacy control, data sharing with health care provides, reminder customizability, and costs) that were the result of a multistep and multistakeholder qualitative approach. Participant preferences, and thus, the relative importance of attributes and their levels were estimated using conditional logit modeling. Analyses consisted of 200 usable surveys, yielding 3196 observations. Results: Our respondents strongly preferred automatic over manually operated self-monitoring (odds ratio [OR] 2.37, 95% CI 2.06-2.72) and no cost over a single payment of 3 Swiss francs (OR 1.72, 95% CI 1.49-1.99). They also preferred having over not having the option of sharing their data with a health care provider of their choice (OR 1.66, 95% CI 1.40-1.97), repeated over single user consents, whenever app data are shared with commercial thirds (OR 1.57, 95% CI 1.31-1.88), and customizable over noncustomizable reminders (OR 1.30, 95% CI 1.09-1.54). While most participants favored thorough privacy infrastructures, the attribute of privacy control was a relatively weak driver of app choice. The attribute of self-monitoring method significantly interacted with gender and perceived personal usefulness of health apps, suggesting that female gender and lower perceived usefulness are associated with relatively weaker preferences for automatic self-monitoring. Conclusions: Based on the preferences of our respondents, we found that the utility of a self-monitoring sun protection app can be increased if the app is simple and adjustable; requires minimal effort, time, or expense; and has an interoperable design and thorough privacy infrastructure. Similar features might be desirable for preventive health apps in other areas, paving the way for future discrete choice experiments. Nonetheless, to fully understand these preference dynamics, further qualitative or mixed method research on mobile self-monitoring-based sun protection and broader preventive mobile self-monitoring is required. International Registered Report Identifier (IRRID): RR2-10.2196/16087 UR - http://www.jmir.org/2020/11/e18889/ UR - http://dx.doi.org/10.2196/18889 UR - http://www.ncbi.nlm.nih.gov/pubmed/33245282 ID - info:doi/10.2196/18889 ER - TY - JOUR AU - Deng, Ning AU - Chen, Juan AU - Liu, Yiyuan AU - Wei, Shuoshuo AU - Sheng, Leiyi AU - Lu, Rong AU - Wang, Zheyu AU - Zhu, Jiarong AU - An, Jiye AU - Wang, Bei AU - Lin, Hui AU - Wang, Xiuyan AU - Zhou, Yumin AU - Duan, Huilong AU - Ran, Pixin PY - 2020/11/25 TI - Using Mobile Health Technology to Deliver a Community-Based Closed-Loop Management System for Chronic Obstructive Pulmonary Disease Patients in Remote Areas of China: Development and Prospective Observational Study JO - JMIR Mhealth Uhealth SP - e15978 VL - 8 IS - 11 KW - COPD KW - mobile health technology KW - closed-loop care pathway KW - chronic disease management KW - exacerbations N2 - Background: Mobile health (mHealth) technology is an increasingly recognized and effective method for disease management and has the potential to intervene in pulmonary function, exacerbation risk, and psychological status of patients with chronic obstructive pulmonary disease (COPD). Objective: This study aimed to investigate the feasibility of an mHealth-based COPD management system designed for Chinese remote areas with many potential COPD patients but limited medical resources. Methods: The system was implemented based on a tailored closed-loop care pathway that breaks the heavy management tasks into detailed pieces to be quantified and executed by computers. Low-cost COPD evaluation and questionnaire-based psychological intervention are the 2 main characteristics of the pathway. A 6-month prospective observational study at the community level was performed to evaluate the effect of the system. Primary outcomes included changes in peak expiratory flow values, quality of life measured using the COPD assessment test scale, and psychological condition. Acute exacerbations, compliance, and adverse events were also measured during the study. Compliance was defined as the ratio of the actual frequency of self-monitoring records to the prescribed number. Results: A total of 56 patients was enrolled; 39 patients completed the 6-month study. There was no significant difference in the mean peak expiratory flow value before and after the 6-month period (366.1, SD 106.7 versus 313.1, SD 116.6; P=.11). Psychological condition significantly improved after 6 months, especially for depression, as measured using the Patient Health Questionnaire-9 scale (median 6.0, IQR 3.0-9.0 versus median 4.0, IQR 0.0-6.0; P=.001). The COPD assessment test score after 6 months of intervention was also lower than that at the baseline, and the difference was significant (median 4.0, IQR 1.0-6.0 versus median 3.0, IQR 0.0-6.0; P=.003). The median overall compliance was 91.1% (IQR 67%-100%). In terms of acute exacerbation, 110 exacerbations were detected and confirmed by health care providers (per 6 months, median 2.0, IQR 1.0-5.0). Moreover, 72 adverse events occurred during the study, including 1 death, 19 hospitalizations, and 52 clinic visits due to persistent respiratory symptoms. Conclusions: We designed and validated a feasible mHealth-based method to manage COPD in remote Chinese areas with limited medical resources. The proposed closed-loop care pathway was effective at the community level. Proper education and frequent communication with health care providers may encourage patients? acceptance and use of smartphones to support COPD self-management. In addition, WeChat might play an important role in improving patient compliance and psychological distress. Further research might explore the effect of such systems on a larger scale and at a higher evidence level. UR - http://mhealth.jmir.org/2020/11/e15978/ UR - http://dx.doi.org/10.2196/15978 UR - http://www.ncbi.nlm.nih.gov/pubmed/33237036 ID - info:doi/10.2196/15978 ER - TY - JOUR AU - Alhodaib, Ibrahim Hala AU - Antza, Christina AU - Chandan, Singh Joht AU - Hanif, Wasim AU - Sankaranarayanan, Sailesh AU - Paul, Sunjay AU - Sutcliffe, Paul AU - Nirantharakumar, Krishnarajah PY - 2020/11/18 TI - Mobile Clinical Decision Support System for the Management of Diabetic Patients With Kidney Complications in UK Primary Care Settings: Mixed Methods Feasibility Study JO - JMIR Diabetes SP - e19650 VL - 5 IS - 4 KW - eHealth KW - clinical decision support application KW - diabetes mellitus KW - chronic kidney disease KW - feasibility study N2 - Background: Attempts to utilize eHealth in diabetes mellitus (DM) management have shown promising outcomes, mostly targeted at patients; however, few solutions have been designed for health care providers. Objective: The purpose of this study was to conduct a feasibility project developing and evaluating a mobile clinical decision support system (CDSS) tool exclusively for health care providers to manage chronic kidney disease (CKD) in patients with DM. Methods: The design process was based on the 3 key stages of the user-centered design framework. First, an exploratory qualitative study collected the experiences and views of DM specialist nurses regarding the use of mobile apps in clinical practice. Second, a CDSS tool was developed for the management of patients with DM and CKD. Finally, a randomized controlled trial examined the acceptability and impact of the tool. Results: We interviewed 15 DM specialist nurses. DM specialist nurses were not currently using eHealth solutions in their clinical practice, while most nurses were not even aware of existing medical apps. However, they appreciated the potential benefits that apps may bring to their clinical practice. Taking into consideration the needs and preferences of end users, a new mobile CDSS app, ?Diabetes & CKD,? was developed based on guidelines. We recruited 39 junior foundation year 1 doctors (44% male) to evaluate the app. Of them, 44% (17/39) were allocated to the intervention group, and 56% (22/39) were allocated to the control group. There was no significant difference in scores (maximum score=13) assessing the management decisions between the app and paper-based version of the app?s algorithm (intervention group: mean 7.24 points, SD 2.46 points; control group: mean 7.39, SD 2.56; t37=?0.19, P=.85). However, 82% (14/17) of the participants were satisfied with using the app. Conclusions: The findings will guide the design of future CDSS apps for the management of DM, aiming to help health care providers with a personalized approach depending on patients? comorbidities, specifically CKD, in accordance with guidelines. UR - https://diabetes.jmir.org/2020/4/e19650 UR - http://dx.doi.org/10.2196/19650 UR - http://www.ncbi.nlm.nih.gov/pubmed/33206055 ID - info:doi/10.2196/19650 ER - TY - JOUR AU - Ologeanu-Taddei, Roxana PY - 2020/11/18 TI - Assessment of mHealth Interventions: Need for New Studies, Methods, and Guidelines for Study Designs JO - JMIR Med Inform SP - e21874 VL - 8 IS - 11 KW - eHealth KW - mHealth KW - usability KW - management KW - survey KW - trust KW - guidelines KW - evaluation UR - http://medinform.jmir.org/2020/11/e21874/ UR - http://dx.doi.org/10.2196/21874 UR - http://www.ncbi.nlm.nih.gov/pubmed/33206060 ID - info:doi/10.2196/21874 ER - TY - JOUR AU - Meacham, C. Meredith AU - Vogel, A. Erin AU - Thrul, Johannes PY - 2020/11/13 TI - Vaping-Related Mobile Apps Available in the Google Play Store After the Apple Ban: Content Review JO - J Med Internet Res SP - e20009 VL - 22 IS - 11 KW - vaping KW - mobile apps KW - nicotine KW - cannabis N2 - Background: In response to health concerns about vaping devices (eg, youth nicotine use, lung injury), Apple removed 181 previously approved vaping-related apps from the App Store in November 2019. This policy change may lessen youth exposure to content that glamorizes vaping; however, it may also block important sources of information and vaping device control for adults seeking to use vaping devices safely. Objective: Understanding the types of nicotine and cannabis vaping?related apps still available in the competing Google Play Store can shed light on how digital apps may reflect information available to consumers. Methods: In December 2019, we searched the Google Play Store for vaping-related apps using the keywords "vape" and "vaping" and reviewed the first 100 apps presented in the results. We reviewed app titles, descriptions, screenshots, and metadata to categorize the intended substance (nicotine or cannabis/tetrahydrocannabinol) and the app?s purpose. The most installed apps in each purpose category were downloaded and evaluated for quality and usability with the Mobile App Rating Scale. Results: Of the first 100 apps, 79 were related to vaping. Of these 79 apps, 43 (54%) were specific to nicotine, 3 (4%) were specific to cannabis, 1 (1%) was intended for either, and for the remaining 31 (39%), the intended substance was unclear. The most common purposes of the apps were making do-it-yourself e-liquids (28/79, 35%) or coils (25/79, 32%), games/entertainment (19/79, 24%), social networking (16/79, 20%), and shopping for vaping products (15/79, 19%). Of the 79 apps, at least 4 apps (5%) paired with vaping devices to control temperature or dose settings, 8 apps (10%) claimed to help people quit smoking using vaping, and 2 apps (3%) had the goal of helping people quit vaping. Conclusions: The majority of vaping-related apps in the Google Play Store had features either to help users continue vaping, such as information for modifying devices, or to maintain interest in vaping. Few apps were for controlling device settings or assisting with quitting smoking or vaping. Assuming that these Google Play Store apps were similar in content to the Apple App Store apps that were removed, it appears that Apple?s ban would have a minimal effect on people who vape with the intention of quitting smoking or who are seeking information about safer vaping via mobile apps. UR - http://www.jmir.org/2020/11/e20009/ UR - http://dx.doi.org/10.2196/20009 UR - http://www.ncbi.nlm.nih.gov/pubmed/33185565 ID - info:doi/10.2196/20009 ER - TY - JOUR AU - Avalos, A. Lyndsay AU - Aghaee, Sara AU - Kurtovich, Elaine AU - Quesenberry Jr, Charles AU - Nkemere, Linda AU - McGinnis, K. MegAnn AU - Kubo, Ai PY - 2020/11/12 TI - A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study JO - JMIR Ment Health SP - e17405 VL - 7 IS - 11 KW - depression KW - postpartum KW - health services, mental KW - eHealth KW - mental health KW - internet-based intervention KW - mindfulness KW - behavioral intervention KW - mobile phone N2 - Background: Approximately 20% of women suffer from postpartum depression (PPD). Due to barriers such as limited access to care, half of the women with PPD do not receive treatment. Therefore, it is critical to identify effective and scalable interventions. Traditional mindfulness programs have been effective in reducing depressive symptoms, however access remains a barrier. A self-paced mobile health (mHealth) mindfulness program may fit the lifestyle of busy mothers who are unable to attend in-person classes. However, little is known regarding the feasibility or efficacy of mHealth mindfulness interventions in postpartum women with depressive symptoms. Objective: This study aims to assess the feasibility, acceptability, and preliminary efficacy of an mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms. Methods: We conducted a single-arm feasibility trial of an mHealth mindfulness intervention within Kaiser Permanente Northern California (KPNC), a large integrated health care system. Participants were identified through clinician referral and electronic health records via KPNC's universal perinatal depression screening program and recruited by the study team. Inclusion criteria included the following: English-speaking, up to 6 months postpartum with a Patient Health Questionnaire (PHQ-8) score of 10 to 19, and no regular mindfulness/meditation practice. Participants were asked to use a mindfulness app, Headspace, 10 to 20 min/day for 6 weeks. Baseline and postintervention surveys captured data on patient-reported outcomes (depression and stress symptoms, sleep quality, and mindfulness). Semistructured interviews captured acceptability. Retention and adherence were used to assess feasibility. Results: Of the 115 women who were contacted and met the eligibility criteria or declined participation before eligibility assessment, 27 (23%) were enrolled. In addition, 70% (19/27) completed the study. The mean age of participants was 31 years (SD 5.2), 30% (8/27) were non-Hispanic White, and, on average, participants were 12.3 weeks postpartum (SD 5.7). Of the women who completed the study, 100% (19/19) used the Headspace app at least once, and nearly half (9/19, 47%) used the app on ?50% of the days during the 6-week intervention period. Of the 16 participants who completed the postintervention interview, 69% (11/16) reported that they were very or extremely satisfied with the app. Interviews indicated that women appreciated the variety of meditations and felt that the program led to reduced anxiety and improved sleep. Significant improvements in pre- and postintervention scores were observed for depressive symptoms (PHQ-8: ?3.8, P=.004), perceived stress (10-item Perceived Stress Scale: ?6.0, P=.005), and sleep quality (Pittsburgh Sleep Quality Index: ?2.1, P=.02, indicating less sleep disturbance). Improvements in mindfulness were also significant (Five Facet Mindfulness Questionnaire-Short Form: 10.9, P=.01). Conclusions: An mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms is feasible and acceptable. An efficacy trial is warranted. UR - https://mental.jmir.org/2020/11/e17405 UR - http://dx.doi.org/10.2196/17405 UR - http://www.ncbi.nlm.nih.gov/pubmed/33180028 ID - info:doi/10.2196/17405 ER - TY - JOUR AU - Seppen, F. Bart AU - den Boer, Pim AU - Wiegel, Jimmy AU - ter Wee, M. Marieke AU - van der Leeden, Marike AU - de Vries, Ralph AU - van der Esch, Martin AU - Bos, H. Wouter PY - 2020/11/5 TI - Asynchronous mHealth Interventions in Rheumatoid Arthritis: Systematic Scoping Review JO - JMIR Mhealth Uhealth SP - e19260 VL - 8 IS - 11 KW - mobile health KW - eHealth KW - digital health KW - telehealth KW - telerheumatology KW - mHealth KW - web app KW - smartphone app KW - activity tracker KW - rheumatoid arthritis KW - rheumatology KW - review KW - telemonitoring N2 - Background: Mobile devices such as smartphones and tablets have surged in popularity in recent years, generating numerous possibilities for their use in health care as mobile health (mHealth) tools. One advantage of mHealth is that it can be provided asynchronously, signifying that health care providers and patients are not communicating in real time. The integration of asynchronous mHealth into daily clinical practice might therefore help to make health care more efficient for patients with rheumatoid arthritis (RA). The benefits have been reviewed in various medical conditions, such as diabetes and asthma, with promising results. However, to date, it is unclear what evidence exists for the use of asynchronous mHealth in the field of RA. Objective: The objective of this study was to map the different asynchronous mHealth interventions tested in clinical trials in patients with RA and to summarize the effects of the interventions. Methods: A systematic search of Pubmed, Scopus, Cochrane, and PsycINFO was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were initially screened and later assessed by two independent researchers. Disagreements on inclusion or exclusion of studies were resolved by discussion. Results: The literature search yielded 1752 abstracts. After deduplication and screening, 10 controlled intervention studies were included. All studies were assessed to be at risk for bias in at least one domain of the Cochrane risk-of-bias tool. In the 10 selected studies, 4 different types of mHealth interventions were used: SMS reminders (to increase medication adherence or physical activity; n=3), web apps (for disease monitoring and/or to provide medical information; n=5), smartphone apps (for disease monitoring; n=1), and pedometers (to increase and track steps; n=1). Measured outcomes varied widely between studies; improvements were seen in terms of medication compliance (SMS reminders), reaching rapid remission (web app), various domains of physical activity (pedometer, SMS reminders, and web apps), patient-physician interaction (web apps), and self-efficacy (smartphone app). Conclusions: SMS reminders, web apps, smartphone apps, and pedometers have been evaluated in intervention studies in patients with RA. These interventions have been used to monitor patients or to support them in their health behavior. The use of asynchronous mHealth led to desirable outcomes in nearly all studies. However, since all studies were at risk of bias and methods used were very heterogeneous, high-quality research is warranted to corroborate these promising results. UR - http://mhealth.jmir.org/2020/11/e19260/ UR - http://dx.doi.org/10.2196/19260 UR - http://www.ncbi.nlm.nih.gov/pubmed/33151161 ID - info:doi/10.2196/19260 ER - TY - JOUR AU - Areemit, Rosawan AU - Lumbiganon, Pagakrong AU - Suphakunpinyo, Chanyut AU - Jetsrisuparb, Arunee AU - Sutra, Sumitr AU - Sripanidkulchai, Kunwadee PY - 2020/10/30 TI - A Mobile App, KhunLook, to Support Thai Parents and Caregivers With Child Health Supervision: Development, Validation, and Acceptability Study JO - JMIR Mhealth Uhealth SP - e15116 VL - 8 IS - 10 KW - mobile app KW - mHealth KW - KhunLook KW - child health supervision KW - maternal and child health handbook KW - feasibility KW - acceptability KW - Thailand KW - mobile phone N2 - Background: In Thailand, children born in government hospitals receive a maternal and child health handbook (MCHH). However, when a new MCHH edition is released, those with the previous editions do not have access to the updated information. A mobile app is an appealing platform to fill this gap. We developed a mobile app called ?KhunLook? as an interactive electronic MCHH intended to assist parents in child health supervision. Objective: This study describes the user requirements and development of the KhunLook mobile app, validity of parents? growth assessments, and parents? evaluation of feasibility and acceptability of the app. Methods: Phase 1 was a qualitative study using individual interviews. The interview data were used to revise the prototype. In phase 2, parents were randomly assigned to assess their children?s growth with the app or the MCHH. The outcomes were compared to those of the physician?s assessment, and congruence was determined. In phase 3, parents evaluated the feasibility and acceptability of the app in comparison to the MCHH through a web-based survey. Results: Four health care providers and 8 parents participated in phase 1. Two themes were identified: (1) the mobile app potentially counters parents? infrequent use of the MCHH with accuracy, attractiveness, convenience, and simplicity, and (2) health supervision needs to be standard, up-to-date, and understandable. KhunLook was publicly launched with a family page and 7 key features: growth and nutrition, development, immunizations, oral health, reminders for the next appointment, memories, and health advice. In phase 2, 56 parents participated in the growth parameter assessments; 34 were in the App group and 22 in the MCHH group. The outcomes of the growth parameter assessments between parents and physicians in both the App and MCHH groups were not significantly different. The congruence proportions were higher in the App group for weight and head circumference, but the differences were not statistically significant. In phase 3, 356 parents from all over Thailand participated in a web-based survey. Parents rated the app feasibility as ?very easy to easy? to use at higher proportions than the MCHH in all health assessment domains (growth, development, and immunizations) and ease-of-use domains with statistical significance (P<.001). The KhunLook app received a significantly higher mean score (8.59/10) than the MCHH (7.6/10) (P<.001). Most parents (317/356, 89.0%) preferred the app over MCHH. Further, 93.5% (333/356) of the parents stated that they would continue to use the app and 96.9% (345/356) would recommend others to use it. Conclusions: KhunLook, a Thai mobile app for child health supervision, was developed, validated for growth assessments, and was well accepted for ease-of-use by parents. Further studies should be conducted with a large scale of users, and the impact of this app on health behaviors and health outcomes must be evaluated. UR - http://mhealth.jmir.org/2020/10/e15116/ UR - http://dx.doi.org/10.2196/15116 UR - http://www.ncbi.nlm.nih.gov/pubmed/33124989 ID - info:doi/10.2196/15116 ER - TY - JOUR AU - Buss, Helen Vera AU - Leesong, Stuart AU - Barr, Margo AU - Varnfield, Marlien AU - Harris, Mark PY - 2020/10/29 TI - Primary Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus Using Mobile Health Technology: Systematic Review of the Literature JO - J Med Internet Res SP - e21159 VL - 22 IS - 10 KW - systematic review KW - mobile health KW - telemedicine KW - primary prevention KW - cardiovascular diseases KW - diabetes mellitus, type 2 N2 - Background: Digital technology is an opportunity for public health interventions to reach a large part of the population. Objective: This systematic literature review aimed to assess the effectiveness of mobile health?based interventions in reducing the risk of cardiovascular disease and type 2 diabetes mellitus. Methods: We conducted the systematic search in 7 electronic databases using a predefined search strategy. We included articles published between inception of the databases and March 2019 if they reported on the effectiveness of an intervention for prevention of cardiovascular disease or type 2 diabetes via mobile technology. One researcher performed the search, study selection, data extraction, and methodological quality assessment. The steps were validated by the other members of the research team Results: The search yielded 941 articles for cardiovascular disease, of which 3 met the inclusion criteria, and 732 for type 2 diabetes, of which 6 met the inclusion criteria. The methodological quality of the studies was low, with the main issue being nonblinding of participants. Of the selected studies, 4 used SMS text messaging, 1 used WhatsApp, and the remaining ones used specific smartphone apps. Weight loss and reduction in BMI were the most reported successful outcomes (reported in 4 studies). Conclusions: Evidence on the effectiveness of mobile health-based interventions in reducing the risk for cardiovascular disease and type 2 diabetes is low due to the quality of the studies and the small effects that were measured. This highlights the need for further high-quality research to investigate the potential of mobile health interventions. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019135405; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=135405 UR - http://www.jmir.org/2020/10/e21159/ UR - http://dx.doi.org/10.2196/21159 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118936 ID - info:doi/10.2196/21159 ER - TY - JOUR AU - Vaezipour, Atiyeh AU - Campbell, Jessica AU - Theodoros, Deborah AU - Russell, Trevor PY - 2020/10/29 TI - Mobile Apps for Speech-Language Therapy in Adults With Communication Disorders: Review of Content and Quality JO - JMIR Mhealth Uhealth SP - e18858 VL - 8 IS - 10 KW - communication disorders KW - speech therapy KW - language therapy KW - ergonomics KW - rehabilitation KW - mobile health KW - mHealth N2 - Background: Worldwide, more than 75% of people with acquired brain injury (ABI) experience communication disorders. Communication disorders are impairments in the ability to communicate effectively, that is, sending, receiving, processing, and comprehending verbal and nonverbal concepts and symbols. Such disorders may have enduring impacts on employment, social participation, and quality of life. Technology-enabled interventions such as mobile apps have the potential to increase the reach of speech-language therapy to treat communication disorders. However, ensuring that apps are evidence-based and of high quality is critical for facilitating safe and effective treatment for adults with communication disorders. Objective: The aim of this review is to identify mobile apps that are currently widely available to adults with communication disorders for speech-language therapy and to assess their content and quality using the validated Mobile App Rating Scale (MARS). Methods: Google Play Store, Apple App Store, and webpages were searched to identify mobile apps for speech-language therapy. Apps were included in the review if they were designed for the treatment of adult communication disorders after ABI, were in English, and were either free or for purchase. Certified speech-language pathologists used the MARS to assess the quality of the apps. Results: From a total of 2680 apps identified from Google Play Store, Apple App Store, and web searches, 2.61% (70/2680) apps met the eligibility criteria for inclusion. Overall, 61% (43/70) were available for download on the iPhone Operating System (iOS) platform, 20% (14/70) on the Android platform, and 19% (13/70) on both iOS and Android platforms. A content analysis of the apps revealed 43 apps for language, 17 apps for speech, 8 apps for cognitive communication, 6 apps for voice, and 5 apps for oromotor function or numeracy. The overall MARS mean score was 3.7 out of 5, SD 0.6, ranging between 2.1 and 4.5, with functionality being the highest-scored subscale (4.3, SD 0.6), followed by aesthetics (3.8, SD 0.8), information (3.4, SD 0.6), and engagement (3.3, SD 0.6). The top 5 apps were Naming Therapy (4.6/5), Speech Flipbook Standard (4.6/5), Number Therapy (4.5/5), Answering Therapy, and Constant Therapy (4.4/5). Conclusions: To our knowledge, this is the first study to systematically identify and evaluate a broad range of mobile apps for speech-language therapy for adults with communication disorders after sustaining ABI. We found a lack of interactive and engaging elements in the apps, a critical factor in sustaining self-managed speech-language therapy. More evidence-based apps with a focus on human factors, user experience, and a patient-led design approach are required to enhance effectiveness and long-term use. UR - http://mhealth.jmir.org/2020/10/e18858/ UR - http://dx.doi.org/10.2196/18858 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118953 ID - info:doi/10.2196/18858 ER - TY - JOUR AU - Xu, Xiaomeng AU - Griva, Konstadina AU - Koh, Mark AU - Lum, Elaine AU - Tan, Shin Woan AU - Thng, Steven AU - Car, Josip PY - 2020/10/29 TI - Creating a Smartphone App for Caregivers of Children With Atopic Dermatitis With Caregivers, Health Care Professionals, and Digital Health Experts: Participatory Co-Design JO - JMIR Mhealth Uhealth SP - e16898 VL - 8 IS - 10 KW - atopic dermatitis KW - eczema KW - mobile phone KW - telehealth N2 - Background: Smartphone apps could support patients and caregivers in disease self-management. However, as patients? experiences and needs might not always align with clinical judgments, the eliciting and engaging of perspectives of all stakeholders in the smartphone app design process is of paramount importance. Objective: The aims of this study are to better understand the needs of and challenges facing caregivers and health care professionals (HCPs) who care for children with atopic dermatitis (AD) and to explore the desirable features and content of a smartphone app that would support AD self-management. Methods: This study adopted a qualitative participatory co-design methodology involving 3 focus group discussions: workshop one focused on caregivers; workshop two engaged with HCPs; and in the last workshop, caregivers and digital health experts were asked to design the wireframe prototype. The participants completed a sociodemographic questionnaire, a technology acceptance questionnaire, and a workshop evaluation form. Results: Twelve caregivers participated in the first workshop, and 10 HCPs participated in the second workshop. Eight caregivers and 4 digital health experts attended the third workshop. Three superordinate themes that reflected caregivers? and HCPs? challenges and needs were identified: empowerment by education, confusion over treatment, and emotional impact. Workshop participants also raised a series of suggestions on the features and contents of the AD self-management app, which informed the last co-design workshop, and described their needs and challenges. In the last workshop, the participants developed a wireframe prototype of the app following the identified requirements and recommendations. Conclusions: The co-design approach was found to be a successful way of engaging with the participants, as it allowed them to express their creativity and helped us to articulate the root of the clinical problems. The co-design workshop was successful in creating and generating new ideas and solutions for smartphone app development. UR - http://mhealth.jmir.org/2020/10/e16898/ UR - http://dx.doi.org/10.2196/16898 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118949 ID - info:doi/10.2196/16898 ER - TY - JOUR AU - Camacho-Rivera, Marlene AU - Vo, Huy AU - Huang, Xueqi AU - Lau, Julia AU - Lawal, Adeola AU - Kawaguchi, Akira PY - 2020/10/29 TI - Evaluating Asthma Mobile Apps to Improve Asthma Self-Management: User Ratings and Sentiment Analysis of Publicly Available Apps JO - JMIR Mhealth Uhealth SP - e15076 VL - 8 IS - 10 KW - mHealth KW - asthma apps KW - sentiment analysis KW - user ratings KW - smartphone KW - mobile phone N2 - Background: The development and use of mobile health (mHealth) apps for asthma management have risen dramatically over the past two decades. Asthma apps vary widely in their content and features; however, prior research has rarely examined preferences of users of publicly available apps. Objective: The goals of this study were to provide a descriptive overview of asthma mobile apps that are publicly available and to assess the usability of asthma apps currently available on the market to identify content and features of apps associated with positive and negative user ratings. Methods: Reviews were collected on June 23, 2020, and included publicly posted reviews until June 21, 2020. To characterize features associated with high or low app ratings, we first dichotomized the average user rating of the asthma app into 2 categories: a high average rating and a low average rating. Asthma apps with average ratings of 4 and above were categorized as having a high average rating. Asthma apps with average ratings of less than 4 were categorized as having a low average rating. For the sentiment analysis, we modeled both 2-word (bi-gram) and 3-word (tri-gram) phrases which commonly appeared across highly rated and lowly rated apps. Results: Of the 10 apps that met the inclusion criteria, a total of 373 reviews were examined across all apps. Among apps reviewed, 53.4% (199/373) received high ratings (average ratings of 4 or 5) and 47.2% (176/373) received low ratings (average ratings of 3 or less). The number of ratings across all apps ranged from 188 (AsthmaMD) to 10 (My Asthma App); 30% (3/10) of apps were available on both Android and iOS. From the sentiment analysis, key features of asthma management that were common among highly rated apps included the tracking of peak flow readings (n=48), asthma symptom monitoring (n=11), and action plans (n=10). Key features related to functionality that were common among highly rated apps included ease of use (n=5). Users most commonly reported loss of data (n=14) and crashing of app (n=12) as functionality issues among poorly rated asthma apps. Conclusions: Our study results demonstrate that asthma app quality, maintenance, and updates vary widely across apps and platforms. These findings may call into question the long-term engagement with asthma apps, a crucial factor for determining their potential to improve asthma self-management and asthma clinical outcomes. UR - http://mhealth.jmir.org/2020/10/e15076/ UR - http://dx.doi.org/10.2196/15076 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118944 ID - info:doi/10.2196/15076 ER - TY - JOUR AU - Teitelman, M. Anne AU - Gregory, F. Emily AU - Jayasinghe, Joshua AU - Wermers, Zara AU - Koo, H. Ja AU - Morone, F. Jennifer AU - Leri, C. Damien AU - Davis, Annet AU - Feemster, A. Kristen PY - 2020/10/29 TI - Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study JO - JMIR Nursing SP - e19503 VL - 3 IS - 1 KW - cervical cancer KW - prevention KW - mobile health KW - parents KW - adolescent health KW - vaccine KW - human papillomavirus N2 - Background: More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. Objective: The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. Methods: Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. Results: Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75% (15/20) of adolescents and 88% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88% (30/34) of parents and 75% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82% (28/34) of parents and 85% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95% CI ?2.15 to 0.15). Conclusions: mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines. UR - https://nursing.jmir.org/2020/1/e19503/ UR - http://dx.doi.org/10.2196/19503 UR - http://www.ncbi.nlm.nih.gov/pubmed/34345789 ID - info:doi/10.2196/19503 ER - TY - JOUR AU - McBride, M. Ciara AU - Morrissey, C. Eimear AU - Molloy, J. Gerard PY - 2020/10/28 TI - Patients? Experiences of Using Smartphone Apps to Support Self-Management and Improve Medication Adherence in Hypertension: Qualitative Study JO - JMIR Mhealth Uhealth SP - e17470 VL - 8 IS - 10 KW - hypertension KW - self-management KW - mobile applications KW - feasibility KW - usability KW - medication adherence KW - qualitative research KW - digital technology KW - mobile phone N2 - Background: Worldwide, hypertension control rates remain suboptimal despite clinically effective antihypertensive drug therapy. Patient failure to take medication as prescribed (ie, nonadherence) is the most important factor contributing to poor control. Smartphone apps can facilitate the delivery of evidence-based behavior change techniques to improve adherence and may provide a scalable, usable, and feasible method to deliver self-management support. Objective: The aim of this study is to explore patients? experiences of the usability and feasibility of smartphone apps to support self-management and improve medication adherence in hypertension. Methods: A qualitative descriptive study was conducted. A total of 11 people living with hypertension from the West of Ireland were sampled purposively and interviewed about their experience of using a self-management app for a 4-week period, which included two key functionalities: self-monitoring of blood pressure (BP) and medication reminders. Thematic analysis was carried out on the semistructured interview data. Results: Participants? age ranged from 43 to 74 years (mean 62 years, SD 9.13). Three themes were identified: digital empowerment of self-management, human versus digital systems, and digital sustainability. Although patients? experience of using the technology to self-monitor BP was one of empowerment, characterized by an enhanced insight and understanding into their condition, control, and personal responsibility, the reminder function was only feasible for patients who reported unintentional nonadherence to treatment. Patients experienced the app as a sustainable tool to support self-management and found it easy to use, including those with limited technological competence. Conclusions: The study?s findings provide new insights into the experience of using apps to support medication adherence in hypertension. Overall, the data support apps as a usable and feasible method to aid self-management of hypertension and highlight the need for personalized functionality, particularly with regard to medication adherence reminder strategies. The study?s findings challenge the perspective that the use of these technologies to support self-management can inevitably add to the burden of treatment experienced by patients. UR - http://mhealth.jmir.org/2020/10/e17470/ UR - http://dx.doi.org/10.2196/17470 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112251 ID - info:doi/10.2196/17470 ER - TY - JOUR AU - Pratap, Abhishek AU - Grant, Daniel AU - Vegesna, Ashok AU - Tummalacherla, Meghasyam AU - Cohan, Stanley AU - Deshpande, Chinmay AU - Mangravite, Lara AU - Omberg, Larsson PY - 2020/10/27 TI - Evaluating the Utility of Smartphone-Based Sensor Assessments in Persons With Multiple Sclerosis in the Real-World Using an App (elevateMS): Observational, Prospective Pilot Digital Health Study JO - JMIR Mhealth Uhealth SP - e22108 VL - 8 IS - 10 KW - multiple sclerosis KW - digital health KW - real-world data KW - real-world evidence KW - remote monitoring KW - smartphone KW - mobile phone KW - neurodegeneration N2 - Background: Multiple sclerosis (MS) is a chronic neurodegenerative disease. Current monitoring practices predominantly rely on brief and infrequent assessments, which may not be representative of the real-world patient experience. Smartphone technology provides an opportunity to assess people?s daily-lived experience of MS on a frequent, regular basis outside of episodic clinical evaluations. Objective: The objectives of this study were to evaluate the feasibility and utility of capturing real-world MS-related health data remotely using a smartphone app, ?elevateMS,? to investigate the associations between self-reported MS severity and sensor-based active functional tests measurements, and the impact of local weather conditions on disease burden. Methods: This was a 12-week, observational, digital health study involving 3 cohorts: self-referred participants who reported an MS diagnosis, clinic-referred participants with neurologist-confirmed MS, and participants without MS (controls). Participants downloaded the elevateMS app and completed baseline assessments, including self-reported physical ability (Patient-Determined Disease Steps [PDDS]), as well as longitudinal assessments of quality of life (Quality of Life in Neurological Disorders [Neuro-QoL] Cognitive, Upper Extremity, and Lower Extremity Function) and daily health (MS symptoms, triggers, health, mobility, pain). Participants also completed functional tests (finger-tapping, walk and balance, voice-based Digit Symbol Substitution Test [DSST], and finger-to-nose) as an independent assessment of MS-related cognition and motor activity. Local weather data were collected each time participants completed an active task. Associations between self-reported baseline/longitudinal assessments, functional tests, and weather were evaluated using linear (for cross-sectional data) and mixed-effects (for longitudinal data) regression models. Results: A total of 660 individuals enrolled in the study; 31 withdrew, 495 had MS (n=359 self-referred, n=136 clinic-referred), and 134 were controls. Participation was highest in clinic-referred versus self-referred participants (median retention: 25.5 vs 7.0 days). The top 5 most common MS symptoms, reported at least once by participants with MS, were fatigue (310/495, 62.6%), weakness (222/495, 44.8%), memory/attention issues (209/495, 42.2%), and difficulty walking (205/495, 41.4%), and the most common triggers were high ambient temperature (259/495, 52.3%), stress (250/495, 50.5%), and late bedtime (221/495, 44.6%). Baseline PDDS was significantly associated with functional test performance in participants with MS (mixed model?based estimate of most significant feature across functional tests [?]: finger-tapping: ?=?43.64, P<.001; DSST: ?=?5.47, P=.005; walk and balance: ?=?.39, P=.001; finger-to-nose: ?=.01, P=.01). Longitudinal Neuro-QoL scores were also significantly associated with functional tests (finger-tapping with Upper Extremity Function: ?=.40, P<.001; walk and balance with Lower Extremity Function: ?=?99.18, P=.02; DSST with Cognitive Function: ?=1.60, P=.03). Finally, local temperature was significantly associated with participants? test performance (finger-tapping: ?=?.14, P<.001; DSST: ?=?.06, P=.009; finger-to-nose: ?=?53.88, P<.001). Conclusions: The elevateMS study app captured the real-world experience of MS, characterized some MS symptoms, and assessed the impact of environmental factors on symptom severity. Our study provides further evidence that supports smartphone app use to monitor MS with both active assessments and patient-reported measures of disease burden. App-based tracking may provide unique and timely real-world data for clinicians and patients, resulting in improved disease insights and management. UR - http://mhealth.jmir.org/2020/10/e22108/ UR - http://dx.doi.org/10.2196/22108 UR - http://www.ncbi.nlm.nih.gov/pubmed/33107827 ID - info:doi/10.2196/22108 ER - TY - JOUR AU - Li, Joyce Lok Yee AU - Wang, Shin-Yi AU - Wu, Cheng-Jung AU - Tsai, Cheng-Yu AU - Wu, Te-Fang AU - Lin, Yaoh-Shiang PY - 2020/10/27 TI - Screening for Hearing Impairment in Older Adults by Smartphone-Based Audiometry, Self-Perception, HHIE Screening Questionnaire, and Free-Field Voice Test: Comparative Evaluation of the Screening Accuracy With Standard Pure-Tone Audiometry JO - JMIR Mhealth Uhealth SP - e17213 VL - 8 IS - 10 KW - hearing impairment KW - self-perception KW - HHIE-S questionnaire KW - free-field voice test KW - mobile phone KW - audiometry KW - mobile health N2 - Background: Hearing impairment is the most frequent sensory deficit in humans, affecting more than 360 million people worldwide. In fact, hearing impairment is not merely a health problem, but it also has a great impact on the educational performance, economic income, and quality of life. Hearing impairment is therefore an important social concern. Objective: We aimed to evaluate and compare the accuracy of self-perception, Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) questionnaire, free-field voice test, and smartphone-based audiometry as tests for screening moderate hearing impairment in older adults in China. Methods: In this study, 41 patients were recruited through a single otology practice. All patients were older than 65 years. Patients with otorrhea and cognitive impairment were excluded. Moderate hearing impairment was defined as mean hearing thresholds at 500, 1000, 2000, and 4000 Hz >40 dB hearing loss (pure-tone average > 40 dB hearing loss). All patients completed 5 hearing tests, namely, the self-perception test, HHIE-S questionnaire test, free-field voice test, smartphone-based audiometry test, and standard pure-tone audiometry by the same audiologist. We compared the results of these tests to the standard audiogram in the better-hearing ear. Results: The sensitivity and the specificity of the self-perception test were 0.58 (95% CI 0.29-0.84) and 0.34 (95% CI 0.19-0.54), respectively. The sensitivity and the specificity of the HHIE-S questionnaire test were 0.67 (95% CI 0.35-0.89) and 0.31 (95% CI 0.316-0.51), respectively. The sensitivity and the specificity of the free-field voice test were 0.83 (95% CI 0.51-0.97) and 0.41 (95% CI 0.24-0.61), respectively. The sensitivity and the specificity of the smartphone-based audiometry test were 0.92 (95% CI 0.60-0.99) and 0.76 (95% CI 0.56-0.89), respectively. Smartphone-based audiometry correctly diagnosed the presence of hearing loss with high sensitivity and high specificity. Conclusions: Smartphone-based audiometry may be a dependable screening test to rule out moderate hearing impairment in the older population. UR - http://mhealth.jmir.org/2020/10/e17213/ UR - http://dx.doi.org/10.2196/17213 UR - http://www.ncbi.nlm.nih.gov/pubmed/33107828 ID - info:doi/10.2196/17213 ER - TY - JOUR AU - Alon, Noy AU - Stern, Dora Ariel AU - Torous, John PY - 2020/10/26 TI - Assessing the Food and Drug Administration?s Risk-Based Framework for Software Precertification With Top Health Apps in the United States: Quality Improvement Study JO - JMIR Mhealth Uhealth SP - e20482 VL - 8 IS - 10 KW - mobile health KW - smartphone KW - Food and Drug Administration KW - software KW - mobile phone N2 - Background: As the development of mobile health apps continues to accelerate, the need to implement a framework that can standardize the categorization of these apps to allow for efficient yet robust regulation is growing. However, regulators and researchers are faced with numerous challenges, as apps have a wide variety of features, constant updates, and fluid use cases for consumers. As past regulatory efforts have failed to match the rapid innovation of these apps, the US Food and Drug Administration (FDA) has proposed that the Software Precertification (Pre-Cert) Program and a new risk-based framework could be the solution. Objective: This study aims to determine whether the risk-based framework proposed by the FDA?s Pre-Cert Program could standardize categorization of top health apps in the United States. Methods: In this quality improvement study during summer 2019, the top 10 apps for 6 disease conditions (addiction, anxiety, depression, diabetes, high blood pressure, and schizophrenia) in Apple iTunes and Android Google Play Store in the United States were classified using the FDA?s risk-based framework. Data on the presence of well-defined app features, user engagement methods, popularity metrics, medical claims, and scientific backing were collected. Results: The FDA?s risk-based framework classifies an app?s risk by the disease condition it targets and what information that app provides. Of the 120 apps tested, 95 apps were categorized as targeting a nonserious health condition, whereas only 7 were categorized as targeting a serious condition and 18 were categorized as targeting a critical condition. As the majority of apps targeted a nonserious condition, their risk categorization was largely determined by the information they provided. The apps that were assessed as not requiring FDA review were more likely to be associated with the integration of external devices than those assessed as requiring FDA review (15/58, 26% vs 5/62, 8%; P=.03) and health information collection (24/58, 41% vs 9/62, 15%; P=.008). Apps exempt from the review were less likely to offer health information (25/58, 43% vs 45/62, 72%; P<.001), to connect users with professional care (7/58, 12% vs 14/62, 23%; P=.04), and to include an intervention (8/58, 14% vs 35/62, 55%; P<.001). Conclusions: The FDA?s risk-based framework has the potential to improve the efficiency of the regulatory review process for health apps. However, we were unable to identify a standard measure that differentiated apps requiring regulatory review from those that would not. Apps exempt from the review also carried concerns regarding privacy and data security. Before the framework is used to assess the need for a formal review of digital health tools, further research and regulatory guidance are needed to ensure that the Pre-Cert Program operates in the greatest interest of public health. UR - http://mhealth.jmir.org/2020/10/e20482/ UR - http://dx.doi.org/10.2196/20482 UR - http://www.ncbi.nlm.nih.gov/pubmed/32927429 ID - info:doi/10.2196/20482 ER - TY - JOUR AU - Yang Meier, Dong AU - Barthelmess, Petra AU - Sun, Wei AU - Liberatore, Florian PY - 2020/10/22 TI - Wearable Technology Acceptance in Health Care Based on National Culture Differences: Cross-Country Analysis Between Chinese and Swiss Consumers JO - J Med Internet Res SP - e18801 VL - 22 IS - 10 KW - wearables KW - health care wearables KW - wearables acceptance KW - cross culture KW - national culture KW - Chinese KW - Swiss KW - moderator KW - digital health KW - health technology acceptance KW - smartwatch N2 - Background: The advancement of wearable devices and growing demand of consumers to monitor their own health have influenced the medical industry. Health care providers, insurers, and global technology companies intend to develop more wearable devices incorporating medical technology and to target consumers worldwide. However, acceptance of these devices varies considerably among consumers of different cultural backgrounds. Consumer willingness to use health care wearables is influenced by multiple factors that are of varying importance in various cultures. However, there is insufficient knowledge of the extent to which social and cultural factors affect wearable technology acceptance in health care. Objective: The aims of this study were to examine the influential factors on the intention to adopt health care wearables, and the differences in the underlying motives and usage barriers between Chinese and Swiss consumers. Methods: A new model for acceptance of health care wearables was conceptualized by incorporating predictors of different theories such as technology acceptance, health behavior, and privacy calculus based on an existing framework. To verify the model, a web-based survey in both the Chinese and German languages was conducted in China and Switzerland, resulting in 201 valid Chinese and 110 valid Swiss respondents. A multigroup partial least squares path analysis was applied to the survey data. Results: Performance expectancy (?=.361, P<.001), social influence (?=.475, P<.001), and hedonic motivation (?=.111, P=.01) all positively affected the behavioral intention of consumers to adopt wearables, whereas effort expectancy, functional congruence, health consciousness, and perceived privacy risk did not demonstrate a significant impact on behavioral intention. The group-specific path coefficients indicated health consciousness (?=.150, P=.01) as a factor positively affecting only the behavior intention of the Chinese respondents, whereas the factors affecting only the behavioral intention of the Swiss respondents proved to be effort expectancy (?=.165, P=.02) and hedonic motivation (?=.212, P=.02). Performance expectancy asserted more of an influence on the behavioral intention of the Swiss (?=.426, P<.001) than the Chinese (?=.271, P<.001) respondents, whereas social influence had a greater influence on the behavioral intention of the Chinese (?=.321, P<.001) than the Swiss (?=.217, P=.004) respondents. Overall, the Chinese consumers displayed considerably higher behavioral intention (P<.001) than the Swiss. These discrepancies are explained by differences in national culture. Conclusions: This is one of the first studies to investigate consumers? intention to adopt wearables from a cross-cultural perspective. This provides a theoretical and methodological foundation for future research, as well as practical implications for global vendors and insurers developing and promoting health care wearables with appropriate features in different countries. The testimonials and support by physicians, evidence of measurement accuracy, and easy handling of health care wearables would be useful in promoting the acceptance of wearables in Switzerland. The opinions of in-group members, involvement of employers, and multifunctional apps providing credible health care advice and solutions in cooperation with health care institutions would increase acceptance among the Chinese. UR - http://www.jmir.org/2020/10/e18801/ UR - http://dx.doi.org/10.2196/18801 UR - http://www.ncbi.nlm.nih.gov/pubmed/33090108 ID - info:doi/10.2196/18801 ER - TY - JOUR AU - Aida, Azusa AU - Svensson, Thomas AU - Svensson, Kishi Akiko AU - Urushiyama, Hirokazu AU - Okushin, Kazuya AU - Oguri, Gaku AU - Kubota, Naoto AU - Koike, Kazuhiko AU - Nangaku, Masaomi AU - Kadowaki, Takashi AU - Yamauchi, Toshimasa AU - Chung, Ung-Il PY - 2020/10/21 TI - Using mHealth to Provide Mobile App Users With Visualization of Health Checkup Data and Educational Videos on Lifestyle-Related Diseases: Methodological Framework for Content Development JO - JMIR Mhealth Uhealth SP - e20982 VL - 8 IS - 10 KW - apps KW - educational videos KW - health checkup KW - lifestyle-related disease KW - mHealth, prevention KW - telehealth KW - visualization N2 - Background: The number of people with lifestyle-related diseases continues to increase worldwide. Improving lifestyle behavior with health literacy may be the key to address lifestyle-related diseases. The delivery of educational videos using mobile health (mHealth) services can replace the conventional way of educating individuals, and visualization can replace the provision of health checkup data. Objective: This paper aimed to describe the development of educational content for MIRAMED, a mobile app aimed at improving users? lifestyle behaviors and health literacy for lifestyle-related diseases. Methods: All videos were based on a single unified framework to provide users with a consistent flow of information. The framework was later turned into a storyboard. The final video contents were created based on this storyboard and further discussions with leading experts and specialist physicians on effective communication with app users about lifestyle-related diseases. Results: The app uses visualization of personal health checkup data and educational videos on lifestyle-related diseases based on the current health guidelines, scientific evidence, and expert opinions of leading specialist physicians in the respective fields. A total of 8 videos were created for specific lifestyle-related diseases affecting 8 organs: (1) brain?cerebrovascular disorder, (2) eyes?diabetic retinopathy, (3) lungs?chronic obstructive pulmonary disease, (4) heart?ischemic heart disease, (5) liver?fatty liver, (6) kidneys?chronic kidney disease (diabetic kidney disease), (7) blood vessels?peripheral arterial disease, and (8) nerves?diabetic neuropathy. Conclusions: Providing enhanced mHealth education using novel digital technologies to visualize conventional health checkup data and lifestyle-related diseases is an innovative strategy. Future studies to evaluate the efficacy of the developed content are planned. UR - http://mhealth.jmir.org/2020/10/e20982/ UR - http://dx.doi.org/10.2196/20982 UR - http://www.ncbi.nlm.nih.gov/pubmed/33084586 ID - info:doi/10.2196/20982 ER - TY - JOUR AU - Evenepoel, Charlotte AU - Clevers, Egbert AU - Deroover, Lise AU - Van Loo, Wendy AU - Matthys, Christophe AU - Verbeke, Kristin PY - 2020/10/21 TI - Accuracy of Nutrient Calculations Using the Consumer-Focused Online App MyFitnessPal: Validation Study JO - J Med Internet Res SP - e18237 VL - 22 IS - 10 KW - dietary assessment KW - MyFitnessPal KW - Nubel KW - nutrition KW - online application KW - diet N2 - Background: Digital food registration via online platforms that are coupled to large food databases obviates the need for manual processing of dietary data. The reliability of such platforms depends on the quality of the associated food database. Objective: In this study, we validate the database of MyFitnessPal versus the Belgian food composition database, Nubel. Methods: After carefully given instructions, 50 participants used MyFitnessPal to each complete a 4-day dietary record 2 times (T1 and T2), with 1 month in between T1 and T2. Nutrient intake values were calculated either manually, using the food composition database Nubel, or automatically, using the database coupled to MyFitnessPal. First, nutrient values from T1 were used as a training set to develop an algorithm that defined upper limit values for energy intake, carbohydrates, fat, protein, fiber, sugar, cholesterol, and sodium. These limits were applied to the MyFitnessPal dataset extracted at T2 to remove extremely high and likely erroneous values. Original and cleaned T2 values were correlated with the Nubel calculated values. Bias was estimated using Bland-Altman plots. Finally, we simulated the impact of using MyFitnessPal for nutrient analysis instead of Nubel on the power of a study design that correlates nutrient intake to a chosen outcome variable. Results: Per food portion, the following upper limits were defined: 1500 kilocalories for total energy intake, 95 grams (g) for carbohydrates, 92 g for fat, 52 g for protein, 22 g for fiber, 70 g for sugar, 600 mg for cholesterol, and 3600 mg for sodium. Cleaning the dataset extracted at T2 resulted in a 2.8% rejection. Cleaned MyFitnessPal values demonstrated strong correlations with Nubel for energy intake (r=0.96), carbohydrates (r=0.90), fat (r=0.90), protein (r=0.90), fiber (r=0.80), and sugar (r=0.79), but weak correlations for cholesterol (?=0.51) and sodium (?=0.53); all P values were ?.001. No bias was found between both methods, except for a fixed bias for fiber and a proportional bias for cholesterol. A 5-10% power loss should be taken into account when correlating energy intake and macronutrients obtained with MyFitnessPal to an outcome variable, compared to Nubel. Conclusions: Dietary analysis with MyFitnessPal is accurate and efficient for total energy intake, macronutrients, sugar, and fiber, but not for cholesterol and sodium. UR - http://www.jmir.org/2020/10/e18237/ UR - http://dx.doi.org/10.2196/18237 UR - http://www.ncbi.nlm.nih.gov/pubmed/33084583 ID - info:doi/10.2196/18237 ER - TY - JOUR AU - Chandrasekaran, Ranganathan AU - Katthula, Vipanchi AU - Moustakas, Evangelos PY - 2020/10/16 TI - Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey JO - J Med Internet Res SP - e22443 VL - 22 IS - 10 KW - wearable healthcare devices KW - mobile health KW - HINTS KW - health technology adoption and use KW - smart wearables N2 - Background: Despite the growing popularity of wearable health care devices (from fitness trackes such as Fitbit to smartwatches such as Apple Watch and more sophisticated devices that can collect information on metrics such as blood pressure, glucose levels, and oxygen levels), we have a limited understanding about the actual use and key factors affecting the use of these devices by US adults. Objective: The main objective of this study was to examine the use of wearable health care devices and the key predictors of wearable use by US adults. Methods: Using a national survey of 4551 respondents, we examined the usage patterns of wearable health care devices (use of wearables, frequency of their use, and willingness to share health data from a wearable with a provider) and a set of predictors that pertain to personal demographics (age, gender, race, education, marital status, and household income), individual health (general health, presence of chronic conditions, weight perceptions, frequency of provider visits, and attitude towards exercise), and technology self-efficacy using logistic regression analysis. Results: About 30% (1266/4551) of US adults use wearable health care devices. Among the users, nearly half (47.33%) use the devices every day, with a majority (82.38% weighted) willing to share the health data from wearables with their care providers. Women (16.25%), White individuals (19.74%), adults aged 18-50 years (19.52%), those with some level of college education or college graduates (25.60%), and those with annual household incomes greater than US $75,000 (17.66%) were most likely to report using wearable health care devices. We found that the use of wearables declines with age: Adults aged >50 years were less likely to use wearables compared to those aged 18-34 years (odds ratios [OR] 0.46-0.57). Women (OR 1.26, 95% CI 0.96-1.65), White individuals (OR 1.65, 95% CI 0.97-2.79), college graduates (OR 1.05, 95% CI 0.31-3.51), and those with annual household incomes greater than US $75,000 (OR 2.6, 95% CI 1.39-4.86) were more likely to use wearables. US adults who reported feeling healthier (OR 1.17, 95% CI 0.98-1.39), were overweight (OR 1.16, 95% CI 1.06-1.27), enjoyed exercise (OR 1.23, 95% CI 1.06-1.43), and reported higher levels of technology self-efficacy (OR 1.33, 95% CI 1.21-1.46) were more likely to adopt and use wearables for tracking or monitoring their health. Conclusions: The potential of wearable health care devices is under-realized, with less than one-third of US adults actively using these devices. With only younger, healthier, wealthier, more educated, technoliterate adults using wearables, other groups have been left behind. More concentrated efforts by clinicians, device makers, and health care policy makers are needed to bridge this divide and improve the use of wearable devices among larger sections of American society. UR - http://www.jmir.org/2020/10/e22443/ UR - http://dx.doi.org/10.2196/22443 UR - http://www.ncbi.nlm.nih.gov/pubmed/33064083 ID - info:doi/10.2196/22443 ER - TY - JOUR AU - Mach, Markus AU - Watzal, Victoria AU - Hasan, Waseem AU - Andreas, Martin AU - Winkler, Bernhard AU - Weiss, Gabriel AU - Strouhal, Andreas AU - Adlbrecht, Christopher AU - Delle Karth, Georg AU - Grabenwöger, Martin PY - 2020/10/15 TI - Fitness-Tracker Assisted Frailty-Assessment Before Transcatheter Aortic Valve Implantation: Proof-of-Concept Study JO - JMIR Mhealth Uhealth SP - e19227 VL - 8 IS - 10 KW - frailty KW - activity KW - fitness KW - tracker KW - transcatheter aortic valve implantation KW - transcatheter aortic valve repair N2 - Background: While transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic valve stenosis, wearable health-monitoring devices are gradually transforming digital patient care. Objective: The aim of this study was to develop a simple, efficient, and economical method for preprocedural frailty assessment based on parameters measured by a wearable health-monitoring device. Methods: In this prospective study, we analyzed data of 50 consecutive patients with mean (SD) age of 77.5 (5.1) years and a median (IQR) European system for cardiac operative risk evaluation (EuroSCORE) II of 3.3 (4.1) undergoing either transfemoral or transapical TAVR between 2017 and 2018. Every patient was fitted with a wrist-worn health-monitoring device (Garmin Vivosmart 3) for 1 week prior to the procedure. Twenty different parameters were measured, and threshold levels for the 3 most predictive categories (ie, step count, heart rate, and preprocedural stress) were calculated. Patients were assigned 1 point per category for exceeding the cut-off value and were then classified into 4 stages (no, borderline, moderate, and severe frailty). Furthermore, the FItness-tracker assisted Frailty-Assessment Score (FIFA score) was compared with the scores of the preprocedural gait speed category derived from the 6-minute walk test (GSC-6MWT) and the Edmonton Frail Scale classification (EFS-C). The primary study endpoint was hospital mortality. Results: The overall preprocedural stress level (P=.02), minutes of high stress per day (P=.02), minutes of rest per day (P=.045), and daily heart rate maximum (P=.048) as single parameters were the strongest predictors of hospital mortality. When comparing the different frailty scores, the FIFA score demonstrated the greatest predictive power for hospital mortality (FIFA area under the curve [AUC] 0.844, CI 0.656-1.000; P=.048; GSC-6MWT AUC 0.671, CI 0.487-0.855; P=.42; EFS-C AUC 0.636, CI 0.254-1.000; P=.44). Conclusions: This proof-of-concept study demonstrates the strong predictive performance of the FIFA score compared to that of the conventional frailty assessments. UR - https://mhealth.jmir.org/2020/10/e19227 UR - http://dx.doi.org/10.2196/19227 UR - http://www.ncbi.nlm.nih.gov/pubmed/33055057 ID - info:doi/10.2196/19227 ER - TY - JOUR AU - Modi, Dhiren AU - Saha, Somen AU - Vaghela, Prakash AU - Dave, Kapilkumar AU - Anand, Ankit AU - Desai, Shrey AU - Shah, Pankaj PY - 2020/10/14 TI - Costing and Cost-Effectiveness of a Mobile Health Intervention (ImTeCHO) in Improving Infant Mortality in Tribal Areas of Gujarat, India: Cluster Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e17066 VL - 8 IS - 10 KW - mHealth, cost-effectiveness KW - life-years saved KW - India, ASHA N2 - Background: During 2013, a mobile health (mHealth) program, Innovative Mobile Technology for Community Health Operation (ImTeCHO), was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as a job aid for Accredited Social Health Activists (ASHAs) and staff of primary health centers to increase coverage of maternal, neonatal, and child health care. Objective: In this study, we assessed the incremental cost per life-years saved as a result of the ImTeCHO intervention as compared to routine maternal, neonatal, and child health care programs. Methods: A two-arm, parallel, stratified cluster randomized trial with 11 clusters (primary health centers) randomly allocated to the intervention (280 ASHAs, n=2,34,134) and control (281 ASHAs, n=2,42,809) arms was initiated in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance assessed all live births and infant deaths in the intervention and control areas. All costs, including those required during the start-up and implementation phases, were estimated from a program perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analyzed to estimate the cost per life-years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties. Results: Out of a total of 5754 live births (3014 in the intervention arm, 2740 in the control arm) reported in the study area, per protocol analysis showed that the implementation of ImTeCHO resulted in saving 11 infant deaths per 1000 live births in the study area at an annual incremental cost of US $163,841, which is equivalent to US $54,360 per 1000 live births. Overall, ImTeCHO is a cost-effective intervention from a program perspective at an incremental cost of US $74 per life-years saved or US $5057 per death averted. In a realistic environment with district scale-up, the program is expected to become even more cost-effective. Conclusions: Overall, the findings of our study strongly suggest that the mHealth intervention as part of the ImTeCHO program is cost-effective and should be considered for replication elsewhere in India. Trial Registration: Clinical Trials Registry of India CTRI/2015/06/005847; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=11820&EncHid=&modid=&compid=%27,%2711820det%27 UR - https://mhealth.jmir.org/2020/10/e17066 UR - http://dx.doi.org/10.2196/17066 UR - http://www.ncbi.nlm.nih.gov/pubmed/33052122 ID - info:doi/10.2196/17066 ER - TY - JOUR AU - Zhao, Zhi Sheng AU - Guo, Ningyuan AU - Wang, Ping Man AU - Fong, Tak Daniel Yee AU - Lai, Kwan Agnes Yuen AU - Chan, Siu-Chee Sophia AU - Lam, Hing Tai AU - Ho, Yin Daniel Sai PY - 2020/10/14 TI - The Association Between Electronic Device Use During Family Time and Family Well-Being: Population-Based Cross-Sectional Study JO - J Med Internet Res SP - e20529 VL - 22 IS - 10 KW - eDevice KW - smartphone KW - mobile phone KW - well-being KW - family dinner KW - family communication KW - public health N2 - Background: Electronic devices (eDevices) may have positive or negative influences on family communication and well-being depending on how they are used. Objective: We examined eDevice use during family time and its association with the quality of family communication and well-being in Hong Kong Chinese adults. Methods: In 2017, a probability-based 2-stage random sampling landline telephone survey collected data on eDevice use in daily life and during family time (eg, family dinner) and the presence of rules banning eDevice use during family dinner. Family communication quality was rated from 0 to 10 with higher scores being favorable. Family well-being was calculated as a composite mean score of 3 items each using the same scale from 0 to 10. The associations of family communication quality and well-being with eDevice use in daily life and during family time were estimated using beta-coefficient (?) adjusting for sociodemographics. The mediating role of family communication quality in the association between eDevice use and family well-being was analyzed. Results: Of the 2064 respondents (mean age 56.4 [SD 19.2] years, 1269/2064 [61.48%] female), 1579/2059 (76.69%) used an eDevice daily for a mean of 3.6 hours (SD 0.1) and 257/686 (37.5%) used it for 30+ minutes before sleep. As much as 794/2046 (38.81%) often or sometimes used an eDevice during family time including dinner (311/2017, 15.42%); 713/2012 (35.44%) reported use of an eDevice by family members during dinner. Lower family communication quality was associated with hours of eDevice use before sleep (adjusted ?=?.25; 95% CI ?0.44 to ?0.05), and often use (vs never use) of eDevice during family dinner by oneself (adjusted ?=?.51; 95% CI ?0.91 to ?0.10) and family members (adjusted ?=?.54; 95% CI ?0.79 to ?0.29). Similarly, lower family well-being was associated with eDevice use before sleep (adjusted ?=?.26; 95% CI ?0.42 to ?0.09), and often use during family dinner by oneself (adjusted ?=?.48; 95% CI ?0.83 to ?0.12) and family members (adjusted ?=?.50; 95% CI ?0.72 to ?0.28). Total ban of eDevice use during family dinner was negatively associated with often use by oneself (adjusted odds ratio 0.49; 95% CI 0.29 to 0.85) and family members (adjusted odds ratio 0.41; 95% CI 0.28, 0.60) but not with family communication and well-being. Lower family communication quality substantially mediated the total effect of the association of eDevice use time before sleep (61.2%) and often use at family dinner by oneself (87.0%) and by family members (67.8%) with family well-being. Conclusions: eDevice use before sleep and during family dinner was associated with lower family well-being, and the association was substantially mediated by family communication quality. Our results suggest that interventions on smart use of eDevice may improve family communication and well-being. UR - http://www.jmir.org/2020/10/e20529/ UR - http://dx.doi.org/10.2196/20529 UR - http://www.ncbi.nlm.nih.gov/pubmed/33052120 ID - info:doi/10.2196/20529 ER - TY - JOUR AU - van Herpen, Marjolein Merel AU - Boeschoten, A. Manon AU - te Brake, Hans AU - van der Aa, Niels AU - Olff, Miranda PY - 2020/9/25 TI - Mobile Insight in Risk, Resilience, and Online Referral (MIRROR): Psychometric Evaluation of an Online Self-Help Test JO - J Med Internet Res SP - e19716 VL - 22 IS - 9 KW - potentially traumatic events KW - mobile mental health KW - self-help KW - online KW - resilience KW - posttraumatic stress disorder N2 - Background: Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user. Objective: The goal of this study was to assess MIRROR?s use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures. Methods: MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR?s outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale?21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form). Results: In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range ?.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: ?219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures. Conclusions: MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic. UR - http://www.jmir.org/2020/9/e19716/ UR - http://dx.doi.org/10.2196/19716 UR - http://www.ncbi.nlm.nih.gov/pubmed/32975521 ID - info:doi/10.2196/19716 ER - TY - JOUR AU - Heidel, Alexandra AU - Hagist, Christian PY - 2020/9/23 TI - Potential Benefits and Risks Resulting From the Introduction of Health Apps and Wearables Into the German Statutory Health Care System: Scoping Review JO - JMIR Mhealth Uhealth SP - e16444 VL - 8 IS - 9 KW - health apps KW - wearables KW - digital health application KW - mHealth N2 - Background: Germany is the first country worldwide that has introduced a digital care act as an incentive system to enhance the use of digital health devices, namely health apps and wearables, among its population. The act allows physicians to prescribe statutory financed and previously certified health apps and wearables to patients. This initiative has the potential to improve treatment quality through better disease management and monitoring. Objective: The aim of this paper was to outline the key concepts related to the potential risks and benefits discussed in the current literature about health apps and wearables. Furthermore, this study aimed to answer the research question: Which risks and benefits may result from the implementation of the digital care act in Germany? Methods: We conducted the scoping study by searching the databases PubMed, Google Scholar, and JMIR using the keywords health apps and wearables. We discussed 55 of 136 identified articles published in the English language from 2015 to March 2019 in this paper using a qualitative thematic analysis approach. Results: We identified four key themes within the articles: Effectivity of health apps and wearables to improve health; users of health apps and wearables; the potential of bring-your-own, self-tracked data; and concerns and data privacy risks. Within these themes, we identified three main stages of benefits for the German health care system: Usage of health apps and wearables; continuing to use health apps and wearables; and sharing bring-your-own; self-tracked data with different agents in the health care sector. Conclusions: The digital care act could lead to an improvement in treatment quality through better patient monitoring, disease management, personalized therapy, and better health education. However, physicians should play an active role in recommendingand supervising health app use to reach digital-illiterate or health-illiterate people. Age must not be an exclusion criterion. Yet, concerns about data privacy and security are very strong in Germany. Transparency about data processing should be provided at all times for continuing success of the digital care act in Germany. UR - http://mhealth.jmir.org/2020/9/e16444/ UR - http://dx.doi.org/10.2196/16444 UR - http://www.ncbi.nlm.nih.gov/pubmed/32965231 ID - info:doi/10.2196/16444 ER - TY - JOUR AU - Dang, Huyen AU - Dao, Sang AU - Carnahan, Emily AU - Kawakyu, Nami AU - Duong, Hong AU - Nguyen, Trung AU - Nguyen, Doan AU - Nguyen, Linh AU - Rivera, Maya AU - Ngo, Tuan AU - Werner, Laurie AU - Nguyen, Nga PY - 2020/9/22 TI - Determinants of Scale-up From a Small Pilot to a National Electronic Immunization Registry in Vietnam: Qualitative Evaluation JO - J Med Internet Res SP - e19923 VL - 22 IS - 9 KW - immunization KW - immunization information system KW - electronic immunization registry KW - scale-up KW - digital health intervention KW - mHealth KW - eHealth N2 - Background: Digital health innovations can improve health system performance, yet previous experience has shown that many innovations do not advance beyond the pilot stage to achieve scale. Vietnam?s National Immunization Information System (NIIS) began as a series of digital health pilots, first initiated in 2010, and was officially launched nationwide in 2017. The NIIS is one of the few examples of an electronic immunization registry (EIR) at national scale in low- and middle-income countries. Objective: The aim of this study was to understand the determinants of scale-up of the national EIR in Vietnam. Methods: This qualitative study explored the facilitators and barriers to national scale-up of the EIR in Vietnam. Qualitative data were collected from October to December 2019 through in-depth key informant interviews and desk review. The mHealth Assessment and Planning for Scale (MAPS) Toolkit guided the development of the study design, interview guides, and analytic framework. MAPS defines the key determinants of success, or the ?axes of scale,? to be groundwork, partnerships, financial health, technology and architecture, operations, and monitoring and evaluation. Results: The partnership and operations axes were critical to the successful scale-up of the EIR in Vietnam, while the groundwork and monitoring and the evaluation axes were considered to be strong contributors in the success of all the other axes. The partnership model leveraged complementary strengths of the technical working group partners: the Ministry of Health General Department of Preventive Medicine, the National Expanded Program on Immunization, Viettel (the mobile network operator), and PATH. The operational approach to introducing the NIIS with lean, iterative, and integrated training and supervision was also a key facilitator to successful scale-up. The financial health, technology and architecture, and operations axes were identified as barriers to successful deployment and scale-up. Key barriers to scale-up included insufficient estimates of operational costs, unanticipated volume of data storage and transmission, lack of a national ID to support interoperability, and operational challenges among end users. Overall, the multiple phases of EIR deployment and scale-up from 2010 to 2017 allowed for continuous learning and improvement that strengthened all the axes and contributed to successful scale-up. Conclusions: The results highlight the importance of the measured, iterative approach that was taken to gradually expand a series of small pilots to nationwide scale. The findings from this study can be used to inform other countries considering, introducing, or in the process of scaling an EIR or other digital health innovations. UR - http://www.jmir.org/2020/9/e19923/ UR - http://dx.doi.org/10.2196/19923 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960184 ID - info:doi/10.2196/19923 ER - TY - JOUR AU - Burns, Kara AU - Nicholas, Rebekah AU - Beatson, Amanda AU - Chamorro-Koc, Marianella AU - Blackler, Alethea AU - Gottlieb, Udo PY - 2020/9/22 TI - Identifying Mobile Health Engagement Stages: Interviews and Observations for Developing Brief Message Content JO - J Med Internet Res SP - e15307 VL - 22 IS - 9 KW - mobile health KW - text messaging KW - social media KW - mobile phone KW - health communication N2 - Background: Interest in mobile health (mHealth) has increased recently, and research suggests that mHealth devices can enhance end-user engagement, especially when used in conjunction with brief message content. Objective: This research aims to explore the stages of engagement framework for mHealth devices and develop a method to generate brief message content to promote sustained user engagement. This study uses the framework by O?Brien and Toms as a point of departure, where engagement is defined as the uptake or the use of an mHealth device. The framework is a linear repeatable process, including point of engagement, period of engagement, disengagement, and re-engagement. Each stage is characterized by attributes related to a person?s technology experience. Although the literature has identified stages of engagement for health-related technology, few studies explore mHealth engagement. Furthermore, little research has determined a method for creating brief message content at each stage in this engagement journey. Methods: Interviews and observations from 19 participants who used mHealth technologies (apps, devices, or wellness websites) in a solo capacity were recruited for sample group 1. In sample group 2, interviews, and observations from 25 participants using mHealth technologies in a group capacity through the Global Corporate Challenge were used. These samples were investigated at 3 time points in both research contexts. The results underwent deductive-inductive thematic analysis for the engagement stages? framework and attributes. Results: In addition to the 4 stages identified by O?Brien and Toms, 2 additional stages, self-management and limited engagement, were identified. Self-management captures where users had disengaged from their technology but were still engaged with their health activity. Limited engagement captures where group mHealth users had minimal interaction with their mHealth technology but continued to engage in a group fitness activity. The results revealed that mHealth engagement stages were nonlinear and embedded in a wider engagement context and that each stage was characterized by a combination of 49 attributes that could be organized into 8 themes. Themes documented the total user experience and included technology usability, technology features, technology aesthetics, use motivations, health awareness, goal setting, social support, and interruptions. Different themes were found to have more relevance at different engagement stages. Knowing themes and attributes at all engagement stages allows technology developers and health care professionals to generate relevant brief message content informed by a person-centered approach. Conclusions: This research extends an existing engagement stages framework and identifies attributes and themes relevant to mHealth technology users? total user experience and incorporates concepts derived from health, business studies, and information systems literature. In addition, we offer a practical 5-step process based on a person-centered approach to develop mHealth technology brief message content for sustained engagement. UR - http://www.jmir.org/2020/9/e15307/ UR - http://dx.doi.org/10.2196/15307 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960181 ID - info:doi/10.2196/15307 ER - TY - JOUR AU - Seppen, F. Bart AU - Wiegel, Jimmy AU - L'ami, J. Merel AU - Duarte dos Santos Rico, Sharon AU - Catarinella, S. Fabio AU - Turkstra, Franktien AU - Boers, Maarten AU - Bos, H. Wouter PY - 2020/9/21 TI - Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies JO - JMIR Form Res SP - e20165 VL - 4 IS - 9 KW - mHealth KW - eHealth KW - patient-reported outcome, smartphone app KW - rheumatoid arthritis KW - self-monitoring KW - telemonitoring KW - mobile phone N2 - Background: Several mobile apps that monitor symptoms of rheumatoid arthritis (RA) exist, but a recent systematic review indicated that high-quality apps are lacking. When patients self-monitor their own disease with patient-reported outcomes (PROs) and self-initiate care at the right moment, it may be possible to reduce the frequency of their clinic visits, which would reduce health care burden and costs. We developed an app, that is, the MijnReuma Reade app, for this purpose and performed 2 pilot tests with weekly self-monitoring. Objective: The primary objective of this study was to design, develop, and evaluate the usability, satisfaction, and usage of the MijnReuma Reade app?an app that allows patients with RA to monitor their own disease. The secondary objective was to review the patients? perspectives on app usage and its intended purpose. Methods: This app was designed in collaboration with patients with RA, rheumatologists, and information technology experts. Two 1-month pilot studies were performed, after which satisfaction (0-10 scale), usability (system usability scale, 0-100), and usage (proportion of completed questionnaires) of this app were assessed. After the second pilot study, semistructured interviews were performed to determine patients? perspectives and the promoters and barriers of app usage. Results: In the first and second pilot study, 42 and 27 patients were included, respectively. Overall, the patients were satisfied (medians, 8 and 7) and found the app usable (mean system usability scores, 76 and 71) in pilot studies 1 and 2, respectively. App usage declined over time in both the pilot studies; 61% (17/28) and 37% (10/27) of the patients who disclosed their usage statistics completed the final weekly questionnaire in pilot study 1 and pilot study 2, respectively. Approximately 81% (25/31) of the patients indicated they would like to skip hospital visits if the self-monitored disease activity is low. In the semistructured interviews, technical problems, internal resistance (respondent fatigue, the app reminded them of their disease), and a lack of symptoms were identified as barriers for usage. Patients reported that ?experiencing more grip on their disease? and ?improved communication with their physician? were promoters for usage. Patients reported that pain positively mediated usage, that is, more pain promoted and less pain discouraged app usage. Conclusions: This study illustrates the feasibility of the MijnReuma Reade app that enables self-monitoring of the disease activity in patients with RA with the overarching aim to allocate clinical consultations according to need. Satisfaction with the app and usability of the app were found to be high; however, app usage declined over time. Patients acknowledged the potential of the app to self-monitor their own disease and would like to be able to skip clinic visits if the monitored disease activity is low. To evaluate this strategy, a randomized controlled trial is underway. UR - http://formative.jmir.org/2020/9/e20165/ UR - http://dx.doi.org/10.2196/20165 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955447 ID - info:doi/10.2196/20165 ER - TY - JOUR AU - Yu, Yu AU - Li, Yilu AU - Li, Tongxin AU - Xi, Shijun AU - Xiao, Xi AU - Xiao, Shuiyuan AU - Tebes, Kraemer Jacob PY - 2020/9/18 TI - New Path to Recovery and Well-Being: Cross-Sectional Study on WeChat Use and Endorsement of WeChat-Based mHealth Among People Living With Schizophrenia in China JO - J Med Internet Res SP - e18663 VL - 22 IS - 9 KW - WeChat KW - mHealth KW - schizophrenia KW - China KW - symptoms KW - functioning KW - recovery KW - quality of life KW - well-being N2 - Background: The past few decades have seen an exponential increase in using mobile phones to support medical care (mobile health [mHealth]) among people living with psychosis worldwide, yet little is known about WeChat use and WeChat-based mHealth among people living with schizophrenia (PLS) in China. Objective: This study aims to assess WeChat use, endorsement of WeChat-based mHealth programs, and health related to WeChat use among PLS. Methods: We recruited a random sample of 400 PLS from 12 communities in Changsha City of Hunan Province, China. WeChat use was assessed using the adapted WeChat Use Intensity Questionnaire (WUIQ). We also compared psychiatric symptoms, functioning, disability, recovery, quality of life, and general well-being between WeChat users and nonusers using one-to-one propensity-score matching. Results: The WeChat use rate was 40.8% in this sample (163/400); 30.7% (50/163) had more than 50 WeChat friends and nearly half (81/163, 49.7%) spent more than half an hour on WeChat, a pattern similar to college students and the elderly. PLS also showed higher emotional connectedness to WeChat use than college students. About 80.4% (131/163) of PLS were willing to participate in a WeChat-based mHealth program, including psychoeducation (91/163, 55.8%), professional support (82/163, 50.3%), and peer support (67/163, 41.1%). Compared with nonusers, WeChat users were younger, better educated, and more likely to be employed. WeChat use was associated with improved health outcomes, including lower psychiatric symptoms, lower depression, higher functioning, better recovery, and higher quality of life. Conclusions: WeChat-based mHealth programs hold promise as an empowering tool to provide cost-effective interventions, to foster global recovery, and to improve both physical and mental well-being among PLS. WeChat and WeChat-based mHealth programs have the potential to offer a new path to recovery and well-being for PLS in China. UR - http://www.jmir.org/2020/9/e18663/ UR - http://dx.doi.org/10.2196/18663 UR - http://www.ncbi.nlm.nih.gov/pubmed/32945774 ID - info:doi/10.2196/18663 ER - TY - JOUR AU - Yan, Xiangyu AU - Su, Hexuan AU - Zhang, Bo AU - Li, Yongjie AU - Zhang, Lingling AU - Jia, Zhongwei PY - 2020/9/17 TI - Adherence of HIV Self-Testing Among Men Who Have Sex With Men in China: Longitudinal Study JO - J Med Internet Res SP - e19627 VL - 22 IS - 9 KW - HIV self-testing KW - adherence KW - men who have sex with men KW - HIV infection KW - condom use KW - mobile app N2 - Background: The World Health Organization recommended HIV self-testing (HIVST) for individuals practicing unsafe sexual behaviors; however, the adherence to HIV testing has not been reported. Objective: In this study, we attempted to determine the adherence to HIVST among men who have sex with men (MSM), as well as the impact factors and potential effects of their adherence. Methods: We conducted a longitudinal study among MSM in Harbin, Heilongjiang province, China from July 1, 2017 to June 30, 2018. A mobile app system was used to provide the ?Mailing rapid test reagent kit? for the HIVST service. The proportion of those who adhered to HIV testing every 3 months was calculated. Logistic regression was used to explore the impact factors related to adherence to HIVST. Rates of HIV infection between MSM who adhered to HIVST and those who did not were compared using Cox proportional hazards regression. Changes of condom use behaviors between the two groups were also compared using the chi-square test. Results: A total of 1315 MSM who received the HIVST service through the app were included in the study. Overall, 10% of the MSM adhered to HIVST, and the proportion of adhering tests was only 34.9%. Adherence of HIVST was associated with marital status (adjusted odds ratio [OR]unmarried vs married 2.31, 95% CI 1.13-4.71) and the number of HIV tests they received (adjusted OR3 times vs 2 times or below 3.36, 95% CI 2.01-5.63; adjusted OR4 times or above vs 2 times or below 7.30, 95% CI 4.67-11.42). Twenty HIV seroconversions were observed during 1-year follow up. The rate of HIV infection in the adherence group (17.10 per 100 person years, 95% CI 8.80-30.84) was significantly higher than that in the nonadherence group (4.80 per 100 person years, 95% CI 2.77-7.88; adjusted hazard ratio 3.33, 95% CI 1.35-8.20). Those who adhered to HIV testing were more likely to improve condom use behaviors, although the difference was not statistically significant. Conclusions: Regular HIV testing is necessary for early detection of HIV infection among MSM. Given the poor adherence, a new internet-based management paradigm for MSM is needed to raise their health awareness to optimize the implementation of HIVST. UR - http://www.jmir.org/2020/9/e19627/ UR - http://dx.doi.org/10.2196/19627 UR - http://www.ncbi.nlm.nih.gov/pubmed/32940619 ID - info:doi/10.2196/19627 ER - TY - JOUR AU - Zaidi, Shehla AU - Kazi, Momin Abdul AU - Riaz, Atif AU - Ali, Ammarah AU - Najmi, Rabia AU - Jabeen, Rawshan AU - Khudadad, Umerdad AU - Sayani, Saleem PY - 2020/9/17 TI - Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study JO - J Med Internet Res SP - e18414 VL - 22 IS - 9 KW - mHealth KW - community health workers KW - usability KW - usefulness KW - task-technology fit N2 - Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan. Objective: Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems. Methods: The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis. Results: Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants. Conclusions: The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology. UR - http://www.jmir.org/2020/9/e18414/ UR - http://dx.doi.org/10.2196/18414 UR - http://www.ncbi.nlm.nih.gov/pubmed/32940612 ID - info:doi/10.2196/18414 ER - TY - JOUR AU - Acharya, Ajay AU - Cunningham, Kenda AU - Manandhar, Shraddha AU - Shrestha, Niva AU - Chen, Mario AU - Weissman, Amy PY - 2020/9/11 TI - Exploring the Use of Mobile Health to Improve Community-Based Health and Nutrition Service Utilization in the Hills of Nepal: Qualitative Study JO - J Med Internet Res SP - e17659 VL - 22 IS - 9 KW - mobile health KW - text messages KW - SMS text message KW - qualitative study KW - Nepal KW - health and nutrition services KW - health mothers? group KW - female community health volunteers KW - mobile phone N2 - Background: With mobile phone coverage and ownership expanding globally, mobile health (mHealth) interventions are increasingly being used to improve coverage and quality of health and nutrition services. However, evidence on mHealth intervention feasibility and factors to consider during program design is limited in low- and middle-income countries like Nepal. Objective: This study aimed to examine the potential of using text messages to improve health and nutrition services by exploring mobile phone ownership and sharing; mobile phone use and skills; and interest, preferences, and limitations regarding mHealth interventions. Methods: We conducted 35 in-depth interviews with 1000-day women (the period from conception to a child?s second birthday), health facility staff, and female community health volunteers (FCHVs), as well as eight focus group discussions with health facility staff, FCHVs, and 1000-day household decision-makers (ie, husbands, mothers-in-law, and fathers-in-law). We also conducted a mobile phone skills test. We employed thematic analysis using framework matrices and analytical memos. Results: The study included 70 study participants, of whom 68 (97%) had a mobile phone, and phone sharing was uncommon. Use of text messages was most commonly reported by 1000-day women and health facility staff than household decision-makers and FCHVs. More than 8 in 10 participants (54/64, 84%) could dial numbers, and the majority (28/34, 82%) of 1000-day women, health facility staff, and male decision-makers could also read and write text messages. We found that 1000-day women preferred educational and reminder messages, whereas health facility staff and FCHVs desired educational and motivational messages. Participants suggested different types of texts for 1000-day women, families, FCHVs, and health facility staff, and reported less value for texts received from unknown phone numbers. Conclusions: A text message?based mHealth intervention is acceptable in the hills of Nepal and has the potential to improve community health and nutrition service utilization, particularly by sending meeting reminders and by providing information. Our findings contribute to text message?based mHealth intervention design in under-resourced settings. UR - http://www.jmir.org/2020/9/e17659/ UR - http://dx.doi.org/10.2196/17659 UR - http://www.ncbi.nlm.nih.gov/pubmed/32915151 ID - info:doi/10.2196/17659 ER - TY - JOUR AU - Askari, Marjan AU - Klaver, Sabine Nicky AU - van Gestel, Johannes Thimon AU - van de Klundert, Joris PY - 2020/9/4 TI - Intention to use Medical Apps Among Older Adults in the Netherlands: Cross-Sectional Study JO - J Med Internet Res SP - e18080 VL - 22 IS - 9 KW - Senior Technology Acceptance Model KW - intention to use KW - elderly KW - older adults KW - medical apps KW - mHealth KW - adoption N2 - Background: The increasing health service demand driven by the aging of the global population calls for the development of modes of health service delivery that are less human resource?intensive. Electronic health (eHealth) and medical apps are expected to play an important role in this development. Although evidence shows mobile medical apps might be effective in improving the care, self-management, self-efficacy, health-related behavior, and medication adherence of older adults, little is known about older adults? intention to use these technologies when needed, or the factors influencing this intention. Objective: The objective of this study was to investigate the relationship of technology acceptance factors and intention to use mobile medical apps among community-dwelling older adults. Methods: Data was collected using questionnaires. The factors selected from the literature have been validated using Cronbach ? and tested for significance using logistic regressions. Results: Almost half (49.7%) of the included older adults reported no intention to use medical apps. Adjusted logistic regression analysis per factor showed that the factors Attitude toward use (odds ratio [OR] 8.50), Perceived usefulness (OR 5.25), Perceived ease of use (OR 4.22), Service availability (OR 3.46), Sense of control (OR 3.40), Self-perceived effectiveness (OR 2.69), Facilities (OR 2.45), Personal innovativeness (OR 2.08), Social relationships (OR 1.79), Subjective norm (OR 1.48), and Feelings of anxiety (OR 0.62) significantly influenced the intention to use mobile medical apps among older adults, whereas the factor Finance (OR 0.98) did not. When considered together, a controlled multivariate logistic regression yielded high explained variances of 0.542 (Cox-Snell R2) and 0.728 (Nagelkerke R2). Conclusions: The high odds ratios and explained variance indicate that the factors associated with the intention to use medical apps are largely understood and the most important factors have been identified. To advance the evidence base, experimental controlled research should investigate the causality between the factors, intention to use, and actual use. For this purpose, our evidence suggests that policies designed to improve Attitude toward use appear most effective, followed by policies addressing Perceived usefulness, Perceived ease of use, Service availability, and Sense of control. UR - https://www.jmir.org/2020/9/e18080 UR - http://dx.doi.org/10.2196/18080 UR - http://www.ncbi.nlm.nih.gov/pubmed/32624465 ID - info:doi/10.2196/18080 ER - TY - JOUR AU - Camacho, Erica AU - Hoffman, Liza AU - Lagan, Sarah AU - Rodriguez-Villa, Elena AU - Rauseo-Ricupero, Natali AU - Wisniewski, Hannah AU - Henson, Philip AU - Torous, John PY - 2020/8/27 TI - Technology Evaluation and Assessment Criteria for Health Apps (TEACH-Apps): Pilot Study JO - J Med Internet Res SP - e18346 VL - 22 IS - 8 KW - app KW - mobile phones KW - smartphones KW - app evaluation KW - technology N2 - Background: Despite the emergence of app evaluation tools, there remains no well-defined process receptive to diverse local needs, rigorous standards, and current content. The need for such a process to assist in the implementation of app evaluation across all medical fields is evident. Such a process has the potential to increase stakeholder engagement and catalyze interest and engagement with present-day app evaluation models. Objective: This study aimed to develop and pilot test the Technology Evaluation and Assessment Criteria for Health apps (TEACH-apps). Methods: Tailoring a well-known implementation framework, Replicating Effective Programs, we present a new process to approach the challenges faced in implementing app evaluation tools today. As a culmination of our experience implementing this process and feedback from stakeholders, we present the four-part process to aid the implementation of mobile health technology. This paper outlines the theory, evidence, and initial versions of the process. Results: The TEACH-apps process is designed to be broadly usable and widely applicable across all fields of health. The process comprises four parts: (1) preconditions (eg, gathering apps and considering local needs), (2) preimplementation (eg, customizing criteria and offering digital skills training), (3) implementation (eg, evaluating apps and creating educational handouts), and (4) maintenance and evolution (eg, repeating the process every 90 days and updating content). TEACH-apps has been tested internally at our hospital, and there is growing interest in partnering health care facilities to test the system at their sites. Conclusions: This implementation framework introduces a process that equips stakeholders, clinicians, and users with the foundational tools to make informed decisions around app use and increase app evaluation engagement. The application of this process may lead to the selection of more culturally appropriate and clinically relevant tools in health care. UR - https://www.jmir.org/2020/8/e18346 UR - http://dx.doi.org/10.2196/18346 UR - http://www.ncbi.nlm.nih.gov/pubmed/32535548 ID - info:doi/10.2196/18346 ER - TY - JOUR AU - Tanue, Asangbeng Elvis AU - Nsagha, Shey Dickson AU - Theophile, Njamen Nana AU - Assob, Nguedia Jules Clement PY - 2020/8/27 TI - Improving Retention in Care and Promoting Adherence to HIV Treatment: Protocol for a Multisite Randomized Controlled Trial of Mobile Phone Text Messaging JO - JMIR Res Protoc SP - e15680 VL - 9 IS - 8 KW - adherence KW - antiretroviral KW - HIV KW - randomized controlled trial KW - retention in care KW - text messaging N2 - Background: The World Health Organization has prioritized the use of new technologies to assist in health care delivery in resource-limited settings. Findings suggest that the use of SMS on mobile phones is an advantageous application in health care delivery, especially in communities with an increasing use of this device. Objective: The main aim of this trial is to assess whether sending weekly motivational text messages (SMS) through mobile phones versus no text messaging will improve retention in care and promote adherence to treatment and health outcomes among patients receiving HIV treatment in Fako Division of Cameroon. Methods: This is a multisite randomized controlled single-blinded trial. Computer-generated random block sizes shall be used to produce a randomization list. Participants shall be randomly allocated into the intervention and control groups determined by serially numbered sealed opaque envelopes. The 156 participants will either receive the mobile phone text message or usual standard of care. We hypothesize that sending weekly motivational SMS reminders will produce a change in behavior to enhance retention; treatment adherence; and, hence, health outcomes. Participants shall be evaluated and data collected at baseline and then at 2, 4, and 6 months after the launch of the intervention. Text messages shall be sent out, and the delivery will be recorded. Primary outcome measures are retention in care and adherence to treatment. Secondary outcomes are clinical (weight, body mass index), biological (virologic suppression, tuberculosis coinfection), quality of life, treatment discontinuation, and mortality. The analysis shall be by intention-to-treat. Analysis of covariates shall be performed to determine factors influencing outcomes. Results: Recruitment and random allocation are complete; 160 participants were allocated into 3 groups (52 in the single SMS, 55 in the double SMS, and 53 in the control). Data collection and analysis are ongoing, and statistical results will be available by the end of August 2019. Conclusions: The interventions will contribute to an improved understanding of which intervention types can be feasible in improving retention in care and promoting adherence to antiretroviral therapy. Trial Registration: Pan African Clinical Trial Registry in South Africa PACTR201802003035922; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3035 International Registered Report Identifier (IRRID): DERR1-10.2196/15680 UR - http://www.researchprotocols.org/2020/8/e15680/ UR - http://dx.doi.org/10.2196/15680 UR - http://www.ncbi.nlm.nih.gov/pubmed/32852282 ID - info:doi/10.2196/15680 ER - TY - JOUR AU - Iio, Misa AU - Miyaji, Yumiko AU - Yamamoto-Hanada, Kiwako AU - Narita, Masami AU - Nagata, Mayumi AU - Ohya, Yukihiro PY - 2020/8/24 TI - Beneficial Features of a mHealth Asthma App for Children and Caregivers: Qualitative Study JO - JMIR Mhealth Uhealth SP - e18506 VL - 8 IS - 8 KW - children KW - caregivers KW - asthma KW - mobile app KW - proposed beneficial features N2 - Background: mHealth and uHealth apps are available for children with asthma and their caregivers. However, previous studies on mHealth apps for children older than 7 years old with asthma are limited, and most studies on asthma apps do not consider interactions involving communication between children and caregivers. Therefore, a prototype mHealth child asthma app was developed for children and their caregivers, with features of tailored feedback messages in continuing self-management and interactions between children and caregivers. Objective: The aim of this study was to identify the beneficial features of a prototype mHealth app developed for children with asthma and their caregivers. Methods: Children diagnosed with persistent asthma by allergy specialists at the National Center for Child Health and Development were recruited. The features of a prototype mHealth app for children with asthma and their caregivers were investigated using semistructured interviews after they tried the app. Data were analyzed using thematic analysis. Content-characteristic words were named and grouped together as categories to explore themes. Results: We recruited 27 children with asthma aged 2 to 12 years and 26 their caregivers. Findings on the good aspects of the app for children older than 7 years old and caregivers suggested 4 themes (confirmation of asthma knowledge, child-caregiver interaction, design of the app, and child?s interest), and 6 categories were identified. Findings on the good aspects of app for children 7 to 12 years old and caregivers suggested 5 themes (new knowledge, manga as a Japanese-style comic, child?s interest, trigger of self-management, and design and operability), and 11 categories were identified. Findings on the beneficial features of app suggested 6 themes (asthma knowledge, elements for continuous, universal design, notification, monitoring, and functions), and 12 categories were identified. Conclusions: Children with asthma and their caregivers perceived that the good aspects of the app were learning asthma knowledge with fun, including manga; interaction between child and caregiver; and easy-to-read design, such as colors. They wanted not only the asthma knowledge but also the universal design and enhanced elements, monitoring, and notification functions of the app. UR - http://mhealth.jmir.org/2020/8/e18506/ UR - http://dx.doi.org/10.2196/18506 UR - http://www.ncbi.nlm.nih.gov/pubmed/32831181 ID - info:doi/10.2196/18506 ER - TY - JOUR AU - Yin, Zenong AU - Errisuriz, L. Vanessa AU - Evans, Martin AU - Inupakutika, Devasena AU - Kaghyan, Sahak AU - Li, Shiyu AU - Esparza, Laura AU - Akopian, David AU - Parra-Medina, Deborah PY - 2020/8/20 TI - A Digital Health Intervention for Weight Management for Latino Families Living in Rural Communities: Perspectives and Lessons Learned During Development JO - JMIR Form Res SP - e20679 VL - 4 IS - 8 KW - mhealth KW - digital intervention KW - Latino families KW - rural population KW - weight KW - self-management KW - diet KW - lifestyle KW - chronic disease UR - http://formative.jmir.org/2020/8/e20679/ UR - http://dx.doi.org/10.2196/20679 UR - http://www.ncbi.nlm.nih.gov/pubmed/32726748 ID - info:doi/10.2196/20679 ER - TY - JOUR AU - Cheng, Chao AU - Ho, Hung Rainbow Tin AU - Guo, Yan AU - Zhu, Mengting AU - Yang, Weixiong AU - Li, Yiran AU - Liu, Zhenguo AU - Zhuo, Shuyu AU - Liang, Qi AU - Chen, Zhenghong AU - Zeng, Yu AU - Yang, Jiali AU - Zhang, Zhanfei AU - Zhang, Xu AU - Monroe-Wise, Aliza AU - Yeung, Sai-Ching PY - 2020/8/18 TI - Development and Feasibility of a Mobile Health?Supported Comprehensive Intervention Model (CIMmH) for Improving the Quality of Life of Patients With Esophageal Cancer After Esophagectomy: Prospective, Single-Arm, Nonrandomized Pilot Study JO - J Med Internet Res SP - e18946 VL - 22 IS - 8 KW - esophageal cancer KW - quality of life KW - nutrition KW - physical exercise KW - psychological support KW - mobile health KW - mHealth N2 - Background: Patients with esophageal cancer often experience clinically relevant deterioration of quality of life (QOL) after esophagectomy owing to malnutrition, lack of physical exercise, and psychological symptoms. Objective: This study aimed to evaluate the feasibility, safety, and efficacy of a comprehensive intervention model using a mobile health system (CIMmH) in patients with esophageal cancer after esophagectomy. Methods: Twenty patients with esophageal cancer undergoing the modified McKeown surgical procedure were invited to join the CIMmH program with both online and offline components for 12 weeks. The participants were assessed before surgery and again at 1 and 3 months after esophagectomy. QOL, depressive symptoms, anxiety, stress, nutrition, and physical fitness were measured. Results: Of the 20 patients, 16 (80%) completed the program. One month after esophagectomy, patients showed significant deterioration in overall QOL (P=.02), eating (P=.005), reflux (P=.04), and trouble with talking (P<.001). At the 3-month follow-up, except for pain (P=.02), difficulty with eating (P=.03), dry mouth (P=.04), and trouble with talking (P=.003), all other QOL dimensions returned to the preoperative level. There were significant reductions in weight (P<.001) and BMI (P=.02) throughout the study, and no significant changes were observed for physical fitness measured by change in the 6-minute walk distance between baseline and the 1-month follow-up (P=.22) or between baseline and the 3-month follow-up (P=.52). Depressive symptoms significantly increased 1 month after surgery (P<.001), while other psychological measures did not show relevant changes. Although there were declines in many measures 1 month after surgery, these were much improved at the 3-month follow-up, and the recovery was more profound and faster than with traditional rehabilitation programs. Conclusions: The CIMmH was feasible and safe and demonstrated encouraging efficacy testing with a control group for enhancing recovery after surgery among patients with esophageal cancer in China. Trial Registration: Chinese Clinical Trial Registry (ChiCTR-IPR-1800019900); http://www.chictr.org.cn/showprojen.aspx?proj=32811. UR - http://www.jmir.org/2020/8/e18946/ UR - http://dx.doi.org/10.2196/18946 UR - http://www.ncbi.nlm.nih.gov/pubmed/32808933 ID - info:doi/10.2196/18946 ER - TY - JOUR AU - Harada, Norihiro AU - Harada, Sonoko AU - Ito, Jun AU - Atsuta, Ryo AU - Hori, Satoshi AU - Takahashi, Kazuhisa PY - 2020/8/14 TI - Mobile Health App for Japanese Adult Patients With Asthma: Clinical Observational Study JO - J Med Internet Res SP - e19006 VL - 22 IS - 8 KW - asthma KW - cough variant asthma KW - mobile health KW - ResearchKit N2 - Background: Inappropriate asthma control reduces quality of life and causes increased exacerbations. Mobile health (mHealth) employs information and communication technology for surveying health-related issues. Objective: This noninterventional, observational study assessed current real-world asthma control levels among Japanese patients with asthma and cough variant asthma (CVA) using the Zensoku-Log app. Methods: We developed the app using the ResearchKit platform and conducted a mobile-based, self-reporting, observational survey among patients with asthma and CVA. The app was downloaded 7855 times between February 2016 and February 2018, and enabled collection of data on symptoms, comorbidities, quality of life, medications, asthma control, and adherence. Results: Of the 1744 eligible participants (median age 33 years; range 20-74 years; male-to-female ratio 38.7:61.3), 50.97% (889/1744) reported unscheduled visits, 62.84% (1096/1744) reported regularly scheduled visits, 23.14% (402/1737) smoked, and 40.75% (705/1730) had pets. In addition, 91.89% (1598/1739) of participants had atopic predisposition, including allergic rhinitis and atopic dermatitis. Daily inhaled corticosteroid and oral corticosteroid treatment had been prescribed for 89.45% (1552/1735) and 22.07% (383/1735) of participants, respectively. Although an asthma control questionnaire demonstrated poor asthma control in 58.48% (1010/1727), a leukotriene receptor antagonist, theophylline, and a long-acting muscarinic antagonist had been prescribed for only 30.66% (532/1735), 15.91% (276/1735), and 4.38% (76/1735), respectively. The Adherence Starts with Knowledge 12 total score was 29. In the 421 participants who repeated the questionnaire, asthma control increased significantly between the initial and last rounds (P=.002). Conclusions: Users of this mHealth app in Japan had poorly controlled asthma and may need more treatment for asthma and their comorbidities. Repeated app users demonstrated improved asthma control. Trial Registration: UMIN Clinical Trial Registry UMIN000021043; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023913. UR - https://www.jmir.org/2020/8/e19006 UR - http://dx.doi.org/10.2196/19006 UR - http://www.ncbi.nlm.nih.gov/pubmed/32795993 ID - info:doi/10.2196/19006 ER - TY - JOUR AU - Lewis, Shon AU - Ainsworth, John AU - Sanders, Caroline AU - Stockton-Powdrell, Charlotte AU - Machin, Matthew AU - Whelan, Pauline AU - Hopkins, Richard AU - He, Zhimin AU - Applegate, Eve AU - Drake, Richard AU - Bamford, Charlie AU - Roberts, Chris AU - Wykes, Til PY - 2020/8/13 TI - Smartphone-Enhanced Symptom Management In Psychosis: Open, Randomized Controlled Trial JO - J Med Internet Res SP - e17019 VL - 22 IS - 8 KW - digital KW - smartphone KW - m-health KW - psychosis KW - mental health KW - self management N2 - Background: Improving recovery from acute symptoms and preventing relapse are two significant challenges in severe mental illness. We developed a personalized smartphone-based app to monitor symptoms in real time and validated its acceptance, reliability, and validity. Objective: To assess (i) acceptability of continuous monitoring to SMI patients and health professionals over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; and (iii) the feasibility of detecting early warning signs of relapse. Methods: The active symptom monitoring smartphone app was built into an end-to-end system in two NHS Trusts to enable real-time symptom self-monitoring and detection by the clinical team of early signs of relapse in people with severe mental illness. We conducted an open randomized controlled trial of active symptom monitoring compared to usual management to assess: (i) acceptability and safety of continuous monitoring over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; (iii) feasibility of detecting early warning signs of relapse communicated to the healthcare staff via an app streaming data to the electronic health record. Eligible participants with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnosis of schizophrenia and related disorders, and a history of relapse within the previous two years were enrolled from an early intervention team and a community mental health team. Results: Of 181 eligible patients, 81 (45%) consented and were randomized to either active symptom monitoring or management as usual. At 12 weeks, 90% (33/36) of those in the active monitoring group continued to use the system and exhibited an adherence rate (defined as responding to >33% of alerts) of 84% (30/36}. Active symptom monitoring was associated with no difference on the empowerment scale in comparison to the usual management group at 12 weeks. The pre-planned intent-to-treat analysis of the primary outcome, a positive score on the Positive and Negative Syndrome Scale (PANSS) scale, showed a significant reduction in the active symptom monitoring group over 12 weeks in the early intervention center. Alerts for personalized early warning signs of relapse were built into the workflows of both NHS Trusts, and 100% of health professional staff used the system in a new digital workflow. Qualitative analyses supported the acceptability of the system to participants and staff. Conclusions: The active smartphone monitoring system is feasible and was accepted by users in a 3-month study of people with severe mental illness, with surprisingly high levels of adherence. App use was associated with psychotic symptom improvement in recent-onset participants, but not those with longstanding illness, supporting the notion of improved self-management. When built into clinical management workflows to enable personalized alerts of symptom deterioration, the app has demonstrated utility in promoting earlier intervention for relapse. Trial Registration: ISRCTN Registry ISRCTN88145142; http://www.isrctn.com/ISRCTN88145142 UR - https://www.jmir.org/2020/8/e17019 UR - http://dx.doi.org/10.2196/17019 UR - http://www.ncbi.nlm.nih.gov/pubmed/32788150 ID - info:doi/10.2196/17019 ER - TY - JOUR AU - Betthauser, M. Lisa AU - Stearns-Yoder, A. Kelly AU - McGarity, Suzanne AU - Smith, Victoria AU - Place, Skyler AU - Brenner, A. Lisa PY - 2020/8/11 TI - Mobile App for Mental Health Monitoring and Clinical Outreach in Veterans: Mixed Methods Feasibility and Acceptability Study JO - J Med Internet Res SP - e15506 VL - 22 IS - 8 KW - veterans KW - mobile app KW - smartphone KW - mental health KW - acceptability KW - feasibility N2 - Background: Advances in mobile health (mHealth) technology have made it possible for patients and health care providers to monitor and track behavioral health symptoms in real time. Ideally, mHealth apps include both passive and interactive monitoring and demonstrate high levels of patient engagement. Digital phenotyping, the measurement of individual technology usage, provides insight into individual behaviors associated with mental health. Objective: Researchers at a Veterans Affairs Medical Center and Cogito Corporation sought to explore the feasibility and acceptability of an mHealth app, the Cogito Companion. Methods: A mixed methodological approach was used to investigate the feasibility and acceptability of the app. Veterans completed clinical interviews and self-report measures, at baseline and at a 3-month follow-up. During the data collection period, participants were provided access to the Cogito Companion smartphone app. The mobile app gathered passive and active behavioral health indicators. Data collected (eg, vocal features and digital phenotyping of everyday social signals) are analyzed in real time. Passive data collected include location via global positioning system (GPS), phone calls, and SMS text message metadata. Four primary model scores were identified as being predictive of the presence or absence of depression or posttraumatic stress disorder (PTSD). Veterans Affairs clinicians monitored a provider dashboard and conducted clinical outreach when indicated. Results: Findings suggest that use of the Cogito Companion app was feasible and acceptable. Veterans (n=83) were interested in and used the app; however, active use declined over time. Nonetheless, data were passively collected, and outreach occurred throughout the study period. On the Client Satisfaction Questionnaire?8, 79% (53/67) of the sample reported scores demonstrating acceptability of the app (mean 26.2, SD 4.3). Many veterans reported liking specific app features (day-to-day monitoring) and the sense of connection they felt with the study clinicians who conducted outreach. Only a small percentage (4/67, 6%) reported concerns regarding personal privacy. Conclusions: Feasibility and acceptability of the Cogito Corporation platform to monitor mental health symptoms, behaviors, and facilitate follow-up in a sample of veterans were supported. Clinically, platforms such as the Cogito Companion system may serve as useful methods to promote monitoring, thereby facilitating early identification of risk and mitigating negative psychiatric outcomes, such as suicide. UR - https://www.jmir.org/2020/8/e15506 UR - http://dx.doi.org/10.2196/15506 UR - http://www.ncbi.nlm.nih.gov/pubmed/32779572 ID - info:doi/10.2196/15506 ER - TY - JOUR AU - Crafoord, Marie-Therése AU - Fjell, Maria AU - Sundberg, Kay AU - Nilsson, Marie AU - Langius-Eklöf, Ann PY - 2020/8/10 TI - Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer: Mixed Methods Study JO - J Med Internet Res SP - e17058 VL - 22 IS - 8 KW - engagement KW - adherence KW - mHealth KW - mobile app KW - cancer supportive care KW - symptom management KW - usage metrics KW - breast cancer KW - prostate cancer N2 - Background: Using mobile technology for symptom management and self-care can improve patient-clinician communication and clinical outcomes in patients with cancer. The interactive app Interaktor has been shown to reduce symptom burden during cancer treatment. It includes symptom assessment, an alert system for contact with health care professionals, access to self-care advice, and visualization of symptom history. It is essential to understand how digital interventions operate; one approach is to examine engagement by assessing usage and exploring user experiences. Actual usage in relation to the intended use?adherence?is an essential factor of engagement. Objective: This study aimed to describe engagement with the Interaktor app among patients with breast or prostate cancer during treatment. Methods: Patients from the intervention groups of two separate randomized controlled trials were included: patients with breast cancer receiving neoadjuvant chemotherapy (n=74) and patients with locally advanced prostate cancer receiving treatment with radiotherapy (n=75). The patients reported their symptoms daily. Sociodemographic and clinical data were obtained from baseline questionnaires and medical records. Logged data usage was retrieved from the server and analyzed descriptively and with multiple regression analysis. Telephone interviews were conducted with patients about their perceptions of using the app and analyzed using content analysis. Results: The median adherence percentage to daily symptom reporting was 83%. Most patients used the self-care advice and free text message component. Among the patients treated for breast cancer, higher age predicted a lower total number of free text messages sent (P=.04). Among the patients treated for prostate cancer, higher age (P=.01) and higher education level (P=.04), predicted an increase in total views on self-care advice, while higher comorbidity (P=.004) predicted a decrease in total views on self-care advice. Being married or living with a partner predicted a higher adherence to daily symptom reporting (P=.02). Daily symptom reporting created feelings of having continuous contact with health care professionals, being acknowledged, and safe. Being contacted by a nurse after a symptom alert was considered convenient and highly valued. Treatment and time-related aspects influenced engagement. Daily symptom reporting was perceived as particularly meaningful at the beginning of treatment. Requests were made for advice on diet and psychological symptoms, as well as for more comprehensive and detailed information as the patient progressed through treatment. Conclusions: Patient engagement in the interactive app Interaktor was high. The app promoted patient participation in their care through continuous and convenient contact with health care professionals. The predictive ability of demographic variables differed between patient groups, but higher age and a higher educational level predicted usage of specific app functions for both patient groups. Patients? experience of relevance and interactivity influenced their engagement positively. UR - https://www.jmir.org/2020/8/e17058 UR - http://dx.doi.org/10.2196/17058 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663140 ID - info:doi/10.2196/17058 ER - TY - JOUR AU - Brower, Jacob AU - LaBarge, C. Monica AU - White, Lauren AU - Mitchell, S. Marc PY - 2020/8/10 TI - Examining Responsiveness to an Incentive-Based Mobile Health App: Longitudinal Observational Study JO - J Med Internet Res SP - e16797 VL - 22 IS - 8 KW - mHealth KW - behavioral economics KW - public health KW - incentives KW - mobile apps KW - mobile phone N2 - Background: The Carrot Rewards app was developed as part of a public-private partnership to reward Canadians with loyalty points for downloading the app, referring friends, completing educational health quizzes, and health-related behaviors with long-term objectives of increasing health knowledge and encouraging healthy behaviors. During the first 3 months after program rollout in British Columbia, a number of program design elements were adjusted, creating observed differences between groups of users with respect to the potential impact of program features on user engagement levels. Objective: This study examines the impact of reducing reward size over time and explored the influence of other program features such as quiz timing, health intervention content, and type of reward program on user engagement with a mobile health (mHealth) app. Methods: Participants in this longitudinal, nonexperimental observational study included British Columbia citizens who downloaded the app between March and July 2016. A regression methodology was used to examine the impact of changes to several program design features on quiz offer acceptance and engagement with this mHealth app. Results: Our results, based on the longitudinal app use of 54,917 users (mean age 35, SD 13.2 years; 65.03% [35,647/54,917] female), indicated that the key drivers of the likelihood of continued user engagement, in order of greatest to least impact, were (1) type of rewards earned by users (eg, movies [+355%; P<.001], air travel [+210%; P<.001], and grocery [+140%; P<.001] relative to gas), (2) time delay between early offers (?64%; P<.001), (3) the content of the health intervention (eg, healthy eating [?10%; P<.001] vs exercise [+20%, P<.001] relative to health risk assessments), and (4) changes in the number of points offered. Our results demonstrate that reducing the number of points associated with a particular quiz by 10% only led to a 1% decrease in the likelihood of offer response (P<.001) and that each of the other design features had larger impacts on participant retention than did changes in the number of points. Conclusions: The results of this study demonstrate that this program, built around the principles of behavioral economics in the form of the ongoing awarding of a small number of reward points instantly following the completion of health interventions, was able to drive significantly higher engagement levels than those demonstrated in previous literature exploring the intersection of mHealth apps and financial incentives. Previous studies have demonstrated the presence of incentive matters to user engagement; however, our results indicate that the number of points offered for these reward point?based health interventions is less important than other program design features such as the type of reward points being offered, the timing of intervention and reward offers, and the content of the health interventions in driving continued engagement by users. UR - https://www.jmir.org/2020/8/e16797 UR - http://dx.doi.org/10.2196/16797 UR - http://www.ncbi.nlm.nih.gov/pubmed/32773371 ID - info:doi/10.2196/16797 ER - TY - JOUR AU - Dauphin, Cassy AU - Clark, Nikia AU - Cadzow, Renee AU - Saad-Harfouche, Frances AU - Rodriguez, Elisa AU - Glaser, Kathryn AU - Kiviniemi, Marc AU - Keller, Maria AU - Erwin, Deborah PY - 2020/8/10 TI - #BlackBreastsMatter: Process Evaluation of Recruitment and Engagement of Pregnant African American Women for a Social Media Intervention Study to Increase Breastfeeding JO - J Med Internet Res SP - e16239 VL - 22 IS - 8 KW - breastfeeding KW - breast cancer education KW - African American mothers KW - Facebook KW - mobile phone, social media N2 - Background: In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children. Objective: This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates. Methods: This pilot study is conducted in collaboration with a local Women, Infants, and Children (WIC) organization and hospital and prenatal clinics of a local health care network. To engage African American women to enroll in the study, several methods and monitoring processes were explored, including WIC electronic text-based messages sent out to all phones of current WIC recipients (referred to as e-blasts); keyword responses to texts from flyers and posters in local community-based organizations, hospitals, and prenatal clinics; keyword responses using electronic links posted in established Facebook groups; and snowball recruitment of other pregnant women by current participants through Facebook. Once enrolled, participants were randomized to 2 study conditions: (1) an intervention group receiving messages about breast cancer risk reduction and breastfeeding or (2) a control group receiving breastfeeding-only messages. Data were obtained through electronic monitoring, SurveyMonkey, qualitative responses on Facebook, focus groups, and interviews. Results: More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages. Conclusions: This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool. Trial Registration: ClinicalTrials.gov NCT03680235; https://clinicaltrials.gov/ct2/show/NCT03680235 UR - https://www.jmir.org/2020/8/e16239 UR - http://dx.doi.org/10.2196/16239 UR - http://www.ncbi.nlm.nih.gov/pubmed/32773377 ID - info:doi/10.2196/16239 ER - TY - JOUR AU - John Leon Singh, Hanson AU - Couch, Danielle AU - Yap, Kevin PY - 2020/8/6 TI - Mobile Health Apps That Help With COVID-19 Management: Scoping Review JO - JMIR Nursing SP - e20596 VL - 3 IS - 1 KW - COVID-19 KW - mobile apps KW - mHealth KW - contact tracing KW - symptom monitoring KW - information provision KW - mobile health N2 - Background: Mobile health (mHealth) apps have played an important role in mitigating the coronavirus disease (COVID-19) response. However, there is no resource that provides a holistic picture of the available mHealth apps that have been developed to combat this pandemic. Objective: Our aim is to scope the evidence base on apps that were developed in response to COVID-19. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, literature searches were conducted on Google Search, Google Scholar, and PubMed using the country?s name as keywords and ?coronavirus,? ?COVID-19,? ?nCOV19,? ?contact tracing,? ?information providing apps,? ?symptom tracking,? ?mobile apps,? ?mobile applications,? ?smartphone,? ?mobile phone,? and ?mHealth.? Countries most affected by COVID-19 and those that first rolled out COVID-19?related apps were included. Results: A total of 46 articles were reviewed from 19 countries, resulting in a total of 29 apps. Among them, 15 (52%) apps were on contact tracing, 7 (24%) apps on quarantine, 7 (24%) on symptom monitoring, and 1 (3%) on information provision. More than half (n=20, 69%) were from governmental sources, only 3 (10%) were from private organizations, and 3 (10%) from universities. There were 6 (21%) apps available on either Android or iOS, and 10 (34%) were available on both platforms. Bluetooth was used in 10 (34%) apps for collecting data, 12 (41%) apps used GPS, and 12 (41%) used other forms of data collection. Conclusions: This review identifies that the majority of COVID-19 apps were for contact tracing and symptom monitoring. However, these apps are effective only if taken up by the community. The sharing of good practices across different countries can enable governments to learn from each other and develop effective strategies to combat and manage this pandemic. UR - https://nursing.jmir.org/2020/1/e20596/ UR - http://dx.doi.org/10.2196/20596 UR - http://www.ncbi.nlm.nih.gov/pubmed/32897271 ID - info:doi/10.2196/20596 ER - TY - JOUR AU - Damschroder, J. Laura AU - Buis, R. Lorraine AU - McCant, A. Felicia AU - Kim, Myra Hyungjin AU - Evans, Richard AU - Oddone, Z. Eugene AU - Bastian, A. Lori AU - Hooks, Gwendolyn AU - Kadri, Reema AU - White-Clark, Courtney AU - Richardson, R. Caroline AU - Gierisch, M. Jennifer PY - 2020/8/4 TI - Effect of Adding Telephone-Based Brief Coaching to an mHealth App (Stay Strong) for Promoting Physical Activity Among Veterans: Randomized Controlled Trial JO - J Med Internet Res SP - e19216 VL - 22 IS - 8 KW - exercise KW - veterans KW - smartphones KW - wearable physical activity tracker KW - behavior change KW - mobile phone KW - online KW - app KW - mobile app KW - wearable N2 - Background: Though maintaining physical conditioning and a healthy weight are requirements of active military duty, many US veterans lose conditioning and rapidly gain weight after discharge from active duty service. Mobile health (mHealth) interventions using wearable devices are appealing to users and can be effective especially with personalized coaching support. We developed Stay Strong, a mobile app tailored to US veterans, to promote physical activity using a wrist-worn physical activity tracker, a Bluetooth-enabled scale, and an app-based dashboard. We tested whether adding personalized coaching components (Stay Strong+Coaching) would improve physical activity compared to Stay Strong alone. Objective: The goal of this study is to compare 12-month outcomes from Stay Strong alone versus Stay Strong+Coaching. Methods: Participants (n=357) were recruited from a national random sample of US veterans of recent wars and randomly assigned to the Stay Strong app alone (n=179) or Stay Strong+Coaching (n=178); both programs lasted 12 months. Personalized coaching components for Stay Strong+Coaching comprised of automated in-app motivational messages (3 per week), telephone-based human health coaching (up to 3 calls), and personalized weekly goal setting. All aspects of the enrollment process and program delivery were accomplished virtually for both groups, except for the telephone-based coaching. The primary outcome was change in physical activity at 12 months postbaseline, measured by average weekly Active Minutes, captured by the Fitbit Charge 2 device. Secondary outcomes included changes in step counts, weight, and patient activation. Results: The average age of participants was 39.8 (SD 8.7) years, and 25.2% (90/357) were female. Active Minutes decreased from baseline to 12 months for both groups (P<.001) with no between-group differences at 6 months (P=.82) or 12 months (P=.98). However, at 12 months, many participants in both groups did not record Active Minutes, leading to missing data in 67.0% (120/179) for Stay Strong and 61.8% (110/178) for Stay Strong+Coaching. Average baseline weight for participants in Stay Strong and Stay Strong+Coaching was 214 lbs and 198 lbs, respectively, with no difference at baseline (P=.54) or at 6 months (P=.28) or 12 months (P=.18) postbaseline based on administrative weights, which had lower rates of missing data. Changes in the number of steps recorded and patient activation also did not differ by arm. Conclusions: Adding personalized health coaching comprised of in-app automated messages, up to 3 coaching calls, plus automated weekly personalized goals, did not improve levels of physical activity compared to using a smartphone app alone. Physical activity in both groups decreased over time. Sustaining long-term adherence and engagement in this mHealth intervention proved difficult; approximately two-thirds of the trial?s 357 participants failed to sync their Fitbit device at 12 months and, thus, were lost to follow-up. Trial Registration: ClinicalTrials.gov NCT02360293; https://clinicaltrials.gov/ct2/show/NCT02360293 International Registered Report Identifier (IRRID): RR2-10.2196/12526 UR - http://www.jmir.org/2020/8/e19216/ UR - http://dx.doi.org/10.2196/19216 UR - http://www.ncbi.nlm.nih.gov/pubmed/32687474 ID - info:doi/10.2196/19216 ER - TY - JOUR AU - Llorens-Vernet, Pere AU - Miró, Jordi PY - 2020/7/31 TI - The Mobile App Development and Assessment Guide (MAG): Delphi-Based Validity Study JO - JMIR Mhealth Uhealth SP - e17760 VL - 8 IS - 7 KW - assessment KW - Delphi method KW - MAG KW - mobile apps KW - mobile health KW - validity KW - guide N2 - Background: In recent years, there has been an exponential growth of mobile health (mHealth)?related apps. This has occurred in a somewhat unsupervised manner. Therefore, having a set of criteria that could be used by all stakeholders to guide the development process and the assessment of the quality of the apps is of most importance. Objective: The aim of this paper is to study the validity of the Mobile App Development and Assessment Guide (MAG), a guide recently created to help stakeholders develop and assess mobile health apps. Methods: To conduct a validation process of the MAG, we used the Delphi method to reach a consensus among participating stakeholders. We identified 158 potential participants: 45 patients as potential end users, 41 health care professionals, and 72 developers. We sent participants an online survey and asked them to rate how important they considered each item in the guide to be on a scale from 0 to 10. Two rounds were enough to reach consensus. Results: In the first round, almost one-third (n=42) of those invited participated, and half of those (n=24) also participated in the second round. Most items in the guide were found to be important to a quality mHealth-related app; a total of 48 criteria were established as important. ?Privacy,? ?security,? and ?usability? were the categories that included most of the important criteria. Conclusions: The data supports the validity of the MAG. In addition, the findings identified the criteria that stakeholders consider to be most important. The MAG will help advance the field by providing developers, health care professionals, and end users with a valid guide so that they can develop and identify mHealth-related apps that are of quality. UR - http://mhealth.jmir.org/2020/7/e17760/ UR - http://dx.doi.org/10.2196/17760 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735226 ID - info:doi/10.2196/17760 ER - TY - JOUR AU - O'Grady, Conor AU - Melia, Ruth AU - Bogue, John AU - O'Sullivan, Mary AU - Young, Karen AU - Duggan, Jim PY - 2020/7/30 TI - A Mobile Health Approach for Improving Outcomes in Suicide Prevention (SafePlan) JO - J Med Internet Res SP - e17481 VL - 22 IS - 7 KW - mobile apps KW - suicide KW - mHealth N2 - Background: Suicide is a prominent cause of death worldwide, particularly among young people. It was the second leading cause of death among those aged 15-29 years globally in 2016. Treatment for patients with suicidal thoughts or behaviors often includes face-to-face psychological therapy with a mental health professional. These forms of interventions may involve maintaining and updating paper-based reports or worksheets in between sessions. Mobile technology can offer a way to support the implementation of evidence-based psychological techniques and the acquisition of protective coping skills. Objective: This study aims to develop a mobile app to facilitate service users? access to mental health support and safety planning. This process involved eliciting expert input from clinicians who are actively engaged in the provision of mental health care. Methods: A survey was distributed to targeted health care professionals to determine what features should be prioritized in a new mobile app relating to suicide prevention. On the basis of the survey results, a clinical design group, comprising 6 members with experience in fields such as mobile health (mHealth), clinical psychology, and suicide prevention, was established. This group was supplemented with further input from additional clinicians who provided feedback over three focus group sessions. The sessions were centered on refining existing app components and evaluating new feature requests. This process was iterated through regular feedback until agreement was reached on the overall app design and functionality. Results: A fully functional mobile app, known as the SafePlan app, was developed and tested with the input of clinicians through an iterative design process. The app?s core function is to provide an interactive safety plan to support users with suicidal thoughts or behaviors as an adjunct to face-to-face therapy. A diary component that facilitates the generalization of skills learned through dialectical behavior therapy was also implemented. Usability testing was carried out on the final prototype by students from a local secondary school, who are representative of the target user population in both age and technology experience. The students were asked to complete a system usability survey (SUS) at the end of this session. The mean overall SUS rating was 71.85 (SD 1.38). Conclusions: The participatory process involving key stakeholders (clinicians, psychologists, and information technology specialists) has resulted in the creation of an mHealth intervention technology that has the potential to increase accessibility to this type of mental health service for the target population. The app has gone through the initial testing phase, and the relevant recommendations have been implemented, and it is now ready for trialing with both clinicians and their patients. UR - http://www.jmir.org/2020/7/e17481/ UR - http://dx.doi.org/10.2196/17481 UR - http://www.ncbi.nlm.nih.gov/pubmed/32729845 ID - info:doi/10.2196/17481 ER - TY - JOUR AU - Brennan, Louise AU - Kessie, Threase AU - Caulfield, Brian PY - 2020/7/29 TI - Patient Experiences of Rehabilitation and the Potential for an mHealth System with Biofeedback After Breast Cancer Surgery: Qualitative Study JO - JMIR Mhealth Uhealth SP - e19721 VL - 8 IS - 7 KW - breast cancer KW - physiotherapy KW - rehabilitation KW - mHealth KW - biofeedback KW - user-centred design KW - cancer N2 - Background: Physiotherapy-led home rehabilitation after breast cancer surgery can protect against the development of upper limb dysfunction and other disabling consequences of surgery. A variety of barriers can limit physical rehabilitation outcomes, and patients may benefit from more support during this time. Mobile health (mHealth) systems can assist patients during rehabilitation by providing exercise support, biofeedback, and information. Before designing mHealth systems for a specific population, developers must first engage with users to understand their experiences and needs. Objective: The aims of this study were to explore patients? rehabilitation experiences and unmet needs during home rehabilitation after breast cancer surgery and to understand their experiences of mHealth technology and the requirements they desire from an mHealth system. Methods: This was the first stage of a user-centered design process for an mHealth system. We interviewed 10 breast cancer survivors under the two main topics of ?Rehabilitation? and ?Technology? and performed a thematic analysis on the interview data. Results: Discussions regarding rehabilitation focused on the acute and long-term consequences of surgery; unmet needs and lack of support; self-driven rehabilitation; and visions for high-quality rehabilitation. Regarding technology, participants reported a lack of mHealth options for this clinical context and using non-cancer?specific applications and wearables. Participants requested an mHealth tool from a reliable source that provides exercise support. Conclusions: There are unmet needs surrounding access to physiotherapy, information, and support during home rehabilitation after breast cancer surgery that could be addressed with an mHealth system. Breast cancer survivors are open to using an mHealth system and require that it comes from a reliable source and focuses on supporting exercise performance. UR - http://mhealth.jmir.org/2020/7/e19721/ UR - http://dx.doi.org/10.2196/19721 UR - http://www.ncbi.nlm.nih.gov/pubmed/32687476 ID - info:doi/10.2196/19721 ER - TY - JOUR AU - Scherr, Foster Thomas AU - Moore, Paige Carson AU - Thuma, Philip AU - Wright, Wilson David PY - 2020/7/28 TI - Evaluating Network Readiness for mHealth Interventions Using the Beacon Mobile Phone App: Application Development and Validation Study JO - JMIR Mhealth Uhealth SP - e18413 VL - 8 IS - 7 KW - mHealth KW - network readiness KW - network assessment KW - mobile network N2 - Background: Mobile health (mHealth) interventions have the potential to transform the global health care landscape. The processing power of mobile devices continues to increase, and growth of mobile phone use has been observed worldwide. Uncertainty remains among key stakeholders and decision makers as to whether global health interventions can successfully tap into this trend. However, when correctly implemented, mHealth can reduce geographic, financial, and social barriers to quality health care. Objective: The aim of this study was to design and test Beacon, a mobile phone?based tool for evaluating mHealth readiness in global health interventions. Here, we present the results of an application validation study designed to understand the mobile network landscape in and around Macha, Zambia, in 2019. Methods: Beacon was developed as an automated mobile phone app that continually collects spatiotemporal data and measures indicators of network performance. Beacon was used in and around Macha, Zambia, in 2019. Results were collected, even in the absence of network connectivity, and asynchronously uploaded to a database for further analysis. Results: Beacon was used to evaluate three mobile phone networks around Macha. Carriers A and B completed 6820/7034 (97.0%) and 6701/7034 (95.3%) downloads and 1349/1608 (83.9%) and 1431/1608 (89.0%) uploads, respectively, while Carrier C completed only 62/1373 (4.5%) file downloads and 0/1373 (0.0%) file uploads. File downloads generally occurred within 4 to 12 seconds, and their maximum download speeds occurred between 2 AM and 5 AM. A decrease in network performance, demonstrated by increases in upload and download durations, was observed beginning at 5 PM and continued throughout the evening. Conclusions: Beacon was able to compare the performance of different cellular networks, show times of day when cellular networks experience heavy loads and slow down, and identify geographic ?dead zones? with limited or no cellular service. Beacon is a ready-to-use tool that could be used by organizations that are considering implementing mHealth interventions in low- and middle-income countries but are questioning the feasibility of the interventions, including infrastructure and cost. It could also be used by organizations that are looking to optimize the delivery of an existing mHealth intervention with improved logistics management. UR - http://mhealth.jmir.org/2020/7/e18413/ UR - http://dx.doi.org/10.2196/18413 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720909 ID - info:doi/10.2196/18413 ER - TY - JOUR AU - Benjumea, Jaime AU - Ropero, Jorge AU - Rivera-Romero, Octavio AU - Dorronzoro-Zubiete, Enrique AU - Carrasco, Alejandro PY - 2020/7/28 TI - Assessment of the Fairness of Privacy Policies of Mobile Health Apps: Scale Development and Evaluation in Cancer Apps JO - JMIR Mhealth Uhealth SP - e17134 VL - 8 IS - 7 KW - privacy KW - mhealth apps KW - fairness assessment scale KW - cancer apps KW - GDPR N2 - Background: Cancer patients are increasingly using mobile health (mHealth) apps to take control of their health. Many studies have explored their efficiency, content, usability, and adherence; however, these apps have created a new set of privacy challenges, as they store personal and sensitive data. Objective: The purpose of this study was to refine and evaluate a scale based on the General Data Protection Regulation and assess the fairness of privacy policies of mHealth apps. Methods: Based on the experience gained from our previous work, we redefined some of the items and scores of our privacy scale. Using the new version of our scale, we conducted a case study in which we analyzed the privacy policies of cancer Android apps. A systematic search of cancer mobile apps was performed in the Spanish version of the Google Play website. Results: The redefinition of certain items reduced discrepancies between reviewers. Thus, use of the scale was made easier, not only for the reviewers but also for any other potential users of our scale. Assessment of the privacy policies revealed that 29% (9/31) of the apps included in the study did not have a privacy policy, 32% (10/31) had a score over 50 out of a maximum of 100 points, and 39% (12/31) scored fewer than 50 points. Conclusions: In this paper, we present a scale for the assessment of mHealth apps that is an improved version of our previous scale with adjusted scores. The results showed a lack of fairness in the mHealth app privacy policies that we examined, and the scale provides developers with a tool to evaluate their privacy policies. UR - http://mhealth.jmir.org/2020/7/e17134/ UR - http://dx.doi.org/10.2196/17134 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720913 ID - info:doi/10.2196/17134 ER - TY - JOUR AU - Rabinovich, Lila AU - Molton, Steven James AU - Ooi, Tsang Wei AU - Paton, Iain Nicholas AU - Batra, Shelly AU - Yoong, Joanne PY - 2020/7/27 TI - Perceptions and Acceptability of Digital Interventions Among Tuberculosis Patients in Cambodia: Qualitative Study of Video-Based Directly Observed Therapy JO - J Med Internet Res SP - e16856 VL - 22 IS - 7 KW - directly observed therapy KW - video recording KW - telemedicine KW - mobile health KW - mHealth KW - tuberculosis KW - low-income settings KW - developing countries KW - patient acceptance of health care KW - patient acceptability KW - Cambodia N2 - Background: Despite the development of effective drugs for treatment, tuberculosis remains one of the leading causes of death from an infectious disease worldwide. One of the greatest challenges to tuberculosis control is patient adherence to treatment. Recent research has shown that video-based directly observed therapy is a feasible and effective approach to supporting treatment adherence in high-income settings. However, few studies have explored the potential for such a solution in a low- or middle-income country setting. Globally, these countries? rapidly rising rate of mobile penetration suggests that the potential for translation of these results may be high. Objective: We sought to examine patient perceptions related to the use of mobile health, and specifically video-based directly observed therapy, in a previously unstudied patient demographic: patients with tuberculosis in a low-income country setting (Cambodia). Methods: We conducted a cross-sectional qualitative study in urban and periurban areas in Cambodia, consisting of 6 focus groups with tuberculosis patients who were receiving treatment (standard directly observed therapy) through a nongovernmental organization. Results: Familiarity with mobile technology and apps was widespread in this population, and overall willingness to consider a mobile app for video-based directly observed therapy was high. However, we identified potential challenges. First, patients very much valued their frequent in-person interactions with their health care provider, which may be reduced with the video-based directly observed therapy intervention. Second, there may be technical issues to address, including how to make the app suitable for illiterate participants. Conclusions: While video-based directly observed therapy is a promising technology, even in country settings where mobile penetration is reportedly almost universal, it should be introduced with caution. However, the results were generally promising and yielded important insights that not only will be translated into the further adaptation of key features of video-based directly observed therapy for tuberculosis patients in Cambodia, but also can inform the future design and successful implementation of video-based directly observed therapy interventions in low- and middle-income settings more generally. UR - https://www.jmir.org/2020/7/e16856 UR - http://dx.doi.org/10.2196/16856 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716309 ID - info:doi/10.2196/16856 ER - TY - JOUR AU - Yin, Huifang AU - Wardenaar, J. Klaas AU - Wang, Yuhao AU - Wang, Nan AU - Chen, Wenjin AU - Zhang, Yan AU - Xu, Guangming AU - Schoevers, A. Robert PY - 2020/7/27 TI - Mobile Mental Health Apps in China: Systematic App Store Search JO - J Med Internet Res SP - e14915 VL - 22 IS - 7 KW - smartphone KW - app KW - mobile mental health KW - mental illness KW - mental health problem KW - China N2 - Background: Smartphones have become ubiquitous in China, offering a promising way to deliver mental health interventions; however, little is known about the current use and characteristics of smartphone apps for mental health. Objective: The purpose of this study was to gain insight into mobile mental health apps available in China as of December 2018. Methods: A systematic search was conducted to identify and evaluate the most downloaded apps from iOS and Android platforms. Apps were categorized according to their main purpose and downloaded to evaluate their content. Each app?s affiliation, cost, target users, information security, and evidence-based nature were evaluated. Results: Of the 172 unique apps that were identified, there were 37 apps (21.5%) for psychological counseling, 50 apps (29.1%) for assessment, 12 apps (7.0%) to relieve stress, 24 apps (14.0%) for psychoeducation, and 49 (28.4%) multipurpose apps (ie, a combination of counseling and assessment). Most apps were developed for adults in the general population (166/172, 96.5%), rather than for psychiatric patients. App-based counseling was mostly provided by psychologists, and of the assessed apps, only 40% (70/172) used evidence-based scales to assess mental health problems such as anxiety or depressed mood. Guided meditation was used as the main technique in stress-relieving apps. Conclusions: Many apps contained useful and evidence-based elements, such as good quality information, validated measurements, and useful meditation methods; however, for mobile apps to contribute significantly to mental health care in China, considerable challenges remain, including the need for more patient-focused apps that can actually take on the role of a health care provider. In addition, efficacy studies are needed. UR - https://www.jmir.org/2020/7/e14915 UR - http://dx.doi.org/10.2196/14915 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716301 ID - info:doi/10.2196/14915 ER - TY - JOUR AU - Edridge, Chloe AU - Wolpert, Miranda AU - Deighton, Jessica AU - Edbrooke-Childs, Julian PY - 2020/7/27 TI - An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial JO - J Med Internet Res SP - e14223 VL - 22 IS - 7 KW - cluster trial KW - behavioral difficulties KW - schools KW - mHealth KW - digital KW - mental health N2 - Background: Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs. Objective: The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people. Methods: The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up. Results: There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone. Conclusions: It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.7019 UR - http://www.jmir.org/2020/7/e14223/ UR - http://dx.doi.org/10.2196/14223 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716299 ID - info:doi/10.2196/14223 ER - TY - JOUR AU - Doma?ska, Barbara AU - Vansant, Stijn AU - Mountian, Irina PY - 2020/7/27 TI - A Companion App to Support Rheumatology Patients Treated with Certolizumab Pegol: Results From a Usability Study JO - JMIR Form Res SP - e17373 VL - 4 IS - 7 KW - rheumatology KW - internet KW - digital health KW - mobile health KW - mHealth KW - smartphone KW - mobile phone KW - validation human factors study N2 - Background: Certolizumab pegol (CZP) is an anti-tumor necrosis factor drug approved for the treatment of multiple moderate to severe chronic inflammatory diseases. In the European Union, CZP is approved for administration by subcutaneous self-injection using a prefilled syringe, prefilled pen, or reusable electromechanical auto-injector (electronic device). CimplyMe is a companion app for use alongside CZP self-injection devices, designed to support CZP-treated patients self-managing their treatment and disease. Objective: This study aimed to validate the usability of the companion app by demonstrating that tasks required for use can be performed successfully by intended end users. Methods: We recruited 15 patients with moderate to severe rheumatoid arthritis, currently prescribed biologic treatment, and using apps on a smart phone. Patients were assessed on their ability to use the companion app in a setting designed to simulate a location where patients regularly administer biologic treatment. To assess the usability of the key features of the app, 8 critical and 3 noncritical tasks were designed. Patients? success on each task was recorded through observations or knowledge-based questions. Successes with difficulty and use errors were also recorded. If a patient made a use error at the first attempt, a second attempt was allowed. Second-attempt use errors were recorded as a task failure. Results: A total of 207 first attempts at the 14 components of the 8 critical tasks were evaluated (3 patients failed to complete one component); 178 (86.0%) critical tasks were successfully completed at the first attempt. The remaining first attempts comprised 16 (7.7%) successes with difficulty and 13 (6.3%) use errors, which had to be repeated. One critical task was not re-attempted by one patient due to time constraints; however, there were no use errors in the 12 completed second attempts. A total of 107 first attempts at the 3 noncritical tasks were made, all of which (107/107, 100.0%) were completed without use errors. Conclusions: In simulated testing, patients were able to successfully use the companion app without formal training. This study suggests the companion app is easy to use and could help patients prescribed CZP better manage their treatment and disease. UR - http://formative.jmir.org/2020/7/e17373/ UR - http://dx.doi.org/10.2196/17373 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716310 ID - info:doi/10.2196/17373 ER - TY - JOUR AU - Fuller-Tyszkiewicz, Matthew AU - Richardson, Ben AU - Little, Keriann AU - Teague, Samantha AU - Hartley-Clark, Linda AU - Capic, Tanja AU - Khor, Sarah AU - Cummins, A. Robert AU - Olsson, A. Craig AU - Hutchinson, Delyse PY - 2020/7/24 TI - Efficacy of a Smartphone App Intervention for Reducing Caregiver Stress: Randomized Controlled Trial JO - JMIR Ment Health SP - e17541 VL - 7 IS - 7 KW - mHealth KW - mobile phone KW - caregiver KW - psychological stress KW - mental health N2 - Background: Caregivers play a pivotal role in maintaining an economically viable health care system, yet they are characterized by low levels of psychological well-being and consistently report unmet needs for psychological support. Mobile app?based (mobile health [mHealth]) interventions present a novel approach to both reducing stress and improving well-being. Objective: This study aims to evaluate the effectiveness of a self-guided mobile app?based psychological intervention for people providing care to family or friends with a physical or mental disability. Methods: In a randomized, single-blind, controlled trial, 183 caregivers recruited through the web were randomly allocated to either an intervention (n=73) or active control (n=110) condition. The intervention app contained treatment modules combining daily self-monitoring with third-wave (mindfulness-based) cognitive-behavioral therapies, whereas the active control app contained only self-monitoring features. Both programs were completed over a 5-week period. It was hypothesized that intervention app exposure would be associated with decreases in depression, anxiety, and stress, and increases in well-being, self-esteem, optimism, primary and secondary control, and social support. Outcomes were assessed at baseline, postintervention, and 3-4 months postintervention. App quality was also assessed. Results: In total, 25% (18/73) of the intervention participants were lost to follow-up at 3 months, and 30.9% (34/110) of the participants from the wait-list control group dropped out before the postintervention survey. The intervention group experienced reductions in stress (b=?2.07; P=.04) and depressive symptoms (b=?1.36; P=.05) from baseline to postintervention. These changes were further enhanced from postintervention to follow-up, with the intervention group continuing to report lower levels of depression (b=?1.82; P=.03) and higher levels of emotional well-being (b=6.13; P<.001), optimism (b=0.78; P=.007), self-esteem (b=?0.84; P=.005), support from family (b=2.15; P=.001), support from significant others (b=2.66; P<.001), and subjective well-being (b=4.82; P<.001). On average, participants completed 2.5 (SD 1.05) out of 5 treatment modules. The overall quality of the app was also rated highly, with a mean score of 3.94 out of a maximum score of 5 (SD 0.58). Conclusions: This study demonstrates that mHealth psychological interventions are an effective treatment option for caregivers experiencing high levels of stress. Recommendations for improving mHealth interventions for caregivers include offering flexibility and customization in the treatment design. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12616000996460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371170 UR - http://mental.jmir.org/2020/7/e17541/ UR - http://dx.doi.org/10.2196/17541 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706716 ID - info:doi/10.2196/17541 ER - TY - JOUR AU - Tuvesson, Hanna AU - Eriksén, Sara AU - Fagerström, Cecilia PY - 2020/7/24 TI - mHealth and Engagement Concerning Persons With Chronic Somatic Health Conditions: Integrative Literature Review JO - JMIR Mhealth Uhealth SP - e14315 VL - 8 IS - 7 KW - engagement KW - eHealth KW - mHealth KW - somatic disease KW - integrative literature review KW - telehealth N2 - Background: Chronic somatic health conditions are a global public health challenge. Being engaged in one?s own health management for such conditions is important, and mobile health (mHealth) solutions are often suggested as key to promoting engagement. Objective: The aim of this study was to review, critically appraise, and synthesize the available research regarding engagement through mHealth for persons with chronic somatic health conditions. Methods: An integrative literature review was conducted. The PubMed, CINAHL, and Inspec databases were used for literature searches. Quality assessment was done with the guidance of Critical Appraisal Skills Programme (CASP) checklists. We used a self-designed study protocol comprising 4 engagement aspects?cognitive, behavioral and emotional, interactional, and the usage of mHealth?as part of the synthesis and analysis. Results: A total of 44 articles met the inclusion criteria and were included in the analysis. mHealth usage was the most commonly occurring engagement aspect, behavioral and emotional aspects the second, cognitive aspects the third, and interactional aspects of engagement the least common aspect in the included articles. The results showed that there is a mix of enablers and barriers to engagement in relation to the 4 engagement aspects. The perceived meaningfulness and need for the solution and its content were important to create and maintain engagement. When perceived as meaningful, suitable, and usable, mHealth can support knowledge gain and learning, facilitate emotional and behavioral aspects such as a sense of confidence, and improve interactions and communications with health care professionals. Conclusions: mHealth solutions have the potential to support health care engagement for persons with chronic somatic conditions. More research is needed to further understand how, by which means, when, and among whom mHealth could further improve engagement for this population. UR - http://mhealth.jmir.org/2020/7/e14315/ UR - http://dx.doi.org/10.2196/14315 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706686 ID - info:doi/10.2196/14315 ER - TY - JOUR AU - Masalski, Marcin AU - Morawski, Krzysztof PY - 2020/7/23 TI - Worldwide Prevalence of Hearing Loss Among Smartphone Users: Cross-Sectional Study Using a Mobile-Based App JO - J Med Internet Res SP - e17238 VL - 22 IS - 7 KW - hearing loss KW - epidemiology KW - mobile-based KW - hearing test KW - pure-tone audiometry N2 - Background: In addition to the aging process, risk factors for hearing loss in adults include, among others, exposure to noise, use of ototoxic drugs, genetics, and limited access to medical care. Differences in exposure to these factors are bound to be reflected in the prevalence of hearing loss. Assessment of hearing loss can easily be carried out on a large scale and at low cost using mobile apps. Objective: This study aimed to conduct a worldwide assessment of the differences in hearing loss prevalence between countries in a group of mobile device users. Methods: Hearing tests were conducted using the open-access Android-based mobile app Hearing Test. The app is available free of charge in the Google Play store, provided that consent to the use of the results for scientific purposes is given. This study included hearing tests carried out on device models supported by the app with bundled headphones in the set. Calibration factors for supported models were determined using the biological method. The tests consisted of self-determining the quietest audible tone in the frequency range from 250 Hz to 8 kHz by adjusting its intensity using the buttons. The ambient noise level was optionally monitored using a built-in microphone. Following the test, the user could compare his hearing threshold against age norms by providing his or her age. The user's location was identified based on the phone?s IP address. Results: From November 23, 2016 to November 22, 2019, 733,716 hearing tests were conducted on 236,716 mobile devices across 212 countries. After rejecting the tests that were incomplete, performed with disconnected headphones, not meeting the time criterion, repeated by the same user, or carried out regularly on one device, 116,733 of 733,716 tests (15.9%) were qualified for further analysis. The prevalence of hearing loss, defined as the average threshold at frequencies 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz above 25 dB HL in the better ear, was calculated at 15.6% (95% CI 15.4-15.8). Statistically significant differences were found between countries (P<.001), with the highest prevalences for Bangladesh, Pakistan, and India (>28%) and the lowest prevalences for Taiwan, Finland, and South Korea (<11%). Conclusions: Hearing thresholds measured by means of mobile devices were congruent with the literature data on worldwide hearing loss prevalence. Uniform recruitment criteria simplify the comparison of the hearing loss prevalence across countries. Hearing testing on mobile devices may be a valid tool in epidemiological studies carried out on a large scale. UR - http://www.jmir.org/2020/7/e17238/ UR - http://dx.doi.org/10.2196/17238 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706700 ID - info:doi/10.2196/17238 ER - TY - JOUR AU - Amor-García, Ángel Miguel AU - Collado-Borrell, Roberto AU - Escudero-Vilaplana, Vicente AU - Melgarejo-Ortuño, Alejandra AU - Herranz-Alonso, Ana AU - Arranz Arija, Ángel José AU - Sanjurjo-Sáez, María PY - 2020/7/23 TI - Assessing Apps for Patients with Genitourinary Tumors Using the Mobile Application Rating Scale (MARS): Systematic Search in App Stores and Content Analysis JO - JMIR Mhealth Uhealth SP - e17609 VL - 8 IS - 7 KW - genitourinary cancer KW - mobile apps KW - eHealth KW - mHealth KW - rating tool N2 - Background: The large number of available cancer apps and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, health care professionals, and users. To date, there have been no analyses or classifications of apps for patients with genitourinary cancers, which are among the most prevalent types of cancer. Objective: The objective of our study was to analyze the quality of apps for patients diagnosed with genitourinary cancers using the Mobile Application Rating Scale (MARS) and identify high-quality apps. Methods: We performed an observational cross-sectional descriptive study of all smartphone apps for patients diagnosed with genitourinary cancers available on iOS and Android platforms. In July 2019, we searched for all available apps for patients with genitourinary cancers (bladder, prostate, cervical, uterine, endometrial, kidney, testicular, and vulvar) or their caregivers. Apps were downloaded and evaluated, and the general characteristics were entered into a database. The evaluation was performed by 2 independent researchers using the MARS questionnaire, which rates 23 evaluation criteria clustered in 5 domains (Engagement, Functionality, Esthetics, Information, and Subjective Quality) on a scale from 1 to 5. Results: In total, 46 apps were analyzed. Of these, 31 (67%) were available on Android, 6 (13%) on iOS, and 9 (20%) on both platforms. The apps were free in 89% of cases (41/46), and 61% (28/46) had been updated in the previous year. The apps were intended for prostate cancer in 30% of cases (14/46) and cervical cancer in 17% (8/46). The apps were mainly informative (63%, 29/46), preventive (24%, 11/46), and diagnostic (13%, 6/46). Only 7/46 apps (15%) were developed by health care organizations. The mean MARS score for the overall quality of the 46 apps was 2.98 (SD 0.77), with a maximum of 4.63 and a minimum of 1.95. Functionality scores were quite similar for most of the apps, with the greatest differences in Engagement and Esthetics, which showed acceptable scores in one-third of the apps. The 5 apps with the highest MARS score were the following: ?Bladder cancer manager,? ?Kidney cancer manager,? ?My prostate cancer manager,? ?Target Ovarian Cancer Symptoms Diary,? and ?My Cancer Coach.? We observed statistically significant differences in the MARS score between the operating systems and the developer types (P<.001 and P=.01, respectively), but not for cost (P=.62). Conclusions: MARS is a helpful methodology to decide which apps can be prescribed to patients and to identify which features should be addressed to improve these tools. Most of the apps designed for patients with genitourinary cancers only try to provide data about the disease, without coherent interactivity. The participation of health professionals in the development of these apps is low; nevertheless, we observed that both the participation of health professionals and regular updates were correlated with quality. UR - http://mhealth.jmir.org/2020/7/e17609/ UR - http://dx.doi.org/10.2196/17609 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706737 ID - info:doi/10.2196/17609 ER - TY - JOUR AU - Islam, Mohaimenul Md AU - Poly, Nasrin Tahmina AU - Walther, Andres Bruno AU - (Jack) Li, Yu-Chuan PY - 2020/7/22 TI - Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis JO - JMIR Mhealth Uhealth SP - e17039 VL - 8 IS - 7 KW - mobile app KW - mHealth KW - obesity KW - physical activity KW - weight gain prevention N2 - Background: Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. Objective: The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. Methods: PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. Results: A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (?1.07 kg, 95% CI ?1.92 to ?0.21, P=.01) and body mass index (?0.45 kg/m2, 95% CI ?0.78 to ?0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95% CI ?2.21 to 2.55, P=.88). Conclusions: The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples. UR - https://mhealth.jmir.org/2020/7/e17039 UR - http://dx.doi.org/10.2196/17039 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706724 ID - info:doi/10.2196/17039 ER - TY - JOUR AU - Andersen, Osman Tariq AU - Langstrup, Henriette AU - Lomborg, Stine PY - 2020/7/20 TI - Experiences With Wearable Activity Data During Self-Care by Chronic Heart Patients: Qualitative Study JO - J Med Internet Res SP - e15873 VL - 22 IS - 7 KW - consumer health information KW - wearable electronic devices KW - self-care KW - chronic illness KW - patient experiences N2 - Background: Most commercial activity trackers are developed as consumer devices and not as clinical devices. The aim is to monitor and motivate sport activities, healthy living, and similar wellness purposes, and the devices are not designed to support care management in a clinical context. There are great expectations for using wearable sensor devices in health care settings, and the separate realms of wellness tracking and disease self-monitoring are increasingly becoming blurred. However, patients? experiences with activity tracking technologies designed for use outside the clinical context have received little academic attention. Objective: This study aimed to contribute to understanding how patients with a chronic disease experience activity data from consumer self-tracking devices related to self-care and their chronic illness. Our research question was: ?How do patients with heart disease experience activity data in relation to self-care and chronic illness?? Methods: We conducted a qualitative interview study with patients with chronic heart disease (n=27) who had an implanted cardioverter-defibrillator. Patients were invited to wear a FitBit Alta HR wearable activity tracker for 3-12 months and provide their perspectives on their experiences with step, sleep, and heart rate data. The average age was 57.2 years (25 men and 2 women), and patients used the tracker for 4-49 weeks (mean 26.1 weeks). Semistructured interviews (n=66) were conducted with patients 2?3 times and were analyzed iteratively in workshops using thematic analysis and abductive reasoning logic. Results: Of the 27 patients, 18 related the heart rate, sleep, and step count data directly to their heart disease. Wearable activity trackers actualized patients? experiences across 3 dimensions with a spectrum of contrasting experiences: (1) knowing, which spanned gaining insight and evoking doubts; (2) feeling, which spanned being reassured and becoming anxious; and (3) evaluating, which spanned promoting improvements and exposing failure. Conclusions: Patients? experiences could reside more on one end of the spectrum, could reside across all 3 dimensions, or could combine contrasting positions and even move across the spectrum over time. Activity data from wearable devices may be a resource for self-care; however, the data may simultaneously constrain and create uncertainty, fear, and anxiety. By showing how patients experience self-tracking data across dimensions of knowing, feeling, and evaluating, we point toward the richness and complexity of these data experiences in the context of chronic illness and self-care. UR - https://www.jmir.org/2020/7/e15873 UR - http://dx.doi.org/10.2196/15873 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706663 ID - info:doi/10.2196/15873 ER - TY - JOUR AU - Fakih El Khoury, Cosette AU - Crutzen, Rik AU - Schols, A. Jos M. G. AU - Halfens, G. Ruud J. AU - Karavetian, Mirey PY - 2020/7/20 TI - A Dietary Mobile App for Patients Undergoing Hemodialysis: Prospective Pilot Study to Improve Dietary Intakes JO - J Med Internet Res SP - e17817 VL - 22 IS - 7 KW - mHealth KW - dietary app KW - hemodialysis diet N2 - Background: Mobile technology has an impact on the health care sector, also within dietetics. Mobile health (mHealth) apps may be used for dietary assessment and self-monitoring, allowing for real-time reporting of food intakes. Changing eating behaviors is quite challenging, and patients undergoing hemodialysis, particularly, struggle to meet the target intakes set by dietary guidelines. Usage of mobile apps that are developed in a person-centered approach and in line with recommendations may support both patients and health care practitioners. Objective: This study is a pilot that aims at estimating the potential efficacy of a dietary intervention using a theory-based, person-centered smartphone app. Results will be used to improve both the app and a planned large-scale trial intended to assess app efficacy thoroughly. Methods: A prospective pilot study was performed at the hemodialysis unit of Al Qassimi Hospital (The Emirate of Sharjah). All patients that fulfilled the study inclusion criteria were considered eligible to be enrolled in the pilot study. Upon successful installation of the app, users met with a dietitian once a week. Outcomes were measured at baseline (T0) and 2 weeks post app usage (T1). This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT 2010 checklist for reporting pilot or feasibility trials. Results: A total of 23 patients completed the pilot intervention. Mean energy intakes increased from 24.4 kcal/kg/day (SD 8.0) to 29.1 kcal/kg/day (SD 7.8) with a medium effect size (d=0.6, 95% CI 0.0-1.2). Mean protein intakes increased from 0.9 g/kg/day (SD 0.3) to 1.3 g/kg/day (SD 0.5) with a large effect size (d=1.0, 95% CI 0.4-1.6); mean intake of high biological value (%HBV) proteins also increased from 58.6% (SD 10.1) to 70.1% (SD 10.7) with a large effect size (d=1.1, 95% CI 0.5-1.7). Dietary intakes of minerals did not change, apart from sodium which decreased from a mean intake of 2218.8 mg/day (SD 631.6) to 1895.3 mg/day (SD 581.0) with a medium effect size (d=0.5, 95% CI 0.1-1.1). Mean serum phosphorus, potassium, and albumin levels did not change relevantly. Mean serum iron increased from 7.9 mg/dL (SD 2.8) to 11.5 mg/dL (SD 7.9) postintervention with a medium effect size (d=0.6, 95% CI 0.0-1.2). Conclusions: This pilot study showed that the KELA.AE app has the potential to improve dietary intakes. Processes related to procedure, resources, tools, and app improvement for a future trial were assessed. A more extended intervention using a randomized controlled trial is required to estimate parameters concerning app efficacy accurately. UR - http://www.jmir.org/2020/7/e17817/ UR - http://dx.doi.org/10.2196/17817 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706698 ID - info:doi/10.2196/17817 ER - TY - JOUR AU - Amann, Julia AU - Fiordelli, Maddalena AU - Brach, Mirjam AU - Bertschy, Sue AU - Scheel-Sailer, Anke AU - Rubinelli, Sara PY - 2020/7/9 TI - Co-designing a Self-Management App Prototype to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e18018 VL - 8 IS - 7 KW - co-design KW - mHealth KW - eHealth KW - self-management KW - spinal cord injury KW - pressure injury N2 - Background: Spinal cord injury is a complex chronic health condition that requires individuals to actively self-manage. Therefore, an evidence-based, self-management app would be of value to support individuals with spinal cord injury in the prevention of pressure injuries. Objective: The main objectives of this study were to (1) establish a co-design approach for developing a high-fidelity prototype app for the self-management of individuals with spinal cord injury, (2) design the prototype that resulted from this process, and (3) conduct the first usability assessment of the prototype app. Methods: We adopted a co-design approach to develop an evidence-based app prototype. Starting from a preliminary content model (based on clinical guidelines for the prevention of pressure injuries) and three research-based user personas, we conducted an ideation workshop involving individuals with spinal cord injury and health care professionals. The ideation workshop formed the basis for two consecutive design sprints. The result of this co-design phase was an interactive app prototype. The prototype was evaluated in two rounds of usability testing (N=4 and N=15, respectively) using a combination of qualitative and quantitative methods. Results: The co-design process resulted in a high-fidelity prototype with two key components: a self-management component and a communication component. The final prototype included a combination of features to support individuals with spinal cord injury in the prevention of pressure injuries, namely a smart camera, pressure injury diary, expert consultation, reminders, and knowledge repository. Findings of the usability testing showed that most participants navigated the app fluently with little back and forth navigation and were able to successfully complete a set of assigned tasks. These positive results are supported by the average system usability score achieved (78.5/100; range 47.5-95.0) and our qualitative analysis of the semistructured interviews. Despite an overall positive evaluation of the app prototype, we identified areas for improvement (eg, inclusion of a search function). Conclusions: Individuals with spinal cord injury often need to navigate competing interests and priorities, paired with uncertainty about the accuracy and relevance of clinical recommendations. Understanding what matters to individuals with spinal cord injury can help guide the design of behavioral interventions that are useful and acceptable to these individuals in their daily lives. This study shows that involving individuals with spinal cord injury and health care professionals in co-designing a self-management app can foster knowledge cocreation at the intersection of lived experience, medical expertise, and technical solutions. UR - https://mhealth.jmir.org/2020/7/e18018 UR - http://dx.doi.org/10.2196/18018 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673241 ID - info:doi/10.2196/18018 ER - TY - JOUR AU - Salgado, Tânia AU - Tavares, Jorge AU - Oliveira, Tiago PY - 2020/7/9 TI - Drivers of Mobile Health Acceptance and Use From the Patient Perspective: Survey Study and Quantitative Model Development JO - JMIR Mhealth Uhealth SP - e17588 VL - 8 IS - 7 KW - digital health KW - mHealth KW - UTAUT2 KW - health management KW - patient empowerment N2 - Background: Mobile health (mHealth) has potential to play a significant role in realizing a reversal of the current paradigm in health care toward a more patient-centric and more collaborative system to improve the outcomes obtained along with the quality and sustainability of health care systems. Objective: The aim of this study was to explore and understand individual mHealth acceptance drivers between two groups of users: those with chronic health conditions and those without. Methods: The extended unified theory of acceptance and usage of technology (UTAUT2) was enhanced with a new health-related framework: behavior intention to recommend and new mediation effects. We applied partial least squares (PLS) causal modeling to test the research model. Results: We obtained 322 valid responses through an online questionnaire. The drivers of behavior intention with statistical significance were performance expectancy (?=.29, P<.001), habit (?=.39, P<.001), and personal empowerment (?=.18, P=.01). The precursors of use behavior were habit (?= .47, P<.001) and personal empowerment (?=.17, P=.01). Behavior intention to recommend was significantly influenced by behavior intention (?=.58, P<.001) and personal empowerment (?=.26, P<.001). The model explained 66% of the total variance in behavior intention, 54% of the variance in use behavior, and 70% of the variance in behavior intention to recommend. Conclusions: Our study demonstrates a significant role of personal empowerment, as a second-order construct, in the mHealth acceptance context. The presence of a chronic health condition predicates an impact on acceptance of this technology. UR - https://mhealth.jmir.org/2020/7/e17588 UR - http://dx.doi.org/10.2196/17588 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673249 ID - info:doi/10.2196/17588 ER - TY - JOUR AU - Toro-Ramos, Tatiana AU - Michaelides, Andreas AU - Anton, Maria AU - Karim, Zulekha AU - Kang-Oh, Leah AU - Argyrou, Charalambos AU - Loukaidou, Elisavet AU - Charitou, M. Marina AU - Sze, Wilson AU - Miller, D. Joshua PY - 2020/7/8 TI - Mobile Delivery of the Diabetes Prevention Program in People With Prediabetes: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e17842 VL - 8 IS - 7 KW - prediabetes KW - body weight KW - mHealth KW - mobile app KW - mobile phone KW - randomized controlled trial N2 - Background: The Centers for Disease Control and Prevention (CDC) diabetes prevention program (DPP) has formed the foundationfor Type 2 Diabetes Mellitus (T2DM) prevention efforts and lifestyle change modifications in multiple care settings. To our knowledge, no randomized controlled trial has verified the efficacy of a fully mobile version of CDC?s diabetes prevention program (DPP). Objective: This study aimed to investigate the long-term weight loss and glycemic efficacy of a mobile-delivered DPP compared with a control group receiving usual medical care. Methods: Adults with prediabetes (N=202) were recruited from a clinic and randomized to either a mobile-delivered, coach-guided DPP (Noom) or a control group that received regular medical care including a paper-based DPP curriculum and no formal intervention. The intervention group learned how to use the Noom program, how to interact with their coach, and the importance of maintaining motivation. They had access to an interactive coach-to-participant interface and group messaging, daily challenges for behavior change, DPP-based education articles, food logging, and automated feedback. Primary outcomes included changes in weight and hemoglobin A1c (HbA1c) levels at 6 and 12 months, respectively. Exploratory secondary outcomes included program engagement as a predictor of changes in weight and HbA1c levels. Results: A total of 202 participants were recruited and randomized into the intervention (n=101) or control group (n=99). In the intention-to-treat (ITT) analyses, changes in the participants? weight and BMI were significantly different at 6 months between the intervention and control groups, but there was no difference in HbA1c levels (mean difference 0.004%, SE 0.05; P=.94). Weight and BMI were lower in the intervention group by ?2.64 kg (SE 0.71; P<.001) and ?0.99 kg/m2 (SE 0.29; P=.001), respectively. These differences persisted at 12 months. However, in the analyses that did not involve ITT, program completers achieved a significant weight loss of 5.6% (SE 0.81; P<.001) at 6 months, maintaining 4.7% (SE 0.88; P<.001) of their weight loss at 12 months. The control group lost ?0.15% at 6 months (SE 0.64; P=.85) and gained 0.33% (SE 0.70; P=.63) at 12 months. Those randomized to the intervention group who did not start the program had no meaningful weight or HbA1c level change, similar to the control group. At 1 year, the intervention group showed a 0.23% reduction in HbA1c levels; those who completed the intervention showed a 0.28% reduction. Those assigned to the control group had a 0.16% reduction in HbA1c levels. Conclusions: This novel mobile-delivered DPP achieved significant weight loss reductions for up to 1 year compared with usual care. This type of intervention reduces the risk of overt diabetes without the added barriers of in-person interventions. Trial Registration: ClinicalTrials.gov NCT03865342; https://clinicaltrials.gov/ct2/show/NCT03865342 UR - https://mhealth.jmir.org/2020/7/e17842 UR - http://dx.doi.org/10.2196/17842 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459631 ID - info:doi/10.2196/17842 ER - TY - JOUR AU - Ismail, Leila AU - Materwala, Huned AU - Karduck, P. Achim AU - Adem, Abdu PY - 2020/7/7 TI - Requirements of Health Data Management Systems for Biomedical Care and Research: Scoping Review JO - J Med Internet Res SP - e17508 VL - 22 IS - 7 KW - big data KW - blockchain KW - data analytics KW - eHealth KW - electronic medical records KW - health care KW - health information management KW - Internet of Things KW - medical research KW - mHealth N2 - Background: Over the last century, disruptive incidents in the fields of clinical and biomedical research have yielded a tremendous change in health data management systems. This is due to a number of breakthroughs in the medical field and the need for big data analytics and the Internet of Things (IoT) to be incorporated in a real-time smart health information management system. In addition, the requirements of patient care have evolved over time, allowing for more accurate prognoses and diagnoses. In this paper, we discuss the temporal evolution of health data management systems and capture the requirements that led to the development of a given system over a certain period of time. Consequently, we provide insights into those systems and give suggestions and research directions on how they can be improved for a better health care system. Objective: This study aimed to show that there is a need for a secure and efficient health data management system that will allow physicians and patients to update decentralized medical records and to analyze the medical data for supporting more precise diagnoses, prognoses, and public insights. Limitations of existing health data management systems were analyzed. Methods: To study the evolution and requirements of health data management systems over the years, a search was conducted to obtain research articles and information on medical lawsuits, health regulations, and acts. These materials were obtained from the Institute of Electrical and Electronics Engineers, the Association for Computing Machinery, Elsevier, MEDLINE, PubMed, Scopus, and Web of Science databases. Results: Health data management systems have undergone a disruptive transformation over the years from paper to computer, web, cloud, IoT, big data analytics, and finally to blockchain. The requirements of a health data management system revealed from the evolving definitions of medical records and their management are (1) medical record data, (2) real-time data access, (3) patient participation, (4) data sharing, (5) data security, (6) patient identity privacy, and (7) public insights. This paper reviewed health data management systems based on these 7 requirements across studies conducted over the years. To our knowledge, this is the first analysis of the temporal evolution of health data management systems giving insights into the system requirements for better health care. Conclusions: There is a need for a comprehensive real-time health data management system that allows physicians, patients, and external users to input their medical and lifestyle data into the system. The incorporation of big data analytics will aid in better prognosis or diagnosis of the diseases and the prediction of diseases. The prediction results will help in the development of an effective prevention plan. UR - https://www.jmir.org/2020/7/e17508 UR - http://dx.doi.org/10.2196/17508 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348265 ID - info:doi/10.2196/17508 ER - TY - JOUR AU - Jung, Timothy AU - Moorhouse, Natasha AU - Shi, Xin AU - Amin, Farhan Muhammad PY - 2020/7/7 TI - A Virtual Reality?Supported Intervention for Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Mixed Methods Study JO - J Med Internet Res SP - e14178 VL - 22 IS - 7 KW - virtual reality KW - COPD KW - rehabilitation N2 - Background: The uptake of traditional pulmonary rehabilitation classes by patients with chronic obstructive pulmonary disease (COPD) is poor because of personal factors that prevent accessibility to the venue. Therefore, there is a need for innovative methods of pulmonary rehabilitation, and virtual reality (VR) could be a promising technology for patients with COPD to access services remotely. Objective: This study aimed to investigate whether VR improves compliance with pulmonary rehabilitation among patients with COPD, a particularly vulnerable patient group (Medical Research Council [MRC] 4 or 5), and whether VR provides a credible alternative to traditional pulmonary rehabilitation programs. Methods: This was an 8-week patient trial using an innovative VR pulmonary rehabilitation program. A purposive sample of 10 patients with COPD graded MRC 4 or 5 and registered at a selected health care center and a hospital in Cumbria, United Kingdom, were included. Qualitative (focus groups and interviews) data were collected, and to further support the qualitative findings, quantitative data (self-report patient surveys) were gathered before and after the 8-week trial. The 5 self-reported surveys included the Patient Activation Measure, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Short Physical Performance Battery, and the Edmonton Frail Scale. Results: In a thematic analysis of the qualitative data, 11 themes emerged specific to delivering pulmonary rehabilitation using VR. The quantitative data further support the qualitative findings by revealing significant improvements in all physical measures. Conclusions: Overall, this study demonstrates how remotely supervised VR-based pulmonary rehabilitation could help to overcome current issues and limitations associated with providing this service to patients with COPD at scale. UR - https://www.jmir.org/2020/7/e14178 UR - http://dx.doi.org/10.2196/14178 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673224 ID - info:doi/10.2196/14178 ER - TY - JOUR AU - Leigh, Simon AU - Ashall-Payne, Liz AU - Andrews, Tim PY - 2020/7/6 TI - Barriers and Facilitators to the Adoption of Mobile Health Among Health Care Professionals From the United Kingdom: Discrete Choice Experiment JO - JMIR Mhealth Uhealth SP - e17704 VL - 8 IS - 7 KW - digital health KW - mHealth KW - discrete-choice KW - preferences KW - mobile phone N2 - Background: Despite the increasing availability of mobile health services, clinical engagement remains minimal. Objective: This study aims to identify and weight barriers to and drivers of health app use among health care professionals (HCPs) from the United Kingdom. Methods: A discrete choice experiment was conducted with 222 HCPs using a web-based survey between March 2019 and June 2019. Participants were recruited to take part via social media and asked to choose their preferred option of 2 hypothetical health apps to prescribe to a hypothetical patient or to prescribe neither. Choices were characterized by differing levels of patient age, cost, published evidence bases, whether they had a National Health Service (NHS) stamp of approval, personal familiarity with the technology, and whether they were recommended by a fellow HCP. The results were analyzed using a mixed logit model, with subgroup analyses to account for heterogeneity. Results: We received 230 responses, a total of 96.5% (n=222/230) of respondents understood the survey task and passed the test of rationality. The median age was between 36 and 45 years, and 62.6% (n=139/222) of the health care providers responding to the survey had previously recommended the use of health apps to patients. Health apps were most likely to be prescribed to patients if they had an NHS stamp of approval or if they were recommended by another HCP (both P<.001). Published studies detailing clinical effectiveness were important (P<.001), but it would take five published studies to have the same impact on prescribing behavior as an NHS stamp of approval and two studies to be as convincing as having used the technology personally. Increasing patient age and costs resulted in significant reductions in digital health prescribing (P<.001), none more so than among allied health professionals. Willingness-to-pay for health apps increased by £124.61 (US $151.14) if an NHS stamp of approval was present and by £29.20 (US $35.42) for each published study. Overall, 8.1% (n=18/222) of respondents were reluctant to use health apps, always choosing the I would prescribe neither option, particularly among older HCPs, nurses, and those who do not use health apps personally. Subgroup analyses revealed significant differences in preferences among HCPs of differing ages and clinical backgrounds. Conclusions: An NHS stamp of approval, published studies, and recommendations from fellow HCPs are significant facilitators of digital prescribing, whereas increasing costs and patient age are significant barriers to engagement. These findings suggest that demonstrating assurances of health apps and supporting both the dissemination and peer-to-peer recommendation of evidence-based technologies are critical if the NHS is to achieve its long-term digital transformation ambitions. UR - https://mhealth.jmir.org/2020/7/e17704 UR - http://dx.doi.org/10.2196/17704 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628118 ID - info:doi/10.2196/17704 ER - TY - JOUR AU - Cawley, Caroline AU - Buckenmeyer, Hannelore AU - Jellison, Trina AU - Rinaldi, B. Joseph AU - Vartanian, B. Keri PY - 2020/7/6 TI - Effect of a Health System?Sponsored Mobile App on Perinatal Health Behaviors: Retrospective Cohort Study JO - JMIR Mhealth Uhealth SP - e17183 VL - 8 IS - 7 KW - mobile health KW - perinatal health KW - health behaviors N2 - Background: Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. Previous studies have looked at whether prenatal apps impact health and behavior outcomes among pregnant and postpartum individuals; however, research has been limited. Objective: The primary objective of this study is to assess whether the use of a health system?sponsored mobile app?Circle by Providence?aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users. Methods: This observational study compared app users and app nonusers using a self-reported survey and electronic medical records. The study took place over 18 months and was conducted at Providence St. Joseph Health in Portland, Oregon. The sample included patients who received prenatal care at one of seven Providence clinics and had a live birth at a Providence hospital. Recruitment occurred on a rolling basis and only those who completed the survey were included. Survey respondents were separated into app users and app nonusers, and survey responses and clinical outcomes were compared across groups using univariate and adjusted multivariate logistic regression. Results: A total of 567 participants were enrolled in the study?167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=.012), were less likely to miss prenatal appointments (P=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of ?purple crying.? Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays. Conclusions: The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care. UR - https://mhealth.jmir.org/2020/7/e17183 UR - http://dx.doi.org/10.2196/17183 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628123 ID - info:doi/10.2196/17183 ER - TY - JOUR AU - Potts, Courtney AU - Bond, Raymond AU - Ryan, Assumpta AU - Mulvenna, Maurice AU - McCauley, Claire AU - Laird, Elizabeth AU - Goode, Deborah PY - 2020/7/6 TI - Ecological Momentary Assessment Within a Digital Health Intervention for Reminiscence in Persons With Dementia and Caregivers: User Engagement Study JO - JMIR Mhealth Uhealth SP - e17120 VL - 8 IS - 7 KW - ecological momentary assessment KW - EMA KW - app KW - behaviour analytics KW - event logging KW - dementia KW - carers KW - reminiscence KW - reminiscing KW - mHealth N2 - Background: User-interaction event logs provide rich and large data sets that can provide valuable insights into how people engage with technology. Approaches such as ecological momentary assessment (EMA) can be used to gather accurate real-time data in an individual?s natural environment by asking questions at any given instant. Objective: The purpose of this study was to evaluate user engagement and responses to EMA questions using InspireD, an app used for reminiscence by persons with dementia and their caregivers. Research findings can be used to inform EMA use within digital health interventions. Methods: A feasibility trial was conducted in which participants (n=56) used the InspireD app over a 12-week period. Participants were a mean age of 73 (SD 13) and were either persons with dementia (n=28) or their caregivers (n=28). Questions, which they could either answer or choose to dismiss, were presented to participants at various instants after reminiscence with personal or generic photos, videos, and music. Presentation and dismissal rates for questions were compared by hour of the day and by trial week to investigate user engagement. Results: Overall engagement was high, with 69.1% of questions answered when presented. Questions that were presented in the evening had the lowest dismissal rate; the dismissal rate for questions presented at 9 PM was significantly lower than the dismissal rate for questions presented at 11 AM (9 PM: 10%; 11 AM: 50%; ?21=21.4, P<.001). Questions asked following reminiscence with personal media, especially those asked after personal photos, were less likely to be answered compared to those asked after other media. In contrast, questions asked after the user had listened to generic media, in particular those asked after generic music, were much more likely to be answered. Conclusions: The main limitation of our study was the lack of generalizability of results to a larger population given the quasi-experimental design and older demographic where half of participants were persons with dementia; however, this study shows that older people are willing to participate and engage in EMA. Based on this study, we propose a series of recommendations for app design to increase user engagement with EMA. These include presenting questions no more than once per day, after 8 PM in the evening, and only if the user is not trying to complete a task within the app. UR - https://mhealth.jmir.org/2020/7/e17120 UR - http://dx.doi.org/10.2196/17120 UR - http://www.ncbi.nlm.nih.gov/pubmed/32420890 ID - info:doi/10.2196/17120 ER - TY - JOUR AU - Hewage, Sumali AU - Audimulam, Jananie AU - Sullivan, Emily AU - Chi, Claudia AU - Yew, Wei Tong AU - Yoong, Joanne PY - 2020/6/30 TI - Barriers to Gestational Diabetes Management and Preferred Interventions for Women With Gestational Diabetes in Singapore: Mixed Methods Study JO - JMIR Form Res SP - e14486 VL - 4 IS - 6 KW - gestational diabetes KW - pregnancy KW - telemedicine KW - self-management KW - patient-centered care KW - mobile phone N2 - Background: Gestational diabetes mellitus (GDM) is associated with risks for both the mother and child. The escalated prevalence of GDM because of obesity and changes in screening criteria demands for greater health care needs than before. Objective: This study aimed to understand the perception of patients and health care providers of the barriers to GDM management and preferred interventions to manage GDM in an Asian setting. Methods: This mixed methods study used a convergent parallel design. Survey data were collected from 216 women with GDM, and semistructured interviews were conducted with 15 women and with 8 health care providers treating patients with GDM. Participants were recruited from 2 specialized GDM clinics at the National University Hospital, Singapore. Results: The patients were predominantly Chinese (102/214, 47.6%), employed (201/272, 73.9%), with higher education (150/216, 69.4%) and prenatal attendance at a private clinic (138/214, 64.2%), already on diet control (210/214, 98.1%), and receiving support and information from the GDM clinic (194/215, 90.2%) and web-based sources (131/215, 60.9%). In particular, working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Most women preferred getting such support directly from health care providers, whether at the GDM clinic (174/215, 80.9%) or elsewhere (116/215, 53.9%). Smartphone apps were the preferred means of additional intervention. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers. Conclusions: A GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, particularly for working women. UR - http://formative.jmir.org/2020/6/e14486/ UR - http://dx.doi.org/10.2196/14486 UR - http://www.ncbi.nlm.nih.gov/pubmed/32602845 ID - info:doi/10.2196/14486 ER - TY - JOUR AU - Inomata, Takenori AU - Nakamura, Masahiro AU - Iwagami, Masao AU - Midorikawa-Inomata, Akie AU - Sung, Jaemyoung AU - Fujimoto, Keiichi AU - Okumura, Yuichi AU - Eguchi, Atsuko AU - Iwata, Nanami AU - Miura, Maria AU - Fujio, Kenta AU - Nagino, Ken AU - Hori, Satoshi AU - Tsubota, Kazuo AU - Dana, Reza AU - Murakami, Akira PY - 2020/6/26 TI - Stratification of Individual Symptoms of Contact Lens?Associated Dry Eye Using the iPhone App DryEyeRhythm: Crowdsourced Cross-Sectional Study JO - J Med Internet Res SP - e18996 VL - 22 IS - 6 KW - contact lens-associated dry eye KW - mobile health KW - ResearchKit KW - smartphone app KW - DryEyeRhythm KW - subjective symptoms KW - risk factors KW - dry eye KW - stratification KW - mobile phone N2 - Background: Discontinuation of contact lens use is mainly caused by contact lens?associated dry eye. It is crucial to delineate contact lens?associated dry eye's multifaceted nature to tailor treatment to each patient?s individual needs for future personalized medicine. Objective: This paper aims to quantify and stratify individual subjective symptoms of contact lens?associated dry eye and clarify its risk factors for future personalized medicine using the smartphone app DryEyeRhythm (Juntendo University). Methods: This cross-sectional study included iPhone (Apple Inc) users in Japan who downloaded DryEyeRhythm. DryEyeRhythm was used to collect medical big data related to contact lens?associated dry eye between November 2016 and January 2018. The main outcome measure was the incidence of contact lens?associated dry eye. Univariate and multivariate adjusted odds ratios of risk factors for contact lens?associated dry eye were determined by logistic regression analyses. The t-distributed Stochastic Neighbor Embedding algorithm was used to depict the stratification of subjective symptoms of contact lens?associated dry eye. Results: The records of 4454 individuals (median age 27.9 years, SD 12.6), including 2972 female participants (66.73%), who completed all surveys were included in this study. Among the included participants, 1844 (41.40%) were using contact lenses, and among those who used contact lenses, 1447 (78.47%) had contact lens?associated dry eye. Multivariate adjusted odds ratios of risk factors for contact lens?associated dry eye were as follows: younger age, 0.98 (95% CI 0.96-0.99); female sex, 1.53 (95% CI 1.05-2.24); hay fever, 1.38 (95% CI 1.10-1.74); mental illness other than depression or schizophrenia, 2.51 (95% CI 1.13-5.57); past diagnosis of dry eye, 2.21 (95% CI 1.63-2.99); extended screen exposure time >8 hours, 1.61 (95% CI 1.13-2.28); and smoking, 2.07 (95% CI 1.49-2.88). The t-distributed Stochastic Neighbor Embedding analysis visualized and stratified 14 groups based on the subjective symptoms of contact lens?associated dry eye. Conclusions: This study identified and stratified individuals with contact lens?associated dry eye and its risk factors. Data on subjective symptoms of contact lens?associated dry eye could be used for prospective prevention of contact lens?associated dry eye progression. UR - http://www.jmir.org/2020/6/e18996/ UR - http://dx.doi.org/10.2196/18996 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589162 ID - info:doi/10.2196/18996 ER - TY - JOUR AU - Keutzer, Lina AU - Simonsson, SH Ulrika PY - 2020/6/26 TI - Medical Device Apps: An Introduction to Regulatory Affairs for Developers JO - JMIR Mhealth Uhealth SP - e17567 VL - 8 IS - 6 KW - MDR KW - medical device regulation KW - medical devices, medical device software KW - mHealth KW - eHealth KW - mobile apps KW - smartphone apps UR - http://mhealth.jmir.org/2020/6/e17567/ UR - http://dx.doi.org/10.2196/17567 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589154 ID - info:doi/10.2196/17567 ER - TY - JOUR AU - Grieger, A. Jessica AU - Norman, J. Robert PY - 2020/6/24 TI - Menstrual Cycle Length and Patterns in a Global Cohort of Women Using a Mobile Phone App: Retrospective Cohort Study JO - J Med Internet Res SP - e17109 VL - 22 IS - 6 KW - body mass index KW - follicular phase KW - fertility KW - luteal phase KW - menstrual cycle KW - mobile application KW - internet KW - ovulation KW - mobile phone N2 - Background: There is increasing information characterizing menstrual cycle length in women, but less information is available on the potential differences across lifestyle variables. Objective: This study aimed to describe differences in menstrual cycle length, variability, and menstrual phase across women of different ages and BMI among a global cohort of Flo app users. We have also reported on demographic and lifestyle characteristics across median cycle lengths. Methods: The analysis was run based on the aggregated anonymized dataset from a menstrual cycle tracker and ovulation calendar that covers all phases of the reproductive cycle. Self-reported information is documented, including demographics, menstrual flow and cycle length, ovulation information, and reproductive health and diseases. Data from women aged ?18 years and who had logged at least three cycles (ie, 2 completed cycles and 1 current cycle) in the Flo app were included (1,579,819 women). Results: Of the 1.5 million users, approximately half (638,683/1,579,819, 40.42%) were aged between 18 and 24 years. Just over half of those reporting BMIs were in the normal range (18.5-24.9 kg/m2; 202,420/356,598, 56.76%) and one-third were overweight or obese (>25 kg/m2; 120,983/356,598, 33.93%). A total of 16.32% (257,889/1,579,819) of women had a 28-day median cycle length. There was a higher percentage of women aged ?40 years who had a 27-day median cycle length than those aged between 18 and 24 years (22,294/120,612, 18.48% vs 60,870/637,601, 9.55%), but a lower percentage with a 29-day median cycle length (10,572/120,612, 8.77% vs 79,626/637,601, 12.49%). There were a higher number of cycles with short luteal phases in younger women, whereas women aged ?40 years had a higher number of cycles with longer luteal phases. Median menstrual cycle length and the length of the follicular and luteal phases were not remarkably different with increasing BMI, except for the heaviest women at a BMI of ?50 kg/m2. Conclusions: On a global scale, we have provided extensive evidence on the characteristics of women and their menstrual cycle length and patterns across different age and BMI groups. This information is necessary to support updates of current clinical guidelines around menstrual cycle length and patterns for clinical use in fertility programs. UR - http://www.jmir.org/2020/6/e17109/ UR - http://dx.doi.org/10.2196/17109 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442161 ID - info:doi/10.2196/17109 ER - TY - JOUR AU - Ding, Xiaodong AU - Cheng, Feng AU - Morris, Robert AU - Chen, Cong AU - Wang, Yiqin PY - 2020/6/22 TI - Machine Learning?Based Signal Quality Evaluation of Single-Period Radial Artery Pulse Waves: Model Development and Validation JO - JMIR Med Inform SP - e18134 VL - 8 IS - 6 KW - pulse wave KW - quality evaluation KW - single period KW - segmentation KW - machine learning N2 - Background: The radial artery pulse wave is a widely used physiological signal for disease diagnosis and personal health monitoring because it provides insight into the overall health of the heart and blood vessels. Periodic radial artery pulse signals are subsequently decomposed into single pulse wave periods (segments) for physiological parameter evaluations. However, abnormal periods frequently arise due to external interference, the inherent imperfections of current segmentation methods, and the quality of the pulse wave signals. Objective: The objective of this paper was to develop a machine learning model to detect abnormal pulse periods in real clinical data. Methods: Various machine learning models, such as k-nearest neighbor, logistic regression, and support vector machines, were applied to classify the normal and abnormal periods in 8561 segments extracted from the radial pulse waves of 390 outpatients. The recursive feature elimination method was used to simplify the classifier. Results: It was found that a logistic regression model with only four input features can achieve a satisfactory result. The area under the receiver operating characteristic curve from the test set was 0.9920. In addition, these classifiers can be easily interpreted. Conclusions: We expect that this model can be applied in smart sport watches and watchbands to accurately evaluate human health status. UR - http://medinform.jmir.org/2020/6/e18134/ UR - http://dx.doi.org/10.2196/18134 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568091 ID - info:doi/10.2196/18134 ER - TY - JOUR AU - Rono, Hillary AU - Bastawrous, Andrew AU - Macleod, David AU - Bunywera, Cosmas AU - Mamboleo, Ronald AU - Wanjala, Emmanuel AU - Burton, Matthew PY - 2020/6/19 TI - Smartphone-Guided Algorithms for Use by Community Volunteers to Screen and Refer People With Eye Problems in Trans Nzoia County, Kenya: Development and Validation Study JO - JMIR Mhealth Uhealth SP - e16345 VL - 8 IS - 6 KW - visual impairment KW - algorithms KW - mobile phone KW - screening KW - mHealth KW - sensitivity KW - specificity N2 - Background: The provision of eye care services is currently insufficient to meet the requirements of eye care. Many people remain unnecessarily visually impaired or at risk of becoming so because of treatable or preventable eye conditions. A lack of access and awareness of services is, in large part, a key barrier to handle this unmet need. Objective: This study aimed to assess whether utilizing novel smartphone-based clinical algorithms can task-shift eye screening to community volunteers (CVs) to accurately identify and refer patients to primary eye care services. In particular, we developed the Peek Community Screening app and assessed its validity in making referral decisions for patients with eye problems. Methods: We developed a smartphone-based clinical algorithm (the Peek Community Screening app) using age, distance vision, near vision, and pain as referral criteria. We then compared CVs? referral decisions using this app with those made by an experienced ophthalmic clinical officer (OCO), which was the reference standard. The same participants were assessed by a trained CV using the app and by an OCO using standard outreach equipment. The outcome was the proportion of all decisions that were correct when compared with that of the OCO. Results: The required sensitivity and specificity for the Peek Community Screening app were achieved after seven iterations. In the seventh iteration, the OCO identified referable eye problems in 65.9% (378/574) of the participants. CVs correctly identified 344 of 378 (sensitivity 91.0%; 95% CI 87.7%-93.7%) of the cases and correctly identified 153 of 196 (specificity 78.1%; 95% CI 71.6%-83.6%) cases as not having a referable eye problem. The positive predictive value was 88.9% (95% CI 85.3%-91.8%), and the negative predictive value was 81.8% (95% CI 75.5%-87.1%). Conclusions: Development of such an algorithm is feasible; however, it requires considerable effort and resources. CVs can accurately use the Peek Community Screening app to identify and refer people with eye problems. An iterative design process is necessary to ensure validity in the local context. UR - https://mhealth.jmir.org/2020/6/e16345 UR - http://dx.doi.org/10.2196/16345 UR - http://www.ncbi.nlm.nih.gov/pubmed/32558656 ID - info:doi/10.2196/16345 ER - TY - JOUR AU - Yang, Qing AU - Hatch, Daniel AU - Crowley, J. Matthew AU - Lewinski, A. Allison AU - Vaughn, Jacqueline AU - Steinberg, Dori AU - Vorderstrasse, Allison AU - Jiang, Meilin AU - Shaw, J. Ryan PY - 2020/6/11 TI - Digital Phenotyping Self-Monitoring Behaviors for Individuals With Type 2 Diabetes Mellitus: Observational Study Using Latent Class Growth Analysis JO - JMIR Mhealth Uhealth SP - e17730 VL - 8 IS - 6 KW - digital phenotype KW - latent class growth analysis KW - type 2 diabetes KW - self-management KW - self-monitoring KW - Mobile Health N2 - Background: Sustained self-monitoring and self-management behaviors are crucial to maintain optimal health for individuals with type 2 diabetes mellitus (T2DM). As smartphones and mobile health (mHealth) devices become widely available, self-monitoring using mHealth devices is an appealing strategy in support of successful self-management of T2DM. However, research indicates that engagement with mHealth devices decreases over time. Thus, it is important to understand engagement trajectories to provide varying levels of support that can improve self-monitoring and self-management behaviors. Objective: The aims of this study were to develop (1) digital phenotypes of the self-monitoring behaviors of patients with T2DM based on their engagement trajectory of using multiple mHealth devices, and (2) assess the association of individual digital phenotypes of self-monitoring behaviors with baseline demographic and clinical characteristics. Methods: This longitudinal observational feasibility study included 60 participants with T2DM who were instructed to monitor their weight, blood glucose, and physical activity using a wireless weight scale, phone-tethered glucometer, and accelerometer, respectively, over 6 months. We used latent class growth analysis (LCGA) with multitrajectory modeling to associate the digital phenotypes of participants? self-monitoring behaviors based on their engagement trajectories with multiple mHealth devices. Associations between individual characteristics and digital phenotypes on participants? self-monitoring behavior were assessed by analysis of variance or the Chi square test. Results: The engagement with accelerometers to monitor daily physical activities was consistently high for all participants over time. Three distinct digital phenotypes were identified based on participants? engagement with the wireless weight scale and glucometer: (1) low and waning engagement group (24/60, 40%), (2) medium engagement group (20/60, 33%), and (3) consistently high engagement group (16/60, 27%). Participants that were younger, female, nonwhite, had a low income, and with a higher baseline hemoglobin A1c level were more likely to be in the low and waning engagement group. Conclusions: We demonstrated how to digitally phenotype individuals? self-monitoring behavior based on their engagement trajectory with multiple mHealth devices. Distinct self-monitoring behavior groups were identified. Individual demographic and clinical characteristics were associated with different self-monitoring behavior groups. Future research should identify methods to provide tailored support for people with T2DM to help them better monitor and manage their condition. International Registered Report Identifier (IRRID): RR2-10.2196/13517 UR - https://mhealth.jmir.org/2020/6/e17730 UR - http://dx.doi.org/10.2196/17730 UR - http://www.ncbi.nlm.nih.gov/pubmed/32525492 ID - info:doi/10.2196/17730 ER - TY - JOUR AU - Sakai, Kenichiro AU - Komatsu, Teppei AU - Iguchi, Yasuyuki AU - Takao, Hiroyuki AU - Ishibashi, Toshihiro AU - Murayama, Yuichi PY - 2020/6/9 TI - Reliability of Smartphone for Diffusion-Weighted Imaging?Alberta Stroke Program Early Computed Tomography Scores in Acute Ischemic Stroke Patients: Diagnostic Test Accuracy Study JO - J Med Internet Res SP - e15893 VL - 22 IS - 6 KW - smartphone app KW - DWI KW - ASPECTS N2 - Background: High-quality neuroimages can be viewed using a medical app installed on a smartphone. Although interdevice agreement between smartphone and desktop PC monitor was found to be favorable for evaluating computed tomography images, there are no interdevice agreement data for diffusion-weighted imaging (DWI). Objective: The aim of our study was to compare DWI interpretation using the Join smartphone app with that using a desktop PC monitor, in terms of interdevice and interrater agreement and elapsed interpretation time. Methods: The ischemic change in the DWI of consecutive patients with acute stroke in the middle cerebral artery territory was graded by 2 vascular neurologists using the Join smartphone app and a desktop PC monitor. The vascular neurologists were blinded to all patient information. Each image was categorized as either Diffusion-Weighted Imaging?Alberta Stroke Program Early Computed Tomography Scores (DWI-ASPECTS) ?7 or DWI-ASPECTS <7 according to the Japanese Society for Neuroendovascular Therapy. We analyzed interdevice agreement and interrater agreement with respect to DWI-ASPECTS. Elapsed interpretation time was compared between DWI-ASPECTS evaluated by the Join smartphone app and a desktop PC monitor. Results: We analyzed the images of 111 patients (66% male; median age=69 years; median National Institutes of Health Stroke Scale score on admission=4). Interdevice agreement regarding DWI-ASPECTS between the smartphone and the desktop PC monitor was favorable (vascular neurologist 1: ?=0.777, P<.001, vascular neurologist 2: ?=0.787, P<.001). Interrater agreement was also satisfactory for the smartphone (?=0.710, P<.001) and the desktop PC monitor (?=0.663, P<.001). Median elapsed interpretation time was similar between the smartphone and the desktop PC monitor (vascular neurologist 1: 1.7 min vs 1.6 min; P=.64); vascular neurologist 2: 2.4 min vs 2.0 min; P=.14). Conclusions: The use of a smartphone app enables vascular neurologists to estimate DWI-ASPECTS accurately and rapidly. The Join medical smartphone app shows great promise in the management of acute stroke. UR - https://www.jmir.org/2020/6/e15893 UR - http://dx.doi.org/10.2196/15893 UR - http://www.ncbi.nlm.nih.gov/pubmed/32515744 ID - info:doi/10.2196/15893 ER - TY - JOUR AU - Ek, Anna AU - Alexandrou, Christina AU - Söderström, Emmie AU - Bergman, Patrick AU - Delisle Nyström, Christine AU - Direito, Artur AU - Eriksson, Ulf AU - Henriksson, Pontus AU - Maddison, Ralph AU - Trolle Lagerros, Ylva AU - Bendtsen, Marcus AU - Löf, Marie PY - 2020/6/8 TI - Effectiveness of a 3-Month Mobile Phone?Based Behavior Change Program on Active Transportation and Physical Activity in Adults: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e18531 VL - 8 IS - 6 KW - behavior change KW - mobile phone intervention KW - physical activity KW - active transportation KW - mobile phone app KW - smartphone app N2 - Background: Active transportation (AT; ie, walking and cycling as a mode for transportation) has been associated with decreased morbidity and mortality; however, low-cost and scalable intervention programs are lacking. Objective: The goal of the research was to determine the effectiveness of a 3-month behavior change program delivered via a mobile phone app to promote AT (TravelVu Plus) on time spent in moderate-to-vigorous physical activity (MVPA). Methods: For this 2-arm parallel randomized controlled trial, we recruited a population-based sample of 254 adults from Stockholm County who were aged 20 to 65 years and had access to a smartphone. On completion of 1-week baseline measures, the 254 participants were randomized to either the control or intervention group (1:1 ratio). Both groups had access to the standard TravelVu app (Trivector AB) for monitoring their AT for 6 months. The intervention group also received a 3-month behavior change program to promote AT (TravelVu Plus app). Assessors of outcomes were blinded to group allocation. Outcomes were objectively measured MVPA at 3 (primary) and 6 months. Secondary outcomes were AT, attitudes toward AT, and health-related quality of life at 3 and 6 months. Results: No effect on MVPA was observed after 3 months (P=.29); however, at 6 months the intervention group had a greater improvement in MVPA than the controls (6.05 minutes per day [95% CI 0.36 to 11.74; P=.04]). A Bayesian analyses showed that there was a 98% probability that the intervention had any effect at 6 months, and a 63% probability that this effect was >5 minute MVPA per day. Conclusions: No effect on MVPA immediately after the intervention period (at 3 months) was observed; however, there was a delayed effect on MVPA (6 minutes per day) at 6 months, which corresponds to approximately 30% of the weekly MVPA recommendation. Our findings suggest that a behavior change program promoting AT delivered via an app may have a relevant effect on PA. Trial Registration: ClinicalTrials.gov NCT03086837; https://clinicaltrials.gov/ct2/show/NCT03086837 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5658-4 UR - https://mhealth.jmir.org/2020/6/e18531 UR - http://dx.doi.org/10.2196/18531 UR - http://www.ncbi.nlm.nih.gov/pubmed/32510462 ID - info:doi/10.2196/18531 ER - TY - JOUR AU - Nwe, Khine AU - Larsen, Erik Mark AU - Nelissen, Natalie AU - Wong, Chi-Wai David PY - 2020/6/5 TI - Medical Mobile App Classification Using the National Institute for Health and Care Excellence Evidence Standards Framework for Digital Health Technologies: Interrater Reliability Study JO - J Med Internet Res SP - e17457 VL - 22 IS - 6 KW - mHealth KW - telehealth KW - evaluation KW - evidence KW - interrater KW - NHS Apps Library KW - NICE N2 - Background: Clinical governance of medical mobile apps is challenging, and there is currently no standard method for assessing the quality of such apps. In 2018, the National Institute for Health and Care Excellence (NICE) developed a framework for assessing the required level of evidence for digital health technologies (DHTs), as determined by their clinical function. The framework can potentially be used to assess mobile apps, which are a subset of DHTs. To be used reliably in this context, the framework must allow unambiguous classification of an app?s clinical function. Objective: The objective of this study was to determine whether mobile health apps could be reliably classified using the NICE evidence standards framework for DHTs. Methods: We manually extracted app titles, screenshots, and content descriptions for all apps listed on the National Health Service (NHS) Apps Library website on July 12, 2019; none of the apps were downloaded. Using this information, 2 mobile health (mHealth) researchers independently classified each app to one of the 4 functional tiers (ie, 1, 2, 3a, and 3b) described in the NICE digital technologies evaluation framework. Coders also answered contextual questions from the framework to identify whether apps were deemed to be higher risk. Agreement between coders was assessed using Cohen ? statistic. Results: In total, we assessed 76 apps from the NHS Apps Library. There was classification agreement for 42 apps. Of these, 0 apps were unanimously classified into Tier 1; 24, into Tier 2; 15, into Tier 3a; and 3, into Tier 3b. There was disagreement between coders in 34/76 cases (45%); interrater agreement was poor (Cohen ?=0.32, 95% CI 0.16-0.47). Further investigation of disagreements highlighted 5 main explanatory themes: apps that did not correspond to any tier, apps that corresponded to multiple tiers, ambiguous tier descriptions, ambiguous app descriptions, and coder error. Conclusions: The current iteration of the NICE evidence standards framework for DHTs did not allow mHealth researchers to consistently and unambiguously classify digital health mobile apps listed on the NHS app library according to their functional tier. UR - http://www.jmir.org/2020/6/e17457/ UR - http://dx.doi.org/10.2196/17457 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501271 ID - info:doi/10.2196/17457 ER - TY - JOUR AU - Lupiáñez-Villanueva, Francisco AU - Folkvord, Frans AU - Vanden Abeele, Mariek PY - 2020/6/4 TI - Influence of the Business Revenue, Recommendation, and Provider Models on Mobile Health App Adoption: Three-Country Experimental Vignette Study JO - JMIR Mhealth Uhealth SP - e17272 VL - 8 IS - 6 KW - mHealth adoption KW - experiment KW - mobile apps KW - self-monitoring KW - privacy paradox KW - business model KW - data protection KW - recommendation KW - health consciousness KW - health information orientation KW - eHealth literacy N2 - Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits of mHealth for patients and health care providers, scientific research examining factors explaining the adoption level of mHealth tools remains scarce. Objective: We performed an experimental vignette study to investigate how four factors related to the business model of an mHealth app affect its adoption and users? willingness to pay: (1) the revenue model (ie, sharing data with third parties vs accepting advertisements); (2) the data protection model (General Data Protection Regulation [GDPR]-compliant data handling vs nonGDPR-compliant data handling); (3) the recommendation model (ie, doctor vs patient recommendation); and (4) the provider model (ie, pharmaceutical vs medical association provider). In addition, health consciousness, health information orientation, and electronic health literacy were explored as intrapersonal predictors of adoption. Methods: We conducted an experimental study in three countries, Spain (N=800), Germany (N=800), and the Netherlands (N=416), to assess the influence of multiple business models and intrapersonal characteristics on the willingness to pay and intention to download a health app. Results: The revenue model did not affect willingness to pay or intentions to download the app in all three countries. In the Netherlands, data protection increased willingness to pay for the health app (P<.001). Moreover, in all three countries, data protection increased the likelihood of downloading the app (P<.001). In Germany (P=.04) and the Netherlands (P=.007), a doctor recommendation increased both willingness to pay and intention to download the health app. For all three countries, apps manufactured in association with a medical organization were more likely to be downloaded (P<.001). Finally, in all three countries, men, younger individuals, those with higher levels of education, and people with a health information orientation were willing to pay more for adoption of the health app and had a higher intention to download the app. Conclusions: The finding that people want their data protected by legislation but are not willing to pay more for data protection suggests that in the context of mHealth, app privacy protection cannot be leveraged as a selling point. However, people do value a doctor recommendation and apps manufactured by a medical association, which particularly influence their intention to download an mHealth app. UR - https://mhealth.jmir.org/2020/6/e17272 UR - http://dx.doi.org/10.2196/17272 UR - http://www.ncbi.nlm.nih.gov/pubmed/32496204 ID - info:doi/10.2196/17272 ER - TY - JOUR AU - Petersen, Maria Jasmine AU - Kemps, Eva AU - Lewis, K. Lucy AU - Prichard, Ivanka PY - 2020/6/3 TI - Associations Between Commercial App Use and Physical Activity: Cross-Sectional Study JO - J Med Internet Res SP - e17152 VL - 22 IS - 6 KW - physical activity KW - mobile applications KW - social networking N2 - Background: In today?s society, commercial physical activity apps (eg, Fitbit and Strava) are ubiquitous and hold considerable potential to increase physical activity behavior. Many commercial physical activity apps incorporate social components, in particular app-specific communities (allowing users to interact with other app users) or the capacity to connect to existing social networking platforms (eg, Facebook or Instagram). There is a growing need to gain greater insights into whether commercial physical activity apps and specific components of these apps (social components) are beneficial in facilitating physical activity. Objective: This study aimed to examine the relationship between the use of commercial physical activity apps and engagement in physical activity. The social components of commercial physical activity apps (app-specific communities and existing social networking platforms) were also explored. This involved isolating specific features (eg, sharing, providing, and receiving encouragement, comparisons, and competitions) of app-specific communities and existing social networking platforms that were most valuable in facilitating physical activity. Methods: A cross-sectional web-based survey was conducted. Participants were 1432 adults (mean age 34.1 years, 1256/1432, 88.00% female) who completed measures assessing physical activity, the use of commercial physical activity apps, and engagement with app-specific communities and existing social networking platforms. Results: Overall, 53.14% (761/1432) of the sample reported engaging with a commercial physical activity app. The most commonly used apps were Fitbit (171/761, 22.5%), Strava (130/761, 17.1%), and Garmin (102/761, 13.4%). The use of physical activity apps was significantly associated with physical activity. Notably, the use of app-specific communities and existing social networking platforms facilitated significantly greater engagement in physical activity. The features of app-specific communities that were most beneficial in promoting engagement in physical activity were providing encouragement to a partner, receiving encouragement from close friends and family, and engaging in competitions with members of public app-specific communities. In relation to existing social networking platforms, sharing physical activity posts predicted engagement in physical activity. Conclusions: The findings indicate that app-specific communities and existing social networking platforms are components of apps that are fundamental in facilitating physical activity. They further suggest that commercial physical activity apps afford high population level reach and hold great potential to promote engagement in physical activity, an important public health consideration. UR - https://www.jmir.org/2020/6/e17152 UR - http://dx.doi.org/10.2196/17152 UR - http://www.ncbi.nlm.nih.gov/pubmed/32490836 ID - info:doi/10.2196/17152 ER - TY - JOUR AU - Patel, Tejal AU - Ivo, Jessica AU - Faisal, Sadaf AU - McDougall, Aidan AU - Carducci, Jillian AU - Pritchard, Sarah AU - Chang, Feng PY - 2020/6/2 TI - A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers JO - J Med Internet Res SP - e18073 VL - 22 IS - 6 KW - electronic medication adherence KW - usability KW - workload KW - geriatrics KW - older adults KW - mobile phone N2 - Background: A decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are unknown. Objective: This study aimed to examine the usability and workload of a sample of electronic medication adherence products. Methods: In a prospective, mixed methods study, a sample of older adults, health care professionals, and caregivers tested the usability and workload of 21 electronic medication adherence products. Each participant tested 5 products, one at a time, after which they completed the system usability scale (SUS) and NASA-task load index (NASA-TLX), instruments that measure the usability and workload involved in using a product. Higher SUS scores indicate more user-friendliness, whereas lower NASA-TLX raw scores indicate less workload when using a product. Results: Electronic medication adherence products required a mean of 12.7 steps (range 5-20) for the appropriate use and took, on average, 15.19 min to complete the setup tasks (range 1-56). Participants were able to complete all steps without assistance 55.3% of the time (103 out of the 186 tests were completed by 39 participants; range 0%-100%). The mean SUS and NASA-TLX raw scores were 52.8 (SD 28.7; range 0-100) and 50.0 (SD 25.7; range 4.2-99.2), respectively, revealing significant variability among the electronic medication adherence products. The most user-friendly products were found to be TimerCap travel size (mean 78.67, SD 15.57; P=.03) and eNNOVEA Weekly Planner with Advanced Auto Reminder (mean 78.13, SD 14.13; P=.049) as compared with MedReady 1700 automated medication dispenser (mean 28.63, SD 21.24). Similarly, MedReady (72.92, SD 18.69) was found to be significantly more work intensive when compared with TimerCap (29.35, SD 20.35; P=.03), e-pill MedGlider home medication management system (28.43, SD 20.80; P=.02), and eNNOVEA (28.65, SD 14.97; P=.03). The e-pill MedTime Station automatic pill dispenser with tipper (71.77, SD 21.98) had significantly more workload than TimerCap (P=.04), MedGlider (P=.03), and eNNOVEA (P=.04). Conclusions: This study demonstrated that variability exists in the usability and workload of different electronic medication adherence products among older adults, caregivers, and clinicians. With few studies having investigated the usability and workload of electronic medication adherence products, no benchmarks exist to compare the usability and workload of these products. However, our study highlights the need to assess the usability and workload of different products marketed to assist with medication taking and provides guidance to clinicians regarding electronic medication adherence product recommendations for their patients. Future development of electronic medication adherence products should ensure that the target populations of patients are able to use these products adequately to improve medication management. UR - https://www.jmir.org/2020/6/e18073 UR - http://dx.doi.org/10.2196/18073 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348292 ID - info:doi/10.2196/18073 ER - TY - JOUR AU - Byambasuren, Oyungerel AU - Beller, Elaine AU - Hoffmann, Tammy AU - Glasziou, Paul PY - 2020/6/1 TI - mHealth App Prescription in Australian General Practice: Pre-Post Study JO - JMIR Mhealth Uhealth SP - e16497 VL - 8 IS - 6 KW - mHealth apps KW - app prescription KW - general practice N2 - Background: Evidence of effectiveness of mobile health (mHealth) apps as well as their usability as non-drug interventions in primary care are emerging around the globe. Objective: This study aimed to explore the feasibility of mHealth app prescription by general practitioners (GPs) and to evaluate the effectiveness of an implementation intervention to increase app prescription. Methods: A single-group, before-and-after study was conducted in Australian general practice. GPs were given prescription pads for 6 mHealth apps and reported the number of prescriptions dispensed for 4 months. After the reporting of month 2, a 2-minute video of one of the apps was randomly selected and sent to each GP. Data were collected through a prestudy questionnaire, monthly electronic reporting, and end-of-study interviews. The primary outcome was the number of app prescriptions (total, monthly, per GP, and per GP per fortnight). Secondary outcomes included confidence in prescribing apps (0-5 scale), the impact of the intervention video on subsequent prescription numbers, and acceptability of the interventions. Results: Of 40 GPs recruited, 39 commenced, and 36 completed the study. In total, 1324 app prescriptions were dispensed over 4 months. The median number of apps prescribed per GP was 30 (range 6-111 apps). The median number of apps prescribed per GP per fortnight increased from the pre-study level of 1.7 to 4.1. Confidence about prescribing apps doubled from a mean of 2 (not so confident) to 4 (very confident). App videos did not affect subsequent prescription rates substantially. Post-study interviews revealed that the intervention was highly acceptable. Conclusions: mHealth app prescription in general practice is feasible, and our implementation intervention was effective in increasing app prescription. GPs need more tailored education and training on the value of mHealth apps and knowledge of prescribable apps to be able to successfully change their prescribing habits to include apps. The future of sustainable and scalable app prescription requires a trustworthy electronic app repository of prescribable mHealth apps for GPs. UR - https://mhealth.jmir.org/2020/6/e16497 UR - http://dx.doi.org/10.2196/16497 UR - http://www.ncbi.nlm.nih.gov/pubmed/32478660 ID - info:doi/10.2196/16497 ER - TY - JOUR AU - Lecomte, Tania AU - Potvin, Stéphane AU - Corbière, Marc AU - Guay, Stéphane AU - Samson, Crystal AU - Cloutier, Briana AU - Francoeur, Audrey AU - Pennou, Antoine AU - Khazaal, Yasser PY - 2020/5/29 TI - Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses JO - JMIR Mhealth Uhealth SP - e17458 VL - 8 IS - 5 KW - apps KW - mental health KW - depression KW - anxiety KW - review KW - meta N2 - Background: Mental health apps have great potential to help people needing support to cope with distress or specific symptoms. In fact, there is an exponential increase in the number of mental health apps available on the internet, with less than 5% being actually studied. Objective: This study aimed to assess the quality of the available evidence regarding the use of mental health apps and to summarize the results obtained so far. Methods: Systematic reviews and meta-analyses were searched, specifically for mobile apps on mental health issues or symptoms, and rated using the Grading of Recommendations Assessment, Development and Evaluation system. Results: A total of 7 meta-analyses were carefully reviewed and rated. Although some meta-analyses looked at any mental health issue and analyzed the data together, these studies were of poorer quality and did not offer strong empirical support for the apps. Studies focusing specifically on anxiety symptoms or depressive symptoms were of moderate to high quality and generally had small to medium effect sizes. Similarly, the effects of apps on stress and quality of life tended to offer small to medium effects and were of moderate to high quality. Studies looking at stand-alone apps had smaller effect sizes but better empirical quality than studies looking at apps with guidance. The studies that included follow-ups mostly found a sustained impact of the app at an 11-week follow-up. Conclusions: This meta-review revealed that apps for anxiety and depression hold great promise with clear clinical advantages, either as stand-alone self-management or as adjunctive treatments. More meta-analyses and more quality studies are needed to recommend apps for other mental health issues or for specific populations. UR - https://mhealth.jmir.org/2020/5/e17458 UR - http://dx.doi.org/10.2196/17458 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348289 ID - info:doi/10.2196/17458 ER - TY - JOUR AU - Ritchie, Jordon AU - Welch, Brandon PY - 2020/5/29 TI - Categorization of Third-Party Apps in Electronic Health Record App Marketplaces: Systematic Search and Analysis JO - JMIR Med Inform SP - e16980 VL - 8 IS - 5 KW - electronic health records KW - medical informatics KW - software KW - interoperability KW - apps KW - app marketplace N2 - Background: Third-party electronic health record (EHR) apps allow health care organizations to extend the capabilities and features of their EHR system. Given the widespread utilization of EHRs and the emergence of third-party apps in EHR marketplaces, it has become necessary to conduct a systematic review and analysis of apps in EHR app marketplaces. Objective: The goal of this review is to organize, categorize, and characterize the availability of third-party apps in EHR marketplaces. Methods: Two informaticists (authors JR and BW) used grounded theory principles to review and categorize EHR apps listed in top EHR vendors? public-facing marketplaces. Results: We categorized a total of 471 EHR apps into a taxonomy consisting of 3 primary categories, 15 secondary categories, and 55 tertiary categories. The three primary categories were administrative (n=203, 43.1%), provider support (n=159, 33.8%), and patient care (n=109, 23.1%). Within administrative apps, we split the apps into four secondary categories: front office (n=77, 37.9%), financial (n=53, 26.1%), office administration (n=49, 24.1%), and office device integration (n=17, 8.4%). Within the provider support primary classification, we split the apps into eight secondary categories: documentation (n=34, 21.3%), records management (n=27, 17.0%), care coordination (n=23, 14.4%), population health (n=18, 11.3%), EHR efficiency (n=16, 10.1%), ordering and prescribing (n=15, 9.4%), medical device integration (n=13, 8.2%), and specialty EHR (n=12, 7.5%). Within the patient care primary classification, we split the apps into three secondary categories: patient engagement (n=50, 45.9%), clinical decision support (n=40, 36.7%), and remote care (n=18, 16.5%). Total app counts varied substantially across EHR vendors. Overall, the distribution of apps across primary categories were relatively similar, with a few exceptions. Conclusions: We characterized and organized a diverse and rich set of third-party EHR apps. This work provides an important reference for developers, researchers, and EHR customers to more easily search, review, and compare apps in EHR app marketplaces. UR - http://medinform.jmir.org/2020/5/e16980/ UR - http://dx.doi.org/10.2196/16980 UR - http://www.ncbi.nlm.nih.gov/pubmed/32469324 ID - info:doi/10.2196/16980 ER - TY - JOUR AU - Jacobson, C. Nicholas AU - Summers, Berta AU - Wilhelm, Sabine PY - 2020/5/29 TI - Digital Biomarkers of Social Anxiety Severity: Digital Phenotyping Using Passive Smartphone Sensors JO - J Med Internet Res SP - e16875 VL - 22 IS - 5 KW - biomarkers KW - machine learning KW - technology assessment, biomedical KW - social anxiety KW - social anxiety disorder KW - mobile phone N2 - Background: Social anxiety disorder is a highly prevalent and burdensome condition. Persons with social anxiety frequently avoid seeking physician support and rarely receive treatment. Social anxiety symptoms are frequently underreported and underrecognized, creating a barrier to the accurate assessment of these symptoms. Consequently, more research is needed to identify passive biomarkers of social anxiety symptom severity. Digital phenotyping, the use of passive sensor data to inform health care decisions, offers a possible method of addressing this assessment barrier. Objective: This study aims to determine whether passive sensor data acquired from smartphone data can accurately predict social anxiety symptom severity using a publicly available dataset. Methods: In this study, participants (n=59) completed self-report assessments of their social anxiety symptom severity, depressive symptom severity, positive affect, and negative affect. Next, participants installed an app, which passively collected data about their movement (accelerometers) and social contact (incoming and outgoing calls and texts) over 2 weeks. Afterward, these passive sensor data were used to form digital biomarkers, which were paired with machine learning models to predict participants? social anxiety symptom severity. Results: The results suggested that these passive sensor data could be utilized to accurately predict participants? social anxiety symptom severity (r=0.702 between predicted and observed symptom severity) and demonstrated discriminant validity between depression, negative affect, and positive affect. Conclusions: These results suggest that smartphone sensor data may be utilized to accurately detect social anxiety symptom severity and discriminate social anxiety symptom severity from depressive symptoms, negative affect, and positive affect. UR - http://www.jmir.org/2020/5/e16875/ UR - http://dx.doi.org/10.2196/16875 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348284 ID - info:doi/10.2196/16875 ER - TY - JOUR AU - Hussain, Tasmeen AU - Smith, Patricia AU - Yee, M. Lynn PY - 2020/5/28 TI - Mobile Phone?Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review JO - JMIR Mhealth Uhealth SP - e15111 VL - 8 IS - 5 KW - mHealth KW - mobile health KW - pregnancy KW - smartphone KW - text messaging KW - mobile applications KW - software KW - chronic disease KW - health behavior N2 - Background: Chronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions. Objective: This study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes. Methods: This systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles, including source, study design, intervention and control, duration, participant age, attrition rate, main outcomes, and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was registered in PROSPERO before initiation. Results: Of the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64%) and were randomized controlled trials (21/28, 75%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes. Data and interventions were heterogeneous, precluding a meta-analysis. Conclusions: In high-income countries, utilization of mobile phone?based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain. UR - https://mhealth.jmir.org/2020/5/e15111 UR - http://dx.doi.org/10.2196/15111 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463373 ID - info:doi/10.2196/15111 ER - TY - JOUR AU - Bowman, Cassandra AU - Lunyera, Joseph AU - Alkon, Aviel AU - Boulware, Ebony L. AU - St Clair Russell, Jennifer AU - Riley, Jennie AU - Fink, C. Jeffrey AU - Diamantidis, Clarissa PY - 2020/5/28 TI - A Patient Safety Educational Tool for Patients With Chronic Kidney Disease: Development and Usability Study JO - JMIR Form Res SP - e16137 VL - 4 IS - 5 KW - patient safety KW - chronic kidney disease KW - patient education KW - mhealth N2 - Background: Chronic kidney disease (CKD) is a health condition that threatens patient safety; however, few interventions provide patient-centered education about kidney-specific safety hazards. Objective: We sought to develop and test the usability of a mobile tablet?based educational tool designed to promote patient awareness of relevant safety topics in CKD. Methods: We used plain language principles to develop content for the educational tool, targeting four patient-actionable safety objectives that are relevant for individuals with CKD. These four objectives included avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs); hypoglycemia awareness (among individuals with diabetes); temporary cessation of certain medications during acute volume depletion to prevent acute kidney injury (ie, ?sick day protocol?); and contrast dye risk awareness. Our teaching strategies optimized human-computer interaction and content retention using audio, animation, and clinical vignettes to reinforce themes. For example, using a vignette of a patient with CKD with pain and pictures of common NSAIDs, participants were asked ?Which of the following pain medicines are safe for Mr. Smith to take for his belly pain?? Assessment methods consisted of preknowledge and postknowledge surveys, with provision of correct responses and explanations. Usability testing of the tablet-based tool was performed among 12 patients with any stage of CKD, and program tasks were rated upon completion as no error, noncritical error (self-corrected), or critical error (needing assistance). Results: The 12 participants in this usability study were predominantly 65 years of age or older (n=7, 58%) and female (n=7, 58%); all participants owned a mobile device and used it daily. Among the 725 total tasks that the participants completed, there were 31 noncritical errors (4.3%) and 15 critical errors (2.1%); 1 participant accounted for 30 of the total errors. Of the 12 participants, 10 (83%) easily completed 90% or more of their tasks. Most participants rated the use of the tablet as very easy (n=7, 58%), the activity length as ?just right? (rather than too long or too short) (n=10, 83%), and the use of clinical vignettes as helpful (n=10, 83%); all participants stated that they would recommend this activity to others. The median rating of the activity was 8 on a scale of 1 to 10 (where 10 is best). We incorporated all participant recommendations into the final version of the educational tool. Conclusions: A tablet-based patient safety educational tool is acceptable and usable by individuals with CKD. Future studies leveraging iterations of this educational tool will explore its impact on health outcomes in this high-risk population. UR - http://formative.jmir.org/2020/5/e16137/ UR - http://dx.doi.org/10.2196/16137 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463366 ID - info:doi/10.2196/16137 ER - TY - JOUR AU - Zhang, Donglan AU - Jin, Lan AU - Liang, Di AU - Geng, Ruijin AU - Liu, Yun AU - Ling, Yu AU - Jiang, Fan AU - Zhang, Yunting PY - 2020/5/28 TI - Assessing Feasibility of an Early Childhood Intervention Using Mobile Phones Among Low-Income Mothers of Newborns: Qualitative Interview Study JO - JMIR Form Res SP - e17179 VL - 4 IS - 5 KW - mobile health KW - interview KW - health belief model KW - early child development N2 - Background: Many children aged younger than 5 years living in low- and middle-income countries are at risk for poor development. Early child development (ECD) programs are cost-effective strategies to reduce poverty, crime, school dropouts, and socioeconomic inequality. With the spread of low-cost mobile phones and internet access in low- and middle-income countries, new service delivery models such as mobile phone?aided interventions have a great potential to improve early childhood development. Objective: This study aimed to identify the beliefs on importance of ECD, feasibility of a proposed intervention using mobile phones and factors that may affect the usability of the intervention among mothers of newborns in a poverty-stricken area in southwestern China. Methods: We conducted an in-depth, semistructured interview study of 25 low-income mothers of newborns recruited from two county hospitals in Yunnan Province. We applied the health belief model and cultural competence theories to identify the facilitators, barriers, and preferences among the target population for parenting knowledge. Results: The results showed that the participants had low health literacy and high perceived needs for learning ECD knowledge. At the same time, they experienced several barriers to learning parenting information and following evidence-based instructions including having limited time, limited financial resources, and different opinions on childcare among family members. Many participants preferred to receive personalized messages tailored to their specific needs and preferred videos or graphics to text only in the messages. Many favored a separate module to support postpartum mental health. Conclusions: The study assessed the acceptability of an early childhood intervention using mobile phones to meet the needs of the target population based on their beliefs, traits, and preferences and provided suggestions to refine the intervention to improve its usability. UR - http://formative.jmir.org/2020/5/e17179/ UR - http://dx.doi.org/10.2196/17179 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463374 ID - info:doi/10.2196/17179 ER - TY - JOUR AU - Gimbel, W. Ronald AU - Rennert, M. Lior AU - Crawford, Paul AU - Little, R. Jeanette AU - Truong, Khoa AU - Williams, E. Joel AU - Griffin, F. Sarah AU - Shi, Lu AU - Chen, Liwei AU - Zhang, LingLing AU - Moss, B. Jennie AU - Marshall, C. Robert AU - Edwards, W. Karen AU - Crawford, J. Kristy AU - Hing, Marie AU - Schmeltz, Amanda AU - Lumsden, Brandon AU - Ashby, Morgan AU - Haas, Elizabeth AU - Palazzo, Kelly PY - 2020/5/26 TI - Enhancing Patient Activation and Self-Management Activities in Patients With Type 2 Diabetes Using the US Department of Defense Mobile Health Care Environment: Feasibility Study JO - J Med Internet Res SP - e17968 VL - 22 IS - 5 KW - mHealth KW - diabetes mellitus KW - patient activation KW - patient-centered care KW - eHealth N2 - Background: Past mobile health (mHealth) efforts to empower type 2 diabetes (T2D) self-management include portals, text messaging, collection of biometric data, electronic coaching, email, and collection of lifestyle information. Objective: The primary objective was to enhance patient activation and self-management of T2D using the US Department of Defense?s Mobile Health Care Environment (MHCE) in a patient-centered medical home setting. Methods: A multisite study, including a user-centered design and a controlled trial, was conducted within the US Military Health System. Phase I assessed preferences regarding the enhancement of the enabling technology. Phase II was a single-blinded 12-month feasibility study that randomly assigned 240 patients to either the intervention (n=123, received mHealth technology and behavioral messages tailored to Patient Activation Measure [PAM] level at baseline) or the control group (n=117, received equipment but not messaging. The primary outcome measure was PAM scores. Secondary outcome measures included Summary of Diabetes Self-Care Activities (SDSCA) scores and cardiometabolic outcomes. We used generalized estimating equations to estimate changes in outcomes. Results: The final sample consisted of 229 patients. Participants were 61.6% (141/229) male, had a mean age of 62.9 years, mean glycated hemoglobin (HbA1c) of 7.5%, mean BMI of 32.7, and a mean duration of T2D diagnosis of 9.8 years. At month 12, the control group showed significantly greater improvements compared with the intervention group in PAM scores (control mean 7.49, intervention mean 1.77; P=.007), HbA1c (control mean ?0.53, intervention mean ?0.11; P=.006), and low-density lipoprotein cholesterol (control mean ?7.14, intervention mean 4.38; P=.01). Both groups showed significant improvement in SDSCA, BMI, waist size, and diastolic blood pressure; between-group differences were not statistically significant. Except for patients with the highest level of activation (PAM level 4), intervention group patients exhibited significant improvements in PAM scores. For patients with the lowest level of activation (PAM level 1), the intervention group showed significantly greater improvement compared with the control group in HbA1c (control mean ?0.09, intervention mean ?0.52; P=.04), BMI (control mean 0.58, intervention mean ?1.22; P=.01), and high-density lipoprotein cholesterol levels (control mean ?4.86, intervention mean 3.56; P<.001). Significant improvements were seen in AM scores, SDSCA, and waist size for both groups and in diastolic and systolic blood pressure for the control group; the between-group differences were not statistically significant. The percentage of participants who were engaged with MHCE for ?50% of days period was 60.7% (68/112; months 0-3), 57.4% (62/108; months 3-6), 49.5% (51/103; months 6-9), and 43% (42/98; months 9-12). Conclusions: Our study produced mixed results with improvement in PAM scores and outcomes in both the intervention and control groups. Structural design issues may have hampered the influence of tailored behavioral messaging within the intervention group. Trial Registration: ClinicalTrials.gov NCT02949037; https://clinicaltrials.gov/ct2/show/NCT02949037 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6993 UR - http://www.jmir.org/2020/5/e17968/ UR - http://dx.doi.org/10.2196/17968 UR - http://www.ncbi.nlm.nih.gov/pubmed/32329438 ID - info:doi/10.2196/17968 ER - TY - JOUR AU - Materia, T. Frank AU - Faasse, Kate AU - Smyth, M. Joshua PY - 2020/5/25 TI - Understanding and Preventing Health Concerns About Emerging Mobile Health Technologies JO - JMIR Mhealth Uhealth SP - e14375 VL - 8 IS - 5 KW - mHealth KW - technology KW - nocebo effect KW - implementation science KW - medically unexplained symptoms UR - http://mhealth.jmir.org/2020/5/e14375/ UR - http://dx.doi.org/10.2196/14375 UR - http://www.ncbi.nlm.nih.gov/pubmed/32449688 ID - info:doi/10.2196/14375 ER - TY - JOUR AU - Yang, Sook Yong AU - Ryu, Wook Gi AU - Park, Gi Chang AU - Yeom, Insun AU - Shim, Won Kyu AU - Choi, Mona PY - 2020/5/25 TI - Mood and Stress Evaluation of Adult Patients With Moyamoya Disease in Korea: Ecological Momentary Assessment Method Using a Mobile Phone App JO - JMIR Mhealth Uhealth SP - e17034 VL - 8 IS - 5 KW - affect KW - ecological momentary assessment KW - mood KW - Moyamoya disease KW - psychological stress N2 - Background: Moyamoya disease (MMD) is a known progressive obstructive cerebrovascular disorder. Monitoring and managing mood and stress are critical for patients with MMD, as they affect clinical outcomes. The ecological momentary assessment (EMA) method is a longitudinal study design by which multiple variable assessments can be performed over time to detect momentary fluctuations and changes in psychological dimensions such as mood and stress over time. Objective: This study aimed to identify predicting factors associated with momentary mood and stress at both the within-person and between-person levels and to examine individual fluctuation of mood over time in the short term using an EMA method combined with a mobile phone app. Methods: Participants aged older than 18 years were recruited from a tertiary hospital in Seoul, Korea, between July 2018 and January 2019. The PsyMate scale for negative affect (NA) and positive affect (PA) and the Trier Inventory for Chronic Stress Scale were uploaded on patient mobile phones. Using a mobile app, data were collected four times a day for 7 days. Pearson correlations and mixed modeling were used to predict relationships between repeatedly measured variables at both the between-person and within-person levels. Results: The mean age of the 93 participants was 40.59 (SD 10.06) years, 66 (71%) were female, and 71 (76%) were married. Participants provided 1929 responses out of a possible 2604 responses (1929/2604, 74.08%). The mean momentary NA and PA values were 2.15 (SD 1.12) and 4.70 (SD 1.31) out of 7, respectively. The momentary stress value was 2.03 (SD 0.98) out of 5. Momentary NA, PA, and stress were correlated (P<.001) and varied over time in relation to momentary variables. Common momentary variables associated with momentary mood and stress at both the within-person (level 1) and between-person (level 2) levels were identified. Momentary NA increased when being alone and being at the hospital at both levels, whereas momentary PA increased when eating or drinking, resting, being at a café, restaurant or a public place but decreased when being alone at both levels. Momentary stress increased when being at the office, at a public place, or as the time of the day went by but decreased when resting or during the weekend. Different factors affecting mood and stress at different levels were identified. Fluctuations in individual momentary mood over time at the within-person level were captured. Conclusions: The EMA method using a mobile phone app demonstrated its ability to capture changes in mood and stress in various environmental contexts in patients with MMD. The results could provide baseline information for developing interventions to manage negative mood and stress of patients with MMD based on the identified predictors affecting mood and stress at two different levels. UR - http://mhealth.jmir.org/2020/5/e17034/ UR - http://dx.doi.org/10.2196/17034 UR - http://www.ncbi.nlm.nih.gov/pubmed/32449687 ID - info:doi/10.2196/17034 ER - TY - JOUR AU - Chai, R. Peter AU - Schwartz, Emily AU - Hasdianda, Adrian Mohammad AU - Azizoddin, R. Desiree AU - Kikut, Anna AU - Jambaulikar, D. Guruprasad AU - Edwards, R. Robert AU - Boyer, W. Edward AU - Schreiber, L. Kristin PY - 2020/5/20 TI - A Brief Music App to Address Pain in the Emergency Department: Prospective Study JO - J Med Internet Res SP - e18537 VL - 22 IS - 5 KW - music therapy KW - pain KW - smartphone KW - technology KW - telemedicine KW - emergency service, hospital N2 - Background: Emergency physicians face the challenge of relieving acute pain daily. While opioids are a potent treatment for pain, the opioid epidemic has ignited a search for nonopioid analgesic alternatives that may decrease the dose or duration of opioid exposure. While behavioral therapies and complementary medicine are effective, they are difficult to deploy in the emergency department. Music is a potential adjunctive therapy that has demonstrated effectiveness in managing pain. Objective: Our objective was to understand the feasibility and potential for an effect of a novel music app to address acute pain and anxiety in patients admitted to an emergency department observation unit. Methods: This prospective cohort study enrolled patients admitted to an emergency department observation unit with pain who had received orders for opioids. We gathered baseline pain and psychosocial characteristics including anxiety, sleep disturbance, and pain catastrophizing using validated questionnaires. Participants received a smartphone-based music intervention and listened to the music in either a supervised (research assistant?delivered music session 3 times during their stay) or unsupervised manner (music used ad lib by participant). The app collected premusic and postmusic pain and anxiety scores, and participants provided qualitative feedback regarding acceptability of operating the music intervention. Results: We enrolled 81 participants and randomly assigned 38 to an unsupervised and 43 to a supervised group. Mean pain in both groups was 6.1 (1.8) out of a possible score of 10. A total of 43 (53%) reported previous use of music apps at home. We observed an overall modest but significant decrease in pain (mean difference ?0.81, 95% CI ?0.45 to ?1.16) and anxiety (mean difference ?0.72, 95% CI ?0.33 to ?1.12) after music sessions. Reduction of pain and anxiety varied substantially among participants. Individuals with higher baseline pain, catastrophizing (about pain), or anxiety reported greater relief. Changes in pain were correlated to changes in anxiety (Pearson ?=0.3, P=.02) but did not vary between supervised and unsupervised groups. Upon conclusion of the study, 46/62 (74%) reported they liked the music intervention, 57/62 (92%) reported the app was easy to use, and 49/62 (79%) reported they would be willing to use the music intervention at home. Conclusions: A smartphone-based music intervention decreased pain and anxiety among patients in an emergency department observation unit, with no difference between supervised and unsupervised use. Individuals reporting the greatest reduction in pain after music sessions included those scoring highest on baseline assessment of catastrophic thinking, suggesting there may be specific patient populations that may benefit more from using music as an analgesic adjunct in the emergency department. Qualitative feedback suggested that this intervention was feasible and acceptable by emergency department patients. UR - http://www.jmir.org/2020/5/e18537/ UR - http://dx.doi.org/10.2196/18537 UR - http://www.ncbi.nlm.nih.gov/pubmed/32432550 ID - info:doi/10.2196/18537 ER - TY - JOUR AU - Kumar, Anupama AU - Wang, Michael AU - Riehm, Alison AU - Yu, Eileen AU - Smith, Ted AU - Kaplin, Adam PY - 2020/5/20 TI - An Automated Mobile Mood Tracking Technology (Mood 24/7): Validation Study JO - JMIR Ment Health SP - e16237 VL - 7 IS - 5 KW - depression KW - text messaging KW - patient monitoring KW - mobile phone KW - short message service KW - ecological momentary assessment KW - digital health N2 - Background: Electronic tracking has been utilized for a variety of health conditions. Previous studies have shown that there is higher adherence to electronic methods vs paper-and-pencil tracking modalities. Electronic tracking also ensures that there are no back-filled entries, where patients have?to appear compliant?entered their responses retrospectively just before their visits with their health care provider. On the basis of the recognition of an unmet need for a Web-based automated platform to track psychiatric outcomes, Johns Hopkins University partnered with Health Central (a subsidiary of Remedy Health Media LLC) to develop Mood 24/7, an electronic, mobile, automated, SMS-based mood tracker. This is a pilot study to validate the use of Mood 24/7 in anticipation of clinical trials to demonstrate the therapeutic benefit on patients? health outcomes of utilizing digital mood-tracking technology. Objective: Mood 24/7 is an electronic mood-monitoring platform developed to accurately and efficiently track mood over time through automated daily SMS texts or emails. This study was designed to assess the accuracy and validity of Mood 24/7 in an outpatient psychiatric setting. Methods: This pilot study involved a retrospective chart review for depressed outpatients (N=9) to compare their self-reported Mood 24/7 daily mood ratings with their psychiatrist?s independent clinical mood assessment at the time of the patient?s visit. Their mood ratings via Mood 24/7 were collected over 36 weeks. In addition, a mixed model analysis was applied to compare the weekly Montgomery-Åsberg Depression Rating Scale (MADRS) scores with Mood 24/7 scores over an average of 3 months. Results: A 97.2% (315/324) digital mood reporting adherence was found over 36 weeks, and a significant correlation (r=0.86, P<.001) was observed between patients? Mood 24/7 scores and their psychiatrist?s blinded clinical assessment of the patient?s mood when seen in the clinic. In addition, a significant concordance (intraclass correlation of 0.69, 95% CI 0.33-0.91, P<.001) was observed in the mixed model analysis of the clinician-administered MADRS vs Mood 24/7 scores over time. Conclusions: Our chart review and mixed model analyses demonstrate that Mood 24/7 is a valid instrument for convenient, simple, noninvasive, and accurate longitudinal mood assessment in the outpatient clinical setting. UR - https://mental.jmir.org/2020/5/e16237 UR - http://dx.doi.org/10.2196/16237 UR - http://www.ncbi.nlm.nih.gov/pubmed/32432558 ID - info:doi/10.2196/16237 ER - TY - JOUR AU - Tan, Han Choon AU - Kyaw, Myint Bhone AU - Smith, Helen AU - Tan, S. Colin AU - Tudor Car, Lorainne PY - 2020/5/15 TI - Use of Smartphones to Detect Diabetic Retinopathy: Scoping Review and Meta-Analysis of Diagnostic Test Accuracy Studies JO - J Med Internet Res SP - e16658 VL - 22 IS - 5 KW - diabetic retinopathy KW - smartphone KW - mobile phone KW - ophthalmoscopy KW - artificial intelligence KW - telemedicine N2 - Background: Diabetic retinopathy (DR), a common complication of diabetes mellitus, is the leading cause of impaired vision in adults worldwide. Smartphone ophthalmoscopy involves using a smartphone camera for digital retinal imaging. Utilizing smartphones to detect DR is potentially more affordable, accessible, and easier to use than conventional methods. Objective: This study aimed to determine the diagnostic accuracy of various smartphone ophthalmoscopy approaches for detecting DR in diabetic patients. Methods: We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for literature published from January 2000 to November 2018. We included studies involving diabetic patients, which compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting DR to an accurate or commonly employed reference standard, such as indirect ophthalmoscopy, slit-lamp biomicroscopy, and tabletop fundus photography. Two reviewers independently screened studies against the inclusion criteria, extracted data, and assessed the quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies?2 tool, with disagreements resolved via consensus. Sensitivity and specificity were pooled using the random effects model. A summary receiver operating characteristic (SROC) curve was constructed. This review is reported in line with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines. Results: In all, nine studies involving 1430 participants were included. Most studies were of high quality, except one study with limited applicability because of its reference standard. The pooled sensitivity and specificity for detecting any DR was 87% (95% CI 74%-94%) and 94% (95% CI 81%-98%); mild nonproliferative DR (NPDR) was 39% (95% CI 10%-79%) and 95% (95% CI 91%-98%); moderate NPDR was 71% (95% CI 57%-81%) and 95% (95% CI 88%-98%); severe NPDR was 80% (95% CI 49%-94%) and 97% (95% CI 88%-99%); proliferative DR (PDR) was 92% (95% CI 79%-97%) and 99% (95% CI 96%-99%); diabetic macular edema was 79% (95% CI 63%-89%) and 93% (95% CI 82%-97%); and referral-warranted DR was 91% (95% CI 86%-94%) and 89% (95% CI 56%-98%). The area under SROC curve ranged from 0.879 to 0.979. The diagnostic odds ratio ranged from 11.3 to 1225. Conclusions: We found heterogeneous evidence showing that smartphone ophthalmoscopy performs well in detecting DR. The diagnostic accuracy for PDR was highest. Future studies should standardize reference criteria and classification criteria and evaluate other available forms of smartphone ophthalmoscopy in primary care settings. UR - http://www.jmir.org/2020/5/e16658/ UR - http://dx.doi.org/10.2196/16658 UR - http://www.ncbi.nlm.nih.gov/pubmed/32347810 ID - info:doi/10.2196/16658 ER - TY - JOUR AU - Rodriguez, Marie Erika AU - Thomas, Daniel AU - Druet, Anna AU - Vlajic-Wheeler, Marija AU - Lane, James Kevin AU - Mahalingaiah, Shruthi PY - 2020/5/14 TI - Identifying Women at Risk for Polycystic Ovary Syndrome Using a Mobile Health App: Virtual Tool Functionality Assessment JO - JMIR Form Res SP - e15094 VL - 4 IS - 5 KW - polycystic ovary syndrome KW - mobile health app KW - Clue KW - menstrual irregularities KW - telemedicine KW - mHealth, mobile phone N2 - Background: Polycystic ovary syndrome (PCOS) is an endocrine disrupting disorder affecting about 10% of reproductive-aged women. PCOS diagnosis may be delayed several years and may require multiple physicians, resulting in lost time for risk-reducing interventions. Menstrual tracking apps are a potential tool to alert women of their risk while also prompting evaluation from a medical professional. Objective: The primary objective of this study was to develop and pilot test the irregular cycle feature, a predictive model that generated a PCOS risk score, in the menstrual tracking app, Clue. The secondary objectives were to run the model using virtual test subjects, create a quantitative risk score, compare the feature?s risk score with that of a physician, and determine the sensitivity and specificity of the model before empirical testing on human subjects. Methods: A literature review was conducted to generate a list of signs and symptoms of PCOS, termed variables. Variables were then assigned a probability and built into a Bayesian network. Questions were created based on these variables. A total of 9 virtual test subjects were identified using self-reported menstrual cycles and answers to the feature?s questions. Upon completion of the questionnaire, a Result Screen and Doctor?s Report summarizing the probability of having PCOS was displayed. This provided information about PCOS and data to facilitate diagnosis by a medical professional. To assess the accuracy of the feature, the same set of 9 virtual test subjects was assigned probabilities by the feature and the physician, who served as the gold standard. The feature recommended individuals with a score greater than or equal to 25% to follow-up with a physician. Differences between the feature and physician scores were evaluated using a t test and a Pearson correlation coefficient in 8 of the 9 virtual test subjects. A second iteration was conducted to assess the feature?s probability capabilities. Results: The irregular cycle feature?s first iteration produced 1 false-positive compared with the physician score and had an absolute mean difference of 15.5% (SD 15.1%) among the virtual test subjects. The second iteration had 2 false positives compared with the physician score and had an absolute mean difference of 18.8% (SD 13.6%). The feature overpredicted the virtual test subjects? risk of PCOS compared with the physician. However, a significant positive correlation existed between the feature and physician score (Pearson correlation coefficient=0.82; P=.01). The second iteration performed worse, with a Pearson correlation coefficient of 0.73 (P=.03). Conclusions: The first iteration of the feature outperformed the second and better predicted the probability of PCOS. Although further research is needed with a more robust sample size, this pilot study indicates the potential value for developing a screening tool to prompt high-risk subjects to seek evaluation by a medical professional. UR - https://formative.jmir.org/2020/5/e15094 UR - http://dx.doi.org/10.2196/15094 UR - http://www.ncbi.nlm.nih.gov/pubmed/32406861 ID - info:doi/10.2196/15094 ER - TY - JOUR AU - Stevens, Timothy AU - McGinnis, S. Ryan AU - Hewgill, Blake AU - Choquette, H. Rebecca AU - Tourville, W. Timothy AU - Harvey, Jean AU - Lachapelle, Richard AU - Beynnon, D. Bruce AU - Toth, J. Michael AU - Skalka, Christian PY - 2020/5/11 TI - A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile?Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation JO - JMIR Hum Factors SP - e16605 VL - 7 IS - 2 KW - device use tracking KW - internet of things KW - neuromuscular electrical stimulation KW - exercise KW - smart devices KW - mHealth KW - rehabilitation KW - mobile health KW - digital health N2 - Background: Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. Objective: This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. Methods: The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System?based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. Results: Compared with the NMES device software?tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. Conclusions: RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing. UR - http://humanfactors.jmir.org/2020/2/e16605/ UR - http://dx.doi.org/10.2196/16605 UR - http://www.ncbi.nlm.nih.gov/pubmed/32384052 ID - info:doi/10.2196/16605 ER - TY - JOUR AU - Hong, Zhen AU - Li, Nian AU - Li, Dajiang AU - Li, Junhua AU - Li, Bing AU - Xiong, Weixi AU - Lu, Lu AU - Li, Weimin AU - Zhou, Dong PY - 2020/5/8 TI - Telemedicine During the COVID-19 Pandemic: Experiences From Western China JO - J Med Internet Res SP - e19577 VL - 22 IS - 5 KW - COVID-19 KW - coronavirus disease KW - medical education KW - pandemics KW - teleteaching KW - tele-education KW - telemedicine UR - http://www.jmir.org/2020/5/e19577/ UR - http://dx.doi.org/10.2196/19577 UR - http://www.ncbi.nlm.nih.gov/pubmed/32349962 ID - info:doi/10.2196/19577 ER - TY - JOUR AU - Haque, Sanaul Md AU - Kangas, Maarit AU - Jämsä, Timo PY - 2020/5/4 TI - A Persuasive mHealth Behavioral Change Intervention for Promoting Physical Activity in the Workplace: Feasibility Randomized Controlled Trial JO - JMIR Form Res SP - e15083 VL - 4 IS - 5 KW - mHealth behavioral change intervention KW - persuasive app KW - UCD KW - game elements KW - physical activity KW - SDT N2 - Background: Employees in an office setting are more likely to remain physically inactive. Physical inactivity has become one of the major barriers to overcoming the risk factors for anxiety, depression, coronary heart disease, certain cancers, and type 2 diabetes. Currently, there is a gap in mobile health (mHealth) apps to promote physical activity (PA) for workers in the workplace. Studies on behavior change theories have concluded that health apps generally lack the use of theoretical constructs. Objective: The objective of this study was to study the feasibility of a persuasive app aimed at encouraging PA among employees and to understand the motivational aspects behind the implementation of mHealth apps among office workers. Methods: A 4-week study using a mixed methods (quantitative and qualitative) design was conducted with office-based employees in cities in 4 countries: Oulu, Finland; Carlow, Ireland; London, United Kingdom; and Dhaka, Bangladesh. Of the 220 invited participants (experimental group, n=115; control group, n=105), 84 participated (experimental group, n=56; control group, n=28), consisting of working-age volunteers working in an office setting. Participants used 2 different interventions: The experimental group used an mHealth app for PA motivation, and the control group used a paper diary. The purpose was to motivate employees to engage in healthier behavior regarding the promotion of PA in the workplace. A user-centered design process was followed to design, develop, and evaluate the mHealth app, incorporating self-determination theory (SDT) and using game elements. The paper diary had no specific theory-driven approach, design technique, nor game elements. Results: Compliance with app usage remained relatively low, with 27 participants (experimental group, n=20; control group, n=7) completing the study. The results support the original hypothesis that the mHealth app would help increase PA (ie, promoting daily walking in the workplace) in comparison to a paper diary (P=.033). The mHealth app supported 2 of the basic SDT psychological needs, namely autonomy (P=.004) and competence (P=.014), but not the needs of relatedness (P=.535). Conclusions: The SDT-based mHealth application motivated employees to increase their PA in the workplace. However, compliance with app usage remained low. Future research should further develop the app based on user feedback and test it in a larger sample. UR - https://formative.jmir.org/2020/5/e15083 UR - http://dx.doi.org/10.2196/15083 UR - http://www.ncbi.nlm.nih.gov/pubmed/32364506 ID - info:doi/10.2196/15083 ER - TY - JOUR AU - Otis, Marisa AU - Zhu, Jack AU - Mustafa-Kutana, N. Suleiman AU - Bernier, V. Angelina AU - Ma Shum, Julio AU - Soros Dupre, A. Arlette AU - Wang, L. Monica PY - 2020/5/1 TI - Testing Usability and Feasibility of a Mobile Educator Tool for Pediatric Diabetes Self-Management: Mixed Methods Pilot Study JO - JMIR Form Res SP - e16262 VL - 4 IS - 5 KW - diabetes mellitus KW - self-management KW - health education KW - mHealth KW - mobile health KW - child health N2 - Background: Mobile interventions hold promise as an intervention modality to engage children in improving diabetes self-management education, attitudes, and behaviors. Objective: This pilot study aimed to explore the usability, acceptability, and feasibility of delivering a mobile diabetes educational tool to parent-child pairs in a clinical setting. Methods: This mixed methods pilot study comprised two concurrent phases with differing study participants. Phase 1 used user testing interviews to collect qualitative data on the usability and acceptability of the tool. Phase 2 used a single-arm pre- and poststudy design to quantitatively evaluate the feasibility and preliminary efficacy of the intervention. Study participants (English-speaking families with youth aged 5-14 years with insulin-dependent diabetes) were recruited from an urban hospital in Massachusetts, United States. In phase 1, parent-child pairs were invited to complete the intervention together and participate in 90-min user testing interviews assessing the tool?s usability and acceptability. Interview transcripts were analyzed using a directed content analysis approach. In phase 2, parent-child pairs were invited to complete the intervention together in the clinical setting. Measures included parental and child knowledge, attitudes, and behaviors related to diabetes management (self-report surveys) and child hemoglobin A1c levels (medical record extractions); data were collected at baseline and 1-month follow-up. Pre- and postoutcomes were compared using paired t tests and the Fisher exact test. Results: A total of 11 parent-child pairs (N=22) participated in phase 1 of the study, and 10 parent-child pairs (N=20) participated in phase 2 of the study. Participants viewed the mobile educational tool as acceptable (high engagement and satisfaction with the layout, activities, and videos) and identified the areas of improvement for tool usability (duration, directions, and animation). Conclusions: The findings from this pilot study suggest that the mobile educational tool is an informative, engaging, and feasible way to deliver diabetes self-management education to parents and children in an urban hospital setting. Data will inform future iterations of this mobile diabetes educational intervention to improve usability and test intervention efficacy. UR - https://formative.jmir.org/2020/5/e16262 UR - http://dx.doi.org/10.2196/16262 UR - http://www.ncbi.nlm.nih.gov/pubmed/32356773 ID - info:doi/10.2196/16262 ER - TY - JOUR AU - Hou, I-Ching AU - Lan, Min-Fang AU - Shen, Shan-Hsiang AU - Tsai, Yu Pei AU - Chang, Jen King AU - Tai, Hao-Chih AU - Tsai, Ay-Jen AU - Chang, Polun AU - Wang, Tze-Fang AU - Sheu, Shuh-Jen AU - Dykes, C. Patricia PY - 2020/4/30 TI - The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach JO - JMIR Mhealth Uhealth SP - e15780 VL - 8 IS - 4 KW - breast cancer KW - mobile health application KW - self-management KW - design thinking N2 - Background: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient?s perspective. Objective: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. Methods: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. Results: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. Conclusions: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer. UR - http://mhealth.jmir.org/2020/4/e15780/ UR - http://dx.doi.org/10.2196/15780 UR - http://www.ncbi.nlm.nih.gov/pubmed/32352390 ID - info:doi/10.2196/15780 ER - TY - JOUR AU - Badawy, M. Sherif AU - Shah, Richa AU - Beg, Usman AU - Heneghan, B. Mallorie PY - 2020/4/28 TI - Habit Strength, Medication Adherence, and Habit-Based Mobile Health Interventions Across Chronic Medical Conditions: Systematic Review JO - J Med Internet Res SP - e17883 VL - 22 IS - 4 KW - habit strength KW - medication adherence KW - habit index KW - medication compliance KW - mobile health KW - health KW - digital health KW - interventions KW - mobile phone N2 - Background: Unintentional medication nonadherence is common and has been associated with poor health outcomes and increased health care costs. Earlier research demonstrated a relationship between habit strength and medication adherence. Previous research also examined a habit?s direct effect on adherence and how habit interacts with more conscious factors to influence or overrule them. However, the relationship between habit and adherence and the role of habit-based mobile health (mHealth) interventions remain unclear. Objective: This review aimed to systematically evaluate the most recent evidence for habit strength, medication adherence, and habit-based mHealth interventions across chronic medical conditions. Methods: A keyword search with combinations of the terms habit, habit strength, habit index, medication adherence, and medication compliance was conducted on the PubMed database. After duplicates were removed, two authors conducted independent abstract and full-text screening. The guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed when reporting evidence across the included and reviewed studies. Results: Of the 687 records examined, 11 met the predefined inclusion criteria and were finalized for data extraction, grading, and synthesis. Most included studies (6/11, 55%) were cross-sectional and used a theoretical model (8/11, 73%). The majority of studies measured habit strength using the self-report habit index and self-report behavioral automaticity index (9/11, 82%). Habit strength was positively correlated with medication adherence in most studies (10/11, 91%). Habit mediated the effects of self-efficacy on medication adherence (1/11, 9%), and social norms moderated the effects of habit strength on medication adherence (1/11, 9%). Habit strength also moderated the effects of poor mental health symptoms and medication adherence (1/11, 9%). None of the included studies reported on using or proposing a habit-based mHealth behavioral intervention to promote medication adherence. Conclusions: Habit strength was strongly correlated with medication adherence, and stronger habit was associated with higher medication adherence rates, regardless of the theoretical model and/or guiding framework. Habit-based interventions should be used to increase medication adherence, and these interventions could leverage widely available mobile technology tools such as mobile apps or text messaging, and existing routines. UR - http://www.jmir.org/2020/4/e17883/ UR - http://dx.doi.org/10.2196/17883 UR - http://www.ncbi.nlm.nih.gov/pubmed/32343250 ID - info:doi/10.2196/17883 ER - TY - JOUR AU - Bernabe-Ortiz, Antonio AU - Pauschardt, Julia AU - Diez-Canseco, Francisco AU - Miranda, Jaime J. PY - 2020/4/21 TI - Sustainability of mHealth Effects on Cardiometabolic Risk Factors: Five-Year Results of a Randomized Clinical Trial JO - J Med Internet Res SP - e14595 VL - 22 IS - 4 KW - mHealth KW - low- and middle-income countries KW - blood pressure KW - body weight N2 - Background: The long-term effects of mobile health (mHealth) interventions have not been documented, especially in resource-constrained settings. Objective: This study aimed to assess the effects of a 1-year mHealth intervention on blood pressure levels and body weight in low-resource urban settings in Peru, 4 years after the completion of the original study. Methods: Four years after the original Grupo de Investigación en Salud Móvil en America Latina (GISMAL) study, we attempted to contact the 212 individuals originally enrolled in the study in Peru. The primary outcomes were systolic and diastolic blood pressure levels and hypertension incidence. Secondary outcome measures were body weight, BMI, and self-reported target behaviors. The study personnel collecting the data were masked to the group assignment. Linear mixed models were used to evaluate the effects of the intervention on primary and secondary outcomes in an intention-to-treat analysis. Results: Data from 164 (77.4%) of the 212 originally enrolled participants were available and analyzed (80 in the intervention group and 84 in the control group). The intervention did not result in changes in systolic (?2.54 mm Hg, 95% CI ?8.23 to 3.15) or diastolic (3.41 mm Hg, 95% CI ?0.75 to 7.57) blood pressure compared with the control group. The intervention reduced the risk of developing hypertension, but the result was not significant (risk ratio (RR) 0.76, 95% CI 0.45-1.28). However, those who received the intervention had lower body weight (?5.42 kg, 95% CI ?10.4 to ?0.48) and BMI (?2.56 kg/m2, 95% CI ?4.46 to ?0.66). In addition, compared to the control participants, those who received ?50% of the scheduled calls during the intervention had greater reductions in body weight (?6.23 kg, 95% CI ?11.47 to ?0.99) and BMI (?2.81 kg/m2, 95% CI ?4.77 to ?0.85). Conclusions: An mHealth intervention comprising motivational interview calls and SMS text messaging appears to have effects on health 4 years after intervention completion. Although there were no effects on blood pressure levels, important reductions in body weight and BMI were seen 5 years after randomization. Thus, mHealth appears to be a promising preventive strategy for noncommunicable diseases in resource-constrained settings. Trial Registration: Clinicaltrials.gov NCT01295216; https://clinicaltrials.gov/ct2/show/NCT01295216 UR - http://www.jmir.org/2020/4/e14595/ UR - http://dx.doi.org/10.2196/14595 UR - http://www.ncbi.nlm.nih.gov/pubmed/32314970 ID - info:doi/10.2196/14595 ER - TY - JOUR AU - Chow, I. Philip PY - 2020/4/20 TI - Developing Mental or Behavioral Health Mobile Apps for Pilot Studies by Leveraging Survey Platforms: A Do-it-Yourself Process JO - JMIR Mhealth Uhealth SP - e15561 VL - 8 IS - 4 KW - app KW - mental health KW - mHealth N2 - Background: Behavioral health researchers are increasingly recognizing the potential of mobile phone apps to deliver empirically supported treatments. However, current options for developing apps typically require large amounts of expertise or money. Objective: This paper aims to describe a pragmatic do-it-yourself approach for researchers to create and pilot an Android mobile phone app using existing survey software (eg, Qualtrics survey platform). Methods: This study was conducted at an academic research center in the United States focused on developing and evaluating behavioral health technologies. The process outlined in this paper was derived and condensed from the steps to building an existing app intervention, iCanThrive, which was developed to enhance mental well-being in women cancer survivors. Results: This paper describes an inexpensive, practical process that uses a widely available survey software, such as Qualtrics, to create and pilot a mobile phone intervention that is presented to participants as a Web viewer app that is downloaded from the Google Play store. Health researchers who are interested in using this process to pilot apps are encouraged to inquire about the survey platforms available to them, the level of security those survey platforms provide, and the regulatory guidelines set forth by their institution. Conclusions: As app interventions continue to gain interest among researchers and consumers alike, it is important to find new ways to efficiently develop and pilot app interventions before committing a large amount of resources. Mobile phone app interventions are an important component to discovering new ways to reach and support individuals with behavioral or mental health disorders. UR - https://mhealth.jmir.org/2020/4/e15561 UR - http://dx.doi.org/10.2196/15561 UR - http://www.ncbi.nlm.nih.gov/pubmed/32310143 ID - info:doi/10.2196/15561 ER - TY - JOUR AU - Ross, L. Edgar AU - Jamison, N. Robert AU - Nicholls, Lance AU - Perry, M. Barbara AU - Nolen, D. Kim PY - 2020/4/16 TI - Clinical Integration of a Smartphone App for Patients With Chronic Pain: Retrospective Analysis of Predictors of Benefits and Patient Engagement Between Clinic Visits JO - J Med Internet Res SP - e16939 VL - 22 IS - 4 KW - chronic pain KW - patient engagement KW - telemedicine KW - mHealth KW - pain measurement N2 - Background: Although many pain-related smartphone apps exist, little attention has been given to understanding how these apps are used over time and what factors contribute to greater compliance and patient engagement. Objective: This retrospective analysis was designed to help identify factors that predicted the benefits and future use of a smartphone pain app among patients with chronic pain. Methods: An app designed for both Android and iOS devices was developed by Brigham and Women?s Hospital Pain Management Center (BWH-PMC) for users with chronic pain to assess and monitor pain and communicate with their providers. The pain app offered chronic pain assessment, push notification reminders and communication, personalized goal setting, relaxation sound files, topics of interest with psychological and medical pain management strategies, and line graphs from daily assessments. BWH-PMC recruited 253 patients with chronic pain over time to use the pain app. All subjects completed baseline measures and were asked to record their progress every day using push notification daily assessments. After 3 months, participants completed follow-up questionnaires and answered satisfaction questions. We defined the number of completed daily assessments as a measure of patient engagement with the pain app. Results: The average age of participants was 51.5 years (SD 13.7, range 18-92), 72.8% (182/253) were female, and 36.8% (78/212) reported the low back as their primary pain site. The number of daily assessments ranged from 1 to 426 (average 62.0, SD 49.9). The app was easy to introduce among patients, and it was well accepted. Those who completed more daily assessments (greater patient engagement) throughout the study were more likely to report higher pain intensity, more activity interference, and greater disability and were generally overweight compared with others. Patients with higher engagement with the app rated the app as offering greater benefit in coping with their pain and expressed more willingness to use the app in the future (P<.05) compared with patients showing lower engagement. Patients completing a small number of daily assessments reported less pain intensity, less daily activity interference, and less pain-related disability on average and were less likely to use the two-way messaging than those who were more engaged with the pain app (P<.05). Conclusions: Patients with chronic pain who appeared to manage their pain better were less likely to report benefits of a smartphone pain app designed for chronic pain management. They demonstrated lower patient engagement in reporting their daily progress, in part, owing to the perceived burden of regularly using an app without a perceived benefit. An intrinsically different pain app designed and targeted for individuals based on early identification of user characteristics and adapted for each individual would likely improve compliance and app-related patient engagement. UR - http://www.jmir.org/2020/4/e16939/ UR - http://dx.doi.org/10.2196/16939 UR - http://www.ncbi.nlm.nih.gov/pubmed/32297871 ID - info:doi/10.2196/16939 ER - TY - JOUR AU - Hsu, Chen-Fang AU - Chien, Tsair-Wei AU - Chow, Chi Julie AU - Yeh, Yu-Tsen AU - Chou, Willy PY - 2020/4/16 TI - An App for Identifying Children at Risk for Developmental Problems Using Multidimensional Computerized Adaptive Testing: Development and Usability Study JO - JMIR Pediatr Parent SP - e14632 VL - 3 IS - 1 KW - computer adaptive testing KW - developmental delay KW - multidimensional KW - mobile phone KW - screening N2 - Background: The use of multidomain developmental screening tools is a viable strategy for pediatric professionals to identify children at risk for developmental problems. However, a specialized multidimensional computer adaptive testing (MCAT) tool has not been developed to date. Objective: We developed an app using MCAT, combined with Multidimensional Screening in Child Development (MuSiC) for toddlers, to help patients and their family members or clinicians identify developmental problems at an earlier stage. Methods: We retrieved 75 item parameters from the MuSiC literature item bank for 1- to 3-year-old children, and simulated 1000 person measures from a normal standard distribution to compare the efficiency and precision of MCAT and nonadaptive testing (NAT) in five domains (ie, cognitive skills, language skills, gross motor skills, fine motor skills, and socioadaptive skills). The number of items saved and the cutoff points for the tool were determined and compared. We then developed an app for a Web-based assessment. Results: MCAT yielded significantly more precise measurements and was significantly more efficient than NAT, with 46.67% (=(75-40)/75) saving in item length when measurement differences less than 5% were allowed. Person-measure correlation coefficients were highly consistent among the five domains. Significantly fewer items were answered on MCAT than on NAT without compromising the precision of MCAT. Conclusions: Developing an app as a tool for parents that can be implemented with their own computers, tablets, or mobile phones for the online screening and prediction of developmental delays in toddlers is useful and not difficult. UR - http://pediatrics.jmir.org/2020/1/e14632/ UR - http://dx.doi.org/10.2196/14632 UR - http://www.ncbi.nlm.nih.gov/pubmed/32297867 ID - info:doi/10.2196/14632 ER - TY - JOUR AU - Hussain-Shamsy, Neesha AU - Shah, Amika AU - Vigod, N. Simone AU - Zaheer, Juveria AU - Seto, Emily PY - 2020/4/13 TI - Mobile Health for Perinatal Depression and Anxiety: Scoping Review JO - J Med Internet Res SP - e17011 VL - 22 IS - 4 KW - mental health KW - depression KW - anxiety KW - pregnancy KW - postpartum KW - smartphone KW - mobile phone KW - text message KW - mHealth N2 - Background: The perinatal period is a vulnerable time during which depression and anxiety commonly occur. If left untreated or undertreated, there may be significant adverse effects; therefore, access to rapid, effective treatment is essential. Treatments for mild-to-moderate symptoms according to a stepped-care approach involve psychoeducation, peer support, and psychological therapy, all of which have been shown to be efficaciously delivered through digital means. Women experience significant barriers to care because of system- and individual-level factors, such as cost, accessibility, and availability of childcare. The use of mobile phones is widespread in this population, and the delivery of mental health services via mobile phones has been suggested as a means of reducing barriers. Objective: This study aimed to understand the extent, range, and nature of mobile health (mHealth) tools for prevention, screening, and treatment of perinatal depression and anxiety in order to identify gaps and inform opportunities for future work. Methods: Using a scoping review framework, 4 databases were searched for terms related to mobile phones, perinatal period, and either depression or anxiety. A total of 477 unique records were retrieved, 81 of which were reviewed by full text. Peer-reviewed publications were included if they described the population as women pregnant or up to 1 year postpartum and a tool explicitly delivered via a mobile phone for preventing, screening, or treating depression or anxiety. Studies published in 2007 or earlier, not in English, or as case reports were excluded. Results: A total of 26 publications describing 22 unique studies were included (77% published after 2017). mHealth apps were slightly more common than texting-based interventions (12/22, 54% vs 10/22, 45%). Most tools were for either depression (12/22, 54%) or anxiety and depression (9/22, 41%); 1 tool was for anxiety only (1/22, 4%). Interventions starting in pregnancy and continuing into the postpartum period were rare (2/22, 9%). Tools were for prevention (10/22, 45%), screening (6/22, 27%), and treatment (6/22, 27%). Interventions delivered included psychoeducation (16/22, 73%), peer support (4/22, 18%), and psychological therapy (4/22, 18%). Cost was measured in 14% (3/22) studies. Conclusions: Future work in this growing area should incorporate active psychological treatment, address continuity of care across the perinatal period, and consider clinical sustainability to realize the potential of mHealth. UR - http://www.jmir.org/2020/4/e17011/ UR - http://dx.doi.org/10.2196/17011 UR - http://www.ncbi.nlm.nih.gov/pubmed/32281939 ID - info:doi/10.2196/17011 ER - TY - JOUR AU - Lim, Lin Su AU - Johal, Jolyn AU - Ong, Wen Kai AU - Han, Yixian Chad AU - Chan, Huak Yiong AU - Lee, Mei Yin AU - Loo, Mun Wai PY - 2020/4/13 TI - Lifestyle Intervention Enabled by Mobile Technology on Weight Loss in Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e14802 VL - 8 IS - 4 KW - diet KW - NAFLD KW - mHealth KW - mobile app, weight loss KW - liver enzymes KW - lifestyle intervention N2 - Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) reaches up to 30% in the Asian adult population, with a higher prevalence in obese patients. Weight reduction is typically recommended for patients at high risk or diagnosed with NAFLD, but is a challenge to achieve. Objective: We aimed to evaluate the effect of a lifestyle intervention with a mobile app on weight loss in NAFLD patients. Methods: This prospective randomized controlled trial included 108 adults with NAFLD confirmed by steatosis on ultrasound and a body mass index ?23 kg/m2 who were recruited from a fatty liver outpatient clinic. The patients were randomly allocated to either a control group (n=53) receiving standard care, consisting of dietary and lifestyle advice by a trained nurse, or an intervention group (n=55) utilizing the Nutritionist Buddy (nBuddy) mobile app in addition to receiving dietary and lifestyle advice by a dietitian. Body weight, alanine aminotransferase (ALT), aspartate aminotransferase (AST), waist circumference, and blood pressure were measured at baseline, and then at 3 and 6 months. Intention-to-treat and per-protocol analyses were used for statistical comparisons. Results: The intervention group had a 5-fold higher likelihood (relative risk 5.2, P=.003, 95% CI 1.8-15.4) of achieving ?5% weight loss compared to the control group at 6 months. The intervention group also showed greater reductions in weight (mean 3.2, SD 4.1 kg vs mean 0.5, SD 2.9 kg; P<.001), waist circumference (mean 2.9, SD 5.0 cm vs mean ?0.7, SD 4.4 cm; P<.001), systolic blood pressure (mean 12.4, SD 14.8 mmHg vs mean 2.4, SD 12.4 mmHg; P=.003), diastolic blood pressure (mean 6.8, SD 8.9 mmHg vs mean ?0.9, SD 10.0 mmHg; P=.001), ALT (mean 33.5, SD 40.4 IU/L vs mean 11.5, SD 35.2 IU/L; P=.004), and AST (mean 17.4, SD 27.5 U/L vs mean 7.4, SD 17.6 IU/L, P=.03) at 6 months. Conclusions: Lifestyle intervention enabled by a mobile app can be effective in improving anthropometric indices and liver enzymes in patients with NAFLD. This treatment modality has the potential to be extended to a larger population scale. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001001381;https://tinyurl.com/w9xnfmp UR - http://mhealth.jmir.org/2020/4/e14802/ UR - http://dx.doi.org/10.2196/14802 UR - http://www.ncbi.nlm.nih.gov/pubmed/32281943 ID - info:doi/10.2196/14802 ER - TY - JOUR AU - Nicklas, M. Jacinda AU - Leiferman, A. Jenn AU - Lockhart, Steven AU - Daly, M. Kristen AU - Bull, S. Sheana AU - Barbour, A. Linda PY - 2020/4/9 TI - Development and Modification of a Mobile Health Program to Promote Postpartum Weight Loss in Women at Elevated Risk for Cardiometabolic Disease: Single-Arm Pilot Study JO - JMIR Form Res SP - e16151 VL - 4 IS - 4 KW - mobile health KW - postpartum KW - chronic disease KW - prevention KW - weight loss N2 - Background: Pregnancy complications in combination with postpartum weight retention lead to significant risks of cardiometabolic disease and obesity. The majority of traditional face-to-face interventions have not been effective in postpartum women. Mobile technology enables the active engagement of postpartum women to promote lifestyle changes to prevent chronic diseases. Objective: We sought to employ an interactive, user-centered, and participatory method of development, evaluation, and iteration to design and optimize the mobile health (mHealth) Fit After Baby program. Methods: For the initial development, a multidisciplinary team integrated evidence-based approaches for health behavior, diet and physical activity, and user-centered design and engagement. We implemented an iterative feedback and design process via 3 month-long beta pilots in which postpartum women with cardiometabolic risk factors participated in the program and provided weekly and ongoing feedback. We also conducted two group interviews using a structured interview guide to gather additional feedback. Qualitative data were recorded, transcribed, and analyzed using established qualitative methods. Modifications based on feedback were integrated into successive versions of the app. Results: We conducted three pilot testing rounds with a total of 26 women. Feedback from each pilot cohort informed changes to the functionality and content of the app, and then a subsequent pilot group participated in the program. We optimized the program in response to feedback through three iterations leading to a final version. Conclusions: This study demonstrates the feasibility of using an interactive, user-centered, participatory method of rapid, iterative design and evaluation to develop and optimize a mHealth intervention program for postpartum women. Trial Registration: ClinicalTrials.gov NCT02384226; https://www.clinicaltrials.gov/ct2/show/NCT02384226 UR - https://formative.jmir.org/2020/4/e16151 UR - http://dx.doi.org/10.2196/16151 UR - http://www.ncbi.nlm.nih.gov/pubmed/32271149 ID - info:doi/10.2196/16151 ER - TY - JOUR AU - Vasudevan, Lavanya AU - Ostermann, Jan AU - Moses, Marwerwe Sara AU - Ngadaya, Esther AU - Mfinanga, Godfrey Sayoki PY - 2020/4/8 TI - Patterns of Mobile Phone Ownership and Use Among Pregnant Women in Southern Tanzania: Cross-Sectional Survey JO - JMIR Mhealth Uhealth SP - e17122 VL - 8 IS - 4 KW - digital health KW - mobile health KW - pregnant women KW - Tanzania N2 - Background: There is a paucity of subnational data on patterns of mobile phone ownership and use in Tanzania to inform the development of digital health interventions. Objective: The aim of this study is to assess patterns of mobile phone ownership and use in pregnant women to inform the feasibility and design of digital health interventions for promoting timely uptake of childhood vaccines in southern Tanzania. Methods: Between August and November 2017, pregnant women in their third trimester were enrolled at health facilities and from surrounding communities, and asked about their patterns of mobile phone ownership and use in an interviewer administered survey. Results: Of 406 women, only 3 had never used a phone. Most women (>98%) could make and receive phone calls. Compared to urban women, rural women reported higher mobile phone use rates but were less likely to be sole owners of phones, and less likely to send or receive SMS, transact money, browse the internet, or use social media via mobile phones. Conclusions: The findings suggest high feasibility for digital health interventions delivered via mobile phones to pregnant women in southern Tanzania. The feasibility of smartphone-based interventions or strategies relying on the use of social media or the internet is limited. UR - https://mhealth.jmir.org/2020/4/e17122 UR - http://dx.doi.org/10.2196/17122 UR - http://www.ncbi.nlm.nih.gov/pubmed/32267240 ID - info:doi/10.2196/17122 ER - TY - JOUR AU - Hauser-Ulrich, Sandra AU - Künzli, Hansjörg AU - Meier-Peterhans, Danielle AU - Kowatsch, Tobias PY - 2020/4/3 TI - A Smartphone-Based Health Care Chatbot to Promote Self-Management of Chronic Pain (SELMA): Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e15806 VL - 8 IS - 4 KW - conversational agent KW - chatbot KW - digital health KW - pain self-management KW - cognitive behavior therapy KW - smartphone KW - psychoeducation KW - text-based KW - health care KW - chronic pain N2 - Background: Ongoing pain is one of the most common diseases and has major physical, psychological, social, and economic impacts. A mobile health intervention utilizing a fully automated text-based health care chatbot (TBHC) may offer an innovative way not only to deliver coping strategies and psychoeducation for pain management but also to build a working alliance between a participant and the TBHC. Objective: The objectives of this study are twofold: (1) to describe the design and implementation to promote the chatbot painSELfMAnagement (SELMA), a 2-month smartphone-based cognitive behavior therapy (CBT) TBHC intervention for pain self-management in patients with ongoing or cyclic pain, and (2) to present findings from a pilot randomized controlled trial, in which effectiveness, influence of intention to change behavior, pain duration, working alliance, acceptance, and adherence were evaluated. Methods: Participants were recruited online and in collaboration with pain experts, and were randomized to interact with SELMA for 8 weeks either every day or every other day concerning CBT-based pain management (n=59), or weekly concerning content not related to pain management (n=43). Pain-related impairment (primary outcome), general well-being, pain intensity, and the bond scale of working alliance were measured at baseline and postintervention. Intention to change behavior and pain duration were measured at baseline only, and acceptance postintervention was assessed via self-reporting instruments. Adherence was assessed via usage data. Results: From May 2018 to August 2018, 311 adults downloaded the SELMA app, 102 of whom consented to participate and met the inclusion criteria. The average age of the women (88/102, 86.4%) and men (14/102, 13.6%) participating was 43.7 (SD 12.7) years. Baseline group comparison did not differ with respect to any demographic or clinical variable. The intervention group reported no significant change in pain-related impairment (P=.68) compared to the control group postintervention. The intention to change behavior was positively related to pain-related impairment (P=.01) and pain intensity (P=.01). Working alliance with the TBHC SELMA was comparable to that obtained in guided internet therapies with human coaches. Participants enjoyed using the app, perceiving it as useful and easy to use. Participants of the intervention group replied with an average answer ratio of 0.71 (SD 0.20) to 200 (SD 58.45) conversations initiated by SELMA. Participants? comments revealed an appreciation of the empathic and responsible interaction with the TBHC SELMA. A main criticism was that there was no option to enter free text for the patients? own comments. Conclusions: SELMA is feasible, as revealed mainly by positive feedback and valuable suggestions for future revisions. For example, the participants? intention to change behavior or a more homogenous sample (eg, with a specific type of chronic pain) should be considered in further tailoring of SELMA. Trial Registration: German Clinical Trials Register DRKS00017147; https://tinyurl.com/vx6n6sx, Swiss National Clinical Trial Portal: SNCTP000002712; https://www.kofam.ch/de/studienportal/suche/70582/studie/46326. UR - http://mhealth.jmir.org/2020/4/e15806/ UR - http://dx.doi.org/10.2196/15806 UR - http://www.ncbi.nlm.nih.gov/pubmed/32242820 ID - info:doi/10.2196/15806 ER - TY - JOUR AU - Linde, S. Ditte AU - Andersen, S. Marianne AU - Mwaiselage, Julius AU - Manongi, Rachel AU - Kjaer, K. Susanne AU - Rasch, Vibeke PY - 2020/4/2 TI - Effectiveness of One-Way Text Messaging on Attendance to Follow-Up Cervical Cancer Screening Among Human Papillomavirus?Positive Tanzanian Women (Connected2Care): Parallel-Group Randomized Controlled Trial JO - J Med Internet Res SP - e15863 VL - 22 IS - 4 KW - telemedicine KW - cervical cancer KW - HPV KW - early detection of cancer KW - Africa N2 - Background: Rapid human papillomavirus (HPV) DNA testing is an emerging cervical cancer screening strategy in resource-limited countries, yet it requires follow-up of women who test HPV positive. Objective: This study aimed to determine if one-way text messages improved attendance to a 14-month follow-up cervical cancer screening among HPV-positive women. Methods: This multicenter, parallel-group randomized controlled trial was conducted at 3 hospitals in Tanzania. Eligible participants were aged between 25 and 60 years, had tested positive to a rapid HPV test during a patient-initiated screening, had been informed of their HPV result, and had a private mobile phone with a valid number. Participants were randomly assigned in a 1:1 ratio to the intervention or control group through an incorporated algorithm in the text message system. The intervention group received one-way text messages, and the control group received no text messages. The primary outcome was attendance at a 14-month health provider-initiated follow-up screening. Participants were not blinded, but outcome assessors were. The analysis was based on intention to treat. Results: Between August 2015 and July 2017, 4080 women were screened for cervical cancer, of which 705 were included in this trial?358 women were allocated to the intervention group, and 347 women were allocated to the control group. Moreover, 16 women were excluded before the analysis because they developed cervical cancer or died (8 from each group). In the intervention group, 24.0% (84/350) women attended their follow-up screening, and in the control group, 23.8% (80/335) women attended their follow-up screening (risk ratio 1.02, 95% CI 0.79-1.33). Conclusions: Attendance to a health provider-initiated follow-up cervical cancer screening among HPV-positive women was strikingly low, and one-way text messages did not improve the attendance rate. Implementation of rapid HPV testing as a primary screening method at the clinic level entails the challenge of ensuring a proper follow-up of women. Trial Registration: ClinicalTrials.gov NCT02509702; https://clinicaltrials.gov/ct2/show/NCT02509702. International Registered Report Identifier (IRRID): RR2-10.2196/10.2196/15863 UR - http://www.jmir.org/2020/4/e15863/ UR - http://dx.doi.org/10.2196/15863 UR - http://www.ncbi.nlm.nih.gov/pubmed/32238335 ID - info:doi/10.2196/15863 ER - TY - JOUR AU - Miralles, Ignacio AU - Granell, Carlos AU - Díaz-Sanahuja, Laura AU - Van Woensel, William AU - Bretón-López, Juana AU - Mira, Adriana AU - Castilla, Diana AU - Casteleyn, Sven PY - 2020/4/2 TI - Smartphone Apps for the Treatment of Mental Disorders: Systematic Review JO - JMIR Mhealth Uhealth SP - e14897 VL - 8 IS - 4 KW - mental health KW - mental disorders KW - treatment KW - intervention KW - mHealth KW - smartphone KW - mobile phone KW - mobile apps KW - systematic review N2 - Background: Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective: This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results: We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions: There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders. UR - https://mhealth.jmir.org/2020/4/e14897 UR - http://dx.doi.org/10.2196/14897 UR - http://www.ncbi.nlm.nih.gov/pubmed/32238332 ID - info:doi/10.2196/14897 ER - TY - JOUR AU - Alameddine, Mohamad AU - Tamim, Hani AU - Hadid, Dima AU - Cheaito, Mohamad-Ali AU - Makki, Maha AU - Maatouk, Hadi AU - Hitti, Eveline PY - 2020/3/31 TI - Patient Attitudes Toward Mobile Device Use by Health Care Providers in the Emergency Department: Cross-Sectional Survey JO - JMIR Mhealth Uhealth SP - e16917 VL - 8 IS - 3 KW - smart devices KW - emergency department KW - patients KW - attitudes KW - digital professionalism KW - code of conduct KW - empathy KW - professionalism KW - distraction KW - attention N2 - Background: Health care provider usage of mobile devices is increasing globally; however, there is little understanding of patient perceptions on this behavior in a health care setting. Objective: The aim of this study was to assess patients? attitudes toward mobile device usage by health care providers in the emergency department and to identify predictors of these attitudes. Methods: The study was carried out at the emergency department of a large academic tertiary care medical center in Lebanon. A cross-sectional survey design was adopted by administering a questionnaire to medically stable adult patients who presented to the emergency department with an emergency severity index of 3, 4, or 5 between January 2017 and March 2018. The questionnaire collected relevant patient demographic information and included questions related to their mobile device usage along with those evaluating attitudes for the use of mobile devices by health care providers with respect to six major domains: role in health care, distraction potential, impact on communication, empathy, privacy, and professionalism. The attitude toward mobile device usage by health care providers in the emergency department was the main outcome variable. A stepwise logistic regression model was used to assess the association between the outcome variable and the demographic and attitude-related independent variables. Results: Among the 438 eligible patients, 338 patients responded to the questionnaire for a response rate of 70.0%. Overall, 313/338 (92.6%) respondents agreed that mobile devices improve health care delivery, whereas 132/338 (39.1%) respondents were opposed to their usage by health care providers in the emergency department (95% CI: 34.0-44.4). The majority (240/338, 71.0%) of patients agreed that mobile devices are a source of distraction to health care providers in the workplace. Females (odds ratio [OR]=1.67, 95% CI: 1.00-2.78) as well as all patients (OR=2.54, 95% CI 1.36-4.76) who believed that mobile devices were a source of distraction, reflecting a lack of professionalism (OR=2.77, 95% CI 1.59-4.82) and impacting the provider?s ability to relate to the patient (OR=2.93, 95% CI 1.72-4.99), were more likely to agree that mobile devices should not be used in the emergency department. Conclusions: Patients? negative attitude toward mobile device use in the emergency department is largely driven by patient gender (females), patient perception of the distraction potential of the devices, and their negative impact on the health care provider?s empathy and professionalism. The findings of this study shed light on the importance of encouraging stakeholders to impose a digital professionalism code of conduct for providers working in acute health care settings. UR - http://mhealth.jmir.org/2020/3/e16917/ UR - http://dx.doi.org/10.2196/16917 UR - http://www.ncbi.nlm.nih.gov/pubmed/32229474 ID - info:doi/10.2196/16917 ER - TY - JOUR AU - Arigo, Danielle AU - Brown, M. Megan AU - Pasko, Kristen AU - Suls, Jerry PY - 2020/3/27 TI - Social Comparison Features in Physical Activity Promotion Apps: Scoping Meta-Review JO - J Med Internet Res SP - e15642 VL - 22 IS - 3 KW - smartphone app KW - physical activity KW - mHealth KW - social comparison KW - behavior change technique N2 - Background: Smartphone apps promoting physical activity (PA) are abundant, but few produce substantial and sustained behavior change. Although many PA apps purport to induce users to compare themselves with others (by invoking social comparison processes), improvements in PA and other health behaviors are inconsistent. Existing literature suggests that social comparison may motivate PA for some people under some circumstances. However, 2 aspects of work that apply social comparison theory to PA apps remain unclear: (1) how comparison processes have been operationalized or harnessed in existing PA apps and (2) whether incorporating sources of variability in response to comparison have been used to tailor comparison features of apps, which could improve their effectiveness for promoting PA. Objective: The aim of this meta-review was to summarize existing systematic, quantitative, and narrative reviews of behavior change techniques in PA apps, with an emphasis on social comparison features, to examine how social comparison is operationalized and implemented. Methods: We searched PubMed, Web of Science, and PsycINFO for reviews of PA smartphone apps. Of the 3743 initial articles returned, 26 reviews met the inclusion criteria. Two independent raters extracted the data from these reviews, including the definition of social comparison used to categorize app features, the percentage of apps categorized as inducing comparison, specific features intended to induce comparison, and any mention of tailoring comparison features. For reference, these data were also extracted for related processes (such as behavioral modeling, norm referencing, and social networking). Results: Of the included review articles, 31% (8/26) categorized app features as prompting social comparison. The majority of these employed Abraham and Michie?s earliest definition of comparison, which differs from versions in later iterations of the same taxonomy. Very few reviews specified what dimension users were expected to compare (eg, steps, physical fitness) or which features of the apps were used to induce comparison (eg, leaderboards, message boards). No review referenced tailoring of comparison features. In contrast, 54% (14/26) reviews categorized features for prompting behavioral modeling and 31% (8/26) referenced tailoring app features for users? personal goals or preferences. Conclusions: The heterogeneity across reviews of PA apps and the absence of relevant information (eg, about dimensions or features relevant for comparison) create confusion about how to best harness social comparison to increase PA and its effectiveness in future research. No evidence was found that important findings from the broader social comparison literature (eg, that people have differing preferences for and responses to social comparison information) have been incorporated in the design of existing PA apps. Greater integration of the mobile health (mHealth) and social comparison literatures may improve the effectiveness of PA apps, thereby increasing the public health impact of these mHealth tools. International Registered Report Identifier (IRRID): RR2-https://osf.io/nh4td/ UR - http://www.jmir.org/2020/3/e15642/ UR - http://dx.doi.org/10.2196/15642 UR - http://www.ncbi.nlm.nih.gov/pubmed/32217499 ID - info:doi/10.2196/15642 ER - TY - JOUR AU - Jin, Haomiao AU - Wu, Shinyi PY - 2020/3/26 TI - Text Messaging as a Screening Tool for Depression and Related Conditions in Underserved, Predominantly Minority Safety Net Primary Care Patients: Validity Study JO - J Med Internet Res SP - e17282 VL - 22 IS - 3 KW - depression KW - diabetes mellitus KW - comorbidity KW - screening KW - primary care KW - health information technology KW - mobile health KW - text messaging KW - patient reported outcome measures N2 - Background: SMS text messaging is an inexpensive, private, and scalable technology-mediated assessment mode that can alleviate many barriers faced by the safety net population to receive depression screening. Some existing studies suggest that technology-mediated assessment encourages self-disclosure of sensitive health information such as depressive symptoms while other studies show the opposite effect. Objective: This study aimed to evaluate the validity of using SMS text messaging to screen depression and related conditions, including anxiety and functional disability, in a low-income, culturally diverse safety net primary care population. Methods: This study used a randomized design with 4 study groups that permuted the order of SMS text messaging and the gold standard interview (INTW) assessment. The participants for this study were recruited from the participants of the prior Diabetes-Depression Care-management Adoption Trial (DCAT). Depression was screened by using the 2-item and 8-item Patient Health Questionnaire (PHQ-2 and PHQ-8, respectively). Anxiety was screened by using the 2-item Generalized Anxiety Disorder scale (GAD-2), and functional disability was assessed by using the Sheehan Disability Scale (SDS). Participants chose to take up the assessment in English or Spanish. Internal consistency and test-retest reliability were evaluated by using Cronbach alpha and intraclass correlation coefficient (ICC), respectively. Concordance was evaluated by using an ICC, a kappa statistic, an area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. A regression analysis was conducted to examine the association between the participant characteristics and the differences in the scores between the SMS text messaging and INTW assessment modes. Results: Overall, 206 participants (average age 57.1 [SD 9.18] years; females: 119/206, 57.8%) were enrolled. All measurements except the SMS text messaging?assessed PHQ-2 showed Cronbach alpha values ?.70, indicating acceptable to good internal consistency. All measurements except the INTW-assessed SDS had ICC values ?0.75, indicating good to excellent test-retest reliability. For concordance, the PHQ-8 had an ICC of 0.73 and AUROC of 0.93, indicating good concordance. The kappa statistic, sensitivity, and specificity for major depression (PHQ-8 ?8) were 0.43, 0.60, and 0.86, respectively. The concordance of the shorter PHQ-2, GAD-2, and SDS scales was poor to fair. The regression analysis revealed that a higher level of personal depression stigma was associated with reporting higher SMS text messaging?assessed PHQ-8 and GAD-2 scores than the INTW-assessed scores. The analysis also determined that the differences in the scores were associated with marital status and personality traits. Conclusions: Depression screening conducted using the longer PHQ-8 scale via SMS text messaging demonstrated good internal consistency, test-retest reliability, and concordance with the gold standard INTW assessment mode. However, care must be taken when deploying shorter scales via SMS text messaging. Further regression analysis supported that a technology-mediated assessment, such as SMS text messaging, may create a private space with less pressure from the personal depression stigma and therefore encourage self-disclosure of depressive symptoms. Trial Registration: ClinicalTrials.gov NCT01781013; https://clinicaltrials.gov/ct2/show/NCT01781013 International Registered Report Identifier (IRRID): RR2-10.2196/12392 UR - http://www.jmir.org/2020/3/e17282/ UR - http://dx.doi.org/10.2196/17282 UR - http://www.ncbi.nlm.nih.gov/pubmed/32213473 ID - info:doi/10.2196/17282 ER - TY - JOUR AU - Bendtsen, Marcus AU - Müssener, Ulrika AU - Linderoth, Catharina AU - Thomas, Kristin PY - 2020/3/20 TI - A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e17208 VL - 8 IS - 3 KW - mHealth KW - positive mental health KW - university students KW - randomized controlled trial N2 - Background: High positive mental health, including the ability to cope with the normal stresses of life, work productively, and be able to contribute to one?s community, has been associated with various health outcomes. The role of positive mental health is therefore increasingly recognized in national mental health promotion programs and policies. Mobile health (mHealth) interventions could be a cost-effective way to disseminate positive psychological interventions to the general population. Objective: The aim of this study was to estimate the effect of a fully automated mHealth intervention on positive mental health, and anxiety and depression symptomology among Swedish university students using a randomized controlled trial design. Methods: A 2-arm, single-blind (researchers), parallel-groups randomized controlled trial with an mHealth positive psychology program intervention group and a relevant online mental health information control group was employed to estimate the effect of the novel intervention. Participants were recruited using digital advertising through student health care centers in Sweden. Inclusion criteria were (1) university students, (2) able to read and understand Swedish, (3) and have access to a mobile phone. Exclusion criteria were high positive mental health, as assessed by the Mental Health Continuum Short Form (MHC-SF), or high depression and anxiety symptomology, as assessed by the Hospital Anxiety Depression Scale (HADS). The primary outcome was positive mental health (MHC-SF), and the secondary outcomes were depression and anxiety symptomatology (HADS). The subscales of MHC-SF were also analyzed as exploratory outcomes. Outcomes were measured 3 months after randomization through questionnaires completed on the participants? mobile phones. Results: A total of 654 participants (median age 25 years), including 510 (78.0%) identifying as female, were randomized to either the intervention (n=348) or control group (n=306). At follow-up, positive mental health was significantly higher in the intervention group compared with the control group (incidence rate ratio [IRR]=1.067, 95% CI 1.024-1.112, P=.002). For both depression and anxiety symptomatology, the intervention group showed significantly lower scores at follow-up compared with the control group (depression: IRR=0.820, 95% CI 0.714-0.942, P=.005; anxiety: IRR=0.899, 95% CI 0.840-0.962, P=.002). Follow-up rates were lower than expected (58.3% for primary outcomes and 52.3% for secondary outcomes); however, attrition analyses did not identify any systematic attrition with respect to baseline variables. Conclusions: The mHealth intervention was estimated to be superior to usual care in increasing positive mental health among university students. A protective effect of the intervention was also found on depressive and anxiety symptoms. These findings demonstrate the feasibility of using an automated mobile phone format to enhance positive mental health, which offers promise for the use of mHealth solutions in public mental health promotion. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN54748632; http://www.isrctn.com/ISRCTN54748632 UR - http://mhealth.jmir.org/2020/3/e17208/ UR - http://dx.doi.org/10.2196/17208 UR - http://www.ncbi.nlm.nih.gov/pubmed/32196462 ID - info:doi/10.2196/17208 ER - TY - JOUR AU - Cordova, David AU - Munoz-Velazquez, Jaime AU - Mendoza Lua, Frania AU - Fessler, Kathryn AU - Warner, Sydni AU - Delva, Jorge AU - Adelman, Nicole AU - AU - Fernandez, Angela AU - Bauermeister, Jose PY - 2020/3/17 TI - Pilot Study of a Multilevel Mobile Health App for Substance Use, Sexual Risk Behaviors, and Testing for Sexually Transmitted Infections and HIV Among Youth: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e16251 VL - 8 IS - 3 KW - youth KW - mHealth KW - illicit drugs KW - sex behavior KW - HIV KW - primary care N2 - Background: Preventing and reducing substance use disorders, sexually transmitted infections (STIs)/HIV, and teen pregnancy, and the associated risk behaviors (ie, substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among the youth. Mobile health (mHealth) apps may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated efficacy in reducing substance use or sexual risk behaviors or improving the uptake of STI/HIV testing among the youth, particularly in clinic settings. Objective: This small-scale study aimed to examine the feasibility of conducting a pilot randomized controlled trial (RCT). We evaluated the effects of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, on the potential mechanisms by which behavior change occurs, namely clinician-youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. We also assessed the ability to measure targeted outcomes of past 30-day substance use (ie, alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use before sex, as well as the uptake of STI/HIV testing. Methods: Employing community-based participatory research principles, 50 youths aged 13 to 21 years were recruited from a youth-centered community health clinic in Southeast Michigan, randomized sequentially to either S4E or enhanced usual practice, and assessed at baseline, immediately postintervention, and 30 days postintervention. S4E consists of 3 modules, including alcohol and drug use, tobacco, and STI/HIV. Results: Relative to youth in the enhanced usual practice group, S4E participants demonstrated higher youth-clinician risk communication (mean 3.22, SD 1.67) and increases in prevention knowledge (? score mean 0.36, SD 0.51) and self-efficacy (? score mean 0.16, SD 0.47). In addition, youth in the S4E group showed reductions in the proportions of past 30-day overall substance use (Cohen h=0.71, 95% CI 0.15 to 1.27), as well as past 30-day alcohol (Cohen h=0.71, 95% CI 0.15 to 1.27), tobacco (Cohen h=0.17, 95% CI ?0.39 to 0.73), and drug use (Cohen h=1.28, 95% CI 0.72 to 1.84). The results also suggest a reduction in the proportion of youths who reported past 30-day condomless sex (Cohen h=0.18, 95% CI ?0.38 to 0.74) and alcohol use before sex (Cohen h=0.44, 95% CI ?0.12 to 1.00). Finally, the findings also demonstrated an increase in the proportion of youths who reported STI/HIV testing over time (Cohen h=0.16, 95% CI ?0.39 to 0.72). Conclusions: The findings suggest the feasibility of a small-scale pilot RCT. S4E demonstrated shifts in the hypothesized direction, reducing substance use, sexual risk behaviors, and improving the uptake of STI/HIV testing among youth in a clinic setting. The findings suggest that a larger RCT may be warranted. Trial Registration: ClinicalTrails.gov NCT03855410, https://clinicaltrials.gov/ct2/show/NCT03855410. UR - https://mhealth.jmir.org/2020/3/e16251 UR - http://dx.doi.org/10.2196/16251 UR - http://www.ncbi.nlm.nih.gov/pubmed/32181747 ID - info:doi/10.2196/16251 ER - TY - JOUR AU - Di Fraia, Marco AU - Tripodi, Salvatore AU - Arasi, Stefania AU - Dramburg, Stephanie AU - Castelli, Sveva AU - Villalta, Danilo AU - Buzzulini, Francesca AU - Sfika, Ifigenia AU - Villella, Valeria AU - Potapova, Ekaterina AU - Perna, Serena AU - Brighetti, Antonia Maria AU - Travaglini, Alessandro AU - Verardo, Pierluigi AU - Pelosi, Simone AU - Zicari, Maria Anna AU - Matricardi, Maria Paolo PY - 2020/3/16 TI - Adherence to Prescribed E-Diary Recording by Patients With Seasonal Allergic Rhinitis: Observational Study JO - J Med Internet Res SP - e16642 VL - 22 IS - 3 KW - mobile health KW - e-Diary KW - precision medicine KW - pollen KW - seasonal allergic rhinitis KW - blended care N2 - Background: Complete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure, can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to their recording. Objective: The objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary explicitly prescribed by an allergist within a blended care approach. Methods: The @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone, Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily through a mobile app (Allergy.Monitor) during the relevant pollen season. Results: Overall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence to device use slowly declined during monitoring in 3 phases: phase A: first week, ?1267/1358, 90%; phase B: second to sixth week, 4992/5884, 80% to 90%; and phase C: seventh week onward, 2063/2606, 70% to 80%. At the individual level, the adherence assessed in the second and third weeks of recording predicted with enough confidence (Rome: Spearman ?=0.75; P<.001; Pordenone: ?=0.81; P<.001) the overall patient adherence to recording and was inversely related to postponed reporting (?=?0.55; P<.001; in both centers). Recording adherence was significantly higher during the peak grass pollen season in Rome, but not in Pordenone. Conclusions: Adherence to daily recording in an e-diary, prescribed and motivated by an allergist in a blended care setting, was very high. This observation supports the use of e-diaries in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis and deserves further investigation in real-life contexts. UR - https://www.jmir.org/2020/3/e16642 UR - http://dx.doi.org/10.2196/16642 UR - http://www.ncbi.nlm.nih.gov/pubmed/32175909 ID - info:doi/10.2196/16642 ER - TY - JOUR AU - Martin, Anne AU - Caon, Maurizio AU - Adorni, Fulvio AU - Andreoni, Giuseppe AU - Ascolese, Antonio AU - Atkinson, Sarah AU - Bul, Kim AU - Carrion, Carme AU - Castell, Conxa AU - Ciociola, Valentina AU - Condon, Laura AU - Espallargues, Mireia AU - Hanley, Janet AU - Jesuthasan, Nithiya AU - Lafortuna, L. Claudio AU - Lang, Alexandra AU - Prinelli, Federica AU - Puidomenech Puig, Elisa AU - Tabozzi, A. Sarah AU - McKinstry, Brian PY - 2020/3/2 TI - A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study JO - JMIR Mhealth Uhealth SP - e14118 VL - 8 IS - 3 KW - health behavior KW - obesity KW - co-design KW - mHealth KW - mobile app KW - mobile phone KW - adolescents KW - youth KW - focus groups N2 - Background: Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. Objective: This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. Methods: A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight?promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants? user experience feedback and development ideas were collected through focus groups and completion of questionnaires. Results: For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. Conclusions: Incorporating adolescents? preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial. UR - https://mhealth.jmir.org/2020/3/e14118 UR - http://dx.doi.org/10.2196/14118 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130179 ID - info:doi/10.2196/14118 ER - TY - JOUR AU - Kim, Yeon Do AU - Kwon, Hee AU - Nam, Ki-Woong AU - Lee, Yongseok AU - Kwon, Hyung-Min AU - Chung, Seob Young PY - 2020/2/27 TI - Remote Management of Poststroke Patients With a Smartphone-Based Management System Integrated in Clinical Care: Prospective, Nonrandomized, Interventional Study JO - J Med Internet Res SP - e15377 VL - 22 IS - 2 KW - mHealth KW - mobile apps KW - stroke care KW - health care KW - patient education KW - self-monitoring of blood pressure N2 - Background: Advances in mobile health (mHealth) have enabled systematic and continuous management of patients with chronic diseases. Objective: We developed a smartphone-based mHealth system and aimed to evaluate its effects on health behavior management and risk factor control in stroke patients. Methods: With a multifaceted stroke aftercare management system that included exercise, medication, and educational materials, we performed a 12-week single-arm intervention among eligible poststroke patients in the stroke clinic from September to December 2016. The intervention consisted of (1) regular blood pressure (BP), blood glucose, and physical activity measurements; (2) stroke education; (3) an exercise program; (4) a medication program; and (5) feedback on reviewing of records by clinicians. Clinical assessments consisted of the stroke awareness score, Beck Depression Inventory-II (BDI), EuroQol-5 Dimensions (EQ-5D), and BP at visit 1 (baseline), visit 2 (4 weeks), and visit 3 (12 weeks). Temporal differences in the parameters over 12 weeks were investigated with repeated-measures analysis of variance. Changes in medication adherence at visit 1-2 (from visit 1 to visit 2) and visit 2-3 (from visit 2 to visit 3) were compared. System satisfaction was evaluated with a self-questionnaire using a 5-point Likert scale at visit 3. Results: The study was approved by the Institutional Review Board in September 2016, and participants were enrolled from September to December 2016. Among the 110 patients enrolled for the study, 99 were included in our analyses. The mean stroke awareness score (baseline: 59.6 [SD 18.1]; 4 weeks: 67.6 [SD 16.0], P<.001; 12 weeks: 74.7 [SD 14.0], P<.001) and BDI score (baseline: 12.7 [SD 10.1]; 4 weeks: 11.2 [SD 10.2], P=.01; 12 weeks: 10.7 [SD 10.2], P<.001) showed gradual improvement; however, no significant differences were found in the mean EQ-5D score (baseline: 0.66 [SD 0.33]; 4 weeks: 0.69 [SD 0.34], P=.01; 12 weeks: 0.69 [SD 0.34], P<.001). Twenty-six patients who had uncontrolled BP at baseline had ?13.92 mmHg (P=.001) and ?6.19 mmHg (P<.001) reductions on average in systolic and diastolic BP, respectively, without any antihypertensive medication change. Medication compliance was better at visit 2-3 (60.9% [SD 37.2%]) than at visit 1-2 (47.8% [SD 38.7%], P<.001). Conclusions: Awareness of stroke, depression, and BP was enhanced when using the smartphone-based mHealth system. Emerging mHealth techniques have potential as new nonpharmacological secondary prevention methods because of their ubiquitous access, near real-time responsiveness, and comparatively lower cost. UR - http://www.jmir.org/2020/2/e15377/ UR - http://dx.doi.org/10.2196/15377 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130140 ID - info:doi/10.2196/15377 ER - TY - JOUR AU - Duan, Huilong AU - Wang, Zheyu AU - Ji, Yumeng AU - Ma, Li AU - Liu, Fang AU - Chi, Mingwei AU - Deng, Ning AU - An, Jiye PY - 2020/2/25 TI - Using Goal-Directed Design to Create a Mobile Health App to Improve Patient Compliance With Hypertension Self-Management: Development and Deployment JO - JMIR Mhealth Uhealth SP - e14466 VL - 8 IS - 2 KW - goal-directed design KW - smartphone KW - mobile health KW - patients KW - hypertension self-management KW - mobile phone N2 - Background: Hypertension is a lifestyle-induced chronic disease that threatens the lives of patients. Control of hypertension requires patients to follow self-management regimes; unfortunately, however, patient compliance with hypertension self-management is low, especially in developing countries. Improvement of patient compliance is premised on meeting patient needs. Mobile health apps are becoming increasingly popular for self-management of chronic diseases. However, few mobile apps have been designed to meet patient needs for hypertension self-management. Objective: The goal of this study was to develop a mobile health app to improve patient compliance with hypertension self-management and evaluate the effectiveness of the app in terms of patient compliance. Methods: The goal-directed design method was applied to guide study design. We divided the study into 4 stages. Stages 1 to 3 comprised the development process. To improve the applicability of the goal-directed design method to chronic disease management, we extracted elements of user models concerned with patient compliance and defined a concrete process for user modeling. In stage 1, personas of hypertensive patients were built using qualitative and quantitative methods. Clustering methods based on questionnaire responses were used to group patients. Qualitative interviews were conducted to identify the needs of different groups. In stage 2, several functional modules were designed to meet the needs of different groups based on the results from stage 1. In stage 3, prototypes of functional modules were designed and implemented as a real app. Stage 4 was the deployment process, in which we conducted a pilot study to investigate patient compliance after using the app. Patient compliance was calculated through the frequency with which they took blood pressure measurements. In addition, qualitative interviews were conducted to learn the underlying reasons for the compliance results. Results: In stage 1, patients were divided into 3 groups based on 82 valid questionnaire responses. Eighteen patients from the different groups (7, 5, and 6 patients) were interviewed, and the needs of the groups were summarized as follows: improve self-management ability, enhance self-management motivation, and receive self-management support. In stages 2 and 3, 6 functional modules were designed and implemented based on specified needs, and the usability of the app was improved through usability tests. In stage 4, 143 patients were recruited to use different versions of the app for 2 months. Results show that patient compliance improved as functional modules were added (P<.001) and was maintained at a high level (rate of 0.73). Interview results from 32 patients show that the design of the app met different needs; thus, patients were more compliant with it. Conclusions: This study developed a mobile health app for hypertension self-management using the goal-directed design method. The app proved to be effective for improving patient compliance with hypertension self-management. UR - http://mhealth.jmir.org/2020/2/e14466/ UR - http://dx.doi.org/10.2196/14466 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130161 ID - info:doi/10.2196/14466 ER - TY - JOUR AU - Bastl, Katharina AU - Bastl, Maximilian AU - Bergmann, Karl-Christian AU - Berger, Markus AU - Berger, Uwe PY - 2020/2/21 TI - Translating the Burden of Pollen Allergy Into Numbers Using Electronically Generated Symptom Data From the Patient?s Hayfever Diary in Austria and Germany: 10-Year Observational Study JO - J Med Internet Res SP - e16767 VL - 22 IS - 2 KW - symptom data KW - Patient?s Hayfever Diary KW - pollen allergy KW - symptom score calculation N2 - Background: Pollen allergies affect a significant proportion of the population globally. At present, Web-based tools such as pollen diaries and mobile apps allow for easy and fast documentation of allergic symptoms via the internet. Objective: This study aimed to characterize the users of the Patient?s Hayfever Diary (PHD), a Web-based platform and mobile app, to apply different symptom score calculations for comparison, and to evaluate the contribution of organs and medications to the total score for the first time. Methods: The PHD users were filtered with regard to their location in Austria and Germany, significant positive correlation to the respective pollen type (birch/grass), and at least 15 entries in the respective season. Furthermore, 4 different symptom score calculation methods were applied to the datasets from 2009 until 2018, of which 2 were raw symptom scores and 2 were symptom load index (normalized) calculations. Pearson correlation coefficients were calculated pairwise for these 4 symptom score calculations. Results: Users were mostly male and belonged to the age groups of 21 to 40 years or >40 years. User numbers have increased in the last 5 years, especially when mobile apps were made available. The Pearson correlation coefficients showed a significant linear relationship above 0.9 among the 4 symptom score datasets and thus indicated no significant difference between the different methods of symptom score calculation. The nose contributed the most to the symptom score and determined about 40% of the score. Conclusions: The exact method of calculation of the symptom score is not critical. All computation methods show the same behavior (increase/decrease during the season). Therefore, the symptom load index is a useful computation method in all fields exploring pollen allergy, and Web-based diaries are a globally applicable tool to monitor the effect of pollen on human health via electronically generated symptom data. UR - http://www.jmir.org/2020/2/e16767/ UR - http://dx.doi.org/10.2196/16767 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130130 ID - info:doi/10.2196/16767 ER - TY - JOUR AU - Robbins, Rebecca AU - Affouf, Mahmoud AU - Seixas, Azizi AU - Beaugris, Louis AU - Avirappattu, George AU - Jean-Louis, Girardin PY - 2020/2/20 TI - Four-Year Trends in Sleep Duration and Quality: A Longitudinal Study Using Data from a Commercially Available Sleep Tracker JO - J Med Internet Res SP - e14735 VL - 22 IS - 2 KW - big data KW - sleep health KW - fitness tracker KW - mHealth N2 - Background: Population estimates of sleep duration and quality are inconsistent because they rely primarily on self-reported data. Passive and ubiquitous digital tracking and wearable devices may provide more accurate estimates of sleep duration and quality. Objective: This study aimed to identify trends in sleep duration and quality in New York City based on 2 million nights of data from users of a popular mobile sleep app. Methods: We examined sleep duration and quality using 2,161,067 nights of data captured from 2015 to 2018 by Sleep Cycle, a popular sleep-tracking app. In this analysis, we explored differences in sleep parameters based on demographic factors, including age and sex. We used graphical matrix representations of data (heat maps) and geospatial analyses to compare sleep duration (in hours) and sleep quality (based on time in bed, deep sleep time, sleep consistency, and number of times fully awake), considering potential effects of day of the week and seasonality. Results: Women represented 46.43% (1,003,421/2,161,067) of the sample, and men represented 53.57% (1,157,646/2,161,067) of individuals in the sample. The average age of the sample was 31.0 years (SD 10.6). The mean sleep duration of the total sample was 7.11 hours (SD 1.4). Women slept longer on average (mean 7.27 hours, SD 1.4) than men (mean 7 hours, SD 1.3; P<.001). Trend analysis indicated longer sleep duration and higher sleep quality among older individuals than among younger (P<.001). On average, sleep duration was longer on the weekend nights (mean 7.19 hours, SD 1.5) than on weeknights (mean 7.09 hours, SD 1.3; P<.001). Conclusions: Our study of data from a commercially available sleep tracker showed that women experienced longer sleep duration and higher sleep quality in nearly every age group than men, and a low proportion of young adults obtained the recommended sleep duration. Future research may compare sleep measures obtained via wearable sleep trackers with validated research-grade measures of sleep. UR - https://www.jmir.org/2020/2/e14735 UR - http://dx.doi.org/10.2196/14735 UR - http://www.ncbi.nlm.nih.gov/pubmed/32078573 ID - info:doi/10.2196/14735 ER - TY - JOUR AU - Blackwell, M. Tenya AU - Dill, J. LeConte AU - Hoepner, A. Lori AU - Geer, A. Laura PY - 2020/2/13 TI - Using Text Messaging to Improve Access to Prenatal Health Information in Urban African American and Afro-Caribbean Immigrant Pregnant Women: Mixed Methods Analysis of Text4baby Usage JO - JMIR Mhealth Uhealth SP - e14737 VL - 8 IS - 2 KW - Text4baby KW - mHealth KW - pregnancy KW - text messaging KW - health information KW - prenatal health KW - disparities N2 - Background: The Text4baby (T4B) mobile health (mHealth) program is acclaimed to provide pregnant women with greater access to prenatal health care, resources, and information. However, little is known about whether urban African American and Afro-Caribbean immigrant pregnant women in the United States are receptive users of innovative health communication methods or of the cultural and systematic barriers that inhibit their behavioral intent to use T4B. Objective: This study aimed to understand the lived experiences of urban African American and Afro-Caribbean immigrant pregnant women with accessing quality prenatal health care and health information; to assess usage of mHealth for seeking prenatal health information; and to measure changes in participants? knowledge, perceptions, and behavioral intent to use the T4B mHealth educational intervention. Methods: An exploratory sequential mixed methods study was conducted among pregnant women and clinical professionals for a phenomenological exploration with focus groups, key informants, interviews, and observations. Qualitative themes were aligned with behavioral and information technology communications theoretical constructs to develop a survey instrument used. repeated-measures pre- and post-test design to evaluate changes in participants? knowledge, attitudes, and beliefs, of mHealth and T4B after a minimum of 4 weeks? exposure to the text message?based intervention. Triangulation and mixing of both qualitative and quantitative data occurred primarily during the survey development and also during final analysis. Results: A total of 9 women participated in phase 1, and 49 patients signed up for T4B and completed a 31-item survey at baseline and again during follow-up. Three themes were identified: (1) patient-provider engagement, (2) social support, and (3) acculturation. With time as a barrier to quality care, inadequate patient-provider engagement left participants feeling indifferent about the prenatal care and information they received in the clinical setting. Of 49 survey participants, 63% (31/49) strongly agreed that T4B would provide them with extra support during their pregnancy. On a Likert scale of 1 to 5, participants? perception of the usefulness of T4B ranked at 4.26, and their perception of the compatibility and relative advantage of using T4B ranked at 4.41 and 4.15, respectively. At follow-up, there was a 14% increase in participants reporting their intent to use T4B and a 28% increase from pretest and posttest in pregnant women strongly agreeing to speak more with their doctor about the information learned through T4B. Conclusions: Urban African American and Afro-Caribbean immigrant pregnant women in Brooklyn endure a number of social and ecological determinants like low health literacy, income, and language that serve as barriers to accessing quality prenatal health care and information, which negatively impacts prenatal health behaviors and outcomes. Our study indicates a number of systematic, political, and other microsystem-level factors that perpetuate health inequities in our study population. UR - http://mhealth.jmir.org/2020/2/e14737/ UR - http://dx.doi.org/10.2196/14737 UR - http://www.ncbi.nlm.nih.gov/pubmed/32053117 ID - info:doi/10.2196/14737 ER - TY - JOUR AU - Escalona-Marfil, Carles AU - Coda, Andrea AU - Ruiz-Moreno, Jorge AU - Riu-Gispert, Miquel Lluís AU - Gironès, Xavier PY - 2020/2/12 TI - Validation of an Electronic Visual Analog Scale mHealth Tool for Acute Pain Assessment: Prospective Cross-Sectional Study JO - J Med Internet Res SP - e13468 VL - 22 IS - 2 KW - pain KW - visual analog pain scale KW - pain measurement KW - mobile phone KW - mHealth KW - validation KW - tablet N2 - Background: Accurate measurement of pain is required to improve its management and in research. The visual analog scale (VAS) on paper format has been shown to be an accurate, valid, reliable, and reproducible way to measure pain intensity. However, some limitations should be considered, some of which can be implemented with the introduction of an electronic VAS version, suitable to be used both in a tablet and a smartphone. Objective: This study aimed to validate a new method of recording pain level by comparing the traditional paper VAS with the pain level module on the newly designed Interactive Clinics app. Methods: A prospective observational cross-sectional study was designed. The sample consisted of 102 participants aged 18 to 65 years. A Force Dial FDK 20 algometer (Wagner Instruments) was employed to induce mild pressure symptoms on the participants? thumbs. Pain was measured using a paper VAS (10 cm line) and the app. Results: Intermethod reliability estimated by ICC(3,1) was 0.86 with a 95% confidence interval of 0.81 to 0.90, indicating good reliability. Intramethod reliability estimated by ICCa(3,1) was 0.86 with a 95% confidence interval of 0.81 to 0.90, also indicating good reliability. Bland-Altman analysis showed a difference of 0.175 (0.49), and limits of agreement ranged from ?0.79 to 1.14. Conclusions: The pain level module on the app is highly reliable and interchangeable with the paper VAS version. This tool could potentially help clinicians and researchers precisely assess pain in a simple, economic way with the use of a ubiquitous technology. UR - http://www.jmir.org/2020/2/e13468/ UR - http://dx.doi.org/10.2196/13468 UR - http://www.ncbi.nlm.nih.gov/pubmed/32049063 ID - info:doi/10.2196/13468 ER - TY - JOUR AU - Wang, Jiani AU - Rogge, A. Alizé AU - Armour, Mike AU - Smith, A. Caroline AU - D?Adamo, R. Christopher AU - Pischke, R. Claudia AU - Yen, Hung-Rong AU - Wu, Mei-Yao AU - Moré, Ocampo Ari Ojeda AU - Witt, M. Claudia AU - Pach, Daniel PY - 2020/2/11 TI - International ResearchKit App for Women with Menstrual Pain: Development, Access, and Engagement JO - JMIR Mhealth Uhealth SP - e14661 VL - 8 IS - 2 KW - dysmenorrhea KW - mHealth KW - mobile applications KW - acupressure KW - pain KW - behavior change techniques (BCTs) KW - ResearchKit KW - recruitment N2 - Background: Primary dysmenorrhea is a common condition in women of reproductive age. A previous app-based study undertaken by our group demonstrated that a smartphone app supporting self-acupressure introduced by a health care professional can reduce menstrual pain. Objective: This study aims to evaluate whether a specific smartphone app is effective in reducing menstrual pain in 18- to 34-year-old women with primary dysmenorrhea in a self-care setting. One group of women has access to the full-featured study app and will be compared with 2 control groups who have access to fewer app features. Here, we report the trial design, app development, user access, and engagement. Methods: On the basis of the practical implications of the previous app-based study, we revised and reengineered the study app and included the ResearchKit (Apple Inc) framework. Behavior change techniques (BCTs) were implemented in the app and validated by expert ratings. User access was estimated by assessing recruitment progress over time. User evolution and baseline survey respondent rate were assessed to evaluate user engagement. Results: The development of the study app for a 3-armed randomized controlled trial required a multidisciplinary team. The app is accessible for the target population free of charge via the Apple App Store. In Germany, within 9 months, the app was downloaded 1458 times and 328 study participants were recruited using it without external advertising. A total of 98.27% (5157/5248) of the app-based baseline questions were answered. The correct classification of BCTs used in the app required psychological expertise. Conclusions: Conducting an innovative app study requires multidisciplinary effort. Easy access and engagement with such an app can be achieved by recruitment via the App Store. Future research is needed to investigate the determinants of user engagement, optimal BCT application, and potential clinical and self-care scenarios for app use. Trial Registration: ClinicalTrials.gov NCT03432611; https://clinicaltrials.gov/ct2/show/NCT03432611 (Archived by WebCite at http://www.webcitation.org/75LLAcnCQ). UR - https://mhealth.jmir.org/2020/2/e14661 UR - http://dx.doi.org/10.2196/14661 UR - http://www.ncbi.nlm.nih.gov/pubmed/32058976 ID - info:doi/10.2196/14661 ER - TY - JOUR AU - Quan, Linh Amanda My AU - Stiell, Ian AU - Perry, J. Jeffrey AU - Paradis, Michelle AU - Brown, Erica AU - Gignac, Jordan AU - Wilson, Lindsay AU - Wilson, Kumanan PY - 2020/1/29 TI - Mobile Clinical Decision Tools Among Emergency Department Clinicians: Web-Based Survey and Analytic Data for Evaluation of The Ottawa Rules App JO - JMIR Mhealth Uhealth SP - e15503 VL - 8 IS - 1 KW - emergency departments KW - mHealth KW - clinical prediction rule KW - decision aids N2 - Background: The Canadian CT Head Rule (CCHR), the Canadian Transient Ischemic Attack (TIA) Score, and the Subarachnoid Hemorrhage (SAH) Rule have all previously demonstrated the potential to significantly standardize care and improve the management of patients in emergency departments (EDs). On the basis of user feedback, we believe that the addition of these rules to the Ottawa Rules App has the potential to increase the app?s usability and user acceptability. Objective: This study aimed to evaluate the perceived usefulness, acceptability, and uptake of the enhanced Ottawa Rules App (which now includes CCHR, TIA, and SAH Rules) among ED clinicians (medical students, residents, nurses, and physicians). Methods: The enhanced Ottawa Rules App was publicly released for free on iOS and Android operating systems in November 2018. This study was conducted across 2 tertiary EDs in Ottawa, Canada. Posters, direct enrollment, snowball sampling, and emails were used for study recruitment. A 24-question Web-based survey was administered to participants via email, and this was used to determine user acceptability of the app and Technology Readiness Index (TRI) scores. In-app user analytics were collected to track user behavior, such as the number of app sessions, length of app sessions, frequency of rule use, and the date app was first opened. Results: A total of 77 ED clinicians completed the study, including 34 nurses, 12 residents, 14 physicians, and 17 medical students completing ED rotations. The median TRI score for this group was 3.38, indicating a higher than average propensity to embrace and adopt new technologies to accomplish goals in their work or daily lives. The majority of respondents agreed or strongly agreed that the app helped participants accurately carry out the clinical rules (56/77, 73%) and that they would recommend this app to their colleagues (64/77, 83%). Feedback from study participants suggested further expansion of the app?more clinical decision rules (CDRs) and different versions of the app tailored to the clinician role. Analysis and comparison of Google Analytics data and in-app data revealed similar usage behavior among study-enrolled users and all app users globally. Conclusions: This study provides evidence that using the Ottawa Rules App (version 3.0.2) to improve and guide patient care would be feasible and widely accepted. The ability to verify self-reported user data (via a Web-based survey) against server analytics data is a notable strength of this study. Participants? continued app use and request for the addition of more CDRs warrant the further development of this app and call for additional studies to evaluate its feasibility and usability in different settings as well as assessment of clinical impact. UR - https://mhealth.jmir.org/2020/1/e15503 UR - http://dx.doi.org/10.2196/15503 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012095 ID - info:doi/10.2196/15503 ER - TY - JOUR AU - Ledel Solem, Konstanse Ingrid AU - Varsi, Cecilie AU - Eide, Hilde AU - Kristjansdottir, Birna Olöf AU - Børøsund, Elin AU - Schreurs, G. Karlein M. AU - Waxenberg, B. Lori AU - Weiss, E. Karen AU - Morrison, J. Eleshia AU - Haaland-Øverby, Mette AU - Bevan, Katherine AU - Zangi, Andersen Heidi AU - Stubhaug, Audun AU - Solberg Nes, Lise PY - 2020/1/21 TI - A User-Centered Approach to an Evidence-Based Electronic Health Pain Management Intervention for People With Chronic Pain: Design and Development of EPIO JO - J Med Internet Res SP - e15889 VL - 22 IS - 1 KW - Web-based interventions KW - eHealth KW - mobile apps KW - evidence-based, user-centered design approach KW - service design KW - chronic pain KW - cognitive behavioral therapy KW - acceptance and commitment therapy N2 - Background: Chronic pain conditions are complicated and challenging to live with. Electronic health (eHealth) interventions show promise in helping people cope with chronic illness, including pain. The success of these interventions depends not only on the technology and intervention content but also on the users? acceptance and adherence. Involving all stakeholders (eg, patients, spouses, health care providers, designers, software developers, and researchers) and exploring their input and preferences in the design and development process is an important step toward developing meaningful interventions and possibly strengthening treatment outcomes. Objective: The aim of this study was to design and develop a user-centered, evidence-based eHealth self-management intervention for people with chronic pain. Methods: The study employed a multidisciplinary and user-centered design approach. Overall, 20 stakeholders from the project team (ie, 7 researchers, 5 editors, 7 software developers, and 1 user representative), together with 33 external stakeholders (ie, 12 health care providers, 1 health care manger, 1 eHealth research psychologist, and 17 patients with chronic pain and 2 of their spouses) participated in a user-centered development process that included workshops, intervention content development, and usability testing. Intervention content was developed and finalized based on existing evidence, stakeholder input, and user testing. Stakeholder input was examined through qualitative analyses with rapid and in-depth analysis approaches. Results: Analyses from stakeholder input identified themes including a need for reliable, trustworthy, and evidence-based content, personalization, options for feedback, behavioral tracking, and self-assessment/registration as factors to include in the intervention. Evidence-based intervention content development resulted in one face-to-face introduction session and 9 app-based educational and exercise-based modules. Usability testing provided further insight into how to optimize the design of the intervention to the user group, identifying accessibility and a simple design to be essential. Conclusions: The design and development process of eHealth interventions should strive to combine well-known evidence-based concepts with stakeholder input. This study, designing and developing the pain management intervention EPIO, illustrates how a stakeholder-centered design approach can provide essential input in the development of an eHealth self-management intervention for people with chronic pain. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104 UR - http://www.jmir.org/2020/1/e15889/ UR - http://dx.doi.org/10.2196/15889 UR - http://www.ncbi.nlm.nih.gov/pubmed/31961331 ID - info:doi/10.2196/15889 ER - TY - JOUR AU - Bricker, B. Jonathan AU - Watson, L. Noreen AU - Heffner, L. Jaimee AU - Sullivan, Brianna AU - Mull, Kristin AU - Kwon, Diana AU - Westmaas, Lee Johann AU - Ostroff, Jamie PY - 2020/1/17 TI - A Smartphone App Designed to Help Cancer Patients Stop Smoking: Results From a Pilot Randomized Trial on Feasibility, Acceptability, and Effectiveness JO - JMIR Form Res SP - e16652 VL - 4 IS - 1 KW - smartphone app KW - mHealth KW - tobacco KW - smoking KW - cancer patient N2 - Background: Persistent smoking after a cancer diagnosis predicts worse treatment outcomes and mortality, but access to effective smoking cessation interventions is limited. Smartphone apps can address this problem by providing a highly accessible, low-cost smoking cessation intervention designed for patients with a recent cancer diagnosis. Objective: This study aimed to summarize our development process and report the trial design, feasibility, participant acceptability, preliminary effectiveness, and impact on processes of change (eg, cancer stigma) of the first-known smoking cessation smartphone app targeted for cancer patients. Methods: We used an agile, user-centered design framework to develop a fully automated smartphone app called Quit2Heal that provided skills training and stories from cancer survivors focusing on coping with internalized shame, cancer stigma, depression, and anxiety as core triggers of smoking. Quit2Heal was compared with the National Cancer Institute?s QuitGuide, a widely used stop smoking app for the general population, in a pilot double-blinded randomized trial with a 2-month follow-up period. Participants were 59 adult smokers diagnosed with cancer within the past 12 months and recruited through 2 cancer center care networks and social media over a 12-month period. The most common types of cancer diagnosed were lung (21/59, 36%) and breast (10/59, 17%) cancers. The 2-month follow-up survey retention rate was 92% (54/59) and did not differ by study arm (P=.15). Results: Compared with QuitGuide participants, Quit2Heal participants were more satisfied with their assigned app (90% [19/21] for Quit2Heal vs 65% [17/26] for QuitGuide; P=.047) and were more likely to report that the app assigned to them was made for someone like them (86% [18/21] for Quit2Heal vs 62% [16/26] for QuitGuide; P=.04). Quit2Heal participants opened their app a greater number of times during the 2-month trial period, although this difference was not statistically significant (mean 10.0, SD 14.40 for Quit2Heal vs mean 6.1, SD 5.3 for QuitGuide; P=.33). Self-reported 30-day point prevalence quit rates at the 2-month follow-up were 20% (5/25) for Quit2Heal versus 7% (2/29) for QuitGuide (odds ratio 5.16, 95% CI 0.71-37.29; P=.10). Quit2Heal participants also showed greater improvement in internalized shame, cancer stigma, depression, and anxiety, although these were not statistically significant (all P>.05). Conclusions: In a pilot randomized trial with a high short-term retention rate, Quit2Heal showed promising acceptability and effectiveness for helping cancer patients stop smoking. Testing in a full-scale randomized controlled trial with a longer follow-up period and a larger sample size is required to test the effectiveness, mediators, and moderators of this promising digital cessation intervention. Trial Registration: ClinicalTrials.gov NCT03600038; https://clinicaltrials.gov/ct2/show/NCT03600038 UR - http://formative.jmir.org/2020/1/e16652/ UR - http://dx.doi.org/10.2196/16652 UR - http://www.ncbi.nlm.nih.gov/pubmed/31951215 ID - info:doi/10.2196/16652 ER - TY - JOUR AU - Melia, Ruth AU - Francis, Kady AU - Hickey, Emma AU - Bogue, John AU - Duggan, Jim AU - O'Sullivan, Mary AU - Young, Karen PY - 2020/1/15 TI - Mobile Health Technology Interventions for Suicide Prevention: Systematic Review JO - JMIR Mhealth Uhealth SP - e12516 VL - 8 IS - 1 KW - mHealth KW - systematic review N2 - Background: Digital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice. Objective: This review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes. Methods: The following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here. Results: A total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review. Conclusions: Further research is needed to evaluate the efficacy of stand-alone mHealth technology?based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice. Trial Registration: PROSPERO CRD42017072899; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72899 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8635 UR - https://mhealth.jmir.org/2020/1/e12516 UR - http://dx.doi.org/10.2196/12516 UR - http://www.ncbi.nlm.nih.gov/pubmed/31939744 ID - info:doi/10.2196/12516 ER - TY - JOUR AU - Alanezi, Fahad AU - Alanzi, Turki PY - 2020/1/15 TI - A Gig mHealth Economy Framework: Scoping Review of Internet Publications JO - JMIR Mhealth Uhealth SP - e14213 VL - 8 IS - 1 KW - gig economy KW - gigs KW - mHealth KW - sharing economy KW - gig mHealth N2 - Background: The gig economy (characterized by short-term contracts rather than being a full-time employee in an organization) is one of the most recent and important tendencies that have expanded through the global economic market thanks to advances in internet and communication technologies. Similarly, mobile health (mHealth) technologies have also evolved rapidly with the development of the internet and mobile apps, attracting attention globally for their health care benefits. Objective: This study aimed to propose an integration of mHealth within the framework of the gig economy that leads to a new dimension of health care services and the proposal of a new term: gig mHealth. Methods: A review and systematic search of articles, books, and opinions that allowed for answering the research questions were executed through the internet. In this sense, the concept of the gig economy and examples, advantages and disadvantages, were reviewed. Similarly, the general characteristics of mHealth technologies were revised. In addition, the role of technology in supporting the development of the gig economy and mHealth technologies and the interactions between them were investigated. Results: The findings suggested that the gig economy is characterized by its flexibility in working hours, on-demand work, free agents, freelancing, freedom in the choice of work, and independent contracts. In addition, an analysis of an mHealth system indicated that it was composed of patients, specialists, nurses, and database administrators. In this system, patients and specialists or nurses are connected to cloud services for the transmission of data and medical information through a mobile app. Here, the administrators update the database and app features, among other technical tasks. Conversely, a general structure of an integrated gig mHealth system was developed. In this structure, the mHealth care services and the mHealth care activities were incorporated into a gig economy model. In addition, a practical example of an integrated view of a gig economy app in mHealth that illustrates the interaction between the patients (consumers) and providers (partners) of mHealth care services, mHealth care activities, health care professionals, and individual contractors was presented. The consumers and providers were interconnected with the health care company, brand, or firm through digital means using a mobile app or Windows platforms. Conclusions: The analysis carried out in this study suggested the possibility of integrating mHealth within the framework of the gig economy enhancing health care service delivery and the management of health care activities. The following 4 major areas of apps proposed in the mHealth framework that can catalyze the operations using the features of the gig economy were sharing/renting medical and diagnostic equipment and resources, on-demand appointments/self-health management, on-demand health care services, and assigning health care activities/gigs to individual contractors. This integration leads to a new dimension for health care services and the proposal of a new term: gig mHealth. UR - https://mhealth.jmir.org/2020/1/e14213 UR - http://dx.doi.org/10.2196/14213 UR - http://www.ncbi.nlm.nih.gov/pubmed/31939745 ID - info:doi/10.2196/14213 ER - TY - JOUR AU - Herbuela, Marquez Von Ralph Dane AU - Karita, Tomonori AU - Francisco, Ernesto Micanaldo AU - Watanabe, Kozo PY - 2020/1/8 TI - An Integrated mHealth App for Dengue Reporting and Mapping, Health Communication, and Behavior Modification: Development and Assessment of Mozzify JO - JMIR Form Res SP - e16424 VL - 4 IS - 1 KW - dengue fever KW - mHealth KW - real-time surveillance KW - health communication KW - behavior modification N2 - Background: For the last 10 years, mobile phones have provided the global health community with innovative and cost-effective strategies to address the challenges in the prevention and management of dengue fever. Objective: The aim is to introduce and describe the design and development process of Mozzify, an integrated mobile health (mHealth) app that features real-time dengue fever case reporting and mapping system, health communication (real-time worldwide news and chat forum/timeline, within-app educational videos, links to local and international health agency websites, interactive signs and symptoms checker, and a hospital directions system), and behavior modification (reminders alert program on the preventive practices against dengue fever). We also aim to assess Mozzify in terms of engagement and information-sharing abilities, functionality, aesthetics, subjective quality, and perceived impact. Methods: The main goals of the Mozzify app were to increase awareness, improve knowledge, and change attitudes about dengue fever, health care-seeking behavior, and intention-to-change behavior on preventive practices for dengue fever among users. It was assessed using the Mobile Application Rating Scale (MARS) among 50 purposively sampled individuals: public health experts (n=5), environment and health-related researchers (n=23), and nonclinical (end users) participants (n=22). Results: High acceptability and excellent satisfaction ratings (mean scores ?4.0 out of 5) based on the MARS subscales indicate that the app has excellent user design, functionality, usability, engagement, and information among public health experts, environment and health-related researchers, and end users. The app?s subjective quality (recommending the app to other people and the app?s overall star rating), and specific quality (increase awareness, improve knowledge, and change attitudes about dengue fever; health care-seeking behavior; and intention-to-change behavior on preventive practices for dengue fever) also obtained excellent satisfaction ratings from the participants. Some issues and suggestions were raised during the focus group and individual discussions regarding the availability of the app for Android devices, language options limitations, provision of predictive surveillance, and inclusion of other mosquito-borne diseases. Conclusions: Mozzify may be a promising integrated strategic health intervention system for dengue fever case reporting and mapping; increase awareness, improve knowledge, and change attitude about dengue fever; and disseminating and sharing information on dengue fever among the general population and health experts. It also can be an effective aid in the successful translation of knowledge on preventive measures against dengue fever to practice. UR - https://formative.jmir.org/2020/1/e16424 UR - http://dx.doi.org/10.2196/16424 UR - http://www.ncbi.nlm.nih.gov/pubmed/31913128 ID - info:doi/10.2196/16424 ER - TY - JOUR AU - Zhang, Renwen AU - Nicholas, Jennifer AU - Knapp, A. Ashley AU - Graham, K. Andrea AU - Gray, Elizabeth AU - Kwasny, J. Mary AU - Reddy, Madhu AU - Mohr, C. David PY - 2019/12/20 TI - Clinically Meaningful Use of Mental Health Apps and its Effects on Depression: Mixed Methods Study JO - J Med Internet Res SP - e15644 VL - 21 IS - 12 KW - mHealth KW - mobile apps KW - mental health KW - engagement N2 - Background: User engagement is key to the effectiveness of digital mental health interventions. Considerable research has examined the clinical outcomes of overall engagement with mental health apps (eg, frequency and duration of app use). However, few studies have examined how specific app use behaviors can drive change in outcomes. Understanding the clinical outcomes of more nuanced app use could inform the design of mental health apps that are more clinically effective to users. Objective: This study aimed to classify user behaviors in a suite of mental health apps and examine how different types of app use are related to depression and anxiety outcomes. We also compare the clinical outcomes of specific types of app use with those of generic app use (ie, intensity and duration of app use) to understand what aspects of app use may drive symptom improvement. Methods: We conducted a secondary analysis of system use data from an 8-week randomized trial of a suite of 13 mental health apps. We categorized app use behaviors through a mixed methods analysis combining qualitative content analysis and principal component analysis. Regression analyses were used to assess the association between app use and levels of depression and anxiety at the end of treatment. Results: A total of 3 distinct clusters of app use behaviors were identified: learning, goal setting, and self-tracking. Each specific behavior had varied effects on outcomes. Participants who engaged in self-tracking experienced reduced depression symptoms, and those who engaged with learning and goal setting at a moderate level (ie, not too much or not too little) also had an improvement in depression. Notably, the combination of these 3 types of behaviors, what we termed ?clinically meaningful use,? accounted for roughly the same amount of variance as explained by the overall intensity of app use (ie, total number of app use sessions). This suggests that our categorization of app use behaviors succeeded in capturing app use associated with better outcomes. However, anxiety outcomes were neither associated with specific behaviors nor generic app use. Conclusions: This study presents the first granular examination of user interactions with mental health apps and their effects on mental health outcomes. It has important implications for the design of mobile health interventions that aim to achieve greater user engagement and improved clinical efficacy. UR - http://www.jmir.org/2019/12/e15644/ UR - http://dx.doi.org/10.2196/15644 UR - http://www.ncbi.nlm.nih.gov/pubmed/31859682 ID - info:doi/10.2196/15644 ER - TY - JOUR AU - Willcox, C. Jane AU - Dobson, Rosie AU - Whittaker, Robyn PY - 2019/12/20 TI - Old-Fashioned Technology in the Era of ?Bling?: Is There a Future for Text Messaging in Health Care? JO - J Med Internet Res SP - e16630 VL - 21 IS - 12 KW - text messaging KW - mHealth KW - behavior change KW - digital health UR - http://www.jmir.org/2019/12/e16630/ UR - http://dx.doi.org/10.2196/16630 UR - http://www.ncbi.nlm.nih.gov/pubmed/31859678 ID - info:doi/10.2196/16630 ER - TY - JOUR AU - Hacking, Damian AU - Mgengwana-Mbakaza, Zodwa AU - Cassidy, Tali AU - Runeyi, Pumeza AU - Duran, Trivino Laura AU - Mathys, Henwood Ruth AU - Boulle, Andrew PY - 2019/12/10 TI - Peer Mentorship via Mobile Phones for Newly Diagnosed HIV-Positive Youths in Clinic Care in Khayelitsha, South Africa: Mixed Methods Study JO - J Med Internet Res SP - e14012 VL - 21 IS - 12 KW - youth KW - HIV KW - peer influence KW - retention in care KW - mobile phone KW - patient navigator N2 - Background: Youths in South Africa are poor utilizers of HIV health services. Medecins Sans Frontieres has been piloting youth-adapted services at a youth clinic in Khayelitsha, including a peer virtual mentorship program over mobile phones, piloted from March 2015 to May 2016. Objective: The objective of this study was to evaluate the effect of the peer mentorship program on youth engagement with HIV services and explore the acceptability of the program to both mentors and mentees. Methods: Antiretroviral initiation, retention in care (RIC), and viral load suppression were compared between youths engaged in the virtual mentorship program and two matched controls. In-depth interviews were also conducted for 5 mentors and 5 mentees to explore acceptability and impact of the program. Results: A total of 40 youths were recruited into the virtual mentorship program over the study period. Of these, data were obtained for 35 and 2 matched controls were randomly sampled for each. There was no difference in baseline demographics (eg, age, gender, and CD4 count). Mentees had increased antiretroviral initiation (28/35, 80% vs 30/70, 42% in matched controls) and viral load completion (28/35, 80% vs 32/70, 45%); however, no differences were found in viral load suppression or RIC at 6 or 12 months. Mentors reported being motivated to participate in the program because of previous personal struggles with HIV and a desire to help their peers. Mentees reported fears of disclosure and lack of acceptance of their status as barrier to accessing services, but they felt free to talk to their mentors, valued the mentorship program, and indicated a preference for phone calls. Conclusions: Peer mentorship in youths is acceptable to both mentors and mentees and appears to increase linkage to care and viral load completion rates. UR - https://www.jmir.org/2019/12/e14012 UR - http://dx.doi.org/10.2196/14012 UR - http://www.ncbi.nlm.nih.gov/pubmed/31821150 ID - info:doi/10.2196/14012 ER - TY - JOUR AU - Zhang, Lei AU - He, Xingxing AU - Shen, Yun AU - Yu, Haoyong AU - Pan, Jiemin AU - Zhu, Wei AU - Zhou, Jian AU - Bao, Yuqian PY - 2019/12/9 TI - Effectiveness of Smartphone App?Based Interactive Management on Glycemic Control in Chinese Patients With Poorly Controlled Diabetes: Randomized Controlled Trial JO - J Med Internet Res SP - e15401 VL - 21 IS - 12 KW - app KW - self-management KW - interactive management KW - guidance KW - glycated hemoglobin A1c KW - diabetes N2 - Background: In recent years, the rapid development of mobile medical technology has provided multiple ways for the long-term management of chronic diseases, especially diabetes. As a new type of management model, smartphone apps are global, convenient, cheap, and interactive. Although apps were proved to be more effective at glycemic control, compared with traditional computer- and Web-based telemedicine technologies, how to gain a further and sustained improvement is still being explored. Objective: The objective of this study was to investigate the effectiveness of an app-based interactive management model by a professional health care team on glycemic control in Chinese patients with poorly controlled diabetes. Methods: This study was a 6-month long, single-center, prospective randomized controlled trial. A total of 276 type 1 or type 2 diabetes patients were enrolled and randomized to the control group (group A), app self-management group (group B), and app interactive management group (group C) in a 1:1:1 ratio. The primary outcome was the change in glycated hemoglobin (HbA1c) level. Missing data were handled by multiple imputation. Results: At months 3 and 6, all 3 groups showed significant decreases in HbA1c levels (all P<.05). Patients in the app interactive management group had a significantly lower HbA1clevel than those in the app self-management group at 6 months (P=.04). The average HbA1c reduction in the app interactive management group was larger than that in the app self-management and control groups at both months 3 and 6 (all P<.05). However, no differences in HbA1c reduction were observed between the app self-management and control groups at both months 3 and 6 (both P>.05). Multivariate line regression analyses also showed that the app interactive management group was associated with the larger reduction of HbA1c compared with groups A and B at both months 3 and 6 (all P>.05). In addition, the app interactive management group had better control of triglyceride and high-density lipoprotein cholesterol levels at both months 3 and 6 compared with baseline (both P<.05). Conclusions: In Chinese patients with poorly controlled diabetes, it was difficult to achieve long-term effective glucose improvement by using app self-management alone, but combining it with interactive management can help achieve rapid and sustained glycemic control. Trial Registration: ClinicalTrials.gov NCT02589730; https://clinicaltrials.gov/ct2/show/NCT02589730. UR - https://www.jmir.org/2019/12/e15401 UR - http://dx.doi.org/10.2196/15401 UR - http://www.ncbi.nlm.nih.gov/pubmed/31815677 ID - info:doi/10.2196/15401 ER - TY - JOUR AU - Zhang, Hui AU - Zhang, Jie AU - Li, Hong-Bao AU - Chen, Yi-Xin AU - Yang, Bin AU - Guo, Yu-Tao AU - Chen, Yun-Dai PY - 2019/12/3 TI - Validation of Single Centre Pre-Mobile Atrial Fibrillation Apps for Continuous Monitoring of Atrial Fibrillation in a Real-World Setting: Pilot Cohort Study JO - J Med Internet Res SP - e14909 VL - 21 IS - 12 KW - atrial fibrillation KW - photoplethysmography KW - continuous detection KW - accuracy KW - smartphone KW - smart band KW - algorithm N2 - Background: Atrial fibrillation is the most common recurrent arrhythmia in clinical practice, with most clinical events occurring outside the hospital. Low detection and nonadherence to guidelines are the primary obstacles to atrial fibrillation management. Photoplethysmography is a novel technology developed for atrial fibrillation screening. However, there has been limited validation of photoplethysmography-based smart devices for the detection of atrial fibrillation and its underlying clinical factors impacting detection. Objective: This study aimed to explore the feasibility of photoplethysmography-based smart devices for the detection of atrial fibrillation in real-world settings. Methods: Subjects aged ?18 years (n=361) were recruited from September 14 to October 16, 2018, for screening of atrial fibrillation with active measurement, initiated by the users, using photoplethysmography-based smart wearable devices (ie, a smart band or smart watches). Of these, 200 subjects were also automatically and periodically monitored for 14 days with a smart band. The baseline diagnosis of ?suspected? atrial fibrillation was confirmed by electrocardiogram and physical examination. The sensitivity and accuracy of photoplethysmography-based smart devices for monitoring atrial fibrillation were evaluated. Results: A total of 2353 active measurement signals and 23,864 periodic measurement signals were recorded. Eleven subjects were confirmed to have persistent atrial fibrillation, and 20 were confirmed to have paroxysmal atrial fibrillation. Smart devices demonstrated >91% predictive ability for atrial fibrillation. The sensitivity and specificity of devices in detecting atrial fibrillation among active recording of the 361 subjects were 100% and about 99%, respectively. For subjects with persistent atrial fibrillation, 127 (97.0%) active measurements and 2240 (99.2%) periodic measurements were identified as atrial fibrillation by the algorithm. For subjects with paroxysmal atrial fibrillation, 36 (17%) active measurements and 717 (19.8%) periodic measurements were identified as atrial fibrillation by the algorithm. All persistent atrial fibrillation cases could be detected as ?atrial fibrillation episodes? by the photoplethysmography algorithm on the first monitoring day, while 14 (70%) patients with paroxysmal atrial fibrillation demonstrated ?atrial fibrillation episodes? within the first 6 days. The average time to detect paroxysmal atrial fibrillation was 2 days (interquartile range: 1.25-5.75) by active measurement and 1 day (interquartile range: 1.00-2.00) by periodic measurement (P=.10). The first detection time of atrial fibrillation burden of <50% per 24 hours was 4 days by active measurement and 2 days by periodic measurementThe first detection time of atrial fibrillation burden of >50% per 24 hours was 1 day for both active and periodic measurements (active measurement: P=.02, periodic measurement: P=.03). Conclusions: Photoplethysmography-based smart devices demonstrated good atrial fibrillation predictive ability in both active and periodic measurements. However, atrial fibrillation type could impact detection, resulting in increased monitoring time. Trial Registration: Chinese Clinical Trial Registry of the International Clinical Trials Registry Platform of the World Health Organization ChiCTR-OOC-17014138; http://www.chictr.org.cn/showprojen.aspx?proj=24191. UR - https://www.jmir.org/2019/12/e14909 UR - http://dx.doi.org/10.2196/14909 UR - http://www.ncbi.nlm.nih.gov/pubmed/31793887 ID - info:doi/10.2196/14909 ER - TY - JOUR AU - Najm, Aurélie AU - Gossec, Laure AU - Weill, Catherine AU - Benoist, David AU - Berenbaum, Francis AU - Nikiphorou, Elena PY - 2019/11/26 TI - Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review JO - JMIR Mhealth Uhealth SP - e14730 VL - 7 IS - 11 KW - mobile health KW - self-management KW - arthritis KW - telemedicine KW - musculoskeletal diseases N2 - Background: Although the increasing availability of mobile health (mHealth) apps may enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health, there is a general lack of evidence on ways to ensure appropriate development and evaluation of apps. Objective: This study aimed to obtain an overview on existing mHealth apps for self-management in patients with RMDs, focusing on content and development methods. Methods: A search was performed up to December 2017 across 5 databases. For each publication relevant to an app for RMDs, information on the disease, purpose, content, and development strategies was extracted and qualitatively assessed. Results: Of 562 abstracts, 32 were included in the analysis. Of these 32 abstracts, 11 (34%) referred to an app linked to a connected device. Most of the apps targeted rheumatoid arthritis (11/32, 34%). The top three aspects addressed by the apps were pain (23/32, 71%), fatigue (15/32, 47%), and physical activity (15/32, 47%). The development process of the apps was described in 84% (27/32) of the articles and was of low to moderate quality in most of the cases. Despite most of the articles having been published within the past two years, only 5 apps were still commercially available at the time of our search. Moreover, only very few studies showed improvement of RMD outcome measures. Conclusions: The development process of most apps was of low or moderate quality in many studies. Owing to the increasing RMD patients? willingness to use mHealth apps for self-management, optimal standards and quality assurance of new apps are mandatory. UR - https://mhealth.jmir.org/2019/11/e14730 UR - http://dx.doi.org/10.2196/14730 UR - http://www.ncbi.nlm.nih.gov/pubmed/31769758 ID - info:doi/10.2196/14730 ER - TY - JOUR AU - Rudolf, Isa AU - Pieper, Katharina AU - Nolte, Helga AU - Junge, Sibylle AU - Dopfer, Christian AU - Sauer-Heilborn, Annette AU - Ringshausen, C. Felix AU - Tümmler, Burkhard AU - von Jan, Ute AU - Albrecht, Urs-Vito AU - Fuge, Jan AU - Hansen, Gesine AU - Dittrich, Anna-Maria PY - 2019/11/21 TI - Assessment of a Mobile App by Adolescents and Young Adults With Cystic Fibrosis: Pilot Evaluation JO - JMIR Mhealth Uhealth SP - e12442 VL - 7 IS - 11 KW - mobile phone KW - mobile phone app KW - mHealth KW - self-management KW - adolescence KW - cystic fibrosis N2 - Background: Cystic fibrosis (CF) continues to be the most common life-limiting chronic pulmonary disease in adolescents and young adults. Treatment of CF demands a high treatment time investment to slow the progression of lung function decline, the most important contributor to morbidity and mortality. Adherence is challenging in CF due to the high treatment burden and the lack of immediate health consequences in case of nonadherence. Lung function decline is particularly pronounced in the transition phase between 12 and 24 years of age. The improvement of self-management and self-responsibility and independence from parents and desire for normalcy are conflicting aspects for many adolescents with CF, which influence adherence to the time-consuming pulmonary therapy. Mobile health (mHealth) care apps could help to support self-management and independence and thereby reconcile seemingly conflicting goals to improve adherence, quality of life, and ultimately CF life expectancy. Objective: This study aimed to (1) assess user behavior and satisfaction among adolescents and young adults with CF over an observation period of three months using an mHealth app; (2) identify areas of improvement for this mHealth app; and (3) compare overall and disease-specific satisfaction, lung function, and anthropometry before and after using the mHealth app. Methods: A total of 27 adolescents and young adults with CF (age range 12-24 years, mean age 16 years, SD 3 years; 14 females, 11 males) used a free mHealth app for three months of whom 25 provided questionnaire data for analysis at the end of the study. Data collection was carried out using questionnaires on usage characteristics and life satisfaction, and standardized assessment of lung function and anthropometry. Results: The use of the reminder function for medication declined from 70% (15/21) of the participants at week 4 to 65% (13/20) at week 8 of the observation period. At the end of the study, only 17% (4/23) of the participants wanted to continue using the app. Nevertheless, 56% (14/25) of participants saw the mobile app as a support for everyday life. Potential improvements targeting hedonistic qualities were identified to improve mHealth app adherence. Comparisons of satisfaction with different life aspects hinted at improvements or stabilization for the subitem respiration and the subitem lack of handicap by CF, suggesting that app use might stabilize certain CF-specific aspects of the weighted satisfaction with life. Lung function and anthropometry were not affected consistently. Conclusions: Most of the patients did not want to continue using the app after the study period. Only a few CF-specific aspects of weighted life satisfaction were possibly stabilized by the mHealth app; clinical parameters were not affected. Adaptation of the functions to adolescent-specific needs could improve the long-term use and thus positively affect the disease course. UR - https://mhealth.jmir.org/2019/11/e12442 UR - http://dx.doi.org/10.2196/12442 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750841 ID - info:doi/10.2196/12442 ER - TY - JOUR AU - Rahman, Abidur Quazi AU - Janmohamed, Tahir AU - Clarke, Hance AU - Ritvo, Paul AU - Heffernan, Jane AU - Katz, Joel PY - 2019/11/20 TI - Interpretability and Class Imbalance in Prediction Models for Pain Volatility in Manage My Pain App Users: Analysis Using Feature Selection and Majority Voting Methods JO - JMIR Med Inform SP - e15601 VL - 7 IS - 4 KW - chronic pain KW - pain volatility KW - data mining KW - cluster analysis KW - machine learning KW - prediction model KW - Manage My Pain KW - pain app N2 - Background: Pain volatility is an important factor in chronic pain experience and adaptation. Previously, we employed machine-learning methods to define and predict pain volatility levels from users of the Manage My Pain app. Reducing the number of features is important to help increase interpretability of such prediction models. Prediction results also need to be consolidated from multiple random subsamples to address the class imbalance issue. Objective: This study aimed to: (1) increase the interpretability of previously developed pain volatility models by identifying the most important features that distinguish high from low volatility users; and (2) consolidate prediction results from models derived from multiple random subsamples while addressing the class imbalance issue. Methods: A total of 132 features were extracted from the first month of app use to develop machine learning?based models for predicting pain volatility at the sixth month of app use. Three feature selection methods were applied to identify features that were significantly better predictors than other members of the large features set used for developing the prediction models: (1) Gini impurity criterion; (2) information gain criterion; and (3) Boruta. We then combined the three groups of important features determined by these algorithms to produce the final list of important features. Three machine learning methods were then employed to conduct prediction experiments using the selected important features: (1) logistic regression with ridge estimators; (2) logistic regression with least absolute shrinkage and selection operator; and (3) random forests. Multiple random under-sampling of the majority class was conducted to address class imbalance in the dataset. Subsequently, a majority voting approach was employed to consolidate prediction results from these multiple subsamples. The total number of users included in this study was 879, with a total number of 391,255 pain records. Results: A threshold of 1.6 was established using clustering methods to differentiate between 2 classes: low volatility (n=694) and high volatility (n=185). The overall prediction accuracy is approximately 70% for both random forests and logistic regression models when using 132 features. Overall, 9 important features were identified using 3 feature selection methods. Of these 9 features, 2 are from the app use category and the other 7 are related to pain statistics. After consolidating models that were developed using random subsamples by majority voting, logistic regression models performed equally well using 132 or 9 features. Random forests performed better than logistic regression methods in predicting the high volatility class. The consolidated accuracy of random forests does not drop significantly (601/879; 68.4% vs 618/879; 70.3%) when only 9 important features are included in the prediction model. Conclusions: We employed feature selection methods to identify important features in predicting future pain volatility. To address class imbalance, we consolidated models that were developed using multiple random subsamples by majority voting. Reducing the number of features did not result in a significant decrease in the consolidated prediction accuracy. UR - http://medinform.jmir.org/2019/4/e15601/ UR - http://dx.doi.org/10.2196/15601 UR - http://www.ncbi.nlm.nih.gov/pubmed/31746764 ID - info:doi/10.2196/15601 ER - TY - JOUR AU - Adeagbo, Oluwafemi AU - Herbst, Carina AU - Blandford, Ann AU - McKendry, Rachel AU - Estcourt, Claudia AU - Seeley, Janet AU - Shahmanesh, Maryam PY - 2019/11/18 TI - Exploring People?s Candidacy for Mobile Health?Supported HIV Testing and Care Services in Rural KwaZulu-Natal, South Africa: Qualitative Study JO - J Med Internet Res SP - e15681 VL - 21 IS - 11 KW - mHealth KW - antiretroviral therapy KW - HIV testing KW - South Africa KW - candidacy framework N2 - Background: The use of mobile communication technologies (mHealth: mobile health) in chronic disease management has grown significantly over the years. mHealth interventions have the potential to decentralize access to health care and make it convenient, particularly in resource-constrained settings. It is against this backdrop that we aimed to codevelop (with potential users) a new generation of mobile phone?connected HIV diagnostic tests and Web-based clinical care pathways needed for optimal delivery of decentralized HIV testing, prevention, and care in low- and middle-income countries. Objective: The aim of this study was to understand ways in which an mHealth intervention could be developed to overcome barriers to existing HIV testing and care services and promote HIV self-testing and linkage to prevention and care in a poor, HIV hyperendemic community in rural KwaZulu-Natal, South Africa. Methods: A total of 54 in-depth interviews and 9 focus group discussions were conducted with potential users (including health care providers) in 2 different communities. Theoretically informed by the candidacy framework, themes were identified from the interview transcripts, manually coded, and thematically analyzed. Results: Participants reported barriers, such as fear of HIV identity, stigma, long waiting hours, clinic space, and health care workers? attitudes, as major impediments to effective uptake of HIV testing and care services. People continued to reassess their candidacy for HIV testing and care services on the basis of their experiences and how they or others were treated within the health systems. Despite the few concerns raised about new technology, mobile phone?linked HIV testing was broadly acceptable to potential users (particularly men and young people) and providers because of its privacy (individual control of HIV testing over health provider?initiated testing), convenience (individual time and place of choice for HIV testing versus clinic-based testing), and time saving. Conclusions: Mobile phone?connected HIV testing and Web-based clinical care and prevention pathways have the potential to support access to HIV prevention and care, particularly for young people and men. Although mHealth provides a way for individuals to test their candidacy for HIV services, the barriers that can make the service unattractive at the clinic level will also need to be addressed if potential demand is to turn into actual demand. UR - https://www.jmir.org/2019/11/e15681 UR - http://dx.doi.org/10.2196/15681 UR - http://www.ncbi.nlm.nih.gov/pubmed/31738174 ID - info:doi/10.2196/15681 ER - TY - JOUR AU - Cueto, Victor AU - Wang, Jason C. AU - Sanders, Michael Lee PY - 2019/11/15 TI - Impact of a Mobile App?Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study JO - JMIR Mhealth Uhealth SP - e14458 VL - 7 IS - 11 KW - child obesity KW - mHealth KW - mobile apps KW - health coaching KW - health behavior KW - self-monitoring KW - behavior change N2 - Background: Effective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement. Objective: The aim of this study was to assess child engagement over time, with a mobile app?based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status. Methods: This was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ? 85th percentile or ? 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan. Results: A total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in ?8.03 (95% CI ?10.19 to ?5.87) and ?9.34 (95% CI ?11.31 to ?7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was ?0.21 (95% CI ?0.25 to ?0.17) per additional coaching session (P<.001). Conclusions: Among overweight and obese children using a mobile app?based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status. UR - http://mhealth.jmir.org/2019/11/e14458/ UR - http://dx.doi.org/10.2196/14458 UR - http://www.ncbi.nlm.nih.gov/pubmed/31730041 ID - info:doi/10.2196/14458 ER - TY - JOUR AU - Camacho, Erica AU - Levin, Leonard AU - Torous, John PY - 2019/11/12 TI - Smartphone Apps to Support Coordinated Specialty Care for Prodromal and Early Course Schizophrenia Disorders: Systematic Review JO - J Med Internet Res SP - e16393 VL - 21 IS - 11 KW - smartphones KW - mobile phones KW - app KW - schizophrenia N2 - Background: Demand for mental health services, especially for clinical high-risk and early psychosis, has increased, creating a need for new solutions to increase access to and quality of care. Smartphones and mobile technology are potential tools to support coordinated specialty care for early psychosis, given their potential to augment the six core roles of care: case management and team leadership, recovery-oriented psychotherapy, medication management, support for employment and education, coordination with primary care services, and family education and support. However, the services smartphones are actually offering specifically for coordinated specialty care and the level of evidence are unknown. Objective: This study aimed to review the published literature on smartphone technology to enhance care for patients with prodromal and early course psychosis and schizophrenia and to analyze studies by type, aligned with coordinated specialty care domains. Methods: A systematic literature search was conducted on August 16 and 17, 2019, using the PubMed, EMBASE, Web of Sciences, and PsycINFO electronic databases. The eligible studies were reviewed and screened based on inclusion and exclusion criteria. Results: The search uncovered 388 unique results, of which 32 articles met the initial inclusion criteria; 21 eligible studies on 16 unique app platforms were identified. Feasibility studies showed a high user engagement and interest among patients, monitoring studies demonstrated a correlation between app assessments and clinical outcomes, and intervention studies indicated that these apps have the potential to advance care. Eighteen studies reported on app use for the case management roles of coordinated specialty care. No app studies focused on employment and education, coordination with primary care services, and family education and support. Conclusions: Although the published literature on smartphone apps for prodromal and first-episode psychosis is small, it is growing exponentially and holds promise to augment both monitoring and interventions. Although the research results and protocols for app studies are not well aligned with all coordinated specialty care roles today, high rates of adoption and feasibility suggest the potential for future efforts. These results will be used to develop coordinated specialty care?specific app evaluation scales and toolkits. UR - http://www.jmir.org/2019/11/e16393/ UR - http://dx.doi.org/10.2196/16393 UR - http://www.ncbi.nlm.nih.gov/pubmed/31714250 ID - info:doi/10.2196/16393 ER - TY - JOUR AU - Koo, Mi Bon AU - Vizer, M. Lisa PY - 2019/11/11 TI - Examining Mobile Technologies to Support Older Adults With Dementia Through the Lens of Personhood and Human Needs: Scoping Review JO - JMIR Mhealth Uhealth SP - e15122 VL - 7 IS - 11 KW - dementia KW - Alzheimer disease KW - mobile health KW - consumer health informatics KW - personhood KW - systematic review KW - smartphone KW - mobile phone KW - tablet computers N2 - Background: With the world?s rapidly growing older adult population, there is an increase in the number of people living with dementia. This growth leads to a strain on their caregivers and our health care system and to an increased attention on mitigating strain by using mobile technology to sustain the independence of people with dementia. However, less attention is given to whether these technologies meet the stated and unstated needs of people with dementia. Objective: The aim of this study was to provide an overview of the current research on mobile technologies for people with dementia, considering the current research through the lens of personhood and human needs, and to identify any gaps that represent research opportunities. Methods: We performed a systematic search in Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL) in October 2018. We screened 5560 articles and identified 24 that met our inclusion and exclusion criteria. We then performed thematic analysis to organize the articles by the types of support mobile technologies provide and mapped those types of support to human needs to identify the gaps in support. Results: Articles described research on mobile technologies that support people with dementia to (1) perform daily activities, (2) maintain social interaction, (3) aid memory, (4) engage in leisure activities, (5) track location, and (6) monitor health. At least one type of support mapped to each human need, with most supporting lower-level needs such as physiological and safety needs. Little attention seems to be paid to personhood. Conclusions: Mobile technologies that support daily activities, relationships, memory, leisure activities, health, and safety can partially compensate for decreased function owing to dementia, but the human needs of people with dementia are often not adequately considered. Most technologies support basic physiological and safety needs, whereas many pay little attention to higher-level needs such as self-esteem and agency. Important research opportunities include using person-centered methods to develop technology to meet higher-level needs and to preserve personhood by incorporating human and psychological needs of people with dementia along with ethical considerations. UR - https://mhealth.jmir.org/2019/11/e15122 UR - http://dx.doi.org/10.2196/15122 UR - http://www.ncbi.nlm.nih.gov/pubmed/31710305 ID - info:doi/10.2196/15122 ER - TY - JOUR AU - Zawati, H. Ma'n AU - Lang, Michael PY - 2019/11/4 TI - Mind the App: Considerations for the Future of Mobile Health in Canada JO - JMIR Mhealth Uhealth SP - e15301 VL - 7 IS - 11 KW - smartphone KW - mobile phone KW - regulation KW - patients KW - physicians UR - https://mhealth.jmir.org/2019/11/e15301 UR - http://dx.doi.org/10.2196/15301 UR - http://www.ncbi.nlm.nih.gov/pubmed/31682580 ID - info:doi/10.2196/15301 ER - TY - JOUR AU - Faruqui, Akhter Syed Hasib AU - Du, Yan AU - Meka, Rajitha AU - Alaeddini, Adel AU - Li, Chengdong AU - Shirinkam, Sara AU - Wang, Jing PY - 2019/11/1 TI - Development of a Deep Learning Model for Dynamic Forecasting of Blood Glucose Level for Type 2 Diabetes Mellitus: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e14452 VL - 7 IS - 11 KW - type 2 diabetes KW - long short-term memory (LSTM)-based recurrent neural networks (RNNs) KW - glucose level prediction KW - mobile health lifestyle data N2 - Background: Type 2 diabetes mellitus (T2DM) is a major public health burden. Self-management of diabetes including maintaining a healthy lifestyle is essential for glycemic control and to prevent diabetes complications. Mobile-based health data can play an important role in the forecasting of blood glucose levels for lifestyle management and control of T2DM. Objective: The objective of this work was to dynamically forecast daily glucose levels in patients with T2DM based on their daily mobile health lifestyle data including diet, physical activity, weight, and glucose level from the day before. Methods: We used data from 10 T2DM patients who were overweight or obese in a behavioral lifestyle intervention using mobile tools for daily monitoring of diet, physical activity, weight, and blood glucose over 6 months. We developed a deep learning model based on long short-term memory?based recurrent neural networks to forecast the next-day glucose levels in individual patients. The neural network used several layers of computational nodes to model how mobile health data (food intake including consumed calories, fat, and carbohydrates; exercise; and weight) were progressing from one day to another from noisy data. Results: The model was validated based on a data set of 10 patients who had been monitored daily for over 6 months. The proposed deep learning model demonstrated considerable accuracy in predicting the next day glucose level based on Clark Error Grid and ±10% range of the actual values. Conclusions: Using machine learning methodologies may leverage mobile health lifestyle data to develop effective individualized prediction plans for T2DM management. However, predicting future glucose levels is challenging as glucose level is determined by multiple factors. Future study with more rigorous study design is warranted to better predict future glucose levels for T2DM management. UR - https://mhealth.jmir.org/2019/11/e14452 UR - http://dx.doi.org/10.2196/14452 UR - http://www.ncbi.nlm.nih.gov/pubmed/31682586 ID - info:doi/10.2196/14452 ER - TY - JOUR AU - Romero, Lee Ryan AU - Kates, Frederick AU - Hart, Mark AU - Ojeda, Amanda AU - Meirom, Itai AU - Hardy, Stephen PY - 2019/10/30 TI - Quality of Deaf and Hard-of-Hearing Mobile Apps: Evaluation Using the Mobile App Rating Scale (MARS) With Additional Criteria From a Content Expert JO - JMIR Mhealth Uhealth SP - e14198 VL - 7 IS - 10 KW - eHealth KW - mobile health KW - mHealth KW - mobile app KW - hearing KW - deaf persons KW - sign language N2 - Background: The spread of technology and dissemination of knowledge across the World Wide Web has prompted the development of apps for American Sign Language (ASL) translation, interpretation, and syntax recognition. There is limited literature regarding the quality, effectiveness, and appropriateness of mobile health (mHealth) apps for the deaf and hard-of-hearing (DHOH) that pose to aid the DHOH in their everyday communication and activities. Other than the star-rating system with minimal comments regarding quality, the evaluation metrics used to rate mobile apps are commonly subjective. Objective: This study aimed to evaluate the quality and effectiveness of DHOH apps using a standardized scale. In addition, it also aimed to identify content-specific criteria to improve the evaluation process by using a content expert, and to use the content expert to more accurately evaluate apps and features supporting the DHOH. Methods: A list of potential apps for evaluation was generated after a preliminary screening for apps related to the DHOH. Inclusion and exclusion criteria were developed to refine the master list of apps. The study modified a standardized rating scale with additional content-specific criteria applicable to the DHOH population for app evaluation. This was accomplished by including a DHOH content expert in the design of content-specific criteria. Results: The results indicate a clear distinction in Mobile App Rating Scale (MARS) scores among apps within the study?s three app categories: ASL translators (highest score=3.72), speech-to-text (highest score=3.6), and hard-of-hearing assistants (highest score=3.90). Of the 217 apps obtained from the search criteria, 21 apps met the inclusion and exclusion criteria. Furthermore, the limited consideration for measures specific to the target population along with a high app turnover rate suggests opportunities for improved app effectiveness and evaluation. Conclusions: As more mHealth apps enter the market for the DHOH population, more criteria-based evaluation is needed to ensure the safety and appropriateness of the apps for the intended users. Evaluation of population-specific mHealth apps can benefit from content-specific measurement criteria developed by a content expert in the field. UR - http://mhealth.jmir.org/2019/10/e14198/ UR - http://dx.doi.org/10.2196/14198 UR - http://www.ncbi.nlm.nih.gov/pubmed/31670695 ID - info:doi/10.2196/14198 ER - TY - JOUR AU - Tønning, Lindbjerg Morten AU - Kessing, Vedel Lars AU - Bardram, Eivind Jakob AU - Faurholt-Jepsen, Maria PY - 2019/10/27 TI - Methodological Challenges in Randomized Controlled Trials on Smartphone-Based Treatment in Psychiatry: Systematic Review JO - J Med Internet Res SP - e15362 VL - 21 IS - 10 KW - psychiatry KW - methodology KW - smartphone KW - mHealth KW - mobile Health KW - digital health KW - digital psychiatry KW - systematic review N2 - Background: Smartphone-based technology is developing at high speed, and many apps offer potential new ways of monitoring and treating a range of psychiatric disorders and symptoms. However, the effects of most available apps have not been scientifically investigated. Within medicine, randomized controlled trials (RCTs) are the standard method for providing the evidence of effects. However, their rigidity and long time frame may contrast with the field of information technology research. Therefore, a systematic review of methodological challenges in designing and conducting RCTs within mobile health is needed. Objective: This systematic review aimed to (1) identify and describe RCTs investigating the effect of smartphone-based treatment in adult patients with a psychiatric diagnosis, (2) discuss methodological challenges in designing and conducting individual trials, and (3) suggest recommendations for future trials. Methods: A systematic search in English was conducted in PubMed, PsycINFO, and EMBASE up to August 12, 2019. The search terms were (1) psychiatric disorders in broad term and for specific disorders AND (2) smartphone or app AND (3) RCT. The Consolidated Standards of Reporting Trials electronic health guidelines were used as a template for data extraction. The focus was on trial design, method, and reporting. Only trials having sufficient information on diagnosis and acceptable diagnostic procedures, having a smartphone as a central part of treatment, and using an RCT design were included. Results: A total of 27 trials comprising 3312 patients within a range of psychiatric diagnoses were included. Among them, 2 trials were concerning drug or alcohol abuse, 3 psychosis, 10 affective disorders, 9 anxiety and posttraumatic stress disorder, 1 eating disorder, and 1 attention-deficit/hyperactivity disorder. In addition, 1 trial used a cross-diagnostic design, 7 trials included patients with a clinical diagnosis that was subsequently assessed and validated by the researchers, and 11 trials had a sample size above 100. Generally, large between-trial heterogeneity and multiple approaches to patient recruitment, diagnostic procedures, trial design, comparator, outcome measures, and analyses were identified. Only 5 trials published a trial protocol. Furthermore, 1 trial provided information regarding technological updates, and only 18 trials reported on the conflicts of interest. No trial addressed the ethical aspects of using smartphones in treatment. Conclusions: This first systematic review of the methodological challenges in designing and conducting RCTs investigating smartphone-based treatment in psychiatric patients suggests an increasing number of trials but with a lower quality compared with classic medical RCTs. Heterogeneity and methodological issues in individual trials limit the evidence. Methodological recommendations are presented. UR - http://www.jmir.org/2019/10/e15362/ UR - http://dx.doi.org/10.2196/15362 UR - http://www.ncbi.nlm.nih.gov/pubmed/31663859 ID - info:doi/10.2196/15362 ER - TY - JOUR AU - Ralph-Nearman, Christina AU - Arevian, C. Armen AU - Puhl, Maria AU - Kumar, Rajay AU - Villaroman, Diane AU - Suthana, Nanthia AU - Feusner, D. Jamie AU - Khalsa, S. Sahib PY - 2019/10/29 TI - A Novel Mobile Tool (Somatomap) to Assess Body Image Perception Pilot Tested With Fashion Models and Nonmodels: Cross-Sectional Study JO - JMIR Ment Health SP - e14115 VL - 6 IS - 10 KW - body image KW - body perception KW - body representation KW - body image disorder KW - eating disorder KW - mobile health KW - mental health KW - mobile app KW - digital health N2 - Background: Distorted perception of one?s body and appearance, in general, is a core feature of several psychiatric disorders including anorexia nervosa and body dysmorphic disorder and is operative to varying degrees in nonclinical populations. Yet, body image perception is challenging to assess, given its subjective nature and variety of manifestations. The currently available methods have several limitations including restricted ability to assess perceptions of specific body areas. To address these limitations, we created Somatomap, a mobile tool that enables individuals to visually represent their perception of body-part sizes and shapes as well as areas of body concerns and record the emotional valence of concerns. Objective: This study aimed to develop and pilot test the feasibility of a novel mobile tool for assessing 2D and 3D body image perception. Methods: We developed a mobile 2D tool consisting of a manikin figure on which participants outline areas of body concern and indicate the nature, intensity, and emotional valence of the concern. We also developed a mobile 3D tool consisting of an avatar on which participants select individual body parts and use sliders to manipulate their size and shape. The tool was pilot tested on 103 women: 65 professional fashion models, a group disproportionately exposed to their own visual appearance, and 38 nonmodels from the general population. Acceptability was assessed via a usability rating scale. To identify areas of body concern in 2D, topographical body maps were created by combining assessments across individuals. Statistical body maps of group differences in body concern were subsequently calculated using the formula for proportional z-score. To identify areas of body concern in 3D, participants? subjective estimates from the 3D avatar were compared to corresponding measurements of their actual body parts. Discrepancy scores were calculated based on the difference between the perceived and actual body parts and evaluated using multivariate analysis of covariance. Results: Statistical body maps revealed different areas of body concern between models (more frequently about thighs and buttocks) and nonmodels (more frequently about abdomen/waist). Models were more accurate at estimating their overall body size, whereas nonmodels tended to underestimate the size of individual body parts, showing greater discrepancy scores for bust, biceps, waist, hips, and calves but not shoulders and thighs. Models and nonmodels reported high ease-of-use scores (8.4/10 and 8.5/10, respectively), and the resulting 3D avatar closely resembled their actual body (72.7% and 75.2%, respectively). Conclusions: These pilot results suggest that Somatomap is feasible to use and offers new opportunities for assessment of body image perception in mobile settings. Although further testing is needed to determine the applicability of this approach to other populations, Somatomap provides unique insight into how humans perceive and represent the visual characteristics of their body. UR - http://mental.jmir.org/2019/10/e14115/ UR - http://dx.doi.org/10.2196/14115 UR - http://www.ncbi.nlm.nih.gov/pubmed/31469647 ID - info:doi/10.2196/14115 ER - TY - JOUR AU - Chaar, Dima AU - Shin, Youn Ji AU - Mazzoli, Amanda AU - Vue, Rebecca AU - Kedroske, Jacob AU - Chappell, Grant AU - Hanauer, A. David AU - Barton, Debra AU - Hassett, L. Afton AU - Choi, Won Sung PY - 2019/10/24 TI - A Mobile Health App (Roadmap 2.0) for Patients Undergoing Hematopoietic Stem Cell Transplant: Qualitative Study on Family Caregivers' Perspectives and Design Considerations JO - JMIR Mhealth Uhealth SP - e15775 VL - 7 IS - 10 KW - caregivers KW - allogeneic hematopoietic stem cell transplant KW - home interviews KW - user experience KW - mobile health apps N2 - Background: Hematopoietic stem cell transplantation (HCT), also referred to as blood and marrow transplantation (BMT), is a high-risk, but potentially curative therapy for a number of cancer and noncancer conditions. BMT Roadmap (Roadmap 1.0) is a mobile health app that was developed as a family caregiver?facing tool to provide informational needs about the health status of patients undergoing inpatient HCT. Objective: This study explored the views and perceptions of family caregivers of patients undergoing HCT and their input regarding further technology development and expansion of BMT Roadmap into the outpatient setting (referred to as Roadmap 2.0). Methods: Semistructured qualitative interviews were conducted among 24 family caregivers. Questions were developed from existing literature coupled with prior in-depth observations and interviews in hospital-based settings to explore the study objectives. Participants were recruited during routine outpatient clinic appointments of HCT patients, and all interviews were conducted in the participants? homes, the setting in which Roadmap 2.0 is intended for use. A thematic analysis was performed using a consistent set of codes derived from our prior research. New emerging codes were also included, and the coding structure was refined with iterative cycles of coding and data collection. Results: Four major themes emerged through our qualitative analysis: (1) stress related to balancing caregiving duties; (2) learning and adapting to new routines (resilience); (3) balancing one?s own needs with the patient?s needs (insight); and (4) benefits of caregiving. When caregivers were further probed about their views on engagement with positive activity interventions (ie, pleasant activities that promote positive emotions and well-being such as expressing gratitude or engaging in activities that promote positive thoughts, emotions, and behaviors), they preferred a ?menu? of positive activities to help support caregiver health and well-being. Conclusions: This study involved family caregivers as participants in the development of new components for Roadmap 2.0. Our research provided a further understanding of the many priorities that hematopoietic stem cell transplant family caregivers face while maintaining balance in their lives. Their schedules can often be unpredictable, even more so once the patient is discharged from the hospital. Our findings suggest that expanding Roadmap 2.0 into the outpatient setting may provide critical caregiver support and that HCT caregivers are interested in and willing to engage in positive activities that may enhance well-being and attenuate the stress associated with caregiving. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.4918 UR - http://mhealth.jmir.org/2019/10/e15775/ UR - http://dx.doi.org/10.2196/15775 UR - http://www.ncbi.nlm.nih.gov/pubmed/31651402 ID - info:doi/10.2196/15775 ER - TY - JOUR AU - Shan, Wei AU - Wang, Ying AU - Luan, Jing AU - Tang, Pengfei PY - 2019/10/23 TI - The Influence of Physician Information on Patients? Choice of Physician in mHealth Services Using China?s Chunyu Doctor App: Eye-Tracking and Questionnaire Study JO - JMIR Mhealth Uhealth SP - e15544 VL - 7 IS - 10 KW - mHealth KW - physician information KW - choice KW - trust N2 - Background: Mobile health (mHealth) is becoming more popular as a way of sharing medical information. For the patient, it saves time, reduces the need for travel, reduces the cost of searching for information, and brings medical services ?to your fingertips.? However, it also brings information overload and makes the patient?s choice of physician more difficult. Objective: This study aimed to identify the types of physician information that play a key role in patients? choice of physician and to explore the mechanism by which this information contributes to this choice. Methods: Based on the stimulus-organism-response (SOR) model and online trust theory, we proposed a research model to explain the influence of physician information on patients? choice of physician. The model was based on cognitive trust and affective trust and considered the moderating role of patient expertise. Study 1 was an eye-tracking experiment (n=42) to identify key factors affecting patients? choice of physician. Study 2 was a questionnaire study (n=272); Partial Least Squares Structural Equation Modeling was used to validate the research model. Results: The results of Study 1 revealed that seven types of physician information played a key role in patients? choice of physician. The results of Study 2 revealed that (1) physicians? profile photo information affected patients? choice of physician by positively influencing affective trust (P<.001); (2) physicians? nonprofile photo information affected patients? choice of physician by positively influencing cognitive trust (P<.001); (3) patient-generated information affected patients? choice of physician by positively affecting cognitive trust (P<.001) and affective trust (P<.001), and patient expertise played a positive moderating role on both (P=.04 and P=.01, respectively); and (4) cognitive trust and affective trust both positively affected patients? choice of physician, with affective trust playing a more significant role (P<.001 and P<.001, respectively). Conclusions: Seven types of physician information were mainly used by patients when choosing physicians offering mHealth services; trust played an important role in this choice. In addition, the level of patient expertise was an important variable in moderating the influence of physician information and patients? trust. This paper supports the theoretical basis of information selection and processing by patients. These findings can help guide app developers in the construction of medical apps and in the management of physician information in order to facilitate patients? choice of physician. UR - http://mhealth.jmir.org/2019/10/e15544/ UR - http://dx.doi.org/10.2196/15544 UR - http://www.ncbi.nlm.nih.gov/pubmed/31647466 ID - info:doi/10.2196/15544 ER - TY - JOUR AU - Kim, Myeongchan AU - Yune, Sehyo AU - Chang, Seyun AU - Jung, Yuseob AU - Sa, Ok Soon AU - Han, Wook Hyun PY - 2019/10/17 TI - The Fever Coach Mobile App for Participatory Influenza Surveillance in Children: Usability Study JO - JMIR Mhealth Uhealth SP - e14276 VL - 7 IS - 10 KW - data collection KW - detecting epidemics KW - mobile app KW - health care app KW - influenza epidemics KW - influenza in children N2 - Background: Effective surveillance of influenza requires a broad network of health care providers actively reporting cases of influenza-like illnesses and positive laboratory results. Not only is this traditional surveillance system costly to establish and maintain but there is also a time lag between a change in influenza activity and its detection. A new surveillance system that is both reliable and timely will help public health officials to effectively control an epidemic and mitigate the burden of the disease. Objective: This study aimed to evaluate the use of parent-reported data of febrile illnesses in children submitted through the Fever Coach app in real-time surveillance of influenza activities. Methods: Fever Coach is a mobile app designed to help parents and caregivers manage fever in young children, currently mainly serviced in South Korea. The app analyzes data entered by a caregiver and provides tailored information for care of the child based on the child?s age, sex, body weight, body temperature, and accompanying symptoms. Using the data submitted to the app during the 2016-2017 influenza season, we built a regression model that monitors influenza incidence for the 2017-2018 season and validated the model by comparing the predictions with the public influenza surveillance data from the Korea Centers for Disease Control and Prevention (KCDC). Results: During the 2-year study period, 70,203 diagnosis data, including 7702 influenza reports, were submitted. There was a significant correlation between the influenza activity predicted by Fever Coach and that reported by KCDC (Spearman ?=0.878; P<.001). Using this model, the influenza epidemic in the 2017-2018 season was detected 10 days before the epidemic alert announced by KCDC. Conclusions: The Fever Coach app successfully collected data from 7.73% (207,699/2,686,580) of the target population by providing care instruction for febrile children. These data were used to develop a model that accurately estimated influenza activity measured by the central government agency using reports from sentinel facilities in the national surveillance network. UR - https://mhealth.jmir.org/2019/10/e14276 UR - http://dx.doi.org/10.2196/14276 UR - http://www.ncbi.nlm.nih.gov/pubmed/31625946 ID - info:doi/10.2196/14276 ER - TY - JOUR AU - Barteit, Sandra AU - Neuhann, Florian AU - Bärnighausen, Till AU - Bowa, Annel AU - Wolter, Sigrid AU - Siabwanta, Hinson AU - Jahn, Albrecht PY - 2019/10/9 TI - Technology Acceptance and Information System Success of a Mobile Electronic Platform for Nonphysician Clinical Students in Zambia: Prospective, Nonrandomized Intervention Study JO - J Med Internet Res SP - e14748 VL - 21 IS - 10 KW - computers, handheld KW - tablets KW - education, medical KW - sub-Saharan Africa KW - Zambia KW - mHealth KW - evidence-based practice KW - medicine N2 - Background: Zambia is still experiencing a severe shortage of health workers, which is impacting the national health care system. Very few people are trained, educational infrastructure is inadequate, and senior human resources for training are not yet sufficient to produce the number of health care workers needed, especially for currently underserved rural areas. Therefore, to strengthen the medical education program of medical licentiates, we implemented a tablet-based electronic learning platform (e-platform) with a medical decision-support component. Objective: As the primary objective, this study aimed to explore the acceptance and information system (IS) success of an e-platform focused on offline-based tablet usage for nonphysician clinical students in a low-resource context in Zambia, Africa. Furthermore, we aimed to evaluate student demographic factors and prior technological experience, as well as medical lecturers? acceptance of technology of the e-platform. Methods: We collected data for the study before and after the intervention. Before the intervention, we collected student demographic data and prior technological experience using a questionnaire. After the intervention, we collected results of the questionnaire on technology acceptance of students and IS success of the e-platform, as well as technology acceptance of medical lecturers. We calculated statistical measures such as means, standard deviations, and correlations of investigated variables. The study report was compiled using the Consolidated Standards of Reporting Trials-Electronic Health checklist. Results: Overall, questionnaire results of students and medical lecturers indicated acceptance of the e-platform and showed higher ratings for overall net benefits and information quality (students) and perceived ease of use and perceived usefulness (medical lecturers) as compared with ratings of other categories. The lowest scores were conveyed for system use and service quality (students) and attitude and behavioral intention (medical lecturers). Conclusions: Acceptance of the e-platform as a learning technology for strengthening medical education in a low-resource context in Zambia was generally high for students and medical lecturers, but shortcomings were also identified. Results indicated low overall usage of the e-platform as a learning and teaching tool. One hindering factor was the tablets? overall weak reliability with regard to its service life and battery life span, and another was the teachers? low engagement with the e-platform. Next steps may include other hardware and more technology-based training for medical lecturers. The evaluation results indicated that the e-platform may open new promise for further strengthening and expanding medical education in this context, especially with more affordable and viable technologies that are available. UR - http://www.jmir.org/2019/10/e14748/ UR - http://dx.doi.org/10.2196/14748 UR - http://www.ncbi.nlm.nih.gov/pubmed/31599731 ID - info:doi/10.2196/14748 ER - TY - JOUR AU - Spartano, L. Nicole AU - Lin, Honghuang AU - Sun, Fangui AU - Lunetta, L. Kathryn AU - Trinquart, Ludovic AU - Valentino, Maureen AU - Manders, S. Emily AU - Pletcher, J. Mark AU - Marcus, M. Gregory AU - McManus, D. David AU - Benjamin, J. Emelia AU - Fox, S. Caroline AU - Olgin, E. Jeffrey AU - Murabito, M. Joanne PY - 2019/9/30 TI - Comparison of On-Site Versus Remote Mobile Device Support in the Framingham Heart Study Using the Health eHeart Study for Digital Follow-up: Randomized Pilot Study Set Within an Observational Study Design JO - JMIR Mhealth Uhealth SP - e13238 VL - 7 IS - 9 KW - wearable electronic devices KW - cell phone KW - fitness trackers KW - electrocardiography KW - epidemiology N2 - Background: New electronic cohort (e-Cohort) study designs provide resource-effective methods for collecting participant data. It is unclear if implementing an e-Cohort study without direct, in-person participant contact can achieve successful participation rates. Objective: The objective of this study was to compare 2 distinct enrollment methods for setting up mobile health (mHealth) devices and to assess the ongoing adherence to device use in an e-Cohort pilot study. Methods: We coenrolled participants from the Framingham Heart Study (FHS) into the FHS?Health eHeart (HeH) pilot study, a digital cohort with infrastructure for collecting mHealth data. FHS participants who had an email address and smartphone were randomized to our FHS-HeH pilot study into 1 of 2 study arms: remote versus on-site support. We oversampled older adults (age ?65 years), with a target of enrolling 20% of our sample as older adults. In the remote arm, participants received an email containing a link to enrollment website and, upon enrollment, were sent 4 smartphone-connectable sensor devices. Participants in the on-site arm were invited to visit an in-person FHS facility and were provided in-person support for enrollment and connecting the devices. Device data were tracked for at least 5 months. Results: Compared with the individuals who declined, individuals who consented to our pilot study (on-site, n=101; remote, n=93) were more likely to be women, highly educated, and younger. In the on-site arm, the connection and initial use of devices was ?20% higher than the remote arm (mean percent difference was 25% [95% CI 17-35] for activity monitor, 22% [95% CI 12-32] for blood pressure cuff, 20% [95% CI 10-30] for scale, and 43% [95% CI 30-55] for electrocardiogram), with device connection rates in the on-site arm of 99%, 95%, 95%, and 84%. Once connected, continued device use over the 5-month study period was similar between the study arms. Conclusions: Our pilot study demonstrated that the deployment of mobile devices among middle-aged and older adults in the context of an on-site clinic visit was associated with higher initial rates of device use as compared with offering only remote support. Once connected, the device use was similar in both groups. UR - https://mhealth.jmir.org/2019/9/e13238 UR - http://dx.doi.org/10.2196/13238 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573928 ID - info:doi/10.2196/13238 ER - TY - JOUR AU - Baumel, Amit AU - Muench, Frederick AU - Edan, Stav AU - Kane, M. John PY - 2019/09/25 TI - Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis JO - J Med Internet Res SP - e14567 VL - 21 IS - 9 KW - user engagement KW - usage KW - adherence KW - retention KW - mental health KW - depression KW - anxiety KW - mHealth N2 - Background: Understanding patterns of real-world usage of mental health apps is key to maximizing their potential to increase public self-management of care. Although developer-led studies have published results on the use of mental health apps in real-world settings, no study yet has systematically examined usage patterns of a large sample of mental health apps relying on independently collected data. Objective: Our aim is to present real-world objective data on user engagement with popular mental health apps. Methods: A systematic engine search was conducted using Google Play to identify Android apps with 10,000 installs or more targeting anxiety, depression, or emotional well-being. Coding of apps included primary incorporated techniques and mental health focus. Behavioral data on real-world usage were obtained from a panel that provides aggregated nonpersonal information on user engagement with mobile apps. Results: In total, 93 apps met the inclusion criteria (installs: median 100,000, IQR 90,000). The median percentage of daily active users (open rate) was 4.0% (IQR 4.7%) with a difference between trackers (median 6.3%, IQR 10.2%) and peer-support apps (median 17.0%) versus breathing exercise apps (median 1.6%, IQR 1.6%; all z?3.42, all P<.001). Among active users, daily minutes of use were significantly higher for mindfulness/meditation (median 21.47, IQR 15.00) and peer support (median 35.08, n=2) apps than for apps incorporating other techniques (tracker, breathing exercise, psychoeducation: medians range 3.53-8.32; all z?2.11, all P<.05). The medians of app 15-day and 30-day retention rates were 3.9% (IQR 10.3%) and 3.3% (IQR 6.2%), respectively. On day 30, peer support (median 8.9%, n=2), mindfulness/meditation (median 4.7%, IQR 6.2%), and tracker apps (median 6.1%, IQR 20.4%) had significantly higher retention rates than breathing exercise apps (median 0.0%, IQR 0.0%; all z?2.18, all P?.04). The pattern of daily use presented a descriptive peak toward the evening for apps incorporating most techniques (tracker, psychoeducation, and peer support) except mindfulness/meditation, which exhibited two peaks (morning and night). Conclusions: Although the number of app installs and daily active minutes of use may seem high, only a small portion of users actually used the apps for a long period of time. More studies using different datasets are needed to understand this phenomenon and the ways in which users self-manage their condition in real-world settings. UR - http://www.jmir.org/2019/9/e14567/ UR - http://dx.doi.org/10.2196/14567 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573916 ID - info:doi/10.2196/14567 ER - TY - JOUR AU - Wang, Taotao AU - Ren, Mengyuan AU - Shen, Ying AU - Zhu, Xiaorou AU - Zhang, Xing AU - Gao, Min AU - Chen, Xueying AU - Zhao, Ai AU - Shi, Yuhui AU - Chai, Weizhong AU - Liu, Xinchuan AU - Sun, Xinying PY - 2019/09/25 TI - The Association Among Social Support, Self-Efficacy, Use of Mobile Apps, and Physical Activity: Structural Equation Models With Mediating Effects JO - JMIR Mhealth Uhealth SP - e12606 VL - 7 IS - 9 KW - mobile apps KW - physical activity KW - social support KW - self-efficacy KW - structural equation modeling N2 - Background: Physical inactivity is a risk factor for chronic noncommunicable diseases. Insufficient physical activity has become an important public health problem worldwide. As mobile apps have rapidly developed, physical activity apps have the potential to improve the level of physical activity among populations. Objective: This study aimed to evaluate the effect of physical activity apps on levels of physical activity among college students. Methods: A Web-based questionnaire was used to survey college students in Beijing from December 27, 2017, to January 5, 2018. According to a previous survey, 43% of college students using physical activity apps and 36% of those who never used such apps achieved the physical activity recommendations. In this study, the sample size was calculated to be 500. The questionnaire consisted of 5 parts: the use of physical activity apps, sports habits, social support, self-efficacy, and social demographic information. Structural equation modeling was used to test the relationships between the use of physical activity apps, self-efficacy, social support, and level of physical activity. Results: Of the 1245 participants, 384 college students (30.8%) used physical activity apps (in the past month). Of these 384 students, 191 (49.7%) gained new friends via the app. College students who were using physical activity apps had a higher level of physical activity and higher scores for social support and self-efficacy (P<.001) than those who did not use such apps. The use of physical activity apps significantly affected the mediating effect of physical activity level through social support (beta=.126; P<.001) and self-efficacy (beta=.294; P<.001). Gender played an important role in app use, self-efficacy, and physical activity in the mediation model: male users spent more time on physical activity and had higher self-efficacy scores (P<.001). Conclusions: This study focused on college students in Beijing and found that the use of physical activity apps is associated with higher physical activity levels among these students. This effect is mainly through the mediation effect of social support and self-efficacy, rather than the direct effect of physical activity apps. The use of physical activity apps is associated with a higher social support level and higher self-efficacy score. Furthermore, a high social support level and high self-efficacy score are associated with higher physical activity levels. UR - http://mhealth.jmir.org/2019/9/e12606/ UR - http://dx.doi.org/10.2196/12606 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573936 ID - info:doi/10.2196/12606 ER - TY - JOUR AU - Greer, Ben AU - Newbery, Katie AU - Cella, Matteo AU - Wykes, Til PY - 2019/09/19 TI - Predicting Inpatient Aggression in Forensic Services Using Remote Monitoring Technology: Qualitative Study of Staff Perspectives JO - J Med Internet Res SP - e15620 VL - 21 IS - 9 KW - telemedicine KW - remote sensing technology KW - wearable sensors KW - aggression KW - risk assessment N2 - Background: Monitoring risk of imminent aggression in inpatient forensic mental health services could be supported by passive remote monitoring technology, but staff attitudes toward the relevance and likelihood of engagement with this technology are unknown. Objective: This study aimed to explore staff views, specifically potential benefits and implementation barriers, on using this technology for monitoring risk of inpatient aggression. Methods: We conducted semistructured focus groups with nurses in an inpatient forensic mental health service. We used thematic analysis with two independent raters to identify themes and subthemes related to staff attitudes toward passive remote monitoring. We subsequently checked with members to ensure the validity of the themes identified by the raters. Results: From January to March 2019, a total of 25 nurses took part in five focus groups. We identified five main themes, one of which concerned the potential benefits that passive remote monitoring could provide for monitoring risk of aggression. Staff suggested it could provide an early warning of impending aggression and enable support to be provided earlier. The remaining themes concerned implementation barriers, including risks to the users? physical and mental well-being; data security concerns and potential access by third parties; the negative impact of a constant stream of real-time data on staff workload; and design characteristics and user awareness of the benefits of passive remote monitoring. Conclusions: Passive remote monitoring technology could support existing methods of monitoring inpatient aggression risk, but multiple barriers to implementation exist. Empirical research is required to investigate whether these potential benefits can be realized, and to identify ways of addressing these barriers to ensure acceptability and user engagement. UR - https://www.jmir.org/2019/9/e15620 UR - http://dx.doi.org/10.2196/15620 UR - http://www.ncbi.nlm.nih.gov/pubmed/31538943 ID - info:doi/10.2196/15620 ER - TY - JOUR AU - Tabi, Katarina AU - Randhawa, Singh Abnashi AU - Choi, Fiona AU - Mithani, Zamina AU - Albers, Friederike AU - Schnieder, Maren AU - Nikoo, Mohammadali AU - Vigo, Daniel AU - Jang, Kerry AU - Demlova, Regina AU - Krausz, Michael PY - 2019/09/11 TI - Mobile Apps for Medication Management: Review and Analysis JO - JMIR Mhealth Uhealth SP - e13608 VL - 7 IS - 9 KW - eHealth KW - mHealth KW - drugs KW - pharmaceuticals KW - therapy N2 - Background: Pharmacotherapy remains one of the major interventional strategies in medicine. However, patients from all age groups and conditions face challenges when taking medications, such as integrating them into the daily routine, understanding their effects and side effects, and monitoring outcomes. In this context, a reliable medication management tool adaptable to the patient?s needs becomes critical. As most people have a mobile phone, mobile apps offer a platform for such a personalized support tool available on the go. Objective: This study aimed to provide an overview of available mobile apps, focusing on those that help patients understand and take their medications. We reviewed the existing apps and provided suggestions for future development based on the concept understand and manage, instead of the conventional adhere to medication. This concept aims to engage and empower patients to be in charge of their health, as well as see medication as part of a broader clinical approach, working simultaneously with other types of interventions or lifestyle changes, to achieve optimal outcomes. Methods: We performed a Web search in the iOS Apple App Store and Android Google Play Store, using 4 search terms: medication management, pill reminder, medication health monitor, and medication helper. We extracted information from the app store descriptions for each eligible app and categorized into the following characteristics: features, author affiliation, specialty, user interface, cost, and user rating. In addition, we conducted Google searches to obtain more information about the author affiliation. Results: A total of 328 apps (175 Android and 153 iOS) were categorized. The majority of the apps were developed by the software industry (73%, 11/15), a minority of them were codeveloped by health care professionals (15%, 3/20) or academia (2.1%; 7/328). The most prevalent specialty was diabetes (23 apps). Only 7 apps focused on mental health, but their content was highly comprehensive in terms of features and had the highest prevalence of the education component. The most prevalent features were reminder, symptom tracker, and ability to share data with a family member or doctor. In addition, we highlighted the features considered innovative and listed practical suggestions for future development and innovations. Conclusions: We identified detailed characteristics of the existing apps, with the aim of informing future app development. Ultimately, the goal was to provide users with effective mobile health solutions, which can be expected to improve their engagement in the treatment process and long-term well-being. This study also highlighted the need for improved standards for reporting on app stores. Furthermore, it underlined the need for a platform to offer health app users an ongoing evaluation of apps by health professionals in addition to other users and to provide them with tools to easily select an appropriate and trustworthy app. UR - http://mhealth.jmir.org/2019/9/e13608/ UR - http://dx.doi.org/10.2196/13608 UR - http://www.ncbi.nlm.nih.gov/pubmed/31512580 ID - info:doi/10.2196/13608 ER - TY - JOUR AU - Chung, Yong Il AU - Jung, Miyeon AU - Lee, Byul Sae AU - Lee, Won Jong AU - Park, Rang Yu AU - Cho, Daegon AU - Chung, Haekwon AU - Youn, Soyoung AU - Min, Ha Yul AU - Park, Jin Hye AU - Lee, Minsun AU - Chung, Seockhoon AU - Son, Ho Byung AU - Ahn, Sei-Hyun PY - 2019/09/06 TI - An Assessment of Physical Activity Data Collected via a Smartphone App and a Smart Band in Breast Cancer Survivors: Observational Study JO - J Med Internet Res SP - e13463 VL - 21 IS - 9 KW - telemedicine KW - breast neoplasms KW - mobile apps KW - quality of life KW - stress, psychological KW - patient compliance KW - smartphone KW - mobile phone KW - wearable electronic devices KW - survivorship N2 - Background: Although distress screening is crucial for cancer survivors, it is not easy for clinicians to recognize distress. Physical activity (PA) data collected by mobile devices such as smart bands and smartphone apps have the potential to be used to screen distress in breast cancer survivors. Objective: The aim of this study was to assess data collection rates of smartphone apps and smart bands in terms of PA data, investigate the correlation between PA data from mobile devices and distress-related questionnaires from smartphone apps, and demonstrate factors associated with data collection with smart bands and smartphone apps in breast cancer survivors. Methods: In this prospective observational study, patients who underwent surgery for breast cancer at Asan Medical Center, Seoul, Republic of Korea, between June 2017 and March 2018 were enrolled and asked to use both a smartphone app and smart band for 6 months. The overall compliance rates of the daily PA data collection via the smartphone walking apps and wearable smart bands were analyzed in a within-subject manner. The longitudinal daily collection rates were calculated to examine the dropout pattern. We also performed multivariate linear regression analysis to examine factors associated with compliance with daily collection. Finally, we tested the correlation between the count of daily average steps and distress level using Pearson correlation analysis. Results: A total of 160 female patients who underwent breast cancer surgeries were enrolled. The overall compliance rates for using a smartphone app and smart bands were 88.0% (24,224/27,513) and 52.5% (14,431/27,513), respectively. The longitudinal compliance rate for smartphone apps was 77.8% at day 180, while the longitudinal compliance rate for smart bands rapidly decreased over time, reaching 17.5% at day 180. Subjects who were young, with other comorbidities, or receiving antihormonal therapy or targeted therapy showed significantly higher compliance rates to the smartphone app. However, no factor was associated with the compliance rate to the smart band. In terms of the correlation between the count of daily steps and distress level, step counts collected via smart band showed a significant correlation with distress level. Conclusions: Smartphone apps or smart bands are feasible tools to collect data on the physical activity of breast cancer survivors. PA data from mobile devices are correlated with participants? distress data, which suggests the potential role of mobile devices in the management of distress in breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 UR - https://www.jmir.org/2019/9/e13463 UR - http://dx.doi.org/10.2196/13463 UR - http://www.ncbi.nlm.nih.gov/pubmed/31493319 ID - info:doi/10.2196/13463 ER - TY - JOUR AU - Loncar-Turukalo, Tatjana AU - Zdravevski, Eftim AU - Machado da Silva, José AU - Chouvarda, Ioanna AU - Trajkovik, Vladimir PY - 2019/09/05 TI - Literature on Wearable Technology for Connected Health: Scoping Review of Research Trends, Advances, and Barriers JO - J Med Internet Res SP - e14017 VL - 21 IS - 9 KW - wearable technology KW - telemedicine KW - assisted living facilities KW - review N2 - Background: Wearable sensing and information and communication technologies are key enablers driving the transformation of health care delivery toward a new model of connected health (CH) care. The advances in wearable technologies in the last decade are evidenced in a plethora of original articles, patent documentation, and focused systematic reviews. Although technological innovations continuously respond to emerging challenges and technology availability further supports the evolution of CH solutions, the widespread adoption of wearables remains hindered. Objective: This study aimed to scope the scientific literature in the field of pervasive wearable health monitoring in the time interval from January 2010 to February 2019 with respect to four important pillars: technology, safety and security, prescriptive insight, and user-related concerns. The purpose of this study was multifold: identification of (1) trends and milestones that have driven research in wearable technology in the last decade, (2) concerns and barriers from technology and user perspective, and (3) trends in the research literature addressing these issues. Methods: This study followed the scoping review methodology to identify and process the available literature. As the scope surpasses the possibilities of manual search, we relied on the natural language processing tool kit to ensure an efficient and exhaustive search of the literature corpus in three large digital libraries: Institute of Electrical and Electronics Engineers, PubMed, and Springer. The search was based on the keywords and properties to be found in articles using the search engines of the digital libraries. Results: The annual number of publications in all segments of research on wearable technology shows an increasing trend from 2010 to February 2019. The technology-related topics dominated in the number of contributions, followed by research on information delivery, safety, and security, whereas user-related concerns were the topic least addressed. The literature corpus evidences milestones in sensor technology (miniaturization and placement), communication architectures and fifth generation (5G) cellular network technology, data analytics, and evolution of cloud and edge computing architectures. The research lag in battery technology makes energy efficiency a relevant consideration in the design of both sensors and network architectures with computational offloading. The most addressed user-related concerns were (technology) acceptance and privacy, whereas research gaps indicate that more efforts should be invested into formalizing clear use cases with timely and valuable feedback and prescriptive recommendations. Conclusions: This study confirms that applications of wearable technology in the CH domain are becoming mature and established as a scientific domain. The current research should bring progress to sustainable delivery of valuable recommendations, enforcement of privacy by design, energy-efficient pervasive sensing, seamless monitoring, and low-latency 5G communications. To complement technology achievements, future work involving all stakeholders providing research evidence on improved care pathways and cost-effectiveness of the CH model is needed. UR - https://www.jmir.org/2019/9/e14017/ UR - http://dx.doi.org/10.2196/14017 UR - http://www.ncbi.nlm.nih.gov/pubmed/31489843 ID - info:doi/10.2196/14017 ER - TY - JOUR AU - Midaglia, Luciana AU - Mulero, Patricia AU - Montalban, Xavier AU - Graves, Jennifer AU - Hauser, L. Stephen AU - Julian, Laura AU - Baker, Michael AU - Schadrack, Jan AU - Gossens, Christian AU - Scotland, Alf AU - Lipsmeier, Florian AU - van Beek, Johan AU - Bernasconi, Corrado AU - Belachew, Shibeshih AU - Lindemann, Michael PY - 2019/08/30 TI - Adherence and Satisfaction of Smartphone- and Smartwatch-Based Remote Active Testing and Passive Monitoring in People With Multiple Sclerosis: Nonrandomized Interventional Feasibility Study JO - J Med Internet Res SP - e14863 VL - 21 IS - 8 KW - multiple sclerosis KW - patient adherence KW - patient satisfaction KW - smartphone KW - wearable electronic devices KW - mobile phone N2 - Background: Current clinical assessments of people with multiple sclerosis are episodic and may miss critical features of functional fluctuations between visits. Objective: The goal of the research was to assess the feasibility of remote active testing and passive monitoring using smartphones and smartwatch technology in people with multiple sclerosis with respect to adherence and satisfaction with the FLOODLIGHT test battery. Methods: People with multiple sclerosis (aged 20 to 57 years; Expanded Disability Status Scale 0-5.5; n=76) and healthy controls (n=25) performed the FLOODLIGHT test battery, comprising active tests (daily, weekly, every two weeks, or on demand) and passive monitoring (sensor-based gait and mobility) for 24 weeks using a smartphone and smartwatch. The primary analysis assessed adherence (proportion of weeks with at least 3 days of completed testing and 4 hours per day passive monitoring) and questionnaire-based satisfaction. In-clinic assessments (clinical and magnetic resonance imaging) were performed. Results: People with multiple sclerosis showed 70% (16.68/24 weeks) adherence to active tests and 79% (18.89/24 weeks) to passive monitoring; satisfaction score was on average 73.7 out of 100. Neither adherence nor satisfaction was associated with specific population characteristics. Test-battery assessments had an at least acceptable impact on daily activities in over 80% (61/72) of people with multiple sclerosis. Conclusions: People with multiple sclerosis were engaged and satisfied with the FLOODLIGHT test battery. FLOODLIGHT sensor-based measures may enable continuous assessment of multiple sclerosis disease in clinical trials and real-world settings. Trial Registration: ClinicalTrials.gov: NCT02952911; https://clinicaltrials.gov/ct2/show/NCT02952911 UR - http://www.jmir.org/2019/8/e14863/ UR - http://dx.doi.org/10.2196/14863 UR - http://www.ncbi.nlm.nih.gov/pubmed/31471961 ID - info:doi/10.2196/14863 ER - TY - JOUR AU - Nouri, S. Sarah AU - Avila-Garcia, Patricia AU - Cemballi, Gunshekar Anupama AU - Sarkar, Urmimala AU - Aguilera, Adrian AU - Lyles, Rees Courtney PY - 2019/08/29 TI - Assessing Mobile Phone Digital Literacy and Engagement in User-Centered Design in a Diverse, Safety-Net Population: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e14250 VL - 7 IS - 8 KW - health information technology KW - mHealth KW - user-centered design KW - health literacy KW - digital literacy KW - limited English proficiency N2 - Background: Health care systems are rapidly deploying digital tools for disease management; however, few studies have evaluated their usability by vulnerable populations. To understand the barriers to app usage among vulnerable populations, we employed user-centered design (UCD) methods in the development of a new text messaging app. Objective: The study aimed to describe variations in patients? engagement in the app design process, focusing on limited health literacy (LHL), limited English proficiency (LEP), and limited digital literacy (LDL). Methods: We conducted 20 in-depth semistructured interviews with primary care patients at a public health care system, used open-ended discussions and card sorting tasks to seek input about mobile phones and text messaging, and used open coding to categorize the patterns of mobile phone usage and to evaluate engagement in the card sorting process. We examined qualitative differences in engagement by examining the extensiveness of participant feedback on existing and novel text messaging content and calculated the proportion of patients providing extensive feedback on existing and novel content, overall and by health literacy, English proficiency, and digital literacy. Results: The average age of the 20 participants was 59 (SD 8) years; 13 (65%) were female, 18 (90%) were nonwhite, 16 (80%) had LHL, and 13 (65%) had LEP. All had depression, and 14 (70%) had diabetes. Most participants had smartphones (18/20, 90%) and regularly used text messaging (15/20, 75%), but 14 (70%) of them reported having difficulty texting because of inability to type, physical disability, and low literacy. We identified 10 participants as specifically having LDL; 7 of these participants had LEP, and all 10 had LHL. Half of the participants required a modification of the card sorting activity owing to not understanding it or not being able to read the cards in the allotted time. The proportion of participants who gave extensive feedback on existing content was lower in participants with limited versus adequate English proficiency (4/13, 30% vs 5/7, 71%), limited versus adequate health literacy (7/16, 44% vs 3/4, 75%), and limited versus adequate digital literacy (4/10, 40% vs 6/10, 60%); none of these differences were statistically significant. When examining the proportion of patients who gave extensive feedback for novel messaging content, those with LHL were less engaged than those with adequate health literacy (8/16, 50% vs 4/4, 100%); there were no statistical differences by any subgroup. Conclusions: Despite widespread mobile phone use, digital literacy barriers are common among vulnerable populations. Engagement in the card sorting activity varied among participants and appeared to be lower among those with LHL, LEP, and LDL. Researchers employing traditional UCD methods should routinely measure these communication domains among their end-user samples. Future work is needed to replicate our findings in larger samples, but augmentation of card sorting with direct observation and audiovisual cues may be more productive in eliciting feedback for those with communication barriers. UR - http://mhealth.jmir.org/2019/8/e14250/ UR - http://dx.doi.org/10.2196/14250 UR - http://www.ncbi.nlm.nih.gov/pubmed/31469083 ID - info:doi/10.2196/14250 ER - TY - JOUR AU - Mohr, C. David AU - Schueller, M. Stephen AU - Tomasino, Noth Kathryn AU - Kaiser, M. Susan AU - Alam, Nameyeh AU - Karr, Chris AU - Vergara, L. Jessica AU - Gray, L. Elizabeth AU - Kwasny, J. Mary AU - Lattie, G. Emily PY - 2019/08/28 TI - Comparison of the Effects of Coaching and Receipt of App Recommendations on Depression, Anxiety, and Engagement in the IntelliCare Platform: Factorial Randomized Controlled Trial JO - J Med Internet Res SP - e13609 VL - 21 IS - 8 KW - depression KW - anxiety KW - mHealth KW - clinical trial N2 - Background: IntelliCare is a modular platform that includes 12 simple apps targeting specific psychological strategies for common mental health problems. Objective: This study aimed to examine the effect of 2 methods of maintaining engagement with the IntelliCare platform, coaching, and receipt of weekly recommendations to try different apps on depression, anxiety, and app use. Methods: A total of 301 participants with depression or anxiety were randomized to 1 of 4 treatments lasting 8 weeks and were followed for 6 months posttreatment. The trial used a 2X2 factorial design (coached vs self-guided treatment and weekly app recommendations vs no recommendations) to compare engagement metrics. Results: The median time to last use of any app during treatment was 56 days (interquartile range 54-57), with 253 participants (84.0%, 253/301) continuing to use the apps over a median of 92 days posttreatment. Receipt of weekly recommendations resulted in a significantly higher number of app use sessions during treatment (overall median=216; P=.04) but only marginal effects for time to last use (P=.06) and number of app downloads (P=.08). Coaching resulted in significantly more app downloads (P<.001), but there were no significant effects for time to last download or number of app sessions (P=.36) or time to last download (P=.08). Participants showed significant reductions in the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) across all treatment arms (P s<.001). Coached treatment led to larger GAD-7 reductions than those observed for self-guided treatment (P=.03), but the effects for the PHQ-9 did not reach significance (P=.06). Significant interaction was observed between receiving recommendations and time for the PHQ-9 (P=.04), but there were no significant effects for GAD-7 (P=.58). Conclusions: IntelliCare produced strong engagement with apps across all treatment arms. Coaching was associated with stronger anxiety outcomes, and receipt of recommendations enhanced depression outcomes. Trial Registration: ClinicalTrials.gov NCT02801877; https://clinicaltrials.gov/ct2/show/NCT02801877 UR - http://www.jmir.org/2019/8/e13609/ UR - http://dx.doi.org/10.2196/13609 UR - http://www.ncbi.nlm.nih.gov/pubmed/31464192 ID - info:doi/10.2196/13609 ER - TY - JOUR AU - Yakovchenko, Vera AU - Hogan, P. Timothy AU - Houston, K. Thomas AU - Richardson, Lorilei AU - Lipschitz, Jessica AU - Petrakis, Ann Beth AU - Gillespie, Chris AU - McInnes, Keith D. PY - 2019/8/4 TI - Automated Text Messaging With Patients in Department of Veterans Affairs Specialty Clinics: Cluster Randomized Trial JO - J Med Internet Res SP - e14750 VL - 21 IS - 8 KW - implementation facilitation KW - texting KW - veterans KW - eHealth KW - self-management KW - digital health KW - digital medicine N2 - Background: Acceptability of mobile phone text messaging as a means of asynchronous communication between health care systems and patients is growing. The US Department of Veterans Affairs (VA) has adopted an automated texting system (aTS) for national rollout. The aTS allows providers to develop clinical texting protocols to promote patient self-management and allows clinical teams to monitor patient progress between in-person visits. Texting-supported hepatitis C virus (HCV) treatment has not been previously tested. Objective: Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), we developed an aTS HCV protocol and conducted a mixed methods, hybrid type 2 effectiveness implementation study comparing two programs supporting implementation of the aTS HCV protocol for medication adherence in patients with HCV. Methods: Seven VA HCV specialty clinics were randomized to usual aTS implementation versus an augmented implementation facilitation program. Implementation process measures included facilitation metrics, usability, and usefulness. Implementation outcomes included provider and patient use of the aTS HCV protocol, and effectiveness outcomes included medication adherence, health perceptions and behaviors, and sustained virologic response (SVR). Results: Across the seven randomized clinics, there were 293 facilitation events using a core set of nine implementation strategies (157 events in augmented implementation facilitation, 136 events in usual implementation). Providers found the aTS appropriate with high potential for scale-up but not without difficulties in startup, patient selection and recruitment, and clinic workflow integration. Patients largely found the aTS easy to use and helpful; however, low perceived need for self-management support contributed to high declination. Reach and use was modest with 197 patients approached, 71 (36%) enrolled, 50 (25%) authenticated, and 32 (16%) using the aTS. In augmented implementation facilitation clinics, more patients actively used the aTS HCV protocol compared with usual clinic patients (20% vs 12%). Patients who texted reported lower distress about failing HCV treatment (13/15, 87%, vs 8/15, 53%; P=.05) and better adherence to HCV medication (11/15, 73%, reporting excellent adherence vs 6/15, 40%; P=.06), although SVR did not differ by group. Conclusions: The aTS is a promising intervention for improving patient self-management; however, augmented approaches to implementation may be needed to support clinician buy-in and patient engagement. Considering the behavioral, social, organizational, and technical scale-up challenges that we documented, successful and sustained implementation of the aTS may require implementation strategies that operate at the clinic, provider, and patient levels. Trial Registration: Retrospectively registered at ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349 UR - https://www.jmir.org/2019/8/e14750/ UR - http://dx.doi.org/10.2196/14750 UR - http://www.ncbi.nlm.nih.gov/pubmed/31444872 ID - info:doi/10.2196/14750 ER - TY - JOUR AU - Yin, Lukas Andrew AU - Hachuel, David AU - Pollak, P. John AU - Scherl, J. Ellen AU - Estrin, Deborah PY - 2019/08/19 TI - Digital Health Apps in the Clinical Care of Inflammatory Bowel Disease: Scoping Review JO - J Med Internet Res SP - e14630 VL - 21 IS - 8 KW - digital health KW - mHealth KW - mobile health KW - mobile technology KW - smartphone KW - eHealth KW - review KW - inflammatory bowel disease KW - Crohn?s disease KW - ulcerative colitis N2 - Background: Digital health is poised to transform health care and redefine personalized health. As Internet and mobile phone usage increases, as technology develops new ways to collect data, and as clinical guidelines change, all areas of medicine face new challenges and opportunities. Inflammatory bowel disease (IBD) is one of many chronic diseases that may benefit from these advances in digital health. This review intends to lay a foundation for clinicians and technologists to understand future directions and opportunities together. Objective: This review covers mobile health apps that have been used in IBD, how they have fit into a clinical care framework, and the challenges that clinicians and technologists face in approaching future opportunities. Methods: We searched PubMed, Scopus, and ClinicalTrials.gov to identify mobile apps that have been studied and were published in the literature from January 1, 2010, to April 19, 2019. The search terms were (?mobile health? OR ?eHealth? OR ?digital health? OR ?smart phone? OR ?mobile app? OR ?mobile applications? OR ?mHealth? OR ?smartphones?) AND (?IBD? OR ?Inflammatory bowel disease? OR ?Crohn's Disease? (CD) OR ?Ulcerative Colitis? (UC) OR ?UC? OR ?CD?), followed by further analysis of citations from the results. We searched the Apple iTunes app store to identify a limited selection of commercial apps to include for discussion. Results: A total of 68 articles met the inclusion criteria. A total of 11 digital health apps were identified in the literature and 4 commercial apps were selected to be described in this review. While most apps have some educational component, the majority of apps focus on eliciting patient-reported outcomes related to disease activity, and a few are for treatment management. Significant benefits have been seen in trials relating to education, quality of life, quality of care, treatment adherence, and medication management. No studies have reported a negative impact on any of the above. There are mixed results in terms of effects on office visits and follow-up. Conclusions: While studies have shown that digital health can fit into, complement, and improve the standard clinical care of patients with IBD, there is a need for further validation and improvement, from both a clinical and patient perspective. Exploring new research methods, like microrandomized trials, may allow for more implementation of technology and rapid advancement of knowledge. New technologies that can objectively and seamlessly capture remote data, as well as complement the clinical shift from symptom-based to inflammation-based care, will help the clinical and health technology communities to understand the full potential of digital health in the care of IBD and other chronic illnesses. UR - http://www.jmir.org/2019/8/e14630/ UR - http://dx.doi.org/10.2196/14630 UR - http://www.ncbi.nlm.nih.gov/pubmed/31429410 ID - info:doi/10.2196/14630 ER - TY - JOUR AU - Petersen, Maria Jasmine AU - Prichard, Ivanka AU - Kemps, Eva PY - 2019/08/16 TI - A Comparison of Physical Activity Mobile Apps With and Without Existing Web-Based Social Networking Platforms: Systematic Review JO - J Med Internet Res SP - e12687 VL - 21 IS - 8 KW - physical activity KW - mobile applications KW - social networking N2 - Background: Physical activity mobile apps present a unique medium to disseminate scalable interventions to increase levels of physical activity. However, the effectiveness of mobile apps has previously been limited by low levels of engagement. Existing Web-based social networking platforms (eg, Facebook and Twitter) afford high levels of popularity, reach, and sustain engagement and, thus, may present an innovative strategy to enhance the engagement, and ultimately the effectiveness of mobile apps. Objective: This study aimed to comparatively examine the effectiveness of, and engagement with, interventions that incorporate physical activity mobile apps in conjunction with and without existing Web-based social networking platforms (eg, Facebook and Twitter). Methods: A systematic review was conducted by following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines. A systematic search of the following databases was conducted: Medline, PsycINFO, Web of Science, Scopus, CINAHL, ProQuest, SPORTDiscus, EMBASE, and Cochrane. According to the comparative objective of this review, 2 independent literature searches were conducted. The first incorporated terms related to apps and physical activity; the second also incorporated terms related to Web-based social networking. The results of the two searches were synthesized and compared narratively. Results: A total of 15 studies were identified, 10 incorporated a physical activity app alone and 5 incorporated an app in conjunction with an existing Web-based social networking platform. Overall, 10 of the 15 interventions were effective in improving one or more physical activity behaviors. Specifically, improvements in physical activity behaviors were reported in 7 of the 10 interventions incorporating physical activity apps alone and in 3 of the 5 interventions incorporating physical activity apps in conjunction with existing Web-based social networking platforms. Interventions incorporating physical activity apps alone demonstrated a decline in app engagement. In contrast, the physical activity apps in conjunction with existing Web-based social networking platforms showed increased and sustained intervention engagement. Conclusions: The interventions incorporating physical activity apps in conjunction with and without existing Web-based social networking platforms demonstrated effectiveness in improving physical activity behaviors. Notably, however, the interventions that incorporated existing Web-based social networking platforms achieved higher levels of engagement than those that did not. This review provides preliminary evidence that existing Web-based social networking platforms may be fundamental to increase engagement with physical activity interventions. UR - https://www.jmir.org/2019/8/e12687/ UR - http://dx.doi.org/10.2196/12687 UR - http://www.ncbi.nlm.nih.gov/pubmed/31420956 ID - info:doi/10.2196/12687 ER - TY - JOUR AU - Shen, Jiayi AU - Zhang, P. Casper J. AU - Jiang, Bangsheng AU - Chen, Jiebin AU - Song, Jian AU - Liu, Zherui AU - He, Zonglin AU - Wong, Yi Sum AU - Fang, Po-Han AU - Ming, Wai-Kit PY - 2019/08/16 TI - Artificial Intelligence Versus Clinicians in Disease Diagnosis: Systematic Review JO - JMIR Med Inform SP - e10010 VL - 7 IS - 3 KW - artificial intelligence KW - deep learning KW - diagnosis KW - diagnostic imaging KW - image interpretation, computer-assisted KW - patient-centered care N2 - Background: Artificial intelligence (AI) has been extensively used in a range of medical fields to promote therapeutic development. The development of diverse AI techniques has also contributed to early detections, disease diagnoses, and referral management. However, concerns about the value of advanced AI in disease diagnosis have been raised by health care professionals, medical service providers, and health policy decision makers. Objective: This review aimed to systematically examine the literature, in particular, focusing on the performance comparison between advanced AI and human clinicians to provide an up-to-date summary regarding the extent of the application of AI to disease diagnoses. By doing so, this review discussed the relationship between the current advanced AI development and clinicians with respect to disease diagnosis and thus therapeutic development in the long run. Methods: We systematically searched articles published between January 2000 and March 2019 following the Preferred Reporting Items for Systematic reviews and Meta-Analysis in the following databases: Scopus, PubMed, CINAHL, Web of Science, and the Cochrane Library. According to the preset inclusion and exclusion criteria, only articles comparing the medical performance between advanced AI and human experts were considered. Results: A total of 9 articles were identified. A convolutional neural network was the commonly applied advanced AI technology. Owing to the variation in medical fields, there is a distinction between individual studies in terms of classification, labeling, training process, dataset size, and algorithm validation of AI. Performance indices reported in articles included diagnostic accuracy, weighted errors, false-positive rate, sensitivity, specificity, and the area under the receiver operating characteristic curve. The results showed that the performance of AI was at par with that of clinicians and exceeded that of clinicians with less experience. Conclusions: Current AI development has a diagnostic performance that is comparable with medical experts, especially in image recognition-related fields. Further studies can be extended to other types of medical imaging such as magnetic resonance imaging and other medical practices unrelated to images. With the continued development of AI-assisted technologies, the clinical implications underpinned by clinicians? experience and guided by patient-centered health care principle should be constantly considered in future AI-related and other technology-based medical research. UR - http://medinform.jmir.org/2019/3/e10010/ UR - http://dx.doi.org/10.2196/10010 UR - http://www.ncbi.nlm.nih.gov/pubmed/31420959 ID - info:doi/10.2196/10010 ER - TY - JOUR AU - Broglia, Emma AU - Millings, Abigail AU - Barkham, Michael PY - 2019/08/15 TI - Counseling With Guided Use of a Mobile Well-Being App for Students Experiencing Anxiety or Depression: Clinical Outcomes of a Feasibility Trial Embedded in a Student Counseling Service JO - JMIR Mhealth Uhealth SP - e14318 VL - 7 IS - 8 KW - counseling KW - students KW - mental health KW - mobile app KW - feasibility studies KW - outcome measures KW - depressive symptoms KW - generalized anxiety KW - universities N2 - Background: Anxiety and depression continue to be prominent experiences of students approaching their university counseling service. These services face unique challenges to ensure that they continue to offer quality support with fewer resources to a growing student population. The convenience and availability of mobile phone apps offer innovative solutions to address therapeutic challenges and expand the reach of traditional support. Objective: The primary aim of this study was to establish the feasibility of a trial in which guided use of a mobile phone well-being app was introduced into a student counseling service and offered as an adjunct to face-to-face counseling. Methods: The feasibility trial used a two-arm, parallel nonrandomized design comparing counseling alone (treatment as usual, or TAU) versus counseling supplemented with guided use of a mobile phone well-being app (intervention) for 38 university students experiencing moderate anxiety or depression. Students in both conditions received up to 6 sessions of face-to-face counseling within a 3-month period. Students who approached the counseling service and were accepted for counseling were invited to join the trial. Feasibility factors evaluated include recruitment duration, treatment preference, randomization acceptability, and intervention fidelity. Clinical outcomes and clinical change were assessed with routine clinical outcome measures administered every counseling session and follow-up phases at 3 and 6 months after recruitment. Results: Both groups demonstrated reduced clinical severity by the end of counseling. This was particularly noticeable for depression, social anxiety, and hostility, whereby clients moved from elevated clinical to low clinical or from low clinical to nonclinical by the end of the intervention. By the 6-month follow-up, TAU clients? (n=18) anxiety had increased whereas intervention clients? (n=20) anxiety continued to decrease, and this group difference was significant (Generalized Anxiety Disorder?7: t22=3.46, P=.002). This group difference was not replicated for levels of depression: students in both groups continued to decrease their levels of depression by a similar amount at the 6-month follow-up (Physical Health Questionnaire?9: t22=1.30, P=.21). Conclusion: Supplementing face-to-face counseling with guided use of a well-being app is a feasible and acceptable treatment option for university students experiencing moderate anxiety or depression. The feasibility trial was successfully embedded into a university counseling service without denying access to treatment and with minimal disruption to the service. This study provides preliminary evidence for using a well-being app to maintain clinical improvements for anxiety following the completion of counseling. The design of the feasibility trial provides the groundwork for the development of future pilot trials and definitive trials embedded in a student counseling service. Trial registration: ISRCTN registry ISRCTN55102899; http://www.isrctn.com/ISRCTN55102899 UR - http://mhealth.jmir.org/2019/8/e14318/ UR - http://dx.doi.org/10.2196/14318 UR - http://www.ncbi.nlm.nih.gov/pubmed/31418424 ID - info:doi/10.2196/14318 ER - TY - JOUR AU - Lozano-Lozano, Mario AU - Melguizo-Rodríguez, Lucia AU - Fernández-Lao, Carolina AU - Galiano-Castillo, Noelia AU - Cantarero-Villanueva, Irene AU - Martín-Martín, Lydia AU - Arroyo-Morales, Manuel PY - 2019/08/14 TI - Association Between the Use of a Mobile Health Strategy App and Biological Changes in Breast Cancer Survivors: Prospective Pre-Post Study JO - J Med Internet Res SP - e15062 VL - 21 IS - 8 KW - mHealth KW - interleukin-6 KW - C-reactive protein KW - breast cancer survivors KW - low-grade inflammatory N2 - Background: There is a bidirectional relationship between chronic low-grade inflammation and cancer. Inflammatory markers, such as interleukin-6 (IL-6), have been associated with both the malignant transformation of epithelial cells and tumor progression, thus linking low-grade inflammation with a higher risk of cancer and recurrence in the survival phase. Therefore, they are considered valuable prognostic biomarkers. Knowing and finding appropriate primary prevention strategies to modify these parameters is a major challenge in reducing the risk of cancer recurrence and increasing survival. Different therapeutic strategies have shown efficacy in the modification of these and other biological parameters, but with contradictory results. There are apparently no strategies in which telemedicine, and specifically mobile health (mHealth), are used as a means to potentially cause biological changes. Objective: The objectives of this study were to: (1) check whether it is feasible to find changes in inflammation biomarkers through an mHealth strategy app as a delivery mechanism of an intervention to monitor energy balance; and (2) discover potential predictors of change of these markers in breast cancer survivors (BCSs). Methods: A prospective quasi-experimental pre-post study was conducted through an mHealth energy balance monitoring app with 73 BCSs, defined as stage I-IIIA of breast cancer and at least six months from the completion of the adjuvant therapy. Measurements included were biological salivary markers (IL-6 and C-reactive protein [CRP]), self-completed questionnaires (the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the user version of the Mobile Application Rating Scale [uMARS] and an ad hoc clinical and sociodemographic questionnaire) and physical objective measures (accelerometry, weight and height). In addition, using the logging data of the mHealth app, the rate of use (in days) was recorded during the entire experimental phase of the study. Using Stata software, a paired two-tailed t test, Pearson and Spearman correlations, and a stepwise multiple regression analysis were used to interpret the data. Results: Analyzing changes in inflammatory biomarker concentrations after using the mHealth app, differences between preassessment CRP (4899.04 pg/ml; SD 1085.25) and IL-6 (87.15 pg/ml; SD 33.59) and postassessment CRP (4221.24 pg/ml; SD 911.55) and IL-6 (60.53 pg/ml; SD 36.31) showed a significant decrease in both markers, with a mean difference of ?635.25 pg/ml (95% CI ?935.65 to ?334.85; P<.001) in CRP and ?26.61 pg/ml (95% CI ?42.51 to ?10.71; P=.002) in IL-6. Stepwise regression analyses revealed that changes in global quality of life, as well as uMARS score and hormonal therapy, were possible predictors of change in CRP concentration after using the mHealth app. In the same way, the type of tumor removal surgery conducted, as well as changes in weight and pain score, were possible predictors of change in IL-6 concentration after using the app. Conclusions: In conclusion, through the results of this study, we hypothesize that there is a possible association between an mHealth energy balance monitoring strategy and biological changes in BCSs. These changes could be explained by different biopsychosocial parameters, such as the use of the application itself, quality of life, pain, type of tumor removal surgery, hormonal treatment or obesity. UR - http://www.jmir.org/2019/8/e15062/ UR - http://dx.doi.org/10.2196/15062 UR - http://www.ncbi.nlm.nih.gov/pubmed/31414667 ID - info:doi/10.2196/15062 ER - TY - JOUR AU - Zhang, Yiyu AU - Liu, Chaoyuan AU - Luo, Shuoming AU - Xie, Yuting AU - Liu, Fang AU - Li, Xia AU - Zhou, Zhiguang PY - 2019/08/13 TI - Factors Influencing Patients? Intentions to Use Diabetes Management Apps Based on an Extended Unified Theory of Acceptance and Use of Technology Model: Web-Based Survey JO - J Med Internet Res SP - e15023 VL - 21 IS - 8 KW - diabetes mellitus KW - mobile applications KW - survey KW - structural equation modeling KW - China N2 - Background: Diabetes poses heavy social and economic burdens worldwide. Diabetes management apps show great potential for diabetes self-management. However, the adoption of diabetes management apps by diabetes patients is poor. The factors influencing patients? intention to use these apps are unclear. Understanding the patients? behavioral intention is necessary to support the development and promotion of diabetes app use. Objective: This study aimed to identify the determinants of patients? intention to use diabetes management apps based on an integrated theoretical model. Methods: The hypotheses of our research model were developed based on an extended Unified Theory of Acceptance and Use of Technology (UTAUT). From April 20 to May 20, 2019, adult patients with diabetes across China, who were familiar with diabetes management apps, were surveyed using the Web-based survey tool Sojump. Structural equation modeling was used to analyze the data. Results: A total of 746 participants who met the inclusion criteria completed the survey. The fitness indices suggested that the collected data fit well with the research model. The model explained 62.6% of the variance in performance expectancy and 57.1% of the variance in behavioral intention. Performance expectancy and social influence had the strongest total effects on behavioral intention (?=0.482; P=.001). Performance expectancy (?=0.482; P=.001), social influence (?=0.223; P=.003), facilitating conditions (?=0.17; P=.006), perceived disease threat (?=0.073; P=.005), and perceived privacy risk (?=?0.073; P=.012) had direct effects on behavioral intention. Additionally, social influence, effort expectancy, and facilitating conditions had indirect effects on behavioral intention that were mediated by performance expectancy. Social influence had the highest indirect effects among the three constructs (?=0.259; P=.001). Conclusions: Performance expectancy and social influence are the most important determinants of the intention to use diabetes management apps. Health care technology companies should improve the usefulness of apps and carry out research to provide clinical evidence for the apps? effectiveness, which will benefit the promotion of these apps. Facilitating conditions and perceived privacy risk also have an impact on behavioral intention. Therefore, it is necessary to improve facilitating conditions and provide solid privacy protection. Our study supports the use of UTAUT in explaining patients? intention to use diabetes management apps. Context-related determinants should also be taken into consideration. UR - http://www.jmir.org/2019/8/e15023/ UR - http://dx.doi.org/10.2196/15023 UR - http://www.ncbi.nlm.nih.gov/pubmed/31411146 ID - info:doi/10.2196/15023 ER - TY - JOUR AU - Murakami, Haruka AU - Kawakami, Ryoko AU - Nakae, Satoshi AU - Yamada, Yosuke AU - Nakata, Yoshio AU - Ohkawara, Kazunori AU - Sasai, Hiroyuki AU - Ishikawa-Takata, Kazuko AU - Tanaka, Shigeho AU - Miyachi, Motohiko PY - 2019/08/02 TI - Accuracy of 12 Wearable Devices for Estimating Physical Activity Energy Expenditure Using a Metabolic Chamber and the Doubly Labeled Water Method: Validation Study JO - JMIR Mhealth Uhealth SP - e13938 VL - 7 IS - 8 KW - physical activity KW - accelerometry KW - energy expenditure KW - indirect calorimetry KW - doubly labeled water N2 - Background: Self-monitoring using certain types of pedometers and accelerometers has been reported to be effective for promoting and maintaining physical activity (PA). However, the validity of estimating the level of PA or PA energy expenditure (PAEE) for general consumers using wearable devices has not been sufficiently established. Objective: We examined the validity of 12 wearable devices for determining PAEE during 1 standardized day in a metabolic chamber and 15 free-living days using the doubly labeled water (DLW) method. Methods: A total of 19 healthy adults aged 21 to 50 years (9 men and 10 women) participated in this study. They followed a standardized PA protocol in a metabolic chamber for an entire day while simultaneously wearing 12 wearable devices: 5 devices on the waist, 5 on the wrist, and 2 placed in the pocket. In addition, they spent their daily lives wearing 12 wearable devices under free-living conditions while being subjected to the DLW method for 15 days. The PAEE criterion was calculated by subtracting the basal metabolic rate measured by the metabolic chamber and 0.1×total energy expenditure (TEE) from TEE. The TEE was obtained by the metabolic chamber and DLW methods. The PAEE values of wearable devices were also extracted or calculated from each mobile phone app or website. The Dunnett test and Pearson and Spearman correlation coefficients were used to examine the variables estimated by wearable devices. Results: On the standardized day, the PAEE estimated using the metabolic chamber (PAEEcha) was 528.8±149.4 kcal/day. The PAEEs of all devices except the TANITA AM-160 (513.8±135.0 kcal/day; P>.05), SUZUKEN Lifecorder EX (519.3±89.3 kcal/day; P>.05), and Panasonic Actimarker (545.9±141.7 kcal/day; P>.05) were significantly different from the PAEEcha. None of the devices was correlated with PAEEcha according to both Pearson (r=?.13 to .37) and Spearman (?=?.25 to .46) correlation tests. During the 15 free-living days, the PAEE estimated by DLW (PAEEdlw) was 728.0±162.7 kcal/day. PAEE values of all devices except the Omron Active style Pro (716.2±159.0 kcal/day; P>.05) and Omron CaloriScan (707.5±172.7 kcal/day; P>.05) were significantly underestimated. Only 2 devices, the Omron Active style Pro (r=.46; P=.045) and Panasonic Actimarker (r=.48; P=.04), had significant positive correlations with PAEEdlw according to Pearson tests. In addition, 3 devices, the TANITA AM-160 (?=.50; P=.03), Omron CaloriScan (?=.48; P=.04), and Omron Active style Pro (?=.48; P=.04), could be ranked in PAEEdlw. Conclusions: Most wearable devices do not provide comparable PAEE estimates when using gold standard methods during 1 standardized day or 15 free-living days. Continuous development and evaluations of these wearable devices are needed for better estimations of PAEE. UR - https://mhealth.jmir.org/2019/8/e13938/ UR - http://dx.doi.org/10.2196/13938 UR - http://www.ncbi.nlm.nih.gov/pubmed/31376273 ID - info:doi/10.2196/13938 ER - TY - JOUR AU - Limmroth, Volker AU - Hechenbichler, Klaus AU - Müller, Christian AU - Schürks, Markus PY - 2019/07/29 TI - Assessment of Medication Adherence Using a Medical App Among Patients With Multiple Sclerosis Treated With Interferon Beta-1b: Pilot Digital Observational Study (PROmyBETAapp) JO - J Med Internet Res SP - e14373 VL - 21 IS - 7 KW - digital observational study KW - BETACONNECT KW - myBETAapp KW - interferon beta-1b KW - multiple sclerosis KW - medication adherence KW - medication compliance KW - medication persistence N2 - Background: Accurate measurement of medication adherence using classical observational studies typically depends on patient self-reporting and is often costly and slow. In contrast, digital observational studies that collect data directly from the patient may pose minimal burden to patients while facilitating accurate, timely, and cost-efficient collection of real-world data. In Germany, ~80% of patients with multiple sclerosis (MS) treated with interferon beta 1b (Betaferon) use an electronic autoinjector (BETACONNECT), which automatically records every injection. Patients may also choose to use a medical app (myBETAapp) to document injection data and their well-being (using a ?wellness tracker? feature). Objective: The goal of this pilot study was to establish a digital study process that allows the collection of medication usage data and to assess medication usage among patients with MS treated with interferon beta-1b who use myBETAapp. Methods: The PROmyBETAapp digital observational study was a mixed prospective and retrospective, noninterventional, cohort study conducted among users of myBETAapp in Germany (as of December 2017: registered accounts N=1334; actively used accounts N=522). Between September and December 2017, users received two invitations on their app asking them to participate. Interested patients were provided detailed information and completed an electronic consent process. Data from consenting patients? devices were collected retrospectively starting from the first day of usage if historical data were available in the database and collected prospectively following consent attainment. In total, 6 months of data on medication usage behavior were collected along with 3 months of wellness tracker data. Descriptive statistics were used to analyze persistence, compliance, and adherence to therapy. Results: Of the 1334 registered accounts, 96 patients (7.2%) provided informed consent to participate in the study. Of these, one patient withdrew consent later. For another patient, injection data could not be recorded during the study period. Follow-up of the remaining 94 patients ended in May 2018. The mean age of participants was 46.6 years, and 50 (53%) were female. Over the 6-month study period, persistence with myBETAapp usage was 96% (90/94), mean compliance was 94% of injections completed, and adherence (persistence and ?80% compliance) was 89% (84/94). There was no apparent difference between male and female participants and no trend across age groups. The wellness tracker was used by 21% of participants (20/94), with a mean of 3.1 entries per user. Conclusions: This study provides important information on medication usage among patients with MS treated with interferon beta-1b and on consenting behavior of patients in digital studies. In future studies, this approach may allow patients? feedback to be rapidly implemented in existing digital solutions. Trial Registration: ClinicalTrials.gov NCT03134573; https://clinicaltrials.gov/ct2/show/NCT03134573 UR - http://www.jmir.org/2019/7/e14373/ UR - http://dx.doi.org/10.2196/14373 UR - http://www.ncbi.nlm.nih.gov/pubmed/31359863 ID - info:doi/10.2196/14373 ER - TY - JOUR AU - Wu, Na AU - Gong, Enying AU - Wang, Bo AU - Gu, Wanbing AU - Ding, Nan AU - Zhang, Zhuoran AU - Chen, Mengyao AU - Yan, L. Lijing AU - Oldenburg, Brian AU - Xu, Li-Qun PY - 2019/07/19 TI - A Smart and Multifaceted Mobile Health System for Delivering Evidence-Based Secondary Prevention of Stroke in Rural China: Design, Development, and Feasibility Study JO - JMIR Mhealth Uhealth SP - e13503 VL - 7 IS - 7 KW - stroke KW - secondary prevention KW - rural health services KW - mobile application KW - software design KW - China N2 - Background: Mobile health (mHealth) technologies hold great promise in improving the delivery of high-quality health care services. Yet, there has been little research so far applying mHealth technologies in the context of delivering stroke care in resource-limited rural regions. Objective: This study aimed to introduce the design and development of an mHealth system targeting primary health care providers and to ascertain its feasibility in supporting the delivery of a System-Integrated techNology-Enabled Model of cAre (SINEMA) service for strengthening secondary prevention of stroke in rural China. Methods: The SINEMA mHealth system was designed by a multidisciplinary team comprising public health researchers, neurologists, and information and communication technology experts. The iterative co-design and development of the mHealth system involved the following 5 steps: (1) assessing the needs of relevant end users through in-depth interviews of stakeholders, (2) designing the functional modules and evidence-based care content, (3) designing and building the system and user interface, (4) improving and enhancing the system through a 3-month pilot test in 4 villages, and (5) finalizing the system and deploying it in field trial, and finally, evaluating its feasibility through a survey of the dominant user group. Results: From the in-depth interviews of 49 relevant stakeholders, we found that village doctors had limited capacity in caring for village-dwelling stroke patients in rural areas. Primary health care workers demonstrated real needs in receiving appropriate training and support from the mHealth system as well as great interests in using the mHealth technologies and tools. Using these findings, we designed a multifaceted mHealth system with 7 functional modules by following the iterative user-centered design and software development approach. The mHealth system, aimed at 3 different types of users (village doctors, town physicians, and county managers), was developed and utilized in a cluster-randomized controlled trial by 25 village doctors in a resource-limited county in rural China to manage 637 stroke patients between July 2017 and July 2018. In the end, a survey on the usability and functions of the mHealth system among village doctors (the dominant group of users, response rate=96%, 24/25) revealed that most of them were satisfied with the essential functions provided (71%) and were keen to continue using it (92%) after the study. Conclusions: The mHealth system was feasible for assisting primary health care providers in rural China in delivering the SINEMA service on the secondary prevention of stroke. Further research and initiatives in scaling up the SINEMA approach and this mHealth system to other resource-limited regions in China and beyond will likely enhance the quality and accessibility of essential secondary prevention among stroke patients. ClinicalTrial: ClinicalTrials.gov NCT03185858; https://clinicaltrials.gov/ct2/show/NCT03185858 International Registered Report Identifier (IRRID): RR2-10.1016/j.ahj.2018.08.015 UR - http://mhealth.jmir.org/2019/7/e13503/ UR - http://dx.doi.org/10.2196/13503 UR - http://www.ncbi.nlm.nih.gov/pubmed/31325288 ID - info:doi/10.2196/13503 ER - TY - JOUR AU - Zhang, Zhaotian AU - Li, Fei AU - Zhang, Haochuan AU - Miao, Zhipeng AU - Wei, Yantao AU - Wang, Li AU - Zhang, Shaochong PY - 2019/06/26 TI - Development and Testing of a Mobile Phone App for Risk Estimation of Gas Volume Expansion and Intraocular Pressure Elevation in Patients With Intravitreous Gas or Air Tamponade: Interobserver Assessment Study JO - JMIR Mhealth Uhealth SP - e14592 VL - 7 IS - 6 KW - intraocular pressure KW - mobile phone KW - vitrectomy KW - air N2 - Background: Pars plana vitrectomy (PPV) with intravitreous tamponade of gas or air has been widely used for a series of vitreoretinal diseases. It is estimated that 100,000 patients per year undergo PPV globally, and half of them were subsequently tamponaded with gas or air. According to Boyle?s law (P1V1=P2V2), patients with an intravitreous remnant of gas or air will be under high risk of intraocular pressure (IOP) elevation and subsequent vision loss owing to the expanded intravitreous gas or air when traveling post operation to a place with a significantly higher altitude. We always explain to patients why postoperative travel is potentially risky. Emergency cases of elevated IOP caused by postoperative traveling would sometimes come to surgeons. However, there have been few disease education or reference tools for both the surgeons and patients to have better communication. Objective: The aim of this study was to introduce and evaluate a mobile phone app developed by surgeons (the authors) for preliminary risk estimation of volume expansion and IOP elevation in patients with intravitreous gas or air when traveling to a place of higher altitude. Methods: The app was developed on the iOS and Android operating systems. Boyle?s law (P1V1=P2V2) was the theoretical basis of the app. Intravitreous gas or air volume and altitude values were independent factors to deduce the risk report. Consecutive patients underwent vitrectomy, and those with an intravitreous remnant of gas or air were recruited. The surgeons judged the vertical height of the fluid/gas interface through the dilated pupil; the patients were instructed to judge it according to their visual field when looking straight ahead and line it out on a chart included in the app. Finally, all the patients were required to fill a Likert scale?based questionnaire with 2 main items to evaluate the participants? user experience and attitudes toward the app. Results: A total of 50 patients were included (30 males and 20 females). All patients could independently operate the app to complete the test. The median heights of the fluid/gas interface independently judged by the surgeon and patients were 40% (range: 10%-75%) and 41% (range: 9%-78%), respectively (P=.63). The median altitude of the participants? destinations was 150.0 m (range: 0-3490 m). The Bland-Altman analysis revealed a good agreement between the surgeons? and patients? judgments (bias of ?0.3%), with 95% limits of agreement of ?5.8% to 5.3%. Overall, the Likert scale revealed a positive attitude from the patients toward the app. Conclusions: The app is reliable for patients to have preliminary risk estimation of intravitreous gas or air volume expansion and IOP elevation if travel to a place of higher altitude is planned. The surgeons could also use it as a platform for better disease communication. UR - http://mhealth.jmir.org/2019/6/e14592/ UR - http://dx.doi.org/10.2196/14592 UR - http://www.ncbi.nlm.nih.gov/pubmed/31244482 ID - info:doi/10.2196/14592 ER - TY - JOUR AU - Pérez-Jover, Virtudes AU - Sala-González, Marina AU - Guilabert, Mercedes AU - Mira, Joaquín José PY - 2019/06/18 TI - Mobile Apps for Increasing Treatment Adherence: Systematic Review JO - J Med Internet Res SP - e12505 VL - 21 IS - 6 KW - mobile health KW - medication alert systems KW - medication adherence N2 - Background: It is estimated that 20% to 50% of patients do not take their medication correctly, and this leads to increased morbidity and inefficacy of therapeutic approaches. Fostering treatment adherence is a priority objective for all health systems. The growth of mobile apps to facilitate therapeutic adherence has significantly increased in recent years. However, the effectiveness of the apps for this purpose has not been evaluated. Objective: This study aimed to analyze whether mobile apps are perceived as useful for managing medication at home and if they actually contribute to increasing treatment adherence in patients. Methods: We carried out a systematic review of research published using Scopus, Cochrane Library, ProQuest, and MEDLINE databases and analyzed the information about their contribution to increasing therapeutic adherence and the perceived usefulness of mobile apps. This review examined studies published between 2000 and 2017. Results: Overall, 11 studies fulfilled the inclusion criteria. The sample sizes of these studies varied between 16 and 99 participants. In addition, 7 studies confirmed that the mobile app increased treatment adherence. In 5 of them, the before and after adherence measures suggested significant statistical improvements, when comparing self-reported adherence and missed dose with a percentage increase ranging between 7% and 40%. The users found mobile apps easy to use and useful for managing their medication. The patients were mostly satisfied with their use, with an average score of 8.1 out of 10. Conclusions: The use of mobile apps helps increase treatment adherence, and they are an appropriate method for managing medication at home. UR - http://www.jmir.org/2019/6/e12505/ UR - http://dx.doi.org/10.2196/12505 UR - http://www.ncbi.nlm.nih.gov/pubmed/31215517 ID - info:doi/10.2196/12505 ER - TY - JOUR AU - Brandt, R. Lena AU - Hidalgo, Liliana AU - Diez-Canseco, Francisco AU - Araya, Ricardo AU - Mohr, C. David AU - Menezes, R. Paulo AU - Miranda, Jaime J. PY - 2019/06/18 TI - Addressing Depression Comorbid With Diabetes or Hypertension in Resource-Poor Settings: A Qualitative Study About User Perception of a Nurse-Supported Smartphone App in Peru JO - JMIR Ment Health SP - e11701 VL - 6 IS - 6 KW - mental health KW - depression KW - noncommunicable diseases KW - mHealth KW - smartphone KW - developing countries N2 - Background: Smartphone apps could constitute a cost-effective strategy to overcome health care system access barriers to mental health services for people in low- and middle-income countries. Objective: The aim of this paper was to explore the patients? perspectives of CONEMO (Emotional Control, in Spanish: Control Emocional), a technology-driven, psychoeducational, and nurse-supported intervention delivered via a smartphone app aimed at reducing depressive symptoms in people with diabetes, hypertension or both who attend public health care centers, as well as the nurses? feedback about their role and its feasibility to be scaled up. Methods: This study combines data from 2 pilot studies performed in Lima, Peru, between 2015 and 2016, to test the feasibility of CONEMO. Interviews were conducted with 29 patients with diabetes, hypertension or both with comorbid depressive symptoms who used CONEMO and 6 staff nurses who accompanied the intervention. Using a content analysis approach, interview notes from patient interviews were transferred to a digital format, coded, and categorized into 6 main domains: the perceived health benefit, usability, adherence, user satisfaction with the app, nurse?s support, and suggestions to improve the intervention. Interviews with nurses were analyzed by the same approach and categorized into 4 domains: general feedback, evaluation of training, evaluation of study activities, and feasibility of implementing this intervention within the existing structures of health system. Results: Patients perceived improvement in their emotional health because of CONEMO, whereas some also reported better physical health. Many encountered some difficulties with using CONEMO, but resolved them with time and practice. However, the interactive elements of the app, such as short message service, android notifications, and pop-up messages were mostly perceived as challenging. Satisfaction with CONEMO was high, as was the self-reported adherence. Overall, patients evaluated the nurse accompaniment positively, but they suggested improvements in the technological training and an increase in the amount of contact. Nurses reported some difficulties in completing their tasks and explained that the CONEMO intervention activities competed with their everyday work routine. Conclusions: Using a nurse-supported smartphone app to reduce depressive symptoms among people with chronic diseases is possible and mostly perceived beneficial by the patients, but it requires context-specific adaptations regarding the implementation of a task shifting approach within the public health care system. These results provide valuable information about user feedback for those building mobile health interventions for depression. UR - https://mental.jmir.org/2019/6/e11701/ UR - http://dx.doi.org/10.2196/11701 UR - http://www.ncbi.nlm.nih.gov/pubmed/31215511 ID - info:doi/10.2196/11701 ER - TY - JOUR AU - Balakrishnan, S. Ashwin AU - Nguyen, G. Hao AU - Shinohara, Katsuto AU - Au Yeung, Reuben AU - Carroll, R. Peter AU - Odisho, Y. Anobel PY - 2019/6/2 TI - A Mobile Health Intervention for Prostate Biopsy Patients Reduces Appointment Cancellations: Cohort Study JO - J Med Internet Res SP - e14094 VL - 21 IS - 6 KW - text messaging KW - appointments and schedules KW - mHealth KW - quality improvement KW - urology KW - prostate neoplasm N2 - Background: Inadequate patient education and preparation for office-based procedures often leads to delayed care, poor patient satisfaction, and increased costs to the health care system. We developed and deployed a mobile health (mHealth) reminder and education program for patients scheduled for transrectal prostate biopsy. Objective: We aimed to evaluate the impact of an mHealth reminder and education program on appointment cancellation rates, communication frequency, and patient satisfaction. Methods: We developed a text message (SMS, short message service)?based program with seven reminders containing links to Web-based content and surveys sent over an 18-day period (14 days before through 3 days after prostate biopsy). Messages contained educational content, reminders, and readiness questionnaires. Demographic information, appointment cancellations or change data, and patient/provider communication events were collected for 6 months before and after launching the intervention. Patient satisfaction was evaluated in the postintervention cohort. Results: The preintervention (n=473) and postintervention (n=359) cohorts were composed of men of similar median age and racial/ethnic distribution living a similar distance from clinic. The postintervention cohort had significantly fewer canceled or rescheduled appointments (33.8% vs 21.2%, P<.001) and fewer same-day cancellations (3.8% vs 0.5%, P<.001). There was a significant increase in preprocedural telephone calls (0.6 vs 0.8 calls per patient, P=.02) in the postintervention cohort, but not a detectable change in postprocedural calls. The mean satisfaction with the program was 4.5 out of 5 (SD 0.9). Conclusions: An mHealth periprocedural outreach program significantly lowered appointment cancellation and rescheduling and was associated with high patient satisfaction scores with a slight increase in preprocedural telephone calls. This led to fewer underused procedure appointments and high patient satisfaction. UR - https://www.jmir.org/2019/6/e14094/ UR - http://dx.doi.org/10.2196/14094 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199294 ID - info:doi/10.2196/14094 ER - TY - JOUR AU - Gill, Roopan AU - Ogilvie, Gina AU - Norman, V. Wendy AU - Fitzsimmons, Brian AU - Maher, Ciana AU - Renner, Regina PY - 2019/05/29 TI - Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care in British Columbia: Phase I JO - J Med Internet Res SP - e13387 VL - 21 IS - 5 KW - mHealth KW - family planning KW - abortion, induced KW - sexual health KW - digital health KW - user-centered design N2 - Background: Over 30% of women in Canada undergo an abortion. Despite the prevalence of the procedure, stigma surrounding abortion in Canada leads to barriers for women to access this service. The vast majority of care is concentrated in urban settings. There is evidence to support utilization of innovative mobile and other technology solutions to empower women to safely and effectively self-manage aspects of the abortion process. This study is part 1 of a 3-phase study that utilizes user-centered design methodology to develop a digital health solution to specifically support follow-up after an induced surgical abortion. Objective: This study aimed to (1) understand how women at 3 surgical abortion clinics in an urban center of British Columbia utilize their mobile phones to access health care information and (2) understand women?s preferences of content and design of an intervention that will support follow-up care after an induced abortion, including contraceptive use. Methods: The study design was based on development-evaluation-implementation process from Medical Research Council Framework for Complex Medical Interventions. This was a mixed-methods formative study. Women (aged 14-45 years) were recruited from 3 urban abortion facilities in British Columbia who underwent an induced abortion. Adaptation of validated surveys and using the technology acceptance model and theory of reasoned action, a cross-sectional survey was designed. Interview topics included demographic information; type of wireless device used; cell phone usage; acceptable information to include in a mobile intervention to support women?s abortion care; willingness to use a mobile phone to obtain reproductive health information; optimal strategies to use a mobile intervention to support women; understand preferences for health information resources; and design qualities in a mobile intervention important for ease of use, privacy, and security. Responses to questions in the survey were summarized using descriptive statistics. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the local ethics board. Results: A waiting-room survey was completed by 50 participants, and semistructured interviews were completed with 8 participants. The average age of participants was 26 years. Furthermore, 94% (47/50) owned a smartphone, 85% (41/48) used their personal phones to go online, and 85% would use their cell phone to assist in clinical care. Qualitative analysis demonstrated that women prefer a comprehensive website that included secure email or text notifications to provide tools and resources for emotional well-being, contraceptive decision making, general sexual health, and postprocedure care. Conclusions: A community-based mixed-methods approach allowed us to understand how women use their cell phones and what women desire in a mobile intervention to support their postabortion care. The findings from this formative phase will assist in the development and testing of a mobile intervention to support follow-up care after an induced surgical abortion. UR - http://www.jmir.org/2019/5/e13387/ UR - http://dx.doi.org/10.2196/13387 UR - http://www.ncbi.nlm.nih.gov/pubmed/31144668 ID - info:doi/10.2196/13387 ER - TY - JOUR AU - Alessa, Tourkiah AU - Hawley, S. Mark AU - Hock, S. Emma AU - de Witte, Luc PY - 2019/05/28 TI - Smartphone Apps to Support Self-Management of Hypertension: Review and Content Analysis JO - JMIR Mhealth Uhealth SP - e13645 VL - 7 IS - 5 KW - smartphone apps KW - mobile apps KW - self-management KW - hypertension KW - blood pressure KW - mobile applications N2 - Background: Hypertension is a widespread chronic disease, and its effective treatment requires self-management by patients. Health-related apps provide an effective way of supporting hypertension self-management. However, the increasing range and variety of hypertension apps available on the market, owing to the global growth in apps, creates the need for patients and health care professionals to be informed about the effectiveness of these apps and the levels of privacy and security that they provide. Objective: This study aimed to describe and assess all available apps supporting hypertension self-management in the most popular app stores and investigate their functionalities. Methods: In January 2018, the UK Apple and Google Play stores were scanned for all free and paid apps supporting hypertension self-management. Apps were included if they were in English, had functionality supporting hypertension self-management, and targeted adult users with hypertension. The included apps were downloaded and their functionalities were investigated. Behavior change techniques (BCTs) linked with the theoretical domain framework (TDF) underpinning potentially effective apps were independently coded by two reviewers. The data privacy and security of the apps were also independently assessed. Results: A total of 186 hypertension apps that met the inclusion criteria were included in this review. The majority of these apps had only one functionality (n=108), while the remainder offered different combinations of functionalities. A small number of apps had comprehensive functionalities (n=30) that are likely to be more effective in supporting hypertension self-management. Most apps lacked a clear theoretical basis, and 24 BCTs identified in these 30 apps were mapped to 10 TDF mechanisms of actions. On an average, 18.4 BCTs were mapped to 6 TDF mechanisms of actions that may support hypertension self-management behaviors. There was a concerning absence of evidence related to the effectiveness and usability of all 186 apps, and involvement of health care professionals in the app development process was minimal. Most apps did not meet the current standards of data security and privacy. Conclusions: Despite the widespread accessibility and availability of smartphone apps with a range of combinations of functionalities that can support the self-management of hypertension, only a small number of apps are likely to be effective. Many apps lack security measures as well as a clear theoretical basis and do not provide any evidence concerning their effectiveness and usability. This raises a serious issue, as health professionals and those with hypertension have insufficient information to make decisions on which apps are safe and effective. UR - http://mhealth.jmir.org/2019/5/e13645/ UR - http://dx.doi.org/10.2196/13645 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140434 ID - info:doi/10.2196/13645 ER - TY - JOUR AU - Romanzini, Possamai Catiana Leila AU - Romanzini, Marcelo AU - Batista, Biagi Mariana AU - Barbosa, Lopes Cynthia Correa AU - Shigaki, Blasquez Gabriela AU - Dunton, Genevieve AU - Mason, Tyler AU - Ronque, Vaz Enio Ricardo PY - 2019/05/15 TI - Methodology Used in Ecological Momentary Assessment Studies About Sedentary Behavior in Children, Adolescents, and Adults: Systematic Review Using the Checklist for Reporting Ecological Momentary Assessment Studies JO - J Med Internet Res SP - e11967 VL - 21 IS - 5 KW - physical activity KW - accelerometry KW - health behavior N2 - Background: The use of ecological momentary assessment (EMA) to measure sedentary behavior (SB) in children, adolescents, and adults can increase the understanding of the role of the context of SB in health outcomes. Objective: The aim of this study was to systematically review literature to describe EMA methodology used in studies on SB in youth and adults, verify how many studies adhere to the Methods aspect of the Checklist for Reporting EMA Studies (CREMAS), and detail measures used to assess SB and this associated context. Methods: A systematic literature review was conducted in the PubMed, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SPORTDiscus databases, covering the entire period of existence of the databases until January 2018. Results: This review presented information about the characteristics and methodology used in 21 articles that utilized EMA to measure SB in youth and adults. There were more studies conducted among youth compared with adults, and studies of youth included more waves and more participants (n=696) than studies with adults (n=97). Most studies (85.7%) adhered to the Methods aspect of the CREMAS. The main criteria used to measure SB in EMA were self-report (81%) with only 19% measuring SB using objective methods (eg, accelerometer). The main equipment to collect objective SB was the ActiGraph, and the cutoff point to define SB was <100 counts/min. Studies most commonly used a 15-min window to compare EMA and accelerometer data. Conclusions: The majority of studies in this review met minimum CREMAS criteria for studies conducted with EMA. Most studies measured SB with EMA self-report (n=17; 81.0%), and a few studies also used objective methods (n=4; 19%). The standardization of the 15-min window criteria to compare EMA and accelerometer data would lead to a comparison between these and new studies. New studies using EMA with mobile phones should be conducted as they can be considered an attractive method for capturing information about the specific context of SB activities of young people and adults in real time or very close to it. UR - https://www.jmir.org/2019/5/e11967/ UR - http://dx.doi.org/10.2196/11967 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094349 ID - info:doi/10.2196/11967 ER - TY - JOUR AU - Lunde, Pernille AU - Nilsson, Blakstad Birgitta AU - Bergland, Astrid AU - Bye, Asta PY - 2019/4/19 TI - Feasibility of a Mobile Phone App to Promote Adherence to a Heart-Healthy Lifestyle: Single-Arm Study JO - JMIR Form Res SP - e12679 VL - 3 IS - 2 KW - mHealth KW - eHealth KW - mobile phone app KW - cardiac rehabilitation N2 - Background: Long-term maintenance of preventive activities is fundamental for achieving improved outcomes in cardiac rehabilitation (CR). Despite this, it has been shown to be a major challenge for many patients to follow recommendations and thereby adhere to a heart-healthy lifestyle. Mobile phone apps have been emphasized as potential tools to promote preventive activities after attendance in a CR program. Before commencing a trial to assess the potential effect of using an app to promote long-term adherence to preventive activities after attendance in CR, a study to assess if it is feasible to use an app is warranted. Objective: The goal of the research is to assess if it is feasible to use a mobile phone app for promoting and monitoring patients? adherence to a heart-healthy lifestyle after CR. Methods: The study included an experimental, pre-post single-arm trial lasting for 12 weeks. All patients received access to an app aimed to guide individuals to change or maintain a heart-healthy lifestyle. During the study period, patients received weekly, individualized monitoring through the app, based on their own goals. Feasibility outcomes assessed were recruitment rate, adherence to the app, resource requirements, and efficacy regarding capability to detect a change in quality of life, health status, and perceived goal achievement as well as evaluating ceiling and floor effect in these outcomes. Criteria for success were preset to be able to evaluate whether the app was feasible to use in a potential future RCT. Results: In total, 71% (17/24) of the patients who completed CR were eligible for a potential RCT as well as for this study. All 14 patients included in the study used the app to promote preventive activities throughout the study. Satisfaction with the technology was high, and the patients found the technology-based follow-up intervention both useful and motivational. Ceiling effect was present in more than 20% of the patients in several domains of the questionnaires evaluating quality of life (36-Item Short Form Health Survey and COOP/WONCA functional health assessments) and health status (EQ-5D). Overall self-rated health status (EuroQol Visual Analog Scale) and perceived goal achievement were found to be outcomes able to detect a change. Conclusions: Individual follow-up through an app after attendance in CR is feasible. All patients used the app for preventive activities and found the app both useful and motivating. Several points of guidance from the patients in the study have been adopted and incorporated into the final design of the RCT now in the field. UR - http://formative.jmir.org/2019/2/e12679/ UR - http://dx.doi.org/10.2196/12679 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066684 ID - info:doi/10.2196/12679 ER - TY - JOUR AU - Ozella, Laura AU - Gauvin, Laetitia AU - Carenzo, Luca AU - Quaggiotto, Marco AU - Ingrassia, Luigi Pier AU - Tizzoni, Michele AU - Panisson, André AU - Colombo, Davide AU - Sapienza, Anna AU - Kalimeri, Kyriaki AU - Della Corte, Francesco AU - Cattuto, Ciro PY - 2019/04/26 TI - Wearable Proximity Sensors for Monitoring a Mass Casualty Incident Exercise: Feasibility Study JO - J Med Internet Res SP - e12251 VL - 21 IS - 4 KW - contact patterns KW - contact networks KW - wearable proximity sensors KW - mass casualty incident KW - simulation KW - medical staff ? patient interaction KW - patients? flow N2 - Background: Over the past several decades, naturally occurring and man-made mass casualty incidents (MCIs) have increased in frequency and number worldwide. To test the impact of such events on medical resources, simulations can provide a safe, controlled setting while replicating the chaotic environment typical of an actual disaster. A standardized method to collect and analyze data from mass casualty exercises is needed to assess preparedness and performance of the health care staff involved. Objective: In this study, we aimed to assess the feasibility of using wearable proximity sensors to measure proximity events during an MCI simulation. In the first instance, our objective was to demonstrate how proximity sensors can collect spatial and temporal information about the interactions between medical staff and patients during an MCI exercise in a quasi-autonomous way. In addition, we assessed how the deployment of this technology could help improve future simulations by analyzing the flow of patients in the hospital. Methods: Data were obtained and collected through the deployment of wearable proximity sensors during an MCI functional exercise. The scenario included 2 areas: the accident site and the Advanced Medical Post, and the exercise lasted 3 hours. A total of 238 participants were involved in the exercise and classified in categories according to their role: 14 medical doctors, 16 nurses, 134 victims, 47 Emergency Medical Services staff members, and 27 health care assistants and other hospital support staff. Each victim was assigned a score related to the severity of his/her injury. Each participant wore a proximity sensor, and in addition, 30 fixed devices were placed in the field hospital. Results: The contact networks show a heterogeneous distribution of the cumulative time spent in proximity by the participants. We obtained contact matrices based on the cumulative time spent in proximity between the victims and rescuers. Our results showed that the time spent in proximity by the health care teams with the victims is related to the severity of the patient?s injury. The analysis of patients? flow showed that the presence of patients in the rooms of the hospital is consistent with the triage code and diagnosis, and no obvious bottlenecks were found. Conclusions: Our study shows the feasibility of the use of wearable sensors for tracking close contacts among individuals during an MCI simulation. It represents, to our knowledge, the first example of unsupervised data collection?ie, without the need for the involvement of observers, which could compromise the realism of the exercise?of face-to-face contacts during an MCI exercise. Moreover, by permitting detailed data collection about the simulation, such as data related to the flow of patients in the hospital, such deployment provides highly relevant input for the improvement of MCI resource allocation and management. UR - http://www.jmir.org/2019/4/e12251/ UR - http://dx.doi.org/10.2196/12251 UR - http://www.ncbi.nlm.nih.gov/pubmed/31025944 ID - info:doi/10.2196/12251 ER - TY - JOUR AU - Menezes, Paulo AU - Quayle, Julieta AU - Garcia Claro, Heloísa AU - da Silva, Simone AU - Brandt, R. Lena AU - Diez-Canseco, Francisco AU - Miranda, Jaime J. AU - Price, N. LeShawndra AU - Mohr, C. David AU - Araya, Ricardo PY - 2019/04/26 TI - Use of a Mobile Phone App to Treat Depression Comorbid With Hypertension or Diabetes: A Pilot Study in Brazil and Peru JO - JMIR Ment Health SP - e11698 VL - 6 IS - 4 KW - depression KW - mHealth KW - pilot study KW - feasibility study KW - PHQ-9 N2 - Background: Depression is underdiagnosed and undertreated in primary health care. When associated with chronic physical disorders, it worsens outcomes. There is a clear gap in the treatment of depression in low- and middle-income countries (LMICs), where specialists and funds are scarce. Interventions supported by mobile health (mHealth) technologies may help to reduce this gap. Mobile phones are widely used in LMICs, offering potentially feasible and affordable alternatives for the management of depression among individuals with chronic disorders. Objective: This study aimed to explore the potential effectiveness of an mHealth intervention to help people with depressive symptoms and comorbid hypertension or diabetes and explore the feasibility of conducting large randomized controlled trials (RCTs). Methods: Emotional Control (CONEMO) is a low-intensity psychoeducational 6-week intervention delivered via mobile phones and assisted by a nurse for reducing depressive symptoms among individuals with diabetes or hypertension. CONEMO was tested in 3 pilot studies, 1 in São Paulo, Brazil, and 2 in Lima, Peru. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at enrollment and at 6-week follow-up. Results: The 3 pilot studies included a total of 66 people. Most participants were females aged between 41 and 60 years. There was a reduction in depressive symptoms as measured by PHQ-9 in all pilot studies. In total, 58% (38/66) of the participants reached treatment success rate (PHQ-9 <10), with 62% (13/21) from São Paulo, 62% (13/21) from the first Lima pilot, and 50% (12/24) from the second Lima pilot study. The intervention, the app, and the support offered by the nurse and nurse assistants were well received by participants in both settings. Conclusions: The intervention was feasible in both settings. Clinical data suggested that CONEMO may help in decreasing participants? depressive symptoms. The findings also indicated that it was possible to conduct RCTs in these settings. UR - http://mental.jmir.org/2019/4/e11698/ UR - http://dx.doi.org/10.2196/11698 UR - http://www.ncbi.nlm.nih.gov/pubmed/31025949 ID - info:doi/10.2196/11698 ER - TY - JOUR AU - Ahn, Hyun Sang AU - Zhiang, Jooho AU - Kim, Hyery AU - Chang, Seyun AU - Shin, Jaewon AU - Kim, Myeongchan AU - Lee, Yura AU - Lee, Jae-Ho AU - Park, Rang Yu PY - 2019/04/22 TI - Postvaccination Fever Response Rates in Children Derived Using the Fever Coach Mobile App: A Retrospective Observational Study JO - JMIR Mhealth Uhealth SP - e12223 VL - 7 IS - 4 KW - patient-generated health data KW - vaccination KW - postvaccination fever KW - digital health care KW - mobile app N2 - Background: Postvaccination fever is a mild adverse event that naturally improves without complications, but is highly prevalent and can be accompanied by febrile convulsions in some cases. These adverse effects may cause parents to delay or avoid vaccinating their children. Objective: This study aimed to identify postvaccination fever patterns and the ability of antipyretics to affect changes in these patterns from data collected from a mobile app named Fever Coach. Methods: Data provided by parents of feverish children derived from a mobile app, Fever Coach, were used to identify postvaccination fever patterns according to vaccinations and the use of antipyretic drugs. We selected single vaccination records that contained five or more body temperature readings performed within 48 hours of vaccination, and we analyzed postvaccination fever onset, offset, duration, and maximum body temperature. Through observing the postvaccination fever response to vaccination, we identified the effects of antipyretic drugs on postvaccination fever onset, offset, and duration times; the extent of fever; and the rate of decline. We also performed logistic regression analysis to determine demographic variables (age, weight, and sex) involved in relatively high fevers (body temperature ?39°C). Results: The total number of Fever Coach users was 25,037, with 3834 users having entered single vaccination records, including 4448 vaccinations and 55,783 body temperature records. Most records were obtained from children receiving the following vaccinations: pneumococcus (n=2069); Japanese encephalitis (n=911); influenza (n=669); diphtheria, tetanus, and pertussis (n=403); and hepatitis A (n=252). According to the 4448 vaccination records, 3427 (77.05%) children had taken antipyretic drugs, and 3238 (89.15%) children took antibiotics at body temperatures above 38°C. The number of children taking antipyretics at a body temperature of 38°C was more than four times that of those taking antipyretics at 37.9°C (307 vs 67 cases). The number of instances in which this temperature threshold was reached was more than four times greater than the number when the temperature was 37.9°C. A comparative analysis of antipyretic and nonantipyretic cases showed there was no difference in onset time; however, offset and duration times were significantly shorter in nonantipyretic cases than in antipyretic cases (P<.001). In nonantipyretic cases, offset times and duration times were 9.9 and 10.1 hours shorter, respectively, than in antipyretic cases. Body temperatures also decreased faster in nonantipyretic cases. Influenza vaccine-associated fevers lasted relatively longer, whereas pneumococcus vaccine-associated fevers were relatively short-lived. Conclusions: These findings suggest that postvaccination fever has its own fever pattern, which is dependent on vaccine type and the presence of antipyretic drugs, and that postvaccination temperature monitoring may ease fever phobia and reduce the unnecessary use of antipyretics in medical care. UR - http://mhealth.jmir.org/2019/4/e12223/ UR - http://dx.doi.org/10.2196/12223 UR - http://www.ncbi.nlm.nih.gov/pubmed/31008712 ID - info:doi/10.2196/12223 ER - TY - JOUR AU - Goodale, Mae Brianna AU - Shilaih, Mohaned AU - Falco, Lisa AU - Dammeier, Franziska AU - Hamvas, Györgyi AU - Leeners, Brigitte PY - 2019/04/18 TI - Wearable Sensors Reveal Menses-Driven Changes in Physiology and Enable Prediction of the Fertile Window: Observational Study JO - J Med Internet Res SP - e13404 VL - 21 IS - 4 KW - algorithms KW - fertility/physiology KW - heart rate KW - machine learning KW - menstrual cycle KW - ovulation detection/methods KW - respiratory rate KW - perfusion KW - skin temperature KW - wearable electronic devices N2 - Background: Previous research examining physiological changes across the menstrual cycle has considered biological responses to shifting hormones in isolation. Clinical studies, for example, have shown that women?s nightly basal body temperature increases from 0.28 to 0.56 ?C following postovulation progesterone production. Women?s resting pulse rate, respiratory rate, and heart rate variability (HRV) are similarly elevated in the luteal phase, whereas skin perfusion decreases significantly following the fertile window?s closing. Past research probed only 1 or 2 of these physiological features in a given study, requiring participants to come to a laboratory or hospital clinic multiple times throughout their cycle. Although initially designed for recreational purposes, wearable technology could enable more ambulatory studies of physiological changes across the menstrual cycle. Early research suggests that wearables can detect phase-based shifts in pulse rate and wrist skin temperature (WST). To date, previous work has studied these features separately, with the ability of wearables to accurately pinpoint the fertile window using multiple physiological parameters simultaneously yet unknown. Objective: In this study, we probed what phase-based differences a wearable bracelet could detect in users? WST, heart rate, HRV, respiratory rate, and skin perfusion. Drawing on insight from artificial intelligence and machine learning, we then sought to develop an algorithm that could identify the fertile window in real time. Methods: We conducted a prospective longitudinal study, recruiting 237 conception-seeking Swiss women. Participants wore the Ava bracelet (Ava AG) nightly while sleeping for up to a year or until they became pregnant. In addition to syncing the device to the corresponding smartphone app daily, women also completed an electronic diary about their activities in the past 24 hours. Finally, women took a urinary luteinizing hormone test at several points in a given cycle to determine the close of the fertile window. We assessed phase-based changes in physiological parameters using cross-classified mixed-effects models with random intercepts and random slopes. We then trained a machine learning algorithm to recognize the fertile window. Results: We have demonstrated that wearable technology can detect significant, concurrent phase-based shifts in WST, heart rate, and respiratory rate (all P<.001). HRV and skin perfusion similarly varied across the menstrual cycle (all P<.05), although these effects only trended toward significance following a Bonferroni correction to maintain a family-wise alpha level. Our findings were robust to daily, individual, and cycle-level covariates. Furthermore, we developed a machine learning algorithm that can detect the fertile window with 90% accuracy (95% CI 0.89 to 0.92). Conclusions: Our contributions highlight the impact of artificial intelligence and machine learning?s integration into health care. By monitoring numerous physiological parameters simultaneously, wearable technology uniquely improves upon retrospective methods for fertility awareness and enables the first real-time predictive model of ovulation. UR - http://www.jmir.org/2019/4/e13404/ UR - http://dx.doi.org/10.2196/13404 UR - http://www.ncbi.nlm.nih.gov/pubmed/30998226 ID - info:doi/10.2196/13404 ER - TY - JOUR AU - Bendtsen, Marcus AU - McCambridge, Jim PY - 2019/04/18 TI - Reducing Alcohol Consumption Among Risky Drinkers in the General Population of Sweden Using an Interactive Mobile Health Intervention: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e13119 VL - 8 IS - 4 KW - telemedicine KW - alcohol drinking KW - randomized controlled trial N2 - Background: Harmful use of alcohol continues to be a leading contributor to premature deaths globally. Not only does harmful drinking have consequences for the individuals consuming at increased levels, but it may also result in a range of negative consequences for their family members and friends. Interventions delivered via mobile phones (mobile health [mHealth] interventions) could potentially support risky drinkers seeking help to reduce their alcohol consumption. Objective: This protocol describes a randomized controlled trial that aims to validly estimate the effect of a novel mHealth intervention targeting risky drinkers in the general population of Sweden. Nested within the trial are 3 substudies that focus on methodological and user satisfaction research questions. Methods: A 2-arm parallel group randomized controlled trial will be employed to estimate the effect of the novel intervention. Participants will be recruited through Web advertisements and social media. The inclusion criteria are as follows: 18 years or older, ownership of a mobile phone, and being classified as a risky drinker according to Swedish guidelines. Participants allocated to the intervention group will receive a novel mHealth intervention. The intervention consists of weekly screening, personalized feedback on current consumption, functions allowing for planning of future consumption, as well as a series of messages delivered throughout the week. Participants allocated to the control group will receive a short message regarding negative consequences of alcohol consumption and a hyperlink that offers more information. Following 2 and 4 months after randomization, both groups will be asked to complete follow-up questionnaires (2-month interval being primary). Primary outcomes are weekly alcohol consumption and heavy episodic drinking. Participants in the control group will be given access to the novel intervention after completing the 4-month follow-up. The trial includes 3 substudies: We will explore whether the mode of presenting information before participants giving informed consent affects participation rates and recall of trial parameters, investigate if the content of the short message received by the control group affects study outcomes and requests for more information, and explore user satisfaction with the intervention and reactions of the control group. Results: Participant recruitment is planned to begin in April 2019 and to last for a maximum of 24 months. The first dataset will be available approximately 2 months after the final participant has been recruited, and the final dataset will be available approximately 2 months later. No participants had been recruited at the time of submitting this protocol. Conclusions: If found effective, the intervention has the potential to reduce negative consequences of alcohol consumption for individuals. The technology has been designed to have potential for extensive reach among those who may benefit. Trial Registration: ISRCTN Registry ISRCTN48317451; http://www.isrctn.com/ISRCTN48317451 (Archived by WebCite at http://www.webcitation.org/779tKLsu3) International Registered Report Identifier (IRRID): PRR1-10.2196/13119 UR - http://www.researchprotocols.org/2019/4/e13119/ UR - http://dx.doi.org/10.2196/13119 UR - http://www.ncbi.nlm.nih.gov/pubmed/30998221 ID - info:doi/10.2196/13119 ER - TY - JOUR AU - Munzer, William Brendan AU - Khan, Mairaj Mohammad AU - Shipman, Barbara AU - Mahajan, Prashant PY - 2019/04/17 TI - Augmented Reality in Emergency Medicine: A Scoping Review JO - J Med Internet Res SP - e12368 VL - 21 IS - 4 KW - augmented reality KW - emergency medicine KW - education KW - telemedicine N2 - Background: Augmented reality is increasingly being investigated for its applications to medical specialties as well as in medical training. Currently, there is little information about its applicability to training and care delivery in the context of emergency medicine. Objective: The objective of this article is to review current literature related to augmented reality applicable to emergency medicine and its training. Methods: Through a scoping review utilizing Scopus, MEDLINE, and Embase databases for article searches, we identified articles involving augmented reality that directly involved emergency medicine or was in an area of education or clinical care that could be potentially applied to emergency medicine. Results: A total of 24 articles were reviewed in detail and were categorized into three groups: user-environment interface, telemedicine and prehospital care, and education and training. Conclusions: Through analysis of the current literature across fields, we were able to demonstrate that augmented reality has utility and feasibility in clinical care delivery in patient care settings, in operating rooms and inpatient settings, and in education and training of emergency care providers. Additionally, we found that the use of augmented reality for care delivery over distances is feasible, suggesting a role in telehealth. Our results from the review of the literature in emergency medicine and other specialties reveal that further research into the uses of augmented reality will have a substantial role in changing how emergency medicine as a specialty will deliver care and provide education and training. UR - http://www.jmir.org/2019/4/e12368/ UR - http://dx.doi.org/10.2196/12368 UR - http://www.ncbi.nlm.nih.gov/pubmed/30994463 ID - info:doi/10.2196/12368 ER - TY - JOUR AU - Wetterholm, Madeleine AU - Bonn, Erika Stephanie AU - Alexandrou, Christina AU - Löf, Marie AU - Trolle Lagerros, Ylva PY - 2019/04/17 TI - Validation of Two Automatic Blood Pressure Monitors With the Ability to Transfer Data via Bluetooth JO - J Med Internet Res SP - e12772 VL - 21 IS - 4 KW - blood pressure monitors KW - diabetes mellitus, type 2 KW - hypertension KW - methods KW - mHealth KW - self-care KW - self-management N2 - Background: Patients with chronic diseases are in need of regular health controls. Diabetes mellitus type 2 is currently the most prevalent chronic metabolic disease. A majority of diabetic patients have at least one comorbid chronic disease, where hypertension is the most common. The standard for blood pressure (BP) measurement is manual BP monitoring at health care clinics. Nevertheless, several advantages of self-measured BP have been documented. With BP data transfer from an automatic BP monitor via Bluetooth to software, for example, a smartphone app, home measurement could effectively be integrated into regular care. Objective: The aim of this study was to validate two commercially available automatic BP monitors with the ability to transfer BP data via Bluetooth (Beurer BM 85 and Andersson Lifesense BDR 2.0), against manual BP monitoring in patients with type 2 diabetes. Methods: A total of 181 participants with type 2 diabetes were recruited from 6 primary care centers in Stockholm, Sweden. BP was first measured using a manual BP monitor and then measured using the two automatic BP monitors. The mean differences between the automatic and manual measurements were calculated by subtracting the manual BP monitor measurement from the automatic monitor measurement. Validity of the two automatic BP monitors was further assessed using Spearman rank correlation coefficients and the Bland-Altman method. Results: In total, 180 participants, 119 men and 61 women, were included. The mean age was 60.1 (SD 11.4) years and the mean body mass index was 30.4 (SD 5.4) kg/m2. The mean difference between the Beurer BM 85 and the manual BP monitor was 11.1 (SD 11.2) mmHg for systolic blood pressure (SBP) and 8.0 (SD 8.1) mmHg for diastolic blood pressure (DBP). The mean difference between the Andersson Lifesense BDR 2.0 and the manual BP monitor was 3.2 (SD 10.8) mmHg for SBP and 4.2 (SD 7.2) mmHg for DBP. The automatic BP measurements were significantly correlated (P<.001) with the manual BP measurement values (Andersson Lifesense BDR 2.0: r=0.78 for SBP and r=0.71 for DBP; Beurer BM 85: r=0.78 for SBP and r=0.69 for DBP). Conclusions: The two automatic BP monitors validated measure sufficiently accurate on a group level, with the Andersson Lifesense BDR 2.0 more often falling within the ranges for what is acceptable in clinical practice compared with the Beurer BM 85. UR - https://www.jmir.org/2019/4/e12772/ UR - http://dx.doi.org/10.2196/12772 UR - http://www.ncbi.nlm.nih.gov/pubmed/30994459 ID - info:doi/10.2196/12772 ER - TY - JOUR AU - Cho, Chul-Hyun AU - Lee, Taek AU - Kim, Min-Gwan AU - In, Peter Hoh AU - Kim, Leen AU - Lee, Heon-Jeong PY - 2019/04/17 TI - Mood Prediction of Patients With Mood Disorders by Machine Learning Using Passive Digital Phenotypes Based on the Circadian Rhythm: Prospective Observational Cohort Study JO - J Med Internet Res SP - e11029 VL - 21 IS - 4 KW - mood disorder KW - circadian rhythm KW - projections and predictions KW - machine learning KW - digital phenotype KW - wearable device N2 - Background: Virtually, all organisms on Earth have their own circadian rhythm, and humans are no exception. Circadian rhythms are associated with various human states, especially mood disorders, and disturbance of the circadian rhythm is known to be very closely related. Attempts have also been made to derive clinical implications associated with mood disorders using the vast amounts of digital log that is acquired by digital technologies develop and using computational analysis techniques. Objective: This study was conducted to evaluate the mood state or episode, activity, sleep, light exposure, and heart rate during a period of about 2 years by acquiring various digital log data through wearable devices and smartphone apps as well as conventional clinical assessments. We investigated a mood prediction algorithm developed with machine learning using passive data phenotypes based on circadian rhythms. Methods: We performed a prospective observational cohort study on 55 patients with mood disorders (major depressive disorder [MDD] and bipolar disorder type 1 [BD I] and 2 [BD II]) for 2 years. A smartphone app for self-recording daily mood scores and detecting light exposure (using the installed sensor) were provided. From daily worn activity trackers, digital log data of activity, sleep, and heart rate were collected. Passive digital phenotypes were processed into 130 features based on circadian rhythms, and a mood prediction algorithm was developed by random forest. Results: The mood state prediction accuracies for the next 3 days in all patients, MDD patients, BD I patients, and BD II patients were 65%, 65%, 64%, and 65% with 0.7, 0.69, 0.67, and 0.67 area under the curve (AUC) values, respectively. The accuracies of all patients for no episode (NE), depressive episode (DE), manic episode (ME), and hypomanic episode (HME) were 85.3%, 87%, 94%, and 91.2% with 0.87, 0.87, 0.958, and 0.912 AUC values, respectively. The prediction accuracy in BD II patients was distinctively balanced as high showing 82.6%, 74.4%, and 87.5% of accuracy (with generally good sensitivity and specificity) with 0.919, 0.868, and 0.949 AUC values for NE, DE, and HME, respectively. Conclusions: On the basis of the theoretical basis of chronobiology, this study proposed a good model for future research by developing a mood prediction algorithm using machine learning by processing and reclassifying digital log data. In addition to academic value, it is expected that this study will be of practical help to improve the prognosis of patients with mood disorders by making it possible to apply actual clinical application owing to the rapid expansion of digital technology. UR - http://www.jmir.org/2019/4/e11029/ UR - http://dx.doi.org/10.2196/11029 UR - http://www.ncbi.nlm.nih.gov/pubmed/30994461 ID - info:doi/10.2196/11029 ER - TY - JOUR AU - Grekin, R. Emily AU - Beatty, R. Jessica AU - Ondersma, J. Steven PY - 2019/04/15 TI - Mobile Health Interventions: Exploring the Use of Common Relationship Factors JO - JMIR Mhealth Uhealth SP - e11245 VL - 7 IS - 4 KW - mobile health KW - mHealth KW - smartphone KW - empathy KW - mobile applications KW - therapeutic alliance UR - http://mhealth.jmir.org/2019/4/e11245/ UR - http://dx.doi.org/10.2196/11245 UR - http://www.ncbi.nlm.nih.gov/pubmed/30985281 ID - info:doi/10.2196/11245 ER - TY - JOUR AU - Ruiz-López, Tomás AU - Sen, Sagar AU - Jakobsen, Elisabeth AU - Tropé, Ameli AU - Castle, E. Philip AU - Hansen, Terning Bo AU - Nygård, Mari PY - 2019/04/08 TI - FightHPV: Design and Evaluation of a Mobile Game to Raise Awareness About Human Papillomavirus and Nudge People to Take Action Against Cervical Cancer JO - JMIR Serious Games SP - e8540 VL - 7 IS - 2 KW - papillomavirus vaccines KW - educational technology KW - uterine cervical neoplasms KW - papillomavirus infections KW - primary prevention KW - secondary prevention KW - early detection of cancer KW - mobile applications KW - health education KW - learning N2 - Background: Human papillomavirus (HPV) is the most common sexually transmitted infection globally. High-risk HPV types can cause cervical cancer, other anogenital cancer, and oropharyngeal cancer; low-risk HPV types can cause genital warts. Cervical cancer is highly preventable through HPV vaccination and screening; however, a lack of awareness and knowledge of HPV and these preventive strategies represents an important barrier to reducing the burden of the disease. The rapid development and widespread use of mobile technologies in the last few years present an opportunity to overcome this lack of knowledge and create new, effective, and modern health communication strategies. Objective: This study aimed to describe the development of a mobile app called FightHPV, a game-based learning tool that educates mobile technology users about HPV, the disease risks associated with HPV infection, and existing preventive methods. Methods: The first version of FightHPV was improved in a design-development-evaluation loop, which incorporated feedback from a beta testing study of 40 participants, a first focus group of 6 participants aged between 40 and 50 years and a second focus group of 23 participants aged between 16 and 18 years. Gameplay data from the beta testing study were collected using Google Analytics (Google), whereas feedback from focus groups was evaluated qualitatively. Of the 29 focus group participants, 26 returned self-administered questionnaires. HPV knowledge before and after playing the game was evaluated in the 22 participants from the second focus group who returned a questionnaire. Results: FightHPV communicates concepts about HPV, associated diseases and their prevention by representing relationships among 14 characters in 6 episodes of 10 levels each, with each level being represented by a puzzle. Main concepts were reinforced with text explanations. Beta testing revealed that many players either failed or had to retry several times before succeeding at the more difficult levels in the game. It also revealed that players gave up at around level 47 of 60, which prompted the redesign of FightHPV to increase accessibility to all episodes. Focus group discussions led to several improvements in the user experience and dissemination of health information in the game, such as making all episodes available from the beginning of the game and rewriting the information in a more appealing way. Among the 26 focus group participants who returned a questionnaire, all stated that FightHPV is an appealing educational tool, 69% (18/26) reported that they liked the game, and 81% (21/26) stated that the game was challenging. We observed an increase in HPV knowledge after playing the game (P=.001). Conclusions: FightHPV was easy to access, use, and it increased awareness about HPV infection, its consequences, and preventive measures. FightHPV can be used to educate people to take action against HPV and cervical cancer. UR - https://games.jmir.org/2019/2/e8540/ UR - http://dx.doi.org/10.2196/games.8540 UR - http://www.ncbi.nlm.nih.gov/pubmed/30958271 ID - info:doi/10.2196/games.8540 ER - TY - JOUR AU - Chu, Yuan-Chia AU - Cheng, Yen-Fu AU - Lai, Ying-Hui AU - Tsao, Yu AU - Tu, Tzong-Yang AU - Young, Tsong Shuenn AU - Chen, Tzer-Shyong AU - Chung, Yu-Fang AU - Lai, Feipei AU - Liao, Wen-Huei PY - 2019/04/01 TI - A Mobile Phone?Based Approach for Hearing Screening of School-Age Children: Cross-Sectional Validation Study JO - JMIR Mhealth Uhealth SP - e12033 VL - 7 IS - 4 KW - hearing tests KW - telemedicine KW - mobile apps KW - audiometry, pure-tone N2 - Background: Pure-tone screening (PTS) is considered as the gold standard for hearing screening programs in school-age children. Mobile devices, such as mobile phones, have the potential for audiometric testing. Objective: This study aimed to demonstrate a new approach to rapidly screen hearing status and provide stratified test values, using a smartphone-based hearing screening app, for each screened ear of school-age children. Method: This was a prospective cohort study design. The proposed smartphone-based screening method and a standard sound-treated booth with PTS were used to assess 85 school-age children (170 ears). Sound-treated PTS involved applying 4 test tones to each tested ear: 500 Hz at 25 dB and 1000 Hz, 2000 Hz, and 4000 Hz at 20 dB. The results were classified as pass (normal hearing in the ear) or fail (possible hearing impairment). The proposed smartphone-based screening employs 20 stratified hearing scales. Thresholds were compared with those of pure-tone average (PTA). Results: A total of 85 subjects (170 ears), including 38 males and 47 females, aged between 11 and 12 years with a mean (SD) of 11 (0.5) years, participated in the trial. Both screening methods produced comparable pass and fail results (pass in 168 ears and fail in 2 ears). The smartphone-based screening detected moderate or worse hearing loss (average PTA>25 dB) accurately. Both the sensitivity and specificity of the smartphone-based screening method were calculated at 100%. Conclusions: The results of the proposed smartphone-based self-hearing test demonstrated high concordance with conventional PTS in a sound-treated booth. Our results suggested the potential use of the proposed smartphone-based hearing screening in a school-age population. UR - https://mhealth.jmir.org/2019/4/e12033/ UR - http://dx.doi.org/10.2196/12033 UR - http://www.ncbi.nlm.nih.gov/pubmed/30932870 ID - info:doi/10.2196/12033 ER - TY - JOUR AU - Doarn, R. Charles AU - Vonder Meulen, Beth Mary AU - Pallerla, Harini AU - Acquavita, P. Shauna AU - Regan, Saundra AU - Elder, Nancy AU - Tubb, R. Matthew PY - 2019/03/29 TI - Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care JO - JMIR Form Res SP - e11300 VL - 3 IS - 1 KW - mobile health KW - smoking cessation KW - primary care KW - decision aid N2 - Background: Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. Objective: The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. Methods: A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. Results: Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. Conclusions: Subject matter experts, although generally amenable to one another?s disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building. UR - https://formative.jmir.org/2019/1/e11300/ UR - http://dx.doi.org/10.2196/11300 UR - http://www.ncbi.nlm.nih.gov/pubmed/30924783 ID - info:doi/10.2196/11300 ER - TY - JOUR AU - Rossmann, Constanze AU - Riesmeyer, Claudia AU - Brew-Sam, Nicola AU - Karnowski, Veronika AU - Joeckel, Sven AU - Chib, Arul AU - Ling, Rich PY - 2019/03/29 TI - Appropriation of Mobile Health for Diabetes Self-Management: Lessons From Two Qualitative Studies JO - JMIR Diabetes SP - e10271 VL - 4 IS - 1 KW - diabetes KW - Germany KW - mHealth KW - mobile phone KW - self-management KW - Singapore N2 - Background: To achieve clarity on mobile health?s (mHealth?s) potential in the diabetes context, it is necessary to understand potential users? needs and expectations, as well as the factors determining their mHealth use. Recently, a few studies have examined the user perspective in the mHealth context, but their explanatory value is constrained because of their limitation to adoption factors. Objective: This paper uses the mobile phone appropriation model to examine how individuals with type 1 or type 2 diabetes integrate mobile technology into their everyday self-management. The study advances the field beyond mere usage metrics or the simple dichotomy of adoption versus rejection. Methods: Data were gathered in 2 qualitative studies in Singapore and Germany, with 21 and 16 respondents, respectively. Conducting semistructured interviews, we asked respondents about their explicit use of diabetes-related apps, their general use of varied mobile technologies to manage their disease, and their daily practices of self-management. Results: The analysis revealed that although some individuals with diabetes used dedicated diabetes apps, most used tools across the entire mobile-media spectrum, including lifestyle and messaging apps, traditional health information websites and forums. The material indicated general barriers to usage, including financial, technical, and temporal restrictions. Conclusions: In sum, we find that use patterns differ regarding users? evaluations, expectancies, and appropriation styles, which might explain the inconclusive picture of effects studies in the diabetes mHealth context. UR - http://diabetes.jmir.org/2019/1/e10271/ UR - http://dx.doi.org/10.2196/10271 UR - http://www.ncbi.nlm.nih.gov/pubmed/30924786 ID - info:doi/10.2196/10271 ER - TY - JOUR AU - Sikder, Taher Abu AU - Yang, Cheng Francis AU - Schafer, Rhiana AU - Dowling, A. Glenna AU - Traeger, Lara AU - Jain, Ananda Felipe PY - 2019/03/21 TI - Mentalizing Imagery Therapy Mobile App to Enhance the Mood of Family Dementia Caregivers: Feasibility and Limited Efficacy Testing JO - JMIR Aging SP - e12850 VL - 2 IS - 1 KW - family caregivers KW - mindfulness KW - depression KW - mobile apps KW - psychotherapy N2 - Background: Family caregivers of patients with Alzheimer disease and related dementias (AD and ADRD) often experience high stress and are at high risk for depression. Technologically delivered therapy is attractive for AD and ADRD caregivers because of the time demands associated with in-person participation. Objective: We aimed to study the feasibility and conduct limited efficacy testing of a mobile app intervention delivering mentalizing imagery therapy (MIT) for family caregivers. Methods: A 4-week trial of the MIT app for family AD and ADRD caregivers was conducted to assess the feasibility of use and investigate changes in depression symptoms, mood, and caregiving experience. Semistructured interviews were conducted to characterize participants? perceived feasibility and benefits. Results: A total of 17 of the 21 (80%) consented participants (mean age 67 years, range 54-79) utilized the app at least once and were further analyzed. Average usage of audio recordings was on 14 (SD 10) days out of 28 possible and comprised 29 (SD 28) individual sessions. There were improvements in depression with a large effect size for those who used the app at least moderately (P=.008), increases in positive mood postintervention (P<.05), and acute increases in mood following daily guided imagery practice (Stretching and Breathing, P<.001; Eye in the Center, P<.001; Nesting Doll, P=.002; Situation Solver, P=.003; and Life Globe, P=.006). Semistructured interviews revealed perceived benefits such as greater ability to remain ?centered? despite caregiving challenges and positive reframing of the caregiver experience. Conclusions: App delivery of MIT is feasible for family AD and ADRD caregivers, including aging seniors. Results showed moderate to high usage of the app for a majority of users. Limited efficacy testing provides justification for studying the MIT app for AD and ADRD caregivers to improve mood and reduce depression in larger, controlled trials. UR - http://aging.jmir.org/2019/1/e12850/ UR - http://dx.doi.org/10.2196/12850 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518275 ID - info:doi/10.2196/12850 ER - TY - JOUR AU - Kwasny, J. Mary AU - Schueller, M. Stephen AU - Lattie, Emily AU - Gray, L. Elizabeth AU - Mohr, C. David PY - 2019/03/21 TI - Exploring the Use of Multiple Mental Health Apps Within a Platform: Secondary Analysis of the IntelliCare Field Trial JO - JMIR Ment Health SP - e11572 VL - 6 IS - 3 KW - mobile apps KW - depression KW - anxiety KW - mobile phone N2 - Background: IntelliCare is a mental health app platform with 14 apps that are elemental, simple and brief to use, and eclectic. Although a variety of apps may improve engagement, leading to better outcomes, they may require navigation aids such as recommender systems that can quickly direct a person to a useful app. Objective: As the first step toward developing navigation and recommender tools, this study explored app-use patterns across the IntelliCare platform and their relationship with depression and anxiety outcomes. Methods: This is a secondary analysis of the IntelliCare Field Trial, which recruited people with depression or anxiety. Participants of the trial received 8 weeks of coaching, primarily by text, and weekly random recommendations for apps. App-use metrics included frequency and lifetime use. Depression and anxiety, measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively, were assessed at baseline and end of treatment. Cluster analysis was utilized to determine patterns of app use; ordinal logistic regression models and log-rank tests were used to determine if these use metrics alone, or in combination, predicted improvement or remission in depression or anxiety. Results: The analysis included 96 people who generally followed recommendations to download and try new apps each week. Apps were clustered into 5 groups: Thinking (apps that targeted or relied on thinking), Calming (relaxation and insomnia), Checklists (apps that used checklists), Activity (behavioral activation and activity), and Other. Both overall frequency of use and lifetime use predicted response for depression and anxiety. The Thinking, Calming, and Checklist clusters were associated with improvement in depression and anxiety, and the Activity cluster was associated with improvement in Anxiety only. However, the use of clusters was less strongly associated with improvement than individual app use. Conclusions: Participants in the field trial remained engaged with a suite of apps for the full 8 weeks of the trial. App-use patterns did fall into clusters, suggesting that some knowledge about the use of one app may be useful in selecting another app that the person is more likely to use and may help suggest apps based on baseline symptomology and personal preference. UR - http://mental.jmir.org/2019/3/e11572/ UR - http://dx.doi.org/10.2196/11572 UR - http://www.ncbi.nlm.nih.gov/pubmed/30896433 ID - info:doi/10.2196/11572 ER - TY - JOUR AU - Quisel, Tom AU - Foschini, Luca AU - Zbikowski, M. Susan AU - Juusola, L. Jessie PY - 2019/03/20 TI - The Association Between Medication Adherence for Chronic Conditions and Digital Health Activity Tracking: Retrospective Analysis JO - J Med Internet Res SP - e11486 VL - 21 IS - 3 KW - activity tracker KW - health behavior KW - eHealth KW - mHealth KW - medication adherence N2 - Background: Chronic diseases have a widespread impact on health outcomes and costs in the United States. Heart disease and diabetes are among the biggest cost burdens on the health care system. Adherence to medication is associated with better health outcomes and lower total health care costs for individuals with these conditions, but the relationship between medication adherence and health activity behavior has not been explored extensively. Objective: The aim of this study was to examine the relationship between medication adherence and health behaviors among a large population of insured individuals with hypertension, diabetes, and dyslipidemia. Methods: We conducted a retrospective analysis of health status, behaviors, and medication adherence from medical and pharmacy claims and health behavior data. Adherence was measured in terms of proportion of days covered (PDC), calculated from pharmacy claims using both a fixed and variable denominator methodology. Individuals were considered adherent if their PDC was at least 0.80. We used step counts, sleep, weight, and food log data that were transmitted through devices that individuals linked. We computed metrics on the frequency of tracking and the extent to which individuals engaged in each tracking activity. Finally, we used logistic regression to model the relationship between adherent status and the activity-tracking metrics, including age and sex as fixed effects. Results: We identified 117,765 cases with diabetes, 317,340 with dyslipidemia, and 673,428 with hypertension between January 1, 2015 and June 1, 2016 in available data sources. Average fixed and variable PDC for all individuals ranged from 0.673 to 0.917 for diabetes, 0.756 to 0.921 for dyslipidemia, and 0.756 to 0.929 for hypertension. A subgroup of 8553 cases also had health behavior data (eg, activity-tracker data). On the basis of these data, individuals who tracked steps, sleep, weight, or diet were significantly more likely to be adherent to medication than those who did not track any activities in both the fixed methodology (odds ratio, OR 1.33, 95% CI 1.29-1.36) and variable methodology (OR 1.37, 95% CI 1.32-1.43), with age and sex as fixed effects. Furthermore, there was a positive association between frequency of activity tracking and medication adherence. In the logistic regression model, increasing the adjusted tracking ratio by 0.5 increased the fixed adherent status OR by a factor of 1.11 (95% CI 1.06-1.16). Finally, we found a positive association between number of steps and adherent status when controlling for age and sex. Conclusions: Adopters of digital health activity trackers tend to be more adherent to hypertension, diabetes, and dyslipidemia medications, and adherence increases with tracking frequency. This suggests that there may be value in examining new ways to further promote medication adherence through programs that incentivize health tracking and leveraging insights derived from connected devices to improve health outcomes. UR - http://www.jmir.org/2019/3/e11486/ UR - http://dx.doi.org/10.2196/11486 UR - http://www.ncbi.nlm.nih.gov/pubmed/30892271 ID - info:doi/10.2196/11486 ER - TY - JOUR AU - Romeo, Amelia AU - Edney, Sarah AU - Plotnikoff, Ronald AU - Curtis, Rachel AU - Ryan, Jillian AU - Sanders, Ilea AU - Crozier, Alyson AU - Maher, Carol PY - 2019/03/19 TI - Can Smartphone Apps Increase Physical Activity? Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e12053 VL - 21 IS - 3 KW - physical activity KW - smartphone KW - mobile phone KW - app KW - mobile apps KW - program KW - health behavior KW - systematic review KW - meta-analysis N2 - Background: Smartphone apps are a promising tool for delivering accessible and appealing physical activity interventions. Given the large growth of research in this field, there are now enough studies using the ?gold standard? of experimental design?the randomized controlled trial design?and employing objective measurements of physical activity, to support a meta-analysis of these scientifically rigorous studies. Objective: This systematic review and meta-analysis aimed to determine the effectiveness of smartphone apps for increasing objectively measured physical activity in adults. Methods: A total of 7 electronic databases (EMBASE, EmCare, MEDLINE, Scopus, Sport Discus, The Cochrane Library, and Web of Science) were searched from 2007 to January 2018. Following the Population, Intervention, Comparator, Outcome and Study Design format, studies were eligible if they were randomized controlled trials involving adults, used a smartphone app as the primary or sole component of the physical activity intervention, used a no- or minimal-intervention control condition, and measured objective physical activity either in the form of moderate-to-vigorous physical activity minutes or steps. Study quality was assessed using a 25-item tool based on the Consolidated Standards of Reporting Trials checklist. A meta-analysis of study effects was conducted using a random effects model approach. Sensitivity analyses were conducted to examine whether intervention effectiveness differed on the basis of intervention length, target behavior (physical activity alone vs physical activity in combination with other health behaviors), or target population (general adult population vs specific health populations). Results: Following removal of duplicates, a total of 6170 studies were identified from the original database searches. Of these, 9 studies, involving a total of 1740 participants, met eligibility criteria. Of these, 6 studies could be included in a meta-analysis of the effects of physical activity apps on steps per day. In comparison with the control conditions, smartphone apps produced a nonsignificant (P=.19) increase in participants? average steps per day, with a mean difference of 476.75 steps per day (95% CI ?229.57 to 1183.07) between groups. Sensitivity analyses suggested that physical activity programs with a duration of less than 3 months were more effective than apps evaluated across more than 3 months (P=.01), and that physical activity apps that targeted physical activity in isolation were more effective than apps that targeted physical activity in combination with diet (P=.04). Physical activity app effectiveness did not appear to differ on the basis of target population. Conclusions: This meta-analysis provides modest evidence supporting the effectiveness of smartphone apps to increase physical activity. To date, apps have been most effective in the short term (eg, up to 3 months). Future research is needed to understand the time course of intervention effects and to investigate strategies to sustain intervention effects over time. UR - http://www.jmir.org/2019/3/e12053/ UR - http://dx.doi.org/10.2196/12053 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888321 ID - info:doi/10.2196/12053 ER - TY - JOUR AU - Hsiao, Ju-Ling AU - Chen, Rai-Fu PY - 2019/03/18 TI - Understanding Determinants of Health Care Professionals? Perspectives on Mobile Health Continuance and Performance JO - JMIR Med Inform SP - e12350 VL - 7 IS - 1 KW - delivery of health care KW - mobile health KW - health information management KW - health care quality, access, and evaluation N2 - Background: With the widespread use of mobile technologies, mobile information systems have become crucial tools in health care operations. Although the appropriate use of mobile health (mHealth) may result in major advances in expanding health care coverage (increasing decision-making speeds, managing chronic conditions, and providing suitable health care in emergencies), previous studies have argued that current mHealth research does not adequately evaluate mHealth interventions, and it does not provide sufficient evidence regarding the effects on health. Objective: The aim of this study was to facilitate the widespread use of mHealth systems; an accurate evaluation of the systems from the users? perspective is essential after the implementation and use of the system in daily health care practices. This study extends the expectation-confirmation model by using characteristics of individuals, technology, and tasks to identify critical factors affecting mHealth continuance and performance from the perspective of health care professionals (HCPs). Methods: A questionnaire survey was used to collect data from HCPs who were experienced in using mHealth systems of a Taiwanese teaching hospital. In total, 282 questionnaires were distributed, and 201 complete and valid questionnaires were returned, thus indicating a valid response rate of 71.3% (201/282). The collected data were analyzed using WarpPLS version 5.0 (ScriptWarp Systems). Results: The results revealed that mHealth continuance (R2=0.522) was mainly affected by perceived usefulness, technology maturity, individual habits, task mobility, and user satisfaction, whereas individual performance (R2=0.492) was affected by mHealth continuance. In addition, user satisfaction (R2=0.548) was affected by confirmation and perceived usefulness of mHealth, whereas perceived usefulness (R2=0.521) was affected by confirmation. This implied that confirmation played a key role in affecting perceived usefulness and user satisfaction. Furthermore, the results showed that mHealth continuance positively affected individual performance. Conclusions: The identified critical factors influencing mHealth continuance and performance can be used as a useful assessment tool by hospitals that have implemented mHealth systems to facilitate the use and infusion of the systems. Furthermore, the results can help health care institutions that intend to introduce or develop mHealth applications to identify critical issues and effectively allocate limited resources to mHealth systems. UR - http://medinform.jmir.org/2019/1/e12350/ UR - http://dx.doi.org/10.2196/12350 UR - http://www.ncbi.nlm.nih.gov/pubmed/30882353 ID - info:doi/10.2196/12350 ER - TY - JOUR AU - Asklund, Ina AU - Samuelsson, Eva AU - Hamberg, Katarina AU - Umefjord, Göran AU - Sjöström, Malin PY - 2019/03/14 TI - User Experience of an App-Based Treatment for Stress Urinary Incontinence: Qualitative Interview Study JO - J Med Internet Res SP - e11296 VL - 21 IS - 3 KW - mobile applications KW - urinary incontinence KW - stress KW - pelvic floor muscle training KW - self-management KW - qualitative research KW - grounded theory KW - women?s health N2 - Background: Stress urinary incontinence (SUI) affects 10%-39% of women. Its first-line treatment consists of lifestyle interventions and pelvic floor muscle training (PFMT), which can be performed supervised or unsupervised. Health apps are increasing in number and can be used to improve adherence to treatments. We developed the Tät app, which provides a 3-month treatment program with a focus on PFMT for women with SUI. The app treatment was evaluated in a randomized controlled trial, which demonstrated efficacy for improving incontinence symptoms and quality of life. In this qualitative interview study, we investigated participant experiences of the app-based treatment. Objective: This study aimed to explore women?s experiences of using an app-based treatment program for SUI. Methods: This qualitative study is based on telephone interviews with 15 selected women, with a mean age of 47 years, who had used the app in the previous randomized controlled trial. A semistructured interview guide with open-ended questions was used, and the interviews were transcribed verbatim. Data were analyzed according to the grounded theory. Results: The results were grouped into three categories: ?Something new!? ?Keeping motivation up!? and ?Good enough?? A core category, ?Enabling my independence,? was identified. The participants appreciated having a new and modern way to access a treatment program for SUI. The use of new technology seemed to make incontinence treatment feel more prioritized and less embarrassing for the subjects. The closeness to their mobile phone and app features like reminders and visual graphs helped support and motivate the women to carry through the PFMT. The participants felt confident that they could perform the treatment program on their own, even though they expressed some uncertainty about whether they were doing the pelvic floor muscle contractions correctly. They felt that the app-based treatment increased their self-confidence and enabled them to take responsibility for their treatment. Conclusions: Use of the app-based treatment program for SUI empowered the women in this study and helped them self-manage their incontinence treatment. They appreciated the app as a new tool for supporting their motivation to carry through a slightly challenging PFMT program. Trial Registration: ClinicalTrials.gov NCT01848938; https://clinicaltrials.gov/ct2/show/NCT01848938 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01848938) UR - http://www.jmir.org/2019/3/e11296/ UR - http://dx.doi.org/10.2196/11296 UR - http://www.ncbi.nlm.nih.gov/pubmed/30869644 ID - info:doi/10.2196/11296 ER - TY - JOUR AU - Tebb, P. Kathleen AU - Leng Trieu, Sang AU - Rico, Rosario AU - Renteria, Robert AU - Rodriguez, Felicia AU - Puffer, Maryjane PY - 2019/03/14 TI - A Mobile Health Contraception Decision Support Intervention for Latina Adolescents: Implementation Evaluation for Use in School-Based Health Centers JO - JMIR Mhealth Uhealth SP - e11163 VL - 7 IS - 3 KW - mobile health KW - adolescent health KW - pregnancy in adolescence N2 - Background: Health care providers are a trusted and accurate source of sexual health information for most adolescents, and clinical guidelines recommend that all youth receive comprehensive, confidential sexual health information and services. However, these guidelines are followed inconsistently. Providers often lack the time, comfort, and skills to provide patient-centered comprehensive contraceptive counseling and services. There are significant disparities in the provision of sexual health services for Latino adolescents, which contribute to disproportionately higher rates of teenage pregnancy. To address this, we developed Health-E You or Salud iTu in Spanish, an evidence-informed mobile health (mHealth) app, to provide interactive, individually tailored sexual health information and contraception decision support for English and Spanish speakers. It is designed to be used in conjunction with a clinical encounter to increase access to patient-centered contraceptive information and services for adolescents at risk of pregnancy. Based on user input, the app provides tailored contraceptive recommendations and asks the youth to indicate what methods they are most interested in. This information is shared with the provider before the in-person visit. The app is designed to prepare youth for the visit and acts as a clinician extender to support the delivery of health education and enhance the quality of patient-centered sexual health care. Despite the promise of this app, there is limited research on the integration of such interventions into clinical practice. Objective: This study described efforts used to support the successful adoption and implementation of the Health-E You app in clinical settings and described facilitators and barriers encountered to inform future efforts aimed at integrating mHealth interventions into clinical settings. Methods: This study was part of a larger, cluster randomized control trial to evaluate the effectiveness of Health-E You on its ability to reduce health disparities in contraceptive knowledge, access to contraceptive services, and unintended pregnancies among sexually active Latina adolescents at 18 school-based health centers (SBHCs) across Los Angeles County, California. App development and implementation were informed by the theory of diffusion of innovation, the Patient-Centered Outcomes Research Institute?s principles of engagement, and iterative pilot testing with adolescents and clinicians. Implementation facilitators and barriers were identified through monthly conference calls, site visits, and quarterly in-person collaborative meetings. Results: Implementation approaches enhanced the development, adoption, and integration of Health-E You into SBHCs. Implementation challenges were also identified to improve the integration of mHealth interventions into clinical settings. Conclusions: This study provides important insights that can inform and improve the implementation efforts for future mHealth interventions. In particular, an implementation approach founded in a strong theoretical framework and active engagement with patient and community partners can enhance the development, adoption, and integration of mHealth technologies into clinical practice. Trial Registration: ClinicalTrials.gov NCT02847858; https://clinicaltrials.gov/ct2/show/NCT02847858 (Archived by WebCite at http://www.webcitation.org/761yVIRTp). UR - http://mhealth.jmir.org/2019/3/e11163/ UR - http://dx.doi.org/10.2196/11163 UR - http://www.ncbi.nlm.nih.gov/pubmed/30869649 ID - info:doi/10.2196/11163 ER - TY - JOUR AU - McManus, D. David AU - Trinquart, Ludovic AU - Benjamin, J. Emelia AU - Manders, S. Emily AU - Fusco, Kelsey AU - Jung, S. Lindsey AU - Spartano, L. Nicole AU - Kheterpal, Vik AU - Nowak, Christopher AU - Sardana, Mayank AU - Murabito, M. Joanne PY - 2019/03/01 TI - Design and Preliminary Findings From a New Electronic Cohort Embedded in the Framingham Heart Study JO - J Med Internet Res SP - e12143 VL - 21 IS - 3 KW - smartphone KW - tele-medicine KW - blood pressure monitoring KW - ambulatory KW - cohort studies N2 - Background: New models of scalable population-based data collection that integrate digital and mobile health (mHealth) data are necessary. Objective: The aim of this study was to describe a cardiovascular digital and mHealth electronic cohort (e-cohort) embedded in a traditional longitudinal cohort study, the Framingham Heart Study (FHS). Methods: We invited eligible and consenting FHS Generation 3 and Omni participants to download the electronic Framingham Heart Study (eFHS) app onto their mobile phones and co-deployed a digital blood pressure (BP) cuff. Thereafter, participants were also offered a smartwatch (Apple Watch). Participants are invited to complete surveys through the eFHS app, to perform weekly BP measurements, and to wear the smartwatch daily. Results: Up to July 2017, we enrolled 790 eFHS participants, representing 76% (790/1044) of potentially eligible FHS participants. eFHS participants were, on average, 53±8 years of age and 57% were women. A total of 85% (675/790) of eFHS participants completed all of the baseline survey and 59% (470/790) completed the 3-month survey. A total of 42% (241/573) and 76% (306/405) of eFHS participants adhered to weekly digital BP and heart rate (HR) uploads, respectively, over 12 weeks. Conclusions: We have designed an e-cohort focused on identifying novel cardiovascular disease risk factors using a new smartphone app, a digital BP cuff, and a smartwatch. Despite minimal training and support, preliminary findings over a 3-month follow-up period show that uptake is high and adherence to periodic app-based surveys, weekly digital BP assessments, and smartwatch HR measures is acceptable. UR - http://www.jmir.org/2019/3/e12143/ UR - http://dx.doi.org/10.2196/12143 UR - http://www.ncbi.nlm.nih.gov/pubmed/30821691 ID - info:doi/10.2196/12143 ER - TY - JOUR AU - Stevens, Maria Wilhelmina Josepha AU - van der Sande, Rob AU - Beijer, J. Lilian AU - Gerritsen, GM Maarten AU - Assendelft, JJ Willem PY - 2019/03/01 TI - eHealth Apps Replacing or Complementing Health Care Contacts: Scoping Review on Adverse Effects JO - J Med Internet Res SP - e10736 VL - 21 IS - 3 KW - eHealth KW - adverse effects KW - scoping review N2 - Background: The use of eHealth has increased tremendously in recent years. eHealth is generally considered to have a positive effect on health care quality and to be a promising alternative to face-to-face health care contacts. Surprisingly little is known about possible adverse effects of eHealth apps. Objective: We conducted a scoping review on empirical research into adverse effects of eHealth apps that aim to deliver health care at a distance. We investigated whether adverse effects were reported and the nature and quality of research into these possible adverse effects. Methods: For this scoping review, we followed the five steps of Arksey and O?Malley?s scoping review methodology. We searched specifically for studies into eHealth apps that replaced or complemented the face-to-face contact between a health professional and a patient in the context of treatment, health monitoring, or supporting self-management. Studies were included when eHealth and adverse effects were mentioned in the title or abstract and when empirical data on adverse effects were provided. All health conditions, with the exception of mental health conditions, all ages, and all sample sizes were included. We examined the literature published between December 2012 and August 2017 in the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and the Cochrane Library. The methodological quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) checklists. Results: Our search identified 79 papers that were potentially relevant; 11 studies met our inclusion criteria after screening. These studies differed in many ways and the majority were characterized by small research populations and low study quality. Adverse effects are rarely subject to systematic scientific research. So far, information on real adverse effects is mainly limited to incidental reporting or as a bycatch from qualitative pilot studies. Despite the shortage of solid research, we found some indications of possible negative impact on patient-centeredness and efficiency, such as less transparency in the relationship between health professionals and patients and time-consuming work routines. Conclusions: There is a lack of high-quality empirical research on adverse effects of eHealth apps that replace or complement face-to-face care. While the development of eHealth apps is ongoing, the knowledge with regard to possible adverse effects is limited. The available research often focuses on efficacy, added value, implementation issues, use, and satisfaction, whereas adverse effects are underexplored. A better understanding of possible adverse effects could be a starting point in improving the positive impact of eHealth-based health care delivery. UR - https://www.jmir.org/2019/3/e10736/ UR - http://dx.doi.org/10.2196/10736 UR - http://www.ncbi.nlm.nih.gov/pubmed/30821690 ID - info:doi/10.2196/10736 ER - TY - JOUR AU - Lall, Priya AU - Rees, Rebecca AU - Law, Yi Gloria Chun AU - Dunleavy, Gerard AU - Coti?, ?iva AU - Car, Josip PY - 2019/02/28 TI - Influences on the Implementation of Mobile Learning for Medical and Nursing Education: Qualitative Systematic Review by the Digital Health Education Collaboration JO - J Med Internet Res SP - e12895 VL - 21 IS - 2 KW - medical education KW - nursing education KW - distance education KW - qualitative research KW - systematic review N2 - Background: In the past 5 decades, digital education has increasingly been used in health professional education. Mobile learning (mLearning), an emerging form of educational technology using mobile devices, has been used to supplement learning outcomes through enabling conversations, sharing information and knowledge with other learners, and aiding support from peers and instructors regardless of geographic distance. Objective: This review aimed to synthesize findings from qualitative or mixed-methods studies to provide insight into factors facilitating or hindering implementation of mLearning strategies for medical and nursing education. Methods: A systematic search was conducted across a range of databases. Studies with the following criteria were selected: examined mLearning in medical and nursing education, employed a mixed-methods or qualitative approach, and published in English after 1994. Findings were synthesized using a framework approach. Results: A total of 1946 citations were screened, resulting in 47 studies being selected for inclusion. Most studies evaluated pilot mLearning interventions. The synthesis identified views on valued aspects of mobile devices in terms of efficiency and personalization but concerns over vigilance and poor device functionality; emphasis on the social aspects of technology, especially in a clinical setting; the value of interaction learning for clinical practice; mLearning as a process, including learning how to use a device; and the importance of institutional infrastructure and policies. Conclusions: The portability of mobile devices can enable interactions between learners and educational material, fellow learners, and educators in the health professions. However, devices need to be incorporated institutionally, and learners and educators need additional support to fully comprehend device or app functions. The strategic support of mLearning is likely to require procedural guidance for practice settings and device training and maintenance services on campus. UR - https://www.jmir.org/2019/2/e12895/ UR - http://dx.doi.org/10.2196/12895 UR - http://www.ncbi.nlm.nih.gov/pubmed/30816847 ID - info:doi/10.2196/12895 ER - TY - JOUR AU - Höchsmann, Christoph AU - Infanger, Denis AU - Klenk, Christopher AU - Königstein, Karsten AU - Walz, P. Steffen AU - Schmidt-Trucksäss, Arno PY - 2019/02/13 TI - Effectiveness of a Behavior Change Technique?Based Smartphone Game to Improve Intrinsic Motivation and Physical Activity Adherence in Patients With Type 2 Diabetes: Randomized Controlled Trial JO - JMIR Serious Games SP - e11444 VL - 7 IS - 1 KW - behavior change KW - exercise adherence KW - gamification KW - intrinsic motivation KW - mhealth KW - mobile phone game KW - physical activity KW - type 2 diabetes N2 - Background: Regular physical activity (PA) is an essential component of a successful type 2 diabetes treatment. However, despite the manifest evidence for the numerous health benefits of regular PA, most patients with type 2 diabetes remain inactive, often due to low motivation and lack of PA enjoyment. A recent and promising approach to help overcome these PA barriers and motivate inactive individuals to change their PA behavior is PA-promoting smartphone games. While short-term results of these games are encouraging, the long-term success in effectively changing PA behavior has to date not been confirmed. It is possible that an insufficient incorporation of motivational elements or flaws in gameplay and storyline in these games affect the long-term motivation to play and thereby prevent sustained changes in PA behavior. We aimed to address these design challenges by developing a PA-promoting smartphone game that incorporates established behavior change techniques and specifically targets inactive type 2 diabetes patients. Objective: To investigate if a self-developed, behavior change technique-based smartphone game designed by an interdisciplinary team is able to motivate inactive individuals with type 2 diabetes for regular use and thereby increase their intrinsic PA motivation. Methods: Thirty-six inactive, overweight type 2 diabetes patients (45-70 years of age) were randomly assigned to either the intervention group or the control group (one-time lifestyle counseling). Participants were instructed to play the smartphone game or to implement the recommendations from the lifestyle counseling autonomously during the 24-week intervention period. Intrinsic PA motivation was assessed with an abridged 12-item version of the Intrinsic Motivation Inventory (IMI) before and after the intervention. In addition, adherence to the game-proposed PA recommendations during the intervention period was assessed in the intervention group via the phone-recorded game usage data. Results: Intrinsic PA motivation (IMI total score) increased significantly in the intervention group (+6.4 (SD 4.2; P<.001) points) while it decreased by 1.9 (SD 16.5; P=.623) points in the control group. The adjusted difference between both groups was 8.1 (95% CI 0.9, 15.4; P=.029) points. The subscales ?interest/enjoyment? (+2.0 (SD 1.9) points, P<.001) and ?perceived competence? (+2.4 (SD 2.4) points, P<.001) likewise increased significantly in the intervention group while they did not change significantly in the control group. The usage data revealed that participants in the intervention group used the game for an average of 131.1 (SD 48.7) minutes of in-game walking and for an average of 15.3 (SD 24.6) minutes of strength training per week. We found a significant positive association between total in-game training (min) and change in IMI total score (beta=0.0028; 95% CI 0.0007-0.0049; P=.01). Conclusions: In inactive individuals with type 2 diabetes, a novel smartphone game incorporating established motivational elements and personalized PA recommendations elicits significant increases in intrinsic PA motivation that are accompanied by de-facto improvements in PA adherence over 24 weeks. Trial Registration: ClinicalTrials.gov NCT02657018; https://clinicaltrials.gov/ct2/show/NCT02657018 UR - http://games.jmir.org/2019/1/e11444/ UR - http://dx.doi.org/10.2196/11444 UR - http://www.ncbi.nlm.nih.gov/pubmed/30758293 ID - info:doi/10.2196/11444 ER - TY - JOUR AU - Willcox, Michelle AU - Moorthy, Anitha AU - Mohan, Diwakar AU - Romano, Karen AU - Hutchful, David AU - Mehl, Garrett AU - Labrique, Alain AU - LeFevre, Amnesty PY - 2019/02/13 TI - Mobile Technology for Community Health in Ghana: Is Maternal Messaging and Provider Use of Technology Cost-Effective in Improving Maternal and Child Health Outcomes at Scale? JO - J Med Internet Res SP - e11268 VL - 21 IS - 2 KW - child health KW - frontline health workers KW - Ghana KW - health information systems KW - maternal health KW - mHealth KW - mobile phone KW - newborn health N2 - Background: Mobile technologies are emerging as tools to enhance health service delivery systems and empower clients to improve maternal, newborn, and child health. Limited evidence exists on the value for money of mobile health (mHealth) programs in low- and middle-income countries. Objective: This study aims to forecast the incremental cost-effectiveness of the Mobile Technology for Community Health (MOTECH) initiative at scale across 170 districts in Ghana. Methods: MOTECH?s ?Client Data Application? allows frontline health workers to digitize service delivery information and track the care of patients. MOTECH?s other main component, the ?Mobile Midwife,? sends automated educational voice messages to mobile phones of pregnant and postpartum women. We measured program costs and consequences of scaling up MOTECH over a 10-year analytic time horizon. Economic costs were estimated from informant interviews and financial records. Health effects were modeled using the Lives Saved Tool with data from an independent evaluation of changes in key services coverage observed in Gomoa West District. Incremental cost-effectiveness ratios were presented overall and for each year of implementation. Uncertainty analyses assessed the robustness of results to changes in key parameters. Results: MOTECH was scaled in clusters over a 3-year period to reach 78.7% (170/216) of Ghana?s districts. Sustaining the program would cost US $17,618 on average annually per district. Over 10 years, MOTECH could potentially save an estimated 59,906 lives at a total cost of US $32 million. The incremental cost per disability-adjusted life year averted ranged from US $174 in the first year to US $6.54 in the tenth year of implementation and US $20.94 (95% CI US $20.34-$21.55) over 10 years. Uncertainty analyses suggested that the incremental cost-effectiveness ratio was most sensitive to changes in health effects, followed by personnel time. Probabilistic sensitivity analyses suggested that MOTECH had a 100% probability of being cost-effective above a willingness-to-pay threshold of US $50. Conclusions: This is the first study to estimate the value for money of the supply- and demand-side of an mHealth initiative. The adoption of MOTECH to improve MNCH service delivery and uptake represents good value for money in Ghana and should be considered for expansion. Integration with other mHealth solutions, including e-Tracker, may provide opportunities to continue or combine beneficial components of MOTECH to achieve a greater impact on health. UR - http://www.jmir.org/2019/2/e11268/ UR - http://dx.doi.org/10.2196/11268 UR - http://www.ncbi.nlm.nih.gov/pubmed/30758296 ID - info:doi/10.2196/11268 ER - TY - JOUR AU - Jongerius, Chiara AU - Russo, Selena AU - Mazzocco, Ketti AU - Pravettoni, Gabriella PY - 2019/02/11 TI - Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review JO - JMIR Mhealth Uhealth SP - e10930 VL - 7 IS - 2 KW - breast cancer care KW - breast cancer management KW - breast cancer prevention KW - breast cancer survivorship KW - mobile applications KW - mHealth applications N2 - Background: The use of mobile health (mHealth) apps in clinical settings is increasing widely. mHealth has been used to promote prevention, improve early detection, manage care, and support survivors and chronic patients. However, data on the efficacy and utility of mHealth apps are limited. Objective: The main objective of this review was to provide an overview of the available research-tested interventions using mHealth apps and their impact on breast cancer care. Methods: A systematic search of Medline, PsycINFO, Embase, and Scopus was performed to identify relevant studies. From the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions? features, outcome measures, and results. Results: We identified 29 empirical studies that described a health care intervention using an mHealth app in breast cancer care. Of these, 7 studies were about the use of an mHealth application in an intervention for breast cancer prevention and early detection, 12 targeted care management, and 10 focused on breast cancer survivors. Conclusions: Our results indicate consistent and promising findings of interventions using mHealth apps that target care management in breast cancer. Among the categories of mHealth apps focusing on survivorship, mHealth-based interventions showed a positive effect by promoting weight loss, improving the quality of life, and decreasing stress. There is conflicting and less conclusive data on the effect of mHealth apps on psychological dimensions. We advocate further investigation to confirm and strengthen these findings. No consistent evidence for the impact of interventions using mHealth apps in breast cancer prevention and early detection was identified due to the limited number of studies identified by our search. Future research should continue to explore the impact of mHealth apps on breast cancer care to build on these initial recommendations. UR - http://mhealth.jmir.org/2019/2/e10930/ UR - http://dx.doi.org/10.2196/10930 UR - http://www.ncbi.nlm.nih.gov/pubmed/30741644 ID - info:doi/10.2196/10930 ER - TY - JOUR AU - Park, Eun Jamie Yea AU - Li, Jenny AU - Howren, Alyssa AU - Tsao, Wen Nicole AU - De Vera, Mary PY - 2019/01/31 TI - Mobile Phone Apps Targeting Medication Adherence: Quality Assessment and Content Analysis of User Reviews JO - JMIR Mhealth Uhealth SP - e11919 VL - 7 IS - 1 KW - medication adherence KW - mobile apps KW - mHealth N2 - Background: With the accessibility and widespread use of mobile phones, mobile phone apps targeting medication adherence may be useful tools to help patients take medications as prescribed. Objective: Our objectives were to (1) characterize and assess mobile phone medication adherence apps guided by a conceptual framework on the focus of adherence interventions and (2) conduct a content analysis of Web-based reviews to explore users? perspectives and experiences with mobile phone medication adherence apps. Methods: We searched for mobile phone medication adherence apps using keyword searches in Apple and Android operating systems. We characterized all apps in terms of number of downloads, ratings, languages, cost, and disease target. We categorized apps according to 4 key features of (1) alerting to take medication, (2) tracking medication taking, (3) reminding to refill or indicating amount of medication left, and (4) storing medication information. We then selected representative apps from each operating system for detailed quality assessment and user testing. We also downloaded Web-based reviews for these selected apps and conducted a qualitative content analysis using an inductive approach involving steps of initial open coding, construction of categories, and abstraction into themes. Results: We identified 704 apps (443 from Apple and 261 from Android). The majority of apps across both operating systems had 1 or 2 features?specifically, 37.2% (165/443) and 38.1% (169/443) of Apple apps, respectively, and 41.4% (108/261) and 31.4% (108/261) of Android apps, respectively. Quality assessment and user testing of 20 selected apps revealed apps varied in quality and commonly focused on behavioral strategies to enhance medication adherence through alerts, reminders, and logs. A total of 1323 eligible Web-based reviews from these 20 selected apps were analyzed, and the following themes emerged: (1) features and functions appreciated by users, which included the ability to set up customized medication regimen details and reminders, monitor other health information (eg, vitals, supplements, and manage multiple people or pets), support health care visits (eg, having a list of medications and necessary health information in 1 app); (2) negative user experiences that captured technical difficulties (glitches, confusing app navigation, and poor interoperability), dosage schedule, and reminder setup inflexibility; and (3) desired functions and features related to optimization of information input, improvement of reminders, and upgrading app performance (better synchronization or backup of data and interoperability). Conclusions: A large number of mobile phone medication adherence apps are currently available. The majority of apps have features representing a behavioral approach to intervention. Findings of the content analysis offer mostly positive feedback as well as insights into current limitations and improvements that could be addressed in current and future medication adherence apps. UR - http://mhealth.jmir.org/2019/1/e11919/ UR - http://dx.doi.org/10.2196/11919 UR - http://www.ncbi.nlm.nih.gov/pubmed/30702435 ID - info:doi/10.2196/11919 ER - TY - JOUR AU - Simblett, Sara AU - Matcham, Faith AU - Siddi, Sara AU - Bulgari, Viola AU - Barattieri di San Pietro, Chiara AU - Hortas López, Jorge AU - Ferrão, José AU - Polhemus, Ashley AU - Haro, Maria Josep AU - de Girolamo, Giovanni AU - Gamble, Peter AU - Eriksson, Hans AU - Hotopf, Matthew AU - Wykes, Til AU - PY - 2019/01/30 TI - Barriers to and Facilitators of Engagement With mHealth Technology for Remote Measurement and Management of Depression: Qualitative Analysis JO - JMIR Mhealth Uhealth SP - e11325 VL - 7 IS - 1 KW - acceptability KW - barriers KW - depression KW - facilitators KW - feasibility KW - mHealth KW - qualitative N2 - Background: Mobile technology has the potential to provide accurate, impactful data on the symptoms of depression, which could improve health management or assist in early detection of relapse. However, for this potential to be achieved, it is essential that patients engage with the technology. Although many barriers to and facilitators of the use of this technology are common across therapeutic areas and technology types, many may be specific to cultural and health contexts. Objective: This study aimed to determine the potential barriers to and facilitators of engagement with mobile health (mHealth) technology for remote measurement and management of depression across three Western European countries. Methods: Participants (N=25; 4:1 ratio of women to men; age range, 25-73 years) who experienced depression participated in five focus groups held in three countries (two in the United Kingdom, two in Spain, and one in Italy). The focus groups investigated the potential barriers to and facilitators of the use of mHealth technology. A systematic thematic analysis was used to extract themes and subthemes. Results: Facilitators and barriers were categorized as health-related factors, user-related factors, and technology-related factors. A total of 58 subthemes of specific barriers and facilitators or moderators emerged. A core group of themes including motivation, potential impact on mood and anxiety, aspects of inconvenience, and ease of use was noted across all countries. Conclusions: Similarities in the barriers to and facilitators of the use of mHealth technology have been observed across Spain, Italy, and the United Kingdom. These themes provide guidance on ways to promote the design of feasible and acceptable cross-cultural mHealth tools. UR - http://mhealth.jmir.org/2019/1/e11325/ UR - http://dx.doi.org/10.2196/11325 UR - http://www.ncbi.nlm.nih.gov/pubmed/30698535 ID - info:doi/10.2196/11325 ER - TY - JOUR AU - Coswig, Victor AU - Silva, E. Anselmo De Athayde Costa AU - Barbalho, Matheus AU - Faria, De Fernando Rosch AU - Nogueira, D. Claudio AU - Borges, Mariane AU - Buratti, R. Jéssica AU - Vieira, B. Ivaldo AU - Román, López Francisco Javier AU - Gorla, I. José PY - 2019/01/30 TI - Assessing the Validity of the MyJump2 App for Measuring Different Jumps in Professional Cerebral Palsy Football Players: An Experimental Study JO - JMIR Mhealth Uhealth SP - e11099 VL - 7 IS - 1 KW - cerebral palsy football KW - jump performance KW - mobile apps KW - mobile phone KW - paralympic sports N2 - Background: Vertical jumps can be used to assess neuromuscular status in sports performance. This is particularly important in Cerebral Palsy Football (CP Football) because players are exposed to high injury risk, but it may be complicated because the gold standard for assessing jump performance is scarce in field evaluation. Thus, field techniques, such as mobile apps, have been proposed as an alternative method for solving this problem. Objective: This study aims to evaluate the reliability of the measures of the MyJump2 app to assess vertical jump performance in professional CP Football. Methods: We assessed 40 male CP Football athletes (age 28.1 [SD 1.4] years, weight 72.5 [SD 6.2] kg, and height 176 [SD 4.2] cm) through the countermovement jump (CMJ) and squat jump (SJ) using a contact mat. At the same time, we assessed the athletes using the MyJump2 app. Results: There were no significant differences between the instruments in SJ height (P=.12) and flight time (P=.15). Additionally, there were no significant differences between the instruments for CMJ in jump height (P=.16) and flight time (P=.13). In addition, it was observed that there were significant and strong intraclass correlations in all SJ variables varying from 0.86 to 0.89 (both P<.001), which was classified as ?almost perfect.? Similar results were observed in all variables from the CMJ, varying from 0.92 to 0.96 (both P ?.001). Conclusions: We conclude that the MyJump2 app presents high validity and reliability for measuring jump height and flight time of the SJ and CMJ in CP Football athletes. UR - http://mhealth.jmir.org/2019/1/e11099/ UR - http://dx.doi.org/10.2196/11099 UR - http://www.ncbi.nlm.nih.gov/pubmed/30698529 ID - info:doi/10.2196/11099 ER - TY - JOUR AU - Weichelt, Bryan AU - Bendixsen, Casper AU - Keifer, Matthew PY - 2019/01/29 TI - Farm Owners and Workers as Key Informants in User-Centered Occupational Health Prototype Development: A Stakeholder-Engaged Project JO - J Med Internet Res SP - e9711 VL - 21 IS - 1 KW - agriculture KW - farmworkers KW - injuries KW - occupational medicine KW - return to work KW - software application N2 - Background: The cost of workplace injuries and illnesses significantly impacts the overall cost of health care and is a significant annual economic burden in the United States. Many dairy and pork farm owners in the Upper Midwest have expanded operations and taken on the role of manager and employer yet receive little training in injury prevention, farm safety, or workers? compensation programs and processes. Clinicians play a key role in the return to work of injured and ill farmers and farmworkers to their jobs, though little to no formal training is offered by medical schools. Objective: This stakeholder-engaged project aimed to develop a prototype application designed to assist clinicians in returning injured farmworkers to light-duty job assignments with their current employers and to assess farm owners? and managers? attitudes toward and barriers to adopting mobile health tools for themselves or their employees. Methods: We conducted 12 semistructured interviews with English-speaking farm owners and farmworkers from the Upper Midwest: 5 English-speaking and Spanish-speaking farmworker focus groups and 8 postproject interviews with farm owners that focused on attitudes and barriers to adoption of the developed software. Interviews and focus groups were audio recorded, and data were analyzed and thematically coded using audio coding. Results: Interviews and worker focus groups guided an iterative design and development cycle, which informed workflow design, button placement, and output sheets that offer specific light-duty farm work recommendations for the injured worker to discuss with his or her employer. Conclusions: The development of a complex prototype intended to impact patient care is a significant undertaking. Reinventing a paper-based process that can eventually integrate with an electronic health record or a private company?s human resources system requires substantial stakeholder input from each facet including patients, employers, and clinical care teams. The prototype is available for testing, but further research is needed in the form of clinical trials to assess the effectiveness of the process and the software?s impact on patients and employers. UR - https://www.jmir.org/2019/1/e9711/ UR - http://dx.doi.org/10.2196/jmir.9711 UR - http://www.ncbi.nlm.nih.gov/pubmed/30694202 ID - info:doi/10.2196/jmir.9711 ER - TY - JOUR AU - Song, Ting AU - Qian, Siyu AU - Yu, Ping PY - 2019/01/29 TI - Mobile Health Interventions for Self-Control of Unhealthy Alcohol Use: Systematic Review JO - JMIR Mhealth Uhealth SP - e10899 VL - 7 IS - 1 KW - systematic review KW - alcohol drinking KW - self-control KW - mobile health KW - mHealth KW - treatment outcome N2 - Background: Unhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear. Objective: This study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes. Methods: We systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings ?mHealth,? ?text message,? ?SMS,? ?App,? ?IVR,? ?self-control,? ?self-regulation,? ?alcohol*,? and ?intervention? were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies. Results: In total, 19 studies were included in the review. Of these 19 studies, 12 (63%) mHealth interventions brought significant positive outcomes in improving participants? health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory. Conclusions: Most studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU. UR - http://mhealth.jmir.org/2019/1/e10899/ UR - http://dx.doi.org/10.2196/10899 UR - http://www.ncbi.nlm.nih.gov/pubmed/30694200 ID - info:doi/10.2196/10899 ER - TY - JOUR AU - Lipschitz, Jessica AU - Miller, J. Christopher AU - Hogan, P. Timothy AU - Burdick, E. Katherine AU - Lippin-Foster, Rachel AU - Simon, R. Steven AU - Burgess, James PY - 2019/01/25 TI - Adoption of Mobile Apps for Depression and Anxiety: Cross-Sectional Survey Study on Patient Interest and Barriers to Engagement JO - JMIR Ment Health SP - e11334 VL - 6 IS - 1 KW - mHealth KW - depression KW - anxiety KW - mobile apps KW - patient preference N2 - Background: Emerging research suggests that mobile apps can be used to effectively treat common mental illnesses like depression and anxiety. Despite promising efficacy results and ease of access to these interventions, adoption of mobile health (mHealth; mobile device?delivered) interventions for mental illness has been limited. More insight into patients? perspectives on mHealth interventions is required to create effective implementation strategies and to adapt existing interventions to facilitate higher rates of adoption. Objective: The aim of this study was to examine, from the patient perspective, current use and factors that may impact the use of mHealth interventions for mental illness. Methods: This was a cross-sectional survey study of veterans who had attended an appointment at a single Veterans Health Administration facility in early 2016 that was associated with one of the following mental health concerns: unipolar depression, any anxiety disorder, or posttraumatic stress disorder. We used the Veteran Affairs Corporate Data Warehouse to create subsets of eligible participants demographically stratified by gender (male or female) and minority status (white or nonwhite). From each subset, 100 participants were selected at random and mailed a paper survey with items addressing the demographics, overall health, mental health, technology ownership or use, interest in mobile app interventions for mental illness, reasons for use or nonuse, and interest in specific features of mobile apps for mental illness. Results: Of the 400 potential participants, 149 (37.3%, 149/400) completed and returned a survey. Most participants (79.9%, 119/149) reported that they owned a smart device and that they use apps in general (71.1%, 106/149). Most participants (73.1%, 87/149) reported interest in using an app for mental illness, but only 10.7% (16/149) had done so. Paired samples t tests indicated that ratings of interest in using an app recommended by a clinician were significantly greater than general interest ratings and even greater when the recommending clinician was a specialty mental health provider. The most frequent concerns related to using an app for mental illness were lacking proof of efficacy (71.8%, 107/149), concerns about data privacy (59.1%, 88/149), and not knowing where to find such an app (51.0%, 76/149). Participants expressed interest in a number of app features with particularly high-interest ratings for context-sensitive apps (85.2%, 127/149), and apps focused on the following areas: increasing exercise (75.8%, 113/149), improving sleep (73.2%, 109/149), changing negative thinking (70.5%, 105/149), and increasing involvement in activities (67.1%, 100/149). Conclusions: Most respondents had access to devices to use mobile apps for mental illness, already used apps for other purposes, and were interested in mobile apps for mental illness. Key factors that may improve adoption include provider endorsement, greater publicity of efficacious apps, and clear messaging about efficacy and privacy of information. Finally, multifaceted apps that address a range of concerns, from sleep to negative thought patterns, may be best received. UR - http://mental.jmir.org/2019/1/e11334/ UR - http://dx.doi.org/10.2196/11334 UR - http://www.ncbi.nlm.nih.gov/pubmed/30681968 ID - info:doi/10.2196/11334 ER - TY - JOUR AU - Bardus, Marco AU - Ali, Ahmed AU - Demachkieh, Farah AU - Hamadeh, Ghassan PY - 2019/01/23 TI - Assessing the Quality of Mobile Phone Apps for Weight Management: User-Centered Study With Employees From a Lebanese University JO - JMIR Mhealth Uhealth SP - e9836 VL - 7 IS - 1 KW - mobile apps KW - weight loss KW - physical activity KW - healthy diet KW - workplace KW - mHealth N2 - Background: Evaluating the quality of mobile health apps for weight loss and weight management is important to understand whether these can be used for obesity prevention and treatment. Recent reviews call for more research on multidimensional aspects of app quality, especially involving end users, as there are already many expert reviews on this domain. However, no quantitative study has investigated how laypersons see popular apps for weight management and perceive different dimensions of app quality. Objective: This study aimed to explore how laypersons evaluate the quality of 6 free weight management apps (My Diet Coach, SparkPeople, Lark, MyFitnessPal, MyPlate, and My Diet Diary), which achieved the highest quality ratings in a related and recent expert review. Methods: A user-centered study was conducted with 36 employees of a Lebanese university. Participants enrolled in the study on a rolling basis between October 2016 and March 2017. Participants were randomly assigned an app to use for 2 weeks. App quality was evaluated at the end of the trial period using the Mobile App Rating Scale user version (uMARS). uMARS assesses the dimensions of engagement, functionality, aesthetics, information, and subjective quality on 5-point scales. Internal consistency and interrater agreement were examined. The associations between uMARS scores and users? demographic characteristics were also explored using nonparametric tests. Analyses were completed in November 2017. Results: Overall, the 6 apps were of moderately good quality (median uMARS score 3.6, interquartile range [IQR] 0.3). The highest total uMARS scores were achieved by Lark (mean 4.0 [SD 0.5]) and MyPlate (mean 3.8 [SD 0.4]), which also achieved the highest subjective quality scores (Lark: mean 3.3 [SD 1.4]; MyPlate: mean 3.3 [SD 0.8]). Functionality was the domain with the highest rating (median 3.9, IQR 0.3), followed by aesthetics (median 3.7, IQR 0.5), information (median 3.7, IQR 0.1), and engagement (median 3.3, IQR 0.2). Subjective quality was judged low (median 2.5, IQR 0.9). Overall, subjective quality was strongly and positively related (P<.001) with total uMARS score (?=.75), engagement (?=.68), information, and aesthetics (?=.60) but not functionality (?=.40; P=.02). Higher engagement scores were reported among healthy (P=.003) and obese individuals (P=.03), who also showed higher total uMARS (P=.04) and subjective quality (P=.05) scores. Conclusions: Although the apps were considered highly functional, they were relatively weak in engagement and subjective quality scores, indicating a low propensity of using the apps in the future. As engagement was the subdomain most strongly associated with subjective quality, app developers and researchers should focus on creating engaging apps, holding constant the functionality, aesthetics, and information quality. The tested apps (in particular Lark and MyPlate) were perceived as more engaging and of higher quality among healthy, obese individuals, making them a promising mode of delivery for self-directed interventions promoting weight control among the sampled population or in similar and comparable settings. UR - https://mhealth.jmir.org/2019/1/e9836/ UR - http://dx.doi.org/10.2196/mhealth.9836 UR - http://www.ncbi.nlm.nih.gov/pubmed/30672742 ID - info:doi/10.2196/mhealth.9836 ER - TY - JOUR AU - Goldin, R. Philippe AU - Lindholm, Riku AU - Ranta, Kristian AU - Hilgert, Outi AU - Helteenvuori, Tiia AU - Raevuori, Anu PY - 2019/01/22 TI - Feasibility of a Therapist-Supported, Mobile Phone?Delivered Online Intervention for Depression: Longitudinal Observational Study JO - JMIR Formativ Res SP - e11509 VL - 3 IS - 1 KW - cognitive therapy KW - depression KW - digital health KW - digital therapeutics KW - mindfulness KW - online intervention N2 - Background: Depression is a very common condition that impairs functioning and is often untreated. More than 60% of the treatments for depressive disorder are administered in primary care settings by care providers who lack the time and expertise to treat depression. To address this issue, we developed Ascend, a therapist-supported, mobile phone?delivered 8-week intervention administered at the Meru Health Online Clinic in Finland. Objective: We conducted two pilot studies to examine the feasibility of the Ascend intervention, specifically, dropout rates, daily practice, weekly group chat use, and changes in depression symptoms. We also explored whether daily practice and weekly group chat use were associated with changes in depression symptoms. Methods: A total of 117 Finnish adults with elevated depressive symptoms enrolled in Ascend, a program that included daily cognitive behavioral and mindfulness meditation exercises delivered through a mobile phone app, anonymous group chat with other users, and chat/phone access to a licensed therapist. Eight weekly themes were delivered in a fixed, sequential format. Depression symptoms were measured at baseline, every second week during the intervention, immediately after the intervention, and 4 weeks after completion of the intervention. Data were analyzed using intent-to-treat repeated-measures analysis of variance and linear regression models. Results: For studies 1 and 2, we observed dropout rates of 27% and 15%, respectively, decreasing daily practice and group chat use, and decreased depression symptoms from baseline to immediately and 4 weeks after the intervention (P<.001). We found that both more daily practice and chat group use predicted the occurrence of fewer depressive symptoms at 4 weeks postintervention (Study 1: ?R2=.38, P=.004 and ?R2=.38, P=.002, respectively; Study 2: ?R2=.16, P<.001 and ?R2=.08, P=.002, respectively). Conclusions: This therapist-supported, mobile phone?delivered treatment for depression is feasible and associated with reduced depression symptoms. Design features that enhance daily practice and group chat use are areas of future investigation. Validation of these results using a controlled study design is needed to establish the evidence base for the Ascend intervention. UR - http://formative.jmir.org/2019/1/e11509/ UR - http://dx.doi.org/10.2196/11509 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/11509 ER - TY - JOUR AU - Somers, Camilla AU - Grieve, Eleanor AU - Lennon, Marilyn AU - Bouamrane, Matt-Mouley AU - Mair, S. Frances AU - McIntosh, Emma PY - 2019/01/17 TI - Valuing Mobile Health: An Open-Ended Contingent Valuation Survey of a National Digital Health Program JO - JMIR Mhealth Uhealth SP - e3 VL - 7 IS - 1 KW - mHealth KW - public health KW - delivery of health care KW - public health systems research N2 - Background: Changing population demographics and technology developments have resulted in growing interest in the potential of consumer-facing digital health. In the United Kingdom, a £37 million (US $49 million) national digital health program delivering assisted living lifestyles at scale (dallas) aimed to deploy such technologies at scale. However, little is known about how consumers value such digital health opportunities. Objective: This study explored consumers? perspectives on the potential value of digital health technologies, particularly mobile health (mHealth), to promote well-being by examining their willingness-to-pay (WTP) for such health solutions. Methods: A contingent valuation study involving a UK-wide survey that asked participants to report open-ended absolute and marginal WTP or willingness-to-accept for the gain or loss of a hypothetical mHealth app, Healthy Connections. Results: A UK-representative cohort (n=1697) and a dallas-like (representative of dallas intervention communities) cohort (n=305) were surveyed. Positive absolute and marginal WTP valuations of the app were identified across both cohorts (absolute WTP: UK-representative cohort £196 or US $258 and dallas-like cohort £162 or US $214; marginal WTP: UK-representative cohort £160 or US $211 and dallas-like cohort £151 or US $199). Among both cohorts, there was a high prevalence of zeros for both the absolute WTP (UK-representative cohort: 467/1697, 27.52% and dallas-like cohort: 95/305, 31.15%) and marginal WTP (UK-representative cohort: 487/1697, 28.70% and dallas-like cohort: 99/305, 32.5%). In both cohorts, better general health, previous amount spent on health apps (UK-representative cohort 0.64, 95% CI 0.27 to 1.01; dallas-like cohort: 1.27, 95% CI 0.32 to 2.23), and age had a significant (P>.00) association with WTP (UK-representative cohort: ?0.1, 95% CI ?0.02 to ?0.01; dallas-like cohort: ?0.02, 95% CI ?0.03 to ?0.01), with younger participants willing to pay more for the app. In the UK-representative cohort, as expected, higher WTP was positively associated with income up to £30,000 or US $39,642 (0.21, 95% CI 0.14 to 0.4) and increased spending on existing phone and internet services (0.52, 95% CI 0.30 to 0.74). The amount spent on existing health apps was shown to be a positive indicator of WTP across cohorts, although the effect was marginal (UK-representative cohort 0.01, 95% CI 0.01 to 0.01; dallas-like cohort 0.01, 95% CI 0.01 to 0.02). Conclusions: This study demonstrates that consumers value mHealth solutions that promote well-being, social connectivity, and health care control, but it is not universally embraced. For mHealth to achieve its potential, apps need to be tailored to user accessibility and health needs, and more understanding of what hinders frequent users of digital technologies and those with long-term conditions is required. This novel application of WTP in a digital health context demonstrates an economic argument for investing in upskilling the population to promote access and expedite uptake and utilization of such digital health and well-being apps. UR - http://mhealth.jmir.org/2019/1/e3/ UR - http://dx.doi.org/10.2196/mhealth.9990 UR - http://www.ncbi.nlm.nih.gov/pubmed/30664488 ID - info:doi/10.2196/mhealth.9990 ER - TY - JOUR AU - Cleghorn, Christine AU - Wilson, Nick AU - Nair, Nisha AU - Kvizhinadze, Giorgi AU - Nghiem, Nhung AU - McLeod, Melissa AU - Blakely, Tony PY - 2019/01/15 TI - Health Benefits and Cost-Effectiveness From Promoting Smartphone Apps for Weight Loss: Multistate Life Table Modeling JO - JMIR Mhealth Uhealth SP - e11118 VL - 7 IS - 1 KW - weight loss diet KW - telemedicine KW - smartphone KW - cost-utility analysis KW - life tables KW - quality-adjusted life years N2 - Background: Obesity is an important risk factor for many chronic diseases. Mobile health interventions such as smartphone apps can potentially provide a convenient low-cost addition to other obesity reduction strategies. Objective: This study aimed to estimate the impacts on quality-adjusted life-years (QALYs) gained and health system costs over the remainder of the life span of the New Zealand population (N=4.4 million) for a smartphone app promotion intervention in 1 calendar year (2011) using currently available apps for weight loss. Methods: The intervention was a national mass media promotion of selected smartphone apps for weight loss compared with no dedicated promotion. A multistate life table model including 14 body mass index?related diseases was used to estimate QALYs gained and health systems costs. A lifetime horizon, 3% discount rate, and health system perspective were used. The proportion of the target population receiving the intervention (1.36%) was calculated using the best evidence for the proportion who have access to smartphones, are likely to see the mass media campaign promoting the app, are likely to download a weight loss app, and are likely to continue using this app. Results: In the base-case model, the smartphone app promotion intervention generated 29 QALYs (95% uncertainty interval, UI: 14-52) and cost the health system US $1.6 million (95% UI: 1.1-2.0 million) with the standard download rate. Under plausible assumptions, QALYs increased to 59 (95% UI: 27-107) and costs decreased to US $1.2 million (95% UI: 0.5-1.8) when standard download rates were doubled. Costs per QALY gained were US $53,600 for the standard download rate and US $20,100 when download rates were doubled. On the basis of a threshold of US $30,000 per QALY, this intervention was cost-effective for M?ori when the standard download rates were increased by 50% and also for the total population when download rates were doubled. Conclusions: In this modeling study, the mass media promotion of a smartphone app for weight loss produced relatively small health gains on a population level and was of borderline cost-effectiveness for the total population. Nevertheless, the scope for this type of intervention may expand with increasing smartphone use, more easy-to-use and effective apps becoming available, and with recommendations to use such apps being integrated into dietary counseling by health workers. UR - https://mhealth.jmir.org/2019/1/e11118/ UR - http://dx.doi.org/10.2196/11118 UR - http://www.ncbi.nlm.nih.gov/pubmed/30664471 ID - info:doi/10.2196/11118 ER - TY - JOUR AU - Langford, T. Aisha AU - Solid, A. Craig AU - Scott, Ebony AU - Lad, Meeki AU - Maayan, Eli AU - Williams, K. Stephen AU - Seixas, A. Azizi PY - 2019/01/14 TI - Mobile Phone Ownership, Health Apps, and Tablet Use in US Adults With a Self-Reported History of Hypertension: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e12228 VL - 7 IS - 1 KW - smartphone KW - text messaging KW - health communication KW - ownership KW - goals KW - cell phone KW - telemedicine KW - hypertension KW - tablets KW - chronic disease N2 - Background: Mobile phone and tablet ownership have increased in the United States over the last decade, contributing to the growing use of mobile health (mHealth) interventions to help patients manage chronic health conditions like diabetes. However, few studies have characterized mobile device ownership and the presence of health-related apps on mobile devices in people with a self-reported history of hypertension. Objective: This study aimed to describe the prevalence of smartphone, tablet, and basic mobile phone ownership and the presence of health apps by sociodemographic factors and self-reported hypertension status (ie, history) in a nationally representative sample of US adults, and to describe whether mobile devices are associated with health goal achievement, medical decision making, and patient-provider communication. Methods: Data from 3285 respondents from the 2017 Health Information National Trends Survey were analyzed. Participants were asked if they owned a smartphone, tablet, or basic mobile phone and if they had health apps on a smartphone or tablet. Participants were also asked if their smartphones or tablets helped them achieve a health-related goal like losing weight, make a decision about how to treat an illness, or talk with their health care providers. Chi-square analyses were conducted to test for differences in mobile device ownership, health app presence, and app helpfulness by patient characteristics. Results: Approximately 1460 (37.6% weighted prevalence) participants reported a history of hypertension. Tablet and smartphone ownership were lower in participants with a history of hypertension than in those without a history of hypertension (55% vs 66%, P=.001, and 86% vs 68%, P<.001, respectively). Participants with a history of hypertension were more likely to own a basic mobile phone only as compared to those without a history of hypertension (16% vs 9%, P<.001). Among those with a history of hypertension exclusively, basic mobile phone, smartphone, and tablet ownership were associated with age and education, but not race or sex. Older adults were more likely to report having a basic mobile phone only, whereas those with higher education were more likely to report owning a tablet or smartphone. Compared to those without a history of hypertension, participants with a history of hypertension were less likely to have health-related apps on their smartphones or tablets (45% vs 30%, P<.001) and report that mobile devices helped them achieve a health-related goal (72% vs 63%, P=.01). Conclusions: Despite the increasing use of smartphones, tablets, and health-related apps, these tools are used less among people with a self-reported history of hypertension. To reach the widest cross-section of patients, a mix of novel mHealth interventions and traditional health communication strategies (eg, print, web based, and in person) are needed to support the diverse needs of people with a history of hypertension. UR - http://mhealth.jmir.org/2019/1/e12228/ UR - http://dx.doi.org/10.2196/12228 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344667 ID - info:doi/10.2196/12228 ER - TY - JOUR AU - Follmann, Andreas AU - Ohligs, Marian AU - Hochhausen, Nadine AU - Beckers, K. Stefan AU - Rossaint, Rolf AU - Czaplik, Michael PY - 2019/01/03 TI - Technical Support by Smart Glasses During a Mass Casualty Incident: A Randomized Controlled Simulation Trial on Technically Assisted Triage and Telemedical App Use in Disaster Medicine JO - J Med Internet Res SP - e11939 VL - 21 IS - 1 KW - augmented reality KW - disaster medicine KW - emergency medical service physician KW - mass casualty incident KW - Smart Glasses KW - telemedicine KW - triage N2 - Background: To treat many patients despite lacking personnel resources, triage is important in disaster medicine. Various triage algorithms help but often are used incorrectly or not at all. One potential problem-solving approach is to support triage with Smart Glasses. Objective: In this study, augmented reality was used to display a triage algorithm and telemedicine assistance was enabled to compare the duration and quality of triage with a conventional one. Methods: A specific Android app was designed for use with Smart Glasses, which added information in terms of augmented reality with two different methods?through the display of a triage algorithm in data glasses and a telemedical connection to a senior emergency physician realized by the integrated camera. A scenario was created (ie, randomized simulation study) in which 31 paramedics carried out a triage of 12 patients in 3 groups as follows: without technical support (control group), with a triage algorithm display, and with telemedical contact. Results: A total of 362 assessments were performed. The accuracy in the control group was only 58%, but the assessments were quicker (on average 16.6 seconds). In contrast, an accuracy of 92% (P=.04) was achieved when using technical support by displaying the triage algorithm. This triaging took an average of 37.0 seconds. The triage group wearing data glasses and being telemedically connected achieved 90% accuracy (P=.01) in 35.0 seconds. Conclusions: Triage with data glasses required markedly more time. While only a tally was recorded in the control group, Smart Glasses led to digital capture of the triage results, which have many tactical advantages. We expect a high potential in the application of Smart Glasses in disaster scenarios when using telemedicine and augmented reality features to improve the quality of triage. UR - https://www.jmir.org/2019/1/e11939/ UR - http://dx.doi.org/10.2196/11939 UR - http://www.ncbi.nlm.nih.gov/pubmed/30609988 ID - info:doi/10.2196/11939 ER - TY - JOUR AU - Pham, Quynh AU - Graham, Gary AU - Lalloo, Chitra AU - Morita, P. Plinio AU - Seto, Emily AU - Stinson, N. Jennifer AU - Cafazzo, A. Joseph PY - 2018/12/21 TI - An Analytics Platform to Evaluate Effective Engagement With Pediatric Mobile Health Apps: Design, Development, and Formative Evaluation JO - JMIR Mhealth Uhealth SP - e11447 VL - 6 IS - 12 KW - analytics KW - engagement KW - log data KW - mobile health KW - mobile apps KW - chronic disease N2 - Background: Mobile health (mHealth) apps for pediatric chronic conditions are growing in availability and challenge investigators to conduct rigorous evaluations that keep pace with mHealth innovation. Traditional research methods are poorly suited to operationalize the agile, iterative trials required to evidence and optimize these digitally mediated interventions. Objective: We sought to contribute a resource to support the quantification, analysis, and visualization of analytic indicators of effective engagement with mHealth apps for chronic conditions. Methods: We applied user-centered design methods to design and develop an Analytics Platform to Evaluate Effective Engagement (APEEE) with consumer mHealth apps for chronic conditions and implemented the platform to analyze both retrospective and prospective data generated from a smartphone-based pain self-management app called iCanCope for young people with chronic pain. Results: Through APEEE, we were able to automate the process of defining, operationalizing, and evaluating effective engagement with iCanCope. Configuring the platform to integrate with the app was feasible and provided investigators with a resource to consolidate, analyze, and visualize engagement data generated by participants in real time. Preliminary efforts to evaluate APEEE showed that investigators perceived the platform to be an acceptable evaluative resource and were satisfied with its design, functionality, and performance. Investigators saw potential in APEEE to accelerate and augment evidence generation and expressed enthusiasm for adopting the platform to support their evaluative practice once fully implemented. Conclusions: Dynamic, real-time analytic platforms may provide investigators with a powerful means to characterize the breadth and depth of mHealth app engagement required to achieve intended health outcomes. Successful implementation of APEEE into evaluative practice may contribute to the realization of effective and evidence-based mHealth care. UR - http://mhealth.jmir.org/2018/12/e11447/ UR - http://dx.doi.org/10.2196/11447 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578179 ID - info:doi/10.2196/11447 ER - TY - JOUR AU - Tong, Ly Huong AU - Coiera, Enrico AU - Laranjo, Liliana PY - 2018/12/21 TI - Using a Mobile Social Networking App to Promote Physical Activity: A Qualitative Study of Users? Perspectives JO - J Med Internet Res SP - e11439 VL - 20 IS - 12 KW - exercise KW - fitness trackers KW - mobile apps KW - mobile phone KW - social networking N2 - Background: Despite many health benefits of physical activity, nearly a third of the world?s adult population is insufficiently active. Technological interventions, such as mobile apps, wearable trackers, and Web-based social networks, offer great promise in promoting physical activity, but little is known about users? acceptability and long-term engagement with these interventions. Objective: The aim of this study was to understand users? perspectives regarding a mobile social networking intervention to promote physical activity. Methods: Participants, mostly university students and staff, were recruited using purposive sampling techniques. Participants were enrolled in a 6-month feasibility study where they were provided with a wearable physical activity tracker (Fitbit Flex 2) and a wireless scale (Fitbit Aria) integrated with a social networking mobile app (named ?fit.healthy.me?). We conducted semistructured, in-depth qualitative interviews and focus groups pre- and postintervention, which were recorded and transcribed verbatim. The data were analyzed in Nvivo 11 using thematic analysis techniques. Results: In this study, 55 participants were enrolled; 51% (28/55) were females, and the mean age was 23.6 (SD 4.6) years. The following 3 types of factors emerged from the data as influencing engagement with the intervention and physical activity: individual (self-monitoring of behavior, goal setting, and feedback on behavior), social (social comparison, similarity and familiarity between users, and participation from other users in the network), and technological. In addition, automation and personalization were observed as enhancing the delivery of both individual and social aspects. Technological limitations were mentioned as potential barriers to long-term usage. Conclusions: Self-regulatory techniques and social factors are important to consider when designing a physical activity intervention, but a one-size-fits-all approach is unlikely to satisfy different users? preferences. Future research should adopt innovative research designs to test interventions that can adapt and respond to users? needs and preferences throughout time. UR - https://www.jmir.org/2018/12/e11439/ UR - http://dx.doi.org/10.2196/11439 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578201 ID - info:doi/10.2196/11439 ER - TY - JOUR AU - Jaimini, Utkarshani AU - Thirunarayan, Krishnaprasad AU - Kalra, Maninder AU - Venkataraman, Revathy AU - Kadariya, Dipesh AU - Sheth, Amit PY - 2018/11/30 TI - ?How Is My Child?s Asthma?? Digital Phenotype and Actionable Insights for Pediatric Asthma JO - JMIR Pediatr Parent SP - e11988 VL - 1 IS - 2 KW - digital phenotype KW - actionable insights KW - asthma control level KW - asthma control test KW - digital phenotype score KW - controller compliance score KW - mobile health N2 - Background: In the traditional asthma management protocol, a child meets with a clinician infrequently, once in 3 to 6 months, and is assessed using the Asthma Control Test questionnaire. This information is inadequate for timely determination of asthma control, compliance, precise diagnosis of the cause, and assessing the effectiveness of the treatment plan. The continuous monitoring and improved tracking of the child?s symptoms, activities, sleep, and treatment adherence can allow precise determination of asthma triggers and a reliable assessment of medication compliance and effectiveness. Digital phenotyping refers to moment-by-moment quantification of the individual-level human phenotype in situ using data from personal digital devices, in particular, mobile phones. The kHealth kit consists of a mobile app, provided on an Android tablet, that asks timely and contextually relevant questions related to asthma symptoms, medication intake, reduced activity because of symptoms, and nighttime awakenings; a Fitbit to monitor activity and sleep; a Microlife Peak Flow Meter to monitor the peak expiratory flow and forced exhaled volume in 1 second; and a Foobot to monitor indoor air quality. The kHealth cloud stores personal health data and environmental data collected using Web services. The kHealth Dashboard interactively visualizes the collected data. Objective: The objective of this study was to discuss the usability and feasibility of collecting clinically relevant data to help clinicians diagnose or intervene in a child?s care plan by using the kHealth system for continuous and comprehensive monitoring of child?s symptoms, activity, sleep pattern, environmental triggers, and compliance. The kHealth system helps in deriving actionable insights to help manage asthma at both the personal and cohort levels. The Digital Phenotype Score and Controller Compliance Score introduced in the study are the basis of ongoing work on addressing personalized asthma care and answer questions such as, ?How can I help my child better adhere to care instructions and reduce future exacerbation?? Methods: The Digital Phenotype Score and Controller Compliance Score summarize the child?s condition from the data collected using the kHealth kit to provide actionable insights. The Digital Phenotype Score formalizes the asthma control level using data about symptoms, rescue medication usage, activity level, and sleep pattern. The Compliance Score captures how well the child is complying with the treatment protocol. We monitored and analyzed data for 95 children, each recruited for a 1- or 3-month-long study. The Asthma Control Test scores obtained from the medical records of 57 children were used to validate the asthma control levels calculated using the Digital Phenotype Scores. Results: At the cohort level, we found asthma was very poorly controlled in 37% (30/82) of the children, not well controlled in 26% (21/82), and well controlled in 38% (31/82). Among the very poorly controlled children (n=30), we found 30% (9/30) were highly compliant toward their controller medication intake?suggesting a re-evaluation for change in medication or dosage?whereas 50% (15/30) were poorly compliant and candidates for a more timely intervention to improve compliance to mitigate their situation. We observed a negative Kendall Tau correlation between Asthma Control Test scores and Digital Phenotype Score as ?0.509 (P<.01). Conclusions: kHealth kit is suitable for the collection of clinically relevant information from pediatric patients. Furthermore, Digital Phenotype Score and Controller Compliance Score, computed based on the continuous digital monitoring, provide the clinician with timely and detailed evidence of a child?s asthma-related condition when compared with the Asthma Control Test scores taken infrequently during clinic visits. UR - http://pediatrics.jmir.org/2018/2/e11988/ UR - http://dx.doi.org/10.2196/11988 UR - http://www.ncbi.nlm.nih.gov/pubmed/31008446 ID - info:doi/10.2196/11988 ER - TY - JOUR AU - Reddy, Kondama Ravi AU - Pooni, Rubin AU - Zaharieva, P. Dessi AU - Senf, Brian AU - El Youssef, Joseph AU - Dassau, Eyal AU - Doyle III, J. Francis AU - Clements, A. Mark AU - Rickels, R. Michael AU - Patton, R. Susana AU - Castle, R. Jessica AU - Riddell, C. Michael AU - Jacobs, G. Peter PY - 2018/12/10 TI - Accuracy of Wrist-Worn Activity Monitors During Common Daily Physical Activities and Types of Structured Exercise: Evaluation Study JO - JMIR Mhealth Uhealth SP - e10338 VL - 6 IS - 12 KW - heart rate KW - energy metabolism KW - fitness trackers KW - high-intensity interval training KW - artificial pancreas N2 - Background: Wrist-worn activity monitors are often used to monitor heart rate (HR) and energy expenditure (EE) in a variety of settings including more recently in medical applications. The use of real-time physiological signals to inform medical systems including drug delivery systems and decision support systems will depend on the accuracy of the signals being measured, including accuracy of HR and EE. Prior studies assessed accuracy of wearables only during steady-state aerobic exercise. Objective: The objective of this study was to validate the accuracy of both HR and EE for 2 common wrist-worn devices during a variety of dynamic activities that represent various physical activities associated with daily living including structured exercise. Methods: We assessed the accuracy of both HR and EE for two common wrist-worn devices (Fitbit Charge 2 and Garmin vívosmart HR+) during dynamic activities. Over a 2-day period, 20 healthy adults (age: mean 27.5 [SD 6.0] years; body mass index: mean 22.5 [SD 2.3] kg/m2; 11 females) performed a maximal oxygen uptake test, free-weight resistance circuit, interval training session, and activities of daily living. Validity was assessed using an HR chest strap (Polar) and portable indirect calorimetry (Cosmed). Accuracy of the commercial wearables versus research-grade standards was determined using Bland-Altman analysis, correlational analysis, and error bias. Results: Fitbit and Garmin were reasonably accurate at measuring HR but with an overall negative bias. There was more error observed during high-intensity activities when there was a lack of repetitive wrist motion and when the exercise mode indicator was not used. The Garmin estimated HR with a mean relative error (RE, %) of ?3.3% (SD 16.7), whereas Fitbit estimated HR with an RE of ?4.7% (SD 19.6) across all activities. The highest error was observed during high-intensity intervals on bike (Fitbit: ?11.4% [SD 35.7]; Garmin: ?14.3% [SD 20.5]) and lowest error during high-intensity intervals on treadmill (Fitbit: ?1.7% [SD 11.5]; Garmin: ?0.5% [SD 9.4]). Fitbit and Garmin EE estimates differed significantly, with Garmin having less negative bias (Fitbit: ?19.3% [SD 28.9], Garmin: ?1.6% [SD 30.6], P<.001) across all activities, and with both correlating poorly with indirect calorimetry measures. Conclusions: Two common wrist-worn devices (Fitbit Charge 2 and Garmin vívosmart HR+) show good HR accuracy, with a small negative bias, and reasonable EE estimates during low to moderate-intensity exercise and during a variety of common daily activities and exercise. Accuracy was compromised markedly when the activity indicator was not used on the watch or when activities involving less wrist motion such as cycle ergometry were done. UR - https://mhealth.jmir.org/2018/12/e10338/ UR - http://dx.doi.org/10.2196/10338 UR - http://www.ncbi.nlm.nih.gov/pubmed/30530451 ID - info:doi/10.2196/10338 ER - TY - JOUR AU - Lefler, L. Leanne AU - Rhoads, J. Sarah AU - Harris, Melodee AU - Funderburg, E. Ashley AU - Lubin, A. Sandra AU - Martel, D. Isis AU - Faulkner, L. Jennifer AU - Rooker, L. Janet AU - Bell, K. Deborah AU - Marshall, Heather AU - Beverly, J. Claudia PY - 2018/12/04 TI - Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study JO - JMIR Aging SP - e12178 VL - 1 IS - 2 KW - heart failure KW - remote monitoring KW - mHealth KW - older adults KW - feasibility KW - self-management N2 - Background: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. Objective: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. Methods: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. Results: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. Conclusions: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF. UR - http://aging.jmir.org/2018/2/e12178/ UR - http://dx.doi.org/10.2196/12178 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518257 ID - info:doi/10.2196/12178 ER - TY - JOUR AU - Pant Pai, Nitika AU - Smallwood, Megan AU - Desjardins, Laurence AU - Goyette, Alexandre AU - Birkas, G. Krisztian AU - Vassal, Anne-Fanny AU - Joseph, Lawrence AU - Thomas, Réjean PY - 2018/11/27 TI - An Unsupervised Smart App?Optimized HIV Self-Testing Program in Montreal, Canada: Cross-Sectional Study JO - J Med Internet Res SP - e10258 VL - 20 IS - 11 KW - feasibility KW - HIV KW - impact KW - mobile phone KW - MSM KW - self-testing N2 - Background: Although HIV self-testing strategies have been recommended by the World Health Organization, HIV self-tests are not yet approved in Canada. Currently approved HIV self-tests offer toll-free lines that are insufficient for initiating expedited linkages to counseling and care, accurate interpretation, and support during HIV self-testing. We developed an innovative, multilingual software app called HIVSmart! to plug these gaps. Objective: This study aimed to test our app-optimized oral HIV self-testing strategy for feasibility in men who have sex with men (MSM) who presented to test at a large sexual health clinic (Clinique Médicale L?Actuel) in Montreal. Methods: Between July 2016 and February 2017, we offered a strategy consisting of the OraQuick In-Home HIV Test (an investigational device) and a tablet installed with the HIVSmart! app to study participants, who presented at a private office in the clinic, mimicking an unsupervised home environment. We evaluated the strategy for its feasibility, acceptability, and preference. Using the HIVSmart! app, participants were guided through the self-testing process. We determined feasibility with a metric defined as the completion rate, which consisted of the following 3 steps: (1) self-test conduct; (2) self-test interpretation; and (3) linkages to care. Participants independently performed, interpreted, recorded their self-test and result, engaged in pre- and posttest counseling, and sought linkages to care. Laboratory tests (p24, Western Blot, and RNA), as per country algorithms, were expedited, and linkages based on the rapid test status were arranged. Results: Mean age of the 451 participants enrolled was 34 (range, 18-73) years. Of all participants, 97.1% (438/451) completed and submitted the survey through the HIVSmart! app. In total, 84.7% (371/438) of the participants were well educated (beyond high school) and 52.5% (230/438) had been tested within the past 6 months. Of the 451, 11.5% (52/451) were on pre-exposure prophylaxis. Feasibility (completion rate), an average proportion of the 3 steps, was computed to be 96.6% (419/451). The acceptability of the strategy was high at 98.5% (451/458). A majority of the participants (448/451, 99.3%) were found to be self-tested and lab-confirmed negative and were counseled after self- and rapid tests. In total, 0.7% (3/451) of the participants who self-tested positive and were lab-confirmed positive were linked to a physician within the same day. Furthermore, 98.8% (417/422) of the participants found the app to be useful and 94.0% (424/451) were willing to recommend it to a friend or partner. Conclusions: The HIVSmart! app-optimized strategy was feasible, accepted, and preferred by an educated, urban MSM population of Montreal. With the app, participants were able to perform, interpret, store results, and get rapidly linked to care. The HIVSmart!-optimized, self-testing strategy could be adapted and contextualized to many at-risk populations within Canada and worldwide, thereby maximizing its public health impact. UR - http://www.jmir.org/2018/11/e10258/ UR - http://dx.doi.org/10.2196/10258 UR - http://www.ncbi.nlm.nih.gov/pubmed/30465709 ID - info:doi/10.2196/10258 ER - TY - JOUR AU - Plante, B. Timothy AU - O'Kelly, C. Anna AU - Urrea, Bruno AU - Macfarlane, T. Zane AU - Appel, J. Lawrence AU - Miller III, R. Edgar AU - Blumenthal, S. Roger AU - Martin, S. Seth PY - 2018/11/21 TI - Auralife Instant Blood Pressure App in Measuring Resting Heart Rate: Validation Study JO - JMIR Biomed Eng SP - e11057 VL - 3 IS - 1 KW - mHealth KW - digital health KW - heart rate KW - validation study KW - photoplethysmography KW - medical informatics KW - mobile phones N2 - Background: mHealth apps that measure heart rate using pulse photoplethysmography (PPG) are classified as class II (moderate-risk) Food and Drug Administration devices; therefore, these devices need clinical validation prior to public release. The Auralife Instant Blood Pressure app (AuraLife IBP app) is an mHealth app that measures blood pressure inaccurately based on a previous validation study. Its ability to measure heart rate has not been previously reported. Objective: The objective of our study was to assess the accuracy and precision of the AuraLife IBP app in measuring heart rate. Methods: We enrolled 85 adults from ambulatory clinics. Two measurements were obtained using the AuraLife IBP app, and 2 other measurements were achieved with a oscillometric device. The order of devices was randomized. Accuracy was assessed by calculating the relative and absolute mean differences between heart rate measurements obtained using each AuraLife IBP app and an average of both standard heart rate measurements. Precision was assessed by calculating the relative and absolute mean differences between individual measurements in the pair for each device. Results: The relative and absolute mean (SD) differences between the devices were 1.1 (3.5) and 2.8 (2.4) beats per minute (BPM), respectively. Meanwhile, the within-device relative and absolute mean differences, respectively, were <0.1 (2.2) and 1.7 (1.4) BPM for the standard device and ?0.1 (3.2) and 2.2 (2.3) BPM for the AuraLife IBP app. Conclusions: The AuraLife IBP app had a high degree of accuracy and precision in the measurement of heart rate. This supports the use of PPG technology in smartphones for monitoring resting heart rate. UR - http://biomedeng.jmir.org/2018/1/e11057/ UR - http://dx.doi.org/10.2196/11057 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/11057 ER - TY - JOUR AU - Hsieh, L. Katherine AU - Fanning, T. Jason AU - Rogers, A. Wendy AU - Wood, A. Tyler AU - Sosnoff, J. Jacob PY - 2018/11/20 TI - A Fall Risk mHealth App for Older Adults: Development and Usability Study JO - JMIR Aging SP - e11569 VL - 1 IS - 2 KW - usability KW - fall risk KW - mHealth app KW - mobile phone N2 - Background: Falls are the leading cause of injury-related death in older adults. Due to various constraints, objective fall risk screening is seldom performed in clinical settings. Smartphones offer a high potential to provide fall risk screening for older adults in home settings. However, there is limited understanding of whether smartphone technology for falls screening is usable by older adults who present age-related changes in perceptual, cognitive, and motor capabilities. Objective: The aims of this study were to develop a fall risk mobile health (mHealth) app and to determine the usability of the fall risk app in healthy, older adults. Methods: A fall risk app was developed that consists of a health history questionnaire and 5 progressively challenging mobility tasks to measure individual fall risk. An iterative design-evaluation process of semistructured interviews was performed to determine the usability of the app on a smartphone and tablet. Participants also completed a Systematic Usability Scale (SUS). In the first round of interviews, 6 older adults participated, and in the second round, 5 older adults participated. Interviews were videotaped and transcribed, and the data were coded to create themes. Average SUS scores were calculated for the smartphone and tablet. Results: There were 2 themes identified from the first round of interviews, related to perceived ease of use and perceived usefulness. While instructions for the balance tasks were difficult to understand, participants found it beneficial to learn about their risk for falls, found the app easy to follow, and reported confidence in using the app on their own. Modifications were made to the app, and following the second round of interviews, participants reported high ease of use and usefulness in learning about their risk of falling. Few differences were reported between using a smartphone or tablet. Average SUS scores ranged from 79 to 84. Conclusions: Our fall risk app was found to be highly usable by older adults as reported from interviews and high scores on the SUS. When designing a mHealth app for older adults, developers should include clear and simple instructions and preventative strategies to improve health. Furthermore, if the design accommodates for age-related sensory changes, smartphones can be as effective as tablets. A mobile app to assess fall risk has the potential to be used in home settings by older adults. UR - http://aging.jmir.org/2018/2/e11569/ UR - http://dx.doi.org/10.2196/11569 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518234 ID - info:doi/10.2196/11569 ER - TY - JOUR AU - Rahman, Abidur Quazi AU - Janmohamed, Tahir AU - Pirbaglou, Meysam AU - Clarke, Hance AU - Ritvo, Paul AU - Heffernan, M. Jane AU - Katz, Joel PY - 2018/11/15 TI - Defining and Predicting Pain Volatility in Users of the Manage My Pain App: Analysis Using Data Mining and Machine Learning Methods JO - J Med Internet Res SP - e12001 VL - 20 IS - 11 KW - chronic pain KW - pain volatility KW - data mining KW - cluster analysis KW - machine learning KW - prediction model KW - Manage My Pain KW - pain app N2 - Background: Measuring and predicting pain volatility (fluctuation or variability in pain scores over time) can help improve pain management. Perceptions of pain and its consequent disabling effects are often heightened under the conditions of greater uncertainty and unpredictability associated with pain volatility. Objective: This study aimed to use data mining and machine learning methods to (1) define a new measure of pain volatility and (2) predict future pain volatility levels from users of the pain management app, Manage My Pain, based on demographic, clinical, and app use features. Methods: Pain volatility was defined as the mean of absolute changes between 2 consecutive self-reported pain severity scores within the observation periods. The k-means clustering algorithm was applied to users? pain volatility scores at the first and sixth month of app use to establish a threshold discriminating low from high volatility classes. Subsequently, we extracted 130 demographic, clinical, and app usage features from the first month of app use to predict these 2 volatility classes at the sixth month of app use. Prediction models were developed using 4 methods: (1) logistic regression with ridge estimators; (2) logistic regression with Least Absolute Shrinkage and Selection Operator; (3) Random Forests; and (4) Support Vector Machines. Overall prediction accuracy and accuracy for both classes were calculated to compare the performance of the prediction models. Training and testing were conducted using 5-fold cross validation. A class imbalance issue was addressed using a random subsampling of the training dataset. Users with at least five pain records in both the predictor and outcome periods (N=782 users) are included in the analysis. Results: k-means clustering algorithm was applied to pain volatility scores to establish a threshold of 1.6 to differentiate between low and high volatility classes. After validating the threshold using random subsamples, 2 classes were created: low volatility (n=611) and high volatility (n=171). In this class-imbalanced dataset, all 4 prediction models achieved 78.1% (611/782) to 79.0% (618/782) in overall accuracy. However, all models have a prediction accuracy of less than 18.7% (32/171) for the high volatility class. After addressing the class imbalance issue using random subsampling, results improved across all models for the high volatility class to greater than 59.6% (102/171). The prediction model based on Random Forests performs the best as it consistently achieves approximately 70% accuracy for both classes across 3 random subsamples. Conclusions: We propose a novel method for measuring pain volatility. Cluster analysis was applied to divide users into subsets of low and high volatility classes. These classes were then predicted at the sixth month of app use with an acceptable degree of accuracy using machine learning methods based on the features extracted from demographic, clinical, and app use information from the first month. UR - http://www.jmir.org/2018/11/e12001/ UR - http://dx.doi.org/10.2196/12001 UR - http://www.ncbi.nlm.nih.gov/pubmed/30442636 ID - info:doi/10.2196/12001 ER - TY - JOUR AU - Liang, Jun AU - Xian, Deqiang AU - Liu, Xingyu AU - Fu, Jing AU - Zhang, Xingting AU - Tang, Buzhou AU - Lei, Jianbo PY - 2018/11/08 TI - Usability Study of Mainstream Wearable Fitness Devices: Feature Analysis and System Usability Scale Evaluation JO - JMIR Mhealth Uhealth SP - e11066 VL - 6 IS - 11 KW - wearable devices KW - usability KW - System Usability Scale KW - function comparison KW - fitness N2 - Background: Wearable devices have the potential to promote a healthy lifestyle because of their real-time data monitoring capabilities. However, device usability is a critical factor that determines whether they will be adopted on a large scale. Usability studies on wearable devices are still scarce. Objective: This study aims to compare the functions and attributes of seven mainstream wearable devices and to evaluate their usability. Methods: The wearable devices selected were the Apple Watch, Samsung Gear S, Fitbit Surge, Jawbone Up3, Mi Band, Huawei Honor B2, and Misfit Shine. A mixed method of feature comparison and a System Usability Scale (SUS) evaluation based on 388 participants was applied; the higher the SUS score, the better the usability of the product. Results: For features, all devices had step counting, an activity timer, and distance recording functions. The Samsung Gear S had a unique sports track recording feature and the Huawei Honor B2 had a unique wireless earphone. The Apple Watch, Samsung Gear S, Jawbone Up3, and Fitbit Surge could measure heart rate. All the devices were able to monitor sleep, except the Apple Watch. For product characteristics, including attributes such as weight, battery life, price, and 22 functions such as step counting, activity time, activity type identification, sleep monitoring, and expandable new features, we found a very weak negative correlation between the SUS scores and price (r=?.10, P=.03) and devices that support expandable new features (r=?.11, P=.02), and a very weak positive correlation between the SUS scores and devices that support the activity type identification function (r=.11, P=.02). The Huawei Honor B2 received the highest score of mean 67.6 (SD 16.1); the lowest Apple Watch score was only 61.4 (SD 14.7). No significant difference was observed among brands. The SUS score had a moderate positive correlation with the user?s experience (length of time the device was used) (r=.32, P<.001); participants in the medical and health care industries gave a significantly higher score (mean 61.1, SD 17.9 vs mean 68.7, SD 14.5, P=.03). Conclusions: The functions of wearable devices tend to be homogeneous and usability is similar across various brands. Overall, Mi Band had the lowest price and the lightest weight. Misfit Shine had the longest battery life and most functions, and participants in the medical and health care industries had the best evaluation of wearable devices. The perceived usability of mainstream wearable devices is unsatisfactory and customer loyalty is not high. A consumer?s SUS rating for a wearable device is related to their personal situation instead of the device brand. Device manufacturers should put more effort into developing innovative functions and improving the usability of their products by integrating more cognitive behavior change techniques. UR - http://mhealth.jmir.org/2018/11/e11066/ UR - http://dx.doi.org/10.2196/11066 UR - http://www.ncbi.nlm.nih.gov/pubmed/30409767 ID - info:doi/10.2196/11066 ER - TY - JOUR AU - Loh, Poh Kah AU - Ramsdale, Erika AU - Culakova, Eva AU - Mendler, H. Jason AU - Liesveld, L. Jane AU - O'Dwyer, M. Kristen AU - McHugh, Colin AU - Gilles, Maxence AU - Lloyd, Terri AU - Goodman, Molly AU - Klepin, D. Heidi AU - Mustian, M. Karen AU - Schnall, Rebecca AU - Mohile, G. Supriya PY - 2018/10/29 TI - Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study JO - JMIR Cancer SP - e10296 VL - 4 IS - 2 KW - Mobile health application KW - geriatric assessment KW - older adults KW - cancer N2 - Background: Older patients with cancer are at an increased risk of adverse outcomes. A geriatric assessment (GA) is a compilation of reliable and validated tools to assess domains that are predictors of morbidity and mortality, and it can be used to guide interventions. However, the implementation of GA and GA-driven interventions is low due to resource and time limitations. GA-driven interventions delivered through a mobile app may support the complex needs of older patients with cancer and their caregivers. Objective: We aimed to evaluate the feasibility and usability of a novel app (TouchStream) and to identify barriers to its use. As an exploratory aim, we gathered preliminary data on symptom burden, health care utilization, and satisfaction. Methods: In a single-site pilot study, we included patients aged ?65 years undergoing treatment for systemic cancer and their caregivers. TouchStream consists of a mobile app and a Web portal. Patients underwent a GA at baseline with the study team (on paper), and the results were used to guide interventions delivered through the app. A tablet preloaded with the app was provided for use at home for 4 weeks. Feasibility metrics included usability (system usability scale of >68 is considered above average), recruitment, retention (number of subjects consented who completed postintervention assessments), and percentage of days subjects used the app. For the last 8 patients, we assessed their symptom burden (severity and interference with 17-items scored from 0-10 where a higher score indicates worse symptoms) using a clinical symptom inventory, health care utilization from the electronic medical records, and satisfaction (6 items scored on a 5-point Likert Scale for both patients and caregivers where a higher score indicates higher satisfaction) using a modified satisfaction survey. Barriers to use were elicited through interviews. Results: A total of 18 patients (mean age 76.8, range 68-87) and 13 caregivers (mean age 69.8, range 38-81) completed the baseline assessment. Recruitment and retention rates were 67% and 80%, respectively. The mean SUS score was 74.0 for patients and 72.2 for caregivers. Mean percentage of days the TouchStream app was used was 78.7%. Mean symptom severity and interference scores were 1.6 and 2.8 at preintervention, and 0.9 and 1.5 at postintervention, respectively. There was a total of 27 clinic calls during the intervention period and 15 during the postintervention period (week 5-8). One patient was hospitalized during the intervention period (week 1-4) and two patients during the postintervention period (week 5-8). Mean satisfaction scores of patients and caregivers with the mobile app were 20.4 and 23.4, respectively. Barriers fell into 3 themes: general experience, design, and functionality. Conclusions: TouchStream is feasible and usable for older patients on cancer treatment and their caregivers. Future studies should evaluate the effects of the TouchStream on symptoms and health care utilization in a randomized fashion. UR - http://cancer.jmir.org/2018/2/e10296/ UR - http://dx.doi.org/10.2196/10296 UR - http://www.ncbi.nlm.nih.gov/pubmed/30373733 ID - info:doi/10.2196/10296 ER - TY - JOUR AU - Thurnheer, E. Simon AU - Gravestock, Isaac AU - Pichierri, Giuseppe AU - Steurer, Johann AU - Burgstaller, M. Jakob PY - 2018/10/22 TI - Benefits of Mobile Apps in Pain Management: Systematic Review JO - JMIR Mhealth Uhealth SP - e11231 VL - 6 IS - 10 KW - mobile application KW - pain KW - pain management KW - smartphone KW - cell phone KW - telemedicine KW - review N2 - Background: Pain is a common condition with a significant physical, psychosocial, and economic impact. Due to enormous progress in mobile device technology as well as the increase in smartphone ownership in the general population, mobile apps can be used to monitor patients with pain and support them in pain management. Objective: The aim of this review was to assess the efficacy of smartphone or computer tablet apps in the management of patients with pain. Methods: In December 2017, a literature search was performed in the following databases: MEDLINE, EMBASE, CINAHL, Cochrane, and PsycINFO. In addition, a bibliography search was conducted. We included studies with at least 20 participants per arm that evaluated the effects of apps on smartphones or computer tablets on improvement in pain. Results: A total of 15 studies with 1962 patients met the inclusion criteria. Of these, 4 studies examined the effect of mobile apps on pain management in an in-clinic setting and 11 in an out-clinic setting. The majority of the original studies reported beneficial effects of the use of a pain app. Severity of pain decreased in most studies where patients were using an app compared with patients not using an app. Other outcomes, such as worst pain or quality of life showed improvements in patients using an app. Due to heterogeneity between the original studies?patient characteristics, app content, and study setting?a synthesis of the results by statistical methods was not performed. Conclusions: Apps for pain management may be beneficial for patients, particularly in an out-clinic setting. Studies have shown that pain apps are workable and well liked by patients and health care professionals. There is no doubt that in the near future, mobile technologies will develop further. Medicine could profit from this development as indicated by our results, but there is a need for more scientific inputs. It is desirable to know which elements of apps or additional devices and tools may improve usability and help patients in pain management. UR - http://mhealth.jmir.org/2018/10/e11231/ UR - http://dx.doi.org/10.2196/11231 UR - http://www.ncbi.nlm.nih.gov/pubmed/30348633 ID - info:doi/10.2196/11231 ER - TY - JOUR AU - Bashi, Nazli AU - Fatehi, Farhad AU - Fallah, Mina AU - Walters, Darren AU - Karunanithi, Mohanraj PY - 2018/10/19 TI - Self-Management Education Through mHealth: Review of Strategies and Structures JO - JMIR Mhealth Uhealth SP - e10771 VL - 6 IS - 10 KW - health education KW - mHealth KW - mobile apps KW - mobile phone KW - patient education KW - self-management education N2 - Background: Despite the plethora of evidence on mHealth interventions for patient education, there is a lack of information regarding their structures and delivery strategies. Objective: This review aimed to investigate the structures and strategies of patient education programs delivered through smartphone apps for people with diverse conditions and illnesses. We also examined the aim of educational interventions in terms of health promotion, disease prevention, and illness management. Methods: We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and PsycINFO for peer-reviewed papers that reported patient educational interventions using mobile apps and published from 2006 to 2016. We explored various determinants of educational interventions, including the content, mode of delivery, interactivity with health care providers, theoretical basis, duration, and follow-up. The reporting quality of studies was evaluated according to the mHealth evidence and reporting assessment criteria. Results: In this study, 15 papers met the inclusion criteria and were reviewed. The studies mainly focused on the use of mHealth educational interventions for chronic disease management, and the main format for delivering interventions was text. Of the 15 studies, 6 were randomized controlled trials (RCTs), which have shown statistically significant effects on patients? health outcomes, including patients? engagement level, hemoglobin A1c, weight loss, and depression. Although the results of RCTs were mostly positive, we were unable to identify any specific effective structure and strategy for mHealth educational interventions owing to the poor reporting quality and heterogeneity of the interventions. Conclusions: Evidence on mHealth interventions for patient education published in peer-reviewed journals demonstrates that current reporting on essential mHealth criteria is insufficient for assessing, understanding, and replicating mHealth interventions. There is a lack of theory or conceptual framework for the development of mHealth interventions for patient education. Therefore, further research is required to determine the optimal structure, strategies, and delivery methods of mHealth educational interventions. UR - https://mhealth.jmir.org/2018/10/e10771/ UR - http://dx.doi.org/10.2196/10771 UR - http://www.ncbi.nlm.nih.gov/pubmed/30341042 ID - info:doi/10.2196/10771 ER - TY - JOUR AU - Quinn, C. Charlene AU - Swasey, K. Krystal AU - Torain, M. Jamila AU - Shardell, D. Michelle AU - Terrin, L. Michael AU - Barr, A. Erik AU - Gruber-Baldini, L. Ann PY - 2018/10/15 TI - An mHealth Diabetes Intervention for Glucose Control: Health Care Utilization Analysis JO - JMIR Mhealth Uhealth SP - e10776 VL - 6 IS - 10 KW - cluster randomized clinical trial KW - health care KW - health service utilization KW - mHealth KW - type 2 diabetes N2 - Background: Type 2 diabetes (T2D) is a major chronic condition requiring management through lifestyle changes and recommended health service visits. Mobile health (mHealth) is a promising tool to encourage self-management, but few studies have investigated the impact of mHealth on health care utilization. Objective: The objective of this analysis was to determine the change in 2-year health service utilization and whether utilization explained a 1.9% absolute decrease in glycated hemoglobin (HbA1c) over 1-year in the Mobile Diabetes Intervention Study (MDIS). Methods: We used commercial claims data from 2006 to 2010 linked to enrolled patients? medical chart data in 26 primary care practices in Maryland, USA. Secondary claims data analyses were available for 56% (92/163) of participants. In the primary MDIS study, physician practices were recruited and randomized to usual care and 1 of 3 increasingly complex interventions. Patients followed physician randomization assignment. The main variables in the analysis included health service utilization by type of service and change in HbA1c. The claims data was aggregated into 12 categories of utilization to assess change in 2-year health service usage, comparing rates of usage pre- and posttrial. We also examined whether utilization explained the 1.9% decrease in HbA1c over 1 year in the MDIS cluster randomized clinical trial. Results: A significant group by time effect was observed in physician office visits, general practitioner visits, other outpatient services, prescription medications, and podiatrist visits. Physician office visits (P=.01) and general practitioner visits (P=.02) both decreased for all intervention groups during the study period, whereas prescription claims (P<.001) increased. The frequency of other outpatient services (P=.001) and podiatrist visits (P=.04) decreased for the control group and least complex intervention group but increased for the 2 most complex intervention groups. No significant effects of utilization were observed to explain the clinically significant change in HbA1c. Conclusions: Claims data analyses identified patterns of utilization relevant to mHealth interventions. Findings may encourage patients and health providers to discuss the utilization of treatment-recommended services, lab tests, and prescribed medications. Trial Registration: ClinicalTrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by Webcite at http://www.webcitation.org/72XgTaxIj) UR - http://mhealth.jmir.org/2018/10/e10776/ UR - http://dx.doi.org/10.2196/10776 UR - http://www.ncbi.nlm.nih.gov/pubmed/30322839 ID - info:doi/10.2196/10776 ER - TY - JOUR AU - Eno, K. Ann AU - Thomas, G. Alvin AU - Ruck, M. Jessica AU - Van Pilsum Rasmussen, E. Sarah AU - Halpern, E. Samantha AU - Waldram, M. Madeleine AU - Muzaale, D. Abimereki AU - Purnell, S. Tanjala AU - Massie, B. Allan AU - Garonzik Wang, M. Jacqueline AU - Lentine, L. Krista AU - Segev, L. Dorry AU - Henderson, L. Macey PY - 2018/10/09 TI - Assessing the Attitudes and Perceptions Regarding the Use of Mobile Health Technologies for Living Kidney Donor Follow-Up: Survey Study JO - JMIR Mhealth Uhealth SP - e11192 VL - 6 IS - 10 KW - follow-up KW - kidney transplantation KW - living kidney donor KW - mobile phone, mHealth N2 - Background: In 2013, the Organ Procurement and Transplantation Network began requiring transplant centers in the United States to collect and report postdonation living kidney donor follow-up data at 6 months, 1 year, and 2 years. Despite this requirement, <50% of transplant centers have been able to collect and report the required data. Previous work identified a number of barriers to living kidney donor follow-up, including logistical and administrative barriers for transplant centers and cost and functional barriers for donors. Novel smartphone-based mobile health (mHealth) technologies might reduce the burden of living kidney donor follow-up for centers and donors. However, the attitudes and perceptions toward the incorporation of mHealth into postdonation care among living kidney donors are unknown. Understanding donor attitudes and perceptions will be vital to the creation of a patient-oriented mHealth system to improve living donor follow-up in the United States. Objective: The goal of this study was to assess living kidney donor attitudes and perceptions associated with the use of mHealth for follow-up. Methods: We developed and administered a cross-sectional 14-question survey to 100 living kidney donors at our transplant center. All participants were part of an ongoing longitudinal study of long-term outcomes in living kidney donors. The survey included questions on smartphone use, current health maintenance behaviors, accessibility to health information, and attitudes toward using mHealth for living kidney donor follow-up. Results: Of the 100 participants surveyed, 94 owned a smartphone (35 Android, 58 iPhone, 1 Blackberry), 37 had accessed their electronic medical record on their smartphone, and 38 had tracked their exercise and physical activity on their smartphone. While 77% (72/93) of participants who owned a smartphone and had asked a medical question in the last year placed the most trust with their doctors, nurses, or other health care professionals regarding answering a health-related question, 52% (48/93) most often accessed health information elsewhere. Overall, 79% (74/94) of smartphone-owning participants perceived accessing living kidney donor information and resources on their smartphone as useful. Additionally, 80% (75/94) perceived completing some living kidney donor follow-up via mHealth as useful. There were no significant differences in median age (60 vs 59 years; P=.65), median years since donation (10 vs 12 years; P=.45), gender (36/75, 36%, vs 37/75, 37%, male; P=.57), or race (70/75, 93%, vs 18/19, 95%, white; P=.34) between those who perceived mHealth as useful for living kidney donor follow-up and those who did not, respectively. Conclusions: Overall, smartphone ownership was high (94/100, 94.0%), and 79% (74/94) of surveyed smartphone-owning donors felt that it would be useful to complete their required follow-up with an mHealth tool, with no significant differences by age, sex, or race. These results suggest that patients would benefit from an mHealth tool to perform living donor follow-up. UR - http://mhealth.jmir.org/2018/10/e11192/ UR - http://dx.doi.org/10.2196/11192 UR - http://www.ncbi.nlm.nih.gov/pubmed/30305260 ID - info:doi/10.2196/11192 ER - TY - JOUR AU - de Korte, Elsbeth AU - Wiezer, Noortje AU - Bakhuys Roozeboom, Maartje AU - Vink, Peter AU - Kraaij, Wessel PY - 2018/10/03 TI - Behavior Change Techniques in mHealth Apps for the Mental and Physical Health of Employees: Systematic Assessment JO - JMIR Mhealth Uhealth SP - e167 VL - 6 IS - 10 KW - behavior change techniques KW - mHealth KW - mental health KW - physical health KW - lifestyle KW - workplace KW - app KW - employee KW - work N2 - Background: Employees remain at risk of developing physical and mental health problems. To improve the lifestyle, health, and productivity many workplace interventions have been developed. However, not all of these interventions are effective. Mobile and wireless technology to support health behavior change (mobile health [mHealth] apps) is a promising, but relatively new domain for the occupational setting. Research on mHealth apps for the mental and physical health of employees is scarce. Interventions are more likely to be useful if they are rooted in health behavior change theory. Evaluating the presence of specific combinations of behavior change techniques (BCTs) in mHealth apps might be used as an indicator of potential quality and effectiveness. Objective: The aim of this study was to assess whether mHealth apps for the mental and physical health of employees incorporate BCTs and, if so, which BCTs can be identified and which combinations of BCTs are present. Methods: An assessment was made of apps aiming to reduce the risk of physical and psychosocial work demands and to promote a healthy lifestyle for employees. A systematic search was performed in iTunes and Google Play. Forty-five apps were screened and downloaded. BCTs were identified using a taxonomy applied in similar reviews. The mean and ranges were calculated. Results: On average, the apps included 7 of the 26 BCTs (range 2-18). Techniques such as ?provide feedback on performance,? ?provide information about behavior-health link,? and ?provide instruction? were used most frequently. Techniques that were used least were ?relapse prevention,? ?prompt self-talk,? ?use follow-up prompts,? and ?provide information about others? approval.? ?Stress management,? ?prompt identification as a role model,? and ?agree on behavioral contract? were not used by any of the apps. The combination ?provide information about behavior-health link? with ?prompt intention formation? was found in 7/45 (16%) apps. The combination ?provide information about behavior-health link? with ?provide information on consequences,? and ?use follow-up prompts? was found in 2 (4%) apps. These combinations indicated potential effectiveness. The least potentially effective combination ?provide feedback on performance? without ?provide instruction? was found in 13 (29%) apps. Conclusions: Apps for the occupational setting might be substantially improved to increase potential since results showed a limited presence of BCTs in general, limited use of potentially successful combinations of BCTs in apps, and use of potentially unsuccessful combinations of BCTs. Increasing knowledge on the effectiveness of BCTs in apps might be used to develop guidelines for app developers and selection criteria for companies and individuals. Also, this might contribute to decreasing the burden of work-related diseases. To achieve this, app developers, health behavior change professionals, experts on physical and mental health, and end-users should collaborate when developing apps for the working context. UR - https://mhealth.jmir.org/2018/10/e167/ UR - http://dx.doi.org/10.2196/mhealth.6363 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/mhealth.6363 ER - TY - JOUR AU - Pung, Alison AU - Fletcher, Louise Susan AU - Gunn, Maree Jane PY - 2018/09/27 TI - Mobile App Use by Primary Care Patients to Manage Their Depressive Symptoms: Qualitative Study JO - J Med Internet Res SP - e10035 VL - 20 IS - 9 KW - mobile apps KW - depression KW - health care KW - general practice N2 - Background: Mobile apps are emerging as tools with the potential to revolutionize the treatment of mental health conditions such as depression. At the forefront of the community health sector, general practitioners are in a unique position to guide the integration of technology and depression management; however, little is currently known about how primary care patients with depressive symptoms are currently using apps. Objective: The objective of our study was to explore the natural patterns of mobile app use among patients with depressive symptoms to facilitate the understanding of the potential role for mobile apps in managing depressive symptoms in the community. Methods: Semistructured phone interviews were conducted with primary care patients in Victoria, Australia, who reported symptoms of depression and were enrolled in a larger randomized controlled trial of depression care. Interviews explored current depression management strategies and the use of mobile apps (if any). Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was iteratively conducted using QSR NVivo 11 Pro to identify emergent themes. Results: A total of 16 participants, aged between 20 to 58 years, took part in the interviews with 11 reporting the use of at least one mobile app to manage depressive symptoms and 5 reporting no app use. A variety of apps were described including relaxation, mindfulness, cognitive, exercise, gaming, social media, and well-being apps to aid with depressive symptoms. Among users, there were the following 4 main patterns of app use: skill acquisition, social connectedness, inquisitive trial, and safety netting. Factors that influenced app use included accessibility, perceptions of technology, and personal compatibility. Health care providers also had a role in initiating app use. Conclusions: Mobile apps are being utilized for self-management of depressive symptoms by primary care patients. This study provided insight into the natural patterns and perspectives of app use, which enhanced the understanding of how this technology may be integrated into the toolbox for the management of depression. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000537459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367152 (Archived at WebCite at http://www.webcitation.org/71Vf06X2T) UR - http://www.jmir.org/2018/9/e10035/ UR - http://dx.doi.org/10.2196/10035 UR - http://www.ncbi.nlm.nih.gov/pubmed/30262449 ID - info:doi/10.2196/10035 ER - TY - JOUR AU - Qiu, Yan AU - Liu, Ying AU - Ren, Wen AU - Qiu, Yunqing AU - Ren, Jingjing PY - 2018/9/25 TI - Internet-Based and Mobile-Based General Practice: Cross-Sectional Survey JO - J Med Internet Res SP - e266 VL - 20 IS - 9 KW - general practice KW - mHealth KW - mobile phone KW - satisfaction KW - health service KW - internet hospital N2 - Background: Globally, mHealth is increasing as a promising technology for promoting the quality of health care. Thus, a growing number of internet hospitals have been established in China to avail all its advantages. However, no study has investigated the service scope and patient satisfaction of the internet hospital to date. Objective: The objective of our study was to explore the features of outpatients in general practice, the disease information, and the satisfaction through an internet rating site. Methods: We collected data from the internet hospital of the First Affiliated Hospital, Zhejiang University between February 2016 and February 2017. Patients visited Web-based clinic via a computer or smartphone. The data included patients? demographic characteristics, disease information, and patients? comments. Results: We enrolled 715 patients with 365 health-related problems. All health conditions involved diseases ranging from internal medicine, surgery, gynecology and obstetrics, pediatrics, dermatology, ophthalmology, stomatology to emergency. Among them, 63.1% patients (451/715) visited traditional hospitals for further management, 25.3% (181/715) had prescriptions, laboratory, or imaging examination appointment, 1% (9/715) used emergency service, and 10% (74/715) needed routine follow-up. All patients received health education. Almost all patients gave positive feedback and 4-5-star rating. Conclusions: The internet hospital is suitable for all health conditions with high satisfaction only when patients have the access to internet via a computer or smartphone. UR - http://www.jmir.org/2018/9/e266/ UR - http://dx.doi.org/10.2196/jmir.8378 UR - http://www.ncbi.nlm.nih.gov/pubmed/30257819 ID - info:doi/10.2196/jmir.8378 ER - TY - JOUR AU - Mitchell, Marc AU - White, Lauren AU - Lau, Erica AU - Leahey, Tricia AU - Adams, A. Marc AU - Faulkner, Guy PY - 2018/9/20 TI - Evaluating the Carrot Rewards App, a Population-Level Incentive-Based Intervention Promoting Step Counts Across Two Canadian Provinces: Quasi-Experimental Study JO - JMIR Mhealth Uhealth SP - e178 VL - 6 IS - 9 KW - behavioral economics KW - financial health incentives KW - mHealth KW - mobile phone KW - physical activity KW - public health N2 - Background: The Carrot Rewards app was developed as part of an innovative public-private partnership to reward Canadians with loyalty points, exchangeable for retail goods, travel rewards, and groceries for engaging in healthy behaviors such as walking. Objective: This study examined whether a multicomponent intervention including goal setting, graded tasks, biofeedback, and very small incentives tied to daily step goal achievement (assessed by built-in smartphone accelerometers) could increase physical activity in two Canadian provinces, British Columbia (BC) and Newfoundland and Labrador (NL). Methods: This 12-week, quasi-experimental (single group pre-post) study included 78,882 participants; 44.39% (35,014/78,882) enrolled in the Carrot Rewards ?Steps? walking program during the recruitment period (June 13?July 10, 2016). During the 2-week baseline (or ?run-in?) period, we calculated participants? mean steps per day. Thereafter, participants earned incentives in the form of loyalty points (worth Can $0.04 ) every day they reached their personalized daily step goal (ie, baseline mean+1000 steps=first daily step goal level). Participants earned additional points (Can $0.40) for meeting their step goal 10+ nonconsecutive times in a 14-day period (called a ?Step Up Challenge?). Participants could earn up to Can $5.00 during the 12-week evaluation period. Upon meeting the 10-day contingency, participants could increase their daily goal by 500 steps, aiming to gradually increase the daily step number by 3000. Only participants with ?5 valid days (days with step counts: 1000-40,000) during the baseline period were included in the analysis (n=32,229).The primary study outcome was mean steps per day (by week), analyzed using linear mixed-effects models. Results: The mean age of 32,229 participants with valid baseline data was 33.7 (SD 11.6) years; 66.11% (21,306/32,229) were female. The mean daily step count at baseline was 6511.22. Over half of users (16,336/32,229, 50.69%) were categorized as ?physically inactive,? accumulating <5000 daily steps at baseline. Results from mixed-effects models revealed statistically significant increases in mean daily step counts when comparing baseline with each study week (P<.001). Compared with baseline, participants walked 115.70 more steps (95% CI 74.59 to 156.81; P<.001) at study week 12. BC and NL users classified as ?high engagers? (app engagement above sample median; 15,511/32,229, 48.13%) walked 738.70 (95% CI 673.81 to 803.54; P<.001) and 346.00 (95% CI 239.26 to 452.74; P<.001) more steps, respectively. Physically inactive, high engagers (7022/32,229, 21.08%) averaged an increase of 1224.66 steps per day (95% CI 1160.69 to 1288.63; P<.001). Effect sizes were modest. Conclusions: Providing very small but immediate rewards for personalized daily step goal achievement as part of a multicomponent intervention increased daily step counts on a population scale, especially for physically inactive individuals and individuals who engaged more with the walking program. Positive effects in both BC and NL provide evidence of replicability. UR - http://mhealth.jmir.org/2018/9/e178/ UR - http://dx.doi.org/10.2196/mhealth.9912 UR - http://www.ncbi.nlm.nih.gov/pubmed/30148712 ID - info:doi/10.2196/mhealth.9912 ER - TY - JOUR AU - Lopez, N. Keila AU - O'Connor, Michael AU - King, Jason AU - Alexander, James AU - Challman, Melissa AU - Lovick, K. Donna AU - Goodly, Nicole AU - Smith, Amelia AU - Fawcett, Elliott AU - Mulligan, Courtney AU - Thompson, Debbe AU - Fordis, Michael PY - 2018/09/11 TI - Improving Transitions of Care for Young Adults With Congenital Heart Disease: Mobile App Development Using Formative Research JO - JMIR Formativ Res SP - e16 VL - 2 IS - 2 KW - adolescent health KW - chronic disease KW - transitions of care KW - health disparities KW - mobile health KW - mHealth KW - patient empowerment KW - patient involvement KW - self-efficacy KW - user-centered design N2 - Background: Congenital heart diseases (CHDs) are the most common type of birth defects. Improvements in CHD care have led to approximately 1.4 million survivors reaching adulthood. Successful transition and transfer from pediatric to adult care is crucial. Unfortunately, less than 30% of adolescents with CHD successfully transition to adult care; this number is lower for minority and lower socioeconomic status populations. Few CHD programs exist to facilitate successful transition. Objective: The goal of our study was to describe the formative research used to develop a prototype mobile app to facilitate transition to adult care for adolescents with CHD. Methods: A literature search about best practices in transition medicine for CHD was conducted to inform app development. Formative research with a diverse group of CHD adolescents and their parents was conducted to determine gaps and needs for CHD transition to adult care. As part of the interview, surveys assessing transition readiness and CHD knowledge were completed. Two adolescent CHD expert panels were convened to inform educational content and app design. Results: The literature review revealed 113 articles, of which 38 were studies on transition programs and attitudes and 3 identified best practices in transition specific to CHD. A total of 402 adolescents aged 15 to 22 years (median 16 years) participated in semistructured interviews. The group was racially and ethnically diverse (12.6% [51/402] African American and 37.8% [152/402] Latino) and 42.0% (169/402) female; 36.3% (146/402) received public insurance. Most adolescents (313/402, 76.7%) had moderate or severe CHD complexity and reported minimal CHD understanding (79.0% [275/348] of those aged 15 to 17 years and 61.1% [33/54] of those aged 18 to 22 years). Average initial transition readiness score was 50.9/100, meaning that transition readiness training was recommended. When participants with moderate to severe CHD (313/402, 77.9%) were asked about technology use, 94.2% (295/313) reported having access to a mobile phone. Interviews with parents revealed limited interactions with the pediatric cardiologist about transition-related topics: 79.4% (331/417) reported no discussions regarding future family planning, and 55.2% (230/417) reported the adolescent had not been screened for mental health concerns (depression, anxiety). Further, 66.4% (277/417) reported not understanding how health care changes as adolescents become adults. Adolescents in the expert panels (2 groups of 3 adolescents each) expressed interest in a CHD-specific tailored app consisting of quick access to specific educational questions (eg, ?Can I exercise??), a CHD story-blog forum, a mentorship platform, a question and answer space, and a checklist to facilitate transition. They expressed interest in using the app to schedule CHD clinic appointments and receive medication reminders. Based on this data, a prototype mobile app was created to assist in adolescent CHD transition. Conclusions: Formative research revealed that most adolescents with CHD had access to mobile phones, were not prepared for transition to adult care, and were interested in an app to facilitate transition to adult CHD care. Understanding adolescent and parent needs, interests, and concerns helped in the development of a mobile app with a broader, tailored approach for adolescents with CHD. UR - http://formative.jmir.org/2018/2/e16/ UR - http://dx.doi.org/10.2196/formative.9963 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/formative.9963 ER - TY - JOUR AU - Mitchell, T. John AU - LeGrand, Sara AU - Hightow-Weidman, B. Lisa AU - McKellar, S. Mehri AU - Kashuba, DM Angela AU - Cottrell, Mackenzie AU - McLaurin, Tony AU - Satapathy, Goutam AU - McClernon, Joseph F. PY - 2018/09/10 TI - Smartphone-Based Contingency Management Intervention to Improve Pre-Exposure Prophylaxis Adherence: Pilot Trial JO - JMIR Mhealth Uhealth SP - e10456 VL - 6 IS - 9 KW - HIV KW - preexposure prophylaxis KW - mobile health N2 - Background: Pre-exposure prophylaxis (PrEP) provides a strong preventative benefit to individuals at risk for HIV. While PrEP adherence is highly correlated with its efficacy, adherence rates are variable both across and within persons. Objective: The objective of this study was to develop and pilot-test a smartphone-based intervention, known as mSMART, that targets PrEP adherence. mSMART provides contingency management in the form of monetary incentives for daily PrEP adherence based on a real-time adherence assessment using a camera-based medication event-monitoring tool as well as medication reminders, PrEP education, individualized behavioral strategies to address PrEP adherence barriers, and medication adherence feedback. Methods: This was a 4-week open-label, phase I trial in a community sample of young men who have sex with men already on PrEP (N=10). Results: Although adherence composite scores corresponding to PrEP biomarkers indicated that 90% (9/10) of the sample already had an acceptable baseline adherence in the protective range, by the end of the 4-week period, the scores improved for 30% (3/10) of the sample?adherence did not worsen for any participants. Participants reported mean PrEP adherence rates of 91% via daily entries in mSMART. At the end of the 4-week period, participants indicated acceptable ratings of satisfaction, usability, and willingness to recommend mSMART to others. There were no technical difficulties associated with smartphone compatibility, user misunderstandings about mSMART features that interfered with daily use, or study attrition. Conclusions: This study is the first to apply contingency management to PrEP adherence. Findings indicated that mSMART is feasible and acceptable. Such an adherence intervention administered via a user-friendly smartphone app can allow for widespread dissemination. Future efficacy trials are needed. Trial Registration: ClinicalTrials.gov NCT02895893; https://clinicaltrials.gov/ct2/show/NCT02895893 (Accessed by Webcite at http://www.webcitation.org/72JskjDJq) UR - http://mhealth.jmir.org/2018/9/e10456/ UR - http://dx.doi.org/10.2196/10456 UR - http://www.ncbi.nlm.nih.gov/pubmed/30201601 ID - info:doi/10.2196/10456 ER - TY - JOUR AU - Paulsen, Mohn Mari AU - Hagen, Lindhart Martina Lovise AU - Frøyen, Hesvik Marte AU - Foss-Pedersen, Julie Rikke AU - Bergsager, Dagfinn AU - Tangvik, Julie Randi AU - Andersen, Frost Lene PY - 2018/09/07 TI - A Dietary Assessment App for Hospitalized Patients at Nutritional Risk: Development and Evaluation of the MyFood App JO - JMIR Mhealth Uhealth SP - e175 VL - 6 IS - 9 KW - decision support system KW - disease-related malnutrition KW - eHealth KW - mHealth KW - dietary assessment KW - validation study N2 - Background: Disease-related malnutrition is a common challenge among hospitalized patients. There seems to be a lack of an effective system to follow-up nutritional monitoring and treatment of patients at nutritional risk after risk assessment. We identify a need for a more standardized system to prevent and treat disease-related malnutrition. Objective: We aimed to develop a dietary assessment app for tablets for use in a hospital setting and to evaluate the app?s ability to measure individual intake of energy, protein, liquid, and food and beverage items among hospitalized patients for two days. We also aimed to measure patients? experiences using the app. Methods: We have developed the MyFood app, which consists of three modules: 1) collection of information about the patient, 2) dietary assessment function, and 3) evaluation of recorded intake compared to individual needs. We used observations from digital photography of the meals, combined with partial weighing of the meal components, as a reference method to evaluate the app?s dietary assessment system for two days. Differences in the intake estimations of energy, protein, liquid, and food and beverage items between MyFood and the photograph method were analyzed on both group and individual level. Results: Thirty-two patients hospitalized at Oslo University Hospital were included in the study. The data collection period ran from March to May 2017. About half of the patients had ?90% agreement between MyFood and the photograph method for energy, protein, and liquid intake on both recording days. Dinner was the meal with the lowest percent agreement between methods. MyFood overestimated patients? intake of bread and cereals and underestimated fruit consumption. Agreement between methods increased from day 1 to day 2 for bread and cereals, spreads, egg, yogurt, soup, hot dishes, and desserts. Ninety percent of participants reported that MyFood was easy to use, and 97% found the app easy to navigate. Conclusions: We developed the MyFood app as a tool to monitor dietary intake among hospitalized patients at nutritional risk. The recorded intake of energy, protein, and liquid using MyFood showed good agreement with the photograph method for the majority of participants. The app?s ability to estimate intake within food groups was good, except for bread and cereals which were overestimated and fruits which were underestimated. The app was well accepted among study participants and has the potential to be a dietary assessment tool for use among patients in clinical practice. UR - http://mhealth.jmir.org/2018/9/e175/ UR - http://dx.doi.org/10.2196/mhealth.9953 UR - http://www.ncbi.nlm.nih.gov/pubmed/30194059 ID - info:doi/10.2196/mhealth.9953 ER - TY - JOUR AU - Newton Jr, L. Robert AU - Carter, A. Leah AU - Johnson, William AU - Zhang, Dachuan AU - Larrivee, Sandra AU - Kennedy, M. Betty AU - Harris, Melissa AU - Hsia, S. Daniel PY - 2018/08/24 TI - A Church-Based Weight Loss Intervention in African American Adults using Text Messages (LEAN Study): Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e256 VL - 20 IS - 8 KW - African Americans KW - behavioral strategies KW - community health KW - mHealth KW - mobile phone KW - obesity KW - text messages KW - weight loss N2 - Background: African American adults experience a high prevalence of obesity and its associated comorbidities, including diabetes. Church-based interventions have been shown to be effective in decreasing weight in this population. mHealth interventions can address two needs for obesity treatment in this community, including enhancing weight loss and providing wide dissemination. Objective: This study aimed to assess the feasibility and efficacy of a church-based weight loss intervention that incorporates mHealth technology. Methods: In this study, 8 churches (n=97) were randomly assigned to the intervention or delayed intervention condition (control group). We recruited participants through their respective church. Volunteer church members were trained by study staff to deliver the 10-session, 6-month intervention. Participants in the intervention group attended group sessions and received automated short message service (SMS) text messages designed to reinforce behavioral strategies. Conversely, participants in the delayed intervention condition received SMS text messages related to health conditions relevant for African American adults. We obtained measures of body composition, blood pressure, blood glucose, and cholesterol. Results: We successfully recruited 97 African American adults, with a mean age of 56.0 (SE 10.3) years and a mean body mass index of 38.6 (SE 6.4) kg/m2 (89/97, 91.8% females), who attended the churches that were randomized to the intervention (n=68) or control (n=29) condition. Of these, 74.2% (72/97) of the participants (47/68, 69.1% intervention; 25/29, 86.2% delayed intervention) completed the 6-month assessment. The average intervention group attendance was 55%. There was a significant difference in weight loss (P=.04) between participants in the intervention (?1.5 (SE 0.5) kg) and control (0.11 (SE 0.6) kg) groups. Among participants in the intervention group, the correlation between the number of SMS text messages sent and the percent body fat loss was r=.3 with P=.04. The participants reported high satisfaction with the automated SMS text messages. Conclusions: Automated SMS text messages were well-received by participants, suggesting that more enhanced mHealth technologies are a viable option for interventions targeting African American adults. Trial Registration: ClinicalTrials.gov NCT02863887; https://clinicaltrials.gov/ct2/show/NCT02863887 (Archived by WebCite at http://www.webcitation.org/71JiYzizO) UR - http://www.jmir.org/2018/8/e256/ UR - http://dx.doi.org/10.2196/jmir.9816 UR - http://www.ncbi.nlm.nih.gov/pubmed/30143478 ID - info:doi/10.2196/jmir.9816 ER - TY - JOUR AU - Simons, Dorien AU - De Bourdeaudhuij, Ilse AU - Clarys, Peter AU - De Cocker, Katrien AU - Vandelanotte, Corneel AU - Deforche, Benedicte PY - 2018/08/24 TI - Effect and Process Evaluation of a Smartphone App to Promote an Active Lifestyle in Lower Educated Working Young Adults: Cluster Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e10003 VL - 6 IS - 8 KW - mHealth KW - mobile apps KW - active transport KW - Fitbit KW - accelerometers KW - mobile phone KW - emerging adulthood KW - physical activity intervention KW - health promotion N2 - Background: Mobile technologies have great potential to promote an active lifestyle in lower educated working young adults, an underresearched target group at a high risk of low activity levels. Objective: The objective of our study was to examine the effect and process evaluation of the newly developed evidence- and theory-based smartphone app ?Active Coach? on the objectively measured total daily physical activity; self-reported, context-specific physical activity; and self-reported psychosocial variables among lower educated working young adults. Methods: We recruited 130 lower educated working young adults in this 2-group cluster randomized controlled trial and assessed outcomes at baseline, posttest (baseline+9 weeks), and follow-up (posttest+3 months). Intervention participants (n=60) used the Active Coach app (for 9 weeks) combined with a Fitbit activity tracker. Personal goals, practical tips, and educational facts were provided to encourage physical activity. The control group received print-based generic physical activity information. Both groups wore accelerometers for objective measurement of physical activity, and individual interviews were conducted to assess the psychosocial variables and context-specific physical activity. Furthermore, intervention participants were asked process evaluation questions and generalized linear mixed models and descriptive statistics were applied. Results: No significant intervention effects were found for objectively measured physical activity, self-reported physical activity, and self-reported psychosocial variables (all P>.05). Intervention participants evaluated the Active Coach app and the combined use with the Fitbit wearable as self-explanatory (36/51, 70.6%), user friendly (40/51, 78.4%), and interesting (34/51, 66.7%). Throughout the intervention, we observed a decrease in the frequency of viewing graphical displays in the app (P<.001); reading the tips, facts, and goals (P<.05); and wearing the Fitbit wearable (P<.001). Few intervention participants found the tips and facts motivating (10/41, 24.4%), used them to be physically active (8/41, 19.6%), and thought they were tailored to their lifestyle (7/41, 17.1%). Conclusions: The lack of significant intervention effects might be due to low continuous user engagement. Advice or feedback that was not perceived as adequately tailored and the difficulty to compete with many popular commercial apps on young people?s smartphones may be responsible for a decrease in the engagement. A stand-alone app does not seem sufficient to promote an active lifestyle among lower educated working young adults; therefore, multicomponent interventions (using both technological and human support), as well as context-specific sensing to provide tailored advice, might be needed in this population. Trial Registration: ClinicalTrials.gov NCT02948803; https://clinicaltrials.gov/ct2/show/results/NCT02948803 (Archived by WebCite at http://www.webcitation.org/71OPFwaoA) UR - http://mhealth.jmir.org/2018/8/e10003/ UR - http://dx.doi.org/10.2196/10003 UR - http://www.ncbi.nlm.nih.gov/pubmed/30143477 ID - info:doi/10.2196/10003 ER - TY - JOUR AU - Scheerman, Maria Janneke Francisca AU - van Empelen, Pepijn AU - van Loveren, Cor AU - van Meijel, Berno PY - 2018/08/17 TI - A Mobile App (WhiteTeeth) to Promote Good Oral Health Behavior Among Dutch Adolescents with Fixed Orthodontic Appliances: Intervention Mapping Approach JO - JMIR Mhealth Uhealth SP - e163 VL - 6 IS - 8 KW - health behavior KW - mHealth KW - oral health KW - oral hygiene KW - dental caries KW - adolescent KW - dental plaque KW - prevention KW - intervention mapping N2 - Background: The insertion of fixed orthodontic appliances increases the risk of dental caries, particularly in adolescents. Caries can be prevented through good oral health behavior. To support adolescents with fixed orthodontic appliances and for promoting oral health behavior, we developed a theory- and evidence-based mHealth program, the WhiteTeeth app. Objective: The objective of our paper was to describe the systematic development and content of the WhiteTeeth app. Methods: For systematic development of the program, we used the intervention mapping (IM) approach. In this paper, we present the results of applying the first 5 steps of IM to the design of an mHealth program: (1) identifying target behaviors and determinants through problem analysis, including a literature search, a survey study, and semistructured interviews, to explore adolescent oral health behavior during orthodontic therapy; (2) defining program outcomes and objectives; (3) selecting theoretical methods and translating them into practical strategies for the program design; (4) producing the program, including a pilot test with 28 adolescents testing the acceptability and usability of the WhiteTeeth app; and (5) planning implementation and adoption. Results: On the basis of our literature search, we identified fluoride use and control of dental plaque levels (eg, tooth brushing and proxy brush usage) as target behaviors for preventing caries. Next, we identified important and changeable determinants of oral health behavior that fitted the theoretical concepts of the Health Action Process Approach (HAPA) theory. The HAPA theory, the self-regulation theory, and the results of the semistructured interviews were used to define the program objectives, that is, the performance and change objectives. After defining the objectives, we identified multiple behavior change techniques that could be used to achieve these objectives, such as providing oral health information and feedback, prompting self-monitoring, coaching of set actions and coping plans, and sending reminders. We translated these methods into practical strategies, such as videos and a brushing timer. Next, we combined these strategies into a single program resulting in the WhiteTeeth app (which is available on both iTunes and Google Play stores as ?Witgebit?). Adolescents with fixed orthodontic appliances and dental professionals were included in the development process to increase the success of implementation. The pilot test revealed that the app users appreciated and liked the app. The WhiteTeeth app can be integrated into current orthodontic care. Conclusions: IM allowed us to identify multiple techniques that have been shown to be the most effective in initiating behavior change, but have not yet been incorporated into existing orthodontic apps. The WhiteTeeth app contains all these techniques, which makes it a unique and promising home-based app for promoting oral health in adolescents with fixed orthodontic appliances. UR - http://mhealth.jmir.org/2018/8/e163/ UR - http://dx.doi.org/10.2196/mhealth.9626 UR - http://www.ncbi.nlm.nih.gov/pubmed/30120085 ID - info:doi/10.2196/mhealth.9626 ER - TY - JOUR AU - Brinker, Josef Titus AU - Brieske, Martin Christian AU - Esser, Stefan AU - Klode, Joachim AU - Mons, Ute AU - Batra, Anil AU - Rüther, Tobias AU - Seeger, Werner AU - Enk, H. Alexander AU - von Kalle, Christof AU - Berking, Carola AU - Heppt, V. Markus AU - Gatzka, V. Martina AU - Bernardes-Souza, Breno AU - Schlenk, F. Richard AU - Schadendorf, Dirk PY - 2018/08/15 TI - A Face-Aging App for Smoking Cessation in a Waiting Room Setting: Pilot Study in an HIV Outpatient Clinic JO - J Med Internet Res SP - e10976 VL - 20 IS - 8 KW - face aging KW - smoking cessation KW - HIV KW - mobile apps KW - HIV patients KW - HIV seropositivity KW - smoking KW - cessation KW - tobacco smoking KW - morphing N2 - Background: There is strong evidence for the effectiveness of addressing tobacco use in health care settings. However, few smokers receive cessation advice when visiting a hospital. Implementing smoking cessation technology in outpatient waiting rooms could be an effective strategy for change, with the potential to expose almost all patients visiting a health care provider without preluding physician action needed. Objective: The objective of this study was to develop an intervention for smoking cessation that would make use of the time patients spend in a waiting room by passively exposing them to a face-aging, public morphing, tablet-based app, to pilot the intervention in a waiting room of an HIV outpatient clinic, and to measure the perceptions of this intervention among smoking and nonsmoking HIV patients. Methods: We developed a kiosk version of our 3-dimensional face-aging app Smokerface, which shows the user how their face would look with or without cigarette smoking 1 to 15 years in the future. We placed a tablet with the app running on a table in the middle of the waiting room of our HIV outpatient clinic, connected to a large monitor attached to the opposite wall. A researcher noted all the patients who were using the waiting room. If a patient did not initiate app use within 30 seconds of waiting time, the researcher encouraged him or her to do so. Those using the app were asked to complete a questionnaire. Results: During a 19-day period, 464 patients visited the waiting room, of whom 187 (40.3%) tried the app and 179 (38.6%) completed the questionnaire. Of those who completed the questionnaire, 139 of 176 (79.0%) were men and 84 of 179 (46.9%) were smokers. Of the smokers, 55 of 81 (68%) said the intervention motivated them to quit (men: 45, 68%; women: 10, 67%); 41 (51%) said that it motivated them to discuss quitting with their doctor (men: 32, 49%; women: 9, 60%); and 72 (91%) perceived the intervention as fun (men: 57, 90%; women: 15, 94%). Of the nonsmokers, 92 (98%) said that it motivated them never to take up smoking (men: 72, 99%; women: 20, 95%). Among all patients, 102 (22.0%) watched another patient try the app without trying it themselves; thus, a total of 289 (62.3%) of the 464 patients were exposed to the intervention (average waiting time 21 minutes). Conclusions: A face-aging app implemented in a waiting room provides a novel opportunity to motivate patients visiting a health care provider to quit smoking, to address quitting at their subsequent appointment and thereby encourage physician-delivered smoking cessation, or not to take up smoking. UR - http://www.jmir.org/2018/8/e10976/ UR - http://dx.doi.org/10.2196/10976 UR - http://www.ncbi.nlm.nih.gov/pubmed/30111525 ID - info:doi/10.2196/10976 ER - TY - JOUR AU - Rohani, A. Darius AU - Faurholt-Jepsen, Maria AU - Kessing, Vedel Lars AU - Bardram, E. Jakob PY - 2018/08/13 TI - Correlations Between Objective Behavioral Features Collected From Mobile and Wearable Devices and Depressive Mood Symptoms in Patients With Affective Disorders: Systematic Review JO - JMIR Mhealth Uhealth SP - e165 VL - 6 IS - 8 KW - mood disorder KW - affective disorder KW - depression KW - depressive mood symptoms KW - bipolar disorder KW - objective features KW - correlation KW - behavior KW - sensor data KW - mobile phone KW - wearable devices KW - systematic review N2 - Background: Several studies have recently reported on the correlation between objective behavioral features collected via mobile and wearable devices and depressive mood symptoms in patients with affective disorders (unipolar and bipolar disorders). However, individual studies have reported on different and sometimes contradicting results, and no quantitative systematic review of the correlation between objective behavioral features and depressive mood symptoms has been published. Objective: The objectives of this systematic review were to (1) provide an overview of the correlations between objective behavioral features and depressive mood symptoms reported in the literature and (2) investigate the strength and statistical significance of these correlations across studies. The answers to these questions could potentially help identify which objective features have shown most promising results across studies. Methods: We conducted a systematic review of the scientific literature, reported according to the preferred reporting items for systematic reviews and meta-analyses guidelines. IEEE Xplore, ACM Digital Library, Web of Sciences, PsychINFO, PubMed, DBLP computer science bibliography, HTA, DARE, Scopus, and Science Direct were searched and supplemented by hand examination of reference lists. The search ended on April 27, 2017, and was limited to studies published between 2007 and 2017. Results: A total of 46 studies were eligible for the review. These studies identified and investigated 85 unique objective behavioral features, covering 17 various sensor data inputs. These features were divided into 7 categories. Several features were found to have statistically significant and consistent correlation directionality with mood assessment (eg, the amount of home stay, sleep duration, and vigorous activity), while others showed directionality discrepancies across the studies (eg, amount of text messages [short message service] sent, time spent between locations, and frequency of mobile phone screen activity). Conclusions: Several studies showed consistent and statistically significant correlations between objective behavioral features collected via mobile and wearable devices and depressive mood symptoms. Hence, continuous and everyday monitoring of behavioral aspects in affective disorders could be a promising supplementary objective measure for estimating depressive mood symptoms. However, the evidence is limited by methodological issues in individual studies and by a lack of standardization of (1) the collected objective features, (2) the mood assessment methodology, and (3) the statistical methods applied. Therefore, consistency in data collection and analysis in future studies is needed, making replication studies as well as meta-analyses possible. UR - http://mhealth.jmir.org/2018/8/e165/ UR - http://dx.doi.org/10.2196/mhealth.9691 UR - http://www.ncbi.nlm.nih.gov/pubmed/30104184 ID - info:doi/10.2196/mhealth.9691 ER - TY - JOUR AU - Pratap, Abhishek AU - Renn, N. Brenna AU - Volponi, Joshua AU - Mooney, D. Sean AU - Gazzaley, Adam AU - Arean, A. Patricia AU - Anguera, A. Joaquin PY - 2018/08/09 TI - Using Mobile Apps to Assess and Treat Depression in Hispanic and Latino Populations: Fully Remote Randomized Clinical Trial JO - J Med Internet Res SP - e10130 VL - 20 IS - 8 KW - mobile apps KW - smartphone KW - depression KW - Hispanics KW - Latinos KW - clinical trial KW - cognition KW - problem solving KW - mHealth KW - minority groups N2 - Background: Most people with mental health disorders fail to receive timely access to adequate care. US Hispanic/Latino individuals are particularly underrepresented in mental health care and are historically a very difficult population to recruit into clinical trials; however, they have increasing access to mobile technology, with over 75% owning a smartphone. This technology has the potential to overcome known barriers to accessing and utilizing traditional assessment and treatment approaches. Objective: This study aimed to compare recruitment and engagement in a fully remote trial of individuals with depression who either self-identify as Hispanic/Latino or not. A secondary aim was to assess treatment outcomes in these individuals using three different self-guided mobile apps: iPST (based on evidence-based therapeutic principles from problem-solving therapy, PST), Project Evolution (EVO; a cognitive training app based on cognitive neuroscience principles), and health tips (a health information app that served as an information control). Methods: We recruited Spanish and English speaking participants through social media platforms, internet-based advertisements, and traditional fliers in select locations in each state across the United States. Assessment and self-guided treatment was conducted on each participant's smartphone or tablet. We enrolled 389 Hispanic/Latino and 637 non-Hispanic/Latino adults with mild to moderate depression as determined by Patient Health Questionnaire-9 (PHQ-9) score?5 or related functional impairment. Participants were first asked about their preferences among the three apps and then randomized to their top two choices. Outcomes were depressive symptom severity (measured using PHQ-9) and functional impairment (assessed with Sheehan Disability Scale), collected over 3 months. Engagement in the study was assessed based on the number of times participants completed active surveys. Results: We screened 4502 participants and enrolled 1040 participants from throughout the United States over 6 months, yielding a sample of 348 active users. Long-term engagement surfaced as a key issue among Hispanic/Latino participants, who dropped from the study 2 weeks earlier than their non-Hispanic/Latino counterparts (P<.02). No significant differences were observed for treatment outcomes between those identifying as Hispanic/Latino or not. Although depressive symptoms improved (beta=?2.66, P=.006) over the treatment course, outcomes did not vary by treatment app. Conclusions: Fully remote mobile-based studies can attract a diverse participant pool including people from traditionally underserved communities in mental health care and research (here, Hispanic/Latino individuals). However, keeping participants engaged in this type of ?low-touch? research study remains challenging. Hispanic/Latino populations may be less willing to use mobile apps for assessing and managing depression. Future research endeavors should use a user-centered design to determine the role of mobile apps in the assessment and treatment of depression for this population, app features they would be interested in using, and strategies for long-term engagement. Trial Registration: Clinicaltrials.gov NCT01808976; https://clinicaltrials.gov/ct2/show/NCT01808976 (Archived by WebCite at http://www.webcitation.org/70xI3ILkz) UR - http://www.jmir.org/2018/8/e10130/ UR - http://dx.doi.org/10.2196/10130 UR - http://www.ncbi.nlm.nih.gov/pubmed/30093372 ID - info:doi/10.2196/10130 ER - TY - JOUR AU - Nsabimana, Placide Alain AU - Uzabakiriho, Bernard AU - Kagabo, M. Daniel AU - Nduwayo, Jerome AU - Fu, Qinyouen AU - Eng, Allison AU - Hughes, Joshua AU - Sia, K. Samuel PY - 2018/08/07 TI - Bringing Real-Time Geospatial Precision to HIV Surveillance Through Smartphones: Feasibility Study JO - JMIR Public Health Surveill SP - e11203 VL - 4 IS - 3 KW - HIV surveillance KW - smartphones KW - mobile phones KW - geospatial data N2 - Background: Precise measurements of HIV incidences at community level can help mount a more effective public health response, but the most reliable methods currently require labor-intensive population surveys. Novel mobile phone technologies are being tested for adherence to medical appointments and antiretroviral therapy, but using them to track HIV test results with automatically generated geospatial coordinates has not been widely tested. Objective: We customized a portable reader for interpreting the results of HIV lateral flow tests and developed a mobile phone app to track HIV test results in urban and rural locations in Rwanda. The objective was to assess the feasibility of this technology to collect front line HIV test results in real time and with geospatial context to help measure HIV incidences and improve epidemiological surveillance. Methods: Twenty health care workers used the technology to track the test results of 2190 patients across 3 hospital sites (2 urban sites in Kigali and a rural site in the Western Province of Rwanda). Mobile phones for less than US $70 each were used. The mobile phone app to record HIV test results could take place without internet connectivity with uploading of results to the cloud taking place later with internet. Results: A total of 91.51% (2004/2190) of HIV test results could be tracked in real time on an online dashboard with geographical resolution down to street level. Out of the 20 health care workers, 14 (70%) would recommend the lateral flow reader, and 100% would recommend the mobile phone app. Conclusions: Smartphones have the potential to simplify the input of HIV test results with geospatial context and in real time to improve public health surveillance of HIV. UR - http://publichealth.jmir.org/2018/3/e11203/ UR - http://dx.doi.org/10.2196/11203 UR - http://www.ncbi.nlm.nih.gov/pubmed/30087088 ID - info:doi/10.2196/11203 ER - TY - JOUR AU - Boonstra, W. Tjeerd AU - Nicholas, Jennifer AU - Wong, JJ Quincy AU - Shaw, Frances AU - Townsend, Samuel AU - Christensen, Helen PY - 2018/07/30 TI - Using Mobile Phone Sensor Technology for Mental Health Research: Integrated Analysis to Identify Hidden Challenges and Potential Solutions JO - J Med Internet Res SP - e10131 VL - 20 IS - 7 KW - passive sensing KW - mental health KW - ubiquitous computing KW - ethics KW - depression KW - mobile health KW - smartphone KW - wearable sensors N2 - Background: Mobile phone sensor technology has great potential in providing behavioral markers of mental health. However, this promise has not yet been brought to fruition. Objective: The objective of our study was to examine challenges involved in developing an app to extract behavioral markers of mental health from passive sensor data. Methods: Both technical challenges and acceptability of passive data collection for mental health research were assessed based on literature review and results obtained from a feasibility study. Socialise, a mobile phone app developed at the Black Dog Institute, was used to collect sensor data (Bluetooth, location, and battery status) and investigate views and experiences of a group of people with lived experience of mental health challenges (N=32). Results: On average, sensor data were obtained for 55% (Android) and 45% (iOS) of scheduled scans. Battery life was reduced from 21.3 hours to 18.8 hours when scanning every 5 minutes with a reduction of 2.5 hours or 12%. Despite this relatively small reduction, most participants reported that the app had a noticeable effect on their battery life. In addition to battery life, the purpose of data collection, trust in the organization that collects data, and perceived impact on privacy were identified as main factors for acceptability. Conclusions: Based on the findings of the feasibility study and literature review, we recommend a commitment to open science and transparent reporting and stronger partnerships and communication with users. Sensing technology has the potential to greatly enhance the delivery and impact of mental health care. Realizing this requires all aspects of mobile phone sensor technology to be rigorously assessed. UR - http://www.jmir.org/2018/7/e10131/ UR - http://dx.doi.org/10.2196/10131 UR - http://www.ncbi.nlm.nih.gov/pubmed/30061092 ID - info:doi/10.2196/10131 ER - TY - JOUR AU - Grossman, R. Molli AU - Zak, Kim Deanah AU - Zelinski, M. Elizabeth PY - 2018/07/30 TI - Mobile Apps for Caregivers of Older Adults: Quantitative Content Analysis JO - JMIR Mhealth Uhealth SP - e162 VL - 6 IS - 7 KW - mobile apps KW - aged KW - elderly KW - caregivers KW - family caregivers KW - carers KW - adult children KW - quality of life KW - dementia N2 - Background: Informal caregivers of older adults provide critical support for their loved ones but are subject to negative health outcomes because of burden and stress. Interventions to provide information and resources as well as social and emotional support reduce burden. Mobile apps featuring access to information, assistance with scheduling, and other features can automate support functions inexpensively and conveniently and reach a greater proportion of caregivers than otherwise possible. Objective: The aim of this study was to identify mobile apps geared towards caregivers of older adults, catalog features, and suggest best practices for adoption based on empirical findings of beneficial interventions in the caregiving literature. Methods: Search for apps focused on ones catered for caregivers of older adults in Google Play and iTunes, compiling their features, and identifying features reflecting categories of support identified in successful intervention studies to negative caregiver outcomes. Intervention research indicates that provision of information and resources, assistance in practical problem solving, coordinating care among multiple caregivers, and emotional support reduce caregiver burden. Results: Despite approximately over 200,000 mobile health?related apps, the availability of mobile apps for caregivers is relatively sparse (n=44 apps) as of October 2017. Apps generally addressed specific categories of support, including information and resources, family communication, and caregiver-recipient interactions. Few apps were comprehensive. Only 8 out of 44 (18%) had features that addressed three or more categories. Few apps provided specific stress reduction exercises for caregivers, which is important for reducing burden. Conclusions: Mobile apps have the potential to provide resources, just­-in­-time information for problem-solving, and stress reduction strategies for caregivers. Many apps offer functions that have been shown to reduce burden and improve health outcomes in caregivers, but few provide emotional support. Using an evidence­-based practice approach, mobile apps for caregivers can provide multiple beneficial support functions. Apps can serve a much larger proportion of this highly underserved population in their mobile form than more traditional means, improving their health and quality of life. UR - http://mhealth.jmir.org/2018/7/e162/ UR - http://dx.doi.org/10.2196/mhealth.9345 UR - http://www.ncbi.nlm.nih.gov/pubmed/30061093 ID - info:doi/10.2196/mhealth.9345 ER - TY - JOUR AU - Alessa, Tourkiah AU - Abdi, Sarah AU - Hawley, S. Mark AU - de Witte, Luc PY - 2018/07/23 TI - Mobile Apps to Support the Self-Management of Hypertension: Systematic Review of Effectiveness, Usability, and User Satisfaction JO - JMIR Mhealth Uhealth SP - e10723 VL - 6 IS - 7 KW - mobile phone KW - mobile application KW - mobile app KW - self-management KW - hypertension KW - blood pressure N2 - Background: Hypertension is a chronic disease that is considered to be a public health problem and requires efforts by patients to manage themselves. The global growth in the use of mobile phones and tablets has been accompanied by the increased use of health apps. Many of these apps support the self-management of hypertension and, therefore, they have the potential benefits of lowering blood pressure. Despite this, there is currently a lack of evidence for their effectiveness, usability, and patient satisfaction with their use. Objective: A systematic review was conducted to assess the effectiveness of apps in lowering blood pressure, as well as their usability and patients? satisfaction with their use. Methods: We conducted searches in the following databases: MEDLINE (OVID), EMBASE (OVID), PsycINFO (OVID), CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), IEEE Xplore ASSIAN, Google Scholar and the main Arabic databases Al Manhal, AskZad, and Mandumah. We looked for studies that used apps in the self-management of hypertension from 2008-2016. We also checked the reference lists of the review papers and all the primary studies for additional references. Results: A total of 21 studies with a total of 3112 participants were included in the review. Of the 14 studies that assessed the effectiveness of the apps in lowering blood pressure, 10 (71.4%) studies (6 RCTs and 4 nonrandomized studies) reported that using the apps led to significant decreases in blood pressure and seemed to be effective in the self-management of hypertension. Of these 10, only 2 (20%) RCTs and 3 (30%) nonrandomized studies had a low?moderate risk of bias. The results of this review are inconclusive regarding which combinations of functionalities would be most effective in lowering blood pressure because of variation in the studies? quality, but the data suggest that apps incorporating more comprehensive functionalities are likely to be more effective. In all the studies that assessed the usability of the apps and users? acceptance of them, all the apps seemed to be accepted and easy to use. Conclusions: Most of the studies reported that apps might be effective in lowering blood pressure and are accepted by users. However, these findings should be interpreted with caution, as most of the studies had a high risk of bias. More well-designed, large-scale studies are required to evaluate the real effect of using apps in lowering blood pressure and to identify the most effective functionality combinations for lowering blood pressure. UR - http://mhealth.jmir.org/2018/7/e10723/ UR - http://dx.doi.org/10.2196/10723 UR - http://www.ncbi.nlm.nih.gov/pubmed/30037787 ID - info:doi/10.2196/10723 ER - TY - JOUR AU - Zulueta, John AU - Piscitello, Andrea AU - Rasic, Mladen AU - Easter, Rebecca AU - Babu, Pallavi AU - Langenecker, A. Scott AU - McInnis, Melvin AU - Ajilore, Olusola AU - Nelson, C. Peter AU - Ryan, Kelly AU - Leow, Alex PY - 2018/07/20 TI - Predicting Mood Disturbance Severity with Mobile Phone Keystroke Metadata: A BiAffect Digital Phenotyping Study JO - J Med Internet Res SP - e241 VL - 20 IS - 7 KW - digital phenotype KW - mHealth KW - ecological momentary assessment KW - keystroke dynamics KW - bipolar disorder KW - depression KW - mania KW - mobile phone N2 - Background: Mood disorders are common and associated with significant morbidity and mortality. Better tools are needed for their diagnosis and treatment. Deeper phenotypic understanding of these disorders is integral to the development of such tools. This study is the first effort to use passively collected mobile phone keyboard activity to build deep digital phenotypes of depression and mania. Objective: The objective of our study was to investigate the relationship between mobile phone keyboard activity and mood disturbance in subjects with bipolar disorders and to demonstrate the feasibility of using passively collected mobile phone keyboard metadata features to predict manic and depressive signs and symptoms as measured via clinician-administered rating scales. Methods: Using a within-subject design of 8 weeks, subjects were provided a mobile phone loaded with a customized keyboard that passively collected keystroke metadata. Subjects were administered the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) weekly. Linear mixed-effects models were created to predict HDRS and YMRS scores. The total number of keystrokes was 626,641, with a weekly average of 9791 (7861), and that of accelerometer readings was 6,660,890, with a weekly average 104,076 (68,912). Results: A statistically significant mixed-effects regression model for the prediction of HDRS-17 item scores was created: conditional R2=.63, P=.01. A mixed-effects regression model for YMRS scores showed the variance accounted for by random effect was zero, and so an ordinary least squares linear regression model was created: R2=.34, P=.001. Multiple significant variables were demonstrated for each measure. Conclusions: Mood states in bipolar disorder appear to correlate with specific changes in mobile phone usage. The creation of these models provides evidence for the feasibility of using passively collected keyboard metadata to detect and monitor mood disturbances. UR - http://www.jmir.org/2018/7/e241/ UR - http://dx.doi.org/10.2196/jmir.9775 UR - http://www.ncbi.nlm.nih.gov/pubmed/30030209 ID - info:doi/10.2196/jmir.9775 ER - TY - JOUR AU - Meng, Jingbo AU - Hussain, Ali Syed AU - Mohr, C. David AU - Czerwinski, Mary AU - Zhang, Mi PY - 2018/07/17 TI - Exploring User Needs for a Mobile Behavioral-Sensing Technology for Depression Management: Qualitative Study JO - J Med Internet Res SP - e10139 VL - 20 IS - 7 KW - mobile sensing KW - mental health KW - depression KW - counseling KW - user-centered design N2 - Background: Today, college students are dealing with depression at some of the highest rates in decades. As the primary mental health service provider, university counseling centers are limited in their capacity and efficiency to provide mental health care due to time constraints and reliance on students? self-reports. A mobile behavioral-sensing platform may serve as a solution to enhance the efficiency and accessibility of university counseling services. Objective: The main objectives of this study are to (1) understand the usefulness of a mobile sensing platform (ie, iSee) in improving counseling services and assisting students? self-management of their depression conditions, and (2) explore what types of behavioral targets (ie, meaningful information extracted from raw sensor data) and feedback to deliver from both clinician and students? perspectives. Methods: We conducted semistructured interviews with 9 clinicians and 12 students with depression recruited from a counseling center at a large Midwestern university. The interviews were 40-50 minutes long and were audio recorded and transcribed. The interview data were analyzed using thematic analysis with an inductive approach. Clinician and student interviews were analyzed separately for comparison. The process of extracting themes involved iterative coding, memo writing, theme revisits, and refinement. Results: From the clinician perspective, the mobile sensing platform helps to improve counseling service by providing objective evidence for clinicians and filling gaps in clinician-patient communication. Clinicians suggested providing students with their sensed behavioral targets organized around personalized goals. Clinicians also recommended delivering therapeutic feedback to students based on their sensed behavioral targets, including positive reinforcement, reflection reminders, and challenging negative thoughts. From the student perspective, the mobile sensing platform helps to ease continued self-tracking practices. Students expressed their need for integrated behavioral targets to understand correlations between behaviors and depression. They also pointed out that they would prefer to avoid seeing negative feedback. Conclusions: Although clinician and student participants shared views on the advantages of iSee in supporting university counseling, they had divergent opinions on the types of behavioral targets and feedback to be provided via iSee. This exploratory work gained initial insights into the design of a mobile sensing platform for depression management and informed a more conclusive research project for the future. UR - http://www.jmir.org/2018/7/e10139/ UR - http://dx.doi.org/10.2196/10139 UR - http://www.ncbi.nlm.nih.gov/pubmed/30021710 ID - info:doi/10.2196/10139 ER - TY - JOUR AU - Bernardes-Souza, Breno AU - Patruz Ananias De Assis Pires, Francisco AU - Madeira, Moreira Gustavo AU - Felício Da Cunha Rodrigues, Túlio AU - Gatzka, Martina AU - Heppt, V. Markus AU - Omlor, J. Albert AU - Enk, H. Alexander AU - Groneberg, A. David AU - Seeger, Werner AU - von Kalle, Christof AU - Berking, Carola AU - Corrêa, Pinto Paulo César Rodrigues AU - Suhre, Leonie Janina AU - Alfitian, Jonas AU - Assis, Aisllan AU - Brinker, Josef Titus PY - 2018/07/17 TI - Facial-Aging Mobile Apps for Smoking Prevention in Secondary Schools in Brazil: Appearance-Focused Interventional Study JO - JMIR Public Health Surveill SP - e10234 VL - 4 IS - 3 KW - dermatology KW - smoking KW - apps KW - photoaging KW - face KW - skin KW - tobacco KW - tobacco cessation KW - tobacco prevention N2 - Background: Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous. Interventions that harness the broad availability of mobile phones as well as adolescents' interest in their appearance may be a novel way to improve school-based prevention. A recent study conducted in Germany showed promising results. However, the transfer to other cultural contexts, effects on different genders, and implementability remains unknown. Objective: In this observational study, we aimed to test the perception and implementability of facial-aging apps to prevent smoking in secondary schools in Brazil in accordance with the theory of planned behavior and with respect to different genders. Methods: We used a free facial-aging mobile phone app (?Smokerface?) in three Brazilian secondary schools via a novel method called mirroring. The students? altered three-dimensional selfies on mobile phones or tablets and images were ?mirrored? via a projector in front of their whole grade. Using an anonymous questionnaire, we then measured on a 5-point Likert scale the perceptions of the intervention among 306 Brazilian secondary school students of both genders in the seventh grade (average age 12.97 years). A second questionnaire captured perceptions of medical students who conducted the intervention and its conduction per protocol. Results: The majority of students perceived the intervention as fun (304/306, 99.3%), claimed the intervention motivated them not to smoke (289/306, 94.4%), and stated that they learned new benefits of not smoking (300/306, 98.0%). Only a minority of students disagreed or fully disagreed that they learned new benefits of nonsmoking (4/306, 1.3%) or that they themselves were motivated not to smoke (5/306, 1.6%). All of the protocol was delivered by volunteer medical students. Conclusions: Our data indicate the potential for facial-aging interventions to reduce smoking prevalence in Brazilian secondary schools in accordance with the theory of planned behavior. Volunteer medical students enjoyed the intervention and are capable of complete implementation per protocol. UR - http://publichealth.jmir.org/2018/3/e10234/ UR - http://dx.doi.org/10.2196/10234 UR - http://www.ncbi.nlm.nih.gov/pubmed/30021713 ID - info:doi/10.2196/10234 ER - TY - JOUR AU - Lee, Jie-Eun AU - Lee, Hwa Dong AU - Oh, Jung Tae AU - Kim, Min Kyoung AU - Choi, Hee Sung AU - Lim, Soo AU - Park, Joo Young AU - Park, Joon Do AU - Jang, Chul Hak AU - Moon, Hoon Jae PY - 2018/07/13 TI - Clinical Feasibility of Monitoring Resting Heart Rate Using a Wearable Activity Tracker in Patients With Thyrotoxicosis: Prospective Longitudinal Observational Study JO - JMIR Mhealth Uhealth SP - e159 VL - 6 IS - 7 KW - activity tracker KW - wearable device KW - heart rate KW - thyrotoxicosis KW - hyperthyroidism KW - Graves? disease N2 - Background: Symptoms and signs of thyrotoxicosis are nonspecific and assessing its clinical status is difficult with conventional physical examinations and history taking. Increased heart rate (HR) is one of the easiest signs to quantify this, and current wearable devices can monitor HR. Objective: We assessed the association between thyroid function and resting HR measured by a wearable activity tracker (WD-rHR) and evaluated the clinical feasibility of using this method in patients with thyrotoxicosis. Methods: Thirty patients with thyrotoxicosis and 10 controls were included in the study. Participants were instructed to use the wearable activity tracker during the study period so that activity and HR data could be collected. The primary study outcomes were verification of changes in WD-rHR during thyrotoxicosis treatment and associations between WD-rHR and thyroid function. Linear and logistic model generalized estimating equation analyses were performed and the results were compared to conventionally obtained resting HR during clinic visits (on-site resting HR) and the Hyperthyroidism Symptom Scale. Results: WD-rHR was higher in thyrotoxic patients than in the control groups and decreased in association with improvement of thyrotoxicosis. A one standard deviation?increase of WD-rHR of about 11 beats per minute (bpm) was associated with the increase of serum free T4 levels (beta=.492, 95% CI 0.367-0.616, P<.001) and thyrotoxicosis risk (odds ratio [OR] 3.840, 95% CI 2.113-6.978, P<.001). Although the Hyperthyroidism Symptom Scale showed similar results with WD-rHR, a 1 SD-increase of on-site rHR (about 16 beats per minute) showed a relatively lower beta and OR (beta=.396, 95% CI 0.204-0.588, P<.001; OR 2.114, 95% CI 1.365-3.273, P<.001) compared with WD-rHR. Conclusions: Heart rate data measured by a wearable device showed reasonable predictability of thyroid function. This simple, easy-to-measure parameter is clinically feasible and has the potential to manage thyroid dysfunction. Trial Registration: ClinicalTrials.gov NCT03009357; https://clinicaltrials.gov/ct2/show/NCT03009357 (Archived by WebCite at http://www.webcitation.org/70h55Llyg) UR - http://mhealth.jmir.org/2018/7/e159/ UR - http://dx.doi.org/10.2196/mhealth.9884 UR - http://www.ncbi.nlm.nih.gov/pubmed/30006328 ID - info:doi/10.2196/mhealth.9884 ER - TY - JOUR AU - Saleh, Shadi AU - Farah, Angie AU - Dimassi, Hani AU - El Arnaout, Nour AU - Constantin, Joanne AU - Osman, Mona AU - El Morr, Christo AU - Alameddine, Mohamad PY - 2018/07/13 TI - Using Mobile Health to Enhance Outcomes of Noncommunicable Diseases Care in Rural Settings and Refugee Camps: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e137 VL - 6 IS - 7 KW - noncommunicable diseases KW - hypertension KW - diabetes mellitus KW - telemedicine KW - mobile health KW - rural health KW - refugees N2 - Background: Rural areas and refugee camps are characterized by poor access of patients to needed noncommunicable disease (NCD)?related health services, including diabetes and hypertension. Employing low-cost innovative eHealth interventions, such as mobile health (mHealth), may help improve NCDs prevention and control among disadvantaged populations. Objective: The aim of this study was to assess the effect of employing low-cost mHealth tools on the accessibility to health services and improvement of health indicators of individuals with NCDs in rural areas and refugee camps in Lebanon. Methods: This is a randomized controlled trial study in which centers were allocated randomly into control and intervention sites. The effect of an employed mHealth intervention is assessed through selected quality indicators examined in both control and intervention groups. Sixteen primary health care centers (eight controls, eight interventions) located in rural areas and Palestinian refugee camps across Lebanon were included in this study. Data on diabetic and hypertensive patients?1433 in the intervention group and 926 in the control group?was extracted from patient files in the pre and postintervention periods. The intervention entailed weekly short message service messages, including medical information, importance of compliance, and reminders of appointments or regular physician follow-up. Internationally established care indicators were utilized in this study. Descriptive analysis of baseline characteristics of participants, bivariate analysis, logistic and linear regression were conducted using SPSS (IBM Corp). Results: Bivariate analysis of quality indicators indicated that the intervention group had a significant increase in blood pressure control (P=.03), as well as a significant decrease in the mean systolic blood pressure (P=.02), mean glycated hemoglobin (HbA1c; P<.01), and in the proportion of HbA1c poor control (P=.02). Separate regression models controlling for age, gender, and setting showed a 28% increase in the odds of blood pressure control (P=.05) and a 38% decrease in the odds of HbA1c poor control (P=.04) among the intervention group in the posttest period. Females were at lower odds of HbA1c poor control (P=.01), and age was statistically associated with annual HbA1c testing (P<.01). Regression models for mean systolic blood pressure, mean diastolic blood pressure, and mean HbA1c showed that a mean decrease in HbA1c of 0.87% (P<.01) pretest to posttest period was observed among the intervention group. Patients in rural areas belonging to the intervention group had a lower HbA1c score as compared with those in refugee camps (P<.01). Conclusions: This study underlines the importance of employing integrative approaches of diseases prevention and control in which existing NCD programs in underserved communities (ie, rural and refugee camps settings) are coupled with innovative, low-cost approaches such as mHealth to provide an effective and amplified effect of traditional NCD-targeted care that can be reflected by improved NCD-related health indicators among the population. Trial Registration: ClinicalTrials.gov NCT03580330; https://clinicaltrials.gov/ct2/show/NCT03580330 (Archived by WebCite at http://www.webcitation.org/70mhVEUwQ) UR - http://mhealth.jmir.org/2018/7/e137/ UR - http://dx.doi.org/10.2196/mhealth.8146 UR - http://www.ncbi.nlm.nih.gov/pubmed/30006326 ID - info:doi/10.2196/mhealth.8146 ER - TY - JOUR AU - Simblett, Sara AU - Greer, Ben AU - Matcham, Faith AU - Curtis, Hannah AU - Polhemus, Ashley AU - Ferrão, José AU - Gamble, Peter AU - Wykes, Til PY - 2018/07/12 TI - Barriers to and Facilitators of Engagement With Remote Measurement Technology for Managing Health: Systematic Review and Content Analysis of Findings JO - J Med Internet Res SP - e10480 VL - 20 IS - 7 KW - mHealth KW - technology KW - engagement KW - systematic review KW - telemedicine KW - remote sensing technology KW - patient participation KW - review N2 - Background: Remote measurement technology refers to the use of mobile health technology to track and measure change in health status in real time as part of a person?s everyday life. With accurate measurement, remote measurement technology offers the opportunity to augment health care by providing personalized, precise, and preemptive interventions that support insight into patterns of health-related behavior and self-management. However, for successful implementation, users need to be engaged in its use. Objective: Our objective was to systematically review the literature to update and extend the understanding of the key barriers to and facilitators of engagement with and use of remote measurement technology, to guide the development of future remote measurement technology resources. Methods: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines involving original studies dating back to the last systematic review published in 2014. We included studies if they met the following entry criteria: population (people using remote measurement technology approaches to aid management of health), intervention (remote measurement technology system), comparison group (no comparison group specified), outcomes (qualitative or quantitative evaluation of the barriers to and facilitators of engagement with this system), and study design (randomized controlled trials, feasibility studies, and observational studies). We searched 5 databases (MEDLINE, IEEE Xplore, EMBASE, Web of Science, and the Cochrane Library) for articles published from January 2014 to May 2017. Articles were independently screened by 2 researchers. We extracted study characteristics and conducted a content analysis to define emerging themes to synthesize findings. Formal quality assessments were performed to address risk of bias. Results: A total of 33 studies met inclusion criteria, employing quantitative, qualitative, or mixed-methods designs. Studies were conducted in 10 countries, included male and female participants, with ages ranging from 8 to 95 years, and included both active and passive remote monitoring systems for a diverse range of physical and mental health conditions. However, they were relatively short and had small sample sizes, and reporting of usage statistics was inconsistent. Acceptability of remote measurement technology according to the average percentage of time used (64%-86.5%) and dropout rates (0%-44%) was variable. The barriers and facilitators from the content analysis related to health status, perceived utility and value, motivation, convenience and accessibility, and usability. Conclusions: The results of this review highlight gaps in the design of studies trialing remote measurement technology, including the use of quantitative assessment of usage and acceptability. Several processes that could facilitate engagement with this technology have been identified and may drive the development of more person-focused remote measurement technology. However, these factors need further testing through carefully designed experimental studies. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42017060644; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=60644 (Archived by WebCite at http://www.webcitation.org/70K4mThTr) UR - http://www.jmir.org/2018/7/e10480/ UR - http://dx.doi.org/10.2196/10480 UR - http://www.ncbi.nlm.nih.gov/pubmed/30001997 ID - info:doi/10.2196/10480 ER - TY - JOUR AU - Campbell, R. Amber AU - Kinvig, Karen AU - Côté, CF Hélène AU - Lester, T. Richard AU - Qiu, Q. Annie AU - Maan, J. Evelyn AU - Alimenti, Ariane AU - Pick, Neora AU - Murray, CM Melanie PY - 2018/07/09 TI - Health Care Provider Utilization and Cost of an mHealth Intervention in Vulnerable People Living With HIV in Vancouver, Canada: Prospective Study JO - JMIR Mhealth Uhealth SP - e152 VL - 6 IS - 7 KW - HIV KW - mHealth KW - health care provider KW - cost KW - health care utilization KW - adherence N2 - Background: Improving adherence to combined antiretroviral therapy (cART) can be challenging, especially among vulnerable populations living with HIV. Even where cART is available free of charge, social determinants of health act as barriers to optimal adherence rates. Patient-centered approaches exploiting mobile phone communications (mHealth) have been shown to improve adherence to cART and promote achievement of suppressed HIV plasma viral loads. However, data are scarce on the health care provider (HCP) time commitments and health care costs associated with such interventions. This knowledge is needed to inform policy and programmatic implementation. Objective: The purpose of this study was to approximate the resources required and to provide an estimate of the costs associated with running an mHealth intervention program to improve medication adherence in people living with HIV (PLWH). Methods: This prospective study of HCP utilization and costs was embedded within a repeated measures effectiveness study of the WelTel short-message service (SMS) mHealth program. The study included 85 vulnerable, nonadherent PLWH in Vancouver, Canada, and resulted in improved medication adherence and HIV plasma viral load among participants. Study participants were provided mobile phones with unlimited texting (where required) and received weekly bidirectional text messages to inquire on their status for one year. A clinic nurse triaged and managed participants' responses, immediately logging all patient interactions by topic, HCP involvement, and time dedicated to addressing issues raised by participants. Interaction costs were determined in Canadian dollars based on HCP type, median salary within our health authority, and their time utilized as part of the intervention. Results: Participant-identified problems within text responses included health-related, social, and logistical issues. Taken together, management of problems required a median of 43 minutes (interquartile range, IQR 17-99) of HCP time per participant per year, for a median yearly cost of Can $36.72 (IQR 15.50-81.60) per participant who responded with at least one problem. The clinic nurse who monitored the texts solved or managed 65% of these issues, and the remaining were referred to a variety of other HCPs. The total intervention costs, including mobile phones, plans, and staffing were a median Can $347.74/highly vulnerable participant per year for all participants or Can $383.18/highly vulnerable participant per year for those who responded with at least one problem. Conclusions: Bidirectional mHealth programs improve HIV care and treatment outcomes for PLWH. Knowledge about the HCP cost associated, here less than Can $50/year, provides stakeholders and decision makers with information relevant to determining the feasibility and sustainability of mHealth programs in a real-world setting. Trial Registration: ClinicalTrials.gov NCT02603536; https://clinicaltrials.gov/ct2/show/NCT02603536 (Archived by WebCite at http://www.webcitation.org/70IYqKUjV). UR - http://mhealth.jmir.org/2018/7/e152/ UR - http://dx.doi.org/10.2196/mhealth.9493 UR - http://www.ncbi.nlm.nih.gov/pubmed/29986845 ID - info:doi/10.2196/mhealth.9493 ER - TY - JOUR AU - Sartor, Francesco AU - Papini, Gabriele AU - Cox, Elisabeth Lieke Gertruda AU - Cleland, John PY - 2018/07/02 TI - Methodological Shortcomings of Wrist-Worn Heart Rate Monitors Validations JO - J Med Internet Res SP - e10108 VL - 20 IS - 7 KW - sensor technology KW - accuracy KW - wearable KW - telemonitoring UR - http://www.jmir.org/2018/7/e10108/ UR - http://dx.doi.org/10.2196/10108 UR - http://www.ncbi.nlm.nih.gov/pubmed/29967000 ID - info:doi/10.2196/10108 ER - TY - JOUR AU - Hollier, M. John AU - Vaughan, O. Adetola AU - Liu, Yan AU - van Tilburg, AL Miranda AU - Shulman, J. Robert AU - Thompson, I. Debbe PY - 2018/06/29 TI - Maternal and Child Acceptability of a Proposed Guided Imagery Therapy Mobile App Designed to Treat Functional Abdominal Pain Disorders in Children: Mixed-Methods Predevelopment Formative Research JO - JMIR Pediatr Parent SP - e6 VL - 1 IS - 1 KW - functional abdominal pain disorders KW - guided imagery therapy KW - mixed methods KW - mobile applications KW - pediatrics KW - parents KW - Technology Acceptance Model KW - imagery (psychotherapy) N2 - Background: Functional abdominal pain disorders are chronic abdominal pain conditions, which affect up to 20% of children worldwide. Of the various functional abdominal pain disorder treatment modalities, psychological therapies such as guided imagery therapy appear most effective. However, there are significant barriers to receiving psychological therapies, including access to trained therapists. Alternatively, remotely delivered psychological therapies for functional abdominal pain disorders have been efficacious. Objective: The objective of our study was to assess acceptability of a proposed guided imagery therapy app designed to treat functional abdominal pain disorders through remote delivery of prerecorded audio sessions and to evaluate user preferences for using such an app. Methods: Using a mixed-methods approach, we conducted a predevelopment formative study among children aged 7 to 12 years with a functional abdominal pain disorder and their parents. The parents completed our modified Technology Acceptance Model (TAM) questionnaire, which quantified behavioral intention and related factors for using a guided imagery therapy app. Dyads participated in separate in-person semistructured interviews to assess their attitudes toward and preferences for a guided imagery therapy app. Questionnaire and interview findings were collected concurrently, analyzed separately, and then integrated through methods triangulation. Results: Among the 15 participating parent-child dyads, 5 (33%) children were Hispanic and 11 (73%) had irritable bowel syndrome. They had diverse socioeconomic status. All parent participants were mothers. The TAM questionnaire indicated that mothers scored favorably on behavioral intention to use a guided imagery therapy app (mean score 12.0, SD 2.6, possible range 3-15). Scores for the TAM factors perceived usefulness, perceived ease of use, hedonic motivation, compatibility, and habit also were favorable. Maternal interviews confirmed positive attitudes toward the proposed app. They advocated a visual component to hold their child?s attention during the guided imagery therapy sessions; recommended incorporating background sounds into the sessions; favored session reminder notifications from the app; and thought the best time for their child to listen to the sessions would be in the evening or before bed. The child interviews also confirmed positive attitudes toward the proposed app. They suggested guided imagery therapy session topics such as sports and adventures; listening to sessions in their bedroom; and the need for parental supervision to install the app on their mobile device. Integration of the quantitative and qualitative methods findings complimented one another on acceptability. The favorable behavioral intention TAM score aligned well with expressed positive maternal and child attitudes toward the app and can be explained by the desire to avoid medications. The questionnaire and interviews also confirmed therapeutic benefit as an intrinsic motivator to promote routine use. Conclusions: A guided imagery therapy app designed to treat pediatric patients with functional abdominal pain disorders appears to be acceptable to both mothers and children. Incorporating parent and child preferences into a guided imagery therapy app could promote therapeutic compliance and increase access to optimal care. UR - http://pediatrics.jmir.org/2018/1/e6/ UR - http://dx.doi.org/10.2196/pediatrics.8535 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518303 ID - info:doi/10.2196/pediatrics.8535 ER - TY - JOUR AU - Zhang, Ling AU - Ding, Ding AU - Neubeck, Lis AU - Gallagher, Patrick AU - Paull, Glenn AU - Gao, Yan AU - Gallagher, Robyn PY - 2018/06/26 TI - Mobile Technology Utilization Among Patients From Diverse Cultural and Linguistic Backgrounds Attending Cardiac Rehabilitation in Australia: Descriptive, Case-Matched Comparative Study JO - JMIR Cardio SP - e13 VL - 2 IS - 1 KW - cultural and linguistic diverse KW - cardiac rehabilitation KW - technology KW - mobile technology KW - information technology N2 - Background: Barriers to attending cardiac rehabilitation (CR), including cultural and linguistic differences, may be addressed by recent technological developments. However, the feasibility of using these approaches in culturally and linguistically diverse patients is yet to be determined. Objective: This study aims to assess the use of mobile technologies and features, as well as confidence in utilization across patients speaking different languages at home (ie, English, Mandarin Chinese, and a language other than English and Mandarin [other]) and are both eligible and physically suitable for CR. In addition, the study aims to determine the sociodemographic correlates of the mobile technology/feature use, including language spoken at home in the three groups mentioned above. Methods: This is a descriptive, case matched, comparative study. Age and gender-matched patients speaking English, Mandarin and other languages (n=30/group) eligible for CR were surveyed for their mobile technology and mobile feature use. Results: ?Participants had a mean age of 66.7 years (SD 13, n=90, range 46-95), with 53.3% (48/90) male. The majority (82/90, 91.1%) used at least one technology device, with 87.8% (79/90) using mobile devices, the most common being smartphones (57/90, 63.3%), tablets (28/90, 31.1%), and text/voice-only phones (24/90, 26.7%). More English-speaking participants used computers than Mandarin or ?other? language speaking participants (P=.003 and .02) and were more confident in doing so compared to Mandarin-speaking participants (P=.003). More Mandarin-speaking participants used smartphones compared with ?other? language speaking participants (P=.03). Most commonly used mobile features were voice calls (77/82, 93.9%), text message (54/82, 65.9%), the internet (39/82, 47.6%), email (36/82, 43.9%), and videoconferencing (Skype or FaceTime [WeChat or QQ] 35/82, 42.7%). Less Mandarin-speaking participants used emails (P=.001) and social media (P=.007) than English-speaking participants. Speaking Mandarin was independently associated with using smartphone, emails, and accessing the web-based medication information (OR 7.238, 95% CI 1.262-41.522; P=.03, OR 0.089, 95% CI 0.016-0.490; P=.006 and OR 0.191, 95% CI 0.037-0.984; P=.05). Conclusions: This study reveals a high usage of mobile technology among CR patients and provides further insights into differences in the technology use across CALD patients in Australia. The findings of this study may inform the design and implementation of future technology-based CR. UR - http://cardio.jmir.org/2018/1/e13/ UR - http://dx.doi.org/10.2196/cardio.9424 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758767 ID - info:doi/10.2196/cardio.9424 ER - TY - JOUR AU - Lopez Segui, Francesc AU - Pratdepadua Bufill, Carme AU - Abdon Gimenez, Nuria AU - Martinez Roldan, Jordi AU - Garcia Cuyas, Francesc PY - 2018/06/21 TI - The Prescription of Mobile Apps by Primary Care Teams: A Pilot Project in Catalonia JO - JMIR Mhealth Uhealth SP - e10701 VL - 6 IS - 6 KW - mobile apps KW - apps KW - mHealth KW - primary health care KW - telemedicine KW - telemonitoring N2 - Background: In Catalonia, the Fundació TIC Salut Social?s mHealth Office created the AppSalut Site to showcase to mobile apps in the field of health and social services. Its primary objective was to encourage the public to look after their health. The catalogue allows primary health care doctors to prescribe certified, connected apps, which guarantees a safe and reliable environment for their use. The generated data can be consulted by health care professionals and included in the patient's clinical history. This document presents the intervention and the major findings following a five-month pilot project conducted in the Barcelona area. Objective: The objective of the pilot study was to test, in a real, controlled environment, the implementation of AppSalut. Specifically, we tested whether (1) the procedures corresponding to the prescription, transmission, and evaluation of the data functions correctly, (2) users interact successfully and accept the tool, and (3) the data travels through existing pathways in accordance with international standards. The evaluation is not based on clinical criteria, but rather on the usability and technological reliability of the intervention and its implementation in the context of primary care. Methods: The project was presented to the Primary Care Team participants to encourage the involvement of doctors. The study involved at least 5 doctors and 5 patients per professional, chosen at their discretion and in accordance with their own clinical criteria. An initial consultation took place, during which the doctor discussed the pilot project with the patient and recommended the app. The patient was sent a text message (SMS, short message service) containing an access code. When the patient arrived home, they accessed their personal health record (PHR) to view the recommendation, download the app, and enter the access code. The patient was then able to start using the app. The data was collected in a standardized manner and automatically sent to the system. In a second visit, the patient looked at the data with their doctor on their clinical station screen. The latter was able to consult the information generated by the patient and select what to include in their electronic health record. In order to assess the performance of the system, three focus groups were performed and two ad-hoc case-specific questionnaires, one for doctors and one for patients, were sent by email. Response was voluntary. Results: A total of 32 doctors made 79 recommendations of apps to patients. On average, the patients uploaded data 13 times per prescribed app, accounting for a total of 16 different variables. Results show that data traveled through the established channels in an adequate manner and in accordance with international standards. This includes the prescription of an app by a doctor, the patient accessing the recommendation via the PHR, app download by the patient from the official app stores, linking of the patient to the public platform through the app, the generation and visualization of the data on the primary care workstation, and its subsequent validation by the clinician. Conclusions: First, the choice of apps to be used is fundamental; the user's perception of the utility of the proposed tool being paramount. Second, thorough face-to-face support is vital for a smooth transition towards a more intense model of telemedicine. Last, a powerful limiting factor is the lack of control over people?s ability to use the apps. UR - http://mhealth.jmir.org/2018/6/e10701/ UR - http://dx.doi.org/10.2196/10701 UR - http://www.ncbi.nlm.nih.gov/pubmed/29929948 ID - info:doi/10.2196/10701 ER - TY - JOUR AU - Fukuoka, Yoshimi AU - Lindgren, G. Teri AU - Mintz, Dov Yonatan AU - Hooper, Julie AU - Aswani, Anil PY - 2018/06/20 TI - Applying Natural Language Processing to Understand Motivational Profiles for Maintaining Physical Activity After a Mobile App and Accelerometer-Based Intervention: The mPED Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e10042 VL - 6 IS - 6 KW - mobile apps KW - physical activity KW - fitness trackers KW - women KW - maintenance KW - accelerometer KW - randomized controlled trial KW - motivation KW - barriers KW - behavioral change N2 - Background: Regular physical activity is associated with reduced risk of chronic illnesses. Despite various types of successful physical activity interventions, maintenance of activity over the long term is extremely challenging. Objective: The aims of this original paper are to 1) describe physical activity engagement post intervention, 2) identify motivational profiles using natural language processing (NLP) and clustering techniques in a sample of women who completed the physical activity intervention, and 3) compare sociodemographic and clinical data among these identified cluster groups. Methods: In this cross-sectional analysis of 203 women completing a 12-month study exit (telephone) interview in the mobile phone-based physical activity education study were examined. The mobile phone-based physical activity education study was a randomized, controlled trial to test the efficacy of the app and accelerometer intervention and its sustainability over a 9-month period. All subjects returned the accelerometer and stopped accessing the app at the last 9-month research office visit. Physical engagement and motivational profiles were assessed by both closed and open-ended questions, such as ?Since your 9-month study visit, has your physical activity been more, less, or about the same (compared to the first 9 months of the study)?? and, ?What motivates you the most to be physically active?? NLP and cluster analysis were used to classify motivational profiles. Descriptive statistics were used to compare participants? baseline characteristics among identified groups. Results: Approximately half of the 2 intervention groups (Regular and Plus) reported that they were still wearing an accelerometer and engaging in brisk walking as they were directed during the intervention phases. These numbers in the 2 intervention groups were much higher than the control group (overall P=.01 and P=.003, respectively). Three clusters were identified through NLP and named as the Weight Loss group (n=19), the Illness Prevention group (n=138), and the Health Promotion group (n=46). The Weight Loss group was significantly younger than the Illness Prevention and Health Promotion groups (overall P<.001). The Illness Prevention group had a larger number of Caucasians as compared to the Weight Loss group (P=.001), which was composed mostly of those who identified as African American, Hispanic, or mixed race. Additionally, the Health Promotion group tended to have lower BMI scores compared to the Illness Prevention group (overall P=.02). However, no difference was noted in the baseline moderate-to-vigorous intensity activity level among the 3 groups (overall P>.05). Conclusions: The findings could be relevant to tailoring a physical activity maintenance intervention. Furthermore, the findings from NLP and cluster analysis are useful methods to analyze short free text to differentiate motivational profiles. As more sophisticated NL tools are developed in the future, the potential of NLP application in behavioral research will broaden. Trial Registration: ClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812 (Archived by WebCite at http://www.webcitation.org/70IkGagAJ) UR - http://mhealth.jmir.org/2018/6/e10042/ UR - http://dx.doi.org/10.2196/10042 UR - http://www.ncbi.nlm.nih.gov/pubmed/29925491 ID - info:doi/10.2196/10042 ER - TY - JOUR AU - Pagoto, Sherry AU - Tulu, Bengisu AU - Agu, Emmanuel AU - Waring, E. Molly AU - Oleski, L. Jessica AU - Jake-Schoffman, E. Danielle PY - 2018/06/20 TI - Using the Habit App for Weight Loss Problem Solving: Development and Feasibility Study JO - JMIR Mhealth Uhealth SP - e145 VL - 6 IS - 6 KW - mobile app KW - mHealth KW - weight loss KW - obesity KW - problem solving N2 - Background: Reviews of weight loss mobile apps have revealed they include very few evidence-based features, relying mostly on self-monitoring. Unfortunately, adherence to self-monitoring is often low, especially among patients with motivational challenges. One behavioral strategy that is leveraged in virtually every visit of behavioral weight loss interventions and is specifically used to deal with adherence and motivational issues is problem solving. Problem solving has been successfully implemented in depression mobile apps, but not yet in weight loss apps. Objective: This study describes the development and feasibility testing of the Habit app, which was designed to automate problem-solving therapy for weight loss. Methods: Two iterative single-arm pilot studies were conducted to evaluate the feasibility and acceptability of the Habit app. In each pilot study, adults who were overweight or obese were enrolled in an 8-week intervention that included the Habit app plus support via a private Facebook group. Feasibility outcomes included retention, app usage, usability, and acceptability. Changes in problem-solving skills and weight over 8 weeks are described, as well as app usage and weight change at 16 weeks. Results: Results from both pilots show acceptable use of the Habit app over 8 weeks with on average two to three uses per week, the recommended rate of use. Acceptability ratings were mixed such that 54% (13/24) and 73% (11/15) of participants found the diet solutions helpful and 71% (17/24) and 80% (12/15) found setting reminders for habits helpful in pilots 1 and 2, respectively. In both pilots, participants lost significant weight (P=.005 and P=.03, respectively). In neither pilot was an effect on problem-solving skills observed (P=.62 and P=.27, respectively). Conclusions: Problem-solving therapy for weight loss is feasible to implement in a mobile app environment; however, automated delivery may not impact problem-solving skills as has been observed previously via human delivery. Trial Registration: ClinicalTrials.gov NCT02192905; https://clinicaltrials.gov/ct2/show/NCT02192905 (Archived by WebCite at http://www.webcitation.org/6zPQmvOF2) UR - http://mhealth.jmir.org/2018/6/e145/ UR - http://dx.doi.org/10.2196/mhealth.9801 UR - http://www.ncbi.nlm.nih.gov/pubmed/29925496 ID - info:doi/10.2196/mhealth.9801 ER - TY - JOUR AU - Spring, Bonnie AU - Pellegrini, Christine AU - McFadden, G. H. AU - Pfammatter, Fidler Angela AU - Stump, K. Tammy AU - Siddique, Juned AU - King, C. Abby AU - Hedeker, Donald PY - 2018/06/19 TI - Multicomponent mHealth Intervention for Large, Sustained Change in Multiple Diet and Activity Risk Behaviors: The Make Better Choices 2 Randomized Controlled Trial JO - J Med Internet Res SP - e10528 VL - 20 IS - 6 KW - health behavior KW - risk factors KW - mobile health KW - behavioral medicine KW - randomized controlled trial N2 - Background: Prevalent co-occurring poor diet and physical inactivity convey chronic disease risk to the population. Large magnitude behavior change can improve behaviors to recommended levels, but multiple behavior change interventions produce small, poorly maintained effects. Objective: The Make Better Choices 2 trial tested whether a multicomponent intervention integrating mHealth, modest incentives, and remote coaching could sustainably improve diet and activity. Methods: Between 2012 and 2014, the 9-month randomized controlled trial enrolled 212 Chicago area adults with low fruit and vegetable and high saturated fat intakes, low moderate to vigorous physical activity (MVPA) and high sedentary leisure screen time. Participants were recruited by advertisements to an open-access website, screened, and randomly assigned to either of two active interventions targeting MVPA simultaneously with, or sequentially after other diet and activity targets (N=84 per intervention) or a stress and sleep contact control intervention (N=44). They used a smartphone app and accelerometer to track targeted behaviors and received personalized remote coaching from trained paraprofessionals. Perfect behavioral adherence was rewarded with an incentive of US $5 per week for 12 weeks. Diet and activity behaviors were measured at baseline, 3, 6, and 9 months; primary outcome was 9-month diet and activity composite improvement. Results: Both simultaneous and sequential interventions produced large, sustained improvements exceeding control (P<.001), and brought all diet and activity behaviors to guideline levels. At 9 months, the interventions increased fruits and vegetables by 6.5 servings per day (95% CI 6.1-6.8), increased MVPA by 24.7 minutes per day (95% CI 20.0-29.5), decreased sedentary leisure by 170.5 minutes per day (95% CI ?183.5 to ?157.5), and decreased saturated fat intake by 3.6% (95% CI ?4.1 to ?3.1). Retention through 9-month follow-up was 82.1%. Self-monitoring decreased from 96.3% of days at baseline to 72.3% at 3 months, 63.5% at 6 months, and 54.6% at 9 months (P<.001). Neither attrition nor decline in self-monitoring differed across intervention groups. Conclusions: Multicomponent mHealth diet and activity intervention involving connected coaching and modest initial performance incentives holds potential to reduce chronic disease risk. Trial Registration: ClinicalTrials.gov NCT01249989; https://clinicaltrials.gov/ct2/show/NCT01249989 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01249989). UR - http://www.jmir.org/2018/6/e10528/ UR - http://dx.doi.org/10.2196/10528 UR - http://www.ncbi.nlm.nih.gov/pubmed/29921561 ID - info:doi/10.2196/10528 ER - TY - JOUR AU - Lin, Yuting AU - Tudor-Sfetea, Carina AU - Siddiqui, Sarim AU - Sherwani, Yusuf AU - Ahmed, Maroof AU - Eisingerich, B. Andreas PY - 2018/06/15 TI - Effective Behavioral Changes through a Digital mHealth App: Exploring the Impact of Hedonic Well-Being, Psychological Empowerment and Inspiration JO - JMIR Mhealth Uhealth SP - e10024 VL - 6 IS - 6 KW - mHealth KW - gamification KW - cognitive behavioral therapy KW - empowerment KW - well-being KW - inspiration KW - mobile app KW - behavior change and prevention KW - digital N2 - Background: New mobile health (mHealth) software apps are emerging and are providing the foundation to radically transform the practice and reach of medical research and care. For this study we collaborated with Quit Genius, a cognitive behavioral therapy (CBT) based mHealth app that helps users quit smoking, to explore the effective design of a digital mHealth app; one that delivers important benefits to its users and helps them change their behaviors for a healthier lifestyle. Objective: The specific aims of this study were to (1) explore the key role of CBT program progress, (2) examine the gamification design app elements that deliver significant benefits (ie, empowerment, well-being, inspiration) to users, (3) explore the effectiveness of these app elements to help users quit smoking or reduce the number of cigarettes smoked, and (4) identify and describe any potential drivers and hindrances arising from the app design elements. Methods: We developed an online survey and sent an email invitation to 4144 individuals, who had previously or were at the time using the Quit Genius mHealth app, to encourage participation in the study. We matched the online survey data with objective app usage data of the study participants. Results: A dataset of 190 completed responses was used. At the time of the survey, respondents had completed an average of 60% of the CBT program in the Quit Genius mHealth app. Of the respondents, 36.3% (69/190) noted to have quit smoking successfully after using the Quit Genius app. As for those who remained smokers after using the app (N=121), the number of cigarettes smoked per day was significantly reduced by 59.6%. The ability of the app to enhance users? hedonic well-being and psychologically empower them in their daily lives was identified as being key in helping users quit smoking. Specifically, the results show that users whose well-being was enhanced through the app were 1.72 times more likely to quit smoking successfully. Moreover, a one-unit increase on a 7-point Likert scale in the app?s ability to empower smokers in their daily lives led to a reduction of cigarettes smoked per day of 53%. The app?s inspiration to users, however, was negatively associated with quitting success and the reduction in cigarette smoked per day. Conclusions: The findings offer important insights for the effective design of digital mHealth apps. Specifically, we find that perceived psychological empowerment and enhanced hedonic well-being from the mobile solution may be a more impactful way to support the effectiveness of mobile cognitive behavioral therapy for smoking cessation than eliciting strong inspiration. UR - http://mhealth.jmir.org/2018/6/e10024/ UR - http://dx.doi.org/10.2196/10024 UR - http://www.ncbi.nlm.nih.gov/pubmed/29907557 ID - info:doi/10.2196/10024 ER - TY - JOUR AU - Sano, Akane AU - Taylor, Sara AU - McHill, W. Andrew AU - Phillips, JK Andrew AU - Barger, K. Laura AU - Klerman, Elizabeth AU - Picard, Rosalind PY - 2018/06/08 TI - Identifying Objective Physiological Markers and Modifiable Behaviors for Self-Reported Stress and Mental Health Status Using Wearable Sensors and Mobile Phones: Observational Study JO - J Med Internet Res SP - e210 VL - 20 IS - 6 KW - mobile health KW - mood KW - machine learning KW - wearable electronic devices KW - smartphone KW - mobile phone KW - mental health KW - psychological stress N2 - Background: Wearable and mobile devices that capture multimodal data have the potential to identify risk factors for high stress and poor mental health and to provide information to improve health and well-being. Objective: We developed new tools that provide objective physiological and behavioral measures using wearable sensors and mobile phones, together with methods that improve their data integrity. The aim of this study was to examine, using machine learning, how accurately these measures could identify conditions of self-reported high stress and poor mental health and which of the underlying modalities and measures were most accurate in identifying those conditions. Methods: We designed and conducted the 1-month SNAPSHOT study that investigated how daily behaviors and social networks influence self-reported stress, mood, and other health or well-being-related factors. We collected over 145,000 hours of data from 201 college students (age: 18-25 years, male:female=1.8:1) at one university, all recruited within self-identified social groups. Each student filled out standardized pre- and postquestionnaires on stress and mental health; during the month, each student completed twice-daily electronic diaries (e-diaries), wore two wrist-based sensors that recorded continuous physical activity and autonomic physiology, and installed an app on their mobile phone that recorded phone usage and geolocation patterns. We developed tools to make data collection more efficient, including data-check systems for sensor and mobile phone data and an e-diary administrative module for study investigators to locate possible errors in the e-diaries and communicate with participants to correct their entries promptly, which reduced the time taken to clean e-diary data by 69%. We constructed features and applied machine learning to the multimodal data to identify factors associated with self-reported poststudy stress and mental health, including behaviors that can be possibly modified by the individual to improve these measures. Results: We identified the physiological sensor, phone, mobility, and modifiable behavior features that were best predictors for stress and mental health classification. In general, wearable sensor features showed better classification performance than mobile phone or modifiable behavior features. Wearable sensor features, including skin conductance and temperature, reached 78.3% (148/189) accuracy for classifying students into high or low stress groups and 87% (41/47) accuracy for classifying high or low mental health groups. Modifiable behavior features, including number of naps, studying duration, calls, mobility patterns, and phone-screen-on time, reached 73.5% (139/189) accuracy for stress classification and 79% (37/47) accuracy for mental health classification. Conclusions: New semiautomated tools improved the efficiency of long-term ambulatory data collection from wearable and mobile devices. Applying machine learning to the resulting data revealed a set of both objective features and modifiable behavioral features that could classify self-reported high or low stress and mental health groups in a college student population better than previous studies and showed new insights into digital phenotyping. UR - http://www.jmir.org/2018/6/e210/ UR - http://dx.doi.org/10.2196/jmir.9410 UR - http://www.ncbi.nlm.nih.gov/pubmed/29884610 ID - info:doi/10.2196/jmir.9410 ER - TY - JOUR AU - Zhang, Melvyn AU - Ying, JiangBo AU - Song, Guo AU - Fung, SS Daniel AU - Smith, Helen PY - 2018/05/24 TI - Attention and Cognitive Bias Modification Apps: Review of the Literature and of Commercially Available Apps JO - JMIR Mhealth Uhealth SP - e10034 VL - 6 IS - 5 KW - attention bias KW - cognitive bias KW - smartphone KW - mHealth KW - psychiatry KW - telemedicine KW - mobile applications N2 - Background: Automatic processes, such as attentional biases or interpretative biases, have been purported to be responsible for several psychiatric disorders. Recent reviews have highlighted that cognitive biases may be modifiable. Advances in eHealth and mHealth have been harnessed for the delivery of cognitive bias modification. While several studies have evaluated mHealth-based bias modification intervention, no review, to our knowledge, has synthesized the evidence for it. In addition, no review has looked at commercial apps and their functionalities and methods of bias modification. A review is essential in determining whether scientifically validated apps are available commercially and the proportion of commercial apps that have been evaluated scientifically. Objective: The objective of this review was primarily to determine the proportion of attention or cognitive bias modification apps that have been evaluated scientifically and secondarily to determine whether the scientifically evaluated apps were commercially available. We also sought to identify commercially available bias modification apps and determine the functionalities of these apps, the methods used for attention or cognitive bias modification, and whether these apps had been evaluated scientifically. Methods: To identify apps in the published literature, we searched PubMed, MEDLINE, PsycINFO, and Scopus for studies published from 2000 to April 17, 2018. The search terms used were ?attention bias? OR ?cognitive bias? AND ?smartphone? OR ?smartphone application? OR ?smartphone app? OR ?mobile phones? OR ?mobile application? OR mobile app? OR ?personal digital assistant.? To identify commercial apps, we conducted a manual cross-sectional search between September 15 and 25, 2017 in the Apple iTunes and Google Play app stores. The search terms used to identify the apps were ?attention bias? and ?cognitive bias.? We also conducted a manual search on the apps with published evaluations. Results: The effectiveness of bias modification was reported in 7 of 8 trials that we identified in the published literature. Only 1 of the 8 previously evaluated apps was commercially available. The 17 commercial apps we identified tended to use either an attention visual search or gamified task. Only 1 commercial app had been evaluated in the published literature. Conclusions: This is perhaps the first review to synthesize the evidence for published mHealth attention bias apps. Our review demonstrated that evidence for mHealth attention bias apps is inconclusive, and quite a few commercial apps have not been validated scientifically. UR - http://mhealth.jmir.org/2018/5/e10034/ UR - http://dx.doi.org/10.2196/10034 UR - http://www.ncbi.nlm.nih.gov/pubmed/29793899 ID - info:doi/10.2196/10034 ER - TY - JOUR AU - Blázquez Martín, David AU - De La Torre, Isabel AU - Garcia-Zapirain, Begonya AU - Lopez-Coronado, Miguel AU - Rodrigues, Joel PY - 2018/05/09 TI - Managing and Controlling Stress Using mHealth: Systematic Search in App Stores JO - JMIR Mhealth Uhealth SP - e111 VL - 6 IS - 5 KW - apps KW - control KW - management KW - mHealth KW - stress N2 - Background: Traditional stress management techniques have been proven insufficient to tackle the needs of today?s population. Computational-based techniques and now mobile health (mHealth) apps are showing promise to enable ease of use and access while educating end users on self-management. Objective: The main aim of this paper was to put forward a systematic review of mHealth apps for stress management. Methods: The scenario chosen for this study consists of a sample of the most relevant mHealth apps found on the British and Spanish online stores of the two main mobile operating systems: iOS and Android. The apps have been categorized and scored base on their impact, presence, number of results, language, and operating system. Results: A total of 433 different mobile apps for stress management was analyzed. Of these apps, 21.7% (94/433) belonged to the ?relaxing music? category, 10.9% (47/433) were in the ?draw and paint? category, 1.2% (5/433) belonged to the ?heart rate control? category, and 1.2% (5/433) fell under ?integral methodology.? Only 2.0% (8/433) of the apps qualified as high or medium interest while 98.0% were low interest. Furthermore, 2.0% (8/433) of the apps were available on both iOS and Android, and 98% of apps ran on only one platform (iOS or Android). Conclusions: There are many low-value apps available at the moment, but the analysis shows that they are adding new functionalities and becoming fully integrated self-management systems with extra capabilities such as professional assistance services and online support communities. UR - http://mhealth.jmir.org/2018/5/e111/ UR - http://dx.doi.org/10.2196/mhealth.8866 UR - http://www.ncbi.nlm.nih.gov/pubmed/29743152 ID - info:doi/10.2196/mhealth.8866 ER - TY - JOUR AU - Lunde, Pernille AU - Nilsson, Blakstad Birgitta AU - Bergland, Astrid AU - Kværner, Jorunn Kari AU - Bye, Asta PY - 2018/05/04 TI - The Effectiveness of Smartphone Apps for Lifestyle Improvement in Noncommunicable Diseases: Systematic Review and Meta-Analyses JO - J Med Internet Res SP - e162 VL - 20 IS - 5 KW - smartphone KW - telemedicine KW - noncommunicable diseases KW - lifestyle KW - diet KW - exercise N2 - Background: Noncommunicable diseases (NCDs) account for 70% of all deaths in a year globally. The four main NCDs are cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes mellitus. Fifty percent of persons with NCD do not adhere to prescribed treatment; in fact, adherence to lifestyle interventions is especially considered as a major challenge. Smartphone apps permit structured monitoring of health parameters, as well as the opportunity to receive feedback. Objective: The aim of this study was to review and assess the effectiveness of app-based interventions, lasting at least 3 months, to promote lifestyle changes in patients with NCDs. Methods: In February 2017, a literature search in five databases (EMBASE, MEDLINE, CINAHL, Academic Research Premier, and Cochrane Reviews and Trials) was conducted. Inclusion criteria was quantitative study designs including randomized and nonrandomized controlled trials that included patients aged 18 years and older diagnosed with any of the four main NCDs. Lifestyle outcomes were physical activity, physical fitness, modification of dietary habits, and quality of life. All included studies were assessed for risk of bias using the Cochrane Collaboration`s risk of bias tool. Meta-analyses were conducted for one of the outcomes (glycated hemoglobin, HbA1c) by using the estimate of effect of mean post treatment with SD or CI. Heterogeneity was tested using the I2 test. All studies included in the meta-analyses were graded. Results: Of the 1588 records examined, 9 met the predefined criteria. Seven studies included diabetes patients only, one study included heart patients only, and another study included both diabetes and heart patients. Statistical significant effect was shown in HbA1c in 5 of 8 studies, as well in body weight in one of 5 studies and in waist circumference in one of 3 studies evaluating these outcomes. Seven of the included studies were included in the meta-analyses and demonstrated significantly overall effect on HbA1c on a short term (3-6 months; P=.02) with low heterogeneity (I2=41%). In the long term (10-12 months), the overall effect on HbA1c was statistical significant (P=.009) and without heterogeneity (I2=0%). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation was low for short term and moderate for long term. Conclusions: Our review demonstrated limited research of the use of smartphone apps for NCDs other than diabetes with a follow-up of at least 3 months. For diabetes, the use of apps seems to improve lifestyle factors, especially to decrease HbA1c. More research with long-term follow-up should be performed to assess the effect of smartphone apps for NCDs other than diabetes. UR - http://www.jmir.org/2018/5/e162/ UR - http://dx.doi.org/10.2196/jmir.9751 UR - http://www.ncbi.nlm.nih.gov/pubmed/29728346 ID - info:doi/10.2196/jmir.9751 ER - TY - JOUR AU - Garcia-Ortiz, Luis AU - Recio-Rodriguez, Ignacio Jose AU - Agudo-Conde, Cristina AU - Patino-Alonso, Carmen María AU - Maderuelo-Fernandez, Jose-Angel AU - Repiso Gento, Irene AU - Puigdomenech Puig, Elisa AU - Gonzalez-Viejo, Natividad AU - Arietaleanizbeaskoa, Soledad Maria AU - Schmolling-Guinovart, Yolanda AU - Gomez-Marcos, Angel Manuel AU - Rodriguez-Sanchez, Emiliano AU - PY - 2018/04/27 TI - Long-Term Effectiveness of a Smartphone App for Improving Healthy Lifestyles in General Population in Primary Care: Randomized Controlled Trial (Evident II Study) JO - JMIR Mhealth Uhealth SP - e107 VL - 6 IS - 4 KW - exercise KW - Mediterranean diet KW - smartphone KW - vascular stiffness N2 - Background: Information and communication technologies are currently among the supporting elements that may contribute to improving health and changing lifestyles. Objective: The aim of this study was to evaluate the long-term effectiveness of adding an app to standardized counseling in order to increase physical activity (PA) and adherence to the Mediterranean diet and to analyze the effects of app adherence in lifestyle changes. Methods: A randomized, multicenter clinical trial with a 12 month-follow up was conducted, involving 833 participants recruited by random sampling in 6 primary Spanish care centers (415 vs 418). Counseling on PA and the Mediterranean diet was given to both groups by a research nurse; however, the counseling + app group (intervention group) received additional training in the use of an app that was designed to promote the Mediterranean diet and PA over a 3-month period. Main outcomes and measures included PA by accelerometer and the 7-day Physical Activity Recall (PAR) questionnaire and adherence to the Mediterranean diet by an adherence screener questionnaire. We considered adherence to the app to be high when it was used for more than 60 days. Results: The mean age was 51 years (SD 12) in the intervention group and 52.3 years (SD 12.0) in the counseling-only group; females predominated in both groups (60.0%, 249/415 and 64.1%, 268/418, respectively). PA by accelerometer declined in both groups at 12 months (P value for tendency in moderate to vigorous PA, [MVPA]=.15). The intervention subgroup with high app adherence had better behavior than the low adherence subgroup (P value for tendency in MVPA=.001). PA analyzed by 7-day PAR did not show changes at 12 months in any of the groups (P value for tendency=.25). In the Mediterranean diet, an increase in adherence was observed in both groups at 12 months with no differences between them (P value for tendency=.46). In these two cases, the group with high app adherence also had better behavior, although without reaching significance for the tendency (P>.05). Conclusions: The participants with strongest app adherence showed better outcomes in terms of maintenance of healthy lifestyles at 12 months than those with weaker adherence. Overall, however, we found no differences between intervention group and counseling-only group in PA increase and adherence to the Mediterranean diet in the long term. Trial Registration: Clinicaltrials.gov NCT02016014; https://clinicaltrials.gov/ct2/show/NCT02016014 (Archived by WebCite at http://www.webcitation.org/6ymEXH6W4) UR - http://mhealth.jmir.org/2018/4/e107/ UR - http://dx.doi.org/10.2196/mhealth.9218 UR - http://www.ncbi.nlm.nih.gov/pubmed/29702473 ID - info:doi/10.2196/mhealth.9218 ER - TY - JOUR AU - Peters, Dorian AU - Deady, Mark AU - Glozier, Nick AU - Harvey, Samuel AU - Calvo, A. Rafael PY - 2018/04/25 TI - Worker Preferences for a Mental Health App Within Male-Dominated Industries: Participatory Study JO - JMIR Ment Health SP - e30 VL - 5 IS - 2 KW - mental health KW - mhealth KW - mobile apps KW - workplace KW - men KW - participatory design N2 - Background: Men are less likely to seek help for mental health problems, possibly because of stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces such as the emergency services or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of mental health technologies men would be willing to engage with, and no app can be effective if the intended users do not engage with it. Objective: The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Methods: Workers from male-dominated workplaces in rural, suburban, and urban locations took part in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. Results: A total of 60 workers aged between 26 and 65 years, 92% (55/60) male, from male-dominated workplaces in rural (16/60, 27%), suburban (14/60, 23%), and urban (30/60, 50%) locations participated in one of the 6 workshops, resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term ?mental health? was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment, and mood-fix tool were highly valued, and app characteristics such as brevity of interactions, minimal on-screen text, and a solutions-oriented approach were considered essential by participants. Some implementation strategies based on these findings are included in the discussion. Conclusions: Future mental health mobile phone apps targeting workers in male-dominated workplaces need to consider language use and preferred features, as well as balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights for mental health technologies, for men in general, and for others in high-stigma environments. UR - http://mental.jmir.org/2018/2/e30/ UR - http://dx.doi.org/10.2196/mental.8999 UR - http://www.ncbi.nlm.nih.gov/pubmed/29695371 ID - info:doi/10.2196/mental.8999 ER - TY - JOUR AU - Albrecht, Urs-Vito AU - Hillebrand, Uta AU - von Jan, Ute PY - 2018/04/25 TI - Relevance of Trust Marks and CE Labels in German-Language Store Descriptions of Health Apps: Analysis JO - JMIR Mhealth Uhealth SP - e10394 VL - 6 IS - 4 KW - mobile phone KW - mobile health app KW - quality assessment KW - quality seals KW - medical device regulation N2 - Background: In addition to mandatory CE marking (?CE? representing Conformité Européenne, with the CE marking being a symbol of free marketability in the European Economic Area) for medical devices, there are various seals, initiatives, action groups, etc, in the health app context. However, whether manufacturers use them to distinguish their apps and attach relevance to them is unclear. Objective: The objective was to take a snapshot of quality seals, regulatory marks, and other orientation aids available on the German app market and to determine whether manufacturers deem such labels relevant enough to apply them to their apps, namely as reflected by mentions in app description texts in a typical app store (ie, Apple?s App Store). Methods: A full survey of the metadata of 103,046 apps from Apple?s German App Store in the Medicine and Health & Fitness categories was carried out. For apps with German-language store descriptions (N=8767), these were automatically searched for the occurrence of relevant keywords and validated manually (N=41). In addition, the websites of various app seal providers were checked for assigned seals. Results: Few manufacturers referenced seals in the descriptions (5/41), although this would have been expected more often based on the seals we were able to identify from the seal providers? Web pages, and there were 34 of 41 that mentioned CE status in the descriptions. Two apps referenced an app directory curated by experts; however, this is not an alternative to CE marks and seals of approval. Conclusions: Currently, quality seals seem to be irrelevant for manufacturers. In line with regulatory requirements, mentions of medical device status are more frequent; however, neither characteristic is effective for identifying high-quality apps. To improve this situation, a possibly legally obligatory, standardized reporting system should be implemented. UR - http://mhealth.jmir.org/2018/4/e10394/ UR - http://dx.doi.org/10.2196/10394 UR - http://www.ncbi.nlm.nih.gov/pubmed/29695374 ID - info:doi/10.2196/10394 ER - TY - JOUR AU - Overdijkink, B. Sanne AU - Velu, V. Adeline AU - Rosman, N. Ageeth AU - van Beukering, DM Monique AU - Kok, Marjolein AU - Steegers-Theunissen, PM Regine PY - 2018/04/24 TI - The Usability and Effectiveness of Mobile Health Technology?Based Lifestyle and Medical Intervention Apps Supporting Health Care During Pregnancy: Systematic Review JO - JMIR Mhealth Uhealth SP - e109 VL - 6 IS - 4 KW - mHealth KW - pregnancy KW - lifestyle KW - health care KW - maternal health N2 - Background: A growing number of mobile health (mHealth) technology?based apps are being developed for personal lifestyle and medical health care support, of which several apps are related to pregnancy. Evidence on usability and effectiveness is limited but crucial for successful implementation. Objective: This study aimed to evaluate the usability, that is, feasibility and acceptability, as well as effectiveness of mHealth lifestyle and medical apps to support health care during pregnancy in high-income countries. Feasibility was defined as the actual use, interest, intention, and continued use; perceived suitability; and ability of users to carry out the activities of the app. Acceptability was assessed by user satisfaction, appreciation, and the recommendation of the app to others. Methods: We performed a systematic review searching the following electronic databases for studies on mHealth technology?based apps in maternal health care in developed countries: EMBASE, MEDLINE Epub (Ovid), Cochrane Library, Web of Science, and Google Scholar. All included studies were scored on quality, using the ErasmusAGE Quality Score or the consolidated criteria for reporting qualitative research. Main outcome measures were usability and effectiveness of mHealth lifestyle and medical health care support apps related to pregnancy. All studies were screened by 2 reviewers individually, and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. Results: Our search identified 4204 titles and abstracts, of which 2487 original studies remained after removing duplicates. We performed full-text screening of 217 studies, of which 29 were included in our study. In total, 19 out of 29 studies reported on mHealth apps to adopt healthy lifestyles and 10 out of 29 studies to support medical care. The lifestyle apps evaluated in 19 studies reported on usability and effectiveness: 10 studies reported positive on acceptability, and 14 studies reported on feasibility with positive results except one study. In total, 4 out of 19 studies evaluating effectiveness showed significant results on weight gain restriction during pregnancy, intake of vegetables and fruits, and smoking cessation. The 10 studies on medical mHealth apps involved asthma care, diabetic treatment, and encouraging vaccination. Only one study on diabetic treatment reported on acceptability with a positive user satisfaction. In total, 9 out of 10 studies reported on effectiveness. Moreover, the power of most studies was inadequate to show significant effects. Conclusions: Most studies on mHealth apps to support lifestyle and medical care for high-income countries reveal the usability of these apps to reduce gestational weight gain, increase intakes of vegetables and fruit, to quit smoking cessation, and to support health care for prevention of asthma and infections during pregnancy. In general, the evidence on effectiveness of these apps is limited and needs further investigation before implementation in medical health care. UR - http://mhealth.jmir.org/2018/4/e109/ UR - http://dx.doi.org/10.2196/mhealth.8834 UR - http://www.ncbi.nlm.nih.gov/pubmed/29691216 ID - info:doi/10.2196/mhealth.8834 ER - TY - JOUR AU - Mitchell, Jason AU - Torres, Beatriz Maria AU - Asmar, Lucy AU - Danh, Thu AU - Horvath, J. Keith PY - 2018/04/24 TI - Developing Sustainable and Impactful Mobile Phone HIV Testing Interventions for Spanish-Speaking Men Who Have Sex With Men in the United States: Lessons Learned From Informative Interviews JO - JMIR Public Health Surveill SP - e45 VL - 4 IS - 2 KW - smartphone KW - HIV testing KW - HIV prevention KW - men who have sex with men KW - Spanish N2 - Background: Although many men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic or Latino MSM, is needed. Many mHealth interventions in development, including the ones on HIV testing, have primarily focused on English-speaking white, black, and MSM of other races. To date, no studies have assessed app use, attitudes, and motivations for downloading and sustaining use of mobile apps and preferences with respect to HIV prevention among Spanish-speaking, Hispanic MSM in the United States. Objective: The primary aims of this study were to determine what features and functions of smartphone apps do Hispanic, Spanish-speaking MSM believe are associated with downloading apps to their smartphones, (2) what features and functions of smartphone apps are most likely to influence men?s sustained use of apps over time, and (3) what features and functions do men prefer in a smartphone app aimed to promote regular testing for HIV. Methods: Interviews (N=15) were conducted with a racially diverse group of sexually active, HIV-negative, Spanish-speaking, Hispanic MSM in Miami, Florida. Interviews were digitally recorded, transcribed verbatim, translated back to English, and de-identified for analysis. A constant-comparison method (ie, grounded theory coding) was employed to examine themes that emerged from the interviews. Results: Personal interest was the primary reason associated with whether men downloaded an app. Keeping personal information secure, cost, influence by peers and posted reviews, ease of use, and functionality affected whether they downloaded and used the app over time. Men also reported that entertainment value and frequency of updates influenced whether they kept and continued to use an app over time. There were 4 reasons why participants chose to delete an app?dislike, lack of use, cost, and lack of memory or space. Participants also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors. Conclusions: The features and functions of mobile apps that Spanish-speaking MSM in this study believed were associated with downloading and/or sustained engagement of an app generally reflected the priorities mentioned in an earlier study with English-speaking MSM. Unlike the earlier study, Spanish-speaking MSM prioritized personal interest in a mobile app and de-emphasized the efficiency of an app to make their lives easier in their decision to download an app to their mobile device. Tailoring mobile apps to the language and needs of Spanish-speaking MSM is critical to help increase their willingness to download a mobile app. Despite the growing number of HIV-prevention apps in development, few are tailored to Spanish-speaking MSM, representing an important gap that should be addressed in future research. UR - http://publichealth.jmir.org/2018/2/e45/ UR - http://dx.doi.org/10.2196/publichealth.8992 UR - http://www.ncbi.nlm.nih.gov/pubmed/29691205 ID - info:doi/10.2196/publichealth.8992 ER - TY - JOUR AU - Lam, A. Jeffrey AU - Dang, Thuy Linh AU - Phan, Tran Ngoc AU - Trinh, Thi Hue AU - Vu, Cong Nguyen AU - Nguyen, Kieu Cuong PY - 2018/04/24 TI - Mobile Health Initiatives in Vietnam: Scoping Study JO - JMIR Mhealth Uhealth SP - e106 VL - 6 IS - 4 KW - mHealth KW - eHealth KW - mobile health KW - telemedicine KW - Vietnam KW - scoping review N2 - Background: Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. Objective: The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. Methods: This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. Results: We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). Conclusions: The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been undertaken. UR - http://mhealth.jmir.org/2018/4/e106/ UR - http://dx.doi.org/10.2196/mhealth.8639 UR - http://www.ncbi.nlm.nih.gov/pubmed/29691214 ID - info:doi/10.2196/mhealth.8639 ER - TY - JOUR AU - Shattuck, Dominick AU - Haile, T. Liya AU - Simmons, G. Rebecca PY - 2018/04/20 TI - Lessons From the Dot Contraceptive Efficacy Study: Analysis of the Use of Agile Development to Improve Recruitment and Enrollment for mHealth Research JO - JMIR Mhealth Uhealth SP - e99 VL - 6 IS - 4 KW - mobile apps KW - mHealth KW - higher mobile research KW - fertility tracker KW - contraceptive KW - family planning KW - fertility awareness method KW - Dot KW - contraceptive efficacy N2 - Background: Smartphone apps that provide women with information about their daily fertility status during their menstrual cycles can contribute to the contraceptive method mix. However, if these apps claim to help a user prevent pregnancy, they must undergo similar rigorous research required for other contraceptive methods. Georgetown University?s Institute for Reproductive Health is conducting a prospective longitudinal efficacy trial on Dot (Dynamic Optimal Timing), an algorithm-based fertility app designed to help women prevent pregnancy. Objective: The aim of this paper was to highlight decision points during the recruitment-enrollment process and the effect of modifications on enrollment numbers and demographics. Recruiting eligible research participants for a contraceptive efficacy study and enrolling an adequate number to statistically assess the effectiveness of Dot is critical. Recruiting and enrolling participants for the Dot study involved making decisions based on research and analytic data, constant process modification, and close monitoring and evaluation of the effect of these modifications. Methods: Originally, the only option for women to enroll in the study was to do so over the phone with a study representative. On noticing low enrollment numbers, we examined the 7 steps from the time a woman received the recruitment message until she completed enrollment and made modifications accordingly. In modification 1, we added call-back and voicemail procedures to increase the number of completed calls. Modification 2 involved using a chat and instant message (IM) features to facilitate study enrollment. In modification 3, the process was fully automated to allow participants to enroll in the study without the aid of study representatives. Results: After these modifications were implemented, 719 women were enrolled in the study over a 6-month period. The majority of participants (494/719, 68.7%) were enrolled during modification 3, in which they had the option to enroll via phone, chat, or the fully automated process. Overall, 29.2% (210/719) of the participants were enrolled via a phone call, 19.9% (143/719) via chat/IM, and 50.9% (366/719) directly through the fully automated process. With respect to the demographic profile of our study sample, we found a significant statistical difference in education level across all modifications (P<.05) but not in age or race or ethnicity (P>.05). Conclusions: Our findings show that agile and consistent modifications to the recruitment and enrollment process were necessary to yield an appropriate sample size. An automated process resulted in significantly higher enrollment rates than one that required phone interaction with study representatives. Although there were some differences in demographic characteristics of enrollees as the process was modified, in general, our study population is diverse and reflects the overall United States population in terms of race/ethnicity, age, and education. Additional research is proposed to identify how differences in mode of enrollment and demographic characteristics may affect participants? performance in the study. Trial Registration: ClinicalTrials.gov NCT02833922; http://clinicaltrials.gov/ct2/show/NCT02833922 (Archived by WebCite at http://www.webcitation.org/6yj5FHrBh) UR - http://mhealth.jmir.org/2018/4/e99/ UR - http://dx.doi.org/10.2196/mhealth.9661 UR - http://www.ncbi.nlm.nih.gov/pubmed/29678802 ID - info:doi/10.2196/mhealth.9661 ER - TY - JOUR AU - Shorey, Shefaly AU - Yang, Yen Yen AU - Dennis, Cindy-Lee PY - 2018/04/19 TI - A Mobile Health App?Based Postnatal Educational Program (Home-but not Alone): Descriptive Qualitative Study JO - J Med Internet Res SP - e119 VL - 20 IS - 4 KW - parents KW - postnatal care KW - mobile applications KW - midwifery KW - nurse midwives KW - nursing N2 - Background: The postnatal period poses numerous challenges for new parents. Various educational programs are available to support new parents during this stressful period. However, the usefulness of educational programs must be evaluated to ascertain their credibility. Objective: The aim of this descriptive, qualitative study was to explore the views of parents of newborns with regard to the content and delivery of a mobile health (mHealth) app?based postnatal educational program. Methods: A qualitative semistructured interview guide was used to collect data from 17 participants who belonged to the intervention group of a randomized controlled trial. The intervention, a 4-week-long access to a mHealth app?based educational program, was evaluated. The interviews were conducted in English and at the participants? homes. Thematic analysis was used to analyze the data. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the findings. Results: The interviews revealed 4 main themes: (1) positive features of the mHealth app, (2) advice from midwives, (3) experiences gained from using the mHealth app, and (4) recommendations for the future. The participants evaluated the educational program to be a good source of information that was tailored to the local context. The different modes of delivery, including audio and video, accentuated the accessibility of information. The parents evaluated that the facilitator of the featured communication platform, a midwife, provided trustworthy advice. Belongingness to a virtual community beyond the hospital endowed the parents the confidence that they were not alone and were supported by other parents and health care professionals. Conclusions: According to the parents, the mHealth app?based educational program was helpful in supporting a multi-ethnic sample of parents during the postnatal period. This insight indicates that the program could be implemented in a wide community of parents in the postnatal period. The helpfulness of the educational program is a testament of the potential benefits of using telemedicine among new parents postnatally. Resources can also be dedicated toward extending the duration of access to the app beyond 1 month and developing relevant content for parents across the perinatal period. UR - http://www.jmir.org/2018/4/e119/ UR - http://dx.doi.org/10.2196/jmir.9188 UR - http://www.ncbi.nlm.nih.gov/pubmed/29674314 ID - info:doi/10.2196/jmir.9188 ER - TY - JOUR AU - Berry, Katherine AU - Salter, Amy AU - Morris, Rohan AU - James, Susannah AU - Bucci, Sandra PY - 2018/04/19 TI - Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire JO - J Med Internet Res SP - e90 VL - 20 IS - 4 KW - mobile health KW - health care provider KW - digital interventions KW - therapeutic alliance KW - mental health KW - measure development N2 - Background: Digital health interventions in the form of smartphone apps aim to improve mental health and enable people access to support as and when needed without having to face the stigma they may experience in accessing services. If we are to evaluate mobile health (mHealth) apps and advance scientific understanding, we also need tools to help us understand in what ways mHealth interventions are effective or not. The concept of therapeutic alliance, a measure of the quality of the relationship between a health care provider and a service user, is a key factor in explaining the effects of mental health interventions. The Agnew Relationship Measure (ARM) is a well-validated measure of therapeutic alliance in face-to-face therapy. Objective: This study presented the first attempt to (1) explore service users? views of the concept of relationship within mHealth mental health interventions and (2) adapt a well-validated face-to-face measure of therapeutic alliance, the Agnew Relationship Measure (ARM), for use with mHealth interventions. Methods: In stage 1, we interviewed 9 mental health service users about the concept of therapeutic alliance in the context of a digital health intervention and derived key themes from interview transcripts using thematic analysis. In stage 2, we used rating scales and open-ended questions to elicit views from 14 service users and 10 mental health staff about the content and face validity of the scale, which replaced the word ?therapist? with the word ?app.? In stage 3, we used the findings from stages 1 and 2 to adapt the measure with the support of a decision-making algorithm about which items to drop, retain, or adapt. Results: Findings suggested that service users do identify relationship concepts when thinking about mHealth interventions, including forming a bond with an app and the ability to be open with an app. However, there were key differences between relationships with health professionals and relationships with apps. For example, apps were not as tailored and responsive to each person?s unique needs. Furthermore, apps were not capable of portraying uniquely human-like qualities such as friendliness, collaboration, and agreement. We made a number of changes to the ARM that included revising 16 items; removing 4 items due to lack of suitable alternatives; and adding 1 item to capture a key theme derived from stage 1 of the study (?The app is like having a member of my care team in my pocket?). Conclusions: This study introduces the mHealth version of the ARM, the mARM, that has good face and content validity. We encourage researchers to include this easy-to-use tool in digital health intervention studies to gather further data about its psychometric properties and advance our understanding of how therapeutic alliance influences the efficacy of mHealth interventions. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 34966555; http://www.isrctn.com/ISRCTN34966555 (Archived by WebCite at http://www.webcitation.org/6ymBVwKif) UR - http://www.jmir.org/2018/4/e90/ UR - http://dx.doi.org/10.2196/jmir.8252 UR - http://www.ncbi.nlm.nih.gov/pubmed/29674307 ID - info:doi/10.2196/jmir.8252 ER - TY - JOUR AU - Emery, L. Joanne AU - Coleman, Tim AU - Sutton, Stephen AU - Cooper, Sue AU - Leonardi-Bee, Jo AU - Jones, Matthew AU - Naughton, Felix PY - 2018/04/19 TI - Uptake of Tailored Text Message Smoking Cessation Support in Pregnancy When Advertised on the Internet (MiQuit): Observational Study JO - J Med Internet Res SP - e146 VL - 20 IS - 4 KW - smoking cessation KW - pregnancy KW - internet KW - telemedicine KW - public health KW - social media N2 - Background: Smoking in pregnancy is a major public health concern. Pregnant smokers are particularly difficult to reach, with low uptake of support options and few effective interventions. Text message?based self-help is a promising, low-cost intervention for this population, but its real-world uptake is largely unknown. Objective: The objective of this study was to explore the uptake and cost-effectiveness of a tailored, theory-guided, text message intervention for pregnant smokers (?MiQuit?) when advertised on the internet. Methods: Links to a website providing MiQuit initiation information (texting a short code) were advertised on a cost-per-click basis on 2 websites (Google Search and Facebook; £1000 budget each) and free of charge within smoking-in-pregnancy webpages on 2 noncommercial websites (National Childbirth Trust and NHS Choices). Daily budgets were capped to allow the Google and Facebook adverts to run for 1 and 3 months, respectively. We recorded the number of times adverts were shown and clicked on, the number of MiQuit initiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely. For the commercial adverts, we calculated the cost per initiation and, using quit rates obtained from an earlier clinical trial, estimated the cost per additional quitter. Results: With equal capped budgets, there were 812 and 1889 advert clicks to the MiQuit website from Google (search-based) and Facebook (banner) adverts, respectively. MiQuit was initiated by 5.2% (42/812) of those clicking via Google (95% CI 3.9%-6.9%) and 2.22% (42/1889) of those clicking via Facebook (95% CI 1.65%-2.99%). Adverts on noncommercial webpages generated 53 clicks over 6 months, with 9 initiations (9/53, 17%; 95% CI 9%-30%). For the commercial websites combined, mean cost per initiation was £24.73; estimated cost per additional quitter, including text delivery costs, was £735.86 (95% CI £227.66-£5223.93). Those initiating MiQuit via Google were typically very early in pregnancy (median gestation 5 weeks, interquartile range 10 weeks); those initiating via Facebook were distributed more evenly across pregnancy (median gestation 16 weeks, interquartile range 14 weeks). Conclusions: Commercial online adverts are a feasible, likely cost-effective method for engaging pregnant smokers in digital cessation support and may generate uptake at a faster rate than noncommercial websites. As a strategy for implementing MiQuit, online advertising has large reach potential and can offer support to a hard-to-reach population of smokers. UR - http://www.jmir.org/2018/4/e146/ UR - http://dx.doi.org/10.2196/jmir.8525 UR - http://www.ncbi.nlm.nih.gov/pubmed/29674308 ID - info:doi/10.2196/jmir.8525 ER - TY - JOUR AU - Rat, Cédric AU - Hild, Sandrine AU - Rault Sérandour, Julie AU - Gaultier, Aurélie AU - Quereux, Gaelle AU - Dreno, Brigitte AU - Nguyen, Jean-Michel PY - 2018/04/13 TI - Use of Smartphones for Early Detection of Melanoma: Systematic Review JO - J Med Internet Res SP - e135 VL - 20 IS - 4 KW - smartphone KW - melanoma KW - screening KW - teledermatology KW - telemedicine KW - mobile app N2 - Background: The early diagnosis of melanoma is associated with decreased mortality. The smartphone, with its apps and the possibility of sending photographs to a dermatologist, could improve the early diagnosis of melanoma. Objective: The aim of our review was to report the evidence on (1) the diagnostic performance of automated smartphone apps and store-and-forward teledermatology via a smartphone in the early detection of melanoma, (2) the impact on the patient?s medical-care course, and (3) the feasibility criteria (focusing on the modalities of picture taking, transfer of data, and time to get a reply). Methods: We conducted a systematic search of PubMed for the period from January 1, 2007 (launch of the first smartphone) to November 1, 2017. Results: The results of the 25 studies included 13 concentrated on store-and-forward teledermatology, and 12 analyzed automated smartphone apps. Store-and-forward teledermatology opens several new perspectives, such as it accelerates the care course (less than 10 days vs 80 days), and the related procedures were assessed in primary care populations. However, the concordance between the conclusion of a teledermatologist and the conclusion of a dermatologist who conducts a face-to-face examination depended on the study (the kappa coefficient range was .20 to .84, median ?=.60). The use of a dermoscope may improve the concordance (the kappa coefficient range was .29 to .87, median ?=.74). Regarding automated smartphone apps, the major concerns are the lack of assessment in clinical practice conditions, the lack of assessment in primary care populations, and their low sensitivity, ranging from 7% to 87% (median 69%). In this literature review, up to 20% of the photographs transmitted were of insufficient quality. The modalities of picture taking and encryption of the data were only partially reported. Conclusions: The use of store-and-forward teledermatology could improve access to a dermatology consultation by optimizing the care course. Our review confirmed the absence of evidence of the safety and efficacy of automated smartphone medical apps. Further research is required to determine quality criteria, as there was major variability among the studies. UR - http://www.jmir.org/2018/4/e135/ UR - http://dx.doi.org/10.2196/jmir.9392 UR - http://www.ncbi.nlm.nih.gov/pubmed/29653918 ID - info:doi/10.2196/jmir.9392 ER - TY - JOUR AU - Zhu, Jiemin AU - Ebert, Lyn AU - Guo, Dongmei AU - Yang, Sumei AU - Han, Qiuying AU - Chan, Wai-Chi Sally PY - 2018/04/11 TI - Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 1): Qualitative Study of Women?s Perceptions JO - JMIR Mhealth Uhealth SP - e85 VL - 6 IS - 4 KW - mobile app KW - breast cancer KW - chemotherapy N2 - Background: Women with breast cancer undergoing chemotherapy experience difficulty in accessing adequate cancer care in China. Mobile apps have the potential to provide easily accessible support for these women. However, there remains a paucity of randomized controlled trials to evaluate the effectiveness of app-based programs targeting specifically women with breast cancer undergoing chemotherapy. Moreover, women?s perceptions and experiences related to using and interacting within the app-based program have rarely been reported. Therefore, an app-based Breast Cancer e-Support program was developed and evaluated using a randomized controlled trial. Based on the incorporation of Bandura?s self-efficacy and social exchange theory, Breast Cancer e-Support program lasted for 12 weeks covering 4 cycles of chemotherapy and had 4 components: (1) a Learning forum, (2) a Discussion forum, (3) an Ask-the-Expert forum, and (4) a Personal Stories forum. Objective: As a part of the randomized controlled trial, the aim of this study was to explore the participants? perception of Breast Cancer e-Support program, its strengths and weaknesses, and suggestions to improve the program. Methods: A descriptive qualitative study was employed. Thirteen women with breast cancer from 2 university-affiliated hospitals in China, who were randomly allocated to the Breast Cancer e-Support program in the randomized controlled trial, were interviewed from November 2016 to February 2017. Purposive sampling was used based on women?s scores of self-efficacy after the completion of the intervention. Inductive content analysis was used to analyze the transcripts, allowing the categories and subcategories to flow from the data. Results: The qualitative interviews revealed that participants perceived the Breast Cancer e-Support program to be helpful in enhancing knowledge, improving confidence level, and promoting emotional well-being. Women also identified access to tailored advice from experts and convenience as the benefits of this program. Physical or psychological health status, stigma related with breast cancer, and app instability were mentioned as the challenges to engagement. Suggestions for improvement included adding message reminders to prompt instant communication and search engine to locate information quickly, supplementing more interesting and practical knowledge, updating the information more often, and quickening the responses to women?s questions. The participants recommended the Breast Cancer e-Support program to be incorporated as routine care to support women during chemotherapy. Conclusions: This study demonstrates the potential of the Breast Cancer e-Support program to support women during chemotherapy. Future app-based programs should apply a family-centered approach and provide more support on stigma associated with the disease to encourage engagement with the app. Suggestions of improvement regarding the design, content, and operation of the app-based intervention should be addressed in future studies. It is promising to incorporate the Breast Cancer e-Support program into routine care to generalize the benefits. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ ACTRN12616000639426.aspx (Archived by WebCite at http://www.webcitation.org/6v1n9hGZq) UR - http://mhealth.jmir.org/2018/4/e85/ UR - http://dx.doi.org/10.2196/mhealth.9311 UR - http://www.ncbi.nlm.nih.gov/pubmed/29643056 ID - info:doi/10.2196/mhealth.9311 ER - TY - JOUR AU - Chevalking, Leon S. K. AU - Ben Allouch, Somaya AU - Brusse-Keizer, Marjolein AU - Postel, G. Marloes AU - Pieterse, E. Marcel PY - 2018/04/09 TI - Identification of Users for a Smoking Cessation Mobile App: Quantitative Study JO - J Med Internet Res SP - e118 VL - 20 IS - 4 KW - mobile applications KW - telemedicine KW - mHealth KW - eHealth KW - tobacco KW - smoking cessation KW - health informatics N2 - Background: The number of mobile apps that support smoking cessation is growing, indicating the potential of the mobile phone as a means to support cessation. Knowledge about the potential end users for cessation apps results in suggestions to target potential user groups in a dissemination strategy, leading to a possible increase in the satisfaction and adherence of cessation apps. Objective: This study aimed to characterize potential end users for a specific mobile health (mHealth) smoking cessation app. Methods: A quantitative study was conducted among 955 Dutch smokers and ex-smokers. The respondents were primarily recruited from addiction care facilities and hospitals through Web-based media via websites and forums. The respondents were surveyed on their demographics, smoking behavior, and personal innovativeness. The intention to use and the attitude toward a cessation app were determined on a 5-point Likert scale. To study the association between the characteristics and intention to use and attitude, univariate and multivariate ordinal logistic regression analyses were performed. Results: The multivariate ordinal logistic regression showed that the number of previous quit attempts (odds ratio [OR] 4.1, 95% CI 2.4-7.0, and OR 3.5, 95% CI 2.0-5.9) and the score on the Fagerstrom Test of Nicotine Dependence (OR 0.8, 95% CI 0.8-0.9, and OR 0.8, 95% CI 0.8-0.9) positively correlates with the intention to use a cessation app and the attitude toward cessation apps, respectively. Personal innovativeness also positively correlates with the intention to use (OR 0.3, 95% CI 0.2-0.4) and the attitude towards (OR 0.2, 95% CI 0.1-0.4) a cessation app. No associations between demographics and the intention to use or the attitude toward using a cessation app were observed. Conclusions: This study is among the first to show that demographic characteristics such as age and level of education are not associated with the intention to use and the attitude toward using a cessation app when characteristics related specifically to the app, such as nicotine dependency and the number of quit attempts, are present in a multivariate regression model. This study shows that the use of mHealth apps depends on characteristics related to the content of the app rather than general user characteristics. UR - http://www.jmir.org/2018/4/e118/ UR - http://dx.doi.org/10.2196/jmir.7606 UR - http://www.ncbi.nlm.nih.gov/pubmed/29631988 ID - info:doi/10.2196/jmir.7606 ER - TY - JOUR AU - Daniel, Fady AU - Jabak, Suha AU - Sasso, Roula AU - Chamoun, Yara AU - Tamim, Hani PY - 2018/04/06 TI - Patient-Physician Communication in the Era of Mobile Phones and Social Media Apps: Cross-Sectional Observational Study on Lebanese Physicians? Perceptions and Attitudes JO - JMIR Med Inform SP - e18 VL - 6 IS - 2 KW - social media KW - communication KW - patient-physician communication KW - technology use N2 - Background: The increased prevalence of virtual communication technology, particularly social media, has shifted the physician-patient relationship away from the well-established face-to-face interaction. The views and habits of physicians in Lebanon toward the use of online apps and social media as forms of patient communication have not been previously described. Objective: The aim of this study is to describe the views of Lebanese physicians toward the use of social media and other online apps as means of patient communication. Methods: This was a cross-sectional observational study using an online survey that addressed physicians? perceptions on the use of virtual communication in their clinical practice. The study took place between April and June 2016, and was directed toward physicians at the American University of Beirut Medical Center. Results: A total of 834 doctors received the online survey, with 238 physicians completing the survey. Most of the participants were from medical specialties. Most responders were attending physicians. Less than half of the respondents believed that Web-based apps and social media could be a useful tool for communicating with patients. Email was the most common form of professional online app, followed by WhatsApp (an instant messaging service). The majority of participants felt that this mode of communication can result in medicolegal issues and that it was a breach of privacy. Participants strictly against the use of virtual forms of communication made up 47.5% (113/238) of the study sample. Conclusions: The majority of physicians at the American University of Beirut Medical Center are reluctant to use virtual communication technology as a form of patient communication. Appropriate policy making and strategies can allow both physicians and patients to communicate virtually in a more secure setting without fear of breaching privacy and confidentiality. UR - http://medinform.jmir.org/2018/2/e18/ UR - http://dx.doi.org/10.2196/medinform.8895 UR - http://www.ncbi.nlm.nih.gov/pubmed/29625955 ID - info:doi/10.2196/medinform.8895 ER - TY - JOUR AU - de Korte, Marieke Elsbeth AU - Wiezer, Noortje AU - Janssen, H. Joris AU - Vink, Peter AU - Kraaij, Wessel PY - 2018/03/28 TI - Evaluating an mHealth App for Health and Well-Being at Work: Mixed-Method Qualitative Study JO - JMIR Mhealth Uhealth SP - e72 VL - 6 IS - 3 KW - mHealth KW - work KW - qualitative research methods KW - interview KW - focus group KW - technology acceptance KW - user satisfaction KW - usability KW - well-being KW - prevention N2 - Background: To improve workers? health and well-being, workplace interventions have been developed, but utilization and reach are unsatisfactory, and effects are small. In recent years, new approaches such as mobile health (mHealth) apps are being developed, but the evidence base is poor. Research is needed to examine its potential and to assess when, where, and for whom mHealth is efficacious in the occupational setting. To develop interventions for workers that actually will be adopted, insight into user satisfaction and technology acceptance is necessary. For this purpose, various qualitative evaluation methods are available. Objective: The objectives of this study were to gain insight into (1) the opinions and experiences of employees and experts on drivers and barriers using an mHealth app in the working context and (2) the added value of three different qualitative methods that are available to evaluate mHealth apps in a working context: interviews with employees, focus groups with employees, and a focus group with experts. Methods: Employees of a high-tech company and experts were asked to use an mHealth app for at least 3 weeks before participating in a qualitative evaluation. Twenty-two employees participated in interviews, 15 employees participated in three focus groups, and 6 experts participated in one focus group. Two researchers independently coded, categorized, and analyzed all quotes yielded from these evaluation methods with a codebook using constructs from user satisfaction and technology acceptance theories. Results: Interviewing employees yielded 785 quotes, focus groups with employees yielded 266 quotes, and the focus group with experts yielded 132 quotes. Overall, participants muted enthusiasm about the app. Combined results from the three evaluation methods showed drivers and barriers for technology, user characteristics, context, privacy, and autonomy. A comparison between the three qualitative methods showed that issues revealed by experts only slightly overlapped with those expressed by employees. In addition, it was seen that the type of evaluation yielded different results. Conclusions: Findings from this study provide the following recommendations for organizations that are planning to provide mHealth apps to their workers and for developers of mHealth apps: (1) system performance influences adoption and adherence, (2) relevancy and benefits of the mHealth app should be clear to the user and should address users? characteristics, (3) app should take into account the work context, and (4) employees should be alerted to their right to privacy and use of personal data. Furthermore, a qualitative evaluation of mHealth apps in a work setting might benefit from combining more than one method. Factors to consider when selecting a qualitative research method are the design, development stage, and implementation of the app; the working context in which it is being used; employees? mental models; practicability; resources; and skills required of experts and users. UR - http://mhealth.jmir.org/2018/3/e72/ UR - http://dx.doi.org/10.2196/mhealth.6335 UR - http://www.ncbi.nlm.nih.gov/pubmed/29592846 ID - info:doi/10.2196/mhealth.6335 ER - TY - JOUR AU - Diez-Canseco, Francisco AU - Toyama, Mauricio AU - Ipince, Alessandra AU - Perez-Leon, Silvana AU - Cavero, Victoria AU - Araya, Ricardo AU - Miranda, Jaime J. PY - 2018/3/15 TI - Integration of a Technology-Based Mental Health Screening Program Into Routine Practices of Primary Health Care Services in Peru (The Allillanchu Project): Development and Implementation JO - J Med Internet Res SP - e100 VL - 20 IS - 3 KW - mental health KW - mHealth KW - SMS KW - textmessaging KW - screening KW - mobile health KW - health services research N2 - Background: Despite their high prevalence and significant burden, mental disorders such as depression remain largely underdiagnosed and undertreated. Objective: The aim of the Allillanchu Project was to design, develop, and test an intervention to promote early detection, opportune referral, and access to treatment of patients with mental disorders attending public primary health care (PHC) services in Lima, Peru. Methods: The project had a multiphase design: formative study, development of intervention components, and implementation. The intervention combined three strategies: training of PHC providers (PHCPs), task shifting the detection and referral of mental disorders, and a mobile health (mHealth) component comprising a screening app followed by motivational and reminder short message service (SMS) to identify at-risk patients. The intervention was implemented by 22 PHCPs from five health centers, working in antenatal care, tuberculosis, chronic diseases, and HIV or AIDS services. Results: Over a period of 9 weeks, from September 2015 to November 2015, 733 patients were screened by the 22 PHCPs during routine consultations, and 762 screening were completed in total. The chronic diseases (49.9%, 380/762) and antenatal care services (36.7%, 380/762) had the higher number of screenings. Time constraints and workload were the main barriers to implementing the screening, whereas the use of technology, training, and supervision of the PHCPs by the research team were identified as facilitators. Of the 733 patients, 21.7% (159/733) screened positively and were advised to seek specialized care. Out of the 159 patients with a positive screening result, 127 had a follow-up interview, 72.4% (92/127) reported seeking specialized care, and 55.1% (70/127) stated seeing a specialist. Both patients and PHCPs recognized the utility of the screening and identified some key challenges to its wider implementation. Conclusions: The use of a screening app supported by training and supervision is feasible and uncovers a high prevalence of unidentified psychological symptoms in primary care. To increase its sustainability and utility, this procedure can be incorporated into the routine practices of existing health care services, following tailoring to the resources and features of each service. The early detection of psychological symptoms by a PHCP within a regular consultation, followed by adequate advice and support, can lead to a significant percentage of patients accessing specialized care and reducing the treatment gap of mental disorders. UR - http://www.jmir.org/2018/3/e100/ UR - http://dx.doi.org/10.2196/jmir.9208 UR - http://www.ncbi.nlm.nih.gov/pubmed/29588272 ID - info:doi/10.2196/jmir.9208 ER - TY - JOUR AU - Henriksen, André AU - Haugen Mikalsen, Martin AU - Woldaregay, Zebene Ashenafi AU - Muzny, Miroslav AU - Hartvigsen, Gunnar AU - Hopstock, Arnesdatter Laila AU - Grimsgaard, Sameline PY - 2018/03/22 TI - Using Fitness Trackers and Smartwatches to Measure Physical Activity in Research: Analysis of Consumer Wrist-Worn Wearables JO - J Med Internet Res SP - e110 VL - 20 IS - 3 KW - motor activity KW - physical activity KW - fitness trackers KW - heart rate KW - photoplethysmography N2 - Background: New fitness trackers and smartwatches are released to the consumer market every year. These devices are equipped with different sensors, algorithms, and accompanying mobile apps. With recent advances in mobile sensor technology, privately collected physical activity data can be used as an addition to existing methods for health data collection in research. Furthermore, data collected from these devices have possible applications in patient diagnostics and treatment. With an increasing number of diverse brands, there is a need for an overview of device sensor support, as well as device applicability in research projects. Objective: The objective of this study was to examine the availability of wrist-worn fitness wearables and analyze availability of relevant fitness sensors from 2011 to 2017. Furthermore, the study was designed to assess brand usage in research projects, compare common brands in terms of developer access to collected health data, and features to consider when deciding which brand to use in future research. Methods: We searched for devices and brand names in six wearable device databases. For each brand, we identified additional devices on official brand websites. The search was limited to wrist-worn fitness wearables with accelerometers, for which we mapped brand, release year, and supported sensors relevant for fitness tracking. In addition, we conducted a Medical Literature Analysis and Retrieval System Online (MEDLINE) and ClinicalTrials search to determine brand usage in research projects. Finally, we investigated developer accessibility to the health data collected by identified brands. Results: We identified 423 unique devices from 132 different brands. Forty-seven percent of brands released only one device. Introduction of new brands peaked in 2014, and the highest number of new devices was introduced in 2015. Sensor support increased every year, and in addition to the accelerometer, a photoplethysmograph, for estimating heart rate, was the most common sensor. Out of the brands currently available, the five most often used in research projects are Fitbit, Garmin, Misfit, Apple, and Polar. Fitbit is used in twice as many validation studies as any other brands and is registered in ClinicalTrials studies 10 times as often as other brands. Conclusions: The wearable landscape is in constant change. New devices and brands are released every year, promising improved measurements and user experience. At the same time, other brands disappear from the consumer market for various reasons. Advances in device quality offer new opportunities for research. However, only a few well-established brands are frequently used in research projects, and even less are thoroughly validated. UR - http://www.jmir.org/2018/3/e110/ UR - http://dx.doi.org/10.2196/jmir.9157 UR - http://www.ncbi.nlm.nih.gov/pubmed/29567635 ID - info:doi/10.2196/jmir.9157 ER - TY - JOUR AU - Levy, Koch Natalie AU - Orzeck-Byrnes, A. Natasha AU - Aidasani, R. Sneha AU - Moloney, N. Dana AU - Nguyen, H. Lisa AU - Park, Agnes AU - Hu, Lu AU - Langford, T. Aisha AU - Wang, Binhuan AU - Sevick, Ann Mary AU - Rogers, S. Erin PY - 2018/03/19 TI - Transition of a Text-Based Insulin Titration Program From a Randomized Controlled Trial Into Real-World Settings: Implementation Study JO - J Med Internet Res SP - e93 VL - 20 IS - 3 KW - insulin/long-acting/administration & dosage KW - diabetes mellitus, type 2/drug therapy KW - medically underserved area KW - telemedicine KW - healthcare disparities N2 - Background: The Mobile Insulin Titration Intervention (MITI) program helps patients with type 2 diabetes find their correct basal insulin dose without in-person care. Requiring only basic cell phone technology (text messages and phone calls), MITI is highly accessible to patients receiving care in safety-net settings. MITI was shown in a randomized controlled trial (RCT) to be efficacious at a New York City (NYC) safety-net clinic where patients often have challenges coming for in-person care. In 2016, MITI was implemented as usual care at Bellevue Hospital (the site of the original RCT) and at Gouverneur Health (a second NYC safety-net clinic) under 2 different staffing models. Objective: This implementation study examined MITI?s transition into real-world settings. To understand MITI?s flexibility, generalizability, and acceptability among patients and providers, we evaluated whether MITI continued to produce positive outcomes in expanded underserved populations, outside of an RCT setting. Methods: Patients enrolled in MITI received weekday text messages asking for their fasting blood glucose (FBG) values and a weekly titration call. The goal was for patients to reach their optimal insulin dose (OID), defined either as the dose of once-daily basal insulin required to achieve either an FBG of 80-130 mg/dL (4.4-7.2 mmol/L) or as the reaching of the maximum dose of 50 units. After 12 weeks, if OID was not reached, the patients were asked to return to the clinic for in-person care and titration. MITI program outcomes, clinical outcomes, process outcomes, and patient satisfaction were assessed. Results: MITI was successful at both sites, each with a different staffing model. Providers referred 170 patients to the program?129 of whom (75.9%, 129/170) were eligible. Of these, 113 (87.6%, 113/129) enrolled. Moreover, 84.1% (95/113) of patients reached their OID, and they did so in an average of 24 days. Clinical outcomes show that mean FBG levels fell from 209 mg/dL (11.6 mmol/L) to 141 mg/dL (7.8 mmol/L), P<.001. HbA1c levels fell from 11.4% (101 mmol/mol) to 10.0% (86 mmol/mol), P<.001. Process outcomes show that 90.1% of MITI?s text message prompts received a response, nurses connected with patients 81.9% of weeks to provide titration instructions, and 85% of attending physicians made at least one referral to the MITI program. Satisfaction surveys showed that most patients felt comfortable sharing information over text and felt the texts reminded them to take their insulin, check their sugar, and make healthy food choices. Conclusions: This implementation study showed MITI to have continued success after transitioning from an RCT program into real-world settings. MITI showed itself to be flexible and generalizable as it easily fits into a second site staffed by general medical clinic?registered nurses and remained acceptable to patients and staff who had high levels of engagement with the program. UR - http://www.jmir.org/2018/3/e93/ UR - http://dx.doi.org/10.2196/jmir.9515 UR - http://www.ncbi.nlm.nih.gov/pubmed/29555621 ID - info:doi/10.2196/jmir.9515 ER - TY - JOUR AU - König, M. Laura AU - Sproesser, Gudrun AU - Schupp, T. Harald AU - Renner, Britta PY - 2018/03/13 TI - Describing the Process of Adopting Nutrition and Fitness Apps: Behavior Stage Model Approach JO - JMIR Mhealth Uhealth SP - e55 VL - 6 IS - 3 KW - mHealth KW - eating KW - physical activity KW - exercise KW - smartphone KW - mobile applications KW - health promotion N2 - Background: Although mobile technologies such as smartphone apps are promising means for motivating people to adopt a healthier lifestyle (mHealth apps), previous studies have shown low adoption and continued use rates. Developing the means to address this issue requires further understanding of mHealth app nonusers and adoption processes. This study utilized a stage model approach based on the Precaution Adoption Process Model (PAPM), which proposes that people pass through qualitatively different motivational stages when adopting a behavior. Objective: To establish a better understanding of between-stage transitions during app adoption, this study aimed to investigate the adoption process of nutrition and fitness app usage, and the sociodemographic and behavioral characteristics and decision-making style preferences of people at different adoption stages. Methods: Participants (N=1236) were recruited onsite within the cohort study Konstanz Life Study. Use of mobile devices and nutrition and fitness apps, 5 behavior adoption stages of using nutrition and fitness apps, preference for intuition and deliberation in eating decision-making (E-PID), healthy eating style, sociodemographic variables, and body mass index (BMI) were assessed. Results: Analysis of the 5 behavior adoption stages showed that stage 1 (?unengaged?) was the most prevalent motivational stage for both nutrition and fitness app use, with half of the participants stating that they had never thought about using a nutrition app (52.41%, 533/1017), whereas less than one-third stated they had never thought about using a fitness app (29.25%, 301/1029). ?Unengaged? nonusers (stage 1) showed a higher preference for an intuitive decision-making style when making eating decisions, whereas those who were already ?acting? (stage 4) showed a greater preference for a deliberative decision-making style (F4,1012=21.83, P<.001). Furthermore, participants differed widely in their readiness to adopt nutrition and fitness apps, ranging from having ?decided to? but not yet begun to act (stage 2; nutrition: 6.88%, 70/1017; fitness: 9.23%, 95/1029) to being ?disengaged? following previous adoption (stage 5; nutrition: 13.77%, 140/1017; fitness: 15.06%, 155/1029). Conclusions: Using a behavior stage model approach to describe the process of adopting nutrition and fitness apps revealed motivational stage differences between nonusers (being ?unengaged,? having ?decided not to act,? having ?decided to act,? and being ?disengaged?), which might contribute to a better understanding of the process of adopting mHealth apps and thus inform the future development of digital interventions. This study highlights that new user groups might be better reached by apps designed to address a more intuitive decision-making style. UR - http://mhealth.jmir.org/2018/3/e55/ UR - http://dx.doi.org/10.2196/mhealth.8261 UR - http://www.ncbi.nlm.nih.gov/pubmed/29535078 ID - info:doi/10.2196/mhealth.8261 ER - TY - JOUR AU - Baskerville, B. Neill AU - Struik, L. Laura AU - Dash, Darly PY - 2018/03/02 TI - Crush the Crave: Development and Formative Evaluation of a Smartphone App for Smoking Cessation JO - JMIR Mhealth Uhealth SP - e52 VL - 6 IS - 3 KW - mobile app KW - smoking cessation KW - young adult KW - software design KW - formative feedback N2 - Background: Emerging evidence supports the use of smartphone apps for smoking cessation, especially in young adults given their high smoking rates and high smartphone ownership rates. Although evaluative evidence is encouraging for supporting smoking cessation, there remains a paucity of research describing the design and development processes of mobile health (mHealth) interventions. Objective: The aim of this paper was to describe the process of developing Crush the Crave (CTC), an evidence-informed app to support smoking cessation in young adults, and the results of a formative evaluation of app usage behavior, as part of a broader program of research that seeks to establish the effectiveness of the CTC app. Methods: The Spiral Technology Action Research (STAR) 5-cycle model (listen, plan, do, act, and study) was employed to guide the development, implementation, and dissemination of CTC. The approach to development and formative evaluation included focus groups with young adult smokers (n=78) across 2 phases, analysis of the content of existing apps, 2 sessions with content experts, and Google Analytics to assess user behavior during a 12-month pilot. Results: LISTEN?focus groups revealed young adult smoker preferences of (1) positive reinforcement, (2) personalization, (3) social support, (4) quit support, (5) tracking the behavior, and (6) tracking quit benefits. PLAN?informed by evidence for smoking cessation, young adult preferences and an assessment of popular cessation apps, content experts produced a mind map and a storyboard describing app content and structure. DO?focus groups with young adult smokers provided feedback on the first version of the app with opinions on content and suggestions for improvement such as providing alerts and distractions from craving. ACT?refinements were made, and app content was organized using the 4 key design components informed by principles of persuasive technology for behavior change: credibility, task support, dialogue support, and social support. CTC was launched in April 2013 and piloted from the period July 2013 to June 2014 where 1987 Android users had 18,567 sessions, resulting in 59,384 page views and 89.58% (1780/1987) of users returning within the same day to use CTC. STUDY?a pragmatic randomized controlled trial of CTC was launched in August 2014 to demonstrate that including mHealth technology as a population-based intervention can help young adult smokers to quit. The results of this phase will be presented in a subsequent publication. Conclusions: CTC is one of the first smoking cessation apps designed to meet the needs of young adult smokers. The development was informed by the inclusion of young adults in the design and the systematic application of multiple stakeholder input, scientific evidence, and theory. The STAR model approach was followed from the beginning of intervention development, which should facilitate optimization of mHealth interventions in the future. Trial Registration: ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i) UR - http://mhealth.jmir.org/2018/3/e52/ UR - http://dx.doi.org/10.2196/mhealth.9011 UR - http://www.ncbi.nlm.nih.gov/pubmed/29500157 ID - info:doi/10.2196/mhealth.9011 ER - TY - JOUR AU - Abt, Grant AU - Bray, James AU - Benson, Clare Amanda PY - 2018/02/28 TI - Measuring Moderate-Intensity Exercise with the Apple Watch: Validation Study JO - JMIR Cardio SP - e6 VL - 2 IS - 1 KW - smartwatch KW - wearables KW - technology KW - physical activity KW - cardiovascular health, Apple Watch N2 - Background: Moderate fitness levels and habitual exercise have a protective effect for cardiovascular disease, stroke, type 2 diabetes, and all-cause mortality. The Apple Watch displays exercise completed at an intensity of a brisk walk or above using a green ?exercise? ring. However, it is unknown if the exercise ring accurately represents an exercise intensity comparable to that defined as moderate-intensity. In order for health professionals to prescribe exercise intensity with confidence, consumer wearable devices need to be accurate and precise if they are to be used as part of a personalized medicine approach to disease management. Objective: The aim of this study was to examine the validity and reliability of the Apple Watch for measuring moderate-intensity exercise, as defined as 40-59% oxygen consumption reserve (VO2R). Methods: Twenty recreationally active participants completed resting oxygen consumption (VO2rest) and maximal oxygen consumption (VO2 max) tests prior to a series of 5-minute bouts of treadmill walking at increasing speed while wearing an Apple Watch on both wrists, and with oxygen consumption measured continuously. Five-minute exercise bouts were added until the Apple Watch advanced the green ?exercise? ring by 5 minutes (defined as the treadmill inflection speed). Validity was examined using a one-sample t-test, with interdevice and intradevice reliability reported as the standardized typical error and intraclass correlation. Results: The mean %VO2R at the treadmill inflection speed was 30% (SD 7) for both Apple Watches. There was a large underestimation of moderate-intensity exercise (left hand: mean difference = -10% [95% CI -14 to -7], d=-1.4; right hand: mean difference = -10% [95% CI -13 to -7], d=-1.5) when compared to the criterion of 40% VO2R. Standardized typical errors for %VO2R at the treadmill inflection speed were small to moderate, with intraclass correlations higher within trials compared to between trials. Conclusions: The Apple Watch threshold for moderate-intensity exercise was lower than the criterion, which would lead to an overestimation of moderate-intensity exercise minutes completed throughout the day. UR - http://cardio.jmir.org/2018/1/e6/ UR - http://dx.doi.org/10.2196/cardio.8574 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758766 ID - info:doi/10.2196/cardio.8574 ER - TY - JOUR AU - Everett, Estelle AU - Kane, Brian AU - Yoo, Ashley AU - Dobs, Adrian AU - Mathioudakis, Nestoras PY - 2018/02/27 TI - A Novel Approach for Fully Automated, Personalized Health Coaching for Adults with Prediabetes: Pilot Clinical Trial JO - J Med Internet Res SP - e72 VL - 20 IS - 2 KW - mobile health KW - prediabetes KW - HbA 1c KW - weight loss KW - blood glucose N2 - Background: Prediabetes is a high-risk state for the future development of type 2 diabetes, which may be prevented through physical activity (PA), adherence to a healthy diet, and weight loss. Mobile health (mHealth) technology is a practical and cost-effective method of delivering diabetes prevention programs in a real-world setting. Sweetch (Sweetch Health, Ltd) is a fully automated, personalized mHealth platform designed to promote adherence to PA and weight reduction in people with prediabetes.  Objective: The objective of this pilot study was to calibrate the Sweetch app and determine the feasibility, acceptability, safety, and effectiveness of the Sweetch app in combination with a digital body weight scale (DBWS) in adults with prediabetes. Methods: This was a 3-month prospective, single-arm, observational study of adults with a diagnosis of prediabetes and body mass index (BMI) between 24 kg/m2 and 40 kg/m2. Feasibility was assessed by study retention. Acceptability of the mobile platform and DBWS were evaluated using validated questionnaires. Effectiveness measures included change in PA, weight, BMI, glycated hemoglobin (HbA1c), and fasting blood glucose from baseline to 3-month visit. The significance of changes in outcome measures was evaluated using paired t test or Wilcoxon matched pairs test. Results: The study retention rate was 47 out of 55 (86%) participants. There was a high degree of acceptability of the Sweetch app, with a median (interquartile range [IQR]) score of 78% (73%-80%) out of 100% on the validated System Usability Scale. Satisfaction regarding the DBWS was also high, with median (IQR) score of 93% (83%-100%). PA increased by 2.8 metabolic equivalent of task (MET)?hours per week (SD 6.8; P=.02), with mean weight loss of 1.6 kg (SD 2.5; P<.001) from baseline. The median change in A1c was ?0.1% (IQR ?0.2% to 0.1%; P=.04), with no significant change in fasting blood glucose (?1 mg/dL; P=.59). There were no adverse events reported. Conclusions: The Sweetch mobile intervention program is a safe and effective method of increasing PA and reducing weight and HbA1c in adults with prediabetes. If sustained over a longer period, this intervention would be expected to reduce diabetes risk in this population. Trial Registration: ClincialTrials.gov NCT02896010; https://clinicaltrials.gov/ct2/show/NCT02896010 (Archived by WebCite at http://www.webcitation.org/6xJYxrgse) UR - http://www.jmir.org/2018/2/e72/ UR - http://dx.doi.org/10.2196/jmir.9723 UR - http://www.ncbi.nlm.nih.gov/pubmed/29487046 ID - info:doi/10.2196/jmir.9723 ER - TY - JOUR AU - Rodrigues, M. Angela AU - Sniehotta, F. Falko AU - Birch-Machin, A. Mark AU - Olivier, Patrick AU - Araújo-Soares, Vera PY - 2018/02/27 TI - Acceptability and Feasibility of a Trial Testing Allocation to Sunscreen and a Smartphone App for Sun Protection: Discontinued Randomized Controlled Trial JO - JMIR Dermatol SP - e1 VL - 1 IS - 1 KW - sunscreening agents KW - sun protection factor KW - smartphone KW - mobile applications KW - feasibility studies KW - randomized controlled trial KW - skin neoplasms KW - melanoma KW - skin aging KW - holidays KW - health promotion KW - health behavior N2 - Background: Recreational sun exposure has been associated with melanoma prevalence, and tourism settings are of particular interest for skin cancer prevention. Effective, affordable, and geographically flexible interventions to promote sun protection are needed. Objective: The aim of this study was to describe the protocol for a definitive randomized controlled trial (RCT) evaluating a smartphone mobile intervention (mISkin app) promoting sun protection in holidaymakers and to assess the acceptability and feasibility of the mISkin app and associated trial procedures in an internal pilot study. Methods: Participants were recruited from the general community. Holidaymakers traveling abroad and owning a smartphone were enrolled in the internal pilot of a 2 (mISkin vs control) x 2 (sun protection factor [SPF] 15 vs SPF 30) RCT with a postholiday follow-up. The smartphone app is fully automated and entails a behavioral intervention to promote sun protection. It consisted of five components: skin assessment, educational videos, ultraviolet (UV) photos, gamification, and prompts for sun protection. Participants were also randomly allocated to receive sunscreen SPF 15 or SPF 30. Primary outcomes for the internal pilot study were acceptability and feasibility of trial procedures and intervention features. Secondary outcomes were collected at baseline and after holidays through face-to-face-assessments and included skin sun damage, sunscreen use (residual weight and application events), and sun protection practices (Web-based questionnaire). Results: From 142 registers of interest, 42 participants were randomized (76% [32/42] female; mean age 35.5 years). Outcome assessments were completed by all participants. Random allocation to SPF 15 versus SPF 30 was found not to be feasible in a definitive trial protocol. Of the 21 people allocated to the mISkin intervention, 19 (91%) installed the mISkin on their phones, and 18 (86%) used it at least once. Participants were satisfied with the mISkin app and made suggestions for further improvements. Due to difficulties with the random allocation to SPF and slow uptake, the trial was discontinued. Conclusions: The internal pilot study concluded that randomization to SPF was not feasible and that recruitment rate was slower than expected because of difficulties with gatekeeper engagement. Possible solutions to the problems identified are discussed. Further refinements to the mISkin app are needed before a definitive trial. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN63943558; http://www.isrctn.com/ISRCTN63943558 (Archived by WebCite at http://www.webcitation.org/6xOLvbab8) UR - https://derma.jmir.org/2018/1/e1/ UR - http://dx.doi.org/10.2196/derma.8608 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/derma.8608 ER - TY - JOUR AU - Grist, Rebecca AU - Porter, Joanna AU - Stallard, Paul PY - 2018/02/23 TI - Acceptability, Use, and Safety of a Mobile Phone App (BlueIce) for Young People Who Self-Harm: Qualitative Study of Service Users? Experience JO - JMIR Ment Health SP - e16 VL - 5 IS - 1 KW - self-injurious behavior KW - mobile apps KW - adolescents KW - telemedicine KW - qualitative research KW - cognitive therapy KW - behavior therapy N2 - Background: Self-harm is common among adolescents and is associated with a number of negative psychosocial outcomes including a higher risk of suicide. Recent reviews highlight the lack of research into specific interventions for children and young people who self-harm. Developing innovative interventions that are coproduced with individuals with lived experience and that reduce self-harm are key challenges for self-harm prevention. Objective: The aim of this study was to explore the acceptability, use, and safety of BlueIce, a mobile phone app for young people who self-harm and who are attending child and adolescent mental health services (CAMHS). Methods: This study is part of a mixed methods phase 1 trial of BlueIce. Young people aged 12-17 years attending specialist CAMHS were recruited. Clinicians were invited to refer young people who were self-harming or who had a history of self-harm. On consent being obtained and baseline measures taken, participants used BlueIce as an adjunct to usual care for an initial familiarization period of 2 weeks. If after this time they wanted to continue, they used BlueIce for a further 10 weeks. Semistructured interviews were conducted at postfamiliarization (2 weeks after using BlueIce) and postuse (12 weeks after using BlueIce) to assess the acceptability, use, and safety of BlueIce. We undertook a qualitative analysis using a deductive approach, and then an inductive approach, to investigate common themes. Results: Postfamiliarization interviews were conducted with 40 participants. Of these, 37 participants elected to use BlueIce, with postuse interviews being conducted with 33 participants. Following 6 key themes emerged from the data: (1) appraisal of BlueIce, (2) usability of BlueIce, (3) safety, (4) benefits of BlueIce, (5) agency and control, and (6) BlueIce less helpful. The participants reported that BlueIce was accessible, easy to use, and convenient. Many highlighted the mood diary and mood lifter sections as particularly helpful in offering a way to track their moods and offering new strategies to manage their thoughts to self-harm. No adverse effects were reported. For those who did not find BlueIce helpful, issues around motivation to stop self-harming impeded their ability to use the app. Conclusions: BlueIce was judged to be a helpful and safe way of supporting adolescents to manage thoughts of self-harming. Adolescents reported numerous benefits of using BlueIce, and all would recommend the app to other young people who were struggling with self-harm. These preliminary findings are encouraging and provide initial support for the acceptability of BlueIce as a self-help intervention used in conjunction with the traditional face-to-face therapy. UR - http://mental.jmir.org/2018/1/e16/ UR - http://dx.doi.org/10.2196/mental.8779 UR - http://www.ncbi.nlm.nih.gov/pubmed/29475823 ID - info:doi/10.2196/mental.8779 ER - TY - JOUR AU - Simons, Dorien AU - De Bourdeaudhuij, Ilse AU - Clarys, Peter AU - De Cocker, Katrien AU - Vandelanotte, Corneel AU - Deforche, Benedicte PY - 2018/02/20 TI - A Smartphone App to Promote an Active Lifestyle in Lower-Educated Working Young Adults: Development, Usability, Acceptability, and Feasibility Study JO - JMIR Mhealth Uhealth SP - e44 VL - 6 IS - 2 KW - mHealth KW - young adult KW - mobile applications KW - physical activity KW - active transport KW - health promotion N2 - Background: Physical activity (PA) levels are problematic in lower-educated working young adults (18-26 years). To promote PA, smartphone apps have great potential, but there is no evidence for their effectiveness in this population. To increase the likelihood that a newly developed app will be effective, formative research and user testing are required. Objective: The aim of this study was to describe the development, usability, acceptability, and feasibility of a new theory- and evidence-based smartphone app to promote an active lifestyle in lower-educated working young adults. Methods: The new app was developed by applying 4 steps. First, determinants important to promote an active lifestyle in this population were selected. Second, evidence-based behavior change techniques were selected to convert the determinants into practical applications. Third, a new smartphone app was developed. Fourth, volunteers (n=11, both lower and higher educated) tested the app on usability, and lower-educated working young adults (n=16) tested its acceptability and feasibility via (think aloud) interviews, a questionnaire, and Google Analytics. The app was accordingly adapted for the final version. Results: A new Android app, Active Coach, was developed that focused on knowledge, attitude, social support, and self-efficacy (based on outcomes from step 1), and that applied self-regulation techniques (based on outcomes from step 2). The app consists of a 9-week program with personal goals, practical tips, and scientific facts to encourage an active lifestyle. To ensure all-day and automatic self-monitoring of the activity behavior, the Active Coach app works in combination with a wearable activity tracker, the Fitbit Charge. Issues detected by the usability test (eg, text errors, wrong messages) were all fixed. The acceptability and feasibility test showed that participants found the app clear, understandable, and motivating, although some aspects needed to be more personal. Conclusions: By applying a stepwise, user-centered approach that regularly consulted the target group, the new app is adapted to their specific needs and preferences. The Active Coach app was overall positively evaluated by the lower-educated working young adults at the end of the development process. UR - http://mhealth.jmir.org/2018/2/e44/ UR - http://dx.doi.org/10.2196/mhealth.8287 UR - http://www.ncbi.nlm.nih.gov/pubmed/29463491 ID - info:doi/10.2196/mhealth.8287 ER - TY - JOUR AU - Colón-Semenza, Cristina AU - Latham, K. Nancy AU - Quintiliani, M. Lisa AU - Ellis, D. Terry PY - 2018/02/15 TI - Peer Coaching Through mHealth Targeting Physical Activity in People With Parkinson Disease: Feasibility Study JO - JMIR Mhealth Uhealth SP - e42 VL - 6 IS - 2 KW - Parkinson disease KW - exercise KW - telemedicine KW - social support KW - fitness tracker N2 - Background: Long-term engagement in exercise and physical activity mitigates the progression of disability and increases quality of life in people with Parkinson disease (PD). Despite this, the vast majority of individuals with PD are sedentary. There is a critical need for a feasible, safe, acceptable, and effective method to assist those with PD to engage in active lifestyles. Peer coaching through mobile health (mHealth) may be a viable approach. Objective: The purpose of this study was to develop a PD-specific peer coach training program and a remote peer-mentored walking program using mHealth technology with the goal of increasing physical activity in persons with PD. We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual-level changes in walking activity, self-efficacy, and disability in the peer mentees. Methods: A peer coach training program and a remote peer-mentored walking program using mHealth was developed and tested in 10 individuals with PD. We matched physically active persons with PD (peer coaches) with sedentary persons with PD (peer mentees), resulting in 5 dyads. Using both Web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening, and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer dyads interacted daily via the FitBit friends mobile app and weekly via telephone calls. Feasibility was determined by examining recruitment, participation, and retention rates. Safety was assessed by monitoring adverse events during the study period. Acceptability was assessed via satisfaction surveys. Individual-level changes in physical activity were examined relative to clinically important differences. Results: Four out of the 5 peer pairs used the FitBit activity tracker and friends function without difficulty. A total of 4 of the 5 pairs completed the 8 weekly phone conversations. There were no adverse events over the course of the study. All peer coaches were ?satisfied? or ?very satisfied? with the training program, and all participants were ?satisfied? or ?very satisfied? with the peer-mentored walking program. All participants would recommend this program to others with PD. Increases in average steps per day exceeding the clinically important difference occurred in 4 out of the 5 mentees. Conclusions: Remote peer coaching using mHealth is feasible, safe, and acceptable for persons with PD. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Larger controlled trials are necessary to examine the effectiveness of this approach. UR - http://mhealth.jmir.org/2018/2/e42/ UR - http://dx.doi.org/10.2196/mhealth.8074 UR - http://www.ncbi.nlm.nih.gov/pubmed/29449201 ID - info:doi/10.2196/mhealth.8074 ER - TY - JOUR AU - Berman, A. Mark AU - Guthrie, L. Nicole AU - Edwards, L. Katherine AU - Appelbaum, J. Kevin AU - Njike, Y. Valentine AU - Eisenberg, M. David AU - Katz, L. David PY - 2018/02/14 TI - Change in Glycemic Control With Use of a Digital Therapeutic in Adults With Type 2 Diabetes: Cohort Study JO - JMIR Diabetes SP - e4 VL - 3 IS - 1 KW - type 2 diabetes KW - mobile health KW - mHealth KW - lifestyle medicine KW - mobile apps KW - digital therapeutics N2 - Background: Intensive lifestyle change can treat and even reverse type 2 diabetes. Digital therapeutics have the potential to deliver lifestyle as medicine for diabetes at scale. Objective: This 12-week study investigates the effects of a novel digital therapeutic, FareWell, on hemoglobin A1c (HbA1c) and diabetes medication use. Methods: Adults with type 2 diabetes and a mobile phone were recruited throughout the United States using Facebook advertisements. The intervention aim was to effect a sustainable shift to a plant-based dietary pattern and regular exercise by advancing culinary literacy and lifestyle skill acquisition. The intervention was delivered by an app paired with specialized human support, also delivered digitally. Health coaching was provided every 2 weeks by telephone, and a clinical team was available for participants requiring additional support. Participants self-reported current medications and HbA1c at the beginning and end of the 12-week program. Self-efficacy related to managing diabetes and maintaining dietary changes was assessed via survey. Engagement was recorded automatically through the app. Results: We enrolled 118 participants with a baseline HbA1c >6.5%. Participants were 81.4% female (96/118) and resided in 38 US states with a mean age of 50.7 (SD 9.4) years, baseline body mass index of 38.1 (SD 8.8) kg/m2, and baseline HbA1c of 8.1% (SD 1.6). At 12 weeks, 86.2% (94/109) of participants were still using the app. Mean change in HbA1c was ?0.8% (97/101, SD 1.3, P<.001) for those reporting end-study data. For participants with a baseline HbA1c >7.0% who did not change medications midstudy, HbA1c change was ?1.1% (67/69, SD 1.4, P<.001). The proportion of participants with an end-study HbA1c <6.5% was 28% (22/97). After completion of the intervention, 17% (16/97) of participants reported a decrease in diabetic medication while 8% (8/97) reported an increase. A total of 57% (55/97) of participants achieved a composite outcome of reducing HbA1c, reducing diabetic medication use, or both; 92% (90/98) reported greater confidence in their ability to manage their diabetes compared to before the program, and 91% (89/98) reported greater confidence in their ability to maintain a healthy dietary pattern. Participants engaged with the app an average of 4.3 times per day. We observed a significantly greater decrease in HbA1c among participants in the highest tertile of app engagement compared to those in the lowest tertile of app engagement (P=.03). Conclusions: Clinically meaningful reductions in HbA1c were observed with use of the FareWell digital therapeutic. Greater glycemic control was observed with increasing app engagement. Engagement and retention were both high in this widely distributed sample. UR - http://diabetes.jmir.org/2018/1/e4/ UR - http://dx.doi.org/10.2196/diabetes.9591 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291074 ID - info:doi/10.2196/diabetes.9591 ER - TY - JOUR AU - Lee, Li-Ang AU - Chao, Yi-Ping AU - Huang, Chung-Guei AU - Fang, Ji-Tseng AU - Wang, Shu-Ling AU - Chuang, Cheng-Keng AU - Kang, Chung-Jan AU - Hsin, Li-Jen AU - Lin, Wan-Ni AU - Fang, Tuan-Jen AU - Li, Hsueh-Yu PY - 2018/02/13 TI - Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial JO - J Med Internet Res SP - e56 VL - 20 IS - 2 KW - cognitive style KW - e-learning KW - mobile technology KW - randomized controlled trial N2 - Background: Electronic learning (e-learning) through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cognitive style of education combined with learning modules can impact learning outcomes and satisfaction in millennial medical students is unknown. Objective: The aim of this study was to assess the impact of cognitive styles and learning modules using mobile e-learning on knowledge gain, competence gain, and satisfaction for emergent ORL-HNS disorders. Methods: This randomized controlled trial included 60 undergraduate medical students who were novices in ORL-HNS at an academic teaching hospital. The cognitive style of the participants was assessed using the group embedded figures test. The students were randomly assigned (1:1) to a novel interactive multimedia (IM) group and conventional Microsoft PowerPoint show (PPS) group matched by age, sex, and cognitive style. The content for the gamified IM module was derived from and corresponded to the textbook-based learning material of the PPS module (video lectures). The participants were unblinded and used fully automated courseware containing the IM or PPS module on a 7-inch tablet for 100 min. Knowledge and competence were assessed using multiple-choice questions and multimedia situation tests, respectively. Each participant also rated their global satisfaction. Results: All of the participants (median age 23 years, range 22-26 years; 36 males and 24 females) received the intended intervention after randomization. Overall, the participants had significant gains in knowledge (median 50%, interquartile range [IQR]=17%-80%, P<.001) and competence (median 13%, IQR=0%-33%, P=.006). There were no significant differences in knowledge gain (40%, IQR=13%-76% vs 60%, IQR=20%-100%, P=.42) and competence gain (0%, IQR= ?21% to 38% vs 25%, IQR=0%-33%, P=.16) between the IM and PPS groups. However, the IM group had a higher satisfaction score (8, IQR=6-9 vs 6, IQR=4-7, P=.01) compared with the PPS group. Using Friedman?s two-way nonparametric analysis of variance, cognitive styles (field-independent, field-intermediate, or field-dependent classification) and learning modules (IM or PPS) had significant effects on both knowledge gain (both adjusted P<.001) and satisfaction (both adjusted P<.001). Conclusions: Mobile e-learning is an effective modality to improve knowledge of emergent ORL-HNS in millennial undergraduate medical students. Our findings suggest the necessity of developing various modules for undergraduate medical students with different cognitive styles. Trial Registration: Clinicaltrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV) UR - http://www.jmir.org/2018/2/e56/ UR - http://dx.doi.org/10.2196/jmir.8987 UR - http://www.ncbi.nlm.nih.gov/pubmed/29439943 ID - info:doi/10.2196/jmir.8987 ER - TY - JOUR AU - O'Reilly, Aidan Martin AU - Slevin, Patrick AU - Ward, Tomas AU - Caulfield, Brian PY - 2018/01/31 TI - A Wearable Sensor-Based Exercise Biofeedback System: Mixed Methods Evaluation of Formulift JO - JMIR Mhealth Uhealth SP - e33 VL - 6 IS - 1 KW - mHealth KW - feedback KW - posture KW - exercise therapy KW - biomedical technology KW - lower extremity KW - physical therapy specialty N2 - Background: Formulift is a newly developed mobile health (mHealth) app that connects to a single inertial measurement unit (IMU) worn on the left thigh. The IMU captures users? movements as they exercise, and the app analyzes the data to count repetitions in real time and classify users? exercise technique. The app also offers feedback and guidance to users on exercising safely and effectively. Objective: The aim of this study was to assess the Formulift system with three different and realistic types of potential users (beginner gym-goers, experienced gym-goers, and qualified strength and conditioning [S&C] coaches) under a number of categories: (1) usability, (2) functionality, (3) the perceived impact of the system, and (4) the subjective quality of the system. It was also desired to discover suggestions for future improvements to the system. Methods: A total of 15 healthy volunteers participated (12 males; 3 females; age: 23.8 years [SD 1.80]; height: 1.79 m [SD 0.07], body mass: 78.4 kg [SD 9.6]). Five participants were beginner gym-goers, 5 were experienced gym-goers, and 5 were qualified and practicing S&C coaches. IMU data were first collected from each participant to create individualized exercise classifiers for them. They then completed a number of nonexercise-related tasks with the app. Following this, a workout was completed using the system, involving squats, deadlifts, lunges, and single-leg squats. Participants were then interviewed about their user experience and completed the System Usability Scale (SUS) and the user version of the Mobile Application Rating Scale (uMARS). Thematic analysis was completed on all interview transcripts, and survey results were analyzed. Results: Qualitative and quantitative analysis found the system has ?good? to ?excellent? usability. The system achieved a mean (SD) SUS usability score of 79.2 (8.8). Functionality was also deemed to be good, with many users reporting positively on the systems repetition counting, technique classification, and feedback. A number of bugs were found, and other suggested changes to the system were also made. The overall subjective quality of the app was good, with a median star rating of 4 out of 5 (interquartile range, IQR: 3-5). Participants also reported that the system would aid their technique, provide motivation, reassure them, and help them avoid injury. Conclusions: This study demonstrated an overall positive evaluation of Formulift in the categories of usability, functionality, perceived impact, and subjective quality. Users also suggested a number of changes for future iterations of the system. These findings are the first of their kind and show great promise for wearable sensor-based exercise biofeedback systems. UR - http://mhealth.jmir.org/2018/1/e33/ UR - http://dx.doi.org/10.2196/mhealth.8115 UR - http://www.ncbi.nlm.nih.gov/pubmed/29386171 ID - info:doi/10.2196/mhealth.8115 ER - TY - JOUR AU - Manor, Brad AU - Yu, Wanting AU - Zhu, Hao AU - Harrison, Rachel AU - Lo, On-Yee AU - Lipsitz, Lewis AU - Travison, Thomas AU - Pascual-Leone, Alvaro AU - Zhou, Junhong PY - 2018/01/30 TI - Smartphone App?Based Assessment of Gait During Normal and Dual-Task Walking: Demonstration of Validity and Reliability JO - JMIR Mhealth Uhealth SP - e36 VL - 6 IS - 1 KW - smartphone KW - gait assessment KW - pocket KW - dual task KW - validity KW - reliability KW - mobile applications N2 - Background: Walking is a complex cognitive motor task that is commonly completed while performing another task such as talking or making decisions. Gait assessments performed under normal and ?dual-task? walking conditions thus provide important insights into health. Such assessments, however, are limited primarily to laboratory-based settings. Objective: The objective of our study was to create and test a smartphone-based assessment of normal and dual-task walking for use in nonlaboratory settings. Methods: We created an iPhone app that used the phone?s motion sensors to record movements during walking under normal conditions and while performing a serial-subtraction dual task, with the phone placed in the user?s pants pocket. The app provided the user with multimedia instructions before and during the assessment. Acquired data were automatically uploaded to a cloud-based server for offline analyses. A total of 14 healthy adults completed 2 laboratory visits separated by 1 week. On each visit, they used the app to complete three 45-second trials each of normal and dual-task walking. Kinematic data were collected with the app and a gold-standard?instrumented GAITRite mat. Participants also used the app to complete normal and dual-task walking trials within their homes on 3 separate days. Within laboratory-based trials, GAITRite-derived heel strikes and toe-offs of the phone-side leg aligned with smartphone acceleration extrema, following filtering and rotation to the earth coordinate system. We derived stride times?a clinically meaningful metric of locomotor control?from GAITRite and app data, for all strides occurring over the GAITRite mat. We calculated stride times and the dual-task cost to the average stride time (ie, percentage change from normal to dual-task conditions) from both measurement devices. We calculated similar metrics from home-based app data. For these trials, periods of potential turning were identified via custom-developed algorithms and omitted from stride-time analyses. Results: Across all detected strides in the laboratory, stride times derived from the app and GAITRite mat were highly correlated (P<.001, r2=.98). These correlations were independent of walking condition and pocket tightness. App- and GAITRite-derived stride-time dual-task costs were also highly correlated (P<.001, r2=.95). The error of app-derived stride times (mean 16.9, SD 9.0 ms) was unaffected by the magnitude of stride time, walking condition, or pocket tightness. For both normal and dual-task trials, average stride times derived from app walking trials demonstrated excellent test-retest reliability within and between both laboratory and home-based assessments (intraclass correlation coefficient range .82-.94). Conclusions: The iPhone app we created enabled valid and reliable assessment of stride timing?with the smartphone in the pocket?during both normal and dual-task walking and within both laboratory and nonlaboratory environments. Additional work is warranted to expand the functionality of this tool to older adults and other patient populations. UR - http://mhealth.jmir.org/2018/1/e36/ UR - http://dx.doi.org/10.2196/mhealth.8815 UR - http://www.ncbi.nlm.nih.gov/pubmed/29382625 ID - info:doi/10.2196/mhealth.8815 ER - TY - JOUR AU - Quanbeck, Andrew AU - Gustafson, H. David AU - Marsch, A. Lisa AU - Chih, Ming-Yuan AU - Kornfield, Rachel AU - McTavish, Fiona AU - Johnson, Roberta AU - Brown, T. Randall AU - Mares, Marie-Louise AU - Shah, V. Dhavan PY - 2018/01/30 TI - Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study JO - J Med Internet Res SP - e37 VL - 20 IS - 1 KW - mobile health KW - mHealth KW - evidence-based practice KW - behavioral medicine N2 - Background: Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. Objective: The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. Methods: In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: The outcomes according to the RE-AIM framework are as follows: Reach?Seva reached 8.31% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness?Patients who were given Seva had significant improvements in their risky drinking days (44% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption?Patients sustained high levels of Seva use?between 53% and 60% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation?At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance?Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. Conclusions: Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge. UR - http://www.jmir.org/2018/1/e37/ UR - http://dx.doi.org/10.2196/jmir.8928 UR - http://www.ncbi.nlm.nih.gov/pubmed/29382624 ID - info:doi/10.2196/jmir.8928 ER - TY - JOUR AU - Wang, Chih-Jau AU - Chaovalit, Pimwadee AU - Pongnumkul, Suporn PY - 2018/01/26 TI - A Breastfeed-Promoting Mobile App Intervention: Usability and Usefulness Study JO - JMIR Mhealth Uhealth SP - e27 VL - 6 IS - 1 KW - mobile health KW - breast feeding KW - mobile applications KW - health promotion KW - usability KW - usefulness N2 - Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants; however, 6-month exclusive breastfeeding rate remains below 20% in Thailand. Although the number of research literature and commercial apps for breastfeeding women is significantly growing, they are country-specific and restricted to English-speaking users. There exists a major knowledge gap on how mobile health apps could support breastfeeding in Thailand. To address these gaps, MoomMae has been developed with the intention to support Thai women in breastfeeding outside of their homes and in keeping their feeding records. Objective: The aim of this study was to evaluate the usability and usefulness of MoomMae, a mobile phone app designed to support breastfeeding women. Methods: Our study was reviewed and approved by Thailand?s National Science and Technology Development Agency (NSTDA) ethics committee. A total of 21 breastfeeding women with at least one Android phone or tablet were recruited via convenience and snowball sampling. The study process for each participant was as follows: the participant was requested to attend a preuse interview and given the app to use for 4 weeks. Following this period, a postuse interview was conducted to examine the usability and usefulness of the app. Both sessions were held individually and audiorecorded for qualitative analysis. Results: The mean scores of usability and usefulness from the postuse survey were 4.33 (SD 0.87; range 1-5) and 4.60 (SD 0.74; range 2-5). Our qualitative analysis revealed a total of 137 feedbacks: 71 related to usability and 66 associated with usefulness. A further sentimental analysis showed that comments on usability were generally negative (59 negative, 11 positive, and 1 neutral), and comments on usefulness were relatively positive (56 positive, 9 negative, and 1 neutral). We discovered 26 unique design issues and proposed recommendations for future improvement. Conclusions: Our usability and usefulness assessment of MoomMae demonstrated that MoomMae has a great potential to be a useful self-management tool for breastfeeding mothers in Thailand. The qualitative analysis suggested that the app is supportive of breastfeeding on demand, but the flow and inputs of the app should be redesigned to be more intuitive. For future implementations, the most desirable feature is a pump-reminding notification system. UR - http://mhealth.jmir.org/2018/1/e27/ UR - http://dx.doi.org/10.2196/mhealth.8337 UR - http://www.ncbi.nlm.nih.gov/pubmed/29374000 ID - info:doi/10.2196/mhealth.8337 ER - TY - JOUR AU - Lee, Anne Rebecca AU - Jung, Elizabeth Mary PY - 2018/01/23 TI - Evaluation of an mHealth App (DeStressify) on University Students? Mental Health: Pilot Trial JO - JMIR Ment Health SP - e2 VL - 5 IS - 1 KW - mHealth KW - mindfulness KW - mental health KW - students N2 - Background: One in five Canadians experience mental health issues with those in the age range of 15 to 24 years being most at risk of a mood disorder. University students have shown significantly higher rates of mental health problems than the general public. Current university support services are limited by factors such as available staff and finances, and social stigma has frequently been identified as an additional barrier that prevents students from accessing these resources. Mobile health (mHealth) apps are one form of alternative health support that is discrete and accessible to students, and although they are recognized as a promising alternative, there is limited research demonstrating their efficacy. Objective: The aim of this study was to evaluate a mindfulness-based app?s (?DeStressify?) efficacy on stress, anxiety, depressive symptomology, sleep behavior, work or class absenteeism, work or school productivity, and quality of life (QoL) among university students. Methods: Full-time undergraduate students at a Canadian university with smartphones and Internet access were recruited through in-class announcements and on-campus posters. Participants randomized into an experimental condition were given and instructed to use the DeStressify app 5 days a week for 4 weeks. Control condition participants were wait-listed. All participants completed pre- and postintervention Web-based surveys to self-assess stress, anxiety, depressive symptomatology, sleep quality, and health-related QoL. Results: A total of 206 responses were collected at baseline, with 163 participants completing the study (86 control, 77 experimental). Using DeStressify was shown to reduce trait anxiety (P=.01) and improve general health (P=.001), energy (P=.01), and emotional well-being (P=.01) in university students, and more participants in the experimental condition believed their productivity improved between baseline and postintervention measurements than the number of participants expected to believe so randomly by chance (P=.01). The app did not significantly improve stress, state anxiety, physical and social functioning, and role limitations because of physical or emotional health problems or pain (P>.05). Conclusions: Mindfulness-based apps may provide an effective alternative support for university students? mental health. Universities and other institutions may benefit from promoting the use of DeStressify or other mindfulness-based mHealth apps among students who are interested in methods of anxiety management or mindfulness-based self-driven health support. Future steps include examining DeStressify and similar mHealth apps over a longer period and in university staff and faculty. UR - http://mental.jmir.org/2018/1/e2/ UR - http://dx.doi.org/10.2196/mental.8324 UR - http://www.ncbi.nlm.nih.gov/pubmed/29362209 ID - info:doi/10.2196/mental.8324 ER - TY - JOUR AU - Marcolino, Soriano Milena AU - Oliveira, Queiroz João Antonio AU - D'Agostino, Marcelo AU - Ribeiro, Luiz Antonio AU - Alkmim, Moreira Maria Beatriz AU - Novillo-Ortiz, David PY - 2018/01/17 TI - The Impact of mHealth Interventions: Systematic Review of Systematic Reviews JO - JMIR Mhealth Uhealth SP - e23 VL - 6 IS - 1 KW - telemedicine KW - medical informatics KW - mobile phones N2 - Background: Mobile phone usage has been rapidly increasing worldwide. mHealth could efficiently deliver high-quality health care, but the evidence supporting its current effectiveness is still mixed. Objective: We performed a systematic review of systematic reviews to assess the impact or effectiveness of mobile health (mHealth) interventions in different health conditions and in the processes of health care service delivery. Methods: We used a common search strategy of five major scientific databases, restricting the search by publication date, language, and parameters in methodology and content. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist. Results: The searches resulted in a total of 10,689 articles. Of these, 23 systematic reviews (371 studies; more than 79,665 patients) were included. Seventeen reviews included studies performed in low- and middle-income countries. The studies used diverse mHealth interventions, most frequently text messaging (short message service, SMS) applied to different purposes (reminder, alert, education, motivation, prevention). Ten reviews were rated as low quality (AMSTAR score 0-4), seven were rated as moderate quality (AMSTAR score 5-8), and six were categorized as high quality (AMSTAR score 9-11). A beneficial impact of mHealth was observed in chronic disease management, showing improvement in symptoms and peak flow variability in asthma patients, reducing hospitalizations and improving forced expiratory volume in 1 second; improving chronic pulmonary diseases symptoms; improving heart failure symptoms, reducing deaths and hospitalization; improving glycemic control in diabetes patients; improving blood pressure in hypertensive patients; and reducing weight in overweight and obese patients. Studies also showed a positive impact of SMS reminders in improving attendance rates, with a similar impact to phone call reminders at reduced cost, and improved adherence to tuberculosis and human immunodeficiency virus therapy in some scenarios, with evidence of decrease of viral load. Conclusions: Although mHealth is growing in popularity, the evidence for efficacy is still limited. In general, the methodological quality of the studies included in the systematic reviews is low. For some fields, its impact is not evident, the results are mixed, or no long-term studies exist. Exceptions include the moderate quality evidence of improvement in asthma patients, attendance rates, and increased smoking abstinence rates. Most studies were performed in high-income countries, implying that mHealth is still at an early stage of development in low-income countries. UR - http://mhealth.jmir.org/2018/1/e23/ UR - http://dx.doi.org/10.2196/mhealth.8873 UR - http://www.ncbi.nlm.nih.gov/pubmed/29343463 ID - info:doi/10.2196/mhealth.8873 ER - TY - JOUR AU - Liu, Hao-Yen AU - Lee, Wui-Chiang AU - Sun, Ying-Chou AU - Fen, Jun-Jeng AU - Chen, Tzeng-Ji AU - Chou, Li-Fang AU - Hwang, Shinn-Jang PY - 2018/01/16 TI - Hospital-Owned Apps in Taiwan: Nationwide Survey JO - JMIR Mhealth Uhealth SP - e22 VL - 6 IS - 1 KW - hospitals KW - telemedicine KW - mobile apps KW - Taiwan KW - mHealth N2 - Background: Over the last decade, the use of mobile phone apps in the health care industry has grown rapidly. Owing to the high penetration rate of Internet use in Taiwan, hospitals are eager to provide their own apps to improve the accessibility of medical care for patients. Objective: The aims of this study were to provide an overview of the currently available hospital-owned apps in Taiwan and to conduct a cross-hospital comparison of app features. Methods: In May 2017, the availability of apps from all 414 hospitals in Taiwan was surveyed from the hospital home pages and the Google Play app store. The features of the downloaded apps were then examined in detail and, for each app, the release date of the last update, download frequency, and rating score were obtained from Google Play. Results: Among all the 414 hospitals in Taiwan, 150 (36.2%) owned Android apps that had been made available for public use, including 95% (18/19) of the academic medical centers, 77% (63/82) of the regional hospitals, and 22.0% (69/313) of the local community hospitals. Among the 13 different functionalities made available by the various hospital-owned apps, the most common were the doctor search (100%, 150/150), real-time queue monitoring (100%, 150/150), and online appointment scheduling (94.7%, 142/150) functionalities. The majority of apps (57.3%, 86/150) had a rating greater than 4 out of 5, 49.3% (74/150) had been updated at some point in 2017, and 36.0% (54/150) had been downloaded 10,000 to 50,000 times. Conclusions: More than one-third of the hospitals owned apps intended to increase patient access to health care. The most common app features might reflect the health care situation in Taiwan, where the overcrowded outpatient departments of hospitals operate in an open-access mode without any strict referral system. Further research should focus on the effectiveness and safety of these apps. UR - http://mhealth.jmir.org/2018/1/e22/ UR - http://dx.doi.org/10.2196/mhealth.8636 UR - http://www.ncbi.nlm.nih.gov/pubmed/29339347 ID - info:doi/10.2196/mhealth.8636 ER - TY - JOUR AU - Gbadamosi, Olatunde Semiu AU - Eze, Chuka AU - Olawepo, Olajide John AU - Iwelunmor, Juliet AU - Sarpong, F. Daniel AU - Ogidi, Grace Amaka AU - Patel, Dina AU - Oko, Okpanachi John AU - Onoka, Chima AU - Ezeanolue, Edozie Echezona PY - 2018/01/15 TI - A Patient-Held Smartcard With a Unique Identifier and an mHealth Platform to Improve the Availability of Prenatal Test Results in Rural Nigeria: Demonstration Study JO - J Med Internet Res SP - e18 VL - 20 IS - 1 KW - mHealth KW - prenatal screening KW - HIV KW - hepatitis B KW - sickle cell disease KW - Nigeria KW - telemedicine KW - prenatal diagnosis KW - infectious disease transmission, vertical N2 - Background: Community-based strategies to test for HIV, hepatitis B virus (HBV), and sickle cell disease (SCD) have expanded opportunities to increase the proportion of pregnant women who are aware of their diagnosis. In order to use this information to implement evidence-based interventions, these results have to be available to skilled health providers at the point of delivery. Most electronic health platforms are dependent on the availability of reliable Internet connectivity and, thus, have limited use in many rural and resource-limited settings. Objective: Here we describe our work on the development and deployment of an integrated mHealth platform that is able to capture medical information, including test results, and encrypt it into a patient-held smartcard that can be read at the point of delivery without the need for an Internet connection. Methods: We engaged a team of implementation scientists, public health experts, and information technology specialists in a requirement-gathering process to inform the design of a prototype for a platform that uses smartcard technology, database deployment, and mobile phone app development. Key design decisions focused on usability, scalability, and security. Results: We successfully designed an integrated mHealth platform and deployed it in 4 health facilities across Benue State, Nigeria. We developed the Vitira Health platform to store test results of HIV, HBV, and SCD in a database, and securely encrypt the results on a Quick Response code embedded on a smartcard. We used a mobile app to read the contents on the smartcard without the need for Internet connectivity. Conclusions: Our findings indicate that it is possible to develop a patient-held smartcard and an mHealth platform that contains vital health information that can be read at the point of delivery using a mobile phone-based app without an Internet connection. Trial Registration: ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE) UR - http://www.jmir.org/2018/1/e18/ UR - http://dx.doi.org/10.2196/jmir.8716 UR - http://www.ncbi.nlm.nih.gov/pubmed/29335234 ID - info:doi/10.2196/jmir.8716 ER - TY - JOUR AU - Jimoh, Florence AU - Lund, K. Elizabeth AU - Harvey, J. Linda AU - Frost, Catherine AU - Lay, James W. AU - Roe, A. Mark AU - Berry, Rachel AU - Finglas, M. Paul PY - 2018/01/15 TI - Comparing Diet and Exercise Monitoring Using Smartphone App and Paper Diary: A Two-Phase Intervention Study JO - JMIR Mhealth Uhealth SP - e17 VL - 6 IS - 1 KW - adolescent KW - smartphone app KW - diet KW - exercise KW - food intake KW - mobile applications N2 - Background: There is increasing recognition that personalized approaches may be more effective in helping people establish healthier eating patterns and exercise more, and that this approach may be particularly effective in adolescents. Objective: The objective of this study was to investigate the use of a smartphone app (FoodWiz2) in supporting healthy lifestyle choices in adolescence. Methods: Participants (N=34: 11 male, 23 female) aged 16-19 years in full- or part-time education were recruited from sixth form colleges, schools, and other further education establishments in Norfolk and Suffolk, United Kingdom, between February and May 2015. Participants recorded food intake and exercise using a paper diary for 4-5 weeks and then used the app for the same duration. Initial nutrition education and general support were provided during the paper diary use, but the app included personalized messages sent in response to app activity. At the end of each study phase, participants completed an online questionnaire to describe their experience of using the paper diary and app. Results: Record completion declined throughout the study, possibly affected by examination pressure. Food intake data showed increased fruit consumption and significantly reduced consumption of chocolate snacks (P=.01) and fizzy drinks (P=.002) among participants using the app. Questionnaire responses indicated that the app was generally preferred to the paper diary, in particular, the app was seen as less boring to use (P=.03) and more acceptable in social settings (P<.001). Conclusions: This app-based approach has shown the potential for a more effective approach to improving adolescent diet and exercise levels. UR - http://mhealth.jmir.org/2018/1/e17/ UR - http://dx.doi.org/10.2196/mhealth.7702 UR - http://www.ncbi.nlm.nih.gov/pubmed/29335239 ID - info:doi/10.2196/mhealth.7702 ER - TY - JOUR AU - Bull, Sheana AU - Thomas, SK Deborah AU - Nyanza, C. Elias AU - Ngallaba, E. Sospatro PY - 2018/01/15 TI - Tanzania Health Information Technology (T-HIT) System: Pilot Test of a Tablet-Based System to Improve Prevention of Mother-to-Child Transmission of HIV JO - JMIR Mhealth Uhealth SP - e16 VL - 6 IS - 1 KW - mHealth KW - decision aids KW - HIV KW - healthcare workers N2 - Background: The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. Objective: The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. Methods: We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Results: Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. Conclusions: T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention compared with a traditional system of paper logs, suggesting potential for improvements in antenatal care for women at risk for HIV. UR - https://mhealth.jmir.org/2018/1/e16/ UR - http://dx.doi.org/10.2196/mhealth.8513 UR - http://www.ncbi.nlm.nih.gov/pubmed/29335236 ID - info:doi/10.2196/mhealth.8513 ER - TY - JOUR AU - McBride, Bronwyn AU - Nguyen, Thanh Liem AU - Wiljer, David AU - Vu, C. Nguyen AU - Nguyen, K. Cuong AU - O'Neil, John PY - 2018/01/11 TI - Development of a Maternal, Newborn and Child mHealth Intervention in Thai Nguyen Province, Vietnam: Protocol for the mMom Project JO - JMIR Res Protoc SP - e6 VL - 7 IS - 1 KW - mobile health KW - Vietnam KW - maternal health KW - reproductive health KW - health equity N2 - Background: Ethnic minority women (EMW) living in mountainous areas of northern Vietnam have disproportionately high infant and maternal mortality rates as a result of low maternal health knowledge, poverty, and remoteness from low-capacity health centers. Objective: The objective of this study was to describe the protocol for the development and evaluation of the mMom intervention, which is an integrated mobile health (mHealth) system designed to improve maternal and infant health knowledge, and behavior among women in remote areas of Thai Nguyen, Vietnam. Methods: This project featured the following four phases: (1) development of an mHealth platform integrated into the existing health management information system in partnership with the provincial health department; (2) ethnographic fieldwork and intervention content development; (3) intervention piloting and implementation; and (4) evaluation of the intervention?s impact on participants? maternal health knowledge, behavior, and interactions with the health system. Results: The mMom project development process resulted in the following: (1) the successful development of the mMom system, including the mHealth platform hardware and integration, the intervention plan and content, and the monitoring and evaluation framework; (2) the piloting and implementation of the intervention as planned; and (3) the implementation of the monitoring and evaluation framework components. Conclusions: This protocol outlines the development of the mMom intervention and describes critical next steps in understanding the impact of the intervention on participants and the wider health system in Thai Nguyen province, Vietnam. UR - http://www.researchprotocols.org/2018/1/e6/ UR - http://dx.doi.org/10.2196/resprot.7912 UR - http://www.ncbi.nlm.nih.gov/pubmed/29326095 ID - info:doi/10.2196/resprot.7912 ER - TY - JOUR AU - Masalski, Marcin AU - Grysi?ski, Tomasz AU - Kr?cicki, Tomasz PY - 2018/01/10 TI - Hearing Tests Based on Biologically Calibrated Mobile Devices: Comparison With Pure-Tone Audiometry JO - JMIR Mhealth Uhealth SP - e10 VL - 6 IS - 1 KW - hearing test KW - mobile health KW - mobile apps KW - pure-tone audiometry N2 - Background: Hearing screening tests based on pure-tone audiometry may be conducted on mobile devices, provided that the devices are specially calibrated for the purpose. Calibration consists of determining the reference sound level and can be performed in relation to the hearing threshold of normal-hearing persons. In the case of devices provided by the manufacturer, together with bundled headphones, the reference sound level can be calculated once for all devices of the same model. Objective: This study aimed to compare the hearing threshold measured by a mobile device that was calibrated using a model-specific, biologically determined reference sound level with the hearing threshold obtained in pure-tone audiometry. Methods: Trial participants were recruited offline using face-to-face prompting from among Otolaryngology Clinic patients, who own Android-based mobile devices with bundled headphones. The hearing threshold was obtained on a mobile device by means of an open access app, Hearing Test, with incorporated model-specific reference sound levels. These reference sound levels were previously determined in uncontrolled conditions in relation to the hearing threshold of normal-hearing persons. An audiologist-assisted self-measurement was conducted by the participants in a sound booth, and it involved determining the lowest audible sound generated by the device within the frequency range of 250 Hz to 8 kHz. The results were compared with pure-tone audiometry. Results: A total of 70 subjects, 34 men and 36 women, aged 18-71 years (mean 36, standard deviation [SD] 11) participated in the trial. The hearing threshold obtained on mobile devices was significantly different from the one determined by pure-tone audiometry with a mean difference of 2.6 dB (95% CI 2.0-3.1) and SD of 8.3 dB (95% CI 7.9-8.7). The number of differences not greater than 10 dB reached 89% (95% CI 88-91), whereas the mean absolute difference was obtained at 6.5 dB (95% CI 6.2-6.9). Sensitivity and specificity for a mobile-based screening method were calculated at 98% (95% CI 93-100.0) and 79% (95% CI 71-87), respectively. Conclusions: The method of hearing self-test carried out on mobile devices with bundled headphones demonstrates high compatibility with pure-tone audiometry, which confirms its potential application in hearing monitoring, screening tests, or epidemiological examinations on a large scale. UR - https://mhealth.jmir.org/2018/1/e10/ UR - http://dx.doi.org/10.2196/mhealth.7800 UR - http://www.ncbi.nlm.nih.gov/pubmed/29321124 ID - info:doi/10.2196/mhealth.7800 ER - TY - JOUR AU - Chen, Huan AU - Chai, Yanling AU - Dong, Le AU - Niu, Wenyi AU - Zhang, Puhong PY - 2018/01/09 TI - Effectiveness and Appropriateness of mHealth Interventions for Maternal and Child Health: Systematic Review JO - JMIR Mhealth Uhealth SP - e7 VL - 6 IS - 1 KW - telemedicine KW - maternal health KW - child health N2 - Background: The application of mobile health (mHealth) technology in reproductive, maternal, newborn, and child health (RMNCH) is increasing worldwide. However, best practice and the most effective mHealth interventions have not been reviewed systematically. Objective: A systematic review and meta-analysis of studies of mHealth interventions for RMNCH around the world were conducted to investigate their characteristics as well as the features and effectiveness of mHealth interventions. Methods: Studies of mHealth interventions for RMNCH between January 2011 and December 2016 were retrieved from 6 databases (PubMed, EMBASE, Global Health, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang Data Knowledge Service Medium). Comparable studies were included in a random-effects meta-analysis for both exclusive breastfeeding (EBF) and antenatal checks (ANC). Descriptive analyses were conducted for mHealth studies with a range of study designs. Results: Analyses of 245 studies were included, including 51 randomized controlled trials (RCTs). Results showed that there are increasing numbers of studies on mHealth interventions for RMNCH. Although 2 meta-analysis, one with 2 RCTs on EBF (odds ratio [OR] 2.03, 95% CI 1.34-3.08, I2=25%) and the other with 3 RCTs on ANC (OR 1.43, 95% CI 1.13-1.79, I2=78%), showed that mHealth interventions are more effective than usual care, almost half (43%) of RCTs showed negative or unclear results on mHealth interventions. Functions described in mHealth interventions were diverse, and the health stages covered were broad. However, single function or single stage appeared to be dominant among mHealth interventions compared with multiple functions or stages. Conclusions: More rigorous evaluations are needed to draw consistent conclusions and to analyze mHealth products with multiple functions, especially those popular in the app markets. UR - http://mhealth.jmir.org/2018/1/e7/ UR - http://dx.doi.org/10.2196/mhealth.8998 UR - http://www.ncbi.nlm.nih.gov/pubmed/29317380 ID - info:doi/10.2196/mhealth.8998 ER - TY - JOUR AU - Robbins, N. Reuben AU - Gouse, Hetta AU - Brown, G. Henry AU - Ehlers, Andries AU - Scott, M. Travis AU - Leu, Cheng-Shiun AU - Remien, H. Robert AU - Mellins, A. Claude AU - Joska, A. John PY - 2018/01/05 TI - A Mobile App to Screen for Neurocognitive Impairment: Preliminary Validation of NeuroScreen Among HIV-Infected South African Adults JO - JMIR Mhealth Uhealth SP - e5 VL - 6 IS - 1 KW - HIV KW - neurocognitive KW - impairment KW - lay health workers KW - resource-limited settings KW - South Africa KW - tablet KW - app KW - neuropsychology N2 - Background: Neurocognitive impairment (NCI) is one of the most common complications of HIV infection, and has serious medical and functional consequences. South Africa has 7 million people living with HIV (PLHIV) with up to three-quarters of antiretroviral therapy (ART)-naïve individuals having NCI. South Africa?s health system struggles to meet the care needs of its millions of PLHIV; screening for NCI is typically neglected due to limited clinical staff trained to administer, score, and interpret neuropsychological tests, as well as long test batteries and limited screening tools for South African populations. Without accurate, clinically useful, and relatively brief NCI screening tests that can be administered by all levels of clinical staff, critical opportunities to provide psychoeducation, behavioral planning, additional ART adherence support, and adjuvant therapies for NCI (when they become available) are missed. To address these challenges and gap in care, we developed an mHealth app screening tool, NeuroScreen, to detect NCI that can be administered by all levels of clinical staff, including lay health workers. Objective: The purpose of this study was to examine sensitivity and specificity of an adapted version of NeuroScreen to detect NCI (as determined by a gold standard neuropsychological test battery administered by a trained research psychometrist) among HIV-infected South Africans when administered by a lay health worker. Methods: A total of 102 HIV-infected black South African adults who had initiated ART at least 12 months prior were administered NeuroScreen and a gold standard neuropsychological test battery in the participants? choice of language (ie, English or isiXhosa). Three composite z scores were calculated for NeuroScreen: (1) sum of all individual test scores, (2) sum of all individual test scores and error scores from four tests, and (3) sum of four tests (abbreviated version). Global deficit scores were calculated for the gold standard battery where a score of 0.5 or greater indicated the presence of NCI. Results: The mean age of participants was 33.31 (SD 7.46) years, most (59.8%, 61/102) had at least 12 years of education, and 81.4% (83/102) of the sample was female. Gold standard test battery results indicated that 26.5% (27/102) of the sample had NCI. Sensitivity and specificity of age-, education-, and sex-adjusted NeuroScreen scores were 81.48% and 74.67% for composite score 1, 81.48% and 81.33% for composite score 2, and 92.59% and 70.67% for composite score 3, respectively. Conclusions: NeuroScreen, a highly automated, easy-to-use, tablet-based screening test to detect NCI among English- and isiXhosa-speaking South African HIV patients demonstrated robust sensitivity and specificity to detect NCI when administered by lay health workers. NeuroScreen could help make screening for NCI more feasible. However, additional research is needed with larger samples and normative test performance data are needed. UR - http://mhealth.jmir.org/2018/1/e5/ UR - http://dx.doi.org/10.2196/mhealth.9148 UR - http://www.ncbi.nlm.nih.gov/pubmed/29305338 ID - info:doi/10.2196/mhealth.9148 ER - TY - JOUR AU - Das, Gitanjali AU - Cheung, Cynthia AU - Nebeker, Camille AU - Bietz, Matthew AU - Bloss, Cinnamon PY - 2018/01/04 TI - Privacy Policies for Apps Targeted Toward Youth: Descriptive Analysis of Readability JO - JMIR Mhealth Uhealth SP - e3 VL - 6 IS - 1 KW - privacy KW - comprehension KW - mobile applications KW - adolescent N2 - Background: Due to the growing availability of consumer information, the protection of personal data is of increasing concern. Objective: We assessed readability metrics of privacy policies for apps that are either available to or targeted toward youth to inform strategies to educate and protect youth from unintentional sharing of personal data. Methods: We reviewed the 1200 highest ranked apps from the Apple and Google Play Stores and systematically selected apps geared toward youth. After applying exclusion criteria, 99 highly ranked apps geared toward minors remained, 64 of which had a privacy policy. We obtained and analyzed these privacy policies using reading grade level (RGL) as a metric. Policies were further compared as a function of app category (free vs paid; entertainment vs social networking vs utility). Results: Analysis of privacy policies for these 64 apps revealed an average RGL of 12.78, which is well above the average reading level (8.0) of adults in the United States. There was also a small but statistically significant difference in word count as a function of app category (entertainment: 2546 words, social networking: 3493 words, and utility: 1038 words; P=.02). Conclusions: Although users must agree to privacy policies to access digital tools and products, readability analyses suggest that these agreements are not comprehensible to most adults, let alone youth. We propose that stakeholders, including pediatricians and other health care professionals, play a role in educating youth and their guardians about the use of Web-based services and potential privacy risks, including the unintentional sharing of personal data. UR - http://mhealth.jmir.org/2018/1/e3/ UR - http://dx.doi.org/10.2196/mhealth.7626 UR - http://www.ncbi.nlm.nih.gov/pubmed/29301737 ID - info:doi/10.2196/mhealth.7626 ER - TY - JOUR AU - Oh, Bumjo AU - Yi, Ga-Hye AU - Han, Kyu Min AU - Kim, Seung Jong AU - Lee, Hee Chang AU - Cho, Belong AU - Kang, Cheol Hee PY - 2018/01/03 TI - Importance of Active Participation in Obesity Management Through Mobile Health Care Programs: Substudy of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e2 VL - 6 IS - 1 KW - physical activity KW - mobile health KW - metabolic syndrome KW - self-report KW - adherence KW - concordance N2 - Background: Due to the prevalence of the westernized dietary pattern and lack of physical activity, the numbers of overweight or obese individuals are increasing, resulting in a growing health burden because of various related diseases. A lifestyle modification approach has additional advantages compared with pharmacological therapies or bariatric surgery. In our randomized controlled trial conducted in 2015, we successfully used a ubiquitous health care (SmartCare) service for patients with metabolic syndrome to achieve a significant weight loss effect. Various useful apps have been developed for the SmartCare Service, which involves using a mobile phone to manage chronic diseases, minimizing time and space restrictions. Many studies have demonstrated weight loss effects using a SmartCare service, but limited data are available regarding the effect of active participation in relation to weight loss. Objective: We aimed to assess the weight loss effect achieved after using the SmartCare service in terms of adherence and participation. We divided the intervention group of the previous study according to participation level, and analyzed whether there was a significant difference in the outcome. Methods: We classified participants into 3 groups according to their adherence. Within the intervention group using the SmartCare service, the active group comprised those transmitting anthropometric measurement data using a mobile phone 3 or more times per week or who had a health consultation 5 or more times during a 24-week period. The passive group comprised those who did not adhere to these levels of engagement. The control group comprised those who did not use the SmartCare service. We compared changes in body weight, body mass index (BMI), body fat percentage, waist circumference, and lipid profile among the 3 groups. Results: We identified 422 participants and analyzed 405, excluding 17 who were missing necessary data for analysis. The active group consisted of 116 participants, compared with 80 in the passive group and 209 in the control group (without SmartCare service). There was a statistically significant difference in improvements to body weight, BMI, body fat percentage, and waist circumference among active participants compared with less active participants and the control group (P<.05). However, the lipid profile changes did not differ significantly between groups. Conclusions: The level of participation may be related to improved weight-related outcomes, which may improve health outcomes. To maximize the effectiveness of the SmartCare service, encouraging active participation is important. Trial Registration: Clinicaltrials.gov NCT01344811; https://clinicaltrials.gov/ct2/show/NCT01344811 (Archived by WebCite at http://www.webcitation.org/6alT2MmIB) UR - http://mhealth.jmir.org/2018/1/e2/ UR - http://dx.doi.org/10.2196/mhealth.8719 UR - http://www.ncbi.nlm.nih.gov/pubmed/29298749 ID - info:doi/10.2196/mhealth.8719 ER - TY - JOUR AU - Jacquemin, Charlotte AU - Servy, Hervé AU - Molto, Anna AU - Sellam, Jérémie AU - Foltz, Violaine AU - Gandjbakhch, Frédérique AU - Hudry, Christophe AU - Mitrovic, Stéphane AU - Fautrel, Bruno AU - Gossec, Laure PY - 2018/01/02 TI - Physical Activity Assessment Using an Activity Tracker in Patients with Rheumatoid Arthritis and Axial Spondyloarthritis: Prospective Observational Study JO - JMIR Mhealth Uhealth SP - e1 VL - 6 IS - 1 KW - fitness tracker KW - exercise KW - rheumatoid arthritis KW - axial spondylarthritis N2 - Background: Physical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA). Objective: The objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population. Methods: This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire. Results: A total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% CI 1.11-1.14). The activity trackers were worn during a mean of 79 (SD 17) days over the 90 days follow-up. Overall, patients considered the use of the tracker very acceptable, with a mean score of 8 out 10. Conclusions: Patients with RA and axSpA performed insufficient physical activity with similar levels in both groups, despite the differences between the 2 diseases. Activity trackers allow longitudinal assessment of physical activity in these patients. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases. UR - http://mhealth.jmir.org/2018/1/e1/ UR - http://dx.doi.org/10.2196/mhealth.7948 UR - http://www.ncbi.nlm.nih.gov/pubmed/29295810 ID - info:doi/10.2196/mhealth.7948 ER - TY - JOUR AU - Badawy, M. Sherif AU - Thompson, A. Alexis AU - Kuhns, M. Lisa PY - 2017/12/22 TI - Medication Adherence and Technology-Based Interventions for Adolescents With Chronic Health Conditions: A Few Key Considerations JO - JMIR Mhealth Uhealth SP - e202 VL - 5 IS - 12 KW - adolescents KW - adherence KW - compliance KW - technology interventions KW - mobile apps KW - text messaging UR - http://mhealth.jmir.org/2017/12/e202/ UR - http://dx.doi.org/10.2196/mhealth.8310 UR - http://www.ncbi.nlm.nih.gov/pubmed/29273573 ID - info:doi/10.2196/mhealth.8310 ER - TY - JOUR AU - Low, A. Carissa AU - Dey, K. Anind AU - Ferreira, Denzil AU - Kamarck, Thomas AU - Sun, Weijing AU - Bae, Sangwon AU - Doryab, Afsaneh PY - 2017/12/19 TI - Estimation of Symptom Severity During Chemotherapy From Passively Sensed Data: Exploratory Study JO - J Med Internet Res SP - e420 VL - 19 IS - 12 KW - patient reported outcome measures KW - cancer KW - mobile health N2 - Background: Physical and psychological symptoms are common during chemotherapy in cancer patients, and real-time monitoring of these symptoms can improve patient outcomes. Sensors embedded in mobile phones and wearable activity trackers could be potentially useful in monitoring symptoms passively, with minimal patient burden. Objective: The aim of this study was to explore whether passively sensed mobile phone and Fitbit data could be used to estimate daily symptom burden during chemotherapy. Methods: A total of 14 patients undergoing chemotherapy for gastrointestinal cancer participated in the 4-week study. Participants carried an Android phone and wore a Fitbit device for the duration of the study and also completed daily severity ratings of 12 common symptoms. Symptom severity ratings were summed to create a total symptom burden score for each day, and ratings were centered on individual patient means and categorized into low, average, and high symptom burden days. Day-level features were extracted from raw mobile phone sensor and Fitbit data and included features reflecting mobility and activity, sleep, phone usage (eg, duration of interaction with phone and apps), and communication (eg, number of incoming and outgoing calls and messages). We used a rotation random forests classifier with cross-validation and resampling with replacement to evaluate population and individual model performance and correlation-based feature subset selection to select nonredundant features with the best predictive ability. Results: Across 295 days of data with both symptom and sensor data, a number of mobile phone and Fitbit features were correlated with patient-reported symptom burden scores. We achieved an accuracy of 88.1% for our population model. The subset of features with the best accuracy included sedentary behavior as the most frequent activity, fewer minutes in light physical activity, less variable and average acceleration of the phone, and longer screen-on time and interactions with apps on the phone. Mobile phone features had better predictive ability than Fitbit features. Accuracy of individual models ranged from 78.1% to 100% (mean 88.4%), and subsets of relevant features varied across participants. Conclusions: Passive sensor data, including mobile phone accelerometer and usage and Fitbit-assessed activity and sleep, were related to daily symptom burden during chemotherapy. These findings highlight opportunities for long-term monitoring of cancer patients during chemotherapy with minimal patient burden as well as real-time adaptive interventions aimed at early management of worsening or severe symptoms. UR - http://www.jmir.org/2017/12/e420/ UR - http://dx.doi.org/10.2196/jmir.9046 UR - http://www.ncbi.nlm.nih.gov/pubmed/29258977 ID - info:doi/10.2196/jmir.9046 ER - TY - JOUR AU - Robbins, Rebecca AU - Krebs, Paul AU - Jagannathan, Ram AU - Jean-Louis, Girardin AU - Duncan, T. Dustin PY - 2017/12/19 TI - Health App Use Among US Mobile Phone Users: Analysis of Trends by Chronic Disease Status JO - JMIR Mhealth Uhealth SP - e197 VL - 5 IS - 12 KW - smartphone KW - telemedicine KW - chronic disease N2 - Background: Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps. Objective: The objective of this study was to explore behaviors and perceptions about mobile phone?based apps for health among individuals with chronic conditions. Methods: Data were collected from a national cross-sectional survey of 1604 mobile phone users in the United States that assessed mHealth use, beliefs, and preferences. This study examined health app use, reason for download, and perceived efficacy by chronic condition. Results: Among participants, having between 1 and 5 apps was reported by 38.9% (314/807) of respondents without a condition and by 6.6% (24/364) of respondents with hypertension. Use of health apps was reported 2 times or more per day by 21.3% (172/807) of respondents without a condition, 2.7% (10/364) with hypertension, 13.1% (26/198) with obesity, 12.3% (20/163) with diabetes, 12.0% (32/267) with depression, and 16.6% (53/319) with high cholesterol. Results of the logistic regression did not indicate a significant difference in health app download between individuals with and without chronic conditions (P>.05). Compared with individuals with poor health, health app download was more likely among those with self-reported very good health (odds ratio [OR] 3.80, 95% CI 2.38-6.09, P<.001) and excellent health (OR 4.77, 95% CI 2.70-8.42, P<.001). Similarly, compared with individuals who report never or rarely engaging in physical activity, health app download was more likely among those who report exercise 1 day per week (OR 2.47, 95% CI 1.6-3.83, P<.001), 2 days per week (OR 4.77, 95% CI 3.27-6.94, P<.001), 3 to 4 days per week (OR 5.00, 95% CI 3.52-7.10, P<.001), and 5 to 7 days per week (OR 4.64, 95% CI 3.11-6.92, P<.001). All logistic regression results controlled for age, sex, and race or ethnicity. Conclusions: Results from this study suggest that individuals with poor self-reported health and low rates of physical activity, arguably those who stand to benefit most from health apps, were least likely to report download and use these health tools. UR - http://mhealth.jmir.org/2017/12/e197/ UR - http://dx.doi.org/10.2196/mhealth.7832 UR - http://www.ncbi.nlm.nih.gov/pubmed/29258981 ID - info:doi/10.2196/mhealth.7832 ER - TY - JOUR AU - Arpaci, Ibrahim AU - Balo?lu, Mustafa AU - Özteke Kozan, ?rem Hatice AU - Kesici, ?ahin PY - 2017/12/14 TI - Individual Differences in the Relationship Between Attachment and Nomophobia Among College Students: The Mediating Role of Mindfulness JO - J Med Internet Res SP - e404 VL - 19 IS - 12 KW - reactive attachment disorder KW - mindfulness KW - anxiety KW - phobic disorders KW - phobia KW - smartphone N2 - Background: There is a growing interest in nomophobia, which is defined as the fear of being out of cellular phone contact, or "feelings of discomfort or anxiety experienced by individuals when they are unable to use their mobile phones or utilize the affordances these devices provide?. However, only limited research can be found in terms of its determinants at present. Contemporary literature suggests that the relationships among attachment styles, mindfulness, and nomophobia have not been investigated. Objective: This study aims to investigate the mediating effect of mindfulness on the relationship between attachment and nomophobia. In addition, the study also focuses on gender differences in attachment, mindfulness, and nomophobia. A theory-based structural model was tested to understand the essentials of the associations between the constructs. Methods: The Experiences in Close Relationships Scale, Nomophobia Questionnaire, and Mindful Attention Awareness Scale were used to collect data from undergraduate students (N=450; 70.9% women [319/450]; mean age=21.94 years [SD 3.61]). Two measurement models (ie, attachment and mindfulness) and a structural model were specified, estimated, and evaluated. Results: The structural equation model shows that the positive direct effects of avoidant (.13, P=.03) and anxious attachment (.48, P<.001) on nomophobia were significant. The negative direct effects of avoidant (?.18, P=.01) and anxious attachment (?.33, P<.001) on mindfulness were also significant. Moreover, mindfulness has a significant negative effect on nomophobia for women only (?.13, P=.03). Finally, the Sobel test showed that the indirect effects of avoidant and anxious attachment on nomophobia via mindfulness were significant (P<.001). The direct and indirect effects of anxious attachment, avoidant attachment, and mindfulness altogether accounted for 33% of the total variance in nomophobia. Gender comparison results show that there is a significant difference in attachment based on gender (F2,447=6.97, P=.01, Wilk ?=.97, partial ?2=.03). Women (mean 68.46 [SD 16.96]) scored significantly higher than men (mean 63.59 [SD 15.97]) in anxious attachment (F1=7.93, P=.01, partial ?2=.02). Gender differences in mindfulness were not significant (F4,448=3.45, P=.69). On the other hand, results do show significant gender differences in nomophobia (F4,445=2.71, P=.03, Wilk ?=.98, partial ?2=.02) where women scored significantly higher than men. Conclusions: In general, individuals who are emotionally more dependent and crave more closeness and attention in the relationship tend to display higher levels of fear or discomfort when they have no access to their mobile phones. However, gender has a differential impact on the relationship between avoidant attachment and nomophobia. This study establishes the impact of mindfulness on nomophobia for women; therefore, future studies should test the effectiveness of mindfulness-based therapy approaches and confirm whether they are effective and efficient. On the basis of significant gender difference in nomophobia and attachment, we conclude that gender should be taken into account in mindfulness-based treatments dealing with nomophobia. UR - http://www.jmir.org/2017/12/e404/ UR - http://dx.doi.org/10.2196/jmir.8847 UR - http://www.ncbi.nlm.nih.gov/pubmed/29242179 ID - info:doi/10.2196/jmir.8847 ER - TY - JOUR AU - Xie, Bo AU - Su, Zhaohui AU - Zhang, Wenhui AU - Cai, Run PY - 2017/12/14 TI - Chinese Cardiovascular Disease Mobile Apps? Information Types, Information Quality, and Interactive Functions for Self-Management: Systematic Review JO - JMIR Mhealth Uhealth SP - e195 VL - 5 IS - 12 KW - mobile health KW - mHealth KW - cardiovascular disease KW - CVD KW - patient preferences KW - information quality KW - self-management KW - mobile applications KW - mobile apps KW - China N2 - Background: China has a large population with cardiovascular disease (CVD) that requires extensive self-management. Mobile health (mHealth) apps may be a useful tool for CVD self-management. Little is currently known about the types and quality of health information provided in Chinese CVD mobile apps and whether app functions are conducive to promoting CVD self-management. Objective: We undertook a systematic review to evaluate the types and quality of health information provided in Chinese CVD mobile apps and interactive app functions for promoting CVD self-management. Methods: Mobile apps targeting end users in China with CVD conditions were selected in February 2017 through a multi-stage process. Three frameworks were used to evaluate the selected apps: (1) types of health information offered were assessed using our Health Information Wants framework, which encompasses 7 types of information; (2) quality of information provided in the apps was assessed using the 11 guidelines recommended by the National Library of Medicine of the National Institutes of Health; and (3) types of interactive app functions for CVD self-management were assessed using a 15-item framework adapted from the literature, including our own prior work. Results: Of 578 apps identified, 82 were eligible for final review. Among these, information about self-care (67/82, 82%) and information specifically regarding CVD (63/82, 77%) were the most common types of information provided, while information about health care providers (22/82, 27%) and laboratory tests (5/82, 6%) were least common. The most common indicators of information quality were the revealing of apps? providers (82/82, 100%) and purpose (82/82, 100%), while the least common quality indicators were the revealing of how apps? information was selected (1/82, 1%) and app sponsorship (0/82, 0%). The most common interactive functions for CVD self-management were those that enabled user interaction with the app provider (57/82, 70%) and with health care providers (36/82, 44%), while the least common interactive functions were those that enabled lifestyle management (13/82, 16%) and psychological health management (6/82, 7%). None of the apps covered all 7 types of health information, all 11 indicators of information quality, or all 15 interactive functions for CVD self-management. Conclusions: Chinese CVD apps are insufficient in providing comprehensive health information, high-quality information, and interactive functions to facilitate CVD self-management. End users should exercise caution when using existing apps. Health care professionals and app developers should collaborate to better understand end users? preferences and follow evidence-based guidelines to develop mHealth apps conducive to CVD self-management. UR - http://mhealth.jmir.org/2017/12/e195/ UR - http://dx.doi.org/10.2196/mhealth.8549 UR - http://www.ncbi.nlm.nih.gov/pubmed/29242176 ID - info:doi/10.2196/mhealth.8549 ER - TY - JOUR AU - Slater, Helen AU - Campbell, M. Jared AU - Stinson, N. Jennifer AU - Burley, M. Megan AU - Briggs, M. Andrew PY - 2017/12/12 TI - End User and Implementer Experiences of mHealth Technologies for Noncommunicable Chronic Disease Management in Young Adults: Systematic Review JO - J Med Internet Res SP - e406 VL - 19 IS - 12 KW - musculoskeletal pain KW - health services research KW - telemedicine KW - noncommunicable disease KW - chronic disease KW - health policy N2 - Background: Chronic noncommunicable diseases (NCDs) such as asthma, diabetes, cancer, and persistent musculoskeletal pain impose an escalating and unsustainable burden on young people, their families, and society. Exploring how mobile health (mHealth) technologies can support management for young people with NCDs is imperative. Objective: The aim of this study was to identify, appraise, and synthesize available qualitative evidence on users? experiences of mHealth technologies for NCD management in young people. We explored the perspectives of both end users (young people) and implementers (health policy makers, clinicians, and researchers). Methods: A systematic review and meta-synthesis of qualitative studies. Eligibility criteria included full reports published in peer-reviewed journals from January 2007 to December 2016, searched across databases including EMBASE, MEDLINE (PubMed), Scopus, and PsycINFO. All qualitative studies that evaluated the use of mHealth technologies to support young people (in the age range of 15-24 years) in managing their chronic NCDs were considered. Two independent reviewers identified eligible reports and conducted critical appraisal (based on the Joanna Briggs Institute Qualitative Assessment and Review Instrument: JBI-QARI). Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive emergent themes across the included data. External validity checking was undertaken by an expert clinical researcher and for relevant content, a health policy expert. Themes were subsequently subjected to a meta-synthesis, with findings compared and contrasted between user groups and policy and practice recommendations derived. Results: Twelve studies met our inclusion criteria. Among studies of end users (N=7), mHealth technologies supported the management of young people with diabetes, cancer, and asthma. Implementer studies (N=5) covered the management of cognitive and communicative disabilities, asthma, chronic self-harm, and attention deficit hyperactivity disorder. Quality ratings were higher for implementer compared with end user studies. Both complementary and unique user themes emerged. Themes derived for end users of mHealth included (1) Experiences of functionality that supported self-management, (2) Acceptance (technical usability and feasibility), (3) Importance of codesign, and (4) Perceptions of benefit (self-efficacy and empowerment). For implementers, derived themes included (1) Characteristics that supported self-management (functional, technical, and behavior change); (2) Implementation challenges (systems level, service delivery level, and clinical level); (3) Adoption considerations for specific populations (training end users; specific design requirements); and (4) Codesign and tailoring to facilitate uptake and person-centered care. Conclusions: Synthesizing available data revealed both complementary and unique user perspectives on enablers and barriers to designing, developing, and implementing mHealth technologies to support young people?s management of their chronic NCDs. Trial Registration: PROSPERO CRD42017056317; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD 42017056317 (Archived by WebCite at http://www.webcitation.org/6vZ5UkKLp) UR - http://www.jmir.org/2017/12/e406/ UR - http://dx.doi.org/10.2196/jmir.8888 UR - http://www.ncbi.nlm.nih.gov/pubmed/29233804 ID - info:doi/10.2196/jmir.8888 ER - TY - JOUR AU - Zhao, Jing AU - Freeman, Becky AU - Li, Mu PY - 2017/12/06 TI - How Do Infant Feeding Apps in China Measure Up? A Content Quality Assessment JO - JMIR Mhealth Uhealth SP - e186 VL - 5 IS - 12 KW - apps KW - mobile phone KW - Chinese N2 - Background: Globally, with the popularization of mobile phones, the number of health-related mobile phone apps has skyrocketed to 259,000 in 2016. In the digital era, people are accessing health information through their fingertips. In China, there are several apps that claim to provide infant feeding and nutrition guidance. However, the quality of information in those apps has not been extensively assessed. Objective: We aimed to assess the quality of Chinese infant feeding apps using comprehensive quality assessment criteria and to explore Chinese mothers? perceptions on apps? quality and usability. Methods: We searched for free-to-download Chinese infant feeding apps in the iTunes and Android App Stores. We conducted a comprehensive assessment of the accountability, scientific basis, accuracy of information relevant to infant feeding, advertising policy, and functionality and carried out a preliminary screening of infant formula advertisements in the apps. In addition, we also conducted exploratory qualitative research through semistructured interviews with Chinese mothers in Shanghai to elicit their views about the quality of apps. Results: A total of 4925 apps were screened, and 26 apps that met the selection criteria were evaluated. All 26 apps were developed by commercial entities, and the majority of them were rated poorly. The highest total score was 62.2 (out of approximately 100) and the lowest was 16.7. In the four quality domains assessed, none of them fulfilled all the accountability criteria. Three out of 26 apps provided information covering the three practices from the World Health Organization?s infant feeding recommendations. Only one app described its advertising policy in its terms of usage. The most common app functionality was a built-in social forum (19/26). Provision of a website link was the least common functionality (2/26). A total of 20 out of 26 apps promoted infant formula banner advertisements on their homepages. In addition, 12 apps included both e-commerce stores and featured infant formula advertisements. In total, 21 mothers were interviewed face-to-face. Mothers highly valued immediate access to parenting information and multifunctionality provided by apps. However, concerns regarding incredible information and commercial activities in apps, as well as the desire for information and support offered by health care professionals were expressed. Conclusions: The findings provide valuable information on Chinese infant feeding apps. The results are concerning, particularly with the relative absence of scientific basis and credibility and the large number of commercial advertisements that are displayed. Apps do seem to be able to provide an opportunity for mothers to access health information and support; it is time for tighter controls on content and advertisements. Ongoing app research and development should focus on implementation of a standard framework, which would drive the development of high-quality apps to support healthy infant feeding through cooperation among academics, health professionals, app users, app developers, and government bodies. UR - http://mhealth.jmir.org/2017/12/e186/ UR - http://dx.doi.org/10.2196/mhealth.8764 UR - http://www.ncbi.nlm.nih.gov/pubmed/29212627 ID - info:doi/10.2196/mhealth.8764 ER - TY - JOUR AU - Pereira-Salgado, Amanda AU - Westwood, A. Jennifer AU - Russell, Lahiru AU - Ugalde, Anna AU - Ortlepp, Bronwen AU - Seymour, F. John AU - Butow, Phyllis AU - Cavedon, Lawrence AU - Ong, Kevin AU - Aranda, Sanchia AU - Breen, Sibilah AU - Kirsa, Suzanne AU - Dunlevie, Andrew AU - Schofield, Penelope PY - 2017/12/06 TI - Mobile Health Intervention to Increase Oral Cancer Therapy Adherence in Patients With Chronic Myeloid Leukemia (The REMIND System): Clinical Feasibility and Acceptability Assessment JO - JMIR Mhealth Uhealth SP - e184 VL - 5 IS - 12 KW - mobile phone KW - neoplasms KW - Internet KW - medication adherence N2 - Background: Optimal dosing of oral tyrosine kinase inhibitor therapy is critical to treatment success and survival of patients with chronic myeloid leukemia (CML). Drug intolerance secondary to toxicities and nonadherence are significant factors in treatment failure. Objective: The objective of this study was to develop and pilot-test the clinical feasibility and acceptability of a mobile health system (REMIND) to increase oral drug adherence and patient symptom self-management among people with CML (chronic phase). Methods: A multifaceted intervention was iteratively developed using the intervention development framework by Schofield and Chambers, consisting of defining the patient problem and iteratively refining the intervention. The clinical feasibility and acceptability were examined via patient and intervention nurse interviews, which were audiotaped, transcribed, and deductively content analyzed. Results: The intervention comprised 2 synergistically operating elements: (1) daily medication reminders and routine assessment of side effects with evidence-based self-care advice delivered in real time and (2) question prompt list (QPL) questions and routinely collected individual patient adherence and side effect profile data used to shape nurses? consultations, which employed motivational interviewing to support adoption of self-management behaviors. A total of 4 consultations and daily alerts and advice were delivered over 10 weeks. In total, 58% (10/17) of patients and 2 nurses participated in the pilot study. Patients reported several benefits of the intervention: help in establishing medication routines, resolution of symptom uncertainty, increased awareness of self-care, and informed decision making. Nurses also endorsed the intervention: it assisted in establishing pill-taking routines and patients developing effective solutions to adherence challenges. Conclusions: The REMIND system with nurse support was usable and acceptable to both patients and nurses. It has the potential to improve adherence and side-effect management and should be further evaluated. UR - http://mhealth.jmir.org/2017/12/e184/ UR - http://dx.doi.org/10.2196/mhealth.8349 UR - http://www.ncbi.nlm.nih.gov/pubmed/29212628 ID - info:doi/10.2196/mhealth.8349 ER - TY - JOUR AU - Dou, Kaili AU - Yu, Ping AU - Deng, Ning AU - Liu, Fang AU - Guan, YingPing AU - Li, Zhenye AU - Ji, Yumeng AU - Du, Ningkai AU - Lu, Xudong AU - Duan, Huilong PY - 2017/12/06 TI - Patients? Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test JO - JMIR Mhealth Uhealth SP - e177 VL - 5 IS - 12 KW - smartphone KW - mobile health KW - patients KW - hypertension KW - chronic disease KW - disease management N2 - Background: Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. Objective: The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients? acceptance of smartphone health technology for chronic disease management. Methods: Multiple theories and factors that may influence patients? acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients? acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients? actual use of a smartphone health app. The partial least square method was used to test the theoretical model. Results: The model accounted for .412 of the variance in patients? intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients? smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients? intentions to use the technology. Age and gender had no significant influence on patients? acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management. Conclusions: This study developed a theoretical model to predict patients? acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients? awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community. UR - https://mhealth.jmir.org/2017/12/e177/ UR - http://dx.doi.org/10.2196/mhealth.7886 UR - http://www.ncbi.nlm.nih.gov/pubmed/29212629 ID - info:doi/10.2196/mhealth.7886 ER - TY - JOUR AU - Huber, Stephan AU - Priebe, A. Janosch AU - Baumann, Kaja-Maria AU - Plidschun, Anne AU - Schiessl, Christine AU - Tölle, R. Thomas PY - 2017/12/04 TI - Treatment of Low Back Pain with a Digital Multidisciplinary Pain Treatment App: Short-Term Results JO - JMIR Rehabil Assist Technol SP - e11 VL - 4 IS - 2 KW - lower back pain KW - app KW - mHealth KW - retrospective study KW - self-management N2 - Background: Even though modern concepts of disease management of unspecific low back pain (LBP) postulate active participation of patients, this strategy is difficult to adapt unless multidisciplinary pain therapy is applied. Recently, mobile health solutions have proven to be effective aides to foster self-management of many diseases. Objective: The objective of this paper was to report on the retrospective short-term results of a digital multidisciplinary pain app for the treatment of LBP. Methods: Kaia is a mobile app that digitalizes multidisciplinary pain treatment and is in the market as a medical product class I. For the current study, the data of anonymized Kaia users was retrospectively analyzed. User data were evaluated for 12 weeks regarding duration of use and effect on in-app user reported pain levels, using the numerical rating scale (NRS), depending on whether LBP was classified as acute, subacute, or chronic back pain according to current guidelines. Results: Data of 180 users were available. The mean age of the users was 33.9 years (SD 10.9). Pain levels decreased from baseline NRS 4.8 to 3.75 for all users at the end of the observation period. Users who completed 4, 8, or 12 weeks showed an even more pronounced decrease in pain level NRS (baseline 4.9 [SD 1.7] versus 3.6 [SD 1.5] at 4 weeks; baseline 4.7 [SD 1.8] versus 3.2 [SD [2.0] at 8 weeks; baseline 4.6 [SD 2.2] versus 2.6 [SD 2.0] at 12 weeks). In addition, subgroup analysis of acute, subacute, or chronic classification revealed no significant main effect of group (P>.30) on the reduction of pain. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective randomized controlled trials (RCTs) will adjust for potential bias and selection effects. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective RCTs will adjust for potential bias and selection effects. UR - http://rehab.jmir.org/2017/2/e11/ UR - http://dx.doi.org/10.2196/rehab.9032 UR - http://www.ncbi.nlm.nih.gov/pubmed/29203460 ID - info:doi/10.2196/rehab.9032 ER - TY - JOUR AU - Pirolli, Peter AU - Mohan, Shiwali AU - Venkatakrishnan, Anusha AU - Nelson, Les AU - Silva, Michael AU - Springer, Aaron PY - 2017/11/30 TI - Implementation Intention and Reminder Effects on Behavior Change in a Mobile Health System: A Predictive Cognitive Model JO - J Med Internet Res SP - e397 VL - 19 IS - 11 KW - mobile applications KW - models, theoretical KW - habits N2 - Background: Implementation intentions are mental representations of simple plans to translate goal intentions into behavior under specific conditions. Studies show implementation intentions can produce moderate to large improvements in behavioral goal achievement. Human associative memory mechanisms have been implicated in the processes by which implementation intentions produce effects. On the basis of the adaptive control of thought-rational (ACT-R) theory of cognition, we hypothesized that the strength of implementation intention effect could be manipulated in predictable ways using reminders delivered by a mobile health (mHealth) app. Objective: The aim of this experiment was to manipulate the effects of implementation intentions on daily behavioral goal success in ways predicted by the ACT-R theory concerning mHealth reminder scheduling. Methods: An incomplete factorial design was used in this mHealth study. All participants were asked to choose a healthy behavior goal associated with eat slowly, walking, or eating more vegetables and were asked to set implementation intentions. N=64 adult participants were in the study for 28 days. Participants were stratified by self-efficacy and assigned to one of two reminder conditions: reminders-presented versus reminders-absent. Self-efficacy and reminder conditions were crossed. Nested within the reminders-presented condition was a crossing of frequency of reminders sent (high, low) by distribution of reminders sent (distributed, massed). Participants in the low frequency condition got 7 reminders over 28 days; those in the high frequency condition were sent 14. Participants in the distributed conditions were sent reminders at uniform intervals. Participants in the massed distribution conditions were sent reminders in clusters. Results: There was a significant overall effect of reminders on achieving a daily behavioral goal (coefficient=2.018, standard error [SE]=0.572, odds ratio [OR]=7.52, 95% CI 0.9037-3.2594, P<.001). As predicted by ACT-R, using default theoretical parameters, there was an interaction of reminder frequency by distribution on daily goal success (coefficient=0.7994, SE=0.2215, OR=2.2242, 95% CI 0.3656-1.2341, P<.001). The total number of times a reminder was acknowledged as received by a participant had a marginal effect on daily goal success (coefficient=0.0694, SE=0.0410, OR=1.0717, 95% CI ?0.01116 to 0.1505, P=.09), and the time since acknowledging receipt of a reminder was highly significant (coefficient=?0.0490, SE=0.0104, OR=0.9522, 95% CI ?0.0700 to ?0.2852], P<.001). A dual system ACT-R mathematical model was fit to individuals? daily goal successes and reminder acknowledgments: a goal-striving system dependent on declarative memory plus a habit-forming system that acquires automatic procedures for performance of behavioral goals. Conclusions: Computational cognitive theory such as ACT-R can be used to make precise quantitative predictions concerning daily health behavior goal success in response to implementation intentions and the dosing schedules of reminders. UR - http://www.jmir.org/2017/11/e397/ UR - http://dx.doi.org/10.2196/jmir.8217 UR - http://www.ncbi.nlm.nih.gov/pubmed/29191800 ID - info:doi/10.2196/jmir.8217 ER - TY - JOUR AU - Maduka, Omosivie AU - Akpan, Godwin AU - Maleghemi, Sylvester PY - 2017/11/30 TI - Using Android and Open Data Kit Technology in Data Management for Research in Resource-Limited Settings in the Niger Delta Region of Nigeria: Cross-Sectional Household Survey JO - JMIR Mhealth Uhealth SP - e171 VL - 5 IS - 11 KW - mobile phones KW - technology KW - Africa N2 - Background: Data collection in Sub-Saharan Africa has traditionally been paper-based. However, the popularization of Android mobile devices and data capture software has brought paperless data management within reach. We used Open Data Kit (ODK) technology on Android mobile devices during a household survey in the Niger Delta region of Nigeria. Objective: The aim of this study was to describe the pros and cons of deploying ODK for data management. Methods: A descriptive cross-sectional household survey was carried out by 6 data collectors between April and May 2016. Data were obtained from 1706 persons in 601 households across 6 communities in 3 states in the Niger Delta. The use of Android mobile devices and ODK technology involved form building, testing, collection, aggregation, and download for data analysis. The median duration for data collection per household and per individual was 25.7 and 9.3 min, respectively. Results: Data entries per device ranged from 33 (33/1706, 1.93%) to 482 (482/1706, 28.25%) individuals between 9 (9/601, 1.5%) and 122 (122/601, 20.3%) households. The most entries (470) were made by data collector 5. Only 2 respondents had data entry errors (2/1706, 0.12%). However, 73 (73/601, 12.1%) households had inaccurate date and time entries for when data collection started and ended. The cost of deploying ODK was estimated at US $206.7 in comparison with the estimated cost of US $466.7 for paper-based data management. Conclusions: We found the use of mobile data capture technology to be efficient and cost-effective. As Internet services improve in Africa, we advocate their use as effective tools for health information management. UR - http://mhealth.jmir.org/2017/11/e171/ UR - http://dx.doi.org/10.2196/mhealth.7827 UR - http://www.ncbi.nlm.nih.gov/pubmed/29191798 ID - info:doi/10.2196/mhealth.7827 ER - TY - JOUR AU - Rathbone, Leigh Amy AU - Clarry, Laura AU - Prescott, Julie PY - 2017/11/28 TI - Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review JO - J Med Internet Res SP - e399 VL - 19 IS - 11 KW - cognitive therapy KW - behavior KW - mHealth KW - mobile KW - phone KW - health KW - treatment efficacy KW - intervention study KW - randomized controlled trial KW - review KW - systematic N2 - Background: Cognitive behavioral therapy (CBT) in its basic principle has developed itself as a stand-alone, substantial method of therapy. With effective application in therapy for a range of mental health issues, the spread of CBT methods to Web-based therapy sources is evident. The development of mobile phone apps using CBT principles is increasing within the research area. Despite the move to Web-based methods of therapy, it is argued that these methods lack the same efficacy of face-to-face therapy sessions. Objective: The aim of this review was to assess extent research findings with regard to the effectiveness of CBT-related mobile health (mHealth) apps. By assessing only studies employing a randomized controlled trial design, the review aimed to determine app efficacy within the highly regarded method of investigation. Methods: A comprehensive literature search was conducted across several databases. Search results were filtered, and results were subject to strict inclusion and exclusion criteria because of the nature of the review. Where possible, analysis of effect size was calculated and results reported. Results: A total of 8 studies investigating the effectiveness of mHealth CBT-related apps across a range of mental health issues were reviewed. Three studies used the app against a control group, and 5 studies used the app intervention against another form of treatment or intervention. A range of effect sizes were seen across all included studies (d=?0.13 to 1.83; 0.03-1.44), with the largest effects often being seen when comparing the data from pre- to posttest for the app engaged group. Conclusions: The studies reviewed support the use of mHealth apps containing CBT principles for a range of mental health issues. However, the effectiveness over longer time periods should be assessed. Researchers and professionals should seek to collaborate effectively when creating new apps to enhance their effectiveness as a treatment for the general public. UR - http://www.jmir.org/2017/11/e399/ UR - http://dx.doi.org/10.2196/jmir.8598 UR - http://www.ncbi.nlm.nih.gov/pubmed/29187342 ID - info:doi/10.2196/jmir.8598 ER - TY - JOUR AU - Sohda, Satoshi AU - Suzuki, Kenta AU - Igari, Ichiro PY - 2017/11/27 TI - Relationship Between the Menstrual Cycle and Timing of Ovulation Revealed by New Protocols: Analysis of Data from a Self-Tracking Health App JO - J Med Internet Res SP - e391 VL - 19 IS - 11 KW - self-tracking KW - person generated health data KW - calendar calculation KW - fertility KW - menstrual cycle N2 - Background: There are many mobile phone apps aimed at helping women map their ovulation and menstrual cycles and facilitating successful conception (or avoiding pregnancy). These apps usually ask users to input various biological features and have accumulated the menstrual cycle data of a vast number of women. Objective: The purpose of our study was to clarify how the data obtained from a self-tracking health app for female mobile phone users can be used to improve the accuracy of prediction of the date of next ovulation. Methods: Using the data of 7043 women who had reliable menstrual and ovulation records out of 8,000,000 users of a mobile phone app of a health care service, we analyzed the relationship between the menstrual cycle length, follicular phase length, and luteal phase length. Then we fitted a linear function to the relationship between the length of the menstrual cycle and timing of ovulation and compared it with the existing calendar-based methods. Results: The correlation between the length of the menstrual cycle and the length of the follicular phase was stronger than the correlation between the length of the menstrual cycle and the length of the luteal phase, and there was a positive correlation between the lengths of past and future menstrual cycles. A strong positive correlation was also found between the mean length of past cycles and the length of the follicular phase. The correlation between the mean cycle length and the luteal phase length was also statistically significant. In most of the subjects, our method (ie, the calendar-based method based on the optimized function) outperformed the Ogino method of predicting the next ovulation date. Our method also outperformed the ovulation date prediction method that assumes the middle day of a mean menstrual cycle as the date of the next ovulation. Conclusions: The large number of subjects allowed us to capture the relationships between the lengths of the menstrual cycle, follicular phase, and luteal phase in more detail than previous studies. We then demonstrated how the present calendar methods could be improved by the better grouping of women. This study suggested that even without integrating various biological metrics, the dataset collected by a self-tracking app can be used to develop formulas that predict the ovulation day when the data are aggregated. Because the method that we developed requires data only on the first day of menstruation, it would be the best option for couples during the early stages of their attempt to have a baby or for those who want to avoid the cost associated with other methods. Moreover, the result will be the baseline for more advanced methods that integrate other biological metrics. UR - http://www.jmir.org/2017/11/e391/ UR - http://dx.doi.org/10.2196/jmir.7468 UR - http://www.ncbi.nlm.nih.gov/pubmed/29180346 ID - info:doi/10.2196/jmir.7468 ER - TY - JOUR AU - Christoforou, Marina AU - Sáez Fonseca, Andrés José AU - Tsakanikos, Elias PY - 2017/11/24 TI - Two Novel Cognitive Behavioral Therapy?Based Mobile Apps for Agoraphobia: Randomized Controlled Trial JO - J Med Internet Res SP - e398 VL - 19 IS - 11 KW - agoraphobia KW - anxiety KW - eHealth KW - computerized interventions KW - mobile applications KW - randomized controlled trial KW - RCT N2 - Background: Despite the large body of literature demonstrating the effectiveness of cognitive behavioral treatments for agoraphobia, many patients remain untreated because of various barriers to treatment. Web-based and mobile-based interventions targeting agoraphobia may provide a solution to this problem, but there is a lack of research investigating the efficacy of such interventions. Objective: The objective of our study was to evaluate for the first time the effectiveness of a self-guided mobile-based intervention primarily targeting agoraphobic symptoms, with respect to a generic mobile app targeting anxiety. Methods: A Web-based randomized controlled trial (RCT) compared a novel mobile app designed to target agoraphobia (called Agoraphobia Free) with a mobile app designed to help with symptoms of anxiety in general (called Stress Free). Both interventions were based on established cognitive behavioral principles. We recruited participants (N=170) who self-identified as having agoraphobia and assessed them online at baseline, midpoint, and end point (posttreatment) over a period of 12 weeks. The primary outcome was symptom severity measured by the Panic and Agoraphobia Scale. Results: Both groups had statistically significant improvements in symptom severity over time (difference ?5.97, 95% CI ?8.49 to ?3.44, P<.001 for Agoraphobia Free and ?6.35, 95% CI ?8.82 to ?3.87, P<.001 for Stress Free), but there were no significant between-group differences on the primary outcome (difference 0.38, 95% CI ?1.96 to 3.20, P=.64). Conclusions: This is, to our knowledge, the first RCT to provide evidence that people who identify as having agoraphobia may equally benefit from a diagnosis-specific and a transdiagnostic mobile-based intervention. We also discuss clinical and research implications for the development and dissemination of mobile mental health apps. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 98453199; http://www.isrctn.com /ISRCTN98453199 (Archived by WebCite at http://www.webcitation.org/6uR5vsdZw) UR - http://www.jmir.org/2017/11/e398/ UR - http://dx.doi.org/10.2196/jmir.7747 UR - http://www.ncbi.nlm.nih.gov/pubmed/29175809 ID - info:doi/10.2196/jmir.7747 ER - TY - JOUR AU - Irace, Concetta AU - Schweitzer, Axel Matthias AU - Tripolino, Cesare AU - Scavelli, Barbara Faustina AU - Gnasso, Agostino PY - 2017/11/21 TI - Diabetes Data Management System to Improve Glycemic Control in People With Type 1 Diabetes: Prospective Cohort Study JO - JMIR Mhealth Uhealth SP - e170 VL - 5 IS - 11 KW - diabetes mellitus KW - blood glucose self-monitoring KW - smartphone KW - internet N2 - Background: Smartphone and Web technology can improve the health care process, especially in chronic diseases. Objective: The aim of this study was to investigate whether the use of blood glucose (BG) data management system, which enables connection to smartphones, the Web, the cloud, and downloading, can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). Methods: This study was a prospective, single-arm, cohort feasibility study with 6 months of duration. T1DM subjects enrolled had experience in self-monitoring blood glucose, but were download data naïve. Fasting BG and glycated hemoglobin (HbA1c) were collected at the enrollment and at follow-up. Subjects were divided into Downloader (DL) and No-downloader (NDL). Results: A total of 63 subjects were analyzed, of which 30 were classified as DL and 33 as NDL. At the end of the study, DL had significantly lower HbA1c, mean daily glucose, standard deviation, percentage of BG values above target, and pre- and postprandial (lunch and dinner) values compared with NDL (all P<.05). The percentage of BG values within treatment target was significantly higher in DL compared with NDL (47% [SD 9] vs 37% [SD 13]; P=.001). Conclusions: The findings suggest that, in T1DM, downloading of BG from data management system, which enables connection to smartphones, the Web, and the cloud, might be a valuable contributor to improved glycemic control. UR - http://mhealth.jmir.org/2017/11/e170/ UR - http://dx.doi.org/10.2196/mhealth.8532 UR - http://www.ncbi.nlm.nih.gov/pubmed/29162560 ID - info:doi/10.2196/mhealth.8532 ER - TY - JOUR AU - Loiselle, G. Carmen AU - Ahmed, Saima PY - 2017/11/10 TI - Is Connected Health Contributing to a Healthier Population? JO - J Med Internet Res SP - e386 VL - 19 IS - 11 KW - connected health KW - mHealth KW - eHealth KW - uHealth KW - ubiquitous health UR - http://www.jmir.org/2017/11/e386/ UR - http://dx.doi.org/10.2196/jmir.8309 UR - http://www.ncbi.nlm.nih.gov/pubmed/29127077 ID - info:doi/10.2196/jmir.8309 ER - TY - JOUR AU - Olson, Daniel AU - Lamb, Molly AU - Lopez, Renee Maria AU - Colborn, Kathryn AU - Paniagua-Avila, Alejandra AU - Zacarias, Alma AU - Zambrano-Perilla, Ricardo AU - Rodríguez-Castro, Ricardo Sergio AU - Cordon-Rosales, Celia AU - Asturias, Jose Edwin PY - 2017/11/09 TI - Performance of a Mobile Phone App-Based Participatory Syndromic Surveillance System for Acute Febrile Illness and Acute Gastroenteritis in Rural Guatemala JO - J Med Internet Res SP - e368 VL - 19 IS - 11 KW - mobile phone KW - app KW - participatory KW - syndromic surveillance KW - norovirus KW - dengue KW - acute febrile illness KW - diarrhea KW - Guatemala N2 - Background: With their increasing availability in resource-limited settings, mobile phones may provide an important tool for participatory syndromic surveillance, in which users provide symptom data directly into a centralized database. Objective: We studied the performance of a mobile phone app-based participatory syndromic surveillance system for collecting syndromic data (acute febrile illness and acute gastroenteritis) to detect dengue virus and norovirus on a cohort of children living in a low-resource and rural area of Guatemala. Methods: Randomized households were provided with a mobile phone and asked to submit weekly reports using a symptom diary app (Vigilant-e). Participants reporting acute febrile illness or acute gastroenteritis answered additional questions using a decision-tree algorithm and were subsequently visited at home by a study nurse who performed a second interview and collected samples for dengue virus if confirmed acute febrile illness and norovirus if acute gastroenteritis. We analyzed risk factors associated with decreased self-reporting of syndromic data using the Vigilant-e app and evaluated strategies to improve self-reporting. We also assessed agreement between self-report and nurse-collected data obtained during home visits. Results: From April 2015 to June 2016, 469 children in 207 households provided 471 person-years of observation. Mean weekly symptom reporting rate was 78% (range 58%-89%). Households with a poor (<70%) weekly reporting rate using the Vigilant-e app during the first 25 weeks of observation (n=57) had a greater number of children (mean 2.8, SD 1.5 vs mean 2.5, SD 1.3; risk ratio [RR] 1.2, 95% CI 1.1-1.4), were less likely to have used mobile phones for text messaging at study enrollment (61%, 35/57 vs 76.7%, 115/150; RR 0.6, 95% CI 0.4-0.9), and were less likely to access care at the local public clinic (35%, 20/57 vs 67.3%, 101/150; RR 0.4, 95% CI 0.2-0.6). Parents of female enrolled participants were more likely to have low response rate (57.1%, 84/147 vs 43.8%, 141/322; RR 1.4, 95% CI 1.1-1.9). Several external factors (cellular tower collapse, contentious elections) were associated with periods of decreased reporting. Poor response rate (<70%) was associated with lower case reporting of acute gastroenteritis, norovirus-associated acute gastroenteritis, acute febrile illness, and dengue virus-associated acute febrile illness (P<.001). Parent-reported syndromic data on the Vigilant-e app demonstrated agreement with nurse-collected data for fever (kappa=.57, P<.001), vomiting (kappa=.63, P<.001), and diarrhea (kappa=.61, P<.001), with decreased agreement as the time interval between parental report and nurse home visit increased (<1 day: kappa=.65-.70; ?2 days: kappa=.08-.29). Conclusions: In a resource-limited area of rural Guatemala, a mobile phone app-based participatory syndromic surveillance system demonstrated a high reporting rate and good agreement between parental reported data and nurse-reported data during home visits. Several household-level and external factors were associated with decreased syndromic reporting. Poor reporting rate was associated with decreased syndromic and pathogen-specific case ascertainment. UR - http://www.jmir.org/2017/11/e368/ UR - http://dx.doi.org/10.2196/jmir.8041 UR - http://www.ncbi.nlm.nih.gov/pubmed/29122738 ID - info:doi/10.2196/jmir.8041 ER - TY - JOUR AU - Mantani, Akio AU - Kato, Tadashi AU - Furukawa, A. Toshi AU - Horikoshi, Masaru AU - Imai, Hissei AU - Hiroe, Takahiro AU - Chino, Bun AU - Funayama, Tadashi AU - Yonemoto, Naohiro AU - Zhou, Qi AU - Kawanishi, Nao PY - 2017/11/03 TI - Smartphone Cognitive Behavioral Therapy as an Adjunct to Pharmacotherapy for Refractory Depression: Randomized Controlled Trial JO - J Med Internet Res SP - e373 VL - 19 IS - 11 KW - major depressive disorder KW - pharmacotherapy-resistant depression KW - mobile phone app KW - cognitive behavioral therapy KW - eHealth N2 - Background: In the treatment of major depression, antidepressants are effective but not curative. Cognitive behavioral therapy (CBT) is also effective, alone or in combination with pharmacotherapy, but accessibility is a problem. Objective: The aim is to evaluate the effectiveness of a smartphone CBT app as adjunctive therapy among patients with antidepressant-resistant major depression. Methods: A multisite, assessor-masked, parallel-group randomized controlled trial was conducted in 20 psychiatric clinics and hospitals in Japan. Participants were eligible if they had a primary diagnosis of major depression and were antidepressant-refractory after taking one or more antidepressants at an adequate dosage for four or more weeks. After a 1-week run-in in which participants started the medication switch and had access to the welcome session of the app, patients were randomized to medication switch alone or to medication switch plus smartphone CBT app via the centralized Web system. The smartphone app, called Kokoro-app (?kokoro? means ?mind? in Japanese), included sessions on self-monitoring, behavioral activation, and cognitive restructuring presented by cartoon characters. The primary outcome was depression severity as assessed by masked telephone assessors with the Patient Health Questionnaire-9 (PHQ-9) at week 9. The secondary outcomes included the Beck Depression Inventory-II (BDI-II) and Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER). Results: In the total sample (N=164), 81 participants were allocated to the smartphone CBT in addition to medication change and 83 to medication change alone. In the former group, all but one participant (80/81, 99%) completed at least half, and 71 (88%) completed at least six of eight sessions. In the intention-to-treat analysis, patients allocated the CBT app scored 2.48 points (95% CI 1.23-3.72, P<.001; standardized mean difference 0.40) lower on PHQ-9 than the control at week 9. The former group also scored 4.1 points (95% CI 1.5-6.6, P=.002) lower on BDI-II and 0.76 points (95% CI ?0.05 to 1.58, P=.07) lower on FIBSER. In the per-protocol sample (comfortable with the smartphone app, still symptomatic, and adherent to medication with mild or less side effects after run-in), the intervention group (n=60) scored 1.72 points (95% CI 0.25-3.18, P=.02) lower on PHQ-9, 3.2 points (95% CI ?0.01 to 6.3, P=.05) lower on BDI-II, and 0.75 points (95% CI 0.03-1.47, P=.04) lower on FIBSER than the control (n=57). The treatment benefits were maintained up to week 17. Conclusions: This is the first study to demonstrate the effectiveness of a smartphone CBT in the treatment of clinically diagnosed depression. Given the merits of the mobile mental health intervention, including accessibility, affordability, quality control, and effectiveness, it is clinically worthwhile to consider adjunctive use of a smartphone CBT app when treating patients with antidepressant-resistant depression. Research into its effectiveness in wider clinical contexts is warranted. Trial Registration: Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik) UR - http://www.jmir.org/2017/11/e373/ UR - http://dx.doi.org/10.2196/jmir.8602 UR - http://www.ncbi.nlm.nih.gov/pubmed/29101095 ID - info:doi/10.2196/jmir.8602 ER - TY - JOUR AU - Gipson, Shih AU - Torous, John AU - Boland, Robert AU - Conrad, Erich PY - 2017/11/01 TI - Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study JO - JMIR Mhealth Uhealth SP - e160 VL - 5 IS - 11 KW - technology KW - graduate medical education KW - mobile phone KW - psychiatry N2 - Background: Mobile technology ownership in the general US population and medical professionals is increasing, leading to increased use in clinical settings. However, data on use of mobile technology by psychiatry residents remain unclear. Objective: In this study, our aim was to provide data on how psychiatric residents use mobile phones in their clinical education as well as barriers relating to technology use. Methods: An anonymous, multisite survey was given to psychiatry residents in 2 regions in the United States, including New Orleans and Boston, to understand their technology use. Results: All participants owned mobile phones, and 79% (54/68) used them to access patient information. The majority do not use mobile phones to implement pharmacotherapy (62%, 42/68) or psychotherapy plans (90%, 61/68). The top 3 barriers to using mobile technology in clinical care were privacy concerns (56%, 38/68), lack of clinical guidance (40%, 27/68), and lack of evidence (29%, 20/68). Conclusions: We conclude that developing a technology curriculum and engaging in research could address these barriers to using mobile phones in clinical practice. UR - http://mhealth.jmir.org/2017/11/e160/ UR - http://dx.doi.org/10.2196/mhealth.7146 UR - http://www.ncbi.nlm.nih.gov/pubmed/29092807 ID - info:doi/10.2196/mhealth.7146 ER - TY - JOUR AU - Fagherazzi, Guy AU - El Fatouhi, Douae AU - Bellicha, Alice AU - El Gareh, Amin AU - Affret, Aurélie AU - Dow, Courtney AU - Delrieu, Lidia AU - Vegreville, Matthieu AU - Normand, Alexis AU - Oppert, Jean-Michel AU - Severi, Gianluca PY - 2017/10/23 TI - An International Study on the Determinants of Poor Sleep Amongst 15,000 Users of Connected Devices JO - J Med Internet Res SP - e363 VL - 19 IS - 10 KW - connected devices KW - sleep KW - Withings KW - Nokia KW - determinants KW - Internet of Things KW - epidemiology KW - wearables KW - lifestyle KW - blood pressure KW - steps KW - heart rate KW - weight N2 - Background: Sleep is a modifiable lifestyle factor that can be a target for efficient intervention studies to improve the quality of life and decrease the risk or burden of some chronic conditions. Knowing the profiles of individuals with poor sleep patterns is therefore a prerequisite. Wearable devices have recently opened new areas in medical research as potential efficient tools to measure lifestyle factors such as sleep quantity and quality. Objectives: The goal of our research is to identify the determinants of poor sleep based on data from a large population of users of connected devices. Methods: We analyzed data from 15,839 individuals (13,658 males and 2181 females) considered highly connected customers having purchased and used at least 3 connected devices from the consumer electronics company Withings (now Nokia). Total and deep sleep durations as well as the ratio of deep/total sleep as a proxy of sleep quality were analyzed in association with available data on age, sex, weight, heart rate, steps, and diastolic and systolic blood pressures. Results: With respect to the deep/total sleep duration ratio used as a proxy of sleep quality, we have observed that those at risk of having a poor ratio (?0.40) were more frequently males (odds ratio [OR]female vs male=0.45, 95% CI 0.38-0.54), younger individuals (OR>60 years vs 18-30 years=0.47, 95% CI 0.35-0.63), and those with elevated heart rate (OR>78 bpm vs ?61 bpm=1.18, 95% CI 1.04-1.34) and high systolic blood pressure (OR>133 mm Hg vs ?116 mm Hg=1.22, 95% CI 1.04-1.43). A direct association with weight was observed for total sleep duration exclusively. Conclusions: Wearables can provide useful information to target individuals at risk of poor sleep. Future alert or mobile phone notification systems based on poor sleep determinants measured with wearables could be tested in intervention studies to evaluate the benefits. UR - http://www.jmir.org/2017/10/e363/ UR - http://dx.doi.org/10.2196/jmir.7930 UR - http://www.ncbi.nlm.nih.gov/pubmed/29061551 ID - info:doi/10.2196/jmir.7930 ER - TY - JOUR AU - Johnson, S. Sara AU - Levesque, A. Deborah AU - Broderick, E. Lynne AU - Bailey, G. Dustin AU - Kerns, D. Robert PY - 2017/10/17 TI - Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention JO - JMIR Med Inform SP - e40 VL - 5 IS - 4 KW - pain management KW - self-management KW - mobile health KW - mhealth N2 - Background: Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. Objective: The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans? stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Methods: Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Results: Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Conclusions: Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program?s long-term effects on pain and pain self-management. UR - http://medinform.jmir.org/2017/4/e40/ UR - http://dx.doi.org/10.2196/medinform.7117 UR - http://www.ncbi.nlm.nih.gov/pubmed/29042341 ID - info:doi/10.2196/medinform.7117 ER - TY - JOUR AU - Abroms, C. Lorien AU - Chiang, Shawn AU - Macherelli, Laura AU - Leavitt, Leah AU - Montgomery, Margaret PY - 2017/10/03 TI - Assessing the National Cancer Institute?s SmokefreeMOM Text-Messaging Program for Pregnant Smokers: Pilot Randomized Trial JO - J Med Internet Res SP - e333 VL - 19 IS - 10 KW - mHealth KW - text messaging KW - SMS KW - mobile phone KW - pregnant KW - smoking KW - quit N2 - Background: Automated text messages on mobile phones have been found to be effective for smoking cessation in adult smokers. Objective: This study aims to test the acceptability and feasibility of SmokefreeMOM, a national smoking cessation text-messaging program for pregnant smokers. Methods: Participants were recruited from prenatal care and randomized to receive SmokefreeMOM (n=55), an automated smoking cessation text-messaging program, or a control text message quitline referral (n=44). Participants were surveyed by phone at baseline and at 1 month and 3 months after enrollment. Results: Results indicate that the SmokefreeMOM program was highly rated overall and rated more favorably than the control condition in its helpfulness at 3-month follow-up (P<.01) and in its frequency of messaging at both 1-month and 3-month follow-ups (P<.001, P<.01, respectively). Despite the presence of technical problems, the vast majority of intervention participants read all program messages, and few participants unsubscribed from the program. There were no significant differences between groups on the use of extra treatment resources or on smoking-related outcomes. However, at the 3-month follow-up, some outcomes favored the intervention group. Conclusions: SmokefreeMOM is acceptable for pregnant smokers. It is recommended that SmokefreeMOM be further refined and evaluated. Trial Registration: Clinicaltrials.gov NCT02412956; https://clinicaltrials.gov/ct2/show/NCT02412956 (Archived by WebCite at http://www.webcitation.org/6tcmeRnbC) UR - http://www.jmir.org/2017/10/e333/ UR - http://dx.doi.org/10.2196/jmir.8411 UR - http://www.ncbi.nlm.nih.gov/pubmed/28974483 ID - info:doi/10.2196/jmir.8411 ER - TY - JOUR AU - Lwin, Oo May AU - Jayasundar, Karthikayen AU - Sheldenkar, Anita AU - Wijayamuni, Ruwan AU - Wimalaratne, Prasad AU - Ernst, C. Kacey AU - Foo, Schubert PY - 2017/10/02 TI - Lessons From the Implementation of Mo-Buzz, a Mobile Pandemic Surveillance System for Dengue JO - JMIR Public Health Surveill SP - e65 VL - 3 IS - 4 KW - pandemics KW - dengue KW - health communication KW - telemedicine KW - epidemiology KW - participatory surveillance KW - participatory epidemiology N2 - Background: Approximately 128 countries and 3.9 billion people are at risk of dengue infection. Incidence of dengue has increased over the past decades, becoming a growing public health concern for countries with populations that are increasingly susceptible to this vector-borne disease, such as Sri Lanka. Almost 55,150 dengue cases were reported in Sri Lanka in 2016, with more than 30.40% of cases (n=16,767) originating from Colombo, which struggles with an outdated manual paper-based dengue outbreak management system. Community education and outreach about dengue are also executed using paper-based media channels such as pamphlets and brochures. Yet, Sri Lanka is one of the countries with the most affordable rates of mobile services in the world, with penetration rates higher than most developing countries. Objectives: To combat the issues of an exhausted dengue management system and to make use of new technology, in 2015, a mobile participatory system for dengue surveillance called Mo-Buzz was developed and launched in Colombo, Sri Lanka. This paper describes the system?s components and uptake, along with other similar disease surveillance systems. Methods: We developed Mo-Buzz and tested its feasibility for dengue. Two versions of the app were developed. The first was for use by public health inspectors (PHIs) to digitize form filling and recording of site visit information, and track dengue outbreaks on a real-time dengue hotspot map using the global positioning system technology. The system also provides updated dengue infographics and educational materials for the PHIs to educate the general public. The second version of Mo-Buzz was created for use by the general public. This system uses dynamic mapping to help educate and inform the general public about potential outbreak regions and allow them to report dengue symptoms and post pictures of potential dengue mosquito?breeding sites, which are automatically sent to the health authorities. Targeted alerts can be sent to users depending on their geographical location. Results: We assessed the usage and the usability of the app and its impact on overall dengue transmission in Colombo. Initial uptake of Mo-Buzz for PHIs was low; however, after more training and incentivizing of usage, the uptake of the app in PHIs increased from less than 10% (n=3) to 76% (n=38). The general public user evaluation feedback was fruitful in providing improvements to the app, and at present, a number of solutions are being reviewed as viable options to boost user uptake. Conclusions: From our Mo-Buzz study, we have learned that initial acceptance of such systems can be slow but eventually positive. Mobile and social media interventions, such as Mo-Buzz, are poised to play a greater role in shaping risk perceptions and managing seasonal and sporadic outbreaks of infectious diseases in Asia and around the world. UR - https://publichealth.jmir.org/2017/4/e65/ UR - http://dx.doi.org/10.2196/publichealth.7376 UR - http://www.ncbi.nlm.nih.gov/pubmed/28970191 ID - info:doi/10.2196/publichealth.7376 ER - TY - JOUR AU - Bellicha, Alice AU - Macé, Sandrine AU - Oppert, Jean-Michel PY - 2017/9/23 TI - Prescribing of Electronic Activity Monitors in Cardiometabolic Diseases: Qualitative Interview-Based Study JO - J Med Internet Res SP - e328 VL - 19 IS - 9 KW - cardiometabolic diseases KW - physical activity KW - physicians? perspectives KW - prescriptions KW - mobile health KW - telemedicine KW - mHealth KW - electronic activity monitors KW - fitness tracker KW - accelerometer KW - smart pedometer N2 - Background: The prevalence of noncommunicable diseases, including those such as type 2 diabetes, obesity, dyslipidemia, and hypertension, so-called cardiometabolic diseases, is high and is increasing worldwide. Strong evidence supports the role of physical activity in management of these diseases. There is general consensus that mHealth technology, including electronic activity monitors, can potentially increase physical activity in patients, but their use in clinical settings remains limited. Practitioners? requirements when prescribing electronic activity monitors have been poorly described. Objective: The aims of this qualitative study were (1) to explore how specialist physicians prescribe electronic activity monitors to patients presenting with cardiometabolic conditions, and (2) to better understand their motivation for and barriers to prescribing such monitors. Methods: We conducted qualitative semistructured interviews in March to May 2016 with 11 senior physicians from a public university hospital in France with expertise in management of cardiometabolic diseases (type 1 and type 2 diabetes, obesity, hypertension, and dyslipidemia). Interviews lasted 45 to 60 minutes and were audiotaped, transcribed verbatim, and analyzed using directed content analysis. We report our findings following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Most physicians we interviewed had never prescribed electronic activity monitors, whereas they frequently prescribed blood glucose or blood pressure self-monitoring devices. Reasons for nonprescription included lack of interest in the data collected, lack of evidence for data accuracy, concern about work overload possibly resulting from automatic data transfer, and risk of patients becoming addicted to data. Physicians expected future marketing of easy-to-use monitors that will accurately measure physical activity duration and intensity and provide understandable motivating feedback. Conclusions: Features of electronic activity monitors, although popular among the general public, do not meet the needs of physicians. In-depth understanding of physicians? expectations is a first step toward designing technologies that can be widely used in clinical settings and facilitate physical activity prescription. Physicians should have a role, along with key health care stakeholders?patients, researchers, information technology firms, the public, and private payers?in developing the most effective methods for integrating activity monitors into patient care. UR - http://www.jmir.org/2017/9/e328/ UR - http://dx.doi.org/10.2196/jmir.8107 UR - http://www.ncbi.nlm.nih.gov/pubmed/28947415 ID - info:doi/10.2196/jmir.8107 ER - TY - JOUR AU - Yu, Hong AU - Gao, Feng AU - Jiang, Liren AU - Ma, Shuoxin PY - 2017/09/15 TI - Development of a Whole Slide Imaging System on Smartphones and Evaluation With Frozen Section Samples JO - JMIR Mhealth Uhealth SP - e132 VL - 5 IS - 9 KW - mobile health KW - image processing KW - cloud computing for health care KW - whole slide imaging N2 - Background: The aim was to develop scalable Whole Slide Imaging (sWSI), a WSI system based on mainstream smartphones coupled with regular optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry objective lenses of different magnifications, and reasonably high throughput. These performance metrics should be evaluated by expert pathologists and match those of high-end scanners. Objective: The aim was to develop scalable Whole Slide Imaging (sWSI), a whole slide imaging system based on smartphones coupled with optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry object lens of different magnification. All performance metrics should be evaluated by expert pathologists and match those of high-end scanners. Methods: In the sWSI design, the digitization process is split asynchronously between light-weight clients on smartphones and powerful cloud servers. The client apps automatically capture FoVs at up to 12-megapixel resolution and process them in real-time to track the operation of users, then give instant feedback of guidance. The servers first restitch each pair of FoVs, then automatically correct the unknown nonlinear distortion introduced by the lens of the smartphone on the fly, based on pair-wise stitching, before finally combining all FoVs into one gigapixel VS for each scan. These VSs can be viewed using Internet browsers anywhere. In the evaluation experiment, 100 frozen section slides from patients randomly selected among in-patients of the participating hospital were scanned by both a high-end Leica scanner and sWSI. All VSs were examined by senior pathologists whose diagnoses were compared against those made using optical microscopy as ground truth to evaluate the image quality. Results: The sWSI system is developed for both Android and iPhone smartphones and is currently being offered to the public. The image quality is reliable and throughput is approximately 1 FoV per second, yielding a 15-by-15 mm slide under 20X object lens in approximately 30-35 minutes, with little training required for the operator. The expected cost for setup is approximately US $100 and scanning each slide costs between US $1 and $10, making sWSI highly cost-effective for infrequent or low-throughput usage. In the clinical evaluation of sample-wise diagnostic reliability, average accuracy scores achieved by sWSI-scan-based diagnoses were as follows: 0.78 for breast, 0.88 for uterine corpus, 0.68 for thyroid, and 0.50 for lung samples. The respective low-sensitivity rates were 0.05, 0.05, 0.13, and 0.25 while the respective low-specificity rates were 0.18, 0.08, 0.20, and 0.25. The participating pathologists agreed that the overall quality of sWSI was generally on par with that produced by high-end scanners, and did not affect diagnosis in most cases. Pathologists confirmed that sWSI is reliable enough for standard diagnoses of most tissue categories, while it can be used for quick screening of difficult cases. Conclusions: As an ultra-low-cost alternative to whole slide scanners, diagnosis-ready VS quality and robustness for commercial usage is achieved in the sWSI solution. Operated on main-stream smartphones installed on normal optical microscopes, sWSI readily offers affordable and reliable WSI to resource-limited or infrequent clinical users. UR - http://mhealth.jmir.org/2017/9/e132/ UR - http://dx.doi.org/10.2196/mhealth.8242 UR - http://www.ncbi.nlm.nih.gov/pubmed/28916508 ID - info:doi/10.2196/mhealth.8242 ER - TY - JOUR AU - Brinker, Josef Titus AU - Brieske, Martin Christian AU - Schaefer, Matthias Christoph AU - Buslaff, Fabian AU - Gatzka, Martina AU - Petri, Philip Maximilian AU - Sondermann, Wiebke AU - Schadendorf, Dirk AU - Stoffels, Ingo AU - Klode, Joachim PY - 2017/09/08 TI - Photoaging Mobile Apps in School-Based Melanoma Prevention: Pilot Study JO - J Med Internet Res SP - e319 VL - 19 IS - 9 KW - melanoma KW - skin cancer KW - prevention KW - mobile apps KW - smartphones KW - photoaging KW - schools KW - secondary schools KW - adolescents N2 - Background: Around 90% of melanomas are caused by exposure to ultraviolet (UV) radiation and are therefore eminently preventable. Tanning behavior is mostly initiated in early adolescence, often with the belief that it increases attractiveness; the problems related to malignant melanoma and other skin cancers are too far in the future to fathom. Given the substantial amount of time children and adolescents spend in schools, as well as with their mobile phones, addressing melanoma prevention via both of these ways is crucial. However, no school-based intervention using mobile apps has been evaluated to date. We recently released a photoaging mobile app, in which a selfie is altered to predict future appearance dependent on UV protection behavior and skin type. Objective: In this pilot study, we aimed to use mobile phone technology to improve school-based melanoma prevention and measure its preliminary success in different subgroups of students with regard to their UV protection behavior, Fitzpatrick skin type and age. Methods: We implemented a free photoaging mobile phone app (Sunface) in 2 German secondary schools via a method called mirroring. We ?mirrored? the students? altered 3-dimensional (3D) selfies reacting to touch on mobile phones or tablets via a projector in front of their whole grade. Using an anonymous questionnaire capturing sociodemographic data as well as risk factors for melanoma we then measured their perceptions of the intervention on a 5-point Likert scale among 205 students of both sexes aged 13-19 years (median 15 years). Results: We measured more than 60% agreement in both items that measured motivation to reduce UV exposure and only 12.5% disagreement: 126 (63.0%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 124 (61.7%) to increase use of sun protection. However, only 25 (12.5%) disagreed with both items. The perceived effect on motivation was increased in participants with Fitzpatrick skin types 1-2 in both tanning bed avoidance (n=74, 71.8% agreement in skin types 1-2 vs n=50, 53.8% agreement in skin types 3-6) and increased use of sun protection (n=70, 68.0% agreement in skin types 1-2 vs n=52, 55.3% agreement in skin types 3-6), and also positively correlated with higher age. Conclusions: We present a novel way of integrating photoaging in school-based melanoma prevention that affects the students? peer group, considers the predictors of UV exposure in accordance with the theory of planned behavior, and is particularly effective in changing behavioral predictors in fair-skinned adolescents (Fitzpatrick skin types 1-2). Further research is required to evaluate the intervention?s prospective effects on adolescents of various cultural backgrounds. UR - http://www.jmir.org/2017/9/e319/ UR - http://dx.doi.org/10.2196/jmir.8661 UR - http://www.ncbi.nlm.nih.gov/pubmed/28887295 ID - info:doi/10.2196/jmir.8661 ER - TY - JOUR AU - Shin, Cheol Jong AU - Kim, Julia AU - Grigsby-Toussaint, Diana PY - 2017/09/07 TI - Mobile Phone Interventions for Sleep Disorders and Sleep Quality: Systematic Review JO - JMIR Mhealth Uhealth SP - e131 VL - 5 IS - 9 KW - mHealth KW - apps KW - mobile health KW - sleep N2 - Background: Although mobile health technologies have been developed for interventions to improve sleep disorders and sleep quality, evidence of their effectiveness remains limited. Objective: A systematic literature review was performed to determine the effectiveness of mobile technology interventions for improving sleep disorders and sleep quality. Methods: Four electronic databases (EBSCOhost, PubMed/Medline, Scopus, and Web of Science) were searched for articles on mobile technology and sleep interventions published between January 1983 and December 2016. Studies were eligible for inclusion if they met the following criteria: (1) written in English, (2) adequate details on study design, (3) focus on sleep intervention research, (4) sleep index measurement outcome provided, and (5) publication in peer-reviewed journals. Results: An initial sample of 2679 English-language papers were retrieved from five electronic databases. After screening and review, 16 eligible studies were evaluated to examine the impact of mobile phone interventions on sleep disorders and sleep quality. These included one case study, three pre-post studies, and 12 randomized controlled trials. The studies were categorized as (1) conventional mobile phone support and (2) utilizing mobile phone apps. Based on the results of sleep outcome measurements, 88% (14/16) studies showed that mobile phone interventions have the capability to attenuate sleep disorders and to enhance sleep quality, regardless of intervention type. In addition, mobile phone intervention methods (either alternatively or as an auxiliary) provide better sleep solutions in comparison with other recognized treatments (eg, cognitive behavioral therapy for insomnia). Conclusions: We found evidence to support the use of mobile phone interventions to address sleep disorders and to improve sleep quality. Our findings suggest that mobile phone technologies can be effective for future sleep intervention research. UR - http://mhealth.jmir.org/2017/9/e131/ UR - http://dx.doi.org/10.2196/mhealth.7244 UR - http://www.ncbi.nlm.nih.gov/pubmed/28882808 ID - info:doi/10.2196/mhealth.7244 ER - TY - JOUR AU - Matava, Clyde AU - Leo, Anne-Marie AU - Alam, Fahad PY - 2017/09/05 TI - Mobile Apps for Teaching Intubation: Scoping Review and Critical Analysis in eLearning JO - JMIR Med Educ SP - e15 VL - 3 IS - 2 KW - anesthesia KW - apps KW - eLearning KW - mLearning KW - intubation KW - difficult airway KW - residents KW - anesthesiology N2 - Background: Airway management is a core skill in anesthesia ensuring adequate oxygenation and delivery of inhalational agents for the patient. Objective: The goals of this study were to critically evaluate the quality of airway management apps and target revised Bloom's Taxonomy cognitive levels. Methods: An electronic search using the keywords ?airway? and ?airway management? was conducted in May 2015 across the App Store, Google Play, BlackBerry World, and Windows Store. Apps were included in the study if their content was related to airway management. App content and characteristics were extracted into a standard form and evaluated. Results: A total of 65 apps met the inclusion criteria, and 73% (47/65) of apps were developed by companies or industry. Anesthesiology trainees were the target audience in only 20% (13/65) of apps. Bag mask ventilation and laryngeal mask airways were covered in only 20% (13/65) of apps. Only 2 apps were supported in the scientific literature. For Bloom?s Taxonomy, 37% (24/65) of apps targeted knowledge, 5% (3/65) comprehension, 22% (14/65) application, 28% (18/65) analysis, 9% (6/65) evaluation, and 0% synthesis. Multivariate analysis identified cost of apps, size of apps (MB), and apps targeting trainees and paramedics to be associated with higher levels of cognitive processing of revised Bloom?s Taxonomy. Conclusions: Apps developed for teaching intubation target lower levels of cognitive processing and are largely not validated by research. Cost, app size, and targeted user are associated with higher cognitive levels. Trainees and all users should be aware of the paucity of the published evidence behind the efficacy of some of these apps. UR - http://mededu.jmir.org/2017/2/e15/ UR - http://dx.doi.org/10.2196/mededu.7919 UR - http://www.ncbi.nlm.nih.gov/pubmed/28874335 ID - info:doi/10.2196/mededu.7919 ER - TY - JOUR AU - Moore, Sarah AU - Tassé, Anne-Marie AU - Thorogood, Adrian AU - Winship, Ingrid AU - Zawati, Ma'n AU - Doerr, Megan PY - 2017/08/30 TI - Consent Processes for Mobile App Mediated Research: Systematic Review JO - JMIR Mhealth Uhealth SP - e126 VL - 5 IS - 8 KW - mHealth, informed consent, smartphone, cell phone, mobile applications, privacy, research ethics N2 - Background: Since the launch of ResearchKit on the iOS platform in March 2015 and ResearchStack on the Android platform in June 2016, many academic and commercial institutions around the world have adapted these frameworks to develop mobile app-based research studies. These studies cover a wide variety of subject areas including melanoma, cardiomyopathy, and autism. Additionally, these app-based studies target a variety of participant populations, including children and pregnant women. Objective: The aim of this review was to document the variety of self-administered remote informed consent processes used in app-based research studies available between May and September 2016. Remote consent is defined as any consenting process with zero in-person steps, when a participant is able to join a study without ever seeing a member of the research team. This type of review has not been previously conducted. The research community would benefit from a rigorous interrogation of the types of consent taken as part of the seismic shift to entirely mobile meditated research studies. Methods: This review examines both the process of information giving and specific content shared, with special attention to data privacy, aggregation, and sharing. Results: Consistency across some elements of the app-based consent processes was found; for example, informing participants about how data will be curated from the phone. Variations in other elements were identified; for example, where specific information is shared and the level of detail disclosed. Additionally, several novel elements present in eConsent not typically seen in traditional consent for research were highlighted. Conclusions: This review advocates the importance of participant informedness in a novel and largely unregulated research setting. UR - http://mhealth.jmir.org/2017/8/e126/ UR - http://dx.doi.org/10.2196/mhealth.7014 UR - http://www.ncbi.nlm.nih.gov/pubmed/28855147 ID - info:doi/10.2196/mhealth.7014 ER - TY - JOUR AU - Bateman, R. Daniel AU - Srinivas, Bhavana AU - Emmett, W. Thomas AU - Schleyer, K. Titus AU - Holden, J. Richard AU - Hendrie, C. Hugh AU - Callahan, M. Christopher PY - 2017/08/30 TI - Categorizing Health Outcomes and Efficacy of mHealth Apps for Persons With Cognitive Impairment: A Systematic Review JO - J Med Internet Res SP - e301 VL - 19 IS - 8 KW - mHealth KW - mobile health KW - applications KW - Alzheimer disease KW - dementia KW - systematic review N2 - Background: Use of mobile health (mHealth) apps is growing at an exponential rate in the United States and around the world. Mild cognitive impairment (MCI), Alzheimer disease, and related dementias are a global health problem. Numerous mHealth interventions exist for this population, yet the effect of these interventions on health has not been systematically described. Objective: The aim of this study is to catalog the types of health outcomes used to measure effectiveness of mHealth interventions and assess which mHealth interventions have been shown to improve the health of persons with MCI, Alzheimer disease, and dementia. Methods: We searched 13 databases, including Ovid MEDLINE, PubMed, EMBASE, the full Cochrane Library, CINAHL, PsycINFO, Ei Compendex, IEEE Xplore, Applied Science & Technology Source, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar from inception through May 2017 for mHealth studies involving persons with cognitive impairment that were evaluated using at least one quantitative health outcome. Proceedings of the Annual ACM Conferences on Human Factors in Computing Systems, the ACM User Interface Software and Technology Symposium, and the IEEE International Symposium on Wearable Computers were searched in the ACM Digital Library from 2012 to 2016. A hand search of JMIR Publications journals was also completed in July 2017. Results: After removal of duplicates, our initial search returned 3955 records. Of these articles, 24 met final inclusion criteria as studies involving mHealth interventions that measured at least one quantitative health outcome for persons with MCI, Alzheimer disease, and dementia. Common quantitative health outcomes included cognition, function, mood, and quality of life. We found that 21.2% (101/476) of the fully reviewed articles were excluded because of a lack of health outcomes. The health outcomes selected were observed to be inconsistent between studies. For those studies with quantitative health outcomes, more than half (58%) reported postintervention improvements in outcomes. Conclusions: Results showed that many mHealth app interventions targeting those with cognitive impairment lack quantitative health outcomes as a part of their evaluation process and that there is a lack of consensus as to which outcomes to use. The majority of mHealth app interventions that incorporated health outcomes into their evaluation noted improvements in the health of persons with MCI, Alzheimer disease, and dementia. However, these studies were of low quality, leading to a grade C level of evidence. Clarification of the benefits of mHealth interventions for people with cognitive impairment requires more randomized controlled trials, larger numbers of participants, and trial designs that minimize bias. Trial Registration: PROSPERO Registration: PROSPERO 2016:CRD42016033846; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42016033846 (Archived by WebCite at http://www.webcitation.org/6sjjwnv1M) UR - http://www.jmir.org/2017/8/e301/ UR - http://dx.doi.org/10.2196/jmir.7814 UR - http://www.ncbi.nlm.nih.gov/pubmed/28855146 ID - info:doi/10.2196/jmir.7814 ER - TY - JOUR AU - Vandenberk, Thijs AU - Stans, Jelle AU - Mortelmans, Christophe AU - Van Haelst, Ruth AU - Van Schelvergem, Gertjan AU - Pelckmans, Caroline AU - Smeets, JP Christophe AU - Lanssens, Dorien AU - De Cannière, Hélène AU - Storms, Valerie AU - Thijs, M. Inge AU - Vaes, Bert AU - Vandervoort, M. Pieter PY - 2017/8/25 TI - Clinical Validation of Heart Rate Apps: Mixed-Methods Evaluation Study JO - JMIR Mhealth Uhealth SP - e129 VL - 5 IS - 8 KW - heart rate KW - software validation KW - remote sensing technology N2 - Background: Photoplethysmography (PPG) is a proven way to measure heart rate (HR). This technology is already available in smartphones, which allows measuring HR only by using the smartphone. Given the widespread availability of smartphones, this creates a scalable way to enable mobile HR monitoring. An essential precondition is that these technologies are as reliable and accurate as the current clinical (gold) standards. At this moment, there is no consensus on a gold standard method for the validation of HR apps. This results in different validation processes that do not always reflect the veracious outcome of comparison. Objective: The aim of this paper was to investigate and describe the necessary elements in validating and comparing HR apps versus standard technology. Methods: The FibriCheck (Qompium) app was used in two separate prospective nonrandomized studies. In the first study, the HR of the FibriCheck app was consecutively compared with 2 different Food and Drug Administration (FDA)-cleared HR devices: the Nonin oximeter and the AliveCor Mobile ECG. In the second study, a next step in validation was performed by comparing the beat-to-beat intervals of the FibriCheck app to a synchronized ECG recording. Results: In the first study, the HR (BPM, beats per minute) of 88 random subjects consecutively measured with the 3 devices showed a correlation coefficient of .834 between FibriCheck and Nonin, .88 between FibriCheck and AliveCor, and .897 between Nonin and AliveCor. A single way analysis of variance (ANOVA; P=.61 was executed to test the hypothesis that there were no significant differences between the HRs as measured by the 3 devices. In the second study, 20,298 (ms) R-R intervals (RRI)?peak-to-peak intervals (PPI) from 229 subjects were analyzed. This resulted in a positive correlation (rs=.993, root mean square deviation [RMSE]=23.04 ms, and normalized root mean square error [NRMSE]=0.012) between the PPI from FibriCheck and the RRI from the wearable ECG. There was no significant difference (P=.92) between these intervals. Conclusions: Our findings suggest that the most suitable method for the validation of an HR app is a simultaneous measurement of the HR by the smartphone app and an ECG system, compared on the basis of beat-to-beat analysis. This approach could lead to more correct assessments of the accuracy of HR apps. UR - http://mhealth.jmir.org/2017/8/e129/ UR - http://dx.doi.org/10.2196/mhealth.7254 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/mhealth.7254 ER - TY - JOUR AU - Rathbone, Leigh Amy AU - Prescott, Julie PY - 2017/08/24 TI - The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review JO - J Med Internet Res SP - e295 VL - 19 IS - 8 KW - mHealth KW - smartphone KW - health KW - review KW - systematic KW - short message service KW - treatment efficacy KW - portable electronic applications KW - intervention study N2 - Background: The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition. Due to the abundance of devices and ease of access they subsequently allow, the utility of mobile health (mHealth) has never been more endemic. A substantial amount of interactive and psychoeducational apps are readily available to download concerning a wide range of health issues. mHealth has the potential to reduce waiting times for appointments; eradicate the need to meet in person with a clinician, successively diminishing the workload of mental health professionals; be more cost effective to practices; and encourage self-care tactics. Previous research has given valid evidence with empirical studies proving the effectiveness of physical and mental health interventions using mobile apps. Alongside apps, there is evidence to show that receiving short message service (SMS) messages, which entail psychoeducation, medication reminders, and links to useful informative Web pages can also be advantageous to a patient?s mental and physical well-being. Available mHealth apps and SMS services and their ever improving quality necessitates a systematic review in the area in reference to reduction of symptomology, adherence to intervention, and usability. Objective: The aim of this review was to study the efficacy, usability, and feasibility of mobile apps and SMS messages as mHealth interventions for self-guided care. Methods: A systematic literature search was carried out in JMIR, PubMed, PsychINFO, PsychARTICLES, Google Scholar, MEDLINE, and SAGE. The search spanned from January 2008 to January 2017. The primary outcome measures consisted of weight management, (pregnancy) smoking cessation, medication adherence, depression, anxiety and stress. Where possible, adherence, feasibility, and usability outcomes of the apps or SMS services were evaluated. Between-group and within-group effect sizes (Cohen d) for the mHealth intervention method group were determined. Results: A total of 27 studies, inclusive of 4658 participants were reviewed. The papers included randomized controlled trials (RCTs) (n=19), within-group studies (n=7), and 1 within-group study with qualitative aspect. Studies show improvement in physical health and significant reductions of anxiety, stress, and depression. Within-group and between-group effect sizes ranged from 0.05-3.37 (immediately posttest), 0.05-3.25 (1-month follow-up), 0.08-3.08 (2-month follow-up), 0.00-3.10 (3-month follow-up), and 0.02-0.27 (6-month follow-up). Usability and feasibility of mHealth interventions, where reported, also gave promising, significant results. Conclusions: The review shows the promising and emerging efficacy of using mobile apps and SMS text messaging as mHealth interventions. UR - http://www.jmir.org/2017/8/e295/ UR - http://dx.doi.org/10.2196/jmir.7740 UR - http://www.ncbi.nlm.nih.gov/pubmed/28838887 ID - info:doi/10.2196/jmir.7740 ER - TY - JOUR AU - Uy, Catherine AU - Lopez, Jennifer AU - Trinh-Shevrin, Chau AU - Kwon, C. Simona AU - Sherman, E. Scott AU - Liang, S. Peter PY - 2017/08/24 TI - Text Messaging Interventions on Cancer Screening Rates: A Systematic Review JO - J Med Internet Res SP - e296 VL - 19 IS - 8 KW - text messaging KW - early detection of cancer KW - breast neoplasms KW - colorectal neoplasms KW - lung neoplasms KW - mHealth KW - uterine cervical neoplasms N2 - Background: Despite high-quality evidence demonstrating that screening reduces mortality from breast, cervical, colorectal, and lung cancers, a substantial portion of the population remains inadequately screened. There is a critical need to identify interventions that increase the uptake and adoption of evidence-based screening guidelines for preventable cancers at the community practice level. Text messaging (short message service, SMS) has been effective in promoting behavioral change in various clinical settings, but the overall impact and reach of text messaging interventions on cancer screening are unknown. Objective: The objective of this systematic review was to assess the effect of text messaging interventions on screening for breast, cervical, colorectal, and lung cancers. Methods: We searched multiple databases for studies published between the years 2000 and 2017, including PubMed, EMBASE, and the Cochrane Library, to identify controlled trials that measured the effect of text messaging on screening for breast, cervical, colorectal, or lung cancers. Study quality was evaluated using the Cochrane risk of bias tool. Results: Our search yielded 2238 citations, of which 31 underwent full review and 9 met inclusion criteria. Five studies examined screening for breast cancer, one for cervical cancer, and three for colorectal cancer. No studies were found for lung cancer screening. Absolute screening rates for individuals who received text message interventions were 0.6% to 15.0% higher than for controls. Unadjusted relative screening rates for text message recipients were 4% to 63% higher compared with controls. Conclusions: Text messaging interventions appear to moderately increase screening rates for breast and cervical cancer and may have a small effect on colorectal cancer screening. Benefit was observed in various countries, including resource-poor and non-English-speaking populations. Given the paucity of data, additional research is needed to better quantify the effectiveness of this promising intervention. UR - http://www.jmir.org/2017/8/e296/ UR - http://dx.doi.org/10.2196/jmir.7893 UR - http://www.ncbi.nlm.nih.gov/pubmed/28838885 ID - info:doi/10.2196/jmir.7893 ER - TY - JOUR AU - Theile, Gudrun AU - Klaas, Vanessa AU - Tröster, Gerhard AU - Guckenberger, Matthias PY - 2017/08/16 TI - mHealth Technologies for Palliative Care Patients at the Interface of In-Patient to Outpatient Care: Protocol of Feasibility Study Aiming to Early Predict Deterioration of Patient?s Health Status JO - JMIR Res Protoc SP - e142 VL - 6 IS - 8 KW - mobile apps KW - palliative care KW - pain KW - symptom assessment KW - hospitalization KW - aged N2 - Background: Palliative care patients are a particularly vulnerable population and one of the critical phases in patients? trajectories is discharge from specialized in-patient palliative care into outpatient care, where availability of a palliative care infrastructure is highly variable. A relevant number of potentially avoidable readmissions and emergency visits of palliative patients is observed due to rapid exacerbation of symptoms indicating the need for a closer patient monitoring. In the last years, different mHealth technology applications have been evaluated in many different patient groups. Objective: The aim of our study is to test feasibility of a remote physical and social tracking system in palliative care patients. Methods: A feasibility study with explorative, descriptive study design, comprised of 3 work packages. From the wards of the Clinic of Radiation-Oncology at the University Hospital Zurich, including the specialized palliative care ward, 30 patients will be recruited and will receive a mobile phone and a tracking bracelet before discharge. The aim of work package A is to evaluate if severely ill patients accept to be equipped with a tracking bracelet and a mobile phone (by semiquantitative questionnaires and guideline interviews). Work package B evaluates the technical feasibility and quality of the acquired electronic health data. Work package C will demonstrate whether physical activity parameters, such as step count, sleep duration, social activity patterns like making calls, and vital signs (eg, heart rate) do correlate with subjective health data and can serve as indicator to early detect and predict changes in patients? health status. Activity parameters will be extracted from the mobile phone?s and wristband?s sensor data using signal processing methods. Subjective health data is captured via electronic version of visual analog scale and Distress Thermometer as well as the European Organization for Research and Treatment of Cancer ? Quality of Life Questionnaire C30 in paper version. Results: Enrollment began in February 2017. First study results will be reported in the middle of 2018. Conclusions: Our project will deliver relevant data on patients? acceptance of activity and social tracking and test the correlation between subjective symptom assessment and objective activity in the vulnerable population of palliative care patients. The proposed study is meant to be preparatory work for an intervention study to test the effect of wireless monitoring of palliative care patients on symptom control and quality of life. UR - http://www.researchprotocols.org/2017/8/e142/ UR - http://dx.doi.org/10.2196/resprot.7676 UR - http://www.ncbi.nlm.nih.gov/pubmed/28814378 ID - info:doi/10.2196/resprot.7676 ER - TY - JOUR AU - Athilingam, Ponrathi AU - Jenkins, Bradlee AU - Johansson, Marcia AU - Labrador, Miguel PY - 2017/08/11 TI - A Mobile Health Intervention to Improve Self-Care in Patients With Heart Failure: Pilot Randomized Control Trial JO - JMIR Cardio SP - e3 VL - 1 IS - 2 KW - heart failure KW - mobile applications KW - self-care KW - quality of life N2 - Background: Heart failure (HF) is a progressive chronic disease affecting 6.5 million Americans and over 15 million individuals globally. Patients with HF are required to engage in complex self-care behaviors. Although the advancements in medicine have enabled people with HF to live longer, they often have poor health-related quality of life and experience severe and frequent symptoms that limit several aspects of their lives. Mobile phone apps have not only created new and interactive ways of communication between patients and health care providers but also provide a platform to enhance adherence to self-care management. Objective: The aim of this pilot study was to test the feasibility of a newly developed mobile app (HeartMapp) in improving self-care behaviors and quality of life of patients with HF and to calculate effect sizes for sample size calculation for a larger study. Methods: This was a pilot feasibility randomized controlled trial. Participants were enrolled in the hospital before discharge and followed at home for 30 days. The intervention group used HeartMapp (n=9), whereas the control group (n=9) received HF education. These apps were downloaded onto their mobile phones for daily use. Results: A total of 72% (13/18) participants completed the study; the mean age of the participants was 53 (SD 4.02) years, 56% (10/18) were females, 61% (11/18) lived alone, 33% (6/18) were African Americans, and 61% (11/18) used mobile phone to get health information. The mean engagement with HeartMapp was 78%. Results were promising with a trend that participants in the HeartMapp group had a significant mean score change on self-care management (8.7 vs 2.3; t3.38=11, P=.01), self-care confidence (6.7 vs 1.8; t2.53=11, P=.28), and HF knowledge (3 vs ?0.66; t2.37=11, P=.04. Depression improved among both groups, more so in the control group (?1.14 vs ?5.17; t1.97=11, P=.07). Quality of life declined among both groups, more so in the control group (2.14 vs 9.0; t?1.43=11, P=.18). Conclusions: The trends demonstrated in this pilot feasibility study warrant further exploration on the use of HeartMapp to improve HF outcomes. Trial Registration: Pilot study, no funding from National agencies, hence not registered. UR - http://cardio.jmir.org/2017/2/e3/ UR - http://dx.doi.org/10.2196/cardio.7848 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758759 ID - info:doi/10.2196/cardio.7848 ER - TY - JOUR AU - Toledo, John Meynard AU - Hekler, Eric AU - Hollingshead, Kevin AU - Epstein, Dana AU - Buman, Matthew PY - 2017/08/09 TI - Validation of a Smartphone App for the Assessment of Sedentary and Active Behaviors JO - JMIR Mhealth Uhealth SP - e119 VL - 5 IS - 8 KW - Sedentary and physical activity measurement KW - smartphone daily-log app KW - self-monitoring app KW - BeWell24 N2 - Background: Although current technological advancements have allowed for objective measurements of sedentary behavior via accelerometers, these devices do not provide the contextual information needed to identify targets for behavioral interventions and generate public health guidelines to reduce sedentary behavior. Thus, self-reports still remain an important method of measurement for physical activity and sedentary behaviors. Objective: This study evaluated the reliability, validity, and sensitivity to change of a smartphone app in assessing sitting, light-intensity physical activity (LPA), and moderate-vigorous physical activity (MVPA). Methods: Adults (N=28; 49.0 years old, standard deviation [SD] 8.9; 85% men; 73% Caucasian; body mass index=35.0, SD 8.3 kg/m2) reported their sitting, LPA, and MVPA over an 11-week behavioral intervention. During three separate 7-day periods, participants wore the activPAL3c accelerometer/inclinometer as a criterion measure. Intraclass correlation (ICC; 95% CI) and bias estimates (mean difference [?] and root of mean square error [RMSE]) were used to compare app-based reported behaviors to measured sitting time (lying/seated position), LPA (standing or stepping at <100 steps/minute), and MVPA (stepping at >100 steps/minute). Results: Test-retest results suggested moderate agreement with the criterion for sedentary time, LPA, and MVPA (ICC=0.65 [0.43-0.82], 0.67 [0.44-0.83] and 0.69 [0.48-0.84], respectively). The agreement between the two measures was poor (ICC=0.05-0.40). The app underestimated sedentary time (?=-45.9 [-67.6, -24.2] minutes/day, RMSE=201.6) and overestimated LPA and MVPA (?=18.8 [-1.30 to 38.9] minutes/day, RMSE=183; and ?=29.3 [25.3 to 33.2] minutes/day, RMSE=71.6, respectively). The app underestimated change in time spent during LPA and MVPA but overestimated change in sedentary time. Both measures showed similar directions in changed scores on sedentary time and LPA. Conclusions: Despite its inaccuracy, the app may be useful as a self-monitoring tool in the context of a behavioral intervention. Future research may help to clarify reasons for under- or over-reporting of behaviors. UR - http://mhealth.jmir.org/2017/8/e119/ UR - http://dx.doi.org/10.2196/mhealth.6974 UR - http://www.ncbi.nlm.nih.gov/pubmed/28793982 ID - info:doi/10.2196/mhealth.6974 ER - TY - JOUR AU - Wang, Yaogang AU - Sun, Li AU - Hou, Jie PY - 2017/08/08 TI - Hierarchical Medical System Based on Big Data and Mobile Internet: A New Strategic Choice in Health Care JO - JMIR Med Inform SP - e22 VL - 5 IS - 3 KW - medical services KW - continuity of patient care KW - mobile health UR - http://medinform.jmir.org/2017/3/e22/ UR - http://dx.doi.org/10.2196/medinform.6799 UR - http://www.ncbi.nlm.nih.gov/pubmed/28790024 ID - info:doi/10.2196/medinform.6799 ER - TY - JOUR AU - Blitchtein-Winicki, Dora AU - Zevallos, Karine AU - Samolski, Reuven M. AU - Requena, David AU - Velarde, Chaska AU - Briceño, Patricia AU - Piazza, Marina AU - Ybarra, L. Michele PY - 2017/08/04 TI - Feasibility and Acceptability of a Text Message-Based Smoking Cessation Program for Young Adults in Lima, Peru: Pilot Study JO - JMIR Mhealth Uhealth SP - e116 VL - 5 IS - 8 KW - Pilot Projects, Text Messaging, Smoking Cessation, Young Adult, Cognitive Therapy, Feasibility Studies, Latinos N2 - Background: In Peru?s urban communities, tobacco smoking generally starts during adolescence and smoking prevalence is highest among young adults. Each year, many attempt to quit, but access to smoking cessation programs is limited. Evidence-based text messaging smoking cessation programs are an alternative that has been successfully implemented in high-income countries, but not yet in middle- and low-income countries with limited tobacco control policies. Objective: The objective was to assess the feasibility and acceptability of an short message service (SMS) text message-based cognitive behavioral smoking cessation program for young adults in Lima, Peru. Methods: Recruitment included using flyers and social media ads to direct young adults interested in quitting smoking to a website where interested participants completed a Google Drive survey. Inclusion criteria were being between ages 18 and 25 years, smoking at least four cigarettes per day at least 6 days per week, willing to quit in the next 30 days, owning a mobile phone, using SMS text messaging at least once in past year, and residing in Lima. Participants joined one of three phases: (1) focus groups and in-depth interviews whose feedback was used to develop the SMS text messages, (2) validating the SMS text messages, and (3) a pilot of the SMS text message-based smoking cessation program to test its feasibility and acceptability among young adults in Lima. The outcome measures included adherence to the SMS text message-based program, acceptability of content, and smoking abstinence self-report on days 2, 7, and 30 after quitting. Results: Of 639 participants who completed initial online surveys, 42 met the inclusion criteria and 35 agreed to participate (focus groups and interviews: n=12; validate SMS text messages: n=8; program pilot: n=15). Common quit practices and beliefs emerged from participants in the focus groups and interviews informed the content, tone, and delivery schedule of the messages used in the SMS text message smoking cessation program. A small randomized controlled pilot trial was performed to test the program?s feasibility and acceptability; nine smokers were assigned to the SMS text message smoking cessation program and six to a SMS text message nutrition program. Participant retention was high: 93% (14/15) remained until day 30 after quit day. In all, 56% of participants (5/9) in the SMS text message smoking cessation program reported remaining smoke-free until day 30 after quit day and 17% of participants (1/6) in the SMS text message nutrition program reported remaining smoke-free during the entire program. The 14 participants who completed the pilot reported that they received valuable health information and approved the delivery schedule of the SMS text messages. Conclusions: This study provides initial evidence that a SMS text message smoking cessation program is feasible and acceptable for young adults residing in Lima. UR - http://mhealth.jmir.org/2017/8/e116/ UR - http://dx.doi.org/10.2196/mhealth.7532 UR - http://www.ncbi.nlm.nih.gov/pubmed/28778850 ID - info:doi/10.2196/mhealth.7532 ER - TY - JOUR AU - Hoj, H. Taylor AU - Covey, L. Emarie AU - Jones, C. Allyn AU - Haines, C. Amanda AU - Hall, Cougar P. AU - Crookston, T. Benjamin AU - West, H. Joshua PY - 2017/08/03 TI - How Do Apps Work? An Analysis of Physical Activity App Users? Perceptions of Behavior Change Mechanisms JO - JMIR Mhealth Uhealth SP - e114 VL - 5 IS - 8 KW - mHealth KW - mobile apps KW - health behavior KW - smartphone N2 - Background: Physical activity apps are commonly used to increase levels of activity and health status. To date, the focus of research has been to determine the potential of apps to influence behavior, to ascertain the efficacy of a limited number of apps to change behavior, and to identify the characteristics of apps that users prefer. Objective: The purpose of this study was to identify the mechanisms by which the use of physical activity apps may influence the users? physical activity behavior. Methods: This study used a cross-sectional survey of users of health-related physical activity apps during the past 6 months. An electronic survey was created in Qualtrics? Web-based survey software and deployed on Amazon Mechanical Turk. Individuals who had used at least one physical activity app in the past 6 months were eligible to respond. The final sample comprised 207 adults living in the United States. 86.0% (178/207) of respondents were between the ages of 26 and 54 years, with 51.2% (106/207) of respondents being female. Behavior change theory informed the creation of 20 survey items relating to the mechanisms of behavior change. Respondents also reported about engagement with the apps, app likeability, and physical activity behavior. Results: Respondents reported that using a physical activity app in the past 6 months resulted in a change in their attitudes, beliefs, perceptions, and motivation. Engagement with the app (P<.001), frequency of app use (P=.03), and app price (P=.01) were related to the reported impact of the behavior change theory or mechanisms of change. The mechanisms of change were associated with self-reported physical activity behaviors (P<.001). Conclusions: The findings from this study provide an overview of the mechanisms by which apps may impact behavior. App developers may wish to incorporate these mechanisms in an effort to increase impact. Practitioners should consider the extent to which behavior change theory is integrated into a particular app when they consider making recommendations to others wishing to increase levels of physical activity. UR - http://mhealth.jmir.org/2017/8/e114/ UR - http://dx.doi.org/10.2196/mhealth.7206 UR - http://www.ncbi.nlm.nih.gov/pubmed/28778846 ID - info:doi/10.2196/mhealth.7206 ER - TY - JOUR AU - Tinschert, Peter AU - Jakob, Robert AU - Barata, Filipe AU - Kramer, Jan-Niklas AU - Kowatsch, Tobias PY - 2017/08/02 TI - The Potential of Mobile Apps for Improving Asthma Self-Management: A Review of Publicly Available and Well-Adopted Asthma Apps JO - JMIR Mhealth Uhealth SP - e113 VL - 5 IS - 8 KW - asthma KW - self care KW - disease management KW - mobile applications KW - smartphone KW - mHealth KW - eHealth KW - mobile health KW - behavior and behavior mechanisms KW - review N2 - Background: Effective disease self-management lowers asthma?s burden of disease for both individual patients and health care systems. In principle, mobile health (mHealth) apps could enable effective asthma self-management interventions that improve a patient?s quality of life while simultaneously reducing the overall treatment costs for health care systems. However, prior reviews in this field have found that mHealth apps for asthma lack clinical evaluation and are often not based on medical guidelines. Yet, beyond the missing evidence for clinical efficacy, little is known about the potential apps might have for improving asthma self-management. Objective: The aim of this study was to assess the potential of publicly available and well-adopted mHealth apps for improving asthma self-management. Methods: The Apple App store and Google Play store were systematically searched for asthma apps. In total, 523 apps were identified, of which 38 apps matched the selection criteria to be included in the review. Four requirements of app potential were investigated: app functions, potential to change behavior (by means of a behavior change technique taxonomy), potential to promote app use (by means of a gamification components taxonomy), and app quality (by means of the Mobile Application Rating Scale [MARS]). Results: The most commonly implemented functions in the 38 reviewed asthma apps were tracking (30/38, 79%) and information (26/38, 68%) functions, followed by assessment (20/38, 53%) and notification (18/38, 47%) functions. On average, the reviewed apps applied 7.12 of 26 available behavior change techniques (standard deviation [SD]=4.46) and 4.89 of 31 available gamification components (SD=4.21). Average app quality was acceptable (mean=3.17/5, SD=0.58), whereas subjective app quality lied between poor and acceptable (mean=2.65/5, SD=0.87). Additionally, the sum scores of all review frameworks were significantly correlated (lowest correlation: r36=.33, P=.04 between number of functions and gamification components; highest correlation: r36=.80, P<.001 between number of behavior change techniques and gamification components), which suggests that an app?s potential tends to be consistent across review frameworks. Conclusions: Several apps were identified that performed consistently well across all applied review frameworks, thus indicating the potential mHealth apps offer for improving asthma self-management. However, many apps suffer from low quality. Therefore, app reviews should be considered as a decision support tool before deciding which app to integrate into a patient?s asthma self-management. Furthermore, several research-practice gaps were identified that app developers should consider addressing in future asthma apps. UR - http://mhealth.jmir.org/2017/8/e113/ UR - http://dx.doi.org/10.2196/mhealth.7177 UR - http://www.ncbi.nlm.nih.gov/pubmed/28768606 ID - info:doi/10.2196/mhealth.7177 ER - TY - JOUR AU - Lucero, James Robert AU - Frimpong, A. Jemima AU - Fehlberg, A. Elizabeth AU - Bjarnadottir, I. Ragnhildur AU - Weaver, T. Michael AU - Cook, Christa AU - Modave, Francois AU - Rathore, H. Mobeen AU - Morano, P. Jamie AU - Ibanez, Gladys AU - Cook, L. Robert PY - 2017/07/27 TI - The Relationship Between Individual Characteristics and Interest in Using a Mobile Phone App for HIV Self-Management: Observational Cohort Study of People Living With HIV JO - JMIR Mhealth Uhealth SP - e100 VL - 5 IS - 7 KW - telemedicine KW - self-care KW - HIV N2 - Background: The human immunodeficiency virus (HIV) continues to be a major health issue in the United States, and an estimated 1.2 million people in the United States are living with HIV. As part of Healthy People 2020, the Office of Disease Prevention and Health Promotion has targeted the persistent demographic and geographic disparities in HIV prevalence and management. Preliminary evidence suggests that mobile health technology (smartphone apps) may be a promising way to support HIV self-management among vulnerable populations of people living with HIV (PLWH) who lack access to appropriate health care services. Objective: This study examines the association between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management. Methods: This study was conducted using cross-sectional survey data collected in the Florida Cohort Study between 2014 and 2016 (N=766). Associations between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management were examined using bivariate analysis and logistic regression. Results: Overall, 85.5% (655/766) of respondents were interested in using a free mobile phone app that supports HIV self-management. Participants expressed the highest interest in app functions that facilitate communication with health care providers (568/740, 76.8%) or help to identify relevant health care services (556/745 74.6%). Age (OR 0.959, 95% CI 0.936-0.982), education (OR 1.281, 95% CI 1.027-1.598) and disability or inability to work (OR 0.296, 95% CI 0.145-0.606) were all significantly associated with being interested in using a free mobile phone app for HIV self-management. Conclusions: This study indicates that a majority of PLWH are interested in using a free mobile phone app to self-manage their condition. The findings can inform the development of mobile phone apps that support effective HIV self-management. UR - http://mhealth.jmir.org/2017/7/e100/ UR - http://dx.doi.org/10.2196/mhealth.7853 UR - http://www.ncbi.nlm.nih.gov/pubmed/28751298 ID - info:doi/10.2196/mhealth.7853 ER - TY - JOUR AU - Peters, Mattson Robert AU - Lui, Matt AU - Patel, Kunjan AU - Tian, Lewis AU - Javaherian, Kavon AU - Sink, Eric AU - Xu, Ran AU - Xu, Zhuchen AU - Aung, Wint AU - Zhou, Li AU - Huynh, Justin AU - Polites, Gregory AU - Blanchard, Melvin AU - Som, Avik AU - Ross, Will AU - Bernal-Mizrachi, Carlos PY - 2017/07/25 TI - Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation JO - JMIR Diabetes SP - e15 VL - 2 IS - 2 KW - diabetes mellitus KW - glycemic control KW - telemedicine KW - electronic health (eHealth) KW - mobile health (mHealth) KW - telehealth KW - SMS KW - diabetes management N2 - Background: Type II diabetes mellitus (T2DM) presents a major disease burden in the United States. Outpatient glycemic control among patients with T2DM remains difficult. Telemedicine shows great potential as an adjunct therapy to aid in glycemic control in real-world settings. Objective: We aimed to explore the effectiveness of EpxDiabetes, a novel digital health intervention, in improving hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) among patients with uncontrolled diabetes. Methods: We recruited 396 patients from a community clinic in St. Louis, Missouri, from a database of patients diagnosed with T2DM and with a most recent HbA1c >7% as part of a quality improvement project. An automated call or text-messaging system was used to monitor patient-reported FBG. If determined to be elevated, care managers were notified by email, text, or electronic medical record alert. Participants self-reported their FBG data by replying to EpxDiabetes automated phone calls or text messages. Data were subsequently analyzed, triaged, and shared with providers to enable appropriate follow-up and care plan adjustments. Absolute HbA1c reduction, patient engagement, and absolute patient-reported FBG reduction were examined at approximately 6 months post implementation. Results: EpxDiabetes had an average 95.6% patient response rate to messages at least once per month and an average 71.1% response rate to messages at least once per week. Subsequent HbA1c drop with EpxDiabetes use over 4 months was -1.15% (95% CI -1.58 to -0.71) for patients with HbA1c >8% at baseline compared to the change in HbA1c over 4 months prior to the implementation of EpxDiabetes of only -0.005 points (95% CI -0.28 to 0.27), P=.0018. Conclusions: EpxDiabetes may help reduce HbA1c in patients with high HbA1c baselines (>8%). The intervention demonstrates high patient engagement sustainable for at least 6 months. UR - http://diabetes.jmir.org/2017/2/e15/ UR - http://dx.doi.org/10.2196/diabetes.7910 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291063 ID - info:doi/10.2196/diabetes.7910 ER - TY - JOUR AU - Bian, Jiang AU - Guo, Yi AU - Xie, Mengjun AU - Parish, E. Alice AU - Wardlaw, Isaac AU - Brown, Rita AU - Modave, François AU - Zheng, Dong AU - Perry, T. Tamara PY - 2017/07/25 TI - Exploring the Association Between Self-Reported Asthma Impact and Fitbit-Derived Sleep Quality and Physical Activity Measures in Adolescents JO - JMIR Mhealth Uhealth SP - e105 VL - 5 IS - 7 KW - mobile health KW - mHealth KW - asthma KW - Fitbit KW - physical activity KW - sleep KW - sleep quality N2 - Background: Smart wearables such as the Fitbit wristband provide the opportunity to monitor patients more comprehensively, to track patients in a fashion that more closely follows the contours of their lives, and to derive a more complete dataset that enables precision medicine. However, the utility and efficacy of using wearable devices to monitor adolescent patients? asthma outcomes have not been established. Objective: The objective of this study was to explore the association between self?reported sleep data, Fitbit sleep and physical activity data, and pediatric asthma impact (PAI). Methods: We conducted an 8?week pilot study with 22 adolescent asthma patients to collect: (1) weekly or biweekly patient?reported data using the Patient-Reported Outcomes Measurement Information System (PROMIS) measures of PAI, sleep disturbance (SD), and sleep?related impairment (SRI) and (2) real-time Fitbit (ie, Fitbit Charge HR) data on physical activity (F-AM) and sleep quality (F?SQ). To explore the relationship among the self-reported and Fitbit measures, we computed weekly Pearson correlations among these variables of interest. Results: We have shown that the Fitbit-derived sleep quality F-SQ measure has a moderate correlation with the PROMIS SD score (average r=?.31, P=.01) and a weak but significant correlation with the PROMIS PAI score (average r=?.18, P=.02). The Fitbit physical activity measure has a negligible correlation with PAI (average r=.04, P=.62). Conclusions: Our findings support the potential of using wrist-worn devices to continuously monitor two important factors?physical activity and sleep?associated with patients? asthma outcomes and to develop a personalized asthma management platform. UR - http://mhealth.jmir.org/2017/7/e105/ UR - http://dx.doi.org/10.2196/mhealth.7346 UR - http://www.ncbi.nlm.nih.gov/pubmed/28743679 ID - info:doi/10.2196/mhealth.7346 ER - TY - JOUR AU - Dogan, Ezgi AU - Sander, Christian AU - Wagner, Xenija AU - Hegerl, Ulrich AU - Kohls, Elisabeth PY - 2017/07/24 TI - Smartphone-Based Monitoring of Objective and Subjective Data in Affective Disorders: Where Are We and Where Are We Going? Systematic Review JO - J Med Internet Res SP - e262 VL - 19 IS - 7 KW - review KW - mood disorders KW - smartphone KW - ecological momentary assessment N2 - Background: Electronic mental health interventions for mood disorders have increased rapidly over the past decade, most recently in the form of various systems and apps that are delivered via smartphones. Objective: We aim to provide an overview of studies on smartphone-based systems that combine subjective ratings with objectively measured data for longitudinal monitoring of patients with affective disorders. Specifically, we aim to examine current knowledge on: (1) the feasibility of, and adherence to, such systems; (2) the association of monitored data with mood status; and (3) the effects of monitoring on clinical outcomes. Methods: We systematically searched PubMed, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials for relevant articles published in the last ten years (2007-2017) by applying Boolean search operators with an iterative combination of search terms, which was conducted in February 2017. Additional articles were identified via pearling, author correspondence, selected reference lists, and trial protocols. Results: A total of 3463 unique records were identified. Twenty-nine studies met the inclusion criteria and were included in the review. The majority of articles represented feasibility studies (n=27); two articles reported results from one randomized controlled trial (RCT). In total, six different self-monitoring systems for affective disorders that used subjective mood ratings and objective measurements were included. These objective parameters included physiological data (heart rate variability), behavioral data (phone usage, physical activity, voice features), and context/environmental information (light exposure and location). The included articles contained results regarding feasibility of such systems in affective disorders, showed reasonable accuracy in predicting mood status and mood fluctuations based on the objectively monitored data, and reported observations about the impact of monitoring on clinical state and adherence of patients to the system usage. Conclusions: The included observational studies and RCT substantiate the value of smartphone-based approaches for gathering long-term objective data (aside from self-ratings to monitor clinical symptoms) to predict changes in clinical states, and to investigate causal inferences about state changes in patients with affective disorders. Although promising, a much larger evidence-base is necessary to fully assess the potential and the risks of these approaches. Methodological limitations of the available studies (eg, small sample sizes, variations in the number of observations or monitoring duration, lack of RCT, and heterogeneity of methods) restrict the interpretability of the results. However, a number of study protocols stated ambitions to expand and intensify research in this emerging and promising field. UR - http://www.jmir.org/2017/7/e262/ UR - http://dx.doi.org/10.2196/jmir.7006 UR - http://www.ncbi.nlm.nih.gov/pubmed/28739561 ID - info:doi/10.2196/jmir.7006 ER - TY - JOUR AU - Stütz, Thomas AU - Emsenhuber, Gerlinde AU - Huber, Daniela AU - Domhardt, Michael AU - Tiefengrabner, Martin AU - Oostingh, Janneke Gertie AU - Fötschl, Ulrike AU - Matis, Nicholas AU - Ginzinger, Simon PY - 2017/07/20 TI - Mobile Phone?Supported Physiotherapy for Frozen Shoulder: Feasibility Assessment Based on a Usability Study JO - JMIR Rehabil Assist Technol SP - e6 VL - 4 IS - 2 KW - telemedicine KW - mobile health KW - mHealth KW - frozen shoulder KW - adhesive capsulitis KW - physiotherapy (techniques) KW - home health aides KW - mobile phone N2 - Background: Patients with frozen shoulder show limited shoulder mobility often accompanied by pain. Common treatment methods include physiotherapy, pain medication, administration of corticosteroids, and surgical capsulotomy. Frozen shoulder often lasts from months to years and mostly affects persons in the age group of 40 to 70 years. It severely reduces the quality of life and the ability to work. Objective: The objective of this study was to evaluate the feasibility of a mobile health (mHealth) intervention that supports patients affected by ?stage two? frozen shoulder. Patients were supported with app-based exercise instructions and tools to monitor their training compliance and progress. These training compliance and progress data supplement the patients? oral reports to the physiotherapists and physicians and can assist them in therapy adjustment. Methods: In order to assess the feasibility of the mHealth intervention, a pilot study of a newly developed app for frozen shoulder patients was conducted with 5 patients for 3 weeks. The main function of the app was the instruction for exercising at home. Standardized questionnaires on usability such as System Usability Scale (SUS) and USE (Usefulness, Satisfaction, and Ease of use), and Technology Acceptance Model-2 (TAM-2) were completed by the study participants at the end of the study. Additionally, a nonstandardized questionnaire was completed by all patients. The correctness of the exercises as conducted by the patients was assessed by a physiotherapist at the end of the study. The mobility of the shoulder and pain in shoulder movement was assessed by a physiotherapist at the start and the end of the study. Results: The pilot study was successfully conducted, and the app was evaluated by the patients after 3 weeks. The results of the standardized questionnaires showed high acceptance (TAM-2) and high usability (SUS) of the developed app. The overall usability of the system as assessed by the SUS questionnaire was very good (an average score of 88 out of 100). The average score of the TAM-2 questionnaire on the intention to further use the app was 4.2 out of 5, which indicated that most patients would use the app if further available. The results of the USE questionnaires highlighted that the patients learned how to use the app easily (an average score of 4.2 out of 5) and were satisfied with the app (an average score of 4.7 out of 5). The frequency of app usage and training was very high based on patient reports and verified by analysis of the usage data. The patients conducted the exercises almost flawlessly. Conclusions: Our results indicate the feasibility of the mHealth intervention, as the app was easy to use and frequently used by the patients. The app supported the patients? physiotherapy by providing clear exercising instructions. UR - http://rehab.jmir.org/2017/2/e6/ UR - http://dx.doi.org/10.2196/rehab.7085 UR - http://www.ncbi.nlm.nih.gov/pubmed/28729234 ID - info:doi/10.2196/rehab.7085 ER - TY - JOUR AU - Sirard, R. John AU - Masteller, Brittany AU - Freedson, S. Patty AU - Mendoza, Albert AU - Hickey, Amanda PY - 2017/07/19 TI - Youth Oriented Activity Trackers: Comprehensive Laboratory- and Field-Based Validation JO - J Med Internet Res SP - e250 VL - 19 IS - 7 KW - child KW - movement KW - fitness trackers N2 - Background: Commercial activity trackers are growing in popularity among adults and some are beginning to be marketed to children. There is, however, a paucity of independent research examining the validity of these devices to detect physical activity of different intensity levels. Objectives: The purpose of this study was to determine the validity of the output from 3 commercial youth-oriented activity trackers in 3 phases: (1) orbital shaker, (2) structured indoor activities, and (3) 4 days of free-living activity. Methods: Four units of each activity tracker (Movband [MB], Sqord [SQ], and Zamzee [ZZ]) were tested in an orbital shaker for 5-minutes at three frequencies (1.3, 1.9, and 2.5 Hz). Participants for Phase 2 (N=14) and Phase 3 (N=16) were 6-12 year old children (50% male). For Phase 2, participants completed 9 structured activities while wearing each tracker, the ActiGraph GT3X+ (AG) research accelerometer, and a portable indirect calorimetry system to assess energy expenditure (EE). For Phase 3, participants wore all 4 devices for 4 consecutive days. Correlation coefficients, linear models, and non-parametric statistics evaluated the criterion and construct validity of the activity tracker output. Results: Output from all devices was significantly associated with oscillation frequency (r=.92-.99). During Phase 2, MB and ZZ only differentiated sedentary from light intensity (P<.01), whereas the SQ significantly differentiated among all intensity categories (all comparisons P<.01), similar to AG and EE. During Phase 3, AG counts were significantly associated with activity tracker output (r=.76, .86, and .59 for the MB, SQ, and ZZ, respectively). Conclusions: Across study phases, the SQ demonstrated stronger validity than the MB and ZZ. The validity of youth-oriented activity trackers may directly impact their effectiveness as behavior modification tools, demonstrating a need for more research on such devices. UR - http://www.jmir.org/2017/7/e250/ UR - http://dx.doi.org/10.2196/jmir.6360 UR - http://www.ncbi.nlm.nih.gov/pubmed/28724509 ID - info:doi/10.2196/jmir.6360 ER - TY - JOUR AU - Välimäki, Maritta AU - Kannisto, Anneli Kati AU - Vahlberg, Tero AU - Hätönen, Heli AU - Adams, E. Clive PY - 2017/07/12 TI - Short Text Messages to Encourage Adherence to Medication and Follow-up for People With Psychosis (Mobile.Net): Randomized Controlled Trial in Finland JO - J Med Internet Res SP - e245 VL - 19 IS - 7 KW - text messaging KW - psychotic disorders KW - randomized controlled trial KW - medication adherence N2 - Background: A text messaging service (short message service [SMS]) has the potential to target large groups of people with long-term illnesses such as serious mental disorders, who may have difficulty with treatment adherence. Robust research on the impact of mobile technology interventions for these patients remains scarce. Objective: The main objective of our study was to investigate the impact of individually tailored short text messages on the rate of psychiatric hospital readmissions, health care service use, and clinical outcomes. In addition, we analyzed treatment costs. Methods: Between September 2011 and November 2012, we randomly assigned 1139 people to a tailored text message intervention (n=569) or usual care (n=570). Participants received semiautomated text messages for up to 12 months or usual care. The primary outcome, based on routinely collected health register data, was patient readmission into a psychiatric hospital during a 12-month follow-up period. Secondary outcomes were related to other service use, coercion, medication, adverse events, satisfaction, social functioning, quality of life, and economic factors (cost analysis). Results: There was 98.24% (1119/1139) follow-up at 12 months. Tailored mobile telephone text messages did not reduce the rate of hospital admissions (242/563, 43.0% of the SMS group vs 216/556, 38.8% of the control group; relative risk 1.11; 95% CI 0.92-1.33; P=.28), time between hospitalizations (mean difference 7.0 days 95% CI ?8.0 to 24.0; P=.37), time spent in a psychiatric hospital during the year (mean difference 2.0 days 95% CI ?2.0 to 7.0; P=.35), or other service outcomes. People who received text messages were less disabled, based on Global Assessment Scale scores at the time of their readmission, than those who did not receive text messages (odds ratio 0.68; 95% CI 0.47-0.97; P=.04). The costs of treatment were higher for people in the SMS group than in the control group (mean ?10,103 vs ?9210, respectively, P<.001). Conclusions: High-grade routinely collected data can provide clear outcomes for pragmatic randomized trials. SMS messaging tailored with the input of each individual patient did not decrease the rate of psychiatric hospital visits after the 12 months of follow-up. Although there may have been other, more subtle effects, the results of these were not evident in outcomes of agreed importance to clinicians, policymakers, and patients and their families. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6rVzZrbuz). UR - http://www.jmir.org/2017/7/e245/ UR - http://dx.doi.org/10.2196/jmir.7028 UR - http://www.ncbi.nlm.nih.gov/pubmed/28701292 ID - info:doi/10.2196/jmir.7028 ER - TY - JOUR AU - Rahman, Abidur Quazi AU - Janmohamed, Tahir AU - Pirbaglou, Meysam AU - Ritvo, Paul AU - Heffernan, M. Jane AU - Clarke, Hance AU - Katz, Joel PY - 2017/07/12 TI - Patterns of User Engagement With the Mobile App, Manage My Pain: Results of a Data Mining Investigation JO - JMIR Mhealth Uhealth SP - e96 VL - 5 IS - 7 KW - chronic pain KW - mhealth KW - opioid use KW - data mining KW - cluster analysis KW - Manage My Pain KW - pain management KW - pain app N2 - Background: Pain is one of the most prevalent health-related concerns and is among the top 3 most common reasons for seeking medical help. Scientific publications of data collected from pain tracking and monitoring apps are important to help consumers and healthcare professionals select the right app for their use. Objective: The main objectives of this paper were to (1) discover user engagement patterns of the pain management app, Manage My Pain, using data mining methods; and (2) identify the association between several attributes characterizing individual users and their levels of engagement. Methods: User engagement was defined by 2 key features of the app: longevity (number of days between the first and last pain record) and number of records. Users were divided into 5 user engagement clusters employing the k-means clustering algorithm. Each cluster was characterized by 6 attributes: gender, age, number of pain conditions, number of medications, pain severity, and opioid use. Z tests and chi-square tests were used for analyzing categorical attributes. Effects of gender and cluster on numerical attributes were analyzed using 2-way analysis of variances (ANOVAs) followed up by pairwise comparisons using Tukey honest significant difference (HSD). Results: The clustering process produced 5 clusters representing different levels of user engagement. The proportion of males and females was significantly different in 4 of the 5 clusters (all P ?.03). The proportion of males was higher than females in users with relatively high longevity. Mean ages of users in 2 clusters with high longevity were higher than users from other 3 clusters (all P <.001). Overall, males were significantly older than females (P <.001). Across clusters, females reported more pain conditions than males (all P <.001). Users from highly engaged clusters reported taking more medication than less engaged users (all P <.001). Females reported taking a greater number of medications than males (P =.04). In 4 of 5 clusters, the percentage of males taking an opioid was significantly greater (all P ?.05) than that of females. The proportion of males with mild pain was significantly higher than that of females in 3 clusters (all P ?.008). Conclusions: Although most users of the app reported being female, male users were more likely to be highly engaged in the app. Users in the most engaged clusters self-reported a higher number of pain conditions, a higher number of current medications, and a higher incidence of opioid usage. The high engagement by males in these clusters does not appear to be driven by pain severity which may, in part, be the case for females. Use of a mobile pain app may be relatively more attractive to highly-engaged males than highly-engaged females, and to those with relatively more complex chronic pain problems. UR - http://mhealth.jmir.org/2017/7/e96/ UR - http://dx.doi.org/10.2196/mhealth.7871 UR - http://www.ncbi.nlm.nih.gov/pubmed/28701291 ID - info:doi/10.2196/mhealth.7871 ER - TY - JOUR AU - Martinez, Mark AU - Park, Bin Su AU - Maison, Isaac AU - Mody, Vicky AU - Soh, Sungkon Lewis AU - Parihar, Singh Harish PY - 2017/07/11 TI - iOS Appstore-Based Phone Apps for Diabetes Management: Potential for Use in Medication Adherence JO - JMIR Diabetes SP - e12 VL - 2 IS - 2 KW - diabetes KW - telemedicine KW - blood glucose self-monitoring glucose monitoring KW - mobile applications KW - self-care KW - mobile health N2 - Background: Currently, various phone apps have been developed to assist patients. Many of these apps are developed to assist patients in the self-management of chronic diseases such as diabetes. It is essential to analyze these various apps to understand the key features that would potentially be instrumental in helping patients successfully achieve goals in disease self-management. Objective: The objective of this study was to conduct a review of all the available diabetes-related apps in the iOS App Store to evaluate which diabetic app is more interactive and offers a wide variety of operations such as monitoring glucose, water, carbohydrate intake, weight, body mass index (BMI), medication, blood pressure (BP) levels, reminders or push notifications, food database, charts, exercise management, email, sync between devices, syncing data directly to the prescribers, and other miscellaneous functions such as (Twitter integration, password protection, retina display, barcode scanner, apple watch functionality, and cloud syncing). Methods: Data was gathered using the iOS App Store on an iPad. The search term ?diabetes? resulted in 1209 results. Many of the results obtained were remotely related to diabetes and focused mainly on diet, exercise, emergency services, refill reminders, providing general diabetes information, and other nontherapeutic options. We reviewed each app description and only included apps that were meant for tracking blood glucose levels. All data were obtained in one sitting by one person on the same device, as we found that carrying out the search at different times or on different devices (iPhones) resulted in varying results. Apps that did not have a feature for tracking glucose levels were excluded from the study. Results: The search resulted in 1209 results; 85 apps were retained based on the inclusion criteria mentioned above. All the apps were reviewed for average customer ratings, number of reviews, price, and functions. Of all the apps surveyed, 18 apps with the highest number of user ratings were used for in-depth analysis. Of these 18 apps, 50% (9/18) also had a medication adherence function. Our analysis revealed that the Diabetes logbook used by the mySugr app was one of the best; it differentiated itself by introducing fun as a method of increasing adherence. Conclusions: A large variation was seen in patient ratings of app features. Many patient reviewers desired simplicity of app functions. Glucose level tracking and email features potentially helped patients and health care providers manage the disease more efficiently. However, none of the apps could sync data directly to the prescribers. Additional features such as graph customization, availability of data backup, and recording previous entries were also requested by many users. Thus, the use of apps in disease management and patient and health-care provider involvement in future app refinement and development should be encouraged. UR - http://diabetes.jmir.org/2017/2/e12/ UR - http://dx.doi.org/10.2196/diabetes.6468 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291096 ID - info:doi/10.2196/diabetes.6468 ER - TY - JOUR AU - Downing, Janelle AU - Bollyky, Jenna AU - Schneider, Jennifer PY - 2017/07/11 TI - Use of a Connected Glucose Meter and Certified Diabetes Educator Coaching to Decrease the Likelihood of Abnormal Blood Glucose Excursions: The Livongo for Diabetes Program JO - J Med Internet Res SP - e234 VL - 19 IS - 7 KW - SMBG KW - blood glucose self-monitoring KW - diabetes remote monitoring KW - diabetes management KW - diabetes mellitus KW - self-care N2 - Background: The Livongo for Diabetes Program offers members (1) a cellular technology-enabled, two-way messaging device that measures blood glucose (BG), centrally stores the glucose data, and delivers messages back to the individual in real time; (2) unlimited BG test strips; and (3) access to a diabetes coaching team for questions, goal setting, and automated support for abnormal glucose excursions. The program is sponsored by at-risk self-insured employers, health plans and provider organizations where it is free to members with diabetes or it is available directly to the person with diabetes where they cover the cost. Objective: The objective of our study was to evaluate BG data from 4544 individuals with diabetes who were enrolled in the Livongo program from October 2014 through December 2015. Methods: Members used the Livongo glucose meter to measure their BG levels an average of 1.8 times per day. We estimated the probability of having a day with a BG reading outside of the normal range (70-180 mg/dL, or 3.9-10.0 mmol/L) in months 2 to 12 compared with month 1 of the program, using individual fixed effects to control for individual characteristics. Results: Livongo members experienced an average 18.4% decrease in the likelihood of having a day with hypoglycemia (BG <70 mg/dL) and an average 16.4% decrease in hyperglycemia (BG >180 mg/dL) in months 2-12 compared with month 1 as the baseline. The biggest impact was seen on hyperglycemia for nonusers of insulin. We do not know all of the contributing factors such as medication or other treatment changes during the study period. Conclusions: These findings suggest that access to a connected glucose meter and certified diabetes educator coaching is associated with a decrease in the likelihood of abnormal glucose excursions, which can lead to diabetes-related health care savings. UR - http://www.jmir.org/2017/7/e234/ UR - http://dx.doi.org/10.2196/jmir.6659 UR - http://www.ncbi.nlm.nih.gov/pubmed/28698167 ID - info:doi/10.2196/jmir.6659 ER - TY - JOUR AU - Cheng, Feng AU - Xu, Junfang AU - Su, Chunyan AU - Fu, Xiaoxing AU - Bricker, Jonathan PY - 2017/07/11 TI - Content Analysis of Smartphone Apps for Smoking Cessation in China: Empirical Study JO - JMIR Mhealth Uhealth SP - e93 VL - 5 IS - 7 KW - smoking cessation KW - smartphone apps KW - China N2 - Background: With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone apps for smoking cessation are increasingly used in China to help smokers quit. Objective: This study analyzed and evaluated the contents of all smoking cessation apps (iOS and Android) available in China, applying the China Clinical Smoking Cessation Guideline (CCSCG; identical to the US Clinical Practice Guideline for Treating Tobacco Use and Dependence) as a framework for analysis. Methods: We conducted a content analysis of Chinese Android and iOS smoking cessation apps (N=64) designed to assist users in quitting smoking. Each app was independently coded by two raters for its approach to smoking cessation and adherence to the CCSCG. We also recorded the features of smoking cessation apps (eg, release date, size, frequency of downloads, user ratings, type, quality scores by raters, and designers). Linear regression was used to test predictors of popularity and user-rated quality. Results: Chinese smoking cessation apps have low levels of adherence to guidelines, with an average score of 11.1 for Android and 14.6 for iOS apps on a scale of 0 to 46. There was no significant association between popularity, user rating, and the characteristics of apps. However, there was a positive relationship between popularity, user rating, and adherence score. Conclusions: Chinese apps for smoking cessation have low levels of adherence to standard clinical practice guidelines. New apps need be developed and existing apps be revised following evidence-based principles in China. UR - http://mhealth.jmir.org/2017/7/e93/ UR - http://dx.doi.org/10.2196/mhealth.7462 UR - http://www.ncbi.nlm.nih.gov/pubmed/28698170 ID - info:doi/10.2196/mhealth.7462 ER - TY - JOUR AU - Gaudet, Jeffrey AU - Gallant, François AU - Bélanger, Mathieu PY - 2017/07/06 TI - A Bit of Fit: Minimalist Intervention in Adolescents Based on a Physical Activity Tracker JO - JMIR Mhealth Uhealth SP - e92 VL - 5 IS - 7 KW - health behavior KW - health promotion KW - mHealth KW - physical activity tracker N2 - Background: Only 5% of Canadian youth meet the recommended 60 minutes of moderate to vigorous physical activity (MVPA) per day, with leisure time being increasingly allocated to technology usage. Direct-to-consumer mHealth devices that promote physical activity, such as wrist-worn physical activity trackers, have features with potential appeal to youth. Objective: The primary purpose of this study was to determine whether a minimalist physical activity tracker-based intervention would lead to an increase in physical activity in young adolescents. A secondary aim of this study was to assess change in physical activity across a 7-week intervention, as measured by the tracker. Methods: Using a quasi-experimental crossover design, two groups of 23 young adolescents (aged 13-14 years) were randomly assigned to immediate intervention or delayed intervention. The intervention consisted of wearing a Fitbit-Charge-HR physical activity tracker over a 7-week period. Actical accelerometers were used to measure participants? levels of MVPA before and at the end of intervention periods for each group. Covariates such as age, sex, stage of change for physical activity behavior, and goal commitment were also measured. Results: There was an increase in physical activity over the course of the study period, though it was not related to overall physical activity tracker use. An intervention response did, however, occur in a subset of participants. Specifically, exposure to the physical activity tracker was associated with an average daily increase in MVPA by more than 15 minutes (P=.01) among participants who reported being in the action and maintenance stages of behavior change in relation to participation in physical activity. Participants in the precontemplation, contemplation, and preparation stages of behavior change had no change in their level of MVPA (P=.81). Conclusions: These results suggest that physical activity trackers may elicit improved physical activity related behavior in young adolescents demonstrating a readiness to be active. Future studies should seek to investigate if integrating physical activity trackers as part of more intensive interventions leads to greater increases in physical activity across different levels of stages of behavior change and if these changes can be sustained over longer periods of time. UR - http://mhealth.jmir.org/2017/7/e92/ UR - http://dx.doi.org/10.2196/mhealth.7647 UR - http://www.ncbi.nlm.nih.gov/pubmed/28684384 ID - info:doi/10.2196/mhealth.7647 ER - TY - JOUR AU - Quade, Patrick AU - Nsoesie, Okanyene Elaine PY - 2017/07/05 TI - A Platform for Crowdsourced Foodborne Illness Surveillance: Description of Users and Reports JO - JMIR Public Health Surveill SP - e42 VL - 3 IS - 3 KW - foodborne illness surveillance KW - crowdsourced surveillance KW - foodborne diseases KW - infectious diseases KW - outbreaks KW - food poisoning KW - Internet KW - mobile KW - participatory surveillance KW - participatory epidemiology N2 - Background: Underreporting of foodborne illness makes foodborne disease burden estimation, timely outbreak detection, and evaluation of policies toward improving food safety challenging. Objective: The objective of this study was to present and evaluate Iwaspoisoned.com, an openly accessible Internet-based crowdsourcing platform that was launched in 2009 for the surveillance of foodborne illness. The goal of this system is to collect data that can be used to augment traditional approaches to foodborne disease surveillance. Methods: Individuals affected by a foodborne illness can use this system to report their symptoms and the suspected location (eg, restaurant, hotel, hospital) of infection. We present descriptive statistics of users and businesses and highlight three instances where reports of foodborne illness were submitted before the outbreaks were officially confirmed by the local departments of health. Results: More than 49,000 reports of suspected foodborne illness have been submitted on Iwaspoisoned.com since its inception by individuals from 89 countries and every state in the United States. Approximately 95.51% (42,139/44,119) of complaints implicated restaurants as the source of illness. Furthermore, an estimated 67.55% (3118/4616) of users who responded to a demographic survey were between the ages of 18 and 34, and 60.14% (2776/4616) of the respondents were female. The platform is also currently used by health departments in 90% (45/50) of states in the US to supplement existing programs on foodborne illness reporting. Conclusions: Crowdsourced disease surveillance through systems such as Iwaspoisoned.com uses the influence and familiarity of social media to create an infrastructure for easy reporting and surveillance of suspected foodborne illness events. If combined with traditional surveillance approaches, these systems have the potential to lessen the problem of foodborne illness underreporting and aid in early detection and monitoring of foodborne disease outbreaks. UR - http://publichealth.jmir.org/2017/3/e42/ UR - http://dx.doi.org/10.2196/publichealth.7076 UR - http://www.ncbi.nlm.nih.gov/pubmed/28679492 ID - info:doi/10.2196/publichealth.7076 ER - TY - JOUR AU - Aikin, J. Kathryn AU - Sullivan, W. Helen AU - Dolina, Suzanne AU - Lynch, Molly AU - Squiers, B. Linda PY - 2017/07/04 TI - Direct-to-Consumer Promotion of Prescription Drugs on Mobile Devices: Content Analysis JO - J Med Internet Res SP - e225 VL - 19 IS - 7 KW - direct-to-consumer promotion KW - direct-to-consumer advertising KW - mobile devices KW - prescription drugs N2 - Background: US Food and Drug Administration (FDA) regulations state that any prescription drug promotion that presents drug benefits to consumers must also disclose certain information about the drug?s risks in a similar manner. Nearly three-quarters of all US mobile phone subscribers use a smartphone, and over half report receiving mobile advertisements on their device. Objective: The objective of this project was to investigate how prescription drugs are being promoted to consumers using mobile technologies. We were particularly interested in the presentation of drug benefits and risks, with regard to presence, placement, and prominence. Methods: We analyzed a sample of 51 mobile promotional communications and their associated linked landing pages. We assessed the content and format of the mobile communications and landing pages with regard to presentation of drug benefits and risks. Results: Of the 51 mobile communications we coded, 41% (21/51) were product claim communications (includes the drug name, benefits, and risks), 22% (11/51) were reminder communications (includes drug name only), and 37% (19/51) were help-seeking communications (includes information about the medical condition but not the drug name). Some of the product claim communications (5/21, 24%) required scrolling to see all the benefit information; in contrast, 95% (20/21) required scrolling to see all the risk information. Of the 19 product claim communications that presented both benefits and risks, 95% (18/19) presented benefits before risks and 47% (9/19) used a bigger font for benefits than for risks. Most mobile communications (35/51, 69%) linked to branded drug websites with both benefits and risks, 25% (13/51) linked to a landing page with benefits but no visible risks, and 6% (3/51) linked to a landing page with risks but no visible benefits. Few landing pages (4/51, 8%) required scrolling to see all the benefit information; in contrast, 51% (26/51) required scrolling to see all the risk information. Of the 35 landing pages with both benefit and risk information, 71% (25/35) presented benefits before risks and 51% (18/35) used a bigger font for benefits than for risks. Conclusions: These results indicate that, while risks and benefits are both represented in mobile communications and their associated landing pages, they are not equally prominent and accessible. This has implications for compliance with FDA fair balance regulations. UR - http://www.jmir.org/2017/7/e225/ UR - http://dx.doi.org/10.2196/jmir.7306 UR - http://www.ncbi.nlm.nih.gov/pubmed/28676469 ID - info:doi/10.2196/jmir.7306 ER - TY - JOUR AU - Nightingale, Ruth AU - Hall, Andrew AU - Gelder, Carole AU - Friedl, Simone AU - Brennan, Eileen AU - Swallow, Veronica PY - 2017/07/04 TI - Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration JO - J Med Internet Res SP - e235 VL - 19 IS - 7 KW - child KW - adolescent KW - long-term condition KW - chronic condition KW - self-management KW - self-care KW - mobile apps KW - apps KW - qualitative N2 - Background: Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. Objective: To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Methods: Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Results: Of the 27 interviews, 19 (70%) interviews were individual and 8 (30%) were joint?5 out of 8 (63%) joint interviews were with a child or young person and their parent, 1 out of 8 (13%) were with a child and both parents, and 2 out of 8 (25%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management app. Reported gaps included the fact that current online information is not usually appropriate for children as it is ?dry? and ?boring,? could be ?scary,? and was either hard to understand or not relevant to individuals? circumstances. For children, searching online was much less accessible than using a professional-endorsed mobile app. Children also reported difficulty explaining their condition to others, maintaining treatment adherence, coping with feeling isolated, and with trying to live a ?normal? life. There was recognition that a developmentally appropriate, CKD-specific app could support the process of explaining the condition to healthy peers, reducing isolation, adhering to care-management plans, and living a ?normal? life. Participants recommended a range of media and content to include in a tailored, interactive, age- and developmentally appropriate app. For example, the user would be able to enter their age and diagnosis so that only age-appropriate and condition-specific content is displayed. Conclusions: Future development of a digital app that meets the identified information and support needs and preferences of children with CKD will maximize its utility, thereby augmenting CKD caregiving and optimizing outcomes. UR - http://www.jmir.org/2017/7/e235/ UR - http://dx.doi.org/10.2196/jmir.7760 UR - http://www.ncbi.nlm.nih.gov/pubmed/28676470 ID - info:doi/10.2196/jmir.7760 ER - TY - JOUR AU - Boyle, Leah AU - Grainger, Rebecca AU - Hall, M. Rosemary AU - Krebs, D. Jeremy PY - 2017/06/30 TI - Use of and Beliefs About Mobile Phone Apps for Diabetes Self-Management: Surveys of People in a Hospital Diabetes Clinic and Diabetes Health Professionals in New Zealand JO - JMIR Mhealth Uhealth SP - e85 VL - 5 IS - 6 KW - mHealth, mobile applications KW - telemedicine KW - diabetes mellitus N2 - Background: People with diabetes mellitus (DM) are using mobile phone apps to support self-management. The numerous apps available to assist with diabetes management have a variety of functions. Some functions, like insulin dose calculators, have significant potential for harm. Objectives: The study aimed to establish (1) whether people with DM in Wellington, New Zealand, use apps for DM self-management and evaluate desirable features of apps and (2) whether health professionals (HPs) in New Zealand treating people with DM recommend apps to patients, the features HPs regard as important, and their confidence with recommending apps. Methods: A survey of patients seen at a hospital diabetes clinic over 12 months (N=539) assessed current app use and desirable features. A second survey of HPs attending a diabetes conference (n=286) assessed their confidence with app recommendations and perceived usefulness. Results: Of the 189 responders (35.0% response rate) to the patient survey, 19.6% (37/189) had used a diabetes app. App users were younger and in comparison to other forms of diabetes mellitus, users prominently had type 1 DM. The most favored feature of the app users was a glucose diary (87%, 32/37), and an insulin calculator was the most desirable function for a future app (46%, 17/37). In non-app users, the most desirable feature for a future app was a glucose diary (64.4%, 98/152). Of the 115 responders (40.2% response rate) to the HPs survey, 60.1% (68/113) had recommended a diabetes app. Diaries for blood glucose levels and carbohydrate counting were considered the most useful app features and the features HPs felt most confident to recommend. HPs were least confident in recommending insulin calculation apps. Conclusions: The use of apps to record blood glucose was the most favored function in apps used by people with diabetes, with interest in insulin dose calculating function. HPs do not feel confident in recommending insulin dose calculators. There is an urgent need for an app assessment process to give confidence in the quality and safety of diabetes management apps to people with diabetes (potential app users) and HPs (potential app prescribers). UR - http://mhealth.jmir.org/2017/6/e85/ UR - http://dx.doi.org/10.2196/mhealth.7263 UR - http://www.ncbi.nlm.nih.gov/pubmed/28666975 ID - info:doi/10.2196/mhealth.7263 ER - TY - JOUR AU - Grundy, Quinn AU - Held, P. Fabian AU - Bero, A. Lisa PY - 2017/06/28 TI - Tracing the Potential Flow of Consumer Data: A Network Analysis of Prominent Health and Fitness Apps JO - J Med Internet Res SP - e233 VL - 19 IS - 6 KW - mobile health KW - smartphone KW - privacy N2 - Background: A great deal of consumer data, collected actively through consumer reporting or passively through sensors, is shared among apps. Developers increasingly allow their programs to communicate with other apps, sensors, and Web-based services, which are promoted as features to potential users. However, health apps also routinely pose risks related to information leaks, information manipulation, and loss of information. There has been less investigation into the kinds of user data that developers are likely to collect, and who might have access to it. Objective: We sought to describe how consumer data generated from mobile health apps might be distributed and reused. We also aimed to outline risks to individual privacy and security presented by this potential for aggregating and combining user data across apps. Methods: We purposively sampled prominent health and fitness apps available in the United States, Canada, and Australia Google Play and iTunes app stores in November 2015. Two independent coders extracted data from app promotional materials on app and developer characteristics, and the developer-reported collection and sharing of user data. We conducted a descriptive analysis of app, developer, and user data collection characteristics. Using structural equivalence analysis, we conducted a network analysis of sampled apps? self-reported sharing of user-generated data. Results: We included 297 unique apps published by 231 individual developers, which requested 58 different permissions (mean 7.95, SD 6.57). We grouped apps into 222 app families on the basis of shared ownership. Analysis of self-reported data sharing revealed a network of 359 app family nodes, with one connected central component of 210 app families (58.5%). Most (143/222, 64.4%) of the sampled app families did not report sharing any data and were therefore isolated from each other and from the core network. Fifteen app families assumed more central network positions as gatekeepers on the shortest paths that data would have to travel between other app families. Conclusions: This cross-sectional analysis highlights the possibilities for user data collection and potential paths that data is able to travel among a sample of prominent health and fitness apps. While individual apps may not collect personally identifiable information, app families and the partners with which they share data may be able to aggregate consumer data, thus achieving a much more comprehensive picture of the individual consumer. The organizations behind the centrally connected app families represent diverse industries, including apparel manufacturers and social media platforms that are not traditionally involved in health or fitness. This analysis highlights the potential for anticipated and voluntary but also possibly unanticipated and involuntary sharing of user data, validating privacy and security concerns in mobile health. UR - http://www.jmir.org/2017/6/e233/ UR - http://dx.doi.org/10.2196/jmir.7347 UR - http://www.ncbi.nlm.nih.gov/pubmed/28659254 ID - info:doi/10.2196/jmir.7347 ER - TY - JOUR AU - Hmone, Pan Myat AU - Li, Mu AU - Alam, Ashraful AU - Dibley, J. Michael PY - 2017/06/28 TI - Mobile Phone Short Messages to Improve Exclusive Breastfeeding and Reduce Adverse Infant Feeding Practices: Protocol for a Randomized Controlled Trial in Yangon, Myanmar JO - JMIR Res Protoc SP - e126 VL - 6 IS - 6 KW - randomized controlled trial KW - mHealth KW - text messaging (SMS) KW - intervention studies KW - exclusive breastfeeding KW - infant and young child feeding KW - nutrition KW - Myanmar KW - pregnant women KW - child health N2 - Background: Myanmar has a high burden of mortality for children aged younger than 5 years in which undernutrition plays a major role. Despite current efforts, the exclusive breastfeeding rate for children under 6 months is only 24%. To date there have been no interventions using mobile phones to improve breastfeeding and other feeding practices in Myanmar. Objective: This study aims to implement a breastfeeding promotion intervention using mobile phone text messages in Yangon, Myanmar, and evaluate its impact on breastfeeding practices. Methods: M528 is a 2-group parallel-arm randomized controlled trial with 9 months follow-up from recruitment until 6 months post-delivery. A total of 353 pregnant women between 28 and 34 weeks? gestation who had access to a mobile phone and were able to read and write have been recruited from the Central Women?s Hospital, Yangon, and allocated randomly to an intervention or control group in a 1:1 ratio. The intervention group received breastfeeding promotional SMS messages 3 times a week while the control group received maternal and child health care messages (excluding breastfeeding-related messages) once a week. The SMS messages were tailored for the women?s stage of gestation or the child?s age. A formative qualitative study was conducted prior to the trial to inform the study design and text message content. We hypothesize that the exclusive breastfeeding rate in the intervention group will be double that in the control group. The primary outcome is exclusive breastfeeding from birth to 6 months and secondary outcomes are median durations of exclusive breastfeeding and other infant feeding practices. Both primary and secondary outcomes were assessed by monthly phone calls at 1 to 6 months postdelivery in both groups. Participants? delivery status was tracked through text messages, phone calls, and hospital records, and delivery characteristics were assessed 1 month after delivery. Child morbidity and breastfeeding self-efficacy scores were assessed at 1, 3, and 5 months postdelivery. Social desirability was measured at 5 months, and text messages expressing delivery success and user experience were assessed at the end of the study. Results: The targeted 353 pregnant women were recruited between January and March 2015. Baseline data have been collected; SMS messages have been developed and pretested and sent to the women from both groups. Follow-up data collection via phone calls has been completed. Data analysis is being done and results are expected soon. This is the first RCT study examining the effects of mobile text messaging for promoting exclusive breastfeeding. Conclusions: This trial is timely in Myanmar following the telecommunications market opening in 2014. Our results will help determine whether text messaging is an effective and feasible method for promoting appropriate feeding practices and will inform further research to assess how this model could be replicated in the broader community. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12615000063516; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367704 (Archived by WebCite at http://www.webcitation.org/ 6rGif3l81) UR - http://www.researchprotocols.org/2017/6/e126/ UR - http://dx.doi.org/10.2196/resprot.7679 UR - http://www.ncbi.nlm.nih.gov/pubmed/28659252 ID - info:doi/10.2196/resprot.7679 ER - TY - JOUR AU - Marsolo, Keith AU - Shuman, William AU - Nix, Jeremy AU - Morrison, F. Caroline AU - Mullins, L. Larry AU - Pai, LH Ahna PY - 2017/06/26 TI - Reducing Parental Uncertainty Around Childhood Cancer: Implementation Decisions and Design Trade-Offs in Developing an Electronic Health Record-Linked Mobile App JO - JMIR Res Protoc SP - e122 VL - 6 IS - 6 KW - electronic health records KW - mobile apps KW - uncertainty KW - ethnographic design N2 - Background: Parents of children newly diagnosed with cancer are confronted with multiple stressors that place them at risk for significant psychological distress. One strategy that has been shown to help reduce uncertainty is the provision of basic information; however, families of newly diagnosed cancer patients are often bombarded with educational material. Technology has the potential to help families manage their informational needs and move towards normalization. Objective: The aim of this study was to create a mobile app that pulls together data from both the electronic health record (EHR) and vetted external information resources to provide tailored information to parents of newly diagnosed children as one method to reduce the uncertainty around their child?s illness. This app was developed to be used by families in a National Institutes of Health (NIH)-funded randomized controlled trial (RCT) aimed at decreasing uncertainty and the subsequent psychological distress. Methods: A 2-phase qualitative study was conducted to elicit the features and content of the mobile app based on the needs and experience of parents of children newly diagnosed with cancer and their providers. Example functions include the ability to view laboratory results, look up appointments, and to access educational material. Educational material was obtained from databases maintained by the National Cancer Institute (NCI) as well as from groups like the Children?s Oncology Group (COG) and care teams within Cincinnati Children?s Hospital Medical Center (CCHMC). The use of EHR-based Web services was explored to allow data like laboratory results to be retrieved in real-time. Results: The ethnographic design process resulted in a framework that divided the content of the mobile app into the following 4 sections: (1) information about the patient?s current treatment and other data from the EHR; (2) educational background material; (3) a calendar to view upcoming appointments at their medical center; and (4) a section where participants in the RCT document the study data. Integration with the NCI databases was straightforward; however, accessing the EHR Web services posed a challenge, though the roadblocks were not technical in nature. The lack of a formal, end-to-end institutional process for requesting Web service access and a mechanism to shepherd the request through all stages of implementation proved to be the biggest barrier. Conclusions: We successfully deployed a mobile app with a custom user interface that can integrate with the EHR to retrieve laboratory results and appointment information using vendor-provided Web services. Developers should expect to face hurdles when integrating with the EHR, but many of them can be addressed with frequent communication and thorough documentation. Executive sponsorship is also a key factor for success. Trial Registration: ClinicalTrials.gov NCT02505165; https://clinicaltrials.gov/ct2/show/NCT02505165 (Archived by WebCite at http://www.Webcitation.org/6r9ZSUgoT) UR - http://www.researchprotocols.org/2017/6/e122/ UR - http://dx.doi.org/10.2196/resprot.7523 UR - http://www.ncbi.nlm.nih.gov/pubmed/28652227 ID - info:doi/10.2196/resprot.7523 ER - TY - JOUR AU - Holmen, Heidi AU - Wahl, Klopstad Astrid AU - Cvancarova Småstuen, Milada AU - Ribu, Lis PY - 2017/06/23 TI - Tailored Communication Within Mobile Apps for Diabetes Self-Management: A Systematic Review JO - J Med Internet Res SP - e227 VL - 19 IS - 6 KW - diabetes mellitus (MeSH) KW - communication (MeSH) KW - mobile apps KW - self-management KW - systematic review KW - mHealth N2 - Background: The prevalence of diabetes is increasing and with the requirements for self-management and risk of late complications, it remains a challenge for the individual and society. Patients can benefit from support from health care personnel in their self-management, and the traditional communication between patients and health care personnel is changing. Smartphones and apps offer a unique platform for communication, but apps with integrated health care personnel communication based on patient data are yet to be investigated to provide evidence of possible effects. Objective: Our goal was to systematically review studies that aimed to evaluate integrated communication within mobile apps for tailored feedback between patients with diabetes and health care personnel in terms of (1) study characteristics, (2) functions, (3) study outcomes, (4) effects, and (5) methodological quality. Methods: A systematic literature search was conducted following our International Prospective Register of Systematic Reviews (PROSPERO) protocol, searching for apps with integrated communication for persons with diabetes tested in a controlled trial in the period 2008 to 2016. We searched the databases PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, Excerpta Medica database (EMBASE), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform. The search was closed in September 2016. Reference lists of primary articles and review papers were assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and we applied the Cochrane risk of bias tool to assess methodological quality. Results: We identified 2822 citations and after duplicate removal, we assessed 1128 citations. A total of 6 papers were included in this systematic review, reporting on data from 431 persons participating in small trials of short duration. The integrated communication features were mostly individualized as written non?real-time feedback. The number of functions varied from 2 to 9, and blood glucose tracking was the most common. HbA1c was the most common primary outcome, but the remaining reported outcomes were not standardized and comparable. Because of both the heterogeneity of the included trials and the poor methodological quality of the studies, a meta-analysis was not possible. A statistically significant improvement in the primary measure of outcome was found in 3 of the 6 included studies, of which 2 were HbA1c and 1 was mean daytime ambulatory blood pressure. Participants in the included trials reported positive usability or feasibility postintervention in 5 out of 6 trials. The overall methodological quality of the trials was, however, scored as an uncertain risk of bias. Conclusions: This systematic review highlights the need for more trials of higher methodological quality. Few studies offer an integrated function for communication and feedback from health care personnel, and the research field represents an area of heterogeneity with few studies of highly rigorous methodological quality. This, in combination with a low number of participants and a short follow-up, is making it difficult to provide reliable evidence of effects for stakeholders. UR - http://www.jmir.org/2017/6/e227/ UR - http://dx.doi.org/10.2196/jmir.7045 UR - http://www.ncbi.nlm.nih.gov/pubmed/28645890 ID - info:doi/10.2196/jmir.7045 ER - TY - JOUR AU - Wright, C. Cassandra J. AU - Dietze, M. Paul AU - Lim, C. Megan S. PY - 2017/06/20 TI - Beyond Basic Feedback in Mobile Brief Interventions: Designing SMS Message Content for Delivery to Young Adults During Risky Drinking Events JO - JMIR Mhealth Uhealth SP - e79 VL - 5 IS - 6 KW - alcohol drinking KW - young adult KW - mHealth KW - text messaging KW - motivational interviewing KW - community-based participatory research N2 - Background: Brief interventions can reduce alcohol consumption in young people through screening and delivery of personally relevant feedback. Recently, Web and mobile platforms have been harnessed to increase the reach of brief interventions. Existing literature on mobile-based alcohol brief interventions indicates mixed use of theory in developing interventions. There is no research available to guide the development of SMS text messaging (short message service, SMS) interventions delivered during risky drinking events. Objective: The aim of this study was to develop and pilot an alcohol-related risk-reduction brief intervention delivered by SMS to Australian young adults during drinking events. This paper describes the development of intervention message content, with specific focus on the context of delivery during drinking events. Methods: A sample of 42 young adults attended 4 workshops; these comprised focus-group style discussion on drinking habits and motivations, discussion of intervention design, analysis of existing alcohol media campaigns, and participant development of message content. Data were analyzed thematically. Results: Participants described a focus on having fun and blocking out any incongruent negative influences during drinking episodes. For content to be acceptable, nonjudgmental and non-authoritative language was deemed essential. A preference for short, actionable messages was observed, including suggestions for reminders around drinking water, organizing transport home, checking on friends, and plans the next day. Participants were excited about the potential for messages to be tailored to individuals, as previous alcohol-related campaigns were deemed too generic and often irrelevant. Normative-based messages were also perceived as largely irrelevant as participants felt that they understood the drinking-related norms of their immediate peers already. Conclusions: Findings from this study offer insights into young adults? drinking events and practical advice for designing alcohol-related brief interventions. During our formative development process, we demonstrated a neat correspondence between young people?s preferences for alcohol harm reduction interventions and the theoretical principles of brief interventions, including acceptable topics and message style. UR - http://mhealth.jmir.org/2017/6/e79/ UR - http://dx.doi.org/10.2196/mhealth.6497 UR - http://www.ncbi.nlm.nih.gov/pubmed/28634153 ID - info:doi/10.2196/mhealth.6497 ER - TY - JOUR UR - ID - ref1 ER - TY - JOUR AU - Chen, Yuzen Robert AU - Feltes, Robert Jordan AU - Tzeng, Shun William AU - Lu, Yunzhu Zoe AU - Pan, Michael AU - Zhao, Nan AU - Talkin, Rebecca AU - Javaherian, Kavon AU - Glowinski, Anne AU - Ross, Will PY - 2017/06/16 TI - Phone-Based Interventions in Adolescent Psychiatry: A Perspective and Proof of Concept Pilot Study With a Focus on Depression and Autism JO - JMIR Res Protoc SP - e114 VL - 6 IS - 6 KW - telemedicine KW - depression KW - autistic disorder KW - mobile applications KW - text messaging KW - child KW - mental health N2 - Background: Telemedicine has emerged as an innovative platform to diagnose and treat psychiatric disorders in a cost-effective fashion. Previous studies have laid the functional framework for monitoring and treating child psychiatric disorders electronically using videoconferencing, mobile phones (smartphones), and Web-based apps. However, phone call and text message (short message service, SMS) interventions in adolescent psychiatry are less studied than other electronic platforms. Further investigations on the development of these interventions are needed. Objective: The aim of this paper was to explore the utility of text message interventions in adolescent psychiatry and describe a user feedback-driven iterative design process for text message systems. Methods: We developed automated text message interventions using a platform for both depression (EpxDepression) and autism spectrum disorder (ASD; EpxAutism) and conducted 2 pilot studies for each intervention (N=3 and N=6, respectively). The interventions were prescribed by and accessible to the patients? healthcare providers. EpxDepression and EpxAutism utilized an automated system to triage patients into 1 of 3 risk categories based on their text responses and alerted providers directly via phone and an online interface when patients met provider-specified risk criteria. Rapid text-based feedback from participants and interviews with providers allowed for quick iterative cycles to improve interventions. Results: Patients using EpxDepression had high weekly response rates (100% over 2 to 4 months), but exhibited message fatigue with daily prompts with mean (SD) overall response rates of 66.3% (21.6%) and 64.7% (8.2%) for mood and sleep questionnaires, respectively. In contrast, parents using EpxAutism displayed both high weekly and overall response rates (100% and 85%, respectively, over 1 to 4 months) that did not decay significantly with time. Monthly participant feedback surveys for EpxDepression (7 surveys) and EpxAutism (18 surveys) preliminarily indicated that for both interventions, daily messages constituted the ?perfect amount? of contact and that EpxAutism, but not EpxDepression, improved patient communication with providers. Notably, EpxDepression detected thoughts of self-harm in patients before their case managers or caregivers were aware of such ideation. Conclusions: Text-message interventions in adolescent psychiatry can provide a cost-effective and engaging method to track symptoms, behavior, and ideation over time. Following the collection of pilot data and feedback from providers and patients, larger studies are already underway to validate the clinical utility of EpxDepression and EpxAutism. Trial Registration: Clinicaltrials.gov NCT03002311; https://clinicaltrials.gov/ct2/show/NCT03002311 (Archived by WebCite at http://www.webcitation.org/6qQtlCIS0) UR - http://www.researchprotocols.org/2017/6/e114/ UR - http://dx.doi.org/10.2196/resprot.7245 UR - http://www.ncbi.nlm.nih.gov/pubmed/28623183 ID - info:doi/10.2196/resprot.7245 ER - TY - JOUR AU - Mao, Yuqing Alice AU - Chen, Connie AU - Magana, Candy AU - Caballero Barajas, Karla AU - Olayiwola, Nwando J. PY - 2017/06/08 TI - A Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction in a National Payer Population: A Retrospective Study JO - JMIR Mhealth Uhealth SP - e80 VL - 5 IS - 6 KW - digital health coaching KW - overweight KW - obesity KW - mobile health KW - weight KW - blood pressure N2 - Background: The prevalence of obesity and associated metabolic conditions continue to be challenging and costly to address for health care systems; 71% of American adults were overweight, with 35% of men and 40% of women diagnosed with obesity in 2014. Digital health coaching is an innovative approach to decreasing the barriers of cost and accessibility of receiving health coaching for the prevention and management of chronic disease in overweight or obese individuals. Objective: To evaluate the early impact of a mobile phone-based health coaching service on weight loss and blood pressure management in a commercially insured population. Methods: This was a retrospective study using existing registry data from a pilot commercial collaboration between Vida Health and a large national insurance provider, which enrolled adult members who were overweight (body mass index >25 kg/m2) and able to engage in a mobile phone-based coaching intervention. Participants received 4 months of intensive health coaching via live video, phone, and text message through the Vida Health app. Participants were also provided with a wireless scale, pedometer, and blood pressure cuff. Of the 1012 enrolled, 763 (75.40%) participants had an initial weight upon enrollment and final weight between 3 and 5 months from enrollment; they served as our intervention group. There were 73 participants out of the 1012 (7.21%) who had weight data 4 months prior to and after Vida coaching, who served as the matched-pair control group. Results: Participants in the intervention group lost an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% (218/763) intervention participants achieved a clinically significant weight loss of 5% or more of TBW, with an average of 9.46% weight loss in this cohort. In the matched-pair control group, participants gained on average 1.81% TBW in 4 months without Vida coaching and lost, on average, 2.47% TBW after 4 months of Vida coaching, demonstrating a statistically significant difference of 4.28% in mean percentage weight change (P<.001). Among 151 intervention participants with blood pressure data, 112 (74.2%) had a baseline blood pressure that was above the goal (systolic blood pressure >120 mmHg); 55 out of 112 (49.1%) participants improved their blood pressure at 4 months by an entire hypertensive stage?as defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Conclusions: Mobile phone app-based health coaching interventions can be an acceptable and effective means to promote weight loss and improve blood pressure management in overweight or obese individuals. Given the ubiquity of mobile phones, digital health coaching may be an innovative solution to decreasing barriers of access to much-needed weight management interventions for obesity. UR - http://mhealth.jmir.org/2017/6/e80/ UR - http://dx.doi.org/10.2196/mhealth.7591 UR - http://www.ncbi.nlm.nih.gov/pubmed/28596147 ID - info:doi/10.2196/mhealth.7591 ER - TY - JOUR AU - Shen, Chen AU - Wang, Ping Man AU - Chu, TW Joanna AU - Wan, Alice AU - Viswanath, Kasisomayajula AU - Chan, Chee Sophia Siu AU - Lam, Hing Tai PY - 2017/06/05 TI - Health App Possession Among Smartphone or Tablet Owners in Hong Kong: Population-Based Survey JO - JMIR Mhealth Uhealth SP - e77 VL - 5 IS - 6 KW - apps KW - smartphone KW - Chinese N2 - Background: Health apps are increasingly used with important implications for health. Hong Kong is one of the most technologically advanced and connected cities?smartphone ownership and Internet access rates are among the highest in the world. Objective: We investigated the prevalence of health app possession and related sociodemographic factors and health behaviors among smartphone or tablet owners in Hong Kong. Methods: A territory-wide population-based dual (landline and mobile) telephone survey was conducted in 2016. Respondents were asked whether they had health-related apps on their smartphones or tablets and what functions were available on the apps (eg, tracking physical activity and logging health records). Logistic regression was used to calculate the adjusted odds ratio (aOR) and 95% CI of health app possession for different demographic characteristics, socioeconomic position (education, employment, and income), health behaviors (smoking, alcohol, and physical activity) and health (body mass index and chronic diseases). Results: Of the 4129 smartphone or tablet owners (81.28%, 4129/5080 respondents), 995 (24.10%) had a health app. Tracking physical activity (67.0% of 995) and logging health records (43.0% of 995) were the most common functions of the health apps. Overall, younger age, higher education, and household income were associated with having health apps (all P<.001). Compared with physical inactivity, engaging in moderate physical activity ?1 day/week was associated with having health apps (aOR 1.45 [95% CI 1.20-1.75] for 1-3 days/week, and aOR 1.32 [95% CI 1.07-1.62] for ?4 days/week). Having a history of chronic diseases was associated with having health apps (aOR 1.36 [95% CI 1.11-1.68]). Conclusions: We have shown a lower prevalence of use of information and communication technologies (ICTs) in respondents with lower education and income in the most developed Chinese city. This could be seen as a confirmation of the ?Inverse information law,? which suggests that those most in need have less use of services and hence receive less benefits from advancements in medicine and health related ICTs. UR - http://mhealth.jmir.org/2017/6/e77/ UR - http://dx.doi.org/10.2196/mhealth.7628 UR - http://www.ncbi.nlm.nih.gov/pubmed/28583905 ID - info:doi/10.2196/mhealth.7628 ER - TY - JOUR AU - King, Elizabeth AU - Kinvig, Karen AU - Steif, Jonathan AU - Qiu, Q. Annie AU - Maan, J. Evelyn AU - Albert, YK Arianne AU - Pick, Neora AU - Alimenti, Ariane AU - Kestler, H. Mary AU - Money, M. Deborah AU - Lester, T. Richard AU - Murray, Margaret Melanie Caroline PY - 2017/06/01 TI - Mobile Text Messaging to Improve Medication Adherence and Viral Load in a Vulnerable Canadian Population Living With Human Immunodeficiency Virus: A Repeated Measures Study JO - J Med Internet Res SP - e190 VL - 19 IS - 6 KW - mHealth KW - HIV KW - medication adherence KW - vulnerable KW - female KW - viral load KW - mobile phone KW - engagement N2 - Background: Combination antiretroviral therapy (cART) as treatment for human immunodeficiency virus (HIV) infection is effective and available, but poor medication adherence limits benefits, particularly in vulnerable populations. In a Kenyan randomized controlled trial, a weekly text-messaging intervention (WelTel) improved cART adherence and HIV viral load (VL). Despite growing evidence for short message service (SMS) text-message interventions in HIV care, there is a paucity of data utilizing these interventions in marginalized or female cohorts. Objective: This study was undertaken to assess whether the standardized WelTel SMS text-message intervention applied to a vulnerable, predominantly female, population improved cART adherence and VL. Methods: We conducted a repeated measures study of the WelTel intervention in high-risk HIV-positive persons by measuring change in VL, CD4 count, and self-reported adherence 12 months before and 12 months after the WelTel intervention was introduced. Inclusion criteria included VL ?200 copies/mL, indication for treatment, and meeting vulnerability criteria. Participants were given a mobile phone with unlimited texting (where required), and weekly check-in text messages were sent for one year from the WelTel computer platform. Clinical data were collected for control and intervention years. Participants were followed by a multidisciplinary team in a clinical setting. Outcomes were assessed using Wilcoxon signed ranks tests for change in CD4 and VL from control year to study end and mixed-effects logistic regressions for change in cART adherence and appointment attendance. A secondary analysis was conducted to assess the effect of response rate on the outcome by modeling final log10 VL by number of responses while controlling for mean log10 VL in the control year. Results: Eighty-five participants enrolled in the study, but 5 withdrew (final N=80). Participants were predominantly female (90%, 72/80) with a variety of vulnerabilities. Mean VL decreased from 1098 copies/mL in the control year to 439 copies/mL at study end (P=.004). Adherence to cART significantly improved (OR 1.14, IQR 1.10-1.18; P<.001), whereas appointment attendance decreased slightly with the intervention (OR 0.81, IQR 0.67-0.99; P=.03). A response was received for 46.57% (1753/3764) of messages sent and 9.62% (362/3764) of text messages sent were replied to with a problem. An outcome analysis examining relationship between reply rate and VL did not meet statistical significance (P=.07), but may be worthy of investigating further in a larger study. Conclusions: WelTel may be an effective tool for improving cART adherence and reducing VLs among high-risk, vulnerable HIV-positive persons. Trial Registration: Clinicaltrials.gov NCT02603536; https://clinicaltrials.gov/ct2/show/NCT02603536 (Archived by WebCite at http://www.webcitation.org/6qK57zCwv) UR - http://www.jmir.org/2017/6/e190/ UR - http://dx.doi.org/10.2196/jmir.6631 UR - http://www.ncbi.nlm.nih.gov/pubmed/28572079 ID - info:doi/10.2196/jmir.6631 ER - TY - JOUR AU - Mitchell, Marc AU - White, Lauren AU - Oh, Paul AU - Alter, David AU - Leahey, Tricia AU - Kwan, Matthew AU - Faulkner, Guy PY - 2017/05/30 TI - Uptake of an Incentive-Based mHealth App: Process Evaluation of the Carrot Rewards App JO - JMIR Mhealth Uhealth SP - e70 VL - 5 IS - 5 KW - financial incentives KW - mHealth KW - behavioral economics KW - public health N2 - Background: Behavioral economics has stimulated renewed interest in financial health incentives worldwide. The Carrot Rewards app was developed as part of a public-private partnership to reward Canadians with loyalty points (eg, movies and groceries) for downloading the app, referring friends, and completing an average of 1 to 2 educational health quizzes per week (?micro-learning?), with long-term objectives of increasing health knowledge and encouraging healthy behaviors. Objective: The main objective of this study was to evaluate uptake of a loyalty points-based mHealth app during the exclusive 3-month launch period in British Columbia (BC), Canada. The secondary aims were to describe the health and sociodemographic characteristics of users, as well as participation levels (eg, proportion of quizzes completed and friends referred). Methods: The app was promoted via loyalty program email campaigns (1.64 million emails). Number of downloads and registrations (users enter age, gender, and valid BC postal code to register) were collected. Additional sociodemographics were inferred by linking postal codes with census data at the local health area (LHA) level. Health risk assessments were also deployed. Participation levels were collected over 3 months and descriptive data were presented. Results: In 3 months, 67,464 individuals downloaded the app; in its first week, Carrot Rewards was the most downloaded health app in Canada. Among valid users (n=57,885; at least one quiz completed), the majority were female (62.96%; 36,446/57,885) and aged 18 to 34 years (54.34%; 31,459/57,885). More than half of the users (52.40%; 30,332/57,885) resided in LHAs where the median personal income was below the provincial average (Can $28,765). Furthermore, 64.42% (37,291/57,885) of users lived in metropolitan (ie, urban) LHAs, compared with 56.17% of the general BC population. The most prevalent risk factors were ?not? meeting physical activity guidelines (72.70%; 31,765/43,692) and ?not? getting the flu shot last year (67.69%; 30,286/44,739). Regarding participation, 60.05% (34,761/57,885) of users were classified as ?very high? engagers (>75% quiz completion rate). Conclusions: Early results suggest that loyalty points may promote mHealth app uptake. The app was downloaded by younger females especially, and BC residents from higher and lower income regions were equally represented. Loyalty points appear to have driven participation throughout the inaugural 3-month period (ie, quiz completion). UR - http://mhealth.jmir.org/2017/5/e70/ UR - http://dx.doi.org/10.2196/mhealth.7323 UR - http://www.ncbi.nlm.nih.gov/pubmed/28559224 ID - info:doi/10.2196/mhealth.7323 ER - TY - JOUR AU - Muench, Frederick AU - Baumel, Amit PY - 2017/05/26 TI - More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions JO - J Med Internet Res SP - e147 VL - 19 IS - 5 KW - alerts KW - digital triggers KW - text messaging KW - haptic triggers KW - reminder systems KW - push alerts KW - mHealth KW - mobile health KW - engagement KW - marketing KW - behavior change KW - behavioral medicine UR - http://www.jmir.org/2017/5/e147/ UR - http://dx.doi.org/10.2196/jmir.7463 UR - http://www.ncbi.nlm.nih.gov/pubmed/28550001 ID - info:doi/10.2196/jmir.7463 ER - TY - JOUR AU - Ezeanolue, Edozie Echezona AU - Gbadamosi, Olatunde Semiu AU - Olawepo, Olajide John AU - Iwelunmor, Juliet AU - Sarpong, Daniel AU - Eze, Chuka AU - Ogidi, Amaka AU - Patel, Dina AU - Onoka, Chima PY - 2017/05/26 TI - An mHealth Framework to Improve Birth Outcomes in Benue State, Nigeria: A Study Protocol JO - JMIR Res Protoc SP - e100 VL - 6 IS - 5 KW - mHealth KW - smart card KW - HIV KW - hepatitis B KW - sickle cell disease KW - mobile health technology KW - Nigeria N2 - Background: The unprecedented coverage of mobile technology across the globe has led to an increase in the use of mobile health apps and related strategies to make health information available at the point of care. These strategies have the potential to improve birth outcomes, but are limited by the availability of Internet services, especially in resource-limited settings such as Nigeria. Objective: Our primary objective is to determine the feasibility of developing an integrated mobile health platform that is able to collect data from community-based programs, embed collected data into a smart card, and read the smart card using a mobile phone-based app without the need for Internet access. Our secondary objectives are to determine (1) the acceptability of the smart card among pregnant women and (2) the usability of the smart card by pregnant women and health facilities in rural Nigeria. Methods: We will leverage existing technology to develop a platform that integrates a database, smart card technology, and a mobile phone-based app to read the smart cards. We will recruit 300 pregnant women with one of the three conditions?HIV, hepatitis B virus infection, and sickle cell trait or disease?and four health facilities in their community. We will use Glasgow?s Reach, Effectiveness, Adoption, Implementation, and Maintenance framework as a guide to assess the implementation, acceptability, and usability of the mHealth platform. Results: We have recruited four health facilities and 300 pregnant women with at least one of the eligible conditions. Over the course of 3 months, we will complete the development of the mobile health platform and each participant will be offered a smart card; staff in each health facility will receive training on the use of the mobile health platform. Conclusions: Findings from this study could offer a new approach to making health data from pregnant women available at the point of delivery without the need for an Internet connection. This would allow clinicians to implement evidence-based interventions in real time to improve health outcomes. Trial Registration: ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE) UR - http://www.researchprotocols.org/2017/5/e100/ UR - http://dx.doi.org/10.2196/resprot.7743 UR - http://www.ncbi.nlm.nih.gov/pubmed/28550003 ID - info:doi/10.2196/resprot.7743 ER - TY - JOUR AU - Goetz, Maren AU - Müller, Mitho AU - Matthies, Maria Lina AU - Hansen, Jenny AU - Doster, Anne AU - Szabo, Akos AU - Pauluschke-Fröhlich, Jan AU - Abele, Harald AU - Sohn, Christof AU - Wallwiener, Markus AU - Wallwiener, Stephanie PY - 2017/05/26 TI - Perceptions of Patient Engagement Applications During Pregnancy: A Qualitative Assessment of the Patient?s Perspective JO - JMIR Mhealth Uhealth SP - e73 VL - 5 IS - 5 KW - pregnancy KW - telemedicine KW - mobile applications KW - information procurement KW - patient participation KW - qualitative research N2 - Background: With growing demand for medical information and health applications in pregnancy, the potential of electronic health (eHealth) and mobile health (mHealth) solutions in clinical care is increasingly unfolding. However, we still do not know how pregnant women engage with mobile apps, how such apps impact routine medical care, and whether benefit expectations are met. Whereas recent research has raised the subject of user distribution and analyzed the content of pregnancy applications, there is still a significant knowledge gap regarding what pregnant women like and dislike about pregnancy tools, along with how such interventions could be improved. Objective: The aim of the study was to examine the perceptions and expectations of mobile and Web-based patient-engagement pregnancy applications. We assessed usability requirements, general acceptance of eHealth, and the impact of eHealth and mHealth pregnancy applications on the doctor-patient interaction and daily clinical routine. Methods: A qualitative study was conducted at the maternity department of a major German university hospital. The sample included 30 women with low- to medium-risk pregnancies. Half of the patients were seen during outpatient care and half were hospitalized for several days. The extent and frequency of Web- and mobile phone app usage were assessed. Semistructured interviews were conducted and analyzed using systematic thematic analysis. Results: Patients had a high demand for Web-based pregnancy applications. Study findings suggested a strong request for personalization, monitoring, and accessibility for frequent use as main themes derived from the interviews. Fostering patient empowerment in the doctor-patient relationship was also highly valued for a pregnancy app. Participants favored further integration of medical apps in their daily routine and pregnancy care. However, concerns were raised about content quality, trustworthiness of Web sources, and individual data security. Conclusions: eHealth and mHealth applications are a highly frequented source of information. Expectations and usability requirements for those applications are also high, thus posing a challenge to interdisciplinary service providers. Patients? attitude toward integrating apps in routine care settings was positive with a favorable influence on patient empowerment. Health care professionals should guide pregnant women toward a successful integration of these educational tools in pregnancy care. UR - http://mhealth.jmir.org/2017/5/e73/ UR - http://dx.doi.org/10.2196/mhealth.7040 UR - http://www.ncbi.nlm.nih.gov/pubmed/28550005 ID - info:doi/10.2196/mhealth.7040 ER - TY - JOUR AU - O'Brien, K. Megan AU - Shawen, Nicholas AU - Mummidisetty, K. Chaithanya AU - Kaur, Saninder AU - Bo, Xiao AU - Poellabauer, Christian AU - Kording, Konrad AU - Jayaraman, Arun PY - 2017/05/25 TI - Activity Recognition for Persons With Stroke Using Mobile Phone Technology: Toward Improved Performance in a Home Setting JO - J Med Internet Res SP - e184 VL - 19 IS - 5 KW - smartphone KW - activities of daily living KW - ambulatory monitoring KW - machine learning KW - stroke rehabilitation N2 - Background: Smartphones contain sensors that measure movement-related data, making them promising tools for monitoring physical activity after a stroke. Activity recognition (AR) systems are typically trained on movement data from healthy individuals collected in a laboratory setting. However, movement patterns change after a stroke (eg, gait impairment), and activities may be performed differently at home than in a lab. Thus, it is important to validate AR for gait-impaired stroke patients in a home setting for accurate clinical predictions. Objective: In this study, we sought to evaluate AR performance in a home setting for individuals who had suffered a stroke, by using different sets of training activities. Specifically, we compared AR performance for persons with stroke while varying the origin of training data, based on either population (healthy persons or persons with stoke) or environment (laboratory or home setting). Methods: Thirty individuals with stroke and fifteen healthy subjects performed a series of mobility-related activities, either in a laboratory or at home, while wearing a smartphone. A custom-built app collected signals from the phone?s accelerometer, gyroscope, and barometer sensors, and subjects self-labeled the mobility activities. We trained a random forest AR model using either healthy or stroke activity data. Primary measures of AR performance were (1) the mean recall of activities and (2) the misclassification of stationary and ambulatory activities. Results: A classifier trained on stroke activity data performed better than one trained on healthy activity data, improving average recall from 53% to 75%. The healthy-trained classifier performance declined with gait impairment severity, more often misclassifying ambulatory activities as stationary ones. The classifier trained on in-lab activities had a lower average recall for at-home activities (56%) than for in-lab activities collected on a different day (77%). Conclusions: Stroke-based training data is needed for high quality AR among gait-impaired individuals with stroke. Additionally, AR systems for home and community monitoring would likely benefit from including at-home activities in the training data. UR - http://www.jmir.org/2017/5/e184/ UR - http://dx.doi.org/10.2196/jmir.7385 UR - http://www.ncbi.nlm.nih.gov/pubmed/28546137 ID - info:doi/10.2196/jmir.7385 ER - TY - JOUR AU - Jongstra, Susan AU - Wijsman, Willemijn Liselotte AU - Cachucho, Ricardo AU - Hoevenaar-Blom, Peternella Marieke AU - Mooijaart, Pieter Simon AU - Richard, Edo PY - 2017/05/25 TI - Cognitive Testing in People at Increased Risk of Dementia Using a Smartphone App: The iVitality Proof-of-Principle Study JO - JMIR Mhealth Uhealth SP - e68 VL - 5 IS - 5 KW - telemedicine KW - cognition KW - neuropsychological tests N2 - Background: Smartphone-assisted technologies potentially provide the opportunity for large-scale, long-term, repeated monitoring of cognitive functioning at home. Objective: The aim of this proof-of-principle study was to evaluate the feasibility and validity of performing cognitive tests in people at increased risk of dementia using smartphone-based technology during a 6 months follow-up period. Methods: We used the smartphone-based app iVitality to evaluate five cognitive tests based on conventional neuropsychological tests (Memory-Word, Trail Making, Stroop, Reaction Time, and Letter-N-Back) in healthy adults. Feasibility was tested by studying adherence of all participants to perform smartphone-based cognitive tests. Validity was studied by assessing the correlation between conventional neuropsychological tests and smartphone-based cognitive tests and by studying the effect of repeated testing. Results: We included 151 participants (mean age in years=57.3, standard deviation=5.3). Mean adherence to assigned smartphone tests during 6 months was 60% (SD 24.7). There was moderate correlation between the firstly made smartphone-based test and the conventional test for the Stroop test and the Trail Making test with Spearman ?=.3-.5 (P<.001). Correlation increased for both tests when comparing the conventional test with the mean score of all attempts a participant had made, with the highest correlation for Stroop panel 3 (?=.62, P<.001). Performance on the Stroop and the Trail Making tests improved over time suggesting a learning effect, but the scores on the Letter-N-back, the Memory-Word, and the Reaction Time tests remained stable. Conclusions: Repeated smartphone-assisted cognitive testing is feasible with reasonable adherence and moderate relative validity for the Stroop and the Trail Making tests compared with conventional neuropsychological tests. Smartphone-based cognitive testing seems promising for large-scale data-collection in population studies. UR - http://mhealth.jmir.org/2017/5/e68/ UR - http://dx.doi.org/10.2196/mhealth.6939 UR - http://www.ncbi.nlm.nih.gov/pubmed/28546139 ID - info:doi/10.2196/mhealth.6939 ER - TY - JOUR AU - Liao, Gen-Yih AU - Chien, Yu-Tai AU - Chen, Yu-Jen AU - Hsiung, Hsiao-Fang AU - Chen, Hsiao-Jung AU - Hsieh, Meng-Hua AU - Wu, Wen-Jie PY - 2017/05/25 TI - What to Build for Middle-Agers to Come? Attractive and Necessary Functions of Exercise-Promotion Mobile Phone Apps: A Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e65 VL - 5 IS - 5 KW - physical exercise KW - middle aged KW - mobile application KW - self efficacy KW - consumer preference N2 - Background: Physical activity is important for middle-agers to maintain health both in middle age and in old age. Although thousands of exercise-promotion mobile phone apps are available for download, current literature offers little understanding regarding which design features can enhance middle-aged adults? quality perception toward exercise-promotion apps and which factor may influence such perception. Objectives: The aims of this study were to understand (1) which design features of exercise-promotion apps can enhance quality perception of middle-agers, (2) whether their needs are matched by current functions offered in app stores, and (3) whether physical activity (PA) and mobile phone self-efficacy (MPSE) influence quality perception. Methods: A total of 105 middle-agers participated and filled out three scales: the International Physical Activity Questionnaire (IPAQ), the MPSE scale, and the need for design features questionnaire. The design features were developed based on the Coventry, Aberdeen, and London?Refined (CALO-RE) taxonomy. Following the Kano quality model, the need for design features questionnaire asked participants to classify design features into five categories: attractive, one-dimensional, must-be, indifferent, and reverse. The quality categorization was conducted based on a voting approach and the categorization results were compared with the findings of a prevalence study to realize whether needs match current availability. In total, 52 multinomial logistic regression models were analyzed to evaluate the effects of PA level and MPSE on quality perception of design features. Results: The Kano analysis on the total sample revealed that visual demonstration of exercise instructions is the only attractive design feature, whereas the other 51 design features were perceived with indifference. Although examining quality perception by PA level, 21 features are recommended to low level, 6 features to medium level, but none to high-level PA. In contrast, high-level MPSE is recommended with 14 design features, medium level with 6 features, whereas low-level participants are recommended with 1 feature. The analysis suggests that the implementation of demanded features could be low, as the average prevalence of demanded design features is 20% (4.3/21). Surprisingly, social comparison and social support, most implemented features in current apps, were categorized into the indifferent category. The magnitude of effect is larger for MPSE because it effects quality perception of more design features than PA. Delving into the 52 regression models revealed that high MPSE more likely induces attractive or one- dimensional categorization, suggesting the importance of technological self-efficacy on eHealth care promotion. Conclusions: This study is the first to propose middle-agers? needs in relation to mobile phone exercise-promotion. In addition to the tailor-made recommendations, suggestions are offered to app designers to enhance the performance of persuasive features. An interesting finding on change of quality perception attributed to MPSE is proposed as future research. UR - http://mhealth.jmir.org/2017/5/e65/ UR - http://dx.doi.org/10.2196/mhealth.6233 UR - http://www.ncbi.nlm.nih.gov/pubmed/28546140 ID - info:doi/10.2196/mhealth.6233 ER - TY - JOUR AU - Grist, Rebecca AU - Porter, Joanna AU - Stallard, Paul PY - 2017/05/25 TI - Mental Health Mobile Apps for Preadolescents and Adolescents: A Systematic Review JO - J Med Internet Res SP - e176 VL - 19 IS - 5 KW - mobile apps KW - smartphone apps KW - mHealth KW - mental health KW - self-help KW - child KW - adolescent KW - preadolescent KW - review N2 - Background: There are an increasing number of mobile apps available for adolescents with mental health problems and an increasing interest in assimilating mobile health (mHealth) into mental health services. Despite the growing number of apps available, the evidence base for their efficacy is unclear. Objective: This review aimed to systematically appraise the available research evidence on the efficacy and acceptability of mobile apps for mental health in children and adolescents younger than 18 years. Methods: The following were systematically searched for relevant publications between January 2008 and July 2016: APA PsychNet, ACM Digital Library, Cochrane Library, Community Care Inform-Children, EMBASE, Google Scholar, PubMed, Scopus, Social Policy and Practice, Web of Science, Journal of Medical Internet Research, Cyberpsychology, Behavior and Social Networking, and OpenGrey. Abstracts were included if they described mental health apps (targeting depression, bipolar disorder, anxiety disorders, self-harm, suicide prevention, conduct disorder, eating disorders and body image issues, schizophrenia, psychosis, and insomnia) for mobile devices and for use by adolescents younger than 18 years. Results: A total of 24 publications met the inclusion criteria. These described 15 apps, two of which were available to download. Two small randomized trials and one case study failed to demonstrate a significant effect of three apps on intended mental health outcomes. Articles that analyzed the content of six apps for children and adolescents that were available to download established that none had undergone any research evaluation. Feasibility outcomes suggest acceptability of apps was good and app usage was moderate. Conclusions: Overall, there is currently insufficient research evidence to support the effectiveness of apps for children, preadolescents, and adolescents with mental health problems. Given the number and pace at which mHealth apps are being released on app stores, methodologically robust research studies evaluating their safety, efficacy, and effectiveness is promptly needed. UR - http://www.jmir.org/2017/5/e176/ UR - http://dx.doi.org/10.2196/jmir.7332 UR - http://www.ncbi.nlm.nih.gov/pubmed/28546138 ID - info:doi/10.2196/jmir.7332 ER - TY - JOUR AU - Zens, Martin AU - Grotejohann, Birgit AU - Tassoni, Adrian AU - Duttenhoefer, Fabian AU - Südkamp, P. Norbert AU - Niemeyer, Philipp PY - 2017/05/23 TI - Development of a Modular Research Platform to Create Medical Observational Studies for Mobile Devices JO - JMIR Res Protoc SP - e99 VL - 6 IS - 5 KW - mHealth KW - telemedicine KW - mobile health KW - app-based study KW - research platform N2 - Background: Observational studies have proven to be a valuable resource in medical research, especially when performed on a large scale. Recently, mobile device-based observational studies have been discovered by an increasing number of researchers as a promising new source of information. However, the development and deployment of app-based studies is not trivial and requires profound programming skills. Objective: The aim of this project was to develop a modular online research platform that allows researchers to create medical studies for mobile devices without extensive programming skills. Methods: The platform approach for a modular research platform consists of three major components. A Web-based platform forms the researchers? main workplace. This platform communicates via a shared database with a platform independent mobile app. Furthermore, a separate Web-based login platform for physicians and other health care professionals is outlined and completes the concept. Results: A prototype of the research platform has been developed and is currently in beta testing. Simple questionnaire studies can be created within minutes and published for testing purposes. Screenshots of an example study are provided, and the general working principle is displayed. Conclusions: In this project, we have created a basis for a novel research platform. The necessity and implications of a modular approach were displayed and an outline for future development given. International researchers are invited and encouraged to participate in this ongoing project UR - http://www.researchprotocols.org/2017/5/e99/ UR - http://dx.doi.org/10.2196/resprot.7705 UR - http://www.ncbi.nlm.nih.gov/pubmed/28536095 ID - info:doi/10.2196/resprot.7705 ER - TY - JOUR AU - Kim, YB Ben AU - Lee, Joon PY - 2017/05/23 TI - Smart Devices for Older Adults Managing Chronic Disease: A Scoping Review JO - JMIR Mhealth Uhealth SP - e69 VL - 5 IS - 5 KW - mobile health KW - mHealth KW - smartphone KW - mobile phone KW - tablet KW - older adults KW - seniors KW - chronic disease KW - chronic disease management KW - scoping review N2 - Background: The emergence of smartphones and tablets featuring vastly advancing functionalities (eg, sensors, computing power, interactivity) has transformed the way mHealth interventions support chronic disease management for older adults. Baby boomers have begun to widely adopt smart devices and have expressed their desire to incorporate technologies into their chronic care. Although smart devices are actively used in research, little is known about the extent, characteristics, and range of smart device-based interventions. Objective: We conducted a scoping review to (1) understand the nature, extent, and range of smart device-based research activities, (2) identify the limitations of the current research and knowledge gap, and (3) recommend future research directions. Methods: We used the Arksey and O?Malley framework to conduct a scoping review. We identified relevant studies from MEDLINE, Embase, CINAHL, and Web of Science databases using search terms related to mobile health, chronic disease, and older adults. Selected studies used smart devices, sampled older adults, and were published in 2010 or after. The exclusion criteria were sole reliance on text messaging (short message service, SMS) or interactive voice response, validation of an electronic version of a questionnaire, postoperative monitoring, and evaluation of usability. We reviewed references. We charted quantitative data and analyzed qualitative studies using thematic synthesis. To collate and summarize the data, we used the chronic care model. Results: A total of 51 articles met the eligibility criteria. Research activity increased steeply in 2014 (17/51, 33%) and preexperimental design predominated (16/50, 32%). Diabetes (16/46, 35%) and heart failure management (9/46, 20%) were most frequently studied. We identified diversity and heterogeneity in the collection of biometrics and patient-reported outcome measures within and between chronic diseases. Across studies, we found 8 self-management supporting strategies and 4 distinct communication channels for supporting the decision-making process. In particular, self-monitoring (38/40, 95%), automated feedback (15/40, 38%), and patient education (13/40, 38%) were commonly used as self-management support strategies. Of the 23 studies that implemented decision support strategies, clinical decision making was delegated to patients in 10 studies (43%). The impact on patient outcomes was consistent with studies that used cellular phones. Patients with heart failure and asthma reported improved quality of life. Qualitative analysis yielded 2 themes of facilitating technology adoption for older adults and 3 themes of barriers. Conclusions: Limitations of current research included a lack of gerontological focus, dominance of preexperimental design, narrow research scope, inadequate support for participants, and insufficient evidence for clinical outcome. Recommendations for future research include generating evidence for smart device-based programs, using patient-generated data for advanced data mining techniques, validating patient decision support systems, and expanding mHealth practice through innovative technologies. UR - http://mhealth.jmir.org/2017/5/e69/ UR - http://dx.doi.org/10.2196/mhealth.7141 UR - http://www.ncbi.nlm.nih.gov/pubmed/28536089 ID - info:doi/10.2196/mhealth.7141 ER - TY - JOUR AU - Sandrick, Janice AU - Tracy, Doreen AU - Eliasson, Arn AU - Roth, Ashley AU - Bartel, Jeffrey AU - Simko, Melanie AU - Bowman, Tracy AU - Harouse-Bell, Karen AU - Kashani, Mariam AU - Vernalis, Marina PY - 2017/05/17 TI - Effect of a Counseling Session Bolstered by Text Messaging on Self-Selected Health Behaviors in College Students: A Preliminary Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e67 VL - 5 IS - 5 KW - health behaviors KW - diet habits KW - exercise KW - sleep KW - text telecommunications KW - universities N2 - Background: The college experience is often the first time when young adults live independently and make their own lifestyle choices. These choices affect dietary behaviors, exercise habits, techniques to deal with stress, and decisions on sleep time, all of which direct the trajectory of future health. There is a need for effective strategies that will encourage healthy lifestyle choices in young adults attending college. Objective: This preliminary randomized controlled trial tested the effect of coaching and text messages (short message service, SMS) on self-selected health behaviors in the domains of diet, exercise, stress, and sleep. A second analysis measured the ripple effect of the intervention on health behaviors not specifically selected as a goal by participants. Methods: Full-time students aged 18-30 years were recruited by word of mouth and campuswide advertisements (flyers, posters, mailings, university website) at a small university in western Pennsylvania from January to May 2015. Exclusions included pregnancy, eating disorders, chronic medical diagnoses, and prescription medications other than birth control. Of 60 participants, 30 were randomized to receive a single face-to-face meeting with a health coach to review results of behavioral questionnaires and to set a health behavior goal for the 8-week study period. The face-to-face meeting was followed by SMS text messages designed to encourage achievement of the behavioral goal. A total of 30 control subjects underwent the same health and behavioral assessments at intake and program end but did not receive coaching or SMS text messages. Results: The texting app showed that 87.31% (2187/2505) of messages were viewed by intervention participants. Furthermore, 28 of the 30 intervention participants and all 30 control participants provided outcome data. Among intervention participants, 22 of 30 (73%) showed improvement in health behavior goal attainment, with the whole group (n=30) showing a mean improvement of 88% (95% CI 39-136). Mean improvement in any behavioral domains was not seen in the control group. Intervention participants also increased their exercise significantly compared with controls, regardless of their self-selected goal category. The increased exercise was paralleled by significantly lower fasting glucose levels. Conclusions: The health coaching session plus tailored SMS text messages improved self-selected health behaviors with a modest ripple effect to include unselected health behaviors. Trial Registration: Clinicaltrials.gov NCT02476604; https://clinicaltrials.gov/ct2/show/NCT02476604 (Archived by WebCite at http://www.webcitation.org/6qAAryS5t) UR - http://mhealth.jmir.org/2017/5/e67/ UR - http://dx.doi.org/10.2196/mhealth.6638 UR - http://www.ncbi.nlm.nih.gov/pubmed/28526664 ID - info:doi/10.2196/mhealth.6638 ER - TY - JOUR AU - Dainty, N. Katie AU - Vaid, Haris AU - Brooks, C. Steven PY - 2017/05/17 TI - North American Public Opinion Survey on the Acceptability of Crowdsourcing Basic Life Support for Out-of-Hospital Cardiac Arrest With the PulsePoint Mobile Phone App JO - JMIR Mhealth Uhealth SP - e63 VL - 5 IS - 5 KW - sudden cardiac death KW - surveys and questionnaires KW - cardiopulmonary resuscitation KW - PulsePoint KW - North America N2 - Background: The PulsePoint Respond app is a novel system that can be implemented in emergency dispatch centers to crowdsource basic life support (BLS) for patients with cardiac arrest and facilitate bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator use while first responders are en route. Objective: The aim of this study was to conduct a North American survey to evaluate the public perception of the above-mentioned strategy, including acceptability and willingness to respond to alerts. Methods: We designed a Web-based survey administered by IPSOS Reid, an established external polling vendor. Sampling was designed to ensure broad representation using recent census statistics. Results: A total of 2415 survey responses were analyzed (1106 from Canada and 1309 from the United States). It was found that 98.37% (1088/1106) of Canadians and 96% (1259/1309) of Americans had no objections to PulsePoint being implemented in their community; 84.27% (932/1106) of Canadians and 55.61% (728/1309) of Americans said they would download the app to become a potential responder to cardiac arrest, respectively. Among Canadians, those who said they were likely to download PulsePoint were also more likely to have ever had CPR training (OR 1.7, 95% CI 1.2-2.4; P=.002); however, this was not true of American respondents (OR 1.0, 95% CI 0.79-1.3; P=.88). When asked to imagine themselves as a cardiac arrest victim, 95.39% (1055/1106) of Canadians and 92.44% (1210/1309) of Americans had no objections to receiving crowdsourced help in a public setting; 88.79% (982/1106) of Canadians and 84.87% (1111/1309) of Americans also had no objections to receiving help in a private setting, respectively. The most common concern identified with respect to PulsePoint implementation was a responder?s lack of ability, training, or access to proper equipment in a public setting. Conclusions: The North American public finds the concept of crowdsourcing BLS for out-of-hospital cardiac arrest to be acceptable. It demonstrates willingness to respond to PulsePoint CPR notifications and to accept help from others alerted by the app if they themselves suffered a cardiac arrest. UR - http://mhealth.jmir.org/2017/5/e63/ UR - http://dx.doi.org/10.2196/mhealth.6926 UR - http://www.ncbi.nlm.nih.gov/pubmed/28526668 ID - info:doi/10.2196/mhealth.6926 ER - TY - JOUR AU - Blocker, Oliver AU - Bullock, Alison AU - Morgan-Jones, Rhidian AU - Ghandour, Adel AU - Richardson, James PY - 2017/05/16 TI - Using Text Messaging in Long-Term Arthroplasty Follow-Up: A Pilot Study JO - JMIR Res Protoc SP - e88 VL - 6 IS - 5 KW - texting KW - text messages KW - short message service KW - patient outcome assessment KW - follow-up studies KW - arthroplasty N2 - Background: Patient-reported outcome measures (PROMs) and mobile technology have the potential to change the way patients are monitored following joint replacement surgery. Objective: The aim of this study was to determine the feasibility of text messaging to record PROMs in long-term follow-up of hip and knee arthroplasty. Our participants were 17 patients 2-years-plus post hip or knee arthroplasty attending clinic with a mobile telephone number on record. Methods: A simple PROM (Oswestry Very Short Form) was texted to the patient. Responses were compared to clinical, radiographic, and existing PROM findings. Patients were interviewed to discover their opinions on this use of texting. Results: A total of 11 patients engaged with the text messaging. Reasons for not engaging included wrong numbers, physical barriers, and lack of understanding. A total of 8 patients attending clinic allowed comparison of text messaging with clinical findings. The average age was 70 years. A total of 4 patient text messaging responses matched clinical and radiographic findings; 3 also matched PROM scores collected in clinic. The 3 patients with mixed responses had abnormal clinical, radiographic, or PROM findings. One patient?s text responses conflicted with clinical outcome. Analysis of patients? views showed a generally positive opinion: patients were happy to communicate with surgeons by text. Practical problems, PROM limitations, and trustworthiness of texting were highlighted. Conclusions: Engaging with changing technology creates challenges for patients and health care professionals. Despite this, our results suggest text messaging is a promising way to communicate with arthroplasty patients. Earlier integration of text communication in the patient pathway may be important and needs further research. UR - http://www.researchprotocols.org/2017/5/e88/ UR - http://dx.doi.org/10.2196/resprot.6047 UR - http://www.ncbi.nlm.nih.gov/pubmed/28512080 ID - info:doi/10.2196/resprot.6047 ER - TY - JOUR AU - Badawy, M. Sherif AU - Barrera, Leonardo AU - Sinno, G. Mohamad AU - Kaviany, Saara AU - O?Dwyer, C. Linda AU - Kuhns, M. Lisa PY - 2017/05/15 TI - Text Messaging and Mobile Phone Apps as Interventions to Improve Adherence in Adolescents With Chronic Health Conditions: A Systematic Review JO - JMIR Mhealth Uhealth SP - e66 VL - 5 IS - 5 KW - adolescents KW - medication adherence KW - chronic health conditions KW - chronic medical conditions KW - text messaging KW - mobile phone apps KW - smartphone apps KW - smartphone applications N2 - Background: The number of adolescents with chronic health conditions (CHCs) continues to increase. Medication nonadherence is a global challenge among adolescents across chronic conditions and is associated with poor health outcomes. While there has been growing interest in the use of mHealth technology to improve medication adherence among adolescents with CHCs, particularly text messaging and mobile phone apps, there has been no prior systematic review of their efficacy. Objective: The purpose of this review was to systematically evaluate the most recent evidence for the efficacy of text messaging and mobile phone apps as interventions to promote medication adherence among adolescents with CHCs. Methods: PubMed, Embase, CENTRAL, PsycINFO, Web of Science, Google Scholar, and additional databases were searched from 1995 until November 2015. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. The Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently screened titles/abstracts, assessed full-text articles, extracted data from included articles, and assessed their quality using Grades of Recommendation, Assessment, Development, and Evaluation criteria. Included studies were described in original research articles that targeted adherence in adolescents with CHCs (12-24 years-old). Results: Of the 1423 records examined, 15 met predefined criteria: text messaging (n=12) and mobile phone apps (n=3). Most studies were performed in the United States (11/15, 73%), were randomized-controlled trials (8/15, 53%), had a sample size <50 (11/15, 73%), and included adherence self-report and/or biomarkers (9/15, 60%). Only four studies were designed based on a theoretical framework. Approaches for text messaging and mobile phone app interventions varied across studies. Seven articles (7/15, 47%) reported significant improvement in adherence with moderate to large standardized mean differences. Most of the included studies were of low or moderate quality. Studies varied in sample size, methods of adherence assessment, and definition of adherence, which prohibited performing a meta-analysis. Conclusions: The use of text messaging and mobile phone app interventions to improve medication adherence among adolescents with CHCs has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. Further evaluation of short- and long-term efficacy and cost-effectiveness of these interventions is warranted given the early and evolving state of the science. UR - http://mhealth.jmir.org/2017/5/e66/ UR - http://dx.doi.org/10.2196/mhealth.7798 UR - http://www.ncbi.nlm.nih.gov/pubmed/28506955 ID - info:doi/10.2196/mhealth.7798 ER - TY - JOUR AU - Tricarico, Christopher AU - Peters, Robert AU - Som, Avik AU - Javaherian, Kavon AU - Ross, Will PY - 2017/05/15 TI - EpxMedTracking: Feasibility Evaluation of an SMS-Based Medication Adherence Tracking System in Community Practice JO - JMIR Res Protoc SP - e87 VL - 6 IS - 5 KW - medication adherence KW - eHealth KW - text messaging N2 - Background: Medication adherence remains a difficult problem to both assess and improve in patients. It is a multifactorial problem that goes beyond the commonly cited reason of forgetfulness. To date, eHealth (also known as mHealth and telehealth) interventions to improve medication adherence have largely been successful in improving adherence. However, interventions to date have used time- and cost-intensive strategies or focused solely on medication reminding, leaving much room for improvement in using a modality as flexible as eHealth. Objective: Our objective was to develop and implement a fully automated short message service (SMS)-based medication adherence system, EpxMedTracking, that reminds patients to take their medications, explores reasons for missed doses, and alerts providers to help address problems of medication adherence in real time. Methods: EpxMedTracking is a fully automated bidirectional SMS-based messaging system with provider involvement that was developed and implemented through Epharmix, Inc. Researchers analyzed 11 weeks of de-identified data from patients cared for by multiple provider groups in routine community practice for feasibility and functionality. Patients included were those in the care of a provider purchasing the EpxMedTracking tool from Epharmix and were enrolled from a clinic by their providers. The primary outcomes assessed were the rate of engagement with the system, reasons for missing doses, and self-reported medication adherence. Results: Of the 25 patients studied over the 11 weeks, 3 never responded and subsequently opted out or were deleted by their provider. No other patients opted out or were deleted during the study period. Across the 11 weeks of the study period, the overall weekly engagement rate was 85.9%. There were 109 total reported missed doses including ?I forgot? at 33 events (30.3%), ?I felt better? at 29 events (26.6%), ?out of meds? at 20 events (18.4%), ?I felt sick? at 19 events (17.4%), and ?other? at 3 events (2.8%). We also noted an increase in self-reported medication adherence in patients using the EpxMedTracking system. Conclusions: EpxMedTracking is an effective tool for tracking self-reported medication adherence over time. It uniquely identifies actionable reasons for missing doses for subsequent provider intervention in real time based on patient feedback. Patients enrolled on EpxMedTracking also self-report higher rates of medication adherence over time while on the system. UR - http://www.researchprotocols.org/2017/5/e87/ UR - http://dx.doi.org/10.2196/resprot.7223 UR - http://www.ncbi.nlm.nih.gov/pubmed/28506954 ID - info:doi/10.2196/resprot.7223 ER - TY - JOUR AU - Skrepnik, Nebojsa AU - Spitzer, Andrew AU - Altman, Roy AU - Hoekstra, John AU - Stewart, John AU - Toselli, Richard PY - 2017/05/09 TI - Assessing the Impact of a Novel Smartphone Application Compared With Standard Follow-Up on Mobility of Patients With Knee Osteoarthritis Following Treatment With Hylan G-F 20: A Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e64 VL - 5 IS - 5 KW - mobile health KW - mHealth KW - mobile apps KW - osteoarthritis KW - osteoarthritis, knee KW - hylan G-F 20 KW - Synvisc N2 - Background: Osteoarthritis (OA) is a leading cause of disability in the United States. Although no disease-modifying therapies exist, patients with knee OA who increase walking may reduce risk of functional limitations. Objective: The objective of the study is to evaluate the impact of a mobile app (OA GO) plus wearable activity monitor/pedometer (Jawbone UP 24) used for 90 days on the mobility of patients with knee OA treated with hylan G-F 20. Methods: Patients with knee OA aged 30 to 80 years who were eligible to receive hylan G-F 20 and were familiar with smartphone technology were enrolled in this randomized, multicenter, open-label study. Patients who had a body mass index above 35 kg/m2 were excluded. All patients received a single 6-mL injection of hylan G-F 20 and wore the Jawbone monitor. The patients were then randomized 1:1 to Jawbone and OA GO (Group A; n=107) with visible feedback (unblinded) or Jawbone only (Group B; n=104) with no visible feedback (blinded). The primary endpoint was mean change from baseline in steps per day at day 90 between Groups A and B. Results: Baseline characteristics were similar between groups. There were significant differences between the increases in least squares (LS) mean number of steps per day (1199 vs 467, P=.03) and the mean percentage change (35.8% vs 11.5%, P=.02) from baseline in favor of Group A over Group B. There was a greater reduction in pain from baseline during the 6-minute walk test in Group A versus Group B. (LS mean change: ?55.3 vs ?33.8, P=.007). Most patients (65.4%) and surveys of physicians (67.3%) reported they would be likely or very likely to use/recommend the devices. Patient Activity Measure-13 scores improved from baseline (LS mean change for Groups A and B: 5.0 vs 6.9), with no significant differences between groups. The occurrence of adverse events was similar in the 2 groups. Conclusions: Use of a novel smartphone app in conjunction with a wearable activity monitor provided additional improvement on mobility parameters such as steps per day and pain with walking in the 6-minute walk test in patients with knee OA who were treated with hylan G-F 20. Results also highlight the amenability of patients and physicians to using mobile health technology in the treatment of OA and suggest further study is warranted. UR - http://mhealth.jmir.org/2017/5/e64/ UR - http://dx.doi.org/10.2196/mhealth.7179 UR - http://www.ncbi.nlm.nih.gov/pubmed/28487266 ID - info:doi/10.2196/mhealth.7179 ER - TY - JOUR AU - Bastl, Katharina AU - Berger, Uwe AU - Kmenta, Maximilian PY - 2017/05/08 TI - Evaluation of Pollen Apps Forecasts: The Need for Quality Control in an eHealth Service JO - J Med Internet Res SP - e152 VL - 19 IS - 5 KW - pollen forecast KW - pollen information service KW - mobile app KW - pollen forecast quality KW - allergen avoidance N2 - Background: Pollen forecasts are highly valuable for allergen avoidance and thus raising the quality of life of persons concerned by pollen allergies. They are considered as valuable free services for the public. Careful scientific evaluation of pollen forecasts in terms of accurateness and reliability has not been available till date. Objective: The aim of this study was to analyze 9 mobile apps, which deliver pollen information and pollen forecasts, with a focus on their accurateness regarding the prediction of the pollen load in the grass pollen season 2016 to assess their usefulness for pollen allergy sufferers. Methods: The following number of apps was evaluated for each location: 3 apps for Vienna (Austria), 4 apps for Berlin (Germany), and 1 app each for Basel (Switzerland) and London (United Kingdom). All mobile apps were freely available. Today?s grass pollen forecast was compared throughout the defined grass pollen season at each respective location with measured grass pollen concentrations. Hit rates were calculated for the exact performance and for a tolerance in a range of ±2 and ±4 pollen per cubic meter. Results: In general, for most apps, hit rates score around 50% (6 apps). It was found that 1 app showed better results, whereas 3 apps performed less well. Hit rates increased when calculated with tolerances for most apps. In contrast, the forecast for the ?readiness to flower? for grasses was performed at a sufficiently accurate level, although only two apps provided such a forecast. The last of those forecasts coincided with the first moderate grass pollen load on the predicted day or 3 days after and performed even from about a month before well within the range of 3 days. Advertisement was present in 3 of the 9 analyzed apps, whereas an imprint mentioning institutions with experience in pollen forecasting was present in only three other apps. Conclusions: The quality of pollen forecasts is in need of improvement, and quality control for pollen forecasts is recommended to avoid potential harm to pollen allergy sufferers due to inadequate forecasts. The inclusion of information on reliability of provided forecasts and a similar handling regarding probabilistic weather forecasts should be considered. UR - http://www.jmir.org/2017/5/e152/ UR - http://dx.doi.org/10.2196/jmir.7426 UR - http://www.ncbi.nlm.nih.gov/pubmed/28483740 ID - info:doi/10.2196/jmir.7426 ER - TY - JOUR AU - Greenleaf, R. Abigail AU - Gibson, G. Dustin AU - Khattar, Christelle AU - Labrique, B. Alain AU - Pariyo, W. George PY - 2017/05/05 TI - Building the Evidence Base for Remote Data Collection in Low- and Middle-Income Countries: Comparing Reliability and Accuracy Across Survey Modalities JO - J Med Internet Res SP - e140 VL - 19 IS - 5 KW - mHealth KW - developing countries KW - Africa South of the Sahara KW - cell phones KW - health surveys KW - reproducibility of results KW - surveys and questionnaires KW - text messaging KW - interviews as topic KW - humans KW - research design KW - data collection methods N2 - Background: Given the growing interest in mobile data collection due to the proliferation of mobile phone ownership and network coverage in low- and middle-income countries (LMICs), we synthesized the evidence comparing estimates of health outcomes from multiple modes of data collection. In particular, we reviewed studies that compared a mode of remote data collection with at least one other mode of data collection to identify mode effects and areas for further research. Objective: The study systematically reviewed and summarized the findings from articles and reports that compare a mode of remote data collection to at least one other mode. The aim of this synthesis was to assess the reliability and accuracy of results. Methods: Seven online databases were systematically searched for primary and grey literature pertaining to remote data collection in LMICs. Remote data collection included interactive voice response (IVR), computer-assisted telephone interviews (CATI), short message service (SMS), self-administered questionnaires (SAQ), and Web surveys. Two authors of this study reviewed the abstracts to identify articles which met the primary inclusion criteria. These criteria required that the survey collected the data from the respondent via mobile phone or landline. Articles that met the primary screening criteria were read in full and were screened using secondary inclusion criteria. The four secondary inclusion criteria were that two or more modes of data collection were compared, at least one mode of data collection in the study was a mobile phone survey, the study had to be conducted in a LMIC, and finally, the study should include a health component. Results: Of the 11,568 articles screened, 10 articles were included in this study. Seven distinct modes of remote data collection were identified: CATI, SMS (singular sitting and modular design), IVR, SAQ, and Web surveys (mobile phone and personal computer). CATI was the most frequent remote mode (n=5 articles). Of the three in-person modes (face-to-face [FTF], in-person SAQ, and in-person IVR), FTF was the most common (n=11) mode. The 10 articles made 25 mode comparisons, of which 12 comparisons were from a single article. Six of the 10 articles included sensitive questions. Conclusions: This literature review summarizes the existing research about remote data collection in LMICs. Due to both heterogeneity of outcomes and the limited number of comparisons, this literature review is best positioned to present the current evidence and knowledge gaps rather than attempt to draw conclusions. In order to advance the field of remote data collection, studies that employ standardized sampling methodologies and study designs are necessary to evaluate the potential for differences by survey modality. UR - http://www.jmir.org/2017/5/e140/ UR - http://dx.doi.org/10.2196/jmir.7331 UR - http://www.ncbi.nlm.nih.gov/pubmed/28476728 ID - info:doi/10.2196/jmir.7331 ER - TY - JOUR AU - Ellis, A. Jennifer PY - 2017/05/05 TI - Leveraging Mobile Phones for Monitoring Risks for Noncommunicable Diseases in the Future JO - J Med Internet Res SP - e137 VL - 19 IS - 5 KW - mHealth KW - low- and middle-income countries KW - noncommunicable diseases KW - health systems strengthening UR - http://www.jmir.org/2017/5/e137/ UR - http://dx.doi.org/10.2196/jmir.7622 UR - http://www.ncbi.nlm.nih.gov/pubmed/28476721 ID - info:doi/10.2196/jmir.7622 ER - TY - JOUR AU - Gibson, G. Dustin AU - Pereira, Amanda AU - Farrenkopf, A. Brooke AU - Labrique, B. Alain AU - Pariyo, W. George AU - Hyder, A. Adnan PY - 2017/05/05 TI - Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review JO - J Med Internet Res SP - e139 VL - 19 IS - 5 KW - survey methodology KW - cellular phone KW - interactive voice response KW - short messages service KW - computer-assisted telephone interview KW - mobile phone surveys N2 - Background: National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys. Objective: The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs). Methods: Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53%). Two articles discussed the findings of 6 IVR surveys (6/19, 32%). Three SMS surveys were identified from 2 articles (3/19, 16%). Approximately 63% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times. Conclusions: Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey. UR - http://www.jmir.org/2017/5/e139/ UR - http://dx.doi.org/10.2196/jmir.7428 UR - http://www.ncbi.nlm.nih.gov/pubmed/28476725 ID - info:doi/10.2196/jmir.7428 ER - TY - JOUR AU - Labrique, Alain AU - Blynn, Emily AU - Ahmed, Saifuddin AU - Gibson, Dustin AU - Pariyo, George AU - Hyder, A. Adnan PY - 2017/05/05 TI - Health Surveys Using Mobile Phones in Developing Countries: Automated Active Strata Monitoring and Other Statistical Considerations for Improving Precision and Reducing Biases JO - J Med Internet Res SP - e121 VL - 19 IS - 5 KW - surveys and questionnaires KW - sampling studies KW - mobile health KW - mobile phone KW - research methodology UR - http://www.jmir.org/2017/5/e121/ UR - http://dx.doi.org/10.2196/jmir.7329 UR - http://www.ncbi.nlm.nih.gov/pubmed/28476726 ID - info:doi/10.2196/jmir.7329 ER - TY - JOUR AU - Ali, Joseph AU - Labrique, B. Alain AU - Gionfriddo, Kara AU - Pariyo, George AU - Gibson, G. Dustin AU - Pratt, Bridget AU - Deutsch-Feldman, Molly AU - Hyder, A. Adnan PY - 2017/05/05 TI - Ethics Considerations in Global Mobile Phone-Based Surveys of Noncommunicable Diseases: A Conceptual Exploration JO - J Med Internet Res SP - e110 VL - 19 IS - 5 KW - ethics KW - mobile phone survey KW - mHealth KW - noncommunicable diseases KW - research ethics KW - bioethics UR - http://www.jmir.org/2017/5/e110/ UR - http://dx.doi.org/10.2196/jmir.7326 UR - http://www.ncbi.nlm.nih.gov/pubmed/28476723 ID - info:doi/10.2196/jmir.7326 ER - TY - JOUR AU - Pariyo, W. George AU - Wosu, C. Adaeze AU - Gibson, G. Dustin AU - Labrique, B. Alain AU - Ali, Joseph AU - Hyder, A. Adnan PY - 2017/05/05 TI - Moving the Agenda on Noncommunicable Diseases: Policy Implications of Mobile Phone Surveys in Low and Middle-Income Countries JO - J Med Internet Res SP - e115 VL - 19 IS - 5 KW - NCDs KW - policy KW - mHealth KW - policy analysis KW - surveys UR - http://www.jmir.org/2017/5/e115/ UR - http://dx.doi.org/10.2196/jmir.7302 UR - http://www.ncbi.nlm.nih.gov/pubmed/28476720 ID - info:doi/10.2196/jmir.7302 ER - TY - JOUR AU - Hyder, A. Adnan AU - Wosu, C. Adaeze AU - Gibson, G. Dustin AU - Labrique, B. Alain AU - Ali, Joseph AU - Pariyo, W. George PY - 2017/05/05 TI - Noncommunicable Disease Risk Factors and Mobile Phones: A Proposed Research Agenda JO - J Med Internet Res SP - e133 VL - 19 IS - 5 KW - mHealth KW - noncommunicable disease KW - mobile phone KW - research agenda KW - survey UR - http://www.jmir.org/2017/5/e133/ UR - http://dx.doi.org/10.2196/jmir.7246 UR - http://www.ncbi.nlm.nih.gov/pubmed/28476722 ID - info:doi/10.2196/jmir.7246 ER - TY - JOUR AU - Miller, Lisa AU - Schüz, Benjamin AU - Walters, Julia AU - Walters, Haydn E. PY - 2017/05/02 TI - Mobile Technology Interventions for Asthma Self-Management: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e57 VL - 5 IS - 5 KW - asthma KW - mhealth KW - medication adherence KW - patient monitoring KW - behavior and behavior mechanisms KW - meta-analysis N2 - Background: Mobile technology interventions (MTI) are becoming increasingly popular in the management of chronic health behaviors. Most MTI allow individuals to monitor medication use, record symptoms, or store and activate disease-management action plans. Therefore, MTI may have the potential to improve low adherence to medication and action plans for individuals with asthma, which is associated with poor clinical outcomes. Objective: A systematic review and meta-analysis were conducted to evaluate the efficacy of MTI on clinical outcomes as well as adherence in individuals with asthma. As the use of evidence-based behavior change techniques (BCT) has been shown to improve intervention effects, we also conducted exploratory analyses to determine the role of BCT and engagement with MTI as moderators of MTI efficacy. Methods: We searched electronic databases for randomized controlled trials up until June 2016. Random effect models were used to assess the effect of MTI on clinical outcomes as well as adherence to preventer medication or symptom monitoring. Mixed effects models assessed whether the features of the MTI (ie, use of BCT) and how often a person engaged with MTI moderated the effects of MTI. Results: The literature search located 11 studies meeting the inclusion criteria, with 9 providing satisfactory data for meta-analysis. Compared with standard treatment, MTI had moderate to large effect sizes (Hedges g) on medication adherence and clinical outcomes. MTI had no additional effects on adherence or clinical outcomes when compared with paper-based monitoring. No moderator effects were found, and the number of studies was small. A narrative review of the two studies, which are not included in the meta-analysis, found similar results. Conclusions: This review indicated the efficacy of MTI for self-management in individuals with asthma and also indicated that MTI appears to be as efficacious as paper-based monitoring. This review also suggested a need for robust studies to examine the effects of BCT use and engagement on MTI efficacy to inform the evidence base for MTI in individuals with asthma. UR - https://mhealth.jmir.org/2017/5/e57/ UR - http://dx.doi.org/10.2196/mhealth.7168 UR - http://www.ncbi.nlm.nih.gov/pubmed/28465281 ID - info:doi/10.2196/mhealth.7168 ER - TY - JOUR AU - Bradway, Meghan AU - Carrion, Carme AU - Vallespin, Bárbara AU - Saadatfard, Omid AU - Puigdomènech, Elisa AU - Espallargues, Mireia AU - Kotzeva, Anna PY - 2017/05/02 TI - mHealth Assessment: Conceptualization of a Global Framework JO - JMIR Mhealth Uhealth SP - e60 VL - 5 IS - 5 KW - mhealth KW - evaluation KW - assessment KW - checklist KW - framework N2 - Background: The mass availability and use of mobile health (mHealth) technologies offers the potential for these technologies to support or substitute medical advice. However, it is worrisome that most assessment initiatives are still not able to successfully evaluate all aspects of mHealth solutions. As a result, multiple strategies to assess mHealth solutions are being proposed by medical regulatory bodies and similar organizations. Objective: We aim to offer a collective description of a universally applicable description of mHealth assessment initiatives, given their current and, as we see it, potential impact. In doing so, we recommend a common foundation for the development or update of assessment initiatives by addressing the multistakeholder issues that mHealth technology adds to the traditional medical environment. Methods: Organized by the Mobile World Capital Barcelona Foundation, we represent a workgroup consisting of patient associations, developers, and health authority representatives, including medical practitioners, within Europe. Contributions from each group?s diverse competencies has allowed us to create an overview of the complex yet similar approaches to mHealth evaluation that are being developed today, including common gaps in concepts and perspectives. In response, we summarize commonalities of existing initiatives and exemplify additional characteristics that we believe will strengthen and unify these efforts. Results: As opposed to a universal standard or protocol in evaluating mHealth solutions, assessment frameworks should respect the needs and capacity of each medical system or country. Therefore, we expect that the medical system will specify the content, resources, and workflow of assessment protocols in order to ensure a sustainable plan for mHealth solutions within their respective countries. Conclusions: A common framework for all mHealth initiatives around the world will be useful in order to assess whatever mHealth solution is desirable in different areas, adapting it to the specifics of each context, to bridge the gap between health authorities, patients, and mHealth developers. We aim to foster a more trusting and collaborative environment to safeguard the well-being of patients and citizens while encouraging innovation of technology and policy. UR - http://mhealth.jmir.org/2017/5/e60/ UR - http://dx.doi.org/10.2196/mhealth.7291 UR - http://www.ncbi.nlm.nih.gov/pubmed/28465282 ID - info:doi/10.2196/mhealth.7291 ER - TY - JOUR AU - Turner, Tami AU - Hingle, Melanie PY - 2017/04/26 TI - Evaluation of a Mindfulness-Based Mobile App Aimed at Promoting Awareness of Weight-Related Behaviors in Adolescents: A Pilot Study JO - JMIR Res Protoc SP - e67 VL - 6 IS - 4 KW - mindfulness KW - adolescent KW - mHealth KW - diet KW - physical activity KW - app N2 - Background: Mindfulness-based interventions are reported to be highly acceptable and have positive effects on youth, yet most are clinic- or school-based aimed at emotional regulation or academic performance. To provide flexible program delivery, we developed and tested a standalone mindfulness-based app aimed at improving weight-related behaviors (eg, diet, physical activity, sleep) in adolescents. Objective: Our objective was to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. Methods: In a single-arm pilot study, 15 adolescents (14-18 years) were prompted to access the app once a day, every day for 6 weeks. Outcomes were measured by in-app and poststudy surveys, and descriptive statistical analyses were performed. Time within a mindfulness state was self-reported during weekly timed practices. Results: The app was rated highly for content and encouraging the practice of activities to promote mindfulness states. Teens reported increased awareness of eating behaviors and high adherence, particularly during physically active practices. Average self-reported time spent in a mindfulness state increased 2.5 times by week 6 (78 [SD 17] seconds) compared to week 1 (31 [SD 21] seconds). Conclusions: The high acceptability and utility ratings of the app, increases in reported time in mindfulness states, and high frequency of participation, including mindful eating and physical activity, suggest the mindfulness-based mobile app has the potential to improve awareness of weight-related behaviors. UR - http://www.researchprotocols.org/2017/4/e67/ UR - http://dx.doi.org/10.2196/resprot.6695 UR - http://www.ncbi.nlm.nih.gov/pubmed/28446423 ID - info:doi/10.2196/resprot.6695 ER - TY - JOUR AU - Wen, Fred Cheng K. AU - Schneider, Stefan AU - Stone, A. Arthur AU - Spruijt-Metz, Donna PY - 2017/04/26 TI - Compliance With Mobile Ecological Momentary Assessment Protocols in Children and Adolescents: A Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e132 VL - 19 IS - 4 KW - ecological momentary assessment KW - compliance KW - youth KW - mHealth N2 - Background: Mobile device-based ecological momentary assessment (mobile-EMA) is increasingly used to collect participants' data in real-time and in context. Although EMA offers methodological advantages, these advantages can be diminished by participant noncompliance. However, evidence on how well participants comply with mobile-EMA protocols and how study design factors associated with participant compliance is limited, especially in the youth literature. Objective: To systematically and meta-analytically examine youth?s compliance to mobile-EMA protocols and moderators of participant compliance in clinical and nonclinical settings. Methods: Studies using mobile devices to collect EMA data among youth (age ?18 years old) were identified. A systematic review was conducted to describe the characteristics of mobile-EMA protocols and author-reported factors associated with compliance. Random effects meta-analyses were conducted to estimate the overall compliance across studies and to explore factors associated with differences in youths? compliance. Results: This review included 42 unique studies that assessed behaviors, subjective experiences, and contextual information. Mobile phones were used as the primary mode of EMA data collection in 48% (20/42) of the reviewed studies. In total, 12% (5/42) of the studies used wearable devices in addition to the EMA data collection platforms. About half of the studies (62%, 24/42) recruited youth from nonclinical settings. Most (98%, 41/42) studies used a time-based sampling protocol. Among these studies, most (95%, 39/41) prompted youth 2-9 times daily, for a study length ranging from 2-42 days. Sampling frequency and study length did not differ between studies with participants from clinical versus nonclinical settings. Most (88%, 36/41) studies with a time-based sampling protocol defined compliance as the proportion of prompts to which participants responded. In these studies, the weighted average compliance rate was 78.3%. The average compliance rates were not different between studies with clinical (76.9%) and nonclinical (79.2%; P=.29) and studies that used only a mobile-EMA platform (77.4%) and mobile platform plus additional wearable devices (73.0%, P=.36). Among clinical studies, the mean compliance rate was significantly lower in studies that prompted participants 2-3 times (73.5%) or 4-5 times (66.9%) compared with studies with a higher sampling frequency (6+ times: 89.3%). Among nonclinical studies, a higher average compliance rate was observed in studies that prompted participants 2-3 times daily (91.7%) compared with those that prompted participants more frequently (4-5 times: 77.4%; 6+ times: 75.0%). The reported compliance rates did not differ by duration of EMA period among studies from either clinical or nonclinical settings. Conclusions: The compliance rate among mobile-EMA studies in youth is moderate but suboptimal. Study design may affect protocol compliance differently between clinical and nonclinical participants; including additional wearable devices did not affect participant compliance. A more consistent compliance-related result reporting practices can facilitate understanding and improvement of participant compliance with EMA data collection among youth. UR - http://www.jmir.org/2017/4/e132/ UR - http://dx.doi.org/10.2196/jmir.6641 UR - http://www.ncbi.nlm.nih.gov/pubmed/28446418 ID - info:doi/10.2196/jmir.6641 ER - TY - JOUR AU - Iacoviello, M. Brian AU - Steinerman, R. Joshua AU - Klein, B. David AU - Silver, L. Theodore AU - Berger, G. Adam AU - Luo, X. Sean AU - Schork, J. Nicholas PY - 2017/04/25 TI - Clickotine, A Personalized Smartphone App for Smoking Cessation: Initial Evaluation JO - JMIR Mhealth Uhealth SP - e56 VL - 5 IS - 4 KW - smoking cessation KW - cigarette smoking KW - tobacco KW - therapeutics KW - smartphone N2 - Background: Tobacco smoking is the leading cause of preventable death in the United States, and the annual economic burden attributable to smoking exceeds US $300 billion. Obstacles to smoking cessation include limited access and adherence to effective cessation interventions. Technology can help overcome these obstacles; many smartphone apps have been developed to aid smoking cessation, but few that conform to the US clinical practice guideline (USCPG) have been rigorously tested and reported in the literature. Clickotine is a novel smartphone app for smoking cessation, designed to deliver the essential features of the USCPG and engineered to engage smokers by personalizing intervention components. Objective: Our objective was to assess the engagement, efficacy, and safety of Clickotine in an initial, single-arm study. Outcomes measured were indicators of engagement with the smartphone app (number of app opens, number of interactions with the Clickotine program, and weeks active with Clickotine), cessation outcomes of 7- and 30-day self-reported abstinence from smoking, and negative health events. Methods: We recruited US residents between 18 and 65 years of age who owned an iPhone and smoked 5 or more cigarettes daily for the study via online advertising. Respondents were prescreened for eligibility by telephone and, if appropriate, directed to a Web portal to provide informed consent, confirm eligibility, and download the Clickotine app. Participants completed study assessments via the online portal at baseline and after 8 weeks. Data were collected in Amazon S3 with no manual data entry, and access to all data was maximally restrictive, logged, and auditable. Results: A total of 416 participants downloaded the app and constituted the intention-to-treat (ITT) sample. On average, participants opened the Clickotine app 100.6 times during the 8-week study (median 69), logged 214.4 interactions with the Clickotine program (median 178), and remained engaged with Clickotine for 5.3 weeks (median 5). Among the ITT sample, 45.2% (188/416) reported 7-day abstinence and 26.2% (109/416) reported 30-day abstinence from smoking after 8 weeks. Completer analysis focused on 365 (87.7%) of the 416 enrolled participants who completed the 8-week questionnaire revealed that 51.5% (188/365) of completers reported 7-day abstinence and 29.9% (109/365) reported 30-day abstinence. Few adverse events, mostly consistent with nicotine withdrawal symptoms, were reported and overall no safety signal was detected. Conclusions: In this initial single-arm trial, Clickotine users appeared to demonstrate encouraging indicators of engagement in terms of the number of app opens, number of program interactions, and continued engagement over time. Clickotine users reported encouraging quit rates while reporting few adverse events. Future research is warranted to assess Clickotine?s efficacy in a randomized controlled trial. Trial Registration: Clinicaltrials.gov NCT02656745; https://clinicaltrials.gov/ct2/show/NCT02656745 (Archived by WebCite at http://www.webcitation.org/6peTT4x60) UR - http://mhealth.jmir.org/2017/4/e56/ UR - http://dx.doi.org/10.2196/mhealth.7226 UR - http://www.ncbi.nlm.nih.gov/pubmed/28442453 ID - info:doi/10.2196/mhealth.7226 ER - TY - JOUR AU - De Cock, Nathalie AU - Vangeel, Jolien AU - Lachat, Carl AU - Beullens, Kathleen AU - Vervoort, Leentje AU - Goossens, Lien AU - Maes, Lea AU - Deforche, Benedicte AU - De Henauw, Stefaan AU - Braet, Caroline AU - Eggermont, Steven AU - Kolsteren, Patrick AU - Van Camp, John AU - Van Lippevelde, Wendy PY - 2017/04/25 TI - Use of Fitness and Nutrition Apps: Associations With Body Mass Index, Snacking, and Drinking Habits in Adolescents JO - JMIR Mhealth Uhealth SP - e58 VL - 5 IS - 4 KW - mhealth KW - adolescents KW - snacks KW - beverages KW - body mass index N2 - Background: Efforts to improve snacking and drinking habits are needed to promote a healthy body mass index (BMI) in adolescents. Although commercial fitness and nutrition mobile phone apps are widely used, little is known regarding their potential to improve health behaviors, especially in adolescents. In addition, evidence on the mechanisms through which such fitness and nutrition apps influence behavior is lacking. Objectives: This study assessed whether the use of commercial fitness or nutrition apps was associated with a lower BMI and healthier snacking and drinking habits in adolescents. Additionally, it explored if perceived behavioral control to eat healthy; attitudes to eat healthy for the good taste of healthy foods, for overall health or for appearance; social norm on healthy eating and social support to eat healthy mediated the associations between the frequency of use of fitness or nutrition apps and BMI, the healthy snack, and beverage ratio. Methods: Cross-sectional self-reported data on snack and beverage consumption, healthy eating determinants, and fitness and nutrition app use of adolescents (N=889; mean age 14.7 years, SD 0.8; 54.8% [481/878] boys; 18.1% [145/803] overweight) were collected in a representative sample of 20 schools in Flanders, Belgium. Height and weight were measured by the researchers. The healthy snack ratio and the healthy beverage ratio were calculated as follows: gram healthy snacks or beverages/(gram healthy snacks or beverages+gram unhealthy snacks or beverages)×100. Multilevel regression and structural equation modeling were used to analyze the proposed associations and to explore multiple mediation. Results: A total of 27.6% (245/889) of the adolescents used fitness, nutrition apps or both. Frequency of using nutrition apps was positively associated with a higher healthy beverage ratio (b=2.96 [1.11], P=.008) and a higher body mass index z-scores (zBMI; b=0.13 [0.05], P=.008. A significant interaction was found between the frequency of using nutrition and for the zBMI (b=?0.03 [0.02], P=.04) and the healthy snack ratio (b=?0.84 [0.37], P=.03). Attitude to eat healthy for appearance mediated both the fitness app use frequency-zBMI (a × b=0.02 [0.01], P=.02) and the nutrition app use frequency-zBMI (a × b=0.04 [0.01], P=.001) associations. No mediation was observed for the associations between the frequency of use of fitness or nutrition apps and the healthy snack or beverage ratio. Conclusions: Commercial fitness and nutrition apps show some association with healthier eating behaviors and BMI in adolescents. However, effective behavior change techniques should be included to affect key determinants of healthy eating. UR - http://mhealth.jmir.org/2017/4/e58/ UR - http://dx.doi.org/10.2196/mhealth.6005 UR - http://www.ncbi.nlm.nih.gov/pubmed/28442455 ID - info:doi/10.2196/mhealth.6005 ER - TY - JOUR AU - Hayashi, Aki AU - Yamaguchi, Satoko AU - Waki, Kayo AU - Fujiu, Katsuhito AU - Hanafusa, Norio AU - Nishi, Takahiro AU - Tomita, Hyoe AU - Kobayashi, Haruka AU - Fujita, Hideo AU - Kadowaki, Takashi AU - Nangaku, Masaomi AU - Ohe, Kazuhiko PY - 2017/04/20 TI - Testing the Feasibility and Usability of a Novel Smartphone-Based Self-Management Support System for Dialysis Patients: A Pilot Study JO - JMIR Res Protoc SP - e63 VL - 6 IS - 4 KW - telemedicine KW - mobile phone app KW - hemodialysis KW - self-management N2 - Background: Diet and fluid restrictions that need continuous self-management are among the most difficult aspects of dialysis treatment. Smartphone applications may be useful for supporting self-management. Objective: Our objective is to investigate the feasibility and usability of a novel smartphone-based self-management support system for dialysis patients. Methods: We developed the Self-Management and Recording System for Dialysis (SMART-D), which supports self-monitoring of three mortality-related factors that can be modified by lifestyle: interdialytic weight gain and predialysis serum potassium and phosphorus concentrations. Data is displayed graphically, with all data evaluated automatically to determine whether they achieve the values suggested by the Japanese Society for Dialysis Therapy guidelines. In a pilot study, 9 dialysis patients used SMART-D system for 2 weeks. A total of 7 of them completed questionnaires rating their assessment of SMART-D?s usability and their satisfaction with the system. In addition, the Kidney Disease Quality of Life scale was compared before and after the study period. Results: All 9 participants were able to use SMART-D with no major problems. Completion rates for body weight, pre- and postdialysis weight, and serum potassium and phosphorus concentrations were, respectively, 89% (SD 23), 95% (SD 7), and 78% (SD 44). Of the 7 participants who completed the usability survey, all were motivated by the sense of security derived from using the system, and 6 of the 7 (86%) reported that using SMART-D helped improve their lifestyle and self-management. Conclusions: Using SMART-D was feasible, and the system was well regarded by patients. Further study with larger scale cohorts and longer study and follow-up periods is needed to evaluate the effects of SMART-D on clinical outcomes and quality of life. UR - http://www.researchprotocols.org/2017/4/e63/ UR - http://dx.doi.org/10.2196/resprot.7105 UR - http://www.ncbi.nlm.nih.gov/pubmed/28428168 ID - info:doi/10.2196/resprot.7105 ER - TY - JOUR AU - Salzwedel, Annett AU - Rabe, Sophie AU - Zahn, Thomas AU - Neuwirth, Julia AU - Eichler, Sarah AU - Haubold, Kathrin AU - Wachholz, Anne AU - Reibis, Rona AU - Völler, Heinz PY - 2017/04/19 TI - User Interest in Digital Health Technologies to Encourage Physical Activity: Results of a Survey in Students and Staff of a German University JO - JMIR Mhealth Uhealth SP - e51 VL - 5 IS - 4 KW - physical activity KW - telemedicine KW - primary prevention KW - healthy lifestyle N2 - Background: Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. Objective: The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. Methods: We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. Results: A total of 1217 students (67.30%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1% (340/485) of employees and 52.67% (641/1217) of students. Within these groups, 53.2% (341/641 students) and 44.2% (150/340 employees)?independent of age, sex, body mass index (BMI), and level of education or professional qualification?indicated an interest in mHealth fitness apps. Conclusions: Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle. UR - http://mhealth.jmir.org/2017/4/e51/ UR - http://dx.doi.org/10.2196/mhealth.7192 UR - http://www.ncbi.nlm.nih.gov/pubmed/28428156 ID - info:doi/10.2196/mhealth.7192 ER - TY - JOUR AU - Dayer, E. Lindsey AU - Shilling, Rebecca AU - Van Valkenburg, Madalyn AU - Martin, C. Bradley AU - Gubbins, O. Paul AU - Hadden, Kristie AU - Heldenbrand, Seth PY - 2017/04/19 TI - Assessing the Medication Adherence App Marketplace From the Health Professional and Consumer Vantage Points JO - JMIR Mhealth Uhealth SP - e45 VL - 5 IS - 4 KW - smartphone KW - apps KW - adherence KW - medication KW - health literacy N2 - Background: Nonadherence produces considerable health consequences and economic burden to patients and payers. One approach to improve medication nonadherence that has gained interest in recent years is the use of smartphone adherence apps. The development of smartphone adherence apps has increased rapidly since 2012; however, literature evaluating the clinical app and effectiveness of smartphone adherence apps to improve medication adherence is generally lacking. Objective: The aims of this study were to (1) provide an updated evaluation and comparison of medication adherence apps in the marketplace by assessing the features, functionality, and health literacy (HL) of the highest-ranking adherence apps and (2) indirectly measure the validity of our rating methodology by determining the relationship between our app evaluations and Web-based consumer ratings. Methods: Two independent reviewers assessed the features and functionality using a 4-domain rating tool of all adherence apps identified based on developer claims. The same reviewers downloaded and tested the 100 highest-ranking apps including an additional domain for assessment of HL. Pearson product correlations were estimated between the consumer ratings and our domain and total scores. Results: A total of 824 adherence apps were identified; of these, 645 unique apps were evaluated after applying exclusion criteria. The median initial score based on descriptions was 14 (max of 68; range 0-60). As a result, 100 of the highest-scoring unique apps underwent user testing. The median overall user-tested score was 31.5 (max of 73; range 0-60). The majority of the user tested the adherence apps that underwent user testing reported a consumer rating score in their respective online marketplace. The mean consumer rating was 3.93 (SD 0.84). The total user-tested score was positively correlated with consumer ratings (r=.1969, P=.04). Conclusions: More adherence apps are available in the Web-based marketplace, and the quality of these apps varies considerably. Consumer ratings are positively but weakly correlated with user-testing scores suggesting that our rating tool has some validity but that consumers and clinicians may assess adherence app quality differently. UR - http://mhealth.jmir.org/2017/4/e45/ UR - http://dx.doi.org/10.2196/mhealth.6582 UR - http://www.ncbi.nlm.nih.gov/pubmed/28428169 ID - info:doi/10.2196/mhealth.6582 ER - TY - JOUR AU - Carroll, K. Jennifer AU - Moorhead, Anne AU - Bond, Raymond AU - LeBlanc, G. William AU - Petrella, J. Robert AU - Fiscella, Kevin PY - 2017/04/19 TI - Who Uses Mobile Phone Health Apps and Does Use Matter? A Secondary Data Analytics Approach JO - J Med Internet Res SP - e125 VL - 19 IS - 4 KW - smartphone KW - cell phone KW - Internet KW - mobile applications KW - health promotion KW - health behavior N2 - Background: Mobile phone use and the adoption of healthy lifestyle software apps (?health apps?) are rapidly proliferating. There is limited information on the users of health apps in terms of their social demographic and health characteristics, intentions to change, and actual health behaviors. Objective: The objectives of our study were to (1) to describe the sociodemographic characteristics associated with health app use in a recent US nationally representative sample; (2) to assess the attitudinal and behavioral predictors of the use of health apps for health promotion; and (3) to examine the association between the use of health-related apps and meeting the recommended guidelines for fruit and vegetable intake and physical activity. Methods: Data on users of mobile devices and health apps were analyzed from the National Cancer Institute?s 2015 Health Information National Trends Survey (HINTS), which was designed to provide nationally representative estimates for health information in the United States and is publicly available on the Internet. We used multivariable logistic regression models to assess sociodemographic predictors of mobile device and health app use and examine the associations between app use, intentions to change behavior, and actual behavioral change for fruit and vegetable consumption, physical activity, and weight loss. Results: From the 3677 total HINTS respondents, older individuals (45-64 years, odds ratio, OR 0.56, 95% CI 0.47-68; 65+ years, OR 0.19, 95% CI 0.14-0.24), males (OR 0.80, 95% CI 0.66-0.94), and having degree (OR 2.83, 95% CI 2.18-3.70) or less than high school education (OR 0.43, 95% CI 0.24-0.72) were all significantly associated with a reduced likelihood of having adopted health apps. Similarly, both age and education were significant variables for predicting whether a person had adopted a mobile device, especially if that person was a college graduate (OR 3.30). Individuals with apps were significantly more likely to report intentions to improve fruit (63.8% with apps vs 58.5% without apps, P=.01) and vegetable (74.9% vs 64.3%, P<.01) consumption, physical activity (83.0% vs 65.4%, P<.01), and weight loss (83.4% vs 71.8%, P<.01). Individuals with apps were also more likely to meet recommendations for physical activity compared with those without a device or health apps (56.2% with apps vs 47.8% without apps, P<.01). Conclusions: The main users of health apps were individuals who were younger, had more education, reported excellent health, and had a higher income. Although differences persist for gender, age, and educational attainment, many individual sociodemographic factors are becoming less potent in influencing engagement with mobile devices and health app use. App use was associated with intentions to change diet and physical activity and meeting physical activity recommendations. UR - http://www.jmir.org/2017/4/e125/ UR - http://dx.doi.org/10.2196/jmir.5604 UR - http://www.ncbi.nlm.nih.gov/pubmed/28428170 ID - info:doi/10.2196/jmir.5604 ER - TY - JOUR AU - Badawy, M. Sherif AU - Kuhns, M. Lisa PY - 2017/04/19 TI - Texting and Mobile Phone App Interventions for Improving Adherence to Preventive Behavior in Adolescents: A Systematic Review JO - JMIR Mhealth Uhealth SP - e50 VL - 5 IS - 4 KW - adolescent KW - text messaging KW - smartphone KW - mobile phone KW - mobile applications KW - medication adherence KW - behavior KW - prevention N2 - Background: Many preventable behaviors contribute to adolescent mortality and morbidity. Non-adherence to preventive measures represents a challenge and has been associated with worse health outcomes in this population. The widespread use of electronic communication technologies by adolescents, particularly the use of text messaging (short message service, SMS) and mobile phones, presents new opportunities to intervene on risk and preventive risk behavior, but little is known about their efficacy. Objective: This study aimed to systematically evaluate evidence for the efficacy of text messaging and mobile phone app interventions to improve adherence to preventive behavior among adolescents and describe intervention approaches to inform intervention development. Methods: This review covers literature published between 1995 and 2015. Searches included PubMed, Embase, CENTRAL, PsycINFO, CINAHL, INSPEC, Web of Science, Google Scholar, and additional databases. The search strategy sought articles on text messaging and mobile phone apps combined with adherence or compliance, and adolescents and youth. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. Two reviewers independently screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Included studies reflect original research?experimental or preexperimental designs with text messaging or mobile phone app interventions?targeting adherence to preventive behavior among adolescents (12-24 years old). The preferred reporting items of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting results, and findings were critically appraised against the Oxford Centre for Evidence-based Medicine criteria. Results: Of 1454 records, 19 met inclusion criteria, including text messaging (n=15) and mobile phone apps (n=4). Studies targeted clinic attendance, contraceptive use, oral health, physical activity and weight management, sun protection, human papillomavirus (HPV) vaccination, smoking cessation, and sexual health. Most studies were performed in the United States (47%, 9/19), included younger adolescents (63%, 12/19), and had sample size <100 (63%, 12/19). Although most studies were randomized controlled trials (RCTs; 58%, 11/19), only 5 followed an intent-to-treat analysis. Only 6 of 19 studies (32%) incorporated a theoretical framework in their design. Most studies reported good feasibility with high acceptability and satisfaction. About half of the included studies (42%, 8/19) demonstrated significant improvement in preventive behavior with moderate standardized mean differences. As early efforts in this field to establish feasibility and initial efficacy, most studies were low to moderate in quality. Studies varied in sample size and methods of preventive behavior adherence or outcome assessment, which prohibited performing a meta-analysis. Conclusions: Despite the promising feasibility and acceptability of text messaging and mobile phone apps in improving preventive behavior among adolescents, overall findings were modest in terms of efficacy. Further research evaluating the efficacy, effectiveness, and cost-effectiveness of these intervention approaches in promoting preventive behavior among adolescents is needed. UR - http://mhealth.jmir.org/2017/4/e50/ UR - http://dx.doi.org/10.2196/mhealth.6837 UR - http://www.ncbi.nlm.nih.gov/pubmed/28428157 ID - info:doi/10.2196/mhealth.6837 ER - TY - JOUR AU - Satre, D. Derek AU - Ly, Khanh AU - Wamsley, Maria AU - Curtis, Alexa AU - Satterfield, Jason PY - 2017/04/18 TI - A Digital Tool to Promote Alcohol and Drug Use Screening, Brief Intervention, and Referral to Treatment Skill Translation: A Mobile App Development and Randomized Controlled Trial Protocol JO - JMIR Res Protoc SP - e55 VL - 6 IS - 4 KW - SBIRT KW - mobile app KW - digital health KW - training, implementation KW - alcohol KW - drug KW - depression KW - anxiety N2 - Background: Translation of knowledge and skills from classroom settings to clinical practice is a major challenge in healthcare training, especially for behavioral interventions. For example, screening, brief intervention, and referral to treatment (SBIRT) is a highly-promoted approach to identifying and treating individuals at risk for alcohol or drug problems, yet effective, routine use of SBIRT has lagged. Objective: The objective of this paper is to describe the development, pilot testing, and trial protocol of a mobile app based on the theory of planned behavior (TPB) to promote SBIRT skill translation and application. Methods: Intended for use after classroom training occurs, the mobile app has three primary functions designed to increase behavioral intent to deliver SBIRT: (1) review skills (ie, address knowledge and beliefs about SBIRT), (2) apply skills with patients (ie, build confidence and perceived behavioral control), and (3) report performance data (ie, increase accountability and social norms and/or influence). The app includes depression and anxiety screening tools due to high comorbidity with substance use. A randomized controlled trial (RCT) is in progress among health and social service learners (N=200) recruited from 3 universities and 6 different training programs in nursing, social work, internal medicine, psychiatry, and psychology. Participants are randomized to SBIRT classroom instruction alone or classroom instruction plus app access prior to beginning their field placement rotations. TPB-based data are collected via Qualtrics or via the mobile app pre-post and SBIRT utilization, weekly for 10 weeks. Key outcomes include the frequency of and self-reported confidence in delivery of SBIRT. Results: Beta testing with advanced practice nursing students (N=22) indicated that the app and its associated assessment tools were acceptable and useful. The system usability scale (SUS) mean was 65.8 (n=19), which indicated that the SBIRT app was acceptable but could benefit from improvement. Indeed, modifications were implemented prior to starting the trial. Enrollment of trial participants began in September 2016. Results are expected by December 2017. Conclusions: This report describes the process of TPB-based app development and testing, and the protocol for a RCT to determine the effectiveness of the app in enhancing skill translation. If effective, this approach could improve SBIRT implementation, fidelity, and clinical outcomes. UR - http://www.researchprotocols.org/2017/4/e55/ UR - http://dx.doi.org/10.2196/resprot.7070 UR - http://www.ncbi.nlm.nih.gov/pubmed/28420604 ID - info:doi/10.2196/resprot.7070 ER - TY - JOUR AU - Saeb, Sohrab AU - Cybulski, R. Thaddeus AU - Schueller, M. Stephen AU - Kording, P. Konrad AU - Mohr, C. David PY - 2017/4/18 TI - Scalable Passive Sleep Monitoring Using Mobile Phones: Opportunities and Obstacles JO - J Med Internet Res SP - e118 VL - 19 IS - 4 KW - sleep monitoring KW - mobile phones KW - decision trees KW - classification N2 - Background: Sleep is a critical aspect of people?s well-being and as such assessing sleep is an important indicator of a person?s health. Traditional methods of sleep assessment are either time- and resource-intensive or suffer from self-reporting biases. Recently, researchers have started to use mobile phones to passively assess sleep in individuals? daily lives. However, this work remains in its early stages, having only examined relatively small and homogeneous populations in carefully controlled contexts. Thus, it remains an open question as to how well mobile device-based sleep monitoring generalizes to larger populations in typical use cases. Objective: The aim of this study was to assess the ability of machine learning algorithms to detect the sleep start and end times for the main sleep period in a 24-h cycle using mobile devices in a diverse sample. Methods: We collected mobile phone sensor data as well as daily self-reported sleep start and end times from 208 individuals (171 females; 37 males), diverse in age (18?66 years; mean 39.3), education, and employment status, across the United States over 6 weeks. Sensor data consisted of geographic location, motion, light, sound, and in-phone activities. No specific instructions were given to the participants regarding phone placement. We used random forest classifiers to develop both personalized and global predictors of sleep state from the phone sensor data. Results: Using all available sensor features, the average accuracy of classifying whether a 10-min segment was reported as sleep was 88.8%. This is somewhat better than using the time of day alone, which gives an average accuracy of 86.9%. The accuracy of the model considerably varied across the participants, ranging from 65.1% to 97.3%. We found that low accuracy in some participants was due to two main factors: missing sensor data and misreports. After correcting for these, the average accuracy increased to 91.8%, corresponding to an average median absolute deviation (MAD) of 38 min for sleep start time detection and 36 min for sleep end time. These numbers are close to the range reported by previous research in more controlled situations. Conclusions: We find that mobile phones provide adequate sleep monitoring in typical use cases, and that our methods generalize well to a broader population than has previously been studied. However, we also observe several types of data artifacts when collecting data in uncontrolled settings. Some of these can be resolved through corrections, but others likely impose a ceiling on the accuracy of sleep prediction for certain subjects. Future research will need to focus more on the understanding of people?s behavior in their natural settings in order to develop sleep monitoring tools that work reliably in all cases for all people. UR - http://www.jmir.org/2017/4/e118/ UR - http://dx.doi.org/10.2196/jmir.6821 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.6821 ER - TY - JOUR AU - Gabrielli, Silvia AU - Dianti, Marco AU - Maimone, Rosa AU - Betta, Marta AU - Filippi, Lorena AU - Ghezzi, Monica AU - Forti, Stefano PY - 2017/04/13 TI - Design of a Mobile App for Nutrition Education (TreC-LifeStyle) and Formative Evaluation With Families of Overweight Children JO - JMIR Mhealth Uhealth SP - e48 VL - 5 IS - 4 KW - mHealth KW - child KW - overweight KW - pediatrics KW - health behavior KW - evaluation studies N2 - Background: Nutrition and diet apps represent today a popular area of mobile health (mHealth), offering the possibility of delivering behavior change (BC) interventions for healthy eating and weight management in a scalable and cost-effective way. However, if commercial apps for pediatric weight management fail to retain users because of a lack of theoretical background and evidence-based content, mHealth apps that are more evidence-based are found less engaging and popular among consumers. Approaching the apps development process from a multidisciplinary and user-centered design (UCD) perspective is likely to help overcome these limitations, raising the chances for an easier adoption and integration of nutrition education apps within primary care interventions. Objective: The aim of this study was to describe the design and development of the TreC-LifeStyle nutrition education app and the results of a formative evaluation with families. Methods: The design of the nutrition education intervention was based on a multidisciplinary UCD approach, involving a team of BC experts, working with 2 nutritionists and 3 pediatricians from a primary care center. The app content was derived from evidence-based knowledge founded on the Food Pyramid and Mediterranean Diet guidelines used by pediatricians in primary care. A formative evaluation of the TreC-LifeStyle app involved 6 families of overweight children (aged 7-12 years) self-reporting daily food intake of children for 6 weeks and providing feedback on the user experience with the mHealth intervention. Analysis of the app?s usage patterns during the intervention and of participants? feedback informed the refinement of the app design and a tuning of the nutrition education strategies to improve user engagement and compliance with the intervention. Results: Design sessions with the contribution of pediatricians and nutritionists helped define the nutrition education app and intervention, providing an effective human and virtual coaching approach to raise parents? awareness about children?s eating behavior and lifestyle. The 6 families participating in the pilot study found the app usable and showed high compliance with the intervention over the 6 weeks, but analysis of their interaction and feedback showed the need for improving some of the app features related to the BC techniques ?monitoring of the behavior? and ?information provision.? Conclusions: The UCD and formative evaluation of TreC-LifeStyle show that nutrition education apps are feasible and acceptable solutions to support health promotion interventions in primary care. UR - http://mhealth.jmir.org/2017/4/e48/ UR - http://dx.doi.org/10.2196/mhealth.7080 UR - http://www.ncbi.nlm.nih.gov/pubmed/28408361 ID - info:doi/10.2196/mhealth.7080 ER - TY - JOUR AU - McBride, L. Deborah AU - LeVasseur, A. Sandra PY - 2017/04/13 TI - Personal Communication Device Use by Nurses Providing In-Patient Care: Survey of Prevalence, Patterns, and Distraction Potential JO - JMIR Hum Factors SP - e10 VL - 4 IS - 2 KW - distraction KW - mobile devices KW - nurses N2 - Background: Coincident with the proliferation of employer-provided mobile communication devices, personal communication devices, including basic and enhanced mobile phones (smartphones) and tablet computers that are owned by the user, have become ubiquitous among registered nurses working in hospitals. While there are numerous benefits of personal communication device use by nurses at work, little is known about the impact of these devices on in-patient care. Objective: Our aim was to examine how hospital-registered nurses use their personal communication devices while doing both work-related and non?work-related activities and to assess the impact of these devices on in-patient care. Methods: A previously validated survey was emailed to 14,797 members of two national nursing organizations. Participants were asked about personal communication device use and their opinions about the impact of these devices on their own and their colleagues? work. Results: Of the 1268 respondents (8.57% response rate), only 5.65% (70/1237) never used their personal communication device at work (excluding lunch and breaks). Respondents self-reported using their personal communication devices at work for work-related activities including checking or sending text messages or emails to health care team members (29.02%, 363/1251), as a calculator (25.34%, 316/1247), and to access work-related medical information (20.13%, 251/1247). Fewer nurses reported using their devices for non?work-related activities including checking or sending text messages or emails to friends and family (18.75%, 235/1253), shopping (5.14%, 64/1244), or playing games (2.73%, 34/1249). A minority of respondents believe that their personal device use at work had a positive effect on their work including reducing stress (29.88%, 369/1235), benefiting patient care (28.74%, 357/1242), improving coordination of patient care among the health care team (25.34%, 315/1243), or increasing unit teamwork (17.70%, 220/1243). A majority (69.06%, 848/1228) of respondents believe that on average personal communication devices have a more negative than positive impact on patient care and 39.07% (481/1231) reported that personal communication devices were always or often a distraction while working. Respondents acknowledged their own device use negatively affected their work performance (7.56%, 94/1243), or caused them to miss important clinical information (3.83%, 47/1225) or make a medical error (0.90%, 11/1218). Respondents reported witnessing another nurse?s use of devices negatively affect their work performance (69.41%, 860/1239), or cause them to miss important clinical information (30.61%, 378/1235) or make a medical error (12.51%, 155/1239). Younger respondents reported greater device use while at work than older respondents and generally had more positive opinions about the impact of personal communication devices on their work. Conclusions: The majority of registered nurses believe that the use of personal communication devices on hospital units raises significant safety issues. The high rate of respondents who saw colleagues distracted by their devices compared to the rate who acknowledged their own distraction may be an indication that nurses are unaware of their own attention deficits while using their devices. There were clear generational differences in personal communication device use at work and opinions about the impact of these devices on patient care. Professional codes of conduct for personal communication device use by hospital nurses need to be developed that maximize the benefits of personal communication device use, while reducing the potential for distraction and adverse outcomes. UR - http://humanfactors.jmir.org/2017/2/e10/ UR - http://dx.doi.org/10.2196/humanfactors.5110 UR - http://www.ncbi.nlm.nih.gov/pubmed/28408359 ID - info:doi/10.2196/humanfactors.5110 ER - TY - JOUR AU - Nahum, Mor AU - Van Vleet, M. Thomas AU - Sohal, S. Vikaas AU - Mirzabekov, J. Julie AU - Rao, R. Vikram AU - Wallace, L. Deanna AU - Lee, B. Morgan AU - Dawes, Heather AU - Stark-Inbar, Alit AU - Jordan, Thomas Joshua AU - Biagianti, Bruno AU - Merzenich, Michael AU - Chang, F. Edward PY - 2017/04/12 TI - Immediate Mood Scaler: Tracking Symptoms of Depression and Anxiety Using a Novel Mobile Mood Scale JO - JMIR Mhealth Uhealth SP - e44 VL - 5 IS - 4 KW - mood disorders KW - mobile KW - ecological momentary assessment KW - depression KW - anxiety N2 - Background: Mood disorders are dynamic disorders characterized by multimodal symptoms. Clinical assessment of symptoms is currently limited to relatively sparse, routine clinic visits, requiring retrospective recollection of symptoms present in the weeks preceding the visit. Novel advances in mobile tools now support ecological momentary assessment of mood, conducted frequently using mobile devices, outside the clinical setting. Such mood assessment may help circumvent problems associated with infrequent reporting and better characterize the dynamic presentation of mood symptoms, informing the delivery of novel treatment options. Objectives: The aim of our study was to validate the Immediate Mood Scaler (IMS), a newly developed, iPad-deliverable 22-item self-report tool designed to capture current mood states. Methods: A total of 110 individuals completed standardized questionnaires (Patient Health Questionnaire, 9-item [PHQ-9]; generalized anxiety disorder, 7-Item [GAD-7]; and rumination scale) and IMS at baseline. Of the total, 56 completed at least one additional session of IMS, and 17 completed one additional administration of PHQ-9 and GAD-7. We conducted exploratory Principal Axis Factor Analysis to assess dimensionality of IMS, and computed zero-order correlations to investigate associations between IMS and standardized scales. Linear Mixed Model (LMM) was used to assess IMS stability across time and to test predictability of PHQ-9 and GAD-7 score by IMS. Results: Strong correlations were found between standard mood scales and the IMS at baseline (r=.57-.59, P<.001). A factor analysis revealed a 12-item IMS (?IMS-12?) with two factors: a ?depression? factor and an ?anxiety? factor. IMS-12 depression subscale was more strongly correlated with PHQ-9 than with GAD-7 (z=1.88, P=.03), but the reverse pattern was not found for IMS-12 anxiety subscale. IMS-12 showed less stability over time compared with PHQ-9 and GAD-7 (.65 vs .91), potentially reflecting more sensitivity to mood dynamics. In addition, IMS-12 ratings indicated that individuals with mild to moderate depression had greater mood fluctuations compared with individuals with severe depression (.42 vs .79; P=.04). Finally, IMS-12 significantly contributed to the prediction of subsequent PHQ-9 (beta=1.03, P=.02) and GAD-7 scores (beta =.93, P=.01). Conclusions: Collectively, these data suggest that the 12-item IMS (IMS-12) is a valid tool to assess momentary mood symptoms related to anxiety and depression. Although IMS-12 shows good correlation with standardized scales, it further captures mood fluctuations better and significantly adds to the prediction of the scales. Results are discussed in the context of providing continuous symptom quantification that may inform novel treatment options and support personalized treatment plans. UR - http://mhealth.jmir.org/2017/4/e44/ UR - http://dx.doi.org/10.2196/mhealth.6544 UR - http://www.ncbi.nlm.nih.gov/pubmed/28404542 ID - info:doi/10.2196/mhealth.6544 ER - TY - JOUR AU - Horsch, HG Corine AU - Lancee, Jaap AU - Griffioen-Both, Fiemke AU - Spruit, Sandor AU - Fitrianie, Siska AU - Neerincx, A. Mark AU - Beun, Jan Robbert AU - Brinkman, Willem-Paul PY - 2017/04/11 TI - Mobile Phone-Delivered Cognitive Behavioral Therapy for Insomnia: A Randomized Waitlist Controlled Trial JO - J Med Internet Res SP - e70 VL - 19 IS - 4 KW - insomnia KW - smartphone app KW - cognitive behavioral therapy KW - eHealth N2 - Background: This study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have insomnia. Objective: The objective of our study was to investigate the efficacy of CBT-I delivered via the Sleepcare mobile phone app, compared with a waitlist control group, in a randomized controlled trial. Methods: We recruited participants in the Netherlands with relatively mild insomnia disorder. After answering an online pretest questionnaire, they were randomly assigned to the app (n=74) or the waitlist condition (n=77). The app packaged a sleep diary, a relaxation exercise, sleep restriction exercise, and sleep hygiene and education. The app was fully automated and adjusted itself to a participant?s progress. Program duration was 6 to 7 weeks, after which participants received posttest measurements and a 3-month follow-up. The participants in the waitlist condition received the app after they completed the posttest questionnaire. The measurements consisted of questionnaires and 7-day online diaries. The questionnaires measured insomnia severity, dysfunctional beliefs about sleep, and anxiety and depression symptoms. The diary measured sleep variables such as sleep efficiency. We performed multilevel analyses to study the interaction effects between time and condition. Results: The results showed significant interaction effects (P<.01) favoring the app condition on the primary outcome measures of insomnia severity (d=?0.66) and sleep efficiency (d=0.71). Overall, these improvements were also retained in a 3-month follow-up. Conclusions: This study demonstrated the efficacy of a fully automated mobile phone app in the treatment of relatively mild insomnia. The effects were in the range of what is found for Web-based treatment in general. This supports the applicability of such technical tools in the treatment of insomnia. Future work should examine the generalizability to a more diverse population. Furthermore, the separate components of such an app should be investigated. It remains to be seen how this app can best be integrated into the current health regimens. Trial Registration: Netherlands Trial Register: NTR5560; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5560 (Archived by WebCite at http://www.webcitation.org/6noLaUdJ4) UR - http://www.jmir.org/2017/4/e70/ UR - http://dx.doi.org/10.2196/jmir.6524 UR - http://www.ncbi.nlm.nih.gov/pubmed/28400355 ID - info:doi/10.2196/jmir.6524 ER - TY - JOUR AU - Peters, Dorian AU - Davis, Sharon AU - Calvo, Alejandro Rafael AU - Sawyer, M. Susan AU - Smith, Lorraine AU - Foster, M. Juliet PY - 2017/04/11 TI - Young People?s Preferences for an Asthma Self-Management App Highlight Psychological Needs: A Participatory Study JO - J Med Internet Res SP - e113 VL - 19 IS - 4 KW - asthma KW - mobile applications KW - quality of life KW - mental health KW - adolescents KW - chronic disease KW - mhealth KW - participatory design N2 - Background: Although the prevalence of mental illness among young people with asthma is known to be twice the rate of the wider population, none of the asthma apps reported have acknowledged or attempted to include psychological support features. This is perhaps because user involvement in the development of asthma apps has been scarce. User involvement, facilitated by participatory design methods, can begin to address these issues while contributing insights to our understanding of the psychological experience associated with asthma and how technology might improve quality of life. Objective: The goal of this participatory user research study was to explore the experience, needs, and ideas of young people with asthma while allowing them to define requirements for an asthma app that would be engaging and effective at improving their well-being. Methods: Young people aged 15-24 years with doctor-diagnosed asthma were invited to participate in a participatory workshop and to complete a workbook designed to elicit their thoughts and ideas about living with asthma, technology use, and the design of an app. Participants generated a number of artifacts (including collages, concept maps, and paper prototypes) designed to reify their ideas, tacit knowledge, and experience. Results: A total of 20 participants (mean age 17.8 years; 60%, 12/20 female) representing a range from inadequately to well-controlled asthma completed a workbook and 13 of these also took part in a workshop (four workshops were held in total), resulting in 102 participant-generated artifacts. Theoretical thematic analysis resulted in a set of personal needs, feature ideas, and app characteristics considered relevant by young people for an asthma support app. The data revealed that psychological factors such as anxiety, and impediments to autonomy, competence, and relatedness (as consistent with self-determination theory [SDT]), were considered major influences on quality of life by young people with asthma. Furthermore, the incorporation of features pertaining to psychological experience was particularly valued by participants. Conclusions: In addition to practical features for asthma management, an app for young people with asthma should include support for the mental health factors associated with lived experience (ie, anxiety, lack of autonomy, and social disconnectedness). We show how support for these factors can be translated into design features of an app for asthma. In addition to informing the development of asthma-support technologies for young people, these findings could have implications for technologies designed to support people with chronic illness more generally. UR - http://www.jmir.org/2017/4/e113/ UR - http://dx.doi.org/10.2196/jmir.6994 UR - http://www.ncbi.nlm.nih.gov/pubmed/28400353 ID - info:doi/10.2196/jmir.6994 ER - TY - JOUR AU - Nicholas, Jennifer AU - Fogarty, S. Andrea AU - Boydell, Katherine AU - Christensen, Helen PY - 2017/04/07 TI - The Reviews Are in: A Qualitative Content Analysis of Consumer Perspectives on Apps for Bipolar Disorder JO - J Med Internet Res SP - e105 VL - 19 IS - 4 KW - mobile applications KW - bipolar disorder KW - smartphone KW - telemedicine KW - qualitative research N2 - Background: The delivery of mobile health (mHealth) services is acceptable to mental health consumers. However, despite the benefits of accessibility, cost-effectiveness, anonymity, and ability to tailor content to individual needs, consumer engagement remains a hurdle for uptake and continued use. This may be unsurprising as few studies have examined app content from the consumer perspective or assessed consumer preferences for the content of apps for mental health management. An opportunity to examine consumer perspectives exists in using naturally generated data that is publically available in the Google Play and Apple app stores. Whereas commercial developers routinely use this data, to date there has been no in-depth evaluation within scientific research. Objective: The aim of our study was to explore what consumers consider useful content for mental health management apps, identify unmet needs, and understand user expectations of mental health apps within the context of apps for bipolar disorder. Methods: Publically available English language consumer reviews of 48 apps for bipolar disorder were used as data, providing a total of 2173 reviews. Review text was coded and analyzed using a team approach to qualitative content analysis. Results were presented in 2 forms: (1) a quantitative summary of the 9 major and minor themes and (2) a qualitative synthesis of key thematic findings. Results: The majority of reviews were for symptom monitoring apps (87.94%, 1911/2173). The qualitative content analysis revealed 5 main themes: (1) laudatory talk, comments regarding the app?s benefits including helpfulness and successful design features (74.00% of reviews, 1608/2173); (2) unfavorable feedback, negative reviews largely concerning unmet needs, privacy and technical issues, and potential dangers of app use (25.54%, 555/2173); (3) conceptions of community, referring to both communities of users with mental ill-health accessed via the app and a community created among app users and developers (24.25%, 527/2173); (4) wishlist features, app features requested by users (17.53%, 381/2173); and (5) apps and therapy, app use within clinical care (10.58%, 230/2173). Four minor themes were also identified: (1) app cost, (2) privacy and data security, (3) comparisons with traditional monitoring, and (4) evidence-based mHealth. Conclusions: Although mostly positive, the proportion of reviews containing wishlist requests indicates consumer needs are not adequately addressed by currently available disorder management apps. Consumers value content that is helpful, supportive, and easy to use, and they are integrating apps into their health management and clinical care without necessarily considering the evidence-base or clinical effectiveness of the tool. User expectations regarding developer responsiveness to their needs has implications for community-based participatory research and integrated knowledge translation. However, this expectation is incompatible with current mHealth funding structures. UR - http://www.jmir.org/2017/4/e105/ UR - http://dx.doi.org/10.2196/jmir.7273 UR - http://www.ncbi.nlm.nih.gov/pubmed/28389420 ID - info:doi/10.2196/jmir.7273 ER - TY - JOUR AU - Ernsting, Clemens AU - Dombrowski, U. Stephan AU - Oedekoven, Monika AU - O´Sullivan, L. Julie AU - Kanzler, Melanie AU - Kuhlmey, Adelheid AU - Gellert, Paul PY - 2017/04/05 TI - Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey JO - J Med Internet Res SP - e101 VL - 19 IS - 4 KW - telemedicine KW - eHealth KW - mHealth KW - smartphone KW - mobile apps KW - health promotion KW - chronic disease KW - health literacy KW - quality of life N2 - Background: Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions. Objective: The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors. Methods: A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied. Results: It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor?s advice. Conclusions: Although there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user?s motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions. UR - http://www.jmir.org/2017/4/e101/ UR - http://dx.doi.org/10.2196/jmir.6838 UR - http://www.ncbi.nlm.nih.gov/pubmed/28381394 ID - info:doi/10.2196/jmir.6838 ER - TY - JOUR AU - Sawares, SA Antoine AU - Shen, Nelson AU - Xue, Yunlin AU - Abi-Jaoude, Alexxa AU - Wiljer, David PY - 2017/04/04 TI - The Impact of Mobile Apps on Alcohol Use Disorder: A Systematic Review Protocol JO - JMIR Res Protoc SP - e49 VL - 6 IS - 4 KW - mobile health KW - apps KW - alcohol use disorder KW - systematic review KW - protocol KW - mental health KW - addiction KW - alcoholism N2 - Background: Alcohol use disorder (AUD) is among the most prevalent mental disorders worldwide and is associated with a diverse range of physical and psychological comorbidities. Despite various types of treatment, there are many barriers to accessing treatment (ie, stigma, cost, accessibility of service, etc). Mobile apps have the potential to overcome these barriers and provide support to those who need it. Objective: The purpose of this systematic review is to assess the effectiveness of mobile apps in reducing alcohol consumption for individuals with AUD and understand the psychological outcomes of using the apps (ie, client empowerment, self-efficacy, etc). Methods: The search strategy was applied to 7 health sciences and interdisciplinary databases. Two reviewers will independently assess all titles and abstracts for relevance and then full texts of relevant articles for eligibility. To be included, the article must be a quantitative evaluation of clinical outcomes using the intervention and the intervention must be a consumer-facing app focused on supporting individuals with AUD. Two reviewers will independently extract data from all eligible articles using a standardized extraction worksheet and will independently assess the study quality. A meta-analysis will be conducted if appropriate. Depending on outcomes reported, pooled risk ratios or standardized mean differences will be calculated and reported in the review. Results: The search strategy yielded 699 unique citations. Of those, 63 (9.0%, 63/699) articles were assessed as relevant for full-text review. The full-text reviews are currently underway and the final review is projected to be completed in the summer of 2017. Conclusions: There is potential for mobile apps to support individuals with AUD to reduce their alcohol consumption. This review will be the first to assess the effectiveness of AUD mobile apps and client experiences using the apps. UR - http://www.researchprotocols.org/2017/4/e49/ UR - http://dx.doi.org/10.2196/resprot.6975 UR - http://www.ncbi.nlm.nih.gov/pubmed/28377366 ID - info:doi/10.2196/resprot.6975 ER - TY - JOUR AU - Reade, Samuel AU - Spencer, Karen AU - Sergeant, C. Jamie AU - Sperrin, Matthew AU - Schultz, M. David AU - Ainsworth, John AU - Lakshminarayana, Rashmi AU - Hellman, Bruce AU - James, Ben AU - McBeth, John AU - Sanders, Caroline AU - Dixon, G. William PY - 2017/03/24 TI - Cloudy with a Chance of Pain: Engagement and Subsequent Attrition of Daily Data Entry in a Smartphone Pilot Study Tracking Weather, Disease Severity, and Physical Activity in Patients With Rheumatoid Arthritis JO - JMIR Mhealth Uhealth SP - e37 VL - 5 IS - 3 KW - smartphone KW - mHealth KW - attrition KW - weather KW - arthritis N2 - Background: The increasing ownership of smartphones provides major opportunities for epidemiological research through self-reported and passively collected data. Objective: This pilot study aimed to codesign a smartphone app to assess associations between weather and joint pain in patients with rheumatoid arthritis (RA) and to study the success of daily self-reported data entry over a 60-day period and the enablers of and barriers to data collection. Methods: A patient and public involvement group (n=5) and 2 focus groups of patients with RA (n=9) supported the codesign of the app collecting self-reported symptoms. A separate ?capture app? was designed to collect global positioning system (GPS) and continuous raw accelerometer data, with the GPS-linking providing local weather data. A total of 20 patients with RA were then recruited to collect daily data for 60 days, with entry and exit interviews. Of these, 17 were loaned an Android smartphone, whereas 3 used their own Android smartphones. Results: Of the 20 patients, 6 (30%) withdrew from the study: 4 because of technical challenges and 2 for health reasons. The mean completion of daily entries was 68% over 2 months. Patients entered data at least five times per week 65% of the time. Reasons for successful engagement included a simple graphical user interface, automated reminders, visualization of data, and eagerness to contribute to this easily understood research question. The main barrier to continuing engagement was impaired battery life due to the accelerometer data capture app. For some, successful engagement required ongoing support in using the smartphones. Conclusions: This successful pilot study has demonstrated that daily data collection using smartphones for health research is feasible and achievable with high levels of ongoing engagement over 2 months. This result opens important opportunities for large-scale longitudinal epidemiological research. UR - http://mhealth.jmir.org/2017/3/e37/ UR - http://dx.doi.org/10.2196/mhealth.6496 UR - http://www.ncbi.nlm.nih.gov/pubmed/28341616 ID - info:doi/10.2196/mhealth.6496 ER - TY - JOUR AU - Alnosayan, Nagla AU - Chatterjee, Samir AU - Alluhaidan, Ala AU - Lee, Edward AU - Houston Feenstra, Linda PY - 2017/03/24 TI - Design and Usability of a Heart Failure mHealth System: A Pilot Study JO - JMIR Hum Factors SP - e9 VL - 4 IS - 1 KW - mHealth KW - telehealth KW - heart failure KW - human factors engineering KW - self-management N2 - Background: Despite the advances in mobile health (mHealth) systems, little is known about patients? and providers? experiences using a new mHealth system design. Objective: This study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment. Methods: Following exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants? feedback on the system?s design. Results: A total of 8 patients with HF participated over a 6-month period. Overall, the mean users? satisfaction with the system ranked 73%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data. Conclusions: Understanding users? experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes. UR - http://humanfactors.jmir.org/2017/1/e9/ UR - http://dx.doi.org/10.2196/humanfactors.6481 UR - http://www.ncbi.nlm.nih.gov/pubmed/28341615 ID - info:doi/10.2196/humanfactors.6481 ER - TY - JOUR AU - Constantinescu, Gabriela AU - Loewen, Irene AU - King, Ben AU - Brodt, Chris AU - Hodgetts, William AU - Rieger, Jana PY - 2017/03/24 TI - Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study JO - JMIR Rehabil Assist Technol SP - e3 VL - 4 IS - 1 KW - app design KW - dysphagia KW - games for health KW - gamification KW - head and neck cancer KW - mHealth KW - mobile health KW - patient adherence KW - patient engagement N2 - Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health apps with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions. Objective: The aim of our study was to (1) identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients and (2) identify appealing biofeedback designs that could be used in a health app. Methods: A total of 10 (4 females) HNC patients (mean=60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs. Results: Facilitators and barriers of adherence to home therapy were described through 6 themes: patient perceptions on outcomes and progress, clinical appointments, cancer treatment, rehabilitation program, personal factors, and connection. App visuals that provide feedback on performance during swallowing exercises should offer an immediate representation of effort relative to a goal. Simple, intuitive graphics were preferred over complex, abstract ones. Continued engagement with the app could be facilitated by tracking progress and by using visuals that build structures with each use. Conclusions: This is a detailed documentation of the initial steps in designing a health app for a specific patient group. Results revealed the importance of patient engagement in early stages of app development. UR - http://rehab.jmir.org/2017/1/e3/ UR - http://dx.doi.org/10.2196/rehab.6319 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582245 ID - info:doi/10.2196/rehab.6319 ER - TY - JOUR AU - Adepoju, Omolade Ibukun-Oluwa AU - Albersen, Antonia Bregje Joanna AU - De Brouwere, Vincent AU - van Roosmalen, Jos AU - Zweekhorst, Marjolein PY - 2017/03/23 TI - mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review JO - JMIR Mhealth Uhealth SP - e38 VL - 5 IS - 3 KW - mHealth KW - decision support systems, clinical KW - sub-Saharan Africa KW - clinical decision-making N2 - Background: In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established. Objective: The aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa. Methods: A scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA. Results: We retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training. Conclusions: The use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings. UR - http://mhealth.jmir.org/2017/3/e38/ UR - http://dx.doi.org/10.2196/mhealth.7185 UR - http://www.ncbi.nlm.nih.gov/pubmed/28336504 ID - info:doi/10.2196/mhealth.7185 ER - TY - JOUR AU - Baumel, Amit AU - Faber, Keren AU - Mathur, Nandita AU - Kane, M. John AU - Muench, Fred PY - 2017/03/21 TI - Enlight: A Comprehensive Quality and Therapeutic Potential Evaluation Tool for Mobile and Web-Based eHealth Interventions JO - J Med Internet Res SP - e82 VL - 19 IS - 3 KW - eHealth KW - mHealth KW - assessment KW - evaluation KW - quality KW - persuasive design KW - behavior change KW - therapeutic alliance N2 - Background: Studies of criteria-based assessment tools have demonstrated the feasibility of objectively evaluating eHealth interventions independent of empirical testing. However, current tools have not included some quality constructs associated with intervention outcome, such as persuasive design, behavior change, or therapeutic alliance. In addition, the generalizability of such tools has not been explicitly examined. Objective: The aim is to introduce the development and further analysis of the Enlight suite of measures, developed to incorporate the aforementioned concepts and address generalizability aspects. Methods: As a first step, a comprehensive systematic review was performed to identify relevant quality rating criteria in line with the PRISMA statement. These criteria were then categorized to create Enlight. The second step involved testing Enlight on 42 mobile apps and 42 Web-based programs (delivery mediums) targeting modifiable behaviors related to medical illness or mental health (clinical aims). Results: A total of 476 criteria from 99 identified sources were used to build Enlight. The rating measures were divided into two sections: quality assessments and checklists. Quality assessments included usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. The checklists included credibility, privacy explanation, basic security, and evidence-based program ranking. The quality constructs exhibited excellent interrater reliability (intraclass correlations=.77-.98, median .91) and internal consistency (Cronbach alphas=.83-.90, median .88), with similar results when separated into delivery mediums or clinical aims. Conditional probability analysis revealed that 100% of the programs that received a score of fair or above (?3.0) in therapeutic persuasiveness or therapeutic alliance received the same range of scores in user engagement and content?a pattern that did not appear in the opposite direction. Preliminary concurrent validity analysis pointed to positive correlations of combined quality scores with selected variables. The combined score that did not include therapeutic persuasiveness and therapeutic alliance descriptively underperformed the other combined scores. Conclusions: This paper provides empirical evidence supporting the importance of persuasive design and therapeutic alliance within the context of a program?s evaluation. Reliability metrics and preliminary concurrent validity analysis indicate the potential of Enlight in examining eHealth programs regardless of delivery mediums and clinical aims. UR - http://www.jmir.org/2017/3/e82/ UR - http://dx.doi.org/10.2196/jmir.7270 UR - http://www.ncbi.nlm.nih.gov/pubmed/28325712 ID - info:doi/10.2196/jmir.7270 ER - TY - JOUR AU - Sigler, Erika Brittany PY - 2017/03/21 TI - Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study JO - JMIR Mhealth Uhealth SP - e36 VL - 5 IS - 3 KW - communication KW - health behavior KW - Medicaid KW - mHealth KW - patient engagement KW - safety-net providers KW - text messaging N2 - Background: Medicaid populations are less engaged in their health care than the rest of the population, translating to worse health outcomes and increased health care costs. Since theory-based mobile health (mHealth) interventions have been shown to increase patient engagement, mobile phones may be an optimal strategy to reach this population. With increased development of theory-based mHealth technology, these interventions must now be evaluated with these medically underserved populations in a real-world setting. Objective: The aim of our study was to investigate care coordinators? perceived value of using a health behavior theory-based mHealth platform with Medicaid clients. In particular, attention was paid to the perceived impact on patient engagement. This research was conducted using the patient-provider text messaging (short message service, SMS) platform, Sense Health (now Wellpass), which integrates the transtheoretical model (TTM), also called the stages of change model; social cognitive theory (SCT); supportive accountability; and motivational interviewing (MI). Methods: Interviews based in grounded theory methodology were conducted with 10 care managers to understand perceptions of the relationship between mHealth and patient engagement. Results: The interviews with care managers yielded a foundation for a grounded theory model, presenting themes that suggested 4 intertwined correlative relationships revolving around patient engagement: (1) A text messaging (short message service, SMS) platform supplements the client-care manager dynamic, which is grounded in high quality, reciprocal-communication to increase patient engagement; (2) Texting enhances the relationship between literacy and access to care for Medicaid patients, increasing low-literacy patients? agency to access services; (3) Texting enhances communication, providing care managers with a new means to support their clients; and (4) Reminders augment client accountability, leading to both increased motivation and readiness to change behaviors, as well as an improved client-care manager relationship. Conclusions: Messaging platform features tied to health behavior theory appear to be effective in improving patient engagement. Two-way communication (supportive accountability), trusted relationships (supportive accountability, SCT), personalized messages (TTM), and patient input (TTM, SCT, MI) appeared as the most relevant components in achieving desired outcomes. Additionally, reminder messages were noted as especially useful in making Medicaid patients accountable and in turn engaging them in their health and health care. These findings convey suggested elements for inclusion in other mHealth interventions aiming to improve patient engagement in Medicaid populations. UR - http://mhealth.jmir.org/2017/3/e36/ UR - http://dx.doi.org/10.2196/mhealth.5892 UR - http://www.ncbi.nlm.nih.gov/pubmed/28325711 ID - info:doi/10.2196/mhealth.5892 ER - TY - JOUR AU - Furberg, D. Robert AU - Taniguchi, Travis AU - Aagaard, Brian AU - Ortiz, M. Alexa AU - Hegarty-Craver, Meghan AU - Gilchrist, H. Kristin AU - Ridenour, A. Ty PY - 2017/03/17 TI - Biometrics and Policing: A Protocol for Multichannel Sensor Data Collection and Exploratory Analysis of Contextualized Psychophysiological Response During Law Enforcement Operations JO - JMIR Res Protoc SP - e44 VL - 6 IS - 3 KW - psychophysiology KW - law enforcement KW - sensor, wearable KW - clinical trial KW - digital health N2 - Background: Stress experienced by law enforcement officers is often extreme and is in many ways unique among professions. Although past research on officer stress is informative, it is limited, and most studies measure stress using self-report questionnaires or observational studies that have limited generalizability. We know of no research studies that have attempted to track direct physiological stress responses in high fidelity, especially within an operational police setting. The outcome of this project will have an impact on both practitioners and policing researchers. To do so, we will establish a capacity to obtain complex, multisensor data; process complex datasets; and establish the methods needed to conduct idiopathic clinical trials on behavioral interventions in similar contexts. Objective: The objective of this pilot study is to demonstrate the practicality and utility of wrist-worn biometric sensor-based research in a law enforcement agency. Methods: We will use nonprobability convenience-based sampling to recruit 2-3 participants from the police department in Durham, North Carolina, USA. Results: Data collection was conducted in 2016. We will analyze data in early 2017 and disseminate our results via peer reviewed publications in late 2017. Conclusions: We developed the Biometrics & Policing Demonstration project to provide a proof of concept on collecting biometric data in a law enforcement setting. This effort will enable us to (1) address the regulatory approvals needed to collect data, including human participant considerations, (2) demonstrate the ability to use biometric tracking technology in a policing setting, (3) link biometric data to law enforcement data, and (4) explore project results for law enforcement policy and training. UR - http://www.researchprotocols.org/2017/3/e44/ UR - http://dx.doi.org/10.2196/resprot.7499 UR - http://www.ncbi.nlm.nih.gov/pubmed/28314707 ID - info:doi/10.2196/resprot.7499 ER - TY - JOUR AU - Dooley, E. Erin AU - Golaszewski, M. Natalie AU - Bartholomew, B. John PY - 2017/03/16 TI - Estimating Accuracy at Exercise Intensities: A Comparative Study of Self-Monitoring Heart Rate and Physical Activity Wearable Devices JO - JMIR Mhealth Uhealth SP - e34 VL - 5 IS - 3 KW - motor activity KW - physical exertion KW - exercise KW - monitoring, physiologic KW - energy metabolism KW - heart rate KW - photoplethysmography N2 - Background: Physical activity tracking wearable devices have emerged as an increasingly popular method for consumers to assess their daily activity and calories expended. However, whether these wearable devices are valid at different levels of exercise intensity is unknown. Objective: The objective of this study was to examine heart rate (HR) and energy expenditure (EE) validity of 3 popular wrist-worn activity monitors at different exercise intensities. Methods: A total of 62 participants (females: 58%, 36/62; nonwhite: 47% [13/62 Hispanic, 8/62 Asian, 7/62 black/ African American, 1/62 other]) wore the Apple Watch, Fitbit Charge HR, and Garmin Forerunner 225. Validity was assessed using 2 criterion devices: HR chest strap and a metabolic cart. Participants completed a 10-minute seated baseline assessment; separate 4-minute stages of light-, moderate-, and vigorous-intensity treadmill exercises; and a 10-minute seated recovery period. Data from devices were compared with each criterion via two-way repeated-measures analysis of variance and Bland-Altman analysis. Differences are expressed in mean absolute percentage error (MAPE). Results: For the Apple Watch, HR MAPE was between 1.14% and 6.70%. HR was not significantly different at the start (P=.78), during baseline (P=.76), or vigorous intensity (P=.84); lower HR readings were measured during light intensity (P=.03), moderate intensity (P=.001), and recovery (P=.004). EE MAPE was between 14.07% and 210.84%. The device measured higher EE at all stages (P<.01). For the Fitbit device, the HR MAPE was between 2.38% and 16.99%. HR was not significantly different at the start (P=.67) or during moderate intensity (P=.34); lower HR readings were measured during baseline, vigorous intensity, and recovery (P<.001) and higher HR during light intensity (P<.001). EE MAPE was between 16.85% and 84.98%. The device measured higher EE at baseline (P=.003), light intensity (P<.001), and moderate intensity (P=.001). EE was not significantly different at vigorous (P=.70) or recovery (P=.10). For Garmin Forerunner 225, HR MAPE was between 7.87% and 24.38%. HR was not significantly different at vigorous intensity (P=.35). The device measured higher HR readings at start, baseline, light intensity, moderate intensity (P<.001), and recovery (P=.04). EE MAPE was between 30.77% and 155.05%. The device measured higher EE at all stages (P<.001). Conclusions: This study provides one of the first validation assessments for the Fitbit Charge HR, Apple Watch, and Garmin Forerunner 225. An advantage and novel approach of the study is the examination of HR and EE at specific physical activity intensities. Establishing validity of wearable devices is of particular interest as these devices are being used in weight loss interventions and could impact findings. Future research should investigate why differences between exercise intensities and the devices exist. UR - http://mhealth.jmir.org/2017/3/e34/ UR - http://dx.doi.org/10.2196/mhealth.7043 UR - http://www.ncbi.nlm.nih.gov/pubmed/28302596 ID - info:doi/10.2196/mhealth.7043 ER - TY - JOUR AU - Tian, Maoyi AU - Zhang, Jing AU - Luo, Rong AU - Chen, Shi AU - Petrovic, Djordje AU - Redfern, Julie AU - Xu, Roman Dong AU - Patel, Anushka PY - 2017/03/16 TI - mHealth Interventions for Health System Strengthening in China: A Systematic Review JO - JMIR Mhealth Uhealth SP - e32 VL - 5 IS - 3 KW - mHealth KW - China KW - health care systems N2 - Background: With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. Objective: The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. Methods: We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. Results: A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. Conclusions: We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care. UR - http://mhealth.jmir.org/2017/3/e32/ UR - http://dx.doi.org/10.2196/mhealth.6889 UR - http://www.ncbi.nlm.nih.gov/pubmed/28302597 ID - info:doi/10.2196/mhealth.6889 ER - TY - JOUR AU - Place, Skyler AU - Blanch-Hartigan, Danielle AU - Rubin, Channah AU - Gorrostieta, Cristina AU - Mead, Caroline AU - Kane, John AU - Marx, P. Brian AU - Feast, Joshua AU - Deckersbach, Thilo AU - Pentland, ?Sandy? Alex AU - Nierenberg, Andrew AU - Azarbayejani, Ali PY - 2017/03/16 TI - Behavioral Indicators on a Mobile Sensing Platform Predict Clinically Validated Psychiatric Symptoms of Mood and Anxiety Disorders JO - J Med Internet Res SP - e75 VL - 19 IS - 3 KW - mHealth KW - post-traumatic stress disorders KW - depression KW - behavioral symptoms N2 - Background: There is a critical need for real-time tracking of behavioral indicators of mental disorders. Mobile sensing platforms that objectively and noninvasively collect, store, and analyze behavioral indicators have not yet been clinically validated or scalable. Objective: The aim of our study was to report on models of clinical symptoms for post-traumatic stress disorder (PTSD) and depression derived from a scalable mobile sensing platform. Methods: A total of 73 participants (67% [49/73] male, 48% [35/73] non-Hispanic white, 33% [24/73] veteran status) who reported at least one symptom of PTSD or depression completed a 12-week field trial. Behavioral indicators were collected through the noninvasive mobile sensing platform on participants? mobile phones. Clinical symptoms were measured through validated clinical interviews with a licensed clinical social worker. A combination hypothesis and data-driven approach was used to derive key features for modeling symptoms, including the sum of outgoing calls, count of unique numbers texted, absolute distance traveled, dynamic variation of the voice, speaking rate, and voice quality. Participants also reported ease of use and data sharing concerns. Results: Behavioral indicators predicted clinically assessed symptoms of depression and PTSD (cross-validated area under the curve [AUC] for depressed mood=.74, fatigue=.56, interest in activities=.75, and social connectedness=.83). Participants reported comfort sharing individual data with physicians (Mean 3.08, SD 1.22), mental health providers (Mean 3.25, SD 1.39), and medical researchers (Mean 3.03, SD 1.36). Conclusions: Behavioral indicators passively collected through a mobile sensing platform predicted symptoms of depression and PTSD. The use of mobile sensing platforms can provide clinically validated behavioral indicators in real time; however, further validation of these models and this platform in large clinical samples is needed. UR - http://www.jmir.org/2017/3/e75/ UR - http://dx.doi.org/10.2196/jmir.6678 UR - http://www.ncbi.nlm.nih.gov/pubmed/28302595 ID - info:doi/10.2196/jmir.6678 ER - TY - JOUR AU - Burke, E. Lora AU - Shiffman, Saul AU - Music, Edvin AU - Styn, A. Mindi AU - Kriska, Andrea AU - Smailagic, Asim AU - Siewiorek, Daniel AU - Ewing, J. Linda AU - Chasens, Eileen AU - French, Brian AU - Mancino, Juliet AU - Mendez, Dara AU - Strollo, Patrick AU - Rathbun, L. Stephen PY - 2017/03/15 TI - Ecological Momentary Assessment in Behavioral Research: Addressing Technological and Human Participant Challenges JO - J Med Internet Res SP - e77 VL - 19 IS - 3 KW - ecological momentary assessment KW - relapse KW - obesity KW - smartphone KW - eating behavior KW - adherence N2 - Background: Ecological momentary assessment (EMA) assesses individuals? current experiences, behaviors, and moods as they occur in real time and in their natural environment. EMA studies, particularly those of longer duration, are complex and require an infrastructure to support the data flow and monitoring of EMA completion. Objective: Our objective is to provide a practical guide to developing and implementing an EMA study, with a focus on the methods and logistics of conducting such a study. Methods: The EMPOWER study was a 12-month study that used EMA to examine the triggers of lapses and relapse following intentional weight loss. We report on several studies that informed the implementation of the EMPOWER study: (1) a series of pilot studies, (2) the EMPOWER study?s infrastructure, (3) training of study participants in use of smartphones and the EMA protocol and, (4) strategies used to enhance adherence to completing EMA surveys. Results: The study enrolled 151 adults and had 87.4% (132/151) retention rate at 12 months. Our learning experiences in the development of the infrastructure to support EMA assessments for the 12-month study spanned several topic areas. Included were the optimal frequency of EMA prompts to maximize data collection without overburdening participants; the timing and scheduling of EMA prompts; technological lessons to support a longitudinal study, such as proper communication between the Android smartphone, the Web server, and the database server; and use of a phone that provided access to the system?s functionality for EMA data collection to avoid loss of data and minimize the impact of loss of network connectivity. These were especially important in a 1-year study with participants who might travel. It also protected the data collection from any server-side failure. Regular monitoring of participants? response to EMA prompts was critical, so we built in incentives to enhance completion of EMA surveys. During the first 6 months of the 12-month study interval, adherence to completing EMA surveys was high, with 88.3% (66,978/75,888) completion of random assessments and around 90% (23,411/25,929 and 23,343/26,010) completion of time-contingent assessments, despite the duration of EMA data collection and challenges with implementation. Conclusions: This work informed us of the necessary preliminary steps to plan and prepare a longitudinal study using smartphone technology and the critical elements to ensure participant engagement in the potentially burdensome protocol, which spanned 12 months. While this was a technology-supported and -programmed study, it required close oversight to ensure all elements were functioning correctly, particularly once human participants became involved. UR - http://www.jmir.org/2017/3/e77/ UR - http://dx.doi.org/10.2196/jmir.7138 UR - http://www.ncbi.nlm.nih.gov/pubmed/28298264 ID - info:doi/10.2196/jmir.7138 ER - TY - JOUR AU - Wu, Yuan AU - Yao, Xun AU - Vespasiani, Giacomo AU - Nicolucci, Antonio AU - Dong, Yajie AU - Kwong, Joey AU - Li, Ling AU - Sun, Xin AU - Tian, Haoming AU - Li, Sheyu PY - 2017/03/14 TI - Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy JO - JMIR Mhealth Uhealth SP - e35 VL - 5 IS - 3 KW - mobile health KW - mHealth KW - mobile applications KW - mobile apps KW - diabetes mellitus KW - classification N2 - Background: Mobile health apps for diabetes self-management have different functions. However, the efficacy and safety of each function are not well studied, and no classification is available for these functions. Objective: The aims of this study were to (1) develop and validate a taxonomy of apps for diabetes self-management, (2) investigate the glycemic efficacy of mobile app-based interventions among adults with diabetes in a systematic review of randomized controlled trials (RCTs), and (3) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy. Methods: We developed a 3-axis taxonomy with columns of clinical modules, rows of functional modules and cells of functions with risk assessments. This taxonomy was validated by reviewing and classifying commercially available diabetes apps. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Chinese Biomedical Literature Database, and ClinicalTrials.gov from January 2007 to May 2016. We included RCTs of adult outpatients with diabetes that compared using mobile app-based interventions with usual care alone. The mean differences (MDs) in hemoglobin A1c (HbA1c) concentrations and risk ratios of adverse events were pooled using a random-effects meta-analysis. After taxonomic classification, we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions. Results: Across 12 included trials involving 974 participants, using app-based interventions was associated with a clinically significant reduction of HbA1c (MD 0.48%, 95% CI 0.19%-0.78%) without excess adverse events. Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes (MD 0.67%, 95% CI 0.30%-1.03% vs MD 0.37%, 95% CI ?0.12%-0.86%). Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction (with complication prevention: MD 1.31%, 95% CI 0.66%-1.96% vs without: MD 0.38%, 95% CI 0.09%-0.67%; intersubgroup P=.01), as was having a structured display (with structured display: MD 0.69%, 95% CI 0.32%-1.06% vs without: MD 0.69%, 95% CI ?0.18%-0.53%; intersubgroup P=.03). However, having a clinical decision-making function was not associated with a larger HbA1c reduction (with clinical decision making: MD 0.19%, 95% CI ?0.24%-0.63% vs without: MD 0.61%, 95% CI 0.27%-0.95%; intersubgroup P=.14). Conclusions: The use of mobile app-based interventions yields a clinically significant HbA1c reduction among adult outpatients with diabetes, especially among those with type 2 diabetes. Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps. UR - http://mhealth.jmir.org/2017/3/e35/ UR - http://dx.doi.org/10.2196/mhealth.6522 UR - http://www.ncbi.nlm.nih.gov/pubmed/28292740 ID - info:doi/10.2196/mhealth.6522 ER - TY - JOUR AU - Darling, Eric Chad AU - Dovancescu, Silviu AU - Saczynski, S. Jane AU - Riistama, Jarno AU - Sert Kuniyoshi, Fatima AU - Rock, Joseph AU - Meyer, E. Theo AU - McManus, D. David PY - 2017/03/13 TI - Bioimpedance-Based Heart Failure Deterioration Prediction Using a Prototype Fluid Accumulation Vest-Mobile Phone Dyad: An Observational Study JO - JMIR Cardio SP - e1 VL - 1 IS - 1 KW - telemedicine KW - outpatient monitoring KW - heart failure KW - electric impedance N2 - Background: Recurrent heart failure (HF) events are common in patients discharged after acute decompensated heart failure (ADHF). New patient-centered technologies are needed to aid in detecting HF decompensation. Transthoracic bioimpedance noninvasively measures pulmonary fluid retention. Objective: The objectives of our study were to (1) determine whether transthoracic bioimpedance can be measured daily with a novel, noninvasive, wearable fluid accumulation vest (FAV) and transmitted using a mobile phone and (2) establish whether an automated algorithm analyzing daily thoracic bioimpedance values would predict recurrent HF events. Methods: We prospectively enrolled patients admitted for ADHF. Participants were trained to use a FAV?mobile phone dyad and asked to transmit bioimpedance measurements for 45 consecutive days. We examined the performance of an algorithm analyzing changes in transthoracic bioimpedance as a predictor of HF events (HF readmission, diuretic uptitration) over a 75-day follow-up. Results: We observed 64 HF events (18 HF readmissions and 46 diuretic uptitrations) in the 106 participants (67 years; 63.2%, 67/106, male; 48.1%, 51/106, with prior HF) who completed follow-up. History of HF was the only clinical or laboratory factor related to recurrent HF events (P=.04). Among study participants with sufficient FAV data (n=57), an algorithm analyzing thoracic bioimpedance showed 87% sensitivity (95% CI 82-92), 70% specificity (95% CI 68-72), and 72% accuracy (95% CI 70-74) for identifying recurrent HF events. Conclusions: Patients discharged after ADHF can measure and transmit daily transthoracic bioimpedance using a FAV?mobile phone dyad. Algorithms analyzing thoracic bioimpedance may help identify patients at risk for recurrent HF events after hospital discharge. UR - http://cardio.jmir.org/2017/1/e1/ UR - http://dx.doi.org/10.2196/cardio.6057 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758769 ID - info:doi/10.2196/cardio.6057 ER - TY - JOUR AU - Zhang, Jing AU - Sun, Lei AU - Liu, Yu AU - Wang, Hongyi AU - Sun, Ningling AU - Zhang, Puhong PY - 2017/03/08 TI - Mobile Device?Based Electronic Data Capture System Used in a Clinical Randomized Controlled Trial: Advantages and Challenges JO - J Med Internet Res SP - e66 VL - 19 IS - 3 KW - mEDC KW - electronic data capture KW - mobile data capture KW - mhealth KW - randomized controlled trial KW - clinical research N2 - Background: Electronic data capture (EDC) systems have been widely used in clinical research, but mobile device?based electronic data capture (mEDC) system has not been well evaluated. Objective: The aim of our study was to evaluate the feasibility, advantages, and challenges of mEDC in data collection, project management, and telemonitoring in a randomized controlled trial (RCT). Methods: We developed an mEDC to support an RCT called ?Telmisartan and Hydrochlorothiazide Antihypertensive Treatment (THAT)? study, which was a multicenter, double-blinded, RCT, with the purpose of comparing the efficacy of telmisartan and hydrochlorothiazide (HCTZ) monotherapy in high-sodium-intake patients with mild to moderate hypertension during a 60 days follow-up. Semistructured interviews were conducted during and after the trial to evaluate the feasibility, advantage, and challenge of mEDC. Nvivo version 9.0 (QSR International) was used to analyze records of interviews, and a thematic framework method was used to obtain outcomes. Results: The mEDC was successfully used to support the data collection and project management in all the 14 study hospitals. A total of 1333 patients were recruited with support of mEDC, of whom 1037 successfully completed all 4 visits. Across all visits, the average time needed for 141 questions per patient was 53 min, which were acceptable to both doctors and patients. All the interviewees, including 24 doctors, 53 patients, 1 clinical research associate (CRA), 1 project manager (PM), and 1 data manager (DM), expressed their satisfaction to nearly all the functions of the innovative mEDC in randomization, data collection, project management, quality control, and remote monitoring in real time. The average satisfaction score was 9.2 (scale, 0-10). The biggest challenge came from the stability of the mobile or Wi-Fi signal although it was not a problem in THAT study. Conclusions: The innovative mEDC has many merits and is well acceptable in supporting data collection and project management in a timely manner in clinical trial. UR - http://www.jmir.org/2017/3/e66/ UR - http://dx.doi.org/10.2196/jmir.6978 UR - http://www.ncbi.nlm.nih.gov/pubmed/28274907 ID - info:doi/10.2196/jmir.6978 ER - TY - JOUR AU - Wen, Dong AU - Zhang, Xingting AU - Liu, Xingyu AU - Lei, Jianbo PY - 2017/03/07 TI - Evaluating the Consistency of Current Mainstream Wearable Devices in Health Monitoring: A Comparison Under Free-Living Conditions JO - J Med Internet Res SP - e68 VL - 19 IS - 3 KW - fitness trackers KW - monitoring, physiologic KW - motor activity KW - activities of daily living KW - health status N2 - Background: Wearable devices are gaining increasing market attention; however, the monitoring accuracy and consistency of the devices remains unknown. Objective: The purpose of this study was to assess the consistency of the monitoring measurements of the latest wearable devices in the state of normal activities to provide advice to the industry and support to consumers in making purchasing choices. Methods: Ten pieces of representative wearable devices (2 smart watches, 4 smart bracelets of Chinese brands or foreign brands, and 4 mobile phone apps) were selected, and 5 subjects were employed to simultaneously use all the devices and the apps. From these devices, intact health monitoring data were acquired for 5 consecutive days and analyzed on the degree of differences and the relationships of the monitoring measurements ??by the different devices. Results: The daily measurements by the different devices fluctuated greatly, and the coefficient of variation (CV) fluctuated in the range of 2-38% for the number of steps, 5-30% for distance, 19-112% for activity duration, .1-17% for total energy expenditure (EE), 22-100% for activity EE, 2-44% for sleep duration, and 35-117% for deep sleep duration. After integrating the measurement data of 25 days among the devices, the measurements of the number of steps (intraclass correlation coefficient, ICC=.89) and distance (ICC=.84) displayed excellent consistencies, followed by those of activity duration (ICC=.59) and the total EE (ICC=.59) and activity EE (ICC=.57). However, the measurements for sleep duration (ICC=.30) and deep sleep duration (ICC=.27) were poor. For most devices, there was a strong correlation between the number of steps and distance measurements (R2>.95), and for some devices, there was a strong correlation between activity duration measurements and EE measurements (R2>.7). A strong correlation was observed in the measurements of steps, distance and EE from smart watches and mobile phones of the same brand, Apple or Samsung (r>.88). Conclusions: Although wearable devices are developing rapidly, the current mainstream devices are only reliable in measuring the number of steps and distance, which can be used as health assessment indicators. However, the measurement consistencies of activity duration, EE, sleep quality, and so on, are still inadequate, which require further investigation and improved algorithms. UR - http://www.jmir.org/2017/3/e68/ UR - http://dx.doi.org/10.2196/jmir.6874 UR - http://www.ncbi.nlm.nih.gov/pubmed/28270382 ID - info:doi/10.2196/jmir.6874 ER - TY - JOUR AU - Guo, Yi AU - Bian, Jiang AU - Leavitt, Trevor AU - Vincent, K. Heather AU - Vander Zalm, Lindsey AU - Teurlings, L. Tyler AU - Smith, D. Megan AU - Modave, François PY - 2017/03/07 TI - Assessing the Quality of Mobile Exercise Apps Based on the American College of Sports Medicine Guidelines: A Reliable and Valid Scoring Instrument JO - J Med Internet Res SP - e67 VL - 19 IS - 3 KW - mHealth KW - mobile apps KW - physical activity KW - measures N2 - Background: Regular physical activity can not only help with weight management, but also lower cardiovascular risks, cancer rates, and chronic disease burden. Yet, only approximately 20% of Americans currently meet the physical activity guidelines recommended by the US Department of Health and Human Services. With the rapid development of mobile technologies, mobile apps have the potential to improve participation rates in exercise programs, particularly if they are evidence-based and are of sufficient content quality. Objective: The goal of this study was to develop and test an instrument, which was designed to score the content quality of exercise program apps with respect to the exercise guidelines set forth by the American College of Sports Medicine (ACSM). Methods: We conducted two focus groups (N=14) to elicit input for developing a preliminary 27-item scoring instruments based on the ACSM exercise prescription guidelines. Three reviewers who were no sports medicine experts independently scored 28 exercise program apps using the instrument. Inter- and intra-rater reliability was assessed among the 3 reviewers. An expert reviewer, a Fellow of the ACSM, also scored the 28 apps to create criterion scores. Criterion validity was assessed by comparing nonexpert reviewers? scores to the criterion scores. Results: Overall, inter- and intra-rater reliability was high with most coefficients being greater than .7. Inter-rater reliability coefficients ranged from .59 to .99, and intra-rater reliability coefficients ranged from .47 to 1.00. All reliability coefficients were statistically significant. Criterion validity was found to be excellent, with the weighted kappa statistics ranging from .67 to .99, indicating a substantial agreement between the scores of expert and nonexpert reviewers. Finally, all apps scored poorly against the ACSM exercise prescription guidelines. None of the apps received a score greater than 35, out of a possible maximal score of 70. Conclusions: We have developed and presented valid and reliable scoring instruments for exercise program apps. Our instrument may be useful for consumers and health care providers who are looking for apps that provide safe, progressive general exercise programs for health and fitness. UR - http://www.jmir.org/2017/3/e67/ UR - http://dx.doi.org/10.2196/jmir.6976 UR - http://www.ncbi.nlm.nih.gov/pubmed/28270378 ID - info:doi/10.2196/jmir.6976 ER - TY - JOUR AU - Tay, Ilona AU - Garland, Suzanne AU - Gorelik, Alexandra AU - Wark, Dennis John PY - 2017/03/07 TI - Development and Testing of a Mobile Phone App for Self-Monitoring of Calcium Intake in Young Women JO - JMIR Mhealth Uhealth SP - e27 VL - 5 IS - 3 KW - behavior therapy KW - cell phones KW - health behavior KW - primary prevention KW - self care KW - telemedicine N2 - Background: Interventions to prevent osteoporosis by increasing dairy intake or physical activity in young women have been limited to increasing osteoporosis knowledge and awareness. However, findings have shown that this does not always lead to a change in behaviors. Self-monitoring using mobile devices in behavioral interventions has yielded significant and positive outcomes. Yet, to our knowledge, mobile self-monitoring has not been used as an intervention strategy to increase calcium intake, particularly in young women, for better bone health outcomes. Objective: As development and testing of mobile app?based interventions requires a sequence of steps, our study focused on testing the acceptability and usability of Calci-app, a dietary app to self-monitor calcium consumption, before it is used in a behavioral change intervention in young women aged 18-25 years. Methods: Calci-app development followed 4 steps: (1) conceptualization, (2) development and pretesting, (3) pilot testing, and (4) mixed methods evaluation. Results: We present the development process of Calci-app and evaluation of the acceptability and usability of the app in young women. Overall, 78% (31/40) of study participants completed the 5-day food record with high compliance levels (defined as more than 3 days of full or partial completion). There was a significant reduction in the proportion of participants completing all meal entries over the 5 days (P=.01). Participants generally found Calci-app easy and convenient to use, but it was time-consuming and they expressed a lack of motivation to use the app. Conclusions: We present a detailed description of the development process of Calci-app and an evaluation of its usability and acceptability to self-monitor dietary calcium intake. The findings from this preliminary study demonstrated acceptable use of Calci-app to self-monitor calcium consumption. However, for regular and long-term use the self-monitoring function in Calci-app could be expanded to allow participants to view their total daily calcium intake compared with the recommended daily intake. Additionally, to facilitate sustainable lifestyle behavior modifications, a combination of various behavior change techniques should be considered, such as education, goal setting, and advice to participants based on their stage of change. The feedback on barriers and facilitators from testing Calci-app will be used to design a bone health mHealth intervention to modify risky lifestyle behaviors in young women for better bone health outcomes. UR - http://mhealth.jmir.org/2017/3/e27/ UR - http://dx.doi.org/10.2196/mhealth.5717 UR - http://www.ncbi.nlm.nih.gov/pubmed/28270379 ID - info:doi/10.2196/mhealth.5717 ER - TY - JOUR AU - Lyons, J. Elizabeth AU - Swartz, C. Maria AU - Lewis, H. Zakkoyya AU - Martinez, Eloisa AU - Jennings, Kristofer PY - 2017/03/06 TI - Feasibility and Acceptability of a Wearable Technology Physical Activity Intervention With Telephone Counseling for Mid-Aged and Older Adults: A Randomized Controlled Pilot Trial JO - JMIR Mhealth Uhealth SP - e28 VL - 5 IS - 3 KW - physical activity KW - technology KW - mobile health KW - health behavior KW - self-control N2 - Background: As adults age, their physical activity decreases and sedentary behavior increases, leading to increased risk of negative health outcomes. Wearable electronic activity monitors have shown promise for delivering effective behavior change techniques. However, little is known about the feasibility and acceptability of non-Fitbit wearables (Fitbit, Inc, San Francisco, California) combined with telephone counseling among adults aged more than 55 years. Objective: The purpose of our study was to determine the feasibility, acceptability, and effect on physical activity of an intervention combining a wearable physical activity monitor, tablet device, and telephone counseling among adults aged 55-79 years. Methods: Adults (N=40, aged 55-79 years, body mass index=25-35, <60 min of activity per week) were randomized to receive a 12-week intervention or to a wait list control. Intervention participants received a Jawbone Up24 monitor, a tablet with the Jawbone Up app installed, and brief weekly telephone counseling. Participants set daily and weekly step goals and used the monitor?s idle alert to notify them when they were sedentary for more than 1 h. Interventionists provided brief counseling once per week by telephone. Feasibility was measured using observation and study records, and acceptability was measured by self-report using validated items. Physical activity and sedentary time were measured using ActivPAL monitors following standard protocols. Body composition was measured using dual-energy x-ray absorptiometry scans, and fitness was measured using a 6-min walk test. Results: Participants were 61.48 years old (SD 5.60), 85% (34/40) female, 65% (26/40) white. Average activity monitor wear time was 81.85 (SD 3.73) of 90 days. Of the 20 Up24 monitors, 5 were reported broken and 1 lost. No related adverse events were reported. Acceptability items were rated at least 4 on a scale of 1-5. Effect sizes for most outcomes were small, including stepping time per day (d=0.35), steps per day (d=0.26), sitting time per day (d=0.21), body fat (d=0.17), and weight (d=0.33). Conclusions: The intervention was feasible and acceptable in this population. Effect sizes were similar to the sizes found using other wearable electronic activity monitors, indicating that when combined with telephone counseling, wearable activity monitors are a potentially effective tool for increasing physical activity and decreasing sedentary behavior. Trial registration: Clinicaltrials.gov NCT01869348; https://clinicaltrials.gov/ct2/show/NCT01869348 (Archived by WebCite at http://www.webcitation.org/6odlIolqy) UR - http://mhealth.jmir.org/2017/3/e28/ UR - http://dx.doi.org/10.2196/mhealth.6967 UR - http://www.ncbi.nlm.nih.gov/pubmed/28264796 ID - info:doi/10.2196/mhealth.6967 ER - TY - JOUR AU - Gimbel, Ronald AU - Shi, Lu AU - Williams, E. Joel AU - Dye, J. Cheryl AU - Chen, Liwei AU - Crawford, Paul AU - Shry, A. Eric AU - Griffin, F. Sarah AU - Jones, O. Karyn AU - Sherrill, W. Windsor AU - Truong, Khoa AU - Little, R. Jeanette AU - Edwards, W. Karen AU - Hing, Marie AU - Moss, B. Jennie PY - 2017/03/06 TI - Enhancing mHealth Technology in the Patient-Centered Medical Home Environment to Activate Patients With Type 2 Diabetes: A Multisite Feasibility Study Protocol JO - JMIR Res Protoc SP - e38 VL - 6 IS - 3 KW - mHealth KW - diabetes mellitus KW - patient activation KW - patient-centered medical home KW - patient centered care KW - eHealth KW - health information N2 - Background: The potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness. Some of the more promising results have been demonstrated using regular collection of biometric devices, SMS text messaging, secure email communication with clinical teams, and regular reporting of quality-of-life variables. In this study, we seek to incorporate several of the most promising mHealth capabilities in a patient-centered medical home (PCMH) workflow. Objective: We aim to address underlying technology needs and gaps related to the use of mHealth technology and the activation of patients living with type 2 diabetes. Stated differently, we enable supporting technologies while seeking to influence patient activation and self-care activities. Methods: This is a multisite phased study, conducted within the US Military Health System, that includes a user-centered design phase and a PCMH-based feasibility trial. In phase 1, we will assess both patient and provider preferences regarding the enhancement of the enabling technology capabilities for type 2 diabetes chronic care management. Phase 2 research will be a single-blinded 12-month feasibility study that incorporates randomization principles. Phase 2 research will seek to improve patient activation and self-care activities through the use of the Mobile Health Care Environment with tailored behavioral messaging. The primary outcome measure is the Patient Activation Measure scores. Secondary outcome measures are Summary of Diabetes Self-care Activities Measure scores, clinical measures, comorbid conditions, health services resource consumption, and technology system usage statistics. Results: We have completed phase 1 data collection. Formal analysis of phase 1 data has not been completed. We have obtained institutional review board approval and began phase 1 research in late fall 2016. Conclusions: The study hypotheses suggest that patients can, and will, improve their activation in chronic care management. Improved activation should translate into improved diabetes self-care. Expected benefits of this research to the scientific community and health care services include improved understanding of how to leverage mHealth technology to activate patients living with type 2 diabetes in self-management behaviors. The research will shed light on implementation strategies in integrating mHealth into the clinical workflow of the PCMH setting. Trial Registration: ClinicalTrials.gov NCT02949037. https://clinicaltrials.gov/ct2/show/NCT02949037. (Archived by WebCite at http://www.webcitation.org/6oRyDzqei) UR - http://www.researchprotocols.org/2017/3/e38/ UR - http://dx.doi.org/10.2196/resprot.6993 UR - http://www.ncbi.nlm.nih.gov/pubmed/28264792 ID - info:doi/10.2196/resprot.6993 ER - TY - JOUR AU - Chow, I. Philip AU - Fua, Karl AU - Huang, Yu AU - Bonelli, Wesley AU - Xiong, Haoyi AU - Barnes, E. Laura AU - Teachman, A. Bethany PY - 2017/03/03 TI - Using Mobile Sensing to Test Clinical Models of Depression, Social Anxiety, State Affect, and Social Isolation Among College Students JO - J Med Internet Res SP - e62 VL - 19 IS - 3 KW - mental health KW - depression KW - social anxiety KW - affect KW - homestay KW - mobile health KW - mHealth N2 - Background: Research in psychology demonstrates a strong link between state affect (moment-to-moment experiences of positive or negative emotionality) and trait affect (eg, relatively enduring depression and social anxiety symptoms), and a tendency to withdraw (eg, spending time at home). However, existing work is based almost exclusively on static, self-reported descriptions of emotions and behavior that limit generalizability. Despite adoption of increasingly sophisticated research designs and technology (eg, mobile sensing using a global positioning system [GPS]), little research has integrated these seemingly disparate forms of data to improve understanding of how emotional experiences in everyday life are associated with time spent at home, and whether this is influenced by depression or social anxiety symptoms. Objective: We hypothesized that more time spent at home would be associated with more negative and less positive affect. Methods: We recruited 72 undergraduate participants from a southeast university in the United States. We assessed depression and social anxiety symptoms using self-report instruments at baseline. An app (Sensus) installed on participants? personal mobile phones repeatedly collected in situ self-reported state affect and GPS location data for up to 2 weeks. Time spent at home was a proxy for social isolation. Results: We tested separate models examining the relations between state affect and time spent at home, with levels of depression and social anxiety as moderators. Models differed only in the temporal links examined. One model focused on associations between changes in affect and time spent at home within short, 4-hour time windows. The other 3 models focused on associations between mean-level affect within a day and time spent at home (1) the same day, (2) the following day, and (3) the previous day. Overall, we obtained many of the expected main effects (although there were some null effects), in which higher social anxiety was associated with more time or greater likelihood of spending time at home, and more negative or less positive affect was linked to longer homestay. Interactions indicated that, among individuals higher in social anxiety, higher negative affect and lower positive affect within a day was associated with greater likelihood of spending time at home the following day. Conclusions: Results demonstrate the feasibility and utility of modeling the relationship between affect and homestay using fine-grained GPS data. Although these findings must be replicated in a larger study and with clinical samples, they suggest that integrating repeated state affect assessments in situ with continuous GPS data can increase understanding of how actual homestay is related to affect in everyday life and to symptoms of anxiety and depression. UR - http://www.jmir.org/2017/3/e62/ UR - http://dx.doi.org/10.2196/jmir.6820 UR - http://www.ncbi.nlm.nih.gov/pubmed/28258049 ID - info:doi/10.2196/jmir.6820 ER - TY - JOUR AU - Ferron, C. Joelle AU - Brunette, F. Mary AU - Geiger, Pamela AU - Marsch, A. Lisa AU - Adachi-Mejia, M. Anna AU - Bartels, J. Stephen PY - 2017/03/03 TI - Mobile Phone Apps for Smoking Cessation: Quality and Usability Among Smokers With Psychosis JO - JMIR Hum Factors SP - e7 VL - 4 IS - 1 KW - mHealth KW - mobile apps KW - smoking cessation KW - schizophrenia KW - psychotic disorders N2 - Background: Smoking is one of the top preventable causes of mortality in people with psychotic disorders such as schizophrenia. Cessation treatment improves abstinence outcomes, but access is a barrier. Mobile phone apps are one way to increase access to cessation treatment; however, whether they are usable by people with psychotic disorders, who often have special learning needs, is not known. Objective: Researchers reviewed 100 randomly selected apps for smoking cessation to rate them based on US guidelines for nicotine addiction treatment and to categorize them based on app functions. We aimed to test the usability and usefulness of the top-rated apps in 21 smokers with psychotic disorders. Methods: We identified 766 smoking cessation apps and randomly selected 100 for review. Two independent reviewers rated each app with the Adherence Index to US Clinical Practice Guideline for Treating Tobacco Use and Dependence. Then, smokers with psychotic disorders evaluated the top 9 apps within a usability testing protocol. We analyzed quantitative results using descriptive statistics and t tests. Qualitative data were open-coded and analyzed for themes. Results: Regarding adherence to practice guidelines, most of the randomly sampled smoking cessation apps scored poorly?66% rated lower than 10 out of 100 on the Adherence Index (Mean 11.47, SD 11.8). Regarding usability, three common usability problems emerged: text-dense content, abstract symbols on the homepage, and subtle directions to edit features. Conclusions: In order for apps to be effective and usable for this population, developers should utilize a balance of text and simple design that facilitate ease of navigation and content comprehension that will help people learn quit smoking skills. UR - http://humanfactors.jmir.org/2017/1/e7/ UR - http://dx.doi.org/10.2196/humanfactors.5933 UR - http://www.ncbi.nlm.nih.gov/pubmed/28258047 ID - info:doi/10.2196/humanfactors.5933 ER - TY - JOUR AU - Lyles, A. Annmarie AU - Amresh, Ashish AU - Huberty, Jennifer AU - Todd, Michael AU - Lee, E. Rebecca PY - 2017/03/02 TI - A Mobile, Avatar-Based App for Improving Body Perceptions Among Adolescents: A Pilot Test JO - JMIR Serious Games SP - e4 VL - 5 IS - 1 KW - adolescents KW - avatars KW - eHealth KW - mHealth KW - perceptions KW - Web-based KW - usability testing N2 - Background: One barrier to effectively treating weight issues among adolescents is that they tend to use social comparison instead of objective measures to evaluate their own health status. When adolescents correctly perceive themselves as overweight, they are more likely to adopt healthy lifestyle behaviors. Objective: The purpose of this pilot test was to develop and assess acceptability and usability of an avatar-based, theoretically derived mobile app entitled Monitor Your Avatar (MYA). Methods: The MYA app was engineered for high school adolescents to identify, using avatars, what they thought they looked like, what they wanted to look like, and what they actually looked like based on body measurements. Results: The MYA app was pilot-tested with male and female adolescents aged 15-18 years to assess for acceptability and usability. A total of 42 students created and viewed their avatars. The majority of the adolescents were female (28/42, 67%), age 16 years (16/42, 38%), white (35/42, 83%), non-Hispanic (36/42, 86%), in grade 10 (20/42, 48%), healthy weight for females (23/28, 82%), and obese for males (7/14, 50%). The adolescents had positive reactions to the avatar app and being able to view avatars that represented them. All but one student (41/42, 98%) indicated some level of comfort viewing the avatars and would use the app in the future to see how their bodies change over time. Conclusions: Avatar-based mobile apps, such as the MYA app, provide immediate feedback and allow users to engage with images that are personalized to represent their perceptions and actual body images. This pilot study adds to the increasing but limited research of using games to improve health outcomes among high school adolescents. There is a need to further adapt the MYA app and gather feedback from a larger number of high school adolescents, including those from diverse backgrounds. UR - http://games.jmir.org/2017/1/e4/ UR - http://dx.doi.org/10.2196/games.6354 UR - http://www.ncbi.nlm.nih.gov/pubmed/28254737 ID - info:doi/10.2196/games.6354 ER - TY - JOUR AU - Bonoto, Cezar Bráulio AU - de Araújo, Eloisa Vânia AU - Godói, Piassi Isabella AU - de Lemos, Pires Lívia Lovato AU - Godman, Brian AU - Bennie, Marion AU - Diniz, Mauricio Leonardo AU - Junior, Guerra Augusto Afonso PY - 2017/03/01 TI - Efficacy of Mobile Apps to Support the Care of Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - JMIR Mhealth Uhealth SP - e4 VL - 5 IS - 3 KW - diabetes mellitus KW - self-care KW - mobile applications KW - telemedicine N2 - Background: Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health apps. Objective: The aim of our study was to evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist DM patients in treatment. Methods: We conducted searches in the electronic databases MEDLINE (Pubmed), Cochrane Register of Controlled Trials (CENTRAL), and LILACS (Latin American and Caribbean Health Sciences Literature), including manual search in references of publications that included systematic reviews, specialized journals, and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, patients with DM, and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager software version 5.3. Results: The literature search identified 1236 publications. Of these, 13 studies were included that evaluated 1263 patients. In 6 RCTs, there were a statistical significant reduction (P<.05) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (mean difference, MD ?0.44; CI: ?0.59 to ?0.29; P<.001; I²=32%).The evaluation favored the treatment in patients who used apps without significant heterogeneity. Conclusions: The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care by contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly by reducing their fear of not knowing how to deal with potential hypoglycemic episodes that may occur. UR - http://mhealth.jmir.org/2017/3/e4/ UR - http://dx.doi.org/10.2196/mhealth.6309 UR - http://www.ncbi.nlm.nih.gov/pubmed/28249834 ID - info:doi/10.2196/mhealth.6309 ER - TY - JOUR AU - Kannisto, Anneli Kati AU - Korhonen, Joonas AU - Adams, E. Clive AU - Koivunen, Hannele Marita AU - Vahlberg, Tero AU - Välimäki, Anneli Maritta PY - 2017/02/21 TI - Factors Associated With Dropout During Recruitment and Follow-Up Periods of a mHealth-Based Randomized Controlled Trial for Mobile.Net to Encourage Treatment Adherence for People With Serious Mental Health Problems JO - J Med Internet Res SP - e46 VL - 19 IS - 2 KW - text messaging KW - mobile health KW - antipsychotics KW - mental health KW - psychiatric services KW - methodological study N2 - Background: Clinical trials are the gold standard of evidence-based practice. Still many papers inadequately report methodology in randomized controlled trials (RCTs), particularly for mHealth interventions for people with serious mental health problems. To ensure robust enough evidence, it is important to understand which study phases are the most vulnerable in the field of mental health care. Objective: We mapped the recruitment and the trial follow-up periods of participants to provide a picture of the dropout predictors from a mHealth-based trial. As an example, we used a mHealth-based multicenter RCT, titled ?Mobile.Net,? targeted at people with serious mental health problems. Methods: Recruitment and follow-up processes of the Mobile.Net trial were monitored and analyzed. Recruitment outcomes were recorded as screened, eligible, consent not asked, refused, and enrolled. Patient engagement was recorded as follow-up outcomes: (1) attrition during short message service (SMS) text message intervention and (2) attrition during the 12-month follow-up period. Multiple regression analysis was used to identify which demographic factors were related to recruitment and retention. Results: We recruited 1139 patients during a 15-month period. Of 11,530 people screened, 36.31% (n=4186) were eligible. This eligible group tended to be significantly younger (mean 39.2, SD 13.2 years, P<.001) and more often women (2103/4181, 50.30%) than those who were not eligible (age: mean 43.7, SD 14.6 years; women: 3633/6514, 55.78%). At the point when potential participants were asked to give consent, a further 2278 refused. Those who refused were a little older (mean 40.2, SD 13.9 years) than those who agreed to participate (mean 38.3, SD 12.5 years; t1842=3.2, P<.001). We measured the outcomes after 12 months of the SMS text message intervention. Attrition from the SMS text message intervention was 4.8% (27/563). The patient dropout rate after 12 months was 0.36% (4/1123), as discovered from the register data. In all, 3.12% (35/1123) of the participants withdrew from the trial. However, dropout rates from the patient survey (either by paper or telephone interview) were 52.45% (589/1123) and 27.8% (155/558), respectively. Almost all participants (536/563, 95.2%) tolerated the intervention, but those who discontinued were more often women (21/27, 78%; P=.009). Finally, participants? age (P<.001), gender (P<.001), vocational education (P=.04), and employment status (P<.001) seemed to predict their risk of dropping out from the postal survey. Conclusions: Patient recruitment and engagement in the 12-month follow-up conducted with a postal survey were the most vulnerable phases in the SMS text message-based trial. People with serious mental health problems may need extra support during the recruitment process and in engaging them in SMS text message-based trials to ensure robust enough evidence for mental health care. ClinicalTrial: International Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6oHcU2SFp) UR - http://www.jmir.org/2017/2/e46/ UR - http://dx.doi.org/10.2196/jmir.6417 UR - http://www.ncbi.nlm.nih.gov/pubmed/28223262 ID - info:doi/10.2196/jmir.6417 ER - TY - JOUR AU - Bain, E. Earle AU - Shafner, Laura AU - Walling, P. David AU - Othman, A. Ahmed AU - Chuang-Stein, Christy AU - Hinkle, John AU - Hanina, Adam PY - 2017/02/21 TI - Use of a Novel Artificial Intelligence Platform on Mobile Devices to Assess Dosing Compliance in a Phase 2 Clinical Trial in Subjects With Schizophrenia JO - JMIR Mhealth Uhealth SP - e18 VL - 5 IS - 2 KW - medication adherence KW - artificial intelligence KW - clinical trials as topic N2 - Background: Accurately monitoring and collecting drug adherence data can allow for better understanding and interpretation of the outcomes of clinical trials. Most clinical trials use a combination of pill counts and self-reported data to measure drug adherence, despite the drawbacks of relying on these types of indirect measures. It is assumed that doses are taken, but the exact timing of these events is often incomplete and imprecise. Objective: The objective of this pilot study was to evaluate the use of a novel artificial intelligence (AI) platform (AiCure) on mobile devices for measuring medication adherence, compared with modified directly observed therapy (mDOT) in a substudy of a Phase 2 trial of the ?7 nicotinic receptor agonist (ABT-126) in subjects with schizophrenia. Methods: AI platform generated adherence measures were compared with adherence inferred from drug concentration measurements. Results: The mean cumulative pharmacokinetic adherence over 24 weeks was 89.7% (standard deviation [SD] 24.92) for subjects receiving ABT-126 who were monitored using the AI platform, compared with 71.9% (SD 39.81) for subjects receiving ABT-126 who were monitored by mDOT. The difference was 17.9% (95% CI -2 to 37.7; P=.08). Conclusions: Using drug levels, this substudy demonstrates the potential of AI platforms to increase adherence, rapidly detect nonadherence, and predict future nonadherence. Subjects monitored using the AI platform demonstrated a percentage change in adherence of 25% over the mDOT group. Subjects were able to use the technology successfully for up to 6 months in an ambulatory setting with early termination rates that are comparable to subjects outside of the substudy. Trial Registration: ClinicalTrials.gov NCT01655680 https://clinicaltrials.gov/ct2/show/NCT01655680?term=NCT01655680 UR - http://mhealth.jmir.org/2017/2/e18/ UR - http://dx.doi.org/10.2196/mhealth.7030 UR - http://www.ncbi.nlm.nih.gov/pubmed/28223265 ID - info:doi/10.2196/mhealth.7030 ER - TY - JOUR AU - Grainger, Rebecca AU - Townsley, Hermaleigh AU - White, Bonnie AU - Langlotz, Tobias AU - Taylor, J. William PY - 2017/02/21 TI - Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality JO - JMIR Mhealth Uhealth SP - e7 VL - 5 IS - 2 KW - mHealth KW - mobile applications KW - telemedicine KW - self-management KW - rheumatoid arthritis N2 - Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis requiring long-term treatment with regular monitoring by a rheumatologist to achieve good health outcomes. Since people with RA may wish to monitor their own disease activity with a smartphone app, it is important to understand the functions and quality of apps for this purpose. Objective: The aim of our study was to assess the features and quality of apps to assist people to monitor their RA disease activity by (1) summarizing the available apps, particularly the instruments used for measurement of RA disease activity; (2) comparing the app features with American College of Rheumatology and European League against Rheumatism (ACR and EULAR) guidelines for monitoring of RA disease activity; and (3) rating app quality with the Mobile App Rating Scale (MARS). Methods: Systematic searches of the New Zealand iTunes and Google Play app stores were used to identify all apps for monitoring of RA disease activity that could be used by people with RA. The apps were described by both key metadata and app functionality. App adherence with recommendations for monitoring of RA disease activity in clinical practice was evaluated by identifying whether apps included calculation of a validated composite disease activity measure and recorded results for future retrieval. App quality was assessed by 2 independent reviewers using the MARS. Results: The search identified 721 apps in the Google Play store and 216 in the iTunes store, of which 19 unique apps met criteria for inclusion (8 from both app stores, 8 iTunes, and 3 Google Play). In total, 14 apps included at least one validated instrument measuring RA disease activity; 7 of 11 apps that allowed users to enter a joint count used the standard 28 swollen and tender joint count; 8 apps included at least one ACR and EULAR-recommended RA composite disease activity (CDA) measure; and 10 apps included data storage and retrieval. Only 1 app, Arthritis Power, included both an RA CDA measure and tracked data, but this app did not include the standard 28 tender and swollen joint count. The median overall MARS score for apps was 3.41/5. Of the 6 apps that scored ?4/5 on the overall MARS rating, only 1 included a CDA score endorsed by ACR and EULAR; however, this app did not have a data tracking function. Conclusions: This review found a lack of high-quality apps for longitudinal assessment of RA disease activity. Current apps fall into two categories: simple calculators primarily for rheumatologists and data tracking tools for people with RA. The latter do not uniformly collect data using validated instruments or composite disease activity measures. There is a need for appropriate, high-quality apps for use by rheumatologists and patients together in co-management of RA. UR - http://mhealth.jmir.org/2017/2/e7/ UR - http://dx.doi.org/10.2196/mhealth.6956 UR - http://www.ncbi.nlm.nih.gov/pubmed/28223263 ID - info:doi/10.2196/mhealth.6956 ER - TY - JOUR AU - Dobson, Rosie AU - Whittaker, Robyn AU - Murphy, Rinki AU - Khanolkar, Manish AU - Miller, Steven AU - Naylor, Joanna AU - Maddison, Ralph PY - 2017/02/15 TI - The Use of Mobile Health to Deliver Self-Management Support to Young People With Type 1 Diabetes: A Cross-Sectional Survey JO - JMIR Diabetes SP - e4 VL - 2 IS - 1 KW - mHealth KW - diabetes mellitus KW - mobile phone KW - mobile applications KW - text messages N2 - Background: Young people living with type 1 diabetes face not only the challenges typical of adolescence, but also the challenges of daily management of their health and evolving understanding of the impact of their diagnosis on their future. Adolescence is a critical time for diabetes self-management, with a typical decline in glycemic control increasing risk for microvascular diabetes complications. To improve glycemic control, there is a need for evidence-based self-management support interventions that address the issues pertinent to this population, utilizing platforms that engage them. Increasingly, mobile health (mHealth) interventions are being developed and evaluated for this purpose with some evidence supporting improved glycemic control. A necessary step to enhance effectiveness of such approaches is to understand young people?s preferences for this mode of delivery. Objective: A cross-sectional survey was conducted to investigate the current and perceived roles of mHealth in supporting young people to manage their diabetes. Methods: Young adults (16-24 years) with type 1 diabetes in Auckland, New Zealand, were invited to take part in a survey via letter from their diabetes specialist. Results: A total of 115 young adults completed the survey (mean age 19.5 years; male 52/115, 45%; European 89/115, 77%), with all reporting they owned a mobile phone and 96% (110/115) of those were smartphones. However, smartphone apps for diabetes management had been used by only 33% (38/115) of respondents. The most commonly reported reason for not using apps was a lack of awareness that they existed. Although the majority felt they managed their diabetes well, 63% (72/115) reported wanting to learn more about diabetes and how to manage it. A total of 64% (74/115) respondents reported that they would be interested in receiving diabetes self-management support via text message (short message service, SMS). Conclusions: Current engagement with mHealth in this population appears low, although the findings from this study provide support for the use of mHealth in this group because of the ubiquity and convenience of mobile devices. mHealth has potential to provide information and support to this population, utilizing mediums commonplace for this group and with greater reach than traditional methods. UR - http://diabetes.jmir.org/2017/1/e4/ UR - http://dx.doi.org/10.2196/diabetes.7221 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291057 ID - info:doi/10.2196/diabetes.7221 ER - TY - JOUR AU - Þórarinsdóttir, Helga AU - Kessing, Vedel Lars AU - Faurholt-Jepsen, Maria PY - 2017/02/13 TI - Smartphone-Based Self-Assessment of Stress in Healthy Adult Individuals: A Systematic Review JO - J Med Internet Res SP - e41 VL - 19 IS - 2 KW - smartphone KW - emotional stress KW - healthy individuals KW - self-report KW - objective smartphone generated measures of stress N2 - Background: Stress is a common experience in today?s society. Smartphone ownership is widespread, and smartphones can be used to monitor health and well-being. Smartphone-based self-assessment of stress can be done in naturalistic settings and may potentially reflect real-time stress level. Objective: The objectives of this systematic review were to evaluate (1) the use of smartphones to measure self-assessed stress in healthy adult individuals, (2) the validity of smartphone-based self-assessed stress compared with validated stress scales, and (3) the association between smartphone-based self-assessed stress and smartphone generated objective data. Methods: A systematic review of the scientific literature was reported and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The scientific databases PubMed, PsycINFO, Embase, IEEE, and ACM were searched and supplemented by a hand search of reference lists. The databases were searched for original studies involving healthy individuals older than 18 years, measuring self-assessed stress using smartphones. Results: A total of 35 published articles comprising 1464 individuals were included for review. According to the objectives, (1) study designs were heterogeneous, and smartphone-based self-assessed stress was measured using various methods (e.g., dichotomized questions on stress, yes or no; Likert scales on stress; and questionnaires); (2) the validity of smartphone-based self-assessed stress compared with validated stress scales was investigated in 3 studies, and of these, only 1 study found a moderate statistically significant positive correlation (r=.4; P<.05); and (3) in exploratory analyses, smartphone-based self-assessed stress was found to correlate with some of the reported smartphone generated objective data, including voice features and data on activity and phone usage. Conclusions: Smartphones are being used to measure self-assessed stress in different contexts. The evidence of the validity of smartphone-based self-assessed stress is limited and should be investigated further. Smartphone generated objective data can potentially be used to monitor, predict, and reduce stress levels. UR - http://www.jmir.org/2017/2/e41/ UR - http://dx.doi.org/10.2196/jmir.6397 UR - http://www.ncbi.nlm.nih.gov/pubmed/28193600 ID - info:doi/10.2196/jmir.6397 ER - TY - JOUR AU - Sahin, Cigdem AU - Naylor, Patti-Jean PY - 2017/02/06 TI - Mixed-Methods Research in Diabetes Management via Mobile Health Technologies: A Scoping Review JO - JMIR Diabetes SP - e3 VL - 2 IS - 1 KW - mHealth KW - self-management KW - methods KW - review N2 - Background: Considering the increasing incidence and prevalence of diabetes worldwide and the high level of patient involvement it requires, diabetes self-management is a serious issue. The use of mobile health (mHealth) in diabetes self-management has increased, but so far research has not provided sufficient information about the uses and effectiveness of mHealth-based interventions. Alternative study designs and more rigorous methodologies are needed. Mixed-methods designs may be particularly useful because both diabetes self-management and mHealth studies require integrating theoretical and methodological approaches. Objective: This scoping review aimed to examine the extent of the use of mixed-methods research in mHealth-based diabetes management studies. The methodological approaches used to conduct mixed-methods studies were analyzed, and implications for future research are provided. Methods: Guided by Arksey and O?Malley?s framework, this scoping review implemented a comprehensive search strategy including reviewing electronic databases, key journal searches, Web-based research and knowledge centers, websites, and handsearching reference lists of the studies. The studies focusing on mHealth technologies and diabetes management were included in the review if they were primary research papers published in academic journals and reported using a combination of qualitative and quantitative methods. The key data extracted from the reviewed studies include purpose of mixing, design type, stage of integration, methods of legitimation, and data collection techniques. Results: The final sample (N=14) included studies focused on the feasibility and usability of mHealth diabetes apps (n=7), behavioral measures related to the mHealth apps (n=6), and challenges of intervention delivery in the mHealth context (n=1). Reviewed studies used advanced forms of mixed-methods designs where integration occurred at multiple points and data were collected using multiple techniques. However, the majority of studies did not identify a specific mixed-methods design or use accepted terminology; nor did they justify using this approach. Conclusions: This review provided important insights into the use of mixed methods in studies focused on diabetes management via mHealth technologies. The prominent role of qualitative methods and tailored measures in diabetes self-management studies was confirmed, and the importance of using multiple techniques and approaches in this field was emphasized. This review suggests defining specific mixed-methods questions, using specific legitimation methods, and developing research designs that overcome sampling and other methodological problems in future studies. UR - http://diabetes.jmir.org/2017/1/e3/ UR - http://dx.doi.org/10.2196/diabetes.6667 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291052 ID - info:doi/10.2196/diabetes.6667 ER - TY - JOUR AU - Carter, C. Michelle AU - Burley, J. Victoria AU - Cade, E. Janet PY - 2017/02/02 TI - Weight Loss Associated With Different Patterns of Self-Monitoring Using the Mobile Phone App My Meal Mate JO - JMIR Mhealth Uhealth SP - e8 VL - 5 IS - 2 KW - self-monitoring KW - mobile phone KW - obesity KW - weight loss N2 - Background: Obesity is a major global public health issue due to its association with a number of serious chronic illnesses and its high economic burden to health care providers. Self-monitoring of diet has been consistently linked to weight loss. However, there is limited evidence about how frequently individuals need to monitor their diet for optimal weight loss. Objective: The aim of this paper is to describe app usage frequency and pattern in the mobile phone arm of a previously conducted randomized controlled trial. The relationship between frequency and pattern of electronic dietary self-monitoring and weight loss is also investigated. Methods: A randomized pilot trial comparing three methods of self-monitoring (mobile phone app, paper diary, Web-based) was previously conducted. Trial duration was 6 months. The mobile phone app My Meal Mate features an electronic food diary and encourages users to self-monitor their dietary intake. All food consumption data were automatically uploaded with a time and date stamp. Post hoc regression analysis of app usage patterns was undertaken in the My Meal Mate group (n=43; female: 77%, 33/43; white: 100%, 43/43; age: mean 41, SD 9 years; body mass index: mean 34, SD 4 kg/m2) to explore the relationship between frequency and pattern of electronic dietary self-monitoring and weight loss. Baseline characteristics of participants were also investigated to identify any potential predictors of dietary self-monitoring. Results: Regression analysis showed that those in the highest frequency-of-use category (recorded ?129 days on the mobile phone app) had a ?6.4 kg (95% CI ?10.0 to ?2.9) lower follow-up weight (adjusted for baseline weight) than those in the lowest frequency-of-use category (recorded ?42 days; P<.001). Long-term intermittent monitoring over 6 months appeared to facilitate greater mean weight loss than other patterns of electronic self-monitoring (ie, monitoring over the short or moderate term and stopping and consistently monitoring over consecutive days). Participant characteristics such as age, baseline weight, sex, ethnicity, conscientiousness, and consideration of future consequences were not statistically associated with extent of self-monitoring. Conclusions: The results of this post hoc exploratory analysis indicate that duration and frequency of app use is associated with improved weight loss, but further research is required to identify whether there are participant characteristics that would reliably predict those who are most likely to regularly self-monitor their diet. ClinicalTrial: ClinicalTrials.gov NCT01744535; http://clinicaltrials.gov/ct2/show/NCT01744535 (Archived by WebCite at http://www.webcitation.org/6FEtc3PVB) UR - http://mhealth.jmir.org/2017/2/e8/ UR - http://dx.doi.org/10.2196/mhealth.4520 UR - http://www.ncbi.nlm.nih.gov/pubmed/28153814 ID - info:doi/10.2196/mhealth.4520 ER - TY - JOUR AU - Hendrikx, Jos AU - Ruijs, S. Loes AU - Cox, GE Lieke AU - Lemmens, MC Paul AU - Schuijers, GP Erik AU - Goris, HC Annelies PY - 2017/02/02 TI - Clinical Evaluation of the Measurement Performance of the Philips Health Watch: A Within-Person Comparative Study JO - JMIR Mhealth Uhealth SP - e10 VL - 5 IS - 2 KW - sedentary lifestyle KW - monitoring, ambulatory KW - monitoring, physiologic KW - accelerometry KW - actigraphy KW - photoplethysmography KW - heart rate KW - energy metabolism KW - adult KW - humans N2 - Background: Physical inactivity is an important modifiable risk factor for chronic diseases. A new wrist-worn heart rate and activity monitor has been developed for unobtrusive data collection to aid prevention and management of lifestyle-related chronic diseases by means of behavioral change programs. Objective: The objective of the study was to evaluate the performance of total energy expenditure and resting heart rate measures of the Philips health watch. Secondary objectives included the assessment of accuracy of other output parameters of the monitor: heart rate, respiration rate at rest, step count, and activity type recognition. Methods: A within-person comparative study was performed to assess the performance of the health watch against (medical) reference measures. Participants executed a protocol including 15 minutes of rest and various activities of daily life. A two one-sided tests approach was adopted for testing equivalence. In addition, error metrics such as mean error and mean absolute percentage error (MAPE) were calculated. Results: A total of 29 participants (14 males; mean age 41.2, SD 14.4, years; mean weight 77.2, SD 10.2, kg; mean height 1.8, SD 0.1, m; mean body mass index 25.1, SD 3.1, kg/m2) completed the 81-minute protocol. Their mean resting heart rate in beats per minute (bpm) was 64 (SD 7.3). With a mean error of ?10 (SD 38.9) kcal and a MAPE of 10% (SD 8.7%), total energy expenditure estimation of the health watch was found to be within the 15% predefined equivalence margin in reference to a portable indirect calorimeter. Resting heart rate determined during a 15-minute rest protocol was found to be within a 10% equivalence margin in reference to a wearable electrocardiogram (ECG) monitor, with a mean deviation of 0 bpm and a maximum deviation of 3 bpm. Heart rate was within 10 bpm and 10% of the ECG monitor reference for 93% of the duration of the protocol. Step count estimates were on average 21 counts lower than a waist-mounted step counter over all walking activities combined, with a MAPE of 3.5% (SD 2.4%). Resting respiration rate was on average 0.7 (SD 1.1) breaths per minute lower than the reference measurement by the spirometer embedded in the indirect calorimeter during the 15-minute rest, resulting in a MAPE of 8.3% (SD 7.0%). Activity type recognition of walking, running, cycling, or other was overall 90% accurate in reference to the activities performed. Conclusions: The health watch can serve its medical purpose of measuring resting heart rate and total energy expenditure over time in an unobtrusive manner, thereby providing valuable data for the prevention and management of lifestyle-related chronic diseases. Trial Registration: Netherlands trial register NTR5552; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5552 (Archived by WebCite at http://www.webcitation.org/6neYJgysl) UR - http://mhealth.jmir.org/2017/2/e10/ UR - http://dx.doi.org/10.2196/mhealth.6893 UR - http://www.ncbi.nlm.nih.gov/pubmed/28153815 ID - info:doi/10.2196/mhealth.6893 ER - TY - JOUR AU - Sage, Adam AU - Roberts, Courtney AU - Geryk, Lorie AU - Sleath, Betsy AU - Tate, Deborah AU - Carpenter, Delesha PY - 2017/02/01 TI - A Self-Regulation Theory?Based Asthma Management Mobile App for Adolescents: A Usability Assessment JO - JMIR Hum Factors SP - e5 VL - 4 IS - 1 KW - mHealth KW - asthma KW - mobile KW - usability N2 - Background: Self-regulation theory suggests people learn to influence their own behavior through self-monitoring, goal-setting, feedback, self-reward, and self-instruction, all of which smartphones are now capable of facilitating. Several mobile apps exist to manage asthma; however, little evidence exists about whether these apps employ user-centered design processes that adhere to government usability guidelines for mobile apps. Objective: Building upon a previous study that documented adolescent preferences for an asthma self-management app, we employed a user-centered approach to assess the usability of a high-fidelity wireframe for an asthma self-management app intended for use by adolescents with persistent asthma. Methods: Individual interviews were conducted with adolescents (ages 11-18 years) with persistent asthma who owned a smartphone (N=8). Adolescents were asked to evaluate a PDF app wireframe consisting of 76 screen shots displaying app features, including log in and home screen, profile setup, settings and info, self-management features, and graphical displays for charting asthma control and medication. Preferences, comments, and suggestions for each set of screen shots were assessed using the audio-recorded interviews. Two coders reached consensus on adolescent evaluations of the following aspects of app features: (1) usability, (2) behavioral intentions to use, (3) confusing aspects, and (4) suggestions for improvement. Results: The app wireframe was generally well received, and several suggestions for improvement were recorded. Suggestions included increased customization of charts and notifications, reminders, and alerts. Participants preferred longitudinal data about asthma control and medication use to be displayed using line graphs. All participants reported that they would find an asthma management app like the one depicted in the wireframe useful for managing their asthma. Conclusions: Early stage usability tests guided by government usability guidelines (usability.gov) revealed areas for improvement for an asthma self-management app for adolescents. Addressing these areas will be critical to developing an engaging and effective asthma self-management app that is capable of improving adolescent asthma outcomes. UR - http://humanfactors.jmir.org/2017/1/e5/ UR - http://dx.doi.org/10.2196/humanfactors.7133 UR - http://www.ncbi.nlm.nih.gov/pubmed/28148471 ID - info:doi/10.2196/humanfactors.7133 ER - TY - JOUR AU - Siebert, N. Johan AU - Ehrler, Frederic AU - Combescure, Christophe AU - Lacroix, Laurence AU - Haddad, Kevin AU - Sanchez, Oliver AU - Gervaix, Alain AU - Lovis, Christian AU - Manzano, Sergio PY - 2017/02/01 TI - A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial JO - J Med Internet Res SP - e31 VL - 19 IS - 2 KW - resuscitation KW - medication errors KW - pharmaceutical preparations KW - pediatrics KW - biomedical technology N2 - Background: During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. Objective: The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods. Methods: The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection. Results: A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods. Conclusions: In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors. UR - http://www.jmir.org/2017/2/e31/ UR - http://dx.doi.org/10.2196/jmir.7005 UR - http://www.ncbi.nlm.nih.gov/pubmed/28148473 ID - info:doi/10.2196/jmir.7005 ER - TY - JOUR AU - Buis, Lorraine AU - Hirzel, Lindsey AU - Dawood, M. Rachelle AU - Dawood, L. Katee AU - Nichols, P. Lauren AU - Artinian, T. Nancy AU - Schwiebert, Loren AU - Yarandi, N. Hossein AU - Roberson, N. Dana AU - Plegue, A. Melissa AU - Mango, C. LynnMarie AU - Levy, D. Phillip PY - 2017/02/01 TI - Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies JO - JMIR Mhealth Uhealth SP - e9 VL - 5 IS - 2 KW - cell phone KW - text messaging KW - hypertension KW - blood pressure KW - African Americans KW - medication adherence KW - telemedicine N2 - Background: Hypertension (HTN) is an important problem in the United States, with an estimated 78 million Americans aged 20 years and older suffering from this condition. Health disparities related to HTN are common in the United States, with African Americans suffering from greater prevalence of the condition than whites, as well as greater severity, earlier onset, and more complications. Medication adherence is an important component of HTN management, but adherence is often poor, and simply forgetting to take medications is often cited as a reason. Mobile health (mHealth) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach. Objective: Our goal was to determine the feasibility, acceptability, and preliminary clinical effectiveness of BPMED, an intervention designed to improve medication adherence among African Americans with uncontrolled HTN, through fully automated text messaging support. Methods: We conducted two parallel, unblinded randomized controlled pilot trials with African-American patients who had uncontrolled HTN, recruited from primary care and emergency department (ED) settings. In each trial, participants were randomized to receive either usual care or the BPMED intervention for one month. Data were collected in-person at baseline and one-month follow-up, assessing the effect on medication adherence, systolic and diastolic blood pressure (SBP and DBP), medication adherence self-efficacy, and participant satisfaction. Data for both randomized controlled pilot trials were analyzed separately and combined. Results: A total of 58 primary care and 65 ED participants were recruited with retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants consistently showed numerically greater, yet nonsignificant, improvements in measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5, P=.26), SBP (mean change ?12.6, SD 24.0 vs mean change ?11.3, SD 25.5 mm Hg, P=.78), and DBP (mean change ?4.9, SD 13.1 mm Hg vs mean change ?3.3, SD 14.3 mm Hg, P=.54). Control and BPMED participants had slight improvements to medication adherence self-efficacy (mean change 0.8, SD 9.8 vs mean change 0.7, SD 7.0) with no significant differences found between groups (P=.92). On linear regression analysis, baseline SBP was the only predictor of SBP change; participants with higher SBP at enrollment exhibited significantly greater improvements at one-month follow-up (?=?0.63, P<.001). In total, 94% (51/54) of BPMED participants agreed/strongly agreed that they were satisfied with the program, regardless of pilot setting. Conclusions: Use of text message reminders to improve medication adherence is a feasible and acceptable approach among African Americans with uncontrolled HTN. Although differences in actual medication adherence and blood pressure between BPMED and usual care controls were not significant, patterns of improvement in the BPMED condition suggest that text message medication reminders may have an effect and fully powered investigations with longer-term follow-up are warranted. Trial Registration: Clinicaltrials.gov NCT01465217; https://clinicaltrials.gov/ct2/show/NCT01465217 (Archived by WebCite at http://www.webcitation.org/6V0tto0lZ). UR - http://mhealth.jmir.org/2017/2/e9/ UR - http://dx.doi.org/10.2196/mhealth.6630 UR - http://www.ncbi.nlm.nih.gov/pubmed/28148474 ID - info:doi/10.2196/mhealth.6630 ER - TY - JOUR AU - Kazi, Momin Abdul AU - Carmichael, Jason-Louis AU - Hapanna, Waqo Galgallo AU - Wangoo, Gikaria Patrick AU - Karanja, Sarah AU - Wanyama, Denis AU - Muhula, Opondo Samuel AU - Kyomuhangi, Bazira Lennie AU - Loolpapit, Mores AU - Wangalwa, Bwire Gilbert AU - Kinagwi, Koki AU - Lester, Todd Richard PY - 2017/01/30 TI - Assessing Mobile Phone Access and Perceptions for Texting-Based mHealth Interventions Among Expectant Mothers and Child Caregivers in Remote Regions of Northern Kenya: A Survey-Based Descriptive Study JO - JMIR Public Health Surveill SP - e5 VL - 3 IS - 1 KW - mobile health KW - text messaging KW - prenatal care KW - immunization KW - Kenya N2 - Background: With a dramatic increase in mobile phone use in low- and middle-income countries, mobile health (mHealth) has great potential to connect health care services directly to participants enrolled and improve engagement of care. Rural and remote global settings may pose both significant challenges and opportunities. Objective: The objective of our study was to understand the demographics, phone usage and ownership characteristics, and feasibility among patients in rural and remote areas of Kenya of having text messaging (short messaging service, SMS)-based mHealth intervention for improvements in antenatal care attendance and routine immunization among children in Northern Kenya. Methods: A survey-based descriptive study was conducted between October 2014 and February 2015 at 8 health facilities in Northern Kenya as part of a program to scale up an mHealth service in rural and remote regions. The study was conducted at 6 government health facilities in Isiolo, Marsabit, and Samburu counties in remote and northern arid lands (NAL). Two less remote health facilities in Laikipia and Meru counties in more populated central highlands were included as comparison sites. Results: A total of 284 participants were surveyed; 63.4% (180/284) were from NAL clinics, whereas 36.6% (104/284) were from adjacent central highland clinics. In the NAL, almost half (48.8%, 88/180) reported no formal education and 24.4% (44/180) self-identified as nomads. The majority of participants from both regions had access to mobile phone: 99.0% (103/104) of participants from central highlands and 82.1% (147/180) of participants from NAL. Among those who had access to a phone, there were significant differences in network challenges and technology literacy between the 2 regions. However, there was no significant difference in the proportion of participants from NAL and central highlands who indicated that they would like to receive a weekly SMS text message from their health care provider (90.0% vs 95.0%; P=.52). Overall, 92.0% (230/250) of participants who had access to a telephone said that they would like to receive a weekly SMS text message from their health care provider. Most phone users already spent the equivalent of 626 SMS text messages on mobile credit for personal use. Conclusions: Despite the remoteness of northern Kenya?s NAL, the results indicate that the majority of pregnant women or care givers attending the maternal, newborn, and child health clinics have access to mobile phone and would like to receive text messages from their health care provider. mHealth programs, if designed appropriately for these settings, may be an innovative way for engaging women in care for improved maternal and newborn child health outcomes in order to achieve sustainable development goals. UR - http://publichealth.jmir.org/2017/1/e5/ UR - http://dx.doi.org/10.2196/publichealth.5386 UR - http://www.ncbi.nlm.nih.gov/pubmed/28137702 ID - info:doi/10.2196/publichealth.5386 ER - TY - JOUR AU - Mellentin, Isabella Angelina AU - Stenager, Elsebeth AU - Nielsen, Bent AU - Nielsen, Søgaard Anette AU - Yu, Fei PY - 2017/01/30 TI - A Smarter Pathway for Delivering Cue Exposure Therapy? The Design and Development of a Smartphone App Targeting Alcohol Use Disorder JO - JMIR Mhealth Uhealth SP - e5 VL - 5 IS - 1 KW - alcohol use disorder KW - exposure therapy KW - mobile application KW - smartphone N2 - Background: Although the number of alcohol-related treatments in app stores is proliferating, none of them are based on a psychological framework and supported by empirical evidence. Cue exposure treatment (CET) with urge-specific coping skills (USCS) is often used in Danish treatment settings. It is an evidence-based psychological approach that focuses on promoting ?confrontation with alcohol cues? as a means of reducing urges and the likelihood of relapse. Objective: The objective of this study was to describe the design and development of a CET-based smartphone app; an innovative delivery pathway for treating alcohol use disorder (AUD). Methods: The treatment is based on Monty and coworkers? manual for CET with USCS (2002). It was created by a multidisciplinary team of psychiatrists, psychologists, programmers, and graphic designers as well as patients with AUD. A database was developed for the purpose of registering and monitoring training activities. A final version of the CET app and database was developed after several user tests. Results: The final version of the CET app includes an introduction, 4 sessions featuring USCS, 8 alcohol exposure videos promoting the use of one of the USCS, and a results component providing an overview of training activities and potential progress. Real-time urges are measured before, during, and after exposure to alcohol cues and are registered in the app together with other training activity variables. Data packages are continuously sent in encrypted form to an external database and will be merged with other data (in an internal database) in the future. Conclusions: The CET smartphone app is currently being tested at a large-scale, randomized controlled trial with the aim of clarifying whether it can be classified as an evidence-based treatment solution. The app has the potential to augment the reach of psychological treatment for AUD. UR - http://mhealth.jmir.org/2017/1/e5/ UR - http://dx.doi.org/10.2196/mhealth.6500 UR - http://www.ncbi.nlm.nih.gov/pubmed/28137701 ID - info:doi/10.2196/mhealth.6500 ER - TY - JOUR AU - Berrouiguet, Sofian AU - Barrigón, Luisa Maria AU - Brandt, A. Sara AU - Nitzburg, C. George AU - Ovejero, Santiago AU - Alvarez-Garcia, Raquel AU - Carballo, Juan AU - Walter, Michel AU - Billot, Romain AU - Lenca, Philippe AU - Delgado-Gomez, David AU - Ropars, Juliette AU - de la Calle Gonzalez, Ivan AU - Courtet, Philippe AU - Baca-García, Enrique PY - 2017/01/26 TI - Ecological Assessment of Clinicians? Antipsychotic Prescription Habits in Psychiatric Inpatients: A Novel Web- and Mobile Phone?Based Prototype for a Dynamic Clinical Decision Support System JO - J Med Internet Res SP - e25 VL - 19 IS - 1 KW - clinical decision-making KW - antipsychotic agents KW - software KW - mobile applications KW - off-label use KW - prescriptions N2 - Background: Electronic prescribing devices with clinical decision support systems (CDSSs) hold the potential to significantly improve pharmacological treatment management. Objective: The aim of our study was to develop a novel Web- and mobile phone?based application to provide a dynamic CDSS by monitoring and analyzing practitioners? antipsychotic prescription habits and simultaneously linking these data to inpatients? symptom changes. Methods: We recruited 353 psychiatric inpatients whose symptom levels and prescribed medications were inputted into the MEmind application. We standardized all medications in the MEmind database using the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD). For each patient, MEmind calculated an average for the daily dose prescribed for antipsychotics (using the N05A ATC code), prescribed daily dose (PDD), and the PDD to DDD ratio. Results: MEmind results found that antipsychotics were used by 61.5% (217/353) of inpatients, with the largest proportion being patients with schizophrenia spectrum disorders (33.4%, 118/353). Of the 217 patients, 137 (63.2%, 137/217) were administered pharmacological monotherapy and 80 (36.8%, 80/217) were administered polytherapy. Antipsychotics were used mostly in schizophrenia spectrum and related psychotic disorders, but they were also prescribed in other nonpsychotic diagnoses. Notably, we observed polypharmacy going against current antipsychotics guidelines. Conclusions: MEmind data indicated that antipsychotic polypharmacy and off-label use in inpatient units is commonly practiced. MEmind holds the potential to create a dynamic CDSS that provides real-time tracking of prescription practices and symptom change. Such feedback can help practitioners determine a maximally therapeutic drug treatment while avoiding unproductive overprescription and off-label use. UR - http://www.jmir.org/2017/1/e25/ UR - http://dx.doi.org/10.2196/jmir.5954 UR - http://www.ncbi.nlm.nih.gov/pubmed/28126703 ID - info:doi/10.2196/jmir.5954 ER - TY - JOUR AU - Lithgow, Kirstie AU - Edwards, Alun AU - Rabi, Doreen PY - 2017/01/23 TI - Smartphone App Use for Diabetes Management: Evaluating Patient Perspectives JO - JMIR Diabetes SP - e2 VL - 2 IS - 1 KW - type 1 diabetes KW - mobile health KW - smartphone N2 - Background: Finding novel ways to engage patients in chronic disease management has led to increased interest in the potential of mobile health technologies for the management of diabetes. There is currently a wealth of smartphone apps for diabetes management that are available for free download or purchase. However, the usability and desirability of these apps has not been extensively studied. These are important considerations, as these apps must be accepted by the patient population at a practical level if they are to be utilized. Objective: The purpose of this study was to gain insight into patient experiences related to the use of smartphone apps for the management of type 1 diabetes. Methods: Adults with type 1 diabetes who had previously (or currently) used apps to manage their diabetes were eligible to participate. Participants (n=12) completed a questionnaire in which they were required to list the names of preferred apps and indicate which app functions they had used. Participants were given the opportunity to comment on app functions that they perceived to be missing from the current technology. Participants were also asked whether they had previously paid for an app and whether they would be willing to do so. Results: MyFitnessPal and iBGStar were the apps most commonly listed as the best available on the market. Blood glucose tracking, carbohydrate counting, and activity tracking were the most commonly used features. Ten participants fulfilled all eligibility criteria, and indicated that they had not encountered any one app that included all of the functions that they had used. The ability to synchronize an app with a glucometer or insulin pump was the most common function that participants stated was missing from current app technology. One participant had previously paid for a diabetes-related app and the other 9 participants indicated that they would be willing to pay. Conclusions: Despite dissatisfaction with the currently available apps, there is interest in using these tools for diabetes management. Adapting existing technology to better meet the needs of this patient population may allow these apps to become more widely utilized. UR - http://diabetes.jmir.org/2017/1/e2/ UR - http://dx.doi.org/10.2196/diabetes.6643 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291051 ID - info:doi/10.2196/diabetes.6643 ER - TY - JOUR AU - Bashi, Nazli AU - Karunanithi, Mohanraj AU - Fatehi, Farhad AU - Ding, Hang AU - Walters, Darren PY - 2017/01/20 TI - Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews JO - J Med Internet Res SP - e18 VL - 19 IS - 1 KW - systematic review KW - patient monitoring KW - mobile phone KW - telemedicine KW - heart failure N2 - Background: Many systematic reviews exist on the use of remote patient monitoring (RPM) interventions to improve clinical outcomes and psychological well-being of patients with heart failure. However, research is broadly distributed from simple telephone-based to complex technology-based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions. Objective: The aim of this study was to investigate the effects of RPM interventions on the health outcomes of patients with heart failure by synthesizing review-level evidence. Methods: We searched PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from 2005 to 2015. We screened reviews based on relevance to RPM interventions using criteria developed for this overview. Independent authors screened, selected, and extracted information from systematic reviews. AMSTAR (Assessment of Multiple Systematic Reviews) was used to assess the methodological quality of individual reviews. We used standardized language to summarize results across reviews and to provide final statements about intervention effectiveness. Results: A total of 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as telemonitoring, home telehealth, mobile phone?based monitoring, and videoconferencing. All-cause mortality and heart failure mortality were the most frequently reported outcomes, but others such as quality of life, rehospitalization, emergency department visits, and length of stay were also reported. Self-care and knowledge were less commonly identified. Conclusions: Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone?based monitoring and videoconferencing, require further investigation. UR - http://www.jmir.org/2017/1/e18/ UR - http://dx.doi.org/10.2196/jmir.6571 UR - http://www.ncbi.nlm.nih.gov/pubmed/28108430 ID - info:doi/10.2196/jmir.6571 ER - TY - JOUR AU - Simmons, G. Rebecca AU - Shattuck, C. Dominick AU - Jennings, H. Victoria PY - 2017/01/18 TI - Assessing the Efficacy of an App-Based Method of Family Planning: The Dot Study Protocol JO - JMIR Res Protoc SP - e5 VL - 6 IS - 1 KW - fertility KW - fertility awareness KW - family planning KW - contraception KW - natural family planning KW - reproductive health KW - mHealth KW - mobile health apps KW - study protocol N2 - Background: Some 222 million women worldwide have unmet needs for contraception; they want to avoid pregnancy, but are not using a contraceptive method, primarily because of concerns about side effects associated with most available methods. Expanding contraceptive options?particularly fertility awareness options that provide women with information about which days during their menstrual cycles they are likely to become pregnant if they have unprotected intercourse?has the potential to reduce unmet need. Making these methods available to women through their mobile phones can facilitate access. Indeed, many fertility awareness applications have been developed for smartphones, some of which are digital platforms for existing methods, requiring women to enter information about fertility signs such as basal body temperature and cervical secretions. Others are algorithms based on (unexplained) calculations of the fertile period of the menstrual cycle. Considering particularly this latter (largely untested) group, it is critical that these apps be subject to the same rigorous research as other contraceptive methods. Dynamic Optimal Timing, available via the Dot app as a free download for iPhone and Android devices, is one such method and the only one that has published the algorithm that forms its basis. It combines historical cycle data with a woman?s own personal cycle history, continuing to accrue this information over time to identify her fertile period. While Dot has a theoretical failure rate of only 3 in 100 for preventing pregnancy with perfect use, its effectiveness in typical use has yet to be determined. Objective: The study objective is to assess both perfect and typical use to determine the efficacy of the Dot app for pregnancy prevention. Methods: To determine actual use efficacy, the Institute for Reproductive Health is partnering with Cycle Technologies, which developed the Dot app, to conduct a prospective efficacy trial, following 1200 women over the course of 13 menstrual cycles to assess pregnancy status over time. This paper outlines the protocol for this efficacy trial, following the Standard Protocol Items: Recommendations for Intervention Trials checklist, to provide an overview of the rationale, methodology, and analysis plan. Participants will be asked to provide daily sexual history data and periodically answer surveys administered through a call center or directly on their phone. Results: Funding for the study was provided in 2013 under the United States Agency for International Development Fertility Awareness for Community Transformation project. Recruitment for the study will begin in January of 2017. The study is expected to last approximately 18 months, depending on recruitment. Findings on the study?s primary outcomes are expected to be finalized by September 2018. Conclusions: Reproducibility and transparency, important aspects of all research, are particularly critical in developing new approaches to research design. This protocol outlines the first study to prospectively test both the efficacy (correct use) and effectiveness (actual use) of a pregnancy prevention app. This protocol and the processes it describes reflect the dynamic integration of mobile technologies, a call center, and Health Insurance Portability and Accountability Act?compliant study procedures. Future fertility app studies can build on our approaches to develop methodologies that can contribute to the evidence base around app-based methods of contraception. ClinicalTrial: ClinicalTrials.gov NCT02833922; https://clinicaltrials.gov/ct2/show/NCT02833922 (Archived be WebCite at http://www.webcitation.org/6nDkr0e76) UR - http://www.researchprotocols.org/2017/1/e5/ UR - http://dx.doi.org/10.2196/resprot.6886 UR - http://www.ncbi.nlm.nih.gov/pubmed/28100441 ID - info:doi/10.2196/resprot.6886 ER - TY - JOUR AU - Pugh, Gemma AU - McCann, Lisa PY - 2017/01/17 TI - Assessing the Quality, Feasibility, and Efficacy of Electronic Patient Platforms Designed to Support Adolescents and Young Adults With Cancer: A Systematic Review Protocol JO - JMIR Res Protoc SP - e4 VL - 6 IS - 1 KW - adolescent KW - neoplasms KW - telemedicine KW - review N2 - Background: A range of innovative websites, mobile technologies, eHealth and mHealth platforms have emerged to support adolescents and young adults (AYAs) with cancer. Previous reviews have identified these various applications and solutions, but no review has summarized the quality, feasibility, and efficacy of existing patient platforms (inclusive of websites, mobile technologies, mHealth and eHealth platforms) developed specifically for young people with cancer. Objective: This paper describes the design of a protocol to conduct a review of published studies or reports which describe or report on an existing platform designed specifically for AYAs who have had a cancer diagnosis. Methods: A search string was developed using a variety of key words and Medical Subject Heading and applied to bibliographic databases. General data (sample characteristics, patient platform development, design and, if applicable, pilot testing outcomes) will be extracted from reports and studies. Drawing on a previously developed coding schematic, the identified patient platforms will be coded for mode of delivery into (1) automated functions, (2) communicative functions, and (3) use of supplementary modes. An adapted version of the Mobile App Rating Scale (MARS) will be used to assess the of quality of each identified patient platform. The methodological quality of included studies will be assessed using the Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (QualSyst). Both authors will independently screen eligible studies for final inclusion and will both be responsible for data extraction and appraisal. Data will be synthesized narratively to provide an overview of identified patient platforms. Results: The review began in October 2016 and is currently in progress. The review paper will be submitted for peer-review and publication in the summer of 2017. Conclusions: This review will be unique in its focus on assessing, where possible, the quality and efficacy of patient platforms for adolescents and young adults diagnosed with cancer. Results generated from this review will provide an invaluable insight into the utility of modern technology in supporting young people with cancer. UR - http://www.researchprotocols.org/2017/1/e4/ UR - http://dx.doi.org/10.2196/resprot.6597 UR - http://www.ncbi.nlm.nih.gov/pubmed/28096067 ID - info:doi/10.2196/resprot.6597 ER - TY - JOUR AU - Scherer, A. Emily AU - Ben-Zeev, Dror AU - Li, Zhigang AU - Kane, M. John PY - 2017/01/12 TI - Analyzing mHealth Engagement: Joint Models for Intensively Collected User Engagement Data JO - JMIR Mhealth Uhealth SP - e1 VL - 5 IS - 1 KW - joint models KW - engagement KW - informative missingness N2 - Background: Evaluating engagement with an intervention is a key component of understanding its efficacy. With an increasing interest in developing behavioral interventions in the mobile health (mHealth) space, appropriate methods for evaluating engagement in this context are necessary. Data collected to evaluate mHealth interventions are often collected much more frequently than those for clinic-based interventions. Additionally, missing data on engagement is closely linked to level of engagement resulting in the potential for informative missingness. Thus, models that can accommodate intensively collected data and can account for informative missingness are required for unbiased inference when analyzing engagement with an mHealth intervention. Objective: The objectives of this paper are to discuss the utility of the joint modeling approach in the analysis of longitudinal engagement data in mHealth research and to illustrate the application of this approach using data from an mHealth intervention designed to support illness management among people with schizophrenia. Methods: Engagement data from an evaluation of an mHealth intervention designed to support illness management among people with schizophrenia is analyzed. A joint model is applied to the longitudinal engagement outcome and time-to-dropout to allow unbiased inference on the engagement outcome. Results are compared to a naïve model that does not account for the relationship between dropout and engagement. Results: The joint model shows a strong relationship between engagement and reduced risk of dropout. Using the mHealth app 1 day more per week was associated with a 23% decreased risk of dropout (P<.001). The decline in engagement over time was steeper when the joint model was used in comparison with the naïve model. Conclusions: Naïve longitudinal models that do not account for informative missingness in mHealth data may produce biased results. Joint models provide a way to model intensively collected engagement outcomes while simultaneously accounting for the relationship between engagement and missing data in mHealth intervention research. UR - http://mhealth.jmir.org/2017/1/e1/ UR - http://dx.doi.org/10.2196/mhealth.6474 UR - http://www.ncbi.nlm.nih.gov/pubmed/28082257 ID - info:doi/10.2196/mhealth.6474 ER - TY - JOUR AU - Pereira-Azevedo, Nuno AU - Osório, Luís AU - Fraga, Avelino AU - Roobol, J. Monique PY - 2017/01/06 TI - Rotterdam Prostate Cancer Risk Calculator: Development and Usability Testing of the Mobile Phone App JO - JMIR Cancer SP - e1 VL - 3 IS - 1 KW - mHealth KW - prostate cancer KW - nomogram N2 - Background: The use of prostate cancer screening tools that take into account relevant prebiopsy information (ie, risk calculators) is recommended as a way of determining the risk of cancer and the subsequent need for a prostate biopsy. This has the potential to limit prostate cancer overdiagnosis and subsequent overtreatment. mHealth apps are gaining traction in urological practice and are used by both practitioners and patients for a variety of purposes. Objective: The impetus of the study was to design, develop, and assess a smartphone app for prostate cancer screening, based on the Rotterdam Prostate Cancer Risk Calculator (RPCRC). Methods: The results of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC) study were used to elaborate several algorithms that allowed the risk of prostate cancer to be estimated. A step-by-step workflow was established to ensure that depending on the available clinical information the most complete risk model of the RPCRC was used. The user interface was designed and then the app was developed as a native app for iOS. The usability of the app was assessed using the Post-Study System Usability Questionnaire (PSSUQ) developed by IBM, in a group of 92 participants comprising urologists, general practitioners, and medical students. Results: A total of 11 questions were built into the app, and, depending on the answers, one of the different algorithms of the RPCRC could be used to predict the risk of prostate cancer and of clinically significant prostate cancer (Gleason score ?7 and clinical stage >T2b). The system usefulness, information quality, and interface quality scores were high?92% (27.7/30), 87% (26.2/30), and 89% (13.4/15), respectively. No usability problems were identified. Conclusions: The RPCRC app is helpful in predicting the risk of prostate cancer and, even more importantly, clinically significant prostate cancer. Its algorithms have been externally validated before and the usability score shows the app?s interface is well designed. Further usability testing is required in different populations to verify these results and ensure that it is easy to use, to warrant a broad appeal, and to provide better patient care. UR - http://cancer.jmir.org/2017/1/e1/ UR - http://dx.doi.org/10.2196/cancer.6750 UR - http://www.ncbi.nlm.nih.gov/pubmed/28410180 ID - info:doi/10.2196/cancer.6750 ER - TY - JOUR AU - Mohr, C. David AU - Tomasino, Noth Kathryn AU - Lattie, G. Emily AU - Palac, L. Hannah AU - Kwasny, J. Mary AU - Weingardt, Kenneth AU - Karr, J. Chris AU - Kaiser, M. Susan AU - Rossom, C. Rebecca AU - Bardsley, R. Leland AU - Caccamo, Lauren AU - Stiles-Shields, Colleen AU - Schueller, M. Stephen PY - 2017/01/05 TI - IntelliCare: An Eclectic, Skills-Based App Suite for the Treatment of Depression and Anxiety JO - J Med Internet Res SP - e10 VL - 19 IS - 1 KW - mHealth KW - eHealth KW - mobile health KW - depression KW - anxiety N2 - Background: Digital mental health tools have tended to use psychoeducational strategies based on treatment orientations developed and validated outside of digital health. These features do not map well to the brief but frequent ways that people use mobile phones and mobile phone apps today. To address these challenges, we developed a suite of apps for depression and anxiety called IntelliCare, each developed with a focused goal and interactional style. IntelliCare apps prioritize interactive skills training over education and are designed for frequent but short interactions. Objective: The overall objective of this study was to pilot a coach-assisted version of IntelliCare and evaluate its use and efficacy at reducing symptoms of depression and anxiety. Methods: Participants, recruited through a health care system, Web-based and community advertising, and clinical research registries, were included in this single-arm trial if they had elevated symptoms of depression or anxiety. Participants had access to the 14 IntelliCare apps from Google Play and received 8 weeks of coaching on the use of IntelliCare. Coaching included an initial phone call plus 2 or more texts per week over the 8 weeks, with some participants receiving an additional brief phone call. Primary outcomes included the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. Participants were compensated up to US $90 for completing all assessments; compensation was not for app use or treatment engagement. Results: Of the 99 participants who initiated treatment, 90.1% (90/99) completed 8 weeks. Participants showed substantial reductions in the PHQ-9 and GAD-7 (P<.001). Participants used the apps an average of 195.4 (SD 141) times over the 8 weeks. The average length of use was 1.1 (SD 2.1) minutes, and 95% of participants downloaded 5 or more of the IntelliCare apps. Conclusions: This study supports the IntelliCare framework of providing a suite of skills-focused apps that can be used frequently and briefly to reduce symptoms of depression and anxiety. The IntelliCare system is elemental, allowing individual apps to be used or not used based on their effectiveness and utility, and it is eclectic, viewing treatment strategies as elements that can be applied as needed rather than adhering to a singular, overarching, theoretical model. Trial Registration: Clinicaltrials.gov NCT02176226; http://clinicaltrials.gov/ct2/show/NCT02176226 (Archived by WebCite at http://www.webcitation/6mQZuBGk1) UR - http://www.jmir.org/2017/1/e10/ UR - http://dx.doi.org/10.2196/jmir.6645 UR - http://www.ncbi.nlm.nih.gov/pubmed/28057609 ID - info:doi/10.2196/jmir.6645 ER - TY - JOUR AU - Bright, Tess AU - Pallawela, Danuk PY - 2016/12/23 TI - Validated Smartphone-Based Apps for Ear and Hearing Assessments: A Review JO - JMIR Rehabil Assist Technol SP - e13 VL - 3 IS - 2 KW - hearing KW - testing KW - mobile KW - audiometry KW - smartphone KW - applications KW - app KW - hearing loss KW - hearing impairment KW - surveys KW - prevalence N2 - Background: An estimated 360 million people have a disabling hearing impairment globally, the vast majority of whom live in low- and middle-income countries (LMICs). Early identification through screening is important to negate the negative effects of untreated hearing impairment. Substantial barriers exist in screening for hearing impairment in LMICs, such as the requirement for skilled hearing health care professionals and prohibitively expensive specialist equipment to measure hearing. These challenges may be overcome through utilization of increasingly available smartphone app technologies for ear and hearing assessments that are easy to use by unskilled professionals. Objective: Our objective was to identify and compare available apps for ear and hearing assessments and consider the incorporation of such apps into hearing screening programs Methods: In July 2015, the commercial app stores Google Play and Apple App Store were searched to identify apps for ear and hearing assessments. Thereafter, six databases (EMBASE, MEDLINE, Global Health, Web of Science, CINAHL, and mHealth Evidence) were searched to assess which of the apps identified in the commercial review had been validated against gold standard measures. A comparison was made between validated apps. Results: App store search queries returned 30 apps that could be used for ear and hearing assessments, the majority of which are for performing audiometry. The literature search identified 11 eligible validity studies that examined 6 different apps. uHear, an app for self-administered audiometry, was validated in the highest number of peer reviewed studies against gold standard pure tone audiometry (n=5). However, the accuracy of uHear varied across these studies. Conclusions: Very few of the available apps have been validated in peer-reviewed studies. Of the apps that have been validated, further independent research is required to fully understand their accuracy at detecting ear and hearing conditions. UR - http://rehab.jmir.org/2016/2/e13/ UR - http://dx.doi.org/10.2196/rehab.6074 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582261 ID - info:doi/10.2196/rehab.6074 ER - TY - JOUR AU - DeHoff, A. Beth AU - Staten, K. Lisa AU - Rodgers, Christine Rylin AU - Denne, C. Scott PY - 2016/12/22 TI - The Role of Online Social Support in Supporting and Educating Parents of Young Children With Special Health Care Needs in the United States: A Scoping Review JO - J Med Internet Res SP - e333 VL - 18 IS - 12 KW - health communication KW - child KW - social media KW - health education KW - health resources KW - early childhood KW - disability KW - neonatal intensive care unit KW - family KW - maternal-child health services N2 - Background: When parents of young children with special health care needs (CSHCN) receive their child?s diagnosis, they encounter information they may not understand, emotions they may not know how to cope with, and questions about their child?s immediate and long-term future that frequently lack answers. The challenge of health care providers is how to prepare parents for caring for their CSHCN, for coping with any resulting challenges, and for accessing the systems and services that can assist them. Objective: The purpose of this work was to review evidence of the information and support needs of parents of young CSHCN and to determine whether online social support can serve as an avenue for learning and empowerment for these parents. Methods: A scoping review identified the challenges, coping mechanisms, and support needs among parents of CSHCN, and the reach and effectiveness of digital technologies with these families and health care providers. We also conducted interviews with professionals serving parents of CSHCN. Results: The literature review and interviews suggested that parents best learn the information they need, and cope with the emotional challenges of raising a CSHCN, with support from other parents of CSHCN, and that young parents in recent years have most often been finding this parent-to-parent support through digital media, particularly social media, consistent with the theory of online social support. Evidence also shows that social media, particularly Facebook, is used by nearly all women aged 18-29 years across racial and socioeconomic lines in the United States. Conclusions: Parents of young CSHCN experience significant stress but gain understanding, receive support, and develop the ability to care for and be advocates for their child through parent-to-parent emotional and informational social support. Online social support is most effective with young adults of childbearing age, with social media and apps being the most useful within the theoretical framework of social support. This opens new opportunities to effectively educate and support parents of young CSHCN. Providers seeking to inform, educate, and support families of CSHCN should develop strategies to help parents find and use social support through digital resources to facilitate their emotional adjustment and practical abilities to care for and access services for their child. UR - http://www.jmir.org/2016/12/e333/ UR - http://dx.doi.org/10.2196/jmir.6722 UR - http://www.ncbi.nlm.nih.gov/pubmed/28007689 ID - info:doi/10.2196/jmir.6722 ER - TY - JOUR AU - Evans, D. William AU - Mays, Darren PY - 2016/12/22 TI - Design and Feasibility of a Text Messaging Intervention to Prevent Indoor Tanning Among Young Adult Women: A Pilot Study JO - JMIR Mhealth Uhealth SP - e137 VL - 4 IS - 4 KW - indoor tanning KW - risk perceptions KW - text messaging KW - feasibility testing N2 - Background: Although skin cancer is largely preventable, it affects nearly 1 of 5 US adults. There is a need for research on how to optimally design persuasive public health indoor tanning prevention messages. Objective: The objective of our study was to examine whether framed messages on indoor tanning behavioral intentions delivered through short message service (SMS) text messaging would produce (1) positive responses to the messages, including message receptivity and emotional response; (2) indoor tanning efficacy beliefs, including response efficacy and self-efficacy; and (3) indoor tanning risk beliefs. Methods: We conducted a pilot study of indoor tanning prevention messages delivered via mobile phone text messaging in a sample of 21 young adult women who indoor tan. Participants completed baseline measures, were randomly assigned to receive gain-, loss-, or balanced-framed text messages, and completed postexposure outcome measures on indoor tanning cognitions and behaviors. Participants received daily mobile phone indoor tanning prevention text messages for 1 week and completed the same postexposure measures as at baseline. Results: Over the 1-week period there were trends or significant changes after receipt of the text messages, including increased perceived susceptibility (P<.001), response efficacy beliefs (P<.001), and message receptivity (P=.03). Ordinary least squares stepwise linear regression models showed an effect of text message exposure on self-efficacy to quit indoor tanning (t6=?2.475, P<.02). Ordinary least squares linear regression including all measured scales showed a marginal effect of SMS texts on self-efficacy (t20=1.905, P=.08). Participants endorsed highly favorable views toward the text messaging protocol. Conclusions: This study supports this use of mobile text messaging as an indoor tanning prevention strategy. Given the nature of skin cancer risk perceptions, the addition of multimedia messaging service is another area of potential innovation for disseminating indoor tanning prevention messages. UR - http://mhealth.jmir.org/2016/4/e137/ UR - http://dx.doi.org/10.2196/mhealth.6493 UR - http://www.ncbi.nlm.nih.gov/pubmed/28007691 ID - info:doi/10.2196/mhealth.6493 ER - TY - JOUR AU - Arean, A. Patricia AU - Hallgren, A. Kevin AU - Jordan, T. Joshua AU - Gazzaley, Adam AU - Atkins, C. David AU - Heagerty, J. Patrick AU - Anguera, A. Joaquin PY - 2016/12/20 TI - The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial JO - J Med Internet Res SP - e330 VL - 18 IS - 12 KW - depression KW - mobile apps KW - RCT KW - randomized controlled trial KW - cognitive training KW - iPST KW - problem-solving therapy N2 - Background: Mobile apps for mental health have the potential to overcome access barriers to mental health care, but there is little information on whether patients use the interventions as intended and the impact they have on mental health outcomes. Objective: The objective of our study was to document and compare use patterns and clinical outcomes across the United States between 3 different self-guided mobile apps for depression. Methods: Participants were recruited through Web-based advertisements and social media and were randomly assigned to 1 of 3 mood apps. Treatment and assessment were conducted remotely on each participant?s smartphone or tablet with minimal contact with study staff. We enrolled 626 English-speaking adults (?18 years old) with mild to moderate depression as determined by a 9-item Patient Health Questionnaire (PHQ-9) score ?5, or if their score on item 10 was ?2. The apps were (1) Project: EVO, a cognitive training app theorized to mitigate depressive symptoms by improving cognitive control, (2) iPST, an app based on an evidence-based psychotherapy for depression, and (3) Health Tips, a treatment control. Outcomes were scores on the PHQ-9 and the Sheehan Disability Scale. Adherence to treatment was measured as number of times participants opened and used the apps as instructed. Results: We randomly assigned 211 participants to iPST, 209 to Project: EVO, and 206 to Health Tips. Among the participants, 77.0% (482/626) had a PHQ-9 score >10 (moderately depressed). Among the participants using the 2 active apps, 57.9% (243/420) did not download their assigned intervention app but did not differ demographically from those who did. Differential treatment effects were present in participants with baseline PHQ-9 score >10, with the cognitive training and problem-solving apps resulting in greater effects on mood than the information control app (?22=6.46, P=.04). Conclusions: Mobile apps for depression appear to have their greatest impact on people with more moderate levels of depression. In particular, an app that is designed to engage cognitive correlates of depression had the strongest effect on depressed mood in this sample. This study suggests that mobile apps reach many people and are useful for more moderate levels of depression. ClinicalTrial: Clinicaltrials.gov NCT00540865; https://www.clinicaltrials.gov/ct2/show/NCT00540865 (Archived by WebCite at http://www.webcitation.org/6mj8IPqQr) UR - http://www.jmir.org/2016/12/e330/ UR - http://dx.doi.org/10.2196/jmir.6482 UR - http://www.ncbi.nlm.nih.gov/pubmed/27998876 ID - info:doi/10.2196/jmir.6482 ER - TY - JOUR AU - Sullivan, K. Rachel AU - Marsh, Samantha AU - Halvarsson, Jakob AU - Holdsworth, Michelle AU - Waterlander, Wilma AU - Poelman, P. Maartje AU - Salmond, Ann Jennifer AU - Christian, Hayley AU - Koh, SC Lenny AU - Cade, E. Janet AU - Spence, C. John AU - Woodward, Alistair AU - Maddison, Ralph PY - 2016/12/19 TI - Smartphone Apps for Measuring Human Health and Climate Change Co-Benefits: A Comparison and Quality Rating of Available Apps JO - JMIR Mhealth Uhealth SP - e135 VL - 4 IS - 4 KW - climate change KW - noncommunicable diseases KW - smartphone apps KW - travel KW - diet KW - greenhouse gas emissions KW - carbon footprint KW - individual KW - behavior change N2 - Background: Climate change and the burden of noncommunicable diseases are major global challenges. Opportunities exist to investigate health and climate change co-benefits through a shift from motorized to active transport (walking and cycling) and a shift in dietary patterns away from a globalized diet to reduced consumption of meat and energy dense foods. Given the ubiquitous use and proliferation of smartphone apps, an opportunity exists to use this technology to capture individual travel and dietary behavior and the associated impact on the environment and health. Objective: The objective of the study is to identify, describe the features, and rate the quality of existing smartphone apps which capture personal travel and dietary behavior and simultaneously estimate the carbon cost and potential health consequences of these actions. Methods: The Google Play and Apple App Stores were searched between October 19 and November 6, 2015, and a secondary Google search using the apps filter was conducted between August 8 and September 18, 2016. Eligible apps were required to estimate the carbon cost of personal behaviors with the potential to include features to maximize health outcomes. The quality of included apps was assessed by 2 researchers using the Mobile Application Rating Scale (MARS). Results: Out of 7213 results, 40 apps were identified and rated. Multiple travel-related apps were identified, however no apps solely focused on the carbon impact or health consequences of dietary behavior. None of the rated apps provided sufficient information on the health consequences of travel and dietary behavior. Some apps included features to maximize participant engagement and encourage behavior change towards reduced greenhouse gas emissions. Most apps were rated as acceptable quality as determined by the MARS; 1 was of poor quality and 10 apps were of good quality. Interrater reliability of the 2 evaluators was excellent (ICC=0.94, 95% CI 0.87-0.97). Conclusions: Existing apps capturing travel and dietary behavior and the associated health and environmental impact are of mixed quality. Most apps do not include all desirable features or provide sufficient health information. Further research is needed to determine the potential of smartphone apps to evoke behavior change resulting in climate change and health co-benefits. UR - http://mhealth.jmir.org/2016/4/e135/ UR - http://dx.doi.org/10.2196/mhealth.5931 UR - http://www.ncbi.nlm.nih.gov/pubmed/27993762 ID - info:doi/10.2196/mhealth.5931 ER - TY - JOUR AU - Recio-Rodriguez, I. Jose AU - Agudo-Conde, Cristina AU - Martin-Cantera, Carlos AU - González-Viejo, Natividad M. ª. AU - Fernandez-Alonso, Carmen Mª Del AU - Arietaleanizbeaskoa, Soledad Maria AU - Schmolling-Guinovart, Yolanda AU - Maderuelo-Fernandez, Jose-Angel AU - Rodriguez-Sanchez, Emiliano AU - Gomez-Marcos, A. Manuel AU - Garcia-Ortiz, Luis AU - PY - 2016/12/19 TI - Short-Term Effectiveness of a Mobile Phone App for Increasing Physical Activity and Adherence to the Mediterranean Diet in Primary Care: A Randomized Controlled Trial (EVIDENT II Study) JO - J Med Internet Res SP - e331 VL - 18 IS - 12 KW - physical activity KW - food KW - information and communication technologies KW - arterial aging N2 - Background: The use of mobile phone apps for improving lifestyles has become generalized in the population, although little is still known about their effectiveness in improving health. Objective: We evaluate the effect of adding an app to standard counseling on increased physical activity (PA) and adherence to the Mediterranean diet, 3 months after implementation. Methods: A randomized, multicenter clinical trial was carried out. A total of 833 participants were recruited in six primary care centers in Spain through random sampling: 415 in the app+counseling group and 418 in the counseling only group. Counseling on PA and the Mediterranean diet was given to both groups. The app+counseling participants additionally received training in the use of an app designed to promote PA and the Mediterranean diet over a 3-month period. PA was measured with the 7-day Physical Activity Recall (PAR) questionnaire and an accelerometer; adherence to the Mediterranean diet was assessed using the Mediterranean Diet Adherence Screener questionnaire. Results: Participants were predominantly female in both the app+counseling (249/415, 60.0%) and counseling only (268/418, 64.1%) groups, with a mean age of 51.4 (SD 12.1) and 52.3 (SD 12.0) years, respectively. Leisure-time moderate-to-vigorous physical activity (MVPA) by 7-day PAR increased in the app+counseling (mean 29, 95% CI 5-53 min/week; P=.02) but not in the counseling only group (mean 17.4, 95% CI ?18 to 53 min/week; P=.38). No differences in increase of activity were found between the two groups. The accelerometer recorded a decrease in PA after 3 months in both groups: MVPA mean ?55.3 (95% CI ?75.8 to ?34.9) min/week in app+counseling group and mean ?30.1 (95% CI ?51.8 to ?8.4) min/week in counseling only group. Adherence to the Mediterranean diet increased in both groups (8.4% in app+counseling and 10.4% in counseling only group), with an increase in score of 0.42 and 0.53 points, respectively (P<.001), but no difference between groups (P=.86). Conclusions: Leisure-time MVPA increased more in the app+counseling than counseling only group, although no difference was found when comparing the increase between the two groups. Counseling accompanied by printed materials appears to be effective in improving adherence to the Mediterranean diet, although the app does not increase adherence. ClinicalTrial: Clinicaltrials.gov NCT02016014; https://clinicaltrials.gov/ct2/show/NCT02016014 (Archived by WebCite at http://www.webcitation.org/6mnopADbf) UR - http://www.jmir.org/2016/12/e331/ UR - http://dx.doi.org/10.2196/jmir.6814 UR - http://www.ncbi.nlm.nih.gov/pubmed/27993759 ID - info:doi/10.2196/jmir.6814 ER - TY - JOUR AU - Singh, Karandeep AU - Drouin, Kaitlin AU - Newmark, P. Lisa AU - Filkins, Malina AU - Silvers, Elizabeth AU - Bain, A. Paul AU - Zulman, M. Donna AU - Lee, Jae-Ho AU - Rozenblum, Ronen AU - Pabo, Erika AU - Landman, Adam AU - Klinger, V. Elissa AU - Bates, W. David PY - 2016/12/19 TI - Patient-Facing Mobile Apps to Treat High-Need, High-Cost Populations: A Scoping Review JO - JMIR Mhealth Uhealth SP - e136 VL - 4 IS - 4 KW - review KW - mobile apps KW - mHealth KW - chronic disease KW - self-management N2 - Background: Self-management is essential to caring for high-need, high-cost (HNHC) populations. Advances in mobile phone technology coupled with increased availability and adoption of health-focused mobile apps have made self-management more achievable, but the extent and quality of the literature supporting their use is not well defined. Objective: The purpose of this review was to assess the breadth, quality, bias, and types of outcomes measured in the literature supporting the use of apps targeting HNHC populations. Methods: Data sources included articles in PubMed and MEDLINE (National Center for Biotechnology Information), EMBASE (Elsevier), the Cochrane Central Register of Controlled Trials (EBSCO), Web of Science (Thomson Reuters), and the NTIS (National Technical Information Service) Bibliographic Database (EBSCO) published since 2008. We selected studies involving use of patient-facing iOS or Android mobile health apps. Extraction was performed by 1 reviewer; 40 randomly selected articles were evaluated by 2 reviewers to assess agreement. Results: Our final analysis included 175 studies. The populations most commonly targeted by apps included patients with obesity, physical handicaps, diabetes, older age, and dementia. Only 30.3% (53/175) of the apps studied in the reviewed literature were identifiable and available to the public through app stores. Many of the studies were cross-sectional analyses (42.9%, 75/175), small (median number of participants=31, interquartile range 11.0-207.2, maximum 11,690), or performed by an app?s developers (61.1%, 107/175). Of the 175 studies, only 36 (20.6%, 36/175) studies evaluated a clinical outcome. Conclusions: Most apps described in the literature could not be located on the iOS or Android app stores, and existing research does not robustly evaluate the potential of mobile apps. Whereas apps may be useful in patients with chronic conditions, data do not support this yet. Although we had 2-3 reviewers to screen and assess abstract eligibility, only 1 reviewer abstracted the data. This is one limitation of our study. With respect to the 40 articles (22.9%, 40/175) that were assigned to 2 reviewers (of which 3 articles were excluded), inter-rater agreement was significant on the majority of items (17 of 30) but fair-to-moderate on others. UR - http://mhealth.jmir.org/2016/4/e136/ UR - http://dx.doi.org/10.2196/mhealth.6445 UR - http://www.ncbi.nlm.nih.gov/pubmed/27993761 ID - info:doi/10.2196/mhealth.6445 ER - TY - JOUR AU - Gualtieri, Lisa AU - Rosenbluth, Sandra AU - Phillips, Jeffrey PY - 2016/12/15 TI - Can a Free Wearable Activity Tracker Change Behavior? The Impact of Trackers on Adults in a Physician-Led Wellness Group JO - iproc SP - e1 VL - 2 IS - 1 KW - wearable activity trackers KW - fitness trackers KW - trackers KW - physical activity KW - chronic disease KW - behavior change KW - wellness group KW - wellness KW - older adults KW - digital health N2 - Background: Wearable activity trackers (trackers) are increasingly popular devices used to track step count and other health indicators. Trackers have the potential to benefit those in need of increased physical activity, such as adults who are older and who face significant health challenges. These populations are least likely to purchase trackers and most likely to face challenges in using them, yet may derive educational, motivational, and health benefits from their use once these barriers are removed. Objective: The aim of this research was to investigate the use of trackers by older adults with chronic medical conditions who had never used trackers previously. Our primary research questions were (1) if participants would accept and use trackers to increase their physical activity; (2) if there were barriers to use besides cost and training; (3) if trackers would educate participants on their baseline and ongoing activity levels and support behavior change; and (4) if clinical outcomes would show improvements in participants? health. Methods: This study was conducted with 10 patients in a 12 week physician-led wellness group offered by Family Doctors, LLC. Patients were given trackers in the second week of the wellness group and were interviewed 2-4 weeks after it ended. The study investigators analyzed the interview notes to extract themes about the participants? attitudes and behavior changes and collected and analyzed participants? clinical data, including weight and LDL-Cholesterol (LDL), over the course of the study. Results: Over the 12-14 weeks of tracker use, improvements were seen in clinical outcomes, attitudes towards the trackers, and physical activity behaviors. Participants lost an average of a half-pound per week (SD=0.408), with a mean total weight loss of 5.97 pounds (P=.0038). Other short-term clinical outcomes included a 9.2% decrease in LDL levels (P=.0377). All participants reported an increase in well-being and confidence in their ability to lead more active lives. We identified 6 major attitudinal themes from our qualitative analysis of the interview notes: (1) barriers to tracker purchase included cost, perceived value, and choice confusion; (2) attitudes towards the trackers shifted for many, from half of the participants expressing excitement and hope and half expressing hesitation or trepidation, to all participants feeling positive towards their tracker at the time of the interviews; (3) trackers served as educational tools for baseline activity levels; (4) trackers provided concrete feedback on physical activity, which motivated behavior change; (5) tracker use reinforced wellness group activities and goals; and (6) although commitment to tracker use did not waver, external circumstances influenced some participants? ongoing use. Conclusions: Our findings suggest that adding trackers to wellness groups comprising older adults with chronic medical conditions can support education and behavior change to be more physically active. The trackers increased participant self-efficacy by providing a tangible, visible reminder of a commitment to increasing activity and immediate feedback on step count and progress towards a daily step goal. While acceptance was high and attitudes ultimately positive, training and support are needed and short-term drop-off in participant use is to be expected. Future research will further consider the potential of trackers in older adults with chronic medical conditions who are unlikely to purchase them, and studies will use larger samples, continue over a longer period of time, and evaluate outcomes independent of a wellness group. UR - http://www.iproc.org/2016/1/e1/ UR - http://dx.doi.org/10.2196/iproc.6245 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/iproc.6245 ER - TY - JOUR AU - Bock, C. Beth AU - Lantini, Ryan AU - Thind, Herpreet AU - Walaska, Kristen AU - Rosen, K. Rochelle AU - Fava, L. Joseph AU - Barnett, P. Nancy AU - Scott-Sheldon, AJ Lori PY - 2016/12/15 TI - The Mobile Phone Affinity Scale: Enhancement and Refinement JO - JMIR Mhealth Uhealth SP - e134 VL - 4 IS - 4 KW - mobile phone KW - psychometrics KW - assessment KW - measure N2 - Background: Existing instruments that assess individuals? relationships with mobile phones tend to focus on negative constructs such as addiction or dependence, and appear to assume that high mobile phone use reflects pathology. Mobile phones can be beneficial for health behavior change, disease management, work productivity, and social connections, so there is a need for an instrument that provides a more balanced assessment of the various aspects of individuals? relationships with mobile phones. Objective: The purpose of this research was to develop, revise, and validate the Mobile Phone Affinity Scale, a multi-scale instrument designed to assess key factors associated with mobile phone use. Methods: Participants (N=1058, mean age 33) were recruited from Amazon Mechanical Turk between March and April of 2016 to complete a survey that assessed participants? mobile phone attitudes and use, anxious and depressive symptoms, and resilience. Results: Confirmatory factor analysis supported a 6-factor model. The final measure consisted of 24 items, with 4 items on each of 6 factors: Connectedness, Productivity, Empowerment, Anxious Attachment, Addiction, and Continuous Use. The subscales demonstrated strong internal consistency (Cronbach alpha range=0.76-0.88, mean 0.83), and high item factor loadings (range=0.57-0.87, mean 0.75). Tests for validity further demonstrated support for the individual subscales. Conclusions: Mobile phone affinity may have an important impact in the development and effectiveness of mobile health interventions, and continued research is needed to assess its predictive ability in health behavior change interventions delivered via mobile phones. UR - http://mhealth.jmir.org/2016/4/e134/ UR - http://dx.doi.org/10.2196/mhealth.6705 UR - http://www.ncbi.nlm.nih.gov/pubmed/27979792 ID - info:doi/10.2196/mhealth.6705 ER - TY - JOUR AU - Murray, Marie Katharine AU - Holtz, Elizabeth Bree AU - Wood, Michael AU - Holmstrom, Amanda AU - Cotten, Shelia AU - Dunneback, Julie AU - Hershey, Denise AU - Vyas, Arpita PY - 2016/12/14 TI - Developing a Patient-Centered mHealth App for Diabetes JO - iproc SP - e11 VL - 2 IS - 1 KW - mHealth KW - type 1 diabetes KW - diabetes self-management KW - adolescent health N2 - Background: Type 1 diabetes (T1D) afflicts approximately 154,000 people under the age of 20. T1D care is complex, which is why parents often manage their child?s disease. Once the child reaches adolescence, they must begin to transition from parent care to self-care. As a result of the inherent complexity of managing T1D, this transition is often difficult. During this time, adherence to the prescribed treatment regimen drops. Uncontrolled T1D can lead to blindness, nervous system disease, kidney disease, amputations, and premature mortality. mHealth apps have been shown to be successful at monitoring and managing chronic diseases, including diabetes. This project is in the formative stages of developing an app for adolescents with T1D to connect with their parents to bridge the transition of care. Our proposed app, MyT1D_Hero, is unique in that it links the child?s information to their parent?s cell phone and promotes positive communication within families. Research suggests this interaction is imperative for a successful transition in care. Objective: The goal of this study was to determine the perceptions of adolescents with T1D and their parents regarding how best to aid in the transition to diabetes self-management. Methods: We conducted two sets of focus groups to examine perceptions of the proposed app. The first study included focus groups and interviews with adolescents aged 13-22 with T1D (n=12) and parents (n=9). These focus groups and interviews helped inform the development of a second set of focus group protocols conducted with adolescents aged 10-13 with T1D (n=5) and parents (n=7). Using grounded theory, the transcripts were analyzed by generating codes based on an iterative examination of the data. Members of the research team then coded the interviews independently; any discrepancies were discussed and resolved. These codes were applied to the transcripts and a list of key themes emerged. Results: The analysis of the initial focus groups and interviews yielded the following key themes: (1) adolescents were more likely to have a phone because they have diabetes and (2) both groups felt that parents nagged and believed an app might reduce conflict. The second session yielded the following key themes: (1) parents want to feel confident in their child?s ability to manage their diabetes independently, but they want to be engaged in managing their child?s T1D; (2) children want more positive communication from their parents regarding their T1D; and (3) customization of the app was important, including adjusting the level of parent involvement. Both studies revealed that incentives and gamification will encourage long-term use of the mobile app. Conclusions: Taking a patient-centered approach to gain insight into the daily management of T1D supports the development of a T1D mHealth app to aid in the transition toward self-management. The first study established the need for and projected usefulness of an app. The second study demonstrated additional necessities for creating an app that meets the needs of adolescents and their parents. Additionally, both studies demonstrated the importance of supportive patient-centered research to tailor mHealth interventions. UR - http://www.iproc.org/2016/1/e11/ UR - http://dx.doi.org/10.2196/iproc.6102 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/iproc.6102 ER - TY - JOUR AU - Biagianti, Bruno AU - Schlosser, Danielle AU - Nahum, Mor AU - Woolley, Josh AU - Vinogradov, Sophia PY - 2016/12/13 TI - Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders JO - JMIR Ment Health SP - e52 VL - 3 IS - 4 KW - psychosis KW - social cognition KW - digital health KW - mobile health N2 - Background: Numerous psychosocial interventions for individuals with chronic psychotic disorders (CPD) have shown positive effects on social cognitive and functional outcome measures. However, access to and engagement with these interventions remains limited. This is partly because these interventions require specially trained therapists, are not available in all clinical settings, and have a high scheduling burden for participants, usually requiring a commitment of several weeks. Delivering interventions remotely via mobile devices may facilitate access, improve scheduling flexibility, and decrease participant burden, thus improving adherence to intervention requirements. To address these needs, we designed the Creating Live Interactions to Mitigate Barriers (CLIMB) digital intervention, which aims to enhance social functioning in people with CPD. CLIMB consists of two treatment components: a computerized social cognition training (SCT) program and optimized remote group therapy (ORGT). ORGT is an innovative treatment that combines remote group therapy with group texting (short message service, SMS). Objectives: The objectives of this single-arm study were to investigate the feasibility of delivering 6 weeks of CLIMB to people with CPD and explore the initial effects on outcomes. Methods: Participants were recruited, screened and enrolled via the Internet, and delivered assessments and interventions remotely using provided tablets (iPads). Participants were asked to complete 18 hours of SCT and to attend 6 remote group therapy sessions. To assess feasibility, adherence to study procedures, attrition rates, engagement metrics, and acceptability of the intervention were evaluated. Changes on measures of social cognition, quality of life, and symptoms were also explored. Results: In total, 27 participants were enrolled over 12 months. Remote assessments were completed successfully on 96% (26/27) of the enrolled participants. Retention in the 6-week trial was 78% (21/27). Of all the iPads used, 95% (22/23) were returned undamaged at the end of the intervention. Participants on average attended 84% of the group therapy sessions, completed a median of 9.5 hours of SCT, and posted a median of 5.2 messages per week on the group text chat. Participants rated CLIMB in the medium range in usability, acceptability, enjoyment, and perceived benefit. Participants showed significant improvements in emotion identification abilities for prosodic happiness (P=.001), prosodic happiness intensity (P=.04), and facial anger (P=.04), with large within-group effect sizes (d=.60 to d=.86). Trend-level improvements were observed on aspects of quality of life (P values less than .09). No improvements were observed for symptoms. Conclusions: It is feasible and acceptable to remotely deliver an intervention aimed at enhancing social functioning in people with CPD using mobile devices. This approach may represent a scalable method to increase treatment access and adherence. Our pilot data also demonstrate within-group gains in some aspects of social cognition after 6 weeks of CLIMB. Future randomized controlled studies in larger samples should evaluate the extent to which CLIMB significantly improves social cognition, symptoms, and quality of life in CPD. UR - http://mental.jmir.org/2016/4/e52/ UR - http://dx.doi.org/10.2196/mental.6671 UR - http://www.ncbi.nlm.nih.gov/pubmed/27965190 ID - info:doi/10.2196/mental.6671 ER - TY - JOUR AU - Modave, François AU - Bian, Jiang AU - Rosenberg, Eric AU - Mendoza, Tonatiuh AU - Liang, Zhan AU - Bhosale, Ravi AU - Maeztu, Carlos AU - Rodriguez, Camila AU - Cardel, I. Michelle PY - 2016/12/13 TI - DiaFit: The Development of a Smart App for Patients with Type 2 Diabetes and Obesity JO - JMIR Diabetes SP - e5 VL - 1 IS - 2 KW - mHealth KW - diabetes KW - obesity KW - apps N2 - Background: Optimal management of chronic diseases, such as type 2 diabetes (T2D) and obesity, requires patient-provider communication and proactive self-management from the patient. Mobile apps could be an effective strategy for improving patient-provider communication and provide resources for self-management to patients themselves. Objective: The objective of this paper is to describe the development of a mobile tool for patients with T2D and obesity that utilizes an integrative approach to facilitate patient-centered app development, with patient and physician interfaces. Our implementation strategy focused on the building of a multidisciplinary team to create a user-friendly and evidence-based app, to be used by patients in a home setting or at the point-of-care. Methods: We present the iterative design, development, and testing of DiaFit, an app designed to improve the self-management of T2D and obesity, using an adapted Agile approach to software implementation. The production team consisted of experts in mobile health, nutrition sciences, and obesity; software engineers; and clinicians. Additionally, the team included citizen scientists and clinicians who acted as the de facto software clients for DiaFit and therefore interacted with the production team throughout the entire app creation, from design to testing. Results: DiaFit (version 1.0) is an open-source, inclusive iOS app that incorporates nutrition data, physical activity data, and medication and glucose values, as well as patient-reported outcomes. DiaFit supports the uploading of data from sensory devices via Bluetooth for physical activity (iOS step counts, FitBit, Apple watch) and glucose monitoring (iHealth glucose meter). The app provides summary statistics and graphics for step counts, dietary information, and glucose values that can be used by patients and their providers to make informed health decisions. The DiaFit iOS app was developed in Swift (version 2.2) with a Web back-end deployed on the Health Insurance Portability and Accountability Act compliant-ready Amazon Web Services cloud computing platform. DiaFit is publicly available on GitHub to the diabetes community at large, under the GNU General Public License agreement. Conclusions: Given the proliferation of health-related apps available to health consumers, it is essential to ensure that apps are evidence-based and user-oriented, with specific health conditions in mind. To this end, we have used a software development approach focusing on community and clinical engagement to create DiaFit, an app that assists patients with T2D and obesity to better manage their health through active communication with their providers and proactive self-management of their diseases. UR - http://diabetes.jmir.org/2016/2/e5/ UR - http://dx.doi.org/10.2196/diabetes.6662 UR - http://www.ncbi.nlm.nih.gov/pubmed/29388609 ID - info:doi/10.2196/diabetes.6662 ER - TY - JOUR AU - Businelle, S. Michael AU - Ma, Ping AU - Kendzor, E. Darla AU - Frank, G. Summer AU - Vidrine, J. Damon AU - Wetter, W. David PY - 2016/12/12 TI - An Ecological Momentary Intervention for Smoking Cessation: Evaluation of Feasibility and Effectiveness JO - J Med Internet Res SP - e321 VL - 18 IS - 12 KW - smartphone KW - mobile applications KW - smoking cessation KW - low income population N2 - Background: Despite substantial public health progress in reducing the prevalence of smoking in the United States overall, smoking among socioeconomically disadvantaged adults remains high. Objective: To determine the feasibility and preliminary effectiveness of a novel smartphone-based smoking cessation app designed for socioeconomically disadvantaged smokers. Methods: Participants were recruited from a safety-net hospital smoking cessation clinic in Dallas, Texas, and were followed for 13 weeks. All participants received standard smoking cessation clinic care (ie, group counseling and cessation pharmacotherapy) and a smartphone with a novel smoking cessation app (ie, Smart-T). The Smart-T app prompted 5 daily ecological momentary assessments (EMAs) for 3 weeks (ie, 1 week before cessation and 2 weeks after cessation). During the precessation period, EMAs were followed by messages that focused on planning and preparing for the quit attempt. During the postcessation period, participant responses to EMAs drove an algorithm that tailored messages to the current level of smoking lapse risk and currently present lapse triggers (eg, urge to smoke, stress). Smart-T offered additional intervention features on demand (eg, one-click access to the tobacco cessation quitline; ?Quit Tips? on coping with urges to smoke, mood, and stress). Results: Participants (N=59) were 52.0 (SD 7.0) years old, 54% (32/59) female, and 53% (31/59) African American, and 70% (40/57) had annual household income less than US $16,000. Participants smoked 20.3 (SD 11.6) cigarettes per day and had been smoking for 31.6 (SD 10.9) years. Twelve weeks after the scheduled quit date, 20% (12/59) of all participants were biochemically confirmed abstinent. Participants responded to 87% of all prompted EMAs and received approximately 102 treatment messages over the 3-week EMA period. Most participants (83%, 49/59) used the on-demand app features. Individuals with greater nicotine dependence and minority race used the Quit Tips feature more than their counterparts. Greater use of the Quit Tips feature was linked to nonabstinence at the 2 (P=.02), 4 (P<.01), and 12 (P=.03) week follow-up visits. Most participants reported that they actually used or implemented the tailored app-generated messages and suggestions (83%, 49/59); the app-generated messages were helpful (97%, 57/59); they would like to use the app in the future if they were to lapse (97%, 57/59); and they would like to refer friends who smoke to use the Smart-T app (85%, 50/59). A minority of participants (15%, 9/59) reported that the number of daily assessments (ie, 5) was ?too high.? Conclusions: This novel just-in-time adaptive intervention delivered an intensive intervention (ie, 102 messages over a 3-week period), was well-liked, and was perceived as helpful and useful by socioeconomically disadvantaged adults who were seeking smoking cessation treatment. Smartphone apps may be used to increase treatment exposure and may ultimately reduce tobacco-related health disparities among socioeconomically disadvantaged adults. UR - http://www.jmir.org/2016/12/e321/ UR - http://dx.doi.org/10.2196/jmir.6058 UR - http://www.ncbi.nlm.nih.gov/pubmed/27956375 ID - info:doi/10.2196/jmir.6058 ER - TY - JOUR AU - Mira, Joaquín José AU - Carrillo, Irene AU - Fernandez, Cesar AU - Vicente, Asuncion Maria AU - Guilabert, Mercedes PY - 2016/12/08 TI - Design and Testing of the Safety Agenda Mobile App for Managing Health Care Managers? Patient Safety Responsibilities JO - JMIR Mhealth Uhealth SP - e131 VL - 4 IS - 4 KW - patient safety KW - mobile apps KW - administrators KW - health service N2 - Background: Adverse events are a reality in clinical practice. Reducing the prevalence of preventable adverse events by stemming their causes requires health managers? engagement. Objective: The objective of our study was to develop an app for mobile phones and tablets that would provide managers with an overview of their responsibilities in matters of patient safety and would help them manage interventions that are expected to be carried out throughout the year. Methods: The Safety Agenda Mobile App (SAMA) was designed based on standardized regulations and reviews of studies about health managers? roles in patient safety. A total of 7 managers used a beta version of SAMA for 2 months and then they assessed and proposed improvements in its design. Their experience permitted redesigning SAMA, improving functions and navigation. A total of 74 Spanish health managers tried out the revised version of SAMA. After 4 months, their assessment was requested in a voluntary and anonymous manner. Results: SAMA is an iOS app that includes 37 predefined tasks that are the responsibility of health managers. Health managers can adapt these tasks to their schedule, add new ones, and share them with their team. SAMA menus are structured in 4 main areas: information, registry, task list, and settings. Of the 74 users who tested SAMA, 64 (86%) users provided a positive assessment of SAMA characteristics and utility. Over an 11-month period, 238 users downloaded SAMA. This mobile app has obtained the AppSaludable (HealthyApp) Quality Seal. Conclusions: SAMA includes a set of activities that are expected to be carried out by health managers in matters of patient safety and contributes toward improving the awareness of their responsibilities in matters of safety. UR - http://mhealth.jmir.org/2016/4/e131/ UR - http://dx.doi.org/10.2196/mhealth.5796 UR - http://www.ncbi.nlm.nih.gov/pubmed/27932315 ID - info:doi/10.2196/mhealth.5796 ER - TY - JOUR AU - Kaphle, Sangya AU - Matheke-Fischer, Michael AU - Lesh, Neal PY - 2016/12/07 TI - Effect of Performance Feedback on Community Health Workers? Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial JO - JMIR Public Health Surveill SP - e169 VL - 2 IS - 2 KW - community health workers KW - performance feedback KW - motivation KW - supportive supervision KW - mHealth apps N2 - Background: Small-scale community health worker (CHW) programs provide basic health services and strengthen health systems in resource-poor settings. This paper focuses on improving CHW performance by providing individual feedback to CHWs working with an mHealth program to address malnutrition in children younger than 5 years. Objective: The paper aims to evaluate the immediate and retention effects of providing performance feedback and supportive supervision on CHW motivation and performance for CHWs working with an mHealth platform to reduce malnutrition in five districts of Madhya Pradesh, India. We expected a positive impact on CHW performance for the indicator they received feedback on. Performance on indicators the CHW did not receive feedback on was not expected to change. Methods: In a randomized controlled trial, 60 CHWs were randomized into three treatment groups based on overall baseline performance ranks to achieve balanced treatment groups. Data for each treatment indicator were analyzed with the other two treatments acting as the control. In total, 10 CHWs were lost to follow-up. There were three performance indicators: case activity, form submissions, and duration of counseling. Each group received weekly calls to provide performance targets and discuss their performance on the specific indicator they were allocated to as well as any challenges or technical issues faced during the week for a 6-week period. Data were collected for a further 4 weeks to assess intertemporal sustained effects of the intervention. Results: We found positive and significant impacts on duration of counseling, whereas case activity and number of form submissions did not show significant improvements as a result of the intervention. We found a moderate to large effect (Glass?s delta=0.97, P=.004) of providing performance feedback on counseling times in the initial 6 weeks. These effects were sustained in the postintervention period (Glass?s delta=1.69, P<.001). The counseling times decreased slightly from the intervention to postintervention period by 2.14 minutes (P=.01). Case activity improved for all CHWs after the intervention. We also performed the analysis by replacing the CHWs lost to follow-up with those in their treatment groups with the closest ranks in baseline performance and found similar results. Conclusions: Calls providing performance feedback are effective in improving CHW motivation and performance. Providing feedback had a positive effect on performance in the case of duration of counseling. The results suggest that difficulty in achieving the performance target can affect results of performance feedback. Regardless of the performance information disclosed, calls can improve performance due to elements of supportive supervision included in the calls encouraging CHW motivation. UR - http://publichealth.jmir.org/2016/2/e169/ UR - http://dx.doi.org/10.2196/publichealth.3381 UR - http://www.ncbi.nlm.nih.gov/pubmed/27927607 ID - info:doi/10.2196/publichealth.3381 ER - TY - JOUR AU - Althoff, Tim AU - White, W. Ryen AU - Horvitz, Eric PY - 2016/12/06 TI - Influence of Pokémon Go on Physical Activity: Study and Implications JO - J Med Internet Res SP - e315 VL - 18 IS - 12 KW - physical activity KW - Pokémon Go KW - mobile health KW - mHealth KW - wearable devices KW - mobile applications KW - games KW - exergames KW - public health N2 - Background: Physical activity helps people maintain a healthy weight and reduces the risk for several chronic diseases. Although this knowledge is widely recognized, adults and children in many countries around the world do not get recommended amounts of physical activity. Although many interventions are found to be ineffective at increasing physical activity or reaching inactive populations, there have been anecdotal reports of increased physical activity due to novel mobile games that embed game play in the physical world. The most recent and salient example of such a game is Pokémon Go, which has reportedly reached tens of millions of users in the United States and worldwide. Objective: The objective of this study was to quantify the impact of Pokémon Go on physical activity. Methods: We study the effect of Pokémon Go on physical activity through a combination of signals from large-scale corpora of wearable sensor data and search engine logs for 32,000 Microsoft Band users over a period of 3 months. Pokémon Go players are identified through search engine queries and physical activity is measured through accelerometers. Results: We find that Pokémon Go leads to significant increases in physical activity over a period of 30 days, with particularly engaged users (ie, those making multiple search queries for details about game usage) increasing their activity by 1473 steps a day on average, a more than 25% increase compared with their prior activity level (P<.001). In the short time span of the study, we estimate that Pokémon Go has added a total of 144 billion steps to US physical activity. Furthermore, Pokémon Go has been able to increase physical activity across men and women of all ages, weight status, and prior activity levels showing this form of game leads to increases in physical activity with significant implications for public health. In particular, we find that Pokémon Go is able to reach low activity populations, whereas all 4 leading mobile health apps studied in this work largely draw from an already very active population. Conclusions: Mobile apps combining game play with physical activity lead to substantial short-term activity increases and, in contrast to many existing interventions and mobile health apps, have the potential to reach activity-poor populations. Future studies are needed to investigate potential long-term effects of these applications. UR - http://www.jmir.org/2016/12/e315/ UR - http://dx.doi.org/10.2196/jmir.6759 UR - http://www.ncbi.nlm.nih.gov/pubmed/27923778 ID - info:doi/10.2196/jmir.6759 ER - TY - JOUR AU - Kessel, A. Kerstin AU - Vogel, ME Marco AU - Schmidt-Graf, Friederike AU - Combs, E. Stephanie PY - 2016/11/24 TI - Mobile Apps in Oncology: A Survey on Health Care Professionals? Attitude Toward Telemedicine, mHealth, and Oncological Apps JO - J Med Internet Res SP - e312 VL - 18 IS - 11 KW - mHealth KW - eHealth KW - telemedicine KW - mobile application KW - app KW - smartphone KW - oncology KW - patient-reported outcome N2 - Background: Mobile apps are an evolving trend in the medical field. To date, few apps in an oncological context exist. Objective: The aim was to analyze the attitude of health care professionals (HCPs) toward telemedicine, mHealth, and mobile apps in the field of oncology. Methods: We developed and conducted an online survey with 24 questions evaluating HCPs? general attitude toward telemedicine and patients using medical mobile apps. Specific questions on the possible functionality for patients and the resulting advantages and disadvantages for both the patients? and HCPs? daily clinical routine were evaluated. Results: A total of 108 HCPs completed the survey. In all, 88.9% (96/108) considered telemedicine useful and 84.3% (91/108) supported the idea of an oncological app complementing classical treatment. Automatic reminders, timetables, and assessment of side effects and quality of life during therapy were rated as the most important functions. In contrast, uncertainty regarding medical responsibility and data privacy were reasons mostly named by critics. Most (64.8%, 70/108) were in favor of an alert function due to data input needing further clarification, and 94% (66/70) were willing to contact the patient after a critical alert. In all, 93.5% (101/108) supported the idea of using the collected data for scientific research. Moreover, 75.0% (81/108) believed establishing a mobile app could be beneficial for the providing hospital. Conclusions: A majority of HCPs are in favor of telemedicine and the use of oncological apps by patients. Assessing side effects can lead to quicker response and thus lower inconvenience for patients. Clinical data, such as life quality and treatment satisfaction, could be used to evaluate and improve the therapy workflow. Eventually, a mobile app would enhance the patients? relationship to their treating department because they are in permanent contact. UR - http://www.jmir.org/2016/11/e312/ UR - http://dx.doi.org/10.2196/jmir.6399 UR - http://www.ncbi.nlm.nih.gov/pubmed/27884810 ID - info:doi/10.2196/jmir.6399 ER - TY - JOUR AU - Ridgers, D. Nicola AU - McNarry, A. Melitta AU - Mackintosh, A. Kelly PY - 2016/11/23 TI - Feasibility and Effectiveness of Using Wearable Activity Trackers in Youth: A Systematic Review JO - JMIR Mhealth Uhealth SP - e129 VL - 4 IS - 4 KW - behaviour change KW - electronic activity monitor KW - mHealth KW - physical activity N2 - Background: The proliferation and popularity of wearable activity trackers (eg, Fitbit, Jawbone, Misfit) may present an opportunity to integrate such technology into physical activity interventions. While several systematic reviews have reported intervention effects of using wearable activity trackers on adults? physical activity levels, none to date have focused specifically on children and adolescents. Objective: The aim of this review was to examine the effectiveness of wearable activity trackers as a tool for increasing children?s and adolescents? physical activity levels. We also examined the feasibility of using such technology in younger populations (age range 5-19 years). Methods: We conducted a systematic search of 5 electronic databases, reference lists, and personal archives to identify articles published up until August 2016 that met the inclusion criteria. Articles were included if they (1) specifically examined the use of a wearable device within an intervention or a feasibility study; (2) included participants aged 5-19 years old; (3) had a measure of physical activity as an outcome variable for intervention studies; (4) reported process data concerning the feasibility of the device in feasibility studies; and (5) were published in English. Data were analyzed in August 2016. Results: In total, we identified and analyzed 5 studies (3 intervention, 2 feasibility). Intervention delivery ranged from 19 days to 3 months, with only 1 study using a randomized controlled trial design. Wearable activity trackers were typically combined with other intervention approaches such as goal setting and researcher feedback. While intervention effects were generally positive, the reported differences were largely nonsignificant. The feasibility studies indicated that monitor comfort and design and feedback features were important factors to children and adolescents. Conclusions: There is a paucity of research concerning the effectiveness and feasibility of wearable activity trackers as a tool for increasing children?s and adolescents? physical activity levels. While there are some preliminary data to suggest these devices may have the potential to increase activity levels through self-monitoring and goal setting in the short term, more research is needed to establish longer-term effects on behavior. UR - http://mhealth.jmir.org/2016/4/e129/ UR - http://dx.doi.org/10.2196/mhealth.6540 UR - http://www.ncbi.nlm.nih.gov/pubmed/27881359 ID - info:doi/10.2196/mhealth.6540 ER - TY - JOUR AU - Agboola, Stephen AU - Jethwani, Kamal AU - Lopez, Lenny AU - Searl, Meghan AU - O?Keefe, Sandra AU - Kvedar, Joseph PY - 2016/11/18 TI - Text to Move: A Randomized Controlled Trial of a Text-Messaging Program to Improve Physical Activity Behaviors in Patients With Type 2 Diabetes Mellitus JO - J Med Internet Res SP - e307 VL - 18 IS - 11 KW - type 2 diabetes KW - text messaging KW - mobile phones KW - physical activity KW - engagement KW - pedometers N2 - Background: Text messages are increasingly being used because of the low cost and the ubiquitous nature of mobile phones to engage patients in self-care behaviors. Self-care is particularly important in achieving treatment outcomes in type 2 diabetes mellitus (T2DM). Objective: This study examined the effect of personalized text messages on physical activity, as measured by a pedometer, and clinical outcomes in a diverse population of patients with T2DM. Methods: Text to Move (TTM) incorporates physical activity monitoring and coaching to provide automated and personalized text messages to help patients with T2DM achieve their physical activity goals. A total of 126 English- or Spanish-speaking patients with glycated hemoglobin A1c (HbA1c) >7 were enrolled in-person to participate in the study for 6 months and were randomized into either the intervention arm that received the full complement of the intervention or a control arm that received only pedometers. The primary outcome was change in physical activity. We also assessed the effect of the intervention on HbA1c, weight, and participant engagement. Results: All participants (intervention: n=64; control: n=62) were included in the analyses. The intervention group had significantly higher monthly step counts in the third (risk ratio [RR] 4.89, 95% CI 1.20 to 19.92, P=.03) and fourth (RR 6.88, 95% CI 1.21 to 39.00, P=.03) months of the study compared to the control group. However, over the 6-month follow-up period, monthly step counts did not differ statistically by group (intervention group: 9092 steps; control group: 3722 steps; RR 2.44, 95% CI 0.68 to 8.74, P=.17). HbA1c decreased by 0.07% (95% CI ?0.47 to 0.34, P=.75) in the TTM group compared to the control group. Within groups, HbA1c decreased significantly from baseline in the TTM group by ?0.43% (95% CI ?0.75 to ?0.12, P=.01), but nonsignificantly in the control group by ?0.21% (95% CI ?0.49 to 0.06, P=.13). Similar changes were observed for other secondary outcomes. Conclusion: Personalized text messaging can be used to improve outcomes in patients with T2DM by employing optimal patient engagement measures. UR - http://www.jmir.org/2016/11/e307/ UR - http://dx.doi.org/10.2196/jmir.6439 UR - http://www.ncbi.nlm.nih.gov/pubmed/27864165 ID - info:doi/10.2196/jmir.6439 ER - TY - JOUR AU - Baskerville, Bruce N. AU - Dash, Darly AU - Wong, Katy AU - Shuh, Alanna AU - Abramowicz, Aneta PY - 2016/11/18 TI - Perceptions Toward a Smoking Cessation App Targeting LGBTQ+ Youth and Young Adults: A Qualitative Framework Analysis of Focus Groups JO - JMIR Public Health Surveill SP - e165 VL - 2 IS - 2 KW - qualitative research KW - focus groups KW - mobile applications KW - telemedicine KW - sexuality KW - smoking cessation KW - smartphone N2 - Background: The prevalence of smoking among lesbian, gay, bisexual, trans, queer, and other sexual minority (LGBTQ+) youth and young adults (YYA) is significantly higher compared with that among non-LGBTQ+ persons. However, in the past, interventions were primarily group cessation classes that targeted LGBTQ+ persons of all ages. mHealth interventions offer an alternate and modern intervention platform for this subpopulation and may be of particular interest for young LGBTQ+ persons. Objective: This study explored LGBTQ+ YYA (the potential users?) perceptions of a culturally tailored mobile app for smoking cessation. Specifically, we sought to understand what LGBTQ+ YYA like and dislike about this potential cessation tool, along with how such interventions could be improved. Methods: We conducted 24 focus groups with 204 LGBTQ+ YYA (aged 16-29 years) in Toronto and Ottawa, Canada. Participants reflected on how an app might support LGBTQ+ persons with smoking cessation. Participants indicated their feelings, likes and dislikes, concerns, and additional ideas for culturally tailored smoking cessation apps. Framework analysis was used to code transcripts and identify the overarching themes. Results: Study findings suggested that LGBTQ+ YYA were eager about using culturally tailored mobile apps for smoking cessation. Accessibility, monitoring and tracking, connecting with community members, tailoring, connecting with social networks, and personalization were key reasons that were valued for a mobile app cessation program. However, concerns were raised about individual privacy and that not all individuals had access to a mobile phone, users might lose interest quickly, an app would need to be marketed effectively, and app users might cheat and lie about progress to themselves. Participants highlighted that the addition of distractions, rewards, notifications, and Web-based and print versions of the app would be extremely useful to mitigate some of their concerns. Conclusions: This study provided insight into the perspectives of LGBTQ+ YYA on a smoking cessation intervention delivered through a mobile app. The findings suggested a number of components of a mobile app that were valued and those that were concerning, as well as suggestions on how to make a mobile app cessation program successful. App development for this subpopulation should take into consideration the opinions of the intended users and involve them in the development and evaluation of mobile-based smoking cessation programs. UR - http://publichealth.jmir.org/2016/2/e165/ UR - http://dx.doi.org/10.2196/publichealth.6188 UR - http://www.ncbi.nlm.nih.gov/pubmed/27864164 ID - info:doi/10.2196/publichealth.6188 ER - TY - JOUR AU - Marko, I. Kathryn AU - Krapf, M. Jill AU - Meltzer, C. Andrew AU - Oh, Julia AU - Ganju, Nihar AU - Martinez, G. Anjali AU - Sheth, G. Sheetal AU - Gaba, D. Nancy PY - 2016/11/18 TI - Testing the Feasibility of Remote Patient Monitoring in Prenatal Care Using a Mobile App and Connected Devices: A Prospective Observational Trial JO - JMIR Res Protoc SP - e200 VL - 5 IS - 4 KW - prenatal care KW - pregnancy KW - mobile app KW - remote pateint monitoring N2 - Background: Excessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth, and preeclampsia. More effective strategies to facilitate adherence to gestational weight gain goals and monitor blood pressure may have a positive health benefit for pregnant women and their babies. The impact of utilizing a remote patient monitoring system to monitor blood pressure and weight gain as a component of prenatal care has not been previously assessed. Objective: The objective of this study is to determine the feasibility of monitoring patients remotely in prenatal care using a mobile phone app and connected digital devices. Methods: In this prospective observational study, 8 women with low risk pregnancy in the first trimester were recruited at an urban academic medical center. Participants received a mobile phone app with a connected digital weight scale and blood pressure cuff for at-home data collection for the duration of pregnancy. At-home data was assessed for abnormal values of blood pressure or weight to generate clinical alerts to the patient and provider. As measures of the feasibility of the system, participants were studied for engagement with the app, accuracy of remote data, efficacy of alert system, and patient satisfaction. Results: Patient engagement with the mobile app averaged 5.5 times per week over the 6-month study period. Weight data collection and blood pressure data collection averaged 1.5 times and 1.1 times per week, respectively. At-home measurements of weight and blood pressure were highly accurate compared to in-office measurements. Automatic clinical alerts identified two episodes of abnormal weight gain with no false triggers. Patients demonstrated high satisfaction with the system. Conclusions: In this pilot study, we demonstrated that a system using a mobile phone app coupled to remote monitoring devices is feasible for prenatal care. UR - http://www.researchprotocols.org/2016/4/e200/ UR - http://dx.doi.org/10.2196/resprot.6167 UR - http://www.ncbi.nlm.nih.gov/pubmed/27864167 ID - info:doi/10.2196/resprot.6167 ER - TY - JOUR AU - Kim, Young Ju AU - Wineinger, E. Nathan AU - Taitel, Michael AU - Radin, M. Jennifer AU - Akinbosoye, Osayi AU - Jiang, Jenny AU - Nikzad, Nima AU - Orr, Gregory AU - Topol, Eric AU - Steinhubl, Steve PY - 2016/11/17 TI - Self-Monitoring Utilization Patterns Among Individuals in an Incentivized Program for Healthy Behaviors JO - J Med Internet Res SP - e292 VL - 18 IS - 11 KW - health behavior KW - mobile health KW - mobile apps KW - reward KW - self blood pressure monitoring KW - blood glucose self-monitoring N2 - Background: The advent of digital technology has enabled individuals to track meaningful biometric data about themselves. This novel capability has spurred nontraditional health care organizations to develop systems that aid users in managing their health. One of the most prolific systems is Walgreens Balance Rewards for healthy choices (BRhc) program, an incentivized, Web-based self-monitoring program. Objective: This study was performed to evaluate health data self-tracking characteristics of individuals enrolled in the Walgreens? BRhc program, including the impact of manual versus automatic data entries through a supported device or apps. Methods: We obtained activity tracking data from a total of 455,341 BRhc users during 2014. Upon identifying users with sufficient follow-up data, we explored temporal trends in user participation. Results: Thirty-four percent of users quit participating after a single entry of an activity. Among users who tracked at least two activities on different dates, the median length of participating was 8 weeks, with an average of 5.8 activities entered per week. Furthermore, users who participated for at least twenty weeks (28.3% of users; 33,078/116,621) consistently entered 8 to 9 activities per week. The majority of users (77%; 243,774/315,744) recorded activities through manual data entry alone. However, individuals who entered activities automatically through supported devices or apps participated roughly four times longer than their manual activity-entering counterparts (average 20 and 5 weeks, respectively; P<.001). Conclusions: This study provides insights into the utilization patterns of individuals participating in an incentivized, Web-based self-monitoring program. Our results suggest automated health tracking could significantly improve long-term health engagement. UR - http://www.jmir.org/2016/11/e292/ UR - http://dx.doi.org/10.2196/jmir.6371 UR - http://www.ncbi.nlm.nih.gov/pubmed/27856407 ID - info:doi/10.2196/jmir.6371 ER - TY - JOUR AU - Epis, Massimiliano Oscar AU - Casu, Cinzia AU - Belloli, Laura AU - Schito, Emanuela AU - Filippini, Davide AU - Muscarà, Marina AU - Gentile, Giovanna Maria AU - Perez Cagnone, Carina Paula AU - Venerelli, Chiara AU - Sonnati, Massimo AU - Schiavetti, Irene AU - Bruschi, Eleonora PY - 2016/11/16 TI - Pixel or Paper? Validation of a Mobile Technology for Collecting Patient-Reported Outcomes in Rheumatoid Arthritis JO - JMIR Res Protoc SP - e219 VL - 5 IS - 4 KW - validation KW - rheumatoid arthritis KW - PROs KW - monitoring KW - electronic device KW - tablet KW - questionnaire KW - paper N2 - Background: In the management of chronic disease, new models for telemonitoring of patients combined with the choice of electronic patient-reported outcomes (ePRO) are being encouraged, with a clear improvement of both patients? and parents? quality of life. An Italian study demonstrated that ePRO were welcome in patients with rheumatoid arthritis (RA), with excellent matching data. Objective: The aim of this study is to evaluate the level of agreement between electronic and paper-and-pencil questionnaire responses. Methods: This is an observational prospective study. Patients were randomly assigned to first complete the questionnaire by paper and pencil and then by tablet or in the opposite order. The questionnaire consisted of 3 independent self-assessment visual rating scales (Visual Analog Scale, Global Health score, Patient Global Assessment of Disease Activity) commonly used in different adult patients, including those with rheumatic diseases. Results: A total of 185 consecutive RA patients were admitted to hospital and were enrolled and completed the questionnaire both on paper and on electronic versions. For all the evaluated items, the intrarater degree of agreement between 2 approaches was found to be excellent (intraclass correlation coefficient>0.75, P<.001). Conclusions: An electronic questionnaire is uploaded in a dedicated Web-based tool that could implement a telemonitoring system aimed at improving the follow-up of RA patients. High intrarater reliability between paper and electronic methods of data collection encourage the use of a new digital app with consequent benefit for the overall health care system. UR - http://www.researchprotocols.org/2016/4/e219/ UR - http://dx.doi.org/10.2196/resprot.5631 UR - http://www.ncbi.nlm.nih.gov/pubmed/27852561 ID - info:doi/10.2196/resprot.5631 ER - TY - JOUR AU - Thakkar, Jay AU - Barry, Tony AU - Thiagalingam, Aravinda AU - Redfern, Julie AU - McEwan, L. Alistair AU - Rodgers, Anthony AU - Chow, K. Clara PY - 2016/11/15 TI - Design Considerations in Development of a Mobile Health Intervention Program: The TEXT ME and TEXTMEDS Experience JO - JMIR Mhealth Uhealth SP - e127 VL - 4 IS - 4 KW - text message KW - mobile phone KW - coronary artery disease KW - mHealth N2 - Background: Mobile health (mHealth) has huge potential to deliver preventative health services. However, there is paucity of literature on theoretical constructs, technical, practical, and regulatory considerations that enable delivery of such services. Objectives: The objective of this study was to outline the key considerations in the development of a text message-based mHealth program; thus providing broad recommendations and guidance to future researchers designing similar programs. Methods: We describe the key considerations in designing the intervention with respect to functionality, technical infrastructure, data management, software components, regulatory requirements, and operationalization. We also illustrate some of the potential issues and decision points utilizing our experience of developing text message (short message service, SMS) management systems to support 2 large randomized controlled trials: TEXT messages to improve MEDication adherence & Secondary prevention (TEXTMEDS) and Tobacco, EXercise and dieT MEssages (TEXT ME). Results: The steps identified in the development process were: (1) background research and development of the text message bank based on scientific evidence and disease-specific guidelines, (2) pilot testing with target audience and incorporating feedback, (3) software-hardware customization to enable delivery of complex personalized programs using prespecified algorithms, and (4) legal and regulatory considerations. Additional considerations in developing text message management systems include: balancing the use of customized versus preexisting software systems, the level of automation versus need for human inputs, monitoring, ensuring data security, interface flexibility, and the ability for upscaling. Conclusions: A merging of expertise in clinical and behavioral sciences, health and research data management systems, software engineering, and mobile phone regulatory requirements is essential to develop a platform to deliver and manage support programs to hundreds of participants simultaneously as in TEXT ME and TEXTMEDS trials. This research provides broad principles that may assist other researchers in developing mHealth programs. UR - http://mhealth.jmir.org/2016/4/e127/ UR - http://dx.doi.org/10.2196/mhealth.5996 UR - http://www.ncbi.nlm.nih.gov/pubmed/27847350 ID - info:doi/10.2196/mhealth.5996 ER - TY - JOUR AU - Chen, Elizabeth AU - Mangone, Rose Emily PY - 2016/11/10 TI - A Systematic Review of Apps using Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) JO - JMIR Mhealth Uhealth SP - e122 VL - 4 IS - 4 KW - mHealth KW - eHealth KW - smartphone KW - mobile phone KW - app KW - teen KW - adolescent KW - young adult KW - systematic review KW - unintended pregnancy KW - family planning KW - pregnancy prevention KW - contraception N2 - Background: Adolescents in the United States and globally represent a high-risk population for unintended pregnancy, which leads to high social, economic, and health costs. Access to smartphone apps is rapidly increasing among youth, but little is known about the strategies that apps employ to prevent pregnancy among adolescents and young adults. Further, there are no guidelines on best practices for adolescent and young adult pregnancy prevention through mobile apps. Objective: This review developed a preliminary evaluation framework for the assessment of mobile apps for adolescent and young adult pregnancy prevention and used this framework to assess available apps in the Apple App Store and Google Play that targeted adolescents and young adults with family planning and pregnancy prevention support. Methods: We developed an assessment rubric called Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) for data extraction using evidence-based and promising best practices from the literature. mCAPP comprises 4 domains: (1) app characteristics, (2) user interface features, (3) adolescent pregnancy prevention best practices, and (4) general sexual and reproductive health (SRH) features. For inclusion in the review, apps that advertised pregnancy prevention services and explicitly mentioned youth, were in English, and were free were systematically identified in the Apple App Store and Google Play in 2015. Screening, data extraction, and 4 interrater reliability checks were conducted by 2 reviewers. Each app was assessed for 92 facets of the mCAPP checklist. Results: Our search returned 4043 app descriptions in the Apple App Store (462) and Google Play (3581). After screening for inclusion criteria, 22 unique apps were included in our analysis. Included apps targeted teens in primarily developed countries, and the most common user interface features were clinic and health service locators. While app strengths included provision of SRH education, description of modern contraceptives, and some use of evidence-based adolescent best practices, gaps remain in the implementation of the majority of adolescent best practices and user interface features. Of the 8 best practices for teen pregnancy prevention operationalized through mCAPP, the most commonly implemented best practice was the provision of information on how to use contraceptives to prevent pregnancy (15/22), followed by provision of accurate information on pregnancy risk of sexual behaviors (13/22); information on SRH communication, negotiation, or refusal skills (10/22); and the use of persuasive language around contraceptive use (9/22). Conclusions: The quality and scope of apps for adolescent pregnancy prevention varies, indicating that developers and researchers may need a supportive framework. mCAPP can help researchers and developers consider mobile-relevant evidence-based best practices for adolescent SRH as they develop teen pregnancy prevention apps. Given the novelty of the mobile approach, further research is needed on the impact of mCAPP criteria via mobile channels on adolescent health knowledge, behaviors, and outcomes. UR - http://mhealth.jmir.org/2016/4/e122/ UR - http://dx.doi.org/10.2196/mhealth.6611 UR - http://www.ncbi.nlm.nih.gov/pubmed/27833070 ID - info:doi/10.2196/mhealth.6611 ER - TY - JOUR AU - Donaire-Gonzalez, David AU - Valentín, Antònia AU - de Nazelle, Audrey AU - Ambros, Albert AU - Carrasco-Turigas, Glòria AU - Seto, Edmund AU - Jerrett, Michael AU - Nieuwenhuijsen, J. Mark PY - 2016/11/10 TI - Benefits of Mobile Phone Technology for Personal Environmental Monitoring JO - JMIR Mhealth Uhealth SP - e126 VL - 4 IS - 4 KW - smartphone KW - cell phones KW - mobile applications KW - monitoring, ambulatory KW - spatio-temporal analysis KW - automatic data processing KW - travel KW - environmental exposure N2 - Background: Tracking individuals in environmental epidemiological studies using novel mobile phone technologies can provide valuable information on geolocation and physical activity, which will improve our understanding of environmental exposures. Objective: The objective of this study was to assess the performance of one of the least expensive mobile phones on the market to track people's travel-activity pattern. Methods: Adults living and working in Barcelona (72/162 bicycle commuters) carried simultaneously a mobile phone and a Global Positioning System (GPS) tracker and filled in a travel-activity diary (TAD) for 1 week (N=162). The CalFit app for mobile phones was used to log participants? geographical location and physical activity. The geographical location data were assigned to different microenvironments (home, work or school, in transit, others) with a newly developed spatiotemporal map-matching algorithm. The tracking performance of the mobile phones was compared with that of the GPS trackers using chi-square test and Kruskal-Wallis rank sum test. The minute agreement across all microenvironments between the TAD and the algorithm was compared using the Gwet agreement coefficient (AC1). Results: The mobile phone acquired locations for 905 (29.2%) more trips reported in travel diaries than the GPS tracker (P<.001) and had a median accuracy of 25 m. Subjects spent on average 57.9%, 19.9%, 9.0%, and 13.2% of time at home, work, in transit, and other places, respectively, according to the TAD and 57.5%, 18.8%, 11.6%, and 12.1%, respectively, according to the map-matching algorithm. The overall minute agreement between both methods was high (AC1 .811, 95% CI .810-.812). Conclusions: The use of mobile phones running the CalFit app provides better information on which microenvironments people spend their time in than previous approaches based only on GPS trackers. The improvements of mobile phone technology in microenvironment determination are because the mobile phones are faster at identifying first locations and capable of getting location in challenging environments thanks to the combination of assisted-GPS technology and network positioning systems. Moreover, collecting location information from mobile phones, which are already carried by individuals, allows monitoring more people with a cheaper and less burdensome method than deploying GPS trackers. UR - http://mhealth.jmir.org/2016/4/e126/ UR - http://dx.doi.org/10.2196/mhealth.5771 UR - http://www.ncbi.nlm.nih.gov/pubmed/27833069 ID - info:doi/10.2196/mhealth.5771 ER - TY - JOUR AU - Gomez Quiñonez, Stefanie AU - Walthouwer, Louis Michel Jean AU - Schulz, Nadine Daniela AU - de Vries, Hein PY - 2016/11/09 TI - mHealth or eHealth? Efficacy, Use, and Appreciation of a Web-Based Computer-Tailored Physical Activity Intervention for Dutch Adults: A Randomized Controlled Trial JO - J Med Internet Res SP - e278 VL - 18 IS - 11 KW - mHealth KW - eHealth KW - Web-based intervention KW - computer-tailored intervention KW - physical activity N2 - Background: Until a few years ago, Web-based computer-tailored interventions were almost exclusively delivered via computer (eHealth). However, nowadays, interventions delivered via mobile phones (mHealth) are an interesting alternative for health promotion, as they may more easily reach people 24/7. Objective: The first aim of this study was to compare the efficacy of an mHealth and an eHealth version of a Web-based computer-tailored physical activity intervention with a control group. The second aim was to assess potential differences in use and appreciation between the 2 versions. Methods: We collected data among 373 Dutch adults at 5 points in time (baseline, after 1 week, after 2 weeks, after 3 weeks, and after 6 months). We recruited participants from a Dutch online research panel and randomly assigned them to 1 of 3 conditions: eHealth (n=138), mHealth (n=108), or control condition (n=127). All participants were asked to complete questionnaires at the 5 points in time. Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity. Furthermore, they received personal feedback aimed at increasing their amount of physical activity when needed. We used analysis of variance and linear regression analyses to examine differences between the 2 study groups and the control group with regard to efficacy, use, and appreciation. Results: Participants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after 6 months than participants in the control group (B=8.48, df=2, P=.03, Cohen d=0.27). We found a small effect size favoring the eHealth condition over the control group (B=6.13, df=2, P=.09, Cohen d=0.21). The eHealth condition had lower dropout rates (117/138, 84.8%) than the mHealth condition (81/108, 75.0%) and the control group (91/127, 71.7%). Furthermore, in terms of usability and appreciation, the eHealth condition outperformed the mHealth condition with regard to participants receiving (t182=3.07, P=.002) and reading the feedback messages (t181=2.34, P=.02), as well as the clarity of the messages (t181=1.99, P=.049). Conclusions: We tested 2 Web-based computer-tailored physical activity intervention versions (mHealth and eHealth) against a control condition with regard to efficacy, use, usability, and appreciation. The overall effect was mainly caused by the more effective eHealth intervention. The mHealth app was rated inferior to the eHealth version with regard to usability and appreciation. More research is needed to assess how both methods can complement each other. Trial Registration: Netherlands Trial Register: NTR4503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4503 (Archived by WebCite at http://www.webcitation.org/6lEi1x40s) UR - http://www.jmir.org/2016/11/e278/ UR - http://dx.doi.org/10.2196/jmir.6171 UR - http://www.ncbi.nlm.nih.gov/pubmed/27829576 ID - info:doi/10.2196/jmir.6171 ER - TY - JOUR AU - Huang, Tzu-Yen Evelyn AU - Williams, Henrietta AU - Hocking, S. Jane AU - Lim, SC Megan PY - 2016/11/08 TI - Safe Sex Messages Within Dating and Entertainment Smartphone Apps: A Review JO - JMIR Mhealth Uhealth SP - e124 VL - 4 IS - 4 KW - mobile apps KW - sexual health KW - STDs KW - sexually transmitted diseases KW - mobile health KW - mHealth N2 - Background: Smartphone apps provide a new platform for entertainment, information distribution, and health promotion activities, as well as for dating and casual sexual encounters. Previous research has shown high acceptability of sexual health interventions via smartphone apps; however, sexual health promotion apps were infrequently downloaded and underused. Integrating sexual health promotion into established apps might be a more effective method. Objective: The objective of our study was to critically review popular sex-related apps and dating apps, in order to ascertain whether they contain any sexual health content. Methods: Part 1: In January 2015, we used the term ?sexual? to search for free apps in the Apple iTunes store and Android Google Play store, and categorized the sexual health content of the 137 apps identified. Part 2: We used the term ?dating? to search for free geosocial-networking apps in the Apple iTunes and Android Google Play stores. The apps were downloaded to test functionality and to determine whether they included sexual health content. Results: Part 1: Of the 137 apps identified, 15 (11.0%) had sexual health content and 15 (11.0%) contained messages about sexual assault or violence. The majority of the apps did not contain any sexual health content. Part 2: We reviewed 60 dating apps: 44 (73%) targeting heterosexual users, 9 (15%) targeting men who have sex with men (MSM), 3 (5%) targeting lesbian women, and 4 (7%) for group dating. Only 9 dating apps contained sexual health content, of which 7 targeted MSM. Conclusions: The majority of sex-related apps and dating apps contained no sexual health content that could educate users about and remind them of their sexual risks. Sexual health practitioners and public health departments will need to work with app developers to promote sexual health within existing popular apps. For those apps that already contain sexual health messages, further study to investigate the effectiveness of the content is needed. UR - http://mhealth.jmir.org/2016/4/e124/ UR - http://dx.doi.org/10.2196/mhealth.5760 UR - http://www.ncbi.nlm.nih.gov/pubmed/27826133 ID - info:doi/10.2196/mhealth.5760 ER - TY - JOUR AU - Anderson, Kevin AU - Burford, Oksana AU - Emmerton, Lynne PY - 2016/11/04 TI - App Chronic Disease Checklist: Protocol to Evaluate Mobile Apps for Chronic Disease Self-Management JO - JMIR Res Protoc SP - e204 VL - 5 IS - 4 KW - health KW - mobile applications KW - app KW - smartphones KW - self-management KW - protocol KW - usability checklist KW - self-care KW - chronic disease N2 - Background: The availability of mobile health apps for self-care continues to increase. While little evidence of their clinical impact has been published, there is general agreement among health authorities and authors that consumers? use of health apps assist in self-management and potentially clinical decision making. A consumer?s sustained engagement with a health app is dependent on the usability and functionality of the app. While numerous studies have attempted to evaluate health apps, there is a paucity of published methods that adequately recognize client experiences in the academic evaluation of apps for chronic conditions. Objective: This paper reports (1) a protocol to shortlist health apps for academic evaluation, (2) synthesis of a checklist to screen health apps for quality and reliability, and (3) a proposed method to theoretically evaluate usability of health apps, with a view towards identifying one or more apps suitable for clinical assessment. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was developed to guide the selection of the apps to be assessed. The screening checklist was thematically synthesized with reference to recurring constructs in published checklists and related materials for the assessment of health apps. The checklist was evaluated by the authors for face and construct validity. The proposed method for evaluation of health apps required the design of procedures for raters of apps, dummy data entry to test the apps, and analysis of raters? scores. Results: The PRISMA flow diagram comprises 5 steps: filtering of duplicate apps; eliminating non-English apps; removing apps requiring purchase, filtering apps not updated within the past year; and separation of apps into their core functionality. The screening checklist to evaluate the selected apps was named the App Chronic Disease Checklist, and comprises 4 sections with 6 questions in each section. The validity check verified classification of, and ambiguity in, wording of questions within constructs. The proposed method to evaluate shortlisted and downloaded apps comprises instructions to attempt set-up of a dummy user profile, and dummy data entry to represent in-range and out-of-range clinical measures simulating a range of user behaviors. A minimum score of 80% by consensus (using the Intraclass Correlation Coefficient) between raters is proposed to identify apps suitable for clinical trials. Conclusions: The flow diagram allows researchers to shortlist health apps that are potentially suitable for formal evaluation. The evaluation checklist enables quantitative comparison of shortlisted apps based on constructs reported in the literature. The use of multiple raters, and comparison of their scores, is proposed to manage inherent subjectivity in assessing user experiences. Initial trial of the combined protocol is planned for apps pertaining to the self-monitoring of asthma; these results will be reported elsewhere. UR - http://www.researchprotocols.org/2016/4/e204/ UR - http://dx.doi.org/10.2196/resprot.6194 UR - http://www.ncbi.nlm.nih.gov/pubmed/27815233 ID - info:doi/10.2196/resprot.6194 ER - TY - JOUR AU - Sathyanarayana, Aarti AU - Joty, Shafiq AU - Fernandez-Luque, Luis AU - Ofli, Ferda AU - Srivastava, Jaideep AU - Elmagarmid, Ahmed AU - Arora, Teresa AU - Taheri, Shahrad PY - 2016/11/04 TI - Sleep Quality Prediction From Wearable Data Using Deep Learning JO - JMIR Mhealth Uhealth SP - e125 VL - 4 IS - 4 KW - wearables KW - sleep quality KW - sleep efficiency KW - actigraphy KW - body sensor networks KW - mobile health KW - connected health KW - accelerometer KW - physical activity KW - pervasive health KW - consumer health informatics KW - deep learning N2 - Background: The importance of sleep is paramount to health. Insufficient sleep can reduce physical, emotional, and mental well-being and can lead to a multitude of health complications among people with chronic conditions. Physical activity and sleep are highly interrelated health behaviors. Our physical activity during the day (ie, awake time) influences our quality of sleep, and vice versa. The current popularity of wearables for tracking physical activity and sleep, including actigraphy devices, can foster the development of new advanced data analytics. This can help to develop new electronic health (eHealth) applications and provide more insights into sleep science. Objective: The objective of this study was to evaluate the feasibility of predicting sleep quality (ie, poor or adequate sleep efficiency) given the physical activity wearable data during awake time. In this study, we focused on predicting good or poor sleep efficiency as an indicator of sleep quality. Methods: Actigraphy sensors are wearable medical devices used to study sleep and physical activity patterns. The dataset used in our experiments contained the complete actigraphy data from a subset of 92 adolescents over 1 full week. Physical activity data during awake time was used to create predictive models for sleep quality, in particular, poor or good sleep efficiency. The physical activity data from sleep time was used for the evaluation. We compared the predictive performance of traditional logistic regression with more advanced deep learning methods: multilayer perceptron (MLP), convolutional neural network (CNN), simple Elman-type recurrent neural network (RNN), long short-term memory (LSTM-RNN), and a time-batched version of LSTM-RNN (TB-LSTM). Results: Deep learning models were able to predict the quality of sleep (ie, poor or good sleep efficiency) based on wearable data from awake periods. More specifically, the deep learning methods performed better than traditional logistic regression. ?CNN had the highest specificity and sensitivity, and an overall area under the receiver operating characteristic (ROC) curve (AUC) of 0.9449, which was 46% better as compared with traditional logistic regression (0.6463). Conclusions: Deep learning methods can predict the quality of sleep based on actigraphy data from awake periods. These predictive models can be an important tool for sleep research and to improve eHealth solutions for sleep. UR - http://mhealth.jmir.org/2016/4/e125/ UR - http://dx.doi.org/10.2196/mhealth.6562 UR - http://www.ncbi.nlm.nih.gov/pubmed/27815231 ID - info:doi/10.2196/mhealth.6562 ER - TY - JOUR AU - Bejar, Maria Luis AU - Sharp, Northrop Brett AU - García-Perea, Dolores María PY - 2016/11/02 TI - The e-EPIDEMIOLOGY Mobile Phone App for Dietary Intake Assessment: Comparison with a Food Frequency Questionnaire JO - JMIR Res Protoc SP - e208 VL - 5 IS - 4 KW - dietary assessment KW - mobile phone application KW - food frequency questionnaire KW - epidemiological methods N2 - Background: There is a great necessity for new methods of evaluation of dietary intake that overcome the limitations of traditional self-reporting methods. Objective: The objective of this study was to develop a new method, based on an app for mobile phones called e-EPIDEMIOLOGY, which was designed to collect individual consumption data for a series of foods/drinks, and to compare this app with a previously validated paper food frequency questionnaire (FFQ). Methods: University students >18 years of age recorded the consumption of certain foods/drinks using e-EPIDEMIOLOGY during 28 consecutive days and then filled out a paper FFQ at the end of the study period. To evaluate the agreement between the categories of habitual consumption for each of the foods/drinks included in the study, cross-classification analysis and a weighted kappa statistic were used. Results: A total of 119 participants completed the study (71% female, 85/119; 29% male, 34/119). Cross-classification analysis showed that 79.8% of the participants were correctly classified into the same category and just 1.1% were misclassified into opposite categories. The average weighted kappa statistic was good (?=.64). Conclusions: The results indicate that e-EPIDEMIOLOGY generated ranks of dietary intakes that were highly comparable with the previously validated paper FFQ. However, it was noted that further testing of e-EPIDEMIOLOGY is required to establish its wider utility. UR - http://www.researchprotocols.org/2016/4/e208/ UR - http://dx.doi.org/10.2196/resprot.5782 UR - http://www.ncbi.nlm.nih.gov/pubmed/27806922 ID - info:doi/10.2196/resprot.5782 ER - TY - JOUR AU - Zhao, Jing AU - Freeman, Becky AU - Li, Mu PY - 2016/11/02 TI - Can Mobile Phone Apps Influence People?s Health Behavior Change? An Evidence Review JO - J Med Internet Res SP - e287 VL - 18 IS - 11 KW - review KW - mobile phone apps KW - apps KW - behavior change KW - intervention KW - mHealth N2 - Background: Globally, mobile phones have achieved wide reach at an unprecedented rate, and mobile phone apps have become increasingly prevalent among users. The number of health-related apps that were published on the two leading platforms (iOS and Android) reached more than 100,000 in 2014. However, there is a lack of synthesized evidence regarding the effectiveness of mobile phone apps in changing people?s health-related behaviors. Objective: The aim was to examine the effectiveness of mobile phone apps in achieving health-related behavior change in a broader range of interventions and the quality of the reported studies. Methods: We conducted a comprehensive bibliographic search of articles on health behavior change using mobile phone apps in peer-reviewed journals published between January 1, 2010 and June 1, 2015. Databases searched included Medline, PreMedline, PsycINFO, Embase, Health Technology Assessment, Education Resource Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles published in the Journal of Medical Internet Research during that same period were hand-searched on the journal?s website. Behavior change mechanisms were coded and analyzed. The quality of each included study was assessed by the Cochrane Risk of Bias Assessment Tool. Results: A total of 23 articles met the inclusion criteria, arranged under 11 themes according to their target behaviors. All studies were conducted in high-income countries. Of these, 17 studies reported statistically significant effects in the direction of targeted behavior change; 19 studies included in this analysis had a 65% or greater retention rate in the intervention group (range 60%-100%); 6 studies reported using behavior change theories with the theory of planned behavior being the most commonly used (in 3 studies). Self-monitoring was the most common behavior change technique applied (in 12 studies). The studies suggest that some features improve the effectiveness of apps, such as less time consumption, user-friendly design, real-time feedback, individualized elements, detailed information, and health professional involvement. All studies were assessed as having some risk of bias. Conclusions: Our results provide a snapshot of the current evidence of effectiveness for a range of health-related apps. Large sample, high-quality, adequately powered, randomized controlled trials are required. In light of the bias evident in the included studies, better reporting of health-related app interventions is also required. The widespread adoption of mobile phones highlights a significant opportunity to impact health behaviors globally, particularly in low- and middle-income countries. UR - http://www.jmir.org/2016/11/e287/ UR - http://dx.doi.org/10.2196/jmir.5692 UR - http://www.ncbi.nlm.nih.gov/pubmed/27806926 ID - info:doi/10.2196/jmir.5692 ER - TY - JOUR AU - Lee, Guna AU - Lee, Yura AU - Chong, Pil Yong AU - Jang, Seongsoo AU - Kim, Na Mi AU - Kim, Hoon Jeong AU - Kim, Sung Woo AU - Lee, Jae-Ho PY - 2016/10/26 TI - Blood Culture Testing via a Mobile App That Uses a Mobile Phone Camera: A Feasibility Study JO - J Med Internet Res SP - e282 VL - 18 IS - 10 KW - blood specimen collection KW - patient safety KW - mobile applications KW - mobile phone KW - user-computer interface KW - bar codes KW - patient identification systems N2 - Background: To evaluate patients with fever of unknown origin or those with suspected bacteremia, the precision of blood culture tests is critical. An inappropriate step in the test process or error in a parameter could lead to a false-positive result, which could then affect the direction of treatment in critical conditions. Mobile health apps can be used to resolve problems with blood culture tests, and such apps can hence ensure that point-of-care guidelines are followed and processes are monitored for blood culture tests. Objective: In this pilot project, we aimed to investigate the feasibility of using a mobile blood culture app to manage blood culture test quality. We implemented the app at a university hospital in South Korea to assess the potential for its utilization in a clinical environment by reviewing the usage data among a small group of users and by assessing their feedback and the data related to blood culture sampling. Methods: We used an iOS-based blood culture app that uses an embedded camera to scan the patient identification and sample number bar codes. A total of 4 medical interns working at 2 medical intensive care units (MICUs) participated in this project, which spanned 3 weeks. App usage and blood culture sampling parameters (including sampler, sampling site, sampling time, and sample volume) were analyzed. The compliance of sampling parameter entry was also measured. In addition, the participants? opinions regarding patient safety, timeliness, efficiency, and usability were recorded. Results: In total, 356/644 (55.3%) of all blood culture samples obtained at the MICUs were examined using the app, including 254/356 (71.3%) with blood collection volumes of 5-7 mL and 256/356 (71.9%) with blood collection from the peripheral veins. The sampling volume differed among the participants. Sampling parameters were completely entered in 354/356 cases (99.4%). All the participants agreed that the app ensured good patient safety, disagreed on its timeliness, and did not believe that it was efficient. Although the bar code scanning speed was acceptable, the Wi-Fi environment required improvement. Moreover, the participants requested feedback regarding their sampling quality. Conclusions: Although this app could be used in the clinical setting, improvements in the app functions, environment network, and internal policy of blood culture testing are needed to ensure hospital-wide use. UR - http://www.jmir.org/2016/10/e282/ UR - http://dx.doi.org/10.2196/jmir.6398 UR - http://www.ncbi.nlm.nih.gov/pubmed/27784649 ID - info:doi/10.2196/jmir.6398 ER - TY - JOUR AU - Yazdanshenas, Hamed AU - Bazargan, Mohsen AU - Jones, Loretta AU - Vawer, May AU - Seto, B. Todd AU - Farooq, Summer AU - Taira, A. Deborah PY - 2016/10/26 TI - Engaging Gatekeeper-Stakeholders in Development of a Mobile Health Intervention to Improve Medication Adherence Among African American and Pacific Islander Elderly Patients With Hypertension JO - JMIR Mhealth Uhealth SP - e116 VL - 4 IS - 4 KW - health KW - technology KW - elderly KW - minority KW - hypertension KW - mHealth N2 - Background: Approximately 70 million people in the United States have hypertension. Although antihypertensive therapy can reduce the morbidity and mortality associated with hypertension, often patients do not take their medication as prescribed. Objective: The goal of this study was to better understand issues affecting the acceptability and usability of mobile health technology (mHealth) to improve medication adherence for elderly African American and Native Hawaiian and Pacific Islander patients with hypertension. Methods: In-depth interviews were conducted with 20 gatekeeper-stakeholders using targeted open-ended questions. Interviews were deidentified, transcribed, organized, and coded manually by two independent coders. Analysis of patient interviews used largely a deductive approach because the targeted open-ended interview questions were designed to explore issues specific to the design and acceptability of a mHealth intervention for seniors. Results: A number of similar themes regarding elements of a successful intervention emerged from our two groups of African American and Native Hawaiian and Pacific Islander gatekeeper-stakeholders. First was the need to teach participants both about the importance of adherence to antihypertensive medications. Second, was the use of mobile phones for messaging and patients need to be able to access ongoing technical support. Third, messaging needs to be short and simple, but personalized, and to come from someone the participant trusts and with whom they have a connection. There were some differences between groups. For instance, there was a strong sentiment among the African American group that the church be involved and that the intervention begin with group workshops, whereas the Native Hawaiian and Pacific Islander group seemed to believe that the teaching could occur on a one-to-one basis with the health care provider. Conclusions: Information from our gatekeeper-stakeholder (key informant) interviews suggests that the design of a mHealth intervention to improve adherence to antihypertensives among the elderly could be very similar for African Americans and Native Hawaiian and Pacific Islanders. The main difference might be in the way in which the program is initiated (possibly through church-based workshops for African Americans and by individual providers for Native Hawaiian and Pacific Islanders). Another difference might be who sends the messages with African Americans wanting someone outside the health care system, but Native Hawaiian and Pacific Islanders preferring a provider. UR - http://mhealth.jmir.org/2016/4/e116/ UR - http://dx.doi.org/10.2196/mhealth.5905 UR - http://www.ncbi.nlm.nih.gov/pubmed/27784651 ID - info:doi/10.2196/mhealth.5905 ER - TY - JOUR AU - Badawy, M. Sherif AU - Kuhns, M. Lisa PY - 2016/10/25 TI - Economic Evaluation of Text-Messaging and Smartphone-Based Interventions to Improve Medication Adherence in Adolescents with Chronic Health Conditions: A Systematic Review JO - JMIR Mhealth Uhealth SP - e121 VL - 4 IS - 4 KW - adolescent KW - text messaging KW - smartphone KW - medication adherence KW - chronic disease KW - cost-benefit analysis N2 - Background: The rate of chronic health conditions (CHCs) in children and adolescents has doubled in the past 20 years, with increased health care costs. Technology-based interventions have demonstrated efficacy to improving medication adherence. However, data to support the cost effectiveness of these interventions are lacking. Objective: The objective of this study is to conduct an economic evaluation of text-messaging and smartphone-based interventions that focus on improving medication adherence in adolescents with CHCs. Methods: Searches included PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, and Inspec. Eligibility criteria included age (12-24 years old), original articles, outcomes for medication adherence, and economic outcomes. Results: Our search identified 1118 unique articles that were independently screened. A total of 156 articles met inclusion criteria and were then examined independently with full-text review. A total of 15 articles met most criteria but lacked economic outcomes such as cost effectiveness or cost-utility data. No articles met all predefined criteria to be included for final review. Only 4 articles (text messaging [n=3], electronic directly observed therapy [n=1]) described interventions with possible future cost-saving but no formal economic evaluation. Conclusions: The evidence to support the cost effectiveness of text-messaging and smartphone-based interventions in improving medication adherence in adolescents with CHCs is insufficient. This lack of research highlights the need for comprehensive economic evaluation of such interventions to better understand their role in cost-savings while improving medication adherence and health outcomes. Economic evaluation of technology-based interventions can contribute to more evidence-based assessment of the scalability, sustainability, and benefits of broader investment of such technology tools in adolescents with CHCs. UR - http://mhealth.jmir.org/2016/4/e121/ UR - http://dx.doi.org/10.2196/mhealth.6425 UR - http://www.ncbi.nlm.nih.gov/pubmed/27780795 ID - info:doi/10.2196/mhealth.6425 ER - TY - JOUR AU - El-Hilly, Abdulla Abdulrahman AU - Iqbal, Syed Sheeraz AU - Ahmed, Maroof AU - Sherwani, Yusuf AU - Muntasir, Mohammed AU - Siddiqui, Sarim AU - Al-Fagih, Zaid AU - Usmani, Omar AU - Eisingerich, B. Andreas PY - 2016/10/24 TI - Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study JO - JMIR Serious Games SP - e18 VL - 4 IS - 2 KW - gamification KW - mhealth KW - mobile health KW - smoking cessation KW - health behavior KW - health policy KW - public health KW - behavioral support N2 - Background: Finding ways to increase and sustain engagement with mHealth interventions has become a challenge during application development. While gamification shows promise and has proven effective in many fields, critical questions remain concerning how to use gamification to modify health behavior. Objective: The objective of this study is to investigate how the gamification of mHealth interventions leads to a change in health behavior, specifically with respect to smoking cessation. Methods: We conducted a qualitative longitudinal study using a sample of 16 smokers divided into 2 cohorts (one used a gamified intervention and the other used a nongamified intervention). Each participant underwent 4 semistructured interviews over a period of 5 weeks. Semistructured interviews were also conducted with 4 experts in gamification, mHealth, and smoking cessation. Interviews were transcribed verbatim and thematic analysis undertaken. Results: Results indicated perceived behavioral control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behavior. Importantly, external social influences exerted a negative effect. We identified 3 critical factors, whose presence was necessary for game engagement: purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), and functional utility (a well-designed game). We summarize these findings in a framework to guide the future development of gamified mHealth interventions. Conclusions: Gamification holds the potential for a low-cost, highly effective mHealth solution that may replace or supplement the behavioral support component found in current smoking cessation programs. The framework reported here has been built on evidence specific to smoking cessation, however it can be adapted to health interventions in other disease categories. Future research is required to evaluate the generalizability and effectiveness of the framework, directly against current behavioral support therapy interventions in smoking cessation and beyond. UR - http://games.jmir.org/2016/2/e18/ UR - http://dx.doi.org/10.2196/games.5678 UR - http://www.ncbi.nlm.nih.gov/pubmed/27777216 ID - info:doi/10.2196/games.5678 ER - TY - JOUR AU - Thomas, Kristin AU - Linderoth, Catharina AU - Bendtsen, Marcus AU - Bendtsen, Preben AU - Müssener, Ulrika PY - 2016/10/20 TI - Text Message-Based Intervention Targeting Alcohol Consumption Among University Students: Findings From a Formative Development Study JO - JMIR Mhealth Uhealth SP - e119 VL - 4 IS - 4 KW - SMS intervention KW - university student drinking KW - formative research N2 - Background: Drinking of alcohol among university students is a global phenomenon; heavy episodic drinking is accepted despite several potential negative consequences. There is emerging evidence that short message service (SMS) text messaging interventions are effective to promote behavior change among students. However, it is still unclear how effectiveness can be optimized through intervention design or how user interest and adherence can be maximized. Objective: The objective of this study was to develop an SMS text message-based intervention targeting alcohol drinking among university students using formative research. Methods: A formative research design was used including an iterative revision process based on input from end users and experts. Data were collected via seven focus groups with students and a panel evaluation involving students (n=15) and experts (n=5). Student participants were recruited from five universities in Sweden. A semistructured interview guide was used in the focus groups and included questions on alcohol culture, message content, and intervention format. The panel evaluation asked participants to rate to what degree preliminary messages were understandable, usable, and had a good tone on a scale from 1 (very low degree) to 4 (very high degree). Participants could also write their own comments for each message. Qualitative data were analyzed using qualitative descriptive analysis. Quantitative data were analyzed using descriptive statistics. The SMS text messages and the intervention format were revised continuously in parallel with data collection. A behavior change technique (BCT) analysis was conducted on the final version of the program. Results: Overall, students were positive toward the SMS text message intervention. Messages that were neutral, motivated, clear, and tangible engaged students. Students expressed that they preferred short, concise messages and confirmed that a 6-week intervention was an appropriate duration. However, there was limited consensus regarding SMS text message frequency, personalization of messages, and timing. Overall, messages scored high on understanding (mean 3.86, SD 0.43), usability (mean 3.70, SD 0.61), and tone (mean 3.78, SD 0.53). Participants added comments to 67 of 70 messages, including suggestions for change in wording, order of messages, and feedback on why a message was unclear or needed major revision. Comments also included positive feedback that confirmed the value of the messages. Twenty-three BCTs aimed at addressing self-regulatory skills, for example, were identified in the final program. Conclusions: The formative research design was valuable and resulted in significant changes to the intervention. All the original SMS text messages were changed and new messages were added. Overall, the findings showed that students were positive toward receiving support through SMS text message and that neutral, motivated, clear, and tangible messages promoted engagement. However, limited consensus was found on the timing, frequency, and tailoring of messages. UR - http://mhealth.jmir.org/2016/4/e119/ UR - http://dx.doi.org/10.2196/mhealth.5863 UR - http://www.ncbi.nlm.nih.gov/pubmed/27765732 ID - info:doi/10.2196/mhealth.5863 ER - TY - JOUR AU - Businelle, S. Michael AU - Ma, Ping AU - Kendzor, E. Darla AU - Frank, G. Summer AU - Wetter, W. David AU - Vidrine, J. Damon PY - 2016/10/17 TI - Using Intensive Longitudinal Data Collected via Mobile Phone to Detect Imminent Lapse in Smokers Undergoing a Scheduled Quit Attempt JO - J Med Internet Res SP - e275 VL - 18 IS - 10 KW - smartphone KW - mobile app KW - mhealth KW - ecological momentary assessment KW - smoking cessation KW - socioeconomic disadvantage, risk estimation N2 - Background: Mobile phone?based real-time ecological momentary assessments (EMAs) have been used to record health risk behaviors, and antecedents to those behaviors, as they occur in near real time. Objective: The objective of this study was to determine if intensive longitudinal data, collected via mobile phone, could be used to identify imminent risk for smoking lapse among socioeconomically disadvantaged smokers seeking smoking cessation treatment. Methods: Participants were recruited into a randomized controlled smoking cessation trial at an urban safety-net hospital tobacco cessation clinic. All participants completed in-person EMAs on mobile phones provided by the study. The presence of six commonly cited lapse risk variables (ie, urge to smoke, stress, recent alcohol consumption, interaction with someone smoking, cessation motivation, and cigarette availability) collected during 2152 prompted or self-initiated postcessation EMAs was examined to determine whether the number of lapse risk factors was greater when lapse was imminent (ie, within 4 hours) than when lapse was not imminent. Various strategies were used to weight variables in efforts to improve the predictive utility of the lapse risk estimator. Results: Participants (N=92) were mostly female (52/92, 57%), minority (65/92, 71%), 51.9 (SD 7.4) years old, and smoked 18.0 (SD 8.5) cigarettes per day. EMA data indicated significantly higher urges (P=.01), stress (P=.002), alcohol consumption (P<.001), interaction with someone smoking (P<.001), and lower cessation motivation (P=.03) within 4 hours of the first lapse compared with EMAs collected when lapse was not imminent. Further, the total number of lapse risk factors present within 4 hours of lapse (mean 2.43, SD 1.37) was significantly higher than the number of lapse risk factors present during periods when lapse was not imminent (mean 1.35, SD 1.04), P<.001. Overall, 62% (32/52) of all participants who lapsed completed at least one EMA wherein they reported ?3 lapse risk factors within 4 hours of their first lapse. Differentially weighting lapse risk variables resulted in an improved risk estimator (weighted area=0.76 vs unweighted area=0.72, P<.004). Specifically, 80% (42/52) of all participants who lapsed had at least one EMA with a lapse risk score above the cut-off within 4 hours of their first lapse. Conclusions: Real-time estimation of smoking lapse risk is feasible and may pave the way for development of mobile phone?based smoking cessation treatments that automatically tailor treatment content in real time based on presence of specific lapse triggers. Interventions that identify risk for lapse and automatically deliver tailored messages or other treatment components in real time could offer effective, low cost, and highly disseminable treatments to individuals who do not have access to other more standard cessation treatments. UR - http://www.jmir.org/2016/10/e275/ UR - http://dx.doi.org/10.2196/jmir.6307 UR - http://www.ncbi.nlm.nih.gov/pubmed/27751985 ID - info:doi/10.2196/jmir.6307 ER - TY - JOUR AU - Geuens, Jonas AU - Swinnen, Willem Thijs AU - Westhovens, Rene AU - de Vlam, Kurt AU - Geurts, Luc AU - Vanden Abeele, Vero PY - 2016/10/13 TI - A Review of Persuasive Principles in Mobile Apps for Chronic Arthritis Patients: Opportunities for Improvement JO - JMIR Mhealth Uhealth SP - e118 VL - 4 IS - 4 KW - persuasive technology KW - mobile applications KW - chronic arthritis N2 - Background: Chronic arthritis (CA), an umbrella term for inflammatory rheumatic and other musculoskeletal diseases, is highly prevalent. Effective disease-modifying antirheumatic drugs for CA are available, with the exception of osteoarthritis, but require a long-term commitment of patients to comply with the medication regimen and management program as well as a tight follow-up by the treating physician and health professionals. Additionally, patients are advised to participate in physical exercise programs. Adherence to exercises and physical activity programs is often very low. Patients would benefit from support to increase medication compliance as well as compliance to the physical exercise programs. To address these shortcomings, health apps for CA patients have been created. These mobile apps assist patients in self-management of overall health measures, health prevention, and disease management. By including persuasive principles designed to reinforce, change, or shape attitudes or behaviors, health apps can transform into support tools that motivate and stimulate users to achieve or keep up with target behavior, also called persuasive systems. However, the extent to which health apps for CA patients consciously and successfully employ such persuasive principles remains unknown. Objective: The objective of this study was to evaluate the number and type of persuasive principles present in current health apps for CA patients. Methods: A review of apps for arthritis patients was conducted across the three major app stores (Google Play, Apple App Store, and Windows Phone Store). Collected apps were coded according to 37 persuasive principles, based on an altered version of the Persuasive System Design taxonomy of Oinas-Kukkonen and Harjuma and the taxonomy of Behavior Change Techniques of Michie and Abraham. In addition, user ratings, number of installs, and price of the apps were also coded. Results: We coded 28 apps. On average, 5.8 out of 37 persuasive principles were used in each app. The most used category of persuasive principles was System Credibility with an average of 2.6 principles. Task Support was the second most used, with an average of 2.3 persuasive principles. Next was Dialogue Support with an average of 0.5 principles. Social Support was last with an average of 0.01 persuasive principles only. Conclusions: Current health apps for CA patients would benefit from adding Social Support techniques (eg, social media, user fora) and extending Dialogue Support techniques (eg, rewards, praise). The addition of automated tracking of health-related parameters (eg, physical activity, step count) could further reduce the effort for CA patients to manage their disease and thus increase Task Support. Finally, apps for health could benefit from a more evidence-based approach, both in developing the app as well as ensuring that content can be verified as scientifically proven, which will result in enhanced System Credibility. UR - http://mhealth.jmir.org/2016/4/e118/ UR - http://dx.doi.org/10.2196/mhealth.6286 UR - http://www.ncbi.nlm.nih.gov/pubmed/27742604 ID - info:doi/10.2196/mhealth.6286 ER - TY - JOUR AU - Ehrler, Frederic AU - Weber, Chloé AU - Lovis, Christian PY - 2016/10/06 TI - Influence of Pedometer Position on Pedometer Accuracy at Various Walking Speeds: A Comparative Study JO - J Med Internet Res SP - e268 VL - 18 IS - 10 KW - frail elderly KW - mHealth KW - walking KW - motor activity N2 - Background: Demographic growth in conjunction with the rise of chronic diseases is increasing the pressure on health care systems in most OECD countries. Physical activity is known to be an essential factor in improving or maintaining good health. Walking is especially recommended, as it is an activity that can easily be performed by most people without constraints. Pedometers have been extensively used as an incentive to motivate people to become more active. However, a recognized problem with these devices is their diminishing accuracy associated with decreased walking speed. The arrival on the consumer market of new devices, worn indifferently either at the waist, wrist, or as a necklace, gives rise to new questions regarding their accuracy at these different positions. Objective: Our objective was to assess the performance of 4 pedometers (iHealth activity monitor, Withings Pulse O2, Misfit Shine, and Garmin vívofit) and compare their accuracy according to their position worn, and at various walking speeds. Methods: We conducted this study in a controlled environment with 21 healthy adults required to walk 100 m at 3 different paces (0.4 m/s, 0.6 m/s, and 0.8 m/s) regulated by means of a string attached between their legs at the level of their ankles and a metronome ticking the cadence. To obtain baseline values, we asked the participants to walk 200 m at their own pace. Results: A decrease of accuracy was positively correlated with reduced speed for all pedometers (12% mean error at self-selected pace, 27% mean error at 0.8 m/s, 52% mean error at 0.6 m/s, and 76% mean error at 0.4 m/s). Although the position of the pedometer on the person did not significantly influence its accuracy, some interesting tendencies can be highlighted in 2 settings: (1) positioning the pedometer at the waist at a speed greater than 0.8 m/s or as a necklace at preferred speed tended to produce lower mean errors than at the wrist position; and (2) at a slow speed (0.4 m/s), pedometers worn at the wrist tended to produce a lower mean error than in the other positions. Conclusions: At all positions, all tested pedometers generated significant errors at slow speeds and therefore cannot be used reliably to evaluate the amount of physical activity for people walking slower than 0.6 m/s (2.16 km/h, or 1.24 mph). At slow speeds, the better accuracy observed with pedometers worn at the wrist could constitute a valuable line of inquiry for the future development of devices adapted to elderly people. UR - http://www.jmir.org/2016/10/e268/ UR - http://dx.doi.org/10.2196/jmir.5916 UR - http://www.ncbi.nlm.nih.gov/pubmed/27713114 ID - info:doi/10.2196/jmir.5916 ER - TY - JOUR AU - Chernick, Stephanie Lauren AU - Schnall, Rebecca AU - Stockwell, S. Melissa AU - Castaño, M. Paula AU - Higgins, Tracy AU - Westhoff, Carolyn AU - Santelli, John AU - Dayan, S. Peter PY - 2016/09/29 TI - Adolescent Female Text Messaging Preferences to Prevent Pregnancy After an Emergency Department Visit: A Qualitative Analysis JO - J Med Internet Res SP - e261 VL - 18 IS - 9 KW - pregnancy in adolescence KW - emergency medicine KW - text messaging KW - reproductive health KW - contraception KW - preventive medicine N2 - Background: Over 15 million adolescents use the emergency department (ED) each year in the United States. Adolescent females who use the ED for medical care have been found to be at high risk for unintended pregnancy. Given that adolescents represent the largest users of text messaging and are receptive to receiving text messages related to their sexual health, the ED visit represents an opportunity for intervention. Objective: The aim of this qualitative study was to explore interest in and preferences for the content, frequency, and timing of an ED-based text message intervention to prevent pregnancy for adolescent females. Methods: We conducted semistructured, open-ended interviews in one urban ED in the United States with adolescent females aged 14-19 years. Eligible subjects were adolescents who were sexually active in the past 3 months, presented to the ED for a reproductive health complaint, owned a mobile phone, and did not use effective contraception. Using an interview guide, enrollment continued until saturation of key themes. The investigators designed sample text messages using the Health Beliefs Model and participants viewed these on a mobile phone. The team recorded, transcribed, and coded interviews based on thematic analysis using the qualitative analysis software NVivo and Excel. Results: Participants (n=14) were predominantly Hispanic (13/14; 93%), insured (13/14; 93%), ED users in the past year (12/14; 86%), and frequent text users (10/14; 71% had sent or received >30 texts per day). All were interested in receiving text messages from the ED about pregnancy prevention, favoring messages that were ?brief,? ?professional,? and ?nonaccusatory.? Respondents favored texts with links to websites, repeated information regarding places to receive ?confidential? care, and focused information on contraception options and misconceptions. Preferences for text message frequency varied from daily to monthly, with random hours of delivery to maintain ?surprise.? No participant feared that text messages would violate her privacy. Conclusions: Adolescent female patients at high pregnancy risk are interested in ED-based pregnancy prevention provided by texting. Understanding preferences for the content, frequency, and timing of messages can guide in designing future interventions in the ED. UR - http://www.jmir.org/2016/9/e261/ UR - http://dx.doi.org/10.2196/jmir.6324 UR - http://www.ncbi.nlm.nih.gov/pubmed/27687855 ID - info:doi/10.2196/jmir.6324 ER - TY - JOUR AU - Coa, Kisha AU - Patrick, Heather PY - 2016/09/29 TI - Baseline Motivation Type as a Predictor of Dropout in a Healthy Eating Text Messaging Program JO - JMIR Mhealth Uhealth SP - e114 VL - 4 IS - 3 KW - mHealth KW - behavior change KW - diet KW - engagement KW - motivation KW - Self-Determination Theory N2 - Background: Growing evidence suggests that text messaging programs are effective in facilitating health behavior change. However, high dropout rates limit the potential effectiveness of these programs. Objective: This paper describes patterns of early dropout in the HealthyYou text (HYTxt) program, with a focus on the impact of baseline motivation quality on dropout, as characterized by Self-Determination Theory (SDT). Methods: This analysis included 193 users of HYTxt, a diet and physical activity text messaging intervention developed by the US National Cancer Institute. Descriptive statistics were computed, and logistic regression models were run to examine the association between baseline motivation type and early program dropout. Results: Overall, 43.0% (83/193) of users dropped out of the program; of these, 65.1% (54/83; 28.0% of all users) did so within the first 2 weeks. Users with higher autonomous motivation had significantly lower odds of dropping out within the first 2 weeks. A one unit increase in autonomous motivation was associated with lower odds (odds ratio 0.44, 95% CI 0.24?0.81) of early dropout, which persisted after adjusting for level of controlled motivation. Conclusions: Applying SDT-based strategies to enhance autonomous motivation might reduce early dropout rates, which can improve program exposure and effectiveness. UR - http://mhealth.jmir.org/2016/3/e114/ UR - http://dx.doi.org/10.2196/mhealth.5992 UR - http://www.ncbi.nlm.nih.gov/pubmed/27688034 ID - info:doi/10.2196/mhealth.5992 ER - TY - JOUR AU - Gunter, Rebecca AU - Fernandes-Taylor, Sara AU - Mahnke, Andrea AU - Awoyinka, Lola AU - Schroeder, Chad AU - Wiseman, Jason AU - Sullivan, Sarah AU - Bennett, Kyla AU - Greenberg, Caprice AU - Kent, Craig K. PY - 2016/09/28 TI - Evaluating Patient Usability of an Image-Based Mobile Health Platform for Postoperative Wound Monitoring JO - JMIR Mhealth Uhealth SP - e113 VL - 4 IS - 3 KW - telemedicine KW - smartphone KW - surgical site infection KW - postoperative wound infection N2 - Background: Surgical patients are increasingly using mobile health (mHealth) platforms to monitor recovery and communicate with their providers in the postdischarge period. Despite widespread enthusiasm for mHealth, few studies evaluate the usability or user experience of these platforms. Objective: Our objectives were to (1) develop a novel image-based smartphone app for postdischarge surgical wound monitoring, and (2) rigorously user test it with a representative population of vascular and general surgery patients. Methods: A total of 9 vascular and general surgery inpatients undertook usability testing of an internally developed smartphone app that allows patients to take digital images of their wound and answer a survey about their recovery. We followed the International Organization for Standardization (ISO) 9241-11 guidelines, focusing on effectiveness, efficiency, and user satisfaction. An accompanying training module was developed by applying tenets of adult learning. Sessions were audio-recorded, and the smartphone screen was mirrored onto a study computer. Digital image quality was evaluated by a physician panel to determine usefulness for clinical decision making. Results: The mean length of time spent was 4.7 (2.1-12.8) minutes on the training session and 5.0 (1.4-16.6) minutes on app completion. 55.5% (5/9) of patients were able to complete the app independently with the most difficulty experienced in taking digital images of surgical wounds. Novice patients who were older, obese, or had groin wounds had the most difficulty. 81.8% of images were sufficient for diagnostic purposes. User satisfaction was high, with an average usability score of 83.3 out of 100. Conclusion: Surgical patients can learn to use a smartphone app for postoperative wound monitoring with high user satisfaction. We identified design features and training approaches that can facilitate ease of use. This protocol illustrates an important, often overlooked, aspect of mHealth development to improve surgical care. UR - http://mhealth.jmir.org/2016/3/e113/ UR - http://dx.doi.org/10.2196/mhealth.6023 UR - http://www.ncbi.nlm.nih.gov/pubmed/27683059 ID - info:doi/10.2196/mhealth.6023 ER - TY - JOUR AU - Dahlberg, Karuna AU - Jaensson, Maria AU - Eriksson, Mats AU - Nilsson, Ulrica PY - 2016/09/28 TI - Evaluation of the Swedish Web-Version of Quality of Recovery (SwQoR): Secondary Step in the Development of a Mobile Phone App to Measure Postoperative Recovery JO - JMIR Res Protoc SP - e192 VL - 5 IS - 3 KW - mHealth KW - ambulatory surgical procedures KW - postoperative period KW - mobile phones N2 - Background: The majority of all surgeries are performed on an outpatient basis (day surgery). The Recovery Assessment by Phone Points (RAPP) app is an app for the Swedish Web-version of Quality of Recovery (SwQoR), developed to assess and follow-up on postoperative recovery after day surgery. Objectives: The objectives of this study are (1) to estimate the extent to which the paper and app versions of the SwQoR provide equivalent values; (2) to contribute evidence as to the feasibility and acceptability of a mobile phone Web-based app for measuring postoperative recovery after day surgery and enabling contact with a nurse; and (3) to contribute evidence as to the content validity of the SwQoR. Methods: Equivalence between the paper and app versions of the SwQoR was measured using a randomized crossover design, in which participants used both the paper and app version. Feasibility and acceptability was evaluated by a questionnaire containing 16 questions regarding the value of the app for follow-up care after day surgery. Content validity evaluation was based on responses by day surgery patients and the staff of the day surgery department. Results: A total of 69 participants completed the evaluation of equivalence between the paper and app versions of the SwQoR. The intraclass correlation coefficient (ICC) for the SwQoR was .89 (95% CI 0.83-0.93) and .13 to .90 for the items. Of the participants, 63 continued testing the app after discharge and completed the follow-up questionnaire. The median score was 69 (inter-quartile range, IQR 66-73), indicating a positive attitude toward using an app for follow-up after day surgery. A total of 18 patients and 12 staff members participated in the content validity evaluation. The item-level content validity index (I-CVI) for the staff group was in the 0.64 to 1.0 range, with a scale-level content validity index (S-CVI) of 0.88. For the patient group, I-CVI was in the range 0.30 to 0.92 and S-CVI was 0.67. The content validity evaluation of the SwQoR, together with three new items, led to a reduction from 34 to 24 items. Conclusions: Day surgery patients had positive attitudes toward using the app for follow-up after surgery, and stated a preference for using the app again if they were admitted for a future day surgery procedure. Equivalence between the app and paper version of the SwQoR was found, but at the item level, the ICC was less than .7 for 9 items. In the content validity evaluation of the SwQoR, staff found more items relevant than the patients, and no items found relevant by either staff or patients were excluded when revising the SwQoR. UR - http://www.researchprotocols.org/2016/3/e192/ UR - http://dx.doi.org/10.2196/resprot.5881 UR - http://www.ncbi.nlm.nih.gov/pubmed/27679867 ID - info:doi/10.2196/resprot.5881 ER - TY - JOUR AU - Huerta-Ramos, Elena AU - Escobar-Villegas, Soledad Maria AU - Rubinstein, Katya AU - Unoka, Szabolcs Zsolt AU - Grasa, Eva AU - Hospedales, Margarita AU - Jääskeläinen, Erika AU - Rubio-Abadal, Elena AU - Caspi, Asaf AU - Bitter, István AU - Berdun, Jesus AU - Seppälä, Jussi AU - Ochoa, Susana AU - Fazekas, Kata AU - AU - Corripio, Iluminada AU - Usall, Judith PY - 2016/09/28 TI - Measuring Users? Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study JO - JMIR Mhealth Uhealth SP - e112 VL - 4 IS - 3 KW - mHealth solution KW - treatment-resistant schizophrenia KW - intervention model KW - qualitative research KW - needs assessment N2 - Background: Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice. Objective: The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST). Methods: Before defining the system requirements, a qualitative study of the needs of outpatients with treatment-resistant schizophrenia was carried out in Spain, Israel, and Hungary. We analyzed the opinions of patients, informal carers, and clinicians concerning the services originally intended to be part of the solution. A total of 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries, using discourse analysis as the framework. Results: A webpage and an online forum were perceived as suitable to get both reliable information on the disease and support. Data transmission by a smart watch (monitoring), Web-based visits, and instant messages (clinical treatment) were valued as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions provided for improving the effectiveness of the solution. Conclusions: Positive receptivity toward m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact. UR - http://mhealth.jmir.org/2016/3/e112/ UR - http://dx.doi.org/10.2196/mhealth.5716 UR - http://www.ncbi.nlm.nih.gov/pubmed/27682896 ID - info:doi/10.2196/mhealth.5716 ER - TY - JOUR AU - Alanzi, Turki AU - Istepanian, Robert AU - Philip, Nada PY - 2016/09/26 TI - Design and Usability Evaluation of Social Mobile Diabetes Management System in the Gulf Region JO - JMIR Res Protoc SP - e93 VL - 5 IS - 3 KW - mobile health KW - mobile diabetes management KW - social networking for health care KW - diabetes mellitus KW - telemedicine KW - electronic health KW - Kingdom of Saudi Arabia N2 - Background: The prevalence of diabetes in the Gulf States is one of the highest globally. It is estimated that 20% of the population in the region has been diagnosed with diabetes and according to the International Diabetes Federation (IDF), five of the IDF?s ?top 10? countries for diabetes prevalence in 2011 and projected for 2030 are in this region. In recent years, there have been an increasing number of clinical studies advocating the use of mobile phone technology for diabetes self-management with improved clinical outcomes. However, there are few studies to date addressing the application of mobile diabetes management in the Gulf region, particularly in the Kingdom of Saudi Arabia (KSA), where there is exponential increase in mobile phone usage and access to social networking. Objective: The objective of this paper is to present the design and development of a new mobile health system for social behavioral change and management tailored for Saudi patients with diabetes called Saudi Arabia Networking for Aiding Diabetes (SANAD). A usability study for the SANAD system is presented to validate the acceptability of using mobile technologies among patients with diabetes in the KSA and the Gulf region. Methods: The SANAD system was developed using mobile phone technology with diabetes management and social networking modules. For the usability study the Questionnaire for User Interaction Satisfaction was used to evaluate the usability aspect of the SANAD system. A total of 33 users with type 2 diabetes participated in the study. Results: The key modules of the SANAD system consist of (1) a mobile diabetes management module; (2) a social networking module; and (3) a cognitive behavioral therapy module for behavioral change issues. The preliminary results of the usability study indicated general acceptance of the patients in using the system with higher usability rating in patients with type 2 diabetes. Conclusions: We found that the acceptability of the system was high among Saudi patients with diabetes, and ongoing work in this research area is underway to conduct a clinical pilot study in the KSA for patients with type 2 diabetes. The wide deployment of such a system is timely and required in the Gulf region due to the wide use of mobile phones and social networking mediums. UR - http://www.researchprotocols.org/2016/3/e93/ UR - http://dx.doi.org/10.2196/resprot.4348 UR - http://www.ncbi.nlm.nih.gov/pubmed/27670696 ID - info:doi/10.2196/resprot.4348 ER - TY - JOUR AU - Wahle, Fabian AU - Kowatsch, Tobias AU - Fleisch, Elgar AU - Rufer, Michael AU - Weidt, Steffi PY - 2016/09/21 TI - Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild JO - JMIR Mhealth Uhealth SP - e111 VL - 4 IS - 3 KW - depression KW - mHealth KW -  activities of daily living KW - classification KW - context awareness KW - cognitive behavioral therapy N2 - Background: Depression is a burdensome, recurring mental health disorder with high prevalence. Even in developed countries, patients have to wait for several months to receive treatment. In many parts of the world there is only one mental health professional for over 200 people. Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context-sensitive intervention support. Objective: The objective of this study is 2-fold, first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinically meaningful depression level, second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms. Methods: A total of 126 adults (age 20-57) were recruited to use the smartphone app Mobile Sensing and Support (MOSS), collecting context-sensitive sensor information and providing just-in-time interventions derived from cognitive behavior therapy. Real-time learning-systems were deployed to adapt to each subject?s preferences to optimize recommendations with respect to time, location, and personal preference. Biweekly, participants were asked to complete a self-reported depression survey (PHQ-9) to track symptom progression. Wilcoxon tests were conducted to compare scores before and after intervention. Correlation analysis was used to test the relationship between adherence and change in PHQ-9. One hundred twenty features were constructed based on smartphone usage and sensors including accelerometer, Wifi, and global positioning systems (GPS). Machine-learning models used these features to infer behavior and context for PHQ-9 level prediction and tailored intervention delivery. Results: A total of 36 subjects used MOSS for ?2 weeks. For subjects with clinical depression (PHQ-9?11) at baseline and adherence ?8 weeks (n=12), a significant drop in PHQ-9 was observed (P=.01). This group showed a negative trend between adherence and change in PHQ-9 scores (rho=?.498, P=.099). Binary classification performance for biweekly PHQ-9 samples (n=143), with a cutoff of PHQ-9?11, based on Random Forest and Support Vector Machine leave-one-out cross validation resulted in 60.1% and 59.1% accuracy, respectively. Conclusions: Proxies for social and physical behavior derived from smartphone sensor data was successfully deployed to deliver context-sensitive and personalized interventions to people with depressive symptoms. Subjects who used the app for an extended period of time showed significant reduction in self-reported symptom severity. Nonlinear classification models trained on features extracted from smartphone sensor data including Wifi, accelerometer, GPS, and phone use, demonstrated a proof of concept for the detection of depression superior to random classification. While findings of effectiveness must be reproduced in a RCT to proof causation, they pave the way for a new generation of digital health interventions leveraging smartphone sensors to provide context sensitive information for in-situ support and unobtrusive monitoring of critical mental health states. UR - http://mhealth.jmir.org/2016/3/e111/ UR - http://dx.doi.org/10.2196/mhealth.5960 UR - http://www.ncbi.nlm.nih.gov/pubmed/27655245 ID - info:doi/10.2196/mhealth.5960 ER - TY - JOUR AU - Kroll, R. Ryan AU - Boyd, Gordon J. AU - Maslove, M. David PY - 2016/09/20 TI - Accuracy of a Wrist-Worn Wearable Device for Monitoring Heart Rates in Hospital Inpatients: A Prospective Observational Study JO - J Med Internet Res SP - e253 VL - 18 IS - 9 KW - biometry/instrumentation KW - clothing KW - monitoring, physiologic KW - informatics KW - clinical trial N2 - Background: As the sensing capabilities of wearable devices improve, there is increasing interest in their application in medical settings. Capabilities such as heart rate monitoring may be useful in hospitalized patients as a means of enhancing routine monitoring or as part of an early warning system to detect clinical deterioration. Objective: To evaluate the accuracy of heart rate monitoring by a personal fitness tracker (PFT) among hospital inpatients. Methods: We conducted a prospective observational study of 50 stable patients in the intensive care unit who each completed 24 hours of heart rate monitoring using a wrist-worn PFT. Accuracy of heart rate recordings was compared with gold standard measurements derived from continuous electrocardiographic (cECG) monitoring. The accuracy of heart rates measured by pulse oximetry (Spo2.R) was also measured as a positive control. Results: On a per-patient basis, PFT-derived heart rate values were slightly lower than those derived from cECG monitoring (average bias of ?1.14 beats per minute [bpm], with limits of agreement of 24 bpm). By comparison, Spo2.R recordings produced more accurate values (average bias of +0.15 bpm, limits of agreement of 13 bpm, P<.001 as compared with PFT). Personal fitness tracker device performance was significantly better in patients in sinus rhythm than in those who were not (average bias ?0.99 bpm vs ?5.02 bpm, P=.02). Conclusions: Personal fitness tracker?derived heart rates were slightly lower than those derived from cECG monitoring in real-world testing and not as accurate as Spo2.R-derived heart rates. Performance was worse among patients who were not in sinus rhythm. Further clinical evaluation is indicated to see if PFTs can augment early warning systems in hospitals. Trial Registration: ClinicalTrials.gov NCT02527408; https://clinicaltrials.gov/ct2/show/NCT02527408 (Archived by WebCite at  http://www.webcitation.org/6kOFez3on) UR - http://www.jmir.org/2016/9/e253/ UR - http://dx.doi.org/10.2196/jmir.6025 UR - http://www.ncbi.nlm.nih.gov/pubmed/27651304 ID - info:doi/10.2196/jmir.6025 ER - TY - JOUR AU - Naughton, Felix AU - Hopewell, Sarah AU - Lathia, Neal AU - Schalbroeck, Rik AU - Brown, Chloë AU - Mascolo, Cecilia AU - McEwen, Andy AU - Sutton, Stephen PY - 2016/09/16 TI - A Context-Sensing Mobile Phone App (Q Sense) for Smoking Cessation: A Mixed-Methods Study JO - JMIR Mhealth Uhealth SP - e106 VL - 4 IS - 3 KW - mobile phone app KW - smoking cessation KW - context sensing KW - tailoring KW - geofence KW - just-in-time adaptive intervention KW - JITAI KW - ecological momentary intervention KW - craving N2 - Background: A major cause of lapse and relapse to smoking during a quit attempt is craving triggered by cues from a smoker's immediate environment. To help smokers address these cue-induced cravings when attempting to quit, we have developed a context-aware smoking cessation app, Q Sense, which uses a smoking episode-reporting system combined with location sensing and geofencing to tailor support content and trigger support delivery in real time. Objective: We sought to (1) assess smokers? compliance with reporting their smoking in real time and identify reasons for noncompliance, (2) assess the app's accuracy in identifying user-specific high-risk locations for smoking, (3) explore the feasibility and user perspective of geofence-triggered support, and (4) identify any technological issues or privacy concerns. Methods: An explanatory sequential mixed-methods design was used, where data collected by the app informed semistructured interviews. Participants were smokers who owned an Android mobile phone and were willing to set a quit date within one month (N=15). App data included smoking reports with context information and geolocation, end-of-day (EoD) surveys of smoking beliefs and behavior, support message ratings, and app interaction data. Interviews were undertaken and analyzed thematically (N=13). Quantitative and qualitative data were analyzed separately and findings presented sequentially. Results: Out of 15 participants, 3 (20%) discontinued use of the app prematurely. Pre-quit date, the mean number of smoking reports received was 37.8 (SD 21.2) per participant, or 2.0 (SD 2.2) per day per participant. EoD surveys indicated that participants underreported smoking on at least 56.2% of days. Geolocation was collected in 97.0% of smoking reports with a mean accuracy of 31.6 (SD 16.8) meters. A total of 5 out of 9 (56%) eligible participants received geofence-triggered support. Interaction data indicated that 50.0% (137/274) of geofence-triggered message notifications were tapped within 30 minutes of being generated, resulting in delivery of a support message, and 78.2% (158/202) of delivered messages were rated by participants. Qualitative findings identified multiple reasons for noncompliance in reporting smoking, most notably due to environmental constraints and forgetting. Participants verified the app?s identification of their smoking locations, were largely positive about the value of geofence-triggered support, and had no privacy concerns about the data collected by the app. Conclusions: User-initiated self-report is feasible for training a cessation app about an individual?s smoking behavior, although underreporting is likely. Geofencing was a reliable and accurate method of identifying smoking locations, and geofence-triggered support was regarded positively by participants. UR - http://mhealth.jmir.org/2016/3/e106/ UR - http://dx.doi.org/10.2196/mhealth.5787 UR - http://www.ncbi.nlm.nih.gov/pubmed/27637405 ID - info:doi/10.2196/mhealth.5787 ER - TY - JOUR AU - Batink, Tim AU - Bakker, Jindra AU - Vaessen, Thomas AU - Kasanova, Zuzana AU - Collip, Dina AU - van Os, Jim AU - Wichers, Marieke AU - Germeys, Inez AU - Peeters, Frenk PY - 2016/09/15 TI - Acceptance and Commitment Therapy in Daily Life Training: A Feasibility Study of an mHealth Intervention JO - JMIR Mhealth Uhealth SP - e103 VL - 4 IS - 3 KW - mHealth KW - behavior change KW - daily life intervention KW - acceptance and commitment therapy KW - experience sampling N2 - Background: With the development of mHealth, it is possible to treat patients in their natural environment. Mobile technology helps to bridge the gap between the therapist?s office and the ?real world.? The ACT in Daily Life training (ACT-DL) was designed as an add-on intervention to help patients practice with acceptance and commitment therapy in their daily lives. The ACT-DL consists of two main components: daily monitoring using experience sampling and ACT training in daily life. Objectives: To assess the acceptability and feasibility of the ACT-DL in a general outpatient population. A secondary objective was to conduct a preliminary examination of the effectiveness of the ACT-DL. Methods: An observational comparative study was conducted. The experimental group consisted of 49 patients who volunteered for ACT-DL, and the control group consisted of 112 patients who did not volunteer. As part of an inpatient treatment program, both groups received a 6-week ACT training. Participants went home to continue their treatment on an outpatient basis, during which time the experimental group received the 4-week add-on ACT-DL. Acceptability and feasibility of the ACT-DL was assessed weekly by telephone survey. Effectiveness of the ACT-DL was evaluated with several self-report questionnaires ( Flexibility Index Test (FIT-60): psychological flexibility, Brief Symptom Inventory: symptoms, Utrechtse Coping List: coping, and Quality of life visual analog scale (QoL-VAS): quality of life). Results: More than three-quarters of the participants (76%) completed the full 4-week training. User evaluations showed that ACT-DL stimulated the use of ACT in daily life: participants practiced over an hour a week (mean 78.8 minutes, standard deviation 54.4), doing 10.4 exercises (standard deviation 6.0) on average. Both ACT exercises and metaphors were experienced as useful components of the training (rated 5 out of 7). Repeated measures ANCOVA did not show significant effects of the ACT-DL on psychological flexibility (P=.88), symptoms (P=.39), avoidant coping (P=.28), or quality of life (P=.15). Conclusions: This is the first study that uses experience sampling to foster awareness in daily life in combination with acceptance and commitment therapy to foster skill building. Adherence to the ACT-DL was high for an intensive mHealth intervention. ACT-DL appears to be an acceptable and feasible mHealth intervention, suitable for a broad range of mental health problems. However, short-term effectiveness could not be demonstrated. Additional clinical trials are needed to examine both short-term and long-term effects. UR - http://mhealth.jmir.org/2016/3/e103/ UR - http://dx.doi.org/10.2196/mhealth.5437 UR - http://www.ncbi.nlm.nih.gov/pubmed/27634747 ID - info:doi/10.2196/mhealth.5437 ER - TY - JOUR AU - Laws, A. Rachel AU - Litterbach, V. Eloise-Kate AU - Denney-Wilson, A. Elizabeth AU - Russell, G. Catherine AU - Taki, Sarah AU - Ong, Kok-Leong AU - Elliott, M. Rosalind AU - Lymer, J. Sharyn AU - Campbell, J. Karen PY - 2016/09/15 TI - A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program JO - J Med Internet Res SP - e248 VL - 18 IS - 9 KW - recruitment KW - mHealth KW - parents KW - social media KW - obesity prevention KW - infant feeding KW - children KW - infants KW - practitioners KW - primary health care N2 - Background: Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs. Objective: The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention. Methods: The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ?18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants? baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews. Results: A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD $14) and highest for practice nurse recruitment (AUD $586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68% versus 48%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app. Conclusions: Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment. UR - http://www.jmir.org/2016/9/e248/ UR - http://dx.doi.org/10.2196/jmir.5691 UR - http://www.ncbi.nlm.nih.gov/pubmed/27634633 ID - info:doi/10.2196/jmir.5691 ER - TY - JOUR AU - Bender, Sarmiento Melinda AU - Santos, Glenn-Milo AU - Villanueva, Carissa AU - Arai, Shoshana PY - 2016/09/08 TI - Development of a Mobile Phone-Based Weight Loss Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Protocol and Early Results From the PilAm Go4Health Randomized Controlled Trial JO - JMIR Res Protoc SP - e178 VL - 5 IS - 3 KW - randomized controlled trial KW - lifestyle intervention KW - weight loss KW - Filipinos KW - type 2 diabetes KW - culturally adapted KW - Asian Americans N2 - Background: Filipino Americans are the second largest Asian subgroup in the United States, and were found to have the highest prevalence of obesity and type 2 diabetes (T2D) compared to all Asian subgroups and non-Hispanic whites. In addition to genetic factors, risk factors for Filipinos that contribute to this health disparity include high sedentary rates and high fat diets. However, Filipinos are seriously underrepresented in preventive health research. Research is needed to identify effective interventions to reduce Filipino diabetes risks, subsequent comorbidities, and premature death. Objective: The overall goal of this project is to assess the feasibility and potential efficacy of the Filipino Americans Go4Health Weight Loss Program (PilAm Go4Health). This program is a culturally adapted weight loss lifestyle intervention, using digital technology for Filipinos with T2D, to reduce their risk for metabolic syndrome. Methods: This study was a 3-month mobile phone-based pilot randomized controlled trial (RCT) weight loss intervention with a wait list active control, followed by a 3-month maintenance phase design for 45 overweight Filipinos with T2D. Participants were randomized to an intervention group (n=22) or active control group (n=23), and analyses of the results are underway. The primary outcome will be percent weight change of the participants, and secondary outcomes will include changes in waist circumference, fasting plasma glucose, glycated hemoglobin A1c, physical activity, fat intake, and sugar-sweetened beverage intake. Data analyses will include descriptive statistics to describe sample characteristics and a feasibility assessment based on recruitment, adherence, and retention. Chi-square, Fisher's exact tests, t-tests, and nonparametric rank tests will be used to assess characteristics of randomized groups. Primary analyses will use analysis of covariance and linear mixed models to compare primary and secondary outcomes at 3 months, compared by arm and controlled for baseline levels. Results: Recruitment was completed in January, 2016, and participant follow-up continued through June, 2016. At baseline, mean age was 57 years, 100% (45/45) of participants self-identified as Filipinos, and the cohort was comprised of 17 males and 28 females. Overall, participants were obese with a baseline mean body mass index of 30.2 kg/m2 (standard deviation 4.9). The majority of participants were immigrants (84%, 38/45), with 47% (21/45) living in the United States for more than 10 years. One third of all participants (33%, 15/45) had previously used a pedometer. Conclusions: This study will provide preliminary evidence to determine if the PilAm Go4Health weight loss lifestyle intervention is feasible, and if the program demonstrates potential efficacy to reduce risks for metabolic syndrome in Filipinos with T2D. Positive results will lend support for a larger RCT to evaluate the effectiveness of the PilAm Go4Health intervention for Filipinos. ClinicalTrial: ClinicalTrials.gov: NCT02290184; https://clinicaltrials.gov/ct2/show/NCT02290184 (Archived at http://www.webcitation.org/6k1kUqKSP) UR - http://www.researchprotocols.org/2016/3/e178/ UR - http://dx.doi.org/10.2196/resprot.5836 UR - http://www.ncbi.nlm.nih.gov/pubmed/27608829 ID - info:doi/10.2196/resprot.5836 ER - TY - JOUR AU - Gomersall, R. Sjaan AU - Ng, Norman AU - Burton, W. Nicola AU - Pavey, G. Toby AU - Gilson, D. Nicholas AU - Brown, J. Wendy PY - 2016/09/07 TI - Estimating Physical Activity and Sedentary Behavior in a Free-Living Context: A Pragmatic Comparison of Consumer-Based Activity Trackers and ActiGraph Accelerometry JO - J Med Internet Res SP - e239 VL - 18 IS - 9 KW - activity tracker KW - physical activity KW - sedentary behavior KW - accelerometry KW - Fitbit KW - Jawbone N2 - Background: Activity trackers are increasingly popular with both consumers and researchers for monitoring activity and for promoting positive behavior change. However, there is a lack of research investigating the performance of these devices in free-living contexts, for which findings are likely to vary from studies conducted in well-controlled laboratory settings. Objective: The aim was to compare Fitbit One and Jawbone UP estimates of steps, moderate-to-vigorous physical activity (MVPA), and sedentary behavior with data from the ActiGraph GT3X+ accelerometer in a free-living context. Methods: Thirty-two participants were recruited using convenience sampling; 29 provided valid data for this study (female: 90%, 26/29; age: mean 39.6, SD 11.0 years). On two occasions for 7 days each, participants wore an ActiGraph GT3X+ accelerometer on their right hip and either a hip-worn Fitbit One (n=14) or wrist-worn Jawbone UP (n=15) activity tracker. Daily estimates of steps and very active minutes were derived from the Fitbit One (n=135 days) and steps, active time, and longest idle time from the Jawbone UP (n=154 days). Daily estimates of steps, MVPA, and longest sedentary bout were derived from the corresponding days of ActiGraph data. Correlation coefficients and Bland-Altman plots with examination of systematic bias were used to assess convergent validity and agreement between the devices and the ActiGraph. Cohen?s kappa was used to assess the agreement between each device and the ActiGraph for classification of active versus inactive (?10,000 steps per day and ?30 min/day of MVPA) comparable with public health guidelines. Results: Correlations with ActiGraph estimates of steps and MVPA ranged between .72 and .90 for Fitbit One and .56 and .75 for Jawbone UP. Compared with ActiGraph estimates, both devices overestimated daily steps by 8% (Fitbit One) and 14% (Jawbone UP). However, mean differences were larger for daily MVPA (Fitbit One: underestimated by 46%; Jawbone UP: overestimated by 50%). There was systematic bias across all outcomes for both devices. Correlations with ActiGraph data for longest idle time (Jawbone UP) ranged from .08 to .19. Agreement for classifying days as active or inactive using the ?10,000 steps/day criterion was substantial (Fitbit One: ?=.68; Jawbone UP: ?=.52) and slight-fair using the criterion of ?30 min/day of MVPA (Fitbit One: ?=.40; Jawbone UP: ?=.14). Conclusions: There was moderate-strong agreement between the ActiGraph and both Fitbit One and Jawbone UP for the estimation of daily steps. However, due to modest accuracy and systematic bias, they are better suited for consumer-based self-monitoring (eg, for the public consumer or in behavior change interventions) rather than to evaluate research outcomes. The outcomes that relate to health-enhancing MVPA (eg, ?very active minutes? for Fitbit One or ?active time? for Jawbone UP) and sedentary behavior (?idle time? for Jawbone UP) should be used with caution by consumers and researchers alike. UR - http://www.jmir.org/2016/9/e239/ UR - http://dx.doi.org/10.2196/jmir.5531 UR - http://www.ncbi.nlm.nih.gov/pubmed/27604226 ID - info:doi/10.2196/jmir.5531 ER - TY - JOUR AU - Egbring, Marco AU - Far, Elmira AU - Roos, Malgorzata AU - Dietrich, Michael AU - Brauchbar, Mathis AU - Kullak-Ublick, A. Gerd AU - Trojan, Andreas PY - 2016/09/06 TI - A Mobile App to Stabilize Daily Functional Activity of Breast Cancer Patients in Collaboration With the Physician: A Randomized Controlled Clinical Trial JO - J Med Internet Res SP - e238 VL - 18 IS - 9 KW - collaboration KW - breast cancer KW - mobile app KW - daily functional activity KW - breast neoplasms N2 - Background: The well-being of breast cancer patients and reporting of adverse events require close monitoring. Mobile apps allow continuous recording of disease- and medication-related symptoms in patients undergoing chemotherapy. Objective: The aim of the study was to evaluate the effects of a mobile app on patient-reported daily functional activity in a supervised and unsupervised setting. Methods: We conducted a randomized controlled study of 139 breast cancer patients undergoing chemotherapy. Patient status was self-measured using Eastern Cooperative Oncology Group scoring and Common Terminology Criteria for Adverse Events. Participants were randomly assigned to a control group, an unsupervised group that used a mobile app to record data, or a supervised group that used the app and reviewed data with a physician. Primary outcome variables were change in daily functional activity and symptoms over three outpatient visits. Results: Functional activity scores declined in all groups from the first to second visit. However, from the second to third visit, only the supervised group improved, whereas the others continued to decline. Overall, the supervised group showed no significant difference from the first (median 90.85, IQR 30.67) to third visit (median 84.76, IQR 18.29, P=.72). Both app-using groups reported more distinct adverse events in the app than in the questionnaire (supervised: n=1033 vs n=656; unsupervised: n=852 vs n=823), although the unsupervised group reported more symptoms overall (n=4808) in the app than the supervised group (n=4463). Conclusions: The mobile app was associated with stabilized daily functional activity when used under collaborative review. App-using participants could more frequently report adverse events, and those under supervision made fewer and more precise entries than unsupervised participants. Our findings suggest that patient well-being and awareness of chemotherapy adverse effects can be improved by using a mobile app in collaboration with the treating physician. ClinicalTrial: ClinicalTrials.gov NCT02004496; https://clinicaltrials.gov/ct2/show/NCT02004496 (Archived by WebCite at http://www.webcitation.org/6k68FZHo2) UR - http://www.jmir.org/2016/9/e238/ UR - http://dx.doi.org/10.2196/jmir.6414 UR - http://www.ncbi.nlm.nih.gov/pubmed/27601354 ID - info:doi/10.2196/jmir.6414 ER - TY - JOUR AU - Alwashmi, Meshari AU - Hawboldt, John AU - Davis, Erin AU - Marra, Carlo AU - Gamble, John-Michael AU - Abu Ashour, Waseem PY - 2016/09/01 TI - The Effect of Smartphone Interventions on Patients With Chronic Obstructive Pulmonary Disease Exacerbations: A Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e105 VL - 4 IS - 3 KW - pulmonary disease, chronic obstructive KW - telemedicine KW - smartphone KW - self care KW - disease progression KW - review KW - meta-analysis N2 - Background: The prevalence and mortality rates of chronic obstructive pulmonary disease (COPD) are increasing worldwide. Therefore, COPD remains a major public health problem. There is a growing interest in the use of smartphone technology for health promotion and disease management interventions. However, the effectiveness of smartphones in reducing the number of patients having a COPD exacerbation is poorly understood. Objective: To summarize and quantify the association between smartphone interventions and COPD exacerbations through a comprehensive systematic review and meta-analysis. Methods: A comprehensive search strategy was conducted across relevant databases (PubMed, Embase, Cochrane, CINHA, PsycINFO, and the Cochrane Library Medline) from inception to October 2015. We included studies that assessed the use of smartphone interventions in the reduction of COPD exacerbations compared with usual care. Full-text studies were excluded if the investigators did not use a smartphone device or did not report on COPD exacerbations. Observational studies, abstracts, and reviews were also excluded. Two reviewers extracted the data and conducted a risk of bias assessment using the US Preventive Services Task Force quality rating criteria. A random effects model was used to meta-analyze the results from included studies. Pooled odds ratios were used to measure the effectiveness of smartphone interventions on COPD exacerbations. Heterogeneity was measured using the I2statistic. Results: Of the 245 unique citations screened, 6 studies were included in the qualitative synthesis. Studies were relatively small with less than 100 participants in each study (range 30 to 99) and follow-up ranged from 4-9 months. The mean age was 70.5 years (SD 5.6) and 74% (281/380) were male. The studies varied in terms of country, type of smartphone intervention, frequency of data collection from the participants, and the feedback strategy. Three studies were included in the meta-analysis. The overall assessment of potential bias of the studies that were included in the meta-analysis was ?Good? for one study and ?Fair? for 2 studies. The pooled random effects odds ratio of patients having an exacerbation was 0.20 in patients using a smartphone intervention (95% CI 0.07-0.62), a reduction of 80% for smartphone interventions compared with usual care. However, there was moderate heterogeneity across the included studies (I2=59%). Conclusion: Although current literature on the role of smartphones in reducing COPD exacerbations is limited, findings from our review suggest that smartphones are useful in reducing the number of patients having a COPD exacerbation. Nevertheless, using smartphones require synergistic strategies to achieve the desired outcome. These results should be interpreted with caution due to the heterogeneity among the studies. Researchers should focus on conducting rigorous studies with adequately powered sample sizes to determine the validity and clinical utility of smartphone interventions in the management of COPD. UR - http://mhealth.jmir.org/2016/3/e105/ UR - http://dx.doi.org/10.2196/mhealth.5921 UR - http://www.ncbi.nlm.nih.gov/pubmed/27589898 ID - info:doi/10.2196/mhealth.5921 ER - TY - JOUR AU - Hsu, Jeffrey AU - Liu, Di AU - Yu, Min Ya AU - Zhao, Tong Hui AU - Chen, Rou Zhi AU - Li, Jiao AU - Chen, Wei PY - 2016/08/29 TI - The Top Chinese Mobile Health Apps: A Systematic Investigation JO - J Med Internet Res SP - e222 VL - 18 IS - 8 KW - mobile health applications KW - mHealth KW - medical informatics KW - China N2 - Background: China?s mHealth market is on track to become a global leader by industry size. The Chinese mobile app market and health care system have peculiarities that distinguish them from other app markets. To date, Chinese mHealth apps have not been systematically investigated. Objective: The objective of this study was to provide an overview of Chinese mHealth apps as of December 2015. Methods: We identified and investigated the most downloaded apps from the iOS and Android platforms. For each app, we analyzed and recorded its main service offered, mHealth initiative, disease and specialty focus, app cost, target user, Web app availability, and emphasis on information security. Standard descriptive statistics were used. Results: A total of 234 apps met the inclusion criteria and were investigated. The apps targeting nonhealth care professionals focused on providing telemedicine and appointment-making services. The apps targeting health care professionals focused on education and peer reviewed articles. The most common disease-specific apps focused primarily on diabetes, hypertension, and hepatitis management. Most apps were free and available on both iOS and Android platforms. Conclusions: The primary mHealth initiatives targeted by the apps reflect Chinese patients? demand for access to medical care. Disease-specific apps are also representative of disease prevalence in China. Government press releases suggest that new policies on the horizon may shift the industry. UR - http://www.jmir.org/2016/8/e222/ UR - http://dx.doi.org/10.2196/jmir.5955 UR - http://www.ncbi.nlm.nih.gov/pubmed/27573724 ID - info:doi/10.2196/jmir.5955 ER - TY - JOUR AU - Jensen, D. Chad AU - Duncombe, M. Kristina AU - Lott, A. Mark AU - Hunsaker, L. Sanita AU - Duraccio, M. Kara AU - Woolford, J. Susan PY - 2016/08/23 TI - An Evaluation of a Smartphone?Assisted Behavioral Weight Control Intervention for Adolescents: Pilot Study JO - JMIR Mhealth Uhealth SP - e102 VL - 4 IS - 3 KW - obesity KW - adolescence KW - weight control KW - electronic intervention KW - self-monitoring N2 - Background: The efficacy of adolescent weight control treatments is modest, and effective treatments are costly and are not widely available. Smartphones may be an effective method for delivering critical components of behavioral weight control treatment including behavioral self-monitoring. Objective: To examine the efficacy and acceptability of a smartphone assisted adolescent behavioral weight control intervention. Methods: A total of 16 overweight or obese adolescents (mean age=14.29 years, standard deviation=1.12) received 12 weeks of combined treatment that consisted of weekly in-person group behavioral weight control treatment sessions plus smartphone self-monitoring and daily text messaging. Subsequently they received 12 weeks of electronic-only intervention, totaling 24 weeks of intervention. Results: On average, participants attained modest but significant reductions in body mass index standard score (zBMI: 0.08 standard deviation units, t (13)=2.22, P=.04, d=0.63) over the in-person plus electronic-only intervention period but did not maintain treatment gains over the electronic-only intervention period. Participants self-monitored on approximately half of combined intervention days but less than 20% of electronic-only intervention days. Conclusions: Smartphones likely hold promise as a component of adolescent weight control interventions but they may be less effective in helping adolescents maintain treatment gains after intensive interventions. UR - http://mhealth.jmir.org/2016/3/e102/ UR - http://dx.doi.org/10.2196/mhealth.6034 UR - http://www.ncbi.nlm.nih.gov/pubmed/27554704 ID - info:doi/10.2196/mhealth.6034 ER - TY - JOUR AU - Larsen, Erik Mark AU - Nicholas, Jennifer AU - Christensen, Helen PY - 2016/08/09 TI - Quantifying App Store Dynamics: Longitudinal Tracking of Mental Health Apps JO - JMIR Mhealth Uhealth SP - e96 VL - 4 IS - 3 KW - mobile applications KW - mobile apps KW - mental health KW - telemedicine KW - depression KW - bipolar disorder KW - suicide N2 - Background: For many mental health conditions, mobile health apps offer the ability to deliver information, support, and intervention outside the clinical setting. However, there are difficulties with the use of a commercial app store to distribute health care resources, including turnover of apps, irrelevance of apps, and discordance with evidence-based practice. Objective: The primary aim of this study was to quantify the longevity and rate of turnover of mental health apps within the official Android and iOS app stores. The secondary aim was to quantify the proportion of apps that were clinically relevant and assess whether the longevity of these apps differed from clinically nonrelevant apps. The tertiary aim was to establish the proportion of clinically relevant apps that included claims of clinical effectiveness. We performed additional subgroup analyses using additional data from the app stores, including search result ranking, user ratings, and number of downloads. Methods: We searched iTunes (iOS) and the Google Play (Android) app stores each day over a 9-month period for apps related to depression, bipolar disorder, and suicide. We performed additional app-specific searches if an app no longer appeared within the main search Results: On the Android platform, 50% of the search results changed after 130 days (depression), 195 days (bipolar disorder), and 115 days (suicide). Search results were more stable on the iOS platform, with 50% of the search results remaining at the end of the study period. Approximately 75% of Android and 90% of iOS apps were still available to download at the end of the study. We identified only 35.3% (347/982) of apps as being clinically relevant for depression, of which 9 (2.6%) claimed clinical effectiveness. Only 3 included a full citation to a published study. Conclusions: The mental health app environment is volatile, with a clinically relevant app for depression becoming unavailable to download every 2.9 days. This poses challenges for consumers and clinicians seeking relevant and long-term apps, as well as for researchers seeking to evaluate the evidence base for publicly available apps. UR - http://mhealth.jmir.org/2016/3/e96/ UR - http://dx.doi.org/10.2196/mhealth.6020 UR - http://www.ncbi.nlm.nih.gov/pubmed/27507641 ID - info:doi/10.2196/mhealth.6020 ER - TY - JOUR AU - Pfammatter, Angela AU - Spring, Bonnie AU - Saligram, Nalini AU - Davé, Raj AU - Gowda, Arun AU - Blais, Linelle AU - Arora, Monika AU - Ranjani, Harish AU - Ganda, Om AU - Hedeker, Donald AU - Reddy, Sethu AU - Ramalingam, Sandhya PY - 2016/08/05 TI - mHealth Intervention to Improve Diabetes Risk Behaviors in India: A Prospective, Parallel Group Cohort Study JO - J Med Internet Res SP - e207 VL - 18 IS - 8 KW - mHealth KW - diabetes KW - health promotion N2 - Background: In low/middle income countries like India, diabetes is prevalent and health care access limited. Most adults have a mobile phone, creating potential for mHealth interventions to improve public health. To examine the feasibility and initial evidence of effectiveness of mDiabetes, a text messaging program to improve diabetes risk behaviors, a global nonprofit organization (Arogya World) implemented mDiabetes among one million Indian adults. Objective: A prospective, parallel cohort design was applied to examine whether mDiabetes improved fruit, vegetable, and fat intakes and exercise. Methods: Intervention participants were randomly selected from the one million Nokia subscribers who elected to opt in to mDiabetes. Control group participants were randomly selected from non-Nokia mobile phone subscribers. mDiabetes participants received 56 text messages in their choice of 12 languages over 6 months; control participants received no contact. Messages were designed to motivate improvement in diabetes risk behaviors and increaseawareness about the causes and complications of diabetes. Participant health behaviors (exercise and fruit, vegetable, and fat intake) were assessed between 2012 and 2013 via telephone surveys by blinded assessors at baseline and 6 months later. Data were cleaned and analyzed in 2014 and 2015. Results: 982 participants in the intervention group and 943 in the control group consented to take the phone survey at baselne. At the end of the 6-monthperiod, 611 (62.22%) in the intervention and 632 (67.02%) in the control group completed the follow-up telephone survey. Participants receiving texts demonstrated greater improvement in a health behavior composite score over 6 months, compared with those who received no messages F(1, 1238) = 30.181, P<.001, 95% CI, 0.251-0.531. Fewer intervention participants demonstrated health behavior decline compared with controls. Improved fruit, vegetable, and fat consumption (P<.01) but not exercise were observed in those receiving messages, as compared with controls. Conclusions: A text messaging intervention was feasible and showed initial evidence of effectiveness in improving diabetes-related health behaviors, demonstrating the potential to facilitate population-level behavior change in a low/middle income country. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12615000423516; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367946&isReview=true (Archived by WebCite at http://www.webcitation.org/6j5ptaJgF) UR - http://www.jmir.org/2016/8/e207/ UR - http://dx.doi.org/10.2196/jmir.5712 UR - http://www.ncbi.nlm.nih.gov/pubmed/27496271 ID - info:doi/10.2196/jmir.5712 ER - TY - JOUR AU - Hartzler, Lisabeth Andrea AU - BlueSpruce, June AU - Catz, L. Sheryl AU - McClure, B. Jennifer PY - 2016/08/05 TI - Prioritizing the mHealth Design Space: A Mixed-Methods Analysis of Smokers? Perspectives JO - JMIR Mhealth Uhealth SP - e95 VL - 4 IS - 3 KW - mobile health KW - human-centered design KW - human-computer interaction KW - smartphone KW - smoking cessation KW - telemedicine KW - software design N2 - Background: Smoking remains the leading cause of preventable disease and death in the United States. Therefore, researchers are constantly exploring new ways to promote smoking cessation. Mobile health (mHealth) technologies could be effective cessation tools. Despite the availability of commercial quit-smoking apps, little research to date has examined smokers? preferred treatment intervention components (ie, design features). Honoring these preferences is important for designing programs that are appealing to smokers and may be more likely to be adopted and used. Objective: The aim of this study was to understand smokers? preferred design features of mHealth quit-smoking tools. Methods: We used a mixed-methods approach consisting of focus groups and written surveys to understand the design preferences of adult smokers who were interested in quitting smoking (N=40). Focus groups were stratified by age to allow differing perspectives to emerge between older (>40 years) and younger (<40 years) participants. Focus group discussion included a ?blue-sky? brainstorming exercise followed by participant reactions to contrasting design options for communicating with smokers, providing social support, and incentivizing program use. Participants rated the importance of preselected design features on an exit survey. Qualitative analyses examined emergent discussion themes and quantitative analyses compared feature ratings to determine which were perceived as most important. Results: Participants preferred a highly personalized and adaptive mHealth experience. Their ideal mHealth quit-smoking tool would allow personalized tracking of their progress, adaptively tailored feedback, and real-time peer support to help manage smoking cravings. Based on qualitative analysis of focus group discussion, participants preferred pull messages (ie, delivered upon request) over push messages (ie, sent automatically) and preferred interaction with other smokers through closed social networks. Preferences for entertaining games or other rewarding incentives to encourage program use differed by age group. Based on quantitative analysis of surveys, participants rated the importance of select design features significantly differently (P<.001). Design features rated as most important included personalized content, the ability to track one?s progress, and features designed to help manage nicotine withdrawal and medication side effects. Design features rated least important were quit-smoking videos and posting on social media. Communicating with stop-smoking experts was rated more important than communicating with family and friends about quitting (P=.03). Perceived importance of various design features varied by age, experience with technology, and frequency of smoking. Conclusions: Future mHealth cessation aids should be designed with an understanding of smokers? needs and preferences for these tools. Doing so does not guarantee treatment effectiveness, but balancing user preferences with best-practice treatment considerations could enhance program adoption and improve treatment outcomes. Grounded in the perspectives of smokers, we identify several design considerations, which should be prioritized when designing future mHealth cessation tools and which warrant additional empirical validation. UR - http://mhealth.jmir.org/2016/3/e95/ UR - http://dx.doi.org/10.2196/mhealth.5742 UR - http://www.ncbi.nlm.nih.gov/pubmed/27496593 ID - info:doi/10.2196/mhealth.5742 ER - TY - JOUR AU - Kim, Junetae AU - Lim, Sanghee AU - Min, Ha Yul AU - Shin, Yong-Wook AU - Lee, Byungtae AU - Sohn, Guiyun AU - Jung, Hae Kyung AU - Lee, Jae-Ho AU - Son, Ho Byung AU - Ahn, Hyun Sei AU - Shin, Soo-Yong AU - Lee, Won Jong PY - 2016/08/04 TI - Depression Screening Using Daily Mental-Health Ratings from a Smartphone Application for Breast Cancer Patients JO - J Med Internet Res SP - e216 VL - 18 IS - 8 KW - depression KW - smartphone applications KW - mental health KW - breast cancer (neoplasms) N2 - Background: Mobile mental-health trackers are mobile phone apps that gather self-reported mental-health ratings from users. They have received great attention from clinicians as tools to screen for depression in individual patients. While several apps that ask simple questions using face emoticons have been developed, there has been no study examining the validity of their screening performance. Objective: In this study, we (1) evaluate the potential of a mobile mental-health tracker that uses three daily mental-health ratings (sleep satisfaction, mood, and anxiety) as indicators for depression, (2) discuss three approaches to data processing (ratio, average, and frequency) for generating indicator variables, and (3) examine the impact of adherence on reporting using a mobile mental-health tracker and accuracy in depression screening. Methods: We analyzed 5792 sets of daily mental-health ratings collected from 78 breast cancer patients over a 48-week period. Using the Patient Health Questionnaire-9 (PHQ-9) as the measure of true depression status, we conducted a random-effect logistic panel regression and receiver operating characteristic (ROC) analysis to evaluate the screening performance of the mobile mental-health tracker. In addition, we classified patients into two subgroups based on their adherence level (higher adherence and lower adherence) using a k-means clustering algorithm and compared the screening accuracy between the two groups. Results: With the ratio approach, the area under the ROC curve (AUC) is 0.8012, indicating that the performance of depression screening using daily mental-health ratings gathered via mobile mental-health trackers is comparable to the results of PHQ-9 tests. Also, the AUC is significantly higher (P=.002) for the higher adherence group (AUC=0.8524) than for the lower adherence group (AUC=0.7234). This result shows that adherence to self-reporting is associated with a higher accuracy of depression screening. Conclusions: Our results support the potential of a mobile mental-health tracker as a tool for screening for depression in practice. Also, this study provides clinicians with a guideline for generating indicator variables from daily mental-health ratings. Furthermore, our results provide empirical evidence for the critical role of adherence to self-reporting, which represents crucial information for both doctors and patients. UR - http://www.jmir.org/2016/8/e216/ UR - http://dx.doi.org/10.2196/jmir.5598 UR - http://www.ncbi.nlm.nih.gov/pubmed/27492880 ID - info:doi/10.2196/jmir.5598 ER - TY - JOUR AU - McClure, B. Jennifer AU - Anderson, L. Melissa AU - Bradley, Katharine AU - An, C. Lawrence AU - Catz, L. Sheryl PY - 2016/08/03 TI - Evaluating an Adaptive and Interactive mHealth Smoking Cessation and Medication Adherence Program: A Randomized Pilot Feasibility Study JO - JMIR Mhealth Uhealth SP - e94 VL - 4 IS - 3 KW - tobacco use cessation KW - smoking KW - mobile health KW - mHealth KW - eHealth KW - secure messaging KW - varenicline N2 - Background: Mobile health (mHealth) interventions hold great promise for helping smokers quit since these programs can have wide reach and facilitate access to comprehensive, interactive, and adaptive treatment content. However, the feasibility, acceptability, and effectiveness of these programs remain largely untested. Objective: To assess feasibility and acceptability of the My Mobile Advice Program (MyMAP) smoking cessation program and estimate its effects on smoking cessation and medication adherence to inform future research planning. Methods: Sixty-six smokers ready to quit were recruited from a large regional health care system and randomized to one of two mHealth programs: (1) standard self-help including psychoeducational materials and guidance how to quit smoking or (2) an adaptive and interactive program consisting of the same standard mHealth self-help content as controls received plus a) real-time, adaptively tailored advice for managing nicotine withdrawal symptoms and medication side-effects and b) asynchronous secure messaging with a cessation counselor. Participants in both arms were also prescribed a 12-week course of varenicline. Follow-up assessments were conducted at 2 weeks post-target quit date (TQD), 3 months post-TQD, and 5 months post-TQD. Indices of program feasibility and acceptability included acceptability ratings, utilization metrics including use of each MyMAP program component (self-help content, secure messaging, and adaptively tailored advice), and open-ended feedback from participants. Smoking abstinence and medication adherence were also assessed to estimate effects on these treatment outcomes. Results: Utilization data indicated the MyMAP program was actively used, with higher mean program log-ins by experimental than control participants (10.6 vs 2.7, P<.001). The majority of experimental respondents thought the MyMAP program could help other people quit smoking (22/24, 92%) and consistently take their stop-smoking medication (17/22, 97%) and would recommend the program to others (20/23, 87%). They also rated the program as convenient, responsive to their needs, and easy to use. Abstinence rates at 5-month follow-up were 36% in the experimental arm versus 24% among controls (odds ratio 1.79 [0.61-5.19], P=.42). Experimental participants used their varenicline an average of 46 days versus 39 among controls (P=.49). More than two-thirds (22/33, 67%) of experimental participants and three-quarters (25/33, 76%) of controls prematurely discontinued their varenicline use (P=.29). Conclusions: The MyMAP intervention was found to be feasible and acceptable. Since the study was not powered for statistical significance, no conclusions can be drawn about the program?s effects on smoking abstinence or medication adherence, but the overall study results suggest further evaluation in a larger randomized trial is warranted. ClinicalTrial: ClinicalTrials.gov NCT02136498; https://clinicaltrials.gov/ct2/show/NCT02136498 (Archived by WebCite at http://www.webcitation.org/6jT3UMFLj) UR - http://mhealth.jmir.org/2016/3/e94/ UR - http://dx.doi.org/10.2196/mhealth.6002 UR - http://www.ncbi.nlm.nih.gov/pubmed/27489247 ID - info:doi/10.2196/mhealth.6002 ER - TY - JOUR AU - Franco, Zenun Rodrigo AU - Fallaize, Rosalind AU - Lovegrove, A. Julie AU - Hwang, Faustina PY - 2016/08/01 TI - Popular Nutrition-Related Mobile Apps: A Feature Assessment JO - JMIR Mhealth Uhealth SP - e85 VL - 4 IS - 3 KW - nutrition apps KW - diet apps KW - food diary KW - nutritional assessment KW - mHealth KW - eHealth KW - mobile phone KW - mobile technology N2 - Background: A key challenge in human nutrition is the assessment of usual food intake. This is of particular interest given recent proposals of eHealth personalized interventions. The adoption of mobile phones has created an opportunity for assessing and improving nutrient intake as they can be used for digitalizing dietary assessments and providing feedback. In the last few years, hundreds of nutrition-related mobile apps have been launched and installed by millions of users. Objective: This study aims to analyze the main features of the most popular nutrition apps and to compare their strategies and technologies for dietary assessment and user feedback. Methods: Apps were selected from the two largest online stores of the most popular mobile operating systems?the Google Play Store for Android and the iTunes App Store for iOS?based on popularity as measured by the number of installs and reviews. The keywords used in the search were as follows: calorie(s), diet, diet tracker, dietician, dietitian, eating, fit, fitness, food, food diary, food tracker, health, lose weight, nutrition, nutritionist, weight, weight loss, weight management, weight watcher, and ww calculator. The inclusion criteria were as follows: English language, minimum number of installs (1 million for Google Play Store) or reviews (7500 for iTunes App Store), relation to nutrition (ie, diet monitoring or recommendation), and independence from any device (eg, wearable) or subscription. Results: A total of 13 apps were classified as popular for inclusion in the analysis. Nine apps offered prospective recording of food intake using a food diary feature. Food selection was available via text search or barcode scanner technologies. Portion size selection was only textual (ie, without images or icons). All nine of these apps were also capable of collecting physical activity (PA) information using self-report, the global positioning system (GPS), or wearable integrations. Their outputs focused predominantly on energy balance between dietary intake and PA. None of these nine apps offered features directly related to diet plans and motivational coaching. In contrast, the remaining four of the 13 apps focused on these opportunities, but without food diaries. One app?FatSecret?also had an innovative feature for connecting users with health professionals, and another?S Health?provided a nutrient balance score. Conclusions: The high number of installs indicates that there is a clear interest and opportunity for diet monitoring and recommendation using mobile apps. All the apps collecting dietary intake used the same nutrition assessment method (ie, food diary record) and technologies for data input (ie, text search and barcode scanner). Emerging technologies, such as image recognition, natural language processing, and artificial intelligence, were not identified. None of the apps had a decision engine capable of providing personalized diet advice. UR - http://mhealth.jmir.org/2016/3/e85/ UR - http://dx.doi.org/10.2196/mhealth.5846 UR - http://www.ncbi.nlm.nih.gov/pubmed/27480144 ID - info:doi/10.2196/mhealth.5846 ER - TY - JOUR AU - Svensson, Åsa AU - Magnusson, Maria AU - Larsson, Christel PY - 2016/07/29 TI - Overcoming Barriers: Adolescents? Experiences Using a Mobile Phone Dietary Assessment App JO - JMIR Mhealth Uhealth SP - e92 VL - 4 IS - 3 KW - adolescents KW - content analysis KW - dietary assessment KW - Self Determination Theory KW - mobile phone app N2 - Background: The use of new technology has the potential to increase participation rates in dietary studies and improve the validity of collected dietary data. However, to evaluate the usability of developed dietary methods, qualitative studies of participants? experiences and perceptions are needed. Objective: To explore adolescents? experiences using a newly developed mobile phone dietary assessment app, with a focus on factors that could affect their recording of dietary intake. Methods: Focus group interviews were conducted with 75 participants who had used a newly developed mobile phone dietary assessment app in a quantitative evaluation study. The interviews were analyzed using qualitative content analysis and the theoretical framework of Self Determination Theory was applied. Results: The adolescents? use of the mobile phone dietary assessment app was characterized by their struggle to overcome several perceived barriers. Facilitators that helped adolescents complete the method were also identified. Motivation was found to be an important facilitator, and intrinsically motivated participants completed the method because they found it fun to use. The autonomous extrinsically motivated participants completed the method for the greater good, in order to contribute to the study. The controlled extrinsically motivated participants completed the method to get a reward or avoid punishment. Amotivated participants did not complete the method. More motivated participants were assumed to be more able to overcome barriers and needed less facilitators. Conclusions: Future studies that examine the recording of food intake should include systematic efforts that aim to minimize identified barriers and promote identified facilitators. Further research should specifically aim at studying methods for (and effects of) increasing intrinsic motivation by supporting autonomy, competence, and relatedness among adolescents asked to participate in dietary studies. UR - http://mhealth.jmir.org/2016/3/e92/ UR - http://dx.doi.org/10.2196/mhealth.5700 UR - http://www.ncbi.nlm.nih.gov/pubmed/27473462 ID - info:doi/10.2196/mhealth.5700 ER - TY - JOUR AU - Mattila, Elina AU - Lappalainen, Raimo AU - Välkkynen, Pasi AU - Sairanen, Essi AU - Lappalainen, Päivi AU - Karhunen, Leila AU - Peuhkuri, Katri AU - Korpela, Riitta AU - Kolehmainen, Marjukka AU - Ermes, Miikka PY - 2016/07/28 TI - Usage and Dose Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis of the Intervention Arm of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e90 VL - 4 IS - 3 KW - mobile apps KW - Acceptance and Commitment Therapy KW - retrospective study KW - adherence N2 - Background: Mobile phone apps offer a promising medium to deliver psychological interventions. A mobile app based on Acceptance and Commitment Therapy (ACT) was developed and studied in a randomized controlled trial (RCT). Objective: To study usage metrics of a mobile ACT intervention and dose-response relationship between usage and improvement in psychological flexibility. Methods: An RCT was conducted to investigate the effectiveness of different lifestyle interventions for overweight people with psychological stress. This paper presents a secondary analysis of the group that received an 8-week mobile ACT intervention. Most of the analyzed 74 participants were female (n=64, 86%). Their median age was 49.6 (interquartile range, IQR 45.4-55.3) years and their mean level of psychological flexibility, measured with the Acceptance and Action Questionnaire II, was 20.4 (95% confidence interval 18.3-22.5). Several usage metrics describing the intensity of use, usage of content, and ways of use were calculated. Linear regression analyses were performed to study the dose-response relationship between usage and the change in psychological flexibility and to identify the usage metrics with strongest association with improvement. Binary logistic regression analyses were further used to assess the role of usage metrics between those who showed improvement in psychological flexibility and those who did not. In addition, associations between usage and baseline participant characteristics were studied. Results: The median number of usage sessions was 21 (IQR 11.8-35), the number of usage days was 15 (IQR 9.0-24), and the number of usage weeks was 7.0 (IQR 4.0-8.0). The participants used the mobile app for a median duration of 4.7 (IQR 3.2-7.2) hours and performed a median of 63 (IQR 46-98) exercises. There was a dose-response relationship between usage and the change in psychological flexibility. The strongest associations with psychological flexibility (results adjusted with gender, age, and baseline psychological variables) were found for lower usage of Self as context related exercises (B=0.22, P=.001) and higher intensity of use, described by the number of usage sessions (B=?0.10, P=.01), usage days (B=?0.17, P=.008), and usage weeks (B=?0.73, P=.02), the number of exercises performed (B=?0.02, P=.03), and the total duration of use (B=?0.30, P=.04). Also, higher usage of Acceptance related exercises (B=?0.18, P=.04) was associated with improvement. Active usage was associated with female gender, older age, and not owning a smart mobile phone before the study. Conclusions: The results indicated that active usage of a mobile ACT intervention was associated with improved psychological flexibility. Usage metrics describing intensity of use as well as two metrics related to the usage of content were found to be most strongly associated with improvement. Trial Registration: ClinicalTrials.gov NCT01738256; https://clinicaltrials.gov/ct2/show/NCT01738256 (Archived by WebCite at http://www.webcitation.org/6iTePjPLL) UR - http://mhealth.jmir.org/2016/3/e90/ UR - http://dx.doi.org/10.2196/mhealth.5241 UR - http://www.ncbi.nlm.nih.gov/pubmed/27468653 ID - info:doi/10.2196/mhealth.5241 ER - TY - JOUR AU - Santos-Lozano, Alejandro AU - Garatachea, Nuria AU - Pareja-Galeano, Helios AU - Fiuza-Luces, Carmen AU - Sanchis-Gomar, Fabian AU - Lucia, Alejandro PY - 2016/07/27 TI - The Era of Smartphones: Back to Our Biological Makeup? JO - JMIR Mhealth Uhealth SP - e63 VL - 4 IS - 3 UR - http://mhealth.jmir.org/2016/3/e63/ UR - http://dx.doi.org/10.2196/mhealth.5193 UR - http://www.ncbi.nlm.nih.gov/pubmed/27465861 ID - info:doi/10.2196/mhealth.5193 ER - TY - JOUR AU - Bruening, Meg AU - van Woerden, Irene AU - Todd, Michael AU - Brennhofer, Stephanie AU - Laska, N. Melissa AU - Dunton, Genevieve PY - 2016/07/27 TI - A Mobile Ecological Momentary Assessment Tool (devilSPARC) for Nutrition and Physical Activity Behaviors in College Students: A Validation Study JO - J Med Internet Res SP - e209 VL - 18 IS - 7 KW - validation study KW - ecological momentary assessment KW - nutritional status KW - physical activity KW - sedentary activity KW - emerging adults N2 - Background: The majority of nutrition and physical activity assessments methods commonly used in scientific research are subject to recall and social desirability biases, which result in over- or under-reporting of behaviors. Real-time mobile-based ecological momentary assessments (mEMAs) may result in decreased measurement biases and minimize participant burden. Objective: The aim was to examine the validity of a mEMA methodology to assess dietary and physical activity levels compared to 24-hour dietary recalls and accelerometers. Methods: This study was a pilot test of the SPARC (Social impact of Physical Activity and nutRition in College) study, which aimed to determine the mechanism by which friendship networks impact weight-related behaviors among young people. An mEMA app, devilSPARC, was developed to assess weight-related behaviors in real time. A diverse sample of 109 freshmen and community mentors attending a large southwestern university downloaded the devilSPARC mEMA app onto their personal mobile phones. Participants were prompted randomly eight times per day over the course of 4 days to complete mEMAs. During the same 4-day period, participants completed up to three 24-hour dietary recalls and/or 4 days of accelerometry. Self-reported mEMA responses were compared to 24-hour dietary recalls and accelerometry measures using comparison statistics, such as match rate, sensitivity and specificity, and mixed model odds ratios, adjusted for within-person correlation among repeated measurements. Results: At the day level, total dietary intake data reported through the mEMA app reflected eating choices also captured by the 24-hour recall. Entrées had the lowest match rate, and fruits and vegetables had the highest match rate. Widening the window of aggregation of 24-hour dietary recall data on either side of the mEMA response resulted in increased specificity and decreased sensitivity. For physical activity behaviors, levels of activity reported through mEMA differed for sedentary versus non-sedentary activity at the day level as measured by accelerometers. Conclusions: The devilSPARC mEMA app is valid for assessing eating behaviors and the presence of sedentary activity at the day level. This mEMA may be useful in studies examining real-time weight-related behaviors. UR - http://www.jmir.org/2016/7/e209/ UR - http://dx.doi.org/10.2196/jmir.5969 UR - http://www.ncbi.nlm.nih.gov/pubmed/27465701 ID - info:doi/10.2196/jmir.5969 ER - TY - JOUR AU - Rivera, Jordan AU - McPherson, Amy AU - Hamilton, Jill AU - Birken, Catherine AU - Coons, Michael AU - Iyer, Sindoora AU - Agarwal, Arnav AU - Lalloo, Chitra AU - Stinson, Jennifer PY - 2016/07/26 TI - Mobile Apps for Weight Management: A Scoping Review JO - JMIR Mhealth Uhealth SP - e87 VL - 4 IS - 3 KW - weight loss KW - obesity KW - mobile apps KW - smartphones KW - mHealth N2 - Background: Obesity remains a major public health concern. Mobile apps for weight loss/management are found to be effective for improving health outcomes in adults and adolescents, and are pursued as a cost-effective and scalable intervention for combating overweight and obesity. In recent years, the commercial market for ?weight loss apps? has expanded at rapid pace, yet little is known regarding the evidence-based quality of these tools for weight control. Objective: To characterize the inclusion of evidence-based strategies, health care expert involvement, and scientific evaluation of commercial mobile apps for weight loss/management. Methods: An electronic search was conducted between July 2014 and July 2015 of the official app stores for four major mobile operating systems. Three raters independently identified apps with a stated goal of weight loss/management, as well as weight loss/management apps targeted to pediatric users. All discrepancies regarding selection were resolved through discussion with a fourth rater. Metadata from all included apps were abstracted into a standard assessment criteria form and the evidence-based strategies, health care expert involvement, and scientific evaluation of included apps was assessed. Evidence-based strategies included: self-monitoring, goal-setting, physical activity support, healthy eating support, weight and/or health assessment, personalized feedback, motivational strategies, and social support. Results: A total of 393 apps were included in this review. Self-monitoring was most common (139/393, 35.3%), followed by physical activity support (108/393, 27.5%), weight assessment (100/393, 25.4%), healthy eating support (91/393, 23.2%), goal-setting (84/393, 21.4%), motivational strategies (28/393, 7.1%), social support (21/393, 5.3%), and personalized feedback (7/393, 1.8%). Of apps, 0.8% (3/393) underwent scientific evaluation and 0.3% (1/393) reported health care expert involvement. No apps were comprehensive in the assessment criteria, with the majority of apps meeting less than two criteria. Conclusions: Commercial mobile apps for weight loss/management lack important evidence-based features, do not involve health care experts in their development process, and have not undergone rigorous scientific testing. This calls into question the validity of apps? claims regarding their effectiveness and safety, at a time when the availability and growth in adoption of these tools is rapidly increasing. Collaborative efforts between developers, researchers, clinicians, and patients are needed to develop and test high-quality, evidence-based mobile apps for weight loss/management before they are widely disseminated in commercial markets. UR - http://mhealth.jmir.org/2016/3/e87/ UR - http://dx.doi.org/10.2196/mhealth.5115 UR - http://www.ncbi.nlm.nih.gov/pubmed/27460502 ID - info:doi/10.2196/mhealth.5115 ER - TY - JOUR AU - Egsgaard, Lindhardt Line AU - Christensen, Søby Trine AU - Petersen, Munk Ida AU - Brønnum, Scavenius Dorthe AU - Boudreau, Ann Shellie PY - 2016/07/20 TI - Do Gender-Specific and High-Resolution Three Dimensional Body Charts Facilitate the Communication of Pain for Women? A Quantitative and Qualitative Study JO - JMIR Hum Factors SP - e19 VL - 3 IS - 2 KW - mHealth KW - app KW - android KW - pain measurement KW - chronic pain KW - three dimensional pain drawing KW - digital communication N2 - Background: Chronic pain is more prevalent among women; however, the majority of standardized pain drawings are often collected using male-like androgynous body representations. Objective: The purpose of this study was to assess whether gender-specific and high-resolution three-dimensional (3D) body charts facilitate the communication of pain for women. Methods: Using mixed-methods and a cross-over design, female patients with chronic pain were asked to provide detailed drawings of their current pain on masculine and feminine two-dimensional (2D) body schemas (N=41, Part I) or on female 2D and 3D high-resolution body schemas (N=41, Part II) on a computer tablet. The consistency of the drawings between body charts were assessed by intraclass correlation coefficient (ICC) and Bland-Altman plots. Semistructured interviews and a preference questionnaire were then used to obtain qualitative and quantitative responses of the drawing experience. Results: The consistency between body charts were high (Part I: ICC=0.980, Part II: ICC=0.994). The preference ratio for the masculine to feminine body schemas were 6:35 and 18:23 for the 2D to 3D female body charts. Patients reported that the 3D body chart enabled a more accurate expression of their pain due to the detailed contours of the musculature and bone structure, however, patients also reported the 3D body chart was too human and believed that skin-like appearance limited ?deep pain? expressions. Conclusions: Providing gender-specific body charts may facilitate the communication of pain and the level of detail (2D vs 3D body charts) should be used according to patients? needs. UR - http://humanfactors.jmir.org/2016/2/e19/ UR - http://dx.doi.org/10.2196/humanfactors.5693 UR - http://www.ncbi.nlm.nih.gov/pubmed/27440737 ID - info:doi/10.2196/humanfactors.5693 ER - TY - JOUR AU - Cheng, Ferrer Paula Glenda AU - Ramos, Munoz Roann AU - Bitsch, Ágila Jó AU - Jonas, Michael Stephan AU - Ix, Tim AU - See, Quetulio Portia Lynn AU - Wehrle, Klaus PY - 2016/07/20 TI - Psychologist in a Pocket: Lexicon Development and Content Validation of a Mobile-Based App for Depression Screening JO - JMIR Mhealth Uhealth SP - e88 VL - 4 IS - 3 KW - depression KW - Psychologist in a Pocket KW - lexicon development KW - text analysis N2 - Background: Language reflects the state of one?s mental health and personal characteristics. It also reveals preoccupations with a particular schema, thus possibly providing insights into psychological conditions. Using text or lexical analysis in exploring depression, negative schemas and self-focusing tendencies may be depicted. As mobile technology has become highly integrated in daily routine, mobile devices have the capacity for ecological momentary assessment (EMA), specifically the experience sampling method (ESM), where behavior is captured in real-time or closer in time to experience in one?s natural environment. Extending mobile technology to psychological health could augment initial clinical assessment, particularly of mood disturbances, such as depression and analyze daily activities, such as language use in communication. Here, we present the process of lexicon generation and development and the initial validation of Psychologist in a Pocket (PiaP), a mobile app designed to screen signs of depression through text analysis. Objective: The main objectives of the study are (1) to generate and develop a depressive lexicon that can be used for screening text-input in mobile apps to be used in the PiaP; and (2) to conduct content validation as initial validation. Methods: The first phase of our research focused on lexicon development. Words related to depression and its symptoms based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and in the ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines classification systems were gathered from focus group discussions with Filipino college students, interviews with mental health professionals, and the review of established scales for depression and other related constructs. Results: The lexicon development phase yielded a database consisting of 13 categories based on the criteria depressive symptoms in the DSM-5 and ICD-10. For the draft of the depression lexicon for PiaP, we were able to gather 1762 main keywords and 9655 derivatives of main keywords. In addition, we compiled 823,869 spelling variations. Keywords included negatively-valenced words like ?sad?, ?unworthy?, or ?tired? which are almost always accompanied by personal pronouns, such as ?I?, ?I?m? or ?my? and in Filipino, ?ako? or ?ko?. For the content validation, only keywords with CVR equal to or more than 0.75 were included in the depression lexicon test-run version. The mean of all CVRs yielded a high overall CVI of 0.90. A total of 1498 main keywords, 8911 derivatives of main keywords, and 783,140 spelling variations, with a total of 793, 553 keywords now comprise the test-run version. Conclusions: The generation of the depression lexicon is relatively exhaustive. The breadth of keywords used in text analysis incorporates the characteristic expressions of depression and its related constructs by a particular culture and age group. A content-validated mobile health app, PiaP may help augment a more effective and early detection of depressive symptoms. UR - http://mhealth.jmir.org/2016/3/e88/ UR - http://dx.doi.org/10.2196/mhealth.5284 UR - http://www.ncbi.nlm.nih.gov/pubmed/27439444 ID - info:doi/10.2196/mhealth.5284 ER - TY - JOUR AU - Frisbee, L. Kathleen PY - 2016/07/19 TI - Variations in the Use of mHealth Tools: The VA Mobile Health Study JO - JMIR Mhealth Uhealth SP - e89 VL - 4 IS - 3 KW - caregivers KW - telemedicine KW - stress (psychological) KW - veterans health N2 - Background: Mobile health (mHealth) technologies exhibit promise for offering patients and their caregivers point-of-need tools for health self-management. This research study involved the dissemination of iPads containing a suite of mHealth apps to family caregivers of veterans who receive care from the Veterans Affairs (VA) Health Administration and have serious physical or mental injuries. Objective: The goal of the study was to identify factors and characteristics of veterans and their family caregivers that predict the use of mHealth apps. Methods: Veteran/family caregiver dyads (N=882) enrolled in VA?s Comprehensive Assistance for Family Caregivers program were recruited to participate in an mHealth pilot program. Veterans and caregivers who participated and received an iPad agreed to have their use of the apps monitored and were asked to complete a survey assessing Caregiver Preparedness, Caregiver Traits, and Caregiver Zarit Burden Inventory baseline surveys. Results: Of the 882 dyads, 94.9% (837/882) of caregivers were women and 95.7% (844/882) of veteran recipients were men. Mean caregiver age was 40 (SD 10.2) years and mean veteran age was 39 (SD 9.15) years, and 39.8% (351/882) lived in rural locations. Most (89%, 788/882) of the caregivers were spouses. Overall, the most frequently used app was Summary of Care, followed by RX Refill, then Journal, Care4Caregivers, VA Pain Coach, and last, VA PTSD Coach. App use was significantly predicted by the caregiver being a spouse, increased caregiver computer skills, a rural living location, lower levels of caregiver preparedness, veteran mental health diagnosis (other than posttraumatic stress disorder), and veteran age. Conclusions: This mHealth Family Caregiver pilot project effectively establishes the VA?s first patient-facing mHealth apps that are integrated within the VA data system. Use varied considerably, and apps that were most used were those that assisted them in their caregiving responsibilities. UR - http://mhealth.jmir.org/2016/3/e89/ UR - http://dx.doi.org/10.2196/mhealth.3726 UR - http://www.ncbi.nlm.nih.gov/pubmed/27436165 ID - info:doi/10.2196/mhealth.3726 ER - TY - JOUR AU - Connelly, Kay AU - Stein, F. Karen AU - Chaudry, Beenish AU - Trabold, Nicole PY - 2016/07/14 TI - Development of an Ecological Momentary Assessment Mobile App for a Low-Literacy, Mexican American Population to Collect Disordered Eating Behaviors JO - JMIR Public Health Surveill SP - e31 VL - 2 IS - 2 KW - feeding and eating disorders KW - health literacy KW - socioeconomic status KW - human-centered computing KW - user-computer interface KW - mobile apps N2 - Background: Ecological momentary assessment (EMA) is a popular method for understanding population health in which participants report their experiences while in naturally occurring contexts in order to increase the reliability and ecological validity of the collected data (as compared to retrospective recall). EMA studies, however, have relied primarily on text-based questionnaires, effectively eliminating low-literacy populations from the samples. Objective: To provide a case study of design of an EMA mobile app for a low-literacy population. In particular, we present the design process and final design of an EMA mobile app for low literate, Mexican American women to record unhealthy eating and weight control behaviors (UEWCBs). Methods: An iterative, user-centered design process was employed to develop the mobile app. An existing EMA protocol to measure UEWCBs in college-enrolled Mexican American women was used as the starting point for the application. The app utilizes an icon interface, with optional audio prompts, that is culturally sensitive and usable by a low-literacy population. A total of 41 women participated over the course of 4 phases of the design process, which included 2 interview and task-based phases (n=8, n=11), focus groups (n=15), and a 5-day, in situ deployment (n=7). Results: Participants? mental models of UEWCBs differed substantially from prevailing definitions found in the literature, prompting a major reorganization of the app interface. Differences in health literacy and numeracy were better identified with the Newest Vital Sign tool, as compared with the Short Assessment of Health Literacy tool. Participants had difficulty imagining scenarios in the interviews to practice recording a specific UEWCB; instead, usability was best tested in situ. Participants were able to use the EMA mobile app over the course of 5 days to record UEWCBs. Conclusions: Results suggest that the iterative, user-centered design process was essential for designing the app to be made usable by the target population. Simply taking the protocol designed for a higher-literacy population and replacing words with icons and/or audio would have been unsuccessful with this population. UR - http://publichealth.jmir.org/2016/2/e31/ UR - http://dx.doi.org/10.2196/publichealth.5511 UR - http://www.ncbi.nlm.nih.gov/pubmed/27418020 ID - info:doi/10.2196/publichealth.5511 ER - TY - JOUR AU - Sheoran, Bhupendra AU - Silva, Lynn Cara AU - Lykens, Elliot James AU - Gamedze, Londiwe AU - Williams, Samantha AU - Ford, VanNess Jessie AU - Habel, A. Melissa PY - 2016/07/14 TI - YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth JO - JMIR Mhealth Uhealth SP - e82 VL - 4 IS - 3 KW - mHealth KW - homelessness KW - youth KW - STD KW - sexually transmitted diseases KW - mobile app N2 - Background: Homeless and unstably housed (H/UH) youth are disproportionately affected by sexual health issues, including human immunodeficiency virus/sexually transmitted diseases, teen pregnancy, and dating violence, and are at a higher risk for poor mental health and underutilization of services. Research suggests that linking health care to H/UH adolescents might help improve their continuity of care, with most preferring to access health care information via the Internet. YTH StreetConnect is a dual-purpose mobile app that helps H/UH youth access health and vital services in Santa Clara County, CA, USA. We developed YTH StreetConnect PRO in parallel with the youth app as a companion tablet app for providers who serve H/UH youth. Objective: The objective of our study was to develop a mobile app to support H/UH youth and their providers in accessing health and vital resources, and to conduct usability and feasibility testing of the app among H/UH youth and technical consultants with local expertise in serving H/UH youth. Methods: Formative research included a literature review on H/UH youths? mobile phone and Internet usage. In January 2015, we conducted interviews with medical and service providers of H/UH youth. Usability and feasibility testing were done with target audiences. Additionally, we conducted focus groups with youth regarding the app?s youth friendliness, accessibility, and usefulness. Results: H/UH youth and their providers noted the app?s functionality, youth friendliness, and resources. Usability testing proposed improvements to the app, including visual updates to the user interface, map icons, new underrepresented resource categories, and the addition of a peer rating system. Limitations included a small sample size among H/UH youth and providers and a single site for the study (Santa Clara County, CA), making the findings ungeneralizable to the US population. Conclusions: YTH StreetConnect is a promising way to increase service utilization, provide referral access, and share resources among H/UH youth and providers. Input from H/UH youth and providers offers insights on how to improve future models of YTH StreetConnect and similar programs that assist H/UH youth. UR - http://mhealth.jmir.org/2016/3/e82/ UR - http://dx.doi.org/10.2196/mhealth.5168 UR - http://www.ncbi.nlm.nih.gov/pubmed/27417882 ID - info:doi/10.2196/mhealth.5168 ER - TY - JOUR AU - Zaidan, Sarah AU - Roehrer, Erin PY - 2016/07/11 TI - Popular Mobile Phone Apps for Diet and Weight Loss: A Content Analysis JO - JMIR Mhealth Uhealth SP - e80 VL - 4 IS - 3 KW - applications KW - diet KW - monitoring KW - obesity KW - weight loss N2 - Background: A review of the literature has revealed that the rates of overweight and obesity have been increasing in Australia over the last two decades and that wellness mobile phone apps play a significant role in monitoring and managing individuals? weight. Although mobile phone app markets (iTunes and Google Play) list thousands of mobile phone health apps, it is not always clear whether those apps are supported by credible sources. Likewise, despite the prevailing use of mobile phone apps to aid with weight management, the usability features of these apps are not well characterized. Objective: The research explored how usability taxonomy could inform the popularity of downloaded, socially focused wellness mobile phone apps, in particular weight loss and diet apps. The aim of the study was to investigate the Australian mobile phone app stores (iTunes and Google Play) in order to examine the usability features of the most popular (ie, most downloaded) wellness apps. Methods: The design of this study comprises 3 main stages: stage 1, identifying apps; stage 2, development of weight loss and diet evaluation framework; and stage 3, application of the evaluation framework. Each stage includes specific data collection, analysis tools, and techniques. Results: The study has resulted in the development of a justified evaluation framework for weight loss and diet mobile phone apps. Applying the evaluation framework to the identified apps has shown that the most downloaded iTunes and Google Play apps are not necessarily the most usable or effective. In addition, the research found that search algorithms for iTunes and Google Play are biased toward apps? titles and keywords that do not accurately define the real functionality of the app. Moreover, the study has also analyzed the apps? user reviews, which served as justification for the developed evaluation framework. Conclusions: The analysis has shown that ease of use, reminder, bar code scanning, motivation, usable for all, and synchronization are significant attributes that should be included in weight loss and diet mobile phone apps and ultimately in potential weight loss and diet evaluation frameworks. UR - http://mhealth.jmir.org/2016/3/e80/ UR - http://dx.doi.org/10.2196/mhealth.5406 UR - http://www.ncbi.nlm.nih.gov/pubmed/27400806 ID - info:doi/10.2196/mhealth.5406 ER - TY - JOUR AU - Lwin, O. May AU - Vijaykumar, Santosh AU - Rathnayake, Sampath Vajira AU - Lim, Gentatsu AU - Panchapakesan, Chitra AU - Foo, Schubert AU - Wijayamuni, Ruwan AU - Wimalaratne, Prasad AU - Fernando, Newton Owen Noel PY - 2016/07/01 TI - A Social Media mHealth Solution to Address the Needs of Dengue Prevention and Management in Sri Lanka JO - J Med Internet Res SP - e149 VL - 18 IS - 7 KW - dengue KW - public health inspector KW - mhealth KW - social media KW - surveillance KW - needs assessment KW - prevention and management N2 - Background: Sri Lanka has witnessed a series of dengue epidemics over the past five years, with the western province, home to the political capital of Colombo, bearing more than half of the dengue burden. Existing dengue monitoring prevention programs are exhausted as public health inspectors (PHIs) cope with increasing workloads and paper-based modes of surveillance and education, characterizing a reactive system unable to cope with the enormity of the problem. On the other hand, the unprecedented proliferation and affordability of mobile phones since 2009 and a supportive political climate have thus far remained unexploited for the use of mobile-based interventions for dengue management. Objective: To conduct a needs assessment of PHIs in Colombo with respect to their dengue-related tasks and develop a new mobile-based system to address these needs while strengthening existing systems. Methods: One-on-one in-depth interviews were conducted with 29 PHIs to a) gain a nuanced, in-depth understanding of the current state of surveillance practices, b) understand the logistical, technological and social challenges they confront, and c) identify opportunities for mobile-based interventions. Quantitative analysis included simple descriptive statistics while qualitative analysis comprised textual analysis of 209 pages of transcripts (or nearly 600 minutes of conversations) using grounded theory approaches. Results: Current paper-based data collection practices for dengue surveillance involved a circuitous, time consuming process that could take between 7-10 days to officially report and record a single case. PHIs confronted challenges in terms of unreliable, standalone GIS devices, delays in registering mosquito breeding sites and lack of engagement from communities while delivering dengue education. These findings, in concert with a high motivation to use mobile-based systems, informed the development of Mo-Buzz, a mobile-based system that integrates three components ? digitized surveillance, dynamic disease mapping and digitized dengue education ? on a common platform. The system was developed through an iterative, evolutionary, collaborative process, consistent with the Spiral model of software development and is currently being used by all 55 PHIs in the CMC system. Conclusions: Given the entrenched nature of existing paper-based systems in PHIs? work habits, we expect a gradual adoption curve for Mo-Buzz in the future. Equally, we expect variable adoption of the system with respect to its specific components, and specific PHI sub-groups (younger versus older). The Mo-Buzz intervention is a response to multiple calls by the global mHealth community for collaborations in the area of mobile interventions for global health. Our experience revealed that the benefits of this paradigm lies in alleviating country-specific public health challenges through a commonly shared understanding of cultural mores, and sharing of knowledge and technologies. We call upon future researchers to further dissect the applicability of the Spiral Model of software development to mHealth interventions and contribute to the mHealth evidence debate from theoretical and applied perspectives. UR - http://www.jmir.org/2016/7/e149/ UR - http://dx.doi.org/10.2196/jmir.4657 UR - http://www.ncbi.nlm.nih.gov/pubmed/27369296 ID - info:doi/10.2196/jmir.4657 ER - TY - JOUR AU - Scott, D. Shannon AU - Albrecht, Lauren AU - Given, M. Lisa AU - Arseneau, Danielle AU - Klassen, P. Terry PY - 2016/06/29 TI - Feasibility of an Electronic Survey on iPads with In-Person Data Collectors for Data Collection with Health Care Professionals and Health Care Consumers in General Emergency Departments JO - JMIR Res Protoc SP - e139 VL - 5 IS - 2 KW - survey development KW - electronic survey KW - survey implementation KW - needs assessment KW - pediatric emergency medicine N2 - Background: Translating Emergency Knowledge for Kids was established to bridge the research-practice gap in pediatric emergency care by bringing the best evidence to Canadian general emergency departments (EDs). The first step in this process was to conduct a national needs assessment to determine the information needs and preferences of health professionals and parents in this clinical setting. Objective: To describe the development and implementation of two electronic surveys, and determine the feasibility of collecting electronic survey data on iPads with in-person data collectors in a busy clinical environment. Methods: Two descriptive surveys were conducted in 32 general EDs. Specific factors were addressed in four survey development and implementation stages: survey design, survey delivery, survey completion, and survey return. Feasibility of the data collection approach was determined by evaluating participation rates, completion rates, average survey time to completion, and usability of the platform. Usability was assessed with the in-person data collectors on five key variables: interactivity, portability, innovativeness, security, and proficiency. Results: Health professional participation rates (1561/2575, 60.62%) and completion rates (1471/1561, 94.23%) were strong. Parental participation rates (974/1099, 88.63%) and completion rates (897/974, 92.09%) were excellent. Mean time to survey completion was 28.08 minutes for health professionals and 43.23 minutes for parents. Data collectors rated the platform ?positively? to ?very positively? on all five usability variables. Conclusions: A number of design and implementation considerations were explored and integrated into this mixed-mode survey data collection approach. Feasibility was demonstrated by the robust survey participation and completion rates, reasonable survey completion times, and very positive usability evaluation results. UR - http://www.researchprotocols.org/2016/2/e139/ UR - http://dx.doi.org/10.2196/resprot.5170 UR - http://www.ncbi.nlm.nih.gov/pubmed/27358205 ID - info:doi/10.2196/resprot.5170 ER - TY - JOUR AU - Zarski, Anna-Carlotta AU - Lehr, Dirk AU - Berking, Matthias AU - Riper, Heleen AU - Cuijpers, Pim AU - Ebert, Daniel David PY - 2016/06/29 TI - Adherence to Internet-Based Mobile-Supported Stress Management: A Pooled Analysis of Individual Participant Data From Three Randomized Controlled Trials JO - J Med Internet Res SP - e146 VL - 18 IS - 6 KW - guidance KW - treatment adherence KW - predictors KW - Internet intervention KW - work-related stress KW - stress management N2 - Background: Nonadherence to treatment is a prevalent issue in Internet interventions. Guidance from health care professionals has been found to increase treatment adherence rates in Internet interventions for a range of physical and mental disorders. Evaluating different guidance formats of varying intensity is important, particularly with respect to improvement of effectiveness and cost-effectiveness. Identifying predictors of nonadherence allows for the opportunity to better adapt Internet interventions to the needs of participants especially at risk for discontinuing treatment. Objective: The goal of this study was to investigate the influence of different guidance formats (content-focused guidance, adherence-focused guidance, and administrative guidance) on adherence and to identify predictors of nonadherence in an Internet-based mobile-supported stress management intervention (ie, GET.ON Stress) for employees. Methods: The data from the groups who received the intervention were pooled from three randomized controlled trials (RCTs) that evaluated the efficacy of the same Internet-based mobile-supported stress management intervention (N=395). The RCTs only differed in terms of the guidance format (content-focused guidance vs waitlist control, adherence-focused guidance vs waitlist control, administrative guidance vs waitlist control). Adherence was defined by the number of completed treatment modules (0-7). An ANOVA was performed to compare the adherence rates from the different guidance formats. Multiple hierarchical linear regression analysis was conducted to evaluate predictors of nonadherence, which included gender, age, education, symptom-related factors, and hope for improvement. Results: In all, 70.5% (93/132) of the content-focused guidance sample, 68.9% (91/132) of the adherence-focused guidance sample, and 42.0% (55/131) of the participants in the administrative guidance sample completed all treatment modules. Guidance had a significant effect on treatment adherence (F2,392=11.64, P<.001; ?2=.05). Participants in the content-focused guidance (mean 5.70, SD 2.32) and adherence-focused guidance samples (mean 5.58, SD 2.33) completed significantly more modules than participants in the administrative guidance sample (mean 4.36, SD 2.78; t223=4.53, P<.001; r=.29). Content-focused guidance was not significantly associated with higher adherence compared to adherence-focused guidance (t262=0.42, P=.67; r=.03). The effect size of r=.03 (95% CI ?0.09 to 0.15) did not pass the equivalence margin of r=.20 and the upper bound of the 95% CI lay below the predefined margin, indicating equivalence between adherence-focused guidance and content-focused guidance. Beyond the influence of guidance, none of the predictors significantly predicted nonadherence. Conclusions: Guidance has been shown to be an influential factor in promoting adherence to an Internet-based mobile-supported stress management intervention. Adherence-focused guidance, which included email reminders and feedback on demand, was equivalent to content-focused guidance with regular feedback while requiring only approximately a quarter of the coaching resources. This could be a promising discovery in terms of cost-effectiveness. However, even after considering guidance, sociodemographic, and symptom-related characteristics, most interindividual differences in nonadherence remain unexplained. Clinical Trial: DRKS00004749; http://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL _ID=DRKS00004749 (Archived by WebCite at http://www.webcitation.org/6QiDk9Zn8); DRKS00005112; http://drks-neu.uniklinik-freiburg. de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005112 (Archived by WebCite at http://www.webcitation.org/6QiDysvev); DRKS00005384; http://drks-neu.uniklinik-freiburg.de/ drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005384 (Archived by WebCite at http://www.webcitation.org/6QiE0xcpE) UR - http://www.jmir.org/2016/6/e146/ UR - http://dx.doi.org/10.2196/jmir.4493 UR - http://www.ncbi.nlm.nih.gov/pubmed/27357528 ID - info:doi/10.2196/jmir.4493 ER - TY - JOUR AU - Brinker, Josef Titus AU - Seeger, Werner AU - Buslaff, Fabian PY - 2016/06/28 TI - Photoaging Mobile Apps in School-Based Tobacco Prevention: The Mirroring Approach JO - J Med Internet Res SP - e183 VL - 18 IS - 6 KW - tobacco KW - smoking KW - adolescents KW - photoaging KW - apps KW - secondary schools KW - adolescent smoking KW - tobacco prevention KW - smoking prevention KW - smoking cessation N2 - Background: Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous. Adolescent smoking can best be prevented through health education at schools. Interventions that take advantage of the broad availability of mobile phones as well as adolescents? interest in their appearance may be a novel way to improve prevention. Objective: In this first pilot study, we aimed to use mobile phone technology in accordance with the theory of planned behavior to improve school-based tobacco prevention. Methods: We used a free photoaging mobile phone app (?Smokerface?) in three German secondary schools via a novel method called mirroring. The students? altered three-dimensional selfies on mobile phones or tablets were ?mirrored? via a projector in front of their whole grade. Using an anonymous questionnaire, we then measured on a 5-point Likert scale the perceptions of the intervention among 125 students of both genders (average age 12.75 years). Results: A majority of the students perceived the intervention as fun (77/125, 61.6%), claimed that the intervention motivated them not to smoke (79/125, 63.2%), and stated that they learned new benefits of non-smoking (81/125, 64.8%). Only a minority of students disagreed or fully disagreed that they learned new benefits of non-smoking (16/125, 12.8%) or that they were themselves motivated not to smoke (18/125, 14.4%). Conclusions: We have presented a novel method to integrate photoaging in school-based tobacco prevention that affects student peer groups and considers the predictors of smoking in accordance with the theory of planned behavior. UR - http://www.jmir.org/2016/6/e183/ UR - http://dx.doi.org/10.2196/jmir.6016 UR - http://www.ncbi.nlm.nih.gov/pubmed/27352819 ID - info:doi/10.2196/jmir.6016 ER - TY - JOUR AU - Lord, Sarah AU - Moore, K. Sarah AU - Ramsey, Alex AU - Dinauer, Susan AU - Johnson, Kimberly PY - 2016/06/28 TI - Implementation of a Substance Use Recovery Support Mobile Phone App in Community Settings: Qualitative Study of Clinician and Staff Perspectives of Facilitators and Barriers JO - JMIR Ment Health SP - e24 VL - 3 IS - 2 KW - substance abuse KW - relapse prevention KW - mobile apps N2 - Background: Research supports the effectiveness of technology-based treatment approaches for substance use disorders. These approaches have the potential to broaden the reach of evidence-based care. Yet, there is limited understanding of factors associated with implementation of technology-based care approaches in different service settings. Objectives: In this study, we explored provider and staff perceptions of facilitators and barriers to implementation of a mobile phone substance use recovery support app with clients in 4 service settings. Methods: Interviews were conducted with leadership and provider stakeholders (N=12) from 4 agencies in the first year of an implementation trial of the mobile phone app. We used the Consolidated Framework for Implementation Research as the conceptual foundation for identifying facilitators and barriers to implementation. Results: Implementation process facilitators included careful planning of all aspects of implementation before launch, engaging a dedicated team to implement and foster motivation, working collaboratively with the app development team to address technical barriers and adapt the app to meet client and agency needs, and consistently reviewing app usage data to inform progress. Implementation support strategies included training all staff to promote organization awareness about the recovery support app and emphasize its priority as a clinical care tool, encouraging clients to try the technology before committing to use, scaling rollout to clients, setting clear expectations with clients about use of the app, and using peer coaches and consistent client-centered messaging to promote engagement. Perceived compatibility of the mobile phone app with agency and client needs and readiness to implement emerged as salient agency-level implementation facilitators. Facilitating characteristics of the recovery support app itself included evidence of its impact for recovery support, perceived relative advantage of the app over usual care, the ability to adapt the app to improve client use, and its ease of use. The mobile phone itself was a strong motivation for clients to opt in to use the app in settings that provided phones. App access was limited in settings that did not provide phones owing to lack of mobile phone ownership or incompatibility of the app with clients? mobile phones. Individual differences in technology literacy and provider beliefs about substance use care either facilitated or challenged implementation. Awareness of patient needs and resources facilitated implementation, whereas external policies and regulations regarding technology use introduced barriers to implementation. Conclusions: The conceptually grounded facilitators and barriers identified in this study can guide systematic targeting of strategies to improve implementation of mobile phone interventions in community treatment settings. Results also inform the design of technology-based therapeutic tools. This study highlights directions for research with regard to implementation of technology-based behavioral health care approaches. UR - http://mental.jmir.org/2016/2/e24/ UR - http://dx.doi.org/10.2196/mental.4927 UR - http://www.ncbi.nlm.nih.gov/pubmed/27352884 ID - info:doi/10.2196/mental.4927 ER - TY - JOUR AU - White, K. Becky AU - Martin, Annegret AU - White, A. James AU - Burns, K. Sharyn AU - Maycock, R. Bruce AU - Giglia, C. Roslyn AU - Scott, A. Jane PY - 2016/06/27 TI - Theory-Based Design and Development of a Socially Connected, Gamified Mobile App for Men About Breastfeeding (Milk Man) JO - JMIR Mhealth Uhealth SP - e81 VL - 4 IS - 2 KW - mHealth KW - smartphone KW - mobile phone KW - app KW - breastfeeding KW - fathers KW - gamification KW - social connectivity N2 - Background: Despite evidence of the benefits of breastfeeding, <15% of Australian babies are exclusively breastfed to the recommended 6 months. The support of the father is one of the most important factors in breastfeeding success, and targeting breastfeeding interventions to the father has been a successful strategy in previous research. Mobile technology offers unique opportunities to engage and reach populations to enhance health literacy and healthy behavior. Objective: The objective of our study was to use previous research, formative evaluation, and behavior change theory to develop the first evidence-based breastfeeding app targeted at men. We designed the app to provide men with social support and information aiming to increase the support men can offer their breastfeeding partners. Methods: We used social cognitive theory to design and develop the Milk Man app through stages of formative research, testing, and iteration. We held focus groups with new and expectant fathers (n=18), as well as health professionals (n=16), and used qualitative data to inform the design and development of the app. We tested a prototype with fathers (n=4) via a think-aloud study and the completion of the Mobile Application Rating Scale (MARS). Results: Fathers and health professionals provided input through the focus groups that informed the app development. The think-aloud walkthroughs identified 6 areas of functionality and usability to be addressed, including the addition of a tutorial, increased size of text and icons, and greater personalization. Testers rated the app highly, and the average MARS score for the app was 4.3 out of 5. Conclusions: To our knowledge, Milk Man is the first breastfeeding app targeted specifically at men. The development of Milk Man followed a best practice approach, including the involvement of a multidisciplinary team and grounding in behavior change theory. It tested well with end users during development. Milk Man is currently being trialed as part of the Parent Infant Feeding Initiative (ACTRN12614000605695). UR - http://mhealth.jmir.org/2016/2/e81/ UR - http://dx.doi.org/10.2196/mhealth.5652 UR - http://www.ncbi.nlm.nih.gov/pubmed/27349756 ID - info:doi/10.2196/mhealth.5652 ER - TY - JOUR AU - BinDhim, F. Nasser AU - Alanazi, M. Eman AU - Aljadhey, Hisham AU - Basyouni, H. Mada AU - Kowalski, R. Stefan AU - Pont, G. Lisa AU - Shaman, M. Ahmed AU - Trevena, Lyndal AU - Alhawassi, M. Tariq PY - 2016/06/27 TI - Does a Mobile Phone Depression-Screening App Motivate Mobile Phone Users With High Depressive Symptoms to Seek a Health Care Professional?s Help? JO - J Med Internet Res SP - e156 VL - 18 IS - 6 KW - mental health KW - depression KW - mobile phone KW - public health informatics KW - patients? screening N2 - Background: The objective of disease screening is to encourage high-risk subjects to seek health care diagnosis and treatment. Mobile phone apps can effectively screen mental health conditions, including depression. However, it is not known how effective such screening methods are in motivating users to discuss the obtained results of such apps with health care professionals. Does a mobile phone depression-screening app motivate users with high depressive symptoms to seek health care professional advice? This study aimed to address this question. Method: This was a single-cohort, prospective, observational study of a free mobile phone depression app developed in English and released on Apple?s App Store. Apple App Store users (aged 18 or above) in 5 countries, that is, Australia, Canada, New Zealand (NZ), the United Kingdom (UK), and the United States (US), were recruited directly via the app?s download page. The participants then completed the Patient Health Questionnaire (PHQ-9), and their depression screening score was displayed to them. If their score was 11 or above and they had never been diagnosed with depression before, they were advised to take their results to their health care professional. They were to follow up after 1 month. Results: A group of 2538 participants from the 5 countries completed PHQ-9 depression screening with the app. Of them, 322 participants were found to have high depressive symptoms and had never been diagnosed with depression, and received advice to discuss their results with health care professionals. About 74% of those completed the follow-up; approximately 38% of these self-reported consulting their health care professionals about their depression score. Only positive attitude toward depression as a real disease was associated with increased follow-up response rate (odds ratio (OR) 3.2, CI 1.38-8.29). Conclusions: A mobile phone depression-screening app motivated some users to seek a depression diagnosis. However, further study should investigate how other app users use the screening results provided by such apps. UR - http://www.jmir.org/2016/6/e156/ UR - http://dx.doi.org/10.2196/jmir.5726 UR - http://www.ncbi.nlm.nih.gov/pubmed/27349441 ID - info:doi/10.2196/jmir.5726 ER - TY - JOUR AU - Versluis, Anke AU - Verkuil, Bart AU - Spinhoven, Philip AU - van der Ploeg, M. Melanie AU - Brosschot, F. Jos PY - 2016/06/27 TI - Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis JO - J Med Internet Res SP - e152 VL - 18 IS - 6 KW - mHealth KW - ecological momentary intervention KW - mental health KW - anxiety KW - depression KW - stress KW - meta-analysis KW - systematic review N2 - Background: Mental health problems are highly prevalent, and there is need for the self-management of (mental) health. Ecological momentary interventions (EMIs) can be used to deliver interventions in the daily life of individuals using mobile devices. Objectives: The aim of this study was to systematically assess and meta-analyze the effect of EMI on 3 highly prevalent mental health outcomes (anxiety, depression, and perceived stress) and positive psychological outcomes (eg, acceptance). Methods: PsycINFO and Web of Science were searched for relevant publications, and the last search was done in September 2015. Three concepts were used to find publications: (1) mental health, (2) mobile phones, and (3) interventions. A total of 33 studies (using either a within- or between-subject design) including 43 samples that received an EMI were identified (n=1301), and relevant study characteristics were coded using a standardized form. Quality assessment was done with the Cochrane Collaboration tool. Results: Most of the EMIs focused on a clinical sample, used an active intervention (that offered exercises), and in over half of the studies, additional support by a mental health professional (MHP) was given. The EMI lasted on average 7.48 weeks (SD=6.46), with 2.80 training episodes per day (SD=2.12) and 108.25 total training episodes (SD=123.00). Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70). This effect did not differ as function of outcome type (ie, anxiety, depression, perceived stress, acceptance, relaxation, and quality of life). The only moderator for which the effect varied significantly was additional support by an MHP (MHP-supported EMI, g=0.73, 95% CI: 0.57-0.88; stand-alone EMI, g=0.45, 95% CI: 0.22-0.69; stand-alone EMI with access to care as usual, g=0.38, 95% CI: 0.11-0.64). In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57). Yet, these between-subject analyses were at risk for publication bias and were not suited for moderator analyses. Furthermore, the overall quality of the studies was relatively low. Conclusions: Results showed that there was a small to medium effect of EMIs on mental health and positive psychological well-being and that the effect was not different between outcome types. Moreover, the effect was larger with additional support by an MHP. Future randomized controlled trials are needed to further strengthen the results and to determine potential moderator variables. Overall, EMIs offer great potential for providing easy and cost-effective interventions to improve mental health and increase positive psychological well-being. UR - http://www.jmir.org/2016/6/e152/ UR - http://dx.doi.org/10.2196/jmir.5642 UR - http://www.ncbi.nlm.nih.gov/pubmed/27349305 ID - info:doi/10.2196/jmir.5642 ER - TY - JOUR AU - Spanakis, G. Emmanouil AU - Santana, Silvina AU - Tsiknakis, Manolis AU - Marias, Kostas AU - Sakkalis, Vangelis AU - Teixeira, António AU - Janssen, H. Joris AU - de Jong, Henri AU - Tziraki, Chariklia PY - 2016/06/24 TI - Technology-Based Innovations to Foster Personalized Healthy Lifestyles and Well-Being: A Targeted Review JO - J Med Internet Res SP - e128 VL - 18 IS - 6 KW - mHealth KW - eHealth KW - lifestyle KW - health promotion KW - health behavior KW - persuasive technologies KW - cloud computing KW - personalized health monitoring KW - interoperability KW - wellness programs N2 - Background: New community-based arrangements and novel technologies can empower individuals to be active participants in their health maintenance, enabling people to control and self-regulate their health and wellness and make better health- and lifestyle-related decisions. Mobile sensing technology and health systems responsive to individual profiles combined with cloud computing can expand innovation for new types of interoperable services that are consumer-oriented and community-based. This could fuel a paradigm shift in the way health care can be, or should be, provided and received, while lessening the burden on exhausted health and social care systems. Objective: Our goal is to identify and discuss the main scientific and engineering challenges that need to be successfully addressed in delivering state-of-the-art, ubiquitous eHealth and mHealth services, including citizen-centered wellness management services, and reposition their role and potential within a broader context of diverse sociotechnical drivers, agents, and stakeholders. Methods: We review the state-of-the-art relevant to the development and implementation of eHealth and mHealth services in critical domains. We identify and discuss scientific, engineering, and implementation-related challenges that need to be overcome to move research, development, and the market forward. Results: Several important advances have been identified in the fields of systems for personalized health monitoring, such as smartphone platforms and intelligent ubiquitous services. Sensors embedded in smartphones and clothes are making the unobtrusive recognition of physical activity, behavior, and lifestyle possible, and thus the deployment of platforms for health assistance and citizen empowerment. Similarly, significant advances are observed in the domain of infrastructure supporting services. Still, many technical problems remain to be solved, combined with no less challenging issues related to security, privacy, trust, and organizational dynamics. Conclusions: Delivering innovative ubiquitous eHealth and mHealth services, including citizen-centered wellness and lifestyle management services, goes well beyond the development of technical solutions. For the large-scale information and communication technology-supported adoption of healthier lifestyles to take place, crucial innovations are needed in the process of making and deploying usable empowering end-user services that are trusted and user-acceptable. Such innovations require multidomain, multilevel, transdisciplinary work, grounded in theory but driven by citizens? and health care professionals? needs, expectations, and capabilities and matched by business ability to bring innovation to the market. UR - http://www.jmir.org/2016/6/e128/ UR - http://dx.doi.org/10.2196/jmir.4863 UR - http://www.ncbi.nlm.nih.gov/pubmed/27342137 ID - info:doi/10.2196/jmir.4863 ER - TY - JOUR AU - Glasner-Edwards, Suzette AU - Patrick, Kevin AU - Ybarra, L. Michele AU - Reback, J. Cathy AU - Rawson, A. Richard AU - Chokron Garneau, Helene AU - Chavez, Kathryn AU - Venegas, Alexandra PY - 2016/06/24 TI - A Cognitive Behavioral Therapy?Based Text Messaging Intervention Versus Medical Management for HIV-Infected Substance Users: Study Protocol for a Pilot Randomized Trial JO - JMIR Res Protoc SP - e131 VL - 5 IS - 2 KW - SMS KW - medication adherence KW - HIV KW - relapse prevention KW - text messaging KW - CBT KW - ART N2 - Background: Evidence-based psychosocial interventions for addictions and related conditions such as cognitive behavioral therapy (CBT) are underutilized. Obstacles to implementation of CBT in clinical settings include limited availability of quality training, supervision, and certification in CBT for clinicians; high rates of clinician turnover and high caseloads; and limited qualifications of the workforce to facilitate CBT expertise. Objective: Mobile phone?based delivery of CBT, if demonstrated to be feasible and effective, could be transformative in broadening its application and improving the quality of addiction treatment. No experimental interventions that deliver CBT targeting both drug use and medication adherence using text messaging have been previously reported; as such, the objective of this study is to develop and test an SMS-based treatment program for HIV-positive adults with comorbid substance use disorders. Methods: With user input, we developed a 12-week CBT-based text messaging intervention (TXT-CBT) targeting antiretroviral (ART) adherence, risk behaviors, and drug use in a population of HIV-infected substance users. Results: The intervention has been developed and is presently being tested in a pilot randomized clinical trial. Results will be reported later this year. Conclusions: This investigation will yield valuable knowledge about the utility of a cost-effective, readily deployable text messaging behavioral intervention for HIV-infected drug users. UR - http://www.researchprotocols.org/2016/2/e131/ UR - http://dx.doi.org/10.2196/resprot.5407 UR - http://www.ncbi.nlm.nih.gov/pubmed/27341852 ID - info:doi/10.2196/resprot.5407 ER - TY - JOUR AU - Bell, Cameron AU - Guerinet, Julien AU - Atkinson, M. Katherine AU - Wilson, Kumanan PY - 2016/06/23 TI - Feasibility and Limitations of Vaccine Two-Dimensional Barcoding Using Mobile Devices JO - J Med Internet Res SP - e143 VL - 18 IS - 6 KW - vaccines KW - feasibility studies KW - immunization KW - automatic data processing KW - cell phones KW - vaccinations/standards N2 - Background: Two-dimensional (2D) barcoding has the potential to enhance documentation of vaccine encounters at the point of care. However, this is currently limited to environments equipped with dedicated barcode scanners and compatible record systems. Mobile devices may present a cost-effective alternative to leverage 2D vaccine vial barcodes and improve vaccine product-specific information residing in digital health records. Objective: Mobile devices have the potential to capture product-specific information from 2D vaccine vial barcodes. We sought to examine the feasibility, performance, and potential limitations of scanning 2D barcodes on vaccine vials using 4 different mobile phones. Methods: A unique barcode scanning app was developed for Android and iOS operating systems. The impact of 4 variables on the scan success rate, data accuracy, and time to scan were examined: barcode size, curvature, fading, and ambient lighting conditions. Two experimenters performed 4 trials 10 times each, amounting to a total of 2160 barcode scan attempts. Results: Of the 1832 successful scans performed in this evaluation, zero produced incorrect data. Five-millimeter barcodes were the slowest to scan, although only by 0.5 seconds on average. Barcodes with up to 50% fading had a 100% success rate, but success rate deteriorated beyond 60% fading. Curved barcodes took longer to scan compared with flat, but success rate deterioration was only observed at a vial diameter of 10 mm. Light conditions did not affect success rate or scan time between 500 lux and 20 lux. Conditions below 20 lux impeded the device?s ability to scan successfully. Variability in scan time was observed across devices in all trials performed. Conclusions: 2D vaccine barcoding is possible using mobile devices and is successful under the majority of conditions examined. Manufacturers utilizing 2D barcodes should take into consideration the impact of factors that limit scan success rates. Future studies should evaluate the effect of mobile barcoding on workflow and vaccine administrator acceptance. UR - http://www.jmir.org/2016/6/e143/ UR - http://dx.doi.org/10.2196/jmir.5591 UR - http://www.ncbi.nlm.nih.gov/pubmed/27339043 ID - info:doi/10.2196/jmir.5591 ER - TY - JOUR AU - Rospo, Gianluca AU - Valsecchi, Viola AU - Bonomi, G. Alberto AU - Thomassen, WJ Inge AU - van Dantzig, Saskia AU - La Torre, Antonio AU - Sartor, Francesco PY - 2016/06/23 TI - Cardiorespiratory Improvements Achieved by American College of Sports Medicine?s Exercise Prescription Implemented on a Mobile App JO - JMIR Mhealth Uhealth SP - e77 VL - 4 IS - 2 KW - cardio-respiratory fitness KW - ACSM guidelines KW - physical activity KW - mobile app N2 - Background: Strong evidence shows that an increase in cardiorespiratory fitness (CRF) and physical activity (PA) reduces cardiovascular disease risk. Objective: To test whether a scientifically endorsed program to increase CRF and PA, implemented on an easy-to-use, always-accessible mobile app would be effective in improving CRF. Methods: Of 63 healthy volunteers participating, 18 tested the user interface of the Cardio-Fitness App (CF-App); and 45 underwent a 2-week intervention period, of whom 33 eventually concluded it. These were assigned into three groups. The Step-based App (Step-App) group (n=8), followed 10,000 steps/day prescription, the CF-App group (n=13), and the Supervised Cardio-Fitness (Super-CF) group (n=12), both followed a heart rate (HR)-based program according to American College of Sports Medicine (ACSM) guidelines, but either implemented on the app, or at the gym, respectively. Participants were tested for CRF, PA, resting systolic and diastolic blood pressures (SBP, DBP), resting, exercise, and recovery HR. Results: CRF increased in all groups (+4.9%; P<.001). SBP decreased in all groups (-2.6 mm Hg; P=.03). DBP decrease was higher in the Super-CF group (-3.5 mm Hg) than in the Step-App group (-2.1 mm Hg; P<.001). Posttest exercise HR decreased in all groups (-3.4 bpm; P=.02). Posttest recovery HR was lower in the Super-CF group (-10.1 bpm) than in the other two groups (CF-App: -4.9 bpm, Step-App: -3.3 bpm; P<.001). The CF-App group, however, achieved these improvements with more training heart beats (P<.01). Conclusions: A 10,000 steps/day target-based app improved CRF similar to an ACSM guideline-based program whether it was implemented on a mobile app or in supervised gym sessions. UR - http://mhealth.jmir.org/2016/2/e77/ UR - http://dx.doi.org/10.2196/mhealth.5518 UR - http://www.ncbi.nlm.nih.gov/pubmed/27339153 ID - info:doi/10.2196/mhealth.5518 ER - TY - JOUR AU - Kim, Young Ju AU - Wineinger, E. Nathan AU - Steinhubl, R. Steven PY - 2016/06/22 TI - The Influence of Wireless Self-Monitoring Program on the Relationship Between Patient Activation and Health Behaviors, Medication Adherence, and Blood Pressure Levels in Hypertensive Patients: A Substudy of a Randomized Controlled Trial JO - J Med Internet Res SP - e116 VL - 18 IS - 6 KW - patient participation KW - blood pressure self-monitoring KW - wireless technology KW - telemedicine KW - health behavior KW - medication adherence N2 - Background: Active engagement in the management of hypertension is important in improving self-management behaviors and clinical outcomes. Mobile phone technology using wireless monitoring tools are now widely available to help individuals monitor their blood pressure, but little is known about the conditions under which such technology can effect positive behavior changes or clinical outcomes. Objective: To study the influence of wireless self-monitoring program and patient activation measures on health behaviors, medication adherence, and blood pressure levels as well as control of blood pressure in hypertensive patients. Methods: We examined a subset of 95 hypertensive participants from a 6-month randomized controlled trial designed to determine the utility of a wireless self-monitoring program (n=52 monitoring program, n=43 control), which consisted of a blood pressure monitoring device connected with a mobile phone, reminders for self-monitoring, a Web-based disease management program, and a mobile app for monitoring and education, compared with the control group receiving a standard disease management program. Study participants provided measures of patient activation, health behaviors including smoking, drinking, and exercise, medication adherence, and blood pressure levels. We assessed the influence of wireless self-monitoring as a moderator of the relationship between patient activation and health behaviors, medication adherence, and control of blood pressure. Results: Improvements in patient activation were associated with improvements in cigarette smoking (beta=?0.46, P<.001) and blood pressure control (beta=0.04, P=.02). This relationship was further strengthened in reducing cigarettes (beta=?0.60, P<.001), alcohol drinking (beta=?0.26, P=.01), and systolic (beta=?0.27, P=.02) and diastolic blood pressure (beta=?0.34, P=.007) at 6 months among individuals participating in the wireless self-monitoring program. No differences were observed with respect to medication adherence. Conclusions: Participation in a wireless self-monitoring program provides individuals motivated to improve their health management with an added benefit above and beyond that of motivation alone. Hypertensive individuals eager to change health behaviors are excellent candidates for mobile health self-monitoring.. Trial Registration: ClinicalTrials.gov NCT01975428, https://clinicaltrials.gov/ct2/show/NCT01975428 (Archived by WebCite at http://www.webcitation.org/6iSO5OgOG) UR - http://www.jmir.org/2016/6/e116/ UR - http://dx.doi.org/10.2196/jmir.5429 UR - http://www.ncbi.nlm.nih.gov/pubmed/27334418 ID - info:doi/10.2196/jmir.5429 ER - TY - JOUR AU - Suffoletto, Brian AU - Kristan, Jeffrey AU - Person Mecca, Laurel AU - Chung, Tammy AU - Clark, B. Duncan PY - 2016/06/22 TI - Optimizing a Text Message Intervention to Reduce Heavy Drinking in Young Adults: Focus Group Findings JO - JMIR Mhealth Uhealth SP - e73 VL - 4 IS - 2 KW - alcohol KW - young adult KW - text messages KW - qualitative N2 - Background: Recent trial results show that an interactive short message service (SMS) text message intervention, Texting to Reduce Alcohol Consumption (TRAC), is effective in reducing heavy drinking in non-treatment-seeking young adults, but may not be optimized. Objective: To assess the usability of the TRAC intervention among young adults in an effort to optimize future intervention design. Methods: We conducted five focus groups with 18 young adults, aged 18-25 years, who had a history of heavy drinking and had been randomized to 12 weeks of the TRAC intervention as part of a clinical trial. A trained moderator followed a semistructured interview guide. Focus groups were audiotaped, transcribed, and analyzed to identify themes. Results: We identified four themes regarding user experiences with the TRAC intervention: (1) ease of use, (2) comfort and confidentiality, (3) increased awareness of drinking behavior, and (4) accountability for drinking behavior. Participants? comments supported the existing features of the TRAC intervention, as well as the addition of other features to increase personalization and continuing engagement with the intervention. Conclusions: Young adults perceived the TRAC intervention as a useful way to help them reduce heavy drinking on weekends. Components that promote ease of use, ensure confidentiality, increase awareness of alcohol consumption, and increase accountability were seen as important. UR - http://mhealth.jmir.org/2016/2/e73/ UR - http://dx.doi.org/10.2196/mhealth.5330 UR - http://www.ncbi.nlm.nih.gov/pubmed/27335099 ID - info:doi/10.2196/mhealth.5330 ER - TY - JOUR AU - Allman-Farinelli, Margaret AU - Partridge, Ruth Stephanie AU - McGeechan, Kevin AU - Balestracci, Kate AU - Hebden, Lana AU - Wong, Annette AU - Phongsavan, Philayrath AU - Denney-Wilson, Elizabeth AU - Harris, F. Mark AU - Bauman, Adrian PY - 2016/06/22 TI - A Mobile Health Lifestyle Program for Prevention of Weight Gain in Young Adults (TXT2BFiT): Nine-Month Outcomes of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e78 VL - 4 IS - 2 KW - young adult KW - weight gain prevention KW - mHealth KW - telehealth KW - fruit KW - vegetables KW - take-out foods KW - sugar-sweetened beverages KW - physical activity N2 - Background: The unprecedented rise in obesity among young adults, who have limited interaction with health services, has not been successfully abated. Objective: The objective of this study was to assess the maintenance outcomes of a 12-week mHealth intervention on prevention of weight gain in young adults and lifestyle behaviors at 9 months from baseline. Methods: A two-arm, parallel, randomized controlled trial (RCT) with subjects allocated to intervention or control 1:1 was conducted in a community setting in Greater Sydney, Australia. From November 2012 to July 2014, 18- to 35-year-old overweight individuals with a body mass index (BMI) of 25-31.99 kg/m2 and those with a BMI ? 23 kg/m2 and a self-reported weight gain of ? 2 kg in the past 12 months were recruited. A 12-week mHealth program ?TXT2BFiT? was administered to the intervention arm. This included 5 coaching calls, 96 text messages, 12 emails, apps, and downloadable resources from the study website. Lifestyle behaviors addressed were intake of fruits, vegetables, sugar-sweetened beverages (SSBs), take-out meals, and physical activity. The control group received 1 phone call to introduce them to study procedures and 4 text messages over 12 weeks. After 12 weeks, the intervention arm received 2 further coaching calls, 6 text messages, and 6 emails with continued access to the study website during 6-month follow-up. Control arm received no further contact. The primary outcome was weight change (kg) with weight measured at baseline and at 12 weeks and self-report at baseline, 12 weeks, and 9 months. Secondary outcomes were change in physical activity (metabolic equivalent of task, MET-mins) and categories of intake for fruits, vegetables, SSBs, and take-out meals. These were assessed via Web-based surveys. Results: Two hundred and fifty young adults enrolled in the RCT. Intervention participants weighed less at 12 weeks compared with controls (model ?=?3.7, 95% CI ?6.1 to ?1.3) and after 9 months (model ?=? 4.3, 95% CI ? 6.9 to ? 1.8). No differences in physical activity were found but all diet behaviors showed that the intervention group, compared with controls at 9 months, had greater odds of meeting recommendations for fruits (OR 3.83, 95% CI 2.10-6.99); for vegetables (OR 2.42, 95% CI 1.32-4.44); for SSB (OR 3.11, 95% CI 1.47-6.59); and for take-out meals (OR 1.88, 95% CI 1.07-3.30). Conclusions: Delivery of an mHealth intervention for prevention of weight gain resulted in modest weight loss at 12 weeks with further loss at 9 months in 18- to 35-year-olds. Although there was no evidence of change in physical activity, improvements in dietary behaviors occurred, and were maintained at 9 months. Owing to its scalable potential for widespread adoption, replication trials should be conducted in diverse populations of overweight young adults. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000924853; (Archived by WebCite at http://www.webcitation.org/6i6iRag55) UR - http://mhealth.jmir.org/2016/2/e78/ UR - http://dx.doi.org/10.2196/mhealth.5768 UR - http://www.ncbi.nlm.nih.gov/pubmed/27335237 ID - info:doi/10.2196/mhealth.5768 ER - TY - JOUR AU - Walter, Michael Benjamin AU - Klare, Peter AU - Neu, Bruno AU - Schmid, M. Roland AU - von Delius, Stefan PY - 2016/06/21 TI - Development and Testing of an Automated 4-Day Text Messaging Guidance as an Aid for Improving Colonoscopy Preparation JO - JMIR Mhealth Uhealth SP - e75 VL - 4 IS - 2 KW - short message service KW - patient education KW - colonoscopy KW - colonoscopy preparation N2 - Background: In gastroenterology a sufficient colon cleansing improves adenoma detection rate and prevents the need for preterm repeat colonoscopies due to invalid preparation. It has been shown that patient education is of major importance for improvement of colon cleansing. Objective: Objective of this study was to assess the function of an automated text messaging (short message service, SMS)?supported colonoscopy preparation starting 4 days before colonoscopy appointment. Methods: After preevaluation to assess mobile phone usage in the patient population for relevance of this approach, a Web-based, automated SMS text messaging system was developed, following which a single-center feasibility study at a tertiary care center was performed. Patients scheduled for outpatient colonoscopy were invited to participate. Patients enrolled in the study group received automated information about dietary recommendations and bowel cleansing during colonoscopy preparation. Data of outpatient colonoscopies with regular preparation procedure were used for pair matching and served as control. Primary end point was feasibility of SMS text messaging support in colonoscopy preparation assessed as stable and satisfactory function of the system. Secondary end points were quality of bowel preparation according to the Boston Bowel Preparation Scale (BBPS) and patient satisfaction with SMS text messaging?provided information assessed by a questionnaire. Results: Web-based SMS text messaging?supported colonoscopy preparation was successful and feasible in 19 of 20 patients. Mean (standard error of the mean, SEM) total BBPS score was slightly higher in the SMS group than in the control group (7.3, SEM 0.3 vs 6.4, SEM 0.2) and for each colonic region (left, transverse, and right colon). Patient satisfaction regarding SMS text messaging?based information was high. Conclusions: Using SMS for colonoscopy preparation with 4 days? guidance including dietary recommendation is a new approach to improve colonoscopy preparation. Quality of colonoscopy preparation was sufficient and patients were highly satisfied with the system during colonoscopy preparation. UR - http://mhealth.jmir.org/2016/2/e75/ UR - http://dx.doi.org/10.2196/mhealth.5289 UR - http://www.ncbi.nlm.nih.gov/pubmed/27329204 ID - info:doi/10.2196/mhealth.5289 ER - TY - JOUR AU - Voth, C. Elizabeth AU - Oelke, D. Nelly AU - Jung, E. Mary PY - 2016/06/15 TI - A Theory-Based Exercise App to Enhance Exercise Adherence: A Pilot Study JO - JMIR mHealth uHealth SP - e62 VL - 4 IS - 2 KW - exercise KW - mHealth KW - app KW - self-monitoring KW - behavior change KW - social cognitive theory N2 - Background: Use of mobile health (mHealth) technology is on an exponential rise. mHealth apps have the capability to reach a large number of individuals, but until now have lacked the integration of evidence-based theoretical constructs to increase exercise behavior in users. Objective: The purpose of this study was to assess the effectiveness of a theory-based, self-monitoring app on exercise and self-monitoring behavior over 8 weeks. Methods: A total of 56 adults (mean age 40 years, SD 13) were randomly assigned to either receive the mHealth app (experimental; n=28) or not to receive the app (control; n=28). All participants engaged in an exercise goal-setting session at baseline. Experimental condition participants received weekly short message service (SMS) text messages grounded in social cognitive theory and were encouraged to self-monitor exercise bouts on the app on a daily basis. Exercise behavior, frequency of self-monitoring exercise behavior, self-efficacy to self-monitor, and self-management of exercise behavior were collected at baseline and at postintervention. Results: Engagement in exercise bouts was greater in the experimental condition (mean 7.24, SD 3.40) as compared to the control condition (mean 4.74, SD 3.70, P=.03, d=0.70) at week 8 postintervention. Frequency of self-monitoring increased significantly over the 8-week investigation between the experimental and control conditions (P<.001, partial ?2=.599), with participants in the experimental condition self-monitoring significantly more at postintervention (mean 6.00, SD 0.93) in comparison to those in the control condition (mean 1.95, SD 2.58, P<.001, d=2.10). Self-efficacy to self-monitor and perceived self-management of exercise behavior were unaffected by this intervention. Conclusions: The successful integration of social cognitive theory into an mHealth exercise self-monitoring app provides support for future research to feasibly integrate theoretical constructs into existing exercise apps. In addition, findings provide preliminary support for theory-based apps to increase self-monitoring and exercise behavior in comparison to a control, no-app condition. UR - http://mhealth.jmir.org/2016/2/e62/ UR - http://dx.doi.org/10.2196/mhealth.4997 UR - http://www.ncbi.nlm.nih.gov/pubmed/27307134 ID - info:doi/10.2196/mhealth.4997 ER - TY - JOUR AU - Serrano, J. Katrina AU - Yu, Mandi AU - Coa, I. Kisha AU - Collins, M. Linda AU - Atienza, A. Audie PY - 2016/06/14 TI - Mining Health App Data to Find More and Less Successful Weight Loss Subgroups JO - J Med Internet Res SP - e154 VL - 18 IS - 6 KW - weight loss KW - mobile health KW - mobile app KW - data mining KW - classification N2 - Background: More than half of all smartphone app downloads involve weight, diet, and exercise. If successful, these lifestyle apps may have far-reaching effects for disease prevention and health cost-savings, but few researchers have analyzed data from these apps. Objective: The purposes of this study were to analyze data from a commercial health app (Lose It!) in order to identify successful weight loss subgroups via exploratory analyses and to verify the stability of the results. Methods: Cross-sectional, de-identified data from Lose It! were analyzed. This dataset (n=12,427,196) was randomly split into 24 subsamples, and this study used 3 subsamples (combined n=972,687). Classification and regression tree methods were used to explore groupings of weight loss with one subsample, with descriptive analyses to examine other group characteristics. Data mining validation methods were conducted with 2 additional subsamples. Results: In subsample 1, 14.96% of users lost 5% or more of their starting body weight. Classification and regression tree analysis identified 3 distinct subgroups: ?the occasional users? had the lowest proportion (4.87%) of individuals who successfully lost weight; ?the basic users? had 37.61% weight loss success; and ?the power users? achieved the highest percentage of weight loss success at 72.70%. Behavioral factors delineated the subgroups, though app-related behavioral characteristics further distinguished them. Results were replicated in further analyses with separate subsamples. Conclusions: This study demonstrates that distinct subgroups can be identified in ?messy? commercial app data and the identified subgroups can be replicated in independent samples. Behavioral factors and use of custom app features characterized the subgroups. Targeting and tailoring information to particular subgroups could enhance weight loss success. Future studies should replicate data mining analyses to increase methodology rigor. UR - http://www.jmir.org/2016/6/e154/ UR - http://dx.doi.org/10.2196/jmir.5473 UR - http://www.ncbi.nlm.nih.gov/pubmed/27301853 ID - info:doi/10.2196/jmir.5473 ER - TY - JOUR AU - Masterson Creber, M. Ruth AU - Maurer, S. Mathew AU - Reading, Meghan AU - Hiraldo, Grenny AU - Hickey, T. Kathleen AU - Iribarren, Sarah PY - 2016/06/14 TI - Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS) JO - JMIR Mhealth Uhealth SP - e74 VL - 4 IS - 2 KW - mobile apps KW - mobile health KW - heart failure KW - self-care KW - self-management KW - review KW - symptom assessment KW - nursing informatics N2 - Background: Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. Objective: The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. Methods: We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, ?heart failure,? ?cardiology,? ?heart failure and self-management?). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Results: Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. Conclusions: This review suggests that few apps meet prespecified criteria for quality, content, or functionality, highlighting the need for further refinement and mapping to evidence-based guidelines and room for overall quality improvement in heart failure symptom monitoring and self-care related apps. UR - http://mhealth.jmir.org/2016/2/e74/ UR - http://dx.doi.org/10.2196/mhealth.5882 UR - http://www.ncbi.nlm.nih.gov/pubmed/27302310 ID - info:doi/10.2196/mhealth.5882 ER - TY - JOUR AU - Wijsman, W. Liselotte AU - Richard, Edo AU - Cachucho, Ricardo AU - de Craen, JM Anton AU - Jongstra, Susan AU - Mooijaart, P. Simon PY - 2016/06/13 TI - Evaluation of the Use of Home Blood Pressure Measurement Using Mobile Phone-Assisted Technology: The iVitality Proof-of-Principle Study JO - JMIR Mhealth Uhealth SP - e67 VL - 4 IS - 2 KW - mobile phone KW - home-based measurements KW - hypertension KW - dementia N2 - Background: Mobile phone-assisted technologies provide the opportunity to optimize the feasibility of long-term blood pressure (BP) monitoring at home, with the potential of large-scale data collection. Objective: In this proof-of-principle study, we evaluated the feasibility of home BP monitoring using mobile phone-assisted technology, by investigating (1) the association between study center and home BP measurements; (2) adherence to reminders on the mobile phone to perform home BP measurements; and (3) referrals, treatment consequences and BP reduction after a raised home BP was diagnosed. Methods: We used iVitality, a research platform that comprises a Website, a mobile phone-based app, and health sensors, to measure BP and several other health characteristics during a 6-month period. BP was measured twice at baseline at the study center. Home BP was measured on 4 days during the first week, and thereafter, at semimonthly or monthly intervals, for which participants received reminders on their mobile phone. In the monthly protocol, measurements were performed during 2 consecutive days. In the semimonthly protocol, BP was measured at 1 day. Results: We included 151 participants (mean age [standard deviation] 57.3 [5.3] years). BP measured at the study center was systematically higher when compared with home BP measurements (mean difference systolic BP [standard error] 8.72 [1.08] and diastolic BP 5.81 [0.68] mm Hg, respectively). Correlation of study center and home measurements of BP was high (R=0.72 for systolic BP and 0.72 for diastolic BP, both P<.001). Adherence was better in participants measuring semimonthly (71.4%) compared with participants performing monthly measurements (64.3%, P=.008). During the study, 41 (27.2%) participants were referred to their general practitioner because of a high BP. Referred participants had a decrease in their BP during follow-up (mean difference final and initial [standard error] ?5.29 [1.92] for systolic BP and ?2.93 [1.08] for diastolic BP, both P<.05). Conclusion: Mobile phone-assisted technology is a reliable and promising method with good adherence to measure BP at home during a 6-month period. This provides a possibility for implementation in large-scale studies and can potentially contribute to BP reduction. UR - http://mhealth.jmir.org/2016/2/e67/ UR - http://dx.doi.org/10.2196/mhealth.5485 UR - http://www.ncbi.nlm.nih.gov/pubmed/27296628 ID - info:doi/10.2196/mhealth.5485 ER - TY - JOUR AU - Stoyanov, R. Stoyan AU - Hides, Leanne AU - Kavanagh, J. David AU - Wilson, Hollie PY - 2016/06/10 TI - Development and Validation of the User Version of the Mobile Application Rating Scale (uMARS) JO - JMIR Mhealth Uhealth SP - e72 VL - 4 IS - 2 KW - MARS KW - mHealth KW - eHealth KW - app evaluation KW - end user KW - app trial KW - mhealth trial KW - user testing KW - mobile application KW - app rating KW - reliability KW - mobile health KW - well being KW - mental health KW - smartphone KW - cellphone KW - telemedicine KW - emental health KW - e-therapy KW - Internet KW - online KW - cognitive behavioral therapy KW - anxiety KW - anxiety disorders KW - depression KW - depressive disorder KW - Australia KW - research translation KW - evidence-informed KW - mHealth implementation KW - mHealth evaluation KW - randomized controlled trial KW - RCT N2 - Background: The Mobile Application Rating Scale (MARS) provides a reliable method to assess the quality of mobile health (mHealth) apps. However, training and expertise in mHealth and the relevant health field is required to administer it. Objective: This study describes the development and reliability testing of an end-user version of the MARS (uMARS). Methods: The MARS was simplified and piloted with 13 young people to create the uMARS. The internal consistency and test-retest reliability of the uMARS was then examined in a second sample of 164 young people participating in a randomized controlled trial of a mHealth app. App ratings were collected using the uMARS at 1-, 3,- and 6-month follow up. Results: The uMARS had excellent internal consistency (alpha = .90), with high individual alphas for all subscales. The total score and subscales had good test-retest reliability over both 1-2 months and 3 months. Conclusions: The uMARS is a simple tool that can be reliably used by end-users to assess the quality of mHealth apps. UR - http://mhealth.jmir.org/2016/2/e72/ UR - http://dx.doi.org/10.2196/mhealth.5849 UR - http://www.ncbi.nlm.nih.gov/pubmed/27287964 ID - info:doi/10.2196/mhealth.5849 ER - TY - JOUR AU - Berrouiguet, Sofian AU - Baca-García, Enrique AU - Brandt, Sara AU - Walter, Michel AU - Courtet, Philippe PY - 2016/06/10 TI - Fundamentals for Future Mobile-Health (mHealth): A Systematic Review of Mobile Phone and Web-Based Text Messaging in Mental Health JO - J Med Internet Res SP - e135 VL - 18 IS - 6 KW - text messaging KW - cell phones KW - mental health KW - Internet KW - medical informatics N2 - Background: Mobile phone text messages (short message service, SMS) are used pervasively as a form of communication. Almost 100% of the population uses text messaging worldwide and this technology is being suggested as a promising tool in psychiatry. Text messages can be sent either from a classic mobile phone or a web-based application. Reviews are needed to better understand how text messaging can be used in mental health care and other fields of medicine. Objective: The objective of the study was to review the literature regarding the use of mobile phone text messaging in mental health care. Methods: We conducted a thorough literature review of studies involving text messaging in health care management. Searches included PubMed, PsycINFO, Cochrane, Scopus, Embase and Web of Science databases on May 25, 2015. Studies reporting the use of text messaging as a tool in managing patients with mental health disorders were included. Given the heterogeneity of studies, this review was summarized using a descriptive approach. Results: From 677 initial citations, 36 studies were included in the review. Text messaging was used in a wide range of mental health situations, notably substance abuse (31%), schizophrenia (22%), and affective disorders (17%). We identified four ways in which text messages were used: reminders (14%), information (17%), supportive messages (42%), and self-monitoring procedures (42%). Applications were sometimes combined. Conclusions: We report growing interest in text messaging since 2006. Text messages have been proposed as a health care tool in a wide spectrum of psychiatric disorders including substance abuse, schizophrenia, affective disorders, and suicide prevention. Most papers described pilot studies, while some randomized clinical trials (RCTs) were also reported. Overall, a positive attitude toward text messages was reported. RCTs reported improved treatment adherence and symptom surveillance. Other positive points included an increase in appointment attendance and in satisfaction with management and health care services. Insight into message content, preventative strategies, and innovative approaches derived from the mental health field may be applicable in other medical specialties. UR - http://www.jmir.org/2016/6/e135/ UR - http://dx.doi.org/10.2196/jmir.5066 UR - http://www.ncbi.nlm.nih.gov/pubmed/27287668 ID - info:doi/10.2196/jmir.5066 ER - TY - JOUR AU - Elbert, Pietertje Sarah AU - Dijkstra, Arie AU - Oenema, Anke PY - 2016/06/10 TI - A Mobile Phone App Intervention Targeting Fruit and Vegetable Consumption: The Efficacy of Textual and Auditory Tailored Health Information Tested in a Randomized Controlled Trial JO - J Med Internet Res SP - e147 VL - 18 IS - 6 KW - mobile phone app KW - health behavior KW - fruit and vegetable intake KW - persuasive communication KW - communication modality KW - audio KW - intervention study N2 - Background: Mobile phone apps are increasingly used to deliver health interventions, which provide the opportunity to present health information via different communication modes. However, scientific evidence regarding the effects of such health apps is scarce. Objective: In a randomized controlled trial, we tested the efficacy of a 6-month intervention delivered via a mobile phone app that communicated either textual or auditory tailored health information aimed at stimulating fruit and vegetable intake. A control condition in which no health information was given was added. Perceived own health and health literacy were included as moderators to assess for which groups the interventions could possibly lead to health behavior change. Methods: After downloading the mobile phone app, respondents were exposed monthly to either text-based or audio-based tailored health information and feedback over a period of 6 months via the mobile phone app. In addition, respondents in the control condition only completed the baseline and posttest measures. Within a community sample (online recruitment), self-reported fruit and vegetable intake at 6-month follow-up was our primary outcome measure. Results: In total, 146 respondents (ranging from 40 to 58 per condition) completed the study (attrition rate 55%). A significant main effect of condition was found on fruit intake (P=.049, partial ?2=0.04). A higher fruit intake was found after exposure to the auditory information, especially in recipients with a poor perceived own health (P=.003, partial ?2=0.08). In addition, health literacy moderated the effect of condition on vegetable intake 6 months later (P<.001, partial ?2=.11). A higher vegetable intake was found for recipients with high health literacy after exposure to the textual or auditory intervention compared to the control condition (contrasts P=.07 and P=.004, respectively). In the case of relatively low health literacy, vegetable intake was the highest in the control condition (contrasts text control: P=.03; audio control: P=.04). Conclusions: This study provides evidence-based insight into the effects of a mobile health app. The app seems to have the potential to change fruit and vegetable intake up to 6 months later, at least for specific groups. We found different effects for fruit and vegetable intake, respectively, suggesting that different underlying psychological mechanisms are associated with these specific behaviors. Based on our results, it seems worthwhile to investigate additional ways to increase fruit and vegetable intake in recipients with low health literacy. ClinicalTrial: International Standard Randomized Controlled Trial Number (ISRCTN): 23466915; http://www.isrctn.com/ISRCTN23466915 (Archived by WebCite at http://www.webcitation.org/6hTtfSvaz) UR - http://www.jmir.org/2016/6/e147/ UR - http://dx.doi.org/10.2196/jmir.5056 UR - http://www.ncbi.nlm.nih.gov/pubmed/27287823 ID - info:doi/10.2196/jmir.5056 ER - TY - JOUR AU - Drott, Jenny AU - Vilhelmsson, Maria AU - Kjellgren, Karin AU - Berterö, Carina PY - 2016/06/09 TI - Experiences With a Self-Reported Mobile Phone-Based System Among Patients With Colorectal Cancer: A Qualitative Study JO - JMIR Mhealth Uhealth SP - e66 VL - 4 IS - 2 KW - cancer KW - conventional content analysis KW - informatics technology systems KW - mHealth KW - self-reported mobile phone-based system KW - symptom monitoring N2 - Background: In cancer care, mobile phone-based systems are becoming more widely used in the assessment, monitoring, and management of side effects. Objective: To explore the experiences of patients with colorectal cancer on using a mobile phone-based system for reporting neurotoxic side effects. Methods: Eleven patients were interviewed (ages 44-68 years). A semistructured interview guide was used to perform telephone interviews. The interviews were transcribed verbatim and analyzed with qualitative content analysis. Results: The patients' experiences of using a mobile phone-based system were identified and constructed as: ?being involved,? ?pacing oneself,? and ?managing the questions.? ?Being involved? refers to their individual feelings. Patients were participating in their own care by being observant of the side effects they were experiencing. They were aware that the answers they gave were monitored in real time and taken into account by health care professionals when planning further treatment. ?Pacing oneself? describes how the patients can have an impact on the time and place they choose to answer the questions. Answering the questionnaire was easy, and despite the substantial number of questions, it was quickly completed. ?Managing the questions? pointed out that the patients needed to be observant because of the construction of the questions. They could not routinely answer all the questions. Patients understood that side effects can vary during the cycles of treatment and need to be assessed repeatedly during treatment. Conclusions: This mobile phone-based system reinforced the patients? feeling of involvement in their own care. The patients were comfortable with the technology and appreciated that the system was not time consuming. UR - http://mhealth.jmir.org/2016/2/e66/ UR - http://dx.doi.org/10.2196/mhealth.5426 UR - http://www.ncbi.nlm.nih.gov/pubmed/27282257 ID - info:doi/10.2196/mhealth.5426 ER - TY - JOUR AU - Matthew-Maich, Nancy AU - Harris, Lauren AU - Ploeg, Jenny AU - Markle-Reid, Maureen AU - Valaitis, Ruta AU - Ibrahim, Sarah AU - Gafni, Amiram AU - Isaacs, Sandra PY - 2016/06/09 TI - Designing, Implementing, and Evaluating Mobile Health Technologies for Managing Chronic Conditions in Older Adults: A Scoping Review JO - JMIR mHealth uHealth SP - e29 VL - 4 IS - 2 KW - Telemedicine KW - Mobile health KW - Health Plan Implementations KW - Evaluation Studies as Topic KW - Design KW - mHealth Innovations KW - Frail Elderly KW - Older Adults KW - Multiple Chronic Conditions KW - Home Care Services KW - Scoping Review KW - Communication KW - Information Communication Technologies N2 - Background: The current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations. Objectives: The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults. Methods: A 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data. Results: We identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies. Conclusions: There is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations. UR - http://mhealth.jmir.org/2016/2/e29/ UR - http://dx.doi.org/10.2196/mhealth.5127 UR - http://www.ncbi.nlm.nih.gov/pubmed/27282195 ID - info:doi/10.2196/mhealth.5127 ER - TY - JOUR AU - Taber, M. Jennifer AU - Klein, M.P William AU - Ferrer, A. Rebecca AU - Augustson, Erik AU - Patrick, Heather PY - 2016/06/08 TI - A Pilot Test of Self-Affirmations to Promote Smoking Cessation in a National Smoking Cessation Text Messaging Program JO - JMIR Mhealth Uhealth SP - e71 VL - 4 IS - 2 KW - self-affirmation KW - smoking cessation KW - mHealth KW - text messaging KW - theoretical study KW - self concept KW - motivation N2 - Background: Although effective smoking cessation treatments, including mHealth interventions, have been empirically validated and are widely available, smoking relapse is likely. Self-affirmation, a process through which individuals focus on their strengths and behaviors, has been shown to reduce negative effects of self-threats and to promote engagement in healthier behavior. Objective: To assess the feasibility of incorporating self-affirmations into an existing text messaging-based smoking cessation program (Smokefree TXT) and to determine whether self-affirmation led to greater engagement and higher cessation rates than the standard intervention. Methods: Data were collected from smokers (n=1261) who subscribed to a free smoking cessation program and met eligibility criteria. The intervention lasted 42 days. The original design was a 2 (Baseline affirmation: 5-item questionnaire present vs absent) × 2 (Integrated affirmation: texts present vs absent) factorial design. Only 17 eligible users completed all baseline affirmation questions and these conditions did not influence any outcomes, so we collapsed across baseline affirmation conditions in analysis. In the integrated affirmation conditions, affirmations replaced approximately 20% of texts delivering motivational content. Results: In all, 687 users remained enrolled throughout the 42-day intervention and 81 reported smoking status at day 42. Among initiators (n=1261), self-affirmation did not significantly improve (1) intervention completion, (2) days enrolled, (3) 1-week smoking status, or (4) 6-week smoking status (all Ps>.10); and among the 687 completers, there were no significant effects of affirmation on cessation (Ps>.25). However, among the 81 responders, those who received affirmations were more likely to report cessation at 6 weeks (97.5%; 39 of 40) than those not given affirmations (78.1%; 32 of 41; ?2(1)=7.08, P=.008). Conclusion: This proof-of-concept study provides preliminary evidence that self-affirmation can be integrated into existing text-based cessation programs, as the affirmations did not lead to any adverse effects (ie, less engagement or lower rates of cessation). Among those who reported smoking status at the end of the intervention period (6.4% of eligible respondents), affirmations facilitated cessation. This study provides a ?proof-of-concept? that brief, low-touch interventions may be integrated into a text messaging program with potential benefits, minimal disruption to the program or users, and little cost. Many questions remain regarding how self-affirmation and similar approaches can promote engagement in population interventions. UR - http://mhealth.jmir.org/2016/2/e71/ UR - http://dx.doi.org/10.2196/mhealth.5635 UR - http://www.ncbi.nlm.nih.gov/pubmed/27278108 ID - info:doi/10.2196/mhealth.5635 ER - TY - JOUR AU - Alonso Rorís, M. Víctor AU - Álvarez Sabucedo, M. Luis AU - Wanden-Berghe, Carmina AU - Santos Gago, M. Juan AU - Sanz-Valero, Javier PY - 2016/06/07 TI - Towards a Mobile-Based Platform for Traceability Control and Hazard Analysis in the Context of Parenteral Nutrition: Description of a Framework and a Prototype App JO - JMIR Res Protoc SP - e57 VL - 5 IS - 2 KW - parenteral nutrition KW - quality control KW - process assessment KW - information management N2 - Background: The parenteral nutrient (PN) mixtures may pose great risks of physical, microbiological, and chemical contamination during their preparation, storage, distribution, and administration. These potential hazards must be controlled under high levels of excellence to prevent any serious complications for the patients. As a result, management control and traceability of any of these medications is of utmost relevance for the patient care, along with ensuring treatment continuity and adherence. Objective: The aim of this study is to develop a mobile-based platform to support the control procedures and traceability services in the domain of parenteral nutrient (PN) mixtures in an efficient and nonintrusive manner. Methods: A comprehensive approach combining techniques of software engineering and knowledge engineering was used for the characterization of the framework. Local try-outs for evaluation were performed in a number of application areas, carrying out a test/retest monitoring to detect possible errors or conflicts in different contexts and control processes throughout the entire cycle of PN. From these data, the absolute and relative frequencies (percentages) were calculated. Results: A mobile application for the Android operating system was developed. This application allows reading different types of tags and interacts with the local server according to a proposed model. Also, through an internal caching mechanism, the availability of the system is preserved even in the event of problems with the network connection. A set of 1040 test traces were generated for the assessment of the system under various environments tested. Among those, 102 traces (9.81%) involved conflictive situations that were properly taken care of in this paper by suggesting solutions to overcome them. Conclusions: A mobile oriented system was generated and tested in order to allow enhanced control and quality management of PN mixtures that is easy to integrate into the daily praxis of health care processes. UR - http://www.researchprotocols.org/2016/2/e57/ UR - http://dx.doi.org/10.2196/resprot.4907 UR - http://www.ncbi.nlm.nih.gov/pubmed/27269189 ID - info:doi/10.2196/resprot.4907 ER - TY - JOUR AU - Young-Afat, A. Danny AU - van Gils, H. Carla AU - Bruinvels, J. David AU - van der Pol, C. Carmen AU - Witkamp, J. Arjen AU - Sijtsema, Sieta AU - Jonasse, Yvette AU - Bijlsma, M. Rhodé AU - Ausems, G. Margreet AU - Bos, M. Annelies AU - van den Bongard, H. Desirée AU - Verkooijen, M. Helena PY - 2016/06/07 TI - Patients? and Health Care Providers? Opinions on a Supportive Health App During Breast Cancer Treatment: A Qualitative Evaluation JO - JMIR Cancer SP - e8 VL - 2 IS - 1 KW - breast cancer KW - health apps KW - quality of life KW - patient-reported outcomes KW - PROs N2 - Background: Health apps are increasingly being used in clinical care and may hold significant theoretical potential. However, they are often implemented in clinical care before any research has been done to confirm actual benefits for patients, physicians, and researchers. Objective: This study aimed to explore experiences of patients and health care providers with the use of a supportive breast cancer app during the first 6 months following diagnosis, in terms of benefits for clinical practice and research purposes. Methods: Between June 2013 and April 2014, breast cancer patients of all ages were invited shortly after diagnosis to use a supportive breast cancer app, and were followed for 6 months. Patients were asked to use the app at their own convenience. In-depth interviews were conducted regularly with patients and their medical team (ie, physicians and nurses) to evaluate their experiences. Results: A total of 15 patients aged 30-63 years participated. The medical team consisted of 7 physicians and 3 specialized breast cancer nurses. Out of the 15 patients, 12 (80%) used the app to obtain information on breast cancer and treatment. A total of 11 out of 12 patients (92%) evaluated this information as useful. All 15 patients used the app to record consultations with practitioners, and 14 (93%) found this useful. Symptom registration was used by 8 out of 15 patients (53%), and was found useful by 4 out of these 8 patients (50%). Overall, 14 out of 15 patients (93%) would recommend the app to other patients. The app, in particular the recording function, was rated as useful by 9 out of 10 medical professionals (90%), and they reported that it did not increase consultation time. These 9 professionals would recommend the app to their patients. Conclusions: This evaluation of a supportive health app shows positive experiences among patients and their medical teams. Based on experiences in this study, patients may need to be actively encouraged to regularly register symptoms within health apps to generate sufficient patient-reported app data for use in clinical practice and scientific research. UR - http://cancer.jmir.org/2016/1/e8/ UR - http://dx.doi.org/10.2196/cancer.5334 UR - http://www.ncbi.nlm.nih.gov/pubmed/28410170 ID - info:doi/10.2196/cancer.5334 ER - TY - JOUR AU - Newman, Craig AU - Shankar, Rohit AU - Hanna, Jane AU - McLean, Brendan AU - Osland, Alex AU - Milligan, Cathryn AU - Ball, Abbie AU - Jory, Caryn AU - Walker, Matthew PY - 2016/06/07 TI - Developing an Evidence-Based Epilepsy Risk Assessment eHealth Solution: From Concept to Market JO - JMIR Res Protoc SP - e82 VL - 5 IS - 2 KW - eHealth KW - mhealth KW - mobile app KW - epilepsy KW - SUDEP KW - self-management KW - self-monitoring KW - smartphone N2 - Introduction: Sudden unexpected death in epilepsy (SUDEP) is possibly the most common cause of death as a result of complications from epilepsy. The need to educate and regularly review risk for all patients with epilepsy is paramount, but rarely delivered in actual clinical practice. Evidence suggests that education around SUDEP and modifiable risk variables translate into better self-management of epilepsy. Objective: We aimed to develop and implement an eHealth solution to support education and self-management of risks, in epilepsy. Methods: We undertook an innovation pathways approach, including problem identification, feasibility assessment, design, implementation, and marketing. People with epilepsy were provided a smartphone-based app (Epilepsy Self-Monitor, EpSMon), which translates the clinical risk assessment tool into an educational and self-monitoring platform, for the self-management of epilepsy. Results: Results include the success of the marketing campaign, and in what areas, with an estimated reach of approximately 38 million people. EpSMon has proved a success in academic and clinical circles, attracting awards and nominations for awards. The number of users of EpSMon, after 3 months, turned out to be lower than expected (N=221). A 4-month trial of the app in use in the United Kingdom, and the success of the marketing strategy, point to necessary changes to the model of delivery and marketing, summarized in this paper. These include the marketing message, user cost model, and need for the availability of an Android version. Conclusions: EpSMon has proven a success in respect to its reception by academics, clinicians, stakeholder groups, and the patients who use it. There is work needed to promote the model and increase its acceptability/attractiveness, including broadening the marketing message, increasing its availability, and reducing its cost. Future development and promotion of the tool will hopefully inform iterative design of its core features for a receptive audience and lead to increased uptake as it is launched worldwide in 2016. UR - http://www.researchprotocols.org/2016/2/e82/ UR - http://dx.doi.org/10.2196/resprot.5389 UR - http://www.ncbi.nlm.nih.gov/pubmed/27269382 ID - info:doi/10.2196/resprot.5389 ER - TY - JOUR AU - Duhm, Julian AU - Fleischmann, Robert AU - Schmidt, Sein AU - Hupperts, Hagen AU - Brandt, A. Stephan PY - 2016/06/06 TI - Mobile Electronic Medical Records Promote Workflow: Physicians? Perspective From a Survey JO - JMIR Mhealth Uhealth SP - e70 VL - 4 IS - 2 KW - tablet PC KW - electronic health record KW - usability KW - health services KW - inpatient care N2 - Background: As a result of demographic changes, physicians are required to deliver needed services with limited resources. Research suggests that tablet PCs with access to patient data may streamline clinical workflow. A recent study found tablets with mobile electronic medical records (EMRs) can facilitate data retrieval and produce time savings across the clinical routine within hospital settings. However, the reasons for these time savings, including details on how tablets were being used, remain unclear. The same applies to physicians? perceptions of this tool within an inpatient setting. Objective: This study examined physicians? perception of tablets with EMRs in an inpatient setting. The rationale was to identify both subjective and objective factors that impacted the successful implementation and use of tablets running an EMR. Methods: We developed a 57-item survey questionnaire designed to examine users? perception of and attitude toward tablets, which was administered to 14 participating physicians following 7 weeks of tablet use. Five participants volunteered to participate in a second study that investigated physicians? patterns of tablet use within the EMR environment by digitally tracking and storing usage behavior. Statistical analyses of questionnaire results included mean values with their bootstrapped 95% confidence intervals and multivariate analysis of variance to identify predictors of tablet use. Results: Physicians reported high degrees of satisfaction with the tablets. There was a general consensus among physicians that tablet use streamlined clinical workflow through optimized data retrieval (rated 0.69, 0.23-1.15 points better than control) and improved communication with patients and other physicians (rated 0.85, 0.54-1.15 and 0.77, 0.38-1.15 points better than control, respectively). Age (F3,11=3.54, P=.04), occupational group (F1,11=7.17, P=.04), and attitude toward novel technologies (F1,11=10.54, P=.02) predicted physicians? satisfaction with the devices and their motivation regarding their further use. Tracking data yielded that only a few of the available functions were used frequently. Conclusions: Although tablet PCs were consistently perceived as beneficial, several factors contributed to the fact that their full potential was not fully exploited. Training in functionality and providing a reliable infrastructure might foster successful tablet implementation. UR - http://mhealth.jmir.org/2016/2/e70/ UR - http://dx.doi.org/10.2196/mhealth.5464 UR - http://www.ncbi.nlm.nih.gov/pubmed/27268720 ID - info:doi/10.2196/mhealth.5464 ER - TY - JOUR AU - Steele Gray, Carolyn AU - Gill, Ashlinder AU - Khan, Irfan Anum AU - Hans, Kaur Parminder AU - Kuluski, Kerry AU - Cott, Cheryl PY - 2016/06/02 TI - The Electronic Patient Reported Outcome Tool: Testing Usability and Feasibility of a Mobile App and Portal to Support Care for Patients With Complex Chronic Disease and Disability in Primary Care Settings JO - JMIR mHealth uHealth SP - e58 VL - 4 IS - 2 KW - eHealth KW - mHealth KW - multimorbidity KW - primary care KW - usability KW - feasibility KW - pilot N2 - Background: People experiencing complex chronic disease and disability (CCDD) face some of the greatest challenges of any patient population. Primary care providers find it difficult to manage multiple discordant conditions and symptoms and often complex social challenges experienced by these patients. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges by supporting goal-oriented primary care delivery. Using the tool, patients and providers collaboratively develop health care goals on a portal linked to a mobile device to help patients and providers track progress between visits. Objectives: This study tested the usability and feasibility of adopting the ePRO tool into a single interdisciplinary primary health care practice in Toronto, Canada. The Fit between Individuals, Fask, and Technology (FITT) framework was used to guide our assessment and explore whether the ePRO tool is: (1) feasible for adoption in interdisciplinary primary health care practices and (2) usable from both the patient and provider perspectives. This usability pilot is part of a broader user-centered design development strategy. Methods: A 4-week pilot study was conducted in which patients and providers used the ePRO tool to develop health-related goals, which patients then monitored using a mobile device. Patients and providers collaboratively set goals using the system during an initial visit and had at least 1 follow-up visit at the end of the pilot to discuss progress. Focus groups and interviews were conducted with patients and providers to capture usability and feasibility measures. Data from the ePRO system were extracted to provide information regarding tool usage. Results: Six providers and 11 patients participated in the study; 3 patients dropped out mainly owing to health issues. The remaining 8 patients completed 210 monitoring protocols, equal to over 1300 questions, with patients often answering questions daily. Providers and patients accessed the portal on an average of 10 and 1.5 times, respectively. Users found the system easy to use, some patients reporting that the tool helped in their ability to self-manage, catalyzed a sense of responsibility over their care, and improved patient-centered care delivery. Some providers found that the tool helped focus conversations on goal setting. However, the tool did not fit well with provider workflows, monitoring questions were not adequately tailored to individual patient needs, and daily reporting became tedious and time-consuming for patients. Conclusions: Although our study suggests relatively low usability and feasibility of the ePRO tool, we are encouraged by the early impact on patient outcomes and generally positive responses from both user groups regarding the potential of the tool to improve care for patients with CCDD. As is consistent with our user-centered design development approach, we have modified the tool based on user feedback, and are now testing the redeveloped tool through an exploratory trial. UR - http://mhealth.jmir.org/2016/2/e58/ UR - http://dx.doi.org/10.2196/mhealth.5331 UR - http://www.ncbi.nlm.nih.gov/pubmed/27256035 ID - info:doi/10.2196/mhealth.5331 ER - TY - JOUR AU - McIntosh, Scott AU - Pérez-Ramos, José AU - Demment, M. Margaret AU - Vélez Vega, Carmen AU - Avendaño, Esteban AU - Ossip, J. Deborah AU - Dye, D. Timothy PY - 2016/06/02 TI - Development and Implementation of Culturally Tailored Offline Mobile Health Surveys JO - JMIR Public Health Surveill SP - e28 VL - 2 IS - 1 KW - mobile health KW - survey research KW - ethical review N2 - Background: In low and middle income countries (LMICs), and other areas with low resources and unreliable access to the Internet, understanding the emerging best practices for the implementation of new mobile health (mHealth) technologies is needed for efficient and secure data management and for informing public health researchers. Innovations in mHealth technology can improve on previous methods, and dissemination of project development details and lessons learned during implementation are needed to provide lessons learned to stakeholders in both the United States and LMIC settings. Objective: The aims of this paper are to share implementation strategies and lessons learned from the development and implementation stages of two survey research projects using offline mobile technology, and to inform and prepare public health researchers and practitioners to implement new mobile technologies in survey research projects in LMICs. Methods: In 2015, two survey research projects were developed and piloted in Puerto Rico and pre-tested in Costa Rica to collect face-to-face data, get formative evaluation feedback, and to test the feasibility of an offline mobile data collection process. Fieldwork in each setting involved survey development, back translation with cultural tailoring, ethical review and approvals, data collector training, and piloting survey implementation on mobile tablets. Results: Critical processes and workflows for survey research projects in low resource settings were identified and implemented. This included developing a secure mobile data platform tailored to each survey, establishing user accessibility, and training and eliciting feedback from data collectors and on-site LMIC project partners. Conclusions: Formative and process evaluation strategies are necessary and useful for the development and implementation of survey research projects using emerging mHealth technologies in LMICs and other low resource settings. Lessons learned include: (1) plan institutional review board (IRB) approvals in multiple countries carefully to allow for development, implementation, and feedback, (2) in addition to testing the content of survey instruments, allow time and consideration for testing the use of novel mHealth technology (hardware and software), (3) incorporate training for and feedback from project staff, LMIC partner staff, and research participants, and (4) change methods accordingly, including content, as mHealth technology usage influences and is influenced by the content and structure of the survey instrument. Lessons learned from early phases of LMIC research projects using emerging mHealth technologies are critical for informing subsequent research methods and study designs. UR - http://publichealth.jmir.org/2016/1/e28/ UR - http://dx.doi.org/10.2196/publichealth.5408 UR - http://www.ncbi.nlm.nih.gov/pubmed/27256208 ID - info:doi/10.2196/publichealth.5408 ER - TY - JOUR AU - Dunton, Fridlund Genevieve AU - Dzubur, Eldin AU - Intille, Stephen PY - 2016/06/01 TI - Feasibility and Performance Test of a Real-Time Sensor-Informed Context-Sensitive Ecological Momentary Assessment to Capture Physical Activity JO - J Med Internet Res SP - e106 VL - 18 IS - 6 KW - mobile phones KW - ecological momentary assessment KW - accelerometer KW - physical activity N2 - Background: Objective physical activity monitors (eg, accelerometers) have high rates of nonwear and do not provide contextual information about behavior. Objective: This study tested performance and value of a mobile phone app that combined objective and real-time self-report methods to measure physical activity using sensor-informed context-sensitive ecological momentary assessment (CS-EMA). Methods: The app was programmed to prompt CS-EMA surveys immediately after 3 types of events detected by the mobile phone?s built-in motion sensor: (1) Activity (ie, mobile phone movement), (2) No-Activity (ie, mobile phone nonmovement), and (3) No-Data (ie, mobile phone or app powered off). In addition, the app triggered random (ie, signal-contingent) ecological momentary assessment (R-EMA) prompts (up to 7 per day). A sample of 39 ethnically diverse high school students in the United States (aged 14-18, 54% female) tested the app over 14 continuous days during nonschool time. Both CS-EMA and R-EMA prompts assessed activity type (eg, reading or doing homework, eating or drinking, sports or exercising) and contextual characteristics of the activity (eg, location, social company, purpose). Activity was also measured with a waist-worn Actigraph accelerometer. Results: The average CS-EMA + R-EMA prompt compliance and survey completion rates were 80.5% and 98.5%, respectively. More moderate-to-vigorous intensity physical activity was recorded by the waist-worn accelerometer in the 30 minutes before CS-EMA activity prompts (M=5.84 minutes) than CS-EMA No-Activity (M=1.11 minutes) and CS-EMA No-Data (M=0.76 minute) prompts (P?s<.001). Participants were almost 5 times as likely to report going somewhere (ie, active or motorized transit) in the 30 minutes before CS-EMA Activity than R-EMA prompts (odds ratio=4.91, 95% confidence interval=2.16-11.12). Conclusions: Mobile phone apps using motion sensor?informed CS-EMA are acceptable among high school students and may be used to augment objective physical activity data collected from traditional waist-worn accelerometers. UR - http://www.jmir.org/2016/6/e106/ UR - http://dx.doi.org/10.2196/jmir.5398 UR - http://www.ncbi.nlm.nih.gov/pubmed/27251313 ID - info:doi/10.2196/jmir.5398 ER - TY - JOUR AU - Rusatira, Christophe Jean AU - Tomaszewski, Brian AU - Dusabejambo, Vincent AU - Ndayiragije, Vincent AU - Gonsalves, Snedden AU - Sawant, Aishwarya AU - Mumararungu, Angeline AU - Gasana, George AU - Amendezo, Etienne AU - Haake, Anne AU - Mutesa, Leon PY - 2016/06/01 TI - Enabling Access to Medical and Health Education in Rwanda Using Mobile Technology: Needs Assessment for the Development of Mobile Medical Educator Apps JO - JMIR Med Educ SP - e7 VL - 2 IS - 1 KW - mobile medical education KW - technology KW - user-centered design N2 - Background: Lack of access to health and medical education resources for doctors in the developing world is a serious global health problem. In Rwanda, with a population of 11 million, there is only one medical school, hence a shortage in well-trained medical staff. The growth of interactive health technologies has played a role in the improvement of health care in developed countries and has offered alternative ways to offer continuous medical education while improving patient's care. However, low and middle-income countries (LMIC) like Rwanda have struggled to implement medical education technologies adapted to local settings in medical practice and continuing education. Developing a user-centered mobile computing approach for medical and health education programs has potential to bring continuous medical education to doctors in rural and urban areas of Rwanda and influence patient care outcomes. Objective: The aim of this study is to determine user requirements, currently available resources, and perspectives for potential medical education technologies in Rwanda. Methods: Information baseline and needs assessments data collection were conducted in all 44 district hospitals (DHs) throughout Rwanda. The research team collected qualitative data through interviews with 16 general practitioners working across Rwanda and 97 self-administered online questionnaires for rural areas. Data were collected and analyzed to address two key questions: (1) what are the currently available tools for the use of mobile-based technology for medical education in Rwanda, and (2) what are user's requirements for the creation of a mobile medical education technology in Rwanda? Results: General practitioners from different hospitals highlighted that none of the available technologies avail local resources such as the Ministry of Health (MOH) clinical treatment guidelines. Considering the number of patients that doctors see in Rwanda, an average of 32 patients per day, there is need for a locally adapted mobile education app that utilizes specific Rwandan medical education resources. Based on our results, we propose a mobile medical education app that could provide many benefits such as rapid decision making with lower error rates, increasing the quality of data management and accessibility, and improving practice efficiency and knowledge. In areas where Internet access is limited, the proposed mobile medical education app would need to run on a mobile device without Internet access. Conclusions: A user-centered design approach was adopted, starting with a needs assessment with representative end users, which provided recommendations for the development of a mobile medical education app specific to Rwanda. Specific app features were identified through the needs assessment and it was evident that there will be future benefits to ongoing incorporation of user-centered design methods to better inform the software development and improve its usability. Results of the user-centered design reported here can inform other medical education technology developments in LMIC to ensure that technologies developed are usable by all stakeholders. UR - http://mededu.jmir.org/2016/1/e7/ UR - http://dx.doi.org/10.2196/mededu.5336 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731861 ID - info:doi/10.2196/mededu.5336 ER - TY - JOUR AU - Farrell, Maureen PY - 2016/05/31 TI - Use of iPhones by Nurses in an Acute Care Setting to Improve Communication and Decision-Making Processes: Qualitative Analysis of Nurses? Perspectives on iPhone Use JO - JMIR mHealth uHealth SP - e43 VL - 4 IS - 2 KW - acute care KW - clinical decision making KW - communication KW - iPhones KW - nursing N2 - Background: Smartphones and other mobile devices are having and will continue to have an impact on health care delivery in acute settings in Australia and overseas. Nurses, unlike physicians, have been slow to adopt these technologies and the reasons for this may relate to the status of both these professions within the hospital setting. Objective: To explore nurses? perspectives on iPhone use within an acute care unit. We examined their experiences and views on how this device may improve communication and decision-making processes at the point of care. Methods: Two focus group discussions, using a semistructured interview, were conducted over the trial period. The discussions focused on the nurses? experiences regarding ease of use, features, and capabilities of the device. The focus groups were recorded, transcribed, and analyzed using semistructured interview questions as a guide. Results: The positive findings indicated that the iPhones were accessible and portable at point of care with patients, enhanced communication in the workplace, particularly among the nurses, and that this technology would evolve and be embraced by all nurses in the future. The negatives were the small screen size when undertaking bedside education for the patient and the invasive nature of the device. Another issue was the perception of being viewed as unprofessional when using the device in real time with the patients and their family. Conclusions: The use of iPhones by nurses in acute care settings has the potential to enhance patient care, especially through more effective communication among nurses, and other health care professionals. To ensure that the benefits of this technology is woven into the everyday practice of the nurse, it is important that leaders in these organizations develop the agenda or policy to ensure that this occurs. UR - http://mhealth.jmir.org/2016/2/e43/ UR - http://dx.doi.org/10.2196/mhealth.5071 UR - http://www.ncbi.nlm.nih.gov/pubmed/27246197 ID - info:doi/10.2196/mhealth.5071 ER - TY - JOUR AU - Puszkiewicz, Patrycja AU - Roberts, L. Anna AU - Smith, Lee AU - Wardle, Jane AU - Fisher, Abigail PY - 2016/05/31 TI - Assessment of Cancer Survivors? Experiences of Using a Publicly Available Physical Activity Mobile Application JO - JMIR Cancer SP - e7 VL - 2 IS - 1 KW - cancer survivors KW - mobile applications KW - mHealth KW - physical activity KW - sleep N2 - Background: Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective: This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors? attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods: The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Of the people who responded to the study advertisement, 73% (16/22) agreed to participate and 100% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one?s lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions: All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population. UR - http://cancer.jmir.org/2016/1/e7/ UR - http://dx.doi.org/10.2196/cancer.5380 UR - http://www.ncbi.nlm.nih.gov/pubmed/28410168 ID - info:doi/10.2196/cancer.5380 ER - TY - JOUR AU - Berry, Natalie AU - Lobban, Fiona AU - Emsley, Richard AU - Bucci, Sandra PY - 2016/05/31 TI - Acceptability of Interventions Delivered Online and Through Mobile Phones for People Who Experience Severe Mental Health Problems: A Systematic Review JO - J Med Internet Res SP - e121 VL - 18 IS - 5 KW - mHealth KW - eHealth KW - severe mental health KW - psychosis KW - bipolar disorder KW - personality disorder KW - severe mental health problems (SMI) KW - acceptability N2 - Background: Psychological interventions are recommended for people with severe mental health problems (SMI). However, barriers exist in the provision of these services and access is limited. Therefore, researchers are beginning to develop and deliver interventions online and via mobile phones. Previous research has indicated that interventions delivered in this format are acceptable for people with SMI. However, a comprehensive systematic review is needed to investigate the acceptability of online and mobile phone-delivered interventions for SMI in depth. Objective: This systematic review aimed to 1) identify the hypothetical acceptability (acceptability prior to or without the delivery of an intervention) and actual acceptability (acceptability where an intervention was delivered) of online and mobile phone-delivered interventions for SMI, 2) investigate the impact of factors such as demographic and clinical characteristics on acceptability, and 3) identify common participant views in qualitative studies that pinpoint factors influencing acceptability. Methods: We conducted a systematic search of the databases PubMed, Embase, PsycINFO, CINAHL, and Web of Science in April 2015, which yielded a total of 8017 search results, with 49 studies meeting the full inclusion criteria. Studies were included if they measured acceptability through participant views, module completion rates, or intervention use. Studies delivering interventions were included if the delivery method was online or via mobile phones. Results: The hypothetical acceptability of online and mobile phone-delivered interventions for SMI was relatively low, while actual acceptability tended to be high. Hypothetical acceptability was higher for interventions delivered via text messages than by emails. The majority of studies that assessed the impact of demographic characteristics on acceptability reported no significant relationships between the two. Additionally, actual acceptability was higher when participants were provided remote online support. Common qualitative factors relating to acceptability were safety and privacy concerns, the importance of an engaging and appealing delivery format, the inclusion of peer support, computer and mobile phone literacy, technical issues, and concerns about the impact of psychological state on intervention use. Conclusions: This systematic review provides an in-depth focus on the acceptability of online and mobile phone-delivered interventions for SMI and identified the need for further research in this area. Based on the results from this review, we recommend that researchers measure both hypothetical and actual acceptability to identify whether initial perceptions of online and mobile phone-delivered interventions change after access. In addition, more focus is needed on the potential impact of demographic and clinical characteristics on acceptability. The review also identified issues with module completion rates and intervention use as measures of acceptability. We therefore advise researchers to obtain qualitative reports of acceptability throughout each phase of intervention development and testing. Further implications and opportunities for future research are discussed. UR - http://www.jmir.org/2016/5/e121/ UR - http://dx.doi.org/10.2196/jmir.5250 UR - http://www.ncbi.nlm.nih.gov/pubmed/27245693 ID - info:doi/10.2196/jmir.5250 ER - TY - JOUR AU - Coughlin, Steven AU - Thind, Herpreet AU - Liu, Benyuan AU - Champagne, Nicole AU - Jacobs, Molly AU - Massey, I. Rachael PY - 2016/05/30 TI - Mobile Phone Apps for Preventing Cancer Through Educational and Behavioral Interventions: State of the Art and Remaining Challenges JO - JMIR Mhealth Uhealth SP - e69 VL - 4 IS - 2 KW - mobile phone apps KW - cancer KW - early detection of cancer KW - diet KW - environmental carcinogens KW - health literacy KW - nutrition KW - obesity KW - prevention KW - randomized controlled trials KW - screening KW - smoking KW - sun safety KW - weight loss N2 - Background: Rapid developments in technology have encouraged the use of mobile phones in smoking cessation, promoting healthy diet, nutrition, and physical activity, sun safety, and cancer screening. Although many apps relating to the prevention of cancer and other chronic diseases are available from major mobile phone platforms, relatively few have been tested in research studies to determine their efficacy. Objective: In this paper, we discuss issues related to the development and testing of new apps for preventing cancer through smoking cessation, sun safety, and other healthy behaviors, including key methodologic issues and outstanding challenges. Methods: An exploratory literature review was conducted using bibliographic searches in PubMed and CINAHL with relevant search terms (eg, smartphones, smoking cessation, cancer prevention, cancer screening, and carcinogens) to identify papers published in English through October 2015. Results: Only 4 randomized controlled trials of the use of mobile phone apps for smoking cessation and 2 trials of apps for sun safety were identified, indicating that it is premature to conduct a systematic search and meta-analysis of the published literature on this topic. Conclusions: Future studies should utilize randomized controlled trial research designs, larger sample sizes, and longer study periods to better establish the cancer prevention and control capabilities of mobile phone apps. In developing new and refined apps for cancer prevention and control, both health literacy and eHealth literacy should be taken into account. There is a need for culturally appropriate, tailored health messages to increase knowledge and awareness of health behaviors such as smoking cessation, cancer screening, and sun safety. Mobile phone apps are likely to be a useful and low-cost intervention for preventing cancer through behavioral changes. UR - http://mhealth.jmir.org/2016/2/e69/ UR - http://dx.doi.org/10.2196/mhealth.5361 UR - http://www.ncbi.nlm.nih.gov/pubmed/27242162 ID - info:doi/10.2196/mhealth.5361 ER - TY - JOUR AU - Masalski, Marcin AU - Kipi?ski, Lech AU - Grysi?ski, Tomasz AU - Kr?cicki, Tomasz PY - 2016/05/30 TI - Hearing Tests on Mobile Devices: Evaluation of the Reference Sound Level by Means of Biological Calibration JO - J Med Internet Res SP - e130 VL - 18 IS - 5 KW - hearing test, mobile device, calibration N2 - Background: Hearing tests carried out in home setting by means of mobile devices require previous calibration of the reference sound level. Mobile devices with bundled headphones create a possibility of applying the predefined level for a particular model as an alternative to calibrating each device separately. Objective: The objective of this study was to determine the reference sound level for sets composed of a mobile device and bundled headphones. Methods: Reference sound levels for Android-based mobile devices were determined using an open access mobile phone app by means of biological calibration, that is, in relation to the normal-hearing threshold. The examinations were conducted in 2 groups: an uncontrolled and a controlled one. In the uncontrolled group, the fully automated self-measurements were carried out in home conditions by 18- to 35-year-old subjects, without prior hearing problems, recruited online. Calibration was conducted as a preliminary step in preparation for further examination. In the controlled group, audiologist-assisted examinations were performed in a sound booth, on normal-hearing subjects verified through pure-tone audiometry, recruited offline from among the workers and patients of the clinic. In both the groups, the reference sound levels were determined on a subject?s mobile device using the Bekesy audiometry. The reference sound levels were compared between the groups. Intramodel and intermodel analyses were carried out as well. Results: In the uncontrolled group, 8988 calibrations were conducted on 8620 different devices representing 2040 models. In the controlled group, 158 calibrations (test and retest) were conducted on 79 devices representing 50 models. Result analysis was performed for 10 most frequently used models in both the groups. The difference in reference sound levels between uncontrolled and controlled groups was 1.50 dB (SD 4.42). The mean SD of the reference sound level determined for devices within the same model was 4.03 dB (95% CI 3.93-4.11). Statistically significant differences were found across models. Conclusions: Reference sound levels determined in the uncontrolled group are comparable to the values obtained in the controlled group. This validates the use of biological calibration in the uncontrolled group for determining the predefined reference sound level for new devices. Moreover, due to a relatively small deviation of the reference sound level for devices of the same model, it is feasible to conduct hearing screening on devices calibrated with the predefined reference sound level. UR - http://www.jmir.org/2016/5/e130/ UR - http://dx.doi.org/10.2196/jmir.4987 UR - http://www.ncbi.nlm.nih.gov/pubmed/27241793 ID - info:doi/10.2196/jmir.4987 ER - TY - JOUR AU - Thilakanathan, Danan AU - Calvo, A. Rafael AU - Chen, Shiping AU - Nepal, Surya AU - Glozier, Nick PY - 2016/05/27 TI - Facilitating Secure Sharing of Personal Health Data in the Cloud JO - JMIR Med Inform SP - e15 VL - 4 IS - 2 KW - self care KW - telemedicine KW - privacy KW - computer security KW - information dissemination N2 - Background: Internet-based applications are providing new ways of promoting health and reducing the cost of care. Although data can be kept encrypted in servers, the user does not have the ability to decide whom the data are shared with. Technically this is linked to the problem of who owns the data encryption keys required to decrypt the data. Currently, cloud service providers, rather than users, have full rights to the key. In practical terms this makes the users lose full control over their data. Trust and uptake of these applications can be increased by allowing patients to feel in control of their data, generally stored in cloud-based services. Objective: This paper addresses this security challenge by providing the user a way of controlling encryption keys independently of the cloud service provider. We provide a secure and usable system that enables a patient to share health information with doctors and specialists. Methods: We contribute a secure protocol for patients to share their data with doctors and others on the cloud while keeping complete ownership. We developed a simple, stereotypical health application and carried out security tests, performance tests, and usability tests with both students and doctors (N=15). Results: We developed the health application as an app for Android mobile phones. We carried out the usability tests on potential participants and medical professionals. Of 20 participants, 14 (70%) either agreed or strongly agreed that they felt safer using our system. Using mixed methods, we show that participants agreed that privacy and security of health data are important and that our system addresses these issues. Conclusions: We presented a security protocol that enables patients to securely share their eHealth data with doctors and nurses and developed a secure and usable system that enables patients to share mental health information with doctors. UR - http://medinform.jmir.org/2016/2/e15/ UR - http://dx.doi.org/10.2196/medinform.4756 UR - http://www.ncbi.nlm.nih.gov/pubmed/27234691 ID - info:doi/10.2196/medinform.4756 ER - TY - JOUR AU - DeLaughter, L. Kathryn AU - Sadasivam, S. Rajani AU - Kamberi, Ariana AU - English, M. Thomas AU - Seward, L. Greg AU - Chan, Wayne S. AU - Volkman, E. Julie AU - Amante, J. Daniel AU - Houston, K. Thomas PY - 2016/05/26 TI - Crave-Out: A Distraction/Motivation Mobile Game to Assist in Smoking Cessation JO - JMIR Serious Games SP - e3 VL - 4 IS - 1 KW - smoking cessation KW - Internet KW - secondary prevention KW - health behavior N2 - Background: Smoking is still the number one preventable cause of death. Cravings?an intense desire or longing for a cigarette?are a major contributor to quit attempt failure. New tools to help smokers? manage their cravings are needed. Objective: To present a case study of the development process and testing of a distraction/motivation game (Crave-Out) to help manage cravings. Methods: We used a phased approach: in Phase 1 (alpha testing), we tested and refined the game concept, using a Web-based prototype. In Phase 2 (beta testing), we evaluated the distraction/motivation potential of the mobile game prototype, using a prepost design. After varying duration of abstinence, smokers completed the Questionnaire of Smoking Urge-Brief (QSU-Brief) measurement before and after playing Crave-Out. Paired t tests were used to compare pregame and postgame QSU-Brief levels. To test dissemination potential, we released the game on the Apple iTunes App Store and tracked downloads between December 22, 2011, and May 5, 2014. Results: Our concept refinement resulted in a multilevel, pattern memory challenge game, with each level increasing in difficulty. Smokers could play the game as long as they wanted. At the end of each level, smokers were provided clear goals for the next level and rewards (positive reinforcement using motivational tokens that represented a benefit of quitting smoking). Negative reinforcement was removed in alpha testing as smokers felt it reminded them of smoking. Measurement of QSU-Brief (N=30) resulted in a pregame mean of 3.24 (SD 1.65) and postgame mean of 2.99 (SD 1.40) with an overall decrease of 0.25 in cravings (not statistically significant). In a subset analysis, the QSU-Brief decrease was significant for smokers abstinent for more than 48 hours (N=5) with a pregame mean of 2.84 (SD 1.16) and a postgame mean of 2.0 (SD 0.94; change=0.84; P =.03). Between December 22, 2011, and May 29, 2014, the game was downloaded 3372 times from the App-Store, with 1526 smokers visiting the online resource www.decide2quit.org linked to the game. Conclusions: Overall, playing the game resulted in small, but nonsignificant decreases in cravings, with changes greater for those had already quit for more than 48 hours. Lessons learned can inform further development. Future research could incorporate mHealth games in multicomponent cessation interventions. Trial Registration: Clinicaltrials.gov NCT00797628; https://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/6hbJr6LWG) UR - http://games.jmir.org/2016/1/e3/ UR - http://dx.doi.org/10.2196/games.4566 UR - http://www.ncbi.nlm.nih.gov/pubmed/27229772 ID - info:doi/10.2196/games.4566 ER - TY - JOUR AU - Dang, Thuy Linh AU - Vu, Cong Nguyen AU - Vu, Dinh Thiem AU - James, L. Spencer AU - Katona, Peter AU - Katona, Lindsay AU - Rosen, M. Joseph AU - Nguyen, Kieu Cuong PY - 2016/05/25 TI - Perceptions of the Feasibility and Practicalities of Text Messaging-Based Infectious Disease Surveillance: A Questionnaire Survey JO - JMIR mHealth uHealth SP - e65 VL - 4 IS - 2 KW - SMS KW - SMS-based KW - infectious diseases KW - text messaging KW - surveillance KW - Vietnam N2 - Background: In Vietnam, infectious disease surveillance data are collected via a paper-based system through four government tiers leading to a large delay. Meanwhile, mobile phones are abundant and very popular in the country, and known to be a useful tool in health care worldwide. Therefore, there is a great potential for the development of a timely disease surveillance system through the use of mobile phone short message service (SMS) text messages. Objective: This study aims to explore insights about the feasibility and practicalities of the utilization of SMS text messaging-based interventions in disease-reporting systems by identifying potential challenges and barriers in the text messaging process and looking at lessons learned. Methods: An SMS text messaging-based disease tracking system was set up in Vietnam with patient reports texted by clinic staff. Two 6-month trials utilizing this disease tracking system were designed and implemented in two northern provinces of Vietnam to report two infectious diseases: diarrhea and influenza-like illness. A structured self-reported questionnaire was developed to measure the feasibility and practicalities of the system from the participants. On the completion of the second trial in 2013, participating health staff from 40 commune health centers in the two pilot provinces were asked to complete the survey (N=80). Results: Most participants were female (61%, 49/80) and nearly half (44%, 35/80) were heads of a commune health center. Approximately two-thirds (63%, 50/80) of participants retained the basic structure of the SMS text message report and there was a strong influence (OR 28.2, 95% CI 5.3-151.2) of those people on the time they spent texting the information. The majority (88%, 70/80) felt the information conveyed in the SMS text message report was not difficult to understand. Most (86%, 69/80) believed that they could report all 28 infectious diseases asked for by the Ministry of Health by using SMS text messaging. Conclusions: From a health center staff perspective, a disease-reporting system utilizing text messaging technology is easy to use and has great potential to be implemented and expanded nationwide. The survey showed positive perceptions and feedback from the participants and contributed to a promising practical solution to improve the surveillance system of infectious disease in Vietnam. UR - http://mhealth.jmir.org/2016/2/e65/ UR - http://dx.doi.org/10.2196/mhealth.4509 UR - http://www.ncbi.nlm.nih.gov/pubmed/27226418 ID - info:doi/10.2196/mhealth.4509 ER - TY - JOUR AU - Milward, Joanna AU - Khadjesari, Zarnie AU - Fincham-Campbell, Stephanie AU - Deluca, Paolo AU - Watson, Rod AU - Drummond, Colin PY - 2016/05/24 TI - User Preferences for Content, Features, and Style for an App to Reduce Harmful Drinking in Young Adults: Analysis of User Feedback in App Stores and Focus Group Interviews JO - JMIR mHealth uHealth SP - e47 VL - 4 IS - 2 KW - alcohol KW - drinking KW - young adults KW - mhealth KW - brief intervention KW - apps KW - smartphone KW - digital KW - focus group N2 - Background: Electronic screening and brief intervention (eSBI) is effective in reducing weekly alcohol consumption when delivered by a computer. Mobile phone apps demonstrate promise in delivering eSBI; however, few have been designed with an evidence-based and user-informed approach. Objective: This study aims to explore from a user perspective, preferences for content, appearance, and operational features to inform the design of a mobile phone app for reducing quantity and frequency of drinking in young adults engaged in harmful drinking (18-30 year olds). Methods: Phase 1 included a review of user reviews of available mobile phone apps that support a reduction in alcohol consumption. Apps were identified on iTunes and Google Play and were categorized into alcohol reduction support, entertainment, blood alcohol content measurement (BAC), or other. eSBI apps with ?18 user reviews were subject to a content analysis, which coded praise, criticism, and recommendations for app content, functionality, and esthetics. Phase 2 included four focus groups with young adults drinking at harmful levels and residing in South London to explore their views on existing eSBI apps and preferences for future content, functionality, and appearance. Detailed thematic analysis of the data was undertaken. Results: In Phase 1, of the 1584 apps extracted, 201 were categorized as alcohol reduction, 154 as BAC calculators, 509 as entertainment, and 720 as other. We classified 32 apps as eSBI apps. Four apps had ?18 user reviews: Change for Life Drinks Tracker, Drinksmeter, Drinkaware, and Alcohol Units Calculator. The highest proportion of content praises were for information and feedback provided in the apps (12/27, 44%), followed by praise for the monitoring features (5/27, 19%). Many (8/12, 67%) criticisms were for the drinking diary; all of these were related to difficulty entering drinks. Over half (18/32, 56%) of functionality criticisms were descriptions of software bugs, and over half of those (10/18, 56%) were for app crashing or freezing. Drinksmeter and Alcohol Units Calculator were the most highly praised apps overall (23/57 and 22/57; 39% of praise overall). In Phase 2, two main themes were identified. The meaningfulness theme reflected how young adults thought apps needed to be tailored to the interests and values of their age group, particularly emphasizing content and feedback around broader health and well-being factors such as exercise, diet, and image. The community theme suggested that young adults want to be able to engage with other app users, both in groups of friends and with online users for motivation and support. Conclusions: Targeted and relevant information and feedback, in addition to easy-to-use monitoring tools, were found to be important features of a mobile phone app to support a reduction in drinking. Future app development should consider tailoring all app aspects to the needs of young adults, considering broader well-being monitoring tools and online community functions. UR - http://mhealth.jmir.org/2016/2/e47/ UR - http://dx.doi.org/10.2196/mhealth.5242 UR - http://www.ncbi.nlm.nih.gov/pubmed/27220371 ID - info:doi/10.2196/mhealth.5242 ER - TY - JOUR AU - Liu, Ying AU - Ren, Wen AU - Qiu, Yan AU - Liu, Juanjuan AU - Yin, Pei AU - Ren, Jingjing PY - 2016/05/24 TI - The Use of Mobile Phone and Medical Apps among General Practitioners in Hangzhou City, Eastern China JO - JMIR mHealth uHealth SP - e64 VL - 4 IS - 2 KW - mobile phone KW - app use KW - general practitioner KW - mobile technology N2 - Background: Mobile phones and mobile phone apps have expanded new forms of health professionals? work. There are many studies on the use of mobile phone apps for different specialists. However, there are no studies on the current use of mobile phone apps among general practitioners (GPs). Objective: The objective of the study was to investigate the extent to which GPs own smartphones with apps and use them to aid their clinical activities. Methods: A questionnaire survey of GPs was undertaken in Hangzhou, Eastern China. Data probing GPs? current use of medical apps in their clinical activities and factors influencing app use were collected and analyzed Results: 125 GPs participated in the survey. 90.4% of GPs owned a mobile phone, with 48.7% owning an iPhone and 47.8% owning an Android phone. Most mobile phone owners had 1-3 medical-related apps, with very few owning more than 4. There was no difference in number of apps between iPhone and Android owners (?2=1.388, P=0.846). 36% of GPs reported using medical-related apps on a daily basis. The majority of doctors reported using apps to aid clinical activities less than 30 minutes per day. Conclusions: A high level of mobile phone ownership and usage among GPs was found in this study, but few people chose medical-related apps to support their clinical practice. UR - http://mhealth.jmir.org/2016/2/e64/ UR - http://dx.doi.org/10.2196/mhealth.4508 UR - http://www.ncbi.nlm.nih.gov/pubmed/27220417 ID - info:doi/10.2196/mhealth.4508 ER - TY - JOUR AU - Scott-Sheldon, J. Lori A. AU - Lantini, Ryan AU - Jennings, G. Ernestine AU - Thind, Herpreet AU - Rosen, K. Rochelle AU - Salmoirago-Blotcher, Elena AU - Bock, C. Beth PY - 2016/05/20 TI - Text Messaging-Based Interventions for Smoking Cessation: A Systematic Review and Meta-Analysis JO - JMIR mHealth uHealth SP - e49 VL - 4 IS - 2 KW - text messaging KW - smoking cessation KW - intervention KW - cigarette smoking KW - meta-analysis N2 - Background: Tobacco use is one of the leading preventable global health problems producing nearly 6 million smoking-related deaths per year. Interventions delivered via text messaging (short message service, SMS) may increase access to educational and support services that promote smoking cessation across diverse populations. Objective: The purpose of this meta-analysis is to (1) evaluate the efficacy of text messaging interventions on smoking outcomes, (2) determine the robustness of the evidence, and (3) identify moderators of intervention efficacy. Methods: Electronic bibliographic databases were searched for records with relevant key terms. Studies were included if they used a randomized controlled trial (RCT) to examine a text messaging intervention focusing on smoking cessation. Raters coded sample and design characteristics, and intervention content. Summary effect sizes, using random-effects models, were calculated and potential moderators were examined. Results: The meta-analysis included 20 manuscripts with 22 interventions (N=15,593; 8128 (54%) women; mean age=29) from 10 countries. Smokers who received a text messaging intervention were more likely to abstain from smoking relative to controls across a number of measures of smoking abstinence including 7-day point prevalence (odds ratio (OR)=1.38, 95% confidence interval (CI)=1.22, 1.55, k=16) and continuous abstinence (OR=1.63, 95% CI=1.19, 2.24, k=7). Text messaging interventions were also more successful in reducing cigarette consumption relative to controls (d+=0.14, 95% CI=0.05, 0.23, k=9). The effect size estimates were biased when participants who were lost to follow-up were excluded from the analyses. Cumulative meta-analysis using the 18 studies (k=19) measuring abstinence revealed that the benefits of using text message interventions were established only after only five RCTs (k=5) involving 8383 smokers (OR=1.39, 95% CI=1.15, 1.67, P<.001). The inclusion of the subsequent 13 RCTs (k=14) with 6870 smokers did not change the established efficacy of text message interventions for smoking abstinence (OR=1.37, 95% CI=1.25, 1.51, P<.001). Smoking abstinence rates were stronger when text messaging interventions (1) were conducted in Asia, North America, or Europe, (2) sampled fewer women, and (3) recruited participants via the Internet. Conclusions: The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well-established. Using text messaging to support quitting behavior, and ultimately long-term smoking abstinence, should be a public health priority. UR - http://mhealth.jmir.org/2016/2/e49/ UR - http://dx.doi.org/10.2196/mhealth.5436 UR - http://www.ncbi.nlm.nih.gov/pubmed/27207211 ID - info:doi/10.2196/mhealth.5436 ER - TY - JOUR AU - Yepes, Maryam AU - Maurer, Jürgen AU - Viswanathan, Barathi AU - Gedeon, Jude AU - Bovet, Pascal PY - 2016/05/20 TI - Potential Reach of mHealth Versus Traditional Mass Media for Prevention of Chronic Diseases: Evidence From a Nationally Representative Survey in a Middle-Income Country in Africa JO - J Med Internet Res SP - e114 VL - 18 IS - 5 KW - digital divide KW - mHealth KW - eHealth KW - mass media KW - mobile phone KW - noncommunicable diseases KW - short message service KW - email KW - internet access KW - developing countries KW - low- and middle-income countries KW - Africa N2 - Background: Public radio and television announcements have a long tradition in public health education. With the global rise of computer and mobile device ownership, short message service (SMS) and email-based health services (mHealth) are promising new tools for health promotion. Objective: Our objectives were to examine 1) self-reported exposure to programs related to noncommunicable diseases (NCDs) on national public television and radio during the 12 months preceding the survey (2013?2014), 2) current ownership of a mobile phone, smartphone, computer, or tablet, and use of the Internet, and 3) willingness of individuals to receive SMS or emails with information on health, with a focus on distribution of these variables across different demographic, socioeconomic status (SES), and NCD risk groups. Methods: We obtained data in a population survey of 1240 participants aged 25?64 years conducted in 2013?2014 in the Seychelles, a rapidly developing small island state in the African region. We administered a structured questionnaire and measured NCD risk factors. Univariate and multivariate analyses explored the relationships between outcomes and sociodemographic variables. Results: Of 1240 participants, 1037 (83.62%) reported exposure to NCD-related programs on public television, while a lower proportion of 740 adults (59.67%), reported exposure via public radio (P <.001). Exposure to NCD-related programs on public television was associated with older age (P <.001) and female sex (P <.001), but not with SES, while exposure to NCD-related programs on public radio was associated with older age (P <.001) and lower SES (P <.001). A total of 1156 (93.22%) owned a mobile phone and ownership was positively associated with female sex (P <.001), younger age (P <.001), and higher SES (P <.001). Only 396 adults (31.93%) owned a smartphone and 244 adults (19.67%) used their smartphone to access the Internet. A total of 1048 adults (84.51%) reported willingness to receive health-related SMS, which was positively associated with female sex (P <.001), younger age (P <.001), and higher SES (P <.001). Controlling for SES, exposure to NCD-related programs on public television or radio and willingness to receive health-related SMS were not independently associated with a person?s NCD risk. Conclusions: Broadcasting health programs through traditional mass media (national public radio and television) reached the majority of the population under study, including older adults and those in lower socioeconomic groups. With a high penetration of mobile phones and willingness to receive health-related SMS, mHealth presents an opportunity for health programs, especially when targeted SMS messages are intended for younger adults and those in higher socioeconomic groups. By contrast, due to reduced Internet access, email-based programs had a more limited reach for health promotion programs. These findings emphasize the different reach of interventions using SMS or email versus traditional mass media, according to demographic and socioeconomic categories, for health education programs in a developing country. UR - http://www.jmir.org/2016/5/e114/ UR - http://dx.doi.org/10.2196/jmir.5592 UR - http://www.ncbi.nlm.nih.gov/pubmed/27207074 ID - info:doi/10.2196/jmir.5592 ER - TY - JOUR AU - Brody, Carinne AU - Dhaliwal, Sukhmani AU - Tuot, Sovannary AU - Johnson, Michael AU - Pal, Khuondyla AU - Yi, Siyan PY - 2016/05/20 TI - Are Text Messages a Feasible and Acceptable Way to Reach Female Entertainment Workers in Cambodia with Health Messages? A Cross-Sectional Phone Survey JO - JMIR mHealth uHealth SP - e52 VL - 4 IS - 2 KW - mHealth KW - short message service KW - Cambodia KW - female sex workers KW - HIV N2 - Background: Despite great achievements in reducing the prevalence of HIV, eliminating new HIV infections remains a challenge in Cambodia. Entertainment venues such as restaurants, karaoke bars, beer gardens, cafes, pubs, and massage parlors are now considered important venues for HIV prevention efforts and other health outreach interventions. Objective: The purpose of this study was to explore phone use and texting practices of female entertainment workers (FEWs) in order to determine if text messaging is a feasible and acceptable way to link FEWs to health services. Methods: This cross-sectional phone survey was conducted in May 2015 with 97 FEWs aged 18?35 years and currently working at an entertainment venue in Phnom Penh. Results: Of the 96 respondents, 51% reported sending text messages daily; of them, 47% used Khmer script and 45% used Romanized Khmer. Younger FEWs were more likely to report daily texting (P<.001). Most FEWs (98%) in this study reported feeling comfortable receiving private health messages despite the fact that 39% were sharing their phone with others. Younger FEWs were less likely to share their phone with others (P=.02). Of all of the FEWs, 47% reported owning a smartphone, and younger women were more likely to own a smartphone than were older women (P=.08). Conclusions: The findings from this study support the development of mHealth interventions targeting high-risk groups in urban areas of Cambodia. Our data suggest that mHealth interventions using texting may be a feasible way of reaching FEWs in Phnom Penh. UR - http://mhealth.jmir.org/2016/2/e52/ UR - http://dx.doi.org/10.2196/mhealth.5297 UR - http://www.ncbi.nlm.nih.gov/pubmed/27207374 ID - info:doi/10.2196/mhealth.5297 ER - TY - JOUR AU - Jamal, Amr AU - Temsah, Mohamad-Hani AU - Khan, A. Samina AU - Al-Eyadhy, Ayman AU - Koppel, Cristina AU - Chiang, F. Michael PY - 2016/05/19 TI - Mobile Phone Use Among Medical Residents: A Cross-Sectional Multicenter Survey in Saudi Arabia JO - JMIR Mhealth Uhealth SP - e61 VL - 4 IS - 2 KW - cell phones KW - mobile phone KW - telemedicine KW - medical education KW - medical residencies KW - educational techniques KW - patient care KW - communication methods KW - WhatsApp KW - Saudi Arabia KW - point of care technology N2 - Background: Mobile phones have great potential for medical education, as they allow health care providers and students to access resources efficiently at the precise time at the point-of-care to help in informed decision making. Objective: The objective of the study was to evaluate the prevalence of mobile phone usage among medical residents and to explore their attitudes, perceptions, and the challenges they experience when using mobile phones in academic and clinical practice. Methods: A cross-sectional survey was conducted on all 133 residents in 17 different specialties across two large academic hospitals in Riyadh, Saudi Arabia. The Web-based validated questionnaire measured mobile phone platform preferences, and their uses in general and medical practice. The perception of confidentiality and safety impact of using mobile phones for communication and accessing patient?s data was also explored, alongside challenges of use and how residents learn to use their mobile phone. Results: With a response rate of 101/133 (75.9%) and mean age of 27.8 (SD 3.0) years, we found that 100/101 (99.0%) of participants were mobile phone users with mean duration of use of 5.12 (SD 2.4) years, and a range from 1 to 12 years. There was no significant difference in use between male and female respondents. A negative linear correlation was found between age and use duration (P=.004). The most common operating system used by participants was the iOS platform (55/101, 54.5%), with English the most commonly used language to operate residents? mobile phones (96/100, 96.0%) despite their native language being Arabic. For communication outside medical practice, chatting applications such as WhatsApp matched phone calls as most commonly used tools (each 88/101, 87.1%). These were also the primary tools for medical communication, but used at a lower rate (each 65/101, 64.4%). In medical practice, drug (83/101, 82.2%) and medical (80/101, 79.2%) references and medical calculation applications (61/101, 60.4%) were the most commonly used. Short battery life (48/92, 52%) was the most common technical difficulty, and distraction at least on a weekly basis (54/92, 58%) was the most likely side effect of using a mobile phone in medical practice. Practically, all participants agreed with the idea of integrating medical staff mobile phones with the hospital information system. Most residents described themselves as self-learners, while half learned from peers, and a quarter learned from the Internet. Only 7/101 (6.9%) had received formal training on the medical use of mobile phones. Over half of residents thought it was safe to discuss patients over their personal, nonencrypted email. Conclusions: Mobile phone use among medical residents has become almost universal in academic and clinical settings. Thus, academic and health care institutions should support proper utilization of these devices in medical training and point-of-care decision making, while continuing to protect patient confidentiality. UR - http://mhealth.jmir.org/2016/2/e61/ UR - http://dx.doi.org/10.2196/mhealth.4904 UR - http://www.ncbi.nlm.nih.gov/pubmed/27197618 ID - info:doi/10.2196/mhealth.4904 ER - TY - JOUR AU - Mummah, Ann Sarah AU - Mathur, Maya AU - King, C. Abby AU - Gardner, D. Christopher AU - Sutton, Stephen PY - 2016/05/18 TI - Mobile Technology for Vegetable Consumption: A Randomized Controlled Pilot Study in Overweight Adults JO - JMIR mHealth uHealth SP - e51 VL - 4 IS - 2 KW - health behavior KW - cell phones KW - telemedicine KW - eating KW - diet KW - vegetables KW - randomized controlled trial KW - pilot projects N2 - Background: Mobile apps present a potentially cost-effective tool for delivering behavior change interventions at scale, but no known studies have tested the efficacy of apps as a tool to specifically increase vegetable consumption among overweight adults. Objective: The purpose of this pilot study was to assess the initial efficacy and user acceptability of a theory-driven mobile app to increase vegetable consumption. Methods: A total of 17 overweight adults aged 42.0 (SD 7.3) years with a body mass index (BMI) of 32.0 (SD 3.5) kg/m2 were randomized to the use of Vegethon (a fully automated theory-driven mobile app enabling self-monitoring of vegetable consumption, goal setting, feedback, and social comparison) or a wait-listed control condition. All participants were recruited from an ongoing 12-month weight loss trial (parent trial). Researchers who performed data analysis were blinded to condition assignment. The primary outcome measure was daily vegetable consumption, assessed using an adapted version of the validated Harvard Food Frequency Questionnaire administered at baseline and 12 weeks after randomization. An analysis of covariance was used to assess differences in 12-week vegetable consumption between intervention and control conditions, controlling for baseline. App usability and satisfaction were measured via a 21-item post-intervention questionnaire. Results: Using intention-to-treat analyses, all enrolled participants (intervention: 8; control: 9) were analyzed. Of the 8 participants randomized to the intervention, 5 downloaded the app and logged their vegetable consumption a mean of 0.7 (SD 0.9) times per day, 2 downloaded the app but did not use it, and 1 never downloaded it. Consumption of vegetables was significantly greater among the intervention versus control condition at the end of the 12-week pilot study (adjusted mean difference: 7.4 servings; 95% CI 1.4-13.5; P=.02). Among secondary outcomes defined a priori, there was significantly greater consumption of green leafy vegetables, cruciferous vegetables, and dark yellow vegetables (adjusted mean difference: 2.6, 1.6, and 0.8 servings; 95% CI 0.1-5.0, 0.1-3.2, and 0.3-1.4; P=.04, P=.04, and P=.004, respectively). Participants reported positive experiences with the app, including strong agreement with the statements ?I have found Vegethon easy to use? and ?I would recommend Vegethon to a friend? (mean 4.6 (SD 0.6) and 4.2 (SD 0.8), respectively, (on a 5-point scale). Conclusions: Vegethon demonstrated initial efficacy and user acceptability. A mobile app intervention may be useful for increasing vegetable consumption among overweight adults. The small sample size prevented precise estimates of effect sizes. Given the improved health outcomes associated with increases in vegetable consumption, these findings indicate the need for larger, longer-term evaluations of Vegethon and similar technologies among overweight adults and other suitable target groups. Trial Registration: ClinicalTrials.gov NCT01826591; https://clinicaltrials.gov/ct2/show/NCT01826591 (Archived by WebCite at http://www.webcitation.org/6hYDw2AOB) UR - http://mhealth.jmir.org/2016/2/e51/ UR - http://dx.doi.org/10.2196/mhealth.5146 UR - http://www.ncbi.nlm.nih.gov/pubmed/27193036 ID - info:doi/10.2196/mhealth.5146 ER - TY - JOUR AU - Gibson, G. Dustin AU - Kagucia, Wangeci E. AU - Ochieng, Benard AU - Hariharan, Nisha AU - Obor, David AU - Moulton, H. Lawrence AU - Winch, J. Peter AU - Levine, S. Orin AU - Odhiambo, Frank AU - O'Brien, L. Katherine AU - Feikin, R. Daniel PY - 2016/05/17 TI - The Mobile Solutions for Immunization (M-SIMU) Trial: A Protocol for a Cluster Randomized Controlled Trial That Assesses the Impact of Mobile Phone Delivered Reminders and Travel Subsidies to Improve Childhood Immunization Coverage Rates and Timeliness in Western Kenya JO - JMIR Res Protoc SP - e72 VL - 5 IS - 2 KW - text message KW - reminders KW - SMS KW - M-PESA KW - Kenya KW - mobile KW - conditional cash transfer KW - CCT KW - incentive KW - measles KW - mHealth KW - immunization KW - pentavalent N2 - Background: Text message (short message service, SMS) reminders and incentives are two demand-side interventions that have been shown to improve health care?seeking behaviors by targeting participant characteristics such as forgetfulness, lack of knowledge, and transport costs. Applying these interventions to routine pediatric immunizations may improve vaccination coverage and timeliness. Objective: The Mobile Solutions for Immunization (M-SIMU) trial aims to determine if text message reminders, either with or without mobile phone?based incentives, sent to infant?s parents can improve immunization coverage and timeliness of routine pediatric vaccines in rural western Kenya. Methods: This is a four-arm, cluster, randomized controlled trial. Villages are randomized to one of four study arms prior to enrollment of participants. The study arms are: (1) no intervention (a general health-related text message will be texted to this group at the time of enrollment), (2) text message reminders only, (3) text message reminders and a 75 Kenyan Shilling (KES) incentive, or (4) text message reminders and a KES200 incentive. Participants assigned to study arms 2-4 will receive two text message reminders; sent 3 days before and one day before the scheduled immunization visit at 6, 10, and 14 weeks for polio and pentavalent (containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenza type b antigens) type b antigens) vaccines, and at 9 months for measles vaccine. Participants in incentive arms will, in addition to text message reminders as above, receive mobile phone?based incentives after each timely vaccination, where timely is defined as vaccination within 2 weeks of the scheduled date for each of the four routine expanded program immunization (EPI) vaccination visits. Mother-infant pairs will be followed to 12 months of age where the primary outcome, a fully immunized child, will be ascertained. A fully immunized child is defined as a child receiving vaccines for bacille Calmette-Guerin, three doses of pentavalent and polio, and measles by 12 months of age. General estimating equation (GEE) models that account for clustering will be employed for primary outcome analyses. Results: Enrollment was completed in October 2014. Twelve month follow-up visits to ascertain immunization status from the maternal and child health booklet were completed in February 2016. Conclusions: This is one of the first studies to examine the effect of text message reminders on immunization coverage and timeliness in a lower income country and is the first study to assess the effect of mobile money-based incentives to improve immunization coverage. Trial Registration: Clinicaltrials.gov NCT01878435; https://clinicaltrials.gov/ct2/show/NCT01878435 (Archived by WebCite at http://www.webcitation.org/6hQlwGYJR) UR - http://www.researchprotocols.org/2016/2/e72/ UR - http://dx.doi.org/10.2196/resprot.5030 UR - http://www.ncbi.nlm.nih.gov/pubmed/27189422 ID - info:doi/10.2196/resprot.5030 ER - TY - JOUR AU - Whitehead, Lisa AU - Seaton, Philippa PY - 2016/05/16 TI - The Effectiveness of Self-Management Mobile Phone and Tablet Apps in Long-term Condition Management: A Systematic Review JO - J Med Internet Res SP - e97 VL - 18 IS - 5 KW - mobile phone KW - apps KW - telemedicine KW - mHealth KW - self-management KW - chronic disease KW - diabetes mellitus KW - cardiovascular diseases KW - lung diseases KW - systematic review N2 - Background: Long-term conditions and their concomitant management place considerable pressure on patients, communities, and health care systems worldwide. International clinical guidelines on the majority of long-term conditions recommend the inclusion of self-management programs in routine management. Self-management programs have been associated with improved health outcomes; however, the successful and sustainable transfer of research programs into clinical practice has been inconsistent. Recent developments in mobile technology, such as mobile phone and tablet computer apps, could help in developing a platform for the delivery of self-management interventions that are adaptable, of low cost, and easily accessible. Objective: We conducted a systematic review to assess the effectiveness of mobile phone and tablet apps in self-management of key symptoms of long-term conditions. Methods: We searched PubMed, Embase, EBSCO databases, the Cochrane Library, and The Joanna Briggs Institute Library for randomized controlled trials that assessed the effectiveness of mobile phone and tablet apps in self-management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 2005?2016. We searched registers of current and ongoing trials, as well as the gray literature. We then checked the reference lists of all primary studies and review papers for additional references. The last search was run in February 2016. Results: Of the 9 papers we reviewed, 6 of the interventions demonstrated a statistically significant improvement in the primary measure of clinical outcome. Where the intervention comprised an app only, 3 studies demonstrated a statistically significant improvement. Interventions to address diabetes mellitus (5/9) were the most common, followed by chronic lung disease (3/9) and cardiovascular disease (1/9). A total of 3 studies included multiple intervention groups using permutations of an intervention involving an app. The duration of the intervention ranged from 6 weeks to 1 year, and final follow-up data ranged from 3 months to 1 year. Sample size ranged from 48 to 288 participants. Conclusions: The evidence indicates the potential of apps in improving symptom management through self-management interventions. The use of apps in mHealth has the potential to improve health outcomes among those living with chronic diseases through enhanced symptom control. Further innovation, optimization, and rigorous research around the potential of apps in mHealth technology will move the field toward the reality of improved health care delivery and outcomes. UR - http://www.jmir.org/2016/5/e97/ UR - http://dx.doi.org/10.2196/jmir.4883 UR - http://www.ncbi.nlm.nih.gov/pubmed/27185295 ID - info:doi/10.2196/jmir.4883 ER - TY - JOUR AU - LeGrand, Sara AU - Muessig, Elizabeth Kathryn AU - McNulty, Tobias AU - Soni, Karina AU - Knudtson, Kelly AU - Lemann, Alex AU - Nwoko, Nkechinyere AU - Hightow-Weidman, B. Lisa PY - 2016/05/13 TI - Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men JO - JMIR Serious Games SP - e6 VL - 4 IS - 1 KW - mobile applications KW - video games KW - serious games KW - HIV KW - medication adherence KW - health knowledge, attitudes, practice KW - youth KW - men who have sex with men N2 - Background: In the United States, the human immunodeficiency virus (HIV) disproportionately affects young men who have sex with men (YMSM). For HIV-positive individuals, adherence to antiretroviral therapy (ART) is critical for achieving optimal health outcomes and reducing secondary transmission of HIV. However, YMSM often struggle with ART adherence. Novel mobile phone apps that incorporate game-based mechanics and social networking elements represent a promising intervention approach for improving ART adherence among YMSM. Objective: This study used a multiphase, iterative development process to create an ART adherence app for YMSM. Methods: The three-phase development process included: (1) theory-based concept development jointly by public health researchers and the technology team, (2) assessment of the target population?s ART adherence needs and app preferences and development and testing of a clickable app prototype, and (3) development and usability testing of the final app prototype. Results: The initial theory-based app concept developed in Phase One included medication reminders, daily ART adherence tracking and visualization, ART educational modules, limited virtual interactions with other app users, and gamification elements. In Phase Two, adherence needs, including those related to information, motivation, and behavioral skills, were identified. Participants expressed preferences for an ART adherence app that was informational, interactive, social, and customizable. Based on the findings from Phase Two, additional gaming features were added in Phase Three, including an interactive battle, superhero app theme, and app storyline. Other features were modified to increase interactivity and customization options and integrate the game theme. During usability testing of the final prototype, participants were able to understand and navigate the app successfully and rated the app favorably. Conclusions: An iterative development process was critical for the development of an ART adherence game app that was viewed as highly acceptable, relevant, and useful by YMSM. UR - http://games.jmir.org/2016/1/e6/ UR - http://dx.doi.org/10.2196/games.5687 UR - http://www.ncbi.nlm.nih.gov/pubmed/27178752 ID - info:doi/10.2196/games.5687 ER - TY - JOUR AU - Iribarren, J. Sarah AU - Schnall, Rebecca AU - Stone, W. Patricia AU - Carballo-Diéguez, Alex PY - 2016/05/13 TI - Smartphone Applications to Support Tuberculosis Prevention and Treatment: Review and Evaluation JO - JMIR mHealth uHealth SP - e25 VL - 4 IS - 2 KW - mobile apps KW - mobile health KW - tuberculosis KW - review N2 - Background: Tuberculosis (TB) remains a major global health problem and is the leading killer due to a single infectious disease. Mobile health (mHealth)?based tools such as smartphone apps have been suggested as tools to support TB control efforts (eg, identification, contact tracing, case management including patient support). Objective: The purpose of this review was to identify and assess the functionalities of mobile apps focused on prevention and treatment of TB. Methods: We searched 3 online mobile app stores. Apps were included if they were focused on TB and were in English, Spanish, or Portuguese. For each included app, 11 functionalities were assessed (eg, inform, instruct, record), and searches were conducted to identify peer-review publications of rigorous testing of the available apps. Results: A total of 1332 potentially relevant apps were identified, with 24 meeting our inclusion criteria. All of the apps were free to download, but 7 required login and password and were developed for specific clinics, regional sites, or research studies. Targeted users were mainly clinicians (n=17); few (n=4) apps were patient focused. Most apps (n=17) had 4 or fewer functions out of 11 (range 1-6). The most common functionalities were inform and record (n=15). Although a number of apps were identified with various functionalities to support TB efforts, some had issues such as incorrect spelling and grammar, inconsistent responses to data entry, problems with crashing, or links to features that had no data. Of more concern, some apps provided potentially harmful information to patients, such as links to natural remedies for TB and natural healers. One-third of the apps (8/24) had not been updated for more than a year and may no longer be supported. Peer-reviewed publications were identified for only two of the included apps. In the gray literature (not found in the app stores), three TB-related apps were identified as in progress, being launched, or tested. Conclusions: Apps identified for TB prevention and treatment had minimal functionality, primarily targeted frontline health care workers, and focused on TB information (eg, general information, guidelines, and news) or data collection (eg, replace paper-based notification or tracking). Few apps were developed for use by patients and none were developed to support TB patient involvement and management in their care (eg, follow-up alerts/reminders, side effects monitoring) or improve interaction with their health care providers, limiting the potential of these apps to facilitate patient-centered care. Our evaluation shows that more refined work is needed to be done in the area of apps to support patients with active TB. Involving TB patients in treatment in the design of these apps is recommended. UR - http://mhealth.jmir.org/2016/2/e25/ UR - http://dx.doi.org/10.2196/mhealth.5022 UR - http://www.ncbi.nlm.nih.gov/pubmed/27177591 ID - info:doi/10.2196/mhealth.5022 ER - TY - JOUR AU - Rodis, Jennifer AU - Aungst, Dy Timothy AU - Brown, V. Nicole AU - Cui, Yan AU - Tam, Leonard PY - 2016/05/12 TI - Enhancing Pharmacy Student Learning and Perceptions of Medical Apps JO - JMIR mHealth uHealth SP - e55 VL - 4 IS - 2 KW - mobile applications KW - pharmacy KW - students KW - health care N2 - Background: The use of mobile apps in health care is growing. Current and future practitioners must be equipped with the skills to navigate and utilize apps in patient care, yet few strategies exist for training health care professional students on the usage of apps. Objective: To characterize first-year pharmacy student use of medical apps, evaluate first-year pharmacy student's perception of skills in finding, evaluating, and using medical apps before and after a focused learning experience, and assess student satisfaction and areas for improvement regarding the learning experience. Methods: Students listened to a recorded, Web-based lecture on finding, evaluating, and using mobile apps in patient care. A 2-hour, interactive workshop was conducted during which students were led by an instructor through a discussion on strategies for finding and using apps in health care. The students practiced evaluating 6 different health care?related apps. Surveys were conducted before and after the focused learning experience to assess students' perceptions of medical apps and current use and perspectives on satisfaction with the learning experience and role of technology in health care. Results: This educational intervention is the first described formal, interactive method to educate student pharmacists on medical apps. With a 99% response rate, surveys conducted before and after the learning experience displayed perceived improvement in student skills related to finding (52/119, 44% before vs 114/120, 95% after), evaluating (18/119, 15% before vs 112/120, 93% after), and using medical apps in patient care (31/119, 26% before vs 108/120, 90% after) and the health sciences classroom (38/119, 32% before vs 104/120, 87% after). Students described satisfaction with the educational experience and agreed that it should be repeated in subsequent years (89/120, 74% agreed or strongly agreed). Most students surveyed possessed portable electronic devices (107/119, 90% mobile phone) and agreed with the concept of medical apps being an important part of the health care profession in the future (112/119, 94% before and 115/120, 96% after). Conclusions: Student pharmacists recognize the key role technology plays in the future of health care. A medical apps workshop was successful in improving student pharmacists' perceptions of ability to find, evaluate, and use medical apps. UR - http://mhealth.jmir.org/2016/2/e55/ UR - http://dx.doi.org/10.2196/mhealth.4843 UR - http://www.ncbi.nlm.nih.gov/pubmed/27174684 ID - info:doi/10.2196/mhealth.4843 ER - TY - JOUR AU - Muuraiskangas, Salla AU - Harjumaa, Marja AU - Kaipainen, Kirsikka AU - Ermes, Miikka PY - 2016/05/11 TI - Process and Effects Evaluation of a Digital Mental Health Intervention Targeted at Improving Occupational Well-Being: Lessons From an Intervention Study With Failed Adoption JO - JMIR Mental Health SP - e13 VL - 3 IS - 2 KW - acceptance and commitment therapy KW - intervention studies KW - mHealth KW - cccupational health KW - process assessment KW - stress KW - mindfulness KW - attrition KW - adoption N2 - Background: Digital interventions have the potential to serve as cost-effective ways to manage occupational stress and well-being. However, little is known about the adoption of individual-level digital interventions at organizations. Objectives: The aim of this paper is to study the effects of an unguided digital mental health intervention in occupational well-being and the factors that influence the adoption of the intervention. Methods: The intervention was based on acceptance and commitment therapy (ACT) and its aim was to teach skills for stress management and mental well-being. It was delivered via a mobile and a Web-based app that were offered to employees of two information and communication technology (ICT) companies. The primary outcome measures were perceived stress and work engagement, measured by a 1-item stress questionnaire (Stress) and the Utrecht Work Engagement Scale (UWES-9). The intervention process was evaluated regarding the change mechanisms and intervention stages using mixed methods. The initial interviews were conducted face-to-face with human resource managers (n=2) of both companies in August 2013. The participants were recruited via information sessions and email invitations. The intervention period took place between November 2013 and March 2014. The participants were asked to complete online questionnaires at baseline, two months, and four months after the baseline measurement. The final phone interviews for the volunteer participants (n=17) and the human resource managers (n=2) were conducted in April to May 2014, five months after the baseline. Results: Of all the employees, only 27 (8.1%, 27/332) took the app into use, with a mean use of 4.8 (SD 4.7) different days. In the beginning, well-being was on good level in both companies and no significant changes in well-being were observed. The activities of the intervention process failed to integrate the intervention into everyday activities at the workplace. Those who took the app into use experienced many benefits such as relief in stressful situations. The app was perceived as a toolkit for personal well-being that gives concrete instructions on how mindfulness can be practiced. However, many barriers to participate in the intervention were identified at the individual level, such as lack of time, lack of perceived need, and lack of perceived benefits. Conclusions: The findings suggest that neither the setting nor the approach used in this study were successful in adopting new digital interventions at the target organizations. Barriers were faced at both the organizational as well as the individual level. At the organizational level, top management needs to be involved in the intervention planning for fitting into the organization policies, the existing technology infrastructure, and also targeting the organizational goals. At the individual level, concretizing the benefits of the preventive intervention and arranging time for app use at the workplace are likely to increase adoption. UR - http://mental.jmir.org/2016/2/e13/ UR - http://dx.doi.org/10.2196/mental.4465 UR - http://www.ncbi.nlm.nih.gov/pubmed/27170553 ID - info:doi/10.2196/mental.4465 ER - TY - JOUR AU - Rhyner, Daniel AU - Loher, Hannah AU - Dehais, Joachim AU - Anthimopoulos, Marios AU - Shevchik, Sergey AU - Botwey, Henry Ransford AU - Duke, David AU - Stettler, Christoph AU - Diem, Peter AU - Mougiakakou, Stavroula PY - 2016/05/11 TI - Carbohydrate Estimation by a Mobile Phone-Based System Versus Self-Estimations of Individuals With Type 1 Diabetes Mellitus: A Comparative Study JO - J Med Internet Res SP - e101 VL - 18 IS - 5 KW - diabetes mellitus, type 1 KW - carbohydrate counting KW - computer vision systems KW - food recognition KW - meal assessment KW - mobile phone KW - food volume estimation N2 - Background: Diabetes mellitus is spreading throughout the world and diabetic individuals have been shown to often assess their food intake inaccurately; therefore, it is a matter of urgency to develop automated diet assessment tools. The recent availability of mobile phones with enhanced capabilities, together with the advances in computer vision, have permitted the development of image analysis apps for the automated assessment of meals. GoCARB is a mobile phone-based system designed to support individuals with type 1 diabetes during daily carbohydrate estimation. In a typical scenario, the user places a reference card next to the dish and acquires two images using a mobile phone. A series of computer vision modules detect the plate and automatically segment and recognize the different food items, while their 3D shape is reconstructed. Finally, the carbohydrate content is calculated by combining the volume of each food item with the nutritional information provided by the USDA Nutrient Database for Standard Reference. Objective: The main objective of this study is to assess the accuracy of the GoCARB prototype when used by individuals with type 1 diabetes and to compare it to their own performance in carbohydrate counting. In addition, the user experience and usability of the system is evaluated by questionnaires. Methods: The study was conducted at the Bern University Hospital, ?Inselspital? (Bern, Switzerland) and involved 19 adult volunteers with type 1 diabetes, each participating once. Each study day, a total of six meals of broad diversity were taken from the hospital?s restaurant and presented to the participants. The food items were weighed on a standard balance and the true amount of carbohydrate was calculated from the USDA nutrient database. Participants were asked to count the carbohydrate content of each meal independently and then by using GoCARB. At the end of each session, a questionnaire was completed to assess the user?s experience with GoCARB. Results: The mean absolute error was 27.89 (SD 38.20) grams of carbohydrate for the estimation of participants, whereas the corresponding value for the GoCARB system was 12.28 (SD 9.56) grams of carbohydrate, which was a significantly better performance ( P=.001). In 75.4% (86/114) of the meals, the GoCARB automatic segmentation was successful and 85.1% (291/342) of individual food items were successfully recognized. Most participants found GoCARB easy to use. Conclusions: This study indicates that the system is able to estimate, on average, the carbohydrate content of meals with higher accuracy than individuals with type 1 diabetes can. The participants thought the app was useful and easy to use. GoCARB seems to be a well-accepted supportive mHealth tool for the assessment of served-on-a-plate meals. UR - http://www.jmir.org/2016/5/e101/ UR - http://dx.doi.org/10.2196/jmir.5567 UR - http://www.ncbi.nlm.nih.gov/pubmed/27170498 ID - info:doi/10.2196/jmir.5567 ER - TY - JOUR AU - Allen, Nelson Luke AU - Christie, Pepall Gillian PY - 2016/05/10 TI - The Emergence of Personalized Health Technology JO - J Med Internet Res SP - e99 VL - 18 IS - 5 KW - personalized health technology KW - population health KW - frugal innovation KW - ethics KW - socioeconomic factors, inequalities KW - technology, health UR - http://www.jmir.org/2016/5/e99/ UR - http://dx.doi.org/10.2196/jmir.5357 UR - http://www.ncbi.nlm.nih.gov/pubmed/27165944 ID - info:doi/10.2196/jmir.5357 ER - TY - JOUR AU - Lodhia, Vaishali AU - Karanja, Sarah AU - Lees, Shelley AU - Bastawrous, Andrew PY - 2016/05/09 TI - Acceptability, Usability, and Views on Deployment of Peek, a Mobile Phone mHealth Intervention for Eye Care in Kenya: Qualitative Study JO - JMIR mHealth uHealth SP - e30 VL - 4 IS - 2 KW - mobile phone KW - mHealth KW - qualitative KW - ophthalmic testing KW - acceptability KW - usability KW - Kenya N2 - Background: The Portable Eye Examination Kit (Peek) is a mobile phone?based ophthalmic testing system that has been developed to perform comprehensive eye examinations. Shortages in ophthalmic personnel, the high cost, and the difficulty in transporting equipment have made it challenging to offer services, particularly in rural areas. Peek offers a solution for overcoming barriers of limited access to traditional ophthalmic testing methods and has been pilot tested on adults in Nakuru, Kenya, and compared with traditional eye examination tools. Objective: This qualitative study evaluated the acceptability and usability of Peek in addition to perceptions regarding its adoption and nationwide deployment. Methods: Semistructured interviews were conducted with patients and analyzed using a framework approach. This included analysis of interviews from 20 patients, 8 health care providers (HCPs), and 4 key decision makers in ophthalmic health care provision in Kenya. The participants were purposefully sampled. The coding structure involved predefined themes for assessing the following: (1) the context, that is, environment, user, task, and technology; (2) patient acceptability, that is, patients' perceived benefits, patient preference, and patient satisfaction; (3) usability, that is, efficiency, effectiveness, learnability, and flexibility and operability of Peek; and (4) the benefits of Peek in strengthening eye care provision, that is, capabilities enhancer, opportunity creator, social enabler, and knowledge generator. Emerging themes relating to the objectives were explored from the data using thematic analysis. Results: Patients found Peek to be acceptable because of its benefits in overcoming the barriers to accessing ophthalmic services. Most thought it to be fast, convenient, and able to reach a large population. All patients expressed being satisfied with Peek. The HCPs perceived it to satisfy the criteria for usability and found Peek to be acceptable based on the technology acceptance model. Peek was also found to have features required for strengthening ophthalmic delivery by aiding detection and diagnosis, provision of decision support, improving communication between provider and patient and among providers, linking patients to services, monitoring, and assisting in education and training. Some of the deployment-related issues included the need for government and community involvement, communication and awareness creation, data protection, infrastructure development including capacity creation, and training and maintenance support. Conclusions: According to all parties interviewed, Peek is an acceptable solution, as it provides a beneficial service, supports patients' needs, and fulfills HCPs' roles, overall contributing to strengthening eye health. UR - http://mhealth.jmir.org/2016/2/e30/ UR - http://dx.doi.org/10.2196/mhealth.4746 UR - http://www.ncbi.nlm.nih.gov/pubmed/27160779 ID - info:doi/10.2196/mhealth.4746 ER - TY - JOUR AU - Finkelstein, Joseph AU - Cha, Me Eun PY - 2016/05/06 TI - Using a Mobile App to Promote Smoking Cessation in Hospitalized Patients JO - JMIR mHealth uHealth SP - e59 VL - 4 IS - 2 KW - mobile apps KW - patient engagement KW - hospital KW - smoking cessation KW - health literacy N2 - Background: The potential of interactive health education for preventive health applications has been widely demonstrated. However, use of mobile apps to promote smoking cessation in hospitalized patients has not been systematically assessed. Objective: This study was conducted to assess the feasibility of using a mobile app for the hazards of smoking education delivered via touch screen tablets to hospitalized smokers. Methods: Fifty-five consecutive hospitalized smokers were recruited. Patient sociodemographics and smoking history was collected at baseline. The impact of the mobile app was assessed by measuring cognitive and behavioral factors shown to promote smoking cessation before and after the mobile app use including hazards of smoking knowledge score (KS), smoking attitudes, and stages of change. Results: After the mobile app use, mean KS increased from 27(3) to 31(3) (P<0.0001). Proportion of patients who felt they ?cannot quit smoking? reduced from 36% (20/55) to 18% (10/55) (P<0.03). Overall, 13% (7/55) of patients moved toward a more advanced stage of change with the proportion of patients in the preparation stage increased from 40% (22/55) to 51% (28/55). Multivariate regression analysis demonstrated that knowledge gains and mobile app acceptance did not depend on age, gender, race, computer skills, income, or education level. The main factors affecting knowledge gain were initial knowledge level (P<0.02), employment status (P<0.05), and high app acceptance (P<0.01). Knowledge gain was the main predictor of more favorable attitudes toward the mobile app (odds ratio (OR)=4.8; 95% confidence interval (CI) (1.1, 20.0)). Attitudinal surveys and qualitative interviews identified high acceptance of the mobile app by hospitalized smokers. Over 92% (51/55) of the study participants recommended the app for use by other hospitalized smokers and 98% (54/55) of the patients were willing to use such an app in the future. Conclusions: Our results suggest that a mobile app promoting smoking cessation is well accepted by hospitalized smokers. The app can be used for interactive patient education and counseling during hospital stays. Development and evaluation of mobile apps engaging patients in their care during hospital stays is warranted. UR - http://mhealth.jmir.org/2016/2/e59/ UR - http://dx.doi.org/10.2196/mhealth.5149 UR - http://www.ncbi.nlm.nih.gov/pubmed/27154792 ID - info:doi/10.2196/mhealth.5149 ER - TY - JOUR AU - Torous, John AU - Kiang, V. Mathew AU - Lorme, Jeanette AU - Onnela, Jukka-Pekka PY - 2016/05/05 TI - New Tools for New Research in Psychiatry: A Scalable and Customizable Platform to Empower Data Driven Smartphone Research JO - JMIR Mental Health SP - e16 VL - 3 IS - 2 KW - mental health KW - schizophrenia KW - evaluation KW - smartphone KW - informatics N2 - Background: A longstanding barrier to progress in psychiatry, both in clinical settings and research trials, has been the persistent difficulty of accurately and reliably quantifying disease phenotypes. Mobile phone technology combined with data science has the potential to offer medicine a wealth of additional information on disease phenotypes, but the large majority of existing smartphone apps are not intended for use as biomedical research platforms and, as such, do not generate research-quality data. Objective: Our aim is not the creation of yet another app per se but rather the establishment of a platform to collect research-quality smartphone raw sensor and usage pattern data. Our ultimate goal is to develop statistical, mathematical, and computational methodology to enable us and others to extract biomedical and clinical insights from smartphone data. Methods: We report on the development and early testing of Beiwe, a research platform featuring a study portal, smartphone app, database, and data modeling and analysis tools designed and developed specifically for transparent, customizable, and reproducible biomedical research use, in particular for the study of psychiatric and neurological disorders. We also outline a proposed study using the platform for patients with schizophrenia. Results: We demonstrate the passive data capabilities of the Beiwe platform and early results of its analytical capabilities. Conclusions: Smartphone sensors and phone usage patterns, when coupled with appropriate statistical learning tools, are able to capture various social and behavioral manifestations of illnesses, in naturalistic settings, as lived and experienced by patients. The ubiquity of smartphones makes this type of moment-by-moment quantification of disease phenotypes highly scalable and, when integrated within a transparent research platform, presents tremendous opportunities for research, discovery, and patient health. UR - http://mental.jmir.org/2016/2/e16/ UR - http://dx.doi.org/10.2196/mental.5165 UR - http://www.ncbi.nlm.nih.gov/pubmed/27150677 ID - info:doi/10.2196/mental.5165 ER - TY - JOUR AU - Dute, Jantine Denise AU - Bemelmans, Erika Wanda Jose AU - Breda, João PY - 2016/05/05 TI - Using Mobile Apps to Promote a Healthy Lifestyle Among Adolescents and Students: A Review of the Theoretical Basis and Lessons Learned JO - JMIR mHealth uHealth SP - e39 VL - 4 IS - 2 KW - mHealth KW - mobile phones KW - behavior change KW - health promotion KW - physical activity KW - nutrition KW - overweight KW - adolescents and students N2 - Background: European adolescents and students tend to have low levels of physical activity and eat unhealthy foods, and the prevalence of overweight and obesity has increased, which poses a public health challenge. Mobile apps play an important role in their daily lives, suggesting their potential to be used in health-promoting strategies. Objective: This review aimed to explore how mobile apps can contribute to the promotion of healthy nutrition, physical activity, and prevention of overweight in adolescents and students. For the apps identified, the review describes the content, the theoretical mechanisms applied, and lessons learned. Methods: The databases Scopus, MEDLINE, Embase, and PsycINFO were searched for English-language publications from January 2009 to November 2013. Studies were included if (1) the primary component of the intervention involves an app; (2) the intervention targets healthy nutrition, or physical activity, or overweight prevention; and (3) the target group included adolescents or students (aged 12-25 years). Results: A total of 15 studies were included, which describe 12 unique apps. Ten of these apps functioned as monitoring tools for assessing dietary intake or physical activity levels. The other apps used a Web-based platform to challenge users to exercise and to allow users to list and photograph their problem foods. For 5 apps, the behavioral theory underpinning their development was clearly specified. Frequently applied behavior change techniques are prompting self-monitoring of behavior and providing feedback on performance. Apps can function self-contained, but most of them are used as part of therapy or to strengthen school programs. From the age of 10 years users may be capable of using apps. Only 4 apps were developed specifically for adolescents. All apps were tested on a small scale and for a short period. Conclusions: Despite large potential and abundant usage by young people, limited research is available on apps and health promotion for adolescents. Apps seem to be a promising health promotion strategy as a monitoring tool. Apps can enable users to set targets, enhance self?monitoring, and increase awareness. Three apps incorporated social features, making them ?social media,? but hardly any evidence appeared available about their potential. UR - http://mhealth.jmir.org/2016/2/e39/ UR - http://dx.doi.org/10.2196/mhealth.3559 UR - http://www.ncbi.nlm.nih.gov/pubmed/27150850 ID - info:doi/10.2196/mhealth.3559 ER - TY - JOUR AU - Sanders, P. James AU - Loveday, Adam AU - Pearson, Natalie AU - Edwardson, Charlotte AU - Yates, Thomas AU - Biddle, JH Stuart AU - Esliger, W. Dale PY - 2016/05/04 TI - Devices for Self-Monitoring Sedentary Time or Physical Activity: A Scoping Review JO - J Med Internet Res SP - e90 VL - 18 IS - 5 KW - sitting time KW - physical activity KW - measurement KW - feedback KW - activity monitor KW - scoping review N2 - Background: It is well documented that meeting the guideline levels (150 minutes per week) of moderate-to-vigorous physical activity (PA) is protective against chronic disease. Conversely, emerging evidence indicates the deleterious effects of prolonged sitting. Therefore, there is a need to change both behaviors. Self-monitoring of behavior is one of the most robust behavior-change techniques available. The growing number of technologies in the consumer electronics sector provides a unique opportunity for individuals to self-monitor their behavior. Objective: The aim of this study is to review the characteristics and measurement properties of currently available self-monitoring devices for sedentary time and/or PA. Methods: To identify technologies, four scientific databases were systematically searched using key terms related to behavior, measurement, and population. Articles published through October 2015 were identified. To identify technologies from the consumer electronic sector, systematic searches of three Internet search engines were also performed through to October 1, 2015. Results: The initial database searches identified 46 devices and the Internet search engines identified 100 devices yielding a total of 146 technologies. Of these, 64 were further removed because they were currently unavailable for purchase or there was no evidence that they were designed for, had been used in, or could readily be modified for self-monitoring purposes. The remaining 82 technologies were included in this review (73 devices self-monitored PA, 9 devices self-monitored sedentary time). Of the 82 devices included, this review identified no published articles in which these devices were used for the purpose of self-monitoring PA and/or sedentary behavior; however, a number of technologies were found via Internet searches that matched the criteria for self-monitoring and provided immediate feedback on PA (ActiGraph Link, Microsoft Band, and Garmin Vivofit) and sedentary time (activPAL VT, the Lumo Back, and Darma). Conclusions: There are a large number of devices that self-monitor PA; however, there is a greater need for the development of tools to self-monitor sedentary time. The novelty of these devices means they have yet to be used in behavior change interventions, although the growing field of wearable technology may facilitate this to change. UR - http://www.jmir.org/2016/5/e90/ UR - http://dx.doi.org/10.2196/jmir.5373 UR - http://www.ncbi.nlm.nih.gov/pubmed/27145905 ID - info:doi/10.2196/jmir.5373 ER - TY - JOUR AU - Schlosser, Danielle AU - Campellone, Timothy AU - Kim, Daniel AU - Truong, Brandy AU - Vergani, Silvia AU - Ward, Charlie AU - Vinogradov, Sophia PY - 2016/04/28 TI - Feasibility of PRIME: A Cognitive Neuroscience-Informed Mobile App Intervention to Enhance Motivated Behavior and Improve Quality of Life in Recent Onset Schizophrenia JO - JMIR Res Protoc SP - e77 VL - 5 IS - 2 KW - schizophrenia KW - mobile app KW - smartphone KW - motivation KW - technology-based intervention KW - social networking KW - coaching KW - negative symptoms KW - quality of life N2 - Background: Despite improvements in treating psychosis, schizophrenia remains a chronic and debilitating disorder that affects approximately 1% of the US population and costs society more than depression, dementia, and other medical illnesses across most of the lifespan. Improving functioning early in the course of illness could have significant implications for long-term outcome of individuals with schizophrenia. Yet, current gold-standard treatments do not lead to clinically meaningful improvements in outcome, partly due to the inherent challenges of treating a population with significant cognitive and motivational impairments. The rise of technology presents an opportunity to develop novel treatments that may circumvent the motivational and cognitive challenges observed in schizophrenia. Objective: The purpose of this study was two-fold: (1) to evaluate the feasibility and acceptability of implementing a Personalized Real-Time Intervention for Motivation Enhancement (PRIME), a mobile app intervention designed to target reward-processing impairments, enhance motivation, and thereby improve quality of life in recent onset schizophrenia, and (2) evaluate the empirical benefits of using an iterative, user-centered design (UCD) process. Methods: We conducted two design workshops with 15 key stakeholders, followed by a series of in-depth interviews in collaboration with IDEO, a design and innovation firm. The UCD approach ultimately resulted in the first iteration of PRIME, which was evaluated by 10 RO participants. Results from the Stage 1 participants were then used to guide the next iteration that is currently being evaluated in an ongoing RCT. Participants in both phases were encouraged to use the app daily with a minimum frequency of 1/week over a 12-week period. Results: The UCD process resulted in the following feature set: (1) delivery of text message (short message service, SMS)-based motivational coaching from trained therapists, (2) individualized goal setting in prognostically important psychosocial domains, (3) social networking via direct peer-to-peer messaging, and (4) community ?moments feed? to capture and reinforce rewarding experiences and goal achievements. Users preferred an experience that highlighted several of the principles of self-determination theory, including the desire for more control of their future (autonomy and competence) and an approach that helps them improve existing relationships (relatedness). IDEO, also recommended an approach that was casual, friendly, and nonstigmatizing, which is in line with the recovery model of psychosis. After 12-weeks of using PRIME, participants used the app, on average, every other day, were actively engaged with its various features each time they logged in and retention and satisfaction was high (20/20, 100% retention, high satisfaction ratings). The iterative design process lead to a 2- to 3-fold increase in engagement from Stage 1 to Stage 2 in almost each aspect of the platform. Conclusions: These results indicate that the neuroscience-informed mobile app, PRIME, is a feasible and acceptable intervention for young people with schizophrenia. UR - http://www.researchprotocols.org/2016/2/e77/ UR - http://dx.doi.org/10.2196/resprot.5450 UR - http://www.ncbi.nlm.nih.gov/pubmed/27125771 ID - info:doi/10.2196/resprot.5450 ER - TY - JOUR AU - Mercer, Kathryn AU - Li, Melissa AU - Giangregorio, Lora AU - Burns, Catherine AU - Grindrod, Kelly PY - 2016/04/27 TI - Behavior Change Techniques Present in Wearable Activity Trackers: A Critical Analysis JO - JMIR mHealth uHealth SP - e40 VL - 4 IS - 2 KW - older adults KW - physical activity KW - wearables KW - mobile health KW - chronic disease management N2 - Background: Wearable activity trackers are promising as interventions that offer guidance and support for increasing physical activity and health-focused tracking. Most adults do not meet their recommended daily activity guidelines, and wearable fitness trackers are increasingly cited as having great potential to improve the physical activity levels of adults. Objective: The objective of this study was to use the Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy to examine if the design of wearable activity trackers incorporates behavior change techniques (BCTs). A secondary objective was to critically analyze whether the BCTs present relate to known drivers of behavior change, such as self-efficacy, with the intention of extending applicability to older adults in addition to the overall population. Methods: Wearing each device for a period of 1 week, two independent raters used CALO-RE taxonomy to code the BCTs of the seven wearable activity trackers available in Canada as of March 2014. These included Fitbit Flex, Misfit Shine, Withings Pulse, Jawbone UP24, Spark Activity Tracker by SparkPeople, Nike+ FuelBand SE, and Polar Loop. We calculated interrater reliability using Cohen's kappa. Results: The average number of BCTs identified was 16.3/40. Withings Pulse had the highest number of BCTs and Misfit Shine had the lowest. Most techniques centered around self-monitoring and self-regulation, all of which have been associated with improved physical activity in older adults. Techniques related to planning and providing instructions were scarce. Conclusions: Overall, wearable activity trackers contain several BCTs that have been shown to increase physical activity in older adults. Although more research and development must be done to fully understand the potential of wearables as health interventions, the current wearable trackers offer significant potential with regard to BCTs relevant to uptake by all populations, including older adults. UR - http://mhealth.jmir.org/2016/2/e40/ UR - http://dx.doi.org/10.2196/mhealth.4461 UR - http://www.ncbi.nlm.nih.gov/pubmed/27122452 ID - info:doi/10.2196/mhealth.4461 ER - TY - JOUR AU - Yingling, R. Leah AU - Brooks, T. Alyssa AU - Wallen, R. Gwenyth AU - Peters-Lawrence, Marlene AU - McClurkin, Michael AU - Cooper-McCann, Rebecca AU - Wiley Jr, L. Kenneth AU - Mitchell, Valerie AU - Saygbe, N. Johnetta AU - Johnson, D. Twanda AU - Curry, E. Rev Kendrick AU - Johnson, A. Allan AU - Graham, P. Avis AU - Graham, A. Lennox AU - Powell-Wiley, M. Tiffany PY - 2016/04/25 TI - Community Engagement to Optimize the Use of Web-Based and Wearable Technology in a Cardiovascular Health and Needs Assessment Study: A Mixed Methods Approach JO - JMIR mHealth uHealth SP - e38 VL - 4 IS - 2 KW - mHealth KW - physical activity KW - community-based participatory research KW - obesity KW - African Americans KW - activity monitoring KW - qualitative research KW - focus groups KW - community N2 - Background: Resource-limited communities in Washington, D.C. have high rates of obesity-related cardiovascular disease in addition to inadequate physical activity (PA) facilities and limited Internet access. Engaging community members in the design and implementation of studies to address these health disparities is essential to the success of community-based PA interventions. Objective: The objective of the study was to use qualitative and quantitative methods to evaluate the feasibility and acceptability of PA-monitoring wristbands and Web-based technology by predominantly African American, church-based populations in resource-limited Washington, D.C. neighborhoods. Methods: To address cardiovascular health in at-risk populations in Washington, D.C., we joined community leaders to establish a community advisory board, the D.C. Cardiovascular Health and Obesity Collaborative (D.C. CHOC). As their first initiative, the Washington, D.C. Cardiovascular Health and Needs Assessment intends to evaluate cardiovascular health, social determinants of health, and PA-monitoring technologies. At the recommendation of D.C. CHOC members, we conducted a focus group and piloted the proposed PA-monitoring system with community members representing churches that would be targeted by the Cardiovascular Health and Needs Assessment. Participants (n=8) agreed to wear a PA-monitoring wristband for two weeks and to log cardiovascular health factors on a secure Internet account. Wristbands collected accelerometer-based data that participants uploaded to a wireless hub at their church. Participants agreed to return after two weeks to participate in a moderated focus group to share experiences using this technology. Feasibility was measured by Internet account usage, wristband utilization, and objective PA data. Acceptability was evaluated through thematic analysis of verbatim focus group transcripts. Results: Study participants (5 males, 3 females) were African American and age 28-70 years. Participant wristbands recorded data on 10.1±1.6 days. Two participants logged cardiovascular health factors on the website. Focus group transcripts revealed that participants felt positively about incorporating the device into their church-based populations, given improvements were made to device training, hub accessibility, and device feedback. Conclusions: PA-monitoring wristbands for objectively measuring PA appear to be a feasible and acceptable technology in Washington, D.C., resource-limited communities. User preferences include immediate device feedback, hands-on device training, explicit instructions, improved central hub accessibility, and designation of a church member as a trained point-of-contact. When implementing technology-based interventions in resource-limited communities, engaging the targeted community may aid in early identification of issues, suggestions, and preferences. ClinicalTrial: Trial Registration: ClinicalTrials.gov NCT01927783; https://clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/6f8wL117u) UR - http://mhealth.jmir.org/2016/2/e38/ UR - http://dx.doi.org/10.2196/mhealth.4489 UR - http://www.ncbi.nlm.nih.gov/pubmed/27113680 ID - info:doi/10.2196/mhealth.4489 ER - TY - JOUR AU - Arambepola, Carukshi AU - Ricci-Cabello, Ignacio AU - Manikavasagam, Pavithra AU - Roberts, Nia AU - French, P. David AU - Farmer, Andrew PY - 2016/04/19 TI - The Impact of Automated Brief Messages Promoting Lifestyle Changes Delivered Via Mobile Devices to People with Type 2 Diabetes: A Systematic Literature Review and Meta-Analysis of Controlled Trials JO - J Med Internet Res SP - e86 VL - 18 IS - 4 KW - Diabetes mellitus, type 2 KW - mobile health KW - text messaging KW - systematic review KW - diet KW - physical activity KW - self-care N2 - Background: Brief automated messages have the potential to support self-management in people with type 2 diabetes, but their effect compared with usual care is unclear. Objective: To examine the effectiveness of interventions to change lifestyle behavior delivered via automated brief messaging in patients with type 2 diabetes. Methods: A systematic literature review of controlled trials examined the impact of interventions, delivered by brief messaging, and intended to promote lifestyle change in people with type 2 diabetes, on behavioral and clinical outcomes. Bibliographic databases searched included Medline, Embase, CINAHL, PsycINFO, and ISI WoK. Two reviewers independently screened citations. We extracted information on study risk of bias, setting (high versus low- and middle-income countries) and intervention characteristics (including use of theory and behavior-change techniques). Outcome measures included acceptability of the interventions and their impact on 1) determinants of lifestyle behavior (knowledge about diabetes, self-efficacy, attitudes towards self-management), 2) lifestyle behavior (diet, physical activity), and 3) clinical and patient-reported outcomes. Where possible, we pooled data using random-effects meta-analyses to obtain estimates of effect size of intervention compared to usual care. Results: We identified 15 trials (15 interventions) meeting our inclusion criteria. Most interventions were delivered via short message service text messaging (n=12) and simultaneously targeted diet and physical activity (n=11). Nine interventions consisted of unidirectional messages, whereas six consisted of bidirectional messages, with patients receiving automated tailored feedback based on self-reported data. The acceptability of the interventions, and their impact on lifestyle behavior and its determinants, were examined in a low proportion of trials, with heterogeneous results being observed. In 13 trials (1155 patients) where data were available, there was a difference in glycated hemoglobin of -0.53% (95% CI -0.59% to -0.47%) between intervention groups compared to usual care. In five trials (406 patients) there was a non-significant difference in body mass index of -0.25 kg/m2 (95% CI -1.02 to 0.52). Interventions based on unidirectional messages produced similar effects in the outcomes examined, compared to those based on bidirectional messages. Interventions conducted in low- and middle-income countries showed a greater impact than those conducted in high-income countries. In general, trials were not free of bias and did not use explicit theory. Conclusions: Automated brief messages strategies can improve health outcomes in people with type 2 diabetes. Larger, methodologically robust trials are needed to confirm these positive results. UR - http://www.jmir.org/2016/4/e86/ UR - http://dx.doi.org/10.2196/jmir.5425 UR - http://www.ncbi.nlm.nih.gov/pubmed/27095386 ID - info:doi/10.2196/jmir.5425 ER - TY - JOUR AU - French, Sophia Rebecca AU - McCarthy, Ona AU - Baraitser, Paula AU - Wellings, Kaye AU - Bailey, V. Julia AU - Free, Caroline PY - 2016/04/15 TI - Young People?s Views and Experiences of a Mobile Phone Texting Intervention to Promote Safer Sex Behavior JO - JMIR mHealth uHealth SP - e26 VL - 4 IS - 2 KW - text messaging KW - young people KW - sexual health KW - intervention KW - qualitative interviews KW - sexual behavior KW - behavior change N2 - Background: The risk of poor sexual health, including unplanned pregnancy and sexually transmitted infections (STIs), is greatest amongst young people. Innovative and acceptable interventions to improve sexual health are required. Mobile phone text messaging (short message service, SMS) interventions have the potential to reach large numbers of people at relatively low cost, but greater understanding is needed on how these interventions should be developed and how they work. Objectives: The aim of this paper is to explore young people?s views of and experiences with a mobile phone text messaging intervention to promote safer sex behavior. Methods: We undertook qualitative interviews with young people aged 16 to 24 years as part of a pilot trial of a sexual health intervention delivered by text message in the United Kingdom. Study participants received sexual health promotion text messages based on behavior-change techniques. The message content, tailored by gender and STI status, included support for correct STI treatment and promotion of safer sex behaviors. Young people were eligible if they had received a positive chlamydia test or had more than one partner and at least one episode of unprotected sex in the last year. Telephone interviews were conducted 2 to 3 weeks after initiation of the intervention. A semi-structured topic guide was followed to explore participant experiences and a thematic analysis was conducted. Results: We conducted 16 telephone interviews with participants who had received the text intervention and an additional four interviews with those in the control group (13 women and 7 men). Intervention participants found text messages easy to understand and appearing to come from a friendly and trustworthy source. They considered the frequency and timing of messages to be appropriate, and delivery via mobile phones convenient. Receipt of support by text message allowed recipients to assimilate information at their own pace, and prompted reflection on and sharing of messages with friends, family members, and partners, thus providing opportunities for education and discussion. For some recipients, the messages had increased their knowledge of how to correctly use condoms. Some described how the messages had increased their confidence and reduced stigma, enabling them to disclose infection to a partner and/or to do so sooner and more calmly. Discussing the messages with a partner reportedly enabled some women to negotiate condom use. Conclusion: From the perspective of the recipients, the tone, frequency, and content of the text messaging-based sexual health intervention was acceptable and appropriate. Their accounts indicated that the intervention increased knowledge, confidence, and safer sex behaviors. A large-scale randomized controlled trial (RCT) is needed to assess effectiveness. UR - http://mhealth.jmir.org/2016/2/e26/ UR - http://dx.doi.org/10.2196/mhealth.4302 UR - http://www.ncbi.nlm.nih.gov/pubmed/27083784 ID - info:doi/10.2196/mhealth.4302 ER - TY - JOUR AU - Horvath, J. Keith AU - Alemu, Dawit AU - Danh, Thu AU - Baker, V. Jason AU - Carrico, W. Adam PY - 2016/04/15 TI - Creating Effective Mobile Phone Apps to Optimize Antiretroviral Therapy Adherence: Perspectives From Stimulant-Using HIV-Positive Men Who Have Sex With Men JO - JMIR mHealth uHealth SP - e48 VL - 4 IS - 2 KW - smartphone apps KW - technology adoption and use KW - men who have sex with men KW - stimulant drug use KW - HIV N2 - Background: The use of stimulant drugs among men who have sex with men (MSM) with human immunodeficiency virus (HIV) is associated with decreased odds of antiretroviral therapy (ART) adherence and elevated risk of forward HIV transmission. Advancing tailored and innovative mobile phone?based ART adherence app interventions for stimulant-using HIV-positive MSM requires greater understanding of their needs and preferences in this emerging area. Objective: The purpose of this study is to (1) assess reasons that stimulant-using HIV-positive MSM download and sustain their use of mobile phone apps in general, and (2) obtain feedback on features and functions that these men prefer in a mobile phone app to optimize their ART adherence. Methods: Focus groups were conducted with stimulant-using HIV-positive MSM (24-57 years of age; mostly non-Hispanic white; 42% once a week or more frequent stimulant drug use) in San Francisco and Minneapolis. Our aim was to explore the mobile phone app features and functions that they considered when deciding to download and sustain their use of general apps over time, as well as specific features and functions that they would like to see incorporated into an ART adherence mobile app. Focus groups were audiorecorded and transcribed verbatim. Thematic analysis was applied to transcripts using line-by-line open coding and organizing codes into meaningful themes. Results: Men reported that they currently had a variety of health and wellness, social media and networking, gaming and entertainment, and utility apps on their mobile phones. Downloading apps to their mobile phones was influenced by the cost of the app, recommendations by a trusted source, and the time it takes to download. In addition, downloading and sustained use of apps was more likely to occur when men had control over most features of the app and apps were perceived to be useful, engaging, secure, and credible. Participants suggested that ART adherence mobile phone apps include social networking features, connections to local resources and their medical chart, and breaking HIV news and updates. Although some men expressed concerns about daily self-monitoring of HIV medication doses, many appreciated receiving a summary of their medication adherence over time and suggested that feedback about missed doses be delivered in an encouraging and humorous manner. Conclusions: In this study, we were able to recruit a relatively high proportion (42%) of HIV-positive MSM reporting weekly or more stimulant use. These results suggest critical design elements that may need to be considered during development of ART adherence-related mobile phone apps for this, and possibly other, high-risk groups. In particular, finding the optimal balance of security, engagement, usefulness, control capabilities, and credibility will be critical to sustained used of HIV treatment apps. UR - http://mhealth.jmir.org/2016/2/e48/ UR - http://dx.doi.org/10.2196/mhealth.5287 UR - http://www.ncbi.nlm.nih.gov/pubmed/27084049 ID - info:doi/10.2196/mhealth.5287 ER - TY - JOUR AU - Nour, Monica AU - Chen, Juliana AU - Allman-Farinelli, Margaret PY - 2016/04/08 TI - Efficacy and External Validity of Electronic and Mobile Phone-Based Interventions Promoting Vegetable Intake in Young Adults: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e58 VL - 18 IS - 4 KW - young adults KW - vegetable consumption KW - mHealth KW - eHealth KW - social marketing N2 - Background: Young adults (18?35 years) remain among the lowest vegetable consumers in many western countries. The digital era offers opportunities to engage this age group in interventions in new and appealing ways. Objective: This systematic review evaluated the efficacy and external validity of electronic (eHealth) and mobile phone (mHealth) -based interventions that promote vegetable intake in young adults. Methods: We searched several electronic databases for studies published between 1990 and 2015, and 2 independent authors reviewed the quality and risk of bias of the eligible papers and extracted data for analyses. The primary outcome of interest was the change in vegetable intake postintervention. Where possible, we calculated effect sizes (Cohen d and 95% CIs) for comparison. A random effects model was applied to the data for meta-analysis. Reach and representativeness of participants, intervention implementation, and program maintenance were assessed to establish external validity. Published validation studies were consulted to determine the validity of tools used to measure intake. We applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate the overall quality of the body of evidence. Results: Of the 14 studies that met the selection criteria, we included 12 in the meta-analysis. In the meta-analysis, 7 studies found positive effects postintervention for fruit and vegetable intake, Cohen d 0.14?0.56 (pooled effect size 0.22, 95% CI 0.11?0.33, I2=68.5%, P=.002), and 4 recorded positive effects on vegetable intake alone, Cohen d 0.11?0.40 (pooled effect size 0.15, 95% CI 0.04?0.28, I2=31.4%, P=.2). These findings should be interpreted with caution due to variability in intervention design and outcome measures. With the majority of outcomes documented as a change in combined fruit and vegetable intake, it was difficult to determine intervention effects on vegetable consumption specifically. Measurement of intake was most commonly by self-report, with 5 studies using nonvalidated tools. Longer-term follow-up was lacking from most studies (n=12). Risk of bias was high among the included studies, and the overall body of evidence was rated as low quality. The applicability of interventions to the broader young adult community was unclear due to poor description of external validity components. Conclusions: Preliminary evidence suggests that eHealth and mHealth strategies may be effective in improving vegetable intake in young adults; whether these small effects have clinical or nutritional significance remains questionable. With studies predominantly reporting outcomes as fruit and vegetable intake combined, we suggest that interventions report vegetables separately. Furthermore, to confidently establish the efficacy of these strategies, better-quality interventions are needed for young adults, using valid measures of intake, with improved reporting on costs, sustainability and long-term effects of programs. Trial registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42015017763; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015017763 (Archived by WebCite at http://www.webcitation.org/6fLhMgUP4) UR - http://www.jmir.org/2016/4/e58/ UR - http://dx.doi.org/10.2196/jmir.5082 UR - http://www.ncbi.nlm.nih.gov/pubmed/27059765 ID - info:doi/10.2196/jmir.5082 ER - TY - JOUR AU - Wang, Qing AU - Egelandsdal, Bjørg AU - Amdam, V. Gro AU - Almli, L. Valerie AU - Oostindjer, Marije PY - 2016/04/07 TI - Diet and Physical Activity Apps: Perceived Effectiveness by App Users JO - JMIR mHealth uHealth SP - e33 VL - 4 IS - 2 KW - diet app KW - physical activity app KW - perceived effectiveness KW - behavioral changes N2 - Background: Diet and physical activity apps are two types of health apps that aim to promote healthy eating and energy expenditure through monitoring of dietary intake and physical activity. No clear evidence showing the effectiveness of using these apps to promote healthy eating and physical activity has been previously reported. Objective: This study aimed to identify how diet and physical activity (PA) apps affected their users. It also investigated if using apps was associated with changes in diet and PA. Methods: First, 3 semi-structured focus group discussions concerning app usability were conducted (15 app users and 8 nonusers; mean age 24.2 years, SD 6.4), including outcome measures such as motivations, experiences, opinions, and adherence. Results from the discussions were used to develop a questionnaire. The questionnaire, which contained questions about behavior changes, app usage, perceived effectiveness, and opinions of app usability, was answered by 500 Norwegians, with a mean age of 25.8 years (SD 5.1). Results: App users found diet and PA apps effective in promoting healthy eating and exercising. These apps affected their actions, health consciousness, and self-education about nutrition and PA; and were also a part of their social lives. Over half of the users perceived that apps were effective in assisting them to eat healthily and to exercise more. Diet apps were more effective when they were frequently used and over a long period of time, compared to infrequent or short-term use (P=.01 and P=.02, respectively). Users who used diet and PA apps, perceived apps as more effective than users who only used one type of app (all P<.05). App users were better at maintaining diet and PA behaviors than nonusers (all P<.05). Young adults found apps fun to use, but sometimes time consuming. They wanted apps to be designed to meet their personal expectations. Conclusions: App usage influenced action, consciousness, self-education about nutrition and PA, and social life. It facilitated maintaining a healthy diet and exercising more. Diet and PA apps of the future can be further strengthened by being tailored to meet personal needs. UR - http://mhealth.jmir.org/2016/2/e33/ UR - http://dx.doi.org/10.2196/mhealth.5114 UR - http://www.ncbi.nlm.nih.gov/pubmed/27056639 ID - info:doi/10.2196/mhealth.5114 ER - TY - JOUR AU - Li, Ying AU - Tan, Jin AU - Shi, Bozhi AU - Duan, Xiaolian AU - Zhong, Daidi AU - Li, Xiaoling AU - Qu, Jianning PY - 2016/04/06 TI - Information and Communication Technology-Powered Diabetes Self-Management Systems in China: A Study Evaluating the Features and Requirements of Apps and Patents JO - JMIR Diabetes SP - e2 VL - 1 IS - 1 KW - apps KW - diabetes KW - information and communication technology KW - self-monitoring of blood glucose KW - patents N2 - Background: For patients with diabetes, the self-monitoring of blood glucose (SMBG) is a recommended way of controlling the blood glucose level. By leveraging the modern information and communication technology (ICT) and the corresponding infrastructure, engineers nowadays are able to merge the SMBG activities into daily life and to dramatically reduce patient?s burden. Such type of ICT-powered SMBG had already been marketed in the United States and the European Union for a decade, but was introduced into the Chinese market only in recent years. Although there is no doubt about the general need for such type of SMBG in the Chinese market, how it could be adapted to the local technical and operational environment is still an open question. Objective: Our overall goal is to understand the local requirements and the current status of deploying ICT-powered SMBG to the Chinese market. In particular, we aim to analyze existing domestic SMBG mobile apps and relevant domestic patents to identify their various aspects, including the common functionalities, innovative feature, defects, conformance to standards, prospects, etc. In the long run, we hope the outcome of this study could help the decision making on how to properly adapt ICT-powered SMBG to the Chinese market. Methods: We identified 289 apps. After exclusion of irrelevant apps, 78 apps remained. These were downloaded and analyzed. A total of 8070 patents related to glucose were identified from patent database. Irrelevant materials and duplicates were excluded, following which 39 patents were parsed to extract the important features. These apps and patents were further compared with the corresponding requirements derived from relevant clinical guidelines and data standards. Results: The most common features of studied apps were blood health data recording, notification, and decision supporting. The most common features of studied patents included mobile terminal, server, and decision supporting. The main difference between patents and apps is that the patents had 2 specific features, namely, interface to the hospital information system and recording personal information, which were not mentioned in the app. The other major finding is that, in general, in terms of the components of the features, although the features identified in both apps and patents conform to the requirements of the relevant clinical guidelines and data standards, upon looking into the details, gaps exist between the features of the identified apps and patents and the relevant clinical guidelines and data standards. In addition, the social media feature that the apps and patents have is not included in the standard requirements list. Conclusions: The development of Chinese SMBG mobile apps and relevant patents is still in the primitive stage. Although the functionalities of most apps and patents can meet the basic requirements of SMBG, gaps have been identified when comparing the functionalities provided by apps and patents with the requirements necessitated by the standards. One of the most important gaps is that only a small portion of the studied apps provides the automatic data transmission and exchange feature, which may hamper the overall performance. The clinical guidelines can thus be further developed to leverage new features provided by ICT-powered SMBG apps (eg, the social media feature, which may help to improve the social intervention of patients with diabetes). UR - http://diabetes.jmir.org/2016/1/e2/ UR - http://dx.doi.org/10.2196/diabetes.4475 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291083 ID - info:doi/10.2196/diabetes.4475 ER - TY - JOUR AU - Wayne, Noah AU - Cercone, Nick AU - Li, Jiye AU - Zohar, Ariel AU - Katz, Joel AU - Brown, Patrick AU - Ritvo, Paul PY - 2016/04/06 TI - Data Mining of a Remote Behavioral Tracking System for Type 2 Diabetes Patients: A Prospective Cohort Study JO - JMIR Diabetes SP - e1 VL - 1 IS - 1 KW - diabetes mellitus, type 2 KW - health coaching KW - mhealth KW - telehealth KW - data mining N2 - Background: Complications from type 2 diabetes mellitus can be prevented when patients perform health behaviors such as vigorous exercise and glucose-regulated diet. The use of smartphones for tracking such behaviors has demonstrated success in type 2 diabetes management while generating repositories of analyzable digital data, which, when better understood, may help improve care. Data mining methods were used in this study to better understand self-monitoring patterns using smartphone tracking software. Objective: Associations were evaluated between the smartphone monitoring of health behaviors and HbA1c reductions in a patient subsample with type 2 diabetes who demonstrated clinically significant benefits after participation in a randomized controlled trial. Methods: A priori association-rule algorithms, implemented in the C language, were applied to app-discretized use data involving three primary health behavior trackers (exercise, diet, and glucose monitoring) from 29 participants who achieved clinically significant HbA1c reductions. Use was evaluated in relation to improved HbA1c outcomes. Results: Analyses indicated that nearly a third (9/29, 31%) of participants used a single tracker, half (14/29, 48%) used two primary trackers, and the remainder (6/29, 21%) of the participants used three primary trackers. Decreases in HbA1c were observed across all groups (0.97-1.95%), but clinically significant reductions were more likely with use of one or two trackers rather than use of three trackers (OR 0.18, P=.04). Conclusions: Data mining techniques can reveal relevant coherent behavior patterns useful in guiding future intervention structure. It appears that focusing on using one or two trackers, in a symbolic function, was more effective (in this sample) than regular use of all three trackers. UR - http://diabetes.jmir.org/2016/1/e1/ UR - http://dx.doi.org/10.2196/diabetes.4506 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291054 ID - info:doi/10.2196/diabetes.4506 ER - TY - JOUR AU - van Kerkhof, Maria Linda Wilhelmina AU - van der Laar, Egbertha Catharina Walthera AU - de Jong, Charlie AU - Weda, Marjolein AU - Hegger, Ingrid PY - 2016/04/06 TI - Characterization of Apps and Other e-Tools for Medication Use: Insights Into Possible Benefits and Risks JO - JMIR mHealth uHealth SP - e34 VL - 4 IS - 2 KW - mobile apps KW - drugs KW - eHealth KW - mHealth KW - medication use N2 - Background: In the past years, an enormous increase in the number of available health-related applications (apps) has occurred, from approximately 5800 in 2011 to over 23,000 in 2013, in the iTunes store. However, little is still known regarding the use, possible effectiveness, and risks of these applications. In this study, we focused on apps and other e-tools related to medicine use. A large subset of the general population uses medicines and might benefit from tools that aid in the use of medicine. Objective: The aim of the present study was to gain more insight into the characteristics, possible risks, and possible benefits of health apps and e-tools related to medication use. Methods: We first made an inventory of apps and other e-tools for medication use (n=116). Tools were coded by two independent researchers, based on the information available in the app stores and websites. Subsequently, for one type of often downloaded apps (aimed at people with diabetes), we investigated users? experiences using an online questionnaire. Results: Results of the inventory show that many apps for medication use are available and that they mainly offer simple functionalities. In line with this, the most experienced benefit by users of apps for regulating blood glucose levels in the online questionnaire was ?information quick and conveniently available?. Other often experienced benefits were improving health and self-reliance. Results of the inventory show that a minority of the apps for medication use has potentially high risks and for many of the apps it is unclear whether and how personal data are stored. In contrast, online questionnaire among users of apps for blood glucose regulation indicates that they hardly ever experience problems or doubts considering reliability and/or privacy. Although, respondents do mention to experience disadvantages of use due to incomplete apps and apps with poor ease of use. Respondents not using app(s) indicate that they might use them in the future if reliability of the apps and instructions on how to use them are more clear. Conclusions: This study shows that for apps and e-tools related to medicine use a small subset of tools might involve relatively high risks. For the large group of nonmedical devices apps, risks are lower, but risks lie in the enormous availability and low levels of regulation. In addition, both users and nonusers indicated that overall quality of apps (ease of use, completeness, good functionalities) is an issue. Considering that important benefits (eg, improving health and self-reliance) are experienced by many of the respondents using apps for regulating blood glucose levels, improving reliability and quality of apps is likely to have many profits. In addition, creating better awareness regarding the existence and how to use apps will likely improve proper use by more people, enhancing the profits of these tools. UR - http://mhealth.jmir.org/2016/2/e34/ UR - http://dx.doi.org/10.2196/mhealth.4149 UR - http://www.ncbi.nlm.nih.gov/pubmed/27052946 ID - info:doi/10.2196/mhealth.4149 ER - TY - JOUR AU - Patel, Bhavesh AU - Johnston, Maximilian AU - Cookson, Natalie AU - King, Dominic AU - Arora, Sonal AU - Darzi, Ara PY - 2016/04/06 TI - Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients JO - J Med Internet Res SP - e79 VL - 18 IS - 4 KW - communication KW - mobile phone KW - pager KW - applications KW - apps KW - escalation of care KW - simulation N2 - Background: Most hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication. Objective: The objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers. Methods: We recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users? satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses. Results: We recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100?121 versus pager median 77, range 39?104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included ?enhances interprofessional efficiency,? ?results in less disturbance,? ?performed desired functions reliably,? and ?allows me to clearly transfer information.? Conclusions: Hark improved the quality of transfer of information about simulated patients and was rated by users as more effective and efficient, and less distracting than pagers. Using this device did not result in delay in patient care. UR - http://www.jmir.org/2016/4/e79/ UR - http://dx.doi.org/10.2196/jmir.4854 UR - http://www.ncbi.nlm.nih.gov/pubmed/27052694 ID - info:doi/10.2196/jmir.4854 ER - TY - JOUR AU - Israni, Ajay AU - Dean, Carl AU - Kasel, Brian AU - Berndt, Lisa AU - Wildebush, Winston AU - Wang, Jason C. PY - 2016/04/04 TI - Why do Patients Forget to Take Immunosuppression Medications and Miss Appointments: Can a Mobile Phone App Help? JO - JMIR Public Health Surveill SP - e15 VL - 2 IS - 1 KW - adherence KW - immunosuppressive medications KW - appointments KW - mobile phone N2 - Background: Kidney transplant recipients must adhere to their immunosuppressive medication regimen. However, non-adherence remains a major problem. Objective: The aim of this paper is to determine how kidney transplant recipients remember to take their medications, and assess their perception and beliefs about adherence to immunosuppressive medications and barriers to medication adherence. In addition, we aim to assess perception and beliefs about willingness to use a hypothetical, mobile phone app to improve adherence. Methods: We conducted a qualitative study that included an average of three home or workplace visits of kidney transplant recipients (N=16) from a single urban transplant center. Results: The qualitative study revealed that transplant recipients understood the importance of taking their immunosuppressive medications and this motivated them to take their medications. The visits showed that most participants have incorporated medication use into their daily lives and that any minor deviation from daily routines could result in non-adherence. Participants also reported other barriers to adherence. All participants were interested in using an app to remind them to take their medication; however, they reported potential barriers to using the app. Conclusions: Although kidney transplant recipients understood the importance of medication adherence, there were significant barriers to maintaining adherence. Participants also reported interest in using a mobile phone app. UR - http://publichealth.jmir.org/2016/1/e15/ UR - http://dx.doi.org/10.2196/publichealth.5285 UR - http://www.ncbi.nlm.nih.gov/pubmed/27227150 ID - info:doi/10.2196/publichealth.5285 ER - TY - JOUR AU - Choo, Seryung AU - Kim, Young Ju AU - Jung, Young Se AU - Kim, Sarah AU - Kim, Eun Jeong AU - Han, Soo Jong AU - Kim, Sohye AU - Kim, Hyun Jeong AU - Kim, Jeehye AU - Kim, Yongseok AU - Kim, Dongouk AU - Steinhubl, Steve PY - 2016/03/31 TI - Development of a Weight Loss Mobile App Linked With an Accelerometer for Use in the Clinic: Usability, Acceptability, and Early Testing of its Impact on the Patient-Doctor Relationship JO - JMIR mHealth uHealth SP - e24 VL - 4 IS - 1 KW - mobile apps KW - electronic health record KW - weight reduction programs KW - physician-patient relations N2 - Background: Although complications of obesity are well acknowledged and managed by clinicians, management of obesity itself is often difficult, which leads to its underdiagnosis and undertreatment in hospital settings. However, tools that could improve the management of obesity, including self-monitoring, engagement with a social network, and open channels of communication between the patient and doctor, are limited in a clinic-based setting. Objective: The objective of our study was to evaluate the usability and acceptability of a newly developed mobile app linked with an accelerometer and its early effects on patient-doctor relationships. Methods: From September 2013 to February 2014, we developed a mobile app linked with an accelerometer as a supportive tool for a clinic-based weight loss program. The app used information from electronic health records and delivered tailored educational material. Personal goal setting, as well as monitoring of weight changes and physical activity combined with feedback, are key features of the app. We also incorporated an interactive message board for patients and doctors. During the period of March 2014 to May 2014, we tested our mobile app for 1 month in participants in a hospital clinic setting. We assessed the app?s usability and acceptability, as well as the patient-doctor relationship, via questionnaires and analysis of app usage data. Results: We recruited 30 individuals (18 male and 12 female) for the study. The median number of log-ins per day was 1.21, with the most frequently requested item being setting goals, followed by track physical activities and view personal health status. Scales of the depth of the patient-doctor relationship decreased from 27.6 (SD 4.8) to 25.1 (SD 4.5) by a Wilcoxon signed rank test (P=.02). Conclusions: A mobile phone app linked with an accelerometer for a clinic-based weight loss program is useful and acceptable for weight management but exhibited less favorable early effects on patient-doctor relationships. UR - http://mhealth.jmir.org/2016/1/e24/ UR - http://dx.doi.org/10.2196/mhealth.4546 UR - http://www.ncbi.nlm.nih.gov/pubmed/27032541 ID - info:doi/10.2196/mhealth.4546 ER - TY - JOUR AU - Shah, Nirtal AU - Aleong, Rosanne AU - So, Ivan PY - 2016/03/29 TI - Novel Use of a Smartphone to Measure Standing Balance JO - JMIR Rehabil Assist Technol SP - e4 VL - 3 IS - 1 KW - mobile application KW - telemedicine KW - postural balance KW - sports medicine KW - mobile phone N2 - Background: Balance assessment and training is utilized by clinicians and their patients to measure and improve balance. There is, however, little consistency in terms of how clinicians, researchers, and patients measure standing balance. Utilizing the inherent sensors in every smartphone, a mobile application was developed to provide a method of objectively measuring standing balance. Objective: We aimed to determine if a mobile phone application, which utilizes the phone?s accelerometer, can quantify standing balance. Methods: Three smartphones were positioned simultaneously above the participants? malleolus and patella and at the level of the umbilicus. Once secured, the myAnkle application was initiated to measure acceleration. Forty-eight participants completed 8 different balance exercises separately for the right and left legs. Accelerometer readings were obtained from each mobile phone and mean acceleration was calculated for each exercise at each ankle and knee and the torso. Results: Mean acceleration vector magnitude was reciprocally transformed to address skewness in the data distribution. Repeated measures ANOVAs were completed using the transformed data. A significant 2-way interaction was revealed between exercise condition and the body position of the phone (P<.001). Post-hoc tests indicated higher acceleration vector magnitude for exercises of greater difficulty. ANOVAs at each body position were conducted to examine the effect of exercise. The results revealed the knee as the location most sensitive for the detection of differences in acceleration between exercises. The accelerometer ranking of exercise difficulty showed high agreement with expert clinical rater rankings (kappa statistic>0.9). Conclusions: The myAnkle application revealed significantly greater acceleration magnitude for exercises of greater difficulty. Positioning of the mobile phone at the knee proved to be the most sensitive to changes in accelerometer values due to exercise difficulty. Application validity was shown through comparison with clinical raters. As such, the myAnkle app has utility as a measurement tool for standing balance. UR - http://rehab.jmir.org/2016/1/e4/ UR - http://dx.doi.org/10.2196/rehab.4511 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582247 ID - info:doi/10.2196/rehab.4511 ER - TY - JOUR AU - Asselbergs, Joost AU - Ruwaard, Jeroen AU - Ejdys, Michal AU - Schrader, Niels AU - Sijbrandij, Marit AU - Riper, Heleen PY - 2016/03/29 TI - Mobile Phone-Based Unobtrusive Ecological Momentary Assessment of Day-to-Day Mood: An Explorative Study JO - J Med Internet Res SP - e72 VL - 18 IS - 3 KW - affect KW - data mining KW - ecological momentary assessment KW - experience sampling KW - mobile phone sensing N2 - Background: Ecological momentary assessment (EMA) is a useful method to tap the dynamics of psychological and behavioral phenomena in real-world contexts. However, the response burden of (self-report) EMA limits its clinical utility. Objective: The aim was to explore mobile phone-based unobtrusive EMA, in which mobile phone usage logs are considered as proxy measures of clinically relevant user states and contexts. Methods: This was an uncontrolled explorative pilot study. Our study consisted of 6 weeks of EMA/unobtrusive EMA data collection in a Dutch student population (N=33), followed by a regression modeling analysis. Participants self-monitored their mood on their mobile phone (EMA) with a one-dimensional mood measure (1 to 10) and a two-dimensional circumplex measure (arousal/valence, ?2 to 2). Meanwhile, with participants? consent, a mobile phone app unobtrusively collected (meta) data from six smartphone sensor logs (unobtrusive EMA: calls/short message service (SMS) text messages, screen time, application usage, accelerometer, and phone camera events). Through forward stepwise regression (FSR), we built personalized regression models from the unobtrusive EMA variables to predict day-to-day variation in EMA mood ratings. The predictive performance of these models (ie, cross-validated mean squared error and percentage of correct predictions) was compared to naive benchmark regression models (the mean model and a lag-2 history model). Results: A total of 27 participants (81%) provided a mean 35.5 days (SD 3.8) of valid EMA/unobtrusive EMA data. The FSR models accurately predicted 55% to 76% of EMA mood scores. However, the predictive performance of these models was significantly inferior to that of naive benchmark models. Conclusions: Mobile phone-based unobtrusive EMA is a technically feasible and potentially powerful EMA variant. The method is young and positive findings may not replicate. At present, we do not recommend the application of FSR-based mood prediction in real-world clinical settings. Further psychometric studies and more advanced data mining techniques are needed to unlock unobtrusive EMA?s true potential. UR - http://www.jmir.org/2016/3/e72/ UR - http://dx.doi.org/10.2196/jmir.5505 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025287 ID - info:doi/10.2196/jmir.5505 ER - TY - JOUR AU - Goyal, Shivani AU - Morita, P. Plinio AU - Picton, Peter AU - Seto, Emily AU - Zbib, Ahmad AU - Cafazzo, A. Joseph PY - 2016/03/24 TI - Uptake of a Consumer-Focused mHealth Application for the Assessment and Prevention of Heart Disease: The <30 Days Study JO - JMIR mHealth uHealth SP - e32 VL - 4 IS - 1 KW - health behavior KW - lifestyle KW - cardiovascular disease KW - prevention KW - risk reduction KW - mobile apps KW - mobile phone KW - incentives N2 - Background: Lifestyle behavior modification can reduce the risk of cardiovascular disease, one of the leading causes of death worldwide, by up to 80%. We hypothesized that a dynamic risk assessment and behavior change tool delivered as a mobile app, hosted by a reputable nonprofit organization, would promote uptake among community members. We also predicted that the uptake would be influenced by incentives offered for downloading the mobile app. Objective: The primary objective of our study was to evaluate the engagement levels of participants using the novel risk management app. The secondary aim was to assess the effect of incentives on the overall uptake and usage behaviors. Methods: We publicly launched the app through the iTunes App Store and collected usage data over 5 months. Aggregate information included population-level data on download rates, use, risk factors, and user demographics. We used descriptive statistics to identify usage patterns, t tests, and analysis of variance to compare group means. Correlation and regression analyses determined the relationship between usage and demographic variables. Results: We captured detailed mobile usage data from 69,952 users over a 5-month period, of whom 23,727 (33.92%) were registered during a 1-month AIR MILES promotion. Of those who completed the risk assessment, 73.92% (42,380/57,330) were female, and 59.38% (34,042/57,330) were <30 years old. While the older demographic had significantly lower uptake than the younger demographic, with only 8.97% of users aged ?51 years old downloading the app, the older demographic completed more challenges than their younger counterparts (F8, 52,422 = 55.10, P<.001). In terms of engagement levels, 84.94% (44,537/52,431) of users completed 1?14 challenges over a 30-day period, and 10.03% (5,259/52,431) of users completed >22 challenges. On average, users in the incentives group completed slightly more challenges during the first 30 days of the intervention (mean 7.9, SD 0.13) than those in the nonincentives group (mean 6.1, SD 0.06, t28870=?12.293, P<.001, d=0.12, 95% CI ?2.02 to ?1.47). The regression analysis suggested that sex, age group, ethnicity, having 5 of the risk factors (all but alcohol), incentives, and the number of family histories were predictors of the number of challenges completed by a user (F14, 56,538 = 86.644, P<.001, adjusted R2 = .021). Conclusion: While the younger population downloaded the app the most, the older population demonstrated greater sustained engagement. Behavior change apps have the potential to reach a targeted population previously thought to be uninterested in or unable to use mobile apps. The development of such apps should assume that older adults will in fact engage if the behavior change elements are suitably designed, integrated into daily routines, and tailored. Incentives may be the stepping-stone that is needed to guide the general population toward preventative tools and promote sustained behavior change. UR - http://mhealth.jmir.org/2016/1/e32/ UR - http://dx.doi.org/10.2196/mhealth.4730 UR - http://www.ncbi.nlm.nih.gov/pubmed/27012937 ID - info:doi/10.2196/mhealth.4730 ER - TY - JOUR AU - Samson, L. Lasse AU - Pape-Haugaard, Louise AU - Meltzer, C. Michelle AU - Fuchs, Martin AU - Schønheyder, C. Henrik AU - Hejlesen, Ole PY - 2016/03/18 TI - Design of a Tablet Computer App for Facilitation of a Molecular Blood Culture Test in Clinical Microbiology and Preliminary Usability Evaluation JO - JMIR mHealth uHealth SP - e20 VL - 4 IS - 1 KW - usability KW - mobile applications KW - tablet computers KW - clinical simulation KW - health information systems KW - diagnostic test KW - clinical microbiology N2 - Background: User mobility is an important aspect of the development of clinical information systems for health care professionals. Mobile phones and tablet computers have obtained widespread use by health care professionals, offering an opportunity for supporting the access to patient information through specialized applications (apps) while supporting the mobility of the users. The use of apps for mobile phones and tablet computers may support workflow of complex tasks, for example, molecular-based diagnostic tests in clinical microbiology. Multiplex Blood Culture Test (MuxBCT) is a molecular-based diagnostic test used for rapid identification of pathogens in positive blood cultures. To facilitate the workflow of the MuxBCT, a specialized tablet computer app was developed as an accessory to the diagnostic test. The app aims to reduce the complexity of the test by step-by-step guidance of microscopy and to assist users in reaching an exact bacterial or fungal diagnosis based on blood specimen observations and controls. Additionally, the app allows for entry of test results, and communication thereof to the laboratory information system (LIS). Objective: The objective of the study was to describe the design considerations of the MuxBCT app and the results of a preliminary usability evaluation. Methods: The MuxBCT tablet app was developed and set up for use in a clinical microbiology laboratory. A near-live simulation study was conducted in the clinical microbiology laboratory to evaluate the usability of the MuxBCT app. The study was designed to achieve a high degree of realism as participants carried out a scenario representing the context of use for the MuxBCT app. As the MuxBCT was under development, the scenario involved the use of molecular blood culture tests similar to the MuxBCT for identification of microorganisms from positive blood culture samples. The study participants were observed, and their interactions with the app were recorded. After the study, the participants were debriefed to clarify observations. Results: Four medical laboratory technicians, for example, representative of end users of the app, participated in the clinical simulation study. Using the MuxBCT app, the study participants successfully identified and reported all microorganisms from the positive blood cultures examined. Three of the four participants reported that they found the app useful, while one study participant reported that she would prefer to make notes on paper and later enter them into the LIS. Conclusions: The preliminary usability evaluation results indicate that use of the MuxBCT tablet app can facilitate the workflow of the MuxBCT diagnostic test. UR - http://mhealth.jmir.org/2016/1/e20/ UR - http://dx.doi.org/10.2196/mhealth.5041 UR - http://www.ncbi.nlm.nih.gov/pubmed/26993432 ID - info:doi/10.2196/mhealth.5041 ER - TY - JOUR AU - Martin, K. Corby AU - Gilmore, Anne L. AU - Apolzan, W. John AU - Myers, A. Candice AU - Thomas, M. Diana AU - Redman, M. Leanne PY - 2016/03/16 TI - Smartloss: A Personalized Mobile Health Intervention for Weight Management and Health Promotion JO - JMIR mHealth uHealth SP - e18 VL - 4 IS - 1 KW - weight loss KW - app KW - eHealth KW - mHealth KW - SmartLoss KW - telehealth KW - mobile website KW - mobile phone N2 - Background: Synonymous with increased use of mobile phones has been the development of mobile health (mHealth) technology for improving health, including weight management. Behavior change theory (eg, the theory of planned behavior) can be effectively encapsulated into mobile phone-based health improvement programs, which is fostered by the ability of mobile phones and related devices to collect and transmit objective data in near real time and for health care or research professionals and clients to communicate easily. Objective: To describe SmartLoss, a semiautomated mHealth platform for weight loss. Methods: We developed and validated a dynamic energy balance model that determines the amount of weight an individual will lose over time if they are adherent to an energy intake prescription. This model was incorporated into computer code that enables adherence to a prescribed caloric prescription determined from the change in body weight of the individual. Data from the individual are then used to guide personalized recommendations regarding weight loss and behavior change via a semiautomated mHealth platform called SmartLoss, which consists of 2 elements: (1) a clinician dashboard and (2) a mobile phone app. SmartLoss includes and interfaces with a network-connected bathroom scale and a Bluetooth-connected accelerometer, which enables automated collection of client information (eg, body weight change and physical activity patterns), as well as the systematic delivery of preplanned health materials and automated feedback that is based on client data and is designed to foster prolonged adherence with body weight, diet, and exercise goals. The clinician dashboard allows for efficient remote monitoring of all clients simultaneously, which may further increase adherence, personalization of treatment, treatment fidelity, and efficacy. Results: Evidence of the efficacy of the SmartLoss approach has been reported previously. The present report provides a thorough description of the SmartLoss Virtual Weight Management Suite, a professionally programmed platform that facilitates treatment fidelity and the ability to customize interventions and disseminate them widely. Conclusions: SmartLoss functions as a virtual weight management clinic that relies upon empirical weight loss research and behavioral theory to promote behavior change and weight loss. UR - http://mhealth.jmir.org/2016/1/e18/ UR - http://dx.doi.org/10.2196/mhealth.5027 UR - http://www.ncbi.nlm.nih.gov/pubmed/26983937 ID - info:doi/10.2196/mhealth.5027 ER - TY - JOUR AU - Militello, Lisa AU - Melnyk, Mazurek Bernadette AU - Hekler, B. Eric AU - Small, Leigh AU - Jacobson, Diana PY - 2016/03/14 TI - Automated Behavioral Text Messaging and Face-to-Face Intervention for Parents of Overweight or Obese Preschool Children: Results From a Pilot Study JO - JMIR mHealth uHealth SP - e21 VL - 4 IS - 1 KW - Child KW - Obesity KW - Overweight KW - Health Behavior KW - Text Messaging/SMS KW - Mobile Health KW - Parents KW - Psychology KW - Behavior Therapy KW - Telemedicine N2 - Background: Children are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period. Objective: The purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting. Methods: Fifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck?s Cognitive Theory guided the TEXT2COPE intervention content and Fogg?s Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention?s relevance to the family?s needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation. Results: Self-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week. Conclusions: Utilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted. UR - http://mhealth.jmir.org/2016/1/e21/ UR - http://dx.doi.org/10.2196/mhealth.4398 UR - http://www.ncbi.nlm.nih.gov/pubmed/26976387 ID - info:doi/10.2196/mhealth.4398 ER - TY - JOUR AU - Povey, Josie AU - Mills, Robert Patj Patj Janama AU - Dingwall, Maree Kylie AU - Lowell, Anne AU - Singer, Judy AU - Rotumah, Darlene AU - Bennett-Levy, James AU - Nagel, Tricia PY - 2016/03/11 TI - Acceptability of Mental Health Apps for Aboriginal and Torres Strait Islander Australians: A Qualitative Study JO - J Med Internet Res SP - e65 VL - 18 IS - 3 KW - mobile apps KW - mental health KW - indigenous populations KW - therapeutics KW - cognitive behavioral therapy KW - acceptance and commitment therapy KW - culturally competent care N2 - Background: Aboriginal and Torres Strait Islander Australians experience high rates of mental illness and psychological distress compared to their non-Indigenous counterparts. E-mental health tools offer an opportunity for accessible, effective, and acceptable treatment. The AIMhi Stay Strong app and the ibobbly suicide prevention app are treatment tools designed to combat the disproportionately high levels of mental illness and stress experienced within the Aboriginal and Torres Strait Islander community. Objective: This study aimed to explore Aboriginal and Torres Strait Islander community members? experiences of using two culturally responsive e-mental health apps and identify factors that influence the acceptability of these approaches. Methods: Using qualitative methods aligned with a phenomenological approach, we explored the acceptability of two culturally responsive e-mental health apps through a series of three 3-hour focus groups with nine Aboriginal and Torres Strait Islander community members. Thematic analysis was conducted and coresearcher and member checking were used to verify findings. Results: Findings suggest strong support for the concept of e-mental health apps and optimism for their potential. Factors that influenced acceptability related to three key themes: personal factors (eg, motivation, severity and awareness of illness, technological competence, and literacy and language differences), environmental factors (eg, community awareness, stigma, and availability of support), and app characteristics (eg, ease of use, content, graphics, access, and security and information sharing). Specific adaptations, such as local production, culturally relevant content and graphics, a purposeful journey, clear navigation, meaningful language, options to assist people with language differences, offline use, and password protection may aid uptake. Conclusions: When designed to meet the needs of Aboriginal and Torres Strait Islander Australians, e-mental health tools add an important element to public health approaches for improving the well-being of Aboriginal and Torres Strait Islander people. UR - http://www.jmir.org/2016/3/e65/ UR - http://dx.doi.org/10.2196/jmir.5314 UR - http://www.ncbi.nlm.nih.gov/pubmed/26969043 ID - info:doi/10.2196/jmir.5314 ER - TY - JOUR AU - Hacking, Damian AU - Haricharan, J. Hanne AU - Brittain, Kirsty AU - Lau, Kwan Yan AU - Cassidy, Tali AU - Heap, Marion PY - 2016/03/10 TI - Hypertension Health Promotion via Text Messaging at a Community Health Center in South Africa: A Mixed Methods Study JO - JMIR mHealth uHealth SP - e22 VL - 4 IS - 1 KW - telemedicine KW - health knowledge, attitudes, practice KW - developing countries KW - hypertension N2 - Background: The use of mobile phones to deliver health care (mHealth) is increasing in popularity due to the high prevalence of mobile phone penetration. This is seen in developing countries, where mHealth may be particularly useful in overcoming traditional access barriers. Non-communicable diseases may be particularly amenable to mHealth interventions, and hypertension is one with an escalating burden in the developing world. Objective: The objective of this study was to test whether the dissemination of health information via a short message service (SMS) led to improvements in health knowledge and self-reported health-related behaviors. Methods: A mixed methods study was carried out among a cohort of 223 hypertension clinic patients, in a resource-poor setting in Cape Town, South Africa, in 2012. Hypertensive outpatients were recruited at the clinic and administered a baseline questionnaire to establish existing knowledge of hypertension. Participants were then randomly assigned to intervention or control groups. The intervention group received 90 SMSes over a period of 17 weeks. Thereafter, the baseline questionnaire was readministered to both groups to gauge if any improvements in health knowledge had occurred. Those who received SMSes were asked additional questions about health-related behavior changes. A focus group was then conducted to obtain in-depth feedback about participants? experience with, and response to, the SMS campaign. Results: No statistically significant changes in overall health knowledge were observed between the control and intervention groups. The intervention group had positive increases in self-reported behavior changes. These were reaffirmed by the focus groups, which also revealed a strong preference for the SMS campaign and the belief that the SMSes acted as a reminder to change, as opposed to providing new information. Conclusions: Although the content of the SMSes was not new, and did not improve health knowledge, SMSes were effective in motivating positive self-reported behavior change among hypertensive patients. Trial Registration: Pan African Clinical Trials Registry Number: PACTR201412000968462. Registered 18 December 2014 (Archived by WebCite at http://www.webcitation.org/6fhtyLRcO). UR - http://mhealth.jmir.org/2016/1/e22/ UR - http://dx.doi.org/10.2196/mhealth.4569 UR - http://www.ncbi.nlm.nih.gov/pubmed/26964505 ID - info:doi/10.2196/mhealth.4569 ER - TY - JOUR AU - Davis, F. Siena AU - Ellsworth, A. Marisa AU - Payne, E. Hannah AU - Hall, M. Shelby AU - West, H. Joshua AU - Nordhagen, L. Amber PY - 2016/03/02 TI - Health Behavior Theory in Popular Calorie Counting Apps: A Content Analysis JO - JMIR mHealth uHealth SP - e19 VL - 4 IS - 1 KW - cell phones KW - mobile applications KW - telemedicine KW - weight loss KW - caloric restriction N2 - Background: Although the Health & Fitness category of the Apple App Store features hundreds of calorie counting apps, the extent to which popular calorie counting apps include health behavior theory is unknown. Objective: This study evaluates the presence of health behavior theory in calorie counting apps. Methods: Data for this study came from an extensive content analysis of the 10 most popular calorie counting apps in the Health & Fitness category of the Apple App Store. Results: Each app was given a theory score to reflect the extent to which health behavior theory was integrated into the app. The highest possible score was 60. Out of the 10 apps evaluated, My Diet Coach obtained the highest theory score of 15. MapMyFitness and Yumget received the lowest scores of 0. The average theory score among the apps was 5.6. Conclusions: Most of the calorie counting apps in the sample contained minimal health behavior theory. UR - http://mhealth.jmir.org/2016/1/e19/ UR - http://dx.doi.org/10.2196/mhealth.4177 UR - http://www.ncbi.nlm.nih.gov/pubmed/26935898 ID - info:doi/10.2196/mhealth.4177 ER - TY - JOUR AU - Bakker, David AU - Kazantzis, Nikolaos AU - Rickwood, Debra AU - Rickard, Nikki PY - 2016/03/01 TI - Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments JO - JMIR Mental Health SP - e7 VL - 3 IS - 1 KW - mobile phones KW - mental health KW - smartphones KW - apps KW - mobile apps KW - depression KW - anxiety KW - cognitive behavior therapy KW - cognitive behavioral therapy KW - clinical psychology N2 - Background: The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. Objective: To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. Methods: A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. Results: Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. Conclusions: Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems. UR - http://mental.jmir.org/2016/1/e7/ UR - http://dx.doi.org/10.2196/mental.4984 UR - http://www.ncbi.nlm.nih.gov/pubmed/26932350 ID - info:doi/10.2196/mental.4984 ER - TY - JOUR AU - Wilhide III, C. Calvin AU - Peeples, M. Malinda AU - Anthony Kouyaté, C. Robin PY - 2016/02/16 TI - Evidence-Based mHealth Chronic Disease Mobile App Intervention Design: Development of a Framework JO - JMIR Res Protoc SP - e25 VL - 5 IS - 1 KW - mHealth KW - mobile applications KW - mobile app design KW - chronic disease KW - diabetes KW - mHealth framework KW - behavioral intervention KW - intervention design KW - mHealth implementation KW - telemedicine N2 - Background: Mobile technology offers new capabilities that can help to drive important aspects of chronic disease management at both an individual and population level, including the ability to deliver real-time interventions that can be connected to a health care team. A framework that supports both development and evaluation is needed to understand the aspects of mHealth that work for specific diseases, populations, and in the achievement of specific outcomes in real-world settings. This framework should incorporate design structure and process, which are important to translate clinical and behavioral evidence, user interface, experience design and technical capabilities into scalable, replicable, and evidence-based mobile health (mHealth) solutions to drive outcomes. Objective: The purpose of this paper is to discuss the identification and development of an app intervention design framework, and its subsequent refinement through development of various types of mHealth apps for chronic disease. Methods: The process of developing the framework was conducted between June 2012 and June 2014. Informed by clinical guidelines, standards of care, clinical practice recommendations, evidence-based research, best practices, and translated by subject matter experts, a framework for mobile app design was developed and the refinement of the framework across seven chronic disease states and three different product types is described. Results: The result was the development of the Chronic Disease mHealth App Intervention Design Framework. This framework allowed for the integration of clinical and behavioral evidence for intervention and feature design. The application to different diseases and implementation models guided the design of mHealth solutions for varying levels of chronic disease management. Conclusions: The framework and its design elements enable replicable product development for mHealth apps and may provide a foundation for the digital health industry to systematically expand mobile health interventions and validate their effectiveness across multiple implementation settings and chronic diseases. UR - http://www.researchprotocols.org/2016/1/e25/ UR - http://dx.doi.org/10.2196/resprot.4838 UR - http://www.ncbi.nlm.nih.gov/pubmed/26883135 ID - info:doi/10.2196/resprot.4838 ER - TY - JOUR AU - English, Lacey Lauren AU - Dunsmuir, Dustin AU - Kumbakumba, Elias AU - Ansermino, Mark John AU - Larson, P. Charles AU - Lester, Richard AU - Barigye, Celestine AU - Ndamira, Andrew AU - Kabakyenga, Jerome AU - Wiens, O. Matthew PY - 2016/02/15 TI - The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda JO - JMIR mHealth uHealth SP - e16 VL - 4 IS - 1 KW - infectious disease KW - postdischarge mortality KW - mHealth KW - prediction model KW - risk assessment KW - usability KW - Africa KW - resource-limited settings N2 - Background: Postdischarge death in children is increasingly being recognized as a major contributor to overall child mortality. The PAediatric Risk Assessment (PARA) app is an mHealth tool developed to aid health care workers in resource-limited settings such as Sub-Saharan Africa to identify pediatric patients at high risk of both in-hospital and postdischarge mortality. The intended users of the PARA app are health care workers (ie, nurses, doctors, and clinical officers) with varying levels of education and technological exposure, making testing of this clinical tool critical to successful implementation. Objective: Our aim was to summarize the usability evaluation of the PARA app among target users, which consists of assessing the ease of use, functionality, and navigation of the interfaces and then iteratively improving the design of this clinical tool. Methods: Health care workers (N=30) were recruited to participate at Mbarara Regional Referral Hospital and Holy Innocents Children?s Hospital in Mbarara, Southwestern Uganda. This usability study was conducted in two phases to allow for iterative improvement and testing of the interfaces. The PARA app was evaluated using quantitative and qualitative measures, which were compared between Phases 1 and 2 of the study. Participants were given two patient scenarios that listed hypothetical information (ie, demographic, social, and clinical data) to be entered into the app and to determine the patient?s risk of in-hospital and postdischarge mortality. Time-to-completion and user errors were recorded for each participant while using the app. A modified computer system usability questionnaire was utilized at the end of each session to elicit user satisfaction with the PARA app and obtain suggestions for future improvements. Results: The average time to complete the PARA app decreased by 30% from Phase 1 to Phase 2, following user feedback and modifications. Participants spent the longest amount of time on the oxygen saturation interface, but modifications following Phase 1 cut this time by half. The average time-to-completion (during Phase 2) for doctors/medical students was 3 minutes 56 seconds. All participants agreed they would use the PARA app if available at their health facility. Given a high PARA risk score, participants suggested several interventions that would be appropriate for the sociocultural context in southwestern Uganda, which involved strengthening discharge and referral procedures within the current health care system. Conclusions: Through feedback and modifications made during this usability study, the PARA app was developed into a user-friendly app, encompassing user expectations and culturally intuitive interfaces for users with a range of technological exposure. Doctors and medical students had shorter task completion times, though all participants reported the usefulness of this tool to improve postdischarge outcomes. UR - http://mhealth.jmir.org/2016/1/e16/ UR - http://dx.doi.org/10.2196/mhealth.5167 UR - http://www.ncbi.nlm.nih.gov/pubmed/26879041 ID - info:doi/10.2196/mhealth.5167 ER - TY - JOUR AU - Hales, Sarah AU - Turner-McGrievy, Gabrielle AU - Fahim, Arjang AU - Freix, Andrew AU - Wilcox, Sara AU - Davis, E. Rachel AU - Huhns, Michael AU - Valafar, Homayoun PY - 2016/02/12 TI - A Mixed-Methods Approach to the Development, Refinement, and Pilot Testing of Social Networks for Improving Healthy Behaviors JO - JMIR Human Factors SP - e8 VL - 3 IS - 1 KW - mHealth KW - obesity KW - weight loss KW - social support KW - social cognitive theory N2 - Background: Mobile health (mHealth) has shown promise as a way to deliver weight loss interventions, including connecting users for social support. Objective: To develop, refine, and pilot test the Social Pounds Off Digitally (POD) Android app for personalized health monitoring and interaction. Methods: Adults who were overweight and obese with Android smartphones (BMI 25-49.9 kg/m2; N=9) were recruited for a 2-month weight loss pilot intervention and iterative usability testing of the Social POD app. The app prompted participants via notification to track daily weight, diet, and physical activity behaviors. Participants received the content of the behavioral weight loss intervention via podcast. In order to re-engage infrequent users (did not use the app within the previous 48 hours), the app prompted frequent users to select 1 of 3 messages to send to infrequent users targeting the behavioral theory constructs social support, self-efficacy, or negative outcome expectations. Body weight, dietary intake (2 24-hr recalls), and reported calories expended during physical activity were assessed at baseline and 2 months. All participants attended 1 of 2 focus groups to provide feedback on use of the app. Results: Participants lost a mean of 0.94 kg (SD 2.22, P=.24) and consumed significantly fewer kcals postintervention (1570 kcal/day, SD 508) as compared to baseline (2384 kcal/day, SD 993, P=.01). Participants reported expending a mean of 171 kcal/day (SD 153) during intentional physical activity following the intervention as compared to 138 kcal/day (SD 139) at baseline, yet this was not a statistically significant difference (P=.57). There was not a statistically significant correlation found between total app entries and percent weight loss over the course of the intervention (r=.49, P=.19). Mean number of app entries was 77.2 (SD 73.8) per person with a range of 0 to 219. Messages targeting social support were selected most often (32/68, 47%), followed by self-efficacy (28/68, 41%), and negative outcome expectations (8/68, 12%). Themes from the focus groups included functionality issues, revisions to the messaging system, and the addition of a point system with rewards for achieving goals. Conclusions: The Social POD app provides an innovative way to re-engage infrequent users by encouraging frequent users to provide social support. Although more time is needed for development, this mHealth intervention can be disseminated broadly for many years and to many individuals without the need for additional intensive in-person hours. UR - http://humanfactors.jmir.org/2016/1/e8/ UR - http://dx.doi.org/10.2196/humanfactors.4512 UR - http://www.ncbi.nlm.nih.gov/pubmed/27026535 ID - info:doi/10.2196/humanfactors.4512 ER - TY - JOUR AU - McClure, B. Jennifer AU - Hartzler, L. Andrea AU - Catz, L. Sheryl PY - 2016/02/12 TI - Design Considerations for Smoking Cessation Apps: Feedback From Nicotine Dependence Treatment Providers and Smokers JO - JMIR mHealth uHealth SP - e17 VL - 4 IS - 1 KW - tobacco use cessation KW - smoking KW - mobile health KW - smartphone N2 - Background: Hundreds of smoking cessation apps are commercially available, but most are not theory-based or designed to take advantage of mobile technology in ways that could make them more engaging and possibly more effective. Considering input from both clinical experts (who understand best practice nicotine dependence treatment requirements) to inform appropriate content and from smokers (the end users) to express their preferences is important in designing these programs in the future. Objective: To assess and compare the opinions of nicotine dependence treatment providers and smokers regarding the design of future smoking cessation apps. Methods: We surveyed providers (n=264) and smokers who own smartphones (n=40) to assess their opinions on the importance of 21 app design features. Features represented 5 domains: cost, reputation, privacy and security, content and user experience, and communication. Domains were chosen to reflect best practice treatment, leverage mobile technology to support smoking cessation, and elicit important user preferences. Data were collected between June and July 2015. Results: Most providers agreed that mHealth apps hold promise for helping people quit smoking (203/264, 76.9%) and would recommend them to their clients/patients (201/264, 76.1%), especially if the app were empirically validated (236/264, 89.4%). Few providers believe effective cessation apps currently exist (112/264, 42.4%). Few smokers (5/40, 13%) had ever downloaded a smoking cessation app; of the ones who had not, most said they would consider doing so (29/35, 83%). Both respondent groups indicated the following features were very to extremely important to include in cessation apps: free or low cost, keeps information private, matches individual needs and interests, adapts as one?s needs and interests change, helps to manage nicotine withdrawal symptoms and medication side effects, and allows users to track their progress. Providers and smokers also indicated gaming and social media connectivity were less important than other features. Despite these similarities, the groups had significantly different opinions about the relative importance of various features. In particular, providers rated privacy as the most important feature, whereas smokers rated low cost and the ability to adaptively tailor content as the most important features. Conclusions: Smoking cessation apps hold great promise as intervention tools but only if they engage users and appropriately treat nicotine dependence. Intervention development should take into consideration the perspectives of both treatment experts and smokers. This paper highlights important perspectives from each of these groups to be considered when designing future app-based smoking cessation programs. UR - http://mhealth.jmir.org/2016/1/e17/ UR - http://dx.doi.org/10.2196/mhealth.5181 UR - http://www.ncbi.nlm.nih.gov/pubmed/26872940 ID - info:doi/10.2196/mhealth.5181 ER - TY - JOUR AU - Powell, C. Adam AU - Torous, John AU - Chan, Steven AU - Raynor, Stephen Geoffrey AU - Shwarts, Erik AU - Shanahan, Meghan AU - Landman, B. Adam PY - 2016/02/10 TI - Interrater Reliability of mHealth App Rating Measures: Analysis of Top Depression and Smoking Cessation Apps JO - JMIR mHealth uHealth SP - e15 VL - 4 IS - 1 KW - mobile applications KW - mental health KW - evaluation studies KW - health apps KW - ratings N2 - Background: There are over 165,000 mHealth apps currently available to patients, but few have undergone an external quality review. Furthermore, no standardized review method exists, and little has been done to examine the consistency of the evaluation systems themselves. Objective: We sought to determine which measures for evaluating the quality of mHealth apps have the greatest interrater reliability. Methods: We identified 22 measures for evaluating the quality of apps from the literature. A panel of 6 reviewers reviewed the top 10 depression apps and 10 smoking cessation apps from the Apple iTunes App Store on these measures. Krippendorff?s alpha was calculated for each of the measures and reported by app category and in aggregate. Results: The measure for interactiveness and feedback was found to have the greatest overall interrater reliability (alpha=.69). Presence of password protection (alpha=.65), whether the app was uploaded by a health care agency (alpha=.63), the number of consumer ratings (alpha=.59), and several other measures had moderate interrater reliability (alphas>.5). There was the least agreement over whether apps had errors or performance issues (alpha=.15), stated advertising policies (alpha=.16), and were easy to use (alpha=.18). There were substantial differences in the interrater reliabilities of a number of measures when they were applied to depression versus smoking apps. Conclusions: We found wide variation in the interrater reliability of measures used to evaluate apps, and some measures are more robust across categories of apps than others. The measures with the highest degree of interrater reliability tended to be those that involved the least rater discretion. Clinical quality measures such as effectiveness, ease of use, and performance had relatively poor interrater reliability. Subsequent research is needed to determine consistent means for evaluating the performance of apps. Patients and clinicians should consider conducting their own assessments of apps, in conjunction with evaluating information from reviews. UR - http://mhealth.jmir.org/2016/1/e15/ UR - http://dx.doi.org/10.2196/mhealth.5176 UR - http://www.ncbi.nlm.nih.gov/pubmed/26863986 ID - info:doi/10.2196/mhealth.5176 ER - TY - JOUR AU - Poirier, Josée AU - Bennett, L. Wendy AU - Jerome, J. Gerald AU - Shah, G. Nina AU - Lazo, Mariana AU - Yeh, Hsin-Chieh AU - Clark, M. Jeanne AU - Cobb, K. Nathan PY - 2016/02/09 TI - Effectiveness of an Activity Tracker- and Internet-Based Adaptive Walking Program for Adults: A Randomized Controlled Trial JO - J Med Internet Res SP - e34 VL - 18 IS - 2 KW - physical activity KW - walking KW - intervention KW - adaptive KW - effectiveness KW - RCT N2 - Background: The benefits of physical activity are well documented, but scalable programs to promote activity are needed. Interventions that assign tailored and dynamically adjusting goals could effect significant increases in physical activity but have not yet been implemented at scale. Objective: Our aim was to examine the effectiveness of an open access, Internet-based walking program that assigns daily step goals tailored to each participant. Methods: A two-arm, pragmatic randomized controlled trial compared the intervention to no treatment. Participants were recruited from a workplace setting and randomized to a no-treatment control (n=133) or to treatment (n=132). Treatment participants received a free wireless activity tracker and enrolled in the walking program, Walkadoo. Assessments were fully automated: activity tracker recorded primary outcomes (steps) without intervention by the participant or investigators. The two arms were compared on change in steps per day from baseline to follow-up (after 6 weeks of treatment) using a two-tailed independent samples t test. Results: Participants (N=265) were 66.0% (175/265) female with an average age of 39.9 years. Over half of the participants (142/265, 53.6%) were sedentary (<5000 steps/day) and 44.9% (119/265) were low to somewhat active (5000-9999 steps/day). The intervention group significantly increased their steps by 970 steps/day over control (P<.001), with treatment effects observed in sedentary (P=.04) and low-to-somewhat active (P=.004) participants alike. Conclusions: The program is effective in increasing daily steps. Participants benefited from the program regardless of their initial activity level. A tailored, adaptive approach using wireless activity trackers is realistically implementable and scalable. Trial Registration: Clinicaltrials.gov NCT02229409, https://clinicaltrials.gov/ct2/show/NCT02229409 (Archived by WebCite at http://www.webcitation.org/6eiWCvBYe) UR - http://www.jmir.org/2016/2/e34/ UR - http://dx.doi.org/10.2196/jmir.5295 UR - http://www.ncbi.nlm.nih.gov/pubmed/26860434 ID - info:doi/10.2196/jmir.5295 ER - TY - JOUR AU - Kang, Hannah AU - Park, Hyeoun-Ae PY - 2016/02/02 TI - A Mobile App for Hypertension Management Based on Clinical Practice Guidelines: Development and Deployment JO - JMIR mHealth uHealth SP - e12 VL - 4 IS - 1 KW - mobile health KW - clinical practice guideline KW - hypertension KW - self-management N2 - Background: Hypertension is a chronic and lifestyle-related disease that requires continuous preventive care. Although there are many evidence-based clinical practice guidelines (CPGs) for hypertension management, applying them to daily management can be difficult for patients with hypertension. A mobile app, based on CPGs, could help patients with hypertension manage their disease. Objective: To develop a mobile app for hypertension management based on CPGs and evaluate its effectiveness in patients with hypertension with respect to perceived usefulness, user satisfaction, and medication adherence. Methods: The hypertension management app (HMA) was developed according to the Web-Roadmap methodology, which includes planning, analysis, design, implementation, and evaluation phases. The HMA was provided to individuals (N=38) with hypertension. Medication adherence was measured before and after using the HMA for 4 weeks. The perceived usefulness and user satisfaction were surveyed in the patients who completed the medication adherence survey. Results: Of the 38 study participants, 29 (76%) participated in medical adherence assessment. Medication adherence, as measured by the Modified Morisky Scale, was significantly improved in these patients after they had used the HMA (P=.001). The perceived usefulness score was 3.7 out of 5. The user satisfaction scores, with respect to using the HMA for blood pressure recording, medication recording, data sending, alerting, recommending, and educating about medication were 4.3, 3.8, 3.1, 3.2, 3.4, and 3.8 out of 5, respectively, in the 19 patients. Conclusions: This study showed that a mobile app for hypertension management based on CPGs is effective at improving medication adherence. UR - http://mhealth.jmir.org/2016/1/e12/ UR - http://dx.doi.org/10.2196/mhealth.4966 UR - http://www.ncbi.nlm.nih.gov/pubmed/26839283 ID - info:doi/10.2196/mhealth.4966 ER - TY - JOUR AU - Con, Danny AU - De Cruz, Peter PY - 2016/02/01 TI - Mobile Phone Apps for Inflammatory Bowel Disease Self-Management: A Systematic Assessment of Content and Tools JO - JMIR mHealth uHealth SP - e13 VL - 4 IS - 1 KW - IBD KW - apps KW - eHealth KW - smartphone KW - mhealth N2 - Background: The rising incidence of inflammatory bowel disease (IBD) over the past decade has resulted in increased health care utilization and longer IBD outpatient waiting lists. Self-management is recognized as an important aspect of chronic disease management but its application to IBD has been limited. The age of IBD onset in a majority of patients is in their 20s to 30s. Mobile phone apps are a technology familiar to young adults and represent an opportunity to explore self-management as a new model of health care delivery for IBD. Objective: The aim of this study was to explore the content and tools of existing IBD apps to identify functionalities that may facilitate patient self-management. Methods: We systematically assessed apps targeted at IBD patients via searches of Google (Android devices) and Apple (iOS devices) app stores with pre-defined inclusion and exclusion criteria. Apps were assessed for specific functionalities; presence of professional medical involvement; consistency with international IBD guidelines based on ?complete,? ?partial,? or ?absent? coverage of consensus statements derived from the European Crohn?s and Colitis Organisation, American College of Gastroenterology, and the Gastroenterology Society of Australia; comprehensiveness of data that could be entered; and average pricing. Results: Of the 238 apps screened, 26 apps were assessed, including 10 available on Android platforms, 8 on iOS platforms, and 8 on both. Over half (14/26, 54%) of the apps had diary functionalities; over a third (10/26, 39%) provided health information about IBD. None of the apps offered decision support to facilitate the self-initiation of medical therapy. Five of 26 (19%) had professional medical involvement in their design. Apps demonstrated ?complete? coverage of only 38% of the international consensus statements explored. The average price of the apps was AUD$1.37. Conclusions: Apps may provide a useful adjunct to the management of IBD patients. However, a majority of current apps suffer from a lack of professional medical involvement and limited coverage of international consensus guidelines. Future studies and app design for IBD should include professional medical involvement, evidence-based guidelines, and functionalities with decision support that are specifically tailored to patient self-management. UR - http://mhealth.jmir.org/2016/1/e13/ UR - http://dx.doi.org/10.2196/mhealth.4874 UR - http://www.ncbi.nlm.nih.gov/pubmed/26831935 ID - info:doi/10.2196/mhealth.4874 ER - TY - JOUR AU - Mercer, Kathryn AU - Giangregorio, Lora AU - Schneider, Eric AU - Chilana, Parmit AU - Li, Melissa AU - Grindrod, Kelly PY - 2016/01/27 TI - Acceptance of Commercially Available Wearable Activity Trackers Among Adults Aged Over 50 and With Chronic Illness: A Mixed-Methods Evaluation JO - JMIR mHealth uHealth SP - e7 VL - 4 IS - 1 KW - chronic disease KW - physical activity KW - sedentary lifestyle KW - wearables N2 - Background: Physical inactivity and sedentary behavior increase the risk of chronic illness and death. The newest generation of ?wearable? activity trackers offers potential as a multifaceted intervention to help people become more active. Objective: To examine the usability and usefulness of wearable activity trackers for older adults living with chronic illness. Methods: We recruited a purposive sample of 32 participants over the age of 50, who had been previously diagnosed with a chronic illness, including vascular disease, diabetes, arthritis, and osteoporosis. Participants were between 52 and 84 years of age (mean 64); among the study participants, 23 (72%) were women and the mean body mass index was 31 kg/m2. Participants tested 5 trackers, including a simple pedometer (Sportline or Mio) followed by 4 wearable activity trackers (Fitbit Zip, Misfit Shine, Jawbone Up 24, and Withings Pulse) in random order. Selected devices represented the range of wearable products and features available on the Canadian market in 2014. Participants wore each device for at least 3 days and evaluated it using a questionnaire developed from the Technology Acceptance Model. We used focus groups to explore participant experiences and a thematic analysis approach to data collection and analysis. Results: Our study resulted in 4 themes: (1) adoption within a comfort zone; (2) self-awareness and goal setting; (3) purposes of data tracking; and (4) future of wearable activity trackers as health care devices. Prior to enrolling, few participants were aware of wearable activity trackers. Most also had been asked by a physician to exercise more and cited this as a motivation for testing the devices. None of the participants planned to purchase the simple pedometer after the study, citing poor accuracy and data loss, whereas 73% (N=32) planned to purchase a wearable activity tracker. Preferences varied but 50% felt they would buy a Fitbit and 42% felt they would buy a Misfit, Jawbone, or Withings. The simple pedometer had a mean acceptance score of 56/95 compared with 63 for the Withings, 65 for the Misfit and Jawbone, and 68 for the Fitbit. To improve usability, older users may benefit from devices that have better compatibility with personal computers or less-expensive Android mobile phones and tablets, and have comprehensive paper-based user manuals and apps that interpret user data. Conclusions: For older adults living with chronic illness, wearable activity trackers are perceived as useful and acceptable. New users may need support to both set up the device and learn how to interpret their data. UR - http://mhealth.jmir.org/2016/1/e7/ UR - http://dx.doi.org/10.2196/mhealth.4225 UR - http://www.ncbi.nlm.nih.gov/pubmed/26818775 ID - info:doi/10.2196/mhealth.4225 ER - TY - JOUR AU - Birney, J. Amelia AU - Gunn, Rebecca AU - Russell, K. Jeremy AU - Ary, V. Dennis PY - 2016/01/26 TI - MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial JO - JMIR mHealth uHealth SP - e8 VL - 4 IS - 1 KW - depression KW - cognitive behavioral therapy KW - behavioral activation KW - positive psychology KW - mobile apps KW - Internet KW - computers N2 - Background: Worldwide, depression is rated as the fourth leading cause of disease burden and is projected to be the second leading cause of disability by 2020. Annual depression-related costs in the United States are estimated at US $210.5 billion, with employers bearing over 50% of these costs in productivity loss, absenteeism, and disability. Because most adults with depression never receive treatment, there is a need to develop effective interventions that can be more widely disseminated through new channels, such as employee assistance programs (EAPs), and directly to individuals who will not seek face-to-face care. Objective: This study evaluated a self-guided intervention, using the MoodHacker mobile Web app to activate the use of cognitive behavioral therapy (CBT) skills in working adults with mild-to-moderate depression. It was hypothesized that MoodHacker users would experience reduced depression symptoms and negative cognitions, and increased behavioral activation, knowledge of depression, and functioning in the workplace. Methods: A parallel two-group randomized controlled trial was conducted with 300 employed adults exhibiting mild-to-moderate depression. Participants were recruited from August 2012 through April 2013 in partnership with an EAP and with outreach through a variety of additional non-EAP organizations. Participants were blocked on race/ethnicity and then randomly assigned within each block to receive, without clinical support, either the MoodHacker intervention (n=150) or alternative care consisting of links to vetted websites on depression (n=150). Participants in both groups completed online self-assessment surveys at baseline, 6 weeks after baseline, and 10 weeks after baseline. Surveys assessed (1) depression symptoms, (2) behavioral activation, (3) negative thoughts, (4) worksite outcomes, (5) depression knowledge, and (6) user satisfaction and usability. After randomization, all interactions with subjects were automated with the exception of safety-related follow-up calls to subjects reporting current suicidal ideation and/or severe depression symptoms. Results: At 6-week follow-up, significant effects were found on depression, behavioral activation, negative thoughts, knowledge, work productivity, work absence, and workplace distress. MoodHacker yielded significant effects on depression symptoms, work productivity, work absence, and workplace distress for those who reported access to an EAP, but no significant effects on these outcome measures for those without EAP access. Participants in the treatment arm used the MoodHacker app an average of 16.0 times (SD 13.3), totaling an average of 1.3 hours (SD 1.3) of use between pretest and 6-week follow-up. Significant effects on work absence in those with EAP access persisted at 10-week follow-up. Conclusions: This randomized effectiveness trial found that the MoodHacker app produced significant effects on depression symptoms (partial eta2 = .021) among employed adults at 6-week follow-up when compared to subjects with access to relevant depression Internet sites. The app had stronger effects for individuals with access to an EAP (partial eta2 = .093). For all users, the MoodHacker program also yielded greater improvement on work absence, as well as the mediating factors of behavioral activation, negative thoughts, and knowledge of depression self-care. Significant effects were maintained at 10-week follow-up for work absence. General attenuation of effects at 10-week follow-up underscores the importance of extending program contacts to maintain user engagement. This study suggests that light-touch, CBT-based mobile interventions like MoodHacker may be appropriate for implementation within EAPs and similar environments. In addition, it seems likely that supporting MoodHacker users with guidance from counselors may improve effectiveness for those who seek in-person support. Trial Registration: ClinicalTrials.gov NCT02335554; https://clinicaltrials.gov/ct2/show/NCT02335554 (Archived by WebCite at http://www.webcitation.org/6dGXKWjWE) UR - http://mhealth.jmir.org/2016/1/e8/ UR - http://dx.doi.org/10.2196/mhealth.4231 UR - http://www.ncbi.nlm.nih.gov/pubmed/26813737 ID - info:doi/10.2196/mhealth.4231 ER - TY - JOUR AU - Vorrink, NW Sigrid AU - Kort, SM Helianthe AU - Troosters, Thierry AU - Lammers, J. Jan-Willem PY - 2016/01/26 TI - A Mobile Phone App to Stimulate Daily Physical Activity in Patients with Chronic Obstructive Pulmonary Disease: Development, Feasibility, and Pilot Studies JO - JMIR mHealth uHealth SP - e11 VL - 4 IS - 1 KW - telemedicine KW - mobile phones KW - chronic obstructive pulmonary disease KW - motor activity N2 - Background: Patients with chronic obstructive pulmonary disease (COPD) demonstrate reduced levels of daily physical activity (DPA) compared to healthy controls. This results in a higher risk of hospital admission and shorter survival. Performing regular DPA reduces these risks. Objective: To develop an eHealth intervention that will support patients with COPD to improve or maintain their DPA after pulmonary rehabilitation. Methods: The design process consisted of literature research and the iterative developing and piloting phases of the Medical Research Council (MRC) model for complex clinical interventions and the involvement of end users. Participants were healthy adults and persons with COPD. Results: The mobile phone interface met all the set requirements. Participants found that the app was stimulating and that reaching their DPA goals was rewarding. The mean (SD) scores on a 7-point scale for usability, ease of use, ease of learning, and contentment were 3.8 (1.8), 5.1 (1.1), 6.0 (1.6), and 4.8 (1.3), respectively. The mean (SD) correlation between the mobile phone and a validated accelerometer was 0.88 (0.12) in the final test. The idea of providing their health care professional with their DPA data caused no privacy issues in the participants. Battery life lasted for an entire day with the final version, and readability and comprehensibility of text and colors were favorable. Conclusions: By employing a user-centered design approach, a mobile phone was found to be an adequate and feasible interface for an eHealth intervention. The mobile phone and app are easy to learn and use by patients with COPD. In the final test, the accuracy of the DPA measurement was good. The final version of the eHealth intervention is presently being tested by our group for efficacy in a randomized controlled trial in COPD patients. UR - http://mhealth.jmir.org/2016/1/e11/ UR - http://dx.doi.org/10.2196/mhealth.4741 UR - http://www.ncbi.nlm.nih.gov/pubmed/26813682 ID - info:doi/10.2196/mhealth.4741 ER - TY - JOUR AU - Kendzor, E. Darla AU - Shuval, Kerem AU - Gabriel, Pettee Kelley AU - Businelle, S. Michael AU - Ma, Ping AU - High, R. Robin AU - Cuate, L. Erica AU - Poonawalla, B. Insiya AU - Rios, M. Debra AU - Demark-Wahnefried, Wendy AU - Swartz, D. Michael AU - Wetter, W. David PY - 2016/01/25 TI - Impact of a Mobile Phone Intervention to Reduce Sedentary Behavior in a Community Sample of Adults: A Quasi-Experimental Evaluation JO - J Med Internet Res SP - e19 VL - 18 IS - 1 KW - sedentary lifestyle KW - mobile phone KW - African Americans KW - physical activity N2 - Background: Greater time spent sedentary is linked with increased risk of breast, colorectal, ovarian, endometrial, and prostate cancers. Given steadily increasing rates of mobile phone ownership, mobile phone interventions may have the potential to broadly influence sedentary behavior across settings. Objective: The purpose of this study was to examine the short-term impact of a mobile phone intervention that targeted sedentary time in a diverse community sample. Methods: Adults participated in a quasi-experimental evaluation of a mobile phone intervention designed to reduce sedentary time through prompts to interrupt periods of sitting. Participants carried mobile phones and wore accelerometers for 7 consecutive days. Intervention participants additionally received mobile phone prompts during self-reported sitting and information about the negative health impact of prolonged sedentariness. The study was conducted from December 2012 to November 2013 in Dallas, Texas. Linear mixed model regression analyses were conducted to evaluate the influence of the intervention on daily accelerometer-determined estimates of sedentary and active time. Results: Participants (N=215) were predominantly female (67.9%, 146/215) and nonwhite (black: 50.7%, 109/215; Latino: 12.1%, 26/215; other: 5.6%, 12/215). Analyses revealed that participants who received the mobile phone intervention had significantly fewer daily minutes of sedentary time (B=?22.09, P=.045) and more daily active minutes (B=23.01, P=.04) than control participants. Conclusions: A simple mobile phone intervention was associated with engaging in less sedentary time and more physical activity. Findings underscore the potential impact of mobile phone interventions to positively influence sedentary behavior and physical activity. UR - http://www.jmir.org/2016/1/e19/ UR - http://dx.doi.org/10.2196/jmir.5137 UR - http://www.ncbi.nlm.nih.gov/pubmed/26810027 ID - info:doi/10.2196/jmir.5137 ER - TY - JOUR AU - Maar, A. Marion AU - Yeates, Karen AU - Toth, Zsolt AU - Barron, Marcia AU - Boesch, Lisa AU - Hua-Stewart, Diane AU - Liu, Peter AU - Perkins, Nancy AU - Sleeth, Jessica AU - Wabano, Jo Mary AU - Williamson, Pamela AU - Tobe, W. Sheldon PY - 2016/01/22 TI - Unpacking the Black Box: A Formative Research Approach to the Development of Theory-Driven, Evidence-Based, and Culturally Safe Text Messages in Mobile Health Interventions JO - JMIR mHealth uHealth SP - e10 VL - 4 IS - 1 KW - Aboriginal people KW - behavioral change wheel KW - cultural safety KW - grounded theory KW - mobile phone KW - semiotics KW - SMS KW - Tanzania KW - text messages N2 - Background: Mobile-cellular subscriptions have increased steadily over the past decade. The accessibility of SMS messages over existing mobile networks is high and has almost universal availability even on older and unsophisticated mobile phones and in geographic settings where wireless coverage is weak. There is intensive exploration of this inexpensive mobile telecommunication technology to improve health services and promote behavior change among vulnerable populations. However, a neglected area of research is the documentation and critical analysis of the formative research process required in the development and refinement of effective SMS messages. Objective: The objective of this qualitative research study was to identify major factors that may impact on the effectiveness of evidence-based SMS messages designed to reduce health inequities in hypertension management in low resource settings, including Aboriginal populations in high-income countries and rural populations in low-income countries. Specifically, we were interested in uncovering the range of mediators that impact on appropriate message content transmission and, ultimately, on health behavior improvements in a range of these sociocultural settings. Methods: Collaborative qualitative research with Canadian Aboriginal and Tanzanian participants was conducted to deconstruct the content and transmission of evidence-based health information contained in SMS messages in the context of an international research project designed to address health inequalities in hypertension, and to develop a grounded theory of the major factors that mediate the effectiveness of this communication. We also examined the interrelationship of these mediators with the three essential conditions of the behavior system of the Behavioral Change Wheel model (capability, opportunity, and motivation) and cultural safety. Results: Four focus groups with a total of 45 participants were conducted. Our grounded theory research revealed how discrepancies develop between the evidence-based text message created by researchers and the message received by the recipient in mobile health interventions. These discrepancies were primarily generated by six mediators of meaning in SMS messages: (1) negative or non-affirming framing of advocacies, (2) fear- or stress-inducing content, (3) oppressive or authoritarian content, (4) incongruity with cultural and traditional practices, (5) disconnect with the reality of the social determinants of health and the diversity of cultures within a population, and (6) lack of clarity and/or practicality of content. These 6 mediators of meaning provide the basis for sound strategies for message development because they impact directly on the target populations? capability, opportunity, and motivation for behavior change. Conclusions: The quality of text messages impacts significantly on the effectiveness of a mobile health intervention. Our research underscores the urgent need for interventions to incorporate and evaluate the quality of SMS messages and to examine the mediators of meaning within each targeted cultural and demographic group. Reporting on this aspect of mobile health intervention research will allow researchers to move away from the current black box of SMS text message development, thus improving the transparency of the process as well as the quality of the outcomes. UR - http://mhealth.jmir.org/2016/1/e10/ UR - http://dx.doi.org/10.2196/mhealth.4994 UR - http://www.ncbi.nlm.nih.gov/pubmed/26800712 ID - info:doi/10.2196/mhealth.4994 ER - TY - JOUR AU - Djaja, Ngadiman AU - Janda, Monika AU - Olsen, M. Catherine AU - Whiteman, C. David AU - Chien, Tsair-Wei PY - 2016/01/22 TI - Estimating Skin Cancer Risk: Evaluating Mobile Computer-Adaptive Testing JO - J Med Internet Res SP - e22 VL - 18 IS - 1 KW - computer adaptive testing KW - skin cancer risk scale KW - non adaptive test KW - Rasch analysis KW - partial credit model N2 - Background: Response burden is a major detriment to questionnaire completion rates. Computer adaptive testing may offer advantages over non-adaptive testing, including reduction of numbers of items required for precise measurement. Objective: Our aim was to compare the efficiency of non-adaptive (NAT) and computer adaptive testing (CAT) facilitated by Partial Credit Model (PCM)-derived calibration to estimate skin cancer risk. Methods: We used a random sample from a population-based Australian cohort study of skin cancer risk (N=43,794). All 30 items of the skin cancer risk scale were calibrated with the Rasch PCM. A total of 1000 cases generated following a normal distribution (mean [SD] 0 [1]) were simulated using three Rasch models with three fixed-item (dichotomous, rating scale, and partial credit) scenarios, respectively. We calculated the comparative efficiency and precision of CAT and NAT (shortening of questionnaire length and the count difference number ratio less than 5% using independent t tests). Results: We found that use of CAT led to smaller person standard error of the estimated measure than NAT, with substantially higher efficiency but no loss of precision, reducing response burden by 48%, 66%, and 66% for dichotomous, Rating Scale Model, and PCM models, respectively. Conclusions: CAT-based administrations of the skin cancer risk scale could substantially reduce participant burden without compromising measurement precision. A mobile computer adaptive test was developed to help people efficiently assess their skin cancer risk. UR - http://www.jmir.org/2016/1/e22/ UR - http://dx.doi.org/10.2196/jmir.4736 UR - http://www.ncbi.nlm.nih.gov/pubmed/26800642 ID - info:doi/10.2196/jmir.4736 ER - TY - JOUR AU - Miyamoto, W. Sheridan AU - Henderson, Stuart AU - Young, M. Heather AU - Pande, Amit AU - Han, J. Jay PY - 2016/01/20 TI - Tracking Health Data Is Not Enough: A Qualitative Exploration of the Role of Healthcare Partnerships and mHealth Technology to Promote Physical Activity and to Sustain Behavior Change JO - JMIR mHealth uHealth SP - e5 VL - 4 IS - 1 KW - mHealth KW - health behavior KW - motivation KW - goals KW - physical activity N2 - Background: Despite the recent explosion of the mobile health (mHealth) industry and consumer acquisition of mHealth tools such as wearable sensors and applications (apps), limited information is known about how this technology can sustain health behavior change and be integrated into health care. Objective: The objective of the study was to understand potential users? views of mHealth technology, the role this technology may have in promoting individual activity goals aimed at improving health, and the value of integrating mHealth technology with traditional health care. Methods: Four focus groups were conducted with adults interested in sharing their views on how mHealth technology could support wellness programs and improve health. Participants (n=30) were enrolled from an employee population at an academic health institution. Qualitative thematic analysis was used to code transcripts and identify overarching themes. Results: Our findings suggest that tracking health data alone may result in heightened awareness of daily activity, yet may not be sufficient to sustain use of mHealth technology and apps, which often have low reuse rates. Participants suggested that context, meaning, and health care partnerships need to be incorporated to engage and retain users. In addition to these findings, drivers for mHealth technology previously identified in the literature, including integration and control of health data were confirmed in this study. Conclusions: This study explores ways that mHealth technologies may be used to not only track data, but to encourage sustained engagement to achieve individual health goals. Implications of these findings include recommendations for mHealth technology design and health care partnership models to sustain motivation and engagement, allowing individuals to achieve meaningful behavior change. UR - http://mhealth.jmir.org/2016/1/e5/ UR - http://dx.doi.org/10.2196/mhealth.4814 UR - http://www.ncbi.nlm.nih.gov/pubmed/26792225 ID - info:doi/10.2196/mhealth.4814 ER - TY - JOUR AU - Mangone, Rose Emily AU - Lebrun, Victoria AU - Muessig, E. Kathryn PY - 2016/01/19 TI - Mobile Phone Apps for the Prevention of Unintended Pregnancy: A Systematic Review and Content Analysis JO - JMIR mHealth uHealth SP - e6 VL - 4 IS - 1 KW - mHealth KW - eHealth KW - mobile phone KW - app KW - systematic review KW - unintended pregnancy KW - family planning KW - pregnancy prevention KW - contraception N2 - Background: Over 50% of pregnancies in the United States are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases health risks for mother and child, leads to high economic costs for society, and increases social disparities. Mobile phone ownership is rapidly increasing, providing opportunities to reach at-risk populations with reproductive health information and tailored unintended pregnancy prevention interventions through mobile phone apps. However, apps that offer support for unintended pregnancy prevention remain unevaluated. Objective: To identify, describe, and evaluate mobile phone apps that purport to help users prevent unintended pregnancy. Methods: We conducted an extensive search of the Apple iTunes and Android Google Play stores for apps that explicitly included or advertised pregnancy prevention or decision-making support in the context of fertility information/tracking, birth control reminders, contraceptive information, pregnancy decision-making, abortion information or counseling, sexual communication/negotiation, and pregnancy tests. We excluded apps that targeted medical professionals or that cost more than US $1.99. Eligible apps were downloaded and categorized by primary purpose. Data extraction was performed on a minimum of 143 attributes in 3 domains: (1) pregnancy prevention best practices, (2) contraceptive methods and clinical services, and (3) user interface. Apps were assigned points for their inclusion of features overall and for pregnancy prevention best practices and contraceptive information. Results: Our search identified 6805 app descriptions in iTunes and Google Play. Of these, 218 unique apps met inclusion criteria and were included in the review. Apps were grouped into 9 categories: fertility trackers (n=72), centers and resources (n=38), birth control reminders (n=35), general sexual and reproductive health (SRH) information (n=17), SRH information targeted specifically to young adults (YA) (n=16), contraceptive information (n=15), service or condom locators (n=12), pregnancy tests (n=10), and games (n=3). Twelve apps scored at least 50 points (out of 94) for overall number of features and at least 15 points (out of 21) for contraceptive information and pregnancy prevention best practices. Overall, 41% of apps did not mention any modern contraceptive methods and 23% mentioned only 1 method. Of apps that did mention a modern contraceptive method, fewer than 50% of these apps provided information on how to use it. YA SRH apps had the highest percentage of pregnancy prevention best practices in each app. Demographic and interface evaluation found that most apps (72%) did not target any race and only 10% explicitly targeted youth. Communication interface features were present in fewer than 50% of apps. Conclusions: This review identified several useful, evidence-based apps that support the prevention of unintended pregnancy. However, most apps miss opportunities to provide users with valuable information, interactive decision aids, and evidence-based interventions for unintended pregnancy prevention. Further, some apps in this space may increase the likelihood of unintended pregnancy due to the low effectiveness of the contraceptive methods promoted. UR - http://mhealth.jmir.org/2016/1/e6/ UR - http://dx.doi.org/10.2196/mhealth.4846 UR - http://www.ncbi.nlm.nih.gov/pubmed/26787311 ID - info:doi/10.2196/mhealth.4846 ER - TY - JOUR AU - Pollard, Mary Christina AU - Howat, A. Peter AU - Pratt, S. Iain AU - Boushey, J. Carol AU - Delp, J. Edward AU - Kerr, Anne Deborah PY - 2016/01/19 TI - Preferred Tone of Nutrition Text Messages for Young Adults: Focus Group Testing JO - JMIR mHealth uHealth SP - e1 VL - 4 IS - 1 KW - text messages KW - tone of voice KW - nutrition messages KW - fruit KW - vegetable KW - junk food KW - alcohol KW - communication N2 - Background: Young adults are a particularly hard to reach group using conventional health promotion practices as they do not see nutrition messages as personally relevant to them. Text messaging (short message service, SMS) offers an innovative approach to reaching young adults to support and promote dietary behavior change. Objective: The aim of this study was to develop and test tonal preferences for nutrition text messages among young adults using focus groups. Methods: A total of 39 young adults aged 18-30 years residing in Perth, Western Australia participated in four focus groups. Participants briefly discussed their perception of healthy eating and their responses to messages about increasing fruit and vegetables, and reducing ?junk food? and alcohol intake. They ranked their preference for 15 nutrition messages across 3 dietary behaviors (fruit and vegetables, junk food, and alcohol) with 5 different message tones (authoritative, empathetic, generation Y, solutions, and substitutions) and identified the messages most likely to persuade young adults to change their diet. A 5-point ranking of the nutrition messages was from the most likely to least likely to persuade (1-5). The focus groups were conducted by a trained facilitator and observer and were recorded. Data driven content analysis was used to explore themes. Tonal preferences and potential motivators were collated and frequencies presented. Results: Participants ranked offering substitutes (29%, 11/39) and using empathy (22%, 9/39) as the most persuasive message techniques in improving diets of young adults, with low responses for Generation Y (17%, 7/39), solutions (17%, 7/39), and authoritative (15%, 6/39) tones. Females were more likely to consider substitution messages persuasive (35%, 7/20) compared with males (22%, 4/19). A greater proportion of males compared with females considered authoritative messages persuasive: (22%, 4/19) compared with (7%, 1/20). There is a strong preference for a substitution tone for fruit and vegetable messages (52%, 20/39), and no overall message tone preference for junk food and alcohol messages. Substitutions were viewed as helpful and practical. Empathy was liked as it acknowledged previous efforts. Responses to authoritative tone were mixed with some feeling guilt while others found them informative. Acceptability of the solutions depended on the behavioral change and acceptability of the solution proposed. Generation Y tone had some support for junk food and alcohol messages, and if favored, was considered casual, humorous, catchy, and motivational. Conclusions: Substitutions and tone of empathy were favored as the most likely execution styles to motivate nutrition behavior change across all participants. There is no ?one size fits all? with different tones preferred by individuals for different dietary behaviors. Although text messaging provides instant message delivery direct to the individual, these results demonstrate the complexity of developing motivational nutrition message for young adults. These findings reveal the importance of considering the tone and content and pretesting messages for health promotion text message interventions. UR - http://mhealth.jmir.org/2016/1/e1/ UR - http://dx.doi.org/10.2196/mhealth.4764 UR - http://www.ncbi.nlm.nih.gov/pubmed/26787115 ID - info:doi/10.2196/mhealth.4764 ER - TY - JOUR AU - Du, Honglu AU - Venkatakrishnan, Anusha AU - Youngblood, Michael Gregory AU - Ram, Ashwin AU - Pirolli, Peter PY - 2016/01/15 TI - A Group-Based Mobile Application to Increase Adherence in Exercise and Nutrition Programs: A Factorial Design Feasibility Study JO - JMIR mHealth uHealth SP - e4 VL - 4 IS - 1 KW - mobile phone KW - app KW - social support N2 - Background: Novel methods of promoting self-monitoring and social support are needed to ensure long-term maintenance of behavior change. In this paper, we directly investigate the effects of group support in an exercise and nutrition program delivered by an mHealth application called Fittle. Objective: Our first specific study aim was to explore whether social support improved adherence in wellness programs. Our second specific study aim was to assess whether media types (ePaper vs mobile) were associated with different levels of compliance and adherence to wellness programs. The third aim was to assess whether the use of an mHealth application led to positive changes to participants? eating behavior, physical activity, and stress level, compared to traditional paper-based programs. Methods: A 2 × 2 (eg, Media: Mobile vs ePaper × Group Type: Team vs Solo) factorial design feasibility study was conducted. A sample of 124 volunteers who were interested in improving eating behavior, increasing physical activity, or reducing stress participated in this study. The study duration was 8 weeks. All groups were self-directed with no ongoing human input from the research team. Results: Participants in ePaper conditions had higher attrition rates compared to participants in Mobile conditions, ?32=9.96, P=.02 (N=124). Participants in Mobile conditions reported their compliance with a much higher frequency closer to the time of challenge activity completion (2-sample Kolmogorov-Smirnov test comparing distributions was highly significant?KS=0.33, P<.001 [N=63]). Participants in ePaper conditions had a much higher frequency of guessing while reporting as compared with those in Mobile conditions??12=25.25, P<.001 (N=63). Together, these findings suggest that the mobile app allowed a more accurate method to report and track health behaviors over a longer period than traditional ePaper-based diaries or log books. There was a significant difference in the overall compliance score for Mobile-Solo (Mean [SD] 0.30 [0.39]) and Mobile-Team (Mean [SD] 0.49 [0.35]) conditions (t50.82=1.94, P=.05). This suggests that working in a team increased participants? overall compliance within Fittle. Survival analysis showed that participants assigned to Team conditions are 66% more likely to engage longer with mHealth app-based intervention than those assigned to the Solo condition. Overall, participants across all groups reported some positive changes in eating behavior, physical activity, and stress level; however, participants in the Mobile-Solo condition reported higher perceived stress levels at the end of the study. Conclusions: The team-based Fittle app is an acceptable and feasible wellness behavior change intervention and a full randomized controlled trial to investigate the efficacy of such an intervention is warranted. UR - http://mhealth.jmir.org/2016/1/e4/ UR - http://dx.doi.org/10.2196/mhealth.4900 UR - http://www.ncbi.nlm.nih.gov/pubmed/26772910 ID - info:doi/10.2196/mhealth.4900 ER - TY - JOUR AU - Price, Matthew AU - Sawyer, Tyler AU - Harris, Madison AU - Skalka, Christian PY - 2016/01/11 TI - Usability Evaluation of a Mobile Monitoring System to Assess Symptoms After a Traumatic Injury: A Mixed-Methods Study JO - JMIR Mental Health SP - e3 VL - 3 IS - 1 KW - mobile phone KW - trauma KW - posttraumatic stress disorder KW - usability N2 - Background: Victims of trauma are at high risk for mental health conditions such as posttraumatic stress disorder and depression. Regular assessment of mental health symptoms in the post-trauma period is necessary to identify those at greatest risk and provide treatment. The multiple demands of the acute post-trauma period present numerous barriers to such assessments. Mobile apps are a method by which to overcome these barriers in order to regularly assess symptoms, identify those at risk, and connect patients to needed services. Objective: The current study conducted a usability evaluation of a system to monitor mental health symptoms after a trauma. The system was developed to promote ease of use and facilitate quick transmission of data. Methods: A sample of 21 adults with a history of trauma completed a standardized usability test in a laboratory setting followed by a qualitative interview. Results: Usability testing indicated that the app was easy to use and that patients were able to answer several questions in less than 1 minute (mean [SD] 29.37 [7.53]; range 15-57). Qualitative analyses suggested that feedback should be included in such an app and recommendations for the type of feedback were offered. Conclusions: The results of the current study indicate that a mobile app to monitor post-trauma mental health symptoms would be well received by victims. Personalized feedback to the user was identified as critical to promote the usability of the software. UR - http://mental.jmir.org/2016/1/e3/ UR - http://dx.doi.org/10.2196/mental.5023 UR - http://www.ncbi.nlm.nih.gov/pubmed/26753673 ID - info:doi/10.2196/mental.5023 ER - TY - JOUR AU - Müller, Matthias Andre AU - Khoo, Selina AU - Morris, Tony PY - 2016/01/07 TI - Text Messaging for Exercise Promotion in Older Adults From an Upper-Middle-Income Country: Randomized Controlled Trial JO - J Med Internet Res SP - e5 VL - 18 IS - 1 KW - exercise KW - text message KW - mobile phone KW - older adults KW - mHealth KW - Asia KW - health behavior KW - behavior maintenance KW - physical activity KW - Malaysia N2 - Background: Mobile technology to promote exercise is effective; however, most evidence is from studies of younger groups in high-income countries. Investigating if short message service (SMS) texting can affect exercise participation in older adults from an upper-middle-income country is important considering the proliferation of mobile phones in developing regions and the increased interest of older adults in using mobile phones. Objective: The main objective was to examine the short- and long-term effects of SMS text messaging on exercise frequency in older adults. Secondary objectives were to investigate how SMS text messages impact study participants? exercise frequency and the effects of the intervention on secondary outcomes. Methods: The Malaysian Physical Activity for Health Study (myPAtHS) was a 24-week, 2-arm, parallel randomized controlled trial conducted in urban Malaysia. Participants were recruited via health talks in resident associations and religious facilities. Older Malaysians (aged 55-70 years) who used mobile phones and did not exercise regularly were eligible to participate in the study. Participants randomly allocated to the SMS texting arm received an exercise booklet and 5 weekly SMS text messages over 12 weeks. The content of the SMS text messages was derived from effective behavior change techniques. The non-SMS texting arm participants received only the exercise booklet. Home visits were conducted to collect outcome data: (1) exercise frequency at 12 and 24 weeks, (2) secondary outcome data (exercise self-efficacy, physical activity?related energy expenditure, sitting time, body mass index, grip and leg strength) at baseline and at 12 and 24 weeks. Intention-to-treat procedures were applied for data analysis. Semistructured interviews focusing primarily on the SMS text messages and their impact on exercise frequency were conducted at weeks 12 and 24. Results: In total, 43 participants were randomized into the SMS texting arm (n=22) and the non-SMS texting arm (n=21). Study-unrelated injuries forced 4 participants to discontinue after a few weeks (they were not included in any analyses). Overall retention was 86% (37/43). After 12 weeks, SMS texting arm participants exercised significantly more than non-SMS texting arm participants (mean difference 1.21 times, bias-corrected and accelerated bootstrap [BCa] 95% CI 0.18-2.24). Interview analysis revealed that the SMS text messages positively influenced SMS texting arm participants who experienced exercise barriers. They described the SMS text messages as being encouraging, a push, and a reminder. After 24 weeks, there was no significant difference between the research arms (mean difference 0.74, BCa 95% CI ?0.30 to 1.76). There were no significant effects for secondary outcomes. Conclusions: This study provides evidence that SMS text messaging is effective in promoting exercise in older adults from an upper-middle-income country. Although the effects were not maintained when SMS text messaging ceased, the results are promising and warrant more research on behavioral mobile health interventions in other regions. Trial Registration: Clinicaltrials.gov NCT02123342; http://clinicaltrials.gov/ct2/show/NCT02123342 (Archived by WebCite at http://www.webcitation.org/6eGSsu2EI). UR - http://www.jmir.org/2016/1/e5/ UR - http://dx.doi.org/10.2196/jmir.5235 UR - http://www.ncbi.nlm.nih.gov/pubmed/26742999 ID - info:doi/10.2196/jmir.5235 ER - TY - JOUR AU - Beiwinkel, Till AU - Kindermann, Sally AU - Maier, Andreas AU - Kerl, Christopher AU - Moock, Jörn AU - Barbian, Guido AU - Rössler, Wulf PY - 2016/01/06 TI - Using Smartphones to Monitor Bipolar Disorder Symptoms: A Pilot Study JO - JMIR Mental Health SP - e2 VL - 3 IS - 1 KW - smartphone KW - sensor technology KW - bipolar disorder KW - monitoring KW - phase transitions KW - communication patterns KW - activity patterns N2 - Background: Relapse prevention in bipolar disorder can be improved by monitoring symptoms in patients' daily life. Smartphone apps are easy-to-use, low-cost tools that can be used to assess this information. To date, few studies have examined the usefulness of smartphone data for monitoring symptoms in bipolar disorder. Objective: We present results from a pilot test of a smartphone-based monitoring system, Social Information Monitoring for Patients with Bipolar Affective Disorder (SIMBA), that tracked daily mood, physical activity, and social communication in 13 patients. The objective of this study was to investigate whether smartphone measurements predicted clinical symptoms levels and clinical symptom change. The hypotheses that smartphone measurements are (1) negatively related to clinical depressive symptoms and (2) positively related to clinical manic symptoms were tested. Methods: Clinical rating scales were administered to assess clinical depressive and manic symptoms. Patients used a smartphone with the monitoring app for up to 12 months. Random-coefficient multilevel models were computed to analyze the relationship between smartphone data and externally rated manic and depressive symptoms. Overall clinical symptom levels and clinical symptom changes were predicted by separating between-patient and within-patient effects. Using established clinical thresholds from the literature, marginal effect plots displayed clinical relevance of smartphone data. Results: Overall symptom levels and change in clinical symptoms were related to smartphone measures. Higher overall levels of clinical depressive symptoms were predicted by lower self-reported mood measured by the smartphone (beta=-.56, P<.001). An increase in clinical depressive symptoms was predicted by a decline in social communication (ie, outgoing text messages: beta=-.28, P<.001) and a decline in physical activity as measured by the smartphone (ie, cell tower movements: beta=-.11, P=.03). Higher overall levels of clinical manic symptoms were predicted by lower physical activity on the smartphone (ie, distance travelled: beta=-.37, P<.001), and higher social communication (beta=.48, P=.03). An increase in clinical manic symptoms was predicted by a decrease in physical activity on the smartphone (beta=-.17, P<.001). Conclusions: Clinical symptoms were related to some objective and subjective smartphone measurements, but not all smartphone measures predicted the occurrence of bipolar symptoms above clinical thresholds. Thus, smartphones have the potential to monitor bipolar disorder symptoms in patients? daily life. Further validation of monitoring tools in a larger sample is needed. Conclusions are limited by the low prevalence of manic and depressive symptoms in the study sample. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 05663421; http://www.controlled-trials.com/ISRCTN05663421 (Archived by WebCite at http://www.webcitation.org/6d9wsibJB) UR - http://mental.jmir.org/2016/1/e2/ UR - http://dx.doi.org/10.2196/mental.4560 UR - http://www.ncbi.nlm.nih.gov/pubmed/26740354 ID - info:doi/10.2196/mental.4560 ER - TY - JOUR AU - Petersen, Carolyn AU - Adams, A. Samantha AU - DeMuro, R. Paul PY - 2015/12/31 TI - mHealth: Don?t Forget All the Stakeholders in the Business Case JO - Med 2.0 SP - e4 VL - 4 IS - 2 KW - Internet KW - mobile KW - mobile health KW - app KW - social media KW - health care market UR - http://www.medicine20.com/2015/2/e4/ UR - http://dx.doi.org/10.2196/med20.4349 UR - http://www.ncbi.nlm.nih.gov/pubmed/26720310 ID - info:doi/10.2196/med20.4349 ER - TY - JOUR AU - Browne, H. Sara AU - Behzadi, Yashar AU - Littlewort, Gwen PY - 2015/12/31 TI - Let Visuals Tell the Story: Medication Adherence in Patients with Type II Diabetes Captured by a Novel Ingestion Sensor Platform JO - JMIR mHealth uHealth SP - e108 VL - 3 IS - 4 KW - ingestion sensor platform KW - data visualization KW - time domain methods KW - medication adherence KW - patient self-management N2 - Background: Chronic diseases such as diabetes require high levels of medication adherence and patient self-management for optimal health outcomes. A novel sensing platform, Digital Health Feedback System (Proteus Digital Health, Redwood City, CA), can for the first time detect medication ingestion events and physiological measures simultaneously, using an edible sensor, personal monitor patch, and paired mobile device. The Digital Health Feedback System (DHFS) generates a large amount of data. Visual analytics of this rich dataset may provide insights into longitudinal patterns of medication adherence in the natural setting and potential relationships between medication adherence and physiological measures that were previously unknown. Objective: Our aim was to use modern methods of visual analytics to represent continuous and discrete data from the DHFS, plotting multiple different data types simultaneously to evaluate the potential of the DHFS to capture longitudinal patterns of medication-taking behavior and self-management in individual patients with type II diabetes. Methods: Visualizations were generated using time domain methods of oral metformin medication adherence and physiological data obtained by the DHFS use in 5 patients with type II diabetes over 37-42 days. The DHFS captured at-home metformin adherence, heart rate, activity, and sleep/rest. A mobile glucose monitor captured glucose testing and level (mg/dl). Algorithms were developed to analyze data over varying time periods: across the entire study, daily, and weekly. Following visualization analysis, correlations between sleep/rest and medication ingestion were calculated across all subjects. Results: A total of 197 subject days, encompassing 141,840 data events were analyzed. Individual continuous patch use varied between 87-98%. On average, the cohort took 78% (SD 12) of prescribed medication and took 77% (SD 26) within the prescribed ±2-hour time window. Average activity levels per subjects ranged from 4000-12,000 steps per day. The combination of activity level and heart rate indicated different levels of cardiovascular fitness between subjects. Visualizations over the entire study captured the longitudinal pattern of missed doses (the majority of which took place in the evening), the timing of ingestions in individual subjects, and the range of medication ingestion timing, which varied from 1.5-2.4 hours (Subject 3) to 11 hours (Subject 2). Individual morning self-management patterns over the study period were obtained by combining the times of waking, metformin ingestion, and glucose measurement. Visualizations combining multiple data streams over a 24-hour period captured patterns of broad daily events: when subjects rose in the morning, tested their blood glucose, took their medications, went to bed, hours of sleep/rest, and level of activity during the day. Visualizations identified highly consistent daily patterns in Subject 3, the most adherent participant. Erratic daily patterns including sleep/rest were demonstrated in Subject 2, the least adherent subject. Correlation between sleep /rest and medication ingestion in each individual subject was evaluated. Subjects 2 and 4 showed correlation between amount of sleep/rest over a 24-hour period and medication-taking the following day (Subject 2: r=.47, P<.02; Subject 4: r=.35, P<.05). With Subject 2, sleep/rest disruptions during the night were highly correlated (r=.47, P<.009) with missing doses the following day. Conclusions: Visualizations integrating medication ingestion and physiological data from the DHFS over varying time intervals captured detailed individual longitudinal patterns of medication adherence and self-management in the natural setting. Visualizing multiple data streams simultaneously, providing a data-rich representation, revealed information that would not have been shown by plotting data streams individually. Such analyses provided data far beyond traditional adherence summary statistics and may form the foundation of future personalized predictive interventions to drive longitudinal adherence and support optimal self-management in chronic diseases such as diabetes. UR - http://mhealth.jmir.org/2015/4/e108/ UR - http://dx.doi.org/10.2196/mhealth.4292 UR - http://www.ncbi.nlm.nih.gov/pubmed/26721413 ID - info:doi/10.2196/mhealth.4292 ER - TY - JOUR AU - Majeed-Ariss, Rabiya AU - Baildam, Eileen AU - Campbell, Malcolm AU - Chieng, Alice AU - Fallon, Debbie AU - Hall, Andrew AU - McDonagh, E. Janet AU - Stones, R. Simon AU - Thomson, Wendy AU - Swallow, Veronica PY - 2015/12/23 TI - Apps and Adolescents: A Systematic Review of Adolescents? Use of Mobile Phone and Tablet Apps That Support Personal Management of Their Chronic or Long-Term Physical Conditions JO - J Med Internet Res SP - e287 VL - 17 IS - 12 KW - adolescents KW - asthma KW - mobile or tablet apps KW - arthritis KW - cancer KW - chronic disease or condition KW - diabetes KW - long-term condition KW - personal or self-management KW - review KW - young people N2 - Background: The prevalence of physical chronic or long-term conditions in adolescents aged 10-24 years is rising. Mobile phone and tablet mobile technologies featuring software program apps are widely used by these adolescents and their healthy peers for social networking or gaming. Apps are also used in health care to support personal condition management and they have considerable potential in this context. There is a growing body of literature on app use in health contexts, thereby making a systematic review of their effectiveness very timely. Objective: To systematically review the literature on the effectiveness of mobile apps designed to support adolescents? management of their physical chronic or long-term conditions. Methods: We conducted a review of the English-language literature published since 2003 in five relevant bibliographical databases using key search terms. Two independent reviewers screened titles and abstracts using data extraction and quality assessment tools. Results: The search returned 1120 hits. Of the 19 eligible full-text papers, four met our review criteria, reporting one pilot randomized controlled trial and three pretest/post-test studies. Samples ranged from 4 to 18 participants, with a combined sample of 46 participants. The apps reported were targeted at type 1 diabetes, asthma, and cancer. Two papers provided data for calculating effect size. Heterogeneity in terms of study design, reported outcomes, follow-up times, participants? ages, and health conditions prevented meta-analyses. There was variation in whether adolescents received guidance in using the app or were solely responsible for navigating the app. Three studies reported some level of patient involvement in app design, development, and/or evaluation. Health professional involvement in the modelling stages of apps was reported in all studies, although it was not always clear whether specific clinical (as opposed to academic) expertise in working with adolescents was represented. The dearth of studies and the small overall sample size emphasizes the need for future studies of the development, evaluation, use, and effectiveness of mobile apps to support adolescents? personal management of their conditions. Conclusions: A key finding of the review is the paucity of evidence-based apps that exist, in contrast to the thousands of apps available on the app market that are not evidence-based or user or professional informed. Although we aimed to assess the effectiveness of apps, the dearth of studies meeting our criteria meant that we were unable to be conclusive in this regard. Based on the available evidence, apps may be considered feasible health interventions, but more studies involving larger sample sizes, and with patient and health professional input at all stages, are needed to determine apps? acceptability and effectiveness. This review provides valuable findings and paves the way for future rigorous development and evaluation of health apps for adolescents with chronic or long-term conditions. UR - http://www.jmir.org/2015/12/e287/ UR - http://dx.doi.org/10.2196/jmir.5043 UR - http://www.ncbi.nlm.nih.gov/pubmed/26701961 ID - info:doi/10.2196/jmir.5043 ER - TY - JOUR AU - Berman, H. Anne AU - Gajecki, Mikael AU - Fredriksson, Morgan AU - Sinadinovic, Kristina AU - Andersson, Claes PY - 2015/12/22 TI - Mobile Phone Apps for University Students With Hazardous Alcohol Use: Study Protocol for Two Consecutive Randomized Controlled Trials JO - JMIR Res Protoc SP - e139 VL - 4 IS - 4 KW - randomized controlled trial, universities, alcohol abuse, prevention, mobile phone, eHealth, mHealth N2 - Background: About 50% of university students overconsume alcohol, and drinking habits in later adulthood are to some extent established during higher educational studies. Several studies have demonstrated that Internet-based interventions have positive effects on drinking habits among university students. Our recent study evaluated two mobile phone apps targeting drinking choices at party occasions via personalized feedback on estimated blood alcohol concentration (eBAC) for students with hazardous drinking. No changes in drinking parameters were found over a seven-week period apart from an increase in number of drinking occasions among men for one of the apps tested. Up to 30% of the study participants drank at potentially harmful levels: higher than the national recommended number of standard drinks per week (a maximum of 9 for women and 14 for men) in Sweden. Objective: (1) To evaluate improved versions of the two mobile phone apps tested in our prior trial, in a new, 3-armed randomized controlled trial among university students with at least hazardous drinking habits according to the Alcohol Use Disorders Identifications Test (AUDIT; Study 1). (2) After 6 weeks, to target study participants showing alcohol consumption higher than the national recommended levels for standard drinks per week by offering them participation in a second, 2-armed randomized trial evaluating an additional mobile phone app with skill enhancement tasks (Study 2). (3) To follow participants at 6, 12 and 18 weeks after recruitment to Study 1 and at 6 and 12 weeks after recruitment to Study 2. Methods: Two randomized controlled trials are conducted. Study 1: Students are recruited at four Swedish universities, via direct e-mail and advertisements on Facebook and student union web sites. Those who provide informed consent, have a mobile phone, and show at least hazardous alcohol consumption according to the AUDIT (?6 for women; ?8 points for men) are randomized into three groups. Group 1 has access to the Swedish government alcohol monopoly?s app, Promillekoll, offering real-time estimated eBAC calculation; Group 2 has access to a Web-based app, PartyPlanner, developed by the research group, offering real-time eBAC calculation with planning and follow-up functions; and Group 3 participants are controls. Follow-up is conducted at 6, 12 and 18 weeks. Study 2. Participants who at the first 6-week follow-up show drinking levels higher than 9 (W) or 14 (M) standard drinks (12 g alcohol) per week, are offered participation in Study 2. Those who consent are randomized to either access to a skills training app, TeleCoach or to a wait-list control group. Results: Latent Markov models for Study 1 and mixed models analyses for Study 2 will be performed. Study 2 data will be analyzed for publication during the spring of 2016; Study 1 data will be analyzed for publication during the fall of 2016. Conclusions: If mobile phone interventions for reducing hazardous alcohol use are found to be effective, the prospects for positively influencing substance use-related health among university students can considerably improve. Trial Registration: ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT02064998 (Archived by WebCite at http://www.webcitation.org/6dy0AlVRP) UR - http://www.researchprotocols.org/2015/4/e139/ UR - http://dx.doi.org/10.2196/resprot.4894 UR - http://www.ncbi.nlm.nih.gov/pubmed/26693967 ID - info:doi/10.2196/resprot.4894 ER - TY - JOUR AU - Cordova, David AU - Bauermeister, A. Jose AU - Fessler, Kathryn AU - Delva, Jorge AU - Nelson, Annabelle AU - Nurenberg, Rachel AU - Mendoza Lua, Frania AU - Alers-Rojas, Francheska AU - Salas-Wright, P. Christopher AU - PY - 2015/12/18 TI - A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study JO - JMIR mHealth uHealth SP - e106 VL - 3 IS - 4 KW - adolescent KW - primary prevention KW - HIV KW - STI KW - mHealth KW - telemedicine KW - primary health care KW - drug users KW - sexually transmitted infections N2 - Background: Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care. Objectives: The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as ?S4E?). Methods: A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis. Results: A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app. Conclusions: There is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances. UR - http://mhealth.jmir.org/2015/4/e106/ UR - http://dx.doi.org/10.2196/mhealth.4620 UR - http://www.ncbi.nlm.nih.gov/pubmed/26685288 ID - info:doi/10.2196/mhealth.4620 ER - TY - JOUR AU - Chen, Juliana AU - Cade, E. Janet AU - Allman-Farinelli, Margaret PY - 2015/12/16 TI - The Most Popular Smartphone Apps for Weight Loss: A Quality Assessment JO - JMIR mHealth uHealth SP - e104 VL - 3 IS - 4 KW - behavior change techniques KW - evaluation KW - obesity KW - quality KW - smartphone apps KW - weight management N2 - Background: Advancements in mobile phone technology have led to the development of smartphones with the capability to run apps. The availability of a plethora of health- and fitness-related smartphone apps has the potential, both on a clinical and public health level, to facilitate healthy behavior change and weight management. However, current top-rated apps in this area have not been extensively evaluated in terms of scientific quality and behavioral theory evidence base. Objective: The purpose of this study was to evaluate the quality of the most popular dietary weight-loss smartphone apps on the commercial market using comprehensive quality assessment criteria, and to quantify the behavior change techniques (BCTs) incorporated. Methods: The top 200-rated Health & Fitness category apps from the free and paid sections of Google Play and iTunes App Store in Australia (n=800) were screened in August 2014. To be included in further analysis, an app had to focus on weight management, include a facility to record diet intake (self-monitoring), and be in English. One researcher downloaded and used the eligible apps thoroughly for 5 days and assessed the apps against quality assessment criteria which included the following domains: accountability, scientific coverage and content accuracy of information relevant to weight management, technology-enhanced features, usability, and incorporation of BCTs. For inter-rater reliability purposes, a second assessor provided ratings on 30% of the apps. The accuracy of app energy intake calculations was further investigated by comparison with results from a 3-day weighed food record (WFR). Results: Across the eligible apps reviewed (n=28), only 1 app (4%) received full marks for accountability. Overall, apps included an average of 5.1 (SD 2.3) out of 14 technology-enhanced features, and received a mean score of 13.5 (SD 3.7) out of 20 for usability. The majority of apps provided estimated energy requirements (24/28, 86%) and used a food database to calculate energy intake (21/28, 75%). When compared against the WFR, the mean absolute energy difference of apps which featured energy intake calculations (23/28, 82%) was 127 kJ (95% CI -45 to 299). An average of 6.3 (SD 3.7) of 26 BCTs were included. Conclusions: Overall, the most popular commercial apps for weight management are suboptimal in quality, given the inadequate scientific coverage and accuracy of weight-related information, and the relative absence of BCTs across the apps reviewed. With the limited regulatory oversight around the quality of these types of apps, this evaluation provides clinicians and consumers an informed view of the highest-quality apps in the current popular app pool appropriate for recommendation and uptake. Further research is necessary to assess the effectiveness of apps for weight management. UR - http://mhealth.jmir.org/2015/4/e104/ UR - http://dx.doi.org/10.2196/mhealth.4334 UR - http://www.ncbi.nlm.nih.gov/pubmed/26678569 ID - info:doi/10.2196/mhealth.4334 ER - TY - JOUR AU - Sze, Yan Yan AU - Daniel, Oluyomi Tinuke AU - Kilanowski, K. Colleen AU - Collins, Lorraine R. AU - Epstein, H. Leonard PY - 2015/12/16 TI - Web-Based and Mobile Delivery of an Episodic Future Thinking Intervention for Overweight and Obese Families: A Feasibility Study JO - JMIR mHealth uHealth SP - e97 VL - 3 IS - 4 KW - obesity KW - ecological momentary intervention KW - episodic future thinking KW - Web-based KW - health behavior N2 - Background: The bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospectively related to obesity. Engaging in episodic future thinking, which involves mental self-projection to pre-experience future events, reduces this bias and energy intake in overweight/obese adults and children. To examine how episodic future thinking can be incorporated into clinical interventions, a Web-based system was created to provide training for adults and children in their everyday lives. Objective: Our study examined the technical feasibility, usability, and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions. Methods: We recruited 20 parent-child dyads (N=40) from the surrounding community and randomized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention. Parents were 44.1 (SD 7.8) years of age with BMI of 34.2 (SD 6.8) kg/m2. Children were 11.0 (SD 1.3) years of age with BMI percentile of 96.0 (SD 1.8). Families met weekly with a case manager for 4 weeks and used the system daily. Adherence was collected through the Web-based system, and perceived acceptance of the Web-based system was assessed postintervention. Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention. Results: All 20 families completed the intervention and attended all sessions. Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use, useful, and helpful. No differences between conditions were found in adherence for parents (P=.65) or children (P=.27). In addition, results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight. Conclusions: We showed that our Web-based system is an accepted technology and a feasible utility. Furthermore, results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control. These results show promising utility in using our Web-based system in interventions. UR - http://mhealth.jmir.org/2015/4/e97/ UR - http://dx.doi.org/10.2196/mhealth.4603 UR - http://www.ncbi.nlm.nih.gov/pubmed/26678959 ID - info:doi/10.2196/mhealth.4603 ER - TY - JOUR AU - Morton, Katie AU - Sutton, Stephen AU - Hardeman, Wendy AU - Troughton, Jacqui AU - Yates, Tom AU - Griffin, Simon AU - Davies, Melanie AU - Khunti, Kamlesh AU - Eborall, Helen PY - 2015/12/15 TI - A Text-Messaging and Pedometer Program to Promote Physical Activity in People at High Risk of Type 2 Diabetes: The Development of the PROPELS Follow-On Support Program JO - JMIR mHealth uHealth SP - e105 VL - 3 IS - 4 KW - physical activity KW - mHealth KW - text messaging KW - pedometer KW - tailoring KW - type 2 diabetes KW - intervention development N2 - Background: Mobile technologies for health (mHealth) represent a promising strategy for reducing type 2 diabetes (T2DM) risk. The PROPELS trial investigates whether structured group-based education alone or supplemented with a follow-on support program combining self-monitoring with pedometers and tailored text-messaging is effective in promoting and maintaining physical activity among people at high risk of T2DM. Objective: This paper describes the iterative development of the PROPELS follow-on support program and presents evidence on its acceptability and feasibility. Methods: We used a modified mHealth development framework with four phases: (1) conceptualization of the follow-on support program using theory and evidence, (2) formative research including focus groups (n=15, ages 39-79 years), (3) pre-testing focus groups using a think aloud protocol (n=20, ages 52-78 years), and (4) piloting (n=11). Analysis was informed by the constant comparative approach, with findings from each phase informing subsequent phases. Results: The first three phases informed the structure, nature, and content of the follow-on support program, including the frequency of text messages, the need for tailored content and two-way interaction, the importance of motivational messages based on encouragement and reinforcement of affective benefits (eg, enjoyment) with minimal messages about weight and T2DM risk, and the need for appropriate language. The refined program is personalized and tailored to the individual?s perceived confidence, previous activity levels, and physical activity goals. The pilot phase indicated that the program appeared to fit well with everyday routines and was easy to use by older adults. Conclusions: We developed a feasible and innovative text messaging and pedometer program based on evidence and behavior change theory and grounded in the experiences, views, and needs of people at high diabetes risk. A large scale trial is testing the effectiveness of this 4-year program over and above structured group education alone. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 83465245; http://www.controlled-trials.com/ISRCTN83465245/83465245 (Archived by WebCite at http://www.webcitation.org/6dfSmrVAe) UR - http://mhealth.jmir.org/2015/4/e105/ UR - http://dx.doi.org/10.2196/mhealth.5026 UR - http://www.ncbi.nlm.nih.gov/pubmed/26678750 ID - info:doi/10.2196/mhealth.5026 ER - TY - JOUR AU - Ehrler, Frederic AU - Haller, Guy AU - Sarrey, Evelyne AU - Walesa, Magali AU - Wipfli, Rolf AU - Lovis, Christian PY - 2015/12/15 TI - Assessing the Usability of Six Data Entry Mobile Interfaces for Caregivers: A Randomized Trial JO - JMIR Human Factors SP - e15 VL - 2 IS - 2 KW - data collection KW - mobile applications KW - computers, handheld KW - user-computer interface KW - vital signs KW - patient safety N2 - Background: There is an increased demand in hospitals for tools, such as dedicated mobile device apps, that enable the recording of clinical information in an electronic format at the patient?s bedside. Although the human-machine interface design on mobile devices strongly influences the accuracy and effectiveness of data recording, there is still a lack of evidence as to which interface design offers the best guarantee for ease of use and quality of recording. Therefore, interfaces need to be assessed both for usability and reliability because recording errors can seriously impact the overall level of quality of the data and affect the care provided. Objective: In this randomized crossover trial, we formally compared 6 handheld device interfaces for both speed of data entry and accuracy of recorded information. Three types of numerical data commonly recorded at the patient?s bedside were used to evaluate the interfaces. Methods: In total, 150 health care professionals from the University Hospitals of Geneva volunteered to record a series of randomly generated data on each of the 6 interfaces provided on a smartphone. The interfaces were presented in a randomized order as part of fully automated data entry scenarios. During the data entry process, accuracy and effectiveness were automatically recorded by the software. Results: Various types of errors occurred, which ranged from 0.7% for the most reliable design to 18.5% for the least reliable one. The length of time needed for data recording ranged from 2.81 sec to 14.68 sec, depending on the interface. The numeric keyboard interface delivered the best performance for pulse data entry with a mean time of 3.08 sec (SD 0.06) and an accuracy of 99.3%. Conclusions: Our study highlights the critical impact the choice of an interface can have on the quality of recorded data. Selecting an interface should be driven less by the needs of specific end-user groups or the necessity to facilitate the developer?s task (eg, by opting for default solutions provided by commercial platforms) than by the level of speed and accuracy an interface can provide for recording information. An important effort must be made to properly validate mobile device interfaces intended for use in the clinical setting. In this regard, our study identified the numeric keyboard, among the proposed designs, as the most accurate interface for entering specific numerical values. This is an important step toward providing clearer guidelines on which interface to choose for the appropriate use of handheld device interfaces in the health care setting. UR - http://humanfactors.jmir.org/2015/2/e15/ UR - http://dx.doi.org/10.2196/humanfactors.4093 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025648 ID - info:doi/10.2196/humanfactors.4093 ER - TY - JOUR AU - Cantrell, Jennifer AU - Ganz, Ollie AU - Ilakkuvan, Vinu AU - Tacelosky, Michael AU - Kreslake, Jennifer AU - Moon-Howard, Joyce AU - Aidala, Angela AU - Vallone, Donna AU - Anesetti-Rothermel, Andrew AU - Kirchner, R. Thomas PY - 2015/11/26 TI - Implementation of a Multimodal Mobile System for Point-of-Sale Surveillance: Lessons Learned From Case Studies in Washington, DC, and New York City JO - JMIR Public Health Surveill SP - e20 VL - 1 IS - 2 KW - mobile technology KW - public health surveillance KW - tobacco KW - point-of-sale KW - implementation KW - tobacco industry advertising KW - marketing N2 - Background: In tobacco control and other fields, point-of-sale surveillance of the retail environment is critical for understanding industry marketing of products and informing public health practice. Innovations in mobile technology can improve existing, paper-based surveillance methods, yet few studies describe in detail how to operationalize the use of technology in public health surveillance. Objective: The aims of this paper are to share implementation strategies and lessons learned from 2 tobacco, point-of-sale surveillance projects to inform and prepare public health researchers and practitioners to implement new mobile technologies in retail point-of-sale surveillance systems. Methods: From 2011 to 2013, 2 point-of-sale surveillance pilot projects were conducted in Washington, DC, and New York, New York, to capture information about the tobacco retail environment and test the feasibility of a multimodal mobile data collection system, which included capabilities for audio or video recording data, electronic photographs, electronic location data, and a centralized back-end server and dashboard. We established a preimplementation field testing process for both projects, which involved a series of rapid and iterative tests to inform decisions and establish protocols around key components of the project. Results: Important components of field testing included choosing a mobile phone that met project criteria, establishing an efficient workflow and accessible user interfaces for each component of the system, training and providing technical support to fieldworkers, and developing processes to integrate data from multiple sources into back-end systems that can be utilized in real-time. Conclusions: A well-planned implementation process is critical for successful use and performance of multimodal mobile surveillance systems. Guidelines for implementation include (1) the need to establish and allow time for an iterative testing framework for resolving technical and logistical challenges; (2) developing a streamlined workflow and user-friendly interfaces for data collection; (3) allowing for ongoing communication, feedback, and technology-related skill-building among all staff; and (4) supporting infrastructure for back-end data systems. Although mobile technologies are evolving rapidly, lessons learned from these case studies are essential for ensuring that the many benefits of new mobile systems for rapid point-of-sale surveillance are fully realized. UR - http://publichealth.jmir.org/2015/2/e20/ UR - http://dx.doi.org/10.2196/publichealth.4191 UR - http://www.ncbi.nlm.nih.gov/pubmed/27227138 ID - info:doi/10.2196/publichealth.4191 ER - TY - JOUR AU - Vergeire-Dalmacion, Godofreda AU - Castillo-Carandang, T. Nina AU - Juban, R. Noel AU - Amarillo, Lourdes Maria AU - Tagle, Pamela Maria AU - Baja, S. Emmanuel PY - 2015/11/19 TI - Texting-Based Reporting of Adverse Drug Reactions to Ensure Patient Safety: A Feasibility Study JO - JMIR Public Health Surveill SP - e12 VL - 1 IS - 2 KW - adverse drug reactions KW - pharmacovigilance KW - postmarketing KW - spontaneous reporting KW - texting N2 - Background: Paper-based adverse drug reaction (ADR) reporting has been in practice for more than 6 decades. Health professionals remain the primary source of reports, while the value of patients? reporting is yet unclear. With the increasing popularity of using electronic gadgets in health, it is expected that the electronic transmission of reports will become the norm within a few years. Objective: The aims of this study are to investigate whether short messaging service or texting can provide an alternative or supplemental method for ADR reporting given the increasing role of mobile phones in health care monitoring; to determine the usefulness of texting in addition to paper-based reporting of ADRs by resident physicians; and to describe the barriers to ADR reporting and estimate the cost for setting up and maintaining a texting-computer reporting system. Methods: This was a pre-post cross-sectional study that measured the number of ADRs texted by 51 resident physicians for 12 months from the Department of Obstetrics and Gynecology and the Department of Adult Medicine of a tertiary government hospital in Manila, Philippines, with 1350-bed capacity. Reports were captured by a texting-computer reporting system. Prior to its implementation, key informant interview and focus group discussion were conducted. Baseline information and practice on the existing paper-based reporting system were culled from the records of the hospital?s Pharmacy and Therapeutics Committee. A postintervention survey questionnaire was administered at the end of 12 months. Results: Only 3 ADRs were texted by 51 resident physicians in 12 months (reporting rate 3/51 or 6%). By contrast, 240 ADRs from the paper-based reporting system from 848 resident physicians of the study hospital were collected and tabulated (reporting rate 240/848 or 28.3%). Texting ADRs was not efficient because of power interruption, competition with the existing paper-based reporting system, and unforeseen expiration of prepaid text loads/credits. The 3 ADRs texted were a report of vivid dreams and nightmares, a report of disturbing dreams and memory lapses, both of which were due to montelukast use, and a report of hepatitis from an isoniazid/rifampicin fixed-dose combination. Nineteen of 51 resident physicians (37%) registered in the reporting system responded to the postintervention survey. The most common reasons for not reporting ADRs were no adverse reaction identified 11/19 (58%) and restrictive reporting syntax 4/19 (21%). All doctors preferred a free form of reporting. The direct cost of the texting-based reporting system was calculated to be US $5581.40 and the indirect cost was US $9989.40. The total cost for texting-based ADR reporting system for 12 months was US $15,570.79. Conclusions: Reporting of ADRs via texting could be lower compared with an existing ADR paper-based system. Problems of Internet connectivity, reporting syntax, and expiration and reliability of text loads/credits should be addressed while implementing a text-based ADR reporting system in a developing country. UR - http://publichealth.jmir.org/2015/2/e12/ UR - http://dx.doi.org/10.2196/publichealth.4605 UR - http://www.ncbi.nlm.nih.gov/pubmed/27227130 ID - info:doi/10.2196/publichealth.4605 ER - TY - JOUR AU - Cadmus-Bertram, Lisa AU - Marcus, H. Bess AU - Patterson, E. Ruth AU - Parker, A. Barbara AU - Morey, L. Brittany PY - 2015/11/19 TI - Use of the Fitbit to Measure Adherence to a Physical Activity Intervention Among Overweight or Obese, Postmenopausal Women: Self-Monitoring Trajectory During 16 Weeks JO - JMIR mHealth uHealth SP - e96 VL - 3 IS - 4 KW - exercise KW - health behavior KW - health promotion KW - Internet KW - mHealth KW - motor activity KW - physical activity KW - technology KW - women N2 - Background: Direct-to-consumer trackers and devices have potential to enhance theory-based physical activity interventions by offering a simple and pleasant way to help participants self-monitor their behavior. A secondary benefit of these devices is the opportunity for investigators to objectively track adherence to physical activity goals across weeks or even months, rather than relying on self-report or a small number of accelerometry wear periods. The use of consumer trackers for continuous monitoring of adherence has considerable potential to enhance physical activity research, but few studies have been published in this rapidly developing area. Objective: The objective of the study was to assess the trajectory of physical activity adherence across a 16-week self-monitoring intervention, as measured by the Fitbit tracker. Methods: Participants were 25 overweight or obese, postmenopausal women enrolled in the intervention arm of a randomized controlled physical activity intervention trial. Each participant received a 16-week technology-based intervention that used the Fitbit physical activity tracker and website. The overall study goal was 150 minutes/week of moderate to vigorous intensity physical activity (MVPA) and 10,000 steps/day; however, goals were set individually for each participant and updated at Week 4 based on progress. Adherence data were collected by the Fitbit and aggregated by Fitabase. Participants also wore an ActiGraph GT3X+ accelerometer for 7 days prior to the intervention and again during Week 16. Results: The median participant logged 10 hours or more/day of Fitbit wear on 95% of the 112 intervention days, with no significant decline in wear over the study period. Participants averaged 7540 (SD 2373) steps/day and 82 minutes/week (SD 43) of accumulated ?fairly active? and ?very active? minutes during the intervention. At Week 4, 80% (20/25) of women chose to maintain/increase their individual MVPA goal and 72% (18/25) of participants chose to maintain/increase their step goal. Physical activity levels were relatively stable after peaking at 3 weeks, with only small declines of 8% for steps (P=.06) and 14% for MVPA (P=.05) by 16 weeks. Conclusions: These data indicate that a sophisticated, direct-to-consumer activity tracker encouraged high levels of self-monitoring that were sustained over 16 weeks. Further study is needed to determine how to motivate additional gains in physical activity and evaluate the long-term utility of the Fitbit tracker as part of a strategy for chronic disease prevention. Trial Registration: Clinicaltrials.gov NCT01837147; http://clinicaltrials.gov/ct2/show/NCT01837147 (Archived by WebCite at http://www.webcitation.org/6d0VeQpvB) UR - http://mhealth.jmir.org/2015/4/e96/ UR - http://dx.doi.org/10.2196/mhealth.4229 UR - http://www.ncbi.nlm.nih.gov/pubmed/26586418 ID - info:doi/10.2196/mhealth.4229 ER - TY - JOUR AU - Gay, Valerie AU - Leijdekkers, Peter PY - 2015/11/18 TI - Bringing Health and Fitness Data Together for Connected Health Care: Mobile Apps as Enablers of Interoperability JO - J Med Internet Res SP - e260 VL - 17 IS - 11 KW - health informatics KW - connected health KW - pervasive and mobile computing KW - ubiquitous and mobile devices N2 - Background: A transformation is underway regarding how we deal with our health. Mobile devices make it possible to have continuous access to personal health information. Wearable devices, such as Fitbit and Apple?s smartwatch, can collect data continuously and provide insights into our health and fitness. However, lack of interoperability and the presence of data silos prevent users and health professionals from getting an integrated view of health and fitness data. To provide better health outcomes, a complete picture is needed which combines informal health and fitness data collected by the user together with official health records collected by health professionals. Mobile apps are well positioned to play an important role in the aggregation since they can tap into these official and informal health and data silos. Objective: The objective of this paper is to demonstrate that a mobile app can be used to aggregate health and fitness data and can enable interoperability. It discusses various technical interoperability challenges encountered while integrating data into one place. Methods: For 8 years, we have worked with third-party partners, including wearable device manufacturers, electronic health record providers, and app developers, to connect an Android app to their (wearable) devices, back-end servers, and systems. Results: The result of this research is a health and fitness app called myFitnessCompanion, which enables users to aggregate their data in one place. Over 6000 users use the app worldwide to aggregate their health and fitness data. It demonstrates that mobile apps can be used to enable interoperability. Challenges encountered in the research process included the different wireless protocols and standards used to communicate with wireless devices, the diversity of security and authorization protocols used to be able to exchange data with servers, and lack of standards usage, such as Health Level Seven, for medical information exchange. Conclusions: By limiting the negative effects of health data silos, mobile apps can offer a better holistic view of health and fitness data. Data can then be analyzed to offer better and more personalized advice and care. UR - http://www.jmir.org/2015/11/e260/ UR - http://dx.doi.org/10.2196/jmir.5094 UR - http://www.ncbi.nlm.nih.gov/pubmed/26581920 ID - info:doi/10.2196/jmir.5094 ER - TY - JOUR AU - Goldenberg, Tamar AU - McDougal, J. Sarah AU - Sullivan, S. Patrick AU - Stekler, D. Joanne AU - Stephenson, Rob PY - 2015/11/16 TI - Building a Mobile HIV Prevention App for Men Who Have Sex With Men: An Iterative and Community-Driven Process JO - JMIR Public Health Surveill SP - e18 VL - 1 IS - 2 KW - HIV KW - AIDS KW - MSM KW - mobile app KW - prevention KW - community N2 - Background: Gay, bisexual, and other men who have sex with men (MSM) account for a disproportionate burden of new HIV infections in the United States. Mobile technology presents an opportunity for innovative interventions for HIV prevention. Some HIV prevention apps currently exist; however, it is challenging to encourage users to download these apps and use them regularly. An iterative research process that centers on the community?s needs and preferences may increase the uptake, adherence, and ultimate effectiveness of mobile apps for HIV prevention. Objective: The aim of this paper is to provide a case study to illustrate how an iterative community approach to a mobile HIV prevention app can lead to changes in app content to appropriately address the needs and the desires of the target community. Methods: In this three-phase study, we conducted focus group discussions (FGDs) with MSM and HIV testing counselors in Atlanta, Seattle, and US rural regions to learn preferences for building a mobile HIV prevention app. We used data from these groups to build a beta version of the app and theater tested it in additional FGDs. A thematic data analysis examined how this approach addressed preferences and concerns expressed by the participants. Results: There was an increased willingness to use the app during theater testing than during the first phase of FGDs. Many concerns that were identified in phase one (eg, disagreements about reminders for HIV testing, concerns about app privacy) were considered in building the beta version. Participants perceived these features as strengths during theater testing. However, some disagreements were still present, especially regarding the tone and language of the app. Conclusions: These findings highlight the benefits of using an interactive and community-driven process to collect data on app preferences when building a mobile HIV prevention app. Through this process, we learned how to be inclusive of the larger MSM population without marginalizing some app users. Though some issues in phase one were able to be addressed, disagreements still occurred in theater testing. If the app is going to address a large and diverse risk group, we cannot include niche functionality that may offend some of the target population. UR - http://publichealth.jmir.org/2015/2/e18/ UR - http://dx.doi.org/10.2196/publichealth.4449 UR - http://www.ncbi.nlm.nih.gov/pubmed/27227136 ID - info:doi/10.2196/publichealth.4449 ER - TY - JOUR AU - Bardus, Marco AU - Smith, R. Jane AU - Samaha, Laya AU - Abraham, Charles PY - 2015/11/16 TI - Mobile Phone and Web 2.0 Technologies for Weight Management: A Systematic Scoping Review JO - J Med Internet Res SP - e259 VL - 17 IS - 11 KW - obesity KW - overweight KW - review KW - cellular phone KW - mobile apps KW - social media KW - mobile health KW - mHealth KW - mobile phone KW - Web 2.0 N2 - Background: Widespread diffusion of mobile phone and Web 2.0 technologies make them potentially useful tools for promoting health and tackling public health issues, such as the increasing prevalence of overweight and obesity. Research in this domain is growing rapidly but, to date, no review has comprehensively and systematically documented how mobile and Web 2.0 technologies are being deployed and evaluated in relation to weight management. Objective: To provide an up-to-date, comprehensive map of the literature discussing the use of mobile phone and Web 2.0 apps for influencing behaviors related to weight management (ie, diet, physical activity [PA], weight control, etc). Methods: A systematic scoping review of the literature was conducted based on a published protocol (registered at PROSPERO: CRD42014010323). Using a comprehensive search strategy, we searched 16 multidisciplinary electronic databases for original research documents published in English between 2004 and 2014. We used duplicate study selection and data extraction. Using an inductively developed charting tool, selected articles were thematically categorized. Results: We identified 457 articles, mostly published between 2013 and 2014 in 157 different journals and 89 conference proceedings. Articles were categorized around two overarching themes, which described the use of technologies for either (1) promoting behavior change (309/457, 67.6%) or (2) measuring behavior (103/457, 22.5%). The remaining articles were overviews of apps and social media content (33/457, 7.2%) or covered a combination of these three themes (12/457, 2.6%). Within the two main overarching themes, we categorized articles as representing three phases of research development: (1) design and development, (2) feasibility studies, and (3) evaluations. Overall, articles mostly reported on evaluations of technologies for behavior change (211/457, 46.2%). Conclusions: There is an extensive body of research on mobile phone and Web 2.0 technologies for weight management. Research has reported on (1) the development, feasibility, and efficacy of persuasive mobile technologies used in interventions for behavior change (PA and diet) and (2) the design, feasibility, and accuracy of mobile phone apps for behavioral assessment. Further research has focused exclusively on analyses of the content and quality of available apps. Limited evidence exists on the use of social media for behavior change, but a segment of studies deal with content analyses of social media. Future research should analyze mobile phone and Web 2.0 technologies together by combining the evaluation of content and design aspects with usability, feasibility, and efficacy/effectiveness for behavior change, or accuracy/validity for behavior assessment, in order to understand which technological components and features are likely to result in effective interventions. UR - http://www.jmir.org/2015/11/e259/ UR - http://dx.doi.org/10.2196/jmir.5129 UR - http://www.ncbi.nlm.nih.gov/pubmed/26573984 ID - info:doi/10.2196/jmir.5129 ER - TY - JOUR AU - Belmon, S. Laura AU - Middelweerd, Anouk AU - te Velde, J. Saskia AU - Brug, Johannes PY - 2015/11/12 TI - Dutch Young Adults Ratings of Behavior Change Techniques Applied in Mobile Phone Apps to Promote Physical Activity: A Cross-Sectional Survey JO - JMIR mHealth uHealth SP - e103 VL - 3 IS - 4 KW - motor activity KW - self efficacy KW - exercise KW - behavior therapy KW - cell phones N2 - Background: Interventions delivered through new device technology, including mobile phone apps, appear to be an effective method to reach young adults. Previous research indicates that self-efficacy and social support for physical activity and self-regulation behavior change techniques (BCT), such as goal setting, feedback, and self-monitoring, are important for promoting physical activity; however, little is known about evaluations by the target population of BCTs applied to physical activity apps and whether these preferences are associated with individual personality characteristics. Objective: This study aimed to explore young adults? opinions regarding BCTs (including self-regulation techniques) applied in mobile phone physical activity apps, and to examine associations between personality characteristics and ratings of BCTs applied in physical activity apps. Methods: We conducted a cross-sectional online survey among healthy 18 to 30-year-old adults (N=179). Data on participants? gender, age, height, weight, current education level, living situation, mobile phone use, personality traits, exercise self-efficacy, exercise self-identity, total physical activity level, and whether participants met Dutch physical activity guidelines were collected. Items for rating BCTs applied in physical activity apps were selected from a hierarchical taxonomy for BCTs, and were clustered into three BCT categories according to factor analysis: ?goal setting and goal reviewing,? ?feedback and self-monitoring,? and ?social support and social comparison.? Results: Most participants were female (n=146), highly educated (n=169), physically active, and had high levels of self-efficacy. In general, we observed high ratings of BCTs aimed to increase ?goal setting and goal reviewing? and ?feedback and self-monitoring,? but not for BCTs addressing ?social support and social comparison.? Only 3 (out of 16 tested) significant associations between personality characteristics and BCTs were observed: ?agreeableness? was related to more positive ratings of BCTs addressing ?goal setting and goal reviewing? (OR 1.61, 95% CI 1.06-2.41), ?neuroticism? was related to BCTs addressing ?feedback and self-monitoring? (OR 0.76, 95% CI 0.58-1.00), and ?exercise self-efficacy? was related to a high rating of BCTs addressing ?feedback and self-monitoring? (OR 1.06, 95% CI 1.02-1.11). No associations were observed between personality characteristics (ie, personality, exercise self-efficacy, exercise self-identity) and participants? ratings of BCTs addressing ?social support and social comparison.? Conclusions: Young Dutch physically active adults rate self-regulation techniques as most positive and techniques addressing social support as less positive among mobile phone apps that aim to promote physical activity. Such ratings of BCTs differ according to personality traits and exercise self-efficacy. Future research should focus on which behavior change techniques in app-based interventions are most effective to increase physical activity. UR - http://mhealth.jmir.org/2015/4/e103/ UR - http://dx.doi.org/10.2196/mhealth.4383 UR - http://www.ncbi.nlm.nih.gov/pubmed/26563744 ID - info:doi/10.2196/mhealth.4383 ER - TY - JOUR AU - Flores Mateo, Gemma AU - Granado-Font, Esther AU - Ferré-Grau, Carme AU - Montaña-Carreras, Xavier PY - 2015/11/10 TI - Mobile Phone Apps to Promote Weight Loss and Increase Physical Activity: A Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e253 VL - 17 IS - 11 KW - mHealth KW - mobile phone KW - apps KW - obesity KW - physical activity KW - intervention N2 - Background: To our knowledge, no meta-analysis to date has assessed the efficacy of mobile phone apps to promote weight loss and increase physical activity. Objective: To perform a systematic review and meta-analysis of studies to compare the efficacy of mobile phone apps compared with other approaches to promote weight loss and increase physical activity. Methods: We conducted a systematic review and meta-analysis of relevant studies identified by a search of PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus from their inception through to August 2015. Two members of the study team (EG-F, GF-M) independently screened studies for inclusion criteria and extracted data. We included all controlled studies that assessed a mobile phone app intervention with weight-related health measures (ie, body weight, body mass index, or waist circumference) or physical activity outcomes. Net change estimates comparing the intervention group with the control group were pooled across studies using random-effects models. Results: We included 12 articles in this systematic review and meta-analysis. Compared with the control group, use of a mobile phone app was associated with significant changes in body weight (kg) and body mass index (kg/m2) of -1.04 kg (95% CI -1.75 to -0.34; I2 = 41%) and -0.43 kg/m2 (95% CI -0.74 to -0.13; I2 = 50%), respectively. Moreover, a nonsignificant difference in physical activity was observed between the two groups (standardized mean difference 0.40, 95% CI -0.07 to 0.87; I2 = 93%). These findings were remarkably robust in the sensitivity analysis. No publication bias was shown. Conclusions: Evidence from this study shows that mobile phone app-based interventions may be useful tools for weight loss. UR - http://www.jmir.org/2015/11/e253/ UR - http://dx.doi.org/10.2196/jmir.4836 UR - http://www.ncbi.nlm.nih.gov/pubmed/26554314 ID - info:doi/10.2196/jmir.4836 ER - TY - JOUR AU - Alvarez, Graziela Ana AU - Sasso, Grace AU - Iyengar, Sriram PY - 2015/11/06 TI - Mobile Virtual Learning Object for the Assessment of Acute Pain as a Learning Tool to Assess Acute Pain in Nursing: An Analysis of the Mental Workload JO - JMIR Medical Education SP - e15 VL - 1 IS - 2 KW - nursing KW - nursing informatics KW - distance learning KW - computer-assisted instruction KW - educational technology KW - nursing education KW - acute pain KW - persuasive technology KW - mental workload N2 - Background: The inclusion of new technologies in education has motivated the development of studies on mental workload. These technologies are now being used in the teaching and learning process. The analysis enables identification of factors intervening in this workload as well as planning of overload prevention for educational activities using these technologies. Objective: To analyze the mental workload of an educational intervention with the Mobile Virtual Learning Object for the Assessment of Acute Pain in adults and newborns, according to the NASA Task Load Index criteria. Methods: A methodological study with data collected from 5 nurses and 75 students, from November of 2013 to February of 2014. Results: The highest students? and specialists? means were in the dimensions of ?Mental demand? (57.20 ± 22.27; 51 ± 29.45) and ?Performance? (58.47 ± 24.19; 73 ± 28.85). The specialists? mental workload index was higher (50.20 ± 7.28) when compared with students? (47.87 ± 16.85) on a scale from 0 to 100 (P=.557). Conclusions: The instrument allowed for the assessment of mental workload after an online educational intervention with a mobile learning virtual object. An excessive overload was not identified among participants. Assessing mental workload from the use of educational technologies at the end of a task is a key to their applicability, with the aim of providing a more effective, stimulating, and long-lasting experience of the learning process. UR - http://mededu.jmir.org/2015/2/e15/ UR - http://dx.doi.org/10.2196/mededu.4958 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731849 ID - info:doi/10.2196/mededu.4958 ER - TY - JOUR AU - Weaver, E. Kathryn AU - Ellis, D. Shellie AU - Denizard-Thompson, Nancy AU - Kronner, Donna AU - Miller, P. David PY - 2015/11/04 TI - Crafting Appealing Text Messages to Encourage Colorectal Cancer Screening Test Completion: A Qualitative Study JO - JMIR mHealth uHealth SP - e100 VL - 3 IS - 4 KW - colorectal cancer KW - screening KW - mhealth KW - text messages KW - qualitative KW - older adults N2 - Background: mHealth interventions that incorporate text messages have great potential to increase receipt of preventive health services such as colorectal cancer screening. However, little is known about older adult perspectives regarding the receipt of text messages from their health care providers. Objective: To assess whether older adults would value and access text messages from their physician?s practice regarding colorectal cancer screening. Methods: We conducted four focus groups with 26 adults, aged 50 to 75 years, who had either recently completed or were overdue for colorectal cancer screening. A trained moderator followed a semistructured interview guide covering participant knowledge and attitudes regarding colorectal cancer screening, potential barriers to colorectal cancer screening, attitudes about receiving electronic communications from a doctor?s office, and reactions to sample text messages. Results: Participant responses to three primary research questions were examined: (1) facilitators and barriers to colorectal cancer screening, (2) attitudes toward receiving text messages from providers, and (3) characteristics of appealing text messages. Two themes related to facilitators of colorectal cancer screening were perceived benefits/need and family experiences and encouragement. Themes related to barriers included unpleasantness, discomfort, knowledge gaps, fear of complications, and system factors. Four themes emerged regarding receipt of text messages from health care providers: (1) comfort and familiarity with technology, (2) privacy concerns/potential for errors, (3) impact on patient-provider relationship, and (4) perceived helpfulness. Many participants expressed initial reluctance to receiving text messages but responded favorably when shown sample messages. Participants preferred messages that contained content that was important to them and were positive and reassuring, personalized, and friendly to novice texters (eg, avoided the use of texting shorthand phrases and complicated replies); they did not want messages that contain bad news or test results. They wanted the ability to choose alternative options such as email or phone calls. Conclusions: Older adults are receptive to receiving cancer screening text messages from health care providers. Sharing sample messages with patients may increase acceptance of this tool in the clinic setting. Supportive tailored text messaging reminders could enhance uptake of colorectal cancer screening by enhancing patient self-efficacy and providing cues to action to complete colonoscopy or fecal occult blood testing. UR - http://mhealth.jmir.org/2015/4/e100/ UR - http://dx.doi.org/10.2196/mhealth.4651 UR - http://www.ncbi.nlm.nih.gov/pubmed/26537553 ID - info:doi/10.2196/mhealth.4651 ER - TY - JOUR AU - Svensson, Åsa AU - Larsson, Christel PY - 2015/11/03 TI - A Mobile Phone App for Dietary Intake Assessment in Adolescents: An Evaluation Study JO - JMIR mHealth uHealth SP - e93 VL - 3 IS - 4 KW - adolescents KW - dietary assessment KW - mobile phone app KW - energy KW - SenseWear Armband N2 - Background: There is a great need for dietary assessment methods that suit the adolescent lifestyle and give valid intake data. Objective: To develop a mobile phone app and evaluate its ability to assess energy intake (EI) and total energy expenditure (TEE) compared with objectively measured TEE. Furthermore, to investigate the impact of factors on reporting accuracy of EI, and to compare dietary intake with a Web-based method. Methods: Participants 14 to 16 years of age were recruited from year nine in schools in Gothenburg, Sweden. In total, 81 adolescents used the mobile phone app over 1 to 6 days. TEE was measured with the SenseWear Armband (SWA) during the same or proximate days. Individual factors were assessed with a questionnaire. A total of 15 participants also recorded dietary intake using a Web-based method. Results: The mobile phone app underestimated EI by 29% on a group level (P<.001) compared to TEE measured with the SWA, and there was no significant correlation between EI and TEE. Accuracy of EI relative to TEE increased with a weekend day in the record (P=.007) and lower BMI z-score (P=.001). TEE assessed with the mobile phone app was 1.19 times the value of TEE measured by the SWA on a group level (P<.001), and the correlation between the methods was .75 (P<.001). Analysis of physical activity levels (PAL) from the mobile phone app stratified by gender showed that accuracy of the mobile phone app was higher among boys. EI, nutrients, and food groups assessed with the mobile phone app and Web-based method among 15 participants were not significantly different and several were significantly correlated, but strong conclusions cannot be drawn due to the low number of participants. Conclusions: By using a mobile phone dietary assessment app, on average 71% of adolescents? EI was captured. The accuracy of reported dietary intake was higher with lower BMI z-score and if a weekend day was included in the record. The daily question in the mobile phone app about physical activity could accurately rank the participants? TEE. UR - http://mhealth.jmir.org/2015/4/e93/ UR - http://dx.doi.org/10.2196/mhealth.4804 UR - http://www.ncbi.nlm.nih.gov/pubmed/26534783 ID - info:doi/10.2196/mhealth.4804 ER - TY - JOUR AU - Willcox, C. Jane AU - van der Pligt, Paige AU - Ball, Kylie AU - Wilkinson, A. Shelley AU - Lappas, Martha AU - McCarthy, A. Elizabeth AU - Campbell, J. Karen PY - 2015/10/28 TI - Views of Women and Health Professionals on mHealth Lifestyle Interventions in Pregnancy: A Qualitative Investigation JO - JMIR mHealth uHealth SP - e99 VL - 3 IS - 4 KW - pregnancy KW - attitude KW - qualitative research KW - mHealth N2 - Background: Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women?s and health professionals? views of mHealth in antenatal care are limited. Objective: This study aimed to explore women?s and health professionals? views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy. Methods: A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed. Results: Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model.Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some health professionals were concerned about the medicolegal risks of mHealth (incorrect or harmful information and privacy concerns), while others acknowledged that mHealth was feasible if inherent risks were addressed.Across both groups, there was uncertainty as to who should be responsible for ensuring high-quality mHealth. The absence of a key pregnancy or women?s advocacy group, lack of health funds for technologies, and the perceived inability of maternity hospitals to embrace technology were seen to be key barriers to provision.Women consistently identified the functionality of mHealth as adding value to antenatal care models. For some health professionals, lack of familiarity with and fear of mHealth limited their engagement with and comprehension of the capacity of new technologies to support antenatal care. Conclusions: Women exhibited positive views regarding mHealth for the promotion of a healthy lifestyle in antenatal care. Conversely, health professionals expressed a much wider variation in attitudes and were more able to identify potential risks and barriers to development and implementation. This study contributes to the understanding of the opportunities and challenges in developing mHealth lifestyle interventions in antenatal care. UR - http://mhealth.jmir.org/2015/4/e99/ UR - http://dx.doi.org/10.2196/mhealth.4869 UR - http://www.ncbi.nlm.nih.gov/pubmed/26510886 ID - info:doi/10.2196/mhealth.4869 ER - TY - JOUR AU - Rangan, M. Anna AU - O'Connor, Sarah AU - Giannelli, Valentina AU - Yap, LH Megan AU - Tang, Ming Lie AU - Roy, Rajshri AU - Louie, Yu Jimmy Chun AU - Hebden, Lana AU - Kay, Judy AU - Allman-Farinelli, Margaret PY - 2015/10/27 TI - Electronic Dietary Intake Assessment (e-DIA): Comparison of a Mobile Phone Digital Entry App for Dietary Data Collection With 24-Hour Dietary Recalls JO - JMIR mHealth uHealth SP - e98 VL - 3 IS - 4 KW - validity KW - dietary assessment KW - mobile phone app KW - young adult N2 - Background: The electronic Dietary Intake Assessment (e-DIA), a digital entry food record mobile phone app, was developed to measure energy and nutrient intake prospectively. This can be used in monitoring population intakes or intervention studies in young adults. Objective: The objective was to assess the relative validity of e-DIA as a dietary assessment tool for energy and nutrient intakes using the 24-hour dietary recall as a reference method. Methods: University students aged 19 to 24 years recorded their food and drink intake on the e-DIA for five days consecutively and completed 24-hour dietary recalls on three random days during this 5-day study period. Mean differences in energy, macro-, and micronutrient intakes were evaluated between the methods using paired t tests or Wilcoxon signed-rank tests, and correlation coefficients were calculated on unadjusted, energy-adjusted, and deattenuated values. Bland-Altman plots and cross-classification into quartiles were used to assess agreement between the two methods. Results: Eighty participants completed the study (38% male). No significant differences were found between the two methods for mean intakes of energy or nutrients. Deattenuated correlation coefficients ranged from 0.55 to 0.79 (mean 0.68). Bland-Altman plots showed wide limits of agreement between the methods but without obvious bias. Cross-classification into same or adjacent quartiles ranged from 75% to 93% (mean 85%). Conclusions: The e-DIA shows potential as a dietary intake assessment tool at a group level with good ranking agreement for energy and all nutrients. UR - http://mhealth.jmir.org/2015/4/e98/ UR - http://dx.doi.org/10.2196/mhealth.4613 UR - http://www.ncbi.nlm.nih.gov/pubmed/26508282 ID - info:doi/10.2196/mhealth.4613 ER - TY - JOUR AU - Block, Gladys AU - Azar, MJ Kristen AU - Romanelli, J. Robert AU - Block, J. Torin AU - Hopkins, Donald AU - Carpenter, A. Heather AU - Dolginsky, S. Marina AU - Hudes, L. Mark AU - Palaniappan, P. Latha AU - Block, H. Clifford PY - 2015/10/23 TI - Diabetes Prevention and Weight Loss with a Fully Automated Behavioral Intervention by Email, Web, and Mobile Phone: A Randomized Controlled Trial Among Persons with Prediabetes JO - J Med Internet Res SP - e240 VL - 17 IS - 10 KW - type 2 diabetes KW - prevention KW - intervention studies KW - prediabetes KW - behavior change KW - obesity KW - physical activity KW - nutrition KW - Internet KW - smartphone KW - weight loss N2 - Background: One-third of US adults, 86 million people, have prediabetes. Two-thirds of adults are overweight or obese and at risk for diabetes. Effective and affordable interventions are needed that can reach these 86 million, and others at high risk, to reduce their progression to diagnosed diabetes. Objective: The aim was to evaluate the effectiveness of a fully automated algorithm-driven behavioral intervention for diabetes prevention, Alive-PD, delivered via the Web, Internet, mobile phone, and automated phone calls. Methods: Alive-PD provided tailored behavioral support for improvements in physical activity, eating habits, and factors such as weight loss, stress, and sleep. Weekly emails suggested small-step goals and linked to an individual Web page with tools for tracking, coaching, social support through virtual teams, competition, and health information. A mobile phone app and automated phone calls provided further support. The trial randomly assigned 339 persons to the Alive-PD intervention (n=163) or a 6-month wait-list usual-care control group (n=176). Participants were eligible if either fasting glucose or glycated hemoglobin A1c (HbA1c) was in the prediabetic range. Primary outcome measures were changes in fasting glucose and HbA1c at 6 months. Secondary outcome measures included clinic-measured changes in body weight, body mass index (BMI), waist circumference, triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio, and Framingham diabetes risk score. Analysis was by intention-to-treat. Results: Participants? mean age was 55 (SD 8.9) years, mean BMI was 31.2 (SD 4.4) kg/m2, and 68.7% (233/339) were male. Mean fasting glucose was in the prediabetic range (mean 109.9, SD 8.4 mg/dL), whereas the mean HbA1c was 5.6% (SD 0.3), in the normal range. In intention-to-treat analyses, Alive-PD participants achieved significantly greater reductions than controls in fasting glucose (mean ?7.36 mg/dL, 95% CI ?7.85 to ?6.87 vs mean ?2.19, 95% CI ?2.64 to ?1.73, P<.001), HbA1c (mean ?0.26%, 95% CI ?0.27 to ?0.24 vs mean ?0.18%, 95% CI ?0.19 to ?0.16, P<.001), and body weight (mean ?3.26 kg, 95% CI ?3.26 to ?3.25 vs mean ?1.26 kg, 95% CI ?1.27 to ?1.26, P<.001). Reductions in BMI, waist circumference, and TG/HDL were also significantly greater in Alive-PD participants than in the control group. At 6 months, the Alive-PD group reduced their Framingham 8-year diabetes risk from 16% to 11%, significantly more than the control group (P<.001). Participation and retention was good; intervention participants interacted with the program a median of 17 (IQR 14) of 24 weeks and 71.1% (116/163) were still interacting with the program in month 6. Conclusions: Alive-PD improved glycemic control, body weight, BMI, waist circumference, TG/HDL ratio, and diabetes risk. As a fully automated system, the program has high potential for scalability and could potentially reach many of the 86 million US adults who have prediabetes as well as other at-risk groups. Trial Registration: Clinicaltrials.gov NCT01479062; https://clinicaltrials.gov/ct2/show/NCT01479062 (Archived by WebCite at http://www.webcitation.org/6bt4V20NR) UR - http://www.jmir.org/2015/10/e240/ UR - http://dx.doi.org/10.2196/jmir.4897 UR - http://www.ncbi.nlm.nih.gov/pubmed/26499966 ID - info:doi/10.2196/jmir.4897 ER - TY - JOUR AU - Hassandra, Mary AU - Lintunen, Taru AU - Kettunen, Tarja AU - Vanhala, Mauno AU - Toivonen, Hanna-Mari AU - Kinnunen, Kimmo AU - Heikkinen, Risto PY - 2015/10/22 TI - Effectiveness of a Mobile Phone App for Adults That Uses Physical Activity as a Tool to Manage Cigarette Craving After Smoking Cessation: A Study Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e125 VL - 4 IS - 4 KW - behavior change KW - mHealth app KW - physical activity KW - randomized controlled trial KW - relapse prevention KW - smoking N2 - Background: Results from studies on the effects of exercise on smoking-related variables have provided strong evidence that physical activity acutely reduces cigarette cravings. Mobile technology may provide some valuable tools to move from explanatory randomized controlled trials to pragmatic randomized controlled trials by testing the acute effectiveness of exercise on quitters under real-life conditions. An mHealth app was developed to be used as a support tool for quitters to manage their cigarette cravings. Objective: The primary aim of this paper is to present the protocol of a study examining the effectiveness of the Physical over smoking app (Ph.o.S) by comparing the point prevalence abstinence rate of a group of users to a comparator group during a 6-month follow-up period. Methods: After initial Web-based screening, eligible participants are recruited to attend a smoking cessation program for 3 weeks to set a quit smoking date. Fifty participants who succeed in quitting will be randomly allocated to the comparator and experimental groups. Both groups will separately have 1 more counseling session on how to manage cravings. In this fourth session, the only difference in treatment between the groups is that the experimental group will have an extra 10-15 minutes of guidance on how to use the fully automated Ph.o.S app to manage cravings during the follow-up period. Data will be collected at baseline, as well as before and after the quit day, and follow-up Web-based measures will be collected for a period of 6 months. The primary efficacy outcome is the 7-day point prevalence abstinence rate, and secondary efficacy outcomes are number of relapses and cravings, self-efficacy of being aware of craving experience, self-efficacy in managing cravings, and power of control in managing cravings. Results: Recruitment for this project commenced in December 2014, and proceeded until May 2015. Follow-up data collection has commenced and will be completed by the end of December 2015. Conclusions: If the Ph.o.S app is shown to be effective, the study will provide evidence for the use of the app as a support tool for people who are trying to manage cravings during smoking cessation programs. It is anticipated that the results of the study will provide knowledge of how physical activity affects cigarette craving in real-life situations and inform the development and delivery of relapse prevention in smoking cessation treatment. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN55259451; http://www.controlled-trials.com/ISRCTN55259451 (Archived by WebCite at http://www.webcitation.org/6cKF2mzEI) UR - http://www.researchprotocols.org/2015/4/e125/ UR - http://dx.doi.org/10.2196/resprot.4600 UR - http://www.ncbi.nlm.nih.gov/pubmed/26494256 ID - info:doi/10.2196/resprot.4600 ER - TY - JOUR AU - Pfaeffli Dale, Leila AU - Whittaker, Robyn AU - Jiang, Yannan AU - Stewart, Ralph AU - Rolleston, Anna AU - Maddison, Ralph PY - 2015/10/21 TI - Text Message and Internet Support for Coronary Heart Disease Self-Management: Results From the Text4Heart Randomized Controlled Trial JO - J Med Internet Res SP - e237 VL - 17 IS - 10 KW - text messaging KW - mHealth KW - cellular phone KW - cardiovascular diseases KW - intervention KW - lifestyle change KW - behavior N2 - Background: Mobile technology has the potential to deliver behavior change interventions (mHealth) to reduce coronary heart disease (CHD) at modest cost. Previous studies have focused on single behaviors; however, cardiac rehabilitation (CR), a component of CHD self-management, needs to address multiple risk factors. Objective: The aim was to investigate the effectiveness of a mHealth-delivered comprehensive CR program (Text4Heart) to improve adherence to recommended lifestyle behaviors (smoking cessation, physical activity, healthy diet, and nonharmful alcohol use) in addition to usual care (traditional CR). Methods: A 2-arm, parallel, randomized controlled trial was conducted in New Zealand adults diagnosed with CHD. Participants were recruited in-hospital and were encouraged to attend center-based CR (usual care control). In addition, the intervention group received a personalized 24-week mHealth program, framed in social cognitive theory, sent by fully automated daily short message service (SMS) text messages and a supporting website. The primary outcome was adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score (?3) at 3 and 6 months. Secondary outcomes included clinical outcomes, medication adherence score, self-efficacy, illness perceptions, and anxiety and/or depression at 6 months. Baseline and 6-month follow-up assessments (unblinded) were conducted in person. Results: Eligible patients (N=123) recruited from 2 large metropolitan hospitals were randomized to the intervention (n=61) or the control (n=62) group. Participants were predominantly male (100/123, 81.3%), New Zealand European (73/123, 59.3%), with a mean age of 59.5 (SD 11.1) years. A significant treatment effect in favor of the intervention was observed for the primary outcome at 3 months (AOR 2.55, 95% CI 1.12-5.84; P=.03), but not at 6 months (AOR 1.93, 95% CI 0.83-4.53; P=.13). The intervention group reported significantly greater medication adherence score (mean difference: 0.58, 95% CI 0.19-0.97; P=.004). The majority of intervention participants reported reading all their text messages (52/61, 85%). The number of visits to the website per person ranged from zero to 100 (median 3) over the 6-month intervention period. Conclusions: A mHealth CR intervention plus usual care showed a positive effect on adherence to multiple lifestyle behavior changes at 3 months in New Zealand adults with CHD compared to usual care alone. The effect was not sustained to the end of the 6-month intervention. A larger study is needed to determine the size of the effect in the longer term and whether the change in behavior reduces adverse cardiovascular events. Trial Registration: ACTRN 12613000901707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364758&isReview=true (Archived by WebCite at http://www.webcitation.org/6c4qhcHKt) UR - http://www.jmir.org/2015/10/e237/ UR - http://dx.doi.org/10.2196/jmir.4944 UR - http://www.ncbi.nlm.nih.gov/pubmed/26490012 ID - info:doi/10.2196/jmir.4944 ER - TY - JOUR AU - Patel, Vishal AU - Hale, M. Timothy AU - Palakodeti, Sandeep AU - Kvedar, C. Joseph AU - Jethwani, Kamal PY - 2015/10/19 TI - Prescription Tablets in the Digital Age: A Cross-Sectional Study Exploring Patient and Physician Attitudes Toward the Use of Tablets for Clinic-Based Personalized Health Care Information Exchange JO - JMIR Res Protoc SP - e116 VL - 4 IS - 4 KW - electronic health records KW - tablets KW - health education KW - self-management KW - primary care KW - physician patient relationship KW - digital health KW - iPad KW - patient-reported outcome measures N2 - Background: To reduce the cost of health care while increasing efficiency and quality, health systems are seeking innovative means to engage and empower patients. Improved use of information technology and electronic health record (EHR) infrastructure is essential, and required for ?meaningful use? as mandated by the federal government. Providing personalized health information using tablets at the point of care could enhance the clinical experience and enable efficient collection of patient reported outcome measures to guide clinical decision making. Objective: The aim of this study is to explore patient and provider attitudes and interest in a proposed clinic-based tablet system for personal health information exchange. To provide a context to understand patients? use of tablets during their clinic visit, we also examine patients? current activities and time spent in the waiting room, and their use of health information resources. Methods: Surveys were administered to 84 patients in the waiting room of a community health center affiliated with Massachusetts General Hospital (MGH) in Boston, MA. This survey included a vignette and illustration describing a proposed tablet-based system in which the patient, upon sign in at the clinic, receives a tablet loaded with personalized information tailored to their specific medical conditions and preferences. Patients were queried about their interest in such a system in comparison to traditional forms of patient education as well as their current health information seeking behaviors and activities and time spent in the waiting room. Interviews with five MGH-affiliated health care providers were conducted to assess their opinions regarding the proposed tablet system. Results: The majority (>60%) of patients were ?very? or ?extremely? interested in the proposed tablet system and thought it would improve their knowledge about their medical condition (60%), assist them in making healthy choices (57%), and help them to feel more comfortable talking with their provider (55%). Patients thought the system would be more motivating, informative, and engaging than traditional printed health education materials. The tablet system was not considered more effective than face-to-face interaction with providers, though 44% thought it would improve their relationship with their physician. Overall, 91% of respondents were willing to learn how to use a tablet and 75% reported being ?very? or ?extremely? confident they could use one. Four of the five providers believed that the proposed tablet system would improve clinical workflow and patient education. Patients and providers were concerned about privacy and security of data collected using the tablets. Conclusions: Both patients and providers were highly amenable to integrating tablets into the clinical experience, and tablets may be useful in improving patients? health knowledge, the collection of patient reported outcome measures, and improved patient-provider communication. Further research into operationalizing such systems and their validation is necessary before integration into standard clinical practice. UR - http://www.researchprotocols.org/2015/4/e116/ UR - http://dx.doi.org/10.2196/resprot.3806 UR - http://www.ncbi.nlm.nih.gov/pubmed/26481906 ID - info:doi/10.2196/resprot.3806 ER - TY - JOUR AU - Carter, Adrian AU - Liddle, Jacki AU - Hall, Wayne AU - Chenery, Helen PY - 2015/10/16 TI - Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions JO - JMIR mHealth uHealth SP - e95 VL - 3 IS - 4 KW - ethics KW - informed consent KW - mHealth KW - mobile phones KW - Parkinson?s disease KW - privacy KW - regulation UR - http://mhealth.jmir.org/2015/4/e95/ UR - http://dx.doi.org/10.2196/mhealth.4538 UR - http://www.ncbi.nlm.nih.gov/pubmed/26474545 ID - info:doi/10.2196/mhealth.4538 ER - TY - JOUR AU - Rhee, Hyekyun AU - Belyea, J. Michael AU - Sterling, Mark AU - Bocko, F. Mark PY - 2015/10/16 TI - Evaluating the Validity of an Automated Device for Asthma Monitoring for Adolescents: Correlational Design JO - J Med Internet Res SP - e234 VL - 17 IS - 10 KW - asthma KW - adolescent KW - ambulatory monitoring KW - device KW - cough KW - validity N2 - Background: Symptom monitoring is a cornerstone of asthma self-management. Conventional methods of symptom monitoring have fallen short in producing objective data and eliciting patients? consistent adherence, particularly in teen patients. We have recently developed an Automated Device for Asthma Monitoring (ADAM) using a consumer mobile device as a platform to facilitate continuous and objective symptom monitoring in adolescents in vivo. Objective: The objectives of the study were to evaluate the validity of the device using spirometer data, fractional exhaled nitric oxide (FeNO), existing measures of asthma symptoms/control and health care utilization data, and to examine the sensitivity and specificity of the device in discriminating asthma cases from nonasthma cases. Methods: A total of 84 teens (42 teens with a current asthma diagnosis; 42 without asthma) aged between 13 and 17 years participated in the study. All participants used ADAM for 7 consecutive days during which participants with asthma completed an asthma diary two times a day. ADAM recorded the frequency of coughing for 24 hours throughout the 7-day trial. Pearson correlation and multiple regression were used to examine the relationships between ADAM data and asthma control, quality of life, and health care utilization at the time of the 7-day trial and 3 months later. A receiver operating characteristic (ROC) curve analysis was conducted to examine sensitivity and specificity based on the area under the curve (AUC) as an indicator of the device?s capacity to discriminate between asthma versus nonasthma cases. Results: ADAM data (cough counts) were negatively associated with forced expiratory volume in first second of expiration (FEV1) (r=?.26, P=.05), forced vital capacity (FVC) (r=?.31, P=.02), and overall asthma control (r=?.41, P=.009) and positively associated with daily activity limitation (r=.46, P=.01), nighttime (r=.40, P=.02) and daytime symptoms (r=.38, P=.02), and health care utilization (r=.61, P<.001). Device data were also a significant predictor of asthma control (?=?.48, P=.003), quality of life (?=?.55, P=.001), and health care utilization (?=.74, P=.004) after 3 months. The ROC curve analysis for the presence of asthma diagnosis had an AUC of 0.71 (95% CI 0.58-0.84), which was significantly different from chance (?21=9.7, P=.002), indicating the device?s discriminating capacity. The optimal cutoff value of the device was 0.56 with a sensitivity of 51.3% and a specificity of 72.7%. Conclusions: This study demonstrates validity of ADAM as a symptom-monitoring device in teens with asthma. ADAM data reflect the current status of asthma control and predict asthma morbidity and quality of life for the near future. A monitoring device such as ADAM can increase patients? awareness of the patterns of cough for early detection of worsening asthma and has the potential for preventing serious and costly future consequences of asthma. UR - http://www.jmir.org/2015/10/e234/ UR - http://dx.doi.org/10.2196/jmir.4975 UR - http://www.ncbi.nlm.nih.gov/pubmed/26475634 ID - info:doi/10.2196/jmir.4975 ER - TY - JOUR AU - Wayne, Noah AU - Perez, F. Daniel AU - Kaplan, M. David AU - Ritvo, Paul PY - 2015/10/05 TI - Health Coaching Reduces HbA1c in Type 2 Diabetic Patients From a Lower-Socioeconomic Status Community: A Randomized Controlled Trial JO - J Med Internet Res SP - e224 VL - 17 IS - 10 KW - diabetes mellitus, type 2 KW - health coaching KW - mHealth KW - telehealth KW - randomized controlled trial KW - RCT N2 - Background: Adoptions of health behaviors are crucial for maintaining good health after type 2 diabetes mellitus (T2DM) diagnoses. However, adherence to glucoregulating behaviors like regular exercise and balanced diet can be challenging, especially for people living in lower-socioeconomic status (SES) communities. Providing cost-effective interventions that improve self-management is important for improving quality of life and the sustainability of health care systems. Objective: To evaluate a health coach intervention with and without the use of mobile phones to support health behavior change in patients with type 2 diabetes. Methods: In this noninferiority, pragmatic randomized controlled trial (RCT), patients from two primary care health centers in Toronto, Canada, with type 2 diabetes and a glycated hemoglobin/hemoglobin A1c (HbA1c) level of ?7.3% (56.3 mmol/mol) were randomized to receive 6 months of health coaching with or without mobile phone monitoring support. We hypothesized that both approaches would result in significant HbA1c reductions, although health coaching with mobile phone monitoring would result in significantly larger effects. Participants were evaluated at baseline, 3 months, and 6 months. The primary outcome was the change in HbA1c from baseline to 6 months (difference between and within groups). Other outcomes included weight, waist circumference, body mass index (BMI), satisfaction with life, depression and anxiety (Hospital Anxiety and Depression Scale [HADS]), positive and negative affect (Positive and Negative Affect Schedule [PANAS]), and quality of life (Short Form Health Survey-12 [SF-12]). Results: A total of 138 patients were randomized and 7 were excluded for a substudy; of the remaining 131, 67 were allocated to the intervention group and 64 to the control group. Primary outcome data were available for 97 participants (74.0%). While both groups reduced their HbA1c levels, there were no significant between-group differences in change of HbA1c at 6 months using intention-to-treat (last observation carried forward [LOCF]) (P=.48) or per-protocol (P=.83) principles. However, the intervention group did achieve an accelerated HbA1c reduction, leading to a significant between-group difference at 3 months (P=.03). This difference was reduced at the 6-month follow-up as the control group continued to improve, achieving a reduction of 0.81% (8.9 mmol/mol) (P=.001) compared with a reduction of 0.84% (9.2 mmol/mol)(P=.001) in the intervention group. Intervention group participants also had significant decreases in weight (P=.006) and waist circumference (P=.01) while controls did not. Both groups reported improvements in mood, satisfaction with life, and quality of life. Conclusions: Health coaching with and without access to mobile technology appeared to improve glucoregulation and mental health in a lower-SES, T2DM population. The accelerated improvement in the mobile phone group suggests the connectivity provided may more quickly improve adoption and adherence to health behaviors within a clinical diabetes management program. Overall, health coaching in primary care appears to lead to significant benefits for patients from lower-SES communities with poorly controlled type 2 diabetes. Trial Registration: ClinicalTrials.gov NCT02036892; http://clinicaltrials.gov/ct2/show/NCT02036892 (Archived by WebCite at http://www.webcitation.org/6b3cJYJOD) UR - http://www.jmir.org/2015/10/e224/ UR - http://dx.doi.org/10.2196/jmir.4871 UR - http://www.ncbi.nlm.nih.gov/pubmed/26441467 ID - info:doi/10.2196/jmir.4871 ER - TY - JOUR AU - Mann, Davina AU - Riddell, Lynn AU - Lim, Karen AU - Byrne, K. Linda AU - Nowson, Caryl AU - Rigo, Manuela AU - Szymlek-Gay, A. Ewa AU - Booth, O. Alison PY - 2015/09/28 TI - Mobile Phone App Aimed at Improving Iron Intake and Bioavailability in Premenopausal Women: A Qualitative Evaluation JO - JMIR mHealth uHealth SP - e92 VL - 3 IS - 3 KW - cell phones KW - telemedicine KW - mobile apps KW - iron KW - behavior therapy KW - focus groups KW - goals N2 - Background: Low iron intake can lead to iron deficiency, which can result in impaired health and iron-deficiency anemia. A mobile phone app, combining successful dietary strategies to increase bioavailable iron with strategies for behavior change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was developed with the aim to increase bioavailable iron intake in premenopausal women. Objective: To evaluate the content, usability, and acceptability of a mobile phone app designed to improve intake of bioavailable dietary iron. Methods: Women aged 18-50 years with an Android mobile phone were invited to participate. Over a 2-week period women were asked to interact with the app. Following this period, semistructured focus groups with participants were conducted. Focus groups were audio recorded and analyzed via an inductive open-coding method using the qualitative analysis software NVivo 10. Themes were identified and frequency of code occurrence was calculated. Results: Four focus groups (n=26) were conducted (age range 19-36 years, mean 24.7, SD 5.2). Two themes about the app?s functionality were identified (frequency of occurrence in brackets): interface and design (134) and usability (86). Four themes about the app?s components were identified: goal tracker (121), facts (78), photo diary (40), and games (46). A number of suggestions to improve the interface and design of the app were provided and will inform the ongoing development of the app. Conclusions: This research indicates that participants are interested in iron and their health and are willing to use an app utilizing behavior change strategies to increase intake of bioavailable iron. The inclusion of information about the link between diet and health, monitoring and tracking of the achievement of dietary goals, and weekly reviews of goals were also seen as valuable components of the app and should be considered in mobile health apps aimed at adult women. UR - http://mhealth.jmir.org/2015/3/e92/ UR - http://dx.doi.org/10.2196/mhealth.4300 UR - http://www.ncbi.nlm.nih.gov/pubmed/26416479 ID - info:doi/10.2196/mhealth.4300 ER - TY - JOUR AU - Schnall, Rebecca AU - Mosley, Patterson Jocelyn AU - Iribarren, J. Sarah AU - Bakken, Suzanne AU - Carballo-Diéguez, Alex AU - Brown III, William PY - 2015/09/18 TI - Comparison of a User-Centered Design, Self-Management App to Existing mHealth Apps for Persons Living With HIV JO - JMIR mHealth uHealth SP - e91 VL - 3 IS - 3 KW - mHealth KW - HIV KW - mobile apps KW - user-centered design N2 - Background: There is preliminary evidence that mobile health (mHealth) apps are feasible, attractive, and an effective platform for the creation of self-management tools for persons living with HIV (PLWH). As a foundation for the current study, we conducted formative research using focus groups, participatory design sessions, and usability evaluation methods to inform the development of a health management app for PLWH. The formative research resulted in identification of the following functional requirements of a mHealth app for self-management: (1) communication between providers and peers, (2) medication reminders, (3) medication log, (4) lab reports, (5) pharmacy information, (6) nutrition and fitness, (7) resources (eg, social services, substance use, video testimonials), (8) settings, and (9) search function. Objective: The purpose of this study was to conduct an ecological review of the existing apps for PLWH and to compare the functionality of existing apps with the app specifications identified in our formative work. Methods: We searched two mobile app stores (Google Play and iTunes) and found a total of 5606 apps. We reviewed the apps, narrowed our search terms, and found a total of 112 apps. Of these, we excluded 97 (86.6%) apps that were either not in English (10/112, 8.9%), not HIV focused (32/112, 28.9%), or focused only on HIV prevention (2/112, 7.8%); targeted health care providers (26/112, 23.2%); provided information only on conference schedules and events (7/112, 6.3%), fundraisers (7/112, 6.3%), specific clinics (7/112, 6.3%), international or narrow local resources (3/112, 2.7%); or were identified in the first search but were no longer on the market at the next review (4/112, 3.6%). The 15 apps meeting inclusion criteria were then evaluated for inclusion of the nine functionalities identified in our earlier work. Results: Of the 15 apps that we included in our final review, none had all of the functionalities that were identified in our formative work. The apps that we identified included the following functionalities: communication with providers and/or peers (4/15, 27%), medication reminders (6/15, 40%), medication logs (7/15, 47%), lab reports (5/15, 33%), pharmacy information (4/15, 27%), resources (7/15, 47%), settings (11/15, 73%), and search function (6/15, 40%). No apps included nutrition or fitness information. Conclusions: Currently, there are only a small number of apps that have been designed for PLWH to manage their health. Of the apps that are currently available, none have all of the desired functionalities identified by PLWH and experts in our formative research. Findings from this work elucidate the need to develop and evaluate mobile apps that meet PLWH?s desired functional specifications. UR - http://mhealth.jmir.org/2015/3/e91/ UR - http://dx.doi.org/10.2196/mhealth.4882 UR - http://www.ncbi.nlm.nih.gov/pubmed/26385783 ID - info:doi/10.2196/mhealth.4882 ER - TY - JOUR AU - Zhu, Egui AU - Lilienthal, Anneliese AU - Shluzas, Aquino Lauren AU - Masiello, Italo AU - Zary, Nabil PY - 2015/09/18 TI - Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework JO - JMIR Medical Education SP - e10 VL - 1 IS - 2 KW - augmented reality KW - health care education KW - antibiotics KW - general practitioners KW - learning environment KW - learning theory KW - mobile technology N2 - Background: Augmented reality (AR) is increasingly used across a range of subject areas in health care education as health care settings partner to bridge the gap between knowledge and practice. As the first contact with patients, general practitioners (GPs) are important in the battle against a global health threat, the spread of antibiotic resistance. AR has potential as a practical tool for GPs to combine learning and practice in the rational use of antibiotics. Objective: This paper was driven by learning theory to develop a mobile augmented reality education (MARE) design framework. The primary goal of the framework is to guide the development of AR educational apps. This study focuses on (1) identifying suitable learning theories for guiding the design of AR education apps, (2) integrating learning outcomes and learning theories to support health care education through AR, and (3) applying the design framework in the context of improving GPs? rational use of antibiotics. Methods: The design framework was first constructed with the conceptual framework analysis method. Data were collected from multidisciplinary publications and reference materials and were analyzed with directed content analysis to identify key concepts and their relationships. Then the design framework was applied to a health care educational challenge. Results: The proposed MARE framework consists of three hierarchical layers: the foundation, function, and outcome layers. Three learning theories?situated, experiential, and transformative learning?provide foundational support based on differing views of the relationships among learning, practice, and the environment. The function layer depends upon the learners? personal paradigms and indicates how health care learning could be achieved with MARE. The outcome layer analyzes different learning abilities, from knowledge to the practice level, to clarify learning objectives and expectations and to avoid teaching pitched at the wrong level. Suggestions for learning activities and the requirements of the learning environment form the foundation for AR to fill the gap between learning outcomes and medical learners? personal paradigms. With the design framework, the expected rational use of antibiotics by GPs is described and is easy to execute and evaluate. The comparison of specific expected abilities with the GP personal paradigm helps solidify the GP practical learning objectives and helps design the learning environment and activities. The learning environment and activities were supported by learning theories. Conclusions: This paper describes a framework for guiding the design, development, and application of mobile AR for medical education in the health care setting. The framework is theory driven with an understanding of the characteristics of AR and specific medical disciplines toward helping medical education improve professional development from knowledge to practice. Future research will use the framework as a guide for developing AR apps in practice to validate and improve the design framework. UR - http://mededu.jmir.org/2015/2/e10/ UR - http://dx.doi.org/10.2196/mededu.4443 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731839 ID - info:doi/10.2196/mededu.4443 ER - TY - JOUR AU - Spark, C. Lauren AU - Fjeldsoe, S. Brianna AU - Eakin, G. Elizabeth AU - Reeves, M. Marina PY - 2015/09/15 TI - Efficacy of a Text Message-Delivered Extended Contact Intervention on Maintenance of Weight Loss, Physical Activity, and Dietary Behavior Change JO - JMIR mHealth uHealth SP - e88 VL - 3 IS - 3 KW - weight KW - physical activity KW - diet KW - mobile telephone KW - intervention KW - behavior change KW - maintenance KW - SMS KW - mhealth KW - textmessaging N2 - Background: Extending contact with participants after the end of an initial intervention is associated with successful maintenance of weight loss and behavior change. However, cost-effective methods of extending intervention contact are needed. Objective: This study investigated whether extended contact via text message was efficacious in supporting long-term weight loss and physical activity and dietary behavior change in breast cancer survivors. Methods: Following the end of an initial 6-month randomized controlled trial of a telephone-delivered weight loss intervention versus usual care, eligible and consenting intervention participants received a 6-month extended contact intervention via tailored text messages targeting a range of factors proposed to influence the maintenance of behavior change. In this single-group, pre-post designed study, within group changes in weight, moderate-to-vigorous physical activity (Actigraph GT3X+ accelerometers), and total energy intake (2x24 hour dietary recalls) were evaluated from baseline to end of initial intervention (6 months), end of extended contact intervention (12 months), and after a no-contact follow-up (18 months) via linear mixed models. Feasibility of implementation was assessed through systematic tracking of text message delivery process outcomes, and participant satisfaction was assessed through semistructured interviews. Results: Participants at baseline (n=29) had a mean age of 54.9 years (SD 8.8), body mass index of 30.0 kg/m2 (SD 4.2), and were recruited a mean 16.6 months (SD 3.2) post diagnosis. From baseline to 18 months, participants showed statistically significantly lower mean weight (-4.2 kg [95% CI -6.0 to -2.4]; P<.001) and higher physical activity (mean 10.4 mins/day [95% CI 3.6-17.2]; P=.003), but no significant differences in energy intake (P=.200). Participants received a mean of 8 text messages every 2 weeks (range 2-11) and reported a high rate of satisfaction. Conclusions: In comparison to interventions without extended contact, results suggest text message?delivered extended contact may support the attenuation of weight regain and promote the maintenance of physical activity. UR - http://mhealth.jmir.org/2015/3/e88/ UR - http://dx.doi.org/10.2196/mhealth.4114 UR - http://www.ncbi.nlm.nih.gov/pubmed/26373696 ID - info:doi/10.2196/mhealth.4114 ER - TY - JOUR AU - Hale, Kelli AU - Capra, Sandra AU - Bauer, Judith PY - 2015/09/14 TI - A Framework to Assist Health Professionals in Recommending High-Quality Apps for Supporting ChronicDisease Self-Management: Illustrative Assessment of Type 2 Diabetes Apps JO - JMIR mHealth uHealth SP - e87 VL - 3 IS - 3 KW - mobile apps KW - chronic disease KW - patient-centered care KW - technology N2 - Background: This paper presents an approach to assist health professionals in recommending high quality apps for supporting chronic disease self-management. Most app reviews focus on popularity, aesthetics, functionality, usability, and information quality. There is no doubt these factors are important in selecting trustworthy apps which are appealing to users, but behavioral theory may be also be useful in matching the apps to user needs. Objective: The framework developed aims to be methodologically sound, capable of selecting popular apps which include content covered by evidence-based programs, consistent with behavioral theory, as well as a patient-centered approach for matching apps to patients? individual needs. Methods: A single disease?type 2 diabetes?was selected to illustrate how the framework can be applied as this was deemed to represent the types of strategies used in many chronic diseases. A systematic approach based on behavioral theory and recommendations from best practice guidelines was developed for matching apps to patients? needs. In March 2014, a series of search strategies was used to identify top-rated iPhone and Android health apps, representing 29 topics from five categories of type 2 diabetes self-management strategies. The topics were chosen from published international guidelines for the management of diabetes. The senior author (KH) assessed the most popular apps found that addressed these topics using the Behavioral Theory Content Survey (BTS), which is based on traditional behavioral theory. A tool to assist decision making when using apps was developed and trialed with health professionals for ease of use and understanding. Results: A total of 14 apps were assessed representing all five topic categories of self-management. Total theoretical scores (BTS scores) were less than 50 on a 100-point scale for all apps. Each app scored less than 50% of the total possible BTS score for all four behavioral theories and for most of the 20 behavioral strategies; however, apps scored higher than 50% of the total possible BTS score for specific strategies related to their primary focus. Our findings suggest that the apps studied would be more effective when used in conjunction with therapy than as stand-alone apps. Apps were categorized according to topic and core intervention strategies. A framework for matching apps to identified patient needs was developed based on app categorization and principles of patient-centered care. The approach was well accepted and understood by a convenience sample of health practitioners. Conclusions: The framework presented can be used by health practitioners to better match apps with client needs. Some apps incorporate highly interactive strategies of behavioral theory, and when used as an adjunct may increase patient participation and the effectiveness of therapy. UR - http://mhealth.jmir.org/2015/3/e87/ UR - http://dx.doi.org/10.2196/mhealth.4532 UR - http://www.ncbi.nlm.nih.gov/pubmed/26369346 ID - info:doi/10.2196/mhealth.4532 ER - TY - JOUR AU - Jaensson, Maria AU - Dahlberg, Karuna AU - Eriksson, Mats AU - Grönlund, Åke AU - Nilsson, Ulrica PY - 2015/09/11 TI - The Development of the Recovery Assessments by Phone Points (RAPP): A Mobile Phone App for Postoperative Recovery Monitoring and Assessment JO - JMIR mHealth uHealth SP - e86 VL - 3 IS - 3 KW - cellular phone KW - postoperative recovery KW - day care N2 - Background: In Sweden, day surgery is performed in almost 2 million patients per year. Patient satisfaction is closely related to potential adverse events during the recovery process. A way to empower patients and give them the opportunity to affect care delivery is to let them evaluate their recovery process. The most common evaluation method is a follow-up telephone call by a nurse one or two days after surgery. In recent years, mHealth apps have been used to evaluate the nurse-patient relationship for self-management in chronic diseases or to evaluate pain after surgery. To the best of our knowledge, no previous research has explored the recovery process after day surgery via mobile phone in a Swedish cohort. Objective: The objective of the study is to describe the process of developing a mobile phone app using a Swedish Web-based Quality of Recovery (SwQoR) questionnaire to evaluate postoperative recovery after day surgery. Methods: The development process included five steps: (1) setting up an interdisciplinary task force, (2) evaluating the potential needs of app users, (3) developing the Swedish Web version of a QoR questionnaire, (4) constructing a mobile phone app, and (5) evaluating the interface and design by staff working in a day-surgery department and patients undergoing day surgery. A task force including specialists in information and communication technology, eHealth, and nursing care worked closely together to develop a Web-based app. Modifications to the QoR questionnaire were inspired by instruments used in the field of recovery for both children and adults. The Web-based app, Recovery Assessment by Phone Points (RAPP) consists of two parts: (1) a mobile app installed on the patient?s private mobile phone, and (2) an administrator interface for the researchers. Results: The final version of the SwQoR questionnaire, which includes 31 items, was successfully installed in RAPP. The interface and the design were evaluated by asking for user opinions about the design and usefulness of the app with 10 day surgery patients. Some minor adjustments were made concerning text size and screen color. Conclusions: Taking advantage of joint expertise, a useable Web-based app adaptable to different technical platforms was constructed. In addition, the SwQoR was successfully transferred into digital format for use on mobile phones. UR - http://mhealth.jmir.org/2015/3/e86/ UR - http://dx.doi.org/10.2196/mhealth.4649 UR - http://www.ncbi.nlm.nih.gov/pubmed/26362403 ID - info:doi/10.2196/mhealth.4649 ER - TY - JOUR AU - Tacchino, Andrea AU - Pedullà, Ludovico AU - Bonzano, Laura AU - Vassallo, Claudio AU - Battaglia, Alberto Mario AU - Mancardi, Gianluigi AU - Bove, Marco AU - Brichetto, Giampaolo PY - 2015/08/31 TI - A New App for At-Home Cognitive Training: Description and Pilot Testing on Patients with Multiple Sclerosis JO - JMIR mHealth uHealth SP - e85 VL - 3 IS - 3 KW - tablet KW - mobile phone KW - mobile device KW - cognitive rehabilitation KW - cognitive impairment KW - working memory KW - self-management KW - adaptive working load algorithms KW - usability N2 - Background: Cognitive impairment is common in people with neurological diseases and severely affects their social and professional life. It has been shown that intensive and personalized cognitive rehabilitation (CR), based on working memory exercises, leads to improved cognitive status of healthy and cognitive-impaired subjects. New technologies would help to promote accessible, at-home, and self-managed CR interventions. Objective: The aim of this paper is to describe the design of Cognitive Training Kit (COGNI-TRAcK), an app for mobile devices, to self-administer an at-home, intensive, and personalized CR intervention based on working memory exercises, and test its disposability-to-use (usability, motivation to use, compliance to treatment) on cognitive-impaired patients with multiple sclerosis (MS). Methods: COGNI-TRAcK includes user-friendly interfaces for personal data input and management and for CR intervention configurations. Inner routines automatically implement adaptive working load algorithms and allow data processing and analysis. A dedicated team developed COGNI-TRAcK with C# programming language, by using the platform Xamarin Studio 4.0.10 for Android (API level 15 and following). Three exercises based on working memory are now available. To assess the disposability-to-use of the system, patients with MS were selected as likely users due to the young age of disease onset. Cognitive-impaired patients with MS (N=16) with a mean age of 49.06 years (SD 9.10) and a mean score of 3.75 (SD 1.92) on the Expanded Disability Status Scale (EDSS) were submitted to an 8-week at-home intervention administered by the app. The intervention consisted of 5 daily scheduled 30-minute sessions per week. Disposability-to-use of COGNI-TRAcK was investigated by means of a questionnaire administered to patients at the end of the training. Results: The adherence to the treatment was 84% (33.4/40). Of the patients with MS, 94% (15/16) understood the instructions given, 100% (16/16) felt independent to use COGNI-TRAcK at home, 75% (12/16) found the exercises interesting, and 81% (13/16) found the exercises useful and were motivated to use the app again. Moreover, during the exercises, patients with MS were highly motivated to perform well (mean score 3.19/4, SE 0.16), experienced rather low levels of stress (mean score 2.19/4, SE 0.26), were not bored (mean score 1.81/4, SE 0.30), and felt amusement (mean score 2.25/4, SE 0.23). Conclusions: As COGNI-TRAcK is highly usable, motivating, and well-accepted by patients with MS, its effectiveness can now be investigated. To improve COGNI-TRAcK, new releases should contain more working memory exercises, have enhanced perceived amusement, and promote Internet communication procedures for data transfer and fostering remote control of the intervention. UR - http://mhealth.jmir.org/2015/3/e85/ UR - http://dx.doi.org/10.2196/mhealth.4269 UR - http://www.ncbi.nlm.nih.gov/pubmed/26323749 ID - info:doi/10.2196/mhealth.4269 ER - TY - JOUR AU - Williams, Patrick John AU - Schroeder, Dirk PY - 2015/08/25 TI - Popular Glucose Tracking Apps and Use of mHealth by Latinos With Diabetes: Review JO - JMIR mHealth uHealth SP - e84 VL - 3 IS - 3 KW - diabetes mellitus KW - mobile health KW - mobile applications KW - systematic review KW - Hispanic N2 - Background: Diabetes mellitus in the United States is an increasingly common chronic disease, costing hundreds of billions of dollars and contributing to hundreds of thousands of deaths each year. The prevalence of diabetes is over 50% higher in Latinos than in the general population, and this group also suffers from higher rates of complications and diabetes-related mortality than NHWs. mHealth is a promising new treatment modality for diabetes, though few smartphone apps have been designed specifically for Latinos. Objective: The objectives of our study were: (1) to identify the most common features of the most popular diabetes apps and consider how such features may be improved to meet the needs of Latinos; (2) to determine the use of diabetes apps among a sample of online Hispanics in the US. Methods: Our study consisted of two parts. First, 20 of the most popular diabetes apps were reviewed in order to ascertain the most prevalent features and functionalities. Second, an online survey was fielded through a popular health website for Latinos (HolaDoctor) inquiring about respondents? use of diabetes apps. Results: Approximately one-third of apps reviewed were available in Spanish. The most common features were blood glucose recording/annotation and activity logs. The majority of apps permitted exportation of data via e-mail but only a third enabled uploading to an online account. Twenty percent of apps reviewed could connect directly with a glucometer, and 30% had reminder functionalities prompting patients to take medications or check blood glucose levels.Over 1600 online surveys were completed during the second half of April 2014. More than 90% of respondents were from the United States, including Puerto Rico. The majority of respondents used a device running on an Android platform while only a quarter used an iPhone. Use of diabetes apps was approximately 3% among diabetic respondents and 3.6% among diabetic respondents who also had a smartphone. Among app users, blood glucose and medication diaries were the most frequently used functionalities while hemoglobin A1c and insulin diaries were the least used. A significant majority of app users did not share their progress on social media though many of these were willing to share it with their doctor. Conclusions: Latino diabetics have unique needs and this should be reflected in diabetes apps designed for this population. Existing research as well as our survey results suggest that many Latinos do not possess the prerequisite diabetes knowledge or self-awareness to fully benefit from the most prevalent functionalities offered by the most popular diabetes apps. We recommend developers incorporate more basic features such as diabetes education, reminders to check blood glucose levels or take medications, Spanish language interfaces, and glucometer connectivities, which are relatively underrepresented in the most popular diabetes apps currently available in Spanish. UR - http://mhealth.jmir.org/2015/3/e84/ UR - http://dx.doi.org/10.2196/mhealth.3986 UR - http://www.ncbi.nlm.nih.gov/pubmed/26307533 ID - info:doi/10.2196/mhealth.3986 ER - TY - JOUR AU - Oh, Bumjo AU - Cho, Belong AU - Han, Kyu Min AU - Choi, Hochun AU - Lee, Na Mi AU - Kang, Hee-Cheol AU - Lee, Hee Chang AU - Yun, Heeseong AU - Kim, Youngho PY - 2015/08/20 TI - The Effectiveness of Mobile Phone-Based Care for Weight Control in Metabolic Syndrome Patients: Randomized Controlled Trial JO - JMIR mHealth uHealth SP - e83 VL - 3 IS - 3 KW - metabolic syndrome X KW - obesity KW - diet KW - exercise KW - mobile health KW - health information management N2 - Background: Overweight and obesity, due to a Westernized diet and lack of exercise, are serious global problems that negatively affect not only personal health, but national economies as well. To solve these problems, preventative-based approaches should be taken rather than medical treatments after the occurrence of disease. The improvement of individual life habits, through continuous care, is thus a paramount, long-term treatment goal. This study describes the effects of ubiquitous health care (uHealth care) or SmartCare services in the treatment of weight loss and obesity. Objective: The aim of this study is to evaluate the effect of SmartCare services on weight loss compared to the effects of existing outpatient treatments in obese patients with metabolic syndrome. Methods: Metabolic syndrome patients who met the inclusion/exclusion criteria were enrolled in the study and randomized into an intervention or control group. The intervention group was provided with remote monitoring and health care services in addition to the existing treatment. The control group was provided with only the existing treatment. Pedometers were given to all of the patients. Additionally, mobile phones and body composition monitors were provided to the intervention group while body weight scales were provided to the control group. The patients visited the hospitals at 12 and 24 weeks following the baseline examination to receive efficacy and safety evaluations. Results: Mean weight reduction from baseline to week 24 was measured as a primary efficacy evaluation parameter and was found to be 2.21 kg (SD 3.60) and 0.77 kg (SD 2.77) in the intervention and control group, respectively. The intervention group had a larger decrement compared to the control group (P<.001). Among the secondary efficacy evaluation parameters, body mass index (BMI) (P<.001), body fat rate (P=.001), decrement of waist measurement (P<.001), and diet habit (P=.012) improvement ratings from baseline to week 24 were found to be superior in the intervention group compared with the control group. The proportion of patients whose body weight decreased by ?10%, lipid profiles, blood pressure, prevalence of metabolic syndrome, change in the number of metabolic syndrome elements, smoking rate, drinking rate, and physical activity were not statistically significant between the groups. Conclusions: The efficacy of SmartCare services was confirmed as the intervention group that received both SmartCare services and the existing treatment had superior results compared with the control group that only received the existing treatment. Importantly, no specific problems with respect to safety concerns were observed. SmartCare service is thus an effective way to control the weight of obese patients with metabolic syndrome. Trial Registration: Clinicaltrials.gov NCT01344811; https://clinicaltrials.gov/ct2/show/NCT01344811 (Archived by Webcite at http://www.webcitation.org/6alT2MmIB) UR - http://mhealth.jmir.org/2015/3/e83/ UR - http://dx.doi.org/10.2196/mhealth.4222 UR - http://www.ncbi.nlm.nih.gov/pubmed/26293568 ID - info:doi/10.2196/mhealth.4222 ER - TY - JOUR AU - Lewis, Lorchan Thomas AU - Wyatt, C. Jeremy PY - 2015/08/19 TI - App Usage Factor: A Simple Metric to Compare the Population Impact of Mobile Medical Apps JO - J Med Internet Res SP - e200 VL - 17 IS - 8 KW - mHealth KW - medical app KW - mobile phone KW - metric KW - risk assessment KW - medical informatics apps KW - population impact KW - mobile health KW - patient safety KW - mobile app N2 - Background: One factor when assessing the quality of mobile apps is quantifying the impact of a given app on a population. There is currently no metric which can be used to compare the population impact of a mobile app across different health care disciplines. Objective: The objective of this study is to create a novel metric to characterize the impact of a mobile app on a population. Methods: We developed the simple novel metric, app usage factor (AUF), defined as the logarithm of the product of the number of active users of a mobile app with the median number of daily uses of the app. The behavior of this metric was modeled using simulated modeling in Python, a general-purpose programming language. Three simulations were conducted to explore the temporal and numerical stability of our metric and a simulated app ecosystem model using a simulated dataset of 20,000 apps. Results: Simulations confirmed the metric was stable between predicted usage limits and remained stable at extremes of these limits. Analysis of a simulated dataset of 20,000 apps calculated an average value for the app usage factor of 4.90 (SD 0.78). A temporal simulation showed that the metric remained stable over time and suitable limits for its use were identified. Conclusions: A key component when assessing app risk and potential harm is understanding the potential population impact of each mobile app. Our metric has many potential uses for a wide range of stakeholders in the app ecosystem, including users, regulators, developers, and health care professionals. Furthermore, this metric forms part of the overall estimate of risk and potential for harm or benefit posed by a mobile medical app. We identify the merits and limitations of this metric, as well as potential avenues for future validation and research. UR - http://www.jmir.org/2015/8/e200/ UR - http://dx.doi.org/10.2196/jmir.4284 UR - http://www.ncbi.nlm.nih.gov/pubmed/26290093 ID - info:doi/10.2196/jmir.4284 ER - TY - JOUR AU - Ford II, H. James AU - Alagoz, Esra AU - Dinauer, Susan AU - Johnson, A. Kimberly AU - Pe-Romashko, Klaren AU - Gustafson, H. David PY - 2015/08/18 TI - Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders JO - J Med Internet Res SP - e201 VL - 17 IS - 8 KW - mHealth KW - substance abuse disorder KW - sustainability KW - funding KW - engagement KW - staff KW - client KW - implementation N2 - Background: Mobile health (mHealth) services are growing in importance in health care research with the advancement of wireless networks, tablets, and mobile phone technologies. These technologies offer a wide range of applications that cover the spectrum of health care delivery. Although preliminary experiments in mHealth demonstrate promising results, more robust real-world evidence is needed for widespread adoption and sustainment of these technologies. Objective: Our aim was to identify the problems/challenges associated with sustained use of an mHealth addiction recovery support app and to determine strategies used by agencies that successfully sustained client use of A-CHESS. Methods: Qualitative inquiry assessed staff perceptions about organizational attributes and strategies associated with sustained use of the mobile app, A-CHESS. A total of 73 interviews of clinicians and administrators were conducted. The initial interviews (n=36) occurred at the implementation of A-CHESS. Follow-up interviews (n=37) occurred approximately 12 and 24 months later. A coding scheme was developed and Multiuser NVivo was used to manage and analyze the blinded interview data. Results: Successful strategies used by treatment providers to sustain A-CHESS included (1) strong leadership support, (2) use of client feedback reports to follow up on non-engaged clients, (3) identify passionate staff and incorporate A-CHESS discussions in weekly meetings, (4) develop A-CHESS guidelines related to client use, (5) establish internal work groups to engage clients, and (6) establish a financial strategy to sustain A-CHESS use. The study also identified attributes of A-CHESS that enhanced as well as inhibited its sustainability. Conclusions: Mobile apps can play an important role in health care delivery. However, providers will need to develop strategies for engaging both staff and patients in ongoing use of the apps. They will also need to rework business processes to accommodate the changes in communication frequency and style, learn to use app data for decision making, and identify financing mechanisms for supporting these changes. UR - http://www.jmir.org/2015/8/e201/ UR - http://dx.doi.org/10.2196/jmir.3965 UR - http://www.ncbi.nlm.nih.gov/pubmed/26286257 ID - info:doi/10.2196/jmir.3965 ER - TY - JOUR AU - Nicholas, Jennifer AU - Larsen, Erik Mark AU - Proudfoot, Judith AU - Christensen, Helen PY - 2015/08/17 TI - Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality JO - J Med Internet Res SP - e198 VL - 17 IS - 8 KW - mobile applications KW - bipolar disorder KW - review KW - telemedicine N2 - Background: With continued increases in smartphone ownership, researchers and clinicians are investigating the use of this technology to enhance the management of chronic illnesses such as bipolar disorder (BD). Smartphones can be used to deliver interventions and psychoeducation, supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible, anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the self-management of BD is only feasible if apps are of appropriate quality. Objective: Our aim was to identify the types of apps currently available for BD in the Google Play and iOS stores and to assess their features and the quality of their content. Methods: A systematic review framework was applied to the search, screening, and assessment of apps. We searched the Australian Google Play and iOS stores for English-language apps developed for people with BD. The comprehensiveness and quality of information was assessed against core psychoeducation principles and current BD treatment guidelines. Management tools were evaluated with reference to the best-practice resources for the specific area. General app features, and privacy and security were also assessed. Results: Of the 571 apps identified, 82 were included in the review. Of these, 32 apps provided information and the remaining 50 were management tools including screening and assessment (n=10), symptom monitoring (n=35), community support (n=4), and treatment (n=1). Not even a quarter of apps (18/82, 22%) addressed privacy and security by providing a privacy policy. Overall, apps providing information covered a third (4/11, 36%) of the core psychoeducation principles and even fewer (2/13, 15%) best-practice guidelines. Only a third (10/32, 31%) cited their information source. Neither comprehensiveness of psychoeducation information (r=-.11, P=.80) nor adherence to best-practice guidelines (r=-.02, P=.96) were significantly correlated with average user ratings. Symptom monitoring apps generally failed to monitor critical information such as medication (20/35, 57%) and sleep (18/35, 51%), and the majority of self-assessment apps did not use validated screening measures (6/10, 60%). Conclusions: In general, the content of currently available apps for BD is not in line with practice guidelines or established self-management principles. Apps also fail to provide important information to help users assess their quality, with most lacking source citation and a privacy policy. Therefore, both consumers and clinicians should exercise caution with app selection. While mHealth offers great opportunities for the development of quality evidence-based mobile interventions, new frameworks for mobile mental health research are needed to ensure the timely availability of evidence-based apps to the public. UR - http://www.jmir.org/2015/8/e198/ UR - http://dx.doi.org/10.2196/jmir.4581 UR - http://www.ncbi.nlm.nih.gov/pubmed/26283290 ID - info:doi/10.2196/jmir.4581 ER - TY - JOUR AU - Litman, Leib AU - Rosen, Zohn AU - Spierer, David AU - Weinberger-Litman, Sarah AU - Goldschein, Akiva AU - Robinson, Jonathan PY - 2015/8/14 TI - Mobile Exercise Apps and Increased Leisure Time Exercise Activity: A Moderated Mediation Analysis of the Role of Self-Efficacy and Barriers JO - J Med Internet Res SP - e195 VL - 17 IS - 8 KW - mobile health KW - apps KW - exercise KW - barriers to exercise KW - self-efficacy KW - BMI N2 - Background: There are currently over 1000 exercise apps for mobile devices on the market. These apps employ a range of features, from tracking exercise activity to providing motivational messages. However, virtually nothing is known about whether exercise apps improve exercise levels and health outcomes and, if so, the mechanisms of these effects. Objective: Our aim was to examine whether the use of exercise apps is associated with increased levels of exercise and improved health outcomes. We also develop a framework within which to understand how exercise apps may affect health and test multiple models of possible mechanisms of action and boundary conditions of these relationships. Within this framework, app use may increase physical activity by influencing variables such as self-efficacy and may help to overcome exercise barriers, leading to improved health outcomes such as lower body mass index (BMI). Methods: In this study, 726 participants with one of three backgrounds were surveyed about their use of exercise apps and health: (1) those who never used exercise apps, (2) those who used exercise apps but discontinued use, and (3) those who are currently using exercise apps. Participants were asked about their long-term levels of exercise and about their levels of exercise during the previous week with the International Physical Activity Questionnaire (IPAQ). Results: Nearly three-quarters of current app users reported being more active compared to under half of non-users and past users. The IPAQ showed that current users had higher total leisure time metabolic equivalent of task (MET) expenditures (1169 METs), including walking and vigorous exercise, compared to those who stopped using their apps (612 METs) or who never used apps (577 METs). Importantly, physical activity levels in domains other than leisure time activity were similar across the groups. The results also showed that current users had lower BMI (25.16) than past users (26.8) and non-users (26.9) and that this association was mediated by exercise levels and self-efficacy. That relationship was also moderated by perceived barriers to exercise. Multiple serial mediation models were tested, which revealed that the association between app use and BMI is mediated by increased self-efficacy and increased exercise. Conclusions: Exercise app users are more likely to exercise during their leisure time, compared to those who do not use exercise apps, essentially fulfilling the role that many of these apps were designed to accomplish. Data also suggest that one way that exercise apps may increase exercise levels and health outcomes such as BMI is by making it easier for users to overcome barriers to exercise, leading to increased self-efficacy. We discuss ways of improving the effectiveness of apps by incorporating theory-driven approaches. We conclude that exercise apps can be viewed as intervention delivery systems consisting of features that help users overcome specific barriers. UR - http://www.jmir.org/2015/8/e195/ UR - http://dx.doi.org/10.2196/jmir.4142 UR - http://www.ncbi.nlm.nih.gov/pubmed/26276227 ID - info:doi/10.2196/jmir.4142 ER - TY - JOUR AU - Patel, Rakesh AU - Green, William AU - Shahzad, Waseem Muhammad AU - Larkin, Chris PY - 2015/08/13 TI - Use of Mobile Clinical Decision Support Software by Junior Doctors at a UK Teaching Hospital: Identification and Evaluation of Barriers to Engagement JO - JMIR mHealth uHealth SP - e80 VL - 3 IS - 3 KW - clinical decision support systems KW - health care technology KW - human-centered computing KW - medical education KW - patient safety KW - ubiquitous and mobile computing N2 - Background: Clinical decision support (CDS) tools improve clinical diagnostic decision making and patient safety. The availability of CDS to health care professionals has grown in line with the increased prevalence of apps and smart mobile devices. Despite these benefits, patients may have safety concerns about the use of mobile devices around medical equipment. Objective: This research explored the engagement of junior doctors (JDs) with CDS and the perceptions of patients about their use. There were three objectives for this research: (1) to measure the actual usage of CDS tools on mobile devices (mCDS) by JDs, (2) to explore the perceptions of JDs about the drivers and barriers to using mCDS, and (3) to explore the perceptions of patients about the use of mCDS. Methods: This study used a mixed-methods approach to study the engagement of JDs with CDS accessed through mobile devices. Usage data were collected on the number of interactions by JDs with mCDS. The perceived drivers and barriers for JDs to using CDS were then explored by interviews. Finally, these findings were contrasted with the perception of patients about the use of mCDS by JDs. Results: Nine of the 16 JDs made a total of 142 recorded interactions with the mCDS over a 4-month period. Only 27 of the 114 interactions (24%) that could be categorized as on-shift or off-shift occurred on-shift. Eight individual, institutional, and cultural barriers to engagement emerged from interviews with the user group. In contrast to reported cautions and concerns about the impact of clinicians? use of mobile phone on patient health and safety, patients had positive perceptions about the use of mCDS. Conclusions: Patients reported positive perceptions toward mCDS. The usage of mCDS to support clinical decision making was considered to be positive as part of everyday clinical practice. The degree of engagement was found to be limited due to a number of individual, institutional, and cultural barriers. The majority of mCDS engagement occurred outside of the workplace. Further research is required to verify these findings and assess their implications for future policy and practice. UR - http://mhealth.jmir.org/2015/3/e80/ UR - http://dx.doi.org/10.2196/mhealth.4388 UR - http://www.ncbi.nlm.nih.gov/pubmed/26272411 ID - info:doi/10.2196/mhealth.4388 ER - TY - JOUR AU - Ramo, E. Danielle AU - Popova, Lucy AU - Grana, Rachel AU - Zhao, Shirley AU - Chavez, Kathryn PY - 2015/08/12 TI - Cannabis Mobile Apps: A Content Analysis JO - JMIR mHealth uHealth SP - e81 VL - 3 IS - 3 KW - cell phones KW - mobile apps KW - cannabis N2 - Background: Mobile technology is pervasive and widely used to obtain information about drugs such as cannabis, especially in a climate of rapidly changing cannabis policy; yet the content of available cannabis apps is largely unknown. Understanding the resources available to those searching for cannabis apps will clarify how this technology is being used to reflect and influence cannabis use behavior. Objective: We investigated the content of 59 cannabis-related mobile apps for Apple and Android devices as of November 26, 2014. Methods: The Apple and Google Play app stores were searched using the terms ?cannabis? and ?marijuana.? Three trained coders classified the top 20 apps for each term and each store, using a coding guide. Apps were examined for the presence of 20 content codes derived by the researchers. Results: Total apps available for each search term were 124 for cannabis and 218 for marijuana in the Apple App Store, and 250 each for cannabis and marijuana on Google Play. The top 20 apps in each category in each store were coded for 59 independent apps (30 Apple, 29 Google Play). The three most common content areas were cannabis strain classification (33.9%), facts about cannabis (20.3%), and games (20.3%). In the Apple App Store, most apps were free (77%), all were rated ?17+? years, and the average user rating was 3.9/5 stars. The most popular apps provided cannabis strain classifications (50%), dispensary information (27%), or general facts about cannabis (27%). Only one app (3%) provided information or resources related to cannabis abuse, addiction, or treatment. On Google Play, most apps were free (93%), rated ?high maturity? (79%), and the average user rating was 4.1/5. The most popular app types offered games (28%), phone utilities (eg, wallpaper, clock; 21%) and cannabis food recipes (21%); no apps addressed abuse, addiction, or treatment. Conclusions: Cannabis apps are generally free and highly rated. Apps were most often informational (facts, strain classification), or recreational (games), likely reflecting and influencing the growing acceptance of cannabis for medical and recreational purposes. Apps addressing addiction or cessation were underrepresented in the most popular cannabis mobile apps. Differences among apps for Apple and Android platforms likely reflect differences in the population of users, developer choice, and platform regulations. UR - http://mhealth.jmir.org/2015/3/e81/ UR - http://dx.doi.org/10.2196/mhealth.4405 UR - http://www.ncbi.nlm.nih.gov/pubmed/26268634 ID - info:doi/10.2196/mhealth.4405 ER - TY - JOUR AU - Kenny, Rachel AU - Dooley, Barbara AU - Fitzgerald, Amanda PY - 2015/08/10 TI - Feasibility of "CopeSmart": A Telemental Health App for Adolescents JO - JMIR Mental Health SP - e22 VL - 2 IS - 3 KW - adolescents KW - emotional self-monitoring KW - feasibility KW - mobile apps KW - positive mental health N2 - Background: Early intervention is important in order to improve mental health outcomes for young people. Given the recent rise in mobile phone ownership among adolescents, an innovative means of delivering such intervention is through the use of mobile phone applications (apps). Objective: The aim of this study was to evaluate the feasibility of ?CopeSmart?, a telemental health app developed to foster positive mental health in adolescents through emotional self-monitoring and the promotion of positive coping strategies. Methods: Forty-three adolescents (88% female) aged 15-17 years downloaded the app and used it over a one-week period. They then completed self-report questionnaires containing both open-ended and closed-ended questions about their experiences of using the app. The app itself captured data related to user engagement. Results: On average participants engaged with the app on 4 of the 7 days within the intervention period. Feedback from users was reasonably positive, with 70% of participants reporting that they would use the app again and 70% reporting that they would recommend it to a friend. Thematic analysis of qualitative data identified themes pertaining to users? experiences of the app, which were both positive (eg, easy to use, attractive layout, emotional self-monitoring, helpful information, notifications, unique) and negative (eg, content issues, did not make user feel better, mood rating issues, password entry, interface issues, engagement issues, technical fixes). Conclusions: Overall findings suggest that telemental health apps have potential as a feasible medium for promoting positive mental health, with the majority of young people identifying such technologies as at least somewhat useful and displaying a moderate level of engagement with them. Future research should aim to evaluate the efficacy of such technologies as tools for improving mental health outcomes in young people. UR - http://mental.jmir.org/2015/3/e22/ UR - http://dx.doi.org/10.2196/mental.4370 UR - http://www.ncbi.nlm.nih.gov/pubmed/26552425 ID - info:doi/10.2196/mental.4370 ER - TY - JOUR AU - Sieverdes, Christopher John AU - Nemeth, S. Lynne AU - Magwood, S. Gayenell AU - Baliga, K. Prabhakar AU - Chavin, D. Kenneth AU - Brunner-Jackson, Brenda AU - Patel, K. Sachin AU - Ruggiero, J. Kenneth AU - Treiber, A. Frank PY - 2015/08/10 TI - Patient-Centered mHealth Living Donor Transplant Education Program for African Americans: Development and Analysis JO - JMIR Res Protoc SP - e84 VL - 4 IS - 3 KW - kidney transplantation KW - living donors KW - mobile apps KW - qualitative research KW - telemedicine N2 - Background: There is a critical need to expand the pool of available kidneys for African Americans who are on the transplant wait-list due to the disproportionally lower availability of deceased donor kidneys compared with other races/ethnic groups. Encouraging living donation is one method to fill this need. Incorporating mHealth strategies may be a way to deliver educational and supportive services to African American transplant-eligible patients and improve reach to those living in remote areas or unable to attend traditional group-session-based programs. Before program development, it is essential to perform formative research with target populations to determine acceptability and cultivate a patient-centered and culturally relevant approach to be used for program development. Objective: The objectives of this study were to investigate African American kidney transplant recipients? and kidney donors?/potential donors? attitudes and perceptions toward mobile technology and its viability in an mHealth program aimed at educating patients about the process of living kidney donation. Methods: Using frameworks from the technology acceptance model and self-determination theory, 9 focus groups (n=57) were administered to African Americans at a southeastern medical center, which included deceased/living donor kidney recipients and living donors/potential donors. After a demonstration of a tablet-based video education session and explanation of a group-based videoconferencing session, focus groups examined members? perceptions about how educational messages should be presented on topics pertaining to the process of living kidney donation and the transplantation. Questionnaires were administered on technology use and perceptions of the potential program communication platform. Transcripts were coded and themes were examined using NVivo 10 software. Results: Qualitative findings found 5 major themes common among all participants. These included the following: (1) strong support for mobile technology use; (2) different media formats were preferred; (3) willingness to engage in video chats, but face-to-face interaction sometimes preferred; (4) media needs to be user friendly; (5) high prevalence of technology access. Our results show that recipients were willing to spend more time on education than the donors group, they wanted to build conversation skills to approach others, and preferred getting information from many sources, whereas the donor group wanted to hear from other living donors. The questionnaires revealed 85% or more of the sample scored 4+ on a 5-point Likert scale, which indicates high degree of interest to use the proposed program, belief that other mHealth technologies would help with adherence to medical regimens, and doctors would make regimen adjustments quicker. In addition, high utilization of mobile technology was reported; 71.9% of the participants had a mobile phone and 43.9% had a tablet. Conclusions: Our study supports the use of an mHealth education platform for African Americans to learn about living donation. However, potential recipients and potential donors have differing needs, and therefore, programs should be tailored to each target audience. UR - http://www.researchprotocols.org/2015/3/e84/ UR - http://dx.doi.org/10.2196/resprot.3715 UR - http://www.ncbi.nlm.nih.gov/pubmed/26265532 ID - info:doi/10.2196/resprot.3715 ER - TY - JOUR AU - Loveday, Adam AU - Sherar, B. Lauren AU - Sanders, P. James AU - Sanderson, W. Paul AU - Esliger, W. Dale PY - 2015/08/05 TI - Technologies That Assess the Location of Physical Activity and Sedentary Behavior: A Systematic Review JO - J Med Internet Res SP - e192 VL - 17 IS - 8 KW - wearable camera KW - global positioning system KW - real-time locating system KW - sitting KW - context N2 - Background: The location in which physical activity and sedentary behavior are performed can provide valuable behavioral information, both in isolation and synergistically with other areas of physical activity and sedentary behavior research. Global positioning systems (GPS) have been used in physical activity research to identify outdoor location; however, while GPS can receive signals in certain indoor environments, it is not able to provide room- or subroom-level location. On average, adults spend a high proportion of their time indoors. A measure of indoor location would, therefore, provide valuable behavioral information. Objective: This systematic review sought to identify and critique technology which has been or could be used to assess the location of physical activity and sedentary behavior. Methods: To identify published research papers, four electronic databases were searched using key terms built around behavior, technology, and location. To be eligible for inclusion, papers were required to be published in English and describe a wearable or portable technology or device capable of measuring location. Searches were performed up to February 4, 2015. This was supplemented by backward and forward reference searching. In an attempt to include novel devices which may not yet have made their way into the published research, searches were also performed using three Internet search engines. Specialized software was used to download search results and thus mitigate the potential pitfalls of changing search algorithms. Results: A total of 188 research papers met the inclusion criteria. Global positioning systems were the most widely used location technology in the published research, followed by wearable cameras, and radio-frequency identification. Internet search engines identified 81 global positioning systems, 35 real-time locating systems, and 21 wearable cameras. Real-time locating systems determine the indoor location of a wearable tag via the known location of reference nodes. Although the type of reference node and location determination method varies between manufacturers, Wi-Fi appears to be the most popular method. Conclusions: The addition of location information to existing measures of physical activity and sedentary behavior will provide important behavioral information. UR - http://www.jmir.org/2015/8/e192/ UR - http://dx.doi.org/10.2196/jmir.4761 UR - http://www.ncbi.nlm.nih.gov/pubmed/26245157 ID - info:doi/10.2196/jmir.4761 ER - TY - JOUR AU - Appelboom, Geoff AU - Taylor, E. Blake AU - Bruce, Eliza AU - Bassile, C. Clare AU - Malakidis, Corinna AU - Yang, Annie AU - Youngerman, Brett AU - D'Amico, Randy AU - Bruce, Sam AU - Bruyère, Olivier AU - Reginster, Jean-Yves AU - Dumont, PL Emmanuel AU - Connolly Jr, Sander E. PY - 2015/07/28 TI - Mobile Phone-Connected Wearable Motion Sensors to Assess Postoperative Mobilization JO - JMIR mHealth uHealth SP - e78 VL - 3 IS - 3 KW - mobilization KW - activity tracking KW - postoperative KW - physiotherapy KW - functional recovery KW - physical therapy KW - gait KW - neurorehabilitation N2 - Background: Early mobilization after surgery reduces the incidence of a wide range of complications. Wearable motion sensors measure movements over time and transmit this data wirelessly, which has the potential to monitor patient recovery and encourages patients to engage in their own rehabilitation. Objective: We sought to determine the ability of off-the-shelf activity sensors to remotely monitor patient postoperative mobility. Methods: Consecutive subjects were recruited under the Department of Neurosurgery at Columbia University. Patients were enrolled during physical therapy sessions. The total number of steps counted by the two blinded researchers was compared to the steps recorded on four activity sensors positioned at different body locations. Results: A total of 148 motion data points were generated. The start time, end time, and duration of each walking session were accurately recorded by the devices and were remotely available for the researchers to analyze. The sensor accuracy was significantly greater when placed over the ankles than over the hips (P<.001). Our multivariate analysis showed that step length was an independent predictor of sensor accuracy. On linear regression, there was a modest positive correlation between increasing step length and increased ankle sensor accuracy (r=.640, r2=.397) that reached statistical significance on the multivariate model (P=.03). Increased gait speed also correlated with increased ankle sensor accuracy, although less strongly (r=.444, r2=.197). We did not note an effect of unilateral weakness on the accuracy of left- versus right-sided sensors. Accuracy was also affected by several specific measures of a patient?s level of physical assistance, for which we generated a model to mathematically adjust for systematic underestimation as well as disease severity. Conclusions: We provide one of the first assessments of the accuracy and utility of widely available and wirelessly connected activity sensors in a postoperative patient population. Our results show that activity sensors are able to provide invaluable information about a patient?s mobility status and can transmit this data wirelessly, although there is a systematic underestimation bias in more debilitated patients. UR - http://mhealth.jmir.org/2015/3/e78/ UR - http://dx.doi.org/10.2196/mhealth.3785 UR - http://www.ncbi.nlm.nih.gov/pubmed/26220691 ID - info:doi/10.2196/mhealth.3785 ER - TY - JOUR AU - Subhi, Yousif AU - Bube, Hjartbro Sarah AU - Rolskov Bojsen, Signe AU - Skou Thomsen, Sofia Ann AU - Konge, Lars PY - 2015/07/27 TI - Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps: A Systematic Review JO - JMIR mHealth uHealth SP - e79 VL - 3 IS - 3 KW - mHealth KW - mobile apps KW - technology N2 - Background: Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether or not app contents adhere to current medical evidence. Objective: To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Methods: We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. Results: Based on inclusion criteria, 52 studies were included in this review. These studies assessed a total of 6520 apps. Studies dealt with a variety of medical specialties and topics. As much as 28 studies assessed expert involvement, which was found in 9-67% of the assessed apps. Thirty studies (including 6 studies that also assessed expert involvement) assessed adherence of app content to current medical evidence. Thirteen studies found that 10-87% of the assessed apps adhered fully to the compared evidence (published studies, recommendations, and guidelines). Seventeen studies found that none of the assessed apps (n=2237) adhered fully to the compared evidence. Conclusions: Most medical mobile phone apps lack expert involvement and do not adhere to relevant medical evidence. UR - http://mhealth.jmir.org/2015/3/e79/ UR - http://dx.doi.org/10.2196/mhealth.4169 UR - http://www.ncbi.nlm.nih.gov/pubmed/26215371 ID - info:doi/10.2196/mhealth.4169 ER - TY - JOUR AU - Brinker, J. Titus AU - Seeger, Werner PY - 2015/07/27 TI - Photoaging Mobile Apps: A Novel Opportunity for Smoking Cessation? JO - J Med Internet Res SP - e186 VL - 17 IS - 7 KW - tobacco prevention, tobacco cessation, photoaging, mobile phone apps, apps, app, smartphones UR - http://www.jmir.org/2015/7/e186/ UR - http://dx.doi.org/10.2196/jmir.4792 UR - http://www.ncbi.nlm.nih.gov/pubmed/26215210 ID - info:doi/10.2196/jmir.4792 ER - TY - JOUR AU - Brand, Leah AU - Beltran, Alicia AU - Buday, Richard AU - Hughes, Sheryl AU - O'Connor, Teresia AU - Baranowski, Janice AU - Dadabhoy, R. Hafza AU - Diep, S. Cassandra AU - Baranowski, Tom PY - 2015/07/24 TI - Training Vegetable Parenting Practices Through a Mobile Game: Iterative Qualitative Alpha Test JO - JMIR Serious Games SP - e6 VL - 3 IS - 2 KW - mobile games KW - games for health KW - serious games KW - pediatric nutrition KW - parenting N2 - Background: Vegetable consumption protects against chronic diseases, but many young children do not eat vegetables. One quest within the mobile application Mommio was developed to train mothers of preschoolers in effective vegetable parenting practices, or ways to approach getting their child to eat and enjoy vegetables. A much earlier version of the game, then called Kiddio, was alpha tested previously, but the game has since evolved in key ways. Objective: The purpose of this research was to alpha test the first quest, substantiate earlier findings and obtain feedback on new game features to develop an effective, compelling parenting game. Methods: Mothers of preschool children (n=20) played a single quest of Mommio 2 to 4 times, immediately after which a semi-structured interview about their experience was completed. Interviews were transcribed and double coded using thematic analysis methods. Results: Mothers generally liked the game, finding it realistic and engaging. Some participants had difficulties with mechanics for moving around the 3-D environment. Tips and hints were well received, and further expansion and customization were desired. Conclusions: Earlier findings were supported, though Mommio players reported more enjoyment than Kiddio players. Continued development will include more user-friendly mechanics, customization, opportunities for environment interaction, and food parenting scenarios. UR - http://games.jmir.org/2015/2/e6/ UR - http://dx.doi.org/10.2196/games.4081 UR - http://www.ncbi.nlm.nih.gov/pubmed/26208899 ID - info:doi/10.2196/games.4081 ER - TY - JOUR AU - Thondoo, Meelan AU - Strachan, Ll Daniel AU - Nakirunda, Maureen AU - Ndima, Sozinho AU - Muiambo, Abel AU - Källander, Karin AU - Hill, Zelee AU - PY - 2015/07/23 TI - Potential Roles of Mhealth for Community Health Workers: Formative Research With End Users in Uganda and Mozambique JO - JMIR mHealth uHealth SP - e76 VL - 3 IS - 3 KW - mobile phones KW - mHealth KW - community health workers KW - motivation KW - performance N2 - Background: Community health workers are reemerging as an essential component of health systems in low-income countries. However, there are concerns that unless they are adequately supported, their motivation and performance will be suboptimal. mHealth presents an opportunity to improve support for community health workers; however, most interventions to date have been designed through a top-down approach, rarely involve the end user, and have not focused on motivation. Objective: To use formative research to explore the views of community health workers in Uganda and Mozambique on the potential role of mHealth in their work delivering integrated community case management of children. Methods: We conducted 24 in-depth interviews and 5 focus group discussions with community health workers in Uganda and Mozambique. Data were collected on: current phone use, preferred phone and charger characteristics, and perceptions of a range of potential mHealth interventions. Interviews were conducted in the local language, were audio recorded and converted into expanded notes. Interviews were coded for key thematic areas using both deductive and inductive codes. Deductive codes included mHealth?s potential impact on motivation and performance. Results: The most salient roles of mHealth in improving performance and motivation were reducing the need for travel, improving efficiency and planning, receiving feedback and information, and improving communication with supervisors and other community health workers. This was mostly through improved voice and short message service (SMS) text communication. Specific components of mHealth interventions that participants felt could improve motivation included increasing their visibility and credibility through branding of phones; providing an SMS response to data submission; and sending SMS messages about the importance of their work and achievements, rather than just reminders or technical messages. Participants identified feasibility issues related to the language of SMS messages, network coverage, and the need for a balance between phone function and battery life. Phones with a dual SIM cards would ameliorate network problems but would reduce battery life. The provision of a solar charger was viewed as beneficial. Conclusions: Conducting formative research with end users is likely to improve mHealth interventions by: (1) identifying interventions that are likely to have the greatest impact and be the most acceptable, (2) developing salient SMS messages, and (3) identifying feasibility issues. mHealth interventions also could have an important impact on health worker motivation, which should be considered by intervention developers and in evaluations, especially as small modifications could have a significant impact. Our study suggests that using phones to improve direct communication should be considered, even when planners aim to focus on the provision of a specific application. UR - http://mhealth.jmir.org/2015/3/e76/ UR - http://dx.doi.org/10.2196/mhealth.4208 UR - http://www.ncbi.nlm.nih.gov/pubmed/26206419 ID - info:doi/10.2196/mhealth.4208 ER - TY - JOUR AU - Frederix, Ines AU - Hansen, Dominique AU - Coninx, Karin AU - Vandervoort, Pieter AU - Vandijck, Dominique AU - Hens, Niel AU - Van Craenenbroeck, Emeline AU - Van Driessche, Niels AU - Dendale, Paul PY - 2015/07/23 TI - Medium-Term Effectiveness of a Comprehensive Internet-Based and Patient-Specific Telerehabilitation Program With Text Messaging Support for Cardiac Patients: Randomized Controlled Trial JO - J Med Internet Res SP - e185 VL - 17 IS - 7 KW - telemedicine KW - eHealth KW - effectiveness KW - Internet N2 - Background: Cardiac telerehabilitation has been introduced as an adjunct or alternative to conventional center-based cardiac rehabilitation to increase its long-term effectiveness. However, before large-scale implementation and reimbursement in current health care systems is possible, well-designed studies on the effectiveness of this new additional treatment strategy are needed. Objective: The aim of this trial was to assess the medium-term effectiveness of an Internet-based, comprehensive, and patient-tailored telerehabilitation program with short message service (SMS) texting support for cardiac patients. Methods: This multicenter randomized controlled trial consisted of 140 cardiac rehabilitation patients randomized (1:1) to a 24-week telerehabilitation program in combination with conventional cardiac rehabilitation (intervention group; n=70) or to conventional cardiac rehabilitation alone (control group; n=70). In the telerehabilitation program, initiated 6 weeks after the start of ambulatory rehabilitation, patients were stimulated to increase physical activity levels. Based on registered activity data, they received semiautomatic telecoaching via email and SMS text message encouraging them to gradually achieve predefined exercise training goals. Patient-specific dietary and/or smoking cessation advice was also provided as part of the telecoaching. The primary endpoint was peak aerobic capacity (VO2 peak). Secondary endpoints included accelerometer-recorded daily step counts, self-assessed physical activities by International Physical Activity Questionnaire (IPAQ), and health-related quality of life (HRQL) assessed by the HeartQol questionnaire at baseline and at 6 and 24 weeks. Results: Mean VO2 peak increased significantly in intervention group patients (n=69) from baseline (mean 22.46, SD 0.78 mL/[min*kg]) to 24 weeks (mean 24.46, SD 1.00 mL/[min*kg], P<.01) versus control group patients (n=70), who did not change significantly (baseline: mean 22.72, SD 0.74 mL/[min*kg]; 24 weeks: mean 22.15, SD 0.77 mL/[min*kg], P=.09). Between-group analysis of aerobic capacity confirmed a significant difference between the intervention group and control group in favor of the intervention group (P<.001). At 24 weeks, self-reported physical activity improved more in the intervention group compared to the control group (P=.01) as did the global HRQL score (P=.01). Conclusions: This study showed that an additional 6-month patient-specific, comprehensive telerehabilitation program can lead to a bigger improvement in both physical fitness (VO2 peak) and associated HRQL compared to center-based cardiac rehabilitation alone. These results are supportive in view of possible future implementation in standard cardiac care. UR - http://www.jmir.org/2015/7/e185/ UR - http://dx.doi.org/10.2196/jmir.4799 UR - http://www.ncbi.nlm.nih.gov/pubmed/26206311 ID - info:doi/10.2196/jmir.4799 ER - TY - JOUR AU - Lane, S. Taylor AU - Armin, Julie AU - Gordon, S. Judith PY - 2015/07/22 TI - Online Recruitment Methods for Web-Based and Mobile Health Studies: A Review of the Literature JO - J Med Internet Res SP - e183 VL - 17 IS - 7 KW - mHealth KW - Internet health KW - online recruitment KW - apps KW - social media KW - review N2 - Background: Internet and mobile health (mHealth) apps hold promise for expanding the reach of evidence-based health interventions. Research in this area is rapidly expanding. However, these studies may experience problems with recruitment and retention. Web-based and mHealth studies are in need of a wide-reaching and low-cost method of recruitment that will also effectively retain participants for the duration of the study. Online recruitment may be a low-cost and wide-reaching tool in comparison to traditional recruitment methods, although empirical evidence is limited. Objective: This study aims to review the literature on online recruitment for, and retention in, mHealth studies. Methods: We conducted a review of the literature of studies examining online recruitment methods as a viable means of obtaining mHealth research participants. The data sources used were PubMed, CINAHL, EbscoHost, PyscINFO, and MEDLINE. Studies reporting at least one method of online recruitment were included. A narrative approach enabled the authors to discuss the variability in recruitment results, as well as in recruitment duration and study design. Results: From 550 initial publications, 12 studies were included in this review. The studies reported multiple uses and outcomes for online recruitment methods. Web-based recruitment was the only type of recruitment used in 67% (8/12) of the studies. Online recruitment was used for studies with a variety of health domains: smoking cessation (58%; 7/12) and mental health (17%; 2/12) being the most common. Recruitment duration lasted under a year in 67% (8/12) of the studies, with an average of 5 months spent on recruiting. In those studies that spent over a year (33%; 4/12), an average of 17 months was spent on recruiting. A little less than half (42%; 5/12) of the studies found Facebook ads or newsfeed posts to be an effective method of recruitment, a quarter (25%; 3/12) of the studies found Google ads to be the most effective way to reach participants, and one study showed better outcomes with traditional (eg in-person) methods of recruitment. Only one study recorded retention rates in their results, and half (50%; 6/12) of the studies recorded survey completion rates. Conclusions: Although online methods of recruitment may be promising in experimental research, more empirical evidence is needed to make specific recommendations. Several barriers to using online recruitment were identified, including participant retention. These unique challenges of virtual interventions can affect the generalizability and validity of findings from Web-based and mHealth studies. There is a need for additional research to evaluate the effectiveness of online recruitment methods and participant retention in experimental mHealth studies. UR - http://www.jmir.org/2015/7/e183/ UR - http://dx.doi.org/10.2196/jmir.4359 UR - http://www.ncbi.nlm.nih.gov/pubmed/26202991 ID - info:doi/10.2196/jmir.4359 ER - TY - JOUR AU - Levy, Natalie AU - Moynihan, Victoria AU - Nilo, Annielyn AU - Singer, Karyn AU - Bernik, S. Lidia AU - Etiebet, Mary-Ann AU - Fang, Yixin AU - Cho, James AU - Natarajan, Sundar PY - 2015/07/17 TI - The Mobile Insulin Titration Intervention (MITI) for Insulin Adjustment in an Urban, Low-Income Population: Randomized Controlled Trial JO - J Med Internet Res SP - e180 VL - 17 IS - 7 KW - patient-centered care KW - health care disparities KW - telemedicine KW - remote consultation KW - cell phones KW - insulin, long-acting KW - text messaging N2 - Background: Diabetes patients are usually started on a low dose of insulin and their dose is adjusted or ?titrated? according to their blood glucose levels. Insulin titration administered through face-to-face visits with a clinician can be time consuming and logistically burdensome for patients, especially those of low socioeconomic status (SES). Given the wide use of mobile phones among this population, there is the potential to use short message service (SMS) text messaging and phone calls to perform insulin titration remotely. Objective: The goals of this pilot study were to (1) evaluate if our Mobile Insulin Titration Intervention (MITI) intervention using text messaging and phone calls was effective in helping patients reach their optimal insulin glargine dose within 12 weeks, (2) assess the feasibility of the intervention within our clinic setting and patient population, (3) collect data on the cost savings associated with the intervention, and (4) measure patient satisfaction with the intervention. Methods: This was a pilot study evaluating an intervention for patients requiring insulin glargine titration in the outpatient medical clinic of Bellevue Hospital Center in New York City. Patients in the intervention arm received weekday SMS text messages from a health management platform requesting their fasting blood glucose values. The clinic?s diabetes nurse educator monitored the texted responses on the platform website each weekday for alarm values. Once a week, the nurse reviewed the glucose values, consulted the MITI titration algorithm, and called patients to adjust their insulin dose. Patients in the usual care arm continued to receive their standard clinic care for insulin titration. The primary outcome was whether a patient reached his/her optimal insulin glargine dose within 12 weeks. Results: A total of 61 patients consented and were randomized into the study. A significantly greater proportion of patients in the intervention arm reached their optimal insulin glargine dose than patients in the usual care arm (88%, 29/33 vs 37%, 10/27; P<.001). Patients responded to 84.3% (420/498) of the SMS text messages requesting their blood glucose values. The nurse reached patients within 2 attempts or by voicemail 91% of the time (90/99 assigned calls). When patients traveled to the clinic, they spent a median of 45 minutes (IQR 30-60) on travel and 39 minutes (IQR 30-64) waiting prior to appointments. A total of 61% (37/61) of patients had appointment copays. After participating in the study, patients in the intervention arm reported higher treatment satisfaction than those in the usual care arm. Conclusions: MITI is an effective way to help low-SES patients reach their optimal insulin glargine dose using basic SMS text messaging and phone calls. The intervention was feasible and patients were highly satisfied with their treatment. The intervention was cost saving in terms of time for patients, who were able to have their insulin titrated without multiple clinic appointments. Similar interventions should be explored to improve care for low-SES patients managing chronic disease. Trial Registration: Clinicaltrials.gov NCT01879579; https://clinicaltrials.gov/ct2/show/NCT01879579 (Archived by WebCite at http://www.webcitation.org/6YZik33L3). UR - http://www.jmir.org/2015/7/e180/ UR - http://dx.doi.org/10.2196/jmir.4716 UR - http://www.ncbi.nlm.nih.gov/pubmed/26187303 ID - info:doi/10.2196/jmir.4716 ER - TY - JOUR AU - Babson, A. Kimberly AU - Ramo, E. Danielle AU - Baldini, Lisa AU - Vandrey, Ryan AU - Bonn-Miller, O. Marcel PY - 2015/07/17 TI - Mobile App-Delivered Cognitive Behavioral Therapy for Insomnia: Feasibility and Initial Efficacy Among Veterans With Cannabis Use Disorders JO - JMIR Res Protoc SP - e87 VL - 4 IS - 3 KW - cannabis KW - marijuana KW - sleep KW - CBT-I KW - intervention N2 - Background: Cannabis is the most frequently used illicit substance in the United States resulting in high rates of cannabis use disorders. Current treatments for cannabis use are often met with high rates of lapse/relapse, tied to (1) behavioral health factors that impact cannabis use such as poor sleep, and (2) access, stigma, supply, and cost of receiving a substance use intervention. Objective: This pilot study examined the feasibility, usability, and changes in cannabis use and sleep difficulties following mobile phone?delivered Cognitive Behavioral Therapy for Insomnia (CBT-I) in the context of a cannabis cessation attempt. Methods: Four male veterans with DSM-5 cannabis use disorder and sleep problems were randomized to receive a 2-week intervention: CBT-I Coach mobile app (n=2) or a placebo control (mood-tracking app) (n=2). Cannabis and sleep measures were assessed pre- and post-treatment. Participants also reported use and helpfulness of each app. Changes in sleep and cannabis use were evaluated for each participant individually. Results: Both participants receiving CBT-I used the app daily over 2 weeks and found the app user-friendly, helpful, and would use it in the future. In addition, they reported decreased cannabis use and improved sleep efficiency; one also reported increased sleep quality. In contrast, one participant in the control group dropped out of the study, and the other used the app minimally and reported increased sleep quality but also increased cannabis use. The mood app was rated as not helpful, and there was low likelihood of future participation. Conclusions: This pilot study examined the feasibility and initial patient acceptance of mobile phone delivery of CBT-I for cannabis dependence. Positive ratings of the app and preliminary reports of reductions in cannabis use and improvements in sleep are both encouraging and support additional evaluation of this intervention. UR - http://www.researchprotocols.org/2015/3/e87/ UR - http://dx.doi.org/10.2196/resprot.3852 UR - http://www.ncbi.nlm.nih.gov/pubmed/26187404 ID - info:doi/10.2196/resprot.3852 ER - TY - JOUR AU - Saeb, Sohrab AU - Zhang, Mi AU - Karr, J. Christopher AU - Schueller, M. Stephen AU - Corden, E. Marya AU - Kording, P. Konrad AU - Mohr, C. David PY - 2015/07/15 TI - Mobile Phone Sensor Correlates of Depressive Symptom Severity in Daily-Life Behavior: An Exploratory Study JO - J Med Internet Res SP - e175 VL - 17 IS - 7 KW - depression KW - mobile health (mHealth) KW - activities of daily living KW - cluster analysis KW - classification N2 - Background: Depression is a common, burdensome, often recurring mental health disorder that frequently goes undetected and untreated. Mobile phones are ubiquitous and have an increasingly large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms. Objective: The objective of this study was to explore the detection of daily-life behavioral markers using mobile phone global positioning systems (GPS) and usage sensors, and their use in identifying depressive symptom severity. Methods: A total of 40 adult participants were recruited from the general community to carry a mobile phone with a sensor data acquisition app (Purple Robot) for 2 weeks. Of these participants, 28 had sufficient sensor data received to conduct analysis. At the beginning of the 2-week period, participants completed a self-reported depression survey (PHQ-9). Behavioral features were developed and extracted from GPS location and phone usage data. Results: A number of features from GPS data were related to depressive symptom severity, including circadian movement (regularity in 24-hour rhythm; r=-.63, P=.005), normalized entropy (mobility between favorite locations; r=-.58, P=.012), and location variance (GPS mobility independent of location; r=-.58, P=.012). Phone usage features, usage duration, and usage frequency were also correlated (r=.54, P=.011, and r=.52, P=.015, respectively). Using the normalized entropy feature and a classifier that distinguished participants with depressive symptoms (PHQ-9 score ?5) from those without (PHQ-9 score <5), we achieved an accuracy of 86.5%. Furthermore, a regression model that used the same feature to estimate the participants? PHQ-9 scores obtained an average error of 23.5%. Conclusions: Features extracted from mobile phone sensor data, including GPS and phone usage, provided behavioral markers that were strongly related to depressive symptom severity. While these findings must be replicated in a larger study among participants with confirmed clinical symptoms, they suggest that phone sensors offer numerous clinical opportunities, including continuous monitoring of at-risk populations with little patient burden and interventions that can provide just-in-time outreach. UR - http://www.jmir.org/2015/7/e175/ UR - http://dx.doi.org/10.2196/jmir.4273 UR - http://www.ncbi.nlm.nih.gov/pubmed/26180009 ID - info:doi/10.2196/jmir.4273 ER - TY - JOUR AU - Hong, Alicia Yan AU - Goldberg, Daniel AU - Ory, G. Marcia AU - Towne Jr, D. Samuel AU - Forjuoh, N. Samuel AU - Kellstedt, Debra AU - Wang, Suojin PY - 2015/6/26 TI - Efficacy of a Mobile-Enabled Web App (iCanFit) in Promoting Physical Activity Among Older Cancer Survivors: A Pilot Study JO - JMIR Cancer SP - e7 VL - 1 IS - 1 KW - physical activity KW - mobile health KW - older adults KW - cancer survivors KW - iCanFit KW - pilot N2 - Background: The benefits of physical activity for cancer survivors are well documented. However, few older cancer survivors are engaged in regular physical activity. Mobile technologies may be an effective method to deliver physical activity promotion programs for older cancer survivors. iCanFit, a mobile-enabled Web-based app, was developed based on formative research and usability testing. This app includes interactive features of physical activity, goal setting and tracking, and receiving personalized visual feedback. Objective: The aim of this study is to pilot test the initial efficacy of iCanFit. Methods: Older cancer survivors (N=30) were recruited online through our collaborative partnership with a cancer survivor's organization. After the participants completed an online baseline survey, they were asked to use the iCanFit website. Instructional videos on how to use the web app were available on the website. Participants were asked to complete a follow-up survey 2-3 months later. Participants? physical activity, quality of life, and their experience with iCanFit were measured. Results: A total of 30 participants completed the baseline survey, and 26 of them (87%, 26/30) also completed a follow-up survey 2-3 months later. The median age of participants was 69 years (range 60-78). Participants? quality of life and engagement in regular physical activity improved significantly after the use of iCanFit. Participants indicated a general affinity towards the key function ?Goals? in iCanFit, which motivated continued activity. They also provided suggestions to further improve the app (eg, adding a reminder functionality, easier or alternative ways of entering activities). Conclusion: The interactive Web-based app iCanFit has demonstrated initial efficacy. Even though our study was limited by a small sample size, convenience sampling, and a short follow-up period, results suggest that using mobile tools to promote physical activity and healthy living among older cancer survivors holds promise. Next steps include refining iCanFit based on users? feedback and developing versatile functionality to allow easier physical activity goal setting and tracking. We also call for more studies on developing and evaluating mobile and web apps for older cancer survivors. UR - http://cancer.jmir.org/2015/1/e7/ UR - http://dx.doi.org/10.2196/cancer.4389 UR - http://www.ncbi.nlm.nih.gov/pubmed/28410158 ID - info:doi/10.2196/cancer.4389 ER - TY - JOUR AU - Blocker, Oliver AU - Hayden, Lydia AU - Bullock, Alison PY - 2015/6/26 TI - Doctors and the Etiquette of Mobile Device Use in Trauma and Orthopedics JO - JMIR mHealth uHealth SP - e71 VL - 3 IS - 2 KW - education, medical KW - cell phones KW - patient-physician relationship N2 - Background: The etiquette surrounding the use of mobile devices, so-called "mobiquette," has been previously identified as a barrier to use in an educational context. Objective: To investigate the influence of mobile device use on patient and staff opinions in the trauma and orthopedics department at a teaching hospital in Wales. Methods: A survey of patients at the bedside and staff in their work environment was undertaken. Data included age, frequency of observed use, suspected main reason for use, and whether doctors? use of a mobile device positively or negatively influenced participants' opinions of them as a professional and as a person. Results: A total of 59 patients and 35 staff responded. The modal age range was 40 to 54 years old. Most patients (78%) never see doctors using mobile devices in the workplace, compared with 3% of staff. The main reason for use was thought to be "communicating with colleagues" (48%) followed by "Internet use/applications for work reasons" (40%). Approximately 40% of patients' opinions of doctors were positively influenced by device use, compared with 82% of staff. This difference between patient and staff opinions was statistically significant for both professional (P<.001) and personal (P=.002) opinions. Conclusions: Patients are likely to have a negative opinion of doctors using mobile devices in the workplace. This can be balanced by the more positive opinions of colleagues. We advise doctors to remember "mobiquette" around patients. UR - http://mhealth.jmir.org/2015/2/e71/ UR - http://dx.doi.org/10.2196/mhealth.4122 UR - http://www.ncbi.nlm.nih.gov/pubmed/26116061 ID - info:doi/10.2196/mhealth.4122 ER - TY - JOUR AU - Genz, Andrew AU - Kirk, Gregory AU - Piggott, Damani AU - Mehta, H. Shruti AU - Linas, S. Beth AU - Westergaard, P. Ryan PY - 2015/6/25 TI - Uptake and Acceptability of Information and Communication Technology in a Community-Based Cohort of People Who Inject Drugs: Implications for Mobile Health Interventions JO - JMIR mHealth uHealth SP - e70 VL - 3 IS - 2 KW - substance abuse KW - intravenous KW - Internet KW - cellular phone KW - text messaging KW - telemedicine N2 - Background: Mobile phone and Internet-based technologies are increasingly used to disseminate health information and facilitate delivery of medical care. While these strategies hold promise for reducing barriers to care for medically-underserved populations, their acceptability among marginalized populations such as people who inject drugs is not well-understood. Objective: To understand patterns of mobile phone ownership, Internet use and willingness to receive health information via mobile devices among people who inject drugs. Methods: We surveyed current and former drug injectors participating in a longitudinal cohort study in Baltimore, Maryland, USA. Respondents completed a 12-item, interviewer-administered questionnaire during a regular semi-annual study visit that assessed their use of mobile technology and preferred modalities of receiving health information. Using data from the parent study, we used logistic regression to evaluate associations among participants? demographic and clinical characteristics and their mobile phone and Internet use. Results: The survey was completed by 845 individuals, who had a median age of 51 years. The sample was 89% African-American, 65% male, and 33% HIV-positive. Participants were generally of low education and income levels. Fewer than half of respondents (40%) indicated they had ever used the Internet. Mobile phones were used by 86% of respondents. Among mobile phone owners, 46% had used their phone for text messaging and 25% had accessed the Internet on their phone. A minority of respondents (42%) indicated they would be interested in receiving health information via phone or Internet. Of those receptive to receiving health information, a mobile phone call was the most favored modality (66%) followed by text messaging (58%) and Internet (51%). Conclusions: Utilization of information and communication technology among this cohort of people who inject drugs was reported at a lower level than what has been estimated for the general U.S. population. Our findings identify a potential barrier to successful implementation of mobile health and Internet-based interventions for people who inject drugs, particularly those who are older and have lower levels of income and educational attainment. As mobile communication technology continues to expand, future studies should re-examine whether mHealth applications become more accessible and accepted by socioeconomically disadvantaged groups. UR - http://mhealth.jmir.org/2015/2/e70/ UR - http://dx.doi.org/10.2196/mhealth.3437 UR - http://www.ncbi.nlm.nih.gov/pubmed/26111915 ID - info:doi/10.2196/mhealth.3437 ER - TY - JOUR AU - Nazneen, Nazneen AU - Rozga, Agata AU - Smith, J. Christopher AU - Oberleitner, Ron AU - Abowd, D. Gregory AU - Arriaga, I. Rosa PY - 2015/06/17 TI - A Novel System for Supporting Autism Diagnosis Using Home Videos: Iterative Development and Evaluation of System Design JO - JMIR mHealth uHealth SP - e68 VL - 3 IS - 2 KW - asynchronous telemedicine system KW - in-home behavior recording KW - naturalistic observation diagnostic assessment KW - NODA Connect KW - NODA smartCapture KW - remote autism diagnosis N2 - Background: Observing behavior in the natural environment is valuable to obtain an accurate and comprehensive assessment of a child?s behavior, but in practice it is limited to in-clinic observation. Research shows significant time lag between when parents first become concerned and when the child is finally diagnosed with autism. This lag can delay early interventions that have been shown to improve developmental outcomes. Objective: To develop and evaluate the design of an asynchronous system that allows parents to easily collect clinically valid in-home videos of their child?s behavior and supports diagnosticians in completing diagnostic assessment of autism. Methods: First, interviews were conducted with 11 clinicians and 6 families to solicit feedback from stakeholders about the system concept. Next, the system was iteratively designed, informed by experiences of families using it in a controlled home-like experimental setting and a participatory design process involving domain experts. Finally, in-field evaluation of the system design was conducted with 5 families of children (4 with previous autism diagnosis and 1 child typically developing) and 3 diagnosticians. For each family, 2 diagnosticians, blind to the child?s previous diagnostic status, independently completed an autism diagnosis via our system. We compared the outcome of the assessment between the 2 diagnosticians, and between each diagnostician and the child?s previous diagnostic status. Results: The system that resulted through the iterative design process includes (1) NODA smartCapture, a mobile phone-based application for parents to record prescribed video evidence at home; and (2) NODA Connect, a Web portal for diagnosticians to direct in-home video collection, access developmental history, and conduct an assessment by linking evidence of behaviors tagged in the videos to the Diagnostic and Statistical Manual of Mental Disorders criteria. Applying clinical judgment, the diagnostician concludes a diagnostic outcome. During field evaluation, without prior training, parents easily (average rating of 4 on a 5-point scale) used the system to record video evidence. Across all in-home video evidence recorded during field evaluation, 96% (26/27) were judged as clinically useful, for performing an autism diagnosis. For 4 children (3 with autism and 1 typically developing), both diagnosticians independently arrived at the correct diagnostic status (autism versus typical). Overall, in 91% of assessments (10/11) via NODA Connect, diagnosticians confidently (average rating 4.5 on a 5-point scale) concluded a diagnostic outcome that matched with the child?s previous diagnostic status. Conclusions: The in-field evaluation demonstrated that the system?s design enabled parents to easily record clinically valid evidence of their child?s behavior, and diagnosticians to complete a diagnostic assessment. These results shed light on the potential for appropriately designed telehealth technology to support clinical assessments using in-home video captured by families. This assessment model can be readily generalized to other conditions where direct observation of behavior plays a central role in the assessment process. UR - http://mhealth.jmir.org/2015/2/e68/ UR - http://dx.doi.org/10.2196/mhealth.4393 UR - http://www.ncbi.nlm.nih.gov/pubmed/26085230 ID - info:doi/10.2196/mhealth.4393 ER - TY - JOUR AU - Yang, Cui AU - Linas, Beth AU - Kirk, Gregory AU - Bollinger, Robert AU - Chang, Larry AU - Chander, Geetanjali AU - Siconolfi, Daniel AU - Braxton, Sharif AU - Rudolph, Abby AU - Latkin, Carl PY - 2015/06/17 TI - Feasibility and Acceptability of Smartphone-Based Ecological Momentary Assessment of Alcohol Use Among African American Men Who Have Sex With Men in Baltimore JO - JMIR mHealth uHealth SP - e67 VL - 3 IS - 2 KW - ecological momentary assessment (EMA) KW - alcohol use KW - HIV KW - African American KW - men who have sex with men (MSM) N2 - Background: Alcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who have sex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better understanding of the social and structural context of alcohol use and its relationship with HIV-related risk behaviors in this population as well as other highly stigmatized populations. Objective: We describe the study design and the implementation, feasibility, reactivity, and acceptability of an EMA study of alcohol use and HIV-related behaviors among African American MSM in Baltimore. Methods: Participants were recruited through flyers and word-of-mouth in Baltimore from September 2013 to November 2014. Each participant was loaned an Android smartphone and instructed to respond to multiple prompts from the mobile app for 4 weeks. Data were collected through (1) random prompts delivered three times daily assessing participants? location, activity, mood, and social context, (2) daily prompts capturing drinking and sex events occurring in the past 24 hours, and (3) event-contingent responses collecting participants? self-reported episodes of drinking. Results: A total of 16 participants enrolled in the study. The current analyses focused on 15 participants who completed at least 24 days of follow-up (mean follow-up time 29 days; range 24-35 days). Study participants (N=15) were a median 38 years of age (range 27-62 years) with low levels of income and educational attainment. Ten individuals self-reported living with HIV/AIDS, over half reported drinking alcohol at least 2-3 times a week, and a third reported binge drinking (ie, 6 or more drinks on one occasion) on a weekly basis. Based on the Alcohol Use Disorders Identification Test (AUDIT) score, nearly half were classified as hazardous drinkers (score 8-15) and a fifth were likely dependent (score ?16). A total of 140 participant-initiated events were reported, and 75% of 1308 random prompts and 81% of 436 daily prompts delivered were answered. Of seven devices used during the study, five were reported lost by participants. We did not observe strong reactivity effects, and self-reported acceptability to study procedures was uniformly favorable. Conclusions: This study provides evidence to support the feasibility and acceptability of using EMA methods for collecting data on alcohol use among African American men who have sex with men living in urban settings. These data provide the basis for future studies of EMA-informed mHealth interventions to promote the reduction of substance use and HIV risk-taking behaviors among African American MSM living in urban settings. UR - http://mhealth.jmir.org/2015/2/e67/ UR - http://dx.doi.org/10.2196/mhealth.4344 UR - http://www.ncbi.nlm.nih.gov/pubmed/26085078 ID - info:doi/10.2196/mhealth.4344 ER - TY - JOUR AU - Karhula, Tuula AU - Vuorinen, Anna-Leena AU - Rääpysjärvi, Katja AU - Pakanen, Mira AU - Itkonen, Pentti AU - Tepponen, Merja AU - Junno, Ulla-Maija AU - Jokinen, Tapio AU - van Gils, Mark AU - Lähteenmäki, Jaakko AU - Kohtamäki, Kari AU - Saranummi, Niilo PY - 2015/06/17 TI - Telemonitoring and Mobile Phone-Based Health Coaching Among Finnish Diabetic and Heart Disease Patients: Randomized Controlled Trial JO - J Med Internet Res SP - e153 VL - 17 IS - 6 KW - health coaching KW - telemonitoring KW - type 2 diabetes KW - heart disease KW - personal health record KW - health-related quality of life N2 - Background: There is a strong will and need to find alternative models of health care delivery driven by the ever-increasing burden of chronic diseases. Objective: The purpose of this 1-year trial was to study whether a structured mobile phone-based health coaching program, which was supported by a remote monitoring system, could be used to improve the health-related quality of life (HRQL) and/or the clinical measures of type 2 diabetes and heart disease patients. Methods: A randomized controlled trial was conducted among type 2 diabetes patients and heart disease patients of the South Karelia Social and Health Care District. Patients were recruited by sending invitations to randomly selected patients using the electronic health records system. Health coaches called patients every 4 to 6 weeks and patients were encouraged to self-monitor their weight, blood pressure, blood glucose (diabetics), and steps (heart disease patients) once per week. The primary outcome was HRQL measured by the Short Form (36) Health Survey (SF-36) and glycosylated hemoglobin (HbA1c) among diabetic patients. The clinical measures assessed were blood pressure, weight, waist circumference, and lipid levels. Results: A total of 267 heart patients and 250 diabetes patients started in the trial, of which 246 and 225 patients concluded the end-point assessments, respectively. Withdrawal from the study was associated with the patients? unfamiliarity with mobile phones?of the 41 dropouts, 85% (11/13) of the heart disease patients and 88% (14/16) of the diabetes patients were familiar with mobile phones, whereas the corresponding percentages were 97.1% (231/238) and 98.6% (208/211), respectively, among the rest of the patients (P=.02 and P=.004). Withdrawal was also associated with heart disease patients? comorbidities?40% (8/20) of the dropouts had at least one comorbidity, whereas the corresponding percentage was 18.9% (47/249) among the rest of the patients (P=.02). The intervention showed no statistically significant benefits over the current practice with regard to health-related quality of life?heart disease patients: beta=0.730 (P=.36) for the physical component score and beta=-0.608 (P=.62) for the mental component score; diabetes patients: beta=0.875 (P=.85) for the physical component score and beta=-0.770 (P=.52) for the mental component score. There was a significant difference in waist circumference in the type 2 diabetes group (beta=-1.711, P=.01). There were no differences in any other outcome variables. Conclusions: A health coaching program supported with telemonitoring did not improve heart disease patients' or diabetes patients' quality of life or their clinical condition. There were indications that the intervention had a differential effect on heart patients and diabetes patients. Diabetes patients may be more prone to benefit from this kind of intervention. This should not be neglected when developing new ways for self-management of chronic diseases. Trial Registration: ClinicalTrials.gov NCT01310491; http://clinicaltrials.gov/ct2/show/NCT01310491 (Archived by WebCite at http://www.webcitation.org/6Z8l5FwAM). UR - http://www.jmir.org/2015/6/e153/ UR - http://dx.doi.org/10.2196/jmir.4059 UR - http://www.ncbi.nlm.nih.gov/pubmed/26084979 ID - info:doi/10.2196/jmir.4059 ER - TY - JOUR AU - Partridge, R. Stephanie AU - McGeechan, Kevin AU - Hebden, Lana AU - Balestracci, Kate AU - Wong, TY Annette AU - Denney-Wilson, Elizabeth AU - Harris, F. Mark AU - Phongsavan, Philayrath AU - Bauman, Adrian AU - Allman-Farinelli, Margaret PY - 2015/06/15 TI - Effectiveness of a mHealth Lifestyle Program With Telephone Support (TXT2BFiT) to Prevent Unhealthy Weight Gain in Young Adults: Randomized Controlled Trial JO - JMIR mHealth uHealth SP - e66 VL - 3 IS - 2 KW - young adults KW - weight gain prevention KW - lifestyle behavior KW - mHealth N2 - Background: Weight gained in young adulthood often persists throughout later life with associated chronic disease risk. Despite this, current population prevention strategies are not specifically designed for young adults. Objective: We designed and assessed the efficacy of an mHealth prevention program, TXT2BFiT, in preventing excess weight gain and improving dietary and physical activity behaviors in young adults at increased risk of obesity and unhealthy lifestyle choices. Methods: A two-arm, parallel-group randomized controlled trial was conducted. Subjects and analyzing researchers were blinded. A total of 250 18- to 35-year-olds with a high risk of weight gain, a body mass index (BMI) of 23.0 to 24.9 kg/m2 with at least 2 kg of weight gain in the previous 12 months, or a BMI of 25.0 to 31.9 kg/m2 were randomized to the intervention or control group. In the 12-week intervention period, the intervention group received 8 text messages weekly based on the transtheoretical model of behavior change, 1 email weekly, 5 personalized coaching calls, a diet booklet, and access to resources and mobile phone apps on a website. Control group participants received only 4 text messages and printed dietary and physical activity guidelines. Measured body weight and height were collected at baseline and at 12 weeks. Outcomes were assessed via online surveys at baseline and at 12 weeks, including self-reported weight and dietary and physical activity measures. Results: A total of 214 participants?110 intervention and 104 control?completed the 12-week intervention period. A total of 10 participants out of 250 (4.0%)?10 intervention and 0 control?dropped out, and 26 participants (10.4%)?5 intervention and 21 control?did not complete postintervention online surveys. Adherence to coaching calls and delivery of text messages was over 90%. At 12 weeks, the intervention group were 2.2 kg (95% CI 0.8-3.6) lighter than controls (P=.005). Intervention participants consumed more vegetables (P=.009), fewer sugary soft drinks (P=.002), and fewer energy-dense takeout meals (P=.001) compared to controls. They also increased their total physical activity by 252.5 MET-minutes (95% CI 1.2-503.8, P=.05) and total physical activity by 1.3 days (95% CI 0.5-2.2, P=.003) compared to controls. Conclusions: The TXT2BFiT low-intensity intervention was successful in preventing weight gain with modest weight loss and improvement in lifestyle behaviors among overweight young adults. The short-term success of the 12-week intervention period shows potential. Maintenance of the behavior change will be monitored at 9 months. Trial Registration: Trial Registration: The Australian New Zealand Clinical Trials Registry ACTRN12612000924853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000924853 (Archived by WebCite at http://www.webcitation.org/6Z6w9LlS9). UR - http://mhealth.jmir.org/2015/2/e66/ UR - http://dx.doi.org/10.2196/mhealth.4530 UR - http://www.ncbi.nlm.nih.gov/pubmed/26076688 ID - info:doi/10.2196/mhealth.4530 ER - TY - JOUR AU - Merchán-Baeza, Antonio Jose AU - González-Sánchez, Manuel AU - Cuesta-Vargas, Antonio PY - 2015/06/11 TI - Mobile Functional Reach Test in People Who Suffer Stroke: A Pilot Study JO - JMIR Rehabil Assist Technol SP - e6 VL - 2 IS - 1 KW - mobile health KW - reliability and validity KW - elderly KW - stroke KW - postural balance N2 - Background: Postural instability is one of the major complications found in people who survive a stroke. Parameterizing the Functional Reach Test (FRT) could be useful in clinical practice and basic research, as this test is a clinically accepted tool (for its simplicity, reliability, economy, and portability) to measure the semistatic balance of a subject. Objective: The aim of this study is to analyze the reliability in the FRT parameterization using inertial sensor within mobile phones (mobile sensors) for recording kinematic variables in patients who have suffered a stroke. Our hypothesis is that the sensors in mobile phones will be reliable instruments for kinematic study of the FRT. Methods: This is a cross-sectional study of 7 subjects over 65 years of age who suffered a stroke. During the execution of FRT, the subjects carried two mobile phones: one placed in the lumbar region and the other one on the trunk. After analyzing the data obtained in the kinematic registration by the mobile sensors, a number of direct and indirect variables were obtained. The variables extracted directly from FRT through the mobile sensors were distance, maximum angular lumbosacral/thoracic displacement, time for maximum angular lumbosacral/thoracic displacement, time of return to the initial position, and total time. Using these data, we calculated speed and acceleration of each. A descriptive analysis of all kinematic outcomes recorded by the two mobile sensors (trunk and lumbar) was developed and the average range achieved in the FRT. Reliability measures were calculated by analyzing the internal consistency of the measures with 95% confidence interval of each outcome variable. We calculated the reliability of mobile sensors in the measurement of the kinematic variables during the execution of the FRT. Results: The values in the FRT obtained in this study (2.49 cm, SD 13.15) are similar to those found in other studies with this population and with the same age range. Intrasubject reliability values observed in the use of mobile phones are all located above 0.831, ranging from 0.831 (time B_C trunk area) and 0.894 (displacement A_B trunk area). Likewise, the observed intersubject values range from 0.835 (time B_C trunk area) and 0.882 (displacement A_C trunk area). On the other hand, the reliability of the FRT was 0.989 (0.981-0.996) and 0.978 (0.970-0.985), intrasubject and intersubject respectively. Conclusions: We found that mobile sensors in mobile phones could be reliable tools in the parameterization of the Functional Reach Test in people who have had a stroke. UR - http://rehab.jmir.org/2015/1/e6/ UR - http://dx.doi.org/10.2196/rehab.4102 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582239 ID - info:doi/10.2196/rehab.4102 ER - TY - JOUR AU - Davies, Jane AU - Bukulatjpi, Sarah AU - Sharma, Suresh AU - Caldwell, Luci AU - Johnston, Vanessa AU - Davis, Saul Joshua PY - 2015/06/10 TI - Development of a Culturally Appropriate Bilingual Electronic App About Hepatitis B for Indigenous Australians: Towards Shared Understandings JO - JMIR Res Protoc SP - e70 VL - 4 IS - 2 KW - culture KW - development KW - health literacy KW - hepatitis B KW - indigenous population KW - language KW - portable electronic apps N2 - Background: Hepatitis B is endemic in Indigenous communities in Northern Australia; however, there is a lack of culturally appropriate educational tools. Health care workers and educators in this setting have voiced a desire for visual, interactive tools in local languages. Mobile phones are increasingly used and available in remote Indigenous communities. In this context, we identified the need for a tablet-based health education app about hepatitis B, developed in partnership with an Australian remote Indigenous community. Objective: To develop a culturally appropriate bilingual app about hepatitis B for Indigenous Australians in Arnhem Land using a participatory action research (PAR) framework. Methods: This project was a partnership between the Menzies School of Health Research, Miwatj Aboriginal Health Corporation, Royal Darwin Hospital Liver Clinic, and Dreamedia Darwin. We have previously published a qualitative study that identified major knowledge gaps about hepatitis B in this community, and suggested that a tablet-based app would be an appropriate and popular tool to improve this knowledge. The process of developing the app was based on PAR principles, particularly ongoing consultation, evaluation, and discussion with the community throughout each iterative cycle. Stages included development of the storyboard, the translation process (forward translation and backtranslation), prelaunch community review, launch and initial community evaluation, and finally, wider launch and evaluation at a viral hepatitis conference. Results: We produced an app called ?Hep B Story? for use with iPad, iPhone, Android tablets, and mobile phones or personal computers. The app is culturally appropriate, audiovisual, interactive, and users can choose either English or Yol?u Matha (the most common language in East Arnhem Land) as their preferred language. The initial evaluation demonstrated a statistically significant improvement in Hep B-related knowledge for 2 of 3 questions (P=.01 and .02, respectively) and overwhelmingly positive opinion regarding acceptability and ease of use (median rating of 5, on a 5-point Likert-type scale when users were asked if they would recommend the app to others). Conclusions: We describe the process of development of a bilingual hepatitis B-specific app for Indigenous Australians, using a PAR framework. The approach was found to be successful with positive evaluations. UR - http://www.researchprotocols.org/2015/2/e70/ UR - http://dx.doi.org/10.2196/resprot.4216 UR - http://www.ncbi.nlm.nih.gov/pubmed/26063474 ID - info:doi/10.2196/resprot.4216 ER - TY - JOUR AU - Piette, D. John AU - Striplin, Dana AU - Marinec, Nicolle AU - Chen, Jenny AU - Trivedi, B. Ranak AU - Aron, C. David AU - Fisher, Lawrence AU - Aikens, E. James PY - 2015/06/10 TI - A Mobile Health Intervention Supporting Heart Failure Patients and Their Informal Caregivers: A Randomized Comparative Effectiveness Trial JO - J Med Internet Res SP - e142 VL - 17 IS - 6 KW - telehealth KW - mobile health KW - heart failure KW - disease management KW - self-management N2 - Background: Mobile health (mHealth) interventions may improve heart failure (HF) self-care, but standard models do not address informal caregivers? needs for information about the patient?s status or how the caregiver can help. Objective: We evaluated mHealth support for caregivers of HF patients over and above the impact of a standard mHealth approach. Methods: We identified 331 HF patients from Department of Veterans Affairs outpatient clinics. All patients identified a ?CarePartner? outside their household. Patients randomized to ?standard mHealth? (n=165) received 12 months of weekly interactive voice response (IVR) calls including questions about their health and self-management. Based on patients? responses, they received tailored self-management advice, and their clinical team received structured fax alerts regarding serious health concerns. Patients randomized to ?mHealth+CP? (n=166) received an identical intervention, but with automated emails sent to their CarePartner after each IVR call, including feedback about the patient?s status and suggestions for how the CarePartner could support disease care. Self-care and symptoms were measured via 6- and 12-month telephone surveys with a research associate. Self-care and symptom data also were collected through the weekly IVR assessments. Results: Participants were on average 67.8 years of age, 99% were male (329/331), 77% where white (255/331), and 59% were married (195/331). During 15,709 call-weeks of attempted IVR assessments, patients completed 90% of their calls with no difference in completion rates between arms. At both endpoints, composite quality of life scores were similar across arms. However, more mHealth+CP patients reported taking medications as prescribed at 6 months (8.8% more, 95% CI 1.2-16.5, P=.02) and 12 months (13.8% more, CI 3.7-23.8, P<.01), and 10.2% more mHealth+CP patients reported talking with their CarePartner at least twice per week at the 6-month follow-up (P=.048). mHealth+CP patients were less likely to report negative emotions during those interactions at both endpoints (both P<.05), were consistently more likely to report taking medications as prescribed during weekly IVR assessments, and also were less likely to report breathing problems or weight gains (all P<.05). Among patients with more depressive symptoms at enrollment, those randomized to mHealth+CP were more likely than standard mHealth patients to report excellent or very good general health during weekly IVR calls. Conclusions: Compared to a relatively intensive model of IVR monitoring, self-management assistance, and clinician alerts, a model including automated feedback to an informal caregiver outside the household improved HF patients? medication adherence and caregiver communication. mHealth+CP may also decrease patients? risk of HF exacerbations related to shortness of breath and sudden weight gains. mHealth+CP may improve quality of life among patients with greater depressive symptoms. Weekly health and self-care monitoring via mHealth tools may identify intervention effects in mHealth trials that go undetected using typical, infrequent retrospective surveys. Trial Registration: ClinicalTrials.gov NCT00555360; https://clinicaltrials.gov/ct2/show/NCT00555360 (Archived by WebCite at http://www.webcitation.org/6Z4Tsk78B). UR - http://www.jmir.org/2015/6/e142/ UR - http://dx.doi.org/10.2196/jmir.4550 UR - http://www.ncbi.nlm.nih.gov/pubmed/26063161 ID - info:doi/10.2196/jmir.4550 ER - TY - JOUR AU - Knight-Agarwal, Catherine AU - Davis, Lee Deborah AU - Williams, Lauren AU - Davey, Rachel AU - Cox, Robert AU - Clarke, Adam PY - 2015/06/05 TI - Development and Pilot Testing of the Eating4two Mobile Phone App to Monitor Gestational Weight Gain JO - JMIR mHealth uHealth SP - e44 VL - 3 IS - 2 KW - pregnancy KW - mobile phone KW - antenatal care KW - maternal obesity KW - intervention N2 - Background: The number of pregnant women with a body mass index (BMI) of 30kg/m2 or more is increasing, which has important implications for antenatal care. Various resource-intensive interventions have attempted to assist women in managing their weight gain during pregnancy with limited success. A mobile phone app has been proposed as a convenient and cost-effective alternative to face-to-face interventions. Objective: This paper describes the process of developing and pilot testing the Eating4Two app, which aims to provide women with a simple gestational weight gain (GWG) calculator, general dietary information, and the motivation to achieve a healthy weight gain during pregnancy. Methods: The project involved the development of app components, including a graphing function that allows the user to record their weight throughout the pregnancy and to receive real-time feedback on weight gain progress and general information on antenatal nutrition. Stakeholder consultation was used to inform development. The app was pilot tested with 10 pregnant women using a mixed method approach via an online survey, 2 focus groups, and 1 individual interview. Results: The Eating4Two app took 7 months to develop and evaluate. It involved several disciplines--including nutrition and dietetics, midwifery, public health, and information technology--at the University of Canberra. Participants found the Eating4Two app to be a motivational tool but would have liked scales or other markers on the graph that demonstrated exact weight gain. They also liked the nutrition information; however, many felt it should be formatted in a more user friendly way. Conclusions: The Eating4Two app was viewed by participants in our study as an innovative support system to help motivate healthy behaviors during pregnancy and as a credible resource for accessing nutrition-focused information. The feedback provided by participants will assist with refining the current prototype for use in a clinical intervention trial. UR - http://mhealth.jmir.org/2015/2/e44/ UR - http://dx.doi.org/10.2196/mhealth.4071 UR - http://www.ncbi.nlm.nih.gov/pubmed/26048313 ID - info:doi/10.2196/mhealth.4071 ER - TY - JOUR AU - Brown III, William AU - Ibitoye, Mobolaji AU - Bakken, Suzanne AU - Schnall, Rebecca AU - Balán, Iván AU - Frasca, Timothy AU - Carballo-Diéguez, Alex PY - 2015/06/04 TI - Cartographic Analysis of Antennas and Towers: A Novel Approach to Improving the Implementation and Data Transmission of mHealth Tools on Mobile Networks JO - JMIR mHealth uHealth SP - e63 VL - 3 IS - 2 KW - cartographic analysis KW - mHealth KW - mobile health KW - antenna KW - short message service KW - text messaging KW - SMS KW - wireless KW - HIV N2 - Background: Most mHealth tools such as short message service (SMS), mobile apps, wireless pill counters, and ingestible wireless monitors use mobile antennas to communicate. Limited signal availability, often due to poor antenna infrastructure, negatively impacts the implementation of mHealth tools and remote data collection. Assessing the antenna infrastructure prior to starting a study can help mitigate this problem. Currently, there are no studies that detail whether and how the antenna infrastructure of a study site or area is assessed. Objective: To address this literature gap, we analyze and discuss the use of a cartographic analysis of antennas and towers (CAAT) for mobile communications for geographically assessing mobile antenna and tower infrastructure and identifying signal availability for mobile devices prior to the implementation of an SMS-based mHealth pilot study. Methods: An alpha test of the SMS system was performed using 11 site staff. A CAAT for the study area?s mobile network was performed after the alpha test and pre-implementation of the pilot study. The pilot study used a convenience sample of 11 high-risk men who have sex with men who were given human immunodeficiency virus test kits for testing nonmonogamous sexual partners before intercourse. Product use and sexual behavior were tracked through SMS. Message frequency analyses were performed on the SMS text messages, and SMS sent/received frequencies of 11 staff and 11 pilot study participants were compared. Results: The CAAT helped us to successfully identify strengths and weaknesses in mobile service capacity within a 3-mile radius from the epicenters of four New York City boroughs. During the alpha test, before CAAT, 1176/1202 (97.84%) text messages were sent to staff, of which 26/1176 (2.21%) failed. After the CAAT, 2934 messages were sent to pilot study participants and none failed. Conclusions: The CAAT effectively illustrated the research area?s mobile infrastructure and signal availability, which allowed us to improve study setup and sent message success rates. The SMS messages were sent and received with a lower fail rate than those reported in previous studies. UR - http://mhealth.jmir.org/2015/2/e63/ UR - http://dx.doi.org/10.2196/mhealth.3941 UR - http://www.ncbi.nlm.nih.gov/pubmed/26043766 ID - info:doi/10.2196/mhealth.3941 ER - TY - JOUR AU - Vincent, James Christopher AU - Niezen, Gerrit AU - O'Kane, Ann Aisling AU - Stawarz, Katarzyna PY - 2015/06/03 TI - Can Standards and Regulations Keep Up With Health Technology? JO - JMIR mHealth uHealth SP - e64 VL - 3 IS - 2 KW - governmental regulations KW - health services KW - medical devices KW - mHealth KW - mobile phones KW - open source initiative KW - software KW - standards KW - technology UR - http://mhealth.jmir.org/2015/2/e64/ UR - http://dx.doi.org/10.2196/mhealth.3918 UR - http://www.ncbi.nlm.nih.gov/pubmed/26041730 ID - info:doi/10.2196/mhealth.3918 ER - TY - JOUR AU - Oreskovic, Michel Nicolas AU - Huang, T. Terry AU - Moon, Jon PY - 2015/06/02 TI - Integrating mHealth and Systems Science: A Combination Approach to Prevent and Treat Chronic Health Conditions JO - JMIR mHealth uHealth SP - e62 VL - 3 IS - 2 KW - mHealth KW - systems science KW - chronic health conditions KW - obesity KW - physical activity UR - http://mhealth.jmir.org/2015/2/e62/ UR - http://dx.doi.org/10.2196/mhealth.4150 UR - http://www.ncbi.nlm.nih.gov/pubmed/26036753 ID - info:doi/10.2196/mhealth.4150 ER - TY - JOUR AU - Kaphle, Sangya AU - Chaturvedi, Sharad AU - Chaudhuri, Indrajit AU - Krishnan, Ram AU - Lesh, Neal PY - 2015/05/28 TI - Adoption and Usage of mHealth Technology on Quality and Experience of Care Provided by Frontline Workers: Observations From Rural India JO - JMIR mHealth uHealth SP - e61 VL - 3 IS - 2 KW - mHealth KW - technology adoption KW - community health workers KW - CommCare N2 - Background: mHealth apps are deployed with the aim of improving access, quality, and experience of health care. It is possible that any mHealth intervention can yield differential impacts for different types of users. Mediating and determining factors, including personal and socioeconomic factors, affect technology adoption, the way health workers leverage and use the technology, and subsequently the quality and experience of care they provide. Objective: To develop a framework to assess whether mHealth platforms affect the quality and experience of care provided by frontline workers, and whether these effects on quality and experience are different depending on the level of technology adoption and individual characteristics of the health worker. Literacy, education, age, and previous mobile experience are identified as individual factors that affect technology adoption and use, as well as factors that affect the quality and experience of care directly and via the technology. Methods: Formative research was conducted with 15 community health workers (CHWs) using CommCare, an mHealth app for maternal and newborn care, in Bihar, India. CHWs were first classified on the level of CommCare adoption using data from CommCareHQ and were then shadowed on home visits to evaluate their levels of technology proficiency, and the quality and experience of care provided. Regression techniques were employed to test the relationships. Out of all the CHWs, 2 of them refused to participate in the home visits, however, we did have information on their levels of technology adoption and background characteristics, which were included in the analysis as relevant. Results: Level of technology adoption was important for both quality and experience of care. The quality score for high users of CommCare was higher by 33.4% (P=.04), on average, compared to low users of CommCare. Those who scored higher on CommCare proficiency also provided significantly higher quality and experience of care, where an additional point in CommCare proficiency score increased the quality score by around half a point (0.541, P=.07), and experience score by around a third of a point (0.308, P=.03). Age affected CommCare user type negatively, with an increase in age increasing the likelihood of belonging to a lower category of CommCare adoption (-0.105, P=.08). Other individual characteristics did not affect adoption or the predicted values estimating the relationship between adoption and quality and experience of care, although illiteracy was able to affect the relationship negatively. Conclusions: mHealth technology adoption by frontline workers can positively impact the quality and experience of care they provide. Individual characteristics, especially literacy and age, can be important elements affecting technology adoption and the way users leverage the technology for their work. Our formative study provides informed hypotheses and methods for further research. UR - http://mhealth.jmir.org/2015/2/e61/ UR - http://dx.doi.org/10.2196/mhealth.4047 UR - http://www.ncbi.nlm.nih.gov/pubmed/26023001 ID - info:doi/10.2196/mhealth.4047 ER - TY - JOUR AU - Zwart, Marie Christine AU - He, Miao AU - Wu, Teresa AU - Demaerschalk, M. Bart AU - Mitchell, Ross Joseph AU - Hara, K. Amy PY - 2015/05/27 TI - Selection and Pilot Implementation of a Mobile Image Viewer: A Case Study JO - JMIR mHealth uHealth SP - e45 VL - 3 IS - 2 KW - mHealth KW - Pilot projects KW - Radiology KW - Telemedicine KW - Teleradiology N2 - Background: For health care providers, mobile image viewing increases image accessibility, which could lead to faster interpretation/consultations and improved patient outcomes. Objective: We explored the technical requirements and challenges associated with implementing a commercial mobile image viewer and conducted a small study testing the hypothesis that the mobile image viewer would provide faster image access. Methods: A total of 19 clinicians (9 radiologists, 3 surgeons, 4 neurologists, and 3 physician assistants) evaluated (1) a desktop commercial picture archiving and communication system (PACS) viewer, (2) a desktop viewer developed internally over 20 years and deployed throughout the enterprise (ENTERPRISE viewer) and (3) a commercial Food and Drug Administration class II-cleared mobile viewer compatible with Web browsers, tablets, and mobile phones. Data were collected during two separate 7-day periods, before and after mobile image viewer deployment. Data included image viewer chosen, time to view first image, technical issues, diagnostic confidence, and ease of use. Results: For 565 image-viewing events, ease of use was identical for PACS and mobile viewers (mean 3.6 for all scores of a possible 4.0), and significantly worse for the enterprise viewer (mean 2.9, P=.001). Technical issues were highest with the enterprise viewer (26%, 56/215) compared with the mobile (7%,19/259, P=.001) and PACS (8%, 7/91, P=.003) viewers. Mean time to first image for the mobile viewer (2.4 minutes) was significantly faster than PACS (12.5 minutes, P=.001) and the enterprise viewer (4.5 minutes, P=.001). Diagnostic confidence was similar for PACS and mobile viewers and worst for enterprise viewer. Mobile image viewing increased by sixfold, from 14% (37/269, before the deployment) to 88.9% (263/296, after the deployment). Conclusions: A mobile viewer provided faster time to first image, improved technical performance, ease of use, and diagnostic confidence, compared with desktop image viewers. UR - http://mhealth.jmir.org/2015/2/e45/ UR - http://dx.doi.org/10.2196/mhealth.4271 UR - http://www.ncbi.nlm.nih.gov/pubmed/26018587 ID - info:doi/10.2196/mhealth.4271 ER - TY - JOUR AU - Alnasser, Abdulaziz Aroub AU - Alkhalifa, Saleh Abdulrahman AU - Sathiaseelan, Arjuna AU - Marais, Debbi PY - 2015/05/20 TI - What Overweight Women Want From a Weight Loss App: A Qualitative Study on Arabic Women JO - JMIR mHealth uHealth SP - e41 VL - 3 IS - 2 KW - weight loss KW - focus groups KW - smartphone KW - mobile apps KW - Arabic KW - qualitative research N2 - Background: Overweight and obesity are international public health issues. With mobile and app use growing globally, the development of weight loss apps are increasing along with evidence that interventions using technology have been effective in the treatment of obesity. Although studies have been conducted regarding what content health professionals would recommend within weight loss apps, there are limited studies that explore users? viewpoints. There is specifically a paucity of research that takes the cultural background of the user into consideration, especially in Middle Eastern countries where the lives and weight loss intervention needs of women not only vary vastly from the West, but the obesity rate is also increasing exponentially. Objective: The current study sought to explore the proposed features of an Arabic weight loss app by seeking the experiences and opinions of overweight and obese Saudi Arabian users in order to design a mobile phone app to fit their needs. Methods: Focus group discussions were conducted with a purposive sample of volunteer overweight and obese Saudi women (BMI ? 25) who were older than 18 years and who owned a mobile phone. The most common Arabic and English weight loss mobile apps were downloaded to initiate dialogue about app usage and to get their opinions on what an ideal weight loss app would look like and the features it would include. All transcribed, translated discussions were thematically analyzed, categorized for each of the main topics of the discussion, and specific quotations were identified. Results: Four focus groups were conducted with a total of 39 participants. Most participants owned an Android mobile phone and only a few participants were aware of the availability of health-related apps. Barriers to weight loss were identified including: motivation, support (social and professional), boring diets, customs, and lifestyle. Diverse themes emerged as suggestions for an ideal weight loss app including: Arabic language and culturally sensitive; motivational support and social networking; dietary and physical activity tools; and a tailorable, user-friendly interface. Conclusions: This study identifies weight loss app features from the users? perspective, which should be considered in the development of a weight loss app for this population. UR - http://mhealth.jmir.org/2015/2/e41/ UR - http://dx.doi.org/10.2196/mhealth.4409 UR - http://www.ncbi.nlm.nih.gov/pubmed/25993907 ID - info:doi/10.2196/mhealth.4409 ER - TY - JOUR AU - Rabbi, Mashfiqui AU - Pfammatter, Angela AU - Zhang, Mi AU - Spring, Bonnie AU - Choudhury, Tanzeem PY - 2015/05/14 TI - Automated Personalized Feedback for Physical Activity and Dietary Behavior Change With Mobile Phones: A Randomized Controlled Trial on Adults JO - JMIR mHealth uHealth SP - e42 VL - 3 IS - 2 KW - mobile health KW - mHealth KW - mobile phone sensing KW - smart systems KW - context-aware systems KW - physical activity KW - self-management KW - personal health care KW - machine learning KW - artificial intelligence N2 - Background: A dramatic rise in health-tracking apps for mobile phones has occurred recently. Rich user interfaces make manual logging of users? behaviors easier and more pleasant, and sensors make tracking effortless. To date, however, feedback technologies have been limited to providing overall statistics, attractive visualization of tracked data, or simple tailoring based on age, gender, and overall calorie or activity information. There are a lack of systems that can perform automated translation of behavioral data into specific actionable suggestions that promote healthier lifestyle without any human involvement. Objective: MyBehavior, a mobile phone app, was designed to process tracked physical activity and eating behavior data in order to provide personalized, actionable, low-effort suggestions that are contextualized to the user?s environment and previous behavior. This study investigated the technical feasibility of implementing an automated feedback system, the impact of the suggestions on user physical activity and eating behavior, and user perceptions of the automatically generated suggestions. Methods: MyBehavior was designed to (1) use a combination of automatic and manual logging to track physical activity (eg, walking, running, gym), user location, and food, (2) automatically analyze activity and food logs to identify frequent and nonfrequent behaviors, and (3) use a standard machine-learning, decision-making algorithm, called multi-armed bandit (MAB), to generate personalized suggestions that ask users to either continue, avoid, or make small changes to existing behaviors to help users reach behavioral goals.We enrolled 17 participants, all motivated to self-monitor and improve their fitness, in a pilot study of MyBehavior. In a randomized two-group trial, investigators randomly assigned participants to receive either MyBehavior?s personalized suggestions (n=9) or nonpersonalized suggestions (n=8), created by professionals, from a mobile phone app over 3 weeks. Daily activity level and dietary intake was monitored from logged data. At the end of the study, an in-person survey was conducted that asked users to subjectively rate their intention to follow MyBehavior suggestions. Results: In qualitative daily diary, interview, and survey data, users reported MyBehavior suggestions to be highly actionable and stated that they intended to follow the suggestions. MyBehavior users walked significantly more than the control group over the 3 weeks of the study (P=.05). Although some MyBehavior users chose lower-calorie foods, the between-group difference was not significant (P=.15). In a poststudy survey, users rated MyBehavior?s personalized suggestions more positively than the nonpersonalized, generic suggestions created by professionals (P<.001). Conclusions: MyBehavior is a simple-to-use mobile phone app with preliminary evidence of efficacy. To the best of our knowledge, MyBehavior represents the first attempt to create personalized, contextualized, actionable suggestions automatically from self-tracked information (ie, manual food logging and automatic tracking of activity). Lessons learned about the difficulty of manual logging and usability concerns, as well as future directions, are discussed. Trial Registration: ClinicalTrials.gov NCT02359981; https://clinicaltrials.gov/ct2/show/NCT02359981 (Archived by WebCite at http://www.webcitation.org/6YCeoN8nv). UR - http://mhealth.jmir.org/2015/2/e42/ UR - http://dx.doi.org/10.2196/mhealth.4160 UR - http://www.ncbi.nlm.nih.gov/pubmed/25977197 ID - info:doi/10.2196/mhealth.4160 ER - TY - JOUR AU - Crane, David AU - Garnett, Claire AU - Brown, James AU - West, Robert AU - Michie, Susan PY - 2015/05/14 TI - Behavior Change Techniques in Popular Alcohol Reduction Apps: Content Analysis JO - J Med Internet Res SP - e118 VL - 17 IS - 5 KW - alcohol KW - behaviour change KW - mHealth KW - smartphone KW - iPhone KW - android KW - apps KW - digital KW - intervention N2 - Background: Mobile phone apps have the potential to reduce excessive alcohol consumption cost-effectively. Although hundreds of alcohol-related apps are available, there is little information about the behavior change techniques (BCTs) they contain, or the extent to which they are based on evidence or theory and how this relates to their popularity and user ratings. Objective: Our aim was to assess the proportion of popular alcohol-related apps available in the United Kingdom that focus on alcohol reduction, identify the BCTs they contain, and explore whether BCTs or the mention of theory or evidence is associated with app popularity and user ratings. Methods: We searched the iTunes and Google Play stores with the terms ?alcohol? and ?drink?, and the first 800 results were classified into alcohol reduction, entertainment, or blood alcohol content measurement. Of those classified as alcohol reduction, all free apps and the top 10 paid apps were coded for BCTs and for reference to evidence or theory. Measures of popularity and user ratings were extracted. Results: Of the 800 apps identified, 662 were unique. Of these, 13.7% (91/662) were classified as alcohol reduction (95% CI 11.3-16.6), 53.9% (357/662) entertainment (95% CI 50.1-57.7), 18.9% (125/662) blood alcohol content measurement (95% CI 16.1-22.0) and 13.4% (89/662) other (95% CI 11.1-16.3). The 51 free alcohol reduction apps and the top 10 paid apps contained a mean of 3.6 BCTs (SD 3.4), with approximately 12% (7/61) not including any BCTs. The BCTs used most often were ?facilitate self-recording? (54%, 33/61), ?provide information on consequences of excessive alcohol use and drinking cessation? (43%, 26/61), ?provide feedback on performance? (41%, 25/61), ?give options for additional and later support? (25%, 15/61) and ?offer/direct towards appropriate written materials? (23%, 14/61). These apps also rarely included any of the 22 BCTs frequently used in other health behavior change interventions (mean 2.46, SD 2.06). Evidence was mentioned by 16.4% of apps, and theory was not mentioned by any app. Multivariable regression showed that apps including advice on environmental restructuring were associated with lower user ratings (?=-46.61, P=.04, 95% CI -91.77 to -1.45) and that both the techniques of ?advise on/facilitate the use of social support? (?=2549.21, P=.04, 95% CI 96.75-5001.67) and the mention of evidence (?=1376.74, P=.02, 95%, CI 208.62-2544.86) were associated with the popularity of the app. Conclusions: Only a minority of alcohol-related apps promoted health while the majority implicitly or explicitly promoted the use of alcohol. Alcohol-related apps that promoted health contained few BCTs and none referred to theory. The mention of evidence was associated with more popular apps, but popularity and user ratings were only weakly associated with the BCT content. UR - http://www.jmir.org/2015/5/e118/ UR - http://dx.doi.org/10.2196/jmir.4060 UR - http://www.ncbi.nlm.nih.gov/pubmed/25977135 ID - info:doi/10.2196/jmir.4060 ER - TY - JOUR AU - Galligioni, Enzo AU - Piras, Maria Enrico AU - Galvagni, Michele AU - Eccher, Claudio AU - Caramatti, Silvia AU - Zanolli, Daniela AU - Santi, Jonni AU - Berloffa, Flavio AU - Dianti, Marco AU - Maines, Francesca AU - Sannicolò, Mirella AU - Sandri, Marco AU - Bragantini, Lara AU - Ferro, Antonella AU - Forti, Stefano PY - 2015/05/13 TI - Integrating mHealth in Oncology: Experience in the Province of Trento JO - J Med Internet Res SP - e114 VL - 17 IS - 5 KW - health informatics KW - mobile health KW - home monitoring KW - supportive care KW - patient safety KW - safe chemotherapy N2 - Background: The potential benefits of the introduction of electronic and mobile health (mHealth) information technologies, to support the safe delivery of intravenous chemotherapy or oral anticancer therapies, could be exponential in the context of a highly integrated computerized system. Objective: Here we describe a safe therapy mobile (STM) system for the safe delivery of intravenous chemotherapy, and a home monitoring system for monitoring and managing toxicity and improving adherence in patients receiving oral anticancer therapies at home. Methods: The STM system is fully integrated with the electronic oncological patient record. After the prescription of chemotherapy, specific barcodes are automatically associated with the patient and each drug, and a bedside barcode reader checks the patient, nurse, infusion bag, and drug sequence in order to trace the entire administration process, which is then entered in the patient?s record. The usability and acceptability of the system was investigated by means of a modified questionnaire administered to nurses. The home monitoring system consists of a mobile phone or tablet diary app, which allows patients to record their state of health, the medications taken, their side effects, and a Web dashboard that allows health professionals to check the patient data and monitor toxicity and treatment adherence. A built-in rule-based alarm module notifies health care professionals of critical conditions. Initially developed for chronic patients, the system has been subsequently customized in order to monitor home treatments with capecitabine or sunitinib in cancer patients (Onco-TreC). Results: The STM system never failed to match the patient/nurse/drug sequence association correctly, and proved to be accurate and reliable in tracing and recording the entire administration process. The questionnaires revealed that the users were generally satisfied and had a positive perception of the system?s usefulness and ease of use, and the quality of their working lives. The pilot studies with the home monitoring system with 43 chronic patients have shown that the approach is reliable and useful for clinicians and patients, but it is also necessary to pay attention to the expectations that mHealth solutions may raise in users. The Onco-TreC version has been successfully laboratory tested, and is now ready for validation. Conclusions: The STM and Onco-TreC systems are fully integrated with our complex and composite information system, which guarantees privacy, security, interoperability, and real-time communications between patients and health professionals. They need to be validated in order to confirm their positive contribution to the safer administration of anticancer drugs. UR - http://www.jmir.org/2015/5/e114/ UR - http://dx.doi.org/10.2196/jmir.3743 UR - http://www.ncbi.nlm.nih.gov/pubmed/25972226 ID - info:doi/10.2196/jmir.3743 ER - TY - JOUR AU - Mendiola, F. Martin AU - Kalnicki, Miriam AU - Lindenauer, Sarah PY - 2015/05/13 TI - Valuable Features in Mobile Health Apps for Patients and Consumers: Content Analysis of Apps and User Ratings JO - JMIR mHealth uHealth SP - e40 VL - 3 IS - 2 KW - mHealth KW - mobile apps KW - consumer preference KW - Affordable Care Act N2 - Background: The explosion of mobile phones with app capabilities coupled with increased expectations of the patient-consumers? role in managing their care presents a unique opportunity to use mobile health (mHealth) apps. Objectives: The aim of this paper is to identify the features and characteristics most-valued by patient-consumers (?users?) that contribute positively to the rating of an app. Methods: A collection of 234 apps associated with reputable health organizations found in the medical, health, and fitness categories of the Apple iTunes store and Google Play marketplace was assessed manually for the presence of 12 app features and characteristics. Regression analysis was used to determine which, if any, contributed positively to a user?s rating of the app. Results: Analysis of these 12 features explained 9.3% (R2=.093 n=234, P<.001) of the variation in an app?s rating, with only 5 reaching statistical significance. Of the 5 reaching statistical significance, plan or orders, export of data, usability, and cost contributed positively to a user?s rating, while the tracker feature detracted from it. Conclusions: These findings suggest that users appreciate features that save time over current methods and identify an app as valuable when it is simple and intuitive to use, provides specific instructions to better manage a condition, and shares data with designated individuals. Although tracking is a core function of most health apps, this feature may detract from a user?s experience when not executed properly. Further investigation into mHealth app features is worthwhile given the inability of the most common features to explain a large portion of an app?s rating. In the future, studies should focus on one category in the app store, specific diseases, or desired behavior change, and methods should include measuring the quality of each feature, both through manual assessment and evaluation of user reviews. Additional investigations into understanding the impact of synergistic features, incentives, social media, and gamification are also warranted to identify possible future trends. UR - http://mhealth.jmir.org/2015/2/e40/ UR - http://dx.doi.org/10.2196/mhealth.4283 UR - http://www.ncbi.nlm.nih.gov/pubmed/25972309 ID - info:doi/10.2196/mhealth.4283 ER - TY - JOUR AU - Huguet, Anna AU - McGrath, J. Patrick AU - Wheaton, Michael AU - Mackinnon, P. Sean AU - Rozario, Sharlene AU - Tougas, E. Michelle AU - Stinson, N. Jennifer AU - MacLean, Cathy PY - 2015/05/08 TI - Testing the Feasibility and Psychometric Properties of a Mobile Diary (myWHI) in Adolescents and Young Adults With Headaches JO - JMIR mHealth uHealth SP - e39 VL - 3 IS - 2 KW - headache KW - diary KW - smartphone KW - feasibility KW - psychometric properties N2 - Background: Headaches are prevalent among teens and young adults. Self-monitoring is essential for managing headaches and can be accomplished with the help of electronic headache diaries. An increasing number of electronic headache diaries exist, yet the absence of quality standards compromises their use for research and clinical purposes. Objective: Our goal was to develop and test the usability, feasibility, and psychometric properties of an electronic diary iPhone application for self-monitoring by adolescents and young adults with headaches. Methods: We used an iterative participatory design to develop and test our electronic headache diary. Participants aged 14-28 years old with recurrent headaches were recruited internationally. Screening and consent were conducted online. Following completion of an online pre-questionnaire, participants downloaded the diary to use in their natural environment for 14 days. An online post-questionnaire was completed following testing. The diary?s usability and feasibility were tested first and determined to be complete when improvements to the diary did not result in a statistically significant impact on indicators of feasibility and adherence. Interviews were conducted with participants of usability and feasibility testing. The psychometric properties of the diary were then tested, and a case study analysis of one participant was completed. Results: Three cycles to test the usability and feasibility were conducted. Each cycle included 11-19 unique participants ranging in age from 16 to 28 years. Following the testing period for each cycle, 15% to 25% of participants took part in the post-cycle interview. Participants perceived the final version of the diary as useful, easy to learn, and efficient to use. Psychometric properties were then tested with a sample of 65 participants (6 aged 14-17 years old; 59 aged 18-28 years old). All items in the diary had substantial between- and within-subjects variability (percent of variance for the two participant groups ranged from 20.64 to 75.60 and 23.74 to 79.21, respectively). Moreover, the Migraine Disability Assessment (MIDAS) included in the diary had adequate between-subjects reliability (R1F=0.66, RKF=0.98), but low within-subjects reliability (RC=0.51). Critical elements of the diary demonstrated adequate convergent and concurrent validity, particularly in the older age group (18-28 years). The validity of some critical elements of the diary could not be explored in the younger age group due to the small subgroup size. The case study provides an example of the potential utility of the diary. Conclusions: Our electronic headache diary was shown to be a usable and feasible self-monitoring tool when used by adolescents and young adults with headaches for 14 days. This study provides preliminary support of its psychometric properties. Our diary has the potential for helping users to better understand their headaches and, consequently, to change behaviors to improve self-management of their headaches. Its effectiveness as a component of an intervention will be the focus of future research. UR - http://mhealth.jmir.org/2015/2/e39/ UR - http://dx.doi.org/10.2196/mhealth.3879 UR - http://www.ncbi.nlm.nih.gov/pubmed/25956377 ID - info:doi/10.2196/mhealth.3879 ER - TY - JOUR AU - Buchholz, Weber Susan AU - Sandi, Giselle AU - Ingram, Diana AU - Welch, Jane Mary AU - Ocampo, V. Edith PY - 2015/05/06 TI - Bilingual Text Messaging Translation: Translating Text Messages From English Into Spanish for the Text4Walking Program JO - JMIR Res Protoc SP - e51 VL - 4 IS - 2 KW - text messaging KW - mobile phone KW - translating KW - language KW - focus groups KW - exercise N2 - Background: Hispanic adults in the United States are at particular risk for diabetes and inadequate blood pressure control. Physical activity improves these health problems; however Hispanic adults also have a low rate of recommended aerobic physical activity. To address improving physical inactivity, one area of rapidly growing technology that can be utilized is text messaging (short message service, SMS). A physical activity research team, Text4Walking, had previously developed an initial database of motivational physical activity text messages in English that could be used for physical activity text messaging interventions. However, the team needed to translate these existing English physical activity text messages into Spanish in order to have culturally meaningful and useful text messages for those adults within the Hispanic population who would prefer to receive text messages in Spanish. Objective: The aim of this study was to translate a database of English motivational physical activity messages into Spanish and review these text messages with a group of Spanish speaking adults to inform the use of these text messages in an intervention study. Methods: The consent form and study documents, including the existing English physical activity text messages, were translated from English into Spanish, and received translation certification as well as Institutional Review Board approval. The translated text messages were placed into PowerPoint, accompanied by a set of culturally appropriate photos depicting barriers to walking, as well as walking scenarios. At the focus group, eligibility criteria for this study included being an adult between 30 to 65 years old who spoke Spanish as their primary language. After a general group introduction, participants were placed into smaller groups of two or three. Each small group was asked to review a segment of the translated text messages for accuracy and meaningfulness. After the break out, the group was brought back together to review the text messages. Results: A translation confirmation group met at a church site in an urban community with a large population of Hispanics. Spanish speaking adults (N=8), with a mean age of 40 (SD 6.3), participated in the study. Participants were engaged in the group and viewed the text messages as culturally appropriate. They also thought that text messages could motivate them to walk more. Twenty-two new text messages were added to the original database of 246 translated text messages. While the text messages were generally understood, specific word preferences were seen related to personal preference, dialect, and level of formality which resulted in minor revisions to four text messages. Conclusions: The English text messages were successfully translated into Spanish by a bilingual research staff and reviewed by Hispanic participants in order to inform the use of these text messages for future intervention studies. These Spanish text messages were recently used in a Text4Walking intervention study. UR - http://www.researchprotocols.org/2015/2/e51/ UR - http://dx.doi.org/10.2196/resprot.3984 UR - http://www.ncbi.nlm.nih.gov/pubmed/25947953 ID - info:doi/10.2196/resprot.3984 ER - TY - JOUR AU - Giesbrecht, Mark Edward AU - Miller, C. William AU - Jin, Tom Boyang AU - Mitchell, M. Ian AU - Eng, J. Janice PY - 2015/04/30 TI - Rehab on Wheels: A Pilot Study of Tablet-Based Wheelchair Training for Older Adults JO - JMIR Rehabil Assist Technol SP - e3 VL - 2 IS - 1 KW - wheelchairs KW - telemedicine KW - self-efficacy KW - aged KW - pilot projects N2 - Background: Alternative and innovative strategies such as mHealth and eLearning are becoming a necessity for delivery of rehabilitation services. For example, older adults who require a wheelchair receive little, if any, training for proficiency with mobility skills. This substantive service gap is due in part to restricted availability of clinicians and challenges for consumers to attend appointments. A research team of occupational therapists and computer scientists engaged clinicians, consumers, and care providers using a participatory action design approach. A tablet-based application, Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels), was developed to enable in-chair home training, online expert trainer monitoring, and trainee-trainer communication via secure voice messaging. Objective: Prior to undertaking a randomized controlled trial (RCT), a pilot study was conducted to determine the acceptability and feasibility of administering an mHealth wheelchair skills training program safely and effectively with two participants of different skill levels. The findings were used to determine whether further enhancements to the program were indicated. Methods: The program included two in-person sessions with an expert trainer and four weeks of independent home training. The EPIC Wheels application included video instruction and demonstration, self-paced training activities, and interactive training games. Participants were provided with a 10-inch Android tablet, mounting apparatus, and mobile Wi-Fi device. Frequency and duration of tablet interactions were monitored and uploaded daily to an online trainer interface. Participants completed a structured evaluation survey and provided feedback post-study. The trainer provided feedback on the training protocol and trainer interface. Results: Both participants perceived the program to be comprehensive, useful, and easily navigated. The trainer indicated usage data was comprehensive and informative for monitoring participant progress and adherence. The application performed equally well with multiple devices. Some initial issues with log-in requests were resolved via tablet-specific settings. Inconsistent Internet connectivity, resulting in delayed data upload and voice messaging, was specific to individual Wi-Fi devices and resolved by standardizing configuration. Based on the pilot results, the software was updated to make content download more robust. Additional features were also incorporated such as check marks for completed content, a more consumer-friendly aesthetic, and achievement awards. The trainer web interface was updated to improve usability and provides both a numerical and visual summary of participant data. Conclusions: The EPIC Wheels pilot study provided useful feedback on the feasibility of a tablet-based home program for wheelchair skills training among older adults, justifying advancement to evaluation in an RCT. The program may be expanded for use with other rehabilitation interventions and populations, particularly for those living in rural or remote locations. Future development will consider integration of built-in tablet sensors to provide performance feedback and enable interactive training activities. Trial Registration: ClinicalTrials.gov NCT01644292; https://clinicaltrials.gov/ct2/show/NCT01644292 (Archived by WebCite at http://www.webcitation.org/6XyvYyTUf). UR - http://rehab.jmir.org/2015/1/e3/ UR - http://dx.doi.org/10.2196/rehab.4274 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582240 ID - info:doi/10.2196/rehab.4274 ER - TY - JOUR AU - Henriksson, Hanna AU - Bonn, E. Stephanie AU - Bergström, Anna AU - Bälter, Katarina AU - Bälter, Olle AU - Delisle, Christine AU - Forsum, Elisabet AU - Löf, Marie PY - 2015/04/24 TI - A New Mobile Phone-Based Tool for Assessing Energy and Certain Food Intakes in Young Children: A Validation Study JO - JMIR mHealth uHealth SP - e38 VL - 3 IS - 2 KW - cell phone KW - digital camera KW - food intake KW - energy intake KW - child KW - DLW KW - FFQ N2 - Background: Childhood obesity is an increasing health problem globally. Obesity may be established already at pre-school age. Further research in this area requires accurate and easy-to-use methods for assessing the intake of energy and foods. Traditional methods have limited accuracy, and place large demands on the study participants and researchers. Mobile phones offer possibilities for methodological advancements in this area since they are readily available, enable instant digitalization of collected data, and also contain a camera to photograph pre- and post-meal food items. We have recently developed a new tool for assessing energy and food intake in children using mobile phones called the Tool for Energy Balance in Children (TECH). Objective: The main aims of our study are to (1) compare energy intake by means of TECH with total energy expenditure (TEE) measured using a criterion method, the doubly labeled water (DLW) method, and (2) to compare intakes of fruits and berries, vegetables, juice, and sweetened beverages assessed by means of TECH with intakes obtained using a Web-based food frequency questionnaire (KidMeal-Q) in 3 year olds. Methods: In this study, 30 Swedish 3 year olds were included. Energy intake using TECH was compared to TEE measured using the DLW method. Intakes of vegetables, fruits and berries, juice, as well as sweetened beverages were assessed using TECH and compared to the corresponding intakes assessed using KidMeal-Q. Wilcoxon matched pairs test, Spearman rank order correlations, and the Bland-Altman procedure were applied. Results: The mean energy intake, assessed by TECH, was 5400 kJ/24h (SD 1500). This value was not significantly different (P=.23) from TEE (5070 kJ/24h, SD 600). However, the limits of agreement (2 standard deviations) in the Bland-Altman plot for energy intake estimated using TECH compared to TEE were wide (2990 kJ/24h), and TECH overestimated high and underestimated low energy intakes. The Bland-Altman plots for foods showed similar patterns. The mean intakes of vegetables, fruits and berries, juice, and sweetened beverages estimated using TECH were not significantly different from the corresponding intakes estimated using KidMeal-Q. Moderate but statistically significant correlations (?=.42-.46, P=.01-.02) between TECH and KidMeal-Q were observed for intakes of vegetables, fruits and berries, and juice, but not for sweetened beverages. Conclusion: We found that one day of recordings using TECH was not able to accurately estimate intakes of energy or certain foods in 3 year old children. UR - http://mhealth.jmir.org/2015/2/e38/ UR - http://dx.doi.org/10.2196/mhealth.3670 UR - http://www.ncbi.nlm.nih.gov/pubmed/25910494 ID - info:doi/10.2196/mhealth.3670 ER - TY - JOUR AU - McBride, Deborah AU - LeVasseur, A. Sandra AU - Li, Dongmei PY - 2015/04/23 TI - Nursing Performance and Mobile Phone Use: Are Nurses Aware of Their Performance Decrements? JO - JMIR Human Factors SP - e6 VL - 2 IS - 1 KW - distraction KW - mobile phone KW - cellular phone KW - Internet KW - nurses KW - hospital KW - non-work related mobile phone use N2 - Background: Prior research has documented the effect of concurrent mobile phone use on medical care. This study examined the extent of hospital registered nurses? awareness of their mobile-phone-associated performance decrements. Objective: The objective of this study was to compare self-reported performance with reported observed performance of others with respect to mobile phone use by hospital registered nurses. Methods: In March 2014, a previously validated survey was emailed to the 10,978 members of the Academy of Medical Surgical Nurses. The responses were analyzed using a two-proportion z test (alpha=.05, two-tailed) to examine whether self-reported and observed rates of error were significantly different. All possible demographic and employment confounders which could potentially contribute to self-reported and observed performance errors were tested for significance. Results: Of the 950 respondents, 825 (8.68%, 825/950) met the inclusion criteria for analysis. The representativeness of the sample relative to the US nursing workforce was assessed using a two-proportion z test. This indicated that sex and location of primary place of employment (urban/rural) were represented appropriately in the study sample. Respondents in the age groups <40 years old were underrepresented, while age groups >55 years old were overrepresented. Whites, American Indians/Alaskan natives, and Native Hawaiian or Pacific Islanders were underrepresented, while Hispanic and multiple/other ethnicities were overrepresented. It was decided to report the unweighted, rather than the weighted survey data, with the recognition that the results, while valuable, may not be generalizable to the entire US registered nursing workforce. A significant difference was found between registered nurses? self-reported and observed rates of errors associated with concurrent mobile phone use in following three categories (1) work performance (z=?26.6142, P<.001, Fisher?s exact test), (2) missing important clinical information (z=?13.9882, P=.008, Fisher?s exact test), and (3) making a medical error (z=?9.6798, P<.001, Fisher?s exact test). Respondents reported that personal mobile phone use by nurses at work was a serious distraction; always (13%, 107/825), often (29.6%, 244/825), sometimes (44.6%, 368/825), rarely (8.7%, 72/825), or never (1.2%, 10/825). On balance, 69.5% (573/825) of respondents believed that nurses? use of personal mobile phones while working had a negative effect on patient care. Since all possible confounders were tested and none were deemed significant, a multivariate analysis was not considered necessary. Conclusions: Many hospitals are drawing up policies that allow workers to decide how to use their devices at work. This study found that nurses express a disproportionately high confidence in their ability to manage the risk associated with the use of mobile phones and may not be able to accurately assess when it is appropriate to use these devices at work. UR - http://humanfactors.jmir.org/2015/1/e6/ UR - http://dx.doi.org/10.2196/humanfactors.4070 UR - http://www.ncbi.nlm.nih.gov/pubmed/27026182 ID - info:doi/10.2196/humanfactors.4070 ER - TY - JOUR AU - Lim, Joanne AU - Cloete, Garth AU - Dunsmuir, T. Dustin AU - Payne, A. Beth AU - Scheffer, Cornie AU - von Dadelszen, Peter AU - Dumont, A. Guy AU - Ansermino, Mark J. PY - 2015/04/17 TI - Usability and Feasibility of PIERS on the Move: An mHealth App for Pre-Eclampsia Triage JO - JMIR mHealth uHealth SP - e37 VL - 3 IS - 2 KW - pulse oximetry KW - mHealth app KW - predictive model KW - usability analysis KW - design methodology N2 - Background: Pre-eclampsia is one of the leading causes of maternal death and morbidity in low-resource countries due to delays in case identification and a shortage of health workers trained to manage the disorder. Pre-eclampsia Integrated Estimate of RiSk (PIERS) on the Move (PotM) is a low cost, easy-to-use, mobile health (mHealth) platform that has been created to aid health workers in making decisions around the management of hypertensive pregnant women. PotM combines two previously successful innovations into a mHealth app: the miniPIERS risk assessment model and the Phone Oximeter. Objective: The aim of this study was to assess the usability of PotM (with mid-level health workers) for iteratively refining the system. Methods: Development of the PotM user interface involved usability testing with target end-users in South Africa. Users were asked to complete clinical scenario tasks, speaking aloud to give feedback on the interface and then complete a questionnaire. The tool was then evaluated in a pilot clinical evaluation in Tygerberg Hospital, Cape Town. Results: After ethical approval and informed consent, 37 nurses and midwives evaluated the tool. During Study 1, major issues in the functionality of the touch-screen keyboard and date scroll wheels were identified (total errors n=212); during Study 2 major improvements in navigation of the app were suggested (total errors n=144). Overall, users felt the app was usable using the Computer Systems Usability Questionnaire; median (range) values for Study 1 = 2 (1-6) and Study 2 = 1 (1-7).To demonstrate feasibility, PotM was used by one research nurse for the pilot clinical study. In total, more than 500 evaluations were performed on more than 200 patients. The median (interquartile range) time to complete an evaluation was 4 min 55 sec (3 min 25 sec to 6 min 56 sec). Conclusions: By including target end-users in the design and evaluation of PotM, we have developed an app that can be easily integrated into health care settings in low- and middle-income countries. Usability problems were often related to mobile phone features (eg, scroll wheels, touch screen use). Larger scale evaluation of the clinical impact of this tool is underway. UR - http://mhealth.jmir.org/2015/2/e37/ UR - http://dx.doi.org/10.2196/mhealth.3942 UR - http://www.ncbi.nlm.nih.gov/pubmed/25887292 ID - info:doi/10.2196/mhealth.3942 ER - TY - JOUR AU - Hekler, B. Eric AU - Buman, P. Matthew AU - Grieco, Lauren AU - Rosenberger, Mary AU - Winter, J. Sandra AU - Haskell, William AU - King, C. Abby PY - 2015/04/15 TI - Validation of Physical Activity Tracking via Android Smartphones Compared to ActiGraph Accelerometer: Laboratory-Based and Free-Living Validation Studies JO - JMIR mHealth uHealth SP - e36 VL - 3 IS - 2 KW - telemedicine KW - cell phones KW - accelerometry KW - motor activity KW - validation studies N2 - Background: There is increasing interest in using smartphones as stand-alone physical activity monitors via their built-in accelerometers, but there is presently limited data on the validity of this approach. Objective: The purpose of this work was to determine the validity and reliability of 3 Android smartphones for measuring physical activity among midlife and older adults. Methods: A laboratory (study 1) and a free-living (study 2) protocol were conducted. In study 1, individuals engaged in prescribed activities including sedentary (eg, sitting), light (sweeping), moderate (eg, walking 3 mph on a treadmill), and vigorous (eg, jogging 5 mph on a treadmill) activity over a 2-hour period wearing both an ActiGraph and 3 Android smartphones (ie, HTC MyTouch, Google Nexus One, and Motorola Cliq). In the free-living study, individuals engaged in usual daily activities over 7 days while wearing an Android smartphone (Google Nexus One) and an ActiGraph. Results: Study 1 included 15 participants (age: mean 55.5, SD 6.6 years; women: 56%, 8/15). Correlations between the ActiGraph and the 3 phones were strong to very strong (?=.77-.82). Further, after excluding bicycling and standing, cut-point derived classifications of activities yielded a high percentage of activities classified correctly according to intensity level (eg, 78%-91% by phone) that were similar to the ActiGraph?s percent correctly classified (ie, 91%). Study 2 included 23 participants (age: mean 57.0, SD 6.4 years; women: 74%, 17/23). Within the free-living context, results suggested a moderate correlation (ie, ?=.59, P<.001) between the raw ActiGraph counts/minute and the phone?s raw counts/minute and a strong correlation on minutes of moderate-to-vigorous physical activity (MVPA; ie, ?=.67, P<.001). Results from Bland-Altman plots suggested close mean absolute estimates of sedentary (mean difference=?26 min/day of sedentary behavior) and MVPA (mean difference=?1.3 min/day of MVPA) although there was large variation. Conclusions: Overall, results suggest that an Android smartphone can provide comparable estimates of physical activity to an ActiGraph in both a laboratory-based and free-living context for estimating sedentary and MVPA and that different Android smartphones may reliably confer similar estimates. UR - http://mhealth.jmir.org/2015/2/e36/ UR - http://dx.doi.org/10.2196/mhealth.3505 UR - http://www.ncbi.nlm.nih.gov/pubmed/25881662 ID - info:doi/10.2196/mhealth.3505 ER - TY - JOUR AU - Majeed-Ariss, Rabiya AU - Hall, G. Andrew AU - McDonagh, Janet AU - Fallon, Deborah AU - Swallow, Veronica PY - 2015/04/07 TI - Mobile Phone and Tablet Apps to Support Young People?s Management of Their Physical Long-Term Conditions: A Systematic Review Protocol JO - JMIR Res Protoc SP - e40 VL - 4 IS - 2 KW - mobile app KW - mobile phone KW - protocol KW - smartphone KW - tablets KW - young people KW - long-term conditions KW - chronic conditions KW - management KW - systematic review N2 - Background: The prevalence of long-term or chronic conditions that limit activity and reduce quality of life in young people aged 10-24 years is rising. This group has distinct health care needs and requires tailored support strategies to facilitate increasing personal responsibility for the management of their condition wherever possible, as they mature. Mobile phone and tablet mobile technologies featuring software program apps are already well used by young people for social networking or gaming. They have also been utilized in health care to support personal condition management, using condition-specific and patient-tailored software. Such apps have much potential, and there is an emerging body of literature on their use in a health context making this review timely. Objective: The objective of this paper is to develop a systematic review protocol focused on identifying and assessing the effectiveness of mobile phone and tablet apps that support young people?s management of their chronic conditions. Methods: The search strategy will include a combination of standardized indexed search terms and free-text terms related to the key concepts of young people; long-term conditions and mobile technology. Peer-reviewed journal articles published from 2003 that meet the inclusion and exclusion criteria will be identified through searching the generated hits from 5 bibliographical databases. Two independent reviewers will screen the titles and abstracts to determine which articles focus on testing interventions identified as a mobile phone or tablet apps, and that have been designed and delivered to support the management of long-term conditions in young people aged 10-24 years. Data extraction and quality assessment tools will be used to facilitate consistent analysis and synthesis. It is anticipated that several studies will meet the selection criteria but that these are likely to be heterogeneous in terms of study design, reported outcomes, follow-up times, participants? age, and health condition. Sub-group analyses will be undertaken and where possible meta-analyses will take place. Results: This review will synthesize available knowledge surrounding tablet and mobile phone apps that support management of long term physical health conditions in young people. The findings will be synthesized to determine which elements of the technologies were most effective for this population. Conclusions: This systematic review aims to synthesize existing literature in order to generate findings that will facilitate the development of an app intervention. The review will form the first phase of development and evaluation of a complex intervention as recommended by the United Kingdom Medical Research Council. The knowledge gained from the review will be verified in subsequent phases, which will include primary qualitative work with health professionals and young people with long term conditions as research participants. Young people living with long-term conditions will be involved as co-researchers and consumer advisors in all subsequent phases to develop and evaluate an app to support the management of long-term physical health conditions. Trial Registration: PROSPERO International prospective register of systematic reviews: CRD42014015418; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014015418#.VRqCpTpnL8E (Archived by Webcite at http://www.webcitation.org/6XREcWqQY). UR - http://www.researchprotocols.org/2015/2/e40/ UR - http://dx.doi.org/10.2196/resprot.4159 UR - http://www.ncbi.nlm.nih.gov/pubmed/25854293 ID - info:doi/10.2196/resprot.4159 ER - TY - JOUR AU - Zan, Shiyi AU - Agboola, Stephen AU - Moore, A. Stephanie AU - Parks, A. Kimberly AU - Kvedar, C. Joseph AU - Jethwani, Kamal PY - 2015/04/01 TI - Patient Engagement With a Mobile Web-Based Telemonitoring System for Heart Failure Self-Management: A Pilot Study JO - JMIR mHealth uHealth SP - e33 VL - 3 IS - 2 KW - heart failure KW - disease self-management KW - remote monitoring KW - telemonitoring KW - interactive voice response system KW - mobile health KW - Web portal KW - patient engagement KW - quality of life N2 - Background: Intensive remote monitoring programs for congestive heart failure have been successful in reducing costly readmissions, but may not be appropriate for all patients. There is an opportunity to leverage the increasing accessibility of mobile technologies and consumer-facing digital devices to empower patients in monitoring their own health outside of the hospital setting. The iGetBetter system, a secure Web- and telephone-based heart failure remote monitoring program, which leverages mobile technology and portable digital devices, offers a creative solution at lower cost. Objective: The objective of this pilot study was to evaluate the feasibility of using the iGetBetter system for disease self-management in patients with heart failure. Methods: This was a single-arm prospective study in which 21 ambulatory, adult heart failure patients used the intervention for heart failure self-management over a 90-day study period. Patients were instructed to take their weight, blood pressure, and heart rate measurements each morning using a WS-30 bluetooth weight scale, a self-inflating blood pressure cuff (Withings LLC, Issy les Moulineaux, France), and an iPad Mini tablet computer (Apple Inc, Cupertino, CA, USA) equipped with cellular Internet connectivity to view their measurements on the Internet. Outcomes assessed included usability and satisfaction, engagement with the intervention, hospital resource utilization, and heart failure-related quality of life. Descriptive statistics were used to summarize data, and matched controls identified from the electronic medical record were used as comparison for evaluating hospitalizations. Results: There were 20 participants (mean age 53 years) that completed the study. Almost all participants (19/20, 95%) reported feeling more connected to their health care team and more confident in performing care plan activities, and 18/20 (90%) felt better prepared to start discussions about their health with their doctor. Although heart failure-related quality of life improved from baseline, it was not statistically significant (P=.55). Over half of the participants had greater than 80% (72/90 days) weekly and overall engagement with the program, and 15% (3/20) used the interactive voice response telephone system exclusively for managing their care plan. Hospital utilization did not differ in the intervention group compared to the control group (planned hospitalizations P=.23, and unplanned hospitalizations P=.99). Intervention participants recorded shorter average length of hospital stay, but no significant differences were observed between intervention and control groups (P=.30). Conclusions: This pilot study demonstrated the feasibility of a low-intensive remote monitoring program leveraging commonly used mobile and portable consumer devices in augmenting care for a fairly young population of ambulatory patients with heart failure. Further prospective studies with a larger sample size and within more diverse patient populations is necessary to determine the effect of mobile-based remote monitoring programs such as the iGetBetter system on clinical outcomes in heart failure. UR - http://mhealth.jmir.org/2015/2/e33/ UR - http://dx.doi.org/10.2196/mhealth.3789 UR - http://www.ncbi.nlm.nih.gov/pubmed/25842282 ID - info:doi/10.2196/mhealth.3789 ER - TY - JOUR AU - East, Lynette Marlene AU - Havard, C. Byron PY - 2015/03/31 TI - Mental Health Mobile Apps: From Infusion to Diffusion in the Mental Health Social System JO - JMIR Mental Health SP - e10 VL - 2 IS - 1 KW - clinical efficacy KW - counselors KW - ethical codes KW - innovation diffusion KW - instructional technology KW - mental health KW - mHealth KW - mobile health KW - smartphone UR - http://mental.jmir.org/2015/1/e10/ UR - http://dx.doi.org/10.2196/mental.3954 UR - http://www.ncbi.nlm.nih.gov/pubmed/26543907 ID - info:doi/10.2196/mental.3954 ER - TY - JOUR AU - Peragallo Urrutia, Rachel AU - Berger, A. Alexander AU - Ivins, A. Amber AU - Beckham, Jenna A. AU - Thorp Jr, M. John AU - Nicholson, K. Wanda PY - 2015/03/30 TI - Internet Use and Access Among Pregnant Women via Computer and Mobile Phone: Implications for Delivery of Perinatal Care JO - JMIR mHealth uHealth SP - e25 VL - 3 IS - 1 KW - pregnancy KW - postpartum period KW - Internet KW - mobile phone KW - health behavior KW - risk reduction behavior N2 - Background: The use of Internet-based behavioral programs may be an efficient, flexible method to enhance prenatal care and improve pregnancy outcomes. There are few data about access to, and use of, the Internet via computers and mobile phones among pregnant women. Objective: We describe pregnant women?s access to, and use of, computers, mobile phones, and computer technologies (eg, Internet, blogs, chat rooms) in a southern United States population. We describe the willingness of pregnant women to participate in Internet-supported weight-loss interventions delivered via computers or mobile phones. Methods: We conducted a cross-sectional survey among 100 pregnant women at a tertiary referral center ultrasound clinic in the southeast United States. Data were analyzed using Stata version 10 (StataCorp) and R (R Core Team 2013). Means and frequency procedures were used to describe demographic characteristics, access to computers and mobile phones, and use of specific Internet modalities. Chi-square testing was used to determine whether there were differences in technology access and Internet modality use according to age, race/ethnicity, income, or children in the home. The Fisher?s exact test was used to describe preferences to participate in Internet-based postpartum weight-loss interventions via computer versus mobile phone. Logistic regression was used to determine demographic characteristics associated with these preferences. Results: The study sample was 61.0% white, 26.0% black, 6.0% Hispanic, and 7.0% Asian with a mean age of 31.0 (SD 5.1). Most participants had access to a computer (89/100, 89.0%) or mobile phone (88/100, 88.0%) for at least 8 hours per week. Access remained high (>74%) across age groups, racial/ethnic groups, income levels, and number of children in the home. Internet/Web (94/100, 94.0%), email (90/100, 90.0%), and Facebook (50/100, 50.0%) were the most commonly used Internet technologies. Women aged less than 30 years were more likely to report use of Twitter and chat rooms compared to women 30 years of age or older. Of the participants, 82.0% (82/100) were fairly willing or very willing to participate in postpartum lifestyle intervention. Of the participants, 83.0% (83/100) were fairly willing or very willing to participate in an Internet intervention delivered via computer, while only 49.0% (49/100) were fairly willing or very willing to do so via mobile phone technology. Older women and women with children tended to be less likely to desire a mobile phone-based program. Conclusions: There is broad access and use of computer and mobile phone technology among southern US pregnant women with varied demographic characteristics. Pregnant women are willing to participate in Internet-supported perinatal interventions. Our findings can inform the development of computer- and mobile phone-based approaches for the delivery of clinical and educational interventions. UR - http://mhealth.jmir.org/2015/1/e25/ UR - http://dx.doi.org/10.2196/mhealth.3347 UR - http://www.ncbi.nlm.nih.gov/pubmed/25835744 ID - info:doi/10.2196/mhealth.3347 ER - TY - JOUR AU - Vollmer Dahlke, Deborah AU - Fair, Kayla AU - Hong, Alicia Y. AU - Beaudoin, E. Christopher AU - Pulczinski, Jairus AU - Ory, G. Marcia PY - 2015/03/27 TI - Apps Seeking Theories: Results of a Study on the Use of Health Behavior Change Theories in Cancer Survivorship Mobile Apps JO - JMIR mHealth uHealth SP - e31 VL - 3 IS - 1 KW - mobile apps KW - health behavior KW - survivorship KW - health promotion KW - eHealth KW - mobile health N2 - Background: Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories. Objective: This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps. Methods: The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems. Results: A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen?s kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps. Conclusions: Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include interactive and adaptive sensors and other forms of dynamic feedback, their content and interventional elements need to be grounded in human computer interface design and health behavior and communication theory and practice. UR - http://mhealth.jmir.org/2015/1/e31/ UR - http://dx.doi.org/10.2196/mhealth.3861 UR - http://www.ncbi.nlm.nih.gov/pubmed/25830810 ID - info:doi/10.2196/mhealth.3861 ER - TY - JOUR AU - Pan, Di AU - Dhall, Rohit AU - Lieberman, Abraham AU - Petitti, B. Diana PY - 2015/03/26 TI - A Mobile Cloud-Based Parkinson?s Disease Assessment System for Home-Based Monitoring JO - JMIR mHealth uHealth SP - e29 VL - 3 IS - 1 KW - mHealth KW - Smartphone KW - Mobile App KW - Cloud application KW - Parkinson?s Disease KW - Home based monitoring KW - Telemedicine KW - Decision marking KW - Tremor KW - Gait difficulty N2 - Background: Parkinson?s disease (PD) is the most prevalent movement disorder of the central nervous system, and affects more than 6.3 million people in the world. The characteristic motor features include tremor, bradykinesia, rigidity, and impaired postural stability. Current therapy based on augmentation or replacement of dopamine is designed to improve patients? motor performance but often leads to levodopa-induced adverse effects, such as dyskinesia and motor fluctuation. Clinicians must regularly monitor patients in order to identify these effects and other declines in motor function as soon as possible. Current clinical assessment for Parkinson?s is subjective and mostly conducted by brief observations made during patient visits. Changes in patients? motor function between visits are hard to track and clinicians are not able to make the most informed decisions about the course of therapy without frequent visits. Frequent clinic visits increase the physical and economic burden on patients and their families. Objective: In this project, we sought to design, develop, and evaluate a prototype mobile cloud-based mHealth app, ?PD Dr?, which collects quantitative and objective information about PD and would enable home-based assessment and monitoring of major PD symptoms. Methods: We designed and developed a mobile app on the Android platform to collect PD-related motion data using the smartphone 3D accelerometer and to send the data to a cloud service for storage, data processing, and PD symptoms severity estimation. To evaluate this system, data from the system were collected from 40 patients with PD and compared with experts? rating on standardized rating scales. Results: The evaluation showed that PD Dr could effectively capture important motion features that differentiate PD severity and identify critical symptoms. For hand resting tremor detection, the sensitivity was .77 and accuracy was .82. For gait difficulty detection, the sensitivity was .89 and accuracy was .81. In PD severity estimation, the captured motion features also demonstrated strong correlation with PD severity stage, hand resting tremor severity, and gait difficulty. The system is simple to use, user friendly, and economically affordable. Conclusions: The key contribution of this study was building a mobile PD assessment and monitoring system to extend current PD assessment based in the clinic setting to the home-based environment. The results of this study proved feasibility and a promising future for utilizing mobile technology in PD management. UR - http://mhealth.jmir.org/2015/1/e29/ UR - http://dx.doi.org/10.2196/mhealth.3956 UR - http://www.ncbi.nlm.nih.gov/pubmed/25830687 ID - info:doi/10.2196/mhealth.3956 ER - TY - JOUR AU - Owen, E. Jason AU - Jaworski, K. Beth AU - Kuhn, Eric AU - Makin-Byrd, N. Kerry AU - Ramsey, M. Kelly AU - Hoffman, E. Julia PY - 2015/03/25 TI - mHealth in the Wild: Using Novel Data to Examine the Reach, Use, and Impact of PTSD Coach JO - JMIR Mental Health SP - e7 VL - 2 IS - 1 KW - PTSD KW - trauma KW - mHealth KW - mental heatlh KW - mobile app KW - public health KW - self-management N2 - Background: A majority of Americans (58%) now use smartphones, making it possible for mobile mental health apps to reach large numbers of those who are living with untreated, or under-treated, mental health symptoms. Although early trials suggest positive effects for mobile health (mHealth) interventions, little is known about the potential public health impact of mobile mental health apps. Objective: The purpose of this study was to characterize reach, use, and impact of ?PTSD Coach?, a free, broadly disseminated mental health app for managing posttraumatic stress disorder (PTSD) symptoms. Methods: Using a mixed-methods approach, aggregate mobile analytics data from 153,834 downloads of PTSD Coach were analyzed in conjunction with 156 user reviews. Results: Over 60% of users engaged with PTSD Coach on multiple occasions (mean=6.3 sessions). User reviews reflected gratitude for the availability of the app and being able to use the app specifically during moments of need. PTSD Coach users reported relatively high levels of trauma symptoms (mean PTSD Checklist Score=57.2, SD=15.7). For users who chose to use a symptom management tool, distress declined significantly for both first-time users (mean=1.6 points, SD=2.6 on the 10-point distress thermometer) and return-visit users (mean=2.0, SD=2.3). Analysis of app session data identified common points of attrition, with only 80% of first-time users reaching the app?s home screen and 37% accessing one of the app?s primary content areas. Conclusions: These findings suggest that PTSD Coach has achieved substantial and sustained reach in the population, is being used as intended, and has been favorably received. PTSD Coach is a unique platform for the delivery of mobile mental health education and treatment, and continuing evaluation and improvement of the app could further strengthen its public health impact. UR - http://mental.jmir.org/2015/1/e7/ UR - http://dx.doi.org/10.2196/mental.3935 UR - http://www.ncbi.nlm.nih.gov/pubmed/26543913 ID - info:doi/10.2196/mental.3935 ER - TY - JOUR AU - Dobson, Rosie AU - Carter, Karen AU - Cutfield, Richard AU - Hulme, Ashley AU - Hulme, Richard AU - McNamara, Catherine AU - Maddison, Ralph AU - Murphy, Rinki AU - Shepherd, Matthew AU - Strydom, Johan AU - Whittaker, Robyn PY - 2015/03/25 TI - Diabetes Text-Message Self-Management Support Program (SMS4BG): A Pilot Study JO - JMIR mHealth uHealth SP - e32 VL - 3 IS - 1 KW - mHealth KW - diabetes mellitus KW - text message KW - mobile phone KW - SMS KW - self-management N2 - Background: The increasing prevalence of diabetes and costly long-term complications associated with poor glycemic control are issues facing health services worldwide. Diabetes self-management, with the support of health care providers, is critical for successful outcomes, however, frequent clinical contact is costly. Text messages via short message service (SMS) have the advantage of instant transmission at low cost and, given the ubiquity of mobile phones, may be the ideal platform for the delivery of diabetes self-management support. A tailored text message-based diabetes support intervention called Self-Management Support for Blood Glucose (SMS4BG) was developed. The intervention incorporates prompts around diabetes education, management, and lifestyle factors (healthy eating, exercise, and stress management), as well as blood glucose monitoring reminders, and is tailored to patient preferences and clinical characteristics. Objective: To determine the usability and acceptability of SMS4BG among adults with poorly controlled diabetes. Methods: Adults (aged 17 to 69 years) with type 1 (n=12) or type 2 diabetes (n=30), a hemoglobin A1c (HbA1c) over 70 mmol/mol (8.6%), and who owned a mobile phone (n=42) were recruited to take part in a 3-month pilot study of SMS4BG. At registration, participants selected the modules they would like to receive and, where appropriate, the frequency and timing of blood glucose monitoring reminders. Patient satisfaction and perceptions of the usability of the program were obtained via semistructured phone interviews conducted at completion of the pilot study. HbA1c was obtained from patient records at baseline and completion of the pilot study. Results: Participants received on average 109 messages during the 3-month program with 2 participants withdrawing early from the study. Follow-up interviews were completed with 93% of participants with all reporting SMS4BG to be useful and appropriate to their age and culture. Participants reported a range of perceived positive impacts of SMS4BG on their diabetes and health behaviors. HbA1c results indicated a positive impact of the program on glycemic control with a significant decrease in HbA1c from baseline to follow-up. Conclusions: A tailored text message-based intervention is both acceptable and useful in supporting self-management in people with poorly controlled diabetes. A randomized controlled trial of longer duration is needed to assess the efficacy and sustainability of SMS4BG. UR - http://mhealth.jmir.org/2015/1/e32/ UR - http://dx.doi.org/10.2196/mhealth.3988 UR - http://www.ncbi.nlm.nih.gov/pubmed/25830952 ID - info:doi/10.2196/mhealth.3988 ER - TY - JOUR AU - Torous, John AU - Staples, Patrick AU - Shanahan, Meghan AU - Lin, Charlie AU - Peck, Pamela AU - Keshavan, Matcheri AU - Onnela, Jukka-Pekka PY - 2015/03/24 TI - Utilizing a Personal Smartphone Custom App to Assess the Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder JO - JMIR Mental Health SP - e8 VL - 2 IS - 1 KW - medical informatics KW - mobile health KW - depression N2 - Background: Accurate reporting of patient symptoms is critical for diagnosis and therapeutic monitoring in psychiatry. Smartphones offer an accessible, low-cost means to collect patient symptoms in real time and aid in care. Objective: To investigate adherence among psychiatric outpatients diagnosed with major depressive disorder in utilizing their personal smartphones to run a custom app to monitor Patient Health Questionnaire-9 (PHQ-9) depression symptoms, as well as to examine the correlation of these scores to traditionally administered (paper-and-pencil) PHQ-9 scores. Methods: A total of 13 patients with major depressive disorder, referred by their clinicians, received standard outpatient treatment and, in addition, utilized their personal smartphones to run the study app to monitor their symptoms. Subjects downloaded and used the Mindful Moods app on their personal smartphone to complete up to three survey sessions per day, during which a randomized subset of PHQ-9 symptoms of major depressive disorder were assessed on a Likert scale. The study lasted 29 or 30 days without additional follow-up. Outcome measures included adherence, measured by the percentage of completed survey sessions, and estimates of daily PHQ-9 scores collected from the smartphone app, as well as from the traditionally administered PHQ-9. Results: Overall adherence was 77.78% (903/1161) and varied with time of day. PHQ-9 estimates collected from the app strongly correlated (r=.84) with traditionally administered PHQ-9 scores, but app-collected scores were 3.02 (SD 2.25) points higher on average. More subjects reported suicidal ideation using the app than they did on the traditionally administered PHQ-9. Conclusions: Patients with major depressive disorder are able to utilize an app on their personal smartphones to self-assess their symptoms of major depressive disorder with high levels of adherence. These app-collected results correlate with the traditionally administered PHQ-9. Scores recorded from the app may potentially be more sensitive and better able to capture suicidality than the traditional PHQ-9. UR - http://mental.jmir.org/2015/1/e8/ UR - http://dx.doi.org/10.2196/mental.3889 UR - http://www.ncbi.nlm.nih.gov/pubmed/26543914 ID - info:doi/10.2196/mental.3889 ER - TY - JOUR AU - Siedner, J. Mark AU - Santorino, Data AU - Haberer, E. Jessica AU - Bangsberg, R. David PY - 2015/03/24 TI - Know Your Audience: Predictors of Success for a Patient-Centered Texting App to Augment Linkage to HIV Care in Rural Uganda JO - J Med Internet Res SP - e78 VL - 17 IS - 3 KW - telemedicine KW - text messaging KW - randomized controlled trial KW - Uganda KW - HIV N2 - Background: Despite investments in infrastructure and evidence for high acceptability, few mHealth interventions have been implemented in sub-Saharan Africa. Objective: We sought to (1) identify predictors of uptake of an mHealth application for a low-literacy population of people living with HIV (PLWH) in rural Uganda and (2) evaluate the efficacy of various short message service (SMS) text message formats to optimize the balance between confidentiality and accessibility. Methods: The trial evaluated the efficacy of a SMS text messaging app to notify PLWH of their laboratory results and request return to care for those with abnormal test results. Participants with a normal laboratory result received a single SMS text message indicating results were normal. Participants with an abnormal test result were randomized to 1 of 3 message formats designed to evaluate trade-offs between clarity and privacy: (1) an SMS text message that stated results were abnormal and requested return to clinic (?direct?), (2) the same message protected by a 4-digit PIN code (?PIN?), and (3) the message ?ABCDEFG? explained at enrollment to indicate abnormal results (?coded?). Outcomes of interest were (1) self-reported receipt of the SMS text message, (2) accurate identification of the message, and (3) return to care within 7 days (for abnormal results) or on the date of the scheduled appointment (for normal results). We fit regression models for each outcome with the following explanatory variables: sociodemographic characteristics, CD4 count result, ability to read a complete sentence, ability to access a test message on enrollment, and format of SMS text message. Results: Seventy-two percent (234/385) of participants successfully receiving a message, 87.6% (219/250) correctly identified the message format, and 60.8% (234/385) returned to clinic at the requested time. Among participants with abnormal tests results (138/385, 35.8%), the strongest predictors of reported message receipt were the ability to read a complete sentence and a demonstrated ability to access a test message on enrollment. Participants with an abnormal result who could read a complete sentence were also more likely to accurately identify the message format (AOR 4.54, 95% CI 1.42-14.47, P=.01) and return to clinic appropriately (AOR 3.81, 95% CI 1.61-9.03, P=.002). Those who were sent a PIN-protected message were less likely to identify the message (AOR 0.11, 95% CI 0.03-0.44, P=.002) or return within 7 days (AOR 0.26, 95% CI 0.10-0.66, P=.005). Gender, age, and socioeconomic characteristics did not predict any outcomes and there were no differences in outcomes between those receiving direct or coded messages. Conclusions: Confirmed literacy at the time of enrollment was a robust predictor of SMS text message receipt, identification, and appropriate response for PLWH in rural Uganda. PIN-protected messages reduced odds of clinic return, but coded messages were as effective as direct messages and might augment privacy. Trial Registration: Clinicaltrials.gov NCT 01579214; https://clinicaltrials.gov/ct2/show/NCT01579214 (Archived by WebCite at http://www.webcitation.org/6Ww8R4sKq). UR - http://www.jmir.org/2015/3/e78/ UR - http://dx.doi.org/10.2196/jmir.3859 UR - http://www.ncbi.nlm.nih.gov/pubmed/25831269 ID - info:doi/10.2196/jmir.3859 ER - TY - JOUR AU - Xu, Wenlong AU - Liu, Yin PY - 2015/03/18 TI - mHealthApps: A Repository and Database of Mobile Health Apps JO - JMIR mHealth uHealth SP - e28 VL - 3 IS - 1 KW - mobile healtlh KW - app repository KW - app database N2 - Background: The market of mobile health (mHealth) apps has rapidly evolved in the past decade. With more than 100,000 mHealth apps currently available, there is no centralized resource that collects information on these health-related apps for researchers in this field to effectively evaluate the strength and weakness of these apps. Objective: The objective of this study was to create a centralized mHealth app repository. We expect the analysis of information in this repository to provide insights for future mHealth research developments. Methods: We focused on apps from the two most established app stores, the Apple App Store and the Google Play Store. We extracted detailed information of each health-related app from these two app stores via our python crawling program, and then stored the information in both a user-friendly array format and a standard JavaScript Object Notation (JSON) format. Results: We have developed a centralized resource that provides detailed information of more than 60,000 health-related apps from the Apple App Store and the Google Play Store. Using this information resource, we analyzed thousands of apps systematically and provide an overview of the trends for mHealth apps. Conclusions: This unique database allows the meta-analysis of health-related apps and provides guidance for research designs of future apps in the mHealth field. UR - http://mhealth.jmir.org/2015/1/e28/ UR - http://dx.doi.org/10.2196/mhealth.4026 UR - http://www.ncbi.nlm.nih.gov/pubmed/25786060 ID - info:doi/10.2196/mhealth.4026 ER - TY - JOUR AU - Levy, Natalie AU - Moynihan, Victoria AU - Nilo, Annielyn AU - Singer, Karyn AU - Bernik, S. Lidia AU - Etiebet, Mary-Ann AU - Fang, Yixin AU - Cho, James AU - Natarajan, Sundar PY - 2015/03/13 TI - The Mobile Insulin Titration Intervention (MITI) for Insulin Glargine Titration in an Urban, Low-Income Population: Randomized Controlled Trial Protocol JO - JMIR Res Protoc SP - e31 VL - 4 IS - 1 KW - patient care management KW - delivery of care KW - health care disparities KW - telemedicine KW - remote consultation N2 - Background: Patients on insulin glargine typically visit a clinician to obtain advice on how to adjust their insulin dose. These multiple clinic visits can be costly and time-consuming, particularly for low-income patients. It may be feasible to achieve insulin titration through text messages and phone calls with patients instead of face-to-face clinic visits. Objective: The objectives of this study are to (1) evaluate if the Mobile Insulin Titration Intervention (MITI) is clinically effective by helping patients reach their optimal dose of insulin glargine, (2) determine if the intervention is feasible within the setting and population, (3) assess patient satisfaction with the intervention, and (4) measure the costs associated with this intervention. Methods: This is a pilot study evaluating an approach to insulin titration using text messages and phone calls among patients with insulin-dependent type 2 diabetes in the outpatient medical clinic of Bellevue Hospital Center, a safety-net hospital in New York City. Patients will be randomized in a 1:1 ratio to either the MITI arm (texting/phone call intervention) or the usual-care arm (in-person clinic visits). Using a Web-based platform, weekday text messages will be sent to patients in the MITI arm, asking them to text back their fasting blood glucose values. In addition to daily reviews for alarm values, a clinician will rereview the texted values weekly, consult our physician-approved titration algorithm, and call the patients with advice on how to adjust their insulin dose. The primary outcome will be whether or not a patient reaches his/her optimal dose of insulin glargine within 12 weeks. Results: Recruitment for this study occurred between June 2013 and December 2014. We are continuing to collect intervention and follow-up data from our patients who are currently enrolled. The results of our data analysis are expected to be available in 2015. Conclusions: This study explores the use of widely-available text messaging and voice technologies for insulin titration. We aim to show that remote insulin titration is clinically effective, feasible, satisfactory, and cost saving for low-income patients in a busy, urban clinic. Trial Registration: Trial Registration: Clinicaltrials.gov NCT01879579; http://clinicaltrials.gov/ct2/show/NCT01879579 (Archived by WebCite at http://www.webcitation.org/6WUEgjZUO). UR - http://www.researchprotocols.org/2015/1/e31/ UR - http://dx.doi.org/10.2196/resprot.4206 UR - http://www.ncbi.nlm.nih.gov/pubmed/25794243 ID - info:doi/10.2196/resprot.4206 ER - TY - JOUR AU - Nhavoto, António José AU - Grönlund, Åke AU - Chaquilla, Ponce Walter PY - 2015/03/09 TI - SMSaúde: Design, Development, and Implementation of a Remote/Mobile Patient Management System to Improve Retention in Care for HIV/AIDS and Tuberculosis Patients JO - JMIR mHealth uHealth SP - e26 VL - 3 IS - 1 KW - mobile health KW - text messaging KW - SMS system KW - patient management KW - design science research KW - Mozambique N2 - Background: The widespread and low cost of mobile phones and the convenience of short message service (SMS) text messaging suggest potential suitability for use with alternative strategies for supporting retention in care and adherence to the treatment of various chronic diseases, such as HIV and tuberculosis (TB). Despite the growing body of literature reporting positive outcomes of SMS text message-based communication with patients, there is yet very little research about the integration of communication technologies and electronic medical records or electronic patient tracking systems. Objective: To design, develop, and implement an integrated mobile phone text messaging system used to follow up with patients with HIV and TB in treatment in Mozambique. Methods: Following the design science research methodology, we developed a Web-based system that provides support to patients. A case study involving three health care sites in Mozambique was a basis for discussing design issues for this kind of system. We used brainstorming techniques to solicit usability requirements, focus group meetings to discuss and define system architecture, and prototyping to test in real environments and to improve the system. Results: We found six sets of system requirements that need to be addressed for success: data collection, telecommunication costs, privacy and data security, text message content, connectivity, and system scalability. A text messaging system was designed and implemented in three health facilities. These sites feed data into a central data repository, which can be used for analysis of operations and decision support. Based on the treatment schedule, the system automatically sent SMS text message appointment reminders, medication reminders, as well as motivational and educational messages to patients enrolled in antiretroviral therapy and TB treatment programs. Conclusions: We successfully defined the requirements for, designed, and implemented a mobile phone text messaging system to support HIV and TB treatments. Implementation of this system could improve patients? self-management skills and strengthen communication between patients and health care providers. UR - http://mhealth.jmir.org/2015/1/e26/ UR - http://dx.doi.org/10.2196/mhealth.3854 UR - http://www.ncbi.nlm.nih.gov/pubmed/25757551 ID - info:doi/10.2196/mhealth.3854 ER - TY - JOUR AU - Scheibe, Madlen AU - Reichelt, Julius AU - Bellmann, Maike AU - Kirch, Wilhelm PY - 2015/03/02 TI - Acceptance Factors of Mobile Apps for Diabetes by Patients Aged 50 or Older: A Qualitative Study JO - Med 2.0 SP - e1 VL - 4 IS - 1 KW - mobile apps KW - mobile health KW - elderly KW - diabetes mellitus KW - blood sugar self-monitoring KW - patient acceptance of health care KW - qualitative research KW - guided interviews N2 - Background: Mobile apps for people with diabetes offer great potential to support therapy management, increase therapy adherence, and reduce the probability of the occurrence of accompanying and secondary diseases. However, they are rarely used by elderly patients due to a lack of acceptance. Objective: We investigated the question ?Which factors influence the acceptance of diabetes apps among patients aged 50 or older?? Particular emphasis was placed on the current use of mobile devices/apps, acceptance-promoting/-inhibiting factors, features of a helpful diabetes app, and contact persons for technical questions. This qualitative study was the third of three substudies investigating factors influencing acceptance of diabetes apps among patients aged 50 or older. Methods: Guided interviews were chosen in order to get a comprehensive insight into the subjective perspective of elderly diabetes patients. At the end of each interview, the patients tested two existing diabetes apps to reveal obstacles in (first) use. Results: Altogether, 32 patients with diabetes were interviewed. The mean age was 68.8 years (SD 8.2). Of 32 participants, 15 (47%) knew apps, however only 2 (6%) had already used a diabetes app within their therapy. The reasons reported for being against the use of apps were a lack of additional benefits (4/8, 50%) compared to current therapy management, a lack of interoperability with other devices/apps (1/8, 12%), and no joy of use (1/8, 12%). The app test revealed the following main difficulties in use: nonintuitive understanding of the functionality of the apps (26/29, 90%), nonintuitive understanding of the menu navigation/labeling (19/29, 66%), font sizes and representations that were too small (14/29, 48%), and difficulties in recognizing and pressing touch-sensitive areas (14/29, 48%). Furthermore, the patients felt the apps lacked individually important functions (11/29, 38%), or felt the functions that were offered were unnecessary for their own therapy needs (10/29, 34%). The most important contents of a helpful diabetes app were reported as the ability to add remarks to measured values (9/28, 32%), the definition of thresholds for blood glucose values and highlighting deviating values (7/28, 25%), and a reminder feature for measurement/medication (7/28, 25%). The most important contact persons for technical questions were family members (19/31, 61%). Conclusions: A lack of additional benefits and ease of use emerged as the key factors for the acceptance of diabetes apps among patients aged 50 or older. Furthermore, it has been shown that the needs of the investigated target group are highly heterogeneous due to varying previous knowledge, age, type of diabetes, and therapy. Therefore, a helpful diabetes app should be individually adaptable. Personal contact persons, especially during the initial phase of use, are of utmost importance to reduce the fear of data loss or erroneous data input, and to raise acceptance among this target group. UR - http://www.medicine20.com/2015/1/e1/ UR - http://dx.doi.org/10.2196/med20.3912 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/med20.3912 ER - TY - JOUR AU - Safran Naimark, Jenny AU - Madar, Zecharia AU - R Shahar, Danit PY - 2015/03/02 TI - The Impact of a Web-Based App (eBalance) in Promoting Healthy Lifestyles: Randomized Controlled Trial JO - J Med Internet Res SP - e56 VL - 17 IS - 3 KW - Web-based KW - healthy lifestyle KW - mobile apps KW - mhealth N2 - Background: The use of Web-based apps to promote a healthy lifestyle is increasing, although most of these programs were not assessed using suitable epidemiological methods. We evaluated the effectiveness of a newly developed Web-based app in promoting a healthy lifestyle and educating adults on such lifestyles. We also analyzed predictors for success in acquiring and maintaining a healthy lifestyle. Objective: Our aim was to compare people receiving a new Web-based app with people who got an introductory lecture alone on healthy lifestyle, weight change, nutritional knowledge, and physical activity, and to identify predictors of success for maintaining a healthy lifestyle. Methods: Subjects were recruited from the community and were randomized into intervention and control groups. The intervention subjects received access to the app without any face-to-face support; the control subjects continued their standard lifestyle. Measurements were taken by the researcher at baseline and after 14 weeks and included weight and waist circumference. Nutritional knowledge, diet quality, and physical activity duration were obtained using online questionnaires. The new Web-based app was developed based on current US Department of Agriculture and Israel Ministry of Health recommendations for healthy lifestyle. The app provides tools for monitoring diet and physical activity while instructing and encouraging healthy diet and physical activity. Results: Out of 99 subjects who were randomized into app and control groups, 85 participants (86%) completed the study, 56 in the intervention and 29 in the control group. The mean age was 47.9 (SD 12.3) years, and mean Body Mass Index was 26.2 (SD 3.9). Among the intervention group only, frequency of app use was 2.7 (SD 1.9) days/week. The mean change in physical activity was 63 (SD 20.8) minutes in the app group and -30 (SD 27.5) minutes in the control group (P=.02). The mean weight change was -1.44 (SD 0.4) kg in the app group and -0.128 (SD 0.36) kg in the control group (P=.03). Knowledge score increased significantly in the app group, 76 (SD 7.5) to 79 (SD 8.7) at the end of the study (P=.04) compared with the control group. Diet quality score also increased significantly at the end of the study, from 67 (SD 9.8) to 71 (SD 7.6; P<.001) in contrast to the control group. Success score (represents the success in maintaining healthy lifestyle) was higher among the app group (68%) compared with 36% in the control group (P<.001). The app frequency of use was significantly related to a higher success score (P<.001). Conclusions: We showed a positive impact of a newly developed Web-based app on lifestyle indicators during an intervention of 14 weeks. These results are promising in the app?s potential to promote a healthy lifestyle, although larger and longer duration studies are needed to achieve more definitive conclusions. Trial Registration: Clinicaltrial.gov number: NCT01913496; http://www.clinicaltrials.gov/ct2/show/NCT01913496 (Archived by WebCite at http://www.webcitation.org/6WSTUEPuJ). UR - http://www.jmir.org/2015/3/e56/ UR - http://dx.doi.org/10.2196/jmir.3682 UR - http://www.ncbi.nlm.nih.gov/pubmed/25732936 ID - info:doi/10.2196/jmir.3682 ER - TY - JOUR AU - Haun, N. Jolie AU - Nazi, M. Kim AU - Chavez, Margeaux AU - Lind, D. Jason AU - Antinori, Nicole AU - Gosline, M. Robert AU - Martin, L. Tracey PY - 2015/02/27 TI - A Participatory Approach to Designing and Enhancing Integrated Health Information Technology Systems for Veterans: Protocol JO - JMIR Res Protoc SP - e28 VL - 4 IS - 1 KW - veterans KW - patient-provider communication KW - Department of Veterans Affairs KW - mixed methods KW - patient-centered care N2 - Background: The Department of Veterans Affairs (VA) has developed health information technologies (HIT) and resources to improve veteran access to health care programs and services, and to support a patient-centered approach to health care delivery. To improve VA HIT access and meaningful use by veterans, it is necessary to understand their preferences for interacting with various HIT resources to accomplish health management related tasks and to exchange information. Objective: The objective of this paper was to describe a novel protocol for: (1) developing a HIT Digital Health Matrix Model; (2) conducting an Analytic Hierarchy Process called pairwise comparison to understand how and why veterans want to use electronic health resources to complete tasks related to health management; and (3) developing visual modeling simulations that depict veterans? preferences for using VA HIT to manage their health conditions and exchange health information. Methods: The study uses participatory research methods to understand how veterans prefer to use VA HIT to accomplish health management tasks within a given context, and how they would like to interact with HIT interfaces (eg, look, feel, and function) in the future. This study includes two rounds of veteran focus groups with self-administered surveys and visual modeling simulation techniques. This study will also convene an expert panel to assist in the development of a VA HIT Digital Health Matrix Model, so that both expert panel members and veteran participants can complete an Analytic Hierarchy Process, pairwise comparisons to evaluate and rank the applicability of electronic health resources for a series of health management tasks. Results: This protocol describes the iterative, participatory, and patient-centered process for: (1) developing a VA HIT Digital Health Matrix Model that outlines current VA patient-facing platforms available to veterans, describing their features and relevant contexts for use; and (2) developing visual model simulations based on direct veteran feedback that depict patient preferences for enhancing the synchronization, integration, and standardization of VA patient-facing platforms. Focus group topics include current uses, preferences, facilitators, and barriers to using electronic health resources; recommendations for synchronizing, integrating, and standardizing VA HIT; and preferences on data sharing and delegation within the VA system. Conclusions: This work highlights the practical, technological, and personal factors that facilitate and inhibit use of current VA HIT, and informs an integrated system redesign. The Digital Health Matrix Model and visual modeling simulations use knowledge of veteran preferences and experiences to directly inform enhancements to VA HIT and provide a more holistic and integrated user experience. These efforts are designed to support the adoption and sustained use of VA HIT to support patient self-management and clinical care coordination in ways that are directly aligned with veteran preferences. UR - http://www.researchprotocols.org/2015/1/e28/ UR - http://dx.doi.org/10.2196/resprot.3815 UR - http://www.ncbi.nlm.nih.gov/pubmed/25803324 ID - info:doi/10.2196/resprot.3815 ER - TY - JOUR AU - Iribarren, J. Sarah AU - Sward, A. Katherine AU - Beck, L. Susan AU - Pearce, F. Patricia AU - Thurston, Diana AU - Chirico, Cristina PY - 2015/02/27 TI - Qualitative Evaluation of a Text Messaging Intervention to Support Patients With Active Tuberculosis: Implementation Considerations JO - JMIR mHealth uHealth SP - e21 VL - 3 IS - 1 KW - mHealth KW - tuberculosis KW - sociotechnical evaluation KW - text messaging N2 - Background: Tuberculosis (TB) remains a major global public health problem and mobile health (mHealth) interventions have been identified as a modality to improve TB outcomes. TextTB, an interactive text-based intervention to promote adherence with TB medication, was pilot-tested in Argentina with results supporting the implementation of trials at a larger scale. Objective: The objective of this research was to understand issues encountered during pilot-testing in order to inform future implementation in a larger-scale trial. Methods: A descriptive, observational qualitative design guided by a sociotechnical framework was used. The setting was a clinic within a public pulmonary-specialized hospital in Argentina. Data were collected through workflow observation over 115 days, text messages (n=2286), review of the study log, and stakeholder input. Emerging issues were categorized as organizational, human, technical, or sociotechnical considerations. Results: Issues related to the intervention included workflow issues (eg, human, training, security), technical challenges (eg, data errors, platform shortcomings), and message delivery issues (eg, unintentional sending of multiple messages, auto-confirmation problems). System/contextual issues included variable mobile network coverage, electrical and Internet outages, and medication shortages. Conclusions: Intervention challenges were largely manageable during pilot-testing, but need to be addressed systematically before proceeding with a larger-scale trial. Potential solutions are outlined. Findings may help others considering implementing an mHealth intervention to anticipate and mitigate certain challenges. Although some of the issues may be context dependent, other issues such as electrical/Internet outages and limited resources are not unique issues to our setting. Release of new software versions did not result in solutions for certain issues, as specific features used were removed. Therefore, other software options will need to be considered before expanding into a larger-scale endeavor. Improved automation of some features will be necessary, however, a goal will be to retain the intervention capability to be interactive, user friendly, and patient focused. Continued collaboration with stakeholders will be required to conduct further research and to understand how such an mHealth intervention can be effectively integrated into larger health systems. UR - http://mhealth.jmir.org/2015/1/e21/ UR - http://dx.doi.org/10.2196/mhealth.3971 UR - http://www.ncbi.nlm.nih.gov/pubmed/25802968 ID - info:doi/10.2196/mhealth.3971 ER - TY - JOUR AU - Payne, E. Hannah AU - Lister, Cameron AU - West, H. Joshua AU - Bernhardt, M. Jay PY - 2015/02/26 TI - Behavioral Functionality of Mobile Apps in Health Interventions: A Systematic Review of the Literature JO - JMIR mHealth uHealth SP - e20 VL - 3 IS - 1 KW - smartphone KW - app KW - health behavior KW - systematic review KW - interventions N2 - Background: Several thousand mobile phone apps are available to download to mobile phones for health and fitness. Mobile phones may provide a unique means of administering health interventions to populations. Objective: The purpose of this systematic review was to systematically search and describe the literature on mobile apps used in health behavior interventions, describe the behavioral features and focus of health apps, and to evaluate the potential of apps to disseminate health behavior interventions. Methods: We conducted a review of the literature in September 2014 using key search terms in several relevant scientific journal databases. Only English articles pertaining to health interventions using mobile phone apps were included in the final sample. Results: The 24 studies identified for this review were primarily feasibility and pilot studies of mobile apps with small sample sizes. All studies were informed by behavioral theories or strategies, with self-monitoring as the most common construct. Acceptability of mobile phone apps was high among mobile phone users. Conclusions: The lack of large sample studies using mobile phone apps may signal a need for additional studies on the potential use of mobile apps to assist individuals in changing their health behaviors. Of these studies, there is early evidence that apps are well received by users. Based on available research, mobile apps may be considered a feasible and acceptable means of administering health interventions, but a greater number of studies and more rigorous research and evaluations are needed to determine efficacy and establish evidence for best practices. UR - http://mhealth.jmir.org/2015/1/e20/ UR - http://dx.doi.org/10.2196/mhealth.3335 UR - http://www.ncbi.nlm.nih.gov/pubmed/25803705 ID - info:doi/10.2196/mhealth.3335 ER - TY - JOUR AU - Baron, Justine AU - Hirani, Shashivadan AU - Newman, Stanton PY - 2015/02/26 TI - A Mobile Telehealth Intervention for Adults With Insulin-Requiring Diabetes: Early Results of a Mixed-Methods Randomized Controlled Trial JO - JMIR Res Protoc SP - e27 VL - 4 IS - 1 KW - mobile telehealth KW - self-management KW - mixed-method design KW - diabetes KW - glycated hemoglobin (HbA1c) KW - health-related quality of life KW - intervention fidelity KW - behavior change N2 - Background: The role of technology in health care delivery has grown rapidly in the last decade. The potential of mobile telehealth (MTH) to support patient self-management is a key area of research. Providing patients with technological tools that allow for the recording and transmission of health parameters to health care professionals (HCPs) may promote behavior changes that result in improved health outcomes. Although for some conditions the evidence of the effectiveness of MTH is clear, to date the findings on the effects of MTH on diabetes management remain inconsistent. Objective: This study aims to evaluate an MTH intervention among insulin-requiring adults with diabetes to establish whether supplementing standard care with MTH results in improved health outcomes?glycated hemoglobin (HbA1c), blood pressure (BP), health-related quality of life (HRQoL), diabetes self-management behaviors, diabetes health care utilization, and diabetes self-efficacy and illness beliefs. An additional objective was to explore the acceptability of MTH and patients? perceptions of, and experience, using it. Methods: A mixed-method design consisting of a 9-month, two-arm, parallel randomized controlled trial (RCT) was used in combination with exit qualitative interviews. Quantitative data was collected at baseline, 3 months, and 9 months. Additional intervention fidelity data, such as participants? MTH transmissions and contacts with the MTH nurse during the study, were also recorded. Results: Data collection for both the quantitative and qualitative components of this study has ended and data analysis is ongoing. A total of 86 participants were enrolled into the study. Out of 86 participants, 45 (52%) were randomized to the intervention group and 36 (42%) to the control group. Preliminary data on MTH training sessions and MTH usage by intervention participants are presented in this paper. We expect to publish complete study results in 2015. Conclusions: The range of data collected in this study will allow for a comprehensive evaluation of processes and outcomes. The early results presented suggest that MTH usage decreases over time and that MTH participants would benefit from attending more than one training session. Trial Registration: ClinicalTrials.gov NCT00922376; http://clinicaltrials.gov/ct2/show/NCT00922376 (Archived by WebCite at http://www.webcitation.org/6Vu4nhLI6). UR - http://www.researchprotocols.org/2015/1/e27/ UR - http://dx.doi.org/10.2196/resprot.4035 UR - http://www.ncbi.nlm.nih.gov/pubmed/25803226 ID - info:doi/10.2196/resprot.4035 ER - TY - JOUR AU - Bock, C. Beth AU - Rosen, K. Rochelle AU - Barnett, P. Nancy AU - Thind, Herpreet AU - Walaska, Kristen AU - Foster, Robert AU - Deutsch, Christopher AU - Traficante, Regina PY - 2015/02/24 TI - Translating Behavioral Interventions Onto mHealth Platforms: Developing Text Message Interventions for Smoking and Alcohol JO - JMIR mHealth uHealth SP - e22 VL - 3 IS - 1 KW - mHealth KW - text message KW - smoking cessation KW - alcohol KW - qualitative methods UR - http://mhealth.jmir.org/2015/1/e22/ UR - http://dx.doi.org/10.2196/mhealth.3779 UR - http://www.ncbi.nlm.nih.gov/pubmed/25714907 ID - info:doi/10.2196/mhealth.3779 ER - TY - JOUR AU - Hamine, Saee AU - Gerth-Guyette, Emily AU - Faulx, Dunia AU - Green, B. Beverly AU - Ginsburg, Sarah Amy PY - 2015/02/24 TI - Impact of mHealth Chronic Disease Management on Treatment Adherence and Patient Outcomes: A Systematic Review JO - J Med Internet Res SP - e52 VL - 17 IS - 2 KW - telemedicine KW - mHealth KW - mobile health KW - patient compliance KW - patient adherence KW - chronic disease KW - diabetes mellitus KW - cardiovascular diseases KW - lung diseases N2 - Background: Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. As the burden of chronic diseases continues to grow globally, so does the impact of non-adherence. Mobile technologies are increasingly being used in health care and public health practice (mHealth) for patient communication, monitoring, and education, and to facilitate adherence to chronic diseases management. Objective: We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management (?mAdherence?), and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers. Methods: We searched PubMed, Embase, and EBSCO databases for studies that assessed the role of mAdherence in chronic disease management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 1980 through May 2014. Outcomes of interest included effect of mHealth on patient adherence to chronic diseases management, disease-specific clinical outcomes after intervention, and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among target end-users. Results: In all, 107 articles met all inclusion criteria. Short message service was the most commonly used mAdherence tool in 40.2% (43/107) of studies. Usability, feasibility, and acceptability or patient preferences for mAdherence interventions were assessed in 57.9% (62/107) of studies and found to be generally high. A total of 27 studies employed randomized controlled trial (RCT) methods to assess impact on adherence behaviors, and significant improvements were observed in 15 of those studies (56%). Of the 41 RCTs that measured effects on disease-specific clinical outcomes, significant improvements between groups were reported in 16 studies (39%). Conclusions: There is potential for mHealth tools to better facilitate adherence to chronic disease management, but the evidence supporting its current effectiveness is mixed. Further research should focus on understanding and improving how mHealth tools can overcome specific barriers to adherence. UR - http://www.jmir.org/2015/2/e52/ UR - http://dx.doi.org/10.2196/jmir.3951 UR - http://www.ncbi.nlm.nih.gov/pubmed/25803266 ID - info:doi/10.2196/jmir.3951 ER - TY - JOUR AU - Atreja, Ashish AU - Khan, Sameer AU - Rogers, D. Jason AU - Otobo, Emamuzo AU - Patel, P. Nishant AU - Ullman, Thomas AU - Colombel, Fred Jean AU - Moore, Shirley AU - Sands, E. Bruce AU - PY - 2015/02/18 TI - Impact of the Mobile HealthPROMISE Platform on the Quality of Care and Quality of Life in Patients With Inflammatory Bowel Disease: Study Protocol of a Pragmatic Randomized Controlled Trial JO - JMIR Res Protoc SP - e23 VL - 4 IS - 1 KW - medical informatics KW - patient reported outcome KW - mHealth KW - engagement N2 - Background: Inflammatory bowel disease (IBD) is a chronic condition of the bowel that affects over 1 million people in the United States. The recurring nature of disease makes IBD patients ideal candidates for patient-engaged care that is centered on enhanced self-management and improved doctor-patient communication. In IBD, optimal approaches to management vary for patients with different phenotypes and extent of disease and past surgical history. Hence, a single quality metric cannot define a heterogeneous disease such as IBD, unlike hypertension and diabetes. A more comprehensive assessment may be provided by complementing traditional quality metrics with measures of the patient?s quality of life (QOL) through an application like HealthPROMISE. Objective: The objective of this pragmatic randomized controlled trial is to determine the impact of the HealthPROMISE app in improving outcomes (quality of care [QOC], QOL, patient adherence, disease control, and resource utilization) as compared to a patient education app. Our hypothesis is that a patient-centric self-monitoring and collaborative decision support platform will lead to sustainable improvement in overall QOL for IBD patients. Methods: Participants will be recruited during face-to-face visits and randomized to either an interventional (ie, HealthPROMISE) or control (ie, education app). Patients in the HealthPROMISE arm will be able to update their information and receive disease summary, quality metrics, and a graph showing the trend of QOL (SIBDQ) scores and resource utilization over time. Providers will use the data for collaborative decision making and quality improvement interventions at the point of care. Patients in the control arm will enter data at baseline, during office visits, and at the end of the study but will not receive any decision support (trend of QOL, alert, or dashboard views). Results: Enrollment in the trial will be starting in first quarter of 2015. It is intended that up to 300 patients with IBD will be recruited into the study (with 1:1 allocation ratio). The primary endpoint is number of quality indicators met in HealthPROMISE versus control arm. Secondary endpoints include decrease in number of emergency visits due to IBD, decrease in number of hospitalization due to IBD, change in generic QOL score from baseline, proportion of patients in each group who meet all eligible outpatient quality metrics, and proportion of patients in disease control in each group. In addition, we plan to conduct protocol analysis of intervention patients with adequate HealthPROMISE utilization (more than 6 log-ins with data entry from week 0 through week 52) achieving above mentioned primary and secondary endpoints. Conclusions: HealthPROMISE is a unique cloud-based patient-reported outcome (PRO) and decision support tool that empowers both patients and providers. Patients track their QOL and symptoms, and providers can use the visual data in real time (integrated with electronic health records [EHRs]) to provide better care to their entire patient population. Using pragmatic trial design, we hope to show that IBD patients who participate in their own care and share in decision making have appreciably improved outcomes when compared to patients who do not. Trial Registration: ClinicalTrials.gov NCT02322307; https://clinicaltrials.gov/ct2/show/NCT02322307 (Archived by WebCite at http://www.webcitation.org/6W8PoYThr). UR - http://www.researchprotocols.org/2015/1/e23/ UR - http://dx.doi.org/10.2196/resprot.4042 UR - http://www.ncbi.nlm.nih.gov/pubmed/25693610 ID - info:doi/10.2196/resprot.4042 ER - TY - JOUR AU - Diez-Canseco, Francisco AU - Zavala-Loayza, Alfredo J. AU - Beratarrechea, Andrea AU - Kanter, Rebecca AU - Ramirez-Zea, Manuel AU - Rubinstein, Adolfo AU - Martinez, Homero AU - Miranda, Jaime J. PY - 2015/02/18 TI - Design and Multi-Country Validation of Text Messages for an mHealth Intervention for Primary Prevention of Progression to Hypertension in Latin America JO - JMIR mHealth uHealth SP - e19 VL - 3 IS - 1 KW - cross-cultural comparison KW - developing countries KW - health literacy KW - hypertension KW - Latin America KW - mHealth KW - preventive medicine KW - prehypertension KW - text messages KW - validation studies N2 - Background: Mobile health (mHealth) has been posited to contribute to the reduction in health gaps and has shown fast and widespread growth in developing countries. This growth demands understanding of, and preparedness for, local cultural contexts. Objective: To describe the design and validation of text messages (short message service, SMS) that will be used for an mHealth behavioral change intervention to prevent hypertension in three Latin American countries: Argentina, Guatemala, and Peru. Methods: An initial set of 64 SMS text messages were designed to promote healthy lifestyles among individuals in different stages of behavior change, addressing four key domains: salt and sodium intake, fruit and vegetable intake, consumption of high fat and sugar foods, and physical activity. The 64 SMS text messages were organized into nine subsets for field validation. In each country 36 people were recruited, half of them being male. Of the participants, 4 per country evaluated each subset of SMS text messages, which contained between 6 and 8 SMS text messages regarding different key domains and stages of change. The understanding and appeal of each SMS text message was assessed using a 7-item questionnaire. The understanding and appeal ratings were used to reach a final set of 56 SMS text messages. Results: Overall, each of the 64 SMS text messages received a total of 12 evaluations (4 per country). The majority of evaluations?742 out of a total of 767 (96.7%) valid responses?revealed an adequate understanding of the key idea contained in the SMS text message. On a scale from 1 to 10, the average appeal score was 8.7 points, with a range of 4 to 10 points. Based on their low scores, 8 SMS text messages per country were discarded. Once the final set of 56 SMS text messages was established, and based on feedback obtained in the field, wording and content of some SMS text messages were improved. Of the final set, 9, 8, and 16 of the SMS text messages were improved based on participant evaluations from Argentina, Guatemala, and Peru, respectively. Most SMS text messages selected for the final set (49/56, 88%) were the same in all countries, except for small wording differences. Conclusions: The final set of SMS text messages produced had very high rates of understanding and appeal in three different Latin American countries. This study highlights the importance of developing and validating a package of simple, preventative SMS text messages, grounded in evidence and theory, across three different Latin American countries with active engagement of end users. UR - http://mhealth.jmir.org/2015/1/e19/ UR - http://dx.doi.org/10.2196/mhealth.3874 UR - http://www.ncbi.nlm.nih.gov/pubmed/25693595 ID - info:doi/10.2196/mhealth.3874 ER - TY - JOUR AU - Shen, Nelson AU - Levitan, Michael-Jane AU - Johnson, Andrew AU - Bender, Lorene Jacqueline AU - Hamilton-Page, Michelle AU - Jadad, R. Alejandro (Alex) AU - Wiljer, David PY - 2015/02/16 TI - Finding a Depression App: A Review and Content Analysis of the Depression App Marketplace JO - JMIR mHealth uHealth SP - e16 VL - 3 IS - 1 KW - mobile apps KW - depression KW - health information KW - consumer KW - mental health N2 - Background: Depression is highly prevalent and causes considerable suffering and disease burden despite the existence of wide-ranging treatment options. Mobile phone apps offer the potential to help close this treatment gap by confronting key barriers to accessing support for depression. Objectives: Our goal was to identify and characterize the different types of mobile phone depression apps available in the marketplace. Methods: A search for depression apps was conducted on the app stores of the five major mobile phone platforms: Android, iPhone, BlackBerry, Nokia, and Windows. Apps were included if they focused on depression and were available to people who self-identify as having depression. Data were extracted from the app descriptions found in the app stores. Results: Of the 1054 apps identified by the search strategy, nearly one-quarter (23.0%, 243/1054) unique depression apps met the inclusion criteria. Over one-quarter (27.7%, 210/758) of the excluded apps failed to mention depression in the title or description. Two-thirds of the apps had as their main purpose providing therapeutic treatment (33.7%, 82/243) or psychoeducation (32.1%, 78/243). The other main purpose categories were medical assessment (16.9%, 41/243), symptom management (8.2%, 20/243), and supportive resources (1.6%, 4/243). A majority of the apps failed to sufficiently describe their organizational affiliation (65.0%, 158/243) and content source (61.7%, 150/243). There was a significant relationship (?25=50.5, P<.001) between the main purpose of the app and the reporting of content source, with most medical assessment apps reporting their content source (80.5%, 33/41). A fifth of the apps featured an e-book (20.6%, 50/243), audio therapy (16.9%, 41/243), or screening (16.9%, 41/243) function. Most apps had a dynamic user interface (72.4%, 176/243) and used text as the main type of media (51.9%, 126/243), and over a third (14.4%, 35/243) incorporated more than one form of media. Conclusion: Without guidance, finding an appropriate depression app may be challenging, as the search results yielded non-depression?specific apps to depression apps at a 3:1 ratio. Inadequate reporting of organization affiliation and content source increases the difficulty of assessing the credibility and reliability of the app. While certification and vetting initiatives are underway, this study demonstrates the need for standardized reporting in app stores to help consumers select appropriate tools, particularly among those classified as medical devices. UR - http://mhealth.jmir.org/2015/1/e16/ UR - http://dx.doi.org/10.2196/mhealth.3713 UR - http://www.ncbi.nlm.nih.gov/pubmed/25689790 ID - info:doi/10.2196/mhealth.3713 ER - TY - JOUR AU - Nasi, Greta AU - Cucciniello, Maria AU - Guerrazzi, Claudia PY - 2015/02/13 TI - The Performance of mHealth in Cancer Supportive Care: A Research Agenda JO - J Med Internet Res SP - e9 VL - 17 IS - 2 KW - mHealth KW - performance KW - organizational performance KW - efficiency KW - effectiveness KW - clinical effectiveness KW - quality of life N2 - Background: Since the advent of smartphones, mHealth has risen to the attention of the health care system as something that could radically change the way health care has been viewed, managed, and delivered to date. This is particularly relevant for cancer, as one of the leading causes of death worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing side effects. Given adequate knowledge, they are able to expect appropriate assessments and interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health care professionals; for enabling early detection and intervention; for lowering costs; and achieving better quality of life. Given its great potential, it is important to evaluate the performance of mHealth. This can be considered from several perspectives, of which organizational performance is particularly relevant, since mHealth may increase the productivity of health care providers and as a result even the productivity of health care systems. Objective: This paper aims to review studies on the evaluation of the performance of mHealth, with particular focus on cancer care and cancer supportive care processes, concentrating on its contribution to organizational performance, as well as identifying some indications for a further research agenda. Methods: We carried out a review of literature, aimed at identifying studies related to the performance of mHealth in general or focusing on cancer care and cancer supportive care. Results: Our analysis revealed that studies are almost always based on a single dimension of performance. Any evaluations of the performance of mHealth are based on very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails to consider the real contribution that mHealth can offer for improving the performance of health care providers, health care systems, and the quality of life in general. Conclusions: Further research should start by stating and explaining what is meant by the evaluation of mHealth?s performance and then conduct more in-depth analysis in order to create shared frameworks to specifically identify the different dimensions of mHealth?s performance. UR - http://www.jmir.org/2015/2/e9/ UR - http://dx.doi.org/10.2196/jmir.3764 UR - http://www.ncbi.nlm.nih.gov/pubmed/25720295 ID - info:doi/10.2196/jmir.3764 ER - TY - JOUR AU - Nasi, Greta AU - Cucciniello, Maria AU - Guerrazzi, Claudia PY - 2015/02/12 TI - The Role of Mobile Technologies in Health Care Processes: The Case of Cancer Supportive Care JO - J Med Internet Res SP - e26 VL - 17 IS - 2 KW - mhealth KW - cancer supportive care KW - cancer care KW - new models of care KW - integrated care KW - health care process KW - care delivery value chain N2 - Background: Health care systems are gradually moving toward new models of care based on integrated care processes shared by different care givers and on an empowered role of the patient. Mobile technologies are assuming an emerging role in this scenario. This is particularly true in care processes where the patient has a particularly enhanced role, as is the case of cancer supportive care. Objective: This paper aims to review existing studies on the actual role and use of mobile technology during the different stages of care processes, with particular reference to cancer supportive care. Methods: We carried out a review of literature with the aim of identifying studies related to the use of mHealth in cancer care and cancer supportive care. The final sample size consists of 106 records. Results: There is scant literature concerning the use of mHealth in cancer supportive care. Looking more generally at cancer care, we found that mHealth is mainly used for self-management activities carried out by patients. The main tools used are mobile devices like mobile phones and tablets, but remote monitoring devices also play an important role. Text messaging technologies (short message service, SMS) have a minor role, with the exception of middle income countries where text messaging plays a major role. Telehealth technologies are still rarely used in cancer care processes. If we look at the different stages of health care processes, we can see that mHealth is mainly used during the treatment of patients, especially for self-management activities. It is also used for prevention and diagnosis, although to a lesser extent, whereas it appears rarely used for decision-making and follow-up activities. Conclusions: Since mHealth seems to be employed only for limited uses and during limited phases of the care process, it is unlikely that it can really contribute to the creation of new care models. This under-utilization may depend on many issues, including the need for it to be embedded into broader information systems. If the purpose of introducing mHealth is to promote the adoption of integrated care models, using mHealth should not be limited to some activities or to some phases of the health care process. Instead, there should be a higher degree of pervasiveness at all stages and in all health care delivery activities. UR - http://www.jmir.org/2015/2/e26/ UR - http://dx.doi.org/10.2196/jmir.3757 UR - http://www.ncbi.nlm.nih.gov/pubmed/25679446 ID - info:doi/10.2196/jmir.3757 ER - TY - JOUR AU - Semple, L. John AU - Sharpe, Sarah AU - Murnaghan, Lucas M. AU - Theodoropoulos, John AU - Metcalfe, A. Kelly PY - 2015/02/12 TI - Using a Mobile App for Monitoring Post-Operative Quality of Recovery of Patients at Home: A Feasibility Study JO - JMIR mHealth uHealth SP - e18 VL - 3 IS - 1 KW - outpatient KW - recovery KW - care KW - post-operative KW - smartphone KW - technology KW - mobile N2 - Background: Mobile apps are being viewed as a new solution for post-operative monitoring of surgical patients. Mobile phone monitoring of patients in the post-operative period can allow expedited discharge and may allow early detection of complications. Objective: The objective of the current study was to assess the feasibility of using a mobile app for the monitoring of post-operative quality of recovery at home following surgery in an ambulatory setting. Methods: We enrolled 65 consecutive patients (n=33, breast reconstruction surgery; n=32, orthopedic surgery) and asked them to use a mobile phone daily to complete a validated quality of recovery scale (QoR-9) and take photographs of the surgical site for the first 30 days post-op. Surgeons were asked to review patient-entered data on each patient in their roster daily. A semistructured questionnaire was administered to patients and surgeons to assess satisfaction and feasibility of the mobile device. Results: All 65 patients completed the study. The mean number of logins was 23.9 (range 7-30) for the breast patients and 19.3 (range 5-30) for the orthopedic patients. The mean number of logins was higher in the first 14 days compared to the 15-30 days post-op for both breast patients (13.4 vs 10.5; P<.001) and for the orthopedic patients (13.4 vs 6.0; P<.001). The mean score for overall satisfaction with using the mobile device was 3.9 for breast patients and 3.7 for orthopedic patients (scored from 1 (poor) to 4 (excellent)). Surgeons reported on the easy-to-navigate design, the portability to monitor patients outside of hospital, and the ability of the technology to improve time efficiency. Conclusions: The use of mobile apps for monitoring the quality of recovery in post-operative patients at home was feasible and acceptable to patients and surgeons in the current study. Future large scale studies in varying patient populations are required. UR - http://mhealth.jmir.org/2015/1/e18/ UR - http://dx.doi.org/10.2196/mhealth.3929 UR - http://www.ncbi.nlm.nih.gov/pubmed/25679749 ID - info:doi/10.2196/mhealth.3929 ER - TY - JOUR AU - Mercer, Kathryn AU - Baskerville, Neill AU - Burns, M. Catherine AU - Chang, Feng AU - Giangregorio, Lora AU - Tomasson Goodwin, Jill AU - Sadat Rezai, Leila AU - Grindrod, Kelly PY - 2015/02/10 TI - Using a Collaborative Research Approach to Develop an Interdisciplinary Research Agenda for the Study of Mobile Health Interventions for Older Adults JO - JMIR mHealth uHealth SP - e11 VL - 3 IS - 1 KW - mHealth KW - mobile health KW - nominal group technique KW - participatory research: collaborative research KW - older adults KW - research KW - seniors N2 - Background: Seniors with chronic diseases are often called on to self-manage their conditions. Mobile health (mHealth) tools may be a useful strategy to help seniors access health information at the point of decision-making, receive real-time feedback and coaching, and monitor health conditions. However, developing successful mHealth interventions for seniors presents many challenges. One of the key challenges is to ensure the scope of possible research questions includes the diverse views of seniors, experts and the stakeholder groups who support seniors as they manage chronic disease. Objective: Our primary objective was to present a case-study of a collaborative research approach to the development of an interdisciplinary research agenda. Our secondary objectives were to report on the results of a nominal group technique (NGT) approach used generate research questions and to assess the success of including non-academic researchers to enrich the scope, priority, and total number of possible research questions. Methods: We invited researchers and stakeholders to participate in a full day meeting that included rapid-style presentations by researchers, health care professionals, technology experts, patients and community groups followed by group discussions. An NGT was used to establish group consensus on the following question: In your opinion, what research needs to be done to better understand the effectiveness, usability and design of mobile health apps and devices for older adults? Results: Overall, the collaborative approach was a very successful strategy to bring together a diverse group of participants with the same end goal. The 32 participants generated 119 items in total. The top three research questions that emerged from the NGT were related to adoption, the need for high quality tools and the digital divide. Strong sub-themes included privacy and security, engagement and design. The NGT also helped us include the perspectives information from non-academic researchers that would not have been captured if the process had been limited to the research team. Conclusions: Developing ways for patients and other stakeholders to have a voice when it comes to developing patient awareness as related to mHealth may guide future research into engagement, ownership, usability and design. It is our intention that our paper be used and adapted by other researchers to engage small or vulnerable populations often excluded from mHealth research and design. UR - http://mhealth.jmir.org/2015/1/e11/ UR - http://dx.doi.org/10.2196/mhealth.3509 UR - http://www.ncbi.nlm.nih.gov/pubmed/25669321 ID - info:doi/10.2196/mhealth.3509 ER - TY - JOUR AU - Goh, Glenn AU - Tan, Chuan Ngiap AU - Malhotra, Rahul AU - Padmanabhan, Uma AU - Barbier, Sylvaine AU - Allen Jr, Carson John AU - Østbye, Truls PY - 2015/02/03 TI - Short-Term Trajectories of Use of a Caloric-Monitoring Mobile Phone App Among Patients With Type 2 Diabetes Mellitus in a Primary Care Setting JO - J Med Internet Res SP - e33 VL - 17 IS - 2 KW - type 2 diabetes mellitus KW - self-management KW - mobile phone KW - mobile apps KW - longitudinal studies N2 - Background: Self-management plays an important role in maintaining good control of diabetes mellitus, and mobile phone interventions have been shown to improve such self-management. The Health Promotion Board of Singapore has created a caloric-monitoring mobile health app, the ?interactive Diet and Activity Tracker? (iDAT). Objective: The objective was to identify and describe short-term (8-week) trajectories of use of the iDAT app among patients with type 2 diabetes mellitus in a primary care setting in Singapore, and identify patient characteristics associated with each trajectory. Methods: A total of 84 patients with type 2 diabetes mellitus from a public primary care clinic in Singapore who had not previously used the iDAT app were enrolled. The app was demonstrated and patients? weekly use of the app was monitored over 8 weeks. Weekly use was defined as any record in terms of food entry or exercise workout entry in that week. Information on demographics, diet and exercise motivation, diabetes self-efficacy (Diabetes Empowerment Scale-Short Form), and clinical variables (body mass index, blood pressure, and glycosylated hemoglobin/HbA1c) were collected at baseline. iDAT app use trajectories were delineated using latent-class growth modeling (LCGM). Association of patient characteristics with the trajectories was ascertained using logistic regression analysis. Results: Three iDAT app use trajectories were observed: Minimal Users (66 out of 84 patients, 78.6%, with either no iDAT use at all or use only in the first 2 weeks), Intermittent-Waning Users (10 out of 84 patients, 11.9%, with occasional weekly use mainly in the first 4 weeks), and Consistent Users (8 out of 84 patients, 9.5%, with weekly use throughout all or most of the 8 weeks). The adjusted odds ratio of being a Consistent User, relative to a Minimal User, was significantly higher for females (OR 19.55, 95% CI 1.78-215.42) and for those with higher exercise motivation scores at baseline (OR 4.89, 95% CI 1.80-13.28). The adjusted odds ratio of being an Intermittent-Waning User relative to a Minimal User was also significantly higher for those with higher exercise motivation scores at baseline (OR 1.82, 95% CI 1.00-3.32). Conclusions: This study provides insight into the nature and extent of usage of a caloric-monitoring app among patients with type 2 diabetes and managed in primary care. The application of LCGM provides a useful framework for evaluating future app use in other patient populations. UR - http://www.jmir.org/2015/2/e33/ UR - http://dx.doi.org/10.2196/jmir.3938 UR - http://www.ncbi.nlm.nih.gov/pubmed/25648130 ID - info:doi/10.2196/jmir.3938 ER - TY - JOUR AU - Abroms, C. Lorien AU - Johnson, R. Pamela AU - Heminger, L. Christina AU - Van Alstyne, M. Judith AU - Leavitt, E. Leah AU - Schindler-Ruwisch, M. Jennifer AU - Bushar, A. Jessica PY - 2015/01/23 TI - Quit4baby: Results From a Pilot Test of a Mobile Smoking Cessation Program for Pregnant Women JO - JMIR mHealth uHealth SP - e10 VL - 3 IS - 1 KW - mobile health KW - tobacco cessation KW - pregnancy KW - text messaging N2 - Background: Text messaging (short message service, SMS) programs have been shown to be effective in helping adult smokers quit smoking. This study describes the results of a pilot test of Quit4baby, a smoking cessation text messaging program for pregnant smokers that was adapted from Text2quit. Objective: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program. Methods: Pregnant women enrolled in Text4baby and who were current smokers or had quit within the last 4 weeks (n=20) were enrolled in Quit4baby. Those under the age of 18, not pregnant, not current smokers, those using nicotine replacement therapy, and those not interested in participating were ineligible. Participants were surveyed at baseline and at 2 and 4 weeks postenrollment. Results: Most participants responded to the program favorably. Highly rated aspects included the content of the program, skills taught within the program, and encouragement and social support provided by the program. Participants reported that the program was helpful in quitting, that the program gave good ideas on quitting, and that they would recommend the program to a friend. Suggestions for improvement included increasing the message dose and making the quitpal more interactive. Conclusions: This pilot test provides support for the feasibility and acceptability of Quit4baby. Future studies are needed to assess whether Quit4baby is effective for smoking cessation during pregnancy. UR - http://mhealth.jmir.org/2015/1/e10/ UR - http://dx.doi.org/10.2196/mhealth.3846 UR - http://www.ncbi.nlm.nih.gov/pubmed/25650765 ID - info:doi/10.2196/mhealth.3846 ER - TY - JOUR AU - Jospe, R. Michelle AU - Fairbairn, A. Kirsty AU - Green, Peter AU - Perry, L. Tracy PY - 2015/01/22 TI - Diet App Use by Sports Dietitians: A Survey in Five Countries JO - JMIR mHealth uHealth SP - e7 VL - 3 IS - 1 KW - nutritional requirements KW - nutrition assessment KW - dietary self-monitoring KW - mobile apps KW - questionnaire KW - telemedicine KW - sports nutritional sciences N2 - Background: Despite the hundreds of diet apps available for use on smartphones (mobile phones), no studies have examined their use as tools for dietary assessment and tracking in sports nutrition. Objective: The aim is to examine the prevalence and perceptions of using smartphone diet apps for dietary assessment and tracking among sports dietitians. Methods: A cross-sectional online survey to examine the use and perception of diet apps was developed and distributed to sports dietitians in Australia, Canada, New Zealand, the United Kingdom, and the United States (US). Results: The overall response rate from the 1709 sports dietitians invited to participate was 10.3% (n=180). diet apps were used by 32.4% (57/176) of sports dietitians to assess and track the dietary intake of athletes. Sports dietitians from the US were more likely to use smartphone diet apps than sports dietitians from other countries (OR=5.61, 95% CI 1.84-17.08, P=.002). Sports dietitians used 28 different diet apps, with 56% (32/57) choosing MyFitnessPal. Overall, sports dietitians held a positive perception of smartphone diet apps, with the majority of respondents viewing diet apps as ?better? (25/53, 47%) or ?equivalent? (22/53, 41%) when compared with traditional dietary assessment methods. Conclusions: Nearly one-third of sports dietitians used mobile phone diet apps in sports nutrition practice, and viewed them as useful in helping to assess and track the dietary intake of athletes. UR - http://mhealth.jmir.org/2015/1/e7/ UR - http://dx.doi.org/10.2196/mhealth.3345 UR - http://www.ncbi.nlm.nih.gov/pubmed/25616274 ID - info:doi/10.2196/mhealth.3345 ER - TY - JOUR AU - van Mierlo, Trevor AU - Fournier, Rachel AU - Fedorak, Richard PY - 2015/01/21 TI - Don?t Forget the Doctor: Gastroenterologists? Preferences on the Development of mHealth Tools for Inflammatory Bowel Disease JO - JMIR mHealth uHealth SP - e5 VL - 3 IS - 1 KW - mHealth KW - adherence KW - concordance KW - compliance KW - shared decision making KW - therapeutic alliance KW - gastroenterology KW - IBD KW - ulcerative colitis N2 - Background: Inflammatory bowel disease (IBD) encompasses a number of disorders of the gastrointestinal tract. Treatment for IBD is lifelong and complex, and the majority of IBD patients seek information on the Internet. However, research has found existing digital resources to be of questionable quality and that patients find content lacking. Gastroenterologists are frontline sources of information for North American IBD patients, but their opinions and preferences for digital content, design, and utility have not been investigated. The purpose of this study is to systematically explore gastroenterologists? perceptions of, and design preferences for, mHealth tools. Objective: Our goal was to critically assess these issues and elicit expert feedback by seeking consensus with Canadian gastroenterologists. Methods: Using a qualitative approach, a closed meeting with 7 gastroenterologists was audio recorded and field notes taken. To synthesize results, an anonymous questionnaire was collected at the end of the session. Participant-led discussion themes included methodological approaches to non-adherence, concordance, patient-centricity, and attributes of digital tools that would be actively supported and promoted. Results: Survey results indicated that 4 of the 7 gastroenterologists had experienced patients bringing digital resources to a visit, but 5 found digital patient resources to be inaccurate or irrelevant. All participants agreed that digital tools were of increasing importance and could be leveraged to aid in consultations and save time. When asked to assess digital attributes that they would be confident to refer patients to, all seven indicated that the inclusion of evidence-based facts were of greatest importance. Patient peer-support networks were deemed an asset but only if closely monitored by experts. When asked about interventions, nearly all (6/7) preferred tools that addressed a mix of compliance and concordance, and only one supported the development of tools that focused on compliance. Participants confirmed that they would actively refer patients and other physicians to digital resources. However, while a number of digital IBD tools exist, gastroenterologists would be reluctant to endorse them. Conclusions: Gastroenterologists appear eager to use digital resources that they believe benefit the physician-patient relationship, but despite the trend of patient-centric tools that focus on concordance (shared decision making and enlightened communication between patients and their health care providers), they would prefer digital tools that highlight compliance (patient following orders). This concordance gap highlights an issue of disparity in digital health: patients may not use tools that physicians promote, and physicians may not endorse tools that patients will use. Further research investigating the concordance gap, and tensions between physician preferences and patient needs, is required. UR - http://mhealth.jmir.org/2015/1/e5/ UR - http://dx.doi.org/10.2196/mhealth.3987 UR - http://www.ncbi.nlm.nih.gov/pubmed/25608628 ID - info:doi/10.2196/mhealth.3987 ER - TY - JOUR AU - Dehling, Tobias AU - Gao, Fangjian AU - Schneider, Stephan AU - Sunyaev, Ali PY - 2015/01/19 TI - Exploring the Far Side of Mobile Health: Information Security and Privacy of Mobile Health Apps on iOS and Android JO - JMIR mHealth uHealth SP - e8 VL - 3 IS - 1 KW - mobile health KW - mobile apps KW - data security KW - software and application security KW - patient privacy KW - health information technology N2 - Background: Mobile health (mHealth) apps aim at providing seamless access to tailored health information technology and have the potential to alleviate global health burdens. Yet, they bear risks to information security and privacy because users need to reveal private, sensitive medical information to redeem certain benefits. Due to the plethora and diversity of available mHealth apps, implications for information security and privacy are unclear and complex. Objective: The objective of this study was to establish an overview of mHealth apps offered on iOS and Android with a special focus on potential damage to users through information security and privacy infringements. Methods: We assessed apps available in English and offered in the categories ?Medical? and ?Health & Fitness? in the iOS and Android App Stores. Based on the information retrievable from the app stores, we established an overview of available mHealth apps, tagged apps to make offered information machine-readable, and clustered the discovered apps to identify and group similar apps. Subsequently, information security and privacy implications were assessed based on health specificity of information available to apps, potential damage through information leaks, potential damage through information manipulation, potential damage through information loss, and potential value of information to third parties. Results: We discovered 24,405 health-related apps (iOS; 21,953; Android; 2452). Absence or scarceness of ratings for 81.36% (17,860/21,953) of iOS and 76.14% (1867/2452) of Android apps indicates that less than a quarter of mHealth apps are in more or less widespread use. Clustering resulted in 245 distinct clusters, which were consolidated into 12 app archetypes grouping clusters with similar assessments of potential damage through information security and privacy infringements. There were 6426 apps that were excluded during clustering. The majority of apps (95.63%, 17,193/17,979; of apps) pose at least some potential damage through information security and privacy infringements. There were 11.67% (2098/17,979) of apps that scored the highest assessments of potential damages. Conclusions: Various kinds of mHealth apps collect and offer critical, sensitive, private medical information, calling for a special focus on information security and privacy of mHealth apps. In order to foster user acceptance and trust, appropriate security measures and processes need to be devised and employed so that users can benefit from seamlessly accessible, tailored mHealth apps without exposing themselves to the serious repercussions of information security and privacy infringements. UR - http://mhealth.jmir.org/2015/1/e8/ UR - http://dx.doi.org/10.2196/mhealth.3672 UR - http://www.ncbi.nlm.nih.gov/pubmed/25599627 ID - info:doi/10.2196/mhealth.3672 ER - TY - JOUR AU - Ubhi, Kaur Harveen AU - Michie, Susan AU - Kotz, Daniel AU - Wong, Chi Wai AU - West, Robert PY - 2015/01/16 TI - A Mobile App to Aid Smoking Cessation: Preliminary Evaluation of SmokeFree28 JO - J Med Internet Res SP - e17 VL - 17 IS - 1 KW - smoking cessation intervention KW - mobile KW - smartphone KW - apps KW - PRIME theory N2 - Background: Little is known about the effectiveness of mobile apps in aiding smoking cessation or their validity for automated collection of data on smoking cessation outcomes. Objective: We conducted a preliminary evaluation of SF28 (SF28 is the name of the app, short for SmokeFree28)?an app aimed at helping smokers to be smoke-free for 28 days. Methods: Data on sociodemographic characteristics, smoking history, number of logins, and abstinence at each login were uploaded to a server from SF28 between August 2012 and August 2013. Users were included if they were aged 16 years or over, smoked cigarettes at the time of registration, had set a quit date, and used the app at least once on or after their quit date. Their characteristics were compared with data from a representative sample of smokers trying to stop smoking in England. The percentage of users recording 28 days of abstinence was compared with a value of 15% estimated for unaided quitting. Correlations were assessed between recorded abstinence for 28 days and well-established abstinence predictors. Results: A total of 1170 users met the inclusion criteria. Compared with smokers trying to quit in England, they had higher consumption, and were younger, more likely to be female, and had a non-manual rather than manual occupation. In total, 18.9% (95% CI 16.7-21.1) were recorded as being abstinent from smoking for 28 days or longer. The mean number of logins was 8.5 (SD 9.0). The proportion recording abstinence for 28 days or longer was higher in users who were older, in a non-manual occupation, and in those using a smoking cessation medication. Conclusions: The recorded 28-day abstinence rates from the mobile app, SF28, suggest that it may help some smokers to stop smoking. Further evaluation by means of a randomized trial appears to be warranted. UR - http://www.jmir.org/2015/1/e17/ UR - http://dx.doi.org/10.2196/jmir.3479 UR - http://www.ncbi.nlm.nih.gov/pubmed/25596170 ID - info:doi/10.2196/jmir.3479 ER - TY - JOUR AU - Kaewkungwal, Jaranit AU - Apidechkul, Tawatchai AU - Jandee, Kasemsak AU - Khamsiriwatchara, Amnat AU - Lawpoolsri, Saranath AU - Sawang, Surasak AU - Sangvichean, Aumnuyphan AU - Wansatid, Peerawat AU - Krongrungroj, Sarinya PY - 2015/01/14 TI - Application of Mobile Technology for Improving Expanded Program on Immunization Among Highland Minority and Stateless Populations in Northern Thailand Border JO - JMIR mHealth uHealth SP - e4 VL - 3 IS - 1 KW - expanded program on immunization KW - EPI KW - hill tribes KW - stateless KW - behavioral change communication KW - mobile technology N2 - Background: Studies of undervaccinated children of minority/stateless populations have highlighted significant barriers at individual, community, and state levels. These include geography-related difficulties, poverty, and social norms/beliefs. Objective: The objective of this study was to assess project outcomes regarding immunization coverage, as well as maternal attitudes and practices toward immunization. Methods: The ?StatelessVac? project was conducted in Thailand-Myanmar-Laos border areas using cell phone-based mechanisms to increase immunization coverage by incorporating phone-to-phone information sharing for both identification and prevention. With limitation of the study among vulnerable populations in low-resource settings, the pre/post assessments without comparison group were conducted. Immunization coverage was collected from routine monthly reports while behavior-change outcomes were from repeat surveys. Results: This study revealed potential benefits of the initiative for case identification; immunization coverage showed an improved trend. Prevention strategies were successfully integrated into the routine health care workflows of immunization activities at point-of-care. A behavior-change-communication package contributes significantly in raising both concern and awareness in relation to child care. Conclusions: The mobile technology has proven to be an effective mechanism in improving a children?s immunization program among these hard-to-reach populations. Part of the intervention has now been revised for use at health centers across the country. UR - http://mhealth.jmir.org/2015/1/e4/ UR - http://dx.doi.org/10.2196/mhealth.3704 UR - http://www.ncbi.nlm.nih.gov/pubmed/25589367 ID - info:doi/10.2196/mhealth.3704 ER - TY - JOUR AU - McBride, L. Deborah AU - LeVasseur, A. Sandra AU - Li, Dongmei PY - 2015/01/13 TI - Non-Work-Related Use of Personal Mobile Phones by Hospital Registered Nurses JO - JMIR mHealth uHealth SP - e3 VL - 3 IS - 1 KW - distraction KW - smartphone KW - cellular phone KW - Internet KW - nurses KW - hospital KW - non-work related smartphone use N2 - Background: Personal mobile phones and other personal communication devices (smartphones and tablet computers) provide users with an ever-increasing number and diversity of non-work-related activities while at work. In hospitals, where the vigilance of health care workers is essential for patient care, the potential distraction of these devices could be hazardous to patients. Objective: The objective of this study was to determine the frequency of non-work-related use of personal mobile phones and other personal communication devices among hospital registered nurses. Methods: In March 2014, a previously validated 30-question survey was emailed to the 10,978 members of the Academy of Medical Surgical Nurses. There were 825 respondents who met the inclusion criteria. Results: The use of a personal mobile phone or other personal communication device while working (excluding meal times and breaks) was reported by 78.1% (644/825) of respondents. Nurses reported regularly (sometimes, often, or always) sending personal emails and text messages (38.6%, 318/825), reading news (25.7%, 212/825), checking/posting on social networking sites (20.8%, 172/825), shopping (9.6%, 79/825), and playing games (6.5%, 54/825) while working. Conclusions: This study found that hospital nurses frequently use their personal mobile phones or other personal communication devices for non-work-related activities at work. The primary activity reported was to send personal emails and text messages to family and friends. UR - http://mhealth.jmir.org/2015/1/e3/ UR - http://dx.doi.org/10.2196/mhealth.4001 UR - http://www.ncbi.nlm.nih.gov/pubmed/25586982 ID - info:doi/10.2196/mhealth.4001 ER - TY - JOUR AU - Irvine, Blair A. AU - Russell, Holly AU - Manocchia, Michael AU - Mino, E. David AU - Cox Glassen, Terri AU - Morgan, Rebecca AU - Gau, M. Jeff AU - Birney, J. Amelia AU - Ary, V. Dennis PY - 2015/01/02 TI - Mobile-Web App to Self-Manage Low Back Pain: Randomized Controlled Trial JO - J Med Internet Res SP - e1 VL - 17 IS - 1 KW - low back pain KW - Internet KW - mobile KW - app KW - computers KW - prevention KW - self-treatment N2 - Background: Nonspecific low back pain (NLBP) is the diagnosis for individuals with back pain that has no underlying medical cause (eg, tumor, infection, fracture, herniated disc, spinal stenosis). The American College of Physicians (ACP) and American Pain Society (APS) recommend multidisciplinary treatments for NLBP that lasts more than 4 weeks. This approach, however, is impractical for many physicians to implement, and relatively few providers offer NLBP treatment that meets the joint ACP-APS guidelines. Objective: This study evaluated the efficacy of a mobile-Web intervention called ?FitBack? to help users implement self-tailored strategies to manage and prevent NLBP occurrences. Methods: A total of 597 adults were recruited, screened, consented, and assessed online at baseline, at 2 months (T2), and at 4 months (T3). After baseline assessments, participants were randomized into three groups: FitBack intervention, alternative care group that received 8 emails urging participants to link to six Internet resources for NLBP, and control group. The FitBack group also received weekly email reminder prompts for 8 weeks plus emails to do assessments. The control group was only contacted to do assessments. Results: Users of the FitBack program showed greater improvement compared to the control group in every comparison of the critical physical, behavioral, and worksite outcome measures at 4-month follow-up. In addition, users of the FitBack program performed better than the alternative care group on current back pain, behavioral, and worksite outcomes at 4-month follow-up. For example, subjects in the control group were 1.7 times more likely to report current back pain than subjects in the FitBack group; subjects in the alternative care group were 1.6 times more likely to report current back pain at 4-month follow-up. Further, the users of the FitBack program showed greater improvement compared to both the control and alternative care groups at 4-month follow-up on patient activation, constructs of the Theory of Planned Behavior, and attitudes toward pain. Conclusions: This research demonstrated that a theoretically based stand-alone mobile-Web intervention that tailors content to users? preferences and interests can be an effective tool in self-management of low back pain. When viewed from the RE-AIM perspective (ie, reach, efficacy/effectiveness, adoption, implementation fidelity, and maintenance), this study supports the notion that there is considerable value in this type of intervention as a potentially cost-effective tool that can reach large numbers of people. The results are promising considering that the FitBack intervention was neither supported by professional caregivers nor integrated within a health promotion campaign, which might have provided additional support for participants. Still, more research is needed on how self-guided mobile-Web interventions will be used over time and to understand factors associated with continuing user engagement. Trial Registration: Clinicaltrials.gov NCT01950091; http://clinicaltrials.gov/ct2/show/NCT01950091 (Archived by WebCite at http://www.webcitation.org/6TwZucX77). UR - http://www.jmir.org/2015/1/e1/ UR - http://dx.doi.org/10.2196/jmir.3130 UR - http://www.ncbi.nlm.nih.gov/pubmed/25565416 ID - info:doi/10.2196/jmir.3130 ER - TY - JOUR AU - Torous, John AU - Chan, Richard Steven AU - Yee-Marie Tan, Shih AU - Behrens, Jacob AU - Mathew, Ian AU - Conrad, J. Erich AU - Hinton, Ladson AU - Yellowlees, Peter AU - Keshavan, Matcheri PY - 2014/12/23 TI - Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct Psychiatric Clinics JO - JMIR Mental Health SP - e5 VL - 1 IS - 1 KW - psychiatry KW - mobile health KW - smartphone N2 - Background: Despite growing interest in mobile mental health and utilization of smartphone technology to monitor psychiatric symptoms, there remains a lack of knowledge both regarding patient ownership of smartphones and their interest in using such to monitor their mental health. Objective: To provide data on psychiatric outpatients? prevalence of smartphone ownership and interest in using their smartphones to run applications to monitor their mental health. Methods: We surveyed 320 psychiatric outpatients from four clinics around the United States in order to capture a geographically and socioeconomically diverse patient population. These comprised a state clinic in Massachusetts (n=108), a county clinic in California (n=56), a hybrid public and private clinic in Louisiana (n=50), and a private/university clinic in Wisconsin (n=106). Results: Smartphone ownership and interest in utilizing such to monitor mental health varied by both clinic type and age with overall ownership of 62.5% (200/320), which is slightly higher than the average United States? rate of ownership of 58% in January 2014. Overall patient interest in utilizing smartphones to monitor symptoms was 70.6% (226/320). Conclusions: These results suggest that psychiatric outpatients are interested in using their smartphones to monitor their mental health and own the smartphones capable of running mental healthcare related mobile applications. UR - http://mental.jmir.org/2014/1/e5/ UR - http://dx.doi.org/10.2196/mental.4004 UR - http://www.ncbi.nlm.nih.gov/pubmed/26543905 ID - info:doi/10.2196/mental.4004 ER - TY - JOUR AU - Agboola, Stephen AU - Flanagan, Clare AU - Searl, Meghan AU - Elfiky, Aymen AU - Kvedar, Joseph AU - Jethwani, Kamal PY - 2014/12/23 TI - Improving Outcomes in Cancer Patients on Oral Anti-Cancer Medications Using a Novel Mobile Phone-Based Intervention: Study Design of a Randomized Controlled Trial JO - JMIR Res Protoc SP - e79 VL - 3 IS - 4 KW - cancer KW - oral anti-cancer medication KW - mobile application KW - randomized controlled trial KW - self-care KW - mHealth KW - medication adherence N2 - Background: The widespread and increasing use of oral anti-cancer medications has been ushered in by a rapidly increasing understanding of cancer pathophysiology. Furthermore, their popular ease of administration and potential cost savings has highlighted their central position in the health care system as a whole. These facts have heightened appreciation of the unique challenges associated with the use of oral anti-cancer medications; especially in the long-term use of these medications and the associated side effects that may impede optimal adherence to their use. Therefore, we developed ChemOtheRapy Assistant, CORA, a personalized mobile phone?based self-management application to help cancer patients on oral anti-cancer medications. Objective: Our objective is to evaluate the effect of CORA on adherence to oral anti-cancer medications and other clinically relevant outcomes in the management of patients with renal and prostate cancer. Methods: The study will be implemented as a 2-parallel group randomized controlled trial in 104 patients with renal or prostate cancer on oral anti-cancer medications over a 3-month study period. The intervention group will use CORA in addition to usual care for self-management while the control group will continue care as usual. Medication adherence will be measured objectively by a Medication Event Monitoring System device and is defined as the percentage of prescribed doses taken. We will also assess the effect of the intervention on cancer-related symptoms measured by the MD Anderson Symptom Inventory and unplanned hospital utilizations. Other outcomes that will be measured at study start, midpoint, and endpoint are health-related quality of life, cancer-related fatigue, and anxiety. Group differences in medication adherence will be examined by t tests or by non-parametric Mann-Whitney tests if the data are not normally distributed. Logistic regression will be used to identify potential predictors of adherence. Results: We expect to have results for this study before the end of 2016. Conclusions: This novel mobile phone?enabled, multimodal self-management and educational intervention could lead to improvements in clinical outcomes and serve as a foundation for future mHealth research in improving outcomes for patients on oral anti-cancer medications. UR - http://www.researchprotocols.org/2014/4/e79/ UR - http://dx.doi.org/10.2196/resprot.4041 UR - http://www.ncbi.nlm.nih.gov/pubmed/25537463 ID - info:doi/10.2196/resprot.4041 ER - TY - JOUR AU - Mergel, Ines PY - 2014/12/23 TI - The Long Way From Government Open Data to Mobile Health Apps: Overcoming Institutional Barriers in the US Federal Government JO - JMIR mHealth uHealth SP - e58 VL - 2 IS - 4 KW - mHealth KW - mobile apps KW - open data KW - prizes and challenges N2 - Background: Government agencies in the United States are creating mobile health (mHealth) apps as part of recent policy changes initiated by the White House?s Digital Government Strategy. Objective: The objective of the study was to understand the institutional and managerial barriers for the implementation of mHealth, as well as the resulting adoption pathways of mHealth. Methods: This article is based on insights derived from qualitative interview data with 35 public managers in charge of promoting the reuse of open data through Challenge.gov, the platform created to run prizes, challenges, and the vetting and implementation of the winning and vendor-created apps. Results: The process of designing apps follows three different pathways: (1) entrepreneurs start to see opportunities for mobile apps, and develop either in-house or contract out to already vetted Web design vendors; (2) a top-down policy mandates agencies to adopt at least two customer-facing mobile apps; and (3) the federal government uses a policy instrument called ?Prizes and Challenges?, encouraging civic hackers to design health-related mobile apps using open government data from HealthData.gov, in combination with citizen needs. All pathways of the development process incur a set of major obstacles that have to be actively managed before agencies can promote mobile apps on their websites and app stores. Conclusions: Beyond the cultural paradigm shift to design interactive apps and to open health-related data to the public, the managerial challenges include accessibility, interoperability, security, privacy, and legal concerns using interactive apps tracking citizen. UR - http://mhealth.jmir.org/2014/4/e58/ UR - http://dx.doi.org/10.2196/mhealth.3694 UR - http://www.ncbi.nlm.nih.gov/pubmed/25537314 ID - info:doi/10.2196/mhealth.3694 ER - TY - JOUR AU - O'Connor, Elodie AU - Farrow, Maree AU - Hatherly, Chris PY - 2014/12/22 TI - Randomized Comparison of Mobile and Web-Tools to Provide Dementia Risk Reduction Education: Use, Engagement and Participant Satisfaction JO - JMIR Mental Health SP - e4 VL - 1 IS - 1 KW - dementia KW - Alzheimer KW - engagement KW - health communication KW - Internet KW - intervention KW - mobile phone KW - risk reduction behavior KW - user perceptions KW - mhealth N2 - Background: Encouraging middle-aged adults to maintain their physical and cognitive health may have a significant impact on reducing the prevalence of dementia in the future. Mobile phone apps and interactive websites may be one effective way to target this age group. However, to date there has been little research investigating the user experience of dementia risk reduction tools delivered in this way. Objective: The aim of this study was to explore participant engagement and evaluations of three different targeted smartphone and Web-based dementia risk reduction tools following a four-week intervention. Methods: Participants completed a Web-based screening questionnaire to collect eligibility information. Eligible participants were asked to complete a Web-based baseline questionnaire and were then randomly assigned to use one of the three dementia risk reduction tools for a period of four weeks: (1) a mobile phone application; (2) an information-based website; and (3) an interactive website. User evaluations were obtained via a Web-based follow-up questionnaire after completion of the intervention. Results: Of 415 eligible participants, 370 (89.16%) completed the baseline questionnaire and were assigned to an intervention group; 200 (54.05%) completed the post-intervention questionnaire. The average age of participants was 52 years, and 149 (75%) were female. Findings indicated that participants from all three intervention groups reported a generally positive impression of the tools across a range of domains. Participants using the information-based website reported higher ratings of their overall impression of the tool, F2,191=4.12, P=.02; how interesting the information was, F2,189=3.53, P=.03; how helpful the information was, F2,192=4.15, P=.02; and how much they learned, F2,188=3.86, P=.02. Group differences were significant between the mobile phone app and information-based website users, but not between the interactive website users and the other two groups. Additionally, participants using the information-based website reported significantly higher scores on their ratings of the ease of navigation, F2,190=4.20, P=.02, than those using the mobile phone app and the interactive website. There were no significant differences between groups on ratings of ease of understanding the information, F2,188=0.27, P=.76. Most participants from each of the three intervention groups indicated that they intended to keep using the dementia risk reduction eHealth tool. Conclusions: Overall, results indicated that while participants across all three intervention groups reported a generally positive experience with the targeted dementia risk reduction tools, participants using the information-based website provided a more favorable evaluation across a range of areas than participants using the mobile phone app. Further research is required to investigate whether targeted dementia risk reduction tools, in the form of interactive websites and mobile apps, can be improved to provide benefits above those gained by providing static information alone. UR - http://mental.jmir.org/2014/1/e4/ UR - http://dx.doi.org/10.2196/mental.3654 UR - http://www.ncbi.nlm.nih.gov/pubmed/26543904 ID - info:doi/10.2196/mental.3654 ER - TY - JOUR AU - Imam, Bita AU - Miller, C. William AU - Finlayson, C. Heather AU - Eng, J. Janice AU - Payne, WC Michael AU - Jarus, Tal AU - Goldsmith, H. Charles AU - Mitchell, M. Ian PY - 2014/12/22 TI - A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e80 VL - 3 IS - 4 KW - amputation KW - adult KW - aged KW - randomized controlled trial KW - telemedicine KW - walking N2 - Background: The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed ?Wii.n.Walk?, an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. Objective: The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. Methods: This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants? homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks? duration. The primary outcome measure will be the ?Two-Minute Walk Test? to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and unsupervised phases, and after 1-year follow up. Results: Study staff have been hired and trained at both sites and recruitment is currently underway. No participants have been enrolled yet. Conclusions: Wii.n.Walk is a promising in-home telehealth intervention that may have useful applications for older adults with LLA who are discharged from rehabilitation or live in remote areas having limited or no access to existing rehabilitation programs. Trial Registration: Clinicaltrial.gov NCT01942798; http://clinicaltrials.gov/ct2/show/NCT01942798 (Archived by WebCite at http://www.webcitation.org/6V0w8baKP). UR - http://www.researchprotocols.org/2014/4/e80/ UR - http://dx.doi.org/10.2196/resprot.4031 UR - http://www.ncbi.nlm.nih.gov/pubmed/25533902 ID - info:doi/10.2196/resprot.4031 ER - TY - JOUR AU - Holmen, Heidi AU - Torbjørnsen, Astrid AU - Wahl, Klopstad Astrid AU - Jenum, Karen Anne AU - Småstuen, Cvancarova Milada AU - Årsand, Eirik AU - Ribu, Lis PY - 2014/12/11 TI - A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH JO - JMIR mHealth uHealth SP - e57 VL - 2 IS - 4 KW - self-care KW - mobile applications KW - cellular phone KW - telemedicine KW - counseling KW - motivational interviewing KW - diabetes mellitus, type 2 KW - hemoglobin A1c protein, human N2 - Background: Self-management is crucial in the daily management of type 2 diabetes. It has been suggested that mHealth may be an important method for enhancing self-management when delivered in combination with health counseling. Objective: The objective of this study was to test whether the use of a mobile phone?based self-management system used for 1 year, with or without telephone health counseling by a diabetes specialist nurse for the first 4 months, could improve glycated hemoglobin A1c (HbA1c) level, self-management, and health-related quality of life compared with usual care. Methods: We conducted a 3-arm prospective randomized controlled trial involving 2 intervention groups and 1 control group. Eligible participants were persons with type 2 diabetes with an HbA1c level ?7.1% (?54.1 mmol/mol) and aged ?18 years. Both intervention groups received the mobile phone?based self-management system Few Touch Application (FTA). The FTA consisted of a blood glucose?measuring system with automatic wireless data transfer, diet manual, physical activity registration, and management of personal goals, all recorded and operated using a diabetes diary app on the mobile phone. In addition, one intervention group received health counseling based on behavior change theory and delivered by a diabetes specialist nurse for the first 4 months after randomization. All groups received usual care by their general practitioner. The primary outcome was HbA1c level. Secondary outcomes were self-management (heiQ), health-related quality of life (SF-36), depressive symptoms (CES-D), and lifestyle changes (dietary habits and physical activity). Data were analyzed using univariate methods (t test, ANOVA) and multivariate linear and logistic regression. Results: A total of 151 participants were randomized: 51 to the FTA group, 50 to the FTA-health counseling (FTA-HC) group, and 50 to the control group. Follow-up data after 1 year were available for 120 participants (79%). HbA1c level decreased in all groups, but did not differ between groups after 1 year. The mean change in the heiQ domain skills and technique acquisition was significantly greater in the FTA-HC group after adjusting for age, gender, and education (P=.04). Other secondary outcomes did not differ between groups after 1 year. In the FTA group, 39% were substantial users of the app; 34% of the FTA-HC group were substantial users. Those aged ?63 years used the app more than their younger counterparts did (OR 2.7; 95% CI 1.02-7.12; P=.045). Conclusions: The change in HbA1c level did not differ between groups after the 1-year intervention. Secondary outcomes did not differ between groups except for an increase in the self-management domain of skill and technique acquisition in the FTA-HC group. Older participants used the app more than the younger participants did. UR - http://mhealth.jmir.org/2014/4/e57/ UR - http://dx.doi.org/10.2196/mhealth.3882 UR - http://www.ncbi.nlm.nih.gov/pubmed/25499872 ID - info:doi/10.2196/mhealth.3882 ER - TY - JOUR AU - Torbjørnsen, Astrid AU - Jenum, Karen Anne AU - Småstuen, Cvancarova Milada AU - Årsand, Eirik AU - Holmen, Heidi AU - Wahl, Klopstad Astrid AU - Ribu, Lis PY - 2014/12/11 TI - A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH JO - JMIR mHealth uHealth SP - e52 VL - 2 IS - 4 KW - self-care KW - quality of life KW - diabetes mellitus, type 2 KW - randomized controlled trials KW - telemedicine KW - mHealth KW - mobile apps KW - counseling KW - complex intervention KW - life style N2 - Background: Self-management support for people with type 2 diabetes is essential in diabetes care. Thus, mobile health technology with or without low-intensity theory-based health counseling could become an important tool for promoting self-management. Objectives: The aim was to evaluate whether the introduction of technology-supported self-management using the Few Touch Application (FTA) diabetes diary with or without health counseling improved glycated hemoglobin (HbA1c) levels, self-management, behavioral change, and health-related quality of life, and to describe the sociodemographic, clinical, and lifestyle characteristics of the participants after 4 months. Methods: A 3-armed randomized controlled trial was conducted in Norway during 2011-2013. In the 2 intervention groups, participants were given a mobile phone for 1 year, which provided access to the FTA diary, a self-help tool that recorded 5 elements: blood glucose, food habits, physical activity, personal goal setting, and a look-up system for diabetes information. One of the intervention groups was also offered theory-based health counseling with a specialist diabetes nurse by telephone for 4 months from baseline. Both intervention groups and the control group were provided usual care according to the national guidelines. Adults with type 2 diabetes and HbA1c ?7.1% were included (N=151). There were 3 assessment points: baseline, 4 months, and 1 year. We report the short-term findings after 4 months. HbA1c was the primary outcome and the secondary outcomes were self-management (Health Education Impact Questionnaire, heiQ), behavioral change (diet and physical activity), and health-related quality of life (SF-36 questionnaire). The data were analyzed using univariate methods (ANOVA), multivariate linear, and logistic regression. Results: Data were analyzed from 124 individuals (attrition rate was 18%). The groups were well balanced at baseline. There were no differences in HbA1c between groups after 4 months, but there was a decline in all groups. There were changes in self-management measured using the health service navigation item in the heiQ, with improvements in the FTA group compared to the control group (P=.01) and in the FTA with health counseling group compared with both other groups (P=.04). This may indicate an improvement in the ability of patients to communicate health needs to their health care providers. Furthermore, the FTA group reported higher scores for skill and technique acquisition at relieving symptoms compared to the control group (P=.02). There were no significant changes in any of the domains of the SF-36. Conclusions: The primary outcome, HbA1c, did not differ between groups after 4 months. Both of the intervention groups had significantly better scores than the control group for health service navigation and the FTA group also exhibited improved skill and technique acquisition. UR - http://mhealth.jmir.org/2014/4/e52/ UR - http://dx.doi.org/10.2196/mhealth.3535 UR - http://www.ncbi.nlm.nih.gov/pubmed/25499592 ID - info:doi/10.2196/mhealth.3535 ER - TY - JOUR AU - Brusse, Carl AU - Gardner, Karen AU - McAullay, Daniel AU - Dowden, Michelle PY - 2014/12/10 TI - Social Media and Mobile Apps for Health Promotion in Australian Indigenous Populations: Scoping Review JO - J Med Internet Res SP - e280 VL - 16 IS - 12 KW - health promotion KW - indigenous health KW - eHealth N2 - Background: Health promotion organizations are increasingly embracing social media technologies to engage end users in a more interactive way and to widely disseminate their messages with the aim of improving health outcomes. However, such technologies are still in their early stages of development and, thus, evidence of their efficacy is limited. Objective: The study aimed to provide a current overview of the evidence surrounding consumer-use social media and mobile software apps for health promotion interventions, with a particular focus on the Australian context and on health promotion targeted toward an Indigenous audience. Specifically, our research questions were: (1) What is the peer-reviewed evidence of benefit for social media and mobile technologies used in health promotion, intervention, self-management, and health service delivery, with regard to smoking cessation, sexual health, and otitis media? and (2) What social media and mobile software have been used in Indigenous-focused health promotion interventions in Australia with respect to smoking cessation, sexual health, or otitis media, and what is the evidence of their effectiveness and benefit? Methods: We conducted a scoping study of peer-reviewed evidence for the effectiveness of social media and mobile technologies in health promotion (globally) with respect to smoking cessation, sexual health, and otitis media. A scoping review was also conducted for Australian uses of social media to reach Indigenous Australians and mobile apps produced by Australian health bodies, again with respect to these three areas. Results: The review identified 17 intervention studies and seven systematic reviews that met inclusion criteria, which showed limited evidence of benefit from these interventions. We also found five Australian projects with significant social media health components targeting the Indigenous Australian population for health promotion purposes, and four mobile software apps that met inclusion criteria. No evidence of benefit was found for these projects. Conclusions: Although social media technologies have the unique capacity to reach Indigenous Australians as well as other underserved populations because of their wide and instant disseminability, evidence of their capacity to do so is limited. Current interventions are neither evidence-based nor widely adopted. Health promotion organizations need to gain a more thorough understanding of their technologies, who engages with them, why they engage with them, and how, in order to be able to create successful social media projects. UR - http://www.jmir.org/2014/12/e280/ UR - http://dx.doi.org/10.2196/jmir.3614 UR - http://www.ncbi.nlm.nih.gov/pubmed/25498835 ID - info:doi/10.2196/jmir.3614 ER - TY - JOUR AU - Mather, Carey AU - Cummings, Elizabeth AU - Allen, Penny PY - 2014/12/10 TI - Nurses? Use of Mobile Devices to Access Information in Health Care Environments in Australia: A Survey of Undergraduate Students JO - JMIR mHealth uHealth SP - e56 VL - 2 IS - 4 KW - undergraduate nurse KW - mobile KW - work integrated learning N2 - Background: The growth of digital technology has created challenges for safe and appropriate use of mobile or portable devices during work-integrated learning (WIL) in health care environments. Personal and professional use of technology has outpaced the development of policy or codes of practice for guiding its use at the workplace. There is a perceived risk that portable devices may distract from provision of patient or client care if used by health professionals or students during employment or WIL. Objective: This study aimed to identify differences in behavior of undergraduate nurses in accessing information, using a portable or mobile device, when undertaking WIL compared to other non-work situations. Methods: A validated online survey was administered to students while on placement in a range of health care settings in two Australian states. Results: There were 84 respondents, with 56% (n=47) reporting access to a mobile or portable device. Differences in use of a mobile device away from, compared with during WIL, were observed for non-work related activities such as messaging (P<.001), social networking (P<.001), shopping on the Internet (P=.01), conducting personal business online (P=.01), and checking or sending non-work related texts or emails to co-workers (P=.04). Study-related activities were conducted more regularly away from the workplace and included accessing University sites for information (P=.03) and checking or sending study-related text messages or emails to friends or co-workers (P=.01). Students continued to access nursing, medical, professional development, and study-related information away from the workplace. Conclusions: Undergraduate nurses limit their access to non-work or non-patient centered information while undertaking WIL. Work-related mobile learning is being undertaken, in situ, by the next generation of nurses who expect easy access to mobile or portable devices at the workplace, to ensure safe and competent care is delivered to their patients. UR - http://mhealth.jmir.org/2014/4/e56/ UR - http://dx.doi.org/10.2196/mhealth.3467 UR - http://www.ncbi.nlm.nih.gov/pubmed/25499736 ID - info:doi/10.2196/mhealth.3467 ER - TY - JOUR AU - Zhang, Melvyn AU - Cheow, Enquan AU - Ho, SH Cyrus AU - Ng, Yeong Beng AU - Ho, Roger AU - Cheok, Soon Christopher Cheng PY - 2014/12/09 TI - Application of Low-Cost Methodologies for Mobile Phone App Development JO - JMIR mHealth uHealth SP - e55 VL - 2 IS - 4 KW - education KW - technology KW - mobile phone apps KW - cost-effectiveness N2 - Background: The usage of mobile phones and mobile phone apps in the recent decade has indeed become more prevalent. Previous research has highlighted a method of using just the Internet browser and a text editor to create an app, but this does not eliminate the challenges faced by clinicians. More recently, two methodologies of app development have been shared, but there has not been any disclosures pertaining to the costs involved. In addition, limitations such as the distribution and dissemination of the apps have not been addressed. Objective: The aims of this research article are to: (1) highlight a low-cost methodology that clinicians without technical knowledge could use to develop educational apps; (2) clarify the respective costs involved in the process of development; (3) illustrate how limitations pertaining to dissemination could be addressed; and (4) to report initial utilization data of the apps and to share initial users? self-rated perception of the apps. Methods: In this study, we will present two techniques of how to create a mobile app using two of the well-established online mobile app building websites. The costs of development are specified and the methodology of dissemination of the apps will be shared. The application of the low-cost methodologies in the creation of the ?Mastering Psychiatry? app for undergraduates and ?Déjà vu? app for postgraduates will be discussed. A questionnaire survey has been administered to undergraduate students collating their perceptions towards the app. Results: For the Mastering Psychiatry app, a cumulative total of 722 users have used the mobile app since inception, based on our analytics. For the Déjà vu app, there has been a cumulative total of 154 downloads since inception. The utilization data demonstrated the receptiveness towards these apps, and this is reinforced by the positive perceptions undergraduate students (n=185) had towards the low-cost self-developed apps. Conclusions: This is one of the few studies that have demonstrated the low-cost methodologies of app development; as well as student and trainee receptivity toward self-created Web-based mobile phone apps. The results obtained have demonstrated that these Web-based low-cost apps are applicable in the real life, and suggest that the methodologies shared in this research paper might be of benefit for other specialities and disciplines. UR - http://mhealth.jmir.org/2014/4/e55/ UR - http://dx.doi.org/10.2196/mhealth.3549 UR - http://www.ncbi.nlm.nih.gov/pubmed/25491323 ID - info:doi/10.2196/mhealth.3549 ER - TY - JOUR AU - Palermo, Claire AU - Perera-Schulz, Dharani AU - Kannan, Anitha AU - Truby, Helen AU - Shiell, Alan AU - Emilda, Sindhu AU - Quenette, Steve PY - 2014/12/04 TI - Development and Evaluation of an iPad App for Measuring the Cost of a Nutritious Diet JO - JMIR mHealth uHealth SP - e50 VL - 2 IS - 4 KW - portable digital device KW - iPad KW - healthy food KW - food cost N2 - Background: Monitoring food costs informs governments of the affordability of healthy diets. Many countries have adopted a standardized healthy food basket. The Victorian Healthy Food Basket contains 44 food items necessary to meet the nutritional requirements of four different Australian family types for a fortnight. Objective: The aim of this study was to describe the development of a new iPad app as core to the implementation of the Victorian Healthy Food Basket. The app significantly automates the data collection. We evaluate if the new technology enhanced the quality and efficacy of the research. Methods: Time taken for data collection and entry was recorded. Semi-structured evaluative interviews were conducted with five field workers during the pilot of the iPad app. Field workers were familiar with previous manual data collection methods. Qualitative process evaluation data was summarized against key evaluation questions. Results: Field workers reported that using the iPad for data collection resulted in increased data accuracy, time savings, and efficient data management, and was preferred over manual collection. Conclusions: Portable digital devices may be considered to improve and extend data collection in the field of food cost monitoring. UR - http://mhealth.jmir.org/2014/4/e50/ UR - http://dx.doi.org/10.2196/mhealth.3314 UR - http://www.ncbi.nlm.nih.gov/pubmed/25486678 ID - info:doi/10.2196/mhealth.3314 ER - TY - JOUR AU - Oliveira, Jonice AU - Souza, Silva Diego Da AU - de Lima, Zudio Patrícia AU - da Silveira, C. Pedro AU - de Souza, Moreira Jano PY - 2014/11/26 TI - Enhancing Knowledge Flow in a Health Care Context: A Mobile Computing Approach JO - JMIR mHealth uHealth SP - e17 VL - 2 IS - 4 KW - knowledge sharing KW - health care KW - mobile computing KW - Medicine 2.0 KW - collaborative interaction KW - social computing N2 - Background: Advances in mobile computing and wireless communication have allowed people to interact and exchange knowledge almost anywhere. These technologies support Medicine 2.0, where the health knowledge flows among all involved people (eg, patients, caregivers, doctors, and patients? relatives). Objective: Our paper proposes a knowledge-sharing environment that takes advantage of mobile computing and contextual information to support knowledge sharing among participants within a health care community (ie, from patients to health professionals). This software environment enables knowledge exchange using peer-to-peer (P2P) mobile networks based on users? profiles, and it facilitates face-to-face interactions among people with similar health interests, needs, or goals. Methods: First, we reviewed and analyzed relevant scientific articles and software apps to determine the current state of knowledge flow within health care. Although no proposal was capable of addressing every aspect in the Medicine 2.0 paradigm, a list of requirements was compiled. Using this requirement list and our previous works, a knowledge-sharing environment was created integrating Mobile Exchange of Knowledge (MEK) and the Easy to Deploy Indoor Positioning System (EDIPS), and a twofold qualitative evaluation was performed. Second, we analyzed the efficiency and reliability of the knowledge that the integrated MEK-EDIPS tool provided to users according to their interest topics, and then performed a proof of concept with health professionals to determine the feasibility and usefulness of using this solution in a real-world scenario. Results: . Using MEK, we reached 100% precision and 80% recall in the exchange of files within the peer-to-peer network. The mechanism that facilitated face-to-face interactions was evaluated by the difference between the location indicated by the EDIPS tool and the actual location of the people involved in the knowledge exchange. The average distance error was <6.28 m for an indoor environment. The usability and usefulness of this tool was assessed by questioning a sample of 18 health professionals: 94% (17/18) agreed the integrated MEK-EDIPS tool provides greater interaction among all the participants (eg, patients, caregivers, doctors, and patients? relatives), most considered it extremely important in the health scenario, 72% (13/18) believed it could increase the knowledge flow in a health environment, and 67% (12/18) recommend it or would like to recommend its use. Conclusions: The integrated MEK-EDIPS tool can provide more services than any other software tool analyzed in this paper. The proposed integrated MEK-EDIPS tool seems to be the best alternative for supporting health knowledge flow within the Medicine 2.0 paradigm. UR - http://mhealth.jmir.org/2014/4/e17/ UR - http://dx.doi.org/10.2196/mhealth.2543 UR - http://www.ncbi.nlm.nih.gov/pubmed/25427923 ID - info:doi/10.2196/mhealth.2543 ER - TY - JOUR AU - Khoo Chee Han, Christopher AU - Shanmugam, AL Rukmanikanthan AU - Choon Siew Kit, David PY - 2014/11/24 TI - Accuracy, Consistency, and Reproducibility of the Triaxial Accelerometer in the iPod Touch: A Pilot Study JO - JMIR mHealth uHealth SP - e39 VL - 2 IS - 4 KW - accelerometry KW - tri-axial accelerometer KW - iPod Touch N2 - Background: The use of a mobile consumer communicative device as a motion analysis tool for patients has been researched and documented previously, examining the triaxial accelerometer embedded in such devices. However, there have been few reports in the literature testing the sensitivity of an embedded triaxial accelerometer. Objective: Our goal in this study was to test the accuracy, consistency, and reproducibility of the triaxial accelerometer in the iPod Touch. Methods: In this pilot study, we subjected the triaxial accelerometer in the iPod Touch to a free fall from a height of 100 cm in order to test its accuracy, consistency, and reproducibility under dynamic conditions. Results: The resultant vectorial sum acceleration was mean 0.999 g (standard gravity; SD 1.51%; 95% CI 0.99-1.01), indicating very high accuracy and sensitivity under dynamic conditions. Conclusions: Our results highlighted the reproducibility of the capability of the triaxial accelerometer in the iPod Touch to capture data accurately and consistently. Thus, the device has huge potential as a motion analysis tool for measuring gait and studying balance and mobility in patients before and after surgery. UR - http://mhealth.jmir.org/2014/4/e39/ UR - http://dx.doi.org/10.2196/mhealth.3008 UR - http://www.ncbi.nlm.nih.gov/pubmed/25486896 ID - info:doi/10.2196/mhealth.3008 ER - TY - JOUR AU - Zhang, WB Melvyn AU - Tsang, Tammy AU - Cheow, Enquan AU - Ho, SH Cyrus AU - Yeong, Beng Ng AU - Ho, CM Roger PY - 2014/11/11 TI - Enabling Psychiatrists to be Mobile Phone App Developers: Insights Into App Development Methodologies JO - JMIR mHealth uHealth SP - e53 VL - 2 IS - 4 KW - smartphone application KW - mobile application KW - creation N2 - Background: The use of mobile phones, and specifically smartphones, in the last decade has become more and more prevalent. The latest mobile phones are equipped with comprehensive features that can be used in health care, such as providing rapid access to up-to-date evidence-based information, provision of instant communications, and improvements in organization. The estimated number of health care apps for mobile phones is increasing tremendously, but previous research has highlighted the lack of critical appraisal of new apps. This lack of appraisal of apps has largely been due to the lack of clinicians with technical knowledge of how to create an evidence-based app. Objective: We discuss two freely available methodologies for developing Web-based mobile phone apps: a website builder and an app builder. With these, users can program not just a Web-based app, but also integrate multimedia features within their app, without needing to know any programming language. Methods: We present techniques for creating a mobile Web-based app using two well-established online mobile app websites. We illustrate how to integrate text-based content within the app, as well as integration of interactive videos and rich site summary (RSS) feed information. We will also briefly discuss how to integrate a simple questionnaire survey into the mobile-based app. A questionnaire survey was administered to students to collate their perceptions towards the app. Results: These two methodologies for developing apps have been used to convert an online electronic psychiatry textbook into two Web-based mobile phone apps for medical students rotating through psychiatry in Singapore. Since the inception of our mobile Web-based app, a total of 21,991 unique users have used the mobile app and online portal provided by WordPress, and another 717 users have accessed the app via a Web-based link. The user perspective survey results (n=185) showed that a high proportion of students valued the textbook and objective structured clinical examination videos featured in the app. A high proportion of students concurred that a self-designed mobile phone app would be helpful for psychiatry education. Conclusions: These methodologies can enable busy clinicians to develop simple mobile Web-based apps for academic, educational, and research purposes, without any prior knowledge of programming. This will be beneficial for both clinicians and users at large, as there will then be more evidence-based mobile phone apps, or at least apps that have been appraised by a clinician. UR - http://mhealth.jmir.org/2014/4/e53/ UR - http://dx.doi.org/10.2196/mhealth.3425 UR - http://www.ncbi.nlm.nih.gov/pubmed/25486985 ID - info:doi/10.2196/mhealth.3425 ER - TY - JOUR AU - Newton Jr, L. Robert AU - Marker, M. Arwen AU - Allen, Raymond H. AU - Machtmes, Ryan AU - Han, Hongmei AU - Johnson, D. William AU - Schuna Jr, M. John AU - Broyles, T. Stephanie AU - Tudor-Locke, Catrine AU - Church, S. Timothy PY - 2014/11/10 TI - Parent-Targeted Mobile Phone Intervention to Increase Physical Activity in Sedentary Children: Randomized Pilot Trial JO - JMIR mHealth uHealth SP - e48 VL - 2 IS - 4 KW - mobile health KW - physical activity intervention KW - child KW - parents KW - pedometers KW - text messaging N2 - Background: Low levels of moderate-to-vigorous physical activity are associated with adverse health consequences. Objective: The intent of the study was to determine the feasibility and efficacy of a 12-week physical activity promotion program targeting children, which was delivered to parents through mobile phones. Methods: Potential participants were recruited through advertisements placed in the newspaper, local hospitals and schools, and an email listserv. Sedentary children aged 6-10 years were randomly assigned to a minimal (MIG) or intensive (IIG) intervention group. Parents in the MIG were given a goal to increase (within 1 month) and maintain their child?s activity at 6000 pedometer steps/day above their baseline levels and to monitor their child?s steps daily. Parents in the IIG were given the same steps/day and monitoring goals, in addition to text messages and articles containing additional behavioral strategies (based on the Social Cognitive Theory) designed to promote their child?s physical activity. The intervention components were delivered via mobile phone. Anthropometrics, body composition, and questionnaires were administered in a clinic. Children wore a New Lifestyles pedometer (NL-1000) each day throughout the intervention and parents were to monitor their child?s step counts daily. Results: Out of 59 children who screened for the study, a total of 27 children (mean age 8.7, SD 1.4 years; 56%, 15/27 female; 59%, 16/27 African American) were enrolled and completed the study. Overall, 97.90% (2220/2268; 98.20%, 1072/1092 for MIG; 97.60%, 1148/1176 for IIG) of expected step data were successfully entered by the parent or study coordinator. Parents in the MIG and IIG were sent approximately 7 and 13 text messages per week, respectively, averaged over the course of the study. IIG parents accessed an average of 6.1 (SD 4.4) articles over the course of the intervention and accessed a fewer number of articles in the last month compared to the first 2 months of the study (P=.002). Children in both the MIG and IIG significantly increased their physical activity, averaged over 12 weeks, by 1427.6 (SD 583.0; P=.02) and 2832.8 (SD 604.9; P<.001) steps/day above baseline, respectively. The between group difference was not statistically significant (P=.10; effect size=.40), nor was the group by time interaction (P=.57). Regardless of group assignment, children who significantly increased their physical activity reported greater increases in physical activity enjoyment (P=.003). The number of behavioral articles accessed by IIG parents was significantly correlated with change in children?s steps/day (r=.575, P=.04). Changes in children?s steps/day were unrelated to changes in their body composition, mood, and food intake. Conclusions: Parent-targeted mobile phone interventions are feasible, yet more intense interventions may be needed to support parents? efforts to increase their children?s physical activity to levels that approximate national recommendations. Trial Registration: Clinicaltrials.gov NCT01551108; http://clinicaltrials.gov/show/NCT01551108 (Archived by WebCite at http://www.webcitation.org/6TNEOzXNX). UR - http://mhealth.jmir.org/2014/4/e48/ UR - http://dx.doi.org/10.2196/mhealth.3420 UR - http://www.ncbi.nlm.nih.gov/pubmed/25386899 ID - info:doi/10.2196/mhealth.3420 ER - TY - JOUR AU - Ashurst, J. Emily AU - Jones, B. Ray AU - Abraham, Charles AU - Jenner, Martin AU - Boddy, Kate AU - Besser, EJ Rachel AU - Hammersley, Suzanne AU - Pinkney, Jonathan PY - 2014/11/07 TI - The Diabetes App Challenge: User-Led Development and Piloting of Internet Applications Enabling Young People With Diabetes to Set the Focus for Their Diabetes Consultations JO - Med 2.0 SP - e5 VL - 3 IS - 2 KW - Type 1 diabetes KW - adolescents KW - mobile technology KW - clinic appointment KW - user-innovation KW - self-care KW - user-centered design N2 - Background: Traditionally, some teenagers and young adults with diabetes have not engaged well at diabetes appointments, giving rise to concerns about long-term health risks. We considered that apps might help this group of patients to improve preparation for, and therefore engagement at their appointments. Although there are already many apps for young people with type 1 diabetes (YPD), we thought that by supporting YPD themselves to develop apps, the resulting products would have greater ?authenticity? and relevance. Objective: To test the feasibility of an online competition to (1) recruit and support YPD to develop apps (mobile or Internet based) to help prepare for clinic appointments, and (2) for these apps to be tested and rated by YPD. Methods: The ?Diabetes App Challenge? was a United Kingdom (UK) national competition, run between June and October 2012 for teams including at least one YPD (aged 16-25) to pilot the design and development of apps for use by other YPD prior to clinic appointments. The competition was advertised by social media, email, AdWords and postings on the Diabetes UK website. Registrants for the competition were supported via email and discussion forum. After app development, other YPD were invited (November 2012-February 2013) to trial the apps, choose and use one prior to a clinic appointment, and review their experiences. Results: Of 56 people (including 28 YPD) who expressed interest in the competition, 6 teams (14 people) developed and submitted an app. Two apps aimed to facilitate agenda setting in clinic consultations, 2 enabled data logging and 2 helped insulin dose calculation. Of 135 YPD who registered to trial the apps, 83 (61.5%) took part (mean age 18.98, 37/83 male). Agenda setting apps were considered most useful for preparing for and setting the focus of clinic appointments (P=.02). Just over half (46/83, 55%) said they would use their chosen app again and 4/5 (67/83, 81%) would recommend it to a friend. Conclusions: This competition to engage YPD in developing and reviewing apps proved successful. App designers and testers saw a need for a range of functions. However, this may, in part, reflect a lack of detailed knowledge of all existing apps and be limited by the technical skills of YPD. App competitions appear worth applying to other patient groups, but future competitions should include a review stage and perhaps focus on ideas for app design for subsequent professional implementation. UR - http://www.medicine20.com/2014/2/e5/ UR - http://dx.doi.org/10.2196/med20.3032 UR - http://www.ncbi.nlm.nih.gov/pubmed/25654312 ID - info:doi/10.2196/med20.3032 ER - TY - JOUR AU - Rempel, R. Gwen AU - Ballantyne, T. Ross AU - Magill-Evans, Joyce AU - Nicholas, B. David AU - Mackie, S. Andrew PY - 2014/11/06 TI - Texting Teens in Transition: The Use of Text Messages in Clinical Intervention Research JO - JMIR mHealth uHealth SP - e45 VL - 2 IS - 4 KW - teens KW - congenital heart disease KW - text messaging KW - SMS KW - qualitative research N2 - Background: The rapidly growing population of young adults living with congenital heart disease (CHD), currently challenging ill-prepared cardiac care systems, presents a novel population in which to consider the use of mHealth. This methodological study was part of a larger study that tested the effectiveness of a clinic-based nursing intervention to prepare teens for transfer from pediatric to adult cardiology care. The intervention included creation of a MyHealth Passport and subsequently SMS (short message service) text messages between the intervention nurse and study participant. Objective: Our aim was to determine (1) the preference of teens with CHD to be contacted via text message following the nursing intervention, (2) the effectiveness of texting to collect data regarding the use of MyHealth Passport after participation in the intervention, (3) the nature of the texting interaction, and (4) the risks and benefits of texting. Methods: Participants were recruited through the intervention study (n=24) by either choosing to receive information from the study coordinator through text message, or texting a question to the study nurses. Inclusion criteria were age 15-17 years, diagnosed with moderate or complex heart disease, and currently being followed by the Division of Cardiology at Stollery Children?s Hospital. Exclusion criteria were heart transplantation and/or less than a 6th grade reading and comprehension ability. Text message transcripts were analyzed by qualitative inductive content analysis. Results: Two-thirds of teens (16/24, 67%) chose text messaging as their preferred contact, making them eligible for the study. Texting was effective in collecting information regarding the MyHealth Passport; all but one teen had their MyHealth Passport on them, and many reported carrying it with them wherever they went. All teens reported showing their MyHealth Passport to at least one person. Seven themes were identified in the texting transcripts: mixing formal and informal language, the passive teen, interaction with health care providers, texting teens in transition, texting as a mechanism to initiate other forms of communication, affirmation, and the nurse as an educator. Benefits of texting were identified as flexibility, ability to respond over time, information presented in byte-sized amounts, and information directly related to patient questions. Risks of texting were identified as the possibility that interactions may not be in-depth, distraction of teen and researcher, and invasiveness. Conclusions: Text messaging was useful in collecting data regarding the use of the MyHealth Passport. Text messaging resulted in conversations with the teens that were sometimes in-depth and meaningful, especially when combined with other communication modalities. Using text messaging in a manner resulting in full conversations with the patients requires more study and may benefit from protocols and the use of solid theoretical foundations that would standardize the interaction so that more conclusions could be drawn. UR - http://mhealth.jmir.org/2014/4/e45/ UR - http://dx.doi.org/10.2196/mhealth.3232 UR - http://www.ncbi.nlm.nih.gov/pubmed/25379624 ID - info:doi/10.2196/mhealth.3232 ER - TY - JOUR AU - Aguilera, Adrian AU - Berridge, Clara PY - 2014/11/05 TI - Qualitative Feedback From a Text Messaging Intervention for Depression: Benefits, Drawbacks, and Cultural Differences JO - JMIR mHealth uHealth SP - e46 VL - 2 IS - 4 KW - mobile health KW - depression KW - text messaging KW - culture KW - digital health KW - cognitive behavioral therapy KW - disparities KW - mental health KW - behavior change N2 - Background: Mobile health interventions are often standardized and assumed to work the same for all users; however, we may be missing cultural differences in the experiences of interventions that may impact how and if an intervention is effective. Objective: The objective of the study was to assess qualitative feedback from participants to determine if there were differences between Spanish speakers and English speakers. Daily text messages were sent to patients as an adjunct to group Cognitive Behavioral Therapy (CBT) for depression. Methods: Messages inquired about mood and about specific themes (thoughts, activities, social interactions) of a manualized group CBT intervention. There were thirty-nine patients who participated in the text messaging pilot study. The average age of the participants was 53 years (SD 10.4; range of 23-72). Results: Qualitative feedback from Spanish speakers highlighted feelings of social support, whereas English speakers noted increased introspection and self-awareness of their mood state. Conclusions: These cultural differences should be explored further, as they may impact the effect of supportive mobile health interventions. Trial Registration: Trial Registration: Clinicaltrials.gov NCT01083628; http://clinicaltrials.gov/ct2/show/study/NCT01083628 (Archived by WebCite at http://www.webcitation.org/6StpbdHuq). UR - http://mhealth.jmir.org/2014/4/e46/ UR - http://dx.doi.org/10.2196/mhealth.3660 UR - http://www.ncbi.nlm.nih.gov/pubmed/25373390 ID - info:doi/10.2196/mhealth.3660 ER - TY - JOUR AU - Lim, C. Megan S. AU - Wright, Cassandra AU - Hellard, E. Margaret PY - 2014/11/03 TI - The Medium and the Message: Fitting Sound Health Promotion Methodology Into 160 Characters JO - JMIR mHealth uHealth SP - e40 VL - 2 IS - 4 KW - text messaging KW - mobile phone KW - health promotion KW - program evaluation? UR - http://mhealth.jmir.org/2014/4/e40/ UR - http://dx.doi.org/10.2196/mhealth.3888 UR - http://www.ncbi.nlm.nih.gov/pubmed/25367387 ID - info:doi/10.2196/mhealth.3888 ER - TY - JOUR AU - Sheoran, Bhupendra AU - Braun, A. Rebecca AU - Gaarde, Patrice Jenna AU - Levine, K. Deborah PY - 2014/11/03 TI - The Hookup: Collaborative Evaluation of a Youth Sexual Health Program Using Text Messaging Technology JO - JMIR mHealth uHealth SP - e51 VL - 2 IS - 4 KW - sexual health KW - STDs KW - HIV KW - mobile phone KW - youth KW - SMS KW - text messaging KW - program evaluation N2 - Background: The Hookup is a collaborative project reaching young people in California with valuable sexual and reproductive health information and linkage to local resources. Due to limited access to subscriber contact information, it has been a challenge to evaluate the program. Objective: The aims of this study were to determine the feasibility of using text messaging (short message service, SMS) as an evaluation tool for an educational text message-based program and to evaluate the program itself. Methods: All subscribers of The Hookup were sent four survey questions via SMS about age, gender, location, referral source and behavior change. An incentive was offered for completing the survey and an opt-out option was provided in the initial message. Results: All existing subscribers of The Hookup (N=2477) received a request to complete the survey using the SMS application on their mobile phones. A total of 832 (33.6%) subscribers responded to the initial question and 481 (20%) answered all four questions. Of the responses, 85% were received in the first two hours of the initial request. Respondents who answered the question about behavior change, 90% reported having made some positive change since subscribing to Hookup, including getting tested for STDs and HIV. Conclusions: The survey methodology initiated a high response rate from The Hookup subscribers. The survey was able to provide data about subscribers in a short time period at minimal cost. The results show potential for using mobile SMS applications to evaluate SMS campaigns. The findings also support using SMS to provide young people with sexual health prevention messaging and linkage to health services. UR - http://mhealth.jmir.org/2014/4/e51/ UR - http://dx.doi.org/10.2196/mhealth.3583 UR - http://www.ncbi.nlm.nih.gov/pubmed/25367444 ID - info:doi/10.2196/mhealth.3583 ER - TY - JOUR AU - Goldenberg, Tamar AU - McDougal, J. Sarah AU - Sullivan, S. Patrick AU - Stekler, D. Joanne AU - Stephenson, Rob PY - 2014/10/29 TI - Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men JO - JMIR mHealth uHealth SP - e47 VL - 2 IS - 4 KW - MSM KW - HIV KW - mobile phone app KW - mHealth KW - HIV prevention N2 - Background: The Centers for Disease Control and Prevention recommends that sexually active men who have sex with men (MSM) in the United States test for human immunodeficiency virus (HIV) at least three times per year, but actual testing frequency is much less frequent. Though mHealth is a popular vehicle for delivering HIV interventions, there are currently no mobile phone apps that target MSM with the specific aim of building an HIV testing plan, and none that focuses on developing a comprehensive prevention plan and link MSM to additional HIV prevention and treatment resources. Previous research has suggested a need for more iterative feedback from the target population to ensure use of these interventions. Objective: The purpose of this study is to understand MSM?s preferences for functionality, format, and design of a mobile phone-based HIV prevention app and to examine MSM?s willingness to use an app for HIV prevention. Methods: We conducted focus group discussions with 38 gay and bisexual men, with two in-person groups in Atlanta, two in Seattle, and one online focus group discussion with gay and bisexual men in rural US regions. These discussions addressed MSM?s general preferences for apps, HIV testing barriers and facilitators for MSM, and ways that an HIV prevention app could address these barriers and facilitators to increase the frequency of HIV testing and prevention among MSM. During focus group discussions, participants were shown screenshots and provided feedback on potential app functions. Results: Participants provided preferences on functionality of the app, including the type and delivery of educational content, the value of interactive engagement, and the importance of social networking as an app component. Participants also discussed preferences on how the language should be framed for the delivery of information, identifying that an app needs to be simultaneously fun and professional. Privacy and altruistic motivation were considered to be important factors in men?s willingness to use a mobile HIV prevention app. Finally, men described the potential impact that a mobile HIV prevention app could have, identifying individual, interpersonal, and community-based benefits. Conclusions: In summary, participants described a comprehensive app that should incorporate innovative ideas to educate and engage men so that they would be motivated to use the app. In order for an app to be useful, it needs to feel safe and trustworthy, which is essential when considering the app?s language and privacy. Participants provided a range of preferences for using an HIV prevention app, including what they felt MSM need with regards to HIV prevention and what they want in order to engage with an app. Making an HIV prevention app enjoyable and usable for MSM is a difficult challenge. However, the usability of the app is vital because no matter how great the intervention, if MSM do not use the app, then it will not be useful. UR - http://mhealth.jmir.org/2014/4/e47/ UR - http://dx.doi.org/10.2196/mhealth.3745 UR - http://www.ncbi.nlm.nih.gov/pubmed/25355249 ID - info:doi/10.2196/mhealth.3745 ER - TY - JOUR AU - Weimann, Edda AU - Stuttaford, C. Maria PY - 2014/10/28 TI - Consumers' Perspectives on National Health Insurance in South Africa: Using a Mobile Health Approach JO - JMIR mHealth uHealth SP - e49 VL - 2 IS - 4 KW - health systems reform KW - public consultation KW - South Africa KW - National Health Insurance (NHI) KW - health systems strengthening (HSS) KW - WHO building blocks KW - social media, GINI Index N2 - Background: Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. Objective: This research is based on a survey using Mxit as a mobile phone?based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. Methods: Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. Results: Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system?s governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. Conclusions: The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform. UR - http://mhealth.jmir.org/2014/4/e49/ UR - http://dx.doi.org/10.2196/mhealth.3533 UR - http://www.ncbi.nlm.nih.gov/pubmed/25351980 ID - info:doi/10.2196/mhealth.3533 ER - TY - JOUR AU - Hilliard, E. Marisa AU - Hahn, Amy AU - Ridge, K. Alana AU - Eakin, N. Michelle AU - Riekert, A. Kristin PY - 2014/10/24 TI - User Preferences and Design Recommendations for an mHealth App to Promote Cystic Fibrosis Self-Management JO - JMIR mHealth uHealth SP - e44 VL - 2 IS - 4 KW - cystic fibrosis KW - qualitative research KW - mobile health N2 - Background: mHealth apps hold potential to provide automated, tailored support for treatment adherence among individuals with chronic medical conditions. Yet relatively little empirical research has guided app development and end users are infrequently involved in designing the app features or functions that would best suit their needs. Self-management apps may be particularly useful for people with chronic conditions like cystic fibrosis (CF) that have complex, demanding regimens. Objective: The aim of this mixed-methods study was to involve individuals with CF in guiding the development of engaging, effective, user-friendly adherence promotion apps that meet their preferences and self-management needs. Methods: Adults with CF (n=16, aged 21-48 years, 50% male) provided quantitative data via a secure Web survey and qualitative data via semi-structured telephone interviews regarding previous experiences using apps in general and for health, and preferred and unwanted features of potential future apps to support CF self-management. Results: Participants were smartphone users who reported sending or receiving text messages (93%, 14/15) or emails (80%, 12/15) on their smartphone or device every day, and 87% (13/15) said it would be somewhat or very hard to give up their smartphone. Approximately one-half (53%, 8/15) reported having health apps, all diet/weight-related, yet many reported that existing nutrition apps were not well-suited for CF management. Participants wanted apps to support CF self-management with characteristics such as having multiple rather than single functions (eg, simple alarms), being specific to CF, and minimizing user burden. Common themes for desired CF app features were having information at one?s fingertips, automation of disease management activities such as pharmacy refills, integration with smartphones? technological capabilities, enhancing communication with health care team, and facilitating socialization within the CF community. Opinions were mixed regarding gamification and earning rewards or prizes. Participants emphasized the need for customization options to meet individual preferences and disease management goals. Conclusions: Unique capabilities of emerging smartphone technologies (eg, social networking integration, movement and location detection, integrated sensors, or electronic monitors) make many of these requests possible. Involving end users in all stages of mHealth app development and collaborating with technology experts and the health care system may result in apps that maintain engagement, improve integration and automation, and ultimately impact self-management and health outcomes. UR - http://mhealth.jmir.org/2014/4/e44/ UR - http://dx.doi.org/10.2196/mhealth.3599 UR - http://www.ncbi.nlm.nih.gov/pubmed/25344616 ID - info:doi/10.2196/mhealth.3599 ER - TY - JOUR AU - Morrison, G. Leanne AU - Hargood, Charlie AU - Lin, Xiaowen Sharon AU - Dennison, Laura AU - Joseph, Judith AU - Hughes, Stephanie AU - Michaelides, T. Danius AU - Johnston, Derek AU - Johnston, Marie AU - Michie, Susan AU - Little, Paul AU - Smith, WF Peter AU - Weal, J. Mark AU - Yardley, Lucy PY - 2014/10/22 TI - Understanding Usage of a Hybrid Website and Smartphone App for Weight Management: A Mixed-Methods Study JO - J Med Internet Res SP - e201 VL - 16 IS - 10 KW - qualitative research KW - weight loss KW - behavioral research KW - mobile apps KW - Internet KW - health KW - program acceptability KW - behavior KW - mixed-methods N2 - Background: Advancements in mobile phone technology offer huge potential for enhancing the timely delivery of health behavior change interventions. The development of smartphone-based health interventions (apps) is a rapidly growing field of research, yet there have been few longitudinal examinations of how people experience and use these apps within their day-to-day routines, particularly within the context of a hybrid Web- and app-based intervention. Objective: This study used an in-depth mixed-methods design to examine individual variation in (1) impact on self-reported goal engagement (ie, motivation, self-efficacy, awareness, effort, achievement) of access to a weight management app (POWeR Tracker) when provided alongside a Web-based weight management intervention (POWeR) and (2) usage and views of POWeR Tracker. Methods: Thirteen adults were provided access to POWeR and were monitored over a 4-week period. Access to POWeR Tracker was provided in 2 alternate weeks (ie, weeks 1 and 3 or weeks 2 and 4). Participants? goal engagement was measured daily via self-report. Mixed effects models were used to examine change in goal engagement between the weeks when POWeR Tracker was and was not available and whether the extent of change in goal engagement varied between individual participants. Usage of POWeR and POWeR Tracker was automatically recorded for each participant. Telephone interviews were conducted and analyzed using inductive thematic analysis to further explore participants? experiences using POWeR and POWeR Tracker. Results: Access to POWeR Tracker was associated with a significant increase in participants? awareness of their eating (?1=0.31, P=.04) and physical activity goals (?1=0.28, P=.03). The level of increase varied between individual participants. Usage data showed that participants used the POWeR website for similar amounts of time during the weeks when POWeR Tracker was (mean 29 minutes, SD 31 minutes) and was not available (mean 27 minutes, SD 33 minutes). POWeR Tracker was mostly accessed in short bursts (mean 3 minutes, SD 2 minutes) during convenient moments or moments when participants deemed the intervention content most relevant. The qualitative data indicated that nearly all participants agreed that it was more convenient to access information on-the-go via their mobiles compared to a computer. However, participants varied in their views and usage of the Web- versus app-based components and the informational versus tracking tools provided by POWeR Tracker. Conclusions: This study provides evidence that smartphones have the potential to improve individuals? engagement with their health-related goals when used as a supplement to an existing online intervention. The perceived convenience of mobile access to information does not appear to deter use of Web-based interventions or strengthen the impact of app access on goal engagement. A mixed-methods design enabled exploration of individual variation in daily usage of the app-based tools. UR - http://www.jmir.org/2014/10/e201/ UR - http://dx.doi.org/10.2196/jmir.3579 UR - http://www.ncbi.nlm.nih.gov/pubmed/25355131 ID - info:doi/10.2196/jmir.3579 ER - TY - JOUR AU - Illiger, Kristin AU - Hupka, Markus AU - von Jan, Ute AU - Wichelhaus, Daniel AU - Albrecht, Urs-Vito PY - 2014/10/21 TI - Mobile Technologies: Expectancy, Usage, and Acceptance of Clinical Staff and Patients at a University Medical Center JO - JMIR mHealth uHealth SP - e42 VL - 2 IS - 4 KW - survey KW - mobile health KW - mobile apps KW - health care KW - privacy KW - data protection KW - patients KW - medical staff KW - staff attitude N2 - Background: Despite their increasing popularity, little is known about how users perceive mobile devices such as smartphones and tablet PCs in medical contexts. Available studies are often restricted to evaluating the success of specific interventions and do not adequately cover the users? basic attitudes, for example, their expectations or concerns toward using mobile devices in medical settings. Objective: The objective of the study was to obtain a comprehensive picture, both from the perspective of the patients, as well as the doctors, regarding the use and acceptance of mobile devices within medical contexts in general well as the perceived challenges when introducing the technology. Methods: Doctors working at Hannover Medical School (206/1151, response 17.90%), as well as patients being admitted to this facility (213/279, utilization 76.3%) were surveyed about their acceptance and use of mobile devices in medical settings. Regarding demographics, both samples were representative of the respective study population. GNU R (version 3.1.1) was used for statistical testing. Fisher?s exact test, two-sided, alpha=.05 with Monte Carlo approximation, 2000 replicates, was applied to determine dependencies between two variables. Results: The majority of participants already own mobile devices (doctors, 168/206, 81.6%; patients, 110/213, 51.6%). For doctors, use in a professional context does not depend on age (P=.66), professional experience (P=.80), or function (P=.34); gender was a factor (P=.009), and use was more common among male (61/135, 45.2%) than female doctors (17/67, 25%). A correlation between use of mobile devices and age (P=.001) as well as education (P=.002) was seen for patients. Minor differences regarding how mobile devices are perceived in sensitive medical contexts mostly relate to data security, patients are more critical of the devices being used for storing and processing patient data; every fifth patient opposed this, but nevertheless, 4.8% of doctors (10/206) use their devices for this purpose. Both groups voiced only minor concerns about the credibility of the provided content or the technical reliability of the devices. While 8.3% of the doctors (17/206) avoided use during patient contact because they thought patients might be unfamiliar with the devices, (25/213) 11.7% of patients expressed concerns about the technology being too complicated to be used in a health context. Conclusions: Differences in how patients and doctors perceive the use of mobile devices can be attributed to age and level of education; these factors are often mentioned as contributors of the problems with (mobile) technologies. To fully realize the potential of mobile technologies in a health care context, the needs of both the elderly as well as those who are educationally disadvantaged need to be carefully addressed in all strategies relating to mobile technology in a health context. UR - http://mhealth.jmir.org/2014/4/e42/ UR - http://dx.doi.org/10.2196/mhealth.3799 UR - http://www.ncbi.nlm.nih.gov/pubmed/25338094 ID - info:doi/10.2196/mhealth.3799 ER - TY - JOUR AU - Kannisto, Anneli Kati AU - Koivunen, Hannele Marita AU - Välimäki, Anneli Maritta PY - 2014/10/17 TI - Use of Mobile Phone Text Message Reminders in Health Care Services: A Narrative Literature Review JO - J Med Internet Res SP - e222 VL - 16 IS - 10 KW - text messaging KW - short message service KW - cellular phone KW - reminder system KW - review N2 - Background: Mobile text messages are a widely recognized communication method in societies, as the global penetration of the technology approaches 100% worldwide. Systematic knowledge is still lacking on how the mobile telephone text messaging (short message service, SMS) has been used in health care services. Objective: This study aims to review the literature on the use of mobile phone text message reminders in health care. Methods: We conducted a systematic literature review of studies on mobile telephone text message reminders. The data sources used were PubMed (MEDLINE), CINAHL, Proquest Databases/ PsycINFO, EMBASE, Cochrane Library, Scopus, and hand searching since 2003. Studies reporting the use of SMS intended to remind patients in health services were included. Given the heterogeneity in the studies, descriptive characteristics, purpose of the study, response rates, description of the intervention, dose and timing, instruments, outcome measures, and outcome data from the studies were synthesized using a narrative approach. Results: From 911 initial citations, 60 studies were included in the review. The studies reported a variety of use for SMS. Mobile telephone text message reminders were used as the only intervention in 73% (44/60) of the studies, and in 27% (16/60) of the remaining studies, SMS was connected to another comprehensive health intervention system. SMS reminders were sent to different patient groups: patients with HIV/AIDS (15%, 9/60) and diabetes (13%, 8/60) being the most common groups. The response rates of the studies varied from 22-100%. Typically, the text message reminders were sent daily. The time before the specific intervention to be rendered varied from 10 minutes (eg, medication taken) to 2 weeks (eg, scheduled appointment). A wide range of different evaluation methods and outcomes were used to assess the impact of SMS varying from existing databases (eg, attendance rate based on medical records), questionnaires, and physiological measures. About three quarters of the studies (77%, 46/60) reported improved outcomes: adherence to medication or to treatment reportedly improved in 40% (24/60) of the studies, appointment attendance in 18% (11/60) of the studies, and non-attendance rates decreased in 18% (11/60) of the studies. Other positive impacts were decreased amount of missed medication doses, more positive attitudes towards medication, and reductions in treatment interruptions. Conclusions: We can conclude that although SMS reminders are used with different patient groups in health care, SMS is less systematically studied with randomized controlled trial study design. Although the amount of evidence for SMS application recommendations is still limited, having 77% (46/60) of the studies showing improved outcomes may indicate its use in health care settings. However, more well-conducted SMS studies are still needed. UR - http://www.jmir.org/2014/10/e222/ UR - http://dx.doi.org/10.2196/jmir.3442 UR - http://www.ncbi.nlm.nih.gov/pubmed/25326646 ID - info:doi/10.2196/jmir.3442 ER - TY - JOUR AU - Hong, Yan AU - Goldberg, Daniel AU - Dahlke, Vollmer Deborah AU - Ory, G. Marcia AU - Cargill, S. Jessica AU - Coughlin, Rachel AU - Hernandez, Edgar AU - Kellstedt, K. Debra AU - Peres, Camille S. PY - 2014/10/13 TI - Testing Usability and Acceptability of a Web Application to Promote Physical Activity (iCanFit) Among Older Adults JO - JMIR Human Factors SP - e2 VL - 1 IS - 1 KW - physical activity KW - mobile health, older adults KW - usability testing KW - user experience N2 - Background: Most older Americans do not exercise regularly and many have chronic conditions. Among an increasing number of fitness mobile and Web apps, few are designed for older adults with chronic conditions despite high ownership rates of mobile tools and Internet access in this population. We designed a mobile-enabled Web app, iCanFit, to promote physical activity in this population. Objective: This study aimed to test the usability and acceptability of iCanFit among older adults in a community setting. Methods: A total of 33 older adults (aged 60 to 82 years) were recruited from communities to test iCanFit. Of these 33, 10 participants completed the usability testing in a computer room of a senior community center. A research assistant timed each Web application task and observed user navigation behavior using usability metrics. The other 23 participants used the website on their own devices at home and provided feedback after 2-3 weeks by completing a user-experience survey assessing ease of use, helpfulness, and satisfaction with iCanFit. Results: Participants completed all 15 tasks on the iCanFit site in an average of 31 (SD 6.9) minutes; some tasks required more time or needed assistance. Participants? comments were addressed to improve the site?s senior friendliness and ease of use. In the user-experience survey, participants reported high levels of usefulness and satisfaction. More than 56% (13/23) of participants indicated they would continue using the program and recommend it to their families or friends. Conclusions: Testing usability and acceptability is a very important step in developing age-appropriate and user-friendly Web apps, especially for older adults. Testing usability and acceptability in a community setting can help reveal users? experiences and feedback in a real-life setting. Our study suggested that older adults had a high degree of acceptance of iCanFit and could use it easily. The efficacy trial of iCanFit is currently underway. UR - http://humanfactors.jmir.org/2014/1/e2/ UR - http://dx.doi.org/10.2196/humanfactors.3787 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025254 ID - info:doi/10.2196/humanfactors.3787 ER - TY - JOUR AU - Furber, Gareth AU - Jones, Margaret Gabrielle AU - Healey, David AU - Bidargaddi, Niranjan PY - 2014/10/08 TI - A Comparison Between Phone-Based Psychotherapy With and Without Text Messaging Support In Between Sessions for Crisis Patients JO - J Med Internet Res SP - e219 VL - 16 IS - 10 KW - telemedicine KW - psychotherapy KW - mental health services KW - mobile health KW - mHealth KW - short message service KW - eHealth N2 - Background: Few studies have tested whether individually tailored text messaging interventions have an effect on clinical outcomes when used to supplement traditional psychotherapy. This is despite the potential to improve outcomes through symptom monitoring, prompts for between-session activities, and psychoeducation. Objective: The intent of the study was to explore the use of individually tailored between-session text messaging, or short message service (SMS), as an adjunct to telephone-based psychotherapy for consumers who present to the Emergency Department (ED) in situational and/or emotional crises. Methods: Over a 4-month period, two therapists offered 68 prospective consumers of a telephone-based psychotherapy service individually tailored between-session text messaging alongside their telephone-based psychotherapy. Attendance and clinical outcomes (depression, anxiety, functional impairment) of those receiving messages were compared against a historical control group (n=157) who received telephone psychotherapy only. Results: A total of 66% (45/68) of the consumers offered SMS accepted the intervention. A total of 432 messages were sent over the course of the trial, the majority involving some kind of psychoeducation or reminders to engage in therapy goals. There were no significant differences in clinical outcomes between consumers who received the SMS and those in the control group. There was a trend for participants in the intervention group to attend fewer sessions than those in the control group (mean 3.7, SD 1.9 vs mean 4.4, SD 2.3). Conclusions: Both groups showed significant improvement over time. Individually tailored SMS were not found to improve clinical outcomes in consumers receiving telephone-based psychotherapy, but the study was underpowered, given the effect sizes noted and the significance level chosen. Given the ease of implementation and positive feedback from therapists and clients, individually tailored text messages should be explored further in future trials with a focus on enhancing the clinical impact of the tailored text messages, and utilizing designs with additional power to test for between-group effects. UR - http://www.jmir.org/2014/10/e219/ UR - http://dx.doi.org/10.2196/jmir.3096 UR - http://www.ncbi.nlm.nih.gov/pubmed/25295667 ID - info:doi/10.2196/jmir.3096 ER - TY - JOUR AU - Lopez, Catalina AU - Ramirez, Camilo Daniel AU - Valenzuela, Ignacio Jose AU - Arguello, Arturo AU - Saenz, Pablo Juan AU - Trujillo, Stephanie AU - Correal, Ernesto Dario AU - Fajardo, Roosevelt AU - Dominguez, Cristina PY - 2014/09/25 TI - Sexual and Reproductive Health for Young Adults in Colombia: Teleconsultation Using Mobile Devices JO - JMIR mHealth uHealth SP - e38 VL - 2 IS - 3 KW - mobile health KW - youth and adolescents KW - telemedicine KW - remote consultation KW - Colombia KW - Latin America. N2 - Background: Sexual risk behaviors associated with poor information on sexuality have contributed to major public health problems in the area of sexual and reproductive health in teenagers and young adults in Colombia. Objective: To report our experience with the use of DoctorChat Mobile to provide sexual education and information among university students in Bogota, Colombia, and knowledge about the sexual risk factors detected among them. Methods: A mobile app that allows patients to ask about sexual and reproductive health issues was developed. Sexual and reproductive risk behaviors in a sample of young adults were measured before and after the use of the app through the validated survey Family Health International (FHI) Behavioral Surveillance Survey (BSS) for Use With Adults Between 15 and 49 Years. A nonprobabilistic convenience recruitment was undertaken through the study´s webpage. After completing the first survey, participants were allowed to download and use the app for a 6-month period (intervention), followed by completion of the same survey once again. For the inferential analysis, data was divided into 3 groups (dichotomous data, discrete quantitative data, and ordinal data) to compare the results of the questions between the first and the second survey. The study was carried out with a sample of university students between 18 and 29 years with access to mobile phones. Participation in the study was voluntary and anonymous. Results: A total of 257 subjects met the selection criteria. The preintervention survey was answered by 232 subjects, and 127 of them fully answered the postintervention survey. In total, 54.3% (69/127) of the subjects completed the survey but did not use the app, leaving an effective population of 58 subjects for analysis. Of these subjects, 53% (31/58) were women and 47% (27/58) were men. The mean age was 21 years, ranging between 18 and 29 years. The differences between the answers from both surveys were not statistically significant. The main sexual risk behaviors identified in the population were homosexual intercourse, nonuse of condoms, sexual intercourse with nonregular and commercial partners, the use of psychoactive substances, and lack of knowledge on symptoms of sexually transmitted diseases and HIV transmission. Conclusions: Although there were no differences between the pre- and postintervention results, the study revealed different risk behaviors among the participating subjects. These findings highlight the importance of promoting high-impact educational strategies on this matter and the importance of providing teenagers and young adults with easily accessible tools with reliable health information, regardless of their socioeconomic status. UR - http://mhealth.jmir.org/2014/3/e38/ UR - http://dx.doi.org/10.2196/mhealth.2904 UR - http://www.ncbi.nlm.nih.gov/pubmed/25263432 ID - info:doi/10.2196/mhealth.2904 ER - TY - JOUR AU - Armstrong, A. Kathleen AU - Semple, L. John AU - Coyte, C. Peter PY - 2014/09/22 TI - Replacing Ambulatory Surgical Follow-Up Visits With Mobile App Home Monitoring: Modeling Cost-Effective Scenarios JO - J Med Internet Res SP - e213 VL - 16 IS - 9 KW - cost-effectiveness KW - ambulatory surgical procedures KW - mobile apps KW - ambulatory monitoring N2 - Background: Women?s College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile app (QoC Health Inc, Toronto) that suggests high patient satisfaction and adequate detection of postoperative complications. Objective: The proposed cost-effectiveness study models the replacement of conventional, in-person postoperative follow-up care with mobile app follow-up care following ambulatory breast reconstruction in post-mastectomy breast cancer patients. Methods: This is a societal perspective cost-effectiveness analysis, wherein all costs are assessed irrespective of the payer. The patient/caregiver, health care system, and externally borne costs are calculated within the first postoperative month based on cost information provided by WCH and QoC Health Inc. The effectiveness of telemedicine and conventional follow-up care is measured as successful surgical outcomes at 30-days postoperative, and is modeled based on previous clinical trials containing similar patient populations and surgical risks. Results: This costing assumes that 1000 patients are enrolled in bring-your-own-device (BYOD) mobile app follow-up per year and that 1.64 in-person follow-ups are attended in the conventional arm within the first month postoperatively. The total cost difference between mobile app and in-person follow-up care is $245 CAD ($223 USD based on the current exchange rate), with in-person follow-up being more expensive ($381 CAD) than mobile app follow-up care ($136 CAD). This takes into account the total of health care system, patient, and external borne costs. If we examine health care system costs alone, in-person follow-up is $38 CAD ($35 USD) more expensive than mobile app follow-up care over the first postoperative month. The baseline difference in effect is modeled to be zero based on clinical trials examining the effectiveness of telephone follow-up care in similar patient populations. An incremental cost-effectiveness ratio (ICER) is not reportable in this scenario. An incremental net benefit (INB) is reportable, and reflects merely the cost difference between the two interventions for any willingness-to-pay value (INB=$245 CAD). The cost-effectiveness of mobile app follow-up even holds in scenarios where all mobile patients attend one in-person follow-up. Conclusions: Mobile app follow-up care is suitably targeted to low-risk postoperative ambulatory patients. It can be cost-effective from a societal and health care system perspective. UR - http://www.jmir.org/2014/9/e213/ UR - http://dx.doi.org/10.2196/jmir.3528 UR - http://www.ncbi.nlm.nih.gov/pubmed/25245774 ID - info:doi/10.2196/jmir.3528 ER - TY - JOUR AU - Lewis, Lorchan Thomas AU - Wyatt, C. Jeremy PY - 2014/09/15 TI - mHealth and Mobile Medical Apps: A Framework to Assess Risk and Promote Safer Use JO - J Med Internet Res SP - e210 VL - 16 IS - 9 KW - risk assessment KW - medical app KW - mobile health KW - mobile phone KW - patient safety KW - smartphone KW - mHealth KW - medical informatics applications UR - http://www.jmir.org/2014/9/e210/ UR - http://dx.doi.org/10.2196/jmir.3133 UR - http://www.ncbi.nlm.nih.gov/pubmed/25223398 ID - info:doi/10.2196/jmir.3133 ER - TY - JOUR AU - Lee, Yun Hee AU - Koopmeiners, S. Joseph AU - Rhee, Greg Taeho AU - Raveis, H. Victoria AU - Ahluwalia, S. Jasjit PY - 2014/08/27 TI - Mobile Phone Text Messaging Intervention for Cervical Cancer Screening: Changes in Knowledge and Behavior Pre-Post Intervention JO - J Med Internet Res SP - e196 VL - 16 IS - 8 KW - cervical cancer KW - Pap test KW - mobile health KW - text-messaging intervention KW - health behavior change KW - Korean American women KW - health disparity N2 - Background: Cervical cancer poses a significant threat to Korean American women, who are reported to have one of the highest cervical cancer mortality rates in the United States. Studies consistently report that Korean American women have the lowest Pap test screening rates across US ethnic groups. Objective: In response to the need to enhance cervical cancer screening in this vulnerable population, we developed and tested a 7-day mobile phone text message-based cervical cancer Screening (mScreening) intervention designed to promote the receipt of Pap tests by young Korean American women. Methods: We developed and assessed the acceptability and feasibility of a 1-week mScreening intervention to increase knowledge of cervical cancer screening, intent to receive screening, and the receipt of a Pap test. Fogg?s Behavior Model was the conceptual framework that guided the development of the mScreening intervention. A series of focus groups were conducted to inform the development of the intervention. The messages were individually tailored for each participant and delivered to them for a 7-day period at each participant?s preferred time. A quasi-experimental research design of 30 Korean American women aged 21 to 29 years was utilized with baseline, post (1 week after the completion of mScreening), and follow-up (3 months after the completion of mScreening) testing. Results: Findings revealed a significant increase in participants? knowledge of cervical cancer (P<.001) and guidelines for cervical cancer screening (P=.006). A total of 23% (7/30) (95% CI 9.9-42.3) of the mScreening participants received a Pap test; 83% (25/30) of the participants expressed satisfaction with the intervention and 97% (29/30) reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention. Conclusions: This study provides evidence of the effectiveness and feasibility of the mScreening intervention. Mobile technology is a promising tool to increase both knowledge and receipt of cervical cancer screening. Given the widespread usage of mobile phones among young adults, a mobile phone-based health intervention could be a low-cost and effective method of reaching populations with low cervical cancer screening rates, using individually tailored messages that cover broad content areas and overcome restrictions to place and time of delivery. UR - http://www.jmir.org/2014/8/e196/ UR - http://dx.doi.org/10.2196/jmir.3576 UR - http://www.ncbi.nlm.nih.gov/pubmed/25164545 ID - info:doi/10.2196/jmir.3576 ER - TY - JOUR AU - Dunford, Elizabeth AU - Trevena, Helen AU - Goodsell, Chester AU - Ng, Hung Ka AU - Webster, Jacqui AU - Millis, Audra AU - Goldstein, Stan AU - Hugueniot, Orla AU - Neal, Bruce PY - 2014/08/21 TI - FoodSwitch: A Mobile Phone App to Enable Consumers to Make Healthier Food Choices and Crowdsourcing of National Food Composition Data JO - JMIR mHealth uHealth SP - e37 VL - 2 IS - 3 KW - smartphone technology KW - traffic light labeling KW - food choices KW - public health nutrition KW - processed food N2 - Background: Front-of-pack nutrition labeling (FoPL) schemes can help consumers understand the nutritional content of foods and may aid healthier food choices. However, most packaged foods in Australia carry no easily interpretable FoPL, and no standard FoPL system has yet been mandated. About two thirds of Australians now own a smartphone. Objective: We sought to develop a mobile phone app that would provide consumers with easy-to-understand nutrition information and support the selection of healthier choices when shopping for food. Methods: An existing branded food database including 17,000 Australian packaged foods underpinned the project. An iterative process of development, review, and testing was undertaken to define a user interface that could deliver nutritional information. A parallel process identified the best approach to rank foods based on nutritional content, so that healthier alternative products could be recommended. Results: Barcode scanning technology was identified as the optimal mechanism for interaction of the mobile phone with the food database. Traffic light labels were chosen as the preferred format for presenting nutritional information, and the Food Standards Australia New Zealand nutrient profiling method as the best strategy for identifying healthier products. The resulting FoodSwitch mobile phone app was launched in Australia in January 2012 and was downloaded by about 400,000 users in the first 18 months. FoodSwitch has maintained a 4-plus star rating, and more than 2000 users have provided feedback about the functionality. Nutritional information for more than 30,000 additional products has been obtained from users through a crowdsourcing function integrated within the app. Conclusions: FoodSwitch has empowered Australian consumers seeking to make better food choices. In parallel, the huge volume of crowdsourced data has provided a novel means for low-cost, real-time tracking of the nutritional composition of Australian foods. There appears to be significant opportunity for this approach in many other countries. UR - http://mhealth.jmir.org/2014/3/e37/ UR - http://dx.doi.org/10.2196/mhealth.3230 UR - http://www.ncbi.nlm.nih.gov/pubmed/25147135 ID - info:doi/10.2196/mhealth.3230 ER - TY - JOUR AU - Hundert, S. Amos AU - Huguet, Anna AU - McGrath, J. Patrick AU - Stinson, N. Jennifer AU - Wheaton, Mike PY - 2014/08/19 TI - Commercially Available Mobile Phone Headache Diary Apps: A Systematic Review JO - JMIR mHealth uHealth SP - e36 VL - 2 IS - 3 KW - headache KW - diary KW - apps KW - smartphone KW - mobile phone KW - technology KW - mHealth KW - review N2 - Background: Headache diaries are often used by headache sufferers to self-monitor headaches. With advances in mobile technology, mobile electronic diary apps are becoming increasingly common. Objective: This review aims to identify and evaluate all commercially available mobile headache diary apps for the two most popular mobile phone platforms, iOS and Android. Methods: The authors developed a priori a set of 7 criteria that define an ideal headache diary app intended to help headache sufferers better understand and manage their headaches, while providing relevant data to health professionals. The app criteria were intended as minimum requirements for an acceptable headache diary app that could be prescribed by health care professionals. Each app was evaluated and scored against each criterion. Results: Of the 38 apps identified, none of the apps met all 7 app criteria. The 3 highest scoring apps, meeting 5 of the app criteria, were iHeadache (developed by Better QOL), ecoHeadache (developed by ecoTouchMedia), and Headache Diary Pro (developed by Froggyware). Only 18% of the apps were created with scientific or clinical headache expertise and none of the apps reported on psychometric properties. Conclusions: Despite the growing market and demand, there is a concerning lack of scientific expertise and evidence base associated with headache diary apps. UR - http://mhealth.jmir.org/2014/3/e36/ UR - http://dx.doi.org/10.2196/mhealth.3452 UR - http://www.ncbi.nlm.nih.gov/pubmed/25138438 ID - info:doi/10.2196/mhealth.3452 ER - TY - JOUR AU - Grindrod, Anne Kelly AU - Gates, Allison AU - Dolovich, Lisa AU - Slavcev, Roderick AU - Drimmie, Rob AU - Aghaei, Behzad AU - Poon, Calvin AU - Khan, Shamrozé AU - Leat, J. Susan PY - 2014/08/15 TI - ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels JO - JMIR mHealth uHealth SP - e35 VL - 2 IS - 3 KW - low vision KW - legibility KW - prescription labelling KW - medication labels KW - usability KW - cognitive impairment KW - visual impairment N2 - Background: In order to take medications safely and effectively, individuals need to be able to see, read, and understand the medication labels. However, one-half of medication labels are currently misunderstood, often because of low literacy, low vision, and cognitive impairment. We sought to design a mobile tool termed ClereMed that could rapidly screen for adults who have difficulty reading or understanding their medication labels. Objective: The aim of this study was to build the ClereMed prototype; to determine the usability of the prototype with adults 55 and over; to assess its accuracy for identifying adults with low-functional reading ability, poor ability on a real-life pill-sorting task, and low cognition; and to assess the acceptability of a touchscreen device with older adults with age-related changes to vision and cognition. Methods: This pilot study enrolled adults (?55 years) who were recruited through pharmacies, retirement residences, and a low-vision optometry clinic. ClereMed is a hypertext markup language (HTML)-5 prototype app that simulates medication taking using an iPad, and also provides information on how to improve the accessibility of prescription labels. A paper-based questionnaire included questions on participant demographics, computer literacy, and the Systems Usability Scale (SUS). Cognition was assessed using the Montreal Cognitive Assessment tool, and functional reading ability was measured using the MNRead Acuity Chart. Simulation results were compared with a real-life, medication-taking exercise using prescription vials, tablets, and pillboxes. Results: The 47 participants had a mean age of 76 (SD 11) years and 60% (28/47) were female. Of the participants, 32% (15/47) did not own a computer or touchscreen device. The mean SUS score was 76/100. ClereMed correctly identified 72% (5/7) of participants with functional reading difficulty, and 63% (5/8) who failed a real-life pill-sorting task, but only 21% (6/28) of participants with cognitive impairment. Participants who owned a computer or touchscreen completed ClereMed in a mean time of 26 (SD 16) seconds, compared with 52 (SD 34) seconds for those who do not own a device (P<.001). Those who had difficulty, struggled with screen glare, button activation, and the ?drag and drop? function. Conclusions: ClereMed was well accepted by older participants, but it was only moderately accurate for reading ability and not for mild cognitive impairment. Future versions may be most useful as part of a larger medication assessment or as a tool to help family members and caregivers identify individuals with impaired functional reading ability. Future research is needed to improve the sensitivity for measuring cognitive impairment and on the feasibility of implementing a mobile app into pharmacy workflow. UR - http://mhealth.jmir.org/2014/3/e35/ UR - http://dx.doi.org/10.2196/mhealth.3250 UR - http://www.ncbi.nlm.nih.gov/pubmed/25131813 ID - info:doi/10.2196/mhealth.3250 ER - TY - JOUR AU - Mirkovic, Jelena AU - Kaufman, R. David AU - Ruland, M. Cornelia PY - 2014/08/13 TI - Supporting Cancer Patients in Illness Management: Usability Evaluation of a Mobile App JO - JMIR mHealth uHealth SP - e33 VL - 2 IS - 3 KW - mobile applications KW - patients KW - cell phone KW - smartphone KW - symptom assessment KW - self-care KW - user-computer interface N2 - Background: Mobile phones and tablets currently represent a significant presence in people?s everyday lives. They enable access to different information and services independent of current place and time. Such widespread connectivity offers significant potential in different app areas including health care. Objective: Our goal was to evaluate the usability of the Connect Mobile app. The mobile app enables mobile access to the Connect system, an online system that supports cancer patients in managing health-related issues. Along with symptom management, the system promotes better patient-provider communication, collaboration, and shared decision making. The Connect Mobile app enables access to the Connect system over both mobile phones and tablets. Methods: The study consisted of usability tests of a high fidelity prototype with 7 cancer patients where the objectives were to identify existing design and functionality issues and to provide patients with a real look-and-feel of the mobile system. In addition, we conducted semistructured interviews to obtain participants? feedback about app usefulness, identify the need for new system features and design requirements, and measure the acceptance of the mobile app and its features within everyday health management. Results: The study revealed a total of 27 design issues (13 for mobile apps and 14 for tablet apps), which were mapped to source events (ie, errors, requests for help, participants' concurrent feedback, and moderator observation). We also applied usability heuristics to identify violations of usability principles. The majority of violations were related to enabling ease of input, screen readability, and glanceability (15 issues), as well as supporting an appropriate match between systems and the real world (7 issues) and consistent mapping of system functions and interactions (4 issues). Feedback from participants also showed the cancer patients? requirements for support systems and how these needs are influenced by different context-related factors, such as type of access terminal (eg, desktop computer, tablet, mobile phone) and phases of illness. Based on the observed results, we proposed design and functionality recommendations that can be used for the development of mobile apps for cancer patients to support their health management process. Conclusions: Understanding and addressing users? requirements is one of the main prerequisites for developing useful and effective technology-based health interventions. The results of this study outline different user requirements related to the design of the mobile patient support app for cancer patients. The results will be used in the iterative development of the Connect Mobile app and can also inform other developers and researchers in development, integration, and evaluation of mobile health apps and services that support cancer patients in managing their health-related issues. UR - http://mhealth.jmir.org/2014/3/e33/ UR - http://dx.doi.org/10.2196/mhealth.3359 UR - http://www.ncbi.nlm.nih.gov/pubmed/25119490 ID - info:doi/10.2196/mhealth.3359 ER - TY - JOUR AU - Lister, Cameron AU - West, H. Joshua AU - Cannon, Ben AU - Sax, Tyler AU - Brodegard, David PY - 2014/08/04 TI - Just a Fad? Gamification in Health and Fitness Apps JO - JMIR Serious Games SP - e9 VL - 2 IS - 2 KW - gamification KW - mobile phone KW - behavioral health KW - health and fitness apps N2 - Background: Gamification has been a predominant focus of the health app industry in recent years. However, to our knowledge, there has yet to be a review of gamification elements in relation to health behavior constructs, or insight into the true proliferation of gamification in health apps. Objective: The objective of this study was to identify the extent to which gamification is used in health apps, and analyze gamification of health and fitness apps as a potential component of influence on a consumer?s health behavior. Methods: An analysis of health and fitness apps related to physical activity and diet was conducted among apps in the Apple App Store in the winter of 2014. This analysis reviewed a sample of 132 apps for the 10 effective game elements, the 6 core components of health gamification, and 13 core health behavior constructs. A regression analysis was conducted in order to measure the correlation between health behavior constructs, gamification components, and effective game elements. Results: This review of the most popular apps showed widespread use of gamification principles, but low adherence to any professional guidelines or industry standard. Regression analysis showed that game elements were associated with gamification (P<.001). Behavioral theory was associated with gamification (P<.05), but not game elements, and upon further analysis gamification was only associated with composite motivational behavior scores (P<.001), and not capacity or opportunity/trigger. Conclusions: This research, to our knowledge, represents the first comprehensive review of gamification use in health and fitness apps, and the potential to impact health behavior. The results show that use of gamification in health and fitness apps has become immensely popular, as evidenced by the number of apps found in the Apple App Store containing at least some components of gamification. This shows a lack of integrating important elements of behavioral theory from the app industry, which can potentially impact the efficacy of gamification apps to change behavior. Apps represent a very promising, burgeoning market and landscape in which to disseminate health behavior change interventions. Initial results show an abundant use of gamification in health and fitness apps, which necessitates the in-depth study and evaluation of the potential of gamification to change health behaviors. UR - http://games.jmir.org/2014/2/e9/ UR - http://dx.doi.org/10.2196/games.3413 UR - http://www.ncbi.nlm.nih.gov/pubmed/25654660 ID - info:doi/10.2196/games.3413 ER - TY - JOUR AU - Lee, Jung-Ah AU - Nguyen, Lu Annie AU - Berg, Jill AU - Amin, Alpesh AU - Bachman, Mark AU - Guo, Yuqing AU - Evangelista, Lorraine PY - 2014/07/23 TI - Attitudes and Preferences on the Use of Mobile Health Technology and Health Games for Self-Management: Interviews With Older Adults on Anticoagulation Therapy JO - JMIR mHealth uHealth SP - e32 VL - 2 IS - 3 KW - anticoagulation therapy KW - health apps KW - health games KW - mobile health technology KW - self-management N2 - Background: Older adults are at substantial risk for cardiovascular disorders that may require anticoagulation therapy. Those on warfarin therapy report dissatisfaction and reduced quality of life (QOL) resulting from the treatment. Advances in the area of mobile health (mHealth) technology have resulted in the design and development of new patient-centric models for the provision of personalized health care services to improve care delivery. However, there is a paucity of research examining the effectiveness of mHealth tools on knowledge, attitudes, and patient satisfaction with treatment, as well as self-management, adherence to therapy, and QOL in older adults with chronic illness conditions requiring long-term warfarin therapy. Objective: The objective of the study was to explore the attitudes and preferences of older adults on warfarin therapy regarding the use of mHealth technology and health games to gain skills for self-management. Methods: We conducted group and individual interviews with patients (60 years or older) on warfarin therapy at two anticoagulation clinics affiliated with an academic medical center. We held 4 group and 2 individual interviews, resulting in 11 patient participants and 2 family caregiver participants. We used structured questions on three topic areas including medication self-management strategies, mHealth technology use, and health games for exercise. We demonstrated some commercial health apps related to medication management, vitamin K content of food, and a videogame for balance exercise. Discussions were audiotaped and transcribed verbatim. Common themes were drawn using content analysis. Results: The participants reported awareness of the importance of staying on schedule with warfarin therapy. They also acknowledged that negative experiences of friends or family members who were taking warfarin influenced their desire to keep on schedule with warfarin therapy. In addition, the participants expressed that the use of mHealth technology may be helpful for medication management. They also expressed the need for family support in the use of health technology devices. Moreover, the participants discussed concerns and challenges to use health technology and health games, and provided suggestions on ways to make mHealth technology and health games elder-friendly. Conclusions: These findings indicate that our older adults on warfarin therapy are interested in mHealth technology specific to warfarin medication management and health games. Further research needs to be done to validate these findings. Elder-friendly designs, technology support, and physical safety using mHealth technology may be useful in this population. These findings can be used to inform a larger study to design and test an elder-centered mHealth technology in this target population. UR - http://mhealth.jmir.org/2014/3/e32/ UR - http://dx.doi.org/10.2196/mhealth.3196 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098413 ID - info:doi/10.2196/mhealth.3196 ER - TY - JOUR AU - Lewis, Lorchan Thomas AU - Boissaud-Cooke, Alexander Matthew AU - Aungst, Dy Timothy AU - Eysenbach, Gunther PY - 2014/07/17 TI - Consensus on Use of the Term ?App? Versus ?Application? for Reporting of mHealth Research JO - J Med Internet Res SP - e174 VL - 16 IS - 7 KW - medical app: mobile app KW - medical informatics: smartphone KW - mHealth UR - http://www.jmir.org/2014/7/e174/ UR - http://dx.doi.org/10.2196/jmir.3460 UR - http://www.ncbi.nlm.nih.gov/pubmed/25033233 ID - info:doi/10.2196/jmir.3460 ER - TY - JOUR AU - Waterlander, Wilma AU - Whittaker, Robyn AU - McRobbie, Hayden AU - Dorey, Enid AU - Ball, Kylie AU - Maddison, Ralph AU - Myers Smith, Katie AU - Crawford, David AU - Jiang, Yannan AU - Gu, Yulong AU - Michie, Jo AU - Ni Mhurchu, Cliona PY - 2014/07/11 TI - Development of an Evidence-Based mHealth Weight Management Program Using a Formative Research Process JO - JMIR Mhealth Uhealth SP - e18 VL - 2 IS - 3 KW - weight loss KW - intervention KW - Internet KW - mobile phone KW - focus groups N2 - Background: There is a critical need for weight management programs that are effective, cost efficient, accessible, and acceptable to adults from diverse ethnic and socioeconomic backgrounds. mHealth (delivered via mobile phone and Internet) weight management programs have potential to address this need. To maximize the success and cost-effectiveness of such an mHealth approach it is vital to develop program content based on effective behavior change techniques, proven weight management programs, and closely aligned with participants? needs. Objective: This study aims to develop an evidence-based mHealth weight management program (Horizon) using formative research and a structured content development process. Methods: The Horizon mHealth weight management program involved the modification of the group-based UK Weight Action Program (WAP) for delivery via short message service (SMS) and the Internet. We used an iterative development process with mixed methods entailing two phases: (1) expert input on evidence of effective programs and behavior change theory; and (2) target population input via focus group (n=20 participants), one-on-one phone interviews (n=5), and a quantitative online survey (n=120). Results: Expert review determined that core components of a successful program should include: (1) self-monitoring of behavior; (2) prompting intention formation; (3) promoting specific goal setting; (4) providing feedback on performance; and (5) promoting review of behavioral goals. Subsequent target group input confirmed that participants liked the concept of an mHealth weight management program and expressed preferences for the program to be personalized, with immediate (prompt) and informative text messages, practical and localized physical activity and dietary information, culturally appropriate language and messages, offer social support (group activities or blogs) and weight tracking functions. Most target users expressed a preference for at least one text message per day. We present the prototype mHealth weight management program (Horizon) that aligns with those inputs. Conclusions: The Horizon prototype described in this paper could be used as a basis for other mHealth weight management programs. The next priority will be to further develop the program and conduct a full randomized controlled trial of effectiveness. UR - http://www.jmir.org/2014/3/e18/ UR - http://dx.doi.org/10.2196/mhealth.2850 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098337 ID - info:doi/10.2196/mhealth.2850 ER - TY - JOUR AU - O'Malley, Grace AU - Dowdall, Grainne AU - Burls, Amanda AU - Perry, J. Ivan AU - Curran, Noirin PY - 2014/06/27 TI - Exploring the Usability of a Mobile App for Adolescent Obesity Management JO - JMIR mHealth uHealth SP - e29 VL - 2 IS - 2 KW - obesity KW - mobile health KW - usability testing KW - adolescent KW - participatory health care N2 - Background: Obesity is a global epidemic. Behavioral change approaches towards improving nutrition, increasing physical activity level, improving sleep, and reducing sitting time are recommended as best practices in adolescent obesity management. However, access to evidence-based treatment is limited and portable technologies such as mobile apps may provide a useful platform to deliver such lifestyle interventions. No evidence-based validated app exists for obesity intervention; therefore, a novel mobile app (Reactivate) was developed for use in the Temple Street W82GO Healthy Lifestyles Program (W82GO). Objective: This study aimed to test the usability (technical effectiveness, efficiency, and user satisfaction) of the Reactivate mobile app in obese adolescents. Methods: Ten adolescents (7 males and 3 females, aged 12-17 years) who had been treated for obesity (>98th percentile for body mass index) at the Temple Street Children's University Hospital were recruited. Participants were given 8 tasks to complete in order to test the technical effectiveness of the app. A research assistant timed the user while completing each task in order to test the relative user efficiency of the app (time-on-task). The tasks fell into 5 categories and required the user to enter personal settings, find and answer surveys, create a message, use the goal setting feature, and enter details regarding their weight and height. In exploration of user satisfaction, each participant completed the standardized software usability measurement inventory (SUMI), which measures 5 aspects of user satisfaction: efficiency, effect, helpfulness, controllability, and learnability. Descriptive statistics were used to explore the mean relative user efficiency and SUMI scores. Results: Mean age was 14.26 (SD 1.58) years. All adolescents completed each of the tasks successfully. The mean relative user efficiency scores were two to three times that of an expert user. Users responded that they would use Reactivate to monitor their growth over time, for motivation, and for goal setting. All users described Reactivate as an important mobile app. Conclusions: Our study describes the usability of a mobile app used in adolescent obesity management. Adolescents found Reactivate easy to use and their SUMI results indicated that the app scored high on user satisfaction. Usability testing is an important step towards refining the development of the Reactivate app, which can be used in the treatment of obesity. The study on the clinical efficacy of the Reactivate app is currently underway. UR - http://mhealth.jmir.org/2014/2/e29/ UR - http://dx.doi.org/10.2196/mhealth.3262 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098237 ID - info:doi/10.2196/mhealth.3262 ER - TY - JOUR AU - Rhee, Hyekyun AU - Miner, Sarah AU - Sterling, Mark AU - Halterman, S. Jill AU - Fairbanks, Eileen PY - 2014/06/19 TI - The Development of an Automated Device for Asthma Monitoring for Adolescents: Methodologic Approach and User Acceptability JO - JMIR mHealth uHealth SP - e27 VL - 2 IS - 2 KW - asthma KW - adolescents KW - symptom monitoring KW - symptom algorithm KW - mobile device N2 - Background: Many adolescents suffer serious asthma related morbidity that can be prevented by adequate self-management of the disease. The accurate symptom monitoring by patients is the most fundamental antecedent to effective asthma management. Nonetheless, the adequacy and effectiveness of current methods of symptom self-monitoring have been challenged due to the individuals? fallible symptom perception, poor adherence, and inadequate technique. Recognition of these limitations led to the development of an innovative device that can facilitate continuous and accurate monitoring of asthma symptoms with minimal disruption of daily routines, thus increasing acceptability to adolescents. Objective: The objectives of this study were to: (1) describe the development of a novel symptom monitoring device for teenagers (teens), and (2) assess their perspectives on the usability and acceptability of the device. Methods: Adolescents (13-17 years old) with and without asthma participated in the evolution of an automated device for asthma monitoring (ADAM), which comprised three phases, including development (Phase 1, n=37), validation/user acceptability (Phase 2, n=84), and post hoc validation (Phase 3, n=10). In Phase 1, symptom algorithms were identified based on the acoustic analysis of raw symptom sounds and programmed into a popular mobile system, the iPod. Phase 2 involved a 7 day trial of ADAM in vivo, and the evaluation of user acceptance using an acceptance survey and individual interviews. ADAM was further modified and enhanced in Phase 3. Results: Through ADAM, incoming audio data were digitized and processed in two steps involving the extraction of a sequence of descriptive feature vectors, and the processing of these sequences by a hidden Markov model-based Viterbi decoder to differentiate symptom sounds from background noise. The number and times of detected symptoms were stored and displayed in the device. The sensitivity (true positive) of the updated cough algorithm was 70% (21/30), and, on average, 2 coughs per hour were identified as false positive. ADAM also kept track of the their activity level throughout the day using the mobile system?s built in accelerometer function. Overall, the device was well received by participants who perceived it as attractive, convenient, and helpful. The participants recognized the potential benefits of the device in asthma care, and were eager to use it for their asthma management. Conclusions: ADAM can potentially automate daily symptom monitoring with minimal intrusiveness and maximal objectivity. The users? acceptance of the device based on its recognized convenience, user-friendliness, and usefulness in increasing symptom awareness underscores ADAM?s potential to overcome the issues of symptom monitoring including poor adherence, inadequate technique, and poor symptom perception in adolescents. Further refinement of the algorithm is warranted to improve the accuracy of the device. Future study is also needed to assess the efficacy of the device in promoting self-management and asthma outcomes. UR - http://mhealth.jmir.org/2014/2/e27/ UR - http://dx.doi.org/10.2196/mhealth.3118 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100184 ID - info:doi/10.2196/mhealth.3118 ER - TY - JOUR AU - Bidmon, Sonja AU - Terlutter, Ralf AU - Röttl, Johanna PY - 2014/06/11 TI - What Explains Usage of Mobile Physician-Rating Apps? Results From a Web-Based Questionnaire JO - J Med Internet Res SP - e148 VL - 16 IS - 6 KW - physician-rating apps KW - physician-rating websites KW - sociodemographic variables KW - psychographic variables KW - digital literacy KW - TAM N2 - Background: Consumers are increasingly accessing health-related information via mobile devices. Recently, several apps to rate and locate physicians have been released in the United States and Germany. However, knowledge about what kinds of variables explain usage of mobile physician-rating apps is still lacking. Objective: This study analyzes factors influencing the adoption of and willingness to pay for mobile physician-rating apps. A structural equation model was developed based on the Technology Acceptance Model and the literature on health-related information searches and usage of mobile apps. Relationships in the model were analyzed for moderating effects of physician-rating website (PRW) usage. Methods: A total of 1006 randomly selected German patients who had visited a general practitioner at least once in the 3 months before the beginning of the survey were randomly selected and surveyed. A total of 958 usable questionnaires were analyzed by partial least squares path modeling and moderator analyses. Results: The suggested model yielded a high model fit. We found that perceived ease of use (PEOU) of the Internet to gain health-related information, the sociodemographic variables age and gender, and the psychographic variables digital literacy, feelings about the Internet and other Web-based applications in general, patients? value of health-related knowledgeability, as well as the information-seeking behavior variables regarding the amount of daily private Internet use for health-related information, frequency of using apps for health-related information in the past, and attitude toward PRWs significantly affected the adoption of mobile physician-rating apps. The sociodemographic variable age, but not gender, and the psychographic variables feelings about the Internet and other Web-based applications in general and patients? value of health-related knowledgeability, but not digital literacy, were significant predictors of willingness to pay. Frequency of using apps for health-related information in the past and attitude toward PRWs, but not the amount of daily Internet use for health-related information, were significant predictors of willingness to pay. The perceived usefulness of the Internet to gain health-related information and the amount of daily Internet use in general did not have any significant effect on both of the endogenous variables. The moderation analysis with the group comparisons for users and nonusers of PRWs revealed that the attitude toward PRWs had significantly more impact on the adoption and willingness to pay for mobile physician-rating apps in the nonuser group. Conclusions: Important variables that contribute to the adoption of a mobile physician-rating app and the willingness to pay for it were identified. The results of this study are important for researchers because they can provide important insights about the variables that influence the acceptance of apps that allow for ratings of physicians. They are also useful for creators of mobile physician-rating apps because they can help tailor mobile physician-rating apps to the consumers? characteristics and needs. UR - http://www.jmir.org/2014/6/e148/ UR - http://dx.doi.org/10.2196/jmir.3122 UR - http://www.ncbi.nlm.nih.gov/pubmed/24918859 ID - info:doi/10.2196/jmir.3122 ER - TY - JOUR AU - Wayne, Noah AU - Ritvo, Paul PY - 2014/06/06 TI - Smartphone-Enabled Health Coach Intervention for People With Diabetes From a Modest Socioeconomic Strata Community: Single-Arm Longitudinal Feasibility Study JO - J Med Internet Res SP - e149 VL - 16 IS - 6 KW - diabetes mellitus KW - type 2 KW - health coaching KW - telehealth N2 - Background: Lower socioeconomic strata (SES) populations have higher chronic disease risks. Smartphone-based interventions can support adoption of health behaviors that may, in turn, reduce the risks of type 2 diabetes-related complications, overcoming the obstacles that some patients may have with regular clinical contact (eg, shiftwork, travel difficulties, miscommunication). Objective: The intent of the study was to develop and test a smartphone-assisted intervention that improves behavioral management of type 2 diabetes in an ethnically diverse, lower SES population within an urban community health setting. Methods: This single-arm pilot study assessed a smartphone application developed with investigator assistance and delivered by health coaches. Participants were recruited from the Black Creek Community Health Centre in Toronto and had minimal prior experience with smartphones. Results: A total of 21 subjects consented and 19 participants completed the 6-month trial; 12 had baseline glycosylated hemoglobin (HbA1c) levels >7.0% and these subjects demonstrated a mean reduction of 0.43% (SD 0.63) (P<.05) with minimal changes in medication. Conclusions: This project supported the feasibility of smartphone-based health coaching for individuals from lower SES with minimal prior smartphone experience. UR - http://www.jmir.org/2014/6/e149/ UR - http://dx.doi.org/10.2196/jmir.3180 UR - http://www.ncbi.nlm.nih.gov/pubmed/24907918 ID - info:doi/10.2196/jmir.3180 ER - TY - JOUR AU - Daruwalla, Jimmy Zubin AU - Wong, Lin Keng AU - Thambiah, Joseph PY - 2014/06/05 TI - The Application of Telemedicine in Orthopedic Surgery in Singapore: A Pilot Study on a Secure, Mobile Telehealth Application and Messaging Platform JO - JMIR mHealth uHealth SP - e28 VL - 2 IS - 2 KW - MyDoc KW - personal data protection KW - secure messaging KW - telehealth KW - telemedicine N2 - Background: The application of telemedicine has been described for its use in medical training and education, management of stroke patients, urologic surgeries, pediatric laparoscopic surgeries, clinical outreach, and the field of orthopedics. However, the usefulness of a secure, mobile telehealth application, and messaging platform has not been well described. Objective: A pilot study was conducted to implement a health insurance portability and accountability act (HIPAA) compliant form of communication between doctors in an orthopedic clinical setting and determine their reactions to MyDoc, a secure, mobile telehealth application, and messaging platform. Methods: By replacing current methods of communication through various mobile applications and text messaging services with MyDoc over a six week period, we gained feedback and determined user satisfaction with this innovative system from questionnaires handed to the program director, program coordinator, one trauma consultant, all orthopedic residents, and six non-orthopedic residents at the National University Hospital in Singapore. Results: Almost everyone who completed the questionnaire strongly agreed that MyDoc should replace current systems of peer to peer communication in the hospital. The majority also felt that the quality of images, videos, and sound were excellent. Almost everyone agreed that they could communicate easily with each other and would feel comfortable doing so routinely. The majority felt that virtual consults through MyDoc should be made available to inpatients as well as outpatients to potentially lessen clinic loads and provide a secure manner in which patients can communicate with their primary teams any time convenient to both. It was also agreed by most that the potential of telerounding had advantages, especially on weekends as a supplement to normal rounds. Conclusions: Potential uses of MyDoc in an orthopedic clinical setting include HIPAA-compliant peer to peer communication, clinical outreach in the setting of trauma, supervision in the operating room or watching procedures being performed remotely, providing both patient and parent reassurance in pediatric orthopedic patients, and finally in the setting of outpatient clinics. With our pilot study having excellent results in terms of acceptance and satisfaction, the integration of a secure, mobile telehealth application, and messaging platform, not only in the orthopedic department but also the hospital in general, has an exciting and limitless potential. More so in this era where downsizing hospital costs is beneficial, doing so may also be mandatory in order to comply with the soon to be introduced personal data protection act. UR - http://mhealth.jmir.org/2014/2/e28/ UR - http://dx.doi.org/10.2196/mhealth.3303 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100283 ID - info:doi/10.2196/mhealth.3303 ER - TY - JOUR AU - Kraschnewski, L. Jennifer AU - Chuang, H. Cynthia AU - Poole, S. Erika AU - Peyton, Tamara AU - Blubaugh, Ian AU - Pauli, Jaimey AU - Feher, Alyssa AU - Reddy, Madhu PY - 2014/06/03 TI - Paging ?Dr. Google?: Does Technology Fill the Gap Created by the Prenatal Care Visit Structure? Qualitative Focus Group Study With Pregnant Women JO - J Med Internet Res SP - e147 VL - 16 IS - 6 KW - qualitative research KW - prenatal care KW - pregnancy resources KW - Women, Infants, and Children Program KW - mhealth KW - mobile phones KW - smartphones KW - Internet KW - patient education KW - consumer health informatics N2 - Background: The prenatal care visit structure has changed little over the past century despite the rapid evolution of technology including Internet and mobile phones. Little is known about how pregnant women engage with technologies and the interface between these tools and medical care, especially for women of lower socioeconomic status. Objective: We sought to understand how women use technology during pregnancy through a qualitative study with women enrolled in the Women, Infants, and Children (WIC) program. Methods: We recruited pregnant women ages 18 and older who owned a smartphone, at a WIC clinic in central Pennsylvania. The focus group guide included questions about women?s current pregnancy, their sources of information, and whether they used technology for pregnancy-related information. Sessions were audiotaped and transcribed. Three members of the research team independently analyzed each transcript, using a thematic analysis approach. Themes related to the topics discussed were identified, for which there was full agreement. Results: Four focus groups were conducted with a total of 17 women. Three major themes emerged as follows. First, the prenatal visit structure is not patient-centered, with the first visit perceived as occurring too late and with too few visits early in pregnancy when women have the most questions for their prenatal care providers. Unfortunately, the educational materials women received during prenatal care were viewed as unhelpful. Second, women turn to technology (eg, Google, smartphone applications) to fill their knowledge gaps. Turning to technology was viewed to be a generational approach. Finally, women reported that technology, although frequently used, has limitations. Conclusions: The results of this qualitative research suggest that the current prenatal care visit structure is not patient-centered in that it does not allow women to seek advice when they want it most. A generational shift seems to have occurred, resulting in pregnant women in our study turning to the Internet and smartphones to fill this gap, which requires significant skills to navigate for useful information. Future steps may include developing interventions to help health care providers assist patients early in pregnancy to seek the information they want and to become better consumers of Internet-based pregnancy resources. UR - http://www.jmir.org/2014/6/e147/ UR - http://dx.doi.org/10.2196/jmir.3385 UR - http://www.ncbi.nlm.nih.gov/pubmed/24892583 ID - info:doi/10.2196/jmir.3385 ER - TY - JOUR AU - Landman, Adam AU - Neri, M. Pamela AU - Robertson, Alexandra AU - McEvoy, Dustin AU - Dinsmore, Michael AU - Sweet, Micheal AU - Bane, Anne AU - Takhar, S. Sukhjit AU - Miles, Stephen PY - 2014/06/02 TI - Efficiency and Usability of a Near Field Communication-Enabled Tablet for Medication Administration JO - JMIR mHealth uHealth SP - e26 VL - 2 IS - 2 KW - medication systems KW - medication errors KW - mobile applications KW - automatic data processing KW - nursing N2 - Background: Barcode-based technology coupled with the electronic medication administration record (e-MAR) reduces medication errors and potential adverse drug events (ADEs). However, many current barcode-enabled medication administration (BCMA) systems are difficult to maneuver and often require multiple barcode scans. We developed a prototype, next generation near field communication-enabled medication administration (NFCMA) system using a tablet. Objective: We compared the efficiency and usability of the prototype NFCMA system with the traditional BCMA system. Methods: We used a mixed-methods design using a randomized observational cross-over study, a survey, and one-on-one interviews to compare the prototype NFCMA system with a traditional BCMA system. The study took place at an academic medical simulation center. Twenty nurses with BCMA experience participated in two simulated patient medication administration scenarios: one using the BCMA system, and the other using the prototype NFCMA system. We collected overall scenario completion time and number of medication scanning attempts per scenario, and compared those using paired t tests. We also collected participant feedback on the prototype NFCMA system using the modified International Business Machines (IBM) Post-Study System Usability Questionnaire (PSSUQ) and a semistructured interview. We performed descriptive statistics on participant characteristics and responses to the IBM PSSUQ. Interview data was analyzed using content analysis with a qualitative description approach to review and categorize feedback from participants. Results: Mean total time to complete the scenarios using the NFCMA and the BCMA systems was 202 seconds and 182 seconds, respectively (P=.09). Mean scan attempts with the NFCMA was 7.6 attempts compared with 6.5 attempts with the BCMA system (P=.12). In the usability survey, 95% (19/20) of participants agreed that the prototype NFCMA system was easy to use and easy to learn, with a pleasant interface. Participants expressed interest in using the NFCMA tablet in the hospital; suggestions focused on implementation issues, such as storage of the mobile devices and infection control methods. Conclusions: The NFCMA system had similar efficiency to the BCMA system in a simulated scenario. The prototype NFCMA system was well received by nurses and offers promise to improve nurse medication administration efficiency. UR - http://mhealth.jmir.org/2014/2/e26/ UR - http://dx.doi.org/10.2196/mhealth.3215 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100043 ID - info:doi/10.2196/mhealth.3215 ER - TY - JOUR AU - Min, Ha Yul AU - Lee, Won Jong AU - Shin, Yong-Wook AU - Jo, Min-Woo AU - Sohn, Guiyun AU - Lee, Jae-Ho AU - Lee, Guna AU - Jung, Hae Kyung AU - Sung, Joohon AU - Ko, Seok Beom AU - Yu, Jong-Han AU - Kim, Jeong Hee AU - Son, Ho Byung AU - Ahn, Hyun Sei PY - 2014/05/23 TI - Daily Collection of Self-Reporting Sleep Disturbance Data via a Smartphone App in Breast Cancer Patients Receiving Chemotherapy: A Feasibility Study JO - J Med Internet Res SP - e135 VL - 16 IS - 5 KW - mobile applications KW - self report KW - compliance KW - breast cancer N2 - Background: Improvements in mobile telecommunication technologies have enabled clinicians to collect patient-reported outcome (PRO) data more frequently, but there is as yet limited evidence regarding the frequency with which PRO data can be collected via smartphone applications (apps) in breast cancer patients receiving chemotherapy. Objective: The primary objective of this study was to determine the feasibility of an app for sleep disturbance-related data collection from breast cancer patients receiving chemotherapy. A secondary objective was to identify the variables associated with better compliance in order to identify the optimal subgroups to include in future studies of smartphone-based interventions. Methods: Between March 2013 and July 2013, patients who planned to receive neoadjuvant chemotherapy for breast cancer at Asan Medical Center who had access to a smartphone app were enrolled just before the start of their chemotherapy and asked to self-report their sleep patterns, anxiety severity, and mood status via a smartphone app on a daily basis during the 90-day study period. Push notifications were sent to participants daily at 9 am and 7 pm. Data regarding the patients? demographics, interval from enrollment to first self-report, baseline Beck?s Depression Inventory (BDI) score, and health-related quality of life score (as assessed using the EuroQol Five Dimensional [EQ5D-3L] questionnaire) were collected to ascertain the factors associated with compliance with the self-reporting process. Results: A total of 30 participants (mean age 45 years, SD 6; range 35-65 years) were analyzed in this study. In total, 2700 daily push notifications were sent to these 30 participants over the 90-day study period via their smartphones, resulting in the collection of 1215 self-reporting sleep-disturbance data items (overall compliance rate=45.0%, 1215/2700). The median value of individual patient-level reporting rates was 41.1% (range 6.7-95.6%). The longitudinal day-level compliance curve fell to 50.0% at day 34 and reached a nadir of 13.3% at day 90. The cumulative longitudinal compliance curve exhibited a steady decrease by about 50% at day 70 and continued to fall to 45% on day 90. Women without any form of employment exhibited the higher compliance rate. There was no association between any of the other patient characteristics (ie, demographics, and BDI and EQ5D-3L scores) and compliance. The mean individual patient-level reporting rate was higher for the subgroup with a 1-day lag time, defined as starting to self-report on the day immediately after enrollment, than for those with a lag of 2 or more days (51.6%, SD 24.0 and 29.6%, SD 25.3, respectively; P=.03). Conclusions: The 90-day longitudinal collection of daily self-reporting sleep-disturbance data via a smartphone app was found to be feasible. Further research should focus on how to sustain compliance with this self-reporting for a longer time and select subpopulations with higher rates of compliance for mobile health care. UR - http://www.jmir.org/2014/5/e135/ UR - http://dx.doi.org/10.2196/jmir.3421 UR - http://www.ncbi.nlm.nih.gov/pubmed/24860070 ID - info:doi/10.2196/jmir.3421 ER - TY - JOUR AU - Al Ayubi, U. Soleh AU - Parmanto, Bambang AU - Branch, Robert AU - Ding, Dan PY - 2014/05/22 TI - A Persuasive and Social mHealth Application for Physical Activity: A Usability and Feasibility Study JO - JMIR mHealth uHealth SP - e25 VL - 2 IS - 2 KW - mobile applications KW - mHealth KW - self-management KW - social support KW - persuasion KW - physical activity KW - usability KW - feasibility studies KW - pedometer N2 - Background: Advances in smartphones and the wide usage of social networking systems offer opportunities for the development of innovative interventions to promote physical activity. To that end, we developed a persuasive and social mHealth application designed to monitor and motivate users to walk more every day. Objective: The objectives of this project were to conduct a focused review on the fundamental characteristics of mHealth for physical activity promotion, to develop an mHealth application that meets such characteristics, and to conduct a feasibility study to deploy the application in everyday life. Methods: This project started as an analytical study to review the fundamental characteristics of the technologies used in physical activity monitoring and promotion. Then, it was followed by a technical development of the application. Next, a 4 week deployment was conducted where participants used the application as part of their daily life. A think-aloud method and in-depth semistructured interviews were conducted following the deployment. A qualitative description method was used to thematically analyze the interviews. Feasibility measures included, adherence to the program, user-system interactions, motivation to use, and experience with physical activity and online social interactions. Results: There were seven fundamental characteristics of physical activity monitoring and promotion that were identified, which were then used as a foundation to develop the application. There were fourteen participants that enrolled in the application evaluation. The age range was from 24 to 45; body mass index ranged from 18.5 to 42.98, with 4 of the subjects falling into the category ?obese?. Half of them were experienced with smartphones, and all were familiar with a social network system. There were thirteen participants that completed the study; one was excluded. Overall, participants gave high scores to almost all of the usability factors examined, with averages of 4.52 out of a 5.00 maximum. Over 29 days, participants used the application for a total of 119,380 minutes (average=7.57 hours/day/participant; SD 1.56). Conclusions: Based on the fundamental characteristics, the application was successfully developed. The usability results suggest that the system is usable and user satisfaction was high. Deploying the application was shown to be feasible for the promotion of daily physical activity. UR - http://mhealth.jmir.org/2014/2/e25/ UR - http://dx.doi.org/10.2196/mhealth.2902 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099928 ID - info:doi/10.2196/mhealth.2902 ER - TY - JOUR AU - Tran, Kim AU - Morra, Dante AU - Lo, Vivian AU - Quan, D. Sherman AU - Abrams, Howard AU - Wu, C. Robert PY - 2014/05/22 TI - Medical Students and Personal Smartphones in the Clinical Environment: The Impact on Confidentiality of Personal Health Information and Professionalism JO - J Med Internet Res SP - e132 VL - 16 IS - 5 KW - medical informatics KW - communication KW - hospitals KW - mobile phone KW - smartphones N2 - Background: Smartphones are becoming ubiquitous in health care settings. The increased adoption of mobile technology such as smartphones may be attributed to their use as a point-of-care information source and to perceived improvements in clinical communication and efficiency. However, little is known about medical students? use of personal smartphones for clinical work. Objective: The intent of the study was to examine final-year medical students? experience with and attitudes toward using personal mobile technology in the clinical environment, with respect to the perceived impact on patient confidentiality and provider professionalism. Methods: Cross-sectional surveys were completed by final-year medical students at the University of Toronto. Respondents were asked about the type of personal mobile phone they use, security features on their personal phone, experiences using their personal phone during clinical rotations, and attitudes about using their personal phone for clinical work purposes. Results: The overall response rate was 45.4% (99/218). Smartphone ownership was prevalent (98%, 97/99) with the majority (86%, 85/99) of participants using their personal phones for patient-related communication during clinical rotations. A total of 26% (26/99) of participants reported not having any type of security feature on their personal phone, 94% (90/96) of participants agreed that using their personal phone for clinical work makes them more efficient, and 86% (82/95) agreed that their personal phone allows them to provide better patient care. Although 68% (65/95) of participants believe that the use of personal phones for patient-related communication with colleagues poses a risk to the privacy and confidentiality of patient health information, 22% (21/96) of participants still use their personal phone to text or email identifiable patient data to colleagues. Conclusions: Our findings suggest that the use of personal smartphones for clinical work by medical students is prevalent. There is a need to more fully address the threat to patient confidentiality posed by the use of unsecured communication devices such as smartphones. UR - http://www.jmir.org/2014/5/e132/ UR - http://dx.doi.org/10.2196/jmir.3138 UR - http://www.ncbi.nlm.nih.gov/pubmed/24855046 ID - info:doi/10.2196/jmir.3138 ER - TY - JOUR AU - Evans, Douglas W. AU - Wallace Bihm, Jasmine AU - Szekely, Daniel AU - Nielsen, Peter AU - Murray, Elizabeth AU - Abroms, Lorien AU - Snider, Jeremy PY - 2014/05/20 TI - Initial Outcomes From a 4-Week Follow-Up Study of the Text4baby Program in the Military Women?s Population: Randomized Controlled Trial JO - J Med Internet Res SP - e131 VL - 16 IS - 5 KW - Text4baby KW - prenatal health care KW - mobile health KW - military health KW - health behavior N2 - Background: The use of mobile phone technologies for health promotion and disease prevention has advanced rapidly in recent years. Text4baby is a theory-based mobile health (mHealth) program in which text messages are delivered to pregnant women and new mothers to improve their health care beliefs and behaviors and improve health status and clinical outcomes. Recent evaluations of Text4baby have found that it improves targeted health attitudes and beliefs, but effects on behavior have not yet been determined. Objective: In this study, investigators aimed to evaluate Text4baby in the military women?s population. Methods: Investigators conducted a randomized controlled trial at Madigan Army Medical Center in Tacoma, Washington, from December 2011 through September 2013. All participants were pregnant women first presenting for care at Madigan. Investigators conducted a baseline assessment using a 24-item, self-administered online survey of attitudes and behaviors related to Text4baby message content. Participants were randomized to Text4baby plus usual care (intervention) or usual care alone (control). Investigators analyzed treatment effects of Text4baby on short-term targeted outcomes 4 weeks post enrollment. Results: For this study, 943 patients were randomized and completed a baseline assessment. The average patient age was 28 years and nearly 70% self-identified as Caucasian. 48.7% of enrollees (459/943) completed the first follow-up assessment. Higher rates of single and working/in-school patients dropped out of the intervention arm of the study, and we adjusted for this finding in subsequent models. However, while investigators were unable to re-survey these participants, only 1.9% of Text4baby enrollees (18/943) dropped the service during the study period. Adjusted and unadjusted logistic generalized estimating equation models were developed to assess intervention effects on measured outcomes. In the model adjusting for age, marital status, having had a previous baby, and race/ethnicity, there was a significant effect of Text4baby intervention exposure on increased agreement with belief in the importance of taking prenatal vitamins (OR 1.91, 95% CI 1.08-3.34, P=.024). All of these attitudes had been targeted by at least one text message during the 4-week evaluation period examined in this study. In unadjusted models, there was a significant effect of intervention exposure on belief in the importance of visiting a health care provider to be a healthy new mother (OR 1.52, 95% CI 1.01-2.31, P=.046) and in the health risks of alcohol during pregnancy (OR 2.06, 95% CI 1.00-4.31, P=.05). No behavioral effects of the intervention were observed in this analysis. Conclusions: Text4baby is a promising program that offers lessons for future mHealth activities. This large-scale study demonstrated initial effects of the program on attitudes and beliefs targeted by the messages received by women during the study period. Results confirm previous findings from Text4baby studies and other mHealth research. Future analyses will examine dosage effects of the intervention on behaviors and clinical outcomes. UR - http://www.jmir.org/2014/5/e131/ UR - http://dx.doi.org/10.2196/jmir.3297 UR - http://www.ncbi.nlm.nih.gov/pubmed/24846909 ID - info:doi/10.2196/jmir.3297 ER - TY - JOUR AU - Becker, Stefan AU - Miron-Shatz, Talya AU - Schumacher, Nikolaus AU - Krocza, Johann AU - Diamantidis, Clarissa AU - Albrecht, Urs-Vito PY - 2014/05/16 TI - mHealth 2.0: Experiences, Possibilities, and Perspectives JO - JMIR mHealth uHealth SP - e24 VL - 2 IS - 2 KW - mHealth KW - mobile applications KW - text-messaging KW - stakeholders KW - consumer KW - mobile technology KW - technology interoperability KW - behavior change KW - regulation UR - http://mhealth.jmir.org/2014/2/e24/ UR - http://dx.doi.org/10.2196/mhealth.3328 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099752 ID - info:doi/10.2196/mhealth.3328 ER - TY - JOUR AU - Lawpoolsri, Saranath AU - Khamsiriwatchara, Amnat AU - Liulark, Wongwat AU - Taweeseneepitch, Komchaluch AU - Sangvichean, Aumnuyphan AU - Thongprarong, Wiraporn AU - Kaewkungwal, Jaranit AU - Singhasivanon, Pratap PY - 2014/05/12 TI - Real-Time Monitoring of School Absenteeism to Enhance Disease Surveillance: A Pilot Study of a Mobile Electronic Reporting System JO - JMIR mHealth uHealth SP - e22 VL - 2 IS - 2 KW - syndromic surveillance KW - schools KW - absenteeism KW - tablets KW - reporting system N2 - Background: School absenteeism is a common source of data used in syndromic surveillance, which can eventually be used for early outbreak detection. However, the absenteeism reporting system in most schools, especially in developing countries, relies on a paper-based method that limits its use for disease surveillance or outbreak detection. Objective: The objective of this study was to develop an electronic real-time reporting system on school absenteeism for syndromic surveillance. Methods: An electronic (Web-based) school absenteeism reporting system was developed to embed it within the normal routine process of absenteeism reporting. This electronic system allowed teachers to update students' attendance status via mobile tablets. The data from all classes and schools were then automatically sent to a centralized database for further analysis and presentation, and for monitoring temporal and spatial patterns of absent students. In addition, the system also had a disease investigation module, which provided a link between absenteeism data from schools and local health centers, to investigate causes of fever among sick students. Results: The electronic school absenteeism reporting system was implemented in 7 primary schools in Bangkok, Thailand, with total participation of approximately 5000 students. During May-October 2012 (first semester), the percentage of absentees varied between 1% and 10%. The peak of school absenteeism (sick leave) was observed between July and September 2012, which coincided with the peak of dengue cases in children aged 6-12 years being reported to the disease surveillance system. Conclusions: The timeliness of a reporting system is a critical function in any surveillance system. Web-based application and mobile technology can potentially enhance the use of school absenteeism data for syndromic surveillance and outbreak detection. This study presents the factors that determine the implementation success of this reporting system. UR - http://mhealth.jmir.org/2014/2/e22/ UR - http://dx.doi.org/10.2196/mhealth.3114 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099501 ID - info:doi/10.2196/mhealth.3114 ER - TY - JOUR AU - Cho, Jaehee AU - Park, Dongjin AU - Lee, Erin H. PY - 2014/05/09 TI - Cognitive Factors of Using Health Apps: Systematic Analysis of Relationships Among Health Consciousness, Health Information Orientation, eHealth Literacy, and Health App Use Efficacy JO - J Med Internet Res SP - e125 VL - 16 IS - 5 KW - health apps KW - health consciousness KW - health information orientation KW - eHealth literacy KW - health app use efficacy N2 - Background: Interest in smartphone health apps has been increasing recently. However, we have little understanding of the cognitive and motivational factors that influence the extent of health-app use. Objective: This study aimed to examine the effects of four cognitive factors?health consciousness, health information orientation, eHealth literacy, and health-app use efficacy?on the extent of health-app use. It also explored the influence of two different use patterns?information and information-behavior use of health apps?with regard to the relationships among the main study variables. Methods: We collected and analyzed 765 surveys in South Korea. According to the results, there was a negligible gender difference: males (50.6%, 387/765) and females (49.4%, 378/765). All participants were adults whose ages ranged from 19 to 59. In order to test the proposed hypotheses, we used a path analysis as a specific form of structural equation modeling. Results: Through a path analysis, we discovered that individuals? health consciousness had a direct effect on their use of health apps. However, unlike the initial expectations, the effects of health information orientation and eHealth literacy on health-app use were mediated by health-app use efficacy. Conclusions: The results from the path analysis addressed a significant direct effect of health consciousness as well as strong mediating effects of health-app use efficacy. These findings contribute to widening our comprehension of the new, digital dimensions of health management, particularly those revolving around mobile technology. UR - http://www.jmir.org/2014/5/e125/ UR - http://dx.doi.org/10.2196/jmir.3283 UR - http://www.ncbi.nlm.nih.gov/pubmed/24824062 ID - info:doi/10.2196/jmir.3283 ER - TY - JOUR AU - Nhavoto, António José AU - Grönlund, Åke PY - 2014/05/08 TI - Mobile Technologies and Geographic Information Systems to Improve Health Care Systems: A Literature Review JO - JMIR mHealth uHealth SP - e21 VL - 2 IS - 2 KW - health care KW - eHealth KW - mobile technology KW - mobile phone KW - SMS KW - text messaging KW - geographic information system KW - GIS N2 - Background: A growing body of research has employed mobile technologies and geographic information systems (GIS) for enhancing health care and health information systems, but there is yet a lack of studies of how these two types of systems are integrated together into the information infrastructure of an organization so as to provide a basis for data analysis and decision support. Integration of data and technical systems across the organization is necessary for efficient large-scale implementation. Objective: The aim of this paper is to identify how mobile technologies and GIS applications have been used, independently as well as in combination, for improving health care. Methods: The electronic databases PubMed, BioMed Central, Wiley Online Library, Scopus, Science Direct, and Web of Science were searched to retrieve English language articles published in international academic journals after 2005. Only articles addressing the use of mobile or GIS technologies and that met a prespecified keyword strategy were selected for review. Results: A total of 271 articles were selected, among which 220 concerned mobile technologies and 51 GIS. Most articles concern developed countries (198/271, 73.1%), and in particular the United States (81/271, 29.9%), United Kingdom (31/271, 11.4%), and Canada (14/271, 5.2%). Applications of mobile technologies can be categorized by six themes: treatment and disease management, data collection and disease surveillance, health support systems, health promotion and disease prevention, communication between patients and health care providers or among providers, and medical education. GIS applications can be categorized by four themes: disease surveillance, health support systems, health promotion and disease prevention, and communication to or between health care providers. Mobile applications typically focus on using text messaging (short message service, SMS) for communication between patients and health care providers, most prominently reminders and advice to patients. These applications generally have modest benefits and may be appropriate for implementation. Integration of health data using GIS technology also exhibit modest benefits such as improved understanding of the interplay of psychological, social, environmental, area-level, and sociodemographic influences on physical activity. The studies evaluated showed promising results in helping patients treating different illnesses and managing their condition effectively. However, most studies use small sample sizes and short intervention periods, which means limited clinical or statistical significance. Conclusions: A vast majority of the papers report positive results, including retention rate, benefits for patients, and economic gains for the health care provider. However, implementation issues are little discussed, which means the reasons for the scarcity of large-scale implementations, which might be expected given the overwhelmingly positive results, are yet unclear. There is also little combination between GIS and mobile technologies. In order for health care processes to be effective they must integrate different kinds of existing technologies and data. Further research and development is necessary to provide integration and better understand implementation issues. UR - http://mhealth.jmir.org/2014/2/e21/ UR - http://dx.doi.org/10.2196/mhealth.3216 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099368 ID - info:doi/10.2196/mhealth.3216 ER - TY - JOUR AU - Ploderer, Bernd AU - Smith, Wally AU - Pearce, Jon AU - Borland, Ron PY - 2014/05/07 TI - A Mobile App Offering Distractions and Tips to Cope With Cigarette Craving: A Qualitative Study JO - JMIR mHealth uHealth SP - e23 VL - 2 IS - 2 KW - smoking cessation KW - relapse prevention KW - quitting KW - mobile phone KW - distraction N2 - Background: Despite considerable effort, most smokers relapse within a few months after quitting due to cigarette craving. The widespread adoption of mobile phones presents new opportunities to provide support during attempts to quit. Objective: To design and pilot a mobile app "DistractMe" to enable quitters to access and share distractions and tips to cope with cigarette cravings. Methods: A qualitative study with 14 smokers who used DistractMe on their mobiles during the first weeks of their quit attempt. Based on interviews, diaries, and log data, we examined how the app supported quitting strategies. Results: Three distinct techniques of coping when using DistractMe were identified: diversion, avoidance, and displacement. We further identified three forms of engagement with tips for coping: preparation, fortification, and confrontation. Overall, strategies to prevent cravings and their effects (avoidance, displacement, preparation, and fortification) were more common than immediate coping strategies (diversion and confrontation). Tips for coping were more commonly used than distractions to cope with cravings, because they helped to fortify the quit attempt and provided opportunities to connect with other users of the application. However, distractions were important to attract new users and to facilitate content sharing. Conclusions: Based on the qualitative results, we recommend that mobile phone-based interventions focus on tips shared by peers and frequent content updates. Apps also require testing with larger groups of users to assess whether they can be self-sustaining. UR - http://mhealth.jmir.org/2014/2/e23/ UR - http://dx.doi.org/10.2196/mhealth.3209 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099632 ID - info:doi/10.2196/mhealth.3209 ER - TY - JOUR AU - Sama, R. Preethi AU - Eapen, J. Zubin AU - Weinfurt, P. Kevin AU - Shah, R. Bimal AU - Schulman, A. Kevin PY - 2014/05/01 TI - An Evaluation of Mobile Health Application Tools JO - JMIR mHealth uHealth SP - e19 VL - 2 IS - 2 KW - cellular phone KW - Internet KW - medical informatics applications KW - social media N2 - Background: The rapid growth in the number of mobile health applications could have profound significance in the prevention of disease or in the treatment of patients with chronic disease such as diabetes. Objective: The objective of this study was to describe the characteristics of the most common mobile health care applications available in the Apple iTunes marketplace. Methods: We undertook a descriptive analysis of a sample of applications in the ?health and wellness? category of the Apple iTunes Store. We characterized each application in terms of its health factor and primary method of user engagement. The main outcome measures of the analysis were price, health factors, and methods of user engagement. Results: Among the 400 applications that met the inclusion criteria, the mean price of the most frequently downloaded paid applications was US $2.24 (SD $1.30), and the mean price of the most currently available paid applications was US $2.27 (SD $1.60). Fitness/training applications were the most popular (43.5%, 174/400). The next two most common categories were health resource (15.0%, 60/400) and diet/caloric intake (14.3%, 57/400). Applications in the health resource category constituted 5.5% (22/400) of the applications reviewed. Self-monitoring was the most common primary user engagement method (74.8%, 299/400). A total of 20.8% (83/400) of the applications used two or more user engagement approaches, with self-monitoring and progress tracking being the most frequent. Conclusions: Most of the popular mobile health applications focus on fitness and self-monitoring. The approaches to user engagement utilized by these applications are limited and present an opportunity to improve the effectiveness of the technology. UR - http://mhealth.jmir.org/2014/2/e19/ UR - http://dx.doi.org/10.2196/mhealth.3088 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099179 ID - info:doi/10.2196/mhealth.3088 ER - TY - JOUR AU - Gamito, Pedro AU - Oliveira, Jorge AU - Lopes, Paulo AU - Brito, Rodrigo AU - Morais, Diogo AU - Silva, Diana AU - Silva, Ana AU - Rebelo, Sara AU - Bastos, Marta AU - Deus, Alberto PY - 2014/04/17 TI - Executive Functioning in Alcoholics Following an mHealth Cognitive Stimulation Program: Randomized Controlled Trial JO - J Med Internet Res SP - e102 VL - 16 IS - 4 KW - alcohol KW - addiction KW - cognitive stimulation KW - executive function KW - mobile health KW - serious games N2 - Background: The consequences of alcohol dependence are severe and may range from physical disease to neuropsychological deficits in several cognitive domains. Alcohol abuse has also been related to brain dysfunction specifically in the prefrontal cortex. Conventional neuropsychological interventions (paper-and-pencil cognitive stimulation training) have a positive effect but are time-consuming, costly, and not motivating for patients. Objective: Our goal was to test the cognitive effects of a novel approach to neuropsychological intervention, using mobile technology and serious games, on patients with alcohol dependence. Methods: The trial design consisted of a two-arm study assessing the cognitive outcomes of neuropsychological intervention with mobile serious games (mHealth) versus control (treatment-as-usual with no neuropsychological intervention) in patients undergoing treatment for alcohol dependence syndrome. Sixty-eight patients were recruited from an alcohol-rehab clinic and randomly assigned to the mHealth (n=33) or control condition (n=35). The intervention on the experimental group consisted of a therapist-assisted cognitive stimulation therapy for 4 weeks on a 2-3 days/week basis. Results: Fourteen patients dropped out of the study. The results of the neuropsychological assessments with the remaining 54 patients showed an overall increase (P<.05) of general cognitive abilities, mental flexibility, psychomotor processing speed, and attentional ability in both experimental (n=26) and control groups (n=28). However, there was a more pronounced improvement (P=.01) specifically in frontal lobe functions from baseline (mean 13.89, SE 0.58) to follow-up (mean 15.50, SE 0.46) in the experimental group but not in the control group. Conclusions: The overall increase in general cognitive function for both experimental and control groups supports the beneficial role of existing alcohol treatment protocols aimed at minimizing withdrawal symptoms, but the differential improvements observed in frontal lobe functioning supports the use of mobile serious games for neuropsychological stimulation to overcome executive dysfunction in patients with alcohol dependence. This trial was negative on two neuropsychological/cognitive tests, and positive on one. Trial Registration: ClinicalTrials.gov NCT01942954; http://www.clinicaltrials.gov/ct2/show/NCT01942954 (Archived by WebCite at http://www.webcitation.org/6OYDqHLwB). UR - http://www.jmir.org/2014/4/e102/ UR - http://dx.doi.org/10.2196/jmir.2923 UR - http://www.ncbi.nlm.nih.gov/pubmed/24742381 ID - info:doi/10.2196/jmir.2923 ER - TY - JOUR AU - Arnhold, Madlen AU - Quade, Mandy AU - Kirch, Wilhelm PY - 2014/04/09 TI - Mobile Applications for Diabetics: A Systematic Review and Expert-Based Usability Evaluation Considering the Special Requirements of Diabetes Patients Age 50 Years or Older JO - J Med Internet Res SP - e104 VL - 16 IS - 4 KW - mobile applications KW - apps KW - mobile health KW - mHealth KW - diabetes mellitus KW - market analysis KW - systematic review KW - elderly KW - usability test KW - expert review N2 - Background: A multitude of mhealth (mobile health) apps have been developed in recent years to support effective self-management of patients with diabetes mellitus type 1 or 2. Objective: We carried out a systematic review of all currently available diabetes apps for the operating systems iOS and Android. We considered the number of newly released diabetes apps, range of functions, target user groups, languages, acquisition costs, user ratings, available interfaces, and the connection between acquisition costs and user ratings. Additionally, we examined whether the available applications serve the special needs of diabetes patients aged 50 or older by performing an expert-based usability evaluation. Methods: We identified relevant keywords, comparative categories, and their specifications. Subsequently, we performed the app review based on the information given in the Google Play Store, the Apple App Store, and the apps themselves. In addition, we carried out an expert-based usability evaluation based on a representative 10% sample of diabetes apps. Results: In total, we analyzed 656 apps finding that 355 (54.1%) offered just one function and 348 (53.0%) provided a documentation function. The dominating app language was English (85.4%, 560/656), patients represented the main user group (96.0%, 630/656), and the analysis of the costs revealed a trend toward free apps (53.7%, 352/656). The median price of paid apps was ?1.90. The average user rating was 3.6 stars (maximum 5). Our analyses indicated no clear differences in the user rating between free and paid apps. Only 30 (4.6%) of the 656 available diabetes apps offered an interface to a measurement device.We evaluated 66 apps within the usability evaluation. On average, apps were rated best regarding the criterion ?comprehensibility? (4.0 out of 5.0), while showing a lack of ?fault tolerance? (2.8 out of 5.0). Of the 66 apps, 48 (72.7%) offered the ability to read the screen content aloud. The number of functions was significantly negative correlated with usability. The presence of documentation and analysis functions reduced the usability score significantly by 0.36 and 0.21 points. Conclusions: A vast number of diabetes apps already exist, but the majority offer similar functionalities and combine only one to two functions in one app. Patients and physicians alike should be involved in the app development process to a greater extent. We expect that the data transmission of health parameters to physicians will gain more importance in future applications.The usability of diabetes apps for patients aged 50 or older was moderate to good. But this result applied mainly to apps offering a small range of functions. Multifunctional apps performed considerably worse in terms of usability. Moreover, the presence of a documentation or analysis function resulted in significantly lower usability scores. The operability of accessibility features for diabetes apps was quite limited, except for the feature ?screen reader?. UR - http://www.jmir.org/2014/4/e104/ UR - http://dx.doi.org/10.2196/jmir.2968 UR - http://www.ncbi.nlm.nih.gov/pubmed/24718852 ID - info:doi/10.2196/jmir.2968 ER - TY - JOUR AU - Smith, L. Kyla AU - Kerr, A. Deborah AU - Fenner, A. Ashley AU - Straker, M. Leon PY - 2014/04/08 TI - Adolescents Just Do Not Know What They Want: A Qualitative Study to Describe Obese Adolescents? Experiences of Text Messaging to Support Behavior Change Maintenance Post Intervention JO - J Med Internet Res SP - e103 VL - 16 IS - 4 KW - telemedicine KW - text messaging KW - adolescent KW - obesity N2 - Background: Adolescents are considered a hard to reach group and novel approaches are needed to encourage good health. Text messaging interventions have been reported as acceptable to adolescents but there is little evidence regarding the use of text messages with overweight and obese adolescents to support engagement or behavior change after the conclusion of a healthy lifestyle program. Objective: The intent of this study was to explore the opinions of overweight adolescents and their parents regarding the use of text messages as a support during the maintenance period following an intervention. Methods: This paper reports on the findings from focus groups conducted with adolescents (n=12) and parents (n=13) who had completed an eight-week intensive intervention known as Curtin University?s Activity, Food and Attitudes Program (CAFAP). Focus groups were conducted three months post intensive intervention. Participants were asked about their experiences of the prior three-month maintenance phase during which adolescents had received tri-weekly text messages based on the self-determination theory and goal-setting theory. Participants were asked about the style and content of text messages used as well as how they used the text messages. Data were analyzed using content and thematic analyses. Results: Two clear themes emerged from the focus groups relating to (1) what adolescents liked or thought they wanted in a text message to support behavior change, and (2) how they experienced or responded to text messages. Within the ?like/want? theme, there were five sub-themes relating to the overall tone of the text, frequency, timing, reference to long-term goals, and inclusion of practical tips. Within the ?response to text? theme, there were four sub-themes describing a lack of motivation, barriers to change, feelings of shame, and perceived unfavorable comparison with other adolescents. What adolescents said they wanted in text messages often conflicted with their actual experiences. Parent reports provided a useful secondary view of adolescent experience. Conclusions: The conflicting views described in this study suggest that overweight and obese adolescents may not know or have the ability to articulate how they would best be supported with text messages during a healthy lifestyle maintenance phase. Further, supporting both engagement and behavior change simultaneously with text messaging may not be possible. Intervention texts should be personalized as much as possible and minimize feelings of guilt and shame in overweight and obese adolescents. Future research with text messaging for overweight and obese adolescents should incorporate clear intervention aims and evaluation methods specifically related to adolescent engagement or behavior change. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12611001187932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611001187932 (Archived by WebCite at http://www.webcitation.org/6LGSbk8d9). UR - http://www.jmir.org/2014/4/e103/ UR - http://dx.doi.org/10.2196/jmir.3113 UR - http://www.ncbi.nlm.nih.gov/pubmed/24713407 ID - info:doi/10.2196/jmir.3113 ER - TY - JOUR AU - Mira, Joaquín José AU - Navarro, Isabel AU - Botella, Federico AU - Borrás, Fernando AU - Nuño-Solinís, Roberto AU - Orozco, Domingo AU - Iglesias-Alonso, Fuencisla AU - Pérez-Pérez, Pastora AU - Lorenzo, Susana AU - Toro, Nuria PY - 2014/04/04 TI - A Spanish Pillbox App for Elderly Patients Taking Multiple Medications: Randomized Controlled Trial JO - J Med Internet Res SP - e99 VL - 16 IS - 4 KW - medication KW - patient nonadherence KW - mobile apps KW - patient safety KW - elderly N2 - Background: Nonadherence and medication errors are common among patients with complex drug regimens. Apps for smartphones and tablets are effective for improving adherence, but they have not been tested in elderly patients with complex chronic conditions and who typically have less experience with this type of technology. Objective: The objective of this study was to design, implement, and evaluate a medication self-management app (called ALICE) for elderly patients taking multiple medications with the intention of improving adherence and safe medication use. Methods: A single-blind randomized controlled trial was conducted with a control and an experimental group (N=99) in Spain in 2013. The characteristics of ALICE were specified based on the suggestions of 3 nominal groups with a total of 23 patients and a focus group with 7 professionals. ALICE was designed for Android and iOS to allow for the personalization of prescriptions and medical advice, showing images of each of the medications (the packaging and the medication itself) together with alerts and multiple reminders for each alert. The randomly assigned patients in the control group received oral and written information on the safe use of their medications and the patients in the experimental group used ALICE for 3 months. Pre and post measures included rate of missed doses and medication errors reported by patients, scores from the 4-item Morisky Medication Adherence Scale (MMAS-4), level of independence, self-perceived health status, and biochemical test results. In the experimental group, data were collected on their previous experience with information and communication technologies, their rating of ALICE, and their perception of the level of independence they had achieved. The intergroup intervention effects were calculated by univariate linear models and ANOVA, with the pre to post intervention differences as the dependent variables. Results: Data were obtained from 99 patients (48 and 51 in the control and experimental groups, respectively). Patients in the experimental group obtained better MMAS-4 scores (P<.001) and reported fewer missed doses of medication (P=.02). ALICE only helped to significantly reduce medication errors in patients with an initially higher rate of errors (P<.001). Patients with no experience with information and communication technologies reported better adherence (P<.001), fewer missed doses (P<.001), and fewer medication errors (P=.02). The mean satisfaction score for ALICE was 8.5 out of 10. In all, 45 of 51 patients (88%) felt that ALICE improved their independence in managing their medications. Conclusions: The ALICE app improves adherence, helps reduce rates of forgetting and of medication errors, and increases perceived independence in managing medication. Elderly patients with no previous experience with information and communication technologies are capable of effectively using an app designed to help them take their medicine more safely. Trial Registration: Clinicaltrials.gov NCT02071498; http://clinicaltrials.gov/ct2/show/NCT02071498 (Archived by WebCite at http://www.webcitation.org/6OJjdHVhD). UR - http://www.jmir.org/2014/4/e99/ UR - http://dx.doi.org/10.2196/jmir.3269 UR - http://www.ncbi.nlm.nih.gov/pubmed/24705022 ID - info:doi/10.2196/jmir.3269 ER - TY - JOUR AU - Wen, Kuang-Yi AU - Miller, M. Suzanne AU - Kilby, Linda AU - Fleisher, Linda AU - Belton, D. Tanisha AU - Roy, Gem AU - Hernandez, Enrique PY - 2014/04/03 TI - Preventing Postpartum Smoking Relapse Among Inner City Women: Development of a Theory-Based and Evidence-Guided Text Messaging Intervention JO - JMIR Res Protoc SP - e20 VL - 3 IS - 2 KW - smoking relapse intervention KW - low-income women KW - mHealth KW - text messaging N2 - Background: Underserved women are at high risk for smoking relapse after childbirth due to their unique socioeconomic and postpartum stressors and barriers. Mobile text messaging technology allows delivery of relapse prevention programs targeted to their personal needs over time. Objective: To describe the development of a social-cognitive theory-based and evidence-guided text messaging intervention for preventing postpartum smoking relapse among inner city women. Methods: Guided by the cognitive-social health information processing framework, user-centered design, and health communication best practices, the intervention was developed through a systematic process that included needs assessment, followed by an iterative cycling through message drafting, health literacy evaluation and rewriting, review by target community members and a scientific advisory panel, and message revision, concluding with usability testing. Results: All message content was theory-grounded, derived by needs assessment analysis and evidence-based materials, reviewed and revised by the target population, health literacy experts, and scientific advisors. The final program, ?Txt2Commit,? was developed as a fully automated system, designed to deliver 3 proactive messages per day for a 1-month postpartum smoking relapse intervention, with crave and lapse user-initiated message functions available when needed. Conclusions: The developmental process suggests that the application of theory and best practices in the design of text messaging smoking cessation interventions is not only feasible but necessary for ensuring that the interventions are evidence based and user-centered. UR - http://www.researchprotocols.org/2014/2/e20/ UR - http://dx.doi.org/10.2196/resprot.3059 UR - http://www.ncbi.nlm.nih.gov/pubmed/24698804 ID - info:doi/10.2196/resprot.3059 ER - TY - JOUR AU - Lund, Stine AU - Rasch, Vibeke AU - Hemed, Maryam AU - Boas, Marie Ida AU - Said, Azzah AU - Said, Khadija AU - Makundu, Hassan Mkoko AU - Nielsen, Bruun Birgitte PY - 2014/03/26 TI - Mobile Phone Intervention Reduces Perinatal Mortality in Zanzibar: Secondary Outcomes of a Cluster Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e15 VL - 2 IS - 1 KW - perinatal mortality KW - text messaging (SMS) KW - mobile phones KW - developing countries N2 - Background: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse. Objective: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. Methods: This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality. Results: Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74). Conclusions: Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT01821222; http://www.clinicaltrials.gov/ct2/show/NCT01821222 (Archived by WebCite at http://www.webcitation.org/6NqxnxYn0). UR - http://mhealth.jmir.org/2014/1/e15/ UR - http://dx.doi.org/10.2196/mhealth.2941 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098184 ID - info:doi/10.2196/mhealth.2941 ER - TY - JOUR AU - Forjuoh, N. Samuel AU - Ory, G. Marcia AU - Wang, Suojin AU - des Bordes, KA Jude AU - Hong, Yan PY - 2014/03/21 TI - Using the iPod Touch for Patient Health Behavior Assessment and Health Promotion in Primary Care JO - JMIR Mhealth Uhealth SP - e14 VL - 2 IS - 1 KW - iPod touch KW - behavior change KW - health behavior assessment KW - health promotion and disease prevention KW - patient-physician communication KW - mobile health technology KW - mHealth N2 - Background: There is a growing recognition of the importance of lifestyle behavior change for health promotion and disease prevention, as well as the concomitant influence of patient?physician communication on effective behavior change. Mobile technology is increasingly being recognized as an important and efficient tool to collect patients? health behavior data and facilitate patient?physician communication. Objective: The aim of this study was to assess the feasibility of an iPod touch-based health behavior assessment (HBA) tool in enhancing patient?physician collaborative goal-setting for health promotion in primary care. Methods: A total of 109 patients from three primary care clinics in central Texas completed a brief HBA, which was programmed on an iPod touch device. An instant feedback report was generated for the patient and their physician simultaneously to facilitate collaborative goal-setting. Within approximately 7 days of the HBA, the patients were phoned for a follow-up survey for their feedback on the iPod touch?based HBA and resultant patient?physician communication. Results: Patients were able to complete an HBA on the iPod touch with ease. Among those who completed the follow-up survey (n=83), 30% (25/83) reported that their physicians discussed the HBA report with them, while 29% (24/83) established behavior change goals with them. More than 90% (75/83) of the patients reported positive experiences with the iPod touch?based HBA. Conclusions: It is feasible to use mobile tools for HBA in the primary care setting. The HBA also facilitated patient?physician communication on behavior change. However, more research is needed on the effectiveness of large scale dissemination of mobile-based HBA technology on health communication and behavior change for preventing or managing lifestyle-related chronic conditions, such as obesity, diabetes, cancer, or heart diseases. UR - http://mhealth.jmir.org/2014/1/e14/ UR - http://dx.doi.org/10.2196/mhealth.2927 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100308 ID - info:doi/10.2196/mhealth.2927 ER - TY - JOUR AU - Kalz, Marco AU - Lenssen, Niklas AU - Felzen, Marc AU - Rossaint, Rolf AU - Tabuenca, Bernardo AU - Specht, Marcus AU - Skorning, Max PY - 2014/03/19 TI - Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study JO - J Med Internet Res SP - e89 VL - 16 IS - 3 KW - basic life support (BLS) KW - cardiopulmonary resuscitation (CPR) KW - external chest compression (ECC) KW - smartphone apps KW - mobile phone KW - mobile health N2 - Background: No systematic evaluation of smartphone/mobile apps for resuscitation training and real incident support is available to date. To provide medical, usability, and additional quality criteria for the development of apps, we conducted a mixed-methods sequential evaluation combining the perspective of medical experts and end-users. Objective: The study aims to assess the quality of current mobile apps for cardiopulmonary resuscitation (CPR) training and real incident support from expert as well as end-user perspective. Methods: Two independent medical experts evaluated the medical content of CPR apps from the Google Play store and the Apple App store. The evaluation was based on pre-defined minimum medical content requirements according to current Basic Life Support (BLS) guidelines. In a second phase, non-medical end-users tested usability and appeal of the apps that had at least met the minimum requirements. Usability was assessed with the System Usability Scale (SUS); appeal was measured with the self-developed ReactionDeck toolkit. Results: Out of 61 apps, 46 were included in the experts? evaluation. A consolidated list of 13 apps resulted for the following layperson evaluation. The interrater reliability was substantial (kappa=.61). Layperson end-users (n=14) had a high interrater reliability (intraclass correlation 1 [ICC1]=.83, P<.001, 95% CI 0.75-0.882 and ICC2=.79, P<.001, 95% CI 0.695-0.869). Their evaluation resulted in a list of 5 recommendable apps. Conclusions: Although several apps for resuscitation training and real incident support are available, very few are designed according to current BLS guidelines and offer an acceptable level of usability and hedonic quality for laypersons. The results of this study are intended to optimize the development of CPR mobile apps. The app ranking supports the informed selection of mobile apps for training situations and CPR campaigns as well as for real incident support. UR - http://www.jmir.org/2014/3/e89/ UR - http://dx.doi.org/10.2196/jmir.2951 UR - http://www.ncbi.nlm.nih.gov/pubmed/24647361 ID - info:doi/10.2196/jmir.2951 ER - TY - JOUR AU - Jibb, A. Lindsay AU - Stevens, J. Bonnie AU - Nathan, C. Paul AU - Seto, Emily AU - Cafazzo, A. Joseph AU - Stinson, N. Jennifer PY - 2014/03/19 TI - A Smartphone-Based Pain Management App for Adolescents With Cancer: Establishing System Requirements and a Pain Care Algorithm Based on Literature Review, Interviews, and Consensus JO - JMIR Res Protoc SP - e15 VL - 3 IS - 1 KW - adolescent KW - pain KW - neoplasms KW - cellular phone KW - algorithms N2 - Background: Pain that occurs both within and outside of the hospital setting is a common and distressing problem for adolescents with cancer. The use of smartphone technology may facilitate rapid, in-the-moment pain support for this population. To ensure the best possible pain management advice is given, evidence-based and expert-vetted care algorithms and system design features, which are designed using user-centered methods, are required. Objective: To develop the decision algorithm and system requirements that will inform the pain management advice provided by a real-time smartphone-based pain management app for adolescents with cancer. Methods: A systematic approach to algorithm development and system design was utilized. Initially, a comprehensive literature review was undertaken to understand the current body of knowledge pertaining to pediatric cancer pain management. A user-centered approach to development was used as the results of the review were disseminated to 15 international experts (clinicians, scientists, and a consumer) in pediatric pain, pediatric oncology and mHealth design, who participated in a 2-day consensus conference. This conference used nominal group technique to develop consensus on important pain inputs, pain management advice, and system design requirements. Using data generated at the conference, a prototype algorithm was developed. Iterative qualitative testing was conducted with adolescents with cancer, as well as pediatric oncology and pain health care providers to vet and refine the developed algorithm and system requirements for the real-time smartphone app. Results: The systematic literature review established the current state of research related to nonpharmacological pediatric cancer pain management. The 2-day consensus conference established which clinically important pain inputs by adolescents would require action (pain management advice) from the app, the appropriate advice the app should provide to adolescents in pain, and the functional requirements of the app. These results were used to build a detailed prototype algorithm capable of providing adolescents with pain management support based on their individual pain. Analysis of qualitative interviews with 9 multidisciplinary health care professionals and 10 adolescents resulted in 4 themes that helped to adapt the algorithm and requirements to the needs of adolescents. Specifically, themes were overall endorsement of the system, the need for a clinical expert, the need to individualize the system, and changes to the algorithm to improve potential clinical effectiveness. Conclusions: This study used a phased and user-centered approach to develop a pain management algorithm for adolescents with cancer and the system requirements of an associated app. The smartphone software is currently being created and subsequent work will focus on the usability, feasibility, and effectiveness testing of the app for adolescents with cancer pain. UR - http://www.researchprotocols.org/2014/1/e15/ UR - http://dx.doi.org/10.2196/resprot.3041 UR - http://www.ncbi.nlm.nih.gov/pubmed/24646454 ID - info:doi/10.2196/resprot.3041 ER - TY - JOUR AU - Cremers, Henricus-Paul AU - Mercken, Liesbeth AU - Crutzen, Rik AU - Willems, Paul AU - de Vries, Hein AU - Oenema, Anke PY - 2014/03/18 TI - Do Email and Mobile Phone Prompts Stimulate Primary School Children to Reuse an Internet-Delivered Smoking Prevention Intervention? JO - J Med Internet Res SP - e86 VL - 16 IS - 3 KW - Internet KW - Internet-delivered intervention KW - prompts KW - primary school children KW - computer-tailoring N2 - Background: Improving the use (eg, initial visit and revisits) of Internet-delivered interventions to promote healthy lifestyles such as non-smoking is one of the largest challenges in the field of eHealth. Prompts have shown to be effective in stimulating reuse of Internet-delivered interventions among adults and adolescents. However, evidence concerning effectiveness of prompts to promote reuse of a website among children is still scarce. Objective: The aim of this study is to investigate (1) whether prompts are effective in promoting reuse of an intervention website containing information on smoking prevention for children, (2) whether the content of the prompt is associated with its effect in terms of reuse, and (3) whether there are differences between children who do or do not respond to prompts. Methods: The sample of this cluster-randomized study consisted of 1124 children (aged 10-11 years) from 108 Dutch primary schools, who were assigned to the experimental group of an Internet-delivered smoking prevention intervention study. All participants completed a Web-based questionnaire on factors related to (non-)smoking. Schools were randomized to a no-prompt group (n=50) or a prompt group (n=58). All children could revisit the intervention website, but only the children in the prompt group received email and SMS prompts to revisit the website. Those prompt messages functioned as a teaser to stimulate reuse of the intervention website. Reuse of the website was objectively tracked by means of a server registration system. Repeated measures analysis of variance and linear regression analysis were performed to assess the effects of prompts on website reuse and to identify individual characteristics of participants who reuse the intervention website. Results: Children in the prompt group reused the intervention website significantly more often compared to children in the no-prompt group (B=1.56, P<.001). Prompts announcing new animated videos (F1,1122=9.33, P=.002) and games about (non-)smoking on the website (F1,1122=8.28, P=.004) resulted in most reuse of the website. Within the prompt group, children with a low socioeconomic status (SES) reused the intervention website more often (B=2.19, P<.001) than children of high SES (B=0.93, P=.005). Conclusions: Prompts can stimulate children to reuse an intervention website aimed at smoking prevention. Prompts showed, furthermore, to stimulate children of a low SES slightly more to reuse an intervention website, which is often a difficult target group in terms of stimulating participation. However, the number of revisits was quite low, which requires further study into how prompts can be optimized in terms of content and frequency to improve the number of revisits. Trial Registration: Netherlands Trial Register Number: NTR3116; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3116 (Archived by WebCite at http://www.webcitation.org/6O0wQYuPI). UR - http://www.jmir.org/2014/3/e86/ UR - http://dx.doi.org/10.2196/jmir.3069 UR - http://www.ncbi.nlm.nih.gov/pubmed/24642082 ID - info:doi/10.2196/jmir.3069 ER - TY - JOUR AU - Renner, Bettina AU - Kimmerle, Joachim AU - Cavael, Dominik AU - Ziegler, Volker AU - Reinmann, Lisa AU - Cress, Ulrike PY - 2014/03/17 TI - Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff JO - J Med Internet Res SP - e85 VL - 16 IS - 3 KW - computer applications software KW - mobile applications KW - learning KW - education, continuing KW - job satisfaction KW - hospitals KW - longitudinal studies KW - self report N2 - Background: Reflection is an important cognitive process in workplace learning; however, it occurs only rarely on its own and therefore needs additional support. Objective: In this study, we investigated the effect of software applications (apps) that aim to support reflection on hospital staff?s actual reflection behavior. In doing so, we also analyzed the relationship between reflection and the job satisfaction of health care professionals. Methods: Reflective learning was introduced in the ward of a neurological hospital by providing apps that aimed to foster particular aspects of individual and collaborative reflection. Data were collected repeatedly: once before the introduction of the apps and again 2 years after the initial measure. We used a questionnaire with subjective ratings of reflection and job satisfaction. Response rates were 34.4% (167/485) for the first and 40.6% (210/517) for the second measure. Results: Collaborative reflection was increased (P=.047) after the provision of the apps (2010: mean 2.84, SD 0.72; 2012: mean 3.06, SD 0.63) in contrast to a control group of other wards of the same hospital (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68). In addition, we revealed a positive correlation between collaborative reflection and job satisfaction (r=.61, P<.001). Conclusions: The findings provide evidence for an effect of the apps on hospital employees? reflection behavior. Apps that foster reflective learning can increase health care professionals? reflection about work experiences and support them in discussing experiences in teams or with their supervisors. The relationship between collaborative reflection and job satisfaction suggests that opportunities for joint reflection on work experiences in a hospital have further impact over and above fostering reflective learning per se. We discuss the limitations of our study and provide suggestions for both future research and the development of Web-based apps. UR - http://www.jmir.org/2014/3/e85/ UR - http://dx.doi.org/10.2196/jmir.3040 UR - http://www.ncbi.nlm.nih.gov/pubmed/24637405 ID - info:doi/10.2196/jmir.3040 ER - TY - JOUR AU - Grindrod, Anne Kelly AU - Li, Melissa AU - Gates, Allison PY - 2014/03/14 TI - Evaluating User Perceptions of Mobile Medication Management Applications With Older Adults: A Usability Study JO - JMIR Mhealth Uhealth SP - e11 VL - 2 IS - 1 KW - medication therapy management KW - medication adherence KW - mHealth KW - mobile health N2 - Background: Medication nonadherence has a significant impact on the health and wellbeing of individuals with chronic disease. Several mobile medication management applications are available to help users track, remember, and read about their medication therapy. Objective: The objective of this study was to explore the usability and usefulness of existing medication management applications for older adults. Methods: We recruited 35 participants aged 50 and over to participate in a 2-hour usability session. The average age ranged from 52-78 years (mean 67 years) and 71% (25/35) of participants were female. Each participant was provided with an iPad loaded with four medication management applications: MyMedRec, DrugHub, Pillboxie, and PocketPharmacist. These applications were evaluated using the 10 item System Usability Scale (SUS) and visual analog scale. An investigator-moderated 30-minute discussion followed, and was recorded. We used a grounded theory (GT) approach to analyze qualitative data. Results: When assessing mobile medication management applications, participants struggled to think of a need for the applications in their own lives. Many were satisfied with their current management system and proposed future use only if cognition and health declined. Most participants felt capable of using the applications after a period of time and training, but were frustrated by their initial experiences with the applications. The early experiences of participants highlighted the benefits of linear navigation and clear wording (eg, ?undo? vs ?cancel?) when designing for older users. While there was no order effect, participants attributed their poor performance to the order in which they tried the applications. They also described being a part of a technology generation that did not encounter the computer until adulthood. Of the four applications, PocketPharmacist was found to be the least usable with a score of 42/100 (P<.0001) though it offered a drug interaction feature that was among the favorite features of participants. The usability scores for MyMedRec (56/100), DrugHub (57/100), and Pillboxie (52/100) were not significantly different and participants preferred MyMedRec and DrugHub for their simple, linear interfaces. Conclusions: With training, adults aged 50 and over can be capable and interested in using mHealth applications for their medication management. However, in order to adopt such technology, they must find a need that their current medication management system cannot fill. Interface diversity and multimodal reminder methods should be considered to increase usability for older adults. Lastly, regulation or the involvement of older adults in development may help to alleviate generation bias and mistrust for applications. UR - http://mhealth.jmir.org/2014/1/e11/ UR - http://dx.doi.org/10.2196/mhealth.3048 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099993 ID - info:doi/10.2196/mhealth.3048 ER - TY - JOUR AU - Liddle, Jacki AU - Ireland, David AU - McBride, J. Simon AU - Brauer, G. Sandra AU - Hall, M. Leanne AU - Ding, Hang AU - Karunanithi, Mohan AU - Hodges, W. Paul AU - Theodoros, Deborah AU - Silburn, A. Peter AU - Chenery, J. Helen PY - 2014/03/12 TI - Measuring the Lifespace of People With Parkinson?s Disease Using Smartphones: Proof of Principle JO - JMIR Mhealth Uhealth SP - e13 VL - 2 IS - 1 KW - Parkinson's disease KW - community KW - telemedicine KW - mHealth N2 - Background: Lifespace is a multidimensional construct that describes the geographic area in which a person lives and conducts their activities, and reflects mobility, health, and well-being. Traditionally, it has been measured by asking older people to self-report the length and frequency of trips taken and assistance required. Global Positioning System (GPS) sensors on smartphones have been used to measure Lifespace of older people, but not with people with Parkinson?s disease (PD). Objective: The objective of this study was to investigate whether GPS data collected via smartphones could be used to indicate the Lifespace of people with PD. Methods: The dataset was supplied via the Michael J Fox Foundation Data Challenge and included 9 people with PD and 7 approximately matched controls. Participants carried smartphones with GPS sensors over two months. Data analysis compared the PD group and the control group. The impact of symptom severity on Lifespace was also investigated. Results: Visualization methods for comparing Lifespace were developed including scatterplots and heatmaps. Lifespace metrics for comparison included average daily distance, percentage of time spent at home, and number of trips into the community. There were no significant differences between the PD and the control groups on Lifespace metrics. Visual representations of Lifespace were organized based on the self-reported severity of symptoms, suggesting a trend of decreasing Lifespace with increasing PD symptoms. Conclusions: Lifespace measured by GPS-enabled smartphones may be a useful concept to measure the progression of PD and the impact of various therapies and rehabilitation programs. Directions for future use of GPS-based Lifespace are provided. UR - http://mhealth.jmir.org/2014/1/e13/ UR - http://dx.doi.org/10.2196/mhealth.2799 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100206 ID - info:doi/10.2196/mhealth.2799 ER - TY - JOUR AU - Leal Neto, B. Onicio AU - Albuquerque, M. Cesar AU - Albuquerque, O. Jones AU - Barbosa, S. Constança PY - 2014/03/10 TI - The Schisto Track: A System for Gathering and Monitoring Epidemiological Surveys by Connecting Geographical Information Systems in Real Time JO - JMIR Mhealth Uhealth SP - e10 VL - 2 IS - 1 KW - epidemiological survey KW - schistosomiasis KW - public health N2 - Background: Using the Android platform as a notification instrument for diseases and disorders forms a new alternative for computerization of epidemiological studies. Objective: The objective of our study was to construct a tool for gathering epidemiological data on schistosomiasis using the Android platform. Methods: The developed application (app), named the Schisto Track, is a tool for data capture and analysis that was designed to meet the needs of a traditional epidemiological survey. An initial version of the app was finished and tested in both real situations and simulations for epidemiological surveys. Results: The app proved to be a tool capable of automation of activities, with data organization and standardization, easy data recovery (to enable interfacing with other systems), and totally modular architecture. Conclusions: The proposed Schisto Track is in line with worldwide trends toward use of smartphones with the Android platform for modeling epidemiological scenarios. UR - http://mhealth.jmir.org/2014/1/e10/ UR - http://dx.doi.org/10.2196/mhealth.2859 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099881 ID - info:doi/10.2196/mhealth.2859 ER - TY - JOUR AU - Jandee, Kasemsak AU - Lawpoolsri, Saranath AU - Taechaboonsermsak, Pimsurang AU - Khamsiriwatchara, Amnat AU - Wansatid, Peerawat AU - Kaewkungwal, Jaranit PY - 2014/03/06 TI - Customized-Language Voice Survey on Mobile Devices for Text and Image Data Collection Among Ethnic Groups in Thailand: A Proof-of-Concept Study JO - JMIR Mhealth Uhealth SP - e7 VL - 2 IS - 1 KW - expanded program on immunization KW - EPI KW - ethnicity KW - mobile technology KW - smartphone questionnaire survey KW - voiced question N2 - Background: Public health surveys are often conducted using paper-based questionnaires. However, many problems are associated with this method, especially when collecting data among ethnic groups who speak a different language from the survey interviewer. The process can be time-consuming and there is the risk of missing important data due to incomplete surveys. Objective: This study was conducted as a proof-of-concept to develop a new electronic tool for data collection, and compare it with standard paper-based questionnaire surveys using the research setting of assessing Knowledge Attitude and Practice (KAP) toward the Expanded Program on Immunization (EPI) among 6 ethnic groups in Chiang Rai Province, Thailand. The two data collection methods were compared on data quality in terms of data completeness and time consumed in collecting the information. In addition, the initiative assessed the participants? satisfaction toward the use of a smartphone customized-language voice-based questionnaire in terms of perceived ease of use and perceived usefulness. Methods: Following a cross-over design, all study participants were interviewed using two data collection methods after a one-week washout period. Questions in the paper-based questionnaires in Thai language were translated to each ethnic language by the interviewer/translator when interviewing the study participant. The customized-language voice-based questionnaires were programmed to a smartphone tablet in six, selectable dialect languages and used by the trained interviewer when approaching participants. Results: The study revealed positive data quality outcomes when using the smartphone, voice-based questionnaire survey compared with the paper-based questionnaire survey, both in terms of data completeness and time consumed in data collection process. Since the smartphone questionnaire survey was programmed to ask questions in sequence, no data was missing and there were no entry errors. Participants had positive attitudes toward answering the smartphone questionnaire; 69% (48/70) reported they understood the questions easily, 71% (50/70) found it convenient, and 66% (46/70) reported a reduced time in data collection. The smartphone data collection method was acceptable by both the interviewers and by the study participants of different ethnicities. Conclusions: To our knowledge, this is the first study showing that the application of specific features of mobile devices like smartphone tablets (including dropdown choices, capturing pictures, and voiced questions) can be successfully used for data collection. The mobile device can be effectively used for capturing photos of secondary data and collecting primary data with customized-language and voiced questionnaire survey. Using smartphone questionnaires can minimize or eliminate missing data and reduce the time consumed during the data collection process. Smartphone customized-language, voice-based questionnaires for data collection can be an alternative and better approach than standard translated paper-based questionnaires for public health surveys, especially when collecting data among ethnic and hard-to-reach groups residing in multilanguage-speaking settings. UR - http://mhealth.jmir.org/2014/1/e7/ UR - http://dx.doi.org/10.2196/mhealth.3058 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098776 ID - info:doi/10.2196/mhealth.3058 ER - TY - JOUR AU - Bouri, Nidhi AU - Ravi, Sanjana PY - 2014/03/05 TI - Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies JO - JMIR Mhealth Uhealth SP - e8 VL - 2 IS - 1 KW - electronic health record KW - personal health record KW - public health emergency KW - mobile health UR - http://mhealth.jmir.org/2014/1/e8/ UR - http://dx.doi.org/10.2196/mhealth.3017 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098942 ID - info:doi/10.2196/mhealth.3017 ER - TY - JOUR AU - Wu, Cheng-Jung AU - Wu, Sheng-Yu AU - Chen, Po-Chun AU - Lin, Yaoh-Shiang PY - 2014/03/03 TI - An Innovative Smartphone-Based Otorhinoendoscope and Its Application in Mobile Health and Teleotolaryngology JO - J Med Internet Res SP - e71 VL - 16 IS - 3 KW - otorhinoendoscope KW - smartphone KW - mobile health KW - teleotolaryngology KW - telediagnosis N2 - Background: The traditional otorhinoendoscope is widely used in the diagnosis of a variety of ear and nose diseases, but only one doctor can use it at a time. It is also very difficult to share observations from one doctor with another doctor. With advances in electronic health technology, the extended potential application of smartphones to support medical practice or mobile health has grown steadily. Objective: The first phase of the study discussed how smartphones may be used for otorhinoscopic imaging and image management via an innovative adaptor. The second phase of the study was to evaluate the diagnostic capability of the smartphone-based otorhinoendoscope, as compared to the traditional otorhinoendoscope, and its application in mobile health and teleotolaryngology. Methods: We designed a unique adaptor to connect the otorhinoendoscope and smartphone in order to perform smartphone-based otorhinoendoscopy. The main aim was to transform the smartphone into an otorhinoendoscope. We devised a method that would allow us to use the smartphone?s camera to capture otorhinoscopic images. Using a freely available Web-based real-time communication application platform and the 3G (or WIFI) network, the smartphone-based otorhinoendoscope could synchronize the smartphone-based otorhinoscopic image with smartphones, tablet PCs, computer notebooks, or personal computers. Results: We investigated the feasibility of telemedicine using a smartphone, tablet PC, and computer notebook. Six types of clinical otorhinoscopic images were acquired via the smartphone-based otorhinoendoscope from six patients, which were examined in this study. Three teleconsultants (doctors A, B, and C) reviewed the six types of clinical otorhinoscopic images and made a telediagnosis. When compared to the face-to-face diagnosis, which was made in-person via a traditional otorhinoendoscope, the three teleconsultants obtained scores of a correct primary telediagnosis 83% (5/6), 100% (6/6), and 100% (6/6) of the time, respectively. When the clinical data were provided, the three teleconsultants obtained a correct secondary telediagnosis score of 100% (6/6), 100% (6/6), and 100% (6/6) of the time, respectively. Conclusions: The use of previously available technologies in the absence of any additional expensive devices could significantly increase the quality of diagnostics while lowering extraneous costs. Furthermore, this could also increase the connectivity between most isolated family doctors and remote referral centers. UR - http://www.jmir.org/2014/3/e71/ UR - http://dx.doi.org/10.2196/jmir.2959 UR - http://www.ncbi.nlm.nih.gov/pubmed/24590187 ID - info:doi/10.2196/jmir.2959 ER - TY - JOUR AU - Wang, Aiguo AU - An, Ning AU - Lu, Xin AU - Chen, Hongtu AU - Li, Changqun AU - Levkoff, Sue PY - 2014/02/17 TI - A Classification Scheme for Analyzing Mobile Apps Used to Prevent and Manage Disease in Late Life JO - JMIR Mhealth Uhealth SP - e6 VL - 2 IS - 1 KW - mHealth KW - app KW - Precede-Proceed Model (PPM) KW - health care process KW - prevention KW - management KW - physical health KW - mental health N2 - Background: There are several mobile apps that offer tools for disease prevention and management among older adults, and promote health behaviors that could potentially reduce or delay the onset of disease. A classification scheme that categorizes apps could be useful to both older adult app users and app developers. Objective: The objective of our study was to build and evaluate the effectiveness of a classification scheme that classifies mobile apps available for older adults in the ?Health & Fitness? category of the iTunes App Store. Methods: We constructed a classification scheme for mobile apps according to three dimensions: (1) the Precede-Proceed Model (PPM), which classifies mobile apps in terms of predisposing, enabling, and reinforcing factors for behavior change; (2) health care process, specifically prevention versus management of disease; and (3) health conditions, including physical health and mental health. Content analysis was conducted by the research team on health and fitness apps designed specifically for older adults, as well as those applicable to older adults, released during the months of June and August 2011 and August 2012. Face validity was assessed by a different group of individuals, who were not related to the study. A reliability analysis was conducted to confirm the accuracy of the coding scheme of the sample apps in this study. Results: After applying sample inclusion and exclusion criteria, a total of 119 apps were included in the study sample, of which 26/119 (21.8%) were released in June 2011, 45/119 (37.8%) in August 2011, and 48/119 (40.3%) in August 2012. Face validity was determined by interviewing 11 people, who agreed that this scheme accurately reflected the nature of this application. The entire study sample was successfully coded, demonstrating satisfactory inter-rater reliability by two independent coders (95.8% initial concordance and 100% concordance after consensus was reached). The apps included in the study sample were more likely to be used for the management of disease than prevention of disease (109/119, 91.6% vs 15/119, 12.6%). More apps contributed to physical health rather than mental health (81/119, 68.1% vs 47/119, 39.5%). Enabling apps (114/119, 95.8%) were more common than reinforcing (20/119, 16.8%) or predisposing apps (10/119, 8.4%). Conclusions: The findings, including face validity and inter-rater reliability, support the integrity of the proposed classification scheme for categorizing mobile apps for older adults in the ?Health and Fitness? category available in the iTunes App Store. Using the proposed classification system, older adult app users would be better positioned to identify apps appropriate for their needs, and app developers would be able to obtain the distributions of available mobile apps for health-related concerns of older adults more easily. UR - http://mhealth.jmir.org/2014/1/e6/ UR - http://dx.doi.org/10.2196/mhealth.2877 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098687 ID - info:doi/10.2196/mhealth.2877 ER - TY - JOUR AU - de Tolly, Marianne Katherine AU - Constant, Deborah PY - 2014/02/14 TI - Integrating Mobile Phones into Medical Abortion Provision: Intervention Development, Use, and Lessons Learned From a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e5 VL - 2 IS - 1 KW - mHealth KW - telemedicine KW - SMS KW - medical abortion KW - USSD KW - mobisite N2 - Background: Medical abortion is legal in South Africa but access and acceptability are hampered by the current protocol requiring a follow-up visit to assess abortion completion. Objective: To assess the feasibility and efficacy of information and follow-up provided via mobile phone after medical abortion in a randomized controlled trial (RCT). Methods: Mobile phones were used in three ways in the study: (1) coaching women through medical abortion using short message service (SMS; text messages); (2) a questionnaire to assess abortion completion via unstructured supplementary service data (USSD, a protocol used by GSM mobile telephones that allows the user to interact with a server via text-based menus) and the South African mobile instant message and social networking application Mxit; and (3) family planning information via SMS, mobisite and Mxit. A needs and context assessment was done to learn about women?s experiences undergoing medical abortion and their use of mobile phones. After development, the mobile interventions were piloted. Recruitment was done by field workers at the clinics. In the RCT, women were interviewed at baseline and exit. Computer logs were also analyzed. All study participants received standard of care at the clinics. Results: In the RCT, 234 women were randomized to the intervention group. Eight did not receive the intervention due to invalid numbers, mis-registration, system failure, or opt-out, leaving 226 participants receiving the full intervention. Of the 226, 190 returned and were interviewed at their clinic follow-up visit. The SMSs were highly acceptable, with 97.9% (186/190) saying that the SMSs helped them through the medical abortion. In terms of mobile phone privacy, 86.3% (202/234) said that it was not likely or possible that someone would see SMSs on their phone, although at exit, 20% (38/190) indicated that they had worried about phone privacy. Having been given training at baseline and subsequently asked via SMS to complete the self-assessment questionnaire, 90.3% (204/226) attempted it, and of those, 86.3% (176/204) reached an endpoint of the questionnaire. For the family planning information, a preference for SMS was indicated by study clients, although the publicly available Mxit/mobisite was heavily used (813,375 pages were viewed) over the study duration. Conclusions: SMS provided a good medium for timed, "push" information that guided and supported women through medical abortion. Women were able to perform a self-assessment questionnaire via mobile phones if provided training and prompted by SMS. Phone privacy needs to be protected in similar settings. This study may contribute to the successful expansion of medical abortion provision aided by mobile phones. Trial Registration: Pan African Clinical Trials Registry (PACTR): PACTR201302000427144; http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201302000427144 (Archived by WebCite at http://www.webcitation.org/6N0fnZfzm). UR - http://mhealth.jmir.org/2014/1/e5/ UR - http://dx.doi.org/10.2196/mhealth.3165 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098569 ID - info:doi/10.2196/mhealth.3165 ER - TY - JOUR AU - Choi, Jounghwa AU - Noh, Ghee-Young AU - Park, Dong-Jin PY - 2014/02/12 TI - Smoking Cessation Apps for Smartphones: Content Analysis With the Self-Determination Theory JO - J Med Internet Res SP - e44 VL - 16 IS - 2 KW - medical informatics applications KW - smoking cessation KW - communication media N2 - Background: Smartphones are increasingly receiving attention from public health scholars and practitioners as a means to assist individuals? health management. A number of smartphone apps for smoking cessation are also available; however, little effort has been made to evaluate the content and functions of these apps employing a theoretical framework. Objective: The present study aims to analyze and evaluate the contents of smoking cessation apps available in South Korea employing the self-determination theory (SDT) as a theoretical framework for analysis. This study analyzes the extent to which smoking cessation apps have features that satisfy the basic needs identified in the SDT, which stimulate autonomous motivation. The type of motivational goal content manifested in the apps and how the goal content was framed are also explored. By assessing the features of smoking cessation apps based on the SDT, this study aims to offer direction for improvement for these apps. Methods: Out of 309 apps identified from the iTunes store and Google Play (excluding 27 duplications), 175 apps were randomly drawn and analyzed. The coding scheme was drafted by the authors based on the SDT and gain/loss framing theory and was further finely tuned through the process of coder training and by establishing intercoder reliability. Once the intercoder reliability was established, the coders divided up the rest of the sample and coded them independently. Results: The analysis revealed that most apps (94.3%, 165/175) had at least one feature that tapped at least 1 of the 3 basic needs. Only 18 of 175 apps (10.3%) addressed all 3 basic needs. For goal content, money (53.7%, 94/175) showed the highest frequency, followed by health (32.0%, 56/175), time (7.4%, 13/175), and appearance (1.1%, 2/175), suggesting that extrinsic goals are more dominantly presented in smoking cessation apps. For the framing of goal content, gain framing appeared more frequently (41.7%, 73/175). Conclusions: The results suggest that these smoking cessation apps may not sufficiently stimulate autonomous motivation; a small number of apps addressed all 3 basic needs suggested by the SDT (ie, autonomy, competence, and relatedness). The apps also tended to present extrinsic goal content (primarily in terms of money) over intrinsic ones (ie, health) by primarily adopting gain framing. Implications of these findings for public health practitioners and consumers are discussed. UR - http://www.jmir.org/2014/2/e44/ UR - http://dx.doi.org/10.2196/jmir.3061 UR - http://www.ncbi.nlm.nih.gov/pubmed/24521881 ID - info:doi/10.2196/jmir.3061 ER - TY - JOUR AU - Albrecht, Urs-Vito AU - von Jan, Ute AU - Kuebler, Joachim AU - Zoeller, Christoph AU - Lacher, Martin AU - Muensterer, J. Oliver AU - Ettinger, Max AU - Klintschar, Michael AU - Hagemeier, Lars PY - 2014/02/12 TI - Google Glass for Documentation of Medical Findings: Evaluation in Forensic Medicine JO - J Med Internet Res SP - e53 VL - 16 IS - 2 KW - Google Glass KW - forensic medicine KW - autopsy, postmortem examination KW - documentation N2 - Background: Google Glass is a promising premarket device that includes an optical head-mounted display. Several proof of concept reports exist, but there is little scientific evidence regarding its use in a medical setting. Objective: The objective of this study was to empirically determine the feasibility of deploying Glass in a forensics setting. Methods: Glass was used in combination with a self-developed app that allowed for hands-free operation during autopsy and postmortem examinations of 4 decedents performed by 2 physicians. A digital single-lens reflex (DSLR) camera was used for image comparison. In addition, 6 forensic examiners (3 male, 3 female; age range 23-48 years, age mean 32.8 years, SD 9.6; mean work experience 6.2 years, SD 8.5) were asked to evaluate 159 images for image quality on a 5-point Likert scale, specifically color discrimination, brightness, sharpness, and their satisfaction with the acquired region of interest. Statistical evaluations were performed to determine how Glass compares with conventionally acquired digital images. Results: All images received good (median 4) and very good ratings (median 5) for all 4 categories. Autopsy images taken by Glass (n=32) received significantly lower ratings than those acquired by DSLR camera (n=17) (region of interest: z=?5.154, P<.001; sharpness: z=?7.898, P<.001; color: z=?4.407, P<.001, brightness: z=?3.187, P=.001). For 110 images of postmortem examinations (Glass: n=54, DSLR camera: n=56), ratings for region of interest (z=?8.390, P<.001) and brightness (z=?540, P=.007) were significantly lower. For interrater reliability, intraclass correlation (ICC) values were good for autopsy (ICC=.723, 95% CI .667-.771, P<.001) and postmortem examination (ICC=.758, 95% CI .727-.787, P<.001). Postmortem examinations performed using Glass took 42.6 seconds longer than those done with the DSLR camera (z=?2.100, P=.04 using Wilcoxon signed rank test). The battery charge of Glass quickly decreased; an average 5.5% (SD 1.85) of its battery capacity was spent per postmortem examination (0.81% per minute or 0.79% per picture). Conclusions: Glass was efficient for acquiring images for documentation in forensic medicine, but the image quality was inferior compared to a DSLR camera. Images taken with Glass received significantly lower ratings for all 4 categories in an autopsy setting and for region of interest and brightness in postmortem examination. The effort necessary for achieving the objectives was higher when using the device compared to the DSLR camera thus extending the postmortem examination duration. Its relative high power consumption and low battery capacity is also a disadvantage. At the current stage of development, Glass may be an adequate tool for education. For deployment in clinical care, issues such as hygiene, data protection, and privacy need to be addressed and are currently limiting chances for professional use. UR - http://www.jmir.org/2014/2/e53/ UR - http://dx.doi.org/10.2196/jmir.3225 UR - http://www.ncbi.nlm.nih.gov/pubmed/24521935 ID - info:doi/10.2196/jmir.3225 ER - TY - JOUR AU - Kim, Heon Jae AU - Kwon, Soon-Sun AU - Shim, Ryul Sung AU - Sun, Yeon Hwa AU - Ko, Myoung Young AU - Chun, Dong-Il AU - Yang, Jae Won AU - Song, Seob Yun PY - 2014/02/10 TI - Validation and Reliability of a Smartphone Application for the International Prostate Symptom Score Questionnaire: A Randomized Repeated Measures Crossover Study JO - J Med Internet Res SP - e38 VL - 16 IS - 2 KW - smartphone KW - International Prostate Symptom Score KW - lower urinary tract symptoms KW - health survey KW - questionnaires N2 - Background: Smartphone-based assessment may be a useful diagnostic and monitoring tool for patients. There have been many attempts to create a smartphone diagnostic tool for clinical use in various medical fields but few have demonstrated scientific validity. Objective: The purpose of this study was to develop a smartphone application of the International Prostate Symptom Score (IPSS) and to demonstrate its validity and reliability. Methods: From June 2012 to May 2013, a total of 1581 male participants (?40 years old), with or without lower urinary tract symptoms (LUTS), visited our urology clinic via the health improvement center at Soonchunhyang University Hospital (Republic of Korea) and were enrolled in this study. A randomized repeated measures crossover design was employed using a smartphone application of the IPSS and the conventional paper form of the IPSS. Paired t test under a hypothesis of non-inferior trial was conducted. For the reliability test, the intraclass correlation coefficient (ICC) was measured. Results: The total score of the IPSS (P=.289) and each item of the IPSS (P=.157-1.000) showed no differences between the paper version and the smartphone version of the IPSS. The mild, moderate, and severe LUTS groups showed no differences between the two versions of the IPSS. A significant correlation was noted in the total group (ICC=.935, P<.001). The mild, moderate, and severe LUTS groups also showed significant correlations (ICC=.616, .549, and .548 respectively, all P<.001).There was selection bias in this study, as only participants who had smartphones could participate. Conclusions: The validity and reliability of the smartphone application version were comparable to the conventional paper version of the IPSS. The smartphone application of the IPSS could be an effective method for measuring lower urinary tract symptoms. UR - http://www.jmir.org/2014/2/e38/ UR - http://dx.doi.org/10.2196/jmir.3042 UR - http://www.ncbi.nlm.nih.gov/pubmed/24513507 ID - info:doi/10.2196/jmir.3042 ER - TY - JOUR AU - BinDhim, F. Nasser AU - McGeechan, Kevin AU - Trevena, Lyndal PY - 2014/02/06 TI - Who Uses Smoking Cessation Apps? A Feasibility Study Across Three Countries via Smartphones JO - JMIR Mhealth Uhealth SP - e4 VL - 2 IS - 1 KW - smartphone KW - handheld computers KW - health promotion KW - tobacco and smoking KW - global health KW - prevention KW - apps KW - health Informatics KW - public health N2 - Background: Smartphone use is growing worldwide. While hundreds of smoking cessation apps are currently available in the app stores, there is no information about who uses them. Smartphones also offer potential as a research tool, but this has not previously been explored. Objective: This study aims to measure and compare the uptake of a smoking cessation app over one year in Australia, the United Kingdom, and the United States. It also assesses the feasibility of conducting research via an app, describing respondents? characteristics (demographics, smoking status, and other health related app use), and examining differences across countries. Methods: This is a cross-sectional exploratory study of adults 18 years and older, passively recruited over one year in 2012, who downloaded this study app (Quit Advisor) via the two largest app stores (Apple and Android). Results: The total number of app downloads after one year was 1751, 72.98% (1278/1751) of them were Apple operation system users. Of these 1751 participants, 47.68% (835/1751) were from the United States, 29.18% (511/1751) were from the United Kingdom, and 16.68% (292/1751) were from Australia. There were 602 participants, 36.75% (602/1638) that completed a questionnaire within the app. Of these 602 participants, 58.8% (354/602) were female and the mean age was 32 years. There were no significant differences between countries in terms of age, operation system used, number of quitting attempts, and language spoken at home. However, there were significant differences between countries in terms of gender and stage of change. There were 77.2% (465/602) of the respondents that were ready to quit in the next 30 days and the majority of these had never sought professional help (eg, ?Quitline?). More than half had downloaded smoking cessation apps in the past and of these, three-quarters had made quitting attempts (lasted at least 24 hours) using an app before. Respondents who had attempted to quit three times or more in the previous year were more likely to have tried smoking cessation apps (OR 3.3, 95% CI 2.1-5.2). There were 50.2% (302/602) of the respondents that had used other health related apps before. Of these, 89.4% (270/302) were using health related apps at least once a week, but 77.5% (234/302) never checked the credibility of the health app publishers before downloading. Conclusions: A smartphone app was able to reach smokers across three countries that were not seeking professional help, but were ready to quit within the next 30 days. Respondents were relatively young and almost demographically similar across all three countries. They also frequently used other health related apps, mostly without checking the credibility of their publishers. UR - http://mhealth.jmir.org/2014/1/e4/ UR - http://dx.doi.org/10.2196/mhealth.2841 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098439 ID - info:doi/10.2196/mhealth.2841 ER - TY - JOUR AU - Bierbrier, Rachel AU - Lo, Vivian AU - Wu, C. Robert PY - 2014/02/03 TI - Evaluation of the Accuracy of Smartphone Medical Calculation Apps JO - J Med Internet Res SP - e32 VL - 16 IS - 2 KW - cellular phone KW - mobile phone KW - mhealth KW - medical informatics applications KW - software KW - computers, handheld N2 - Background: Mobile phones with operating systems and capable of running applications (smartphones) are increasingly being used in clinical settings. Medical calculating applications are popular mhealth apps for smartphones. These include, for example, apps that calculate the severity or likelihood of disease-based clinical scoring systems, such as determining the severity of liver disease, the likelihood of having a pulmonary embolism, and risk stratification in acute coronary syndrome. However, the accuracy of these apps has not been assessed. Objective: The objective of this study was to evaluate the accuracy of smartphone-based medical calculation apps. Methods: A broad search on Google Play, BlackBerry World, and the iTunes App Store was conducted to find medical calculation apps for smartphones. The list of apps was narrowed down based on inclusion and exclusion criteria focusing on functions thought to be relevant by a panel of general internists (number of functions =13). Ten case values were inputted for each function and were compared to manual calculations. For each case, the correct answer was assigned a score of 1. A score for the 10 cases was calculated based on the accuracy of the results for each function on each app. Results: We tested 14 apps and 13 functions for each app if that function was available. We conducted 10 cases for each function for a total of 1240 tests. Most functions tested on the apps were accurate in their results with an overall accuracy of 98.6% (17 errors in 1240 tests). In all, 6 of 14 (43%) apps had 100% accuracy. Although 11 of 13 (85%) functions had perfect accuracy, there were issues with 2 functions: the Child-Pugh scores and Model for End-Stage Liver Disease (MELD) scores on 8 apps. Approximately half of the errors were clinically significant resulting in a significant change in prognosis (8/17, 47%). Conclusions: The results suggest that most medical calculating apps provide accurate and reliable results. The free apps that were 100% accurate and contained the most functions desired by internists were CliniCalc, Calculate by QxMD, and Medscape. When using medical calculating apps, the answers will likely be accurate; however, it is important to be careful when calculating MELD scores or Child-Pugh scores on some apps. Despite the few errors found, greater scrutiny is warranted to ensure full accuracy of smartphone medical calculator apps. UR - http://www.jmir.org/2014/2/e32/ UR - http://dx.doi.org/10.2196/jmir.3062 UR - http://www.ncbi.nlm.nih.gov/pubmed/24491911 ID - info:doi/10.2196/jmir.3062 ER - TY - JOUR AU - Burner, R. Elizabeth AU - Menchine, D. Michael AU - Kubicek, Katrina AU - Robles, Marisela AU - Arora, Sanjay PY - 2014/01/29 TI - Perceptions of Successful Cues to Action and Opportunities to Augment Behavioral Triggers in Diabetes Self-Management: Qualitative Analysis of a Mobile Intervention for Low-Income Latinos With Diabetes JO - J Med Internet Res SP - e25 VL - 16 IS - 1 KW - diabetes KW - Latinos KW - cellular phone N2 - Background: The increasing prevalence of diabetes and the associated cost of managing this complicated disease have a significant impact on public health outcomes and health expenditures, especially among resource-poor Latino patients. Mobile health (mHealth) may be the solution to reaching this group and improving their health. Objective: In this qualitative study, we examined nuances of motivation, intention, and triggers to action effected by TExT-MED (Trial to Examine Text Messaging for Emergency Department patient with Diabetes), an mHealth intervention tailored to low-income, urban Latinos with diabetes. TExT-MED is a fully-automated, text message-based program designed to increase knowledge, self-efficacy, and subsequent disease management and glycemic control. Methods: We conducted 5 focus group interviews with 24 people who participated in TExT-MED. We employed a modified grounded theory analytic approach?an iterative process of coding and immersion in the data used to recognize the patterns and links between concepts voiced by the participants. We coded data to identify themes of participant experiences, motivations, and responses to the program. We organized themes into a theory of TExT-MED?s action. Results: Participants enjoyed their experience with TExT-MED and believed it improved their diabetes management. Through analysis of the transcripts, we identified that the strengths of the program were messages that cued specific behaviors such as medication reminders and challenge messages. Our analysis also revealed that increasing personalization of message delivery and content could augment these cues. Conclusions: This in-depth qualitative analysis of TExT-MED shows that low-income Latino patients will accept text messages as a behavioral intervention. This mHealth intervention acts as a behavioral trigger rather than an education platform. Personalization is an opportunity to enhance these cues to action and further research should be conducted on the ideal forms of personalization. UR - http://www.jmir.org/2014/1/e25/ UR - http://dx.doi.org/10.2196/jmir.2881 UR - http://www.ncbi.nlm.nih.gov/pubmed/24476784 ID - info:doi/10.2196/jmir.2881 ER - TY - JOUR AU - Torous, John AU - Friedman, Rohn AU - Keshavan, Matcheri PY - 2014/01/21 TI - Smartphone Ownership and Interest in Mobile Applications to Monitor Symptoms of Mental Health Conditions JO - JMIR mHealth uHealth SP - e2 VL - 2 IS - 1 KW - psychiatry KW - mobile KW - smartphone KW - depression KW - technology KW - applications N2 - Background: Patient retrospective recollection is a mainstay of assessing symptoms in mental health and psychiatry. However, evidence suggests that these retrospective recollections may not be as accurate as data collection though the experience sampling method (ESM), which captures patient data in ?real time? and ?real life.? However, the difficulties in practical implementation of ESM data collection have limited its impact in psychiatry and mental health. Smartphones with the capability to run mobile applications may offer a novel method of collecting ESM data that may represent a practical and feasible tool for mental health and psychiatry. Objective: This paper aims to provide data on psychiatric patients? prevalence of smartphone ownership, patterns of use, and interest in utilizing mobile applications to monitor their mental health conditions. Methods: One hundred psychiatric outpatients at a large urban teaching hospital completed a paper-and-pencil survey regarding smartphone ownership, use, and interest in utilizing mobile applications to monitor their mental health condition. Results: Ninety-seven percent of patients reported owning a phone and 72% reported that their phone was a smartphone. Patients in all age groups indicated greater than 50% interest in using a mobile application on a daily basis to monitor their mental health condition. Conclusions: Smartphone and mobile applications represent a practical opportunity to explore new modalities of monitoring, treatment, and research of psychiatric and mental health conditions. UR - http://mhealth.jmir.org/2014/1/e2/ UR - http://dx.doi.org/10.2196/mhealth.2994 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098314 ID - info:doi/10.2196/mhealth.2994 ER - TY - JOUR AU - Antypas, Konstantinos AU - Wangberg, C. Silje PY - 2014/01/10 TI - Combining Users? Needs With Health Behavior Models in Designing an Internet- and Mobile-Based Intervention for Physical Activity in Cardiac Rehabilitation JO - JMIR Res Protoc SP - e4 VL - 3 IS - 1 KW - focus group KW - design methodology KW - user involvement KW - user needs KW - health behavior models KW - tailoring KW - SMS KW - Internet KW - cardiac rehabilitation KW - smoking cessation KW - physical activity N2 - Background: Internet-based physical activity interventions have great potential in supporting patients in cardiac rehabilitation. Health behavior change theories and user input are identified as important contributors in the effectiveness of the interventions, but they are rarely combined in a systematic way in the design of the interventions. Objective: The aim of this study is to identify the appropriate theoretical framework, along with the needs of the users of a physical activity intervention for cardiac rehabilitation, and to combine them into an effective Internet- and mobile-based intervention. Methods: We explain the theoretical framework of the intervention in a narrative overview of the existing health behavior change literature as it applies to physical activity. We also conducted a focus group with 11 participants of a cardiac rehabilitation program and used thematic analysis to identify and analyze patterns of meaning in the transcribed data. Results: We chose stage-based approaches, specifically the transtheoretical model and the health action process approach as our main framework for tailoring, supplemented with other theoretical concepts such as regulatory focus within the appropriate stages. From the thematic analysis of the focus group data, we identified seven themes: (1) social, (2) motivation, (3) integration into everyday life, (4) information, (5) planning, (6) monitoring and feedback, and (7) concerns and potential problems. The final design of the intervention was based on both the theoretical review and the user input, and it is explained in detail. Conclusions: We applied a combination of health behavioral theory and user input in designing our intervention. We think this is a promising design approach with the potential to combine the high efficacy of theory-based interventions with the higher perceived usefulness of interventions designed according to user input. Trial Registration: Clinicaltrials.gov NCT01223170; http://clinicaltrials.gov/show/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6M5FqT9Q2). UR - http://www.researchprotocols.org/2014/1/e4/ UR - http://dx.doi.org/10.2196/resprot.2725 UR - http://www.ncbi.nlm.nih.gov/pubmed/24413185 ID - info:doi/10.2196/resprot.2725 ER - TY - JOUR AU - Martínez-Pérez, Borja AU - de la Torre-Díez, Isabel AU - López-Coronado, Miguel AU - Sainz-De-Abajo, Beatriz PY - 2014/01/09 TI - Comparison of Mobile Apps for the Leading Causes of Death Among Different Income Zones: A Review of the Literature and App Stores JO - JMIR Mhealth Uhealth SP - e1 VL - 2 IS - 1 KW - apps KW - different income zones KW - leading causes of death KW - mobile apps KW - World Health Organization (WHO) N2 - Background: The advances achieved in technology, medicine, and communications in the past decades have created an excellent scenario for the improvement and expansion of eHeath and mHealth in particular. Mobile phones, smartphones, and tablets are exceptional means for the application of mobile health, especially for those diseases and health conditions that are the deadliest worldwide. Objective: The main aim of this paper was to compare the amount of research and the number of mobile apps dedicated to the diseases and conditions that are the leading causes of death according to the World Health Organization grouped by different income regions. These diseases and conditions were ischemic heart disease; stroke and other cerebrovascular diseases; lower respiratory infections; chronic obstructive pulmonary disease; diarrheal diseases; HIV/AIDS; trachea, bronchus, and lung cancers; malaria; and Alzheimer disease and other dementias. Methods: Two reviews were conducted. In the first, the systems IEEE Xplore, Scopus, Web of Knowledge, and PubMed were used to perform a literature review of applications related to the mentioned diseases. The second was developed in the currently most important mobile phone apps stores: Google play, iTunes, BlackBerry World, and Windows Phone Apps+Games. Results: Search queries up to June 2013 located 371 papers and 557 apps related to the leading causes of death, and the following findings were obtained. Alzheimer disease and other dementias are included in the diseases with more apps, although it is not among the top 10 causes of death worldwide, whereas lower respiratory infections, the third leading cause of death, is one of the less researched and with fewer apps. Two diseases that are the first and second of low-income countries (lower respiratory infections and diarrheal diseases) have very little research and few commercial applications. HIV/AIDS, in the top 6 of low-income and middle-income zones, is one of the diseases with more research and applications, although it is not in the top 10 in high-income countries. Trachea, bronchus, and lung cancers are the third cause of death in high-income countries but are one of the least researched diseases with regard to apps. Conclusions: Concerning mobile apps, there is more work done in the commercial field than in the research field, although the distribution among the diseases is similar in both fields. In general, apps for common diseases of low- and middle-income countries are not as abundant as those for typical diseases of developed countries. Nevertheless, there are some exceptions such as HIV/AIDS, due to its important social conscience; and trachea, bronchus and lung cancers, which was totally unexpected. UR - http://www.mhealth.jmir.org/2014/1/e1/ UR - http://dx.doi.org/10.2196/mhealth.2779 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099695 ID - info:doi/10.2196/mhealth.2779 ER - TY - JOUR AU - Albrecht, Urs-Vito PY - 2013/12/30 TI - Transparency of Health-Apps for Trust and Decision Making JO - J Med Internet Res SP - e277 VL - 15 IS - 12 KW - smartphone KW - technology KW - education KW - medicine KW - app KW - health care KW - Android KW - iPhone KW - BlackBerry KW - Windows Phone KW - mobile phone KW - standards UR - http://www.jmir.org/2013/12/e277/ UR - http://dx.doi.org/10.2196/jmir.2981 UR - http://www.ncbi.nlm.nih.gov/pubmed/24449711 ID - info:doi/10.2196/jmir.2981 ER - TY - JOUR AU - Bender, Lorene Jacqueline AU - Yue, Kwan Rossini Ying AU - To, Jason Matthew AU - Deacken, Laetitia AU - Jadad, R. Alejandro PY - 2013/12/23 TI - A Lot of Action, But Not in the Right Direction: Systematic Review and Content Analysis of Smartphone Applications for the Prevention, Detection, and Management of Cancer JO - J Med Internet Res SP - e287 VL - 15 IS - 12 KW - mobile KW - Internet KW - cancer KW - software applications KW - apps N2 - Background: Mobile phones have become nearly ubiquitous, offering a promising means to deliver health interventions. However, little is known about smartphone applications (apps) for cancer. Objective: The purpose of this study was to characterize the purpose and content of cancer-focused smartphone apps available for use by the general public and the evidence on their utility or effectiveness. Methods: We conducted a systematic review of the official application stores for the four major smartphone platforms: iPhone, Android, Nokia, and BlackBerry. Apps were included in the review if they were focused on cancer and available for use by the general public. This was complemented by a systematic review of literature from MEDLINE, Embase, and the Cochrane Library to identify evaluations of cancer-related smartphone apps. Results: A total of 295 apps from the smartphone app stores met the inclusion criteria. The majority of apps targeted breast cancer (46.8%, 138/295) or cancer in general (28.5%, 84/295). The reported app purpose was predominantly to raise awareness about cancer (32.2%, 95/295) or to provide educational information about cancer (26.4%, 78/295), followed by apps to support fundraising efforts (12.9%, 38/295), assist in early detection (11.5%, 34/295), promote a charitable organization (10.2%, 30/295), support disease management (3.7%, 11/295), cancer prevention (2.0%, 6/295), or social support (1.0%, 3/295). The majority of the apps did not describe their organizational affiliation (64.1%, 189/295). Apps affiliated with non-profit organizations were more likely to be free of cost (?21=16.3, P<.001) and have a fundraising or awareness purpose (?22=13.3, P=.001). The review of the health literature yielded 594 articles, none of which reported an evaluation of a cancer-focused smartphone application. Conclusions: There are hundreds of cancer-focused apps with the potential to enhance efforts to promote behavior change, to monitor a host of symptoms and physiological indicators of disease, and to provide real-time supportive interventions, conveniently and at low cost. However, there is a lack of evidence on their utility, effectiveness, and safety. Future efforts should focus on improving and consolidating the evidence base into a whitelist for public consumption. UR - http://www.jmir.org/2013/12/e287/ UR - http://dx.doi.org/10.2196/jmir.2661 UR - http://www.ncbi.nlm.nih.gov/pubmed/24366061 ID - info:doi/10.2196/jmir.2661 ER - TY - JOUR AU - Buis, R. Lorraine AU - Hirzel, Lindsey AU - Turske, A. Scott AU - Des Jardins, R. Terrisca AU - Yarandi, Hossein AU - Bondurant, Patricia PY - 2013/12/19 TI - Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part II): Assessment of Participants' Perceptions on Efficacy JO - J Med Internet Res SP - e282 VL - 15 IS - 12 KW - diabetes mellitus, type 2 KW - mobile health KW - cellular phone KW - text messaging KW - risk reduction behavior KW - program evaluation N2 - Background: Although there is great enthusiasm in both the public and private sector for the further development and use of large-scale consumer-facing public health applications for mobile platforms, little is known about user experience and satisfaction with this type of approach. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing, mobile phone-based health information service targeting type 2 diabetes, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. This program was marketed via large public health campaigns and drew many users within the respective communities. Objective: The purpose of this investigation was to use the RE-AIM framework to document txt4health efficacy by focusing on perceptions of satisfaction, usage, and behavior change among individuals who used txt4health in pilot studies in Southeast Michigan and Greater Cincinnati. Methods: We conducted a multimodal user survey with txt4health users recruited via text message through the program to understand participant perceptions of program use and satisfaction, as well as self-reported perceptions of behavior change as a result of using txt4health. Results: Txt4health users reported very high levels of program satisfaction, with 67.1% (108/161) reporting satisfaction scores of ?8 on a 10-point scale, with 10 equivalent to most satisfied (mean 8.2, SD 1.6). All survey participants agreed/strongly agreed that the messages included in txt4health were clear and easy to understand (100.0%, 160/160), and most found txt4health made them knowledgeable about their risk for type 2 diabetes (88.1%, 140/159) and made them conscious of their diet and physical activity (88.8%, 142/160). Most participants reported that txt4health helped them to make behavior changes related to diet; after having completed txt4health, most agreed/strongly agreed that they are more likely to replace sugary drinks, such as juice or soda, with water (78.0%, 124/159), have a piece of fresh fruit instead of dessert (74.2%, 118/159), substitute a small salad for chips or fries when dining out (76.1%, 121/159), buy healthier foods when grocery shopping (79.7%, 126/158), and eat more grilled, baked, or broiled foods instead of fried (75.5%, 120/159). Conclusions: Results from this study suggest that participants in txt4health, a large-scale, public health?focused text message program targeting type 2 diabetes, have positive perceptions of the program and that participation has led to positive behavior change. UR - http://www.jmir.org/2013/12/e282/ UR - http://dx.doi.org/10.2196/jmir.2929 UR - http://www.ncbi.nlm.nih.gov/pubmed/24356359 ID - info:doi/10.2196/jmir.2929 ER - TY - JOUR AU - Buis, R. Lorraine AU - Hirzel, Lindsey AU - Turske, A. Scott AU - Des Jardins, R. Terrisca AU - Yarandi, Hossein AU - Bondurant, Patricia PY - 2013/12/19 TI - Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part I): Assessment of Participant Reach and Adoption JO - J Med Internet Res SP - e281 VL - 15 IS - 12 KW - diabetes mellitus, type 2 KW - mobile health KW - cellular phone KW - text messaging KW - risk reduction behavior KW - program evaluation N2 - Background: There are an estimated 25.8 million American children and adults, equivalent to 8.3% of the US population, living with diabetes. Diabetes is particularly burdensome on minority populations. The use of mobile technologies for reaching broad populations is a promising approach, given its wide footprint and ability to deliver inexpensive personalized messages, to increase awareness of type 2 diabetes and promote behavior changes targeting risk factors associated with type 2 diabetes. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing mobile health information service, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. Txt4health is a mobile health information service designed to help people understand their risk for type 2 diabetes and become more informed about the steps they can take to lead healthy lives. Objective: The purpose of this investigation was to use the RE-AIM framework to document txt4health reach and adoption by focusing on enrollment and participant engagement in program pilots in Southeast Michigan and Greater Cincinnati. Methods: We conducted a retrospective records analysis of individual-level txt4health system data from participants in Southeast Michigan and Greater Cincinnati to determine participant usage of txt4health and engagement with the program. Results: Results from the retrospective records analysis revealed that 5570 participants initiated the 2-step enrollment process via 1 of 3 enrollment strategies: text message, website, or directly with Beacon staff who signed participants up via the website. In total, 33.00% (1838/5570) of participants completed the 2-step enrollment process and were fully enrolled in the program. All participants (100.00%, 1620/1620) who enrolled via text message completed the entire 2-step enrollment process versus 5.52% (218/3950) of participants who enrolled via website or a Beacon staff member. Of those who fully enrolled, 71.00% (1305/1838) completed the diabetes risk assessment and 74.27% (1365/1838) set an initial weight loss goal. Overall, 39.06% (718/1838) of participants completed all 14 weeks of the program and 56.26% (1034/1838) dropped out before completing all 14 weeks, with the bulk of dropouts occurring in the first 4 weeks. Length of participation varied greatly, ranging from 0-48.7 weeks (median 8.6, mean 15.8, SD 15.8). Wide variability of participant engagement in regards to weekly weight and physical activity was documented. Conclusions: Although broadly focused public health text message interventions may have the potential to reach large populations and show high levels of engagement among some users, the level of individual engagement among participants varies widely, suggesting that this type of approach may not be appropriate for all. UR - http://www.jmir.org/2013/12/e281/ UR - http://dx.doi.org/10.2196/jmir.2928 UR - http://www.ncbi.nlm.nih.gov/pubmed/24356329 ID - info:doi/10.2196/jmir.2928 ER - TY - JOUR AU - Sharifi, Mona AU - Dryden, M. Eileen AU - Horan, M. Christine AU - Price, Sarah AU - Marshall, Richard AU - Hacker, Karen AU - Finkelstein, A. Jonathan AU - Taveras, M. Elsie PY - 2013/12/06 TI - Leveraging Text Messaging and Mobile Technology to Support Pediatric Obesity-Related Behavior Change: A Qualitative Study Using Parent Focus Groups and Interviews JO - J Med Internet Res SP - e272 VL - 15 IS - 12 KW - child KW - obesity KW - overweight KW - health behavior KW - text messaging KW - telemedicine N2 - Background: Text messaging (short message service, SMS) is a widely accessible and potentially cost-effective medium for encouraging behavior change. Few studies have examined text messaging interventions to influence child health behaviors or explored parental perceptions of mobile technologies to support behavior change among children. Objective: Our aim was to examine parental acceptability and preferences for text messaging to support pediatric obesity-related behavior change. Methods: We conducted focus groups and follow-up interviews with parents of overweight and obese children, aged 6-12 years, seen for ?well-child? care in eastern Massachusetts. A professional moderator used a semistructured discussion guide and sample text messages to catalyze group discussions. Seven participants then received 3 weeks of text messages before a follow-up one-on-one telephone interview. All focus groups and interviews were recorded and transcribed verbatim. Using a framework analysis approach, we systematically coded and analyzed group and interview data to identify salient and convergent themes. Results: We reached thematic saturation after five focus groups and seven follow-up interviews with a total of 31 parents of diverse race/ethnicity and education levels. Parents were generally enthusiastic about receiving text messages to support healthy behaviors for their children and preferred them to paper or email communication because they are brief and difficult to ignore. Participants anticipated high responsiveness to messaging endorsed by their child?s doctor and indicated they would appreciate messages 2-3 times/week or more as long as content remains relevant. Suggestions for maintaining message relevance included providing specific strategies for implementation and personalizing information. Most felt the negative features of text messaging (eg, limited message size) could be overcome by providing links within messages to other media including email or websites. Conclusions: Text messaging is a promising medium for supporting pediatric obesity-related behavior change. Parent perspectives could assist in the design of text-based interventions. Trial Registration: Clinicaltrials.gov NCT01565161; http://clinicaltrials.gov/show/NCT01565161 (Archived by WebCite at http://www.webcitation.org/6LSaqFyPP). UR - http://www.jmir.org/2013/12/e272/ UR - http://dx.doi.org/10.2196/jmir.2780 UR - http://www.ncbi.nlm.nih.gov/pubmed/24317406 ID - info:doi/10.2196/jmir.2780 ER - TY - JOUR AU - Burns, Nicole Michelle AU - Montague, Enid AU - Mohr, C. David PY - 2013/12/05 TI - Initial Design of Culturally Informed Behavioral Intervention Technologies: Developing an mHealth Intervention for Young Sexual Minority Men With Generalized Anxiety Disorder and Major Depression JO - J Med Internet Res SP - e271 VL - 15 IS - 12 KW - mobile health KW - eHealth KW - cultural competency KW - minority health KW - male homosexuality KW - male adolescents KW - young adult KW - anxiety KW - depression N2 - Background: To our knowledge, there is no well-articulated process for the design of culturally informed behavioral intervention technologies. Objective: This paper describes the early stages of such a process, illustrated by the methodology for the ongoing development of a behavioral intervention technology targeting generalized anxiety disorder and major depression among young sexual minority men. Methods: We integrated instructional design for Internet behavioral intervention technologies with greater detail on information sources that can identify user needs in understudied populations, as well as advances in the understanding of technology-specific behavioral intervention technology dimensions that may need to be culturally tailored. Results: General psychological theory describing how to effect change in the clinical target is first integrated with theory describing potentially malleable factors that help explain the clinical problem within the population. Additional information sources are then used to (1) evaluate the theory, (2) identify population-specific factors that may affect users? ability to relate to and benefit from the behavioral intervention technology, and (3) establish specific skills, attitudes, knowledge, etc, required to change malleable factors posited in the theory. User needs result from synthesis of this information. Product requirements are then generated through application of the user needs to specific behavioral intervention technology dimensions (eg, technology platform). We provide examples of considerations relevant to each stage of this process and how they were applied. Conclusions: This process can guide the initial design of other culturally informed behavioral intervention technologies. This first attempt to create a systematic design process can spur development of guidelines for design of behavioral intervention technologies aimed to reduce health disparities. UR - http://www.jmir.org/2013/12/e271/ UR - http://dx.doi.org/10.2196/jmir.2826 UR - http://www.ncbi.nlm.nih.gov/pubmed/24311444 ID - info:doi/10.2196/jmir.2826 ER - TY - JOUR AU - Li, Ye AU - Wang, Wei AU - van Velthoven, Helena Michelle AU - Chen, Li AU - Car, Josip AU - Rudan, Igor AU - Zhang, Yanfeng AU - Wu, Qiong AU - Du, Xiaozhen AU - Scherpbier, W. Robert PY - 2013/12/04 TI - Text Messaging Data Collection for Monitoring an Infant Feeding Intervention Program in Rural China: Feasibility Study JO - J Med Internet Res SP - e269 VL - 15 IS - 12 KW - text messaging KW - data collection KW - program evaluation KW - child nutrition sciences N2 - Background: An effective data collection method is crucial for high quality monitoring of health interventions. The traditional face-to-face data collection method is labor intensive, expensive, and time consuming. With the rapid increase of mobile phone subscribers, text messaging has the potential to be used for evaluation of population health interventions in rural China. Objective: The objective of this study was to explore the feasibility of using text messaging as a data collection tool to monitor an infant feeding intervention program. Methods: Participants were caregivers of children aged 0 to 23 months in rural China who participated in an infant feeding health education program. We used the test-retest method. First, we collected data with a text messaging survey and then with a face-to-face survey for 2 periods of 3 days. We compared the response rate, data agreement, costs, and participants? acceptability of the two methods. Also, we interviewed participants to explore their reasons for not responding to the text messages and the reasons for disagreement in the two methods. In addition, we evaluated the most appropriate time during the day for sending text messages. Results: We included 258 participants; 99 (38.4%) participated in the text messaging survey and 177 (68.6%) in the face-to-face survey. Compared with the face-to-face survey, the text messaging survey had much lower response rates to at least one question (38.4% vs 68.6%) and to all 7 questions (27.9% vs 67.4%) with moderate data agreement (most kappa values between .5 and .75, the intraclass correlation coefficients between .53 to .72). Participants who took part in both surveys gave the same acceptability rating for both methods (median 4.0 for both on a 5-point scale, 1=disliked very much and 5=liked very much). The costs per questionnaire for the text messaging method were much lower than the costs for the face-to-face method: ¥19.7 (US $3.13) versus ¥33.9 (US $5.39) for all questionnaires, and ¥27.1 (US $4.31) versus ¥34.4 (US $5.47) for completed questionnaires. The main reasons for not replying were that participants did not receive text messages, they were too busy to reply, or they did not see text messages in time. The main reasons for disagreement in responses were that participants forgot their answers in the text messaging survey and that they changed their minds. We found that participants were more likely to reply to text messages immediately during 2 time periods: 8 AM to 3 PM and 8 PM to 9 PM. Conclusions: The text messaging method had reasonable data agreement and low cost, but a low response rate. Further research is needed to evaluate effectiveness of measures that can increase the response rate, especially in collecting longitudinal data by text messaging. UR - http://www.jmir.org/2013/12/e269/ UR - http://dx.doi.org/10.2196/jmir.2906 UR - http://www.ncbi.nlm.nih.gov/pubmed/24305514 ID - info:doi/10.2196/jmir.2906 ER - TY - JOUR AU - Steinberg, M. Dori AU - Levine, L. Erica AU - Askew, Sandy AU - Foley, Perry AU - Bennett, G. Gary PY - 2013/11/18 TI - Daily Text Messaging for Weight Control Among Racial and Ethnic Minority Women: Randomized Controlled Pilot Study JO - J Med Internet Res SP - e244 VL - 15 IS - 11 KW - self-monitoring KW - mHealth KW - text messaging KW - weight loss KW - black women N2 - Background: Daily self-monitoring of diet and physical activity behaviors is a strong predictor of weight loss success. Text messaging holds promise as a viable self-monitoring modality, particularly among racial/ethnic minority populations. Objective: This pilot study evaluated the feasibility of a text messaging intervention for weight loss among predominantly black women. Methods: Fifty obese women were randomized to either a 6-month intervention using a fully automated system that included daily text messages for self-monitoring tailored behavioral goals (eg, 10,000 steps per day, no sugary drinks) along with brief feedback and tips (n=26) or to an education control arm (n=24). Weight was objectively measured at baseline and at 6 months. Adherence was defined as the proportion of text messages received in response to self-monitoring prompts. Results: The average daily text messaging adherence rate was 49% (SD 27.9) with 85% (22/26) texting self-monitored behavioral goals 2 or more days per week. Approximately 70% (16/23) strongly agreed that daily texting was easy and helpful and 76% (16/21) felt the frequency of texting was appropriate. At 6 months, the intervention arm lost a mean of 1.27 kg (SD 6.51), and the control arm gained a mean of 1.14 kg (SD 2.53; mean difference ?2.41 kg, 95% CI ?5.22 to 0.39; P=.09). There was a trend toward greater text messaging adherence being associated with greater percent weight loss (r=?.36; P=.08), but this did not reach statistical significance. There was no significant association between goal attainment and text messaging adherence and no significant predictors of adherence. Conclusions: Given the increasing penetration of mobile devices, text messaging may be a useful self-monitoring tool for weight control, particularly among populations most in need of intervention. Trial Registration: Clinicaltrials.gov: NCT00939081; http://clinicaltrials.gov/show/NCT00939081 (Archived by WebCite at http://www.webcitation.org/6KiIIcnk1). UR - http://www.jmir.org/2013/11/e244/ UR - http://dx.doi.org/10.2196/jmir.2844 UR - http://www.ncbi.nlm.nih.gov/pubmed/24246427 ID - info:doi/10.2196/jmir.2844 ER - TY - JOUR AU - Donker, Tara AU - Petrie, Katherine AU - Proudfoot, Judy AU - Clarke, Janine AU - Birch, Mary-Rose AU - Christensen, Helen PY - 2013/11/15 TI - Smartphones for Smarter Delivery of Mental Health Programs: A Systematic Review JO - J Med Internet Res SP - e247 VL - 15 IS - 11 KW - mobile applications KW - mobile mental health KW - mobile phones KW - self-help KW - depression KW - anxiety KW - stress KW - substance use N2 - Background: The rapid growth in the use of mobile phone applications (apps) provides the opportunity to increase access to evidence-based mental health care. Objective: Our goal was to systematically review the research evidence supporting the efficacy of mental health apps for mobile devices (such as smartphones and tablets) for all ages. Methods: A comprehensive literature search (2008-2013) in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, PsycINFO, PsycTESTS, Compendex, and Inspec was conducted. We included trials that examined the effects of mental health apps (for depression, anxiety, substance use, sleep disturbances, suicidal behavior, self-harm, psychotic disorders, eating disorders, stress, and gambling) delivered on mobile devices with a pre- to posttest design or compared with a control group. The control group could consist of wait list, treatment-as-usual, or another recognized treatment. Results: In total, 5464 abstracts were identified. Of those, 8 papers describing 5 apps targeting depression, anxiety, and substance abuse met the inclusion criteria. Four apps provided support from a mental health professional. Results showed significant reductions in depression, stress, and substance use. Within-group and between-group intention-to-treat effect sizes ranged from 0.29-2.28 and 0.01-0.48 at posttest and follow-up, respectively. Conclusions: Mental health apps have the potential to be effective and may significantly improve treatment accessibility. However, the majority of apps that are currently available lack scientific evidence about their efficacy. The public needs to be educated on how to identify the few evidence-based mental health apps available in the public domain to date. Further rigorous research is required to develop and test evidence-based programs. Given the small number of studies and participants included in this review, the high risk of bias, and unknown efficacy of long-term follow-up, current findings should be interpreted with caution, pending replication. Two of the 5 evidence-based mental health apps are currently commercially available in app stores. UR - http://www.jmir.org/2013/11/e247/ UR - http://dx.doi.org/10.2196/jmir.2791 UR - http://www.ncbi.nlm.nih.gov/pubmed/24240579 ID - info:doi/10.2196/jmir.2791 ER - TY - JOUR AU - Kirwan, Morwenna AU - Vandelanotte, Corneel AU - Fenning, Andrew AU - Duncan, J. Mitch PY - 2013/11/13 TI - Diabetes Self-Management Smartphone Application for Adults With Type 1 Diabetes: Randomized Controlled Trial JO - J Med Internet Res SP - e235 VL - 15 IS - 11 KW - type 1 diabetes KW - mobile health KW - mobile phone KW - text message KW - education N2 - Background: Persistently poor glycemic control in adult type 1 diabetes patients is a common, complex, and serious problem initiating significant damage to the cardiovascular, renal, neural, and visual systems. Currently, there is a plethora of low-cost and free diabetes self-management smartphone applications available in online stores. Objective: The aim of this study was to examine the effectiveness of a freely available smartphone application combined with text-message feedback from a certified diabetes educator to improve glycemic control and other diabetes-related outcomes in adult patients with type 1 diabetes in a two-group randomized controlled trial. Methods: Patients were recruited through an online type 1 diabetes support group and letters mailed to adults with type 1 diabetes throughout Australia. In a 6-month intervention, followed by a three-month follow-up, patients (n=72) were randomized to usual care (control group) or usual care and the use of a smartphone application (Glucose Buddy) with weekly text-message feedback from a Certified Diabetes Educator (intervention group). All outcome measures were collected at baseline and every three months over the study period. Patients? glycosylated hemoglobin levels (HbA1c) were measured with a blood test and diabetes-related self-efficacy, self-care activities, and quality of life were measured with online questionnaires. Results: The mean age of patients was 35.20 years (SD 10.43) (28 male, 44 female), 39% (28/72) were male, and patients had been diagnosed with type 1 diabetes for a mean of 18.94 years (SD 9.66). Of the initial 72 patients, 53 completed the study (25 intervention, 28 control group). The intervention group significantly improved glycemic control (HbA1c) from baseline (mean 9.08%, SD 1.18) to 9-month follow-up (mean 7.80%, SD 0.75), compared to the control group (baseline: mean 8.47%, SD 0.86, follow-up: mean 8.58%, SD 1.16). No significant change over time was found in either group in relation to self-efficacy, self-care activities, and quality of life. Conclusions: In adjunct to usual care, the use of a diabetes-related smartphone application combined with weekly text-message support from a health care professional can significantly improve glycemic control in adults with type 1 diabetes. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12612000132842; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000132842 (Archived by WebCite at http://www.webcitation.org/6Kl4jqn5u). UR - http://www.jmir.org/2013/11/e235/ UR - http://dx.doi.org/10.2196/jmir.2588 UR - http://www.ncbi.nlm.nih.gov/pubmed/24225149 ID - info:doi/10.2196/jmir.2588 ER - TY - JOUR AU - Plaza, Inmaculada AU - Demarzo, Piva Marcelo Marcos AU - Herrera-Mercadal, Paola AU - García-Campayo, Javier PY - 2013/11/01 TI - Mindfulness-Based Mobile Applications: Literature Review and Analysis of Current Features JO - JMIR Mhealth Uhealth SP - e24 VL - 1 IS - 2 KW - mobile health KW - mHealth KW - mindfulness KW - social networks KW - personalized education KW - health informatics KW - evidence-based medicine N2 - Background: Interest in mindfulness has increased exponentially, particularly in the fields of psychology and medicine. The trait or state of mindfulness is significantly related to several indicators of psychological health, and mindfulness-based therapies are effective at preventing and treating many chronic diseases. Interest in mobile applications for health promotion and disease self-management is also growing. Despite the explosion of interest, research on both the design and potential uses of mindfulness-based mobile applications (MBMAs) is scarce. Objective: Our main objective was to study the features and functionalities of current MBMAs and compare them to current evidence-based literature in the health and clinical setting. Methods: We searched online vendor markets, scientific journal databases, and grey literature related to MBMAs. We included mobile applications that featured a mindfulness-based component related to training or daily practice of mindfulness techniques. We excluded opinion-based articles from the literature. Results: The literature search resulted in 11 eligible matches, two of which completely met our selection criteria?a pilot study designed to evaluate the feasibility of a MBMA to train the practice of ?walking meditation,? and an exploratory study of an application consisting of mood reporting scales and mindfulness-based mobile therapies. The online market search eventually analyzed 50 available MBMAs. Of these, 8% (4/50) did not work, thus we only gathered information about language, downloads, or prices. The most common operating system was Android. Of the analyzed apps, 30% (15/50) have both a free and paid version. MBMAs were devoted to daily meditation practice (27/46, 59%), mindfulness training (6/46, 13%), assessments or tests (5/46, 11%), attention focus (4/46, 9%), and mixed objectives (4/46, 9%). We found 108 different resources, of which the most used were reminders, alarms, or bells (21/108, 19.4%), statistics tools (17/108, 15.7%), audio tracks (15/108, 13.9%), and educational texts (11/108, 10.2%). Daily, weekly, monthly statistics, or reports were provided by 37% (17/46) of the apps. 28% (13/46) of them permitted access to a social network. No information about sensors was available. The analyzed applications seemed not to use any external sensor. English was the only language of 78% (39/50) of the apps, and only 8% (4/50) provided information in Spanish. 20% (9/46) of the apps have interfaces that are difficult to use. No specific apps exist for professionals or, at least, for both profiles (users and professionals). We did not find any evaluations of health outcomes resulting from the use of MBMAs. Conclusions: While a wide selection of MBMAs seem to be available to interested people, this study still shows an almost complete lack of evidence supporting the usefulness of those applications. We found no randomized clinical trials evaluating the impact of these applications on mindfulness training or health indicators, and the potential for mobile mindfulness applications remains largely unexplored. UR - http://mhealth.jmir.org/2013/2/e24/ UR - http://dx.doi.org/10.2196/mhealth.2733 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099314 ID - info:doi/10.2196/mhealth.2733 ER - TY - JOUR AU - Nielsen, Agger Jeppe AU - Mathiassen, Lars PY - 2013/10/30 TI - Interpretive Flexibility in Mobile Health: Lessons From a Government-Sponsored Home Care Program JO - J Med Internet Res SP - e236 VL - 15 IS - 10 KW - home health care KW - mobile health KW - mobile technology KW - implementation process KW - government sponsorship KW - case study N2 - Background: Mobile technologies have emerged as important tools that health care personnel can use to gain easy access to client data anywhere. This is particularly useful for nurses and care workers in home health care as they provide services to clients in many different settings. Although a growing body of evidence supports the use of mobile technologies, the diverse implications of mobile health have yet to be fully documented. Objective: Our objective was to examine a large-scale government-sponsored mobile health implementation program in the Danish home care sector and to understand how the technology was used differently across home care agencies. Methods: We chose to perform a longitudinal case study with embedded units of analysis. We included multiple data sources, such as written materials, a survey to managers across all 98 Danish municipalities, and semistructured interviews with managers, care workers, and nurses in three selected home care agencies. We used process models of change to help analyze the overall implementation process from a longitudinal perspective and to identify antecedent conditions, key events, and practical outcomes. Results: Strong collaboration between major stakeholders in the Danish home care sector (government bodies, vendors, consultants, interest organizations, and managers) helped initiate and energize the change process, and government funding supported quick and widespread technology adoption. However, although supported by the same government-sponsored program, mobile technology proved to have considerable interpretive flexibility with variation in perceived nature of technology, technology strategy, and technology use between agencies. What was first seen as a very promising innovation across the Danish home care sector subsequently became the topic of debate as technology use arrangements ran counter to existing norms and values in individual agencies. Conclusions: Government-sponsored programs can have both positive and negative results, and managers need to be aware of this and the interpretive flexibility of mobile technology. Mobile technology implementation is a complex process that is best studied by combining organization-level analysis with features of the wider sociopolitical and interorganizational environment. UR - http://www.jmir.org/2013/10/e236/ UR - http://dx.doi.org/10.2196/jmir.2816 UR - http://www.ncbi.nlm.nih.gov/pubmed/24172852 ID - info:doi/10.2196/jmir.2816 ER - TY - JOUR AU - Mickan, Sharon AU - Tilson, K. Julie AU - Atherton, Helen AU - Roberts, Wyn Nia AU - Heneghan, Carl PY - 2013/10/28 TI - Evidence of Effectiveness of Health Care Professionals Using Handheld Computers: A Scoping Review of Systematic Reviews JO - J Med Internet Res SP - e212 VL - 15 IS - 10 KW - handheld computers KW - mobile devices KW - mhealth KW - PDA KW - information seeking behavior KW - evidence-based practice KW - delivery of health care KW - clinical practice KW - health technology adoption KW - diffusion of innovation KW - systematic review KW - evidence synthesis KW - documentation N2 - Background: Handheld computers and mobile devices provide instant access to vast amounts and types of useful information for health care professionals. Their reduced size and increased processing speed has led to rapid adoption in health care. Thus, it is important to identify whether handheld computers are actually effective in clinical practice. Objective: A scoping review of systematic reviews was designed to provide a quick overview of the documented evidence of effectiveness for health care professionals using handheld computers in their clinical work. Methods: A detailed search, sensitive for systematic reviews was applied for Cochrane, Medline, EMBASE, PsycINFO, Allied and Complementary Medicine Database (AMED), Global Health, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. All outcomes that demonstrated effectiveness in clinical practice were included. Classroom learning and patient use of handheld computers were excluded. Quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A previously published conceptual framework was used as the basis for dual data extraction. Reported outcomes were summarized according to the primary function of the handheld computer. Results: Five systematic reviews met the inclusion and quality criteria. Together, they reviewed 138 unique primary studies. Most reviewed descriptive intervention studies, where physicians, pharmacists, or medical students used personal digital assistants. Effectiveness was demonstrated across four distinct functions of handheld computers: patient documentation, patient care, information seeking, and professional work patterns. Within each of these functions, a range of positive outcomes were reported using both objective and self-report measures. The use of handheld computers improved patient documentation through more complete recording, fewer documentation errors, and increased efficiency. Handheld computers provided easy access to clinical decision support systems and patient management systems, which improved decision making for patient care. Handheld computers saved time and gave earlier access to new information. There were also reports that handheld computers enhanced work patterns and efficiency. Conclusions: This scoping review summarizes the secondary evidence for effectiveness of handheld computers and mhealth. It provides a snapshot of effective use by health care professionals across four key functions. We identified evidence to suggest that handheld computers provide easy and timely access to information and enable accurate and complete documentation. Further, they can give health care professionals instant access to evidence-based decision support and patient management systems to improve clinical decision making. Finally, there is evidence that handheld computers allow health professionals to be more efficient in their work practices. It is anticipated that this evidence will guide clinicians and managers in implementing handheld computers in clinical practice and in designing future research. UR - http://www.jmir.org/2013/10/e212/ UR - http://dx.doi.org/10.2196/jmir.2530 UR - http://www.ncbi.nlm.nih.gov/pubmed/24165786 ID - info:doi/10.2196/jmir.2530 ER - TY - JOUR AU - Abebe, A. Nebeyou AU - Capozza, L. Korey AU - Des Jardins, R. Terrisca AU - Kulick, A. David AU - Rein, L. Alison AU - Schachter, A. Abigail AU - Turske, A. Scott PY - 2013/10/15 TI - Considerations for Community-Based mHealth Initiatives: Insights From Three Beacon Communities JO - J Med Internet Res SP - e221 VL - 15 IS - 10 KW - mHealth KW - mobile health KW - mobile phone KW - Type 2 diabetes mellitus KW - text messaging KW - short message service (SMS) KW - risk reduction KW - self management UR - http://www.jmir.org/2013/10/e221/ UR - http://dx.doi.org/10.2196/jmir.2803 UR - http://www.ncbi.nlm.nih.gov/pubmed/24128406 ID - info:doi/10.2196/jmir.2803 ER - TY - JOUR AU - Blackman, CA Kacie AU - Zoellner, Jamie AU - Berrey, M. Leanna AU - Alexander, Ramine AU - Fanning, Jason AU - Hill, L. Jennie AU - Estabrooks, A. Paul PY - 2013/10/04 TI - Assessing the Internal and External Validity of Mobile Health Physical Activity Promotion Interventions: A Systematic Literature Review Using the RE-AIM Framework JO - J Med Internet Res SP - e224 VL - 15 IS - 10 KW - physical activity KW - mobile technology KW - review KW - generalizability N2 - Background: Mobile health (mHealth) interventions are effective in promoting physical activity (PA); however, the degree to which external validity indicators are reported is unclear. Objective: The purpose of this systematic review was to use the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to determine the extent to which mHealth intervention research for promoting PA reports on factors that inform generalizability across settings and populations and to provide recommendations for investigators planning to conduct this type of research. Methods: Twenty articles reflecting 15 trials published between 2000 and 2012 were identified through a systematic review process (ie, queries of three online databases and reference lists of eligible articles) and met inclusion criteria (ie, implementation of mobile technologies, target physical activity, and provide original data). Two researchers coded each article using a validated RE-AIM data extraction tool (reach, efficacy/effectiveness, adoption, implementation, maintenance). Two members of the study team independently abstracted information from each article (inter-rater reliability >90%) and group meetings were used to gain consensus on discrepancies. Results: The majority of studies were randomized controlled trials (n=14). The average reporting across RE-AIM indicators varied by dimension (reach=53.3%, 2.67/5; effectiveness/efficacy=60.0%, 2.4/4; adoption=11.1%, 0.7/6; implementation=24.4%, 0.7/3; maintenance=0%, 0/3). While most studies described changes in the primary outcome (effectiveness), few addressed the representativeness of participants (reach) or settings (adoption) and few reported on issues related to maintenance and degree of implementation fidelity. Conclusions: This review suggests that more focus is needed on research designs that highlight and report on both internal and external validity indicators. Specific recommendations are provided to encourage future mHealth interventionists and investigators to report on representativeness, settings, delivery agents for planned interventions, the extent to which protocol is delivered as intended, and maintenance of effects at the individual or organizational level. UR - http://www.jmir.org/2013/10/e224/ UR - http://dx.doi.org/10.2196/jmir.2745 UR - http://www.ncbi.nlm.nih.gov/pubmed/24095951 ID - info:doi/10.2196/jmir.2745 ER - TY - JOUR AU - Okazaki, Shintaro AU - Castañeda, Alberto José AU - Sanz, Silvia PY - 2013/09/18 TI - Clinicians? Assessment of Mobile Monitoring: A Comparative Study in Japan and Spain JO - Med 2.0 SP - e11 VL - 2 IS - 2 KW - comparative study KW - health monitoring KW - personal innovativeness KW - smartphone KW - psychic distance N2 - Background: The gradual but steady shift toward telemedicine during the past decades is a clear response to important health problems that most industrialized countries have been facing. The growing elderly population and changing dietary habits have led to an increase in people with chronic diseases and overall health care expenditures. As more consumers use their mobile device as their preferred information and communication technology (ICT) device, mobile health monitoring has been receiving increasing attention in recent years. Objective: This study examines clinicians? perception of factors determining mobile health monitoring acceptance in Japan and Spain. The study proposes a causal model consisting of innovation seeking, new ICT attributes (perceived value, time-place flexibility, and compatibility), and usage intention. In addition, cross-country differences are posited for the hypothesized relationships among the proposed constructs. Methods: A questionnaire survey was performed to test our research model and hypotheses. The sample consisted of clinicians from various medical specialties. In total, 471 and 497 usable responses were obtained in Japan and Spain, respectively. Results: In both countries, the collected data fit the model well with all the hypothesized paths among the constructs being supported. Furthermore, the moderating effects of psychic distance were observed in most of the paths. Conclusions: Our study demonstrates the importance of new ICT attributes, namely perceived value, time-place flexibility, and compatibility, in the clinicians' adoption of mobile health monitoring. In particular, our results clearly indicated that perceived medical value and ubiquitous nature of the tool are the two main benefits clinicians are likely to perceive (and appreciate) in both countries. This tendency will be stronger for those with a greater propensity to seek innovation in ICT. In terms of cross-country comparison, the strength of the path from innovation seeking to perceived value was greater in Japan than in Spain. Since the number of clinicians per 10,000 residents is substantially fewer in Japan compared with Spain, clinicians with a greater propensity to seek innovation in ICT may have perceived greater value in using mobile health monitoring to improve remote patient care. UR - http://www.medicine20.com/2013/2/e11/ UR - http://dx.doi.org/10.2196/med20.2874 UR - http://www.ncbi.nlm.nih.gov/pubmed/25075234 ID - info:doi/10.2196/med20.2874 ER - TY - JOUR AU - Schoenberger, Yu-Mei AU - Phillips, Janice AU - Mohiuddin, Omar Mohammed AU - McNees, Patrick AU - Scarinci, Isabel PY - 2013/09/09 TI - Acceptability of Delivering and Accessing Health Information Through Text Messaging Among Community Health Advisors JO - JMIR Mhealth Uhealth SP - e22 VL - 1 IS - 2 KW - community health workers KW - mobile health KW - text messaging KW - cancer N2 - Background: Communication technologies can play a significant role in decreasing communication inequalities and cancer disparities by promoting cancer control and enhancing population and individual health. Studies have shown that technology, such as the mobile phone short message service (SMS) or text messaging, can be an effective health communication strategy that influences individuals? health-related decisions, behaviors, and outcomes. Objective: The purpose of this study was to explore usage of communication technologies, assess the acceptability of mobile technology for delivery and access of health information, and identify cancer and health information needs among Deep South Network for Cancer Control trained Community Health Advisors as Research Partners (CHARPs). Methods: A mixed-method design was used, and a triangulation protocol was followed to combine quantitative and qualitative data. Focus groups (4 focus groups; n=37) and self-administered surveys (n=77) were conducted to determine CHARPs mobile phone and text message usage. The objective was to include identification of barriers and facilitators to a mobile phone intervention. Results: All participants were African American (37/37, 100%), 11/37 (89%) were women, and the mean age was 53.4 (SD 13.9; focus groups) and 59.9 (SD 8.7; survey). Nearly all (33/37, 89%) of focus group participants reported owning a mobile phone. Of those, 8/33 (24%) owned a smartphone, 22/33 (67%) had a text messaging plan, and 18/33 (55%) and 11/33 (33%) received and sent text messages several times a week or day, respectively. Similar responses were seen among the survey participants, with 75/77 (97%) reporting owning a mobile phone, and of those, 22/75 (30%) owned a smartphone, 39/75 (53%) had a text messaging plan, and 37/75 (50%) received and 27/75 (37%) sent text messages several times a week or day. The benefits of a text messaging system mentioned by focus group participants included alternative form of communication, quick method for disseminating information, and privacy of communication. The main barriers reported by both groups to using mobile technology to receive health information were cost and not knowing how to text message. Ways to overcome barriers were explored with focus group participants, and education was the most proposed solution. Majority of CHARPs were in favor of receiving a weekly text message that would provide cancer/health information. Conclusions: The findings from this study indicate that CHARPs are receptive to receiving text messages focusing on cancer/health information and would be likely to engage in mobile health research. These findings represent the first step in the development of an interactive mobile health program designed to provide cancer/health information and a support network for the Deep South Network Community Health Advisors as Research Partners (DSN CHARPs). UR - http://mhealth.jmir.org/2013/2/e22/ UR - http://dx.doi.org/10.2196/mhealth.2641 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099140 ID - info:doi/10.2196/mhealth.2641 ER - TY - JOUR AU - McGillicuddy, W. John AU - Gregoski, J. Mathew AU - Weiland, K. Anna AU - Rock, A. Rebecca AU - Brunner-Jackson, M. Brenda AU - Patel, K. Sachin AU - Thomas, S. Beje AU - Taber, J. David AU - Chavin, D. Kenneth AU - Baliga, K. Prabhakar AU - Treiber, A. Frank PY - 2013/09/04 TI - Mobile Health Medication Adherence and Blood Pressure Control in Renal Transplant Recipients: A Proof-of-Concept Randomized Controlled Trial JO - JMIR Res Protoc SP - e32 VL - 2 IS - 2 KW - smartphone KW - kidney transplantation KW - medication adherence KW - mobile health N2 - Background: Mobile phone based programs for kidney transplant recipients are promising tools for improving long-term graft outcomes and better managing comorbidities (eg, hypertension, diabetes). These tools provide an easy to use self-management framework allowing optimal medication adherence that is guided by the patients? physiological data. This technology is also relatively inexpensive, has an intuitive interface, and provides the capability for real-time personalized feedback to help motivate patient self-efficacy. Automated summary reports of patients? adherence and blood pressure can easily be uploaded to providers? networks helping reduce clinical inertia by reducing regimen alteration time. Objective: The aim of this study was to assess the feasibility, acceptability, and preliminary outcomes of a prototype mobile health (mHealth) medication and blood pressure (BP) self-management system for kidney transplant patients with uncontrolled hypertension. Methods: A smartphone enabled medication adherence and BP self-management system was developed using a patient and provider centered design. The development framework utilized self-determination theory with iterative stages that were guided and refined based on patient/provider feedback. A 3-month proof-of-concept randomized controlled trial was conducted in 20 hypertensive kidney transplant patients identified as non-adherent to their current medication regimen based on a month long screening using an electronic medication tray. Participants randomized to the mHealth intervention had the reminder functions of their electronic medication tray enabled and received a bluetooth capable BP monitor and a smartphone that received and transmitted encrypted physiological data and delivered reminders to measure BP using text messaging. Controls received standard of care and their adherence continued to be monitored with the medication tray reminders turned off. Providers received weekly summary reports of patient medication adherence and BP readings. Results: Participation and retention rates were 41/55 (75%) and 31/34 (91%), respectively. The prototype system appears to be safe, highly acceptable, and useful to patients and providers. Compared to the standard care control group (SC), the mHealth intervention group exhibited significant improvements in medication adherence and significant reductions in clinic-measured systolic blood pressures across the monthly evaluations. Physicians made more anti-hypertensive medication adjustments in the mHealth group versus the standard care group (7 adjustments in 5 patients versus 3 adjustments in 3 patients) during the 3-month trial based on the information provided in the weekly reports. Conclusions: These data support the acceptability and feasibility of the prototype mHealth system. Further trials with larger sample sizes and additional biomarkers (eg, whole blood medication levels) are needed to examine efficacy and effectiveness of the system for improving medication adherence and blood pressure control after kidney transplantation over longer time periods. Trial Registration: Clinicaltrials.gov NCT01859273; http://clinicaltrials.gov/ct2/show/NCT01859273 (Archived by WebCite at http://www.webcitation.org/6IqfCa3A3). UR - http://www.researchprotocols.org/2013/2/e32/ UR - http://dx.doi.org/10.2196/resprot.2633 UR - http://www.ncbi.nlm.nih.gov/pubmed/24004517 ID - info:doi/10.2196/resprot.2633 ER - TY - JOUR AU - Abel, Olubunmi AU - Shatunov, Aleksey AU - Jones, R. Ashley AU - Andersen, M. Peter AU - Powell, F. John AU - Al-Chalabi, Ammar PY - 2013/09/04 TI - Development of a Smartphone App for a Genetics Website: The Amyotrophic Lateral Sclerosis Online Genetics Database (ALSoD) JO - JMIR Mhealth Uhealth SP - e18 VL - 1 IS - 2 KW - ALSoD KW - amyotrophic lateral sclerosis KW - frontotemporal dementia KW - Web-bases KW - database KW - genetics KW - bioinformatics KW - mobile website KW - app N2 - Background: The ALS Online Genetics Database (ALSoD) website holds mutation, geographical, and phenotype data on genes implicated in amyotrophic lateral sclerosis (ALS) and links to bioinformatics resources, publications, and tools for analysis. On average, there are 300 unique visits per day, suggesting a high demand from the research community. To enable wider access, we developed a mobile-friendly version of the website and a smartphone app. Objective: We sought to compare data traffic before and after implementation of a mobile version of the website to assess utility. Methods: We identified the most frequently viewed pages using Google Analytics and our in-house analytic monitoring. For these, we optimized the content layout of the screen, reduced image sizes, and summarized available information. We used the Microsoft .NET framework mobile detection property (HttpRequest.IsMobileDevice in the Request.Browser object in conjunction with HttpRequest.UserAgent), which returns a true value if the browser is a recognized mobile device. For app development, we used the Eclipse integrated development environment with Android plug-ins. We wrapped the mobile website version with the WebView object in Android. Simulators were downloaded to test and debug the applications. Results: The website automatically detects access from a mobile phone and redirects pages to fit the smaller screen. Because the amount of data stored on ALSoD is very large, the available information for display using smartphone access is deliberately restricted to improve usability. Visits to the website increased from 2231 to 2820, yielding a 26% increase from the pre-mobile to post-mobile period and an increase from 103 to 340 visits (230%) using mobile devices (including tablets). The smartphone app is currently available on BlackBerry and Android devices and will be available shortly on iOS as well. Conclusions: Further development of the ALSoD website has allowed access through smartphones and tablets, either through the website or directly through a mobile app, making genetic data stored on the database readily accessible to researchers and patients across multiple devices. UR - http://mhealth.jmir.org/2013/2/e18/ UR - http://dx.doi.org/10.2196/mhealth.2706 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098641 ID - info:doi/10.2196/mhealth.2706 ER - TY - JOUR AU - Post, Ann Lori AU - Vaca, E. Federico AU - Doran, M. Kelly AU - Luco, Cali AU - Naftilan, Matthew AU - Dziura, James AU - Brandt, Cynthia AU - Bernstein, Steven AU - Jagminas, Liudvikas AU - D'Onofrio, Gail PY - 2013/09/03 TI - New Media Use by Patients Who Are Homeless: The Potential of mHealth to Build Connectivity JO - J Med Internet Res SP - e195 VL - 15 IS - 9 KW - homelessness KW - mHealth KW - connectivity KW - emergency department N2 - Background: Patients experiencing homelessness represent a disproportionate share of emergency department (ED) visits due to poor access to primary care and high levels of unmet health care needs. This is in part due to the difficulty of communicating and following up with patients who are experiencing homelessness. Objective: To determine the prevalence and types of ?new media? use among ED patients who experience homelessness. Methods: This was a cross-sectional observational study with sequential enrolling of patients from three emergency departments 24/7 for 6 weeks. In total, 5788 ED patients were enrolled, of whom 249 experienced homelessness. Analyses included descriptive statistics, and unadjusted and adjusted odds ratios. Results: 70.7% (176/249) of patients experiencing homelessness own cell phones compared to 85.90% (4758/5539) of patients in stable housing (P=.001) with the former more likely to own Androids, 70% (53/76) versus 43.89% (1064/2424), and the latter more likely to have iPhones, 44.55% (1080/2424) versus 17% (13/76) (P=.001). There is no significant difference in new media use, modality, or frequency for both groups; however, there is a difference in contract plan with 50.02% (2380/4758) of stably housed patients having unlimited minutes versus 37.5% (66/176) of homeless patients. 19.78% (941/4758) of patients in stable housing have pay-as-you-go plans versus 33.0% (58/176) of homeless patients (P=.001). Patients experiencing homelessness are more likely to want health information on alcohol/substance abuse, mental health, domestic violence, pregnancy and smoking cessation. Conclusions: This study is unique in its characterization of new media ownership and use among ED patients experiencing homelessness. New media is a powerful tool to connect patients experiencing homelessness to health care. UR - http://www.jmir.org/2013/9/e195/ UR - http://dx.doi.org/10.2196/jmir.2724 UR - http://www.ncbi.nlm.nih.gov/pubmed/24001876 ID - info:doi/10.2196/jmir.2724 ER - TY - JOUR AU - Haug, Severin AU - Schaub, P. Michael AU - Venzin, Vigeli AU - Meyer, Christian AU - John, Ulrich AU - Gmel, Gerhard PY - 2013/09/02 TI - A Pre-Post Study on the Appropriateness and Effectiveness of a Web- and Text Messaging-Based Intervention to Reduce Problem Drinking in Emerging Adults JO - J Med Internet Res SP - e196 VL - 15 IS - 9 KW - alcohol intervention KW - problem drinking KW - young people KW - text messaging KW - Internet N2 - Background: Problem drinking, particularly risky single-occasion drinking (RSOD), also called ?binge drinking?, is widespread among adolescents and young adults in most Western countries. Few studies have tested the effectiveness of interventions to reduce RSOD in young people with heterogeneous and particularly lower educational background. Objective: To test the appropriateness and initial effectiveness of a combined, individually tailored Web- and text messaging (SMS)?based intervention program to reduce problem drinking in vocational school students. Methods: The fully automated program provided: (1) online feedback about an individual?s drinking pattern compared to the drinking norms of an age- and gender-specific reference group, and (2) recurrent individualized SMS messages over a time period of 3 months. Generalized Estimating Equation (GEE) analyses were used to investigate the longitudinal courses of the following outcomes over the study period of 3 months: RSOD, alcohol-related problems, mean number of standard drinks per week, and maximum number of standard drinks on an occasion. Results: The program was tested in 36 school classes at 7 vocational schools in Switzerland. Regardless of their drinking behavior, 477 vocational school students who owned a mobile phone were invited to participate in the program. Of these, 364 (76.3%) participated in the program. During the intervention period, 23 out of 364 (6.3%) persons unsubscribed from participating in the program. The GEE analyses revealed decreases in the percentage of persons with RSOD from baseline (75.5%, 210/278) to follow-up assessment (67.6%, 188/278, P<.001), in the percentage of persons with alcohol-related problems (20.4%, 57/280 to 14.3%, 40/280, P=.009), and in the mean number of standard drinks per week: 13.4 (SD 15.3) to 11.3 (SD 14.0), P=.002. They also revealed a trend toward a decrease in the mean of the maximum number of drinks consumed on an occasion: 11.3 (SD 10.3) to 10.5 (SD 10.3), P=.08. Conclusions: The results show high acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented within school classes. UR - http://www.jmir.org/2013/9/e196/ UR - http://dx.doi.org/10.2196/jmir.2755 UR - http://www.ncbi.nlm.nih.gov/pubmed/23999406 ID - info:doi/10.2196/jmir.2755 ER - TY - JOUR AU - Khosropour, M. Christine AU - Johnson, A. Brent AU - Ricca, V. Alexandra AU - Sullivan, S. Patrick PY - 2013/08/27 TI - Enhancing Retention of an Internet-Based Cohort Study of Men Who Have Sex With Men (MSM) via Text Messaging: Randomized Controlled Trial JO - J Med Internet Res SP - e194 VL - 15 IS - 8 KW - HIV infections/prevention and control KW - prospective studies KW - Internet/organization and administration KW - SMS text messaging KW - homosexuality KW - male/statistics and numerical data N2 - Background: Black and Hispanic men who have sex with men (MSM) are disproportionately affected by HIV in the United States. The Internet is a promising vehicle for delivery of HIV prevention interventions to these men, but retention of MSM of color in longitudinal Internet-based studies has been problematic. Text message follow-up may enhance retention in these studies. Objective: To compare retention in a 12-month prospective Internet-based study of HIV-negative MSM randomized to receive bimonthly follow-up surveys either through an Internet browser online or through text messages. Methods: Internet-using MSM were recruited through banner advertisements on social networking and Internet-dating sites. White, black, and Hispanic men who were ?18, completed an online baseline survey, and returned an at-home HIV test kit, which tested HIV negative, were eligible. Men were randomized to receive follow-up surveys every 2 months on the Internet or by text message for 12 months (unblinded). We used time-to-event methods to compare the rate of loss-to-follow-up (defined as non-response to a follow-up survey after multiple systematically-delivered contact attempts) in the 2 follow-up groups, overall and by race/ethnicity. Results are reported as hazard ratios (HR) and 95% confidence intervals (CI) of the rate of loss-to-follow-up for men randomized to text message follow-up compared to online follow-up. Results: Of 1489 eligible and consenting men who started the online baseline survey, 895 (60%) completed the survey and were sent an at-home HIV test kit. Of these, 710 of the 895 (79%) returned the at-home HIV test kit, tested HIV-negative, and were followed prospectively. The study cohort comprised 66% white men (470/710), 15% (106/710) black men, and 19% (134/710) Hispanic men. At 12 months, 77% (282/366) of men randomized to online follow-up were retained in the study, compared to 70% (241/344) men randomized to text message follow-up (HR=1.30, 95% CI 0.97-1.73). The rate of loss-to-follow-up was non-significantly higher in the text message arm compared to the online arm for both white (HR=1.43, 95% CI 0.97-1.73) and Hispanic men (HR=1.71, 95% CI 0.91-3.23); however, loss-to-follow-up among black men was non-significantly lower among those who received text message follow-up compared to online follow-up (HR=0.78, 95% CI 0.41-1.50). In the online arm, black men were significantly more likely to be lost to follow-up compared to white men (HR=2.25, 95% CI 1.36-3.71), but this was not the case in the text message arm (HR=1.23, 95% CI 0.70-2.16). Conclusions: We retained >70% of MSM enrolled in an online study for 12 months; thus, engaging men in online studies for a sufficient time to assess sustained outcomes is possible. Text message follow-up of an online cohort of MSM is feasible, and may result in higher retention among black MSM. UR - http://www.jmir.org/2013/8/e194/ UR - http://dx.doi.org/10.2196/jmir.2756 UR - http://www.ncbi.nlm.nih.gov/pubmed/23981905 ID - info:doi/10.2196/jmir.2756 ER - TY - JOUR AU - Ribu, Lis AU - Holmen, Heidi AU - Torbjørnsen, Astrid AU - Wahl, Klopstad Astrid AU - Grøttland, Astrid AU - Småstuen, Cvancarova Milada AU - Elind, Elisabeth AU - Bergmo, Strand Trine AU - Breivik, Elin AU - Årsand, Eirik PY - 2013/08/26 TI - Low-Intensity Self-Management Intervention for Persons With Type 2 Diabetes Using a Mobile Phone-Based Diabetes Diary, With and Without Health Counseling and Motivational Interviewing: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e34 VL - 2 IS - 2 KW - self-management KW - empowerment KW - health-related quality of life KW - acceptability KW - type 2 diabetes KW - lifestyle intervention KW - complex intervention KW - mHealth KW - telemedicine KW - motivation KW - health counseling KW - mixed methods N2 - Background: The present study protocol is designed to cover the Norwegian part of the European Union Collaborative Project?REgioNs of Europe WorkINg together for HEALTH (RENEWING HEALTH). Self-management support is an important element of care for persons with type 2 diabetes (T2D) for achieving metabolic control and positive lifestyle changes. Telemedicine (TM) with or without health counseling may become an important technological aid for self-management and may provide a user-centered model of care. In spite of many earlier studies on TM, there remains a lack of consensus in research findings about the effect of TM interventions. Objective: The aim of RENEWING HEALTH is to validate and evaluate innovative TM tools on a large scale through a common evaluation, making it easier for decision makers to choose the most efficient and cost-effective technological interventions. The Norwegian pilot study evaluates whether the introduction of a mobile phone with a diabetes diary application together with health counseling intervention produces benefits in terms of the desired outcomes, as reflected in the hemoglobin A1c level, health-related quality of life, behavior change, and cost-effectiveness. Methods: The present study has a mixed-method design comprising a three-armed prospective randomized controlled trial and qualitative interviews with study data collected at three time points: baseline, after 4 months, and after 1 year. The patients? registrations on the application are recorded continuously and are sent securely to a server. Results: The inclusion of patients started in March 2011, and 100% of the planned sample size is included (N=151). Of all the participants, 26/151 patients (17.2%) are lost to follow-up by now, and 11/151 patients (7.3%) are still in the trial. Results of the study protocol will be presented in 2014. Conclusions: The key goals of this trial are to investigate the effect of an electronic diabetes diary app with and without health counseling, and to determine whether health counseling is important to the continued use of the application and the patients? health competence and acceptability. Research within this area is needed because few studies have investigated the effectiveness of apps used in long-term interventions with this degree of self-management. Trial Registration: Clinicaltrials.gov NCT01315756; http://clinicaltrials.gov/ct2/show/NCT01315756 (Archived by WebCite at http://www.webcitation/6BTyuRMpH). UR - http://www.researchprotocols.org/2013/2/e34/ UR - http://dx.doi.org/10.2196/resprot.2768 UR - http://www.ncbi.nlm.nih.gov/pubmed/23978690 ID - info:doi/10.2196/resprot.2768 ER - TY - JOUR AU - Albrecht, Urs-Vito AU - Folta-Schoofs, Kristian AU - Behrends, Marianne AU - von Jan, Ute PY - 2013/08/20 TI - Effects of Mobile Augmented Reality Learning Compared to Textbook Learning on Medical Students: Randomized Controlled Pilot Study JO - J Med Internet Res SP - e182 VL - 15 IS - 8 KW - problem-based learning KW - cellular phone KW - education KW - medical KW - emotions N2 - Background: By adding new levels of experience, mobile Augmented Reality (mAR) can significantly increase the attractiveness of mobile learning applications in medical education. Objective: To compare the impact of the heightened realism of a self-developed mAR blended learning environment (mARble) on learners to textbook material, especially for ethically sensitive subjects such as forensic medicine, while taking into account basic psychological aspects (usability and higher level of emotional involvement) as well as learning outcomes (increased learning efficiency). Methods: A prestudy was conducted based on a convenience sample of 10 third-year medical students. The initial emotional status was captured using the ?Profile of Mood States? questionnaire (POMS, German variation); previous knowledge about forensic medicine was determined using a 10-item single-choice (SC) test. During the 30-minute learning period, the students were randomized into two groups: the first group consisted of pairs of students, each equipped with one iPhone with a preinstalled copy of mARble, while the second group was provided with textbook material. Subsequently, both groups were asked to once again complete the POMS questionnaire and SC test to measure changes in emotional state and knowledge gain. Usability as well as pragmatic and hedonic qualities of the learning material was captured using AttrakDiff2 questionnaires. Data evaluation was conducted anonymously. Descriptive statistics for the score in total and the subgroups were calculated before and after the intervention. The scores of both groups were tested against each other using paired and unpaired signed-rank tests. An item analysis was performed for the SC test to objectify difficulty and selectivity. Results: Statistically significant, the mARble group (6/10) showed greater knowledge gain than the control group (4/10) (Wilcoxon z=2.232, P=.03). The item analysis of the SC test showed a difficulty of P=0.768 (s=0.09) and a selectivity of RPB=0.2. For mARble, fatigue (z=2.214, P=.03) and numbness (z=2.07, P=.04) decreased with statistical significance when comparing pre- and post-tests. Vigor rose slightly, while irritability did not increase significantly. Changes in the control group were insignificant. Regarding hedonic quality (identification, stimulation, attractiveness), there were significant differences between mARble (mean 1.179, CI ?0.440 to 0.440) and the book chapter (mean ?0.982, CI ?0.959 to 0.959); the pragmatic quality mean only differed slightly. Conclusions: The mARble group performed considerably better regarding learning efficiency; there are hints for activating components of the mAR concept that may serve to fascinate the participants and possibly boost interest in the topic for the remainder of the class. While the small sample size reduces our study?s conclusiveness, its design seems appropriate for determining the effects of interactive eLearning material with respect to emotions, learning efficiency, and hedonic and pragmatic qualities using a larger group. Trial Registration: German Clinical Trial Register (DRKS), DRKS-ID: DRKS00004685; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004685. UR - http://www.jmir.org/2013/8/e182/ UR - http://dx.doi.org/10.2196/jmir.2497 UR - http://www.ncbi.nlm.nih.gov/pubmed/23963306 ID - info:doi/10.2196/jmir.2497 ER - TY - JOUR AU - Galán-Mercant, Alejandro AU - Cuesta-Vargas, I. Antonio PY - 2013/08/16 TI - Differences in Trunk Accelerometry Between Frail and Nonfrail Elderly Persons in Sit-to-Stand and Stand-to-Sit Transitions Based on a Mobile Inertial Sensor JO - JMIR Mhealth Uhealth SP - e21 VL - 1 IS - 2 KW - frail syndrome KW - sit-to-stand KW - stand-to-sit KW - mobile phone KW - inertial sensor N2 - Background: Clinical frailty syndrome is a common geriatric syndrome, which is characterized by physiological reserve decreases and increased vulnerability. The changes associated to ageing and frailties are associated to changes in gait characteristics and the basic functional capacities. Traditional clinical evaluation of Sit-to-Stand (Si-St) and Stand-to-Sit (St-Si) transition is based on visual observation of joint angle motion to describe alterations in coordination and movement pattern. The latest generation smartphones often include inertial sensors with subunits such as accelerometers and gyroscopes, which can detect acceleration. Objective: Firstly, to describe the variability of the accelerations, angular velocity, and displacement of the trunk during the Sit-to-Stand and Stand-to-Sit transitions in two groups of frail and physically active elderly persons, through instrumentation with the iPhone 4 smartphone. Secondly, we want to analyze the differences between the two study groups. Methods: A cross-sectional study that involved 30 subjects over 65 years, 14 frail and 16 fit subjects. The participants were classified with frail syndrome by the Fried criteria. Linear acceleration was measured along three orthogonal axes using the iPhone 4 accelerometer. Each subject performed up to three successive Si-St and St-Si postural transitions using a standard chair with armrest. Results: Significant differences were found between the two groups of frail and fit elderly persons in the accelerometry and angular displacement variables obtained in the kinematic readings of the trunk during both transitions. Conclusions: The inertial sensor fitted in the iPhone 4 is able to study and analyze the kinematics of the Si-St and St-Si transitions in frail and physically active elderly persons. The accelerometry values for the frail elderly are lower than for the physically active elderly, while variability in the readings for the frail elderly is also lower than for the control group. UR - http://mhealth.jmir.org/2013/2/e21/ UR - http://dx.doi.org/10.2196/mhealth.2710 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098977 ID - info:doi/10.2196/mhealth.2710 ER - TY - JOUR AU - Haug, Severin AU - Schaub, P. Michael AU - Venzin, Vigeli AU - Meyer, Christian AU - John, Ulrich PY - 2013/08/16 TI - Efficacy of a Text Message-Based Smoking Cessation Intervention for Young People: A Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e171 VL - 15 IS - 8 KW - smoking cessation KW - text messaging (SMS) KW - young people KW - school KW - students N2 - Background: Smoking prevalence remains high, particularly among adolescents and young adults with lower educational levels, posing a serious public health problem. There is limited evidence of effective smoking cessation interventions in this population. Objective: To test the efficacy of an individually tailored, fully automated text messaging (short message service, SMS)?based intervention for smoking cessation in young people. Methods: A 2-arm cluster randomized controlled trial, using school class as the randomization unit, was conducted to test the efficacy of the SMS text messaging intervention compared to an assessment-only control group. Students who smoked were proactively recruited via online screening in vocational school classes. Text messages, tailored to demographic and smoking-related variables, were sent to the participants of the intervention group at least 3 times per week over a period of 3 months. A follow-up assessment was performed 6 months after study inclusion. The primary outcome measure was 7-day smoking abstinence. Secondary outcomes were 4-week smoking abstinence, cigarette consumption, stage of change, and attempts to quit smoking. We used regression models controlling for baseline differences between the study groups to test the efficacy of the intervention. Both complete-case analyses (CCA) and intention-to-treat analyses (ITT) were performed. Subgroup analyses were conducted for occasional and daily smokers. Results: A total of 2638 students in 178 vocational school classes in Switzerland participated in the online screening. Overall, 1012 persons met the inclusion criteria for study participation, and 755 persons (74.6%) participated in the study (intervention: n=372; control: n=383). Of the 372 program participants, 9 (2.4%) unsubscribed from the program during the intervention period. Six-month follow-up data were obtained for 559 study participants (74.0%). The 7-day smoking abstinence rate at follow-up was 12.5% in the intervention group and 9.6% in the control group (ITT: P=.92). No differences between the study groups were observed in 4-week point prevalence abstinence rates. The decrease in the mean number of cigarettes smoked per day from baseline to follow-up was higher in the intervention group than in the control group (ITT: P=.002). No differences between the groups were observed in stage of change (ITT: P=.82) and quit attempts (ITT: P=.38). The subgroup analyses revealed lower cigarette consumption in both occasional and daily smokers in the intervention group compared to the control group. Occasional smokers in the intervention group made more attempts to quit smoking than occasional smokers in the control group. Conclusions: This study demonstrated the potential of an SMS text message?based intervention to reach a high proportion of young smokers with low education levels. The intervention did not have statistically significant short-term effects on smoking cessation; however, it resulted in statistically significant lower cigarette consumption. Additionally, it resulted in statistically significant more attempts to quit smoking in occasional smokers. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 19739792; http://www.controlled-trials.com/ISRCTN19739792 (Archived by WebCite at http://webcitation.org/6IGETTHmr). UR - http://www.jmir.org/2013/8/e171/ UR - http://dx.doi.org/10.2196/jmir.2636 UR - http://www.ncbi.nlm.nih.gov/pubmed/23956024 ID - info:doi/10.2196/jmir.2636 ER - TY - JOUR AU - Albrecht, Urs-Vito AU - von Jan, Ute AU - Sedlacek, Ludwig AU - Groos, Stephanie AU - Suerbaum, Sebastian AU - Vonberg, Ralf-Peter PY - 2013/08/14 TI - Standardized, App-Based Disinfection of iPads in a Clinical and Nonclinical Setting: Comparative Analysis JO - J Med Internet Res SP - e176 VL - 15 IS - 8 KW - tablet PC KW - hygiene KW - disinfection KW - nosocomial transmission N2 - Background: With the use of highly mobile tools like tablet PCs in clinical settings, an effective disinfection method is a necessity. Since manufacturers do not allow cleaning methods that make use of anything but a dry fleece, other approaches have to be established to ensure patient safety and to minimize risks posed by microbiological contamination. Objective: The ability of isopropanol wipes to decontaminate iPads was evaluated prospectively in a observer blinded, comparative analysis of devices used in a clinical and a nonclinical setting. Methods: 10 new iPads were randomly deployed to members of the nursing staff of 10 clinical wards, to be used in a clinical setting over a period of 4 weeks. A pre-installed interactive disinfection application (deBac-app, PLRI MedAppLab, Germany) was used on a daily basis. Thereafter, the number and species of remaining microorganisms on the surface of the devices (13 locations; front and back) was evaluated using contact agar plates. Following this, the 10 iPads were disinfected and randomly deployed to medical informatics professionals who also used the devices for 4 weeks but were forbidden to use disinfecting agents. The quality of a single, standardized disinfection process was then determined by a final surface disinfection process of all devices in the infection control laboratory. No personal data were logged with the devices. The evaluation was performed observer blinded with respect to the clinical setting they were deployed in and personnel that used the devices. Results: We discovered a 2.7-fold (Mann-Whitney U test, z=-3.402, P=.000670) lower bacterial load on the devices used in the clinical environment that underwent a standardized daily disinfection routine with isopropanol wipes following the instructions provided by ?deBac-app?. Under controlled conditions, an average reduction of the mainly Gram-positive normal skin microbiological load of 99.4% (Mann-Whitney U test, z=-3.1798, P=.001474) for the nonclinical group and 98.1% (Mann-Whitney U test, z=3.1808, P=.001469) for the clinical group was achieved using one complete disinfecting cycle. Conclusions: Normal use of tablet PCs leads to a remarkable amount of microbial surface contamination. Standardized surface disinfection with isopropanol wipes as guided by the application significantly reduces this microbial load. When performed regularly, the disinfection process helps with maintaining a low germ count during use. This should reduce the risk of subsequent nosocomial pathogen transmission. Unfortunately, applying a disinfection procedure such as the one we propose may lead to losing the manufacturer?s warranty for the devices; this remains an unsolved issue. UR - http://www.jmir.org/2013/8/e176/ UR - http://dx.doi.org/10.2196/jmir.2643 UR - http://www.ncbi.nlm.nih.gov/pubmed/23945468 ID - info:doi/10.2196/jmir.2643 ER - TY - JOUR AU - Silveira, Patrícia AU - van de Langenberg, Rolf AU - van het Reve, Eva AU - Daniel, Florian AU - Casati, Fabio AU - de Bruin, D. Eling PY - 2013/08/12 TI - Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: A Phase II Preclinical Exploratory Trial JO - J Med Internet Res SP - e159 VL - 15 IS - 8 KW - motivation KW - exercises KW - aged KW - tablet KW - mobility KW - delivery of health care N2 - Background: Reaction time, coordination, and cognition performance typically diminish in older adults, which may lead to gait impairments, falls, and injuries. Regular strength?balance exercises are highly recommended to reduce this problem and to improve health, well-being, and independence in old age. However, many older people face a lack of motivation in addition to other strong barriers to exercise. We developed ActiveLifestyle, an information technology (IT)-based system for active and healthy aging aiming at improving balance and strength. ActiveLifestyle is a training app that runs on a tablet and assists, monitors, and motivates older people to follow personalized training plans autonomously at home. Objective: The objectives were to (1) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people, (2) assess the impact of ActiveLifestyle on physical activity behavior change, and (3) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed. Methods: A total of 44 older adults followed personalized, 12-week strength and balance training plans. All participants performed the exercises autonomously at home. Questionnaires were used to assess the technological familiarity and stage of behavior change, as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle. Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study. Pretests and posttests were performed to evaluate gait speed of the participants before and after the study. Results: Participants were 75 years (SD 6), predominantly female (64%), held a trade or professional diploma (54%), and their past profession was in a sitting position (43%). Of the 44 participants who enrolled, 33 (75%) completed the study. The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength?balance exercises (median 6 on a 7-point Likert scale). Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan, as well as to change their behavior permanently toward a more physically active lifestyle. The exercises were effective to improve preferred and fast gait speed. Conclusions: ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength?balance exercises over 12 weeks and had low dropout rates. The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention. The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time. UR - http://www.jmir.org/2013/8/e159/ UR - http://dx.doi.org/10.2196/jmir.2579 UR - http://www.ncbi.nlm.nih.gov/pubmed/23939401 ID - info:doi/10.2196/jmir.2579 ER - TY - JOUR AU - Rai, Arun AU - Chen, Liwei AU - Pye, Jessica AU - Baird, Aaron PY - 2013/08/02 TI - Understanding Determinants of Consumer Mobile Health Usage Intentions, Assimilation, and Channel Preferences JO - J Med Internet Res SP - e149 VL - 15 IS - 8 KW - mobile health KW - consumer preferences KW - adoption KW - health information technology KW - multivariate analyses N2 - Background: Consumer use of mobile devices as health service delivery aids (mHealth) is growing, especially as smartphones become ubiquitous. However, questions remain as to how consumer traits, health perceptions, situational characteristics, and demographics may affect consumer mHealth usage intentions, assimilation, and channel preferences. Objective: We examine how consumers? personal innovativeness toward mobile services (PIMS), perceived health conditions, health care availability, health care utilization, demographics, and socioeconomic status affect their (1) mHealth usage intentions and extent of mHealth assimilation, and (2) preference for mHealth as a complement or substitute for in-person doctor visits. Methods: Leveraging constructs from research in technology acceptance, technology assimilation, consumer behavior, and health informatics, we developed a cross-sectional online survey to study determinants of consumers? mHealth usage intentions, assimilation, and channel preferences. Data were collected from 1132 nationally representative US consumers and analyzed by using moderated multivariate regressions and ANOVA. Results: The results indicate that (1) 430 of 1132 consumers in our sample (37.99%) have started using mHealth, (2) a larger quantity of consumers are favorable to using mHealth as a complement to in-person doctor visits (758/1132, 66.96%) than as a substitute (532/1132, 47.00%), and (3) consumers? PIMS and perceived health conditions have significant positive direct influences on mHealth usage intentions, assimilation, and channel preferences, and significant positive interactive influences on assimilation and channel preferences. The independent variables within the moderated regressions collectively explained 59.70% variance in mHealth usage intentions, 60.41% in mHealth assimilation, 34.29% in preference for complementary use of mHealth, and 45.30% in preference for substitutive use of mHealth. In a follow-up ANOVA examination, we found that those who were more favorable toward using mHealth as a substitute for in-person doctor visits than as a complement indicated stronger intentions to use mHealth (F1,702=20.14, P<.001) and stronger assimilation of mHealth (F1,702=41.866, P<.001). Conclusions: Multiple predictors are shown to have significant associations with mHealth usage intentions, assimilation, and channel preferences. We suggest that future initiatives to promote mHealth should shift targeting of consumers from coarse demographics to nuanced considerations of individual dispositions toward mobile service innovations, complementary or substitutive channel use preferences, perceived health conditions, health services availability and utilization, demographics, and socioeconomic characteristics. UR - http://www.jmir.org/2013/8/e149/ UR - http://dx.doi.org/10.2196/jmir.2635 UR - http://www.ncbi.nlm.nih.gov/pubmed/23912839 ID - info:doi/10.2196/jmir.2635 ER - TY - JOUR AU - Bock, Beth AU - Heron, Kristin AU - Jennings, Ernestine AU - Morrow, Kathleen AU - Cobb, Victoria AU - Magee, Joshua AU - Fava, Joseph AU - Deutsch, Christopher AU - Foster, Robert PY - 2013/07/30 TI - A Text Message Delivered Smoking Cessation Intervention: The Initial Trial of TXT-2-Quit: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e17 VL - 1 IS - 2 KW - smoking cessation KW - tobacco KW - texting, text messaging KW - mobile health KW - mHealth KW - health communications N2 - Background: Mobile technology offers the potential to deliver health-related interventions to individuals who would not otherwise present for in-person treatment. Text messaging (short message service, SMS), being the most ubiquitous form of mobile communication, is a promising method for reaching the most individuals. Objective: The goal of the present study was to evaluate the feasibility and preliminary efficacy of a smoking cessation intervention program delivered through text messaging. Methods: Adult participants (N=60, age range 18-52 years) took part in a single individual smoking cessation counseling session, and were then randomly assigned to receive either daily non-smoking related text messages (control condition) or the TXT-2-Quit (TXT) intervention. TXT consisted of automated smoking cessation messages tailored to individual?s stage of smoking cessation, specialized messages provided on-demand based on user requests for additional support, and a peer-to-peer social support network. Generalized estimating equation analysis was used to assess the primary outcome (7-day point-prevalence abstinence) using a 2 (treatment groups)×3 (time points) repeated measures design across three time points: 8 weeks, 3 months, and 6 months. Results: Smoking cessation results showed an overall significant group difference in 7-day point prevalence abstinence across all follow-up time points. Individuals given the TXT intervention, with higher odds of 7-day point prevalence abstinence for the TXT group compared to the Mojo group (OR=4.52, 95% CI=1.24, 16.53). However, individual comparisons at each time point did not show significant between-group differences, likely due to reduced statistical power. Intervention feasibility was greatly improved by switching from traditional face-to-face recruitment methods (4.7% yield) to an online/remote strategy (41.7% yield). Conclusions: Although this study was designed to develop and provide initial testing of the TXT-2-Quit system, these initial findings provide promising evidence that a text-based intervention can be successfully implemented with a diverse group of adult smokers. Trial Registration: ClinicalTrials.gov: NCT01166464; http://clinicaltrials.gov/ct2/show/NCT01166464 (Archived by WebCite athttp://www.webcitation.org/6IOE8XdE0). UR - http://mhealth.jmir.org/2013/2/e17/ UR - http://dx.doi.org/10.2196/mhealth.2522 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098502 ID - info:doi/10.2196/mhealth.2522 ER - TY - JOUR AU - Mattila, Elina AU - Orsama, Anna-Leena AU - Ahtinen, Aino AU - Hopsu, Leila AU - Leino, Timo AU - Korhonen, Ilkka PY - 2013/07/29 TI - Personal Health Technologies in Employee Health Promotion: Usage Activity, Usefulness, and Health-Related Outcomes in a 1-Year Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e16 VL - 1 IS - 2 KW - health promotion KW - intervention KW - Internet KW - mobile phones KW - device KW - risk factors KW - health technology N2 - Background: Common risk factors such as obesity, poor nutrition, physical inactivity, stress, and sleep deprivation threaten the wellness and work ability of employees. Personal health technologies may help improve engagement in health promotion programs and maintenance of their effect. Objective: This study investigated personal health technologies in supporting employee health promotion targeting multiple behavioral health risks. We studied the relations of usage activity to demographic and physiological characteristics, health-related outcomes (weight, aerobic fitness, blood pressure and cholesterol), and the perceived usefulness of technologies in wellness management. Methods: We conducted a subgroup analysis of the technology group (114 subjects, 33 males, average age 45 years, average BMI 27.1 kg/m2) of a 3-arm randomized controlled trial (N=352). The trial was organized to study the efficacy of a face-to-face group intervention supported by technologies, including Web services, mobile applications, and personal monitoring devices. Technology usage was investigated based on log files and questionnaires. The associations between sustained usage of Web and mobile technologies and demographic and physiological characteristics were analyzed by comparing the baseline data of sustained and non-sustained users. The associations between sustained usage and changes in health-related outcomes were studied by repeated analysis of variance, using data measured by baseline and end questionnaires, and anthropometric and laboratory measurements. The experienced usability, usefulness, motivation, and barriers to using technologies were investigated by 4 questionnaires and 2 interviews. Results: 111 subjects (97.4%) used technologies at some point of the study, and 33 (29.9%) were classified as sustained users of Web or mobile technologies. Simple technologies, weight scales and pedometer, attracted the most users. The sustained users were slightly older 47 years (95% CI 44 to 49) versus 44 years (95% CI 42 to 45), P=.034 and had poorer aerobic fitness at baseline (mean difference in maximal metabolic equivalent 1.0, 95% Cl 0.39 to 1.39; P=.013) than non-sustained users. They succeeded better in weight management: their weight decreased -1.2 kg (95% CI -2.38 to -0.01) versus +0.6 kg (95% CI -0.095 to 1.27), P=.006; body fat percentage -0.9%-units (95% CI -1.64 to -0.09) versus +0.3%-units (95% CI -0.28 to 0.73), P=.014; and waist circumference -1.4 cm (95% CI -2.60 to -0.20) versus +0.7 cm (95% CI -0.21 to 1.66), P=.01. They also participated in intervention meetings more actively: median 4 meetings (interquartile range; IQR 4?5) versus 4 meetings (IQR 3?4), P=.009. The key factors in usefulness were: simplicity, integration into daily life, and clear feedback on progress. Conclusions: Despite active initial usage, less than 30% of subjects continued using Web or mobile technologies throughout the study. Sustained users achieved better weight-related outcomes than non-sustained users. High non-usage attrition and modest outcomes cast doubt on the potential of technologies to support interventions. UR - http://mhealth.jmir.org/2013/2/e16/ UR - http://dx.doi.org/10.2196/mhealth.2557 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098385 ID - info:doi/10.2196/mhealth.2557 ER - TY - JOUR AU - Martínez-Pérez, Borja AU - de la Torre-Díez, Isabel AU - López-Coronado, Miguel AU - Herreros-González, Jesús PY - 2013/07/24 TI - Mobile Apps in Cardiology: Review JO - JMIR Mhealth Uhealth SP - e15 VL - 1 IS - 2 KW - apps KW - cardiology KW - heart KW - m-health KW - mobile applications N2 - Background: Cardiovascular diseases are the deadliest diseases worldwide, with 17.3 million deaths in 2008 alone. Among them, heart-related deaths are of the utmost relevance; a fact easily proven by the 7.25 million deaths caused by ischemic heart disease alone in that year. The latest advances in smartphones and mHealth have been used in the creation of thousands of medical apps related to cardiology, which can help to reduce these mortality rates. Objective: The aim of this paper is to study the literature on mobile systems and applications currently available, as well as the existing apps related to cardiology from the leading app stores and to then classify the results to see what is available and what is missing, focusing particularly on commercial apps. Methods: Two reviews have been developed. One is a literature review of mobile systems and applications, retrieved from several databases and systems such as Scopus, PubMed, IEEE Xplore, and Web of Knowledge. The other is a review of mobile apps in the leading app stores, Google play for Android and Apple?s App Store for iOS. Results: Search queries up to May 2013 located 406 papers and 710 apps related to cardiology and heart disease. The most researched section in the literature associated with cardiology is related to mobile heart (and vital signs) monitoring systems and the methods involved in the classification of heart signs in order to detect abnormal functions. Other systems with a significant number of papers are mobile cardiac rehabilitation systems, blood pressure measurement, and systems for the detection of heart failure. The majority of apps for cardiology are heart monitors and medical calculators. Other categories with a high number of apps are those for ECG education and interpretation, cardiology news and journals, blood pressure tracking, heart rate monitoring using an external device, and CPR instruction. There are very few guides on cardiac rehabilitation and apps for the management of the cardiac condition, and there were no apps that assist people who have undergone a heart transplant. Conclusions: The distribution of work in the field of cardiology apps is considerably disproportionate. Whereas some systems have significant research and apps are available, other important systems lack such research and lack apps, even though the contribution they could provide is significant. UR - http://mhealth.jmir.org/2013/2/e15/ UR - http://dx.doi.org/10.2196/mhealth.2737 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098320 ID - info:doi/10.2196/mhealth.2737 ER - TY - JOUR AU - Mulvaney, A. Shelagh AU - Ho, Yun-Xian AU - Cala, M. Cather AU - Chen, Qingxia AU - Nian, Hui AU - Patterson, L. Barron AU - Johnson, B. Kevin PY - 2013/07/17 TI - Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones JO - J Med Internet Res SP - e141 VL - 15 IS - 7 KW - asthma KW - adherence KW - mobile technology KW - adolescent KW - assessment N2 - Background: Self-report is the most common method of measuring medication adherence but is influenced by recall error and response bias, and it typically does not provide insight into the causes of poor adherence. Ecological momentary assessment (EMA) of health behaviors using mobile phones offers a promising alternative to assessing adherence and collecting related data that can be clinically useful for adherence problem solving. Objective: To determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making. Methods: We utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system. Adolescents aged 12-18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center. A survey including barriers to mobile phone use, the Illness Management Survey, and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline. Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month. The Asthma Control Test (ACT) was administered at 2 study time points: baseline and 1 month after baseline. Results: The sample consisted of 53 adolescents who were primarily African American (34/53, 64%) and female (31/53, 58%) with incomes US$40K/year or lower (29/53, 55%). The majority of adolescents (37/53, 70%) reported that they carried their phones with them everywhere, but only 47% (25/53) were able to use their mobile phone at school. Adolescents responded to an average of 20.1 (SD 8.1) of the 30 daily calls received (67%). Response frequency declined during the last week of the month (b=-0.29, P<.001) and was related to EMA-reported levels of rescue inhaler adherence (r= 0.33, P=.035). Using EMA, adolescents reported an average of 0.63 (SD 1.2) asthma symptoms per day and used a rescue inhaler an average of 70% of the time (SD 35%) when they experienced symptoms. About half (26/49, 53%) of the instances of nonadherence took place in the presence of friends. The EMA-measured adherence to rescue inhaler use correlated appropriately with asthma control as measured by the ACT (r=-0.33, P=.034). Conclusions: Mobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents. The EMA method was consistent with the ACT, a widely established measure of asthma control, and results provided valuable insights regarding the context of adherence decision making that could be used clinically for problem solving or as feedback to adolescents in a mobile or Web-based support system. UR - http://www.jmir.org/2013/7/e141/ UR - http://dx.doi.org/10.2196/jmir.2413 UR - http://www.ncbi.nlm.nih.gov/pubmed/23864345 ID - info:doi/10.2196/jmir.2413 ER - TY - JOUR AU - Taka?, Boris AU - Català, Andreu AU - Rodríguez Martín, Daniel AU - van der Aa, Nico AU - Chen, Wei AU - Rauterberg, Matthias PY - 2013/07/15 TI - Position and Orientation Tracking in a Ubiquitous Monitoring System for Parkinson Disease Patients With Freezing of Gait Symptom JO - JMIR Mhealth Uhealth SP - e14 VL - 1 IS - 2 KW - Parkinson disease KW - Freezing of Gait KW - context-aware system KW - indoor localization KW - person orientation N2 - Background: Freezing of gait (FoG) is one of the most disturbing and least understood symptoms in Parkinson disease (PD). Although the majority of existing assistive systems assume accurate detections of FoG episodes, the detection itself is still an open problem. The specificity of FoG is its dependency on the context of a patient, such as the current location or activity. Knowing the patient's context might improve FoG detection. One of the main technical challenges that needs to be solved in order to start using contextual information for FoG detection is accurate estimation of the patient's position and orientation toward key elements of his or her indoor environment. Objective: The objectives of this paper are to (1) present the concept of the monitoring system, based on wearable and ambient sensors, which is designed to detect FoG using the spatial context of the user, (2) establish a set of requirements for the application of position and orientation tracking in FoG detection, (3) evaluate the accuracy of the position estimation for the tracking system, and (4) evaluate two different methods for human orientation estimation. Methods: We developed a prototype system to localize humans and track their orientation, as an important prerequisite for a context-based FoG monitoring system. To setup the system for experiments with real PD patients, the accuracy of the position and orientation tracking was assessed under laboratory conditions in 12 participants. To collect the data, the participants were asked to wear a smartphone, with and without known orientation around the waist, while walking over a predefined path in the marked area captured by two Kinect cameras with non-overlapping fields of view. Results: We used the root mean square error (RMSE) as the main performance measure. The vision based position tracking algorithm achieved RMSE = 0.16 m in position estimation for upright standing people. The experimental results for the proposed human orientation estimation methods demonstrated the adaptivity and robustness to changes in the smartphone attachment position, when the fusion of both vision and inertial information was used. Conclusions: The system achieves satisfactory accuracy on indoor position tracking for the use in the FoG detection application with spatial context. The combination of inertial and vision information has the potential for correct patient heading estimation even when the inertial wearable sensor device is put into an a priori unknown position. UR - http://mhealth.jmir.org/2013/2/e14/ UR - http://dx.doi.org/10.2196/mhealth.2539 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098265 ID - info:doi/10.2196/mhealth.2539 ER - TY - JOUR AU - Zhong, Daidi AU - Kirwan, J. Michael AU - Duan, Xiaolian PY - 2013/07/12 TI - Regulatory Barriers Blocking Standardization of Interoperability JO - JMIR Mhealth Uhealth SP - e13 VL - 1 IS - 2 KW - medical device regulation KW - device interoperability KW - personal health device KW - standardization UR - http://mhealth.jmir.org/2013/2/e13/ UR - http://dx.doi.org/10.2196/mhealth.2654 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098204 ID - info:doi/10.2196/mhealth.2654 ER - TY - JOUR AU - Parmanto, Bambang AU - Pramana, Gede AU - Yu, Xie Daihua AU - Fairman, D. Andrea AU - Dicianno, E. Brad AU - McCue, P. Michael PY - 2013/07/11 TI - iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions JO - JMIR Mhealth Uhealth SP - e10 VL - 1 IS - 2 KW - mobile health KW - mhealth KW - self-care KW - clinician-directed self-care KW - self-management KW - telehealth KW - telemedicine KW - smartphone KW - chronic disease management KW - spina bifida KW - patient-clinician communications N2 - Background: Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population. Objective: The project?s goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians. Methods: We developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery. Results: There were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient?s self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients? conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau. Conclusions: The system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement with patients, and has been highly utilized. UR - http://mhealth.jmir.org/2013/2/e10/ UR - http://dx.doi.org/10.2196/mhealth.2391 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100682 ID - info:doi/10.2196/mhealth.2391 ER - TY - JOUR AU - Ahtinen, Aino AU - Mattila, Elina AU - Välkkynen, Pasi AU - Kaipainen, Kirsikka AU - Vanhala, Toni AU - Ermes, Miikka AU - Sairanen, Essi AU - Myllymäki, Tero AU - Lappalainen, Raimo PY - 2013/07/10 TI - Mobile Mental Wellness Training for Stress Management: Feasibility and Design Implications Based on a One-Month Field Study JO - JMIR Mhealth Uhealth SP - e11 VL - 1 IS - 2 KW - stress KW - mental health KW - mobile phone KW - acceptance and commitment therapy KW - field studies KW - user experience KW - design N2 - Background: Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens. Objective: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management. Methods: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week?s and one month?s use. In-depth user experience interviews were conducted after one month?s use to study the acceptance and user experiences of Oiva. Results: Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems. Conclusions: A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection. UR - http://mhealth.jmir.org/2013/2/e11/ UR - http://dx.doi.org/10.2196/mhealth.2596 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100683 ID - info:doi/10.2196/mhealth.2596 ER - TY - JOUR AU - Piette, D. John AU - Sussman, B. Jeremy AU - Pfeiffer, N. Paul AU - Silveira, J. Maria AU - Singh, Satinder AU - Lavieri, S. Mariel PY - 2013/07/05 TI - Maximizing the Value of Mobile Health Monitoring by Avoiding Redundant Patient Reports: Prediction of Depression-Related Symptoms and Adherence Problems in Automated Health Assessment Services JO - J Med Internet Res SP - e118 VL - 15 IS - 7 KW - cellular phone KW - telemedicine KW - depression KW - self-care N2 - Background: Interactive voice response (IVR) calls enhance health systems? ability to identify health risk factors, thereby enabling targeted clinical follow-up. However, redundant assessments may increase patient dropout and represent a lost opportunity to collect more clinically useful data. Objective: We determined the extent to which previous IVR assessments predicted subsequent responses among patients with depression diagnoses, potentially obviating the need to repeatedly collect the same information. We also evaluated whether frequent (ie, weekly) IVR assessment attempts were significantly more predictive of patients? subsequent reports than information collected biweekly or monthly. Methods: Using data from 1050 IVR assessments for 208 patients with depression diagnoses, we examined the predictability of four IVR-reported outcomes: moderate/severe depressive symptoms (score ?10 on the PHQ-9), fair/poor general health, poor antidepressant adherence, and days in bed due to poor mental health. We used logistic models with training and test samples to predict patients? IVR responses based on their five most recent weekly, biweekly, and monthly assessment attempts. The marginal benefit of more frequent assessments was evaluated based on Receiver Operator Characteristic (ROC) curves and statistical comparisons of the area under the curves (AUC). Results: Patients? reports about their depressive symptoms and perceived health status were highly predictable based on prior assessment responses. For models predicting moderate/severe depression, the AUC was 0.91 (95% CI 0.89-0.93) when assuming weekly assessment attempts and only slightly less when assuming biweekly assessments (AUC: 0.89; CI 0.87-0.91) or monthly attempts (AUC: 0.89; CI 0.86-0.91). The AUC for models predicting reports of fair/poor health status was similar when weekly assessments were compared with those occurring biweekly (P value for the difference=.11) or monthly (P=.81). Reports of medication adherence problems and days in bed were somewhat less predictable but also showed small differences between assessments attempted weekly, biweekly, and monthly. Conclusions: The technical feasibility of gathering high frequency health data via IVR may in some instances exceed the clinical benefit of doing so. Predictive analytics could make data gathering more efficient with negligible loss in effectiveness. In particular, weekly or biweekly depressive symptom reports may provide little marginal information regarding how the person is doing relative to collecting that information monthly. The next generation of automated health assessment services should use data mining techniques to avoid redundant assessments and should gather data at the frequency that maximizes the value of the information collected. UR - http://www.jmir.org/2013/7/e118/ UR - http://dx.doi.org/10.2196/jmir.2582 UR - http://www.ncbi.nlm.nih.gov/pubmed/23832021 ID - info:doi/10.2196/jmir.2582 ER - TY - JOUR AU - van der Weegen, Sanne AU - Verwey, Renée AU - Spreeuwenberg, Marieke AU - Tange, Huibert AU - van der Weijden, Trudy AU - de Witte, Luc PY - 2013/07/02 TI - The Development of a Mobile Monitoring and Feedback Tool to Stimulate Physical Activity of People With a Chronic Disease in Primary Care: A User-Centered Design JO - JMIR Mhealth Uhealth SP - e8 VL - 1 IS - 2 KW - user-centered design KW - self-management KW - physical activity KW - accelerometry KW - remote sensing technology KW - primary health care N2 - Background: Physical activity is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes. A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients. As a prerequisite for useful technology, it is important to involve the end-users in the design process from an early stage. Objective: The aim of this study was to investigate the user requirements for a tool to stimulate physical activity, embedded in primary care practice. The leading principle of this tool is to change behavior by self-monitoring, goal-setting, and feedback. Methods: The research team collected qualitative data among 15 patients, 16 care professionals, and several experts. A prototype was developed in three stages. In stage 1, the literature was searched to identify end-users and context. In stage 2, the literature, experts and patient representatives were consulted to set up a use case with the general idea of the innovation. In stage 3, individual interviews and focus groups were held to identify the end-user requirements. Based on these requirements a prototype was built by the engineering team. Results: The development process has led to a tool that generally meets the requirements of the end-users. A tri-axial activity sensor, worn on the hip, is connected by Bluetooth to a smartphone. In an app, quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization, and an image shows a sun when the goal is reached. Overviews about activity per half an hour, per day, week, and month are provided. In the menu of the app and on a secured website, patients can enter information in individual sessions or read feedback messages generated by the system. The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient. Conclusions: This study demonstrates that a user-centered approach brings in valuable details (such as the requirements for feedback in activity minutes per day) to improve the fit between the user, technology, and the organization of care, which is important for the usability and acceptability of the tool. The tool embedded in primary care will be evaluated in a randomized controlled trial. UR - http://mhealth.jmir.org/2013/2/e8/ UR - http://dx.doi.org/10.2196/mhealth.2526 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099556 ID - info:doi/10.2196/mhealth.2526 ER - TY - JOUR AU - Kim, Hyun-Young AU - Park, Hyeoun-Ae AU - Min, Ha Yul AU - Jeon, Eunjoo PY - 2013/06/28 TI - Development of an Obesity Management Ontology Based on the Nursing Process for the Mobile-Device Domain JO - J Med Internet Res SP - e130 VL - 15 IS - 6 KW - obesity management KW - ontology KW - nursing process N2 - Background: Lifestyle modification is the most important factor in the management of obesity. It is therefore essential to enhance client participation in voluntary and continuous weight control. Objective: The aim of this study was to develop an obesity management ontology for application in the mobile-device domain. We considered the concepts of client participation in behavioral modification for obesity management and focused on minimizing the amount of information exchange between the application and the database when providing tailored interventions. Methods: An obesity management ontology was developed in seven phases: (1) defining the scope of obesity management, (2) selecting a foundational ontology, (3) extracting the concepts, (4) assigning relationships between these concepts, (5) evaluating representative layers of ontology content, (6) representing the ontology formally with Protégé, and (7) developing a prototype application for obesity management. Results: Behavioral interventions, dietary advice, and physical activity were proposed as obesity management strategies. The nursing process was selected as a foundation of ontology, representing the obesity management process. We extracted 127 concepts, which included assessment data (eg, sex, body mass index, and waist circumference), inferred data to represent nursing diagnoses and evaluations (eg, degree of and reason for obesity, and success or failure of lifestyle modifications), and implementation (eg, education and advice). The relationship linking concepts were ?part of?, ?instance of?, ?derives of?, ?derives into?, ?has plan?, ?followed by?, and ?has intention?. The concepts and relationships were formally represented using Protégé. The evaluation score of the obesity management ontology was 4.5 out of 5. An Android-based obesity management application comprising both agent and client parts was developed. Conclusions: We have developed an ontology for representing obesity management with the nursing process as a foundation of ontology. UR - http://www.jmir.org/2013/6/e130/ UR - http://dx.doi.org/10.2196/jmir.2512 UR - http://www.ncbi.nlm.nih.gov/pubmed/23811542 ID - info:doi/10.2196/jmir.2512 ER - TY - JOUR AU - Weaver, R. Emma AU - Horyniak, R. Danielle AU - Jenkinson, Rebecca AU - Dietze, Paul AU - Lim, SC Megan PY - 2013/06/25 TI - ?Let?s get Wasted!? and Other Apps: Characteristics, Acceptability, and Use of Alcohol-Related Smartphone Applications JO - JMIR Mhealth Uhealth SP - e9 VL - 1 IS - 1 KW - alcohol drinking KW - young adult KW - mobile phone KW - applications N2 - Background: Smartphone applications (?apps?) offer a number of possibilities for health promotion activities. However, young people may also be exposed to apps with incorrect or poor quality information, since, like the Internet, apps are mostly unregulated. Little is known about the quality of alcohol-related apps or what influence they may have on young people?s behavior. Objective: To critically review popular alcohol-related smartphone apps and to explore young people?s opinions of these apps, their acceptability, and use for alcohol-related health promotion. Methods: First, a content analysis of 500 smartphone apps available via Apple iTunes and Android Google Play stores was conducted. Second, all available blood alcohol concentration (BAC) apps were tested against four individual case profiles of known BAC from a previous study. Third, two focus group discussions explored how young people use alcohol-related apps, particularly BAC apps. Results: 384 apps were included; 50% (192) were entertainment apps, 39% (148) were BAC apps, and 11% (44) were health promotion and/or stop drinking?related apps. When testing the BAC apps, there was wide variation in results, with apps tending to overestimate BAC scores compared with recorded scores. Participants were skeptical of the accuracy of BAC apps, and there was an overall concern that these apps would be used as a form of entertainment, further encouraging young people to drink, rather than reduce their drinking and risk taking. Conclusions: The majority of popular alcohol-related apps encouraged alcohol consumption. Apps estimating blood alcohol concentration were widely available but were highly unreliable. Health departments and prominent health organizations need to endorse alcohol smartphone apps that are accurate and evidence-based to give specific apps credibility in the ever-expanding market of unregulated apps. UR - http://mhealth.jmir.org/2013/1/e9/ UR - http://dx.doi.org/10.2196/mhealth.2709 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100681 ID - info:doi/10.2196/mhealth.2709 ER - TY - JOUR AU - Hingle, Melanie AU - Yoon, Donella AU - Fowler, Joseph AU - Kobourov, Stephen AU - Schneider, Lee Michael AU - Falk, Daniel AU - Burd, Randy PY - 2013/06/24 TI - Collection and Visualization of Dietary Behavior and Reasons for Eating Using Twitter JO - J Med Internet Res SP - e125 VL - 15 IS - 6 KW - dietary behavior KW - data visualization KW - social media KW - mobile health KW - mHealth N2 - Background: Increasing an individual?s awareness and understanding of their dietary habits and reasons for eating may help facilitate positive dietary changes. Mobile technologies allow individuals to record diet-related behavior in real time from any location; however, the most popular software applications lack empirical evidence supporting their efficacy as health promotion tools. Objective: The purpose of this study was to test the feasibility and acceptability of a popular social media software application (Twitter) to capture young adults? dietary behavior and reasons for eating. A secondary aim was to visualize data from Twitter using a novel analytic tool designed to help identify relationships among dietary behaviors, reasons for eating, and contextual factors. Methods: Participants were trained to record all food and beverages consumed over 3 consecutive days (2 weekdays and 1 weekend day) using their mobile device?s native Twitter application. A list of 24 hashtags (#) representing food groups and reasons for eating were provided to participants to guide reporting (eg, #protein, #mood). Participants were encouraged to annotate hashtags with contextual information using photos, text, and links. User experience was assessed through a combination of email reports of technical challenges and a 9-item exit survey. Participant data were captured from the public Twitter stream, and frequency of hashtag occurrence and co-occurrence were determined. Contextual data were further parsed and qualitatively analyzed. A frequency matrix was constructed to identify food and behavior hashtags that co-occurred. These relationships were visualized using GMap algorithmic mapping software. Results: A total of 50 adults completed the study. In all, 773 tweets including 2862 hashtags (1756 foods and 1106 reasons for eating) were reported. Frequently reported food groups were #grains (n=365 tweets), #dairy (n=221), and #protein (n=307). The most frequently cited reasons for eating were #social (activity) (n=122), #taste (n=146), and #convenience (n=173). Participants used a combination of study-provided hash tags and their own hash tags to describe behavior. Most rated Twitter as easy to use for the purpose of reporting diet-related behavior. ?Maps? of hash tag occurrences and co-occurrences were developed that suggested time-varying diet and behavior patterns. Conclusions: Twitter combined with an analytical software tool provides a method for capturing real-time food consumption and diet-related behavior. Data visualization may provide a method to identify relationships between dietary and behavioral factors. These findings will inform the design of a study exploring the use of social media and data visualization to identify relationships between food consumption, reasons for engaging in specific food-related behaviors, relevant contextual factors, and weight and health statuses in diverse populations. UR - http://www.jmir.org/2013/6/e125/ UR - http://dx.doi.org/10.2196/jmir.2613 UR - http://www.ncbi.nlm.nih.gov/pubmed/23796439 ID - info:doi/10.2196/jmir.2613 ER - TY - JOUR AU - Martínez-Pérez, Borja AU - de la Torre-Díez, Isabel AU - López-Coronado, Miguel PY - 2013/06/14 TI - Mobile Health Applications for the Most Prevalent Conditions by the World Health Organization: Review and Analysis JO - J Med Internet Res SP - e120 VL - 15 IS - 6 KW - apps KW - mHealth KW - mobile applications KW - prevalent conditions KW - World Health Organization (WHO) N2 - Background: New possibilities for mHealth have arisen by means of the latest advances in mobile communications and technologies. With more than 1 billion smartphones and 100 million tablets around the world, these devices can be a valuable tool in health care management. Every aid for health care is welcome and necessary as shown by the more than 50 million estimated deaths caused by illnesses or health conditions in 2008. Some of these conditions have additional importance depending on their prevalence. Objective: To study the existing applications for mobile devices exclusively dedicated to the eight most prevalent health conditions by the latest update (2004) of the Global Burden of Disease (GBD) of the World Health Organization (WHO): iron-deficiency anemia, hearing loss, migraine, low vision, asthma, diabetes mellitus, osteoarthritis (OA), and unipolar depressive disorders. Methods: Two reviews have been carried out. The first one is a review of mobile applications in published articles retrieved from the following systems: IEEE Xplore, Scopus, ScienceDirect, Web of Knowledge, and PubMed. The second review is carried out by searching the most important commercial app stores: Google play, iTunes, BlackBerry World, Windows Phone Apps+Games, and Nokia's Ovi store. Finally, two applications for each condition, one for each review, were selected for an in-depth analysis. Results: Search queries up to April 2013 located 247 papers and more than 3673 apps related to the most prevalent conditions. The conditions in descending order by the number of applications found in literature are diabetes, asthma, depression, hearing loss, low vision, OA, anemia, and migraine. However when ordered by the number of commercial apps found, the list is diabetes, depression, migraine, asthma, low vision, hearing loss, OA, and anemia. Excluding OA from the former list, the four most prevalent conditions have fewer apps and research than the final four. Several results are extracted from the in-depth analysis: most of the apps are designed for monitoring, assisting, or informing about the condition. Typically an Internet connection is not required, and most of the apps are aimed for the general public and for nonclinical use. The preferred type of data visualization is text followed by charts and pictures. Assistive and monitoring apps are shown to be frequently used, whereas informative and educational apps are only occasionally used. Conclusions: Distribution of work on mobile applications is not equal for the eight most prevalent conditions. Whereas some conditions such as diabetes and depression have an overwhelming number of apps and research, there is a lack of apps related to other conditions, such as anemia, hearing loss, or low vision, which must be filled. UR - http://www.jmir.org/2013/6/e120/ UR - http://dx.doi.org/10.2196/jmir.2600 UR - http://www.ncbi.nlm.nih.gov/pubmed/23770578 ID - info:doi/10.2196/jmir.2600 ER - TY - JOUR AU - Donaire-Gonzalez, David AU - de Nazelle, Audrey AU - Seto, Edmund AU - Mendez, Michelle AU - Nieuwenhuijsen, J. Mark AU - Jerrett, Michael PY - 2013/06/13 TI - Comparison of Physical Activity Measures Using Mobile Phone-Based CalFit and Actigraph JO - J Med Internet Res SP - e111 VL - 15 IS - 6 KW - cellular phone KW - accelerometry KW - global positioning systems KW - motor activity KW - monitoring KW - physiologic N2 - Background: Epidemiological studies on physical activity often lack inexpensive, objective, valid, and reproducible tools for measuring physical activity levels of participants. Novel sensing technologies built into smartphones offer the potential to fill this gap. Objective: We sought to validate estimates of physical activity and determine the usability for large population-based studies of the smartphone-based CalFit software. Methods: A sample of 36 participants from Barcelona, Spain, wore a smartphone with CalFit software and an Actigraph GT3X accelerometer for 5 days. The ease of use (usability) and physical activity measures from both devices were compared, including vertical axis counts (VT) and duration and energy expenditure predictions for light, moderate, and vigorous intensity from Freedson?s algorithm. Statistical analyses included (1) Kruskal-Wallis rank sum test for usability measures, (2) Spearman correlation and linear regression for VT counts, (3) concordance correlation coefficient (CCC), and (4) Bland-Altman plots for duration and energy expenditure measures. Results: Approximately 64% (23/36) of participants were women. Mean age was 31 years (SD 8) and mean body mass index was 22 kg/m2 (SD 2). In total, 25/36 (69%) participants recorded at least 3 days with at least 10 recorded hours of physical activity using CalFit. The linear association and correlations for VT counts were high (adjusted R2=0.85; correlation coefficient .932, 95% CI 0.931-0.933). CCCs showed high agreement for duration and energy expenditure measures (from 0.83 to 0.91). Conclusions: The CalFit system had lower usability than the Actigraph GT3X because the application lacked a means to turn itself on each time the smartphone was powered on. The CalFit system may provide valid estimates to quantify and classify physical activity. CalFit may prove to be more cost-effective and easily deployed for large-scale population health studies than other specialized instruments because cell phones are already carried by many people. UR - http://www.jmir.org/2013/6/e111/ UR - http://dx.doi.org/10.2196/jmir.2470 UR - http://www.ncbi.nlm.nih.gov/pubmed/23896156 ID - info:doi/10.2196/jmir.2470 ER - TY - JOUR AU - Ehrler, Frederic AU - Wipfli, Rolf AU - Teodoro, Douglas AU - Sarrey, Everlyne AU - Walesa, Magali AU - Lovis, Christian PY - 2013/06/12 TI - Challenges in the Implementation of a Mobile Application in Clinical Practice: Case Study in the Context ofan Application that Manages the Daily Interventions of Nurses JO - JMIR Mhealth Uhealth SP - e7 VL - 1 IS - 1 KW - hospital information systems KW - computers, handheld KW - equipment design KW - nurses KW - mobile health KW - pilot projects KW - user-computer interface N2 - Background: Working in a clinical environment requires unfettered mobility. This is especially true for nurses who are always on the move providing patients? care in different locations. Since the introduction of clinical information systems in hospitals, this mobility has often been considered hampered by interactions with computers. The popularity of personal mobile assistants such as smartphones makes it possible to gain easy access to clinical data anywhere. Objective: To identify the challenges involved in the deployment of clinical applications on handheld devices and to share our solutions to these problems. Methods: A team of experts underwent an iterative development process of a mobile application prototype that aimed to improve the mobility of nurses during their daily clinical activities. Through the process, challenges inherent to mobile platforms have emerged. These issues have been classified, focusing on factors related to ensuring information safety and quality, as well as pleasant and efficient user experiences. Results: The team identified five main challenges related to the deployment of clinical mobile applications and presents solutions to overcome each of them: (1) Financial: Equipping every care giver with a new mobile device requires substantial investment that can be lowered if users use their personal device instead, (2) Hardware: The constraints inherent to the clinical environment made us choose the mobile device with the best tradeoff between size and portability, (3) Communication: the connection of the mobile application with any existing clinical information systems (CIS) is insured by a bridge formatting the information appropriately, (4) Security: In order to guarantee the confidentiality and safety of the data, the amount of data stored on the device is minimized, and (5) User interface: The design of our user interface relied on homogeneity, hierarchy, and indexicality principles to prevent an increase in data acquisition errors. Conclusions: The introduction of nomadic computing often raises enthusiastic reactions from users, but several challenges due to specific constraints of mobile platforms must be overcome. The ease of development of mobile applications and their rapid spread should not overshadow the real challenges of clinical applications and the potential threats for patient safety and the liability of people and organizations using them. For example, careful attention must be given to the overall architecture of the system and to user interfaces. If these precautions are not taken, it can easily lead to unexpected failures such as an increased number of input errors, loss of data, or decreased efficiency. UR - http://mhealth.jmir.org/2013/1/e7/ UR - http://dx.doi.org/10.2196/mhealth.2344 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100680 ID - info:doi/10.2196/mhealth.2344 ER - TY - JOUR AU - van Heerden, Alastair AU - Norris, Shane AU - Tollman, Stephen AU - Richter, Linda AU - Rotheram-Borus, Jane Mary PY - 2013/06/10 TI - Collecting Maternal Health Information From HIV-Positive Pregnant Women Using Mobile Phone-Assisted Face-to-Face Interviews in Southern Africa JO - J Med Internet Res SP - e116 VL - 15 IS - 6 KW - mobile phones KW - human immunodeficiency virus KW - mobile health N2 - Background: Most of the world?s women living with human immunodeficiency virus (HIV) reside in sub-Saharan Africa. Although efforts to reduce mother-to-child transmission are underway, obtaining complete and accurate data from rural clinical sites to track progress presents a major challenge. Objective: To describe the acceptability and feasibility of mobile phones as a tool for clinic-based face-to-face data collection with pregnant women living with HIV in South Africa. Methods: As part of a larger clinic-based trial, 16 interviewers were trained to conduct mobile phone?assisted personal interviews (MPAPI). These interviewers (participant group 1) completed the same short questionnaire based on items from the Technology Acceptance Model at 3 different time points. Questions were asked before training, after training, and 3 months after deployment to clinic facilities. In addition, before the start of the primary intervention trial in which this substudy was undertaken, 12 mothers living with HIV (MLH) took part in a focus group discussion exploring the acceptability of MPAPI (participant group 2). Finally, a sample of MLH (n=512) enrolled in the primary trial were asked to assess their experience of being interviewed by MPAPI (participant group 3). Results: Acceptability of the method was found to be high among the 16 interviewers in group 1. Perceived usefulness was reported to be slightly higher than perceived ease of use across the 3 time points. After 3 months of field use, interviewer perceptions of both perceived ease of use and perceived usefulness were found to be higher than before training. The feasibility of conducting MPAPI interviews in this setting was found to be high. Network coverage was available in all clinics and hardware, software, cost, and secure transmission to the data center presented no significant challenges over the 21-month period. For the 12 MHL participants in group 2, anxiety about the multimedia capabilities of the phone was evident. Their concern centered on the possibility that their privacy may be invaded by interviewers using the mobile phone camera to photograph them. For participants in group 3, having the interviewer sit beside vs across from the interviewee during the MPAPI interview was received positively by 94.7% of MHL. Privacy (6.3%) and confidentiality (5.3%) concerns were low for group 3 MHL. Conclusions: Mobile phones were found both to be acceptable and feasible in the collection of maternal and child health data from women living with HIV in South Africa. Trial Registration: Clinicaltrials.gov NCT00972699; http://clinicaltrials.gov/ct2/show/NCT00972699 (Archived by WebCite at http://clinicaltrials.gov/ct2/show/NCT00972699) UR - http://www.jmir.org/2013/6/e116/ UR - http://dx.doi.org/10.2196/jmir.2207 UR - http://www.ncbi.nlm.nih.gov/pubmed/23748182 ID - info:doi/10.2196/jmir.2207 ER - TY - JOUR AU - Bellini, Pierfrancesco AU - Boncinelli, Sergio AU - Grossi, Francesco AU - Mangini, Marco AU - Nesi, Paolo AU - Sequi, Leonardo PY - 2013/05/23 TI - Mobile Emergency, an Emergency Support System for Hospitals in Mobile Devices: Pilot Study JO - JMIR Res Protoc SP - e19 VL - 2 IS - 1 KW - emergency KW - hospital emergency KW - emergency communication management KW - mobile emergency N2 - Background: Hospitals are vulnerable to natural disasters, man-made disasters, and mass causalities events. Within a short time, hospitals must provide care to large numbers of casualties in any damaged infrastructure, despite great personnel risk, inadequate communications, and limited resources. Communications are one of the most common challenges and drawbacks during in-hospital emergencies. Emergency difficulties in communicating with personnel and other agencies are mentioned in literature. At the moment of emergency inception and in the earliest emergency phases, the data regarding the true nature of the incidents are often inaccurate. The real needs and conditions are not yet clear, hospital personnel are neither efficiently coordinated nor informed on the real available resources. Information and communication technology solutions in health care turned out to have a great positive impact both on daily working practice and situations. Objective: The objective of this paper was to find a solution that addresses the aspects of communicating among medical personnel, formalizing the modalities and protocols and the information to guide the medical personnel during emergency conditions with a support of a Central Station (command center) to cope with emergency management and best practice network to produce and distribute intelligent content made available in the mobile devices of the medical personnel. The aim was to reduce the time needed to react and to cope with emergency organization, while facilitating communications. Methods: The solution has been realized by formalizing the scenarios, extracting, and identifying the requirements by using formal methods based on unified modeling language (UML). The system and was developed using mobile programming under iOS Apple and PHP: Hypertext Preprocessor My Structured Query Language (PHP MySQL). Formal questionnaires and time sheets were used for testing and validation, and a control group was used in order to estimate the reduction of time needed to cope with emergency cases. First, we have tested the usability and the functionalities of the solution proposed, then a real trial was performed to assess the reduction in communication time and the efficiency of the solution with respect to a case without Mobile Emergency tools. Results: The solution was based on the development of a mobile emergency application and corresponding server device to cope with emergencies and facilitate all the related activities and communications, such as marking the position, contacting people, and recovering the exits information. The solution has been successfully tested within the Careggi Hospital, the largest medical infrastructure in Florence and Tuscany area in Italy, thus demonstrating the validity of the identified modalities, procedures, and the reduction in the time needed to cope with the emergency conditions. The trial was not registered as the test was conducted in realistic but simulated emergency conditions. Conclusions: By analyzing the requirements for developing a mobile app, and specifically the functionalities, codes, and design of the Mobile Emergency app, we have revealed the real advantages of using mobile emergency solutions compared to other more traditional solutions to effectively handle emergency situations in hospital settings. UR - http://www.researchprotocols.org/2013/1/e19/ UR - http://dx.doi.org/10.2196/resprot.2293 UR - http://www.ncbi.nlm.nih.gov/pubmed/23702566 ID - info:doi/10.2196/resprot.2293 ER - TY - JOUR AU - Fiordelli, Maddalena AU - Diviani, Nicola AU - Schulz, J. Peter PY - 2013/05/21 TI - Mapping mHealth Research: A Decade of Evolution JO - J Med Internet Res SP - e95 VL - 15 IS - 5 KW - mHealth KW - systematic review KW - health outcomes N2 - Background: For the last decade, mHealth has constantly expanded as a part of eHealth. Mobile applications for health have the potential to target heterogeneous audiences and address specific needs in different situations, with diverse outcomes, and to complement highly developed health care technologies. The market is rapidly evolving, making countless new mobile technologies potentially available to the health care system; however, systematic research on the impact of these technologies on health outcomes remains scarce. Objective: To provide a comprehensive view of the field of mHealth research to date and to understand whether and how the new generation of smartphones has triggered research, since their introduction 5 years ago. Specifically, we focused on studies aiming to evaluate the impact of mobile phones on health, and we sought to identify the main areas of health care delivery where mobile technologies can have an impact. Methods: A systematic literature review was conducted on the impact of mobile phones and smartphones in health care. Abstracts and articles were categorized using typologies that were partly adapted from existing literature and partly created inductively from publications included in the review. Results: The final sample consisted of 117 articles published between 2002 and 2012. The majority of them were published in the second half of our observation period, with a clear upsurge between 2007 and 2008, when the number of articles almost doubled. The articles were published in 77 different journals, mostly from the field of medicine or technology and medicine. Although the range of health conditions addressed was very wide, a clear focus on chronic conditions was noted. The research methodology of these studies was mostly clinical trials and pilot studies, but new designs were introduced in the second half of our observation period. The size of the samples drawn to test mobile health applications also increased over time. The majority of the studies tested basic mobile phone features (eg, text messaging), while only a few assessed the impact of smartphone apps. Regarding the investigated outcomes, we observed a shift from assessment of the technology itself to assessment of its impact. The outcome measures used in the studies were mostly clinical, including both self-reported and objective measures. Conclusions: Research interest in mHealth is growing, together with an increasing complexity in research designs and aim specifications, as well as a diversification of the impact areas. However, new opportunities offered by new mobile technologies do not seem to have been explored thus far. Mapping the evolution of the field allows a better understanding of its strengths and weaknesses and can inform future developments. UR - http://www.jmir.org/2013/5/e95/ UR - http://dx.doi.org/10.2196/jmir.2430 UR - http://www.ncbi.nlm.nih.gov/pubmed/23697600 ID - info:doi/10.2196/jmir.2430 ER - TY - JOUR AU - Elias, Pierre AU - Rajan, O. Nithin AU - McArthur, Kara AU - Dacso, C. Clifford PY - 2013/05/21 TI - InSpire to Promote Lung Assessment in Youth: Evolving the Self-Management Paradigms of Young People With Asthma JO - Med 2.0 SP - e1 VL - 2 IS - 1 KW - pediatric asthma KW - chronic disease management KW - mobile phones KW - spirometry KW - gamification N2 - Background: Asthma is the most common chronic disease in childhood, disproportionately affecting urban, minority, and disadvantaged children. Individualized care plans supported by daily lung-function monitoring can reduce morbidity and mortality. However, despite 20 years of interventions to increase adherence, only 50% of US youth accurately follow their care plans, which leads to millions of preventable hospitalizations, emergency room visits, and sick days every year. We present a feasibility study of a novel, user-centered approach to increasing young people?s lung-function monitoring and asthma self-care. Promoting Lung Assessment in Youth (PLAY) helps young people become active managers of their asthma through the Web 2.0 principles of participation, cocreation, and information sharing. Specifically, PLAY combines an inexpensive, portable spirometer with the motivational power and convenience of mobile phones and virtual-community gaming. Objective: The objective of this study was to develop and pilot test InSpire, a fully functional interface between a handheld spirometer and an interactive game and individualized asthma-care instant-messaging system housed on a mobile phone. Methods: InSpire is an application for mobile smartphones that creates a compelling world in which youth collaborate with their physicians on managing their asthma. Drawing from design-theory on global timer mechanics and role playing, we incentivized completing spirometry maneuvers by making them an engaging part of a game young people would want to play. The data can be sent wirelessly to health specialists and return care recommendations to patients in real-time. By making it portable and similar to applications normally desired by the target demographic, InSpire is able to seamlessly incorporate asthma management into their lifestyle. Results: We describe the development process of building and testing the InSpire prototype. To our knowledge, the prototype is a first-of-its kind mobile one-stop shop for asthma management. Feasibility testing in children aged 7 to 14 with asthma assessed likability of the graphical user interface as well as young people?s interest in our incentivizing system. Nearly 100% of children surveyed said they would play games like those in PLAY if they involved breathing into a spirometer. Two-thirds said they would prefer PLAY over the spirometer alone, whereas 1/3 would prefer having both. No children said they would prefer the spirometer over PLAY. Conclusions: Previous efforts at home-monitoring of asthma in children have experienced rapid decline in adherence. An inexpensive monitoring technology combined with the computation, interactive communication, and display ability of a mobile phone is a promising approach to sustainable adherence to lung-function monitoring and care plans. An exciting game that redefines the way youth conduct health management by inviting them to collaborate in their health better can be an incentive and a catalyst for more far-reaching goals. UR - http://www.medicine20.com/2013/1/e1/ UR - http://dx.doi.org/10.2196/med20.2014 UR - http://www.ncbi.nlm.nih.gov/pubmed/25075232 ID - info:doi/10.2196/med20.2014 ER - TY - JOUR AU - Luo, Nancy AU - Chapman, G. Christopher AU - Patel, K. Bhakti AU - Woodruff, N. James AU - Arora, M. Vineet PY - 2013/05/08 TI - Expectations of iPad Use in an Internal Medicine Residency Program: Is It Worth the ?Hype?? JO - J Med Internet Res SP - e88 VL - 15 IS - 5 KW - iPad KW - mobile tablet computing KW - technology KW - expectation dynamics KW - hype N2 - Background: While early reports highlight the benefits of tablet computing in hospitals, introducing any new technology can result in inflated expectations. Objective: The aim of the study is to compare anticipated expectations of Apple iPad use and perceptions after deployment among residents. Methods: 115 internal medicine residents received Apple iPads in October 2010. Residents completed matched surveys on anticipated usage and perceptions after distribution 1 month prior and 4 months after deployment. Results: In total, 99% (114/115) of residents responded. Prior to deployment, most residents believed that the iPad would improve patient care and efficiency on the wards; however, fewer residents ?strongly agreed? after deployment (34% vs 15% for patient care, P<.001; 41% vs 24% for efficiency, P=.005). Residents with higher expectations were more likely to report using the iPad for placing orders post call and during admission (71% vs 44% post call, P=.01, and 16% vs 0% admission, P=.04). Previous Apple iOS product owners were also more likely to use the iPad in key areas. Overall, 84% of residents thought the iPad was a good investment for the residency program, and over half of residents (58%) reported that patients commented on the iPad in a positive way. Conclusions: While the use of tablets such as the iPad by residents is generally well received, high initial expectations highlight the danger of implementing new technologies. Education on the realistic expectations of iPad benefits may be warranted. UR - http://www.jmir.org/2013/5/e88/ UR - http://dx.doi.org/10.2196/jmir.2524 UR - http://www.ncbi.nlm.nih.gov/pubmed/23656727 ID - info:doi/10.2196/jmir.2524 ER - TY - JOUR AU - Shaw, J. Ryan AU - Bosworth, B. Hayden AU - Hess, C. Jeffrey AU - Silva, G. Susan AU - Lipkus, M. Isaac AU - Davis, L. Linda AU - Johnson, M. Constance PY - 2013/05/07 TI - Development of a Theoretically Driven mHealth Text Messaging Application for Sustaining Recent Weight Loss JO - JMIR Mhealth Uhealth SP - e5 VL - 1 IS - 1 KW - mHealth KW - short message service KW - SMS KW - text messaging KW - weight loss maintenance N2 - Background: Mobile phone short message service (SMS) text messaging, has the potential to serve as an intervention medium to promote sustainability of weight loss that can be easily and affordably used by clinicians and consumers. Objective: To develop theoretically driven weight loss sustaining text messages and pilot an mHealth SMS text messaging intervention to promote sustaining recent weight loss in order to understand optimal frequency and timing of message delivery, and for feasibility and usability testing. Results from the pilot study were used to design and construct a patient privacy compliant automated SMS application to deliver weight loss sustaining messages. Methods: We first conducted a pilot study in which participants (N=16) received a daily SMS text message for one month following a structured weight loss program. Messages were developed from diet and exercise guidelines. Following the intervention, interviews were conducted and self-reported weight was collected via SMS text messaging. Results: All participants (N=16) were capable of sending and receiving SMS text messages. During the phone interview at 1 month post-baseline and at 3 months post-baseline, 13/14 (93%) of participants who completed the study reported their weight via SMS. At 3 months post-baseline, 79% (11/14) participants sustained or continued to lose weight. Participants (13/14, 93%) were favorable toward the messages and the majority (10/14, 71%) felt they were useful in helping them sustain weight loss. All 14 participants who completed the interview thought SMS was a favorable communication medium and was useful to receive short relevant messages promptly and directly. All participants read the messages when they knew they arrived and most (11/14, 79%) read the messages at the time of delivery. All participants felt that at least one daily message is needed to sustain weight loss behaviors and that they should be delivered in the morning. Results were then used to develop the SMS text messaging application. Conclusions: Study results demonstrated the feasibility of developing weight loss SMS text messages, and the development of an mHealth SMS text messaging application. SMS text messaging was perceived as an appropriate and accepted tool to deliver health promotion content. UR - http://mhealth.jmir.org/2013/1/e5/ UR - http://dx.doi.org/10.2196/mhealth.2343 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100678 ID - info:doi/10.2196/mhealth.2343 ER - TY - JOUR AU - Price, Matthew AU - Williamson, Deborah AU - McCandless, Romina AU - Mueller, Martina AU - Gregoski, Mathew AU - Brunner-Jackson, Brenda AU - Treiber, Eveline AU - Davidson, Lydia AU - Treiber, Frank PY - 2013/04/26 TI - Hispanic Migrant Farm Workers' Attitudes Toward Mobile Phone-Based Telehealth for Management of Chronic Health Conditions JO - J Med Internet Res SP - e76 VL - 15 IS - 4 KW - mobile phone KW - hypertension KW - health care disparities KW - rural health N2 - Background: Mobile phone?based interventions present a means of providing high quality health care to hard-to-reach underserved populations. Migrant farm workers (MFWs) are among the most underserved populations in the United States due to a high prevalence of chronic diseases yet limited access to health care. However, it is unknown if MFWs have access to mobile phone devices used in mobile health (mHealth) interventions, or if they are willing to use such technologies. Objective: Determine rates of ownership of mobile devices and willingness to use mHealth strategies in MFWs. Methods: A demonstration of mHealth devices and a survey were individually administered to 80 Hispanic MFWs to evaluate use of mobile phones and mHealth devices and willingness to use such technologies. Results: Of the 80 participants, 81% (65/80) owned cell phones capable of sending and receiving health-related messages. Most participants (65/80, 81%) were receptive to using mHealth technology and felt it would be helpful in enhancing medication adherence, self-monitoring health conditions, and receiving quicker medication changes from their doctors (median scores ?4 on 5-point Likert scales). Relations between age and attitudes toward using mHealth were not statistically significant. Conclusions: Hispanic MFWs have access to mobile phones and are willing to use mHealth devices. Future work is needed to comprehensively evaluate the degree to which these devices could be used. UR - http://www.jmir.org/2013/4/e76/ UR - http://dx.doi.org/10.2196/jmir.2500 UR - http://www.ncbi.nlm.nih.gov/pubmed/23624105 ID - info:doi/10.2196/jmir.2500 ER - TY - JOUR AU - Silva, M. Bruno AU - Rodrigues, JPC Joel AU - Canelo, Fábio AU - Lopes, C. Ivo AU - Zhou, Liang PY - 2013/04/25 TI - A Data Encryption Solution for Mobile Health Apps in Cooperation Environments JO - J Med Internet Res SP - e66 VL - 15 IS - 4 KW - mobile health KW - mHealth KW - mobile computing KW - eHealth KW - cooperation KW - encryption KW - security N2 - Background: Mobile Health (mHealth) proposes health care delivering anytime and anywhere. It aims to answer several emerging problems in health services, including the increasing number of chronic diseases, high costs on national health services, and the need to provide direct access to health services, regardless of time and place. mHealth systems include the use of mobile devices and apps that interact with patients and caretakers. However, mobile devices present several constraints, such as processor, energy, and storage resource limitations. The constant mobility and often-required Internet connectivity also exposes and compromises the privacy and confidentiality of health information. Objective: This paper presents a proposal, construction, performance evaluation, and validation of a data encryption solution for mobile health apps (DE4MHA), considering a novel and early-proposed cooperation strategy. The goal was to present a robust solution based on encryption algorithms that guarantee the best confidentiality, integrity, and authenticity of users health information. In this paper, we presented, explained, evaluated the performance, and discussed the cooperation mechanisms and the proposed encryption solution for mHealth apps. Methods: First, we designed and deployed the DE4MHA. Then two studies were performed: (1) study and comparison of symmetric and asymmetric encryption/decryption algorithms in an mHealth app under a cooperation environment, and (2) performance evaluation of the DE4MHA. Its performance was evaluated through a prototype using an mHealth app for obesity prevention and cares, called SapoFit. We then conducted an evaluation study of the mHealth app with cooperation mechanisms and the DE4MHA using real users and a real cooperation scenario. In 5 days, 5 different groups of 7 students selected randomly agreed to use and experiment the SapoFit app using the 7 devices available for trials. Results: There were 35 users of SapoFit that participated in this study. The performance evaluation of the app was done using 7 real mobile devices in 5 different days. The results showed that confidentiality and protection of the users? health information was guaranteed and SapoFit users were able to use the mHealth app with satisfactory quality. Results also showed that the app with the DE4MHA presented nearly the same results as the app without the DE4MHA. The performance evaluation results considered the probability that a request was successfully answered as a function of the number of uncooperative nodes in the network. The service delivery probability decreased with the increase of uncooperative mobile nodes. Using DE4MHA, it was observed that performance presented a slightly worse result. The service average was also slightly worse but practically insignificantly different than with DE4MHA, being considered negligible. Conclusions: This paper proposed a data encryption solution for mobile health apps, called DE4MHA. The data encryption algorithm DE4MHA with cooperation mechanisms in mobile health allow users to safely obtain health information with the data being carried securely. These security mechanisms did not deteriorate the overall network performance and the app, maintaining similar performance levels as without the encryption. More importantly, it offers a robust and reliable increase of privacy, confidentiality, integrity, and authenticity of their health information. Although it was experimented on a specific mHealth app, SapoFit, both DE4MHA and the cooperation strategy can be deployed in other mHealth apps. UR - http://www.jmir.org/2013/4/e66/ UR - http://dx.doi.org/10.2196/jmir.2498 UR - http://www.ncbi.nlm.nih.gov/pubmed/23624056 ID - info:doi/10.2196/jmir.2498 ER - TY - JOUR AU - Lewis, Lorchan Thomas PY - 2013/04/24 TI - A Systematic Self-Certification Model for Mobile Medical Apps JO - J Med Internet Res SP - e89 VL - 15 IS - 4 KW - smartphone KW - technology KW - education KW - medicine KW - app KW - health care KW - Android KW - iPhone KW - BlackBerry KW - mobile phone KW - standards UR - http://www.jmir.org/2013/4/e89/ UR - http://dx.doi.org/10.2196/jmir.2446 UR - http://www.ncbi.nlm.nih.gov/pubmed/23615332 ID - info:doi/10.2196/jmir.2446 ER - TY - JOUR AU - Albrecht, Urs-Vito AU - Behrends, Marianne AU - Schmeer, Regina AU - Matthies, K. Herbert AU - von Jan, Ute PY - 2013/04/23 TI - Usage of Multilingual Mobile Translation Applications in Clinical Settings JO - JMIR Mhealth Uhealth SP - e4 VL - 1 IS - 1 KW - medical informatics applications KW - nursing care KW - cultural deprivation N2 - Background: Communication between patients and medical staff can be challenging if both parties have different cultural and linguistic backgrounds. Specialized applications can potentially alleviate these problems and significantly contribute to an effective, improved care process when foreign language patients are involved. Objective: The objective for this paper was to discuss the experiences gained from a study carried out at the Hannover Medical School regarding the use of a mobile translation application in hospital wards. The conditions for successfully integrating these technologies in the care process are discussed. Methods: iPads with a preinstalled copy of an exemplary multilingual assistance tool (?xprompt?) designed for use in medical care were deployed on 10 wards. Over a period of 6 weeks, approximately 160 employees of the care staff had the opportunity to gather experiences with the devices while putting them to use during their work. Afterwards, the participants were asked to fill out an anonymous, paper-based questionnaire (17 questions) covering the usability of the iPads, translation apps in general, and the exemplary chosen application specifically. For questions requiring a rating, Likert scales were employed. The retained data were entered into an electronic survey system and exported to Microsoft Excel 2007 for further descriptive analysis. Results: Of 160 possible participants, 42 returned the questionnaire and 39 completed the questions concerning the chosen app. The demographic data acquired via the questionnaire (ie, age, professional experience, gender) corresponded to the values for the entire care staff at the Hannover Medical School. Most respondents (35/39, 90%) had no previous experience with an iPad. On a 7-point scale, the participants generally rated mobile translation tools as helpful for communicating with foreign language patients (36/39, 92%; median=5, IQR=2). They were less enthusiastic about xprompt?s practical use (36/39, median=4, IQR=2.5), although the app was perceived as easy-to-use (36/39, median=6, IQR=3) and there were no obvious problems with the usability of the device (36/39, median=6, IQR=2). Conclusions: The discrepancy between the expert ratings for xprompt (collected from the App Store and online) and the opinions of the study?s participants can probably be explained by the differing approaches of the two user groups. The experts had clear expectations, whereas, without a more thorough introduction, our study participants perceived using the app as too time consuming in relation to the expected benefit. The introduction of such tools in today?s busy care settings should therefore be more carefully planned to heighten acceptance of new tools. Still, the low return rate of the questionnaires only allows for speculations on the data, and further research is necessary. Trial Registration: This study was approved by the local institutional review board (IRB), Trial ID number: 1145-2011. UR - http://mhealth.jmir.org/2013/1/e4/ UR - http://dx.doi.org/10.2196/mhealth.2268 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100677 ID - info:doi/10.2196/mhealth.2268 ER - TY - JOUR AU - Dennison, Laura AU - Morrison, Leanne AU - Conway, Gemma AU - Yardley, Lucy PY - 2013/04/18 TI - Opportunities and Challenges for Smartphone Applications in Supporting Health Behavior Change: Qualitative Study JO - J Med Internet Res SP - e86 VL - 15 IS - 4 KW - mobile phone KW - cellular phone KW - behavior KW - health KW - qualitative research KW - focus groups N2 - Background: There is increasing interest from academics and clinicians in harnessing smartphone applications (apps) as a means of delivering behavioral interventions for health. Despite the growing availability of a range of health-related apps on the market, academic research on the development and evaluation of such apps is in the relatively early stages. A few existing studies have explored the views of various populations on using mobile phones for health-related issues and some studies are beginning to report user feedback on specific apps. However, there remains little in depth research on users? (and potential users?) experiences and views on a wide range of features and technologies that apps are, or will soon be, capable of. In particular, research on young adults is lacking, which is an unfortunate omission considering that this group comprises of a good number of mobile technology adoptors. Objective: The current study sought to explore young adults? perspectives on apps related to health behavior change. It sought their experiences and views of features that might support health behavior change and issues that contribute to interest in and willingness to use such apps. Methods: Four focus groups were conducted with 19 students and staff at a University in the United Kingdom. Participants included 13 females and 6 males with a mean age of 23.79 (SD 7.89). The focus group discussions centred on participants? experiences of using smartphone apps to support a healthy lifestyle, and their interest in and feelings about features and capabilities of such apps. The focus groups were recorded, transcribed, and analyzed using inductive thematic analysis. Results: Study findings suggested that young, currently healthy adults have some interest in apps that attempt to support health-related behavior change. Accuracy and legitimacy, security, effort required, and immediate effects on mood emerged as important influences on app usage. The ability to record and track behavior and goals and the ability to acquire advice and information ?on the go? were valued. Context-sensing capabilities and social media features tended to be considered unnecessary and off-putting. Conclusions: This study provided insight into the opportunities and challenges involved in delivering health-related behavioral interventions through smartphone apps. The findings suggested a number of valued features and characteristics that app developers may wish to consider when creating health behavior apps. Findings also highlighted several major challenges that appeared to need further consideration and research to ensure the development of effective and well-accepted behavior change apps. UR - http://www.jmir.org/2013/4/e86/ UR - http://dx.doi.org/10.2196/jmir.2583 UR - http://www.ncbi.nlm.nih.gov/pubmed/23598614 ID - info:doi/10.2196/jmir.2583 ER - TY - JOUR AU - Thomas, Graham J. AU - Wing, R. Rena PY - 2013/04/17 TI - Health-E-Call, a Smartphone-Assisted Behavioral Obesity Treatment: Pilot Study JO - JMIR Mhealth Uhealth SP - e3 VL - 1 IS - 1 KW - obesity KW - behavior KW - weight loss KW - mobile phone KW - technology N2 - Background: Individual and group-based behavioral weight loss treatment (BWL) produces average weight loss of 5-10% of initial body weight, which improves health and wellbeing. However, BWL is an intensive treatment that is costly and not widely available. Smartphones may be a useful tool for promoting adherence to key aspects of BWL, such as self-monitoring, thereby facilitating weight loss while reducing the need for intensive in-person contact. Objective: The objective of this study was to evaluate smartphones as a method of delivering key components of established and empirically validated behavioral weight loss treatment, with an emphasis on adherence to self-monitoring. Methods: Twenty overweight/obese participants (95% women; 85% non-Hispanic White; mean age 53.0, SE 1.9) received 12-24 weeks of behavioral weight loss treatment consisting of smartphone-based self-monitoring, feedback, and behavioral skills training. Participants also received brief weekly weigh-ins and paper weight loss lessons. Results: Average weight loss was 8.4kg (SE 0.8kg; 9%, SE 1% of initial body weight) at 12 weeks and 10.9kg (SE 1.1kg; 11%, SE 1% of initial body weight) at 24 weeks. Adherence to the self-monitoring protocol was 91% (SE 3%) during the first 12 weeks and 85% (SE 4%) during the second 12 weeks. Conclusions: Smartphones show promise as a tool for delivering key components of BWL and may be particularly advantageous for optimizing adherence to self-monitoring, a cornerstone of BWL. UR - http://mhealth.jmir.org/2013/1/e3/ UR - http://dx.doi.org/10.2196/mhealth.2164 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100672 ID - info:doi/10.2196/mhealth.2164 ER - TY - JOUR AU - Baron, Sophie AU - Goutard, Flavie AU - Nguon, Kunthy AU - Tarantola, Arnaud PY - 2013/04/16 TI - Use of a Text Message-Based Pharmacovigilance Tool in Cambodia: Pilot Study JO - J Med Internet Res SP - e68 VL - 15 IS - 4 KW - cellular phone KW - text messages KW - texting KW - short message service KW - vaccines KW - adverse events KW - surveillance KW - adverse drug reaction reporting systems KW - pharmacovigilance N2 - Background: There is no functional pharmacovigilance system in Cambodia to our knowledge. Mobile phone?based tools, such as short message service (SMS) text messages, are increasingly used for surveillance purposes. Objective: To pilot-test the FrontlineSMS mobile phone?based tool for notification of adverse events, using Cambodia?s only International Vaccination Center at the Institut Pasteur du Cambodge as a field site. Methods: People receiving vaccinations, aged over 18 years, and who owned a cell phone were recruited in the study following informed consent. The names and mobile phone numbers of the participants interviewed were entered each day into the FrontlineSMS software. Two days after being vaccinated, participants received an automatically generated SMS text message asking whether any adverse events had occurred. Their SMS reply was number-coded and exported from the software daily to an Excel spreadsheet and examined before being saved. If the participant replied with a code for a severe adverse event (8 or 9), they were automatically advised to consult the nearest doctor. Results: The active surveillance study was conducted over 72 days in the spring of 2012. Patients agreed to be asked by SMS text message whether unwanted events had occurred after vaccination. Of 1331 persons aged over 18 years referred to the vaccination unit, 184 (13.8%) were asked and agreed to participate. When texted for clinical status 48 hours after vaccination, 52 (28.3%) participants did not reply, 101 (54.9%) sent an immediate SMS reply, and 31 (16.8%) sent an SMS reply after additional prompting. Of the initial 184 participants, 132 (71.7%) replied. These 132 participants received 135 vaccine doses and 109 (82.6%) reported no adverse events, whereas 23 (17.4%) reported adverse events, all benign. Conclusions: Notification using an SMS-based text message system is already used in Cambodia for syndromic surveillance in health centers and reporting by health care workers. Our results show that such tools can also be useful for notification by patients or health users in Cambodia, especially in an urban setting. UR - http://www.jmir.org/2013/4/e68/ UR - http://dx.doi.org/10.2196/jmir.2477 UR - http://www.ncbi.nlm.nih.gov/pubmed/23591700 ID - info:doi/10.2196/jmir.2477 ER - TY - JOUR AU - Carter, Clare Michelle AU - Burley, Jane Victoria AU - Nykjaer, Camilla AU - Cade, Elizabeth Janet PY - 2013/04/15 TI - Adherence to a Smartphone Application for Weight Loss Compared to Website and Paper Diary: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e32 VL - 15 IS - 4 KW - smartphone KW - obesity KW - text message KW - app N2 - Background: There is growing interest in the use of information communication technologies to treat obesity. An intervention delivered by smartphone could be a convenient, potentially cost-effective, and wide-reaching weight management strategy. Although there have been studies of texting-based interventions and smartphone applications (apps) used as adjuncts to other treatments, there are currently no randomized controlled trials (RCT) of a stand-alone smartphone application for weight loss that focuses primarily on self-monitoring of diet and physical activity. Objective: The aim of this pilot study was to collect acceptability and feasibility outcomes of a self-monitoring weight management intervention delivered by a smartphone app, compared to a website and paper diary. Methods: A sample of 128 overweight volunteers were randomized to receive a weight management intervention delivered by smartphone app, website, or paper diary. The smartphone app intervention, My Meal Mate (MMM), was developed by the research team using an evidence-based behavioral approach. The app incorporates goal setting, self-monitoring of diet and activity, and feedback via weekly text message. The website group used an existing commercially available slimming website from a company called Weight Loss Resources who also provided the paper diaries. The comparator groups delivered a similar self-monitoring intervention to the app, but by different modes of delivery. Participants were recruited by email, intranet, newsletters, and posters from large local employers. Trial duration was 6 months. The intervention and comparator groups were self-directed with no ongoing human input from the research team. The only face-to-face components were at baseline enrollment and brief follow-up sessions at 6 weeks and 6 months to take anthropometric measures and administer questionnaires. Results: Trial retention was 40/43 (93%) in the smartphone group, 19/42 (55%) in the website group, and 20/43 (53%) in the diary group at 6 months. Adherence was statistically significantly higher in the smartphone group with a mean of 92 days (SD 67) of dietary recording compared with 35 days (SD 44) in the website group and 29 days (SD 39) in the diary group (P<.001). Self-monitoring declined over time in all groups. In an intention-to-treat analysis using baseline observation carried forward for missing data, mean weight change at 6 months was -4.6 kg (95% CI ?6.2 to ?3.0) in the smartphone app group, ?2.9 kg (95% CI ?4.7 to ?1.1) in the diary group, and ?1.3 kg (95% CI ?2.7 to 0.1) in the website group. BMI change at 6 months was ?1.6 kg/m2 (95% CI ?2.2 to ?1.1) in the smartphone group, ?1.0 kg/m2 (95% CI ?1.6 to ?0.4) in the diary group, and ?0.5 kg/m2 (95% CI ?0.9 to 0.0) in the website group. Change in body fat was ?1.3% (95% CI ?1.7 to ?0.8) in the smartphone group, ?0.9% (95% CI ?1.5 to ?0.4) in the diary group, and ?0.5% (95% CI ?0.9 to 0.0) in the website group. Conclusions: The MMM app is an acceptable and feasible weight loss intervention and a full RCT of this approach is warranted. Trial Registration: ClinicalTrials.gov NCT01744535; http://clinicaltrials.gov/ct2/show/NCT01744535 (Archived by WebCite at http://www.webcitation.org/6FEtc3PVB) UR - http://www.jmir.org/2013/4/e32/ UR - http://dx.doi.org/10.2196/jmir.2283 UR - http://www.ncbi.nlm.nih.gov/pubmed/23587561 ID - info:doi/10.2196/jmir.2283 ER - TY - JOUR AU - Ainsworth, John AU - Palmier-Claus, E. Jasper AU - Machin, Matthew AU - Barrowclough, Christine AU - Dunn, Graham AU - Rogers, Anne AU - Buchan, Iain AU - Barkus, Emma AU - Kapur, Shitij AU - Wykes, Til AU - Hopkins, S. Richard AU - Lewis, Shôn PY - 2013/04/05 TI - A Comparison of Two Delivery Modalities of a Mobile Phone-Based Assessment for Serious Mental Illness: Native Smartphone Application vs Text-Messaging Only Implementations JO - J Med Internet Res SP - e60 VL - 15 IS - 4 KW - mobile phone KW - psychosis KW - assessment KW - schizophrenia KW - text-messages N2 - Background: Mobile phone?based assessment may represent a cost-effective and clinically effective method of monitoring psychotic symptoms in real-time. There are several software options, including the use of native smartphone applications and text messages (short message service, SMS). Little is known about the strengths and limitations of these two approaches in monitoring symptoms in individuals with serious mental illness. Objective: The objective of this study was to compare two different delivery modalities of the same diagnostic assessment for individuals with non-affective psychosis?a native smartphone application employing a graphical, touch user interface against an SMS text-only implementation. The overall hypothesis of the study was that patient participants with sewrious mental illness would find both delivery modalities feasible and acceptable to use, measured by the quantitative post-assessment feedback questionnaire scores, the number of data points completed, and the time taken to complete the assessment. It was also predicted that a native smartphone application would (1) yield a greater number of data points, (2) take less time, and (3) be more positively appraised by patient participant users than the text-based system. Methods: A randomized repeated measures crossover design was employed. Participants with currently treated Diagnostic and Statistical Manual (Fourth Edition) schizophrenia or related disorders (n=24) were randomly allocated to completing 6 days of assessment (four sets of questions per day) with a native smartphone application or the SMS text-only implementation. There was then a 1-week break before completing a further 6 days with the alternative delivery modality. Quantitative feedback questionnaires were administered at the end of each period of sampling. Results: A greater proportion of data points were completed with the native smartphone application in comparison to the SMS text-only implementation (? = -.25, SE=.11, P=.02), which also took significantly less time to complete (? =.78, SE= .09, P<.001). Although there were no significant differences in participants? quantitative feedback for the two delivery modalities, most participants reported preferring the native smartphone application (67%; n=16) and found it easier to use (71%; n=16). 33% of participants reported that they would be willing to complete mobile phone assessment for 5 weeks or longer. Conclusions: Native smartphone applications and SMS text are both valuable methods of delivering real-time assessment in individuals with schizophrenia. However, a more streamlined graphical user interface may lead to better compliance and shorter entry times. Further research is needed to test the efficacy of this technology within clinical services, to assess validity over longer periods of time and when delivered on patients? own phones. UR - http://www.jmir.org/2013/4/e60/ UR - http://dx.doi.org/10.2196/jmir.2328 UR - http://www.ncbi.nlm.nih.gov/pubmed/23563184 ID - info:doi/10.2196/jmir.2328 ER - TY - JOUR AU - Palazuelos, Daniel AU - Diallo, B. Assiatou AU - Palazuelos, Lindsay AU - Carlile, Narath AU - Payne, D. Jonathan AU - Franke, F. Molly PY - 2013/04/04 TI - User Perceptions of an mHealth Medicine Dosing Tool for Community Health Workers JO - JMIR Mhealth Uhealth SP - e2 VL - 1 IS - 1 KW - community health worker KW - cellular phone KW - mobile health KW - Mexico KW - Guatemala KW - decision support techniques KW - medical order entry systems N2 - Background: Mobile health (mHealth) technologies provide many potential benefits to the delivery of health care. Medical decision support tools have shown particular promise in improving quality of care and provider workflow. Frontline health workers such as Community Health Workers (CHWs) have been shown to be effective in extending the reach of care, yet only a few medicine dosing tools are available to them. Objective: We developed an mHealth medicine dosing tool tailored to the skill level of CHWs to assist in the delivery of care. The mHealth tool was created for CHWs with primary school education working in rural Mexico and Guatemala. Perceptions and impressions of this tool were collected and compared to an existing paper-based medicine dosing tool. Methods: Seventeen Partners In Health CHWs in rural Mexico and Guatemala completed a one-day training in the mHealth medicine dosing tool. Following the training, a prescription dosing test was administered, and CHWs were given the choice to use the mHealth or paper-based tool to answer 7 questions. Subsequently, demographic and qualitative data was collected using a questionnaire and an in-person interview conducted in Spanish, then translated into English. The qualitative questions captured data on 4 categories: comfort, acceptability, preference, and accuracy. Qualitative responses were analyzed for major themes and quantitative variables were analyzed using SAS. Results: 82% of the 17 CHWs chose the mHealth tool for at least 1 of 7 questions compared to 53% (9/17) who chose to use the paper-based tool. 93% (13/14) rated the phone as being easy or very easy to use, and 56% (5/9) who used the paper-based tool rated it as easy or very easy. Dosing accuracy was generally higher among questions answered using the mHealth tool relative to questions answered using the paper-based tool. Analysis of major qualitative themes indicated that the mHealth tool was perceived as being quick, easy to use, and as having complete information. The mHealth tool was seen as an acceptable dosing tool to use and as a way for CHWs to gain credibility within the community. Conclusions: A tailored cell phone-based mHealth medicine dosing tool was found to be useful and acceptable by CHWs in rural Mexico and Guatemala. The streamlined workflow of the mHealth tool and benefits such as the speed and self-lighting were found to be particularly useful features. Well designed and positioned tools such as this may improve effective task shifting by reinforcing the tasks that different cadres of workers are asked to perform. Further studies can explore how to best implement this mHealth tool in real-world settings, including how to incorporate the best elements of the paper-based tool that were also found to be helpful. UR - http://mhealth.jmir.org/2013/1/e2/ UR - http://dx.doi.org/10.2196/mhealth.2459 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100670 ID - info:doi/10.2196/mhealth.2459 ER - TY - JOUR AU - Kristjánsdóttir, Birna Ólöf AU - Fors, A. Egil AU - Eide, Erlend AU - Finset, Arnstein AU - Stensrud, Lauritzen Tonje AU - van Dulmen, Sandra AU - Wigers, Hørven Sigrid AU - Eide, Hilde PY - 2013/03/28 TI - A Smartphone-Based Intervention With Diaries and Therapist Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain. Part 2: 11-month Follow-up Results of a Randomized Trial JO - J Med Internet Res SP - e72 VL - 15 IS - 3 KW - Internet-based personalized feedback KW - widespread chronic pain KW - fibromyalgia KW - pain management KW - eHealth KW - smartphone KW - Internet KW - cognitive therapy KW - catastrophization N2 - Background: Internet-based interventions are increasingly used to support self-management of individuals with chronic illnesses. Web-based interventions may also be effective in enhancing self-management for individuals with chronic pain, but little is known about long-term effects. Research on Web-based interventions to support self-management following participation in pain management programs is limited. Objective: The aim is to examine the long-term effects of a 4-week smartphone-intervention with diaries and therapist-written feedback following an inpatient chronic pain rehabilitation program, previously found to be effective at short-term and 5-month follow-ups. Methods: 140 women with chronic widespread pain, participating in a 4-week inpatient rehabilitation program, were randomized into two groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of one face-to-face individual session and 4 weeks of written communication via a smartphone, consisting of three diaries daily to elicit pain-related thoughts, feelings, and activities, as well as daily personalized written feedback based on cognitive behavioral principles from a therapist. Both groups were given access to an informational website to promote constructive self-management. Outcomes were measured with self-reported paper-and-pencil format questionnaires with catastrophizing as the primary outcome measure. Secondary outcomes included daily functioning and symptom levels, acceptance of pain, and emotional distress. Results: By the 11-month follow-up, the favorable between-group differences previously reported post-intervention and at 5-month follow-up on catastrophizing, acceptance, functioning, and symptom level were no longer evident (P>.10). However, there was more improvement in catastrophizing scores during the follow-up period in the intervention group (M=-2.36, SD 8.41) compared to the control group (M=.40, SD 7.20), P=.045. Also, per protocol within-group analysis showed a small positive effect (Cohen?s d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up. A positive effect (Cohen?s d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group. Small to large negative effects were found within the control group on functioning and symptom levels, emotional distress, and fatigue (P=.05) from the intervention baseline to the 11-month follow-up. Conclusion: The long-term results of this randomized trial are ambiguous. No significant between-group effect was found on the study variables at 11-month follow-up. However, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group. This study provides modest evidence supporting the long-term effect of the intervention. Trial Registration: Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6FF7KUXo0) UR - http://www.jmir.org/2013/3/e72/ UR - http://dx.doi.org/10.2196/jmir.2442 UR - http://www.ncbi.nlm.nih.gov/pubmed/23538392 ID - info:doi/10.2196/jmir.2442 ER - TY - JOUR AU - Tatara, Naoe AU - Årsand, Eirik AU - Skrøvseth, Olav Stein AU - Hartvigsen, Gunnar PY - 2013/03/27 TI - Long-Term Engagement With a Mobile Self-Management System for People With Type 2 Diabetes JO - JMIR Mhealth Uhealth SP - e1 VL - 1 IS - 1 KW - Type 2 diabetes KW - self-management KW - user-involved design process KW - mobile phone KW - usage KW - usability KW - mHealth N2 - Background: In a growing number of intervention studies, mobile phones are used to support self-management of people with Type 2 diabetes mellitus (T2DM). However, it is difficult to establish knowledge about factors associated with intervention effects, due to considerable differences in research designs and outcome measures as well as a lack of detailed information about participants? engagement with the intervention tool. Objective: To contribute toward accumulating knowledge about factors associated with usage and usability of a mobile self-management application over time through a thorough analysis of multiple types of investigation on each participant?s engagement. Methods: The Few Touch application is a mobile-phone?based self-management tool for patients with T2DM. Twelve patients with T2DM who have been actively involved in the system design used the Few Touch application in a real-life setting from September 2008 until October 2009. During this period, questionnaires and semistructured interviews were conducted. Recorded data were analyzed to investigate usage trends and patterns. Transcripts from interviews were thematically analyzed, and the results were further analyzed in relation to the questionnaire answers and the usage trends and patterns. Results: The Few Touch application served as a flexible learning tool for the participants, responsive to their spontaneous needs, as well as supporting regular self-monitoring. A significantly decreasing (P<.05) usage trend was observed among 10 out of the 12 participants, though the magnitude of the decrease varied widely. Having achieved a sense of mastery over diabetes and experiences of problems were identified as reasons for declining motivation to continue using the application. Some of the problems stemmed from difficulties in integrating the use of the application into each participant?s everyday life and needs, although the design concepts were developed in the process where the participants were involved. The following factors were identified as associated with usability and/or usage over time: Integration with everyday life; automation; balance between accuracy and meaningfulness of data with manual entry; intuitive and informative feedback; and rich learning materials, especially about foods. Conclusion: Many grounded design implications were identified through a thorough analysis of results from multiple types of investigations obtained through a year-long field trial of the Few Touch application. The study showed the importance and value of involving patient-users in a long-term trial of a tool to identify factors influencing usage and usability over time. In addition, the study confirmed the importance of detailed analyses of each participant?s usage of the provided tool for better understanding of participants? engagement over time. UR - http://mhealth.jmir.org/2013/1/e1/ UR - http://dx.doi.org/10.2196/mhealth.2432 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100649 ID - info:doi/10.2196/mhealth.2432 ER - TY - JOUR AU - Nundy, Shantanu AU - Razi, R. Rabia AU - Dick, J. Jonathan AU - Smith, Bryan AU - Mayo, Ainoa AU - O'Connor, Anne AU - Meltzer, O. David PY - 2013/03/11 TI - A Text Messaging Intervention to Improve Heart Failure Self-Management After Hospital Discharge in a Largely African-American Population: Before-After Study JO - J Med Internet Res SP - e53 VL - 15 IS - 3 KW - heart failure KW - self-care KW - patient education KW - cellular phone KW - text messaging KW - African Americans N2 - Background: There is increasing interest in finding novel approaches to reduce health disparities in readmissions for acute decompensated heart failure (ADHF). Text messaging is a promising platform for improving chronic disease self-management in low-income populations, yet is largely unexplored in ADHF. Objective: The purpose of this pre-post study was to assess the feasibility and acceptability of a text message?based (SMS: short message service) intervention in a largely African American population with ADHF and explore its effects on self-management. Methods: Hospitalized patients with ADHF were enrolled in an automated text message?based heart failure program for 30 days following discharge. Messages provided self-care reminders and patient education on diet, symptom recognition, and health care navigation. Demographic and cell phone usage data were collected on enrollment, and an exit survey was administered on completion. The Self-Care of Heart Failure Index (SCHFI) was administered preintervention and postintervention and compared using sample t tests (composite) and Wilcoxon rank sum tests (individual). Clinical data were collected through chart abstraction. Results: Of 51 patients approached for recruitment, 27 agreed to participate and 15 were enrolled (14 African-American, 1 White). Barriers to enrollment included not owning a personal cell phone (n=12), failing the Mini-Mental exam (n=3), needing a proxy (n=2), hard of hearing (n=1), and refusal (n=3). Another 3 participants left the study for health reasons and 3 others had technology issues. A total of 6 patients (5 African-American, 1 White) completed the postintervention surveys. The mean age was 50 years (range 23-69) and over half had Medicaid or were uninsured (60%, 9/15). The mean ejection fraction for those with systolic dysfunction was 22%, and at least two-thirds had a prior hospitalization in the past year. Participants strongly agreed that the program was easy to use (83%), reduced pills missed (66%), and decreased salt intake (66%). Maintenance (mean composite score 49 to 78, P=.003) and management (57 to 86, P=.002) improved at 4 weeks, whereas confidence did not change (57 to 75, P=.11). Of the 6 SCHFI items that showed a statistically significant improvement, 5 were specifically targeted by the texting intervention. Conclusions: Over half of ADHF patients in an urban, largely African American community were eligible and interested in participating in a text messaging program following discharge. Access to mobile phones was a significant barrier that should be addressed in future interventions. Among the participants who completed the study, we observed a high rate of satisfaction and preliminary evidence of improvements in heart failure self-management. UR - http://www.jmir.org/2013/3/e53/ UR - http://dx.doi.org/10.2196/jmir.2317 UR - http://www.ncbi.nlm.nih.gov/pubmed/23478028 ID - info:doi/10.2196/jmir.2317 ER - TY - JOUR AU - Stinson, N. Jennifer AU - Jibb, A. Lindsay AU - Nguyen, Cynthia AU - Nathan, C. Paul AU - Maloney, Marie Anne AU - Dupuis, Lee L. AU - Gerstle, Ted J. AU - Alman, Benjamin AU - Hopyan, Sevan AU - Strahlendorf, Caron AU - Portwine, Carol AU - Johnston, L. Donna AU - Orr, Mike PY - 2013/03/08 TI - Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer JO - J Med Internet Res SP - e51 VL - 15 IS - 3 KW - neoplasms KW - pain KW - child KW - adolescent KW - youth KW - cellular phone KW - game N2 - Background: Pain is one of the most common and distressing symptoms reported by adolescents with cancer. Despite advancements in pain assessment and management research, pain due to cancer and/or its treatments continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the adolescent with cancer group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration, location, and the impact pain has on an adolescent?s life (ie, relationships, school work, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 20 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a Web interface. Each diary entry represents a pain case filed by an adolescent with cancer and a reward system (ie, moving up through law-enforcement team ranks, built-in videotaped acknowledgements from fictitious officers) encourages consistent use of the diary. Objective: Our objective was to design, develop, and test the usability, feasibility, compliance, and satisfaction of a game-based smartphone pain assessment tool for adolescents with cancer. Methods: We used both low- and high-fidelity qualitative usability testing with qualitative semi-structured, audio-taped interviews and iterative cycles to design and refine the iPhone based Pain Squad app. Qualitative thematic analysis of interviews using constant comparative methodology captured emergent themes related to app usability. Content validity was assessed using question importance-rating surveys completed by participants. Compliance and satisfaction data were collected following a 2-week feasibility trial where users were alarmed to record their pain twice daily on the app. Results: Thematic analysis of usability interviews showed the app to be appealing overall to adolescents. Analyses of both low- and high-fidelity testing resulted in minor revisions to the app to refine the theme and improve its usability. Adolescents resoundingly endorsed the game-based nature of the app and its virtual reward system. The importance of app pain diary questions was established by content validity analysis. Compliance with the app, assessed during feasibility testing, was high (mean 81%, SD 22%) and adolescents from this phase of the study found the app likeable, easy to use, and not bothersome to complete. Conclusions: A multifaceted usability approach demonstrated how the Pain Squad app could be made more appealing to children and adolescents with cancer. The game-based nature and built-in reward system of the app was appealing to adolescents and may have resulted in the high compliance rates and satisfaction ratings observed during clinical feasibility testing. UR - http://www.jmir.org/2013/3/e51/ UR - http://dx.doi.org/10.2196/jmir.2350 UR - http://www.ncbi.nlm.nih.gov/pubmed/23475457 ID - info:doi/10.2196/jmir.2350 ER - TY - JOUR AU - Solvoll, Terje AU - Scholl, Jeremiah AU - Hartvigsen, Gunnar PY - 2013/03/07 TI - Physicians Interrupted by Mobile Devices in Hospitals: Understanding the Interaction Between Devices, Roles, and Duties JO - J Med Internet Res SP - e56 VL - 15 IS - 3 KW - Ethnography KW - Mobile communication KW - interruptions KW - Context-aware computing KW - Pervasive computing KW - User-centered design methods KW - Health care KW - Pagers KW - Wireless phones KW - CSCW KW - HCI N2 - Background: A common denominator of modern hospitals is a variety of communication problems. In particular, interruptions from mobile communication devices are a cause of great concern for many physicians. Objective: To characterize how interruptions from mobile devices disturb physicians in their daily work. The gathered knowledge will be subsequently used as input for the design and development of a context-sensitive communication system for mobile communications suitable for hospitals. Methods: This study adheres to an ethnographic and interpretive field research approach. The data gathering consisted of participant observations, non-structured and mostly ad hoc interviews, and open-ended discussions with a selected group of physicians. Eleven physicians were observed for a total of 135 hours during May and June 2009. Results: The study demonstrates to what degree physicians are interrupted by mobile devices in their daily work and in which situations they are interrupted, such as surgery, examinations, and during patients/relatives high-importance level conversations. The participants in the study expected, and also indicated, that wireless phones probably led to more interruptions immediately after their introduction in a clinic, when compared to a pager, but this changed after a short while. The unpleasant feeling experienced by the caller when interrupting someone by calling them differs compared to sending a page message, which leaves it up to the receiver when to return the call. Conclusions: Mobile devices, which frequently interrupt physicians in hospitals, are a problem for both physicians and patients. The results from this study contribute to knowledge being used as input for designing and developing a prototype for a context-sensitive communication system for mobile communication suitable for hospitals. We combined these findings with results from earlier studies and also involved actual users to develop the prototype, CallMeSmart. This system intends to reduce such interruptions and at the same time minimize the number of communication devices needed per user. UR - http://www.jmir.org/2013/3/e56/ UR - http://dx.doi.org/10.2196/jmir.2473 UR - http://www.ncbi.nlm.nih.gov/pubmed/23470528 ID - info:doi/10.2196/jmir.2473 ER - TY - JOUR AU - Schnall, Rebecca AU - Okoniewski, Anastasia AU - Tiase, Victoria AU - Low, Alexander AU - Rodriguez, Martha AU - Kaplan, Steven PY - 2013/03/06 TI - Using Text Messaging to Assess Adolescents' Health Information Needs: An Ecological Momentary Assessment JO - J Med Internet Res SP - e54 VL - 15 IS - 3 KW - text messaging KW - ecological momentary assessment KW - mobile health technology N2 - Background: Use of mobile technology has made a huge impact on communication, access, and information/resource delivery to adolescents. Mobile technology is frequently used by adolescents. Objective: The purpose of this study was to understand the health information needs of adolescents in the context of their everyday lives and to assess how they meet their information needs. Methods: We gave 60 adolescents smartphones with unlimited text messaging and data for 30 days. Each smartphone had applications related to asthma, obesity, human immunodeficiency virus, and diet preinstalled on the phone. We sent text messages 3 times per week and asked the following questions: (1) What questions did you have about your health today? (2) Where did you look for an answer (mobile device, mobile application, online, friend, book, or parent)? (3) Was your question answered and how? (4) Anything else? Results: Our participants ranged from 13-18 years of age, 37 (62%) participants were male and 22 (37%) were female. Of the 60 participants, 71% (42/60) participants identified themselves as Hispanic and 77% (46/60) were frequent users of mobile devices. We had a 90% (1935/2150) response rate to our text messages. Participants sent a total of 1935 text messages in response to the ecological momentary assessment questions. Adolescents sent a total of 421 text messages related to a health information needs, and 516 text messages related to the source of information to the answers of their questions, which were related to parents, friends, online, mobile apps, teachers, or coaches. Conclusions: Text messaging technology is a useful tool for assessing adolescents? health behavior in real-time. Adolescents are willing to use text messaging to report their health information. Findings from this study contribute to the evidence base on addressing the health information needs of adolescents. In particular, attention should be paid to issues related to diet and exercise. These findings may be the harbinger for future obesity prevention programs for adolescents. UR - http://www.jmir.org/2013/3/e54/ UR - http://dx.doi.org/10.2196/jmir.2395 UR - http://www.ncbi.nlm.nih.gov/pubmed/23467200 ID - info:doi/10.2196/jmir.2395 ER - TY - JOUR AU - Hong, Yan AU - Dahlke, Vollmer Deborah AU - Ory, Marcia AU - Hochhalter, Angela AU - Reynolds, Jana AU - Purcell, Pena Ninfa AU - Talwar, Divya AU - Eugene, Nola PY - 2013/02/14 TI - Designing iCanFit: A Mobile-Enabled Web Application to Promote Physical Activity for Older Cancer Survivors JO - JMIR Res Protoc SP - e12 VL - 2 IS - 1 KW - older cancer survivors KW - physical activity, survivorship, mHealth, website design KW - user-computer interface KW - protocol development KW - formative research N2 - Background: Most older cancer survivors (OCS) do not engage in regular physical activity (PA) despite well-known health benefits. With the increased use of mobile technologies among older adults, mobile tools may be an effective method to deliver PA promotion programs for OCS. Objective: To document the process of designing an OCS-friendly mobile-enabled Web application of PA promotion program. Methods: Mixed methods encompassing group discussions, individual interviews, and brief surveys with community leaders, OCS, cancer care providers, and software professionals were used in this formative research. Results: The varied stakeholders welcomed the idea of developing an online tool to promote PA in OCS. Our formative research revealed several major barriers to regular PA including limited access to senior-friendly PA resources, lack of motivation and social support, and insufficient knowledge and skills on building safe and appropriate workout plans. This feedback was incorporated into the development of iCanFit, a mobile-enabled Web application, designed specifically for OCS. The iCanFit online tools allow users to locate PA resources, set and track goals for PA, network with peer OCS in a secure online space, and receive practical and evidence-informed healthy tips. Conclusions: Our mixed-method formative research led to the design of iCanFit protocol to promote PA and well-being of OCS. The involvement of stakeholders is critical in the planning and design of the mobile application in order to enhance program relevance, appeal, and match with the needs of target users. UR - http://www.researchprotocols.org/2013/1/e12/ UR - http://dx.doi.org/10.2196/resprot.2440 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612053 ID - info:doi/10.2196/resprot.2440 ER - TY - JOUR AU - Lee, Kyung Myung AU - Park, Hyeoun-Ae AU - Yun, Ho Young AU - Chang, Jung Yoon PY - 2013/02/13 TI - Development and Formative Evaluation of a Web-Based Self-Management Exercise and Diet Intervention Program With Tailored Motivation and Action Planning for Cancer Survivors JO - JMIR Res Protoc SP - e11 VL - 2 IS - 1 KW - Internet KW - health planning KW - exercise KW - diet KW - self-care KW - wellness programs N2 - Background: Most dietary and exercise interventions developed to date for cancer survivors have employed intensive clinic-based face-to-face counseling sessions. However, when the clinic-based face-to-face intervention ends, the participants cannot receive feedback from the experts, and the motivation for regular exercise and diet practices decreases. One way to overcome the shortcomings of clinic-based face-to-face intervention is to employ the Internet to this end. To maximize effectiveness when providing Web-based interventions, action planning should be able to start at the right time, education should be tailored to motivational readiness, and self-efficacy should be enhanced at appropriate intervals. Objective: The aim of this study was to develop a Web-based self-management diet and exercise intervention program with the aid of the transtheoretical model (TTM) and to conduct formative evaluations. Methods: The Web-based self-management exercise and diet intervention program was developed employing a 5-phase system development life-cycle (SDLC) method. The 5 phases were 1) identification of user requirements, 2) system design, 3) system development, 4) system evaluation, and 5) system application. An expert group composed of 3 content experts, a Web developer, and 2 Web designers, evaluated the usability and accuracy of the content. The program was evaluated by 30 breast cancer survivors for perceived ease of use. Results: The Web-based self-managed exercise and diet intervention program contained 5 components differing in screen layout. These components are introduction, assessment, education (tailored information provision), action planning (goal setting, scheduling, keeping a diary), and automatic feedback. Education, action planning, and automatic feedback were tailored to each participant through the assessment. The processes of change, self-efficacy, and decisional balance, which are the principal strategies encouraging behavioral change according to the TTM theory, were reflected in the education, and self-efficacy was also reflected in the automatic feedback. After iterative testing by experts on problems that arose in terms of usability and content accuracy during system operation, the perceived ease of use of the program was evaluated by 29 breast cancer survivors. The end users rated the program as being easy to understand and use (a total usability score of 81.3 points). In addition, program feasibility was evaluated using the percentage of patients (27/30, 90%) who consistently used the program. Conclusions: The use of Internet technology allowed immediate and easy access to interventions, real-time monitoring of progress, online education, tailored action planning, and tailored short message services using mobile phones. UR - http://www.researchprotocols.org/2013/1/e11/ UR - http://dx.doi.org/10.2196/resprot.2331 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612029 ID - info:doi/10.2196/resprot.2331 ER - TY - JOUR AU - Källander, Karin AU - Tibenderana, K. James AU - Akpogheneta, J. Onome AU - Strachan, L. Daniel AU - Hill, Zelee AU - ten Asbroek, A. Augustinus H. AU - Conteh, Lesong AU - Kirkwood, R. Betty AU - Meek, R. Sylvia PY - 2013/01/25 TI - Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review JO - J Med Internet Res SP - e17 VL - 15 IS - 1 KW - mHealth KW - community health worker KW - Africa N2 - Background: Mobile health (mHealth) describes the use of portable electronic devices with software applications to provide health services and manage patient information. With approximately 5 billion mobile phone users globally, opportunities for mobile technologies to play a formal role in health services, particularly in low- and middle-income countries, are increasingly being recognized. mHealth can also support the performance of health care workers by the dissemination of clinical updates, learning materials, and reminders, particularly in underserved rural locations in low- and middle-income countries where community health workers deliver integrated community case management to children sick with diarrhea, pneumonia, and malaria. Objective: Our aim was to conduct a thematic review of how mHealth projects have approached the intersection of cellular technology and public health in low- and middle-income countries and identify the promising practices and experiences learned, as well as novel and innovative approaches of how mHealth can support community health workers. Methods: In this review, 6 themes of mHealth initiatives were examined using information from peer-reviewed journals, websites, and key reports. Primary mHealth technologies reviewed included mobile phones, personal digital assistants (PDAs) and smartphones, patient monitoring devices, and mobile telemedicine devices. We examined how these tools could be used for education and awareness, data access, and for strengthening health information systems. We also considered how mHealth may support patient monitoring, clinical decision making, and tracking of drugs and supplies. Lessons from mHealth trials and studies were summarized, focusing on low- and middle-income countries and community health workers. Results: The review revealed that there are very few formal outcome evaluations of mHealth in low-income countries. Although there is vast documentation of project process evaluations, there are few studies demonstrating an impact on clinical outcomes. There is also a lack of mHealth applications and services operating at scale in low- and middle-income countries. The most commonly documented use of mHealth was 1-way text-message and phone reminders to encourage follow-up appointments, healthy behaviors, and data gathering. Innovative mHealth applications for community health workers include the use of mobile phones as job aides, clinical decision support tools, and for data submission and instant feedback on performance. Conclusions: With partnerships forming between governments, technologists, non-governmental organizations, academia, and industry, there is great potential to improve health services delivery by using mHealth in low- and middle-income countries. As with many other health improvement projects, a key challenge is moving mHealth approaches from pilot projects to national scalable programs while properly engaging health workers and communities in the process. By harnessing the increasing presence of mobile phones among diverse populations, there is promising evidence to suggest that mHealth can be used to deliver increased and enhanced health care services to individuals and communities, while helping to strengthen health systems. UR - http://www.jmir.org/2013/1/e17/ UR - http://dx.doi.org/10.2196/jmir.2130 UR - http://www.ncbi.nlm.nih.gov/pubmed/23353680 ID - info:doi/10.2196/jmir.2130 ER - TY - JOUR AU - Brendryen, Håvar AU - Johansen, Ayna AU - Nesvåg, Sverre AU - Kok, Gerjo AU - Duckert, Fanny PY - 2013/01/23 TI - Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach JO - JMIR Res Protoc SP - e6 VL - 2 IS - 1 KW - early intervention KW - at-risk drinkers KW - hazardous drinking KW - harmful drinking KW - intervention mapping KW - Internet, cell phone, eHealth, short message service N2 - Background: Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. Objective: The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. Methods: We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. Results: The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels. Conclusions: The descriptions of the treatment rationale for Balance, the alcohol intervention reported herein, provides an intervention blueprint that will aid in interpreting the results from future program evaluations. It will ease comparisons of program rationales across interventions, and may assist intervention development. By putting just-in-time therapy within a complete theoretical and practical context, including the tunnel delivery strategy and the self-regulation perspective, we have contributed to an understanding of how multiple delivery strategies in eHealth interventions can be combined. Additionally, this is a call for action to improve the reporting practices within eHealth research. Possible ways to achieve such improvement include using a systematic and structured approach, and for intervention reports to be published after peer-review and separately from evaluation reports. UR - http://www.researchprotocols.org/2013/1/e6/ UR - http://dx.doi.org/10.2196/resprot.2371 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612478 ID - info:doi/10.2196/resprot.2371 ER - TY - JOUR AU - Lappalainen, Päivi AU - Kaipainen, Kirsikka AU - Lappalainen, Raimo AU - Hoffrén, Henna AU - Myllymäki, Tero AU - Kinnunen, Marja-Liisa AU - Mattila, Elina AU - Happonen, P. Antti AU - Rusko, Heikki AU - Korhonen, Ilkka PY - 2013/01/09 TI - Feasibility of a Personal Health Technology-Based Psychological Intervention for Men with Stress and Mood Problems: Randomized Controlled Pilot Trial JO - JMIR Res Protoc SP - e1 VL - 2 IS - 1 KW - stress KW - technology-supported mini-intervention KW - personal health technologies KW - cognitive behaviour therapy KW - acceptance and commitment therapy KW - mhealth KW - mobile health KW - smartphone KW - Internet N2 - Background: Work-related stress is a significant problem for both people and organizations. It may lead to mental illnesses such as anxiety and depression, resulting in increased work absences and disabilities. Scalable interventions to prevent and manage harmful stress can be delivered with the help of technology tools to support self-observations and skills training. Objective: The aim of this study was to assess the feasibility of the P4Well intervention in treatment of stress-related psychological problems. P4Well is a novel intervention which combines modern psychotherapy (the cognitive behavioral therapy and the acceptance and commitment therapy) with personal health technologies to deliver the intervention via multiple channels, includinggroup meetings, Internet/Web portal, mobile phone applications, and personal monitoring devices. Methods: This pilot study design was a small-scale randomized controlled trial that compared the P4Well intervention with a waiting list control group. In addition to personal health technologies for self-assessment, the intervention consisted of 3 psychologist-assisted group meetings. Self-assessed psychological measures through questionnaires were collected offline pre- and post-intervention, and 6 months after the intervention for the intervention group. Acceptance and usage of technology tools were measured with user experience questionnaires and usage logs. Results: A total of 24 subjects were randomized: 11 participants were followed up in the intervention group (1 was lost to follow-up) and 12 participants did not receive any intervention (control group). Depressive and psychological symptoms decreased and self-rated health and working ability increased. All participants reported they had benefited from the intervention. All technology tools had active users and 10/11 participants used at least 1 tool actively. Physiological measurements with personal feedback were considered the most useful intervention component. Conclusions: Our results confirm the feasibility of the intervention and suggest that it had positive effects on psychological symptoms, self-rated health, and self-rated working ability. The intervention seemed to have a positive impact on certain aspects of burnout and job strain, such as cynicism and over-commitment. Future studies need to investigate the effectiveness, benefits, and possible problems of psychological interventions which incorporate new technologies. Trial Registration: The Finnish Funding Agency for Technology and Innovation (TEKES), Project number 40011/08 UR - http://www.researchprotocols.org/2013/1/e1/ UR - http://dx.doi.org/10.2196/resprot.2389 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611946 ID - info:doi/10.2196/resprot.2389 ER - TY - JOUR AU - Zarghom, Saman AU - Di Fonzo, David AU - Leung, Fok-Han PY - 2013/01/11 TI - Does Socioeconomic Status Affect Patients? Ease of Use of a Touch-Screen (iPad) Patient Survey? JO - Interact J Med Res SP - e1 VL - 2 IS - 1 KW - socioeconomic factors KW - age factors KW - medical informatics KW - computer-user interface UR - http://www.i-jmr.org/2013/1/e1/ UR - http://dx.doi.org/10.2196/ijmr.2314 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612116 ID - info:doi/10.2196/ijmr.2314 ER - TY - JOUR AU - McGillicuddy, William John AU - Weiland, Katherine Ana AU - Frenzel, Maximiliane Ronja AU - Mueller, Martina AU - Brunner-Jackson, Marie Brenda AU - Taber, James David AU - Baliga, Kalyanpur Prabhakar AU - Treiber, Anton Frank PY - 2013/01/08 TI - Patient Attitudes Toward Mobile Phone-Based Health Monitoring: Questionnaire Study Among Kidney Transplant Recipients JO - J Med Internet Res SP - e6 VL - 15 IS - 1 KW - cellular phone KW - attitude KW - kidney transplantation KW - telemedicine KW - mobile phone KW - smartphone KW - mhealth N2 - Background: Mobile phone based remote monitoring of medication adherence and physiological parameters has the potential of improving long-term graft outcomes in the recipients of kidney transplants. This technology is promising as it is relatively inexpensive, can include intuitive software and may offer the ability to conduct close patient monitoring in a non-intrusive manner. This includes the optimal management of comorbidities such as hypertension and diabetes. There is, however, a lack of data assessing the attitudes of renal transplant recipients toward this technology, especially among ethnic minorities. Objective: To assess the attitudes of renal transplant recipients toward mobile phone based remote monitoring and management of their medical regimen; and to identify demographic or clinical characteristics that impact on this attitude. Methods: After a 10 minute demonstration of a prototype mobile phone based monitoring system, a 10 item questionnaire regarding attitude toward remote monitoring and the technology was administered to the participants, along with the 10 item Perceived Stress Scale and the 7 item Morisky Medication Adherence Scale. Results: Between February and April 2012, a total of 99 renal transplant recipients were identified and agreed to participate in the survey. The results of the survey indicate that while 90% (87/97) of respondents own a mobile phone, only 7% (7/98) had any prior knowledge of mobile phone based remote monitoring. Despite this, the majority of respondents, 79% (78/99), reported a positive attitude toward the use of a prototype system if it came at no cost to themselves. Blacks were more likely than whites to own smartphones (43.1%, 28/65 vs 20.6%, 7/34; P=.03) and held a more positive attitude toward free use of the prototype system than whites (4.25±0.88 vs 3.76±1.07; P=.02). Conclusions: The data demonstrates that kidney transplant recipients have a positive overall attitude toward mobile phone based health technology (mHealth). Additionally, the data demonstrates that most kidney transplant recipients own and are comfortable using mobile phones and that many of these patients already own and use smart mobile phones. The respondents felt that mHealth offers an opportunity for improved self-efficacy and improved provider driven medical management. Respondents were comfortable with the idea of being monitored using mobile technology and are confident that their privacy can be protected. The small subset of kidney transplant recipients who are less interested in mHealth may be less technologically adept as reflected by their lower mobile phone ownership rates. As a whole, kidney transplant recipients are receptive to the technology and believe in its utility. UR - http://www.jmir.org/2013/1/e6/ UR - http://dx.doi.org/10.2196/jmir.2284 UR - http://www.ncbi.nlm.nih.gov/pubmed/23305649 ID - info:doi/10.2196/jmir.2284 ER - TY - JOUR AU - Kristjánsdóttir, Birna Ólöf AU - Fors, A. Egil AU - Eide, Erlend AU - Finset, Arnstein AU - Stensrud, Lauritzen Tonje AU - van Dulmen, Sandra AU - Wigers, Hørven Sigrid AU - Eide, Hilde PY - 2013/01/07 TI - A Smartphone-Based Intervention With Diaries and Therapist-Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain: Randomized Controlled Trial JO - J Med Internet Res SP - e5 VL - 15 IS - 1 KW - Widespread Chronic Pain KW - Fibromyalgia KW - Self-management KW - Mobile phones KW - Internet KW - Cognitive Therapy KW - Catastrophization, Recurrence N2 - Background: Internet-based interventions using cognitive behavioral approaches can be effective in promoting self-management of chronic pain conditions. Web-based programs delivered via smartphones are increasingly used to support the self-management of various health disorders, but research on smartphone interventions for persons with chronic pain is limited. Objective: The aim of this trial was to study the efficacy of a 4-week smartphone-delivered intervention with written diaries and therapist feedback following an inpatient chronic pain rehabilitation program. Methods: A total of 140 women with chronic widespread pain who participated in a 4-week inpatient rehabilitation program were randomized into 2 groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of 1 face-to-face session and 4 weeks of written communication via a smartphone. Participants received 3 smartphone diary entries daily to support their awareness of and reflection on pain-related thoughts, feelings, and activities. The registered diaries were immediately available to a therapist who submitted personalized written feedback daily based on cognitive behavioral principles. Both groups were given access to a noninteractive website after discharge to promote constructive self-management. Outcomes were measured with self-reported questionnaires. The primary outcome measure of catastrophizing was determined using the pain catastrophizing scale (score range 0-52). Secondary outcomes included acceptance of pain, emotional distress, functioning, and symptom levels. Results: Of the 140 participants, 112 completed the study: 48 in the intervention group and 64 in the control group. Immediately after the intervention period, the intervention group reported less catastrophizing (mean 9.20, SD 5.85) than the control group (mean 15.71, SD 9.11, P<.001), yielding a large effect size (Cohen?s d=0.87) for study completers. At 5-month follow-up, the between-group effect sizes remained moderate for catastrophizing (Cohen?s d=0.74, P=.003), acceptance of pain (Cohen?s d=0.54, P=.02), and functioning and symptom levels (Cohen?s d=0.75, P=.001). Conclusions: The results suggest that a smartphone-delivered intervention with diaries and personalized feedback can reduce catastrophizing and prevent increases in functional impairment and symptom levels in women with chronic widespread pain following inpatient rehabilitation. Trial Registration: Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6DUejLpPY) UR - http://www.jmir.org/2013/1/e5/ UR - http://dx.doi.org/10.2196/jmir.2249 UR - http://www.ncbi.nlm.nih.gov/pubmed/23291270 ID - info:doi/10.2196/jmir.2249 ER - TY - JOUR AU - Muessig, E. Kathryn AU - Pike, C. Emily AU - LeGrand, Sara AU - Hightow-Weidman, B. Lisa PY - 2013/01/04 TI - Mobile Phone Applications for the Care and Prevention of HIV and Other Sexually Transmitted Diseases: A Review JO - J Med Internet Res SP - e1 VL - 15 IS - 1 KW - HIV KW - technology KW - mobile phone applications N2 - Background: Mobile phone applications (apps) provide a new platform for delivering tailored human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention and care. Objective: To identify and evaluate currently available mobile phone apps related to the prevention and care of HIV and other STDs. Methods: We searched the Apple iTunes and Android Google Play stores for HIV/STD-related apps, excluding apps that exclusively targeted industry, providers, and researchers. Each eligible app was downloaded, tested, and assessed for user ratings and functionality as well as 6 broad content areas of HIV prevention and care: HIV/STD disease knowledge, risk reduction/safer sex, condom promotion, HIV/STD testing information, resources for HIV-positive persons, and focus on key populations. Results: Search queries up to May 2012 identified 1937 apps. Of these, 55 unique apps met the inclusion criteria (12 for Android, 29 for iPhone, and 14 for both platforms). Among these apps, 71% provided disease information about HIV/STDs, 36% provided HIV/STD testing information or resources, 29% included information about condom use or assistance locating condoms, and 24% promoted safer sex. Only 6 apps (11%) covered all 4 of these prevention areas. Eight apps (15%) provided tools or resources specifically for HIV/STD positive persons. Ten apps included information for a range of sexual orientations, 9 apps appeared to be designed for racially/ethnically diverse audiences, and 15 apps featured interactive components. Apps were infrequently downloaded (median 100-500 downloads) and not highly rated (average customer rating 3.7 out of 5 stars). Conclusions: Most available HIV/STD apps have failed to attract user attention and positive reviews. Public health practitioners should work with app developers to incorporate elements of evidence-based interventions for risk reduction and improve app inclusiveness and interactivity. UR - http://www.jmir.org/2013/1/e1/ UR - http://dx.doi.org/10.2196/jmir.2301 UR - http://www.ncbi.nlm.nih.gov/pubmed/23291245 ID - info:doi/10.2196/jmir.2301 ER - TY - JOUR AU - Ybarra, Michele AU - Ba?c? Bosi, Tülay A. AU - Korchmaros, Josephine AU - Emri, Salih PY - 2012/12/27 TI - A Text Messaging-Based Smoking Cessation Program for Adult Smokers: Randomized Controlled Trial JO - J Med Internet Res SP - e172 VL - 14 IS - 6 KW - smoking cessation KW - Middle East KW - text messaging KW - pilot study N2 - Background: Despite promising data in Western countries, there is a dearth of research into the efficacy of text messaging-based smoking cessation programs in other settings, including the Middle East, where smoking prevalence rates are higher. Objective: This paper reports cessation rates observed in SMS Turkey, a text messaging-based smoking cessation program for adult smokers in Ankara, Turkey. Methods: This study was a small-scale, parallel-group randomized controlled trial (RCT) conducted in Ankara, Turkey. Participants were adult daily smokers who were seriously thinking about quitting in the next 15 days and living in Ankara, Turkey. The text messaging intervention, SMS Turkey, provided 6 weeks of daily messages aimed at giving participants skills to help them quit smoking. Messages were sent in an automated fashion, except 2 days and 7 days after the initial quit day. On days 2 and 7, the research assistant manually assigned participants to content ?paths? based on whether they were still not smoking or had relapsed. The control arm received a brochure that provided similar information about smoking cessation. The main outcome measure was self-reported 3-month sustained abstinence, verified by carbon monoxide (CO) readings. Neither participants nor researchers were blinded to arm assignment. Results: The 151 participants were randomly assigned to 1 of 2 groups: 76 to the SMS Turkey intervention group and 75 to the brochure control group. Using intention to treat, all 151 participants were included in analyses. Three-month cessation trends were not significantly higher in the intervention group: 11% intervention vs 5% control had quit (?21=1.4, P=.24; R2=2.0, 95% CI 0.62-6.3). When the sample was stratified by sex, female intervention participants (14%, n=5) were significantly more likely to have quit at 3 months than female control participants (0%, n=0; ?21=3.7, P=.05). Among light smokers (ie, those smoking less than 20 cigarettes per day), intervention participants (17%, n=5) also were significantly more likely to have quit compared to control participants (0%, n=0; ?21=5.3, P=.02). We noted no difference in cessation rates for males or heavy smokers.Participants experienced significant technology problems during the study. Some participants received duplicate text messages at least once during the trial; others failed to receive some program messages. Neither receiving duplicate messages (?21=0.12, P=.73), or missing 5 or more program messages (?21=0.75, P=.39) negatively affected quitting rates. Conclusions: Although the study was not powered to detect statistically significant differences, as the primary aim was to provide estimates of effect size that could be used to better inform a power analysis for a larger trial, findings provide optimism that SMS Turkey may be able to affect quitting rates in environments with high smoking prevalence, such as Ankara, Turkey. The SMS Turkey software program did not work as well as it did 2 years previous. The system will need to be updated to maintain software compatibility with ongoing technology evolution. Trial Registration: Clinicaltrials.gov NCT00912795 http://clinicaltrials.gov/ct2/show/NCT00912795 (Archived by WebCite at http://www.webcitation.org/6Ch1cIA8l). UR - http://www.jmir.org/2012/6/e172/ UR - http://dx.doi.org/10.2196/jmir.2231 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.2231 ER - TY - JOUR AU - Okazaki, Shintaro AU - Castañeda, Alberto José AU - Sanz, Silvia AU - Henseler, Jörg PY - 2012/12/21 TI - Factors Affecting Mobile Diabetes Monitoring Adoption Among Physicians: Questionnaire Study and Path Model JO - J Med Internet Res SP - e183 VL - 14 IS - 6 KW - Blood glucose self-monitoring KW - Diabetes mellitus KW - Internet KW - Diabetes self-management KW - Health informatics KW - Mobile health KW - Mobile device KW - Mobile diabetes monitoring KW - Path analysis N2 - Background: Patients with type 1 and type 2 diabetes often find it difficult to control their blood glucose level on a daily basis because of distance or physical incapacity. With the increase in Internet-enabled smartphone use, this problem can be resolved by adopting a mobile diabetes monitoring system. Most existing studies have focused on patients? usability perceptions, whereas little attention has been paid to physicians? intentions to adopt this technology. Objective: The aim of the study was to evaluate the perceptions and user acceptance of mobile diabetes monitoring among Japanese physicians. Methods: A questionnaire survey of physicians was conducted in Japan. The structured questionnaire was prepared in a context of a mobile diabetes monitoring system that controls blood glucose, weight, physical activity, diet, insulin and medication, and blood pressure. Following a thorough description of mobile diabetes monitoring with a graphical image, questions were asked relating to system quality, information quality, service quality, health improvement, ubiquitous control, privacy and security concerns, perceived value, subjective norms, and intention to use mobile diabetes monitoring. The data were analyzed by partial least squares (PLS) path modeling. Results: In total, 471 physicians participated from 47 prefectures across Japan, of whom 134 were specialized in internal and gastrointestinal medicine. Nine hypotheses were tested with both the total sample and the specialist subsample; results were similar for both samples in terms of statistical significance and the strength of path coefficients. We found that system quality, information quality, and service quality significantly affect overall quality. Overall quality determines the extent to which physicians perceive the value of mobile health monitoring. However, in contrast to our initial predictions, overall quality does not have a significant direct effect on the intention to use mobile diabetes monitoring. With regard to net benefits, both ubiquitous control and health improvement are significant predictors. Net benefits in turn significantly motivate physicians to use mobile health monitoring, and has a strong influence on perceived value. Perceived value and subjective norms are predictors of intention to use. In our sample, concerns over privacy and security risk have no significant effects on intention to use mobile diabetes monitoring. Among the 3 control variables, only age significantly affected intention to use mobile diabetes monitoring, whereas experience and gender were not significant predictors of intention. Conclusions: Physicians consider perceived value and net benefits as the most important motivators to use mobile diabetes monitoring. Overall quality assessment does affect their intention to use this technology, but only indirectly through perceived value. Net benefits seem to be a strong driver in both a direct and indirect manner, implying that physicians may perceive health improvement with ubiquitous control as a true utility by enhancing cost-effective monitoring, and simultaneously recognize it as a way to create value for their clinical practices. UR - http://www.jmir.org/2012/6/e183/ UR - http://dx.doi.org/10.2196/jmir.2159 UR - http://www.ncbi.nlm.nih.gov/pubmed/23257115 ID - info:doi/10.2196/jmir.2159 ER - TY - JOUR AU - Baggott, Christina AU - Gibson, Faith AU - Coll, Beatriz AU - Kletter, Richard AU - Zeltzer, Paul AU - Miaskowski, Christine PY - 2012/12/11 TI - Initial Evaluation of an Electronic Symptom Diary for Adolescents with Cancer JO - JMIR Res Protoc SP - e23 VL - 1 IS - 2 KW - mHealth, eHealth, patient-reported outcomes, symptom assessment, adolescent, cancer N2 - Background: The delivery of optimal care depends on accurate communication between patients and clinicians regarding untoward symptoms. Documentation of patients? symptoms necessitates reliance on memory, which is often imprecise. We developed an electronic diary (eDiary) for adolescents and young adults (AYAs) with cancer to record symptoms. Objective: The purpose of this paper is to describe the utility of an eDiary designed for AYAs with cancer, including dependability of the mobile application, the reasons for any missing recorded data, patients? adherence rates to daily symptom queries, and patients? perceptions of the usefulness and acceptability of symptom data collection via mobile phones. Methods: Our team developed an electronic symptom diary based on interviews conducted with AYAs with cancer and their clinicians. This diary included daily severity ratings of pain, nausea, vomiting, fatigue, and sleep. The occurrence of other selected physical sequelae was assessed daily. Additionally, patients selected descriptors of their mood. A 3-week trial of the eDiary was conducted with 10 AYA cancer patients. Mobile phones with service plans were loaned to patients who were instructed to report their symptoms daily. Patients completed a brief questionnaire and were interviewed to elicit their perceptions of the eDiary and any technical difficulties encountered. Results: Overall adherence to daily symptom reports exceeded 90%. Young people experienced few technical difficulties and reported benefit from daily symptom reports. Symptom occurrence rates were high and considerable inter- and intra-patient variability was noted in symptom and mood reports. Conclusions: We demonstrated the utility of an eDiary that may contribute insight into patients? symptom patterns to promote effective symptom management. UR - http://www.researchprotocols.org/2012/2/e23/ UR - http://dx.doi.org/10.2196/resprot.2175 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612521 ID - info:doi/10.2196/resprot.2175 ER - TY - JOUR AU - Fanning, Jason AU - Mullen, P. Sean AU - McAuley, Edward PY - 2012/11/21 TI - Increasing Physical Activity With Mobile Devices: A Meta-Analysis JO - J Med Internet Res SP - e161 VL - 14 IS - 6 KW - Behavior change, exercise, meta-analysis, mobile phone, physical activity, review N2 - Background: Regular physical activity has established physical and mental health benefits; however, merely one quarter of the U.S. adult population meets national physical activity recommendations. In an effort to engage individuals who do not meet these guidelines, researchers have utilized popular emerging technologies, including mobile devices (ie, personal digital assistants [PDAs], mobile phones). This study is the first to synthesize current research focused on the use of mobile devices for increasing physical activity. Objective: To conduct a meta-analysis of research utilizing mobile devices to influence physical activity behavior. The aims of this review were to: (1) examine the efficacy of mobile devices in the physical activity setting, (2) explore and discuss implementation of device features across studies, and (3) make recommendations for future intervention development. Methods: We searched electronic databases (PubMed, PsychINFO, SCOPUS) and identified publications through reference lists and requests to experts in the field of mobile health. Studies were included that provided original data and aimed to influence physical activity through dissemination or collection of intervention materials with a mobile device. Data were extracted to calculate effect sizes for individual studies, as were study descriptives. A random effects meta-analysis was conducted using the Comprehensive Meta-Analysis software suite. Study quality was assessed using the quality of execution portion of the Guide to Community Preventative Services data extraction form. Results: Four studies were of ?good? quality and seven of ?fair? quality. In total, 1351 individuals participated in 11 unique studies from which 18 effects were extracted and synthesized, yielding an overall weight mean effect size of g = 0.54 (95% CI = 0.17 to 0.91, P = .01). Conclusions: Research utilizing mobile devices is gaining in popularity, and this study suggests that this platform is an effective means for influencing physical activity behavior. Our focus must be on the best possible use of these tools to measure and understand behavior. Therefore, theoretically grounded behavior change interventions that recognize and act on the potential of smartphone technology could provide investigators with an effective tool for increasing physical activity. UR - http://www.jmir.org/2012/6/e161/ UR - http://dx.doi.org/10.2196/jmir.2171 UR - http://www.ncbi.nlm.nih.gov/pubmed/23171838 ID - info:doi/10.2196/jmir.2171 ER - TY - JOUR AU - Furberg, D. Robert AU - Uhrig, D. Jennifer AU - Bann, M. Carla AU - Lewis, A. Megan AU - Harris, L. Jennie AU - Williams, Peyton AU - Coomes, Curtis AU - Martin, Nicole AU - Kuhns, Lisa PY - 2012/11/16 TI - Technical Implementation of a Multi-Component, Text Message?Based Intervention for Persons Living with HIV JO - JMIR Res Protoc SP - e17 VL - 1 IS - 2 KW - short message service KW - SMS KW - text message KW - mobile phone KW - mHealth KW - HIV KW - tailored messaging N2 - Background: Men who have sex with men (MSM) continue to be severely and disproportionately affected by the HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) epidemic in the United States. Effective antiretroviral therapy has altered the HIV epidemic from being an acute disease to a chronic, manageable condition for many people living with HIV. The pervasiveness, low cost, and convenience of Short Message Service (SMS) suggests its potential suitability for supporting the treatment of conditions that must be managed over an extended period. Objective: The purpose of this proof-of-concept study was to develop, implement, and test a tailored SMS-based intervention for HIV-positive MSM. Prior studies do not routinely provide sufficiently detailed descriptions of their technical implementations, restricting the ability of subsequent efforts to reproduce successful interventions. This article attempts to fill this gap by providing a detailed description of the implementation of an SMS-based intervention to provide tailored health communication messages for HIV-positive MSM. Methods: We used archives from the SMS system, including participant responses to messages and questions sent via SMS, as the data sources for results reported in this article. Consistent with the purpose of this article, our analysis was limited to basic descriptive statistics, including frequency distributions, means and standard deviations. Results: During the implementation period, we sent a total of 7,194 messages to study participants, received 705 SMS responses to our two-way SMS questions of participants, and 317 unprompted SMS message acknowledgements from participants. Ninety two percent of participants on antiretroviral therapy (ART) responded to at least one of the weekly medication adherence questions administered via SMS, and 27% of those had their medication adherence messages changed over the course of the study based on their answers to the weekly questions. Participants who responded to items administered via SMS to assess satisfaction with and use of the messages reported generally positive perceptions, although response rates were low overall. Conclusions: Results confirm the technical feasibility of deploying a dynamically tailored, SMS-based intervention designed to provide ongoing behavioral reinforcement for HIV-positive MSM. Lessons learned related to text programming, message delivery and study logistics will be helpful to others planning and implementing similar interventions. UR - http://www.researchprotocols.org/2012/2/e17/ UR - http://dx.doi.org/10.2196/resprot.2017 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612237 ID - info:doi/10.2196/resprot.2017 ER - TY - JOUR AU - Wu, Wanmin AU - Dasgupta, Sanjoy AU - Ramirez, E. Ernesto AU - Peterson, Carlyn AU - Norman, J. Gregory PY - 2012/10/05 TI - Classification Accuracies of Physical Activities Using Smartphone Motion Sensors JO - J Med Internet Res SP - e130 VL - 14 IS - 5 KW - Activity classification KW - machine learning KW - accelerometer KW - gyroscope KW - smartphone N2 - Background: Over the past few years, the world has witnessed an unprecedented growth in smartphone use. With sensors such as accelerometers and gyroscopes on board, smartphones have the potential to enhance our understanding of health behavior, in particular physical activity or the lack thereof. However, reliable and valid activity measurement using only a smartphone in situ has not been realized. Objective: To examine the validity of the iPod Touch (Apple, Inc.) and particularly to understand the value of using gyroscopes for classifying types of physical activity, with the goal of creating a measurement and feedback system that easily integrates into individuals? daily living. Methods: We collected accelerometer and gyroscope data for 16 participants on 13 activities with an iPod Touch, a device that has essentially the same sensors and computing platform as an iPhone. The 13 activities were sitting, walking, jogging, and going upstairs and downstairs at different paces. We extracted time and frequency features, including mean and variance of acceleration and gyroscope on each axis, vector magnitude of acceleration, and fast Fourier transform magnitude for each axis of acceleration. Different classifiers were compared using the Waikato Environment for Knowledge Analysis (WEKA) toolkit, including C4.5 (J48) decision tree, multilayer perception, naive Bayes, logistic, k-nearest neighbor (kNN), and meta-algorithms such as boosting and bagging. The 10-fold cross-validation protocol was used. Results: Overall, the kNN classifier achieved the best accuracies: 52.3%?79.4% for up and down stair walking, 91.7% for jogging, 90.1%?94.1% for walking on a level ground, and 100% for sitting. A 2-second sliding window size with a 1-second overlap worked the best. Adding gyroscope measurements proved to be more beneficial than relying solely on accelerometer readings for all activities (with improvement ranging from 3.1% to 13.4%). Conclusions: Common categories of physical activity and sedentary behavior (walking, jogging, and sitting) can be recognized with high accuracies using both the accelerometer and gyroscope onboard the iPod touch or iPhone. This suggests the potential of developing just-in-time classification and feedback tools on smartphones. UR - http://www.jmir.org/2012/5/e130/ UR - http://dx.doi.org/10.2196/jmir.2208 UR - http://www.ncbi.nlm.nih.gov/pubmed/23041431 ID - info:doi/10.2196/jmir.2208 ER - TY - JOUR AU - Ozdalga, Errol AU - Ozdalga, Ark AU - Ahuja, Neera PY - 2012/09/27 TI - The Smartphone in Medicine: A Review of Current and Potential Use Among Physicians and Students JO - J Med Internet Res SP - e128 VL - 14 IS - 5 KW - Smartphone KW - technology KW - education KW - medicine KW - telemedicine KW - health care KW - Android KW - iPhone KW - BlackBerry KW - mobile phone N2 - Background: Advancements in technology have always had major impacts in medicine. The smartphone is one of the most ubiquitous and dynamic trends in communication, in which one?s mobile phone can also be used for communicating via email, performing Internet searches, and using specific applications. The smartphone is one of the fastest growing sectors in the technology industry, and its impact in medicine has already been significant. Objective: To provide a comprehensive and up-to-date summary of the role of the smartphone in medicine by highlighting the ways in which it can enhance continuing medical education, patient care, and communication. We also examine the evidence base for this technology. Methods: We conducted a review of all published uses of the smartphone that could be applicable to the field of medicine and medical education with the exclusion of only surgical-related uses. Results: In the 60 studies that were identified, we found many uses for the smartphone in medicine; however, we also found that very few high-quality studies exist to help us understand how best to use this technology. Conclusions: While the smartphone?s role in medicine and education appears promising and exciting, more high-quality studies are needed to better understand the role it will have in this field. We recommend popular smartphone applications for physicians that are lacking in evidence and discuss future studies to support their use. UR - http://www.jmir.org/2012/5/e128/ UR - http://dx.doi.org/10.2196/jmir.1994 UR - http://www.ncbi.nlm.nih.gov/pubmed/23017375 ID - info:doi/10.2196/jmir.1994 ER - TY - JOUR AU - Zhang, Shuyi AU - Wu, Qiong AU - van Velthoven, HMMT Michelle AU - Chen, Li AU - Car, Josip AU - Rudan, Igor AU - Zhang, Yanfeng AU - Li, Ye AU - Scherpbier, W. Robert PY - 2012/09/18 TI - Smartphone Versus Pen-and-Paper Data Collection of Infant Feeding Practices in Rural China JO - J Med Internet Res SP - e119 VL - 14 IS - 5 KW - Data collection KW - health survey KW - questionnaires KW - infant feeding KW - smartphone N2 - Background: Maternal, Newborn, and Child Health (MNCH) household survey data are collected mainly with pen-and-paper. Smartphone data collection may have advantages over pen-and-paper, but little evidence exists on how they compare. Objective: To compare smartphone data collection versus the use of pen-and-paper for infant feeding practices of the MNCH household survey. We compared the two data collection methods for differences in data quality (data recording, data entry, open-ended answers, and interrater reliability), time consumption, costs, interviewers? perceptions, and problems encountered. Methods: We recruited mothers of infants aged 0 to 23 months in four village clinics in Zhaozhou Township, Zhao County, Hebei Province, China. We randomly assigned mothers to a smartphone or a pen-and-paper questionnaire group. A pair of interviewers simultaneously questioned mothers on infant feeding practices, each using the same method (either smartphone or pen-and-paper). Results: We enrolled 120 mothers, and all completed the study. Data recording errors were prevented in the smartphone questionnaire. In the 120 pen-and-paper questionnaires (60 mothers), we found 192 data recording errors in 55 questionnaires. There was no significant difference in recording variation between the groups for the questionnaire pairs (P = .32) or variables (P = .45). The smartphone questionnaires were automatically uploaded and no data entry errors occurred. We found that even after double data entry of the pen-and-paper questionnaires, 65.0% (78/120) of the questionnaires did not match and needed to be checked. The mean duration of an interview was 10.22 (SD 2.17) minutes for the smartphone method and 10.83 (SD 2.94) minutes for the pen-and-paper method, which was not significantly different between the methods (P = .19). The mean costs per questionnaire were higher for the smartphone questionnaire (¥143, equal to US $23 at the exchange rate on April 24, 2012) than for the pen-and-paper questionnaire (¥83, equal to US $13). The smartphone method was acceptable to interviewers, and after a pilot test we encountered only minor problems (eg, the system halted for a few seconds or it shut off), which did not result in data loss. Conclusions: This is the first study showing that smartphones can be successfully used for household data collection on infant feeding in rural China. Using smartphones for data collection, compared with pen-and-paper, eliminated data recording and entry errors, had similar interrater reliability, and took an equal amount of time per interview. While the costs for the smartphone method were higher than the pen-and-paper method in our small-scale survey, the costs for both methods would be similar for a large-scale survey. Smartphone data collection should be further evaluated for other surveys and on a larger scale to deliver maximum benefits in China and elsewhere. UR - http://www.jmir.org/2012/5/e119/ UR - http://dx.doi.org/10.2196/jmir.2183 UR - http://www.ncbi.nlm.nih.gov/pubmed/22989894 ID - info:doi/10.2196/jmir.2183 ER - TY - JOUR AU - Hebden, Lana AU - Cook, Amelia AU - van der Ploeg, P. Hidde AU - Allman-Farinelli, Margaret PY - 2012/08/22 TI - Development of Smartphone Applications for Nutrition and Physical Activity Behavior Change JO - JMIR Res Protoc SP - e9 VL - 1 IS - 2 KW - cellular phone KW - young adult KW - primary prevention KW - lifestyle KW - health behavior N2 - Background: Young adults (aged 18 to 35) are a population group at high risk for weight gain, yet we know little about how to intervene in this group. Easy access to treatment and support with self-monitoring of their behaviors may be important. Smartphones are gaining in popularity with this population group and software applications (?apps?) used on these mobile devices are a novel technology that can be used to deliver brief health behavior change interventions directly to individuals en masse, with potentially favorable cost-utility. However, existing apps for modifying nutrition or physical activity behaviors may not always reflect best practice guidelines for weight management. Objective: This paper describes the process of developing four apps aimed at modifying key lifestyle behaviors associated with weight gain during young adulthood, including physical activity, and consumption of take-out foods (fast food), fruit and vegetables, and sugar-sweetened drinks. Methods: The development process involved: (1) deciding on the behavior change strategies, relevant guidelines, graphic design, and potential data collection; (2) selecting the platform (Web-based versus native); (3) creating the design, which required decisions about the user interface, architecture of the relational database, and programming code; and (4) testing the prototype versions with the target audience (young adults aged 18 to 35). Results: The four apps took 18 months to develop, involving the fields of marketing, nutrition and dietetics, physical activity, and information technology. Ten subjects provided qualitative feedback about using the apps. The slow running speed of the apps (due to a reliance on an active Internet connection) was the primary issue identified by this group, as well as the requirement to log in to the apps. Conclusions: Smartphone apps may be an innovative medium for delivering individual health behavior change intervention en masse, but researchers must give consideration to the target population, available technologies, existing commercial apps, and the possibility that their use will be irregular and short-lived. UR - http://www.researchprotocols.org/2012/2/e9/ UR - http://dx.doi.org/10.2196/resprot.2205 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611892 ID - info:doi/10.2196/resprot.2205 ER - TY - JOUR AU - Chen, Connie AU - Haddad, David AU - Selsky, Joshua AU - Hoffman, E. Julia AU - Kravitz, L. Richard AU - Estrin, E. Deborah AU - Sim, Ida PY - 2012/08/09 TI - Making Sense of Mobile Health Data: An Open Architecture to Improve Individual- and Population-Level Health JO - J Med Internet Res SP - e112 VL - 14 IS - 4 KW - Mobile health KW - software tools KW - software engineering KW - open access to information KW - open architecture KW - open source KW - evaluation methodology KW - data analysis KW - data visualization UR - http://www.jmir.org/2012/4/e112/ UR - http://dx.doi.org/10.2196/jmir.2152 UR - http://www.ncbi.nlm.nih.gov/pubmed/22875563 ID - info:doi/10.2196/jmir.2152 ER - TY - JOUR AU - Frøisland, Helge Dag AU - Årsand, Eirik AU - Skårderud, Finn PY - 2012/08/06 TI - Improving Diabetes Care for Young People With Type 1 Diabetes Through Visual Learning on Mobile Phones: Mixed-Methods Study JO - J Med Internet Res SP - e111 VL - 14 IS - 4 KW - Diabetes KW - adolescents KW - user-centered design KW - education KW - eHealth KW - mHealth KW - mobile phones KW - short message service KW - SMS KW - qualitative research KW - triangulation of methods N2 - Background: Only 17% of Norwegian children and adolescents with diabetes achieve international treatment goals measured by glycated hemoglobin (HbA1c). Classic patient?physician consultations seem to be poorly adapted to young children. New strategies that are better attuned to young people to improve support of adolescents? self-management of diabetes need to be tested and evaluated. Objective: (1) To explore how applications for mobile phones can be used in follow-up of adolescents with type 1 diabetes, and (2) to use the findings to guide further development of the applications and as a basis for future studies. Method: We pilot tested two mobile phone applications: (1) an application that contained a picture-based diabetes diary to record physical activity and photos taken with the phone camera of food eaten, where the phone also communicated with the glucometer by Bluetooth technology to capture blood glucose values, and (2) a Web-based, password-secured and encrypted short message service (SMS), based on access using login passwords received via SMS to be used by participants to send messages to their providers when they faced obstacles in everyday life, and to send educational messages to the participants. At the end of the 3-month pilot study, 12 participants (7 girls and 5 boys ) aged 13?19 years completed semistructured interviews. The participants had a mean HbA1c value of 8.3 (SD 0.3), mean age of 16.2 (SD 1.7) years, mean body mass index of 23.3 (SD 3.2) kg/m2, and mean diabetes duration of 7.5 (SD 4.6) years. We applied three additional measurements: change in metabolic control as measured by HbA1c, the System Usability Scale, and diabetes knowledge. Results: From the interviews, three main categories emerged: visualization, access, and software changes. Participants appreciated the picture-based diary more than the SMS solution. Visualization of cornerstones in diabetes self-care (ie, diet, insulin dosage, physical activity, and pre- and postprandial glucose measurements all transformed into one picture) in the mobile diary was found to be an important educational tool through reflections in action. This led to a change in participants? applied knowledge about the management of their disease. Additional measurements supplemented and supported the qualitative findings. However, changes in HbA1c and participants? theoretical knowledge as tested by a 27-item questionnaire, based on a national health informatics? diabetes quiz, before and after the intervention were not statistically significant (P = .38 and P = .82, respectively, paired-samples t test). Participants suggested additional functionality, and we will implement this in the design of the next software generation. Conclusion: Participants reported an increased understanding of applied knowledge, which seem to positively affect diabetes self-care. Visual impressions seem well adapted to the maturation of the adolescent brain, facilitating the link between theoretical knowledge and executive functions. SMS gave the adolescents a feeling of increased access and security. Participants gave valuable input for further development of these applications. UR - http://www.jmir.org/2012/4/e111/ UR - http://dx.doi.org/10.2196/jmir.2155 UR - http://www.ncbi.nlm.nih.gov/pubmed/22868871 ID - info:doi/10.2196/jmir.2155 ER - TY - JOUR AU - Välimäki, Maritta AU - Hätönen, Heli AU - Adams, E. Clive PY - 2012/08/02 TI - Mobile.net: Mobile Telephone Text Messages to Encourage Adherence to Medication and to Follow up With People With Psychosis: Methods and Protocol for a Multicenter Randomized Controlled Two-Armed Trial JO - JMIR Res Protoc SP - e8 VL - 1 IS - 2 KW - Adherence KW - text messages KW - psychosis N2 - Background: Schizophrenia is a high-cost, chronic, serious mental illness. There is a clear need to improve treatments and expand access to care for persons with schizophrenia, but simple, tailored interventions are missing. Objective: To evaluate the impact of tailored mobile telephone text messages to encourage adherence to medication and to follow up with people with psychosis at 12 months. Methods: Mobile.Net is a pragmatic randomized trial with inpatient psychiatric wards allocated to two parallel arms. The trial will include 24 sites and 45 psychiatric hospital wards providing inpatient care in Finland. The participants will be adult patients aged 18?65 years, of either sex, with antipsychotic medication (Anatomical Therapeutic Chemical classification 2011) on discharge from a psychiatric hospital, who have a mobile phone, are able to use the Finnish language, and are able to give written informed consent to participate in the study. The intervention group will receive semiautomatic system (short message service [SMS]) messages after they have been discharged from the psychiatric hospital. Patients will choose the form, content, timing, and frequency of the SMS messages related to their medication, keeping appointments, and other daily care. SMS messages will continue to the end of the study period (12 months) or until participants no longer want to receive the messages. Patients will be encouraged to contact researchers if they feel that they need to adjust the message in any way. At all times, both groups will receive usual care at the discretion of their team (psychiatry and nursing). The primary outcomes are service use and healthy days by 12 months based on routine data (admission to a psychiatric hospital, time to next hospitalization, time in hospital during this year, and healthy days). The secondary outcomes are service use, coercive measures, medication, adverse events, satisfaction with care, the intervention, and the trial, social functioning, and economic factors. Data will be collected 12 months after baseline. The outcomes are based on the national health registers and patients? subjective evaluations. The primary analysis will be by intention-to-treat. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN): 27704027; http://www.controlled-trials.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/69FkM4vcq) UR - http://www.researchprotocols.org/2012/2/e8/ UR - http://dx.doi.org/10.2196/resprot.2136 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611874 ID - info:doi/10.2196/resprot.2136 ER - TY - JOUR AU - Ybarra, L. Michele AU - Holtrop, Summers Jodi AU - Ba?ci Bosi, Tülay A. AU - Emri, Salih PY - 2012/07/24 TI - Design Considerations in Developing a Text Messaging Program Aimed at Smoking Cessation JO - J Med Internet Res SP - e103 VL - 14 IS - 4 KW - Smoking cessation KW - mHealth KW - text messaging N2 - Background: Cell phone text messaging is gaining increasing recognition as an important tool that can be harnessed for prevention and intervention programs across a wide variety of health research applications. Despite the growing body of literature reporting positive outcomes, very little is available about the design decisions that scaffold the development of text messaging-based health interventions. What seems to be missing is documentation of the thought process of investigators in the initial stages of protocol and content development. This omission is of particular concern because many researchers seem to view text messaging as the intervention itself instead of simply a delivery mechanism. Certainly, aspects of this technology may increase participant engagement. Like other interventions, however, the content is a central driver of the behavior change. Objective: To address this noted gap in the literature, we discuss the protocol decisions and content development for SMS Turkey (or Cebiniz birakin diyor in Turkish), a smoking cessation text messaging program for adult smokers in Turkey. Methods: Content was developed in English and translated into Turkish. Efforts were made to ensure that the protocol and content were grounded in evidence-based smoking cessation theory, while also reflective of the cultural aspects of smoking and quitting in Turkey. Results: Methodological considerations included whether to provide cell phones and whether to reimburse participants for texting costs; whether to include supplementary intervention resources (eg, personal contact); and whether to utilize unidirectional versus bidirectional messaging. Program design considerations included how messages were tailored to the quitting curve and one?s smoking status after one?s quit date, the number of messages participants received per day, and over what period of time the intervention lasted. Conclusion: The content and methods of effective smoking cessation quitline programs were a useful guide in developing SMS Turkey. Proposed guidelines in developing text messaging-based behavior change programs are offered. UR - http://www.jmir.org/2012/4/e103/ UR - http://dx.doi.org/10.2196/jmir.2061 UR - http://www.ncbi.nlm.nih.gov/pubmed/22832182 ID - info:doi/10.2196/jmir.2061 ER - TY - JOUR AU - Renner, Adell Karen AU - PY - 2012/05/23 TI - Harm Reduction Text Messages Delivered During Alcohol Drinking: Feasibility Study Protocol JO - JMIR Res Protoc SP - e4 VL - 1 IS - 1 KW - harm reduction KW - alcohol KW - eHealth KW - mobile phone KW - brief intervention KW - smartphone UR - http://www.researchprotocols.org/2012/1/e4/ UR - http://dx.doi.org/10.2196/resprot.1970 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611773 ID - info:doi/10.2196/resprot.1970 ER - TY - JOUR AU - West, H. Joshua AU - Hall, Cougar P. AU - Hanson, L. Carl AU - Barnes, D. Michael AU - Giraud-Carrier, Christophe AU - Barrett, James PY - 2012/05/14 TI - There?s an App for That: Content Analysis of Paid Health and Fitness Apps JO - J Med Internet Res SP - e72 VL - 14 IS - 3 KW - mHealth KW - iPhone KW - app N2 - Background: The introduction of Apple?s iPhone provided a platform for developers to design third-party apps, which greatly expanded the functionality and utility of mobile devices for public health. Objective: This study provides an overview of the developers? written descriptions of health and fitness apps and appraises each app?s potential for influencing behavior change. Methods: Data for this study came from a content analysis of health and fitness app descriptions available on iTunes during February 2011. The Health Education Curriculum Analysis Tool (HECAT) and the Precede-Proceed Model (PPM) were used as frameworks to guide the coding of 3336 paid apps. Results: Compared to apps with a cost less than US $0.99, apps exceeding US $0.99 were more likely to be scored as intending to promote health or prevent disease (92.55%, 1925/3336 vs 83.59%, 1411/3336; P<.001), to be credible or trustworthy (91.11%, 1895/3336 vs 86.14%, 1454/3349; P<.001), and more likely to be used personally or recommended to a health care client (72.93%, 1517/2644 vs 66.77%, 1127/2644; P<.001). Apps related to healthy eating, physical activity, and personal health and wellness were more common than apps for substance abuse, mental and emotional health, violence prevention and safety, and sexual and reproductive health. Reinforcing apps were less common than predisposing and enabling apps. Only 1.86% (62/3336) of apps included all 3 factors (ie, predisposing, enabling, and reinforcing). Conclusions: Development efforts could target public health behaviors for which few apps currently exist. Furthermore, practitioners should be cautious when promoting the use of apps as it appears most provide health-related information (predisposing) or make attempts at enabling behavior, with almost none including all theoretical factors recommended for behavior change. UR - http://www.jmir.org/2012/3/e72/ UR - http://dx.doi.org/10.2196/jmir.1977 UR - http://www.ncbi.nlm.nih.gov/pubmed/22584372 ID - info:doi/10.2196/jmir.1977 ER - TY - JOUR AU - Cafazzo, A. Joseph AU - Casselman, Mark AU - Hamming, Nathaniel AU - Katzman, K. Debra AU - Palmert, R. Mark PY - 2012/05/08 TI - Design of an mHealth App for the Self-management of Adolescent Type 1 Diabetes: A Pilot Study JO - J Med Internet Res SP - e70 VL - 14 IS - 3 KW - Type 1 diabetes mellitus KW - adolescent KW - cellular phone KW - self-care KW - chronic disease N2 - Background: The use of mHealth apps has shown improved health outcomes in adult populations with type 2 diabetes mellitus. However, this has not been shown in the adolescent type 1 population, despite their predisposition to the use of technology. We hypothesized that a more tailored approach and a strong adherence mechanism is needed for this group. Objective: To design, develop, and pilot an mHealth intervention for the management of type 1 diabetes in adolescents. Methods: We interviewed adolescents with type 1 diabetes and their family caregivers. Design principles were derived from a thematic analysis of the interviews. User-centered design was then used to develop the mobile app bant. In the 12-week evaluation phase, a pilot group of 20 adolescents aged 12?16 years, with a glycated hemoglobin (HbA1c) of between 8% and 10% was sampled. Each participant was supplied with the bant app running on an iPhone or iPod Touch and a LifeScan glucometer with a Bluetooth adapter for automated transfers to the app. The outcome measure was the average daily frequency of blood glucose measurement during the pilot compared with the preceding 12 weeks. Results: Thematic analysis findings were the role of data collecting rather than decision making; the need for fast, discrete transactions; overcoming decision inertia; and the need for ad hoc information sharing. Design aspects of the resultant app emerged through the user-centered design process, including simple, automated transfer of glucometer readings; the use of a social community; and the concept of gamification, whereby routine behaviors and actions are rewarded in the form of iTunes music and apps. Blood glucose trend analysis was provided with immediate prompting of the participant to suggest both the cause and remedy of the adverse trend. The pilot evaluation showed that the daily average frequency of blood glucose measurement increased 50% (from 2.4 to 3.6 per day, P = .006, n = 12). A total of 161 rewards (average of 8 rewards each) were distributed to participants. Satisfaction was high, with 88% (14/16 participants) stating that they would continue to use the system. Demonstrating improvements in HbA1c will require a properly powered study of sufficient duration. Conclusions: This mHealth diabetes app with the use of gamification incentives showed an improvement in the frequency of blood glucose monitoring in adolescents with type 1 diabetes. Extending this to improved health outcomes will require the incentives to be tied not only to frequency of blood glucose monitoring but also to patient actions and decision making based on those readings such that glycemic control can be improved. UR - http://www.jmir.org/2012/3/e70/ UR - http://dx.doi.org/10.2196/jmir.2058 UR - http://www.ncbi.nlm.nih.gov/pubmed/22564332 ID - info:doi/10.2196/jmir.2058 ER - TY - JOUR AU - Kirwan, Morwenna AU - Duncan, J. Mitch AU - Vandelanotte, Corneel AU - Mummery, Kerry W. PY - 2012/04/20 TI - Using Smartphone Technology to Monitor Physical Activity in the 10,000 Steps Program: A Matched Case?Control Trial JO - J Med Internet Res SP - e55 VL - 14 IS - 2 KW - smartphone KW - health behavior KW - physical activity KW - matched case-control study KW - intervention N2 - Background: Website-delivered physical activity interventions are successful in producing short-term behavior change. However, problems with engagement and retention of participants in these programs prevent long-term behavior change. New ways of accessing online content (eg, via smartphones) may enhance engagement in these interventions, which in turn may improve the effectiveness of the programs. Objective: To measure the potential of a newly developed smartphone application to improve health behaviors in existing members of a website-delivered physical activity program (10,000 Steps, Australia). The aims of the study were to (1) examine the effect of the smartphone application on self-monitoring and self-reported physical activity levels, (2) measure the perceived usefulness and usability of the application, and (3) examine the relationship between the perceived usefulness and usability of the application and its actual use. Methods: All participants were existing members of the 10,000 Steps program. We recruited the intervention group (n = 50) via email and instructed them to install the application on their smartphone and use it for 3 months. Participants in this group were able to log their steps by using either the smartphone application or the 10,000 Steps website. Following the study, the intervention group completed an online questionnaire assessing perceived usability and usefulness of the smartphone application. We selected control group participants (n = 150), matched for age, gender, level of self-monitoring, preintervention physical activity level, and length of membership in the 10,000 Steps program, after the intervention was completed. We collected website and smartphone usage statistics during the entire intervention period. Results: Over the study period (90 days), the intervention group logged steps on an average of 62 days, compared with 41 days in the matched group. Intervention participants used the application 71.22% (2210/3103) of the time to log their steps. Logistic regression analyses revealed that use of the application was associated with an increased likelihood to log steps daily during the intervention period compared with those not using the application (odds ratio 3.56, 95% confidence interval 1.72?7.39). Additionally, use of the application was associated with an increased likelihood to log greater than 10,000 steps on each entry (odds ratio 20.64, 95% confidence interval 9.19?46.39). Linear regression analysis revealed a nonsignificant relationship between perceived usability (r = .216, P = .21) and usefulness (r = .229, P = .17) of the application and frequency of logging steps in the intervention group. Conclusion: Using a smartphone application as an additional delivery method to a website-delivered physical activity intervention may assist in maintaining participant engagement and behavior change. However, due to study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study. UR - http://www.jmir.org/2012/2/e55/ UR - http://dx.doi.org/10.2196/jmir.1950 UR - http://www.ncbi.nlm.nih.gov/pubmed/22522112 ID - info:doi/10.2196/jmir.1950 ER - TY - JOUR AU - Daugherty, L. Bethany AU - Schap, E. TusaRebecca AU - Ettienne-Gittens, Reynolette AU - Zhu, M. Fengqing AU - Bosch, Marc AU - Delp, J. Edward AU - Ebert, S. David AU - Kerr, A. Deborah AU - Boushey, J. Carol PY - 2012/04/13 TI - Novel Technologies for Assessing Dietary Intake: Evaluating the Usability of a Mobile Telephone Food Record Among Adults and Adolescents JO - J Med Internet Res SP - e58 VL - 14 IS - 2 KW - Mobile telephone food record KW - dietary assessment KW - technology KW - image analysis KW - volume estimation N2 - Background: The development of a mobile telephone food record has the potential to ameliorate much of the burden associated with current methods of dietary assessment. When using the mobile telephone food record, respondents capture an image of their foods and beverages before and after eating. Methods of image analysis and volume estimation allow for automatic identification and volume estimation of foods. To obtain a suitable image, all foods and beverages and a fiducial marker must be included in the image. Objective: To evaluate a defined set of skills among adolescents and adults when using the mobile telephone food record to capture images and to compare the perceptions and preferences between adults and adolescents regarding their use of the mobile telephone food record. Methods: We recruited 135 volunteers (78 adolescents, 57 adults) to use the mobile telephone food record for one or two meals under controlled conditions. Volunteers received instruction for using the mobile telephone food record prior to their first meal, captured images of foods and beverages before and after eating, and participated in a feedback session. We used chi-square for comparisons of the set of skills, preferences, and perceptions between the adults and adolescents, and McNemar test for comparisons within the adolescents and adults. Results: Adults were more likely than adolescents to include all foods and beverages in the before and after images, but both age groups had difficulty including the entire fiducial marker. Compared with adolescents, significantly more adults had to capture more than one image before (38% vs 58%, P = .03) and after (25% vs 50%, P = .008) meal session 1 to obtain a suitable image. Despite being less efficient when using the mobile telephone food record, adults were more likely than adolescents to perceive remembering to capture images as easy (P < .001). Conclusions: A majority of both age groups were able to follow the defined set of skills; however, adults were less efficient when using the mobile telephone food record. Additional interactive training will likely be necessary for all users to provide extra practice in capturing images before entering a free-living situation. These results will inform age-specific development of the mobile telephone food record that may translate to a more accurate method of dietary assessment. UR - http://www.jmir.org/2012/2/e58/ UR - http://dx.doi.org/10.2196/jmir.1967 UR - http://www.ncbi.nlm.nih.gov/pubmed/22504018 ID - info:doi/10.2196/jmir.1967 ER - TY - JOUR AU - Dowshen, Nadia AU - Kuhns, M. Lisa AU - Johnson, Amy AU - Holoyda, James Brian AU - Garofalo, Robert PY - 2012/04/05 TI - Improving Adherence to Antiretroviral Therapy for Youth Living with HIV/AIDS: A Pilot Study Using Personalized, Interactive, Daily Text Message Reminders JO - J Med Internet Res SP - e51 VL - 14 IS - 2 KW - Adolescents KW - HIV/AIDS KW - adherence KW - text messaging KW - short message service KW - SMS KW - mobile health intervention N2 - Background: For youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), nonadherence to antiretroviral therapy (ART) can lead to poor health outcomes and significantly decreased life expectancy. Objective: To evaluate the feasability, acceptability, and preliminary efficacy of short message service (SMS) or text message reminders to improve adherence to ART for youth living with HIV/AIDS. Methods: We conducted this prospective pilot study using a pre?post design from 2009 to 2010 at a community-based health center providing clinical services to youth living with HIV/AIDS. Eligibility criteria included HIV-positive serostatus, age 14?29 years, use of a personal cell phone, English-speaking, and being on ART with documented poor adherence. During the 24-week study period, participants received personalized daily SMS reminders and a follow-up message 1 hour later assessing whether they took the medication, and asking participants to respond via text message with the number 1 if they took the medication and 2 if they did not. Outcome measures were feasibility, acceptability, and adherence. Self-reported adherence was determined using the visual analog scale (VAS) and AIDS Clinical Trial Group (ACTG) questionnaire 4-day recall. Viral load and CD4 cell count were followed as biomarkers of adherence and disease progression at 0, 12, and 24 weeks. Results: Participants (N = 25) were mean age 23 (range 14?29) years, 92% (n = 23) male, 60% (n = 15) black, and 84% (n = 21) infected through unprotected sex. Mean VAS scores significantly increased at 12 and 24 weeks in comparison with baseline (week 0: 74.7, week 12: 93.3, P < .001; week 24: 93.1, P < .001). ACTG questionnaire 4-day recall also improved (week 0: 2.33, week 12: 3.24, P = .002; week 24: 3.19, P = .005). There was no significant difference in CD4 cell count or viral load between baseline and 12- or 24-week follow-up, although there was a trend toward improvement of these biomarkers and a small to moderate standardized effect size (range of Cohen d: ?0.51 to 0.22). Of 25 participants, 21 (84%) were retained, and 20 of the 21 (95%) participants who completed the study found the intervention helpful to avoid missing doses. Conclusions: In this pilot study, personalized, interactive, daily SMS reminders were feasible and acceptable, and they significantly improved self-reported adherence. Larger controlled studies are needed to determine the impact of this intervention on ART adherence and other related health outcomes for youth living with HIV/AIDS. UR - http://www.jmir.org/2012/2/e51/ UR - http://dx.doi.org/10.2196/jmir.2015 UR - http://www.ncbi.nlm.nih.gov/pubmed/22481246 ID - info:doi/10.2196/jmir.2015 ER - TY - JOUR AU - Seto, Emily AU - Leonard, J. Kevin AU - Cafazzo, A. Joseph AU - Barnsley, Jan AU - Masino, Caterina AU - Ross, J. Heather PY - 2012/02/16 TI - Mobile Phone-Based Telemonitoring for Heart Failure Management: A Randomized Controlled Trial JO - J Med Internet Res SP - e31 VL - 14 IS - 1 KW - heart failure KW - telemedicine KW - mobile phone KW - patient monitoring KW - randomized controlled trial N2 - Background: Previous trials of telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined. Objective: The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes. Methods: One hundred patients were recruited from a heart function clinic and randomized into telemonitoring and control groups. The telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients? mobile phones and alerts to a cardiologist?s mobile phone as required. Results: Baseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70% of telemonitoring patients completed at least 80% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics. Conclusions: Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones. Trial Registration: ClinicalTrials.gov NCT00778986 UR - http://www.jmir.org/2012/1/e31/ UR - http://dx.doi.org/10.2196/jmir.1909 UR - http://www.ncbi.nlm.nih.gov/pubmed/22356799 ID - info:doi/10.2196/jmir.1909 ER - TY - JOUR AU - Seto, Emily AU - Leonard, J. Kevin AU - Cafazzo, A. Joseph AU - Barnsley, Jan AU - Masino, Caterina AU - Ross, J. Heather PY - 2012/02/10 TI - Perceptions and Experiences of Heart Failure Patients and Clinicians on the Use of Mobile Phone-Based Telemonitoring JO - J Med Internet Res SP - e25 VL - 14 IS - 1 KW - heart failure KW - telemonitoring KW - mobile phone KW - patient monitoring KW - self-care KW - qualitative research N2 - Background: Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs. Objectives: The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring. Methods: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient?s mobile phone based on their physiological values. Alerts were also sent to a cardiologist?s mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach. Results: The telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients? heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system. Conclusions: The success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions. Key Words: UR - http://www.jmir.org/2012/1/e25/ UR - http://dx.doi.org/10.2196/jmir.1912 UR - http://www.ncbi.nlm.nih.gov/pubmed/22328237 ID - info:doi/10.2196/jmir.1912 ER - TY - JOUR AU - Whittaker, Robyn AU - Merry, Sally AU - Stasiak, Karolina AU - McDowell, Heather AU - Doherty, Iain AU - Shepherd, Matthew AU - Dorey, Enid AU - Parag, Varsha AU - Ameratunga, Shanthi AU - Rodgers, Anthony PY - 2012/01/24 TI - MEMO?A Mobile Phone Depression Prevention Intervention for Adolescents: Development Process and Postprogram Findings on Acceptability From a Randomized Controlled Trial JO - J Med Internet Res SP - e13 VL - 14 IS - 1 KW - Mobile phone KW - depression prevention KW - adolescents KW - cognitive behavioral therapy N2 - Background: Prevention of the onset of depression in adolescence may prevent social dysfunction, teenage pregnancy, substance abuse, suicide, and mental health conditions in adulthood. New technologies allow delivery of prevention programs scalable to large and disparate populations. Objective: To develop and test the novel mobile phone delivery of a depression prevention intervention for adolescents. We describe the development of the intervention and the results of participants? self-reported satisfaction with the intervention. Methods: The intervention was developed from 15 key messages derived from cognitive behavioral therapy (CBT). The program was fully automated and delivered in 2 mobile phone messages/day for 9 weeks, with a mixture of text, video, and cartoon messages and a mobile website. Delivery modalities were guided by social cognitive theory and marketing principles. The intervention was compared with an attention control program of the same number and types of messages on different topics. A double-blind randomized controlled trial was undertaken in high schools in Auckland, New Zealand, from June 2009 to April 2011. Results: A total of 1348 students (13?17 years of age) volunteered to participate at group sessions in schools, and 855 were eventually randomly assigned to groups. Of these, 835 (97.7%) self-completed follow-up questionnaires at postprogram interviews on satisfaction, perceived usefulness, and adherence to the intervention. Over three-quarters of participants viewed at least half of the messages and 90.7% (379/418) in the intervention group reported they would refer the program to a friend. Intervention group participants said the intervention helped them to be more positive (279/418, 66.7%) and to get rid of negative thoughts (210/418, 50.2%)?significantly higher than proportions in the control group. Conclusions: Key messages from CBT can be delivered by mobile phone, and young people report that these are helpful. Change in clinician-rated depression symptom scores from baseline to 12 months, yet to be completed, will provide evidence on the effectiveness of the intervention. If proven effective, this form of delivery may be useful in many countries lacking widespread mental health services but with extensive mobile phone coverage. ClinicalTrial: Australia New Zealand Clinical Trials Registry (ACTRN): 12609000405213; http://www.anzctr.org.au/trial_view.aspx?ID=83667 (Archived by WebCite at http://www.webcitation.org/64aueRqOb) UR - http://www.jmir.org/2012/1/e13/ UR - http://dx.doi.org/10.2196/jmir.1857 UR - http://www.ncbi.nlm.nih.gov/pubmed/22278284 ID - info:doi/10.2196/jmir.1857 ER - TY - JOUR AU - Déglise, Carole AU - Suggs, Suzanne L. AU - Odermatt, Peter PY - 2012/01/12 TI - Short Message Service (SMS) Applications for Disease Prevention in Developing Countries JO - J Med Internet Res SP - e3 VL - 14 IS - 1 KW - Mobile health KW - developing countries KW - prevention KW - SMS KW - short message service N2 - Background: The last decade has witnessed unprecedented growth in the number of mobile phones in the developing world, thus linking millions of previously unconnected people. The ubiquity of mobile phones, which allow for short message service (SMS), provides new and innovative opportunities for disease prevention efforts. Objective: The aim of this review was to describe the characteristics and outcomes of SMS interventions for disease prevention in developing countries and provide recommendations for future work. Methods: A systematic search of peer-reviewed and gray literature was performed for papers published in English, French, and German before May 2011 that describe SMS applications for disease prevention in developing countries. Results: A total of 34 SMS applications were described, among which 5 had findings of an evaluation reported. The majority of SMS applications were pilot projects in various levels of sophistication; nearly all came from gray literature sources. Many applications were initiated by the project with modes of intervention varying between one-way or two-way communication, with or without incentives, and with educative games. Evaluated interventions were well accepted by the beneficiaries. The primary barriers identified were language, timing of messages, mobile network fluctuations, lack of financial incentives, data privacy, and mobile phone turnover. Conclusion: This review illustrates that while many SMS applications for disease prevention exist, few have been evaluated. The dearth of peer-reviewed studies and the limited evidence found in this systematic review highlight the need for high-quality efficacy studies examining behavioral, social, and economic outcomes of SMS applications and mobile phone interventions aimed to promote health in developing country contexts. UR - http://www.jmir.org/2012/1/e3/ UR - http://dx.doi.org/10.2196/jmir.1823 UR - http://www.ncbi.nlm.nih.gov/pubmed/22262730 ID - info:doi/10.2196/jmir.1823 ER - TY - JOUR AU - Bexelius, Christin AU - Sandin, Sven AU - Trolle Lagerros, Ylva AU - Litton, Jan-Eric AU - Löf, Marie PY - 2011/09/25 TI - Estimation of Physical Activity Levels Using Cell Phone Questionnaires: A Comparison With Accelerometry for Evaluation of Between-Subject and Within-Subject Variations JO - J Med Internet Res SP - e70 VL - 13 IS - 3 KW - Cell phone KW - Internet KW - physical activity KW - epidemiology N2 - Background: Physical activity promotes health and longevity. Further elaboration of the role of physical activity for human health in epidemiological studies on large samples requires accurate methods that are easy to use, cheap, and possible to repeat. The use of telecommunication technologies such as cell phones is highly interesting in this respect. In an earlier report, we showed that physical activity level (PAL) assessed using a cell phone procedure agreed well with corresponding estimates obtained using the doubly labeled water method. However, our earlier study indicated high within-subject variation in relation to between-subject variations in PAL using cell phones, but we could not assess if this was a true variation of PAL or an artifact of the cell phone technique. Objective: Our objective was to compare within- and between-subject variations in PAL by means of cell phones with corresponding estimates using an accelerometer. In addition, we compared the agreement of daily PAL values obtained using the cell phone questionnaire with corresponding data obtained using an accelerometer. Methods: PAL was measured both with the cell phone questionnaire and with a triaxial accelerometer daily during a 2-week study period in 21 healthy Swedish women (20 to 45 years of age and BMI from 17.7 kg/m2 to 33.6 kg/m2). The results were evaluated by fitting linear mixed effect models and descriptive statistics and graphs. Results: With the accelerometer, 57% (95% confidence interval [CI] 40%-66%) of the variation was within subjects, while with the cell phone, within-subject variation was 76% (95% CI 59%-83%). The day-to-day variations in PAL observed using the cell phone questions agreed well with the corresponding accelerometer results. Conclusions: Both the cell phone questionnaire and the accelerometer showed high within-subject variations. Furthermore, day-to-day variations in PAL within subjects assessed using the cell phone agreed well with corresponding accelerometer values. Consequently, our cell phone questionnaire is a promising tool for assessing levels of physical activity. The tool may be useful for large-scale prospective studies. UR - http://www.jmir.org/2011/3/e70/ UR - http://dx.doi.org/10.2196/jmir.1686 UR - http://www.ncbi.nlm.nih.gov/pubmed/21946080 ID - info:doi/10.2196/jmir.1686 ER - TY - JOUR AU - Chomutare, Taridzo AU - Fernandez-Luque, Luis AU - Årsand, Eirik AU - Hartvigsen, Gunnar PY - 2011/09/22 TI - Features of Mobile Diabetes Applications: Review of the Literature and Analysis of Current Applications Compared Against Evidence-Based Guidelines JO - J Med Internet Res SP - e65 VL - 13 IS - 3 KW - Mobile health (mHealth) KW - diabetes mellitus KW - blood glucose self-monitoring KW - social networks KW - personal health records (PHR) KW - personalized education KW - diabetes self-management KW - health informatics N2 - Background: Interest in mobile health (mHealth) applications for self-management of diabetes is growing. In July 2009, we found 60 diabetes applications on iTunes for iPhone; by February 2011 the number had increased by more than 400% to 260. Other mobile platforms reflect a similar trend. Despite the growth, research on both the design and the use of diabetes mHealth applications is scarce. Furthermore, the potential influence of social media on diabetes mHealth applications is largely unexplored. Objective: Our objective was to study the salient features of mobile applications for diabetes care, in contrast to clinical guideline recommendations for diabetes self-management. These clinical guidelines are published by health authorities or associations such as the National Institute for Health and Clinical Excellence in the United Kingdom and the American Diabetes Association. Methods: We searched online vendor markets (online stores for Apple iPhone, Google Android, BlackBerry, and Nokia Symbian), journal databases, and gray literature related to diabetes mobile applications. We included applications that featured a component for self-monitoring of blood glucose and excluded applications without English-language user interfaces, as well as those intended exclusively for health care professionals. We surveyed the following features: (1) self-monitoring: (1.1) blood glucose, (1.2) weight, (1.3) physical activity, (1.4) diet, (1.5) insulin and medication, and (1.6) blood pressure, (2) education, (3) disease-related alerts and reminders, (4) integration of social media functions, (5) disease-related data export and communication, and (6) synchronization with personal health record (PHR) systems or patient portals. We then contrasted the prevalence of these features with guideline recommendations. Results: The search resulted in 973 matches, of which 137 met the selection criteria. The four most prevalent features of the applications available on the online markets (n = 101) were (1) insulin and medication recording, 63 (62%), (2) data export and communication, 61 (60%), (3) diet recording, 47 (47%), and (4) weight management, 43 (43%). From the literature search (n = 26), the most prevalent features were (1) PHR or Web server synchronization, 18 (69%), (2) insulin and medication recording, 17 (65%), (3) diet recording, 17 (65%), and (4) data export and communication, 16 (62%). Interestingly, although clinical guidelines widely refer to the importance of education, this is missing from the top functionalities in both cases. Conclusions: While a wide selection of mobile applications seems to be available for people with diabetes, this study shows there are obvious gaps between the evidence-based recommendations and the functionality used in study interventions or found in online markets. Current results confirm personalized education as an underrepresented feature in diabetes mobile applications. We found no studies evaluating social media concepts in diabetes self-management on mobile devices, and its potential remains largely unexplored. UR - http://www.jmir.org/2011/3/e65/ UR - http://dx.doi.org/10.2196/jmir.1874 UR - http://www.ncbi.nlm.nih.gov/pubmed/21979293 ID - info:doi/10.2196/jmir.1874 ER - TY - JOUR AU - Wu, Robert AU - Rossos, Peter AU - Quan, Sherman AU - Reeves, Scott AU - Lo, Vivian AU - Wong, Brian AU - Cheung, Mark AU - Morra, Dante PY - 2011/08/29 TI - An Evaluation of the Use of Smartphones to Communicate Between Clinicians: A Mixed-Methods Study JO - J Med Internet Res SP - e59 VL - 13 IS - 3 KW - Email KW - cellular phone KW - interdisciplinary communication KW - hospital communication systems N2 - Background: Communication between clinicians is critical to providing quality patient care but is often hampered by limitations of current systems. Smartphones such as BlackBerrys may improve communication, but studies of these technologies have been limited to date. Objective: Our objectives were to describe how smartphones were adopted for clinical communication within general internal medical wards and determine their impact on team effectiveness and communication. Methods: This was a mixed-methods study that gathered data from the frequency of smartphone calls and email messages, clinicians' interviews, and ethnographic observations of clinical communication interactions. Triangulation of qualitative and quantitative data was undertaken to develop common themes that encompass comprehensive and representative insights across different methods. Results: Findings from our study indicated that over a 24-hour period, nurses sent on average 22.3 emails to the physicians mostly through the ?team smartphone,? the designated primary point of contact for a specific medical team. Physicians carrying the team smartphone received on average 21.9 emails and 6.4 telephone calls while sending out 6.9 emails and initiating 8.3 telephone calls over the 24-hour period. Our analyses identified both positive and negative outcomes associated with the use of smartphones for clinical communication. There was a perceived improvement in efficiency over the use of pagers for clinical communication for physicians, nurses, and allied health professionals. In particular, residents found that the use of smartphones helped to increase their mobility and multitasking abilities. Negative outcomes included frequent interruptions and discordance between what doctors and nurses considered urgent. Nurses perceived a worsening of the interprofessional relationships due to overreliance on messaging by text with a resulting decrease in verbal communication. Unprofessional behaviors were observed in the use of smartphones by residents. Conclusions: Routine adoption of smartphones by residents appeared to improve efficiency over the use of pagers for physicians, nurses, and allied health professionals. This was balanced by negative communication issues of increased interruptions, a gap in perceived urgency, weakened interprofessional relationships, and unprofessional behavior. Further communication interventions are required that balance efficiency and interruptions while maintaining or even improving interprofessional relationships and professionalism. UR - http://www.jmir.org/2011/3/e59/ UR - http://dx.doi.org/10.2196/jmir.1655 UR - http://www.ncbi.nlm.nih.gov/pubmed/21875849 ID - info:doi/10.2196/jmir.1655 ER - TY - JOUR AU - Burns, Nicole Michelle AU - Begale, Mark AU - Duffecy, Jennifer AU - Gergle, Darren AU - Karr, J. Chris AU - Giangrande, Emily AU - Mohr, C. David PY - 2011/08/12 TI - Harnessing Context Sensing to Develop a Mobile Intervention for Depression JO - J Med Internet Res SP - e55 VL - 13 IS - 3 KW - Depression KW - behavior therapy KW - telemedicine KW - mobile health KW - mobile phone KW - cellular phone KW - sensors KW - data mining KW - artificial intelligence KW - context-aware systems N2 - Background: Mobile phone sensors can be used to develop context-aware systems that automatically detect when patients require assistance. Mobile phones can also provide ecological momentary interventions that deliver tailored assistance during problematic situations. However, such approaches have not yet been used to treat major depressive disorder. Objective: The purpose of this study was to investigate the technical feasibility, functional reliability, and patient satisfaction with Mobilyze!, a mobile phone- and Internet-based intervention including ecological momentary intervention and context sensing. Methods: We developed a mobile phone application and supporting architecture, in which machine learning models (ie, learners) predicted patients? mood, emotions, cognitive/motivational states, activities, environmental context, and social context based on at least 38 concurrent phone sensor values (eg, global positioning system, ambient light, recent calls). The website included feedback graphs illustrating correlations between patients? self-reported states, as well as didactics and tools teaching patients behavioral activation concepts. Brief telephone calls and emails with a clinician were used to promote adherence. We enrolled 8 adults with major depressive disorder in a single-arm pilot study to receive Mobilyze! and complete clinical assessments for 8 weeks. Results: Promising accuracy rates (60% to 91%) were achieved by learners predicting categorical contextual states (eg, location). For states rated on scales (eg, mood), predictive capability was poor. Participants were satisfied with the phone application and improved significantly on self-reported depressive symptoms (betaweek = ?.82, P < .001, per-protocol Cohen d = 3.43) and interview measures of depressive symptoms (betaweek = ?.81, P < .001, per-protocol Cohen d = 3.55). Participants also became less likely to meet criteria for major depressive disorder diagnosis (bweek = ?.65, P = .03, per-protocol remission rate = 85.71%). Comorbid anxiety symptoms also decreased (betaweek = ?.71, P < .001, per-protocol Cohen d = 2.58). Conclusions: Mobilyze! is a scalable, feasible intervention with preliminary evidence of efficacy. To our knowledge, it is the first ecological momentary intervention for unipolar depression, as well as one of the first attempts to use context sensing to identify mental health-related states. Several lessons learned regarding technical functionality, data mining, and software development process are discussed. Trial Registration: Clinicaltrials.gov NCT01107041; http://clinicaltrials.gov/ct2/show/NCT01107041 (Archived by WebCite at http://www.webcitation.org/60CVjPH0n) UR - http://www.jmir.org/2011/3/e55/ UR - http://dx.doi.org/10.2196/jmir.1838 UR - http://www.ncbi.nlm.nih.gov/pubmed/21840837 ID - info:doi/10.2196/jmir.1838 ER - TY - JOUR AU - Fukuoka, Yoshimi AU - Kamitani, Emiko AU - Bonnet, Kemberlee AU - Lindgren, Teri PY - 2011/07/14 TI - Real-Time Social Support Through a Mobile Virtual Community to Improve Healthy Behavior in Overweight and Sedentary Adults: A Focus Group Analysis JO - J Med Internet Res SP - e49 VL - 13 IS - 3 KW - Mobile phone KW - physical activity KW - weight loss KW - diet KW - overweight KW - sedentary lifestyle KW - focus group KW - social support KW - diabetes mellitus N2 - Background: The onset of type 2 diabetes mellitus can be prevented or delayed by lifestyle changes. Communication technologies such as a mobile phone can be used as a means of delivering these lifestyle changes. Objectives: The purposes of this analysis were to explore applicability of potential components of a mobile phone-based healthy lifestyle program and to understand motivators and barriers to continued engagement in a mobile phone healthy lifestyle program. Methods: We conducted 6 focus groups (4 female and 2 male groups) in May and June 2010 with 35 focus group participants. The qualitative data were analyzed by 3 researchers using a qualitative description method in an ATLAS.ti software program. Inclusion criteria for enrollment in a focus group were as follows: (1) being aged from 30 to 69 years, (2) speaking and reading English, (3) having a sedentary lifestyle at work or during leisure time (screened by the Brief Physical Activity Survey questionnaire), and (4) having a body mass index (BMI) >25 kg/m2 (Asian >23 kg/m2) based on self-reported weight and height or 5) having a self-reported prediabetic condition. Results: The mean age was 51 (SD 10.6) years; 54% (n = 19) were white; 71% (n = 25) used a mobile phone at least once a week during the last month prior to the study enrollment; and mean BMI was 32.5 (SD 6.5) kg/m2. In the qualitative analyses, the following 4 major themes and their subthemes emerged: (1) real-time social support (real-time peer support from participants who are similarly engaged in a diet or physical activity program, and professional support from health care providers or a researcher), (2) tailoring of mobile phone programs (3) self-monitoring and motivation, and (4) potential barriers and sustainability of the program (fear of failing, age and mobile technologies, and loss of interest over time). Conclusions: Participants from a wide range of age and racial groups expressed interest in a mobile phone-based lifestyle program. Such a program that incorporates the themes that we identified may be able to help motivate participants to increase their physical activity and to improve their diet. UR - http://www.jmir.org/2011/3/e49/ UR - http://dx.doi.org/10.2196/jmir.1770 UR - http://www.ncbi.nlm.nih.gov/pubmed/21752785 ID - info:doi/10.2196/jmir.1770 ER - TY - JOUR AU - Mitchell, Ross J. AU - Sharma, Pranshu AU - Modi, Jayesh AU - Simpson, Mark AU - Thomas, Monroe AU - Hill, D. Michael AU - Goyal, Mayank PY - 2011/05/06 TI - A Smartphone Client-Server Teleradiology System for Primary Diagnosis of Acute Stroke JO - J Med Internet Res SP - e31 VL - 13 IS - 2 KW - Acute stroke KW - teleradiology KW - computed tomography KW - mhealth KW - mobile phone N2 - Background: Recent advances in the treatment of acute ischemic stroke have made rapid acquisition, visualization, and interpretation of images a key factor for positive patient outcomes. We have developed a new teleradiology system based on a client-server architecture that enables rapid access to interactive advanced 2-D and 3-D visualization on a current generation smartphone device (Apple iPhone or iPod Touch, or an Android phone) without requiring patient image data to be stored on the device. Instead, a server loads and renders the patient images, then transmits a rendered frame to the remote device. Objective: Our objective was to determine if a new smartphone client-server teleradiology system is capable of providing accuracies and interpretation times sufficient for diagnosis of acute stroke. Methods: This was a retrospective study. We obtained 120 recent consecutive noncontrast computed tomography (NCCT) brain scans and 70 computed tomography angiogram (CTA) head scans from the Calgary Stroke Program database. Scans were read by two neuroradiologists, one on a medical diagnostic workstation and an iPod or iPhone (hereafter referred to as an iOS device) and the other only on an iOS device. NCCT brain scans were evaluated for early signs of infarction, which includes early parenchymal ischemic changes and dense vessel sign, and to exclude acute intraparenchymal hemorrhage and stroke mimics. CTA brain scans were evaluated for any intracranial vessel occlusion. The interpretations made on an iOS device were compared with those made at a workstation. The total interpretation times were recorded for both platforms. Interrater agreement was assessed. True positives, true negatives, false positives, and false negatives were obtained, and sensitivity, specificity, and accuracy of detecting the abnormalities on the iOS device were computed. Results: The sensitivity, specificity, and accuracy of detecting intraparenchymal hemorrhage were 100% using the iOS device with a perfect interrater agreement (kappa = 1). The sensitivity, specificity, and accuracy of detecting acute parenchymal ischemic change were 94.1%, 100%, and 98.09% respectively for reader 1 and 97.05%, 100%, and 99.04% for reader 2 with nearly perfect interrater agreement (kappa = .8). The sensitivity, specificity, and accuracy of detecting dense vessel sign were 100%, 95.4%, and 96.19% respectively for reader 1 and 72.2%, 100%, and 95.23% for reader 2 using the iOS device with a good interrater agreement (kappa = .69). The sensitivity, specificity, and accuracy of detecting vessel occlusion on CT angiography scans were 94.4%, 100%, and 98.46% respectively for both readers using the iOS device, with perfect interrater agreement (kappa = 1). No significant difference (P < .05) was noted in the interpretation time between the workstation and iOS device. Conclusion: The smartphone client-server teleradiology system appears promising and may have the potential to allow urgent management decisions in acute stroke. However, this study was retrospective, involved relatively few patient studies, and only two readers. Generalizing conclusions about its clinical utility, especially in other diagnostic use cases, should not be made until additional studies are performed. UR - http://www.jmir.org/2011/2/e31/ UR - http://dx.doi.org/10.2196/jmir.1732 UR - http://www.ncbi.nlm.nih.gov/pubmed/21550961 ID - info:doi/10.2196/jmir.1732 ER -